Multimodality imaging of ectopic focus in Graves' Disease.

Herein, we report imaging findings related to an ectopic focus of thyroid tissue in a young female with Graves' disease. The occurrence of ectopic thyroid tissue affects approximately 7% of adult population and represents commonly an occasional finding. Only rarely ectopic tissue can present with metastasis or develop a primary thyroid carcinoma. Multimodality imaging may be of help in this case to detect thyroid ectopia, although recent studies question its capability to differentiate benign from malignant tissue.

The immune-metabolic-prognostic index and clinical outcomes in patients with non-small cell lung carcinoma under checkpoint inhibitors.

PURPOSE: This prospective study evaluated whether peripheral blood biomarkers and metabolic parameters on F-18 fludeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) could be associated with clinical outcome in non-small cell lung carcinoma (NSCLC) patients treated with immune checkpoint inhibitors (ICI). METHODS: Data from 33 patients with NSCLC and treated with ICI were collected. Complete blood cell counts before and at the first restaging were measured. All patients underwent F-18 FDG PET/CT at baseline, while 25 patients at the first restaging. Progression-free survival (PFS) and overall survival (OS) were determined and compared using the Kaplan-Meier and the log-rank test. The median follow-up was 11.3 months (range 1-17 months). RESULTS: Multivariate analyses demonstrated that low neutrophil-to-lymphocyte ratio (NLR < 4.9) and low total lesion glycolysis (TLG < 541.5 ml) at the first restaging were significantly associated with PFS (both p = 0.019) and OS (p = 0.001 and p = 0.048, respectively). An immune-metabolic-prognostic index (IMPI), based on post-NLR and post-TLG was developed, categorizing 3 groups: high risk, 2 factors; intermediate risk, 1 factor; low risk, 0 factors. Median PFS for low, intermediate and high risk was 7.8 months (95% CI 4.6-11.0), 5.6 months (95% CI 3.8-7.4), and 1.8 months (95% CI 1.6-2.0) (p < 0.001) respectively. Likewise, median OS was 15.2 months (95% CI 10.9-19.6), 13.2 months (95% CI 5.9-20.3), and 2.8 months (95% CI 1.4-4.2) (p < 0.001), respectively. CONCLUSION: IMPI at the first restaging, combining both inflammatory and metabolic biomarkers, was correlated with PFS and OS. IMPI can be a potentially valuable tool for identifying NSCLC patients who are likely to benefit from ICI.

Predictive and Prognostic Role of Metabolic Response in Patients With Stage III NSCLC Treated With Neoadjuvant Chemotherapy.

INTRODUCTION: The purpose of this study was to assess the predictive and prognostic role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in candidates with stage III non-small-cell lung cancer (NSCLC) to neoadjuvant chemotherapy. PATIENTS AND METHODS: Sixty-six patients with stage III NSCLC treated with induction chemotherapy from March 2013 to December 2017 were retrospectively identified. Response assessment were evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and European Organisation for Research and Treatment of Cancer (EORTC) criteria. 18F-FDG PET/CT metabolic parameters were analyzed as absolute values as well as percentage changes (Δ) between 2 consecutive scans, for primary tumor (T) and for regional lymph nodes (N). All clinical variables and metabolic parameters were compared with treatment response and correlated with progression-free survival (PFS) and overall survival (OS), based on a median follow-up of 9.4 months. RESULTS: Post-induction therapy standardized uptake value (SUV)max_T, SUVmean_T, metabolic tumor volume (MTV_T), and total lesion glycolysis of the tumor (TLG_T) varied significantly between responders and non-responders (6.6 vs. 13.8; P = .001; 4.2 vs. 8.1; P < .001; 6 vs. 17.9; P = .002; and 24.1 vs. 136.3; P < .001, respectively). Likewise, percentage changes (Δ_T) were significantly different between the 2 groups (P < .001). Along with primary tumor, also post-SUVmax_N, post-SUVmean_N, and post-TLG_N (P = .024, P = .015, and P = .024, respectively), as well as all percentage changes (Δ_N) were different between responders and non-responders. RECIST 1.1 and EORTC response classifications were discordant in 27 patients (40.9%; κ = 0.265; P = .003). On multivariate analysis, post-TLG_N was an independent predictor for both PFS and OS, whereas RECIST 1.1 was a predictor only for OS. CONCLUSIONS: Several metabolic parameters may differentiate responders from non-responders following neoadjuvant chemotherapy in stage III NSCLC. As compared with RECIST 1.1, EORTC seems to be more appropriate for evaluation therapeutic response. Finally, post-TLG_N has significant prognostic information.

Hyperprogressive Disease in Patients with Non-Small Cell Lung Cancer Treated with Checkpoint Inhibitors: The Role of 18F-FDG PET/CT.

A new pattern of response, so-called hyperprogressive disease (HPD), is emerging during treatment with immune checkpoint inhibitors (ICIs). Our aim was to investigate the prevalence of such a phenomenon and to assess its association with clinical variables and metabolic parameters by 18F-FDG PET/CT. Methods: Data from 50 patients (34 men and 16 women; median age, 73 y) with non-small cell lung carcinoma treated with ICIs were prospectively collected. All patients underwent contrast-enhanced CT, 18F-FDG PET/CT, and complete peripheral blood sampling at baseline before ICI treatment. HPD was defined according to clinical and radiologic criteria. Because of rapid disease progression or worsening of clinical condition, radiologic response assessment was available for only 46 of the 50 patients. Overall survival (OS) was analyzed using the Kaplan-Meier method and the log-rank test. A Cox proportional hazards regression analysis was used to evaluate factors independently associated with OS. Median follow-up was 12.4 mo (range, 9.7-15.2 mo). Results: We identified the following response categories: 10 cases as complete or partial response, 17 cases as stable disease, 5 cases as progressive disease, and 14 cases as HPD. Among metabolic parameters, we observed a statistically significant association between HPD status and tumor burden, expressed by both TLG (756.1 cm3 for HPD vs. 475.6 cm3 for non-HPD, P = 0.042) and MTV (287.3 for HPD vs. 62.1 for non-HPD, P = 0.011). Among clinical variables, 12 of 14 patients (85.7%) within the HPD group, compared with 8 of 32 patients (25%) in the non-HPD group, had more than 2 metastatic sites (P < 0.001). In addition, the derived neutrophil-to-lymphocyte ratio and platelet count were significantly associated with HPD status (P = 0.038 and P = 0.025, respectively). Survival analysis showed a median OS of 4 mo for the HPD group, compared with 15 mo for the non-HPD group (P = 0.003). Likewise, median OS was significantly different when we considered all the response categories: complete or partial response, stable disease, progressive disease, and HPD (P = 0.001). Finally, multivariate analysis identified metabolic tumor volume and derived neutrophil-to-lymphocyte ratio as independent predictors for OS. Conclusion: Our results suggest that the use of ICIs might represent a concern in patients with high metabolic tumor burden and inflammatory indices at baseline. However, additional studies are needed.

Total metabolic tumor volume by 18F-FDG PET/CT for the prediction of outcome in patients with non-small cell lung cancer.

OBJECTIVE: Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are imaging parameters derived from 18F-FDG PET/CT that have been proposed for risk stratification of cancer patients. The aim of our study was to test whether these whole-body volumetric imaging parameters may predict outcome in patients with non-small cell lung cancer (NSCLC). METHODS: Sixty-five patients (45 men, 20 women; mean age ± SD, 65 ± 12 years), with histologically proven NSCLC who had undergone 18F-FDG PET/CT scan before any therapy, were included in the study. Imaging parameters including SUVmax, SUVmean, total MTV (MTVTOT) and whole-body TLG (TLGWB) were determined. Univariate and multivariate analyses of clinical and imaging variables were performed using Cox proportional hazards regression. Survival analysis was performed using Kaplan-Meier method and log-rank tests. RESULTS: A total of 298 lesions were analyzed including 65 primary tumors, 114 metastatic lymph nodes and 119 distant metastases. MTVTOT and TLGWB could be determined in 276 lesions. Mean value of MTVTOT was 81.83 ml ± 14.63 ml (SE) whereas mean value of TLGWB was 459.88 g ± 77.02 g (SE). Univariate analysis showed that, among the variables tested, primary tumor diameter (p = 0.0470), MTV of primary tumor (p = 0.0299), stage (p < 0.0001), treatment (p < 0.0001), MTVTOT (p = 0.0003) and TLGWB (p = 0.0002) predicted progression-free survival in NSCLC patients, while age (p = 0.0550), MTV of primary tumor (p = 0.0375), stage (p < 0.0001), treatment (p < 0.0001), MTVTOT (p = 0.0001) and TLGWB (p = 0.0008) predicted overall survival. At multivariate analysis age, TLGWB and stage were retained in the model for prediction of progression-free survival (p < 0.0001), while age, MTVTOT and stage were retained in the model for prediction of overall survival (p < 0.0001). Survival analysis showed that patients with TLGWB ≤ 54.7 g had a significantly prolonged progression-free survival as compared to patients with TLGWB > 54.7 g (p < 0.0001). Moreover, overall survival was significantly better in patients showing a MTVTOT ≤ 9.5 ml as compared to those having MTVTOT > 9.5 ml (p < 0.0001). Similar results were obtained in a subgroup of 43 patients with advanced disease (stages III and IV). CONCLUSIONS: Whole-body PET-based volumetric imaging parameters are able to predict outcome in NSCLC patients.

Outcome of Patients With Differentiated Thyroid Cancer Treated With 131-Iodine on the Basis of a Detectable Serum Thyroglobulin Level After Initial Treatment.

Background: In patients with differentiated thyroid cancer (DTC) and raising serum thyroglobulin (Tg) after total or near-total thyroidectomy and 131I remnant ablation an empiric 131I therapy may be considered. However, outcome data after empiric therapy in did not show a clear evidence of improved survival. We assessed the efficacy of such empiric 131I therapy in patients with DTC and evaluated the long-term outcome. Methods: A total of 100 patients with DTC showing raised Tg level during follow-up after thyroidectomy and 131I ablation were treated with a further 131I therapy (6.1 ± 1.7 GBq). Whole-body scan (WBS) was performed 5-7 days after therapy. Tg value at 12 months after 131I therapy was considered as an indicator of treatment response: ≤1.5 ng/ml complete remission (CR), >50% decrease partial remission (PR), higher than pre-therapy progression disease (PD), all other cases stable disease (SD). Patients were followed-up for 96 ± 75 months. Results: After 12 months, 62% of patients were in CR, 16% in PR, 8% in SD, and 14% in PD. WBS was positive in 41% of patients and negative in 59% (P = NS). Among patients with local recurrences at WBS 89% showed either CR or PR, while 71% of patients with distant metastases were in SD or PD (P < 0.001). Distant metastases at WBS (P < 0.05), CR (P < 0.0001), and CR + PR (P < 0.0001) were predictors of both progression free survival and overall survival. Conclusion: There is a beneficial effect of 131I therapy on outcome of patients with DTC treated on the basis of elevated Tg value. In these patients, survival is affected by achievement of CR or PR at 12 months evaluation after 131I therapy and by the presence of distant metastases at WBS.

A New Relational Database Including Clinical Data and Myocardial Perfusion Imaging Findings in Coronary Artery Disease.

BACKGROUND: The aim of this study was to test a relational database including clinical data and imaging findings in a large cohort of subjects with suspected or known Coronary Artery Disease (CAD) undergoing stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging. METHODS: We developed a relational database including clinical and imaging data of 7995 subjects with suspected or known CAD. The software system was implemented by PostgreSQL 9.2, an open source object-relational database, and managed from remote by pgAdmin III. Data were arranged according to a logic of aggregation and stored in a schema with twelve tables. Statistical software was connected to the database directly downloading data from server to local personal computer. RESULTS: There was no problem or anomaly for database implementation and user connections to the database. The epidemiological analysis performed on data stored in the database demonstrated abnormal SPECT findings in 46% of male subjects and 19% of female subjects. Imaging findings suggest that the use of SPECT imaging in our laboratory is appropriate. CONCLUSION: The development of a relational database provides a free software tool for the storage and management of data in line with the current standard.