101
|
Rogasch JMM, Steffen IG, Riedel S, Apostolova I, Wertzel H, Achenbach HJ, Steinkrüger FLGA, Kalinski T, Schultz M, Schreiber J, Amthauer H, Furth C. Dual time point imaging for F18-FDG-PET/CT does not improve the accuracy of nodal staging in non-small cell lung cancer patients. Eur Radiol 2015; 26:2808-18. [DOI: 10.1007/s00330-015-4093-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/12/2015] [Accepted: 10/27/2015] [Indexed: 11/30/2022]
|
102
|
Apostolova I, Derlin T, Salamon J, Amthauer H, Granström S, Brenner W, Mautner VF, Buchert R. Cerebral glucose metabolism in adults with neurofibromatosis type 1. Brain Res 2015; 1625:97-101. [PMID: 26335059 DOI: 10.1016/j.brainres.2015.08.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/17/2015] [Accepted: 08/21/2015] [Indexed: 11/26/2022]
Abstract
Previous studies with positron emission tomography (PET) and the glucose analog F-18-fluorodeoxyglucose (FDG) in patients with neurofibromatosis type 1 (NF1) suggest reduced cerebral glucose metabolism in NF1 specifically in the thalamus. The latter is distinguished by extensive neural circuitry connections which makes thalamic hypoactivity in NF1 an interesting finding. Yet it is not very well confirmed, since previous studies were limited by small sample size and/or poorly matched control groups. Primary aim of the present study therefore was to compare brain FDG PET between a large sample of NF1 patients and a well-matched control group. Secondary aim was to test for an NF1-associated FDG effect in the amygdala, as increased blood flow in the amygdala has recently been detected in a mouse model of NF1. Fifty adult NF1 patients and 50 gender- and age-matched control subjects were included retrospectively. Voxel-wise comparison of brain FDG uptake was performed using the statistical parametric mapping (SPM8). Additional region-of-interest (ROI) analysis was performed using standard ROI templates. Voxel-based testing revealed a single 11.2 ml cluster of reduced FDG uptake in the thalamus of NF1 patients. There was no further significant cluster throughout the whole brain including the amygdala, neither hypo nor hyper. ROI-analysis confirmed reduction of thalamic FDG uptake in the NF1 group (p<0.0005) with a magnitude of 7.6%. In conclusion, adults with NF1 show reduced brain activity specifically in thalamus. There is no indication of abnormal brain activity in the amygdala in humans with NF1.
Collapse
Affiliation(s)
- Ivayla Apostolova
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany.
| | - Thorsten Derlin
- Department of Nuclear Medicine, Medical University Hannover, Hannover, Germany
| | - Johannes Salamon
- Department of Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Amthauer
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Sofia Granström
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, University Medicine Charité Berlin, Berlin, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Buchert
- Department of Nuclear Medicine, University Medicine Charité Berlin, Berlin, Germany
| |
Collapse
|
103
|
Grosser OS, Ulrich G, Furth C, Pech M, Ricke J, Amthauer H, Ruf J. Intrahepatic Activity Distribution in Radioembolization with Yttrium-90–Labeled Resin Microspheres Using the Body Surface Area Method—A Less than Perfect Model. J Vasc Interv Radiol 2015; 26:1615-21. [DOI: 10.1016/j.jvir.2015.07.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 06/05/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022] Open
|
104
|
Grosser OS, Kupitz D, Ruf J, Czuczwara D, Steffen IG, Furth C, Thormann M, Loewenthal D, Ricke J, Amthauer H. Optimization of SPECT-CT Hybrid Imaging Using Iterative Image Reconstruction for Low-Dose CT: A Phantom Study. PLoS One 2015; 10:e0138658. [PMID: 26390216 PMCID: PMC4577107 DOI: 10.1371/journal.pone.0138658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 09/01/2015] [Indexed: 11/29/2022] Open
Abstract
Background Hybrid imaging combines nuclear medicine imaging such as single photon emission computed tomography (SPECT) or positron emission tomography (PET) with computed tomography (CT). Through this hybrid design, scanned patients accumulate radiation exposure from both applications. Imaging modalities have been the subject of long-term optimization efforts, focusing on diagnostic applications. It was the aim of this study to investigate the influence of an iterative CT image reconstruction algorithm (ASIR) on the image quality of the low-dose CT images. Methodology/Principal Findings Examinations were performed with a SPECT-CT scanner with standardized CT and SPECT-phantom geometries and CT protocols with systematically reduced X-ray tube currents. Analyses included image quality with respect to photon flux. Results were compared to the standard FBP reconstructed images. The general impact of the CT-based attenuation maps used during SPECT reconstruction was examined for two SPECT phantoms. Using ASIR for image reconstructions, image noise was reduced compared to FBP reconstructions for the same X-ray tube current. The Hounsfield unit (HU) values reconstructed by ASIR were correlated to the FBP HU values(R2 ≥ 0.88) and the contrast-to-noise ratio (CNR) was improved by ASIR. However, for a phantom with increased attenuation, the HU values shifted for low X-ray tube currents I ≤ 60 mA (p ≤ 0.04). In addition, the shift of the HU values was observed within the attenuation corrected SPECT images for very low X-ray tube currents (I ≤ 20 mA, p ≤ 0.001). Conclusion/Significance In general, the decrease in X-ray tube current up to 30 mA in combination with ASIR led to a reduction of CT-related radiation exposure without a significant decrease in image quality.
Collapse
Affiliation(s)
- Oliver S. Grosser
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
- * E-mail:
| | - Dennis Kupitz
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Juri Ruf
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Damian Czuczwara
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Ingo G. Steffen
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Christian Furth
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Markus Thormann
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - David Loewenthal
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Jens Ricke
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Holger Amthauer
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| |
Collapse
|
105
|
Apostolova I, Niedzielska D, Derlin T, Koziolek EJ, Amthauer H, Salmen B, Pahnke J, Brenner W, Mautner VF, Buchert R. Perfusion single photon emission computed tomography in a mouse model of neurofibromatosis type 1: towards a biomarker of neurologic deficits. J Cereb Blood Flow Metab 2015; 35:1304-12. [PMID: 25785829 PMCID: PMC4528004 DOI: 10.1038/jcbfm.2015.43] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/21/2015] [Accepted: 02/16/2015] [Indexed: 12/16/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a single-gene disorder affecting neurologic function in humans. The NF1+/- mouse model with germline mutation of the NF1 gene presents with deficits in learning, attention, and motor coordination, very similar to NF1 patients. The present study performed brain perfusion single-photon emission computed tomography (SPECT) in NF1+/- mice to identify possible perfusion differences as surrogate marker for altered cerebral activity in NF1. Cerebral perfusion was measured with hexamethyl-propyleneamine oxime (HMPAO) SPECT in NF1+/- mice and their wild-type littermates longitudinally at juvenile age and at young adulthood. Histology and immunohistochemistry were performed to test for structural changes. There was increased HMPAO uptake in NF1 mice in the amygdala at juvenile age, which reduced to normal levels at young adulthood. There was no genotype effect on thalamic HMPAO uptake, which was confirmed by ex vivo measurements of F-18-fluorodeoxyglucose uptake in the thalamus. Morphologic analyses showed no major structural abnormalities. However, there was some evidence of increased density of microglial somata in the amygdala of NF1-deficient mice. In conclusion, there is evidence of increased perfusion and increased density of microglia in juvenile NF1 mice specifically in the amygdala, both of which might be associated with altered synaptic plasticity and, therefore, with cognitive deficits in NF1.
Collapse
Affiliation(s)
- Ivayla Apostolova
- 1] Department of Nuclear Medicine, University Medicine Charité Berlin, Berlin, Germany [2] Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Dagmara Niedzielska
- Department of Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Eva J Koziolek
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Amthauer
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Benedikt Salmen
- Neuroscience Research Center, University Medicine Charité Berlin, Berlin, Germany
| | - Jens Pahnke
- 1] Department of Neuropathology, Oslo University Hospital (OUS), University of Oslo (UiO), Oslo, Norway [2] LIED, University of Lübeck, Lübeck, Germany [3] Leibniz Institute of Plant Biochemistry, Halle, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, University Medicine Charité Berlin, Berlin, Germany
| | - Victor F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Buchert
- Department of Nuclear Medicine, University Medicine Charité Berlin, Berlin, Germany
| |
Collapse
|
106
|
Seidensticker M, Garlipp B, Scholz S, Mohnike K, Popp F, Steffen I, Seidensticker R, Stübs P, Pech M, PowerskI M, Hass P, Costa SD, Amthauer H, Bruns C, Ricke J. Locally ablative treatment of breast cancer liver metastases: identification of factors influencing survival (the Mammary Cancer Microtherapy and Interventional Approaches (MAMMA MIA) study). BMC Cancer 2015; 15:517. [PMID: 26169362 PMCID: PMC4501116 DOI: 10.1186/s12885-015-1499-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 06/18/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Liver metastases from breast cancer (LMBC) are typically considered to indicate systemic disease spread and patients are most often offered systemic palliative treatment only. However, retrospective studies suggest that some patients may have improved survival with local treatment of their liver metastases compared to systemic therapy alone. In the absence of randomized trials, it is important to identify patient characteristics indicating that benefit from local treatment can be expected. METHODS 59 patients undergoing radiofrequency ablation (RFA), interstitial brachytherapy (BT), or radioembolization (RE) of LMBC as a salvage treatment were studied. Potential factors influencing survival were analyzed in a multivariate Cox model. For factors identified to have an independent survival impact, Kaplan-Meier analysis and comparison of overall survival (OS) using the log-rank test was performed. RESULTS Median OS following local interventional treatment was 21.9 months. Considering only factors evaluable at treatment initiation, maximum diameter of liver metastases (≥3.9 cm; HR: 3.1), liver volume (≥ 1376 mL; HR: 2.3), and history of prior chemotherapy (≥ 3 lines of treatment; HR: 2.5-2.6) showed an independent survival impact. When follow-up data were included in the analysis, significant factors were maximum diameter of liver metastases (≥ 3.9 cm; HR: 3.1), control of LMBC during follow-up (HR: 0.29), and objective response as best overall response (HR: 0.21). Neither the presence of any extrahepatic metastases nor presence of bone metastases only had a significant survival impact. Median OS was 38.7 vs. 16.1 months in patients with metastases < vs. ≥ 3.9 cm, 36.6 vs. 10.2 months for patients having objective response vs. stable/progressive disease, and 38.5 vs. 14.2 months for patients having controlled vs. non-controlled disease at follow-up. CONCLUSION Local control of LMBC confers a survival benefit and local interventional treatment for LMBC should be studied in a randomized trial. Patients with small metastases and limited history of systemic LMBC treatment are most likely to benefit from local approaches. Limited extrahepatic disease should not lead to exclusion from a randomized study and should not be a contraindication for local LMBC treatment as long as no randomized data are available.
Collapse
Affiliation(s)
- Max Seidensticker
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
| | - Benjamin Garlipp
- Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany.
| | - Sophia Scholz
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - Konrad Mohnike
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
| | - Felix Popp
- Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany.
| | - Ingo Steffen
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - Ricarda Seidensticker
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
| | - Patrick Stübs
- Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany.
| | - Maciej Pech
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany. .,Second Department of Radiology, Medical University of Gdansk, Gdansk, Poland.
| | - Maciej PowerskI
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - Peter Hass
- Institut für Strahlentherapie, Universitätsklinik Magdeburg, Magdeburg, Germany.
| | - Serban-Dan Costa
- Universitätsklinik Magdeburg, Universitätsfrauenklinik, Magdeburg, Germany.
| | - Holger Amthauer
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
| | - Christiane Bruns
- International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany. .,Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany.
| | - Jens Ricke
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
| |
Collapse
|
107
|
Dobrindt O, Amthauer H, Krueger A, Ruf J, Wissel H, Grosser OS, Seidensticker M, Lohmann CH. Hybrid SPECT/CT for the assessment of a painful hip after uncemented total hip arthroplasty. BMC Med Imaging 2015; 15:18. [PMID: 26033371 PMCID: PMC4459070 DOI: 10.1186/s12880-015-0056-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 04/22/2015] [Indexed: 12/03/2022] Open
Abstract
Background The diagnosis of hip pain after total hip replacement (THR) represents a highly challenging question that is of increasing concern to orthopedic surgeons. This retrospective study assesses bone scintigraphy with Hybrid SPECT/CT for the diagnosis of painful THR in a selected cohort of patients. Methods Bone SPECT/CT datasets of 23 patients (mean age 68.9 years) with a painful hip after THR were evaluated. Selection of the patients required an inconclusive radiograph, normal serum levels of inflammatory parameters (CRP and ESR) or a negative aspiration of the hip joint prior to the examination. The standard of reference was established by an interdisciplinary adjudication-panel using all imaging data and clinical follow-up data (>12 month). Pathological and physiological uptake patterns were defined and applied. Results The cause of pain in this study group could be determined in 18 out of 23 cases. Reasons were aseptic loosening (n = 5), spine-related (n = 5), heterotopic ossification (n = 5), neuronal (n = 1), septic loosening (n = 1) and periprosthetic stress fracture (n = 1). In (n = 5) cases the cause of hip pain could not be identified. SPECT/CT imaging correctly identified the cause of pain in (n = 13) cases, in which the integrated CT-information led to the correct diagnosis in (n = 4) cases, mainly through superior anatomic correlation. Loosening was correctly assessed in all cases with a definite diagnosis. Conclusions SPECT/CT of THA reliably detects or rules out loosening and provides valuable information about heterotopic ossifications. Furthermore differential diagnoses may be detected with a whole-body scan and mechanical or osseous failure is covered by CT-imaging. SPECT/CT holds great potential for imaging-based assessment of painful prostheses.
Collapse
Affiliation(s)
- Oliver Dobrindt
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany. .,Charité - Universitätsmedizin, Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charitéplatz 1, 10117, Berlin, Germany.
| | - Holger Amthauer
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
| | - Alexander Krueger
- Orthopädische Universitätsklinik, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
| | - Juri Ruf
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany. .,Universitätsklinikum Freiburg, Klinik für Nuklearmedizin, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Heiko Wissel
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
| | - Oliver S Grosser
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
| | - Max Seidensticker
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
| | - Christoph H Lohmann
- Orthopädische Universitätsklinik, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
| |
Collapse
|
108
|
Rogasch JM, Steffen IG, Hofheinz F, Großer OS, Furth C, Mohnike K, Hass P, Walke M, Apostolova I, Amthauer H. The association of tumor-to-background ratios and SUVmax deviations related to point spread function and time-of-flight F18-FDG-PET/CT reconstruction in colorectal liver metastases. EJNMMI Res 2015; 5:31. [PMID: 25992306 PMCID: PMC4427576 DOI: 10.1186/s13550-015-0111-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/22/2015] [Indexed: 01/11/2023] Open
Abstract
Background The maximum standardized uptake value (SUVmax) is a common clinical parameter for quantification in F18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), but it is influenced by image reconstruction. The aim of this study was to analyze the association of SUVmax deviations related to point spread function (PSF) and time-of-flight (TOF) reconstruction with tumor-to-background ratios (TBR) in colorectal liver metastases (CRLM). Methods Fifteen patients (f, 6; m, 9; median age, 59 years; range, 32 to 72 years) with 28 liver metastases were included retrospectively. FDG-PET/CT imaging (median activity, 237 MBq; range, 231 to 252 MBq; median uptake, 61 min; range, 55 to 67 min) was performed on a Siemens Biograph mCT 64 followed by image reconstruction using 3D-ordered subset expectation maximization (3D-OSEM) or 3D-OSEM with PSF modeling - both with and without TOF information. Differences in SUVmax were analyzed using the Friedman test and Wilcoxon test for paired non-parametric data. The correlation of inter-method differences with the lesions’ TBR was studied using Spearman’s rank correlation coefficient (rho). Differences between lesions with low (<4.8) and high (>4.8) TBR were analyzed using the Mann-Whitney U test (TBR measured with 3D-OSEM; binarized by its median). Results There was a significant correlation of the lesions’ TBR with relative SUVmax differences related to PSF (PSF + TOF vs. 3D-OSEM + TOF, rho = 0.61; PSF vs. 3D-OSEM, rho = 0.52) or TOF (PSF + TOF vs. PSF, rho = −0.58; 3D-OSEM + TOF vs. 3D-OSEM, rho = −0.61). Accordingly, PSF algorithms only showed higher SUVmax than non-PSF algorithms in lesions with a high TBR (median differences at low/high TBR, +2.6%/+9.1% [PSF + TOF vs. 3D-OSEM + TOF]; +0.7%/+6.4% [PSF vs. 3D-OSEM]). TOF integration also led to higher SUVmax but mainly at low TBR (low/high TBR, +10.4%/+1.8% [PSF + TOF vs. PSF]; +8.6%/−0.1% [3D-OSEM + TOF vs. 3D-OSEM]). Conclusions Both PSF and TOF reconstruction resulted in a substantial alteration of SUVmax in CRLM. TOF provided the highest SUVmax increase in low-contrast lesions while - vice versa - PSF showed the most relevant increase in high-contrast lesions. Thus, one should be aware that quantitative analyses of lesions with varying TBR, e.g., in radiotherapy or follow-up studies, may be mainly affected by either PSF or TOF reconstruction, respectively.
Collapse
Affiliation(s)
- Julian Mm Rogasch
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120 Germany
| | - Ingo G Steffen
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120 Germany
| | - Frank Hofheinz
- Helmholtz-Zentrum Dresden-Rossendorf, PET Center, Institute of Radiopharmaceutical Cancer Research, Bautzner Landstraße 400, Dresden, 01328 Germany
| | - Oliver S Großer
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120 Germany
| | - Christian Furth
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120 Germany
| | - Konrad Mohnike
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120 Germany
| | - Peter Hass
- Klinik für Strahlentherapie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120 Germany
| | - Mathias Walke
- Klinik für Strahlentherapie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120 Germany
| | - Ivayla Apostolova
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120 Germany
| | - Holger Amthauer
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120 Germany
| |
Collapse
|
109
|
Rothe JH, Rudolph I, Rohwer N, Kupitz D, Gregor-Mamoudou B, Derlin T, Furth C, Amthauer H, Brenner W, Buchert R, Cramer T, Apostolova I. Time course of contrast enhancement by micro-CT with dedicated contrast agents in normal mice and mice with hepatocellular carcinoma: comparison of one iodinated and two nanoparticle-based agents. Acad Radiol 2015; 22:169-78. [PMID: 25282584 DOI: 10.1016/j.acra.2014.07.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/27/2014] [Accepted: 07/28/2014] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of the present study was to characterize the kinetics of two nanoparticle-based contrast agents for preclinical imaging, Exitron nano 6000 and Exitron nano 12000, and the iodinated agent eXIA 160 in both healthy mice and in a mouse model of hepatocellular carcinoma (HCC). Semiautomatic segmentation of liver lesions for estimation of total tumor load of the liver was evaluated in HCC mice. MATERIALS AND METHODS The normal time course of contrast enhancement was assessed in 15 healthy C57BL/6 mice. Imaging of tumor spread in the liver was evaluated in 15 mice harboring a transgenic HCC model (ASV-B mice). Automatic segmentation of liver lesions for determination of total tumor burden of the liver was tested in three additional ASV-B mice before and after an experimental therapy. RESULTS In healthy mice, clearance of the contrast agent from blood was completed within 3-4 hours for eXIA 160 and Exitron nano 6000, whereas complete blood clearance of Exitron nano 12000 required about 24 hours. eXIA 160 provided maximum liver contrast at 1 hour post injection (p.i.) followed by a continuous decline. Enhancement of liver contrast with Exitron nano 6000 and Exitron nano 12000 reached a plateau at about 4 hours p.i., which lasted until the end of the measurements at 96 hours p.i. Maximum contrast enhancement of the liver was not statistically different between Exitron nano 6000 and Exitron nano 12000, but was about three times lower for eXIA 160 (P < .05). Visually Exitron nano 12000 provided the best liver-to-tumor contrast. Semiautomatic liver and tumor segmentation was feasible after the administration of Exitron nano 12000 but did not work properly for the other two contrast agents. CONCLUSIONS Both nanoparticle-based contrast agents provided stronger and longer lasting contrast enhancement of healthy liver parenchyma. Exitron nano 12000 allowed automatic segmentation of tumor lesions for estimation of the total tumor load in the liver.
Collapse
Affiliation(s)
- Jan H Rothe
- Clinic of Nuclear Medicine, University Medicine Charité, Berlin, Germany
| | - Ines Rudolph
- Clinic of Hepatology and Gastroenterology, University Medicine Charité, Berlin, Germany; German Cancer Consortium, Deutsches Krebsforschungzentrum (DKFZ), Heidelberg, Germany
| | - Nadine Rohwer
- Clinic of Hepatology and Gastroenterology, University Medicine Charité, Berlin, Germany
| | - Dennis Kupitz
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University, Magdeburg A.ö.R., Magdeburg, Germany
| | | | - Thorsten Derlin
- Clinic of Radiology, University Medical Center, Hamburg, Germany
| | - Christian Furth
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University, Magdeburg A.ö.R., Magdeburg, Germany
| | - Holger Amthauer
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University, Magdeburg A.ö.R., Magdeburg, Germany
| | - Winfried Brenner
- Clinic of Nuclear Medicine, University Medicine Charité, Berlin, Germany
| | - Ralph Buchert
- Clinic of Nuclear Medicine, University Medicine Charité, Berlin, Germany
| | - Thorsten Cramer
- Clinic of Hepatology and Gastroenterology, University Medicine Charité, Berlin, Germany
| | - Ivayla Apostolova
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University, Magdeburg A.ö.R., Magdeburg, Germany.
| |
Collapse
|
110
|
Poeppel TD, Boy C, Bockisch A, Kotzerke J, Buchmann I, Ezziddin S, Scheidhauer K, Krause BJ, Schmidt D, Amthauer H, Rösch F, Nagarajah J, Führer D, Lahner H, Pöpperl G, Hörsch D, Walter MA, Baum RP. [Peptide receptor radionuclide therapy for patients with somatostatin receptor expressing tumours. German Guideline (S1)]. Nuklearmedizin 2015; 54:1-N2. [PMID: 25683107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Indexed: 06/04/2023]
Abstract
This document describes the guideline for peptide receptor radionuclide therapy (PRRT) published by the German Society of Nuclear Medicine (DGN) and accepted by the Association of the Scientific Medical Societies in Germany (AWMF) to be included in the official AWMF Guideline Registry. These recommendations are a prerequisite for the quality management in the treatment of patients with somatostatin receptor expressing tumours using PRRT. They are aimed at guiding nuclear medicine specialists in selecting likely candidates to receive PRRT and to deliver the treatment in a safe and effective manner. The recommendations are based on an interdisciplinary consensus. The document contains background information and definitions and covers the rationale, indications and contraindications for PRRT. Essential topics are the requirements for institutions performing the therapy, e. g. presence of an expert for medical physics, intense cooperation with all colleagues involved in the treatment of a patient, and a certificate of instruction in radiochemical labelling and quality control are required. Furthermore, it is specified which patient data have to be available prior to performance of therapy and how treatment has to be carried out technically. Here, quality control and documentation of labelling are of great importance. After treatment, clinical quality control is mandatory (work-up of therapy data and follow-up of patients). Essential elements of follow-up are specified in detail. The complete treatment inclusive after-care has to be realised in close cooperation with the involved medical disciplines. Generally, the decision for PRRT should be undertaken within the framework of a multi-disciplinary tumour board.
Collapse
Affiliation(s)
- T D Poeppel
- Dr. Thorsten Pöppel, Universitätsklinikum Essen, Klinik für Nuklearmedizin, Hufelandstr. 55, 45122 Essen, Germany, E-mail:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
111
|
Apostolova I, Rogasch J, Buchert R, Wertzel H, Achenbach HJ, Schreiber J, Riedel S, Furth C, Lougovski A, Schramm G, Hofheinz F, Amthauer H, Steffen IG. Quantitative assessment of the asphericity of pretherapeutic FDG uptake as an independent predictor of outcome in NSCLC. BMC Cancer 2014; 14:896. [PMID: 25444154 PMCID: PMC4265451 DOI: 10.1186/1471-2407-14-896] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/21/2014] [Indexed: 12/05/2022] Open
Abstract
Background The aim of the present study was to evaluate the predictive value of a novel quantitative measure for the spatial heterogeneity of FDG uptake, the asphericity (ASP) in patients with non-small cell lung cancer (NSCLC). Methods FDG-PET/CT had been performed in 60 patients (15 women, 45 men; median age, 65.5 years) with newly diagnosed NSCLC prior to therapy. The FDG-PET image of the primary tumor was segmented using the ROVER 3D segmentation tool based on thresholding at the volume-reproducing intensity threshold after subtraction of local background. ASP was defined as the relative deviation of the tumor’s shape from a sphere. Univariate and multivariate Cox regression as well as Kaplan-Meier (KM) analysis and log-rank test with respect to overall (OAS) and progression-free survival (PFS) were performed for clinical variables, SUVmax/mean, metabolically active tumor volume (MTV), total lesion glycolysis (TLG), ASP and “solidity”, another measure of shape irregularity. Results ASP, solidity and “primary surgical treatment” were significant independent predictors of PFS in multivariate Cox regression with binarized parameters (HR, 3.66; p < 0.001, HR, 2.11; p = 0.05 and HR, 2.09; p = 0.05), ASP and “primary surgical treatment” of OAS (HR, 3.19; p = 0.02 and HR, 3.78; p = 0.01, respectively). None of the other semi-quantitative PET parameters showed significant predictive value with respect to OAS or PFS. Kaplan-Meier analysis revealed a probability of 2-year PFS of 52% in patients with low ASP compared to 12% in patients with high ASP (p < 0.001). Furthermore, it showed a higher OAS rate in the case of low versus high ASP (1-year-OAS, 91% vs. 67%: p = 0.02). Conclusions The novel parameter asphericity of pretherapeutic FDG uptake seems to provide better prognostic value for PFS and OAS in NCSLC compared to SUV, metabolic tumor volume, total lesion glycolysis and solidity.
Collapse
Affiliation(s)
- Ivayla Apostolova
- Clinic of Radiology and Nuclear Medicine, University Hospital, Otto-von-Guericke University Magdeburg, Leipziger Strasse 44, Magdeburg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
112
|
Kolodziej A, Lippert M, Angenstein F, Neubert J, Pethe A, Grosser OS, Amthauer H, Schroeder UH, Reymann KG, Scheich H, Ohl FW, Goldschmidt J. SPECT-imaging of activity-dependent changes in regional cerebral blood flow induced by electrical and optogenetic self-stimulation in mice. Neuroimage 2014; 103:171-180. [DOI: 10.1016/j.neuroimage.2014.09.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 08/13/2014] [Accepted: 09/08/2014] [Indexed: 12/29/2022] Open
|
113
|
Rogasch JM, Hofheinz F, Lougovski A, Furth C, Ruf J, Großer OS, Mohnike K, Hass P, Walke M, Amthauer H, Steffen IG. The influence of different signal-to-background ratios on spatial resolution and F18-FDG-PET quantification using point spread function and time-of-flight reconstruction. EJNMMI Phys 2014; 1:12. [PMID: 26501454 PMCID: PMC6890905 DOI: 10.1186/2197-7364-1-12] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/04/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND F18-fluorodeoxyglucose positron-emission tomography (FDG-PET) reconstruction algorithms can have substantial influence on quantitative image data used, e.g., for therapy planning or monitoring in oncology. We analyzed radial activity concentration profiles of differently reconstructed FDG-PET images to determine the influence of varying signal-to-background ratios (SBRs) on the respective spatial resolution, activity concentration distribution, and quantification (standardized uptake value [SUV], metabolic tumor volume [MTV]). METHODS Measurements were performed on a Siemens Biograph mCT 64 using a cylindrical phantom containing four spheres (diameter, 30 to 70 mm) filled with F18-FDG applying three SBRs (SBR1, 16:1; SBR2, 6:1; SBR3, 2:1). Images were reconstructed employing six algorithms (filtered backprojection [FBP], FBP + time-of-flight analysis [FBP + TOF], 3D-ordered subset expectation maximization [3D-OSEM], 3D-OSEM + TOF, point spread function [PSF], PSF + TOF). Spatial resolution was determined by fitting the convolution of the object geometry with a Gaussian point spread function to radial activity concentration profiles. MTV delineation was performed using fixed thresholds and semiautomatic background-adapted thresholding (ROVER, ABX, Radeberg, Germany). RESULTS The pairwise Wilcoxon test revealed significantly higher spatial resolutions for PSF + TOF (up to 4.0 mm) compared to PSF, FBP, FBP + TOF, 3D-OSEM, and 3D-OSEM + TOF at all SBRs (each P < 0.05) with the highest differences for SBR1 decreasing to the lowest for SBR3. Edge elevations in radial activity profiles (Gibbs artifacts) were highest for PSF and PSF + TOF declining with decreasing SBR (PSF + TOF largest sphere; SBR1, 6.3%; SBR3, 2.7%). These artifacts induce substantial SUVmax overestimation compared to the reference SUV for PSF algorithms at SBR1 and SBR2 leading to substantial MTV underestimation in threshold-based segmentation. In contrast, both PSF algorithms provided the lowest deviation of SUVmean from reference SUV at SBR1 and SBR2. CONCLUSIONS At high contrast, the PSF algorithms provided the highest spatial resolution and lowest SUVmean deviation from the reference SUV. In contrast, both algorithms showed the highest deviations in SUVmax and threshold-based MTV definition. At low contrast, all investigated reconstruction algorithms performed approximately equally. The use of PSF algorithms for quantitative PET data, e.g., for target volume definition or in serial PET studies, should be performed with caution - especially if comparing SUV of lesions with high and low contrasts.
Collapse
Affiliation(s)
- Julian Mm Rogasch
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120, Germany.
| | - Frank Hofheinz
- PET Center, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Landstraße 400, Dresden, 01328, Germany.
| | - Alexandr Lougovski
- PET Center, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Landstraße 400, Dresden, 01328, Germany.
| | - Christian Furth
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120, Germany.
| | - Juri Ruf
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120, Germany. .,Klinik für Nuklearmedizin, Universitätsklinikum Freiburg, Hugstetter Straße 55, Freiburg im Breisgau, 79106, Germany.
| | - Oliver S Großer
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120, Germany.
| | - Konrad Mohnike
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120, Germany.
| | - Peter Hass
- Klinik für Strahlentherapie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120, Germany.
| | - Mathias Walke
- Klinik für Strahlentherapie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120, Germany.
| | - Holger Amthauer
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120, Germany.
| | - Ingo G Steffen
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, Magdeburg, 39120, Germany.
| |
Collapse
|
114
|
Amthauer H, Ulrich G, Grosser OS, Ricke J. Reply: Pretreatment Dosimetry in HCC Radioembolization with 90Y Glass Microspheres Cannot Be Invalidated with a Bare Visual Evaluation of 99mTc-MAA Uptake of Colorectal Metastases Treated with Resin Microspheres. J Nucl Med 2014; 55:1216-8. [DOI: 10.2967/jnumed.114.138198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
115
|
Ricke J, Schuette K, Rosmorduc O, Peck-Radosavljevic M, Verslype C, Sangro B, Walecki J, Klumpen HJ, Peynircioglu B, Yalcin S, Bartolozzi C, Amthauer H, Malfertheiner P. Sorafenib in combination with local microtherapy guided by gadolinium-EOB-DTPA enhanced MRI in patients with inoperable hepatocellular carcinoma (SORAMIC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps4154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jens Ricke
- Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | | | | | | | | | - Bruno Sangro
- Clinica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Jerzy Walecki
- Centralny Szpital Kliniczny, MSWiA, Warszawa, Poland
| | | | | | | | | | - Holger Amthauer
- Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | | |
Collapse
|
116
|
Kobe C, Kuhnert G, Kahraman D, Haverkamp H, Eich HT, Franke M, Persigehl T, Klutmann S, Amthauer H, Bockisch A, Kluge R, Wolf HH, Maintz D, Fuchs M, Borchmann P, Diehl V, Drzezga A, Engert A, Dietlein M. Assessment of tumor size reduction improves outcome prediction of positron emission tomography/computed tomography after chemotherapy in advanced-stage Hodgkin lymphoma. J Clin Oncol 2014; 32:1776-81. [PMID: 24799482 DOI: 10.1200/jco.2013.53.2507] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Positron emission tomography (PET) after chemotherapy can guide consolidating radiotherapy in advanced-stage Hodgkin lymphoma (HL). This analysis aims to improve outcome prediction by integrating additional criteria derived by computed tomography (CT). PATIENTS AND METHODS The analysis set consisted of 739 patients with residues≥2.5 cm after chemotherapy from a total of 2,126 patients treated in the HD15 trial (HD15 for advanced stage Hodgkin's disease: Quality assurance protocol for reduction of toxicity and the prognostic relevance of fluorodeoxyglucose-positron-emission tomography [FDG-PET] in the first-line treatment of advanced-stage Hodgkin's disease) performed by the German Hodgkin Study Group. A central panel performed image analysis and interpretation of CT scans before and after chemotherapy as well as PET scans after chemotherapy. Prognosis was evaluated by using progression-free survival (PFS); groups were compared with the log-rank test. Potential prognostic factors were investigated by using receiver operating characteristic analysis and logistic regression. RESULTS In all, 548 (74%) of 739 patients had PET-negative residues after chemotherapy; these patients did not receive additional radiotherapy and showed a 4-year PFS of 91.5%. The 191 PET-positive patients (26%) receiving additional radiotherapy had a 4-year PFS of 86.1% (P=.022). CT alone did not allow further separation of patients in partial remission by risk of recurrence (P=.9). In the subgroup of the 54 PET-positive patients with a relative reduction of less than 40%, the risk of progression or relapse within the first year was 23.1% compared with 5.3% for patients with a larger reduction (difference, 17.9%; 95% CI, 5.8% to 30%). CONCLUSION Patients with HL who have PET-positive residual disease after chemotherapy and poor tumor shrinkage are at high risk of progression or relapse.
Collapse
Affiliation(s)
- Carsten Kobe
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
| | - Georg Kuhnert
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Deniz Kahraman
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Heinz Haverkamp
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Hans-Theodor Eich
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Mareike Franke
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Thorsten Persigehl
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Susanne Klutmann
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Holger Amthauer
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Andreas Bockisch
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Regine Kluge
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Hans-Heinrich Wolf
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - David Maintz
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Michael Fuchs
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Peter Borchmann
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Volker Diehl
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Alexander Drzezga
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Andreas Engert
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Markus Dietlein
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| |
Collapse
|
117
|
Garlipp B, de Baere T, Damm R, Irmscher R, van Buskirk M, Stübs P, Deschamps F, Meyer F, Seidensticker R, Mohnike K, Pech M, Amthauer H, Lippert H, Ricke J, Seidensticker M. Left-liver hypertrophy after therapeutic right-liver radioembolization is substantial but less than after portal vein embolization. Hepatology 2014; 59:1864-73. [PMID: 24259442 DOI: 10.1002/hep.26947] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 11/17/2013] [Indexed: 12/22/2022]
Abstract
UNLABELLED In patients with liver malignancies potentially amenable to curative extended right hepatectomy but insufficient size of the future liver remnant (FLR), portal vein embolization (PVE) of the tumor-bearing liver is used to induce contralateral liver hypertrophy but leaves the tumor untreated. Radioembolization (RE) treats the tumor in the embolized lobe along with contralateral hypertrophy induction. We performed a matched-pair analysis to compare the capacity for hypertrophy induction of these two modalities. Patients with right-hepatic secondary liver malignancies with no or negligible left-hepatic tumor involvement who were treated by right-lobar PVE (n = 141) or RE (n = 35) at two centers were matched for criteria known to influence liver regeneration following PVE: 1) baseline FLR/Total liver volume ratio (<25 versus ≥ 25%); 2) prior platinum-containing systemic chemotherapy; 3) embolization of segments 5-8 versus 4-8; and 4) baseline platelet count (<200 versus ≥ 200 Gpt/L).The primary endpoint was relative change in FLR volume from baseline to follow-up. Twenty-six matched pairs were identified. FLR volume increase from baseline to follow-up (median 33 [24-56] days after PVE or 46 [27-79] days after RE) was significant in both groups but PVE produced significantly more FLR hypertrophy than RE (61.5 versus 29%, P < 0.001). Time between treatment and follow-up was not correlated with the degree of contralateral hypertrophy achieved in both groups. Although group differences in patient history and treatment setting were present and some bias cannot be excluded, this was minimized by the matched-pair design, as remaining group differences after matching were found to have no significant influence on contralateral hypertrophy development. CONCLUSION PVE induces significantly more contralateral hypertrophy than RE with therapeutic (nonlobectomy) doses. However, contralateral hypertrophy induced by RE is substantial and RE minimizes the risk of tumor progression in the treated lobe, possibly making it a suitable modality for selected patients.
Collapse
Affiliation(s)
- Benjamin Garlipp
- Universitätsklinikum Magdeburg, Klinik für Allgemein-, Viszeral- und Gefäβchirurgie, Magdeburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
118
|
Mohnike K, Lambertini A, Steffen I, Ulrich G, Grosser OS, Pech M, Amthauer H, Ricke J. Der prädiktive Wert von 99 m Tc-markierten HSA-B20 Mikrosphären für die spätere Verteilung von 90Y- SIR- Mikrosphären bei der Radioembolisation von kolorektalen Lebermetastasen: vorläufige Ergebnisse. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
119
|
Seidensticker M, Garlipp B, De Baere T, Damm R, Irmscher R, Seidensticker R, Mohnike K, Pech M, Lippert H, Amthauer H, Ricke J. Matched pair Analyse der Hypertrophieinduktion des linken Leberlappens nach kontralateraler Pfortaderembolisation oder Radioembolisation mit Yttrium90-Mikrosphären. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
120
|
Seidensticker R, Seidensticker M, Doegen K, Mohnike K, Schütte K, Stübs P, Kettner E, Pech M, Amthauer H, Ricke J. Das inoperable intrahepatische cholangiozelluläre Karzinom: Evaluierung eines individualisierten multimodalen Therapiekonzeptes. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
121
|
Zarva A, Mohnike K, Damm R, Ruf J, Seidensticker R, Ulrich G, Seidensticker M, Pech M, Ricke J, Amthauer H. Safety of repeated radioembolizations in patients with advanced primary and secondary liver tumors and progressive disease after first selective internal radiotherapy. J Nucl Med 2014; 55:360-6. [PMID: 24516256 DOI: 10.2967/jnumed.113.127662] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED The purpose of this study was to assess the safety of repeated (90)Y radioembolization with resin microspheres in patients with extensive primary and secondary liver tumors after failure of first radioembolization. METHODS Between 2007 and 2011, 21 patients (12 women, 9 men; mean age, 61.0 y) with nonresectable advanced liver tumors (breast cancer liver metastases, n = 7; colorectal liver metastases, n = 5; hepatocellular carcinoma, n = 8; cholangiocellular carcinoma, n = 1) were repeatedly treated by radioembolization. Safety was the primary endpoint. Whole-liver treatment was achieved with sequential treatment sessions in most patients, with selective embolization of the left and right liver lobes within 6 wk. Toxicity was documented prospectively and according to Common Terminology Criteria for Adverse Events 4.0 criteria based on laboratory parameters; magnetic-resonance tomography; and clinical examinations 3 d, 6 wk, and every 3 mo after selective internal radiotherapy (SIRT). Metric variables were evaluated using the Student t test. Overall survival was assessed by Kaplan-Meier statistics. RESULTS Patients received an average of 1.6 whole-liver treatments performed in 3.0 unilobar radioembolizations (liver lobes sequentially). The mean total activity administered was 2.57 GBq. No radioembolization-induced liver disease was observed in any of the patients. Three patients showed reversible grade III to IV toxicities according to laboratory values, which returned to pretreatment levels after 6 wk. In 1 patient, a treatment-related duodenal ulcer occurred. Median overall survival was 18 mo after first radioembolization. CONCLUSION In advanced liver tumors, repeated whole-liver treatments with (90)Y radioembolization can be performed with an acceptable toxicity profile.
Collapse
Affiliation(s)
- Alina Zarva
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Magdeburg, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
122
|
Steffen IG, Hofheinz F, Rogasch JM, Furth C, Amthauer H, Ruf J. Influence of rigid coregistration of PET and CT data on metabolic volumetry: a user's perspective. EJNMMI Res 2013; 3:85. [PMID: 24369858 PMCID: PMC3880978 DOI: 10.1186/2191-219x-3-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 12/07/2013] [Indexed: 11/29/2022] Open
Abstract
Background While non-rigid fusion is by definition expected to alter the information of positron emission tomography (PET) data, we assessed whether rigid transformation also influences metabolic tumor volume (MTV) determination. Methods The PET/computed tomography (CT) data of 28 solid pulmonary lesions of 20 tumor patients examined with 18 F-Fluordeoxyglucose (FDG) was retrospectively analyzed. The original (OR) hardware-coregistered PET images were fused with contrast-enhanced diagnostic CT (CT1, 1 mm slices) and low dose CT (CT5, 5 mm slices). After automatic rigid transformation (Mirada Fusion7D) using two algorithms (rigid fast (RF), rigid slow (RS)), MTV and maximal standardized uptake value (SUVmax) were determined applying four different segmentation methods with either fixed or background-adapted thresholding and compared to OR-PET data. Results Relative differences in SUVmax compared to OR data revealed no significant differences for RF (median, −0.1%; interquartile range (IQR), −1.1% to 0.9%; p = 0.75) and RS (median, 0.5%; IQR, −0.6% to 1.3%; p = 0.19) in CT1, whereas in CT5 significant deviations were observed for RF (median, −9.0%; IQR, −10.9 to −6.1; p < 0.001) and RS (median, −8.4%; IQR, −11.1 to −5.6; p < 0.001). Relative MTV differences were 0.7% (IQR, −3.0% to 2.7%; p = 0.76) for RF and −1.3% (IQR, −3.6% to 0.9%; p = 0.12) for RS in CT1. Coregistration led to significant MTV differences in RF (median, 10.4%; IQR, 7.4% to 16.7%; p < 0.001) and RS (median, 10.6%; IQR, 5.4% to 17.7%; p < 0.001) in CT5. Conclusions Rigid coregistration of PET data allows a quantitative evaluation with reasonable accuracy in most cases. However, in some cases, it can result in substantial deviations of MTV and SUVmax. Therefore, it is recommended to perform quantitative evaluation in the original PET data rather than in coregistered PET data.
Collapse
Affiliation(s)
- Ingo G Steffen
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A,ö,R, Leipziger Strasse 44, Magdeburg 39120, Germany.
| | | | | | | | | | | |
Collapse
|
123
|
Furth C, Steffen IG, Erdrich AS, Hundsdoerfer P, Ruf J, Henze G, Schönberger S, Amthauer H, Hautzel H. Explorative analyses on the value of interim PET for prediction of response in pediatric and adolescent non-Hodgkin lymphoma patients. EJNMMI Res 2013; 3:71. [PMID: 24139528 PMCID: PMC3853769 DOI: 10.1186/2191-219x-3-71] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 10/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study is to evaluate the predictive value of FDG-PET (PET) in pediatric and adolescent patients suffering from non-Hodgkin lymphoma (pNHL) in comparison to information provided by conventional imaging methods (CIM). METHODS Imaging was performed at baseline and at interim (after 2 cycles of chemotherapy). The response assessment in PET was carried out visually and semi-quantitatively, the latter one by use of percentage decrease in SUVmax from baseline to interim (ΔSUVmax). The PET-based results were compared to the findings by CIM. Progression-free survival (PFS) was analyzed using Kaplan-Meier curves (KM) and log-rank test. RESULTS The final study included 16 patients (mean follow-up time, 60.2 months (range, 4.0 to 85.7 months)). Relapse occurred in four patients. Visual PET compared to CIM revealed higher sensitivity (3/4 vs 1/4) and NPV (6/7 vs 10/13), and equal PPV (3/9 vs 1/3), but lower specificity (6/12 vs 10/12) and accuracy (9/16 vs 11/16). False-positive findings in PET at interim were predominantly observed in patients presenting bulky disease (5/6), whereas CIM was true-negative in all of these cases. KM analyses revealed no significant differences in 5-year PFS neither for CIM (76.9% vs 66.7%; p = 0.67) nor for visual PET (85.7% vs 66.7%; p = 0.34) nor for ΔSUVmax (88.9% vs 57.1%; p = 0.12). CONCLUSIONS The predictive value of iPET in pediatric patients suffering from NHL was limited due to considerably high amount of false-positive findings, especially in patients suffering from bulky disease. However, due to our limited sample size, final conclusions cannot be drawn and, thus, call for further evaluation of PET in pNHL in larger and more homogenous patient series.
Collapse
Affiliation(s)
- Christian Furth
- Department of Radiology and Nuclear Medicine, Medical School, Otto von Guericke University Magdeburg A,ö,R, Leipziger Strasse 44, Magdeburg 39120, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
124
|
Ulrich G, Dudeck O, Grosser OS, Amthauer H. Reply: Value of 99mTc-Macroaggregated Albumin SPECT for Radioembolization Treatment Planning. J Nucl Med 2013; 54:1682. [DOI: 10.2967/jnumed.113.123349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
125
|
|
126
|
Ricke J, Großer O, Amthauer H. Y90-radioembolization of lung metastases via the bronchial artery: a report of 2 cases. Cardiovasc Intervent Radiol 2013; 36:1664-1669. [PMID: 23839007 DOI: 10.1007/s00270-013-0690-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 06/11/2013] [Indexed: 12/30/2022]
Abstract
We report successful Y90-radioembolization of the lung applying Y90-resin microspheres via the bronchial artery in two patients with diffuse colorectal and renal cancer metastases, respectively. The deposition of radioactive Y90-resin-microspheres was technically feasible and resulted in a reasonable absorbed dose in the tumors. However, open questions remain regarding dosimetry and safe dose exposure to the lung. The technique warrants thorough investigation before clinical use. A Phase I trial to evaluate safety and preliminary efficacy is under preparation.
Collapse
Affiliation(s)
- Jens Ricke
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg AöR, Leipzigerstrasse 44, 39120, Magdeburg, Germany.
| | - Oliver Großer
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg AöR, Leipzigerstrasse 44, 39120, Magdeburg, Germany
| | - Holger Amthauer
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg AöR, Leipzigerstrasse 44, 39120, Magdeburg, Germany
| |
Collapse
|
127
|
Piatek S, Wex T, Adolf D, Klose S, Westphal S, Amthauer H, Halangk W, Jahn O, Riebau C, Winckler S. Präventive Knochendichtemessung bei postmenopausalen Frauen. Unfallchirurg 2013; 116:596-601. [DOI: 10.1007/s00113-012-2169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
128
|
Bretschneider T, Tienken C, Mohnike K, Furth C, Hass P, Ruf J, Amthauer H, Ricke J. Bildgesteuerte HDR-Brachytherapie von Nierenmalignomen und nierennah gelegenen Metastasen: Evaluation der Nierentoleranzdosis. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
129
|
Ricke J, Ulrich G, Breier L, Gensecke P, Steffen IG, Furth C, Seidensticker R, Seidensticker M, Pech M, Kettner E, Amthauer H. Beeinflußt eine Vortherapie mit BEVACIZUMAB die Y90-Radioembolisation bei hepatisch metastasiertem colo-rektalem Karzinom? ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
130
|
Furth C, Erdrich AS, Steffen IG, Ruf J, Stiebler M, Kahraman D, Kobe C, Schönberger S, Grandt R, Hundsdoerfer P, Hauptmann K, Amthauer H, Hautzel H. Interim PET response criteria in paediatric non-Hodgkin's lymphoma. Results from a retrospective multicenter reading. Nuklearmedizin 2013; 52:148-56. [PMID: 23928982 DOI: 10.3413/nukmed-0546-12-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 03/10/2013] [Indexed: 12/22/2022]
Abstract
AIM To evaluate the use and reliability of the PET-based response criteria for interim PET (iPET) in terms of interobserver variability in pediatric and adolescent patients suffering from non-Hodgkin´s lymphoma (NHL). Particular attention was given to the identification of visual cutoff to separate patients with a favourable outcome. PATIENTS, METHODS Retrospective analysis of PET-datasets of 18 children and adolescents suffering from NHL who underwent iPET after two cycles of chemotherapy for response assessment. Datasets were evaluated and rated in three independent review centers (RC) (blinded-read, intra-center consensus) using a visual 5-point response scale. Ratings were compared to clinical outcome. Pairwise interobserver agreement was analysed with Cohen's kappa-test (κ). Overall agreement (between attended RCs) was assessed with Fleiss' κ-test. RESULTS Four patients suffered relapse (early, n = 2; late, n = 2). Per region analyses on interobserver variability revealed a "substantial" agreement (Fleiss' κ = 0.618). Per patient analyses revealed concordant iPET-ratings in eight patients: iPET-negative (iPET-), n = 5; iPET-positive (iPET+), n = 2; iPET-inconclusive (iPET±), n = 1. Discordant ratings were found in the remaining patients. Patients with early relapse were concordantly identified using mediastinal blood pool structures (MBPS, score ≥ 3) as visual cutoff between iPET+ or iPET-, respectively. However, patients with late relapse were not concordantly identified taking the MBPS as visual cutoff. CONCLUSION The iPET interpretation using a dedicated PET-based response scale assured a low interobserver variability in per-region but not in per-patient analyses in a multicenter read. Using a sensitive read out (iPET+, score ≥ 3) a reliable identification of patients suffering relapse was limited to those with early relapse.
Collapse
Affiliation(s)
- C Furth
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University Magdeburg A.ö.R., Magdeburg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
131
|
Piatek S, Adolf D, Wex T, Halangk W, Klose S, Westphal S, Amthauer H, Winckler S. Multiparameter analysis of serum levels of C-telopeptide crosslaps, bone-specific alkaline phosphatase, cathepsin K, osteoprotegerin and receptor activator of nuclear factor κB ligand in the diagnosis of osteoporosis. Maturitas 2013; 74:363-8. [DOI: 10.1016/j.maturitas.2013.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 12/17/2012] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
|
132
|
Ulrich G, Dudeck O, Furth C, Ruf J, Grosser OS, Adolf D, Stiebler M, Ricke J, Amthauer H. Predictive Value of Intratumoral 99mTc-Macroaggregated Albumin Uptake in Patients with Colorectal Liver Metastases Scheduled for Radioembolization with 90Y-Microspheres. J Nucl Med 2013; 54:516-22. [DOI: 10.2967/jnumed.112.112508] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
133
|
Ruf J, Schiefer J, Kropf S, Furth C, Ulrich G, Kosiek O, Denecke T, Pavel M, Pascher A, Wiedenmann B, Amthauer H. Quantification in (68)Ga-DOTA(0)-Phe(1)-Tyr(3)-octreotide positron emission tomography/computed tomography: can we be impartial about partial volume effects? Neuroendocrinology 2013; 97:369-74. [PMID: 23486004 DOI: 10.1159/000350418] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 03/05/2013] [Indexed: 11/19/2022]
Abstract
AIM In combined positron emission tomography/computed tomography (PET/CT) of neuroendocrine neoplasms using (68)Ga-DOTA(0)-Phe(1)-Tyr(3)-octreotide ((68)Ga-DOTATOC), partial volume effects (PVEs) may occur in smaller lesions. This study determined the lesional cutoff size for the occurrence of PVEs in a clinical setting. METHODS Retrospective assessment of 51 PET/CT examinations (16-slice PET/CT device) for malignant PET foci was carried out. In all foci, the maximal standardized uptake value (SUVmax) and maximal lesion diameter on axial CT was documented. Determined SUVmax and lesional sizes were correlated via LOESS regression. In the resulting curve, the cutoff point for SUVmax size dependency was determined visually and mathematically using 2 approximating straight lines. RESULTS In 45 patients, 313 of 413 PET foci found were malignant, measurable on CT and had a roughly spherical geometry (SUVmax: 2.5-103.3, mean ± SD 20.5 ± 15.18; CT diameter: 5-103 mm, mean ± SD 21.8 ± 13.1 mm). The cutoff lesional size for the occurrence of PVEs was 20.4 mm by the mathematical approach and 25 mm by visual assessment. CONCLUSION In (68)Ga-DOTATOC imaging, the clinical lesional size threshold is far larger than expected from systemic resolution only. Thus, tracer uptake quantification is only acceptable in sufficiently large lesions.
Collapse
Affiliation(s)
- Juri Ruf
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Germany. juri.ruf @ uniklinik-freiburg.de
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
134
|
Furth C, Meseck RM, Steffen IG, Schoenberger S, Denecke T, Henze G, Hautzel H, Hofheinz F, Großer O, Hundsdoerfer P, Amthauer H, Ruf J. SUV-measurements and patient-specific corrections in pediatric Hodgkin-lymphoma: is there a benefit for PPV in early response assessment by FDG-PET? Pediatr Blood Cancer 2012; 59:475-80. [PMID: 22190514 DOI: 10.1002/pbc.24047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Accepted: 11/18/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND To evaluate the influence of different SUV-measurements and patient-specific corrections thereof on the positive predictive value (PPV) of FDG-PET in pediatric Hodgkin lymphoma (pHL) using SUV-based response assessment. METHODS PET-datasets of 33 children [female, n = 13, male, n = 20; range of age, 8.0-17.8 (mean, 15.0) years; follow-up, 44.5-83.3 (mean 63.0) months] with HL were analyzed retrospectively. PET-scans were obtained baseline (PET1) and after two cycles of chemotherapy (PET2). Within the leading lesion maximal SUV (SUVmax) and mean SUVs were generated by using isocontur-thresholds for different volumes of interest: Absolute, SUV2.5; relative to SUVmax, SUVmean40% to SUVmean70%. Generated SUVs were adjusted to body weight (SUV) and corrected for body surface area (SUV_BSA), patient's blood glucose and a combination thereof. The decrease in SUV or respective derivates thereof between PET1 and PET2 (ΔSUV) was assessed for response prediction using receiver operating characteristics (ROC)-analysis. RESULTS Three patients had recurrence of disease. ROC-analysis showed the most accurate differentiation of responders and non-responders for ΔSUVmax_BSA [AUC, 0.97; P = 0.0026; sensitivity, 100%; specificity, 93.3%; PPV, 60.0%; negative predictive value (NPV), 100%; accuracy, 93.3%]. However, comparable results were obtained for conventional ΔSUVmax-determination (AUC, 0.96; P = 0.0112; sensitivity, 100%; specificity, 90.0%; PPV, 50.0%; NPV, 100%; accuracy, 90.9%). Threshold-based approaches were less effective or technically not performable in all patients. CONCLUSIONS At early response assessment by FDG-PET, patient-specific correction of ΔSUVmax by BSA improves PPV without impairment of excellent NPV in pHL. However, it is not statistically superior to simple ΔSUVmax-analyses. Larger cohorts are needed to investigate this observation.
Collapse
Affiliation(s)
- Christian Furth
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University Magdeburg A.ö.R., Magdeburg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
135
|
Dobrindt O, Hoffmeyer B, Ruf J, Seidensticker M, Steffen IG, Fischbach F, Zarva A, Wieners G, Ulrich G, Lohmann CH, Amthauer H. Estimation of return-to-sports-time for athletes with stress fracture - an approach combining risk level of fracture site with severity based on imaging. BMC Musculoskelet Disord 2012; 13:139. [PMID: 22866765 PMCID: PMC3485631 DOI: 10.1186/1471-2474-13-139] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 07/30/2012] [Indexed: 12/11/2022] Open
Abstract
Background The aim was to compare the return-to-sports-time (RTST) following stress fractures on the basis of site and severity of injury. This retrospective study was set up at a single institution. Diagnosis was confirmed by an interdisciplinary adjudication panel and images were rated in a blinded-read setting. Methods 52 athletes (female, n = 30; male, n = 22; mean age, 22.8 years) with stress fracture (SFX) who had undergone at least one examination, either MRI or bone scintigraphy, were included. Magnetic resonance images (MRI) and/or bone scintigraphy (BS) of SFX were classified as either low- or high-grade SFX, according to existing grading systems. For MRI, high-grade SFX was defined as visibility of a fracture line or bone marrow edema in T1-, T2-weighted and short tau inversion recovery (STIR) sequences, with low-grade SFX showing no fracture line and bone marrow edema only in STIR and/or T2-weighted sequences. In BS images, a mild and poorly defined focal tracer uptake represented a low-grade lesion, whereas an intense and sharply marginated uptake marked a high-grade SFX. In addition, all injuries were categorized by location as high- or low-risk stress fractures. RTST was obtained from the clinical records. All patients were treated according to a non-weight-bearing treatment plan and comprehensive follow-up data was complete until full recovery. Two-sided Wilcoxon’s rank sum test was used for group comparisons. Results High-risk SFX had a mean RTST of 132 days (d) [IQR 64d – 132d] compared to 119d [IQR 50d – 110d] for low-risk sites (p = 0.19). RTST was significantly longer (p = 0.01) in high-grade lesions [mean, 143d; IQR 66d – 134d] than in low-grade [mean, 95d; IQR 42d – 94d]. Analysis of high-risk SFX showed no difference in RTST (p = 0.45) between high- and low-grade [mean, 131d; IQR 72d – 123d vs. mean, 135d; IQR 63d – 132d]. In contrast, the difference was significant for low-risk SFX (p = 0.005) [low-grade; mean, 61d; IQR 35d – 78d vs. high-grade; mean, 153d; IQR 64d – 164d]. Conclusion For SFX at low-risk sites, the significant difference in RTST between low- and high-grade lesions allows more accurate estimation of RTST by this approach. Both location of the injury and severity determined by imaging should therefore be considered for prediction of RTST.
Collapse
Affiliation(s)
- Oliver Dobrindt
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R. Otto-von-Guericke Universität, Leipziger Straße 44, Magdeburg 39120, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
136
|
Furth C, Genseke P, Amthauer H, Neumann G, Krause H, Seidensticker M, Wiemann D, Rißmann A, Liehr UB, Ruf J. Evaluation of Functional MR-Urography in Complex Obstructive Uropathy of Infants: Comparison to the Conventional Diagnostic Algorithm - A Pilot Study. Klin Padiatr 2012; 224:296-302. [DOI: 10.1055/s-0032-1316295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- C. Furth
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University Magdeburg, Germany
| | - P. Genseke
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University Magdeburg, Germany
| | - H. Amthauer
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University Magdeburg, Germany
| | - G. Neumann
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University Magdeburg, Germany
| | - H. Krause
- Department of Paediatric Surgery, Medical School, Otto-von-Guericke University Magdeburg, Germany
| | - M. Seidensticker
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University Magdeburg, Germany
| | - D. Wiemann
- Department of Paediatrics, Medical School, Otto-von-Guericke University Magdeburg, Germany
| | - A. Rißmann
- Department of Paediatrics, Medical School, Otto-von-Guericke University Magdeburg, Germany
| | - U.-B. Liehr
- Department of Urology, Medical School, Otto-von-Guericke University Magdeburg, Germany
| | - J. Ruf
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University Magdeburg, Germany
| |
Collapse
|
137
|
Ricke J, Schuette K, Rosmorduc O, Jakob A, Verslype C, Sangro B, Walecki J, Klumpen HJ, Peynircioglu B, Yalcin B, Bartolozzi C, Amthauer H, Malfertheiner P. Sorafenib in combination with local microtherapy guided by gadolinium-EOB-DTPA enhanced MRI in patients with inoperable hepatocellular carcinoma (HCC) (SORAMIC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.tps4148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS4148 Background: HCC is a leading cause of cancer-related mortality in both men and women. It represents the fifth most common cancer worldwide with an increasing incidence. For the individual patient tumor stage at diagnosis (number and size of nodules, presence or absence of vascular invasion, presence or absence of extrahepatic spread), liver function and general health status are the principal prognostic factors. The clinical management of HCC requires a comprehensive, multidisciplinary approach. In early HCC curative treatment can be achieved by local ablation, resection or liver transplantation. In intermediate stages patients (pts) are offered locoregional treatment with palliative intent (transarterial chemoembolisation (TACE), Yttrium-90-radioembolisation (SIRT)). In advanced disease systemic therapy with sorafenib (sor) has the potential to prolong survival of pts and is standard of care in pts with preserved liver function. Studies on the combined use of locoregional and systemic therapy with their potential of a beneficial synergism are few and conducted in a small number of pts. Methods: This phase II-study is composed of three substudies with the following primary objectives: 1. In pts in whom local ablation is appropriate to determine if sor in combination with RFA prolongs the time-to-recurrence in comparison with RFA plus placebo. Primary endpoint (PEP): time to recurrence, n = 290 pts 2. In pts in whom RFA is not appropriate (palliative treatment group) to determine if the combination of SIRT and sor improves the overall survival in comparison to sor alone. PEP: overall survival, n = 375 pts 3. To confirm in a 2-step procedure that Gd-EOB-DTPA enhanced MRI is non-inferior or superior compared with contrast-enhanced multislice CT for stratification of pts to a palliative or a local ablation treatment strategy. PEP: correct stratification of pts to a palliative versus local ablation treatment strategy; n = 830 pts The trial has started in December 2010 as a multinational and multicentric study. 90 pts have been enrolled until January 31st 2012 with 51 pts randomized in the palliative arm and 14 pts treated in the curative arm.
Collapse
Affiliation(s)
- Jens Ricke
- Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | | | | | - Chris Verslype
- Digestive Oncology, University Hospitals Gasthuisberg, Leuven, Belgium
| | - Bruno Sangro
- Liver Unit, Clinica Universitaria and CIBEREHD, Pamplona, Spain
| | - Jerzy Walecki
- Centralny Szpital Kliniczny, MSWiA, Warszawa, Poland
| | - Heinz-Josef Klumpen
- Academisch Medisch Centrum Universiteit van Amsterdam, Amsterdam, Netherlands
| | | | - Bulent Yalcin
- Ankara University School of Medicine, Ankara, Turkey
| | | | | | | |
Collapse
|
138
|
Engert A, Haverkamp H, Kobe C, Markova J, Renner C, Ho A, Zijlstra J, Král Z, Fuchs M, Hallek M, Kanz L, Döhner H, Dörken B, Engel N, Topp M, Klutmann S, Amthauer H, Bockisch A, Kluge R, Kratochwil C, Schober O, Greil R, Andreesen R, Kneba M, Pfreundschuh M, Stein H, Eich HT, Müller RP, Dietlein M, Borchmann P, Diehl V. Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin's lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial. Lancet 2012; 379:1791-9. [PMID: 22480758 DOI: 10.1016/s0140-6736(11)61940-5] [Citation(s) in RCA: 417] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The intensity of chemotherapy and need for additional radiotherapy in patients with advanced stage Hodgkin's lymphoma has been unclear. We did a prospective randomised clinical trial comparing two reduced-intensity chemotherapy variants with our previous standard regimen. Chemotherapy was followed by PET-guided radiotherapy. METHODS In this parallel group, open-label, multicentre, non-inferiority trial (HD15), 2182 patients with newly diagnosed advanced stage Hodgkin's lymphoma aged 18-60 years were randomly assigned to receive either eight cycles of BEACOPP(escalated) (8×B(esc) group), six cycles of BEACOPP(escalated) (6×B(esc) group), or eight cycles of BEACOPP(14) (8×B(14) group). Randomisation (1:1:1) was done centrally by stratified minimisation. Non-inferiority of the primary endpoint, freedom from treatment failure, was assessed using repeated CIs for the hazard ratio (HR) according to the intention-to-treat principle. Patients with a persistent mass after chemotherapy measuring 2·5 cm or larger and positive on PET scan received additional radiotherapy with 30 Gy; the negative predictive value for tumour recurrence of PET at 12 months was an independent endpoint. This trial is registered with Current Controlled Trials, number ISRCTN32443041. FINDINGS Of the 2182 patients enrolled in the study, 2126 patients were included in the intention-to-treat analysis set, 705 in the 8×B(esc) group, 711 in the 6×B(esc) group, and 710 in the 8×B(14) group. Freedom from treatment failure was sequentially non-inferior for the 6×B(esc) and 8×B(14) groups as compared with 8×B(esc). 5-year freedom from treatment failure rates were 84·4% (97·5% CI 81·0-87·7) for the 8×B(esc) group, 89·3% (86·5-92·1) for 6×B(esc) group, and 85·4% (82·1-88·7) for the 8×B(14) group (97·5% CI for difference between 6×B(esc) and 8×B(esc) was 0·5-9·3). Overall survival in the three groups was 91·9%, 95·3%, and 94·5% respectively, and was significantly better with 6×B(esc) than with 8×B(esc) (97·5% CI 0·2-6·5). The 8×B(esc) group showed a higher mortality (7·5%) than the 6×B(esc) (4·6%) and 8×B(14) (5·2%) groups, mainly due to differences in treatment-related events (2·1%, 0·8%, and 0·8%, respectively) and secondary malignancies (1·8%, 0·7%, and 1·1%, respectively). The negative predictive value for PET at 12 months was 94·1% (95% CI 92·1-96·1); and 225 (11%) of 2126 patients received additional radiotherapy. INTERPRETATION Treatment with six cycles of BEACOPP(escalated) followed by PET-guided radiotherapy was more effective in terms of freedom from treatment failure and less toxic than eight cycles of the same chemotherapy regimen. Thus, six cycles of BEACOPP(escalated) should be the treatment of choice for advanced stage Hodgkin's lymphoma. PET done after chemotherapy can guide the need for additional radiotherapy in this setting. FUNDING Deutsche Krebshilfe and the Swiss Federal Government.
Collapse
Affiliation(s)
- Andreas Engert
- University Hospital of Cologne, Department of Internal Medicine I, Köln, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
139
|
Seidensticker M, Garlipp B, Irmscher R, Damm R, Seidensticker R, Mohnike K, Ulrich G, Pech M, Lippert H, Amthauer H, Ricke J. Hypertrophieinduktion des linken Leberlappens nach rechtshepatischer Yttrium-90-Radioembolisation. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
140
|
Seidensticker R, Henze A, Seidensticker M, Ulrich G, Mohnike K, Pech M, Amthauer H, Ricke J. Evaluation der Wertigkeit der prätherapeutischen Tc-99m-MAA-Szintigraphie zur Vorhersage des Hepatozytenfunktionsverlusts in der Gd-EOB-DTPA-verstärkten MRT nach Yttrium-90-Radioembolisation. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
141
|
Seidensticker M, Scholz S, Seidensticker R, Damm R, Mohnike K, Ulrich G, Pech M, Amthauer H, Ricke J. Lokale Ablation hepatischer Metastasen des Mammakarzinoms: prätherapeutische Einflussfaktoren auf das mediane Überleben (OS). ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
142
|
Dobrindt O, Hoffmeyer B, Ruf J, Seidensticker M, Steffen IG, Zarva A, Fischbach F, Wieners G, Furth C, Lohmann CH, Amthauer H. MRI versus bone scintigraphy. Evaluation for diagnosis and grading of stress injuries. Nuklearmedizin 2012; 51:88-94. [PMID: 22473075 DOI: 10.3413/nukmed-0448-11-12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 03/18/2012] [Indexed: 11/20/2022]
Abstract
AIM This study was set up to determine the value of magnetic resonance imaging (MRI) and bone scintigraphy (BS) for the diagnosis of stress injuries in athletes, and furthermore to assess reliability and prediction of healing time. PATIENTS, METHODS Imaging data was analyzed retrospectively from 28 athletes who had received MRI and BS examinations for suspected stress injuries. MRI- and BS-data were rated by three specialists each in a blinded read, using a 5-point score (i.e. 0-4: inconspicuous to high-grade stress fracture). An interdisciplinary expert truth-panel set the reference standard. Standard statistical parameters, Fleiss' kappa (κ), and group comparisons were calculated. RESULTS The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for detection of stress injuries were 71.4%, 85.7%, 78.6%, 83.3% and, 75.0%, for MRI and 92.9%, 73.8%, 83.3%, 78.0% and, 91.2% for BS, respectively. Interobserver reliability for the diagnosis of a stress injury was κ = 0.9 for BS and κ = 0.85 for MRI. Mean healing times of mild (grades 1 and 2) and severe (grades 3 and 4) stress injuries were 88 days (d) versus 142d for BS and 57d versus 116d for MRI. No significant difference in healing time could be shown. CONCLUSIONS MRI and BS reliably detect stress injuries. MRI is to be recommended as the primary imaging modality due to its potential for assessment of differential diagnoses and the lack of radiation exposure, the value of BS lies in the exclusion of stress fractures after inconclusive MRI examinations.
Collapse
Affiliation(s)
- O Dobrindt
- Klinik für Radiologie und Nuklearmedizin, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
143
|
Seidensticker R, Seidensticker M, Damm R, Mohnike K, Schütte K, Malfertheiner P, Van Buskirk M, Pech M, Amthauer H, Ricke J. Hepatic toxicity after radioembolization of the liver using (90)Y-microspheres: sequential lobar versus whole liver approach. Cardiovasc Intervent Radiol 2011; 35:1109-18. [PMID: 22037709 DOI: 10.1007/s00270-011-0295-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 10/05/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE (90)Y-radioembolization (RE) is a promising technique for delivering high doses of radiation to liver tumors but may result in compromise of liver function. To gain further perspective, we evaluated the toxicity rates of sequential lobar versus "whole liver" (90)Y-radioembolization. METHODS Thirty-four patients with liver malignancy in noncirrhotic livers were included; (90)Y-radioembolization was performed as either whole liver or sequential lobar treatment in 17 patients each. Standard clinical and liver specific laboratory parameters as well as MR imaging before treatment and at follow-up (6 and 12 weeks) after radioembolization were evaluated for toxicity using the Common Terminology Criteria for Adverse Events (CTCAE). Volumetry of the liver, tumor, and spleen and measurement of portal vein diameter also were performed. RESULTS Three months after whole liver RE, 14 liver-related grade 3/4 events were recorded versus 2 events after sequential lobar treatment (P < 0.05). Three patients treated with whole liver RE suffered from radioembolization-induced liver disease (REILD). Pathological increases in bilirubin at 3 months were observed for the whole liver group only (52.3 vs. 18.7 μmol/l, P = 0.012). Total liver volume did not change significantly in either group, but shrinkage of the initially treated hepatic lobe with compensatory hypertrophy of the subsequently treated lobe was observed in the sequential lobar group (P < 0.05). Portal vein diameter increased significantly in whole liver-treated patients only (+17% vs. +6.6%, P = 0.043). CONCLUSIONS Noncirrhotic patients undergoing sequential lobar radioembolization had less hepatic toxicity compared to whole liver embolization. The sequential approach should be the preferred strategy.
Collapse
Affiliation(s)
- Ricarda Seidensticker
- Universitätsklinikum Magdeburg, Klinik für Radiologie & Nuklearmedizin, Magdeburg, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
144
|
Thormann M, Amthauer H, Adolf D, Wollrab A, Ricke J, Speck O. Efficacy of diphenhydramine in the prevention of vertigo and nausea at 7 T MRI. Eur J Radiol 2011; 82:768-72. [PMID: 21945402 DOI: 10.1016/j.ejrad.2011.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 08/03/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE In this study the potential of diphenhydramine in reducing respectively preventing vertigo and nausea induced by the ultra-high static magnetic field at 7 T was evaluated. MATERIALS AND METHODS In a prospective, double blinded, placebo controlled, cross-over randomized study the sensations of 34 volunteers before, during and after exposure to the static magnetic field with and without drug respectively placebo administration were quantified. Fast table motion was applied to increase the incidence of otherwise sparse reports of field related sensations. RESULTS The strength of vertigo can be reduced by the application of diphenhydramine. CONCLUSION Diphenhydramine, even at a low dose, reduces the strength of vertigo at ultra-high static magnetic fields, may be used preventively, and could pave the way to even higher field strength.
Collapse
Affiliation(s)
- Markus Thormann
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Str. 44, 39120 Magdeburg, Germany.
| | | | | | | | | | | |
Collapse
|
145
|
Bittner V, Ullrich G, Thormann M, Müller NG, Friederichs C, Amthauer H, Heinze HJ, Bittner DM. Positive FP-CIT SPECT (DaTSCAN) in Clinical Alzheimer's Disease - An Unexpected Finding? Dement Geriatr Cogn Dis Extra 2011; 1:283-91. [PMID: 22545039 PMCID: PMC3235939 DOI: 10.1159/000330470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Clinically, Alzheimer's disease (AD) is by far the most common cause of dementia. Criteria for the diagnosis of dementia with Lewy bodies (DLB) are highly specific but not at all sensitive, which is reflected by the higher number of DLB cases detected histopathologically at autopsy. Imaging of dopamine transporter with FP-CIT SPECT is one possibility to increase sensitivity. Pathological confirmation was also included in the revised consensus criteria for the diagnosis of DLB. However, in the absence of parkinsonism, one of the core features, a clinical diagnosis of AD is more likely. The role of FP-CIT SPECT in DLB diagnosis remains to be clarified. Based on our 3 case reports and a review of the literature, the utility of this imaging method in the differential diagnosis of AD and DLB is highlighted.
Collapse
Affiliation(s)
- Verena Bittner
- Departments of Neurology, Magdeburg, University of Magdeburg, Magdeburg, Germany
| | | | | | | | | | | | | | | |
Collapse
|
146
|
Purz S, Mauz-Körholz C, Körholz D, Hasenclever D, Krausse A, Sorge I, Ruschke K, Stiefel M, Amthauer H, Schober O, Kranert WT, Weber WA, Haberkorn U, Hundsdörfer P, Ehlert K, Becker M, Rössler J, Kulozik AE, Sabri O, Kluge R. [18F]Fluorodeoxyglucose positron emission tomography for detection of bone marrow involvement in children and adolescents with Hodgkin's lymphoma. J Clin Oncol 2011; 29:3523-8. [PMID: 21825262 DOI: 10.1200/jco.2010.32.4996] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Currently, a routine bone marrow biopsy (BMB) is performed to detect bone marrow (BM) involvement in pediatric Hodgkin's lymphoma (HL) stage greater than IIA. [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) is increasingly used for the initial staging of HL. The value of using FDG-PET to detect BM involvement has not been sufficiently defined. We compared the results of BMBs and FDG-PET for the diagnosis of BM involvement in a large pediatric group with HL. PATIENTS AND METHODS The initial staging of 175 pediatric patients with newly diagnosed classical HL stage greater than IIA was determined by using BMB, FDG-PET, chest computed tomography (CT), and magnetic resonance imaging (MRI) or CT of the neck, abdomen, and pelvis. Staging images were prospectively evaluated by a central review board. Skeletal regions that were suggestive of BM involvement by either method were re-evaluated by using different imaging modalities. In suspicious cases, bone scintigraphy was performed. If follow-up FDG-PET scans were available, the remission of skeletal lesions during treatment was evaluated. RESULTS BMB results were positive in seven of 175 patients and were identified by FDG-PET. FDG-PET scans showed BM involvement in 45 patients. In addition, the lesions of 32 of these 45 patients had a typical multifocal pattern. In 38 of 39 follow-up positron emission tomography scans, most of the skeletal lesions disappeared after chemotherapy. There was no patient with skeletal findings suggestive of BM involvement by MRI or CT with a negative FDG-PET. CONCLUSION FDG-PET is a sensitive and specific method for the detection of BM involvement in pediatric HL. The sensitivity of a BMB appears compromised by the focal pattern of BM involvement. Thus, FDG-PET may safely be substituted for a BMB in routine staging procedures.
Collapse
Affiliation(s)
- Sandra Purz
- Department of Nuclear Medicine, University of Leipzig, Liebigstrasse 18, 04103 Leipzig, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
147
|
Seidensticker R, Denecke T, Kraus P, Seidensticker M, Mohnike K, Fahlke J, Kettner E, Hildebrandt B, Dudeck O, Pech M, Amthauer H, Ricke J. Matched-pair comparison of radioembolization plus best supportive care versus best supportive care alone for chemotherapy refractory liver-dominant colorectal metastases. Cardiovasc Intervent Radiol 2011; 35:1066-73. [PMID: 21800231 DOI: 10.1007/s00270-011-0234-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 07/14/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE This study was designed to evaluate overall survival after radioembolization or best supportive care (BSC) in patients with chemotherapy-refractory liver-dominant metastatic colorectal cancer (mCRC). METHODS This was a matched-pair comparison of patients who received radioembolization plus BSC or BSC alone for extensive liver disease. Twenty-nine patients who received radioembolization were retrospectively matched with a contemporary cohort of >500 patients who received BSC from 3 centers in Germany. Using clinical databases, patients were initially matched for prior treatments and tumor burden and then 29 patients were consecutively identified with two or more of four matching criteria: synchronous/metachronous metastases, tumor burden, increased ALP, and/or CEA >200 U/ml. Survival was calculated from date of progression before radioembolization or BSC by using Kaplan-Meier analysis. RESULTS Of 29 patients in each study arm, 16 pairs (55.2%) matched for all four criteria, and 11 pairs (37.9%) matched three criteria. Patients in both groups had a similar performance status (Karnofsky index, median 80% [range, 60-100%]). Compared with BSC alone, radioembolization prolonged survival (median, 8.3 vs. 3.5 months; P < 0.001) with a hazard ratio of 0.3 (95% confidence interval, 0.16-0.55; P < 0.001) in a multivariate Cox proportional hazard model. Treatment-related adverse events following radioembolization included: grade 1-2 fatigue (n = 20, 69%), grade 1 abdominal pain/nausea (n = 14, 48.3%), and grade 2 gastrointestinal ulceration (n = 3, 10.3%). Three cases of grade 3 radiation-induced liver disease were symptomatically managed. CONCLUSIONS Radioembolization offers a promising addition to BSC in treatment-refractory patients for whom there are limited options. Survival was prolonged and adverse events were generally mild-to-moderate in nature and manageable.
Collapse
Affiliation(s)
- Ricarda Seidensticker
- Universitätsklinikum Magdeburg, Klinik für Radiologie & Nuklearmedizin, Magdeburg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
148
|
Ricke J, Schuette K, Graziadei IW, Jakob A, Verslype C, Sangro B, Walecki J, Klümpen HJ, Peynircioglu B, Yalcin S, Bartolozzi C, Amthauer H, Malfertheiner P. Evaluation of sorafenib in combination with local microtherapy guided by gadolinium-EOB-DTPA enhanced MRI in patients with inoperable hepatocellular carcinoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
149
|
Ruf J, Schiefer J, Furth C, Kosiek O, Kropf S, Heuck F, Denecke T, Pavel M, Pascher A, Wiedenmann B, Amthauer H. 68Ga-DOTATOC PET/CT of Neuroendocrine Tumors: Spotlight on the CT Phases of a Triple-Phase Protocol. J Nucl Med 2011; 52:697-704. [DOI: 10.2967/jnumed.110.083741] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
|
150
|
Ulrich G, Zeile M, Großer OS, Ruf J, Seidensticker R, Zarva A, Pech M, Ricke J, Amthauer H, Dudeck O. Prognostische Bedeutung des intratumoralen Uptakes von Tc-99m-MAA vor transarterieller Radioembolisation (TARE) bei hepatisch metastasiertem kolorektalem Karzinom. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|