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Covington MF, Hoffman JM, Morton KA, Buckway B, Boucher KM, Rosenthal RE, Porretta JM, Brownson KE, Matsen CB, Vaklavas C, Ward JH, Wei M, Buys SS, Chittoria N, Yakish ED, Archibald ZG, Burrell LD, Butterfield RI, Yap JT. Prospective Pilot Study of 18F-Fluoroestradiol PET/CT in Patients With Invasive Lobular Carcinomas. AJR Am J Roentgenol 2023; 221:228-239. [PMID: 36919879 DOI: 10.2214/ajr.22.28809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND. PET/CT with 18F-fluoroestradiol (FES) (FDA-approved in 2020) depicts tissues expressing estrogen receptor (ER). Invasive lobular carcinoma (ILC) is commonly ER positive. OBJECTIVE. The primary aim of this study was to assess the frequency with which sites of histologically proven ILC have abnormal uptake on FES PET/CT. METHODS. This prospective single-center pilot study, conducted from December 2020 to August 2021, enrolled patients with histologically confirmed ILC to undergo FES PET/CT; patients optionally underwent FDG PET/CT. Two nuclear radiologists assessed FES PET/CT and FDG PET/CT studies for abnormal uptake corresponding to known ILC sites at enrollment and for additional sites of abnormal uptake, resolving differences by consensus. The primary endpoint was percentage of known ILC sites showing abnormal FES uptake. The alternative to the null hypothesis was that more than 60% of sites would have abnormal FES uptake, exceeding the percentage of ILC with abnormal FDG uptake described in prior literature. A sample size of 24 biopsied lesions was preselected to provide 81% power for the alternative hypothesis (one-sided α = .10). Findings on FES PET/CT and FDG PET/CT were summarized for additional secondary endpoints. RESULTS. The final analysis included 17 patients (mean age, 59.1 ± 13.2 years) with 25 sites of histologically confirmed ILC at enrollment (22 breast lesions, two axillary lymph nodes, one distant metastasis). FES PET/CT showed abnormal uptake in 22 of 25 (88%) lesions, sufficient to reject the null hypothesis (p = .002). Thirteen patients underwent FDG PET/CT. Four of 23 (17%) sites of histologically confirmed ILC, including additional sites detected and confirmed after enrollment, were identified with FES PET/CT only, and 1 of 23 (4%) was identified only with FDG PET/CT (p = .18). FES PET/CT depicted additional lesions not detected with standard-of-care evaluation in 4 of 17 (24%) patients (two contralateral breast cancers and two metastatic axillary lymph nodes, all with subsequent histologic confirmation). Use of FES PET/CT resulted in changes in clinical stage with respect to standard-of-care evaluation in 3 of 17 (18%) patients. CONCLUSION. The primary endpoint of the trial was met. The frequency of abnormal FES uptake among sites of histologically known ILC was found to be to be significantly greater than 60%. CLINICAL IMPACT. This pilot study shows a potential role of FES PET/CT in evaluation of patients with ILC. TRIAL REGISTRATION. ClinicalTrials.gov NCT04252859.
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Affiliation(s)
- Matthew F Covington
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
| | - John M Hoffman
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
| | - Kathryn A Morton
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
- Present affiliation: Summit Physician Specialists, Murray, UT
| | - Brandon Buckway
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT
| | | | | | - Jane M Porretta
- Department of Surgery, University of Utah, Salt Lake City, UT
| | | | - Cindy B Matsen
- Department of Surgery, University of Utah, Salt Lake City, UT
| | - Christos Vaklavas
- Department of Internal Medicine, Oncology Division, University of Utah, Salt Lake City, UT
| | - John H Ward
- Department of Internal Medicine, Oncology Division, University of Utah, Salt Lake City, UT
| | - Mei Wei
- Department of Internal Medicine, Oncology Division, University of Utah, Salt Lake City, UT
| | - Saundra S Buys
- Department of Internal Medicine, Oncology Division, University of Utah, Salt Lake City, UT
| | - Namita Chittoria
- Department of Internal Medicine, Oncology Division, University of Utah, Salt Lake City, UT
| | - Ellen D Yakish
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
| | - Zane G Archibald
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
| | - Lance D Burrell
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
- Present affiliation: Society of Nuclear Medicine and Molecular Imaging, Reston, VA
| | - Regan I Butterfield
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
| | - Jeffrey T Yap
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
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Hammers DB, Suhrie K, Dixon A, Gradwohl BD, Archibald ZG, King JB, Spencer RJ, Duff K, Hoffman JM. Relationship between a novel learning slope metric and Alzheimer's disease biomarkers. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2022; 29:799-819. [PMID: 33952156 PMCID: PMC8568738 DOI: 10.1080/13825585.2021.1919984] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/18/2021] [Indexed: 01/07/2023]
Abstract
The Learning Ratio (LR) is a novel learning score examining the proportion of information learned over successive learning trials relative to information available to be learned. Validation is warranted to understand LR's sensitivity to Alzheimer's disease (AD) pathology. One-hundred twenty-three participants across the AD continuum underwent memory assessment, quantitative brain imaging, and genetic analysis. LR scores were calculated from the HVLT-R, BVMT-R, RBANS List Learning, and RBANS Story Memory, and compared to total hippocampal volumes,18F-Flutemetamol composite SUVR uptake, and APOE ε4 status. Lower LR scores were consistently associated with smaller total hippocampal volumes, greater cerebral β-amyloid deposition, and APOE ε4 positivity. This LR score outperformed a traditional learning slope calculation in all analyses. LR is sensitive to AD pathology along the AD continuum - more so than a traditional raw learning score - and reducing the competition between the first trial and subsequent trials can better depict learning capacity.
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Affiliation(s)
- Dustin B. Hammers
- Center for Alzheimer’s Care, Imaging, and Research, Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Kayla Suhrie
- Center for Alzheimer’s Care, Imaging, and Research, Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Ava Dixon
- Center for Alzheimer’s Care, Imaging, and Research, Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Brian D. Gradwohl
- Mercy Health Hauenstein Neurosciences, Mercy Health, Muskegon, MI, USA
| | - Zane G. Archibald
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jace B. King
- Utah Center for Advanced Imaging Research, Department of Radiology & Imaging Sciences, University of Utah, 729 Arapeen Drive, Salt Lake City, UT, USA
| | - Robert J. Spencer
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor MI, USA
- Michigan Medicine, Department of Psychiatry, Neuropsychology Section, Ann Arbor MI, USA
| | - Kevin Duff
- Center for Alzheimer’s Care, Imaging, and Research, Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - John M. Hoffman
- Center for Alzheimer’s Care, Imaging, and Research, Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Binneboese A, Covington MF, Horn KP, Archibald ZG, Boucher KM, Morton KA, Hoffman JM. Correlation between FDG-PET uptake and survival in patients with primary brain tumors. Am J Nucl Med Mol Imaging 2021; 11:196-206. [PMID: 34234998 PMCID: PMC8255218] [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: 01/28/2021] [Accepted: 05/07/2021] [Indexed: 06/13/2023]
Abstract
This study evaluates F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) semi-quantitative analysis as biomarker of tumor aggressiveness and predictor of survival in patients with primary brain tumors. Semi-quantitative analyses (SUVmax, SUVmean) were derived from FDG PET images in 78 patients with suspected recurrence of primary brain tumors based on MRI. SUVmax and the ratio of lesion SUVmax to the SUVmean of contralateral white matter (SUVmax/WM) were measured. A one-way Analysis of Variance (ANOVA), Kaplan-Meier analyses and the log rank test for evaluating statistical significance were utilized. There was statistical significance for time between FDG-PET and patient death. There was a significant difference with respect to FDG-PET time to death between patients with glioblastoma and patients with anaplastic oligodendroglioma, oligodendroglioma, and other histological subtypes. There is significant correlation with SUVmax/WM and patient survival following FDG-PET when a cut-point ratio of 1.90 is used. A 1.90 cut-point ratio of SUVmax/WM was associated with a difference in survival. GBM was associated with a significant difference in terms of reduced survival following FDG PET compared to most other histological sub-types. These results may inform current treatment and counseling strategies for patients with primary brain tumors.
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Affiliation(s)
- Adam Binneboese
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of UtahSalt Lake, UT, USA
- Huntsman Cancer Institute, University of UtahSalt Lake, UT, USA
| | - Matthew F Covington
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of UtahSalt Lake, UT, USA
- Huntsman Cancer Institute, University of UtahSalt Lake, UT, USA
- Department of Radiology and Imaging Sciences, University of UtahSalt Lake, UT, USA
| | - Kevin P Horn
- Division of Nuclear Medicine, Department of Radiology, University of WashingtonSeattle, WA, USA
| | | | - Kenneth M Boucher
- Huntsman Cancer Institute, University of UtahSalt Lake, UT, USA
- Department of Internal Medicine, University of UtahSalt Lake, UT, USA
| | - Kathryn A Morton
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of UtahSalt Lake, UT, USA
- Huntsman Cancer Institute, University of UtahSalt Lake, UT, USA
- Department of Radiology and Imaging Sciences, University of UtahSalt Lake, UT, USA
| | - John M Hoffman
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of UtahSalt Lake, UT, USA
- Huntsman Cancer Institute, University of UtahSalt Lake, UT, USA
- Department of Radiology and Imaging Sciences, University of UtahSalt Lake, UT, USA
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Hammers DB, Kucera A, Spencer RJ, Abildskov TJ, Archibald ZG, Hoffman JM, Wilde EA. Examining the Relationship between a Verbal Incidental Learning Measure from the WAIS-IV and Neuroimaging Biomarkers for Alzheimer's Pathology. Dev Neuropsychol 2020; 45:95-109. [PMID: 32374196 DOI: 10.1080/87565641.2020.1762602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Convergent validation of a verbal incidental learning (IL) task from the WAIS-IV using neuroimaging biomarkers is warranted to understand its sensitivity to Alzheimer's disease (AD) pathology. Fifty-five memory clinic patients aged 59 to 87 years received neuropsychological assessment, and measures of IL and quantitative brain imaging. Worse IL-Total Score and IL-Similarities performances were significantly associated with smaller hemispheric hippocampal volumes. IL measures were not significantly correlated with cerebral β-amyloid burden, though a trend was present and effect sizes were mild. These hippocampal volume results suggest that this IL task may be sensitive to AD pathology along the AD continuum.
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Affiliation(s)
- Dustin B Hammers
- Center for Alzheimer's Care, Imaging, and Research, Department of Neurology, University of Utah , Salt Lake City, UT, USA
| | - Amanda Kucera
- University of Utah Health Care , Salt Lake City, UT, USA
| | - Robert J Spencer
- Mental Health Service, VA Ann Arbor Healthcare System , Ann Arbor, MI, USA
| | - Tracy J Abildskov
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah , Salt Lake City, UT, USA
| | - Zane G Archibald
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah , Salt Lake City, UT, USA
| | - John M Hoffman
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah , Salt Lake City, UT, USA
| | - Elizabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah , Salt Lake City, UT, USA.,George E. Wahlen Veterans Affairs Medical Center , Salt Lake City, UT, USA
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