Small Cell Lung Cancer Staging: Prospective Comparison of Conventional Staging Tests, FDG PET/CT, Whole-Body MRI, and Coregistered FDG PET/MRI.

BACKGROUND. Whole-body MRI and FDG PET/MRI have shown encouraging results for staging of thoracic malignancy but are poorly studied for staging of small cell lung cancer (SCLC). OBJECTIVE. The purpose of our study was to compare the performance of conventional staging tests, FDG PET/CT, whole-body MRI, and FDG PET/MRI for staging of SCLC. METHODS. This prospective study included 98 patients (64 men, 34 women; median age, 74 years) with SCLC who underwent conventional staging tests (brain MRI; neck, chest, and abdominopelvic CT; and bone scintigraphy), FDG PET/CT, and whole-body MRI within 2 weeks before treatment; coregistered FDG PET/MRI was generated. Two nuclear medicine physicians independently reviewed conventional tests and FDG PET/CT examinations in separate sessions, and two chest radiologists independently reviewed whole-body MRI and FDG PET/MRI examinations in separate sessions. Readers assessed T, N, and M categories; TNM stage; and Veterans Administration Lung Cancer Study Group (VALSG) stage. Reader pairs subsequently reached consensus. Stages determined clinically during tumor board sessions served as the reference standard. RESULTS. Accuracy for T category was higher (p < .05) for whole-body MRI (94.9%) and FDG PET/MRI (94.9%) than for FDG PET/CT (85.7%). Accuracy for N category was higher (p < .05) for whole-body MRI (84.7%), FDG PET/MRI (83.7%), and FDG PET/CT (81.6%) than for conventional staging tests (75.5%). Accuracy for M category was higher (p < .05) for whole-body MRI (94.9%), FDG PET/MRI (94.9%), and FDG PET/CT (94.9%) than for conventional staging tests (84.7%). Accuracy for TNM stage was higher (p < .05) for whole-body MRI (88.8%) and FDG PET/MRI (86.7%) than for FDG PET/CT (77.6%) and conventional staging tests (72.4%). Accuracy for VALSG stage was higher (p < .05) for whole-body MRI (95.9%), FDG PET/MRI (95.9%), and FDG PET/CT (98.0%) than for conventional staging tests (82.7%). Interobserver agreement, expressed as kappa coefficients, ranged from 0.81 to 0.94 across imaging tests and staging endpoints. CONCLUSION. FDG PET/CT, whole-body MRI, and coregistered FDG PET/MRI outperformed conventional tests for various staging endpoints in patients with SCLC. Whole-body MRI and FDG PET/MRI outperformed FDG PET/CT for T category and thus TNM stage, indicating the utility of MRI for assessing extent of local invasion in SCLC. CLINICAL IMPACT. Incorporation of either MRI approach may improve initial staging evaluation in SCLC.

Argentivorous Molecules with Chromophores in Side Arms: Silver Ion-Induced Turn On and Turn Off of Fluorescence.

The synthesis of argentivorous molecules (L1 and L2) having two chromophores (4-(anthracen-9-yl)benzyl or 4-(pyren-1-yl)benzyl groups) and two benzyl groups and the fluorescence properties of their silver complexes in a solution and the solid state are reported. A crystallographic approach for the Ag+ complexes with L1 and L2 revealed that the observed fluorescence changes stem from the excimer formation and extinction of fluorescent. Furthermore, binding stabilities of L1 and L2 toward Ag+ ions were estimated by the Ag+-induced UV-vis and PL spectral changes.

(89)Sr bremsstrahlung single photon emission computed tomography using a gamma camera for bone metastases.

OBJECTIVE: Strontium-89 chloride ((89)Sr) bremsstrahlung single photon emission computed tomography (SPECT) imaging was evaluated for detecting more detailed whole body (89)Sr distribution. METHODS: (89)Sr bremsstrahlung whole body planar and merged SPECT images were acquired using two-detector SPECT system. Energy window A (100 keV ± 50 %) for planar imaging and energy window A plus adjacent energy window B (300 keV ± 50 %) for SPECT imaging were set on the continuous spectrum. Thirteen patients with multiple bone metastases were evaluated. Bone metastases can be detected with (99m)Tc-HMDP whole body planar and merged SPECT images and compared with (89)Sr bremsstrahlung whole body planar and merged SPECT images. Based on the location of metastatic lesions seen as hot spots on (99m)Tc-HMDP images as a reference, the hot spots on (89)Sr bremsstrahlung images were divided into the same bone parts as (99m)Tc-HMDP images (a total of 35 parts in the whole body), and the number of hot spots were counted. We also evaluated the incidence of extra-osseous uptakes in the intestine on (89)Sr bremsstrahlung whole body planar images. RESULTS: A total of 195 bone metastatic lesions were detected in both (99m)Tc-HMDP whole body planar and merged SPECT images. Detection of hot spot lesions in (89)Sr merged SPECT images (127 of 195; 66 %) was more frequent than in (89)Sr whole body planar images (108 of 195; 56 %), based on metastatic bone lesions in (99m)Tc-HMDP whole body planar and merged SPECT images. A large intestinal (89)Sr accumulation was detected in 5 of the 13 patients (38 %). CONCLUSIONS: (89)Sr bremsstrahlung-merged SPECT imaging could be more useful for detailed detection of whole body (89)Sr distribution than planar imaging. Intestinal (89)Sr accumulation due to (89)Sr physiologic excretion was detected in feces for 4 days after tracer injection.

[A trial of 89Sr bremsstrahlung SPECT].

OBJECTIVE: 89Sr bremsstrahlung SPECT imaging has been evaluated for detecting the more detailed whole body 89Sr distribution. METHODS: 89Sr bremsstrahlung whole body planar and merged SPECT images were acquired by using two detectors type SPECT system. Energy window A (100 keV +/- 50%) for planar imaging, and energy window A plus adjacent energy window B (300 keV +/- 50%) for SPECT imaging were set on the continuous spectrum. Those images were compared with 99mTc-H-MDP whole body planar and merged SPECT images. To verify the accumulation obtained by bremsstrahlung whole body planar and merged SPECT image, we made original phantom based on the counts of clinical study imaging. RESULTS: On 89Sr bremsstrahlung merged SPECT image, focal accumulations were recognized in the parts of 99mTc-H-MDP merged SPECT accumulation. Focal accumulations were much clearer on 89Sr bremsstrahlung merged SPECT imaging than those of whole body planar image of 89Sr bremsstrahlung. In phantom study, counts of each concentration linearly increase as acquisition time and number of rotation increase on planar and SPECT images. CONCLUSIONS: 89Sr bremsstrahlung merged SPECT imaging would be useful for detecting the more detailed whole body 89Sr distribution.