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Efficacy of Camrelizumab in Advanced Non-Small-Cell Lung Cancer and Prognostic Analysis of Different PET/CT Features. JOURNAL OF ONCOLOGY 2022; 2022:9942918. [PMID: 35368889 PMCID: PMC8975645 DOI: 10.1155/2022/9942918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022]
Abstract
Objective To evaluate the efficacy of the PD-1 inhibitor camrelizumab plus chemotherapy in the first-line treatment of advanced non-small-cell lung cancer (NSCLC) and the prognostic differences of patients with different PET/CT features. Methods Between December 2018 and October 2020, 100 patients with NSCLC assessed for eligibility treated in our institution were recruited and randomly assigned (1 : 1) to receive either the TC regimen chemotherapy (control group) or the TC regimen chemotherapy plus camrelizumab (study group). The primary endpoints were clinical efficacy, progression-free survival (PFS), and overall survival (OS). A decrease of max standard uptake value (SUVmax) of >30% in primary lung cancer was considered as metabolic remission. The prognostic differences of the eligible patients with different PET/CT features were assessed. Survival data were analyzed using the Kaplan-Meier method to obtain the survival rate and calculate the median survival time. Results The metabolic remission rate and objective remission rate were significantly higher with chemotherapy plus camrelizumab versus chemotherapy alone. The study group had significantly higher CD3+ and CD4+ T-cell ratios and CD4+/CD8+ ratio and significantly lower CD8+ T-cell ratio than the control group after treatment. PFS (10 months versus 4 months) and OS (HR = 37.094, P ≤ 0.001) were better with camrelizumab plus chemotherapy versus stand-alone chemotherapy. The incidence of adverse events (AE) was similar between the two groups. The patients in the study group were stratified into metabolic remission and metabolic nonremission based on PET/CT results. Intersubgroup analysis showed significantly better PFS and OS in the metabolic remission group than in the nonmetabolic remission group. Conclusion The camrelizumab plus chemotherapy as a first-line treatment option for NSCLC significantly increases the survival benefit. Metabolic status shown by PET/CT correlates with long-term prognosis and demonstrates a great potential for early assessment of efficacy to support the choice of treatment regimens.
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2
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Iravani A, Turgeon GA, Akhurst T, Callahan JW, Bressel M, Everitt SJ, Siva S, Hofman MS, Hicks RJ, Ball DL, Mac Manus MP. PET-detected pneumonitis following curative-intent chemoradiation in non-small cell lung cancer (NSCLC): recognizing patterns and assessing the impact on the predictive ability of FDG-PET/CT response assessment. Eur J Nucl Med Mol Imaging 2019; 46:1869-1877. [PMID: 31190177 DOI: 10.1007/s00259-019-04388-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 05/31/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Inflammatory FDG uptake in the lung (PET-pneumonitis) following curative-intent radiotherapy (RT)/chemo-RT (CRT) in non-small cell lung cancer (NSCLC) can pose a challenge in FDG-PET/CT response assessment. The aim of this study is to describe different patterns of PET-pneumonitis to guide the interpretation of FDG-PET/CT and investigate its association with tumor response and overall survival (OS). METHODS Retrospective analysis was performed on 87 NSCLC patients in three prospective trials who were treated with radical RT (n = 7) or CRT (n = 80), with baseline and post-treatment FDG-PET/CT. Visual criteria were performed for post-treatment FDG-PET/CT response assessment. The grading of PET-pneumonitis was based on relative lung uptake intensity compared to organs of reference and classified as per Deauville score from grade 1-5. Distribution patterns of PET-pneumonitis were defined as follows: A) patchy/sub-pleural; B) diffuse (involving more than a segment); and C) peripheral (diffusely surrounding a photopenic region). RESULTS Follow-up FDG-PET/CT scans were performed approximately 3 months (median, 89 days; interquartile range, 79-93) after RT. Overall, PET-pneumonitis was present in 62/87 (71%) of patients, with Deauville 2 or 3 in 12/62 (19%) and 4 or 5 in 50/62 (81%) of patients. The frequency of patterns A, B and C of PET-pneumonitis was 19/62 (31%), 20/62 (32%) and 23/62 (37%), respectively. No association was found between grade or pattern of PET-pneumonitis and overall response at follow-up PET/CT (p = 0.27 and p = 0.56, respectively). There was also no significant association between PET-pneumonitis and OS (hazard ratio [HR], 1.3; 95% confidence interval [CI], 0.6-2.5; p = 0.45). Early FDG-PET/CT response assessment, however, was prognostic for OS (HR, 1.7; 95% CI, 1.2-2.2; p < 0.001). CONCLUSION PET-pneumonitis is common in early post-CRT/RT, but pattern recognition may assist in response assessment by FDG-PET/CT. While FDG-PET/CT is a powerful tool for response assessment and prognostication, PET-pneumonitis does not appear to confound early response assessment or to independently predict OS.
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Affiliation(s)
- Amir Iravani
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
| | - Guy-Anne Turgeon
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Tim Akhurst
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Jason W Callahan
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Mathias Bressel
- Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sarah J Everitt
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.,Radiation Therapy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Medical Imaging and Radiation Sciences, Faculty of Medicine and Dentistry, Monash University, Clayton, VIC, Australia
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Michael S Hofman
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Rodney J Hicks
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - David L Ball
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Michael P Mac Manus
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Gkogkozotou VKI, Gkiozos IC, Charpidou AG, Kotteas EA, Boura PG, Tsagouli SN, Syrigos KN. PET/CT and brain MRI role in staging NSCLC: prospective assessment of the accuracy, reliability and cost-effectiveness. Lung Cancer Manag 2019; 7:LMT02. [PMID: 30643581 PMCID: PMC6307538 DOI: 10.2217/lmt-2018-0008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/09/2018] [Indexed: 12/31/2022] Open
Abstract
Aim: To determine whether PET/CT and brain MRI used in staging NSCLC can be accurate, reliable and cost-effective tools. NSCLC represents 80–85% of lung cancer and adequate information on the initial tumor staging is critical for planning an optimal therapeutic strategy. Patients & methods: Data from 30 newly diagnosed NSCLC patients in Greece were collected and prospectively recorded. Patients with potential resectable disease were evaluated to ensure that there are no detectable metastases that would rule out the possibility of a curative surgery. Results: Divergence occurred in 50% of cases of staging with CT or PET/CT alone, while metastases undetectable by the CT were revealed using PET/CT. Unnecessary thoracotomies were avoided by 10% of patients and another 10% was operated on after chemotherapy with a better prognosis. Conclusion: PET/CT and brain MRI combined are reliable for correct staging, reducing avoidable thoracotomies, morbidity rates and costs.
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Affiliation(s)
| | - Ioannis C Gkiozos
- Oncology Unit, 3rd Department of Medicine, National & Kapodistrian University of Athens Medical School, Athens, 11527, GR
| | - Andriani G Charpidou
- Oncology Unit, 3rd Department of Medicine, National & Kapodistrian University of Athens Medical School, Athens, 11527, GR
| | - Elias A Kotteas
- Oncology Unit, 3rd Department of Medicine, National & Kapodistrian University of Athens Medical School, Athens, 11527, GR
| | - Paraskevi G Boura
- Oncology Unit, 3rd Department of Medicine, National & Kapodistrian University of Athens Medical School, Athens, 11527, GR
| | - Sophia N Tsagouli
- Oncology Unit, 3rd Department of Medicine, National & Kapodistrian University of Athens Medical School, Athens, 11527, GR
| | - Konstantinos N Syrigos
- Oncology Unit, 3rd Department of Medicine, National & Kapodistrian University of Athens Medical School, Athens, 11527, GR
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Yuan N, Zhang X, Cao Y, Jiang X, Zhao S, Feng Y, Fan Y, Lu Z, Gao H. Contrast-enhanced computerized tomography combined with a targeted nanoparticle contrast agent for screening for early-phase non-small cell lung cancer. Exp Ther Med 2017; 14:5063-5068. [PMID: 29201215 DOI: 10.3892/etm.2017.5140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 05/11/2017] [Indexed: 12/13/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is a major cause of morbidity and mortality, and patients with NSCLC are frequently diagnosed at an advanced stage. This is primarily due to a lack of advanced and sensitive protocols for the detection of early stage NSCLC. Therefore, methods for the accurate diagnosis of early stage NSCLC are urgently required to improve survival rates. The present study investigated the use of contrast-enhanced computerized tomography (CECT) combined with a targeted nanoparticle contrast agent (TNCA) to diagnose early-stage NSCLC in a mice xenograft model. The TNCA used was lenvatinib, a multi-target tyrosine kinase inhibitor that inhibits vascular endothelial growth factor receptor 1-3, fibroblast growth factor receptor 1-4, platelet-derived growth factor receptor β, proto-oncogene tyrosine-protein kinase receptor Ret and mast/stem cell growth factor receptor Kit. Xenograft NSCLC mice were established and used to analyze the efficacy of CECT-TNCA compared with CT scanning alone. The TNCA was inhaled with the use of an atomizer. The results demonstrated that CECT-TNCA improved the sensitivity of the diagnosis of early stage NSCLC. In addition, imaging using the TNCA enabled the visualization of nodules in the lung in mice with early stage NSCLC. In addition, lung nodule signal enhancement was increased in CECT-TNCA compared with CT, suggesting a high accurate accumulation of the TNCA in tumor nodules. Mice diagnosed with early stage NSCLC exhibited a higher eradication rate of NSCLC after treatment with cisplatin compared with mice with advanced stage NSCLC. These data indicate that the sensitivity and accuracy of CT imaging for the diagnosis of early stage NSCLC was improved through combination with the liposome-encapsulated TNCA.
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Affiliation(s)
- Ninglu Yuan
- Department of Radiology, The First Hospital of Shijiazhuang City, Shijiazhuang, Hebei 050011, P.R. China
| | - Xiaohe Zhang
- Department of Cardiothoracic Surgery, The First Hospital of Shijiazhuang City, Shijiazhuang, Hebei 050011, P.R. China
| | - Yonghui Cao
- Department of Radiology, The First Hospital of Shijiazhuang City, Shijiazhuang, Hebei 050011, P.R. China
| | - Xiaojie Jiang
- Department of Computerized Tomography, The First Hospital of Shijiazhuang City, Shijiazhuang, Hebei 050011, P.R. China
| | - Si Zhao
- Department of Radiology, The First Hospital of Shijiazhuang City, Shijiazhuang, Hebei 050011, P.R. China
| | - Yingying Feng
- Department of Radiology, The First Hospital of Shijiazhuang City, Shijiazhuang, Hebei 050011, P.R. China
| | - Yimeng Fan
- Department of Computerized Tomography, The First Hospital of Shijiazhuang City, Shijiazhuang, Hebei 050011, P.R. China
| | - Zhitao Lu
- Department of Radiology, The First Hospital of Shijiazhuang City, Shijiazhuang, Hebei 050011, P.R. China
| | - Hongmei Gao
- Department of Radiology, The First Hospital of Shijiazhuang City, Shijiazhuang, Hebei 050011, P.R. China
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Zhang K, Du X, Yu K, Zhang K, Zhou Y. Application of novel targeting nanoparticles contrast agent combined with contrast-enhanced computed tomography during screening for early-phase gastric carcinoma. Exp Ther Med 2017; 15:47-54. [PMID: 29387181 PMCID: PMC5769276 DOI: 10.3892/etm.2017.5388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 05/05/2017] [Indexed: 12/12/2022] Open
Abstract
Gastric cancer is one of the most common human tumors worldwide. The biggest bottleneck is a lack of advanced and sensitive protocols for the diagnosis of patients with early-stage gastric cancer. Therefore, more sensitive methods of diagnosing gastric cancer are urgently required to improve survival rates. In this clinical study, contrast-enhanced computed tomography (CECT) with targeting nanoparticles contrast agent (CECT-TNCA) was used to diagnose early-stage gastric cancer. The specific-targeted tyrosine kinase inhibitors of gastric cancer, including platelet-derived growth factor receptor-β, Ret and Kit, were used as TNCAs. A total of 484 patients with suspected gastric cancer were voluntarily recruited to investigate the efficacy of CECT-TNCA in the diagnosis of patients with early-stage gastric cancer. Patients with suspected gastric cancer were subjected CT and CECT-TNCA to detect whether gastric tumors existed. TNCA was orally administered before CT and CECT-TNCA (20 min). Our diagnostic data revealed that CECT-TNCA improved sensitivity and provided a new protocol to diagnose tumors in patients with suspected gastric cancer at the early stage. In addition, imaging using CECT-TNCA enabled the visualization of tiny nodules in the gastric area. CECT-TNCA diagnosed 182 patients with suspected gastric cancer as tumor-free. CECT-TNCA confirmed gastric cancer in 302 patients. Our novel diagnosis indicated significantly (P<0.01) differential signal enhancement in the gastric nodules via CECT-TNCA compared with CT, suggesting higher accuracy and the accumulation of TNCA in tumor nodules in the stomach. Furthermore, survival rates of patients detected by early-diagnosis of CECT-TNCA were significantly higher than the mean five-year survival (P<0.01). In conclusion, our investigations demonstrate that the sensibility and accuracy of CT is improved through combination with liposome-encapsulated nanoparticle contrast agent for the diagnosis of early stage gastric cancer when compared with single CT detection. CECT-TNCA improves the accuracy of CT and diagnostic confidence in assessing mural enhancement in patients with suspected gastric cancer.
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Affiliation(s)
- Kaimin Zhang
- Physical Examination Center, Xianning Central Hospital, Xianning, Hubei 437000, P.R. China
| | - Xijian Du
- Department of Radiology, Xianning Central Hospital, Xianning, Hubei 437000, P.R. China
| | - Kaihu Yu
- Department of Radiology, Xianning Central Hospital, Xianning, Hubei 437000, P.R. China
| | - Kaiyu Zhang
- Department of Radiology, The First People's Hospital of Xianning City, Xianning, Hubei 437000, P.R. China
| | - Yicheng Zhou
- Department of Radiology, Tongji Medical College, Huazhong University of Science Tongji Hospital, Wuhan, Hubei 430030, P.R. China
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Sanz-Santos J, Serra P, Andreo F, Torky M, Centeno C, Morán T, Carcereny E, Fernández E, García-Reina S, Ruiz-Manzano J. Transbronchial and transesophageal fine-needle aspiration using a single ultrasound bronchoscope in the diagnosis of locoregional recurrence of surgically-treated lung cancer. BMC Pulm Med 2017; 17:46. [PMID: 28241873 PMCID: PMC5330131 DOI: 10.1186/s12890-017-0388-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/22/2017] [Indexed: 12/18/2022] Open
Abstract
Background The present study sought to evaluate the usefulness of EBUS-TBNA in the diagnosis of locoregional recurrence of lung cancer in a cohort of lung cancer patients who were previously treated surgically, and describe our initial experience of EUS-B-FNA in this clinical scenario. Methods We retrospectively studied the clinical records of all patients with a previous surgically-treated lung cancer who were referred to our bronchoscopy unit after suspicion of locoregional recurrence. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were evaluated. Results Seventy-three patients were included. EBUS-TBNA confirmed malignancy in 40 patients: 34 confirmed to have locoregional recurrence, six had metachronous tumours. Of the 33 patients with non-malignant EBUS-TBNA; 2 had specific non-malignant diseases, 26 underwent radiological follow up and 5 patients underwent surgery. Of the 26 patients who had radiological follow up; 18 remained stable, three presented thoracic radiological progression and 5 presented extrathoracic progression. Of the 5 patients who underwent surgery; 3 had metachronous tumours, one confirmed to be a true negative and one presented nodal invasion. Seven patients underwent EUS-B-FNA, four of them confirmed to have recurrence. The sensitivity, specificity, NPV, PPV and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were 80.9, 100, 69.2, 100 and 86.6% respectively. Conclusions EBUS-TBNA is an accurate procedure for the diagnosis of locoregional recurrence of surgically-treated lung cancer. EUS-B-FNA combined with EBUS-TBNA broads the diagnostic yield of EBUS-TBNA alone.
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Affiliation(s)
- José Sanz-Santos
- Pulmonology Department, Hospital Germans Trias i Pujol, Carretera de Canyet S/N. 08916, Badalona, Barcelona, Spain.
| | - Pere Serra
- Pulmonology Department, Hospital Germans Trias i Pujol, Carretera de Canyet S/N. 08916, Badalona, Barcelona, Spain.,Department de Medicina. Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Felipe Andreo
- Pulmonology Department, Hospital Germans Trias i Pujol, Carretera de Canyet S/N. 08916, Badalona, Barcelona, Spain
| | - Mohamed Torky
- Pulmonology Department, Hospital Germans Trias i Pujol, Carretera de Canyet S/N. 08916, Badalona, Barcelona, Spain
| | - Carmen Centeno
- Pulmonology Department, Hospital Germans Trias i Pujol, Carretera de Canyet S/N. 08916, Badalona, Barcelona, Spain
| | - Teresa Morán
- Catalan Institute of Oncology, Badalona, Barcelona, Spain
| | - Enric Carcereny
- Thoracic Surgery Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Esther Fernández
- Thoracic Surgery Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Samuel García-Reina
- Thoracic Surgery Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Juan Ruiz-Manzano
- Pulmonology Department, Hospital Germans Trias i Pujol, Carretera de Canyet S/N. 08916, Badalona, Barcelona, Spain
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7
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Jiménez-Bonilla JF, Quirce R, Martínez-Rodríguez I, De Arcocha-Torres M, Carril JM, Banzo I. The Role of PET/CT Molecular Imaging in the Diagnosis of Recurrence and Surveillance of Patients Treated for Non-Small Cell Lung Cancer. Diagnostics (Basel) 2016; 6:diagnostics6040036. [PMID: 27706025 PMCID: PMC5192511 DOI: 10.3390/diagnostics6040036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/08/2016] [Accepted: 09/22/2016] [Indexed: 12/28/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is the leading cause of cancer mortality worldwide and its prognosis remains poor. Molecular imaging with 18F-FDG PET/CT can metabolically characterize the nature of lesions as benign or malignant, allowing a better staging at the diagnosis of this kind of patient. This advantage can also be applied in the re-staging due to the suspicion of recurrent disease. Many patients have a recurrence of the disease, including surgically treated patients. In the current context, with new personalized oncological treatments, the surveillance for recurrence and its accurate diagnosis are crucial to improve their survival. In this paper, we revise the current knowledge about the clinical and molecular factors related to the recurrent disease. In the context of new, promising, available personalized treatments, the role of molecular imaging with PET/CT and 18F-FDG and non-18F-FDG radiotracers in the follow-up of NSCLC-treated patients is especially attractive and interesting.
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Affiliation(s)
- Julio Francisco Jiménez-Bonilla
- Nuclear Medicine Department, University Hospital Marqués de Valdecilla, Molecular Imaging IDIVAL, University of Cantabria, 39008 Santander, Spain.
| | - Remedios Quirce
- Nuclear Medicine Department, University Hospital Marqués de Valdecilla, Molecular Imaging IDIVAL, University of Cantabria, 39008 Santander, Spain.
| | - I Martínez-Rodríguez
- Nuclear Medicine Department, University Hospital Marqués de Valdecilla, Molecular Imaging IDIVAL, University of Cantabria, 39008 Santander, Spain.
| | - María De Arcocha-Torres
- Nuclear Medicine Department, University Hospital Marqués de Valdecilla, Molecular Imaging IDIVAL, University of Cantabria, 39008 Santander, Spain.
| | - José Manuel Carril
- Nuclear Medicine Department, University Hospital Marqués de Valdecilla, Molecular Imaging IDIVAL, University of Cantabria, 39008 Santander, Spain.
| | - Ignacio Banzo
- Nuclear Medicine Department, University Hospital Marqués de Valdecilla, Molecular Imaging IDIVAL, University of Cantabria, 39008 Santander, Spain.
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