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Nasioudis D, Pashankar FD. Management of recurrent and persistent malignant ovarian germ cell tumors: a narrative review. Int J Gynecol Cancer 2024; 34:1454-1460. [PMID: 38991656 DOI: 10.1136/ijgc-2023-005052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Approximately 10% of patients with malignant ovarian germ cell tumors will experience a tumor relapse. Given the rarity of malignant ovarian germ cell tumors, management of these patients is challenging. Secondary cytoreductive surgery can be considered for carefully selected patients with a goal to achieve complete gross or optimal resection. For patients with platinum sensitive disease who have already received platinum-based chemotherapy, standard dose chemotherapy with paclitaxel/ifosfamide/cisplatin or vinblastine/ifosfamide/cisplatin can be considered. High-dose chemotherapy protocols at specialized centers should be explored even for patients with platinum-resistant disease; however, optimal timing is under investigation. A subset of patients with malignant ovarian germ cell tumors harbors potentially actionable genomic alterations. Further research is required to identify novel therapeutic approaches for these patients.
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Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wumener X, Zhang Y, Zang Z, Du F, Ye X, Zhang M, Liu M, Zhao J, Sun T, Liang Y. The value of dynamic FDG PET/CT in the differential diagnosis of lung cancer and predicting EGFR mutations. BMC Pulm Med 2024; 24:227. [PMID: 38730287 PMCID: PMC11088023 DOI: 10.1186/s12890-024-02997-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES 18F-fluorodeoxyglucose (FDG) PET/CT has been widely used for the differential diagnosis of cancer. Semi-quantitative standardized uptake value (SUV) is known to be affected by multiple factors and may make it difficult to differentiate between benign and malignant lesions. It is crucial to find reliable quantitative metabolic parameters to further support the diagnosis. This study aims to evaluate the value of the quantitative metabolic parameters derived from dynamic FDG PET/CT in the differential diagnosis of lung cancer and predicting epidermal growth factor receptor (EGFR) mutation status. METHODS We included 147 patients with lung lesions to perform FDG PET/CT dynamic plus static imaging with informed consent. Based on the results of the postoperative pathology, the patients were divided into benign/malignant groups, adenocarcinoma (AC)/squamous carcinoma (SCC) groups, and EGFR-positive (EGFR+)/EGFR-negative (EGFR-) groups. Quantitative parameters including K1, k2, k3, and Ki of each lesion were obtained by applying the irreversible two-tissue compartmental modeling using an in-house Matlab software. The SUV analysis was performed based on conventional static scan data. Differences in each metabolic parameter among the group were analyzed. Wilcoxon rank-sum test, independent-samples T-test, and receiver-operating characteristic (ROC) analysis were performed to compare the diagnostic effects among the differentiated groups. P < 0.05 were considered statistically significant for all statistical tests. RESULTS In the malignant group (N = 124), the SUVmax, k2, k3, and Ki were higher than the benign group (N = 23), and all had-better performance in the differential diagnosis (P < 0.05, respectively). In the AC group (N = 88), the SUVmax, k3, and Ki were lower than in the SCC group, and such differences were statistically significant (P < 0.05, respectively). For ROC analysis, Ki with cut-off value of 0.0250 ml/g/min has better diagnostic specificity than SUVmax (AUC = 0.999 vs. 0.70). In AC group, 48 patients further underwent EGFR testing. In the EGFR (+) group (N = 31), the average Ki (0.0279 ± 0.0153 ml/g/min) was lower than EGFR (-) group (N = 17, 0.0405 ± 0.0199 ml/g/min), and the difference was significant (P < 0.05). However, SUVmax and k3 did not show such a difference between EGFR (+) and EGFR (-) groups (P>0.05, respectively). For ROC analysis, the Ki had a cut-off value of 0.0350 ml/g/min when predicting EGFR status, with a sensitivity of 0.710, a specificity of 0.588, and an AUC of 0.674 [0.523-0.802]. CONCLUSION Although both techniques were specific, Ki had a greater specificity than SUVmax when the cut-off value was set at 0.0250 ml/g/min for the differential diagnosis of lung cancer. At a cut-off value of 0.0350 ml/g/min, there was a 0.710 sensitivity for EGFR status prediction. If EGFR testing is not available for a patient, dynamic imaging could be a valuable non-invasive screening method.
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Affiliation(s)
- Xieraili Wumener
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | - Yarong Zhang
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | | | - Fen Du
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | - Xiaoxing Ye
- Department of pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | - Maoqun Zhang
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | - Ming Liu
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | - Jiuhui Zhao
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | - Tao Sun
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
| | - Ying Liang
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China.
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Wu Y, Fu F, Meng N, Wang Z, Li X, Bai Y, Zhou Y, Liang D, Zheng H, Yang Y, Wang M, Sun T. The role of dynamic, static, and delayed total-body PET imaging in the detection and differential diagnosis of oncological lesions. Cancer Imaging 2024; 24:2. [PMID: 38167538 PMCID: PMC10759379 DOI: 10.1186/s40644-023-00649-5] [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: 09/12/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES Commercialized total-body PET scanners can provide high-quality images due to its ultra-high sensitivity. We compared the dynamic, regular static, and delayed 18F-fluorodeoxyglucose (FDG) scans to detect lesions in oncologic patients on a total-body PET/CT scanner. MATERIALS & METHODS In all, 45 patients were scanned continuously for the first 60 min, followed by a delayed acquisition. FDG metabolic rate was calculated from dynamic data using full compartmental modeling, whereas regular static and delayed SUV images were obtained approximately 60- and 145-min post-injection, respectively. The retention index was computed from static and delayed measures for all lesions. Pearson's correlation and Kruskal-Wallis tests were used to compare parameters. RESULTS The number of lesions was largely identical between the three protocols, except MRFDG and delayed images on total-body PET only detected 4 and 2 more lesions, respectively (85 total). FDG metabolic rate (MRFDG) image-derived contrast-to-noise ratio and target-to-background ratio were significantly higher than those from static standardized uptake value (SUV) images (P < 0.01), but this is not the case for the delayed images (P > 0.05). Dynamic protocol did not significantly differentiate between benign and malignant lesions just like regular SUV, delayed SUV, and retention index. CONCLUSION The potential quantitative advantages of dynamic imaging may not improve lesion detection and differential diagnosis significantly on a total-body PET/CT scanner. The same conclusion applied to delayed imaging. This suggested the added benefits of complex imaging protocols must be weighed against the complex implementation in the future. CLINICAL RELEVANCE Total-body PET/CT was known to significantly improve the PET image quality due to its ultra-high sensitivity. However, whether the dynamic and delay imaging on total-body scanner could show additional clinical benefits is largely unknown. Head-to-head comparison between two protocols is relevant to oncological management.
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Affiliation(s)
- Yaping Wu
- Department of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, Henan, People's Republic of China
| | - Fangfang Fu
- Department of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, Henan, People's Republic of China
| | - Nan Meng
- Department of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, Henan, People's Republic of China
| | - Zhenguo Wang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, People's Republic of China
| | - Xiaochen Li
- Department of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, Henan, People's Republic of China
| | - Yan Bai
- Department of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, Henan, People's Republic of China
| | - Yun Zhou
- School of Biomedical Engineering, Shanghai Tech University, Shanghai, People's Republic of China
| | - Dong Liang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, People's Republic of China
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, People's Republic of China
| | - Yongfeng Yang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, People's Republic of China
| | - Meiyun Wang
- Department of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, Henan, People's Republic of China
- Laboratory of Brain Science and Brain-Like Intelligence TechnologyInstitute for Integrated Medical Science and Engineering, Henan Academy of Sciences, Zhengzhou, Henan, People's Republic of China
| | - Tao Sun
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, People's Republic of China.
- Research Institute of Innovative Medical Equipment, United Imaging, Shenzhen, Guangdong, China.
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Roya M, Mostafapour S, Mohr P, Providência L, Li Z, van Snick JH, Brouwers AH, Noordzij W, Willemsen ATM, Dierckx RAJO, Lammertsma AA, Glaudemans AWJM, Tsoumpas C, Slart RHJA, van Sluis J. Current and Future Use of Long Axial Field-of-View Positron Emission Tomography/Computed Tomography Scanners in Clinical Oncology. Cancers (Basel) 2023; 15:5173. [PMID: 37958347 PMCID: PMC10648837 DOI: 10.3390/cancers15215173] [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: 09/16/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
The latest technical development in the field of positron emission tomography/computed tomography (PET/CT) imaging has been the extension of the PET axial field-of-view. As a result of the increased number of detectors, the long axial field-of-view (LAFOV) PET systems are not only characterized by a larger anatomical coverage but also by a substantially improved sensitivity, compared with conventional short axial field-of-view PET systems. In clinical practice, this innovation has led to the following optimization: (1) improved overall image quality, (2) decreased duration of PET examinations, (3) decreased amount of radioactivity administered to the patient, or (4) a combination of any of the above. In this review, novel applications of LAFOV PET in oncology are highlighted and future directions are discussed.
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Affiliation(s)
- Mostafa Roya
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands; (S.M.); (P.M.); (L.P.); (Z.L.); (J.H.v.S.); (A.H.B.); (W.N.); (A.T.M.W.); (R.A.J.O.D.); (A.A.L.); (A.W.J.M.G.); (C.T.); (J.v.S.)
| | - Samaneh Mostafapour
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands; (S.M.); (P.M.); (L.P.); (Z.L.); (J.H.v.S.); (A.H.B.); (W.N.); (A.T.M.W.); (R.A.J.O.D.); (A.A.L.); (A.W.J.M.G.); (C.T.); (J.v.S.)
| | - Philipp Mohr
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands; (S.M.); (P.M.); (L.P.); (Z.L.); (J.H.v.S.); (A.H.B.); (W.N.); (A.T.M.W.); (R.A.J.O.D.); (A.A.L.); (A.W.J.M.G.); (C.T.); (J.v.S.)
| | - Laura Providência
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands; (S.M.); (P.M.); (L.P.); (Z.L.); (J.H.v.S.); (A.H.B.); (W.N.); (A.T.M.W.); (R.A.J.O.D.); (A.A.L.); (A.W.J.M.G.); (C.T.); (J.v.S.)
| | - Zekai Li
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands; (S.M.); (P.M.); (L.P.); (Z.L.); (J.H.v.S.); (A.H.B.); (W.N.); (A.T.M.W.); (R.A.J.O.D.); (A.A.L.); (A.W.J.M.G.); (C.T.); (J.v.S.)
| | - Johannes H. van Snick
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands; (S.M.); (P.M.); (L.P.); (Z.L.); (J.H.v.S.); (A.H.B.); (W.N.); (A.T.M.W.); (R.A.J.O.D.); (A.A.L.); (A.W.J.M.G.); (C.T.); (J.v.S.)
| | - Adrienne H. Brouwers
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands; (S.M.); (P.M.); (L.P.); (Z.L.); (J.H.v.S.); (A.H.B.); (W.N.); (A.T.M.W.); (R.A.J.O.D.); (A.A.L.); (A.W.J.M.G.); (C.T.); (J.v.S.)
| | - Walter Noordzij
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands; (S.M.); (P.M.); (L.P.); (Z.L.); (J.H.v.S.); (A.H.B.); (W.N.); (A.T.M.W.); (R.A.J.O.D.); (A.A.L.); (A.W.J.M.G.); (C.T.); (J.v.S.)
| | - Antoon T. M. Willemsen
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands; (S.M.); (P.M.); (L.P.); (Z.L.); (J.H.v.S.); (A.H.B.); (W.N.); (A.T.M.W.); (R.A.J.O.D.); (A.A.L.); (A.W.J.M.G.); (C.T.); (J.v.S.)
| | - Rudi A. J. O. Dierckx
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands; (S.M.); (P.M.); (L.P.); (Z.L.); (J.H.v.S.); (A.H.B.); (W.N.); (A.T.M.W.); (R.A.J.O.D.); (A.A.L.); (A.W.J.M.G.); (C.T.); (J.v.S.)
| | - Adriaan A. Lammertsma
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands; (S.M.); (P.M.); (L.P.); (Z.L.); (J.H.v.S.); (A.H.B.); (W.N.); (A.T.M.W.); (R.A.J.O.D.); (A.A.L.); (A.W.J.M.G.); (C.T.); (J.v.S.)
| | - Andor W. J. M. Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands; (S.M.); (P.M.); (L.P.); (Z.L.); (J.H.v.S.); (A.H.B.); (W.N.); (A.T.M.W.); (R.A.J.O.D.); (A.A.L.); (A.W.J.M.G.); (C.T.); (J.v.S.)
| | - Charalampos Tsoumpas
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands; (S.M.); (P.M.); (L.P.); (Z.L.); (J.H.v.S.); (A.H.B.); (W.N.); (A.T.M.W.); (R.A.J.O.D.); (A.A.L.); (A.W.J.M.G.); (C.T.); (J.v.S.)
| | - Riemer H. J. A. Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands; (S.M.); (P.M.); (L.P.); (Z.L.); (J.H.v.S.); (A.H.B.); (W.N.); (A.T.M.W.); (R.A.J.O.D.); (A.A.L.); (A.W.J.M.G.); (C.T.); (J.v.S.)
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, 7522 NB Enchede, The Netherlands
| | - Joyce van Sluis
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands; (S.M.); (P.M.); (L.P.); (Z.L.); (J.H.v.S.); (A.H.B.); (W.N.); (A.T.M.W.); (R.A.J.O.D.); (A.A.L.); (A.W.J.M.G.); (C.T.); (J.v.S.)
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Jiao H, Qiu Y, Huang W, Zhang Y, Chen Z, Wang A, Kang L. Alpha-fetoprotein-elevated postpubertal testicular teratoma with retroperitoneal metastasis on 18F-FDG PET/CT: case report and literature review. Front Med (Lausanne) 2023; 10:1269587. [PMID: 37731724 PMCID: PMC10508336 DOI: 10.3389/fmed.2023.1269587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023] Open
Abstract
Postpubertal testicular teratoma exhibits malignant biological behavior and has metastatic potential. We report a case of a 17-year-old patient diagnosed with postpubertal testicular teratoma with massive retroperitoneal metastasis. The pathological examination revealed a mature teratoma without any other components. However, the patient had a significantly increased level of AFP, and 18F-FDG PET/CT showed the retroperitoneal metastasis had increased FDG uptake, with a SUVmax of 15.6, suggesting the coexistence of other germ cell tumor components, and the patient might have a poor prognosis. After resection of the retroperitoneal tumor, PET/CT further revealed multiple abdominal and pelvic metastases, with a SUVmax of 22.5. Therefore, the patient received a cycle of chemotherapy and follow-up PET/CT imaging showed the achievement of complete metabolic response after the treatment. In this case, PET/CT played a crucial role in detecting metastasis, compensating for the limitations of pathological sampling, thus establishing a definitive diagnosis and predicting prognosis. And it was evident that PET/CT also has the advantage of evaluating therapeutic efficacy.
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Affiliation(s)
- Hao Jiao
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Yongkang Qiu
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Wenpeng Huang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Yongbai Zhang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Zhao Chen
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Aixiang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
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Wang D, Qiu B, Liu Q, Xia L, Liu S, Zheng C, Liu H, Mo Y, Zhang X, Hu Y, Zheng S, Zhou Y, Fu J, Chen N, Liu F, Zhou R, Guo J, Fan W, Liu H. Patlak-Ki derived from ultra-high sensitivity dynamic total body [ 18F]FDG PET/CT correlates with the response to induction immuno-chemotherapy in locally advanced non-small cell lung cancer patients. Eur J Nucl Med Mol Imaging 2023; 50:3400-3413. [PMID: 37310427 DOI: 10.1007/s00259-023-06298-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE This study aimed to investigate the predictive value of metabolic features in response to induction immuno-chemotherapy in patients with locally advanced non-small cell cancer (LA-NSCLC), using ultra-high sensitivity dynamic total body [18F]FDG PET/CT. METHODS The study analyzed LA-NSCLC patients who received two cycles of induction immuno-chemotherapy and underwent a 60-min dynamic total body [18F]FDG PET/CT scan before treatment. The primary tumors (PTs) were manually delineated, and their metabolic features, including the Patlak-Ki, Patlak-Intercept, maximum SUV (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were evaluated. The overall response rate (ORR) to induction immuno-chemotherapy was evaluated according to RECIST 1.1 criteria. The Patlak-Ki of PTs was calculated from the 20-60 min frames using the Patlak graphical analysis. The best feature was selected using Laplacian feature importance scores, and an unsupervised K-Means method was applied to cluster patients. ROC curve was used to examine the effect of selected metabolic feature in predicting tumor response to treatment. The targeted next generation sequencing on 1021 genes was conducted. The expressions of CD68, CD86, CD163, CD206, CD33, CD34, Ki67 and VEGFA were assayed through immunohistochemistry. The independent samples t test and the Mann-Whitney U test were applied in the intergroup comparison. Statistical significance was considered at P < 0.05. RESULTS Thirty-seven LA-NSCLC patients were analyzed between September 2020 and November 2021. All patients received two cycles of induction chemotherapy combined with Nivolumab/ Camrelizumab. The Laplacian scores showed that the Patlak-Ki of PTs had the highest importance for patient clustering, and the unsupervised K-Means derived decision boundary of Patlak-Ki was 2.779 ml/min/100 g. Patients were categorized into two groups based on their Patlak-Ki values: high FDG Patlak-Ki (H-FDG-Ki, Patlak-Ki > 2.779 ml/min/100 g) group (n = 23) and low FDG Patlak-Ki (L-FDG-Ki, Patlak-Ki ≤ 2.779 ml/min/100 g) group (n = 14). The ORR to induction immuno-chemotherapy was 67.6% (25/37) in the whole cohort, with 87% (20/23) in H-FDG-Ki group and 35.7% (5/14) in L-FDG-Ki group (P = 0.001). The sensitivity and specificity of Patlak-Ki in predicting the treatment response were 80% and 75%, respectively [AUC = 0.775 (95%CI 0.605-0.945)]. The expression of CD3+/CD8+ T cells and CD86+/CD163+/CD206+ macrophages were higher in the H-FDG-Ki group, while Ki67, CD33+ myeloid cells, CD34+ micro-vessel density (MVD) and tumor mutation burden (TMB) were comparable between the two groups. CONCLUSIONS The total body [18F]FDG PET/CT scanner performed a dynamic acquisition of the entire body and clustered LA-NSCLC patients into H-FDG-Ki and L-FDG-Ki groups based on the Patlak-Ki. Patients with H-FDG-Ki demonstrated better response to induction immuno-chemotherapy and higher levels of immune cell infiltration in the PTs compared to those with L-FDG-Ki. Further studies with a larger patient cohort are required to validate these findings.
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Affiliation(s)
- DaQuan Wang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Bo Qiu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - QianWen Liu
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - LiangPing Xia
- Department of VIP, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - SongRan Liu
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | | | - Hui Liu
- United Imaging Healthcare, Shanghai, China
| | - YiWen Mo
- Department of Nuclear Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Xu Zhang
- Department of Nuclear Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - YingYing Hu
- Department of Nuclear Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - ShiYang Zheng
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Yin Zhou
- SuZhou TongDiao Company, Suzhou, China
| | - Jia Fu
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - NaiBin Chen
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - FangJie Liu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Rui Zhou
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - JinYu Guo
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Wei Fan
- Department of Nuclear Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China.
| | - Hui Liu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China.
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7
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Bhoil A. Lesion Analysis in PERCIST 1.0: Clinical Ease versus Research Requisite-Where Does the Balance Exist? World J Nucl Med 2023; 22:100-107. [PMID: 37223629 PMCID: PMC10202569 DOI: 10.1055/s-0042-1750406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Background Semiqualitative parameter SUVmax has been the most frequently used semiquantitative positron emission tomography (PET) parameter for response evaluation, but only metabolic activity of a single (most metabolic) lesion is predicted. Newer response parameters such as tumor lesion glycolysis (TLG) incorporating lesions' metabolic volume or whole-body metabolic tumor burden (MTBwb) are being explored for response evaluation. Evaluation and comparison of response with different semiquantitative PET parameters such as SUVmax and TLG in most metabolic lesion, multiple lesions (max of five), and MTBwb in advanced non-small cell lung cancer (NSCLC) patients were made. The different PET parameters were analyzed for response evaluation, overall survival (OS), and progression-free survival (PFS). Methods 18 F-FDG-PET/CT (18-fluorine-fluorodeoxyglucose positron emission tomography/computed tomography) imaging was performed in 23 patients (M = 14, F = 9, mean age = 57.6 years) with stage IIIB-IV advanced NSCLC before initiation of therapy with oral estimated glomerular filtration rate-tyrosine kinase inhibitor for early and late response evaluation. The quantitative PET parameters such as SUVmax and TLG were measured in single (most metabolic) lesion, multiple lesions, and MTBwb. The parameters SUVmax, TLG, and MTBwb were compared for early and late response evaluation and analyzed for OS and PFS Results No significant difference in change in response evaluation was seen in patients evaluated with most metabolic lesion, multiple lesions, or MTBwb. Difference in early (DC 22, NDC 1) and late (DC 20, NDC 3) response evaluation was seen that remained unchanged when lesions were measured in terms of number of lesions or the MTBwb. The early imaging was seen to be statistically significant to the OS compared with late imaging. Conclusions Single (most metabolic) lesion shows similar disease response and OS to multiple lesions and MTBwb. Response evaluation by late imaging offered no significant advantage compared with early imaging. Thus, early response evaluation with SUVmax parameter offers a good balance between clinical ease and research requisition.
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Affiliation(s)
- Amit Bhoil
- Department of Nuclear Medicine, Mahajan Imaging and Labs, New Delhi, India
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8
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Sato D, Izu A, Sakakibara M, Hayashi S, Kawachi R, Shimamura M, Masuda S, Sakurai H. A neuroendocrine tumor within an anterior mediastinal mature teratoma: a case report. J Cardiothorac Surg 2022; 17:333. [PMID: 36550490 PMCID: PMC9783718 DOI: 10.1186/s13019-022-02091-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mature teratomas are benign germ cell tumors. On rare occasions, they have been associated with somatic malignancies and are termed rare germ cell tumors with a somatic-type malignancy (GCTSM). Mature teratomas commonly comprise adenocarcinomas; only seven previous cases of mature teratomas with neuroendocrine tumors have been reported to date. Here, we report a patient with a neuroendocrine tumor whithin a mature teratoma. CASE PRESENTATION A 26-year-old man visited our department complaining of chest tightness. Contrast-enhanced computed tomography (CT) scans showed a strongly enhanced lesion within a 10-cm encapsulated cystic lesion in the anterior mediastinum. Positron emission tomography (PET) scans showed no areas of significant 18F-fluorodeoxyglucose (18F-FDG) accumulation. He underwent complete tumor resection via the transsternal approach. Histopathological examination of the specimen indicated a neuroendocrine tumor contained within a mature teratoma. CONCLUSIONS In this case, a neuroendocrine tumor was contained within a mature teratoma. Our patient had no specific symptoms and his serum markers were within the normal range. Although PET is beneficial for diagnosing other GCTSM, it is not useful in detecting a neuroendocrine tumor. Therefore, the preoperative diagnosis of neuroendocrine tumors contained within mature teratomas remains challenging. However, GCTSM should be suspected in patients exhibiting CT findings of a mediastinal tumor, measuring ≥ 6 cm, in addition to characteristic GCTSM findings. Moreover, surgery should be performed carefully in such cases.
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Affiliation(s)
- Daisuke Sato
- grid.260969.20000 0001 2149 8846Department of Respiratory Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
| | - Asami Izu
- grid.260969.20000 0001 2149 8846Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
| | - Masashi Sakakibara
- grid.260969.20000 0001 2149 8846Department of Respiratory Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
| | - Sohei Hayashi
- grid.260969.20000 0001 2149 8846Department of Respiratory Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
| | - Riken Kawachi
- grid.260969.20000 0001 2149 8846Department of Respiratory Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
| | - Mie Shimamura
- grid.260969.20000 0001 2149 8846Department of Respiratory Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
| | - Shinobu Masuda
- grid.260969.20000 0001 2149 8846Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
| | - Hiroyuki Sakurai
- grid.260969.20000 0001 2149 8846Department of Respiratory Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
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9
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Abstract
Testicular cancer is a curable cancer. The success of physicians in curing the disease is underpinned by multidisciplinary advances. Cisplatin-based combination chemotherapy and the refinement of post-chemotherapy surgical procedures and diagnostic strategies have greatly improved long term survival in most patients. Despite such excellent outcomes, several controversial dilemmas exist in the approaches to clinical stage I disease, salvage chemotherapy, post-chemotherapy surgical procedures, and implementing innovative imaging studies. Relapse after salvage chemotherapy has a poor prognosis and the optimal treatment is not apparent. Recent research has provided insight into the molecular mechanisms underlying cisplatin resistance. Phase 2 studies with targeted agents have failed to show adequate efficacy; however, our understanding of cisplatin resistant disease is rapidly expanding. This review summarizes recent advances and discusses relevant issues in the biology and management of testicular cancer.
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Affiliation(s)
- Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, National Cancer Institute, Bratislava, Slovakia
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Lifespan Academic Medical Center, Providence, RI, USA
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10
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Wang Z, Wu Y, Li X, Bai Y, Chen H, Ding J, Shen C, Hu Z, Liang D, Liu X, Zheng H, Yang Y, Zhou Y, Wang M, Sun T. Comparison between a dual-time-window protocol and other simplified protocols for dynamic total-body 18F-FDG PET imaging. EJNMMI Phys 2022; 9:63. [PMID: 36104580 PMCID: PMC9474964 DOI: 10.1186/s40658-022-00492-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Efforts have been made both to avoid invasive blood sampling and to shorten the scan duration for dynamic positron emission tomography (PET) imaging. A total-body scanner, such as the uEXPLORER PET/CT, can relieve these challenges through the following features: First, the whole-body coverage allows for noninvasive input function from the aortic arteries; second, with a dramatic increase in sensitivity, image quality can still be maintained at a high level even with a shorter scan duration than usual. We implemented a dual-time-window (DTW) protocol for a dynamic total-body 18F-FDG PET scan to obtain multiple kinetic parameters. The DTW protocol was then compared to several other simplified quantification methods for total-body FDG imaging that were proposed for conventional setup. METHODS The research included 28 patient scans performed on an uEXPLORER PET/CT. By discarding the corresponding data in the middle of the existing full 60-min dynamic scan, the DTW protocol was simulated. Nonlinear fitting was used to estimate the missing data in the interval. The full input function was obtained from 15 subjects using a hybrid approach with a population-based image-derived input function. Quantification was carried out in three areas: the cerebral cortex, muscle, and tumor lesion. Micro- and macro-kinetic parameters for different scan durations were estimated by assuming an irreversible two-tissue compartment model. The visual performance of parametric images and region of interest-based quantification in several parameters were evaluated. Furthermore, simplified quantification methods (DTW, Patlak, fractional uptake ratio [FUR], and standardized uptake value [SUV]) were compared for similarity to the reference net influx rate Ki. RESULTS Ki and K1 derived from the DTW protocol showed overall good consistency (P < 0.01) with the reference from the 60-min dynamic scan with 10-min early scan and 5-min late scan (Ki correlation: 0.971, 0.990, and 0.990; K1 correlation: 0.820, 0.940, and 0.975 in the cerebral cortex, muscle, and tumor lesion, respectively). Similar correlationss were found for other micro-parameters. The DTW protocol had the lowest bias relative to standard Ki than any of the quantification methods, followed by FUR and Patlak. SUV had the weakest correlation with Ki. The whole-body Ki and K1 images generated by the DTW protocol were consistent with the reference parametric images. CONCLUSIONS Using the DTW protocol, the dynamic total-body FDG scan time can be reduced to 15 min while obtaining accurate Ki and K1 quantification and acceptable visual performance in parametric images. However, the trade-off between quantification accuracy and protocol implementation feasibility must be considered in practice. We recommend that the DTW protocol be used when the clinical task requires reliable visual assessment or quantifying multiple micro-parameters; FUR with a hybrid input function may be a more feasible approach to quantifying regional metabolic rate with a known lesion position or organs of interest.
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Affiliation(s)
- Zhenguo Wang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Yaping Wu
- Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, People's Republic of China
| | - Xiaochen Li
- Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, People's Republic of China
| | - Yan Bai
- Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, People's Republic of China
| | - Hongzhao Chen
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Jie Ding
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Chushu Shen
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Zhanli Hu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Dong Liang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Xin Liu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Yongfeng Yang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Yun Zhou
- Central Research Institute, United Imaging Healthcare Group Co., Ltd, Shanghai, People's Republic of China
- School of Biomedical Engineering, Shanghai Tech University, Shanghai, People's Republic of China
| | - Meiyun Wang
- Henan Provincial People's Hospital and the People's Hospital of Zhengzhou, University of Zhengzhou, Zhengzhou, People's Republic of China.
| | - Tao Sun
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China.
- United Imaging Research Institute of Innovative Medical Equipment, Shenzhen, People's Republic of China.
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11
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Wu Y, Feng T, Zhao Y, Xu T, Fu F, Huang Z, Meng N, Li H, Shao F, Wang M. Whole-body Parametric Imaging of FDG PET using uEXPLORER with Reduced Scan Time. J Nucl Med 2021; 63:622-628. [PMID: 34385335 PMCID: PMC8973287 DOI: 10.2967/jnumed.120.261651] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 06/14/2021] [Indexed: 11/25/2022] Open
Abstract
Parametric imaging of the net influx rate (Ki) in 18F-FDG PET has been shown to provide improved quantification and specificity for cancer detection compared with SUV imaging. Current methods of generating parametric images usually require a long dynamic scanning time. With the recently developed uEXPLORER scanner, a dramatic increase in sensitivity has reduced the noise in dynamic imaging, making it more robust to use a nonlinear estimation method and flexible protocols. In this work, we explored 2 new possible protocols besides the standard 60-min one for the possibility of reducing scanning time for Ki imaging. Methods: The gold standard protocol (protocol 1) was conventional dynamic scanning with a 60-min scanning time. The first proposed protocol (protocol 2) included 2 scanning periods: 0–4 min and 54–60 min after injection. The second proposed protocol (protocol 3) consisted of a single scanning period from 50 to 60 min after injection, with a second injection applied at 56 min. The 2 new protocols were simulated from the 60-min standard scans. A hybrid input function combining the population-based input function and the image-derived input function (IDIF) was used. The results were also compared with the IDIF acquired from protocol 1. A previously developed maximum-likelihood approach was used to estimate the Ki images. In total, 7 cancer patients imaged using the uEXPLORER scanner were enrolled in this study. Lesions were identified from the patient data, and the lesion Ki values were compared among the different protocols. Results: The acquired hybrid input function was comparable in shape to the IDIF for each patient. The average difference in area under the curve was about 3%, suggesting good quantitative accuracy. The visual difference between the Ki images generated using IDIF and those generated using the hybrid input function was also minimal. The acquired Ki images using different protocols were visually comparable. The average Ki difference in the lesions was 2.8% ± 2.1% for protocol 2 and 1% ± 2.2% for protocol 3. Conclusion: The results suggest that it is possible to acquire Ki images using the nonlinear estimation approach with a much-reduced scanning time. Between the 2 new protocols, the protocol with dual injection shows the greatest promise in terms of practicality.
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Affiliation(s)
- Yaping Wu
- Department of Medical Imaging, Henan Provincial People's Hospital, China
| | | | | | | | - Fangfang Fu
- Department of Medical Imaging, Henan Provincial People's Hospital, China
| | - Zhun Huang
- Department of Medical Imaging, Henan Provincial People's Hospital, China
| | - Nan Meng
- Department of Medical Imaging, Henan Provincial People's Hospital, China
| | | | - Fengmin Shao
- Department of Medical Imaging, Henan Provincial People's Hospital, China, China
| | - Meiyun Wang
- Department of Medical Imaging, Henan Provincial People's Hospital, China
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12
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Makovník M, Rejleková K, Uhrin I, Mego M, Chovanec M. Intricacies of Radiographic Assessment in Testicular Germ Cell Tumors. Front Oncol 2021; 10:587523. [PMID: 33585206 PMCID: PMC7874236 DOI: 10.3389/fonc.2020.587523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
Testicular germ cell tumors (GCTs) are malignancies with a unique biology, pathology, clinical appearance, and excellent outcomes. A correct radiographic assessment of GCTs is extremely important for the clinical management in several typical scenarios. Advancements in the field of diagnostic medicine bring an increasing number of sophisticated imaging methods to increase the performance of imaging studies. The conventional computed tomography (CT) remains the mainstay of diagnostic imaging in the management of GCTs. While certain improvements in the sensitivity and specificity are suggested with magnetic resonance (MR) imaging with lymphotrophic nanoparticles in evaluating retroperitoneal lymph nodes during the staging procedure, further exploration in larger prospective studies is needed. A common diagnostic dilemma is assessing the post-chemotherapy residual disease in GCTs. Several studies have consistently shown advantages in the utility of positron emission tomography (PET) scanning in post-chemotherapy residual retroperitoneal lymph nodes in patients with seminoma, but not with non-seminoma. Recommendations suggest that seminoma patients with a residual disease in the retroperitoneum larger than 3 cm should be subjected for PET scanning with 18-fluorodeoxyglucose. Relatively high sensitivity, specificity and a negative predictive value (80-95%) may guide clinical decision to spare these patients of high morbidity of an unnecessary surgery. However, a positive predictive value of around 50% renders PET scanning difficult to interpret in the case of positive finding. These patients often require extremely difficult surgical procedures with the high risk of post-operative morbidity. Therefore, seminoma patients with PET positive residual masses larger than 3 cm still remain a serious challenge in the decision making of nuclear medicine specialist, oncologists, and urologic surgeons. In this article, we aim to summarize data on controversial dilemmas in staging procedures, active surveillance, and post-chemotherapy assessment of GCTs based on the available published literature.
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Affiliation(s)
- Marek Makovník
- Radiology Department, National Cancer Institute, Bratislava, Slovakia
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Katarína Rejleková
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Ivan Uhrin
- Radiology Department, National Cancer Institute, Bratislava, Slovakia
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
- Translational Research Unit, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
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13
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Revels JW, Wang SS, Gangadhar K, Ali A, Ali AA, Lee JH. Multimodality Radiological Pictorial Review of Testicular Carcinoma: From Initial Staging to Restaging. Res Rep Urol 2020; 12:599-613. [PMID: 33294422 PMCID: PMC7718994 DOI: 10.2147/rru.s257243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022] Open
Abstract
With an overall 5-year survival rate >95%, patients with testicular cancer have a great prognosis. Although initial diagnosis is based on clinical examination, imaging does play a significant role in the diagnosis and prognosis of testicular cancer, which are dependent on tumor burden and staging. Successful treatment requires appropriate disease assessment throughout a patient’s treatment: evaluating treatment response, restaging, and monitoring for disease recurrence after treatment completion. Ultrasound is usually the initial screening modality for painless testicular masses, and computedtomography (CT) the most commonly used for staging and restaging. However, with regard to seminomas, positron-emission tomography (PET) combined with CT is slowly taking priority. With regard to nonseminomatous germ-cell tumors, PET-CT has not proven to be completely effective, due to a high number of false-negative results. The purpose of this paper is to provide radiologists with a pictorial review of testicular carcinoma from initial staging through posttreatment follow-up.
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Affiliation(s)
- Jonathan W Revels
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Sherry S Wang
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake, UT, USA
| | - Kiran Gangadhar
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Arafat Ali
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Al-Amin Ali
- Department of Literature, Science, and Arts, University of Michigan, Ann Arbor, MI, USA
| | - Jean H Lee
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
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14
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Samimi R, Kamali-Asl A, Geramifar P, van den Hoff J, Rahmim A. Short-duration dynamic FDG PET imaging: Optimization and clinical application. Phys Med 2020; 80:193-200. [DOI: 10.1016/j.ejmp.2020.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/04/2020] [Accepted: 11/01/2020] [Indexed: 12/12/2022] Open
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15
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Feng T, Zhao Y, Shi H, Li H, Zhang X, Wang G, Price PM, Badawi RD, Cherry SR, Jones T. Total-Body Quantitative Parametric Imaging of Early Kinetics of 18F-FDG. J Nucl Med 2020; 62:738-744. [PMID: 32948679 DOI: 10.2967/jnumed.119.238113] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 08/06/2020] [Indexed: 02/01/2023] Open
Abstract
Parametric imaging has been shown to provide better quantitation physiologically than SUV imaging in PET. With the increased sensitivity from a recently developed total-body PET scanner, whole-body scans with higher temporal resolution become possible for dynamic analysis and parametric imaging. In this paper, we focus on deriving the parameter k 1 using compartmental modeling and on developing a method to acquire whole-body 18F-FDG PET parametric images using only the first 90 s of the postinjection scan data with the total-body PET system. Methods: Dynamic projections were acquired with a time interval of 1 s for the first 30 s and a time interval of 2 s for the following minute. Image-derived input functions were acquired from the reconstructed dynamic sequences in the ascending aorta. A 1-tissue-compartment model with 4 parameters (k 1, k 2, blood fraction, and delay time) was used. A maximum-likelihood-based estimation method was developed with the 1-tissue-compartment model solution. The accuracy of the acquired parameters was compared with the ones estimated using a 2-tissue-compartment irreversible model with 1-h-long data. Results: All 4 parametric images were successfully calculated using data from 2 volunteers. By comparing the time-activity curves acquired from the volumes of interest, we showed that the parameters estimated using our method were able to predict the time-activity curves of the early dynamics of 18F-FDG in different organs. The delay-time effects for different organs were also clearly visible in the reconstructed delay-time image with delay variations of as large as 40 s. The estimated parameters using both 90-s data and 1-h data agreed well for k 1 and blood fraction, whereas a large difference in k 2 was found between the 90-s and 1-h data, suggesting k 2 cannot be reliably estimated from the 90-s scan. Conclusion: We have shown that with total-body PET and the increased sensitivity, it is possible to estimate parametric images based on the very early dynamics after 18F-FDG injection. The estimated k 1 might potentially be used clinically as an indicator for identifying abnormalities.
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Affiliation(s)
- Tao Feng
- UIH America Inc., Houston, Texas
| | | | - Hongcheng Shi
- Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Xuezhu Zhang
- Department of Biomedical Engineering, University of California Davis, Davis, California
| | - Guobao Wang
- Department of Biomedical Engineering, University of California Davis, Davis, California
| | | | - Ramsey D Badawi
- Department of Biomedical Engineering, University of California Davis, Davis, California.,Department of Radiology, University of California Davis Medical Center, Davis, California
| | - Simon R Cherry
- Department of Biomedical Engineering, University of California Davis, Davis, California.,Department of Radiology, University of California Davis Medical Center, Davis, California
| | - Terry Jones
- Department of Radiology, University of California Davis Medical Center, Davis, California
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16
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Ovarian and non-ovarian teratomas: a wide spectrum of features. Jpn J Radiol 2020; 39:143-158. [PMID: 32875471 DOI: 10.1007/s11604-020-01035-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023]
Abstract
Teratoma is a germ cell tumor (GCT) derived from stem cells of the early embryo and the germ line. Teratoma is the most common neoplasm of the ovaries and is usually diagnosed easily using imagings by detecting fat components. However, there are various histopathological types and the imaging findings differ according to the type. Teratoma usually occurs in the gonads or in the midline due to migration of primordial germ cells during development. The clinical course of teratomas depends on the age of the patient, histological type, and anatomical site. Sometimes teratomas show unusual manifestations, such as mature teratoma without demonstrable fat components, torsion, rupture, growing teratoma syndrome, anti-N-methyl-D-aspartate receptor encephalitis, and autoimmune hemolytic anemia. For all of these reasons, teratomas demonstrate a wide spectrum of imaging features and radiologists should be familiar with these variabilities. The present article aims to introduce a model encompassing types of GCTs based on their developmental potential, and to review several histopathological types in various anatomical sites and unusual manifestations of teratomas, with representative imaging findings.
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17
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Fluid-filled Cystic Lesions of the Lungs. J Thorac Imaging 2020; 36:208-217. [PMID: 32271279 DOI: 10.1097/rti.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A pulmonary cyst usually refers to an air-filled space with a smooth, thin wall. Fluid-filled cystic lesions of the lungs include a range of etiologies such as true cysts, congenital malformations, infections, and benign and malignant neoplasms. With relatively little solid component, these lesions often have similar imaging appearances to one another. This article focuses on key imaging features and clinical characteristics that can be used to narrow the differential diagnosis.
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18
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Jaklitsch M, Sobral M, de Figueiredo AAFP, Martins A, Marques HP. Rare giant: mature cystic teratoma in the liver. J Surg Case Rep 2019; 2019:rjz347. [PMID: 31832137 PMCID: PMC6900339 DOI: 10.1093/jscr/rjz347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/23/2019] [Accepted: 10/28/2019] [Indexed: 12/23/2022] Open
Abstract
Teratomas are rare pluripotent embryonic tumours occurring mostly in gonadal organs and pediatric age groups. Mature cystic teratoma in the liver are rare, and to the best of our knowledge, only a dozen cases in adults have been published in the literature. We present a 27-year-old female who had a history of loss of appetite and mild abdominal distention. Computed Tomography revealed a liver mass suggestive of teratoma. The patient underwent elective surgery, and the diagnosis of mature cystic liver teratoma was confirmed histologically. Measuring 23 cm in a longitudinal axis, the patient had an uneventful post-operative evolution and was discharged on day eight. Teratomas in the liver are a rare finding, especially in adults, mostly due to their asymptomatic evolution. Due to the possibility of malignant transformation, complete surgical resection remains the best treatment option.
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Affiliation(s)
- Manuel Jaklitsch
- Hepato-Biliary and Transplantation Center, Curry Cabral Hospital, Lisbon's Central Hospitals and University Center, Portugal.,Master Fellow in Hepatobiliary-Pancreatic Surgery, Institut Hépato-Biliaire Henri Bismuth, Villejuif, France
| | - Mafalda Sobral
- Hepato-Biliary and Transplantation Center, Curry Cabral Hospital, Lisbon's Central Hospitals and University Center, Portugal
| | - António Augusto Ferreira Pinto de Figueiredo
- Hepato-Biliary and Transplantation Center, Curry Cabral Hospital, Lisbon's Central Hospitals and University Center, Portugal.,Department of Pathology, Curry Cabral Hospital, Lisbon's Central Hospitals and University Center, Lisbon, Portugal
| | - Americo Martins
- Hepato-Biliary and Transplantation Center, Curry Cabral Hospital, Lisbon's Central Hospitals and University Center, Portugal
| | - Hugo Pinto Marques
- Hepato-Biliary and Transplantation Center, Curry Cabral Hospital, Lisbon's Central Hospitals and University Center, Portugal.,Nova Medical School, Lisbon, Portugal
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Imaging of Metastatic Germ Cell Tumors in Male Patients From Initial Diagnosis to Treatment-Related Toxicities: A Primer for Radiologists. AJR Am J Roentgenol 2019; 214:24-33. [PMID: 31573853 DOI: 10.2214/ajr.19.21623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. This review describes the influence of histology and metastatic sites on prognosis in male patients with metastatic germ cell tumors (GCTs) and explains the role imaging in assessing therapeutic response, residual disease, recurrence, sand treatment-related toxicities. CONCLUSION. Seminomatous and nonseminomatous GCTs differ in imaging appearance, pattern of spread, and prognosis, and an organ-based approach is helpful in prognostication. Multimodality imaging aids in accurate staging, prognostication, characterization of treatment response, and identification of therapy-related toxicity.
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20
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Rahmim A, Lodge MA, Karakatsanis NA, Panin VY, Zhou Y, McMillan A, Cho S, Zaidi H, Casey ME, Wahl RL. Dynamic whole-body PET imaging: principles, potentials and applications. Eur J Nucl Med Mol Imaging 2018; 46:501-518. [PMID: 30269154 DOI: 10.1007/s00259-018-4153-6] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/28/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE In this article, we discuss dynamic whole-body (DWB) positron emission tomography (PET) as an imaging tool with significant clinical potential, in relation to conventional standard uptake value (SUV) imaging. BACKGROUND DWB PET involves dynamic data acquisition over an extended axial range, capturing tracer kinetic information that is not available with conventional static acquisition protocols. The method can be performed within reasonable clinical imaging times, and enables generation of multiple types of PET images with complementary information in a single imaging session. Importantly, DWB PET can be used to produce multi-parametric images of (i) Patlak slope (influx rate) and (ii) intercept (referred to sometimes as "distribution volume"), while also providing (iii) a conventional 'SUV-equivalent' image for certain protocols. RESULTS We provide an overview of ongoing efforts (primarily focused on FDG PET) and discuss potential clinically relevant applications. CONCLUSION Overall, the framework of DWB imaging [applicable to both PET/CT(computed tomography) and PET/MRI (magnetic resonance imaging)] generates quantitative measures that may add significant value to conventional SUV image-derived measures, with limited pitfalls as we also discuss in this work.
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Affiliation(s)
- Arman Rahmim
- Department of Radiology and Radiological Science, Johns Hopkins University, JHOC Building Room 3245, 601 N. Caroline St, Baltimore, MD, 21287, USA. .,Departments of Radiology and Physics & Astronomy, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada.
| | - Martin A Lodge
- Department of Radiology and Radiological Science, Johns Hopkins University, JHOC Building Room 3245, 601 N. Caroline St, Baltimore, MD, 21287, USA
| | | | | | - Yun Zhou
- Department of Radiology and Radiological Science, Johns Hopkins University, JHOC Building Room 3245, 601 N. Caroline St, Baltimore, MD, 21287, USA
| | - Alan McMillan
- Department of Radiology, University of Wisconsin, Madison, WI, 53705, USA
| | - Steve Cho
- Department of Radiology, University of Wisconsin, Madison, WI, 53705, USA
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland
| | | | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
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Katiyar P, Divine MR, Kohlhofer U, Quintanilla-Martinez L, Schölkopf B, Pichler BJ, Disselhorst JA. Spectral Clustering Predicts Tumor Tissue Heterogeneity Using Dynamic 18F-FDG PET: A Complement to the Standard Compartmental Modeling Approach. J Nucl Med 2016; 58:651-657. [PMID: 27811120 DOI: 10.2967/jnumed.116.181370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/19/2016] [Indexed: 12/11/2022] Open
Abstract
In this study, we described and validated an unsupervised segmentation algorithm for the assessment of tumor heterogeneity using dynamic 18F-FDG PET. The aim of our study was to objectively evaluate the proposed method and make comparisons with compartmental modeling parametric maps and SUV segmentations using simulations of clinically relevant tumor tissue types. Methods: An irreversible 2-tissue-compartmental model was implemented to simulate clinical and preclinical 18F-FDG PET time-activity curves using population-based arterial input functions (80 clinical and 12 preclinical) and the kinetic parameter values of 3 tumor tissue types. The simulated time-activity curves were corrupted with different levels of noise and used to calculate the tissue-type misclassification errors of spectral clustering (SC), parametric maps, and SUV segmentation. The utility of the inverse noise variance- and Laplacian score-derived frame weighting schemes before SC was also investigated. Finally, the SC scheme with the best results was tested on a dynamic 18F-FDG measurement of a mouse bearing subcutaneous colon cancer and validated using histology. Results: In the preclinical setup, the inverse noise variance-weighted SC exhibited the lowest misclassification errors (8.09%-28.53%) at all noise levels in contrast to the Laplacian score-weighted SC (16.12%-31.23%), unweighted SC (25.73%-40.03%), parametric maps (28.02%-61.45%), and SUV (45.49%-45.63%) segmentation. The classification efficacy of both weighted SC schemes in the clinical case was comparable to the unweighted SC. When applied to the dynamic 18F-FDG measurement of colon cancer, the proposed algorithm accurately identified densely vascularized regions from the rest of the tumor. In addition, the segmented regions and clusterwise average time-activity curves showed excellent correlation with the tumor histology. Conclusion: The promising results of SC mark its position as a robust tool for quantification of tumor heterogeneity using dynamic PET studies. Because SC tumor segmentation is based on the intrinsic structure of the underlying data, it can be easily applied to other cancer types as well.
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Affiliation(s)
- Prateek Katiyar
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany.,Max Planck Institute for Intelligent Systems, Tuebingen, Germany; and
| | - Mathew R Divine
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Ursula Kohlhofer
- Institute of Pathology and Neuropathology, Eberhard Karls University Tuebingen and Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University Tuebingen and Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Bernd J Pichler
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Jonathan A Disselhorst
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Kassem TW. Do we need 18F-FDG PET/CT scan in staging and management of testicular tumors? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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23
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Lee M, Yeum TS, Kim JW, Oh S, Lee SA, Moon HR, Choi YH, Han YM, Choi JM, Jang DK. Recent chemotherapy reduces the maximum-standardized uptake value of 18F-fluoro-deoxyglucose positron emission tomography in colorectal cancer. Gut Liver 2014; 8:254-64. [PMID: 24827621 PMCID: PMC4026642 DOI: 10.5009/gnl.2014.8.3.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/AIMS The aim of this study was to evaluate the influence of recent chemotherapy on the patterns of the maximum-standardized uptake value (M-SUV) and sensitivity of (18)F-fluoro-deoxyglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) in colorectal cancer. METHODS We retrospectively analyzed the FDG-PET/CT of 509 patients who underwent surgery for colorectal cancer. Subgroup analysis was performed according to chemotherapy status; 401 patients were not treated with chemotherapy and 108 patients were treated with chemotherapy within 6 months prior to surgery. Pathologic analysis of the surgical specimen was used as the gold standard. RESULTS The M-SUV was significantly lower in patients treated with chemotherapy than in those not treated with chemotherapy in pathologically confirmed same stages of disease. The difference in the sensitivity of the M-SUV according to chemotherapy status was greatest using a cutoff M-SUV value of 6.4 (p<0.001). The longest diameter of the primary tumor was the most important factor that correlated with M-SUV of the primary tumor irrespective of the chemotherapy effect (p<0.001). The M-SUV of the primary tumor was not an independent predictor of lymph node metastasis in colorectal cancer. CONCLUSIONS The results indicate that the M-SUV of FDG-PET/CT should be interpreted in the context of concurrent chemotherapy.
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Affiliation(s)
- Minjong Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Tae Sung Yeum
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Ji Won Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea, Departments of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sohee Oh
- Departments of Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Shin Ae Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Hong Ran Moon
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Young Hoon Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Yoo Min Han
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Ji Min Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Dong Kee Jang
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
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24
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Wood MJ, Tirumani SH, Sweeney C, Ramaiya NH, Howard SA. Approach to risk stratification in testicular germ cell tumors: a primer for radiologists. ACTA ACUST UNITED AC 2014; 40:1871-86. [DOI: 10.1007/s00261-014-0304-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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25
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Sharma P, Jain TK, Parida GK, Karunanithi S, Patel C, Sharma A, Thulkar S, Julka PK, Bal C, Kumar R. Diagnostic accuracy of integrated (18)F-FDG PET/CT for restaging patients with malignant germ cell tumours. Br J Radiol 2014; 87:20140263. [PMID: 24896199 PMCID: PMC4112389 DOI: 10.1259/bjr.20140263] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/22/2014] [Accepted: 06/02/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Evaluation of utility of fluorine-18 fludeoxyglucose ((18)F-FDG) positron emission tomography/CT (PET/CT) for restaging patients with primary malignant germ cell tumours (GCTs). METHODS Data of 92 patients (age, 31.94 ± 10.1 years; male/female, 86/6) with histopathologically confirmed malignant GCTs (gonadal, 88; mediastinal, 4; seminomatous, 47 and non-seminomatous, 45) who underwent (18)F-FDG PET/CT for restaging (suspected recurrence/post-therapy evaluation) were retrospectively analysed. Two experienced nuclear medicine physicians reviewed the PET/CT images in consensus, qualitatively and semi-quantitatively [maximum standardized uptake value (SUVmax)]. Histopathology (if available) and clinical/imaging/biochemical follow-up (minimum of 6 months) were employed as the reference standard. RESULTS (18)F-FDG PET/CT was interpreted as positive in 59 and negative in 33 patients. Local disease was seen in 5, nodal disease in 50 and distant metastasis in 22 patients. PET/CT was true positive in 49, false positive in 10, true negative in 30 and false negative in 3 patients. (18)F-FDG PET/CT showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 94.2%, 75.0%, 83.0%, 90.9% and 85.8% overall; 90.0%, 74.0%, 72.0%, 90.9% and 80.8% in seminomatous GCT; and 96.8%, 76.9%, 91.1%, 90.9% and 91.1% in non-seminomatous GCT, respectively. Difference in PET/CT accuracy for seminomatous and non-seminomatous GCTs was not significant (p = 0.263). PET/CT demonstrated disease in 13 patients with negative/equivocal conventional imaging findings and in 9 patients with normal tumour markers. No site- or histology-based difference was seen in SUVmax. CONCLUSION (18)F-FDG PET/CT demonstrates high diagnostic accuracy for restaging patients with malignant GCTs. It has comparable diagnostic performance in both seminomatous and non-seminomatous malignant GCTs. ADVANCES IN KNOWLEDGE The present article demonstrates high diagnostic accuracy of (18)F-FDG PET/CT for restaging both seminomatous and non-seminomatous malignant GCTs in a large patient population.
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Affiliation(s)
- P Sharma
- 1 Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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26
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Kotasidis FA, Tsoumpas C, Rahmim A. Advanced kinetic modelling strategies: towards adoption in clinical PET imaging. Clin Transl Imaging 2014. [DOI: 10.1007/s40336-014-0069-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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27
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O'Donovan EJ, Thway K, Moskovic EC. Extragonadal teratomas of the adult abdomen and pelvis: a pictorial review. Br J Radiol 2014; 87:20140116. [PMID: 24983762 DOI: 10.1259/bjr.20140116] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Teratomas comprise a spectrum of tumours that have striking imaging appearances and are commonly considered when evaluating a mass in the female pelvis. A subgroup of these tumours located in an extragonadal abdominopelvic location, in contrast, are extremely rare and can affect both sexes. Extragonadal teratomas can occur at all ages, are particularly unusual in adults and can cause confusion in the differential diagnosis, especially in children. Familiarity with the imaging features of the spectrum of teratomas within the abdominal cavity is therefore of great importance, as radiological diagnosis can guide treatment, prevent delays in diagnosis and avoid sequelae. This article summarizes the radiological appearances of these rare extragonadal tumours in adults in relation to their pathology, malignant potential, location and behaviour. Although uncommon, teratomas should be considered in the differential diagnosis of extragonadal abdominal masses, particularly in young adults.
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Diagnostic performance of fluorine-18-fluorodeoxyglucose positron emission tomography in the postchemotherapy management of patients with seminoma: systematic review and meta-analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:852681. [PMID: 24963486 PMCID: PMC4052095 DOI: 10.1155/2014/852681] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 04/11/2014] [Indexed: 12/04/2022]
Abstract
Objective. To meta-analyze published data about the diagnostic performance of fluorine-18-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in the postchemotherapy management of patients with seminoma. Methods. A comprehensive literature search of studies published through January 2014 on this topic was performed. All retrieved studies were reviewed and qualitatively analyzed. Pooled sensitivity and specificity, positive and negative predictive values (PPV and NPV), accuracy, and area under the summary ROC curve (AUC) of 18F-FDG-PET or PET/CT on a per examination-based analysis were calculated. Subgroup analyses considering the size of residual/recurrent lesions were carried out. Results. Nine studies including 375 scans were selected. The pooled analysis provided the following results: sensitivity 78% (95% confidence interval (95% CI): 67–87%), specificity 86% (95% CI: 81–89%), PPV 58% (95% CI: 48–68%), NPV 94% (95% CI: 90–96%), and accuracy 84% (95% CI: 80–88%). The AUC was 0.90. A better diagnostic accuracy of 18F-FDG-PET or PET/CT in evaluating residual/recurrent lesions >3 cm compared to those <3 cm was found. Conclusions. 18F-FDG-PET and PET/CT were demonstrated to be accurate imaging methods in the postchemotherapy management of patients with seminoma; nevertheless possible sources of false-negative and false-positive results should be considered. The literature focusing on this setting still remains limited and cost-effectiveness analyses are warranted.
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Zhu W, Li Q, Bai B, Conti PS, Leahy RM. Patlak image estimation from dual time-point list-mode PET data. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:913-924. [PMID: 24710160 PMCID: PMC4209255 DOI: 10.1109/tmi.2014.2298868] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We investigate using dual time-point PET data to perform Patlak modeling. This approach can be used for whole body dynamic PET studies in which we compute voxel-wise estimates of Patlak parameters using two frames of data for each bed position. Our approach directly uses list-mode arrival times for each event to estimate the Patlak parametric image. We use a penalized likelihood method in which the penalty function uses spatially variant weighting to ensure a count independent local impulse response. We evaluate performance of the method in comparison to fractional changes in SUV values (%DSUV) between the two frames using Cramer Rao analysis and Monte Carlo simulation. Receiver operating characteristic (ROC) curves are used to compare performance in differentiating tumors relative to background based on the dynamic data sets. Using area under the ROC curve as a performance metric, we show superior performance of Patlak relative to %DSUV over a range of dynamic data sets and parameters. These results suggest that Patlak analysis may be appropriate for analysis of dual time-point whole body PET data and could lead to superior detection of tumors relative to %DSUV metrics.
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Affiliation(s)
- Wentao Zhu
- Signal and Image Processing Institute, University of Southern California, LA, CA 90089 USA
| | - Quanzheng Li
- Massachusetts General Hospital, Boston, MA, 02114 USA
| | - Bing Bai
- Department of Radiology, University of Southern California, LA, CA 90089 USA
| | - Peter S. Conti
- Department of Radiology, University of Southern California, LA, CA 90089 USA
| | - Richard M. Leahy
- Signal and Image Processing Institute, University of Southern California, LA, CA 90089 USA
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The Additional Value of Attenuation Correction CT Acquired During 18F-FDG PET/CT in Differentiating Mature From Immature Teratomas. Clin Nucl Med 2014; 39:e193-6. [DOI: 10.1097/rlu.0b013e3182a20d5c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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31
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Li Y, Liu Z, Dong C, He P, Liu X, Zhu Z, Jia B, Li F, Wang F. Noninvasive detection of human-induced pluripotent stem cell (hiPSC)-derived teratoma with an integrin-targeting agent (99m)Tc-3PRGD2. Mol Imaging Biol 2013; 15:58-67. [PMID: 22707047 DOI: 10.1007/s11307-012-0571-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Since their discovery in 2006, induced pluripotent stem cells (iPSCs) have gained increasing interest for tissue regeneration and transplantation therapies. However, teratoma formation after iPSC transplantation is one of the most serious drawbacks that may limit their further clinical application. We investigated here whether human iPSC-derived teratomas could be detected by an integrin-targeting agent (99m)Tc-PEG(4)-E[PEG(4)-c(RGDfK)](2) ((99m)Tc-3PRGD2). METHODS Human-induced pluripotent stem cells (hiPSCs) were generated and characterized. In vitro integrin α(v)β(3) expression levels of hiPSC- and hiPSC-derived teratoma cells were determined by flow cytometry. (99m)Tc-3PRGD2 was prepared, and planar gamma imaging and biodistribution studies were carried out in teratoma-bearing severe combined immunodeficient (SCID) mice. Positron emission tomography (PET) imaging of teratomas with 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG) was also performed for comparison. Integrin α(v)β(3) expression in teratoma tissues was determined by immunofluorescence staining. RESULTS (99m)Tc-3PRGD2 showed high (2.82 ± 0.21 and 2.69 ± 0.73%ID/g at 0.5 and 1 h pi, respectively) and specific (teratoma uptake decreased from 2.69 ± 0.73 to 0.53 ± 0.26%ID/g after blocking with cold 3PRGD2) uptake in teratoma tissues, and planar gamma imaging demonstrated the feasibility of noninvasively detecting the teratoma formation with (99m)Tc-3PRGD2. (18)F-FDG showed low teratoma uptake and thus failed to detect the teratomas. Ex vivo immunofluorescence staining validated the integrin α(v)β(3) expression in the vasculature during teratoma formation. CONCLUSION Gamma imaging with (99m)Tc-3PRGD2 is a promising approach for the noninvasive monitoring of tumorigenicity after hiPSCs transplantation.
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Affiliation(s)
- Yang Li
- Stem Cell Research Center and Department of Cell Biology, School of Basic Medical Sciences, Peking University, Beijing 100191, China
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Karakatsanis NA, Lodge MA, Tahari AK, Zhou Y, Wahl RL, Rahmim A. Dynamic whole-body PET parametric imaging: I. Concept, acquisition protocol optimization and clinical application. Phys Med Biol 2013; 58:7391-418. [PMID: 24080962 PMCID: PMC3941007 DOI: 10.1088/0031-9155/58/20/7391] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Static whole-body PET/CT, employing the standardized uptake value (SUV), is considered the standard clinical approach to diagnosis and treatment response monitoring for a wide range of oncologic malignancies. Alternative PET protocols involving dynamic acquisition of temporal images have been implemented in the research setting, allowing quantification of tracer dynamics, an important capability for tumor characterization and treatment response monitoring. Nonetheless, dynamic protocols have been confined to single-bed-coverage limiting the axial field-of-view to ~15-20 cm, and have not been translated to the routine clinical context of whole-body PET imaging for the inspection of disseminated disease. Here, we pursue a transition to dynamic whole-body PET parametric imaging, by presenting, within a unified framework, clinically feasible multi-bed dynamic PET acquisition protocols and parametric imaging methods. We investigate solutions to address the challenges of: (i) long acquisitions, (ii) small number of dynamic frames per bed, and (iii) non-invasive quantification of kinetics in the plasma. In the present study, a novel dynamic (4D) whole-body PET acquisition protocol of ~45 min total length is presented, composed of (i) an initial 6 min dynamic PET scan (24 frames) over the heart, followed by (ii) a sequence of multi-pass multi-bed PET scans (six passes × seven bed positions, each scanned for 45 s). Standard Patlak linear graphical analysis modeling was employed, coupled with image-derived plasma input function measurements. Ordinary least squares Patlak estimation was used as the baseline regression method to quantify the physiological parameters of tracer uptake rate Ki and total blood distribution volume V on an individual voxel basis. Extensive Monte Carlo simulation studies, using a wide set of published kinetic FDG parameters and GATE and XCAT platforms, were conducted to optimize the acquisition protocol from a range of ten different clinically acceptable sampling schedules examined. The framework was also applied to six FDG PET patient studies, demonstrating clinical feasibility. Both simulated and clinical results indicated enhanced contrast-to-noise ratios (CNRs) for Ki images in tumor regions with notable background FDG concentration, such as the liver, where SUV performed relatively poorly. Overall, the proposed framework enables enhanced quantification of physiological parameters across the whole body. In addition, the total acquisition length can be reduced from 45 to ~35 min and still achieve improved or equivalent CNR compared to SUV, provided the true Ki contrast is sufficiently high. In the follow-up companion paper, a set of advanced linear regression schemes is presented to particularly address the presence of noise, and attempt to achieve a better trade-off between the mean-squared error and the CNR metrics, resulting in enhanced task-based imaging.
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Affiliation(s)
- Nicolas A. Karakatsanis
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Martin A. Lodge
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Abdel K. Tahari
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Y. Zhou
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Richard L. Wahl
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Arman Rahmim
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, 21287, USA
- Department of Electrical & Computer Engineering, Johns Hopkins University, Baltimore, MD, 21287, USA
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Karakatsanis NA, Lodge MA, Zhou Y, Wahl RL, Rahmim A. Dynamic whole-body PET parametric imaging: II. Task-oriented statistical estimation. Phys Med Biol 2013; 58:7419-45. [PMID: 24080994 PMCID: PMC3941010 DOI: 10.1088/0031-9155/58/20/7419] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the context of oncology, dynamic PET imaging coupled with standard graphical linear analysis has been previously employed to enable quantitative estimation of tracer kinetic parameters of physiological interest at the voxel level, thus, enabling quantitative PET parametric imaging. However, dynamic PET acquisition protocols have been confined to the limited axial field-of-view (~15-20 cm) of a single-bed position and have not been translated to the whole-body clinical imaging domain. On the contrary, standardized uptake value (SUV) PET imaging, considered as the routine approach in clinical oncology, commonly involves multi-bed acquisitions, but is performed statically, thus not allowing for dynamic tracking of the tracer distribution. Here, we pursue a transition to dynamic whole-body PET parametric imaging, by presenting, within a unified framework, clinically feasible multi-bed dynamic PET acquisition protocols and parametric imaging methods. In a companion study, we presented a novel clinically feasible dynamic (4D) multi-bed PET acquisition protocol as well as the concept of whole-body PET parametric imaging employing Patlak ordinary least squares (OLS) regression to estimate the quantitative parameters of tracer uptake rate Ki and total blood distribution volume V. In the present study, we propose an advanced hybrid linear regression framework, driven by Patlak kinetic voxel correlations, to achieve superior trade-off between contrast-to-noise ratio (CNR) and mean squared error (MSE) than provided by OLS for the final Ki parametric images, enabling task-based performance optimization. Overall, whether the observer's task is to detect a tumor or quantitatively assess treatment response, the proposed statistical estimation framework can be adapted to satisfy the specific task performance criteria, by adjusting the Patlak correlation-coefficient (WR) reference value. The multi-bed dynamic acquisition protocol, as optimized in the preceding companion study, was employed along with extensive Monte Carlo simulations and an initial clinical (18)F-deoxyglucose patient dataset to validate and demonstrate the potential of the proposed statistical estimation methods. Both simulated and clinical results suggest that hybrid regression in the context of whole-body Patlak Ki imaging considerably reduces MSE without compromising high CNR. Alternatively, for a given CNR, hybrid regression enables larger reductions than OLS in the number of dynamic frames per bed, allowing for even shorter acquisitions of ~30 min, thus further contributing to the clinical adoption of the proposed framework. Compared to the SUV approach, whole-body parametric imaging can provide better tumor quantification, and can act as a complement to SUV, for the task of tumor detection.
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Affiliation(s)
- Nicolas A. Karakatsanis
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Martin A. Lodge
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Y. Zhou
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Richard L. Wahl
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Arman Rahmim
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, 21287, USA
- Department of Electrical & Computer Engineering, Johns Hopkins University, Baltimore, MD, 21287, USA
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Shintani Y, Funaki S, Nakagiri T, Inoue M, Sawabata N, Minami M, Kadota Y, Okumura M. Experience with thoracoscopic resection for mediastinal mature teratoma: a retrospective analysis of 15 patients. Interact Cardiovasc Thorac Surg 2013; 16:441-4. [PMID: 23287591 DOI: 10.1093/icvts/ivs543] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Although video-assisted thoracoscopic surgery (VATS) is widely used for the resection of a mediastinal mass, it is converted to an open resection in some patients with a mature teratoma because of dense adhesions. We reviewed cases with a mature teratoma removed by VATS and investigated the indications for that procedure for this tumour. METHODS We retrospectively investigated 15 patients with a benign mediastinal mature teratoma who underwent a thoracoscopic procedure. RESULTS The mean tumour diameter was 5.3 cm (range 3.2-8.5). The mean operative time was 188 min (78-430), and intraoperative blood loss was 138 ml (10-450). Thoracoscopic resection was completed in all except 3 patients with larger tumours, which presented the most difficult problems with dissection. Each of those 3 had severe preoperative chest pain and a tumour larger than 5.5 cm. No mortality or postoperative complications were recorded, except for postoperative chylothorax. Tumour recurrence did not develop in any patient during the mean follow-up period of 4.6 years. CONCLUSIONS For selected patients with a mediastinal teratoma, VATS may be considered standard care, as most are benign. In contrast, an open approach may be more appropriate for patients with a large tumour or preoperative symptoms.
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Affiliation(s)
- Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan.
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Tomasi G, Turkheimer F, Aboagye E. Importance of quantification for the analysis of PET data in oncology: review of current methods and trends for the future. Mol Imaging Biol 2012; 14:131-46. [PMID: 21842339 DOI: 10.1007/s11307-011-0514-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In oncology, positron emission tomography (PET) is an important tool for tumour diagnosis and staging, assessment of response to treatment and evaluation of the pharmacokinetic properties and efficacy of new drugs. Despite its quantitative potential, however, in daily clinical practice PET is used almost exclusively with 2-deoxy-2-[(18)F]fluoro-D-glucose ([(18)F]FDG) and, in addition, [(18)F]FDG data are normally assessed visually or using simple indices as the standardised uptake value (SUV). After explaining why more sophisticated quantification methods can be useful in oncology, the paper reviews the approaches that are commonly used and those available but not routinely employed. Particular emphasis is addressed to the SUV, for its importance in clinical practice. Issues specific to PET quantification in oncology and related examples are then discussed. Finally, some ideas for the development of new quantitative methods for analysing PET data in oncology and for the application of approaches already existing but not commonly employed are presented.
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Affiliation(s)
- Giampaolo Tomasi
- Comprehensive Cancer Imaging Center, Imperial College, Hammersmith Hospital London, London W120NN, UK
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Kim JE, Kim EK, Lee DH, Kim SW, Suh C, Lee JS. False-positive hypermetabolic lesions on post-treatment PET-CT after influenza vaccination. Korean J Intern Med 2011; 26:210-2. [PMID: 21716913 PMCID: PMC3110855 DOI: 10.3904/kjim.2011.26.2.210] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 03/17/2008] [Accepted: 04/03/2008] [Indexed: 11/27/2022] Open
Abstract
We report a case of a 59-year-old man with testicular germ cell tumor who showed new hypermetabolic lesions at the left axillary lymph nodes on a post-treatment positron emission tomography-computed tomography (PET-CT) scan. The hypermetabolic lesions were found to be caused by an influenza vaccination 10 days prior to the PET-CT scan and disappeared without additional treatment. To date, he is alive with complete remission.
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Affiliation(s)
- Jeong-Eun Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Kyoung Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Ho Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-We Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Shin Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Sohaib S, Cook G, Koh DM. Imaging Studies for Germ Cell Tumors. Hematol Oncol Clin North Am 2011; 25:487-502, vii. [DOI: 10.1016/j.hoc.2011.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Joly F, Paciencia M, Bor C, Aide N. Postchemotherapy Residual Masses in Nonseminomatous Germ Cell Tumor Patients: 18F-FLT PET Is Unlikely to Identify Mature Teratoma, but Imaging of αvβ3 Integrin Expression Could. J Nucl Med 2011; 52:840. [DOI: 10.2967/jnumed.110.087171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Testicular cancer is a rare tumor, subdivided into seminomatous and nonseminomatous tumors. Whereas there are no serum tumor markers in the first group, they are present in nonseminomatous tumors, and are also important prognostic factors. Overall, the prognosis for testicular cancers is good, which makes the choice of accurate treatment intensity between under- and overtreatment often difficult. Residual masses in advanced clinical stages occur frequently but are nonvital tissue. PET with F-18 FDG has no defined role in imaging of primary tumors where CT is the first-choice imaging modality. For assessing the success of chemotherapy in the presence of residual masses, especially in pure seminoma, F-18 FDG PET is an important tool. In nonseminomatous tumors, it is hampered by the false-negative results in mature teratoma, for which reason false-negative results are a common problem. F-18 FDG PET performs best in predicting relapse in seminoma residuals larger than 3 cm. So far, no alternative to F-18 FDG for PET imaging of testicular cancer has been found. PET-CT has not yet been proven to be superior to PET alone in testicular cancer.
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Portwine C, Marriott C, Barr RD. PET imaging for pediatric oncology: an assessment of the evidence. Pediatr Blood Cancer 2010; 55:1048-61. [PMID: 20979168 DOI: 10.1002/pbc.22747] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Positron emission tomography (PET) has shown potential benefits when used in therapeutic clinical trials for children with cancer. However, existing trials are limited in scope with small numbers of patients and varied observations, making accurate conclusions about the usefulness of PET scanning impossible. This review examines PET and its applications in pediatric oncology. While evidence is limited, there appears to be a basis for rigorous evaluation of this imaging modality before widespread application without validation from clinical trials.
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Affiliation(s)
- Carol Portwine
- Division of Pediatric Hematology/Oncology, McMaster University, Hamilton, Ontario, Canada.
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Sterbis JR, Rice KR, Javitt MC, Schenkman NS, Brassell SA. Fusion imaging: a novel staging modality in testis cancer. J Cancer 2010; 1:223-9. [PMID: 21103077 PMCID: PMC2990077 DOI: 10.7150/jca.1.223] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 11/03/2010] [Indexed: 11/30/2022] Open
Abstract
Objective: Computed tomography and chest radiographs provide the standard imaging for staging, treatment, and surveillance of testicular germ cell neoplasms. Positron emission tomography has recently been utilized for staging, but is somewhat limited in its ability to provide anatomic localization. Fusion imaging combines the metabolic information provided by positron emission tomography with the anatomic precision of computed tomography. To the best of our knowledge, this represents the first study of the effectiveness using fusion imaging in evaluation of patients with testis cancer. Methods: A prospective study of 49 patients presenting to Walter Reed Army Medical Center with testicular cancer from 2003 to 2009 was performed. Fusion imaging was compared with conventional imaging, tumor markers, pathologic results, and clinical follow-up. Results: There were 14 true positives, 33 true negatives, 1 false positive, and 1 false negative. Sensitivity, specificity, positive predictive value, and negative predictive value were 93.3, 97.0, 93.3, and 97.0% respectively. In 11 patient scenarios, fusion imaging differed from conventional imaging. Utility was found in superior lesion detection compared to helical computed tomography due to anatomical/functional image co-registration, detection of micrometastasis in lymph nodes (pathologic nodes < 1cm), surveillance for recurrence post-chemotherapy, differentiating fibrosis from active disease in nodes < 2.5cm, and acting as a quality assurance measure to computed tomography alone. Conclusions: In addition to demonstrating a sensitivity and specificity comparable or superior to conventional imaging, fusion imaging shows promise in providing additive data that may assist in clinical decision-making.
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Affiliation(s)
- Joseph R Sterbis
- 1. Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC, USA
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Aide N, Briand M, Bohn P, Dutoit S, Lasnon C, Chasle J, Rouvet J, Modzelewski R, Vela A, Deslandes E, Vera P, Poulain L, Carreiras F. αvβ3 imaging can accurately distinguish between mature teratoma and necrosis in 18F-FDG-negative residual masses after treatment of non-seminomatous testicular cancer: a preclinical study. Eur J Nucl Med Mol Imaging 2010; 38:323-33. [PMID: 20882281 DOI: 10.1007/s00259-010-1624-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 09/09/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE We assessed whether imaging α(v)β(3) integrin could distinguish mature teratoma from necrosis in human non-seminomatous germ cell tumour (NSGCT) post-chemotherapy residual masses. METHODS Human embryonal carcinoma xenografts (six/rat) were untreated (controls) or treated to form mature teratomas with low-dose cisplatin and all-trans retinoic acid (ATRA) over a period of 8 weeks. In another group, necrosis was induced in xenografts with high-dose cisplatin plus etoposide (two cycles). (18)F-Fluorodeoxyglucose ((18)F-FDG) small animal positron emission tomography (SA PET) imaging was performed in three rats (one control and two treated for 4 and 8 weeks with cisplatin+ATRA). Imaging of α(v)β(3) expression was performed in six rats bearing mature teratomas and two rats with necrotic lesions on a microSPECT/CT device after injection of the tracer [(99m)Tc]HYNIC-RGD [6-hydrazinonicotinic acid conjugated to cyclo(Arg-Gly-Asp-D-Phe-Lys)]. Correlative immunohistochemistry studies of human and mouse α(v)β(3) expression were performed. RESULTS Cisplatin+ATRA induced differentiation of the xenografts. After 8 weeks, some glandular structures and mesenchymal cells were visible; in contrast, control tumours showed undifferentiated tissues. SA PET imaging showed that mature teratoma had very low avidity for (18)F-FDG [mean standardised uptake value (SUV(mean)) = 0.48 ± 0.05] compared to untreated embryonal carcinoma (SUV(mean) = 0.92 ± 0.13) (p = 0.005). α(v)β(3) imaging accurately distinguished mature teratoma (tumour to muscle ratio = 4.29 ± 1.57) from necrosis (tumour to muscle ratio = 1.3 ± 0.26) (p = 0.0002). Immunohistochemistry studies showed that α(v)β(3) integrin expression was strong in the glandular structures of mature teratoma lesions and negative in host stroma. CONCLUSION Imaging α(v)β(3) integrin accurately distinguished mature teratoma from necrosis following cisplatin-based treatment in human NSGCT xenografts.
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Affiliation(s)
- Nicolas Aide
- EA1772, IFR 146 ICORE, GRECAN, François Baclesse Cancer Centre and Caen University, Caen, France.
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FDG-PET probe-guided surgery for recurrent retroperitoneal testicular tumor recurrences. Eur J Surg Oncol 2010; 36:1092-5. [PMID: 20828977 DOI: 10.1016/j.ejso.2010.08.129] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 08/02/2010] [Accepted: 08/16/2010] [Indexed: 11/22/2022] Open
Abstract
AIM Tumor marker based recurrences of previously treated testicular cancer are generally detected with CT scan. They sometimes cannot be visualized with conventional morphologic imaging. FDG-PET has the ability to detect these recurrences. PET probe-guided surgery, may facilitate the extent of surgery and optimize the surgical resection. METHODS Three patients with resectable 2nd or 3rd recurrent testicular cancer based on elevated tumor markers after previous various chemotherapy schedules and resections of residual retroperitoneal tumor masses were included in this study. A diagnostic FDG-PET was performed and a hotspot in previously operated area of the retroperitoneal space in all three patients was visualized. PET probe-guided surgery was performed using a high-energy gamma probe 3 h post-injection of 500 MBq FDG. RESULTS All patients showed extended adhesions and scar tissue in the retroperitoneal area due to the previous surgeries. Pre-operative PET/CT scan showed a good correlation with intra-operative PET probe-guided detection of recurrent lesions. There was a high target to background ratio (TGB) of 5:1 during the procedure. In one patient, a 2 cm large lesion, which did not show on pre-operative FDG-PET scan, was detected with the PET probe. Histopathologic tissue evaluation demonstrated recurrent vital tumor in all PET probe positive lesions. CONCLUSIONS PET probe-guided surgery seems to be a promising tool to localize FDG-PET positive lesion in recurrent testicular cancer in hardly accessible surgical locations. PET probe-guided surgery might be a useful technique in surgical oncology for recurrent testicular cancer and has the potential to be applied in surgery of other malignant diseases.
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Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors. J Nucl Med 2009; 50 Suppl 1:122S-50S. [PMID: 19403881 DOI: 10.2967/jnumed.108.057307] [Citation(s) in RCA: 2658] [Impact Index Per Article: 177.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED The purpose of this article is to review the status and limitations of anatomic tumor response metrics including the World Health Organization (WHO) criteria, the Response Evaluation Criteria in Solid Tumors (RECIST), and RECIST 1.1. This article also reviews qualitative and quantitative approaches to metabolic tumor response assessment with (18)F-FDG PET and proposes a draft framework for PET Response Criteria in Solid Tumors (PERCIST), version 1.0. METHODS PubMed searches, including searches for the terms RECIST, positron, WHO, FDG, cancer (including specific types), treatment response, region of interest, and derivative references, were performed. Abstracts and articles judged most relevant to the goals of this report were reviewed with emphasis on limitations and strengths of the anatomic and PET approaches to treatment response assessment. On the basis of these data and the authors' experience, draft criteria were formulated for PET tumor response to treatment. RESULTS Approximately 3,000 potentially relevant references were screened. Anatomic imaging alone using standard WHO, RECIST, and RECIST 1.1 criteria is widely applied but still has limitations in response assessments. For example, despite effective treatment, changes in tumor size can be minimal in tumors such as lymphomas, sarcoma, hepatomas, mesothelioma, and gastrointestinal stromal tumor. CT tumor density, contrast enhancement, or MRI characteristics appear more informative than size but are not yet routinely applied. RECIST criteria may show progression of tumor more slowly than WHO criteria. RECIST 1.1 criteria (assessing a maximum of 5 tumor foci, vs. 10 in RECIST) result in a higher complete response rate than the original RECIST criteria, at least in lymph nodes. Variability appears greater in assessing progression than in assessing response. Qualitative and quantitative approaches to (18)F-FDG PET response assessment have been applied and require a consistent PET methodology to allow quantitative assessments. Statistically significant changes in tumor standardized uptake value (SUV) occur in careful test-retest studies of high-SUV tumors, with a change of 20% in SUV of a region 1 cm or larger in diameter; however, medically relevant beneficial changes are often associated with a 30% or greater decline. The more extensive the therapy, the greater the decline in SUV with most effective treatments. Important components of the proposed PERCIST criteria include assessing normal reference tissue values in a 3-cm-diameter region of interest in the liver, using a consistent PET protocol, using a fixed small region of interest about 1 cm(3) in volume (1.2-cm diameter) in the most active region of metabolically active tumors to minimize statistical variability, assessing tumor size, treating SUV lean measurements in the 1 (up to 5 optional) most metabolically active tumor focus as a continuous variable, requiring a 30% decline in SUV for "response," and deferring to RECIST 1.1 in cases that do not have (18)F-FDG avidity or are technically unsuitable. Criteria to define progression of tumor-absent new lesions are uncertain but are proposed. CONCLUSION Anatomic imaging alone using standard WHO, RECIST, and RECIST 1.1 criteria have limitations, particularly in assessing the activity of newer cancer therapies that stabilize disease, whereas (18)F-FDG PET appears particularly valuable in such cases. The proposed PERCIST 1.0 criteria should serve as a starting point for use in clinical trials and in structured quantitative clinical reporting. Undoubtedly, subsequent revisions and enhancements will be required as validation studies are undertaken in varying diseases and treatments.
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Affiliation(s)
- Richard L Wahl
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-0817, USA.
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Cao F, Li Z, Lee A, Liu Z, Chen K, Wang H, Cai W, Chen X, Wu JC. Noninvasive de novo imaging of human embryonic stem cell-derived teratoma formation. Cancer Res 2009; 69:2709-13. [PMID: 19318556 DOI: 10.1158/0008-5472.can-08-4122] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Teratoma formation can be a serious drawback after the therapeutic transplantation of human embryonic stem (hES) cells. Therefore, noninvasive imaging of teratomas could be a valuable tool for monitoring patients undergoing hES cell treatment. Here, we investigated the angiogenic process within teratomas derived from hES cells and now report the first example of using (64)Cu-labeled RGD tetramer ((64)Cu-DOTA-RGD4) for positron emission tomography imaging of teratoma formation by targeting alpha(v)beta(3) integrin. H9 hES cells (2 x 10(6)), stably expressing firefly luciferase, and enhanced green fluorescence protein (Fluc-eGFP) were injected into adult nude mice (n=12) s.c. Eight weeks after transplantation, these hES cell grafts evolved into teratomas as confirmed by longitudinal bioluminescence imaging. Under micropositron emission tomography imaging, 2-deoxy-2-[(18)F]fluoro-D-glucose and 3'-deoxy-3'-[(18)F]-fluorothymidine both failed to detect hES cell-derived teratomas (0.8+/-0.5 versus 1.1+/-0.4 %ID/g, respectively; P=not significant versus background signals). By contrast, (64)Cu-DOTA-RGD4 revealed specific and prominent uptake in vascularized teratoma and significantly lower uptake in control tumors (human ovarian carcinoma 2008 cell line), which had low integrin expression (10.1+/-3.4 versus 1.4+/-1.2 %ID/g; P<0.01). Immunofluorescence staining of CD31 and beta(3) integrin also supported our in vivo imaging results (P<0.05). Moreover, we found that the cells dissociated from teratomas showed higher alpha(v)beta(3) integrin expression than the 2008 cells. In conclusion, by targeting alpha(v)beta(3) integrin, we successfully showed the ability of (64)Cu-DOTA-RGD4 to noninvasively visualize teratoma formation in vivo for the first time.
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Affiliation(s)
- Feng Cao
- Cardiology Department of Xijing Hospital, Xi'an, China
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Oechsle K, Hartmann M, Brenner W, Venz S, Weissbach L, Franzius C, Kliesch S, Mueller S, Krege S, Heicappell R, Bares R, Bokemeyer C, de Wit M. [18F]Fluorodeoxyglucose Positron Emission Tomography in Nonseminomatous Germ Cell Tumors After Chemotherapy: The German Multicenter Positron Emission Tomography Study Group. J Clin Oncol 2008; 26:5930-5. [DOI: 10.1200/jco.2008.17.1157] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose In patients with metastatic nonseminomatous germ cell cancer (NSGCT), residual masses after chemotherapy (CTX) can consist of vital carcinoma, mature teratoma, or necrosis. This prospective trial has evaluated the accuracy of [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) for the prediction of histology compared with computed tomography (CT) and serum tumor markers (STM). Patients and Methods A total of 121 patients with stage IIC or III NSGCT scheduled for secondary resection after cisplatin-based CTX were included. FDG-PET was performed after completion of CTX. All results were confirmed by histopathology and correlated to STM and CT. Results Prediction of tumor viability with FDG-PET was correct in 56%, which did not reach the expected clinically relevant level of 70%, and was not better than the accuracy of CT (55%) or STM (56%). Sensitivity and specificity of FDG-PET were 70% and 48%. The positive predictive values were not significantly different (55%, 61%, and 59% for CT, STM, and PET, respectively). Judging only vital carcinoma as a true malignant finding, the negative predictive value increased to 83% for FDG-PET. Conclusion The presence of vital carcinoma and mature teratoma is common (55%) in residual masses in patients with NSGCT, and CT and STM cannot reliably predict absence of disease. In contrast to prior studies, this prospective trial, which is the only with histologic confirmation in all patients, demonstrated that FDG-PET is unable to give a clear additional clinical benefit to the standard diagnostic procedures, CT and STM, in the prediction of tumor viability in residual masses.
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Affiliation(s)
- Karin Oechsle
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Michael Hartmann
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Winfried Brenner
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Stephan Venz
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Lothar Weissbach
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Christiane Franzius
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Sabine Kliesch
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Stephan Mueller
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Susanne Krege
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Ruediger Heicappell
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Roland Bares
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Carsten Bokemeyer
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Maike de Wit
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
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Sakurai H, Miyashita Y, Oyama T. Adenocarcinoma arising in anterior mediastinal mature cystic teratoma: report of a case. Surg Today 2008; 38:348-51. [PMID: 18368326 DOI: 10.1007/s00595-007-3633-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Accepted: 08/01/2007] [Indexed: 11/25/2022]
Abstract
Mediastinal mature teratoma with malignant components is a very rare condition. A 57-year-old man presented with a large (14 x 10 cm) encapsulated and lobulated cystic mass involving the anterior mediastinum. The most consistent diagnosis on the basis of radiological findings was mature cystic teratoma, and a surgical resection was thus indicated. The operation was performed through a median sternotomy, and the tumor was extirpated with a combined resection of the pericardium and left mediastinal pleura. Although the pathological diagnosis was mature cystic teratoma, this patient showed a recurrence of malignant effusion 7 months following the operation. The earlier resected specimen was pathologically re-reviewed according to the blocked entire mass, and small foci of adenocarcinoma were thus found within the tumor.
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Affiliation(s)
- Hiroyuki Sakurai
- Department of Thoracic Surgery, Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo 108-0073, Japan
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49
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Yen TC, Chuang CK, Lai CH. Lower Genitourinary Tract. Clin Nucl Med 2008. [DOI: 10.1007/978-3-540-28026-2_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Wilms tumour: prognostic factors, staging, therapy and late effects. Pediatr Radiol 2008; 38:2-17. [PMID: 18026723 DOI: 10.1007/s00247-007-0687-7] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 10/15/2007] [Accepted: 10/24/2007] [Indexed: 10/22/2022]
Abstract
Wilms tumour is the most common malignant renal tumour in children. Dramatic improvements in survival have occurred as the result of advances in anaesthetic and surgical management, irradiation and chemotherapy. Current therapies are based on trials and studies primarily conducted by large multi-institutional cooperatives including the Société Internationale d'Oncologie Pédiatrique (SIOP) and the Children's Oncology Group (COG). The primary goals are to treat patients according to well-defined risk groups in order to achieve the highest cure rates, to decrease the frequency and intensity of acute and late toxicity and to minimize the cost of therapy. The SIOP trials and studies largely focus on the issue of preoperative therapy, whereas the COG trials and studies start with primary surgery. This paper reviews prognostic factors and staging systems for Wilms tumour and its current treatment with surgery and chemotherapy. Surgery remains a crucial part of treatment for nephroblastoma, providing local primary tumour control and adequate staging and possibly controlling the metastatic spread and central vascular extension of the disease. Partial nephrectomy, when technically feasible, seems reasonable not only in those with bilateral disease but also in those with unilateral disease where the patient has urological disorders or syndromes predisposing to malignancy. Partial nephrectomy, however, is frequently not sufficient for an anaplastic variant of tumour. The late effects for Wilms tumour and its treatment are also reviewed. The treatment of Wilms tumour has been a success story, and currently in excess of 80% of children diagnosed with Wilms tumour can look forward to long-term survival, with less than 20% experiencing serious morbidity at 20 years from diagnosis. The late complications are a consequence of the type and intensity of treatment required, which in turn reflects the nature and extent of the original tumour. Continual international trial development and participation will improve matching of treatment needs with prognosis, reducing long-term complications in the majority. The advent of molecular markers of disease severity and improved functional imaging might help.
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