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Fiz F, Cirone A, Righi S, Massollo M, Amoroso L, Bottoni G, Conte M, Gambaro M, Massone F, Orengo S, Bruzzone GS, Sorrentino S, Garaventa A, Piccardo A. Reaching the target dose with one single 131 I-mIBG administration in high-risk neuroblastoma: The determinant impact of the primary tumour. Pediatr Blood Cancer 2024; 71:e30806. [PMID: 38082548 DOI: 10.1002/pbc.30806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/13/2023] [Accepted: 11/19/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND 131 I-metaiodobenzylguanidine (131 I-mIBG) effectiveness in children with metastasised neuroblastoma (NB) is linked to the effective dose absorbed by the target; a target of 4 Gy whole-body dose threshold has been proposed. Achieving this dose often requires administering 131 I-mIBG twice back-to-back, which may cause haematological toxicity. In this study, we tried identifying the factors predicting the achievement of 4 Gy whole-body dose with a single radiopharmaceutical administration. MATERIALS AND METHODS Children affected by metastatic NB and treated with a high 131 I-mIBG activity (>450 MBq (megabecquerel)/kg) were evaluated retrospectively. Kinetics measurements were carried out at multiple time points to estimate the whole-body dose, which was compared with clinical and activity-related parameters. RESULTS Seventeen children (12 females, median age 3 years, age range: 1.5-6.9 years) were included. Eleven of them still bore the primary tumour. The median whole-body dose was 2.88 Gy (range: 1.63-4.22 Gy). Children with a 'bulky' primary (>30 mL) received a higher whole-body dose than those with smaller or surgically removed primaries (3.42 ± 0.74 vs. 2.48 ± 0.65 Gy, respectively, p = .016). Conversely, the correlation between activity/kg and the whole-body dose was moderate (R: 0.42, p = .093). In the multivariate analysis, the volume of the primary tumour was the most relevant predictor of the whole-body dose (p = .002). CONCLUSIONS These data suggest that the presence of a bulky primary tumour can significantly prolong the 131 I-mIBG biological half-life, effectively increasing the absorbed whole-body dose. This information could be used to model the administered activity, allowing to attain the target dose without needing a two-step radiopharmaceutical administration.
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Affiliation(s)
- Francesco Fiz
- Department of Nuclear Medicine, Galliera Hospital, Genoa, Italy
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital, Tübingen, Germany
| | - Alessio Cirone
- Department of Medical Physics, Galliera Hospital, Genoa, Italy
| | - Sergio Righi
- Department of Medical Physics, Galliera Hospital, Genoa, Italy
| | | | | | | | - Massimo Conte
- Oncology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Monica Gambaro
- Department of Medical Physics, Galliera Hospital, Genoa, Italy
| | | | - Stefano Orengo
- Department of Medical Physics, Galliera Hospital, Genoa, Italy
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Piccardo A, Treglia G, Fiz F, Bar-Sever Z, Bottoni G, Biassoni L, Borgwardt L, de Keizer B, Jehanno N, Lopci E, Kurch L, Massollo M, Nadel H, Roca Bielsa I, Shulkin B, Vali R, De Palma D, Cecchin D, Santos AI, Zucchetta P. The evidence-based role of catecholaminergic PET tracers in Neuroblastoma. A systematic review and a head-to-head comparison with mIBG scintigraphy. Eur J Nucl Med Mol Imaging 2024; 51:756-767. [PMID: 37962616 PMCID: PMC10796700 DOI: 10.1007/s00259-023-06486-9] [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: 07/13/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Molecular imaging is pivotal in staging and response assessment of children with neuroblastoma (NB). [123I]-metaiodobenzylguanidine (mIBG) is the standard imaging method; however, it is characterised by low spatial resolution, time-consuming acquisition procedures and difficult interpretation. Many PET catecholaminergic radiotracers have been proposed as a replacement for [123I]-mIBG, however they have not yet made it into clinical practice. We aimed to review the available literature comparing head-to-head [123I]-mIBG with the most common PET catecholaminergic radiopharmaceuticals. METHODS We searched the PubMed database for studies performing a head-to-head comparison between [123I]-mIBG and PET radiopharmaceuticals including meta-hydroxyephedrine ([11C]C-HED), 18F-18F-3,4-dihydroxyphenylalanine ([18F]DOPA) [124I]mIBG and Meta-[18F]fluorobenzylguanidine ([18F]mFBG). Review articles, preclinical studies, small case series (< 5 subjects), case reports, and articles not in English were excluded. From each study, the following characteristics were extracted: bibliographic information, technical parameters, and the sensitivity of the procedure according to a patient-based analysis (PBA) and a lesion-based analysis (LBA). RESULTS Ten studies were selected: two regarding [11C]C-HED, four [18F]DOPA, one [124I]mIBG, and three [18F]mFBG. These studies included 181 patients (range 5-46). For the PBA, the superiority of the PET method was reported in two out of ten studies (both using [18F]DOPA). For LBA, PET detected significantly more lesions than scintigraphy in seven out of ten studies. CONCLUSIONS PET/CT using catecholaminergic tracers shows superior diagnostic performance than mIBG scintigraphy. However, it is still unknown if such superiority can influence clinical decision-making. Nonetheless, the PET examination appears promising for clinical practice as it offers faster image acquisition, less need for sedation, and a single-day examination.
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Affiliation(s)
- Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura Delle Cappuccine 14, 16128, Genoa, Italy.
| | - Giorgio Treglia
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Francesco Fiz
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura Delle Cappuccine 14, 16128, Genoa, Italy
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital, Tübingen, Germany
| | - Zvi Bar-Sever
- Department of Nuclear Medicine, Schneider Children's Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Gianluca Bottoni
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura Delle Cappuccine 14, 16128, Genoa, Italy
| | - Lorenzo Biassoni
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Lise Borgwardt
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bart de Keizer
- Department of Nuclear Medicine and Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nina Jehanno
- Department of Nuclear Medicine, Institut Curie Paris, Paris, France
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS-Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Michela Massollo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura Delle Cappuccine 14, 16128, Genoa, Italy
| | - Helen Nadel
- Department of Pediatric Nuclear Medicine, Lucile Packard Children's Hospital of Stanford (CA), Palo Alto, USA
| | | | - Barry Shulkin
- St Jude Children's Research Hospital, Memphis, TN, USA
| | - Reza Vali
- Division of Nuclear Medicine, Department of Diagnostic Imaging, The Hospital for Sick Children of Toronto, Toronto, Canada
| | - Diego De Palma
- Nuclear Medicine Unit, Ospedale Di Circolo of Varese, Varese, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine - DIMED, University Hospital of Padova, Padua, Italy
| | - Ana Isabel Santos
- Department of Nuclear Medicine, Hospital Garcia de Orta, Almada, Portugal
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine - DIMED, University Hospital of Padova, Padua, Italy
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Piccardo A, Fiz F, Bottoni G, Foppiani L, Albano D, Bertagna F, Catrambone U, Mariani F, Sambucco B, Massollo M, Treglia G, Trimboli P. Does it work in childhood and adolescence? The predictive role of postoperative/preablative stimulated thyroglobulin levels in paediatric thyroid cancer. A systematic review of the literature. Rev Endocr Metab Disord 2024; 25:53-63. [PMID: 37743443 DOI: 10.1007/s11154-023-09835-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Thyroglobulin is a well-established disease marker during follow-up in paediatric differentiated thyroid cancer. However, no conclusive data on the role of endogenously stimulated thyroglobulin after thyroidectomy (ptTg) in predicting disease-specific outcomes are available. This review aims to establish the prognostic value of ptTg in children with DTC. METHODS Online medical databases were searched for studies evaluating the association between ptTg and disease-specific outcomes in DTC-affected children. Documents not in English, preclinical studies, other review articles, case reports, and small case series were excluded. The risk of bias was assessed with the QUADAS-2 tool. RESULTS Twelve studies, analysing 1043 children in total, were included in the review. They all had a retrospective design and were published between 2016 and 2022. Of all patients, 1008 (97%) and 849 (81%) had undergone thyroidectomy and RAI, respectively. Eight studies (756 children) evaluated the correlation between ptTg and disease persistence/relapse: six reported a significant association between these parameters; a specific ptTg cut-off (10-14 ng/ml) was identified at the multivariate analysis in three studies. The remaining four studies assessed the link between ptTg levels and disease extension, with three reporting a correlation between ptTg and lung/nodal metastases. DISCUSSION ptTg is a readily available and inexpensive parameter, bearing a strong prognostic power in identifying disease persistence, relapse, and the presence of metastases in children affected by DTC.
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Affiliation(s)
- Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, 16128, Italy.
- Centro della Tiroide, E.O. "Ospedali Galliera", Genoa, Italy.
| | - Francesco Fiz
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, 16128, Italy
- Centro della Tiroide, E.O. "Ospedali Galliera", Genoa, Italy
| | - Gianluca Bottoni
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, 16128, Italy
- Centro della Tiroide, E.O. "Ospedali Galliera", Genoa, Italy
| | - Luca Foppiani
- Centro della Tiroide, E.O. "Ospedali Galliera", Genoa, Italy
- Department of Internal Medicine, E.O. "Ospedali Galliera", Genoa, Italy
| | - Domenico Albano
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili Di Brescia, P.le Spedali Civili 1, Brescia, 25123, Italy
| | - Francesco Bertagna
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili Di Brescia, P.le Spedali Civili 1, Brescia, 25123, Italy
| | - Ugo Catrambone
- Centro della Tiroide, E.O. "Ospedali Galliera", Genoa, Italy
- Department of General and Endocrine Surgery, "Ospedali Galliera", Genoa, Italy
| | - Federica Mariani
- Centro della Tiroide, E.O. "Ospedali Galliera", Genoa, Italy
- Department of General and Endocrine Surgery, "Ospedali Galliera", Genoa, Italy
| | - Beatrice Sambucco
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, 16128, Italy
- Centro della Tiroide, E.O. "Ospedali Galliera", Genoa, Italy
| | - Michela Massollo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, 16128, Italy
- Centro della Tiroide, E.O. "Ospedali Galliera", Genoa, Italy
| | - Giorgio Treglia
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Pierpaolo Trimboli
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland.
- Clinic of Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Via Ospedale 12, Bellinzona, 6500, Switzerland.
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Foppiani L, Fiz F, Dezzana M, Massollo M, Bottoni G, Piccardo A. Is it iodine-refractory? The first post-therapeutic [ 131I]iodine and diagnostic [ 123I]iodine scans can underestimate the metastatic disease load in thyroid cancer: A case report. Rev Esp Med Nucl Imagen Mol 2024; 43:61-62. [PMID: 37923215 DOI: 10.1016/j.remnie.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Luca Foppiani
- Department of Internal Medicine, E. O. Ospedali Galliera, Genoa, Italy
| | - Francesco Fiz
- Department of Nuclear Medicine, E. O. Ospedali Galliera, Genoa, Italy.
| | - Marih Dezzana
- Department of Pathology, E. O. Ospedali Galliera, Genoa, Italy
| | - Michela Massollo
- Department of Nuclear Medicine, E. O. Ospedali Galliera, Genoa, Italy
| | - Gianluca Bottoni
- Department of Nuclear Medicine, E. O. Ospedali Galliera, Genoa, Italy
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, E. O. Ospedali Galliera, Genoa, Italy
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Cistaro A, Quartuccio N, Piccardo A, Meo G, Gandoglia I, Schiera IG, Fania P, Lupidi F, Bottoni G, Massollo M, Altrinetti V, Pestarino E, Iacozzi M, Iantorno M, Del Sette M. Brain positron emission tomography in idiopathic normal-pressure hydrocephalus: new 18 F-fluorodeoxyglucose pattern in a long-known syndrome. Nucl Med Commun 2023; 44:1163-1167. [PMID: 37779439 DOI: 10.1097/mnm.0000000000001763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
AIM Patients with idiopathic normal-pressure hydrocephalus (iNPH) can show a global reduction in cerebral glucose metabolism at [ 18 F]Fluorodeoxyglucose (FDG) PET. The presence of caudate hypometabolism has been identified as a potential biomarker in iNPH, yet there is limited evidence of hypermetabolic findings in patients with iNPH so far. METHODS We retrieved retrospectively patients with iNPH and normal cognitive assessment, evaluated before surgery undergoing brain [ 18 F]FDG-PET. The 18 F-FDG-PET brain scans were compared to those of a control group of healthy subjects, matched for age and sex, by statistical parametric mapping (SPM) to identify areas of relative hypo- and hypermetabolism. Furthermore, the existence of a correlation between areas of hypo- and hypermetabolism in the patient group was tested. RESULTS Seven iNPH patients (mean age 74 ± 6 years) were found in the hospital database. SPM group analysis revealed clusters of significant hypometabolism ( P = 0.001) in the iNPH group in the dorsal striatum, involving caudate and putamen bilaterally. Clusters of significant hypermetabolism ( P = 0.001) were revealed in the bilateral superior and precentral frontal gyrus (BA 4, 6). A significant inverse correlation between striatal hypometabolism and bilateral superior and precentral frontal gyrus hypermetabolism was revealed ( P < 0.001 corrected for multiple comparisons). CONCLUSION In this cohort, patients with iNPH showed subcortical hypometabolism, including bilateral dorsal striatum. To the best of our knowledge, this is the first report demonstrating a hypermetabolic pattern in the primary motor and premotor areas, and showing an inverse correlation between the striatum and motor cortex in patients with iNPH.
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Affiliation(s)
| | - Natale Quartuccio
- Nuclear Medicine Unit, Ospedali Riuniti Villa Sofia, Cervello, Palermo,
| | - Arnoldo Piccardo
- Nuclear Medicine Department, Ente Ospedaliero Ospedali Galliera,
| | - Giuseppe Meo
- Department of Neurology, IRCCS Ospedale Policlinico San Martino,
| | | | | | | | - Francesco Lupidi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa and
| | - Gianluca Bottoni
- Nuclear Medicine Department, Ente Ospedaliero Ospedali Galliera,
| | - Michela Massollo
- Nuclear Medicine Department, Ente Ospedaliero Ospedali Galliera,
| | - Vania Altrinetti
- Nuclear Medicine Department, Ente Ospedaliero Ospedali Galliera,
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Fiz F, Bottoni G, Massollo M, Trimboli P, Catrambone U, Bacigalupo L, Righi S, Treglia G, Imperiale A, Piccardo A. [18F]F-Choline PET/CT and 4D-CT in the evaluation of primary hyperparathyroidism: rivals or allies? Q J Nucl Med Mol Imaging 2023; 67:130-137. [PMID: 37232932 DOI: 10.23736/s1824-4785.23.03514-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Primary hyperparathyroidism is a hard-to-diagnose condition that can run without symptoms for many years without causing symptoms; yet, it can cause dire long-term consequences, such as osteoporosis and renal impairment. First-line diagnostic methods include ultrasound and parathyroid scintigraphy, which provide unsatisfactory results in terms of detection rate. Second-line imaging methods include [18F]F-Choline PET/CT, 4D-CT, and their combination. These methods have shown a great detection rate and sensitivity; however, they are to this day less widespread than the first-line ones. Both the two methods (PET and 4D-CT) have their specific advantages and field of application, as well as their specific limitations. In this narrative review, we will describe the advantages and disadvantages of the two techniques extensively. Moreover, we will try to identify whether the combined examination can play a role and how relevant this role is. Finally, we will try to define the specific clinical situation in which each method can provide the best contribution to diagnosing parathyroid tissue hyperfunction.
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Affiliation(s)
- Francesco Fiz
- Department of Nuclear Medicine, Ospedali Galliera, Genoa, Italy -
| | | | | | - Pierpaolo Trimboli
- Clinic of Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Ugo Catrambone
- Department of General and Endocrine Surgery, Ospedali Galliera, Genoa, Italy
| | | | - Sergio Righi
- Department of Medical Physics, Ospedali Galliera, Genoa, Italy
| | - Giorgio Treglia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Alessio Imperiale
- Department of Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg University Hospitals, Strasbourg, France
- Department of Radiobiology, Hadrontherapy and Molecular Imaging (DRHIM), IPHC, UMR-7178, CNRS/Unistra, Strasbourg, France
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Fiz F, Bini F, Gabriele E, Bottoni G, Garrè ML, Marinozzi F, Milanaccio C, Verrico A, Massollo M, Bosio V, Lattuada M, Rossi A, Ramaglia A, Puntoni M, Morana G, Piccardo A. Role of Dynamic Parameters of 18F-DOPA PET/CT in Pediatric Gliomas. Clin Nucl Med 2022; 47:517-524. [PMID: 35353725 DOI: 10.1097/rlu.0000000000004185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF THE REPORT PET with 18F-DOPA can be used to evaluate grading and aggressiveness of pediatric cerebral gliomas. However, standard uptake parameters may underperform in circumscribed lesions and in diffuse pontine gliomas. In this study, we tested whether dynamic 18F-DOPA PET could overcome these limitations. PATIENTS AND METHODS Patients with available dynamic 18F-DOPA PET were included retrospectively. Static parameters (tumor/striatum ratio [T/S] and tumor/cortex ratio [T/N]) and dynamic ones, calculated on the tumor time activity curve (TAC), including time-to-peak (TTP), slope steepness, the ratio between tumor and striatum TAC steepness (dynamic slope ratio [DSR]), and TAC shape (accumulation vs plateau), were evaluated as predictors of high/low grading (HG and LG) and of progression-free survival and overall survival. RESULTS Fifteen patients were included; T/S, T/N, TTP, TAC slope steepness, and DSR were not significantly different between HG and LG. The accumulation TAC shape was more prevalent in the LG than in the HG group (75% vs 27%). On progression-free survival univariate analysis, TAC accumulation shape predicted longer survival (P < 0.001), whereas T/N and DSR showed borderline significance; on multivariate analyses, only TAC shape was retained (P < 0.01, Harrell C index, 0.93-0.95). On overall survival univariate analysis, T/N (P < 0.05), DSR (P < 0.05), and TAC "accumulating" shape predicted survival (P < 0.001); once more, only this last parameter was retained in the multivariate models (P < 0.05, Harrell C index, 0.86-0.89). CONCLUSIONS Dynamic 18F-DOPA PET analysis outperforms the static parameter evaluation in grading assessment and survival prediction. Evaluation of the curve shape is a simple-to-use parameter with strong predictive power.
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Affiliation(s)
- Francesco Fiz
- From the Department of Nuclear Medicine, E.O. "Ospedali Galliera," Genoa
| | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome
| | - Edoardo Gabriele
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome
| | - Gianluca Bottoni
- From the Department of Nuclear Medicine, E.O. "Ospedali Galliera," Genoa
| | | | - Franco Marinozzi
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome
| | | | | | - Michela Massollo
- From the Department of Nuclear Medicine, E.O. "Ospedali Galliera," Genoa
| | | | | | - Andrea Rossi
- Pediatric Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genova
| | - Antonia Ramaglia
- Pediatric Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genova
| | - Matteo Puntoni
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma
| | | | - Arnoldo Piccardo
- From the Department of Nuclear Medicine, E.O. "Ospedali Galliera," Genoa
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Cistaro A, Quartuccio N, Garganese MC, Villani MF, Altini C, Pizzoferro M, Piccardo A, Cabria M, Massollo M, Maghnie M, Campennì A, Siracusa M, Baldari S, Panareo S, Urso L, Bartolomei M, De Palma D, Grossi A, Mazzoletti A, Dondi F, Bertagna F, Giubbini R, Albano D. Prognostic factors in children and adolescents with differentiated thyroid carcinoma treated with total thyroidectomy and RAI: a real-life multicentric study. Eur J Nucl Med Mol Imaging 2022; 49:1374-1385. [PMID: 34664092 PMCID: PMC8921094 DOI: 10.1007/s00259-021-05586-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 08/27/2021] [Accepted: 10/09/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE This multicentric study aimed to investigate the main prognostic factors associated with treatment response at 1 year after radioactive iodine therapy (RAIT) and the last disease status in pediatric patients affected by differentiated thyroid carcinoma (DTC). MATERIALS AND METHODS In the period 1990-2020, all consecutive patients ≤ 18 years from six different centers were retrospectively included. Patients were classified as low, intermediate, and high risk for persistence/recurrence. The response to RAIT was evaluated and scored 1 year later according to 2015 ATA guidelines. Moreover, at the last follow-up, the disease status was evaluated and dichotomized as no evidence of disease (NED) or persistent disease. RESULTS Two hundred and eighty-five patients (197 female, 88 male; mean age 14.4 years) were recruited. All, except nine, underwent near-total thyroidectomy followed by RAIT. One-year after first RAIT, 146/276 (53%) patients had excellent response, 37/276 (14%) indeterminate response, and 91/276 (33%) incomplete response. One-year after RAIT, children with excellent response had significantly lower stimulated thyroglobulin (sTg) compared to not excellent group (median sTg 4.4 ng/ml vs 52.5 ng/ml, p < 0.001). ROC curve showed sTg higher than 27.2 ng/ml as the most accurate to predict 1-year treatment response. After a median follow-up of 133 months, NED was present in 241 cases (87%) while persistent disease in 35 (13%). At multivariate analysis, sTg and 1-year treatment response categories were both significantly associated with the last disease status (p value 0.023 and < 0.001). CONCLUSIONS In pediatric DTC, sTg is significantly associated with 1-year treatment response and final outcome. However, 1-year response is the principal prognostic factor able to predict pediatric DTCs outcome.
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Affiliation(s)
- Angelina Cistaro
- Associazione Italiana Medicina Nucleare (AIMN), Pediatric Study Group, Milan, Italy
- Nuclear Medicine Division, Salus Alliance Medical, Genoa, Italy
| | - Natale Quartuccio
- Associazione Italiana Medicina Nucleare (AIMN), Pediatric Study Group, Milan, Italy
- Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina E Benfratelli, Palermo, Italy
| | - Maria Carmen Garganese
- Associazione Italiana Medicina Nucleare (AIMN), Pediatric Study Group, Milan, Italy
- Imaging Department, Nuclear Medicine Unit, IRCCS Bambino Gesù Pediatric Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Maria Felicia Villani
- Imaging Department, Nuclear Medicine Unit, IRCCS Bambino Gesù Pediatric Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Claudio Altini
- Imaging Department, Nuclear Medicine Unit, IRCCS Bambino Gesù Pediatric Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Milena Pizzoferro
- Imaging Department, Nuclear Medicine Unit, IRCCS Bambino Gesù Pediatric Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Arnoldo Piccardo
- Associazione Italiana Medicina Nucleare (AIMN), Pediatric Study Group, Milan, Italy
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Manlio Cabria
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Michela Massollo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
- Nuclear Medicine Unit, University Hospital "G. Martino", Messina, Italy
| | - Massimiliano Siracusa
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
- Nuclear Medicine Unit, University Hospital "G. Martino", Messina, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
- Nuclear Medicine Unit, University Hospital "G. Martino", Messina, Italy
| | - Stefano Panareo
- Nuclear Medicine Department, Azienda Ospedaliera Universitaria Di Modena, Modena, Italy
| | - Luca Urso
- Nuclear Medicine Unit, Oncological Medical and Specialist Department, University Hospital of Ferrara, Ferrara, Italy
| | - Mirco Bartolomei
- Nuclear Medicine Unit, Oncological Medical and Specialist Department, University Hospital of Ferrara, Ferrara, Italy
| | - Diego De Palma
- Associazione Italiana Medicina Nucleare (AIMN), Pediatric Study Group, Milan, Italy
- Department of Nuclear Medicine, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Armando Grossi
- Endocrine Pathology of Chronic and Post Cancer Diseases Unit, IRCCS Bambino Gesù Pediatric Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Angelica Mazzoletti
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili Di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Francesco Dondi
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili Di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili Di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili Di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Domenico Albano
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili Di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
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9
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Massollo M, Fiz F, Bottoni G, Ugolini M, Paparo F, Puppo C, Provinciali N, Iacozzi M, Altrinetti V, Cistaro A, Cabria M, DeCensi A, Treglia G, Piccardo A. To Enhance or Not to Enhance? The Role of Contrast Medium 18F-FDG PET/CT in Recurrent Ovarian Carcinomas. ACTA ACUST UNITED AC 2021; 57:medicina57060561. [PMID: 34206116 PMCID: PMC8229308 DOI: 10.3390/medicina57060561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/11/2022]
Abstract
Background and Objectives: 18F-fluorodeoxyglucose (FDG) positron emission tomography/X-ray computed tomography (PET/CT) represents the mainstay diagnostic procedure for suspected ovarian cancer (OC) recurrence. PET/CT can be integrated with contrast medium and in various diagnostic settings; however, the effective benefit of this procedure is still debated. We aimed to compare the diagnostic capabilities of low-dose and contrast-enhanced PET/CT (PET/ldCT and PET/ceCT) in patients with suspected ovarian cancer relapse. Materials and Methods: 122 OC patients underwent both PET/ldCT and PET/ceCT. Two groups of nuclear medicine physicians and radiologists scored the findings as positive or negative. Clinical/radiological follow-up was used as ground truth. Sensitivity, specificity, negative/positive predictive value, and accuracy were calculated at the patient and the lesion level. Results: A total of 455 and 474 lesions were identified at PET/ldCT and PET/ceCT, respectively. At the lesion level, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were not significantly different between PET/ldCT and PET/ceCT (98%, 93.3%, 97.4%, 94.9%, and 96.9% for PET/ldCT; 99%, 95.5%, 98.3%, 97%, and 98% for PET/ceCT, p = ns). At the patient level, no significant differences in these parameters were identified (e.g., p = 0.22 and p = 0.35 for accuracy, in the peritoneum and lymph nodes, respectively). Smaller peritoneal/lymph node lesions close to physiological FDG uptake sources were found in the cases of misidentification by PET/ldCT. PET/ceCT prompted a change in clinical management in four cases (3.2%) compared to PET/ldCT. Conclusions: PET/ceCT does not perform better than PET/ldCT but can occasionally clarify doubtful peritoneal findings on PET/ldCT. To avoid unnecessary dose to the patient, PET/ceCT should be excluded in selected cases.
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Affiliation(s)
- Michela Massollo
- Department of Nuclear Medicine, E.O. “Ospedali Galliera”, Mura delle Cappuccine 14, 16128 Genoa, Italy; (M.M.); (G.B.); (M.I.); (V.A.); (A.C.); (M.C.); (A.P.)
| | - Francesco Fiz
- Department of Nuclear Medicine, E.O. “Ospedali Galliera”, Mura delle Cappuccine 14, 16128 Genoa, Italy; (M.M.); (G.B.); (M.I.); (V.A.); (A.C.); (M.C.); (A.P.)
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Milan, Italy
- Correspondence:
| | - Gianluca Bottoni
- Department of Nuclear Medicine, E.O. “Ospedali Galliera”, Mura delle Cappuccine 14, 16128 Genoa, Italy; (M.M.); (G.B.); (M.I.); (V.A.); (A.C.); (M.C.); (A.P.)
| | - Martina Ugolini
- Department of Medical Physics, E.O. “Ospedali Galliera”, 16128 Genoa, Italy;
- Department of Oncology, E.O. “Ospedali Galliera”, 16128 Genoa, Italy; (N.P.); (A.D.)
| | - Francesco Paparo
- Department of Radiology, E.O. “Ospedali Galliera, 16128 Genoa, Italy; (F.P.); (C.P.)
| | - Cristina Puppo
- Department of Radiology, E.O. “Ospedali Galliera, 16128 Genoa, Italy; (F.P.); (C.P.)
| | - Nicoletta Provinciali
- Department of Oncology, E.O. “Ospedali Galliera”, 16128 Genoa, Italy; (N.P.); (A.D.)
| | - Massimiliano Iacozzi
- Department of Nuclear Medicine, E.O. “Ospedali Galliera”, Mura delle Cappuccine 14, 16128 Genoa, Italy; (M.M.); (G.B.); (M.I.); (V.A.); (A.C.); (M.C.); (A.P.)
| | - Vania Altrinetti
- Department of Nuclear Medicine, E.O. “Ospedali Galliera”, Mura delle Cappuccine 14, 16128 Genoa, Italy; (M.M.); (G.B.); (M.I.); (V.A.); (A.C.); (M.C.); (A.P.)
| | - Angelina Cistaro
- Department of Nuclear Medicine, E.O. “Ospedali Galliera”, Mura delle Cappuccine 14, 16128 Genoa, Italy; (M.M.); (G.B.); (M.I.); (V.A.); (A.C.); (M.C.); (A.P.)
| | - Manlio Cabria
- Department of Nuclear Medicine, E.O. “Ospedali Galliera”, Mura delle Cappuccine 14, 16128 Genoa, Italy; (M.M.); (G.B.); (M.I.); (V.A.); (A.C.); (M.C.); (A.P.)
| | - Andrea DeCensi
- Department of Oncology, E.O. “Ospedali Galliera”, 16128 Genoa, Italy; (N.P.); (A.D.)
| | - Giorgio Treglia
- Faculty of Biology and Medicine, University of Lausanne, 1100 Lausanne, Switzerland;
- Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, 6900 Lugano, Switzerland
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. “Ospedali Galliera”, Mura delle Cappuccine 14, 16128 Genoa, Italy; (M.M.); (G.B.); (M.I.); (V.A.); (A.C.); (M.C.); (A.P.)
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10
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Casali M, Lauri C, Altini C, Bertagna F, Cassarino G, Cistaro A, Erba AP, Ferrari C, Mainolfi CG, Palucci A, Prandini N, Baldari S, Bartoli F, Bartolomei M, D’Antonio A, Dondi F, Gandolfo P, Giordano A, Laudicella R, Massollo M, Nieri A, Piccardo A, Vendramin L, Muratore F, Lavelli V, Albano D, Burroni L, Cuocolo A, Evangelista L, Lazzeri E, Quartuccio N, Rossi B, Rubini G, Sollini M, Versari A, Signore A. State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation. Clin Transl Imaging 2021; 9:299-339. [PMID: 34277510 PMCID: PMC8271312 DOI: 10.1007/s40336-021-00445-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/19/2021] [Indexed: 02/06/2023]
Abstract
AIM The diagnosis, severity and extent of a sterile inflammation or a septic infection could be challenging since there is not one single test able to achieve an accurate diagnosis. The clinical use of 18F-fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) imaging in the assessment of inflammation and infection is increasing worldwide. The purpose of this paper is to achieve an Italian consensus document on [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases, such as osteomyelitis (OM), prosthetic joint infections (PJI), infective endocarditis (IE), prosthetic valve endocarditis (PVE), cardiac implantable electronic device infections (CIEDI), systemic and cardiac sarcoidosis (SS/CS), diabetic foot (DF), fungal infections (FI), tuberculosis (TBC), fever and inflammation of unknown origin (FUO/IUO), pediatric infections (PI), inflammatory bowel diseases (IBD), spine infections (SI), vascular graft infections (VGI), large vessel vasculitis (LVV), retroperitoneal fibrosis (RF) and COVID-19 infections. METHODS In September 2020, the inflammatory and infectious diseases focus group (IIFG) of the Italian Association of Nuclear Medicine (AIMN) proposed to realize a procedural paper about the clinical applications of [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases. The project was carried out thanks to the collaboration of 13 Italian nuclear medicine centers, with a consolidate experience in this field. With the endorsement of AIMN, IIFG contacted each center, and the pediatric diseases focus group (PDFC). IIFG provided for each team involved, a draft with essential information regarding the execution of [18F]FDG PET/CT or PET/MRI scan (i.e., indications, patient preparation, standard or specific acquisition modalities, interpretation criteria, reporting methods, pitfalls and artifacts), by limiting the literature research to the last 20 years. Moreover, some clinical cases were required from each center, to underline the teaching points. Time for the collection of each report was from October to December 2020. RESULTS Overall, we summarized 291 scientific papers and guidelines published between 1998 and 2021. Papers were divided in several sub-topics and summarized in the following paragraphs: clinical indications, image interpretation criteria, future perspectivess and new trends (for each single disease), while patient preparation, image acquisition, possible pitfalls and reporting modalities were described afterwards. Moreover, a specific section was dedicated to pediatric and PET/MRI indications. A collection of images was described for each indication. CONCLUSIONS Currently, [18F]FDG PET/CT in oncology is globally accepted and standardized in main diagnostic algorithms for neoplasms. In recent years, the ever-closer collaboration among different European associations has tried to overcome the absence of a standardization also in the field of inflammation and infections. The collaboration of several nuclear medicine centers with a long experience in this field, as well as among different AIMN focus groups represents a further attempt in this direction. We hope that this document will be the basis for a "common nuclear physicians' language" throughout all the country. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40336-021-00445-w.
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Affiliation(s)
- Massimiliano Casali
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Chiara Lauri
- grid.7841.aNuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Corinna Altini
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Francesco Bertagna
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Gianluca Cassarino
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | | | - Anna Paola Erba
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Cristina Ferrari
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Ciro Gabriele Mainolfi
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Andrea Palucci
- grid.415845.9Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Napoleone Prandini
- grid.418324.80000 0004 1781 8749Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Sergio Baldari
- grid.10438.3e0000 0001 2178 8421Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Francesco Bartoli
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Mirco Bartolomei
- grid.416315.4Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | - Adriana D’Antonio
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Francesco Dondi
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Patrizia Gandolfo
- grid.418324.80000 0004 1781 8749Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Alessia Giordano
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Riccardo Laudicella
- grid.10438.3e0000 0001 2178 8421Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | | | - Alberto Nieri
- grid.416315.4Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | | | - Laura Vendramin
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Francesco Muratore
- Rheumatology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Valentina Lavelli
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Domenico Albano
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Luca Burroni
- grid.415845.9Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Alberto Cuocolo
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Laura Evangelista
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Elena Lazzeri
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Natale Quartuccio
- grid.419995.9Nuclear Medicine Unit, A.R.N.A.S. Civico di Cristina and Benfratelli Hospitals, Palermo, Italy
| | - Brunella Rossi
- Nuclear Medicine Unit, Department of Services, ASUR MARCHE-AV5, Ascoli Piceno, Italy
| | - Giuseppe Rubini
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Martina Sollini
- grid.417728.f0000 0004 1756 8807Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Alberto Signore
- grid.7841.aNuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
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11
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Piccardo A, Siri G, Raffa S, Castellana M, Foppiani L, Bottoni G, Ugolini M, Cistaro A, Catrambone U, Altrinetti V, Massollo M, Arlandini A, Giovanella L, Cabria M, Trimboli P. How to better stratify the risk of differentiated thyroid carcinomas: the key role of radioactive iodine therapy, age, and gender. Eur J Nucl Med Mol Imaging 2020; 48:822-830. [PMID: 32955602 DOI: 10.1007/s00259-020-05020-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/31/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE The risk of relapse of differentiated thyroid carcinomas (DTC) and their indication for radioactive iodine therapy (RAI) are assessed according to ATA risk stratification system principally based on tumor-nodes-metastasis (TNM) staging. However, while establishing the indication for RAI may be a "dilemma," performing it can improve the risk stratification. We aimed to evaluate whether (1) the stratification of risk of recurrence differs when TNM is considered with or without peri-RAI findings and (2) the assessment of the risk of disease-specific mortality is improved by adding age and gender. METHODS From our database, all DTC patients treated with thyroidectomy and RAI from 1992 to 2017 were included. Subjects with a follow-up shorter than 1 year and positive thyroid antibodies were excluded. Patients were classified into (1) a three-category ATA model based on TNM (basic model) and (2) a five-category model based on TNM plus peri-RAI findings, i.e., thyroglobulin and 131I whole-body scan (advanced model). Relapse was proven by histology and/or imaging. Differences in disease-free survival (DFS) and overall survival (OS) were assessed. RESULTS We enrolled 907 patients; of these, 4.4% died and 21% suffered recurrence. According to the basic model, there were 11.8% high-risk, 32.9% intermediate-risk, and 55.3% low-risk patients. According to the advanced model, 29.9% of patients were re-classified in a higher risk category and the five categories of this model displayed significantly different risks of relapse and death. The estimate of DFS was significantly higher in the advanced model than in the basic one (ΔC-index = + 6.8%, P < .001). By adding age and gender to the advanced model, the highest performance in predicting death was achieved (ΔC-index = + 5.1%, P < .001). CONCLUSIONS The peri-RAI findings are essential in order to carefully stratify the risk of DTC recurrence. Integrating these data with age and gender enables those cases at highest risk of death to be identified.
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Affiliation(s)
- Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy.
| | - Giacomo Siri
- Department of Mathematics, University of Genoa, Genoa, Italy.,Scientific Directorate, Galliera Hospital, Genoa, Italy
| | - Stefano Raffa
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Castellana
- National Institute of Gastroenterology "Saverio De Bellis", Castellana Grotte, Bari, Italy
| | - Luca Foppiani
- Department of Internal Medicine, E.O. "Ospedali Galliera", Genoa, Italy
| | - Gianluca Bottoni
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Martina Ugolini
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Angelina Cistaro
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy
| | | | - Vania Altrinetti
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Michela Massollo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy
| | | | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Manlio Cabria
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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12
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Piccardo A, Trimboli P, Puntoni M, Foppiani L, Treglia G, Naseri M, Bottoni GL, Massollo M, Sola S, Ferrarazzo G, Bruzzone M, Catrambone U, Arlandini A, Paone G, Ceriani L, Cabria M, Giovanella L. Role of 18F-Choline Positron Emission Tomography/Computed Tomography to Detect Structural Relapse in High-Risk Differentiated Thyroid Cancer Patients. Thyroid 2019; 29:549-556. [PMID: 30864903 DOI: 10.1089/thy.2018.0552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to evaluate the role of 18F-choline (18F-FCH) positron emission tomography (PET)/computed tomography (CT) in high-risk differentiated thyroid cancer (DTC) patients with suspected relapse. It also compared 18F-FCH-PET/CT results with those of fludeoxyglucose (18F-FDG)-PET/CT and evaluated the additional diagnostic value and clinical impact of the combined use of these two tracers. Finally, it assessed the association between the clinical, biochemical, and histological parameters and 18F-FCH-PET/CT and 18F-FDG-PET/CT results. METHODS The study prospectively enrolled high-risk DTC patients treated with thyroidectomy and radioactive iodine therapy and presenting high/increasing thyroglobulin levels under thyrotropin suppression, negative/inconclusive neck ultrasound, and negative 131I whole-body scan. All patients underwent 18F-FDG-PET/CT and 18F-FCH-PET/CT within 30 days of each other. Experienced nuclear medicine physicians examined the images of both procedures, and an integrated analysis of the two PET/CT modalities was also conducted. For each modality, a patient-based analysis (PBA) and lesion-based-analysis (LBA) was performed. On PBA, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were calculated. On LBA, only sensitivity was calculated. The standard of reference was based on clinical, imaging, and histological data. RESULTS Twenty-five high-risk DTC patients were included; DTC relapse/persistence was confirmed in 23 patients. On PBA, 18F-FDG-PET/CT, 18F-FCH-PET/CT, and the integrated evaluation of the two imaging modalities showed the following rates: sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 69.6%, 100%, 22.2%, 100%, and 72% versus 56.5%, 100%, 16.7%, 100%, and 60% versus 82.6%, 100%, 33.3%, 100%, and 84%, respectively. When compared with 18F-FDG-PET/CT, the integrated analysis of these two imaging procedures changed the clinical management in 4/23 (17%) patients. On LBA, the sensitivity rates of 18F-FDG-PET/CT, 18F-FCH-PET/CT, and the combined evaluation of the two modalities were 58.7%, 38.1%, and 66.7%, respectively; when only lymph node involvement was considered, the rates were 56.3%, 53.1%, and 68.8%, respectively. Serum thyroglobulin doubling time (Tg-DT) <12 months was significantly associated with positive 18F-FCH-PET/CT. A trend toward a significant association was also found between positive 18F-FDG-PET/CT and both Tg-DT <12 months and DTC aggressive subtypes. CONCLUSION 18F-FCH-PET/CT may add important information during the follow-up of high-risk DTC patients. 18F-FCH-PET/CT may be considered a useful complementary tool in patients affected by non-aggressive DTC subtypes, with Tg-DT <12 months, high risk of lymph node spreading, and negative or doubtful 18F-FDG-PET/CT.
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Affiliation(s)
- Arnoldo Piccardo
- 1 Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Switzerland
- 2 Department of Nuclear Medicine; Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Pierpaolo Trimboli
- 1 Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Switzerland
| | - Matteo Puntoni
- 3 Clinical Trial Unit, Office of the Scientific Director; Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Luca Foppiani
- 4 Department of Internal Medicine, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Giorgio Treglia
- 1 Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Switzerland
| | - Mehrdad Naseri
- 2 Department of Nuclear Medicine; Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Gian Luca Bottoni
- 2 Department of Nuclear Medicine; Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Michela Massollo
- 2 Department of Nuclear Medicine; Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Simona Sola
- 5 Department of Histopathology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Giulia Ferrarazzo
- 2 Department of Nuclear Medicine; Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Martina Bruzzone
- 6 Pathology Unit, ASL 3 Genovese, Villa Scassi Hospital, Genoa, Italy
| | - Ugo Catrambone
- 7 Department of Surgery; Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Anselmo Arlandini
- 7 Department of Surgery; Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Gaetano Paone
- 1 Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Switzerland
| | - Luca Ceriani
- 1 Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Switzerland
| | - Manlio Cabria
- 2 Department of Nuclear Medicine; Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Luca Giovanella
- 1 Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Switzerland
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Piccardo A, Trimboli P, Foppiani L, Treglia G, Ferrarazzo G, Massollo M, Bottoni G, Giovanella L. PET/CT in thyroid nodule and differentiated thyroid cancer patients. The evidence-based state of the art. Rev Endocr Metab Disord 2019; 20:47-64. [PMID: 30900067 DOI: 10.1007/s11154-019-09491-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A more conservative approach to the clinical management of thyroid nodules and differentiated thyroid cancer has recently been proposed by the 2015 ATA guidelines. In this context, fine-needle aspiration biopsy has been reserved for nodules with particular ultrasound features or dimensions that exclude low-risk thyroid lesions. Accordingly, a less aggressive surgical approach (i.e. lobectomy) has been recommended as the first-choice treatment in nodules with indeterminate cytology or in small cytologically confirmed malignant nodules. At the same time, radioactive remnant ablation has been considered only for DTC patients with concrete risks of disease persistence/relapse after thyroidectomy. In addition, further radioactive iodine therapies (RAI) have been proposed only for patients presenting unresectable and iodine-avid structural relapse. In this complex scenario, which requires attention to each clinical aspect of the patient, the introduction of accurate diagnostic tools is highly warranted. PET/CT is a very sensitive and specific diagnostic procedure that can better characterize the risk of thyroid nodules, identify DTC relapse early and predict the response to RAI. Thus, it seems essential to customize a more conservative approach to thyroid nodules and DTC patients. The aim of this review is to report the principal clinical context in which PET/CT has been used and to evaluate the evidence-based support for each diagnostic indication.
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Affiliation(s)
- Arnoldo Piccardo
- Department of Nuclear Medicine, Galliera Hospital, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy.
| | - Pierpaolo Trimboli
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Lugano, Bellinzona, Switzerland
| | - Luca Foppiani
- Department of Internal Medicine, Galliera Hospital, Genoa, Italy
| | - Giorgio Treglia
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Lugano, Bellinzona, Switzerland
- Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Giulia Ferrarazzo
- Department of Nuclear Medicine, Galliera Hospital, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Michela Massollo
- Department of Nuclear Medicine, Galliera Hospital, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Gianluca Bottoni
- Department of Nuclear Medicine, Galliera Hospital, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Luca Giovanella
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Lugano, Bellinzona, Switzerland
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Zullo L, Buschiazzo A, Massollo M, Riondato M, Democrito A, Marini C, Benfenati F, Sambuceti G. Small-Animal 18F-FDG PET for Research on Octopus vulgaris: Applications and Future Directions in Invertebrate Neuroscience and Tissue Regeneration. J Nucl Med 2018. [PMID: 29523626 DOI: 10.2967/jnumed.117.205393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study aimed to develop a method of administering 18F-FDG to the common octopus in order to perform a PET biodistribution assay characterizing glucose metabolism in organs and regenerating tissues. Methods: Seven animals (two of which had a regenerating arm) were anesthetized with 3.7% MgCl2 in artificial seawater and then injected with 18-30 MBq of isosmotic 18F-FDG through either the left branchial heart or the anterior vena cava. After an uptake time of about 50 min, the animals were sacrificed and placed on the bed of a small-animal PET scanner, and 10-min static acquisitions were obtained at 3-4 bed positions to visualize the entire body. To confirm image interpretation, internal organs of interest were collected and counted with a γ-counter. Results: Administration through the anterior vena cava resulted in a good full-body distribution of 18F-FDG as seen on the PET images. Uptake was high in the mantle mass and relatively lower in the arms. In particular, the brain, optic lobes, and arms were clearly identified and were measured for their uptake (SUVmax: 6.57 ± 1.86, 7.59 ± 1.66, and 1.12 ± 0.06, respectively). Interestingly, 18F-FDG uptake was up to 3-fold higher in the highly proliferating areas of regenerating arms. Conclusion: This study represents a stepping-stone to the use of noninvasive functional techniques for addressing questions about invertebrate neuroscience and regenerative medicine.
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Affiliation(s)
- Letizia Zullo
- Center for Synaptic Neuroscience and Technology, Italian Institute of Technology, Genoa, Italy
| | - Ambra Buschiazzo
- Division of Nuclear Medicine, Department of Health Science, University of Genoa, Genoa, Italy
| | | | | | | | - Cecilia Marini
- Division of Nuclear Medicine, Department of Health Science, University of Genoa, Genoa, Italy.,Nuclear Medicine Unit, IRCCS San Martino, Genoa, Italy.,Institute of Molecular Bioimaging and Physiology (IBFM), CNR, Milan, Italy; and
| | - Fabio Benfenati
- Center for Synaptic Neuroscience and Technology, Italian Institute of Technology, Genoa, Italy.,Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Gianmario Sambuceti
- Division of Nuclear Medicine, Department of Health Science, University of Genoa, Genoa, Italy.,Nuclear Medicine Unit, IRCCS San Martino, Genoa, Italy.,Institute of Molecular Bioimaging and Physiology (IBFM), CNR, Milan, Italy; and
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15
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Piccardo A, Puntoni M, Ferrarazzo G, Foppiani L, Bottoni G, Altrinetti V, Treglia G, Naseri M, Dib B, Cabria M, Trimboli P, Massollo M, Giovanella L. Could short thyroid hormone withdrawal be an effective strategy for radioiodine remnant ablation in differentiated thyroid cancer patients? Eur J Nucl Med Mol Imaging 2018; 45:1218-1223. [PMID: 29460027 DOI: 10.1007/s00259-018-3955-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/18/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Current guidelines recommend thyroid hormone withdrawal (THW) of 3-4 weeks before radioiodine remnant ablation (RRA) of differentiated thyroid carcinoma (DTC). We aimed to evaluate (1) the reliability of a shorter THW (i.e., 14 days) to achieve adequate TSH levels (i.e., 30 mU/l), (2) the association between length of THW and response to therapy, and (3) the potential association between pre-ablation TSH levels and patients' outcome. METHODS After thyroidectomy, all patients started LT4 therapy, which was subsequently discontinued in order to perform RRA. Patients were broken down into two groups according to the length of THW: group A, 2 weeks of THW, and group B, 3-4 weeks of THW. We used clinical, biochemical, and imaging data to evaluate patients' outcome. By means of univariate and multivariate analysis, including main DTC prognostic factors, we assessed the impact of THW length and TSH levels on patients' outcome. RESULTS We evaluated 222 patients, 85 of whom were treated with RRA after a THW period of 2 weeks (group A). All other 137 patients underwent RRA after 3-4 weeks THW (group B). At the time of RRA all patients presented TSH levels ≥30 mU/l. After a median follow-up time of 3.4 years, we found 183 patients (82%) with excellent response to treatment and 39 patients (18%) showing incomplete response. Kaplan-Meier response to therapy curves showed that ablation-Tg, tumor size, and lymph node status were significantly associated with prognosis; no associations were found between THW length, TSH levels, and prognosis. Multivariate Cox model showed that only ablation-Tg was significantly associated with treatment response. CONCLUSIONS Prior to RRA, a short 2-week THW is an effective method to stimulate TSH levels. No difference in terms of incomplete response to treatment was observed between DTC patients prepared for RRA with a short THW and those with the long THW.
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Affiliation(s)
| | - Matteo Puntoni
- Clinical Trial Unit, Office of the Scientific Director, Galliera Hospital, Genoa, Italy
| | | | | | | | | | - Giorgio Treglia
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Mehrdad Naseri
- Nuclear Medicine Department, Galliera Hospital, Genoa, Italy
| | - Bassam Dib
- Nuclear Medicine Department, Galliera Hospital, Genoa, Italy
| | - Manlio Cabria
- Nuclear Medicine Department, Galliera Hospital, Genoa, Italy
| | - Pierpaolo Trimboli
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | - Luca Giovanella
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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16
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Piccardo A, Puntoni M, Morbelli S, Bongioanni F, Paparo F, Altrinetti V, Gonella R, Gennari A, Iacozzi M, Sambuceti G, DeCensi A, Massollo M. 18F-FDG PET/CT is a prognostic biomarker in patients affected by bone metastases from breast cancer in comparison with 18F-NaF PET/CT. Nuklearmedizin 2017; 54:163-72. [DOI: 10.3413/nukmed-0727-15-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/26/2015] [Indexed: 01/18/2023]
Abstract
SummaryAim: To compare 18F-FDG PET/CT and 18F-NaF PET/CT with respect to disease prognostication and outcome in patients affected by bone metastases from breast cancer (BC). Patients, methods: We retrospectively investigated 32 women with BC and documented bone metastases. Semi-quantitative parameters were applied to 18F-FDG PET/CT and 18F-Na PET/CT in order to evaluate disease extent and tumour metabolism. We used time-to-event analyses (Kaplan Meier and COX proportional hazard methods) to estimate progression-free (PFS) and overall survival (OS) in order to assess the independent prognostic value of 18F-FDG PET/CT and 18F-Na PET/CT. Results: The sensitivity of 18F-NaF PET/CT (100%) was higher (p < 0.05) than that of 18F-FDG PET/CT (72% and 72%). None of the 18F-FDG PET/CT-negative patients showed disease progression at the end of follow-up. After adjustment for age, Ki-67 levels, presence of visceral metastases, hormone therapy, duration of bone disease and response to first-line therapy, only 18F-FDG SUV mean [HR 15.7, 95% confidence interval (CI) 1.15-214.5] and 18F-FDG whole-body bone metabolic burden (WB-B-MB) (HR 16.9; 95%CI 1.87-152.2) were independently and significantly associated with OS. None of the 18F-NaF PET/CT parameters were associated with OS. None of the conventional clinical prognostic parameters remained significantly associated with OS after the inclusion of PET/ CT parameters in the model. Conclusion: 18F-FDG PET/CT is independently associated with OS in BC patients with bone metastases and its prognostic impact seems to be higher than conventional clinical and biological prognostic factors. Although 18F-NaF PET/CT has a higher diagnostic sensitivity than 18F-FDG PET/ CT, it is not independently associated with OS.
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17
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Morbelli S, Alama A, Ferrarazzo G, Coco S, Genova C, Rijavec E, Bongioanni F, Biello F, Dal Bello MG, Barletta G, Massollo M, Vanni I, Piva R, Nieri A, Bauckneht M, Sambuceti G, Grossi F. Circulating Tumor DNA Reflects Tumor Metabolism Rather Than Tumor Burden in Chemotherapy-Naive Patients with Advanced Non-Small Cell Lung Cancer: 18F-FDG PET/CT Study. J Nucl Med 2017; 58:1764-1769. [PMID: 28450567 DOI: 10.2967/jnumed.117.193201] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 03/16/2017] [Accepted: 04/11/2017] [Indexed: 01/25/2023] Open
Abstract
We aimed to evaluate the relationships between circulating tumor cells (CTCs) or plasma cell-free DNA (cfDNA) on one side and a comprehensive range of 18F-FDG PET/CT-derived parameters on the other side in chemotherapy-naive patients with advanced non-small cell lung cancer (NSCLC). Methods: From a group of 79 patients included in a trial evaluating the role of pretreatment circulating tumor markers as predictors of prognosis in chemotherapy-naive patients with advanced NSCLC, we recruited all those who underwent 18F-FDG PET/CT for clinical reasons at our institution before inclusion in the trial (and thus just before chemotherapy). For each patient, a peripheral blood sample was collected at baseline for the evaluation of CTCs and cfDNA. CTCs were isolated by size using a filtration-based device and then morphologically identified and enumerated; cfDNA was isolated from plasma and quantified by a quantitative polymerase chain reaction using human telomerase reverse transcriptase. The following 18F-FDG PET/CT-derived parameters were computed: maximum diameter of the primary lesion (T), of the largest lymph node (N), and of the largest metastatic lesion (M); SUVmax; SUVmean; size-incorporated SUVmax; metabolic tumor volume; and total lesion glycolysis. All parameters were independently measured for T, N, and M. The associations among CTCs, cfDNA, and 18F-FDG PET/CT-derived parameters were evaluated by multivariate-analysis. Patients were divided into 2 groups according to the presence of either limited metastatic involvement (M1a or M1b due to extrathoracic lymph nodes only) or disseminated metastatic disease. The presence or absence of metabolically active bone lesions was also recorded for each patient, and patient subgroups were compared. Results: Thirty-seven patients recruited in the trial matched our PET-based criteria (24 men; age, 64.5 ± 8.1 y). SUVmax for the largest metastatic lesion was the only variable independently associated with baseline cfDNA levels (P = 0.016). Higher levels of cfDNA were detected in the subgroup of patients with metabolically active bone lesions (P = 0.02), but no difference was highlighted when patients with more limited metastatic disease were compared with patients with disseminated metastatic disease. Conclusion: The correlation of cfDNA levels with tumor metabolism, but not with metabolic tumor volume at regional or distant levels, suggests that cfDNA may better reflect tumor biologic behavior or aggressiveness rather than tumor burden in metastatic NSCLC.
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Affiliation(s)
- Silvia Morbelli
- Nuclear Medicine Unit, IRCCS AOU San Martino-National Cancer Research Institute, Genoa, Italy .,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Angela Alama
- Lung Cancer Unit, IRCCS AOU San Martino-National Cancer Research Institute, Genoa, Italy; and
| | - Giulia Ferrarazzo
- Nuclear Medicine Unit, IRCCS AOU San Martino-National Cancer Research Institute, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Simona Coco
- Lung Cancer Unit, IRCCS AOU San Martino-National Cancer Research Institute, Genoa, Italy; and
| | - Carlo Genova
- Lung Cancer Unit, IRCCS AOU San Martino-National Cancer Research Institute, Genoa, Italy; and
| | - Erika Rijavec
- Lung Cancer Unit, IRCCS AOU San Martino-National Cancer Research Institute, Genoa, Italy; and
| | - Francesca Bongioanni
- Nuclear Medicine Unit, IRCCS AOU San Martino-National Cancer Research Institute, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Federica Biello
- Lung Cancer Unit, IRCCS AOU San Martino-National Cancer Research Institute, Genoa, Italy; and
| | | | - Giulia Barletta
- Lung Cancer Unit, IRCCS AOU San Martino-National Cancer Research Institute, Genoa, Italy; and
| | | | - Irene Vanni
- Lung Cancer Unit, IRCCS AOU San Martino-National Cancer Research Institute, Genoa, Italy; and
| | - Roberta Piva
- Nuclear Medicine Unit, IRCCS AOU San Martino-National Cancer Research Institute, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Alberto Nieri
- Nuclear Medicine Unit, IRCCS AOU San Martino-National Cancer Research Institute, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Matteo Bauckneht
- Nuclear Medicine Unit, IRCCS AOU San Martino-National Cancer Research Institute, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine Unit, IRCCS AOU San Martino-National Cancer Research Institute, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Francesco Grossi
- Lung Cancer Unit, IRCCS AOU San Martino-National Cancer Research Institute, Genoa, Italy; and
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18
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Piccardo A, Puntoni M, Bottoni G, Treglia G, Foppiani L, Bertoli M, Catrambone U, Arlandini A, Dib B, Altrinetti V, Massollo M, Bossert I, Cabria M, Bertagna F, Giovanella L. Differentiated Thyroid Cancer lymph-node relapse. Role of adjuvant radioactive iodine therapy after lymphadenectomy. Eur J Nucl Med Mol Imaging 2016; 44:926-934. [DOI: 10.1007/s00259-016-3593-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/06/2016] [Indexed: 01/26/2023]
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19
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Piccardo A, Puntoni M, Treglia G, Foppiani L, Bertagna F, Paparo F, Massollo M, Dib B, Paone G, Arlandini A, Catrambone U, Casazza S, Pastorino A, Cabria M, Giovanella L. Thyroid nodules with indeterminate cytology: prospective comparison between 18F-FDG-PET/CT, multiparametric neck ultrasonography, 99mTc-MIBI scintigraphy and histology. Eur J Endocrinol 2016; 174:693-703. [PMID: 26966173 DOI: 10.1530/eje-15-1199] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/19/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the role of (18)F-flurodeoxiglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) in predicting malignancy of thyroid nodules with indeterminate cytology. PATIENTS AND METHODS We analysed 87 patients who have been scheduled to undergo surgery for thyroid nodule with indeterminate cytology. All patients underwent (18)F-FDG-PET/CT, multiparametric neck ultrasonography (MPUS), and (99m)Tc-methoxyisobutylisonitrile scintigraphy ((99m)Tc-MIBI-scan). Histopathology was the standard of reference. We compared the sensitivity (SE), specificity (SP), accuracy (AC), positive (PPV) and negative predictive (NPV) values of (18)F-FDG-PET/CT with those of (99m)Tc-MIBI-scan and MPUS in detecting cancer. Univariate and multivariate analyses evaluated the association between each diagnostic tool and histopathology. RESULTS On histopathology, 69 out of 87 nodules were found to be benign and 18 to be malignant. The SE, SP, AC, PPV and NPV of (18)F-FDG-PET/CT were 94, 58, 66, 37 and 98% respectively. The SE, AC and NPV of (18)F-FDG-PET/CT were significantly higher than those of MPUS and (99m)Tc-MIBI-scan. The association of both positive (18)F-FDG-PET/CT and MPUS (FDG+/MPUS+) showed significantly lower SE (61% vs 94%) and NPV (88% vs 98%) than (18)F-FDG-PET/CT alone, but significantly higher SP (77% vs 58%). On univariate analysis, (18)F-FDG-PET/CT and the combination of FDG+/MPUS+ and of FDG+/MIBI- were all significantly associated with histopathology. On multivariate analysis, only FDG+/MIBI- was significantly associated with histopathology. CONCLUSION The AC of (18)F-FDG-PET /CT in detecting thyroid malignancy is higher than that of (99m)Tc-MIBI-scan and MPUS. A negative (18)F-FDG-PET/CT correctly predicts benign findings on histopathology. The association of FDG+/MPS+ is significantly more specific than (18)F-FDG-PET/CT alone in identifying differentiated thyroid cancer. A positive (18)F-FDG-PET/CT is significantly associated with malignancy when qualitative (99m)Tc-MIBI-scan is rated as negative.
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Affiliation(s)
- A Piccardo
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - M Puntoni
- Clinical Trial UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - G Treglia
- Department of Nuclear Medicine and PET/CT CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - L Foppiani
- Internal MedicineGalliera Hospital, Genoa, Italy
| | - F Bertagna
- Department of Nuclear MedicineUniversity of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - F Paparo
- Department of RadiologyGalliera Hospital, Genoa, Italy
| | - M Massollo
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - B Dib
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - G Paone
- Department of Nuclear Medicine and PET/CT CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - A Arlandini
- Department of SurgeryThyroid Centre, Galliera Hospital, Genoa, Italy
| | - U Catrambone
- Department of SurgeryThyroid Centre, Galliera Hospital, Genoa, Italy
| | - S Casazza
- Department of PathologyGalliera Hospital, Genoa, Italy
| | - A Pastorino
- Department of PathologyGalliera Hospital, Genoa, Italy
| | - M Cabria
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - L Giovanella
- Department of Nuclear Medicine and PET/CT CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
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20
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Biello F, Rijavec E, Genova C, Barletta G, Maggioni C, Dal Bello M, Alama A, Coco S, Truini A, Vanni I, Morbelli S, Ferrarazzo G, Bongioanni F, Massollo M, Sambuceti G, Grossi F. Correlation between circulating tumor biomarkers and positron-emission tomography in advanced non-small cell lung cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv343.29] [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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21
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Morana G, Piccardo A, Puntoni M, Nozza P, Cama A, Raso A, Mascelli S, Massollo M, Milanaccio C, Garrè ML, Rossi A. Diagnostic and prognostic value of 18F-DOPA PET and 1H-MR spectroscopy in pediatric supratentorial infiltrative gliomas: a comparative study. Neuro Oncol 2015; 17:1637-47. [PMID: 26405202 DOI: 10.1093/neuonc/nov099] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 05/05/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND (1)H-MR spectroscopy (MRS) and (18)F-dihydroxyphenylalanine (DOPA) PET are noninvasive imaging techniques able to assess metabolic features of brain tumors. The aim of this study was to compare diagnostic and prognostic information gathered by (18)F-DOPA PET and (1)H-MRS in children with supratentorial infiltrative gliomas or nonneoplastic brain lesions suspected to be gliomas. METHODS We retrospectively analyzed 27 pediatric patients with supratentorial infiltrative brain lesions on conventional MRI (21 gliomas and 6 nonneoplastic lesions) who underwent (18)F-DOPA PET and (1)H-MRS within 2 weeks of each other. (1)H-MRS data (choline/N-acetylaspartate, choline-to-creatine ratios, and presence of lactate) and (18)F-DOPA uptake parameters (lesion-to-normal tissue and lesion-to-striatum ratios) were compared and correlated with histology, WHO tumor grade, and patient outcome. RESULTS (1)H-MRS and (18)F-DOPA PET data were positively correlated. Sensitivity, specificity, and accuracy in distinguishing gliomas from nonneoplastic lesions were 95%, 83%, and 93% for (1)H-MRS and 76%, 83%, and 78% for (18)F-DOPA PET, respectively. No statistically significant differences were found between the 2 techniques (P > .05). Significant differences regarding (18)F-DOPA uptake and (1)H-MRS ratios were found between low-grade and high-grade gliomas (P≤.001 and P≤.04, respectively). On multivariate analysis, (18)F-DOPA uptake independently correlated with progression-free survival (P≤.05) and overall survival (P = .04), whereas (1)H-MRS did not show significant association with outcome. CONCLUSIONS (1)H-MRS and (18)F-DOPA PET provide useful complementary information for evaluating the metabolism of pediatric brain lesions. (1)H-MRS represents the method of first choice for differentiating brain gliomas from nonneoplastic lesions.(18)F-DOPA uptake better discriminates low-grade from high-grade gliomas and is an independent predictor of outcome.
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Affiliation(s)
- Giovanni Morana
- Istituto Giannina Gaslini, Genova, Italy (G.M., P.N., A.C., A.R., S.M., C.M., M.L.G., A.R.); Nuclear Medicine Unit, Ospedali Galliera, Genova, Italy (A.P., M.M.); Clinical Trial Unit, Scientific Directorate, Ospedali Galliera, Genova, Italy (M.P.)
| | - Arnoldo Piccardo
- Istituto Giannina Gaslini, Genova, Italy (G.M., P.N., A.C., A.R., S.M., C.M., M.L.G., A.R.); Nuclear Medicine Unit, Ospedali Galliera, Genova, Italy (A.P., M.M.); Clinical Trial Unit, Scientific Directorate, Ospedali Galliera, Genova, Italy (M.P.)
| | - Matteo Puntoni
- Istituto Giannina Gaslini, Genova, Italy (G.M., P.N., A.C., A.R., S.M., C.M., M.L.G., A.R.); Nuclear Medicine Unit, Ospedali Galliera, Genova, Italy (A.P., M.M.); Clinical Trial Unit, Scientific Directorate, Ospedali Galliera, Genova, Italy (M.P.)
| | - Paolo Nozza
- Istituto Giannina Gaslini, Genova, Italy (G.M., P.N., A.C., A.R., S.M., C.M., M.L.G., A.R.); Nuclear Medicine Unit, Ospedali Galliera, Genova, Italy (A.P., M.M.); Clinical Trial Unit, Scientific Directorate, Ospedali Galliera, Genova, Italy (M.P.)
| | - Armando Cama
- Istituto Giannina Gaslini, Genova, Italy (G.M., P.N., A.C., A.R., S.M., C.M., M.L.G., A.R.); Nuclear Medicine Unit, Ospedali Galliera, Genova, Italy (A.P., M.M.); Clinical Trial Unit, Scientific Directorate, Ospedali Galliera, Genova, Italy (M.P.)
| | - Alessandro Raso
- Istituto Giannina Gaslini, Genova, Italy (G.M., P.N., A.C., A.R., S.M., C.M., M.L.G., A.R.); Nuclear Medicine Unit, Ospedali Galliera, Genova, Italy (A.P., M.M.); Clinical Trial Unit, Scientific Directorate, Ospedali Galliera, Genova, Italy (M.P.)
| | - Samantha Mascelli
- Istituto Giannina Gaslini, Genova, Italy (G.M., P.N., A.C., A.R., S.M., C.M., M.L.G., A.R.); Nuclear Medicine Unit, Ospedali Galliera, Genova, Italy (A.P., M.M.); Clinical Trial Unit, Scientific Directorate, Ospedali Galliera, Genova, Italy (M.P.)
| | - Michela Massollo
- Istituto Giannina Gaslini, Genova, Italy (G.M., P.N., A.C., A.R., S.M., C.M., M.L.G., A.R.); Nuclear Medicine Unit, Ospedali Galliera, Genova, Italy (A.P., M.M.); Clinical Trial Unit, Scientific Directorate, Ospedali Galliera, Genova, Italy (M.P.)
| | - Claudia Milanaccio
- Istituto Giannina Gaslini, Genova, Italy (G.M., P.N., A.C., A.R., S.M., C.M., M.L.G., A.R.); Nuclear Medicine Unit, Ospedali Galliera, Genova, Italy (A.P., M.M.); Clinical Trial Unit, Scientific Directorate, Ospedali Galliera, Genova, Italy (M.P.)
| | - Maria Luisa Garrè
- Istituto Giannina Gaslini, Genova, Italy (G.M., P.N., A.C., A.R., S.M., C.M., M.L.G., A.R.); Nuclear Medicine Unit, Ospedali Galliera, Genova, Italy (A.P., M.M.); Clinical Trial Unit, Scientific Directorate, Ospedali Galliera, Genova, Italy (M.P.)
| | - Andrea Rossi
- Istituto Giannina Gaslini, Genova, Italy (G.M., P.N., A.C., A.R., S.M., C.M., M.L.G., A.R.); Nuclear Medicine Unit, Ospedali Galliera, Genova, Italy (A.P., M.M.); Clinical Trial Unit, Scientific Directorate, Ospedali Galliera, Genova, Italy (M.P.)
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Paparo F, Massollo M, Rollandi L, Piccardo A, Ruggieri FG, Rollandi GA. The clinical role of multimodality imaging in the detection of prostate cancer recurrence after radical prostatectomy and radiation therapy: past, present, and future. Ecancermedicalscience 2015; 9:570. [PMID: 26435743 PMCID: PMC4583244 DOI: 10.3332/ecancer.2015.570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 03/30/2015] [Indexed: 12/18/2022] Open
Abstract
Detection of the recurrence sites in prostate cancer (PCa) patients affected by biochemical recurrence after radical prostatectomy (RP) and radiation therapy (RT) is still a challenge for clinicians, nuclear medicine physicians, and radiologists. In the era of personalised and precision care, this task requires the integration, amalgamation, and combined analysis of clinical and imaging data from multiple sources. At present, multiparametric Magnetic Resonance Imaging (mpMRI) and choline–positron emission tomography (PET) are giving encouraging results; their combination allows the effective detection of local, lymph nodal, and skeletal recurrences at low PSA levels. Future diagnostic perspectives include the clinical implementation of PET/MRI scanners, multimodal fusion imaging platforms for retrospective co-registration of PET and MR images, real-time transrectal ultrasound/mpMRI fusion imaging, and novel organ-specific PET radiotracers.
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Affiliation(s)
- Francesco Paparo
- Radiology Unit, Department of Diagnostic Imaging, E O Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
| | - Michela Massollo
- Nuclear Medicine Unit, Department of Diagnostic Imaging, E O Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
| | - Ludovica Rollandi
- Klinikum Augsburg Radiologie, Stelingstrasse 2, 86156 Augsburg, Germany
| | - Arnoldo Piccardo
- Nuclear Medicine Unit, Department of Diagnostic Imaging, E O Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
| | - Filippo Grillo Ruggieri
- Radiotherapy Unit, Department of Diagnostic Imaging, E O Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
| | - Gian Andrea Rollandi
- Radiology Unit, Department of Diagnostic Imaging, E O Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
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Piccardo A, Morana G, Massollo M, Pescetto M, Conte M, Garaventa A. Brain Metastasis from Neuroblastoma Depicted by (18)F-DOPA PET/CT. Nucl Med Mol Imaging 2015; 49:241-2. [PMID: 26279699 DOI: 10.1007/s13139-015-0322-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 01/14/2015] [Accepted: 01/19/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Arnoldo Piccardo
- Nuclear Medicine Department, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
| | - Giovanni Morana
- Neuroradiology Unit, G. Gaslini Children's Hospital, Genoa, Italy
| | - Michela Massollo
- Nuclear Medicine Department, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
| | - Marco Pescetto
- Anaesthesiology Department, Galliera Hospital, Genoa, Italy
| | - Massimo Conte
- Department of Haematology-Oncology, G. Gaslini Children's Hospital, Genoa, Italy
| | - Alberto Garaventa
- Department of Haematology-Oncology, G. Gaslini Children's Hospital, Genoa, Italy
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Foppiani L, Massollo M, Del Monte P, Bandelloni R, Arlandini A, Piccardo A. Late-onset metastasis of renal cell carcinoma into a hot thyroid nodule: an uncommon finding not to be overlooked. Case Rep Endocrinol 2015; 2015:268714. [PMID: 25628901 PMCID: PMC4299556 DOI: 10.1155/2015/268714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 11/30/2014] [Indexed: 11/25/2022] Open
Abstract
We report the case of a 74-year-old man with a four-year history of right nephrectomy for clear cell renal carcinoma (CCRC) who was diagnosed with hyperthyroidism. On ultrasound (US), a 5 cm solid isohypoechoic nodule with intranodular vascularization was found in the left thyroid lobe. The nodule was deemed autonomous on (99m)Tc thyroid scan. Methimazole was started and serum thyroid hormone levels quickly normalized; euthyroidism was maintained with a very low dosage of antithyroid drug. Over time, compressive symptoms and local pain occurred and US revealed growth of the nodule. Total thyroidectomy was performed and the combined histological and immunohistochemical evaluation deemed the nodule compatible with metastasis of CCRC; on 2-year follow-up, no tumor relapse was ascertained. In patients with a history of cancer, a thyroid nodule, even if hyperfunctioning, must be suspected of being a metastasis and investigated. Hot nodules, which are largely benign, may be vulnerable to metastatic colonization owing to their rich vascularization. In these cases, surgery may be curative.
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Affiliation(s)
- Luca Foppiani
- Internal Medicine, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
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25
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Marini C, Salani B, Massollo M, Amaro A, Esposito AI, Orengo AM, Capitanio S, Emionite L, Riondato M, Bottoni G, Massara C, Boccardo S, Fabbi M, Campi C, Ravera S, Angelini G, Morbelli S, Cilli M, Cordera R, Truini M, Maggi D, Pfeffer U, Sambuceti G. Direct inhibition of hexokinase activity by metformin at least partially impairs glucose metabolism and tumor growth in experimental breast cancer. Cell Cycle 2014; 12:3490-9. [PMID: 24240433 PMCID: PMC3906335 DOI: 10.4161/cc.26461] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Emerging evidence suggests that metformin, a widely used anti-diabetic drug, may be useful in the prevention and treatment of different cancers. In the present study, we demonstrate that metformin directly inhibits the enzymatic function of hexokinase (HK) I and II in a cell line of triple-negative breast cancer (MDA-MB-231). The inhibition is selective for these isoforms, as documented by experiments with purified HK I and II as well as with cell lysates. Measurements of 18F-fluoro-deoxyglycose uptake document that it is dose- and time-dependent and powerful enough to virtually abolish glucose consumption despite unchanged availability of membrane glucose transporters. The profound energetic imbalance activates phosphorylation and is subsequently followed by cell death. More importantly, the “in vivo” relevance of this effect is confirmed by studies of orthotopic xenografts of MDA-MB-231 cells in athymic (nu/nu) mice. Administration of high drug doses after tumor development caused an evident tumor necrosis in a time as short as 48 h. On the other hand, 1 mo metformin treatment markedly reduced cancer glucose consumption and growth. Taken together, our results strongly suggest that HK inhibition contributes to metformin therapeutic and preventive potential in breast cancer.
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Affiliation(s)
- Cecilia Marini
- CNR Institute of Bioimages and Molecular Physiology; Milan, Section of Genoa, Genoa, Italy
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26
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Bartolini A, Loi M, Paolo DD, Emionite L, Sacchi A, Curnis F, Bottoni G, Massollo M, Gagliani C, Bruno S, Gori A, Longhi R, Cilli M, Tacchetti C, Corti A, Sambuceti G, Ponzoni M, Marchiò S, Pastorino F. Abstract 1778: Characterization and anti-tumor functionality of a neuroblastoma-specific peptide, either free or conjugated to nanocarriers. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-1778] [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
Introduction. The identification of peptide ligands specific for solid tumors is expected to provide targeting moieties to improve delivery and to decrease toxicity of chemotherapy. We have recently identified the peptide HSYWLRS as a specific ligand for neuroblastoma (NB), a childhood tumor mostly refractory to current therapies.
Experimental procedures. The capability of peptide HSYWLRS to recognize NB cells was evaluated by coupling Qdot fluorescent nanoparticles with HSYWLRS or its scrambled version (SCR). NB cell association and internalization of HSYWLRS-targeted liposomes were tested by FACS and confocal microscopy studies. We further evaluated a potential role of this peptide in perturbing tumor-stroma interactions and tumor growth. NB cell lines stably transfected with eGFP were mixed with endothelial cells in the presence of either SCR or HSYWLRS peptides. Cell morphology and reciprocal cellular interactions were evaluated by optical and fluorescence microscopy. We finally performed therapeutic experiments with mice orthotopically injected with luc-trasfected NB cells and treated with HSYWLRS-targeted, doxorubicin-loaded liposomes (HSYWLRS-SL[DXR]). Anti-tumor efficacy was evaluated by BLI imaging. In vivo imaging was also performed by injecting mice with a bolus of fluorodeoxyglucose during a list mode acquisition lasting one hour using a dedicated micro-PET system. After framing rate optimization, tumor glucose consumption was measured using Patlak graphical approach and normalizing the slope of regression line for serum glucose level.
Results. FACS analysis showed that HSYWLRS-Qdot and SCR-Qdot bound NB cells in a dose-dependent manner, however with different intensity, being HSYWLRS-Qdot the more potent. The binding of HSYWLRS-Qdot was efficiently inhibited by an excess of HSYWLRS, but not by control SCR peptide. In contrast, the binding of SCR-Qdot was not inhibited neither by an excess of SCR nor by HSYWLRS peptide, suggesting that the binding of SCR-Qdot is not specific. Again, the specific peptide-driven binding of HSYWLRS-SL to NB cells was inhibited by an excess of HSYWLRS peptide. In all cases, HSYWLRS specifically altered in vitro the interactions of NB cells with endothelium. Similarly, this peptide statistically decreased tumor take and growth when co-injected with tumor cells in the adrenal gland of nude mice.
Preliminary in vivo results obtained by BLI and micro-PET devises indicated that HSYWLRS-SL[DXR] decrease tumor growth through a reduction of tumor glucose consumption, leading to an enhanced life span in treated mice.
Conclusion. Our findings demonstrate that HSYWLRS peptide recognizes NB cells and is functional in the design of nanocarriers with therapeutic efficacy paving the way to its clinical development.
Citation Format: Alice Bartolini, Monica Loi, Daniela Di Paolo, Laura Emionite, Angelina Sacchi, Flavio Curnis, Gianluca Bottoni, Michela Massollo, Cristina Gagliani, Silvia Bruno, Alessandro Gori, Renato Longhi, Michele Cilli, Carlo Tacchetti, Angelo Corti, Gianmario Sambuceti, Mirco Ponzoni, Serena Marchiò, Fabio Pastorino. Characterization and anti-tumor functionality of a neuroblastoma-specific peptide, either free or conjugated to nanocarriers. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1778. doi:10.1158/1538-7445.AM2014-1778
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Affiliation(s)
- Alice Bartolini
- 1Laboratory of Tumor Microenvironment, Institute for Cancer Research, Candiolo (TO), Italy
| | - Monica Loi
- 2Experimental Therapy Unit, Laboratory of Oncology, Istituto Giannina Gaslini, Genoa, Italy
| | - Daniela D. Paolo
- 2Experimental Therapy Unit, Laboratory of Oncology, Istituto Giannina Gaslini, Genoa, Italy
| | - Laura Emionite
- 3Animal Facility, IRCCS Azienda Ospedaliera Universitaria San Martino–IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Angelina Sacchi
- 4Division of Molecular Oncology San Raffaele Scientific Institute, Milan, Italy
| | - Flavio Curnis
- 4Division of Molecular Oncology San Raffaele Scientific Institute, Milan, Italy
| | - Gianluca Bottoni
- 5Nuclear Medicine Unit, IRCCS Azienda Ospedaliera Universitaria San Martino–IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Michela Massollo
- 5Nuclear Medicine Unit, IRCCS Azienda Ospedaliera Universitaria San Martino–IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Cristina Gagliani
- 6Department of Experimental Medicine University of Genoa, Genoa, Italy
| | - Silvia Bruno
- 6Department of Experimental Medicine University of Genoa, Genoa, Italy
| | - Alessandro Gori
- 7Istituto di Chimica del Riconoscimento Molecolare, CNR, Milan, Italy
| | - Renato Longhi
- 7Istituto di Chimica del Riconoscimento Molecolare, CNR, Milan, Italy
| | - Michele Cilli
- 3Animal Facility, IRCCS Azienda Ospedaliera Universitaria San Martino–IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Carlo Tacchetti
- 8Department of Experimental Medicine University of Genoa; Experimental Imaging Center, Scientific Institute San Raffaele, Milan, Italy
| | - Angelo Corti
- 4Division of Molecular Oncology San Raffaele Scientific Institute, Milan, Italy
| | - Gianmario Sambuceti
- 5Nuclear Medicine Unit, IRCCS Azienda Ospedaliera Universitaria San Martino–IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Mirco Ponzoni
- 2Experimental Therapy Unit, Laboratory of Oncology, Istituto Giannina Gaslini, Genoa, Italy
| | - Serena Marchiò
- 1Laboratory of Tumor Microenvironment, Institute for Cancer Research, Candiolo (TO), Italy
| | - Fabio Pastorino
- 2Experimental Therapy Unit, Laboratory of Oncology, Istituto Giannina Gaslini, Genoa, Italy
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Morbelli S, Ghigliotti G, Spinella G, Marini C, Bossert I, Cimmino M, Pane B, Rousas N, Cittadini G, Massollo M, Camellino D, Riondato M, Palombo D, Barisione C, Sambuceti G. Systemic vascular inflammation in abdominal aortic aneurysm patients: a contrast-enhanced PET/CT study. Q J Nucl Med Mol Imaging 2014; 58:299-309. [PMID: 24658166] [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: 06/03/2023]
Abstract
AIM The aim of this paper was to investigate the presence of systemic vascular inflammation and its relationship with risk factors and biomarkers of systemic inflammation related to atherosclerosis in asymptomatic abdominal aortic aneurysm (AAA) patients. METHODS Thirty AAA patients and 30 age-matched controls underwent contrast-enhanced 2-deoxy-2-[18F]fluoro-D-glucose (FDG) PET/CT. C-reactive protein, erythrocyte sedimentation rate, white blood cell count and differential, serum fibrinogen, D-dimer and full lipid panel were also evaluated. Region of interest analyses were performed to obtain target-to-background (TBR) metabolism of aorta, subclavian, carotid, iliac arteries and AAA. CT-based arterial calcium load (CL) was evaluated. Arterial Metabolism and CL intergroup differences were tested (unpaired t-test). Linear regression analysis was performed only between blood biomarkers on one side and both TBR and ACL of the arterial districts that resulted significantly different between patients and controls on the other. In all the analyses P values <0.05 were considered significant. RESULT FDG-uptake was higher with respect to controls in aorta, carotid and iliac arteries (P<0.01, P<0.007, P<0.04 respectively). AAA and aorta metabolism showed an inverse correlation with HDL-chol (P<0.02 and P<0.01, respectively) while only aorta showed a direct correlation with lymphocytes' count (P<0.02). Carotid metabolism was directly correlated with monocytes' count and C-reactive protein concentration (P<0.02 and P<0.004, respectively). CONCLUSION The present findings support the relevance of systemic vascular inflammation in all phases of atherosclerosis-related disorders. Moreover they confirm the concept that acute ischemic syndromes might represent the local result of a systemic inflammation rather than the focal involvement of a single arterial lesion.
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Affiliation(s)
- S Morbelli
- Nuclear Medicine Unit IRCCS San Martino University Hospital, IST Dept of Health Sciences, University of Genoa, Genoa, Italy -
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Fiz F, Marini C, Piva R, Miglino M, Massollo M, Bongioanni F, Morbelli S, Bottoni G, Campi C, Bacigalupo A, Bruzzi P, Frassoni F, Piana M, Sambuceti G. Adult Advanced Chronic Lymphocytic Leukemia: Computational Analysis of Whole-Body CT Documents a Bone Structure Alteration. Radiology 2014; 271:805-13. [DOI: 10.1148/radiol.14131944] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Camellino D, Morbelli S, Paparo F, Massollo M, Sambuceti G, Cimmino MA. Polymyalgia rheumatica or lymphoma recurrence? Positron emission tomography/computed tomography is a specific imaging technique that helps differential diagnosis. Rheumatology (Oxford) 2014; 53:809. [DOI: 10.1093/rheumatology/keu038] [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: 11/14/2022] Open
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30
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Morbelli S, Conzi R, Campus C, Cittadini G, Bossert I, Massollo M, Fornarini G, Calamia I, Marini C, Fiz F, Ghersi C, Derchi LE, Sambuceti G. Contrast-enhanced [18 F] fluorodeoxyglucose-positron emission tomography/computed tomography in clinical oncology: tumor-, site-, and question-based comparison with standard positron emission tomography/computed tomography. Cancer Imaging 2014; 14:10. [PMID: 25609564 PMCID: PMC4332024 DOI: 10.1186/1470-7330-14-10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 03/06/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The present study aimed to evaluate the added value of contrast-enhanced computed tomography (ceCT) in comparison to standard, non-enhanced CT in the context of a combined positron emission tomography (PET)/CT examination by means of a tumor-, site-, and clinical question-based approach. METHODS Analysis was performed in 202 patients undergoing PET/CT consisting of a multiphase CT protocol followed by a whole-body PET. The Cochran Q test was performed, followed by a multiple comparisons correction (McNemar test and Bonferroni adjustment), to compare standard and contrast-enhanced PET (cePET/CT). Histopathology or clinical-radiologic follow-up greater than 1 year was used as a reference. RESULTS cePET/CT showed significantly different results with respect to standard PET/CT in head and neck and gastrointestinal cancer (P = 0.02 and 0.0002, respectively), in the evaluation of lesions located in the abdomen (P = 0.009), and in the context of disease restaging (P = 0.003). In all these clinical scenarios, adding ceCT resulted in a distinct benefit, by yielding a higher percentage of change in patient management. CONCLUSION These data strongly underline the importance of strictly selecting patients for the combined exam. In particular, patient selection should not be driven solely by mere tumor classification, but should also account for the clinical question and the anatomical location of the neoplastic disease, which can significantly impact patient management.
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Affiliation(s)
- Silvia Morbelli
- Nuclear Medicine Unit, IRCCS AOU San Martino- IST, Department of Health Sciences, University of Genoa, Largo R Benzi, 10, Genoa 16132, Italy
| | - Raffaella Conzi
- Department of Radiology, IRCCS AOU San Martino-IST, Genoa, Italy
| | | | | | - Irene Bossert
- Nuclear Medicine Unit, IRCCS AOU San Martino- IST, Department of Health Sciences, University of Genoa, Largo R Benzi, 10, Genoa 16132, Italy
| | - Michela Massollo
- Nuclear Medicine Unit, IRCCS AOU San Martino- IST, Department of Health Sciences, University of Genoa, Largo R Benzi, 10, Genoa 16132, Italy
| | - Giuseppe Fornarini
- Department of Medical Oncology, IRCCS AOU San Martino- IST, Genoa, Italy
| | - Iolanda Calamia
- Nuclear Medicine Unit, IRCCS AOU San Martino- IST, Department of Health Sciences, University of Genoa, Largo R Benzi, 10, Genoa 16132, Italy
| | - Cecilia Marini
- Institute of Molecular Bioimaging and Physiology, CNR, Genoa-Milan, Italy
| | - Francesco Fiz
- Nuclear Medicine Unit, IRCCS AOU San Martino- IST, Department of Health Sciences, University of Genoa, Largo R Benzi, 10, Genoa 16132, Italy
| | - Chiara Ghersi
- Nuclear Medicine Unit, IRCCS AOU San Martino- IST, Department of Health Sciences, University of Genoa, Largo R Benzi, 10, Genoa 16132, Italy
| | - Lorenzo E Derchi
- Department of Radiology, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine Unit, IRCCS AOU San Martino- IST, Department of Health Sciences, University of Genoa, Largo R Benzi, 10, Genoa 16132, Italy
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31
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Morbelli S, Fiz F, Piccardo A, Picori L, Massollo M, Pestarino E, Marini C, Cabria M, Democrito A, Cittadini G, Villavecchia G, Bruzzi P, Alavi A, Sambuceti G. Divergent determinants of 18F-NaF uptake and visible calcium deposition in large arteries: relationship with Framingham risk score. Int J Cardiovasc Imaging 2013; 30:439-47. [PMID: 24318613 DOI: 10.1007/s10554-013-0342-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 11/29/2013] [Indexed: 12/17/2022]
Abstract
To compare regional vascular distribution and biological determinants of visible calcium load, as assessed by computed tomography, as well as of molecular calcium deposition as assessed by (18)F-NaF positron emission tomography. Eighty oncologic patients undergoing (18)F-NaF PET/CT scan were included in the study. Cardiovascular-risk stratification was performed according to a simplified version of the Framingham model [including age, diabetes, smoking, systolic blood pressure and body mass index (BMI)]. Arterial (18)F-NaF uptake was measured by drawing regions of interest comprising the arteries on each slice of the transaxial PET/CT and normalized to blood (18)F-NaF activity to obtain the arterial target-to-background ratio (TBR). The degree of arterial calcification (AC) was measured using a software program providing Agatston-like scores. Differences in mean values and regression analysis were tested. Predictors of AC and TBR were evaluated by univariate and multivariate analysis. p value of 0.05 was considered statistically significant. No correlation was documented between regional calcium load and regional TBR in any of the studied arterial segments. Visible calcium deposition was found to be dependent upon age while it was not influenced by all the remaining determinants of cardiovascular risk. By contrast, (18)F-NaF uptake was significantly correlated with all descriptors of cardiovascular risk, with the exception of BMI. Vascular (18)F-NaF uptake displays a different regional distribution, as well as different biological predictors, when compared to macroscopic AC. The tight dependency of tracer retention upon ongoing biological determinants of vascular damage suggests that this tool might provide an unexplored window on plaque pathophysiology.
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Affiliation(s)
- Silvia Morbelli
- Nuclear Medicine Unit, Department of Health Sciences, IRCCS AOU San Martino, IST, University of Genoa, Largo R. Benzi, 10, 16132, Genoa, Italy,
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Salani B, Marini C, Rio AD, Ravera S, Massollo M, Orengo AM, Amaro A, Passalacqua M, Maffioli S, Pfeffer U, Cordera R, Maggi D, Sambuceti G. Metformin impairs glucose consumption and survival in Calu-1 cells by direct inhibition of hexokinase-II. Sci Rep 2013; 3:2070. [PMID: 23797762 PMCID: PMC3691576 DOI: 10.1038/srep02070] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 06/03/2013] [Indexed: 12/27/2022] Open
Abstract
The anti-hyperglycaemic drug metformin has important anticancer properties as shown by the direct inhibition of cancer cells proliferation. Tumor cells avidly use glucose as a source for energy production and cell building blocks. Critical to this phenotype is the production of glucose-6-phosphate (G6P), catalysed by hexokinases (HK) I and II, whose role in glucose retention and metabolism is highly advantageous for cell survival and proliferation. Here we show that metformin impairs the enzymatic function of HKI and II in Calu-1 cells. This inhibition virtually abolishes cell glucose uptake and phosphorylation as documented by the reduced entrapment of 18F-fluorodeoxyglucose. In-silico models indicate that this action is due to metformin capability to mimic G6P features by steadily binding its pocket in HKII. The impairment of this energy source results in mitochondrial depolarization and subsequent cell death. These results could represent a starting point to open effective strategies in cancer prevention and treatment.
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Affiliation(s)
- Barbara Salani
- Department of Internal Medicine-DIMI, University of Genova, 16132 Genova, Italy
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Cimmino MA, Camellino D, Paparo F, Morbelli S, Massollo M, Cutolo M, Sambuceti G. High frequency of capsular knee involvement in polymyalgia rheumatica/giant cell arteritis patients studied by positron emission tomography. Rheumatology (Oxford) 2013; 52:1865-72. [PMID: 23850896 DOI: 10.1093/rheumatology/ket229] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Peripheral arthritis has been described in up to 50% of PMR patients, with knee involvement in the majority. This study was designed to evaluate by PET/CT the knees of patients with PMR and GCA and to identify the knee structures involved by inflammation. METHODS Twenty-five consecutive patients with PMR (19) or GCA (6) were studied in comparison with 25 age- and sex-matched controls who underwent PET/CT for initial staging of cancer. Clinical features, ESR and CRP were evaluated. Simultaneous FDG-PET and CT imaging from the skull base to the knee was performed after injection of 4.8-5.2 MBq of [(18)F]FDG per kilogram body weight. The knee anatomical structures being evaluated included joints, fibrous capsule, synovial recesses and bursae. RESULTS At PET/CT, 21/25 patients (84%) showed bilateral diffuse uptake at the knees. The tracer clearly outlined the contour of the fibrous capsule. In 50 knees, 90% of capsular sites were involved by inflammation in comparison with 23% of intracapsular sites and 4.7% of extracapsular sites (P < 0.0001). No correlation was found between PET/CT results and ESR or CRP. FDG uptake, with a pattern similar to that observed in 96% of PMR/GCA patients, was seen in 20% of controls (P = 0.03). CONCLUSION Our findings suggest that bilateral capsulitis of the knee is detectable in most PMR/GCA patients if a sensitive imaging technique such as PET/CT is used.
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Affiliation(s)
- Marco A Cimmino
- Clinica Reumatologica, Dipartimento di Medicina Interna e Specialità Mediche, Viale Benedetto XV, 6, 16132 Genova, Italy.
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Camellino D, Morbelli S, Paparo F, Massollo M, Sambuceti G, Cutolo M, Cimmino MA. FRI0349 Is interspinous bursitis the explanation of cervical and lumbar pain in polymyalgia rheumatica? a study with fdg-pet/ct. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1476] [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: 11/03/2022]
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Sambuceti G, Massollo M, Marini C, Podestà M, Cassanelli C, Morbelli S, Fiz F, Buschiazzo A, Capitanio S, Augeri C, Curti G, Piana M, Frassoni F. Trafficking and homing of systemically administered stem cells: the need for appropriate analysis tools of radionuclide images. Q J Nucl Med Mol Imaging 2013; 57:207-215. [PMID: 23822992] [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: 06/02/2023]
Abstract
AIM Despite its enormous relevance, homing of hematopoietic stem cells (SCs) remains relatively uncertain due to the limitations of measuring small number of systemically administered cells in the different organs. Despite its high sensitivity, radionuclide detection has been relatively underutilized to this purpose since it cannot differentiate hematopietic SCs recruited by target tissues from those circulating in the blood pool. Our study aims to verify the potential of tracer kinetic approaches in estimating the recruitment of labeled SCs after their systemic administration. METHODS Twenty-four Lewis rats underwent administration of 2 millions cells labeled with 37 MBq of 99mTc-exametazime. Animals were divided into 2 groups according to administered cells: hematopoietic SCs or cells obtained from a line of rat hepatoma. Cell injection was performed during a planar dynamic acquisition. Regions of interest were positioned to plot time activity curves on heart, lungs, liver and spleen. Blood cell clearance was evaluated according to common stochastic analysis approach. Either fraction of dose in each organ at the end of the experiment or computing the slope of regression line provided by Patlak or Logan graphical approach estimated cell recruitment. At the end of the study, animals were sacrificed and the number of cells retained in the same organs was estimated by in vitro counting. RESULTS Cell number, documented by the dose fraction retained in each organ at imaging was consistently higher with respect to the "gold standard" in vitro counting in all experiments. An inverse correlation was observed between degree of overestimation and blood clearance of labeled cells (r=-0.56, P<0.05). Logan plot analysis consistently provided identifiable lines, whose slope values closely agreed with the "in vitro" estimation of hepatic and splenic cell recruitment. CONCLUSION The simple evaluation of organ radioactivity concentration does not provide reliable estimates of local recruitment of systemically administered cells. Yet, the combined analysis of temporal trends of tracer (cell) tissue accumulation and blood clearance can provide quantitative estimations of cell homing in the different organs.
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Affiliation(s)
- G Sambuceti
- Department of Internal Medicine, University of Genoa, Genoa, Italy.
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Riondato M, Democrito A, Bagnara MC, Massollo M, Sambuceti GM. TCH-030 PET/CT Imaging with [11C]Choline as a Radiopharmaceutical For the Detection of Recurrent Prostate Cancer: A Reliable Production Method and Quality Control. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.221] [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: 11/04/2022] Open
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Morbelli S, Marini C, Adami GF, Kudomi N, Camerini G, Iozzo P, Massollo M, Capitanio S, Bodrato S, Verardi MT, Papadia F, Cordera R, Knuuti J, Scopinaro N, Sambuceti G. Tissue specificity in fasting glucose utilization in slightly obese diabetic patients submitted to bariatric surgery. Obesity (Silver Spring) 2013; 21:E175-81. [PMID: 23404920 DOI: 10.1002/oby.20003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 05/05/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The present study was planned to investigate, by means of quantitative FDG-PET, how bariatric surgery (BS) modifies the metabolic pattern of the whole body and different tissues in slightly obese patients with type 2 diabetes mellitus (T2DM). DESIGN AND METHODS Before, 1 and 4 months after BS, 21 consecutive slightly obese T2DM patients underwent blood sampling to estimate plasma levels of glucose, insulin, glycosylated hemoglobin. At the same time points, these patients underwent a dynamic (18) F-FDG PET study of thorax and upper abdomen in fasting state and after washout of T2DM therapy. Gjedde-Patlak analysis was applied to estimate glucose uptake in the whole body and in different tissues (myocardium, skeletal back muscle, adipose tissue, and liver). RESULTS Surgical intervention quickly lowered levels of both insulin and glucose documenting an amelioration of glucose tolerance. Similarly, skeletal muscle and myocardial glucose uptake significantly increased soon after surgery (P < 0.001 and P < 0.01 at 1 month versus baseline, respectively) and remained substantially stable thereafter. By contrast, glucose uptake slightly decreased from its baseline values in the liver (P < 0.01 at 4 months) while no response could be documented over time in the adipose tissue. CONCLUSIONS These findings document that BS-induced modification of glucose homeostasis in slightly obese T2DM patients is mostly due to an increase in muscle glucose consumption. The surgically modified metabolic pattern of these patients might be of interest as a new model to investigate mechanism underlying insulin resistance.
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Affiliation(s)
- Silvia Morbelli
- Nuclear Medicine Unit, Department Internal Medicine, University of Genoa, Genoa, Italy.
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Massollo M, Marini C, Brignone M, Emionite L, Salani B, Riondato M, Capitanio S, Fiz F, Democrito A, Amaro A, Morbelli S, Piana M, Maggi D, Cilli M, Pfeffer U, Sambuceti G. Metformin temporal and localized effects on gut glucose metabolism assessed using 18F-FDG PET in mice. J Nucl Med 2013; 54:259-66. [PMID: 23287574 DOI: 10.2967/jnumed.112.106666] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
UNLABELLED In the course of metformin treatment, staging abdominal cancer lesions with (18)F-FDG PET images is often hindered by the presence of a high bowel radioactivity. The present study aimed to verify the mechanism underlying this phenomenon. METHODS Fifty-three mice were submitted to dynamic acquisitions of (18)F-FDG kinetics under fasting conditions. Three small-animal PET scans were obtained over a 4-mo study period. The animals were subdivided into 4 groups according to the following metformin administration protocol: group 1, untreated mice (n = 15); group 2, mice exposed to metformin treatment (750 mg/kg/d) for the 48 h before each PET study (pulsed, n = 10); group 3, mice treated for the whole study period (prolonged, n = 10); and group 4, mice in which prolonged treatment was interrupted 48 h before PET (interrupted, n = 8). The rate constant of (18)F-FDG uptake was estimated by Patlak analysis. At the end of the study, the ileum and colon were harvested, washed, and counted ex vivo. Two further groups, of 5 animals each, were included to evaluate the effect of prolonged metformin treatment on phosphorylated adenosine monophosphate (AMP)-activated protein kinase (pAMPK) form and gene expression for thioredoxin-interacting protein (TXNIP). RESULTS Pulsed treatment did not modify gut tracer retention with respect to the untreated group. Conversely, prolonged treatment induced a progressive increase in (18)F-FDG uptake that selectively involved the colonic wall, without any significant contamination of bowel content. This effect persisted after a complete drug washout in the interrupted group. These responses were paralleled by increased pAMPK availability and by reduced expression of TXNIP messenger RNA in colonic enterocytes exposed to prolonged metformin treatment. CONCLUSION Metformin causes a selective increase in colonic (18)F-FDG uptake. This effect appears after a relatively long period of treatment and persists soon after drug washout. Accordingly, the increased bowel glucose metabolism reflects a biologic response to chronic metformin treatment characterized by increased levels of pAMPK and reduced levels of TXNIP.
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Affiliation(s)
- Michela Massollo
- Nuclear Medicine, Department of Internal Medicine, University of Genoa and IRCCS San Martino-IST, 16132 Genoa, Italy
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Würth R, Pattarozzi A, Gatti M, Bajetto A, Corsaro A, Parodi A, Sirito R, Massollo M, Marini C, Zona G, Fenoglio D, Sambuceti G, Filaci G, Daga A, Barbieri F, Florio T. Metformin selectively affects human glioblastoma tumor-initiating cell viability: A role for metformin-induced inhibition of Akt. Cell Cycle 2012; 12:145-56. [PMID: 23255107 DOI: 10.4161/cc.23050] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cancer stem cell theory postulates that a small population of tumor-initiating cells is responsible for the development, progression and recurrence of several malignancies, including glioblastoma. In this perspective, tumor-initiating cells represent the most relevant target to obtain effective cancer treatment. Metformin, a first-line drug for type II diabetes, was reported to possess anticancer properties affecting the survival of cancer stem cells in breast cancer models. We report that metformin treatment reduced the proliferation rate of tumor-initiating cell-enriched cultures isolated from four human glioblastomas. Metformin also impairs tumor-initiating cell spherogenesis, indicating a direct effect on self-renewal mechanisms. Interestingly, analyzing by FACS the antiproliferative effects of metformin on CD133-expressing subpopulation, a component of glioblastoma cancer stem cells, a higher reduction of proliferation was observed as compared with CD133-negative cells, suggesting a certain degree of cancer stem cell selectivity in its effects. In fact, glioblastoma cell differentiation strongly reduced sensitivity to metformin treatment. Metformin effects in tumor-initiating cell-enriched cultures were associated with a powerful inhibition of Akt-dependent cell survival pathway, while this pathway was not affected in differentiated cells. The specificity of metformin antiproliferative effects toward glioblastoma tumor-initiating cells was confirmed by the lack of significant inhibition of normal human stem cells (umbilical cord-derived mesenchymal stem cells) in vitro proliferation after metformin exposure. Altogether, these data clearly suggest that metformin exerts antiproliferative activity on glioblastoma cells, showing a higher specificity toward tumor-initiating cells, and that the inhibition of Akt pathway may represent a possible intracellular target of this effect.
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Affiliation(s)
- Roberto Würth
- Department of Internal Medicine, University of Genova, Genoa, Italy
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Sambuceti G, Brignone M, Marini C, Massollo M, Fiz F, Morbelli S, Buschiazzo A, Campi C, Piva R, Massone AM, Piana M, Frassoni F. Estimating the whole bone-marrow asset in humans by a computational approach to integrated PET/CT imaging. Eur J Nucl Med Mol Imaging 2012; 39:1326-38. [PMID: 22639281 DOI: 10.1007/s00259-012-2141-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 04/17/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE Despite their relevance in clinical medicine, the extension and activity of the bone marrow (BM) cannot be directly evaluated in vivo. We propose a new method to estimate these variables by combining structural and functional maps provided by CT and PET. METHODS BM extension and glucose uptake were estimated in 102 patients undergoing whole-body PET/CT because of a history of nonmetastatic melanoma. Image analysis assumed that the BM is surrounded by compact bone. An iterative optimization scheme was applied to each CT slice to identify the external border of the bone. To identify compact bone, the algorithm measured the average Hounsfield coefficient within a two-pixel ring located just inside the bone contour. All intraosseous pixels with an attenuation coefficient lower than this cut-off were flagged as 1, while the remaining pixels were set at 0. Binary masks created from all CT slices were thus applied to the PET data to determine the metabolic activity of the intraosseous volume (IBV). RESULTS Estimated whole-body IBV was 1,632 ± 587 cm(3) and was higher in men than in women (2,004 ± 498 cm(3) vs. 1,203 ± 354 cm(3), P < 0.001). Overall, it was strictly correlated with ideal body weight (r = 0.81, P = 0.001) but only loosely with measured body weight (r = 0.43, P = 0.01). The average FDG standardized uptake value (SUV) in the thoracic and lumbar vertebrae was 2.01 ± 0.36, Accordingly, intraosseous voxels with SUV ≥ 1.11 (mean spine SUV - 2.5 × SD) were considered as active "red" BM and those with SUV <1.11 as "yellow" BM. Estimated red BM volume was 541 ± 195 ml, with a higher prevalence in the axial than in the appendicular skeleton (87 ± 8 % vs. 10 ± 8 %, P < 0.001). Again, red BM volume was higher in men than in women (7.8 ± 2.2 vs. 6.7 ± 2.1 ml/kg body weight, P < 0.05), but in women it occupied a greater fraction of the IBV (32 ± 7 % vs. 36 ± 10 %, P < 0.05). Patient age modestly predicted red BM SUV, while it was robustly and inversely correlated with red BM volume. CONCLUSION Our computational analysis of PET/CT images provides a first estimation of the extension and metabolism of the BM in a population of adult patients without haematooncological disorders. This information might represent a new window to explore pathophysiology the BM and the response of BM diseases to chemotherapy.
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Affiliation(s)
- Gianmario Sambuceti
- Nuclear Medicine, Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, 16132 Genova, Italy.
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Palombo D, Morbelli S, Spinella G, Pane B, Marini C, Rousas N, Massollo M, Cittadini G, Camellino D, Sambuceti G. A positron emission tomography/computed tomography (PET/CT) evaluation of asymptomatic abdominal aortic aneurysms: another point of view. Ann Vasc Surg 2011; 26:491-9. [PMID: 22197524 DOI: 10.1016/j.avsg.2011.05.038] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 04/05/2011] [Accepted: 05/27/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND To assess the prevalence of increased (18)F-fluorodeoxyglucose (FDG) uptake in aneurysmal walls, adopting a case-control approach in a population of asymptomatic patients with abdominal aortic aneurysm (AAA). METHODS This study included 40 males (mean age: 74 years, range: 59-93 years), consecutive, white Caucasian patients, with asymptomatic infrarenal AAA. The mean diameter of AAA was 4.9 cm (range: 4.8-5.4 cm), detected by computed tomography (CT) scan. Control Subjects: 44 age-matched controls subjects (mean age: 71 years, range: 59-85 years, 24 males, 20 females) who were selected according to a case-control criterion among a population of patients without any clinical evidence of atherosclerotic disease. Patients and controls underwent simultaneous FDG-positron emission tomography (PET) and CT imaging from the skull base to the femoral neck by using an integrated PET/CT scanner. PET/CT studies were analysed both visually and quantitatively. For quantitative analysis, circular CT-based regions of interest (ROIs) were drawn on the AAA, on all the aortic segments, and on the large vessel included in the study (carotid, subclavian, and iliac arteries). FDG uptake was quantified by calculating the mean and maximum standardized uptake values (SUVs) within each ROI and normalizing for the blood-pool SUV to obtain the final target-to-background ratio. Arterial calcium load was graded according to a semiquantitative five-point scale based on calcification of the arterial ring. RESULTS Metabolic activity in the aneurysmal aortic segment was even lower with respect to both the adjacent--nonaneurysmal--samples of patient group and the corresponding arterial segments of control subjects (P < 0.001 and P < 0.01, respectively). In visual analysis, no patients showed an increased focal uptake of degree adequate to identify the aneurysmal arterial wall. AAA patients showed significantly higher values of total calcium load (ACL) than controls in ascending aorta and subclavian and iliac arteries (P < 0.01), and only in AAA patient group, a significant correlation was present between values of ACL in both iliac arteries and abdominal aorta on one side and wall metabolic activity in the same arteries on the other (P < 0.05). CONCLUSIONS In conclusion, our results suggest that FDG hot spot, as well an increased diffuse uptake of FDG, in PET/CT studies is an extremely rare finding in patients with AAA of diameter close to surgical indications.
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Affiliation(s)
- Domenico Palombo
- Division of Vascular and Endovascular Surgery, IRCCS San Martino University Hospital-IST, University of Genoa, Genoa, Italy
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Marini C, Giusti M, Armonino R, Ghigliotti G, Bezante G, Vera L, Morbelli S, Pomposelli E, Massollo M, Gandolfo P, Minuto F, Sambuceti G. Reduced coronary flow reserve in patients with primary hyperparathyroidism: a study by G-SPECT myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2010; 37:2256-63. [PMID: 20821006 DOI: 10.1007/s00259-010-1599-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 08/09/2010] [Indexed: 12/21/2022]
Abstract
PURPOSE The mechanisms underlying increased cardiovascular risk in primary hyperparathyroidism (pHPT) have not been fully defined. Recently, this issue has become the subject of renewed interest due to the increasing evidence that the endothelium and vascular wall are targets for parathyroid hormone (PTH). The aim of this study was to measure regional coronary flow reserve (CFR) to determine whether the vascular damage induced by pHPT extends to affect the coronary microvascular function. METHODS A total of 22 pHPT patients without a history of coronary artery disease and 7 age-matched control subjects were recruited. Dipyridamole myocardial blood flow (MBF) was assessed using 99mTc-sestamibi by measuring first-transit counts in the pulmonary artery and myocardial count rate from G-SPECT images. Baseline MBF was estimated 2 h later according to the same procedure. Regional CFR was defined as the ratio between dipyridamole and baseline MBF using a 17-segment left ventricular model. RESULTS Three pHPT patients showed reversible perfusion defects and were excluded from the analysis. In the remaining 19, CFR was significantly lower with respect to the control subjects (1.88±0.64 vs. 3.36±0.66, respectively; p<0.01). Moreover, patients studied for more than 28 months from pHPT diagnosis showed lower CFR values than the others (1.42±0.18 vs. 2.25±0.64, respectively; p<0.01). Consequently, the time from diagnosis to the nuclear study showed a reasonable correlation with the degree of CFR impairment (Spearman's rho -0.667, p<0.02). CONCLUSION pHPT is associated with a significant dysfunction of the coronary microcirculation. This disorder might contribute to the high cardiovascular risk of conditions characterized by chronic elevations in serum PTH levels.
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Affiliation(s)
- Cecilia Marini
- CNR Institute of Bioimages and Molecular Physiology, Milan, Genoa Section, Genoa, Italy.
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Sambuceti G, Morbelli S, Vanella L, Kusmic C, Marini C, Massollo M, Augeri C, Corselli M, Ghersi C, Chiavarina B, Rodella LF, L'Abbate A, Drummond G, Abraham NG, Frassoni F. Diabetes impairs the vascular recruitment of normal stem cells by oxidant damage, reversed by increases in pAMPK, heme oxygenase-1, and adiponectin. Stem Cells 2009; 27:399-407. [PMID: 19038792 PMCID: PMC2729677 DOI: 10.1634/stemcells.2008-0800] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atherosclerosis progression is accelerated in diabetes mellitus (DM) by either direct endothelial damage or reduced availability and function of endothelial progenitor cells (EPCs). Both alterations are related to increased oxidant damage. AIM We examined if DM specifically impairs vascular signaling, thereby reducing the recruitment of normal EPCs, and if increases in antioxidant levels by induction of heme oxygenase-1 (HO-1) can reverse this condition. METHODS Control and diabetic rats were treated with the HO-1 inducer cobalt protoporphyrin (CoPP) once a week for 3 weeks. Eight weeks after the development of diabetes, EPCs harvested from the aorta of syngenic inbred normal rats and labeled with technetium-99m-exametazime were infused via the femoral vein to estimate their blood clearance and aortic recruitment. Circulating endothelial cells (CECs) and the aortic expression of thrombomodulin (TM), CD31, and endothelial nitric oxide synthase (eNOS) were used to measure endothelial damage. RESULTS DM reduced blood clearance and aortic recruitment of EPCs. Both parameters were returned to control levels by CoPP treatment without affecting EPC kinetics in normal animals. These abnormalities of EPCs in DM were paralleled by reduced serum adiponectin levels, increased numbers of CECs, reduced endothelial expression of phosphorylated eNOS, and reduced levels of TM, CD31, and phosphorylated AMP-activated protein kinase (pAMPK). CoPP treatment restored all of these parameters to normal levels. CONCLUSION Type II DM and its related oxidant damage hamper the interaction between the vascular wall and normal EPCs by mechanisms that are, at least partially, reversed by the induction of HO-1 gene expression, adiponectin, and pAMPK levels.
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Affiliation(s)
- Gianmario Sambuceti
- Department of Internal Medicine, University of Genoa, S. Martino Hospital, Genoa, Italy.
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