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Khojasteh E, Dehdashti F, Shokeen M. Molecular imaging of bone metastasis. J Bone Oncol 2023; 40:100477. [PMID: 37193117 PMCID: PMC10182320 DOI: 10.1016/j.jbo.2023.100477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 05/18/2023] Open
Abstract
Recent advances in molecularly targeted modular designs for in vivo imaging applications has thrusted open possibilities of investigating deep molecular interactions non-invasively and dynamically. The shifting landscape of biomarker concentration and cellular interactions throughout pathological progression requires quick adaptation of imaging agents and detection modalities for accurate readouts. The synergy of state of art instrumentation with molecularly targeted molecules is resulting in more precise, accurate and reproducible data sets, which is facilitating investigation of several novel questions. Small molecules, peptides, antibodies and nanoparticles are some of the commonly used molecular targeting vectors that can be applied for imaging as well as therapy. The field of theranostics, which encompasses joint application of therapy and imaging, is successfully leveraging the multifunctional use of these biomolecules [[1], [2]]. Sensitive detection of cancerous lesions and accurate assessment of treatment response has been transformative for patient management. Particularly, since bone metastasis is one of the dominant causes of morbidity and mortality in cancer patients, imaging can be hugely impactful in this patient population. The intent of this review is to highlight the utility of molecular positron emission tomography (PET) imaging in the context of prostate and breast bone metastatic cancer, and multiple myeloma. Furthermore, comparisons are drawn with traditionally utilized bone scans (skeletal scintigraphy). Both these modalities can be synergistic or complementary for assessing lytic- and blastic- bone lesions.
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Affiliation(s)
- Eliana Khojasteh
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Farrokh Dehdashti
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Monica Shokeen
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
- Corresponding author at: Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA.
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Hansen JA, Naghavi-Behzad M, Gerke O, Baun C, Falch K, Duvnjak S, Alavi A, Høilund-Carlsen PF, Hildebrandt MG. Diagnosis of bone metastases in breast cancer: Lesion-based sensitivity of dual-time-point FDG-PET/CT compared to low-dose CT and bone scintigraphy. PLoS One 2021; 16:e0260066. [PMID: 34793550 PMCID: PMC8601566 DOI: 10.1371/journal.pone.0260066] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 11/02/2021] [Indexed: 11/18/2022] Open
Abstract
We compared lesion-based sensitivity of dual-time-point FDG-PET/CT, bone scintigraphy (BS), and low-dose CT (LDCT) for detection of various types of bone metastases in patients with metastatic breast cancer. Prospectively, we included 18 patients with recurrent breast cancer who underwent dual-time-point FDG-PET/CT with LDCT and BS within a median time interval of three days. A total of 488 bone lesions were detected on any of the modalities and were categorized by the LDCT into osteolytic, osteosclerotic, mixed morphologic, and CT-negative lesions. Lesion-based sensitivity was 98.2% (95.4-99.3) and 98.8% (96.8-99.5) for early and delayed FDG-PET/CT, respectively, compared with 79.9% (51.1-93.8) for LDCT, 76.0% (36.3-94.6) for BS, and 98.6% (95.4-99.6) for the combined BS+LDCT. BS detected only 51.2% of osteolytic lesions which was significantly lower than other metastatic types. SUVs were significantly higher for all lesion types on delayed scans than on early scans (P<0.0001). Osteolytic and mixed-type lesions had higher SUVs than osteosclerotic and CT-negative metastases at both time-points. FDG-PET/CT had significantly higher lesion-based sensitivity than LDCT and BS, while a combination of the two yielded sensitivity comparable to that of FDG-PET/CT. Therefore, FDG-PET/CT could be considered as a sensitive one-stop-shop in case of clinical suspicion of bone metastases in breast cancer patients.
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Affiliation(s)
- Jeanette Ansholm Hansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Mohammad Naghavi-Behzad
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- * E-mail:
| | - Oke Gerke
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Christina Baun
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Kirsten Falch
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sandra Duvnjak
- Radiology Department–Breast Imaging, Herlev Gentofte Hospital, Copenhagen, Denmark
- Mammography Screening Center in the Capital Region, Herlev Gentofte Hospital, Copenhagen, Denmark
| | - Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Poul Flemming Høilund-Carlsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Malene Grubbe Hildebrandt
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Centre for Personalized Response Monitoring in Oncology, Odense University Hospital, Odense, Denmark
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Liu F, Dong J, Shen Y, Yun C, Wang R, Wang G, Tan J, Wang T, Yao Q, Wang B, Li L, Mi J, Zhou D, Xiong F. Comparison of PET/CT and MRI in the Diagnosis of Bone Metastasis in Prostate Cancer Patients: A Network Analysis of Diagnostic Studies. Front Oncol 2021; 11:736654. [PMID: 34671558 PMCID: PMC8522477 DOI: 10.3389/fonc.2021.736654] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/10/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Accurate diagnosis of bone metastasis status of prostate cancer (PCa) is becoming increasingly more important in guiding local and systemic treatment. Positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) have increasingly been utilized globally to assess the bone metastases in PCa. Our meta-analysis was a high-volume series in which the utility of PET/CT with different radioligands was compared to MRI with different parameters in this setting. MATERIALS AND METHODS Three databases, including Medline, Embase, and Cochrane Library, were searched to retrieve original trials from their inception to August 31, 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The methodological quality of the included studies was assessed by two independent investigators utilizing Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). A Bayesian network meta-analysis was performed using an arm-based model. Absolute sensitivity and specificity, relative sensitivity and specificity, diagnostic odds ratio (DOR), and superiority index, and their associated 95% confidence intervals (CI) were used to assess the diagnostic value. RESULTS Forty-five studies with 2,843 patients and 4,263 lesions were identified. Network meta-analysis reveals that 68Ga-labeled prostate membrane antigen (68Ga-PSMA) PET/CT has the highest superiority index (7.30) with the sensitivity of 0.91 and specificity of 0.99, followed by 18F-NaF, 11C-choline, 18F-choline, 18F-fludeoxyglucose (FDG), and 18F-fluciclovine PET/CT. The use of high magnetic field strength, multisequence, diffusion-weighted imaging (DWI), and more imaging planes will increase the diagnostic value of MRI for the detection of bone metastasis in prostate cancer patients. Where available, 3.0-T high-quality MRI approaches 68Ga-PSMA PET/CT was performed in the detection of bone metastasis on patient-based level (sensitivity, 0.94 vs. 0.91; specificity, 0.94 vs. 0.96; superiority index, 4.43 vs. 4.56). CONCLUSIONS 68Ga-PSMA PET/CT is recommended for the diagnosis of bone metastasis in prostate cancer patients. Where available, 3.0-T high-quality MRI approaches 68Ga-PSMA PET/CT should be performed in the detection of bone metastasis.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yelong Shen
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Canhua Yun
- Department of Nuclear Medicine, The Second Hospital of Shandong University, Jinan, China
| | - Ruixiao Wang
- Department of Urology Surgery, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Ganggang Wang
- Department of Urology Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Jiyang Tan
- Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Tao Wang
- Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Qun Yao
- Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Bomin Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lianxin Li
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jingyi Mi
- Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Fei Xiong
- Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, China
- *Correspondence: Fei Xiong,
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Comparison of PSMA-PET/CT, choline-PET/CT, NaF-PET/CT, MRI, and bone scintigraphy in the diagnosis of bone metastases in patients with prostate cancer: a systematic review and meta-analysis. Skeletal Radiol 2019; 48:1915-1924. [PMID: 31127357 DOI: 10.1007/s00256-019-03230-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A systematic review and meta-analysis to compare the diagnostic performance of prostate-specific membrane antigen (PSMA)-PET/CT, choline-PET/CT, Sodium Fluoride (NaF) PET/CT, MRI, and bone scintigraphy (BS) in detecting bone metastases in patients with prostate cancer. METHODS We searched PubMed and Embase for articles published between January 1990 and September 2018. Two evaluators independently extracted the sensitivity, specificity, the numbers of true and false positives, and true and false negatives. We calculated the pooled sensitivity, specificity, and 95% confidence intervals (CI) for each method. We calculated the tests' diagnostic odds ratios (DOR); drew the summary receiver operating characteristic (SROC) curves; and obtained the areas under the curves (AUC), Q* values, and 95% CIs. RESULTS The per-patient pooled sensitivities of PSMA-PET/CT, choline-PET/CT, NaF-PET/CT, MRI, and BS were 0.97, 0.87, 0.96, 0.91, and 0.86, respectively. The pooled specificities were 1.00, 0.99, 0.97, 0.96, and 0.95, respectively. The pooled DOR values were 504.16, 673.67, 242.63, and 114.44, respectively. The AUC were 1.00, 0.99, 0.99, 0.98, and 0.95, respectively. The per-lesion pooled sensitivities of PSMA-PET/CT, choline-PET/CT, NaF-PET/CT, MRI, and bone imaging were 0.88, 0.80, 0.97, 0.81 and 0.68, respectively. CONCLUSIONS According to the meta-analysis, PSMA-PET/CT had the highest per-patient sensitivity and specificity in detecting bone metastases with prostate cancer. The sensitivities of NaF-PET/CT and MRI were better than those for choline-PET/CT and BS. The specificity of PSMA-PET/CT was significantly better than BS. Others were similar. For per-lesion, NaF-PET/CT had the highest sensitivity, PSMA-PET/CT had higher sensitivity than choline-PET/CT and MRI, and BS had the lowest sensitivity.
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Han S, Li Y, Li Y, Zhao M. Diagnostic efficacy of PET/CT in bone tumors. Oncol Lett 2019; 17:4271-4276. [PMID: 30944621 PMCID: PMC6444356 DOI: 10.3892/ol.2019.10101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/22/2019] [Indexed: 11/19/2022] Open
Abstract
Clinical value of PET/CT (positron emission tomography/computed tomography) in the diagnosis of malignant bone tumors (BT) was investigated. Fifty-four patients with BT were first diagnosed by ordinary CT and then by PET/CT. The diagnostic efficacy outcomes and diagnosis of malignant BT by clinical stage of the two methods for BT were observed and recorded, and the diagnostic value of PET/CT in the diagnosis of BT was evaluated. There were 14 cases of benign BT patients, 15 cases of stage I, 10 cases of stage II and 15 cases of stage III in malignant BT patients. The diagnostic coincidence rate of PET/CT was 92.59% and the diagnostic coincidence rate of CT was 72.22%, which showed that the diagnostic coincidence rate of PET/CT was significantly higher than that of CT (P<0.05). The sensitivity, negative predictive value and positive predictive value of PET/CT were 95.00, 85.71 and 95.00%, respectively, which were higher than those of CT (P<0.05). CT and PET/CT were used for the clinical staging and pathological diagnosis of malignant BT; the results showed that the diagnostic accuracy of PET/CT in the clinical stages of malignant BT was also significantly higher than that of CT (P<0.05). The diagnostic efficacy of PET/CT in BT is better than that in CT. PET/CT can diagnose the pathological properties of BT more accurately, and can also effectively diagnose the clinical stage of malignant BT and provide clinical diagnostic basis for follow-up procedures.
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Affiliation(s)
- Songhui Han
- Department of Intervention, Henan Province Luoyang Orthopedic Traumatological Hospital (Henan Provincal Orthopedic Hospital), Luoyang, Henan 471002, P.R. China
| | - Yanzhou Li
- Department of Intervention, Henan Province Luoyang Orthopedic Traumatological Hospital (Henan Provincal Orthopedic Hospital), Luoyang, Henan 471002, P.R. China
| | - Yuejing Li
- Department of Intervention, Henan Province Luoyang Orthopedic Traumatological Hospital (Henan Provincal Orthopedic Hospital), Luoyang, Henan 471002, P.R. China
| | - Min Zhao
- Department of Intervention, Henan Province Luoyang Orthopedic Traumatological Hospital (Henan Provincal Orthopedic Hospital), Luoyang, Henan 471002, P.R. China
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Guo Y, Wang L, Hu J, Feng D, Xu L. Diagnostic performance of choline PET/CT for the detection of bone metastasis in prostate cancer: A systematic review and meta-analysis. PLoS One 2018; 13:e0203400. [PMID: 30192819 PMCID: PMC6128558 DOI: 10.1371/journal.pone.0203400] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/20/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose The aim of this study was to evaluate the diagnostic performance of choline positron emission tomography/computed tomography (PET/CT) for the detection of bone metastasis in patients with prostate cancer. Methods MEDLINE, EMBASE and the Cochrane Library were searched up to 20 February 2018 for studies that used 11C-choline or 18F-choline PET/CT for the detection of bone metastasis in patients with prostate cancer and “histopathology and/or clinical follow-up” as the reference standard. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Pooled diagnostic accuracy with the 95% confidence interval (CI) was calculated using a bivariate random effects model. We also constructed hierarchical summary receiver operating characteristic curves and performed meta-regression analyses. Results Fourteen studies with reasonable methodological quality were included in the analysis. On a per-patient basis, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were 0.89 (95% CI 0.80–0.94), 0.98 (95% CI 0.95–0.99), 40.4 (95% CI 19.7–82.6), 0.12 (95% CI 0.07–0.20), and 344 (95% CI 148–803), respectively. On a per-lesion basis, the pooled sensitivity, specificity, PLR, NLR, and DOR were 0.91 (95% CI 0.85–0.94), 0.97 (95% CI 0.95–0.98), 34.1 (95% CI 20.0–58.1), 0.10 (95% CI 0.06–0.16), and 358 (95% CI 165–778), respectively. In the meta-regression analysis, the clinical setting (staging vs. restaging) was the only source of study heterogeneity on a per-patient basis. Conclusions Choline PET/CT shows excellent diagnostic performance for the detection of bone metastasis. However, a negative choline PET/CT result cannot ensure the lack of bone metastasis.
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Affiliation(s)
- Yu Guo
- Department of Orthopaedic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
- Department of Orthopaedic Surgery, Suzhou Dushuhu Public Hospital (Soochow University Multi-Disciplinary Polyclinic), Suzhou, Jiangsu, China
| | - Ling Wang
- Department of Orthopaedic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Junjie Hu
- Department of Urology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Dehong Feng
- Department of Orthopaedic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
- * E-mail: (LX); (DF)
| | - Lijuan Xu
- Laboratory Center, The Affiliated Suzhou Hospital of Nanjing Medical University, The North District of Suzhou Municipal Hospital, Suzhou, Jiangsu, China
- * E-mail: (LX); (DF)
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