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Khandelwal Y, Singh Parihar A, Sistani G, Ramirez-Fort MK, Zukotynski K, Subramaniam RM. Role of PET/Computed Tomography in Gastric and Colorectal Malignancies. PET Clin 2024; 19:177-186. [PMID: 38199915 DOI: 10.1016/j.cpet.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
This article focuses on the role of PET/computed tomography in evaluating and managing gastric cancer and colorectal cancer. The authors start with describing the common aspects of imaging with 2-deoxy-2-18F-d-glucose, followed by tumor-specific discussions of gastric and colorectal malignancies. Finally, the authors provide a brief overview of non-FDG tracers including their potential clinical applications, and describe future directions in imaging these malignancies.
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Affiliation(s)
- Yogita Khandelwal
- Department of Nuclear Medicine, AIIMS Campus, Ansari Nagar East, New Delhi, Delhi 110016, India
| | - Ashwin Singh Parihar
- Mallinckodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA
| | - Golmehr Sistani
- Medical Imaging Department, Royal Victoria Regional Health Centre, 201 Georgian Drive, Barrie, ON L4M 6M2, Canada
| | | | - Katherine Zukotynski
- Department of Medical Imaging, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
| | - Rathan M Subramaniam
- Faculty of Medicine, Nursing, Midwifery & Health Sciences, 160 Oxford Street, Darlinghurst, NSW 2010, Australia
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Khatami A, Sistani G, Sutherland DEK, DeBrabandere S, Reid RH, Laidley DT. Toxicity and Tolerability of 177Lu-DOTA-TATE PRRT with a Modified Administered Activity Protocol in NETs of Variable Origin - A Phase 2 Registry Study. Curr Radiopharm 2022; 15:123-133. [PMID: 35135467 PMCID: PMC9900697 DOI: 10.2174/1874471014666210810100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Peptide receptor radionuclide therapy (PRRT) has been recently approved for advanced, metastatic, or progressive neuroendocrine tumors (NETs). OBJECTIVE This study reports the adverse events (AEs) observed with patient-tailored administered activity. METHODS Fifty-two PRRT naive patients were treated with 177Lu-DOTATATE. The administered activity ranges between 2.78 and 5.55 GBq/cycle using the patient's unique characteristics (age, symptoms, blood work, and biomarkers). RESULTS The protocol was well tolerated with the overwhelming majority of participants being forty- six (88%), completing all 4 induction therapy cycles. The median cumulative administered activity was 19.6 GBq (ranged 3.8-22.3 GBq). A total of 42/52 (81%) reported at least one symptom, and 43/52 (83%) had evidence of biochemical abnormality at enrollment that would meet grade 1 or 2 criteria for AEs. These symptoms only slightly increase with treatment to 50/52 (96%) and 51/52 (98%), respectively. The most common symptoms were mild fatigue (62%), shortness of breath (50%), nausea (44%), abdominal pain (38%), and musculoskeletal pain (37%). The most common biomarker abnormalities were mild anemia (81%), reduced estimated glomerular filtration rate (eGFR) (58%), increased alkaline phosphatase (ALP) (50%), and leukopenia (37%). Of critical importance, no 177Lu-DOTATATE related grade 3 or 4 AEs were observed. CONCLUSION Tailoring the administered activity of 177Lu-DOTATATE to the individual patient with a variety of NETs is both safe and well-tolerated. No patient developed severe grade 3 or 4 AEs. Most patients exhibit symptoms or biochemical abnormality before treatment and this only slightly worsens following induction therapy.
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Affiliation(s)
- Alireza Khatami
- Division of Nuclear Medicine, Department of Medical Imaging, Western University, London, ON N645C1, Canada; ,Address correspondence to this author at the Division of Nuclear Medicine, Department of Medical Imaging, Western University, London, ON N645C1, Canada; E-mail:
| | - Golmehr Sistani
- Division of Nuclear Medicine, Department of Medical Imaging, Western University, London, ON N645C1, Canada; ,Division of Radiology, Department of Medical Imaging, Western University, London, ON, Canada
| | - Duncan E. K. Sutherland
- Division of Nuclear Medicine, Department of Medical Imaging, Western University, London, ON N645C1, Canada;
| | - Sarah DeBrabandere
- Division of Nuclear Medicine, Department of Medical Imaging, Western University, London, ON N645C1, Canada;
| | - Robert H. Reid
- Division of Nuclear Medicine, Department of Medical Imaging, Western University, London, ON N645C1, Canada;
| | - David T. Laidley
- Division of Nuclear Medicine, Department of Medical Imaging, Western University, London, ON N645C1, Canada;
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Young S, Metser U, Sistani G, Langer DL, Bauman G. Establishing a Provincial Registry for Recurrent Prostate Cancer: Providing Access to PSMA PET/CT in Ontario, Canada. Front Oncol 2021; 11:722430. [PMID: 34408985 PMCID: PMC8366560 DOI: 10.3389/fonc.2021.722430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Prostate Specific Membrane Antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is becoming established as a standard of care for the (re)staging of high-risk primary and prostate cancer recurrence after primary therapy. Despite the favorable performance of this imaging modality with high accuracy in disease detection, the availability of PSMA PET/CT varies across jurisdictions worldwide due to variability in the selection of PSMA PET/CT agent, regulatory approvals and funding. In Canada, PSMA based radiopharmaceuticals are still considered investigational new drug (IND), creating limitations in the deployment of these promising imaging agents. While regulatory approval rests with Health Canada, as a single payer health system, funding for Health Canada approved drugs and devices is decided by Provincial Health Ministries. Ontario Health (Cancer Care Ontario) (OH-CCO) is the agency of the Ministry of Health (MOH) in Ontario responsible for making recommendations to the MOH around the organization and funding of cancer services within Ontario (population of 15 million), and the PET Steering Committee of OH-CCO is responsible for providing recommendations on the introduction of new PET radiopharmaceuticals and indications. For Health Canada approved PET radiopharmaceuticals like 18F-FDG, OH-CCO (on behalf of the MOH) provides coverage based on levels of evidence and specific PET Registries are established to aid in real-world evidence collection to inform OH-CCO regarding emerging PET applications. In the case of PSMA PET/CT, adapting this model to an IND PSMA PET/CT agent, 18F-DCFPyL, necessitated the creation of a hybrid Registry-Study model to leverage the existing OH-CCO Registry structure while respecting the need for a Health Canada Clinical Trials Application (CTA) for the deployment of this agent in the province. Within the first 2 years of the registry, over 1700 men have been imaged resulting in a change in management (compared to pre-PET management plans) in over half of the men imaged. In this article, we describe the organization and deployment of the PSMA PET/CT (PREP) Registry throughout the province to provide access for men with suspected prostate cancer recurrence along with key stakeholder perspectives and preliminary results.
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Affiliation(s)
- Sympascho Young
- London Regional Cancer Program, Department of Oncology, Western University and London Health Sciences Centre, London, ON, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, Princess Margaret Hospital, University Health Network, Mount Sinai Hospital, Women's College Hospital and University of Toronto, Toronto, ON, Canada
| | - Golmehr Sistani
- Department of Medical Imaging, London Health Sciences Center and Western University, London, ON, Canada
| | - Deanna L Langer
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Glenn Bauman
- London Regional Cancer Program, Department of Oncology, Western University and London Health Sciences Centre, London, ON, Canada
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Pedro VP, Sistani G, Rachinsky I, Zukotynski K, Bauman G, Liu W. Case - Prostate-specific antigen bounce: A pitfall in prostate-specific membrane antigen interpretation. Can Urol Assoc J 2021; 15:E620-E621. [PMID: 33999811 DOI: 10.5489/cuaj.7257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Golmehr Sistani
- Department of Radiology, Department of Imaging, London Health Sciences Centre and Western University, London, ON, Canada.,Department of Nuclear Medicine, Department of Imaging, London Health Sciences Centre and Western University, London, ON, Canada
| | - Irina Rachinsky
- Department of Nuclear Medicine, Department of Imaging, London Health Sciences Centre and Western University, London, ON, Canada
| | - Katherine Zukotynski
- Departments of Medicine and Radiology, McMaster University, Hamilton, ON, Canada
| | - Glenn Bauman
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, ON, Canada
| | - Wei Liu
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, ON, Canada
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Shaygan B, Zukotynski K, Bénard F, Ménard C, Kuk J, Sistani G, Bauman G, Veit-Haibach P, Metser U. Canadian Urological Association best practice report: Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) and PET/magnetic resonance (MR) in prostate cancer. Can Urol Assoc J 2021; 15:162-172. [PMID: 33661093 DOI: 10.5489/cuaj.7268] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) is increasingly being used worldwide as part of the clinical workup for men with prostate cancer. With high overall accuracy for the detection of prostate cancer, PSMA-targeted PET has an increasingly established role in the setting of biochemical failure after primary therapy and an evolving role in the setting of initial disease staging; its utility for guiding management in the setting of metastatic disease is less clear. Although the specificity is high, familiarization with potential pitfalls in the interpretation of PSMA-targeted PET, including knowledge of the causes for false-positive and negative examinations, is critical. The aim of this best practice report is to provide an illustrative discussion of the current and evolving clinical indications for PSMA-targeted PET, as well as a review of physiological radiopharmaceutical biodistribution and potential imaging pitfalls.
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Affiliation(s)
- Bobby Shaygan
- Department of Urology, McMaster University, Hamilton, ON, Canada
| | - Katherine Zukotynski
- Departments of Medicine and Radiology, McMaster University, Hamilton, ON, Canada
| | - François Bénard
- PET Functional Imaging, BC Cancer, Vancouver, BC, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Cynthia Ménard
- Department of Radiation Oncology, Université de Montréal, Montreal, QC, Canada
| | - Joda Kuk
- Grand River Regional Cancer Centre, Grand River Hospital, Kitchener, ON, Canada
| | - Golmehr Sistani
- Department of Medical Imaging, Western University, London, ON, Canada
| | - Glenn Bauman
- Department of Oncology, Western University, London, ON, Canada
| | | | - Ur Metser
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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Sistani G, Zukotynski KA, Akincioglu C, Romsa JG, Warrington JC. Internal Jugular Vein and Cerebral Venous Sinus Infective Thrombophlebitis Detected With 99mTc-HMPAO White Blood Cell Scintigraphy. Clin Nucl Med 2021; 46:e112-e113. [PMID: 33156045 DOI: 10.1097/rlu.0000000000003352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 35-year-old man with a history of renal transplant, congenital cystinosis, and diabetes was admitted to the hospital with fever, bilateral parotid gland swelling, and acute renal failure. He had 99mTc-HMPAO-WBC (99mTc-hexamethylpropyleneamineoxime white blood cell) imaging for the evaluation of possible parotitis. There was intense radiopharmaceutical uptake along the right internal jugular vein extending to the right sigmoid and transverse and superior sagittal sinuses, suggestive of infective thrombophlebitis or Lemierre syndrome. This study illustrates the value of 99mTc-HMPAO-WBC imaging as a tool for evaluating thrombophlebitis, particularly in patients with renal failure in whom contrast-enhanced CT may not be possible.
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Sistani G, Metser U, Bauman GS, Laidley DT, Pautler SE, Zukotynski KA. Case series - 18F-DCFPyL-positron emission tomography/computed tomography (PET/CT) time of imaging. Can Urol Assoc J 2020; 15:E376-E379. [PMID: 33382375 DOI: 10.5489/cuaj.6984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Golmehr Sistani
- Department of Medical Imaging, Western University, London, ON, Canada
| | - Ur Metser
- Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - Glenn S Bauman
- Department of Radiation Oncology, Western University, London, ON, Canada
| | - David T Laidley
- Department of Nuclear Medicine, Western University, London, ON, Canada
| | - Stephen E Pautler
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
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Sistani G, Bjazevic J, Kassam Z, Romsa J, Pautler S. The value of 99mTc-sestamibi single-photon emission computed tomography-computed tomography in the evaluation and risk stratification of renal masses. Can Urol Assoc J 2020; 15:197-201. [PMID: 33212002 DOI: 10.5489/cuaj.6708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Differentiation of renal cell carcinoma (RCC) from oncocytoma is a common diagnostic dilemma. A few studies have shown that 99mTc-sestamibi (MIBI) imaging has the potential to characterize indeterminate renal masses. This comparative study evaluated the utility of MIBI single-photon emission computed tomography-computed tomography (SPECT-CT) in the assessment and risk stratification of renal masses. METHODS A total of 29 patients with 31 renal masses who had cross-sectional imaging and MIBI SPECT-CT were included. Lesions were categorized as either MIBI-positive or -negative on SPECT-CT. Individual lesion density ranged from 22-56 Hounsfield units (HU) on the non-contrast CT part of SPECT-CT. Quantitative relative MIBI uptake was calculated by measuring tumor to ipsilateral renal parenchymal uptake. The imaging results were correlated with histopathology. RESULTS All oncocytic lesions, including seven oncocytomas and one hybrid oncocytic chromophobe tumor (100%), were positive on MIBI. One chromophobe RCC showed low-grade MIBI uptake. The remaining RCC subtypes, including 15 clear-cell, four papillary, two mixed clear-cell and papillary, and one chromophobe, were MIBI-negative. The quantitative relative tumor uptake showed statistically significant higher uptake in the low-risk/oncocytic lesions compared to RCCs. CONCLUSIONS This study demonstrates that MIBI SPECT-CT is valuable in the characterization of indeterminate renal masses. The combination of MIBI uptake on SPECT and lesion density on non-contrast CT can be used for risk stratification of renal masses. This technique may reduce the need for further imaging (multiphasic CT or magnetic resonance imaging), renal mass biopsy, or surgical resection of low-risk renal masses. Subsequently, more patients could be followed with active surveillance.
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Affiliation(s)
| | | | - Zahra Kassam
- London Health Sciences Centre, London, ON, Canada
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