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Kröning P, Berg S, Freitag MT, Schoot RA, Fischer A, Puzik A, Feuchtinger T, Niemeyer C, Meyer PT, Uhl M, Hettmer S. Bone marrow disease in rhabdomyosarcoma visualized by 2-[ 18F]fluorodeoxyglucose positron emission tomography/computed tomography. Pediatr Radiol 2024:10.1007/s00247-024-05933-5. [PMID: 38671145 DOI: 10.1007/s00247-024-05933-5] [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] [Received: 12/17/2023] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
Bone marrow metastases-noted in 6% of patients with rhabdomyosarcoma-have been linked to very poor outcomes. Bilateral bone marrow sampling from iliac crests has been the gold standard for bone marrow examination in rhabdomyosarcoma, but sampling errors due to patchy bone marrow involvement may limit its sensitivity. Here, we report the case of a 6-year-old boy with embryonal rhabdomyosarcoma of the skull base and multiple 2-[18F]fluoro-2-deoxy-D-glucose (2-[18F]FDG)-avid bone marrow metastases visualized by positron emission tomography and computed tomography (2-[18F]FDG PET/CT). His bone marrow aspirates were tumor-free. This case illustrates the diagnostic value of 2-[18F]FDG PET/CT in the detection of bone marrow metastases in rhabdomyosarcoma patients, which may re-shape the definition of bone marrow disease and, ultimately, alter disease staging and risk stratification.
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Affiliation(s)
- Pia Kröning
- Division of General Pediatrics, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Sebastian Berg
- Division of Pediatric Radiology, Department of Radiology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Martin T Freitag
- Department of Nuclear Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Reineke A Schoot
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Alexandra Fischer
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Alexander Puzik
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - T Feuchtinger
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Charlotte Niemeyer
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Philipp Tobias Meyer
- Department of Nuclear Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Markus Uhl
- Division of Pediatric Radiology, Department of Radiology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Simone Hettmer
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.
- Universitätsmedizin Halle, Martin Luther University, Pediatrics 1, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.
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Arbuznikova D, Klotsotyra A, Uhlmann L, Domogalla LC, Steinacker N, Mix M, Niedermann G, Spohn SK, Freitag MT, Grosu AL, Meyer PT, Gratzke C, Eder M, Zamboglou C, Eder AC. Exploring the role of combined external beam radiotherapy and targeted radioligand therapy with [ 177Lu]Lu-PSMA-617 for prostate cancer - from bench to bedside. Theranostics 2024; 14:2560-2572. [PMID: 38646643 PMCID: PMC11024848 DOI: 10.7150/thno.93249] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/02/2024] [Indexed: 04/23/2024] Open
Abstract
Management of prostate cancer (PC) might be improved by combining external beam radiotherapy (EBRT) and prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) with lutetium-177 (177Lu)-labeled PSMA inhibitors. We hypothesized a higher efficacy of the combination due to augmentation of the radiation dose to the tumor and interactions of EBRT with PSMA expression potentially increasing radiopharmaceutical uptake. Therefore, this study analyzed the influence of radiation on PSMA expression levels in vitro. The results were translated to evaluate the efficacy of the combination of photon EBRT and [177Lu]Lu-PSMA-617 in a murine PC xenograft model. Finally, a clinical case report on a combined elective field EBRT with RLT dose escalation illustrates a proof-of-concept. Methods: PSMA gene and protein expression were assessed in human PSMA-overexpressing LNCaP cells after irradiation using reverse transcription quantitative polymerase chain reaction (RT-qPCR), flow cytometry and On-Cell Western assays. In the in vivo therapy study, LNCaP tumor-bearing BALB/c nu/nu mice were irradiated once with 2 Gy X-ray EBRT and injected with 40 MBq [177Lu]Lu-PSMA-617 after 4 h or received single or no treatment (n = 10 each). Tumor-absorbed doses by [177Lu]Lu-PSMA-617 were calculated according to the Medical Internal Radiation Dosimetry (MIRD) formalism after deriving time-activity curves using a gamma probe. An exemplified patient case is demonstrated where fractionated EBRT (54 Gy to prostate; 45 Gy to pelvic lymphatics) and three cycles of [177Lu]Lu-PSMA-617 (3.4-6.0 GBq per cycle) were sequentially combined under concurrent androgen deprivation for treating locally advanced PC. Results: At 4 h following irradiation with 2-8 Gy, LNCaP cells displayed a PSMA protein upregulation by around 18% relative to non-irradiated cells, and a stronger upregulation on mRNA level (up to 2.6-fold). This effect was reversed by 24 h when PSMA protein levels were downregulated by up to 22%. Mice treated with the combination therapy showed significantly improved outcomes regarding tumor control and median survival (p < 0.0001) as compared to single or no treatment. Relative to monotherapy with PSMA-RLT or EBRT, the tumor doubling time was prolonged 1.7- or 2.7-fold and the median survival was extended by 24% or 60% with the combination, respectively. Additionally, tumors treated with EBRT exhibited a 14% higher uptake of the radiopharmaceutical as evident from the calculated tumor-absorbed dose, albeit with high variability in the data. Concerning the patient case, the tri-modality treatment was well tolerated and the patient responded with a long-lasting complete biochemical remission for five years following end of PSMA-RLT. The patient then developed a biochemical relapse with oligo-recurrent disease on follow-up imaging. Conclusion: The present preclinical and clinical data demonstrate that the combination of EBRT with dose escalation by PSMA-RLT improves tumor control and potentially prolongs survival. This may pave the way for further clinical investigations of this approach to explore the curative potential of the combination therapy.
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Affiliation(s)
- Daria Arbuznikova
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Division of Radiopharmaceutical Development, German Cancer Consortium (DKTK), partner site Freiburg, Freiburg, Germany and German Cancer Research Center, Heidelberg, Germany
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Aikaterini Klotsotyra
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lisa Uhlmann
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Division of Radiopharmaceutical Development, German Cancer Consortium (DKTK), partner site Freiburg, Freiburg, Germany and German Cancer Research Center, Heidelberg, Germany
| | - Lisa-Charlotte Domogalla
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Division of Radiopharmaceutical Development, German Cancer Consortium (DKTK), partner site Freiburg, Freiburg, Germany and German Cancer Research Center, Heidelberg, Germany
| | - Nils Steinacker
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Division of Radiopharmaceutical Development, German Cancer Consortium (DKTK), partner site Freiburg, Freiburg, Germany and German Cancer Research Center, Heidelberg, Germany
| | - Michael Mix
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Niedermann
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), partner site Freiburg, a partnership between the German Cancer Research Center and Medical Center - University of Freiburg, Freiburg, Germany
| | - Simon K.B. Spohn
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), partner site Freiburg, a partnership between the German Cancer Research Center and Medical Center - University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Program, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin T. Freitag
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anca L. Grosu
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp T. Meyer
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Eder
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Division of Radiopharmaceutical Development, German Cancer Consortium (DKTK), partner site Freiburg, Freiburg, Germany and German Cancer Research Center, Heidelberg, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Oncology Center, European University Cyprus, Limassol, Cyprus
| | - Ann-Christin Eder
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Division of Radiopharmaceutical Development, German Cancer Consortium (DKTK), partner site Freiburg, Freiburg, Germany and German Cancer Research Center, Heidelberg, Germany
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Friebe L, Freitag MT, Braun M, Nicolas G, Bauman A, Bushnell D, Christ E, Wild D. Peptide Receptor Radionuclide Therapy Is Effective for Clinical Control of Symptomatic Metastatic Insulinoma: A Long-Term Retrospective Analysis. J Nucl Med 2024; 65:228-235. [PMID: 38164592 DOI: 10.2967/jnumed.123.265894] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/25/2023] [Indexed: 01/03/2024] Open
Abstract
Metastatic insulinoma is a rare malignant neuroendocrine tumor characterized by inappropriate insulin secretion, resulting in life-threatening hypoglycemia, which is often difficult to treat. There is currently very limited information about the efficacy of peptide receptor radionuclide therapy (PRRT) for clinical control of hypoglycemia. The aim of this long-term retrospective study was to evaluate the therapeutic efficacy of PRRT for improving hypoglycemia, to evaluate the change of medication after PRRT, and to calculate progression-free survival (PFS) and overall survival (OS). Methods: Inclusion criteria were histologically proven somatostatin receptor-positive metastatic malignant insulinoma and at least 2 cycles of [90Y]Y-DOTATOC or [177Lu]Lu-DOTATOC therapy from early 2000 to early 2022. A semiquantitative scoring system was used to quantify the severity and frequency of hypoglycemic episodes under background antihypoglycemic therapy (somatostatin analog, diazoxide, everolimus, corticosteroids): score 0, no hypoglycemic episodes; score 1, hypoglycemic events requiring additional conservative treatment with optimization of nutrition; score 2, severe hypoglycemia necessitating hospitalization and combined medication or history of hypoglycemic coma. Hypoglycemic score before and after PRRT was analyzed. Time of benefit was defined as a time range of fewer hypoglycemic episodes in the observation period than at baseline. Information on antihypoglycemic medication before and after therapy, PFS, and OS was recorded. Results: Twenty-six of 32 patients with a total of 106 [90Y]Y-DOTATOC/[177Lu]Lu-DOTATOC cycles were included. The average observation period was 21.5 mo (range, 2.3-107.4 mo). Before therapy, 81% (n = 21) of the patients had a hypoglycemia score of 2 and 19% (n = 5) had a score of 1. After PRRT, 81% of patients (n = 21) had a decreased score, and the remaining 5 patients showed a stable situation. There was temporary worsening of hypoglycemia just after injection of [90Y]Y-DOTATOC/[177Lu]Lu-DOTATOC in 19% of patients. The average time of benefit in the observation period was 17.2 mo (range, 0-70.2 mo). Antihypoglycemic medication reduction was achieved in 58% (n = 15) of patients. The median OS and PFS after the start of PRRT were 19.7 mo (95% CI, 6.5-32.9 mo) and 11.7 mo (95% CI, 4.9-18.5 mo), respectively. Conclusion: To our knowledge, our study included the largest cohort of patients with malignant insulinoma to be evaluated. Long-lasting symptom control and reduction of antihypoglycemic medications were shown in most patients after late-line PRRT.
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Affiliation(s)
- Liene Friebe
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Martin T Freitag
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- ENETS Center of Excellence for Neuroendocrine and Endocrine Tumors, University Hospital Basel, Basel, Switzerland
- Clinic of Nuclear Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Martin Braun
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Guillaume Nicolas
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- ENETS Center of Excellence for Neuroendocrine and Endocrine Tumors, University Hospital Basel, Basel, Switzerland
| | - Andreas Bauman
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - David Bushnell
- Division of Nuclear Medicine, Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Emanuel Christ
- ENETS Center of Excellence for Neuroendocrine and Endocrine Tumors, University Hospital Basel, Basel, Switzerland
- Department of Endocrinology, Diabetology, and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Damian Wild
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland;
- ENETS Center of Excellence for Neuroendocrine and Endocrine Tumors, University Hospital Basel, Basel, Switzerland
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Freitag MT, Haaf P, Zellweger MJ. Severe myocardial ischemia detected in routine oncological positron emission tomography/computed tomography with 18F-fluorodeoxyglucose. Eur Heart J 2023; 44:2412. [PMID: 37029729 PMCID: PMC10327877 DOI: 10.1093/eurheartj/ehad208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Affiliation(s)
- Martin T Freitag
- Division of Nuclear Medicine, University Hospital of Basel, University of Basel, Petersgraben 4, 4031 Basel, Kanton Basel-Stadt, Switzerland
| | - Philip Haaf
- Clinic of Cardiology, University Hospital of Basel, University of Basel, Petersgraben 4, 4031 Basel, Kanton Basel-Stadt, Switzerland
| | - Michael J Zellweger
- Clinic of Cardiology, University Hospital of Basel, University of Basel, Petersgraben 4, 4031 Basel, Kanton Basel-Stadt, Switzerland
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Demartin S, Goffette P, Christ E, Freitag MT, Maiter D, Maria Furnica R. Adult-onset nesidioblastosis: a challenging diagnosis revealed by glucagon-like-peptide-1 receptor imaging. Endocrinol Diabetes Metab Case Rep 2022; 2022:22-0325. [PMID: 36448840 PMCID: PMC9716366 DOI: 10.1530/edm-22-0325] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/09/2022] [Indexed: 11/07/2023] Open
Abstract
Summary A 52-year-old female presented with recurrent episodes of fasting or post-absorptive hypoglycemia. A 72-h fasting test confirmed endogenous hyperinsulinemia. Conventional imaging was unremarkable. Selective pancreatic arterial calcium stimulation and hepatic venous sampling showed a maximum calcium-stimulated insulin concentration from several pancreatic areas, mainly the proximal splenic artery and the proximal gastroduodenal artery, suggesting the presence of one or more occult insulinoma(s) in the region of the pancreatic body. 68Ga-DOTA-exendin-4 PET/CT showed however generalized increased uptake in the pancreas and a diagnosis of nesidioblastosis was therefore suspected. The patient has been since successfully treated with dietetic measures and diazoxide. Treatment efficacy was confirmed by a flash glucose monitoring system with a follow-up of 7 months. Learning points Adult nesidioblastosis is a rare cause of endogenous hyperinsulinemic hypoglycemia. The distinction between insulinoma and nesidioblastosis is essential since the therapeutic strategies are different. 68Ga-DOTA-exendin-4 PET/CT emerges as a new noninvasive diagnostic tool for the localization of an endogenous source of hyperinsulinemic hypoglycemia. Medical management with dietetic measures and diazoxide need to be considered as a valuable option to treat patients with adult nesidioblastosis. Flash glucose monitoring system is helpful for the evaluation of treatment efficacy.
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Affiliation(s)
- Sophie Demartin
- Department of Endocrinology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Pierre Goffette
- Department of Radiology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Emanuel Christ
- Department of Endocrinology, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Martin T Freitag
- Clinic of Radiology and Nuclear Medicine, Division of Nuclear Medicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Dominique Maiter
- Department of Endocrinology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Raluca Maria Furnica
- Department of Endocrinology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Freitag MT, Bremerich J, Wild D, Haaf P, Zellweger MJ, Caobelli F. Quantitative myocardial perfusion 82Rb-PET assessed by hybrid PET/coronary-CT: Normal values and diagnostic performance. J Nucl Cardiol 2022; 29:464-473. [PMID: 32676910 DOI: 10.1007/s12350-020-02264-4] [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: 02/28/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to assess normal values for quantified myocardial blood flow (MBF) on a hybrid PET/coronary-CT scanner and to test their diagnostic performance in patients with suspected CAD. MATERIALS AND METHODS Patients underwent 82Rb-PET/CT and integrated CT-based coronary angiography (CCTA) and were classified as normal (no stenosis), with non-obstructive stenosis (< 50%) and with CAD (≥ 50%). Global and regional stress MBF (sMBF), rest MBF and myocardial flow reserve (MFR) were calculated. Ischemia was defined as SDS ≥ 2, severe ischemia as SDS ≥ 7. RESULTS 357 consecutive patients were included. Global sMBF and MFR were higher in normal patients than in patients with CAD (3.61 ± 0.71 vs 3.04 ± 0.77, P < 0.0001; 3.08 ± 0.84 vs 2.68 ± 0.79, P = 0.0001), but not different compared to patients with non-obstructive stenosis (3.61 ± 0.71 vs 3.43 ± 0.69, P = 0.052; 3.08 ± 0.84 vs 2.99 ± 0.82, P = 0.45). sMBF yielded superior accuracy over MFR in identifying both ischemia (AUC 0.74 vs 0.62, P = 0.003) and severe ischemia (AUC 0.88 vs 0.78, P = 0.012). Optimal threshold for global sMBF to rule out myocardial ischemia was 3.5 mL g-1 min-1. CONCLUSIONS Normal quantitative values are provided. Global sMBF provided higher diagnostic accuracy than MFR. Using sMBF-threshold of 3.5 mL·g-1·min-1 on 82Rb-PET/CT yielded similar NPV (96%) as CCTA to rule out CAD. Hence, resting scan could be omitted in patients with sMBF values above reference.
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Affiliation(s)
- Martin T Freitag
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Jens Bremerich
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Damian Wild
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Philip Haaf
- Clinic of Cardiology, University Hospital Basel, Basel, Switzerland
| | | | - Federico Caobelli
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
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Paddubny K, Freitag MT, Kratochwil C, Koerber S, Radtke JP, Sakovich R, Kopka K, Giesel FL. Fluorine-18 Prostate-specific Membrane Antigen-1007 Positron Emission Tomography/Computed Tomography and Multiparametric Magnetic Resonance Imaging in Diagnostics of Local Recurrence in a Prostate Cancer Patient After Recent Radical Prostatectomy. Clin Genitourin Cancer 2018; 16:103-105. [DOI: 10.1016/j.clgc.2017.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 09/24/2017] [Indexed: 01/30/2023]
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Will L, Giesel FL, Freitag MT, Berger AK, Mier W, Kopka K, Koerber SA, Rathke H, Kremer C, Kratochwil C, Kauczor HU, Haberkorn U, Weber TF. Integration of CT urography improves diagnostic confidence of 68Ga-PSMA-11 PET/CT in prostate cancer patients. Cancer Imaging 2017; 17:30. [PMID: 29262870 PMCID: PMC5738706 DOI: 10.1186/s40644-017-0132-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/08/2017] [Indexed: 01/04/2023] Open
Abstract
Background To prove the feasibility of integrating CT urography (CTU) into 68Ga-PSMA-11 PET/CT and to analyze the impact of CTU on assigning focal tracer accumulation in the ureteric space to either ureteric excretion or metastatic disease concerning topographic attribution and diagnostic confidence. Methods Ten prostate cancer patients who underwent 68Ga-PSMA-11 PET/CT including CTU because of biochemical relapse or known metastatic disease were retrospectively analyzed. CTU consisted of an excretory phase 10 min after injection of 80 mL iodinated contrast material. Ureter opacification at CTU was evaluated using the following score: 0, 0% opacification; 1, < 50%; 2, 50–99%; 3, 100%. Topographic attribution and confidence of topographic attribution of focal tracer accumulation in the ureteric space were separately assessed for 68Ga-PSMA-11 PET/CT without and with CTU. Diagnostic confidence was evaluated using the following score: 0, < 25% confidence; 1, 26–50%; 2, 51–75%; 3, 76–100%. Results At CTU, mean ureter opacification score was 2.6 ± 0.7. At 68Ga-PSMA-11 PET/CT without CTU, mean confidence of topographic attribution of focal tracer accumulation was 2.5 ± 0.7 in total and 2.6 ± 0.7 for metastatic disease. At 68Ga-PSMA-11 PET/CT with CTU, mean confidence of topographic attribution of focal areas of tracer accumulation was significantly higher with 2.9 ± 0.2 in total and 2.7 ± 0.9 for metastatic disease (p < 0.001). In 4 of 34 findings (12%) attribution to either ureteric excretion or metastatic disease was discrepant between 68Ga-PSMA-11 PET/CT without and with CTU (n.s). Conclusions Integration of CTU into 68Ga-PSMA-11 PET/CT is feasible and increases diagnostic confidence of assigning focal areas of tracer accumulation in the ureteric space to either metastatic disease or ureteric excretion.
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Affiliation(s)
- Leon Will
- Department of Nuclear Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Cooperation Unit Nuclear Medicine, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Martin T Freitag
- Division of Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Anne K Berger
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Walter Mier
- Department of Nuclear Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Klaus Kopka
- Division of Radiopharmaceutical Chemistry, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Hendrik Rathke
- Department of Nuclear Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christophe Kremer
- Department of Nuclear Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Cooperation Unit Nuclear Medicine, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Tim F Weber
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Freitag MT, Kesch C, Cardinale J, Flechsig P, Floca R, Eiber M, Bonekamp D, Radtke JP, Kratochwil C, Kopka K, Hohenfellner M, Stenzinger A, Schlemmer HP, Haberkorn U, Giesel F. Simultaneous whole-body 18F-PSMA-1007-PET/MRI with integrated high-resolution multiparametric imaging of the prostatic fossa for comprehensive oncological staging of patients with prostate cancer: a pilot study. Eur J Nucl Med Mol Imaging 2017; 45:340-347. [PMID: 29038888 DOI: 10.1007/s00259-017-3854-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/05/2017] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The aim of the present study was to explore the clinical feasibility and reproducibility of a comprehensive whole-body 18F-PSMA-1007-PET/MRI protocol for imaging prostate cancer (PC) patients. METHODS Eight patients with high-risk biopsy-proven PC underwent a whole-body PET/MRI (3 h p.i.) including a multi-parametric prostate MRI after 18F-PSMA-1007-PET/CT (1 h p.i.) which served as reference. Seven patients presented with non-treated PC, whereas one patient presented with biochemical recurrence. SUVmean-quantification was performed using a 3D-isocontour volume-of-interest. Imaging data was consulted for TNM-staging and compared with histopathology. PC was confirmed in 4/7 patients additionally by histopathology after surgery. PET-artifacts, co-registration of pelvic PET/MRI and MRI-data were assessed (PI-RADS 2.0). RESULTS The examinations were well accepted by patients and comprised 1 h. SUVmean-values between PET/CT (1 h p.i.) and PET/MRI (3 h p.i.) were significantly correlated (p < 0.0001, respectively) and similar to literature of 18F-PSMA-1007-PET/CT 1 h vs 3 h p.i. The dominant intraprostatic lesion could be detected in all seven patients in both PET and MRI. T2c, T3a, T3b and T4 features were detected complimentarily by PET and MRI in five patients. PET/MRI demonstrated moderate photopenic PET-artifacts surrounding liver and kidneys representing high-contrast areas, no PET-artifacts were observed for PET/CT. Simultaneous PET-readout during prostate MRI achieved optimal co-registration results. CONCLUSIONS The presented 18F-PSMA-1007-PET/MRI protocol combines efficient whole-body assessment with high-resolution co-registered PET/MRI of the prostatic fossa for comprehensive oncological staging of patients with PC.
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Affiliation(s)
- Martin T Freitag
- Department of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg, Germany.
| | - Claudia Kesch
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jens Cardinale
- Division of Radiopharmaceutical Chemistry, German Cancer Research Center, Heidelberg, Germany
| | - Paul Flechsig
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ralf Floca
- Medical Image Computing Group, German Cancer Research Center, Heidelberg, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University Hospital Munich, Munich, Germany
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Jan P Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Kopka
- Division of Radiopharmaceutical Chemistry, German Cancer Research Center, Heidelberg, Germany
| | | | | | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Frederik Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
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10
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Freitag MT, Fenchel M, Bäumer P, Heußer T, Rank CM, Kachelrieß M, Paech D, Kopka K, Bickelhaupt S, Dimitrakopoulou-Strauss A, Maier-Hein K, Floca R, Ladd ME, Schlemmer HP, Maier F. Improved clinical workflow for simultaneous whole-body PET/MRI using high-resolution CAIPIRINHA-accelerated MR-based attenuation correction. Eur J Radiol 2017; 96:12-20. [PMID: 29103469 DOI: 10.1016/j.ejrad.2017.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 04/29/2017] [Revised: 08/17/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To explore the value and reproducibility of a novel magnetic resonance based attenuation correction (MRAC) using a CAIPIRINHA-accelerated T1-weighted Dixon 3D-VIBE sequence for whole-body PET/MRI compared to the clinical standard. METHODS The PET raw data of 19 patients from clinical routine were reconstructed with standard MRAC (MRACstd) and the novel MRAC (MRACcaipi), a prototype CAIPIRINHA accelerated Dixon 3D-VIBE sequence, both acquired in 19 s/bed position. Volume of interests (VOIs) for liver, lung and all voxels of the total image stack were created to calculate standardized uptake values (SUVmean) followed by inter-method agreement (Passing-Bablok regression, Bland-Altman analysis). A voxel-wise SUV comparison per patient was performed for intra-individual correlation between MRACstd and MRACcaipi. Difference images (MRACstd-MRACcaipi) of attenuation maps and SUV images were calculated. The image quality of in/opposed-phase water and fat images obtained from MRACcaipi was assessed by two readers on a 5-point Likert-scale including intra-class coefficients for inter-reader agreement. RESULTS SUVmean correlations of VOIs demonstrated high linearity (0.95<Spearman's rho<1, p<0.0001, respectively), substantiated by voxel-wise SUV scatter-plots (1.79×108 pixels). Outliers could be explained by different physiological conditions between the scans such as different segmentation of air-containing tissue, lungs, kidneys, metal implants, diaphragm edge or small air bubbles in the gastrointestinal tracts that moved between MRAC acquisitions. Nasal sinuses and the trachea were better segmented in MRACcaipi. High-resolution T1w Dixon 3D VIBE images were acquired in all cases and could be used for PET/MRI fusion. MRACcaipi images were of high diagnostic quality (4.2±0.8) with 0.92-0.96 intra-class correlation. CONCLUSIONS The novel prototype MRACcaipi extends the value for attenuation correction by providing a high spatial resolution DIXON-based dataset suited for diagnostic assessment towards time-efficient whole-body PET/MRI.
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Affiliation(s)
- Martin T Freitag
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | | | - Philipp Bäumer
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thorsten Heußer
- Department of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christopher M Rank
- Department of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marc Kachelrieß
- Department of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Paech
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Klaus Kopka
- Division of Radiopharmaceutical Chemistry, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Klaus Maier-Hein
- Junior Group Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ralf Floca
- Junior Group Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mark E Ladd
- Department of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Physics and Astronomy and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | | | - Florian Maier
- Department of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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11
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Heußer T, Mann P, Rank CM, Schäfer M, Dimitrakopoulou-Strauss A, Schlemmer HP, Hadaschik BA, Kopka K, Bachert P, Kachelrieß M, Freitag MT. Investigation of the halo-artifact in 68Ga-PSMA-11-PET/MRI. PLoS One 2017; 12:e0183329. [PMID: 28817656 PMCID: PMC5560715 DOI: 10.1371/journal.pone.0183329] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 08/02/2017] [Indexed: 01/12/2023] Open
Abstract
Objectives Combined positron emission tomography (PET) and magnetic resonance imaging (MRI) targeting the prostate-specific membrane antigen (PSMA) with a 68Ga-labelled PSMA-analog (68Ga-PSMA-11) is discussed as a promising diagnostic method for patients with suspicion or history of prostate cancer. One potential drawback of this method are severe photopenic (halo-) artifacts surrounding the bladder and the kidneys in the scatter-corrected PET images, which have been reported to occur frequently in clinical practice. The goal of this work was to investigate the occurrence and impact of these artifacts and, secondly, to evaluate variants of the standard scatter correction method with regard to halo-artifact suppression. Methods Experiments using a dedicated pelvis phantom were conducted to investigate whether the halo-artifact is modality-, tracer-, and/or concentration-dependent. Furthermore, 31 patients with history of prostate cancer were selected from an ongoing 68Ga-PSMA-11-PET/MRI study. For each patient, PET raw data were reconstructed employing six different variants of PET scatter correction: absolute scatter scaling, relative scatter scaling, and relative scatter scaling combined with prompt gamma correction, each of which was combined with a maximum scatter fraction (MaxSF) of MaxSF = 75% or MaxSF = 40%. Evaluation of the reconstructed images with regard to halo-artifact suppression was performed both quantitatively using statistical analysis and qualitatively by two independent readers. Results The phantom experiments did not reveal any modality-dependency (PET/MRI vs. PET/CT) or tracer-dependency (68Ga vs. 18F-FDG). Patient- and phantom-based data indicated that halo-artifacts derive from high organ-to-background activity ratios (OBR) between bladder/kidneys and surrounding soft tissue, with a positive correlation between OBR and halo size. Comparing different variants of scatter correction, reducing the maximum scatter fraction from the default value MaxSF = 75% to MaxSF = 40% was found to efficiently suppress halo-artifacts in both phantom and patient data. In 1 of 31 patients, reducing the maximum scatter fraction provided new PET-based information changing the patient’s diagnosis. Conclusion Halo-artifacts are particularly observed for 68Ga-PSMA-11-PET/MRI due to 1) the biodistribution of the PSMA-11-tracer resulting in large OBRs for bladder and kidneys and 2) inaccurate scatter correction methods currently used in clinical routine, which tend to overestimate the scatter contribution. If not compensated for, 68Ga-PSMA-11 uptake pathologies may be masked by halo-artifacts leading to false-negative diagnoses. Reducing the maximum scatter fraction was found to efficiently suppress halo-artifacts.
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Affiliation(s)
- Thorsten Heußer
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philipp Mann
- Applied Medical Radiation Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christopher M. Rank
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Schäfer
- Divison of Radiopharmaceutical Chemistry, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | | | - Klaus Kopka
- Divison of Radiopharmaceutical Chemistry, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Bachert
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marc Kachelrieß
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin T. Freitag
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- * E-mail:
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12
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Rank CM, Heußer T, Wetscherek A, Freitag MT, Sedlaczek O, Schlemmer HP, Kachelrieß M. Respiratory motion compensation for simultaneous PET/MR based on highly undersampled MR data. Med Phys 2017; 43:6234. [PMID: 27908174 DOI: 10.1118/1.4966128] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Positron emission tomography (PET) of the thorax region is impaired by respiratory patient motion. To account for motion, the authors propose a new method for PET/magnetic resonance (MR) respiratory motion compensation (MoCo), which uses highly undersampled MR data with acquisition times as short as 1 min/bed. METHODS The proposed PET/MR MoCo method (4D jMoCo PET) uses radial MR data to estimate the respiratory patient motion employing MR joint motion estimation and image reconstruction with temporal median filtering. Resulting motion vector fields are incorporated into the system matrix of the PET reconstruction. The proposed approach is evaluated for the thorax region utilizing a PET/MR simulation with 1 min MR acquisition time and simultaneous PET/MR measurements of six patients with MR acquisition times of 1 and 5 min and radial undersampling factors of 11.2 and 2.2, respectively. Reconstruction results are compared to 3D PET, 4D gated PET and a standard MoCo method (4D sMoCo PET), which performs iterative image reconstruction and motion estimation sequentially. Quantitative analysis comprises the parameters SUVmean, SUVmax, full width at half-maximum/lesion volume, contrast and signal-to-noise ratio. RESULTS For simulated PET data, our quantitative analysis shows that the proposed 4D jMoCo PET approach with temporal filtering achieves the best quantification accuracy of all tested reconstruction methods with a mean absolute deviation of 2.3% when compared to the ground truth. For measured PET patient data, the mean absolute deviation of 4D jMoCo PET using a 1 min MR acquisition for motion estimation is 2.1% relative to the 5 min MR acquisition. This demonstrates a robust behavior even in case of strong undersampling at MR acquisition times as short as 1 min. In contrast, 4D sMoCo PET shows considerable reduction of quantification accuracy for the 1 min MR acquisition time. Relative to 3D PET, the proposed 4D jMoCo PET approach with temporal filtering yields an average increase of SUVmean, SUVmax, and contrast of 29.9% and 13.8% for simulated and measured PET data, respectively. CONCLUSIONS Employing artifact-robust motion estimation enables PET/MR respiratory MoCo with MR acquisition times as short as 1 min/bed improving PET image quality and quantification accuracy.
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Affiliation(s)
- Christopher M Rank
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Thorsten Heußer
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Andreas Wetscherek
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany and Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 123 Old Brompton Road, London SW7 3RP, United Kingdom
| | - Martin T Freitag
- Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Oliver Sedlaczek
- Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Marc Kachelrieß
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
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13
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Heußer T, Rank CM, Berker Y, Freitag MT, Kachelrieß M. MLAA-based attenuation correction of flexible hardware components in hybrid PET/MR imaging. EJNMMI Phys 2017; 4:12. [PMID: 28251575 PMCID: PMC5332322 DOI: 10.1186/s40658-017-0177-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 10/07/2016] [Accepted: 02/01/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Accurate PET quantification demands attenuation correction (AC) for both patient and hardware attenuation of the 511 keV annihilation photons. In hybrid PET/MR imaging, AC for stationary hardware components such as patient table and MR head coil is straightforward, employing CT-derived attenuation templates. AC for flexible hardware components such as MR-safe headphones and MR radiofrequency (RF) surface coils is more challenging. Registration-based approaches, aligning CT-based attenuation templates with the current patient position, have been proposed but are not used in clinical routine. Ignoring headphone or RF coil attenuation has been shown to result in regional activity underestimation values of up to 18%. We propose to employ the maximum-likelihood reconstruction of attenuation and activity (MLAA) algorithm to estimate the attenuation of flexible hardware components. Starting with an initial attenuation map not including flexible hardware components, the attenuation update of MLAA is applied outside the body outline only, allowing to estimate hardware attenuation without modifying the patient attenuation map. Appropriate prior expectations on the attenuation coefficients are incorporated into MLAA. The proposed method is investigated for non-TOF PET phantom and 18F-FDG patient data acquired with a clinical PET/MR device, using headphones or RF surface coils as flexible hardware components. RESULTS Although MLAA cannot recover the exact physical shape of the hardware attenuation maps, the overall attenuation of the hardware components is accurately estimated. Therefore, the proposed algorithm significantly improves PET quantification. Using the phantom data, local activity underestimation when neglecting hardware attenuation was reduced from up to 25% to less than 3% under- or overestimation as compared to reference scans without hardware present or to CT-derived AC. For the patient data, we found an average activity underestimation of 7.9% evaluated in the full brain and of 6.1% for the abdominal region comparing the uncorrected case with MLAA. CONCLUSIONS MLAA is able to provide accurate estimations of the attenuation of flexible hardware components and can therefore be used to significantly improve PET quantification. The proposed approach can be readily incorporated into clinical workflow.
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Affiliation(s)
- Thorsten Heußer
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Christopher M Rank
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany
| | - Yannick Berker
- Department of Radiology, University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, 19104, PA, USA.,Physics of Molecular Imaging Systems, RWTH Aachen University, Pauwelsstraße 19, Aachen, 52074, Germany
| | - Martin T Freitag
- Department of Radiology, German Cancer Research Center (DKFZ), Neuenheimer Feld 280, Heidelberg, 69120, Germany
| | - Marc Kachelrieß
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany
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14
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Freitag MT, Bickelhaupt S, Ziener C, Meier-Hein K, Radtke JP, Mosebach J, Kuder TA, Schlemmer HP, Laun FB. [Selected clinically established and scientific techniques of diffusion-weighted MRI. In the context of imaging in oncology]. Radiologe 2016; 56:137-47. [PMID: 26801187 DOI: 10.1007/s00117-015-0066-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 01/26/2023]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) technique that was established in the clinical routine primarily for the detection of brain ischemia. In the past 15 years its clinical use has been extended to oncological radiology, as tumor and metastases can be depicted in DWI due to their hypercellular nature. PRINCIPLES The basis of DWI is the Stejskal-Tanner experiment. The diffusion properties of tissue can be visualized after acquisition of at least two diffusion-weighted series using echo planar imaging and a specific sequence of gradient pulses. CLINICAL APPLICATIONS The use of DWI in prostate MRI was reported to be one of the first established applications that found its way into internationally recognized clinical guidelines of the European Society of Urological Radiology (ESUR) and the prostate imaging reporting and data system (PI-RADS) scale. Due to recently reported high specificity and negative predictive values of 94% and 92%, respectively, its regular use for breast MRI is expected in the near future. Furthermore, DWI can also reliably be used for whole-body imaging in patients with multiple myeloma or for measuring the extent of bone metastases. OUTLOOK New techniques in DWI, such as intravoxel incoherent motion imaging, diffusion kurtosis imaging and histogram-based analyses represent promising approaches to achieve a more quantitative evaluation for tumor detection and therapy response.
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Affiliation(s)
- M T Freitag
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland.
| | - S Bickelhaupt
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
| | - C Ziener
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
| | - K Meier-Hein
- Abteilung für medizinische Informatik, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - J P Radtke
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland.,Abteilung für Urologie, Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - J Mosebach
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
| | - T-A Kuder
- Abteilung für Medizinische Physik in der Radiologie, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - H-P Schlemmer
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
| | - F B Laun
- Abteilung für Medizinische Physik in der Radiologie, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
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15
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Radtke JP, Schwab C, Wolf MB, Freitag MT, Alt CD, Kesch C, Popeneciu IV, Huettenbrink C, Gasch C, Klein T, Bonekamp D, Duensing S, Roth W, Schueler S, Stock C, Schlemmer HP, Roethke M, Hohenfellner M, Hadaschik BA. Multiparametric Magnetic Resonance Imaging (MRI) and MRI–Transrectal Ultrasound Fusion Biopsy for Index Tumor Detection: Correlation with Radical Prostatectomy Specimen. Eur Urol 2016; 70:846-853. [DOI: 10.1016/j.eururo.2015.12.052] [Citation(s) in RCA: 216] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/29/2015] [Indexed: 11/26/2022]
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16
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Freitag MT, Maier-Hein KH, Binczyk F, Laun FB, Weber C, Bonekamp D, Tarnawski R, Bobek-Billewicz B, Polanska J, Majchrzak H, Stieltjes B. Early Detection of Malignant Transformation in Resected WHO II Low-Grade Glioma Using Diffusion Tensor-Derived Quantitative Measures. PLoS One 2016; 11:e0164679. [PMID: 27741525 PMCID: PMC5065360 DOI: 10.1371/journal.pone.0164679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/29/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Here, we retrospectively investigate the value of voxel-wisely plotted diffusion tensor-derived (DTI) axial, radial and mean diffusivity for the early detection of malignant transformation (MT) in WHO II glioma compared to contrast-enhanced images. MATERIALS AND METHODS Forty-seven patients underwent brain magnetic resonance imaging follow-up between 2006-2014 after gross-tumor resection of intra-axial WHO II glioma. Axial/Mean/Radial diffusivity maps (AD/MD/RD) were generated from DTI data. ADmin/MDmin/RDmin values were quantified within tumor regions-of-interest generated by two independent readers including tumor contrast-to-noise (CNR). Sensitivity/specificity and area-under-the-curve (AUC) were calculated using receiver-operating-characteristic analysis. Inter-reader agreement was assessed (Cohen's kappa). RESULTS Eighteen patients demonstrated malignant transformation (MT) confirmed in 8/18 by histopathology and in 10/18 through imaging follow-up. Twelve of 18 patients (66.6%) with MT showed diffusion restriction timely coincidental with contrast-enhancement (CE). In the remaining six patients (33.3%), the diffusion restriction preceded the CE. The mean gain in detection time using DTI was (0.8±0.5 years, p = 0.028). Compared to MDmin and RDmin, ROC-analysis showed best diagnostic value for ADmin (sensitivity/specificity 94.94%/89.7%, AUC 0.96; p<0.0001) to detect MT. CNR was highest for AD (1.83±0.14), compared to MD (1.31±0.19; p<0.003) and RD (0.90±0.23; p<0.0001). Cohen's Kappa was 0.77 for ADmin, 0.71 for MDmin and 0.65 for RDmin (p<0.0001, respectively). CONCLUSION MT is detectable at the same time point or earlier compared to T1w-CE by diffusion restriction in diffusion-tensor-derived maps. AD demonstrated highest sensitivity/specificity/tumor-contrast compared to radial or mean diffusivity (= apparent diffusion coefficient) to detect MT.
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Affiliation(s)
- Martin T. Freitag
- Quantitative Imaging-based Disease Characterization, German Cancer Research Center, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Klaus H. Maier-Hein
- Junior Group Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
| | | | - Frederik B. Laun
- Division of Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Christian Weber
- Junior Group Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Rafal Tarnawski
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Department of Radiology, Gliwice, Poland
| | - Barbara Bobek-Billewicz
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Department of Radiology, Gliwice, Poland
| | - Joanna Polanska
- Silesian University of Technology, Data Mining Group, Gliwice, Poland
| | - Henryk Majchrzak
- Department of Neurosurgery, Medical University of Silesia, Sosnowiec, Katowice, Poland
| | - Bram Stieltjes
- Quantitative Imaging-based Disease Characterization, German Cancer Research Center, Heidelberg, Germany
- Department of Radiology, University Hospital Basel, Basel, Switzerland
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17
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Straub S, Schneider TM, Emmerich J, Freitag MT, Ziener CH, Schlemmer HP, Ladd ME, Laun FB. Suitable reference tissues for quantitative susceptibility mapping of the brain. Magn Reson Med 2016; 78:204-214. [DOI: 10.1002/mrm.26369] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 06/24/2016] [Accepted: 07/13/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Sina Straub
- Department of Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Till M. Schneider
- Department of Neuroradiology; University of Heidelberg; Heidelberg Germany
- Department of Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Julian Emmerich
- Department of Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Martin T. Freitag
- Department of Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Christian H. Ziener
- Department of Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | | | - Mark E. Ladd
- Department of Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Frederik B. Laun
- Department of Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
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Stahl V, Maier F, Freitag MT, Floca RO, Berger MC, Umathum R, Berriel Diaz M, Herzig S, Weber MA, Dimitrakopoulou-Strauss A, Rink K, Bachert P, Ladd ME, Nagel AM. In vivoassessment of cold stimulation effects on the fat fraction of brown adipose tissue using DIXON MRI. J Magn Reson Imaging 2016; 45:369-380. [DOI: 10.1002/jmri.25364] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 06/15/2016] [Indexed: 12/13/2022] Open
Affiliation(s)
- Vanessa Stahl
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Florian Maier
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Martin T. Freitag
- Department of Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Ralf O. Floca
- Medical and Biological Informatics, German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Moritz C. Berger
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Reiner Umathum
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Mauricio Berriel Diaz
- Institute for Diabetes and Cancer IDC Helmholtz Center Munich and Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital; Neuherberg Germany
| | - Stephan Herzig
- Institute for Diabetes and Cancer IDC Helmholtz Center Munich and Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital; Neuherberg Germany
| | - Marc-André Weber
- Diagnostic and Interventional Radiology; University Hospital of Heidelberg; Heidelberg Germany
| | | | - Kristian Rink
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Peter Bachert
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Mark E. Ladd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Armin M. Nagel
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ); Heidelberg Germany
- Department of Diagnostic and Interventional Radiology; University Medical Center Ulm; Ulm Germany
- Institute of Radiology; University Hospital Erlangen; Erlangen Germany
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19
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Rank CM, Heußer T, Buzan MTA, Wetscherek A, Freitag MT, Dinkel J, Kachelrieß M. 4D respiratory motion-compensated image reconstruction of free-breathing radial MR data with very high undersampling. Magn Reson Med 2016; 77:1170-1183. [PMID: 26991911 DOI: 10.1002/mrm.26206] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [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: 10/12/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 11/10/2022]
Abstract
PURPOSE To develop four-dimensional (4D) respiratory time-resolved MRI based on free-breathing acquisition of radial MR data with very high undersampling. METHODS We propose the 4D joint motion-compensated high-dimensional total variation (4D joint MoCo-HDTV) algorithm, which alternates between motion-compensated image reconstruction and artifact-robust motion estimation at multiple resolution levels. The algorithm is applied to radial MR data of the thorax and upper abdomen of 12 free-breathing subjects with acquisition times between 37 and 41 s and undersampling factors of 16.8. Resulting images are compared with compressed sensing-based 4D motion-adaptive spatio-temporal regularization (MASTeR) and 4D high-dimensional total variation (HDTV) reconstructions. RESULTS For all subjects, 4D joint MoCo-HDTV achieves higher similarity in terms of normalized mutual information and cross-correlation than 4D MASTeR and 4D HDTV when compared with reference 4D gated gridding reconstructions with 8.4 ± 1.1 times longer acquisition times. In a qualitative assessment of artifact level and image sharpness by two radiologists, 4D joint MoCo-HDTV reveals higher scores (P < 0.05) than 4D HDTV and 4D MASTeR at the same undersampling factor and the reference 4D gated gridding reconstructions, respectively. CONCLUSIONS 4D joint MoCo-HDTV enables time-resolved image reconstruction of free-breathing radial MR data with undersampling factors of 16.8 while achieving low-streak artifact levels and high image sharpness. Magn Reson Med 77:1170-1183, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Christopher M Rank
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Thorsten Heußer
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Maria T A Buzan
- Department of Pneumology, Iuliu Hatieganu University of Medicine and Pharmacy, Hasdeu Str. 6, 400371, Cluj-Napoca, Romania.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Amalienstr. 5, 69126, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Andreas Wetscherek
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Martin T Freitag
- Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Julien Dinkel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Amalienstr. 5, 69126, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.,Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Marc Kachelrieß
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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Radtke JP, Hadaschik BA, Wolf MB, Freitag MT, Schwab C, Alt C, Roth W, Duensing S, Pahernik SA, Roethke MC, Schlemmer HP, Hohenfellner M, Teber D. The Impact of Magnetic Resonance Imaging on Prediction of Extraprostatic Extension and Prostatectomy Outcome in Patients with Low-, Intermediate- and High-Risk Prostate Cancer: Try to Find a Standard. J Endourol 2015; 29:1396-405. [DOI: 10.1089/end.2015.0358] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Boris A. Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Maya B. Wolf
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin T. Freitag
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Constantin Schwab
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Wilfried Roth
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Duensing
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Sascha A. Pahernik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias C. Roethke
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Dogu Teber
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
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21
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Sachpekidis C, Mosebach J, Freitag MT, Wilhelm T, Mai EK, Goldschmidt H, Haberkorn U, Schlemmer HP, Delorme S, Dimitrakopoulou-Strauss A. Application of (18)F-FDG PET and diffusion weighted imaging (DWI) in multiple myeloma: comparison of functional imaging modalities. Am J Nucl Med Mol Imaging 2015; 5:479-492. [PMID: 26550539 PMCID: PMC4620175] [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] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 08/26/2015] [Indexed: 06/05/2023]
Abstract
Aim of this prospective study was to assess the sensitivity of positron emission tomography (PET) and diffusion-weighted imaging (DWI) in detecting multiple myeloma (MM) lesions, using the well-established morphologic modalities magnetic resonance imaging (MRI) and computed tomography (CT) as the standard of reference (RS). The study included 24 MM patients (15 newly diagnosed, 9 pre-treated). All underwent (18)F-FDG PET/CT and wholebody DWI. The findings in PET and DWI were compared to matching imaging findings in combined non-enhanced T1w, fat-saturated T2w (TIRM)- MRI, and low-dose CT. Patient-based analysis revealed that 15/24 patients (10 primary MM, 5 pre-treated) had myeloma lesions according to our RS. PET was positive in 13/24 patients (11 primary MM, 2 pre-treated) and DWI in 18/24 patients (12 primary MM, 6 pre-treated). Lesion-based analysis demonstrated 128 MM lesions, of which PET depicted 60/128 lesions (sensitivity 47%), while DWI depicted 99/128 lesions (sensitivity 77%). Further analysis including only the 15 untreated MM patients revealed a sensitivity of 90% for both PET and DWI and an overall concordance of PET and DWI of 72%. In conclusion, DWI was more sensitive than (18)F-FDG PET in detecting myeloma lesions in a mixed population of primary and pre-treated MM patients. However, (18)F-FDG PET and DWI demonstrated equivalent sensitivities in the sub-population of primary, untreated MM patients. This higher sensitivity of DWI in pre-treated patients may be due to the fact that (18)F-FDG PET becomes negative earlier in the course of treatment in contrary to MRI, in which already treated lesions can remain visible.
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Affiliation(s)
- Christos Sachpekidis
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ)Heidelberg, Germany
| | - Jennifer Mosebach
- Department of Radiology, German Cancer Research Center (DKFZ)Heidelberg, Germany
| | - Martin T Freitag
- Department of Radiology, German Cancer Research Center (DKFZ)Heidelberg, Germany
| | - Thomas Wilhelm
- Department of Radiology, German Cancer Research Center (DKFZ)Heidelberg, Germany
| | - Elias K Mai
- Department of Medicine V, University Clinic HeidelbergHeidelberg, Germany
| | | | - Uwe Haberkorn
- Division of Nuclear Medicine, University Clinic HeidelbergHeidelberg, Germany
| | | | - Stefan Delorme
- Department of Radiology, German Cancer Research Center (DKFZ)Heidelberg, Germany
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22
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Radtke JP, Schwab C, Wolf MB, Freitag MT, Alt C, Kesch C, Popeneciu IV, Huettenbrink C, Bergstraesser-Gasch C, Klein T, Duensing S, Roth S, Schlemmer HP, Roethke M, Hohenfellner M, Hadaschik B. Multiparametric magnetic resonance tomography and MRI/TRUS-fusion-biopsy for index lesion detection: correlation with radical prostatectomy specimen. Cancer Imaging 2015. [PMCID: PMC4601104 DOI: 10.1186/1470-7330-15-s1-s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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23
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Freitag MT, Weber C, Maier-Hein K, Tarnawski R, Bobek-Billewicz B, Binczyck F, Polanska J, Stieltjes B. Multiparametrical diffusion weighted imaging for the detection of anaplastic transformation of low-grade gliomas. Cancer Imaging 2014. [PMCID: PMC4242738 DOI: 10.1186/1470-7330-14-s1-s11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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24
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Falquez R, Couto B, Ibanez A, Freitag MT, Berger M, Arens EA, Lang S, Barnow S. Corrigendum: Detaching from the negative by reappraisal: the role of right superior frontal gyrus (BA9/32). Front Behav Neurosci 2014. [PMCID: PMC4141284 DOI: 10.3389/fnbeh.2014.00264] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Rosalux Falquez
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology University of HeidelbergHeidelberg, Germany
- *Correspondence:
| | - Blas Couto
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro UniversityBuenos Aires, Argentina
- Diego Portales University, UDP-INECO Foundation Core on Neuroscience (UIFCoN)Santiago, Chile
| | - Agustin Ibanez
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro UniversityBuenos Aires, Argentina
- Diego Portales University, UDP-INECO Foundation Core on Neuroscience (UIFCoN)Santiago, Chile
- Departamento de Psicología, Universidad Autónoma del CaribeBarranquilla, Colombia
| | - Martin T. Freitag
- Department of Radiology, German Cancer Research Center (DKFZ)Heidelberg, Germany
| | - Moritz Berger
- Department of Radiology, German Cancer Research Center (DKFZ)Heidelberg, Germany
| | - Elisabeth A. Arens
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology University of HeidelbergHeidelberg, Germany
| | - Simone Lang
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology University of HeidelbergHeidelberg, Germany
| | - Sven Barnow
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology University of HeidelbergHeidelberg, Germany
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Freitag MT, Breithaupt M, Berger M, Umathum R, Nagel AM, Hassel J, Ladd ME, Schlemmer HP, Semmler W, Stieltjes B. In vivo visualization of mesoscopic anatomy of healthy and pathological lymph nodes using 7T MRI: A feasibility study. J Magn Reson Imaging 2014; 41:1405-12. [DOI: 10.1002/jmri.24686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 06/11/2014] [Accepted: 06/11/2014] [Indexed: 01/27/2023] Open
Affiliation(s)
- Martin T. Freitag
- Section Quantitative Imaging Based Disease Characterization, Department of Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Mathies Breithaupt
- Division of Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Moritz Berger
- Division of Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Reiner Umathum
- Division of Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Armin M. Nagel
- Division of Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Jessica Hassel
- Department of Dermatology; National Center for Tumor Diseases (NCT), University of Heidelberg; Heidelberg Germany
| | - Mark E. Ladd
- Division of Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | | | - Wolfhard Semmler
- Division of Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Bram Stieltjes
- Section Quantitative Imaging Based Disease Characterization, Department of Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
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Falquez R, Couto B, Ibanez A, Freitag MT, Berger M, Arens EA, Lang S, Barnow S. Detaching from the negative by reappraisal: the role of right superior frontal gyrus (BA9/32). Front Behav Neurosci 2014; 8:165. [PMID: 24847230 PMCID: PMC4023069 DOI: 10.3389/fnbeh.2014.00165] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 01/20/2014] [Accepted: 04/18/2014] [Indexed: 12/30/2022] Open
Abstract
The ability to reappraise the emotional impact of events is related to long-term mental health. Self-focused reappraisal (REAPPself), i.e., reducing the personal relevance of the negative events, has been previously associated with neural activity in regions near right medial prefrontal cortex, but rarely investigated among brain-damaged individuals. Thus, we aimed to examine the REAPPself ability of brain-damaged patients and healthy controls considering structural atrophies and gray matter intensities, respectively. Twenty patients with well-defined cortex lesions due to an acquired circumscribed tumor or cyst and 23 healthy controls performed a REAPPself task, in which they had to either observe negative stimuli or decrease emotional responding by REAPPself. Next, they rated the impact of negative arousal and valence. REAPPself ability scores were calculated by subtracting the negative picture ratings after applying REAPPself from the ratings of the observing condition. The scores of the patients were included in a voxel-based lesion-symptom mapping (VLSM) analysis to identify deficit related areas (ROI). Then, a ROI group-wise comparison was performed. Additionally, a whole-brain voxel-based-morphometry (VBM) analysis was run, in which healthy participant's REAPPself ability scores were correlated with gray matter intensities. Results showed that (1) regions in the right superior frontal gyrus (SFG), comprising the right dorsolateral prefrontal cortex (BA9) and the right dorsal anterior cingulate cortex (BA32), were associated with patient's impaired down-regulation of arousal, (2) a lesion in the depicted ROI occasioned significant REAPPself impairments, (3) REAPPself ability of controls was linked with increased gray matter intensities in the ROI regions. Our findings show for the first time that the neural integrity and the structural volume of right SFG regions (BA9/32) might be indispensable for REAPPself. Implications for neurofeedback research are discussed.
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Affiliation(s)
- Rosalux Falquez
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Heidelberg Heidelberg, Germany
| | - Blas Couto
- Laboratory of Experimental Psychology and Neuroscience, Institute of Cognitive Neurology, Favaloro University Buenos Aires, Argentina ; UDP-INECO Foundation Core on Neuroscience, Diego Portales University Santiago, Chile
| | - Agustin Ibanez
- Laboratory of Experimental Psychology and Neuroscience, Institute of Cognitive Neurology, Favaloro University Buenos Aires, Argentina ; UDP-INECO Foundation Core on Neuroscience, Diego Portales University Santiago, Chile ; Departamento de Psicología, Universidad Autónoma del Caribe Barranquilla, Colombia
| | - Martin T Freitag
- Department of Radiology, German Cancer Research Center Heidelberg, Germany
| | - Moritz Berger
- Department of Radiology, German Cancer Research Center Heidelberg, Germany
| | - Elisabeth A Arens
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Heidelberg Heidelberg, Germany
| | - Simone Lang
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Heidelberg Heidelberg, Germany
| | - Sven Barnow
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Heidelberg Heidelberg, Germany
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Freitag MT, van Bruggen T, Fritzsche KH, Henze R, Brunner R, Parzer P, Resch F, Stieltjes B. Reduced lateralization in early onset schizophrenia. Neurosci Lett 2013; 537:23-8. [DOI: 10.1016/j.neulet.2013.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/18/2012] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
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Freitag MT, Walder N, Nogradi A, Parzer P, Hartmann J, Redl H, Stieltjes B. MRT-Manganbildgebung zur Therapieevaluierung von Erythropoietin am Rückenmarkstrauma im Tierversuch. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1329768] [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: 10/27/2022]
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