Diffusion-weighted MRI, 11C-choline PET and 18F-fluorodeoxyglucose PET for predicting the Gleason score in prostate carcinoma.

OBJECTIVES: To evaluate the accuracy of transrectal ultrasound-guided (TRUS) biopsy, diffusion-weighted (DW) magnetic resonance imaging (MRI), (11)C-choline (CHOL) positron emission tomography (PET), and (18)F-fluorodeoxyglucose (FDG) PET in predicting the prostatectomy Gleason risk (GR). METHODS: The study included 21 patients who underwent TRUS biopsy and multi-technique imaging before radical prostatectomy. Values from five different tests (TRUS biopsy, DW MRI, CHOL PET, FDG PET, and combined DW MRI/CHOL PET) were correlated with the prostatectomy GR using Spearman's ρ. Tests that were found to have significant correlations were used to classify patients into GR groups. RESULTS: The following tests had significant correlations with prostatectomy GR: TRUS biopsy (ρ = 0.617, P = 0.003), DW MRI (ρ = -0.601, P = 0.004), and combined DW MRI/CHOL PET (ρ = -0.623, P = 0.003). CHOL PET alone and FDG PET only had weak correlations. The correct GR classification rates were 67% with TRUS biopsy, 67% with DW MRI, and 76% with combined DW MRI/CHOL PET. CONCLUSIONS: DW MRI and combined DW MRI/CHOL PET have significant correlations and high rates of correct classification of the prostatectomy GR, the strength and accuracy of which are comparable with TRUS biopsy. KEY POINTS: • Accurate determination of the Gleason score is essential for prostate cancer management. • DW MRI ± CHOL PET correlated significantly with prostatectomy Gleason score. • These correlations are similar to that between TRUS biopsy and prostatectomy.

Comparison of 11C-PiB and 18F-florbetaben for Aß imaging in ageing and Alzheimer's disease.

PURPOSE: Amyloid imaging with (18)F-labelled radiotracers will allow widespread use of this technique, facilitating research, diagnosis and therapeutic development for Alzheimer's disease (AD). The purpose of this analysis was to compare data on cortical Aß deposition in subjects who had undergone both (11)C-PiB (PiB) and (18)F-florbetaben (FBB) PET imaging. METHODS: We identified ten healthy elderly controls (HC) and ten patients with AD who had undergone PET imaging after intravenous injection of 370 MBq of PiB and 300 MBq of FBB under separate research protocols. PiB and FBB images were coregistered so that placement of regions of interest was identical on both scans and standard uptake value ratios (SUVR) using the cerebellar cortex as reference region were calculated between 40 and 70 min and between 90 and 110 min after injection for PiB and FBB, respectively. RESULTS: Significantly higher SUVR values (p < 0.0001) in most cortical areas were observed in AD patients when compared with HC with both radiotracers. Global SUVR values in AD patients were on average 75% higher than in HC with PiB and 56% higher with FBB. There was an excellent linear correlation between PiB and FBB global SUVR values (r = 0.97, p < 0.0001) with similar effect sizes for distinguishing AD from HC subjects for both radiotracers (Cohen's d 3.3 for PiB and 3.0 for FBB). CONCLUSION: FBB, while having a narrower dynamic range than PiB, clearly distinguished HC from AD patients, with a comparable effect size. FBB seems a suitable (18)F radiotracer for imaging AD pathology in vivo.

Radiation dosimetry of beta-amyloid tracers 11C-PiB and 18F-BAY94-9172.

UNLABELLED: Beta-amyloid (Abeta) imaging has great potential to aid in the diagnosis of Alzheimer disease and the development of therapeutics. The radiation dosimetry of Abeta radioligands may influence their application; therefore, we calculated and compared the effective doses (EDs) of 11C-PiB and a new 18F-labeled ligand, 18F-BAY94-9172. METHODS: Attenuation-corrected whole-body scans were performed at 0, 15, 30, 45, and 60 min after injection of 350+/-28 MBq (mean+/-SD) of 11C-PiB in 6 subjects and at 0, 20, 60, 120, and 180 min after injection of 319+/-27 MBq of 18F-BAY94-9172 in 3 subjects. Coregistered CT was used to define volumes of interest (VOIs) on the PET images. The source organs were the brain, lungs, liver, kidneys, spleen, and vertebrae. The VOIs for the contents of the gallbladder, urinary bladder, lower large intestine, upper large intestine, and small intestine were also defined. Total activity in each organ at each time point was calculated by use of reference organ volumes. The resultant time-activity curves were fitted with constrained exponential fits, and cumulated activities were determined. A dynamic bladder voiding model was used. The OLINDA/EXM program was used to calculate the whole-body EDs from the acquired data. RESULTS: For 11C-PiB, the highest absorbed doses were in the gallbladder wall (44.80+/-29.30 microGy/MBq), urinary bladder wall (26.30+/-8.50 microGy/MBq), liver (19.88+/-3.58 microGy/MBq), and kidneys (12.92+/-3.37 microGy/MBq). The ED was 5.29+/-0.66 microSv/MBq. For 18F-BAY94-9172, the highest doses were also in the gallbladder wall (132.40+/-43.40 microGy/MBq), urinary bladder wall (24.77+/-7.36 microGy/MBq), and liver (39.07+/-8.31 microGy/MBq). The ED was 14.67+/-1.39 microSv/MBq. CONCLUSION: The estimated organ doses for 11C-PiB were comparable to those reported in earlier research. With the doses used in published studies (300-700 MBq), the EDs would range from 1.6 to 3.7 mSv. The ED of 18F-BAY94-9172 was 30% lower than that of 18F-FDG and, at the published dose of 300 MBq, would yield an ED of 4.4 mSv. The dosimetry of both Abeta radioligands is suitable for clinical and research applications.

Standardized Expression of 18F-NAV4694 and 11C-PiB ß-Amyloid PET Results with the Centiloid Scale.

UNLABELLED: A common quantitative output value for PET measures of ß-amyloid (Aß) binding across tracers and methods would allow better comparison of data across sites and application of universal diagnostic and prognostic values. A method has recently been developed that generates a unit of measurement called the centiloid. We applied this method to 2-[2-(18)F-fluoro-6-(methylamino)-3-pyridinyl]-1-benzofuran-5-ol ((18)F-NAV4694) and (11)C-Pittsburgh compound B ((11)C-PiB) Aß images to derive the scaling factor required to express tracer binding in centiloids. METHODS: Fifty-five participants, including 10 young controls (33 ± 7 y old), underwent both (11)C-PiB and (18)F-NAV4694 imaging no more than 3 mo apart, with the images acquired 50-70 min after tracer injection. The images were spatially normalized and analyzed using the standard centiloid method and regions (cortex and whole-cerebellum reference) downloaded from the Global Alzheimer Association Interactive Network website. RESULTS: SUV ratios (SUVRs) showed a strong correlation in tracer binding ((18)F-NAV4694 SUVR = 1.09 × (11)C-PiB SUVR - 0.08, R(2) = 0.99). The equation to convert (18)F-NAV4694 to centiloids [100 × ((18)F-NAV4694 SUVR - 1.028)/1.174] was similar to a published equation for (11)C-PiB [100 × ((11)C-PiB SUVR - 1.009)/1.067]. In the young controls, the variance ratio ((18)F-NAV4694 centiloid SD divided by (11)C-PiB centiloid SD) was 0.85. CONCLUSION: The results for both (11)C-PiB and (18)F-NAV4694 can now be expressed in centiloids, an important step that should allow better clinical and research use of Aß imaging. The standard centiloid method also showed that (18)F-NAV4694 has slightly higher Aß binding and lower variance than (11)C-PiB, important properties for detecting early Aß deposition and change over time.

Imaging and quantitation of the hypoxic cell fraction of viable tumor in an animal model of intracerebral high grade glioma using [18F]fluoromisonidazole (FMISO).

We have demonstrated that FMISO uptake is significantly higher in tumor tissue in the C6 intracerebral glioma rat model compared to normal brain, and that there is persisting hypoxia in gliomas independent of tumor size. FMISO uptake was observed homogeneously throughout viable glioma tissue in tumor sizes ranging from 2mm to almost 1cm. Quantitation of uptake of FMISO showed a tumor/brain ratio of 1.9 and a tumor/blood ratio of 2.6 at 2 hours post injection.

Head-to-head comparison of 11C-PiB and 18F-AZD4694 (NAV4694) for ß-amyloid imaging in aging and dementia.

UNLABELLED: (11)C-Pittsburgh compound-B ((11)C-PiB) is the benchmark radiotracer for imaging of ß-amyloid (Aß) plaque in Alzheimer disease (AD). (18)F-labeled Aß tracers subsequently developed for clinical use show higher nonspecific white matter binding and, in some cases, lower cortical binding in AD that could lead to less accurate interpretation of scans. We compared the cortical and white matter binding of a new (18)F-labeled Aß tracer, (18)F-AZD4694 (recently renamed NAV4694), with (11)C-PiB in the same subjects. METHODS: Forty-five participants underwent PET imaging with (11)C-PiB and (18)F-AZD4694 (25 healthy elderly controls [HCs], 10 subjects with mild cognitive impairment, 7 subjects with probable AD, and 3 subjects with probable frontotemporal dementia). Images were coregistered so that region-of-interest placement was identical on both scans, and standardized uptake value ratios (SUVRs) using the cerebellar cortex as a reference region were calculated between 40 and 70 min after injection for both tracers. RESULTS: (18)F-AZD4694 showed reversible binding kinetics similar to (11)C-PiB, reaching an apparent steady state at 50 min after injection. Both radiotracers showed a similar dynamic range of neocortical SUVR (1.1-3.3 and 1.0-3.2 SUVR for (11)C-PiB and (18)F-AZD4694, respectively) and identical low nonspecific white matter binding, with frontal cortex-to-white matter ratios of 0.7 ± 0.2 and 1.3 ± 0.2 for both radiotracers in HCs and AD subjects, respectively. There was an excellent linear correlation between (11)C-PiB and (18)F-AZD4694 neocortical SUVR (slope of 0.95, r = 0.99, P < 0.0001). CONCLUSION: (18)F-AZD4694 displays imaging characteristics nearly identical to those of (11)C-PiB. The low white matter and high cortical binding in AD indicate that this tracer is well suited to both clinical and research use.

Amyloid imaging with (18)F-florbetaben in Alzheimer disease and other dementias.

UNLABELLED: Amyloid imaging with (18)F-labeled radiotracers will allow widespread use, facilitating research, diagnosis, and therapeutic development for Alzheimer disease. The purpose of the study program was to compare cortical amyloid deposition using (18)F-florbetaben and PET in controls and subjects with mild cognitive impairment (MCI), frontotemporal lobar degeneration (FTLD), dementia with Lewy bodies (DLB), vascular dementia (VaD), Parkinson disease (PD), and Alzheimer disease (AD). METHODS: One hundred nine subjects in 3 clinical studies at Austin Health were reviewed: 32 controls, 20 subjects with MCI, and 30 patients with AD, 11 with FTLD, 7 with DLB, 5 with PD, and 4 with VaD underwent PET after intravenous injection of 300 MBq of (18)F-florbetaben. Standardized uptake value ratios (SUVR) using the cerebellar cortex as a reference region were calculated between 90 and 110 min after injection. RESULTS: When compared with the other groups, AD patients demonstrated significantly higher SUVRs (P < 0.0001) in neocortical areas. Most AD patients (96%) and 60% of MCI subjects showed diffuse cortical (18)F-florbetaben retention. In contrast, only 9% of FTLD, 25% of VaD, 29% of DLB, and no PD patients and 16% of controls showed cortical binding. Although there was a correlation between Mini Mental State Examination and ß-amyloid burden in the MCI group, no correlation was observed in controls, FTLD or AD. CONCLUSION: (18)F-florbetaben had high sensitivity for AD, clearly distinguished patients with FTLD from AD, and provided results comparable to those reported with (11)C-Pittsburgh Compound B in a variety of neurodegenerative diseases.

Evaluation of 18 F-fluorodeoxyglucose positron emission tomography and computed tomography with histopathologic correlation in the initial staging of head and neck cancer.

OBJECTIVE: To prospectively evaluate the use of 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) in the initial staging of squamous cell head and neck carcinoma. SUMMARY BACKGROUND DATA: The status of cervical lymph nodes is an important prognostic factor and determinant of management approach in squamous cell head and neck cancer. METHODS: FDG-PET findings were compared with those of computed tomography (CT) before removal of the primary tumor and/or neck dissection. Histopathologic analysis was used as the gold standard for assessment of the sensitivity and specificity of these modalities. RESULTS: FDG-PET correctly identified the primary tumor in 35 of 40 patients in whom the site of the primary was known clinically and still present (sensitivity 88%). None of four unknown primaries were detected. Tumors not detected by FDG-PET were generally superficial, with depths of less than 4 mm. CT correctly identified 18 of the 35 primary tumors (sensitivity 51%). Eleven of 17 CT false-negative tumors were detected by FDG-PET. The sensitivity and specificity for the presence of metastatic neck disease on FDG-PET were 82% and 100%, respectively; those for CT were 81% and 81%, respectively. FDG-PET was true positive for metastatic neck disease in two of the three CT false-negative patients. CONCLUSIONS: FDG-PET shows promise in the initial staging of head and neck cancer and provides additional accuracy to a conventional staging process using CT.