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Blakkisrud J, Peterson AB, Wildermann SJ, Kingkiner G, Wong KK, Wang C, Frey KA, Stokke C, Dewaraja YK. SPECT/CT Image-Derived Absorbed Dose to Red Marrow Correlates with Hematologic Toxicity in Patients Treated with [ 177Lu]Lu-DOTATATE. J Nucl Med 2024; 65:753-760. [PMID: 38548350 PMCID: PMC11064826 DOI: 10.2967/jnumed.123.266843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/21/2024] [Indexed: 05/03/2024] Open
Abstract
Hematologic toxicity, although often transient, is the most common limiting adverse effect during somatostatin peptide receptor radionuclide therapy. This study investigated the association between Monte Carlo-derived absorbed dose to the red marrow (RM) and hematologic toxicity in patients being treated for their neuroendocrine tumors. Methods: Twenty patients each receiving 4 treatment cycles of [177Lu]Lu-DOTATATE were included. Multiple-time-point 177Lu SPECT/CT imaging-based RM dosimetry was performed using an artificial intelligence-driven workflow to segment vertebral spongiosa within the field of view (FOV). This workflow was coupled with an in-house macroscale/microscale Monte Carlo code that incorporates a spongiosa microstructure model. Absorbed dose estimates to RM in lumbar and thoracic vertebrae within the FOV, considered as representations of the whole-body RM absorbed dose, were correlated with hematologic toxicity markers at about 8 wk after each cycle and at 3- and 6-mo follow-up after completion of all cycles. Results: The median of absorbed dose to RM in lumbar and thoracic vertebrae within the FOV (D median,vertebrae) ranged from 0.019 to 0.11 Gy/GBq. The median of cumulative absorbed dose across all 4 cycles was 1.3 Gy (range, 0.6-2.5 Gy). Hematologic toxicity was generally mild, with no grade 2 or higher toxicity for platelets, neutrophils, or hemoglobin. However, there was a decline in blood counts over time, with a fractional value relative to baseline at 6 mo of 74%, 97%, 57%, and 97%, for platelets, neutrophils, lymphocytes, and hemoglobin, respectively. Statistically significant correlations were found between a subset of hematologic toxicity markers and RM absorbed doses, both during treatment and at 3- and 6-mo follow-up. This included a correlation between the platelet count relative to baseline at 6-mo follow up: D median,vertebrae (r = -0.64, P = 0.015), D median,lumbar (r = -0.72, P = 0.0038), D median,thoracic (r = -0.58, P = 0.029), and D average,vertebrae (r = -0.66, P = 0.010), where D median,lumbar and D median,thoracic are median absorbed dose to the RM in the lumbar and thoracic vertebrae, respectively, within the FOV and D average,vertebrae is the mass-weighted average absorbed dose of all vertebrae. Conclusion: This study found a significant correlation between image-derived absorbed dose to the RM and hematologic toxicity, including a relative reduction of platelets at 6-mo follow up. These findings indicate that absorbed dose to the RM can potentially be used to understand and manage hematologic toxicity in peptide receptor radionuclide therapy.
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Affiliation(s)
- Johan Blakkisrud
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Michigan;
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
| | - Avery B Peterson
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiation Oncology, Wayne State University, Detroit, Michigan
| | - Scott J Wildermann
- Department of Nuclear Engineering and Radiologic Science, University of Michigan, Ann Arbor, Michigan
| | - Griffen Kingkiner
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Ka Kit Wong
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Chang Wang
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan; and
| | - Kirk A Frey
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Caroline Stokke
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - Yuni K Dewaraja
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Else T, Wong KK, Frey KA, Brooks AF, Viglianti BL, Raffel DM. 3-[ 18F]Fluoro- para-hydroxyphenethylguanidine (3-[ 18F]pHPG) PET-A Novel Imaging Modality for Paraganglioma. J Endocr Soc 2024; 8:bvae049. [PMID: 38617812 PMCID: PMC11010306 DOI: 10.1210/jendso/bvae049] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Indexed: 04/16/2024] Open
Abstract
Context Functional positron emission tomography (PET) imaging for the characterization of pheochromocytoma and paraganglioma (PCC/PGL) and for detection of metastases in malignant disease, offers valuable clinical insights that can significantly guide patient treatment. Objective This work aimed to evaluate a novel PET radiotracer, 3-[18F]fluoro-para-hydroxyphenethylguanidine (3-[18F]pHPG), a norepinephrine analogue, for its ability to localize PCC/PGL. Methods 3-[18F]pHPG PET/CT whole-body scans were performed on 16 patients (8 male:8 female; mean age 47.6 ± 17.6 years; range, 19-74 years) with pathologically confirmed or clinically diagnosed PCC/PGL. After intravenous administration of 304 to 475 MBq (8.2-12.8 mCi) of 3-[18F]pHPG, whole-body PET scans were performed at 90 minutes in all patients. 3-[18F]pHPG PET was interpreted for abnormal findings consistent with primary tumor or metastasis, and biodistribution in normal organs recorded. Standardized uptake value (SUV) measurements were obtained for target lesions and physiological organ distributions. Results 3-[18F]pHPG PET showed high radiotracer uptake and trapping in primary tumors, and metastatic tumor lesions that included bone, lymph nodes, and other solid organ sites. Physiological biodistribution was universally present in salivary glands (parotid, submandibular, sublingual), thyroid, heart, liver, adrenals, kidneys, and bladder. Comparison [68Ga]DOTATATE PET/CT was available in 10 patients and in all cases showed concordant distribution. Comparison [123I]meta-iodobenzylguanidine [123I]mIBG planar scintigraphy and SPECT/CT scans were available for 4 patients, with 3-[18F]pHPG showing a greater number of metastatic lesions. Conclusion We found the kinetic profile of 3-[18F]pHPG PET affords high activity retention within benign and metastatic PCC/PGL. Therefore, 3-[18F]pHPG PET imaging provides a novel modality for functional imaging and staging of malignant paraganglioma with advantages of high lesion affinity, whole-body coregistered computed tomography, and rapid same-day imaging.
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Affiliation(s)
- Tobias Else
- Endocrinology, Metabolism, and Diabetes, University of Michigan, Ann Arbor, MI 48109-5674, USA
| | - Ka Kit Wong
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI 48109-0028, USA
| | - Kirk A Frey
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI 48109-0028, USA
| | - Allen F Brooks
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI 48109-0028, USA
| | - Benjamin L Viglianti
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI 48109-0028, USA
| | - David M Raffel
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI 48109-0028, USA
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Wang C, Peterson AB, Wong KK, Roseland ME, Schipper MJ, Dewaraja YK. Single-Time-Point Imaging for Dosimetry After [ 177Lu]Lu-DOTATATE: Accuracy of Existing Methods and Novel Data-Driven Models for Reducing Sensitivity to Time-Point Selection. J Nucl Med 2023; 64:1463-1470. [PMID: 37500260 PMCID: PMC10478823 DOI: 10.2967/jnumed.122.265338] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/27/2023] [Indexed: 07/29/2023] Open
Abstract
Estimation of the time-integrated activity (TIA) for dosimetry from imaging at a single time point (STP) facilitates the clinical translation of dosimetry-guided radiopharmaceutical therapy. However, the accuracy of the STP methods for TIA estimation varies on the basis of time-point selection. We constructed patient data-driven regression models to reduce the sensitivity to time-point selection and to compare these new models with commonly used STP methods. Methods: SPECT/CT performed at time period (TP) 1 (3-5 h), TP2 (days 1-2), TP3 (days 3-5), and TP4 (days 6-8) after cycle 1 of [177Lu]Lu-DOTATATE therapy involved 27 patients with 100 segmented tumors and 54 kidneys. Influenced by the previous physics-based STP models of Madsen et al. and Hänscheid et al., we constructed an STP prediction expression, TIA = A(t) × g(t), in a SPECT data-driven way (model 1), in which A(t) is the observed activity at imaging time t, and the curve, g(t), is estimated with a nonparametric generalized additive model by minimizing the normalized mean square error relative to the TIA derived from 4-time-point SPECT (reference TIA). Furthermore, we fit a generalized additive model that incorporates baseline biomarkers as auxiliary data in addition to the single activity measurement (model 2). Leave-one-out cross validation was performed to evaluate STP models using mean absolute error (MAE) and mean square error between the predicted and reference TIA. Results: At days 3-5, all evaluated STP methods performed very well, with an MAE of less than 7% (between-patient SD of <10%) for both kidneys and tumors. At other TPs, the Madsen method and data-driven models 1 and 2 performed reasonably well (MAEs < 17% for kidneys and < 32% for tumors), whereas the error with the Hänscheid method was substantially higher. The proof of concept of adding baseline biomarkers to the prediction model was demonstrated and showed a moderate enhancement at TP1, especially for estimating kidney TIA (MAE ± SD from 15.6% ± 1.3% to 11.8% ± 1.0%). Evaluations on 500 virtual patients using clinically relevant time-activity simulations showed a similar performance. Conclusion: The performance of the Madsen method and proposed data-driven models is less sensitive to TP selection than is the Hänscheid method. At the earliest TP, which is the most practical, the model incorporating baseline biomarkers outperforms other methods that rely only on the single activity measurement.
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Affiliation(s)
- Chang Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan;
| | - Avery B Peterson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiation Oncology, Wayne State University, Detroit, Michigan; and
| | - Ka Kit Wong
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Molly E Roseland
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Matthew J Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Yuni K Dewaraja
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Allen SG, Rosen BS, Aryal M, Cao Y, Schipper MJ, Wong KK, Casper KA, Chinn SB, Malloy KM, Prince ME, Rosko AJ, Shuman AG, Spector ME, Stucken CL, Swiecicki PL, Worden FP, Brenner JC, Schonewolf CA, Elliott DA, Mierzwa ML, Shah JL. Initial Feasibility and Acute Toxicity Outcomes From a Phase 2 Trial of 18F-Fluorodeoxyglucose Positron Emission Tomography Response-Based De-escalated Definitive Chemoradiotherapy for p16+ Oropharynx Cancer: A Planned Interim Analysis. Int J Radiat Oncol Biol Phys 2023; 117:171-180. [PMID: 36931572 DOI: 10.1016/j.ijrobp.2023.03.043] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
PURPOSE 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) parameters are prognostic of oncologic outcomes in human papillomavirus-associated oropharyngeal squamous cell carcinoma (OPSCC). We used FDG-PET imaging biomarkers to select patients for de-escalated chemoradiotherapy (CRT), hypothesizing that acute toxicity will be improved with de-escalation. METHODS AND MATERIALS This is a planned interim initial feasibility and acute toxicity report from a phase 2, prospective, nonrandomized study, which enrolled patients with stage I-II p16+ OPSCC. All patients started definitive CRT to 70 Gy in 35 fractions, and those who met de-escalation criteria on midtreatment FDG-PET at fraction 10 completed treatment at 54 Gy in 27 fractions. We report the acute toxicity and patient-reported outcomes for 59 patients with a minimum follow-up of 3 months. RESULTS There were no statistically significant differences between baseline patient characteristics in the standard and de-escalated cohorts. There were 28 of 59 (47.5%) patients who met FDG-PET de-escalation criteria and collectively received 20% to 30% less dose to critical organs at risk known to affect toxicity. At 3 months posttreatment, patients who received de-escalated CRT lost significantly less weight (median, 5.8% vs 13.0%; P < .001), had significantly less change from baseline in penetration-aspiration scale score (median, 0 vs 1; P = .018), and had significantly fewer aspiration events on repeat swallow study (8.0% vs 33.3%, P = .037) compared with patients receiving standard CRT. CONCLUSIONS Approximately half of patients with early-stage p16+ OPSCC are selected for de-escalation of definitive CRT using midtreatment FDG-PET biomarkers, which resulted in significantly improved rates of observed acute toxicity. Further follow-up is ongoing and will be required to determine whether this de-escalation approach preserves the favorable oncologic outcomes for patients with p16+ OPSCC before adoption.
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Affiliation(s)
- Steven G Allen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Benjamin S Rosen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Madhava Aryal
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Yue Cao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Matthew J Schipper
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Ka Kit Wong
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mark E Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan; Surgery Services-ENT Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Paul L Swiecicki
- Department of Internal Medicine, Division of Medical Oncology, University of Michigan, Ann Arbor, Michigan
| | - Francis P Worden
- Department of Internal Medicine, Division of Medical Oncology, University of Michigan, Ann Arbor, Michigan
| | - J Chad Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - David A Elliott
- Radiation Oncology Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jennifer L Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Radiation Oncology Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
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Akhavanallaf A, Peterson AB, Fitzpatrick K, Roseland M, Wong KK, El-Naqa I, Zaidi H, Dewaraja YK. The predictive value of pretherapy [ 68Ga]Ga-DOTA-TATE PET and biomarkers in [ 177Lu]Lu-PRRT tumor dosimetry. Eur J Nucl Med Mol Imaging 2023; 50:2984-2996. [PMID: 37171633 PMCID: PMC10981963 DOI: 10.1007/s00259-023-06252-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Metastatic neuroendocrine tumors (NETs) overexpressing type 2 somatostatin receptors are the target for peptide receptor radionuclide therapy (PRRT) through the theragnostic pair of 68Ga/177Lu-DOTATATE. The main purpose of this study was to develop machine learning models to predict therapeutic tumor dose using pre therapy 68Ga -PET and clinicopathological biomarkers. METHODS We retrospectively analyzed 90 segmented metastatic NETs from 25 patients (M14/F11, age 63.7 ± 9.5, range 38-76) treated by 177Lu-DOTATATE at our institute. Patients underwent both pretherapy [68Ga]Ga-DOTA-TATE PET/CT and four timepoints SPECT/CT at ~ 4, 24, 96, and 168 h post-177Lu-DOTATATE infusion. Tumors were segmented by a radiologist on baseline CT or MRI and transferred to co-registered PET/CT and SPECT/CT, and normal organs were segmented by deep learning-based method on CT of the PET and SPECT. The SUV metrics and tumor-to-normal tissue SUV ratios (SUV_TNRs) were calculated from 68Ga -PET at the contour-level. Posttherapy dosimetry was performed based on the co-registration of SPECT/CTs to generate time-integrated-activity, followed by an in-house Monte Carlo-based absorbed dose estimation. The correlation between delivered 177Lu Tumor absorbed dose and PET-derived metrics along with baseline clinicopathological biomarkers (such as Creatinine, Chromogranin A and prior therapies) were evaluated. Multiple interpretable machine-learning algorithms were developed to predict tumor dose using these pretherapy information. Model performance on a nested tenfold cross-validation was evaluated in terms of coefficient of determination (R2), mean-absolute-error (MAE), and mean-relative-absolute-error (MRAE). RESULTS SUVmean showed a significant correlation (q-value < 0.05) with absorbed dose (Spearman ρ = 0.64), followed by TLSUVmean (SUVmean of total-lesion-burden) and SUVpeak (ρ = 0.45 and 0.41, respectively). The predictive value of PET-SUVmean in estimation of posttherapy absorbed dose was stronger compared to PET-SUVpeak, and SUV_TNRs in terms of univariate analysis (R2 = 0.28 vs. R2 ≤ 0.12). An optimal trivariate random forest model composed of SUVmean, TLSUVmean, and total liver SUVmean (normal and tumoral liver) provided the best performance in tumor dose prediction with R2 = 0.64, MAE = 0.73 Gy/GBq, and MRAE = 0.2. CONCLUSION Our preliminary results demonstrate the feasibility of using baseline PET images for prediction of absorbed dose prior to 177Lu-PRRT. Machine learning models combining multiple PET-based metrics performed better than using a single SUV value and using other investigated clinicopathological biomarkers. Developing such quantitative models forms the groundwork for the role of 68Ga -PET not only for the implementation of personalized treatment planning but also for patient stratification in the era of precision medicine.
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Affiliation(s)
- Azadeh Akhavanallaf
- Department of Radiology, University of Michigan, 1301 Catherine, 2276 Medical Science I/5610, Ann Arbor, MI, 48109, USA.
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland.
| | - Avery B Peterson
- Department of Radiology, University of Michigan, 1301 Catherine, 2276 Medical Science I/5610, Ann Arbor, MI, 48109, USA
| | - Kellen Fitzpatrick
- Department of Radiology, University of Michigan, 1301 Catherine, 2276 Medical Science I/5610, Ann Arbor, MI, 48109, USA
| | - Molly Roseland
- Department of Radiology, University of Michigan, 1301 Catherine, 2276 Medical Science I/5610, Ann Arbor, MI, 48109, USA
| | - Ka Kit Wong
- Department of Radiology, University of Michigan, 1301 Catherine, 2276 Medical Science I/5610, Ann Arbor, MI, 48109, USA
| | - Issam El-Naqa
- Department of Machine Learning, Moffitt Cancer Center, Tampa, FL, USA
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland
- Geneva University Neurocenter, Geneva University, CH-1205, Geneva, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, Netherlands
- Department of Nuclear Medicine, University of Southern Denmark, DK-500, Odense, Denmark
| | - Yuni K Dewaraja
- Department of Radiology, University of Michigan, 1301 Catherine, 2276 Medical Science I/5610, Ann Arbor, MI, 48109, USA
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Ali U, Zainal M, Zainol Z, Tai CW, Tang SF, Lee PC, Wong KK. Performance evaluation of two multiplex qualitative RT-PCR assays for detection of respiratory infection in paediatric population. Malays J Pathol 2023; 45:215-227. [PMID: 37658531] [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: 09/03/2023]
Abstract
INTRODUCTION Acute respiratory infection (ARI) contributes to significant mortality and morbidity worldwide and is usually caused by a wide range of respiratory pathogens. This study aims to describe the performance of QIAstat-Dx® Respiratory Panel V2 (RP) and RespiFinder® 2SMART assays for respiratory pathogens detection. MATERIALS AND METHODS A total of 110 nasopharyngeal swabs (NPS) were collected from children aged one month to 12 years old who were admitted with ARI in UKMMC during a one-year period. The two qPCR assays were conducted in parallel. RESULTS Ninety-seven samples (88.2%) were positive by QIAstat-Dx RP and 86 (78.2%) by RespiFinder assay. The overall agreement on both assays was substantial (kappa value: 0.769) with excellent concordance rate of 96.95%. Using both assays, hRV/EV, INF A/H1N1 and RSV were the most common pathogens detected. Influenza A/H1N1 infection was significantly seen higher in older children (age group > 60 months old) (53.3%, p-value < 0.05). Meanwhile, RSV and hRV/EV infection were seen among below one-year-old children. Co-infections by two to four pathogens were detected in 17 (17.5%) samples by QIAstat-Dx RP and 12 (14%) samples by RespiFinder, mainly involving hRV/EV. Bacterial detection was observed only in 5 (4.5%) and 6 (5.4%) samples by QIAstat-Dx RP and RespiFinder, respectively, with Mycoplasma pneumoniae the most common detected. CONCLUSION The overall performance of the two qPCR assays was comparable and showed excellent agreement. Both detected various clinically important respiratory pathogens in a single test with simultaneous multiple infection detection. The use of qPCR as a routine diagnostic test can improve diagnosis and management.
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Affiliation(s)
- U Ali
- Universiti Kebangsaan Malaysia, Department of Medical Microbiology and Immunology, Kuala Lumpur, Malaysia
| | - M Zainal
- Universiti Kebangsaan Malaysia, Department of Medical Microbiology and Immunology, Kuala Lumpur, Malaysia.
| | - Z Zainol
- Universiti Kebangsaan Malaysia, Department of Medical Microbiology and Immunology, Kuala Lumpur, Malaysia
| | - C W Tai
- Universiti Kebangsaan Malaysia, Department of Paediatric, Kuala Lumpur, Malaysia
| | - S F Tang
- Universiti Kebangsaan Malaysia, Department of Paediatric, Kuala Lumpur, Malaysia
| | - P C Lee
- Universiti Kebangsaan Malaysia, Department of Paediatric, Kuala Lumpur, Malaysia
| | - K K Wong
- Universiti Kebangsaan Malaysia, Department of Medical Microbiology and Immunology, Kuala Lumpur, Malaysia
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Yu Q, Falkenhain K, Little JP, Wong KK, Nie J, Shi Q, Kong Z. Effects of ketone supplements on blood β-hydroxybutyrate, glucose and insulin: A systematic review and three-level meta-analysis. Complement Ther Clin Pract 2023; 52:101774. [PMID: 37327753 DOI: 10.1016/j.ctcp.2023.101774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Effects of ketone supplements as well as relevant dose-response relationships and time effects on blood β-hydroxybutyrate (BHB), glucose and insulin are controversial. OBJECTIVE This study aimed to summarize the existing evidence and synthesize the results, and demonstrate underlying dose-response relationships as well as sustained time effects. METHODS Medline, Web of Science, Embase, and Cochrane Central Register of Controlled Trials were searched for relevant randomized crossover/parallel studies published until 25th November 2022. Three-level meta-analysis compared the acute effects of exogenous ketone supplementation and placebo in regulating blood parameters, with Hedge's g used as measure of effect size. Effects of potential moderators were explored through multilevel regression models. Dose-response and time-effect models were established via fractional polynomial regression. RESULTS The meta-analysis with 327 data points from 30 studies (408 participants) indicated that exogenous ketones led to a significant increase in blood BHB (Hedge's g = 1.4994, 95% CI [1.2648, 1.7340]), reduction in glucose (Hedge's g = -0.3796, 95% CI [-0.4550, -0.3041]), and elevation in insulin of non-athlete healthy population (Hedge's g = 0.1214, 95%CI [0.0582, 0.3011]), as well as insignificant change in insulin of obesity and prediabetes. Nonlinear dose-response relationship between ketone dosage and blood parameter change was observed in some time intervals for BHB (30-60 min; >120 min) and insulin (30-60 min; 90-120 min), with linear relationship observed for glucose (>120 min). Nonlinear associations between time and blood parameter change were found in BHB (>550 mg/kg) and glucose (450-550 mg/kg), with linear relationship observed in BHB (≤250 mg/kg) and insulin (350-550 mg/kg). CONCLUSION Dose-response relationships and sustained time effects were observed in BHB, glucose and insulin following ketone supplementation. Glucose-lowering effect without increasing insulin load among population of obesity and prediabetes was of remarkable clinical implication. REGISTRY AND REGISTRY NUMBER PROSPERO (CRD42022360620).
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Affiliation(s)
- Qian Yu
- Faculty of Education, University of Macau, Macao, China
| | - Kaja Falkenhain
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Jonathan P Little
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Ka Kit Wong
- Faculty of Education, University of Macau, Macao, China
| | - Jinlei Nie
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China
| | - Qingde Shi
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China
| | - Zhaowei Kong
- Faculty of Education, University of Macau, Macao, China.
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8
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Peterson AB, Wang C, Wong KK, Frey KA, Muzik O, Schipper MJ, Dewaraja YK. 177Lu-DOTATATE Theranostics: Predicting Renal Dosimetry From Pretherapy 68Ga-DOTATATE PET and Clinical Biomarkers. Clin Nucl Med 2023; 48:393-399. [PMID: 37010563 PMCID: PMC10353839 DOI: 10.1097/rlu.0000000000004599] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Indexed: 04/04/2023]
Abstract
PURPOSE Pretreatment predictions of absorbed doses can be especially valuable for patient selection and dosimetry-guided individualization of radiopharmaceutical therapy. Our goal was to build regression models using pretherapy 68Ga-DOTATATE PET uptake data and other baseline clinical factors/biomarkers to predict renal absorbed dose delivered by 177Lu-DOTATATE peptide receptor radionuclide therapy (177Lu-PRRT) for neuroendocrine tumors. We explore the combination of biomarkers and 68Ga PET uptake metrics, hypothesizing that they will improve predictive power over univariable regression. PATIENTS AND METHODS Pretherapy 68Ga-DOTATATE PET/CTs were analyzed for 25 patients (50 kidneys) who also underwent quantitative 177Lu SPECT/CT imaging at approximately 4, 24, 96, and 168 hours after cycle 1 of 177Lu-PRRT. Kidneys were contoured on the CT of the PET/CT and SPECT/CT using validated deep learning-based tools. Dosimetry was performed by coupling the multi-time point SPECT/CT images with an in-house Monte Carlo code. Pretherapy renal PET SUV metrics, activity concentration per injected activity (Bq/mL/MBq), and other baseline clinical factors/biomarkers were investigated as predictors of the 177Lu SPECT/CT-derived mean absorbed dose per injected activity to the kidneys using univariable and bivariable models. Leave-one-out cross-validation (LOOCV) was used to estimate model performance using root mean squared error and absolute percent error in predicted renal absorbed dose including mean absolute percent error (MAPE) and associated standard deviation (SD). RESULTS The median therapy-delivered renal dose was 0.5 Gy/GBq (range, 0.2-1.0 Gy/GBq). In LOOCV of univariable models, PET uptake (Bq/mL/MBq) performs best with MAPE of 18.0% (SD = 13.3%), and estimated glomerular filtration rate (eGFR) gives an MAPE of 28.5% (SD = 19.2%). Bivariable regression with both PET uptake and eGFR gives LOOCV MAPE of 17.3% (SD = 11.8%), indicating minimal improvement over univariable models. CONCLUSIONS Pretherapy 68Ga-DOTATATE PET renal uptake can be used to predict post-177Lu-PRRT SPECT-derived mean absorbed dose to the kidneys with accuracy within 18%, on average. Compared with PET uptake alone, including eGFR in the same model to account for patient-specific kinetics did not improve predictive power. Following further validation of these preliminary findings in an independent cohort, predictions using renal PET uptake can be used in the clinic for patient selection and individualization of treatment before initiating the first cycle of PRRT.
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Affiliation(s)
- Avery B. Peterson
- Department of Radiology, University of Michigan, Ann Arbor
- Department of Radiation Oncology, Wayne State University, Detroit
| | - Chang Wang
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Ka Kit Wong
- Department of Radiology, University of Michigan, Ann Arbor
| | - Kirk A. Frey
- Department of Radiology, University of Michigan, Ann Arbor
| | - Otto Muzik
- Department of Pediatrics, Wayne State University, Detroit, MI
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Wong KK, Kua KP, Ooi KS, Cheah FC. The effects of N-acetylcysteine on lung alveolar epithelial cells infected with respiratory syncytial virus. Malays J Pathol 2023; 45:43-50. [PMID: 37119245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is one of the most common causes of acute lower respiratory infection in infants and young children. Mucolytic agents, such as acetylcysteine and carbocysteine have reported benefits in alleviating acute upper or lower respiratory infections. Among these, N-acetylcysteine (NAC) has cyto-protective effects when cells are infected with the RSV. MATERIALS AND METHODS Our study investigated primarily the dose-dependent effects of NAC on respiratory alveolar epithelial (A549) cells when co-cultured with RSV in vitro. Three different concentrations of NAC were used, 0.1 mM, 1 mM, and 10 mM. The cytotoxicity of RSV-infected cells was measured by lactate dehydrogenase and antiviral activity of NAC on cell cultures was evaluated by immunofluorescence. RESULTS Pre-treatment with the highest dose, 10 mM NAC, resulted in features of cell injury even without RSV infection. The proportion of cells infected by RSV and RSV-induced cell death decreased by more than 3-fold when cells were pre-treated with 1 mM NAC. Pre-treatment at the lowest dose, 0.1 mM, did not show any significant changes. CONCLUSION A moderate dose of NAC (1 mM) appeared protective of RSV infection to lung alveolar epithelial cells. However, a higher dose of NAC (10 mM) may be relatively toxic and injurious to these cells.
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Affiliation(s)
- K K Wong
- Universiti Kebangsaan Malaysia Medical Centre, Department of Medical Microbiology and Immunology, Kuala Lumpur, Malaysia
| | - K P Kua
- Puchong Health Clinic, Petaling District Health Office, Selangor, Malaysia
| | - K S Ooi
- Universiti Kebangsaan Malaysia Medical Centre, Department of Paediatrics, Kuala Lumpur, Malaysia
| | - F C Cheah
- Universiti Kebangsaan Malaysia Medical Centre, Department of Paediatrics, Kuala Lumpur, Malaysia.
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Abstract
PURPOSE OF REVIEW Thyroid cancers are endocrine neoplasms with diverse gene expression and behavior, for which constantly evolving anatomic and functional imaging/theranostic agents have an essential role for diagnosis, staging, and treatment. RECENT FINDINGS To achieve definitive diagnosis, neck ultrasound and associated risk stratification systems, notably Thyroid Imaging Reporting and Data System (TI-RADS), allow improved thyroid nodule characterization and management guidance. Radioactive iodine-131 (RAI) has long played a role in management of differentiated thyroid cancer (DTC), with recent literature emphasizing its effectiveness for intermediate-high risk cancers, exploring use of dosimetry for personalized medicine, and potential for retreatment with RAI following tumor redifferentiation. Iodine-124 positron emission tomography/computed tomography (PET/CT) has promising application for DTC staging and dosimetry. F18-fluorodeoxyglucose (FDG) PET/CT is used for staging of high risk DTC and identification of noniodine-avid disease recurrences, with metabolic uptake consistently portending poor prognosis. Poorly differentiated and anaplastic thyroid cancers are best assessed with anatomic imaging and F18-FDG PET/ CT, though recent studies show a potential theranostic role for Ga68/Lu177-prostate-specific membrane antigen. Medullary thyroid cancers are evaluated with ultrasound, CT, magnetic resonance imaging, and various positron-emitting radiotracers for PET imaging (F18-DOPA, F18-FDG, and recently Ga68-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-octreotate (DOTATATE)); the latter may enable treatment with Lu177-DOTATATE. SUMMARY Multidisciplinary collaboration is essential to streamline appropriate management, given the wide array of available imaging and new therapies for metabolic and genetically complex cancers.
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Affiliation(s)
- Molly E. Roseland
- Division of Nuclear Medicine, Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Division of Body Imaging, Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Yuni K. Dewaraja
- Division of Nuclear Medicine, Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ka Kit Wong
- Division of Nuclear Medicine, Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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11
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Wong KK, Frey KA, Niedbala J, Kaza RK, Worden FP, Fitzpatrick KJ, Dewaraja YK. Differences in tumor-to-normal organ SUV ratios measured with 68 Ga-DOTATATE PET compared with 177 Lu-DOTATATE SPECT in patients with neuroendocrine tumors. Nucl Med Commun 2022; 43:892-900. [PMID: 35703269 PMCID: PMC9288505 DOI: 10.1097/mnm.0000000000001592] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Our goal is to quantitatively compare radiotracer biodistributions within tumors and major normal organs on pretherapy 68 Ga-DOTATATE PET to post-therapy 177 Lu-DOTATATE single-photon emission computed tomography (SPECT) in patients receiving peptide receptor radionuclide therapy (PRRT). METHODS PET/CT at ~ 60 min postinjection of Ga-68 DOTATATE and research 177 Lu-SPECT/CT imaging ~ at 4 h (SPECT1) and ~ 24 h (SPECT2) post-cycle#1 were available. Manual contours of lesions on baseline CT or MRI were applied to co-registered SPECT/CT and PET/CT followed by deep learning-based CT auto-segmentation of organs. Tumor-to-normal organ ratios (TNR) were calculated from standardized uptake values (SUV) mean and SUV peak for tumor, and SUV mean for non-tumoral liver (nliver), spleen and kidney. RESULTS There were 90 lesons in 24 patients with progressive metastatic neuroendocrine tumor. The correlation between PET and SPECT SUV TNRs were poor/moderate: PET versus SPECT1 R 2 = 0.19, 0.21, 0.29; PET versus SPECT2 R 2 = 0.06, 0.16, 0.33 for TNR nliver ,TNR spleen ,TNR kidney , respectively. Across all patients, the average value of the TNR measured on PET was significantly lower than on SPECT at both time points ( P < 0.001). Using SUV mean for tumor, average TNR values and 95% confidence intervals (CI) were PET: TNR nliver = 3.5 [CI: 3.0-3.9], TNR spleen = 1.3 [CI, 1.2-1.5], TNR kidney = 1.7 [CI: 1.6-1.9]; SPECT1: TNR nliver = 10 [CI: 8.2-11.7], TNR spleen = 2.9 [CI: 2.5-3.4], TNR kidney = 2.8 [CI: 2.3-3.3]; SPECT2: TNR nliver = 16.9 [CI: 14-19.9], TNR spleen = 3.6 [CI: 3-4.2], TNR kidney = 3.6 [CI: 3.0-4.2]. Comparison of PET and SPECT results in a sphere phantom study demonstrated that these differences are not attributed to imaging modality. CONCLUSIONS Differences in TNR exist for the theranostic pair, with significantly higher SUV TNR on 177 Lu SPECT compared with 68 Ga PET. We postulate this phenomenon is due to temporal differences in DOTATATE uptake and internalization in tumor as compared to normal organs.
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Affiliation(s)
- Ka Kit Wong
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Kirk A. Frey
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Jeremy Niedbala
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Ravi K. Kaza
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Francis P. Worden
- Department of Endocrine Oncology, University of Michigan, Ann Arbor, Michigan 48109
| | - Kellen J. Fitzpatrick
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Yuni K. Dewaraja
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
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12
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Dewaraja YK, Mirando DM, Peterson AB, Niedbala J, Millet JD, Mikell JK, Frey KA, Wong KK, Wilderman SJ, Nelson AS. A pipeline for automated voxel dosimetry: application in patients with multi-SPECT/CT imaging following 177Lu peptide receptor radionuclide therapy. J Nucl Med 2022; 63:1665-1672. [PMID: 35422445 PMCID: PMC9635679 DOI: 10.2967/jnumed.121.263738] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Received: 12/21/2021] [Revised: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
Patient-specific dosimetry in radiopharmaceutical therapy (RPT) is impeded by the lack of tools that are accurate and practical for the clinic. Our aims were to construct and test an integrated voxel-level pipeline that automates key components (organ segmentation, registration, dose-rate estimation, and curve fitting) of the RPT dosimetry process and then to use it to report patient-specific dosimetry in 177Lu-DOTATATE therapy. Methods: An integrated workflow that automates the entire dosimetry process, except tumor segmentation, was constructed. First, convolutional neural networks (CNNs) are used to automatically segment organs on the CT portion of one post-therapy SPECT/CT scan. Second, local contour intensity-based SPECT--SPECT alignment results in volume-of-interest propagation to other time points. Third, dose rate is estimated by explicit Monte Carlo (MC) radiation transport using the fast, Dose Planning Method code. Fourth, the optimal function for dose-rate fitting is automatically selected for each voxel. When reporting mean dose, we apply partial-volume correction, and uncertainty is estimated by an empiric approach of perturbing segmentations. Results: The workflow was used with 4-time-point 177Lu SPECT/CT imaging data from 20 patients with 77 neuroendocrine tumors, segmented by a radiologist. CNN-defined kidneys resulted in high Dice values (0.91-0.94) and only small differences (2%-5%) in mean dose when compared with manual segmentation. Contour intensity-based registration led to visually enhanced alignment, and the voxel-level fitting had high R 2 values. Across patients, dosimetry results were highly variable; for example, the average of the mean absorbed dose (Gy/GBq) was 3.2 (range, 0.2-10.4) for lesions, 0.49 (range, 0.24-1.02) for left kidney, 0.54 (range, 0.31-1.07) for right kidney, and 0.51 (range, 0.27-1.04) for healthy liver. Patient results further demonstrated the high variability in the number of cycles needed to deliver hypothetical threshold absorbed doses of 23 Gy to kidney and 100 Gy to tumor. The uncertainty in mean dose, attributable to variability in segmentation, averaged 6% (range, 3%-17%) for organs and 10% (range, 3%-37%) for lesions. For a typical patient, the time for the entire process was about 25 min (∼2 min manual time) on a desktop computer, including time for CNN organ segmentation, coregistration, MC dosimetry, and voxel curve fitting. Conclusion: A pipeline integrating novel tools that are fast and automated provides the capacity for clinical translation of dosimetry-guided RPT.
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Affiliation(s)
- Yuni K Dewaraja
- Department of Radiology, University of Michigan, Ann Arbor, Michigan;
| | | | - Avery B Peterson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiation Oncology, Wayne State University, Detroit, Michigan; and
| | - Jeremy Niedbala
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - John D Millet
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Justin K Mikell
- Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kirk A Frey
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Ka Kit Wong
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Scott J Wilderman
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
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13
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Wong KK, Else T, Viglianti BL, Brooks AF, Frey KA, Raffel DM. PET imaging of metastatic paraganglioma using novel 3-[ 18F]fluoro-para-hydroxyphenethylguanidine (3-[ 18F]pHPG) radiotracer. Eur J Nucl Med Mol Imaging 2022; 49:2098-2099. [PMID: 35089374 DOI: 10.1007/s00259-021-05639-y] [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] [Received: 08/28/2021] [Accepted: 11/24/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Ka Kit Wong
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI, USA.
| | - Tobias Else
- Endocrinology, Metabolism, and Diabetes, University of Michigan Hospital, Ann Arbor, MI, USA
| | | | - Allen F Brooks
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Kirk A Frey
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI, USA
| | - David M Raffel
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI, USA
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14
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Devasia TP, Dewaraja YK, Frey KA, Wong KK, Schipper MJ. A Novel Time-Activity Information-Sharing Approach Using Nonlinear Mixed Models for Patient-Specific Dosimetry with Reduced Imaging Time Points: Application in SPECT/CT After 177Lu-DOTATATE. J Nucl Med 2021; 62:1118-1125. [PMID: 33443063 DOI: 10.2967/jnumed.120.256255] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 09/04/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022] Open
Abstract
Multiple-time-point SPECT/CT imaging for dosimetry is burdensome for patients and lacks statistical efficiency. A novel method for joint kidney time-activity estimation based on a statistical mixed model, a prior cohort of patients with complete time-activity data, and only 1 or 2 imaging points for new patients was compared with previously proposed single-time-point methods in virtual and clinical patient data. Methods: Data were available for 10 patients with neuroendocrine tumors treated with 177Lu-DOTATATE and imaged up to 4 times between days 0 and 7 using SPECT/CT. Mixed models using 1 or 2 time points were evaluated retrospectively in the clinical cohort, using the multiple-time-point fit as the reference. Time-activity data for 250 virtual patients were generated using parameter values from the clinical cohort. Mixed models were fit using 1 (∼96 h) and 2 (4 h, ∼96 h) time points for each virtual patient combined with complete data for the other patients in each dataset. Time-integrated activities (TIAs) calculated from mixed model fits and other reduced-time-point methods were compared with known values. Results: All mixed models and single-time-point methods performed well overall, achieving mean bias < 7% in the virtual cohort. Mixed models exhibited lower bias, greater precision, and substantially fewer outliers than did single-time-point methods. For clinical patients, 1- and 2-time-point mixed models resulted in more accurate TIA estimates for 94% (17/18) and 72% (13/18) of kidneys, respectively. In virtual patients, mixed models resulted in more than a 2-fold reduction in the proportion of kidneys with |bias| > 10% (6% vs. 15%). Conclusion: Mixed models based on a historical cohort of patients with complete time-activity data and new patients with only 1 or 2 SPECT/CT scans demonstrate less bias on average and significantly fewer outliers when estimating kidney TIA, compared with popular reduced-time-point methods. Use of mixed models allows for reduction of the imaging burden while maintaining accuracy, which is crucial for clinical implementation of dosimetry-based treatment.
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Affiliation(s)
- Theresa P Devasia
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan;
| | - Yuni K Dewaraja
- Department of Radiology, University of Michigan, Ann Arbor, Michigan; and
| | - Kirk A Frey
- Department of Radiology, University of Michigan, Ann Arbor, Michigan; and
| | - Ka Kit Wong
- Department of Radiology, University of Michigan, Ann Arbor, Michigan; and
| | - Matthew J Schipper
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
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15
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Abstract
ABSTRACT In addition to gastroenteropancreatic neuroendocrine neoplasms, a wide variety of tumors express somatostatin receptors. Somatostatin receptor imaging, heavily utilized in neuroendocrine oncology, may also have utility in the diagnosis of other neoplasms and raises the possibility of potential therapeutic options. We describe the case of a 60-year-old man who underwent 68Ga-DOTATATE PET/CT, demonstrating an avid invasive pituitary macroadenoma. This mass was persistent and refractory despite traditional treatment options. Because of the avidity, 177Lu-DOTATATE therapy was offered, although not ultimately performed, demonstrating a potential treatment for challenging cases utilizing the principles of theranostics.
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Affiliation(s)
- Noah Lybik
- From the University of Michigan Medical School
| | | | - Ka Kit Wong
- Department of Radiology, University of Michigan
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16
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Kun E, Tsang YTM, Ng CW, Gershenson DM, Wong KK. MEK inhibitor resistance mechanisms and recent developments in combination trials. Cancer Treat Rev 2020; 92:102137. [PMID: 33340965 DOI: 10.1016/j.ctrv.2020.102137] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [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: 09/28/2020] [Revised: 11/26/2020] [Accepted: 11/29/2020] [Indexed: 02/07/2023]
Abstract
The mitogen-activated protein kinase (MAPK) pathway plays a vital role in cellular processes such as gene expression, cell proliferation, cell survival, and apoptosis. Also known as the RAS-RAF-MEK-ERK pathway, the MAPK pathway has been implicated in approximately one-third of all cancers. Mutations in RAS or RAF genes such as KRAS and BRAF are common, and these mutations typically promote malignancies by over-activating MEK and ERK downstream, which drives sustained cell proliferation and uninhibited cell growth. Development of drugs targeting this pathway has been a research area of great interest, especially drugs targeting the inhibition of MEK. In vitro and clinical studies have shown promise for certain MEK inhibitors (MEKi) , and MEKi have become the first treatment option for certain cancers. Despite promising results, not all patients have a response to MEKi, and mechanisms of resistance typically arise in patients who do have a positive initial response. This paper summarizes recent developments regarding MEKi, the mechanisms of adaptive resistance to MEKi, and the potential solutions to the issue of adaptive MEKi resistance.
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Affiliation(s)
- E Kun
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y T M Tsang
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C W Ng
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D M Gershenson
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K K Wong
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
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Farah Izati A, Wong KK, Che Maraina CH. IL-23/IL-17 axis in the pathogenesis and treatment of systemic lupus erythematosus and rheumatoid arthritis. Malays J Pathol 2020; 42:333-347. [PMID: 33361714] [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: 06/12/2023]
Abstract
Interleukin-23 (IL-23) and IL-17 are the gatekeepers of CD4+ T helper 17 (Th17) cells where IL-23 is required for the development and expansion of Th17 cells that subsequently produce IL-17 to promote inflammation. Owing to such pro-inflammatory properties, the IL-23/IL-17 axis has emerged as an important mechanism in the pathogenesis of autoimmune diseases including systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). In recent years, therapeutic antibodies targeting IL-23 (e.g. ustekinumab, tildrakizumab, guselkumab) or IL-17 (e.g. brodalumab, secukinumab, ixekizumab) have been approved for the treatment of various autoimmune diseases. In this review, we describe the pathogenic mechanisms of IL-23/IL-17 axis in SLE and RA, as well as summarising the findings from phase II and III clinical trials of anti-IL-23/IL-17 therapeutic antibodies in SLE and RA patients. In particular, phase II study has demonstrated that the anti-IL-23 antibody (ustekinumab) confers enhanced treatment outcomes in SLE patients, while anti-IL-17 antibodies (secukinumab and ixekizumab) have shown improved clinical benefits for RA patients in phase II/III studies. Our review highlights the emerging importance of targeting the IL-23/IL-17 axis in SLE and RA patients.
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Affiliation(s)
- A Farah Izati
- Universiti Sains Malaysia, School of Medical Sciences, Department of Immunology, 16150 Kubang Kerian, Kelantan, Malaysia.
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18
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Singer MC, Marchal F, Angelos P, Bernet V, Boucai L, Buchholzer S, Burkey B, Eisele D, Erkul E, Faure F, Freitag SK, Gillespie MB, Harrell RM, Hartl D, Haymart M, Leffert J, Mandel S, Miller BS, Morris J, Pearce EN, Rahmati R, Ryan WR, Schaitkin B, Schlumberger M, Stack BC, Van Nostrand D, Wong KK, Randolph G. Salivary and lacrimal dysfunction after radioactive iodine for differentiated thyroid cancer: American Head and Neck Society Endocrine Surgery Section and Salivary Gland Section joint multidisciplinary clinical consensus statement of otolaryngology, ophthalmology, nuclear medicine and endocrinology. Head Neck 2020; 42:3446-3459. [PMID: 32812307 DOI: 10.1002/hed.26417] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/03/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Postoperative radioactive iodine (RAI) administration is widely utilized in patients with differentiated thyroid cancer. While beneficial in select patients, it is critical to recognize the potential negative sequelae of this treatment. The prevention, diagnosis, and management of the salivary and lacrimal complications of RAI exposure are addressed in this consensus statement. METHODS A multidisciplinary panel of experts was convened under the auspices of the American Head and Neck Society Endocrine Surgery and Salivary Gland Sections. Following a comprehensive literature review to assess the current best evidence, this group developed six relevant consensus recommendations. RESULTS Consensus recommendations on RAI were made in the areas of patient assessment, optimal utilization, complication prevention, and complication management. CONCLUSION Salivary and lacrimal complications secondary to RAI exposure are common and need to be weighed when considering its use. The recommendations included in this statement provide direction for approaches to minimize and manage these complications.
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Affiliation(s)
- Michael C Singer
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Francis Marchal
- Department of Otolaryngology - Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Peter Angelos
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Vic Bernet
- Department of Endocrinology, Mayo Clinic Jacksonville, Jacksonville, Florida, USA
| | - Laura Boucai
- Department of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Samanta Buchholzer
- Maxillofacial Surgery and Oral Medicine and Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Brian Burkey
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - David Eisele
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evren Erkul
- Department of Otorhinolaryngology, Gulhane Medical School, University of Health Sciences, Istanbul, Turkey
| | - Frederic Faure
- Department of Otolaryngology - Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Suzanne K Freitag
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Marion Boyd Gillespie
- Department of Otolaryngology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Richard Mack Harrell
- Memorial Center for Integrative Endocrine Surgery, Memorial Healthcare System, Hollywood, Florida, USA
| | - Dana Hartl
- Department of Head and Neck Oncology, Institut de Cancerologie Gustave Roussy, Villejuif, France
| | - Megan Haymart
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Susan Mandel
- Department of Endocrinology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Barbra S Miller
- Division of Endocrine Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - John Morris
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth N Pearce
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Rahmatullah Rahmati
- Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - William R Ryan
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Barry Schaitkin
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris-Saclay, Villejuif, France
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Doug Van Nostrand
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Ka Kit Wong
- Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Gregory Randolph
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Hill J, Shao X, Wright JS, Stauff J, Sherman PS, Arteaga J, Wong KK, Viglianti BL, Scott PJH, Brooks AF. Synthesis and Evaluation of 11C- and 18F-Labeled SOAT1 Inhibitors as Macrophage Foam Cell Imaging Agents. ACS Med Chem Lett 2020; 11:1299-1304. [PMID: 32551015 PMCID: PMC7294710 DOI: 10.1021/acsmedchemlett.0c00127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/30/2020] [Indexed: 11/30/2022] Open
Abstract
PD-132301, an inhibitor of sterol O-acyltransferase 1 (SOAT1; also known as acyl-coenzyme A:cholesterol acyltransferase-1, ACAT1), is under clinical investigation for numerous adrenal disorders. Radiolabeled SOAT1 inhibitors could support drug discovery and help diagnose SOAT1-related disorders, such as atherosclerosis. We synthesized two radiolabeled SOAT1 inhibitors, [11C]PD-132301 and fluorine analogue [18F]1. Rat biodistribution studies were conducted with both agents and, as the most selective tracer, [11C]PD-132301 was advanced to preclinical positron emission tomography studies in (atherosclerotic) ApoE-/- mice. The uptake of [11C]PD-132301 in SOAT1-rich tissue warrants further investigation into the compound as an atherosclerosis and adrenal imaging agent.
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Affiliation(s)
- James
R. Hill
- Institute
for Molecular Bioscience, The University
of Queensland, Brisbane, Queensland 4072, Australia
- Department
of Radiology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Xia Shao
- Department
of Radiology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Jay S. Wright
- Department
of Radiology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Jenelle Stauff
- Department
of Radiology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Phillip S. Sherman
- Department
of Radiology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Janna Arteaga
- Department
of Radiology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Ka Kit Wong
- Department
of Radiology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Benjamin L. Viglianti
- Department
of Radiology, University of Michigan, Ann Arbor, Michigan 48109, United States
- Nuclear
Medicine Service, Veterans Administration, Ann Arbor, Michigan 48105, United States
| | - Peter J. H. Scott
- Department
of Radiology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Allen F. Brooks
- Department
of Radiology, University of Michigan, Ann Arbor, Michigan 48109, United States
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D’Rozario AL, Kao C, Mullins AE, Memarian N, Yee B, Duffy S, Banerjee D, Cho G, Wong KK, Kremerskothen K, Chapman J, Haroutonian C, Bartlett DJ, Naismith SL, Grunstein RR. 0669 The Effects Of Continuous Positive Airway Pressure Therapy In Moderate To Severe Obstructive Sleep Apnea: A High-density EEG Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.665] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
A previous high-density electroencephalography (EEG) investigation in asymptomatic OSA showed regional deficits in sleep EEG power particularly slow wave activity (SWA) during NREM sleep in the parietal region. It is unclear whether treatment with CPAP can reverse local sleep EEG abnormalities in OSA, and whether any recovery is related to improvement in sleep-dependent memory consolidation.
Methods
Fifteen male participants (age 50.4±6.5yrs, AHI 51.7±23.5/h) with moderate-severe OSA (AHI>15/h) underwent overnight polysomnography with 256-channel high-density EEG at baseline and following 3 months of CPAP therapy. A word paired associates declarative memory task was administered before and after sleep. After artefact removal, spectral analysis was performed for all channels. Topographical power maps were calculated for standard frequency ranges for NREM sleep (164 channels within a 0.57 radius from the vertex). Maps were compared using both absolute and normalized power (z-scores computed for each subject) and differences between baseline and treatment were determined by statistical nonparametric mapping.
Results
In 11 CPAP compliant patients (intolerant of CPAP [n=3]/high-density EEG [n=1]), analysis of polysomnographic variables showed that total sleep time did not differ but N1 (baseline vs. treatment: 66.9 vs. 39.5 mins,p=0.008) and N2 (195.0 vs. 150.6 mins,p=0.002) sleep was lower and N3 (89.8 vs. 128.7 mins,p=0.003) was higher after CPAP. Topographic analysis of high-density EEG data revealed a regional increase in SWA (1-4.5Hz) EEG power during N3 sleep in a cluster of electrodes overlying the centro-parietal cortex (cluster mean t-value=2.87,p=0.02). The change in overnight declarative memory consolidation (% recognition) after CPAP was significantly correlated with the change in slow spindle frequency activity in frontal regions (cluster mean r=0.875,p=0.003).
Conclusion
CPAP treatment may enhance localised deficits in sleep EEG activity in OSA, and specific regional recovery may translate to memory improvements in the short-term. These data also highlight the potential for long-term therapeutic effects on cognitive outcomes in OSA.
Support
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Affiliation(s)
- A L D’Rozario
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - C Kao
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - A E Mullins
- Icahn School of Medicine, Mount Sinai, New York City, New York, USA
| | - N Memarian
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - B Yee
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - S Duffy
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - D Banerjee
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - G Cho
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - K K Wong
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - K Kremerskothen
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - J Chapman
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - C Haroutonian
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - D J Bartlett
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - S L Naismith
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - R R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
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21
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Wong KK, Sedig LK, Bloom DA, Hutchinson RJ, Shulkin BL. 18F-2-fluoro-2-deoxyglucose uptake in white adipose tissue on pediatric oncologic positron emission tomography (PET)/computed tomography (CT). Pediatr Radiol 2020; 50:524-533. [PMID: 31776602 DOI: 10.1007/s00247-019-04574-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/16/2019] [Accepted: 11/12/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Altered biodistribution of [F-18]2-fluoro-2-deoxyglucose (FDG) is sometimes encountered in pediatric patients undergoing chemotherapy for lymphoma on post-induction positron emission tomography (PET) imaging. A characteristic pattern of increased FDG uptake in white adipose tissue can be seen, particularly in the buccal regions, body wall and gluteal regions, with a shift of radiotracer away from the blood pool and liver. This altered biodistribution has been attributed to effects of corticosteroids in pediatric and adult patients and is important to recognize because of its potential for limiting the diagnostic quality of the PET scan and interfering with therapeutic response assessment. OBJECTIVE In contrast to the well-known metabolically active brown fat seen on up to one-third of pediatric PET scans, white fat is usually non-metabolically active. We sought to determine the incidence of altered distribution of FDG in subcutaneous white adipose tissue in pediatric patients undergoing PET imaging and to assess the association with corticosteroid use. MATERIALS AND METHODS We reviewed the medical records and imaging for four children in whom altered biodistribution in white adipose tissue was present on post-induction FDG PET/CT, identified during routine clinical practice. All four were receiving corticosteroids as part of their chemotherapy. We then retrospectively reviewed oncology FDG PET/CT scans over a 2-year period (1,361 scans in 689 patients) to determine the incidence of uptake in white fat by qualitative visual assessment. In the children identified with altered biodistribution, we measured maximum standard uptake value (SUVmax) and mean standard uptake value (SUVmean) in areas of subcutaneous white fat, the buccal regions, body wall or gluteal soft-tissue regions, liver and blood pool. We reviewed all medical records, including medication lists. We summarize the relevant clinical and imaging findings of 13 pediatric patients, including the 4 index patients. RESULTS We determined the incidence of FDG uptake in white fat to be rare, found in 9 of 1,361 (0.6%) PET scans performed for pediatric cancer evaluation. FDG uptake was increased in subcutaneous adipose tissue, particularly in the buccal regions, body wall and gluteal regions, with a shift of radiotracer away from the blood pool and liver. The degree of increased uptake in peripheral white fat varied from marked to mild, and the biodistribution was distinct from that of brown adipose tissue. Children with this altered biodistribution were uniformly receiving corticosteroids as part of induction treatment for their cancer, and these findings were only identified on post-induction PET/CT. Follow-up PET/CT documented resolution of this effect after treatment with corticosteroids ceased. CONCLUSION Our findings support the current understanding that characteristic uptake of FDG in white adipose tissue is mediated by corticosteroid effect. Although this altered biodistribution is rare (<1% of PET scans) it could impair the diagnostic quality of the scan, affecting image interpretation, and should be recognized when present.
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Affiliation(s)
- Ka Kit Wong
- Division of Nuclear Medicine, Department of Radiology, C. S. Mott Children's Hospital, University of Michigan Health System, B1G505 University Hospital SPC 5028, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5028, USA.
| | - Laura K Sedig
- Division of Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics, C. S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - David A Bloom
- Section of Pediatric Radiology, Department of Radiology, C. S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Raymond J Hutchinson
- Division of Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics, C. S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Barry L Shulkin
- Division of Nuclear Medicine, Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
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22
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Zainol Rashid Z, Othman SN, Abdul Samat MN, Ali UK, Wong KK. Diagnostic performance of COVID-19 serology assays. Malays J Pathol 2020; 42:13-21. [PMID: 32342927] [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: 06/11/2023]
Abstract
INTRODUCTION The World Health Organization (WHO) declared COVID-19 outbreak as a world pandemic on 12th March 2020. Diagnosis of suspected cases is confirmed by nucleic acid assays with real-time PCR, using respiratory samples. Serology tests are comparatively easier to perform, but their utility may be limited by the performance and the fact that antibodies appear later during the disease course. We aimed to describe the performance data on serological assays for COVID-19. MATERIALS AND METHODS A review of multiple reports and kit inserts on the diagnostic performance of rapid tests from various manufacturers that are commercially available were performed. Only preliminary data are available currently. RESULTS From a total of nine rapid detection test (RDT) kits, three kits offer total antibody detection, while six kits offer combination SARS-CoV-2 IgM and IgG detection in two separate test lines. All kits are based on colloidal gold-labeled immunochromatography principle and one-step method with results obtained within 15 minutes, using whole blood, serum or plasma samples. The sensitivity for both IgM and IgG tests ranges between 72.7% and 100%, while specificity ranges between 98.7% to 100%. Two immunochromatography using nasopharyngeal or throat swab for detection of COVID-19 specific antigen are also reviewed. CONCLUSIONS There is much to determine regarding the value of serological testing in COVID-19 diagnosis and monitoring. More comprehensive evaluations of their performance are rapidly underway. The use of serology methods requires appropriate interpretations of the results and understanding the strengths and limitations of such tests.
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Affiliation(s)
- Z Zainol Rashid
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Medical Microbiology & Immunology, 56000 Kuala Lumpur, Malaysia.
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23
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Che Rahim MJ, Wan Mohamad WM, Saddki N, Taib H, Wan Abhamid WZ, Wong KK, Wan Ghazali WS. Elevated serum rheumatoid factor, anti-citrullinated protein antibodies and active rheumatoid arthritis disease are not associated with chronic periodontitis. Malays J Pathol 2019; 41:267-272. [PMID: 31901911] [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: 06/10/2023]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease of the joints with the involvement of other systems. Previous studies have demonstrated its association with chronic periodontitis (CP), a chronic inflammatory disease of tooth-supporting tissues. Positive rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) in RA patients have been found to be associated with CP. The aim of this study is to determine the prevalence of CP in RA patients, and to investigate the association of ACPA, RF status and RA disease activity with CP and non-CP RA patients. MATERIALS AND METHODS A comparative cross-sectional study involving 98 RA patients was conducted at Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia. Clinical oral examination was carried out to determine the CP status of RA patients. RF, ACPA and erythrocyte sedimentation rate (ESR) were measured, and the 28-joint Disease Activity Score (DAS-28) was assessed. RESULTS Forty-five patients (45.9%) were found to have CP (95% CI: 0.36-0.56). No significant difference was observed in the prevalence of positive RF (p=0.989) or ACPA (p=0.431) in CP and non-CP RA patients. There was also no significant association between active RA disease (DAS-28 score ≥3.2) and RF positivity in CP (p=0.927) and non-CP (p=0.431) RA patients as well as ACPA positivity in CP (p=0.780) and non-CP (p=0.611) RA patients. CONCLUSION In our cohort of RA patients, we did not find significant associations between elevated RF, ACPA, or active RA disease with the presence of CP. There were also no significant associations between elevated RF or ACPA with active RA disease.
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Affiliation(s)
- M J Che Rahim
- Universiti Sains Malaysia, School of Medical Sciences, Department of Internal Medicine, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
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24
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Wong KK, Stubbs E, McRae M, McRae M. CTA in preoperative planning for DIEP breast reconstruction: what the reconstructive surgeon wants to know. A modified Delphi study. Clin Radiol 2019; 74:973.e15-973.e26. [PMID: 31492417 DOI: 10.1016/j.crad.2019.07.016] [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] [Received: 02/06/2019] [Accepted: 07/19/2019] [Indexed: 11/19/2022]
Abstract
AIM To gather expert reconstructive surgical opinion to define and rank the surgically most important anatomy and provide guidance for report content to radiologists when reading a preoperative computed tomography angiography (CTA). MATERIALS AND METHODS A modified Delphi approach was used, involving a panel of 13 microsurgery experts across North America. Data from three consecutive online surveys were collected and returned to the respondents in the subsequent survey, allowing each respondent to see the range of opinions from other field experts. RESULTS Response rates were 62%, 77%, and 69% for each of the three survey rounds, respectively. The panel identified that the most important perforator characteristics in selecting the optimal perforator are diameter of the vein, perforator location within the flap, and diameter of the artery, respectively. The stated preference was for perforators located below the umbilicus. If no suitable perforator was located below the umbilicus, the panel would consider perforators up to 2 cm above the umbilicus. The most important considerations for the preoperative radiology planning report are: the size of the perforator vein, perforator location relative to landmarks, and the size of the perforator artery. DISCUSSION Based on the panel of expert reconstructive microsurgeons, the most surgically important anatomical considerations to be assessed and included in preoperative CTA reports for DIEP flap breast reconstruction were determined. The recommendations for reporting of preoperative DIEP breast reconstructions are presented, which, in consultation with local surgeons, can be used to form a template for reporting.
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Affiliation(s)
- K K Wong
- Michael G. DeGroote School of Medicine, Hamilton ON L8S 4L8, Canada.
| | - E Stubbs
- Department of Radiology, St Joseph's Healthcare Hamilton, Hamilton ON L8N 4A6, Canada
| | - M McRae
- Department of Plastic Surgery, St Joseph's Healthcare Hamilton, Hamilton ON L8N 4A6, Canada
| | - M McRae
- Department of Plastic Surgery, St Joseph's Healthcare Hamilton, Hamilton ON L8N 4A6, Canada
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25
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Syahidatulamali CS, Wan Syamimee WG, Azwany YN, Wong KK, Che Maraina CH. Association of anti-CLIC2 and anti-HMGB1 autoantibodies with higher disease activity in systemic lupus erythematosus patients. J Postgrad Med 2019; 63:257-261. [PMID: 28862243 PMCID: PMC5664871 DOI: 10.4103/jpgm.jpgm_499_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by numerous autoantibodies. In this study, we investigated the presence of anti-chloride intracellular channel 2 (anti-CLIC2) and anti-high mobility group box 1 (anti-HMGB1) autoantibodies in SLE patients (n = 43) versus healthy controls ([HCs] n = 43), and their association with serological parameters (antinuclear antibody [ANA], anti-double-stranded DNA [anti-dsDNA], and C-reactive protein [CRP]) and disease activity using Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score (active or inactive). SETTINGS AND DESIGN Case-control study at Rheumatology Clinic of Universiti Sains Malaysia Hospital. SUBJECTS AND METHODS The sera of SLE patients and HCs were tested for the presence of anti-CLIC2 and anti-HMGB1 autoantibodies using human recombinant proteins and ELISA methodologies. Other serological parameters were evaluated according to routine procedures, and patients' demographic and clinical data were obtained. STATISTICAL ANALYSIS Mann-Whitney U-test, Chi-square test, Fisher's exact test, and receiver operating characteristic analysis. RESULTS Anti-CLIC2 autoantibody levels were significantly higher in SLE patients compared to HCs (P = 0.0035), whereas anti-HMGB1 autoantibody levels were not significantly elevated (P = 0.7702). Anti-CLIC2 and anti-HMGB1 autoantibody levels were not associated with ANA pattern, anti-dsDNA, and CRP. Interestingly, SLEDAI score (≥6) was associated with anti-CLIC2 (P = 0.0046) and with anti-HMGB1 (P = 0.0091) autoantibody levels. CONCLUSION Our findings support the potential of using anti-CLIC2 autoantibodies as a novel biomarker for SLE patients. Both anti-CLIC2 and anti-HMGB1 autoantibody levels demonstrated potential in monitoring SLE disease activity.
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Affiliation(s)
- C S Syahidatulamali
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia
| | - W G Wan Syamimee
- Department of Medical, School of Medical Sciences, Universiti Sains , Health Campus, Kelantan, Malaysia
| | - Y Nor Azwany
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia
| | - K K Wong
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia
| | - C H Che Maraina
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia
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26
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Mohd Ashari NS, Mohamed Sanusi SNF, Mohd Yasin MA, Che Hussin CM, Wong KK, Shafei MN. Major depressive disorder patients on antidepressant treatments display higher number of regulatory T cells. Malays J Pathol 2019; 41:169-176. [PMID: 31427552] [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: 06/10/2023]
Abstract
INTRODUCTION Regulatory T cell (Treg) is a subtype of T lymphocyte that plays a crucial role in establishing immunologic self-tolerance and maintaining immune homeostasis. In this study, we set out to investigate the percentage and absolute count of Tregs in major depressive disorder (MDD) patients and their correlation with disease severity. MATERIALS & METHODS This is a case-control study consisting of 47 MDD patients and 47 healthy controls. MDD patients were treated with antidepressant drugs according to their physician's choice. The severity of MDD was assessed using Beck Depression Inventory (BDI) and Montgomery-Asberg Depression Rating Scale (MADRS) at the time of recruitment. Healthy controls completed the Depression Anxiety Scoring System (DASS21) questionnaire to ensure they were in good mental health without history of MDD. The percentage and absolute count of CD4+ CD25+ Tregs and CD4+ CD25+ FOXP3+ Tregs were identified by multiparameter flow cytometry. RESULTS The percentage and absolute count of CD4+ CD25+ Treg cells were significantly higher in MDD patients than in healthy controls (P<0.001, in both cases). Likewise, the percentage and absolute count of CD4+ CD25+ FOXP3+ Treg cells were also significantly higher in MDD patients compared to healthy controls (P=0.003 and P=0.002, respectively). However, there was no significant correlation between the percentage and absolute count of CD4+ CD25+ Treg and CD4+ CD25+ FOXP3+ Treg cells with BDI or MADRS score. CONCLUSIONS Our results suggest that antidepressant treatments contributed to an upregulation of Tregs in MDD patients.
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Affiliation(s)
- N S Mohd Ashari
- Universiti Sains Malaysia, School of Medical Sciences, Department of Immunology, 16150 Kubang Kerian, Kelantan, Malaysia.
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27
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Soo YO, Abrigo J, Chu W, Leung KT, Fong WC, Li SH, Li R, Ng PW, Wong KK, Wong LKS, Leung TWH. Risk of intracerebral haemorrhage in patients with cerebral microbleeds taking warfarin for atrial fibrillation: a prospective study. Hong Kong Med J 2019; 25 Suppl 5:6-8. [PMID: 31416977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- Y O Soo
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - J Abrigo
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - W Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - K T Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - W C Fong
- Department of Medicine, Queen Elizabeth Hospital
| | - S H Li
- Department of Medicine, North District Hospital
| | - R Li
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital
| | - P W Ng
- Department of Medicine and Geriatrics, United Christian Hospital
| | - K K Wong
- Department of Medicine, Yan Chai Hospital
| | - L K S Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - T W H Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
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28
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Heng PY, Sulong A, Ali UKS, Wong KK. Molecular detection of Enterobacteriaceae isolates producing bla OXA-48 and bla OXA-181 genes: A single centre study. Malays J Pathol 2019; 41:139-148. [PMID: 31427549] [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: 06/10/2023]
Abstract
INTRODUCTION OXA-48, a carbapenem-hydrolysing class D β-lactamase, and its variant, OXA-181, are increasingly reported worldwide. This study aimed to describe the prevalence and distribution of OXA-48 and OXA-181 carbapenem-resistant Enterobacteriaceae (CRE) in a tertiary medical centre in Malaysia. MATERIALS & METHODS A total of 13,098 Enterobacteriaceae isolates from various clinical samples were sent to our laboratory between January 2011 and December 2012. Of these, 90 demonstrated reduced susceptibility to at least one carbapenem and were included in this study. Only 88 isolates were successfully subcultured on blood agar (BA). Another 2 isolates failed to grow and were excluded. Of the 88, 2 isolates had the same identification number (repetitive isolates); therefore, 1 isolate was excluded from further analyses. Only 87 isolates were subjected to molecular detection of the blaOXA-48 and blaOXA-181 genes by polymerase chain reaction. RESULTS Eighty-seven non-repetitive isolates grew following subculture on BA. Of these, 9 (10.34%) were positive for OXA-48 (7 Klebsiella pneumoniae, 2 Escherichia coli). Each isolate originated from different patients. All patients had a history of treatment with at least one cephalosporin and/or carbapenem prior to the isolation of OXA-48 CRE. OXA-181 was detected in one (1.15%) out of the 87 isolates; CONCLUSIONS: The prevalence of OXA-48 and OXA-181 CRE among all Enterobacteriaceae isolates in our institution is 0.069% and 0.008%, respectively. Nevertheless, our findings suggest that OXA-48 and OXA-181 carbapenemases appear to be important and possibly under-recognised causes of carbapenem resistance in Malaysia.
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Affiliation(s)
- P Y Heng
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Medical Microbiology & Immunology, Kuala Lumpur, Malaysia.
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29
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Rahman WT, Wale DJ, Viglianti BL, Townsend DM, Manganaro MS, Gross MD, Wong KK, Rubello D. The impact of infection and inflammation in oncologic 18F-FDG PET/CT imaging. Biomed Pharmacother 2019; 117:109168. [PMID: 31334700 PMCID: PMC7104808 DOI: 10.1016/j.biopha.2019.109168] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/22/2019] [Accepted: 06/25/2019] [Indexed: 12/30/2022] Open
Abstract
Sites of infection and inflammation can be misleading in oncology PET/CT imaging because these areas commonly show 18F-FDG activity. Caution in the interpretation must be taken to avoid the misdiagnosis of malignancy. Utilization of both CT findings as well as patient history can help differentiate benign infectious and inflammatory processes from malignancy, although occasionally additional work-up may be required. This article discusses the mechanism of 18F-FDG uptake in infection and inflammation with illustrative examples.
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Affiliation(s)
- W Tania Rahman
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Daniel J Wale
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Health System, Ann Arbor, MI, USA.
| | - Benjamin L Viglianti
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Health System, Ann Arbor, MI, USA
| | - Danyelle M Townsend
- Division of Drug Discovery and Pharmaceutical Sciences, Medical University of South Carolina, USA
| | - Matthew S Manganaro
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Milton D Gross
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Health System, Ann Arbor, MI, USA
| | - Ka Kit Wong
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Domenico Rubello
- Department of Nuclear Medicine, Radiology, Neuroradiology, Interventional Radiology, Pathology, Santa Maria della Misericordia Hospital, Rovigo, Italy.
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Winton WP, Brooks AF, Wong KK, Scott PJH, Viglianti BL. Synthesis of 6-(Fluoromethyl)-19-norcholest-5(10)-en-3-ol, a Fluorinated Analogue of NP-59, using the Mild Fluorinating Reagent, TBAF(Pinacol)2. SynOpen 2019. [DOI: 10.1055/s-0037-1611845] [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: 10/26/2022] Open
Abstract
For 45 years, efforts to prepare a fluorinated analogue of the scintiscanning/SPECT agent 6-(iodomethyl)-19-norcholest-5(10)-en-3-ol (NP-59) for development of a PET imaging agent have failed due to undesired elimination reactions and unexpected rearrangements observed while utilizing a wide variety of fluorinating conditions (e.g., cesium fluoride, silver fluoride, (2-chloro-1,1,2-trifluoroethyl)diethylamine (FAR), diethylaminosulfur trifluoride (DAST), and hexafluoropropene diethylamine FPA). Herein, we report the full synthesis of NP-59, followed by the four-step synthesis of 6-(fluoromethyl)-19-norcholest-5(10)-en-3-ol (FNP-59) using a recently developed mild fluorinating reagent, less prone to producing elimination reactions in the preparation of primary fluorides, TBAF(pinacol)2, with an overall yield of 16% (four steps). Also included is an evaluation of the TBAF(pinacol)2 reagent on eight test substrates to investigate its scope.
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Affiliation(s)
- Wade P. Winton
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School
| | - Allen F. Brooks
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School
| | - Ka Kit Wong
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School
| | - Peter J. H. Scott
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School
| | - Benjamin L. Viglianti
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School
- Nuclear Medicine Service, Ann Arbor Veterans Administration
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Viglianti BL, Wale DJ, Ma T, Johnson TD, Bohnen NI, Wong KK, Ky C, Frey KA, Townsend DM, Rubello D, Gross MD. Effects of plasma glucose levels on regional cerebral 18F-fluorodeoxyglucose uptake: Implications for dementia evaluation with brain PET imaging. Biomed Pharmacother 2019; 112:108628. [PMID: 30784923 PMCID: PMC6714976 DOI: 10.1016/j.biopha.2019.108628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/08/2019] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose: Hyperglycemia affects FDG uptake in the brain, potentially emulating
Alzheimer’s disease in normal individuals. This study investigates
global and regional cerebral FDG uptake as a function of plasma glucose in a
cohort of patients. Methods: 120 consecutive male patients with FDG PET/CT for initial oncologic
staging (July-Dee 2015) were reviewed. Patients with dementia,
cerebrovascular accident, structural brain lesion, prior oncology treatment
or high metabolic tumor burden (recently shown affecting brain FDG uptake)
were excluded. 53 (24 nondiabetic) eligible patients (age 65.7 ± 2.8
mean ± SE) were analyzed with parametric computer software,
MIMneuro™. Regional Z-scores were evaluated as a function of plasma
glucose and age using multi variable linear mixed effects models with false
discovery analysis adjusting for multiple comparisons. If the regression
slope was significantly (p < 0.05) different than zero, hyperglycemia
effect was present. Results: There was a negative inverse relationship (p < 0.001) between
global brain FDG uptake and hyperglycemia. No regional hyperglycemia effect
on uptake were present when subjects were normalized using pons or
cerebellum. However, regional hyperglycemia effects were seen (p <
0.047–0.001) when normalizing by the whole brain. No obvious pattern
was seen in the regions affected. Age had a significant effect using whole
brain normalization (p < 0.04–0.01). Conclusions: Cortical variation in FDG uptake were identified when subjects were
hyperglycemic. However, these variations didn’t fit a particular
pattern of dementia and the severity of the affect is not likely to alter
clinical interpretation.
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Affiliation(s)
- Benjamin L Viglianti
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA.
| | - Daniel J Wale
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA
| | - Tianwen Ma
- Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Timothy D Johnson
- Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Nicolaas I Bohnen
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA
| | - Ka Kit Wong
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Christy Ky
- University of Michigan School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kirk A Frey
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Danyelle M Townsend
- Department of Physiology, Division of New Drugs Development, University of Southern Carolina, USA
| | - Domenico Rubello
- Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy.
| | - Milton D Gross
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA
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Treekitkarnmongkol W, Solis LM, Kai K, Thompson AM, Tian W, Wistuba II, Sasai K, Jltsumori Y, Sahin AA, Hawke DH, Lee JM, Qin L, Bawa-Khalfe T, Rad R, Wong KK, Abbott CM, Katayama H, Sen S. Abstract P1-05-05: eEF1A2 facilitates PTEN-GSK3β mediated Aurora-A protein degradation during S-G2 phase inactivated in PTEN-deficient breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-05-05] [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: 11/16/2022]
Abstract
Abstract
The AURKA gene, encoding Aurora kinase-A (Aurora-A), is frequently amplified and overexpressed across multiple cancer types correlating with poor prognosis. Although the AURKA gene is frequently amplified in human cancers, underlying mechanism(s) for Aurora-A protein stability through different phases of cell cycle are not well elucidated. Inhibiting the kinase activity and promoting protein degradation are two well-validated conceptual strategies for targeting protein kinases in cancers. Here, we demonstrate that Eukaryotic Elongation Factor 1 Alpha 2 (eEF1A2) facilitates PTEN-GSK3β mediated Aurora-A protein degradation through the SCF complex (SKP1-Cul1-FBXW7) during the S/G2 phase of proliferating cells. In contrast, this mechanism is inactivated in cancer cells accompanying PTEN-GSK3β pathway deficiency. Mechanistically, eEF1A2 interacts with Aurora-A, GSK3β, FBXW7 and Cul1-E3 ligase, as the SCF complex, to facilitate Aurora-A polyubiquitination for 26S proteasomal degradation. eEF1A2 promotes PTEN phosphorylation at T366 and stability, inactivates AKT and activates GSK3β which in turn phosphorylates Aurora-A at S283, S284 and S342. The phosphorylation of Aurora-A at S342 is detected during S/G2 phase of cell mitosis in parallel with eEF1A2-SCF complex formation with active form of GSK3β and neddylated Cul1. Conversely, genetic ablation of EEF1A2 and PTEN, activation of AKT, inhibition of GSK3β, expression of Aurora-A phosphodeficient-mutant attenuates the Aurora-A protein degradation which is corroborated in Aurora-A overexpressing mouse mammary carcinomas and human breast carcinomas. This study identifies a novel mechanism of Aurora-A protein degradation mediated eEF1A2-PTEN-GSK3β pathway and provides a framework for the discovery of Aurora-A therapeutic targets in breast cancer that harbors deficiency of PTEN tumor suppressor pathway.
Citation Format: Treekitkarnmongkol W, Solis LM, Kai K, Thompson AM, Tian W, Wistuba II, Sasai K, Jltsumori Y, Sahin AA, Hawke DH, Lee JM, Qin L, Bawa-Khalfe T, Rad R, Wong KK, Abbott CM, Katayama H, Sen S. eEF1A2 facilitates PTEN-GSK3β mediated Aurora-A protein degradation during S-G2 phase inactivated in PTEN-deficient breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-05-05.
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Affiliation(s)
- W Treekitkarnmongkol
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - LM Solis
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - K Kai
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - AM Thompson
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - W Tian
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - II Wistuba
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - K Sasai
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - Y Jltsumori
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - AA Sahin
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - DH Hawke
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - JM Lee
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - L Qin
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - T Bawa-Khalfe
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - R Rad
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - KK Wong
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - CM Abbott
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - H Katayama
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - S Sen
- The University of Texas M.D. Anderson Cancer Center, Houston, TX; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; University of Ottawa, Ottawa, ON, Canada; Houston Methodist Research Institute, Houston, TX; University of Houston, Houston, TX; Technische Universität München, München, BY, Germany; University of Edinburgh, Edinburgh, United Kingdom
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Wong YP, Tan GC, Wong KK, Anushia S, Cheah FC. Gardnerella vaginalis in perinatology: An overview of the clinicopathological correlation. Malays J Pathol 2018; 40:267-286. [PMID: 30580358] [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: 06/09/2023]
Abstract
Gardnerella vaginalis (GV) is a facultatively anaerobic gram-variable bacillus and is the major organism involved in bacterial vaginosis. GV-associated bacterial vaginosis has been associated with adverse pregnancy outcomes include preterm parturition and subclinical chorioamnionitis. Inflammatory response induced by GV presents paediatric problems as well. Studies had shown that increased levels of proinflammatory cytokines include TNF-α, IL-1β and IL-6 following fetal inflammatory response syndrome secondary to GV-induced intrauterine infection may result in the development of periventricular leukomalacia and bronchopulmonary dysplasia in the infected fetus. There is increasing evidence that GV-associated BV infection serves as a risk factor for long-term neurological complications, such as cerebral palsy and learning disability. GV is fastidious and could elude conventional detection methods such as bacterial cultures. With current more sophisticated molecular biology detection methods, its role and pathogenic effects have been shown to have a greater impact on intrauterine inflammation and fetal/neonatal infection. This review gives an overview on the characteristics of GV and its virulence properties. Its detrimental role in causing unfavourable GV-related perinatal outcomes, with emphasis on the possible mechanistic pathways is discussed. The discovery of disease mechanisms allows the building of a strong platform where further research on innovative therapies can be based on, for instance, an anti-TLR monoclonal antibody as therapeutic agent to halt inflammation-precipitate adverse perinatal outcomes.
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Affiliation(s)
- Y P Wong
- Universiti Kebangsaan Malaysia Medical Centre, Departments of Pathology, Kuala Lumpur, Malaysia.
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Wong KK, Shulkin BL, Gross MD, Avram AM. Efficacy of radioactive iodine treatment of graves' hyperthyroidism using a single calculated 131I dose. Clin Diabetes Endocrinol 2018; 4:20. [PMID: 30505461 PMCID: PMC6260735 DOI: 10.1186/s40842-018-0071-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 11/12/2018] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the success rate of therapeutic administration of a single calculated 131I activity for eliminating hyperthyroidism due to Graves’ disease. Methods and materials Patients with Graves’ hyperthyroidism underwent pinhole thyroid imaging, 24-h radioactive iodine uptake (RAIU) measurements and clinical examination and received a calculated 131I activity of 0.2 mCi per estimated gram of thyroid tissue, adjusted for the 24-h RAIU. The goal of RAI treatment was to achieve hypothyroidism within 3–6 months of 131I administration. Response to RAI therapy was assessed at 7 weeks and 3 months by clinical and biochemical follow-up. Results The study included 316 hyperthyroid patients with Graves’ disease (F238:M78, mean age 42.1 ± 16 y, 4–94). 179 patients (56.6%) had no prior therapeutic intervention (treatment-naive patients), whereas 6 patients had prior thyroid surgery, and 131 (41.5%) had been treated with anti-thyroid medications. The mean estimated thyroid gland size was 50.2 g ± 18, range 15–100. Mean RAIU was 0.57 ± 0.17 (normal 0.07–0.30). RAI doses ranged from 5 to 70 mCi (mean dose = 18.1 mCi). Successful treatment of hyperthyroidism at our institution was obtained after a single therapeutic 131-I activity administration in 295 of 316 (93.3%) patients. Multivariate logistic regression analysis demonstrated that failure of 131I therapy was associated with previous PTU therapy (p < 0.001). The mean response time after successful RAI therapy was 110.2 days, with cumulative response of 25% at 61 days, 50% by 84 days and 75% by 118 days after radioiodine administration. The mean time to respond for those on prior PTU medications was 297 days compared to 116 days for those on MMI and 109 days for those not previously treated with antithyroid medications. In patients with persistent hyperthyroidism, failure of RAI therapy was documented in 16 patients (76.2%) within (less than) one year after 131I administration and in 5 patients (23.8%) more than one year after initial therapy, considered late failure. Conclusion Successful 131I therapy for Graves’ hyperthyroidism with a single calculated dose can be achieved in the majority (> 90%) of patients, adjusting for the thyroid size and 24 h uptake measurement.
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Affiliation(s)
- Ka Kit Wong
- 1Nuclear Medicine/Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5028 USA
| | - Barry L Shulkin
- 2Nuclear Medicine/Radiology, St. Jude Children's Research Hospital, Memphis, TN 38105 USA
| | - Milton D Gross
- 1Nuclear Medicine/Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5028 USA.,Nuclear Medicine Service, Department of Veterans Affairs Health System, Ann Arbor, MI 48105 USA
| | - Anca M Avram
- 1Nuclear Medicine/Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5028 USA
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Rowbotham SP, Li F, Dost AFM, Louie SM, Marsh BP, Pessina P, Anbarasu CR, Brainson CF, Tuminello SJ, Lieberman A, Ryeom S, Schlaeger TM, Aronow BJ, Watanabe H, Wong KK, Kim CF. H3K9 methyltransferases and demethylases control lung tumor-propagating cells and lung cancer progression. Nat Commun 2018; 9:4559. [PMID: 30455465 PMCID: PMC6242814 DOI: 10.1038/s41467-018-07077-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/10/2018] [Indexed: 12/25/2022] Open
Abstract
Epigenetic regulators are attractive anticancer targets, but the promise of therapeutic strategies inhibiting some of these factors has not been proven in vivo or taken into account tumor cell heterogeneity. Here we show that the histone methyltransferase G9a, reported to be a therapeutic target in many cancers, is a suppressor of aggressive lung tumor-propagating cells (TPCs). Inhibition of G9a drives lung adenocarcinoma cells towards the TPC phenotype by de-repressing genes which regulate the extracellular matrix. Depletion of G9a during tumorigenesis enriches tumors in TPCs and accelerates disease progression metastasis. Depleting histone demethylases represses G9a-regulated genes and TPC phenotypes. Demethylase inhibition impairs lung adenocarcinoma progression in vivo. Therefore, inhibition of G9a is dangerous in certain cancer contexts, and targeting the histone demethylases is a more suitable approach for lung cancer treatment. Understanding cellular context and specific tumor populations is critical when targeting epigenetic regulators in cancer for future therapeutic development.
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Affiliation(s)
- S P Rowbotham
- Stem Cell Program, Division of Hematology/Oncology and Pulmonary and Respiratory Diseases, Children's Hospital Boston, Boston, MA, 02115, USA
- Department of Genetics, Harvard Medical School, Boston, MA, 02115, USA
| | - F Li
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY, 10016, USA
| | - A F M Dost
- Stem Cell Program, Division of Hematology/Oncology and Pulmonary and Respiratory Diseases, Children's Hospital Boston, Boston, MA, 02115, USA
- Department of Genetics, Harvard Medical School, Boston, MA, 02115, USA
| | - S M Louie
- Stem Cell Program, Division of Hematology/Oncology and Pulmonary and Respiratory Diseases, Children's Hospital Boston, Boston, MA, 02115, USA
- Department of Genetics, Harvard Medical School, Boston, MA, 02115, USA
| | - B P Marsh
- Stem Cell Program, Division of Hematology/Oncology and Pulmonary and Respiratory Diseases, Children's Hospital Boston, Boston, MA, 02115, USA
- Department of Genetics, Harvard Medical School, Boston, MA, 02115, USA
| | - P Pessina
- Stem Cell Program, Division of Hematology/Oncology and Pulmonary and Respiratory Diseases, Children's Hospital Boston, Boston, MA, 02115, USA
- Department of Genetics, Harvard Medical School, Boston, MA, 02115, USA
| | - C R Anbarasu
- Stem Cell Program, Division of Hematology/Oncology and Pulmonary and Respiratory Diseases, Children's Hospital Boston, Boston, MA, 02115, USA
- Department of Genetics, Harvard Medical School, Boston, MA, 02115, USA
| | - C F Brainson
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, KY, 40536, USA
| | - S J Tuminello
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - A Lieberman
- Department of Cancer Biology, Perelman School of Medicine at the University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, 19104, USA
| | - S Ryeom
- Department of Cancer Biology, Perelman School of Medicine at the University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, 19104, USA
| | - T M Schlaeger
- Stem Cell Program, Division of Hematology/Oncology and Pulmonary and Respiratory Diseases, Children's Hospital Boston, Boston, MA, 02115, USA
| | - B J Aronow
- Division of Biomedical Informatics, Cincinnati Children's Research Foundation, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - H Watanabe
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - K K Wong
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY, 10016, USA
| | - C F Kim
- Stem Cell Program, Division of Hematology/Oncology and Pulmonary and Respiratory Diseases, Children's Hospital Boston, Boston, MA, 02115, USA.
- Department of Genetics, Harvard Medical School, Boston, MA, 02115, USA.
- Harvard Stem Cell Institute, Cambridge, MA, 02138, USA.
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Manganaro MS, Millet JD, Brown RK, Viglianti BL, Wale DJ, Wong KK. The utility of bone scintigraphy with SPECT/CT in the evaluation and management of frostbite injuries. Br J Radiol 2018; 92:20180545. [PMID: 30359097 DOI: 10.1259/bjr.20180545] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE: Frostbite is a localized cold-thermal injury resulting from prolonged exposure of flesh to freezing and near freezing temperatures. The depth and extent of frostbite injuries are not easily assessed, from a clinical standpoint, at the time of injury making it challenging to plan appropriate management and treatment. METHODS: A review of the literature of management of cold-related injuries and retrospective case review of the imaging and clinical course of frostbite injury. RESULTS: Bone scintigraphy with single photon emission computed tomography (SPECT)/CT was performed in the acute and subacute course of frostbite injuries, subsequently leading to earlier definitive management and shorter hospital stay. CONCLUSION: Multiphase technetium-99m-methylenediphosphonate (99mTc-MDP) bone scintigraphy with SPECT/CT can expedite clinical management of frostbite injuries by determining the extent of injury and can accurately predict the level of amputation if needed. ADVANCES IN KNOWLEDGE: SPECT/CT is underutilized at many facilities but can have a profound and immediate impact on clinical management of patients with frostbite when used in combination with physiological bone scan imaging.
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Affiliation(s)
- Matthew S Manganaro
- 1 Departments of Radiology/Nuclear Medicine, University of Michigan Hospital , Ann Arbor, MI , USA
| | - John D Millet
- 1 Departments of Radiology/Nuclear Medicine, University of Michigan Hospital , Ann Arbor, MI , USA
| | - Richard Kj Brown
- 1 Departments of Radiology/Nuclear Medicine, University of Michigan Hospital , Ann Arbor, MI , USA
| | - Benjamin L Viglianti
- 1 Departments of Radiology/Nuclear Medicine, University of Michigan Hospital , Ann Arbor, MI , USA.,2 Nuclear Medicine Service, VA Ann Arbor Healthcare , Ann Arbor, MI , USA
| | - Daniel J Wale
- 1 Departments of Radiology/Nuclear Medicine, University of Michigan Hospital , Ann Arbor, MI , USA.,2 Nuclear Medicine Service, VA Ann Arbor Healthcare , Ann Arbor, MI , USA
| | - Ka Kit Wong
- 1 Departments of Radiology/Nuclear Medicine, University of Michigan Hospital , Ann Arbor, MI , USA
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Karakasheva TA, Lin EW, Tang Q, Qiao E, Waldron TJ, Soni M, Klein-Szanto AJ, Sahu V, Basu D, Ohashi S, Baba K, Giaccone ZT, Walker SR, Frank DA, Wileyto EP, Long Q, Dunagin MC, Raj A, Diehl JA, Wong KK, Bass AJ, Rustgi AK. IL-6 Mediates Cross-Talk between Tumor Cells and Activated Fibroblasts in the Tumor Microenvironment. Cancer Res 2018; 78:4957-4970. [PMID: 29976575 DOI: 10.1158/0008-5472.can-17-2268] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/06/2018] [Accepted: 06/28/2018] [Indexed: 12/18/2022]
Abstract
The tumor microenvironment (TME) plays a major role in the pathogenesis of multiple cancer types, including upper-gastrointestinal (GI) cancers that currently lack effective therapeutic options. Cancer-associated fibroblasts (CAF) are an essential component of the TME, contributing to tumorigenesis by secreting growth factors, modifying the extracellular matrix, supporting angiogenesis, and suppressing antitumor immune responses. Through an unbiased approach, we have established that IL-6 mediates cross-talk between tumor cells and CAF not only by supporting tumor cell growth, but also by promoting fibroblast activation. As a result, IL-6 receptor (IL6Rα) and downstream effectors offer opportunities for targeted therapy in upper-GI cancers. IL-6 loss suppressed tumorigenesis in physiologically relevant three-dimensional (3D) organotypic and 3D tumoroid models and murine models of esophageal cancer. Tocilizumab, an anti-IL6Rα antibody, suppressed tumor growth in vivo in part via inhibition of STAT3 and MEK/ERK signaling. Analysis of a pan-cancer TCGA dataset revealed an inverse correlation between IL-6 and IL6Rα overexpression and patient survival. Therefore, we expanded evaluation of tocilizumab to head and neck squamous cell carcinoma patient-derived xenografts and gastric adenocarcinoma xenografts, demonstrating suppression of tumor growth and altered STAT3 and ERK1/2 gene signatures. We used small-molecule inhibitors of STAT3 and MEK1/2 signaling to suppress tumorigenesis in the 3D organotypic model of esophageal cancer. We demonstrate that IL6 is a major contributor to the dynamic cross-talk between tumor cells and CAF in the TME. Our findings provide a translational rationale for inhibition of IL6Rα and downstream signaling pathways as a novel targeted therapy in oral-upper-GI cancers.Significance: These findings demonstrate the interaction of esophageal cancer and cancer-associated fibroblasts through IL-6 signaling, providing rationale for a novel therapeutic approach to target these cancers. Cancer Res; 78(17); 4957-70. ©2018 AACR.
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Affiliation(s)
- Tatiana A Karakasheva
- Division of Gastroenterology, Department of Medicine, Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Eric W Lin
- Division of Gastroenterology, Department of Medicine, Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Qiaosi Tang
- Division of Gastroenterology, Department of Medicine, Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Edmund Qiao
- Division of Gastroenterology, Department of Medicine, Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Todd J Waldron
- Division of Gastroenterology, Department of Medicine, Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Monica Soni
- Division of Gastroenterology, Department of Medicine, Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Varun Sahu
- Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Department of Otolaryngology - Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Devraj Basu
- Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Department of Otolaryngology - Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Surgery Service, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Shinya Ohashi
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiichiro Baba
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Zachary T Giaccone
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Sarah R Walker
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - David A Frank
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - E Paul Wileyto
- Department of Biostatistics, Epidemiology and Bioinformatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Qi Long
- Department of Biostatistics, Epidemiology and Bioinformatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Margaret C Dunagin
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arjun Raj
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J Alan Diehl
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina
| | - K K Wong
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Adam J Bass
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Anil K Rustgi
- Division of Gastroenterology, Department of Medicine, Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. .,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Abstract
Jaundice is caused by an accumulation of bilirubin in the blood. The presentation in infants and children can be indicative of a wide range of conditions, with some self-limiting and others potentially life-threatening. This article aims to provide a concise review of the common medical and surgical causes in children and discuss their diagnosis and management.
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Affiliation(s)
- Y Y Chee
- Departments of 1Paediatrics and Adolescent Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - P H Chung
- Daepartment of Surgery, The University of Hong Kong, Pokfulam, Hong Kong
| | - R M Wong
- Departments of 1Paediatrics and Adolescent Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - K K Wong
- Daepartment of Surgery, The University of Hong Kong, Pokfulam, Hong Kong
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Chapman J, Poon J, Wong KK, Mullins AE, Cho G, Yee BJ, Kim J, Grunstein RR, Marshall NS, D’Rozario A. 0452 Intra-individual Stability of Quantitative EEG as a Biomarker in Obstructive Sleep Apnea. Sleep 2018. [DOI: 10.1093/sleep/zsy061.451] [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: 11/14/2022] Open
Affiliation(s)
- J Chapman
- Woolcock Institute of Medical Research/University of Sydney, Missenden Road, AUSTRALIA
- Sydney Local Health District, Sydney, AUSTRALIA
| | - J Poon
- University of Sydney Medical School, Sydney, AUSTRALIA
- Woolcock Institute of Medical Research/University of Sydney, Missenden Road, AUSTRALIA
| | - K K Wong
- Woolcock Institute of Medical Research/University of Sydney, Missenden Road, AUSTRALIA
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia, Sydney, AUSTRALIA
| | - A E Mullins
- Woolcock Institute of Medical Research/University of Sydney, Missenden Road, AUSTRALIA
- University of Sydney Nursing School, Sydney, AUSTRALIA
| | - G Cho
- Woolcock Institute of Medical Research/University of Sydney, Missenden Road, AUSTRALIA
| | - B J Yee
- Woolcock Institute of Medical Research/University of Sydney, Missenden Road, AUSTRALIA
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia, Sydney, AUSTRALIA
| | - J Kim
- Woolcock Institute of Medical Research/University of Sydney, Missenden Road, AUSTRALIA
| | - R R Grunstein
- Woolcock Institute of Medical Research/University of Sydney, Missenden Road, AUSTRALIA
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia, Sydney, AUSTRALIA
| | - N S Marshall
- Woolcock Institute of Medical Research/University of Sydney, Missenden Road, AUSTRALIA
- University of Sydney Nursing School, Sydney, AUSTRALIA
| | - A D’Rozario
- Woolcock Institute of Medical Research/University of Sydney, Missenden Road, AUSTRALIA
- University of Sydney School of Psychology, Sydney, AUSTRALIA
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Viglianti BL, Wale DJ, Wong KK, Johnson TD, Ky C, Frey KA, Gross MD. Effects of Tumor Burden on Reference Tissue Standardized Uptake for PET Imaging: Modification of PERCIST Criteria. Radiology 2018; 287:993-1002. [PMID: 29558296 DOI: 10.1148/radiol.2018171356] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose To examine the effect metabolic burden (tumor and/or cardiac myocyte uptake) has on fluorine 18 fluorodeoxyglucose (FDG) distribution in organs and tissues of interest. Materials and Methods Positron emission tomographic (PET)/computed tomographic (CT) scans at the Ann Arbor Veterans Affairs hospital from January to July 2015 were reviewed. A total of 107 scans (50 patients; mean age, 64.3 years ± 13.2 [standard deviation]) had metabolic tissue burden assessed by using total lesion glycolysis (TLG) obtained from autosegmentation of the tumor and/or cardiac tissue. Standardized uptake value (SUV) and subsequent normalized SUV uptake in target organs and tissues were compared with 436 FDG PET/CT scans previously reported in 229 patients as a function of TLG to describe the effect(s) that metabolic burden has on reference tissue (blood pool, liver, and brain) FDG uptake. Subsequent regression by using linear mixed-effects models was used. If the slope of the regression was significantly (P < .05) different than zero, then an effect from TLG was present. Results There was a negative inverse relationship (P < .0001) between FDG uptake within reference tissues (blood pool, liver, and brain) and TLG in comparison to the study population at similar blood glucose levels. This TLG effect was no longer statistically significant (P > .05) when FDG uptake was normalized to a reference tissue (eg, blood pool or liver). Conclusion Metabolic tissue burden can have a significant effect on SUV measurements for PET imaging. This effect can be mitigated by normalizing FDG uptake to a reference tissue. © RSNA, 2018.
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Affiliation(s)
- Benjamin L Viglianti
- From the Department of Nuclear Medicine and Molecular Imaging, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, Mich 48109 (B.L.V., D.J.W., K.K.W., K.A.F., M.D.G.); Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, Mich (B.L.V., D.J.W., M.D.G.); Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Mich (T.D.J.); and University of Michigan School of Medicine, University of Michigan, Ann Arbor, Mich (C.K.)
| | - Daniel J Wale
- From the Department of Nuclear Medicine and Molecular Imaging, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, Mich 48109 (B.L.V., D.J.W., K.K.W., K.A.F., M.D.G.); Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, Mich (B.L.V., D.J.W., M.D.G.); Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Mich (T.D.J.); and University of Michigan School of Medicine, University of Michigan, Ann Arbor, Mich (C.K.)
| | - Ka Kit Wong
- From the Department of Nuclear Medicine and Molecular Imaging, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, Mich 48109 (B.L.V., D.J.W., K.K.W., K.A.F., M.D.G.); Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, Mich (B.L.V., D.J.W., M.D.G.); Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Mich (T.D.J.); and University of Michigan School of Medicine, University of Michigan, Ann Arbor, Mich (C.K.)
| | - Timothy D Johnson
- From the Department of Nuclear Medicine and Molecular Imaging, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, Mich 48109 (B.L.V., D.J.W., K.K.W., K.A.F., M.D.G.); Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, Mich (B.L.V., D.J.W., M.D.G.); Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Mich (T.D.J.); and University of Michigan School of Medicine, University of Michigan, Ann Arbor, Mich (C.K.)
| | - Christy Ky
- From the Department of Nuclear Medicine and Molecular Imaging, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, Mich 48109 (B.L.V., D.J.W., K.K.W., K.A.F., M.D.G.); Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, Mich (B.L.V., D.J.W., M.D.G.); Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Mich (T.D.J.); and University of Michigan School of Medicine, University of Michigan, Ann Arbor, Mich (C.K.)
| | - Kirk A Frey
- From the Department of Nuclear Medicine and Molecular Imaging, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, Mich 48109 (B.L.V., D.J.W., K.K.W., K.A.F., M.D.G.); Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, Mich (B.L.V., D.J.W., M.D.G.); Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Mich (T.D.J.); and University of Michigan School of Medicine, University of Michigan, Ann Arbor, Mich (C.K.)
| | - Milton D Gross
- From the Department of Nuclear Medicine and Molecular Imaging, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, Mich 48109 (B.L.V., D.J.W., K.K.W., K.A.F., M.D.G.); Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, Mich (B.L.V., D.J.W., M.D.G.); Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Mich (T.D.J.); and University of Michigan School of Medicine, University of Michigan, Ann Arbor, Mich (C.K.)
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Wong KK, Gandhi A, Rubello D, Gross MD, Jaffe C. Challenging Diagnosis of Postpartum Thyroiditis and Co-Existing Thyroid Nodule. AACE Clin Case Rep 2018. [DOI: 10.4158/ep171755.cr] [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] Open
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Islam MA, Alam F, Gan SH, Sasongko TH, Wan Ghazali WS, Wong KK. A 15-year single centre retrospective study of antiphospholipid syndrome patients from Northern Malaysia. Malays J Pathol 2017; 39:123-133. [PMID: 28866693] [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: 06/07/2023]
Abstract
BACKGROUND Antiphospholipid syndrome (APS) is an autoimmune disorder characterised by thrombosis and/or pregnancy morbidity in the presence of antiphospholipid antibodies (aPLs) based on the Sydney criteria. We aimed to explore the clinico-laboratory features and treatment strategies of APS patients retrospectively. METHODOLOGY The medical records of APS patients registered under Hospital Universiti Sains Malaysia (Kelantan state) between 2000 and 2015 were reviewed. RESULTS A total of 17 APS subjects (age 40.7 ± 12.8 years) including 11 primary (64.7%) and six secondary APS (35.3%) patients were identified. The follow-up period was 9.5 ± 6.7 years with male:female ratio of 1.0:4.7. Pregnancy morbidity was the most common clinical manifestation (11/14; 78.6%) followed by recurrent venous thrombosis (10/17; 58.8%). For other clinical features, menorrhagia was the most frequently observed manifestation (4/14; 28.6%) followed by aPLs-associated thrombocytopenia (4/17; 23.5%) and ovarian cyst (3/14; 21.4%). LA and aCL were positive in 94.1% (16/17) and 81.8% (9/11) of the patients, respectively. APTT value (76.7 ± 17.0 sec) was significantly high (p < 0.05). Low intensity warfarin alone was successful to maintain target INR (2.0 - 3.0) and prevent recurrence of thrombosis. CONCLUSION The tendency of pregnancy morbidity in this cohort of Malaysian Kelantanese APS patients was high compared to other previously reported APS cohorts. Low intensity warfarin was successful in preventing recurrence of thrombosis, however, APS women receiving long-term anticoagulants should be monitored for possible occurrence of menorrhagia and ovarian cysts.
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Affiliation(s)
- M A Islam
- Universiti Sains Malaysia, School of Medical Sciences, Human Genome Centre, Kelantan, Malaysia.
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Wong KK, Dow K. CANADIAN PAEDIATRICIANS’ PERCEPTIONS OF NEONATAL PULSE OXIMETRY SCREENING. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.052] [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: 11/13/2022] Open
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D’Rozario AL, Hoyos C, Kim J, Vakulin A, Wong KK, Leow J, Bartlett DJ, Grunstein RR. 0514 SIX MONTHS OF CONTINUOUS POSITIVE AIRWAY PRESSURE TREATMENT IMPROVES NEUROBEHAVIORAL FUNCTION AND QUANTITATIVE SLEEP ELECTROENCEPHALOGRAM MEASURES IN OBSTRUCTIVE SLEEP APNEA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.513] [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: 11/12/2022] Open
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Rosko A, Birkeland A, Shuman A, Prince M, Bradford C, Wolf G, Worden F, Eisbruch A, Srinivasan A, Wong KK, Spector ME. Positron emission tomography-CT prediction of occult nodal metastasis in recurrent laryngeal cancer. Head Neck 2017; 39:980-987. [PMID: 28236331 DOI: 10.1002/hed.24719] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 11/30/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the predictive value of positron emission tomography (PET)-CT in identifying occult nodal metastasis in clinically and radiographically N0 patients with recurrent laryngeal cancer undergoing salvage laryngectomy. METHODS Retrospective review of 46 clinically and radiographically N0 patients with recurrent laryngeal cancer who underwent a PET-CT examination before salvage laryngectomy with neck dissection from January 1, 2002, to December 31, 2014, was performed. RESULTS Two patients (16.7%) had true-positive PET-CT results, whereas 10 patients (83.3%) had false-negative scans, 1 patient (2.9%) had a false-positive result and 33 patients (97.1%) had a true-negative PET-CT. The sensitivity of PET-CT was 16.7% (95% confidence interval [CI], 3.5% to 46.0%) with a specificity of 97.1% (95% CI, 83.8% to 99.9%), positive predictive value (PPV) of 66.7% (95% CI, 20.2% to 94.4%), and negative predictive value (NPV) of 76.7% (95% CI, 62.1% to 87.0%). CONCLUSION PET-CT has poor sensitivity and NPV making PET-CT an imperfect predictor of nodal disease in recurrent laryngeal cancer. © 2017 Wiley Periodicals, Inc. Head Neck 39: 980-987, 2017.
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Affiliation(s)
- Andrew Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Andrew Birkeland
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Andrew Shuman
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Mark Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Carol Bradford
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Gregory Wolf
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Francis Worden
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ashok Srinivasan
- Department of Radiology, Division of Neuroradiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ka Kit Wong
- Department of Radiology, Division of Nuclear Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
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Viglianti BL, Wong KK, Wimer SM, Parameswaran A, Nan B, Ky C, Townsend DM, Rubello D, Frey KA, Gross MD. Effect of hyperglycemia on brain and liver 18F-FDG standardized uptake value (FDG SUV) measured by quantitative positron emission tomography (PET) imaging. Biomed Pharmacother 2017; 88:1038-1045. [PMID: 28192877 DOI: 10.1016/j.biopha.2017.01.166] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 01/08/2017] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Blood glucose is routinely measured prior to 18F-fluorodeoxyglucose (FDG) administration in positron emission tomography (PET) imaging to identify hyperglycemia that may affect image quality. In this study we explore the effects of blood glucose levels upon semi-quantitative standardized uptake value (SUV) measurements of target organs and tissues of interest and in particular address the relationship of blood glucose to FDG accumulation in the brain and liver. METHODS 436 FDG PET/CT consecutive studies performed for oncology staging in 229 patients (226 male) at the Ann Arbor Veterans Administration Healthcare System were reviewed. All patients had blood glucose measured (112.4±34.1mg/dL) prior to injection of 466.2±51.8MBq (12.6±1.4mCi) of FDG. SUV measurements of brain, aortic arch blood-pool, liver, and spleen were obtained at 64.5±10.2min' post-injection. RESULTS We found a negative inverse relationship of brain SUV with increasing plasma glucose, levels for both absolute and normalized (either to blood-pool or liver) values. Higher blood glucose levels had a mild effect upon liver and blood-pool SUV. By contrast, spleen SUV was independent of blood glucose, but demonstrated the greatest variability (deviation on linear regression). In contrast to other tissues, liver and spleen SUV normalized to blood-pool SUV were not dependent upon blood glucose levels. CONCLUSION The effects of hyperglycemia upon FDG uptake in brain and liver, over a range of blood glucose values generally considered acceptable for clinical PET imaging, may have measurable effects on semi-quantitative image analysis.
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Affiliation(s)
- Benjamin L Viglianti
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA.
| | - Ka Kit Wong
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie M Wimer
- Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA
| | - Aishwarya Parameswaran
- Michigan Institute for Clinical and Health Research (MICHR), University of Michigan, Ann Arbor, MI, USA
| | - Bin Nan
- Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Christy Ky
- University of Michigan School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Danyelle M Townsend
- Department of Drug Discovery and Pharmaceutical Sciences, Medical University of Southern Carolina, USA
| | - Domenico Rubello
- Department of Nuclear Medicine, Radiology, NeuroRadiology, Medical Physics, Clinical Laboratory, Microbiology, Pathology, Santa Maria della Misericordia Hospital, Rovigo, Italy.
| | - Kirk A Frey
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Milton D Gross
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA
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Wale DJ, Wong KK, Viglianti BL, Rubello D, Gross MD. Contemporary imaging of incidentally discovered adrenal masses. Biomed Pharmacother 2017; 87:256-262. [PMID: 28063406 DOI: 10.1016/j.biopha.2016.12.090] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/08/2016] [Accepted: 12/22/2016] [Indexed: 12/11/2022] Open
Abstract
Adrenal lesions are routinely encountered incidentally in clinical practice. Although most of these lesions are benign, malignancy needs to be excluded. Therefore, the initial clinical workup is to exclude aggressive characteristics suggesting malignancy and to identify characteristics predictive of the most common benign lesion, an adrenal adenoma. Predicting a benign adenoma using a variety of imaging modalities has been widely studied using unenhanced computed tomography (CT), contrast enhanced CT, and magnetic resonance (MR) imaging. This review article describes the currently used imaging protocols and clinical interpretation criteria of common adrenal lesions. An adenoma can be predicted if a homogenous soft tissue adrenal mass demonstrates low attenuation (upper threshold value of 10 Hounsfield Units) on unenhanced CT, demonstrates an absolute enhancement washout of ≥ 60% and/or relative enhancement washout of ≥ 40% on adrenal washout contrast enhanced CT, or demonstrates signal loss in opposed-phased MR imaging. If an adrenal adenoma cannot be predicted based upon these criteria, the lesion should be evaluated for other imaging characteristics that suggest a specific pathology, such as an adrenal cyst or myelolipoma. Although nonspecific and with limitations, 18F-fluorodeoxyglucose (FDG) PET/CT has a potential role for differentiating benign from malignant lesions based upon the amount of radiopharmaceutical uptake with malignant lesions generally having greater uptake. If clinical and/or hormonal screening suggests a pheochromocytoma, consideration can be given to 18F-dihydroxyphenylalanine (DOPA) or 123I-metaiodobenzylguanidine (MIBG) in addition to CT and MR. Finally, this review proposes a diagnostic work-up strategy for routine use in clinical practice.
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Affiliation(s)
- Daniel J Wale
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI 48109, USA; Department of Nuclear Medicine, Department of Veterans Affairs Health System, Ann Arbor, MI 48105, USA.
| | - Ka Kit Wong
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI 48109, USA
| | - Benjamin L Viglianti
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI 48109, USA; Department of Nuclear Medicine, Department of Veterans Affairs Health System, Ann Arbor, MI 48105, USA
| | - Domenico Rubello
- Radiology, Medical Physics, Santa Maria della Misericordia Hospital, 45100 Rovigo, Italy
| | - Milton D Gross
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI 48109, USA; Department of Nuclear Medicine, Department of Veterans Affairs Health System, Ann Arbor, MI 48105, USA
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Law M, Wong KK, Tso WK, Lee V, Luk MY, Tong CC, Chu F. Personnel dose reduction in 90Y microspheres liver-directed radioembolization: from interventional radiology suite to patient ward. Br J Radiol 2016; 90:20160591. [PMID: 27993095 DOI: 10.1259/bjr.20160591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To describe a method to reduce the external radiation exposure emitted from the patient after liver-directed radioembolization using 90Y glass microspheres, to quantitatively estimate the occupational dose of medical personnel providing patient care to the patient radioembolized with the use of the method and to discuss radiation exposure to patients who are adjacent if the patient radioembolized needs hospitalization. METHODS A lead-lined blanket of lead equivalence of 0.5 mm was used to cover the patient abdomen immediately after the 90Y radioembolization procedure, in order to reduce the radiation emitted from the patient. The interventional radiologist used a rod-type puncture site compressor for haemostasis to avoid direct contact with possible residual radioactivity at the puncture site. Dose rates were measured at the interventional radiologist chest and hand positions during puncture site pressing for haemostasis with and without the use of the blanket. The measurement results were applied to estimate the occupational dose of colleagues performing patient care to the patient radioembolized. The exposure to patients adjacent in the ward was estimated if the patient radioembolized was hospitalized. RESULTS The radiation exposures measured at the radiologist chest and hand positions have been significantly reduced with the lead-lined blanket in place. The radiologist, performing puncture site pressing at the end of radioembolization procedure, would receive an average hand dose of 1.95 μSv and body dose under his own lead apron of 0.30 μSv for an average 90Y microsphere radioactivity of 2.54 GBq. Other medical personnel, nurses and porters, would receive occupational doses corresponding to an hour of background radiation. If the patient radioembolized using 90Y needs hospitalization in a common ward, using the lead-lined blanket to cover the abdomen of the patient and keeping a distance of 2 m from the patient who is adjacent would reduce the exposure by 0.42% of dose limit for the general public. CONCLUSION By placing a lead-lined blanket on the patient abdominal region after 90Y radioembolization, hospital staff receive minimal radiation exposure in order to comply with the radiation protection "as low as reasonably achievable" principle. There will be no increase in radiation level in ward if the patient radioembolized using 90Y needs to be hospitalized. Therefore, the patient radioembolized can be accommodated alternatively at a corner bed of a common ward if an isolation room with private toilet facility is not available. Advances in knowledge: To reduce exposure to personnel providing patient care to patients radioembolized using 90Y.
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Affiliation(s)
- Martin Law
- 1 Department of Radiology, Queen Mary Hospital, Hong Kong
| | - K K Wong
- 1 Department of Radiology, Queen Mary Hospital, Hong Kong
| | - W K Tso
- 1 Department of Radiology, Queen Mary Hospital, Hong Kong
| | - Victor Lee
- 2 Department of Clinical Oncology, University of Hong Kong, Hong Kong
| | - M Y Luk
- 3 Department of Clinical Oncology, Queen Mary Hospital, Hong Kong
| | - C C Tong
- 3 Department of Clinical Oncology, Queen Mary Hospital, Hong Kong
| | - Ferdinand Chu
- 1 Department of Radiology, Queen Mary Hospital, Hong Kong
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Affiliation(s)
- Ka Kit Wong
- Divisions of Pediatric Radiology and Nuclear Medicine, Department of Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, Michigan
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Wong KK, Chondrogiannis S, Bowles H, Fuster D, Sánchez N, Rampin L, Rubello D. Hybrid-fusion SPECT/CT systems in parathyroid adenoma: Technological improvements and added clinical diagnostic value. Rev Esp Med Nucl Imagen Mol 2016; 35:385-390. [PMID: 27554661 DOI: 10.1016/j.remn.2016.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
Abstract
Nuclear medicine traditionally employs planar and single photon emission computed tomography (SPECT) imaging techniques to depict the biodistribution of radiotracers for the diagnostic investigation of a range of disorders of endocrine gland function. The usefulness of combining functional information with anatomy derived from computed tomography (CT), magnetic resonance imaging (MRI), and high resolution ultrasound (US), has long been appreciated, either using visual side-by-side correlation, or software-based co-registration. The emergence of hybrid SPECT/CT camera technology now allows the simultaneous acquisition of combined multi-modality imaging, with seamless fusion of 3D volume datasets. Thus, it is not surprising that there is growing literature describing the many advantages that contemporary SPECT/CT technology brings to radionuclide investigation of endocrine disorders, showing potential advantages for the pre-operative locating of the parathyroid adenoma using a minimally invasive surgical approach, especially in the presence of ectopic glands and in multiglandular disease. In conclusion, hybrid SPECT/CT imaging has become an essential tool to ensure the most accurate diagnostic in the management of patients with hyperparathyroidism.
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Affiliation(s)
- K K Wong
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - S Chondrogiannis
- Department of Nuclear Medicine, Radiology, Medical Physics, Clinical Pathology, Rovigo Hospital, Rovigo, Italy
| | - H Bowles
- Nuclear Medicine Department, Hospital Clinic, Barcelona University, Barcelona, Spain
| | - D Fuster
- Nuclear Medicine Department, Hospital Clinic, Barcelona University, Barcelona, Spain
| | - N Sánchez
- Nuclear Medicine Department, Hospital Clinic, Barcelona University, Barcelona, Spain
| | - L Rampin
- Department of Nuclear Medicine, Radiology, Medical Physics, Clinical Pathology, Rovigo Hospital, Rovigo, Italy
| | - D Rubello
- Department of Nuclear Medicine, Radiology, Medical Physics, Clinical Pathology, Rovigo Hospital, Rovigo, Italy.
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