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Zhang Z, Guo S, Cheng C, Cao K, Jiang H, Jin G, Zuo C. Integrated 68 Ga-FAPI-04 PET/MR in Pancreatic Cancer : Prediction of Tumor Response and Tumor Resectability After Neoadjuvant Therapy. Clin Nucl Med 2024; 49:715-721. [PMID: 38914015 DOI: 10.1097/rlu.0000000000005300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
PURPOSE This study aimed to investigate the value of 68 Ga-fibroblast activation protein inhibitor (FAPI) PET/MR semiquantitative parameters in the prediction of tumor response and resectability after neoadjuvant therapy in patients with pancreatic cancer. PATIENTS AND METHODS This study was performed retrospectively in patients with borderline resectable or locally advanced pancreatic cancer who underwent 68 Ga-FAPI PET/MRI from June 2020 to June 2022. The SUV max , SUV mean , SUV peak , uptake tumor volume (UTV), and total lesion FAP expression (TLF) of the primary tumor were recorded. The target-to-background ratios (TBRs) of the primary tumor to normal tissue muscle (TBR muscle ) and blood (TBR blood ) were also calculated. In addition, the minimum apparent diffusion coefficient value of the tumor was measured. After 3-4 cycles of gemcitabine + nab-paclitaxel chemotherapy, patients were divided into responders and nonresponders groups according to RECIST criteria (v.1.1). They were also divided into resectable and unresectable groups according to the surgical outcome. The variables were compared separately between groups. RESULTS A total of 18 patients who met the criteria were included in this study. The UTV and TLF were significantly higher in nonresponders than in responders ( P < 0.05). The SUV max , SUV mean , and TBR muscle were significantly higher in unresectable patients than in resectable ones ( P < 0.05). Receiver operating characteristic curve analysis identified UTV (area under the curve [AUC] = 0.840, P = 0.015) and TLF (AUC = 0.877, P = 0.007) as significant predictors for the response to gemcitabine + nab-paclitaxel chemotherapy, with cutoff values of 25.05 and 167.38, respectively. In addition, SUV max (AUC = 0.838, P = 0.016), SUV mean (AUC = 0.812, P = 0.026), and TBR muscle (AUC = 0.787, P = 0.041) were significant predictors of the resectability post-NCT, with cutoff values of 14.0, 6.0, and 13.9, respectively. According to logistic regression analysis, TLF was found to be significantly associated with tumor response ( P = 0.032) and was an independent predictor of tumor response ( P = 0.032). In addition, apparent diffusion coefficient value was an independent predictor of tumor resectability ( P = 0.043). CONCLUSIONS This pilot study demonstrates the value of 68 Ga-FAPI PET/MR for the prediction of tumor response and resectability after neoadjuvant therapy. It may aid in individualized patient management by guiding the treatment regimens.
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Affiliation(s)
- Zeyu Zhang
- From the Departments of Nuclear Medicine
| | | | - Chao Cheng
- From the Departments of Nuclear Medicine
| | | | - Hui Jiang
- Pathology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Gang Jin
- Hepatobiliary Pancreatic Surgery
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Gordon JW, Chen HY, Nickles T, Lee PM, Bok R, Ohliger MA, Okamoto K, Ko AH, Larson PEZ, Wang ZJ. Hyperpolarized 13C Metabolic MRI of Patients with Pancreatic Ductal Adenocarcinoma. J Magn Reson Imaging 2024; 60:741-749. [PMID: 38041836 PMCID: PMC11144260 DOI: 10.1002/jmri.29162] [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: 08/02/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDA) is the third leading cause of cancer-related death in the United States. However, early response assessment using the current approach of measuring changes in tumor size on computed tomography (CT) or MRI is challenging. PURPOSE To investigate the feasibility of hyperpolarized (HP) [1-13C]pyruvate MRI to quantify metabolism in the normal appearing pancreas and PDA, and to assess changes in PDA metabolism following systemic chemotherapy. STUDY TYPE Prospective. SUBJECTS Six patients (65.0 ± 7.6 years, 2 females) with locally advanced or metastatic PDA enrolled prior to starting a new line of systemic chemotherapy. FIELD STRENGTH/SEQUENCE 3-T, T1-weighted gradient echo, metabolite-selective 13C echoplanar imaging. ASSESSMENT Time-resolved HP [1-13C]pyruvate data were acquired before (N = 6) and 4-weeks after (N = 3) treatment initiation. Pyruvate metabolism, as quantified by pharmacokinetic modeling and metabolite area-under-the-curve ratios, was assessed in manually segmented PDA and normal appearing pancreas ROIs (N = 5). The change in tumor metabolism before and 4-weeks after treatment initiation was assessed in primary PDA (N = 2) and liver metastases (N = 1), and was compared to objective tumor response defined by response evaluation criteria in solid tumors (RECIST) on subsequent CTs. STATISTICAL TESTS Descriptive tests (mean ± standard deviation), model fit error for pharmacokinetic rate constants. RESULTS Primary PDA showed reduced alanine-to-lactate ratios when compared to normal pancreas, due to increased lactate-to-pyruvate or reduced alanine-to-pyruvate ratios. Of the three patients who received HP [1-13C]pyruvate MRI before and 4-weeks after treatment initiation, one patient had a primary tumor with early metabolic response (increase in alanine-to-lactate) and subsequent partial response according to RECIST, one patient had a primary tumor with relatively stable metabolism and subsequent stable disease by RECIST, and one patient had metastatic PDA with increase in lactate-to-pyruvate of the liver metastases and corresponding progressive disease according to RECIST. DATA CONCLUSION Altered pyruvate metabolism with increased lactate or reduced alanine was observed in the primary tumor. Early metabolic response assessed at 4-weeks after treatment initiation correlated with subsequent objective tumor response assessed using RECIST. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Jeremy W Gordon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Hsin-Yu Chen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Tanner Nickles
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Philip M Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Robert Bok
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Kimberly Okamoto
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Andrew H Ko
- Department of Medicine, University of California, San Francisco, California, USA
| | - Peder E Z Larson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, California, USA
| | - Zhen J Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, California, USA
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Duncan ZN, Summerlin D, West JT, Packard AT, Morgan DE, Galgano SJ. PET/MRI for evaluation of patients with pancreatic cancer. Abdom Radiol (NY) 2023; 48:3601-3609. [PMID: 37191756 DOI: 10.1007/s00261-023-03943-9] [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: 02/17/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/17/2023]
Abstract
Pancreatic cancers are the third leading cause of cancer-related death in the USA and outcomes remain poor despite improvements in imaging and treatment paradigms. Currently, computed tomography (CT) and magnetic resonance imaging (MRI) are frequently utilized for staging and restaging of these malignancies, but positron emission tomography (PET)/CT can play a role in troubleshooting and improve whole-body staging. PET/MRI is a novel imaging modality that allows for simultaneous acquisition of PET and MRI images, leading to improved image quality and potential increased sensitivity. Early studies suggest that PET/MRI may play a larger role in pancreatic cancer imaging in future. This manuscript will briefly discuss current imaging approaches to pancreatic cancer and outline existing evidence and published data supporting the use of PET/MRI for pancreatic cancers.
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Affiliation(s)
- Zoey N Duncan
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - David Summerlin
- Department of Radiology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Janelle T West
- Department of Radiology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | | | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA.
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Tu W, Gottumukkala RV, Schieda N, Lavallée L, Adam BA, Silverman SG. Perineural Invasion and Spread in Common Abdominopelvic Diseases: Imaging Diagnosis and Clinical Significance. Radiographics 2023; 43:e220148. [PMID: 37319024 DOI: 10.1148/rg.220148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Malignancies and other diseases may spread by multiple pathways, including direct extension, hematogenous spread, or via lymphatic vessels. A less-well-understood route is the peripheral nervous system, which is known as perineural spread (PNS). In addition to accounting for pain and other neurologic symptoms, PNS affects both disease prognosis and management. Although PNS is commonly discussed in relation to head and neck tumors, there is emerging data regarding PNS in abdominopelvic malignancies and other conditions such as endometriosis. Due to improved contrast and spatial resolution, perineural invasion, a finding heretofore diagnosed only at pathologic examination, can be detected at CT, MRI, and PET/CT. PNS most commonly manifests as abnormal soft-tissue attenuation extending along neural structures, and diagnosis of it is aided by optimizing imaging parameters, understanding pertinent anatomy, and becoming familiar with the typical neural pathways of spread that largely depend on the disease type and location. In the abdomen, the celiac plexus is a central structure that innervates the major abdominal organs and is the principal route of PNS in patients with pancreatic and biliary carcinomas. In the pelvis, the lumbosacral plexus and inferior hypogastric plexus are the central structures and principal routes of PNS in patients with pelvic malignancies. Although the imaging findings of PNS may be subtle, a radiologic diagnosis can have a substantial effect on patient care. Knowledge of anatomy and known routes of PNS and optimizing imaging parameters is of utmost importance in providing key information for prognosis and treatment planning. © RSNA, 2023 Supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Wendy Tu
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Ravi V Gottumukkala
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola Schieda
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Luke Lavallée
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin A Adam
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Stuart G Silverman
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
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Li J, Fu C, Zhao S, Pu Y, Yang F, Zeng S, Yang C, Gao H, Chen L. The progress of PET/MRI in clinical management of patients with pancreatic malignant lesions. Front Oncol 2023; 13:920896. [PMID: 37188192 PMCID: PMC10175752 DOI: 10.3389/fonc.2023.920896] [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: 04/15/2022] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Recently, the morbidity and mortality of pancreatic cancer have been increasing year by year. Because of its deep anatomical location and because most presented patients often suffer from abdominal pain or jaundice, it is difficult to diagnose pancreatic cancer at an early stage, leading to late clinical stage and poor prognosis. integrated positron emission tomography/magnetic resonance imaging (PET/MRI) fusion imaging not only has the characteristics of high resolution and multi-parameter imaging of MRI, but also combines the high sensitivity and the semi-quantitative characteristics of PET. In addition, the continuous development of novel MRI imaging and PET imaging biomarkers provide a unique and precise research direction for future pancreatic cancer research. This review summarizes the value of PET/MRI in the diagnosis, staging, efficacy monitoring, and prognosis evaluation of pancreatic cancer, and prognosis for developing emerging imaging agents and artificial intelligence radiomics in pancreatic cancer.
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Affiliation(s)
- Jindan Li
- Department of PET-CT/MR Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Chaojiang Fu
- Department of Emergency, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Kunming, Yunnan, China
| | - Sheng Zhao
- Department of PET-CT/MR Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yongzhu Pu
- Department of PET-CT/MR Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Fake Yang
- Department of PET-CT/MR Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Shuguang Zeng
- Department of Information Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical Cancer Center of Yunnan Province, Kunming, Yunnan, China
| | - Conghui Yang
- Department of PET-CT/MR Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Hongqiang Gao
- Department of Hepatobiliary Surgery, The First People’s Hospital of Kunming City & Ganmei Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Long Chen, ; Hongqiang Gao,
| | - Long Chen
- Department of PET-CT/MR Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- *Correspondence: Long Chen, ; Hongqiang Gao,
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Frank KJ, Mulero-Sánchez A, Berninger A, Ruiz-Cañas L, Bosma A, Görgülü K, Wu N, Diakopoulos KN, Kaya-Aksoy E, Ruess DA, Kabacaoğlu D, Schmidt F, Kohlmann L, van Tellingen O, Thijssen B, van de Ven M, Proost N, Kossatz S, Weber WA, Sainz B, Bernards R, Algül H, Lesina M, Mainardi S. Extensive preclinical validation of combined RMC-4550 and LY3214996 supports clinical investigation for KRAS mutant pancreatic cancer. Cell Rep Med 2022; 3:100815. [PMID: 36384095 PMCID: PMC9729824 DOI: 10.1016/j.xcrm.2022.100815] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/05/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022]
Abstract
Over 90% of pancreatic cancers present mutations in KRAS, one of the most common oncogenic drivers overall. Currently, most KRAS mutant isoforms cannot be targeted directly. Moreover, targeting single RAS downstream effectors induces adaptive resistance mechanisms. We report here on the combined inhibition of SHP2, upstream of KRAS, using the allosteric inhibitor RMC-4550 and of ERK, downstream of KRAS, using LY3214996. This combination shows synergistic anti-cancer activity in vitro, superior disruption of the MAPK pathway, and increased apoptosis induction compared with single-agent treatments. In vivo, we demonstrate good tolerability and efficacy of the combination, with significant tumor regression in multiple pancreatic ductal adenocarcinoma (PDAC) mouse models. Finally, we show evidence that 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) can be used to assess early drug responses in animal models. Based on these results, we will investigate this drug combination in the SHP2 and ERK inhibition in pancreatic cancer (SHERPA; ClinicalTrials.gov: NCT04916236) clinical trial, enrolling patients with KRAS-mutant PDAC.
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Affiliation(s)
- Katrin J Frank
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Antonio Mulero-Sánchez
- Division of Molecular Carcinogenesis, Oncode Institute, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands
| | - Alexandra Berninger
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Laura Ruiz-Cañas
- Department of Biochemistry, Universidad Autónoma de Madrid (UAM) and Instituto de Investigaciones Biomédicas "Alberto Sols" (IIBM), CSIC-UAM, 28029 Madrid, Spain; Chronic Diseases and Cancer, Area 3, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
| | - Astrid Bosma
- Division of Molecular Carcinogenesis, Oncode Institute, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands
| | - Kıvanç Görgülü
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Nan Wu
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Kalliope N Diakopoulos
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Ezgi Kaya-Aksoy
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Dietrich A Ruess
- Department of General and Visceral Surgery, Center of Surgery, Medical Center-University of Freiburg, 79106 Freiburg, Germany
| | - Derya Kabacaoğlu
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Fränze Schmidt
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Larissa Kohlmann
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Olaf van Tellingen
- Division of Pharmacology, The Netherlands Cancer Institute, 1066CX Amsterdam, the Netherlands
| | - Bram Thijssen
- Division of Molecular Carcinogenesis, Oncode Institute, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands
| | - Marieke van de Ven
- Mouse Clinic for Cancer and Aging Research, Preclinical Intervention Unit, The Netherlands Cancer Institute, 1066CX Amsterdam, the Netherlands
| | - Natalie Proost
- Mouse Clinic for Cancer and Aging Research, Preclinical Intervention Unit, The Netherlands Cancer Institute, 1066CX Amsterdam, the Netherlands
| | - Susanne Kossatz
- Department of Nuclear Medicine at Klinikum Rechts der Isar and Central Institute for Translational Cancer Research (TranslaTUM), Technische Universität München, 81675 Munich, Germany; Department of Chemistry, Technische Universität München, 85748 Munich, Germany
| | - Wolfgang A Weber
- Department of Nuclear Medicine at Klinikum Rechts der Isar and Central Institute for Translational Cancer Research (TranslaTUM), Technische Universität München, 81675 Munich, Germany
| | - Bruno Sainz
- Department of Biochemistry, Universidad Autónoma de Madrid (UAM) and Instituto de Investigaciones Biomédicas "Alberto Sols" (IIBM), CSIC-UAM, 28029 Madrid, Spain; Chronic Diseases and Cancer, Area 3, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
| | - Rene Bernards
- Division of Molecular Carcinogenesis, Oncode Institute, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands
| | - Hana Algül
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Marina Lesina
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Sara Mainardi
- Division of Molecular Carcinogenesis, Oncode Institute, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands.
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Kim SS, Lee S, Lee HS, Bang S, Han K, Park MS. Retrospective Evaluation of Treatment Response in Patients with Nonmetastatic Pancreatic Cancer Using CT and CA 19-9. Radiology 2022; 303:548-556. [PMID: 35258374 DOI: 10.1148/radiol.212236] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Imaging studies have limitations in evaluating pancreatic ductal adenocarcinoma (PDAC) treatment response. Purpose To investigate the effectiveness of combined CT and carbohydrate antigen 19-9 (CA 19-9) evaluation at 8 weeks after first-line treatment to predict overall survival (OS) of patients with nonmetastatic PDAC. Materials and Methods Patients with nonmetastatic PDAC who received first-line treatment with either chemotherapy or concurrent chemoradiation in a single-center PDAC cohort registry were retrospectively enrolled in the study between January 2013 and December 2016. Follow-up CT images obtained 8 weeks after treatment were evaluated according to Response Evaluation Criteria in Solid Tumors. Patients with partial response (PR) or stable disease (SD) were defined as CT responders, and those with progressive disease (PD) were defined as CT nonresponders. Patients with a normalized CA 19-9 level at 8-week follow-up were defined as CA 19-9 responders, and those with a nonnormalized or nonelevated CA 19-9 level were defined as CA 19-9 nonresponders. OS was compared using the Kaplan-Meier method with Breslow analysis. Results A total of 197 patients (mean age ± standard deviation, 65 years ± 10; 107 men) were evaluated. Patients with PD (n = 17) showed shorter OS than those with SD (n = 147; P < .001) or PR (n = 33; P = .003). OS did not differ between the patients with PR and those with SD (P = .60). When the CT and CA 19-9 responses were integrated, OS was longest in CT and CA 19-9 responders (group 1, n = 27; median OS, 26.6 months [95% CI: 9.0, 44.1]), followed by CT responders but CA 19-9 nonresponders (group 2, n = 153; median OS, 15.9 months [95% CI: 13.3, 18.5]; P = .007 vs group 1) and CT and CA 19-9 nonresponders (group 3, n = 17; median OS, 6.5 months [95% CI: 0.8, 12.2]; P < .001 vs group 2). Conclusion Integrated evaluation with CT and carbohydrate antigen 19-9 response allowed more accurate stratification of survival in patients with pancreatic ductal adenocarcinoma in the early treatment period than did evaluation according to Response Evaluation Criteria in Solid Tumors. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Seung-Seob Kim
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea (S.S.K., S.L., M.S.P.); Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.S.L., S.B.); and Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.)
| | - Sunyoung Lee
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea (S.S.K., S.L., M.S.P.); Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.S.L., S.B.); and Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.)
| | - Hee Seung Lee
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea (S.S.K., S.L., M.S.P.); Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.S.L., S.B.); and Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.)
| | - Seungmin Bang
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea (S.S.K., S.L., M.S.P.); Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.S.L., S.B.); and Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.)
| | - Kyunghwa Han
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea (S.S.K., S.L., M.S.P.); Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.S.L., S.B.); and Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.)
| | - Mi-Suk Park
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea (S.S.K., S.L., M.S.P.); Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.S.L., S.B.); and Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.)
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Eaton KD, Romine PE, Martins RG, Leblond A, Carr LL, Vesselle HJ. Adaptive Fluorodeoxyglucose-Positron Emission Tomography Based Chemotherapy Selection for Metastatic Non-small Cell Lung Cancer. Cureus 2021; 13:e18804. [PMID: 34796077 PMCID: PMC8590825 DOI: 10.7759/cureus.18804] [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] [Accepted: 10/15/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives The change in tumor fluorodeoxyglucose (FDG) uptake by positron emission tomography (PET) scan after one cycle of platinum-based chemotherapy has been shown to predict progression-free and overall survival (PFS and OS) among advanced non-small cell lung cancer (NSCLC) patients. Using early FDG-PET response to determine subsequent chemotherapy, we aim to evaluate the role that adaptive chemotherapy regimens have on later CT response, PFS, and OS in patients with advanced NSCLC. Materials and Methods Chemotherapy-naïve patients with metastatic NSCLC received carboplatin and paclitaxel (CP) on day one and repeated FDG-PET on day 18. PET-responding patients continued CP chemotherapy for a total of four cycles. PET non-responders were switched to alternate docetaxel and gemcitabine (DG) for three additional cycles. The primary outcome was the CT Response Evaluation Criteria in Solid Tumors (RECIST 1.0) response. Secondary endpoints included PFS and OS. Results Forty-six patients initiated treatment with chemotherapy on trial and were evaluable by PET/CT. Of these, 19 (41%) met the FDG-PET criteria for the response after a single cycle of CP. Only one non-responding patient had a CT response. Despite the lack of CT response in the DG arm, no trend for worse PFS or OS was seen between the two arms. Conclusions This work demonstrates that changing chemotherapy in the event of non-response by PET did not lead to improved CT RECIST response. However, non-responding patients who switched chemotherapy had similar PFS and OS to those who responded by PET and continued the same regimen.
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Affiliation(s)
- Keith D Eaton
- Medical Oncology, University of Washington, Seattle, USA
| | | | | | - Antoine Leblond
- Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, CAN
| | | | - Hubert J Vesselle
- Nuclear Medicine, Fred Hutchinson Cancer Research Center, Seattle, USA
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9
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Systematic review and meta-analysis of diagnostic performance of CT imaging for assessing resectability of pancreatic ductal adenocarcinoma after neoadjuvant therapy: importance of CT criteria. Abdom Radiol (NY) 2021; 46:5201-5217. [PMID: 34331549 DOI: 10.1007/s00261-021-03198-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the CT diagnostic performance for evaluating resectability of pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant therapy and identify the factor(s) that affect(s) diagnostic performance. METHODS Databases were searched to identify studies published from January 1, 2000, to November 5, 2019 that evaluated the CT diagnostic performance for assessing resectability of post-neoadjuvant PDAC. Two reviewers independently extracted data and assessed the study quality. A meta-analysis was performed to obtain summary sensitivity and specificity values using a bivariate random-effects model, and heterogeneity across studies was assessed. Univariable meta-regression analysis was performed with eight variables, including the different CT criteria for resectability, conventional National Comprehensive Cancer Network (NCCN) criteria for upfront surgery, and modified criteria for post-neoadjuvant surgery. RESULTS Ten studies were included and analyzed. The summary sensitivity and specificity for resectability were 78% (95% CI 68-86%) and 60% (95% CI 44-74%), respectively. No significant heterogeneity was identified (bivariate correlation coefficient ρ = - 1, p-value for hierarchical summary receiver operating characteristics model β = 0.667). The two different CT criteria showed different diagnostic performance (p < 0.01), with higher sensitivity (81% [95% CI 73-90%] vs. 28% [95% CI 15-42%], p < 0.01) and lower specificity (57% [95% CI 41-73%] vs. 90% [95% CI 80-100%], p < 0.01) for the modified criteria. No other variables affected the diagnostic performance. CONCLUSION CT criteria were the factors that affected the diagnostic performance. Modification of the conventional criteria improved sensitivity but lowered specificity. Further modifications are required to improve specificity and uniformity.
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10
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Galgano SJ, Calderone CE, Xie C, Smith EN, Porter KK, McConathy JE. Applications of PET/MRI in Abdominopelvic Oncology. Radiographics 2021; 41:1750-1765. [PMID: 34597228 DOI: 10.1148/rg.2021210035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With PET/MRI, the strengths of PET and MRI are combined to allow simultaneous image acquisition and near-perfect image coregistration. MRI is increasingly being used for staging and restaging of abdominopelvic oncologic lesions, including prostate, hepatobiliary, pancreatic, neuroendocrine, cervical, and rectal cancers. Fluorine 18-fluorodeoxyglucose PET/CT has long been considered a cornerstone of oncologic imaging, and the development of multiple targeted radiotracers has led to increased research on and use of these agents in clinical practice. Thus, simultaneously performed PET/MRI enables the acquisition of complementary imaging information, with distinct advantages over PET/CT and MR image acquisitions. The authors provide an overview of PET/MRI, including descriptions of the major differences between PET/MRI and PET/CT, as well as case examples and treatment protocols for patients with commonly encountered malignancies in the abdomen and pelvis. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Samuel J Galgano
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Carli E Calderone
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Charlies Xie
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Elainea N Smith
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Kristin K Porter
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Jonathan E McConathy
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
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11
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McKinney M, Griffin MO, Tolat PP. Multimodality Imaging for the Staging of Pancreatic Cancer. Surg Oncol Clin N Am 2021; 30:621-637. [PMID: 34511186 DOI: 10.1016/j.soc.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Imaging plays a key role in the diagnosis, staging, and follow-up of pancreatic ductal adenocarcinoma. The pancreatic protocol dual-phase multidetector computed tomography scan is the imaging modality of choice. A computed tomography scan is highly accurate for pancreatic tumor detection, assessment of resectability, and detection of metastatic disease. This article reviews key principles of the acquisition, interpretation, and reporting of pancreatic ductal adenocarcinoma imaging with computed tomography scanning and highlights potential roles for newer and supplemental imaging technologies. We discuss the importance of structured interpretation and reporting for providing the most complete and accurate assessment of tumor stage and resectability.
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Affiliation(s)
- Martin McKinney
- Department of Radiology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Michael O Griffin
- Department of Radiology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA; Department of and Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Parag P Tolat
- Department of Radiology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA; Department of and Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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12
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Min LA, Castagnoli F, Vogel WV, Vellenga JP, van Griethuysen JJM, Lahaye MJ, Maas M, Beets Tan RGH, Lambregts DMJ. A decade of multi-modality PET and MR imaging in abdominal oncology. Br J Radiol 2021; 94:20201351. [PMID: 34387508 PMCID: PMC9328040 DOI: 10.1259/bjr.20201351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate trends observed in a decade of published research on multimodality PET(/CT)+MR imaging in abdominal oncology, and to explore how these trends are reflected by the use of multimodality imaging performed at our institution. METHODS First, we performed a literature search (2009-2018) including all papers published on the multimodality combination of PET(/CT) and MRI in abdominal oncology. Retrieved papers were categorized according to a structured labelling system, including study design and outcome, cancer and lesion type under investigation and PET-tracer type. Results were analysed using descriptive statistics and evolutions over time were plotted graphically. Second, we performed a descriptive analysis of the numbers of MRI, PET/CT and multimodality PET/CT+MRI combinations (performed within a ≤14 days interval) performed during a similar time span at our institution. RESULTS Published research papers involving multimodality PET(/CT)+MRI combinations showed an impressive increase in numbers, both for retrospective combinations of PET/CT and MRI, as well as hybrid PET/MRI. Main areas of research included new PET-tracers, visual PET(/CT)+MRI assessment for staging, and (semi-)quantitative analysis of PET-parameters compared to or combined with MRI-parameters as predictive biomarkers. In line with literature, we also observed a vast increase in numbers of multimodality PET/CT+MRI imaging in our institutional data. CONCLUSIONS The tremendous increase in published literature on multimodality imaging, reflected by our institutional data, shows the continuously growing interest in comprehensive multivariable imaging evaluations to guide oncological practice. ADVANCES IN KNOWLEDGE The role of multimodality imaging in oncology is rapidly evolving. This paper summarizes the main applications and recent developments in multimodality imaging, with a specific focus on the combination of PET+MRI in abdominal oncology.
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Affiliation(s)
- Lisa A Min
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | | | - Wouter V Vogel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jisk P Vellenga
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joost J M van Griethuysen
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands.,Faculty or Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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13
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Harder FN, Jungmann F, Kaissis GA, Lohöfer FK, Ziegelmayer S, Havel D, Quante M, Reichert M, Schmid RM, Demir IE, Friess H, Wildgruber M, Siveke J, Muckenhuber A, Steiger K, Weichert W, Rauscher I, Eiber M, Makowski MR, Braren RF. [ 18F]FDG PET/MRI enables early chemotherapy response prediction in pancreatic ductal adenocarcinoma. EJNMMI Res 2021; 11:70. [PMID: 34322781 PMCID: PMC8319249 DOI: 10.1186/s13550-021-00808-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/08/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose In this prospective exploratory study, we evaluated the feasibility of [18F]fluorodeoxyglucose ([18F]FDG) PET/MRI-based chemotherapy response prediction in pancreatic ductal adenocarcinoma at two weeks upon therapy onset. Material and methods In a mixed cohort, seventeen patients treated with chemotherapy in neoadjuvant or palliative intent were enrolled. All patients were imaged by [18F]FDG PET/MRI before and two weeks after onset of chemotherapy. Response per RECIST1.1 was then assessed at 3 months [18F]FDG PET/MRI-derived parameters (MTV50%, TLG50%, MTV2.5, TLG2.5, SUVmax, SUVpeak, ADCmax, ADCmean and ADCmin) were assessed, using multiple t-test, Man–Whitney-U test and Fisher’s exact test for binary features. Results At 72 ± 43 days, twelve patients were classified as responders and five patients as non-responders. An increase in ∆MTV50% and ∆ADC (≥ 20% and 15%, respectively) and a decrease in ∆TLG50% (≤ 20%) at 2 weeks after chemotherapy onset enabled prediction of responders and non-responders, respectively. Parameter combinations (∆TLG50% and ∆ADCmax or ∆MTV50% and ∆ADCmax) further improved discrimination. Conclusion Multiparametric [18F]FDG PET/MRI-derived parameters, in particular indicators of a change in tumor glycolysis and cellularity, may enable very early chemotherapy response prediction. Further prospective studies in larger patient cohorts are recommended to their clinical impact. Supplementary Information The online version contains supplementary material available at 10.1186/s13550-021-00808-4.
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Affiliation(s)
- Felix N Harder
- Institute of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Friederike Jungmann
- Institute of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georgios A Kaissis
- Institute of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Computing, Faculty of Engineering, Imperial College of Science, Technology and Medicine, London, SW7 2AZ, UK
| | - Fabian K Lohöfer
- Institute of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sebastian Ziegelmayer
- Institute of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniel Havel
- Institute of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael Quante
- Internal Medicine II, Faculty of Medicine, Freiburg University Hospital, Freiburg, Germany
| | - Maximillian Reichert
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Roland M Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Ihsan Ekin Demir
- Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Moritz Wildgruber
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Jens Siveke
- Institute for Developmental Cancer Therapeutics, West German Cancer Center, University Hospital Essen, Essen, Germany
| | | | - Katja Steiger
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Marcus R Makowski
- Institute of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Rickmer F Braren
- Institute of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany. .,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
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14
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Seifert R, Küper A, Tewes M, Heuschmid M, Welt A, Fendler WP, Herrmann K, Decker T. [18F]-Fluorodeoxyglucose Positron Emission Tomography/CT to Assess the Early Metabolic Response in Patients with Hormone Receptor-Positive HER2-Negative Metastasized Breast Cancer Treated with Cyclin-Dependent 4/6 Kinase Inhibitors. Oncol Res Treat 2021; 44:400-407. [PMID: 34102639 DOI: 10.1159/000516422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/09/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Addition of cyclin-dependent 4/6 kinase (CDK4/6) inhibitors to endocrine therapy is standard of care in the treatment of women with advanced hormone receptor-positive HER2-negative breast cancer. However, the predictive factors for the treatment response to CDK4/6 inhibitor therapy are poorly elucidated. Early changes in the by [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) uptake of tumors receiving different kinds of therapy have proven to reliably predict treatment outcomes in a variety of malignancies. Therefore, the feasibility of early metabolic response assessment to predict the long-term treatment response to CDK4/6 inhibitor therapy was evaluated in the present study. METHODS Eight patients underwent FDG-PET/CT before and after the initiation of CDK4/6 inhibitor therapy (ribociclib, palbociclib or abemcaciclib). CDK4/6 inhibitor therapy was combined with either aromatase inhibition or fulvestrant. The median interval between the treatment start (including baseline PET) and the follow-up PET examination was 14 days. Conventional radiographic staging was performed 3 months after the start of CDK4/6 inhibitor therapy. The percentual changes in molecular tumor volume, SUVpeak, the summed SUVpeak of up to 5 metastases (PERCIST-5), and total lesion glycolysis (TLG) were calculated for each patient. RESULTS Three patients showed progressive disease after 3 months of CDK4/6 inhibitor therapy, whereas 5 patients showed disease control (3 stable disease and 2 partial remission). Disease control was maintained in these patients (follow-up range 7-22 months). Patients with disease control had a significantly greater decline in TLG (-55.3 vs. 16.7%; p < 0.05). The same was true for the PERCIST-5 (-21.9 vs. 11.3%, p < 0.05). All patients with progressive TLG showed treatment failure and/or a poor outcome. CONCLUSION Elevated TLG on early FDG-PET seems to be associated with long-term treatment failure and a poor outcome in patients undergoing CDK4/6 inhibitor therapy for metastatic breast cancer. Early findings indicate a potential prognostic value of early FDG-PET in this setting and warrant a prospective evaluation.
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Affiliation(s)
- Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Essen, Germany
| | - Alina Küper
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Mitra Tewes
- West German Cancer Center (WTZ), Essen, Germany.,Department of Medical Oncology, University Hospital Essen, Essen, Germany
| | - Martin Heuschmid
- Department of Radiology, St. Elisabethen-Klinikum, Ravensburg, Germany
| | - Anja Welt
- West German Cancer Center (WTZ), Essen, Germany.,Department of Medical Oncology, University Hospital Essen, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Essen, Germany
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15
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Ward RD, Amorim B, Li W, King J, Umutlu L, Groshar D, Harisinghani M, Catalano O. Abdominal and pelvic 18F-FDG PET/MR: a review of current and emerging oncologic applications. Abdom Radiol (NY) 2021; 46:1236-1248. [PMID: 32949272 DOI: 10.1007/s00261-020-02766-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022]
Abstract
Positron emission tomography (PET) using fluorodeoxyglucose (18F-FDG) combined with magnetic resonance imaging (MR) is an emerging hybrid modality that has shown utility in evaluating abdominal and pelvic disease entities. Together, the high soft tissue contrast and metabolic/functional imaging capabilities make this modality ideal for oncologic imaging in many organ systems. Its clinical utility continues to evolve and future research will help solidify its role in oncologic imaging. In this manuscript, we aim to (1) provide an overview of the various PET/MR systems, describing the strengths and weaknesses of each system, and (2) review the oncologic applications for 18F-FDG PET/MR in the abdomen and pelvis.
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Affiliation(s)
- Ryan D Ward
- Cleveland Clinic, Department of Abdominal Imaging, 9500 Euclid Ave, L10, Cleveland, OH, 44195, USA
| | - Barbara Amorim
- Division of Nuclear Medicine, University of Campinas, Rua Vital Brasil 251, Campinas, Brazil
| | - Weier Li
- Department of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Joseph King
- Department of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - David Groshar
- Assuta Medical Center, Habrzel 20, 6971028, Tel-Aviv, Israel
- Sackler School of Medicine, Tel-Aviv, Israel
| | - Mukesh Harisinghani
- Department of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Onofrio Catalano
- Department of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
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16
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Garnier J, Robin F, Ewald J, Marchese U, Bergeat D, Boudjema K, Delpero JR, Sulpice L, Turrini O. Pancreatectomy with Vascular Resection After Neoadjuvant FOLFIRINOX: Who Survives More Than a Year After Surgery? Ann Surg Oncol 2021; 28:4625-4634. [PMID: 33462718 DOI: 10.1245/s10434-020-09520-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Experienced pancreatic surgeons, for whom complexity is not an issue, must decide at the end of neoadjuvant therapy whether to continue or discontinue surgery, when pancreatectomy with vascular resection is planned in patients with pancreatic ductal adenocarcinoma (PDAC). OBJECTIVE Our study aimed to determine preoperative factors that can predict short postoperative survival in such situations. METHODS Overall, 105 patients with borderline or locally advanced PDAC received neoadjuvant FOLFIRINOX (followed by chemoradiation in 22% of patients) and underwent pancreatectomy with segmental venous and/or arterial resection at two high-volume centers. The primary endpoint was overall survival (OS) of < 1 year after surgery for patients who did not die from the surgery. RESULTS Tumors were classified as borderline in 78% of cases and locally advanced in 22% of cases. Mean CA19-9 at diagnosis was 934 U/mL, which significantly decreased to 213 U/mL (p < 0.01) after a median of six cycles of FOLFIRINOX. Pancreaticoduodenectomy was performed most often (76%). The vast majority of patients underwent venous resection (92%), and a simultaneous arterial resection was performed in 16 patients (15%). The severe morbidity rate and 30- and 90-day mortality rates were 21%, 8.5%, and 10.4%, respectively. The median OS after surgery was 23 months. In the multivariate analysis, preoperative CA19-9 ≥ 450 U/mL was the only preoperative factor independently associated with OS of < 1 year (p = 0.044). CONCLUSION The preoperative CA19-9 value should be considered in the clinical decision-making process when complex vascular resection is required.
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Affiliation(s)
- Jonathan Garnier
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France.
| | - Fabien Robin
- Department of Hepato-Biliary and Digestive Surgery, CHU Rennes, Université Rennes 1, Rennes, France
| | - Jacques Ewald
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Ugo Marchese
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Damien Bergeat
- Department of Hepato-Biliary and Digestive Surgery, CHU Rennes, Université Rennes 1, Rennes, France
| | - Karim Boudjema
- Department of Hepato-Biliary and Digestive Surgery, CHU Rennes, Université Rennes 1, Rennes, France
| | - Jean-Robert Delpero
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Laurent Sulpice
- Department of Hepato-Biliary and Digestive Surgery, CHU Rennes, Université Rennes 1, Rennes, France
| | - Olivier Turrini
- Department of Surgical Oncology, Institut Paoli-Calmettes, Aix-Marseille University, CRCM, Marseille, France
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17
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Impact of PET/MRI in the Treatment of Pancreatic Adenocarcinoma: a Retrospective Cohort Study. Mol Imaging Biol 2021; 23:456-466. [PMID: 33415677 DOI: 10.1007/s11307-020-01569-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE Imaging is central to the diagnosis and management of Pancreatic Ductal Adenocarcinoma (PDAC). This study evaluated if positron emission tomography (PET)/magnetic resonance imaging (MRI) elicited treatment modifications in PDAC when compared to standard of care imaging (SCI). PROCEDURES This retrospective study included consecutive patients with PDAC who underwent 2-deoxy-2-[18F]fluoro-D-glucose ([18F]F-FDG) PET/MRI and SCI from May 2017 to January 2019. SCI included abdominal computed tomography (CT), MRI, and/or PET/CT. For patients who had more than one pair of PET/MRI and SCI, each management decision was independently evaluated. Treatment strategies based on each modality were extracted from electronic medical records. Follow-up was evaluated until January 2020. RESULTS Twenty-five patients underwent 37 PET/MRI's, mean age was 65 ± 9 years and 13 (13/25, 52 %) were men. 49 % (18/37, 95 % CI 33-64 %) of the PET/MRI scans changed clinical management. Whether the SCI included a PET/CT or not did not significantly modify the probability of management change (OR = 0.9, 95 % CI 0.2-4, p = 1). One hundred percent (33/33) of the available follow-up data confirmed PET/MRI findings. CONCLUSIONS PET/MRI significantly changed PDAC management, consistently across the different SCI modalities it was compared to. These findings suggest a role for PET/MRI in the management of PDAC.
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18
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Therapeutic response assessment in pancreatic ductal adenocarcinoma: society of abdominal radiology review paper on the role of morphological and functional imaging techniques. Abdom Radiol (NY) 2020; 45:4273-4289. [PMID: 32936417 DOI: 10.1007/s00261-020-02723-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/17/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDA) is the third leading cause of cancer-related death in the United States and is projected to be the second by 2030. Systemic combination chemotherapy is considered an essential first-line treatment for the majority of patients with PDA, in both the neoadjuvant and palliative settings. In addition, a number of novel therapies are being tested in clinical trials for patients with advanced PDA. In all cases, accurate and timely assessment of treatment response is critical to guide therapy, reduce drug toxicities and cost from a failing therapy, and aid adaptive clinical trials. Conventional morphological imaging has significant limitations, especially in the context of determining primary tumor response and resectability following neoadjuvant therapies. In this article, we provide an overview of current therapy options for PDA, highlight several morphological imaging findings that may be helpful to reduce over-staging following neoadjuvant therapy, and discuss a number of emerging imaging, and non-imaging, tools that have shown promise in providing a more precise quantification of disease burden and treatment response in PDA.
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Borderline Resectable and Locally Advanced Pancreatic Cancer: FDG PET/MRI and CT Tumor Metrics for Assessment of Pathologic Response to Neoadjuvant Therapy and Prediction of Survival. AJR Am J Roentgenol 2020; 217:730-740. [PMID: 33084382 DOI: 10.2214/ajr.20.24567] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND. Imaging biomarkers of response to neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDA) are needed to optimize treatment decisions and long-term outcomes. OBJECTIVE. The purpose of this study was to investigate metrics from PET/MRI and CT to assess pathologic response of PDA to NAT and to predict overall survival (OS). METHODS. This retrospective study included 44 patients with 18F-FDG-avid borderline resectable or locally advanced PDA on pretreatment PET/MRI who also underwent post-NAT PET/MRI before surgery between August 2016 and February 2019. Carbohydrate antigen 19-9 (CA 19-9) level, metabolic metrics from PET/MRI, and morphologic metrics from CT (n = 34) were compared between pathologic responders (College of American Pathologists scores 0 and 1) and nonresponders (scores 2 and 3). AUCs were measured for metrics significantly associated with pathologic response. Relation to OS was evaluated with Cox proportional hazards models. RESULTS. Among 44 patients (22 men, 22 women; mean age, 62 ± 11.6 years), 19 (43%) were responders, and 25 (57%) were nonresponders. Median OS was 24 months (range, 6-42 months). Before treatment, responders and nonresponders did not differ in CA 19-9 level, metabolic metrics, or CT metrics (p > .05). After treatment, responders and nonresponders differed in complete metabolic response (CMR) (responders, 89% [17/19]; nonresponders, 40% [10/25]; p = .04], mean change in SUVmax (ΔSUVmax; responders, -70% ± 13%; nonresponders, -37% ± 42%; p < .001), mean change in SUVmax corrected to serum glucose level (ΔSUVgluc) (responders, -74% ± 12%; nonresponders, -30% ± 58%; p < .001), RECIST response on CT (responders, 93% [13/14]; nonresponders, 50% [10/20]; p = .02)], and mean change in tumor volume on CT (ΔTvol) (responders, -85% ± 21%; nonresponders, 57% ± 400%; p < .001). The AUC of CMR for pathologic response was 0.75; ΔSUVmax, 0.83; ΔSUVgluc, 0.87; RECIST, 0.71; and ΔTvol 0.86. The AUCs of bivariable PET/MRI and CT models were 0.83 (CMR and ΔSUVmax), 0.87 (CMR and ΔSUVgluc), and 0.87 (RECIST and ΔTvol). OS was associated with CMR (p = .03), ΔSUVmax (p = .003), ΔSUVgluc (p = .003), and RECIST (p = .046). CONCLUSION. Unlike CA 19-9 level, changes in metabolic metrics from PET/MRI and morphologic metrics from CT after NAT were associated with pathologic response and OS in patients with PDA, warranting prospective validation. CLINICAL IMPACT. Imaging metrics associated with pathologic response and OS in PDA could help guide clinical management and outcomes for patients with PDA who undergo emergency therapeutic interventions.
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20
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Abstract
Importance In the past few decades, there has been rapid advancements in imaging technologies that have become irreplaceable in the pre-operative assessment of patients with pancreatic tumors. Modern imaging modalities, including computed tomography (CT) and endoscopic ultrasound (EUS), can provide critical information of the absence or presence of metastatic disease in pancreatic cancer, as well as details on the local extent and resectability, allowing for the selection of stage appropriate treatments and pre-operatively determined surgical approach. Objective The aim of this review is to discuss staging, resectability, and imaging for patients with pancreatic tumors. Evidence Review A literature review was performed of articles relevant to the topics of staging, resectability, and imaging of pancreatic tumors. Imaging modalities included CT, EUS, magnetic resonance imaging (MRI), positron emission tomography (PET), antibody-based and narrow band imaging. Findings CT pancreas protocol combined with EUS serve as the primary modalities in diagnosis, staging, and surgical planning in patients with pancreatic tumors. MRI is an alternative to CT with near equivalent utility in the pre-operative setting. In some circumstances, PET-CT may be a cost-effective initial study to detect distant disease. Conclusions and Relevance Current imaging technologies play a critical role in the evaluation of patients with pancreatic tumors. Advances in the past 3 decades in imaging technologies have revolutionized the process of assessment of stage and resectability in patients with pancreatic tumors. Future imaging technologies will address current limitation in the evaluation of occult metastatic disease.
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Panda A, Goenka AH, Hope TA, Veit-Haibach P. PET/Magnetic Resonance Imaging Applications in Abdomen and Pelvis. Magn Reson Imaging Clin N Am 2020; 28:369-380. [DOI: 10.1016/j.mric.2020.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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22
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Moradi F, Iagaru A. The Role of Positron Emission Tomography in Pancreatic Cancer and Gallbladder Cancer. Semin Nucl Med 2020; 50:434-446. [PMID: 32768007 DOI: 10.1053/j.semnuclmed.2020.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
18F-FDG-PET is complementary to conventional imaging in patients with clinical suspicion for exocrine pancreatic malignancies. It has similar if not superior sensitivity and specificity for detection of cancer, and when combined with contrast enhanced anatomic imaging of the abdomen, can improve diagnostic accuracy and aid in staging, assessment for resectability, radiation therapy planning, and prognostication. Various metabolic pathways affect FDG uptake in pancreatic ductal adenocarcinoma. The degree of uptake reflects histopathology, aggressiveness, metastatic potential, and metabolic profile of malignant cell and their interaction with cancer stroma. After treatment, FDG-PET is useful for detection of residual or recurrent cancer and can be used to assess and monitor response to therapy in unresectable or metastatic disease. The degree and pattern of uptake combined with other imaging features are useful in characterization of incidental pancreatic lesions and benign processes such as inflammation. Several novel PET radiopharmaceuticals have been developed to improve detection and management of pancreatic cancer. Gallbladder carcinoma is typically FDG avid and when anatomic imaging is equivocal PET can be used to assess metastatic involvement with high specificity and inform subsequent management.
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Affiliation(s)
- Farshad Moradi
- Division of Nuclear Medicine, Department of Radiology, Stanford University, Stanford, CA.
| | - Andrei Iagaru
- Division of Nuclear Medicine, Department of Radiology, Stanford University, Stanford, CA
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23
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Simpson G, Spieler B, Dogan N, Portelance L, Mellon EA, Kwon D, Ford JC, Yang F. Predictive value of 0.35 T magnetic resonance imaging radiomic features in stereotactic ablative body radiotherapy of pancreatic cancer: A pilot study. Med Phys 2020; 47:3682-3690. [DOI: 10.1002/mp.14200] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Garrett Simpson
- Department of Radiation Oncology University of Miami Miami FL 33136 USA
| | - Benjamin Spieler
- Department of Radiation Oncology University of Miami Miami FL 33136 USA
| | - Nesrin Dogan
- Department of Radiation Oncology University of Miami Miami FL 33136 USA
| | | | - Eric A. Mellon
- Department of Radiation Oncology University of Miami Miami FL 33136 USA
| | - Deukwoo Kwon
- Department of Radiation Oncology University of Miami Miami FL 33136 USA
| | - John C. Ford
- Department of Radiation Oncology University of Miami Miami FL 33136 USA
| | - Fei Yang
- Department of Radiation Oncology University of Miami Miami FL 33136 USA
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24
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Kulkarni NM, Mannelli L, Zins M, Bhosale PR, Arif-Tiwari H, Brook OR, Hecht EM, Kastrinos F, Wang ZJ, Soloff EV, Tolat PP, Sangster G, Fleming J, Tamm EP, Kambadakone AR. White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology's disease-focused panel for pancreatic ductal adenocarcinoma: Part II, update on imaging techniques and screening of pancreatic cancer in high-risk individuals. Abdom Radiol (NY) 2020; 45:729-742. [PMID: 31768594 DOI: 10.1007/s00261-019-02290-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive gastrointestinal malignancy with a poor 5-year survival rate. Its high mortality rate is attributed to its aggressive biology and frequently late presentation. While surgical resection remains the only potentially curative treatment, only 10-20% of patients will present with surgically resectable disease. Over the past several years, development of vascular bypass graft techniques and introduction of neoadjuvant treatment regimens have increased the number of patients who can undergo resection with a curative intent. While the role of conventional imaging in the detection, characterization, and staging of patients with PDAC is well established, its role in monitoring treatment response, particularly following neoadjuvant therapy remains challenging because of the complex anatomic and histological nature of PDAC. Novel morphologic and functional imaging techniques (such as DECT, DW-MRI, and PET/MRI) are being investigated to improve the diagnostic accuracy and the ability to measure response to therapy. There is also a growing interest to detect PDAC and its precursor lesions at an early stage in asymptomatic patients to increase the likelihood of achieving cure. This has led to the development of pancreatic cancer screening programs. This article will review recent updates in imaging techniques and the current status of screening and surveillance of individuals at a high risk of developing PDAC.
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Affiliation(s)
- Naveen M Kulkarni
- Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | | | - Marc Zins
- Department of Radiology, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| | - Priya R Bhosale
- Abdominal Imaging Department, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1473, Houston, TX, 77030-400, USA
| | - Hina Arif-Tiwari
- Department of Medical Imaging, University of Arizona College of Medicine, 1501 N. Campbell Ave, P.O. Box 245067, Tucson, AZ, 85724, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Shapiro 4, Boston, MA, 02215-5400, USA
| | - Elizabeth M Hecht
- Department of Radiology, Columbia University Medical Center, 622 W 168th St, PH1-317, New York, NY, 10032, USA
| | - Fay Kastrinos
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Cancer, 161 Fort Washington Avenue, Suite: 862, New York, NY, 10032, USA
| | - Zhen Jane Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Erik V Soloff
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Parag P Tolat
- Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Guillermo Sangster
- Department of Radiology, Ochsner LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Jason Fleming
- Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Eric P Tamm
- Abdominal Imaging Department, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1473, Houston, TX, 77030-400, USA
| | - Avinash R Kambadakone
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
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25
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Assessment of Response to Neoadjuvant Therapy Using CT Texture Analysis in Patients With Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma. AJR Am J Roentgenol 2019; 214:362-369. [PMID: 31799875 DOI: 10.2214/ajr.19.21152] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE. The goal of this study was to assess the correlation between CT-derived texture features of pancreatic ductal adenocarcinoma (PDAC) and histologic and biochemical markers of response to neoadjuvant treatment as well as disease-free survival in patients with potentially resectable PDAC. SUBJECTS AND METHODS. Thirty-nine patients completed this prospective study protocol between November 2013 and December 2016. All patients received neoadjuvant chemotherapy, underwent surgical resection, and had histologic grading of tumor response. Similar CT protocol was used for all patients. Pancreatic (late arterial) phase of pre- and posttreatment CT scans were evaluated. Histogram analysis and spatial-band-pass filtration were used to extract textural features. Correlation between textural parameters, histologic response, biochemical response, and genetic mutations was assessed using Mann-Whitney test, chi-square analysis, and multivariate logistic regression. Association with disease-free survival was assessed using Kaplan-Meier method and Cox model. RESULTS. Pretreatment mean positive pixel (MPP) at fine- and medium-level filtration, pretreatment kurtosis at medium-level filtration, changes in kurtosis, and pretreatment tumor SD were statistically different between patients with no or poor histologic response and favorable histologic response (p < 0.05). Changes in skewness and kurtosis at medium-level filtration significantly correlated with biochemical response (p < 0.01). On the basis of multivariate analysis, patients with higher MPP at pretreatment CT were more likely to have favorable histologic response (odds ratio, 1.06; 95% CI, 1.002-1.12). The Cox model for association between textural features and disease-free survival was statistically significant (p = 0.001). CONCLUSION. Textural features extracted from baseline pancreatic phase CT imaging of patients with potentially resectable PDAC and longitudinal changes in tumor heterogeneity can be used as biomarkers for predicting histologic response to neoadjuvant chemotherapy and disease-free survival.
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Panda A, Garg I, Johnson GB, Truty MJ, Halfdanarson TR, Goenka AH. Molecular radionuclide imaging of pancreatic neoplasms. Lancet Gastroenterol Hepatol 2019; 4:559-570. [DOI: 10.1016/s2468-1253(19)30081-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/26/2019] [Accepted: 03/02/2019] [Indexed: 02/07/2023]
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27
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Ropella-Panagis KM, Seiberlich N, Gulani V. Magnetic Resonance Fingerprinting: Implications and Opportunities for PET/MR. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2019; 3:388-399. [PMID: 32864537 DOI: 10.1109/trpms.2019.2897425] [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] [Indexed: 11/07/2022]
Abstract
Magnetic Resonance Imaging (MRI) can be used to assess anatomical structure, and its sensitivity to a variety of tissue properties enables superb contrast between tissues as well as the ability to characterize these tissues. However, despite vast potential for quantitative and functional evaluation, MRI is typically used qualitatively, in which the underlying tissue properties are not measured, and thus the brightness of each pixel is not quantitatively meaningful. Positron Emission Tomography (PET) is an inherently quantitative imaging modality that interrogates functional activity within a tissue, probed by a molecule of interest coupled with an appropriate tracer. These modalities can complement one another to provide clinical information regarding both structure and function, but there are still technical and practical hurdles in the way of the integrated use of both modalities. Recent advances in MRI have moved the field in an increasingly quantitative direction, which is complementary to PET, and could also potentially help solve some of the challenges in PET/MR. Magnetic Resonance Fingerprinting (MRF) is a recently described MRI-based technique which can efficiently and simultaneously quantitatively map several tissue properties in a single exam. Here, the basic principles behind the quantitative approach of MRF are laid out, and the potential implications for combined PET/MR are discussed.
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Affiliation(s)
| | - Nicole Seiberlich
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Vikas Gulani
- Department of Radiology, Case Western Reserve University, Cleveland, OH 44106 USA
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