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Perrier L, Balusson F, Morelle M, Castelli J, Thariat J, Benezery K, Hasbini A, Gery B, Berger A, Liem X, Guihard S, Chapet S, Thureau S, Auberdiac P, Pommier P, Ruffier A, Devillers A, Oger E, Campillo-Gimenez B, de Crevoisier R. Cost-effectiveness of weekly adaptive radiotherapy versus standard IMRT in head and neck cancer alongside the ARTIX trial. Radiother Oncol 2024; 193:110116. [PMID: 38316193 DOI: 10.1016/j.radonc.2024.110116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/21/2024] [Accepted: 01/28/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND AND PURPOSE We performed a cost-effectiveness analysis (CEA) comparing an adaptive radiotherapy (ART) strategy, based on weekly replanning, aiming to correct the parotid gland overdose during treatment and expecting therefore to decrease xerostomia, when compared to a standard IMRT. MATERIALS AND METHODS We conducted the ARTIX trial, a randomized, parallel-group, multicentric study comparing a systematic weekly replanning ART to a standard IMRT. The primary endpoint was the frequency of xerostomia at 12 months, measured by stimulating salivary flow with paraffin. The CEA was designed alongside the ARTIX trial which was linked to the French national health data system (SNDS). For each patient, healthcare consumptions and costs were provided by the SNDS. The reference case analysis was based on the primary endpoint of the trial. Sensitivity and scenario analyses were performed. RESULTS Of the 129 patients randomly assigned between 2013 and 2018, only 2 records were not linked to the SNDS, which provides a linkage proportion of 98.4%. All of the other 127 records were linked with good to very good robustness. On the intent-to-treat population at 12 months, mean total costs per patient were €41,564 (SD 23,624) and €33,063 (SD 16,886) for ART and standard IMRT arms, respectively (p = 0.033). Incremental cost effectiveness ratio (ICER) was €162,444 per xerostomia avoided. At 24 months, ICER was €194,521 per xerostomia avoided. For both progression-free and overall survival, ART was dominated by standard IMRT. CONCLUSION The ART strategy was deemed to be not cost-effective compared with standard IMRT for patients with locally advanced oropharyngeal cancer.
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Affiliation(s)
- Lionel Perrier
- Univ Lyon, Leon Berard Cancer Center, GATE UMR 5824, 28 Prom. Léa et Napoléon Bullukian F-69008, Lyon, France; Human and Social Science Department, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian F-69008, Lyon, France.
| | - Frédéric Balusson
- Pharmacovigilance and Pharmacoepidemiology, CHU Rennes, Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Magali Morelle
- Univ Lyon, Leon Berard Cancer Center, GATE UMR 5824, 28 Prom. Léa et Napoléon Bullukian F-69008, Lyon, France
| | - Joël Castelli
- Department of Radiotherapy, Centre Eugene Marquis, Avenue Bataille Flandres Dunkerques F35000, Rennes, France
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse, Laboratoire de Physique Corpusculaire, IN2P3/ENISAEN-CNRS, Normandie Université, Caen, France
| | - Karen Benezery
- Department of Radiotherapy, Centre Antoine Lacassagne, Avenue de Valombrose F06000, Nice, France
| | - Ali Hasbini
- Radiotherapy, Clinique Pasteur-Lanroze, 32 Rue Auguste Kervern F29200, Brest, France
| | - Bernard Gery
- Department of Radiation Oncology, Centre François Baclesse, Laboratoire de Physique Corpusculaire, IN2P3/ENISAEN-CNRS, Normandie Université, Caen, France
| | - Antoine Berger
- Department of Radiotherapy, CHU Poitiers, 2 Rue de la Milétrie F86000, Poitiers, France
| | - Xavier Liem
- Academic Department of Radiation Oncology and Brachytherapy, Oscar Lambret Center, Lille, France
| | - Sébastien Guihard
- Department of Radiotherapy, ICANS, 17 rue Albert Calmette F67033, Strasbourg, France
| | - Sophie Chapet
- Department of Radiotherapy, Centre Jean-Bernard, institut inter-régional de cancérologie (ILC), CCS, 64, rue de Degré F-72000, Le Mans, France
| | - Sébastien Thureau
- Department of Radiotherapy, Centre Henri Becquerel, 1 Rue d'Amiens F76038, Rouen, France; Quantif LITIS EA 4108, University of Rouen, 22, Boulevard Gambetta F-76183, Rouen Cedex 1, France
| | - Pierre Auberdiac
- Radiotherapy, Clinique Claude Bernard, 1 rue du Père Colombier F81000, Albi, France
| | - Pascal Pommier
- Department of Radiotherapy, ICO-Angers, 15, rue André Boquel 49055, Angers cedex 02, France
| | - Amandine Ruffier
- Department of Radiotherapy, Centre Jean-Bernard, institut inter-régional de cancérologie (ILC), CCS, 64, rue de Degré F-72000, Le Mans, France
| | - Anne Devillers
- Department of Nuclear Medicine, Centre Eugene Marquis, Avenue Bataille Flandres Dunkerques F35000, Rennes, France
| | - Emmanuel Oger
- Pharmacovigilance and Pharmacoepidemiology, CHU Rennes, Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Boris Campillo-Gimenez
- Department of Clinical Research, Centre Eugene Marquis, Avenue Bataille Flandres Dunkerques F35000, Rennes, France; Inserm, LTSI-UMR 1099, University of Rennes, F-35000, Rennes, France
| | - Renaud de Crevoisier
- Department of Radiotherapy, Centre Eugene Marquis, Avenue Bataille Flandres Dunkerques F35000, Rennes, France
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Marchal E, Palard-Novello X, Lhomme F, Meyer ME, Manson G, Devillers A, Marolleau JP, Houot R, Girard A. Baseline [ 18F]FDG PET features are associated with survival and toxicity in patients treated with CAR T cells for large B cell lymphoma. Eur J Nucl Med Mol Imaging 2024; 51:481-489. [PMID: 37721580 DOI: 10.1007/s00259-023-06427-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE Chimeric antigen receptor (CAR) T cells have established themselves as an effective treatment for refractory or relapsed large B cell lymphoma (LBCL). Recently, the sDmax, which corresponds to the distance separating the two farthest lesions standardized by the patient's body surface area, has appeared as a prognostic factor in LBCL. This study aimed to identify [18F]FDG-PET biomarkers associated with prognosis and predictive of adverse events in patients treated with CAR T cells. METHODS Patients were retrospectively included from two different university hospitals. They were being treated with CAR T cells for LBCL and underwent [18F]FDG-PET just before CAR T cell infusion. Lesions were segmented semi-automatically with a threshold of 41% of the maximal uptake. In addition to clinico-biological features, sDmax, total metabolic tumor volume (TMTV), SUVmax, and uptake intensity of healthy lymphoid organs and liver were collected. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The occurrence of adverse events, such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), was reported. RESULTS Fifty-six patients were included. The median follow-up was 9.7 months. Multivariate analysis showed that TMTV (cut-off of 36 mL) was an independent prognostic factor for PFS (p < 0.001) and that sDmax (cut-off of 0.15 m-1) was an independent prognostic factor for OS (p = 0.008). Concerning the occurrence of adverse events, a C-reactive protein level > 35 mg/L (p = 0.006) and a liver SUVmean > 2.5 (p = 0.027) before CAR T cells were associated with grade 2 to 4 CRS and a spleen SUVmean > 1.9 with grade 2 to 4 ICANS. CONCLUSION TMTV and sDmax had independent prognostic values, respectively, on PFS and OS. Regarding adverse events, the mean liver and spleen uptakes were associated with the occurrence of grade 2 to 4 CRS and ICANS, respectively. Integrating these biomarkers into the clinical workflow could be useful for early adaptation of patients management.
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Affiliation(s)
- E Marchal
- Department of Nuclear Medicine, Amiens-Picardie University Hospital, Amiens, France.
| | - X Palard-Novello
- Department of Nuclear Medicine, University Rennes, CLCC Eugène Marquis, INSERM, LTSI-UMR 1099, Rennes, France
| | - F Lhomme
- Department of Clinical Hematology, Rennes University Hospital, Rennes, France
| | - M E Meyer
- Department of Nuclear Medicine, Amiens-Picardie University Hospital, Amiens, France
| | - G Manson
- Department of Clinical Hematology, Rennes University Hospital, Rennes, France
| | - A Devillers
- Department of Nuclear Medicine, CLCC Eugène Marquis, Rennes, France
| | - J P Marolleau
- Department of Hematology, Amiens-Picardie University Hospital, Amiens, France
| | - R Houot
- Department of Clinical Hematology, Rennes University Hospital, Rennes, France
| | - A Girard
- Department of Nuclear Medicine, Amiens-Picardie University Hospital, Amiens, France
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Mouheb M, Pierre-Jean M, Devillers A, Fermé C, Benchalal M, Manson G, Le Jeune F, Houot R, Palard-Novello X. Prognostic Value of Baseline Tumor Burden and Tumor Dissemination Extracted From 18 F-FDG PET/CT in a Cohort of Adult Patients With Early or Advanced Hodgkin Lymphoma. Clin Nucl Med 2024; 49:e1-e5. [PMID: 38015041 DOI: 10.1097/rlu.0000000000004930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
PURPOSE We aimed to assess the prognostic value of baseline tumor burden and dissemination parameters extracted from 18 F-FDG PET/CT in patients with early or advanced Hodgkin lymphoma (HL) treated with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) or escalated BEACOPP (increased bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). PATIENTS AND METHODS Patients aged ≥18 years with classical Hodgkin lymphoma were retrospectively included. Progression-free survival (PFS) analysis of dichotomized clinicobiological and PET/CT parameters (SUV max , TMTV, TLG, D max , and D bulk ) was performed. Optimal cutoff values for quantitative metrics were defined as the values maximizing the Youden index from receiver operating characteristic analysis. PFS rates were estimated with Kaplan-Meier curves, and the log-rank test was used to assess statistical significance. Hazard ratios were calculated using Cox proportional hazards models. RESULTS With a median age of 32 years, 166 patients were enrolled. A total of 111 patients had ABVD or ABVD-like treatment with or without radiotherapy and 55 patients with escalated BEACOPP treatment. The median follow-up was 55 months. Only International Prognostic Score (IPS >1), TMTV >107 cm 3 , and TLG >1628 were found to be significant prognostic factors for PFS on univariate analysis. Multivariate analysis revealed that IPS and TLG were independently prognostic and, combined, identified 4 risk groups ( P < 0.001): low (low TLG and low IPS; 4-year PFS, 95%), intermediate-low (high IPS and low TLG; 4-year PFS, 79%), intermediate-high (low IPS and high TLG; 4-year PFS, 78%), and high (high TLG and high IPS; 4-year PFS, 71%). CONCLUSIONS Combining baseline TLG with IPS could improve PFS prediction.
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Affiliation(s)
| | | | | | | | | | - Guillaume Manson
- Univ Rennes, CHU de Rennes, INSERM, MOBIDIC-UMR 1236, Rennes, France
| | | | - Roch Houot
- Univ Rennes, CHU de Rennes, INSERM, MOBIDIC-UMR 1236, Rennes, France
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Castelli J, Thariat J, Benezery K, Hasbini A, Gery B, Berger A, Liem X, Guihard S, Chapet S, Thureau S, Auberdiac P, Pommier P, Ruffier A, Perrier L, Devillers A, Campillo-Gimenez B, de Crevoisier R. Weekly Adaptive Radiotherapy vs Standard Intensity-Modulated Radiotherapy for Improving Salivary Function in Patients With Head and Neck Cancer: A Phase 3 Randomized Clinical Trial. JAMA Oncol 2023; 9:1056-1064. [PMID: 37261806 PMCID: PMC10236337 DOI: 10.1001/jamaoncol.2023.1352] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/08/2023] [Indexed: 06/02/2023]
Abstract
Importance Xerostomia is a major toxic effect associated with intensity-modulated radiotherapy (IMRT) for oropharyngeal cancers. Objective To assess whether adaptive radiotherapy (ART) improves salivary function compared with IMRT in patients with head and neck cancer. Design, Setting, and Participants This phase 3 randomized clinical trial was conducted in 11 French centers. Patients aged 18 to 75 years with stage III-IVB squamous cell oropharyngeal cancer treated with chemoradiotherapy were enrolled between July 5, 2013, and October 1, 2018. Data were analyzed from November 2021 to May 2022. Interventions The patients were randomly assigned (1:1) to receive standard IMRT (without replanning) or ART (systematic weekly replanning). Main Outcomes and Measures The primary end point was the frequency of xerostomia, measured by stimulating salivary flow with paraffin. Secondary end points included salivary gland excretory function measured using technetium-99m pertechnetate scintigraphy, patient-reported outcomes (Eisbruch xerostomia-specific questionnaire and the MD Anderson Symptom Inventory for Head and Neck Cancer questionnaire), early and late toxic effects, disease control, and overall and cancer-specific survival. Results A total of 132 patients were randomized, and after 1 exclusion in the ART arm, 131 were analyzed: 66 in the ART arm (mean [SD] age at inclusion, 60 [8] years; 57 [86.4%] male) and 65 in the standard IMRT arm (mean [SD] age at inclusion, 60 [8] years; 57 [87.7%] male). The median follow-up was 26.4 months (IQR, 1.2-31.3 months). The mean (SD) salivary flow (paraffin) at 12 months was 630 (450) mg/min in the ART arm and 584 (464) mg/min in the standard arm (P = .64). The mean (SD) excretory function of the parotid gland at 12 months, measured by scintigraphy, improved in the ART arm (48% [17%]) compared with the standard arm (41% [17%]) (P = .02). The 2-year-overall survival was 76.9% (95% CI, 64.7%-85.4%) in both arms. Conclusions and Relevance This randomized clinical trial did not demonstrate a benefit of ART in decreasing xerostomia compared with standard IMRT. No significant differences were found in secondary end points except for parotid gland excretory function, as assessed by scintigraphy, or in survival rates. Trial Registration ClinicalTrials.gov Identifier: NCT01874587.
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Affiliation(s)
- Joël Castelli
- University of Rennes, CLCC Eugène Marquis, Inserm, LTSI–UMR 1099, Rennes, France
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse, Laboratoire de Physique Corpusculaire, Normandie Universite, Caen, France
| | - Karen Benezery
- Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France
| | - Ali Hasbini
- Radiotherapy, Clinique Pasteur-Lanroze, Brest, France
| | - Bernard Gery
- Department of Radiation Oncology, Centre François Baclesse, Laboratoire de Physique Corpusculaire, Normandie Universite, Caen, France
| | - Antoine Berger
- Department of Radiotherapy, CHU Poitiers, Poitiers, France
| | - Xavier Liem
- Academic Department of Radiation Oncology and Brachytherapy, Oscar Lambret Center, Lille, France
| | - Sébastien Guihard
- Department of Radiotherapy, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Sophie Chapet
- Department of Radiotherapy, CHU Tours, Tours, France
| | | | | | - Pascal Pommier
- Department of Radiotherapy, Centre Léon Bérard, Lyon, France
| | | | - Lionel Perrier
- University Lyon, Léon Bérard Cancer Centre, Lyon, France
| | - Anne Devillers
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
| | | | - Renaud de Crevoisier
- University of Rennes, CLCC Eugène Marquis, Inserm, LTSI–UMR 1099, Rennes, France
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Mouheb M, Pierre-Jean M, Fermé C, Devillers A, Lamy T, Le Jeune F, Houot R, Palard-Novello X. Dissemination patterns of Hodgkin lymphoma using a probability network model based on [ 18F]-FDG PET/CT. Eur J Nucl Med Mol Imaging 2023; 50:1414-1422. [PMID: 36522437 DOI: 10.1007/s00259-022-06086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The preferred hypothesis for the dissemination patterns of Hodgkin lymphoma (HL) is the contiguity hypothesis. However, this hypothesis is based on studies performed before the advent of [18F]-FDG PET/CT which is now the established reference for HL staging. This study aims to extract the dissemination patterns of HL using [18F]-FDG PET/CT and a probability network model. METHODS We retrospectively analyzed [18F]-FDG PET/CT performed for initial staging of patients with classical HL. The HL involvement status (presence of absence) was reported for 19 supra- and infra-diaphragmatic lymph node regions and 4 extranodal regions (lung, spleen, liver, and osteo- medullary). The analysis of HL dissemination was carried out using HL involvement status for all regions through 3 distinct methods: comparison of nearby lymph node regions, correlation assessment between all regions and relationship strength between all regions using Ising network model. RESULTS A total of 196 patients were included. Our results showed strong relationships between nearby involved lymph node regions (for example between the left pelvic and the abdominal lymph node regions (relationship strength = 0.980)) and between more distant regions (for example between right and left axillary lymph node regions (strength = 0.714)). Furthermore, involvement of the infra-diaphragmatic lymph node regions was significantly correlated with Ann Arbor stage IV (phi = 0.56, p < 0.001). CONCLUSION This study confirms the hypothesis of lymphatic dissemination of HL in a contiguous mode, with additional links between more distant regions. These predictable dissemination patterns could be useful for the initial staging assessment of patients with HL using [18F]-FDG PET/CT.
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Affiliation(s)
- Mehdi Mouheb
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, Rennes, France
| | | | | | - Anne Devillers
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, Rennes, France
| | - Thierry Lamy
- Univ Rennes, CHU de Rennes, INSERM, BIGRES - UMR 1236, Rennes, France
| | - Florence Le Jeune
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, Rennes, France
| | - Roch Houot
- Univ Rennes, CHU de Rennes, INSERM, BIGRES - UMR 1236, Rennes, France
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Meneret P, Novello XP, Farce J, Le Reste P, Metais A, Chiforeanu D, Riffaud L, Devillers A, Le Jeune F, Girard A. Quelle est la meilleure méthode de délimitation du volume tumoral total des gliomes avant traitement en TEP à la [18F]-FDOPA ? Une étude contrôlée par biopsie. Médecine Nucléaire 2023. [DOI: 10.1016/j.mednuc.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Creff G, Jegoux F, Palard X, Depeursinge A, Abgral R, Marianowski R, Leclere JC, Eugene T, Malard O, Crevoisier RD, Devillers A, Castelli J. 18F-FDG PET/CT-Based Prognostic Survival Model After Surgery for Head and Neck Cancer. J Nucl Med 2022; 63:1378-1385. [PMID: 34887336 PMCID: PMC9454462 DOI: 10.2967/jnumed.121.262891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/16/2021] [Indexed: 12/24/2022] Open
Abstract
The aims of this multicenter study were to identify clinical and preoperative PET/CT parameters predicting overall survival (OS) and distant metastasis-free survival (DMFS) in a cohort of head and neck squamous cell carcinoma patients treated with surgery, to generate a prognostic model of OS and DMFS, and to validate this prognostic model with an independent cohort. Methods: A total of 382 consecutive patients with head and neck squamous cell carcinoma, divided into training (n = 318) and validation (n = 64) cohorts, were retrospectively included. The following PET/CT parameters were analyzed: clinical parameters, SUVmax, SUVmean, metabolic tumor volume (MTV), total lesion glycolysis, and distance parameters for the primary tumor and lymph nodes defined by 2 segmentation methods (relative SUVmax threshold and absolute SUV threshold). Cox analyses were performed for OS and DMFS in the training cohort. The concordance index (c-index) was used to identify highly prognostic parameters. These prognostic parameters were externally tested in the validation cohort. Results: In multivariable analysis, the significant parameters for OS were T stage and nodal MTV, with a c-index of 0.64 (P < 0.001). For DMFS, the significant parameters were T stage, nodal MTV, and maximal tumor-node distance, with a c-index of 0.76 (P < 0.001). These combinations of parameters were externally validated, with c-indices of 0.63 (P < 0.001) and 0.71 (P < 0.001) for OS and DMFS, respectively. Conclusion: The nodal MTV associated with the maximal tumor-node distance was significantly correlated with the risk of DMFS. Moreover, this parameter, in addition to clinical parameters, was associated with a higher risk of death. These prognostic factors may be used to tailor individualized treatment.
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Affiliation(s)
- Gwenaelle Creff
- Department of Otolaryngology-Head and Neck Surgery (HNS), University Hospital, Rennes, France;
| | - Franck Jegoux
- Department of Otolaryngology–Head and Neck Surgery (HNS), University Hospital, Rennes, France
| | - Xavier Palard
- Department of Nuclear Medicine, Cancer Institute, Rennes, France
| | | | - Ronan Abgral
- Department of Nuclear Medicine, University Hospital, Brest, France
| | - Remi Marianowski
- Department of Otolaryngology–HNS, University Hospital, Brest, France
| | | | - Thomas Eugene
- Department of Nuclear Medicine, University Hospital, Nantes, France
| | - Olivier Malard
- Department of Otolaryngology–HNS, University Hospital, Nantes, France
| | - Renaud De Crevoisier
- Department of Radiation Oncology, Cancer Institute, Rennes, France; and,LTSI (Image and Signal Processing Laboratory), INSERM, U1099, Rennes, France
| | - Anne Devillers
- Department of Nuclear Medicine, Cancer Institute, Rennes, France
| | - Joel Castelli
- Department of Radiation Oncology, Cancer Institute, Rennes, France; and,LTSI (Image and Signal Processing Laboratory), INSERM, U1099, Rennes, France
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Otman H, Farce J, Meneret P, Palard-Novello X, Le Reste PJ, Lecouillard I, Vauleon E, Chanchou M, Carsin Nicol B, Bertaux M, Devillers A, Mariano-Goulart D, Cachin F, Girard A, Le Jeune F. Delayed [ 18 F]-FDG PET Imaging Increases Diagnostic Performance and Reproducibility to Differentiate Recurrence of Brain Metastases From Radionecrosis. Clin Nucl Med 2022; 47:800-806. [PMID: 35695724 DOI: 10.1097/rlu.0000000000004305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Differentiating brain metastasis recurrence from radiation necrosis can be challenging during MRI follow-up after stereotactic radiotherapy. [ 18 F]-FDG is the most available PET tracer, but standard images performed 30 to 60 minutes postinjection provide insufficient accuracy. We compared the diagnostic performance and interobserver agreement of [ 18 F]-FDG PET with delayed images (4-5 hours postinjection) with the ones provided by standard and dual-time-point imaging. METHODS Consecutive patients referred for brain [ 18 F]-FDG PET after inconclusive MRI were retrospectively included between 2015 and 2020 in 3 centers. Two independent nuclear medicine physicians interpreted standard (visually), delayed (visually), and dual-time-point (semiquantitatively) images, respectively. Adjudication was applied in case of discrepancy. The final diagnosis was confirmed histologically or after 6 months of MRI follow-up. Areas under the receiver operating characteristic curves were pairwise compared. RESULTS Forty-eight lesions from 46 patients were analyzed. Primary tumors were mostly located in the lungs (57%) and breast (23%). The median delay between radiotherapy and PET was 15.7 months. The final diagnosis was tumor recurrence in 24 of 48 lesions (50%), with histological confirmation in 19 of 48 lesions (40%). Delayed images provided a larger area under the receiver operating characteristic curve (0.88; 95% confidence interval [CI], 0.75-0.95) than both standard (0.69; 95% CI, 0.54-0.81; P = 0.0014) and dual-time-point imaging (0.77; 95% CI, 0.63-0.88; P = 0.045), respectively. Interobserver agreement was almost perfect with delayed images ( κ = 0.83), whereas it was moderate with both standard ( κ = 0.48) and dual-time-point images ( κ = 0.61). CONCLUSIONS [ 18 F]-FDG PET with delayed images is an accurate and reliable alternative to differentiate metastasis recurrence from radiation necrosis in case of inconclusive MRI after brain stereotactic radiotherapy.
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Affiliation(s)
- Hosameldin Otman
- From the Department of Nuclear Medicine, Jean Perrin Center, Clermont-Ferrand
| | - Julien Farce
- Department of Nuclear Medicine, Eugène Marquis Center
| | | | | | | | | | | | | | | | - Marc Bertaux
- Department of Nuclear Medicine, Foch hospital, Suresnes
| | | | - Denis Mariano-Goulart
- Department of Nuclear Medicine. Montpellier University Hospital. PYMEDEXP, University of Montpellier, INSERM, CNRS, Montpellier, France
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Perazzi M, Castelli J, De Crevoisier R, Lievre A, Palard-Novello X, Devillers A, Guimas V, Le Scodan R, Gnep K. PO-1326 PET/CT parameters to predict survival and recurrence in patients with locally advanced anal cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03290-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Girard A, François M, Chaboub N, Le Reste PJ, Devillers A, Saint-Jalmes H, Le Jeune F, Palard-Novello X. Impact of point-spread function reconstruction on dynamic and static 18F-DOPA PET/CT quantitative parameters in glioma. Quant Imaging Med Surg 2022; 12:1397-1404. [PMID: 35111633 DOI: 10.21037/qims-21-742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/17/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Quantification of dynamic and static parameters extracted from 3,4-dihydroxy-6-[18F]-fluoro-L-phenylalanine (18F-DOPA, FDOPA) positron emission tomography (PET)/computed tomography (CT) plays a critical role for glioma assessment. The objective of the present study was to investigate the impact of point-spread function (PSF) reconstruction on these quantitative parameters. METHODS Fourteen patients with untreated gliomas and investigated with FDOPA PET/CT were analyzed. The distribution of the 14 cases was as follows: 6 astrocytomas-isocitrate dehydrogenase-mutant; 2 oligodendrogliomas/1p19q-codeleted-isocitrate dehydrogenase-mutant; and 6 isocitrate dehydrogenase-wild-type glioblastomas. A 0-20-min dynamic images (8×15, 2×30, 2×60, and 3×300 s post-injection) and a 0-20-min static image were reconstructed with and without PSF. Tumoral volumes-of-interest were generated on all of the PET series and the background volumes-of-interest were generated on the 0-20-min static image with and without PSF. Static parameters (SUVmax and SUVmean) of the tumoral and the background volumes-of-interest and kinetic parameters (K1 and k2) of the tumoral volumes-of-interest extracted from using full kinetic analysis were provided. PSF and non-PSF quantitative parameters values were compared. RESULTS Thirty-three tumor volumes-of-interest and 14 background volumes-of-interest were analyzed. PSF images provided higher tumor SUVmax than non-PSF images for 23/33 VOIs [median SUVmax =3.0 (range, 1.4-10.2) with PSF vs. 2.7 (range, 1.4-9.1) without PSF; P<0.001] and higher tumor SUVmean for 13/33 volumes-of-interest [median SUVmean =2.0 (range, 0.8-7.6) with PSF vs. 2.0 (range, 0.8-7.4) without PSF; P=0.002]. K1 and k2 were significantly lower with PSF than without PSF [respectively median K1 =0.077 mL/ccm/min (range, 0.043-0.445 mL/ccm/min) with PSF vs. 0.101 mL/ccm/min (range, 0.055-0.578 mL/ccm/min) without PSF; P<0.001 and median k2 =0.070 min-1 (range, 0.025-0.146 min-1) with PSF vs. 0.081 min-1 (range, 0.027-0.180 min-1) without PSF; P<0.001]. Background SUVmax and SUVmean were statistically unaffected [respectively median SUVmax =1.7 (range, 1.3-2.0) with PSF vs. 1.7 (range, 1.3-1.9) without PSF; P=0.346 and median SUVmean =1.5 (range, 1.0-1.8) with PSF vs. 1.5 (range, 1.0-1.7) without PSF; P=0.371]. CONCLUSIONS The present study confirms that PSF significantly increases tumor activity concentrations measured on PET images. PSF algorithms for quantitative PET/CT analysis should be used with caution, especially for quantification of kinetic parameters.
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Affiliation(s)
- Antoine Girard
- Univ Rennes, CLCC Eugène Marquis, Noyau Gris Centraux EA 4712, Rennes, France
| | - Madani François
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI-UMR 1099, Rennes, France
| | - Nibras Chaboub
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI-UMR 1099, Rennes, France
| | | | - Anne Devillers
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI-UMR 1099, Rennes, France
| | | | - Florence Le Jeune
- Univ Rennes, CLCC Eugène Marquis, Noyau Gris Centraux EA 4712, Rennes, France
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11
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Girard A, Le Reste PJ, Metais A, Carsin Nicol B, Chiforeanu DC, Bannier E, Campillo-Gimenez B, Devillers A, Palard-Novello X, Le Jeune F. Combining 18F-DOPA PET and MRI with perfusion-weighted imaging improves delineation of high-grade subregions in enhancing and non-enhancing gliomas prior treatment: a biopsy-controlled study. J Neurooncol 2021; 155:287-295. [PMID: 34686993 DOI: 10.1007/s11060-021-03873-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 09/06/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE We aimed to compare spatial extent of high-grade subregions detected with combined [18F]-dihydroxyphenylalanine (18F-DOPA) PET and MRI to the one provided by advanced multimodal MRI alone including Contrast-enhanced (CE) and Perfusion weighted imaging (PWI). Then, we compared the accuracy between imaging modalities, in a per biopsy analysis. METHODS Participants with suspected diffuse glioma were prospectively included between June 2018 and September 2019. Volumes of high-grade subregions were delineated respectively on 18F-DOPA PET and MRI (CE and PWI). Up to three per-surgical neuronavigation-guided biopsies were performed per patient. RESULTS Thirty-eight biopsy samples from sixteen participants were analyzed. Six participants (38%) had grade IV IDH wild-type glioblastoma, six (38%) had grade III IDH-mutated astrocytoma and four (24%) had grade II IDH-mutated gliomas. Three patients had intratumoral heterogeneity with coexisting high- and low-grade tumor subregions. High-grade volumes determined with combined 18F-DOPA PET/MRI (median of 1.7 [interquartile range (IQR) 0.0, 19.1] mL) were larger than with multimodal MRI alone (median 1.3 [IQR 0.0, 12.8] mL) with low overlap (median Dice's coefficient 0.24 [IQR 0.08, 0.59]). Delineation volumes were substantially increased in five (31%) patients. In a per biopsy analysis, combined 18F-DOPA PET/MRI detected high-grade subregions with an accuracy of 58% compared to 42% (p = 0.03) with CE MRI alone and 50% (p = 0.25) using multimodal MRI (CE + PWI). CONCLUSIONS The addition of 18F-DOPA PET to multimodal MRI (CE and PWI) enlarged the delineation volumes and enhanced overall accuracy for detection of high-grade subregions. Thus, combining 18F-DOPA with advanced MRI may improve treatment planning in newly diagnosed gliomas.
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Affiliation(s)
- Antoine Girard
- Department of Nuclear Medicine, Eugène Marquis Center, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France.
- Signal and Image Processing Laboratory (LTSI), INSERM-University of Rennes 1, Rennes, France.
| | | | - Alice Metais
- Department of Pathology, Rennes University Hospital, Rennes, France
| | | | | | - Elise Bannier
- Department of Radiology, Rennes University Hospital, Rennes, France
- Empenn IRISA Research Team, Rennes University-CNRS-INRIA-INSERM, Rennes, France
| | - Boris Campillo-Gimenez
- Department of Medical Oncology, Eugène Marquis Center, Rennes, France
- Signal and Image Processing Laboratory (LTSI), INSERM-University of Rennes 1, Rennes, France
| | - Anne Devillers
- Department of Nuclear Medicine, Eugène Marquis Center, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France
| | - Xavier Palard-Novello
- Department of Nuclear Medicine, Eugène Marquis Center, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France
- Signal and Image Processing Laboratory (LTSI), INSERM-University of Rennes 1, Rennes, France
| | - Florence Le Jeune
- Department of Nuclear Medicine, Eugène Marquis Center, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France
- Signal and Image Processing Laboratory (LTSI), INSERM-University of Rennes 1, Rennes, France
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12
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Duval X, Le Moing V, Tubiana S, Esposito-Farèse M, Ilic-Habensus E, Leclercq F, Bourdon A, Goehringer F, Selton-Suty C, Chevalier E, Boutoille D, Piriou N, Le Tourneau T, Chirouze C, Seronde MF, Morel O, Piroth L, Eicher JC, Humbert O, Revest M, Thébault E, Devillers A, Delahaye F, Boibieux A, Grégoire B, Hoen B, Laouenan C, Iung B, Rouzet F. Impact of Systematic Whole-body 18F-Fluorodeoxyglucose PET/CT on the Management of Patients Suspected of Infective Endocarditis: The Prospective Multicenter TEPvENDO Study. Clin Infect Dis 2021; 73:393-403. [PMID: 32488236 DOI: 10.1093/cid/ciaa666] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/27/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Diagnostic and patients' management modifications induced by whole-body 18F-FDG-PET/CT had not been evaluated so far in prosthetic valve (PV) or native valve (NV) infective endocarditis (IE)-suspected patients. METHODS In sum, 140 consecutive patients in 8 tertiary care hospitals underwent 18F-FDG-PET/CT. ESC-2015-modified Duke criteria and patients' management plan were established jointly by 2 experts before 18F-FDG-PET/CT. The same experts reestablished Duke classification and patients' management plan immediately after qualitative interpretation of 18F-FDG-PET/CT. A 6-month final Duke classification was established. RESULTS Among the 70 PV and 70 NV patients, 34 and 46 were classified as definite IE before 18F-FDG-PET/CT. Abnormal perivalvular 18F-FDG uptake was recorded in 67.2% PV and 24.3% NV patients respectively (P < .001) and extracardiac uptake in 44.3% PV and 51.4% NV patients. IE classification was modified in 24.3% and 5.7% patients (P = .005) (net reclassification index 20% and 4.3%). Patients' managements were modified in 21.4% PV and 31.4% NV patients (P = .25). It was mainly due to perivalvular uptake in PV patients and to extra-cardiac uptake in NV patients and consisted in surgery plan modifications in 7 patients, antibiotic plan modifications in 22 patients and both in 5 patients. Altogether, 18F-FDG-PET/CT modified classification and/or care in 40% of the patients (95% confidence interval: 32-48), which was most likely to occur in those with a noncontributing echocardiography (P < .001) or IE classified as possible at baseline (P = .04), while there was no difference between NV and PV. CONCLUSIONS Systematic 18F-FDG-PET/CT did significantly and appropriately impact diagnostic classification and/or IE management in PV and NV-IE suspected patients. CLINICAL TRIALS REGISTRATION NCT02287792.
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Affiliation(s)
- Xavier Duval
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,INSERM UMR-1137 IAME, Paris, France.,University Paris Diderot, Paris 7, UFR de Médecine-Bichat, Paris, France
| | - Vincent Le Moing
- Department of Infectious Diseases, University Hospital of Montpellier, Montpellier, France
| | - Sarah Tubiana
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,INSERM UMR-1137 IAME, Paris, France
| | - Marina Esposito-Farèse
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,Unité de Recherche Clinique, AP-HP, HUPNVS, Hôpital Universitaire Paris Nord-Val de Seine, Paris, France
| | - Emila Ilic-Habensus
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France
| | - Florence Leclercq
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Aurélie Bourdon
- Department of Nuclear Medicine, University Hospital of Montpellier, Montpellier, France
| | - François Goehringer
- Department of Infectious Diseases, University Hospital of Nancy, Nancy, France
| | | | - Elodie Chevalier
- Department of Nuclear Medicine, University Hospital of Nancy, Nancy, France
| | - David Boutoille
- Department of Infectious Diseases, CIC UIC 1413 INSERM, University Hospital of Nantes, Nantes, France
| | - Nicolas Piriou
- Thorax Institute, INSERM, UMR 1087, University Hospital of Nantes, Nantes, France.,Department of Nuclear Medicine, Nantes University Hospital, G. et R. Laennec Hospital, Nantes, France
| | - Thierry Le Tourneau
- Thorax Institute, INSERM, UMR 1087, University Hospital of Nantes, Nantes, France
| | - Catherine Chirouze
- University Hospital of Besançon, France, UMR CNRS 6249 Chrono-Environnement, Bourgogne University, Franche-Comté, Dijon, France
| | | | - Olivier Morel
- Department of Nuclear Medicine, University Hospital of Besançon, Besançon, France
| | - Lionel Piroth
- Department of Infectious Diseases, University Hospital of Dijon, INSERM CIC 1432, CHU Dijon, France
| | | | - Olivier Humbert
- Department of Nuclear Medicine, University Hospital of Dijon, Dijon, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, University Hospital of Rennes France, INSERM U1230 CHU Rennes, France.,INSERM CIC 1414, University Hospital of Rennes, France
| | | | - Anne Devillers
- Department of Nuclear Medicine, University Hospital of Rennes, France
| | | | - André Boibieux
- Department of Nuclear Medicine, University Hospital of Lyon, Lyon, France
| | - Bastien Grégoire
- Department of Infectious Diseases, University Hospital of Lyon, Lyon, France
| | - Bruno Hoen
- Department of Infectious Diseases, University Hospital of Nancy, Nancy, France
| | - Cédric Laouenan
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,INSERM UMR-1137 IAME, Paris, France.,University Paris Diderot, Paris 7, UFR de Médecine-Bichat, Paris, France.,Unité de Recherche Clinique, AP-HP, HUPNVS, Hôpital Universitaire Paris Nord-Val de Seine, Paris, France
| | - Bernard Iung
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,INSERM UMR-1137 IAME, Paris, France.,University Paris Diderot, Paris 7, UFR de Médecine-Bichat, Paris, France
| | - François Rouzet
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,INSERM UMR-1137 IAME, Paris, France.,University Paris Diderot, Paris 7, UFR de Médecine-Bichat, Paris, France.,Department of Nuclear Medicine, AP-HP, University Hospital of Bichat, Paris, France
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13
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Girard A, Le Reste PJ, Metais A, Chaboub N, Devillers A, Saint-Jalmes H, Jeune FL, Palard-Novello X. Additive Value of Dynamic FDOPA PET/CT for Glioma Grading. Front Med (Lausanne) 2021; 8:705996. [PMID: 34307430 PMCID: PMC8299331 DOI: 10.3389/fmed.2021.705996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose: The aim of this study was to assess the value of the FDOPA PET kinetic parameters extracted using full kinetic analysis for tumor grading with neuronavigation-guided biopsies as reference in patients with newly-diagnosed gliomas. Methods: Fourteen patients with untreated gliomas were investigated. Twenty minutes of dynamic positron-emission tomography (PET) imaging and a 20-min static image 10 min after injection were reconstructed from a 40-min list-mode acquisition immediately after FDOPA injection. Tumors volume-of-interest (VOI) were generated based on the MRI-guided brain biopsies. Static parameters (TBRmax and TBRmean) and kinetic parameters [K1 and k2 using full kinetic analysis with the reversible single-tissue compartment model with blood volume parameter and the time-to-peak (TTP)] were extracted. Performances of each parameter for differentiating low-grade gliomas (LGG) from high-grade gliomas (HGG) were evaluated by receiver-operating characteristic analyses (area under the curve; AUC). Results: Thirty-two tumoral VOI were analyzed. K1, k2, and TTP were significantly higher for HGG than for LGG (median K1-value = 0.124 vs. 0.074 ml/ccm/min, p = 0.025, median k2-value = 0.093 vs. 0.063 min−1, p = 0.025, and median TTP-value = 10.0 vs. 15.0 min, p = 0.025). No significant difference was observed for the static parameters. The AUC for the kinetic parameters was higher than the AUC for the static parameters (respectively, AUCK1 = 0.787, AUCk2 = 0.785, AUCTTP = 0.775, AUCTBRmax = 0.551, AUCTBRmean = 0.575), significantly compared to TBRmax (respectively, p = 0.001 for K1, p = 0.031 for k2, and p = 0.029 for TTP). Conclusion: The present study suggests an additive value of FDOPA PET/CT kinetic parameters for newly-diagnosed gliomas grading.
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Affiliation(s)
- Antoine Girard
- Univ Rennes, CLCC Eugène Marquis, Noyau Gris Centraux EA 4712, Rennes, France
| | | | | | - Nibras Chaboub
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, Rennes, France
| | - Anne Devillers
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, Rennes, France
| | - Hervé Saint-Jalmes
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, Rennes, France
| | - Florence Le Jeune
- Univ Rennes, CLCC Eugène Marquis, Noyau Gris Centraux EA 4712, Rennes, France
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14
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Creff G, Jegoux F, Palard X, Depeursinge A, Abgral R, Marianowski R, Leclere JC, Eugene T, Malard O, de Crevoisier R, Devillers A, Castelli J. P-177 FDG-PET/CT-based prognostic survival model after surgery for head and neck cancer. Oral Oncol 2021. [DOI: 10.1016/s1368-8375(21)00462-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Bouvry C, Abgrall S, Devillers A, Lepareur N. Comparison of [68Ga]Ga precursors for blood cell radiolabeling. Nucl Med Biol 2021. [DOI: 10.1016/s0969-8051(21)00359-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Proisy M, Vivier PH, Morel B, Bruneau B, Sembely-Taveau C, Vacheresse S, Devillers A, Lecloirec J, Bodet-Milin C, Dubois M, Hamonic S, Bajeux E, Ganivet A, Adamsbaum C, Treguier C. Whole-body MR imaging in suspected physical child abuse: comparison with skeletal survey and bone scintigraphy findings from the PEDIMA prospective multicentre study. Eur Radiol 2021; 31:8069-8080. [PMID: 33912993 DOI: 10.1007/s00330-021-07896-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/26/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To assess the contribution of whole-body magnetic resonance imaging (WBMRI) and bone scintigraphy (BS) in addition to skeletal survey (SS) in detecting traumatic bone lesions and soft-tissue injuries in suspected child abuse. METHODS In this prospective, multicentre, diagnostic accuracy study, children less than 3 years of age with suspected physical abuse were recruited. Each child underwent SS, BS and WBMRI. A blinded first review was performed in consensus by five paediatric radiologists and three nuclear medicine physicians. A second review investigated discrepancies reported between the modalities using a consensus result of all modalities as the reference standard. We calculated the sensitivity, specificity and corresponding 95% confidence interval for each imaging modality (SS, WBMRI and BS) and for the combinations [SS + WBMRI] and [SS + BS]. RESULTS One hundred seventy children were included of which sixty-four had at least one lesion. In total, 146 lesions were included. The sensitivity and specificity of each examination were, respectively, as follows: 88.4% [95% CI, 82.0-93.1] and 99.7% [95% CI, 99.5-99.8] for the SS, 69.9% [95% CI, 61.7-77.2] and 99.5% [95% CI, 99.2-99.7] for WBMRI and 54.8% [95% CI, 46.4-63.0] and 99.7% [95% CI, 99.5-99.9] for BS. Sensitivity and specificity were, respectively, 95.9% [95% CI, 91.3-98.5] and 99.2% [95% CI, 98.9-99.4] for the combination SS + WBMRI and 95.2% [95% CI, 90.4-98.1] and 99.4% [95% CI, 99.2-99.6] for the combination SS + BS, with no statistically significant difference between them. CONCLUSION SS was the most sensitive independent imaging modality; however, the additional combination of either WBMRI or BS examinations offered an increased accuracy. KEY POINTS • SS in suspected infant abuse was the most sensitive independent imaging modality in this study, especially for detecting metaphyseal and rib lesions, and remains essential for evaluation. • The combination of either SS + BS or SS + WBMRI provides greater accuracy in diagnosing occult and equivocal bone injuries in the difficult setting of child abuse. • WBMRI is a free-radiation technique that allows additional diagnosis of soft-tissue and visceral injuries.
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Affiliation(s)
- Maïa Proisy
- Radiology Department, CHU Rennes, F-35200, Rennes, France.
| | - Pierre-Hugues Vivier
- Pediatric Radiology, service de Radiologie, Ramsay - Générale de Santé, University Hospital Charles Nicolle - Radiology, Hôpital Privé de l'Estuaire, 505 rue Irène Joliot Curie, 76620, Le Havre, France
| | | | | | | | | | - Anne Devillers
- Nuclear Medicine Department, CRLC Rennes, Rennes, France
| | - Joseph Lecloirec
- Nuclear Medicine Department, CRLC Henri Becquerel, Rouen, France
| | - Caroline Bodet-Milin
- CHU Nantes, Nuclear Medicine Department, Université de Nantes, CNRS, Inserm, CRCINA, Nantes, France
| | - Marine Dubois
- Radiology Department, CHU Rennes, F-35200, Rennes, France
| | - Stéphanie Hamonic
- Public Heatlh and Epidemiology Department, CHU Rennes, Rennes, France
| | - Emma Bajeux
- Public Heatlh and Epidemiology Department, CHU Rennes, Rennes, France
| | - Anne Ganivet
- Research and Innovation Department, CHU Rennes, Rennes, France
| | - Catherine Adamsbaum
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270, Le Kremlin-Bicêtre, France
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Blangis F, Taylor M, Adamsbaum C, Devillers A, Gras-Le Guen C, Launay E, Bossuyt PM, Cohen JF, Chalumeau M. Add-on bone scintigraphy after negative radiological skeletal survey for the diagnosis of skeletal injury in children suspected of physical abuse: a systematic review and meta-analysis. Arch Dis Child 2021; 106:361-366. [PMID: 32998873 DOI: 10.1136/archdischild-2020-319065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/11/2020] [Accepted: 08/27/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To systematically assess the extent to which bone scintigraphy (BS) could improve the detection rate of skeletal injury in children suspected of physical abuse with an initial negative radiological skeletal survey (RSS). STUDY DESIGN We searched MEDLINE and Web of Science for series of ≥20 children suspected of physical abuse who underwent RSS and add-on BS. We assessed the risk of bias and the heterogeneity and performed random-effects meta-analyses. RESULTS After screening 1140 unique search results, we reviewed 51 full-text articles, and included 7 studies (783 children, mostly ≤3 years old). All studies were of either high or unclear risk of bias. Substantial heterogeneity was observed in meta-analyses. The summary detection rate of skeletal injury with RSS alone was 52% (95% CI 37 to 68). The summary absolute increase in detection rate with add-on BS was 10 percentage points (95% CI 6 to 15); the summary relative detection rate was 1.19 (95% CI 1.13 to 1.25); the summary number of children with a negative RSS who needed to undergo a BS to detect one additional child with skeletal injury (number needed to test) was 3 (95% CI 2 to 7). CONCLUSIONS From the available evidence, add-on BS in young children suspected of physical abuse with a negative RSS might allow for a clinically significant improvement of the detection rate of children with skeletal injury, for a limited number of BS procedures required. The quality of the reviewed evidence was low, pointing to the need for high-quality studies in this field.
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Affiliation(s)
- Flora Blangis
- Obstetrical, Perinatal and Pediatric Epidemiology Research team, Epidemiology and Statistics Research Center, Université de Paris, INSERM, F-75004 Paris, France .,Inserm CIC 1413, Nantes University Hospital, F-44000 Nantes, France.,Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université de Paris, F-75015 Paris, France
| | - Melissa Taylor
- Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université de Paris, F-75015 Paris, France
| | - Catherine Adamsbaum
- Department of Pediatric Radiology, AP-HP, Bicêtre hospital, F-94270 Le Kremlin Bicêtre, France
| | - Anne Devillers
- Department of Nuclear Medicine, Centre Eugène Marquis, F-35000 Rennes, France
| | - Christèle Gras-Le Guen
- Obstetrical, Perinatal and Pediatric Epidemiology Research team, Epidemiology and Statistics Research Center, Université de Paris, INSERM, F-75004 Paris, France.,Inserm CIC 1413, Nantes University Hospital, F-44000 Nantes, France.,Department of Pediatric Emergency Care, Nantes University Hospital, F-44000 Nantes, France
| | - Elise Launay
- Obstetrical, Perinatal and Pediatric Epidemiology Research team, Epidemiology and Statistics Research Center, Université de Paris, INSERM, F-75004 Paris, France.,Inserm CIC 1413, Nantes University Hospital, F-44000 Nantes, France.,Department of Pediatric Emergency Care, Nantes University Hospital, F-44000 Nantes, France
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, Amsterdam, The Netherlands
| | - Jérémie F Cohen
- Obstetrical, Perinatal and Pediatric Epidemiology Research team, Epidemiology and Statistics Research Center, Université de Paris, INSERM, F-75004 Paris, France.,Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université de Paris, F-75015 Paris, France
| | - Martin Chalumeau
- Obstetrical, Perinatal and Pediatric Epidemiology Research team, Epidemiology and Statistics Research Center, Université de Paris, INSERM, F-75004 Paris, France.,Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université de Paris, F-75015 Paris, France
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Cuvilliers C, Palard-Novello X, Pontoizeau C, Meneret P, Devillers A, Le Jeune F, Girard A. The Added Value of Bloodpool SPECT/CT in Painful Non-Operated Foot and Ankle Undiagnosed With Standard Three-Phase Bone Scintigraphy. Front Med (Lausanne) 2021; 8:634419. [PMID: 33763434 PMCID: PMC7982933 DOI: 10.3389/fmed.2021.634419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/28/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: To evaluate the interest of adding a bloodpool SPECT/CT to standard three-phase bone scintigraphy (BS) for etiological diagnosis of subacute and chronic lower extremity pains. Methods: We prospectively included patients addressed for pain of lower extremities lasting for at least 6 weeks, without previous surgery. They underwent a standard three-phase BS including late phase SPECT/CT, modified with an additional bloodpool SPECT/CT acquisition. Two independent physicians interpreted the images provided by both protocols. Diagnostic conclusion, diagnostic confidence, and interrater agreements were compared. Results: One hundred and eighteen lower extremities from 113 patients were analyzed (71 men, median age of 53 years). Adding bloodpool SPECT/CT to standard three-phase BS changed diagnostic conclusions in 24.6% (29/118) of lower extremities. The modified protocol revealed at least one diagnostic conclusion explaining the pain in 89% of extremities, rather than 83.1% with the standard protocol (p = 0.02). Tendinopathies were diagnosed in 12.7% of lower extremities, rather than 4.2% with standard BS (p = 0.002). Adding bloodpool SPECT/CT substantially increased overall confidence of each reader (p < 0.001). Inter-reader agreement was not significantly impacted. Conclusion: Adding bloodpool SPECT/CT to standard three-phase BS impacted diagnostic conclusion in a quarter of the patients with painful lower extremities, notably by revealing significantly more tendonitis.
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Affiliation(s)
- Cécile Cuvilliers
- Nuclear Medicine Department, Centre Eugène Marquis, Rennes, France.,University of Rennes 1, Rennes, France
| | - Xavier Palard-Novello
- Nuclear Medicine Department, Centre Eugène Marquis, Rennes, France.,University of Rennes 1, Rennes, France
| | | | - Pierre Meneret
- Nuclear Medicine Department, Centre Eugène Marquis, Rennes, France.,University of Rennes 1, Rennes, France
| | - Anne Devillers
- Nuclear Medicine Department, Centre Eugène Marquis, Rennes, France
| | - Florence Le Jeune
- Nuclear Medicine Department, Centre Eugène Marquis, Rennes, France.,University of Rennes 1, Rennes, France
| | - Antoine Girard
- Nuclear Medicine Department, Centre Eugène Marquis, Rennes, France.,University of Rennes 1, Rennes, France
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19
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Creff G, Devillers A, Depeursinge A, Palard-Novello X, Acosta O, Jegoux F, Castelli J. Evaluation of the Prognostic Value of FDG PET/CT Parameters for Patients With Surgically Treated Head and Neck Cancer: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2021; 146:471-479. [PMID: 32215611 DOI: 10.1001/jamaoto.2020.0014] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Head and neck squamous cell cancer (HNSCC) represents the seventh most frequent cancer worldwide. More than half of the patients diagnosed with HNSCC are treated with primary surgery. Objective To report the available evidence on the value of quantitative parameters of fluorodeoxyglucose F 18-labeled positron emission tomography and computed tomography (FDG-PET/CT) performed before surgical treatment of HNSCC to estimate overall survival (OS), disease-free survival (DFS), and distant metastasis (DM) and to discuss their limitations. Evidence Review A systematic review of the English-language literature in PubMed/MEDLINE and ScienceDirect published between January 2003 and February 15, 2019, was performed between March 1 and July 27, 2019, to identify articles addressing the association between preoperative FDG-PET/CT parameters and oncological outcomes among patients with HNSCC. Articles included those that addressed the following: (1) cancer of the oral cavity, oropharynx, hypopharynx, or larynx; (2) surgically treated (primary or for salvage); (3) pretreatment FDG-PET/CT; (4) quantitative or semiquantitative evaluation of the FDG-PET/CT parameters; and (5) the association between the value of FDG-PET/CT parameters and clinical outcomes. Quality assessment was performed using the Oxford Centre for Evidence-Based Medicine level of evidence. Findings A total of 128 studies were retrieved from the databases, and 36 studies met the inclusion criteria; these studies comprised 3585 unique patients with a median follow-up of 30.6 months (range, 16-53 months). Of these 36 studies, 32 showed an association between at least 1 FDG-PET/CT parameter and oncological outcomes (OS, DFS, and DM). The FDG-PET/CT volumetric parameters (metabolic tumor volume [MTV] and total lesion glycolysis [TLG]) were independent prognostic factors in most of the data, with a higher prognostic value than the maximum standard uptake value (SUVmax). For example, in univariate analysis of OS, the SUVmax was correlated with OS in 5 of 11 studies, MTV in 11 of 12 studies, and TLG in 6 of 9 studies. The spatial distribution of metabolism via textural indices seemed promising, although that factor is currently poorly evaluated: only 3 studies analyzed data from radiomics indices. Conclusions and Relevance The findings of this study suggest that the prognostic effectiveness of FDG-PET/CT parameters as biomarkers of OS, DFS, and DM among patients with HNSCC treated with surgery may be valuable. The volumetric parameters (MTV and TLG) seemed relevant for identifying patients with a higher risk of postsurgical disease progression who could receive early therapeutic intervention to improve their prognosis. However, further large-scale studies including exclusively surgery-treated patients stratified according to localization and further analysis of the textural indices are required to define a reliable FDG-PET/CT-based prognostic model of mortality and recurrence risk for these patients.
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Affiliation(s)
- Gwenaelle Creff
- Department of Otolaryngology-Head and Neck Surgery, Rennes University Hospital, Rennes, France
| | - Anne Devillers
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
| | - Adrien Depeursinge
- University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | | | - Oscar Acosta
- LTSI (Image and Signal Processing Laboratory), INSERM, U1099, Rennes, France
| | - Franck Jegoux
- Department of Otolaryngology-Head and Neck Surgery, Rennes University Hospital, Rennes, France
| | - Joel Castelli
- Department of Radiation Oncology, Cancer Institute Eugène Marquis, Rennes, France
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20
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Dissaux G, Visvikis D, Da-Ano R, Pradier O, Chajon E, Barillot I, Duvergé L, Masson I, Abgral R, Santiago Ribeiro MJ, Devillers A, Pallardy A, Fleury V, Mahé MA, De Crevoisier R, Hatt M, Schick U. Pretreatment 18F-FDG PET/CT Radiomics Predict Local Recurrence in Patients Treated with Stereotactic Body Radiotherapy for Early-Stage Non-Small Cell Lung Cancer: A Multicentric Study. J Nucl Med 2019; 61:814-820. [PMID: 31732678 DOI: 10.2967/jnumed.119.228106] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023] Open
Abstract
The aim of this retrospective multicentric study was to develop and evaluate a prognostic 18F-FDG PET/CT radiomic signature in early-stage non-small cell lung cancer patients treated with stereotactic body radiotherapy (SBRT). Methods: Patients from 3 different centers (n = 27, 29, and 8) were pooled to constitute the training set, whereas the patients from a fourth center (n = 23) were used as the testing set. The primary endpoint was local control. The primary tumor was semiautomatically delineated in the PET images using the fuzzy locally adaptive Bayesian algorithm, and manually in the low-dose CT images. In total, 184 Image Biomarkers Standardization Initiative-compliant radiomic features were extracted. Seven clinical and treatment parameters were included. We used ComBat to harmonize radiomic features extracted from the 4 institutions relying on different PET/CT scanners. In the training set, variables found significant in the univariate analysis were fed into a multivariate regression model, and models were built by combining independent prognostic factors. Results: Median follow-up was 21.1 mo (range, 1.7-63.4 mo) and 25.5 mo (range, 7.7-57.8 mo) in training and testing sets, respectively. In univariate analysis, none of the clinical variables, 2 PET features, and 2 CT features were significantly predictive of local control. The best predictive models in the training set were obtained by combining one feature from PET (Information Correlation 2) and one feature from CT (flatness), reaching a sensitivity of 100% and a specificity of 96%. Another model combining 2 PET features (Information Correlation 2 and strength) reached sensitivity of 100% and specificity of 88%, both with an undefined hazard ratio (P < 0.001). The latter model obtained an accuracy of 0.91 (sensitivity, 100%; specificity, 81%), with a hazard ratio undefined (P = 0.023) in the testing set; however, other models relying on CT radiomic features only or the combination of PET and CT features failed to validate in the testing set. Conclusion: We showed that 2 radiomic features derived from 18F-FDG PET were independently associated with local control in patients with non-small cell lung cancer undergoing SBRT and could be combined in an accurate predictive model. This model could provide local relapse-related information and could be helpful in clinical decision making.
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Affiliation(s)
- Gurvan Dissaux
- Radiation Oncology Department, University Hospital, Brest, France .,LaTIM, INSERM, UMR 1101, University of Brest, Brest, France
| | | | - Ronrick Da-Ano
- LaTIM, INSERM, UMR 1101, University of Brest, Brest, France
| | - Olivier Pradier
- Radiation Oncology Department, University Hospital, Brest, France.,LaTIM, INSERM, UMR 1101, University of Brest, Brest, France
| | - Enrique Chajon
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
| | - Isabelle Barillot
- Department of Radiation Oncology, University Hospital, Tours, France
| | - Loig Duvergé
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
| | - Ingrid Masson
- Department of Radiation Oncology, ICO, Saint-Herblain, France
| | - Ronan Abgral
- Nuclear Medicine Department, University Hospital, Brest, France
| | | | - Anne Devillers
- Nuclear Medicine Department, Centre Eugene Marquis, Rennes, France
| | - Amandine Pallardy
- Nuclear Medicine Department, University Hospital, Nantes, France; and
| | - Vincent Fleury
- Nuclear Medicine Department, ICO, Saint-Herblain, France
| | - Marc-André Mahé
- Department of Radiation Oncology, ICO, Saint-Herblain, France
| | | | - Mathieu Hatt
- LaTIM, INSERM, UMR 1101, University of Brest, Brest, France
| | - Ulrike Schick
- Radiation Oncology Department, University Hospital, Brest, France.,LaTIM, INSERM, UMR 1101, University of Brest, Brest, France
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21
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Alix L, Néel A, Cador B, Smail A, Serratrice J, Closs-Prophette F, Jego P, Devillers A, Decaux O. Diagnostic value of 18-F fluorodeoxyglucose PET/CT and bone scan in Schnitzler syndrome. Autoimmunity 2019; 52:264-271. [PMID: 31646899 DOI: 10.1080/08916934.2019.1680649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Schnitzler syndrome is an auto-inflammatory disease defined by chronic urticarial eruption and monoclonal gammopathy. 18F fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is often performed, but its utility in Schnitzler syndrome has not been specifically investigated. The aim of this study was to determine whether PET/CT is informative in the diagnosis and follow-up of Schnitzler syndrome relative to other imaging techniques, including bone scans.Patients and methods: Patients of this study were selected from the French cohort established by Néel et al. All patients with a diagnosis of Schnitzler syndrome (according to Strasbourg's and Lipsker's criteria) who had at least one PET/CT were included. Data were collected from medical records. PET/CT scans were all reviewed by a nuclear physician blinded to the clinical and imaging data.Results: Ten patients underwent at least one PET/CT scan and all had at least one 99mTechnetium bone scan during their follow-up. The most frequent PET/CT abnormalities were diffuse bone-marrow and/or increased femoral fluorodeoxyglucose uptake, but they did not correlate with disease activity. Conversely, bone-scan abnormalities, including mainly increased radiotracer uptake in long bones, appeared to strongly correlate with Schnitzler syndrome activity.Discussion: PET/CT does not appear to be useful for the diagnosis and follow-up of Schnitzler syndrome. However, bone scans appear to be more sensitive for diagnosis and may correlate with clinical activity. Bone scans may be well positioned to distinguish Schnitzler syndrome relapse from other aetiologies of bone, joint, or muscle pain.Conclusion: Bone scans may be favoured over PET/CT in Schnitzler syndrome.
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Affiliation(s)
- L Alix
- Internal Medicine Department, Rennes University Hospital, Rennes, France
| | - A Néel
- Internal Medicine Department, Nantes University Hospital, Nantes, France
| | - B Cador
- Internal Medicine Department, Rennes University Hospital, Rennes, France
| | - A Smail
- Internal Medicine Department, Amiens University Hospital, Amiens, France
| | - J Serratrice
- Internal Medicine Department, Geneva University Hospital, Geneva, Switzerland
| | | | - P Jego
- Internal Medicine Department, Rennes University Hospital, Rennes, France
| | - A Devillers
- Nuclear Medicine Department, Regional Center for the Fight against Cancer, Rennes, France
| | - O Decaux
- Internal Medicine Department, Rennes University Hospital, Rennes, France
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22
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Dissaux G, Visvikis D, Pradier O, Chajon É, Barillot I, Duverge L, Masson I, Abgral R, Santiago Ribeiro MJ, Devillers A, Pallardy A, Fleury V, Mahé MA, de Crevoisier R, Hatt M, Schick U. Prédiction de la récidive locale par l’analyse de texture dérivée de l’imagerie tomographique par émission de positon (TEP/TDM) des cancers pulmonaires non à petites cellules localisés traités par irradiation stéréotaxique. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Beaumont J, Acosta O, Devillers A, Palard-Novello X, Chajon E, de Crevoisier R, Castelli J. Voxel-based identification of local recurrence sub-regions from pre-treatment PET/CT for locally advanced head and neck cancers. EJNMMI Res 2019; 9:90. [PMID: 31535233 PMCID: PMC6751236 DOI: 10.1186/s13550-019-0556-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022] Open
Abstract
Background Overall, 40% of patients with a locally advanced head and neck cancer (LAHNC) treated by chemoradiotherapy (CRT) present local recurrence within 2 years after the treatment. The aims of this study were to characterize voxel-wise the sub-regions where tumor recurrence appear and to predict their location from pre-treatment 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) images. Materials and methods Twenty-six patients with local failure after treatment were included in this study. Local recurrence volume was identified by co-registering pre-treatment and recurrent PET/CT images using a customized rigid registration algorithm. A large set of voxel-wise features were extracted from pre-treatment PET to train a random forest model allowing to predict local recurrence at the voxel level. Results Out of 26 expert-assessed registrations, 15 provided enough accuracy to identify recurrence volumes and were included for further analysis. Recurrence volume represented on average 23% of the initial tumor volume. The MTV with a threshold of 50% of SUVmax plus a 3D margin of 10 mm covered on average 89.8% of the recurrence and 96.9% of the initial tumor. SUV and MTV alone were not sufficient to identify the area of recurrence. Using a random forest model, 15 parameters, combining radiomics and spatial location, were identified, allowing to predict the recurrence sub-regions with a median area under the receiver operating curve of 0.71 (range 0.14–0.91). Conclusion As opposed to regional comparisons which do not bring enough evidence for accurate prediction of recurrence volume, a voxel-wise analysis of FDG-uptake features suggested a potential to predict recurrence with enough accuracy to consider tailoring CRT by dose escalation within likely radioresistant regions.
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Affiliation(s)
- J Beaumont
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France
| | - O Acosta
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France
| | - A Devillers
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France.,Department of Radiotherapy, Centre Eugene Marquis, avenue de la Bataille Flandre Dunkerque, 35000, Rennes, France
| | - X Palard-Novello
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France.,Department of Radiotherapy, Centre Eugene Marquis, avenue de la Bataille Flandre Dunkerque, 35000, Rennes, France
| | - E Chajon
- Department of Radiotherapy, Centre Eugene Marquis, avenue de la Bataille Flandre Dunkerque, 35000, Rennes, France
| | - R de Crevoisier
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France.,Department of Radiotherapy, Centre Eugene Marquis, avenue de la Bataille Flandre Dunkerque, 35000, Rennes, France
| | - J Castelli
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France. .,Department of Radiotherapy, Centre Eugene Marquis, avenue de la Bataille Flandre Dunkerque, 35000, Rennes, France.
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24
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Bailly C, Carlier T, Berriolo-Riedinger A, Casasnovas O, Gyan E, Meignan M, Moreau A, Burroni B, Djaileb L, Gressin R, Devillers A, Lamy T, Thieblemont C, Hermine O, Kraeber-Bodéré F, Le Gouill S, Bodet-Milin C. Prognostic value of FDG-PET in patients with mantle cell lymphoma: results from the LyMa-PET Project. Haematologica 2019; 105:e33-e36. [PMID: 31371411 DOI: 10.3324/haematol.2019.223016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Clément Bailly
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes.,Department of Nuclear Medicine, CHU Nantes, Nantes
| | - Thomas Carlier
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes.,Department of Nuclear Medicine, CHU Nantes, Nantes
| | | | | | | | | | | | | | - Loïc Djaileb
- Department of Nuclear Medicine, CHU Grenoble-Alpes, Grenoble
| | - Remy Gressin
- Onco Hematology Department, Hospital University Grenoble, La Tronche, Grenoble
| | | | - Thierry Lamy
- Department of Hematology, CHU Rennes.,Inserm U1236, University of Rennes, Rennes
| | | | - Olivier Hermine
- Department of Hematology, CHU Paris - Hôpital Necker-Enfants Malades, Paris
| | - Françoise Kraeber-Bodéré
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes.,Department of Nuclear Medicine, CHU Nantes, Nantes.,Department of Nuclear Medicine, ICO-René Gauducheau, Saint-Herblain
| | - Steven Le Gouill
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes .,Department of Hematology, CHU Nantes, Nantes, France
| | - Caroline Bodet-Milin
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes.,Department of Nuclear Medicine, CHU Nantes, Nantes
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25
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Dissaux G, Hatt M, Visvikis D, Pradier O, Chajon E, Barillot I, Duverge L, Masson I, Abgral R, Santiago-Ribeiro M, Devillers A, Kraeber-Bodéré F, Mahé M, De Crevoisier R, Schick U. EP-1936 PET/CT Radiomics predict local recurrence in patients treated with SBRT for early-stage NSCLC. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Palard-Novello X, Beuzit L, Gambarota G, Le Jeune F, Garin E, Salaün PY, Devillers A, Querellou S, Bourguet P, Saint-Jalmes H. Comparison of 18F-Choline PET/CT and MRI functional parameters in prostate cancer. Ann Nucl Med 2018; 33:47-54. [PMID: 30219990 DOI: 10.1007/s12149-018-1302-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 09/11/2018] [Indexed: 11/30/2022]
Abstract
AIM 18F-Choline (FCH) uptake parameters are strong indicators of aggressive disease in prostate cancer. Functional parameters derived by magnetic resonance imaging (MRI) are also correlated to aggressive disease. The aim of this work was to evaluate the relationship between metabolic parameters derived by FCH PET/CT and functional parameters derived by MRI. MATERIALS AND METHODS Fourteen patients with proven prostate cancer who underwent FCH PET/CT and multiparametric MRI were enrolled. FCH PET/CT consisted in a dual phase: early pelvic list-mode acquisition and late whole-body acquisition. FCH PET/CT and multiparametric MRI examinations were registered and tumoral volume-of-interest were drawn on the largest lesion visualized on the apparent diffusion coefficient (ADC) map and projected onto the different multiparametric MR images and FCH PET/CT images. Concerning the FCH uptake, kinetic parameters were extracted with the best model selected using the Akaike information criterion between the one- and two-tissue compartment models with an imaging-derived plasma input function. Other FCH uptake parameters (early SUVmean and late SUVmean) were extracted. Concerning functional parameters derived by MRI scan, cell density (ADC from diffusion weighting imaging) and vessel permeability (Ktrans and Ve using the Tofts pharmakinetic model from dynamic contrast-enhanced imaging) parameters were extracted. Spearman's correlation coefficients were calculated to compare parameters. RESULTS The one-tissue compartment model for kinetic analysis of PET images was selected. Concerning correlation analysis between PET parameters, K1 was highly correlated with early SUVmean (r = 0.83, p < 0.001) and moderately correlated with late SUVmean (r = 0.66, p = 0.010) and early SUVmean was highly correlated with late SUVmean (r = 0.90, p < 0.001). No significant correlation was found between functional MRI parameters. Concerning correlation analysis between PET and functional MRI parameters, K1 (from FCH PET/CT imaging) was moderately correlated with Ktrans (from perfusion MR imaging) (r = 0.55, p = 0.041). CONCLUSIONS No significant correlation was found between FCH PET/CT and multiparametric MRI metrics except FCH influx which is moderately linked to the vessel permeability in prostate cancer.
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Affiliation(s)
- Xavier Palard-Novello
- Univ Rennes, Inserm, LTSI-UMR1099, 35000, Rennes, France. .,Department of Nuclear Medicine, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France.
| | - Luc Beuzit
- Department of Medical Imaging, Centre Hospitalier Universitaire, 35000, Rennes, France
| | | | - Florence Le Jeune
- Department of Nuclear Medicine, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France.,Univ Rennes-EA 4712, 35000, Rennes, France
| | - Etienne Garin
- Department of Nuclear Medicine, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France.,Univ Rennes, Inserm, UMR 124, 35000, Rennes, France
| | - Pierre-Yves Salaün
- Department of Nuclear Medicine, Centre Hospitalier Universitaire, 29200, Brest, France.,University of Bretagne Occidentale, EA 3878, 29200, Brest, France
| | - Anne Devillers
- Department of Nuclear Medicine, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France
| | - Solène Querellou
- Department of Nuclear Medicine, Centre Hospitalier Universitaire, 29200, Brest, France.,University of Bretagne Occidentale, EA 3878, 29200, Brest, France
| | - Patrick Bourguet
- Department of Nuclear Medicine, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France
| | - Hervé Saint-Jalmes
- Univ Rennes, Inserm, LTSI-UMR1099, 35000, Rennes, France.,Department of Nuclear Medicine, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France
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27
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Palard-Novello X, Blin AL, Le Jeune F, Garin E, Salaün PY, Devillers A, Gambarota G, Querellou S, Bourguet P, Saint-Jalmes H. Optimization of temporal sampling for 18F-choline uptake quantification in prostate cancer assessment. EJNMMI Res 2018; 8:49. [PMID: 29904817 PMCID: PMC6002329 DOI: 10.1186/s13550-018-0410-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/06/2018] [Indexed: 01/12/2023] Open
Abstract
Background Suboptimal temporal sampling of time-activity curves (TAC) from dynamic 18F-fluoromethylcholine (FCH) PET images may introduce bias in quantification of FCH uptake in prostate cancer assessment. We sought to define an optimal temporal sampling protocol for dynamic FCH PET imaging. Seven different time samplings were tested: 5 × 60″, 10 × 30″, 15 × 15″–1 × 75″, 6 × 10″–8 × 30″, 12 × 5″–8 × 30″; 10 × 5″–4 × 10″–3 × 20″–5 × 30″, and 8 × 3″–8 × 12″–6 × 30″. First, the irreversible and reversible one-tissue compartment model with blood volume parameter (VB) (respectively, 1T1K+VB and 1T2k+VB, with K1 = transfer coefficient from the arterial blood to the tissue compartment and k2 = transfer coefficient from the tissue compartment to the arterial blood) were compared for 37 lesions from 32 patients who underwent FCH PET imaging for initial or recurrence assessment of prostate cancer, and the model was selected using the Akaike information criterion. To determine the optimal time sampling, K1 values extracted from 1000 noisy-simulated TAC using Monte Carlo method from the seven different time samplings were compared to a target K1 value which is the average of the K1 values extracted from the 37 lesions using an imaging-derived input function for each patient. K1 values extracted with the optimal time sampling for each tumoral lesion were compared to K1 values extracted from each of the other time samplings for the 37 lesions. Results The 1T2k + VB model was selected. The target K1 value as the objective was 0.506 mL/ccm/min (range 0.216–1.246). Results showed a significant difference between K1 values from the simulated TAC with the seven different time samplings analyzed. The closest K1 value from the simulated TAC to the target K1 value was obtained by the 12 × 5″–8 × 30″ time sampling. Concerning the clinical validation, K1 values extracted from the optimal time sampling (12 × 5″–8 × 30″) were significantly different with K1 values extracted from the other time samplings, except for the comparison with K1 values extracted from the 10 × 5″–4 × 10″–3 × 20″–5 × 30″ time sampling. Conclusions A two-phase framing of dynamic PET reconstruction with frame durations of 5 s (blood phase) and 30 s (tissue phase) could be used to sample the TAC for uptake quantification in prostate cancer assessment.
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Affiliation(s)
- Xavier Palard-Novello
- LTSI-UMR1099, Univ Rennes, Inserm, F-35000, Rennes, France. .,Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France.
| | - Anne-Lise Blin
- LTSI-UMR1099, Univ Rennes, Inserm, F-35000, Rennes, France
| | - Florence Le Jeune
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France.,Univ Rennes-EA 4712, Rennes, France
| | - Etienne Garin
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France.,UMR 124, Univ Rennes, Inserm, Rennes, France
| | - Pierre-Yves Salaün
- Department of Nuclear Medicine, Centre Hospitalier Universitaire, Brest, France.,University of Bretagne Occidentale-EA 3878, Brest, France
| | - Anne Devillers
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
| | | | - Solène Querellou
- Department of Nuclear Medicine, Centre Hospitalier Universitaire, Brest, France.,University of Bretagne Occidentale-EA 3878, Brest, France
| | - Patrick Bourguet
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
| | - Hervé Saint-Jalmes
- LTSI-UMR1099, Univ Rennes, Inserm, F-35000, Rennes, France.,Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
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Beaumont J, Acosta O, Devillers A, Palard-Novello X, Chajon E, De Crevoisier R, Castelli J. EP-1172: Characterization of recurrence origin using pre-treatment PET/CT for head and neck cancers. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31482-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Palard-Novello X, Blin AL, Bourhis D, Garin E, Salaün PY, Devillers A, Querellou S, Bourguet P, Le Jeune F, Saint-Jalmes H. Comparison of choline influx from dynamic 18F-Choline PET/CT and clinicopathological parameters in prostate cancer initial assessment. Ann Nucl Med 2018; 32:281-287. [PMID: 29492810 DOI: 10.1007/s12149-018-1246-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/26/2018] [Indexed: 12/25/2022]
Abstract
AIM The aim of the study was to compare the kinetic analysis of 18F-labeled choline (FCH) uptake with static analysis and clinicopathological parameters in patients with newly diagnosed prostate cancer (PC). MATERIALS AND METHODS Sixty-one patients were included. PSA was performed few days before FCH PET/CT. Gleason scoring (GS) was collected from systematic sextant biopsies. FCH PET/CT consisted in a dual phase: early pelvic list-mode acquisition (from 0 to10 min post-injection) and late whole-body acquisition (60 min post-injection). PC volume of interest was drawn using an adaptative thresholding (40% of the maximal uptake) on the late acquisition and projected onto an early static frame of 10 min and each of the 20 reconstructed frames of 30 s. Kinetic analysis was performed using an imaging-derived plasma input function. Early kinetic parameter (K1 as influx) and static parameters (early SUVmean, late SUVmean, and retention index) were extracted and compared to clinicopathological parameters. RESULTS K1 was significantly, but moderately correlated with early SUVmean (r = 0.57, p < 0.001) and late SUVmean (r = 0.43, p < 0.001). K1, early SUVmean, and late SUVmean were moderately correlated with PSA level (respectively, r = 0.36, p = 0.004; r = 0.67, p < 0.001; r = 0.51, p < 0.001). Concerning GS, K1 was higher for patients with GS ≥ 4 + 3 than for patients with GS < 4 + 3 (median value 0.409 vs 0.272 min- 1, p < 0.001). No significant difference was observed for static parameters. CONCLUSIONS FCH influx index K1 seems to be related to GS and could be a non-invasive tool to gain further information concerning tumor aggressiveness.
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Affiliation(s)
- Xavier Palard-Novello
- University of Rennes 1, Rennes, France. .,Department of Nuclear Medicine, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France. .,UMR1099 INSERM, Rennes, France.
| | - Anne-Lise Blin
- University of Rennes 1, Rennes, France.,UMR1099 INSERM, Rennes, France
| | - David Bourhis
- Department of Nuclear Medicine, Centre Hospitalier Universitaire, Brest, France
| | - Etienne Garin
- University of Rennes 1, Rennes, France.,Department of Nuclear Medicine, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France.,UMR 1241 INSERM, Rennes, France
| | - Pierre-Yves Salaün
- Department of Nuclear Medicine, Centre Hospitalier Universitaire, Brest, France.,University of Bretagne Occidentale, Brest, France.,EA 3878, Brest, France
| | - Anne Devillers
- Department of Nuclear Medicine, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France
| | - Solène Querellou
- Department of Nuclear Medicine, Centre Hospitalier Universitaire, Brest, France.,University of Bretagne Occidentale, Brest, France.,EA 3878, Brest, France
| | | | - Florence Le Jeune
- University of Rennes 1, Rennes, France.,Department of Nuclear Medicine, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France.,EA 4712, Rennes, France
| | - Hervé Saint-Jalmes
- University of Rennes 1, Rennes, France.,Department of Nuclear Medicine, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France.,UMR1099 INSERM, Rennes, France
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Castelli J, Depeursinge A, Nditifei-Ndoh V, Devillers A, Dicente Y, Schaer R, Prior J, Bourhis J, Sire C, de Crevoisier R. Valeur de la tomographie par émission de positons au ( 18 F)-fluorodésoxyglucose pour prédire la récidive dans les cancers ORL non oropharyngé pris en charge par chimioradiothérapie. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Roman-Jimenez G, Acosta O, Leseur J, Devillers A, Der Sarkissian H, Guzman L, Grossiord E, Ospina JD, De Crevoisier R. Random forests to predict tumor recurrence following cervical cancer therapy using pre- and per-treatment 18F-FDG PET parameters. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:2444-2447. [PMID: 28324966 DOI: 10.1109/embc.2016.7591224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The ability to predict tumor recurrence after chemoradiotherapy of locally advanced cervical cancer is a crucial clinical issue to intensify the treatment of the most high-risk patients. The objective of this study was to investigate tumor metabolism characteristics extracted from pre- and per-treatment 18F-FDG PET images to predict 3-year overall recurrence (OR). A total of 53 locally advanced cervical cancer patients underwent pre- and per-treatment 18F-FDG PET (respectively PET1 and PET2). Tumor metabolism was characterized through several delineations using different thresholds, based on a percentage of the maximum uptake, and applied by region-growing. The SUV distribution in PET1 and PET2 within each segmented region was characterized through 7 intensity and histogram-based parameters, 9 shape descriptors and 16 textural features for a total of 1026 parameters. Predictive capability of the extracted parameters was assessed using the area under the receiver operating curve (AUC) associated to univariate logistic regression models and random forest (RF) classifier. In univariate analyses, 36 parameters were highly significant predictors of 3-year OR (p<;0.01), AUC ranging from 0.72 to 0.83. With RF, the Out-of-Bag (OOB) error rate using the totality of the extracted parameters was 26.42% (AUC=0.72). By recursively eliminating the less important variables, OOB error rate of the RF classifier using the nine most important parameters was 13.21% (AUC=0.90). Results suggest that both pre- and per-treatment 18F-FDG PET exams provide meaningful information to predict the tumor recurrence. RF classifier is able to handle a very large number of extracted features and allows the combination of the most prognostic parameters to improve the prediction.
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Castelli J, Depeursinge A, Ndoh V, Prior J, Ozsahin M, Devillers A, Chajon E, De Crevoisier R, Scher N, Jegoux F, Vauleon E, De Bari B, Bourhis J. PO-0604: A PET-based nomogram to predict survival in oropharyngeal cancers radiotherapy. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31040-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vera P, Thureau S, Chaumet-Riffaud P, Modzelewski R, Bohn P, Vermandel M, Hapdey S, Pallardy A, Mahé MA, Lacombe M, Boisselier P, Guillemard S, Olivier P, Beckendorf V, Salem N, Charrier N, Chajon E, Devillers A, Aide N, Danhier S, Denis F, Muratet JP, Martin E, Riedinger AB, Kolesnikov-Gauthier H, Dansin E, Massabeau C, Courbon F, Farcy Jacquet MP, Kotzki PO, Houzard C, Mornex F, Vervueren L, Paumier A, Fernandez P, Salaun M, Dubray B. Phase II Study of a Radiotherapy Total Dose Increase in Hypoxic Lesions Identified by 18F-Misonidazole PET/CT in Patients with Non-Small Cell Lung Carcinoma (RTEP5 Study). J Nucl Med 2017; 58:1045-1053. [PMID: 28254869 DOI: 10.2967/jnumed.116.188367] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/07/2017] [Indexed: 01/09/2023] Open
Abstract
See an invited perspective on this article on page 1043.This multicenter phase II study investigated a selective radiotherapy dose increase to tumor areas with significant 18F-misonidazole (18F-FMISO) uptake in patients with non-small cell lung carcinoma (NSCLC). Methods: Eligible patients had locally advanced NSCLC and no contraindication to concomitant chemoradiotherapy. The 18F-FMISO uptake on PET/CT was assessed by trained experts. If there was no uptake, 66 Gy were delivered. In 18F-FMISO-positive patients, the contours of the hypoxic area were transferred to the radiation oncologist. It was necessary for the radiotherapy dose to be as high as possible while fulfilling dose-limiting constraints for the spinal cord and lungs. The primary endpoint was tumor response (complete response plus partial response) at 3 mo. The secondary endpoints were toxicity, disease-free survival (DFS), and overall survival at 1 y. The target sample size was set to demonstrate a response rate of 40% or more (bilateral α = 0.05, power 1-β = 0.95). Results: Seventy-nine patients were preincluded, 54 were included, and 34 were 18F-FMISO-positive, 24 of whom received escalated doses of up to 86 Gy. The response rate at 3 mo was 31 of 54 (57%; 95% confidence interval [CI], 43%-71%) using RECIST 1.1 (17/34 responders in the 18F-FMISO-positive group). DFS and overall survival at 1 y were 0.86 (95% CI, 0.77-0.96) and 0.63 (95% CI, 0.49-0.74), respectively. DFS was longer in the 18F-FMISO-negative patients (P = 0.004). The radiotherapy dose was not associated with DFS when adjusting for the 18F-FMISO status. One toxic death (66 Gy) and 1 case of grade 4 pneumonitis (>66 Gy) were reported. Conclusion: Our approach results in a response rate of 40% or more, with acceptable toxicity. 18F-FMISO uptake in NSCLC patients is strongly associated with poor prognosis features that could not be reversed by radiotherapy doses up to 86 Gy.
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Affiliation(s)
- Pierre Vera
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Sébastien Thureau
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, Rouen, France
| | - Philippe Chaumet-Riffaud
- Department of Nuclear Medicine, Hôpitaux universitaires Paris Sud Bicêtre AP-HP and University Paris Sud, Paris, France
| | - Romain Modzelewski
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Pierre Bohn
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Maximilien Vermandel
- University Lille, Inserm, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, France
| | - Sébastien Hapdey
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Amandine Pallardy
- Department of Nuclear Medicine, Nantes University Hospital, Nantes, France
| | - Marc-André Mahé
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest (ICO)-René Gauducheau, Nantes, France
| | - Marie Lacombe
- Department of Nuclear Medicine, Institut de Cancérologie de l'Ouest (ICO), Nantes, France
| | - Pierre Boisselier
- Department of Radiation Oncology, Institut régional du Cancer Montpellier (ICM), Montpellier, France
| | - Sophie Guillemard
- Department of Nuclear Medicine, Institut régional du Cancer Montpellier (ICM), Montpellier, France
| | - Pierre Olivier
- Department of Nuclear Medicine, Brabois University Hospital, Nancy, France
| | - Veronique Beckendorf
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - Naji Salem
- Department of Radiation Oncology, Institut Paoli Calmette, Marseille, France
| | - Nathalie Charrier
- Department of Nuclear Medicine, Institut Paoli Calmette, Marseille, France
| | - Enrique Chajon
- Department of Radiation Oncology, Centre regional de lutte contre le cancer de Bretagne Eugène Marquis, Rennes, France
| | - Anne Devillers
- Department of Nuclear Medicine, Centre regional de lutte contre le cancer de Bretagne Eugène Marquis, Rennes, France
| | - Nicolas Aide
- Nicolas Aide, Nuclear Medicine and TEP Centre, Caen University Hospital and Inserm U1086 ANTICIPE, Caen, France
| | - Serge Danhier
- Department of Radiation Oncology, François Baclesse Cancer Center, Caen, France
| | - Fabrice Denis
- Department of Radiation Oncology, Institut Inter-Régional de Cancérologie (ILC), Centre Jean Bernard/Clinique Victor Hugo, Le Mans, France
| | - Jean-Pierre Muratet
- Department of Nuclear Medicine, Institut Inter-Régional de Cancérologie (ILC), Centre Jean Bernard/Clinique Victor Hugo, Le Mans, France
| | - Etienne Martin
- Radiation Oncology, Centre Georges-Francois Leclerc, Dijon, France
| | | | | | - Eric Dansin
- Department of Radiation Oncology, Oscar Lambret Center, Lille cedex, France
| | - Carole Massabeau
- Département de Radiothérapie. Institut Universitaire du Cancer, Toulouse cedex 9, France
| | - Fredéric Courbon
- Department of Nuclear Medicine, Institut Claudius Regaud, IUCT, Toulouse cedex 9, France
| | - Marie-Pierre Farcy Jacquet
- Department of Radiation Oncology, CHU de Nîmes, Institut de cancérologie du Gard, Rue Henri Pujol, Nîmes, France
| | - Pierre-Olivier Kotzki
- Department of Nuclear Medicine, Institut régional du Cancer Montpellier (ICM), Montpellier, France.,Department of Nuclear Medicine, CHU de Nîmes, Institut de cancérologie du Gard, Nîmes, France
| | - Claire Houzard
- Department of Nuclear Medicine, Hospices Civils de Lyon, Lyon, France
| | - Francoise Mornex
- Department of Radiation Oncology, Hospices Civils de Lyon, Lyon, France
| | | | - Amaury Paumier
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, site Paul Papin, France
| | - Philippe Fernandez
- Department of Nuclear Medicine, Hôpital Pellegrin, CHU de Bordeaux, France; and
| | - Mathieu Salaun
- Normandy University, UNIROUEN, QuantIF-LITIS EA 4108, Rouen University Hospital, Department of Pulmonology-Thoracic Oncology-Respiratory Intensive Care, Rouen, France
| | - Bernard Dubray
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, Rouen, France
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Castelli J, Depeursinge A, Ndoh V, Prior JO, Ozsahin M, Devillers A, Bouchaab H, Chajon E, de Crevoisier R, Scher N, Jegoux F, Laguerre B, De Bari B, Bourhis J. A PET-based nomogram for oropharyngeal cancers. Eur J Cancer 2017; 75:222-230. [PMID: 28237868 DOI: 10.1016/j.ejca.2017.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/28/2016] [Accepted: 01/14/2017] [Indexed: 12/23/2022]
Abstract
PURPOSE In the context of locally advanced oropharyngeal cancer (LAOC) treated with definitive radiotherapy (RT) (combined with chemotherapy or cetuximab), the aims of this study were: (1) to identify PET-FDG parameters correlated with overall survival (OS) from a first cohort of patients; then (2) to compute a prognostic score; and (3) finally to validate this scoring system in a second independent cohort of patients. MATERIALS AND METHODS A total of 76 consecutive patients (training cohort from Rennes) treated with chemoradiotherapy or RT with cetuximab for LAOC were used to build a predictive model of locoregional control (LRC) and OS based on PET-FDG parameters. After internal calibration and validation of this model, a nomogram and a scoring system were developed and tested in a validation cohort of 46 consecutive patients treated with definitive RT for LAOC in Lausanne. RESULTS In multivariate analysis, the metabolic tumour volume (MTV) of the primary tumour and the lymph nodes were independent predictive factors for LRC and OS. Internal calibration showed a very good adjustment between the predicted OS and the observed OS at 24 months. Using the predictive score, two risk groups were identified (median OS 42 versus 14 months, p < 0.001) and confirmed in the validation cohort from Lausanne (median OS not reached versus 26 months, p=0.008). CONCLUSIONS This is the first report of a PET-based nomogram in oropharyngeal cancer. Interestingly, it appeared stronger than the classical prognostic factors and was validated in independent cohorts markedly diverging in many aspects, which suggest that the observed signal was robust.
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Affiliation(s)
- J Castelli
- Radiotherapy Department, Lausanne University Hospital, Switzerland; INSERM, U1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France
| | - A Depeursinge
- Ecole Polytechnique Fédérale de Lausanne, CH-1015, Lausanne, VD, Switzerland; University of Applied Sciences Western Switzerland, 3960, Sierre, Switzerland
| | - V Ndoh
- Radiotherapy Department, Centre Eugene Marquis, Rennes, F-35000, France
| | - J O Prior
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Switzerland
| | - M Ozsahin
- Radiotherapy Department, Lausanne University Hospital, Switzerland
| | - A Devillers
- Nuclear Medicine Department, Centre Eugene Marquis, Rennes, F-35000, France
| | - H Bouchaab
- Radiotherapy Department, Lausanne University Hospital, Switzerland
| | - E Chajon
- Radiotherapy Department, Centre Eugene Marquis, Rennes, F-35000, France
| | - R de Crevoisier
- Radiotherapy Department, Centre Eugene Marquis, Rennes, F-35000, France
| | - N Scher
- Radiotherapy Department, Lausanne University Hospital, Switzerland
| | - F Jegoux
- Head and Neck Department, CHU Rennes, Rennes, F-35000, France
| | - B Laguerre
- Oncology Department, Centre Eugene Marquis, Rennes, F-35000, France
| | - B De Bari
- Radiotherapy Department, Lausanne University Hospital, Switzerland
| | - J Bourhis
- Radiotherapy Department, Lausanne University Hospital, Switzerland.
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Alix L, Decaux O, Devillers A, Néel A, Jego P. Intérêt du TEP-scanner dans le syndrome de Schnitzler et comparaison aux autres examens d’imagerie. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Castelli J, De Bari B, Depeursinge A, Simon A, Devillers A, Roman Jimenez G, Prior J, Ozsahin M, de Crevoisier R, Bourhis J. Overview of the predictive value of quantitative 18 FDG PET in head and neck cancer treated with chemoradiotherapy. Crit Rev Oncol Hematol 2016; 108:40-51. [PMID: 27931839 DOI: 10.1016/j.critrevonc.2016.10.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/08/2016] [Accepted: 10/26/2016] [Indexed: 02/03/2023] Open
Abstract
18 F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) allows to quantify the metabolic activity of a tumor (glycolysis) and has become a reference tool in oncology for the staging, restaging, radiotherapy planning and monitoring response in many cancers. Quantitative analyses have been introduced in order to overcome some of the limits of the visual methods, allowing an easier and more objective comparison of the inter- and intra-patients variations. The aims of this review were to report available evidences on the clinical value of quantitative PET/CT parameters in HNC. Forty-five studies, for a total of 2928 patients, were analyzed. Most of the data available dealt with the intensity of the metabolism, calculated from the Standard Uptake Value (SUV). Metabolic Tumor Volume (MTV) was well correlated with overall survival and disease free survival, with a higher predictive value than the maximum SUV. Spatial distribution of metabolism and textural analyses seems promising.
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Affiliation(s)
- J Castelli
- Radiotherapy Department, CHUV, Lausanne, Switzerland; INSERM, U1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France.
| | - B De Bari
- Radiotherapy Department, CHUV, Lausanne, Switzerland
| | - A Depeursinge
- University of Applied Sciences Western Switzerland, 3960 Sierre, Switzerland; Ecole Polytechnique Fédérale de Lausanne, CH-1015 Lausanne VD, Switzerland
| | - A Simon
- INSERM, U1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France
| | - A Devillers
- Nuclear Medecine Department, Centre Eugene Marquis, Rennes, F-35000, France
| | - G Roman Jimenez
- INSERM, U1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France; Keosys Medical imaging, 1 Impasse Augustin Fresnel, Saint-Herblain, F-44815, France
| | - J Prior
- Nuclear Medecine Department, CHUV, Switzerland
| | - M Ozsahin
- Radiotherapy Department, CHUV, Lausanne, Switzerland
| | - R de Crevoisier
- INSERM, U1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France; Radiotherapy Department, Centre Eugene Marquis, Rennes, F-35000, France
| | - J Bourhis
- Radiotherapy Department, CHUV, Lausanne, Switzerland
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Jaksic N, Colliaux J, Castelli J, Lena H, Bellec J, Kerjouan M, Devillers A, Ricordel C, de Latour B, de Crevoisier R, Chajon E. La réponse tumorale précoce évaluée sur tomographie conique au cours de la radiothérapie est prédictive du pronostic des cancers bronchiques non à petites cellules localement évolués. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Leseur J, Roman-Jimenez G, Devillers A, Ospina-Arango JD, Williaume D, Castelli J, Terve P, Lavoue V, Garin E, Lejeune F, Acosta O, De Crevoisier R. Pre- and per-treatment 18F-FDG PET/CT parameters to predict recurrence and survival in cervical cancer. Radiother Oncol 2016; 120:512-518. [DOI: 10.1016/j.radonc.2016.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 11/29/2022]
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Roman-Jimenez G, Acosta O, Leseur J, Devillers A, Le Gouestre J, Ospina JD, Simon A, Terve P, De Crevoisier R. Weighted quantification of ¹⁸F-FDG tumor metabolism activity using fuzzy-thresholding to predict post-treatment tumor recurrence. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:2239-42. [PMID: 26736737 DOI: 10.1109/embc.2015.7318837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cervical cancer is one of the most common cancer to affect women worldwide. Despite the efficiency of radiotherapy treatment, some patients present post-treatment tumor recurrence which increases the risk of death. Early outcome prediction could help oncologists to adapt the treatment. Several studies suggest that quantification of tumor activity using (18)FFDG PET imaging could be used to predict post-treatment tumor recurrence. In this paper we study the predictive value of weighted quantification of tumor metabolism extracted by fuzzy-thresholding for tumor recurrence of locally advanced cervical cancer. Fifty-three patients with locally advanced cervical cancer treated by chemo-radiotherapy were considered in our study. For each patient, a coregistered (18)F-FDG PET/CT scan was acquired before the treatment and was segmented using different hard and fuzzy segmentations methods. The tumor activity was extracted through the total lesion glycolysis and through a weighted analog of the total lesion glycolysis using the probability maps provided by the fuzzy segmentations. Outcomes prediction was performed using the area under the receiver operating characteristic curve (AUC) and the Harrell's C-index. Results suggest that weighted quantification of tumor activity seems to be strongly informative and could be used to predict post-treatment tumor recurrence in cervical cancer.
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Devillers A, Vitellius M, Brandicourt P, Labat J, Savoye-Collet C. An atypical acute small-bowel obstruction. Diagn Interv Imaging 2016; 97:133-6. [DOI: 10.1016/j.diii.2015.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 01/21/2015] [Accepted: 01/26/2015] [Indexed: 10/23/2022]
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Bahri H, Laurence L, Edeline J, Leghzali H, Devillers A, Raoul JL, Cuggia M, Mesbah H, Clement B, Boucher E, Garin E. High prognostic value of 18F-FDG PET for metastatic gastroenteropancreatic neuroendocrine tumors: a long-term evaluation. J Nucl Med 2014; 55:1786-90. [PMID: 25286923 DOI: 10.2967/jnumed.114.144386] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
UNLABELLED This study aimed to evaluate the long-term prognostic usefulness of (18)F-FDG PET for patients with metastatic gastroenteropancreatic neuroendocrine tumors (GEPNETs). METHODS Thirty-eight patients with metastatic GEPNETs were prospectively enrolled. Initial check-up comprised CT scan, (111)In-pentetreotide scintigraphy (SRS), and (18)F-FDG PET. Only (18)F-FDG PET-positive lesions with a maximum standardized uptake value (SUVmax) greater than 4.5 or an SUV ratio (SUVmax tumor to SUVmax nontumoral liver tissue, or T/NT ratio) of 2.5 or greater were considered positive for prognosis-that is, indicating a poor prognosis. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Factors associated with survival were assessed with univariate and multivariate analyses, using the Cox regression model. RESULTS Median PFS and OS were significantly higher for patients with a negative (18)F-FDG PET finding, with an OS of 119.5 mo (95% confidence interval [CI], 72-∞), than for patients with a positive (18)F-FDG PET finding (only 15 mo [95% CI, 4-27]) (P < 10(-3)). Median PFS and OS were significantly higher for the patient group that had a positive SRS than the group with a negative SRS (P = 0.0002). For patients with a positive SRS, PFS and OS were significantly shorter when the (18)F-FDG PET finding was positive: 19.5 mo (95% CI, 4-37) for PFS and 119.5 mo (95% CI, 81-∞) for OS (P < 10(-3)). In the patient group with a low-grade GEPNET and a positive SRS, PFS and OS were also significantly lower for patients with a positive (18)F-FDG PET. At 48-mo follow-up, 100% of patients who had a positive (18)F-FDG PET for disease progression (of which 47% were also SRS-positive) were deceased, and 87% of patients with a negative (18)F-FDG PET were alive (P < 0.0001). The T/NT ratio was the only parameter associated with OS on multivariate analysis. CONCLUSION Overall, (18)F-FDG PET appears to be of major importance in the prognostic evaluation of metastatic GEPNET. A positive (18)F-FDG PET with an SUV ratio (T/NT) of 2.5 or greater was a poor prognostic factor, with a 4-y survival rate of 0%. A positive SRS does not eliminate the need for performing (18)F-FDG PET, which is of greater prognostic utility.
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Affiliation(s)
- Haïfa Bahri
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Rennes, France
| | - Lenoir Laurence
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Rennes, France Inserm, UMR991, Liver Metabolisms and Cancer, Rennes, France University of Rennes 1, Rennes, France
| | - Julien Edeline
- Inserm, UMR991, Liver Metabolisms and Cancer, Rennes, France University of Rennes 1, Rennes, France Department of Medical Oncology, Cancer Institute Eugène Marquis, Rennes, France
| | - Houda Leghzali
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Rennes, France
| | - Anne Devillers
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Rennes, France
| | - Jean-Luc Raoul
- Department of Medical Oncology, Comprehensive Cancer Center, Institute Paoli Calmette, Marseille, France
| | - Marc Cuggia
- Department of Medical Computing, CHU Pontchaillou, Rennes, France; and
| | - Habiba Mesbah
- Department of Medical Informations, Cancer Institute Eugène Marquis, Rennes, France
| | - Bruno Clement
- Inserm, UMR991, Liver Metabolisms and Cancer, Rennes, France
| | - Eveline Boucher
- Inserm, UMR991, Liver Metabolisms and Cancer, Rennes, France Department of Medical Oncology, Cancer Institute Eugène Marquis, Rennes, France
| | - Etienne Garin
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Rennes, France Inserm, UMR991, Liver Metabolisms and Cancer, Rennes, France University of Rennes 1, Rennes, France
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Revest M, Patrat-Delon S, Devillers A, Tattevin P, Michelet C. Contribution of 18fluoro-deoxyglucose PET/CT for the diagnosis of infectious diseases. Med Mal Infect 2014; 44:251-60. [DOI: 10.1016/j.medmal.2014.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 02/03/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
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Roman Jimenez G, Leseur J, Devillers A, Ospina J, Acosta O, Terve P, Gobeli M, Lavoué V, Williaume D, De Crevoisier R. PD-0356: 18F-FDG PET parameters during radio-chemotherapy to predict tumor recurrence in cervical cancer. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lafond C, Chajon E, Devillers A, Louvel G, Toublanc S, Olivier M, Simon A, De Crevoisier R, Manens JP. Impact of MLC leaf width on volumetric-modulated arc therapy planning for head and neck cancers. J Appl Clin Med Phys 2013; 14:4074. [PMID: 24257269 PMCID: PMC5714620 DOI: 10.1120/jacmp.v14i6.4074] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 12/10/2012] [Accepted: 06/25/2013] [Indexed: 12/21/2022] Open
Abstract
This dosimetric study investigated the impact of multileaf collimators (MLC) leaf width in volumetric‐modulated arc therapy (VMAT) for head and neck cancers (HNC), either with a “standard” simultaneously integrated boost technique (S‐SIB) or with a “dose painting” SIB technique (DP‐SIB). HNC patients were planned either with an S‐SIB comprising three dose levels, from 56 to 70 Gy (16 patients), or with a DP‐SIB comprising five dose levels, from 56 to 84 Gy (8 patients), in 35 fractions. Two VMAT plans were calculated for each SIB technique using two Elekta MLCs: MLCi2 with 10 mm leaf width and Beam Modulator (BM) with 4 mm leaf width. Dose distributions were evaluated by comparing doses on PTVs, main OARs, and healthy tissue, and by comparing conformation indexes. Treatment efficiencies were evaluated by comparing the number of monitor units and the number of needed arcs. Comparisons of the two MLCs depending on the two SIB techniques showed: i) Regarding PTVs: Dmean and D2% on lower doses PTV decreased respectively by 0.5 Gy (p=0.01) and 0.9 Gy (p=0.01) with BM than with MLCi2 for S‐SIB; no significant difference was found for DP‐SIB; ii) Regarding OARs: for spinal cord and brainstem, D2% decreased respectively by 1.2 Gy (p=0.03) and 4.2 Gy (p=0.04) with BM than with MLCi2 for S‐SIB; for controlateral parotid, D50% decreased by 1.5 Gy (p=0.01) with BM than with MLCi2 for S‐SIB; iii) Regarding treatment efficiency : the number of monitor units was 44% (p=0.00) and 51% (p=0.01) higher with BM for S‐SIB and DP‐SIB, respectively. Two arcs were more frequently needed with BM to reach an acceptable dose distribution. This study demonstrated that Beam Modulator (4 mm leaf width) and MLCi2 (10 mm leaf width) MLCs from Elekta provided satisfactory dose distributions for treatment delivery with VMAT technique for complex HNC cases with standard and dose painting prescriptions. OAR sparing was better with BM, mainly for brainstem and spinal cord. However, delivery efficiency of VMAT plans was better with MLCi2. PACS numbers: 87.56.N‐, 87.56.nk, 87.55.D‐
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Affiliation(s)
- Caroline Lafond
- Centre Eugène Marquis, INSERM U1099, Laboratoire du Traitement du Signal et de l'Image.
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Roman-Jimenez G, Ospina JD, Leseur J, Devillers A, Castelli J, Simon A, Terve P, Acosta O, de Crevoisier R. Investigating the contribution of pre- and per-treatment 18F-FDG PET-CT segmentation methodologies for post-treatment tumor recurrence prediction in cervical cancer. Ing Rech Biomed 2013. [DOI: 10.1016/j.irbm.2013.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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46
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Bonichon F, Palussière J, Godbert Y, Pulido M, Descat E, Devillers A, Meunier C, Leboulleux S, de Baère T, Galy-Lacour C, Lagoarde-Segot L, Cazeau AL. Diagnostic accuracy of 18F-FDG PET/CT for assessing response to radiofrequency ablation treatment in lung metastases: a multicentre prospective study. Eur J Nucl Med Mol Imaging 2013; 40:1817-27. [DOI: 10.1007/s00259-013-2521-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 07/11/2013] [Indexed: 01/21/2023]
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Thureau S, Chaumet-Riffaud P, Modzelewski R, Fernandez P, Tessonnier L, Vervueren L, Cachin F, Berriolo-Riedinger A, Olivier P, Kolesnikov-Gauthier H, Blagosklonov O, Bridji B, Devillers A, Collombier L, Courbon F, Gremillet E, Houzard C, Caignon JM, Roux J, Aide N, Brenot-Rossi I, Doyeux K, Dubray B, Vera P. Interobserver agreement of qualitative analysis and tumor delineation of 18F-fluoromisonidazole and 3'-deoxy-3'-18F-fluorothymidine PET images in lung cancer. J Nucl Med 2013; 54:1543-50. [PMID: 23918733 DOI: 10.2967/jnumed.112.118083] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
UNLABELLED As the preparation phase of a multicenter clinical trial using (18)F-fluoro-2-deoxy-d-glucose ((18)F-FDG), (18)F-fluoromisonidazole ((18)F-FMISO), and 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) in non-small cell lung cancer (NSCLC) patients, we investigated whether 18 nuclear medicine centers would score tracer uptake intensity similarly and define hypoxic and proliferative volumes for 1 patient and we compared different segmentation methods. METHODS Ten (18)F-FDG, ten (18)F-FMISO, and ten (18)F-FLT PET/CT examinations were performed before and during curative-intent radiotherapy in 5 patients with NSCLC. The gold standards for uptake intensity and volume delineation were defined by experts. The between-center agreement (18 nuclear medicine departments connected with a dedicated network, SFMN-net [French Society of Nuclear Medicine]) in the scoring of uptake intensity (5-level scale, then divided into 2 levels: 0, normal; 1, abnormal) was quantified by κ-coefficients (κ). The volumes defined by different physicians were compared by overlap and κ. The uptake areas were delineated with 22 different methods of segmentation, based on fixed or adaptive thresholds of standardized uptake value (SUV). RESULTS For uptake intensity, the κ values between centers were, respectively, 0.59 for (18)F-FDG, 0.43 for (18)F-FMISO, and 0.44 for (18)F-FLT using the 5-level scale; the values were 0.81 for (18)F-FDG and 0.77 for both (18)F-FMISO and (18)F-FLT using the 2-level scale. The mean overlap and mean κ between observers were 0.13 and 0.19, respectively, for (18)F-FMISO and 0.2 and 0.3, respectively, for (18)F-FLT. The segmentation methods yielded significantly different volumes for (18)F-FMISO and (18)F-FLT (P < 0.001). In comparison with physicians, the best method found was 1.5 × maximum SUV (SUVmax) of the aorta for (18)F-FMISO and 1.3 × SUVmax of the muscle for (18)F-FLT. The methods using the SUV of 1.4 and the method using 1.5 × the SUVmax of the aorta could be used for (18)F-FMISO and (18)F-FLT. Moreover, for (18)F-FLT, 2 other methods (adaptive threshold based on 1.5 or 1.6 × muscle SUVmax) could be used. CONCLUSION The reproducibility of the visual analyses of (18)F-FMISO and (18)F-FLT PET/CT images was demonstrated using a 2-level scale across 18 centers, but the interobserver agreement was low for the (18)F-FMISO and (18)F-FLT volume measurements. Our data support the use of a fixed threshold (1.4) or an adaptive threshold using the aorta background to delineate the volume of increased (18)F-FMISO or (18)F-FLT uptake. With respect to the low tumor-on-background ratio of these tracers, we suggest the use of a fixed threshold (1.4).
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Affiliation(s)
- Sébastien Thureau
- Nuclear Medicine and Radiotherapy, Henri Becquerel Cancer Center and Rouen University Hospital, and QuantIF-LITIS (EA [Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, Rouen, France
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Leseur J, Devillers A, Louvel G, Williaume D, Lévêque J, Bouriel C, Garin É, de Crevoisier R. Intérêt de la TEP et de l’IRM en cours de chimioradiothérapie pour prédire la récidive dans les cancers du col de l’utérus localement évolués. Cancer Radiother 2012. [DOI: 10.1016/j.canrad.2012.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Leseur J, Devillers A, Williaume D, Le Prisé E, Fougerou C, Bouriel C, Levêque J, Monpetit E, Blanchot J, de Crevoisier R, Garin E. [((18)F)-fluorodeoxyglucose PET/CT in cervix cancer: lymph node assessment and prognostic/predictive value of primary tumour analysis]. Cancer Radiother 2011; 15:699-708. [PMID: 22104953 DOI: 10.1016/j.canrad.2011.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 04/15/2011] [Accepted: 05/22/2011] [Indexed: 12/30/2022]
Abstract
PURPOSE In cervix carcinoma: (a) to evaluate the ability of ((18)F)-fluorodeoxyglucose (FDG) positron emission tomography (PET) in the lymph node detection; (b) to investigate the prognostic and predictive value of the primary cervical PET parameters. PATIENTS AND METHODS Ninety patients treated for cervix carcinoma and evaluated initially by MRI and FGD PET were included. The performances of FDG-PET for lymph node detection (relatively to the lymph node dissection) have been described (sensitivity, specificity, positive predictive value and negative predictive value). PET tumour parameters analyzed were: maximum standard uptake value (SUVmax), the volume and the maximum diameter. The prognostic and predictive values of these parameters were investigated. The tumour response was evaluated on surgical specimens. RESULTS PET detected the cervical tumour with a sensitivity of 97% (mean values: SUVmax=15.8, volume=27 mm(3), maximum diameter=47). For the detection of the lymph nodes, the values of sensibility, specificity, positive predictive value and negative predictive value were: 86, 56, 69 and 78% in the pelvic, and 90, 67, 50 and 95% for the para-aortic area, respectively. The SUVmax was correlated with histologic response (P=0.04). The frequency of partial histological response was significantly higher for tumour SUVmax>10.9 (P=0.017). The maximum PET diameter and pathologic response had an impact on disease-free survival and overall survival in multivariate analysis (P<0.05). CONCLUSION PET has high sensitivity in detecting pelvic and para-aortic lymph nodes. Some primary cervical tumour PET parameters are useful as prognostic and predictive factors.
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Affiliation(s)
- J Leseur
- Département des Radiations, Centre Eugène-Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France.
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50
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Lafond C, Chajon E, Louvel G, Devillers A, Simon A, Olivier M, de Crevoisier R, Manens JP. VMAT et « dose painting » en ORL : quel impact sur la dose délivrée aux organes à risque ? Cancer Radiother 2011. [DOI: 10.1016/j.canrad.2011.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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