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Ortega C, Eshet Y, Prica A, Anconina R, Johnson S, Constantini D, Keshavarzi S, Kulanthaivelu R, Metser U, Veit-Haibach P. Combination of FDG PET/CT Radiomics and Clinical Parameters for Outcome Prediction in Patients with Hodgkin’s Lymphoma. Cancers (Basel) 2023; 15:cancers15072056. [PMID: 37046717 PMCID: PMC10093084 DOI: 10.3390/cancers15072056] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Purpose: The aim of the study is to evaluate the prognostic value of a joint evaluation of PET and CT radiomics combined with standard clinical parameters in patients with HL. Methods: Overall, 88 patients (42 female and 46 male) with a median age of 43.3 (range 21–85 years) were included. Textural analysis of the PET/CT images was performed using freely available software (LIFE X). 65 radiomic features (RF) were evaluated. Univariate and multivariate models were used to determine the value of clinical characteristics and FDG PET/CT radiomics in outcome prediction. In addition, a binary logistic regression model was used to determine potential predictors for radiotherapy treatment and odds ratios (OR), with 95% confidence intervals (CI) reported. Features relevant to survival outcomes were assessed using Cox proportional hazards to calculate hazard ratios with 95% CI. Results: albumin (p = 0.034) + ALP (p = 0.028) + CT radiomic feature GLRLM GLNU mean (p = 0.012) (Area under the curve (AUC): 95% CI (86.9; 100.0)—Brier score: 3.9, 95% CI (0.1; 7.8) remained significant independent predictors for PFS outcome. PET-SHAPE Sphericity (p = 0.033); CT grey-level zone length matrix with high gray-level zone emphasis (GLZLM SZHGE mean (p = 0.028)); PARAMS XSpatial Resampling (p = 0.0091) as well as hemoglobin results (p = 0.016) remained as independent factors in the final model for a binary outcome as predictors of the need for radiotherapy (AUC = 0.79). Conclusion: We evaluated the value of baseline clinical parameters as well as combined PET and CT radiomics in HL patients for survival and the prediction of the need for radiotherapy treatment. We found that different combinations of all three factors/features were independently predictive of the here evaluated endpoints.
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Yusufaly TI, Zou J, Nelson TJ, Williamson CW, Simon A, Singhal M, Liu H, Wong H, Saenz CC, Mayadev J, McHale MT, Yashar CM, Eskander R, Sharabi A, Hoh CK, Obrzut S, Mell LK. Improved Prognosis of Treatment Failure in Cervical Cancer with Nontumor PET/CT Radiomics. J Nucl Med 2022; 63:1087-1093. [PMID: 34711618 PMCID: PMC9258568 DOI: 10.2967/jnumed.121.262618] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/20/2021] [Indexed: 01/03/2023] Open
Abstract
Radiomics has been applied to predict recurrence in several disease sites, but current approaches are typically restricted to analyzing tumor features, neglecting nontumor information in the rest of the body. The purpose of this work was to develop and validate a model incorporating nontumor radiomics, including whole-body features, to predict treatment outcomes in patients with previously untreated locoregionally advanced cervical cancer. Methods: We analyzed 127 cervical cancer patients treated definitively with chemoradiotherapy and intracavitary brachytherapy. All patients underwent pretreatment whole-body 18F-FDG PET/CT. To quantify effects due to the tumor itself, the gross tumor volume (GTV) was directly contoured on the PET/CT image. Meanwhile, to quantify effects arising from the rest of the body, the planning target volume (PTV) was deformably registered from each planning CT to the PET/CT scan, and a semiautomated approach combining seed-growing and manual contour review generated whole-body muscle, bone, and fat segmentations on each PET/CT image. A total of 965 radiomic features were extracted for GTV, PTV, muscle, bone, and fat. Ninety-five patients were used to train a Cox model of disease recurrence including both radiomic and clinical features (age, stage, tumor grade, histology, and baseline complete blood cell counts), using bagging and split-sample-validation for feature reduction and model selection. To further avoid overfitting, the resulting models were tested for generalization on the remaining 32 patients, by calculating a risk score based on Cox regression and evaluating the c-index (c-index > 0.5 indicates predictive power). Results: Optimal performance was seen in a Cox model including 1 clinical biomarker (whether or not a tumor was stage III-IVA), 2 GTV radiomic biomarkers (PET gray-level size-zone matrix small area low gray level emphasis and zone entropy), 1 PTV radiomic biomarker (major axis length), and 1 whole-body radiomic biomarker (CT bone root mean square). In particular, stratification into high- and low-risk groups, based on the linear risk score from this Cox model, resulted in a hazard ratio of 0.019 (95% CI, 0.004, 0.082), an improvement over stratification based on clinical stage alone, which had a hazard ratio of 0.36 (95% CI, 0.16, 0.83). Conclusion: Incorporating nontumor radiomic biomarkers can improve the performance of prognostic models compared with using only clinical and tumor radiomic biomarkers. Future work should look to further test these models in larger, multiinstitutional cohorts.
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Affiliation(s)
- Tahir I. Yusufaly
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Jingjing Zou
- Department of Family Medicine and Public Health and Department of Mathematics, University of California San Diego, La Jolla, California
| | - Tyler J. Nelson
- Center for Precision Radiation Medicine, La Jolla, California
| | - Casey W. Williamson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Aaron Simon
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | | | - Hannah Liu
- Center for Precision Radiation Medicine, La Jolla, California
| | - Hank Wong
- Center for Precision Radiation Medicine, La Jolla, California
| | - Cheryl C. Saenz
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of California San Diego, La Jolla, California; and
| | - Jyoti Mayadev
- Center for Precision Radiation Medicine, La Jolla, California;,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Michael T. McHale
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of California San Diego, La Jolla, California; and
| | - Catheryn M. Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Ramez Eskander
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of California San Diego, La Jolla, California; and
| | - Andrew Sharabi
- Center for Precision Radiation Medicine, La Jolla, California;,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Carl K. Hoh
- Department of Radiology, Division of Nuclear Medicine, University of California San Diego, La Jolla, California
| | - Sebastian Obrzut
- Department of Radiology, Division of Nuclear Medicine, University of California San Diego, La Jolla, California
| | - Loren K. Mell
- Center for Precision Radiation Medicine, La Jolla, California;,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
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Kume A, Toriihara A, Shimizu R, Harata N, Isogai J, Tanaka H. The standardized uptake value calculated from 111In-ibritumomab tiuxetan single-photon emission computed tomography/computed tomography is a useful predictor of the clinical response in patients treated by 90Y- ibritumomab tiuxetan therapy. J Clin Exp Hematop 2021; 61:29-34. [PMID: 33551439 PMCID: PMC8053570 DOI: 10.3960/jslrt.20055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
90Y-Ibritumomab tiuxetan (IT) therapy is a radioimmunotherapy for indolent
B-cell lymphoma. Several predictors of insufficient therapeutic effects have been
reported. We performed a retrospective study at a single institute to investigate whether
111In SPECT/CT can predict the therapeutic effects and grade of cytopenia due
to 90Y-IT therapy. We enrolled 16 consecutive patients who underwent
90Y-IT therapy, including 15 who underwent 111In-IT SPECT/CT.
After 90Y-IT therapy, there were 4 patients in complete remission in whom the
lesion SUVmax on 111In-IT SPECT/CT and soluble IL-2
receptor were significantly lower than those of the other patients (P<0.05 and
P<0.05, respectively). Based on the log-rank test of factors associated with the
progression-free survival (PFS), ≥2 previous treatment regimens was significantly
associated with a poor prognosis (P<0.05). The SUV on 111In-IT SPECT/CT may
be a good predictor of the clinical response to 90Y-IT therapy.
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Affiliation(s)
- Ayaka Kume
- Department of Hematology, Asahi General Hospital, Chiba, Japan
| | | | - Ryo Shimizu
- Department of Hematology, Asahi General Hospital, Chiba, Japan
| | - Naoki Harata
- Department of Radiology, Asahi General Hospital, Chiba, Japan
| | - Jun Isogai
- Department of Radiology, Asahi General Hospital, Chiba, Japan
| | - Hiroaki Tanaka
- Department of Hematology, Asahi General Hospital, Chiba, Japan
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4
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Ceriani L, Milan L, Virili C, Cascione L, Paone G, Trimboli P, Giovanella L. Radiomics Analysis of [ 18F]-Fluorodeoxyglucose-Avid Thyroid Incidentalomas Improves Risk Stratification and Selection for Clinical Assessment. Thyroid 2021; 31:88-95. [PMID: 32517585 DOI: 10.1089/thy.2020.0224] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: [18F]-Fluorodeoxyglucose (FDG)-avid thyroid lesions incidentally detected on positron emission tomography/computed tomography (PET/CT) scans represent a tumor lesion in about 30% of cases. The present study evaluated the ability of PET metrics and radiomics features to predict final diagnosis of [18F]FDG thyroid incidentalomas (TIs). Methods: A total of 104 patients with 107 TIs were retrospectively studied; 30 nodules (28%) were diagnosed as malignant. After volumetric segmentation of each thyroid lesion, metabolic tumor volume (MTV), total lesion glycolysis (TLG), standardized uptake values (SUVs), and metabolic heterogeneity were estimated, and 107 radiomics features were extracted following a standard protocol. Results: MTV, TLG, SUVmax, SUVmean, and SUVpeak among functional PET parameters, and gray-level co-occurrence matrix (GLCM)_InverseDifferenceMoment, shape_Sphericity, GLCM_SumSquares, firstorder_Maximum2DDiameterSlice, firstorder_Energy, and GLCM_Contrast among nonredundant radiomics features, showed significantly different values between malignant and benign TIs (Mann-Whitney U-test, p < 0.01 for all). Univariate logistic regression revealed that these parameters demonstrated good ability to predict final diagnosis of TIs (p < 0.02 for all). Shape_Sphericity was the best predictor classifying 82% of TIs correctly (p < 0.0001). Only TLG, SUVmax, and shape_Sphericity retained significance (p < 0.0001) by multivariate analysis. Malignant lesion prevalence increased from 7% to 100% in accordance with the number (score, 0-3) of the three positive parameters present (χ2 trend, p < 0.0001). A score of 0 excludes malignant TIs with a negative predictive value of 93%, while a score of 3 predicted malignancy with a positive predictive value of 100%. Conclusions: PET metrics and radiomics analysis can improve identification of [18F]FDG-avid TIs at high risk of malignancy. A model based on TLG, SUVmax, and shape_Sphericity may allow prediction of a final diagnosis, providing useful information for the management of TIs.
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Affiliation(s)
- Luca Ceriani
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Lugano, Switzerland
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera italiana, Bellinzona, Switzerland
| | - Lisa Milan
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Lugano, Switzerland
| | - Camilla Virili
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Luciano Cascione
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera italiana, Bellinzona, Switzerland
- SIB Swiss Institute of Bioinformatics, Quartier Sorge-Batiment Amphipole, Lausanne, Switzerland
| | - Gaetano Paone
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Lugano, Switzerland
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Lugano, Switzerland
- Competence Centre for Thyroid Diseases, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Lugano, Switzerland
- Competence Centre for Thyroid Diseases, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
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Hanaoka K, Miyaji N, Yoneyama H, Ogawa M, Maeda T, Sakaguchi K, Iimori T, Tsushima H. [Radiological Technology for Targeted Radionuclide Therapy]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2020; 76:1237-1247. [PMID: 33342942 DOI: 10.6009/jjrt.2020_jsrt_76.12.1237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Targeted radioisotope therapy (TRT) is a radiotherapy using radioisotope or drug incorporating it and has been used as a treatment for selectively irradiating cancer cells. In recent years, interest in TRT has increased due to improvements in radionuclide production technology, development of new drugs and imaging modalities, and improvements in radiation technology. In order to enhance the effect of TRT, measurement of individual radiation doses to tumor tissue and organs at risk is important using highly quantitative nuclear medicine images. In this paper, we present a review of literature on optimization of TRT, which is a new research area from the perspective of radiation technology.
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Affiliation(s)
- Kohei Hanaoka
- Institute of Advanced Clinical Medicine, Kindai University
| | - Noriaki Miyaji
- Department of Nuclear Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research
| | - Hiroto Yoneyama
- Department of Radiological Technology, Kanazawa University Hospital
| | | | - Takamasa Maeda
- Radiological Technology Section, QST Hospital, National Institutes for Quantum and Radiological Science and Technology
| | | | | | - Hiroyuki Tsushima
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences
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6
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Yoon JK, Park BN, Ryu EK, An YS, Lee SJ. Current Perspectives on 89Zr-PET Imaging. Int J Mol Sci 2020; 21:ijms21124309. [PMID: 32560337 PMCID: PMC7352467 DOI: 10.3390/ijms21124309] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022] Open
Abstract
89Zr is an emerging radionuclide that plays an essential role in immuno-positron emission tomography (PET) imaging. The long half-life of 89Zr (t1/2 = 3.3 days) is favorable for evaluating the in vivo distribution of monoclonal antibodies. Thus, the use of 89Zr is promising for monitoring antibody-based cancer therapies. Immuno-PET combines the sensitivity of PET with the specificity of antibodies. A number of studies have been conducted to investigate the feasibility of 89Zr immuno-PET imaging for predicting the efficacy of radioimmunotherapy and antibody therapies, imaging target expression, detecting target-expressing tumors, and the monitoring of anti-cancer chemotherapies. In this review, we summarize the current status of PET imaging using 89Zr in both preclinical and clinical studies by highlighting the use of immuno-PET for the targets of high clinical relevance. We also present 89Zr-PET applications other than immuno-PET, such as nanoparticle imaging and cell tracking. Finally, we discuss the limitations and the ongoing research being performed to overcome the remaining hurdles.
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Affiliation(s)
- Joon-Kee Yoon
- Department of Nuclear Medicine & Molecular Imaging, Ajou University School of Medicine, Worldcup-ro 164, Suwon 16499, Korea; (B.-N.P.); (Y.-S.A.); (S.-J.L.)
- Correspondence: ; Tel.: +82-31-219-4303
| | - Bok-Nam Park
- Department of Nuclear Medicine & Molecular Imaging, Ajou University School of Medicine, Worldcup-ro 164, Suwon 16499, Korea; (B.-N.P.); (Y.-S.A.); (S.-J.L.)
| | - Eun-Kyoung Ryu
- Division of Magnetic Resonance, Korea Basic Science Institute, 162, Yeongudanji-ro, Cheongju 28119, Korea;
| | - Young-Sil An
- Department of Nuclear Medicine & Molecular Imaging, Ajou University School of Medicine, Worldcup-ro 164, Suwon 16499, Korea; (B.-N.P.); (Y.-S.A.); (S.-J.L.)
| | - Su-Jin Lee
- Department of Nuclear Medicine & Molecular Imaging, Ajou University School of Medicine, Worldcup-ro 164, Suwon 16499, Korea; (B.-N.P.); (Y.-S.A.); (S.-J.L.)
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7
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Yonekura Y, Mattsson S, Flux G, Bolch WE, Dauer LT, Fisher DR, Lassmann M, Palm S, Hosono M, Doruff M, Divgi C, Zanzonico P. ICRP Publication 140: Radiological Protection in Therapy with Radiopharmaceuticals. Ann ICRP 2019; 48:5-95. [PMID: 31565950 DOI: 10.1177/0146645319838665] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiopharmaceuticals are increasingly used for the treatment of various cancers with novel radionuclides, compounds, tracer molecules, and administration techniques. The goal of radiation therapy, including therapy with radiopharmaceuticals, is to optimise the relationship between tumour control probability and potential complications in normal organs and tissues. Essential to this optimisation is the ability to quantify the radiation doses delivered to both tumours and normal tissues. This publication provides an overview of therapeutic procedures and a framework for calculating radiation doses for various treatment approaches. In radiopharmaceutical therapy, the absorbed dose to an organ or tissue is governed by radiopharmaceutical uptake, retention in and clearance from the various organs and tissues of the body, together with radionuclide physical half-life. Biokinetic parameters are determined by direct measurements made using techniques that vary in complexity. For treatment planning, absorbed dose calculations are usually performed prior to therapy using a trace-labelled diagnostic administration, or retrospective dosimetry may be performed on the basis of the activity already administered following each therapeutic administration. Uncertainty analyses provide additional information about sources of bias and random variation and their magnitudes; these analyses show the reliability and quality of absorbed dose calculations. Effective dose can provide an approximate measure of lifetime risk of detriment attributable to the stochastic effects of radiation exposure, principally cancer, but effective dose does not predict future cancer incidence for an individual and does not apply to short-term deterministic effects associated with radiopharmaceutical therapy. Accident prevention in radiation therapy should be an integral part of the design of facilities, equipment, and administration procedures. Minimisation of staff exposures includes consideration of equipment design, proper shielding and handling of sources, and personal protective equipment and tools, as well as education and training to promote awareness and engagement in radiological protection. The decision to hold or release a patient after radiopharmaceutical therapy should account for potential radiation dose to members of the public and carers that may result from residual radioactivity in the patient. In these situations, specific radiological protection guidance should be provided to patients and carers.
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8
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Morbelli S, Capitanio S, Guerra L, Rigacci L. Predictive value of pre-treatment FDG PET in patients with non-Hodgkin lymphoma treated with radioimmunotherapy: a systematic review. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00330-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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9
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Tatsumi M, Isohashi K, Matsunaga K, Watabe T, Kato H, Kanakura Y, Hatazawa J. Volumetric and texture analysis on FDG PET in evaluating and predicting treatment response and recurrence after chemotherapy in follicular lymphoma. Int J Clin Oncol 2019; 24:1292-1300. [DOI: 10.1007/s10147-019-01482-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/31/2019] [Indexed: 01/09/2023]
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10
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Hosono M. Perspectives for Concepts of Individualized Radionuclide Therapy, Molecular Radiotherapy, and Theranostic Approaches. Nucl Med Mol Imaging 2019; 53:167-171. [PMID: 31231436 DOI: 10.1007/s13139-019-00586-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 11/29/2022] Open
Abstract
Radionuclide therapy (RNT) stands on the delivery of radiation to tumors or non-tumor target organs using radiopharmaceuticals that are designed to have specific affinity to targets. RNT is recently called molecular radiotherapy (MRT) by some advocators in order to emphasize its characteristics as radiotherapy and the relevance of dosimetry-guided optimization of treatment. Moreover, RNT requires relevant radiation protection standards because it employs unsealed radionuclides and gives therapeutic radiation doses in humans. On the basis of these radiation protection standards, the development and use of radiopharmaceuticals for combined application through diagnostics and therapeutics lead to theranostic approaches that will enhance the efficacy and safety of treatment by implementing dosimetry-based individualization.
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Affiliation(s)
- Makoto Hosono
- Institute of Advanced Clinical Medicine and Department of Radiology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511 Japan
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11
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Besemer AE, Grudzinski JJ, Weichert JP, Hall LT, Bednarz BP. Pretreatment CLR 124 Positron Emission Tomography Accurately Predicts CLR 131 Three-Dimensional Dosimetry in a Triple-Negative Breast Cancer Patient. Cancer Biother Radiopharm 2018; 34:13-23. [PMID: 30351218 DOI: 10.1089/cbr.2018.2568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION CLR1404 is a theranostic molecular agent that can be radiolabeled with 124I (CLR 124) for positron emission tomography (PET) imaging, or 131I (CLR 131) for single-photon emission computed tomography (SPECT) imaging and targeted radionuclide therapy. This pilot study evaluated a pretreatment dosimetry methodology in a triple-negative breast cancer patient who was uniquely enrolled in both a CLR 124 PET imaging clinical trial and a CLR 131 therapeutic dose escalation clinical trial. MATERIALS AND METHODS Three-dimensional PET/CT images were acquired at 1, 3, 24, 48, and 120 h postinjection of 178 MBq CLR 124. One month later, pretherapy 2D whole-body planar images were acquired at 0.25, 5, 24, 48, and 144 h postinjection of 370 MBq CLR 131. Following the therapeutic administration of 1990 MBq CLR 131, 3D SPECT/CT images were acquired at 74, 147, 334, and 505 h postinjection. The therapeutic CLR 131 voxel-level absorbed dose was estimated from PET (RAPID PET) and SPECT (RAPID SPECT) images using a Geant4-based Monte Carlo dosimetry platform called RAPID (Radiopharmaceutical Assessment Platform for Internal Dosimetry), and region of interest (ROI) mean doses were also estimated using the OLINDA/EXM software based on PET (OLINDA PET), SPECT (OLINDA SPECT), and planar (OLINDA planar) images. RESULTS The RAPID PET and OLINDA PET tracer-predicted ROI mean doses correlated well (m ≥ 0.631, R2 ≥ 0.694, p ≤ 0.01) with both the RAPID SPECT and OLINDA SPECT therapeutic mean doses. The 2D planar images did not have any significant correlations. The ROI mean doses differed by -4% to -43% between RAPID and OLINDA/EXM, and by -19% to 29% between PET and SPECT. The 3D dose distributions and dose volume histograms calculated with RAPID were similar for the PET/CT and SPECT/CT. CONCLUSIONS This pilot study demonstrated that CLR 124 pretreatment PET images can be used to predict CLR 131 3D therapeutic dosimetry better than CLR 131 2D planar images. In addition, unlike OLINDA/EXM, Monte Carlo dosimetry methods were capable of accurately predicting dose heterogeneity, which is important for predicting dose-response relationships and clinical outcomes.
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Affiliation(s)
- Abigail E Besemer
- 1 Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.,2 Department of Human Oncology, University of Wisconsin-Madison, Madison, Wisconsin.,3 Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Joseph J Grudzinski
- 1 Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jamey P Weichert
- 1 Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.,4 Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.,5 Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lance T Hall
- 4 Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.,5 Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Bryan P Bednarz
- 1 Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
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12
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Integrated texture parameter of 18F-FDG PET may be a stratification factor for the survival of nonoperative patients with locally advanced non-small-cell lung cancer. Nucl Med Commun 2018; 39:732-740. [DOI: 10.1097/mnm.0000000000000860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Abstract
Although visual assessment using the Deauville criteria is strongly recommended by guidelines for treatment response monitoring in all FDG-avid lymphoma histologies, the high rate of false-positives and concerns about interobserver variability have motivated the development of quantitative tools to facilitate objective measurement of tumor response in both routine and clinical trial settings. Imaging studies using functional quantitative measures play a significant role in profiling oncologic processes. These quantitative metrics allow for objective end points in multicenter clinical trials. However, the standardization of imaging procedures including image acquisition parameters, reconstruction and analytic measures, and validation of these methods are essential to enable an individualized treatment approach. A robust quality control program associated with the inclusion of proper scanner calibration, cross-calibration with dose calibrators and across other scanners is required for accurate quantitative measurements. In this section, we will review the technical and methodological considerations related to PET-derived quantitative metrics and the relevant published data to emphasize the potential value of these metrics in the prediction of patient prognosis in lymphoma.
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Affiliation(s)
- Lale Kostakoglu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Stéphane Chauvie
- Department of Medical Physics, 'Santa Croce e Carle' Hospital, Cuneo, Italy
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14
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Ceriani L, Milan L, Martelli M, Ferreri AJM, Cascione L, Zinzani PL, Di Rocco A, Conconi A, Stathis A, Cavalli F, Bellei M, Cozens K, Porro E, Giovanella L, Johnson PW, Zucca E. Metabolic heterogeneity on baseline 18FDG-PET/CT scan is a predictor of outcome in primary mediastinal B-cell lymphoma. Blood 2018; 132:179-186. [PMID: 29720487 DOI: 10.1182/blood-2018-01-826958] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/05/2018] [Indexed: 12/19/2022] Open
Abstract
An important unmet need in the management of primary mediastinal B-cell lymphoma (PMBCL) is to identify the patients for whom first-line therapy will fail to intervene before the lymphoma becomes refractory. High heterogeneity of intratumoral 18F-fluorodeoxyglucose (18FDG) uptake distribution on positron emission tomography/computed tomography (PET/CT) scans has been suggested as a possible marker of chemoresistance in solid tumors. In the present study, we investigated the prognostic value of metabolic heterogeneity (MH) in 103 patients with PMBCL prospectively enrolled in the International Extranodal Lymphoma Study Group (IELSG) 26 study, aimed at clarifying the role of PET in this lymphoma subtype. MH was estimated using the area under curve of cumulative standardized uptake value-volume histogram (AUC-CSH) method. Progression-free survival at 5 years was 94% vs 73% in low- and high-MH groups, respectively (P = .0001). In a Cox model of progression-free survival including dichotomized MH, metabolic tumor volume, total lesion glycolysis (TLG), international prognostic index, and tumor bulk (mediastinal mass > 10 cm), as well as age as a continuous variable, only TLG (P < .001) and MH (P < .001) retained statistical significance. Using these 2 features to construct a simple prognostic model resulted in early and accurate (positive predictive value, 89%; negative predictive value, ≥90%) identification of patients at high risk for progression at a point that would allow the use of risk-adapted treatments. This may provide an important opportunity for the design of future trials aimed at helping the minority of patients who harbor chemorefractory PMBCL. The study is registered at ClinicalTrials.gov as NCT00944567.
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Affiliation(s)
- Luca Ceriani
- Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Lisa Milan
- Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Maurizio Martelli
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Andrés J M Ferreri
- Department of Onco-Hematology, Unit of Lymphoid Malignancies, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Pier Luigi Zinzani
- Institute of Hematology "Seràgnoli", University of Bologna, Bologna Italy
| | - Alice Di Rocco
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | | | - Anastasios Stathis
- Division of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | - Monica Bellei
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Elena Porro
- Institute of Oncology Research, Bellinzona, Switzerland
| | - Luca Giovanella
- Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Peter W Johnson
- Cancer Research UK Centre, University of Southampton, Southampton, United Kingdom; and
| | - Emanuele Zucca
- Institute of Oncology Research, Bellinzona, Switzerland
- Division of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Medical Oncology, University of Bern, Bern, Switzerland
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15
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Use of PET and Other Functional Imaging to Guide Target Delineation in Radiation Oncology. Semin Radiat Oncol 2018; 28:171-177. [DOI: 10.1016/j.semradonc.2018.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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16
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Eskian M, Khorasanizadeh M, Zinzani PL, Rezaei N. Radioimmunotherapy as the first line of treatment in non-Hodgkin lymphoma. Immunotherapy 2018; 10:699-711. [DOI: 10.2217/imt-2017-0169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy. The estimated deaths and new cases of NHL in the USA in 2018 have reached 19,910 and 74,680, respectively, with 5-year survival rate of 71%. Therapeutic interventions for NHL consist of chemotherapy, radiation therapy and immunotherapy. Radioimmunotherapy (RIT) is a potential alternative treatment for NHL that is currently used in different lines of treatment. Studies show that nuclear medicine physicians and radiation oncologists are not yet certain about the proper line for administration of RIT. Herein, we have reviewed the efficiency and toxicity of RIT as the first line of treatment, and discussed potential novel indications, and strategies such as modifying induction therapy and using rituximab maintenance to optimize the efficiency of RIT as the first line of treatment. Our review indicates that it is more logical to postpone conventional therapies to the second or third lines of treatment instead of RIT.
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Affiliation(s)
- Mahsa Eskian
- Department of Immunology, Research Center for Immunodeficiencies, Children's Medical Center Hospital, Tehran University of Medical Sciences Dr. Qarib St, Keshavarz Blvd, Tehran 14194, Iran
- Department of Immunology, Cancer Immunology Project (CIP), Universal Scientific Education & Research Network (USERN), Tehran 14194, Iran
| | - MirHojjat Khorasanizadeh
- Department of Immunology, Research Center for Immunodeficiencies, Children's Medical Center Hospital, Tehran University of Medical Sciences Dr. Qarib St, Keshavarz Blvd, Tehran 14194, Iran
- Department of Immunology, Cancer Immunology Project (CIP), Universal Scientific Education & Research Network (USERN), Tehran 14194, Iran
| | - Pier L Zinzani
- Department of Hematology and Oncological Sciences ‘L. e A. Seràgnoli,’ University of Bologna, Bologna 40138, Italy
| | - Nima Rezaei
- Department of Immunology, Research Center for Immunodeficiencies, Children's Medical Center Hospital, Tehran University of Medical Sciences Dr. Qarib St, Keshavarz Blvd, Tehran 14194, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran 14194, Iran
- Network of Immunity in Infection, Malignancy & Autoimmunity (NIIMA), Universal Scientific Education & Research Network (USERN), Boston, MA, USA
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17
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Lee JW, Lee SM. Radiomics in Oncological PET/CT: Clinical Applications. Nucl Med Mol Imaging 2018; 52:170-189. [PMID: 29942396 PMCID: PMC5995782 DOI: 10.1007/s13139-017-0500-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/22/2017] [Accepted: 09/29/2017] [Indexed: 12/11/2022] Open
Abstract
18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is widely used for staging, evaluating treatment response, and predicting prognosis in malignant diseases. FDG uptake and volumetric PET parameters such as metabolic tumor volume have been used and are still used as conventional PET parameters to assess biological characteristics of tumors. However, in recent years, additional features derived from PET images by computational processing have been found to reflect intratumoral heterogeneity, which is related to biological tumor features, and to provide additional predictive and prognostic information, which leads to the concept of radiomics. In this review, we focus on recent clinical studies of malignant diseases that investigated intratumoral heterogeneity on PET/CT, and we discuss its clinical role in various cancers.
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Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100 Gil 25, Seo-gu, Incheon, 22711 South Korea
- Institute for Integrative Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
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18
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Drug Discovery by Molecular Imaging and Monitoring Therapy Response in Lymphoma. Int J Mol Sci 2017; 18:ijms18081639. [PMID: 28749424 PMCID: PMC5578029 DOI: 10.3390/ijms18081639] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/23/2017] [Accepted: 07/23/2017] [Indexed: 12/12/2022] Open
Abstract
Molecular imaging allows a noninvasive assessment of biochemical and biological processes in living subjects. Treatment strategies for malignant lymphoma depend on histology and tumor stage. For the last two decades, molecular imaging has been the mainstay diagnostic test for the staging of malignant lymphoma and the assessment of response to treatment. This technology enhances our understanding of disease and drug activity during preclinical and clinical drug development. Here, we review molecular imaging applications in drug development, with an emphasis on oncology. Monitoring and assessing the efficacy of anti-cancer therapies in preclinical or clinical models are essential and the multimodal molecular imaging approach may represent a new stage for pharmacologic development in cancer. Monitoring the progress of lymphoma therapy with imaging modalities will help patients. Identifying and addressing key challenges is essential for successful integration of molecular imaging into the drug development process. In this review, we highlight the general usefulness of molecular imaging in drug development and radionuclide-based reporter genes. Further, we discuss the different molecular imaging modalities for lymphoma therapy and their preclinical and clinical applications.
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Besemer AE, Titz B, Grudzinski JJ, Weichert JP, Kuo JS, Robins HI, Hall LT, Bednarz BP. Impact of PET and MRI threshold-based tumor volume segmentation on patient-specific targeted radionuclide therapy dosimetry using CLR1404. Phys Med Biol 2017; 62:6008-6025. [PMID: 28682793 DOI: 10.1088/1361-6560/aa716d] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Variations in tumor volume segmentation methods in targeted radionuclide therapy (TRT) may lead to dosimetric uncertainties. This work investigates the impact of PET and MRI threshold-based tumor segmentation on TRT dosimetry in patients with primary and metastatic brain tumors. In this study, PET/CT images of five brain cancer patients were acquired at 6, 24, and 48 h post-injection of 124I-CLR1404. The tumor volume was segmented using two standardized uptake value (SUV) threshold levels, two tumor-to-background ratio (TBR) threshold levels, and a T1 Gadolinium-enhanced MRI threshold. The dice similarity coefficient (DSC), jaccard similarity coefficient (JSC), and overlap volume (OV) metrics were calculated to compare differences in the MRI and PET contours. The therapeutic 131I-CLR1404 voxel-level dose distribution was calculated from the 124I-CLR1404 activity distribution using RAPID, a Geant4 Monte Carlo internal dosimetry platform. The TBR, SUV, and MRI tumor volumes ranged from 2.3-63.9 cc, 0.1-34.7 cc, and 0.4-11.8 cc, respectively. The average ± standard deviation (range) was 0.19 ± 0.13 (0.01-0.51), 0.30 ± 0.17 (0.03-0.67), and 0.75 ± 0.29 (0.05-1.00) for the JSC, DSC, and OV, respectively. The DSC and JSC values were small and the OV values were large for both the MRI-SUV and MRI-TBR combinations because the regions of PET uptake were generally larger than the MRI enhancement. Notable differences in the tumor dose volume histograms were observed for each patient. The mean (standard deviation) 131I-CLR1404 tumor doses ranged from 0.28-1.75 Gy GBq-1 (0.07-0.37 Gy GBq-1). The ratio of maximum-to-minimum mean doses for each patient ranged from 1.4-2.0. The tumor volume and the interpretation of the tumor dose is highly sensitive to the imaging modality, PET enhancement metric, and threshold level used for tumor volume segmentation. The large variations in tumor doses clearly demonstrate the need for standard protocols for multimodality tumor segmentation in TRT dosimetry.
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Affiliation(s)
- Abigail E Besemer
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States of America. Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, United States of America
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20
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Nakahara T, Daisaki H, Yamamoto Y, Iimori T, Miyagawa K, Okamoto T, Owaki Y, Yada N, Sawada K, Tokorodani R, Jinzaki M. Use of a digital phantom developed by QIBA for harmonizing SUVs obtained from the state-of-the-art SPECT/CT systems: a multicenter study. EJNMMI Res 2017. [PMID: 28639254 PMCID: PMC5479776 DOI: 10.1186/s13550-017-0300-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Although quantitative analysis using standardized uptake value (SUV) becomes realistic in clinical single-photon emission computed tomography/computed tomography (SPECT/CT) imaging, reconstruction parameter settings can deliver different quantitative results among different SPECT/CT systems. This study aims to propose a use of the digital reference object (DRO), which is a National Electrical Manufacturers Association (NEMA) phantom-like object developed by the Quantitative Imaging Biomarker Alliance (QIBA) fluorodeoxyglucose-positron emission tomography technical committee, for the purpose of harmonizing SUVs in Tc-99m SPECT/CT imaging. METHODS The NEMA body phantom with determined Tc-99m concentration was scanned with the four state-of-the-art SPECT/CT systems. SPECT data were reconstructed using different numbers of the product of subset and iteration numbers (SI) and the width of 3D Gaussian filter (3DGF). The mean (SUVmean), maximal (SUVmax), and peak (SUVpeak) SUVs for six hot spheres (10, 13, 17, 22, 28, and 37 mm) were measured after converting SPECT count into SUV using Becquerel calibration factor. DRO smoothed by 3DGF with a FWHM of 17 mm (DRO17 mm) was generated, and the corresponding SUVs were measured. The reconstruction condition to yield the lowest root mean square error (RMSE) of SUVmeans for all the spheres between DRO17 mm and actual phantom images was determined as the harmonized condition for each SPECT/CT scanner. Then, inter-scanner variability in all quantitative metrics was measured before (i.e., according to the manufacturers' recommendation or the policies of their own departments) and after harmonization. RESULTS RMSE was lowest in the following reconstruction conditions: SI of 100 and 3DGF of 13 mm for Brightview XCT, SI of 160 and 3DGF of 3 pixels for Discovery NM/CT, SI of 60 and 3DGF of 2 pixels for Infinia, and SI of 140 and 3DGF of 15 mm for Symbia. In pre-harmonized conditions, coefficient of variations (COVs) among the SPECT/CT systems were greater than 10% for all quantitative metrics in three of the spheres, SUVmax and SUVmean, in one of the spheres. In contrast, all metrics except SUVmax in the 17-mm sphere yielded less than 10% of COVs after harmonization. CONCLUSIONS Our proposed method clearly reduced inter-scanner variability in SUVs. A digital phantom developed by QIBA would be useful for harmonizing SUVs in multicenter trials using SPECT/CT.
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Affiliation(s)
- Tadaki Nakahara
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Hiromitsu Daisaki
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, 323-1 Kamioki-machi, Maebashi, Gunma, 371-0052, Japan
| | - Yasushi Yamamoto
- Department of Radiology, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Takashi Iimori
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Kazuyuki Miyagawa
- Department of Radiology, Kochi Medical Hospital, 2125-1 Ike, Kochi-shi, Kochi, 781-8555, Japan
| | - Tomoya Okamoto
- Department of Radiology, Tsugaru General Hospital, 12-3 Iwaki-machi, Goshogawara-shi, Aomori, 037-0074, Japan
| | - Yoshiki Owaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Radiological Sciences, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo, 116-8551, Japan
| | - Nobuhiro Yada
- Department of Radiology, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Koichi Sawada
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Ryotaro Tokorodani
- Department of Radiology, Kochi Medical Hospital, 2125-1 Ike, Kochi-shi, Kochi, 781-8555, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Eskian M, Khorasanizadeh M, Kraeber-Bodere F, Rezaei N. Radioimmunotherapy in non-Hodgkin lymphoma: Prediction and assessment of response. Crit Rev Oncol Hematol 2016; 107:182-189. [DOI: 10.1016/j.critrevonc.2016.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/24/2016] [Accepted: 10/12/2016] [Indexed: 12/20/2022] Open
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22
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Mendler CT, Feuchtinger A, Heid I, Aichler M, D'Alessandria C, Pirsig S, Blechert B, Wester HJ, Braren R, Walch A, Skerra A, Schwaiger M. Tumor Uptake of Anti-CD20 Fabs Depends on Tumor Perfusion. J Nucl Med 2016; 57:1971-1977. [PMID: 27417649 DOI: 10.2967/jnumed.116.176784] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/21/2016] [Indexed: 12/22/2022] Open
Abstract
Antibodies have become an established treatment modality in cancer therapy during the last decade. However, these treatments often suffer from an insufficient and heterogeneous response despite validated antigen or target receptor expression in the tumor. In fact, therapeutic success depends on both the presence of the tumor antigen and its accessibility by the antibody. In search of a suitable preclinical animal model to evaluate the mechanisms of tumor heterogeneity and hemodynamics, we characterized two exemplary non-Hodgkin lymphoma subtypes with comparable CD20 expression and metabolism, SUDHL-4 and Granta-519, using multimodal imaging techniques. METHODS To investigate in vivo biodistribution, two differently modified αCD20 antigen-binding fragments (Fab), prepared by PASylation with a 200-residue polypeptide tag comprising Pro, Ala, and Ser (PAS200) and by fusion with an albumin-binding domain (ABD), were radiolabeled with 125I and intravenously injected into immunocompromised mice bearing corresponding xenografts. RESULTS Validation with 18F-FDG revealed a similar distribution in vital tumor tissue 1 h after injection. However, large differences in tumor uptake were observed when the CD20-specific radiotracers 125I-Fab-ABD and 125I-Fab-PAS200 were applied (respective percentages injected dose per gram at 24 h after injection: 12.3 and 2.4 for Granta-519 vs. 5.8 and 1.2 for SUDHL-4). Three-dimensional light-sheet fluorescence microscopy with Cy5-Fab-PAS200 confirmed better tracer extravasation in the Granta-519 tumors. Moreover, dynamic contrast-enhanced (DCE) MRI revealed significantly reduced perfusion in the SUDHL-4 tumors. CONCLUSION Tracer uptake was highly dependent on local tumor perfusion and Fab permeation in the SUDHL-4 and Granta-519 tumors. Thus, the SUDHL-4 xenograft offers an excellent model for investigating the influence of therapies affecting tumor angiogenesis.
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Affiliation(s)
- Claudia Theresa Mendler
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany .,Munich Center for Integrated Protein Science (CIPS-M) and Lehrstuhl für Biologische Chemie, Technische Universität München, Freising (Weihenstephan), Germany
| | - Annette Feuchtinger
- Research Unit Analytical Pathology, Institute of Pathology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Irina Heid
- Institute of Radiology, Klinikum rechts der Isar, Technische Universität München, München, Germany; and
| | - Michaela Aichler
- Research Unit Analytical Pathology, Institute of Pathology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Calogero D'Alessandria
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Sabine Pirsig
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Birgit Blechert
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Hans-Jürgen Wester
- Pharmaceutical Radiochemistry, Technische Universität München, Garching, Germany
| | - Rickmer Braren
- Institute of Radiology, Klinikum rechts der Isar, Technische Universität München, München, Germany; and
| | - Axel Walch
- Research Unit Analytical Pathology, Institute of Pathology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Arne Skerra
- Munich Center for Integrated Protein Science (CIPS-M) and Lehrstuhl für Biologische Chemie, Technische Universität München, Freising (Weihenstephan), Germany
| | - Markus Schwaiger
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
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