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Bennett R, Li EV, Ho AY, Aguiar JA, Neill C, Rowe SP, Patel HD, Savas H, Ross AE. Implementation of PSMA PET/CT and alignment of ordering to SNMMI appropriate use criteria in a large network system. Prostate 2024; 84:717-722. [PMID: 38450787 DOI: 10.1002/pros.24687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/09/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION The Society of Nuclear Medicine and Molecular Imaging (SNMMI) provides appropriate use criteria (AUC) for prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) which include guidance on imaging in newly diagnosed prostate cancer and in patients with biochemically recurrent (BCR) disease. This study aims to examine trends in PSMA implementation and the prevalence and outcomes of scans ordered in scenarios deemed rarely appropriate or not meeting SNMMI AUC. METHODS We retrospectively identified patients who were diagnosed with presumptive National Comprehensive Cancer Network unfavorable intermediate, high, or very high risk prostate cancer, patients who underwent staging for BCR, and all patients staged with PSMA between July 2021 and March 2023. Positivity was validated by adherence to a predetermined reference standard. RESULTS The frequency of PSMA use increased in initial staging from 24% to 80% and work-up of BCR from 91% to 99% over our study period. In addition, 5% (17/340) of PSMA scans ordered for initial staging did not meet AUC and 3% (15/557) of posttreatment scans were deemed rarely appropriate. Initial staging orders not meeting SNMMI AUC resulted in no positivity (0/17), while rarely appropriate posttreatment scans were falsely positive in 75% (3/4) of cases. Urologists (53%, 17/32) comprised the largest ordering specialty in rarely appropriate use. CONCLUSION The frequency of PSMA use rose across the study period. A significant minority of patients received PSMA PET/CT in rarely appropriate scenarios yielding no positivity in initial staging and significant false positivity post-therapy. Further education of providers and electronic medical record-based interventions could help limit the rarely appropriate use of PET imaging.
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Affiliation(s)
- Richard Bennett
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Eric V Li
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Austin Y Ho
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jonathan A Aguiar
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Clayton Neill
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Steven P Rowe
- Molecular Imaging and Therapeutics, Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hiten D Patel
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Hatice Savas
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ashley E Ross
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Paiella S, Landoni L, Tebaldi S, Zuffante M, Salgarello M, Cingarlini S, D'Onofrio M, Parisi A, Deiro G, Manfrin E, Bianchi B, Montagnini G, Crinò SF, Bassi C, Salvia R. Dual-Tracer (68Ga-DOTATOC and 18F-FDG-)-PET/CT Scan and G1-G2 Nonfunctioning Pancreatic Neuroendocrine Tumors: A Single-Center Retrospective Evaluation of 124 Nonmetastatic Resected Cases. Neuroendocrinology 2022; 112:143-152. [PMID: 33508821 DOI: 10.1159/000514809] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/28/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The combined use of 68gallium (68Ga)-DOTA-peptides and 18fluorine-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) scans in the workup of pancreatic neuroendocrine tumors (PanNETs) is controversial. This study aimed at assessing both tracers' capability to identify tumors and to assess its association with pathological predictors of recurrence. METHODS Prospectively collected, preoperative, dual-tracer PET/CT scan data of G1-G2, nonmetastatic, PanNETs that underwent surgery between January 2013 and October 2019 were retrospectively analyzed. RESULTS The final cohort consisted of 124 cases. There was an approximately equal distribution of males and females (50.8%/49.2%) and G1 and G2 tumors (49.2%/50.8%). The disease was detected in 122 (98.4%) and 64 (51.6%) cases by 68Ga-DOTATOC and by 18F-FDG PET/CT scans, respectively, with a combined sensitivity of 99.2%. 18F-FDG-positive examinations found G2 tumors more often than G1 (59.4 vs. 40.6%; p = 0.036), and 18F-FDG-positive PanNETs were larger than negative ones (median tumor size 32 mm, interquartile range [IQR] 21 vs. 26 mm, IQR 20; p = 0.019). The median Ki67 for 18F-FDG-positive and -negative examinations was 3 (IQR 4) and 2 (IQR 4), respectively (p = 0.029). At least 1 pathological predictor of recurrence was present in 74.6% of 18F-FDG-positive cases (vs. 56.7%; p = 0.039), whereas this was not found when dichotomizing the PanNETs by their dimensions (≤/>20 mm). None of the 2 tracers predicted nodal metastasis. The receiver operating characteristic curve analysis showed that 18F-FDG uptake higher than 4.2 had a sensitivity of 49.2% and specificity of 73.3% for differentiating G1 from G2 (AUC = 0.624, p = 0.009). CONCLUSION The complementary adoption of 68Ga-DOTATOC and 18F-FDG tracers may be valuable in the diagnostic workup of PanNETs despite not being a game-changer for the management of PanNETs ≤20 mm.
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Affiliation(s)
- Salvatore Paiella
- Pancreas Institute, General and Pancreatic Surgery Unit, University of Verona Hospital Trust, Verona, Italy
| | - Luca Landoni
- Pancreas Institute, General and Pancreatic Surgery Unit, University of Verona Hospital Trust, Verona, Italy
| | - Sarah Tebaldi
- Pancreas Institute, General and Pancreatic Surgery Unit, University of Verona Hospital Trust, Verona, Italy
| | - Michele Zuffante
- Nuclear Medicine Unit, Integrated University Hospital of Verona, Verona, Italy
| | - Matteo Salgarello
- Department of Nuclear Medicine, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Sara Cingarlini
- Pancreas Institute, Oncology Unit, University of Verona Hospital Trust, Verona, Italy
| | - Mirko D'Onofrio
- Pancreas Institute, Radiology Unit, University of Verona Hospital Trust, Verona, Italy
| | - Alice Parisi
- Pancreas Institute, Department of Diagnostics and Public Health, Section of Pathology, University Verona Hospital Trust, Verona, Italy
| | - Giacomo Deiro
- Pancreas Institute, General and Pancreatic Surgery Unit, University of Verona Hospital Trust, Verona, Italy
| | - Erminia Manfrin
- Pancreas Institute, Department of Diagnostics and Public Health, Section of Pathology, University Verona Hospital Trust, Verona, Italy
| | - Beatrice Bianchi
- Pancreas Institute, General and Pancreatic Surgery Unit, University of Verona Hospital Trust, Verona, Italy
| | - Greta Montagnini
- Pancreas Institute, General and Pancreatic Surgery Unit, University of Verona Hospital Trust, Verona, Italy
| | - Stefano Francesco Crinò
- Pancreas Institute, Gastroenterology and Digestive Endoscopy Unit, University of Verona Hospital Trust, Verona, Italy
| | - Claudio Bassi
- Pancreas Institute, General and Pancreatic Surgery Unit, University of Verona Hospital Trust, Verona, Italy
| | - Roberto Salvia
- Pancreas Institute, General and Pancreatic Surgery Unit, University of Verona Hospital Trust, Verona, Italy
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Schwartz RG, Vidula H. 2020 vision: New insights on hypoxia imaging to assess cardiac and extra-cardiac active inflammatory sarcoidosis. J Nucl Cardiol 2021; 28:2149-2150. [PMID: 32034664 DOI: 10.1007/s12350-020-02032-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ronald G Schwartz
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, AC-G, Rochester, NY, 14642-8679, USA.
- Division of Nuclear Medicine, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Himabindu Vidula
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, AC-G, Rochester, NY, 14642-8679, USA
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Wahadat AR, Tanis W, Swart LE, Scholtens A, Krestin GP, van Mieghem NMDA, Schurink CAM, van der Spoel TIG, van den Brink FS, Vossenberg T, Slart RHJA, Glaudemans AWJM, Roos-Hesselink JW, Budde RPJ. Added value of 18F-FDG-PET/CT and cardiac CTA in suspected transcatheter aortic valve endocarditis. J Nucl Cardiol 2021; 28:2072-2082. [PMID: 31792918 PMCID: PMC8648682 DOI: 10.1007/s12350-019-01963-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/05/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUNDS Transcatheter-implanted aortic valve infective endocarditis (TAVI-IE) is difficult to diagnose when relying on the Duke Criteria. Our aim was to assess the additional diagnostic value of 18F-fluorodeoxyglucose (18F-FDG) positron emission/computed tomography (PET/CT) and cardiac computed tomography angiography (CTA) in suspected TAVI-IE. METHODS A multicenter retrospective analysis was performed in all patients who underwent 18F-FDG-PET/CT and/or CTA with suspected TAVI-IE. Patients were first classified with Duke Criteria and after adding 18F-FDG-PET/CT and CTA, they were classified with European Society of Cardiology (ESC) criteria. The final diagnosis was determined by our Endocarditis Team based on ESC guideline recommendations. RESULTS Thirty patients with suspected TAVI-IE were included. 18F-FDG-PET/CT was performed in all patients and Cardiac CTA in 14/30. Using the Modified Duke Criteria, patients were classified as 3% rejected (1/30), 73% possible (22/30), and 23% definite (7/30) TAVI-IE. Adding 18F-FDG-PET/CT and CTA supported the reclassification of 10 of the 22 possible cases as "definite TAVI-IE" (5/22) or "rejected TAVI-IE" (5/22). This changed the final diagnosis to 20% rejected (6/30), 40% possible (12/30), and 40% definite (12/30) TAVI-IE. CONCLUSIONS Addition of 18F-FDG-PET/CT and/or CTA changed the final diagnosis in 33% of patients and proved to be a valuable diagnostic tool in patients with suspected TAVI-IE.
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Affiliation(s)
- Ali R Wahadat
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands.
- Departments Radiology, Erasmus MC, NA-2618, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands.
| | - Wilco Tanis
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Laurens E Swart
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Asbjørn Scholtens
- Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Carolina A M Schurink
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tycho I G van der Spoel
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
- Department of Cardiology, Utrecht Medical Center, Utrecht, The Netherlands
| | - Floris S van den Brink
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Cardiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Tessel Vossenberg
- Department of Cardiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine & Molecular Imaging, Medical Imaging Center, University Medical Center of Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine & Molecular Imaging, Medical Imaging Center, University Medical Center of Groningen, Groningen, The Netherlands
| | | | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Robson PM, Vergani V, Benkert T, Trivieri MG, Karakatsanis NA, Abgral R, Dweck MR, Moreno PR, Kovacic JC, Block KT, Fayad ZA. Assessing the qualitative and quantitative impacts of simple two-class vs multiple tissue-class MR-based attenuation correction for cardiac PET/MR. J Nucl Cardiol 2021; 28:2194-2204. [PMID: 31898004 PMCID: PMC7329599 DOI: 10.1007/s12350-019-02002-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hybrid PET/MR imaging has significant potential in cardiology due to its combination of molecular PET imaging and cardiac MR. Multi-tissue-class MR-based attenuation correction (MRAC) is necessary for accurate PET quantification. Moreover, for thoracic PET imaging, respiration is known to lead to misalignments of MRAC and PET data that result in PET artifacts. These factors can be addressed by using multi-echo MR for tissue segmentation and motion-robust or motion-gated acquisitions. However, the combination of these strategies is not routinely available and can be prone to errors. In this study, we examine the qualitative and quantitative impacts of multi-class MRAC compared to a more widely available simple two-class MRAC for cardiac PET/MR. METHODS AND RESULTS In a cohort of patients with cardiac sarcoidosis, we acquired MRAC data using multi-echo radial gradient-echo MR imaging. Water-fat separation was used to produce attenuation maps with up to 4 tissue classes including water-based soft tissue, fat, lung, and background air. Simultaneously acquired 18F-fluorodeoxyglucose PET data were subsequently reconstructed using each attenuation map separately. PET uptake values were measured in the myocardium and compared between different PET images. The inclusion of lung and subcutaneous fat in the MRAC maps significantly affected the quantification of 18F-fluorodeoxyglucose activity in the myocardium but only moderately altered the appearance of the PET image without introduction of image artifacts. CONCLUSION Optimal MRAC for cardiac PET/MR applications should include segmentation of all tissues in combination with compensation for the respiratory-related motion of the heart. Simple two-class MRAC is adequate for qualitative clinical assessment.
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Affiliation(s)
- Philip M Robson
- Translational and Molecular Imaging Institute, Leon and Norma Hess Center for Science and Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Pl, 1470 Madison Ave, TMII - 1st floor, New York, NY, 10029, USA.
| | - Vittoria Vergani
- Translational and Molecular Imaging Institute, Leon and Norma Hess Center for Science and Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Pl, 1470 Madison Ave, TMII - 1st floor, New York, NY, 10029, USA
- Cardiothoracic and Vascular Department, Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | - Thomas Benkert
- Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University School of Medicine, New York, NY, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Maria Giovanna Trivieri
- Translational and Molecular Imaging Institute, Leon and Norma Hess Center for Science and Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Pl, 1470 Madison Ave, TMII - 1st floor, New York, NY, 10029, USA
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Pl, New York, NY, 10029, USA
| | - Nicolas A Karakatsanis
- Translational and Molecular Imaging Institute, Leon and Norma Hess Center for Science and Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Pl, 1470 Madison Ave, TMII - 1st floor, New York, NY, 10029, USA
- Division of Radiopharmaceutical Sciences, Department of Radiology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Ronan Abgral
- Department of Nuclear Medicine, University Hospital of Brest, European University of Brittany, EA3878 GETBO, Brest, France
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Pedro R Moreno
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Pl, New York, NY, 10029, USA
| | - Jason C Kovacic
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Pl, New York, NY, 10029, USA
| | - Kai Tobias Block
- Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University School of Medicine, New York, NY, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Leon and Norma Hess Center for Science and Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Pl, 1470 Madison Ave, TMII - 1st floor, New York, NY, 10029, USA
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Treglia G, Slart RHJA, Glaudemans AWJM. Diagnostic performance and image interpretation of 18F-FDG PET/CT in aortic graft infection: Two sides of the same coin. J Nucl Cardiol 2021; 28:2229-2232. [PMID: 31933157 DOI: 10.1007/s12350-020-02029-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/02/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Giorgio Treglia
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
- Health Technology Assessment Unit, Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, Via Lugano 4F, 6500, Bellinzona, Switzerland.
| | - Riemer H J A Slart
- Department of Nuclear Medicine & Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine & Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Sharma V, Mughal L, Dimitropoulos G, Sheikh A, Griffin M, Moss A, Notghi A, Pandit M, Connolly DL, Varma C, Kirchhof P. The additive prognostic value of coronary calcium score (CCS) to single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI)-real world data from a single center. J Nucl Cardiol 2021; 28:2086-2096. [PMID: 31797319 DOI: 10.1007/s12350-019-01965-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 01/07/2023]
Abstract
AIMS Single-photon emission computed tomography myocardial perfusion imaging [SPECT-MPI] is a functional test for coronary ischemia. We aimed to assess the additive prognostic value of coronary calcium score (CCS) to SPECT-MPI in stable patients. METHODS This study is a retrospective analysis of 655 patients who underwent SPECT-MPI with CCS (2012 to 2017). Receiver operator characteristic (ROC) identified CCS cutoff value for all-cause mortality: CCS+ if > cutoff value and MPI+ if ≥ 5% total perfusion defect (TPD). Patients were divided into 1 MPI-/CCS-; 2 MPI+/CCS-; 3 MPI-/CCS+; 4 MPI+/CCS+ and compared. Cox proportional hazard analysis identified predictors of mortality. RESULTS CCS cutoff for all-cause mortality was > 216 (C statistic 0.756, P < 0.0001). In MPI+ groups, mean TPD was similar (13.4% and 13.1% respectively) but mortality was higher in the CCS+ (12.5% vs. 4.8%, P = 0.22) as was the severe LV systolic dysfunction (8.0% vs. 0%, P = 0.095). In MPI- groups, mean TPD was similar (0.7% and 0.9% respectively) but all-cause mortality was higher in the CCS+ (10.7% vs. 1.6%, P < 0.0001) as was severe LVSD (2.9 % vs. 0.3% P = 0.016). Age, smoking, renal impairment ,and CCS > 216 were independent predictors of mortality. CONCLUSIONS Patients with raised CCS on SPECT-MPI have increased mortality and poor LV function despite a negative MPI.
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Affiliation(s)
- Vinoda Sharma
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom.
| | - Lal Mughal
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | | | - Awais Sheikh
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Michael Griffin
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Alexandra Moss
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Alp Notghi
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Manish Pandit
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Derek L Connolly
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Chetan Varma
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Paulus Kirchhof
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
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Nodoushani A, El-Sady MS, Park MA, Castilloveitia GL, Falk RH, Di Carli MF, Kijewski MF, Dorbala S. Reproducibility and Repeatability of Assessment of Myocardial Light Chain Amyloidosis Burden Using 18F-Florbetapir PET/CT. J Nucl Cardiol 2021; 28:2004-2010. [PMID: 31758410 PMCID: PMC9513526 DOI: 10.1007/s12350-019-01961-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND 18F-florbetapir PET is emerging as an excellent quantitative tool to quantify cardiac light chain (AL) amyloidosis burden. The primary aim of this study was to determine interobserver reproducibility and intraobserver repeatability, defined per the recommendations of the Quantitative Imaging Biomarker Alliance technical performance group, of PET 18F-florbetapir retention index (RI) in patients with cardiac AL amyloidosis. METHODS The study cohort comprised 37 subjects with systemic AL amyloidosis enrolled in the prospective study: Molecular Imaging of Primary Amyloid Cardiomyopathy (clinical trials.gov NCT: 02641145). Using 10 mCi of 18F-florbetapir, a 60-minute dynamic cardiac scan was acquired. Global and segmental left ventricular estimates of retention index (RI) of 18F-florbetapir were calculated (Carimas 2.9 software, Turku, Finland). RI was analyzed twice, at least 24 hours apart, by two independent observers. Intraobserver repeatability and interobserver reproducibility were evaluated using Bland-Altman plots and scatter plots with fitted linear regression curves. RESULTS All reproducibility (interobserver, r = 0.98) and repeatability (intraobserver, R=0.99 for each observer) measures of 18F-florbetapir RI are excellent. On the Bland-Altman plots, the agreement limits for global 18F-florbetapir RI were high and ranged for reproducibility (interobserver) from - 9.3 to + 9.4% (Fig. 1), and for repeatability (observer 1 from - 10.8 to + 10.7% and from - 9.2 to + 11.4%, for observer 2). CONCLUSIONS The present study showed excellent interobserver reproducibility and intraobserver repeatability of 18F-florbetapir PET retention index in patients with cardiac AL amyloidosis.
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Affiliation(s)
- Ariana Nodoushani
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
| | - Mohammed Samir El-Sady
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Mi-Ae Park
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | | | - Rodney H Falk
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Heart & Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Marcelo F Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Marie Foley Kijewski
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Heart & Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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9
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Roque A, Pizzi MN. 18F-FDG PET/CT and cardiac CTA in transcatheter aortic valve implanted endocarditis: Still at the beginning of a long road. J Nucl Cardiol 2021; 28:2083-2085. [PMID: 31975331 DOI: 10.1007/s12350-020-02035-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Albert Roque
- Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- IDI (Institut de Diagnòstic per la Imatge), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - María Nazarena Pizzi
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Barcelona, Spain.
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
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Juneau D, Pelletier-Galarneau M. Revisiting the relevance of the 3-month safety period in the evaluation of prosthetic valve endocarditis with FDG-PET/CT. J Nucl Cardiol 2021; 28:2269-2271. [PMID: 32056103 DOI: 10.1007/s12350-020-02070-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Daniel Juneau
- Department of Medical Imaging, Centre Hospitalier de l'Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, H2X 0C1, Canada.
- University of Ottawa Heart Institute, Ottawa, Canada.
| | - Matthieu Pelletier-Galarneau
- Department of Medical Imaging, Institut de Cardiologie de Montréal, Montréal, Canada
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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11
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Prato FS, Wisenberg G. Reproducibility and repeatability of assessment of myocardial light chain amyloidosis burden using 18F-florbetapir PET/CT. J Nucl Cardiol 2021; 28:2011-2013. [PMID: 31797317 DOI: 10.1007/s12350-019-01971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Frank S Prato
- Departments of Medical Biophysics, Medical Imaging and Physics and Astronomy, Western University, London, ON, Canada.
- Lawson Imaging, Lawson Health Research Institute, London, ON, Canada.
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12
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Meng J, Zhao H, Liu Y, Chen D, Hacker M, Wei Y, Li X, Zhang X, Kreissl MC. Assessment of cardiac tumors by 18F-FDG PET/CT imaging: Histological correlation and clinical outcomes. J Nucl Cardiol 2021; 28:2233-2243. [PMID: 31933156 DOI: 10.1007/s12350-019-02022-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/15/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND To evaluate the diagnostic value of 18F-FDG PET/CT in distinguishing benign versus malignant cardiac tumors as well as to assess its prognostic value. METHODS We analyzed 38 patients with cardiac tumors who underwent 18F-FDG PET/CT and followed for median 8.5 ± 12.5 months. SUVmax and TBRmax (maximum tumor-to-background ratio) by receiver-operating characteristic (ROC) curve analysis were used to obtain threshold for the diagnosis of malignancy as defined by histology (n = 38). Survival was assessed and correlated with the dignity of the lesions and PET parameters. RESULTS Optimal cut-off values indicating malignancy were as follows: SUVmax = 3.44, with 100% sensitivity and 92.9% specificity, and TBRmax = 1.55, with 95.8% sensitivity and 92.9% specificity. A significant difference of 18F-FDG uptake was observed between primary benign (n = 14, SUVmax = 2.35 ± 1.31, TBRmax = 1.05 ± 0.50) compared to primary malignant cardiac tumors (n = 11, SUVmax = 8.90 ± 4.23, TBRmax = 3.82 ± 1.44) as well as cardiac metastases and lymphoma (n = 13, SUVmax = 14.37 ± 8.05, TBRmax = 6.19 ± 3.38) (all P < .001). Survival rate was significantly lower in patients with malignant as compared to benign cardiac tumors (P < .05). Regression analysis revealed that the lesion dignity determined by the cut-off value of SUVmax was an independent predictor for death in patients with cardiac tumors (P < .05). CONCLUSION 18F-FDG uptake in cardiac tumors can differentiate between benign and malignant cardiac tumors and predicts survival.
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Affiliation(s)
- Jingjing Meng
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Honglei Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongmin Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dong Chen
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währinger Gürthel 18-20, Floor 3L, 1090, Vienna, Austria
| | - Yongxiang Wei
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xiang Li
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währinger Gürthel 18-20, Floor 3L, 1090, Vienna, Austria
| | - Xiaoli Zhang
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
| | - Michael C Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
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13
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Andrews JPM, MacNaught G, Moss AJ, Doris MK, Pawade T, Adamson PD, van Beek EJR, Lucatelli C, Lassen ML, Robson PM, Fayad ZA, Kwiecinski J, Slomka PJ, Berman DS, Newby DE, Dweck MR. Cardiovascular 18F-fluoride positron emission tomography-magnetic resonance imaging: A comparison study. J Nucl Cardiol 2021; 28:1-12. [PMID: 31792913 PMCID: PMC8616877 DOI: 10.1007/s12350-019-01962-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/01/2019] [Accepted: 11/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND 18F-Fluoride uptake denotes calcification activity in aortic stenosis and atherosclerosis. While PET/MR has several advantages over PET/CT, attenuation correction of PET/MR data is challenging, limiting cardiovascular application. We compared PET/MR and PET/CT assessments of 18F-fluoride uptake in the aortic valve and coronary arteries. METHODS AND RESULTS 18 patients with aortic stenosis or recent myocardial infarction underwent 18F-fluoride PET/CT followed immediately by PET/MR. Valve and coronary 18F-fluoride uptake were evaluated independently. Both standard (Dixon) and novel radial GRE) MR attenuation correction (AC) maps were validated against PET/CT with results expressed as tissue-to-background ratios (TBRs). Visually, aortic valve 18F-fluoride uptake was similar on PET/CT and PET/MR. TBRMAX values were comparable with radial GRE AC (PET/CT 1.55±0.33 vs. PET/MR 1.58 ± 0.34, P = 0.66; 95% limits of agreement - 27% to + 25%) but performed less well with Dixon AC (1.38 ± 0.44, P = 0.06; bias (-)14%; 95% limits of agreement - 25% to + 53%). In native coronaries, 18F-fluoride uptake was similar on PET/MR to PET/CT regardless of AC approach. PET/MR identified 28/29 plaques identified on PET/CT; however, stents caused artifact on PET/MR making assessment of 18F-fluoride uptake challenging. CONCLUSION Cardiovascular PET/MR demonstrates good visual and quantitative agreement with PET/CT. However, PET/MR is hampered by stent-related artifacts currently limiting clinical application.
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Affiliation(s)
- Jack P M Andrews
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK.
| | - Gillian MacNaught
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Alastair J Moss
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Mhairi K Doris
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Tania Pawade
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Philip D Adamson
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Edwin J R van Beek
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Christophe Lucatelli
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Zahi A Fayad
- Icahn School of Medicine at Mount Sinai, New York, PA, USA
| | - Jacek Kwiecinski
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | | | | | - David E Newby
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Marc R Dweck
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
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14
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Lu T, Yang G. 18F-FDG PET/CT imaging in the diagnosis of drug-induced lung disease and pulmonary infection in lymphoma. Medicine (Baltimore) 2021; 100:e27107. [PMID: 34664833 PMCID: PMC8448047 DOI: 10.1097/md.0000000000027107] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/12/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Lymphoma is a hematological disease with high prevalence. Multi-cycle chemotherapy (CHT) or local radiotherapy is applied usually; however, adverse events have been reported, such as drug-induced lung disease (DILD). Positron emission tomography/computed tomography (PET/CT) is often used to evaluate the lesion, treatment effect, and prognosis of lymphoma. We investigated DILD and pulmonary infection (PI) after multi-cycle CHT in lymphoma patients, to identify DILD and PI, provide guidance for later treatment for them. METHODS In all, 677 patients diagnosed with lymphoma and who underwent CHT were included. These patients underwent 18fluorodeoxyglucose (18F-FDG) PET/CT before and after CHT at Shandong Cancer Hospital (affiliated with Shandong University) between April 2015 and November 2019. Fifty patients developed DILD, 41 patients had lung infections; lesion characteristics were analyzed based on clinical characteristics, laboratory examinations, and PET/CT imaging. RESULTS Among the 677 lymphoma patients, there were 50 cases of DILD, with an incidence rate of 7.4%. PET/CT showed an elevated 18fluorodeoxyglucose uptake lung background, septal thickening and reticulation, multiple ground glass-like shadows, and grid-shaped blur shadows, which were more common in the lung periphery and under the pleura. The maximum standardized uptake value in the lung was 2.45 ± 0.52. Pulmonary infections occurred in 41 patients, and the maximum standardized uptake value was 4.05 ± 1.42. Age, sex, CHT cycle, Ann-Arbor stage, and lymphocyte levels were not significantly different between DILD and PI patients. Leukocyte and neutrophils showed significant differences; the PI patients had increased laboratory indexes of leukocyte and neutrophils. The mean number of CHT cycles was 4 cycles for DILD and PI. CONCLUSIONS PET/CT imaging has high sensitivity and detection rates for primary and metastatic lymphoma lesions. DILD mostly occurs in the middle and late stages of CHT. Laboratory tests and PET/CT can evaluate the lesions and treatment effects, and provide guidance for subsequent treatment plans for patients.
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Affiliation(s)
- Tingting Lu
- Medical Imaging Center, Xi’An QinHuang Hospital, Xi’an, Shanxi, China
| | - Guoren Yang
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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15
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Kitajima K, Yamamoto S, Kawanaka Y, Komoto H, Shimatani K, Hanasaki T, Taguchi M, Nagasawa S, Yamada Y, Kanematsu A, Yamakado K. Assessment of the viability and treatment response of bone metastases in patients with metastatic castration-resistant prostate cancer using choline PET/CT. Medicine (Baltimore) 2021; 100:e26206. [PMID: 34115004 PMCID: PMC8202546 DOI: 10.1097/md.0000000000026206] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/11/2021] [Indexed: 01/04/2023] Open
Abstract
This study aimed to evaluate the clinical use of choline-PET/CT for discriminating viable progressive osteoblastic bone metastasis from benign osteoblastic change induced by the treatment effect and evaluating the response of bone metastasis to treatment in metastatic castration-resistant prostate cancer (mCRPC) patients. Thirty patients with mCRPC underwent a total of 56 11C-choline-PET/CT scans for restaging, because 4 patients received 1 scan and 26 had 2 scans. Using 2 (pre- and post-treatment) 11C-choline-PET/CT examinations per patient, treatment response was assessed according to European Organization for Research and Treatment of Cancer (EORTC) criteria in 20 situations, in which only bony metastases were observed on 11C-choline-PET/CT scans. Viable bone metastases and osteoblastic change induced by the treatment effect were identified in 53 (94.6%) and 29 (51.8%) of 56 11C-choline-PET/CT scans, respectively. In 27 cases (48.2%), 11C-choline-PET/CT scans could discriminate the 2 entities. The mean SUVmax of the metastatic bony lesions was 5.82 ± 3.21, 5.95 ± 3.96, 6.73 ± 5.04, and 7.91 ± 3.25 for the osteoblastic, osteolytic, mixed, and invisible types, respectively. Of the 20 situations analyzed, CMR, PMR, SMD, and PMD, as determined by the EORTC, were seen in 1, 2, 3, and 14 cases, respectively. Of the 13 patients with increasing PSA trend, all 13 showed PMD. Of the 2 patients with PSA response of <50%, both 2 showed SMD. Of the 5 patients with PSA response of ≥50%, 1 showed CMR, 2 showed PMR, 1 showed SMD, and 1 showed PMD. Choline-PET/CT is very useful to discriminate viable progressive osteoblastic bone metastasis from osteoblastic change, and assess treatment response of bone metastases in mCRPC.
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Affiliation(s)
| | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Hyogo, Japan
| | | | | | | | | | | | - Seiji Nagasawa
- Department of Urology, Hyogo College of Medicine, Hyogo, Japan
| | - Yusuke Yamada
- Department of Urology, Hyogo College of Medicine, Hyogo, Japan
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Segawa T, Koga H, Oshina M, Fukushima M, Inanami H. The Diagnostic Value of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for the Detection of Surgical Site Infection after Spine Surgery. Spine (Phila Pa 1976) 2021; 46:E602-E610. [PMID: 33290366 DOI: 10.1097/brs.0000000000003847] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE The purpose of this study was to assess the diagnostic yield of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) for surgical site infection (SSI) after spine surgery. SUMMARY OF BACKGROUND DATA Diagnosis of SSI in the spine based on F-18 FDG PET/CT requires experienced nuclear medical physicians for a detailed analysis of F-18 FDG distribution pattern. It has also been reported that increases in the maximal standardized uptake values of F-18 FDG (SUVmax) closely correlated with SSI, suggesting potential of more objective and quantitative diagnosis. METHODS We assessed the diagnostic yield of F-18 FDG PET/CT (pattern-based diagnosis by nuclear medical physicians and SUVmax-based diagnosis) for SSI in 52 subjects who underwent spine surgery. The 52 subjects included 11 nonimplant and 41 implant cases. F-18 FDG PET/CT was performed in 33 and 19 cases in early (≤12 weeks after the surgery) and late (>12 weeks) phases, respectively. The final diagnosis of SSI was based on the results of pathogen identification, plain radiography, and CT and/or magnetic resonance imaging or response to antibiotics and/or reoperation. RESULTS SUVmax-based diagnosis was performed with a cut off value of 5.0 as determined by receiver operating characteristic analysis. Both pattern-based and SUVmax-based diagnoses demonstrated excellent diagnostic yields with high sensitivity (97% and 90%), specificity (100% and 100%), and accuracy (98% and 94%). High diagnostic yields (accuracy of ≥90%) were consistently observed irrespective of presence or absence of implantation or interval between surgery and F-18 FDG PET/CT. CONCLUSION F-18 FDG PET/CT can be the procedure of choice for investigation of SSI in the spine when other imaging fails to provide a definitive diagnosis.Level of Evidence: 4.
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Affiliation(s)
- Tomohide Segawa
- Department of Orthopedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hisashi Koga
- Department of Orthopedic Surgery, Iwai Orthopedic Medical Hospital, Tokyo, Japan
| | - Masahito Oshina
- Department of Orthopedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Masayoshi Fukushima
- Department of Orthopedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hirohiko Inanami
- Department of Orthopedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
- Department of Orthopedic Surgery, Iwai Orthopedic Medical Hospital, Tokyo, Japan
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Bogoni M, Cerci JJ, Cornelis FH, Nanni C, Tabacchi E, SchÖder H, Shyn PB, Sofocleous CT, Solomon SB, Kirov AS. Practice and prospects for PET/CT guided interventions. Q J Nucl Med Mol Imaging 2021; 65:20-31. [PMID: 33494585 PMCID: PMC10446123 DOI: 10.23736/s1824-4785.21.03291-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 06/12/2023]
Abstract
During the past 10 years, performing real-time molecular imaging with positron emission tomography (PET) in combination with computed tomography (CT) during interventional procedures has undergone rapid development. Keeping in mind the interest of the nuclear medicine readers, an update is provided of the current workflows using real-time PET/CT in percutaneous biopsies and tumor ablations. The clinical utility of PET/CT guided biopsies in cancer patients with lung, liver, lymphoma, and bone tumors are reviewed. Several technological developments, including the introduction of new PET tracers and robotic arms as well as opportunities provided through acquiring radioactive biopsy specimens are briefly reviewed.
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Affiliation(s)
| | | | | | - Cristina Nanni
- Unit of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Elena Tabacchi
- Unit of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Heiko SchÖder
- Unit of Nuclear Medicine, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Constantinos T Sofocleous
- Unit of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B Solomon
- Unit of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Assen S Kirov
- Unit of Molecular Imaging and Therapy Physics, Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA -
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Singh N, Alexander NA, Lachance K, Lewis CW, McEvoy A, Akaike G, Byrd D, Behnia S, Bhatia S, Paulson KG, Nghiem P. Clinical benefit of baseline imaging in Merkel cell carcinoma: Analysis of 584 patients. J Am Acad Dermatol 2021; 84:330-339. [PMID: 32707254 PMCID: PMC7854967 DOI: 10.1016/j.jaad.2020.07.065] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) guidelines derive from melanoma and do not recommend baseline cross-sectional imaging for most patients. However, MCC is more likely to have metastasized at diagnosis than melanoma. OBJECTIVE To determine how often baseline imaging identifies clinically occult MCC in patients with newly diagnosed disease with and without palpable nodal involvement. METHODS Analysis of 584 patients with MCC with a cutaneous primary tumor, baseline imaging, no evident distant metastases, and sufficient staging data. RESULTS Among 492 patients with clinically uninvolved regional nodes, 13.2% had disease upstaged by imaging (8.9% in regional nodes, 4.3% in distant sites). Among 92 patients with clinically involved regional nodes, 10.8% had disease upstaged to distant metastatic disease. Large (>4 cm) and small (<1 cm) primary tumors were both frequently upstaged (29.4% and 7.8%, respectively). Patients who underwent positron emission tomography-computed tomography more often had disease upstaged (16.8% of 352), than those with computed tomography alone (6.9% of 231; P = .0006). LIMITATIONS This was a retrospective study. CONCLUSIONS In patients with clinically node-negative disease, baseline imaging showed occult metastatic MCC at a higher rate than reported for melanoma (13.2% vs <1%). Although imaging is already recommended for patients with clinically node-positive MCC, these data suggest that baseline imaging is also indicated for patients with clinically node-negative MCC because upstaging is frequent and markedly alters management and prognosis.
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Affiliation(s)
- Neha Singh
- Department of Medicine, Division of Dermatology, University of Washington, Seattle, Washington
| | - Nora A Alexander
- Department of Medicine, Division of Dermatology, University of Washington, Seattle, Washington
| | - Kristina Lachance
- Department of Medicine, Division of Dermatology, University of Washington, Seattle, Washington
| | - Christopher W Lewis
- Department of Medicine, Division of Dermatology, University of Washington, Seattle, Washington; Department of Physical Medicine and Rehabilitation, Northwestern University, Evanston, Illinois
| | - Aubriana McEvoy
- Department of Medicine, Division of Dermatology, University of Washington, Seattle, Washington; Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Gensuke Akaike
- Department of Radiology, Division of Nuclear Medicine, University of Washington, Seattle, Washington
| | - David Byrd
- Department of Surgery, Section of Surgical Oncology, University of Washington, Seattle, Washington
| | - Sanaz Behnia
- Department of Radiology, Division of Nuclear Medicine, University of Washington, Seattle, Washington
| | - Shailender Bhatia
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Paul Nghiem
- Department of Medicine, Division of Dermatology, University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington.
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Pitalua-Cortes Q, García-Perez FO, Vargas-Ahumada J, Gonzalez-Rueda S, Gomez-Argumosa E, Ignacio-Alvarez E, Soldevilla-Gallardo I, Torres-Agredo L. Head-to-Head Comparison of 68Ga-PSMA-11 and 131I in the Follow-Up of Well-Differentiated Metastatic Thyroid Cancer: A New Potential Theragnostic Agent. Front Endocrinol (Lausanne) 2021; 12:794759. [PMID: 35002972 PMCID: PMC8727771 DOI: 10.3389/fendo.2021.794759] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Thyroid cancer is the main endocrine neoplasia worldwide, for which 131I therapy is the cornerstone treatment. One of the main problems of follow up in patients with this type of cancer, is the need for thyroglobulin stimulation, not to mention the poor availability of 123I or 124I, to perform studies with a higher degree of sensitivity. Prostatic Specific Membrane Antigen (PSMA) PET/CT has demonstrated to be quite useful in a diversified number of neoplasms, on behalf of its capacity of evaluating the extent of type II carboxypeptidase expression in vascular endothelium. The end point of this article is to assess whether this novel image method possesses applicability in thyroid neoplasms follow up, for diagnostic and potentially therapeutic purposes. METHODS We retrospectively evaluated well differentiated metastatic thyroid cancer patients, who underwent a post therapeutic 131I dose whole body scan (WBS) and complementary SPECT/CT, as well as 68Ga-PSMA-11 PET/CT. RESULTS Ten patients with differentiated thyroid cancer were included, of whom 80% were women and 20% men, mean age was 58 years old (± 11.6). Sixty-four metastatic lesions were analyzed, 67.19% had papillary histology and 32.81% were follicular type, the most affected site of metastases was bone in 57.81%, followed by lung 17.19%, lymph nodes 7.81%, postoperative thyroid bed 4.69%, brain 4.69% and others 7.81%. 68Ga PSMA-11 PET/CT detected 64/64 lesions, all of them also identified by computed tomography (CT), whereas 131I SPECT/CT detected 55/64 lesions. Discrepant lesions were localized in lung 44.4%, brain 22.2%, postoperative thyroid bed 11.1%, lymph nodes 11.1% and bone 11.1%. The degree of correspondence among observers was outstanding for both radiotracers, but close upon perfect for PSMA-11 (κ = 0.98; 95% CI, 0.80 - 0.91), as opposed to 131 I (κ = 0.86; 95% CI, 0.71 - 0.76). CONCLUSIONS 68Ga-PSMA PET/CT showed an utterly superior capability for metastatic lesion detection when compared to 131I SPECT/CT. These findings suggest that PSMA PET/CT could possibly and precociously identify radioiodine refractoriness. PSMA uptake values not only expedite diagnosis, but also award it the ability to be used for therapeutic intents.
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Affiliation(s)
- Quetzali Pitalua-Cortes
- Nuclear Medicine and Molecular Imaging Department, National Cancer Institute, Mexico City, Mexico
| | - Francisco Osvaldo García-Perez
- Nuclear Medicine and Molecular Imaging Department, National Cancer Institute, Mexico City, Mexico
- *Correspondence: Francisco Osvaldo García-Perez,
| | - Joel Vargas-Ahumada
- Nuclear Medicine and Molecular Imaging Department, National Cancer Institute, Mexico City, Mexico
| | - Sofia Gonzalez-Rueda
- Nuclear Medicine and Molecular Imaging Department, National Cancer Institute, Mexico City, Mexico
| | - Edgar Gomez-Argumosa
- Nuclear Medicine and Molecular Imaging Department, National Cancer Institute, Mexico City, Mexico
| | - Eleazar Ignacio-Alvarez
- Nuclear Medicine and Molecular Imaging Department, National Cancer Institute, Mexico City, Mexico
| | - Irma Soldevilla-Gallardo
- Nuclear Medicine and Molecular Imaging Department, National Cancer Institute, Mexico City, Mexico
| | - Liliana Torres-Agredo
- Nuclear Medicine Department, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
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Peng L, Zhao J, Mao F, Sun Q. 68Ga-NEB PET/CT can be a new method for diagnosing chylous fistula: Case reports of a rare complication after breast cancer surgery. Medicine (Baltimore) 2020; 99:e21201. [PMID: 32702884 PMCID: PMC7373633 DOI: 10.1097/md.0000000000021201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
RATIONALE We hypothesize that with the determination of lymph fistula location 3-dimensionally, application of appropriate pressure would promote fistula healing, and a secondary surgery may be avoided. Ga-labeled 1,4,7-triazacyclononane-N, N', N"-triacetic acid (NOTA) conjugated with truncated Evan blue (NEB) forms a complex with serum albumin in the interstitial fluid after it is locally injected and allows rapid visualization of the lymphatic system. PATIENT CONCERNS A 44-year-old woman had a chief complaint of left nipple discharge. A 38-year-old woman came to the hospital after sensing a right breast mass. DIAGNOSES The 2 patients were diagnosed with chylous fistula after breast cancer surgery based on the findings of a novel method, Ga-NOTA-Evans Blue (NEB) positron emission tomography/computed tomography. INTERVENTIONS We successfully obtained clear images to locate the fistula using Ga-NEB positron emission tomography/computed tomography (PET/CT) for both patients. The lymphatic vessels and lymph nodes could be clearly visualized owing to the Ga-NEB activity during PET/CT. OUTCOMES Three-dimensional positioning to locate the fistula could direct the application of the pressure dressing and reduce drainage markedly. LESSONS Ga-NEB PET/CT may be a new method for diagnosing chylous fistula and providing guidance for treatment.
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Reinert CP, Gatidis S, Sekler J, Dittmann H, Pfannenberg C, la Fougère C, Nikolaou K, Forschner A. Clinical and prognostic value of tumor volumetric parameters in melanoma patients undergoing 18F-FDG-PET/CT: a comparison with serologic markers of tumor burden and inflammation. Cancer Imaging 2020; 20:44. [PMID: 32631431 PMCID: PMC7339397 DOI: 10.1186/s40644-020-00322-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 04/16/2020] [Accepted: 06/29/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To investigate the association of tumor volumetric parameters in melanoma patients undergoing 18F-FDG-PET/CT with serologic tumor markers and inflammatory markers and the role as imaging predictors for overall survival. METHODS A patient cohort with advanced melanoma undergoing 18F-FDG-PET/CT for planning metastasectomy between 04/2013 and 01/2015 was retrospectively included. The volumetric PET parameters whole-body MTV and whole-body TLG as well as the standard uptake value (SUV) peak were quantified using 50%-isocontour volumes of interests (VOIs) and then correlated with the serologic parameters lactate dehydrogenase (LDH), S-100 protein, c-reactive protein (CRP) and alkaline phosphatase (AP). PET parameters were dichotomized by their respective medians and correlated with overall survival (OS) after PET/CT. OS was compared between patients with or without metastases and increased or not-increased serologic parameters. RESULTS One hundred seven patients (52 female; 65 ± 13.1yr.) were included. LDH was strongly associated with MTV (rP = 0.73, p < 0.001) and TLG (rP = 0.62, p < 0.001), and moderately associated with SUVpeak (rP = 0.55, p < 0.001). S-100 protein showed a moderate association with MTV (rP = 0.54, p < 0.001) and TLG (rP = 0.48, p < 0.001) and a weak association with SUVpeak (rP = 0.42, p < 0.001). A strong association was observed between CRP and MTV (rP = 0.66, p < 0.001) and a moderate to weak association between CRP and TLG (rP = 0.53, p < 0.001) and CRP and SUVpeak (rP = 0.45, p < 0.001). For differentiation between patients with or without metastases, receiver operating characteristic (ROC) analysis revealed a cut-off value of 198 U/l for serum LDH (AUC 0.81, sensitivity 0.80, specificity 0.72). Multivariate analysis for OS revealed that both MTV and TLG were strong independent prognostic factors. TLG, MTV and SUVpeak above patient median were accompanied with significantly reduced estimated OS compared to the PET parameters below patient median (e.g. TLG: 37.1 ± 3.2 months vs. 55.9 ± 2.5 months, p < 0.001). Correspondingly, both elevated serum LDH and S-100 protein were accompanied with significantly reduced OS (36.5 ± 4.9 months and 37.9 ± 4.4 months) compared to normal serum LDH (49.2 ± 2.4 months, p = 0.01) and normal S-100 protein (49.0 ± 2.5 months, p = 0.01). CONCLUSIONS Tumor volumetric parameters in 18F-FDG-PET/CT serve as prognostic imaging biomarkers in patients with advanced melanoma which are associated with established serologic tumor markers and inflammatory markers.
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Affiliation(s)
- Christian Philipp Reinert
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany.
| | - Sergios Gatidis
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
| | - Julia Sekler
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
| | - Helmut Dittmann
- Department of Radiology, Nuclear Medicine and Clinical Molecular Imaging, University Hospital, Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
| | - Christina Pfannenberg
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
| | - Christian la Fougère
- Department of Radiology, Nuclear Medicine and Clinical Molecular Imaging, University Hospital, Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK). Partner Site Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK). Partner Site Tübingen, Tübingen, Germany
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tübingen, Liebermeisterstrasse 25, 72076, Tübingen, Germany
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Su W, Ren S, Zhu X, Zhang H, Zuo C. Standardized thresholds of volume-based PET/CT parameters predicting survival of patients with pancreatic head cancer treated with stereotactic body radiation therapy. Ann Nucl Med 2020; 34:379-387. [PMID: 32277421 DOI: 10.1007/s12149-020-01454-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/04/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To explore standardized relative thresholds of volume-based parameters on FDG PET/CT, and define the optimal prognosticator among the relative thresholds for patients with locally advanced pancreatic head cancer (LAPHC) treated by stereotactic body radiation therapy (SBRT). METHODS Thirty-five patients with LAPHC were enrolled, and all underwent SBRT and baseline FDG PET/CT scan. Maximum standardized uptake value (SUVmax) was measured, and metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were calculated under the relative (30%, 40%, and 50%) thresholds of SUVmax. Survival analysis was performed via univariate and multivariate analyses, and independent prognostic factors were determined by Cox proportional hazard models and corresponding survival curves and scatter diagram were drawn. RESULTS The median overall survival (OS) and progression-free survival (PFS) were 13.8 and 9.8 months, respectively. On univariate analysis, MTV(40%) < 5.6 cm3, accumulated dose (AD) ≥ 36 Gy and the absence of pancreatic duct (PD) stents were significantly correlated with both superior OS and PFS, TLG (40%) < 29.9 was related to better OS and biological effective dose (BED10) ≥ 57.6 Gy was related to better PFS (all with p < 0.05). Further, multivariate analysis demonstrated both MTV (40%) and AD were independent prognosticators for OS and PFS, and BED10 was an independent predictor for PFS (all with p < 0.05). Scatter diagram showed BED10 to be a stronger clinical prognosis predictor for PFS than AD. CONCLUSIONS MTV (40%) was the optimal prognosticator among the relative thresholds of SUVmax for tumor delineation on PET/CT for LAPHC patients receiving SBRT. AD was also favorable indicators for OS and PFS of patients, and BED10 was more sensitive than AD in predicting the PFS of patients.
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Affiliation(s)
- Weiwei Su
- Departments of Nuclear Medicine, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433, People's Republic of China
| | - Shengnan Ren
- Departments of Nuclear Medicine, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433, People's Republic of China
| | - Xiaofei Zhu
- Departments of Radiotherapy, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433, People's Republic of China
| | - Huojun Zhang
- Departments of Radiotherapy, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433, People's Republic of China.
| | - Changjing Zuo
- Departments of Nuclear Medicine, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433, People's Republic of China.
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Exadaktylou P, Papadopoulos N, Chatzipavlidou V, Giammarile F. Non-Oncological PET/CT imaging during SARS-CoV-2 pandemic. Hell J Nucl Med 2020; 23 Suppl:51-56. [PMID: 32860397] [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: 07/01/2020] [Accepted: 08/03/2020] [Indexed: 06/11/2023]
Abstract
In December 2019 a new β-CoV, Severe Acute Respiratory Coronavirus- 2 (SARS-CoV-2), has been identified in Wuhan Hubei Province, China. Within a few months it spread rapidly to more than 114 countries and the disease, Coronavirus disease 2019 (COVID-19), was declared pandemic on 11th February 2020 by the World Health Organization (WHO). Until 20 June 2020 8:09 am, 8,465,085 cases of COVID-19 were confirmed globally, with 454,258 deaths. The first incidence in Greece was documented on 26 February 2020 in Thessaloniki and up to 20 June 2020 8:09 am, 3,227 confirmed cases of COVID-19 were reported, with 188 deaths. At the time of writing USA and Brazil, are the countries with the highest disease burden. Governments have imposed a variety of suggestions and restrictions in order to control the spread of the virus, focusing mainly on social distancing, self-isolation, personal hygiene and personal protective equipment (PPE). Greece was one of the countries that implemented early drastic measures thus succeeding in controlling the virus transmission; having a profound economical effect though.
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Affiliation(s)
- P Exadaktylou
- 3rd Department of Nuclear Medicine, Aristotle University of Thessaloniki, Medical School, Papageorgiou General Hospital, 56403 Thessaloniki, Greece.
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Prenosil GA, Weitzel T, Fürstner M, Hentschel M, Krause T, Cumming P, Rominger A, Klaeser B. Towards guidelines to harmonize textural features in PET: Haralick textural features vary with image noise, but exposure-invariant domains enable comparable PET radiomics. PLoS One 2020; 15:e0229560. [PMID: 32176698 PMCID: PMC7075630 DOI: 10.1371/journal.pone.0229560] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/10/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose Image texture is increasingly used to discriminate tissues and lesions in PET/CT. For quantification or in computer-aided diagnosis, textural feature analysis must produce robust and comparable values. Because statistical feature values depend on image count statistics, we investigated in depth the stability of Haralick features values as functions of acquisition duration, and for common image resolutions and reconstructions. Methods A homogeneous cylindrical phantom containing 9.6 kBq/ml Ge-68 was repeatedly imaged on a Siemens Biograph mCT, with acquisition durations ranging from three seconds to three hours. Images with 1.5, 2, and 4 mm isometrically spaced voxels were reconstructed with filtered back-projection (FBP), ordered subset expectation maximization (OSEM), and the Siemens TrueX algorithm. We analysed Haralick features derived from differently quantized (3 to 8-bit) grey level co-occurrence matrices (GLCMs) as functions of exposure E, which we defined as the product of activity concentration in a volume of interest (VOI) and acquisition duration. The VOI was a 50 mm wide cube at the centre of the phantom. Feature stability was defined for df/dE → 0. Results The most stable feature values occurred in low resolution FBPs, whereas some feature values from 1.5 mm TrueX reconstructions ranged over two orders of magnitude. Within the same reconstructions, most feature value-exposure curves reached stable plateaus at similar exposures, regardless of GLCM quantization. With 8-bit GLCM, median time to stability was 16 s and 22 s for FBPs, 18 s and 125 s for OSEM, and 23 s, 45 s, and 76 s for PSF reconstructions, with longer durations for higher resolutions. Stable exposures coincided in OSEM and TrueX reconstructions with image noise distributions converging to a Gaussian. In FBP, the occurrence of stable values coincided the disappearance of negatives image values in the VOI. Conclusions Haralick feature values depend strongly on exposure, but invariance exists within defined domains of exposure. Here, we present an easily replicable procedure to identify said stable exposure domains, where image noise does not substantially add to textural feature values. Only by imaging at predetermined feature-invariant exposure levels and by adjusting exposure to expected activity concentrations, can textural features have a quantitative use in PET/CT. The necessary exposure levels are attainable by modern PET/CT systems in clinical routine.
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Affiliation(s)
- George Amadeus Prenosil
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
| | - Thilo Weitzel
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Fürstner
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Hentschel
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Krause
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Paul Cumming
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- School of Psychology and Counselling and IHBI, Queensland University of Technology, Brisbane, Australia
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernd Klaeser
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland
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Mastrocola LE, Amorim BJ, Vitola JV, Brandão SCS, Grossman GB, Lima RDSL, Lopes RW, Chalela WA, Carreira LCTF, Araújo JRND, Mesquita CT, Meneghetti JC. Update of the Brazilian Guideline on Nuclear Cardiology - 2020. Arq Bras Cardiol 2020; 114:325-429. [PMID: 32215507 PMCID: PMC7077582 DOI: 10.36660/abc.20200087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Barbara Juarez Amorim
- Universidade Estadual de Campinas (Unicamp), Campinas, SP - Brazil
- Sociedade Brasileira de Medicina Nuclear (SBMN), São Paulo, SP - Brazil
| | | | | | - Gabriel Blacher Grossman
- Hospital Moinhos de Vento, Porto Alegre, RS - Brazil
- Clínica Cardionuclear, Porto Alegre, RS - Brazil
| | - Ronaldo de Souza Leão Lima
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
- Fonte Imagem Medicina Diagnóstica, Rio de Janeiro, RJ - Brazil
- Clínica de Diagnóstico por Imagem (CDPI), Grupo DASA, Rio de Janeiro, RJ - Brazil
| | | | - William Azem Chalela
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | | | | | | | - José Claudio Meneghetti
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
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Zhang L, Wu F, Zhu R, Wu D, Ding Y, Zhang Z, Gao Y, Wan Y. Application of computed tomography, positron emission tomography-computed tomography, magnetic resonance imaging, endobronchial ultrasound, and mediastinoscopy in the diagnosis of mediastinal lymph node staging of non-small-cell lung cancer: A protocol for a systematic review. Medicine (Baltimore) 2020; 99:e19314. [PMID: 32118758 PMCID: PMC7478550 DOI: 10.1097/md.0000000000019314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Ruling out distant metastases, non-small cell lung cancer (NSCLC)treatment depends on the results of mediastinal node staging (N staging). Several diagnostic methods play central roles in mediastinal N staging. This study is intended to evaluate the existing diagnostic methods and report quality, and to search for the best method for staging mediastinal lymph nodes. METHODS We searched PubMed, Embase, and the Cochrane Library to identify relevant studies, including randomized controlled trials and retrospective studies. These studies report the application of computed tomography, positron emission tomography-computed tomography, magnetic resonance imaging, endobronchial ultrasound, and mediastinoscopy in the diagnosis of mediastinal lymph node staging of NSCLC. The quality of the literature was assessed using the Quality Assessment of Diagnostic Accuracy Study 2. The true positive, false positive, true negative, and false negative of each study was extracted. The corresponding sensitivity, specificity, and other indicators were calculated and the Summary Receiver Operating curve was established. Then, head-to-head and indirect comparison meta-analyses will be conducted. RESULTS The results of this study will be published in a peer-reviewed journal. CONCLUSION This study will provide basis for mediastinal lymph node staging of non-small cell lung cancer. PROSPERO REGISTRATION NUMBER CRD42019145667.
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Affiliation(s)
- Longguo Zhang
- The Second Clinical Medical School of Lanzhou University
| | - Fanqi Wu
- Department of Respiratory, Lanzhou University Second Hospital
| | - Rui Zhu
- The Second Clinical Medical School of Lanzhou University
| | - Di Wu
- The Second Clinical Medical School of Lanzhou University
| | - Yao Ding
- The First Clinical Medical College
| | - Zhongmei Zhang
- The Second Clinical Medical School of Lanzhou University
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yixin Wan
- Department of Respiratory, Lanzhou University Second Hospital
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Sollini M, Cozzi L, Ninatti G, Antunovic L, Cavinato L, Chiti A, Kirienko M. PET/CT radiomics in breast cancer: Mind the step. Methods 2020; 188:122-132. [PMID: 31978538 DOI: 10.1016/j.ymeth.2020.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/08/2020] [Accepted: 01/14/2020] [Indexed: 12/22/2022] Open
Abstract
The aim of the present review was to assess the current status of positron emission tomography/computed tomography (PET/CT) radiomics research in breast cancer, and in particular to analyze the strengths and weaknesses of the published papers in order to identify challenges and suggest possible solutions and future research directions. Various combinations of the terms "breast", "radiomic", "PET", "radiomics", "texture", and "textural" were used for the literature search, extended until 8 July 2019, within the PubMed/MEDLINE database. Twenty-six articles fulfilling the inclusion/exclusion criteria were retrieved in full text and analyzed. The studies had technical and clinical objectives, including diagnosis, biological characterization (correlation with histology, molecular subtypes and IHC marker expression), prediction of response to neoadjuvant chemotherapy, staging, and outcome prediction. We reviewed and discussed the selected investigations following the radiomics workflow steps related to the clinical, technical, analysis, and reporting issues. Most of the current evidence on the clinical role of PET/CT radiomics in breast cancer is at the feasibility level. Harmonized methods in image acquisition, post-processing and features calculation, predictive models and classifiers trained and validated on sufficiently representative datasets, adherence to consensus guidelines, and transparent reporting will give validity and generalizability to the results.
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Affiliation(s)
- Martina Sollini
- Nuclear Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano (Milan), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Luca Cozzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy; Radiation Oncology, Humanitas Clinical and Research Center - IRCCS, Rozzano (Milan), Italy
| | - Gaia Ninatti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Lidija Antunovic
- Nuclear Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano (Milan), Italy
| | - Lara Cavinato
- Nuclear Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano (Milan), Italy
| | - Arturo Chiti
- Nuclear Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano (Milan), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Margarita Kirienko
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy.
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Yoon S, Ryu KH, Baek HJ, Kim TH, Moon JI, Choi BH, Park SE, Ha JY, Song DH, An HJ, Heo YJ. Cervical Lymph Nodes Detected by F-18 FDG PET/CT in Oncology Patients: Added Value of Subsequent Ultrasonography for Determining Nodal Metastasis. ACTA ACUST UNITED AC 2019; 56:medicina56010016. [PMID: 31906183 PMCID: PMC7022812 DOI: 10.3390/medicina56010016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/29/2019] [Accepted: 12/30/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: To investigate the diagnostic performance of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and subsequent ultrasonography (US) for determining cervical nodal metastasis in oncology patients. Materials and Methods: Fifty-nine cervical lymph nodes (LNs) initially detected by PET/CT with subsequent neck US were included in this retrospective study. All LNs were subjected to US-guided fine-needle aspiration or core needle biopsy. The maximum standardized uptake value (SUVmax) and sonographic features were assessed. Results: Forty-three of 59 cervical LNs detected by PET/CT were malignant. PET/CT alone showed a highest diagnostic value for metastatic LNs with 81.4% sensitivity, 68.8% specificity, and 78% accuracy when SUVmax ≥5.8 was applied as an optimal cut-off value. Combined PET/CT and subsequent US diagnoses for determining nodal metastasis showed the following diagnostic performance: 81.4% sensitivity, 87.5% specificity, and 83.1% accuracy. There was a significant difference in the diagnostic performance between the two diagnostic imaging approaches (p = 0.006). Conclusions: Combined diagnosis using subsequent US showed a significantly higher diagnostic performance for determining nodal metastasis in the neck. Therefore, we believe that our proposed diagnostic strategy using subsequent US can be helpful in evaluating cervical LNs on PET/CT. Moreover, our results clarify the need for US-guided tissue sampling in oncology patients.
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Affiliation(s)
- Seokho Yoon
- Department of Nuclear Medicine and Molecular Imaging, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea;
| | - Kyeong Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea; (K.H.R.); (J.I.M.); (B.H.C.); (S.E.P.); (J.Y.H.)
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea; (K.H.R.); (J.I.M.); (B.H.C.); (S.E.P.); (J.Y.H.)
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, 816-15 Jinju-daero, Jinju 52727, Korea
- Correspondence: ; Tel.: +82-55-214-3140
| | - Tae Hoon Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea;
| | - Jin Il Moon
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea; (K.H.R.); (J.I.M.); (B.H.C.); (S.E.P.); (J.Y.H.)
| | - Bo Hwa Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea; (K.H.R.); (J.I.M.); (B.H.C.); (S.E.P.); (J.Y.H.)
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea; (K.H.R.); (J.I.M.); (B.H.C.); (S.E.P.); (J.Y.H.)
| | - Ji Young Ha
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea; (K.H.R.); (J.I.M.); (B.H.C.); (S.E.P.); (J.Y.H.)
| | - Dae Hyun Song
- Department of Pathology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea; (D.H.S.); (H.J.A.)
| | - Hyo Jung An
- Department of Pathology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea; (D.H.S.); (H.J.A.)
| | - Young Jin Heo
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan 47392, Korea
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Pike LC, Thomas CM, Guerrero-Urbano T, Michaelidou A, Greener T, Miles E, Eaton D, Barrington SF. Guidance on the use of PET for treatment planning in radiotherapy clinical trials. Br J Radiol 2019; 92:20190180. [PMID: 31437023 PMCID: PMC6849663 DOI: 10.1259/bjr.20190180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/16/2019] [Accepted: 08/19/2019] [Indexed: 12/22/2022] Open
Abstract
The aim of this article is to propose meaningful guidance covering the practical and technical issues involved when planning or conducting clinical trials involving positron emission tomography (PET)-guided radiotherapy. The complexity of imaging requirements will depend on the study aims, design and PET methods used. Where PET is used to adapt radiotherapy, a high level of accuracy and reproducibility is required to ensure effective and safe treatment delivery. The guidance in this document is intended to assist researchers designing clinical trials involving PET-guided radiotherapy to provide sufficient information about the appropriate methods to complete PET-CT imaging to a consistent standard at participating centres. The guidance is divided into six categories: application of PET in radiotherapy, resource requirements, quality assurance, imaging protocol design, data management and image processing. Each section provides an overview of the recent literature to support the specific recommendations. This guidance builds on previous recommendations from the National Cancer Research Institute PET Research Network and has been produced in collaboration with the National Radiotherapy Trials Quality Assurance Group.
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Affiliation(s)
- Lucy C Pike
- King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, King’s College London, King’s Health Partners, London, UK
| | | | | | | | - Tony Greener
- Radiotherapy Physics, Guy's & St Thomas’ NHS Foundation Trust, London, UK
| | - Elizabeth Miles
- National Radiotherapy Trials QA Group, Mount Vernon Hospital, Northwood, UK
| | | | - Sally F Barrington
- King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, King’s College London, King’s Health Partners, London, UK
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30
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Abstract
In radiation therapy, the accurate delineation of gross tumor volume (GTV) is crucial for treatment planning. However, it is challenging for head and neck cancer (HNC) due to the morphology complexity of various organs in the head, low targets to background contrast and potential artifacts on conventional planning CT images. Thus, manual delineation of GTV on anatomical images is extremely time consuming and suffers from inter-observer variability that leads to planning uncertainty. With the wide use of PET/CT imaging in oncology, complementary functional and anatomical information can be utilized for tumor contouring and bring a significant advantage for radiation therapy planning. In this study, by taking advantage of multi-modality PET and CT images, we propose an automatic GTV segmentation framework based on deep learning for HNC. The backbone of this segmentation framework is based on 3D convolution with dense connections which enables a better information propagation and takes full advantage of the features extracted from multi-modality input images. We evaluate our proposed framework on a dataset including 250 HNC patients. Each patient receives both planning CT and PET/CT imaging before radiation therapy (RT). Manually delineated GTV contours by radiation oncologists are used as ground truth in this study. To further investigate the advantage of our proposed Dense-Net framework, we also compared with the framework using 3D U-Net which is the state-of-the-art in segmentation tasks. Meanwhile, for each frame, the performance comparison between single modality input (PET or CT image) and multi-modality input (both PET/CT) is conducted. Dice coefficient, mean surface distance (MSD), 95th-percentile Hausdorff distance (HD95) and displacement of mass centroid (DMC) are calculated for quantitative evaluation. The dataset is split into train (140 patients), validation (35 patients) and test (75 patients) groups to optimize the network. Based on the results on independent test group, our proposed multi-modality Dense-Net (Dice 0.73) shows better performance than the compared network (Dice 0.71). Furthermore, the proposed Dense-Net structure has less trainable parameters than the 3D U-Net, which reduces the prediction variability. In conclusion, our proposed multi-modality Dense-Net can enable satisfied GTV segmentation for HNC using multi-modality images and yield superior performance than conventional methods. Our proposed method provides an automatic, fast and consistent solution for GTV segmentation and shows potentials to be generally applied for radiation therapy planning of a variety of cancer (e.g. lung, sarcoma, liver and so on).
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Affiliation(s)
- Zhe Guo
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China 100081
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA 02114
| | - Ning Guo
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA 02114
| | - Kuang Gong
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA 02114
| | - Shun’an Zhong
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China 100081
| | - Quanzheng Li
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA 02114
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Van Weehaeghe D, Koole M, Schmidt ME, Deman S, Jacobs AH, Souche E, Serdons K, Sunaert S, Bormans G, Vandenberghe W, Van Laere K. [ 11C]JNJ54173717, a novel P2X7 receptor radioligand as marker for neuroinflammation: human biodistribution, dosimetry, brain kinetic modelling and quantification of brain P2X7 receptors in patients with Parkinson's disease and healthy volunteers. Eur J Nucl Med Mol Imaging 2019; 46:2051-2064. [PMID: 31243495 DOI: 10.1007/s00259-019-04369-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/23/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE The P2X7 receptor (P2X7R) is an ATP-gated ion channel predominantly expressed on activated microglia and is important in neurodegenerative diseases including Parkinson's disease (PD). In this first-in-human study, we investigated [11C]JNJ54173717 ([11C]JNJ717), a selective P2X7R tracer, in healthy volunteers (HV) and PD patients. Biodistribution, dosimetry, kinetic modelling and short-term test-retest variation (TRV), as well as possible genotype effects, were investigated. METHODS Biodistribution and radiation dosimetry studies were performed in three HV (mean age 30 ± 2 years, two women) using whole-body PET/CT. The most appropriate kinetic model was determined in 11 HV (mean age 62 ± 10 years, six women) and 10 PD patients (mean age 64 ± 8 years, three women; mean UPDRS motor score 21 ± 8) using 90-min dynamic simultaneous PET/MR scans. The total volume of distribution (VT) was calculated using a one-tissue and a two-tissue compartment model (1TCM, 2TCM) and Logan graphical analysis, and its time stability was assessed. Seven subjects underwent retest scans (mean age 60 ± 13 years, four HV, one woman). A group analysis was performed to compare PD patients and HV. Finally, 13 exons of P2X7R were genotyped in all subjects included in the second part of the study. RESULTS The mean effective dose was 4.47 ± 0.32 μSv/MBq, with the highest absorbed doses to the gallbladder, liver and small intestine. A reversible 2TCM was the most appropriate kinetic model with relatively homogeneous VT values in the grey and white matter. Average VT values were 3.4 ± 0.8 in HV and 3.3 ± 0.7 in PD patients, with no significant difference between the groups, but a possible genotype effect (rs3751143) was identified which can affect VT. Average TRV was 10-15%. The stability of VT over time allowed a reduction in scan time to 70 min. CONCLUSION [11C]JNJ717 is safe and suitable for quantifying P2X7R expression in human brain. In this pilot study, no significant differences in P2X7R binding were found between HV and PD patients. The results also suggest that genotype effects need to be incorporated in future P2X7R PET analyses.
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Affiliation(s)
- Donatienne Van Weehaeghe
- Division of Nuclear Medicine and Molecular Imaging, University Hospitals of Leuven and KU Leuven, Leuven, Belgium.
| | - Michel Koole
- Division of Nuclear Medicine and Molecular Imaging, University Hospitals of Leuven and KU Leuven, Leuven, Belgium
| | - Mark E Schmidt
- Janssen Research and Development: Beerse, Beerse, Belgium
| | - Stephanie Deman
- Genomics Core, UZ Leuven, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Andreas H Jacobs
- European Institute for Molecular Imaging (EIMI), Westfalian Wilhelms University (WWU) Münster, Münster, Germany
- Department of Geriatrics and Neurology, Johanniter Hospital Bonn, Bonn, Germany
| | - Erika Souche
- Genomics Core, UZ Leuven, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Kim Serdons
- Division of Nuclear Medicine and Molecular Imaging, University Hospitals of Leuven and KU Leuven, Leuven, Belgium
| | - Stefan Sunaert
- Department of Radiology, University Hospitals Leuven, Gasthuisberg, UZ, Leuven, Belgium
| | - Guy Bormans
- Laboratory for Radiopharmaceutical Research, KU Leuven, Leuven, Belgium
| | - Wim Vandenberghe
- Department of Neurosciences, KU Leuven, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Koen Van Laere
- Division of Nuclear Medicine and Molecular Imaging, University Hospitals of Leuven and KU Leuven, Leuven, Belgium
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Morsing A, Hildebrandt MG, Vilstrup MH, Wallenius SE, Gerke O, Petersen H, Johansen A, Andersen TL, Høilund-Carlsen PF. Hybrid PET/MRI in major cancers: a scoping review. Eur J Nucl Med Mol Imaging 2019; 46:2138-2151. [PMID: 31267161 DOI: 10.1007/s00259-019-04402-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/13/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE PET/MRI was introduced for clinical use in 2011 and is now an established modality for the imaging of brain and certain pelvic cancers, whereas clinical use for the imaging of other forms of cancer is not yet widespread. We therefore systematically investigated what has been published on the use of PET/MRI compared to PET/CT in the imaging of cancers outside the brain, focusing on clinical areas of application related to diagnosis, staging and restaging. METHODS A systematic search of PubMed/MEDLINE, Embase and the Cochrane Library was performed. Studies evaluating the diagnostic performance of simultaneous PET/MRI in cancer patients were chosen. RESULTS A total of 3,138 publications were identified and 116 published during the period 2012-2018 were included and were grouped according to the major cancer forms: 13 head and neck (HNC), 9 breast (BC), 21 prostate (PC), 14 gynaecological, 13 gastrointestinal (GIC), and 46 various cancers. Data from studies comparing PET/MRI and PET/CT for staging/restaging suggested the superiority of 18F-FDG PET/MRI for the detection of tumour extension and retropharyngeal lymph node metastases in nasopharyngeal cancer, and for the detection of liver metastases and possibly bone marrow metastases in high-risk BC. FDG PET/MRI tended to be inferior for the detection of lung metastases in HNC and BC. 68Ga-PSMA-11 PET/MRI was superior to PET/CT for the detection of local PC recurrence. FDG PET/MRI was superior to FDG PET/CT for the detection of local tumour invasion in cervical cancer and had higher accuracy for the detection of liver metastases in colorectal cancer. CONCLUSION The scoping review methodology resulted in the identification of a huge number of records, of which less than 5% were suitable for inclusion and only a limited number allowed conclusions on the advantages/disadvantages of PET/MRI compared to PET/CT in the oncological setting. There was evidence to support the use of FDG PET/MRI in staging of nasopharyngeal cancer and high-risk BC. Preliminary data indicate the superiority of PET/MRI for the detection of local recurrence in PC, local tumour invasion in cervical cancer, and liver metastases in colorectal cancer. These conclusions are based on small datasets and need to be further explored.
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Affiliation(s)
- Anni Morsing
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
- MAgNetic Resonance Technology for Response Adapted Radiotherapy (MANTRA), Odense University Hospital, Odense, Denmark.
| | - Malene Grubbe Hildebrandt
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Innovative Medical Technology (CIMT), Odense University Hospital, Odense, Denmark
| | - Mie Holm Vilstrup
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | | | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Henrik Petersen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Allan Johansen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Thomas Lund Andersen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- MAgNetic Resonance Technology for Response Adapted Radiotherapy (MANTRA), Odense University Hospital, Odense, Denmark
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Qichang W, Lin B, Gege Z, Youjia Z, Qingjie M, Renjie W, Bin J. Diagnostic performance of 18F-FDG-PET/CT in DTC patients with thyroglobulin elevation and negative iodine scintigraphy: a meta-analysis. Eur J Endocrinol 2019; 181:93-102. [PMID: 31117054 DOI: 10.1530/eje-19-0261] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 04/08/2019] [Accepted: 05/19/2019] [Indexed: 11/08/2022]
Abstract
PURPOSE To evaluate the accuracy of 18F-FDG-PET/CT for the detection of recurrent and/or metastatic diseases in differentiated thyroid cancer (DTC) patients with thyroglobulin elevation and negative iodine scintigraphy. Whether PET/CT with TSH stimulation (sPET/CT) had better diagnostic performance than PET/CT without TSH stimulation (nsPET/CT) in this scenario was also evaluated. METHODS PubMed and Embase databases were searched for eligible studies from January 2001 to December 2018. Only studies with clearly stated reference standard (histopathology confirmation and/or clinical/imaging follow-up) were included. Publication bias was assessed by Deeks funnel plot. The pooled sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the summary receiver-operating characteristics curve (AUC) for PET/CT was determined by random-effect analysis, respectively. sPET/CT and nsPET/CT were compared pairwise for all diagnostic estimate indexes using Z-test. RESULTS We included 17 studies with 1195 patients in this meta-analysis. The pooled sensitivity, specificity, DOR and AUC for PET/CT on patient-based data were 0.86 (95% CI: 0.79-0.91), 0.84 (95% CI: 0.72-0.91), 31.00 (95% CI: 12.00-80.00) and 0.91 (95% CI: 0.88-0.93), respectively. There was high heterogeneity (I 2 = 80% for sensitivity, I 2 = 82% for specificity) and possible publication bias (P = 0.01). Z test did not detect statistically significant difference between sPET/CT and nsPET/CT for all the diagnostic estimate indexes (all P > 0.05). CONCLUSIONS On patient-based analysis, 18F-FDG-PET/CT has high diagnostic accuracy for the detection of recurrent and/or metastatic diseases in DTC patients with thyroglobulin elevation and negative iodine scintigraphy, but existing studies were limited by high heterogeneity and possible publication bias. The diagnostic performance of sPET/CT may be not superior to nsPET/CT.
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Affiliation(s)
- Wan Qichang
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Bai Lin
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhao Gege
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhang Youjia
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ma Qingjie
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wang Renjie
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ji Bin
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
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Sharpley FA, Neffa P, Panitsas F, Kothari J, Subesinghe M, Cutter D, Shcolnik Szor R, Martinez GA, Rocha V, Ramasamy K. Long-term clinical outcomes in a cohort of patients with solitary plasmacytoma treated in the modern era. PLoS One 2019; 14:e0219857. [PMID: 31335866 PMCID: PMC6650037 DOI: 10.1371/journal.pone.0219857] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/02/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The risk of recurrence of solitary plasmacytoma (SP)/progression to MM is well established, but patient, imaging and treatment factors influencing risk of progression require further evaluation. METHODS This is a retrospective analysis of 66 SP patients (23 UK, 43 Brazil) diagnosed 1989-2016. Patient baseline characteristics were recorded. The incidence of progression to MM was calculated, including biochemical and imaging findings and the treatment modality received. Survival estimates were determined by Kaplan-Meier analyses. RESULTS With a median follow-up of 53.6 months the 5 year overall survival (OS) was 90.7% (95%CI 79-96%). The median progression free survival (PFS) from diagnosis was 61 months. Cumulative incidence of progression to MM was 49.9% at 5 years (95% CI 35.6-62.6%) and was significantly higher with bone plasmacytoma (47.2%, 95%CI 31.9-61.1%), than an extramedullary location (8.3%, 95%CI 0.4-32.3%, Gray test p = 0.0095)). The majority of patients with solitary bony plasmacytoma (SBP) received radiotherapy (RT) (51/53, 96.2%) whereas most extramedullary cases were treated with surgical resection (7/13, 53.8%). A small proportion of SBP patients received additional upfront chemotherapy, with 5/6 in remission after a median follow-up (FU) of 10 years. The diagnostic yield of surveillance functional FU imaging without other indications of relapse/progression was low. The positive predictive value of functional FU imaging was high but with a low negative predictive value, especially in cases of suspected relapse/progression. CONCLUSION Our data suggests functional imaging should be used if clinical suspicion of relapse/progression, rather than a routine surveillance tool, and upfront adjuvant chemotherapy is worthy of prospective evaluation.
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Affiliation(s)
- F. A. Sharpley
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - P Neffa
- Division of Hematology, Hospital das Clinicas of the University of São Paulo, São Paulo, Brazil
| | - F. Panitsas
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - J. Kothari
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
- NIHR BRC Blood Theme, Oxford, United Kingdom
| | - M. Subesinghe
- Department of Cancer imaging, School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
| | - D. Cutter
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - R. Shcolnik Szor
- Division of Hematology, Hospital das Clinicas of the University of São Paulo, São Paulo, Brazil
| | - G. Aparedcida Martinez
- Division of Hematology, Hospital das Clinicas of the University of São Paulo, São Paulo, Brazil
| | - V. Rocha
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
- Division of Hematology, Hospital das Clinicas of the University of São Paulo, São Paulo, Brazil
| | - K. Ramasamy
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
- NIHR BRC Blood Theme, Oxford, United Kingdom
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Kao PF, Lee KW, Huang CW, Yang SF, Chang-Yao Tsao T. Multicenter integrated positron emission tomography/computer tomography imaging quality assurance accreditation interobserver reliability study with the American College of Radiology phantom. J Chin Med Assoc 2019; 82:225-230. [PMID: 30908415 DOI: 10.1097/jcma.0000000000000033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Integrated positron emission tomography/computer tomography (PET/CT) image quality assurance ensures accurate, reproducible, and quantitative assessment of comparable scanner performance. We performed a preliminary multicenter PET/CT imaging quality assurance test with a fillable tomographic phantom in six medical centers in Taiwan. METHODS The phantom was filled with fixed proportions of fluorine-18 radionuclide solution in the background and with different spheres to simulate cold and hot lesions, and body background radioactivity. Imaging acquisitions were performed by using recommended parameters in different sites according to different brand names of the instrument. All imaging was subjectively scored by eight experienced nuclear medicine physicians as the spatial resolution of four hot vials (score 0-4), six cold spheres (score 0-6), and six cold rod areas (score 0-6), and overall satisfaction (score 0-5). Interobserver correlation and receiver operating characteristic (ROC) curve were analyzed. RESULTS The detection ability of hot vials, cold spheres, and cold rods was 4.0 ± 0.1, 5.2 ± 0.8, and 3.8 ± 0.9, respectively. Overall satisfaction was 4.0 ± 0.8. The ROC analysis revealed that the area under the curve for hot vials, cold spheres, and cold rods was 0.984, 0.887, and 0.928 respectively. The interobserver correlation for detectability of cold spheres and cold rods was 0.88 and 0.96, respectively. CONCLUSION The results of the study indicated that (1) PET/CT imaging quality assurance for comparable scanner performance could be established on the basis of a standard phantom and (2) good interobserver correlation can be observed for those with accurate and interpretable results.
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Affiliation(s)
- Pan-Fu Kao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Department of Nuclear Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
- Molecular Imaging Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Kuo-Wei Lee
- Institute of Nuclear Energy Research, Atomic Energy Council, Executive Yuan, Taoyuan, Taiwan, ROC
| | - Chi-Wen Huang
- Department of Nuclear Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
- Molecular Imaging Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Center of Clinical Research, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Thomas Chang-Yao Tsao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Division of Thoracic Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
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Abstract
Automatic tumor segmentation from medical images is an important step for computer-aided cancer diagnosis and treatment. Recently, deep learning has been successfully applied to this task, leading to state-of-the-art performance. However, most of existing deep learning segmentation methods only work for a single imaging modality. PET/CT scanner is nowadays widely used in the clinic, and is able to provide both metabolic information and anatomical information through integrating PET and CT into the same utility. In this study, we proposed a novel multi-modality segmentation method based on a 3D fully convolutional neural network (FCN), which is capable of taking account of both PET and CT information simultaneously for tumor segmentation. The network started with a multi-task training module, in which two parallel sub-segmentation architectures constructed using deep convolutional neural networks (CNNs) were designed to automatically extract feature maps from PET and CT respectively. A feature fusion module was subsequently designed based on cascaded convolutional blocks, which re-extracted features from PET/CT feature maps using a weighted cross entropy minimization strategy. The tumor mask was obtained as the output at the end of the network using a softmax function. The effectiveness of the proposed method was validated on a clinic PET/CT dataset of 84 patients with lung cancer. The results demonstrated that the proposed network was effective, fast and robust and achieved significantly performance gain over CNN-based methods and traditional methods using PET or CT only, two V-net based co-segmentation methods, two variational co-segmentation methods based on fuzzy set theory and a deep learning co-segmentation method using W-net.
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Affiliation(s)
- Xiangming Zhao
- Key Laboratory of Image Processing and Intelligent Control of Ministry of Education of China, School of Automation, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Laquan Li
- Key Laboratory of Image Processing and Intelligent Control of Ministry of Education of China, School of Automation, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Wei Lu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | - Shan Tan
- Key Laboratory of Image Processing and Intelligent Control of Ministry of Education of China, School of Automation, Huazhong University of Science and Technology, Wuhan 430074, China
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Huang SM, Yin L, Yue JL, Li YF, Yang Y, Lin ZC. Direct comparison of choline PET/CT and MRI in the diagnosis of lymph node metastases in patients with prostate cancer. Medicine (Baltimore) 2018; 97:e13344. [PMID: 30557983 PMCID: PMC6320103 DOI: 10.1097/md.0000000000013344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Lymph node detection in prostate cancer is challenging and critical to determine treatment policy. Choline PET/CT (positron emission tomography/computed tomography) and magnetic resonance imaging (MRI) have been used for the evaluation of lymph node metastasis in patients with prostate cancer for the past decade. However, only limited patients underwent direct comparison studies. PURPOSE To evaluate the diagnostic performance of choline PET/CT compared with MRI imaging for detecting lymph node metastases in prostate cancer patients. MATERIAL AND METHODS Relevant English-language articles published before February 2018 were searched in PubMed database, Embase database, and Cochrane Library databases search using the keywords: (Prostate Neoplasm OR Prostate Cancer OR prostate carcinoma) and (Lymph Node) and (PET/CT OR positron emission tomography/computed tomography) and (choline or 2-hydroxy-N,N,N-trimethylethanaminium) and (magnetic resonance imaging OR MRI). Articles were included that directly compare the diagnostic performance and clinical utility of choline PET/CT and MRI for detecting lymph node metastases in prostate cancer patients. Study quality was assessed with QUADAS criteria. Analyses were performed on a per patient and a per node basis. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were calculated using Meta-Disc 1.4 software. Summary receiver-operating characteristic (SROC) curves constructed. RESULTS A total of 362 patients from 8 studies involving fulfilled the inclusion criteria. On patient-based analysis, the pooled sensitivity, specificity, and DOR with a 95% confidence interval (CI) for choline PET/CT imaging were 0.59 (95%CI, 0.50-0.67), 0.92 (95%CI, 0.87-0.96), 17.37 (95%CI, 4.42-68.33), and for MRI imaging, they were 0.52 (95%CI, 0.44-0.61), 0.87 (95%CI, 0.81-0.92), 6.05 (95%CI, 3.09-11.85), respectively. On node-based, the corresponding values for choline PET/CT imaging were 0.51 (95%CI, 0.46-0.57), 0.99 (95%CI, 0.98-0.99), 65.55 (95%CI, 23.55-182.45), and for MRI imaging, they were 0.39 (95%CI, 0.34-0.44), 0.97 (95%CI, 0.96-0.97), 15.86 (95%CI, 8.96-28.05), respectively. CONCLUSION Choline PET/CT performed better than MRI imaging in evaluating the lymph nodes metastasis of prostate cancer patients and had the potential to be broadly applied in clinical practice.
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Alkhybari EM, McEntee MF, Brennan PC, Willowson KP, Hogg P, Kench PL. Determining and updating PET/CT and SPECT/CT diagnostic reference levels: A systematic review. Radiat Prot Dosimetry 2018; 182:532-545. [PMID: 30137488 DOI: 10.1093/rpd/ncy113] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/28/2018] [Indexed: 06/08/2023]
Abstract
The aim of this systematic review is to investigate the national diagnostic reference level (NDRL) methods for positron emission tomography/computed tomography (PET/CT) and single photon emission tomography/computed tomography (SPECT/CT) procedures. A search strategy was based on the preferred, reporting items for systematic review and meta-analysis (PRISMA). Relevant articles retrieved from Medline, Scopus, Web of Science, Embase, Cinahl, and Google Scholar published up to October 2017. The search yielded 1057 articles. Fourteen articles were included in the review after a screening process. Relevant information from the selected articles were summarised and analysed. Discrepancies were found between the methodologies utilised to establish and report both PET/CT and SPECT/CT NDRLs, e.g. patient sampling and administered activity. Further research should focus on reporting more NDRLs for hybrid PET/CT and SPECT/CT examinations, and establish a robust NDRL standard for the CT portion associated with PET/CT and SPECT/CT examinations. This review provides updated NDRL reommndations to deliver more comparable international radation doses for administered activity and CT dose across PET/CT and SPECT/CT clinics.
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Affiliation(s)
- Essam M Alkhybari
- The Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, NSW 2006 Australia
- Department of Radiology and Medical Imaging, Faculty of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Mark F McEntee
- The Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, NSW 2006 Australia
| | - Patrick C Brennan
- The Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, NSW 2006 Australia
| | - Kathy P Willowson
- Institute of Medical Physics, Faculty of Science, The University of Sydney, NSW, Australia
| | - Peter Hogg
- School of Health Sciences, University of Salford Manchester, UK
| | - Peter L Kench
- The Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, NSW 2006 Australia
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Presotto L, Iaccarino L, Sala A, Vanoli EG, Muscio C, Nigri A, Bruzzone MG, Tagliavini F, Gianolli L, Perani D, Bettinardi V. Low-dose CT for the spatial normalization of PET images: A validation procedure for amyloid-PET semi-quantification. Neuroimage Clin 2018; 20:153-160. [PMID: 30094164 PMCID: PMC6072675 DOI: 10.1016/j.nicl.2018.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/22/2018] [Accepted: 07/13/2018] [Indexed: 12/17/2022]
Abstract
The reference standard for spatial normalization of brain positron emission tomography (PET) images involves structural Magnetic Resonance Imaging (MRI) data. However, the lack of such structural information is fairly common in clinical settings. This might lead to lack of proper image quantification and to evaluation based only on visual ratings, which does not allow research studies or clinical trials based on quantification. PET/CT systems are widely available and CT normalization procedures need to be explored. Here we describe and validate a procedure for the spatial normalization of PET images based on the low-dose Computed Tomography (CT) images contextually acquired for attenuation correction in PET/CT systems. We included N = 34 subjects, spanning from cognitively normal to mild cognitive impairment and dementia, who underwent amyloid-PET/CT (18F-Florbetaben) and structural MRI scans. The proposed pipeline is based on the SPM12 unified segmentation algorithm applied to low-dose CT images. The validation of the normalization pipeline focused on 1) statistical comparisons between regional and global 18F-Florbetaben-PET/CT standardized uptake value ratios (SUVrs) estimated from both CT-based and MRI-based normalized PET images (SUVrCT, SUVrMRI) and 2) estimation of the degrees of overlap between warped gray matter (GM) segmented maps derived from CT- and MRI-based spatial transformations. We found negligible deviations between regional and global SUVrs in the two CT and MRI-based methods. SUVrCT and SUVrMRI global uptake scores showed negligible differences (mean ± sd 0.01 ± 0.03). Notably, the CT- and MRI-based warped GM maps showed excellent overlap (90% within 1 mm). The proposed analysis pipeline, based on low-dose CT images, allows accurate spatial normalization and subsequent PET image quantification. A CT-based analytical pipeline could benefit both research and clinical practice, allowing the recruitment of larger samples and favoring clinical routine analysis.
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Affiliation(s)
- Luca Presotto
- Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Leonardo Iaccarino
- Vita-Salute San Raffaele University, Milan, Italy; In vivo human molecular and structural neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Arianna Sala
- Vita-Salute San Raffaele University, Milan, Italy; In vivo human molecular and structural neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emilia G Vanoli
- Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Cristina Muscio
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milano, Italy
| | - Anna Nigri
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milano, Italy
| | - Maria Grazia Bruzzone
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milano, Italy
| | - Fabrizio Tagliavini
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milano, Italy
| | - Luigi Gianolli
- Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Daniela Perani
- Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; In vivo human molecular and structural neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Miwa K, Wagatsuma K, Iimori T, Sawada K, Kamiya T, Sakurai M, Miyaji N, Murata T, Sato E. Multicenter study of quantitative PET system harmonization using NIST-traceable 68Ge/ 68Ga cross-calibration kit. Phys Med 2018; 52:98-103. [PMID: 30139617 DOI: 10.1016/j.ejmp.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/06/2018] [Accepted: 07/03/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The present study aimed to define the errors in SUV and demonstrate the feasibility of SUV harmonization among contemporary PET/CT scanners using a novel National Institute of Standards and Technology (NIST)-traceable 68Ge/68Ga source as the reference standard. METHODS We used 68Ge/68Ga dose calibrator and PET sources made with same batch of 68Ge/68Ga embedded in epoxy that is traceable to the NIST standard. Bias in the amount of radioactivity and the radioactive concentrations measured by the dose calibrators and PET/CT scanners, respectively, was determined at five Japanese sites. We adjusted optimal dial setting of the dose calibrators and PET reconstruction parameters to close the actual amount of radioactivity and the radioactive concentration, respectively, of the NIST-traceable 68Ge/68Ga sources to harmonize SUV. Errors in SUV before and after harmonization were then calculated at each site. RESULTS The average bias in the amount of radioactivity and the radioactive concentrations measured by dose calibrator and PET scanner was -4.94% and -12.22%, respectively, before, and -0.14% and -4.81%, respectively, after harmonization. Corresponding averaged errors in SUV measured under clinical conditions were underestimated by 7.66%, but improved by -4.70% under optimal conditions. CONCLUSION Our proposed method using an NIST-traceable 68Ge/68Ga source identified bias in values obtained using dose calibrators and PET scanners, and reduced SUV variability to within 5% across different models of PET scanners at five sites. Our protocol using a standard source has considerable potential for harmonizing the SUV when contemporary PET scanners are involved in multicenter studies.
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Affiliation(s)
- Kenta Miwa
- Department of Radiological Sciences, School of Health Science, International University of Health and Welfare, Tochigi, Japan.
| | - Kei Wagatsuma
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takashi Iimori
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Koichi Sawada
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takashi Kamiya
- Department of Medical Technology, Osaka University Hospital, Osaka, Japan
| | - Minoru Sakurai
- Clinical Imaging Center for Healthcare, Nippon Medical School, Tokyo, Japan
| | - Noriaki Miyaji
- Department of Nuclear Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Taisuke Murata
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Eisuke Sato
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, Tokyo, Japan
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Pu Y, Zhang JX, Liu H, Appelbaum D, Meng J, Penney BC. Developing and validating a novel metabolic tumor volume risk stratification system for supplementing non-small cell lung cancer staging. Eur J Nucl Med Mol Imaging 2018; 45:2079-2092. [PMID: 29882161 DOI: 10.1007/s00259-018-4059-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/23/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE We hypothesized that whole-body metabolic tumor volume (MTVwb) could be used to supplement non-small cell lung cancer (NSCLC) staging due to its independent prognostic value. The goal of this study was to develop and validate a novel MTVwb risk stratification system to supplement NSCLC staging. METHODS We performed an IRB-approved retrospective review of 935 patients with NSCLC and FDG-avid tumor divided into modeling and validation cohorts based on the type of PET/CT scanner used for imaging. In addition, sensitivity analysis was conducted by dividing the patient population into two randomized cohorts. Cox regression and Kaplan-Meier survival analyses were performed to determine the prognostic value of the MTVwb risk stratification system. RESULTS The cut-off values (10.0, 53.4 and 155.0 mL) between the MTVwb quartiles of the modeling cohort were applied to both the modeling and validation cohorts to determine each patient's MTVwb risk stratum. The survival analyses showed that a lower MTVwb risk stratum was associated with better overall survival (all p < 0.01), independent of TNM stage together with other clinical prognostic factors, and the discriminatory power of the MTVwb risk stratification system, as measured by Gönen and Heller's concordance index, was not significantly different from that of TNM stage in both cohorts. Also, the prognostic value of the MTVwb risk stratum was robust in the two randomized cohorts. The discordance rate between the MTVwb risk stratum and TNM stage or substage was 45.1% in the modeling cohort and 50.3% in the validation cohort. CONCLUSION This study developed and validated a novel MTVwb risk stratification system, which has prognostic value independent of the TNM stage and other clinical prognostic factors in NSCLC, suggesting that it could be used for further NSCLC pretreatment assessment and for refining treatment decisions in individual patients.
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Affiliation(s)
- Yonglin Pu
- Department of Radiology, The University of Chicago, 5841 S. Maryland Ave., MC 2026, Chicago, IL, 60637, USA.
| | - James X Zhang
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Haiyan Liu
- Department of Nuclear Medicine, First Hospital and Molecular Imaging Precision Medical Collaborative Innovation Center, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Daniel Appelbaum
- Department of Radiology, The University of Chicago, 5841 S. Maryland Ave., MC 2026, Chicago, IL, 60637, USA
| | - Jianfeng Meng
- Department of Respiratory Medicine, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541002, Guangxi Zhuang Autonomous Region, China
| | - Bill C Penney
- Department of Radiology, The University of Chicago, 5841 S. Maryland Ave., MC 2026, Chicago, IL, 60637, USA
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Gaitanis A, Kastis GA, Vlastou E, Bouziotis P, Verginis P, Anagnostopoulos CD. Investigation of Image Reconstruction Parameters of the Mediso nanoScan PC Small-Animal PET/CT Scanner for Two Different Positron Emitters Under NEMA NU 4-2008 Standards. Mol Imaging Biol 2018; 19:550-559. [PMID: 27995432 DOI: 10.1007/s11307-016-1035-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 11/26/2022]
Abstract
PURPOSE The Tera-Tomo 3D image reconstruction algorithm (a version of OSEM), provided with the Mediso nanoScan® PC (PET8/2) small-animal positron emission tomograph (PET)/x-ray computed tomography (CT) scanner, has various parameter options such as total level of regularization, subsets, and iterations. Also, the acquisition time in PET plays an important role. This study aims to assess the performance of this new small-animal PET/CT scanner for different acquisition times and reconstruction parameters, for 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) and Ga-68, under the NEMA NU 4-2008 standards. PROCEDURES Various image quality metrics were calculated for different realizations of [18F]FDG and Ga-68 filled image quality (IQ) phantoms. RESULTS [18F]FDG imaging produced improved images over Ga-68. The best compromise for the optimization of all image quality factors is achieved for at least 30 min acquisition and image reconstruction with 52 iteration updates combined with a high regularization level. CONCLUSION A high regularization level at 52 iteration updates and 30 min acquisition time were found to optimize most of the figures of merit investigated.
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Affiliation(s)
- Anastasios Gaitanis
- PET/CT Department and Small Animal PET/CT Unit, Centre for Clinical Research, Experimental Surgery & Translational Research, Biomedical Research Foundation of the Academy of Athens (BRFAA), Athens, Greece.
| | - George A Kastis
- Research Center of Mathematics, Academy of Athens, Athens, Greece
- Radiochemical Studies Laboratory, Institute of Nuclear and Radiological Sciences & Technology, Energy & Safety (I.N.RA.S.T.E.S.), N.C.S.R. "Demokritos", Athens, Greece
| | - Elena Vlastou
- PET/CT Department and Small Animal PET/CT Unit, Centre for Clinical Research, Experimental Surgery & Translational Research, Biomedical Research Foundation of the Academy of Athens (BRFAA), Athens, Greece
| | - Penelope Bouziotis
- Radiochemical Studies Laboratory, Institute of Nuclear and Radiological Sciences & Technology, Energy & Safety (I.N.RA.S.T.E.S.), N.C.S.R. "Demokritos", Athens, Greece
| | - Panayotis Verginis
- Division of Clinical, Experimental Surgery, and Translational Research, Biomedical Research Foundation, Academy of Athens, 4 Soranou Efessiou Street, Athens, Greece
| | - Constantinos D Anagnostopoulos
- PET/CT Department and Small Animal PET/CT Unit, Centre for Clinical Research, Experimental Surgery & Translational Research, Biomedical Research Foundation of the Academy of Athens (BRFAA), Athens, Greece
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Yu J, Zheng J, Xu W, Weng J, Gao L, Tao L, Liang F, Zhang J. Accuracy of 18F-FDOPA Positron Emission Tomography and 18F-FET Positron Emission Tomography for Differentiating Radiation Necrosis from Brain Tumor Recurrence. World Neurosurg 2018; 114:e1211-e1224. [PMID: 29625311 DOI: 10.1016/j.wneu.2018.03.179] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Distinguishing radiation necrosis from brain tumor recurrence remains challenging. We performed a meta-analysis to assess the diagnostic accuracy of 2 different amino acid tracers used in positron emission tomography/computed tomography scans: 18F-FDOPA (6-[18F]-fluoro-L-3,4-dihydroxyphenylalanine) and 18F-FET (O-(2-18F-fluoroethyl)-L-tyrosine). METHODS We searched for studies in 3 databases: PubMed, Embase, and Chinese Biomedical databases. The data were extracted from eligible studies and then processed with heterogeneity test, threshold effect test, and calculations of sensitivity, specificity, and area under the summary receiver operating characteristic curve. Meta-regression and subgroup analyses were performed to explore the source of heterogeneity. RESULTS A total of 48 studies (18F-FDOPA, n = 21; 18F-FET, n = 27) were included. Quantitative synthesis determined pooled weight values in the 18F-FDOPA and 18F-FET groups: sensitivity, 0.85 versus 0.82; specificity, 0.77 versus 0.80; diagnostic odds ratio, 21.7 versus 23.03; area under the curve (AUC) values, 0.8771 versus 0.8976 (P = 0.46). Moreover, the type of tumor was identified as the possible source of the significant heterogeneity (I2 = 52%; P = 0.003) found in the 18F-FDOPA group. In meta-regression and subgroup analyses, 18F-FDOPA showed better diagnostic accuracy in patients with glioma compared with patients with brain metastases (AUC values, 0.9691 vs. 0.837; P < 0.01). 18F-FDOPA also showed a significant advantage in the diagnosis of glioma recurrence compared with 18F-FET (AUC values, 0.9691 vs. 0.9124; P = 0.015). CONCLUSIONS Both 18F-FDOPA and 18F-FET exhibit moderate overall accuracy in diagnosing brain tumor recurrence from radiation necrosis. However, 18F-FDOPA is more adept at diagnosing glioma recurrence compared with brain metastases, and it is more effective than 18F-FET in diagnosing glioma recurrence.
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Affiliation(s)
- Jun Yu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jingwei Zheng
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Weilin Xu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiaqi Weng
- Shaoxin Keqiao Women & Children's Hospital, Shaoxin, Zhejiang, China
| | - Liansheng Gao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Li Tao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Feng Liang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Jianmin Zhang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Brain Research Institute, Zhejiang University, Hangzhou, Zhejiang, China; Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, China.
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Bernstine H, Domachevsky L, Nidam M, Goldberg N, Abadi-Korek I, Shpilberg O, Groshar D. 18F-FDG PET/MR imaging of lymphoma nodal target lesions: Comparison of PET standardized uptake value (SUV) with MR apparent diffusion coefficient (ADC). Medicine (Baltimore) 2018; 97:e0490. [PMID: 29668631 PMCID: PMC5916693 DOI: 10.1097/md.0000000000010490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To compare positron emission tomography (PET) standardized uptake value (SUV) with magnetic resonance (MR) apparent diffusion coefficient (ADC) of nodal target lesions in patients with F-fluoro-2-deoxyglucose (FDG)-avid lymphomas by simultaneous PET/MR.Patients with histologically proven Hodgkin and non-Hodgkin lymphoma underwent PET/MR limited field of view of FDG-avid target nodal lesions. For PET images, a region of interest (ROI) was drawn around the target nodal lesion and the SUVmax and SUVmean was measured. For MR ADC measurements a ROI was placed over the target nodal lesion on diffusion-weighted imaging (DWI) and ADCmin and ADCmean (mean ADC) values within the ROI were recorded.Thirty-nine patients (19 women, 20 men; 13 patients with Hodgkin lymphoma and 26 with non-Hodgkin lymphoma) were included in the analysis. Sixty-six nodal lesions detected by PET/CT (19 PET-negative and 47 PET-positive) were analyzed by PET/MR. PET/MR quantitative assessments showed that ADCmin and ADCmean were accurate for discriminating positive from negative nodal lymphoma, with an AUC of 0.927 and 0.947, respectively. The ROC curve analysis of ADCmean versus SUVmax and SUVmean was not statistically significant (difference=0.044, P = .08 and difference = 0.045, P = .07; respectively). A substantial inverse association was observed between ADCmean with SUVmean and SUVmax (rho = -0.611; -0.607; P < .0001, respectively). A moderate inverse association was found between ADCmin with SUVmean and SUVmax (rho = -0.529, -0.520; P < .0001, respectively). Interobserver variability of quantitative assessment showed very good agreement for all variables (ICC>0.87).A significant correlation between ADCs and SUVs is found in FDG avid lymphomas. ADCmean is not inferior to PET SUV in discriminating positive and negative nodal lymphomas. Further larger studies are warranted to validate quantitative PET/MR for lymphoma patient management.
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Affiliation(s)
- Hanna Bernstine
- Department of Nuclear Medicine
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | - David Groshar
- Department of Nuclear Medicine
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Almeida ND, Adams C, Davis GL, Starke RM, Buro J, Nasr N, McRae D, Cernica G, Caputy A, Hong R, Sherman J. Effectiveness of Positron Emission Tomography/Computed Tomography as a Guide for Palliative Radiation Therapy for Spinal Metastases. World Neurosurg 2018; 115:e67-e72. [PMID: 29614361 DOI: 10.1016/j.wneu.2018.03.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 03/24/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE As back pain is the presenting symptom in 95% of patients with epidural spinal metastases, appropriately identifying and treating the most symptomatic levels can provide significant palliation. The purpose of this study was to analyze the ability of combined positron emission tomography (PET)/computed tomography (CT) to identify spinal metastases with high metabolic activity and guide radiotherapy. We sought to correlate improvement in back pain with reduction in standard uptake value (SUV) after treatment. METHODS Retrospective review was performed of 72 patients with spinal metastases treated with stereotactic ablative radiation therapy at a single center between 2002 and 2014. PET/CT was used to calculate SUVs for spinal metastases, and treatment planning was based on PET/CT results. Preoperative and postoperative pain levels were assessed in all patients. RESULTS Reduction in pain scores was found in 78% of treated patients. A significant reduction in pain was identified in patients with >5 metastases compared with fewer lesions (P < 0.05). Degree of change in SUV did not correlate significantly with pain relief. However, comparing pretreatment and posttreatment PET/CT, patients with improved pain consistently displayed decreased SUV. CONCLUSIONS PET/CT was shown to be a useful adjunct in radiation treatment planning with change in SUV correlating with symptomatic improvement. This study paves the way for future prospective studies to further assess utility and cost-effectiveness of this imaging modality in radiation treatment planning for spinal metastases.
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Affiliation(s)
- Neil D Almeida
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Crystal Adams
- Department of Neurological Surgery, George Washington University Hospital, Washington, DC, USA
| | - Gregory L Davis
- Department of Neurological Surgery, George Washington University Hospital, Washington, DC, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Justin Buro
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Nadim Nasr
- Department of Radiation Oncology, Virginia Hospital Center, Arlington, Virginia, USA
| | - Don McRae
- Department of Radiation Oncology, Virginia Hospital Center, Arlington, Virginia, USA
| | - George Cernica
- Department of Radiation Oncology, Virginia Hospital Center, Arlington, Virginia, USA
| | - Anthony Caputy
- Department of Neurological Surgery, George Washington University Hospital, Washington, DC, USA
| | - Robert Hong
- Department of Radiation Oncology, Virginia Hospital Center, Arlington, Virginia, USA
| | - Jonathan Sherman
- Department of Neurological Surgery, George Washington University Hospital, Washington, DC, USA.
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Lv W, Yuan Q, Wang Q, Ma J, Jiang J, Yang W, Feng Q, Chen W, Rahmim A, Lu L. Robustness versus disease differentiation when varying parameter settings in radiomics features: application to nasopharyngeal PET/CT. Eur Radiol 2018. [PMID: 29520429 DOI: 10.1007/s00330-018-5343-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [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: 10/17/2022]
Abstract
OBJECTIVES To investigate the impact of parameter settings as used for the generation of radiomics features on their robustness and disease differentiation (nasopharyngeal carcinoma (NPC) versus chronic nasopharyngitis (CN) in FDG PET/CT imaging). METHODS We studied 106 patients (69/37 NPC/CN, pathology confirmed), and extracted 57 radiomics features under different parameter settings. Robustness was assessed by the intra-class correlation coefficient (ICC). Logistic regression with leave-one-out cross validation was used to generate classification probabilities, and diagnostic performance was assessed by the area under the receiver operating characteristic curve (AUC). RESULTS Varying averaging strategies and symmetry, 4/26 GLCM features showed poor range of pairwise ICCs of 0.02-0.98, while depicting good AUCs of 0.82-0.91. Varying distances, 5/26 GLCM features showed ICCs of 0.82-0.99 while corresponding AUCs were 0.52-0.91. 6/13 GLRLM features showed both high AUC (0.81-0.89) and high ICC (0.85-0.99) regarding to averaging strategies. 7/13 GLSZM features showed AUCs of 0.81-0.90 while having ICCs of 0.01-0.99 under different neighbourhoods. 2/5 NGTDM features showed AUCs of 0.81-0.85 while having ICCs of 0.19-0.89 for different window sizes. Differentiating a subset of NPC (stages I-II) form CN, both SumEntropy and SZLGE achieved significantly higher AUCs than metabolically active tumour volume (AUC: 0.91 vs. 0.72, p<0.01). CONCLUSIONS Radiomics features depicting poor absolute-scale robustness regarding to parameter settings can still lead to good diagnostic performance. As such, robustness of radiomics features should not be overemphasized for removal of features towards assessment of clinical tasks. For differentiating NPC from CN, some radiomics features (e.g. SumEntropy, SZLGE, LGZE) outperformed conventional metrics. KEY POINTS • Poor robustness did not necessarily translate into poor differentiation performance. • Absolute-scale robustness of radiomics features should not be overemphasized. • Radiomics features SumEntropy, SZLGE and LGZE outperformed conventional metrics.
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Affiliation(s)
- Wenbing Lv
- School of Biomedical Engineering and Guangdong Provincal Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Baiyun District, Guangzhou, Guangdong, 510515, China
| | - Qingyu Yuan
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, 1023 Shatai Road, Baiyun District, Guangzhou, Guangdong, 510515, China
| | - Quanshi Wang
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, 1023 Shatai Road, Baiyun District, Guangzhou, Guangdong, 510515, China
| | - Jianhua Ma
- School of Biomedical Engineering and Guangdong Provincal Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Baiyun District, Guangzhou, Guangdong, 510515, China.
| | - Jun Jiang
- School of Biomedical Engineering and Guangdong Provincal Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Baiyun District, Guangzhou, Guangdong, 510515, China
| | - Wei Yang
- School of Biomedical Engineering and Guangdong Provincal Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Baiyun District, Guangzhou, Guangdong, 510515, China
| | - Qianjin Feng
- School of Biomedical Engineering and Guangdong Provincal Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Baiyun District, Guangzhou, Guangdong, 510515, China
| | - Wufan Chen
- School of Biomedical Engineering and Guangdong Provincal Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Baiyun District, Guangzhou, Guangdong, 510515, China
| | - Arman Rahmim
- Department of Radiology, Johns Hopkins University, 601 N. Caroline St, Baltimore, MD, 21287, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, 3101 Wyman Park Drive, Baltimore, MD, 21218, USA
| | - Lijun Lu
- School of Biomedical Engineering and Guangdong Provincal Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Baiyun District, Guangzhou, Guangdong, 510515, China.
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Kaalep A, Sera T, Rijnsdorp S, Yaqub M, Talsma A, Lodge MA, Boellaard R. Feasibility of state of the art PET/CT systems performance harmonisation. Eur J Nucl Med Mol Imaging 2018; 45:1344-1361. [PMID: 29500480 PMCID: PMC5993859 DOI: 10.1007/s00259-018-3977-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 02/12/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE The objective of this study was to explore the feasibility of harmonising performance for PET/CT systems equipped with time-of-flight (ToF) and resolution modelling/point spread function (PSF) technologies. A second aim was producing a working prototype of new harmonising criteria with higher contrast recoveries than current EARL standards using various SUV metrics. METHODS Four PET/CT systems with both ToF and PSF capabilities from three major vendors were used to acquire and reconstruct images of the NEMA NU2-2007 body phantom filled conforming EANM EARL guidelines. A total of 15 reconstruction parameter sets of varying pixel size, post filtering and reconstruction type, with three different acquisition durations were used to compare the quantitative performance of the systems. A target range for recovery curves was established such that it would accommodate the highest matching recoveries from all investigated systems. These updated criteria were validated on 18 additional scanners from 16 sites in order to demonstrate the scanners' ability to meet the new target range. RESULTS Each of the four systems was found to be capable of producing harmonising reconstructions with similar recovery curves. The five reconstruction parameter sets producing harmonising results significantly increased SUVmean (25%) and SUVmax (26%) contrast recoveries compared with current EARL specifications. Additional prospective validation performed on 18 scanners from 16 EARL accredited sites demonstrated the feasibility of updated harmonising specifications. SUVpeak was found to significantly reduce the variability in quantitative results while producing lower recoveries in smaller (≤17 mm diameter) sphere sizes. CONCLUSIONS Harmonising PET/CT systems with ToF and PSF technologies from different vendors was found to be feasible. The harmonisation of such systems would require an update to the current multicentre accreditation program EARL in order to accommodate higher recoveries. SUVpeak should be further investigated as a noise resistant alternative quantitative metric to SUVmax.
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Affiliation(s)
- Andres Kaalep
- Department of Medical Technology, North Estonia Medical Centre Foundation, J. Sutiste Str 19, 13419, Tallinn, Estonia.
| | - Terez Sera
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
- On behalf of EANM Research Limited (EARL), Vienna, Austria
| | - Sjoerd Rijnsdorp
- Department of Medical Physics, Catharina Hospital, Eindhoven, The Netherlands
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Anne Talsma
- Department of Radiology, Martini Hospital, Groningen, Netherlands
| | - Martin A Lodge
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Ronald Boellaard
- On behalf of EANM Research Limited (EARL), Vienna, Austria.
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, Groningen, the Netherlands.
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Schiller K, Devecka M, Maurer T, Eiber M, Gschwend J, Schwaiger M, Combs SE, Habl G. Impact of 68Ga-PSMA-PET imaging on target volume definition and guidelines in radiation oncology - a patterns of failure analysis in patients with primary diagnosis of prostate cancer. Radiat Oncol 2018; 13:36. [PMID: 29490670 PMCID: PMC5831712 DOI: 10.1186/s13014-018-0977-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/15/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND 68Ga-PSMA-PET-imaging has proven to be a highly sensitive and specific diagnostic element for patients with prostate cancer (PC). Does the standard clinical target volume (CTV) cover the majority of 68Ga-PSMA-PET detected lymph nodes (LNs) in a primary setting? METHODS 25 out of 159 patients with primary PC who underwent 68Ga-PSMA-PET-imaging were analyzed in the process of this study. These 25 high-risk patients had a total of 126 LNs with positive 68Ga-PSMA-ligand uptake. A standard CTV according to the 'Radiation Therapy Oncology Group' consensus was delineated and LNs were judged whether they were in- or outside of this target volume. With a Pearson correlation we additionally evaluated whether the Gleason score, the prostate-specific antigen (PSA) value or the risk according to the Roach formula correlate with a higher chance of LNs being outside of the CTV in uncommon LN locations. RESULTS 81 (64.3%) of 126 LNs were covered by the CTV with a complete coverage of all positive LNs inside the respective radiation volume in 11 of 25 patients (44%). LNs that were not covered by the CTV included (para-aortic,) common-iliac, pre-sacral, obturatoric, para-rectal, para-vesical and pre-acetabular locations. In a statistical analysis neither the Gleason score, nor the PSA value, nor the calculated risk with the Roach formula correlated with LNs being inside or outside of the CTV in this patient group. CONCLUSION 68Ga-PSMA-PET-imaging proves to be a valuable asset for patients and physicians for primary diagnosis and treatment planning. In our study, trusting the RTOG consensus for CTV delineation would have led to up to 35.7% of all LNs not to be included in the clinical radiation volume, which might have resulted in insufficient radiation dose coverage.
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Affiliation(s)
- K. Schiller
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
| | - M. Devecka
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
| | - T. Maurer
- Department of Urology, Technical University Munich (TUM), Munich, Germany
| | - M. Eiber
- Department of Nuclear Medicine, Technical University Munich (TUM), Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK) Partner Site Munich, Heidelberg, Germany
| | - J. Gschwend
- Department of Urology, Technical University Munich (TUM), Munich, Germany
| | - M. Schwaiger
- Department of Nuclear Medicine, Technical University Munich (TUM), Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK) Partner Site Munich, Heidelberg, Germany
| | - S. E. Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
- Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum, Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK) Partner Site Munich, Heidelberg, Germany
| | - G. Habl
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
- Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum, Munich, Germany
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Takagi H, Sakamoto J, Osaka Y, Shibata T, Fujita S, Sasagawa T. Usefulness of the maximum standardized uptake value for the diagnosis and staging of patients with cervical cancer undergoing positron emission tomography/computed tomography. Medicine (Baltimore) 2018; 97:e9856. [PMID: 29443749 PMCID: PMC5839850 DOI: 10.1097/md.0000000000009856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/14/2018] [Accepted: 01/22/2018] [Indexed: 11/27/2022] Open
Abstract
Cervical cancer recently has become more common among younger women in Japan. Diagnosing early-stage cancer is straightforward using cervical cytodiagnosis and histological diagnosis. However, postmenopausal endophytic cervical cancer and skip lesions in cervical adenocarcinoma are difficult to detect. We compared the maximum standardized uptake value (SUVmax) of 18F-fluorodeoxy-glucose positron emission tomography/computed tomography (PET/CT) for primary staging of cervical cancer and evaluated the relationship of the imaging findings to prognosis.This was a retrospective study of 38 patients with cervical cancer who underwent PET/CT. Patients were grouped according to disease stage, and the mean SUVmax, overall survival, and progression-free survival (PFS) were evaluated.The mean SUVmax was significantly different between patients with stage ≤I and ≥II diseases among those with squamous (P > .001) and glandular (P = .023) lesions. With an SUVmax of receiver operating characteristic curves as the optimal cutoff value, the log-rank test for PFS revealed a statistically significant difference between the 2 disease stages (P = .020 and P = .016, respectively).SUVmax is useful to differentiate between stage ≤I and ≥II cervical cancer. SUVmax may be useful for the prognostic evaluation of disease recurrence in patients with cervical cancer.
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Delivanis DA, Bancos I, Atwell TD, Schmit GD, Eiken PW, Natt N, Erickson D, Maraka S, Young WF, Nathan MA. Diagnostic performance of unenhanced computed tomography and 18 F-fluorodeoxyglucose positron emission tomography in indeterminate adrenal tumours. Clin Endocrinol (Oxf) 2018; 88:30-36. [PMID: 28815667 DOI: 10.1111/cen.13448] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/03/2017] [Accepted: 08/11/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evidence on the diagnostic performance of adrenal imaging is limited. We aimed to assess the diagnostic performance of unenhanced computed tomography (CT) and 18 F-fluorodeoxyglucose (18 FDG) positron emission tomography (PET)/CT imaging in a high-risk population for adrenal malignancy using an optimal reference standard. DESIGN Retrospective cohort study. METHODS Imaging studies of patients with adrenal nodules who underwent adrenal biopsy and/or adrenalectomy between 1994 and 2014 were reviewed and compared to the reference standard of histology. Eighty % of patients presented with known or suspected extra-adrenal malignancy. RESULTS Unenhanced abdominal CT was performed in 353 patients with adrenal lesions; median size was 3 (0.7-15) cm and median radiodensity was 33 (-21-78) Hounsfield units (HU). Radiodensity of >10 HU diagnosed malignancy with a sensitivity of 100%, specificity of 33%, positive predictive value (PPV) of 72% and negative predictive value (NPV) of 100%. 18 FDG-PET/CT was performed in 89 patients; median tumour size was 2.1 (0.7-9.2) cm. Maximum standardized uptake (SUV max) was higher in malignant lesions when compared to benign lesions (median=10 [2.3-29.4] vs 3.7 [1.4-24.5], respectively, P<.0001). Similarly, median SUV max lesion to SUV max liver ratio (ALR) in malignant lesions was higher than in benign lesions (median=3 [0.74-13.4] vs 1.2 [0.5-6.6], respectively, P<.0001). 18 FDG-PET/CT ALR >1.8 diagnosed malignancy with a sensitivity of 87%, specificity of 84%, PPV of 85% and NPV of 86%. CONCLUSION Noncontract CT radiodensity of ≤10 HU excludes malignancy even in a high-risk population. For indeterminate adrenal lesions, given a superior specificity, 18 FDG-PET/CT could be considered as a second stage imaging study.
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Affiliation(s)
- Danae A Delivanis
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | | | - Grant D Schmit
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Neena Natt
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Dana Erickson
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Spyridoula Maraka
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Department of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Health Care System, Little Rock, AR, USA
| | - William F Young
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Mark A Nathan
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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