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1.
Mol Pharm ; 19(2): 720-727, 2022 02 07.
Article in English | MEDLINE | ID: mdl-34936367

ABSTRACT

Radiolabeled prostate-specific membrane antigen (PSMA) ligands have been rapidly adopted as part of patient care for prostate cancer. In this study, a new series of 18F-labeled PSMA-targeting agents was developed based on the high-affinity Glu-ureido-Lys scaffold and 18F-vinyl sulfones (VSs), the tumor uptake and tumor/major organ contrast of which could be tuned by pharmacokinetic linkers within the molecules. In particular, 18F-PEG3-VS-PSMAi showed the highest tumor uptake (12.1 ± 2.2%ID/g at 0.5 h p.i.) and 18F-PEG2-VS-PSMAi showed the highest tumor-to-liver ratio (T/L = 3.7 ± 1.0, 4.8 ± 1.2, and 6.3 ± 1.1 at 0.5, 1.5, and 3 h p.i. respectively). Significantly, compared with the FDA-approved 68Ga-PSMA-11, the newly developed 18F-PEG3-VS-PSMAi has an almost double tumor uptake (P < 0.0001) when tested in the same animal model. In conclusion, 18F-VS-labeled PSMA ligands are promising PET agents with prominent tumor uptake and high contrast. The lead agents 18F-PEG2-VS-PSMAi and 18F-PEG3-VS-PSMAi warrant further evaluation in prostate cancer patients.


Subject(s)
Prostate , Prostatic Neoplasms , Animals , Antigens, Surface , Cell Line, Tumor , Fluorine Radioisotopes/pharmacokinetics , Gallium Isotopes , Gallium Radioisotopes , Glutamate Carboxypeptidase II , Humans , Male , Positron Emission Tomography Computed Tomography/methods , Positron-Emission Tomography/methods , Prostate/pathology , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , Radiopharmaceuticals/pharmacokinetics , Sulfones
2.
Mol Imaging Biol ; 24(1): 60-69, 2022 02.
Article in English | MEDLINE | ID: mdl-34622425

ABSTRACT

PURPOSE: To evaluate the correlation of radiomic features in pelvic [2-deoxy-2-18F]fluoro-D-glucose positron emission tomography/magnetic resonance imaging and computed tomography ([18F]FDG PET/MRI and [18F]FDG PET/CT) in patients with primary cervical cancer (CCa). PROCEDURES: Nineteen patients with histologically confirmed primary squamous cell carcinoma of the cervix underwent same-day [18F]FDG PET/MRI and PET/CT. Two nuclear medicine physicians performed a consensus reading in random order. Free-hand regions of interest covering the primary cervical tumors were drawn on PET, contrast-enhanced pelvic CT, and pelvic MR (T2 weighted and ADC) images. Several basic imaging features, standard uptake values (SUVmean, SUVmax, and SUVpeak), total lesion glycolysis (TLG), metabolic tumor volume (MTV), and more advanced texture analysis features were calculated. Pearson's correlation test was used to assess the correlation between each pair of features. Features were compared between local and metastatic tumors, and their role in predicting metastasis was evaluated by receiver operating characteristic curves. RESULTS: For a total of 101 extracted features, 1104/5050 pairs of features showed a significant correlation (ρ ≥ 0.70, p < 0.05). There was a strong correlation between 190/484 PET pairs of features from PET/MRI and PET/CT, 91/418 pairs of CT and PET from PET/CT, 79/418 pairs of T2 and PET from PET/MRI, and 50/418 pairs of ADC and PET from PET/MRI. Significant difference was seen between eight features in local and metastatic tumors including MTV, TLG, and entropy on PET from PET/CT; MTV and TLG on PET from PET/MRI; compactness and entropy on T2; and entropy on ADC images. CONCLUSIONS: We demonstrated strong correlation of many extracted radiomic features between PET/MRI and PET/CT. Eight radiomic features calculated on PET/CT and PET/MRI were significantly different between local and metastatic CCa. This study paves the way for future studies to evaluate the diagnostic and predictive potential of radiomics that could guide clinicians toward personalized patients care.


Subject(s)
Positron Emission Tomography Computed Tomography , Uterine Cervical Neoplasms , Female , Fluorodeoxyglucose F18 , Humans , Magnetic Resonance Imaging , Pilot Projects , Positron-Emission Tomography/methods , Radiopharmaceuticals , Retrospective Studies , Tomography, X-Ray Computed , Tumor Burden , Uterine Cervical Neoplasms/diagnostic imaging
3.
Mol Imaging ; 2022: 5358545, 2022.
Article in English | MEDLINE | ID: mdl-35517711

ABSTRACT

Introduction: Positron emission tomography (PET) imaging with prostate-specific membrane antigen- (PSMA-) binding tracers has been found incidentally to demonstrate uptake in CNS tumors. Following the encouraging findings of several such case reports, there is a growing interest in the potential application of PSMA-targeted PET imaging for diagnostics, theranostics, and monitoring of CNS tumors. This is a systematic literature review on PSMA-binding tracers in CNS tumors. Methods: A PubMed search was conducted, including preclinical and clinical reports. One hundred and twelve records were identified, and after screening, 56 were included in the final report. Results: Tissue studies demonstrated PSMA expression in tumor vascular endothelial cells, without expression in normal brain tissue, though the extent and intensity of staining varied by anti-PSMA antibody and methodology. Most included studies reported on gliomas, which showed strong PSMA ligand uptake and more favorable tumor to background ratios than other PET tracers. There are also case reports demonstrating PSMA ligand uptake in prostate cancer brain metastases, nonprostate cancer brain metastases, and meningiomas. We also review the properties of the various PSMA-binding radiotracers available. Therapeutic and theranostic applications of PSMA-binding tracers have been studied, including labeled alpha- and beta-ray emitting isotopes, as well as PSMA targeting in directing MRI-guided focused ultrasound. Conclusions: There is a potential application for PSMA-targeted PET in neuro-oncology as a combination of diagnostic and therapeutic use, as a theranostic modality for managing CNS tumors. Further research is needed regarding the mechanism(s) of PSMA expression in CNS tumors and its differential performance by tumor type.


Subject(s)
Brain Neoplasms , Prostatic Neoplasms , Brain Neoplasms/diagnostic imaging , Endothelial Cells/metabolism , Endothelial Cells/pathology , Humans , Ligands , Male , Neuroimaging , Positron-Emission Tomography , Prostate , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/metabolism , Radiopharmaceuticals
4.
Mol Imaging ; 2022: 9222331, 2022.
Article in English | MEDLINE | ID: mdl-35517712

ABSTRACT

Purpose: Bacterial cancer therapy (BCT) research using engineered Salmonella typhimurium has increased in recent years. 2-Deoxy-2[18F] fluoro-D-glucose positron emission tomography (FDG PET) is widely used in cancer patients to detect cancer, monitor treatment responses, and predict prognoses. The aim of this pilot study was to investigate FDG uptake patterns in a mouse tumor model after BCT. Procedures. BCT was performed via the intravenous injection of attenuated S. typhimurium (SLΔppGpp/lux) into female mice bearing a tumor (derived from CT26 murine colon cancer cells) in the right thigh. 18F-FDG PET images acquired before BCT and at different time points after BCT. In vivo bioluminescence imaging confirmed bacterial presence in the tumor. The tumor volume, standardized uptake value (SUV) of FDG (SUVmax and SUVmean), early SUV reduction%, and normalized tumor volume change were analyzed. Results: Early after BCT (1 or 2 days post-injection (dpi)), FDG tumor uptake decreased in 10 out of 11 mice and then increased at later stages. FDG uptake before BCT was correlated with normalized tumor volume change after BCT. Early FDG reduction% after BCT was correlated with normalized volume change after BCT. Conclusions: Early after BCT, FDG tumor uptake decreased and then increased at later stages. The higher the FDG tumor uptake before BCT, the better the BCT response. FDG uptake patterns were related to tumor volume change after BCT. Therefore, FDG uptake was a good candidate for evaluating BCT.


Subject(s)
Colonic Neoplasms , Fluorodeoxyglucose F18 , Animals , Colonic Neoplasms/diagnostic imaging , Colonic Neoplasms/therapy , Female , Glucose , Humans , Mice , Pilot Projects , Positron-Emission Tomography/methods , Radiopharmaceuticals , Salmonella typhimurium
5.
Neuroimaging Clin N Am ; 32(2): 287-298, 2022 May.
Article in English | MEDLINE | ID: mdl-35526957

ABSTRACT

18FDG-PET plays an important role in cancer imaging. However, there are certain challenges with interpreting head and neck 18FDG-PET. In this article, examples of technical issues that can undermine the interpretation of the scans, normal physiologic activity that can mimic lesions or obscure lesions, and causes of false positives and false negatives on posttreatment cancer imaging are discussed. In addition, suggestions for addressing potential pitfalls on head and neck 18FDG-PET are highlighted.


Subject(s)
Fluorodeoxyglucose F18 , Head and Neck Neoplasms , Head and Neck Neoplasms/diagnostic imaging , Humans , Positron-Emission Tomography/methods , Radiopharmaceuticals
6.
Contrast Media Mol Imaging ; 2022: 9614678, 2022.
Article in English | MEDLINE | ID: mdl-35494209

ABSTRACT

Objective: To evaluate 18F-fluorodeoxyglucose positron emission tomography (18FDG PET) and clinical parameters to differentiate rheumatoid arthritis (RA) and polymyalgia rheumatic (PMR). Patients and Methods. This retrospective study evaluated 54 patients with suspected RA (n = 23) and PMR (n = 31) who underwent 18F-FDG PET/CT before treatment. The complete diagnosis was based on each classification criterion and at least followed up for 6 months. Demographic and clinical data were also collected. Semiquantitative analysis (maximum standardized uptake value, SUVmax) of abnormal 18F-FDG uptake was undertaken at 17 musculoskeletal sites, and two scoring systems (mean reference (liver/control) scores) were evaluated. The differential diagnostic efficacy of each independent parameter was evaluated using the receiver operating characteristic (ROC) curve. Integrated discriminatory improvement (IDI) and bootstrap tests were used to evaluate the improvement in diagnostic efficacy using a combination of multiple parameters. Results: The ROC curve analysis of SUVmax indicated that the interspinous ligament showed the highest discriminative diagnostic value (sensitivity, 64.5%; specificity, 78.3%; area under the curve (AUC), 0.764; positive predictive value, 0.800; negative predictive value, 0.621). The combined model with the rheumatoid factor (RF) and metabolic parameters of 18F-FDG PET resulted in the highest AUC of 0.892 and showed significant reclassification by IDI (IDI, 9.51%; 95% confidence interval: 0.021-0.175; P = 0.013). According to the bootstrap test, compared with RF alone, the combination of RF and metabolic parameters showed an improvement in ROC and was statistically significant (P = 0.017). Conclusions: The combination of 18F-FDG PET metabolic and clinical parameters can further improve the differential diagnosis of RA and PMR.


Subject(s)
Arthritis, Rheumatoid , Fluorodeoxyglucose F18 , Arthritis, Rheumatoid/diagnostic imaging , Humans , Positron Emission Tomography Computed Tomography/methods , Positron-Emission Tomography , Radiopharmaceuticals , Retrospective Studies
7.
Clin Nucl Med ; 47(6): 503-511, 2022 Jun 01.
Article in English | MEDLINE | ID: mdl-35507433

ABSTRACT

OBJECTIVES: This practice parameter (PP) for Lutetium-177 (Lu-177) DOTATATE peptide receptor radionuclide therapy (PRRT) aims to guide authorized users in selection of appropriate adult candidates with gastroeneropancreatic neuroendocrine tumors (GEP-NETs) from foregut, midgut, and hindgut. The essential selection criteria include somatostatin receptor-positive GEP-NETs, which are usually inoperable and progressed despite standard therapy. Lu-177 DOTATATE is a radiopharmaceutical with high avidity for somatostatin receptors that are overexpressed by these tumors. This document ensures safe handling of Lu-177 DOTATATE by the authorized users and safe management of affected patients. METHODS: The document was developed according to the systematic process developed by the American College of Radiology (ACR) and described on the ACR Web site (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards). The PP development was led by 2 ACR Committees on Practice Parameters (Nuclear Medicine and Molecular Imaging and Radiation Oncology) collaboratively with the American College of Nuclear Medicine, American Society of Radiation Oncology, and Society of Nuclear Medicine and Molecular Imaging. RESULTS: The Lu-177 DOTATATE PP reviewed pharmacology, indications, adverse effects, personnel qualifications, and required clinical evaluation before starting the treatment, as well as the recommended posttherapy monitoring, quality assurance, documentation, and appropriate radiation safety instructions provided in written form and explained to the patients. CONCLUSIONS: Lu-177 DOTATATE is available for therapy of inoperable and/or advanced GEP-NETs when conventional therapy had failed. It can reduce tumor size, improve symptoms, and increase the progression free survival. The PP document provides clinical guidance for authorized users to assure an appropriate, consistent, and safe practice of Lu-177 DOTATATE.


Subject(s)
Neuroendocrine Tumors , Organometallic Compounds , Adult , Humans , Lutetium/therapeutic use , Neuroendocrine Tumors/drug therapy , Neuroendocrine Tumors/radiotherapy , Octreotide/therapeutic use , Organometallic Compounds/therapeutic use , Positron-Emission Tomography , Radioisotopes/therapeutic use , Radionuclide Imaging , Radiopharmaceuticals/therapeutic use
8.
Clin Nucl Med ; 47(6): e457-e465, 2022 Jun 01.
Article in English | MEDLINE | ID: mdl-35507438

ABSTRACT

ABSTRACT: Gliomas are characterized by an inherent diffuse and irregular morphology that prevents defining a boundary between tumor and healthy tissue, both in imaging assessment and surgical field. The effective identification of the extent of the disease in diffuse and multiple gliomas is crucial for their management but doing so by radiological means can be challenging. We present a broad spectrum of diffuse and multiple gliomas using 18F-fluorocholine PET/CT, demonstrating the potential of metabolic imaging in the evaluation of these gliomas, with implications in patient clinical management and outcome.


Subject(s)
Glioma , Positron Emission Tomography Computed Tomography , Choline/analogs & derivatives , Glioma/diagnostic imaging , Glioma/pathology , Humans , Positron Emission Tomography Computed Tomography/methods , Radiopharmaceuticals
9.
Radiol Technol ; 93(5): 431-436, 2022.
Article in English | MEDLINE | ID: mdl-35508408

ABSTRACT

BACKGROUND: This case report details a 57-year-old African American man with pancreatic neuroendocrine tumors (NETs). The patient underwent positron emission tomography (PET) imaging using gallium Ga 68 dotatate, which localized the tumors. Selected tumors were treated with 4 doses of 200 mCi of lutetium Lu 177 dotatate during a period of 8 months. At the conclusion of treatment, the patient demonstrated improvement, progressing from bedbound and confused to ambulatory and coherent. In addition, the patient stated he felt no adverse effects. DISCUSSION: Pancreatic NETs are rare tumors affecting 0.001% of the population. These tumors are associated with various symptoms and are classified as functional or nonfunctional. Imaging modalities, such as computed tomography (CT), magnetic resonance (MR) imaging, and gallium Ga 68-labeled PET, are essential in detecting and evaluating pancreatic NETs. For patients with localized NETs, the primary treatment is surgery; however, the radiopharmaceuticals yttrium Y 90 microspheres and lutetium Lu 177 dotatate are used as therapy to treat nonresectable tumors. CONCLUSION: Lutetium Lu 177 dotatate is used in NET cases that are deemed inoperable and for patients who are not responding to treatment. This case study demonstrates the effectiveness of combining imaging with Ga 68-labeled PET and treatment with lutetium Lu 177 dotatate. This treatment is not a cure but has been shown to improve a patient's quality of life.


Subject(s)
Neuroendocrine Tumors , Nuclear Medicine , Pancreatic Neoplasms , Humans , Lutetium , Male , Middle Aged , Neuroendocrine Tumors/diagnostic imaging , Neuroendocrine Tumors/radiotherapy , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/therapy , Positron Emission Tomography Computed Tomography/methods , Positron-Emission Tomography , Quality of Life , Radionuclide Imaging , Radiopharmaceuticals
10.
Sci Rep ; 12(1): 7148, 2022 May 03.
Article in English | MEDLINE | ID: mdl-35504955

ABSTRACT

Aim of this study was to validate the prognostic impact of clinical parameters and baseline 18F-FDG-PET/CT derived textural features to predict histopathologic response and survival in patients with esophageal squamous cell carcinoma undergoing neoadjuvant chemoradiation (nCRT) and surgery. Between 2005 and 2014, 38 ESCC were treated with nCRT and surgery. For all patients, the 18F-FDG-PET-derived parameters metabolic tumor volume (MTV), SUVmax, contrast and busyness were calculated for the primary tumor using a SUV-threshold of 3. The parameter uniformity was calculated using contrast-enhanced computed tomography. Based on histopathological response to nCRT, patients were classified as good responders (< 10% residual tumor) (R) or non-responders (≥ 10% residual tumor) (NR). Regression analyses were used to analyse the association of clinical parameters and imaging parameters with treatment response and overall survival (OS). Good response to nCRT was seen in 27 patients (71.1%) and non-response was seen in 11 patients (28.9%). Grading was the only parameter predicting response to nCRT (Odds Ratio (OR) = 0.188, 95% CI: 0.040-0.883; p = 0.034). No association with histopathologic treatment response was seen for any of the evaluated imaging parameters including SUVmax, MTV, busyness, contrast and uniformity. Using multivariate Cox-regression analysis, the heterogeneity parameters busyness (Hazard Ratio (HR) = 1.424, 95% CI: 1.044-1.943; p = 0.026) and contrast (HR = 6.678, 95% CI: 1.969-22.643; p = 0.002) were independently associated with OS, while no independent association with OS was seen for SUVmax and MTV. In patients with ESCC undergoing nCRT and surgery, baseline 18F-FDG-PET/CT derived parameters could not predict histopathologic response to nCRT. However, the PET/CT derived features busyness and contrast were independently associated with OS and should be further investigated.


Subject(s)
Esophageal Neoplasms , Esophageal Squamous Cell Carcinoma , Esophageal Neoplasms/diagnostic imaging , Esophageal Neoplasms/therapy , Esophageal Squamous Cell Carcinoma/diagnostic imaging , Esophageal Squamous Cell Carcinoma/therapy , Fluorodeoxyglucose F18/metabolism , Humans , Multimodal Imaging/methods , Neoadjuvant Therapy , Neoplasm, Residual , Positron Emission Tomography Computed Tomography/methods , Radiopharmaceuticals/metabolism
11.
Hell J Nucl Med ; 25(1): 71-82, 2022.
Article in English | MEDLINE | ID: mdl-35503558

ABSTRACT

OBJECTIVE: Planar dosimetry is often performed in developing countries due to its simplicity during basic quantitative dosimetry. The geometric mean method is often used during planar dosimetry and imaging counts can be corrected for background, attenuation and scatter. The aim of our study was to develop computerized software called Masterdose that may be used for therapeutic isotope planar organ personalized dosimetry. MATERIALS AND METHODS: Masterdose software uses various methods to correct for background, scatter and attenuation.We also introduced a method to convert imaging counts to activity on the software,which is Java based and runs on Windows, Linux and Macintosh platforms. RESULTS: Three user interfaces named image processing, quantification and dosimetry were developed for the software. Masterdose could quantify kidney and liver doses of lutetium-177-DOTA-0-Tyr3-octreotate (177Lu-DOTATATE) patients. The software was validated throughcalculation of the kidney and liver doses of ten neuroendocrine tumour patients (NET) treated with 177Lu-DOTATATE. CONCLUSION: Masterdose presents an option for planar quantification that can be used as a quality control tool to verify imaging counts and perform dosimetry in particular organs.


Subject(s)
Neuroendocrine Tumors , Organometallic Compounds , Developing Countries , Humans , Organometallic Compounds/therapeutic use , Positron-Emission Tomography , Radiometry/methods , Radionuclide Imaging , Radiopharmaceuticals/therapeutic use , Software
12.
Hell J Nucl Med ; 25(1): 63-70, 2022.
Article in English | MEDLINE | ID: mdl-35503557

ABSTRACT

To determine whether the prognostic stratification of non-small cell lung cancer (NSCLC) patients could be made by fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)-derived parameters such as maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). A total of 106 patients who were initially diagnosed with NSCLC with clinical stage III or stage IV at our hospital from January 2015 to January 2018 were included. The metabolic and volumetric parameters of 18F-FDG PET/CT were systematically collected, and their optimal cut-off values were determined on the basis of the receiver operating characteristic (ROC) curves. Kaplan-Meier methods and log-rank test were used to evaluate the relationships between 18F-FDG PET/CT-derived parameters and overall survival (OS) of NSCLC patients. The univariate and multivariate Cox analysis were conducted to identify the independent predictors of OS. The optimal cut-off value of SUVmax was 8.94 and area under the curve (AUC) for identifying patients with mortality risk was 0.618 (95% confidence interval [CI]: 0.490-0.745), with a sensitivity of 78.6% and specificity of 53.3%. The optimal cut-off value of MTV40 was 12.44 and the AUC value was 0.785 (95%CI: 0.676-0.893), with a sensitivity of 85.7% and specificity of 71.7%. Furthermore, the ROC curves identified 71.95 as the optimal cut-off value of TLG40, and the AUC value, sensitivity and specificity were 0.782 (95%CI: 0.681-0.883), 78.6% and 70.4%, respectively. The Kaplan-Meier curves showed that SUVmax (HR for SUVmax >8.94: 3.501, 95%CI: 1.133-10.817, P=0.029), MTV40 (HR: 6.926 for MTV40 >12.44, 95%CI: 2.244-21.378, P=0.001) and TLG40 (HR: 4.314 for TLG40 >71.95, 95%CI: 1.503-12.381, P=0.007) were significantly associated with poor OS of NSCLC patients. However, only MTV40 (HR: 4.235, 95%CI: 1.324-13.526, P=0.015) was shown to have an independent role in the multivariate Cox analysis. Metabolic tumor volume had a superiority in predicting the prognosis of NSCLC patients compared with other metabolic and volumetric parameters, suggesting that it might be a valuable prognostic marker.


Subject(s)
Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Carcinoma, Non-Small-Cell Lung/metabolism , Carcinoma, Non-Small-Cell Lung/pathology , Fluorodeoxyglucose F18/metabolism , Glycolysis , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/metabolism , Positron Emission Tomography Computed Tomography/methods , Prognosis , Radiopharmaceuticals/metabolism , Retrospective Studies , Tumor Burden
15.
Semin Roentgenol ; 57(2): 134-138, 2022 Apr.
Article in English | MEDLINE | ID: mdl-35523526

ABSTRACT

Molecular breast imaging (MBI) is a nuclear medicine study performed with dedicated gamma camera systems optimized to image the uptake of Tc-99m sestamibi in the breast. MBI provides a relatively low-cost and simple functional breast imaging method that can identify breast cancers obscured by dense fibroglandular tissue on mammography. Recent studies have also found that background levels of uptake in benign dense tissue may provide breast cancer risk information. This article discusses the latest updates in MBI technology, recent evidence supporting its clinical use, and work in progress that may aid in wider adoption of MBI.


Subject(s)
Breast Neoplasms , Breast , Breast/diagnostic imaging , Breast Neoplasms/diagnostic imaging , Female , Gamma Cameras , Humans , Mammography/methods , Molecular Imaging/methods , Radiopharmaceuticals , Technetium Tc 99m Sestamibi
16.
BMC Cancer ; 22(1): 495, 2022 May 05.
Article in English | MEDLINE | ID: mdl-35513804

ABSTRACT

BACKGROUND: To rethink the clinical significance of standardized uptake values (SUVs) of nasopharyngeal carcinoma (NPC) on 18F-fluorodeoxyglucose (18F-FDG) positron-emission tomography (PET). METHODS: We retrospectively reviewed 369 NPC patients who underwent pretreatment 18F-FDG PET. The predictive value of the SUVmax of the primary tumor (SUVmax-t) and regional lymph nodes (SUVmax-n) was evaluated using probability density functions. Receiver operating characteristic curves were used to determine optimal cutoffs for the SUVmax-n/SUVmax-t ratio (NTR). Kaplan-Meier and Cox regression analyses were used to assess survival. RESULTS: The optimal SUVmax-t and SUVmax-n cutoffs were 7.5 and 6.9, respectively. High SUVmax-t and SUVmax-n were related to local and regional recurrence, respectively. Patients with low SUVmax had better 3-year overall survival (OS). To avoid cross-sensitization of cutoff points, we stratified patients with high SUVmax into the low and high NTR groups. The 3-year distant metastasis-free survival (DMFS; 92.3 vs. 80.6%, P = 0.009), progression-free survival (PFS; 84.0 vs. 67.7%, P = 0.011), and OS (95.9 vs. 89.2%, P = 0.002) significantly differed between the high vs. low NTR groups for patients with high SUVmax. Multivariable analysis showed that NTR was an independent prognostic factor for DMFS (hazard ratio [HR]: 2.037, 95% CI: 1.039-3.992, P = 0.038), PFS (HR: 1.636, 95% CI: 1.021-2.621, P = 0.041), and OS (HR: 2.543, 95% CI: 1.214-5.325, P = 0.013). CONCLUSION: High SUVmax was associated with NPC recurrence. NTR is a potential prognosticator for DMFS, suggesting that heterogeneity in the pretreatment 18F-FDG uptake between the primary tumor and lymph nodes is associated with high invasion and metastatic potential.


Subject(s)
Fluorodeoxyglucose F18 , Nasopharyngeal Neoplasms , Humans , Nasopharyngeal Carcinoma/diagnostic imaging , Nasopharyngeal Neoplasms/pathology , Positron Emission Tomography Computed Tomography/methods , Positron-Emission Tomography/methods , Prognosis , Radiopharmaceuticals , Retrospective Studies , Tomography, X-Ray Computed
17.
Comput Math Methods Med ; 2022: 8974859, 2022.
Article in English | MEDLINE | ID: mdl-35419077

ABSTRACT

The aim study to study the significance of pet clinical examination image technology for early gastric mucosal adenocarcinoma, improve the accuracy and accuracy of image examination results of gastric cancer, and provide important reference significance and value for early treatment. Study methods, we used the experimental method of clinical medicine to obtain some reference data through the intervention of different image examinations on experimental patients of different groups and stages, These data show that the use of PET-CT imaging can improve the one-year survival rate of patients and reduce the one-year recurrence rate. Lymphatic metastasis rate and hematogenous metastasis rate, so as to highlight the advantages of PET-CT imaging.


Subject(s)
Adenocarcinoma , Stomach Neoplasms , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Fluorodeoxyglucose F18 , Humans , Neoplasm Staging , Positron Emission Tomography Computed Tomography , Positron-Emission Tomography/methods , Radiopharmaceuticals , Retrospective Studies , Stomach Neoplasms/diagnostic imaging , Stomach Neoplasms/surgery , Tomography, X-Ray Computed/methods
18.
Am J Clin Oncol ; 45(5): 202-207, 2022 May 01.
Article in English | MEDLINE | ID: mdl-35446279

ABSTRACT

OBJECTIVE: The objective of this study was to examine tumor response with positron emission tomography (PET)/magnetic resonance imaging (MRI) during chemoradiotherapy as a predictor of outcome in patients with p16-positive oropharynx cancer. MATERIALS AND METHODS: Patients with p16-positive oropharynx cancer were treated with chemoradiotherapy. Low-risk (LR) disease was defined as T1-T3 and N0-2b and ≤10 pack-years and intermediate-risk (IR) disease as T4 or N2c-3 or >10 pack-years. Patients underwent a PET/MRI scan pretreatment and at fraction 10. Change in value of imaging means were analyzed by analysis of variance. K-means clustering with Euclidean distance functions were used for patient clustering. Silhouette width was used to determine the optimal number of clusters. Linear regression was performed on all radiographic metrics using patient and disease characteristics. RESULTS: Twenty-four patients were enrolled with 7 LR and 11 IR patients available for analysis. Pretreatment imaging characteristics between LR and IR patients were similar. Patients with LR disease exhibited a larger reduction in maximum standardized uptake value (SUV) compared with IR patients (P<0.05). Cluster analysis defined 2 cohorts that exhibited a similar intratreatment response. Cluster 1 contained 7 of 7 LR patients and 8 of 11 IR patients. Cluster 2 contained 3 of 11 IR patients. Cluster 2 exhibited significant differences compared with cluster 1 in the change in primary tumor peak SUV and largest lymph node median SUV. CONCLUSIONS: We identified that IR p16-positive oropharynx cancers exhibit heterogeneity in their PET/MRI response to chemoradiotherapy. These data support further study of intratreatment imaging response as a potential mechanism to identify patients with IR oropharynx cancer suitable for treatment deintensification.


Subject(s)
Oropharyngeal Neoplasms , Positron-Emission Tomography , Chemoradiotherapy/methods , Fluorodeoxyglucose F18 , Humans , Magnetic Resonance Imaging , Oropharyngeal Neoplasms/diagnostic imaging , Oropharyngeal Neoplasms/therapy , Positron-Emission Tomography/methods , Prospective Studies , Radiopharmaceuticals
19.
PLoS One ; 17(4): e0266704, 2022.
Article in English | MEDLINE | ID: mdl-35446848

ABSTRACT

PURPOSE: To devise a new body-habitus normalizer to be used in the calculation of an SUV that is specific to the PET tracer 18F-FDG. METHODS: A cohort of 481-patients was selected for analysis of 18F-FDG uptake into tissues unaffected by their disease. Among these, 65-patients had only brain concentrations measured and the remaining 416 were randomly divided into an 86-patient test set and a 330-patient training set. Within the test set, normal liver, spleen and blood measures were made. In the training set, only normal liver concentrations were measured. Using data from the training set, a simple polynomial function of height and weight was selected and optimized in a fitting procedure to predict each patient's mean liver %ID/ml. This function, when used as a normalizer, defines a new SUV metric (SUVfdg) which we compared to SUV metrics normalized by body weight (SUVbw), lean-body mass (SUVlbm) and body surface-area (SUVbsa) in a five-fold cross-validation. SUVfdg was also evaluated in the independent brain-only and whole-body test sets. RESULTS: For patients of all sizes including pediatric patients, the normal range of liver 18F-FDG uptake at 60 minutes post injection in units of SUVfdg is 1.0 ± 0.16. Liver, blood, and spleen SUVfdg in all comparisons had lower coefficients of variation compared to SUVbw SUVlbm and SUVbsa. Blood had a mean SUVfdg of 0.8 ± 0.11 and showed no correlation with age, height, or weight. Brain SUVfdg measures were significantly higher (P<0.01) in pediatric patients (4.7 ± 0.9) compared to adults (3.1 ± 0.6). CONCLUSION: A new SUV metric, SUVfdg, is proposed. It is hoped that SUVfdg will prove to be better at classifying tumor lesions compared to SUV metrics in current use. Other tracers may benefit from similarly tracer-specific body habitus normalizers.


Subject(s)
Fluorodeoxyglucose F18 , Neoplasms , Adult , Body Height , Body Surface Area , Child , Cohort Studies , Humans , Positron-Emission Tomography , Radiopharmaceuticals
20.
Front Endocrinol (Lausanne) ; 13: 861434, 2022.
Article in English | MEDLINE | ID: mdl-35450421

ABSTRACT

Peptide receptor radionuclide therapy (PRRT) using radiolabeled somatostatin analogs has been used for over two decades for the treatment of well-differentiated neuroendocrine tumors (NETs), and the publication of the NETTER-1 trials has further strengthened its clinical use. However, many aspects of this treatment are still under discussion. The purpose of this review is to collect and discuss the new available evidence, published in 2021, on the use of 177Lu-Oxodotreotide (DOTATATE) or 90Y-Edotreotide (DOTATOC) in adult patients with NETs focusing on the following hot topics: 1) PRRT use in new clinical settings, broaden its indications; 2) the short- and long-term safety; and 3) the identification of prognostic and predictive factors. The review suggests a possible future increase of PRRT applications, using it in other NETs, as a neoadjuvant treatment, or for rechallenge. Regarding safety, available studies, even those with long follow-up, supported the low rates of adverse events, even though 1.8% of treated patients developed a second malignancy. Finally, there is a lack of prognostic and predictive factors for PRRT, with the exception of the crucial role of nuclear imaging for both patient selection and treatment response estimation.


Subject(s)
Neuroendocrine Tumors , Adult , Humans , Neuroendocrine Tumors/pathology , Positron-Emission Tomography , Prognosis , Radionuclide Imaging , Radiopharmaceuticals/therapeutic use , Somatostatin/therapeutic use
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