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Grubmüller B, Huebner NA, Rasul S, Clauser P, Pötsch N, Grubmüller KH, Hacker M, Hartenbach S, Shariat SF, Hartenbach M, Baltzer P. Dual-Tracer PET-MRI-Derived Imaging Biomarkers for Prediction of Clinically Significant Prostate Cancer. Curr Oncol 2023; 30:1683-1691. [PMID: 36826090 PMCID: PMC9954891 DOI: 10.3390/curroncol30020129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate if imaging biomarkers derived from 3-Tesla dual-tracer [(18)F]fluoromethylcholine (FMC) and [68Ga]Ga-PSMAHBED-CC conjugate 11 (PSMA)-positron emission tomography can adequately predict clinically significant prostate cancer (csPC). METHODS We assessed 77 biopsy-proven PC patients who underwent 3T dual-tracer PET/mpMRI followed by radical prostatectomy (RP) between 2014 and 2017. We performed a retrospective lesion-based analysis of all cancer foci and compared it to whole-mount histopathology of the RP specimen. The primary aim was to investigate the pretherapeutic role of the imaging biomarkers FMC- and PSMA-maximum standardized uptake values (SUVmax) for the prediction of csPC and to compare it to the mpMRI-methods and PI-RADS score. RESULTS Overall, we identified 104 cancer foci, 69 were clinically significant (66.3%) and 35 were clinically insignificant (33.7%). We found that the combined FMC+PSMA SUVmax were the only significant parameters (p < 0.001 and p = 0.049) for the prediction of csPC. ROC analysis showed an AUC for the prediction of csPC of 0.695 for PI-RADS scoring (95% CI 0.591 to 0.786), 0.792 for FMC SUVmax (95% CI 0.696 to 0.869), 0.852 for FMC+PSMA SUVmax (95% CI 0.764 to 0.917), and 0.852 for the multivariable CHAID model (95% CI 0.763 to 0.916). Comparing the AUCs, we found that FMC+PSMA SUVmax and the multivariable model were significantly more accurate for the prediction of csPC compared to PI-RADS scoring (p = 0.0123, p = 0.0253, respectively). CONCLUSIONS Combined FMC+PSMA SUVmax seems to be a reliable parameter for the prediction of csPC and might overcome the limitations of PI-RADS scoring. Further prospective studies are necessary to confirm these promising preliminary results.
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Affiliation(s)
- Bernhard Grubmüller
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
- Department of Urology and Andrology, University Hospital Krems, 3500 Krems, Austria
- Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
- Working Group of Diagnostic Imaging in Urology, Austrian Society of Urology, 1090 Vienna, Austria
| | - Nicolai A. Huebner
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
- Working Group of Diagnostic Imaging in Urology, Austrian Society of Urology, 1090 Vienna, Austria
| | - Sazan Rasul
- Department of Biomedical Imaging and Image Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Nina Pötsch
- Department of Biomedical Imaging and Image Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Karl Hermann Grubmüller
- Department of Urology and Andrology, University Hospital Krems, 3500 Krems, Austria
- Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Department of Urology, Weill Medical College of Cornell University, New York, NY 10021, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Urology, Second Faculty of Medicine, Charles University, 116 36 Prague, Czech Republic
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman 19328, Jordan
- Karl Landsteiner Institute of Urology and Andrology, 1010 Vienna, Austria
| | - Markus Hartenbach
- Department of Biomedical Imaging and Image Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Pascal Baltzer
- Department of Biomedical Imaging and Image Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
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2
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Papp L, Spielvogel CP, Grubmüller B, Grahovac M, Krajnc D, Ecsedi B, Sareshgi RAM, Mohamad D, Hamboeck M, Rausch I, Mitterhauser M, Wadsak W, Haug AR, Kenner L, Mazal P, Susani M, Hartenbach S, Baltzer P, Helbich TH, Kramer G, Shariat SF, Beyer T, Hartenbach M, Hacker M. Supervised machine learning enables non-invasive lesion characterization in primary prostate cancer with [ 68Ga]Ga-PSMA-11 PET/MRI. Eur J Nucl Med Mol Imaging 2021; 48:1795-1805. [PMID: 33341915 PMCID: PMC8113201 DOI: 10.1007/s00259-020-05140-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/29/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Risk classification of primary prostate cancer in clinical routine is mainly based on prostate-specific antigen (PSA) levels, Gleason scores from biopsy samples, and tumor-nodes-metastasis (TNM) staging. This study aimed to investigate the diagnostic performance of positron emission tomography/magnetic resonance imaging (PET/MRI) in vivo models for predicting low-vs-high lesion risk (LH) as well as biochemical recurrence (BCR) and overall patient risk (OPR) with machine learning. METHODS Fifty-two patients who underwent multi-parametric dual-tracer [18F]FMC and [68Ga]Ga-PSMA-11 PET/MRI as well as radical prostatectomy between 2014 and 2015 were included as part of a single-center pilot to a randomized prospective trial (NCT02659527). Radiomics in combination with ensemble machine learning was applied including the [68Ga]Ga-PSMA-11 PET, the apparent diffusion coefficient, and the transverse relaxation time-weighted MRI scans of each patient to establish a low-vs-high risk lesion prediction model (MLH). Furthermore, MBCR and MOPR predictive model schemes were built by combining MLH, PSA, and clinical stage values of patients. Performance evaluation of the established models was performed with 1000-fold Monte Carlo (MC) cross-validation. Results were additionally compared to conventional [68Ga]Ga-PSMA-11 standardized uptake value (SUV) analyses. RESULTS The area under the receiver operator characteristic curve (AUC) of the MLH model (0.86) was higher than the AUC of the [68Ga]Ga-PSMA-11 SUVmax analysis (0.80). MC cross-validation revealed 89% and 91% accuracies with 0.90 and 0.94 AUCs for the MBCR and MOPR models respectively, while standard routine analysis based on PSA, biopsy Gleason score, and TNM staging resulted in 69% and 70% accuracies to predict BCR and OPR respectively. CONCLUSION Our results demonstrate the potential to enhance risk classification in primary prostate cancer patients built on PET/MRI radiomics and machine learning without biopsy sampling.
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Affiliation(s)
- L Papp
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - C P Spielvogel
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Applied Metabolomics, Vienna, Austria
| | - B Grubmüller
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - M Grahovac
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - D Krajnc
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - B Ecsedi
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - R A M Sareshgi
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - D Mohamad
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - M Hamboeck
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - I Rausch
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - M Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - A R Haug
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Applied Metabolomics, Vienna, Austria
| | - L Kenner
- Christian Doppler Laboratory for Applied Metabolomics, Vienna, Austria
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - P Mazal
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - M Susani
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | | | - P Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Common General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - T H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Common General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - G Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - S F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - T Beyer
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - M Hartenbach
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - M Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Aksoy O, Pencik J, Hartenbach M, Moazzami AA, Schlederer M, Balber T, Varady A, Philippe C, Baltzer PA, Mazumder B, Whitchurch JB, Roberts CJ, Haitel A, Herac M, Susani M, Mitterhauser M, Marculescu R, Stangl-Kremser J, Hassler MR, Kramer G, Shariat SF, Turner SD, Tichy B, Oppelt J, Pospisilova S, Hartenbach S, Tangermann S, Egger G, Neubauer HA, Moriggl R, Culig Z, Greiner G, Hoermann G, Hacker M, Heery DM, Merkel O, Kenner L. Thyroid and androgen receptor signaling are antagonized by μ-Crystallin in prostate cancer. Int J Cancer 2020; 148:731-747. [PMID: 33034050 PMCID: PMC7756625 DOI: 10.1002/ijc.33332] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 07/23/2020] [Accepted: 09/02/2020] [Indexed: 12/29/2022]
Abstract
Androgen deprivation therapy (ADT) remains a key approach in the treatment of prostate cancer (PCa). However, PCa inevitably relapses and becomes ADT resistant. Besides androgens, there is evidence that thyroid hormone thyroxine (T4) and its active form 3,5,3'-triiodo-L-thyronine (T3) are involved in the progression of PCa. Epidemiologic evidences show a higher incidence of PCa in men with elevated thyroid hormone levels. The thyroid hormone binding protein μ-Crystallin (CRYM) mediates intracellular thyroid hormone action by sequestering T3 and blocks its binding to cognate receptors (TRα/TRβ) in target tissues. We show in our study that low CRYM expression levels in PCa patients are associated with early biochemical recurrence and poor prognosis. Moreover, we found a disease stage-specific expression of CRYM in PCa. CRYM counteracted thyroid and androgen signaling and blocked intracellular choline uptake. CRYM inversely correlated with [18F]fluoromethylcholine (FMC) levels in positron emission tomography/magnetic resonance imaging of PCa patients. Our data suggest CRYM as a novel antagonist of T3- and androgen-mediated signaling in PCa. The role of CRYM could therefore be an essential control mechanism for the prevention of aggressive PCa growth.
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Affiliation(s)
- Osman Aksoy
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - Jan Pencik
- Department of Pathology, Medical University Vienna, Vienna, Austria.,Center for Biomarker Research in Medicine (CBmed), Graz, Austria.,Present address: Jan Pencik, Molecular and Cell Biology Laboratory, The Salk Institute for Biological Studies, La Jolla, California, USA
| | - Markus Hartenbach
- Department of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Ali A Moazzami
- Department of Molecular Sciences, Uppsala BioCenter, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | | | - Theresa Balber
- Department of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, Vienna, Austria.,Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria.,Department for Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Vienna, Austria
| | - Adam Varady
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - Cecile Philippe
- Department of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Pascal A Baltzer
- Department of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Bismoy Mazumder
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | | | | | - Andrea Haitel
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - Merima Herac
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - Martin Susani
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - Markus Mitterhauser
- Department of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, Vienna, Austria.,Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria
| | | | | | - Gero Kramer
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University Vienna, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Departments of Urology, Weill Cornell Medical College, New York, New York, USA.,Department of Urology, University of Texas Southwestern, Dallas, Texas, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK.,Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Boris Tichy
- Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Jan Oppelt
- Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Sarka Pospisilova
- Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Sabrina Hartenbach
- Histo Consulting Inc., Ulm, Germany.,Department of Pathology, Rudolfinerhaus Privatklinik Gmbh, Vienna, Austria
| | - Simone Tangermann
- Unit for Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Gerda Egger
- Department of Pathology, Medical University Vienna, Vienna, Austria.,Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria
| | - Heidi A Neubauer
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Richard Moriggl
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Zoran Culig
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria
| | - Georg Greiner
- Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria
| | - Gregor Hoermann
- Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria.,MLL Munich Leukemia Laboratory, Munich, Germany
| | - Marcus Hacker
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria.,Department of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, Vienna, Austria
| | - David M Heery
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Olaf Merkel
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - Lukas Kenner
- Department of Pathology, Medical University Vienna, Vienna, Austria.,Center for Biomarker Research in Medicine (CBmed), Graz, Austria.,Unit for Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Vienna, Austria.,Christian Doppler Laboratory for Applied Metabolomics (CDL-AM), Medical University of Vienna, Vienna, Austria
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4
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Faisal M, Hartenbach S, Schratter A, Köstler WJ, Kaufmann H, Seemann R, Lill C, Hamzavi S, Wutzl A, Erovic BM. Lymphoepithelial Carcinoma of Larynx and Hypopharynx: A Rare Clinicopathological Entity. Cancers (Basel) 2020; 12:cancers12092431. [PMID: 32867094 PMCID: PMC7565469 DOI: 10.3390/cancers12092431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/18/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/05/2022] Open
Abstract
(1) Background: Lymphoepithelial carcinoma of the hypopharynx and larynx is a rare tumor with fewer than 50 cases in the published literature. We present a literature review to discuss the clinical findings, viral or genetic associations, diagnostic challenges, histopathological findings and therapeutic aspects of the disease. (2) Methods: A comprehensive literature review was performed through MEDLINE/PubMed from 1968 to 2018. We identified 21 studies comprising 46 patients. Data on all the clinicopathological features, diagnostic modalities, treatment options and viral or genetic etiology were extracted and analyzed using SPSS. (3) Results: The mean age of presentation was 64 years (range 40–82 years) and mostly involved males. The supraglottis and pyriform sinus were the most commonly involved sub-sites, with surgery as the preferred treatment modality. The presence of the Epstein–Barr virus possibly directs a viral etiology. The incidence of cervical and distant metastasis was 54% and 21%, respectively. The median survival time was 30 months. (4) Conclusions: Lymphoepithelial carcinoma of the hypopharynx is an aggressive tumor with a strong predilection for regional and distant metastasis. Surgery, in combination with adjuvant therapy, provides promising results. Immunohistochemistry helps in differentiating LEC from other pathologies.
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Affiliation(s)
- Muhammad Faisal
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria; (M.F.); (R.S.); (C.L.); (S.H.); (A.W.)
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore 54000, Pakistan;
| | - Sabrina Hartenbach
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore 54000, Pakistan;
| | - Annemarie Schratter
- Institute of Radio-Oncology, Kaiser-Franz-Josef Hospital, 1180 Vienna, Austria;
| | - Wolfgang J. Köstler
- Clinical Division of Oncology, Department of Medicine, Comprehensive Cancer Center, Medical University of Vienna, 1180 Vienna, Austria;
| | - Hannes Kaufmann
- Clinical Oncology and Hematology, Kaiser-Franz-Josef Hospital, 1180 Vienna, Austria;
| | - Rudolf Seemann
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria; (M.F.); (R.S.); (C.L.); (S.H.); (A.W.)
| | - Claudia Lill
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria; (M.F.); (R.S.); (C.L.); (S.H.); (A.W.)
| | - Sasan Hamzavi
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria; (M.F.); (R.S.); (C.L.); (S.H.); (A.W.)
| | - Arno Wutzl
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria; (M.F.); (R.S.); (C.L.); (S.H.); (A.W.)
| | - Boban M. Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria; (M.F.); (R.S.); (C.L.); (S.H.); (A.W.)
- Correspondence: ; Tel.: +43-1-404-224-518
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5
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Grubmüller B, Baltzer P, Hartenbach S, D'Andrea D, Helbich TH, Haug AR, Goldner GM, Wadsak W, Pfaff S, Mitterhauser M, Balber T, Berroteran-Infante N, Grahovac M, Babich J, Seitz C, Kramer G, Susani M, Mazal P, Kenner L, Shariat SF, Hacker M, Hartenbach M. PSMA Ligand PET/MRI for Primary Prostate Cancer: Staging Performance and Clinical Impact. Clin Cancer Res 2018; 24:6300-6307. [PMID: 30139879 DOI: 10.1158/1078-0432.ccr-18-0768] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/11/2018] [Accepted: 08/20/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Primary staging of prostate cancer relies on modalities, which are limited. We evaluate simultaneous [68Ga]Ga-PSMA-11 PET (PSMA-PET)/MRI as a new diagnostic method for primary tumor-node-metastasis staging compared with histology and its impact on therapeutic decisions. EXPERIMENTAL DESIGN We investigated 122 patients with PSMA-PET/MRI prior to planned radical prostatectomy (RP). Primary endpoint was the accuracy of PSMA-PET/MRI in tumor staging as compared with staging-relevant histology. In addition, a multidisciplinary team reassessed the initial therapeutic approach to evaluate its impact on the therapeutic management. RESULTS PSMA-PET/MRI correctly identified prostate cancer in 119 of 122 patients (97.5%). Eighty-one patients were treated with RP and pelvic lymphadenectomy. The accuracy for T staging was 82.5% [95% confidence interval (CI), 73-90; P < 0.001], for T2 stage was 85% (95% CI, 71-94; P < 0.001), for T3a stage was 79% (95% CI, 43-85; P < 0.001), for T3b stage was 94% (95% CI, 73-100; P < 0.001), and for N1 stage was 93% (95% CI, 84-98; P < 0.001). PSMA-PET/MRI changed the therapeutic strategy in 28.7% of the patients with either the onset of systemic therapy/radiotherapy (n = 16) or active surveillance (n = 19). CONCLUSIONS PSMA-PET/MRI can provide an accurate staging of newly diagnosed prostate cancer. In addition, treatment strategies were changed in almost a third of the patients due to the information of this hybrid imaging technique.
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Affiliation(s)
| | - Pascal Baltzer
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alexander R Haug
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gregor M Goldner
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Wadsak
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria.,Center for Biomarker Research in Medicine, CBmed GmbH, Graz, Austria
| | - Sarah Pfaff
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Markus Mitterhauser
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Applied Diagnostics, Vienna, Austria
| | - Theresa Balber
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Neydher Berroteran-Infante
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Marko Grahovac
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - John Babich
- Division of Radiopharmaceutical Sciences, Department of Radiology, Weill Medical College of Cornell University, New York, New York
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Martin Susani
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Peter Mazal
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Lukas Kenner
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.,Department of Experimental and Laboratory Animal Pathology, Medical University of Vienna, Vienna, Austria.,Institute of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, University of Texas Southwestern, Dallas, Texas.,Department of Urology and Division of Medical Oncology, Weill Medical College of Cornell University, New York, New York
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Markus Hartenbach
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria.
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6
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Hartenbach M, Weber S, Albert NL, Hartenbach S, Hirtl A, Zacherl MJ, Paprottka PM, Tiling R, Bartenstein P, Hacker M, Haug AR. Evaluating Treatment Response of Radioembolization in Intermediate-Stage Hepatocellular Carcinoma Patients Using 18F-Fluoroethylcholine PET/CT. J Nucl Med 2015; 56:1661-6. [PMID: 26405170 DOI: 10.2967/jnumed.115.158758] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 04/20/2015] [Accepted: 08/17/2015] [Indexed: 12/15/2022] Open
Abstract
UNLABELLED The aim of this study was to evaluate (18)F-fluoroethylcholine PET/CT as a metabolic imaging technique for the assessment of treatment response to (90)Y radioembolization in patients with locally advanced hepatocellular carcinoma (HCC). METHODS Thirty-four HCC patients undergoing 78 (18)F-fluoroethylcholine PET/CT scans were identified for this study. Patients with initial or follow-up metastastic disease (n = 9) were excluded at the time point of the metastatic occurrence as well as patients with negative α-fetoprotein (AFP; n = 1), resulting in 24 patients and 57 scans that were eligible. All patients were scheduled for radioembolization and underwent 1 pretherapeutic and at least 1 posttherapeutic (18)F-fluoroethylcholine PET/CT scan. Volume-of-interest analysis and volume-of-interest subtractions were performed. Maximum, mean, and peak standardized uptake value (SUV) analysis was performed, and the total intrahepatic (18)F-fluoroethylcholine positive tumor volume (FEC-PTV) and tumor-to-background ratio were assessed. Statistical analysis was performed using a decreasing AFP of at least 20% as a standard of reference for therapy response including receiver-operating-characteristic analyses as well as descriptive and correlation analyses and multiple logistic regression. RESULTS Fourteen follow-up examinations were categorized as responder and 19 follow-up examinations as nonresponder. Absolute AFP values did not correlate with SUV parameters (P = 0.055). In receiver-operating-characteristic analyses, the initial mean SUV, Δmaximum SUV, and Δtumor-to-background ratio demonstrated the highest area under the curve, 0.84 (P = 0.009), 0.83 (P = 0.011), and 0.83 (P = 0.012), respectively, resulting in a positive prediction of 82%, 83%, and 91% at the respective cutoff points. When multiple logistic regression analysis was applied, this resulted in an area under the curve of 0.90 (P = 0.001), with a positive prediction of 94% and a sensitivity of 94%. The FEC-PTV did not reach significance in the presented dataset. CONCLUSION (18)F-fluoroethylcholine PET/CT demonstrates a high potential for follow-up assessment in the context of radioembolization in patients with locally advanced, but nonmetastatic, HCC and initially elevated AFP, possibly enabling early therapy monitoring independent of morphology.
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Affiliation(s)
- Markus Hartenbach
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Weber
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Sabrina Hartenbach
- Institute of Pathology, German Armed Forces Hospital Ulm, Ulm, Germany; and
| | - Albert Hirtl
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Mathias J Zacherl
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Philipp M Paprottka
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Reinhold Tiling
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alexander R Haug
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
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Hartenbach M, Delker A, Hartenbach S, Schlichtiger J, Niedermoser S, Wängler C, Wängler B, Böning G, Gildehaus FJ, Neumaier K, Lauber K, Kraft K, Belka C, Hacker M, Meineke V, Bartenstein P. Dose-dependent uptake of 3'-deoxy-3'-[(18) F]fluorothymidine by the bowel after total-body irradiation. Mol Imaging Biol 2014; 16:846-53. [PMID: 24915935 DOI: 10.1007/s11307-014-0755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study is to non-invasively assess early, irradiation-induced normal tissue alterations via metabolic imaging with 3'-deoxy-3'-[(18) F]fluorothymidine ([(18) F]FLT). PROCEDURES Twenty-nine male C57BL/6 mice were investigated by [(18) F]FLT positron emission tomography for 7 days after total body irradiation (1, 4, and 8 Gy) versus 'sham' irradiation (0 Gy). Target/background ratios were determined. The imaging results were validated by histology and immunohistochemistry (Thymidine kinase 1, Ki-67). RESULTS [(18) F]FLT demonstrated a dose-dependent intestinal accumulation post irradiation. Mean target/background ratio (±standard error) 0 Gy: 1.4 (0.2), 1 Gy: 1.7 (0.1), 4 Gy: 3.1 (0.3), 8 Gy: 4.2 (0.6). Receiver operating characteristic analysis (area under the curve, p value): 0 vs. 1 Gy: 0.81, 0.049; 0 vs. 4 Gy: 1.0, 0.0016; and 0 vs. 8 Gy: 1.0, 0.0020. Immunohistochemistry confirmed the results. CONCLUSIONS [(18) F]FLT seems to provide dose-dependent information on radiation-induced proliferation in the bowel. This opens the perspective for monitoring therapy-related side-effects as well as assessing, e.g., radiation accident victims.
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Hartenbach M, Hartenbach S, Bechtloff W, Danz B, Kraft K, Klemenz B, Sparwasser C, Hacker M. Combined PET/MRI Improves Diagnostic Accuracy in Patients with Prostate Cancer: A Prospective Diagnostic Trial. Clin Cancer Res 2014; 20:3244-53. [DOI: 10.1158/1078-0432.ccr-13-2653] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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