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Fukai S, Daisaki H, Umeda T, Shimada N, Terauchi T, Koizumi M. Evaluation of two-dimensional total bone uptake (2D-TBU) and bone scan index (BSI) extracted from active bone metastatic burden on the bone scintigraphy in patients with radium-223 treatment. Ann Nucl Med 2024; 38:450-459. [PMID: 38517659 DOI: 10.1007/s12149-024-01918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/25/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Radium-223 is a first alpha-emitting radionuclide treatment for metastatic castration-resistant prostate cancer (mCRPC) patients with bone metastases. Although the spread-based bone scan index (BSI) and novel index of the intensity-based two-dimensional total bone uptake (2D-TBU) from bone scintigraphy may provide useful input in radium-223 treatment, they have not been evaluated in detail yet. This study aimed to fill this gap by evaluating BSI and 2D-TBU in patients treated with radium-223. METHODS Twenty-seven Japanese patients with mCRPC treated with radium-223 were retrospectively analyzed. The patients were evaluated via blood tests and bone scans at baseline and 3 cycles intervals of treatment. BSI and 2D-TBU were analyzed via VSBONE BSI in terms of correlations, response to radium-223 treatment, association with treatment completion, and the Kaplan-Meier survival analysis was performed. RESULTS Nineteen patients (70.4%) completed six cycles of radium-223 treatment, whereas eight patients (29.6%) did not complete the treatment regimen. A significant difference in baseline BSI and 2D-TBU was observed between these groups of patients. Both BSI and 2D-TBU were highly correlated (r = 0.96, p < 0.001). Univariate analysis showed an association between radium-223 completion in median BSI and 2D-TBU values (p = 0.015) and completion percentage differences (91.7% vs. 45.5%; p = 0.027). The Kaplan-Meier product limit estimator showed that the median overall survival was 25.2 months (95% CI 14.0-33.6 months) in the completion group and 7.5 months (95% CI 3.3-14.2 months) in the without completion group (p < 0.001). The overall survival based on median cutoff levels showed a significant difference in 2D-TBU (p = 0.007), but not in BSI (p = 0.15). CONCLUSIONS The 2D-TBU may offer advantages over BSI in classifying patients towards radium-223 treatment based on the degree of progression of bone metastases. This study supports the importance of preliminary assessment of bone metastasis status using BSI and 2D-TBU extracted from VSBONE BSI for radium-223 treatment decisions.
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Affiliation(s)
- Shohei Fukai
- Department of Nuclear Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
- Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, 323-1 Kamioki-machi, Maebashi, Gunma, 371-0052, Japan.
| | - Hiromitsu Daisaki
- Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, 323-1 Kamioki-machi, Maebashi, Gunma, 371-0052, Japan
| | - Takuro Umeda
- Department of Nuclear Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Naoki Shimada
- Department of Nuclear Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takashi Terauchi
- Department of Nuclear Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Mitsuru Koizumi
- Department of Nuclear Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Lu HH, Chiu NT, Tsai MH. Increase of prostate-specific antigen doubling time predicts survival in metastatic castration-resistant prostate cancer patients undergoing radium therapy. Ann Nucl Med 2024:10.1007/s12149-024-01924-6. [PMID: 38647876 DOI: 10.1007/s12149-024-01924-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/13/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Radium-223 (Ra-223) is an important treatment modality for bone-dominant metastatic castration-resistant prostate cancer (mCRPC). However, there is currently a lack of effective markers to monitor treatment response during treatment. We aim to investigate the response in prostate-specific antigen doubling time (PSADT) as a potential marker for assessing Ra-223 treatment in mCRPC patients. METHODS We retrospectively collected data from mCRPC patients who underwent radium treatment at our institution between August 2020 and June 2023. Prostate-specific antigen (PSA) measurements prior to treatment and during treatment were collected. Baseline PSADT was calculated from PSA measurements prior to Ra-223 treatment; interim PSADT was calculated from PSA measurements before Ra-223 treatment and prior to the fourth course injection. Overall survival was calculated from the start of treatment to the date of death. Univariable and multivariable analysis using the Cox proportional hazards model were performed to examine the association of factors with overall survival. RESULTS We included 35 patients from our institution, with a median overall survival of 13.3 months. Eighteen (51.4%) completed all six courses of treatment. PSA dynamic response (interim PSADT > baseline PSADT or decreased PSA) was observed in 20 patients. Overall survival was associated with a PSA dynamic response (HR = 0.318, 95% CI 0.133-0.762, p = 0.010) when compared to patients without response. CONCLUSIONS Dynamic changes in PSADT were associated with survival in mCRPC patients receiving radium therapy. Comparing interim and baseline PSADT could serve as a valuable marker for determining treatment benefits.
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Affiliation(s)
- Hsi-Huei Lu
- Division of Nuclear Medicine, Department of Medical Imaging, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Nan-Tsing Chiu
- Division of Nuclear Medicine, Department of Medical Imaging, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Mu-Hung Tsai
- Department of Radiation Oncology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
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Pereira WDP, Carvalheira L, Lopes JM, Aguiar PFD, Moreira RM, Oliveira ECD. Data reconciliation connected to guard bands to set specification limits related to risk assessment for radiopharmaceutical activity. Heliyon 2023; 9:e22992. [PMID: 38125475 PMCID: PMC10731080 DOI: 10.1016/j.heliyon.2023.e22992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Radiopharmaceuticals have been used to diagnose several diseases, particularly because the procedure is non-invasive. However, it is important that the correct amount of radiopharmaceutical is used to avoid inaccurate diagnostic results and suboptimal therapeutic outcomes. The amount of the radiopharmaceutical is measured when produced (by the supplier) and a second time (by the receiver), before it's use. When measured at the receiver, the result is corrected for its normal radioactivity decay. Even then, it is possible that both measurements should be considered nominal different or even statistically different when compared through various statistical tools. This research combines two innovative techniques in the field of clinical metrology. The first technique is data reconciliation, which not only enhances measurement accuracy but also reduces measurement uncertainty. The second technique involves using uncertainty information to establish specification limits for compliance assessments. In this way, our proposal aimed to minimize the risk of making incorrect decisions regarding the conformity of the concentration of radiopharmaceutical activity, that is, rejecting an item or batch that is within specification or accepting an item or batch that is outside of specification. A spreadsheet, based on these metrology fundamentals, is available to help the user with the calculations, presenting numerical and graphical results for some common radioisotopes. Reliable specification limits can be calculated and used to determine if the radiopharmaceutical is in accordance with its proposed application.
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Affiliation(s)
| | - Luciana Carvalheira
- Argonauta Reactor Service, Nuclear Engineering Institute, R. Hélio de Almeida 75, 21941-614, Rio de Janeiro, Brazil
| | - José Marques Lopes
- Earth and Environmental Physics Department, Physics Institute, Federal University of Bahia, Campus Universitário de Ondina, 40210-340, Salvador, Brazil
- Postgraduate Program in Geochemistry, Petroleum and Environment (POSPETRO), Federal University of Bahia, Av. Milton Santos s/n°, Salvador, 40170-110, Brazil
| | - Paula Fernandes de Aguiar
- Federal University of Rio de Janeiro, Chemistry Institute, Avenida Athos da Silveira Ramos 149, 21941-909, Rio de Janeiro, Brazil
| | - Rosana Medeiros Moreira
- National Institute of Technology, Av. Venezuela 82 20081-312, Rio de Janeiro, Brazil
- National Institute of Metrology, Quality and Technology (INMETRO), Av. Nossa Senhora das Graças 50, 25250-020, Duque de Caxias, Brazil
| | - Elcio Cruz de Oliveira
- Postgraduate Programme in Metrology, Pontifical Catholic University of Rio de Janeiro, R. Marquês de São Vicente 225, 22451-900, Rio de Janeiro, Brazil
- Logistics, Operational Planning and Control, Measurement and Product Inventory Management, PETROBRAS S.A., Av. Henrique Valadares 28, 20231-030, Rio de Janeiro, Brazil
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Che WQ, Li YJ, Tsang CK, Wang YJ, Chen Z, Wang XY, Xu AD, Lyu J. How to use the Surveillance, Epidemiology, and End Results (SEER) data: research design and methodology. Mil Med Res 2023; 10:50. [PMID: 37899480 PMCID: PMC10614369 DOI: 10.1186/s40779-023-00488-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023] Open
Abstract
In the United States (US), the Surveillance, Epidemiology, and End Results (SEER) program is the only comprehensive source of population-based information that includes stage of cancer at the time of diagnosis and patient survival data. This program aims to provide a database about cancer incidence and survival for studies of surveillance and the development of analytical and methodological tools in the cancer field. Currently, the SEER program covers approximately half of the total cancer patients in the US. A growing number of clinical studies have applied the SEER database in various aspects. However, the intrinsic features of the SEER database, such as the huge data volume and complexity of data types, have hindered its application. In this review, we provided a systematic overview of the commonly used methodologies and study designs for retrospective epidemiological research in order to illustrate the application of the SEER database. Therefore, the goal of this review is to assist researchers in the selection of appropriate methods and study designs for enhancing the robustness and reliability of clinical studies by mining the SEER database.
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Affiliation(s)
- Wen-Qiang Che
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
- Department of Clinical Research, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Yuan-Jie Li
- Planning & Discipline Construction Office, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Chi-Kwan Tsang
- Clinical Neuroscience Institute, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Yu-Jiao Wang
- Department of Pathology, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Zheng Chen
- Department of Urology, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Xiang-Yu Wang
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
| | - An-Ding Xu
- Department of Neurology, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
| | - Jun Lyu
- Department of Clinical Research, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, 510632, China.
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Kitajima K, Kuyama J, Kawahara T, Suga T, Otani T, Sugawara S, Kono Y, Tamaki Y, Seko-Nitta A, Ishiwata Y, Ito K, Toriihara A, Watanabe S, Hosono M, Miyake H, Yamamoto S, Sasaki R, Narita M, Yamakado K. Assessing Therapeutic Response to Radium-223 with an Automated Bone Scan Index among Metastatic Castration-Resistant Prostate Cancer Patients: Data from Patients in the J-RAP-BSI Trial. Cancers (Basel) 2023; 15:2784. [PMID: 37345121 DOI: 10.3390/cancers15102784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023] Open
Abstract
To evaluate the usefulness of change in the automated bone scan index (aBSI) value derived from bone scintigraphy findings as an imaging biomarker for the assessment of treatment response and survival prediction in metastatic castration-resistant prostate cancer (mCRPC) patients treated with Ra-223. This study was a retrospective investigation of a Japanese cohort of 205 mCRPC patients who received Ra-223 in 14 hospitals between July 2016 and August 2020 and for whom bone scintigraphy before and after radium-223 treatment was available. Correlations of aBSI change, with changes in the serum markers alkaline phosphatase (ALP) and prostate-specific antigen (PSA) were evaluated. Additionally, the association of those changes with overall survival (OS) was assessed using the Cox proportional-hazards model and Kaplan-Meier curve results. Of the 205 patients enrolled, 165 (80.5%) completed six cycles of Ra-223. Following treatment, ALP decline (%ALP < 0%) was noted in 72.2% (148/205), aBSI decline (%aBSI < 0%) in 52.7% (108/205), and PSA decline (%PSA < 0%) in 27.8% (57/205). Furthermore, a reduction in both aBSI and ALP was seen in 87 (42.4%), a reduction in only ALP was seen in 61 (29.8%), a reduction in only aBSI was seen in 21 (10.2%), and in both aBSI and ALP increasing/stable (≥0%) was seen in 36 (17.6%) patients. Multiparametric analysis showed changes in PSA [hazard ratio (HR) 4.30, 95% confidence interval (CI) 2.32-8.77, p < 0.0001], aBSI (HR 2.22, 95%CI 1.43-3.59, p = 0.0003), and ALP (HR 2.06, 95%CI 1.35-3.14, p = 0.0008) as significant prognostic factors for OS. For mCRPC patients treated with Ra-223, aBSI change is useful as an imaging biomarker for treatment response assessment and survival prediction.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Hyogo Medical University, Hyogo 663-8131, Japan
| | - Junpei Kuyama
- Nuclear Medicine, Chiba Cancer Center, Chiba 260-8717, Japan
| | - Takashi Kawahara
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Kanagawa 232-0024, Japan
| | - Tsuyoshi Suga
- Department of Radiology, Kobe City Medical Center General Hospital, Hyogo 650-0047, Japan
| | - Tomoaki Otani
- Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8303, Japan
| | - Shigeyasu Sugawara
- Advanced Clinical Research Center, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Yumiko Kono
- Department of Radiology, Kansai Medical University, Osaka 573-1191, Japan
| | - Yukihisa Tamaki
- Department of Radiation Oncology, Faculty of Medicine, Shimane University, Shimane 693-0021, Japan
| | - Ayumi Seko-Nitta
- Department of Radiology, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Yoshinobu Ishiwata
- Department of Radiology, Yokohama City University Hospital, Kanagawa 236-0004, Japan
| | - Kimiteru Ito
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Akira Toriihara
- PET Imaging Center, Asahi General Hospital, Toyama, 939-0741, Japan
| | - Shiro Watanabe
- Department of Nuclear Medicine, Hokkaido University Hospital, Hokkaido 060-8648, Japan
| | - Makoto Hosono
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osaka 577-8502, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Shizuoka 431-3125, Japan
| | - Shingo Yamamoto
- Department of Urology, Hyogo Medical University, Hyogo 663-8131, Japan
| | - Ryohei Sasaki
- Department of Radiation Oncology, Graduate School of Medicine, Kobe University, Hyogo 650-0017, Japan
| | - Mitsuhiro Narita
- Department of Urology, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo Medical University, Hyogo 663-8131, Japan
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De Feo MS, Frantellizzi V, Bauckneht M, Farcomeni A, Filippi L, Rizzini EL, Lavelli V, Stazza ML, Di Raimondo T, Fornarini G, Rebuzzi SE, Filippo M, Mammucci P, Marongiu A, Monari F, Rubini G, Spanu A, De Vincentis G. The DASciS Software for BSI Calculation as a Valuable Prognostic Tool in mCRPC Treated with 223RaCl2: A Multicenter Italian Study. Biomedicines 2023; 11:biomedicines11041103. [PMID: 37189721 DOI: 10.3390/biomedicines11041103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND/AIM Radium-223 dichloride (223RaCl2) represents a therapeutic option for metastatic castration-resistant prostate cancer (mCRPC) patients dealing with symptomatic bone metastases. The identification of baseline variables potentially affecting the life-prolonging role of 223RaCl2 is still ongoing. Bone scan index (BSI) defines the total load of bone metastatic disease detected on a bone scan (BS) and is expressed as a percentage value of the whole bone mass. The aim of this multicenter study was to assess the impact of baseline BSI on overall survival (OS) in mCRPC patients treated with 223RaCl2. For this purpose, the DASciS software developed by the Sapienza University of Rome for BSI calculation was shared between six Italian Nuclear Medicine Units. METHODS 370 pre-treatment BS were analyzed through the DASciS software. Other clinical variables relevant to OS analysis were taken into account for the statistical analysis. RESULTS Of a total of 370 patients, 326 subjects had died at the time of our retrospective analysis. The median OS time from the first cycle of 223RaCl2 to the date of death from any cause or last contact was 13 months (95%CI 12-14 months). The mean BSI value resulted in 2.98% ± 2.42. The center-adjusted univariate analysis showed that baseline BSI was significantly associated with OS as an independent risk factor (HR 1.137, 95%CI: 1.052-1.230, p = 0.001), meaning that patients with higher BSI values had worse OS. When adjusting for other measures on multivariate analysis, in addition to Gleason score and baseline values of Hb, tALP, and PSA, baseline BSI was confirmed to be a statistically significant parameter (HR 1.054, 95%CI: 1.040-1.068, p < 0.001). CONCLUSIONS Baseline BSI significantly predicts OS in mCRPC treated with 223RaCl2. The DASciS software was revealed to be a valuable tool for BSI calculation, showing rapid processing time and requiring no more than a single demonstrative training for each participating center.
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Affiliation(s)
- Maria Silvia De Feo
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy
| | - Viviana Frantellizzi
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy
| | - Matteo Bauckneht
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Alessio Farcomeni
- Department of Economics & Finance, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Luca Filippi
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, 04100 Latina, Italy
| | - Elisa Lodi Rizzini
- Radiation Oncology, IRCSS Azienza Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Valentina Lavelli
- Nuclear Medicine Section, Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Maria Lina Stazza
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Tania Di Raimondo
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Sara Elena Rebuzzi
- Medical Oncology, Ospedale San Paolo, 17100 Savona, Italy
- Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, 16132 Genova, Italy
| | - Mammini Filippo
- Radiation Oncology, IRCSS Azienza Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Radiation Oncology, Department of Medical and Surgical Siences (DIMEC), Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Paolo Mammucci
- Nuclear Medicine Section, Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Andrea Marongiu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Fabio Monari
- Radiation Oncology, IRCSS Azienza Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Radiation Oncology, Department of Medical and Surgical Siences (DIMEC), Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Giuseppe Rubini
- Nuclear Medicine Section, Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy
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