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Riaz S, Priftakis D, Afaq A, Kayani I, Bomanji J. 68 Ga-PSMA-Avid Intranasal Solitary Fibrous Tumor. Clin Nucl Med 2023; 48:e184-e185. [PMID: 36727873 DOI: 10.1097/rlu.0000000000004572] [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: 02/03/2023]
Abstract
ABSTRACT The utility of molecular imaging in solitary fibrous tumors has not been fully established. We present a rare case of recurrent intranasal solitary fibrous tumor incidentally localized on 68 Ga-PSMA PET/CT scan, which turned out to be metabolically inactive on 18 F-FDG PET/CT.
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Affiliation(s)
- Saima Riaz
- From the Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Dimitrios Priftakis
- From the Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Asim Afaq
- Department of Radiology, University of Iowa Roy Carver College of Medicine, Iowa City, IA
| | - Irfan Kayani
- From the Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Jamshed Bomanji
- From the Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
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2
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Asif M, Alrashdi AO, Fadhali MM, Afaq A, Bakar A. First-Principles Investigations of Thermoelectric Behavior of RuCrX (X = Si, Ge, Sn). ACS Omega 2022; 7:45353-45360. [PMID: 36530261 PMCID: PMC9753640 DOI: 10.1021/acsomega.2c05928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
The half-Heusler alloys have not only been recognized for spintronic and memory devices but also for thermoelectric applications. In this research work, the detailed study for thermoelectric parameters of RuCrX (X = Si, Ge, Sn) half-Heusler alloys has been carried out by using the pseudopotential approach alongside the Boltzmann transport theory. The RuCrX (X= Si, Ge, Sn) was reported stable in C1 b -type structure by means of energy-volume optimization, elastic stability criteria, positive phonon frequencies in phonon dispersion curves, and formation energies. The all important thermoelectric properties of these alloys have not yet been explored. The thermoelectric properties such as Seebeck coefficient, electronic part of thermal conductivity, electrical conductivity, and power factor have been discussed within a specific temperature range (300-1200 K). The calculated value of the power factor was found to be 5.11 × 1011 W/(m K2 s) for RuCrSi, 3.42 × 1011 W/(m K2 s) for RuCrGe, and 1.85 × 1011 W/(m K2 s) for RuCrSn at 1200 K.
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Affiliation(s)
- Muhammad Asif
- Department
of Physics, COMSATS University Islamabad, Lahore Campus, Lahore, 54000, Pakistan
| | - Ayash O Alrashdi
- King
Abdulaziz City for Science and Technology, Riyadh, 11442, Saudi Arabia
| | - Mohammed M. Fadhali
- Department
of Physics, Faculty of Science, Jazan University, Jazan, 45142, Saudi Arabia
- Department
of Physics, Faculty of Science, Ibb University, Ibb, 70270Yemen
| | - A. Afaq
- Centre
of Excellence in Solid State Physics, University
of the PunjabLahore, 54000, Pakistan
| | - Abu Bakar
- Centre
of Excellence in Solid State Physics, University
of the PunjabLahore, 54000, Pakistan
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3
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Fadhali MM, Bakar A, Ali S, Afaq A, Hegazy H. Effect of pressure on structural, electronic dispersion relations, optical and thermoelectric properties of CsNbO3 perovskite for photovoltaic and energy applications. Polyhedron 2022. [DOI: 10.1016/j.poly.2022.116217] [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: 11/23/2022]
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4
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Wang Y, Galante JR, Haroon A, Wan S, Afaq A, Payne H, Bomanji J, Adeleke S, Kasivisvanathan V. The future of PSMA PET and WB MRI as next-generation imaging tools in prostate cancer. Nat Rev Urol 2022; 19:475-493. [PMID: 35789204 DOI: 10.1038/s41585-022-00618-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/09/2022]
Abstract
Radiolabelled prostate-specific membrane antigen (PSMA)-based PET-CT has been shown in numerous studies to be superior to conventional imaging in the detection of nodal or distant metastatic lesions. 68Ga-PSMA PET-CT is now recommended by many guidelines for the detection of biochemically relapsed disease after radical local therapy. PSMA radioligands can also function as radiotheranostics, and Lu-PSMA has been shown to be a potential new line of treatment for metastatic castration-resistant prostate cancer. Whole-body (WB) MRI has been shown to have a high diagnostic performance in the detection and monitoring of metastatic bone disease. Prospective, randomized, multicentre studies comparing 68Ga-PSMA PET-CT and WB MRI for pelvic nodal and metastatic disease detection are yet to be performed. Challenges for interpretation of PSMA include tracer trapping in non-target tissues and also urinary excretion of tracers, which confounds image interpretation at the vesicoureteral junction. Additionally, studies have shown how long-term androgen deprivation therapy (ADT) affects PSMA expression and could, therefore, reduce tracer uptake and visibility of PSMA+ lesions. Furthermore, ADT of short duration might increase PSMA expression, leading to the PSMA flare phenomenon, which makes the accurate monitoring of treatment response to ADT with PSMA PET challenging. Scan duration, detection of incidentalomas and presence of metallic implants are some of the major challenges with WB MRI. Emerging data support the wider adoption of PSMA PET and WB MRI for diagnosis, staging, disease burden evaluation and response monitoring, although their relative roles in the standard-of-care management of patients are yet to be fully defined.
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Affiliation(s)
- Yishen Wang
- School of Clinical Medicine, University of Cambridge, Cambridge, UK. .,Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK.
| | - Joao R Galante
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Athar Haroon
- Department of Nuclear Medicine, Barts Health NHS Trust, London, UK
| | - Simon Wan
- Institute of Nuclear Medicine, University College London, London, UK
| | - Asim Afaq
- Institute of Nuclear Medicine, University College London, London, UK.,Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London, London, UK
| | - Sola Adeleke
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Chen SH, Miles K, Taylor SA, Ganeshan B, Rodriquez M, Fraioli F, Wan S, Afaq A, Shortman R, Walls D, Hoy L, Endozo R, Bhargava A, Hanson M, Huang J, Raouf S, Francis D, Siddiqi S, Arulampalam T, Sizer B, Machesney M, Reay-Jones N, Dindyal S, Ng T, Groves AM. Correction to: FDG-PET/CT in colorectal cancer: potential for vascular-metabolic imaging to provide markers of prognosis. Eur J Nucl Med Mol Imaging 2022; 49:786-787. [PMID: 34894284 PMCID: PMC9172773 DOI: 10.1007/s00259-021-05546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Shih-Hsin Chen
- Institute of Nuclear Medicine, University College London (UCL), London, UK
- Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kenneth Miles
- Institute of Nuclear Medicine, University College London (UCL), London, UK
| | - Stuart A. Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, University College London (UCL), London, UK
| | - Manuel Rodriquez
- Surgery and Cancer Board, Imaging Division, University College London Hospitals (UCLH) NHS Foundation Trust, University College Hospital (UCH), London, UK
- Department of Research Pathology, Cancer Institute, UCL, London, UK
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London (UCL), London, UK
| | - Simon Wan
- Institute of Nuclear Medicine, University College London (UCL), London, UK
| | - Asim Afaq
- Institute of Nuclear Medicine, University College London (UCL), London, UK
- University of Iowa, Carver College of Medicine, Iowa City, USA
| | - Robert Shortman
- Institute of Nuclear Medicine, University College London (UCL), London, UK
| | - Darren Walls
- Institute of Nuclear Medicine, University College London (UCL), London, UK
| | - Luke Hoy
- Institute of Nuclear Medicine, University College London (UCL), London, UK
| | - Raymond Endozo
- Institute of Nuclear Medicine, University College London (UCL), London, UK
| | - Aman Bhargava
- Institute of Health Barts and London Medical School, Queen Mary University of London (QMUL), London, UK
| | - Matthew Hanson
- Division of Cancer and Clinical Support, Barking, Havering and Redbridge University Hospitals NHS Trust, Queens and King George Hospitals, Essex, UK
| | - Joseph Huang
- Division of Cancer and Clinical Support, Barking, Havering and Redbridge University Hospitals NHS Trust, Queens and King George Hospitals, Essex, UK
| | - Sherif Raouf
- Division of Cancer and Clinical Support, Barking, Havering and Redbridge University Hospitals NHS Trust, Queens and King George Hospitals, Essex, UK
- Radiotherapy Department, Barts Cancer Centre, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Daren Francis
- Department of Colorectal Surgery, Barnet and Chase Farm Hospitals, Royal Free London NHS Foundation Trust, London, UK
| | - Shahab Siddiqi
- Department of Lower GI Surgery and Coloproctology, Mid Essex Hospital Services NHS Trust, Broomfield Hospital, Essex, UK
| | - Tan Arulampalam
- Department of Surgery & Department of Clinical Oncology, East Suffolk and North Essex NHS Foundation Trust, Colchester General Hospital, Essex, UK
| | - Bruce Sizer
- Department of Surgery & Department of Clinical Oncology, East Suffolk and North Essex NHS Foundation Trust, Colchester General Hospital, Essex, UK
| | - Michael Machesney
- Barts Health NHS Trust, Cancer Clinical Board, Colorectal Surgery, Whipps Cross Hospital, London, UK
| | - Nicholas Reay-Jones
- East and North Hertfordshire NHS Trust, Colorectal Surgery, Queen Elizabeth II Hospital, Hertfordshire, UK
| | - Sanjay Dindyal
- East and North Hertfordshire NHS Trust, Colorectal Surgery, Lister Hospital, Hertfordshire, UK
| | - Tony Ng
- School of Cancer & Pharmaceutical Sciences, Kings College London (KCL), London, UK
| | - Ashley M. Groves
- Institute of Nuclear Medicine, University College London (UCL), London, UK
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Ball B, Woroszchuk E, Sukumaran A, West H, Afaq A, Carruthers-Lay D, Muselius B, Gee L, Langille M, Pladwig S, Kazi S, Hendriks A, Geddes-McAlister J. Proteome and secretome profiling of zinc availability in Cryptococcus neoformans identifies Wos2 as a subtle influencer of fungal virulence determinants. BMC Microbiol 2021; 21:341. [PMID: 34903172 PMCID: PMC8667453 DOI: 10.1186/s12866-021-02410-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 12/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fungal infections impact over 25% of the global population. For the opportunistic fungal pathogen, Cryptococcus neoformans, infection leads to cryptococcosis. In the presence of the host, disease is enabled by elaboration of sophisticated virulence determinants, including polysaccharide capsule, melanin, thermotolerance, and extracellular enzymes. Conversely, the host protects itself from fungal invasion by regulating and sequestering transition metals (e.g., iron, zinc, copper) important for microbial growth and survival. RESULTS Here, we explore the intricate relationship between zinc availability and fungal virulence via mass spectrometry-based quantitative proteomics. We observe a core proteome along with a distinct zinc-regulated protein-level signature demonstrating a shift away from transport and ion binding under zinc-replete conditions towards transcription and metal acquisition under zinc-limited conditions. In addition, we revealed a novel connection among zinc availability, thermotolerance, as well as capsule and melanin production through the detection of a Wos2 ortholog in the secretome under replete conditions. CONCLUSIONS Overall, we provide new biological insight into cellular remodeling at the protein level of C. neoformans under regulated zinc conditions and uncover a novel connection between zinc homeostasis and fungal virulence determinants.
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Affiliation(s)
- B Ball
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Rd. E, Guelph, Ontario, N1G 2W1, Canada
| | - E Woroszchuk
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Rd. E, Guelph, Ontario, N1G 2W1, Canada
| | - A Sukumaran
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Rd. E, Guelph, Ontario, N1G 2W1, Canada
| | - H West
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Rd. E, Guelph, Ontario, N1G 2W1, Canada
| | - A Afaq
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Rd. E, Guelph, Ontario, N1G 2W1, Canada
| | - D Carruthers-Lay
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Rd. E, Guelph, Ontario, N1G 2W1, Canada
| | - B Muselius
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Rd. E, Guelph, Ontario, N1G 2W1, Canada
| | - L Gee
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Rd. E, Guelph, Ontario, N1G 2W1, Canada
| | - M Langille
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Rd. E, Guelph, Ontario, N1G 2W1, Canada
| | - S Pladwig
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Rd. E, Guelph, Ontario, N1G 2W1, Canada
| | - S Kazi
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Rd. E, Guelph, Ontario, N1G 2W1, Canada
| | - A Hendriks
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Rd. E, Guelph, Ontario, N1G 2W1, Canada
| | - J Geddes-McAlister
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Rd. E, Guelph, Ontario, N1G 2W1, Canada.
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7
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Chen SH, Miles K, Taylor SA, Ganeshan B, Rodriquez M, Fraioli F, Wan S, Afaq A, Shortman R, Walls D, Hoy L, Endozo R, Bhargava A, Hanson M, Huang J, Raouf S, Francis D, Siddiqi S, Arulampalam T, Sizer B, Machesney M, Reay-Jones N, Dindyal S, Ng T, Groves AM. FDG-PET/CT in colorectal cancer: potential for vascular-metabolic imaging to provide markers of prognosis. Eur J Nucl Med Mol Imaging 2021; 49:371-384. [PMID: 33837843 PMCID: PMC8712298 DOI: 10.1007/s00259-021-05318-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/13/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE This study assesses the potential for vascular-metabolic imaging with FluoroDeoxyGlucose (FDG)-Positron Emission Tomography/Computed Tomography (PET/CT) perfusion to provide markers of prognosis specific to the site and stage of colorectal cancer. METHODS This prospective observational study comprised of participants with suspected colorectal cancer categorized as either (a) non-metastatic colon cancer (M0colon), (b) non-metastatic rectal cancer (M0rectum), or (c) metastatic colorectal cancer (M+). Combined FDG-PET/CT perfusion imaging was successfully performed in 286 participants (184 males, 102 females, age: 69.60 ± 10 years) deriving vascular and metabolic imaging parameters. Vascular and metabolic imaging parameters alone and in combination were investigated with respect to overall survival. RESULTS A vascular-metabolic signature that was significantly associated with poorer survival was identified for each patient group: M0colon - high Total Lesion Glycolysis (TLG) with increased Permeability Surface Area Product/Blood Flow (PS/BF), Hazard Ratio (HR) 3.472 (95% CI: 1.441-8.333), p = 0.006; M0rectum - high Metabolic Tumour Volume (MTV) with increased PS/BF, HR 4.567 (95% CI: 1.901-10.970), p = 0.001; M+ participants, high MTV with longer Time To Peak (TTP) enhancement, HR 2.421 (95% CI: 1.162-5.045), p = 0.018. In participants with stage 2 colon cancer as well as those with stage 3 rectal cancer, the vascular-metabolic signature could stratify the prognosis of these participants. CONCLUSION Vascular and metabolic imaging using FDG-PET/CT can be used to synergise prognostic markers. The hazard ratios suggest that the technique may have clinical utility.
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Affiliation(s)
- Shih-hsin Chen
- Division of Medicine, Research Department of Imaging, University College London (UCL), London, UK
- Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kenneth Miles
- Division of Medicine, Research Department of Imaging, University College London (UCL), London, UK
| | - Stuart A. Taylor
- Division of Medicine, Research Department of Imaging, University College London (UCL), London, UK
- Centre for Medical Imaging, University College London, London, UK
| | - Balaji Ganeshan
- Division of Medicine, Research Department of Imaging, University College London (UCL), London, UK
| | - Manuel Rodriquez
- University College London Hospitals (UCLH) NHS Foundation Trust, Surgery and Cancer Board, Imaging Division, University College Hospital (UCH), London, UK
- Department of Research Pathology, Cancer Institute, UCL, London, UK
| | - Francesco Fraioli
- University College London Hospitals (UCLH) NHS Foundation Trust, Surgery and Cancer Board, Imaging Division, University College Hospital (UCH), London, UK
| | - Simon Wan
- University College London Hospitals (UCLH) NHS Foundation Trust, Surgery and Cancer Board, Imaging Division, University College Hospital (UCH), London, UK
| | - Asim Afaq
- University College London Hospitals (UCLH) NHS Foundation Trust, Surgery and Cancer Board, Imaging Division, University College Hospital (UCH), London, UK
- University of Iowa, Carver College of Medicine, Iowa City, USA
| | - Robert Shortman
- Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Darren Walls
- Division of Medicine, Research Department of Imaging, University College London (UCL), London, UK
| | - Luke Hoy
- Division of Medicine, Research Department of Imaging, University College London (UCL), London, UK
| | - Raymond Endozo
- University College London Hospitals (UCLH) NHS Foundation Trust, Surgery and Cancer Board, Imaging Division, University College Hospital (UCH), London, UK
| | - Aman Bhargava
- Institute of Health Barts and London Medical School, Queen Mary University of London (QMUL), London, UK
| | - Matthew Hanson
- Barking, Havering and Redbridge University Hospitals NHS Trust, Division of Cancer and Clinical Support, Queens and King George Hospitals, Essex, UK
| | - Joseph Huang
- Barking, Havering and Redbridge University Hospitals NHS Trust, Division of Cancer and Clinical Support, Queens and King George Hospitals, Essex, UK
| | - Sherif Raouf
- Barking, Havering and Redbridge University Hospitals NHS Trust, Division of Cancer and Clinical Support, Queens and King George Hospitals, Essex, UK
- Radiotherapy Department, Barts Cancer Centre, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Daren Francis
- Royal Free London NHS Foundation Trust, Department of Colorectal Surgery, Barnet and Chase Farm Hospitals, London, UK
| | - Shahab Siddiqi
- Mid Essex Hospital Services NHS Trust, Department of Lower GI Surgery and Coloproctology, Broomfield Hospital, Essex, UK
| | - Tan Arulampalam
- East Suffolk and North Essex NHS Foundation Trust, Department of Surgery & Department of Clinical Oncology, Colchester General Hospital, Essex, UK
| | - Bruce Sizer
- East Suffolk and North Essex NHS Foundation Trust, Department of Surgery & Department of Clinical Oncology, Colchester General Hospital, Essex, UK
| | - Michael Machesney
- Barts Health NHS Trust, Cancer Clinical Board, Colorectal Surgery, Whipps Cross Hospital, London, UK
| | - Nicholas Reay-Jones
- East and North Hertfordshire NHS Trust, Colorectal Surgery, Queen Elizabeth II Hospital, Hertfordshire, UK
| | - Sanjay Dindyal
- East and North Hertfordshire NHS Trust, Colorectal Surgery, Lister Hospital, Hertfordshire, UK
| | - Tony Ng
- School of Cancer & Pharmaceutical Sciences, Kings College London (KCL), London, UK
| | - Ashley M Groves
- Division of Medicine, Research Department of Imaging, University College London (UCL), London, UK
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8
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Ganeshan B, Miles K, Afaq A, Punwani S, Rodriguez M, Wan S, Walls D, Hoy L, Khan S, Endozo R, Shortman R, Hoath J, Bhargava A, Hanson M, Francis D, Arulampalam T, Dindyal S, Chen SH, Ng T, Groves A. Texture Analysis of Fractional Water Content Images Acquired during PET/MRI: Initial Evidence for an Association with Total Lesion Glycolysis, Survival and Gene Mutation Profile in Primary Colorectal Cancer. Cancers (Basel) 2021; 13:2715. [PMID: 34072712 PMCID: PMC8199380 DOI: 10.3390/cancers13112715] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 01/07/2023] Open
Abstract
To assess the capability of fractional water content (FWC) texture analysis (TA) to generate biologically relevant information from routine PET/MRI acquisitions for colorectal cancer (CRC) patients. Thirty consecutive primary CRC patients (mean age 63.9, range 42-83 years) prospectively underwent FDG-PET/MRI. FWC tumor parametric images generated from Dixon MR sequences underwent TA using commercially available research software (TexRAD). Data analysis comprised (1) identification of functional imaging correlates for texture features (TF) with low inter-observer variability (intraclass correlation coefficient: ICC > 0.75), (2) evaluation of prognostic performance for FWC-TF, and (3) correlation of prognostic imaging signatures with gene mutation (GM) profile. Of 32 FWC-TF with ICC > 0.75, 18 correlated with total lesion glycolysis (TLG, highest: rs = -0.547, p = 0.002). Using optimized cut-off values, five MR FWC-TF identified a good prognostic group with zero mortality (lowest: p = 0.017). For the most statistically significant prognostic marker, favorable prognosis was significantly associated with a higher number of GM per patient (medians: 7 vs. 1.5, p = 0.009). FWC-TA derived from routine PET/MRI Dixon acquisitions shows good inter-operator agreement, generates biological relevant information related to TLG, GM count, and provides prognostic information that can unlock new clinical applications for CRC patients.
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Affiliation(s)
- Balaji Ganeshan
- Research Department of Imaging, Division of Medicine, University College London (UCL), London WC1E 6BT, UK; (K.M.); (S.P.); (D.W.); (L.H.); (J.H.); (S.-H.C.); (A.G.)
| | - Kenneth Miles
- Research Department of Imaging, Division of Medicine, University College London (UCL), London WC1E 6BT, UK; (K.M.); (S.P.); (D.W.); (L.H.); (J.H.); (S.-H.C.); (A.G.)
| | - Asim Afaq
- Imaging Division, Surgery and Cancer Board, University College London Hospitals (UCLH) NHS Foundation Trust, University College Hospital (UCH), London NW1 2BU, UK; (A.A.); (M.R.); (S.W.); (S.K.); (R.E.); (R.S.); (S.D.)
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Shonit Punwani
- Research Department of Imaging, Division of Medicine, University College London (UCL), London WC1E 6BT, UK; (K.M.); (S.P.); (D.W.); (L.H.); (J.H.); (S.-H.C.); (A.G.)
| | - Manuel Rodriguez
- Imaging Division, Surgery and Cancer Board, University College London Hospitals (UCLH) NHS Foundation Trust, University College Hospital (UCH), London NW1 2BU, UK; (A.A.); (M.R.); (S.W.); (S.K.); (R.E.); (R.S.); (S.D.)
| | - Simon Wan
- Imaging Division, Surgery and Cancer Board, University College London Hospitals (UCLH) NHS Foundation Trust, University College Hospital (UCH), London NW1 2BU, UK; (A.A.); (M.R.); (S.W.); (S.K.); (R.E.); (R.S.); (S.D.)
| | - Darren Walls
- Research Department of Imaging, Division of Medicine, University College London (UCL), London WC1E 6BT, UK; (K.M.); (S.P.); (D.W.); (L.H.); (J.H.); (S.-H.C.); (A.G.)
| | - Luke Hoy
- Research Department of Imaging, Division of Medicine, University College London (UCL), London WC1E 6BT, UK; (K.M.); (S.P.); (D.W.); (L.H.); (J.H.); (S.-H.C.); (A.G.)
| | - Saif Khan
- Imaging Division, Surgery and Cancer Board, University College London Hospitals (UCLH) NHS Foundation Trust, University College Hospital (UCH), London NW1 2BU, UK; (A.A.); (M.R.); (S.W.); (S.K.); (R.E.); (R.S.); (S.D.)
| | - Raymond Endozo
- Imaging Division, Surgery and Cancer Board, University College London Hospitals (UCLH) NHS Foundation Trust, University College Hospital (UCH), London NW1 2BU, UK; (A.A.); (M.R.); (S.W.); (S.K.); (R.E.); (R.S.); (S.D.)
| | - Robert Shortman
- Imaging Division, Surgery and Cancer Board, University College London Hospitals (UCLH) NHS Foundation Trust, University College Hospital (UCH), London NW1 2BU, UK; (A.A.); (M.R.); (S.W.); (S.K.); (R.E.); (R.S.); (S.D.)
| | - John Hoath
- Research Department of Imaging, Division of Medicine, University College London (UCL), London WC1E 6BT, UK; (K.M.); (S.P.); (D.W.); (L.H.); (J.H.); (S.-H.C.); (A.G.)
| | - Aman Bhargava
- Institute of Health Barts and London Medical School, Queen Mary University of London (QMUL), London E1 2AD, UK;
| | - Matthew Hanson
- Division of Cancer and Clinical Support, Barking, Havering and Redbridge University Hospitals NHS Trust, Queens and King George Hospitals, Essex IG3 8YB, UK;
| | - Daren Francis
- Department of Colorectal Surgery, Royal Free London NHS Foundation Trust, Barnet and Chase Farm Hospitals, London NW3 2QG, UK;
| | - Tan Arulampalam
- Department of Surgery, East Suffolk and North Essex NHS Foundation Trust, Colchester General Hospital, Colchester CO4 5JL, UK;
| | - Sanjay Dindyal
- Imaging Division, Surgery and Cancer Board, University College London Hospitals (UCLH) NHS Foundation Trust, University College Hospital (UCH), London NW1 2BU, UK; (A.A.); (M.R.); (S.W.); (S.K.); (R.E.); (R.S.); (S.D.)
| | - Shih-Hsin Chen
- Research Department of Imaging, Division of Medicine, University College London (UCL), London WC1E 6BT, UK; (K.M.); (S.P.); (D.W.); (L.H.); (J.H.); (S.-H.C.); (A.G.)
- Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Tony Ng
- School of Cancer & Pharmaceutical Sciences, King’s College London (KCL), London WC2R 2LS, UK;
| | - Ashley Groves
- Research Department of Imaging, Division of Medicine, University College London (UCL), London WC1E 6BT, UK; (K.M.); (S.P.); (D.W.); (L.H.); (J.H.); (S.-H.C.); (A.G.)
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9
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Abstract
A decade of PET/MRI clinical imaging has passed and many of the pitfalls are similar to those on earlier studies. However, techniques to overcome them have emerged and continue to develop. Although clinically significant lung nodules are demonstrable, smaller nodules may be detected using ultrashort/zero echo-time (TE) lung MRI. Fast reconstruction ultrashort TE sequences have also been used to achieve high-resolution lung MRI even with free-breathing. The introduction and improvement of time-of-flight scanners and increasing the axial length of the PET detector arrays have more than doubled the sensitivity of the PET part of the system. MRI for attenuation correction has provided many potential pitfalls, including misclassification of tissue classes based on MRI information for attenuation correction. Although the use of short echo times have helped to address these pitfalls, one of the most exciting developments has been the use of deep learning algorithms and computational neural networks to rapidly provide soft tissue, fat, bone and air information for the attenuation correction as a supplement to the attenuation correction information from fat-water imaging. Challenges with motion correction, particularly respiratory and cardiac remain but are being addressed with respiratory monitors and using PET data. In order to address truncation artefacts, the system manufacturers have developed methods to extend the MR field-of-view for the purpose of the attenuation and scatter corrections. General pitfalls like stitching of body sections for individual studies, optimum delivery of images for viewing and reporting, and resource implications for the sheer volume of data generated remain Methods to overcome these pitfalls serve as a strong foundation for the future of PET/MRI. Advances in the underlying technology with significant evolution in hard-ware and software and the exiting developments in use of deep learning algorithms and computational neural networks will drive the next decade of PET/MRI imaging.
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Affiliation(s)
- Asim Afaq
- University of Iowa Carver College of Medicine, Iowa City; Institute of Nuclear Medicine, UCL/ UCLH London, UK
| | | | | | - Simon Wan
- Institute of Nuclear Medicine, UCL/ UCLH London, UK
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Patrick Veit Haibach
- Toronto Joint Dept. Medical Imaging, University Health Network, Sinai Health System, Women's College University of Toronto, Canada
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10
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Afaq A, Payne H, Davda R, Hines J, Cook GJ, Meagher M, Priftakis D, Warbey VS, Kelkar A, Orczyk C, Mitra A, Needleman S, Ferris M, Mullen G, Bomanji J. A Phase II, Open-label study to assess safety and management change using 68Ga-THP PSMA PET/CT in patients with high risk primary prostate cancer or biochemical recurrence after radical treatment: The PRONOUNCED study. J Nucl Med 2021; 62:jnumed.120.257527. [PMID: 33741648 PMCID: PMC8612191 DOI: 10.2967/jnumed.120.257527] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 09/30/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 12/30/2022] Open
Abstract
Objectives: To assess the safety and clinical impact of a novel, kit-based formulation of 68Ga-THP PSMA positron emission tomography/computed tomography (PET/CT) when used to guide the management of patients with prostate cancer (PCa). Methods: Patients were prospectively recruited in to one of: Group A: high-risk untreated prostate cancer; Gleason score >4+3, or PSA >20 ng/mL or clinical stage >T2c. Group B: biochemical recurrence (BCR) and eligible for salvage treatment after radical prostatectomy with two consecutive rises in prostate specific antigen (PSA) with a three month interval in between reads and final PSA >0.1 ng/mL or a PSA level >0.5 ng/mL. Group C: BCR with radical curative radiotherapy or brachytherapy at least three months prior to enrolment, and an increase in PSA level >2.0 ng/mL above the nadir level after radiotherapy or brachytherapy. Patients underwent evaluation with PET/CT 60 minutes following intravenous administration of 160±30 MBq of 68Ga-THP PSMA. Safety was assessed by means including vital signs, cardiovascular profile, serum haematology, biochemistry, urinalysis, PSA, and Adverse Events (AEs). A change in management was reported when the predefined clinical management of the patient altered as a result of 68Ga-THP PSMA PET/CT findings. Results: Forty-nine patients were evaluated with PET/CT; 20 in Group A, 21 in Group B and 8 in Group C. No patients experienced serious AEs discontinued the study due to AEs, or died during the study. Two patients had Treatment Emergent AEs attributed to 68Ga-THP-PSMA (pruritus in one patient and intravenous catheter site rash in another). Management change secondary to PET/CT occurred in 42.9% of all patients; 30% in Group A, 42.9% in Group B and 75% in Group C. Conclusion: 68Ga-THP PSMA was safe to use with no serious AE and no AE resulting in withdrawal from the study. 68Ga-THP PSMA PET/CT changed the management of patients in 42.9% of the study population, comparable to studies using other PSMA tracers. These data form the basis of a planned Phase III study of 68Ga-THP PSMA in patients with prostate cancer.
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Affiliation(s)
- Asim Afaq
- Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Heather Payne
- Radiotherapy Department, University College London Hospitals, London, United Kingdom
| | - Reena Davda
- Radiotherapy Department, University College London Hospitals, London, United Kingdom
| | - John Hines
- Department of Urology, University College London Hospitals, London, United Kingdom
| | - Gary J.R. Cook
- Cancer Imaging Department, King’s College London, London, United Kingdom
| | - Marie Meagher
- Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Dimitrios Priftakis
- Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Victoria S. Warbey
- Cancer Imaging Department, King’s College London, London, United Kingdom
| | - Anand Kelkar
- Department of Urology, University College London Hospitals, London, United Kingdom
- Department of Urology, Barking, Havering, and Redbridge Hospitals, Essex, United Kingdom
| | - Clement Orczyk
- Department of Urology, University College London Hospitals, London, United Kingdom
| | - Anita Mitra
- Radiotherapy Department, University College London Hospitals, London, United Kingdom
| | - Sarah Needleman
- Department of Oncology, Royal Free Hospital, London, United Kingdom; and
| | | | - Greg Mullen
- Theragnostics Ltd., Bracknell, United Kingdom
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
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11
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Scarsbrook AF, Bottomley D, Teoh EJ, Bradley KM, Payne H, Afaq A, Bomanji J, van As N, Chua S, Hoskin P, Chambers A, Cook GJ, Warbey VS, Han S, Leung HY, Chau A, Miller MP, Gleeson FV. Effect of 18F-Fluciclovine Positron Emission Tomography on the Management of Patients With Recurrence of Prostate Cancer: Results From the FALCON Trial. Int J Radiat Oncol Biol Phys 2020; 107:316-324. [PMID: 32068113 DOI: 10.1016/j.ijrobp.2020.01.050] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/17/2019] [Accepted: 01/31/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Early and accurate localization of lesions in patients with biochemical recurrence (BCR) of prostate cancer may guide salvage therapy decisions. The present study, 18F-Fluciclovine PET/CT in biochemicAL reCurrence Of Prostate caNcer (FALCON; NCT02578940), aimed to evaluate the effect of 18F-fluciclovine on management of men with BCR of prostate cancer. METHODS AND MATERIALS Men with a first episode of BCR after curative-intent primary therapy were enrolled at 6 UK sites. Patients underwent 18F-fluciclovine positron emission tomography/computed tomography (PET/CT) according to standardized procedures. Clinicians documented management plans before and after scanning, recording changes to treatment modality as major and changes within a modality as other. The primary outcome measure was record of a revised management plan postscan. Secondary endpoints were evaluation of optimal prostate specific antigen (PSA) threshold for detection, salvage treatment outcome assessment based on 18F-fluciclovine-involvement, and safety. RESULTS 18F-Fluciclovine was well tolerated in the 104 scanned patients (median PSA = 0.79 ng/mL). Lesions were detected in 58 out of 104 (56%) patients. Detection was broadly proportional to PSA level; ≤1 ng/mL, 1 out of 3 of scans were positive, and 93% scans were positive at PSA >2.0 ng/mL. Sixty-six (64%) patients had a postscan management change (80% after a positive result). Major changes (43 out of 66; 65%) were salvage or systemic therapy to watchful waiting (16 out of 66; 24%); salvage therapy to systemic therapy (16 out of 66; 24%); and alternative changes to treatment modality (11 out of 66, 17%). The remaining 23 out of 66 (35%) management changes were modifications of the prescan plan: most (22 out of 66; 33%) were adjustments to planned brachytherapy/radiation therapy to include a 18F-fluciclovine-guided boost. Where 18F-fluciclovine guided salvage therapy, the PSA response rate was higher than when 18F-fluciclovine was not involved (15 out of 17 [88%] vs 28 out of 39 [72%]). CONCLUSIONS 18F-Fluciclovine PET/CT located recurrence in the majority of men with BCR, frequently resulting in major management plan changes. Incorporating 18F-fluciclovine PET/CT into treatment planning may optimize targeting of recurrence sites and avoid futile salvage therapy.
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Affiliation(s)
- Andrew F Scarsbrook
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; University of Leeds, Leeds, United Kingdom.
| | | | | | - Kevin M Bradley
- PETIC, Wales Research and Diagnostic PET Imaging Centre, Cardiff, United Kingdom
| | - Heather Payne
- University College London Hospitals, NHS Foundation Trust, London, United Kingdom
| | - Asim Afaq
- University College London Hospitals, NHS Foundation Trust, London, United Kingdom
| | - Jamshed Bomanji
- University College London Hospitals, NHS Foundation Trust, London, United Kingdom
| | - Nicholas van As
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Sue Chua
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Peter Hoskin
- Mount Vernon Cancer Centre, London, United Kingdom
| | | | - Gary J Cook
- King's College London and Guy's & St Thomas' PET Centre, St Thomas' Hospital, London, United Kingdom
| | - Victoria S Warbey
- King's College London and Guy's & St Thomas' PET Centre, St Thomas' Hospital, London, United Kingdom
| | - Sai Han
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, United Kingdom
| | - Hing Y Leung
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom; CRUK Beatson Institute, Glasgow, United Kingdom
| | - Albert Chau
- Blue Earth Diagnostics, Oxford, United Kingdom
| | | | - Fergus V Gleeson
- Departments of Radiology and Nuclear Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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12
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Kim M, Torrealdea F, Adeleke S, Rega M, Evans V, Beeston T, Soteriou K, Thust S, Kujawa A, Okuchi S, Isaac E, Piga W, Lambert JR, Afaq A, Demetriou E, Choudhary P, Cheung KK, Naik S, Atkinson D, Punwani S, Golay X. Challenges in glucoCEST MR body imaging at 3 Tesla. Quant Imaging Med Surg 2019; 9:1628-1640. [PMID: 31728307 PMCID: PMC6828585 DOI: 10.21037/qims.2019.10.05] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/27/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to translate dynamic glucose enhancement (DGE) body magnetic resonance imaging (MRI) based on the glucose chemical exchange saturation transfer (glucoCEST) signal to a 3 T clinical field strength. METHODS An infusion protocol for intravenous (i.v.) glucose was optimised using a hyperglycaemic clamp to maximise the chances of detecting exchange-sensitive MRI signal. Numerical simulations were performed to define the optimum parameters for glucoCEST measurements with consideration to physiological conditions. DGE images were acquired for patients with lymphomas and prostate cancer injected i.v. with 20% glucose. RESULTS The optimised hyperglycaemic clamp infusion based on the DeFronzo method demonstrated higher efficiency and stability of glucose delivery as compared to manual determination of glucose infusion rates. DGE signal sensitivity was found to be dependent on T2, B1 saturation power and integration range. Our results show that motion correction and B0 field inhomogeneity correction are crucial to avoid mistaking signal changes for a glucose response while field drift is a substantial contributor. However, after B0 field drift correction, no significant glucoCEST signal enhancement was observed in tumour regions of all patients in vivo. CONCLUSIONS Based on our simulated and experimental results, we conclude that glucose-related signal remains elusive at 3 T in body regions, where physiological movements and strong effects of B1 + and B0 render the originally small glucoCEST signal difficult to detect.
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Affiliation(s)
- Mina Kim
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Francisco Torrealdea
- Medical Physics and Biomedical Engineering, University College Hospital, London, UK
| | | | - Marilena Rega
- Institute of Nuclear Medicine, University College Hospital, London, UK
| | | | | | | | - Stefanie Thust
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Aaron Kujawa
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Sachi Okuchi
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | | | - Asim Afaq
- Institute of Nuclear Medicine, University College Hospital, London, UK
| | - Eleni Demetriou
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Pratik Choudhary
- King’s College Hospital NHS Foundation Trust, London, UK
- Department of Diabetes, School of Life Course Sciences, King’s College London, London, UK
| | | | - Sarita Naik
- Department of Diabetes and Endocrinology, University College Hospital, London, UK
| | | | | | - Xavier Golay
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
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13
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Bottomley D, Scarsbrook A, Teoh E, Payne H, Afaq A, Bomanji J, van As N, Chua S, Hoskin P, Chambers A, Cook G, Chau A, Miller M, Gleeson F. Impact of Positron Emission Tomography (PET) with 18F-Fluciclovine on Management of Patients with Recurrence of Prostate Cancer: Results from the Falcon Trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.128] [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: 11/16/2022]
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14
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Afaq A, Gleeson F, Scarsbrook A, Bradley K, Subesinghe M, Macpherson R, Haroon A, Patel N, Chua S, Wong WL, Vinjamuri S, Warbey VS, Cook GJ, Bomanji J. UK guidelines on 18F-fluciclovine PET/CT in prostate cancer imaging. Nucl Med Commun 2019; 40:662-674. [PMID: 31145206 DOI: 10.1097/mnm.0000000000001030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The purpose of these guidelines is to assist specialists in Nuclear Medicine and Radionuclide Radiology in recommending, performing, interpreting and reporting F-fluciclovine PET/computed tomography. It should be recognised that adherence to the guidance in this document will not assure an accurate diagnosis or a successful outcome. These guidelines will assist individual departments in the formulation of their own local protocols. The guidelines apply to studies on adults. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources and the needs of the patient in order to deliver effective and safe medical care.
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Affiliation(s)
- Asim Afaq
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust
| | | | - Andrew Scarsbrook
- Department of Nuclear Medicine, St James's University Hospital, Leeds
| | | | - Manil Subesinghe
- King's College London and Guy's and St Thomas' PET Centre, St Thomas' Hospital
- Department of Cancer Imaging KCL School of Biomedical Engineering and Imaging Sciences, London
| | - Ruth Macpherson
- Radiation Physics and Protection, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Oxford
| | - Athar Haroon
- Department of Nuclear Medicine, Barts Health NHS Trust, St Bartholomew's Hospital
| | | | - Sue Chua
- Department of Nuclear Medicine and PET/CT, The Royal Marsden Hospital NHS Foundation Trust
| | - Wai-Lup Wong
- Paul Strickland Scanner Centre, Mount Vernon Hospital
| | - Sobhan Vinjamuri
- Department of Nuclear Medicine, Royal Liverpool University Hospital, Liverpool, UK
| | - Victoria S Warbey
- King's College London and Guy's and St Thomas' PET Centre, St Thomas' Hospital
- Department of Cancer Imaging KCL School of Biomedical Engineering and Imaging Sciences, London
| | - Gary J Cook
- King's College London and Guy's and St Thomas' PET Centre, St Thomas' Hospital
- Department of Cancer Imaging KCL School of Biomedical Engineering and Imaging Sciences, London
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust
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15
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Hameed M, Ganeshan B, Shur J, Mukherjee S, Afaq A, Batura D. The clinical utility of prostate cancer heterogeneity using texture analysis of multiparametric MRI. Int Urol Nephrol 2019; 51:817-824. [PMID: 30929224 DOI: 10.1007/s11255-019-02134-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 02/16/2019] [Accepted: 03/21/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine if multiparametric MRI (mpMRI) derived filtration-histogram based texture analysis (TA) can differentiate between different Gleason scores (GS) and the D'Amico risk in prostate cancer. METHODS We retrospectively studied patients whose pre-operative 1.5T mpMRI had shown a visible tumour and who subsequently underwent radical prostatectomy (RP). Guided by tumour location from the histopathology report, we drew a region of interest around the dominant visible lesion on a single axial slice on the T2, Apparent Diffusion Coefficient (ADC) map and early arterial phase post-contrast T1 image. We then performed TA with a filtration-histogram software (TexRAD -Feedback Medical Ltd, Cambridge, UK). We correlated GS and D'Amico risk with texture using the Spearman's rank correlation test. RESULTS We had 26 RP patients with an MR-visible tumour. Mean of positive pixels (MPP) on ADC showed a significant negative correlation with GS at coarse texture scales. MPP showed a significant negative correlation with GS without filtration and with medium filtration. MRI contrast texture without filtration showed a significant, negative correlation with D'Amico score. MR T2 texture showed a significant, negative correlation with the D'Amico risk, particularly at textures without filtration, medium texture scales and coarse texture scales. CONCLUSION ADC map mpMRI TA correlated negatively with GS, and T2 and post-contrast images with the D'Amico risk score. These associations may allow for better assessment of disease prognosis and a non-invasive method of follow-up for patients on surveillance. Further, identifying clinically significant prostate cancer is essential to reduce harm from over-diagnosis and over-treatment.
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Affiliation(s)
- Maira Hameed
- Department of Radiology, Imperial College Healthcare NHS Trust, South Wharf Road, London, UK
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK
| | - Joshua Shur
- Joint Department of Medical Imaging, University Health Network, Toronto, Canada
| | - Subhabrata Mukherjee
- Department of Urology, Dartford and Gravesham NHS Trust, Darenth Wood Road, Dartford, UK
| | - Asim Afaq
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK
| | - Deepak Batura
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, London, UK.
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16
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Aker M, Ganeshan B, Afaq A, Wan S, Groves AM, Arulampalam T. Magnetic Resonance Texture Analysis in Identifying Complete Pathological Response to Neoadjuvant Treatment in Locally Advanced Rectal Cancer. Dis Colon Rectum 2019; 62:163-170. [PMID: 30451764 DOI: 10.1097/dcr.0000000000001224] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A certain proportion of patients with locally advanced rectal cancer experience complete response after undergoing neoadjuvant chemoradiotherapy. These patients might be suitable for a conservative "watch and wait" approach, avoiding high-morbidity surgery. Texture analysis is a new modality that can assess heterogeneity in medical images by statistically analyzing gray-level intensities on a pixel-by-pixel basis. This study hypothesizes that texture analysis of magnetic resonance images can identify patients with a complete response. OBJECTIVE This study aims to determine whether texture analysis of magnetic resonance images as a quantitative imaging biomarker can accurately identify patients with complete response. DESIGN This is a retrospective diagnostic accuracy study. SETTINGS This study was conducted at Colchester General Hospital, January 2003 to 2014. PATIENTS All patients diagnosed with locally advanced rectal cancer who underwent long-course chemoradiotherapy had a posttreatment magnetic resonance scan and underwent surgery are included. INTERVENTION Texture analysis was extracted from T2-weighted magnetic resonance images of the rectal cancer. MAIN OUTCOME MEASURES Textural features that are able to identify complete responders were identified by a Mann-Whitney U test. Their diagnostic accuracy in identifying complete responders was determined by the area under the receiver operator characteristics curve. Cutoff values were determined by the Youden index. Pathology was the standard of reference. RESULTS One hundred fourteen patients with first posttreatment MRI scans (6.2 weeks after completion of neoadjuvant treatment) were included. Sixty-eight patients had a second posttreatment scan (10.4 weeks). With no filtration, mean (p = 0.033), SD (p = 0.048), entropy (p = 0.007), and skewness (p = 0.000) from first posttreatment scans, and SD (p = 0.042), entropy (p = 0.014), mean of positive pixels (p = 0.032), and skewness (p = 0.000) from second posttreatment scans were all able to identify complete response. Area under the curve ranged from 0.750 to 0.88. LIMITATIONS Texture analysis of MRI is a new modality; therefore, further studies are necessary to standardize the methodology of extraction of texture features, timing of scans, and acquisition parameters. CONCLUSIONS Texture analysis of MRI is a potentially significant imaging biomarker that can accurately identify patients who have experienced complete response and might be suitable for a nonsurgical approach. (Cinicaltrials.gov:NCT02439086). See Video Abstract at http://links.lww.com/DCR/A760.
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Affiliation(s)
- Medhat Aker
- Department of General Surgery, Colchester General Hospital, Colchester, United Kingdom
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Asim Afaq
- Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Simon Wan
- Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Tan Arulampalam
- Department of General Surgery, Colchester General Hospital, Colchester, United Kingdom
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17
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Afaq A, Bomanji J. Prostate-specific membrane antigen positron emission tomography in the management of recurrent prostate cancer. Br Med Bull 2018; 128:37-48. [PMID: 30272121 DOI: 10.1093/bmb/ldy032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/30/2018] [Indexed: 11/12/2022]
Abstract
INTRODUCTION There is an unmet clinical need for early, accurate imaging of recurrent prostate cancer to improve patient outcomes. Staging, by conventional bone scintigraphy and CT have become outdated. 68Ga-PSMA PET/CT imaging in this setting has developed rapidly, with widespread International adoption in line with evidence-based guidelines in this group of patients. SOURCES OF DATA A PubMed search of English language articles was performed using following keywords: PSMA, PET/CT, biochemical recurrence, prostate cancer. The search revealed 85 articles, of which 75 were original; 70 of these involved use of the most widely available type of PSMA tracer (HBED). The review also relied on the clinical experience of reporting over 1000 PSMA PET/CT studies at a major tertiary referral centre for uro-oncology, with the majority of cases having been performed in the biochemical recurrence setting from 2015 to 2018. AREAS OF AGREEMENT 68Ga-PSMA PET is a game changer and superior to choline PET and other established tracers which have been used in prostate cancer evaluation. Detection of recurrence at the prostate bed remains challenging due to bladder and urethral tracer accumulation. The main strength of PSMA PET/CT is its ability to identify small (<8 mm) pathological lymph nodes, upstaging nodal status in up to two-thirds of cases. Additionally, PSMA PET/CT, detects bone and bone marrow metastases missed by conventional bone and CT imaging. Thus, PSMA PET/CT has major impact on patient management, with studies reporting overall changes in 39-76% of cases. AREAS OF CONTROVERSY Controversy exists regarding patient access and NHS affordability of PSMA PET/CT imaging. Currently, no reimbursement is available under the NHS tariff system. The cost outlay for tertiary hospital linked PET centres ranges from £150-170 K. Large referral volumes, and technical advances in manufacturing process will make this tracer cost neutral and similar to the current funded, but less sensitive, choline PET. Current NICE guidelines for prostate cancer management do not include a recommendation on when PSMA PET/CT should be used and this is likely to remain the case in the next revision, due in 2019. GROWING POINTS Although PSMA PET/CT imaging results in significant management change, there is a need for high quality economic evaluation and cost analysis for this modality. Lack of this data will result in poor adoption of this technique and thus limit patient access. Furthermore, it is hoped that future tracers will become even more sensitive and identify disease at earlier thresholds. AREAS TIMELY FOR DEVELOPING RESEARCH Well-designed clinical trials with consideration of the health economic benefit of using PSMA PET/CT will be essential to provide a basis for entry into guidelines such as NICE and to provide a rationale for reimbursement.
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Affiliation(s)
- Asim Afaq
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
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Rega M, Torrealdea F, Hearle J, Zaiss M, Cavalho A, Afaq A, Punwani S, Golay X, Dickson J, Shankar A, Hyare H. RADI-06. CORRELATION BETWEEN APT-CEST AND 18F-CHOLINE PET IN GLIOMA AT 3T. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | - Asim Afaq
- Institute of Nuclear Medicine, London, UK
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19
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Teoh EJ, Bottomley DM, Scarsbrook A, Payne H, Afaq A, Bomanji J, Van As N, Chua S, Hoskin P, Chambers A, Cook GJ, Warbey VS, Chau A, Ward P, Miller MP, Stevens DJ, Wilson L, Gleeson FV. The FALCON trial: Impact of 18F-fluciclovine PET/CT on clinical management choices for men with biochemically recurrent prostate cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
165 Background: Detection of the extent of local recurrence and of metastases in biochemical recurrence (BCR) of prostate cancer facilitates selection of appropriate treatment. The FALCON trial (NCT02578940) assessed the impact of 18F-fluciclovine PET/CT on the clinical management of men with BCR of prostate cancer following initial radical therapy. Methods: Men being considered for curative-intent salvage therapy following first BCR were recruited at 6 UK sites. Management plans were documented prior to and following 18F-fluciclovine PET/CT imaging. Post-scan changes to treatment modality such as salvage radiotherapy [RT] to systemic therapy were classed as ‘major’, while changes within a modality (e.g. modified RT fields) were classed as ‘other’. A pre-planned interim analysis of the first 85 patients was conducted; recruitment was to be stopped for efficacy if the number of treatment changes was > 45 (52.9%; 97.5% CI: 40.3–62.3%), or for futility if ≤ 8 (9.4%, 97.5% CI: 3.6–18.9%). Results: The 85 enrolled patients were a mean 4.8 y post-initial diagnosis, with a median age of 67 y and median PSA of 0.63ng/mL. Twelve (14.1%) had a Gleason score ≤ 6, 60 (70.6%) had a score of 7 and 13 (15.3%) had a score ≥ 8. Most (56; 65.9%) had previously undergone radical prostatectomy (RP), with 27 having received RT (± other therapy). The majority of those imaged (52; 61.2%) had a change in management (CIM) post-scan (Table). Recruitment was subsequently stopped as the pre-specified condition defining overwhelming efficacy was met. Conclusions: This prospective trial shows 18F-fluciclovine PET/CT has substantial impact on clinical decisions for men with a first BCR of prostate cancer after curative-intent primary therapy. Clinical trial information: NCT02578940. [Table: see text]
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Affiliation(s)
- Eugene Jueren Teoh
- Oxford University Hospitals/ NHS Foundation Trust, Oxford, United Kingdom
| | | | | | | | - Asim Afaq
- University College London, London, United Kingdom
| | | | - Nick Van As
- Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Sue Chua
- Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Peter Hoskin
- Mount Vernon Cancer Centre, London, United Kingdom
| | | | | | | | - Albert Chau
- Blue Earth Diagnostics, Oxford, United Kingdom
| | | | | | | | - Lynn Wilson
- Blue Earth Diagnostics, Oxford, United Kingdom
| | - Fergus V. Gleeson
- Oxford University Hospitals/ NHS Foundation Trust, Oxford, United Kingdom
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Binzel K, Adelaja A, Wright CL, Scharre D, Zhang J, Knopp MV, Teoh EJ, Bottomley D, Scarsbrook A, Payne H, Afaq A, Bomanji J, van As N, Chua S, Hoskin P, Chambers A, Cook GJ, Warbey VS, Chau A, Ward P, Miller MP, Stevens DJ, Wilson L, Gleeson FV, Scheidhauer K, Seidl C, Autenrieth M, Bruchertseifer F, Apostolidis C, Kurtz F, Horn T, Pfob C, Schwaiger M, Gschwend J, D'Alessandria C, Morgenstern A, Uprimny C, Kroiss A, Decristoforo C, von Guggenberg E, Nilica B, Horninger W, Virgolini I, Rasul S, Poetsch N, Woehrer A, Preusser M, Mitterhauser M, Wadsak W, Widhalm G, Mischkulnig M, Hacker M, Traub-Weidinger T, Wright CL, Binzel K, Wuthrick EJ, Miller ED, Maniawski P, Zhang J, Knopp MV, Rep S, Hocevar M, Vaupotic J, Zdesar U, Zaletel K, Lezaic L, Mairinger S, Filip T, Sauberer M, Flunkert S, Wanek T, Stanek J, Okamura N, Langer O, Kuntner C, Fornito MC, Balzano R, Di Martino V, Cacciaguerra S, Russo G, Seifert D, Kleinova M, Cepa A, Ralis J, Hanc P, Lebeda O, Mosa M, Vandenberghe S, Mikhaylova E, Borys D, Viswanath V, Stockhoff M, Efthimiou N, Caribe P, Van Holen R, Karp JS, Binzel K, Zhang J, Wright CL, Maniawski P, Knopp MV, Haller PM, Farhan C, Piackova E, Jäger B, Knoll P, Kiss A, Podesser BK, Wojta J, Huber K, Mirzaei S, Traxl A, Komposch K, Glitzner E, Wanek T, Mairinger S, Sibilia M, Langer O, Fornito MC, Russello M, Russo G, Balzano R, Sorko S, Gallowitsch HJ, Kohlfuerst S, Matschnig S, Rieser M, Sorschag M, Lind P, Ležaič L, Rep S, Žibert J, Frelih N, Šuštar S, Binzel K, Adelaja A, Wright CL, Scharre D, Zhang J, Knopp MV, Baum RP, Langbein T, Singh A, Shahinfar M, Schuchardt C, Volk GF, Kulkarni HR, Fornito MC, Cacciaguerra S, Balzano R, Di Martino GV, Russo G, Thomson WH, Kudlacek M, Karik M, Farhan C, Rieger H, Pokieser W, Glaser K, Mirzaei S, Petz V, Tugendsam C, Buchinger W, Schmoll-Hauer B, Schenk IP, Rudolph K, Krebs M, Zettinig G, Zoufal V, Wanek T, Krohn M, Mairinger S, Stanek J, Sauberer M, Filip T, Pahnke J, Langer O, Weitzer F, Pernthaler B, Salamon S, Aigner R, Koranda P, Henzlová L, Kamínek M, Váchalová M, Bachleda P, Summer D, Garousi J, Oroujeni M, Mitran B, Andersson KG, Vorobyeva A, Löfblom JN, Orlova A, Tolmachev V, Decristoforo C, Kaeopookum P, Summer D, Orasch T, Lechner B, Petrik M, Novy Z, Rangger C, Haas H, Decristoforo C. Abstracts of the 33rd International Austrian Winter Symposium : Zell am See, Austria. 24-27 January 2018. EJNMMI Res 2018; 8:5. [PMID: 29362999 PMCID: PMC5780335 DOI: 10.1186/s13550-017-0354-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- K Binzel
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - A Adelaja
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - C L Wright
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - D Scharre
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - J Zhang
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M V Knopp
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - E J Teoh
- Departments of Radiology and Nuclear Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D Bottomley
- The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Scarsbrook
- The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Payne
- University College London, London, UK
| | - A Afaq
- University College London, London, UK
| | - J Bomanji
- University College London, London, UK
| | - N van As
- The Royal Marsden NHS Foundation Trust, London, UK
| | - S Chua
- The Royal Marsden NHS Foundation Trust, London, UK
| | - P Hoskin
- Mount Vernon Cancer Centre, London, UK
| | | | - G J Cook
- King's College London, London, UK
| | | | - A Chau
- Blue Earth Diagnostics, Oxford, UK
| | - P Ward
- Blue Earth Diagnostics, Oxford, UK
| | | | | | - L Wilson
- Blue Earth Diagnostics, Oxford, UK
| | - F V Gleeson
- Departments of Radiology and Nuclear Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K Scheidhauer
- TU München, Klinikum rechts der Isar, Nuklearmedizin, München, Germany
| | - C Seidl
- TU München, Klinikum rechts der Isar, Nuklearmedizin, München, Germany
| | - M Autenrieth
- TU München, Klinikum rechts der Isar, Urologie, München, Germany
| | | | | | - F Kurtz
- TU München, Klinikum rechts der Isar, Urologie, München, Germany
| | - T Horn
- TU München, Klinikum rechts der Isar, Urologie, München, Germany
| | - C Pfob
- TU München, Klinikum rechts der Isar, Nuklearmedizin, München, Germany
| | - M Schwaiger
- TU München, Klinikum rechts der Isar, Nuklearmedizin, München, Germany
| | - J Gschwend
- TU München, Klinikum rechts der Isar, Urologie, München, Germany
| | - C D'Alessandria
- TU München, Klinikum rechts der Isar, Nuklearmedizin, München, Germany
| | | | - C Uprimny
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - A Kroiss
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - C Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - E von Guggenberg
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - B Nilica
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - W Horninger
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - I Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - S Rasul
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - N Poetsch
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - A Woehrer
- Clinical Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Clinical University of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - M Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
- CBmed GmbH, Center for Biomarker Research in Medicine, Graz, Austria
| | - G Widhalm
- Clinical University of Neuro-surgery, Medical University of Vienna, Vienna, Austria
| | - M Mischkulnig
- Clinical University of Neuro-surgery, Medical University of Vienna, Vienna, Austria
| | - M Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - T Traub-Weidinger
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - C L Wright
- Wright Center of Innovation, The Ohio State University, Columbus, OH, USA
| | - K Binzel
- Wright Center of Innovation, The Ohio State University, Columbus, OH, USA
| | - E J Wuthrick
- Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - E D Miller
- Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - P Maniawski
- Clinical Science, Philips Healthcare, Cleveland, OH, USA
| | - J Zhang
- Wright Center of Innovation, The Ohio State University, Columbus, OH, USA
| | - M V Knopp
- Wright Center of Innovation, The Ohio State University, Columbus, OH, USA
| | - Sebastijan Rep
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marko Hocevar
- Department of Oncological Surgery, Oncology Institute Ljubljana, Ljubljana, Slovenia
| | | | - Urban Zdesar
- Institute of Occupational Safety Ljubljana, Ljubljana, Slovenia
| | - Katja Zaletel
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Luka Lezaic
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - S Mairinger
- Biomedical Systems, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Thomas Filip
- Biomedical Systems, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M Sauberer
- Biomedical Systems, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - S Flunkert
- Neuropharmacology, QPS Austria GmbH, Grambach, Austria
| | - T Wanek
- Biomedical Systems, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - J Stanek
- Biomedical Systems, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - N Okamura
- Division of Pharmacology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - O Langer
- Biomedical Systems, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - C Kuntner
- Biomedical Systems, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M C Fornito
- Nuclear Medicine Department PET/TC center Arnas Garibaldi Catania, Catania, Italy
| | - R Balzano
- Nuclear Medicine Department PET/TC center Arnas Garibaldi Catania, Catania, Italy
| | - V Di Martino
- Nuclear Medicine Department PET/TC center Arnas Garibaldi Catania, Catania, Italy
| | - S Cacciaguerra
- Pediatric Surgery Department Arnas Garibaldi Catania, Catania, Italy
| | - G Russo
- H. Pharmacy Department Arnas Garibaldi Catania, Catania, Italy
| | - D Seifert
- Nuclear Physics Institute of the CAS, Rez, Czech Republic
| | - M Kleinova
- Nuclear Physics Institute of the CAS, Rez, Czech Republic
| | - A Cepa
- Nuclear Physics Institute of the CAS, Rez, Czech Republic
| | - J Ralis
- Nuclear Physics Institute of the CAS, Rez, Czech Republic
| | - P Hanc
- Nuclear Physics Institute of the CAS, Rez, Czech Republic
| | - O Lebeda
- Nuclear Physics Institute of the CAS, Rez, Czech Republic
| | - M Mosa
- Charles university Faculty of Science Prague, Prague, Czech Republic
| | - S Vandenberghe
- MEDISIP research group, Ghent University, Ghent, Belgium
| | | | - D Borys
- Silesian University of Technology Gliwice, Gliwice, Poland
| | - V Viswanath
- PET instrumentation group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M Stockhoff
- MEDISIP research group, Ghent University, Ghent, Belgium
| | - N Efthimiou
- MEDISIP research group, Ghent University, Ghent, Belgium
| | - P Caribe
- MEDISIP research group, Ghent University, Ghent, Belgium
| | - R Van Holen
- MEDISIP research group, Ghent University, Ghent, Belgium
| | - J S Karp
- PET instrumentation group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - K Binzel
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - J Zhang
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - C L Wright
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - M V Knopp
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - P M Haller
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Chest Pain Unit, Wilhelminenhospital Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - C Farhan
- Department of Nuclear Medicine with PET-Center, Wilhelminenhospital, Vienna, Austria
| | - E Piackova
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Chest Pain Unit, Wilhelminenhospital Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - B Jäger
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Chest Pain Unit, Wilhelminenhospital Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - P Knoll
- Department of Nuclear Medicine with PET-Center, Wilhelminenhospital, Vienna, Austria
| | - A Kiss
- Department of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - B K Podesser
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
- Department of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - J Wojta
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - K Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Chest Pain Unit, Wilhelminenhospital Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
- Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - S Mirzaei
- Department of Nuclear Medicine with PET-Center, Wilhelminenhospital, Vienna, Austria
| | - A Traxl
- Center for Health & Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - K Komposch
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Glitzner
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - T Wanek
- Center for Health & Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - S Mairinger
- Center for Health & Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M Sibilia
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - O Langer
- Center for Health & Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - M C Fornito
- Nuclear Medicine Department PET/TC Center ARNAS Garibaldi, Catania, Italy
| | - M Russello
- Liver Unit ARNAS Garibaldi, Catania, Italy
| | - G Russo
- H.Pharmacy Department ARNAS Garibaldi, Catania, Italy
| | - R Balzano
- Nuclear Medicine Department PET/TC Center ARNAS Garibaldi, Catania, Italy
| | - S Sorko
- Department of Nuclear Medicine and Endocrinology, PET/CT Center, Klinikum Klagenfurt, Klagenfurt, Austria
| | - H J Gallowitsch
- Department of Nuclear Medicine and Endocrinology, PET/CT Center, Klinikum Klagenfurt, Klagenfurt, Austria
| | - S Kohlfuerst
- Department of Nuclear Medicine and Endocrinology, PET/CT Center, Klinikum Klagenfurt, Klagenfurt, Austria
| | - S Matschnig
- Department of Nuclear Medicine and Endocrinology, PET/CT Center, Klinikum Klagenfurt, Klagenfurt, Austria
| | - M Rieser
- Department of Nuclear Medicine and Endocrinology, PET/CT Center, Klinikum Klagenfurt, Klagenfurt, Austria
| | - M Sorschag
- Department of Nuclear Medicine and Endocrinology, PET/CT Center, Klinikum Klagenfurt, Klagenfurt, Austria
| | - P Lind
- Department of Nuclear Medicine and Endocrinology, PET/CT Center, Klinikum Klagenfurt, Klagenfurt, Austria
| | - L Ležaič
- Departments of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - S Rep
- Departments of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - J Žibert
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - N Frelih
- Departments of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - S Šuštar
- Departments of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - K Binzel
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - A Adelaja
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - C L Wright
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - D Scharre
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - J Zhang
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M V Knopp
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - R P Baum
- Theranostics Center for Molecular Radiotherapy and Molecular ImagZentralklinik Bad Berka, Bad Berka, Germany
| | - T Langbein
- Theranostics Center for Molecular Radiotherapy and Molecular ImagZentralklinik Bad Berka, Bad Berka, Germany
| | - A Singh
- Theranostics Center for Molecular Radiotherapy and Molecular ImagZentralklinik Bad Berka, Bad Berka, Germany
| | - M Shahinfar
- Theranostics Center for Molecular Radiotherapy and Molecular ImagZentralklinik Bad Berka, Bad Berka, Germany
| | - C Schuchardt
- Theranostics Center for Molecular Radiotherapy and Molecular ImagZentralklinik Bad Berka, Bad Berka, Germany
| | - G F Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - H R Kulkarni
- Theranostics Center for Molecular Radiotherapy and Molecular ImagZentralklinik Bad Berka, Bad Berka, Germany
| | - M C Fornito
- Nuclear Medicine Department Arnas Garibaldi, Catania, Italy
| | | | - R Balzano
- Nuclear Medicine Department Arnas Garibaldi, Catania, Italy
| | - G V Di Martino
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - G Russo
- Pharmacy H. Department Arnas Garibaldi, Catania, Italy
| | - W H Thomson
- Physics and Nuclear Medicine, City Hospital, Birmingham, UK
| | - M Kudlacek
- Institute of Nuclear Medicine with PET-Center, Wilhelminenspital, Vienna, Austria
| | - M Karik
- Department of Viceral and General Surgery, Wilhelminenspital, Vienna, Austria
| | - C Farhan
- Institute of Nuclear Medicine with PET-Center, Wilhelminenspital, Vienna, Austria
| | - H Rieger
- Institute of Pathology and Microbiology, Wilhelminenspital, Vienna, Austria
| | - W Pokieser
- Institute of Pathology and Microbiology, Wilhelminenspital, Vienna, Austria
| | - K Glaser
- Department of Viceral and General Surgery, Wilhelminenspital, Vienna, Austria
| | - S Mirzaei
- Institute of Nuclear Medicine with PET-Center, Wilhelminenspital, Vienna, Austria
| | - V Petz
- Schilddruesenpraxis Josefstadt, Vienna, Austria
| | - C Tugendsam
- Schilddruesenpraxis Josefstadt, Vienna, Austria
| | - W Buchinger
- Schilddrueseninstitut Gleisdorf, Gleisdorf, Austria
| | - B Schmoll-Hauer
- Schilddruesenpraxis Josefstadt, Vienna, Austria
- Department of Nuclear Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - I P Schenk
- Schilddruesenpraxis Josefstadt, Vienna, Austria
- Department of Nuclear Medicine, Sozialmedizinisches Zentrum Hietzing, Vienna, Austria
| | - K Rudolph
- Schilddruesenpraxis Josefstadt, Vienna, Austria
| | - M Krebs
- Schilddruesenpraxis Josefstadt, Vienna, Austria
- Clinical Division of Endocrinology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - G Zettinig
- Schilddruesenpraxis Josefstadt, Vienna, Austria
| | - V Zoufal
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - T Wanek
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M Krohn
- Department of Neuro-/Pathology, University of Oslo (UiO) and Oslo University Hospital (OUS), Oslo, Norway
| | - S Mairinger
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - J Stanek
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - M Sauberer
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - T Filip
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - J Pahnke
- Department of Neuro-/Pathology, University of Oslo (UiO) and Oslo University Hospital (OUS), Oslo, Norway
| | - O Langer
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - F Weitzer
- Meduni Graz, Univ. Klinik für Radiologie, Abteilung für Nuklearmedizin, Graz, Austria
| | - B Pernthaler
- Meduni Graz, Univ. Klinik für Radiologie, Abteilung für Nuklearmedizin, Graz, Austria
| | - S Salamon
- Meduni Graz, Univ. Klinik für Radiologie, Abteilung für Nuklearmedizin, Graz, Austria
| | - R Aigner
- Meduni Graz, Univ. Klinik für Radiologie, Abteilung für Nuklearmedizin, Graz, Austria
| | - P Koranda
- Department of Nuclear Medicine, University Hospital Olomouc and Palacky University, Olomouc, Czech Republic
| | - L Henzlová
- Department of Nuclear Medicine, University Hospital Olomouc and Palacky University, Olomouc, Czech Republic
| | - M Kamínek
- Department of Nuclear Medicine, University Hospital Olomouc and Palacky University, Olomouc, Czech Republic
| | - Mo Váchalová
- Department of Vascular and Transplantation Surgery, University Hospital Olomouc and Palacky University, Olomouc, Czech Republic
| | - P Bachleda
- Department of Vascular and Transplantation Surgery, University Hospital Olomouc and Palacky University, Olomouc, Czech Republic
| | - D Summer
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - J Garousi
- Institute of Immunology, Genetic and Pathology, Uppsala University, SE-75185, Uppsala, Sweden
| | - M Oroujeni
- Institute of Immunology, Genetic and Pathology, Uppsala University, SE-75185, Uppsala, Sweden
| | - B Mitran
- Division of Molecular Imaging, Department of Medicinal Chemistry, Uppsala University, SE-751 83, Uppsala, Sweden
| | - K G Andersson
- Division of Protein Technology, KTH Royal Institute of Technology, SE-10691, Stockholm, Sweden
| | - A Vorobyeva
- Institute of Immunology, Genetic and Pathology, Uppsala University, SE-75185, Uppsala, Sweden
| | - J N Löfblom
- Division of Protein Technology, KTH Royal Institute of Technology, SE-10691, Stockholm, Sweden
| | - A Orlova
- Division of Molecular Imaging, Department of Medicinal Chemistry, Uppsala University, SE-751 83, Uppsala, Sweden
| | - V Tolmachev
- Institute of Immunology, Genetic and Pathology, Uppsala University, SE-75185, Uppsala, Sweden
| | - C Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - P Kaeopookum
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
- Research and Development Division, Thailand Institute of Nuclear Technology, Nakhonnayok, Thailand
| | - D Summer
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - T Orasch
- Division of Molecular Biology, Biocenter, Medical University Innsbruck, Innsbruck, Austria
| | - B Lechner
- Division of Molecular Biology, Biocenter, Medical University Innsbruck, Innsbruck, Austria
| | - M Petrik
- Faculty of Medicine and Dentistry, Institute of Molecular and Translation Medicine, Palacky University, Olomouc, Czech Republic
| | - Z Novy
- Faculty of Medicine and Dentistry, Institute of Molecular and Translation Medicine, Palacky University, Olomouc, Czech Republic
| | - C Rangger
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - H Haas
- Division of Molecular Biology, Biocenter, Medical University Innsbruck, Innsbruck, Austria
| | - C Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
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Afaq A, Alahmed S, Chen SH, Lengana T, Haroon A, Payne H, Ahmed H, Punwani S, Sathekge M, Bomanji J. Impact of 68Ga-Prostate-Specific Membrane Antigen PET/CT on Prostate Cancer Management. J Nucl Med 2018; 59:89-92. [PMID: 28747520 DOI: 10.2967/jnumed.117.192625] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/26/2017] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to assess the impact of 68Ga-prostate-specific membrane antigen (68Ga-PSMA) PET/CT on the management of prostate cancer in patients with biochemical recurrence (BCR). Methods: Documented management plans before and after 68Ga-PSMA PET/CT in 100 patients with BCR were retrospectively reviewed, and changes in plans were recorded. Results: Management changed after 68Ga-PSMA PET/CT in 39 patients (39%). The management changes occurred in 23 (33.8%) of 68 patients with radical prostatectomy and 16 (50%) of 32 patients previously treated with radical radiotherapy. Positive scan results (P < 0.001) and higher prostate-specific antigen (PSA) levels (P = 0.024) were associated with management changes. No significant association with management change was found for Gleason grade, stage, presence of metastatic disease, PSA velocity, or PSA doubling time. Conclusion:68Ga-PSMA PET/CT altered management in 39% of patients with BCR, and changes occurred more often in patients with radical radiotherapy treatment, positive 68Ga-PSMA scan results, and higher PSA levels.
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Affiliation(s)
- Asim Afaq
- Institute of Nuclear Medicine, University College London Hospital, London, United Kingdom
| | - Suliman Alahmed
- Department of Radiology and Medical Imaging, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Shih-Hsin Chen
- Institute of Nuclear Medicine, University College London Hospital, London, United Kingdom
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Thabo Lengana
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Athar Haroon
- Department of Nuclear Medicine, St. Bartholemew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Heather Payne
- Department of Oncology, University College London Hospital, London, United Kingdom
| | - Hashim Ahmed
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, United Kingdom; and
- Department of Radiology, University College London Hospital, London, United Kingdom
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospital, London, United Kingdom
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Cuadrado M, Afaq A, Kayani I, Cwynarski K, Lambert J, Townsend W, McNamara C. Utility of baseline assessment with FDG-PET-CT compared with CT Scanning in people with diffuse large B-cell lymphoma (DLBCL). Hematol Oncol 2017. [DOI: 10.1002/hon.2439_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M. Cuadrado
- Haematology; University College London Hospital; London UK
| | - A. Afaq
- Nuclear Medicine; University College London Hospital; London UK
| | - I. Kayani
- Nuclear Medicine; University College London Hospital; London UK
| | - K. Cwynarski
- Haematology; University College London Hospital; London UK
| | - J. Lambert
- Haematology; University College London Hospital; London UK
| | - W. Townsend
- Haematology; University College London Hospital; London UK
| | - C. McNamara
- Haematology; University College London Hospital; London UK
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Jalil O, Afaq A, Ganeshan B, Patel UB, Boone D, Endozo R, Groves A, Sizer B, Arulampalam T. Magnetic resonance based texture parameters as potential imaging biomarkers for predicting long-term survival in locally advanced rectal cancer treated by chemoradiotherapy. Colorectal Dis 2017; 19:349-362. [PMID: 27538267 DOI: 10.1111/codi.13496] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 02/22/2016] [Accepted: 06/08/2016] [Indexed: 12/12/2022]
Abstract
AIM The study aimed to investigate whether textural features of rectal cancer on MRI can predict long-term survival in patients treated with long-course chemoradiotherapy. METHOD Textural analysis (TA) using a filtration-histogram technique of T2-weighted pre- and 6-week post-chemoradiotherapy MRI was undertaken using TexRAD, a proprietary software algorithm. Regions of interest enclosing the largest cross-sectional area of the tumour were manually delineated on the axial images and the filtration step extracted features at different anatomical scales (fine, medium and coarse) followed by quantification of statistical features [mean intensity, standard deviation, entropy, skewness, kurtosis and mean of positive pixels (MPP)] using histogram analysis. Cox multiple regression analysis determined which univariate features including textural, radiological and histological independently predicted overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS). RESULTS MPP [fine texture, hazard ratio (HR) 6.9, 95% CI: 2.43-19.55, P < 0.001], mean (medium texture, HR 5.6, 95% CI: 1.4-21.7, P = 0.007) and extramural venous invasion (EMVI) on MRI (HR 2.96, 95% CI: 1.04-8.37, P = 0.041) independently predicted OS while mean (medium texture, HR 4.53, 95% CI: 1.58-12.94, P = 0.003), MPP (fine texture, HR 3.36, 95% CI: 1.36-8.31, P = 0.008) and threatened circumferential resection margin (CRM) on MRI (HR 3.1, 95% CI: 1.01-9.46, P = 0.046) predicted DFS. For OS, EMVI on MRI (HR 4.23, 95% CI: 1.41-12.69, P = 0.01) and for DFS kurtosis (medium texture, HR 3.97, 95% CI: 1.44-10.94, P = 0.007) and CRM involvement on MRI (HR 3.36, 95% CI: 1.21-9.32, P = 0.02) were the independent post-treatment factors. Only TA independently predicted RFS on pre- or post-treatment analyses. CONCLUSION MR based TA of rectal cancers can predict outcome before undergoing surgery and could potentially select patients for individualized therapy.
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Affiliation(s)
- O Jalil
- Colchester University Hospital, Colchester, UK
| | - A Afaq
- Institute of Nuclear Medicine, University College London, London, UK
| | - B Ganeshan
- Institute of Nuclear Medicine, University College London, London, UK
| | - U B Patel
- London North-West NHS Trust, London, UK
| | - D Boone
- Colchester University Hospital, Colchester, UK
| | - R Endozo
- Institute of Nuclear Medicine, University College London, London, UK
| | - A Groves
- Institute of Nuclear Medicine, University College London, London, UK
| | - B Sizer
- Colchester University Hospital, Colchester, UK
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Ganeshan B, Miles KA, Babikir S, Shortman R, Afaq A, Ardeshna KM, Groves AM, Kayani I. CT-based texture analysis potentially provides prognostic information complementary to interim fdg-pet for patients with hodgkin's and aggressive non-hodgkin's lymphomas. Eur Radiol 2017; 27:1012-1020. [PMID: 27380902 PMCID: PMC5306313 DOI: 10.1007/s00330-016-4470-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/03/2016] [Accepted: 06/07/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the ability of computed tomography texture analysis (CTTA) to provide additional prognostic information in patients with Hodgkin's lymphoma (HL) and high-grade non-Hodgkin's lymphoma (NHL). METHODS This retrospective, pilot-study approved by the IRB comprised 45 lymphoma patients undergoing routine 18F-FDG-PET-CT. Progression-free survival (PFS) was determined from clinical follow-up (mean-duration: 40 months; range: 10-62 months). Non-contrast-enhanced low-dose CT images were submitted to CTTA comprising image filtration to highlight features of different sizes followed by histogram-analysis using kurtosis. Prognostic value of CTTA was compared to PET FDG-uptake value, tumour-stage, tumour-bulk, lymphoma-type, treatment-regime, and interim FDG-PET (iPET) status using Kaplan-Meier analysis. Cox regression analysis determined the independence of significantly prognostic imaging and clinical features. RESULTS A total of 27 patients had aggressive NHL and 18 had HL. Mean PFS was 48.5 months. There was no significant difference in pre-treatment CTTA between the lymphoma sub-types. Kaplan-Meier analysis found pre-treatment CTTA (medium feature scale, p=0.010) and iPET status (p<0.001) to be significant predictors of PFS. Cox analysis revealed that an interaction between pre-treatment CTTA and iPET status was the only independent predictor of PFS (HR: 25.5, 95% CI: 5.4-120, p<0.001). Specifically, pre-treatment CTTA risk stratified patients with negative iPET. CONCLUSION CTTA can potentially provide prognostic information complementary to iPET for patients with HL and aggressive NHL. KEY POINTS • CT texture-analysis (CTTA) provides prognostic information complementary to interim FDG-PET in Lymphoma. • Pre-treatment CTTA and interim PET status were significant predictors of progression-free survival. • Patients with negative interim PET could be further stratified by pre-treatment CTTA. • Provide precision surveillance where additional imaging reserved for patients at greatest recurrence-risk. • Assists in risk-adapted treatment strategy based on interim PET and CTTA.
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Affiliation(s)
- B Ganeshan
- Institute of Nuclear Medicine, University College London, Euston Rd, London, UK.
| | - K A Miles
- Institute of Nuclear Medicine, University College London, Euston Rd, London, UK
| | - S Babikir
- Human Health Division, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency (IAEA), Vienna, Austria
| | - R Shortman
- Institute of Nuclear Medicine, University College London, Euston Rd, London, UK
| | - A Afaq
- Institute of Nuclear Medicine, University College London, Euston Rd, London, UK
| | - K M Ardeshna
- Institute of Nuclear Medicine, University College London, Euston Rd, London, UK
| | - A M Groves
- Institute of Nuclear Medicine, University College London, Euston Rd, London, UK
| | - I Kayani
- Institute of Nuclear Medicine, University College London, Euston Rd, London, UK
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Afaq A, Ganeshan B, Grenader T, Azzopardi G, Endozo R, Bridgewater J, Groves A. Quantification of tumour heterogeneity and glucose metabolism on pre-chemoradiation PET/CT predicts survival in anal cancer. Cancer Imaging 2015. [PMCID: PMC4601793 DOI: 10.1186/1470-7330-15-s1-s11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
- Mark Wills
- Radiology Registrar in the Department of Imaging, Hammersmith Hospital, Imperial College NHS Trust, London W12 0HS
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Wills M, Harvey CJ, Kuzmich S, Afaq A, Cosgrove D. Ultrasound of the gall bladder and biliary tree: part 2. Br J Hosp Med (Lond) 2014; 75:318-24. [PMID: 25040407 DOI: 10.12968/hmed.2014.75.6.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ultrasound is the modality of choice for the initial assessment of the gall bladder and the biliary tree. This article details normal ultrasound appearances of the biliary tree, as well as appearances of biliary obstruction, biliary cirrhosis, biliary gall-stones, developmental disorders, cholangiopathies and cholangiocarcinoma.
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Affiliation(s)
- Mark Wills
- Radiology Registrar in the Department of Imaging, Hammersmith Hospital, Imperial College NHS Trust, London W12 0HS
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Donati OF, Afaq A, Vargas HA, Mazaheri Y, Zheng J, Moskowitz CS, Hricak H, Akin O. Prostate MRI: evaluating tumor volume and apparent diffusion coefficient as surrogate biomarkers for predicting tumor Gleason score. Clin Cancer Res 2014; 20:3705-11. [PMID: 24850842 DOI: 10.1158/1078-0432.ccr-14-0044] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate whether tumor volume derived from apparent diffusion coefficient (ADC) maps (VolumeADC) and tumor mean ADC value (ADCmean) are independent predictors of prostate tumor Gleason score (GS). EXPERIMENTAL DESIGN Tumor volume and GS were recorded from whole-mount histopathology for 131 men (median age, 60 years) who underwent endorectal diffusion-weighted MRI for local staging of prostate cancer before prostatectomy. VolumeADC and ADCmean were derived from ADC maps and correlated with histopathologic tumor volume and GS. Univariate and multivariate analyses were performed to evaluate prediction of tumor aggressiveness. Areas under receiver-operating characteristics curves (AUC) were calculated to evaluate the performance of VolumeADC and ADCmean in discriminating tumors of GS 6 and GS ≥7. RESULTS Histopathology identified 116 tumor foci >0.5 mL. VolumeADC correlated significantly with histopathologic tumor volume (ρ = 0.683). The correlation increased with increasing GS (ρ = 0.453 for GS 6 tumors; ρ = 0.643 for GS 7 tumors; ρ = 0.980 for GS ≥8 tumors). Both VolumeADC (ρ = 0.286) and ADCmean (ρ = -0.309) correlated with GS. At univariate analysis, both VolumeADC (P = 0.0325) and ADCmean (P = 0.0033) could differentiate GS = 6 from GS ≥7 tumor foci. However, at multivariate analysis, only ADCmean (P = 0.0156) was a significant predictor of tumor aggressiveness (i.e., GS 6 vs. GS ≥7). For differentiating GS 6 from GS ≥7 tumors, AUCs were 0.644 and 0.704 for VolumeADC and ADCmean, respectively, and 0.749 for both parameters combined. CONCLUSION In patients with prostate cancer, ADCmean is an independent predictor of tumor aggressiveness, but VolumeADC is not. The latter parameter adds little to the ADCmean in predicting tumor GS.
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Affiliation(s)
- Olivio F Donati
- Authors' Affiliations: Department of Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland; and
| | - Asim Afaq
- Authors' Affiliations: Department of Radiology, Institute of Nuclear Medicine, National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | | | | | - Junting Zheng
- Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Chaya S Moskowitz
- Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Oguz Akin
- Authors' Affiliations: Department of Radiology,
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Donati OF, Mazaheri Y, Afaq A, Vargas HA, Zheng J, Moskowitz CS, Hricak H, Akin O. Prostate cancer aggressiveness: assessment with whole-lesion histogram analysis of the apparent diffusion coefficient. Radiology 2014; 271:143-52. [PMID: 24475824 DOI: 10.1148/radiol.13130973] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate the relationship between prostate cancer aggressiveness and histogram-derived apparent diffusion coefficient (ADC) parameters obtained from whole-lesion assessment of diffusion-weighted magnetic resonance (MR) imaging of the prostate and to determine which ADC metric may help best differentiate low-grade from intermediate- or high-grade prostate cancer lesions. MATERIALS AND METHODS The institutional review board approved this retrospective HIPAA-compliant study of 131 men (median age, 60 years) who underwent diffusion-weighted MR imaging before prostatectomy for prostate cancer. Clinically significant tumors (tumor volume > 0.5 mL) were identified at whole-mount step-section histopathologic examination, and Gleason scores of the tumors were recorded. A volume of interest was drawn around each significant tumor on ADC maps. The mean, median, and 10th and 25th percentile ADCs were determined from the whole-lesion histogram and correlated with the Gleason score by using the Spearman correlation coefficient (ρ). The ability of each parameter to help differentiate tumors with a Gleason score of 6 from those with a Gleason score of at least 7 was assessed by using the area under the receiver operating characteristic curve (Az). RESULTS In total, 116 clinically significant lesions (89 in the peripheral zone, 27 in the transition zone) were identified in 85 of the 131 patients (65%). Forty-six patients did not have a clinically significant lesion. For mean ADC, median ADC, 10th percentile ADC, and 25th percentile ADC, the Spearman ρ values for correlation with Gleason score were -0.31, -0.30, -0.36, and -0.35, respectively, whereas the Az values for differentiating lesions with a Gleason score of 6 from those with a Gleason score of at least 7 were 0.704, 0.692, 0.758, and 0.723, respectively. The Az of 10th percentile ADC was significantly higher than that of the mean ADC for all lesions and peripheral zone lesions (P = .0001). CONCLUSION When whole-lesion histograms were used to derive ADC parameters, 10th percentile ADC correlated with Gleason score better than did other ADC parameters, suggesting that 10th percentile ADC may prove to be optimal for differentiating low-grade from intermediate- or high-grade prostate cancer with diffusion-weighted MR imaging.
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Affiliation(s)
- Olivio F Donati
- From the Departments of Radiology (O.F.D., A.A., H.A.V., H.H., O.A.), Medical Physics (Y.M.), and Epidemiology and Biostatistics (J.Z., C.S.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
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Wills M, Harvey CJ, Kuzmich S, Afaq A, Lim A, Cosgrove D. Characterizing malignant liver lesions with contrast-enhanced ultrasound. Br J Hosp Med (Lond) 2014; 75:151-4. [DOI: 10.12968/hmed.2014.75.3.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Chris J Harvey
- Consultant Radiologist in the Department of Imaging, Hammersmith Hospital, Imperial College NHS Trust, London W12 0HS
| | - Siarhei Kuzmich
- Consultant Radiologist in the Department of Radiology, Whipps Cross Hospital, London
| | - Asim Afaq
- Senior Clinical Research Associate and Honorary Radiology Consultant in the University College London Hospitals Biomedical Research Centre, London
| | - Adrian Lim
- Consultant Radiologist in the Department of Radiology, Charing Cross Hospital, London
| | - David Cosgrove
- Emeritus Professor of Clinical Ultrasound, Hammersmith Hospital, London
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Wills M, Harvey CJ, Kuzmich S, Afaq A, Lim A, Cosgrove D. Characterizing benign liver lesions and trauma with contrast-enhanced ultrasound. Br J Hosp Med (Lond) 2014; 75:91-5. [DOI: 10.12968/hmed.2014.75.2.91] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Chris J Harvey
- Consultant Radiologist in the Department of Imaging, Hammersmith Hospital, Imperial College NHS Trust, London W12 0HS
| | - Siarhei Kuzmich
- Consultant Radiologist in the Department of Radiology, Whipps Cross Hospital, London
| | - Asim Afaq
- Senior Clinical Research Associate and Honorary Radiology Consultant in the University College London Hospitals Biomedical Research Centre, London
| | - Adrian Lim
- Consultant Radiologist in the Department of Radiology, Charing Cross Hospital, London
| | - David Cosgrove
- Emeritus Professor of Clinical Ultrasound, Hammersmith Hospital, London
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Win T, Thomas BA, Lambrou T, Hutton BF, Screaton NJ, Porter JC, Maher TM, Endozo R, Shortman RI, Afaq A, Lukey P, Ell PJ, Groves AM. Areas of normal pulmonary parenchyma on HRCT exhibit increased FDG PET signal in IPF patients. Eur J Nucl Med Mol Imaging 2014; 41:337-42. [PMID: 23942907 PMCID: PMC3890564 DOI: 10.1007/s00259-013-2514-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 07/07/2013] [Indexed: 11/07/2022]
Abstract
PURPOSE Patients with idiopathic pulmonary fibrosis (IPF) show increased PET signal at sites of morphological abnormality on high-resolution computed tomography (HRCT). The purpose of this investigation was to investigate the PET signal at sites of normal-appearing lung on HRCT in IPF. METHODS Consecutive IPF patients (22 men, 3 women) were prospectively recruited. The patients underwent (18)F-FDG PET/HRCT. The pulmonary imaging findings in the IPF patients were compared to the findings in a control population. Pulmonary uptake of (18)F-FDG (mean SUV) was quantified at sites of morphologically normal parenchyma on HRCT. SUVs were also corrected for tissue fraction (TF). The mean SUV in IPF patients was compared with that in 25 controls (patients with lymphoma in remission or suspected paraneoplastic syndrome with normal PET/CT appearances). RESULTS The pulmonary SUV (mean ± SD) uncorrected for TF in the controls was 0.48 ± 0.14 and 0.78 ± 0.24 taken from normal lung regions in IPF patients (p < 0.001). The TF-corrected mean SUV in the controls was 2.24 ± 0.29 and 3.24 ± 0.84 in IPF patients (p < 0.001). CONCLUSION IPF patients have increased pulmonary uptake of (18)F-FDG on PET in areas of lung with a normal morphological appearance on HRCT. This may have implications for determining disease mechanisms and treatment monitoring.
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Affiliation(s)
- Thida Win
- Respiratory Medicine, Lister Hospital, Stevenage, UK
| | - Benjamin A. Thomas
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
| | - Tryphon Lambrou
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
| | - Brian F. Hutton
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
| | | | - Joanna C. Porter
- Centre for Respiratory Diseases, University College Hospital, University College London, Euston Rd, London, UK
| | - Toby M. Maher
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Raymondo Endozo
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
| | - Robert I. Shortman
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
| | - Asim Afaq
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
| | - Pauline Lukey
- Fibrosis DPU, Research and Development, GSK, Stevenage, UK
| | - Peter J. Ell
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
| | - Ashley M. Groves
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
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Al-Nabhani KZ, Syed R, Michopoulou S, Alkalbani J, Afaq A, Panagiotidis E, O'Meara C, Groves A, Ell P, Bomanji J. Qualitative and quantitative comparison of PET/CT and PET/MR imaging in clinical practice. J Nucl Med 2014; 55:88-94. [PMID: 24337608 DOI: 10.2967/jnumed.113.123547] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
UNLABELLED The aim of this study was to prospectively compare whole-body PET/MR imaging and PET/CT, qualitatively and quantitatively, in oncologic patients and assess the confidence and degree of inter- and intraobserver agreement in anatomic lesion localization. METHODS Fifty patients referred for staging with known cancers underwent PET/CT with low-dose CT for attenuation correction immediately followed by PET/MR imaging with 2-point Dixon attenuation correction. PET/CT scans were obtained according to standard protocols (56 ± 20 min after injection of an average 367 MBq of (18)F-FDG, 150 MBq of (68)Ga-DOTATATE, or 333.8 MBq of (18)F-fluoro-ethyl-choline; 2.5 min/bed position). PET/MR was performed with 5 min/bed position. Three dual-accredited nuclear medicine physicians/radiologists identified the lesions and assigned each to an exact anatomic location. The image quality, alignment, and confidence in anatomic localization of lesions were scored on a scale of 1-3 for PET/CT and PET/MR imaging. Quantitative analysis was performed by comparing the standardized uptake values. Intraclass correlation coefficients and the Wilcoxon signed-rank test were used to assess intra- and interobserver agreement in image quality, alignment, and confidence in lesion localization for the 2 modalities. RESULTS Two hundred twenty-seven tracer-avid lesions were identified in 50 patients. Of these, 225 were correctly identified on PET/CT and 227 on PET/MR imaging by all 3 observers. The confidence in anatomic localization improved by 5.1% when using PET/MR imaging, compared with PET/CT. The mean percentage interobserver agreement was 96% for PET/CT and 99% for PET/MR imaging, and intraobserver agreement in lesion localization across the 2 modalities was 93%. There was 10% (5/50 patients) improvement in local staging with PET/MR imaging, compared with PET/CT. CONCLUSION In this first study, we show the effectiveness of whole-body PET/MR imaging in oncology. There is no statistically significant difference between PET/MR imaging and PET/CT in respect of confidence and degree of inter- and intraobserver agreement in anatomic lesion localization. The PET data on both modalities were similar; however, the observed superior soft-tissue resolution of MR imaging in head and neck, pelvis, and colorectal cancers and of CT in lung and mediastinal nodal disease points to future tailored use in these locations.
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Affiliation(s)
- Khalsa Z Al-Nabhani
- Institute of Nuclear Medicine, University College London Hospital NHS Foundation Trust, London NW1 2BU, United Kingdom
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Abstract
BACKGROUND The introduction of the new simultaneous PET/MRI scanner opens new opportunities in functional imaging. SOURCES OF DATA This article is based on the literature review and our personal experience of the first simultaneous PET/MRI scanner in the UK. AREAS OF AGREEMENT PET/CT is well established and a key component of management guidance in a range of diseases. MRI has superior soft tissue resolution, which is useful in the evaluation of many diseases. AREAS OF CONTROVERSY There are currently no guidelines regarding clinical use of PET/MRI, and those centres with a PET/MRI facility are undertaking research to look for a 'key application'. GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH This review briefly describes some of the technical advances, present comparisons with the diagnostic performance of current imaging modalities (PET/CT and MRI) and identifies potential indications and research directions.
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Affiliation(s)
- Asim Afaq
- Institute of Nuclear Medicine, University College London Hospital NHS Trust, London, UK
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Riaz N, Afaq A, Akin O, Pei X, Kollmeier MA, Cox B, Hricak H, Zelefsky MJ. Pretreatment Endorectal Coil Magnetic Resonance Imaging Findings Predict Biochemical Tumor Control in Prostate Cancer Patients Treated With Combination Brachytherapy and External-Beam Radiotherapy. Int J Radiat Oncol Biol Phys 2012; 84:707-11. [DOI: 10.1016/j.ijrobp.2012.01.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 01/03/2012] [Accepted: 01/04/2012] [Indexed: 10/28/2022]
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Vargas HA, Akin O, Afaq A, Goldman D, Zheng J, Moskowitz CS, Shukla-Dave A, Eastham J, Scardino P, Hricak H. Magnetic resonance imaging for predicting prostate biopsy findings in patients considered for active surveillance of clinically low risk prostate cancer. J Urol 2012; 188:1732-8. [PMID: 23017866 DOI: 10.1016/j.juro.2012.07.024] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE A barrier to the acceptance of active surveillance for men with prostate cancer is the risk of underestimating the cancer burden on initial biopsy. We assessed the value of endorectal magnetic resonance imaging in predicting upgrading on confirmatory biopsy in men with low risk prostate cancer. MATERIALS AND METHODS A total of 388 consecutive men (mean age 60.6 years, range 33 to 89) with clinically low risk prostate cancer (initial biopsy Gleason score 6 or less, prostate specific antigen less than 10 ng/ml, clinical stage T2a or less) underwent endorectal magnetic resonance imaging before confirmatory biopsy. Three radiologists independently and retrospectively scored tumor visibility on endorectal magnetic resonance imaging using a 5-point scale (1-definitely no tumor to 5-definitely tumor). Inter-reader agreement was assessed with weighted kappa statistics. Associations between magnetic resonance imaging scores and confirmatory biopsy findings were evaluated using measures of diagnostic performance and multivariate logistic regression. RESULTS On confirmatory biopsy, Gleason score was upgraded in 79 of 388 (20%) patients. Magnetic resonance imaging scores of 2 or less had a high negative predictive value (0.96-1.0) and specificity (0.95-1.0) for upgrading on confirmatory biopsy. A magnetic resonance imaging score of 5 was highly sensitive for upgrading on confirmatory biopsy (0.87-0.98). At multivariate analysis patients with higher magnetic resonance imaging scores were more likely to have disease upgraded on confirmatory biopsy (odds ratio 2.16-3.97). Inter-reader agreement and diagnostic performance were higher for the more experienced readers (kappa 0.41-0.61, AUC 0.76-0.79) than for the least experienced reader (kappa 0.15-0.39, AUC 0.61-0.69). Magnetic resonance imaging performed similarly in predicting low risk and very low risk (Gleason score 6, less than 3 positive cores, less than 50% involvement in all cores) prostate cancer. CONCLUSIONS Adding endorectal magnetic resonance imaging to the initial clinical evaluation of men with clinically low risk prostate cancer helps predict findings on confirmatory biopsy and assess eligibility for active surveillance.
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Affiliation(s)
- Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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Abstract
Anatomical response assessment criteria have been in use for decades, with the WHO guidelines being replaced by Response Evaluation Criteria in Solid Tumors (RECIST), updated in 2009 to RECIST 1.1. These methods rely on a change in size of a tumor as the main response criteria, but newer cytostatic agents tend to target tumor function at a molecular level before changing the size of a lesion. Recent modifications, such as the Choi criteria, have improved assessment by taking into account density of tumor, but all of these criteria fail to utilize functional imaging parameters, which are becoming increasingly available, including perfusion CT, perfusion MRI, diffusion-weighted imaging, magnetic resonance spectroscopy, dynamic contrast-enhanced ultrasound and combined PET/computed tomography. Developments in these modalities and standardization of imaging acquisition will help to optimize the next set of response criteria, with inclusion of multiparametric, functional modalities, evaluating tumors at the same molecular level at which they are being targeted by therapeutic agents.
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Affiliation(s)
- Asim Afaq
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Riaz N, Afaq A, Pei X, Akin O, Zelefsky M. Pre-treatment Endorectal Coil MRI Findings Predict Biochemical Tumor Control in Prostate Cancer Patients Treated with Combination Brachytherapy and External Beam Radiotherapy. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.618] [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: 11/15/2022]
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Abstract
UNLABELLED What's known on the subject? and What does the study add? This article reviews what is currently known about diffusion weighted MRI (DW-MRI) in prostate cancer. This mini-review concisely summarises, for clinical managing patients with prostate cancer, the clinical utility of diffusion weighted MRI. OBJECTIVE • To review the clinical utility of diffusion-weighted magnetic resonance imaging (DW-MRI) in patients with prostate cancer. MATERIAL AND METHODS • The current literature on prostate cancer and DW-MRI was reviewed. RESULTS • DW-MRI can be readily acquired on a modern scanner with a short image acquisition time and no need for i.v. contrast medium. • The image contrast is based on the diffusion of water molecules and thus reflects tissue cellularity. • There is increasing evidence that DW- MRI improves the sensitivity and specificity of prostate cancer detection as well as the identification of tumour aggressiveness. • DW-MRI is also showing substantial promise as a response biomarker for both local and metastatic disease CONCLUSIONS • DW-MRI is proving to be a useful adjunct to conventional T2-weighted MRI sequences. • The eventual role of DW-MRI in combination with other MRI techniques for multiparametric assessment of prostate cancer needs to be defined further.
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Affiliation(s)
- Asim Afaq
- Department of Diagnostic Imaging, Royal Marsden Hospital, London, UK
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Abstract
Diffusion-weighted magnetic resonance imaging (DWI) is increasingly being used to assess tumour response to a variety of anticancer treatments. The technique is quick to perform without the need for administration of exogenous contrast medium, and enables the apparent diffusion coefficient (ADC) of tissues to be quantified. Studies have shown that ADC increases in response to a variety of treatments including chemotherapy, radiotherapy, minimally invasive therapies and novel therapeutics. In this article, we review the rationale of applying DWI for tumour assessment, the evidence for ADC measurements in relation to specific treatments and some of the practical considerations for using ADC to evaluate treatment response.
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Affiliation(s)
- A Afaq
- Royal Marsden Hospital, Downs Road, Sutton, UK
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Niewiarowski S, Gogbashian A, Afaq A, Kantor R, Win Z. Abdominal X-ray signs of intra-intestinal drug smuggling. J Forensic Leg Med 2010; 17:198-202. [PMID: 20382355 DOI: 10.1016/j.jflm.2009.12.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 11/11/2009] [Accepted: 12/22/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION "Body packers" either swallow or insert drug filled packets rectally or vaginally in order to smuggle illicit drugs. AXR is used routinely to screen suspects for the presence of intra-intestinal drug packages. AXR diagnosis can be difficult as stool or gas within the intestine may resemble ingested foreign bodies. We identify the frequency and co-existence of several signs; tic-tac sign, rosette sign, double condom sign, dense surrounding material, density and discover a new sign; parallelism, which will aid in increasing the radiological accuracy. METHODS We retrospectively reviewed 285 AXRs performed for suspicion of drug smuggling during the period of March 2006-March 2009 to identify the frequency of these signs. RESULTS Of the 285 AXRs performed 59 were positive, 221 negative and five were indeterminate. The tic-tac sign was present in 93%, double condom sign in 73%, dense surrounding wrapping material in 36% and parallelism in 27%. Sixty one percentage of drug packages were iso-dense to faeces and 39% hyperdense. Twenty percentage of the positive abdominal radiographs demonstrated one of the radiographic signs, 39% demonstrated two signs, 32% demonstrated three and 7% four. The most common radiographic sign combination was the tic-tac sign with either dense surrounding material or double condom sign. CONCLUSION The most commonly encountered radiographic sign is the tic-tac sign, followed by the double condom sign and dense surrounding material. We also discover a new sign, "parallelism" which although uncommon is highly specific. Accuracy is further increased by comparing the density of packages to faeces and looking for the co-existence of multiple signs.
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Affiliation(s)
- Sylwia Niewiarowski
- Hillingdon Hospital, Pield Heath Road, Hillingdon, Uxbridge, Middlesex, London UB8 3NN, United Kingdom.
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Afaq A, Patel JH, Gardner AW, Hennebry TA. Predictors of change in walking distance in patients with peripheral arterial disease undergoing endovascular intervention. Clin Cardiol 2009; 32:E7-11. [PMID: 19645033 DOI: 10.1002/clc.20553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Endovascular treatment of peripheral artery disease is becoming frequent, yet the clinical factors which predict ambulatory outcomes are not known. HYPOTHESIS To identify predictors of change in walking distance in patients who underwent endovascular intervention for their lower extremity peripheral arterial disease (PAD). METHODS A total of 134 patients underwent lower extremity peripheral arterial intervention, 52 patients were contacted via phone between 1 and 36 months (a mean of 22 mo) after their initial procedure. The remaining 82 patients were excluded due to the following reasons: death (n = 13), contact information was not available (n = 50), and refusal to participate in the follow-up (n = 19). RESULTS The patients were 63 +/- 12 years old (mean +/- standard deviation [SD]), 46% were male, 47% were diabetics, 49% had coronary artery disease, of whom 29% had prior revascularization, and 22% had coronary artery bypass grafts (CABG). The disease severity described by Fontaine classification were as follows: 44.2% were in stage II, 15.4% were in stage III, and 40.4% were in stage IV. Walking distance was improved in 21% of patients, worsened in 73% of patients, and unchanged in 6% of patients. Stepwise multiple regression demonstrated that patients who started to walk or exercise (R = 0.372, P < 0.012) and who had a prior history of CABG (R = 0.467, P < 0.006) were the only independent predictors of the change in walking distance at follow-up. Those who started to walk reported worse walking distance at follow-up, while those with a history of CABG reported better walking distance at follow-up. CONCLUSION CABG prior to endovascular intervention is predictive of favorable change in walking distance in patients with PAD at follow-up. Therefore, post-CABG patients are good candidates for exercise rehabilitation and risk factor modification.
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Affiliation(s)
- A Afaq
- Department of Medicine, Section of Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190, USA
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Adhikary S, Tyagi S, Sapkota G, Afaq A, Bhattarai BK, Agrawal CS. Port exteriorization appendectomy: is it the future? Nepal Med Coll J 2008; 10:30-34. [PMID: 18700628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The time honoured surgical procedure open appendectomy seems to be on the decline, it may be replaced in the modern era by laparoscopic appendectomy ("in appendectomy") performed with three trocars, or by the port exteriorization appendectomy ("out appendectomy") which can be done with two ports or even one. These techniques combine the benefits of decreased tissue trauma and operative time in addition to other advantages of minimal invasion. We conducted this study to know the effectiveness of Port Exteriorization Appendectomy, to analyze its complications and to assess the conversion rate. A one year prospective study consisted of fifty cases; a combination of emergency and elective group. They were operated under general anaesthesia and different variables were documented. Mean operative time, conversion rate, hospital stay, complications and patient satisfaction. There were 27 females with the (F: M) ratio of 1.17:1. The operative time of 23.3 mins, conversion in 4 (8.0%) patients and 2.4 days of hospital stay contributed to 86.0% operative success rate. Surgical site infection was seen in 5 (10.0%) patients and one (2.0%) developed pelvic abscess. On analysis of the satisfaction level, 44(93.6%) were completely satisfied and one (2.1%) patient seemed disappointed with the technique for cosmesis though, 42 (89.3%) remained completely satisfied and 5(10.7%) didn't like their scars. Port exteriorization appendectomy's efficacy can be verified by 86.0% success rate, operative time of 23.3 mins, indoor stay of 2.4 days, and minimal undesirable sequlae. However, more authentic results could be obtained if this technique is compared to open or laparoscopic appendectomy in a well designed randomized controlled clinical trial.
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Affiliation(s)
- S Adhikary
- Department of Surgery, BP Koirala Institute of Health Sciences, Dharan, Nepal.
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Subedi SK, Afaq A, Adhikary S, Niraula SR, Agrawal CS. Factors influencing mortality in perforated duodenal ulcer following emergency surgical repair. JNMA J Nepal Med Assoc 2007; 46:31-5. [PMID: 17721560] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Duodenal perforation is a common abdominal catastrophe with excellent outcome if prompt resuscitation and surgical repair of perforation are done. The aim of this study was to identify factors associated with death after surgery in patients with duodenal perforation. One hundred and forty-five patients who underwent Graham's patch repair for perforated duodenal ulcer between 14 April 2002 and 31 December 2004 were studied. The mean age was 45.99 years and 61 patients (42.07 %) were referrals. There were 124 (85.52 %) males and 21 (14.48 %) females. There were 10 deaths (6.9 %). The mean time delay was 2.46 days. It was 2.37 days in survivors, 3.7 days in non-survivors. The time delay was 3.25 days for females and 3.13 days for patients referred from another hospital. The mortality was significantly associated with time delay between perforation and operation (p<0.01), presence of co-morbid conditions (P<0.04), respiratory rate (p<0.02), raised blood urea (p<0.01) and serum creatinine (p<0.001), size of perforation (p<0.005), amount of peritoneal fluid (p=0.003) and requirement of postoperative intensive care unit support (p=0.003). Time delay between perforation and operation, preoperative blood urea and serum creatinine, size of perforation and amount of peritoneal fluid, presence of co-morbid conditions and need for post operative ICU support are the important predictors of outcome after emergency surgery for duodenal perforation.
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Affiliation(s)
- S K Subedi
- BP Koirala Institute of Health Sciences, Dharan, Nepal.
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Abstract
BACKGROUND AND AIMS The global epidemiology of hepatitis delta virus (HDV) infection is changing. This study was performed to determine the epidemiology and clinical impact of hepatitis delta in Pakistan. METHODS Countrywide data was collected from 1994 to 2001. A total of 8721 patients were tested for hepatitis delta antibody. A subset of 97 hepatitis delta antibody reactive inpatients with chronic liver disease were compared to 97 patients admitted with liver disease due to hepatitis B alone. RESULTS Of the 8721 patients tested, 1444 (16.6%) were reactive for hepatitis delta antibody. Most were males (87.4%, P < 0.001) and younger (mean age 31 years, P < 0.001) compared to HDV non-reactive patients. Prevalence of delta infection was highest in the rural (range 25-60%) compared to the urban population (range 6.5-11%). Analysis of the inpatient data showed that delta infected patients had significantly less severe clinical liver disease and a trend towards lesser development of hepatocellular carcinoma compared to delta negative patients. CONCLUSIONS (i) HDV infection is present in 16.6% of hepatitis B infected patients in Pakistan, most commonly in younger males living in rural areas; and (ii) delta virus infected patients have less severe clinical liver disease compared to delta negative, hepatitis B patients.
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Affiliation(s)
- Khalid Mumtaz
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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Affiliation(s)
- Asim Afaq
- Imperial College School of Medicine, London, England
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Afaq A. Diabetic nephropathy and dyslipidaemia. J R Soc Med 2001; 94:369-70. [PMID: 11418715 PMCID: PMC1281618 DOI: 10.1177/014107680109400726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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