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Chen Z, Long Y, Zhang Y, Zhang B, He Q, Zhang X. Detection efficacy of analog [ 18F]FDG PET/CT, digital [ 18F]FDG, and [ 13N]NH 3 PET/CT: a prospective, comparative study of patients with lung adenocarcinoma featuring ground glass nodules. Eur Radiol 2023; 33:2118-2127. [PMID: 36322193 DOI: 10.1007/s00330-022-09186-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This prospective study compared the detection efficacy of analog 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) (aF PET/CT), digital [18F]FDG PET/CT (dF PET/CT), and digital 13N-ammonia (13N-NH3) PET/CT (dN PET/CT) for patients with lung adenocarcinoma featuring ground glass nodules (GGNs). METHODS Eighty-seven patients with lung adenocarcinoma featuring GGNs who underwent dF and dN PET/CT were enrolled. Based on the GGN component, diameter, and solid-part size, 87 corresponding patients examined using aF PET/CT were included, with age, sex, and lesion characteristics closely matched. Images were visually evaluated, and the tumor to background ratio (TBR) was used for semi-quantitative analysis. RESULTS Ultimately, 40 and 47 patients with pure GGNs (pGGNs) and mixed GGNs (mGGNs), respectively, were included. dF PET/CT revealed more positive lesions and higher tracer uptake in GGNs than did aF PET/CT (53/87 vs. 26/87, p < 0.05; TBR: 3.08 ± 4.85 vs. 1.42 ± 0.93, p < 0.05), especially in mGGNs (44/47 vs. 26/47, p < 0.05; TBR: 4.48 ± 6.17 vs. 1.78 ± 1.16, p < 0.05). However, dN PET/CT detected more positive lesions than did dF PET/CT (71/87 vs. 53/87, p < 0.05), especially in pGGNs (24/40 vs. 9/40, p < 0.05). CONCLUSIONS dF PET/CT provides superior detection efficacy over aF PET/CT for patients with lung adenocarcinoma featuring GGNs, particularly mGGNs. dN PET/CT revealed superior detection efficacy over dF PET/CT, particularly in pGGNs. aF, dF, and dN PET/CT are valuable non-invasive examinations for lung cancer featuring GGNs, with dN PET/CT offering the best detection performance. KEY POINTS • Digital PET/CT provides superior detection efficacy over analog PET/CT in patients with lung adenocarcinoma featuring GGNs. • dN PET/CT can offer more help in the early detection of malignant GGN.
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Affiliation(s)
- Zhifeng Chen
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yali Long
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yuying Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Bing Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Qiao He
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Xiangsong Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China.
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Castello A, Castellani M, Florimonte L, Ciccariello G, Mansi L, Lopci E. PET radiotracers in glioma: a review of clinical indications and evidence. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00523-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Borja AJ, Saini J, Raynor WY, Ayubcha C, Werner TJ, Alavi A, Revheim ME, Nagaraj C. Role of Molecular Imaging with PET/MR Imaging in the Diagnosis and Management of Brain Tumors. PET Clin 2022; 17:431-451. [PMID: 35662494 DOI: 10.1016/j.cpet.2022.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Gliomas are the most common primary brain tumors. Hybrid PET/MR imaging has revolutionized brain tumor imaging, allowing for noninvasive, simultaneous assessment of morphologic, functional, metabolic, and molecular parameters within the brain. Molecular information obtained from PET imaging may aid in the detection, classification, prognostication, and therapeutic decision making for gliomas. 18F-fluorodeoxyglucose (FDG) has been widely used in the setting of brain tumor imaging, and multiple techniques may be employed to optimize this methodology. More recently, a number of non-18F-FDG-PET radiotracers have been applied toward brain tumor imaging and are used in clinical practice.
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Affiliation(s)
- Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jitender Saini
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, Karnataka 560-029, India
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Cyrus Ayubcha
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Mona-Elisabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, Oslo 0315, Norway
| | - Chandana Nagaraj
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, Karnataka 560-029, India.
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PET Imaging in Neuro-Oncology: An Update and Overview of a Rapidly Growing Area. Cancers (Basel) 2022; 14:cancers14051103. [PMID: 35267411 PMCID: PMC8909369 DOI: 10.3390/cancers14051103] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/08/2022] [Accepted: 02/19/2022] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Positron emission tomography (PET) is a functional imaging technique which plays an increasingly important role in the management of brain tumors. Owing different radiotracers, PET allows to image different metabolic aspects of the brain tumors. This review outlines currently available PET radiotracers and their respective indications in neuro-oncology. It specifically focuses on the investigation of gliomas, meningiomas, primary central nervous system lymphomas as well as brain metastases. Recent advances in the production of PET radiotracers, image analyses and translational applications to peptide radionuclide receptor therapy, which allow to treat brain tumors with radiotracers, are also discussed. The objective of this review is to provide a comprehensive overview of PET imaging’s potential in neuro-oncology as an adjunct to brain magnetic resonance imaging (MRI). Abstract PET plays an increasingly important role in the management of brain tumors. This review outlines currently available PET radiotracers and their respective indications. It specifically focuses on 18F-FDG, amino acid and somatostatin receptor radiotracers, for imaging gliomas, meningiomas, primary central nervous system lymphomas as well as brain metastases. Recent advances in radiopharmaceuticals, image analyses and translational applications to therapy are also discussed. The objective of this review is to provide a comprehensive overview of PET imaging’s potential in neuro-oncology as an adjunct to brain MRI for all medical professionals implicated in brain tumor diagnosis and care.
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Laudicella R, Quartuccio N, Argiroffi G, Alongi P, Baratto L, Califaretti E, Frantellizzi V, De Vincentis G, Del Sole A, Evangelista L, Baldari S, Bisdas S, Ceci F, Iagaru A. Unconventional non-amino acidic PET radiotracers for molecular imaging in gliomas. Eur J Nucl Med Mol Imaging 2021; 48:3925-3939. [PMID: 33851243 DOI: 10.1007/s00259-021-05352-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/04/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The objective of this review was to explore the potential clinical application of unconventional non-amino acid PET radiopharmaceuticals in patients with gliomas. METHODS A comprehensive search strategy was used based on SCOPUS and PubMed databases using the following string: ("perfusion" OR "angiogenesis" OR "hypoxia" OR "neuroinflammation" OR proliferation OR invasiveness) AND ("brain tumor" OR "glioma") AND ("Positron Emission Tomography" OR PET). From all studies published in English, the most relevant articles were selected for this review, evaluating the mostly used PET radiopharmaceuticals in research centers, beyond amino acid radiotracers and 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG), for the assessment of different biological features, such as perfusion, angiogenesis, hypoxia, neuroinflammation, cell proliferation, tumor invasiveness, and other biological characteristics in patients with glioma. RESULTS At present, the use of non-amino acid PET radiopharmaceuticals specifically designed to assess perfusion, angiogenesis, hypoxia, neuroinflammation, cell proliferation, tumor invasiveness, and other biological features in glioma is still limited. CONCLUSION The use of investigational PET radiopharmaceuticals should be further explored considering their promising potential and studies specifically designed to validate these preliminary findings are needed. In the clinical scenario, advancements in the development of new PET radiopharmaceuticals and new imaging technologies (e.g., PET/MR and the application of the artificial intelligence to medical images) might contribute to improve the clinical translation of these novel radiotracers in the assessment of gliomas.
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Affiliation(s)
- R Laudicella
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - N Quartuccio
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - G Argiroffi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - P Alongi
- Nuclear Medicine Unit,, Fondazione Istituto G. Giglio, Ct. da Pietra Pollastra-pisciotto, Cefalù, Italy
| | - L Baratto
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, CA, USA
| | - E Califaretti
- Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, Corso AM Dogliotti 14, 10126, Turin, Italy
| | - V Frantellizzi
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza, "Sapienza" University of Rome, Rome, Italy
| | - G De Vincentis
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza, "Sapienza" University of Rome, Rome, Italy
| | - A Del Sole
- Department of Health Sciences, University of Milan, Milan, Italy
| | - L Evangelista
- Nuclear Medicine Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - S Baldari
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - S Bisdas
- Department of Neuroradiology, University College London, London, UK
| | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology, IRCCS, Milan, Italy.
| | - Andrei Iagaru
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, CA, USA
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Long Y, Qiu J, Zhang B, He P, Shi X, He Q, Chen Z, Shen W, Li Z, Zhang X. Pharmacological Vitamin C Treatment Impedes the Growth of Endogenous Glutamine-Dependent Cancers by Targeting Glutamine Synthetase. Front Pharmacol 2021; 12:671902. [PMID: 34054545 PMCID: PMC8150514 DOI: 10.3389/fphar.2021.671902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/29/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: Glutamine synthetase (GS) is the only currently known enzyme responsible for synthesizing endogenous glutamine (Gln). GS exerts a critical role in the oncogenesis of endogenous Gln-dependent cancers, making it an attractive target for anti-tumor therapies. A mixed-function oxidation system consisting of vitamin C (VC), oxygen, and trace metals can oxidize GS and promote its degradation. The current study aims to explore the effect of pharmacological VC treatment on GS. Methods: Endogenous Gln-dependent cancer lines (breast cancer MCF7 and prostate cancer PC3) were selected to establish chronic Gln-deprived MCF7 and PC3 cell models. The expression of GS in parental and chronic Gln-deprived tumor cells exposed to VC treatment and control was determined by Western blot analysis. The anti-cancer effects of VC on parental and chronic Gln-deprived tumor cells were assessed by CCK-8 and annexin V-FITC/PI FACS assays. In addition, changes in cellular reactive oxygen species (ROS), glutathione (GSH) levels and NADPH/NADP + ratio were analyzed to explore the underlying mechanisms. Moreover, BALB/c nude mice xenografting with parental and chronic Gln-deprived prostate cancer cells were constructed to evaluate the in vivo therapeutic effect of VC. Finally, tumor 13N-ammonia uptake in mice bearing prostate cancer xenografts was analyzed following treatment with VC and the expression of GS in xenografts were detected by immunohistochemistry. Results: Cells overexpressing GS were obtained by chronic Gln deprivation. We found that the cytotoxic effect of VC on cancer cells was positively correlated with the expression of GS. Additionally, VC treatment led to a significant increase in ROS production, as well as GSH depletion and NADPH/NADP + reduction. These changes could be reversed by the antioxidant N-acetyl-L-cysteine (NAC). Furthermore, pharmacological VC treatment exhibited a more significant therapeutic effect on xenografts of prostate cancer cells overexpressing GS, that could be well monitored by 13N-ammonia PET/CT imaging. Conclusion: Our findings indicate that VC can kill cancer cells by targeting glutamine synthetase to induce oxidative stress. VC could be used as an anti-cancer treatment for endogenous glutamine-dependent cancers.
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Affiliation(s)
- Yali Long
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jia Qiu
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bing Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Peng He
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xinchong Shi
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qiao He
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhifeng Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wanqing Shen
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhoulei Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiangsong Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Albano D, Giubbini R, Bertagna F. 13N-NH 3 PET/CT in oncological disease. Jpn J Radiol 2019; 37:799-807. [PMID: 31599383 DOI: 10.1007/s11604-019-00883-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/30/2019] [Indexed: 01/21/2023]
Abstract
13N-Ammonia (13N-NH3) is widely used positron emission tomography/computed tomography (PET/CT) radiotracer for the measurement of myocardial blood perfusion; the possible role of 13N-NH3 PET or PET/CT in oncological disease is not yet clear. Aim of this review is to evaluate the diagnostic performances of 13N-NH3 PET in this field. A comprehensive computer literature search of the PubMed/MEDLINE, Scopus, and Embase databases was conducted including articles up to June 2019. Eighteen articles were finally included in the review. From the analyses of the selected studies, the following main findings could be drawn: (1) 13N-NH3 PET is useful in discriminating between gliomas and non-neoplastic brain lesions, and among gliomas between high-grade and low-grade gliomas; (2) 13N-NH3 PET have better diagnostic performance than 18F-FDG in studying gliomas; (3) a combination of 13N-NH3 PET and 18F-FDG PET may be useful to differentiate between several cerebral lesions (gliomas, cerebral lymphoma, meningioma); (4) only preliminary results about the positive impact in liver and prostate cancer.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, P.le Spedali Civili 1; 25123, Brescia, Italy.
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, P.le Spedali Civili 1; 25123, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, P.le Spedali Civili 1; 25123, Brescia, Italy
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He Q, Zhang L, Zhang B, Shi X, Yi C, Zhang X. Diagnostic accuracy of 13N-ammonia PET, 11C-methionine PET and 18F-fluorodeoxyglucose PET: a comparative study in patients with suspected cerebral glioma. BMC Cancer 2019; 19:332. [PMID: 30961564 PMCID: PMC6454631 DOI: 10.1186/s12885-019-5560-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 03/31/2019] [Indexed: 11/10/2022] Open
Abstract
Background The treatment of patients with glioma depended on the nature of the lesion and on histological grade of the tumor. Positron emission tomography (PET) using 13N-ammonia (NH3), 11C-methionine (MET) and 18F-fluorodeoxyglucose (FDG) have been used to assess brain tumors. Our aim was to compare their diagnostic accuracies in patients with suspected cerebral glioma. Methods Ninety patients with suspicion of glioma based on previous CT/MRI, who underwent NH3 PET, MET PET and FDG PET, were prospectively enrolled in the study. The reference standard was established by histology or clinical and radiological follow-up. Images were interpreted by visual evaluation and semi-quantitative analysis using the lesion-to-normal white matter uptake ratio (L/WM ratio). Results Finally, 30 high-grade gliomas (HGG), 27 low-grade gliomas (LGG), 10 non-glioma tumors and 23 non-neoplastic lesions (NNL) were diagnosed. On visual evaluation, sensitivity and specificity for differentiating tumors from NNL were 62.7% (42/67) and 95.7% (22/23) for NH3 PET, 94.0% (63/67) and 56.5% (13/23) for MET PET, and 35.8% (24/67) and 65.2% (15/23) for FDG PET. On semi-quantitative analysis, brain tumors showed significantly higher L/WM ratios than NNL both in NH3 and MET PET (both P < 0.001). The sensitivity, specificity and the area under the curve (AUC) by receiver operating characteristic (ROC) analysis, respectively, were 64.2, 100% and 0.819 for NH3; and 89.6, 69.6% and 0.840 for MET. Besides, the L/WM ratios of NH3, MET and FDG PET in HGG all significantly higher than that in LGG (all P < 0.001). The predicted (by ROC) accuracy of the tracers (AUC shown in parentheses) were 86.0% (0.896) for NH3, 87.7% (0.928) for MET and 93.0% (0.964) for FDG. While no significant differences in the AUC were seen between them. Conclusion NH3 PET has remarkably high specificity for the differentiation of brain tumors from NNL, but low sensitivity for the detection of LGG. MET PET was found to be highly useful for detection of brain tumors. However, like FDG, high MET uptake is frequently observed in some NNL. NH3, MET and FDG PET all appears to be valuable for evaluating the histological grade of gliomas.
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Affiliation(s)
- Qiao He
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, Guangdong Province, 510080, People's Republic of China
| | - Linqi Zhang
- Department of Nuclear Medicine, Affiliated Cancer Hospital&Institute of Guangzhou Medical University, Guangzhou, 510095, People's Republic of China
| | - Bing Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, Guangdong Province, 510080, People's Republic of China
| | - Xinchong Shi
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, Guangdong Province, 510080, People's Republic of China
| | - Chang Yi
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, Guangdong Province, 510080, People's Republic of China
| | - Xiangsong Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, Guangdong Province, 510080, People's Republic of China.
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Khangembam BC, Singhal A, Kumar R, Bal C. Tc-99m Glucoheptonate Single Photon Emission Computed Tomography-Computed Tomography for Detection of Recurrent Glioma: A Prospective Comparison with N-13 Ammonia Positron Emission Tomography-Computed Tomography. Indian J Nucl Med 2019; 34:107-117. [PMID: 31040521 PMCID: PMC6481207 DOI: 10.4103/ijnm.ijnm_164_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose of the Study: To assess the efficacies of Tc-99m glucoheptonate single photon emission computed tomography-computed tomography (Tc-99m GHA SPECT-CT) and N-13 ammonia positron emission tomography-computed tomography (N-13 NH3 PET-CT) in detecting recurrent glioma. Materials and Methods: Fifty-five consecutive, histologically proven, and previously treated glioma patients (age, 38.9 ± 12.2 years; 61.8% males) presenting with clinical suspicion of recurrence were evaluated with Tc-99m GHA SPECT-CT and N-13 NH3 PET-CT. Images were evaluated both qualitatively and semiquantitatively. A combination of clinicoradiological follow-up, repeat imaging, and/or biopsy (when available) was considered as the reference standard. Results: Based on the reference standard, 28/55 (50.9%) patients had recurrence. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy of Tc-99m GHA SPECT-CT, and N-13 NH3 PET-CT were 85.7%, 85.2%, 85.7%, 85.2%, 85.5% and 78.6%, 88.9%, 88.0%, 80.0%, 83.6%, respectively (concordant findings in 46 patients). The performances of the two modalities were equivalent both in overall and subgroup McNemar analyses (P = 0.508, overall; P = 0.687, low grade; P = 1.000, high grade). Conclusion: Tc-99m GHA SPECT-CT is an alternative imaging modality equally efficacious as N-13 NH3 PET-CT in detecting recurrent glioma.
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Affiliation(s)
- Bangkim Chandra Khangembam
- Department of Nuclear Medicine, Institute of Liver and Biliary Sciences, New Delhi, India.,Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhinav Singhal
- Department of Nuclear Medicine, Institute of Liver and Biliary Sciences, New Delhi, India.,Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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The role of 13N-ammonia in the differential diagnosis of gliomas and brain inflammatory lesions. Ann Nucl Med 2018; 33:61-67. [PMID: 30350180 DOI: 10.1007/s12149-018-1308-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the utility of 13N-ammonia PET/CT imaging in the differential diagnosis of gliomas and brain inflammations. METHODS 13N-ammonia PET/CT imaging data of 77 patients with gliomas and 34 patients with brain inflammations were retrospectively analyzed. No patients received any treatment before 13N-ammonia imaging. All the patients were diagnosed by stereotactic biopsy or clinical follow-up. Visual and semi-quantitative analysis was performed to analyze the results of 13N-ammonia imaging. Finally, the uptake ratios of each lesion were calculated and its differences among different groups were tested with one-way ANOVA. RESULTS 29.4% inflammations, 51.6% low-grade gliomas and 91.3% high-grade gliomas were positive by visual analysis in 13N-ammonia imaging. The sensitivity, specificity and accuracy for the diagnosis of gliomas were 75.3%, 55.8% and 67.8%, respectively. As for semi-quantitative analysis, the T/G ratios of inflammatory lesions, low-grade gliomas and high-grade gliomas were 0.88 ± 0.24, 1.04 ± 0.43 and 1.43 ± 0.49, respectively. One-way ANOVA revealed that the T/G ratios of high-grade gliomas were significantly higher than those of low-grade gliomas and inflammations (P < 0.05), but there was no statistical difference between low-grade gliomas and inflammations (P = 0.118). Among the inflammatory lesions, T/G ratios were not statistically different between infectious and demyelinating lesions (P > 0.05). ROC curve analysis showed that the optimal cut-off value of T/G ratio in distinguishing gliomas from inflammations was 1.21 with the AUC 0.78. The sensitivity, specificity, accuracy, PPV and NPV were 52.9%, 94.4%, 65.3%, 95.7% and 45.9%, respectively. ROC curve analysis showed that the optimal cut-off value of T/G ratio in distinguishing high-grade gliomas from low-grade gliomas was 1.06 with the AUC 0.78. The sensitivity, specificity, accuracy, PPV and NPV were 81.5%, 67.7%, 76.5%, 81.5% and 67.7%, respectively. ROC curve analysis showed that the optimal cut-off value of T/G ratio in distinguishing high-grade gliomas from low-grade gliomas and inflammations was 1.19 with the AUC 0.84. The sensitivity, specificity, accuracy, PPV and NPV were 70.4%, 85.1%, 78.5%, 79.2% and 78.1%, respectively. CONCLUSIONS 13N-ammonia imaging is effective in distinguishing high-grade gliomas from low-grade gliomas and inflammations, but its role in the differential diagnosis of low-grade gliomas and brain inflammatory lesions is limited, and the accuracy needs to be improved.
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11
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Croteau E, Renaud JM, Richard MA, Ruddy TD, Bénard F, deKemp RA. PET Metabolic Biomarkers for Cancer. BIOMARKERS IN CANCER 2016; 8:61-9. [PMID: 27679534 PMCID: PMC5030827 DOI: 10.4137/bic.s27483] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/08/2016] [Accepted: 05/19/2016] [Indexed: 02/06/2023]
Abstract
The body's main fuel sources are fats, carbohydrates (glucose), proteins, and ketone bodies. It is well known that an important hallmark of cancer cells is the overconsumption of glucose. Positron emission tomography (PET) imaging using the glucose analog (18)F-fluorodeoxyglucose ((18)F-FDG) has been a powerful cancer diagnostic tool for many decades. Apart from surgery, chemotherapy and radiotherapy represent the two main domains for cancer therapy, targeting tumor proliferation, cell division, and DNA replication-all processes that require a large amount of energy. Currently, in vivo clinical imaging of metabolism is performed almost exclusively using PET radiotracers that assess oxygen consumption and mechanisms of energy substrate consumption. This paper reviews the utility of PET imaging biomarkers for the detection of cancer proliferation, vascularization, metabolism, treatment response, and follow-up after radiation therapy, chemotherapy, and chemotherapy-related side effects.
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Affiliation(s)
- Etienne Croteau
- National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada; Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jennifer M Renaud
- National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Marie Anne Richard
- Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Terrence D Ruddy
- National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - François Bénard
- Division of Nuclear Medicine, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Robert A deKemp
- National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
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12
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He Q, Shi X, Zhang L, Yi C, Zhang X, Zhang X. De Novo Glutamine Synthesis: Importance for the Proliferation of Glioma Cells and Potentials for Its Detection With 13N-Ammonia. Mol Imaging 2016; 15:15/0/1536012116645440. [PMID: 27118759 PMCID: PMC5470141 DOI: 10.1177/1536012116645440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/23/2016] [Indexed: 11/29/2022] Open
Abstract
Purpose: The aim of this study was to investigate the role of de novo glutamine (Gln) synthesis in the proliferation of C6 glioma cells and its detection with 13N-ammonia. Methods: Chronic Gln-deprived C6 glioma (0.06C6) cells were established. The proliferation rates of C6 and 0.06C6 cells were measured under the conditions of Gln deprivation along with or without the addition of ammonia or glutamine synthetase (GS) inhibitor. 13N-ammonia uptake was assessed in C6 cells by gamma counting and in rats with C6 and 0.06C6 xenografts by micro–positron emission tomography (PET) scanning. The expression of GS in C6 cells and xenografts was assessed by Western blotting and immunohistochemistry, respectively. Results: The Gln-deprived C6 cells showed decreased proliferation ability but had a significant increase in GS expression. Furthermore, we found that low concentration of ammonia was sufficient to maintain the proliferation of Gln-deprived C6 cells, and 13N-ammonia uptake in C6 cells showed Gln-dependent decrease, whereas inhibition of GS markedly reduced the proliferation of C6 cells as well as the uptake of 13N-ammoina. Additionally, microPET/computed tomography exhibited that subcutaneous 0.06C6 xenografts had higher 13N-ammonia uptake and GS expression in contrast to C6 xenografts. Conclusion: De novo Gln synthesis through ammonia–glutamate reaction plays an important role in the proliferation of C6 cells. 13N-ammonia can be a potential metabolic PET tracer for Gln-dependent tumors.
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Affiliation(s)
- Qiao He
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xinchong Shi
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Linqi Zhang
- Department of Nuclear Medicine, the Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Chang Yi
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xuezhen Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiangsong Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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13N-ammonia combined with 18F-FDG could discriminate between necrotic high-grade gliomas and brain abscess. Clin Nucl Med 2015; 40:195-9. [PMID: 25546194 DOI: 10.1097/rlu.0000000000000649] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Accurate prediction of brain abscess is beneficial for timely management. In this study, we investigated the utility of 13N-ammonia and its combination with 18F-FDG in differentiating brain abscess from necrotic high-grade gliomas. PATIENTS AND METHODS Thirteen patients with ring-like enhancement high-grade gliomas and 11 patients with brain abscess were recruited in our study. All of them underwent both 18F-FDG and 13N-ammonia PET imaging. Lesion uptake was evaluated by lesion to normal gray matter ratio (L/N). Histopathology diagnosis was obtained for all the patients after PET imaging. RESULTS The L/N values of 18F-FDG were not significantly different between brain abscess and necrotic high-grade gliomas (P = 0.35). The uptake of 13N-ammonia in gliomas was higher than that in abscess lesions (L/N: 1.38 ± 0.31 vs 0.84 ± 0.18, P < 0.001). The receiver operating characteristic curve analysis determined the optimal L/N cutoff value (13N-ammonia) of 1.0 with the area under the curve of 0.94 and the overall accuracy of 87.5%. Discriminant analysis demonstrated that the combination of 18F-FDG and 13N-ammonia could distinguish the 2 clinical entities with higher accuracy of 95%, and only 1 necrotic glioma lesion was misclassified into the abscess group. CONCLUSIONS 13N-ammonia is effective in distinguishing brain abscess from necrotic high-grade gliomas, and its combination with 18F-FDG could further elevate the diagnostic accuracy.
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Momosaki S, Ito M, Tonomura M, Abe K. Assessment of glutamine synthetase activity by [13N]ammonia uptake in living rat brain. Synapse 2014; 69:26-32. [DOI: 10.1002/syn.21781] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/07/2014] [Accepted: 08/22/2014] [Indexed: 01/21/2023]
Affiliation(s)
- Sotaro Momosaki
- Department of Drug Metabolism & Pharmacokinetics; Research Laboratory for Development; Shionogi & Co., Ltd., Futaba-cho Toyonaka Osaka 561-0825 Japan
| | - Miwa Ito
- Department of Drug Metabolism & Pharmacokinetics; Research Laboratory for Development; Shionogi & Co., Ltd., Futaba-cho Toyonaka Osaka 561-0825 Japan
| | - Misato Tonomura
- Department of Drug Metabolism & Pharmacokinetics; Research Laboratory for Development; Shionogi & Co., Ltd., Futaba-cho Toyonaka Osaka 561-0825 Japan
| | - Kohji Abe
- Department of Drug Metabolism & Pharmacokinetics; Research Laboratory for Development; Shionogi & Co., Ltd., Futaba-cho Toyonaka Osaka 561-0825 Japan
- Department of Molecular Imaging in Medicine; Osaka University Graduate School of Medicine; 2-2, Yamada-oka Suita Osaka 565-0871 Japan
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15
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Khangembam BC, Sharma P, Karunanithi S, Singhal A, Das CJ, Kumar P, Julka PK, Bandopadhyaya GP, Kumar R, Malhotra A, Bal C. 13N-Ammonia PET/CT for detection of recurrent glioma: a prospective comparison with contrast-enhanced MRI. Nucl Med Commun 2013; 34:1046-1054. [PMID: 24025920 DOI: 10.1097/mnm.0b013e328365bb41] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We assessed the value of N-ammonia PET-computed tomography (PET/CT) in recurrent glioma and compared the results with those of contrast-enhanced MRI (CE MRI). MATERIALS AND METHODS Fifty-two (mean age, 39.8±11.6 years; male, 33; female, 19) histopathologically proven and previously treated glioma patients with clinical suspicion of recurrence were evaluated with 13N-ammonia PET/CT and CE MRI. PET/CT images were evaluated qualitatively and quantitatively (maximum standardized uptake value). Tumour to white matter (T/W), tumour to grey matter (T/G) and tumour to pituitary (T/P) ratios were calculated and cutoff levels were derived with receiver operating characteristic curve analysis. Sensitivity, specificity and predictive values were compared. A combination of clinical follow-up, repeat imaging and biopsy (when available) was taken as the reference standard. RESULTS On the basis of the reference standard, 23 out of 52 patients were seen to have recurrence. Overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 13N-ammonia PET/CT were 82.6, 86.2, 82.6, 86.2 and 84.6%, respectively, whereas those of CE MRI were 96.7, 48.3, 59.5, 93.3 and 69.2%, respectively. Overall, 13N-ammonia PET/CT was statistically superior to CE MRI (P=0.001). In low-grade tumours, 13N-ammonia PET/CT performed better than MRI with an accuracy of 86.8 versus 68.4% (P=0.003). In high-grade tumours, both the modalities had comparable performances with accuracies of 78.6% for N-ammonia PET/CT and 71.4% for CE MRI (P=0.250). Among the ratios, T/P was the most useful, with the largest area under the curve (0.825; P=0.0001). CONCLUSION N-Ammonia PET/CT shows higher accuracy compared with contrast-enhanced MRI for detecting recurrent gliomas, particularly in low-grade tumours.
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Affiliation(s)
- Bangkim C Khangembam
- Departments of aNuclear Medicine bRadiodiagnosis cRadiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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16
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The combination of 13N-ammonia and 18F-FDG in predicting primary central nervous system lymphomas in immunocompetent patients. Clin Nucl Med 2013; 38:98-102. [PMID: 23334122 DOI: 10.1097/rlu.0b013e318279b6cc] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Accurate identification of primary central nervous system lymphoma (PCNSL) and its differentiation from other brain tumors remain difficult but are essential for treatment. In this study, we investigated whether (13)N-ammonia combined with (18)F-FDG could distinguish PCNSL from solid gliomas effectively. METHODS Ten consecutive patients with final diagnosis of PCNSL (5 female and 5 male patients; mean [SD] age, 59.10 [12.47] years; range, 43-74 years) and another fifteen consecutive patients with solid glioma lesions (5 female and 10 male patients; mean [SD] age, 46.73 [19.61] years; range, 14-72 years) were included in this study. PET/CT imaging was performed for all of them with both (18)F-FDG and (13)N-ammonia as tracers. Tumor-to-gray matter (T/G) ratios were calculated for the evaluation of tumor uptake. Both Student t test and discriminant analysis were recruited to assess the differential efficacy of these 2 tracers. RESULTS The T/G ratios of (18)F-FDG in PCNSL lesions were higher than in solid gliomas (3.26 [1.18] vs 1.56 [0.41], P < 0.001), whereas the T/G ratios of (13)N-ammonia in PCNSL lesions were lower than in solid gliomas significantly (1.38 [0.20] vs 2.11 [0.69], P < 0.001). All the lesions of PCNSL displayed higher T/G ratios of (18)F-FDG than (13)N-ammonia, whereas 14 (77.8%) of 18 glioma lesions showed contrary results. Tumor classification by means of canonical discriminant analysis yielded an overall accuracy of 96.9%, and only one glioma lesion was misclassified into the PCNSL group. CONCLUSIONS PCNSLs and solid gliomas have different metabolic profiles on N-ammonia and F-FDG imaging. The combination of these 2 tracers can distinguish these 2 clinical entities effectively and make an accurate prediction of PCNSL.
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Valotassiou V, Leondi A, Angelidis G, Psimadas D, Georgoulias P. SPECT and PET imaging of meningiomas. ScientificWorldJournal 2012; 2012:412580. [PMID: 22623896 PMCID: PMC3353476 DOI: 10.1100/2012/412580] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 01/26/2012] [Indexed: 12/21/2022] Open
Abstract
Meningiomas arise from the meningothelial cells of the arachnoid membranes. They are the most common primary intracranial neoplasms and represent about 20% of all intracranial tumors. They are usually diagnosed after the third decade of life and they are more frequent in women than in men. According to the World Health Organization (WHO) criteria, meningiomas can be classified into grade I meningiomas, which are benign, grade II (atypical) and grade III (anaplastic) meningiomas, which have a much more aggressive clinical behaviour. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are routinely used in the diagnostic workup of patients with meningiomas. Molecular Nuclear Medicine Imaging with Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET) could provide complementary information to CT and MRI. Various SPECT and PET tracers may provide information about cellular processes and biological characteristics of meningiomas. Therefore, SPECT and PET imaging could be used for the preoperative noninvasive diagnosis and differential diagnosis of meningiomas, prediction of tumor grade and tumor recurrence, response to treatment, target volume delineation for radiation therapy planning, and distinction between residual or recurrent tumour from scar tissue.
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Affiliation(s)
- Varvara Valotassiou
- Nuclear Medicine Department, University Hospital of Larissa, Mezourlo, Larissa, Greece.
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Martín A, San Sebastián E, Gómez-Vallejo V, Llop J. Positron emission tomograghy with [¹³N]ammonia evidences long-term cerebral hyperperfusion after 2h-transient focal ischemia. Neuroscience 2012; 213:47-53. [PMID: 22521831 DOI: 10.1016/j.neuroscience.2012.03.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 03/20/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE It is well known that after cerebral ischemia, brain suffers blood flow changes over time that have been correlated with inflammation, angiogenesis and functional recovery processes. Nevertheless, post-ischemic spatiotemporal changes of brain perfusion have not been fully investigated to date. Here we tested whether PET with [¹³N]ammonia would evidence the perfusion changes presented by different brain regions in an experimental model of brain ischemia. EXPERIMENTAL PROCEDURES Seven rats were subjected to a 2-h transient middle cerebral artery occlusion with reperfusion. PET studies were performed longitudinally using [¹³N]ammonia at 1, 3, 7, 14, 21 and 28 days after cerebral ischemia. RESULTS In vivo PET imaging showed a significant increase in [¹³N]ammonia uptake at 7 days after cerebral ischemia with respect to one day after the occlusion in the cerebral territory irrigated by the MCA in both the ischemic and contralateral hemispheres. This increase was followed by a return to control values at day 28 after ischemia onset. Brain regions located both inside and outside the primary infarct areas showed similar perfusion changes after cerebral ischemia. CONCLUSIONS [¹³N]ammonia shows hemodynamic changes after stroke involving hyperperfusion that might be related to angiogenesis and functional recovery. Long-term blood hyperperfusion is found both in ischemic and remote areas to infarction. These results may contribute to a better understanding of the evolution of cerebral ischemic lesion in animal models.
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Affiliation(s)
- A Martín
- Molecular Imaging Unit, CIC biomaGUNE, Spain.
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Abstract
PURPOSE Relatively high Tl-201 uptakes have been reported in all types of meningiomas, and it have been proposed that (201)TlCl SPECT could predict histologic types of meningiomas and differentiate the benign and aggressive meningiomas. Similar to Tl-201, (13)N-(13)NH(4)(+) is an analog of K(+) and could substitute K(+) in some cases. The aim of this study was to evaluate the capacity of PET with (13)N-NH(3) to discriminate meningioma from healthy tissue, and compare with F-18 FDG. METHODS Eleven patients with the neuroradiologic diagnosis of meningiomas were studied with (13)N-NH(3), and 10 of them were performed with F-18 FDG PET within 3 days. Ten of them were histologically confirmed (6 grade I, 4 grade II), and another one was proved by radiologic (computed tomography and magnetic resonance imaging) and clinical investigation.The PET images were evaluated by semiquantitative analysis using tumor-to-white matter ratio (T/W). RESULTS (13)N-NH(3) uptake was obviously increased in all 11 meningiomas with a good contrast to the surrounding normal brain tissues. Conversely, F-18 FDG uptake was decreased in comparison with the contralateral side in all 7 patients with grade I meningiomas and moderately increased in the remaining patient with grade II meningioma. The T/W ratio of (13)N-NH(3) was higher than that of F-18 FDG (7.03 ± 1.62 vs. 1.44 ± 0.57, P < 0.005). T/W of (13)N-NH(3) uptake was not useful for differentiating benign (Grade I) from atypical (Grade II) meningiomas (P = 0.88), whereas the T/W ratio of F-18 FDG uptake was better than that of N-NH3 for differentiating benign from malignant meningiomas (P = 0.037). CONCLUSIONS These preliminary results suggest that (13)N-NH(3) has relatively greater uptake in meningiomas in comparison with F-18 FDG. Clinical applications of (13)N-NH(3) PET for grading and follow-up of meningiomas need to be assessed in further studies.
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Abstract
For most cancers, PET is essentially a diagnostic tool. For brain tumors, PET has got its main contribution at the level of the therapeutic management. Indeed, specific reasons render the therapeutic management of brain tumors, especially gliomas, a real challenge. Although some gliomas may appear well-delineated on conventional neuroimaging such as CT and MRI, they are by nature infiltrating neoplasms and the interface between tumor and normal brain tissue may not be accurately defined. Moreover, gliomas may present as ill-defined lesions for which various MRI sequences combination does not provide a unique contour for tumor delineation. Also, gliomas are often histologically heterogeneous with anaplastic areas evolving within a low-grade tumor, and contrast-enhancement on CT or MRI does not represent a good marker for anaplastic tissue detection. Finally, assessment of tumor residue, recurrence, or progression, may be altered by different signals related to inflammation or adjuvant therapies, and contrast enhancement on CT and MRI is not an appropriate marker at the postoperative or posttherapeutic stage. These limitations of conventional neuroimaging in detecting tumor tissue, delineating tumor extent and evidencing anaplastic changes, lead to potential inaccuracy in lesion targeting at different steps of the management (diagnostic, surgical, postoperative, and posttherapeutic stages). Molecular information provided by PET has proved helpful to supplement morphological imaging data in this context. F-18 FDG and amino-acid tracers such as C-11 methionine (C-11 MET) provide complementary metabolic data that are independent from the anatomical MR information. These tracers help in the definition of glioma extension, detection of anaplastic areas, and postoperative follow-up. Additionally, PET data have a prognostic value independently of histology. To take advantage of PET data in glioma treatment, PET might be integrated in the planning of image-guided biopsy, resection, and radiosurgery.
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Affiliation(s)
- Serge Goldman
- PET-Biomedical Cyclotron Unit, ERASME Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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21
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Xiangsong Z, Weian C, Dianchao Y, Xiaoyan W, Zhifeng C, Xiongchong S. Usefulness of 13N-NH3 PET in the evaluation of brain lesions that are hypometabolic on 18F-FDG PET. J Neurooncol 2011; 105:103-7. [DOI: 10.1007/s11060-011-0570-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 03/26/2011] [Indexed: 11/30/2022]
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Glioma recurrence versus radiation necrosis: accuracy of current imaging modalities. J Neurooncol 2009; 95:1-11. [DOI: 10.1007/s11060-009-9897-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 04/06/2009] [Indexed: 01/09/2023]
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Abstract
PURPOSE The purpose of this study is to determine whether there is a qualitative and quantitative relationship between the breakdown of the blood-brain barrier, defined radiologically by the contrast enhancement of MRI, and the uptake of N-NH3 in brain tumors. METHODS The results of N-NH3 PET in 42 patients suspected of having brain tumors were compared with the findings of contrast-enhanced MRI. A histopathological diagnosis was carried out in 33 patients, and a clinical diagnosis was performed in the remaining patients. PET and MRI images were visually inspected, and the contrast index (CI) of MRI and the uptake index (UI) of N-NH3 were measured. RESULTS Contrast enhancement of MRIs was seen in 20 of 29 brain tumors (69%). Increased uptake of N-NH3 was seen in 24 of 29 brain tumors (83%). Nineteen of 20 contrast-enhancing brain tumors exhibited the increased uptake of N-NH3 (95%). Areas of the increased N-NH3 uptake corresponded to areas enhanced on MR images in the majority of cases. Five out of nine nonenhancing tumors exhibited increased uptake of N-NH3 (56%). The contrast enhancement of MRIs was seen in nine of 13 nonneoplastic lesions (69%). None of the nonneoplastic lesions showed increased uptake of N-NH3, yielding a specificity of 100% for brain tumors (0 of 13). CI for tumor tissue was 1.46+/-0.64. UI of N-NH3 for tumor tissue was 1.64+/-0.71. CI and UI for tumor tissue were significantly correlated (r=0.86, P<0.01). A statistically significant difference in uptake levels of N-NH3 between contrast-enhancing tumors and nonenhancing tumors (1.88+/-0.66, n=20 vs. 1.11+/-0.52, n=9, P<0.01) was observed. UI was higher in brain tumors compared with the nonneoplastic lesions (1.64+/-0.71 vs. 0.71+/-0.19, P<0.01). CONCLUSION N-NH3 is a potential selective contrast-enhanced tracer for brain tumor, and may prove especially useful for evaluating the contrast-enhancing lesions on MRI to distinguish brain tumors from nonneoplastic lesions.
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Abstract
Multiple biomedical imaging techniques are used in all phases of cancer management. Imaging forms an essential part of cancer clinical protocols and is able to furnish morphological, structural, metabolic and functional information. Integration with other diagnostic tools such as in vitro tissue and fluids analysis assists in clinical decision-making. Hybrid imaging techniques are able to supply complementary information for improved staging and therapy planning. Image guided and targeted minimally invasive therapy has the promise to improve outcome and reduce collateral effects. Early detection of cancer through screening based on imaging is probably the major contributor to a reduction in mortality for certain cancers. Targeted imaging of receptors, gene therapy expression and cancer stem cells are research activities that will translate into clinical use in the next decade. Technological developments will increase imaging speed to match that of physiological processes. Targeted imaging and therapeutic agents will be developed in tandem through close collaboration between academia and biotechnology, information technology and pharmaceutical industries.
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Affiliation(s)
- Leonard Fass
- GE Healthcare, 352 Buckingham Avenue, Slough, SL1 4ER, UK.
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Alexiou GA, Fotopoulos AD, Papadopoulos A, Kyritsis AP, Polyzoidis KS, Tsiouris S. Evaluation of brain tumor recurrence by (99m)Tc-tetrofosmin SPECT: a prospective pilot study. Ann Nucl Med 2007; 21:293-8. [PMID: 17634847 DOI: 10.1007/s12149-007-0027-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2006] [Accepted: 03/26/2007] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The differentiation between brain tumor recurrence and post-irradiation injury remains an imaging challenge. Computed tomography (CT) and magnetic resonance imaging (MRI) cannot always distinguish between the two. Although glioma cell line studies substantiated a plausible imaging superiority of (99m)Tc-tetrofosmin ((99m)Tc-TF) over other radiopharmaceuticals, little has been reported on its in vivo imaging properties. We assessed (99m)Tc-TF single-photon emission CT (SPECT) in cases where morphologic brain imaging was inconclusive between recurrence and radionecrosis. METHODS A total of 11 patients (7 men, 4 women) were evaluated. The initial diagnosis was glioblastoma multiforme (4), anaplastic astrocytoma (1), anaplastic oligodendroglioma (3), grade-II astrocytoma (2), and low-grade oligodendroglioma (1). All patients had been operated on and then received adjuvant external-beam radiotherapy. After a mean follow-up period of 25 months, there was clinical suspicion of recurrence, for which (99m)Tc-TF SPECT was performed. RESULTS In 8/11 cases, an abnormally increased tracer uptake appeared in the region that CT and/or MRI indicated as suspicious; in half of these cases, recurrence was confirmed histologically after surgery and in the other four by growth of the lesion over a 6-month follow-up period, and clinical deterioration. The remaining 3/11 patients had faint tracer uptake in the suspicious region, compatible with radiation injury; these lesions remained morphologically unaltered in a mean 12-month follow-up period, with no clinical deterioration in the patient's condition, a course strongly favoring the diagnosis of radiation injury. CONCLUSIONS Metabolic brain imaging by (99m)Tc-TF could offer useful information in the workup of treated brain tumors, where radiomorphologic findings between recurrence and radionecrosis are inconclusive.
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Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, University of Ioannina School of Medicine, Neohoropoulo, Ioannina, Greece.
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27
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Xiangsong Z, Weian C. Differentiation of recurrent astrocytoma from radiation necrosis: a pilot study with 13N-NH3 PET. J Neurooncol 2006; 82:305-11. [PMID: 17120157 DOI: 10.1007/s11060-006-9286-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Accepted: 10/24/2006] [Indexed: 11/30/2022]
Abstract
UNLABELLED Differentiation of posttherapy radiation necrosis from recurrent brain tumor remains a challenging diagnostic problem. The combination of the imaging modalities on the basis of different physiologic mechanisms could improve diagnostic accuracy. The present study assessed the role of (13)N-NH(3) PET in differentiating recurrent cerebral astrocytoma from radiation necrosis. METHODS Seven patients, who were previously treated with conventional external-beam radiation therapy after surgical resection for cerebral astrocytomas, and showed the enhancing brain lesions on T1-weighted gadiolinium-enhanced MR studies performed in 6 months or above after the radiotherapies, were examined prospectively with (13)N-NH(3) and FDG PET. Five lesions with tumor recurrence and two with radiation necrosis were histologically verified by either surgical resection or stereotactic biopsy. One lesion of radiation necrosis was confirmed clinicoradiologically. RESULTS In all eight lesions the (13)N-NH(3) PET scans were concordant with the final diagnosis (100%, 8/8). The lesions with recurrent tumor showed moderately to markedly increased (13)N-NH(3) uptake (grade = 4-5). The lesions with radiation necrosis showed absent or less (13)N-NH(3) uptake than surrounding area (grade = 1-2). The FDG PET scans were concordant with the final diagnosis in six of eight lesions (75%, 6/8), and there were one false-negative result and one false-positive result. The diagnostic result of (13)N-NH(3) PET was discordant with FDG PET in two lesions. One lesion with gliosis and radiation necrosis showed slightly increased FDG uptake (grade = 4), but less (13)N-NH(3) uptake (grade = 2). The other lesion with anaplastic astrocytoma showed moderately increased (13)N-NH(3) uptake (grade = 4), but slightly less FDG uptake than surrounding area (grade = 2). CONCLUSIONS The recurrent astrocytomas showed increased (13)N-NH(3) uptake, and the radiation necrosis showed absent or less (13)N-NH(3) uptake, and (13)N-NH(3) seem superior to (18)F-FDG for this purpose, suggesting that (13)N-NH(3) is a promising tracer for separating radiation necrosis from astrocytoma recurrence. However, the patient population in this study was small. Thus, the further studies are needed to settle this issue.
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Affiliation(s)
- Zhang Xiangsong
- Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China.
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