1
|
Xhima K, Ottoy J, Gibson E, Zukotynski K, Scott C, Feliciano GJ, Adamo S, Kuo PH, Borrie MJ, Chertkow H, Frayne R, Laforce R, Noseworthy MD, Prato FS, Sahlas DJ, Smith EE, Sossi V, Thiel A, Soucy JP, Tardif JC, Goubran M, Black SE, Ramirez J. Distinct spatial contributions of amyloid pathology and cerebral small vessel disease to hippocampal morphology. Alzheimers Dement 2024. [PMID: 38574400 DOI: 10.1002/alz.13791] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/22/2024] [Accepted: 02/09/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Cerebral small vessel disease (SVD) and amyloid beta (Aβ) pathology frequently co-exist. The impact of concurrent pathology on the pattern of hippocampal atrophy, a key substrate of memory impacted early and extensively in dementia, remains poorly understood. METHODS In a unique cohort of mixed Alzheimer's disease and moderate-severe SVD, we examined whether total and regional neuroimaging measures of SVD, white matter hyperintensities (WMH), and Aβ, as assessed by 18F-AV45 positron emission tomography, exert additive or synergistic effects on hippocampal volume and shape. RESULTS Frontal WMH, occipital WMH, and Aβ were independently associated with smaller hippocampal volume. Frontal WMH had a spatially distinct impact on hippocampal shape relative to Aβ. In contrast, hippocampal shape alterations associated with occipital WMH spatially overlapped with Aβ-vulnerable subregions. DISCUSSION Hippocampal degeneration is differentially sensitive to SVD and Aβ pathology. The pattern of hippocampal atrophy could serve as a disease-specific biomarker, and thus guide clinical diagnosis and individualized treatment strategies for mixed dementia.
Collapse
Affiliation(s)
- Kristiana Xhima
- Dr. Sandra E. Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Julie Ottoy
- Dr. Sandra E. Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Erin Gibson
- Dr. Sandra E. Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Zukotynski
- Dr. Sandra E. Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
- Departments of Medicine and Radiology, McMaster University, Hamilton, Ontario, Canada
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Christopher Scott
- Dr. Sandra E. Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Ginelle J Feliciano
- Dr. Sandra E. Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Sabrina Adamo
- Dr. Sandra E. Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Phillip H Kuo
- Departments of Medical Imaging, Medicine, Biomedical Engineering, University of Arizona, Tucson, Arizona, USA
| | - Michael J Borrie
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Howard Chertkow
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Richard Frayne
- Departments of Radiology and Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, Université Laval, Quebec City, Quebec, Canada
| | - Michael D Noseworthy
- Departments of Medicine and Radiology, McMaster University, Hamilton, Ontario, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Frank S Prato
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Vesna Sossi
- Physics and Astronomy Department and DM Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Thiel
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Jean-Paul Soucy
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Maged Goubran
- Dr. Sandra E. Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Dr. Sandra E. Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joel Ramirez
- Dr. Sandra E. Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Weinstein S, Kim DH, Fowler KJ, Birkholz JH, Cash BD, Cilenti E, Dane B, Horvat N, Kambadakone AR, Korngold EK, Liu PS, Lo BM, McCrary M, Mellnick V, Pietryga JA, Santillan CS, Zukotynski K, Carucci LR. ACR Appropriateness Criteria® Left Lower Quadrant Pain: 2023 Update. J Am Coll Radiol 2023; 20:S471-S480. [PMID: 38040465 DOI: 10.1016/j.jacr.2023.08.013] [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] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
The differential diagnosis for left lower quadrant pain is wide and conditions range from the benign and self-limited to life-threatening surgical emergencies. Along with patient history, physical examination, and laboratory tests, imaging is often critical to limit the differential diagnosis and identify life-threatening abnormalities. This document will discuss the guidelines for the appropriate use of imaging in the initial workup for patients who present with left lower quadrant pain, patients with suspected diverticulitis, and patients with suspected complications from diverticulitis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California, San Diego, San Diego, California
| | - James H Birkholz
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Elizabeth Cilenti
- MedStar Georgetown University Hospital, Washington, District of Columbia, Primary care physician
| | - Bari Dane
- NYU Grossman School of Medicine, New York, New York
| | - Natally Horvat
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Marion McCrary
- Duke Signature Care, Durham, North Carolina; American College of Physicians
| | - Vincent Mellnick
- Mallinckrodt Institute of Radiology, Saint Louis, Missouri; Committee on Emergency Radiology-GSER
| | - Jason A Pietryga
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Katherine Zukotynski
- McMaster University, Hamilton, Ontario, Canada; Commission on Nuclear Medicine and Molecular Imaging
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
| |
Collapse
|
4
|
Russo GK, Zaheer A, Kamel IR, Porter KK, Archer-Arroyo K, Bashir MR, Cash BD, Fung A, McCrary M, McGuire BM, Shih RD, Stowers J, Thakrar KH, Vij A, Wahab SA, Zukotynski K, Carucci LR. ACR Appropriateness Criteria® Right Upper Quadrant Pain: 2022 Update. J Am Coll Radiol 2023; 20:S211-S223. [PMID: 37236744 DOI: 10.1016/j.jacr.2023.02.011] [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] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Acute right upper quadrant pain is one of the most common presenting symptoms in hospital emergency departments, as well as outpatient settings. Although gallstone-related acute cholecystitis is a leading consideration in diagnosis, a myriad of extrabiliary sources including hepatic, pancreatic, gastroduodenal, and musculoskeletal should also be considered. This document focuses on the diagnostic accuracy of imaging studies performed specifically to evaluate acute right upper quadrant pain, with biliary etiologies including acute cholecystitis and its complications being the most common. An additional consideration of extrabiliary sources such as acute pancreatitis, peptic ulcer disease, ascending cholangitis, liver abscess, hepatitis, and painful liver neoplasms remain a diagnostic consideration in the right clinical setting. The use of radiographs, ultrasound, nuclear medicine, CT, and MRI for these indications are discussed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | | | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin K Porter
- Panel Vice-Chair, University of Alabama Medical Center, Birmingham, Alabama; Council Steering Committee, ACR
| | | | | | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Alice Fung
- Oregon Health & Science University, Portland, Oregon; Liver Reporting & Data System Technique Working Group
| | - Marion McCrary
- Duke Signature Care, Durham, North Carolina; American College of Physicians
| | - Brendan M McGuire
- University of Alabama at Birmingham, Birmingham, Alabama; Primary care physician
| | - Richard D Shih
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; American College of Emergency Physicians
| | - John Stowers
- Oregon Health & Science University, Portland, Oregon; American College of Surgeons
| | | | - Abhinav Vij
- New York University Langone Medical Center, New York, New York
| | - Shaun A Wahab
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Katherine Zukotynski
- McMaster University, Hamilton, Ontario, Canada; Commission on Nuclear Medicine and Molecular Imaging
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
| |
Collapse
|
5
|
Gravitis AC, Tufa U, Zukotynski K, Streiner DL, Friedman D, Laze J, Chinvarun Y, Devinsky O, Wennberg R, Carlen PL, Bardakjian BL. Ictal ECG-based assessment of sudden unexpected death in epilepsy. Front Neurol 2023; 14:1147576. [PMID: 36994379 PMCID: PMC10040863 DOI: 10.3389/fneur.2023.1147576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
IntroductionPrevious case-control studies of sudden unexpected death in epilepsy (SUDEP) patients failed to identify ECG features (peri-ictal heart rate, heart rate variability, corrected QT interval, postictal heart rate recovery, and cardiac rhythm) predictive of SUDEP risk. This implied a need to derive novel metrics to assess SUDEP risk from ECG.MethodsWe applied Single Spectrum Analysis and Independent Component Analysis (SSA-ICA) to remove artifact from ECG recordings. Then cross-frequency phase-phase coupling (PPC) was applied to a 20-s mid-seizure window and a contour of −3 dB coupling strength was determined. The contour centroid polar coordinates, amplitude (alpha) and angle (theta), were calculated. Association of alpha and theta with SUDEP was assessed and a logistic classifier for alpha was constructed.ResultsAlpha was higher in SUDEP patients, compared to non-SUDEP patients (p < 0.001). Theta showed no significant difference between patient populations. The receiver operating characteristic (ROC) of a logistic classifier for alpha resulted in an area under the ROC curve (AUC) of 94% and correctly classified two test SUDEP patients.DiscussionThis study develops a novel metric alpha, which highlights non-linear interactions between two rhythms in the ECG, and is predictive of SUDEP risk.
Collapse
Affiliation(s)
- Adam C. Gravitis
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Uilki Tufa
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Katherine Zukotynski
- Department of Radiology, McMaster University, Hamilton, ON, Canada
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - David L. Streiner
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Daniel Friedman
- Grossman School of Medicine, New York University, New York, NY, United States
| | - Juliana Laze
- Grossman School of Medicine, New York University, New York, NY, United States
| | - Yotin Chinvarun
- Department of Medicine, Phramongkutklao Royal Army Hospital, Bangkok, Thailand
| | - Orrin Devinsky
- Grossman School of Medicine, New York University, New York, NY, United States
| | - Richard Wennberg
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
| | - Peter L. Carlen
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
| | - Berj L. Bardakjian
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
- *Correspondence: Berj L. Bardakjian
| |
Collapse
|
6
|
Sigurdson SS, al Salman K, Mesci A, Tsakiridis T, Dayes IS, Quan K, Goldberg M, Schnarr K, Kapoor A, Shayegan B, Bauman G, Zukotynski K, Lukka H. Patterns of failure with 18F-DCFPyL PSMA PET/CT in the post-prostatectomy setting: A regional cohort analysis. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.309] [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: 03/15/2023] Open
Abstract
309 Background: The participants are patients enrolled in the PSMA-PET Registry for Recurrent Prostate Cancer (PREP) who were referred for [18F]-DCFPyL PET/CT at our institution in Hamilton, Canada. The Registry is the only funded access to PSMA PET/CT for patients in Ontario. Methods: Our analysis includes all men who had a PSMA PET/CT on the Registry between April 2019 and December 2021 and are either node positive, or persistently detectable PSA after initial radical prostatectomy (RP), or biochemical failure after initial RP. Results: In total 177 men were enrolled on the Registry who met the above criteria. 170 men had complete pathological information available and were included. The pre-PSMA PET/CT median PSA was 0.27 ng/mL. Overall, the probability of a positive PSMA PET/CT result was 59.4%, and the incidence increased with increasing PSA. Lymph node (LN) and distant metastases (DM) were detected more frequently in patients with Grade groups 3-5 and higher pathologic tumor (pT) and nodal (pN1) disease. Across all 170 patients the most common site for LN recurrence was in the internal iliac chain (15.9%), followed by the external iliac (14.7%), obturator (11.8%), common iliac (10.0%), pre-sacral (8.8%), para-aortic (7.7%), and peri-rectal (5.9%) chains. The PSMA PET/CT recurrence rate, PSA, and pathological tumor stage is reported, with the location of the recurrence indicated. Conclusions: Our prospective study elucidates patterns of failure for prostate cancer patients with biochemical recurrence after RP and could impact management at diagnosis and after RP. There is a significant risk of pelvic LN positivity on PSMA PET/CT, which emphasizes the importance of including pelvic LNs within salvage radiation volumes. [Table: see text]
Collapse
Affiliation(s)
| | - Khalid al Salman
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Aruz Mesci
- University of Toronto and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Ian S. Dayes
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Kimmen Quan
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Mira Goldberg
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Kara Schnarr
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Anil Kapoor
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Bobby Shayegan
- St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | - Glenn Bauman
- Department of Oncology, University of Western Ontario, London, Ontario, London, ON, Canada
| | | | - Himu Lukka
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| |
Collapse
|
7
|
Ottoy J, Ozzoude M, Zukotynski K, Kang MS, Adamo S, Scott C, Ramirez J, Swardfager W, Lam B, Bhan A, Mojiri P, Kiss A, Strother S, Bocti C, Borrie M, Chertkow H, Frayne R, Hsiung R, Laforce RJ, Noseworthy MD, Prato FS, Sahlas DJ, Smith EE, Kuo PH, Chad JA, Pasternak O, Sossi V, Thiel A, Soucy JP, Tardif JC, Black SE, Goubran M. Amyloid-PET of the white matter: Relationship to free water, fiber integrity, and cognition in patients with dementia and small vessel disease. J Cereb Blood Flow Metab 2023; 43:921-936. [PMID: 36695071 DOI: 10.1177/0271678x231152001] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
White matter (WM) injury is frequently observed along with dementia. Positron emission tomography with amyloid-ligands (Aβ-PET) recently gained interest for detecting WM injury. Yet, little is understood about the origin of the altered Aβ-PET signal in WM regions. Here, we investigated the relative contributions of diffusion MRI-based microstructural alterations, including free water and tissue-specific properties, to Aβ-PET in WM and to cognition. We included a unique cohort of 115 participants covering the spectrum of low-to-severe white matter hyperintensity (WMH) burden and cognitively normal to dementia. We applied a bi-tensor diffusion-MRI model that differentiates between (i) the extracellular WM compartment (represented via free water), and (ii) the fiber-specific compartment (via free water-adjusted fractional anisotropy [FA]). We observed that, in regions of WMH, a decrease in Aβ-PET related most closely to higher free water and higher WMH volume. In contrast, in normal-appearing WM, an increase in Aβ-PET related more closely to higher cortical Aβ (together with lower free water-adjusted FA). In relation to cognitive impairment, we observed a closer relationship with higher free water than with either free water-adjusted FA or WM PET. Our findings support free water and Aβ-PET as markers of WM abnormalities in patients with mixed dementia, and contribute to a better understanding of processes giving rise to the WM PET signal.
Collapse
Affiliation(s)
- Julie Ottoy
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Miracle Ozzoude
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Katherine Zukotynski
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Departments of Medicine and Radiology, McMaster University, Hamilton, ON, Canada.,Department of Medical Imaging, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Min Su Kang
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Sabrina Adamo
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Christopher Scott
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Joel Ramirez
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Walter Swardfager
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Benjamin Lam
- Department of Medicine (Division of Neurology), Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Aparna Bhan
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Parisa Mojiri
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Stephen Strother
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,The Rotman Research Institute Baycrest, University of Toronto, Toronto, ON, Canada
| | - Christian Bocti
- Service de Neurologie, Département de Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Michael Borrie
- Lawson Health Research Institute, Western University, London, ON, Canada
| | - Howard Chertkow
- Jewish General Hospital and Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Richard Frayne
- Departments of Radiology and Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Robin Hsiung
- Physics and Astronomy Department and DM Center for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Robert Jr Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, Université Laval, Québec, QC, Canada
| | - Michael D Noseworthy
- Departments of Medicine and Radiology, McMaster University, Hamilton, ON, Canada.,Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada
| | - Frank S Prato
- Lawson Health Research Institute, Western University, London, ON, Canada
| | | | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Phillip H Kuo
- Department of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Jordan A Chad
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,The Rotman Research Institute Baycrest, University of Toronto, Toronto, ON, Canada
| | - Ofer Pasternak
- Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Vesna Sossi
- Physics and Astronomy Department and DM Center for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Thiel
- Jewish General Hospital and Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Jean-Paul Soucy
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | | | - Sandra E Black
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medicine (Division of Neurology), Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Maged Goubran
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | |
Collapse
|
8
|
Bénard F, Harsini S, Wilson D, Zukotynski K, Abikhzer G, Turcotte E, Cossette M, Metser U, Romsa J, Martin M, Mar C, Saad F, Soucy JP, Eigl BJ, Black P, Krauze A, Burrell S, Nichol A, Tardif JC. Intra-individual comparison of 18F-sodium fluoride PET-CT and 99mTc bone scintigraphy with SPECT in patients with prostate cancer or breast cancer at high risk for skeletal metastases (MITNEC-A1): a multicentre, phase 3 trial. Lancet Oncol 2022; 23:1499-1507. [PMID: 36343655 DOI: 10.1016/s1470-2045(22)00642-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/03/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Detection of skeletal metastases in patients with prostate cancer or breast cancer remains a major clinical challenge. We aimed to compare the diagnostic performance of 99mTc-methylene diphosphonate (99mTc-MDP) single-photon emission CT (SPECT) and 18F-sodium fluoride (18F-NaF) PET-CT for the detection of osseous metastases in patients with high-risk prostate or breast cancer. METHODS MITNEC-A1 was a prospective, multicentre, single-cohort, phase 3 trial conducted in ten hospitals across Canada. Patients aged 18 years or older with breast or prostate cancer with a WHO performance status of 0-2 and with high risk or clinical suspicion for bone metastasis, but without previously documented bone involvement, were eligible. 18F-NaF PET-CT and 99mTc-MDP SPECT were done within 14 days of each other for each participant. Two independent reviewers interpreted each modality without knowledge of other imaging findings. The primary endpoint was the overall accuracy of 99mTc-MDP SPECT and 18F-NaF PET-CT scans for the detection of bone metastases in the per-protocol population. A combination of histopathological, clinical, and imaging follow-up for up to 24 months was used as the reference standard to assess the imaging results. Safety was assessed in all enrolled participants. This study is registered with ClinicalTrials.gov, NCT01930812, and is complete. FINDINGS Between July 11, 2014, and March 3, 2017, 290 patients were screened, 288 of whom were enrolled (64 participants with breast cancer and 224 with prostate cancer). 261 participants underwent both 18F-NaF PET-CT and 99mTc-MDP SPECT and completed the required follow-up for statistical analysis. Median follow-up was 735 days (IQR 727-750). Based on the reference methods used, 109 (42%) of 261 patients had bone metastases. In the patient-based analysis, 18F-NaF PET-CT was more accurate than 99mTc-MDP SPECT (84·3% [95% CI 79·9-88·7] vs 77·4% [72·3-82·5], difference 6·9% [95% CI 1·3-12·5]; p=0·016). No adverse events were reported for the 288 patients recruited. INTERPRETATION 18F-NaF has the potential to displace 99mTc-MDP as the bone imaging radiopharmaceutical of choice in patients with high-risk prostate or breast cancer. FUNDING Canadian Institutes of Health Research.
Collapse
Affiliation(s)
- François Bénard
- BC Cancer Research Institute, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
| | - Sara Harsini
- BC Cancer Research Institute, Vancouver, BC, Canada
| | - Don Wilson
- BC Cancer Research Institute, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Eric Turcotte
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Mariève Cossette
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Ur Metser
- University Health Network, Toronto, ON, Canada
| | - Jonathan Romsa
- Division of Nuclear Medicine, London Health Sciences Centre, London, ON, Canada; St Joseph's Health Care, London, ON, Canada; Western University, London, ON, Canada
| | - Montgomery Martin
- BC Cancer Research Institute, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Colin Mar
- BC Cancer Research Institute, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Fred Saad
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Jean-Paul Soucy
- Department of Radiology, McGill University, Montreal, QC, Canada
| | | | - Peter Black
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Andra Krauze
- BC Cancer Research Institute, Vancouver, BC, Canada
| | - Steven Burrell
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Alan Nichol
- BC Cancer Research Institute, Vancouver, BC, Canada
| | | |
Collapse
|
9
|
Kambadakone AR, Santillan CS, Kim DH, Fowler KJ, Birkholz JH, Camacho MA, Cash BD, Dane B, Felker RA, Grossman EJ, Korngold EK, Liu PS, Marin D, McCrary M, Pietryga JA, Weinstein S, Zukotynski K, Carucci LR. ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update. J Am Coll Radiol 2022; 19:S445-S461. [PMID: 36436969 DOI: 10.1016/j.jacr.2022.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
This document focuses on imaging in the adult and pregnant populations with right lower quadrant (RLQ) abdominal pain, including patients with fever and leukocytosis. Appendicitis remains the most common surgical pathology responsible for RLQ abdominal pain in the United States. Other causes of RLQ pain include right colonic diverticulitis, ureteral stone, and infectious enterocolitis. Appropriate imaging in the diagnosis of appendicitis has resulted in decreased negative appendectomy rate from as high as 25% to approximately 1% to 3%. Contrast-enhanced CT remains the primary and most appropriate imaging modality to evaluate this patient population. MRI is approaching CT in sensitivity and specificity as this technology becomes more widely available and utilization increases. Unenhanced MRI and ultrasound remain the diagnostic procedures of choice in the pregnant patient. MRI and ultrasound continue to perform best in the hands of the experts. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
- Avinash R Kambadakone
- Division Chief, Abdominal Imaging, Massachusetts General Hospital, Boston, Massachusetts; Medical Director, Martha's Vineyard Hospital Imaging.
| | - Cynthia S Santillan
- Vice Chair of Clinical Operations, University of California, San Diego, San Diego, California
| | - David H Kim
- Panel Chair; Vice Chair of Education, Department of Radiology, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California, San Diego, San Diego, California. ACR LI-RADS; Division Chief, SAR Portfolio Director; RSNA Radiology Senior DE
| | - James H Birkholz
- Divisional Director, Quality and Safety (Abdominal Imaging), Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. Radiology Representative to the Interdisciplinary Dysmotility (GIMIG) Conference
| | - Marc A Camacho
- The University of South Florida Morsani College of Medicine, Tampa, Florida; Committee on Emergency Radiology-GSER
| | - Brooks D Cash
- Chief of Gastroenterology, Hepatology, and Nutrition Division, University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Bari Dane
- Director of Body CT, Abdominal Imaging; Director of Quality and Safety Outpatient Imaging, NYU Grossman School of Medicine, New York, New York
| | - Robin A Felker
- Associate Clerkship Director for Internal Medicine, Georgetown University; Primary care physician, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Eric J Grossman
- Medical Director, Multi-Specialty Clinic, Santa Barbara Cottage Hospital, Santa Barbara, California; American College of Surgeons
| | - Elena K Korngold
- Section Chief, Body Imaging, Chair, Department of Radiology Promotion and Tenure Committee, Oregon Health and Science University, Portland, Oregon
| | - Peter S Liu
- Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | - Marion McCrary
- Associate Director of Duke GME Coaching, Duke Signature Care, Durham, North Carolina; American College of Physicians; Governor-Elect, American College of Physicians North Carolina Chapter
| | | | | | - Katherine Zukotynski
- Co-Associate Chair for Research, Department of Radiology, McMaster University, Hamilton, Ontario, Canada; Commission on Nuclear Medicine and Molecular Imaging
| | - Laura R Carucci
- Specialty Chair; Section Chief Abdominal Imaging, Director of MRI and CT, Virginia Commonwealth University Medical Center, Richmond, Virginia
| |
Collapse
|
10
|
Ottoy J, Ozzoude M, Zukotynski K, Adamo S, Scott C, Gaudet V, Ramirez J, Swardfager W, Cogo-Moreira H, Lam B, Bhan A, Mojiri P, Kang MS, Rabin JS, Kiss A, Strother S, Bocti C, Borrie M, Chertkow H, Frayne R, Hsiung R, Laforce RJ, Noseworthy MD, Prato FS, Sahlas DJ, Smith EE, Kuo PH, Sossi V, Thiel A, Soucy JP, Tardif JC, Black SE, Goubran M. Vascular burden and cognition: Mediating roles of neurodegeneration and amyloid PET. Alzheimers Dement 2022; 19:1503-1517. [PMID: 36047604 DOI: 10.1002/alz.12750] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/06/2022]
Abstract
It remains unclear to what extent cerebrovascular burden relates to amyloid beta (Aβ) deposition, neurodegeneration, and cognitive dysfunction in mixed disease populations with small vessel disease and Alzheimer's disease (AD) pathology. In 120 subjects, we investigated the association of vascular burden (white matter hyperintensity [WMH] volumes) with cognition. Using mediation analyses, we tested the indirect effects of WMH on cognition via Aβ deposition (18 F-AV45 positron emission tomography [PET]) and neurodegeneration (cortical thickness or 18 F fluorodeoxyglucose PET) in AD signature regions. We observed that increased total WMH volume was associated with poorer performance in all tested cognitive domains, with the strongest effects observed for semantic fluency. These relationships were mediated mainly via cortical thinning, particularly of the temporal lobe, and to a lesser extent serially mediated via Aβ and cortical thinning of AD signature regions. WMH volumes differentially impacted cognition depending on lobar location and Aβ status. In summary, our study suggests mainly an amyloid-independent pathway in which vascular burden affects cognitive function via localized neurodegeneration. HIGHLIGHTS: Alzheimer's disease often co-exists with vascular pathology. We studied a unique cohort enriched for high white matter hyperintensities (WMH). High WMH related to cognitive impairment of semantic fluency and executive function. This relationship was mediated via temporo-parietal atrophy rather than metabolism. This relationship was, to lesser extent, serially mediated via amyloid beta and atrophy.
Collapse
Affiliation(s)
- Julie Ottoy
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Miracle Ozzoude
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Zukotynski
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Departments of Medicine and Radiology, McMaster University, Hamilton, Ontario, Canada.,Department of Medical Imaging, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina Adamo
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Scott
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Gaudet
- Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Joel Ramirez
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Walter Swardfager
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Hugo Cogo-Moreira
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Education, ICT and Learning, Østfold University College, Halden, Norway
| | - Benjamin Lam
- Department of Medicine (Division of Neurology), University of Toronto, Toronto, Ontario, Canada
| | - Aparna Bhan
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Parisa Mojiri
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Min Su Kang
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer S Rabin
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Strother
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,The Rotman Research Institute Baycrest, University of Toronto, Toronto, Ontario, Canada
| | - Christian Bocti
- Département de Médecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Michael Borrie
- Lawson Health Research Institute, Western University, London, Ontario, Canada
| | - Howard Chertkow
- Jewish General Hospital and Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Richard Frayne
- Departments of Radiology and Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Robin Hsiung
- Physics and Astronomy Department and DM Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Jr Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, Université Laval, Quebec City, Quebec, Canada
| | - Michael D Noseworthy
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Frank S Prato
- Lawson Health Research Institute, Western University, London, Ontario, Canada
| | | | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Phillip H Kuo
- Department of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, Arizona, USA
| | - Vesna Sossi
- Physics and Astronomy Department and DM Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Thiel
- Jewish General Hospital and Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Jean-Paul Soucy
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Sandra E Black
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine (Division of Neurology), University of Toronto, Toronto, Ontario, Canada.,Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Maged Goubran
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
11
|
Ménard C, Young S, Zukotynski K, Hamilton RJ, Bénard F, Yip S, McCabe C, Saad F, Brundage M, Nitulescu R, Bauman G. PSMA PET/CT guided intensification of therapy in patients at risk of advanced prostate cancer (PATRON): a pragmatic phase III randomized controlled trial. BMC Cancer 2022; 22:251. [PMID: 35260100 DOI: 10.1186/s12885-022-09283-z] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Positron emission tomography targeting the prostate specific membrane antigen (PSMA PET/CT) has demonstrated unparalleled performance as a staging examination for prostate cancer resulting in substantial changes in management. However, the impact of altered management on patient outcomes is largely unknown. This study aims to assess the impact of intensified radiotherapy or surgery guided by PSMA PET/CT in patients at risk of advanced prostate cancer. METHODS This pan-Canadian phase III randomized controlled trial will enroll 776 men with either untreated high risk prostate cancer (CAPRA score 6-10 or stage cN1) or biochemically recurrent prostate cancer post radical prostatectomy (PSA > 0.1 ng/mL). Patients will be randomized 1:1 to either receive conventional imaging or conventional plus PSMA PET imaging, with intensification of radiotherapy or surgery to newly identified disease sites. The primary endpoint is failure free survival at 5 years. Secondary endpoints include rates of adverse events, time to next-line therapy, as well as impact on health-related quality of life and cost effectiveness as measured by incremental cost per Quality Adjusted Life Years gained. DISCUSSION This study will help create level 1 evidence needed to demonstrate whether or not intensification of radiotherapy or surgery based on PSMA PET findings improves outcomes of patients at risk of advanced prostate cancer in a manner that is cost-effective. TRIAL REGISTRATION This trial was prospectively registered in ClinicalTrials.gov as NCT04557501 on September 21, 2020.
Collapse
Affiliation(s)
- Cynthia Ménard
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
| | - Sympascho Young
- Department of Oncology, London Health Sciences Centre, Western University, London, ON, Canada
| | - Katherine Zukotynski
- Departments of Medicine and Radiology, McMaster University, Hamilton, ON, Canada.,Department of Medical Imaging, Western University, London, ON, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Robert J Hamilton
- Department of Surgery (Urology), Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - François Bénard
- Department of Radiology, British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - Steven Yip
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Christopher McCabe
- Institute for Health Economics, University of Alberta, Edmonton, AB, Canada
| | - Fred Saad
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Michael Brundage
- Department of Oncology, Kingston Regional Cancer Centre, Queen's University, Kingston, ON, Canada
| | - Roy Nitulescu
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.,CHUM Center for the Integration and Analysis of Medical Data (CITADEL), Quebec, Canada
| | - Glenn Bauman
- Department of Oncology, London Health Sciences Centre, Western University, London, ON, Canada
| |
Collapse
|
12
|
Chin J, Metser U, Zukotynski K, Mak V, Langer D, Maccrostie P, Finelli A, Kapoor A, Lavallee L, Klotz L, Hagerty M, Hildebrand C, Bauman G. Effect of 18F-DCFPyL PET/CT (=PSMA PET) on the management of patients with suspected limited residual/recurrent disease following radical prostatectomy: Results of a prospective, multicenter registry trial. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Metser U, Zukotynski K, Mak V, Langer D, MacCrostie P, Finelli A, Kapoor A, Chin J, Lavallée L, Klotz LH, Hagerty M, Hildebrand C, Bauman G. Effect of 18F-DCFPyL PET/CT on the Management of Patients with Recurrent Prostate Cancer: Results of a Prospective Multicenter Registry Trial. Radiology 2022; 303:414-422. [PMID: 35076300 DOI: 10.1148/radiol.211824] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The high positivity rate of prostate-specific membrane antigen (PSMA) PET in the setting of biochemical failure (BCF), even when conventional imaging is negative, is promising. Purpose To assess the disease detection rate of PSMA-based PET/CT with fluorine 18-DCFPyL as a radiotracer and the PET-directed management change in men with suspected limited recurrent prostate cancer. Materials and Methods This prospective multicenter registry (Ontario PSMA-PET Registry for Recurrent Prostate Cancer, or PREP) enrolled men with BCF after primary therapy (radical prostatectomy plus or minus salvage radiation therapy or primary radiation therapy) and zero to four disease sites at conventional imaging (CT and bone scintigraphy). The positivity rate of PSMA PET according to serum prostate-specific antigen (PSA) level; frequency of local-egional, oligometastatic, and extensive metastatic recurrence; and rate of change in management after PET findings were recorded. The nonparametric Mood median test was used to assess the association between serum PSA level and change in management. Results A total of 1289 men (median age, 71 years [interquartile range, 65-75 years]) were evaluated. PSMA PET helped detect disease in 841 of 1289 men (65%) and in 615 of 999 men (62%) with negative conventional imaging. The recurrence detection rates according to serum PSA level at enrollment were 38% (160 of 424 men), 63% (107 of 171 men), and 83% (573 of 692 men) for PSA under 0.5 ng/mL, 0.5-1.0 ng/mL, and above 1.0 ng/mL, respectively. At PSMA PET, 399 of 1289 men (31%) had local-regional recurrence, 314 (24%) had oligometastatic disease, and 128 (10%) had extensive metastases. Following PET examination, a change in planned management was recorded in 748 of 1289 men (58%), and in 371 of 1250 men (30%), there was a change in management intent, more commonly from palliative to potentially curative intent (255 of 1289 men [20%]). Conclusion Prostate-specific membrane antigen PET helped detect additional sites of disease compared with conventional imaging in approximately 60% of men with biochemical failure and suspected low-volume metastatic disease, resulting in frequent change in management, including a change from palliative to curative or radical intent therapy in 20% of men. Long-term follow-up is needed to determine whether this impacts disease control. Clinical trial registration no. NCT03718260 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Civelek in this issue.
Collapse
Affiliation(s)
- Ur Metser
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Katherine Zukotynski
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Victor Mak
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Deanna Langer
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Pamela MacCrostie
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Antonio Finelli
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Anil Kapoor
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Joseph Chin
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Luke Lavallée
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Laurence H Klotz
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Marlon Hagerty
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Catherine Hildebrand
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Glenn Bauman
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| |
Collapse
|
14
|
Tufa U, Gravitis A, Zukotynski K, Chinvarun Y, Devinsky O, Wennberg R, Carlen PL, Bardakjian BL. A Peri-Ictal EEG-Based Biomarker for Sudden Unexpected Death in Epilepsy (SUDEP) Derived From Brain Network Analysis. Front Netw Physiol 2022; 2:866540. [PMID: 36926093 PMCID: PMC10013055 DOI: 10.3389/fnetp.2022.866540] [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] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading seizure-related cause of death in epilepsy patients. There are no validated biomarkers of SUDEP risk. Here, we explored peri-ictal differences in topological brain network properties from scalp EEG recordings of SUDEP victims. Functional connectivity networks were constructed and examined as directed graphs derived from undirected delta and high frequency oscillation (HFO) EEG coherence networks in eight SUDEP and 14 non-SUDEP epileptic patients. These networks were proxies for information flow at different spatiotemporal scales, where low frequency oscillations coordinate large-scale activity driving local HFOs. The clustering coefficient and global efficiency of the network were higher in the SUDEP group pre-ictally, ictally and post-ictally (p < 0.0001 to p < 0.001), with features characteristic of small-world networks. These results suggest that cross-frequency functional connectivity network topology may be a non-invasive biomarker of SUDEP risk.
Collapse
Affiliation(s)
- Uilki Tufa
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Adam Gravitis
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Katherine Zukotynski
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada.,Department of Radiology and Medicine, McMaster University, Hamilton, ON, Canada
| | - Yotin Chinvarun
- Comprehensive Epilepsy Program and Neurology Unit, Phramongkutklao Hospital, Bangkok, Thailand
| | - Orrin Devinsky
- Department of Neurology, New York University School of Medicine, New York, NY, United States
| | - Richard Wennberg
- Division of Neurology, Toronto Western Hospital, Toronto, ON, Canada
| | - Peter L Carlen
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Department of Neurology, New York University School of Medicine, New York, NY, United States.,Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Berj L Bardakjian
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
15
|
Ottoy J, Ozzoude M, Zukotynski K, Adamo SM, Scott CJM, Gaudet V, Ramirez J, Swardfager W, Lam B, Bhan A, Kiss A, Strother SC, Bocti C, Borrie M, Chertkow H, Frayne R, Hsiung GR, Laforce R, Noseworthy MD, Prato FS, Sahlas DJ, Smith EE, Sossi V, Thiel A, Soucy J, Tardif J, Goubran M, Black SE. Amyloid‐independent vascular contributions to cortical atrophy and cognition in a multi‐center mixed cohort with low to severe small vessel disease. Alzheimers Dement 2021. [DOI: 10.1002/alz.056326] [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: 11/11/2022]
Affiliation(s)
- Julie Ottoy
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto Toronto ON Canada
| | - Miracle Ozzoude
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto Toronto ON Canada
| | - Katherine Zukotynski
- Departments of Medicine and Radiology, McMaster University Hamilton ON Canada
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute Toronto ON Canada
| | - Sabrina M. Adamo
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto Toronto ON Canada
| | - Christopher J. M. Scott
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute Toronto ON Canada
| | - Vincent Gaudet
- Department of Electrical and Computer Engineering, University of Waterloo Waterloo ON Canada
| | - Joel Ramirez
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto Toronto ON Canada
| | - Walter Swardfager
- Department of Pharmacology & Toxicology, University of Toronto Toronto ON Canada
| | - Benjamin Lam
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute Toronto ON Canada
| | - Aparna Bhan
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute Toronto ON Canada
| | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, University of Toronto Toronto ON Canada
| | | | - Christian Bocti
- Département de Médecine, Université de Sherbrooke Sherbrooke QC Canada
| | - Michael Borrie
- Lawson Health Research Institute, Western University London ON Canada
| | | | - Richard Frayne
- Departments of Radiology and Clinical Neuroscience, University of Calgary Calgary AB Canada
| | - Ging‐Yuek Robin Hsiung
- Djavad Mowafaghian Centre for Brain Health, University of British Colombia Vancouver BC Canada
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, CHU de Québec/Université Laval/Hôpital de l’Enfant‐Jésus Quebec City QC Canada
| | - Michael D. Noseworthy
- Department of Electrical and Computer Engineering, McMaster University Hamilton ON Canada
| | - Frank S. Prato
- Lawson Health Research Institute, Western University London ON Canada
| | | | - Eric E. Smith
- Hotchkiss Brain Institute, University of Calgary Calgary AB Canada
| | - Vesna Sossi
- Physics and Astronomy Department and DM Center for Brain Health, University of British Columbia Vancouver BC Canada
| | - Alexander Thiel
- Jewish General Hospital, McGill University Montreal QC Canada
| | - Jean‐Paul Soucy
- Montreal Neurological Institute, McGill University Montreal QC Canada
| | | | - Maged Goubran
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto Toronto ON Canada
| | - Sandra E. Black
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto Toronto ON Canada
| |
Collapse
|
16
|
Liu W, Fakir H, Randhawa G, Alfano R, Corkum M, Kassam Z, Rachinsky I, Chung HT, Chung P, Loblaw A, Morton G, Sexton T, Kapoor A, Ward A, Zukotynski K, Emmett L, Bauman G. Defining radio-recurrent intra-prostatic target volumes using PSMA-targeted PET/CT and multi-parametric MRI. Clin Transl Radiat Oncol 2021; 32:41-47. [PMID: 34841094 PMCID: PMC8606298 DOI: 10.1016/j.ctro.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/13/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/01/2022] Open
Abstract
Purpose Our purpose was to evaluate intra-prostatic cancer volumes for salvage radiotherapy in men with recurrent prostate cancer confined to the prostate post-primary radiotherapy using mpMRI and 18F-DCFPyL PET/CT (PET). Methods Men with biochemical failure post-primary radiotherapy were enrolled in a multi-centre trial investigating mpMRI and PET. All men with isolated intra-prostatic recurrence are included in this secondary analysis. The intra-prostatic gross tumour volume (GTV) was manually delineated on mpMRI and was also delineated on PET using three methods: 1. manually, 2. using a 30% threshold of maximum intra-prostatic standard uptake value (SUVmax), and 3. using a 67% threshold of this SUVmax. Clinical target volumes (CTV) including expansions on each GTV were generated. Conformity indices were performed between the mpMRI CTV and each PET CTV. Correlation with biopsy and clinical outcomes were performed. Results Of the 36 men included, 30 (83%) had disease in two quadrants or less using the combination of mpMRI and PET. Mean target volume (union of CTV on mpMRI and CTV manually delineated on PET) was 12.2 cc (49% of prostate gland volume). 12/36 (33%) men had a biopsy. Per-patient sensitivity was 91% for mpMRI and 82% for PET. Conclusions mpMRI and PET provide complementary information for delineation of intra-prostatic recurrent disease. Union of CTV on mpMRI and PET is often less than 50% of the prostate, suggesting this imaging could help define a target for focal salvage therapy.
Collapse
Affiliation(s)
- Wei Liu
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Hatim Fakir
- Department of Oncology and Department of Medical Biophysics, London Health Sciences Centre and Western University, London, Canada
| | | | - Ryan Alfano
- Department of Radiation Oncology, Windsor Regional Cancer Centre, Windsor Regional Hospital, Windsor, Canada
| | - Mark Corkum
- Division of Radiation Oncology, The Ottawa Hospital Cancer Centre and the University of Ottawa, Ottawa, Canada
| | - Zahra Kassam
- Department of Medical Imaging, St. Joseph's Health Care and Western University, London, Canada
| | - Irina Rachinsky
- Division of Nuclear Medicine, London Health Sciences Centre and Western University, London, Canada
| | - Hans T Chung
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Peter Chung
- Department of Radiation Oncology, University of Toronto, Toronto, Canada.,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada.,Institute of Health Care Policy and Evaluation, University of Toronto, Canada
| | - Gerard Morton
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Tracy Sexton
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Anil Kapoor
- Urologic Cancer Centre for Research & Innovation and McMaster University, Hamilton, Canada
| | - Aaron Ward
- Department of Medical Biophysics, Lawson Health Research Institute and Western University, London, Canada
| | - Katherine Zukotynski
- Division of Nuclear Medicine, London Health Sciences Centre and Western University, London, Canada.,Departments of Medicine and Radiology, McMaster University, Hamilton, Canada
| | - Louise Emmett
- Department of Nuclear Medicine and Theranostics, St. Vincent's Hospital and University of New South Wales, Sydney, Australia
| | - Glenn Bauman
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| |
Collapse
|
17
|
McCrindle B, Zukotynski K, Doyle TE, Noseworthy MD. A Radiology-focused Review of Predictive Uncertainty for AI Interpretability in Computer-assisted Segmentation. Radiol Artif Intell 2021; 3:e210031. [PMID: 34870219 PMCID: PMC8637228 DOI: 10.1148/ryai.2021210031] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/09/2021] [Accepted: 08/25/2021] [Indexed: 11/11/2022]
Abstract
The recent advances and availability of computer hardware, software tools, and massive digital data archives have enabled the rapid development of artificial intelligence (AI) applications. Concerns over whether AI tools can "communicate" decisions to radiologists and primary care physicians is of particular importance because automated clinical decisions can substantially impact patient outcome. A challenge facing the clinical implementation of AI stems from the potential lack of trust clinicians have in these predictive models. This review will expand on the existing literature on interpretability methods for deep learning and review the state-of-the-art methods for predictive uncertainty estimation for computer-assisted segmentation tasks. Last, we discuss how uncertainty can improve predictive performance and model interpretability and can act as a tool to help foster trust. Keywords: Segmentation, Quantification, Ethics, Bayesian Network (BN) © RSNA, 2021.
Collapse
Affiliation(s)
- Brian McCrindle
- From the Department of Electrical and Computer Engineering (B.M., T.E.D., M.D.N.), Department of Radiology, Faculty of Health Sciences (K.Z., M.D.N.), and School of Biomedical Engineering (K.Z., T.E.D., M.D.N.), McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8; and Vector Institute for Artificial Intelligence, Toronto, Canada (T.E.D.)
| | - Katherine Zukotynski
- From the Department of Electrical and Computer Engineering (B.M., T.E.D., M.D.N.), Department of Radiology, Faculty of Health Sciences (K.Z., M.D.N.), and School of Biomedical Engineering (K.Z., T.E.D., M.D.N.), McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8; and Vector Institute for Artificial Intelligence, Toronto, Canada (T.E.D.)
| | - Thomas E. Doyle
- From the Department of Electrical and Computer Engineering (B.M., T.E.D., M.D.N.), Department of Radiology, Faculty of Health Sciences (K.Z., M.D.N.), and School of Biomedical Engineering (K.Z., T.E.D., M.D.N.), McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8; and Vector Institute for Artificial Intelligence, Toronto, Canada (T.E.D.)
| | - Michael D. Noseworthy
- From the Department of Electrical and Computer Engineering (B.M., T.E.D., M.D.N.), Department of Radiology, Faculty of Health Sciences (K.Z., M.D.N.), and School of Biomedical Engineering (K.Z., T.E.D., M.D.N.), McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8; and Vector Institute for Artificial Intelligence, Toronto, Canada (T.E.D.)
| |
Collapse
|
18
|
Park S, Parihar AS, Bodei L, Hope TA, Mallak N, Millo C, Prasad K, Wilson D, Zukotynski K, Mittra E. Somatostatin Receptor Imaging and Theranostics: Current Practice and Future Prospects. J Nucl Med 2021; 62:1323-1329. [PMID: 34301785 PMCID: PMC9364764 DOI: 10.2967/jnumed.120.251512] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022] Open
Abstract
A new era of precision diagnostics and therapy for patients with neuroendocrine neoplasms began with the approval of somatostatin receptor (SSTR) radiopharmaceuticals for PET imaging followed by peptide receptor radionuclide therapy (PRRT). With the transition from SSTR-based γ-scintigraphy to PET, the higher sensitivity of the latter raised questions regarding the direct application of the planar scintigraphy-based Krenning score for PRRT eligibility. Also, to date, the role of SSTR PET in response assessment and predicting outcome remains under evaluation. In this comprehensive review article, we discuss the current role of SSTR PET in all aspects of neuroendocrine neoplasms, including its relation to conventional imaging, selection of patients for PRRT, and the current understanding of SSTR PET-based response assessment. We also provide a standardized reporting template for SSTR PET with a brief discussion.
Collapse
Affiliation(s)
- Sonya Park
- Department of Nuclear Medicine, Seoul St. Mary's Hospital, Seoul, Korea
| | - Ashwin Singh Parihar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Lisa Bodei
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Nadine Mallak
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon
| | - Corina Millo
- Department of Nuclear Medicine, RAD&IS, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Kalpna Prasad
- Department of Nuclear Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Don Wilson
- BC Cancer, Vancouver, British Columbia, Canada
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Zukotynski
- Departments of Radiology and Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erik Mittra
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon;
| |
Collapse
|
19
|
Brosch-Lenz J, Yousefirizi F, Zukotynski K, Beauregard JM, Gaudet V, Saboury B, Rahmim A, Uribe C. Role of Artificial Intelligence in Theranostics:: Toward Routine Personalized Radiopharmaceutical Therapies. PET Clin 2021; 16:627-641. [PMID: 34537133 DOI: 10.1016/j.cpet.2021.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We highlight emerging uses of artificial intelligence (AI) in the field of theranostics, focusing on its significant potential to enable routine and reliable personalization of radiopharmaceutical therapies (RPTs). Personalized RPTs require patient-specific dosimetry calculations accompanying therapy. Additionally we discuss the potential to exploit biological information from diagnostic and therapeutic molecular images to derive biomarkers for absorbed dose and outcome prediction; toward personalization of therapies. We try to motivate the nuclear medicine community to expand and align efforts into making routine and reliable personalization of RPTs a reality.
Collapse
Affiliation(s)
- Julia Brosch-Lenz
- Department of Integrative Oncology, BC Cancer Research Institute, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Fereshteh Yousefirizi
- Department of Integrative Oncology, BC Cancer Research Institute, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Katherine Zukotynski
- Department of Medicine and Radiology, McMaster University, 1200 Main Street West, Hamilton, Ontario L9G 4X5, Canada
| | - Jean-Mathieu Beauregard
- Department of Radiology and Nuclear Medicine, Cancer Research Centre, Université Laval, 2325 Rue de l'Université, Québec City, Quebec G1V 0A6, Canada; Department of Medical Imaging, Research Center (Oncology Axis), CHU de Québec - Université Laval, 2325 Rue de l'Université, Québec City, Quebec G1V 0A6, Canada
| | - Vincent Gaudet
- Department of Electrical and Computer Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA; Department of Computer Science and Electrical Engineering, University of Maryland Baltimore County, Baltimore, MD, USA; Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Arman Rahmim
- Department of Integrative Oncology, BC Cancer Research Institute, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada; Department of Radiology, University of British Columbia, 11th Floor, 2775 Laurel St, Vancouver, British Columbia V5Z 1M9, Canada; Department of Physics, University of British Columbia, 325 - 6224 Agricultural Road, Vancouver, British Columbia V6T 1Z1, Canada
| | - Carlos Uribe
- Department of Radiology, University of British Columbia, 11th Floor, 2775 Laurel St, Vancouver, British Columbia V5Z 1M9, Canada; Department of Functional Imaging, BC Cancer, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada.
| |
Collapse
|
20
|
Kudo T, Lahey R, Hirschfeld CB, Williams MC, Lu B, Alasnag M, Bhatia M, Henry Bom HS, Dautov T, Fazel R, Karthikeyan G, Keng FY, Rubinshtein R, Better N, Cerci RJ, Dorbala S, Raggi P, Shaw LJ, Villines TC, Vitola JV, Choi AD, Malkovskiy E, Goebel B, Cohen YA, Randazzo M, Pascual TN, Pynda Y, Dondi M, Paez D, Einstein AJ, Einstein AJ, Paez D, Dondi M, Better N, Cerci R, Dorbala S, Pascual TN, Raggi P, Shaw LJ, Villines TC, Vitola JV, Williams MC, Pynda Y, Hinterleitner G, Lu Y, Morozova O, Xu Z, Hirschfeld CB, Cohen Y, Goebel B, Malkovskiy E, Randazzo M, Choi A, Lopez-Mattei J, Parwani P, Nasery MN, Goda A, Shirka E, Benlabgaa R, Bouyoucef S, Medjahedi A, Nailli Q, Agolti M, Aguero RN, Alak MDC, Alberguina LG, Arroñada G, Astesiano A, Astesiano A, Norton CB, Benteo P, Blanco J, Bonelli JM, Bustos JJ, Cabrejas R, Cachero J, Campisi R, Canderoli A, Carames S, Carrascosa P, Castro R, Cendoya O, Cognigni LM, Collaud C, Collaud C, Cortes C, Courtis J, Cragnolino D, Daicz M, De La Vega A, De Maria ST, Del Riego H, Dettori F, Deviggiano A, Dragonetti L, Embon M, Enriquez RE, Ensinas J, Faccio F, Facello A, Topping W, Tweed K, Weir-Mccall J, Abbara S, Abbasi T, Abbott B, Abohashem S, Abramson S, Al-Abboud T, Al-Mallah M, Garofalo D, Almousalli O, Ananthasubramaniam K, Kumar MA, Askew J, Attanasio L, Balmer-Swain M, Bayer RR, Bernheim A, Bhatti S, Bieging E, Geronazzo R, Blankstein R, Bloom S, Blue S, Bluemke D, Borges A, Branch K, Bravo P, Brothers J, Budoff M, Bullock-Palmer R, Gonza N, Burandt A, Burke FW, Bush K, Candela C, Capasso E, Cavalcante J, Chang D, Chatterjee S, Chatzizisis Y, Cheezum M, Gutierrez L, Chen T, Chen J, Chen M, Choi A, Clarcq J, Cordero A, Crim M, Danciu S, Decter B, Dhruva N, Guzzo MA, Doherty N, Doukky R, Dunbar A, Duvall W, Edwards R, Esquitin K, Farah H, Fentanes E, Ferencik M, Fisher D, Guzzo MA, Fitzpatrick D, Foster C, Fuisz T, Gannon M, Gastner L, Gerson M, Ghoshhajra B, Goldberg A, Goldner B, Gonzalez J, Hasbani V, Gore R, Gracia-López S, Hage F, Haider A, Haider S, Hamirani Y, Hassen K, Hatfield M, Hawkins C, Hawthorne K, Huerin M, Heath N, Hendel R, Hernandez P, Hill G, Horgan S, Huffman J, Hurwitz L, Iskandrian A, Janardhanan R, Jellis C, Jäger V, Jerome S, Kalra D, Kaviratne S, Kay F, Kelly F, Khalique O, Kinkhabwala M, Iii GK, Kircher J, Kirkbride R, Lewkowicz JM, Kontos M, Kottam A, Krepp J, Layer J, Lee SH, Leppo J, Lesser J, Leung S, Lewin H, Litmanovich D, López De Munaín MNA, Liu Y, Lopez-Mattei J, Magurany K, Markowitz J, Marn A, Matis SE, Mckenna M, Mcrae T, Mendoza F, Merhige M, Lotti JM, Min D, Moffitt C, Moncher K, Moore W, Morayati S, Morris M, Mossa-Basha M, Mrsic Z, Murthy V, Nagpal P, Marquez A, Napier K, Nelson K, Nijjar P, Osman M, Parwani P, Passen E, Patel A, Patil P, Paul R, Phillips L, Masoli O, Polsani V, Poludasu R, Pomerantz B, Porter T, Prentice R, Pursnani A, Rabbat M, Ramamurti S, Rich F, Luna HR, Masoli OH, Robinson A, Robles K, Rodríguez C, Rorie M, Rumberger J, Russell R, Sabra P, Sadler D, Schemmer M, Schoepf UJ, Mastrovito E, Shah S, Shah N, Shanbhag S, Sharma G, Shayani S, Shirani J, Shivaram P, Sigman S, Simon M, Slim A, Mayoraz M, Smith D, Smith A, Soman P, Sood A, Srichai-Parsia MB, Streeter J, T A, Tawakol A, Thomas D, Thompson R, Melado GE, Torbet T, Trinidad D, Ullery S, Unzek S, Uretsky S, Vallurupalli S, Verma V, Waller A, Wang E, Ward P, Mele A, Weissman G, Wesbey G, White K, Winchester D, Wolinsky D, Yost S, Zgaljardic M, Alonso O, Beretta M, Ferrando R, Merani MF, Kapitan M, Mut F, Djuraev O, Rozikhodjaeva G, Le Ngoc H, Mai SH, Nguyen XC, Meretta AH, Molteni S, Montecinos M, Noguera E, Novoa C, Sueldo CP, Ascani SP, Pollono P, Pujol MP, Radzinschi A, Raimondi G, Redruello M, Rodríguez M, Rodríguez M, Romero RL, Acuña AR, Rovaletti F, San Miguel L, Solari L, Strada B, Traverso S, Traverzo SS, Espeche MDHV, Weihmuller JS, Wolcan J, Zeffiro S, Sakanyan M, Beuzeville S, Boktor R, Butler P, Calcott J, Carr L, Chan V, Chao C, Chong W, Dobson M, Downie D, Dwivedi G, Elison B, Engela J, Francis R, Gaikwad A, Basavaraj AG, Goodwin B, Greenough R, Hamilton-Craig C, Hsieh V, Joshi S, Lederer K, Lee K, Lee J, Magnussen J, Mai N, Mander G, Murton F, Nandurkar D, Neill J, O'Rourke E, O'Sullivan P, Pandos G, Pathmaraj K, Pitman A, Poulter R, Premaratne M, Prior D, Ridley L, Rutherford N, Salehi H, Saunders C, Scarlett L, Seneviratne S, Shetty D, Shrestha G, Shulman J, Solanki V, Stanton T, Stuart M, Stubbs M, Swainson I, Taubman K, Taylor A, Thomas P, Unger S, Upton A, Vamadevan S, Van Gaal W, Verjans J, Voutnis D, Wayne V, Wilson P, Wong D, Wong K, Younger J, Feuchtner G, Mirzaei S, Weiss K, Maroz-Vadalazhskaya N, Gheysens O, Homans F, Moreno-Reyes R, Pasquet A, Roelants V, Van De Heyning CM, Ríos RA, Soldat-Stankovic V, Stankovic S, Albernaz Siqueira MH, Almeida A, Alves Togni PH, Andrade JH, Andrade L, Anselmi C, Araújo R, Azevedo G, Bezerra S, Biancardi R, Grossman GB, Brandão S, Pianta DB, Carreira L, Castro B, Chang T, Cunali F, Cury R, Dantas R, de Amorim Fernandes F, De Lorenzo A, De Macedo Filho R, Erthal F, Fernandes F, Fernandes J, Fernandes F, De Souza TF, Alves WF, Ghini B, Goncalves L, Gottlieb I, Hadlich M, Kameoka V, Lima R, Lima A, Lopes RW, Machado e Silva R, Magalhães T, Silva FM, Mastrocola LE, Medeiros F, Meneghetti JC, Naue V, Naves D, Nolasco R, Nomura C, Oliveira JB, Paixao E, De Carvalho FP, Pinto I, Possetti P, Quinta M, Nogueira Ramos RR, Rocha R, Rodrigues A, Rodrigues C, Romantini L, Sanches A, Santana S, Sara da Silva L, Schvartzman P, Matushita CS, Senra T, Shiozaki A, Menezes de Siqueira ME, Siqueira C, Smanio P, Soares CE, Junior JS, Bittencourt MS, Spiro B, Mesquita CT, Torreao J, Torres R, Uellendahl M, Monte GU, Veríssimo O, Cabeda EV, Pedras FV, Waltrick R, Zapparoli M, Naseer H, Garcheva-Tsacheva M, Kostadinova I, Theng Y, Abikhzer G, Barette R, Chow B, Dabreo D, Friedrich M, Garg R, Hafez MN, Johnson C, Kiess M, Leipsic J, Leung E, Miller R, Oikonomou A, Probst S, Roifman I, Small G, Tandon V, Trivedi A, White J, Zukotynski K, Canessa J, Muñoz GC, Concha C, Hidalgo P, Lovera C, Massardo T, Vargas LS, Abad P, Arturo H, Ayala S, Benitez L, Cadena A, Caicedo C, Moncayo AC, Moncayo AC, Gomez S, Gutierrez Villamil CT, Jaimes C, Londoño J, Londoño Blair JL, Pabon L, Pineda M, Rojas JC, Ruiz D, Escobar MV, Vasquez A, Vergel D, Zuluaga A, Gamboa IB, Castro G, González U, Baric A, Batinic T, Franceschi M, Paar MH, Jukic M, Medakovic P, Persic V, Prpic M, Punda A, Batista JF, Gómez Lauchy JM, Gutierrez YM, Gutierrez YM, Menéndez R, Peix A, Rochela L, Panagidis C, Petrou I, Engelmann V, Kaminek M, Kincl V, Lang O, Simanek M, Abdulla J, Bøttcher M, Christensen M, Gormsen LC, Hasbak P, Hess S, Holdgaard P, Johansen A, Kyhl K, Norgaard BL, Øvrehus KA, Rønnow Sand NP, Steffensen R, Thomassen A, Zerahn B, Perez A, Escorza Velez GA, Velez MS, Abdel Aziz IS, Abougabal M, Ahmed T, Allam A, Asfour A, Hassan M, Hassan A, Ibrahim A, Kaffas S, Kandeel A, Ali MM, Mansy A, Maurice H, Nabil S, Shaaban M, Flores AC, Poksi A, Knuuti J, Kokkonen V, Larikka M, Uusitalo V, Bailly M, Burg S, Deux JF, Habouzit V, Hyafil F, Lairez O, Proffit F, Regaieg H, Sarda-Mantel L, Tacher V, Schneider RP, Ayetey H, Angelidis G, Archontaki A, Chatziioannou S, Datseris I, Fragkaki C, Georgoulias P, Koukouraki S, Koutelou M, Kyrozi E, Repasos E, Stavrou P, Valsamaki P, Gonzalez C, Gutierrez G, Maldonado A, Buga K, Garai I, Maurovich-Horvat P, Schmidt E, Szilveszter B, Várady E, Banthia N, Bhagat JK, Bhargava R, Bhat V, Bhatia M, Choudhury P, Chowdekar VS, Irodi A, Jain S, Joseph E, Kumar S, Girijanandan Mahapatra PD, Mitra D, Mittal BR, Ozair A, Patel C, Patel T, Patel R, Patel S, Saxena S, Sengupta S, Singh S, Singh B, Sood A, Verma A, Affandi E, Alam PS, Edison E, Gunawan G, Hapkido H, Hidayat B, Huda A, Mukti AP, Prawiro D, Soeriadi EA, Syawaluddin H, Albadr A, Assadi M, Emami F, Houshmand G, Maleki M, Rostami MT, Zakavi SR, Zaid EA, Agranovich S, Arnson Y, Bar-Shalom R, Frenkel A, Knafo G, Lugassi R, Maor Moalem IS, Mor M, Muskal N, Ranser S, Shalev A, Albano D, Alongi P, Arnone G, Bagatin E, Baldari S, Bauckneht M, Bertelli P, Bianco F, Bonfiglioli R, Boni R, Bruno A, Bruno I, Busnardo E, Califaretti E, Camoni L, Carnevale A, Casoni R, Cavallo AU, Cavenaghi G, Chierichetti F, Chiocchi M, Cittanti C, Colletta M, Conti U, Cossu A, Cuocolo A, Cuzzocrea M, De Rimini ML, De Vincentis G, Del Giudice E, Del Torto A, Della Tommasina V, Durmo R, Erba PA, Evangelista L, Faletti R, Faragasso E, Farsad M, Ferro P, Florimonte L, Frantellizzi V, Fringuelli FM, Gatti M, Gaudiano A, Gimelli A, Giubbini R, Giuffrida F, Ialuna S, Laudicella R, Leccisotti L, Leva L, Liga R, Liguori C, Longo G, Maffione M, Mancini ME, Marcassa C, Milan E, Nardi B, Pacella S, Pepe G, Pontone G, Pulizzi S, Quartuccio N, Rampin L, Ricci F, Rossini P, Rubini G, Russo V, Sacchetti GM, Sambuceti G, Scarano M, Sciagrà R, Sperandio M, Stefanelli A, Ventroni G, Zoboli S, Baugh D, Chambers D, Madu E, Nunura F, Asano H, Chimura CM, Fujimoto S, Fujisue K, Fukunaga T, Fukushima Y, Fukuyama K, Hashimoto J, Ichikawa Y, Iguchi N, Imai M, Inaki A, Ishimura H, Isobe S, Kadokami T, Kato T, Kudo T, Kumita S, Maruno H, Mataki H, Miyagawa M, Morimoto R, Moroi M, Nagamachi S, Nakajima K, Nakata T, Nakazato R, Nanasato M, Naya M, Norikane T, Ohta Y, Okayama S, Okizaki A, Otomi Y, Otsuka H, Saito M, Sakata SY, Sarai M, Sato D, Shiraishi S, Suwa Y, Takanami K, Takehana K, Taki J, Tamaki N, Taniguchi Y, Teragawa H, Tomizawa N, Tsujita K, Umeji K, Wakabayashi Y, Yamada S, Yamazaki S, Yoneyama T, Rawashdeh M, Batyrkhanov D, Dautov T, Makhdomi K, Ombati K, Alkandari F, Garashi M, Coie TL, Rajvong S, Kalinin A, Kalnina M, Haidar M, Komiagiene R, Kviecinskiene G, Mataciunas M, Vajauskas D, Picard C, Karim NKA, Reichmuth L, Samuel A, Allarakha MA, Naojee AS, Alexanderson-Rosas E, Barragan E, González-Montecinos AB, Cabada M, Rodriguez DC, Carvajal-Juarez I, Cortés V, Cortés F, De La Peña E, Gama-Moreno M, González L, Ramírez NG, Jiménez-Santos M, Matos L, Monroy E, Morelos M, Ornelas M, Ortga Ramirez JA, Preciado-Anaya A, Preciado-Gutiérrez ÓU, Barragan AP, Rosales Uvera SG, Sandoval S, Tomas MS, Sierra-Galan LM, Sierra-Galan LM, Siu S, Vallejo E, Valles M, Faraggi M, Sereegotov E, Ilic S, Ben-Rais N, Alaoui NI, Taleb S, Pa Myo KP, Thu PS, Ghimire RK, Rajbanshi B, Barneveld P, Glaudemans A, Habets J, Koopmans KP, Manders J, Pool S, Scholte A, Scholtens A, Slart R, Thimister P, Van Asperen EJ, Veltman N, Verschure D, Wagenaar N, Edmond J, Ellis C, Johnson K, Keenan R, Kueh SH(A, Occleshaw C, Sasse A, To A, Van Pelt N, Young C, Cuadra T, Roque Vanegas HB, Soli IA, Issoufou DM, Ayodele T, Madu C, Onimode Y, Efros-Monsen E, Forsdahl SH, Hildre Dimmen JM, Jørgensen A, Krohn I, Løvhaugen P, Bråten AT, Al Dhuhli H, Al Kindi F, Al-Bulushi N, Jawa Z, Tag N, Afzal MS, Fatima S, Younis MN, Riaz M, Saadullah M, Herrera Y, Lenturut-Katal D, Vázquez MC, Ortellado J, Akhter A, Cao D, Cheung S, Dai X, Gong L, Han D, Hou Y, Li C, Li T, Li D, Li S, Liu J, Liu H, Lu B, Ng MY, Sun K, Tang G, Wang J, Wang X, Wang ZQ, Wang Y, Wang Y, Wu J, Wu Z, Xia L, Xiao J, Xu L, Yang Y, Yin W, Yu J, Yuan L, Zhang T, Zhang L, Zhang YG, Zhang X, Zhu L, Alfaro A, Abrihan P, Barroso A, Cruz E, Gomez MR, Magboo VP, Medina JM, Obaldo J, Pastrana D, Pawhay CM, Quinon A, Tang JM, Tecson B, Uson KJ, Uy M, Kostkiewicz M, Kunikowska J, Bettencourt N, Cantinho G, Ferreira A, Syed G, Arnous S, Atyani S, Byrne A, Gleeson T, Kerins D, Meehan C, Murphy D, Murphy M, Murray J, O'Brien J, Bang JI, Bom H, Cho SG, Hong CM, Jang SJ, Jeong YH, Kang WJ, Kim JY, Lee J, Namgung CK, So Y, Won KS, Majstorov V, Vavlukis M, Salobir BG, Štalc M, Benedek T, Benedek I, Mititelu R, Stan CA, Ansheles A, Dariy O, Drozdova O, Gagarina N, Gulyaev VM, Itskovich I, Karalkin A, Kokov A, Migunova E, Pospelov V, Ryzhkova D, Saifullina G, Sazonova S, Sergienko V, Shurupova I, Trifonova T, Ussov WY, Vakhromeeva M, Valiullina N, Zavadovsky K, Zhuravlev K, Alasnag M, Okarvi S, Saranovic DS, Keng F, Jason See JH, Sekar R, Yew MS, Vondrak A, Bejai S, Bennie G, Bester R, Engelbrecht G, Evbuomwan O, Gongxeka H, Vuuren MJ, Kaplan M, Khushica P, Lakhi H, Louw L, Malan N, Milos K, Modiselle M, More S, Naidoo M, Scholtz L, Vangu M, Aguadé-Bruix S, Blanco I, Cabrera A, Camarero A, Casáns-Tormo I, Cuellar-Calabria H, Flotats A, Fuentes Cañamero ME, García ME, Jimenez-Heffernan A, Leta R, Diaz JL, Lumbreras L, Marquez-Cabeza JJ, Martin F, Martinez de Alegria A, Medina F, Canal MP, Peiro V, Pubul-Nuñez V, Rayo Madrid JI, Rey CR, Perez RR, Ruiz J, Hernández GS, Sevilla A, Zeidán N, Nanayakkara D, Udugama C, Simonsson M, Alkadhi H, Buechel RR, Burger P, Ceriani L, De Boeck B, Gräni C, Juillet de Saint Lager Lucas A, Kamani CH, Kawel-Boehm N, Manka R, Prior JO, Rominger A, Vallée JP, Khiewvan B, Premprabha T, Thientunyakit T, Sellem A, Kir KM, Sayman H, Sebikali MJ, Muyinda Z, Kmetyuk Y, Korol P, Mykhalchenko O, Pliatsek V, Satyr M, Albalooshi B, Ahmed Hassan MI, Anderson J, Bedi P, Biggans T, Bularga A, Bull R, Burgul R, Carpenter JP, Coles D, Cusack D, Deshpande A, Dougan J, Fairbairn T, Farrugia A, Gopalan D, Gummow A, Ramkumar PG, Hamilton M, Harbinson M, Hartley T, Hudson B, Joshi N, Kay M, Kelion A, Khokhar A, Kitt J, Lee K, Low C, Mak SM, Marousa N, Martin J, Mcalindon E, Menezes L, Morgan-Hughes G, Moss A, Murray A, Nicol E, Patel D, Peebles C, Pugliese F, Luis Rodrigues JC, Rofe C, Sabharwal N, Schofield R, Semple T, Sharma N, Strouhal P, Subedi D. Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia. JACC: Asia 2021; 1:187-199. [PMID: 36338167 PMCID: PMC9627847 DOI: 10.1016/j.jacasi.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/12/2021] [Accepted: 06/29/2021] [Indexed: 11/27/2022]
Abstract
Background The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.
Collapse
|
21
|
Avram AM, Zukotynski K, Nadel HR, Giovanella LM. MANAGEMENT OF DIFFERENTIATED THYROID CANCER: THE STANDARD OF CARE. J Nucl Med 2021; 63:189-195. [PMID: 34413146 DOI: 10.2967/jnumed.121.262402] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/05/2021] [Indexed: 11/16/2022] Open
Abstract
In the past decade the management of differentiated thyroid cancer (DTC) underwent a paradigm shift towards the use of risk-stratification with the goal of maximizing benefit and minimizing morbidity of radioiodine (131I) therapy. 131I therapy is guided by information derived from surgical histopathology, molecular markers, postoperative diagnostic radioiodine scintigraphy and thyroglobulin (Tg) levels. 131I is used for diagnostic imaging and therapy of DTC based on physiologic sodium-iodine symporter expression in normal and neoplastic thyroid tissue. We summarize the essential information at the core of multidisciplinary DTC management, which emphasizes individualization of 131I therapy according to the patient's risk for tumor recurrence.
Collapse
Affiliation(s)
| | | | | | - Luca M Giovanella
- Clinic for Nuclear Medicine and Thyroid Competence Center, Imaging Institute of Southern Switzerland, Switzerland
| |
Collapse
|
22
|
Zukotynski K, Black SE, Kuo PH, Bhan A, Adamo S, Scott CJM, Lam B, Masellis M, Kumar S, Fischer CE, Tartaglia MC, Lang AE, Tang-Wai DF, Freedman M, Vasdev N, Gaudet V. Exploratory Assessment of K-means Clustering to Classify 18F-Flutemetamol Brain PET as Positive or Negative. Clin Nucl Med 2021; 46:616-620. [PMID: 33883495 DOI: 10.1097/rlu.0000000000003668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/26/2022]
Abstract
RATIONALE We evaluated K-means clustering to classify amyloid brain PETs as positive or negative. PATIENTS AND METHODS Sixty-six participants (31 men, 35 women; age range, 52-81 years) were recruited through a multicenter observational study: 19 cognitively normal, 25 mild cognitive impairment, and 22 dementia (11 Alzheimer disease, 3 subcortical vascular cognitive impairment, and 8 Parkinson-Lewy Body spectrum disorder). As part of the neurocognitive and imaging evaluation, each participant had an 18F-flutemetamol (Vizamyl, GE Healthcare) brain PET. All studies were processed using Cortex ID software (General Electric Company, Boston, MA) to calculate SUV ratios in 19 regions of interest and clinically interpreted by 2 dual-certified radiologists/nuclear medicine physicians, using MIM software (MIM Software Inc, Cleveland, OH), blinded to the quantitative analysis, with final interpretation based on consensus. K-means clustering was retrospectively used to classify the studies from the quantitative data. RESULTS Based on clinical interpretation, 46 brain PETs were negative and 20 were positive for amyloid deposition. Of 19 cognitively normal participants, 1 (5%) had a positive 18F-flutemetamol brain PET. Of 25 participants with mild cognitive impairment, 9 (36%) had a positive 18F-flutemetamol brain PET. Of 22 participants with dementia, 10 (45%) had a positive 18F-flutemetamol brain PET; 7 of 11 participants with Alzheimer disease (64%), 1 of 3 participants with vascular cognitive impairment (33%), and 2 of 8 participants with Parkinson-Lewy Body spectrum disorder (25%) had a positive 18F-flutemetamol brain PET. Using clinical interpretation as the criterion standard, K-means clustering (K = 2) gave sensitivity of 95%, specificity of 98%, and accuracy of 97%. CONCLUSIONS K-means clustering may be a powerful algorithm for classifying amyloid brain PET.
Collapse
Affiliation(s)
| | | | - Phillip H Kuo
- Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona Cancer Center, University of Arizona, Tucson, AZ
| | - Aparna Bhan
- LC Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto
| | - Sabrina Adamo
- LC Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto
| | - Christopher J M Scott
- LC Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto
| | | | | | | | - Corinne E Fischer
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, University of Toronto
| | | | | | | | | | | | - Vincent Gaudet
- Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
23
|
Petibon Y, Fahey F, Cao X, Levin Z, Sexton-Stallone B, Falone A, Zukotynski K, Kwatra N, Lim R, Bar-Sever Z, Chemli Y, Treves ST, Fakhri GE, Ouyang J. Detecting lumbar lesions in 99m Tc-MDP SPECT by deep learning: Comparison with physicians. Med Phys 2021; 48:4249-4261. [PMID: 34101855 DOI: 10.1002/mp.15033] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/16/2021] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE 99m Tc-MDP single-photon emission computed tomography (SPECT) is an established tool for diagnosing lumbar stress, a common cause of low back pain (LBP) in pediatric patients. However, detection of small stress lesions is complicated by the low quality of SPECT, leading to significant interreader variability. The study objectives were to develop an approach based on a deep convolutional neural network (CNN) for detecting lumbar lesions in 99m Tc-MDP scans and to compare its performance to that of physicians in a localization receiver operating characteristic (LROC) study. METHODS Sixty-five lesion-absent (LA) 99m Tc-MDP studies performed in pediatric patients for evaluating LBP were retrospectively identified. Projections for an artificial focal lesion were acquired separately by imaging a 99m Tc capillary tube at multiple distances from the collimator. An approach was developed to automatically insert lesions into LA scans to obtain realistic lesion-present (LP) 99m Tc-MDP images while ensuring knowledge of the ground truth. A deep CNN was trained using 2.5D views extracted in LP and LA 99m Tc-MDP image sets. During testing, the CNN was applied in a sliding-window fashion to compute a 3D "heatmap" reporting the probability of a lesion being present at each lumbar location. The algorithm was evaluated using cross-validation on a 99m Tc-MDP test dataset which was also studied by five physicians in a LROC study. LP images in the test set were obtained by incorporating lesions at sites selected by a physician based on clinical likelihood of injury in this population. RESULTS The deep learning (DL) system slightly outperformed human observers, achieving an area under the LROC curve (AUCLROC ) of 0.830 (95% confidence interval [CI]: [0.758, 0.924]) compared with 0.785 (95% CI: [0.738, 0.830]) for physicians. The AUCLROC for the DL system was higher than that of two readers (difference in AUCLROC [ΔAUCLROC ] = 0.049 and 0.053) who participated to the study and slightly lower than that of two other readers (ΔAUCLROC = -0.006 and -0.012). Another reader outperformed DL by a more substantial margin (ΔAUCLROC = -0.053). CONCLUSION The DL system provides comparable or superior performance than physicians in localizing small 99m Tc-MDP positive lumbar lesions.
Collapse
Affiliation(s)
- Yoann Petibon
- Gordon Center of Medical Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Frederic Fahey
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Nuclear Medicine and Molecular Imaging, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Xinhua Cao
- Division of Nuclear Medicine and Molecular Imaging, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Zakhar Levin
- Gordon Center of Medical Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Briana Sexton-Stallone
- Division of Nuclear Medicine and Molecular Imaging, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Anthony Falone
- Division of Nuclear Medicine and Molecular Imaging, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Katherine Zukotynski
- Departments of Medicine and Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Neha Kwatra
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Nuclear Medicine and Molecular Imaging, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ruth Lim
- Gordon Center of Medical Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Zvi Bar-Sever
- Institute of Nuclear Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yanis Chemli
- Gordon Center of Medical Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - S Ted Treves
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Georges El Fakhri
- Gordon Center of Medical Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jinsong Ouyang
- Gordon Center of Medical Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
24
|
Villa D, Scott DW, Morin R, Nakamura H, Larouche JF, Cheung M, Johnson N, Elemary M, Keating MM, Tonseth P, Zukotynski K, Mayo S, Goswami R, Laister R, Kuruvilla J. A PHASE II STUDY OF ACALABRUTINIB IN COMBINATION WITH R‐CHOP CHEMOTHERAPY PRIOR TO AUTOLOGOUS STEM CELL TRANSPLANTATION IN PREVIOUSLY UNTREATED MANTLE CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.171_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- D. Villa
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - D. W. Scott
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - R. Morin
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - H. Nakamura
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - J. F. Larouche
- Centre Hospitalier Universitaire de Québec Hôpital de l’Enfant‐Jésus Quebec City Canada
| | - M. Cheung
- Sunnybrook Health Sciences Centre Department of Hematology Toronto Canada
| | - N. Johnson
- Jewish General Hospital Department of Hematology Montreal Canada
| | - M. Elemary
- Saskatchewan Cancer Agency Saskatoon Cancer Centre Saskatoon Canada
| | - M. M. Keating
- Nova Scotia Cancer Centre QEII Health Sciences Centre Halifax Canada
| | - P. Tonseth
- BC Cancer Department of Functional Imaging Vancouver Canada
| | - K. Zukotynski
- McMaster University Departments of Radiology and Medicine Hamilton Canada
| | - S. Mayo
- University of Toronto Lawrence S. Bloomberg Faculty of Nursing Toronto Canada
| | - R. Goswami
- Sunnybrook Health Sciences Centre Department of Laboratory Medicine and Pathobiology Toronto Canada
| | - R. Laister
- University Health Network Princess Margaret Cancer Centre Toronto Canada
| | - J. Kuruvilla
- University Health Network Princess Margaret Cancer Centre Toronto Canada
| |
Collapse
|
25
|
Kapoor A, Zukotynski K, Tajzler C, Hoogenes J, Matsumoto E, Uy M, Bauman G, Metser U, Finelli A, Ding M, Shayegan B. PSMA-PET/CT Registry for Recurrent Prostate Cancer (PREP): Initial findings from a single center. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5064] [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: 11/20/2022] Open
Abstract
5064 Background: Several lesion-targeted therapies exist for locally recurrent or limited stage metastatic prostate cancer (PCa) post-radiotherapy (RT) and radical prostatectomy (RP). However, detection of disease sites is limited using conventional imaging (CI) including computed tomography (CT) and bone scan. Prostate specific membrane antigen (PSMA) targeting PET radiopharmaceuticals like [18F]DCFPyL may help detect disease not seen on CI. Our objective was to assess the ability of PSMA targeted PET/CT to detect sites of disease recurrence and impact on patient management. Methods: This multi-center prospective registry study included six Ontario centers. Eligible patients in 1 of 7 clinical cohorts (Table) were identified and approved by Cancer Care Ontario (CCO) to have restaging with PSMA targeted PET/CT. Referring physicians were asked to complete a form indicating whether a change in management strategy would occur based on the PET/CT results. At 6 months post-PET/CT, actual patient management will be confirmed via provincial registries. These interim results are from a single center. Results: 253 patients were enrolled and had a PSMA targeted PET/CT. At baseline, median age was 71 years (range 50-102 years) and median PSA was 2.7 ng/mL (range 0.04-134.0 ng/mL). The majority of patients (n=59; 23.3%) were in cohort 2 (biochemical failure post-RP). In patients with negative CI, PSMA targeted PET/CT detected disease sites in 68.5% (170/248), resulting in a change in management for 67.8% (137/202) overall and 72.1% and 64.3% post-RT and post-RP, respectively. Conclusions: PSMA targeted PET/CT detected occult lesions on CI in the majority of patients enrolled, leading to a high rate of change in management. Our institutional results are in keeping with preliminary results reported for the provincial cohort. Clinical trial information: NCT03718260. [Table: see text]
Collapse
Affiliation(s)
- Anil Kapoor
- McMaster University Hamilton, Hamilton, ON, Canada
| | | | | | | | | | - Michael Uy
- McMaster University, Hamilton, ON, Canada
| | - Glenn Bauman
- Western University, London Regional Cancer Program, London, ON, Canada
| | - Ur Metser
- Princess Margaret Hospital, Toronto, ON, Canada
| | | | | | | |
Collapse
|
26
|
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
| |
Collapse
|
27
|
Wahl RL, Chareonthaitawee P, Clarke B, Drzezga A, Lindenberg L, Rahmim A, Thackeray J, Ulaner GA, Weber W, Zukotynski K, Sunderland J. Mars Shot for Nuclear Medicine, Molecular Imaging, and Molecularly Targeted Radiopharmaceutical Therapy. J Nucl Med 2021; 62:6-14. [PMID: 33334911 DOI: 10.2967/jnumed.120.253450] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023] Open
Abstract
The Society of Nuclear Medicine and Molecular Imaging created the Value Initiative in 2017 as a major component of its strategic plan to further demonstrate the value of molecular imaging and molecularly targeted radiopharmaceutical therapy to patients, physicians, payers, and funding agencies. The research and discovery domain, 1 of 5 under the Value Initiative, has a goal of advancing the research and development of diagnostic and therapeutic nuclear medicine. Research and discovery efforts and achievements are essential to ensure a bright future for NM and to translate science to practice. Given the remarkable progress in the field, leaders from the research and discovery domain and society councils identified 5 broad areas of opportunity with potential for substantive growth and clinical impact. This article discusses these 5 growth areas, identifying specific areas of particularly high importance for future study and development. As there was an understanding that goals should be both visionary yet achievable, this effort was called the Mars shot for nuclear medicine.
Collapse
Affiliation(s)
- Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University St. Louis, Missouri
| | | | - Bonnie Clarke
- Research and Discovery, Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Alexander Drzezga
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany, German Center for Neurodegenerative Diseases, Bonn-Cologne, Germany, and Institute of Neuroscience and Medicine, Molecular Organization of the Brain, Forschungszentrum Jülich, Jülich, Germany
| | - Liza Lindenberg
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Arman Rahmim
- Departments of Radiology and Physics, University of British Columbia, Vancouver, British Columbia, Canada; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - James Thackeray
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Gary A Ulaner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, and Molecular Imaging and Therapy, Hoag Cancer Center, Newport Beach, California
| | - Wolfgang Weber
- Department of Nuclear Medicine, Technical University Munich, Munich, Germany
| | - Katherine Zukotynski
- Departments of Medicine and Radiology, McMaster University, Hamilton, Ontario, Canada; and
| | - John Sunderland
- Departments of Radiology and Physics, University of Iowa, Iowa City, Iowa
| |
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
Young S, Liu W, Zukotynski K, Bauman G. Prostate-specific membrane antigen targeted PET/CT for recurrent prostate cancer: a clinician's guide. Expert Rev Anticancer Ther 2021; 21:641-655. [PMID: 33476253 DOI: 10.1080/14737140.2021.1878883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION PSMA-targeted PET/CT is a 'Next Generation Imaging' technique with superior sensitivity and specificity for detecting recurrent prostate cancer compared with conventional imaging, allowing more accurate staging and re-staging. AREAS COVERED This article reviews the role of PSMA-targeted PET/CT in clinical management of men with recurrent prostate cancer. EXPERT OPINION Through enhanced spatial characterization of recurrent prostate cancer, PSMA-targeted PET/CT has shown significant impact on management decisions. In particular, by identifying men with recurrence confined to the prostate or pelvic nodes, PSMA-targeted PET/CT enables selective deployment of localized salvage therapies for management of biochemical failure after primary treatment with prostatectomy or radiotherapy. In oligometastatic disease, PSMA-targeted PET/CT may improve patient selection and treatment accuracy for metastasis-directed therapy and early phase II studies show encouraging results in delaying the need for systemic therapy. Further, quantitative PSMA-targeted PET/CT for monitoring response and therapeutic PSMA-targeted radiopharmaceuticals are emerging as encouraging treatment options in the setting of castrate-resistant disease.
Collapse
Affiliation(s)
- Sympascho Young
- Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Wei Liu
- Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | | | - Glenn Bauman
- Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| |
Collapse
|
30
|
Liu W, Zukotynski K, Emmett L, Chung HT, Chung P, Wolfson R, Rachinsky I, Kapoor A, Metser U, Loblaw A, Morton G, Sexton T, Lock M, Helou J, Berlin A, Boylan C, Archer S, Pond GR, Bauman G. Utilization of Salvage and Systemic Therapies for Recurrent Prostate Cancer as a Result of 18F-DCFPyL PET/CT Restaging. Adv Radiat Oncol 2021; 6:100553. [PMID: 33521396 PMCID: PMC7820022 DOI: 10.1016/j.adro.2020.08.010] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/02/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose Our purpose was to investigate the effect of the addition of prostate-specific membrane antigen (PSMA)-targeted positron emission tomography/computed tomography (PET/CT) in patients with recurrent prostate cancer post-primary radiation therapy. Methods and Materials A prospective, multi-institutional clinical trial evaluated 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) PET/CT restaging in 79 men with recurrent prostate cancer post-primary radiation therapy. We report actual patient management and compare this with proposed management both before and after PSMA-targeted PET/CT. Results Most patients (59%) had a major change in actual management compared with pre-PET/CT proposed management. The rate of major change was underestimated by immediately post-PET/CT surveys (32%). Eighteen patients with PSMA avidity in the prostate gland suspicious for malignancy had a prostate biopsy. Sensitivity, specificity, and positive predictive values of PSMA uptake in the prostate were 86%, 67%, and 92%, respectively. Thirty percent of patients had directed salvage therapy and 41% underwent systemic therapy. Eleven out of 79 patients (14%) had high-dose-rate brachytherapy alone for local recurrence, and 91% were free of recurrence at a median follow-up of 20 months. Conclusions Most patients had a major change in actual management compared with pre-PSMA-targeted PET/CT planned management, and this was underestimated by post-PET/CT questionnaires.
Collapse
Affiliation(s)
- Wei Liu
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | | | - Louise Emmett
- Department of Nuclear Medicine and Theranostics, St. Vincent’s Hospital and University of New South Wales, Sydney, Australia
| | - Hans T. Chung
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Peter Chung
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Robert Wolfson
- Department of Medical Imaging, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Irina Rachinsky
- Division of Nuclear Medicine, London Health Sciences Centre and Western University, London, Canada
| | - Anil Kapoor
- Urologic Cancer Centre for Research & Innovation and McMaster University, Hamilton, Canada
| | - Ur Metser
- Department of Medical Imaging, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Institute of Health Care Policy and Evaluation, University of Toronto, Canada
| | - Gerard Morton
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Tracy Sexton
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Michael Lock
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Joelle Helou
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Techna Institute, University Health Network, Toronto, Canada
| | - Colm Boylan
- Department of Diagnostic Imaging, St. Joseph’s Healthcare and McMaster University, Hamilton, Canada
| | - Susan Archer
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Gregory R. Pond
- Department of Oncology, McMaster University, Hamilton, Canada
| | - Glenn Bauman
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
- Corresponding author: Glenn Bauman, MD, FRCPC
| |
Collapse
|
31
|
Brisson M, Brodeur C, Létourneau‐Guillon L, Masellis M, Stoessl J, Tamm A, Zukotynski K, Ismail Z, Gauthier S, Rosa‐Neto P, Soucy J. CCCDTD5: Clinical role of neuroimaging and liquid biomarkers in patients with cognitive impairment. Alzheimers Dement (N Y) 2021; 6:e12098. [PMID: 33532543 PMCID: PMC7821956 DOI: 10.1002/trc2.12098] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/11/2020] [Indexed: 04/21/2023]
Abstract
Since 1989, four Canadian Consensus Conferences on the Diagnosis and Treatment of Dementia (CCCDTDs) have provided evidence-based dementia diagnostic and treatment guidelines for Canadian clinicians and researchers. We present the results from the Neuroimaging and Fluid Biomarkers Group of the 5th CCCDTD (CCCDTD5), which addressed topics chosen by the steering committee to reflect advances in the field and build on our previous guidelines. Recommendations on Imaging and Fluid Biomarker Use from this Conference cover a series of different fields. Prior structural imaging recommendations for both computerized tomography (CT) and magnetic resonance imaging (MRI) remain largely unchanged, but MRI is now more central to the evaluation than before, with suggested sequences described here. The use of visual rating scales for both atrophy and white matter anomalies is now included in our recommendations. Molecular imaging with [18F]-fluorodeoxyglucose ([18F]-FDG) Positron Emisson Tomography (PET) or [99mTc]-hexamethylpropyleneamine oxime/ethylene cysteinate dimer ([99mTc]-HMPAO/ECD) Single Photon Emission Tomography (SPECT), should now decidedly favor PET. The value of [18F]-FDG PET in the assessment of neurodegenerative conditions has been established with greater certainty since the previous conference, and it has now been recognized as a useful biomarker to establish the presence of neurodegeneration by a number of professional organizations around the world. Furthermore, the role of amyloid PET has been clarified and our recommendations follow those from other groups in multiple countries. SPECT with [123I]-ioflupane (DaTscanTM) is now included as a useful study in differentiating Alzheimer's disease (AD) from Lewy body disease. Finally, liquid biomarkers are in a rapid phase of development and, could lead to a revolution in the assessment AD and other neurodegenerative conditions at a reasonable cost. We hope these guidelines will be useful for clinicians, researchers, policy makers, and the lay public, to inform a current and evidence-based approach to the use of neuroimaging and liquid biomarkers in clinical dementia evaluation and management.
Collapse
Affiliation(s)
- Mélanie Brisson
- Centre hospitalier de l'université de QuébecQuebec CityCanada
| | | | | | | | - Jon Stoessl
- Vancouver Coastal Health, University of British‐ColumbiaVancouverCanada
| | | | | | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute and O'Brien Institute for Public HealthUniversity of CalgaryCalgaryCanada
| | | | - Pedro Rosa‐Neto
- McGill Center for Studies in AgingCanada
- McConnell Brain Imaging Centre, Montreal Neurological InstituteMontrealCanada
| | - Jean‐Paul Soucy
- Centre hospitalier de l'université de MontréalMontrealCanada
- McConnell Brain Imaging Centre, Montreal Neurological InstituteMontrealCanada
- PERFORM Center, Concordia UniversityMontrealCanada
| |
Collapse
|
32
|
Roncali E, Capala J, Benedict SH, Akabani G, Bednarz B, Bhadrasain V, Bolch WE, Buchsbaum JC, Coleman NC, Dewaraja YK, Frey E, Ghaly M, Grudzinski J, Hobbs RF, Howell RW, Humm JL, Kunos CA, Larson S, Lin FI, Madsen M, Mirzadeh S, Morse D, Pryma D, Sgouros G, St. James S, Wahl RL, Xiao Y, Zanzonico P, Zukotynski K. Overview of the First NRG Oncology–National Cancer Institute Workshop on Dosimetry of Systemic Radiopharmaceutical Therapy. J Nucl Med 2020; 62:1133-1139. [DOI: 10.2967/jnumed.120.255547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
|
33
|
Driscoll B, Wong R, Vishway C, Laidley D, Myrehaug S, Brierley J, Juergens R, Shessel A, Farncombe T, Zukotynski K, Stodilka R, Caldwell C, Yeung I. Optimizing the SPECT Imaging Workflow For Individualized Dosimetry in Lu177-DOTATATE Treatment Of Progressive Metastatic Neoendocrine Tumors. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
34
|
Zukotynski K, Gaudet V, Uribe CF, Mathotaarachchi S, Smith KC, Rosa-Neto P, Bénard F, Black SE. Machine Learning in Nuclear Medicine: Part 2-Neural Networks and Clinical Aspects. J Nucl Med 2020; 62:22-29. [PMID: 32978286 DOI: 10.2967/jnumed.119.231837] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/13/2020] [Indexed: 12/12/2022] Open
Abstract
This article is the second part in our machine learning series. Part 1 provided a general overview of machine learning in nuclear medicine. Part 2 focuses on neural networks. We start with an example illustrating how neural networks work and a discussion of potential applications. Recognizing that there is a spectrum of applications, we focus on recent publications in the areas of image reconstruction, low-dose PET, disease detection, and models used for diagnosis and outcome prediction. Finally, since the way machine learning algorithms are reported in the literature is extremely variable, we conclude with a call to arms regarding the need for standardized reporting of design and outcome metrics and we propose a basic checklist our community might follow going forward.
Collapse
Affiliation(s)
- Katherine Zukotynski
- Departments of Medicine and Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Vincent Gaudet
- Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Carlos F Uribe
- PET Functional Imaging, BC Cancer, Vancouver, British Columbia, Canada
| | | | - Kenneth C Smith
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Pedro Rosa-Neto
- Translational Neuroimaging Lab, McGill University, Montreal, Quebec, Canada
| | - François Bénard
- PET Functional Imaging, BC Cancer, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Sandra E Black
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
35
|
Tsakiridis T, Bonert M, Zukotynski K, Anagnostopoulos AE. Radiographic and metabolic evolution of prostate cancer lung metastasis detected by prostate-specific membrane antigen and fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography. World J Nucl Med 2020; 19:421-424. [PMID: 33623514 PMCID: PMC7875042 DOI: 10.4103/wjnm.wjnm_17_20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/19/2020] [Accepted: 03/31/2020] [Indexed: 11/04/2022] Open
Abstract
We describe the case of a 75-year-old patient who progressed over a 12-year period from localized to symptomatic metastatic prostate cancer (PrCa) with lung as the sole organ of involvement. In this case, the specific sequence of positron emission tomography (PET)-based next-generation imaging with 18F-sodium fluoride-, 18F-fluoro-2-deoxy-D-glucose-, and 18F-DCFPyL PET/computed tomography and biopsies allowed illustration of the pathway of disease progression from nonglycolytic hormone-sensitive PrCa to glycolytic castrate-resistant PrCa without neuroendocrine features. The observations provide a unique insight into the timelines of anatomical and metabolic progression of metastatic PrCa. They highlight the value of close radiographic surveillance of metastatic PrCa with modern imaging to guide early treatment interventions.
Collapse
Affiliation(s)
- Theodoros Tsakiridis
- Division of Radiation Oncology, Juravinski Cancer Center, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michael Bonert
- Department of Pathology, St. Joseph's Hospital, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Katherine Zukotynski
- Department of Radiology and Medicine, McMaster University, Hamilton, Ontario, Canada
| | | |
Collapse
|
36
|
Liu W, Bauman G, Zukotynski K, Finelli A, Chin J, Klotz L, Lukka H, Lavallee L, Hagerty M, Metser U. 62: A Prospective Provincial Psma-Pet Registry for Recurrent Prostate Cancer: Preliminary Results. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)30954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
37
|
Meem M, Zukotynski K, Raman S, Emmenegger U. Bone scan use in the management of metastatic castration-resistant prostate cancer: Survey of practice patterns among Canadian radiation oncologists, medical oncologists, and urologists. Can Urol Assoc J 2020; 14:E601-E603. [PMID: 32520699 DOI: 10.5489/cuaj.6320] [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]
Abstract
The use of skeletal scintigraphy with technetium-99 methylene diphosphonate (hereafter referred to as a bone scan) for evaluating response to systemic treatment in men with metastatic castration-resistant prostate cancer (mCRPC) is an evolving paradigm in this era of advancing therapies and imaging techniques. Indeed, the interpretation of bone scans can be challenging, and there is a growing expectation that advanced imaging techniques such as prostate-specific membrane antigen positron emission tomography/computer tomography (PSMA PET/CT) may play a complementary role.1 The Prostate Cancer Working Group (PCWG) has outlined specific criteria to define disease progression with respect to bone scans performed as part of clinical trials.2 However, there is no high-level evidence for the scheduling and interpretation of bone scans during routine therapeutic interventions for mCRPC. Thus, patterns of bone scan use are variable and practice-dependent outside of clinical trials.
Collapse
Affiliation(s)
- Mahbuba Meem
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katherine Zukotynski
- Departments of Medicine and Radiology, McMaster University, Hamilton, ON, Canada
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Urban Emmenegger
- Sunnybrook Odette Cancer Centre and Research Institute, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
38
|
Pawson A, Ghumman Z, Kuo PH, Jadvar H, Bartel T, Shayegan B, Zukotynski K. A review of prostate cancer imaging, positron emission tomography, and radiopharmaceutical-based therapy. Can Urol Assoc J 2020; 14:130-138. [PMID: 32254013 DOI: 10.5489/cuaj.6506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Amy Pawson
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Hossein Jadvar
- University of Southern California, Los Angeles, CA, United States
| | - Twyla Bartel
- Global Advanced Imaging, PLLC, Little Rock, AR, United States
| | | | | |
Collapse
|
39
|
Affiliation(s)
- Erin E Grady
- Division of Nuclear Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Katherine Zukotynski
- Departments of Radiology and Medicine, McMaster University, Hamilton, Ontario, Canada
| | | |
Collapse
|
40
|
Liu W, Zukotynski K, Emmett L, Chung HT, Chung P, Wolfson R, Rachinsky I, Kapoor A, Metser U, Loblaw A, Morton G, Sexton T, Lock M, Helou J, Berlin A, Boylan C, Archer S, Pond GR, Bauman G. A Prospective Study of 18F-DCFPyL PSMA PET/CT Restaging in Recurrent Prostate Cancer following Primary External Beam Radiotherapy or Brachytherapy. Int J Radiat Oncol Biol Phys 2019; 106:546-555. [PMID: 31730876 DOI: 10.1016/j.ijrobp.2019.11.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/28/2019] [Accepted: 11/01/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Radio-recurrent prostate cancer is typically detected by a rising prostate-specific antigen and may reflect local or distant disease. Positron emission tomography (PET) radiotracers targeting prostate-specific membrane antigen, such as 18F-DCFPyL have shown promise in restaging men with recurrent disease postprostatectomy but are less well characterized in the setting of radio-recurrent disease. METHODS AND MATERIALS A prospective, multi-institutional study was conducted to evaluate the effect of 18F-DCFPyL PET/computed tomography (CT) when added to diagnostic imaging (DI; CT abdomen and pelvis, bone scan, multiparametric magnetic resonance imaging pelvis) for men with radio-recurrent prostate cancer. All men were imaged with DI and subsequently underwent 18F-DCFPyL PET/CT with local and central reads. Tie break reads were performed as required. Management questionnaires were completed after DI and again after 18F-DCFPyL PET/CT. Discordance in patterns of disease detected with 18F-DCFPyL PET/CT versus DI and changes in management were characterized. RESULTS Seventy-nine men completed the study. Most men had T1 disease (62%) and Gleason score <7 (95%). Median prostate-specific antigen at diagnosis was 7.4 ng/mL and at relapse was 4.8 ng/mL. DI detected isolated intraprostatic recurrence in 38 out of 79 men (48%), regional nodal recurrence in 9 out of 79 (11%), distant disease in 12 out of 79 (15%), and no disease in 26 out of 79 (33%). 18F-DCFPyL PET/CT detected isolated intraprostatic recurrence in 38 out of 79 men (48%), regional nodal recurrence in 21 out of 79 (27%), distant disease in 24 out of 79 (30%), and no disease in 10 out of 79 (13%). DI identified 8 out of 79 (10%) patients to have oligometastatic disease, compared with 21 out of 79 (27%) with 18F-DCFPyL PET/CT. 18F-DCFPyL PET/CT changed proposed management in 34 out of 79 (43%) patients. CONCLUSIONS 18F-DCFPyL PET/CT identified extraprostatic disease in twice as many men with radio-recurrent prostate cancer compared with DI and detected a site of recurrence in 87% of men compared with 67% with DI. Furthermore, 18F-DCFPyL PET/CT identified potentially actionable disease (prostate only recurrence or oligometastatic disease) in 75% of men and changed proposed management in 43% of men.
Collapse
Affiliation(s)
- Wei Liu
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Katherine Zukotynski
- Department of Radiology, Hamilton Health Sciences Centre and McMaster University, Hamilton, Canada
| | - Louise Emmett
- Department of Nuclear Medicine and Theranostics, St. Vincent's Hospital and University of New South Wales, Sydney, Australia
| | - Hans T Chung
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Peter Chung
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Robert Wolfson
- Department of Medical Imaging, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Irina Rachinsky
- Division of Nuclear Medicine, London Health Sciences Centre and Western University, London, Canada
| | - Anil Kapoor
- Urologic Cancer Centre for Research & Innovation and McMaster University, Hamilton, Ontario
| | - Ur Metser
- Department of Medical Imaging, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; University of Toronto, Institute of Health Care Policy and Evaluation, Toronto, Canada
| | - Gerard Morton
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Tracy Sexton
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Michael Lock
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Joelle Helou
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Colm Boylan
- Department of Diagnostic Imaging, St. Joseph's Healthcare and McMaster University, Hamilton, Canada
| | - Susan Archer
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, Canada
| | - Glenn Bauman
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada.
| |
Collapse
|
41
|
Meem M, Zukotynski K, Raman S, Emmenegger U. 189 Bone Scans in the Management of Metastatic Castrate-Resistant Prostate Cancer: Survey of Patterns of Practice in Canadian Radiation Oncologists, Medical Oncologists and Urologists. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33247-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
42
|
Wong RK, Myrehaug S, Brierley J, Laidley D, Juergens R, Yeung I, Breen S, Shessel A, Driscoll B, Farncombe T, Zukotynski K, Stodilka R, Caldwell C, Liu AZ, Valliant J, McCann J, Metser U, Mohan R, Beauregard JM, Jaffray D. 70 Quantifying Tumour Dose Using Individualized Dosimetry Methodology in 177LU Dotatate Therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
43
|
Liu W, Fakir H, Randhawa G, Kassam Z, Chung H, Chung P, Ward A, Zukotynski K, Emmett L, Bauman G. DRIVE: Defining Radiorecurrent Intraprostatic Target Volumes. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
44
|
Slosky J, Zukotynski K. Fifth Anniversary of SNMMI Professional Relations Fellowship. J Nucl Med 2019; 60:20N. [PMID: 31481596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- Jack Slosky
- JJS Consulting, retired from Lantheus Medical Imaging
| | | |
Collapse
|
45
|
Acuff SN, Mathotaarachchi S, Zukotynski K, Osborne D, Subramaniam R. Clinical and Technical Considerations for Brain PET Imaging for Dementia. J Nucl Med Technol 2019; 48:5-8. [PMID: 31182663 DOI: 10.2967/jnmt.118.220087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/13/2019] [Indexed: 11/16/2022] Open
Abstract
The number of cases of dementia has dramatically increased over the last decade. Imaging of the brain with PET has been used for many years, but in the past decade the radiopharmaceuticals and technology available for imaging dementia have vastly improved. In recent years, the U.S. Food and Drug Administration has approved 3 PET radiopharmaceuticals for detecting amyloid in brain, and tau PET radiopharmaceuticals are being investigated in clinical trials for use in dementia imaging. This paper will discuss different forms of dementia that can be imaged with PET, review common radiopharmaceuticals used for imaging dementia, and provide technical recommendations for performing the studies.
Collapse
Affiliation(s)
- Shelley N Acuff
- Department of Radiology, University of Tennessee Medical Center, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | | | - Katherine Zukotynski
- Departments of Medicine and Radiology, McMaster University, Hamilton, Ontario, Canada; and
| | - Dustin Osborne
- Department of Radiology, University of Tennessee Medical Center, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | | | | |
Collapse
|
46
|
Uribe CF, Mathotaarachchi S, Gaudet V, Smith KC, Rosa-Neto P, Bénard F, Black SE, Zukotynski K. Machine Learning in Nuclear Medicine: Part 1—Introduction. J Nucl Med 2019; 60:451-458. [DOI: 10.2967/jnumed.118.223495] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/27/2018] [Indexed: 12/11/2022] Open
|
47
|
Fahey F, Christian P, Zukotynski K, Sexton-Stallone B, Kiss C, Clarke B, Onar-Thomas A, Poussaint TY. Use of a Qualification Phantom for PET Brain Imaging in a Multicenter Consortium: A Collaboration Between the Pediatric Brain Tumor Consortium and the SNMMI Clinical Trials Network. J Nucl Med 2018; 60:677-682. [PMID: 30530829 DOI: 10.2967/jnumed.118.219998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/14/2018] [Indexed: 01/13/2023] Open
Abstract
The purpose of this study was to assess image quality and quantitative brain PET across a multicenter consortium. Methods: All academic centers and children's hospitals in the Pediatric Brain Tumor Consortium (PBTC) scanned a phantom developed by the Society of Nuclear Medicine and Molecular Imaging Clinical Trials Network (SNMMI CTN) for the validation of brain PET studies associated with clinical trials. The phantom comprises 2 separate, fillable sections: a resolution/uniformity section and a clinical simulation section. The resolution/uniformity section is a cylinder 12.7 cm long and 20 cm in diameter; spatial resolution is evaluated subjectively with 2 sets of rods (hot and cold) of varying diameter (4.0, 5.0, 6.25, 7.81, 9.67, and 12.2 mm) and spacing (twice the rod diameter). The clinical simulation section simulates a transverse section of midbrain with ventricles and gray and white matter compartments. If properly filled, hot rods have a 4:1 target-to-background ratio, and gray-to-white matter sections have a 4:1 ratio. Uniformity and image quality were evaluated using the SUV in a small volume of interest as well as subjectively by 2 independent observers using a 4-point scale. Results: Eleven PBTC sites scanned the phantom on 13 PET scanners. The phantom's complexity led to suboptimal filling, particularly of the hot rod section, in 5 sites. The SUV in the uniformity section was within 10% of unity on only 5 of 13 scanners, although 12 of 13 were subjectively judged to have very good to excellent uniformity. Four of 6 hot rods were discernable by all 13 scanners, whereas 3 of 6 cold rods were discernable by only 5 scanners. Four of 13 scanners had a gray-to-white matter ratio between 3.0 and 5.0 (4.0 is truth); however, 11 of 13 scanners were subjectively judged to have very good or excellent image quality. Conclusion: Eleven sites were able to image a powerful phantom developed by the SNMMI CTN that evaluated image uniformity, spatial resolution, and image quality of brain PET. There was considerable variation in PET data across the PBTC sites, possibly resulting from variations in scanning across the sites due to challenges in filling the phantom.
Collapse
Affiliation(s)
- Frederic Fahey
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts .,Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Paul Christian
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Katherine Zukotynski
- Department of Medicine and Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Briana Sexton-Stallone
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Christina Kiss
- Clinical Trials Network, Society of Nuclear Medicine and Molecular Imaging, Reston Virginia
| | - Bonnie Clarke
- Clinical Trials Network, Society of Nuclear Medicine and Molecular Imaging, Reston Virginia
| | | | - Tina Young Poussaint
- Department of Radiology, Harvard Medical School, Boston, Massachusetts.,Division of Neuroradiology, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| |
Collapse
|
48
|
Schwarz SW, Decristoforo C, Goodbody AE, Singhal N, Saliba S, Ruddock P, Zukotynski K, Ross AA. Harmonization of United States, European Union and Canadian First-in-Human Regulatory Requirements for Radiopharmaceuticals-Is This Possible? J Nucl Med 2018; 60:jnumed.118.209460. [PMID: 30262520 DOI: 10.2967/jnumed.118.209460] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/07/2018] [Indexed: 11/16/2022] Open
Abstract
In recent years, several new radiotracers and radionuclide therapies have been developed. There is a renaissance in nuclear medicine and molecular imaging today, for example, in terms of the ability to image and treat neuroendocrine and prostate malignancies. In order to be able to bring a new drug product from bench to bedside and assist patients, while also ensuring patient safety, stringent regulations must be met. However, differences in regulatory requirements, often based on jurisdictional politics rather than scientific evidence, can hinder global co-operation, increase expense, and slow progress. In an effort to rise above these differences, nuclear medicine advocacy organizations, regulators, and international agencies have begun to identify commonalities in the regulations to achieve harmonization. Indeed, a more streamlined approach to radiopharmaceutical drug development across jurisdictions could be achieved through establishing harmonized requirements for pre-clinical studies and manufacturing standards. This paper provides an educational overview of the regulatory and submission requirements governing investigational radiopharmaceuticals for first-in-human radiopharmaceuticals across the European and North American continents. It is hoped that through ongoing collaboration, regulatory reform and harmonization can become a reality and speed access to the most up-to-date evidence-based patient care for all.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Andrew A Ross
- Department of Diagnostic Imaging, Queen Elizabeth Health Sciences Center, Canada
| |
Collapse
|
49
|
|
50
|
Affiliation(s)
- Michael Simon
- Department of Medicine (Simon), Maimonides Medical Center, Brooklyn, NY; McMaster University (Zukotynski), Hamilton, Ont.; Department of Radiology & Biomedical Imaging (Naeger), University of California, San Francisco, Calif
| | - Katherine Zukotynski
- Department of Medicine (Simon), Maimonides Medical Center, Brooklyn, NY; McMaster University (Zukotynski), Hamilton, Ont.; Department of Radiology & Biomedical Imaging (Naeger), University of California, San Francisco, Calif
| | - David M Naeger
- Department of Medicine (Simon), Maimonides Medical Center, Brooklyn, NY; McMaster University (Zukotynski), Hamilton, Ont.; Department of Radiology & Biomedical Imaging (Naeger), University of California, San Francisco, Calif.
| |
Collapse
|