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Eisazadeh R, Mirshahvalad SA, Schwieghofer-Zwink G, Hehenwarter L, Rendl G, Gampenrieder S, Greil R, Pirich C, Beheshti M. Pre-treatment 68 Ga-PSMA-11 PET/CT Prognostic Value in Predicting Response to 177Lu-PSMA-I&T Therapy and Patient Survival. Mol Imaging Biol 2024; 26:360-369. [PMID: 38360991 DOI: 10.1007/s11307-024-01900-6] [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: 11/09/2023] [Revised: 01/15/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE To assess the prognostic value of pre-treatment [68Ga]Ga-PSMA-11 PET/CT and other baseline clinical characteristics in predicting prostate cancer (PCa) patients response to [177Lu]Lu-PSMA (PSMA-I&T), as well as patient survival. PROCEDURES In this retrospective study, 81 patients who received [177Lu]Lu-PSMA-I&T between October 2018 and January 2023 were reviewed. Eligible patients had metastatic castration-resistant PCa, underwent pre-treatment [68Ga]Ga-PSMA-11 PET/CT, and had serum prostate-specific antigen (PSA) levels available. On PET/CT images, SUVmax, SULmax, SUVpeak, and SULpeak of the most-avid tumoral lesion, as well as SUVmean of the parotid gland (P-SUVmean) and liver (L-SUVmean), were measured. Also, whole-body PSMA tumour volume (PSMA-TV) and total lesion PSMA (TL-PSMA) were calculated. To interpret treatment response after [177Lu]Lu-PSMA-I&T, a composite of PSA values and [68Ga]Ga-PSMA-11 PET/CT findings were considered. The outcomes were dichotomised into progressive versus controlled (stable disease or partial response) disease. Then, the association of baseline parameters with patient response was evaluated. Also, survival analyses were performed to assess baseline parameters in predicting overall survival. RESULTS Sixty patients (age:73 ± 8, PSA:185 ± 371) were included. Patients received at least one cycle of [177Lu]Lu-PSMA therapy (median = 4). Overall, half of the patients showed disease progression. In the progressive versus controlled disease evaluation, the highest SULmax, as well as SUVmax and SULmax to both backgrounds (L-SUVmean and P-SUVmean), were significantly correlated with the outcome (p-values < 0.05). In the multivariate analysis, only SULmax to the L-SUVmean remained significant (p-value = 0.038). The best cut-off was 8 (AUC = 0.71). With a median follow-up of 360 days, 11 mortal events were documented. In the multivariate survival analysis, only SULmax to P-SUVmean (cut-off = 2.4; p-value = 0.043) retained significance (hazard ratio = 4.0). CONCLUSIONS A greater level of PSMA uptake, specifically higher tumour-to-background uptake in the hottest lesion, may hold substantial prognostic significance, considering both [177Lu]Lu-PSMA-I&T response and patient survival. These ratios may have the potential to be used for PCa patient selection for radioligand therapy.
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Affiliation(s)
- Roya Eisazadeh
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
- Joint Department of Medical Imaging, University Medical Imaging Toronto (UMIT), University Health Network, Mount Sinai Hospital & Women's College Hospital; University of Toronto, Toronto, ON, Canada
| | - Gregor Schwieghofer-Zwink
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Lukas Hehenwarter
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Gundula Rendl
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Simon Gampenrieder
- Department of Internal Medicine III With Haematology, Medical Oncology, and Oncologic Center, University Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III With Haematology, Medical Oncology, and Oncologic Center, University Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.
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Kalantari F, Schweighofer-Zwink G, Rendl G, Pirich C, Beheshti M. 18F-FDG and 68Ga-PSMA PET/CT in Paratesticular Mesothelioma. Clin Nucl Med 2024; 49:332. [PMID: 38427957 DOI: 10.1097/rlu.0000000000005123] [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: 03/03/2024]
Abstract
ABSTRACT A 66-year-old man with local prostate adenocarcinoma underwent radical prostatectomy (Gleason score 3 + 4 = 7, pT2c) in 2016. Four years later, he presented with a hydrocele and cystic atypical change in the left scrotum and soft tissue in the left groin. Final histopathology revealed spermatic cord mesothelioma and left hemangiosis carcinomatosa. A bone biopsy of the sacrum revealed infiltrates of a prostatic adenocarcinoma with small cell neuroendocrine differentiation. Dual-tracer PET/CT imaging using 18F-FDG and 68Ga-PSMA was able to identify local recurrence of scrotal mesothelioma and differentiate metastases of prostate cancer from malignant mesothelioma.
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Affiliation(s)
- Forough Kalantari
- From the Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria
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Eisazadeh R, Shahbazi-Akbari M, Mirshahvalad SA, Pirich C, Beheshti M. Application of Artificial Intelligence in Oncologic Molecular PET-Imaging: A Narrative Review on Beyond [ 18F]F-FDG Tracers Part II. [ 18F]F-FLT, [ 18F]F-FET, [ 11C]C-MET and Other Less-Commonly Used Radiotracers. Semin Nucl Med 2024; 54:293-301. [PMID: 38331629 DOI: 10.1053/j.semnuclmed.2024.01.002] [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] [Received: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
Following the previous part of the narrative review on artificial intelligence (AI) applications in positron emission tomography (PET) using tracers rather than 18F-fluorodeoxyglucose ([18F]F-FDG), in this part we review the impact of PET-derived radiomics data on the diagnostic performance of other PET radiotracers, 18F-O-(2-fluoroethyl)-L-tyrosine ([18F]F-FET), 18F-Fluorothymidine ([18F]F-FLT) and 11C-Methionine ([11C]C-MET). [18F]F-FET-PET, using an artificial amino acid taken up into upregulated tumoral cells, showed potential in lesion detection and tumor characterization, especially with its ability to reflect glioma heterogeneity. [18F]F-FET-PET-derived textural features appeared to have the potential to reveal considerable information for accurate delineation for guiding biopsy and treatment, differentiate between low-grade and high-grade glioma and related wild-type genotypes, and distinguish pseudoprogression from true progression. In addition, models built using clinical parameters and [18F]F-FET-PET-derived radiomics features showed acceptable results for survival stratification of glioblastoma patients. [18F]F-FLT-PET-based characteristics also showed potential in evaluating glioma patients, correlating with Ki-67 and patient prognosis. AI-based PET-volumetry using this radiotracer as a proliferation marker also revealed promising preliminary results in terms of guide-targeting bone marrow-preserving adaptive radiation therapy. Similar to [18F]F-FET, the other amino acid tracer which reflects cellular proliferation, [11C]C-MET, has also shown acceptable performance in predicting tumor grade, distinguishing brain tumor recurrence from radiation necrosis, and treatment monitoring by PET-derived radiomics models. In addition, PET-derived radiomics features of various radiotracers such as [18F]F-DOPA, [18F]F-FACBC, [18F]F-NaF, [68Ga]Ga-CXCR-4 and [18F]F-FMISO may also provide useful information for tumor characterization and predict of disease outcome. In conclusion, AI using tracers beyond [18F]F-FDG could improve the diagnostic performance of PET-imaging for specific indications and help clinicians in their daily routine by providing features that are often not detectable by the naked eye.
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Affiliation(s)
- Roya Eisazadeh
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Malihe Shahbazi-Akbari
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria; Research center for Nuclear Medicine, Department of Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria; Research center for Nuclear Medicine, Department of Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran; Joint Department of Medical Imaging, University Medical Imaging Toronto (UMIT), University Health Network, Mount Sinai Hospital & Women's College Hospital; University of Toronto, Toronto, Ontario, Canada
| | - Christian Pirich
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria.
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Kalantari F, Rendl G, Hecht S, Pirich C, Beheshti M. [Atypisches lokales Larynxkarzinom-Rezidiv imitiert als entzündlicher thyreoidaler Uptake in der 18F-FDG PET/CT]. ROFO-FORTSCHR RONTG 2024; 196:195-196. [PMID: 37944939 DOI: 10.1055/a-2123-3867] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Forough Kalantari
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
- School of medicine, Department of Nuclear medicine, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Gundula Rendl
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Stefan Hecht
- Department of Radiology, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria., Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christian Pirich
- Department of Nuclear Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
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Zamani-Siahkali N, Mirshahvalad SA, Farbod A, Divband G, Pirich C, Veit-Haibach P, Cook G, Beheshti M. SPECT/CT, PET/CT, and PET/MRI for Response Assessment of Bone Metastases. Semin Nucl Med 2024:S0001-2998(23)00093-4. [PMID: 38172001 DOI: 10.1053/j.semnuclmed.2023.11.005] [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] [Received: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/05/2024]
Abstract
Recent developments in hybrid SPECT/CT systems and the use of cadmium-zinc-telluride (CZT) detectors have improved the diagnostic accuracy of bone scintigraphy. These advancements have paved the way for novel quantitative approaches to accurate and reproducible treatment monitoring of bone metastases. PET/CT imaging using [18F]F-FDG and [18F]F-NaF have shown promising clinical utility in bone metastases assessment and monitoring response to therapy and prediction of treatment response in a broad range of malignancies. Additionally, specific tumor-targeting tracers like [99mTc]Tc-PSMA, [68Ga]Ga-PSMA, or [11C]C- or [18F]F-Choline revealed high diagnostic performance for early assessment and prognostication of bone metastases, particularly in prostate cancer. PET/MRI appears highly accurate imaging modality, but has associated limitations notably, limited availability, more complex logistics and high installation costs. Advances in artificial intelligence (Al) seem to improve the accuracy of imaging modalities and provide an assistant role in the evaluation of treatment response of bone metastases.
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Affiliation(s)
- Nazanin Zamani-Siahkali
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria; Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria; Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Abolfazl Farbod
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria; Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Gary Cook
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria.
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Zamani-Siahkali N, Mirshahvalad SA, Pirich C, Beheshti M. Diagnostic Performance of [ 18F]F-FDG Positron Emission Tomography (PET) in Non-Ophthalmic Malignant Melanoma: A Systematic Review and Meta-Analysis of More Than 10,000 Melanoma Patients. Cancers (Basel) 2024; 16:215. [PMID: 38201642 PMCID: PMC10778455 DOI: 10.3390/cancers16010215] [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: 11/27/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
We described the diagnostic performance of [18F]F-FDG-PET in malignant melanoma by conducting a comprehensive systematic review and meta-analysis of the existing literature. The study was designed following PRISMA-DTA. Original articles with adequate crude data for meta-analytic calculations that evaluated [18F]F-FDG-PET and compared it with a valid reference standard were considered eligible. The pooled measurements were calculated based on the data level (patient/lesion-based). Regarding sub-groups, diagnostic performances were calculated for local, regional and distant involvement. The bivariate model was employed to calculate sensitivity and specificity. The initial search resulted in 6678 studies. Finally, 100 entered the meta-analysis, containing 82 patient-based (10,403 patients) and 32 lesion-based (6188 lesions) datasets. At patient level, overall, [18F]F-FDG-PET had pooled sensitivity and specificity of 81% (95%CI: 73-87%) and 92% (95%CI: 90-94%), respectively. To detect regional lymph node metastasis, the pooled sensitivity and specificity were 56% (95%CI: 40-72%) and 97% (95%CI: 94-99%), respectively. To detect distant metastasis, they were 88% (95%CI: 81-93%) and 94% (95%CI: 91-96%), respectively. At lesion level, [18F]F-FDG-PET had a pooled sensitivity and specificity of 70% (95%CI: 57-80%) and 94% (95%CI: 88-97%), respectively. Thus, [18F]F-FDG-PET is a valuable diagnostic modality for melanoma assessment. It was accurate in various clinical scenarios. However, despite its high specificity, it showed low sensitivity in detecting regional lymph node metastasis and could not replace lymph node biopsy.
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Affiliation(s)
- Nazanin Zamani-Siahkali
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
- Department of Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran 1461884513, Iran
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
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Mohseninia N, Zamani-Siahkali N, Harsini S, Divband G, Pirich C, Beheshti M. Bone Metastasis in Prostate Cancer: Bone Scan Versus PET Imaging. Semin Nucl Med 2024; 54:97-118. [PMID: 37596138 DOI: 10.1053/j.semnuclmed.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 08/20/2023]
Abstract
Prostate cancer is the second most common cause of malignancy among men, with bone metastasis being a significant source of morbidity and mortality in advanced cases. Detecting and treating bone metastasis at an early stage is crucial to improve the quality of life and survival of prostate cancer patients. This objective strongly relies on imaging studies. While CT and MRI have their specific utilities, they also possess certain drawbacks. Bone scintigraphy, although cost-effective and widely available, presents high false-positive rates. The emergence of PET/CT and PET/MRI, with their ability to overcome the limitations of standard imaging methods, offers promising alternatives for the detection of bone metastasis. Various radiotracers targeting cell division activity or cancer-specific membrane proteins, as well as bone seeking agents, have been developed and tested. The use of positron-emitting isotopes such as fluorine-18 and gallium-68 for labeling allows for a reduced radiation dose and unaffected biological properties. Furthermore, the integration of artificial intelligence (AI) and radiomics techniques in medical imaging has shown significant advancements in reducing interobserver variability, improving accuracy, and saving time. This article provides an overview of the advantages and limitations of bone scan using SPECT and SPECT/CT and PET imaging methods with different radiopharmaceuticals and highlights recent developments in hybrid scanners, AI, and radiomics for the identification of prostate cancer bone metastasis using molecular imaging.
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Affiliation(s)
- Nasibeh Mohseninia
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Nazanin Zamani-Siahkali
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria; Department of Nuclear Medicine, Research center for Nuclear Medicine and Molecular Imaging, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Harsini
- Department of Molecular Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
| | | | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria.
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Mirshahvalad SA, Eisazadeh R, Shahbazi-Akbari M, Pirich C, Beheshti M. Application of Artificial Intelligence in Oncologic Molecular PET-Imaging: A Narrative Review on Beyond [ 18F]F-FDG Tracers - Part I. PSMA, Choline, and DOTA Radiotracers. Semin Nucl Med 2024; 54:171-180. [PMID: 37752032 DOI: 10.1053/j.semnuclmed.2023.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023]
Abstract
Artificial intelligence (AI) has evolved significantly in the past few decades. This thriving trend has also been seen in medicine in recent years, particularly in the field of imaging. Machine learning (ML), deep learning (DL), and their methods (eg, SVM, CNN), as well as radiomics, are the terminologies that have been introduced to this field and, to some extent, become familiar to the expert clinicians. PET is one of the modalities that has been enhanced via these state-of-the-art algorithms. This robust imaging technique further merged with anatomical modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), to provide reliable hybrid modalities, PET/CT and PET/MRI. Applying AI-based algorithms on the different components (PET, CT, and MRI) has resulted in promising results, maximizing the value of PET imaging. However, [18F]F-FDG, the most commonly utilized tracer in molecular imaging, has been mainly in the spotlight. Thus, we aimed to look into the less discussed tracers in this review, moving beyond [18F]F-FDG. The novel non-[18F]F-FDG agents also showed to be valuable in various clinical tasks, including lesion detection and tumor characterization, accurate delineation, and prognostic impact. Regarding prostate patients, PSMA-based models were highly accurate in determining tumoral lesions' location and delineating them, particularly within the prostate gland. However, they also could assess whole-body images to detect extra-prostatic lesions in a patient automatically. Considering the prognostic value of prostate-specific membrane antigen (PSMA) PET using AI, it could predict response to treatment and patient survival, which are crucial in patient management. Choline imaging, another non-[18F]F-FDG tracer, similarly showed acceptable results that may be of benefit in the clinic, though the current evidence is significantly more limited than PSMA. Lastly, different subtypes of DOTA ligands were found to be valuable. They could diagnose tumoral lesions in challenging sites and even predict histopathology grade, being a highly advantageous noninvasive tool. In conclusion, the current limited investigations have shown promising results, leading us to a bright future for AI in molecular imaging beyond [18F]F-FDG.
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Affiliation(s)
- Seyed Ali Mirshahvalad
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria; Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - Roya Eisazadeh
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Malihe Shahbazi-Akbari
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria; Research Center for Nuclear Medicine, Department of Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Christian Pirich
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria.
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Kalantari F, Mirshahvalad SA, Hoellwerth M, Schweighofer-Zwink G, Huber-Schönauer U, Hitzl W, Rendl G, Koelblinger P, Pirich C, Beheshti M. Prognostic Value of Baseline 18F-FDG PET/CT to Predict Brain Metastasis Development in Melanoma Patients. Cancers (Basel) 2023; 16:127. [PMID: 38201554 PMCID: PMC10778001 DOI: 10.3390/cancers16010127] [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: 11/28/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
To investigate the value of 18F-FDG-PET/CT in predicting the occurrence of brain metastases in melanoma patients, in this retrospective study 201 consecutive patients with pathology-proven melanoma, between 2008 and 2021, were reviewed. Those who underwent 18F-FDG-PET/CT for initial staging were considered eligible. Baseline assessment included histopathology, 18F-FDG-PET/CT, and brain MRI. Also, all patients had serial follow-ups for diagnosing brain metastasis development. Baseline 18F-FDG-PET/CT parameters were analysed using competing risk regression models to analyze their correlation with the occurrence of brain metastases. Overall, 159 patients entered the study. The median follow-up was six years. Among clinical variables, the initial M-stage and TNM-stage were significantly correlated with brain metastasis. Regarding 18F-FDG-PET/CT parameters, regional metastatic lymph node uptake values, as well as prominent SULmax (pSULmax) and prominent SUVmean (pSUVmean), were significantly correlated with the outcome. Cumulative incidences were 10% (6.3-16%), 31% (24.4-38.9%), and 35.2% (28.5-43.5%) after 1, 5, and 10 years. There were significant correlations between pSULmax (p-value < 0.001) and pSULpeak (p-value < 0.001) and the occurrence of brain metastases. The higher these values, the sooner the patient developed brain metastases. Thus, baseline 18F-FDG-PET/CT may have the potential to predict brain metastasis in melanoma patients. Those with high total metabolic activity should undergo follow-up/complementary evaluations, such as brain MRI.
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Affiliation(s)
- Forough Kalantari
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (F.K.); (S.A.M.); (G.S.-Z.); (U.H.-S.); (G.R.); (C.P.)
- Department of Nuclear Medicine, University Hospital, Iran University of Medical Sciences, 1461884513 Tehran, Iran
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (F.K.); (S.A.M.); (G.S.-Z.); (U.H.-S.); (G.R.); (C.P.)
- Joint Department of Medical Imaging (University Medical Imaging Toronto (UMIT)), University Health Network, Mount Sinai Hospital–Women’s College Hospital, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Magdalena Hoellwerth
- Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.H.); (P.K.)
| | - Gregor Schweighofer-Zwink
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (F.K.); (S.A.M.); (G.S.-Z.); (U.H.-S.); (G.R.); (C.P.)
| | - Ursula Huber-Schönauer
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (F.K.); (S.A.M.); (G.S.-Z.); (U.H.-S.); (G.R.); (C.P.)
| | - Wolfgang Hitzl
- Biostatistics and Publication of Clinical Trial Studies, Research and Innovation Management (RIM), Paracelsus Medical University, 5020 Salzburg, Austria;
- Department of Ophthalmology and Optometry, Paracelsus Medical University, 5020 Salzburg, Austria
- Research Program Experimental Ophthalmology & Glaucoma Research, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Gundula Rendl
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (F.K.); (S.A.M.); (G.S.-Z.); (U.H.-S.); (G.R.); (C.P.)
| | - Peter Koelblinger
- Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.H.); (P.K.)
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (F.K.); (S.A.M.); (G.S.-Z.); (U.H.-S.); (G.R.); (C.P.)
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (F.K.); (S.A.M.); (G.S.-Z.); (U.H.-S.); (G.R.); (C.P.)
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10
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Kalantari F, Mohseninia N, Wetsch A, Harsini S, Hehenwarter L, Schweighofer-Zwink G, Zamani-Siahkali N, Rendl G, Beheshti M, Pirich C. Head-to-Head Comparison of CZT-SPECT and SPECT/CT Myocardial Perfusion Imaging: Interobserver and Intraobserver Agreement and Diagnostic Performance. Life (Basel) 2023; 13:1879. [PMID: 37763283 PMCID: PMC10532584 DOI: 10.3390/life13091879] [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: 06/22/2023] [Revised: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) plays a crucial role in diagnosing coronary artery disease (CAD), with single-photon emission computed tomography (SPECT) being a widely accepted method. The accuracy of MPI relies on image quality and the expertise of physicians. While CZT-SPECT cameras offer advantages, they can be susceptible to attenuation artifacts. Therefore, our objective was to evaluate the diagnostic accuracy of CZT-SPECT and SPECT/CT in a clinical setting. METHOD We conducted a prospective single-center study involving patients with known or suspected stable ischemic heart disease who underwent SPECT-MPI using CZT-SPECT and SPECT/CT scanners, and the latter was equipped with cardiofocal collimation. Experienced physicians performed analysis and reporting based on automated quantification and visual image interpretation. RESULTS A total of 77 patients (32 women (41.6%) and 45 men (58.4%) with an average age of 71.9 ± 8.9 years) were included. The agreement between readers regarding the final conclusion based on imaging reporting using both devices was very high (Kappa 0.87-0.93). Per-vessel analysis revealed a trend suggesting that CZT-SPECT was superior to conventional SPECT/CT in terms of sensitivity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, although the difference did not reach statistical significance. CONCLUSION Our study demonstrated that CZT-SPECT imaging offers comparable diagnostic accuracy, improved patient comfort, and eliminates CT-induced radiation compared to SPECT/CT. These findings suggest that cardiac CZT-SPECT imaging has the potential to become a valuable imaging modality in clinical practice.
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Affiliation(s)
- Forough Kalantari
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria (N.Z.-S.)
| | - Nasibeh Mohseninia
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria (N.Z.-S.)
| | - Andreas Wetsch
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria (N.Z.-S.)
| | - Sara Harsini
- BC Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
| | - Lukas Hehenwarter
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria (N.Z.-S.)
| | - Gregor Schweighofer-Zwink
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria (N.Z.-S.)
| | - Nazanin Zamani-Siahkali
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria (N.Z.-S.)
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran 1411713135, Iran
| | - Gundula Rendl
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria (N.Z.-S.)
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria (N.Z.-S.)
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria (N.Z.-S.)
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Grambozov B, Kalantari F, Beheshti M, Stana M, Karner J, Ruznic E, Zellinger B, Sedlmayer F, Rinnerthaler G, Zehentmayr F. Pretreatment 18-FDG-PET/CT parameters can serve as prognostic imaging biomarkers in recurrent NSCLC patients treated with reirradiation-chemoimmunotherapy. Radiother Oncol 2023; 185:109728. [PMID: 37301259 DOI: 10.1016/j.radonc.2023.109728] [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: 02/20/2023] [Revised: 05/02/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE Our study aimed to assess whether quantitative pretreatment 18F-FDG-PET/CT parameters could predict prognostic clinical outcome of recurrent NSCLC patients who may benefit from ablative reirradiation. MATERIALS AND METHODS Forty-eight patients with recurrent NSCLC of all UICC stages who underwent ablative thoracic reirradiation were analyzed. Twenty-nine (60%) patients received immunotherapy with or without chemotherapy in addition to reirradiation. Twelve patients (25%) received reirradiation only and seven (15%) received chemotherapy and reirradiation. Pretreatment 18-FDG-PET/CT was mandatory in initial diagnosis and recurrence, based on which volumetric and intensity quantitative parameters were measured before reirradiation and their impact on overall survival, progression-free survival, and locoregional control was assessed. RESULTS With a median follow-up time of 16.7 months, the median OS was 21.8 months (95%-CI: 16.2-27.3). On multivariate analysis, OS and PFS were significantly influenced by MTV (p < 0.001 for OS; p = 0.006 for PFS), TLG (p < 0.001 for OS; p = 0.001 for PFS) and SUL peak (p = 0.0024 for OS; p = 0.02 for PFS) of the tumor and MTV (p = 0.004 for OS; p < 0.001 for PFS) as well as TLG (p = 0.007 for OS; p = 0.015 for PFS) of the metastatic lymph nodes. SUL peak of the tumor (p = 0.05) and the MTV of the lymph nodes (p = 0.003) were only PET quantitative parameters that significantly impacted LRC. CONCLUSION Pretreatment tumor and metastastic lymph node MTV, TLG and tumor SUL peak significantly correlated with clinical outcome in recurrent NSCLC patients treated with reirradiation-chemoimmunotherapy.
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Affiliation(s)
- Brane Grambozov
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria.
| | - Forough Kalantari
- Department of Nuclear Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran; Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Markus Stana
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Josef Karner
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Elvis Ruznic
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Barbara Zellinger
- Institute of Pathology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Felix Sedlmayer
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria; radART - Institute for Research and Development on Advanced Radiation Technologies, Paracelsus Medical University, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; Cancer Cluster Salzburg, 5020 Salzburg, Austria
| | - Franz Zehentmayr
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria; radART - Institute for Research and Development on Advanced Radiation Technologies, Paracelsus Medical University, Salzburg, Austria
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12
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Ayati N, Jamshidi-Araghi Z, Hoellwerth M, Schweighofer-Zwink G, Hitzl W, Koelblinger P, Pirich C, Beheshti M. Predictive value and accuracy of [ 18F]FDG PET/CT modified response criteria for checkpoint immunotherapy in patients with advanced melanoma. Eur J Nucl Med Mol Imaging 2023; 50:2715-2726. [PMID: 37140669 PMCID: PMC10317870 DOI: 10.1007/s00259-023-06247-8] [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: 01/30/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE Immune checkpoint inhibitors (ICIs) are widely used in metastatic melanoma and dramatically alter the treatment of these patients. Given the high cost and potential toxicity, a reliable method for evaluating treatment response is needed. In this study, we assessed tumor response in patients with metastatic melanoma treated with ICIs using three modified response criteria: PET Response Evaluation Criteria for Immunotherapy (PERCIMT), PET Response Criteria in Solid Tumors for up to Five Lesions (PERCIST5), and immunotherapy-modified PET Response Criteria in Solid Tumors for up to Five Lesions (imPERCIST5). METHODS Ninety-one patients with non-resectable stage IV metastatic melanoma who received ICIs were retrospectively enrolled in this study. Each patient had two [18F]FDG PET/CT scans performed before and after ICI therapy. Responses at the follow-up scan were evaluated according to PERCIMT, PERCIST5, and imPERCIST5 criteria. Patients were classified into four groups: complete metabolic response (CMR), partial metabolic response (PMR), progressive metabolic disease (PMD), and stable metabolic disease (SMD). To assess the "disease control rate," two groups have been defined based on each criterion: patients with CMR, PMR, and SMD as "disease-controlled group (i.e., responders)" and PMD as the "uncontrolled-disease group (i.e., non-responders)". The correspondence between metabolic tumor response defined by these criteria and clinical outcome was assessed and compared. RESULTS The response and the disease control rates were 40.7% and 71.4%, 41.8% and 50.5%, and 54.9% and 74.7% based on the PERCIMT, PERCIST5, and imPERCIST5 criteria, respectively. PERCIMT and imPERCIST5 showed significantly different disease control rates from that of PERCIST5 (P < 0.001), whereas it was not significant between PERCIMT and imPERCIST5. Overall survival was significantly longer in the metabolic responder groups than in the non-responder groups based on PERCIMT and PERCIST5 criteria (PERCIMT: 2.48 versus 1.47 years, P = 0.003; PERCIST5: 2.57 versus 1.81 years. P = 0.017). However, according to imPERCIST5 criterion, this difference was not observed (P = 0.12). CONCLUSION Although the appearance of new lesions can be secondary to an inflammatory response to ICIs and indicative of pseudoprogression, given the higher rate of true progression, the appearance of new lesions should be interpreted deliberately. Of the three assessed modified criteria, PERCIMT appear to provide more reliable metabolic response assessment that correlates strongly with overall patient survival.
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Affiliation(s)
- Narjess Ayati
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Zahra Jamshidi-Araghi
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
- Department of Nuclear Medicine, Shahid Rajaie Cardiovascular, Medical & Research Center, Tehran, Iran
| | - Magdalena Hoellwerth
- Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Gregor Schweighofer-Zwink
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Wolfgang Hitzl
- Biostatistics and Publication of Clinical Trial Studies, Research and Innovation Management (RIM), Paracelsus Medical University, Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria
- Research Program Experimental Ophthalmology & Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Peter Koelblinger
- Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.
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Ranjbar S, Zakavi SR, Eisazadeh R, Mirshahvalad SA, Pilz J, Jamshidi-Araghi Z, Schweighofer-Zwink G, Koelblinger P, Pirich C, Beheshti M. Impact of [ 18F]FDG PET/CT in the Assessment of Immunotherapy-Induced Arterial Wall Inflammation in Melanoma Patients Receiving Immune Checkpoint Inhibitors. Diagnostics (Basel) 2023; 13:diagnostics13091617. [PMID: 37175008 PMCID: PMC10178249 DOI: 10.3390/diagnostics13091617] [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: 03/23/2023] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
We aimed to investigate the role of [18F]FDG positron emission tomography/computed tomography (PET/CT) in the early detection of arterial wall inflammation (AWI) in melanoma patients receiving immune checkpoint inhibitors (ICIs). Our retrospective study enrolled 95 melanoma patients who had received ICIs. Inclusion criteria were ICI therapy for at least six months and at least three [18F]FDG PET/CTs, including one pretreatment session plus two scans three and six months after treatment initiation. AWI was assessed using quantitative and qualitative methods in the subclavian artery, thoracic aorta, and abdominal aorta. We found three patients with AWI visual suspicion in the baseline scan, which increased to five in the second and twelve in the third session. Most of these patients' treatments were terminated due to either immune-related adverse events (irAEs) or disease progression. In the overall population, the ratio of arterial-wall maximum standardized uptake value (SUVmax)/liver-SUVmax was significantly higher three months after treatment than the pretreatment scan in the thoracic aorta (0.83 ± 0.12 vs. 0.79 ± 0.10; p-value = 0.01) and subclavian artery (0.67 ± 0.13 vs. 0.63 ± 0.12; p-value = 0.01), and it remained steady in the six-month follow-up. None of our patients were diagnosed with definite clinical vasculitis on the dermatology follow-up reports. To conclude, our study showed [18F]FDG PET/CT's potential to visualise immunotherapy-induced subclinical inflammation in large vessels. This may lead to more accurate prediction of irAEs and better patient management.
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Affiliation(s)
- Shaghayegh Ranjbar
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Seyed Rasoul Zakavi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Roya Eisazadeh
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Julia Pilz
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
- Department of Urology, Ordensklinikum Linz, 4020 Linz, Austria
| | - Zahra Jamshidi-Araghi
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Gregor Schweighofer-Zwink
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Peter Koelblinger
- Department of Dermatology, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Christian Pirich
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
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14
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Mirshahvalad SA, Seyedinia SS, Huemer F, Schweighofer-Zwink G, Koch O, Hitzl W, Weiss L, Emannuel K, Greil R, Pirich C, Beheshti M. Prognostic value of [ 18F]FDG PET/CT on treatment response and progression-free survival of gastroesophageal cancer patients undergoing perioperative FLOT chemotherapy. Eur J Radiol 2023; 163:110843. [PMID: 37119707 DOI: 10.1016/j.ejrad.2023.110843] [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: 11/25/2022] [Revised: 03/17/2023] [Accepted: 04/17/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE To evaluate the prognostic role of [18F]FDG PET/CT metabolic parameters in gastric cancer (GC) and gastroesophageal adenocarcinoma (GEJAC) patients receiving neoadjuvant chemotherapy. METHOD In this retrospective study, 31 patients with biopsy-proven GC or GEJAC were included between August 2016 and March 2020. [18F]FDG PET/CT was performed before the neoadjuvant chemotherapy. Primary tumours' semi-quantitative metabolic parameters were extracted. All patients received a perioperative FLOT regimen thereafter. Post-chemotherapy [18F]FDG PET/CT was performed in most patients (17/31). All patients underwent surgical resection. Histopathology response to treatment and progression-free survival (PFS) were evaluated. Two-sided p-values < 0.05 were considered statistically significant. RESULTS Thirty-one patients (mean age = 62 ± 8), including 21 GC and 10 GEJAC patients, were evaluated. 20/31(65%) patients were histopathology responders to neoadjuvant chemotherapy, including twelve complete and eight partial responders. During the median follow-up of 42.0 months, nine patients experienced recurrence. The median PFS was 60(95% CI:32.9-87.1) months. Pre-neoadjuvant chemotherapy SULpeak was significantly correlated with pathological response to treatment (p-value = 0.03;odds ratio = 16.75). In survival analysis, SUVmax (p-value = 0.01;hazard ratio[HR] = 1.55), SUVmean (p-value = 0.04;HR = 2.73), SULpeak (p-value < 0.001;HR = 1.91) and SULmean (p-value = 0.04;HR = 4.22) in the post-neoadjuvant chemotherapy pre-operative [18F]FDG PET/CT showed significant correlation with PFS. Additionally, aspects of staging were significantly correlated with PFS (p-value = 0.01;HR = 2.21). CONCLUSIONS Pre-neoadjuvant chemotherapy [18F]FDG PET/CT parameters, especially SULpeak, could predict the pathological response to treatment in GC and GEJAC patients. Additionally, in survival analysis, post-chemotherapy metabolic parameters significantly correlated with PFS. Thus, performing [18F]FDG PET/CT before chemotherapy may help to identify patients at risk for inadequate response to perioperative FLOT and, after chemotherapy, may predict clinical outcomes.
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Affiliation(s)
- Seyed Ali Mirshahvalad
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Seyedeh Sara Seyedinia
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Florian Huemer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology, and Rheumatology, Oncologic Center, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Gregor Schweighofer-Zwink
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Oliver Koch
- Department of Surgery, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Wolfgang Hitzl
- Biostatistics and Publication of Clinical Trial Studies, Research and Innovation Management (RIM), Paracelsus Medical University, 5020 Salzburg, Austria; Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Lukas Weiss
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology, and Rheumatology, Oncologic Center, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Klaus Emannuel
- Department of Surgery, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology, and Rheumatology, Oncologic Center, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Christian Pirich
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria.
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15
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Fendler WP, Eiber M, Beheshti M, Bomanji J, Calais J, Ceci F, Cho SY, Fanti S, Giesel FL, Goffin K, Haberkorn U, Jacene H, Koo PJ, Kopka K, Krause BJ, Lindenberg L, Marcus C, Mottaghy FM, Oprea-Lager DE, Osborne JR, Piert M, Rowe SP, Schöder H, Wan S, Wester HJ, Hope TA, Herrmann K. PSMA PET/CT: joint EANM procedure guideline/SNMMI procedure standard for prostate cancer imaging 2.0. Eur J Nucl Med Mol Imaging 2023; 50:1466-1486. [PMID: 36604326 PMCID: PMC10027805 DOI: 10.1007/s00259-022-06089-w] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [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: 10/30/2022] [Accepted: 12/18/2022] [Indexed: 01/07/2023]
Abstract
Here we aim to provide updated guidance and standards for the indication, acquisition, and interpretation of PSMA PET/CT for prostate cancer imaging. Procedures and characteristics are reported for a variety of available PSMA small radioligands. Different scenarios for the clinical use of PSMA-ligand PET/CT are discussed. This document provides clinicians and technicians with the best available evidence, to support the implementation of PSMA PET/CT imaging in research and routine practice.
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Affiliation(s)
- Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
- PET Committee of the German Society of Nuclear Medicine, Marburg, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Mohsen Beheshti
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, UCLH NHS Foundation Trust, London, UK
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, USA
| | - Francesco Ceci
- Division of Nuclear Medicine and Theranostics, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Steve Y Cho
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Frederik L Giesel
- Department of Nuclear Medicine, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University and Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Karolien Goffin
- Department of Nuclear Medicine, Division of Nuclear Medicine and Molecular Imaging, University Hospital Leuven, KU Leuven, Louvain, Belgium
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Heather Jacene
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, USA
| | | | - Klaus Kopka
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- School of Science, Faculty of Chemistry and Food Chemistry, Technical University Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, Dresden, Germany
| | - Bernd J Krause
- Department of Nuclear Medicine, University Medical Center, University of Rostock, Rostock, Germany
| | - Liza Lindenberg
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Charles Marcus
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH Aachen University, Aachen, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VU University Medical Center, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Joseph R Osborne
- Department of Radiology, Division of Molecular Imaging and Therapeutics, Weill Cornell Medicine, New York, NY, USA
| | - Morand Piert
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Michigan, Ann Arbor, MI, USA
| | - Steven P Rowe
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Heiko Schöder
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Simon Wan
- Institute of Nuclear Medicine, UCLH NHS Foundation Trust, London, UK
| | - Hans-Jürgen Wester
- Pharmaceutical Radiochemistry, Technische Universität München, Walther-Meißner-Str. 3, 85748, Garching, Germany
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
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Seyedinia SS, Mirshahvalad SA, Schweighofer-Zwink G, Hehenwarter L, Rendl G, Pirich C, Beheshti M. Evolving Role of [ 18F]Flurocholine PET/CT in Assessing Primary Hyperparathyroidism: Can It Be Considered the First-Line Functional Imaging Approach? J Clin Med 2023; 12:jcm12030812. [PMID: 36769460 PMCID: PMC9917644 DOI: 10.3390/jcm12030812] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/25/2022] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
The accurate detection of hyperfunctioning parathyroid tissue (HFPT) is pivotal in the preoperative assessment of primary hyperparathyroidism (PHPT). PET/CT using [18F]fluorocholine ([18F]FCH) showed superior diagnostic performance compared to conventional functional imaging modalities. We aimed to evaluate the diagnostic performance of [18F]FCH PET/CT as a first-line functional imaging approach in patients with clinically diagnosed PHPT. The imaging and clinical data of 321 PHPT patients, including 271 overt PHPT and 50 mild PHPT, who underwent [18F]FCH PET/CT as first-line imaging were analysed in this retrospective study. Histopathology was the reference standard. In case of no available histopathology evaluation (conservative management), imaging and clinical follow-ups were considered reference standards. In the overt group (n = 271), [18F]FCH PET/CT showed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 0.99, 0.91, 1.00, 0.80, and 0.99, respectively. Regarding the correlation of the index lesions and initial laboratory data, all [18F]FCH PET/CT parameters (SUVs, SULs, and mSAD) were significantly correlated with the serum iPTH level. Additionally, SUVmax, SULpeak, and mSAD were significantly associated with the serum calcium level. In the mild group (n = 50), [18F]FCH PET/CT showed a sensitivity, specificity, PPV, NPV, and accuracy of 0.93, 0.75, 0.95, 0.67, and 0.90. In conclusion, [18F]FCH PET/CT revealed high diagnostic performance in the detection of HFPTs and the potential to be considered as a first-line imaging modality in the assessment of PHPT, including both overt and mild types. However, its cost-benefit concerning the clinical impact of early PHPT detection should be investigated in future studies.
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Affiliation(s)
- Seyedeh Sara Seyedinia
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON M5G 2M2, Canada
| | - Gregor Schweighofer-Zwink
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Lukas Hehenwarter
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Gundula Rendl
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Christian Pirich
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +43-(0)5-7255-26602
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Huemer F, Hecht S, Scharinger B, Schlintl V, Rinnerthaler G, Schlick K, Heregger R, Melchardt T, Wimmer A, Mühlbacher I, Koch OO, Neureiter D, Klieser E, Seyedinia S, Beheshti M, Greil R, Weiss L. Body composition dynamics and impact on clinical outcome in gastric and gastro-esophageal junction cancer patients undergoing perioperative chemotherapy with the FLOT protocol. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04096-w. [PMID: 35864270 DOI: 10.1007/s00432-022-04096-w] [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: 04/03/2022] [Accepted: 05/27/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Perioperative chemotherapy with FLOT constitutes a standard of care approach for locally advanced, resectable gastric or gastro-esophageal junction (GEJ) cancer. We aimed at investigating anthropometric, CT-based and FDG-PET-based body composition parameters and dynamics during this multidisciplinary approach and the impact on clinical outcomes. METHODS This retrospective, single-center study was based on medical records and (FDG-PET)-CT images among gastric/GEJ cancer patients undergoing perioperative FLOT chemotherapy. RESULTS Between 2016 and 2021, 46 gastric/GEJ cancer patients started perioperative FLOT at our tertiary cancer center (Salzburg, Austria). At a median follow-up of 32 months median PFS was 47.4 months and median OS was not reached. The skeletal muscle index (SMI, cm2/m2) turned out to be the only body composition parameter with a statistically significant decrease during pre-operative FLOT (51.3 versus 48.8 cm2/m2, p = 0.02). Neither pre-FLOT body mass index (BMI), nor SMI had an impact on the duration of pre-operative FLOT, the time interval from pre-operative FLOT initiation to surgery, the necessity of pre-operative or post-operative FLOT de-escalation or the likelihood of the start of postoperative chemotherapy. Pre-FLOT BMI (overweight versus normal, HR: 0.11, 95% CI: 0.02-0.65, p = 0.02) and pre-FLOT SMI (sarcopenia versus no sarcopenia, HR: 5.08, 95% CI: 1.27-20.31, p = 0.02) were statistically significantly associated with PFS in the multivariable analysis. CONCLUSION The statistically significant SMI loss during pre-operative FLOT and the meaningful impact of baseline SMI and BMI on PFS argue for the implementation of a nutritional screening and support program prior to the initiation of pre-operative FLOT in clinical routine.
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Affiliation(s)
- Florian Huemer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Stefan Hecht
- Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Bernhard Scharinger
- Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Verena Schlintl
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Konstantin Schlick
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ronald Heregger
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Angela Wimmer
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Iris Mühlbacher
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Oliver Owen Koch
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Daniel Neureiter
- Cancer Cluster Salzburg, Salzburg, Austria
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Eckhard Klieser
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Sara Seyedinia
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Lukas Weiss
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria.
- Cancer Cluster Salzburg, Salzburg, Austria.
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Manafi-Farid R, Ataeinia B, Ranjbar S, Jamshidi Araghi Z, Moradi MM, Pirich C, Beheshti M. ImmunoPET: Antibody-Based PET Imaging in Solid Tumors. Front Med (Lausanne) 2022; 9:916693. [PMID: 35836956 PMCID: PMC9273828 DOI: 10.3389/fmed.2022.916693] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 04/09/2022] [Accepted: 05/24/2022] [Indexed: 12/13/2022] Open
Abstract
Immuno-positron emission tomography (immunoPET) is a molecular imaging modality combining the high sensitivity of PET with the specific targeting ability of monoclonal antibodies. Various radioimmunotracers have been successfully developed to target a broad spectrum of molecules expressed by malignant cells or tumor microenvironments. Only a few are translated into clinical studies and barely into clinical practices. Some drawbacks include slow radioimmunotracer kinetics, high physiologic uptake in lymphoid organs, and heterogeneous activity in tumoral lesions. Measures are taken to overcome the disadvantages, and new tracers are being developed. In this review, we aim to mention the fundamental components of immunoPET imaging, explore the groundbreaking success achieved using this new technique, and review different radioimmunotracers employed in various solid tumors to elaborate on this relatively new imaging modality.
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Affiliation(s)
- Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahar Ataeinia
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Shaghayegh Ranjbar
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Zahra Jamshidi Araghi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mobin Moradi
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- *Correspondence: Mohsen Beheshti ; orcid.org/0000-0003-3918-3812
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Manafi-Farid R, Askari E, Shiri I, Pirich C, Asadi M, Khateri M, Zaidi H, Beheshti M. [ 18F]FDG-PET/CT radiomics and artificial intelligence in lung cancer: Technical aspects and potential clinical applications. Semin Nucl Med 2022; 52:759-780. [PMID: 35717201 DOI: 10.1053/j.semnuclmed.2022.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 02/07/2023]
Abstract
Lung cancer is the second most common cancer and the leading cause of cancer-related death worldwide. Molecular imaging using [18F]fluorodeoxyglucose Positron Emission Tomography and/or Computed Tomography ([18F]FDG-PET/CT) plays an essential role in the diagnosis, evaluation of response to treatment, and prediction of outcomes. The images are evaluated using qualitative and conventional quantitative indices. However, there is far more information embedded in the images, which can be extracted by sophisticated algorithms. Recently, the concept of uncovering and analyzing the invisible data extracted from medical images, called radiomics, is gaining more attention. Currently, [18F]FDG-PET/CT radiomics is growingly evaluated in lung cancer to discover if it enhances the diagnostic performance or implication of [18F]FDG-PET/CT in the management of lung cancer. In this review, we provide a short overview of the technical aspects, as they are discussed in different articles of this special issue. We mainly focus on the diagnostic performance of the [18F]FDG-PET/CT-based radiomics and the role of artificial intelligence in non-small cell lung cancer, impacting the early detection, staging, prediction of tumor subtypes, biomarkers, and patient's outcomes.
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Affiliation(s)
- Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Emran Askari
- Department of Nuclear Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Isaac Shiri
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Mahboobeh Asadi
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maziar Khateri
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland; Geneva University Neurocenter, Geneva University, Geneva, Switzerland; Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
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van den Wyngaert T, de Schepper S, Elvas F, Seyedinia SS, Beheshti M. Positron emission tomography-magnetic resonance imaging as a research tool in musculoskeletal conditions. Q J Nucl Med Mol Imaging 2022; 66:15-30. [PMID: 35005878 DOI: 10.23736/s1824-4785.22.03434-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Compared to positron emission tomography/computed tomography (PET/CT), the uptake of PET- magnetic resonance imaging (MRI) has been slow, even more so in clinical practice compared to the (pre-)clinical research setting. However, for applications in musculoskeletal (MSK) research, the combination of PET and MRI into a single modality offers attractive advantages over other imaging modalities. Most importantly, MRI has exquisite soft-tissue detail without the use of contrast agents or ionizing radiation, superior bone marrow visualization, and an extensive spectrum of distinct multiparametric assessment methods. In the preclinical setting, the introduction of PET inserts for small-animal MRI machines has proven to be a successful concept in bringing this technology to the lab. Initial hurdles in quantification have been mainly overcome in this setting. In parallel, a promising range of radiochemistry techniques has been developed to create multimodality probes that offer the possibility of simultaneously querying different metabolic pathways. Not only will these applications help in elucidating disease mechanisms, but they can also facilitate drug development. The clinical applications of PET/MRI in MSK are still limited, but encouraging initial results with novel radiotracers suggest a high potential for use in various MSK conditions, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and inflammation and infection. Further innovations will be required to bring down the cost of PET/MRI to justify a broader clinical implementation, and remaining issues with quality control and standardization also need to be addressed. Nevertheless, PET/MRI is a powerful platform for MSK research with distinct qualities that are not offered by other techniques.
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Affiliation(s)
- Tim van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium -
- Faculty of Medicine and Health Sciences (MICA), University of Antwerp, Wilrijk, Belgium -
- Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium -
| | - Stijn de Schepper
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences (MICA), University of Antwerp, Wilrijk, Belgium
| | - Filipe Elvas
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences (MICA), University of Antwerp, Wilrijk, Belgium
| | - Seyedeh S Seyedinia
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
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Schweighofer-Zwink G, Manafi-Farid R, Kölblinger P, Hehenwarter L, Harsini S, Pirich C, Beheshti M. Prognostic value of 2-[ 18F]FDG PET-CT in metastatic melanoma patients receiving immunotherapy. Eur J Radiol 2021; 146:110107. [PMID: 34922117 DOI: 10.1016/j.ejrad.2021.110107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/10/2021] [Accepted: 12/08/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The 2-fluorodeoxyglucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT) is used for the evaluation of response to immunotherapy in malignant melanoma. Here, we evaluated the prognostic value of various metabolic parameters in baseline and different time points after therapy. METHODS In this retrospective study, 51 metastatic melanoma patients, who had received immunotherapy, were included. Patients with baseline and two follow-up 2-[18F]FDG PET/CT studies (3 and 6 months after therapy) were selected. Multiple metabolic parameters and tumor-to-background ratios (TBRs) were extracted and correlated with OS. RESULTS The 3- and 5-year OS rates were 49% and 43.1%, respectively. On baseline 2-[18F]FDG PET/CT, only standardized uptake value corrected for lean body mass (SULmax and SULpeak), as well as most of the TBRs were predictive for 3- and 5-year OS rates. Metabolic tumor volume (MTV), total lesion glycolysis (TLG), and most of the TBRs were predictive on both follow-up studies. Also, the changes in values of MTV, TLG and most of the TBRs from the baseline to the 3-month and 6- month follow-up studies were prognostic. On multivariate analysis, all of the most predictive parameters for OS were derived from the 3-month follow-up study. The ratio of TBRmean to the mediastinum was the best factor (cutoff value of 2.15, sensitivity of 88.5% and specificity of 68.0% for 3-year survival). CONCLUSION Metabolic parameters derived from 2-[18F]FDG PET/CT are valuable tools for the prediction of 3- and 5-year OS rates in metastatic melanoma patients undergoing immunotherapy. The 3-month follow-up 2-[18F]FDG PET/CT is of particular importance in this regard.
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Affiliation(s)
- Gregor Schweighofer-Zwink
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical sciences, 1411713135 Tehran, Iran
| | - Peter Kölblinger
- Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Lukas Hehenwarter
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Sara Harsini
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical sciences, 1411713135 Tehran, Iran; Association of Nuclear Medicine and Molecular Imaging (ANMMI), Universal Scientific Education and Research Network (USERN), 1419733151 Tehran, Iran
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria.
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22
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Radzikowski KC, Rendl G, Beheshti M, Pirich C. 18F Choline PET/CT in a patient with HRPT2 mutation: Detecting parathyroid carcinoma recurrence and concomitant breast carcinoma. Nuklearmedizin 2021; 61:62-64. [PMID: 34844271 DOI: 10.1055/a-1670-9315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Gundula Rendl
- Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mohsen Beheshti
- Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christian Pirich
- Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University Salzburg, Salzburg, Austria
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Manafi-Farid R, Ranjbar S, Jamshidi Araghi Z, Pilz J, Schweighofer-Zwink G, Pirich C, Beheshti M. Molecular Imaging in Primary Staging of Prostate Cancer Patients: Current Aspects and Future Trends. Cancers (Basel) 2021; 13:5360. [PMID: 34771523 PMCID: PMC8582501 DOI: 10.3390/cancers13215360] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/19/2022] Open
Abstract
Accurate primary staging is the cornerstone in all malignancies. Different morphological imaging modalities are employed in the evaluation of prostate cancer (PCa). Regardless of all developments in imaging, invasive histopathologic evaluation is still the standard method for the detection and staging of the primary PCa. Magnetic resonance imaging (MRI) and computed tomography (CT) play crucial roles; however, functional imaging provides additional valuable information, and it is gaining ever-growing acceptance in the management of PCa. Targeted imaging with different radiotracers has remarkably evolved in the past two decades. [111In]In-capromab pendetide scintigraphy was a new approach in the management of PCa. Afterwards, positron emission tomography (PET) tracers such as [11C/18F]choline and [11C]acetate were developed. Nevertheless, none found a role in the primary staging. By introduction of the highly sensitive small molecule prostate-specific membrane antigen (PSMA) PET/CT, as well as recent developments in MRI and hybrid PET/MRI systems, non-invasive staging of PCa is being contemplated. Several studies investigated the role of these sophisticated modalities in the primary staging of PCa, showing promising results. Here, we recapitulate the role of targeted functional imaging. We briefly mention the most popular radiotracers, their diagnostic accuracy in the primary staging of PCa, and impact on patient management.
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Affiliation(s)
- Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran 1411713135, Iran;
| | - Shaghayegh Ranjbar
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Zahra Jamshidi Araghi
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Julia Pilz
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Gregor Schweighofer-Zwink
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Christian Pirich
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Mohsen Beheshti
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
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24
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Szigeti F, Schweighofer-Zwink G, Meissnitzer M, Hauser-Kronberger C, Hitzl W, Kunit T, Forstner R, Pirich C, Beheshti M. Incremental Impact of [ 68 Ga]Ga-PSMA-11 PET/CT in Primary N and M Staging of Prostate Cancer Prior to Curative-Intent Surgery: a Prospective Clinical Trial in Comparison with mpMRI. Mol Imaging Biol 2021; 24:50-59. [PMID: 34519966 PMCID: PMC8760214 DOI: 10.1007/s11307-021-01650-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/29/2021] [Accepted: 09/01/2021] [Indexed: 01/21/2023]
Abstract
Purpose The main objective of this prospective study was to assess the value of gallium-68 prostate-specific membrane antigen ([68 Ga]Ga-PSMA-11) positron emission tomography/computed tomography (PET/CT) in primary N and M staging of intermediate- and high-risk prostate cancer (PCa) patients before planned curative-intent radical prostatectomy (RPE) and extended pelvic lymph node dissection (ePLND). The second objective was to compare the [68 Ga]Ga-PSMA-11 PET/CT findings with standard of care pelvic multi-parametric magnetic resonance imaging (mpMRI) in the detection of locoregional lymph node metastases and intraprostatic prostate cancer. Procedures A total of 81 patients (mean age: 64.5 years, baseline mean trigger PSA (tPSA) 15.4 ng/ml, ± 15.9) with biopsy proven PCa (24 intermediate- and 57 high risk) scheduled for RPE and ePLND were enrolled in this prospective study. In 52 patients [68 Ga]Ga-PSMA-11 PET/CT, pelvic mpMRI, and RPE with ePLND have been performed. Clinical risk stratification and related biomarkers as well as Gleason score (GS) were recorded. The location of the index lesion (IL) was documented systematically for each modality using a standardized segmentation of the prostate in six segments. Distant bone and lymph node metastasis detected by [68 Ga]Ga-PSMA-11 PET/CT were documented. [68 Ga]Ga-PSMA-11 PET/CT findings were correlated with results of mpMRI and histopathology. A consensus of imaging, clinical and/or follow-up findings were used for determining the distant metastases, which were not verified by histopathology. Results In the patient cohort who underwent RPE, [68 Ga]Ga-PSMA-11 PET/CT and mpMRI detected the IL in 86.5% and 98.1% of the patients, respectively. The median of the maximum standardized uptake value (SUVmax) in the intraprostatic IL was 12 (range, 4.7–67.8). Intraprostatic IL of the high-risk patients showed significantly higher SUVmax than those in patients with intermediate risk for distant metastases (n = 48; median: 17.84 vs. 8.77; p = 0.02). In total 729 LN were removed by ePLND in 48 patients. The histopathology verified 26 pelvic lymph node metastases (pLNM) in 20.8% (10/48) of the patients, which have been correctly identified in 60% of the patients on [68 Ga]Ga-PSMA-11 PET/CT, and in 50% on mpMRI. All but one pLNM had a maximum diameter below 10 mm. Bone metastases (BM) and distant LNM (dLNM) were found in 17.3% of the patients on [68 Ga]Ga-PSMA-11 PET/CT imaging. 39.0% of the [68 Ga]Ga-PSMA-11 PET-positive BM showed no suspicious morphological correlation on CT. Conclusion [68 Ga]Ga-PSMA-11 PET/CT shows high diagnostic performance for N and M staging of patients with intermediate- and high-risk prostate cancer and seems to be superior to pelvic mpMRI in the detection of locoregional lymph node metastases. A significant correlation was found between SUVmax of the intraprostatic index lesion and risk stratification based on tPSA level and GS. The results of this study emphasize again on the role of metabolic molecular imaging using specific tracers in selected patients, leading to tailored therapy approach. Supplementary Information The online version contains supplementary material available at 10.1007/s11307-021-01650-9.
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Affiliation(s)
- Florian Szigeti
- Salzburg University of Applied Sciences, Radiation Technology Degree Program, Salzburg, Austria
| | - Gregor Schweighofer-Zwink
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine and Endocrinology, University Hospital, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Matthias Meissnitzer
- Department of Radiology, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | | | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University, 5020, Salzburg, Austria.,Department of Ophthalmology and Optometry, University Hospital, Paracelsus Medical University, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, 5020, Salzburg, Austria
| | - Thomas Kunit
- Department of Urology and Andrology, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Rosemarie Forstner
- Department of Radiology, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine and Endocrinology, University Hospital, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine and Endocrinology, University Hospital, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
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Araghi ZJ, Ranjbar S, Paar M, Pirich C, Beheshti M. Accurate detection of intracranial extension of jugulotympanic paraganglioma by [ 18F]FDOPA-PET/CT comparing to MRI. Eur J Nucl Med Mol Imaging 2021; 49:412-414. [PMID: 34378065 PMCID: PMC8712304 DOI: 10.1007/s00259-021-05490-1] [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] [Received: 06/17/2021] [Accepted: 07/03/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Zahra Jamshidi Araghi
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Shaghayegh Ranjbar
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Michael Paar
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.
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Pilz J, Hehenwarter L, Zimmermann G, Rendl G, Schweighofer-Zwink G, Beheshti M, Pirich C. Feasibility of equivalent performance of 3D TOF [ 18F]-FDG PET/CT with reduced acquisition time using clinical and semiquantitative parameters. EJNMMI Res 2021; 11:44. [PMID: 33934218 PMCID: PMC8088415 DOI: 10.1186/s13550-021-00784-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background High-performance time-of-flight (TOF) positron emission tomography (PET) systems have the capability for rapid data acquisition while preserving diagnostic image quality. However, determining a reliable and clinically applicable cut-off of the acquisition time plays an important role in routine practice. This study aimed to assess the diagnostic equivalence of short acquisition time of 57 with routine 75 seconds per bed position (s/BP) of [18F]-fluoro-deoxy-glucose (FDG) PET. Phantom studies applying EARL criteria suggested the feasibility of shortened acquisition time in routine clinical imaging by 3D TOF PET/CT scanners. Ninety-six patients with melanoma, lung or head and neck cancer underwent a standard whole-body, skull base-to-thigh or vertex-to-thigh [18F]-FDG PET/CT examination using the 3D TOF Ingenuity TF PET/CT system (Philips, Cleveland, OH). The [18F]-FDG activity applied was equal to 4MBq per kg body weight. Retrospectively, PET list-mode data were used to calculate a second PET study per patient with a reduced acquisition time of 57 s instead of routine 75 s/BP. PET/CT data were reconstructed using a 3D OSEM TOF algorithm. Blinded patient data were analysed by two nuclear medicine physicians. The number of [18F]-FDG-avid lesions per body region (head&neck, thorax, abdomen, bone, extremity) and image quality (grade 1–5) were evaluated. Semiquantitative analyses were performed by standardized uptake value (SUV) measurements using 3D volume of interests (VOI). The visual and semiquantitative diagnostic equivalence of 214 [18F]-FDG-avid lesions were analysed in the routine standard (75 s/BP) as well as the calculated PET/CT studies with short acquisition time. Statistical analyses were performed by equivalence testing and Bland–Altman plots. Results Lesion detection rate per patient’s body region agreed in > 98% comparing 57 s/BP and 75 s/BP datasets. Overall image quality was determined as equal or superior to 75 s in 80% and 69%, respectively. In the semiquantitative lesion-based analyses, a significant equivalence was found between the 75 s/BP and 57 s/BP PET/CT images both for SUVmax (p = 0.004) and SUVmean (p = 0.003). Conclusion The results of this study demonstrate significant clinical and semiquantitative equivalence between short acquisition time of 57 s/BP and standard 75 s/BP 3D TOF [18F]-FDG PET/CT scanning, which may improve the patient’s workflow in routine practice.
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Affiliation(s)
- Julia Pilz
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Hehenwarter
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Gundula Rendl
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Gregor Schweighofer-Zwink
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Mohsen Beheshti
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Christian Pirich
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
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Beheshti M, Mottaghy FM. Special Issue: Emerging Technologies for Medical Imaging Diagnostics, Monitoring and Therapy of Cancers. J Clin Med 2021; 10:jcm10061327. [PMID: 33806986 PMCID: PMC8005165 DOI: 10.3390/jcm10061327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/20/2021] [Indexed: 11/16/2022] Open
Abstract
Molecular imaging and therapy play an increasingly important role in the field of "precision medicine" as an emergent prospect for management of the cancerous disease [...].
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Affiliation(s)
- Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +43-(0)5-7255-26602; Fax: +43-(0)5-7255-26699
| | - Felix M. Mottaghy
- Department of Nuclear Medicine, University Hospital, RWTH University, 52074 Aachen, Germany;
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, 6229 Maastricht, The Netherlands
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Manafi-Farid R, Harsini S, Saidi B, Ahmadzadehfar H, Herrmann K, Briganti A, Walz J, Beheshti M. Factors predicting biochemical response and survival benefits following radioligand therapy with [ 177Lu]Lu-PSMA in metastatic castrate-resistant prostate cancer: a review. Eur J Nucl Med Mol Imaging 2021; 48:4028-4041. [PMID: 33677734 PMCID: PMC8484081 DOI: 10.1007/s00259-021-05237-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/16/2020] [Accepted: 02/01/2021] [Indexed: 12/21/2022]
Abstract
Background Prostate cancer (PC) is one of the most common cancers in men. Although the overall prognosis is favorable, the management of metastatic castration-resistant prostate cancer (mCRPC) patients is challenging. Usually, mCRPC patients with progressive disease are considered for radioligand therapy (RLT) after exhaustion of other standard treatments. The prostate-specific membrane antigen (PSMA) labeled with Lutetium-177 ([177Lu]Lu-PSMA) has been widely used, showing favorable and successful results in reducing prostate-specific antigen (PSA) levels, increasing quality of life, and decreasing pain, in a multitude of studies. Nevertheless, approximately thirty percent of patients do not respond to [177Lu]Lu-PSMA RLT. Here, we only reviewed and reported the evaluated factors and their impact on survival or biochemical response to treatment to have an overview of the potentialprognostic parameters in [177Lu]Lu-PSMA RLT. Methods Studies were retrieved by searching MEDLINE/PubMed and GoogleScholar. The search keywords were as follows: {(“177Lu-PSMA”) AND (“radioligand”) AND (“prognosis”) OR (“predict”)}. Studies discussing one or more factors which may be prognostic or predictive of response to [177Lu]Lu-PSMA RLT, that is PSA response and survival parameters, were included. Results Several demographic, histological, biochemical, and imaging factors have been assessed as predictive parameters for the response to thistreatment; however, the evaluated factors were diverse, and the results mostly were divergent, except for the PSA level reduction after treatment, which unanimously predicted prolonged survival. Conclusion Several studies have investigated a multitude of factors to detect those predicting response to [177Lu]Lu-PSMA RLT. The results wereinconsistent regarding some factors, and some were evaluated in only a few studies. Future prospective randomized trials are required to detect theindependent prognostic factors, and to further determine the clinical and survival benefits of [177Lu]Lu-PSMA RLT.
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Affiliation(s)
- Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Tehran University of Medical sciences, Tehran, Iran
| | - Sara Harsini
- Research Center for Nuclear Medicine, Tehran University of Medical sciences, Tehran, Iran.,Association of Nuclear Medicine and Molecular Imaging (ANMMI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Bahare Saidi
- Research Center for Nuclear Medicine, Tehran University of Medical sciences, Tehran, Iran
| | | | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital, Essen, Germany
| | - Alberto Briganti
- Urological Research Institute, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Jochen Walz
- Department of Urology, Institute Paoli-Calmettes Cancer Centre, Marseille, France
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University, Salzburg, Austria. .,Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany.
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Mottaghy FM, Hertel F, Beheshti M. Will we successfully avoid the garbage in garbage out problem in imaging data mining? An overview on current concepts and future directions in molecular imaging. Methods 2021; 188:1-3. [PMID: 33592236 DOI: 10.1016/j.ymeth.2021.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- F M Mottaghy
- Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany; Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Germany; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands.
| | - F Hertel
- Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany
| | - M Beheshti
- Division of Molecular Imaging and Theranostics, University Hospital, Paracelsus Medical University, Salzburg, Austria
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Altunay B, Morgenroth A, Beheshti M, Vogg A, Wong NCL, Ting HH, Biersack HJ, Stickeler E, Mottaghy FM. HER2-directed antibodies, affibodies and nanobodies as drug-delivery vehicles in breast cancer with a specific focus on radioimmunotherapy and radioimmunoimaging. Eur J Nucl Med Mol Imaging 2020; 48:1371-1389. [PMID: 33179151 PMCID: PMC8113197 DOI: 10.1007/s00259-020-05094-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [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: 08/26/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of the present paper is to review the role of HER2 antibodies, affibodies and nanobodies as vehicles for imaging and therapy approaches in breast cancer, including a detailed look at recent clinical data from antibody drug conjugates and nanobodies as well as affibodies that are currently under development. RESULTS Clinical and preclinical studies have shown that the use of monoclonal antibodies in molecular imaging is impaired by slow blood clearance, associated with slow and low tumor uptake and with limited tumor penetration potential. Antibody fragments, such as nanobodies, on the other hand, can be radiolabelled with short-lived radioisotopes and provide high-contrast images within a few hours after injection, allowing early diagnosis and reduced radiation exposure of patients. Even in therapy, the small radioactively labeled nanobodies prove to be superior to radioactively labeled monoclonal antibodies due to their higher specificity and their ability to penetrate the tumor. CONCLUSION While monoclonal antibodies are well established drug delivery vehicles, the current literature on molecular imaging supports the notion that antibody fragments, such as affibodies or nanobodies, might be superior in this approach.
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Affiliation(s)
- Betül Altunay
- Department of Nuclear Medicine, University Hospital Aachen, RWTH Aachen University, 52074, Aachen, Germany
| | - Agnieszka Morgenroth
- Department of Nuclear Medicine, University Hospital Aachen, RWTH Aachen University, 52074, Aachen, Germany
| | - Mohsen Beheshti
- Department of Nuclear Medicine, University Hospital Aachen, RWTH Aachen University, 52074, Aachen, Germany.,Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Düsseldorf, Kerpener Str. 62, 50937, Cologne, Germany.,Division of Molecular PET-Imaging and Theranostics , Paracelsus Medical University , Salzburg, 5020, Austria
| | - Andreas Vogg
- Department of Nuclear Medicine, University Hospital Aachen, RWTH Aachen University, 52074, Aachen, Germany
| | | | - Hong Hoi Ting
- Nanomab Technology Limited, Shanghai, People's Republic of China
| | | | - Elmar Stickeler
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Düsseldorf, Kerpener Str. 62, 50937, Cologne, Germany.,Department of Gynecology and Obstetrics, RWTH Aachen, Aachen, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital Aachen, RWTH Aachen University, 52074, Aachen, Germany. .,Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Düsseldorf, Kerpener Str. 62, 50937, Cologne, Germany. .,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), 6202, Maastricht, The Netherlands.
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Heesch A, Maurer J, Stickeler E, Beheshti M, Mottaghy FM, Morgenroth A. Development of Radiotracers for Breast Cancer-The Tumor Microenvironment as an Emerging Target. Cells 2020; 9:cells9102334. [PMID: 33096754 PMCID: PMC7590199 DOI: 10.3390/cells9102334] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 12/17/2022] Open
Abstract
Molecular imaging plays an increasingly important role in the diagnosis and treatment of different malignancies. Radiolabeled probes enable the visualization of the primary tumor as well as the metastases and have been also employed in targeted therapy and theranostic approaches. With breast cancer being the most common malignancy in women worldwide it is of special interest to develop novel targeted treatments. However, tumor microenvironment and escape mechanisms often limit their therapeutic potential. Addressing tumor stroma associated targets provides a promising option to inhibit tumor growth and angiogenesis and to disrupt tumor tissue architecture. This review describes recent developments on radiolabeled probes used in diagnosis and treatment of breast cancer especially in triple negative type with the focus on potential targets offered by the tumor microenvironment, like tumor associated macrophages, cancer associated fibroblasts, and endothelial cells.
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Affiliation(s)
- Amelie Heesch
- Department of Nuclear Medicine, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany; (A.H.); (M.B.); (F.M.M.)
| | - Jochen Maurer
- Department of Obstetrics and Gynecology, University Hospital Aachen (UKA), 52074 Aachen, Germany; (J.M.); (E.S.)
| | - Elmar Stickeler
- Department of Obstetrics and Gynecology, University Hospital Aachen (UKA), 52074 Aachen, Germany; (J.M.); (E.S.)
| | - Mohsen Beheshti
- Department of Nuclear Medicine, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany; (A.H.); (M.B.); (F.M.M.)
- Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Felix M. Mottaghy
- Department of Nuclear Medicine, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany; (A.H.); (M.B.); (F.M.M.)
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), 6202 Maastricht, The Netherlands
| | - Agnieszka Morgenroth
- Department of Nuclear Medicine, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany; (A.H.); (M.B.); (F.M.M.)
- Correspondence:
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Cucca A, Mania D, Sharma K, Acosta I, Berberian M, Beheshti M, Biagioni M, Droby A, Di Rocco A, Ghilardi M, Inglese M, Rizzo J, Feigin A. Neural correlates of visuospatial dysfunction in Parkinson's Disease: A multimodal biomarker study. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.163] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Beheshti M, Manafi-Farid R, Geinitz H, Vali R, Loidl W, Mottaghy FM, Langsteger W. Multiphasic 68Ga-PSMA PET/CT in the Detection of Early Recurrence in Prostate Cancer Patients with a PSA Level of Less Than 1 ng/mL: A Prospective Study of 135 Patients. J Nucl Med 2020. [PMID: 32060214 DOI: 10.3969/j.issn.2095-4344.2248] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The main objective of this prospective study was to determine the impact of multiphasic acquisition of 68Ga-PSMA PET/CT in the detection of recurrent prostate cancer in the early stage of biochemical recurrence with a prostate-specific antigen (PSA) level of less than 1 ng/mL. Also, 68Ga-PSMA PET/CT positivity was correlated with clinical parameters for the assessment of predictive markers. Methods: A prospective monocentric study was conducted on 135 prostate cancer patients with biochemical recurrence and a PSA level of less than 1 ng/mL. All patients had undergone initial prostatectomy, with additional radiation therapy in 19.3% of patients and androgen-deprivation therapy in 7.4%. The patients underwent dynamic acquisitions from the prostate bed (1-8 min after injection), standard whole-body acquisitions (60 min after injection), and limited-bed-position delayed acquisitions (120-150 min after injection). The studies were reviewed by 2 board-certified nuclear medicine specialists, independently. A combination of visual and semiquantitative analyses and correlation with morphologic (e.g., MRI) or clinical follow-up findings was used for the final interpretation of lesions as benign or malignant. 68Ga-prostate-specific membrane antigen (PSMA) PET/CT positivity was also correlated with primary clinical findings. Results: Incorporating the information from all phases, we were able to detect 116 lesions in 49.6% of patients (22 local recurrences, 63 lymph nodes, and 31 distant metastases). The detection rates were 31.8%, 44.9%, and 71.4% for PSA < 0.2 ng/mL, 0.2 ≤ PSA < 0.5, and 0.5 ≤ PSA < 1, respectively. Additional dynamic or delayed phases resulted in better determination of equivocal lesions and a higher diagnostic performance in 25.9% of patients. Stand-alone dynamic and delayed images led to better interpretation of equivocal findings in the prostate bed (31.4%) and in other lesions (lymph node or bone) (20%), respectively. Conclusion:68Ga-PSMA PET/CT showed promise for early detection of recurrent disease in patients with a PSA level of 0.5-1.0 ng/mL. However, it showed limited value in patients with a PSA level of less than 0.5 ng/mL. Multiphasic 68Ga-PSMA PET/CT led to a better determination of equivocal findings. Although dynamic images may provide helpful information for assessment of the prostate bed, delayed acquisitions seem to have a greater impact in clarifying equivocal findings.
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Affiliation(s)
- Mohsen Beheshti
- Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany .,Department of Nuclear Medicine, Paracelsus Medical University, Salzburg, Austria.,Department of Nuclear Medicine and Endocrinology, PET-CT Center Linz, St. Vincent's Hospital, Linz, Austria
| | - Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hans Geinitz
- Department of Radiation-Oncology, St. Vincent's Hospital, Linz, Austria
| | - Reza Vali
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Wolfgang Loidl
- Department of Urology, St. Vincent's Hospital, Linz, Austria; and
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Werner Langsteger
- Department of Nuclear Medicine and Endocrinology, PET-CT Center Linz, St. Vincent's Hospital, Linz, Austria
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Mueller M, Heinzel A, Beheshti M. Intraspinales Meningeom als Differenzialdiagnose einer fokalen 2-[18F]FDG-Mehranreicherung. ROFO-FORTSCHR RONTG 2020; 193:198-200. [PMID: 32643770 DOI: 10.1055/a-1203-0800] [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: 10/23/2022]
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Wagner MW, Bilbily A, Beheshti M, Shammas A, Vali R. Artificial intelligence and radiomics in pediatric molecular imaging. Methods 2020; 188:37-43. [PMID: 32544594 DOI: 10.1016/j.ymeth.2020.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/02/2020] [Accepted: 06/10/2020] [Indexed: 12/22/2022] Open
Abstract
In the past decade, a new approach for quantitative analysis of medical images and prognostic modelling has emerged. Defined as the extraction and analysis of a large number of quantitative parameters from medical images, radiomics is an evolving field in precision medicine with the ultimate goal of the discovery of new imaging biomarkers for disease. Radiomics has already shown promising results in extracting diagnostic, prognostic, and molecular information latent in medical images. After acquisition of the medical images as part of the standard of care, a region of interest is defined often via a manual or semi-automatic approach. An algorithm then extracts and computes quantitative radiomics parameters from the region of interest. Whereas radiomics captures quantitative values of shape and texture based on predefined mathematical terms, neural networks have recently been used to directly learn and identify predictive features from medical images. Thereby, neural networks largely forego the need for so called "hand-engineered" features, which appears to result in significantly improved performance and reliability. Opportunities for radiomics and neural networks in pediatric nuclear medicine/radiology/molecular imaging are broad and can be thought of in three categories: automating well-defined administrative or clinical tasks, augmenting broader administrative or clinical tasks, and unlocking new methods of generating value. Specific applications include intelligent order sets, automated protocoling, improved image acquisition, computer aided triage and detection of abnormalities, next generation voice dictation systems, biomarker development, and therapy planning.
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Affiliation(s)
- Matthias W Wagner
- Department of Diagnostic Imaging, Division of Neuroradiology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Alexander Bilbily
- Department of Diagnostic Imaging, Division of Nuclear Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Mohsen Beheshti
- Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany; Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University, Salzburg, Austria
| | - Amer Shammas
- Department of Diagnostic Imaging, Division of Nuclear Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Reza Vali
- Department of Diagnostic Imaging, Division of Nuclear Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
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Schwerz S, Mueller M, Lindemann-Docter K, Heinzel A, Mottaghy FM, Beheshti M. Hepatic candidiasis mimicking lymphoma on 18F-FDG PET/CT in a patient with T cell lymphoma. Eur J Nucl Med Mol Imaging 2020; 47:2925-2926. [PMID: 32337632 PMCID: PMC7567715 DOI: 10.1007/s00259-020-04824-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 12/05/2022]
Affiliation(s)
- Sandra Schwerz
- Department of Nuclear Medicine, University Hospital, RWTH University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Marguerite Mueller
- Department of Nuclear Medicine, University Hospital, RWTH University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | | | - Alexander Heinzel
- Department of Nuclear Medicine, University Hospital, RWTH University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital, RWTH University, Pauwelsstrasse 30, 52074, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Mohsen Beheshti
- Department of Nuclear Medicine, University Hospital, RWTH University, Pauwelsstrasse 30, 52074, Aachen, Germany. .,Department of Nuclear Medicine, Paracelsus Medical University, Salzburg, Austria.
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Beheshti M, Manafi-Farid R, Geinitz H, Vali R, Loidl W, Mottaghy FM, Langsteger W. Multiphasic 68Ga-PSMA PET/CT in the Detection of Early Recurrence in Prostate Cancer Patients with a PSA Level of Less Than 1 ng/mL: A Prospective Study of 135 Patients. J Nucl Med 2020; 61:1484-1490. [PMID: 32060214 DOI: 10.2967/jnumed.119.238071] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 10/11/2019] [Accepted: 02/06/2020] [Indexed: 01/27/2023] Open
Abstract
The main objective of this prospective study was to determine the impact of multiphasic acquisition of 68Ga-PSMA PET/CT in the detection of recurrent prostate cancer in the early stage of biochemical recurrence with a prostate-specific antigen (PSA) level of less than 1 ng/mL. Also, 68Ga-PSMA PET/CT positivity was correlated with clinical parameters for the assessment of predictive markers. Methods: A prospective monocentric study was conducted on 135 prostate cancer patients with biochemical recurrence and a PSA level of less than 1 ng/mL. All patients had undergone initial prostatectomy, with additional radiation therapy in 19.3% of patients and androgen-deprivation therapy in 7.4%. The patients underwent dynamic acquisitions from the prostate bed (1-8 min after injection), standard whole-body acquisitions (60 min after injection), and limited-bed-position delayed acquisitions (120-150 min after injection). The studies were reviewed by 2 board-certified nuclear medicine specialists, independently. A combination of visual and semiquantitative analyses and correlation with morphologic (e.g., MRI) or clinical follow-up findings was used for the final interpretation of lesions as benign or malignant. 68Ga-prostate-specific membrane antigen (PSMA) PET/CT positivity was also correlated with primary clinical findings. Results: Incorporating the information from all phases, we were able to detect 116 lesions in 49.6% of patients (22 local recurrences, 63 lymph nodes, and 31 distant metastases). The detection rates were 31.8%, 44.9%, and 71.4% for PSA < 0.2 ng/mL, 0.2 ≤ PSA < 0.5, and 0.5 ≤ PSA < 1, respectively. Additional dynamic or delayed phases resulted in better determination of equivocal lesions and a higher diagnostic performance in 25.9% of patients. Stand-alone dynamic and delayed images led to better interpretation of equivocal findings in the prostate bed (31.4%) and in other lesions (lymph node or bone) (20%), respectively. Conclusion: 68Ga-PSMA PET/CT showed promise for early detection of recurrent disease in patients with a PSA level of 0.5-1.0 ng/mL. However, it showed limited value in patients with a PSA level of less than 0.5 ng/mL. Multiphasic 68Ga-PSMA PET/CT led to a better determination of equivocal findings. Although dynamic images may provide helpful information for assessment of the prostate bed, delayed acquisitions seem to have a greater impact in clarifying equivocal findings.
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Affiliation(s)
- Mohsen Beheshti
- Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany .,Department of Nuclear Medicine, Paracelsus Medical University, Salzburg, Austria.,Department of Nuclear Medicine and Endocrinology, PET-CT Center Linz, St. Vincent's Hospital, Linz, Austria
| | - Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hans Geinitz
- Department of Radiation-Oncology, St. Vincent's Hospital, Linz, Austria
| | - Reza Vali
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Wolfgang Loidl
- Department of Urology, St. Vincent's Hospital, Linz, Austria; and
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Werner Langsteger
- Department of Nuclear Medicine and Endocrinology, PET-CT Center Linz, St. Vincent's Hospital, Linz, Austria
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Loberg C, Mallek D, Mottaghy FM, Beheshti M, Heinzel A. Female Patient with Simultaneous Occurrence of Subacute Thyroiditis and Focal Autonomy. Nuklearmedizin 2019; 58:401-402. [DOI: 10.1055/a-0981-5675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Clinical presentationA 57-year-old female patient presented at the emergency department with fatigue, increased sweating, flushing symptoms, loss of appetite, drowsiness and severe diarrhea. Besides she also mentioned painful left-sided sore throat radiating to the temples, beginning two weeks after a flu and subfebrile temperatures.
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Ibrahim A, Vallières M, Woodruff H, Primakov S, Beheshti M, Keek S, Refaee T, Sanduleanu S, Walsh S, Morin O, Lambin P, Hustinx R, Mottaghy FM. Radiomics Analysis for Clinical Decision Support in Nuclear Medicine. Semin Nucl Med 2019; 49:438-449. [DOI: 10.1053/j.semnuclmed.2019.06.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Ataeinia B, Loberg C, Kravets H, Beheshti M, von Mallek D, Mottaghy FM, Heinzel A. Successful palliative peptide receptor radionuclide therapy for impending compression of vena cava due to unresectable liver metastasis of neuroendocrine tumor. EXCLI J 2019; 18:273-276. [PMID: 31338000 PMCID: PMC6635723 DOI: 10.17179/excli2019-1220] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/25/2019] [Indexed: 11/10/2022]
Abstract
We present the case of a 77 year old male patient with metastatic pancreatic neuroendocrine tumor (NET). The patient was initially treated by extensive surgical resection that however, led to severe complications with delayed recovery. During follow-up, a number of new liver metastases were detected, one of which was in segment I with impending compression of the inferior vena cava. Due to age and general condition of the patient, instead of further surgical treatment, the patient received four cycles of 177Lu-DOTATOC resulting in an overall partial response with successful tumor reduction in liver segment I, resolving an impending compression of vena cava.
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Affiliation(s)
- Bahar Ataeinia
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Christina Loberg
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Hanna Kravets
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Mohsen Beheshti
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Dirk von Mallek
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alexander Heinzel
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
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Karamzade-Ziarati N, Manafi-Farid R, Ataeinia B, Langsteger W, Pirich C, Mottaghy FM, Beheshti M. Molecular imaging of bone metastases using tumor-targeted tracers. Q J Nucl Med Mol Imaging 2019; 63:136-149. [PMID: 31315347 DOI: 10.23736/s1824-4785.19.03206-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bone metastasis is a disastrous manifestation of most malignancies, especially in breast, prostate and lung cancers. Since asymptomatic bone metastases are not uncommon, early detection, precise assessment, and localization of them are very important. Various imaging modalities have been employed in the setting of diagnosis of bone metastasis, from plain radiography and bone scintigraphy to SPECT, SPECT/CT, PET/CT, MRI. However, each modality showed its own limitation providing accurate diagnostic performance. In this regard, various tumor-targeted radiotracers have been introduced for molecular imaging of bone metastases using modern hybrid modalities. In this article we review the strength of different cancer-specific radiopharmaceuticals in the detection of bone metastases. As shown in the literature, among various tumor-targeted tracers, 68Ga DOTA-conjugated-peptides, 68Ga PSMA, 18F DOPA, 18F galacto-RGD integrin, 18F FDG, 11C/18F acetate, 11C/18F choline, 111In octreotide, 123/131I MIBG, 99mTc MIBI, and 201Tl have acceptable capabilities in detecting bone metastases depending on the cancer type. However, different study designs and gold standards among reviewed articles should be taken into consideration.
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Affiliation(s)
- Najme Karamzade-Ziarati
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahar Ataeinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Werner Langsteger
- PET-CT Center Linz, Department of Nuclear Medicine, Ordensklinikum, St. Vincent's Hospital, Linz, Austria
| | - Christian Pirich
- Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University, Salzburg, Austria
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Mohsen Beheshti
- Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University, Salzburg, Austria - .,Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany
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Hochreiter J, Mattiassich G, Hitzl W, Weber G, Beheshti M, Ortmaier R. Quantitative in vivo assessment of bone allograft viability using 18F-fluoride PET/CT after glenoid augmentation in reverse shoulder arthroplasty: a pilot study. Eur J Orthop Surg Traumatol 2019; 29:1399-1404. [PMID: 31172286 DOI: 10.1007/s00590-019-02463-x] [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] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Success after glenoid bone augmentation in total shoulder arthroplasty depends on osseous integration and non-resorption. Standard imaging techniques, such as computed tomography (CT) and X-rays, cannot quantify bone viability. Therefore, we introduce a new technique to assess graft viability using 18F-sodium fluoride (18F-NaF) PET-CT for femoral allografts in reverse total shoulder arthroplasty (RSA). MATERIALS AND METHODS Patient charts were reviewed following glenoid augmentation using femoral allografts in reverse total shoulder arthroplasty. A total of seven patients were included in this study. 18F-NaF PET-CT was used to assess graft viability and graft fusion. Semiquantitative assessment of 18F-NaF uptake was performed by means of a standardized uptake value (SUV). Radiographs were used to assess fusion. The mean age of the patients at the time of follow-up was 83.4 years (range 79-92), and the mean follow-up was 44.4 months. RESULTS Viability and fusion were confirmed in all allografts using semiquantitative analysis of 18F-NaF PET-CT by means of standardized uptake value (SUVmax). Metabolic activity of medullary region of a vertebral spine was defined as a reference background. The mean value of maximum tracer activity in the allograft was not statistically different from native bone in the reference vertebrae (p = 0.14). CONCLUSIONS 18F-NaF PET-CT is a practicable tool to quantitatively assess viability in large bone allografts after glenoid augmentation in RSA. The study shows viability and fusion in all allografts. LEVEL OF EVIDENCE Level IV, treatment study.
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Affiliation(s)
- Josef Hochreiter
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria
| | - Georg Mattiassich
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria
| | - Wolfgang Hitzl
- Department of Biostatistics, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Georg Weber
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria
| | - Mohsen Beheshti
- Department of Nuclear Medicine, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe, Seilerstätte 4, 4020, Linz, Austria
| | - Reinhold Ortmaier
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria. .,Research Unit for Orthopedic Sports Medicine and Injury Prevention, ISAG/UMIT, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria.
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Beheshti M, Heinzel A, von Mallek D, Filss C, Mottaghy FM. Prostate-specific membrane antigen radioligand therapy of prostate cancer. Q J Nucl Med Mol Imaging 2019; 63:29-36. [PMID: 30644306 DOI: 10.23736/s1824-4785.19.03155-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Defining an optimal therapeutic approach in metastatic castration-resistance prostate cancer (mCRPC) patients in advanced stages is still challenging in routine clinical practice. Prostate-specific membrane antigen (PSMA) targeted radionuclide therapy with β- or α-emitters such as 177-Lutethium (177Lu) or 225-Actinium (225A) has been a main focus at multiple academic research centers in the last few years. This review article provides an overview of PSMA characteristics, clinical performance, safety and toxicity of PSMA targeted β- or α-radiation therapy.
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Affiliation(s)
- Mohsen Beheshti
- Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany - .,Department of Nuclear Medicine and Endocrinology, Paracelsus Medical University, Salzburg, Austria -
| | - Alexander Heinzel
- Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany
| | - Dirk von Mallek
- Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany
| | - Christian Filss
- Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Beheshti M, Sægrov S. Detection of extraneous water ingress into the sewer system using tandem methods - a case study in Trondheim city. Water Sci Technol 2019; 79:231-239. [PMID: 30865594 DOI: 10.2166/wst.2019.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Infiltration and inflow (I/I) of extraneous water in separate sewer systems are serious concerns in urban water management for their environmental, social and economic consequences. Effective reduction of I/I requires knowing where excess water ingress and illicit connections are located. The present study focuses on I/I detection in the foul sewer network of a catchment in Trondheim, Norway, during a period without snowmelt or groundwater infiltration. Fiber-optic distributed temperature sensing (DTS) was used for the first time in Norway to detect I/I sources in tandem with closed-circuit television inspection (CCTV) and smoke testing. DTS was an accurate and feasible method for I/I detection, though it cannot identify exact types of failure and sources of I/I. Therefore, other complementary methods must be used, e.g. CCTV or smoke testing. However, CCTV was not completely useful in confirming the DTS results. This study provides practical insights for the rehabilitation and repair of sewer networks that suffer from the undesirable I/I of extraneous water.
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Affiliation(s)
- M Beheshti
- Department of Civil and Environmental Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway E-mail:
| | - S Sægrov
- Department of Civil and Environmental Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway E-mail:
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Bartel TB, Kuruva M, Gnanasegaran G, Beheshti M, Cohen EJ, Weissman AF, Yarbrough TL. SNMMI Procedure Standard for Bone Scintigraphy 4.0. J Nucl Med Technol 2018; 46:398-404. [PMID: 30518604] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
| | - Manohar Kuruva
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | | | - Erica J Cohen
- Edward Hines, Jr., VA Hospital, Hines, Illinois; and
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Nayyar S, Beheshti M, Liang T, Masse S, Bhaskaran A, Downar E, Vigmond E, Nanthakumar K. PREDICTING VENTRICULAR TACHYCARDIA CHANNELS IN HUMANS FROM ENTROPY ANALYSIS OF SINUS RHYTHM ELECTROGRAMS. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.396] [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: 10/28/2022] Open
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Schweighofer-Zwink G, Hehenwarter L, Rendl G, Rettenbacher L, Langsteger W, Beheshti M, Pirich C. [Imaging of parathyroid adenomas with F‑18 choline PET-CT]. Wien Med Wochenschr 2018; 169:15-24. [PMID: 30264384 DOI: 10.1007/s10354-018-0660-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/11/2017] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Ultrasound and sestamibi scintigraphy are the recommended standard procedures for initial diagnosis in primary hyperparathyroidism (pHPT). Recently, F‑18 choline positron emission tomography computed tomography (choline PET/CT) has been shown promising results for the diagnostic work up of primary hyperparathyroidism (pHPT) suggesting superiority over conventional scintigraphy using Tc99m sestamibi based protocols using planar dual-phase imaging, SPECT or SPECT/CT. METHODS This review presents the results of F‑18 choline PET/CT on the basis of a literature search using the keywords "primary hyperparathyroidism and choline", "primary hyperparathyroidism and PET", "parathyroid adenoma and choline" und "parathyroid adenoma and PET". RESULTS 6 studies were identified dealing with the diagnostic impact of choline PET/CT. The studies included 5 to 151 patients. Localization of single gland adenomas can be achieved with choline PET/CT in 80 up to 96% of cases. A high sensitivity and accuracy of choline PET/CT imaging is documented even in cases of repeated surgery for recurrent pHPT, in coexistant nodular goiter or in the detection of adenoma in atypical localization. CONCLUSIONS Using choline PET/CT parathyroid adenoma and probably parathyroid hyperplasia can be exactly localized in most patients with pHPT. Thus, a minimal-invasive surgical procedure is feasible with decreased risk of complications but high success rate in terms of biochemical cure. The diagnostic accuracy in multiglandular disease remains to be established.
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Affiliation(s)
- Gregor Schweighofer-Zwink
- UK für Nuklearmedizin und Endokrinologie, Universitätsklinikum Salzburg der Paracelus Medizinischen Privatuniversität, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.
| | - Lukas Hehenwarter
- UK für Nuklearmedizin und Endokrinologie, Universitätsklinikum Salzburg der Paracelus Medizinischen Privatuniversität, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - Gundula Rendl
- UK für Nuklearmedizin und Endokrinologie, Universitätsklinikum Salzburg der Paracelus Medizinischen Privatuniversität, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - Lukas Rettenbacher
- UK für Nuklearmedizin und Endokrinologie, Universitätsklinikum Salzburg der Paracelus Medizinischen Privatuniversität, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - Werner Langsteger
- Abteilung für Nuklearmedizin und Endokrinologie, Ordensklinikum Linz, Seilerstätte 4, 4010, Linz, Österreich
| | - Mohsen Beheshti
- UK für Nuklearmedizin und Endokrinologie, Universitätsklinikum Salzburg der Paracelus Medizinischen Privatuniversität, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.,Abteilung für Nuklearmedizin und Endokrinologie, Ordensklinikum Linz, Seilerstätte 4, 4010, Linz, Österreich
| | - Christian Pirich
- UK für Nuklearmedizin und Endokrinologie, Universitätsklinikum Salzburg der Paracelus Medizinischen Privatuniversität, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
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Shahrestani S, Ismail MC, Kakooei S, Beheshti M, Zabihiazadboni M, Zavareh MA. Iridium Oxide pH Sensor Based on Stainless Steel Wire for pH Mapping on Metal Surface. ACTA ACUST UNITED AC 2018. [DOI: 10.1088/1757-899x/328/1/012014] [Citation(s) in RCA: 2] [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: 11/11/2022]
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Beheshti M, Hehenwarter L, Paymani Z, Rendl G, Imamovic L, Rettenbacher R, Tsybrovskyy O, Langsteger W, Pirich C. 18F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with 99mTc-MIBI or 99mTc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients. Eur J Nucl Med Mol Imaging 2018. [PMID: 29516131 PMCID: PMC6097754 DOI: 10.1007/s00259-018-3980-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [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] [Indexed: 11/21/2022]
Abstract
Purpose In this prospective study we compared the accuracy of 18F-fluorocholine PET/CT with that of 99mTc-MIBI or99mTc-tetrofosmin SPECT/CT in the preoperative detection of parathyroid adenoma in patients with primary hyperparathyroidism. We also assessed the value of semiquantitative parameters in differentiating between parathyroid hyperplasia and adenoma. Methods Both 18F-fluorocholine PET/CT and 99mTc-MIBI/tetrofosmin SPECT/CT were performed in 100 consecutive patients with biochemical evidence of primary hyperparathyroidism. At least one abnormal focus on either 18F-fluorocholine or 99mTc-MIBI/tetrofosmin corresponding to a parathyroid gland or ectopic parathyroid tissue was considered as a positive finding. In 76 patients with positive findings on at least one imaging modality, surgical exploration was performed within 6 months, and the results were related to histopathological findings and clinical and laboratory findings at 3–6 months as the standard of truth. In 24 patients, no surgery was performed: in 18 patients with positive imaging findings surgery was refused or considered risky, and in 6 patients imaging was negative. Therefore, data from 82 patients (76 undergoing surgery, 6 without surgery) in whom the standard of truth criteria were met, were used in the final analysis. Results All patients showed biochemical evidence of primary hyperparathyroidism with a mean serum calcium level of 2.78 ± 0.34 mmol/l and parathormone (PTH) level of 196.5 ± 236.4 pg/ml. The study results in 76 patients with verified histopathology and 3 patients with negative imaging findings were analysed. Three of six patients with negative imaging showed normalized serum PTH and calcium levels on laboratory follow-up at 3 and 6 months, and the results were considered true negative. In a patient-based analysis, the detection rate with 18F-fluorocholine PET/CT was 93% (76/82), but was only 61% (50/82) with 99mTc-MIBI/tetrofosmin SPECT/CT. In a lesion-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of 18F-fluorocholine PET/CT in the detection of parathyroid adenoma were 93.7%, 96.0%, 90.2%, 97.4% and 95.3%, respectively, and of 99mTc-MIBI/tetrofosmin SPECT/CT were 60.8%, 98.5%, 94.1%, 86.3% and 87.7%, respectively. Although 18F-fluorocholine PET-positive adenomatous lesions showed higher SUVmax values than the hyperplastic glands (6.80 ± 3.78 vs. 4.53 ± 0.40) in the semiquantitative analysis, the difference was not significant (p = 0.236). The mean size (measured as the length of the greatest dimension) and weight of adenomas were 15.9 ± 7.6 mm (median 15 mm, range 1–40 mm) and 1.71 ± 1.86 g (median 1 g, range: 0.25–9 g), respectively. Among the analysed parameters including serum calcium and PTH and the size and weight of parathyroid adenomas, size was significantly different between patients with negative 99mTc-MIBI/tetrofosmin SPECT/CT and those with positive 99mTc-MIBI/tetrofosmin SPECT/CT (mean size 13.4 ± 7.6 mm vs. 16.9 ± 7.4 mm, respectively; p = 0.042). Conclusion In this prospective study, 18F-fluorocholine PET/CT showed promise as a functional imaging modality, being clearly superior to 99mTc-MIBI/tetrofosmin SPECT/CT, especially in the detection and localization of small parathyroid adenomas in patients with primary hyperparathyroidism. SUVmax was higher in parathyroid adenomas than in hyperplasia. However, further evaluation of this modality is needed.
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Affiliation(s)
- Mohsen Beheshti
- Department of Nuclear Medicine & Endocrinology, PET-CT Center Linz, Ordensklinikum, St. Vincent's Hospital, Linz, Austria.,Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University Salzburg, University Hospital, Müllner Hauptstraße 48, A-5020, Salzburg, Austria
| | - Lukas Hehenwarter
- Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University Salzburg, University Hospital, Müllner Hauptstraße 48, A-5020, Salzburg, Austria
| | - Zeinab Paymani
- Department of Nuclear Medicine & Endocrinology, PET-CT Center Linz, Ordensklinikum, St. Vincent's Hospital, Linz, Austria.,Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Gundula Rendl
- Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University Salzburg, University Hospital, Müllner Hauptstraße 48, A-5020, Salzburg, Austria
| | - Larisa Imamovic
- Department of Nuclear Medicine & Endocrinology, PET-CT Center Linz, Ordensklinikum, St. Vincent's Hospital, Linz, Austria
| | | | - Oleksiy Tsybrovskyy
- Department of Clinical Pathology, Ordensklinikum, St. Vincent's Hospital, Linz, Austria
| | - Werner Langsteger
- Department of Nuclear Medicine & Endocrinology, PET-CT Center Linz, Ordensklinikum, St. Vincent's Hospital, Linz, Austria
| | - Christian Pirich
- Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University Salzburg, University Hospital, Müllner Hauptstraße 48, A-5020, Salzburg, Austria.
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