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Lee SY, Kingham TP, LaGratta MD, Jessurun J, Cherqui D, Jarnagin WR, Kluger MD. PET-avid hepatocellular adenomas: incidental findings associated with HNF1-α mutated lesions. HPB (Oxford) 2016; 18:41-8. [PMID: 26776850 PMCID: PMC4750225 DOI: 10.1016/j.hpb.2015.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatocellular adenoma (HCA) is the second most common benign liver neoplasm and occurs predominantly in women in their reproductive years. Positron emission tomography (PET) using [18F] fluorodeoxyglucose (FDG) is commonly used in cancer staging, surveillance and evaluation of treatment response. PET-avid HCA are rare and can be falsely interpreted as malignancies. METHODS A retrospective review of four institutions' database was performed to identify the PET-avid HCAs with clinico-pathological correlation. RESULTS Nine patients with histological proven PET-avid HCA was identified. Eight out of 9 patients were female with a median age at diagnosis of 44 years. All patients' tumors with available histological subtyping (8/8) were HNF1-α mutated and had no inflammatory changes; 6 out the 9 lesions had prominent (>50%) steatotic changes. CONCLUSION Hepatocellular adenomas, specifically the HNF1-α subtype, can cause false-positive PET findings when seeking to identify malignancy. Concomitantly, PET-CT may have the potential to identify the HCA histopathologic variant with the lowest malignant and hemorrhagic potential.
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Affiliation(s)
- Ser Yee Lee
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States,Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
| | - Maria D. LaGratta
- New York-Presbyterian Hospital – Weill Cornell Medical Center, Diagnostic Radiology, 1305 York Avenue, New York, NY 10021, United States
| | - Jose Jessurun
- New York Presbyterian Hospital – Weill Cornell Medical College, Surgical Pathology, 525 East 68th Street, New York, NY 10065, United States
| | - Daniel Cherqui
- Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - William R. Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
| | - Michael D. Kluger
- New York Presbyterian Hospital Columbia Presbyterian Medical Center, Department of Surgery, 161 Fort Washington Avenue 823, New York, NY 10024, United States,Correspondence Michael D. Kluger, New York Presbyterian Hospital Columbia Presbyterian Medical Center, Department of Surgery, 161 Fort Washington Avenue 823, New York, NY 10024, United States.
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Lee SY, Kingham TP, LaGratta MD, Jessurun J, Cherqui D, Jarnagin WR, Kluger MD. PET-avid hepatocellular adenomas: incidental findings associated with HNF1-α mutated lesions. HPB (Oxford) 2015:n/a-n/a. [PMID: 26472264 DOI: 10.1111/hpb.12489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/07/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatocellular adenoma (HCA) is the second most common benign liver neoplasm and occurs predominantly in women in their reproductive years. Positron-emission tomography (PET) using [18F] fluorodeoxyglucose (FDG) is commonly used in cancer staging, surveillance and evaluation of the treatment response. PET-avid HCA is rare and can be falsely interpreted as malignancies. METHODS A retrospective review of four institutions' database was performed to identify the PET-avid HCAs with clinico-pathological correlation. RESULTS Nine patients with histological proven PET-avid HCA was identified. Eight out of nine patients were female with a median age at diagnosis of 44 years. All patients' tumours with available histological subtyping (8/8) were HNF1-α mutated and had no inflammatory changes; six out the nine lesions had prominent (>50%) steatotic changes. CONCLUSION Hepatocellular adenomas, specifically the HNF1-α subtype, can cause false-positive PET findings when seeking to identify malignancy. Concomitantly, PET-CT may have the potential to identify the HCA histopathological variant with the lowest malignant and haemorrhagic potential.
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Affiliation(s)
- Ser Yee Lee
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, New York Presbyterian Hospital Weill-Cornell Medical Center, New York, NY, USA
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria D LaGratta
- Diagnostic Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Jose Jessurun
- Surgical Pathology, New York Presbyterian Hospital - Weill Cornell Medical College, New York, NY, USA
| | - Daniel Cherqui
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, New York Presbyterian Hospital Weill-Cornell Medical Center, New York, NY, USA
- Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael D Kluger
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, New York Presbyterian Hospital Weill-Cornell Medical Center, New York, NY, USA
- Department of Surgery, New York Presbyterian Hospital Columbia Presbyterian Medical Center, New York, NY, USA
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Shin J, Choi Y, Kim J, Yu AR, Shin JS, Choi YY, Roh J. High doses of caffeine reduce in vivo osteogenic activity in prepubertal rats. J Anat 2015; 227:10-20. [PMID: 26041429 DOI: 10.1111/joa.12332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/27/2022] Open
Abstract
Caffeine adversely affects endochondral ossification during fetal skeletal growth, and results in increased incidence of delayed and abnormal fetal skeletal development. Chronic caffeine intake also decreases growth hormone secretion. Thus, it is conceivable that caffeine may disrupt bone growth during the peripubertal period. This study aimed to investigate the impact of high-caffeine consumption on bone growth throughout puberty. A total of 51 male rats (21 days old) were divided randomly into three groups: a control group and two groups fed caffeine via gavage with 120 and 180 mg kg(-1) day(-1) for 4 weeks. After death, the final length and weight of leg bones were measured, and the tibia processed for histomorphometric analysis. Caffeine caused a significant decrease in body mass gain. This was accompanied with proportional decreases in lean body mass and body fat. In addition, bone mass and osteogenic activity in vivo were assessed using dual-energy X-ray absorptiometry and (18) F-NaF positron emission tomography. The results showed significant decreases of bone mass and in vivo osteogenic activity in the caffeine-fed groups. Rats fed with caffeine showed a significantly shorter and lighter tibia and femur and the vertebral column compared with controls. In addition, caffeine does not increase the width of the growth plates (GPs), it slows the rate at which the GP closes due to a slower rate of growth. These results demonstrated that caffeine altered osteogenic activity, leading to delayed peripubertal longitudinal bone growth and maturation. Given that osteogenic cells undergo dynamic changes in metabolic activity and that the pubertal growth spurt is mainly stimulated by growth hormone/insulin-like growth factor-1 and sex steroids during pubertal development, caffeine could suppress ossification by interfering with both physiological changes in hormonal secretion and osteogenic activity during this critical period. Further study will be needed to investigate the cellular/molecular mechanism by which caffeine affects osteogenesis using in vitro experimental models.
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Affiliation(s)
- Jiwon Shin
- Laboratory of Reproductive Endocrinology, Department of Anatomy & Cell Biology, College of Medicine, Hanyang University, Seoul, Korea
| | - Yuri Choi
- Laboratory of Reproductive Endocrinology, Department of Anatomy & Cell Biology, College of Medicine, Hanyang University, Seoul, Korea
| | - Jisook Kim
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Korea
| | - A-Ram Yu
- Department of Nuclear Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Ji-Soo Shin
- Laboratory of Reproductive Endocrinology, Department of Anatomy & Cell Biology, College of Medicine, Hanyang University, Seoul, Korea
| | - Yun-Young Choi
- Department of Nuclear Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Jaesook Roh
- Laboratory of Reproductive Endocrinology, Department of Anatomy & Cell Biology, College of Medicine, Hanyang University, Seoul, Korea
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Cherry SR. Fundamentals of Positron Emission Tomography and Applications in Preclinical Drug Development. J Clin Pharmacol 2013; 41:482-91. [PMID: 11361044 DOI: 10.1177/00912700122010357] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Positron emission tomography (PET) is a nuclear imaging technique that can dynamically image trace amounts of positron-labeled radiopharmaceuticals in vivo. Tracer concentrations can be determined quantitatively, and by application of appropriate tracer kinetic models, the rates of a wide range of different biological processes can be measured noninvasively in humans. PET has been used as a research tool for more than 25 years and has also found clinical applications, particularly in oncology, neurological disorders, and cardiovascular disease. Recently, there has been tremendous interest in applying PET technology to in vivo small-animal imaging. Significant improvements in the imaging technology now permit a wide range of PET studies in mice and rats, using compact, relatively low-cost, dedicated small-animal PET scanners. This article reviews the fundamental basis of PET imaging and discusses the development of small-animal PET scanners and their possible application in preclinical drug development.
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Affiliation(s)
- S R Cherry
- Crump Institute for Molecular Imaging and Department of Molecular and Medical Pharmacology, UCLA School of Medicine, Los Angeles, California, 90095-1770, USA
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Lee SJ, Oh SJ, Kim JY, Ryu JS, Kim SY, Moon DH. Synthesis and In vitro Evaluation of 99mTc-diglucosediethylenetriamine (DGTA) as a Potential Tumor Imaging Agent. B KOREAN CHEM SOC 2011. [DOI: 10.5012/bkcs.2011.32.7.2410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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High-glycolytic cancers and their interplay with the body’s glucose demand and supply cycle. Med Hypotheses 2011; 76:157-65. [DOI: 10.1016/j.mehy.2010.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 08/23/2010] [Accepted: 09/05/2010] [Indexed: 12/12/2022]
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Schiepers C, Dahlbom M. Molecular imaging in oncology: the acceptance of PET/CT and the emergence of MR/PET imaging. Eur Radiol 2010; 21:548-54. [PMID: 21174096 PMCID: PMC3032196 DOI: 10.1007/s00330-010-2033-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 12/02/2010] [Indexed: 01/11/2023]
Abstract
In the last decade, PET-only systems have been phased out and replaced with PET-CT systems. This merger of a functional and anatomical imaging modality turned out to be extremely useful in clinical practice. Currently, PET-CT is a major diagnostic tool in oncology. At the dawn of the merger of MRI and PET, another breakthrough in clinical imaging is expected. The combination of these imaging modalities is challenging, but has particular features such as imaging biological processes at the same time in specific body locations.
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Affiliation(s)
- Christiaan Schiepers
- Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, 200 Medical Plaza, Suite B-114, Los Angeles, CA 90095-7370 USA
| | - Magnus Dahlbom
- Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, 200 Medical Plaza, Suite B-114, Los Angeles, CA 90095-7370 USA
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Salem N, Balkman JD, Wang J, Wilson DL, Lee Z, King CL, Basilion JP. In vivo imaging of schistosomes to assess disease burden using positron emission tomography (PET). PLoS Negl Trop Dis 2010; 4:e827. [PMID: 20877718 PMCID: PMC2943464 DOI: 10.1371/journal.pntd.0000827] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 08/20/2010] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Schistosomes are chronic intravascular helminth parasites of humans causing a heavy burden of disease worldwide. Diagnosis of schistosomiasis currently requires the detection of schistosome eggs in the feces and urine of infected individuals. This method unreliably measures disease burden due to poor sensitivity and wide variances in egg shedding. In vivo imaging of schistosome parasites could potentially better assess disease burden, improve management of schistosomiasis, facilitate vaccine development, and enhance study of the parasite's biology. Schistosoma mansoni (S. mansoni) have a high metabolic demand for glucose. In this work we investigated whether the parasite burden in mice could be assessed by positron emission tomography (PET) imaging with 2-deoxy-2[(18)F]fluoro-D-glucose (FDG). METHODOLOGY/PRINCIPAL FINDINGS Live adult S. mansoni worms FDG uptake in vitro increased with the number of worms. Athymic nude mice infected with S. mansoni 5-6 weeks earlier were used in the imaging studies. Fluorescence molecular tomography (FMT) imaging with Prosense 680 was first performed. Accumulation of the imaging probe in the lower abdomen correlated with the number of worms in mice with low infection burden. The total FDG uptake in the common portal vein and/or regions of elevated FDG uptake in the liver linearly correlated to the number of worms recovered from infected animals (R(2) =0.58, P<0.001, n = 40). FDG uptake showed a stronger correlation with the worm burden in mice with more than 50 worms (R(2) = 0.85, P<0.001, n = 17). Cryomicrotome imaging confirmed that most of the worms in a mouse with a high infection burden were in the portal vein, but not in a mouse with a low infection burden. FDG uptake in recovered worms measured by well counting closely correlated with worm number (R(2) = 0.85, P<0.001, n = 21). Infected mice showed a 32% average decrease in total FDG uptake after three days of praziquantel treatment (P = 0.12). The total FDG uptake in untreated mice increased on average by 36% over the same period (P = 0.052). CONCLUSION FDG PET may be useful to non-invasively quantify the worm burden in schistosomiasis-infected animals. Future investigations aiming at minimizing non-specific FDG uptake and to improve the recovery of signal from worms located in the lower abdomen will include the development of more specific radiotracers.
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Affiliation(s)
- Nicolas Salem
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Jason D. Balkman
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
| | - Jing Wang
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - David L. Wilson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Zhenghong Lee
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Christopher L. King
- Center for Global Health and Disease, Case Western Reserve University, Cleveland, Ohio, United States of America
- Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - James P. Basilion
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America
- NFCR Center for Molecular Imaging, Case Western Reserve University, Cleveland, Ohio, United States of America
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Watanabe H, Kanematsu M, Kondo H, Kako N, Yamamoto N, Yamada T, Goshima S, Hoshi H, Bae KT. Preoperative detection of prostate cancer: A comparison with 11C-choline PET, 18F-fluorodeoxyglucose PET and MR imaging. J Magn Reson Imaging 2010; 31:1151-6. [DOI: 10.1002/jmri.22157] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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C-11 acetate does not enhance usefulness of F-18 FDG PET/CT in differentiating between focal nodular hyperplasia and hepatic adenoma. Clin Nucl Med 2010; 34:659-65. [PMID: 19893396 DOI: 10.1097/rlu.0b013e3181b53488] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF THE REPORT We assessed the usefulness of F-18 fluorodeoxyglucose positron emission tomography (FDG PET) and C-11 acetate PET (AC PET) in distinguishing hepatic lesions due to consequential disease (hepatocellular adenoma and malignant lesions) from focal nodular hyperplasia (FNH) in patients at low risk of malignancy. MATERIALS AND METHODS Thirty-one patients with 43 lesions were prospectively enrolled. The diagnostic work-up included Doppler and contrast-enhanced ultrasonography, contrast-enhanced computed tomography, and/or magnetic resonance imaging. Fine needle biopsy was performed if the imaging study was inconclusive. The work-up revealed 36 FNH and 7 consequential lesions (5 hepatocellular adenoma, 1 hepatoma, and 1 metastasis). All patients underwent FDG and AC PET. FDG PET with target/background ratio (T/Br) greater than 1.2 and AC PET with T/Br of less than 1.2 were considered positive test for consequential disease. RESULTS On FDG PET, we had 6 true-positive out of 7 lesions due to consequential diseases, with a sensitivity of 85.7%, and 33 true-negative out of 36 lesions with FNH, with a specificity of 91.7%. Using AC PET, there were 2 true-positive lesions out of 7 caused by neoplasms, with a sensitivity of 28.6%, and 34 true-negative lesions out of 36 FNH, with a specificity of 94.4%. CONCLUSIONS When the goal is differentiating FNH from liver neoplasms, AC PET offered no additional diagnostic advantage over what is achieved with FDG PET.
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García Garzón J, Rodríguez A, Cabrera A. Tomografía por emisión de positrones de cuerpo completo (PET/TAC) con 18F-fluorodesoxiglucosa. ACTA ACUST UNITED AC 2009; 28:85-9. [DOI: 10.1016/s0212-6982(09)70706-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
In early studies on energy metabolism of tumor cells, it was proposed that the enhanced glycolysis was induced by a decreased oxidative phosphorylation. Since then it has been indiscriminately applied to all types of tumor cells that the ATP supply is mainly or only provided by glycolysis, without an appropriate experimental evaluation. In this review, the different genetic and biochemical mechanisms by which tumor cells achieve an enhanced glycolytic flux are analyzed. Furthermore, the proposed mechanisms that arguably lead to a decreased oxidative phosphorylation in tumor cells are discussed. As the O(2) concentration in hypoxic regions of tumors seems not to be limiting for the functioning of oxidative phosphorylation, this pathway is re-evaluated regarding oxidizable substrate utilization and its contribution to ATP supply versus glycolysis. In the tumor cell lines where the oxidative metabolism prevails over the glycolytic metabolism for ATP supply, the flux control distribution of both pathways is described. The effect of glycolytic and mitochondrial drugs on tumor energy metabolism and cellular proliferation is described and discussed. Similarly, the energy metabolic changes associated with inherent and acquired resistance to radiotherapy and chemotherapy of tumor cells, and those determined by positron emission tomography, are revised. It is proposed that energy metabolism may be an alternative therapeutic target for both hypoxic (glycolytic) and oxidative tumors.
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Affiliation(s)
- Rafael Moreno-Sánchez
- Instituto Nacional de Cardiología, Departamento de Bioquímica, Juan Badiano no. 1, Tlalpan, México DF 14080, Mexico.
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Chignola R, Milotti E. A phenomenological approach to the simulation of metabolism and proliferation dynamics of large tumour cell populations. Phys Biol 2007; 2:8-22. [PMID: 16204852 DOI: 10.1088/1478-3967/2/1/002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A major goal of modern computational biology is to simulate the collective behaviour of large cell populations starting from the intricate web of molecular interactions occurring at the microscopic level. In this paper we describe a simplified model of cell metabolism, growth and proliferation, suitable for inclusion in a multicell simulator, now under development (Chignola R and Milotti E 2004 Physica A 338 261-6). Nutrients regulate the proliferation dynamics of tumour cells which adapt their behaviour to respond to changes in the biochemical composition of the environment. This modelling of nutrient metabolism and cell cycle at a mesoscopic scale level leads to a continuous flow of information between the two disparate spatiotemporal scales of molecular and cellular dynamics that can be simulated with modern computers and tested experimentally.
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Affiliation(s)
- Roberto Chignola
- Dipartimento Scientifico e Tecnologico, Università di Verona and Istituto Nazionale di Fisica Nucleare, Sezione di Trieste-Strada Le Grazie, 15-CV1, I-37134 Verona, Italy.
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Donaldson MJ, Pulido JS, Mullan BP, Inwards DJ, Cantrill H, Johnson MR, Han MK. Combined positron emission tomography/computed tomography for evaluation of presumed choroidal metastases. Clin Exp Ophthalmol 2006; 34:846-51. [PMID: 17181615 DOI: 10.1111/j.1442-9071.2006.01364.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Choroidal metastases are the most common intraocular malignancy and are the first sign of systemic malignancy in approximately one-third of patients. Of patients with no previous diagnosis of cancer, oncological evaluation fails to find the primary lesion in approximately 50% of cases. Newer imaging modalities such as combined positron emission tomography/computed tomography (PET/CT) may improve the yield of the systemic work-up. METHODS Consecutive patients presenting with presumed choroidal metastases were evaluated with whole body combined PET/CT scanning. RESULTS Four patients presenting to a tertiary referral hospital with choroidal metastases as the first sign of systemic malignancy were evaluated. In all four cases, PET/CT demonstrated the ocular lesion, and the primary malignancy which was confirmed by tissue biopsy. False-negative results were seen in two cases of cerebral metastases. PET/CT demonstrated lesions not visible on CT or magnetic resonance imaging in two cases. CONCLUSIONS Combined PET/CT is a useful addition to the work-up of patients with choroidal metastases. It provides the opportunity to detect lesions not visible with other imaging modalities and the ability to image patients with contraindications to magnetic resonance imaging. It is essential to correlate PET images with clinical information and the results of other imaging modalities and tissue biopsy remains the gold standard in the diagnosis of malignancy. False positives and negatives can occur with PET/CT, and further research is needed before this promising technology becomes a routine part of the evaluation of patients with choroidal metastases.
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Affiliation(s)
- Mark J Donaldson
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Li J, Miller MA, Hutchins GD, Burr DB. Imaging bone microdamage in vivo with positron emission tomography. Bone 2005; 37:819-24. [PMID: 16236565 DOI: 10.1016/j.bone.2005.06.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Revised: 05/24/2005] [Accepted: 06/03/2005] [Indexed: 10/25/2022]
Abstract
Microdamage accumulation in bone is now considered a contributing cause for bone fragility in older women. However, there is still no method to detect and quantify microdamage in vivo. We have found that positron emission tomography (PET) may be useful to detect and quantify bone microdamage in vivo using a high-resolution PET scanner with [18F]NaF as the tracer. We have done several experiments using the rat ulnar loading model that demonstrate that (1) high-resolution [18F]NaF PET can detect newly created microdamage in vivo; (2) the microdamage detected in this way is co-localized with damage detected by histological and autoradiographic procedures; and (3) high-resolution [18F]NaF PET can distinguish between the effects of mechanical loading that does not produce damage and fatigue loading that creates microdamage. The high-resolution [18F]NaF PET shows promise as a non-invasive means to image bone microdamage.
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Affiliation(s)
- Jiliang Li
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Drive, MS 5035, Indianapolis, IN 46202, USA.
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Freudenberg LS, Fischer M, Antoch G, Jentzen W, Gutzeit A, Rosenbaum SJ, Bockisch A, Egelhof T. Dual modality of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography in patients with cervical carcinoma of unknown primary. Med Princ Pract 2005; 14:155-60. [PMID: 15863988 DOI: 10.1159/000084632] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate an optimized F-18-flurodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) acquisition protocol for head and neck cancer and assess the usefulness of combined FDG-PET/CT in locating unknown primary tumors in patients with biopsy-proven cervical lymph node metastases. SUBJECTS AND METHODS Twenty-one patients with cervical lymph node metastases of unknown primary tumors underwent staging with FDG-PET/CT. The images of FDG-PET alone, CT alone, FDG-PET/CT read side by side and fused and FDG-PET/CT were evaluated separately by 2 physicians. Imaging results were correlated with either histology (n = 14) or clinical follow-up (n = 7). RESULTS On the fused FDG-PET/CT images, primary tumors were identified in 12 patients (57%); with FDG-PET alone and FDG-PET and CT read side by side 11 (52%) primary tumors were found while CT alone identified 5 (23%) primary tumors. CONCLUSION Our data indicate that fused FDG-PET and CT images increased the sensitivity of detecting carcinoma of unknown primary (CUP) tumors compared to CT alone, but not to FDG-PET alone or FDG-PET and CT read side by side. Hence accurate fusion of functional and morphologic data by FDG-PET/CT is a promising imaging modality in the clinical workup of patients with cervical CUP tumors.
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Dammann F, Horger M, Mueller-Berg M, Schlemmer H, Claussen CD, Claussen C, Hoffman J, Eschmann S, Bares R. Rational Diagnosis of Squamous Cell Carcinoma of the Head and Neck Region: Comparative Evaluation of CT, MRI, and18FDG PET. AJR Am J Roentgenol 2005; 184:1326-31. [PMID: 15788619 DOI: 10.2214/ajr.184.4.01841326] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to evaluate the efficiency of (18)FDG PET, CT, and MRI for the preoperative staging of squamous cell carcinoma (SCC) of the head and neck region. CONCLUSION MRI is recommended as the method of choice in the preoperative evaluation of SCC of the oral cavity and the oropharynx. PET can provide relevant diagnostic information in case of equivocal findings by MRI or CT. Routine use of PET, however, does not appear to be necessary if optimized MRI is available.
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Affiliation(s)
- Florian Dammann
- Department of Diagnostic Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, Tuebingen D-72076, Germany
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Mazumdar M. Group sequential design for comparative diagnostic accuracy studies: implications and guidelines for practitioners. Med Decis Making 2004; 24:525-33. [PMID: 15359002 DOI: 10.1177/0272989x04269240] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Comparative diagnostic accuracy (CDA) studies are typically small retrospective studies supporting a higher accuracy for one modality over another for either staging a particular disease or assessing response to therapy, and they are used to generate hypotheses for larger prospective trials. The purpose of this article is to introduce the group sequential design (GSD) approach in planning these larger trials. METHODS Methodology needed for using GSD in the CDA studies is recently developed. In this article, GSD with the O'Brien and Fleming (OBF) stopping rule is described and guidelines for sample size calculation are provided. Simulated data is used to demonstrate the application of GSD in the design/analysis of a clinical trial in the CDA study setting. RESULTS The expected sample size needed for planning a trial with GSD (under the OBF stopping rule) is slightly inflated but may ultimately result in greater savings of patient resources. CONCLUSION GSD is a specialized statistical method that is helpful in balancing the ethical and financial advantages of stopping a study early against the risk of an incorrect conclusion and should be adopted for planning CDA studies.
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Affiliation(s)
- Madhu Mazumdar
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 E. 63rd St., 3rd floor, New York, NY 10021, USA.
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Fukuda KI, Taniguchi H, Koh T, Kunishima S, Yamagishi H. Relationships between oxygen and glucose metabolism in human liver tumours: positron emission tomography using (15)O and (18)F-deoxyglucose. Nucl Med Commun 2004; 25:577-83. [PMID: 15167517 DOI: 10.1097/01.mnm.0000126627.01919.1d] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recently, investigators have measured glucose utilization in liver tumours using F-deoxyglucose positron emission tomography (FDG PET) in order to characterize tumours and predict therapeutic effects. However, the detectability of liver tumours by this method remains unclear. In addition, no study has examined the association between oxygen and glucose metabolism in liver tumours using PET. AIM To evaluate these associations in human liver tumours in vivo using O and FDG. METHODS Thirteen patients with liver tumours were studied: six with hepatocellular carcinoma (HCC), one with cholangiocarcinoma (CCC) and six with metastatic colon cancer (MET). We measured regional tumour blood flow (Ft), regional oxygen extraction fraction (OEF) and regional metabolic rate of oxygen (MRO2) using O PET. Using FDG PET, we determined a standardized uptake value (SUV) for liver tumours as an index of glucose metabolism. RESULTS The mean values (mean+/-SE) for Ft, OEF, MRO2 and SUV were 42.5+/-7.0 ml x (100 g) x min, 43.4+/-4.9%, 2.57+/-0.39 ml x (100g) x min and 4.01+/-0.36, respectively. SUV for MET (4.44+/-0.48) was higher than that for HCC (3.52+/-0.59), and the blood flow in MET [31.4+/-4.1 ml x (100 g) x min] was lower than that in HCC [57.1+/-12.4 ml x (100 g) x min]. Significant negative correlations were noted between MRO2 and SUV (r=-0.741, P=0.004), and between Ft and SUV (r=-0.713, P=0.006). No correlation was apparent between Ft and OEF (r=-0.348, P=0.24), or between OEF and SUV (r=-0.023, P=0.94). CONCLUSION O and FDG PET showed a significant negative correlation between MRO2 and SUV in human liver tumours. In addition, MRO2 depends on Ft rather than on OEF.
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Affiliation(s)
- Ken-ichiro Fukuda
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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20
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Yamamoto F, Tsukamoto E, Nakada K, Takei T, Zhao S, Asaka M, Tamaki N. 18p-FDG PET is superior to67Ga SPECT in the staging of non-Hodgkin’s lymphoma. Ann Nucl Med 2004; 18:519-26. [PMID: 15515753 DOI: 10.1007/bf02984570] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Our study aims to compare diagnostic accuracy between 18F-FDG PET and 67Ga SPECT in the staging of non-Hodgkin's lymphoma. METHODS Twenty-eight patients with non-Hodgkin's lymphoma, underwent 18F-FDG PET, 67Ga SPECT and CT for the pretreatment staging of malignant lymphoma between August 1999 and March 2002. 18F-FDG PET imaging was obtained 60 minutes after the intravenous administration of 185 MBq of 18F-FDG. 67Ga SPECT imaging was obtained 2 days after the intravenous administration of 148 MBq of 67Ga. 18F-FDG PET and 67Ga SPECT were performed within one month. Both imagings were performed on the area from the neck to the pelvis. The 18F-FDG PET and 67Ga SPECT findings were compared with the CT findings and the clinical course. RESULTS Sixty-six nodal lesions were clinically confirmed. Of these, 32 were identified by both 18F-FDG PET and 67Ga SPECT. The remaining 34 lesions were identified only by 18F-FDG PET. The mean (+/- SD) sizes' of the nodes were 34.7 +/- 32.4 mm for 18F-FDG-positive and 67Ga-positive lesions and 15.7 +/- 8.3 mm for 18F-FDG-positive and 67Ga-negative lesions (p < 0.001). Of the 23 extranodal lesions, 12 were identified by both 18F-FDG PET and 67Ga SPECT, whereas 6 lesions were identified by only 18F-FDG PET. Five lesions were not identified by either technique. No 18F-FDG-negative but 67Ga-positive nodal or extranodal lesions were observed. The difference in findings between the two studies is related to the difference in the size but not in the histology or site of the lesions. CONCLUSION 18F-FDG PET detected significantly more lesions particularly small lesions than 67Ga SPECT. Thus, 18F-FDG PET is considered to be superior to 67Ga SPECT in the staging of non-Hodgkin' s lymphoma.
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Affiliation(s)
- Fumiyasu Yamamoto
- Third Department of Internal Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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21
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Antoch G, Kaiser GM, Mueller AB, Metz KA, Zhang H, Kuehl H, Westermann S, Broelsch CE, Mueller SP, Bockisch A, Debatin JF. Intraoperative Radiation Therapy in Liver Tissue in a Pig Model: Monitoring with Dual-Modality PET/CT. Radiology 2004; 230:753-60. [PMID: 14764888 DOI: 10.1148/radiol.2303021183] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess, in a pig model, the value of dual-modality positron emission tomography (PET)/computed tomography (CT) for monitoring radiation therapy. MATERIALS AND METHODS Central bile duct resection followed by creation of a biliodigestive anastomosis was performed in nine pigs. Six of these pigs were also treated with intraoperative radiation therapy (IORT) (20 Gy) in the area of the anastomosis. Two, 4, and 8 weeks postoperatively, contrast material-enhanced fluorine 18 fluorodeoxyglucose (FDG) PET/CT of the liver was performed in all of the animals. The radioactive tracer concentration in the region of the anastomosis was quantified, and the values were compared intraindividually with the values at the liver periphery. Histologic evaluation of the liver was performed 8 weeks postoperatively. The PET/CT images were assessed for changes in liver volume and bile duct diameter over time. RESULTS In all nine pigs, the region of the anastomosis could be clearly defined on the fused PET/CT images. PET/CT revealed a decreased concentration of FDG in the irradiated field 2 and 4 weeks after IORT. At 8 weeks, however, the distribution of the tracer in the irradiated pigs did not differ from that in the nonirradiated pigs. Homogeneous tracer uptake in all liver regions was observed in the nonirradiated animals. The CT images showed an increase in liver volume in all pigs and bile duct dilatation that increased over time in the irradiated pigs. CONCLUSION The morphologic and functional changes due to IORT in liver tissue can be accurately monitored with dual-modality PET/CT. By enabling the integration of functional and morphologic data, PET/CT may have an important role in monitoring radiation treatment.
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MESH Headings
- Anastomosis, Roux-en-Y
- Animals
- Bile Ducts, Extrahepatic/radiation effects
- Bile Ducts, Extrahepatic/surgery
- Brachytherapy/instrumentation
- Combined Modality Therapy
- Dilatation, Pathologic/pathology
- Energy Metabolism/radiation effects
- Female
- Fluorodeoxyglucose F18
- Hepatic Artery/pathology
- Hepatic Artery/radiation effects
- Hepatic Duct, Common/pathology
- Hepatic Duct, Common/radiation effects
- Image Interpretation, Computer-Assisted
- Jejunum/radiation effects
- Jejunum/surgery
- Liver/pathology
- Liver/radiation effects
- Liver Regeneration/radiation effects
- Necrosis
- Particle Accelerators
- Portal Vein/pathology
- Portal Vein/radiation effects
- Radiation Injuries, Experimental/diagnosis
- Radiation Injuries, Experimental/pathology
- Sensitivity and Specificity
- Swine
- Tomography, Emission-Computed
- Tomography, X-Ray Computed
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Affiliation(s)
- Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Germany.
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22
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Wolf G, Nicoletti R, Schultes G, Schwarz T, Schaffler G, Aigner RM. Preoperative Image Fusion of Fluoro-2-Deoxy-d-Glucose???Positron Emission Tomography and Computed Tomography Data Sets in Oral Maxillofacial Carcinoma. J Comput Assist Tomogr 2003; 27:889-95. [PMID: 14600456 DOI: 10.1097/00004728-200311000-00010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim was to evaluate the clinical and therapeutic value of digital image fusion of 2-[18]-fluoro-2-deoxy-D-glucose (F18-FDG) positron emission tomography (PET) and computed tomography (CT) in patients suffering from an oral maxillofacial carcinoma. METHODS Seventeen patients (11 male, 6 female; age range: 45-89 years) suffering from an oral maxillofacial carcinoma underwent CT and F18-FDG-PET (333-370 MBq). The data of the 2 imaging modalities were fused on an image workstation. This image fusion was then visualized in the axial, coronal, and sagittal planes. RESULTS PET showed a high pathologic FDG uptake in the tumor in 17 of 17 patients. CT detected the tumor in 12 of 17 patients. The image fusion of FDG-PET and CT showed the tumor in 17 of 17 patients. The final diagnosis was carcinoma of the mandible in 9 of 17 patients, carcinoma of the mouth floor in 3 of 17 patients, carcinoma of the tongue in 3 of 17 patients, carcinoma of the roof of the mouth in 1 of 17 patients, and carcinoma of the parotis gland in 1 of 17 patients. CONCLUSIONS Preoperative image fusion of FDG-PET and CT data sets in oral maxillofacial carcinoma is possible in the clinical routine. Combined morphologic (CT) and functional (PET) imaging improves tumor localization even if the tumor is hardly visible on CT because of the artefacts of dental metallic implants (3/17 patients) or because of the small size of the tumor (2/17 patients). Image fusion is helpful for planning possible surgery (visual models) or radiotherapy (exact region of interest).
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Affiliation(s)
- Gerald Wolf
- Department of Radiology, Karl-Franzens-University, Graz, Austria.
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23
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Picchio M, Landoni C, Messa C, Gianolli L, Matarrese M, De Cobelli F, Maschio AD, Fazio F. Positive [11C]choline and negative [18F]FDG with positron emission tomography in recurrence of prostate cancer. AJR Am J Roentgenol 2002; 179:482-4. [PMID: 12130458 DOI: 10.2214/ajr.179.2.1790482] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- M Picchio
- Department of Nuclear Medicine, Institute H San Raffaele, Via Olgettina 60, 20132, Milan, Italy
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24
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Guppy M, Leedman P, Zu X, Russell V. Contribution by different fuels and metabolic pathways to the total ATP turnover of proliferating MCF-7 breast cancer cells. Biochem J 2002; 364:309-15. [PMID: 11988105 PMCID: PMC1222574 DOI: 10.1042/bj3640309] [Citation(s) in RCA: 188] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
For the past 70 years the dominant perception of cancer metabolism has been that it is fuelled mainly by glucose (via aerobic glycolysis) and glutamine. Consequently, investigations into the diagnosis, treatment and the basic metabolism of cancer cells have been directed by this perception. However, the data on cancer metabolism are equivocal, and in this study we have sought to clarify the issue. Using an innovative system we have measured the total ATP turnover of the MCF-7 breast cancer cell line, the contributions to this turnover by oxidative and glycolytic ATP production and the contributions to the oxidative component by glucose, lactate, glutamine, palmitate and oleate. The total ATP turnover over approx. 5 days was 26.8 micromol of ATP.10(7) cells(-1).h(-1). ATP production was 80% oxidative and 20% glycolytic. Contributions to the oxidative component were approx. 10% glucose, 14% glutamine, 7% palmitate, 4% oleate and 65% from unidentified sources. The contribution by glucose (glycolysis and oxidation) to total ATP turnover was 28.8%, glutamine contributed 10.7% and glucose and glutamine combined contributed 40%. Glucose and glutamine are significant fuels, but they account for less than half of the total ATP turnover. The contribution of aerobic glycolysis is not different from that in a variety of other non-transformed cell types.
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Affiliation(s)
- Michael Guppy
- Biochemistry and Molecular Biology, School of Biomedical and Chemical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
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25
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Abstract
Positron emission tomography (PET) using (18)F-fluorodeoxyglucose (FDG) is increasingly used in the diagnostic management of colorectal cancer patients. It provides a highly sensitive and specific diagnosis which is entirely based upon alterations of the glucose metabolism found in malignant tissues. The information provided by FDG-PET is independent of the underlying structural characteristics of the lesions and, therefore, it is essentially complementary to the available structural imaging modalities such as CT, MRI and (endoscopic) ultrasound. Several studies have now been performed on the use of FDG-PET in colorectal adenocarcinoma for primary pre-operative staging, for diagnosis and (re)staging of recurrent disease, for localization and staging of occult recurrent disease, and for the assessment of the metabolic effects of chemotherapy and radiotherapy. This chapter aims to clarify some fundamental issues of both detection device and radiotracer, the proven indications for FDG-PET, the strength and limitations of the technique, and how its implementation would affect patient management.
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Affiliation(s)
- Patrick Flamen
- Department of Nuclear Medicine, University Hospital Gasthuisberg, Leuven, Belgium
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26
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Kaim AH, Burger C, Ganter CC, Goerres GW, Kamel E, Weishaupt D, Dizendorf E, Schaffner A, von Schulthess GK. PET-CT-guided percutaneous puncture of an infected cyst in autosomal dominant polycystic kidney disease: case report. Radiology 2001; 221:818-21. [PMID: 11719684 DOI: 10.1148/radiol.2213010445] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An infected cyst in autosomal dominant polycystic kidney disease was identified with a combined positron emission tomographic (PET) and computed tomographic (CT) system, an experimental setup mimicking an integrated CT-PET scanner. Image fusion of fluorine 18 fluorodeoxyglucose PET and CT images allowed exact localization of the infected cyst among many cysts identified on previous CT and magnetic resonance images. Confirmation was obtained instantly, followed by CT-guided percutaneous puncture. Integrated imaging systems hold promise for direct PET-guided puncture of areas of increased fluorodeoxyglucose uptake by using the anatomic accuracy of CT.
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Affiliation(s)
- A H Kaim
- Department of Nuclear Medicine, University Hospital of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
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27
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Cabrera Villegas A, Cánovas Fernández A, Martín Urreta JC. [Post-radiation pneumonitis in a case of Hodgkin's lymphoma assessed with PET-FDG by residual mediastinal mass]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2000; 19:288-92. [PMID: 11062100 DOI: 10.1016/s0212-6982(00)71876-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The PET-FDG is a useful method to assess the post-radiotherapy residual masses in supradiaphragmatic lymphoma patients. We present the case of a patient with residual mediastinic mass revealed by CT after the patient had completed treatment for Hodgkin's disease and in whom the PET study demonstrated a typical pattern of post-radiation pneumonitis. When these patients are re-assessed early after radiotherapy, the different tracer uptake patterns should be taken into account in order to identify the existence of radiotherapy sequela and avoid false positive results.
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Affiliation(s)
- A Cabrera Villegas
- Centro PET (Servicio de Medicina Nuclear), Clínica V. San Sebastián, Bilbao
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28
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Abstract
Tumour imaging is an essential part of the practice of oncology, with a crucial role in screening programmes and in diagnosis and staging of established disease. Furthermore, the assessment of tumour size by imaging, usually with computer tomography (CT) scanning, is a key component in determining the tumour response to therapy both in clinical trials and in daily oncology practice. Techniques such as CT, ultrasound (US) and magnetic resonance imaging (MRI) provide high resolution anatomical images with detailed structural information. However, these imaging modalities yield limited functional information on the tumour tissues and often cannot distinguish residual disease from non-viable or necrotic tumour masses, nor can they detect minimal residual disease. In contrast, radiopharmaceutical imaging and, in particular, positron emission tomography (PET) can give some functional information about the underlying tissues. The possibility of refining these techniques and also the emergence of newer imaging modalities that can detect changes in cancers at the physiological, cellular or molecular levels, gives rise to the notion that these methods will have implications for drug development strategies and also future clinical management. In this review, we briefly discuss the current role of imaging in clinical practice, describe some of the advances in imaging modalities currently undergoing evaluation, and speculate on the future role of these techniques in developmental therapeutics programmes.
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Affiliation(s)
- R M Glasspool
- CRC Department of Medical Oncology, University of Glasgow, Beatson Laboratories, Garscube Estate, Switchback Road, G61 1BD, Glasgow, UK.
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29
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Schaffler GJ, Groell R, Schoellnast H, Kriegl D, Ruppert-Kohlmaier A, Schwarz T, Aigner RM. Digital image fusion of CT and PET data sets--clinical value in abdominal/pelvic malignancies. J Comput Assist Tomogr 2000; 24:644-7. [PMID: 10966202 DOI: 10.1097/00004728-200007000-00024] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We investigated the clinical relevance of digital image fusion of CT and 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) positron emission tomography (PET) studies in patients with suspected abdominal and/or pelvic metastasis. METHOD Nineteen patients with suspected residual/recurrent malignancies underwent CT and [18F]FDG PET studies of the abdomen and/or pelvis. The data sets of both modalities were fused on a digital workstation by automatic adaptation of the pixel size and the slice thickness. Different body positions were corrected by semiautomatic adaptation of the body axes. The fused images were reconstructed in sagittal, coronal, and axial planes. RESULTS Good spatial correlation between both modalities was achieved in all patients. Image fusion improved the spatial allocation of pathologically increased [18F]FDG uptake in 7 of 35 lesions (20%). CONCLUSION This work suggests that digital image fusion of CT and [18F]FDG PET data sets improves the anatomical localization of foci with increased [18F]FDG enhancement of the retroperitoneum and the abdominal/pelvic wall, respectively.
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Affiliation(s)
- G J Schaffler
- Department of Radiology, University Hospital Graz, Austria.
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30
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Stevens CW, Lee JS, Cox J, Komaki R. Novel approaches to locally advanced unresectable non-small cell lung cancer. Radiother Oncol 2000; 55:11-8. [PMID: 10788683 DOI: 10.1016/s0167-8140(00)00163-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The management of advanced non-small cell lung cancer (NSCLC) is rapidly evolving. Advances in combined chemo-radiation therapy have led to improvements in patient survival which are statistically significant, but most patients still succumb to their disease. New chemotherapeutic agents, such as taxanes (paclitaxel, docetaxel), topoisomerase inhibitors (topotecan, irinotecan), and novel analogs (gemcitabine, vinorelbine), may offer the promise of improved outcome, but have not yet been tested in phase III trials. Molecular therapeutics, such as gene therapy, drugs that target specific oncogene activation (such as Ki-ras inactivation by farnesyl transferase inhibitors), and hypoxic cell toxins (such as tirapazamine), are in clinical trials. The optimum use of these agents awaits more rapid and widespread molecular diagnostics. Finally, technological advances in radiotherapy will allow higher tumor doses, while minimizing doses to dose-limiting normal structures, such as the esophagus, normal lung and heart. We describe a move towards molecular strategies, both for therapy and diagnostics, that may result in more effective treatment. While the outcome for patients with advanced non-small cell lung carcinoma is still poor, new agents are being developed rapidly and offer the hope of improved survival.
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Affiliation(s)
- C W Stevens
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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31
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Cremerius U, Wildberger JE, Borchers H, Zimny M, Jakse G, Günther RW, Buell U. Does positron emission tomography using 18-fluoro-2-deoxyglucose improve clinical staging of testicular cancer?--Results of a study in 50 patients. Urology 1999; 54:900-4. [PMID: 10565755 DOI: 10.1016/s0090-4295(99)00272-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To compare positron emission tomography (PET) using 18-fluoro-2-deoxyglucose (FDG) with conventional clinical staging in unselected patients with germ cell cancer. METHODS Fifty patients underwent PET scans of the abdomen (n = 50) and chest (n = 41 ) after the initial diagnosis. PET images were evaluated qualitatively and quantitatively using standardized uptake values (SUVs). The results were compared with computed tomography (CT) results and tumor markers (human chorionic gonadotropin, alpha-fetoprotein, and lactate dehydrogenase). Retroperitoneal lymphadenectomy in 12 patients and clinical staging, including follow-up data in all patients, were taken as a reference standard. RESULTS PET detected metastases in 13 (87%) of 15 patients and excluded metastases in 33 (94%) of 35 patients. A sensitivity of 73% and a specificity of 94% were obtained using CT. The respective values for tumor marker determination were 67% and 100%. Retroperitoneal metastases were detected in 2 patients by PET only and in 1 patient by CT only. In the latter patient, surgery of a residual mass after chemotherapy revealed a well-differentiated teratoma. False-negative findings with PET and CT occurred in 2 patients with retroperitoneal metastases approximately 10 mm in size. False-positive findings were due to sarcoidosis or to muscular activity of the neck. Quantitative FDG uptake was very heterogeneous, with an SUV ranging from 1.8 to 17.3. CONCLUSIONS FDG PET has the potential to improve clinical staging of testicular cancer. However, PET, as well as CT, is limited in the detection of small retroperitoneal lymph node metastases.
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Affiliation(s)
- U Cremerius
- Department of Nuclear Medicine, Aachen University of Technology, Germany
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