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Chesnais H, Bastin N, Miguez S, Kargilis D, Kalluri A, Terry A, Rajapakse CS. Predicting Fractures Using Vertebral 18F-NaF Uptake in Prostate Cancer Patients. J Bone Metab 2023; 30:329-337. [PMID: 38073266 PMCID: PMC10721380 DOI: 10.11005/jbm.2023.30.4.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/01/2023] [Accepted: 10/08/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Patients with prostate cancer tend to be at heightened risk for fracture due to bone metastases and treatment with androgen-deprivation therapy. Bone mineral density (BMD) derived from dual energy X-ray absorptiometry (DXA) is the standard for determining fracture risk in this population. However, BMD often fails to predict many osteoporotic fractures. Patients with prostate cancer also undergo 18F-sodium fluoride (18F-NaF)-positron emission tomography/computed tomography (PET/CT) to monitor metastases. The purpose of this study was to assess whether bone deposition, assessed by 18F-NaF uptake in 18F-NaF PET/CT, could predict incident fractures better than DXA- or CT-derived BMD in patients with prostate cancer. METHODS This study included 105 males with prostate cancer who had undergone full body 18F-NaF PET/CT. Standardized uptake value (SUVmean and SUVmax) and CT-derived Hounsfield units (HU), a correlate of BMD, were recorded for each vertebral body. The average SUVmean, SUVmax, and HU were calculated for cervical, thoracic, lumbar, and sacral areas. The t-test was used to assess significant differences between fracture and no-fracture groups. RESULTS The SUVmean and SUVmax values for the thoracic area were lower in the fracture group than in the no-fracture group. There was no significant difference in cervical, thoracic, lumbar or sacral HU between the 2 groups. CONCLUSIONS Our study reports that lower PET-derived non-metastatic bone deposition in the thoracic spine is correlated with incidence of fractures in patients with prostate cancer. CT-derived HU, a correlate of DXA-derived BMD, was not predictive of fracture risk. 18F-NaF PET/CT may provide important insight into bone quality and fracture risk.
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Affiliation(s)
- Helene Chesnais
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nikita Bastin
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sofia Miguez
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Kargilis
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Anita Kalluri
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashley Terry
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
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2
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Lindgren Belal S, Larsson M, Holm J, Buch-Olsen KM, Sörensen J, Bjartell A, Edenbrandt L, Trägårdh E. Automated quantification of PET/CT skeletal tumor burden in prostate cancer using artificial intelligence: The PET index. Eur J Nucl Med Mol Imaging 2023; 50:1510-1520. [PMID: 36650356 PMCID: PMC10027829 DOI: 10.1007/s00259-023-06108-4] [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: 09/14/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
PURPOSE Consistent assessment of bone metastases is crucial for patient management and clinical trials in prostate cancer (PCa). We aimed to develop a fully automated convolutional neural network (CNN)-based model for calculating PET/CT skeletal tumor burden in patients with PCa. METHODS A total of 168 patients from three centers were divided into training, validation, and test groups. Manual annotations of skeletal lesions in [18F]fluoride PET/CT scans were used to train a CNN. The AI model was evaluated in 26 patients and compared to segmentations by physicians and to a SUV 15 threshold. PET index representing the percentage of skeletal volume taken up by lesions was estimated. RESULTS There was no case in which all readers agreed on prevalence of lesions that the AI model failed to detect. PET index by the AI model correlated moderately strong to physician PET index (mean r = 0.69). Threshold PET index correlated fairly with physician PET index (mean r = 0.49). The sensitivity for lesion detection was 65-76% for AI, 68-91% for physicians, and 44-51% for threshold depending on which physician was considered reference. CONCLUSION It was possible to develop an AI-based model for automated assessment of PET/CT skeletal tumor burden. The model's performance was superior to using a threshold and provides fully automated calculation of whole-body skeletal tumor burden. It could be further developed to apply to different radiotracers. Objective scan evaluation is a first step toward developing a PET/CT imaging biomarker for PCa skeletal metastases.
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Affiliation(s)
- Sarah Lindgren Belal
- Division of Nuclear Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden.
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.
- Wallenberg Center for Molecular Medicine, Lund University, Malmö, Sweden.
| | | | - Jorun Holm
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | | | - Jens Sörensen
- Division of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Bjartell
- Division of Urological Cancer, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Lars Edenbrandt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Elin Trägårdh
- Division of Nuclear Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Malmö, Sweden
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3
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Nautiyal A, Jha AK, Mithun S, Sawant V, Jadhav R, Khairnar K, Rangarajan V. Normal Skeletal Standardized Uptake Values Obtained from Quantitative Single-Photon Emission Computed Tomography/Computed Tomography: Time-Dependent Study on Breast Cancer Patients. Indian J Nucl Med 2021; 36:398-411. [PMID: 35125758 PMCID: PMC8771070 DOI: 10.4103/ijnm.ijnm_47_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/14/2021] [Accepted: 08/31/2021] [Indexed: 11/09/2022] Open
Abstract
Aim: To estimate the standard uptake values (SUVs) of Tc-99m methylene-diphosphonate (Tc-99m MDP) from normal skeletal sites in breast cancer patients using quantitative single-photon emission computed tomography (SPECT). Materials and Methods: A total of 60 breast cancer patients who underwent Tc-99m MDP SPECT/CT study at different postinjection acquisition times were included in this study. Based on postinjection acquisition time, patients were divided into four study groups (n_15 each), i.e. Ist (2 h), IInd (3 h), IIIrd (4 h), and IVth (5 h). Image quantification (SUVmax and SUVmean) was performed using Q.Metrix software. Delineation of volume of interest was shaped around different bones of the skeletal system. Results: The highest normal SUVmax and SUVmean values were observed in lumber and thoracic vertebra (8.89 ± 2.26 and 2.89 ± 0.58) for Group I and in pelvis and thoracic (9.6 ± 1.32 and 3.04 ± 0.64), (10.93 ± 3.91 and 3.65 ± 0.97), (11.33 ± 2.67 and 3.65 ± 0.22) for Group II, III and IV, respectively. Lowest normal SUVmax and SUVmean values were observed in humerus and ribs (3.22 ± 0.67 and 0.97 ± 0.18), (5.16 ± 1.82 and 1.18 ± 0.16) for Group I, IV, and in humerus (3.17 ± 0.58 and 0.85 ± 0.26), (3.98 ± 1.12 and 1.04 ± 0.28) for Group II and III, respectively. Significant difference (P < 0.05) noted in SUVmax for sternum, cervical, humerus, ribs, and pelvis with respect to time. However, significant difference (P < 0.05) noted in SUVmean for all skeletal sites with respect to time. Conclusions: Our study shows variability in normal SUV values for different skeletal sites in breast cancer patients. Vertebral bodies and pelvis contribute highest SUV values. Time dependency of SUVs emphasizes the usefulness of routinely acquired images at the same time after Tc-99m MDP injection, especially in follow-up studies.
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Affiliation(s)
- Amit Nautiyal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ashish Kumar Jha
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sneha Mithun
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Viraj Sawant
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Raveena Jadhav
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kranti Khairnar
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
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4
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18F-Sodium Fluoride PET as a Diagnostic Modality for Metabolic, Autoimmune, and Osteogenic Bone Disorders: Cellular Mechanisms and Clinical Applications. Int J Mol Sci 2021; 22:ijms22126504. [PMID: 34204387 PMCID: PMC8234710 DOI: 10.3390/ijms22126504] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/13/2021] [Accepted: 06/13/2021] [Indexed: 01/31/2023] Open
Abstract
In a healthy body, homeostatic actions of osteoclasts and osteoblasts maintain the integrity of the skeletal system. When cellular activities of osteoclasts and osteoblasts become abnormal, pathological bone conditions, such as osteoporosis, can occur. Traditional imaging modalities, such as radiographs, are insensitive to the early cellular changes that precede gross pathological findings, often leading to delayed disease diagnoses and suboptimal therapeutic strategies. 18F-sodium fluoride (18F-NaF)-positron emission tomography (PET) is an emerging imaging modality with the potential for early diagnosis and monitoring of bone diseases through the detection of subtle metabolic changes. Specifically, the dissociated 18F- is incorporated into hydroxyapatite, and its uptake reflects osteoblastic activity and bone perfusion, allowing for the quantification of bone turnover. While 18F-NaF-PET has traditionally been used to detect metastatic bone disease, recent literature corroborates the use of 18F-NaF-PET in benign osseous conditions as well. In this review, we discuss the cellular mechanisms of 18F-NaF-PET and examine recent findings on its clinical application in diverse metabolic, autoimmune, and osteogenic bone disorders.
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5
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Ayubcha C, Raynor WY, Borja AJ, Seraj SM, Rojulpote C, Werner TJ, Revheim ME, Rajapakse CS, Alavi A. Magnetic resonance imaging-based partial volume-corrected 18F-sodium fluoride positron emission tomography in the femoral neck. Nucl Med Commun 2021; 42:416-420. [PMID: 33306627 DOI: 10.1097/mnm.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES 18F-sodium fluoride (NaF) is a radiotracer used in PET that reflects calcium metabolism and osteoblastic activity. In this study, we assessed the construct validity of a novel application of global assessment to measure NaF uptake in the femoral neck as a method of evaluating physiologic changes in osteoblastic metabolism with age. METHODS Whole-body NaF-PET/computed tomography (CT) images and MRI of 24 male patients with a history of nonmetastatic prostate cancer between the ages of 36 and 82 years (67.8 ± 9.6) were analyzed. A region of interest delineated the entire femoral neck on the PET/CT image to determine the mean standardized uptake value (SUVmean). Correction for the partial volume effect was performed by measuring the volume of inert yellow bone marrow by MRI segmentation. Multiple linear regression was used to assess the relationship of uptake with age and body weight. RESULTS The SUVmean with and without partial volume correction decreased with respect to age (P = 0.001 and P = 0.002, respectively). Body weight was not significantly related to any measured PET parameter. CONCLUSION Our results support the use of global NaF uptake with magnetic resonance-derived partial volume correction in the femoral neck. Because osteoblastic metabolism is known to decrease with normal aging, the observed decrease in NaF uptake constitutes evidence for convergent validity, indicating that the proposed methodology likely reflects systemic osteoblastic activity. Future studies of this methodology are warranted in other instances of varying osteoblastic activity such as in metabolic bone diseases and for the evaluation of therapy targeting osteoblastic metabolism.
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Affiliation(s)
- Cyrus Ayubcha
- Department of Radiology, Hospital of the University of Pennsylvania
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania
- Department of Medicine, Drexel University College of Medicine
| | - Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania
- Department of Orthopedic Surgery, Hospital of the University of Pennsylvania
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Siavash M Seraj
- Department of Radiology, Hospital of the University of Pennsylvania
| | | | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of the University of Pennsylvania
- Division for Radiology and Nuclear Medicine, Oslo University Hospital
- Department of Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Chamith S Rajapakse
- Department of Radiology, Hospital of the University of Pennsylvania
- Department of Orthopedic Surgery, Hospital of the University of Pennsylvania
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania
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6
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Hassan H, Othman MF, Razak HRA. 18F-labeled bisphosphonate as an alternative candidate to the gold standard [18F]sodium fluoride ([18F]NaF) for PET bone imaging. Curr Med Imaging 2021; 17:1271-1275. [PMID: 33593263 DOI: 10.2174/1573405617666210216091202] [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: 11/19/2020] [Revised: 12/24/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022]
Abstract
Bone metastases are a common source of malignancy in the skeleton and occur much more often than primary bone cancer. Several works were ongoing to identify early markers for bone metastasis and novel drug targets to improve patients' quality of life. As some concerns exist with the [18F]sodium fluoride in positron emission tomography (PET) bone imaging, there has been an increase in the number of targeted radiopharmaceutical markers for bone metastases imaging in its competitor, 68Ga. Since 18F properties are superior to those of 68Ga, there is a distinct motivation for developing 18F radiopharmaceuticals for bone metastases imaging.
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Affiliation(s)
- Hishar Hassan
- Centre for Diagnostic Nuclear Imaging, Universiti Putra Malaysia, 43400 Serdang, Selangor. Malaysia
| | - Muhammad Faiz Othman
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA, 42300 Bandar Puncak Alam, Selangor. Malaysia
| | - Hairil Rashmizal Abdul Razak
- Department of Radiology, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor. Malaysia
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7
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Zirakchian Zadeh M, Østergaard B, Raynor WY, Revheim ME, Seraj SM, Acosta-Montenegro O, Ayubcha C, Yellanki DP, Al-Zaghal A, Nielsen AL, Constantinescu CM, Gerke O, Werner TJ, Zhuang H, Abildgaard N, Høilund-Carlsen PF, Alavi A. Comparison of 18F-sodium fluoride uptake in the whole bone, pelvis, and femoral neck of multiple myeloma patients before and after high-dose therapy and conventional-dose chemotherapy. Eur J Nucl Med Mol Imaging 2020; 47:2846-2855. [DOI: 10.1007/s00259-020-04768-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/10/2020] [Indexed: 02/06/2023]
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8
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Korkmaz U, Ustun F. 18F-NaF PET/CT and Extraordinary Involvement: Non-calcific Brain Involvement in a Prostate Cancer Case. Mol Imaging Radionucl Ther 2020; 29:41-44. [PMID: 32079388 PMCID: PMC7057725 DOI: 10.4274/mirt.galenos.2019.85547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
With the increase in the diagnosis of the cancer, the frequency of using imaging methods for diagnosis and for staging is also increased. Because of the complex structure of cancer and tumor behavior, the assessment methods have been updated and metabolic imaging has gained weight. The most popular of these techniques is hybrid positron emission tomography/computed tomography (PET/CT) systems. Prostate cancer is the second most common cancer in the world, is the fifth common type in cancer-related male deaths. Estimation of prognosis and treatment planning of the patients are based on the TNM classification. Bone metastasis is a prognostic factor of morbidity and mortality in prostate cancer. Sodium fluoride (NaF) PET/CT is a promising imaging modality in evaluation of skeletal system. This article will review the involvement of 18F-NaF in extra-osseous tissues in the prostate cancer and reveal the fundamental differences between 18F-NaF imaging and 18F-FDG imaging in these areas.
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Affiliation(s)
- Ulku Korkmaz
- Trakya University Faculty of Medicine, Department of Nuclear Medicine, Edirne, Turkey
| | - Funda Ustun
- Trakya University Faculty of Medicine, Department of Nuclear Medicine, Edirne, Turkey
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9
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Ahuja K, Sotoudeh H, Galgano SJ, Singh R, Gupta N, Gaddamanugu S, Choudhary G. 18F-Sodium Fluoride PET: History, Technical Feasibility, Mechanism of Action, Normal Biodistribution, and Diagnostic Performance in Bone Metastasis Detection Compared with Other Imaging Modalities. J Nucl Med Technol 2019; 48:9-16. [PMID: 31811067 DOI: 10.2967/jnmt.119.234336] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
Abstract
The skeleton is the third most common site for metastasis overall, after the lungs and liver. Accurate diagnosis of osseous metastasis is critical for initial staging, treatment planning, restaging, treatment monitoring, and survival prediction. Currently, 99mTc-methylene diphosphonate whole-body scanning is the cornerstone of imaging to detect osseous metastasis. Although 18F-sodium fluoride (18F-NaF) was one of the oldest medical tracers for this purpose, it was replaced by other tracers because of their better physical properties, until recently. Continued development of PET scanners has opened a new era for 18F-NaF, and given its higher sensitivity, there have been increasing applications in imaging. In this review, we will discuss the history, technical aspects, radiobiology, and biodistribution of this tracer. Finally, we compare the accuracy of 18F-NaF PET with other conventional imaging methods for detection of osseous metastasis.
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Affiliation(s)
- Kriti Ahuja
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Houman Sotoudeh
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ramandeep Singh
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Nishant Gupta
- Department of Radiology, Columbia University at Bassett Healthcare, Cooperstown, New York
| | | | - Gagandeep Choudhary
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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10
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The beginning of the end for conventional RECIST - novel therapies require novel imaging approaches. Nat Rev Clin Oncol 2019; 16:442-458. [PMID: 30718844 DOI: 10.1038/s41571-019-0169-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Owing to improvements in our understanding of the biological principles of tumour initiation and progression, a wide variety of novel targeted therapies have been developed. Developments in biomedical imaging, however, have not kept pace with these improvements and are still mainly designed to determine lesion size alone, which is reflected in the Response Evaluation Criteria in Solid Tumors (RECIST). Imaging approaches currently used for the evaluation of treatment responses in patients with solid tumours, therefore, often fail to detect successful responses to novel targeted agents and might even falsely suggest disease progression, a scenario known as pseudoprogression. The ability to differentiate between responders and nonresponders early in the course of treatment is essential to allowing the early adjustment of treatment regimens. Various imaging approaches targeting a single dedicated tumour feature, as described in the hallmarks of cancer, have been successful in preclinical investigations, and some have been evaluated in pilot clinical trials. However, these approaches have largely not been implemented in clinical practice. In this Review, we describe current biomedical imaging approaches used to monitor responses to treatment in patients receiving novel targeted therapies, including a summary of the most promising future approaches and how these might improve clinical practice.
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11
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The Continuing Evolution of Molecular Functional Imaging in Clinical Oncology: The Road to Precision Medicine and Radiogenomics (Part I). Mol Diagn Ther 2019; 23:1-26. [PMID: 30411216 DOI: 10.1007/s40291-018-0366-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The present era of precision medicine sees 'cancer' as a consequence of molecular derangements occurring at the commencement of the disease process, with morphologic changes happening much later in the process of tumorigenesis. Conventional imaging techniques, such as computed tomography (CT), ultrasound, and magnetic resonance imaging (MRI), play an integral role in the detection of disease at a macroscopic level. However, molecular functional imaging (MFI) techniques entail the visualisation and quantification of biochemical and physiological processes occurring during tumorigenesis, and thus has the potential to play a key role in heralding the transition from the concept of 'one size fits all' to 'precision medicine'. Integration of MFI with other fields of tumour biology such as genomics has spawned a novel concept called 'radiogenomics', which could serve as an indispensable tool in translational cancer research. With recent advances in medical image processing, such as texture analysis, deep learning, and artificial intelligence (AI), the future seems promising; however, their clinical utility remains unproven at present. Despite the emergence of novel imaging biomarkers, a majority of these require validation before clinical translation is possible. In this two-part review, we discuss the systematic collaboration across structural, anatomical, and molecular imaging techniques that constitute MFI. Part I reviews positron emission tomography, radiogenomics, AI, and optical imaging, while part II reviews MRI, CT and ultrasound, their current status, and recent advances in the field of precision oncology.
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13
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Harmon SA, Mena E, Shih JH, Adler S, McKinney Y, Bergvall E, Mehralivand S, Sowalsky AG, Couvillon A, Madan RA, Gulley JL, Eary J, Mease RC, Pomper MG, Dahut WL, Turkbey B, Lindenberg L, Choyke PL. A comparison of prostate cancer bone metastases on 18F-Sodium Fluoride and Prostate Specific Membrane Antigen ( 18F-PSMA) PET/CT: Discordant uptake in the same lesion. Oncotarget 2018; 9:37676-37688. [PMID: 30701023 PMCID: PMC6340866 DOI: 10.18632/oncotarget.26481] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/04/2018] [Indexed: 12/27/2022] Open
Abstract
Purpose Prostate-Specific Membrane Antigen (PSMA) PET/CT has been introduced as a sensitive method for characterizing metastatic prostate cancer. The purpose of this study is to compare the spatial concordance of 18F-NaF PET/CT and 18F-PSMA-targeted PET/CT within prostate cancer bone metastases. Methods Prostate cancer patients with known bone metastases underwent PSMA-targeted PET/CT (18F-DCFBC or 18F-DCFPyL) and 18F-NaF PET/CT. In pelvic and spinal lesions detected by both radiotracers, regions-of-interest (ROIs) derived by various thresholds of uptake intensity were compared for spatial colocalization. Overlap volume was correlated with uptake characteristics and disease status. Results The study included 149 lesions in 19 patients. Qualitatively, lesions exhibited a heterogeneous range of spatial concordance between PSMA and NaF uptake from completely matched to completely discordant. Quantitatively, overlap volume decreased as a function of tracer intensity. and disease status, where lesions from patients with castration-sensitive disease showed higher spatial concordance while lesions from patients with castration-resistant disease demonstrated more frequent spatial discordance. Conclusion As metastatic prostate cancer progresses from castration-sensitive to castration-resistant, greater discordance is observed between NaF PET and PSMA PET uptake. This may indicate a possible phenotypic shift to tumor growth that is more independent of bone remodeling via osteoblastic formation.
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Affiliation(s)
- Stephanie A Harmon
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA.,Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Esther Mena
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Joanna H Shih
- Biometric Research Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Stephen Adler
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA.,Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Yolanda McKinney
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Ethan Bergvall
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Sherif Mehralivand
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Adam G Sowalsky
- Laboratory of Genitourinary Cancer Pathogenesis, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Anna Couvillon
- Genitourinary Malignancies Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Ravi A Madan
- Genitourinary Malignancies Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - James L Gulley
- Genitourinary Malignancies Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Janet Eary
- Cancer Imaging Program, National Cancer Institute, NIH, Rockville, MD, USA
| | - Ronnie C Mease
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin G Pomper
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William L Dahut
- Genitourinary Malignancies Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Liza Lindenberg
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
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14
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Perk T, Chen S, Harmon S, Lin C, Bradshaw T, Perlman S, Liu G, Jeraj R. A statistically optimized regional thresholding method (SORT) for bone lesion detection in 18F-NaF PET/CT imaging. ACTA ACUST UNITED AC 2018; 63:225018. [DOI: 10.1088/1361-6560/aaebba] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Zhang Y, Chen Y, Huang Z, Zhang L, Wan Q, Lei L. Comparison of 18F-NaF PET/CT and 18F-FDG PET/CT for Detection of Skull-Base Invasion and Osseous Metastases in Nasopharyngeal Carcinoma. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:8271313. [PMID: 30254551 PMCID: PMC6145050 DOI: 10.1155/2018/8271313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/09/2018] [Indexed: 11/17/2022]
Abstract
Our study aimed at comparing the diagnostic value of 18F-NaF positron emission tomography-computed tomography (PET/CT) and 18F-fluorodeoxyglucose (FDG) PET/CT for detection of skull-base invasion and osseous metastases in patients with nasopharyngeal carcinoma (NPC). Our study retrospectively analyzed 45 patients with pathologically proven NPC. They all underwent both 18F-NaF PET/CT and 18F-FDG PET/CT within a 7-day interval. Bone metastases were confirmed by follow-up using PET/CT, enhance-contrast computed tomography (CT), and magnetic resonance image (MRI). These two examinations were compared using per-patient-based analysis and per-lesion-based analysis. 18F-NaF PET/CT detected 27 patients with skull-base invasion, whereas 18F-FDG PET/CT detected 17 patients. 18F-NaF PET/CT and 18F-FDG PET/CT differed significantly in diagnosing skull-base invasion (p=0.02) and sensitivity (p=0.008). The sensitivity, specificity, and agreement rate of 18F-NaF PET/CT for detecting bone metastatic lesions were 98.3%, 65.7%, and 92.9%, respectively; these values were 42.9%, 97.1%, and 51.9%, respectively, for 18F-FDG PET/CT. 18F-NaF PET/CT and 18F-FDG PET/CT differed significantly in the number of osseous metastases detected (t=2.45, p=0.18) sensitivity (p < 0.0001) and specificity (p=0.003). In patients with nasopharyngeal carcinoma, 18F-NaF PET/CT assessed invasion of the skull base better and detected more osseous metastases than 18F-FDG PET/CT.
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Affiliation(s)
- Yin Zhang
- Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yue Chen
- Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Zhanwen Huang
- Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Li Zhang
- Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qiang Wan
- Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lei Lei
- Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
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Hulsart-Billström G, Selvaraju RK, Estrada S, Lubberink M, Asplund V, Bergman K, Marsell R, Larsson S, Antoni G. Non-invasive tri-modal visualisation via PET/SPECT/μCT of recombinant human bone morphogenetic protein-2 retention and associated bone regeneration: A proof of concept. J Control Release 2018; 285:178-186. [DOI: 10.1016/j.jconrel.2018.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 07/06/2018] [Accepted: 07/06/2018] [Indexed: 01/02/2023]
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17
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Fiz F, Dittman H, Campi C, Morbelli S, Marini C, Brignone M, Bauckneht M, Piva R, Massone AM, Piana M, Sambuceti G, la Fougère C. Assessment of Skeletal Tumor Load in Metastasized Castration-Resistant Prostate Cancer Patients: A Review of Available Methods and an Overview on Future Perspectives. Bioengineering (Basel) 2018; 5:bioengineering5030058. [PMID: 30060546 PMCID: PMC6163573 DOI: 10.3390/bioengineering5030058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 07/23/2018] [Accepted: 07/26/2018] [Indexed: 11/16/2022] Open
Abstract
Metastasized castration-resistant prostate cancer (mCRPC), is the most advanced form of prostate neoplasia, where massive spread to the skeletal tissue is frequent. Patients with this condition are benefiting from an increasing number of treatment options. However, assessing tumor response in patients with multiple localizations might be challenging. For this reason, many computational approaches have been developed in the last decades to quantify the skeletal tumor burden and treatment response. In this review, we analyzed the progressive development and diffusion of such approaches. A computerized literature search of the PubMed/Medline was conducted, including articles between January 2008 and March 2018. The search was expanded by manually reviewing the reference list of the chosen articles. Thirty-five studies were identified. The number of eligible studies greatly increased over time. Studies could be categorized in the following categories: automated analysis of 2D scans, SUV-based thresholding, hybrid CT- and SUV-based thresholding, and MRI-based thresholding. All methods are discussed in detail. Automated analysis of bone tumor burden in mCRPC is a growing field of research; when choosing the appropriate method of analysis, it is important to consider the possible advantages as well as the limitations thoroughly.
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Affiliation(s)
- Francesco Fiz
- Nuclear Medicine Unit, Department of Radiology, Uni-Klinikum Tübingen, 72076 Tübingen, Germany.
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy.
| | - Helmut Dittman
- Nuclear Medicine Unit, Department of Radiology, Uni-Klinikum Tübingen, 72076 Tübingen, Germany.
| | - Cristina Campi
- Nuclear Medicine Unit, Department of Medicine-DIMED, University Hospital of Padua, 35128 Padua, Italy.
| | - Silvia Morbelli
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, 16132 Genoa, Italy.
| | | | - Massimo Brignone
- Department of Engineering, University of Genoa, Pole of Savona, 17100 Savona, Italy.
| | - Matteo Bauckneht
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, 16132 Genoa, Italy.
| | - Roberta Piva
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, 16132 Genoa, Italy.
| | - Anna Maria Massone
- National Council of Research-SPIN, 16152 Genoa, Italy.
- Department of Mathematics, University of Genoa, 16146 Genoa, Italy.
| | - Michele Piana
- National Council of Research-SPIN, 16152 Genoa, Italy.
- Department of Mathematics, University of Genoa, 16146 Genoa, Italy.
| | - Gianmario Sambuceti
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, 16132 Genoa, Italy.
| | - Christian la Fougère
- Nuclear Medicine Unit, Department of Radiology, Uni-Klinikum Tübingen, 72076 Tübingen, Germany.
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Abstract
OBJECTIVE The aim of this article is to present examples in which sodium fluoride labelled with 18F (NaF) bone PET/CT would be a useful adjunct to guide complex clinical decisions about the staging, restaging, and treatment approach for patients with skeletal metastases and benign causes of NaF activity that can be mistaken for bone metastases. We present a pictorial review of selected cases of this cohort of patients. CONCLUSION NaF PET/CT hybrid fusion imaging is extremely useful in identifying potential causes of pain in patients with malignancies that have an affinity for skeletal metastases. This technique can help detect bone metastases, in problem solving, and to direct appropriate management.
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Nair R, Lamb BW, Geurts N, Alghazo O, Lam W, Lawrentschuk N, Murphy DG. The Role of Local Therapy for Oligometastatic Prostate Cancer: Should We Expect a Cure? Urol Clin North Am 2017; 44:623-633. [PMID: 29107278 DOI: 10.1016/j.ucl.2017.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The role of local treatment in oligometastatic prostate cancer remains contentious. Treatment of the prostate in metastatic disease may confer benefit, but prospective data are lacking. With improvements in treatments, aggressive strategies directed at metastases have increasingly become of clinical interest. Current evidence suggests good local control can be achieved; however, further data are required to determine overall cancer outcomes. This article evaluates the evidence available and consider whether local treatment of oligometastatic disease is a feasible, safe, and a positive strategy in this disease cohort. Cure should not be expected, although prolonged disease and treatment-free survival may be observed.
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Affiliation(s)
- Rajesh Nair
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| | - Benjamin W Lamb
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| | - Nicolas Geurts
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| | - Omar Alghazo
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| | - Wayne Lam
- Department of Urology, The University of Hong Kong, 9/F, Knowles Building Pok Fu Lam Road, Pok Fu Lam, Hong Kong SAR, China
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia; Department of Surgery, Austin Health, University of Melbourne, Parkville, 145 Studley Rd, Heidelberg Victoria 3084, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia; Sir Peter MacCallum Cancer centre, Department of Oncology, University of Melbourne, 305 Grattan Street, Melbourne VIC 3000, Australia.
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Sachpekidis C, Hillengass J, Goldschmidt H, Anwar H, Haberkorn U, Dimitrakopoulou-Strauss A. Quantitative analysis of 18F-NaF dynamic PET/CT cannot differentiate malignant from benign lesions in multiple myeloma. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2017; 7:148-156. [PMID: 28913153 PMCID: PMC5596317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/07/2017] [Indexed: 06/07/2023]
Abstract
A renewed interest has been recently developed for the highly sensitive bone-seeking radiopharmaceutical 18F-NaF. Aim of the present study is to evaluate the potential utility of quantitative analysis of 18F-NaF dynamic PET/CT data in differentiating malignant from benign degenerative lesions in multiple myeloma (MM). 80 MM patients underwent whole-body PET/CT and dynamic PET/CT scanning of the pelvis with 18F-NaF. PET/CT data evaluation was based on visual (qualitative) assessment, semi-quantitative (SUV) calculations, and absolute quantitative estimations after application of a 2-tissue compartment model and a non-compartmental approach leading to the extraction of fractal dimension (FD). In total 263 MM lesions were demonstrated on 18F-NaF PET/CT. Semi-quantitative and quantitative evaluations were performed for 25 MM lesions as well as for 25 benign, degenerative and traumatic lesions. Mean SUVaverage for MM lesions was 11.9 and mean SUVmax was 23.2. Respectively, SUVaverage and SUVmax for degenerative lesions were 13.5 and 20.2. Kinetic analysis of 18F-NaF revealed the following mean values for MM lesions: K1 = 0.248 (1/min), k3 = 0.359 (1/min), influx (Ki) = 0.107 (1/min), FD = 1.382, while the respective values for degenerative lesions were: K1 = 0.169 (1/min), k3 = 0.422 (1/min), influx (Ki) = 0.095 (1/min), FD = 1. 411. No statistically significant differences between MM and benign degenerative disease regarding SUVaverage, SUVmax, K1, k3 and influx (Ki) were demonstrated. FD was significantly higher in degenerative than in malignant lesions. The present findings show that quantitative analysis of 18F-NaF PET data cannot differentiate malignant from benign degenerative lesions in MM patients, supporting previously published results, which reflect the limited role of 18F-NaF PET/CT in the diagnostic workup of MM.
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Affiliation(s)
- Christos Sachpekidis
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ)Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (DKFZ)Heidelberg, Germany
| | - Jens Hillengass
- Department of Internal Medicine V, University Hospital HeidelbergHeidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University Hospital HeidelbergHeidelberg, Germany
- National Center for Tumor Diseases (NCT) HeidelbergHeidelberg, Germany
| | - Hoda Anwar
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ)Heidelberg, Germany
| | - Uwe Haberkorn
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ)Heidelberg, Germany
- Department of Nuclear Medicine, University of HeidelbergHeidelberg, Germany
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21
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Harmon SA, Perk T, Lin C, Eickhoff J, Choyke PL, Dahut WL, Apolo AB, Humm JL, Larson SM, Morris MJ, Liu G, Jeraj R. Quantitative Assessment of Early [ 18F]Sodium Fluoride Positron Emission Tomography/Computed Tomography Response to Treatment in Men With Metastatic Prostate Cancer to Bone. J Clin Oncol 2017; 35:2829-2837. [PMID: 28654366 DOI: 10.1200/jco.2017.72.2348] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose [18F]Sodium fluoride (NaF) positron emission tomography (PET)/computed tomography (CT) is a promising radiotracer for quantitative assessment of bone metastases. This study assesses changes in early NaF PET/CT response measures in metastatic prostate cancer for correlation to clinical outcomes. Patients and Methods Fifty-six patients with metastatic castration-resistant prostate cancer (mCRPC) with osseous metastases had NaF PET/CT scans performed at baseline and after three cycles of chemotherapy (n = 16) or androgen receptor pathway inhibitors (n = 40). A novel technology, Quantitative Total Bone Imaging, was used for analysis. Global imaging metrics, including maximum standardized uptake value (SUVmax) and total functional burden (SUVtotal), were extracted from composite lesion-level statistics for each patient and tracked throughout treatment. Progression-free survival (PFS) was calculated as a composite end point of progressive events using conventional imaging and/or physician discretion of clinical benefit; NaF imaging was not used for clinical evaluation. Cox proportional hazards regression analyses were conducted between imaging metrics and PFS. Results Functional burden (SUVtotal) assessed midtreatment was the strongest univariable PFS predictor (hazard ratio, 1.97; 95% CI, 1.44 to 2.71; P < .001). Classification of patients based on changes in functional burden showed stronger correlation to PFS than did the change in number of lesions. Various global imaging metrics outperformed baseline clinical markers in predicting outcome, including SUVtotal and SUVmean. No differences in imaging response or PFS correlates were found for different treatment cohorts. Conclusion Quantitative total bone imaging enables comprehensive disease quantification on NaF PET/CT imaging, showing strong correlation to clinical outcomes. Total functional burden assessed after three cycles of hormonal therapy or chemotherapy was predictive of PFS for men with mCRPC. This supports ongoing development of NaF PET/CT-based imaging biomarkers in mCRPC to bone.
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Affiliation(s)
- Stephanie A Harmon
- Stephanie A. Harmon, Timothy Perk, Christie Lin, Jens Eickhoff, Glenn Liu, and Robert Jeraj, University of Wisconsin-Madison; Glenn Liu and Robert Jeraj, Prostate Cancer Clinical Trials Consortium, Madison, WI; Peter L. Choyke, William L. Dahut, and Andrea B. Apolo, National Cancer Institute, Bethesda, MD; John L. Humm, Steven M. Larson, and Michael J. Morris, Memorial Sloan Kettering Cancer Center; and Steven M. Larson and Michael J. Morris, Prostate Cancer Clinical Trials Consortium, New York, NY
| | - Timothy Perk
- Stephanie A. Harmon, Timothy Perk, Christie Lin, Jens Eickhoff, Glenn Liu, and Robert Jeraj, University of Wisconsin-Madison; Glenn Liu and Robert Jeraj, Prostate Cancer Clinical Trials Consortium, Madison, WI; Peter L. Choyke, William L. Dahut, and Andrea B. Apolo, National Cancer Institute, Bethesda, MD; John L. Humm, Steven M. Larson, and Michael J. Morris, Memorial Sloan Kettering Cancer Center; and Steven M. Larson and Michael J. Morris, Prostate Cancer Clinical Trials Consortium, New York, NY
| | - Christie Lin
- Stephanie A. Harmon, Timothy Perk, Christie Lin, Jens Eickhoff, Glenn Liu, and Robert Jeraj, University of Wisconsin-Madison; Glenn Liu and Robert Jeraj, Prostate Cancer Clinical Trials Consortium, Madison, WI; Peter L. Choyke, William L. Dahut, and Andrea B. Apolo, National Cancer Institute, Bethesda, MD; John L. Humm, Steven M. Larson, and Michael J. Morris, Memorial Sloan Kettering Cancer Center; and Steven M. Larson and Michael J. Morris, Prostate Cancer Clinical Trials Consortium, New York, NY
| | - Jens Eickhoff
- Stephanie A. Harmon, Timothy Perk, Christie Lin, Jens Eickhoff, Glenn Liu, and Robert Jeraj, University of Wisconsin-Madison; Glenn Liu and Robert Jeraj, Prostate Cancer Clinical Trials Consortium, Madison, WI; Peter L. Choyke, William L. Dahut, and Andrea B. Apolo, National Cancer Institute, Bethesda, MD; John L. Humm, Steven M. Larson, and Michael J. Morris, Memorial Sloan Kettering Cancer Center; and Steven M. Larson and Michael J. Morris, Prostate Cancer Clinical Trials Consortium, New York, NY
| | - Peter L Choyke
- Stephanie A. Harmon, Timothy Perk, Christie Lin, Jens Eickhoff, Glenn Liu, and Robert Jeraj, University of Wisconsin-Madison; Glenn Liu and Robert Jeraj, Prostate Cancer Clinical Trials Consortium, Madison, WI; Peter L. Choyke, William L. Dahut, and Andrea B. Apolo, National Cancer Institute, Bethesda, MD; John L. Humm, Steven M. Larson, and Michael J. Morris, Memorial Sloan Kettering Cancer Center; and Steven M. Larson and Michael J. Morris, Prostate Cancer Clinical Trials Consortium, New York, NY
| | - William L Dahut
- Stephanie A. Harmon, Timothy Perk, Christie Lin, Jens Eickhoff, Glenn Liu, and Robert Jeraj, University of Wisconsin-Madison; Glenn Liu and Robert Jeraj, Prostate Cancer Clinical Trials Consortium, Madison, WI; Peter L. Choyke, William L. Dahut, and Andrea B. Apolo, National Cancer Institute, Bethesda, MD; John L. Humm, Steven M. Larson, and Michael J. Morris, Memorial Sloan Kettering Cancer Center; and Steven M. Larson and Michael J. Morris, Prostate Cancer Clinical Trials Consortium, New York, NY
| | - Andrea B Apolo
- Stephanie A. Harmon, Timothy Perk, Christie Lin, Jens Eickhoff, Glenn Liu, and Robert Jeraj, University of Wisconsin-Madison; Glenn Liu and Robert Jeraj, Prostate Cancer Clinical Trials Consortium, Madison, WI; Peter L. Choyke, William L. Dahut, and Andrea B. Apolo, National Cancer Institute, Bethesda, MD; John L. Humm, Steven M. Larson, and Michael J. Morris, Memorial Sloan Kettering Cancer Center; and Steven M. Larson and Michael J. Morris, Prostate Cancer Clinical Trials Consortium, New York, NY
| | - John L Humm
- Stephanie A. Harmon, Timothy Perk, Christie Lin, Jens Eickhoff, Glenn Liu, and Robert Jeraj, University of Wisconsin-Madison; Glenn Liu and Robert Jeraj, Prostate Cancer Clinical Trials Consortium, Madison, WI; Peter L. Choyke, William L. Dahut, and Andrea B. Apolo, National Cancer Institute, Bethesda, MD; John L. Humm, Steven M. Larson, and Michael J. Morris, Memorial Sloan Kettering Cancer Center; and Steven M. Larson and Michael J. Morris, Prostate Cancer Clinical Trials Consortium, New York, NY
| | - Steven M Larson
- Stephanie A. Harmon, Timothy Perk, Christie Lin, Jens Eickhoff, Glenn Liu, and Robert Jeraj, University of Wisconsin-Madison; Glenn Liu and Robert Jeraj, Prostate Cancer Clinical Trials Consortium, Madison, WI; Peter L. Choyke, William L. Dahut, and Andrea B. Apolo, National Cancer Institute, Bethesda, MD; John L. Humm, Steven M. Larson, and Michael J. Morris, Memorial Sloan Kettering Cancer Center; and Steven M. Larson and Michael J. Morris, Prostate Cancer Clinical Trials Consortium, New York, NY
| | - Michael J Morris
- Stephanie A. Harmon, Timothy Perk, Christie Lin, Jens Eickhoff, Glenn Liu, and Robert Jeraj, University of Wisconsin-Madison; Glenn Liu and Robert Jeraj, Prostate Cancer Clinical Trials Consortium, Madison, WI; Peter L. Choyke, William L. Dahut, and Andrea B. Apolo, National Cancer Institute, Bethesda, MD; John L. Humm, Steven M. Larson, and Michael J. Morris, Memorial Sloan Kettering Cancer Center; and Steven M. Larson and Michael J. Morris, Prostate Cancer Clinical Trials Consortium, New York, NY
| | - Glenn Liu
- Stephanie A. Harmon, Timothy Perk, Christie Lin, Jens Eickhoff, Glenn Liu, and Robert Jeraj, University of Wisconsin-Madison; Glenn Liu and Robert Jeraj, Prostate Cancer Clinical Trials Consortium, Madison, WI; Peter L. Choyke, William L. Dahut, and Andrea B. Apolo, National Cancer Institute, Bethesda, MD; John L. Humm, Steven M. Larson, and Michael J. Morris, Memorial Sloan Kettering Cancer Center; and Steven M. Larson and Michael J. Morris, Prostate Cancer Clinical Trials Consortium, New York, NY
| | - Robert Jeraj
- Stephanie A. Harmon, Timothy Perk, Christie Lin, Jens Eickhoff, Glenn Liu, and Robert Jeraj, University of Wisconsin-Madison; Glenn Liu and Robert Jeraj, Prostate Cancer Clinical Trials Consortium, Madison, WI; Peter L. Choyke, William L. Dahut, and Andrea B. Apolo, National Cancer Institute, Bethesda, MD; John L. Humm, Steven M. Larson, and Michael J. Morris, Memorial Sloan Kettering Cancer Center; and Steven M. Larson and Michael J. Morris, Prostate Cancer Clinical Trials Consortium, New York, NY
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Etchebehere E, Brito AE, Rezaee A, Langsteger W, Beheshti M. Therapy assessment of bone metastatic disease in the era of 223radium. Eur J Nucl Med Mol Imaging 2017; 44:84-96. [DOI: 10.1007/s00259-017-3734-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 02/05/2023]
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Longitudinal Computed Tomography Monitoring of Pelvic Bones in Patients With Breast Cancer Using Automated Bone Subtraction Software. Invest Radiol 2017; 52:288-294. [DOI: 10.1097/rli.0000000000000343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Yoon J, Ballas L, Desai B, Jadvar H. Prostate-Specific Antigen and Prostate-Specific Antigen Kinetics in Predicting 18F-Sodium Fluoride Positron Emission Tomography-Computed Tomography Positivity for First Bone Metastases in Patients with Biochemical Recurrence after Radical Prostatectomy. World J Nucl Med 2017; 16:229-236. [PMID: 28670183 PMCID: PMC5460308 DOI: 10.4103/1450-1147.207286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We evaluated the association between serum prostate specific antigen (PSA) level and kinetics to predict 18F-sodium fluoride positron emission tomography-computed tomography (18F-NaF PET-CT) positivity for first bone metastases in men with biochemical recurrence after radical prostatectomy. All 18F-NaF PET-CT scans that were performed at our institution during 2010–2014 were queried to find patients who demonstrated biochemical recurrence after radical prostatectomy. Records were reviewed to obtain data on PSA levels and kinetics at the time of 18F-NaF PET-CT and pathologic features of the prostatectomy specimen, which were then used for receiver operating characteristic (ROC) analysis to determine predictability for 18F-NaF PET positivity. Thirty-six patients met our inclusion criteria. Of these, 8 (22.2%) had positive 18F-NaF PET-CT scans. Mean values for PSA, PSA doubling time (PSADT), and PSA velocity (PSAV) were 2.02 ng/ml (range: 0.06–11.7 ng/ml), 13.2 months (range: 1.11–60.84), and 1.28 ng/ml/year (range: 0.1–5.28) for 18F-NaF PET-CT negative scans, and 4.11 ng/ml (range: 0.04–14.38 ng/ml), 8.9 months (range; 0.7–27.8), and 9.06 ng/ml/year (range: 0.04–50.2) for 18F-NaF PET-CT positive scans, respectively (P = 0.07, 0.47, and 0.02, respectively, for PSA, PSADT, and PSAV). ROC analysis for 18F-NaF PET-CT positivity resulted in area under the curve (AUC) values of 0.634 for PSA, 0.598 for PSADT, and 0.688 for PSAV. ROC analysis with combined models gave AUC values of 0.723 for a combination of PSA and PSADT, 0.689 for a combination of PSA and PSAV, and 0.718 for grouping of PSA, PSADT, and PSAV. There was no significant association between 18F-NaF PET-CT positivity and primary tumor Gleason score, TN staging, and status of surgical margins. 18F-NaF PET-CT detected first-time osseous metastases in 22.2% of our patients with biochemical recurrence after prostatectomy with the PSA level range ≤11.7 ng/ml. PSAV was statistically significant in predicting 18F-NaF PET-CT positivity. ROC analysis demonstrated higher AUCs when PSA was combined with PSA kinetics parameters.
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Affiliation(s)
- James Yoon
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Leslie Ballas
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Bhushan Desai
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hossein Jadvar
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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25
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Ahmed F, Muzaffar R, Fernandes H, Tu Y, Albalooshi B, Osman MM. Skeletal Metastasis as Detected by 18F-FDG PET with Negative CT of the PET/CT: Frequency and Impact on Cancer Staging and/or Management. Front Oncol 2016; 6:208. [PMID: 27777898 PMCID: PMC5056322 DOI: 10.3389/fonc.2016.00208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/13/2016] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The aim of our study is to assess the frequency of detection of PET-positive computed tomography (CT)-negative skeletal metastases (SM) and determine the impact of such detection on staging and/or management in patients who had FDG PET/CT as part of the cancer work-up. METHODS We retrospectively reviewed 2000 18F-FDG PET/CT scans of known cancer patients. A log was kept to record cases of suspected SM with or without bone changes from the low-dose non-contrast CT. The presence or absence of SM was evaluated based on available pathological and clinical data. The impact of detection of such lesions on cancer staging and/or management was evaluated by a board certified oncologist. RESULTS Of the 2000 cases, 18F-FDG PET/CT suggested SM in 146/2000 (7.3%). Of those 146 cases, 105 (72%) were positive on both PET and CT. The remaining 41 (28%) had PET-positive CT-negative bone lesions. SM was confirmed in 36/41 (88%) PET-positive/CT-negative cases. This was based on biopsy, imaging, or clinical follow-up. The detection of PET-positive CT-negative SM did not change staging or management in 7/36 (19.4%). However, staging and/or management was affected in 29/36 (80.6%). CONCLUSION SM is not uncommon in 18F-FDG PET/CT, as it accounts for 146/2000 (7.3%) of cases. PET demonstrated FDG-avid SM without a CT abnormality in at least 36/146 (25%). Patients staging and/or management changed in 29/36 (80.5%). We concluded that 18F-FDG PET is sensitive in the detection of SM with significant impact on staging and/or management.
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Affiliation(s)
- Fatma Ahmed
- Saint Louis University , Saint Louis, MO , USA
| | | | | | - Yifan Tu
- Saint Louis University , Saint Louis, MO , USA
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26
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Lin C, Bradshaw T, Perk T, Harmon S, Eickhoff J, Jallow N, Choyke PL, Dahut WL, Larson S, Humm JL, Perlman S, Apolo AB, Morris MJ, Liu G, Jeraj R. Repeatability of Quantitative 18F-NaF PET: A Multicenter Study. J Nucl Med 2016; 57:1872-1879. [PMID: 27445292 DOI: 10.2967/jnumed.116.177295] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/18/2016] [Indexed: 12/17/2022] Open
Abstract
18F-NaF, a PET radiotracer of bone turnover, has shown potential as an imaging biomarker for assessing the response of bone metastases to therapy. This study aimed to evaluate the repeatability of 18F-NaF PET-derived SUV imaging metrics in individual bone lesions from patients in a multicenter study. METHODS Thirty-five castration-resistant prostate cancer patients with multiple metastases underwent 2 whole-body (test-retest) 18F-NaF PET/CT scans 3 ± 2 d apart from 1 of 3 imaging sites. A total of 411 bone lesions larger than 1.5 cm3 were automatically segmented using an SUV threshold of 15 g/mL. Two levels of analysis were performed: lesion-level, in which measures were extracted from individual-lesion regions of interest (ROI), and patient-level, in which all lesions within a patient were grouped into a patient ROI for analysis. Uptake was quantified with SUVmax, SUVmean, and SUVtotal Test-retest repeatability was assessed using Bland-Altman analysis, intraclass correlation coefficient (ICC), coefficient of variation, critical percentage difference, and repeatability coefficient. The 95% limit of agreement (LOA) of the ratio between test and retest measurements was calculated. RESULTS At the lesion level, the coefficient of variation for SUVmax, SUVmean, and SUVtotal was 14.1%, 6.6%, and 25.5%, respectively. At the patient level, it was slightly smaller: 12.0%, 5.3%, and 18.5%, respectively. ICC was excellent (>0.95) for all SUV metrics. Lesion-level 95% LOA for SUVmax, SUVmean, and SUVtotal was (0.76, 1.32), (0.88, 1.14), and (0.63, 1.71), respectively. Patient-level 95% LOA was slightly narrower, at (0.79, 1.26), (0.89, 1.10), and (0.70, 1.44), respectively. We observed significant differences in the variance and sample mean of lesion-level and patient-level measurements between imaging sites. CONCLUSION The repeatability of SUVmax, SUVmean, and SUVtotal for 18F-NaF PET/CT was similar between lesion- and patient-level ROIs. We found significant differences in lesion-level and patient-level distributions between sites. These results can be used to establish 18F-NaF PET-based criteria for assessing treatment response at the lesion and patient levels. 18F-NaF PET demonstrates repeatability levels useful for clinically quantifying the response of bone lesions to therapy.
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Affiliation(s)
- Christie Lin
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Tyler Bradshaw
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Timothy Perk
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Stephanie Harmon
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Jens Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Ngoneh Jallow
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Peter L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - William L Dahut
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Steven Larson
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John Laurence Humm
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Scott Perlman
- Department of Radiology, University of Wisconsin, Madison, Wisconsin.,University of Wisconsin Carbone Cancer Center, Madison, Wisconsin; and
| | - Andrea B Apolo
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Michael J Morris
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Glenn Liu
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin.,University of Wisconsin Carbone Cancer Center, Madison, Wisconsin; and
| | - Robert Jeraj
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin .,University of Wisconsin Carbone Cancer Center, Madison, Wisconsin; and
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