Efficacy and safety of selective internal radiation therapy with yttrium-90 for the treatment of unresectable hepatocellular carcinoma.

BACKGROUND: This retrospective analysis was undertaken to evaluate the efficiency of SIRT with Y-90 microspheres and determined prognostic factors affecting patients with unresectable HCC. METHODS: A total of 97 patients diagnosed with unresectable HCC who underwent SIRT with Y-90 microspheres. Patient survival was assessed using the Kaplan-Meier method, and prognostic factors affecting survival were assessed using log-rank tests and Cox proportional hazards regression. RESULTS: Among the 97 patients (90 males, mean age 60.4 ± 12.3 years) who underwent SIRT, the median clinical follow-up was 16.4 (1.8-62) months. The median overall survival (OS) was 23.9 ± 2.4 months. Tumor response according to the Modified RECIST in patients followed up beyond 6 months included a complete response (CR) to treatment in 12 patients (18.8%), partial response (PR) in 23 (35.8%), stable disease (SD) in 8 (12.5%), and progressive disease (PD) in 21 (32.8%). Factors associated with longer OS included age > 65 years, BCLC stage B, tumor size < 5 cm, tumor burden < 25%, and tumor response (CR/PR). In multivariate analysis, unilobar disease and objective tumor response (CR/PR) were predictors of longer OS. CONCLUSION: SIRT was an effective treatment for unresectable HCC. Unilobar disease before SIRT and tumor response (CR/PR) were positive prognostic factors.

The Prognostic Value of Sequential 18 F-FDG PET/CT Metabolic Parameters in Outcomes of Upper-Third Esophageal Squamous Cell Carcinoma Patients Treated with Definitive Chemoradiotherapy.

Objective The aim of this study is to determine prognostic values of sequential 18 F-FDG PET/CT metabolic parameters in locally advanced esophageal squamous cell carcinoma (ESCC) patients treated with definitive chemoradiotherapy. Materials and Methods Forty locally advanced ESCC patients treated with definitive chemoradiotherapy (dCRT) who received pre-treatment 18 F-FDG PET/CT (PET1) and 3-months post-treatment 18 F-FDG PET/CT (PET2) were enrolled in the prospective study. 18 F-FDG PET parameters of the primary tumor including maximum and mean standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated on PET delineated primary tumor. Using Kaplan-Meier curves to estimated overall survival (OS), progression-free survival (PFS), and local-regional control (LRC). Cox regression analysis was performed to find significant prognostic factors for survival. Results With a median follow-up of 13.5 months, the 4-year OS, PFS, and LRC rates were 67.3%, 52.6%, and 53.4% respectively. Patients with MTV 2 > 5.7 had lower OS, PFS, and LRC rates than the lower MTV 2 group (p < 0.05). Univariate Cox regression analysis showed that MTV2 was a significant prognostic factor for OS, PFS, and LRC (p < 0.05). Conclusion MTV parameter of sequential 18 F-FDG PET/CT could be used as a prognostic factor for OS, PFS, and LRC in locally advanced ESCC patients treated with dCRT.

Screening and treatment of brain metastasis from papillary thyroid carcinoma: a case series.

BACKGROUND: The brain metastasis from differentiated thyroid carcinoma (DTC) is a rare condition and its prognosis is poor. The standard protocol for screening and treatment of patients with brain metastases from papillary thyroid cancer (PTC) remains controversial. This report aims to share the experience of a single center in the management of brain metastases from DTC. MATERIAL AND METHODS: Five patients with brain metastases were identified from 5000 patients with DTC attending the department of nuclear medicine, Hospital 108 between 2016 to 2022. The statistical software Statistical Package for Social Sciences (SPSS) 20.0 (SPSS Inc., Chicago, IL, USA) was used to analyze the data. RESULTS: Five patients with brain metastases from DTC were revealed by MRI, 18F-FDG PET/CT with contrast enhancement, and 131I-SPECT/CT. The median time of overall survival (OS) was 15 months, ranging from 10 to 65 months. Two out of the five patients underwent surgery, and futher 2 patients were treated with stereotactic surgery (SRS). All patients are still alive. CONCLUSIONS: Brain metastases from DTC are rare. MRI is the preferred imaging mobility to screen brain lesions in DTC. The primary treatment modalities are surgery and SRS.

Prognostic Role of Diastolic Left Ventricular Mechanical Dyssynchrony by Gated Single Photon Emission Computed Tomography Myocardial Perfusion Imaging in Post-Myocardial Infarction.

Objective This study is aimed to assess the prognostic value of diastolic left ventricular mechanical dyssynchrony (LVMD) measured by gated-single photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI) in post-myocardial infarction (MI). Subjects and Methods The study was conducted on 106 post-MI from January 2015 to January 2019. First, the indices of diastolic LVMD phase standard deviation (PSD) and histogram bandwidth (HBW) of post-MI were measured using the Cardiac Emory Toolbox. Subsequently, the post-MI patients were followed up, and the primary endpoint was major adverse cardiac events (MACEs). Finally, the prognostic value of dyssynchrony parameters for MACE was analyzed by the receiver-operating characteristics curve and survival analyses. Results With the cut-off values of 55.5 degrees of PSD, the sensitivity and specificity in prediction of MACE were 75% and 80.8%, with the cut-off values of 174.5 degrees of HBW, the sensitivity and specificity were 75% and 83.3% respectively. There was a significant difference of time to MACE between groups of PSD less than 55.5 degrees and more than 55.5 degrees. PSD, HBW, and left ventricle ejection fraction (LVEF) assessed on GSPECT were significant factors in the prediction of MACE. Conclusion Diastolic LVMD parameters of PSD and HBW derived from GSPECT are significant prognostic factors in predicting MACE in post-MI patients.

PSMA-based 18F-DCFPyL PET: a better choice than multiparametric MRI for prostate cancer diagnosis?

Owing to the high tissue contrast, multiparametric MRI (mpMRI) has already been the most widely applied imaging method for prostate cancer. Recently, prostate-specific membrane antigen (PSMA) ligands for nuclear imaging are emerging as a promising modality in prostate cancer, especially since the 2 PET/CT agents (68Ga-PSMA-11 and 18F-DCFPy) approved by U.S. Food and Drug Administration (FDA). However, limited studies have performed the comparison of mpMRI versus recently approved 18F-DCFPyL PET/CT. In this issue of AJNMMI, Lu et al. compared the performance of 18F-DCFPyL PET/CT and pelvic mpMRI in intermediate-high risk and biochemical recurrent prostate cancer patients. The results demonstrated the two modalities have a good concordance rate for patient-based analysis, and 18F-DCFPyL PET/CT has a better diagnostic performance in detecting lymph node metastases and bone metastases for lesion-based analysis. The use of 18F-DCFPyL PET/CT provides more diagnostic confidence to better assess prostate cancer lesions.

Pretreatment 18F-FDG PET/CT-Derived Parameters in Predicting Clinical Outcomes of Locally Advanced Upper Third Esophageal Squamous Cell Carcinoma After Definitive Chemoradiation Therapy.

Purpose: The aim of this study was to investigate whether standard uptake values (SUVs) of pretreatment 18F-FDG PET/CT were the surrogate parameters for predicting the outcomes in locally advanced esophageal squamous cell carcinoma patients treated with definitive chemoradiotherapy. Materials and Methods: Sixty patients with esophageal squamous cell carcinoma underwent pretreatment 18F-FDG PET/CT and received definitive chemoradiotherapy. 18F-FDG metabolic parameters including SUVmax, SUVmean, SULpeak, total lesion glycolysis (TLG), and metabolic tumor volume (MTV) of primary tumor were calculated. The receiver-operating characteristic (ROC) curve was used to determine the optimal cutoff value of FDG PET/CT-derived parameters that associated with treatment response. Estimating progression-free survival (PFS) and overall survival (OS) was analyzed by using Kaplan-Meier methods. Univariate and multivariate analysis for PFS and OS was performed using Cox regression. Results: Complete response was achieved in 38.3%. The 4-year OS and PFS rates were 48.6% and 44.4%, respectively. SUVmean with a cutoff value of 6.1 could predict complete response with sensitivity of 69.6%, specificity of 78.4%, and accuracy of 75%. Cox multi-factor regression analyses revealed SUVmean > 6.1 as an independent prognostic factor for OS (HR = 6.74, p = 0.02) and PFS (HR = 6.53, p < 0.001). Conclusions: Our study suggests that SUVmean of the primary tumor in pretreatment 18F-FDG PET/CT may be used as an independent predictor in esophageal squamous cell carcinoma patients treated with definitive chemoradiotherapy.

Relationship between clinicopathologic factors and FDG avidity in radioiodine-negative recurrent or metastatic differentiated thyroid carcinoma.

BACKGROUND: In this study, we investigated the relationship between clinicopathologic factors, BRAFV600E mutation status and [18F] F-fluoro-2-deoxyglucose (FDG) avidity in patients with radioiodine (RAI)-negative recurrent or metastatic differentiated thyroid cancer (DTC). METHODS: From 2015 to 2018 all patients with suspected recurrent or metastatic radioiodine-negative DTC patients who underwent FDG positron emission tomography/computed tomography (PET/CT) were retrospectively reviewed. Suspected lesions on FDG PET/CT were biopsied and underwent BRAFV600E mutation testing by immunohistochemistry and real-time PCR. Tumor size, recurrent versus metastatic disease, histopathologic features including classical type versus aggressive subtypes (poorly differentiated, tall cell, columnar cell, hobnail variants) and BRAFV600E mutation status were correlated with the SUVmax of highest hypermetabolic lesions on FDG PET/CT by the univariate analysis using logistic regression. RESULTS: Sixty-three consecutive patients, 55 (87.3%) female, with median age of 48 (range 17-81) were included. The majority of patients had BRAFV600E mutation and classical subtype, 55/63 (87.3%) and 45/63(71.4%), respectively. Thyroglobulin at the time of suspected recurrence was 262.7 ng/ml (range 16.3-1000) and patients received a median 3 prior RAI treatments. Fifty-four patients (85.7%) had local recurrence. The majority of patients 58/63 (92.1%) had FDG-avid disease on PET/CT. On univariate analysis, tumor size aggressive histopathologic types and distant metastasis are the significant factors for predicting FDG uptake, p = 0.04, p = 0.001 and p = 0.004 respectively. Although FDG uptake of BRAFV600E bearing recurrent/metastatic RAIR DTC lesions was higher than those without the mutation, the difference did not reach statistical significance, SUVmax of 7.11 versus 4.91, respectively, p = 0.2. CONCLUSION: The majority of recurrent or metastatic RAI-negative DTC have BRAFV600E mutation and detectable disease on FDG PET/CT. FDG avidity of the recurrent or metastatic RAI-negative DTC is independently associated with the aggressive histopathologic features.

Diagnostic and prognostic value of 99mTc-MAA SPECT/CT for treatment planning of 90Y-resin microsphere radioembolization for hepatocellular carcinoma: comparison with planar image.

99mTc-macroaggregated albumin (MAA) imaging is performed before transarterial radioembolization (TARE), in which SPECT/CT is presumed more precise than planar image. However, additive role of SPECT/CT has not been well established. Thirty-four consecutive hepatocellular carcinoma patients of intermediate and advanced stages who underwent 90Y-microsphere TARE were recruited. On pre-treatment planning scan using 99mTc-MAA, image characteristics and absorbed dose for target tumors calculated by partition model methods were estimated on planar image and SPECT/CT, respectively. The measurements were repeated on post-treatment 90Y PET/CT, as the reference standard. Treatment response was assessed and predictive values of image parameters were analyzed. The image characteristics including heterogeneity, necrosis and thrombosis uptake were better delineated on SPECT/CT than planar scan. The agreement and correlation of TNr between SPECT/CT and PET/CT were stronger than those between planar scan and PET/CT. Tumor dose estimated on 99mTc-MAA SPECT/CT was more effective than planar image for prediction of treatment response, with cutoff value 125 Gy (sensitivity of 86% and specificity of 75%). In conclusion, 99mTc-MAA SPECT/CT is more closely correlated with post-treatment 90Y PET/CT, and is more effective for predicting treatment response than planar scan. SPECT/CT is superior to planar image in simulation before 90Y TARE.

Value of Dedicated Head and Neck 18F-FDG PET/CT Protocol in Detecting Recurrent and Metastatic Lesions in Post-surgical Differentiated Thyroid Carcinoma Patients with High Serum Thyroglobulin Level and Negative 131I Whole-body Scan.

OBJECTIVES: In clinical practice, approximately 10-25% of post-surgical differentiated thyroid carcinoma (DTC) patients with high serum thyroglobulin (Tg) and negative 131I whole-body scan (WBS) have poor prognosis due to recurrent or metastatic lesions after radioactive iodine treatment. The purpose of this study was to evaluate the value of 18F-FDG PET/CT scan in DTC patients with high serum Tg level and negative 131I WBS. METHODS: 69 post-surgical DTC patients with high serum Tg level and negative post ablation 131I WBS were enrolled in this study. All DTC patients underwent head and neck ultrasound, CT scan and whole-body 18F-FDG PET/CT, based on the dedicated head and neck protocol. RESULTS: Overall, 92 lesions were detected in 43 (62.3%) out of 69 patients with positive 18F-FDG PET/CT scan, compared to only 39 lesions detected on CT scan in 26 (37.7%) out of 69 patients. The sensitivity, accuracy and negative predictive value of 18F-FDG PET/CT were 88%, 87% % and 76%, respectively, which were significantly higher than those of CT scan (67.2%, 54.3% and 48.8%, respectively) (P<0.01). Specificity and positive predictive value of 18F-FDG PET/CT (90.5% and 95.2%, respectively) were similar to those of CT scan (95.2% and 96.2%, respectively) (P>0.05). The maximum standardized uptake value (SUVmax) threshold was 4.5 with a good diagnostic value (sensitivity of 92.3% and specificity of 100%). The dedicated head and neck 18F-FDG PET/CT protocol altered the treatment plan in 33 (47.8%) out of 69 DTC patients with high serum Tg level and negative 131I WBS. CONCLUSION: Dedicated head and neck 18F-FDG PET/CT protocol showed a higher diagnostic value, compared to CT scan and played an important role in detecting recurrent or metastatic lesions in post-surgical DTC patients with high serum Tg level and negative 131I WBS.