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Ye Z, Kou Y, Shen J, Dang J, Tan X, Jiang X, Wang X, Lu H, Chen S, Cheng Z. A comparative study of 18F-PSMA-1007 PET/CT and pelvic MRI in newly diagnosed prostate cancer. BMC Med Imaging 2024; 24:192. [PMID: 39080625 PMCID: PMC11290235 DOI: 10.1186/s12880-024-01376-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
PURPOSE To evaluate the difference in the diagnostic efficacy of 18F-PSMA-1007 PET/CT and pelvic MRI in primary prostate cancer, as well as the correlation between the two methods and histopathological parameters and serum PSA levels. METHODS A total of 41 patients with suspected prostate cancer who underwent 18F-PSMA-1007 PET/CT imaging in our department from 2018 to 2023 were retrospectively collected. All patients underwent 18F-PSMA-1007 PET/CT and MRI scans. The sensitivity, PPV and diagnostic accuracy of MRI and 18F-PSMA-1007 PET/CT in the diagnosis of prostate cancer were calculated after comparing the results of MRI and 18F-PSMA-1007 PET/CT with biopsy. The Spearman test was used to calculate the correlation between 18F-PSMA-1007 PET/CT, MRI parameters, histopathological indicators, and serum PSA levels. RESULTS Compared with histopathological results, the sensitivity, PPV and diagnostic accuracy of 18F-PSMA-1007 PET/CT in the diagnosis of prostate cancer were 95.1%, 100.0% and 95.1%, respectively. The sensitivity, PPV and diagnostic accuracy of MRI in the diagnosis of prostate cancer were 82.9%, 100.0% and 82.9%, respectively. There was a mild to moderately positive correlation between Gleason (Gs) score, Ki-67 index, serum PSA level and 18F-PSMA-1007 PET/CT parameters (p < 0.05). There was a moderately negative correlation between the expression of AMACR (P504S) and 18F-PSMA-1007 PET/CT parameters (p < 0.05). The serum PSA level and the Gs score were moderately positively correlated with the MRI parameters (p < 0.05). There was no correlation between histopathological parameters and MRI parameters (p > 0.05). CONCLUSION Compared with MRI, 18F-PSMA-1007 PET/CT has higher sensitivity and diagnostic accuracy in the detection of malignant prostate tumors. In addition, the Ki-67 index and AMACR (P504S) expression were only correlated with 18F-PSMA-1007 PET/CT parameters. Gs score and serum PSA level were correlated with 18F-PSMA-1007 PET/CT and MRI parameters. 18F-PSMA-1007 PET/CT examination can provide certain reference values for the clinical diagnosis, evaluation, and treatment of malignant prostate tumors.
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Affiliation(s)
- Zhenyan Ye
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
- Guang'an District People's Hospital, Guangan, China
| | - Ying Kou
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Jiaqi Shen
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Jun Dang
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaofei Tan
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Xiao Jiang
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoxiong Wang
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Hao Lu
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Shirong Chen
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Zhuzhong Cheng
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
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Alshamrani AFA. Diagnostic Accuracy of Molecular Imaging Techniques for Detecting Prostate Cancer: A Systematic Review. Diagnostics (Basel) 2024; 14:1315. [PMID: 39001206 PMCID: PMC11240585 DOI: 10.3390/diagnostics14131315] [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: 05/20/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
Molecular imaging modalities show valuable non-invasive techniques capable of precisely and selectively addressing molecular markers associated with prostate cancer (PCa). This systematic review provides an overview of imaging markers utilized in positron emission tomography (PET) methods, specifically focusing on the pathways and mediators involved in PCa. This systematic review aims to evaluate and analyse existing literature on the diagnostic accuracy of molecular imaging techniques for detecting PCa. The PubMed, EBSCO, ScienceDirect, and Web of Science databases were searched, identifying 32 studies that reported molecular imaging modalities for detecting PCa. Numerous imaging modalities and radiotracers were used to detect PCa, including 68Ga-prostate-specific membrane antigen (PSMA) PET/computed tomography (CT), 68Ga-PSMA-11 PET/magnetic resonance imaging (MRI), 18F-PSMA-1007 PET/CT, 18F-DCFPyL PET/MRI, 18F-choline PET/MRI, and 18F-fluoroethylcholine PET/MRI. Across 11 studies, radiolabelled 68Ga-PSMA PET/CT imaging had a pooled sensitivity of 80 (95% confidence interval [CI]: 35-93), specificity of 90 (95% CI: 71-98), and accuracy of 86 (95% CI: 64-96). The PSMA-ligand 68Ga-PET/CT showed good diagnostic performance and appears promising for detecting and staging PCa.
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Affiliation(s)
- Abdullah Fahad A Alshamrani
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Madinah 42353, Saudi Arabia
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Caracciolo M, Castello A, Lopci E. PSMA PET/CT Versus mpMRI for the Detection of Clinically Significant Prostate Cancer: An Updated Overview. Semin Nucl Med 2024; 54:30-38. [PMID: 37951766 DOI: 10.1053/j.semnuclmed.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
In the last years, PSMA-PET imaging and multiparametric MRI (mpMRI) have improved the clinical management of prostate cancer (PCa) patients. Currently, mpMRI is recommended by the EAU (European Association of Urology) guidelines for the primary diagnosis of PCa, whereas PSMA-PET is reserved for disease staging, particularly in high risk localized or locally advanced disease, as well as for biochemical recurrence after surgery. Nevertheless, several studies have explored the added value of PSMA-PET in other clinical scenarios, including primary diagnosis and especially for the detection of clinically significant PCa (csPCa). In the present contribution, we will provide an overview and an update on the current literature on imaging detection of csPCa, with a particular focus on mpMRI, PSMA-PET and their comparison.
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Affiliation(s)
- Matteo Caracciolo
- Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | - Angelo Castello
- Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS - Humanitas Research Hospital, Rozzano, Milan, Italy.
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A Systematic Review of the Variability in Performing and Reporting Intraprostatic Prostate-specific Membrane Antigen Positron Emission Tomography in Primary Staging Studies. EUR UROL SUPPL 2023; 50:91-105. [PMID: 37101769 PMCID: PMC10123424 DOI: 10.1016/j.euros.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 03/06/2023] Open
Abstract
Context Prostate cancer (PCa) remains one of the leading causes of cancer-related deaths in men worldwide. Men at risk are typically offered multiparametric magnetic resonance imaging and, if suspicious, a targeted biopsy. However, false-negative rates of magnetic resonance imaging are consistently 18%; therefore, there is growing interest in improving the diagnostic performance of imaging through novel technologies. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is being utilised for PCa staging and, more recently, for intraprostatic tumour localisation. However, significant variability has been observed in how PSMA PET is performed and reported. Objective In this review, we aim to evaluate how pervasive this variability is in trials investigating the performance of PSMA PET in primary PCa workup. Evidence acquisition Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed an optimal search in five different databases. After removing duplicates, 65 studies were included in our review. Evidence synthesis Studies dated back as early as 2016, with numerous different source countries. There was variation in the reference standard for PSMA PET, with some using biopsy specimens or surgical specimens, and in some cases, a combination of the two. Similar inconsistencies were noted when studies selected histological definitions of clinically significant PCa, while some omitted their definition altogether. The most significant variations in performing PSMA PET were the radiotracer type, dose, acquisition time after injection, and the PET camera being utilised. Substantial variation in the reporting of PSMA PET was noted, with no consistency in defining what constitutes a positive intraprostatic lesion. Across 65 studies, four different definitions were used. Conclusions This systematic review has highlighted considerable variation in obtaining and performing a PSMA PET study in the context of primary PCa diagnosis. Given the discrepancy in how PSMA PET was performed and reported, it questions the homogony of studies from centre to centre. Standardisation of PSMA PET is required for this to become a consistently useful and reproducible modality in the diagnosis of PCa. Patient summary Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is being utilised for staging and localisation of prostate cancer (PCa); however, there is significant variability in performing and reporting PSMA PET. Standardisation of PSMA PET is required for results to be consistently useful and reproducible for the diagnosis of PCa.
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Saule L, Radzina M, Liepa M, Roznere L, Lioznovs A, Ratniece M, Mamis E, Vjaters E. Recurrent Prostate Cancer Diagnostics with 18F-PSMA-1007 PET/CT: A Systematic Review of the Current State. Diagnostics (Basel) 2022; 12:diagnostics12123176. [PMID: 36553183 PMCID: PMC9777208 DOI: 10.3390/diagnostics12123176] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Early diagnosis of recurrent prostate cancer is a cornerstone for further adequate therapy planning. Therefore, clinical practice and research still focuses on diagnostic tools that can detect prostate cancer in early recurrence when it is undetectable in conventional diagnostic imaging. 18F-PSMA-1007 PET/CT is a novel method to evaluate patients with biochemical recurrent PCa. The aim of this review was to evaluate the role of 18F-PSMA-1007 PET/CT in prostate cancer local recurrence, lymph node metastases and bone metastases detection. METHODS Original studies, reviews and five meta-analyses were included in this article. A total of 70 studies were retrieved, 31 were included in the study. RESULTS All patients described in the studies underwent 18F-PSMA-1007 PET/CT. The administered 18F-PSMA-1007 individual dose ranged from 159 ± 31 MBq to 363.93 ± 69.40 MBq. Results showed that 18F-PSMA-1007 PET/CT demonstrates a good detection rate in recurrent prostate cancer. CONCLUSIONS 18F-PSMA-1007 PET/CT appears to achieve reliable performance in detecting recurrent prostate cancer. The high detection rate of 18F-PSMA-1007 PET/CT in recurrent prostate cancer was confirmed, especially in local recurrence and small lymph nodes with non-specific characteristics on conventional diagnostic imaging methods. However, several authors emphasize some limitations for this tracer-for example, non-specific uptake in bone lesions that can mimic bone metastases.
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Affiliation(s)
- Laura Saule
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia
- Correspondence: ; Tel.: +371-26131556
| | - Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia
| | - Mara Liepa
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Lilita Roznere
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia
| | - Andrejs Lioznovs
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Madara Ratniece
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia
| | - Edgars Mamis
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia
| | - Egils Vjaters
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia
- Center of Urology, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
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The Role of [ 68Ga]PSMA PET/CT for Clinical Suspicion of Prostate Cancer in Patients with or without Previous Negative Biopsy: A Systematic Review. Cancers (Basel) 2022; 14:cancers14205036. [PMID: 36291820 PMCID: PMC9600353 DOI: 10.3390/cancers14205036] [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: 09/14/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary In this paper we systematically evaluate the evidence regarding the role of [68Ga]PSMA PET/CT for clinical suspicions of prostate cancer in patients with or without previous negative biopsy. A critical review of PubMed and Web of Science according to the PRISMA statement was conducted. Eighteen publications were selected for inclusion in the analysis. In 8 articles, there was a direct comparison with mpMRI. [68Ga]PSMA PET/CT resulted more accurate in identifying primary prostate cancer with PSA values between 4 and 20 ng/mL than mpMRI. Moreover, its use combined with MRI improved sensitivity for csPCa detection, thus potentially avoiding unnecessary biopsies. Overall, [68Ga]PSMA PET/CT resulted a promising technique in patients with clinical suspicion of PCa and precedent negative biopsy or contraindications to MRI. Abstract The purpose of the study is to systematically evaluate the evidence regarding the role of [68Ga]PSMA PET/CT for clinical suspicions of prostate cancer in patients with or without previous negative biopsy. We performed a critical review of PubMed and Web of Science according to the PRISMA statement. Eighteen publications were selected for inclusion in this analysis. QUADAS-2 evaluation was adopted for quality analyses. [68Ga]PSMA-11 was the radiotracer of choice in 15 studies, while [68Ga]PSMA-617 was used in another 3. In 8 articles, there was a direct comparison with mpMRI. The total number of patients included was 1379, ranging from 15 to 291, with a median age of 64 years (range: 42–90). The median baseline PSA value was 12.9 ng/mL, ranging from 0.85 to 4156 ng/mL. Some studies evaluated the PSMA uptake comparing the SUVmax of suspicious lesions with the SUVmax of the normal biodistribution to find out optimal cut-off points. In addition, some studies suggested a significant association between PSA levels, PSA density, and [68Ga]PSMA PET/CT finding. [68Ga]PSMA PET/CT seems to be more accurate in identifying primary prostate cancer with PSA values between 4 and 20 ng/mL than mpMRI. Moreover, in some trials, the combination of PSMA PET/CT and MRI improved the NPV in the detection of clinically significant prostate cancer (csPCa) than MRI alone. Our findings are limited by the small numbers of studies and patient heterogeneity. [68Ga]PSMA PET/CT is a promising technique in patients with clinical suspicion of PCa and precedent negative biopsy or contraindications to MRI. Furthermore, its use combined with MRI improves sensitivity for csPCa detection and can avoid unnecessary biopsies.
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Soni BK, Verma P, Shah AK, Singh R, Sonawane S, Asopa RV. Comparison of Multiparametric Magnetic Resonance Imaging and Gallium-68 Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography for Detecting Carcinoma Prostate in Patients with Serum Prostate-Specific Antigen between 4 and 20 ng/ml. Indian J Nucl Med 2021; 36:245-251. [PMID: 34658547 PMCID: PMC8481845 DOI: 10.4103/ijnm.ijnm_243_20] [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: 12/28/2020] [Revised: 04/16/2021] [Accepted: 05/07/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction We carried out this study to compare the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) and gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (Ga-68 PSMA PET/CT) to detect prostatic carcinoma in patients with serum prostate-specific antigen (PSA) between 4 and 20 ng/ml in prebiopsy setting. Materials and Methods This prospective study evaluated men with serum PSA values between 4 and 20 ng/ml. All patients underwent mpMRI and Ga-68 PSMA PET/CT, followed by 12-core transrectal ultrasonography (TRUS)-guided biopsy to detect prostatic carcinoma. The diagnostic accuracy of mpMRI and PSMA PET/CT scan was compared with histopathological findings. Results There were thirty patients included in the study with a median age of 73 years (age range: 69-79 years). The median total serum PSA was 8.0 ng/ml (5.0-19.9 ng/ml). Of these, 18 had an identifiable lesion on imaging and had histopathological findings suggestive of carcinoma prostate. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI were 100%, 92.30%, 94.73%, and 100%, respectively, and that of PSMA PET scan were 94.44%, 100%, 100%, and 92.31%, respectively. The diagnostic accuracy of both was 96.67%. Conclusion PSMA PET scan showed higher PPV and specificity while mpMRI showed higher sensitivity and NPV. The accuracy in predicting presence of carcinoma was the same for both. PSMA PET showed higher specificity and PPV and predicted the subsequent need of biopsy. In our study, the NPV of PET, though good, was lower than mpMRI. Prospective trials with larger sample size are needed. In combination, PET/MRI may achieve greater accuracy and may serve as investigation of choice.
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Affiliation(s)
| | - Priyanka Verma
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Amit Kumar Shah
- Department of Urology, INHS Asvini, Mumbai, Maharashtra, India
| | - Rajendra Singh
- Department of Pathology, INHS Asvini, Mumbai, Maharashtra, India
| | - Sunita Sonawane
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Ramesh V Asopa
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
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Singh H. Making the Case for Prostate-Specific Membrane Antigen-Targeted Positron Emission Tomography/Computed Tomography in Suspected Prostate Cancer. Indian J Nucl Med 2020; 35:281-282. [PMID: 33642750 PMCID: PMC7905282 DOI: 10.4103/ijnm.ijnm_175_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 02/04/2023] Open
Abstract
Prostate specific membrane antigen (PSMA) over-expression is a hallmark of prostate adenocarcinoma and many PSMA targeting positron emission tomography (PET) radiopharmaceuticals have been developed over the last decade. The role of 68Ga-PSMA-11 PET-computed tomography (CT) is well established in staging and biochemical recurrence of PCa, with growing interest and evidence regarding its utility in suspected prostate cancer.
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Affiliation(s)
- Harmandeep Singh
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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