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Hartmann K, Gillman JA, Lazor JW, Ware JB, Weeks JK, Nasrallah IM, Farwell MD, Pantel AR. 68 Ga-DOTATATE PET to Characterize Lesions in the Neuroaxis. Clin Nucl Med 2024; 49:9-15. [PMID: 38048554 DOI: 10.1097/rlu.0000000000004966] [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: 12/06/2023]
Abstract
AIM The differentiation of paragangliomas, schwannomas, meningiomas, and other neuroaxis tumors in the head and neck remains difficult when conventional MRI is inconclusive. This study assesses the utility of 68 Ga-DOTATATE PET/CT as an adjunct to hone the diagnosis. PATIENTS AND METHODS This retrospective study considered 70 neuroaxis lesions in 52 patients with 68 Ga-DOTATATE PET/CT examinations; 22 lesions (31%) had pathologic confirmation. Lesions were grouped based on pathological diagnosis and best radiologic diagnosis when pathology was not available. Wilcoxon rank sum tests were used to test for differences in SUV max among paragangliomas, schwannomas, and meningiomas. Receiver operator characteristic curves were constructed. RESULTS Paragangliomas had a significantly greater 68 Ga-DOTATATE uptake (median SUV max , 62; interquartile range [IQR], 89) than nonparagangliomas. Schwannomas had near-zero 68 Ga-DOTATATE uptake (median SUV max , 2; IQR, 1). Intermediate 68 Ga-DOTATATE uptake was seen for meningiomas (median SUV max , 19; IQR, 6) and other neuroaxis lesions (median SUV max , 7; IQR, 9). Receiver operator characteristic analysis demonstrated an area under the curve of 0.87 for paragangliomas versus all other lesions and 0.97 for schwannomas versus all other lesions. CONCLUSIONS Marked 68 Ga-DOTATATE uptake (>50 SUV max ) favors a diagnosis of paraganglioma, although paragangliomas exhibit a wide variability of uptake. Low to moderate level 68 Ga-DOTATATE uptake is nonspecific and may represent diverse pathophysiology including paraganglioma, meningioma, and other neuroaxis tumors but essentially excludes schwannomas, which exhibited virtually no uptake.
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Affiliation(s)
- Katherine Hartmann
- From the Department of Radiology, Hospital of the University of Pennsylvania, Pennsylvania, PA
| | | | - Jillian W Lazor
- From the Department of Radiology, Hospital of the University of Pennsylvania, Pennsylvania, PA
| | - Jeffrey B Ware
- From the Department of Radiology, Hospital of the University of Pennsylvania, Pennsylvania, PA
| | - Joanna K Weeks
- From the Department of Radiology, Hospital of the University of Pennsylvania, Pennsylvania, PA
| | - Ilya M Nasrallah
- From the Department of Radiology, Hospital of the University of Pennsylvania, Pennsylvania, PA
| | - Michael D Farwell
- From the Department of Radiology, Hospital of the University of Pennsylvania, Pennsylvania, PA
| | - Austin R Pantel
- From the Department of Radiology, Hospital of the University of Pennsylvania, Pennsylvania, PA
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Gitto SB, Pantel AR, Makvandi M, Kim H, Medvedev S, Weeks JK, Torigian DA, Hsieh CJ, Ferman B, Latif NA, Tanyi JL, Martin LP, Lanzo SM, Liu F, Cao Q, Mills GB, Doot RK, Mankoff DA, Mach RH, Lin LL, Simpkins F. Abstract 5610: [18F]FluorThanatrace ([18F]FTT) PET Imaging of PARP-inhibitor drug-target engagement as a biomarker of response in ovarian cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-5610] [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: 04/07/2023]
Abstract
Abstract
Purpose: Poly(ADP-ribose) polymerase enzyme inhibitors (PARPi) have become the standard-of-care treatment for homologous recombination deficient (HRD) high-grade serous ovarian cancer (HGSOC). However, not all HRD tumors respond to PARPi and biomarkers to predict response are needed. [18F]FluorThanatrace (FTT) is a PARPi-analog PET radiotracer that non-invasively measures PARP-1 expression. Herein, we evaluate the ability of FTT uptake to serve as a biomarker to predict response to PARPi in patient-derived xenograft (PDX) models and patients with HGSOC.
Patients and Methods: In PDX models, FTT-PET was performed before and after PARPi (olaparib), ataxia-telangiectasia inhibitor (ATRi), or both. Changes in FTT were correlated with tumor size changes. Patients with HRD and HGSOC that were enrolled in CAPRI (PARPi+ATRi), LIGHT (PARPi only), or off-trial (PARPi only) were selected for this single-center, prospective, cohort, IRB-approved study. FTT-PET/CT imagining was obtained from the skull base to the proximal thighs on an Ingenuity TF scanner (Philips Healthcare) 60-90 minutes after intravenous infusion of 8-12 mCi FTT. Subjects were imaged with FTT-PET at baseline and after ~1 week of PARPi monotherapy treatment. Target lesions (primary tumor and/or metastases) were identified at the time of the baseline imaging on correlative anatomic imaging using RECIST 1.1 and maximum standardized uptake value (SUVmax) data, normalized by body weight, was collected. Changes in FTT-PET uptake were compared to changes in tumor size, CA-125, and progression free survival (PFS).
Results: A decrease in FTT tumor uptake after 1 week of PARPi treatment correlated with response to PARPi+ATRi treatment in PARPi-resistant PDX models (r=0.81-0.83, P=0.1-0.22). In HGSOC patients (n=13), percent differences in FTT-PET after ~7 days of PARPi compared to baseline correlated with the first RECIST response (r=0.60, P=0.034), best RECIST response (r=0.75, P=0.01), best CA-125 response (r=0.73, P=0.033), and PFS (r=0.67, P=0.027). All patients with >50% reduction in FTT uptake had >6-month PFS and >50% reduction in CA-125 (P=0.004 and P=0.016, respectively). Utilizing only baseline FTT uptake correlated to best RECIST response (r=-0.65, P=0.035) but did not predict response when corelated with other measures. Importantly, a decrease in FTT uptake does not appear to be associated with a reduction in tumor burden or apoptosis in response to drug cytotoxic activity at this early timepoint, indicating specificity for drug-target engagement.
Conclusions: The decline in FTT uptake shortly after PARPi initiation compared to baseline provides an in vivo measure of drug-target engagement and shows promise as an early biomarker to guide PARPi therapy. FTT-PET has both pre-clinical and clinical applications warranting further study, including guiding PARPi combination therapy.
Citation Format: Sarah B. Gitto, Austin R. Pantel, Mehran Makvandi, Hyoung Kim, Sergey Medvedev, Joanna K. Weeks, Drew A. Torigian, Chia-Ju Hsieh, Benjamin Ferman, Nawar A. Latif, Janos L. Tanyi, Lainie P. Martin, Shannon M. Lanzo, Fang Liu, Quy Cao, Gordon B. Mills, Robert K. Doot, David A. Mankoff, Robert H. Mach, Lilie L. Lin, Fiona Simpkins. [18F]FluorThanatrace ([18F]FTT) PET Imaging of PARP-inhibitor drug-target engagement as a biomarker of response in ovarian cancer. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5610.
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Affiliation(s)
- Sarah B. Gitto
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Austin R. Pantel
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Mehran Makvandi
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Hyoung Kim
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Sergey Medvedev
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Joanna K. Weeks
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Drew A. Torigian
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Chia-Ju Hsieh
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Benjamin Ferman
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Nawar A. Latif
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Janos L. Tanyi
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Lainie P. Martin
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Shannon M. Lanzo
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Fang Liu
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Quy Cao
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Gordon B. Mills
- 2Oregon Health & Science University School of Medicine, Portland, OR
| | - Robert K. Doot
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - David A. Mankoff
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Robert H. Mach
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
| | - Lilie L. Lin
- 3MD Anderson Cancer Center, The University of Texas, Houston, TX
| | - Fiona Simpkins
- 1Perelman School of Med. Univ. of Pennsylvania, Philadelphia, PA
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O'Brien SR, Edmonds CE, Lanzo SM, Weeks JK, Mankoff DA, Pantel AR. 18F-Fluoroestradiol: Current Applications and Future Directions. Radiographics 2023; 43:e220143. [PMID: 36821506 DOI: 10.1148/rg.220143] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
In the United States, breast cancer is the second leading cause of cancer death in all women and the leading cause of cancer death in Black women. The breast cancer receptor profile, assessed with immunohistochemical staining of tissue samples, allows prediction of outcomes and direction of patient treatment. Approximately 80% of newly diagnosed breast cancers are hormone receptor (HR) positive, which is defined as estrogen receptor (ER) and/or progesterone receptor (PR) positive. Patients with ER-positive disease can be treated with therapies targeting the ER; however, the assessment of ER expression with immunohistochemical staining of biopsy specimens has several limitations including sampling error, false-negative results, challenging or inaccessible biopsy sites, and the inability to synchronously and serially assess all metastatic sites to identify spatial and/or temporal ER heterogeneity. In May 2020, after decades of research, the U.S. Food and Drug Administration approved the PET radiotracer fluorine 18 (18F) fluoroestradiol (FES) for clinical use in patients with ER-positive recurrent or metastatic breast cancer as an adjunct to biopsy. FES binds to the ER in the nucleus of ER-expressing cells, enabling whole-body in vivo assessment of ER expression. This article is focused on the approved uses of FES in the United States, including identification of a target lesion for confirmatory biopsy, in vivo assessment of biopsy-proven ER-positive disease, and evaluation of spatial and temporal ER heterogeneity. FES is an example of precision medicine that has been leveraged to optimize the care of patients with breast cancer. © RSNA, 2023 See the invited commentary by Fowler in this issue. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Sophia R O'Brien
- From the Department of Radiology, Division of Breast Imaging (S.R.O., C.E.E.) and Division of Nuclear Medicine Imaging and Therapy (S.R.O., S.M.L., J.K.W., D.A.M., A.R.P.), Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein-Radiology Administration, Philadelphia, PA 19104
| | - Christine E Edmonds
- From the Department of Radiology, Division of Breast Imaging (S.R.O., C.E.E.) and Division of Nuclear Medicine Imaging and Therapy (S.R.O., S.M.L., J.K.W., D.A.M., A.R.P.), Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein-Radiology Administration, Philadelphia, PA 19104
| | - Shannon M Lanzo
- From the Department of Radiology, Division of Breast Imaging (S.R.O., C.E.E.) and Division of Nuclear Medicine Imaging and Therapy (S.R.O., S.M.L., J.K.W., D.A.M., A.R.P.), Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein-Radiology Administration, Philadelphia, PA 19104
| | - Joanna K Weeks
- From the Department of Radiology, Division of Breast Imaging (S.R.O., C.E.E.) and Division of Nuclear Medicine Imaging and Therapy (S.R.O., S.M.L., J.K.W., D.A.M., A.R.P.), Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein-Radiology Administration, Philadelphia, PA 19104
| | - David A Mankoff
- From the Department of Radiology, Division of Breast Imaging (S.R.O., C.E.E.) and Division of Nuclear Medicine Imaging and Therapy (S.R.O., S.M.L., J.K.W., D.A.M., A.R.P.), Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein-Radiology Administration, Philadelphia, PA 19104
| | - Austin R Pantel
- From the Department of Radiology, Division of Breast Imaging (S.R.O., C.E.E.) and Division of Nuclear Medicine Imaging and Therapy (S.R.O., S.M.L., J.K.W., D.A.M., A.R.P.), Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein-Radiology Administration, Philadelphia, PA 19104
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Pantel AR, Gitto SB, Makvandi M, Kim H, Medvedv S, Weeks JK, Torigian DA, Hsieh CJ, Ferman B, Latif NA, Tanyi JL, Martin LP, Lanzo SM, Liu F, Cao Q, Mills GB, Doot RK, Mankoff DA, Mach RH, Lin LL, Simpkins F. [18F]FluorThanatrace ([18F]FTT) PET Imaging of PARP-inhibitor Drug-Target Engagement as a Biomarker of Response in Ovarian Cancer, a pilot study. Clin Cancer Res 2022; 29:1515-1527. [PMID: 36441795 DOI: 10.1158/1078-0432.ccr-22-1602] [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] [Received: 06/29/2022] [Revised: 09/26/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Purpose: Poly(ADP-ribose) polymerase enzyme inhibitors (PARPi) have become the standard-of-care treatment for homologous recombination deficient (HRD) high-grade serous ovarian cancer (HGSOC). However, not all HRD tumors respond to PARPi. Biomarkers to predict response are needed. [18F]FluorThanatrace ([18F]FTT) is a PARPi-analog PET radiotracer that non-invasively measures PARP-1 expression. Herein, we evaluate [18F]FTT as a biomarker to predict response to PARPi in patient-derived xenograft (PDX) models and subjects with HRD HGSOC. Methods: In PDX models, [18F]FTT-PET was performed before and after PARPi (olaparib), ataxia-telangiectasia inhibitor (ATRi), or both (PARPi-ATRi). Changes in [18F]FTT were correlated with tumor volume changes. Subjects were imaged with [18F]FTT-PET at baseline and after ~1 week of PARPi. Changes in [18F]FTT-PET uptake were compared to changes in tumor size (RECIST1.1), CA-125, and progression-free survival (PFS). Results: A decrease in [18F]FTT tumor uptake after PARPi correlated with response to PARPi, or PARPi-ATRi treatment in PARPi-resistant PDX models (r=0.77-0.81). In subjects (n=11), percent difference in [18F]FTT-PET after ~7 days of PARPi compared to baseline correlated with best RECIST response (P=0.01), best CA-125 response (P=0.033), and PFS (P=0.027). All subjects with >50% reduction in [18F]FTT uptake had >6-month PFS and >50% reduction in CA-125. Utilizing only baseline [18F]FTT uptake did not predict such responses. Conclusions: The decline in [18F]FTT uptake shortly after PARPi initiation provides a measure of drug-target engagement and shows promise as a biomarker to guide PARPi therapies in this pilot study. These results support additional pre-clinical mechanistic and clinical studies in subjects receiving PARPi +/- combination therapy.
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Affiliation(s)
| | | | - Mehran Makvandi
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Hyoung Kim
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Sergey Medvedv
- University of Pennsylvania, Philadelphia, PA, United States
| | | | - Drew A. Torigian
- Hospital of the University of Pennsylvania, Philadelphia, United States
| | - Chia-Ju Hsieh
- University of Pennsylvania, Philadelphia, United States
| | - Benjamin Ferman
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Nawar A. Latif
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Janos L. Tanyi
- Hospital of the University of Pennsylvania, United States
| | - Lainie P. Martin
- University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, United States
| | | | - Fang Liu
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Quy Cao
- Perleman University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | | | - Robert K. Doot
- University of Pennsylvania, Philadelphia, PA, United States
| | | | - Robert H. Mach
- University of Pennsylvania, Philadelphia, PA, United States
| | - Lilie L. Lin
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Singh A, Horng H, Roshkovan L, Weeks JK, Hershman M, Noël P, Luna JM, Cohen EA, Pantalone L, Shinohara RT, Bauml JM, Thompson JC, Aggarwal C, Carpenter EL, Katz SI, Kontos D. Development of a robust radiomic biomarker of progression-free survival in advanced non-small cell lung cancer patients treated with first-line immunotherapy. Sci Rep 2022; 12:9993. [PMID: 35705618 PMCID: PMC9200843 DOI: 10.1038/s41598-022-14160-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/05/2022] [Indexed: 12/03/2022] Open
Abstract
We aim to determine the feasibility of a novel radiomic biomarker that can integrate with other established clinical prognostic factors to predict progression-free survival (PFS) in patients with non-small cell lung cancer (NSCLC) undergoing first-line immunotherapy. Our study includes 107 patients with stage 4 NSCLC treated with pembrolizumab-based therapy (monotherapy: 30%, combination chemotherapy: 70%). The ITK-SNAP software was used for 3D tumor volume segmentation from pre-therapy CT scans. Radiomic features (n = 102) were extracted using the CaPTk software. Impact of heterogeneity introduced by image physical dimensions (voxel spacing parameters) and acquisition parameters (contrast enhancement and CT reconstruction kernel) was mitigated by resampling the images to the minimum voxel spacing parameters and harmonization by a nested ComBat technique. This technique was initialized with radiomic features, clinical factors of age, sex, race, PD-L1 expression, ECOG status, body mass index (BMI), smoking status, recurrence event and months of progression-free survival, and image acquisition parameters as batch variables. Two phenotypes were identified using unsupervised hierarchical clustering of harmonized features. Prognostic factors, including PDL1 expression, ECOG status, BMI and smoking status, were combined with radiomic phenotypes in Cox regression models of PFS and Kaplan Meier (KM) curve-fitting. Cox model based on clinical factors had a c-statistic of 0.57, which increased to 0.63 upon addition of phenotypes derived from harmonized features. There were statistically significant differences in survival outcomes stratified by clinical covariates, as measured by the log-rank test (p = 0.034), which improved upon addition of phenotypes (p = 0.00022). We found that mitigation of heterogeneity by image resampling and nested ComBat harmonization improves prognostic value of phenotypes, resulting in better prediction of PFS when added to other prognostic variables.
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Affiliation(s)
- Apurva Singh
- Department of Radiology, Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Rm D702 Richards Bldg., 3700 Hamilton Walk, Philadelphia, PA, 19104, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Hannah Horng
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Leonid Roshkovan
- Department of Radiology, Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Rm D702 Richards Bldg., 3700 Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Joanna K Weeks
- Department of Radiology, Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Rm D702 Richards Bldg., 3700 Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Michelle Hershman
- Department of Radiology, Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Rm D702 Richards Bldg., 3700 Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Peter Noël
- Department of Radiology, Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Rm D702 Richards Bldg., 3700 Hamilton Walk, Philadelphia, PA, 19104, USA
| | - José Marcio Luna
- Department of Radiology, Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Rm D702 Richards Bldg., 3700 Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Eric A Cohen
- Department of Radiology, Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Rm D702 Richards Bldg., 3700 Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Lauren Pantalone
- Department of Radiology, Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Rm D702 Richards Bldg., 3700 Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Russell T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Joshua M Bauml
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jeffrey C Thompson
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Medicine, Pulmonary, Allergy and Critical Care Medicine, Thoracic Oncology Group, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Charu Aggarwal
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Erica L Carpenter
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sharyn I Katz
- Department of Radiology, Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Rm D702 Richards Bldg., 3700 Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Despina Kontos
- Department of Radiology, Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Rm D702 Richards Bldg., 3700 Hamilton Walk, Philadelphia, PA, 19104, USA.
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Weeks JK, O’Brien SR, Rosenspire KC, Dubroff JG, Pantel AR. Evolving Bilateral Hypermetabolic Axillary Lymphadenopathy on FDG PET/CT Following 2-Dose COVID-19 Vaccination. Clin Nucl Med 2021; 46:1011-1012. [PMID: 34735411 PMCID: PMC8575109 DOI: 10.1097/rlu.0000000000003711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 50-year-old woman with stage IV sigmoid adenocarcinoma presented for restaging FDG PET/CT status post neoadjuvant chemotherapy/immunotherapy and diverting sigmoid colostomy. FDG PET/CT demonstrated FDG uptake in the known sigmoid mass and in abdominopelvic lymph node metastases. Bilateral, asymmetric, hypermetabolic axillary lymphadenopathy was also observed, an atypical pattern of spread for colon cancer. Further investigation revealed the patient had received both doses of COVID-19 vaccine in the 2 months prior to presentation. The authors discuss immunogenic nodal hypermetabolism following vaccination against COVID-19 and incorporating vaccination history to aid in PET/CT interpretation, especially in malignancies involving the axillae.
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Affiliation(s)
| | | | - Karen C. Rosenspire
- Division of Nuclear Medicine Imaging and Therapy, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jacob G. Dubroff
- Division of Nuclear Medicine Imaging and Therapy, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Austin R. Pantel
- Division of Nuclear Medicine Imaging and Therapy, Hospital of the University of Pennsylvania, Philadelphia, PA
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Weeks JK, Pakpoor J, Park BJ, Robinson NJ, Rubinstein NA, Prouty SM, Nachiappan AC. Harnessing Augmented Reality and CT to Teach First-Year Medical Students Head and Neck Anatomy. Acad Radiol 2021; 28:871-876. [PMID: 32828663 DOI: 10.1016/j.acra.2020.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 03/24/2020] [Revised: 06/30/2020] [Accepted: 07/05/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES Three-dimensional (3D) visualization has been shown to benefit new generations of medical students and physicians-in-training in a variety of contexts. However, there is limited research directly comparing student performance after using 3D tools to those using two-dimensional (2D) screens. MATERIALS AND METHODS A CT was performed on a donated cadaver and a 3D CT hologram was created. A total of 30 first-year medical students were randomly assigned into two groups to review head and neck anatomy in a teaching session that incorporated CT. The first group used an augmented reality headset, while the second group used a laptop screen. The students were administered a five-question anatomy test before and after the session. Two-tailed t-tests were used for statistical comparison of pretest and posttest performance within and between groups. A feedback survey was distributed for qualitative data. RESULTS Pretest vs. posttest comparison of average percentage of questions answered correctly demonstrated both groups showing significant in-group improvement (p < 0.05), from 59% to 95% in the augmented reality group, and from 57% to 80% in the screen group. Between-group analysis indicated that posttest performance was significantly better in the augmented reality group (p = 0.022, effect size = 0.73). CONCLUSION Immersive 3D visualization has the potential to improve short-term anatomic recall in the head and neck compared to traditional 2D screen-based review, as well as engage millennial learners to learn better in anatomy laboratory. Our findings may reflect additional benefit gained from the stereoscopic depth cues present in augmented reality-based visualization.
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Affiliation(s)
- Joanna K Weeks
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Suite 130, Philadelphia, PA
| | - Jina Pakpoor
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Suite 130, Philadelphia, PA
| | - Brian J Park
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Suite 130, Philadelphia, PA
| | - Nicole J Robinson
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Neal A Rubinstein
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stephen M Prouty
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Arun C Nachiappan
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Suite 130, Philadelphia, PA.
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Park BJ, Weeks JK, Pakpoor J, Nachiappan AC. Response to Letter to the Editor: Augmented Reality and Mixed Reality Head-Mounted Displays for Anatomy Education. Acad Radiol 2021; 28:889. [PMID: 33820703 DOI: 10.1016/j.acra.2021.01.037] [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] [Received: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 10/21/2022]
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Wong TT, Weeks JK, Ahmed FS, Francescone MA, Rasiej MJ, Liu MZ, Kazam JK. How Many Radiographs Does It Take to Screen for Femoral Cam Morphology?: A Noninferiority Study. Curr Probl Diagn Radiol 2019; 50:48-53. [PMID: 31351696 DOI: 10.1067/j.cpradiol.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 06/28/2019] [Accepted: 07/11/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare a 2-view radiograph series (AP of the pelvis and 45° Dunn of the hip) with a 5-view radiograph series for sensitivity in identifying femoral cam morphology. MATERIALS AND METHODS This is a retrospective review of consecutive patients with a 5-view radiograph series (AP pelvis and AP, 45° Dunn, frog lateral, and false profile of the affected hip) from 2016 to 2017. Three fellowship trained radiologists blindly and independently evaluated 2 views (AP pelvis and Dunn) for a femoral cam lesion, acetabular rim calcification, Tonnis grade, and important incidental findings. Two weeks later, the same assessment was made on all 5 views. A noninferiority test of the 2-view series vs the 5-view series for sensitivity in identifying femoral cam morphology was conducted. Individual reader sensitivity calculations were performed and agreement was determined with the kappa statistic. RESULTS The 2-view series was noninferior to the 5-view series for cam identification (P value = 0.010). In comparing the 2-view vs 5-view series for individual readers, there was no difference in the sensitivities (84%-100% vs 85%-98%, P = 0.85-1.0) or specificities (11%-56% vs 7%-56%, P = 0.58-1.0) for cam identification. There was fair to excellent 2-view intrareader agreement (k = 0.38-0.93) and similar inter-reader agreement between the 2-view and 5-view (k = 0.33 vs 0.37). CONCLUSIONS A 2-view radiograph series (AP pelvis and Dunn hip) is noninferior to a 5-view radiograph series for sensitivity in identifying femoral cam morphology.
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Affiliation(s)
- Tony T Wong
- New York Presbyterian Hospital, Columbia University Medical Center, Department of Radiology, New York NY.
| | - Joanna K Weeks
- New York Presbyterian Hospital, Columbia University Medical Center, Department of Radiology, New York NY
| | - Firas S Ahmed
- New York Presbyterian Hospital, Columbia University Medical Center, Department of Radiology, New York NY
| | - Mark A Francescone
- New York Presbyterian Hospital, Columbia University Medical Center, Department of Radiology, New York NY
| | - Michael J Rasiej
- New York Presbyterian Hospital, Columbia University Medical Center, Department of Radiology, New York NY
| | - Michael Z Liu
- New York Presbyterian Hospital, Columbia University Medical Center, Department of Radiology, New York NY
| | - Jonathan K Kazam
- New York Presbyterian Hospital Brooklyn Methodist, Department of Radiology, Brooklyn, NY
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11
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Simpson DT, Teague MS, Weeks JK, Lewis AD, D'Addio PM, Moore JD, Thompson JA, Harris AC, Cannella RT, Kaup BZ, Kerscher O, Leu M. Broad, Multi-Year Sampling Effort Highlights Complex Dynamics of the Tick-Borne Pathogen Ehrlichia chaffeensis (Rickettsiales: Anaplasmatacae). J Med Entomol 2019; 56:162-168. [PMID: 30295826 DOI: 10.1093/jme/tjy171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Indexed: 06/08/2023]
Abstract
Ehrlichia chaffeensis (Rickettsiales: Anaplasmatacae), an understudied bacterial pathogen emerging in the eastern United States, is increasing throughout the range of its vector, the lone star tick [Amblyomma americanum, L. (Acari: Ixodidae)]. To mitigate human disease risk, we must understand what factors drive E. chaffeensis prevalence. Here, we report patterns of E. chaffeensis prevalence in southeastern Virginia across 4 yr and ask how seasonal weather patterns affect variation in rates of E. chaffeensis occurrence. We collected A. americanum nymphs at 130 plots across southeastern Virginia in 2012, 2013, 2015, and 2016, and used polymerase chain reaction and gel electrophoresis to test for the presence of E. chaffeensis DNA. Prevalence estimates varied among years, ranging from 0.9% to 3.7%, and persistence of E. chaffeensis occurrence varied across space, with some sites never testing positive, and one site testing positive every year. Using generalized linear mixed-effects models, we related E. chaffeensis occurrence to temperature, humidity, vapor-pressure deficit, and precipitation during seasons up to 21 mo prior to sampling. Surprisingly, all support was lent to a positive effect of temperature during the previous fall and winter (i.e., prior to the nymphs' hatching), which we hypothesize to influence reservoir host population dynamics through changes to mortality or natality. Although further work is necessary to truly elucidate the mechanisms at play, our study shows E. chaffeensis distribution to be very dynamic across multiple dimensions, demanding broad concerted monitoring efforts that can consider both space and time.
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Affiliation(s)
| | | | | | | | | | - Julia D Moore
- Biology Department, William & Mary, Williamsburg, VA
| | - Joseph A Thompson
- Biology Department, William & Mary, Williamsburg, VA
- VHB Vanasse Hangen Brustlin, 351 McLaws Circle, Suite, Williamsburg, VA
| | - Alan C Harris
- Biology Department, William & Mary, Williamsburg, VA
- Department of Anatomy and Neurobiology, Virginia Commonwealth University School of Medicine, E. Marshall Street, Richmond, VA
| | | | - Brent Z Kaup
- Department of Sociology, William & Mary, Williamsburg, VA
| | | | - Matthias Leu
- Biology Department, William & Mary, Williamsburg, VA
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12
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Abstract
Venous aneurysms are benign vascular lesions usually located in the neck, lower extremity, and abdomen, but rarely in the upper extremity. There may be a mistake or delay in diagnosis because they are uncommon. We report a case of a healthy 54-year-old man who had a cephalic venous aneurysm in his wrist that grew slowly over 20 years. The diagnosis was made on MRI and confirmed with excisional surgery. Radiologists should consider venous aneurysms in the differential when evaluating soft tissue masses as they will often be the first to make the correct diagnosis.
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Affiliation(s)
- Joanna K Weeks
- Department of Radiology, New York-Presbyterian Hospital at Columbia University, 622 West 168th St., MC-28, New York, NY 10032, USA
| | - Robert J Strauch
- Department of Orthopedic Surgery, New York-Presbyterian Hospital at Columbia University, 622 West 168th Street, PH 11-1119, New York, NY 10032, USA
| | - Renu K Virk
- Department of Pathology and Cell Biology, New York-Presbyterian Hospital at Columbia University, 630 West 168th Street, PH Stem 15-124, New York, NY 10032, USA
| | - Tony T Wong
- Department of Radiology, New York-Presbyterian Hospital at Columbia University, 622 West 168th St., MC-28, New York, NY 10032, USA.
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Weeks JK, Helton KJ, Conley ME, Onciu M, Khan RB. Diffuse CNS vasculopathy with chronic Epstein-Barr virus infection in X-linked lymphoproliferative disease. AJNR Am J Neuroradiol 2006; 27:884-6. [PMID: 16611784 PMCID: PMC8133978] [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: 05/08/2023]
Abstract
We report a patient with X-linked lymphoproliferative disease (XLP) who developed multiple central nervous system (CNS) manifestations of Epstein-Barr virus infection. XLP, or Duncan syndrome, is a rare inherited disorder characterized by the inability to clear Epstein-Barr virus infection. In addition to Epstein-Barr virus encephalitis, CNS lymphoproliferative disease, and lymphoma, this patient also developed MR angiographic evidence of diffuse fusiform aneurysmal dilation of intracranial vessels.
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Affiliation(s)
- J K Weeks
- Department of Radiological Sciences, St Jude Children's Research Hospital, Memphis, TN 38105-3300, USA
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14
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Wadkins RM, Morton CL, Weeks JK, Oliver L, Wierdl M, Danks MK, Potter PM. Structural constraints affect the metabolism of 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxycamptothecin (CPT-11) by carboxylesterases. Mol Pharmacol 2001; 60:355-62. [PMID: 11455023 DOI: 10.1124/mol.60.2.355] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [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: 11/22/2022] Open
Abstract
7-Ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxycamptothecin [CPT-11 (irinotecan)] is a water-soluble camptothecin-derived prodrug that is activated by esterases to yield the potent topoisomerase I poison SN-38. We identified a rabbit liver carboxylesterase (CE) that was very efficient at CPT-11 metabolism; however, a human homolog that was more than 81% identical to this protein activated the drug poorly. Recently, two other human CEs have been isolated that are efficient in the conversion of CPT-11 to SN-38, yet both demonstrate little homology to the rabbit protein. To understand this phenomenon, we have characterized a series of esterases from human and rabbit, including several chimeric proteins, for their ability to metabolize CPT-11. Computer predictive modeling indicated that the ability of each enzyme to activate CPT-11 was dependent on the size of the entrance to the active site. Kinetic studies with a series of nitrophenyl and naphthyl esters confirmed these predictions, indicating that activation of CPT-11 by a CE is constrained by size-limited access of the drug to the active site catalytic amino acid residues.
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Affiliation(s)
- R M Wadkins
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Wierdl M, Morton CL, Weeks JK, Danks MK, Harris LC, Potter PM. Sensitization of human tumor cells to CPT-11 via adenoviral-mediated delivery of a rabbit liver carboxylesterase. Cancer Res 2001; 61:5078-82. [PMID: 11431344] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Irinotecan, 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxycamptothecin (CPT-11) is activated by carboxylesterases (CE) to yield the potent topoisomerase I inhibitor, SN-38. We have demonstrated previously that a rabbit liver CE is approximately 100-1000-fold more efficient at drug activation than a highly homologous human CE. In an attempt to use rabbit CE expression in combination with CPT-11 for gene therapy approaches for the treatment of cancer, we have developed an adenoviral vector expressing this intracellular CE. After transduction, this virus produces very high levels of CE activity in a panel of human tumor cell lines and results in marked sensitization to CPT-11 of all of the transduced cells. Reductions in IC(50) values for this drug ranged from 11-127-fold. Additionally, comparison with an adenovirus expressing a secreted form of the rabbit CE indicated that a collateral effect could be achieved with reductions in the IC(50) values ranging from 4-19-fold. These data suggest that the described reagents may be suitable for use in vivo in a viral-directed enzyme prodrug therapy approach using CPT-11.
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Affiliation(s)
- M Wierdl
- Department of Molecular Pharmacology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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