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Yousefirizi F, Liyanage A, Klyuzhin IS, Rahmim A. From code sharing to sharing of implementations: Advancing reproducible AI development for medical imaging through federated testing. J Med Imaging Radiat Sci 2024; 55:101745. [PMID: 39208523 DOI: 10.1016/j.jmir.2024.101745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/22/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The reproducibility crisis in AI research remains a significant concern. While code sharing has been acknowledged as a step toward addressing this issue, our focus extends beyond this paradigm. In this work, we explore "federated testing" as an avenue for advancing reproducible AI research and development especially in medical imaging. Unlike federated learning, where a model is developed and refined on data from different centers, federated testing involves models developed by one team being deployed and evaluated by others, addressing reproducibility across various implementations. METHODS Our study follows an exploratory design aimed at systematically evaluating the sources of discrepancies in shared model execution for medical imaging and outputs on the same input data, independent of generalizability analysis. We distributed the same model code to multiple independent centers, monitoring execution in different runtime environments while considering various real-world scenarios for pre- and post-processing steps. We analyzed deployment infrastructure by comparing the impact of different computational resources (GPU vs. CPU) on model performance. To assess federated testing in AI models for medical imaging, we performed a comparative evaluation across different centers, each with distinct pre- and post-processing steps and deployment environments, specifically targeting AI-driven positron emission tomography (PET) imaging segmentation. More specifically, we studied federated testing for an AI-based model for surrogate total metabolic tumor volume (sTMTV) segmentation in PET imaging: the AI algorithm, trained on maximum intensity projection (MIP) data, segments lymphoma regions and estimates sTMTV. RESULTS Our study reveals that relying solely on open-source code sharing does not guarantee reproducible results due to variations in code execution, runtime environments, and incomplete input specifications. Deploying the segmentation model on local and virtual GPUs compared to using Docker containers showed no effect on reproducibility. However, significant sources of variability were found in data preparation and pre-/post- processing techniques for PET imaging. These findings underscore the limitations of code sharing alone in achieving consistent and accurate results in federated testing. CONCLUSION Achieving consistently precise results in federated testing requires more than just sharing models through open-source code. Comprehensive pipeline sharing, including pre- and post-processing steps, is essential. Cloud-based platforms that automate these processes can streamline AI model testing across diverse locations. Standardizing protocols and sharing complete pipelines can significantly enhance the robustness and reproducibility of AI models.
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Affiliation(s)
- Fereshteh Yousefirizi
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, Canada.
| | - Annudesh Liyanage
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, Canada; Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - Ivan S Klyuzhin
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, Canada
| | - Arman Rahmim
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, Canada; Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada; Department of Biomedical Engineering, University of British Columbia, Vancouver, Canada
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Hou X, He Y, Liu G, Chen S, Shi H. SPECT/CT imaging: quantifying 99mTc-MDP concentration in the spine and pelvis. Ann Nucl Med 2024:10.1007/s12149-024-01967-9. [PMID: 39154304 DOI: 10.1007/s12149-024-01967-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/05/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE This study aimed to identify a relatively robust SUV for guiding clinical practice through quantitative measurement and comparison of various normalization methods based on the SUV of 99mTc-MDP in the normal spine and pelvis using an integrated SPECT/CT scanner. METHODS Between June 2017 and September 2019, a total of 500 oncology patients (mean age, 60.9; men, 66.0%) who underwent bone SPECT/CT scans with 99mTc-MDP were enrolled in this retrospective study. The mean SUV (SUVmean) of 4962 spinal and pelvic bones was calculated based on the patients' body weight (BW), lean body mass (LBM), bone mineral content (BMC), body surface area (BSA), and body mass index (BMI), defined as SUVbw, SUVlbm, SUVbmc, SUVbsa, and SUVbmi, respectively. The coefficients of variation (CoVs) of the aforementioned parameters were compared, and the correlation and multiple linear regression analyses were used to compare the extent to which these parameters were affected by sex, age, height, weight, BMI, and CT values. RESULTS The average SUVs in the normal spine and pelvis displayed a relatively wide variability: 4.573 ± 1.972 for SUVbw, 3.555 ± 1.517 for SUVlbm, 0.163 ± 0.071 for SUVbmc, 0.124 ± 0.052 for SUVbsa, and 1.668 ± 0.732 for SUVbmi. In general, SUVbsa had relatively lowest CoV (42.1%) in all vertebrae and pelvis compared with other SUVs. For correlation analyses, all SUVs displayed weak but significant correlations with age and CT values. For regression analyses, SUVbsa was influenced only by age, BMI, and CT values independently. The effects of these variables on SUVbsa were all smaller than those on conventional SUVbw. CONCLUSIONS The SUVs of 99mTc-MDP in normal bone derived from quantitative bone SPECT/CT could serve as a reference for evaluating tumor bone metastasis, but it should be assessed on a site-specific basis. SUVbsa exhibited superior robustness among all the SUV normalization variations, indicating potential clinical applications.
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Affiliation(s)
- Xiaoguang Hou
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Nuclear Medicine Institute of Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Yibo He
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Nuclear Medicine Institute of Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Guobing Liu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Nuclear Medicine Institute of Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Shuguang Chen
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- Nuclear Medicine Institute of Fudan University, Shanghai, China.
- Shanghai Institute of Medical Imaging, Shanghai, China.
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- Nuclear Medicine Institute of Fudan University, Shanghai, China.
- Shanghai Institute of Medical Imaging, Shanghai, China.
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Nakamura S, Nakatani K, Yoshino K, Koyama T. Effects of Glucose Intolerance on Physiological Accumulation in Salivary Glands and Palatine Tonsils During 18F-Fluorodeoxyglucose Positron Emission Tomography. Cureus 2024; 16:e67387. [PMID: 39310613 PMCID: PMC11414136 DOI: 10.7759/cureus.67387] [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] [Accepted: 08/19/2024] [Indexed: 09/25/2024] Open
Abstract
PURPOSE We evaluated the effects of chronic hyperglycemia on physiological accumulation in salivary glands and tonsils during 18F-fluorodeoxyglucose positron emission tomography (FDG-PET/CT). MATERIALS AND METHODS 12,738 patients underwent whole-body FDG-PET/CT in our institute during the study period. Of these, the case group comprised 777 patients with a blood glucose (BG) level >140 mg/dL; the control group comprised an equal number of randomly selected age- and sex-matched individuals with a BG level <110 mg/dL. Within the case group, the diabetic subgroup was defined as individuals with a BG level >200 mg/dL. Visual assessment and accumulation intensity among tissues were compared between the case and control groups, including (1) the mean difference in maximum standardized uptake value (SUVmax), (2) the difference in the proportion of patients with visible tissues on maximum intensity projection images, and (3) differences between the diabetic subgroup and the control group. RESULTS Parotid, submandibular, sublingual, and tonsillar tissues all showed significantly lower SUVmax in the case group than in the control group. The proportions of individuals with visible uptake in the parotid and tonsillar tissues and in the sublingual gland were significantly smaller in the case group than in the control group. Tonsillar uptake was observed in more than 90% of individuals in the control group but in two-thirds of patients in the diabetic subgroup. Accumulation in the parotid and submandibular glands was visible in approximately 80% of individuals in the control group but only half of patients in the diabetic subgroup. CONCLUSION Physiological accumulation in salivary glands and tonsils is significantly reduced among individuals with hyperglycemia or diabetes.
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Affiliation(s)
- Shoki Nakamura
- Department of Diagnostic Radiology, Kurashiki Central Hospital, Kurashiki, JPN
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, JPN
| | - Koya Nakatani
- Department of Diagnostic Radiology, Kurashiki Central Hospital, Kurashiki, JPN
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, JPN
| | - Kumiko Yoshino
- Department of Diagnostic Radiology, Kurashiki Central Hospital, Kurashiki, JPN
| | - Takashi Koyama
- Department of Diagnostic Radiology, Kurashiki Central Hospital, Kurashiki, JPN
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Donnelly R, McDermott M, McManus G, Franciosi AN, Keane MP, McGrath EE, McCarthy C, Murphy DJ. Meta-analysis of [ 18F]FDG-PET/CT in pulmonary sarcoidosis. Eur Radiol 2024:10.1007/s00330-024-10949-4. [PMID: 39044038 DOI: 10.1007/s00330-024-10949-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 05/29/2024] [Accepted: 06/16/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND 18F-Fluorodeoxyglucose (FDG) PET/CT is emerging as a tool in the diagnosis and evaluation of pulmonary sarcoidosis, however, there is limited consensus regarding its diagnostic performance and prognostic value. METHOD A meta-analysis was conducted with PubMed, Science Direct, MEDLINE, Scopus, and CENTRAL databases searched up to and including September 2023. 1355 studies were screened, with seventeen (n = 708 patients) suitable based on their assessment of the diagnostic performance or prognostic value of FDG-PET/CT. Study quality was assessed using the QUADAS-2 tool. Forest plots of pooled sensitivity and specificity were generated to assess diagnostic performance. Pooled changes in SUVmax were correlated with changes in pulmonary function tests (PFT). RESULTS FDG-PET/CT in diagnosing suspected pulmonary sarcoidosis (six studies, n = 400) had a pooled sensitivity of 0.971 (95%CI 0.909-1.000, p = < 0.001) and specificity of 0.873 (95%CI 0.845-0.920)(one study, n = 169). Eleven studies for prognostic analysis (n = 308) indicated a pooled reduction in pulmonary SUVmax of 4.538 (95%CI 5.653-3.453, p = < 0.001) post-treatment. PFTs displayed improvement post-treatment with a percentage increase in predicted forced vital capacity (FVC) and diffusion capacity of the lung for carbon monoxide (DLCO) of 7.346% (95%CI 2.257-12.436, p = 0.005) and 3.464% (95%CI -0.205-7.132, p = 0.064), respectively. Reduction in SUVmax correlated significantly with FVC (r = 0.644, p < 0.001) and DLCO (r = 0.582, p < 0.001) improvement. CONCLUSION In cases of suspected pulmonary sarcoidosis, FDG-PET/CT demonstrated good diagnostic performance and correlated with functional health scores. FDG-PET/CT may help to guide immunosuppression in cases of complex sarcoidosis or where treatment rationalisation is needed. CLINICAL RELEVANCE STATEMENT FDG-PET/CT has demonstrated a high diagnostic performance in the evaluation of suspected pulmonary sarcoidosis with radiologically assessed disease activity correlating strongly with clinically derived pulmonary function tests. KEY POINTS In diagnosing pulmonary sarcoidosis, FDG-PET/CT had a sensitivity and specificity of 0.971 and 0.873, respectively. Disease activity, as determined by SUVmax, reduced following treatment in all the included studies. Reduction in SUVmax correlated with an improvement in functional vital capacity, Diffusion Capacity of the Lungs for Carbon Monoxide, and subjective health scoring systems.
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Affiliation(s)
- Ryan Donnelly
- St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland.
- University College Dublin, Belfield, Dublin, 4, Ireland.
| | | | - Gerry McManus
- St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland
| | - Alessandro N Franciosi
- St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland
- University College Dublin, Belfield, Dublin, 4, Ireland
| | - Michael P Keane
- St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland
- University College Dublin, Belfield, Dublin, 4, Ireland
| | - Emmet E McGrath
- St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland
- University College Dublin, Belfield, Dublin, 4, Ireland
| | - Cormac McCarthy
- St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland.
- University College Dublin, Belfield, Dublin, 4, Ireland.
| | - David J Murphy
- St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland.
- University College Dublin, Belfield, Dublin, 4, Ireland.
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Liu Q, Tsai YJ, Gallezot JD, Guo X, Chen MK, Pucar D, Young C, Panin V, Casey M, Miao T, Xie H, Chen X, Zhou B, Carson R, Liu C. Population-based deep image prior for dynamic PET denoising: A data-driven approach to improve parametric quantification. Med Image Anal 2024; 95:103180. [PMID: 38657423 DOI: 10.1016/j.media.2024.103180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
The high noise level of dynamic Positron Emission Tomography (PET) images degrades the quality of parametric images. In this study, we aim to improve the quality and quantitative accuracy of Ki images by utilizing deep learning techniques to reduce the noise in dynamic PET images. We propose a novel denoising technique, Population-based Deep Image Prior (PDIP), which integrates population-based prior information into the optimization process of Deep Image Prior (DIP). Specifically, the population-based prior image is generated from a supervised denoising model that is trained on a prompts-matched static PET dataset comprising 100 clinical studies. The 3D U-Net architecture is employed for both the supervised model and the following DIP optimization process. We evaluated the efficacy of PDIP for noise reduction in 25%-count and 100%-count dynamic PET images from 23 patients by comparing with two other baseline techniques: the Prompts-matched Supervised model (PS) and a conditional DIP (CDIP) model that employs the mean static PET image as the prior. Both the PS and CDIP models show effective noise reduction but result in smoothing and removal of small lesions. In addition, the utilization of a single static image as the prior in the CDIP model also introduces a similar tracer distribution to the denoised dynamic frames, leading to lower Ki in general as well as incorrect Ki in the descending aorta. By contrast, as the proposed PDIP model utilizes intrinsic image features from the dynamic dataset and a large clinical static dataset, it not only achieves comparable noise reduction as the supervised and CDIP models but also improves lesion Ki predictions.
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Affiliation(s)
- Qiong Liu
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
| | - Yu-Jung Tsai
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | | | - Xueqi Guo
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Ming-Kai Chen
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Darko Pucar
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Colin Young
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | | | - Michael Casey
- Siemens Medical Solutions USA, Inc., Knoxville, TN, USA
| | - Tianshun Miao
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Huidong Xie
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Xiongchao Chen
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Bo Zhou
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Richard Carson
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Chi Liu
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.
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Metrard G, Cohen C, Bailly M. Comprehensive literature review of oral and intravenous contrast-enhanced PET/CT: a step forward? Front Med (Lausanne) 2024; 11:1373260. [PMID: 38566921 PMCID: PMC10985176 DOI: 10.3389/fmed.2024.1373260] [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: 01/19/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
The integration of diagnostic CT scans into PET/CT facilitates a comprehensive single examination, presenting potential advantages for patients seeking a thorough one-shot check-up. The introduction of iodinated contrast media during PET scanning raises theoretical concerns about potential interference with uptake quantification, due to the modification of tissue density on CT. Nevertheless, this impact appears generally insignificant for clinical use, compared to the intrinsic variability of standardized uptake values. On the other hand, with the growing indications of PET, especially 18F-FDG PET, contrast enhancement increases the diagnostic performances of the exam, and provides additional information. This improvement in performance achieved through contrast-enhanced PET/CT must be carefully evaluated considering the associated risks and side-effects stemming from the administration of iodinated contrast media. Within this article, we present a comprehensive literature review of contrast enhanced PET/CT, examining the potential impact of iodinated contrast media on quantification, additional side-effects and the pivotal clinically demonstrated benefits of an all-encompassing examination for patients. In conclusion, the clinical benefits of iodinated contrast media are mainly validated by the large diffusion in PET protocols. Contrary to positive oral contrast, which does not appear to offer any major advantage in patient management, intravenous iodine contrast media provides clinical benefits without significant artifact on images or quantification. However, studies on the benefit-risk balance for patients are still lacking.
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Affiliation(s)
- Gilles Metrard
- Nuclear Medicine Department, Orléans University Hospital, Orléans, France
- Centre de Biophysique Moléculaire, CNRS UPR 4301, Université d’Orléans, Orléans, France
| | - Clara Cohen
- Radiology Department, Orléans University Hospital, Orléans, France
| | - Matthieu Bailly
- Nuclear Medicine Department, Orléans University Hospital, Orléans, France
- Centre de Biophysique Moléculaire, CNRS UPR 4301, Université d’Orléans, Orléans, France
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Lu W, Duan Y, Li K, Cheng Z, Qiu J. Metabolic interactions between organs in overweight and obesity using total-body positron emission tomography. Int J Obes (Lond) 2024; 48:94-102. [PMID: 37816863 DOI: 10.1038/s41366-023-01394-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/15/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Overweight and obesity is a complex condition resulting from unbalanced energy homeostasis among various organs. However, systemic abnormalities in overweight and obese people are seldom explored in vivo by metabolic imaging techniques. The aim of this study was to determine metabolic abnormities throughout the body in overweight and obese adults using total-body positron emission tomography (PET) glucose uptake imaging. METHODS Thirty normal weight subjects [body mass index (BMI) < 25 kg/m2, 55.47 ± 13.94 years, 16 men and 14 women], and 26 overweight and obese subjects [BMI ≥ 25 kg/m2, 52.38 ± 9.52 years, 21 men and 5 women] received whole-body 18F-fluorodeoxyglucose PET imaging using the uEXPLORER. Whole-body standardized uptake value normalized by lean body mass (SUL) images were calculated. Metabolic networks were constructed based on the whole-body SUL images using covariance network approach. Both group-level and individual-level network differences between normal weight and overweight/obese subjects were evaluated. Correlation analysis was conducted between network properties and BMI for the overweight/obese subjects. RESULTS Compared with normal weight subjects, overweight/obese subjects exhibited altered network connectivity strength in four network nodes, namely the pancreas (p = 0.033), spleen (p = 0.021), visceral adipose tissue (VAT) (p = 1.12 × 10-5) and bone (p = 0.021). Network deviations of overweight/obese subjects from the normal weight were positively correlated with BMI (r = 0.718, p = 3.64 × 10-5). In addition, overweight/obese subjects experienced altered connections between organs, and some of the altered connections, including pancreas-right lung and VAT-bilateral lung connections were significantly correlated with BMI. CONCLUSION Overweight/obese individuals exhibit metabolic alterations in organ level, and altered metabolic interactions at the systemic level. The proposed approach using total-body PET imaging can reveal individual metabolic variability and metabolic deviations between organs, which would open up a new path for understanding metabolic alterations in overweight and obesity.
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Affiliation(s)
- Weizhao Lu
- School of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271016, China
| | - Yanhua Duan
- Department of PET-CT, the First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital Affiliated to Shandong University, Jinan, 250014, China
| | - Kun Li
- Department of PET-CT, the First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital Affiliated to Shandong University, Jinan, 250014, China
| | - Zhaoping Cheng
- Department of PET-CT, the First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital Affiliated to Shandong University, Jinan, 250014, China.
| | - Jianfeng Qiu
- School of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271016, China.
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Zorz A, D'Alessio A, Guida F, Ramadan RM, Richetta E, Cuppari L, Pellerito R, Sacchetti GM, Brambilla M, Paiusco M, Stasi M, Matheoud R. Impact of patient's habitus on image quality and quantitative metrics in 18F-FDG PET/CT images. Phys Med 2023; 109:102584. [PMID: 37060633 DOI: 10.1016/j.ejmp.2023.102584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023] Open
Abstract
PURPOSE To study how the quantitative parameters of 18F-FDG PET imaging change with the emission scan duration (ESD) and the body-mass-index (BMI) in phantom and patients on a time-of-flight (TOF)-PET/CT system. METHODS The image-quality phantom with (b-NEMA-IQ, BMI = 29.2 kg/m2) and without (NEMA-IEC, BMI = 21.4 kg/m2) a 'belt' of water-bags was filled with 18F-FDG activities to obtain nominal standardized uptake values (SUV) of 19, 8 and 5. Patients with BMI ≤ 25 kg/m2 (L-BMI) and BMI > 25 kg/m2 (H-BMI) were enrolled in this study. Phantom and patients underwent list-mode PET acquisition at 120 s/bed-position. Images reconstructed with clinical protocol and different ESD (120, 90, 75, 60, 45, 30 s) were analysed for comparison of maximum SUV (SUVmax), maximum standardized uptake value lean-body-mass corrected (SULmax) and noise. RESULTS 79 oncologic patients (45 L-BMI, 44 H-BMI) were analysed. From 90 s to 30 s, an increasing variation of SUVmax and SULmax with respect to the reference 120 s time was observed, from 18% to 60% and from 16% to 37% for phantom and patients, respectively. SUVmax values were significantly higher (+50%) in b-NEMA-IQ than NEMA-IQ phantom and in H-BMI (+33%) than L-BMI patients. No significant difference was found in SULmax for the two BMI categories in both phantom and patients. CV values decreased when increasing ESD, being higher in H-BMI patients (0.13-0.25) and b-NEMA-IQ phantom (0.15-0.28) than in L-BMI patients (0.11-0.21) and NEMA-IQ phantom (0.11-0.20). CONCLUSIONS Reduction of ESD may severely impact on the variations of SUVmax and SULmax in 18F-FDG PET/CT imaging. This study confirms recommendations of using SUL for lesion uptake quantification, being unaffected by BMI variation.
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Affiliation(s)
- Alessandra Zorz
- Medical Physics Department, Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, Padova, Italy
| | - Andrea D'Alessio
- Medical Physics Department, University Hospital Maggiore della Carità, C.so Mazzini 18, Novara, Italy
| | - Federica Guida
- Medical Physics Department, Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, Padova, Italy
| | - Rehema Masaka Ramadan
- Department of Medical Physics, University of Trieste, Via Tiepolo 11, Trieste, Italy; Abdus Salam International Centre for Theoretical Physics (ICTP), Strada Costiera 11, Trieste, Italy
| | - Elisa Richetta
- Medical Physics Department, AO Ordine Mauriziano di Torino, Via Magellano 1, Torino, Italy
| | - Lea Cuppari
- Nuclear Medicine Department, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Riccardo Pellerito
- Nuclear Medicine Department, AO Ordine Mauriziano Torino, Via Magellano 1, Torino, Italy
| | - Gian Mauro Sacchetti
- Nuclear Medicine Department, University Hospital Maggiore della Carità, Novara, Italy
| | - Marco Brambilla
- Medical Physics Department, University Hospital Maggiore della Carità, C.so Mazzini 18, Novara, Italy
| | - Marta Paiusco
- Medical Physics Department, Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, Padova, Italy
| | - Michele Stasi
- Medical Physics Department, AO Ordine Mauriziano di Torino, Via Magellano 1, Torino, Italy
| | - Roberta Matheoud
- Medical Physics Department, University Hospital Maggiore della Carità, C.so Mazzini 18, Novara, Italy.
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Sundar LKS, Hacker M, Beyer T. Whole-Body PET Imaging: A Catalyst for Whole-Person Research? J Nucl Med 2023; 64:197-199. [PMID: 36460342 PMCID: PMC9902855 DOI: 10.2967/jnumed.122.264555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Beyer
- Quantitative Imaging and Medical Physics Team, Medical University of Vienna, Vienna, Austria; and
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10
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Gherghe M, Mutuleanu MD, Stanciu AE, Irimescu I, Lazar AM, Toma RV, Trifanescu OG, Anghel RM. Quantitative Assessment of Treatment Response in Metastatic Breast Cancer Patients by SPECT-CT Bone Imaging-Getting Closer to PET-CT. Cancers (Basel) 2023; 15:696. [PMID: 36765651 PMCID: PMC9913230 DOI: 10.3390/cancers15030696] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/15/2023] [Accepted: 01/21/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Cancer represents the major cause of death mainly through its ability to spread to other organs, highlighting the importance of metastatic disease diagnosis and accurate follow up for treatment management purposes. Although until recently the main method for imaging interpretation was represented by qualitative methods, quantitative analysis of SPECT-CT data represents a viable, objective option. METHODS Seventy-five breast cancer patients presenting metastatic bone disease underwent at least two Bone SPECT-CT studies using [99mTc]-HDP between November 2019 to October 2022. RESULTS Our findings show a good positive relationship between the qualitative methods of imaging interpretation and quantitative analysis, with a correlation coefficient of 0.608 between qualitative whole body scintigraphy and quantitative SPECT-CT, and a correlation coefficient of 0.711 between the qualitative and quantitative interpretation of SPECT-CT data; nevertheless, there is a need for accurate, objective and reproducible methods for imaging interpretation, especially for research purposes. CONCLUSIONS Quantitative evaluation of the SPECT-CT data has the potential to be the first choice of imaging interpretation for patient follow up and treatment response evaluation, especially for research purposes, because of its objectivity and expression of uptake changes in absolute units.
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Affiliation(s)
- Mirela Gherghe
- Nuclear Medicine Department, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 București, Romania
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Mario-Demian Mutuleanu
- Nuclear Medicine Department, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 București, Romania
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Adina Elena Stanciu
- Carcinogenesis and Molecular Biology Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Ionela Irimescu
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Alexandra Maria Lazar
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Radu Valeriu Toma
- Oncology Department, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania
- Radiotherapy I Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Oana Gabriela Trifanescu
- Oncology Department, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania
- Radiotherapy II Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Rodica Maricela Anghel
- Oncology Department, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania
- Radiotherapy II Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
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Gherghe M, Lazar AM, Simion L, Irimescu IN, Sterea MC, Mutuleanu MD, Anghel RM. Standardized Uptake Values on SPECT/CT: A Promising Alternative Tool for Treatment Evaluation and Prognosis of Metastatic Neuroendocrine Tumours. Diagnostics (Basel) 2023; 13:318. [PMID: 36673128 PMCID: PMC9857822 DOI: 10.3390/diagnostics13020318] [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: 11/25/2022] [Revised: 01/04/2023] [Accepted: 01/13/2023] [Indexed: 01/17/2023] Open
Abstract
(1) Background: The aim of our study was to assess the feasibility of 99mTcEDDA/HYNIC-TOC SPECT/CT quantitative analysis in evaluating treatment response and disease progression in patients with NETs. (2) Methods: This prospective monocentric study evaluated 35 SPECT/CT examinations performed on 14 patients with neuroendocrine tumours who underwent a baseline and at least one follow-up 99mTcEDDA/HYNIC-TOC scan as part of their clinical management. The examination protocol included a whole-body scan acquired 2 h after the radiotracer’s administration, with the SPECT/CT performed 4 h post-injection. Images were analyzed by two experienced physicians and patients were classified into response categories based on their changes in SUV values. (3) Results: We evaluated 14 baseline studies and 21 follow-up scans, accounting for 123 lesions. A statistically positive correlation has been found between the SUVmax and SUVpeak values in tumoral lesions (p < 0.05). No correlation has been found between the SUV values and the ki67 proliferation index. Finally, 64.29% patients were classified as SD at the end of the study, with only 14.29% of patients exhibiting PD and 21.43% patients with PR. (4) Conclusions: The quantitative analysis of 99mTcEDDA/HYNIC-TOC SPECT/CT data in patients with neuroendocrine tumours could represent an alternative to 68Ga-DOTA-peptides PET/CT for the monitoring and prognosis of NETs.
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Affiliation(s)
- Mirela Gherghe
- Nuclear Medicine Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania
- Nuclear Medicine Department, Institute of Oncology “Professor Doctor Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Alexandra Maria Lazar
- Nuclear Medicine Department, Institute of Oncology “Professor Doctor Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Laurentiu Simion
- Department of Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- 1st Clinic of General Surgery and Surgical Oncology, Bucharest Oncology Institute, 022328 Bucharest, Romania
| | - Ionela-Nicoleta Irimescu
- Nuclear Medicine Department, Institute of Oncology “Professor Doctor Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Maria-Carla Sterea
- Nuclear Medicine Department, Institute of Oncology “Professor Doctor Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Mario-Demian Mutuleanu
- Nuclear Medicine Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania
- Nuclear Medicine Department, Institute of Oncology “Professor Doctor Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Rodica Maricela Anghel
- Oncology Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania
- Radiotherapy Department, Institute of Oncology “Professor Doctor Alexandru Trestioreanu”, 022328 Bucharest, Romania
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12
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Berz AM, Boughdad S, Vietti-Violi N, Digklia A, Dromain C, Dunet V, Duran R. Imaging assessment of toxicity related to immune checkpoint inhibitors. Front Immunol 2023; 14:1133207. [PMID: 36911692 PMCID: PMC9995973 DOI: 10.3389/fimmu.2023.1133207] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
In recent years, a wide range of cancer immunotherapies have been developed and have become increasingly important in cancer treatment across multiple oncologic diseases. In particular, immune checkpoint inhibitors (ICIs) offer promising options to improve patient outcomes. However, a major limitation of these treatments consists in the development of immune-related adverse events (irAEs) occurring in potentially any organ system and affecting up to 76% of the patients. The most frequent toxicities involve the skin, gastrointestinal tract, and endocrine system. Although mostly manageable, potentially life-threatening events, particularly due to neuro-, cardiac, and pulmonary toxicity, occur in up to 30% and 55% of the patients treated with ICI-monotherapy or -combination therapy, respectively. Imaging, in particular computed tomography (CT), magnetic resonance imaging (MRI), and 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG-PET/CT), plays an important role in the detection and characterization of these irAEs. In some patients, irAEs can even be detected on imaging before the onset of clinical symptoms. In this context, it is particularly important to distinguish irAEs from true disease progression and specific immunotherapy related response patterns, such as pseudoprogression. In addition, there are irAEs which might be easily confused with other pathologies such as infection or metastasis. However, many imaging findings, such as in immune-related pneumonitis, are nonspecific. Thus, accurate diagnosis may be delayed underling the importance for adequate imaging features characterization in the appropriate clinical setting in order to provide timely and efficient patient management. 18F-FDG-PET/CT and radiomics have demonstrated to reliably detect these toxicities and potentially have predictive value for identifying patients at risk of developing irAEs. The purpose of this article is to provide a review of the main immunotherapy-related toxicities and discuss their characteristics on imaging.
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Affiliation(s)
- Antonia M Berz
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Sarah Boughdad
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Naïk Vietti-Violi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Clarisse Dromain
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rafael Duran
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Predictive Value of 18F-Fluorodeoxyglucose Positron-Emission Tomography Metabolic and Volumetric Parameters for Systemic Metastasis in Tonsillar Cancer. Cancers (Basel) 2022; 14:cancers14246242. [PMID: 36551727 PMCID: PMC9777518 DOI: 10.3390/cancers14246242] [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: 11/21/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Although the prognosis of tonsillar cancer (human papillomavirus-positive oropharyngeal squamous cell carcinoma) is improving, disease control failure (distant metastasis) still occurs in some cases. We explored whether several 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET) parameters can predict metastasis. We retrospectively reviewed the medical records of 55 patients with tonsil squamous cell carcinoma who underwent pretreatment 18F-FDG positron-emission tomography/computed tomography (PET/CT) followed by primary surgery. During the follow-up period, systemic metastases were found in 7 of the 55 patients. The most common sites were the lungs (33%), bone (22%), brain/skull base (22%), small bowel (11%), and liver (11%). Pathologically, P53 mutation was less common in patients with systemic metastasis (41.7% vs. 14.3%, p = 0.054) than without systemic metastasis. In terms of PET parameters, the metabolic tumor volume (MTV2.5) and total lesion glycolysis (TLG2.5) values were lower in the primary tumor, and higher in the metastatic lymph nodes, of human papillomavirus (HPV)-positive compared to HPV-negative patients (all p < 0.05). The MTV2.5, TLG2.5, and tumor−to−liver uptake ratio were 36.07 ± 54.24 cm3, 183.46 ± 298.62, and 4.90 ± 2.77, respectively, in the systemic metastasis group, respectively; all of these values were higher than those of the patients without systemic metastasis (all p < 0.05). The MTV2.5 value was significantly different between the groups even when the values for the primary tumor and metastatic lymph nodes were summed (53.53 ± 57.78 cm3, p = 0.036). The cut-off value, area under the curve (95% confidence interval), sensitivity, and specificity of MTV2.5 for predicting systemic metastasis were 11.250 cm3, 0.584 (0.036−0.832), 0.571, and 0.565, respectively. The MTV2.5 of metastatic lymph nodes and summed MTV2.5 values of the primary tumor and metastatic lymph nodes were significantly higher in tonsillar cancer patients with than without systemic metastases. We suggest PET/CT scanning for pre-treatment cancer work-up and post-treatment surveillance to consider additional systemic therapy in patients with a high risk of disease control failure.
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Sobhi A, Talaat hamed S, Hussein ES, Lasheen S, Hussein M, Ebrahim Y. Predicting pathological response of locally advanced breast cancer to neoadjuvant chemotherapy: comparing the performance of whole body 18F-FDG PETCT versus DCE-MRI of the breast. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00743-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
With the expansion of the use of the neoadjuvant chemotherapy(NAC) in locally advanced breast cancer (LABC), both dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET CT) are promising methods for assessment of the tumor response during chemotherapy. We aimed to evaluate the diagnostic accuracy of DCE-MRI of breast &18 F-FDG PETCT regarding the assessment of early response to neoadjuvant chemotherapy (NAC) in locally advanced breast cancer patients (LABC) and pathologic complete response (pCR) prediction.
Results
A total of forty LABC patients who had NAC were included in the study. Before and during NAC, PET/CT and DCE-MRI were used. Various morphological and functional criteria were compared and linked with post-operative pathology for both. The MRI sensitivity and specificity in assessing NAC response in conjunction with pathological data were 100% (p = 0.001) and 12.5% (p = 0.18) respectively. The equivalent readings for PET/CT were 94.1% (p = 0.001) and 25% (p = 0.18), respectively, although the estimated total accuracy for both MRI and PETCT was the same measuring 94.1% (p = 0.001) and 25% (p = 0.18) (72%). PETCT had a higher overall accuracy than MRI in assessing the response of axillary lymph nodes (ALN) to NAC (64% and 56%, respectively). Longest diameter of lesion, ADC value, and maximal enhancement in baseline MRI, SUVmax and SUV mean in baseline PETCT were all significant predictors of rCR.
Conclusion
During NAC in the primary breast mass and ALN, DCE-MRI demonstrated a better sensitivity in predicting pCR in LABC patients. Although both MRI and PETCT were equally accurate in detecting pCR of LABC patients to NAC, PETCT was more accurate in detecting pathological response of ALN to NAC.
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Ahmed A, Ali M, Salah H, Eisa RE, Mohieldin H, Omer H, Sulieman A, Tamam N, Bradley D. Evaluation of uptake values of FDG: Body surface area Vs. body weight correction. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gales LN, Brotea-Mosoiu S, Trifanescu OG, Lazar AM, Gherghe M. Understanding COVID Vaccination and Its Implication in Cancer Patients’ Imaging of Lymph Nodes by PET-CT. Diagnostics (Basel) 2022; 12:diagnostics12092163. [PMID: 36140564 PMCID: PMC9497665 DOI: 10.3390/diagnostics12092163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/11/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
(1) Background: The appearance of enlarged lymph nodes on imaging adds another layer of complexity to the differential diagnosis of disease progression versus immune response to COVID-19 vaccines. Our aim was to find an optimal timing between the vaccination and the PET-CT scan. (2) Methods: 25 cancer patients with 18F-FDG PET-CT evaluations and a history of COVID-19 vaccination between September 2021 and December 2021 were retrospectively analyzed to characterize the lymph nodes related to the time interval from COVID vaccination. (3) Results: All patients presented one or more adenopathies localized in the ipsilateral axilla (96%), ipsilateral cervical area (20%), ipsilateral retropectoral (20%) and pulmonary hilum (8%). The median value of SUVmax was 3.5 ± 0.5. There was a significant indirect correlation between SUVmax and the time passed between the vaccination and the PET CT (Pearson Correlation r = −0.54, p = 0.005). There was no significant difference (p = 0.19) in the SUVmax value in patients receiving Moderna mRNA-1273 vaccine vs. BNT162b2 mRNA Pfizer vaccine. (4) Conclusions: Lymph node enlargement is commonly seen in patients post-vaccination for COVID-19 and must be differentiated from disease progression. The data from our study strongly suggests that the minimum interval of time between an mRNA vaccine and a PET-CT should be more than six weeks.
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Affiliation(s)
- Laurentia Nicoleta Gales
- Oncology Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
- Oncology Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania
| | - Silvia Brotea-Mosoiu
- Oncology Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
- Oncology Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania
- Correspondence:
| | - Oana Gabriela Trifanescu
- Oncology Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
- Oncology Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania
| | - Alexandra Maria Lazar
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Mirela Gherghe
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
- Nuclear Medicine Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania
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Riauka TA, Baracos VE, Reif R, Juengling FD, Robinson DM, Wieler M, McEwan AJB. Rapid Standardized CT-Based Method to Determine Lean Body Mass SUV for PET-A Significant Improvement Over Prediction Equations. Front Oncol 2022; 12:812777. [PMID: 35875083 PMCID: PMC9302197 DOI: 10.3389/fonc.2022.812777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/26/2022] [Indexed: 01/18/2023] Open
Abstract
In 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) studies, maximum standardized uptake value (SUVmax) is the parameter commonly used to provide a measurement of the metabolic activity of a tumor. SUV normalized by body mass is affected by the proportions of body fat and lean tissue, which present high variability in patients with cancer. SUV corrected by lean body mass (LBM), denoted as SUL, is recommended to provide more accurate, consistent, and reproducible SUV results; however, LBM is frequently estimated rather than measured. Given the increasing importance of a quantitative PET parameter, especially when comparing PET studies over time to evaluate disease response clinically, and its use in oncological clinical trials, we set out to evaluate the commonly used equations originally derived by James (1976) and Janmahasatian et al. (2005) against computerized tomography (CT)-derived measures of LBM. Methods Whole-body 18F-FDG PET images of 195 adult patients with cancer were analyzed retrospectively. Representative liver SUVmean was normalized by total body mass. SUL was calculated using a quantitative determination of LBM based on the CT component of the PET/CT study (LBMCT) and compared against the equation-estimated SUL. Bland and Altman plots were generated for SUV-SUL differences. Results This consecutive sample of patients undergoing usual care (men, n = 96; women, n = 99) varied in body mass (38-127 kg) and in Body Mass Index (BMI) (14.7-47.2 kg/m2). LBMCT weakly correlated with body mass (men, r2 = 0.32; women, r2 = 0.22), and thus SUV and SULCT were also weakly correlated (men, r2 = 0.24; women, r2 = 0.11). Equations proved inadequate for the assessment of LBM. LBM estimated by James' equation showed a mean bias (overestimation of LBM compared with LBMCT) in men (+6.13 kg; 95% CI 4.61-7.65) and in women (+6.32 kg; 95% CI 5.26-7.39). Janmahasatian's equation provided similarly poor performance. Conclusions CT-based LBM determinations incorporate the patient's current body composition at the time of a PET/CT study, and the information garnered can provide care teams with information with which to more accurately determine FDG uptake values, allowing comparability over multiple scans and treatment courses and will provide a robust basis for the use of PET Response Criteria in Solid Tumors (PERCIST) in clinical trials.
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Affiliation(s)
- Terence A. Riauka
- Division of Medical Physics, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Vickie E. Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Switzerland
| | - Rebecca Reif
- Division of Oncologic Imaging, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Freimut D. Juengling
- Division of Oncologic Imaging, Department of Oncology, University of Alberta, Edmonton, AB, Canada
- Medical Faculty, University Bern, Bern, Switzerland
| | - Don M. Robinson
- Division of Medical Physics, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Marguerite Wieler
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Alexander J. B. McEwan
- Division of Oncologic Imaging, Department of Oncology, University of Alberta, Edmonton, AB, Canada
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Puri T, Blake GM. Comparison of ten predictive equations for estimating lean body mass with dual-energy X-ray absorptiometry in older patients. Br J Radiol 2022; 95:20210378. [PMID: 35143259 PMCID: PMC10993957 DOI: 10.1259/bjr.20210378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 12/30/2021] [Accepted: 01/24/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES White fat contributes to body weight (BW) but accumulates very little [18F]fluorodeoxyglucose ([18F]FDG) in the fasting state. As a result, higher standardised uptake values normalised to BW (SUV) are observed in non-fatty tissue in obese patients compared to those in non-obese patients. Therefore, SUV normalised to lean body mass (SUL) that makes tumour uptake values less dependent on patients' body habitus is considered more appropriate. This study aimed to assess ten mathematical equations to predict lean body mass (LBM) by comparison with dual-energy X-ray absorptiometry (DXA) as the reference method. METHODS DXA-based LBM was compared with ten equation-based estimates of LBM in terms of the slope, bias and 95% limits of agreement (LOA) of Bland-Altman plots, and Pearson correlation coefficients (r). Data from 747 men and 811 women aged 60-65 years were included. RESULTS Gallagher's equation was optimal in males (slope = 0.13, bias = -2.4 kg, LOA = 12.8 kg and r = 0.900) while Janmahasatian's equation was optimal in females (slope = 0.14, bias = -0.9 kg, LOA = 10.7 kg and r = 0.876). Janmahasatian's equation performed slightly better than Gallagher's in the pooled male and female data (slope = 0.00, bias = -1.6 kg, LOA = 12.3 kg and r = 0.959). CONCLUSIONS The Gallagher and Janmahasatian equations were optimal and almost indistinguishable in predicting LBM in subjects aged 60-65 years. ADVANCES IN KNOWLEDGE Determination of the optimum equation for predicting lean body mass to improve the calculation of SUL for [18F]FDG PET quantification.
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Affiliation(s)
- Tanuj Puri
- School of Biomedical Engineering and Imaging Sciences,
King’s College London, St. Thomas’ Hospital,
London, United Kingdom
| | - Glen M Blake
- School of Biomedical Engineering and Imaging Sciences,
King’s College London, St. Thomas’ Hospital,
London, United Kingdom
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Beattie BJ, Akhurst TJ, Augensen F, Humm JL. SUVfdg: A standard-uptake-value (SUV) body habitus normalizer specific to fluorodeoxyglucose (FDG) in humans. PLoS One 2022; 17:e0266704. [PMID: 35446848 PMCID: PMC9022879 DOI: 10.1371/journal.pone.0266704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/25/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
To devise a new body-habitus normalizer to be used in the calculation of an SUV that is specific to the PET tracer 18F-FDG.
Methods
A cohort of 481-patients was selected for analysis of 18F-FDG uptake into tissues unaffected by their disease. Among these, 65-patients had only brain concentrations measured and the remaining 416 were randomly divided into an 86-patient test set and a 330-patient training set. Within the test set, normal liver, spleen and blood measures were made. In the training set, only normal liver concentrations were measured. Using data from the training set, a simple polynomial function of height and weight was selected and optimized in a fitting procedure to predict each patient’s mean liver %ID/ml. This function, when used as a normalizer, defines a new SUV metric (SUVfdg) which we compared to SUV metrics normalized by body weight (SUVbw), lean-body mass (SUVlbm) and body surface-area (SUVbsa) in a five-fold cross-validation. SUVfdg was also evaluated in the independent brain-only and whole-body test sets.
Results
For patients of all sizes including pediatric patients, the normal range of liver 18F-FDG uptake at 60 minutes post injection in units of SUVfdg is 1.0 ± 0.16. Liver, blood, and spleen SUVfdg in all comparisons had lower coefficients of variation compared to SUVbw SUVlbm and SUVbsa. Blood had a mean SUVfdg of 0.8 ± 0.11 and showed no correlation with age, height, or weight. Brain SUVfdg measures were significantly higher (P<0.01) in pediatric patients (4.7 ± 0.9) compared to adults (3.1 ± 0.6).
Conclusion
A new SUV metric, SUVfdg, is proposed. It is hoped that SUVfdg will prove to be better at classifying tumor lesions compared to SUV metrics in current use. Other tracers may benefit from similarly tracer-specific body habitus normalizers.
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Affiliation(s)
- Bradley J. Beattie
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
- * E-mail:
| | - Tim J. Akhurst
- Division of Radiation Oncology and Cancer Imaging, The Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Finn Augensen
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - John L. Humm
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
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Sarikaya I. Biology of Cancer and PET Imaging: Pictorial Review. J Nucl Med Technol 2022; 50:jnmt.121.263534. [PMID: 35440477 DOI: 10.2967/jnmt.121.263534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Development and spread of cancer is a multi-step and complex process which involves number of alterations, interactions and molecular networks. PET imaging is closely related with biology of cancer as it detects the cancer based on biological and pathological changes in tumor cells and tumor microenvironment. In this review article, biology of development and spread of cancer and role of PET imaging in Oncology was summarized and supported with various PET images demonstrating cancer spread patterns.
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21
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Rendl G, Schweighofer-Zwink G, Sorko S, Gallowitsch HJ, Hitzl W, Reisinger D, Pirich C. Assessment of Treatment Response to Lenvatinib in Thyroid Cancer Monitored by F-18 FDG PET/CT Using PERCIST 1.0, Modified PERCIST and EORTC Criteria-Which One Is Most Suitable? Cancers (Basel) 2022; 14:cancers14081868. [PMID: 35454777 PMCID: PMC9029268 DOI: 10.3390/cancers14081868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 12/10/2022] Open
Abstract
Background: We aimed to compare the established metabolic response criteria PERCIST and EORTC for their applicability and predictive value in terms of clinical response assessment early after the initiation of lenvatinib therapy in patients with metastatic radioiodine-refractory (RAI) thyroid cancer (TC). Methods: In 25 patients treated with lenvatinib, baseline and 4-month follow-up F-18 FDG PET/CT images were analyzed using PERCIST 1.0, modified PERCIST (using SUVpeak or SUVmax) and EORTC criteria. Two groups were defined: disease control (DC) and progressive disease (PD), which were correlated with PFS and OS. Results: PERCIST, mPERCIST, PERCISTmax and EORTC could be applied in 80%, 80%, 88% and 100% of the patients based on the requirements of lesion assessment criteria, respectively. With PERCIST, mPERCIST, PERCISTmax and EORTC, the patients classified as DC and PD ranged from 65 to 68% and from 32 to 35%, respectively. Patients with DC exhibited a longer median PFS than patients with PD for EORTC (p < 0.014) and for PERCIST and mPERCIST (p = 0.037), respectively. Conclusion: EORTC and the different PERCIST criteria performed equally regarding the identification of patients with PD requiring treatment changes. However, the applicability of PERCIST 1.0 using SULpeak seems restricted due to the significant proportion of small tumor lesions.
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Affiliation(s)
- Gundula Rendl
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, 5020 Salzburg, Austria; (G.S.-Z.); (D.R.); (C.P.)
- Correspondence: ; Tel.: +43-5-7255-58994
| | - Gregor Schweighofer-Zwink
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, 5020 Salzburg, Austria; (G.S.-Z.); (D.R.); (C.P.)
| | - Stefan Sorko
- Department of Nuclear Medicine and Endocrinology, PET/CT Centre, Klinikum Klagenfurt am Wörthersee, 9020 Klagenfurt, Austria; (S.S.); (H.-J.G.)
| | - Hans-Jürgen Gallowitsch
- Department of Nuclear Medicine and Endocrinology, PET/CT Centre, Klinikum Klagenfurt am Wörthersee, 9020 Klagenfurt, Austria; (S.S.); (H.-J.G.)
| | - Wolfgang Hitzl
- Research and Innovation Management, Biostatistics and Publication of Clinical Trial Studies, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria;
- Department of Ophthalmology and Optometry, University Hospital Salzburg, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
- Research Program Experimental Ophthalmology and Glaucoma Research, University Hospital Salzburg, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Diana Reisinger
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, 5020 Salzburg, Austria; (G.S.-Z.); (D.R.); (C.P.)
| | - Christian Pirich
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, 5020 Salzburg, Austria; (G.S.-Z.); (D.R.); (C.P.)
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22
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El-Galaly TC, Villa D, Cheah CY, Gormsen LC. Pre-treatment total metabolic tumour volumes in lymphoma: Does quantity matter? Br J Haematol 2022; 197:139-155. [PMID: 35037240 DOI: 10.1111/bjh.18016] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/23/2021] [Accepted: 12/10/2021] [Indexed: 11/28/2022]
Abstract
Positron emission tomography/computed tomography (PET/CT) is used for the staging of lymphomas. Clinical information, such as Ann Arbor stage and number of involved sites, is derived from baseline staging and correlates with tumour volume. With modern imaging software, exact measures of total metabolic tumour volumes (tMTV) can be determined, in a semi- or fully-automated manner. Several technical factors, such as tumour segmentation and PET/CT technology influence tMTV and there is no consensus on a standardized uptake value (SUV) thresholding method, or how to include the volumes in the bone marrow and spleen. In diffuse large B-cell lymphoma, follicular lymphoma, peripheral T-cell lymphoma, and Hodgkin lymphoma, tMTV has been shown to predict progression-free survival and/or overall survival, after adjustments for clinical risk scores. However, most studies have used receiver operating curves to determine the optimal cut-off for tMTV and many studies did not include a training-validation approach, which led to the risk of overestimation of the independent prognostic value of tMTV. The identified cut-off values are heterogeneous, even when the same SUV thresholding method is used. Future studies should focus on testing tMTV in homogeneously-treated cohorts and seek to validate identified cut-off values externally so that a prognostic value can be documented, over and above currently used clinical surrogates for tumour volume.
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Affiliation(s)
- Tarec Christoffer El-Galaly
- Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Diego Villa
- BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, British Columbia, Canada
| | - Chan Yoon Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Lars C Gormsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
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23
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Kang S, Kim JD, Choi DL, Choi B. Predicting the Recurrence of Hepatocellular Carcinoma after Primary Living Donor Liver Transplantation Using Metabolic Parameters Obtained from 18F-FDG PET/CT. J Clin Med 2022; 11:jcm11020354. [PMID: 35054048 PMCID: PMC8778128 DOI: 10.3390/jcm11020354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/26/2022] Open
Abstract
This study evaluated the prognostic value of metabolic parameters based on the standardized uptake value (SUV) normalized by total body weight (bwSUV) and by lean body mass (SUL) measured on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for predicting tumor recurrence after primary living donor liver transplantation (LDLT) in patients with hepatocellular carcinoma (HCC) without transplantation locoregional therapy. This retrospective study enrolled 49 patients with HCC. The maximum tumor bwSUV (T-bwSUVmax) and SUL (T-SULmax) were measured on PET. The maximum bwSUV (L-bwSUVmax), mean bwSUV (L-bwSUVmean), maximum SUL (L-SULmax), and mean SUL (L-SULmean) were measured in the liver. All metabolic parameters were evaluated using survival analyses and compared to clinicopathological factors. Tumor recurrence occurred in 16/49 patients. Kaplan–Meier analysis revealed that all metabolic parameters were significant (p < 0.05). Univariate analysis revealed that prothrombin-induced by vitamin K absence or antagonist-II; T-stage; tumor number; tumor size; microvascular invasion; the Milan criteria, University of California, San Francisco (UCSF), and up-to-seven criteria; T-bwSUVmax/L-bwSUVmean; T-SULmax; T-SULmax/L-SULmax; and T-SULmax/L-SULmean were significant predictors. Multivariate analysis revealed that the T-SULmax/L-SULmean (hazard ratio = 115.6; p = 0.001; cut-off, 1.81) and UCSF criteria (hazard ratio = 172.1; p = 0.010) were independent predictors of tumor recurrence. SUL-based metabolic parameters, especially T-SULmax/L-SULmean, were significant, independent predictors of HCC recurrence post-LDLT.
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Affiliation(s)
- Sungmin Kang
- Department of Nuclear Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea;
| | - Joo Dong Kim
- Division of Hepatobiliary Pancreas Surgery and Abdominal Organ Transplantation, Department of Surgery, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea; (J.D.K.); (D.L.C.)
| | - Dong Lak Choi
- Division of Hepatobiliary Pancreas Surgery and Abdominal Organ Transplantation, Department of Surgery, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea; (J.D.K.); (D.L.C.)
| | - Byungwook Choi
- Department of Nuclear Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea;
- Correspondence: ; Tel.: +82-53-650-4789
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24
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Quantitative Analysis of SPECT-CT Data in Metastatic Breast Cancer Patients-The Clinical Significance. Cancers (Basel) 2022; 14:cancers14020273. [PMID: 35053436 PMCID: PMC8773966 DOI: 10.3390/cancers14020273] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/24/2021] [Accepted: 01/02/2022] [Indexed: 01/13/2023] Open
Abstract
Simple Summary Breast cancer represents one of the most common cancers diagnosed in female patients, with up to 75% of the patients with stage IV breast cancer developing metastatic bone lesions. Early detection of bone metastasis and differentiating them from degenerative lesions using molecular imaging techniques, such as SPECT-CT, is important for therapeutic purposes and patient follow-up. This study was conducted to determine if the quantitative analysis of the data acquired by performing SPECT-CT scans can help in differentiating between metastatic lesions and degenerative bone disease. In 70 female patients, we identified the radiotracer uptake in metastatic and degenerative bone lesions and determined the diagnostic accuracy of the SPECT-CT quantitative analysis in differentiating between the two types of lesions. The results provided valuable information that can improve the diagnostic accuracy of metastatic bone lesions and treatment response evaluation in breast cancer patients. Abstract Purpose: To assess the potential added value of the SPECT-CT quantitative analysis in metastatic breast cancer lesions detection and differentiation from degenerative lesions. Methods: This prospective monocentric study was conducted on 70 female patients who underwent SPECT-CT bone scans using 99mTc–HDP that identified the presence of metastatic bone lesions and degenerative lesions in each patient. Once the lesions were identified, a quantitative analysis of radiotracer uptake was conducted. The highest one to five SUVmax values for both metastatic and degenerative bone lesions were identified in each patient and the data were then statistically analyzed. Results: The SUVmax value was significantly higher in metastatic bone lesions than in degenerative lesions (p < 0.001). The diagnostic accuracy of SPECT-CT quantitative data analysis revealed a sensitivity of 91.5% and a specificity of 93.3% at a cut-off value of the SUVmax of 16.6 g/mL. Conclusion: Quantitative analysis performed using SPECT-CT data can improve the diagnostic accuracy in differentiating between metastatic bone lesions and degenerative lesions, thus leading to appropriate treatment and better follow-up in metastatic breast cancer patients.
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25
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Toward Reliable Uptake Metrics in Large Vessel Vasculitis Studies. Diagnostics (Basel) 2021; 11:diagnostics11111986. [PMID: 34829332 PMCID: PMC8617769 DOI: 10.3390/diagnostics11111986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study is to investigate the influence of sex, age, fat mass, fasting blood glucose level (FBGL), and estimated glomerular filtration rate (eGFR) on blood pool activity in patients with large vessel vasculitis (LVV). Blood pool activity was measured in the superior caval vein using mean, maximum, and peak standardized uptake values corrected for body weight (SUVs) and lean body mass (SULs) in 41 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans of LVV patients. Sex influence on the blood pool activity was assessed with t-tests, while linear correlation analyses were used for age, fat mass, FBGL, and eGFR. Significantly higher SUVs were found in women compared with men, whereas SULs were similar between sexes. In addition, higher fat mass was associated with increased SUVs (r = 0.56 to 0.65; all p < 0.001) in the blood pool, but no correlations were found between SULs and fat mass (r = −0.25 to −0.15; all p > 0.05). Lower eGFR was associated with a higher FDG blood pool activity for all uptake values. In FDG-PET/CT studies with LVV patients, we recommend using SUL over SUV, while caution is advised in interpreting SUV and SUL measures when patients have impaired kidney function.
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26
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Adel M, Fawzy A, Younes J, ElRasad S. Role of Positron Emission Tomography with 2-Deoxy-2-[fluorine-18]fluoro-D-glucose Integrated with Computed Tomography in the Evaluation of Hepatic Metabolic Activity due to Steatosis in Lymphoma Patients and its Impact on Deauville Score. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Liver uptake of 2-Deoxy-2-[fluorine-18]fluoro-D-glucose integrated (18F-FDG) is taken as the reference tissue in interpretation of Deauville score (DS), which is considered a response assessment.
AIM: This study was conducted to evaluate the prevalence of hepatic steatosis in patients with lymphoma and the impact of hepatic metabolic activity due to steatosis on 18F-FDG liver uptake and its effect on DS.
MATERIAL AND METHODS: This prospective study was conducted on 77 cases. Seventy-seven patients had baseline positron emission tomography/computed tomography (PET/CT), 69 patients had interim PET/CT, 31 patients had end of treatment (EOT) PET/CT, and 3 patients had follow-up (FU) PET/CT after EOT. The study included 49 female patients (63.6%) and 28 male patients (36.4%). The mean age = 39.5 + 13. Forty-one patients (53.2%) diagnosed as non-Hodgkin lymphoma [HL] while 36 patients (46.8%) diagnosed as HL. Steatosis was diagnosed on the unenhanced CT part of PET/CT examinations using a cutoff value of 42 Hounsfield units. Both maximum standardized uptake value (SUVmax) and SULmax were recorded on the liver and the tumor target lesion. DS was then computed.
RESULTS: Among 77 cases, prevalence of steatosis in baseline (10/77, 12.9%), interim (13/69, 18.8%), and EOT/FU (4/31, 12.9%), there was no significant difference in hepatic steatosis during their time course of their treatment. There was correlation between Liver SUVmax with body mass index (BMI) in each of interim and EOT PET/CT. Regarding SULmax, there was no correlation with BMI. There was no change in interpretation of DS using either SUVmax or SULmax.
CONCLUSION: Steatosis has no practical issue regarding liver metabolic activity (either SUVmax or SULmax) in interpretation of DS. Liver SUVmax is affected by body weight. Unlike, SULmax is not affected by body weight.
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27
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Reyes Marlés RH, Navarro Fernández JL, Puertas García-Sandoval JP, Santonja Medina F, Mohamed Salem L, Frutos Esteban L, Contreras Gutiérrez JF, Castellón Sánchez MI, Ruiz Merino G, Claver Valderas MA. Clinical value of baseline 18F-FDG PET/CT in soft tissue sarcomas. Eur J Hybrid Imaging 2021; 5:16. [PMID: 34476632 PMCID: PMC8413431 DOI: 10.1186/s41824-021-00110-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/24/2021] [Indexed: 01/18/2023] Open
Abstract
Background The use of 18F-FDG Positron emission tomography/Computed tomography (PET/CT) in the initial staging of many cancers is clearly established. Most soft tissue sarcoma (STS) has a high affinity for 18F-FDG, which is why 18F-FDG PET/CT has been proposed as a non-invasive method, useful in diagnosis and follow-up. The standardized uptake value values (SUV), the volume-based metabolic parameters MTV (metabolic tumor volume), and TLG (total lesion glycolysis) determine tumor viability and provide its total volume and the total activity of metabolically active tumor cells. The histological grade is the most important predictor of metastases and mortality associated with STS, and a significant relationship between the metabolic parameters of 18F-FDG PET/CT and the histological grade has been described. Methods A retrospective study was conducted on STS patients, who had histological grade according to the FNCLCC (Fédération Nationale des Centres de Lutte Contre Le Cancer) criteria, as well as a baseline PET/CT. SUV (SUVmax, SUVmean, and SUVpeak), MTV, and TLG were quantified. A T-student test was performed to establish the relationship between the metabolic biomarkers and the histological grade. Their usefulness as predictors of the histological grade was verified using receiver operator characteristic (ROC) curves. A survival function study was performed using the Kaplan–Meier method. To assess the prognostic utility of the metabolic biomarkers we use the Log-Rank method. Results The SUV values were useful to discriminate high-grade STS. We found a significant relationship between the histological grade and the SUV values. SUVmax, SUVpeak, MTV, and TLG were predictors of overall survival (OS). There were no significant differences in the OS for the SUVmean, or in the disease-free survival (DFS) for SUVmax, SUVmean, SUVpeak, MTV, and TLG. Conclusions The SUVmax, SUVmean, and SUVpeak values correlate with the HG and are useful to discriminate high-grade from low-grade STS. Patients with high SUVmax, SUVpeak, MTV, and TLG have a significantly lower OS.
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Affiliation(s)
- Rafael Hernando Reyes Marlés
- Nuclear Medicine Division (DIMEC), Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Las Palmas, Spain. .,Nuclear Medicine Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
| | | | | | - Fernando Santonja Medina
- Orthopedics and Traumatology Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Laroussi Mohamed Salem
- Nuclear Medicine Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Laura Frutos Esteban
- Nuclear Medicine Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | | | - Guadalupe Ruiz Merino
- Data Analytics Department, Instituto Murciano de Investigación Biosanitaria (IMIB) Virgen de la Arrixaca, El Palmar, Murcia, Spain
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28
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Schierz JH, Sarikaya I, Wollina U, Unger L, Sarikaya A. Immune checkpoint inhibitor related adverse effects and FDG PET/CT findings. J Nucl Med Technol 2021; 49:324-329. [PMID: 34330805 DOI: 10.2967/jnmt.121.262151] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
Immune check-point inhibitor (ICI) treatments activate the T-cells against tumor. Activated T-cells not only attack the tumor but also healthy cells, causing an autoimmune reaction in various tissues. These immune related adverse effects (IRAE) cause 18F-fluorodeoxyglucose (FDG) uptake in various tissues due to inflammation. It is important to recognize and report these findings on FDG Positron Emission Tomography/Computed Tomography (PET/CT) studies. FDG PET helps to determine the presence, location and severity of IRAEs. In severe cases, ICI treatments are interrupted or suspended and anti-inflammatory treatments are started. FDG uptake due IRAEs may mimic metastases or disease progression. Their presence may also help predicting response to treatment and have prognostic implications. In this review article, we will provide basic information about ICI treatments, IRAEs and FDG PET/CT findings.
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Affiliation(s)
| | - Ismet Sarikaya
- Kuwait University Faculty of Medicine, Department of Nuclear Medicine, Kuwait, Kuwait
| | - Uwe Wollina
- Municipal Hospital Dresden, Department of Dermatology, Dresden, Germany
| | - Leonore Unger
- Municipal Hospital Dresden, Department of Rheumatology, Dresden, Germany
| | - Ali Sarikaya
- Trakya university Faculty of Medicine, Department of Nuclear Medicine, Turkey
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29
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Zhao J, Xue Q, Chen X, You Z, Wang Z, Yuan J, Liu H, Hu L. Evaluation of SUVlean consistency in FDG and PSMA PET/MR with Dixon-, James-, and Janma-based lean body mass correction. EJNMMI Phys 2021; 8:17. [PMID: 33598849 PMCID: PMC7889776 DOI: 10.1186/s40658-021-00363-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/04/2021] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To systematically evaluate the consistency of various standardized uptake value (SUV) lean body mass (LBM) normalization methods in a clinical positron emission tomography/magnetic resonance imaging (PET/MR) setting. METHODS SUV of brain, liver, prostate, parotid, blood, and muscle were measured in 90 18F-FDG and 28 18F-PSMA PET/MR scans and corrected for LBM using the James, Janma (short for Janmahasatian), and Dixon approaches. The prospective study was performed from December 2018 to August 2020 at Shanghai East Hospital. Forty dual energy X-ray absorptiometry (DXA) measurements of non-fat mass were used as the reference standard. Agreement between different LBM methods was assessed by linear regression and Bland-Altman statistics. SUV's dependency on BMI was evaluated by means of linear regression and Pearson correlation. RESULTS Compared to DXA, the Dixon approach presented the least bias in LBM/weight% than James and Janma models (bias 0.4±7.3%, - 8.0±9.4%, and - 3.3±8.3% respectively). SUV normalized by body weight (SUVbw) was positively correlated with body mass index (BMI) for both FDG (e.g., liver: r = 0.45, p < 0.001) and PSMA scans (r = 0.20, p = 0.31), while SUV normalized by lean body mass (SUVlean) revealed a decreased dependency on BMI (r = 0.22, 0.08, 0.14, p = 0.04, 0.46, 0.18 for Dixon, James, and Janma models, respectively). The liver SUVbw of obese/overweight patients was significantly larger (p < 0.001) than that of normal patients, whereas the bias was mostly eliminated in SUVlean. One-way ANOVA showed significant difference (p < 0.001) between SUVlean in major organs measured using Dixon method vs James and Janma models. CONCLUSION Significant systematic variation was found using different approaches to calculate SUVlean. A consistent correction method should be applied for serial PET/MR scans. The Dixon method provides the most accurate measure of LBM, yielding the least bias of all approaches when compared to DXA.
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Affiliation(s)
- Jun Zhao
- Department of Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Qiaoyi Xue
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Xing Chen
- Department of Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhiwen You
- Department of Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhe Wang
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Jianmin Yuan
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Hui Liu
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Lingzhi Hu
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
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