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Garibotto V, Trombella S, Antelmi L, Bosco P, Redolfi A, Tabouret-Viaud C, Rager O, Gold G, Giannakopoulos P, Morbelli S, Nobili F, Perneczky R, Didic M, Guedj E, Drzezga A, Ossenkoppele R, Berckel BV, Ratib O, Frisoni GB. A Comparison of Two Statistical Mapping Tools for Automated Brain FDG-PET Analysis in Predicting Conversion to Alzheimer's Disease in Subjects with Mild Cognitive Impairment. Curr Alzheimer Res 2021; 17:1186-1194. [PMID: 33583380 DOI: 10.2174/1567205018666210212162443] [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: 03/20/2020] [Revised: 10/24/2020] [Accepted: 12/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Automated voxel-based analysis methods are used to detect cortical hypometabolism typical of Alzheimer's Disease (AD) on FDG-PET brain scans. We compared the accuracy of two clinically validated tools for their ability to identify those MCI subjects progressing to AD at followup, to evaluate the impact of the analysis method on FDG-PET diagnostic performance. METHODS SPMGrid and BRASS (Hermes Medical Solutions, Stockholm, Sweden) were tested on 131 MCI and elderly healthy controls from the EADC PET dataset. The concordance between the tools was tested by correlating the quantitative parameters (z- and t-values), calculated by the two software tools, and by measuring the topographical overlap of the abnormal regions (Dice score). Three independent expert readers blindly assigned a diagnosis based on the two map sets. We used conversion to AD dementia as the gold standard. RESULTS The t-map and z-map calculated with SPMGrid and BRASS, respectively, showed a good correlation (R > .50) for the majority of individual cases (128/131) and for the majority of selected regions of interest (ROIs) (98/116). The overlap of the hypometabolic patterns from the two tools was, however, poor (Dice score .36). The diagnostic performance was comparable, with BRASS showing significantly higher sensitivity (.82 versus .59) and SPMGrid showing higher specificity (.87 versus .52). CONCLUSION Despite similar diagnostic performance in predicting conversion to AD in MCI subjects, the two tools showed significant differences, and the maps provided by the tools showed limited overlap. These results underline the urgency for standardization across FDG-PET analysis methods for their use in clinical practice.
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Affiliation(s)
- Valentina Garibotto
- Laboratory of Neuroimaging and Innovative Molecular Tracer, University of Geneva, Geneva, Switzerland
| | - Sara Trombella
- Laboratory of Neuroimaging and Innovative Molecular Tracer, University of Geneva, Geneva, Switzerland
| | - Luigi Antelmi
- University of Cote d'Azur, Inria Sophia Antipolis, Epione Research Project, Nice, France
| | - Paolo Bosco
- IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Pisa, Italy
| | - Alberto Redolfi
- Laboratory of Neuroinformatics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Claire Tabouret-Viaud
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Olivier Rager
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
| | | | | | - Silvia Morbelli
- Department of Nuclear Medicine, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Flavio Nobili
- Department of Nuclear Medicine, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Robert Perneczky
- Department of Psychiatry and Psychotherapy, Ludwig, Maximilians-Universitaet Muenchen, Munich, Germany
| | - Mira Didic
- Aix-Marseille Universite, CNRS, Ecole Centrale Marseille, UMR 7249, Institut Fresnel, Marseille, France
| | - Eric Guedj
- Aix-Marseille Universite, CNRS, Ecole Centrale Marseille, UMR 7249, Institut Fresnel, Marseille, France
| | - Alexander Drzezga
- Department of Nuclear Medicine, Technische Universitaet, Munich, Germany
| | - Rik Ossenkoppele
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, Netherlands
| | - Bart Van Berckel
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, Netherlands
| | - Osman Ratib
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging, University of Geneva, Geneva, Switzerland
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Rager O, Radojewski P, Dumont RA, Treglia G, Giovanella L, Walter MA. Radioisotope imaging for discriminating benign from malignant cytologically indeterminate thyroid nodules. Gland Surg 2019; 8:S118-S125. [PMID: 31475099 DOI: 10.21037/gs.2019.03.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The risk of malignancy in thyroid nodules with indeterminate cytological classification (Bethesda III-IV) ranges from 10% to 40%, and early delineation is essential as delays in diagnosis can be associated with increased mortality. Several radioisotope imaging techniques are available for discriminating benign from malignant cytologically indeterminate thyroid nodules, and for supporting clinical decision-making. These techniques include iodine-123, technetium-99m-pertechnetate, technetium-99m-methoxy-isobutyl-isonitrile (technetium-99m-MIBI), and fluorine-18-fluorodeoxyglucose (fluorine-18-FDG). This review discusses the currently available radioisotope imaging techniques for evaluation of thyroid nodules, including the mechanism of radiotracer uptake and the indications for their use.
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Affiliation(s)
- Olivier Rager
- Nuclear Medicine Department, Geneva University Hospitals, Geneva, Switzerland.,IMGE (Imagerie Moléculaire Genève), Geneva, Switzerland
| | - Piotr Radojewski
- Nuclear Medicine Department, Geneva University Hospitals, Geneva, Switzerland
| | - Rebecca A Dumont
- Nuclear Medicine Department, Geneva University Hospitals, Geneva, Switzerland
| | - Giorgio Treglia
- Clinic of Nuclear Medicine and PET/CT Center, Ente Ospedaliero Cantonale, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luca Giovanella
- Clinic of Nuclear Medicine and PET/CT Center, Ente Ospedaliero Cantonale, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Martin A Walter
- Nuclear Medicine Department, Geneva University Hospitals, Geneva, Switzerland
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Rager O, Picarra M, Astrinakis E, Garibotto V, Amzalag G. Incidental 18F-FDG Uptake of the Pubic Ramus and Abdominal Muscles due to Athletic Pubalgia During Acute Prostatitis. Mol Imaging Radionucl Ther 2018; 27:133-135. [PMID: 30317850 PMCID: PMC6191733 DOI: 10.4274/mirt.19484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A 23-year-old African native male patient presented with fever, lumbalgia and dysuria after returning from a trip to Togo. His physical examination revealed pain over the pubic symphysis and rectal tenderness on digital exam. The C-reactive protein (CRP) level was elevated along with positive blood and urinary cultures for methicillin-resistant Staphylococcus aureus. An magnetic resonance imaging that has been performed to rule out arthritis/osteomyelitis in the pubis revealed edema of the symphysis. An 18F-FDG positron emission tomography/computed tomography supported the diagnosis of prostate infection and showed a focal uptake of the pubic symphysis, with diffuse hyper-metabolism of the insertions of the rectus abdominis and longus adductor muscles, corresponding to athletic pubalgia. Fever and CRP responded rapidly to antibiotherapy.
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Affiliation(s)
- Olivier Rager
- University Hospital of Geneva, Clinic of Nuclear Medicine, Geneva, Switzerland
| | - Marlise Picarra
- University Hospital of Geneva, Clinic of Radiology, Geneva, Switzerland
| | | | - Valentina Garibotto
- University Hospital of Geneva, Clinic of Nuclear Medicine, Geneva, Switzerland
| | - Gaël Amzalag
- University Hospital of Geneva, Clinic of Nuclear Medicine, Geneva, Switzerland
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Rager O, Lee-Felker SA, Tabouret-Viaud C, Felker ER, Poncet A, Amzalag G, Garibotto V, Zaidi H, Walter MA. Accuracy of whole-body HDP SPECT/CT, FDG PET/CT, and their combination for detecting bone metastases in breast cancer: an intra-personal comparison. Am J Nucl Med Mol Imaging 2018; 8:159-168. [PMID: 30042868 PMCID: PMC6056244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/24/2018] [Indexed: 06/08/2023]
Abstract
New generation SPECT/CT scanners allow rapid whole-body imaging, and potentially facilitate significantly improved diagnostic accuracy. Thus, the aim of this study was to compare the diagnostic accuracy of whole-body Tc-99m-HDP SPECT/CT, F-18-FDG PET/CT, and their combination for detecting bone metastases in breast cancer. Women with biopsy-proven breast cancer that were referred for whole-body SPECT/CT and FDG PET/CT were consecutively included in this retrospective study. Two blinded readers independently interpreted all scans. In a per-patient analysis, the diagnostic performances of whole-body SPECT/CT, FDG PET/CT, and their combination were compared using receiver operating characteristic (ROC) analysis. In a per-lesion analysis, the performances were compared using figures of merit (FoM) differences in Jackknife alternative free-response ROC analysis, which considers the location information. Follow-up served as reference standard. Overall, 25 consecutive women (median age: 55; range 38-82) with 117 lesions were included. The median follow-up was 21 months (2-46 months). The per-patient analysis revealed no significant differences in diagnostic performance (P = 0.16), while the per-lesion analysis revealed a diagnostic superiority of whole-body SPECT/CT over FDG PET/CT (P = 0.004). Specifically, the PET/CT FoM was significantly lower than the SPECT/CT FoM (FoM difference = -0.11, 95% CI [-0.21; -0.02], P = 0.021). No significant difference was observed between SPECT/CT and the combination of SPECT/CT and PET/CT. The per-lesion analysis suggest that SPECT/CT has a higher diagnostic accuracy than FDG PET/CT for the detection of bone metastases. Thus, SPECT/CT may be a useful adjunct to FDG PET/CT for staging of breast cancer patients.
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Affiliation(s)
- Olivier Rager
- Department of Nuclear Medicine, Geneva University and University Hospitals of GenevaRue Gabrielle-Perret-Gentil, 4, CH-1211 Geneva, Switzerland
- IMGE (Imagerie Moléculaire Genève)20 Chemin Beau Soleil, CH-1206 Geneva, Switzerland
| | - Stephanie A Lee-Felker
- Department of Nuclear Medicine, Geneva University and University Hospitals of GenevaRue Gabrielle-Perret-Gentil, 4, CH-1211 Geneva, Switzerland
- Department of Radiology, Ronald Reagan-UCLA Medical Center757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095, USA
| | - Claire Tabouret-Viaud
- Department of Nuclear Medicine, Geneva University and University Hospitals of GenevaRue Gabrielle-Perret-Gentil, 4, CH-1211 Geneva, Switzerland
| | - Ely R Felker
- Department of Nuclear Medicine, Geneva University and University Hospitals of GenevaRue Gabrielle-Perret-Gentil, 4, CH-1211 Geneva, Switzerland
- Department of Radiology, Ronald Reagan-UCLA Medical Center757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095, USA
| | - Antoine Poncet
- CRC and Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of GenevaRue Gabrielle-Perret-Gentil, 4, CH-1211 Geneva, Switzerland
| | - Gaël Amzalag
- Department of Nuclear Medicine, Geneva University and University Hospitals of GenevaRue Gabrielle-Perret-Gentil, 4, CH-1211 Geneva, Switzerland
| | - Valentina Garibotto
- Department of Nuclear Medicine, Geneva University and University Hospitals of GenevaRue Gabrielle-Perret-Gentil, 4, CH-1211 Geneva, Switzerland
| | - Habib Zaidi
- Department of Nuclear Medicine, Geneva University and University Hospitals of GenevaRue Gabrielle-Perret-Gentil, 4, CH-1211 Geneva, Switzerland
- Geneva Neuroscience Center, Geneva UniversityCH-1205 Geneva, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen9700 RB Groningen, Netherlands
| | - Martin A Walter
- Department of Nuclear Medicine, Geneva University and University Hospitals of GenevaRue Gabrielle-Perret-Gentil, 4, CH-1211 Geneva, Switzerland
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Namdar M, Rager O, Priamo J, Frei A, Noble S, Amzalag G, Ratib O, Nkoulou R. Prognostic value of revascularising viable myocardium in elderly patients with stable coronary artery disease and left ventricular dysfunction: a PET/CT study. Int J Cardiovasc Imaging 2018; 34:1673-1678. [DOI: 10.1007/s10554-018-1380-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/24/2018] [Indexed: 11/24/2022]
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Vincenti G, Quercioli A, Zaidi H, Nkoulou R, Dewarrat S, Rager O, Ambrosio G, Seimbille Y, Mach F, Ratib O, Schindler TH. Combined evaluation of myocardial perfusion and coronary morphology in the identification of subclinical CAD. Nuklearmedizin 2018; 49:173-82. [DOI: 10.3413/nukmed-0312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 07/03/2010] [Indexed: 11/20/2022]
Abstract
Summary
Purpose: To evaluate the mean effective radiation dose of 13N-ammonia PET/CT and ECGpulsing CT angiography (CTA) in the evaluation of myocardial perfusion, myocardial blood flow (MBF) and coronary morphology for the identification of subclinical CAD. Patients, material, methods: Following rest-stress 13N-ammonia PET/CT perfusion imaging and MBF quantification, ECG-pulsing CTA at a pulse window of 70% of the R-R cycle was performed in ten healthy controls and in sixteen individuals with cardiovascular risk factors. Individual radiation dose exposure for ECG-pulsing CTA was estimated from the dose-length product. Results: PET demonstrated normal perfusion in all study individuals, while hyperemic MBFs during dipyridamole stimulation and the myocardial flow reserve (MFR) in cardiovascular risk individuals were significantly lower than in healthy controls (1.34 ± 0.26 vs. 2.28 ± 0.47 ml/g/min and 1.48 ± 0.39 vs. 3.24 ± 0.81, both p . 0.0001). Further, ECG-pulsing CTA identified mild calcified and non-calcified coronary plaque burden in 7 (43%) individuals of the cardiovascular risk group. Rest-stress 13N-ammonia PET/CT perfusion study yielded a mean effective radiation dose of 3.07 ± 0.06 mSv (2.07 ± 0.06 mSv from the rest-stress 13N-ammonia injections and 1.0 mSv from the 2 CT transmission scans), while ECG-pulsing CTA was associated with 5.57 ± 2.00 mSv. The mean effective radiation dose of the combined 13N-ammonia PET/CT and ECG-pulsing CTA exams in the evaluation of myocardial perfusion and coronary morphology was 8.0 ± 1.5 mSv. Conclusion: 13N-ammonia PET/CT and ECG-pulsing CTA affords cardiac hybrid imaging studies in the evaluation of subclinical CAD with a relatively low mean effective radiation exposure of 8.0 ± 1.5mSv.
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Amzalag G, Rager O, Tabouret-Viaud C, Wissmeyer M, Sfakianaki E, de Perrot T, Ratib O, Miralbell R, Giovacchini G, Garibotto V, Zilli T. Target Definition in Salvage Radiotherapy for Recurrent Prostate Cancer: The Role of Advanced Molecular Imaging. Front Oncol 2016; 6:73. [PMID: 27065024 PMCID: PMC4814800 DOI: 10.3389/fonc.2016.00073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 12/20/2015] [Accepted: 03/14/2016] [Indexed: 12/28/2022] Open
Abstract
Salvage radiotherapy (SRT) represents the main treatment option for relapsing prostate cancer in patients after radical prostatectomy. Several open questions remain unanswered in terms of target volumes definition and delivered doses for SRT: the effective dose necessary to achieve biochemical control in the SRT setting may be different if the tumor recurrence is micro- or macroscopic. At the same time, irradiation of only the prostatic bed or of the whole pelvis will depend on the localization of the recurrence, local or locoregional. In the “theragnostic imaging” era, molecular imaging using positron emission tomography (PET) constitutes a useful tool for clinicians to define the site of the recurrence, the extent of disease, and individualize salvage treatments. The best option currently available in clinical routine is the combination of radiolabeled choline PET imaging and multiparametric magnetic resonance imaging (MRI), associating the nodal and distant metastases identification based on PET with the local assessment by MRI. A new generation of targeted tracers, namely, prostate-specific membrane antigen, show promising results, with a contrast superior to choline imaging and a higher detection rate even for low prostate-specific antigen levels; validation studies are ongoing. Finally, imaging targeting bone remodeling, using whole-body SPECT–CT, is a relevant complement to molecular/metabolic PET imaging when bone involvement is suspected.
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Affiliation(s)
- Gaël Amzalag
- Division of Nuclear Medicine, Hospital of Neuchâtel, Neuchâtel, Switzerland; Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
| | - Olivier Rager
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital , Geneva , Switzerland
| | - Claire Tabouret-Viaud
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital , Geneva , Switzerland
| | - Michael Wissmeyer
- Division of Nuclear Medicine, Hospital of Neuchâtel, Neuchâtel, Switzerland; Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
| | - Electra Sfakianaki
- Division of Radiology, Geneva University Hospital , Geneva , Switzerland
| | - Thomas de Perrot
- Division of Radiology, Geneva University Hospital , Geneva , Switzerland
| | - Osman Ratib
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Raymond Miralbell
- Faculty of Medicine, Geneva University, Geneva, Switzerland; Division of Radiation-Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Giampiero Giovacchini
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli , Zurich , Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Thomas Zilli
- Faculty of Medicine, Geneva University, Geneva, Switzerland; Division of Radiation-Oncology, Geneva University Hospital, Geneva, Switzerland
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Abstract
Breast cancer is an international public health concern in which an optimal treatment plan requires a precise staging. Both MRI and PET imaging techniques have made significant progress in the last decades with constant improvements that made both modalities clinically relevant in several stages of breast cancer management and follow-up. On one hand, specific breast MRI permits high diagnostic accuracy for local tumor staging, and whole-body MRI can also be of great use in distant staging, eventually accompanied by organ-specific MRI sequences. Moreover, many different MRI sequences can be performed, including functional MRI, letting us foresee important improvements in breast cancer characterization in the future. On the contrary, (18)F-FDG-PET has a high diagnostic performance for the detection of distant metastases, and several other tracers currently under development may profoundly affect breast cancer management in the future with better determination of different types of breast cancers allowing personalized treatments. As a consequence PET/MR is a promising emerging technology, and it is foreseeable that in cases where both PET and MRI data are needed, a hybrid acquisition is justified when available. However, at this stage of deployment of such hybrid scanners in a clinical setting, more data are needed to demonstrate their added value beyond just patient comfort of having to undergo a single examination instead of two, and the higher confidence of diagnostic interpretation of these co-registered images. Optimized imaging protocols are still being developed and are prone to provide more efficient hybrid protocols with a potential improvement in diagnostic accuracy. More convincing studies with larger number of patients as well as cost-effectiveness studies are needed. This article provides insights into the current state-of-the-art of PET/MR in patients with breast cancer and gives an outlook on future developments of both imaging techniques and potential applications in the future.
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Affiliation(s)
- Claire Tabouret-Viaud
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Diomidis Botsikas
- Service de Radiologie, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Bénédicte M A Delattre
- Service de Radiologie, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Ismini Mainta
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Gaël Amzalag
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Olivier Rager
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Vincent Vinh-Hung
- Service de Radio-Oncologie, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Raymond Miralbell
- Service de Radio-Oncologie, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland; Servei de Radio-Oncologia, Instituto Oncológico Teknon, Barcelona, Spain
| | - Osman Ratib
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland.
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Purohit BS, Vargas MI, Ailianou A, Merlini L, Poletti PA, Platon A, Delattre BM, Rager O, Burkhardt K, Becker M. Orbital tumours and tumour-like lesions: exploring the armamentarium of multiparametric imaging. Insights Imaging 2016; 7:43-68. [PMID: 26518678 PMCID: PMC4729705 DOI: 10.1007/s13244-015-0443-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/03/2015] [Accepted: 10/08/2015] [Indexed: 12/13/2022] Open
Abstract
Although the orbit is a small anatomical space, the wide range of structures present within it are often the site of origin of various tumours and tumour-like conditions, both in adults and children. Cross-sectional imaging is mandatory for the detection, characterization, and mapping of these lesions. This review focuses on multiparametric imaging of orbital tumours. Each tumour is reviewed in relation to its clinical presentation, compartmental location, imaging characteristics, and its histological features. We herein describe orbital tumours as lesions of the globe (retinoblastoma, uveal melanoma), optic nerve sheath complex (meningioma, optic nerve glioma), conal-intraconal compartment (hemangioma), extraconal compartment (dermoid/epidermoid, lacrimal gland tumours, lymphoma, rhabdomysarcoma), and bone and sinus compartment (fibrous dysplasia). Lesions without any typical compartmental localization and those with multi-compartment involvement (veno-lymphatic malformation, plexiform neurofibroma, idiopathic orbital pseudotumour, IgG4 related disease, metastases) are also reviewed. We discuss the role of advanced imaging techniques, such as MR diffusion-weighted imaging (DWI), diffusion tensor imaging, fluoro-2-deoxy-D-glucose positron emission tomography CT (FDG-PET CT), and positron emission tomography MRI (MRI PET) as problem-solving tools in the evaluation of those orbital masses that present with non-specific morphologic imaging findings. Main messages/Teaching points • A compartment-based approach is essential for the diagnosis of orbital tumours. • CT and MRI play a key role in the work-up of orbital tumours. • DWI, PET CT, and MRI PET are complementary tools to solve diagnostic dilemmas. • Awareness of salient imaging pearls and diagnostic pitfalls avoids interpretation errors.
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Affiliation(s)
- Bela S Purohit
- Department of Radiology, Geneva University Hospital and University of Geneva, Rue, Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Maria Isabel Vargas
- Department of Neuroradiology, Geneva University Hospital and University of Geneva, Rue, Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Angeliki Ailianou
- Department of Radiology, Geneva University Hospital and University of Geneva, Rue, Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Laura Merlini
- Department of Radiology, Geneva University Hospital and University of Geneva, Rue, Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Pierre-Alexandre Poletti
- Department of Radiology, Geneva University Hospital and University of Geneva, Rue, Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Alexandra Platon
- Department of Radiology, Geneva University Hospital and University of Geneva, Rue, Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Bénédicte M Delattre
- Department of Radiology, Geneva University Hospital and University of Geneva, Rue, Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Olivier Rager
- Department of Nuclear Medicine, Geneva University Hospital and University of Geneva, Rue, Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Karim Burkhardt
- Department of Clinical Pathology, Geneva University Hospital and University of Geneva, Rue, Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Minerva Becker
- Department of Radiology, Geneva University Hospital and University of Geneva, Rue, Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.
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Durante S, Haller S, Amzalag G, Tessitore E, Rager O. 99mTc-HDP SPECT With CT Myelography in a 1-Step Procedure. Clin Nucl Med 2016; 41:74-5. [DOI: 10.1097/rlu.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Varoquaux A, Rager O, Dulguerov P, Burkhardt K, Ailianou A, Becker M. Diffusion-weighted and PET/MR Imaging after Radiation Therapy for Malignant Head and Neck Tumors. Radiographics 2015; 35:1502-27. [PMID: 26252192 DOI: 10.1148/rg.2015140029] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Interpreting imaging studies of the irradiated neck constitutes a challenge because of radiation therapy-induced tissue alterations, the variable appearances of recurrent tumors, and functional and metabolic phenomena that mimic disease. Therefore, morphologic magnetic resonance (MR) imaging, diffusion-weighted (DW) imaging, positron emission tomography with computed tomography (PET/CT), and software fusion of PET and MR imaging data sets are increasingly used to facilitate diagnosis in clinical practice. Because MR imaging and PET often yield complementary information, PET/MR imaging holds promise to facilitate differentiation of tumor recurrence from radiation therapy-induced changes and complications. This review focuses on clinical applications of DW and PET/MR imaging in the irradiated neck and discusses the added value of multiparametric imaging to solve diagnostic dilemmas. Radiologists should understand key features of radiation therapy-induced tissue alterations and potential complications seen at DW and PET/MR imaging, including edema, fibrosis, scar tissue, soft-tissue necrosis, bone and cartilage necrosis, cranial nerve palsy, and radiation therapy-induced arteriosclerosis, brain necrosis, and thyroid disorders. DW and PET/MR imaging also play a complementary role in detection of residual and recurrent disease. Interpretation pitfalls due to technical, functional, and metabolic phenomena should be recognized and avoided. Familiarity with DW and PET/MR imaging features of expected findings, potential complications, and treatment failure after radiation therapy increases diagnostic confidence when interpreting images of the irradiated neck. Online supplemental material is available for this article.
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Affiliation(s)
- Arthur Varoquaux
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
| | - Olivier Rager
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
| | - Pavel Dulguerov
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
| | - Karim Burkhardt
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
| | - Angeliki Ailianou
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
| | - Minerva Becker
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
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Rager O, Baskin A, Amzalag G, Buchegger F, Miralbell R, Ratib O, Zilli T, Garibotto V. Significance of 18F-fluorocholine PET/CT positive pulmonary lesions in prostate cancer patients. Nuklearmedizin 2015. [PMID: 26213186 DOI: 10.3413/nukmed-0737-15-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To assess the frequency and the significance of incidental pulmonary lesions with 18F-fluorocholine (18F-FCH) PET/CT in prostate cancer (PCa) patients. PATIENTS, METHODS 225 consecutive PCa patients referred for 18F-FCH PET/CT (median age 68 years) were retrospectively evaluated for the presence of lesions in the lungs: 173 referred for restaging and 52 for initial staging regarding their high risk of extra prostatic extension. The final diagnosis was based on histopathological or on clinical and radiological follow-up. RESULTS 13 patients had 18F-FCH positive pulmonary and 8 patients malignant lesions: 5 patients (38%) had a primary lung cancer (2 squamous cell carcinomas, 1 papillary adenocarcinoma, 1 typical pulmonary carcinoid, 1 bronchioloalveolar carcinoma) and 3 patients (23%) PCa metastases. Benign lesions were found in 5 subjects (38%). SUVmax and maximum diameter were neither significantly different in primary and metastatic tumors nor between malignant and benign lesions. CONCLUSIONS Although our results suggest that incidental uptake in the lungs in PCa patients are nonspecific, their detection may have a significant impact on patient management knowing that more than 60% represent malignant disease.
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Affiliation(s)
- O Rager
- Dr. Olivier Rager, Nuclear Medicine Department, Faculty of Medecine, University of Geneva, rue Gabrielle-Perret-Gentil, 4, 1211 Geneva, Switzerland, Tel. +41/223 72 71 44, Fax +41/223 72 71 69,
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13
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Karaca S, Rager O, Ratib O, Kalangos A. Long-term results confirmed that 18F-FDG-PET/CT was an excellent diagnostic modality for early detection of vascular grafts infection. Q J Nucl Med Mol Imaging 2014; 62:200-208. [PMID: 25319041 DOI: 10.23736/s1824-4785.16.02746-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We sought to evaluate the potential role of positron emission tomography-computed tomography (PET-CT) for the detection and diagnosis of potential infections of vascular grafts using combining metabolic (i.e., radioactive fluorine-fluoro-D-deoxyglucose [18F-FDG]) PET with morphological (CT) information and investigate long-term capability. METHODS Seventeen patients with suspected vascular-graft infection underwent thoracic-abdominal-pelvic FDG PET combined with contrast-enhanced CT using a hybrid PET-CT scanner providing co-registered PET and CT images. RESULTS In this retrospect study, we suspected graft infection in 14 of 17 patients detected using PET-CT and increased the maximal uptake of 18F-FDG around the grafts. Other vascular localizations were not observed. All patients with positive PET-CT results underwent redo-surgery, and the infection was ultimately confirmed using microbiological testing in 12 of 14 patients. Follow-up time was median of 58 months (range 36-73 months) for all 17 patients. In these patients, there was no further evidence of graft infection found on clinical and imaging follow-up. CONCLUSIONS This is first investigation presenting long-term follow-up, which confirmed that 18F-FDG-PET/CT is an excellent diagnostic modality for suspected vascular graft infection. 18F-FDG PET-CT exhibited a sensitivity of 100% and specificity of 71.4% for the detection of vascular-graft infection.
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Affiliation(s)
- Saziye Karaca
- Service of Cardiovascular Surgery, University Hospital Geneva, Geneva, Switzerland -
| | - Olivier Rager
- Service of Nuclear Medicine, University Hospital Geneva, Geneva, Switzerland
| | - Osman Ratib
- Service of Nuclear Medicine, University Hospital Geneva, Geneva, Switzerland
| | - Afksendiyos Kalangos
- Service of Cardiovascular Surgery, University Hospital Geneva, Geneva, Switzerland
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Karaca S, Rager O, Kalangos A. Successful treatment of persistent chylopericardium with somatostatin after operation on ascending aorta. Ann Thorac Surg 2014; 97:e97-9. [PMID: 24694457 DOI: 10.1016/j.athoracsur.2013.11.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/18/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
Chylopericardium after intrathoracic surgical procedures rarely occurs. Optimal guidelines for the management of chylopericardium are lacking. In this case report, we describe our experience in treating chylopericadium with somatostatin in a 47-year-old man who underwent replacement of the ascending aorta and aortic valvuloplasty after aortic rupture. Postoperatively, a late tamponade was drained, and microbiologic analyses confirmed chyle. Conservative treatment including total parental nutrition failed, so we initiated somatostatin treatment as a continuous perfusion, with good results.
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Affiliation(s)
- Saziye Karaca
- Service of Cardiovascular Surgery, University Hospital Geneva, Geneva, Switzerland.
| | - Olivier Rager
- Service of Nuclear Medicine, University Hospital Geneva, Geneva, Switzerland
| | - Afksendiyos Kalangos
- Service of Cardiovascular Surgery, University Hospital Geneva, Geneva, Switzerland
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de Perrot T, Rager O, Scheffler M, Lord M, Pusztaszeri M, Iselin C, Ratib O, Vallee JP. Potential of hybrid ¹⁸F-fluorocholine PET/MRI for prostate cancer imaging. Eur J Nucl Med Mol Imaging 2014; 41:1744-55. [PMID: 24841413 DOI: 10.1007/s00259-014-2786-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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: 01/09/2014] [Accepted: 04/15/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE To report the first results of hybrid (18)F-fluorocholine PET/MRI imaging for the detection of prostate cancer. METHODS This analysis included 26 consecutive patients scheduled for prostate PET/MRI before radical prostatectomy. The examinations were performed on a hybrid whole-body PET/MRI scanner. The MR acquisitions which included T2-weighted, diffusion-weighted and dynamic contrast-enhanced sequences were followed during the same session by whole-body PET scans. Parametric maps were constructed to measure normalized T2-weighted intensity (nT2), apparent diffusion coefficient (ADC), volume transfer constant (K (trans)), extravascular extracellular volume fraction (v e) and standardized uptake values (SUV). With pathology as the gold standard, ROC curves were calculated using logistic regression for each parameter and for the best combination with and without PET to obtain a MR model versus a PETMR model. RESULTS Of the 26 patients initially selected, 3 were excluded due to absence of an endorectal coil (2 patients) or prosthesis artefacts (1 patient). In the whole prostate, the area under the curve (AUC) for SUVmax, ADC, nT2, K (trans) and v e were 0.762, 0.756, 0.685, 0.611 and 0.529 with a best threshold at 3.044 for SUVmax and 1.075 × 10(-3) mm(2)/s for ADC. The anatomical distinction between the transition zone and the peripheral zone showed the potential of the adjunctive use of PET. In the peripheral zone, the AUC of 0.893 for the PETMR model was significantly greater (p = 0.0402) than the AUC of 0.84 for the MR model only. In the whole prostate, no relevant correlation was observed between ADC and SUVmax. The SUVmax was not affected by the Gleason score. CONCLUSION The performance of a hybrid whole-body (18)F-fluorocholine PET/MRI scan in the same session combined with a prostatic MR examination did not interfere with the diagnostic accuracy of the MR sequences. The registration of the PET data and the T2 anatomical MR sequence data allowed precise localization of hypermetabolic foci in the prostate. While in the transition zone the adenomatous hyperplasia interfered with cancer detection by PET, the quantitative analysis tool performed well for cancer detection in the peripheral zone.
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Affiliation(s)
- Thomas de Perrot
- Division of Radiology, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland,
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16
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Buchegger F, Garibotto V, Zilli T, Allainmat L, Jorcano S, Vees H, Rager O, Steiner C, Zaidi H, Seimbille Y, Ratib O, Miralbell R. First imaging results of an intraindividual comparison of (11)C-acetate and (18)F-fluorocholine PET/CT in patients with prostate cancer at early biochemical first or second relapse after prostatectomy or radiotherapy. Eur J Nucl Med Mol Imaging 2013; 41:68-78. [PMID: 24104592 DOI: 10.1007/s00259-013-2540-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/06/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE (18)F-Fluorocholine (FCH) and (11)C-acetate (ACE) PET are widely used for detection of recurrent prostate cancer (PC). We present the first results of a comparative, prospective PET/CT study of both tracers evaluated in the same patients presenting with recurrence and low PSA to compare the diagnostic information provided by the two tracers. METHODS The study group comprised 23 patients studied for a rising PSA level after radical prostatectomy (RP, 7 patients, PSA ≤ 3 ng/ml), curative radiotherapy (RT, 7 patients, PSA ≤ 5 ng/ml) or RP and salvage RT (9 patients, PSA ≤ 5 ng/ml). Both FCH and ACE PET/CT scans were performed in a random sequence a median of 4 days (range 0 to 11 days) apart. FCH PET/CT was started at injection (307 ± 16 MBq) with a 10-min dynamic acquisition of the prostate bed, followed by a whole-body PET scan and late (45 min) imaging of the pelvis. ACE PET/CT was performed as a double whole-body PET scan starting 5 and 22 min after injection (994 ± 72 MBq), and a late view (45 min) of the prostate bed. PET/CT scans were blindly reviewed by two independent pairs of two experienced nuclear medicine physicians, discordant subgroup results being discussed to reach a consensus for positive, negative end equivocal results. RESULTS PET results were concordant in 88 out of 92 local, regional and distant findings (Cohen's kappa 0.929). In particular, results were concordant in all patients concerning local status, bone metastases and distant findings. Lymph-node results were concordant in 19 patients and different in 4 patients. On a per-patient basis results were concordant in 22 of 23 patients (14 positive, 5 negative and 3 equivocal). In only one patient was ACE PET/CT positive for nodal metastases while FCH PET/CT was overall negative; interestingly, the ACE-positive and FCH-negative lymph nodes became positive in a second FCH PET/CT scan performed a few months later. CONCLUSION Overall, ACE and FCH PET/CT showed excellent concordance, on both a per-lesion and a per-patient basis, suggesting that both tracers perform equally for recurrent prostate cancer staging.
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Affiliation(s)
- Franz Buchegger
- Nuclear Medicine Division, University Hospital of Geneva, 1211, Geneva 14, Switzerland,
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Varoquaux A, Rager O, Lovblad KO, Masterson K, Dulguerov P, Ratib O, Becker CD, Becker M. Functional imaging of head and neck squamous cell carcinoma with diffusion-weighted MRI and FDG PET/CT: quantitative analysis of ADC and SUV. Eur J Nucl Med Mol Imaging 2013; 40:842-52. [PMID: 23436068 PMCID: PMC3644194 DOI: 10.1007/s00259-013-2351-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [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: 11/09/2012] [Accepted: 01/15/2013] [Indexed: 12/17/2022]
Abstract
Purpose Head and neck squamous cell carcinoma (HNSCC) may cause a decreased apparent diffusion coefficient (ADC) on diffusion-weighted magnetic resonance imaging (DW MRI) and an increased standardized uptake value (SUV) on fluorodeoxyglucose (FDG) positron emission tomography (PET/CT). We analysed the reproducibility of ADC and SUV measurements in HNSCC and evaluated whether these biomarkers are correlated or independent. Methods This retrospective analysis of DW MRI and FDG PET/CT data series included 34 HNSCC in 33 consecutive patients. Two experienced readers measured tumour ADC and SUV values independently. Statistical comparison and correlation with histopathology was done. Intra- and inter-observer agreement for ADC and SUV measurements was assessed. Results Intraclass correlation coefficient (ICC) analysis showed almost perfect reproducibility (>0.90) for ADCmean, ADCmin, SUVmax and SUVmean values for intra-observer and inter-observer agreement. Mean ADCmean and ADCmin in HNSCC were 1.05 ± 0.34 × 10−3 mm2/s and 0.65 ± 0.29 × 10−3 mm2/s, respectively. Mean SUVmean and mean SUVmax were 7.61 ± 3.87 and 12.8 ± 5.0, respectively. Although statistically not significant, a trend towards higher SUV and lower ADC was observed with increasing tumour dedifferentiation. Pearson’s correlation analysis showed no significant correlation between ADC and SUV measurements (r −0.103, −0.051; p 0.552, 0.777). Conclusion Our data suggest that ADC and SUV values are reproducible and independent biomarkers in HNSCC.
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Affiliation(s)
- Arthur Varoquaux
- Department of Radiology, Geneva University Hospital, Geneva 14, Switzerland
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Tsirella E, Mavrakanas T, Rager O, Tsartsalis S, Kallaras K, Kokkas B, Mironidou-Tzouveleki M. Low dose pioglitazone does not affect bone formation and resorption markers or bone mineral density in streptozocin-induced diabetic rats. J Physiol Pharmacol 2012; 63:201-204. [PMID: 22653908] [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] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 04/10/2012] [Indexed: 06/01/2023]
Abstract
Our study aims to investigate the effect of a low-dose pioglitazone regimen on bone mineral density and bone formation-resorption markers in control and diabetic rats. Wistar rats were divided into 4 groups: non-diabetic controls, control rats receiving pioglitazone (3 mg/kg), streptozocin-treated diabetic rats (50 mg/kg), diabetic rats treated with pioglitazone (3 mg/kg). The duration of the experiment was 8 weeks. Diabetes in our rats was associated with weight loss, increased urinary calcium excretion and reduced plasma osteocalcin levels. Diabetes mellitus did not affect bone mineral density. Pioglitazone administration had no impact on bone formation and resorption markers levels and did not modify bone mineral density in the four studied groups. Pioglitazone at the 3 mg/kg dose was not associated with significant skeletal complications in our experimental model.
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Affiliation(s)
- E Tsirella
- A'Laboratory of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Rager O, Parrens M, Brière J, Lippert E, Milpied N, Pellegrin JL, Viallard JF. [Utility of the bone marrow biopsy in the diagnosis of essential thrombocytemia]. Presse Med 2011; 40:e507-15. [PMID: 21737230 DOI: 10.1016/j.lpm.2011.04.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 03/03/2011] [Accepted: 04/04/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The recent discovery of the Janus Kinase 2 (JAK2(V617F)) mutation, an indicator of clonal expansion, has widely modified the diagnostic work-up of myeloproliferative disorders. However, histopathologic criteria of the WHO classification, focused on megakaryocytes abnormalities, have taken a central role in the diagnosis of essential thrombocytemia (ET), particularly to distinguish it from the prefibrotic myelofibrosis (PMF) evolving to a clinic myelofibrosis unlike true ET. The aim of our study is to evaluate inter-observer reproducibility and prognostic implications of these pathological criteria comparing diagnoses with clinical and biological follow-up. METHODS Forty-four patients presenting with isolated thrombocytemia were retrospectively evaluated. All patients were initially diagnosed with ET based on the PVSG classification from 1997. The initial bone marrow biopsy specimens were re-evaluated using the Thiele pathological classification: true ET, prefibrotic myelofibrosis (PMF) and early myelofibrosis. Patients were followed for a median of 6 years. RESULTS Our population includes three patients with polycythemia vera and 41 patients with true ET. Based on clinical and biological follow-up, diagnoses were changed to idiopathic myelofibrosis in four of six patients with "early" myelofibrosis (66.7%), but in only one of 14 patients with PMF (7.15%). In contrast, the diagnosis of true ET was not changed in the 21 cases. Inter-observer reproducibility for pathological classification was 100%. CONCLUSION In this study, our diagnostic methodology based on the clinico-biological follow-up, which has not been evaluated in previous studies, calls into question the diagnostic value of the pathological criteria in PMF.
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Affiliation(s)
- Olivier Rager
- Hôpital Haut-Lévêque, service de médecine interne, 3604 Pessac, France
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Valenta I, Quercioli A, Vincenti G, Nkoulou R, Dewarrat S, Rager O, Zaidi H, Seimbille Y, Mach F, Ratib O, Schindler TH. Structural epicardial disease and microvascular function are determinants of an abnormal longitudinal myocardial blood flow difference in cardiovascular risk individuals as determined with PET/CT. J Nucl Cardiol 2010; 17:1023-33. [PMID: 20658271 DOI: 10.1007/s12350-010-9272-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [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: 04/01/2010] [Accepted: 07/02/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to determine whether epicardial structural disease may affect the manifestation of a longitudinal decrease in myocardial blood flow (MBF) or MBF difference during hyperemia in cardiovascular risk individuals, and its dependency on the flow increase. METHODS AND RESULTS In 54 cardiovascular risk individuals (at risk) and in 26 healthy controls, MBF was measured with (13)N-ammonia and PET/CT in mL/g/min at rest and during dipyridamole stimulation. Computed tomography coronary angiography (CTA) was performed using a 64-slice CT of a PET/CT system. Absolute MBFs during dipyridamole stimulation were mildly lower in the mid-distal than in the mid-LV myocardium in controls (2.20 ± .51 vs 2.29 ± .51, P < .0001), while it was more pronounced in at risk with normal and abnormal CTA (1.56 ± .42 vs 1.91 ± .46 and 1.18 ± .34 vs 1.51 ± .40 mL/g/min, respectively, P < .0001), resulting in a longitudinal MBF difference that was highest in at risk with normal CTA, intermediate in at risk abnormal CTA, and lowest in controls (.35 ± .16 and .22 ± .09 vs .09 ± .04 mL/g/min, respectively, P < .0001). On multivariate analysis, log-CCS and mid-LV hyperemic MBF increase, indicative of microvascular function, were independent predictors of the observed longitudinal MBF difference (P ≤ .004 by ANOVA). CONCLUSIONS Epicardial structural disease and microvascular function are important determinants of an abnormal longitudinal MBF difference as determined with PET/CT.
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Affiliation(s)
- Ines Valenta
- Department of Internal Medicine, Cardiovascular Center, Nuclear Cardiology, University Hospital of Geneva, Geneva, Switzerland
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