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Marchetti L, Perrucci L, Pellegrino F, Baroni L, Merlo A, Tilli M, Rambaldi I, Maietti E, Carnevale A, Bartolomei M, Giganti M. Diagnostic Contribution of Contrast-Enhanced CT as Compared with Unenhanced Low-Dose CT in PET/CT Staging and Treatment Response Assessment of 18F-FDG-Avid Lymphomas: A Prospective Study. J Nucl Med 2021; 62:1372-1379. [PMID: 33712534 DOI: 10.2967/jnumed.120.259242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/29/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to assess the added diagnostic value of contrast-enhanced CT (CECT) as compared with unenhanced CT (UECT) in PET/CT staging and treatment response assessment of 18F-FDG-avid lymphomas. Methods: 170 PET/UECT scans followed by CECT scans were prospectively performed for staging (n = 85) and for treatment response assessment (n = 85) of 18F-FDG-avid lymphomas, during a single session using an integrated 64-slice PET/CT scanner. CECT and UECT images were evaluated separately by 2 radiologists, whereas PET images were evaluated by 2 nuclear physicians. Nodal and extranodal UECT and CECT findings were classified according to the Lugano criteria and were successively compared with PET/CT results, considered the gold standard. In the analyzed groups, the agreement rate with the disease status determined via PET was calculated separately for UECT and CECT using the McNemar test on paired data. The added value of the contrast medium was shown by the agreement between the PET and CECT results and the lack of agreement between UECT and PET. Results: CECT enabled the identification of additional extranodal lesions (hepatic, muscular, and gastric) in only 3 staging group cases (3.5%), indicating different stages as compared with UECT, whereas there was absolute agreement between CECT and UECT in terms of treatment response assessment. The added diagnostic value of CECT was lower than the established threshold for clinical relevance (15%). The McNemar test indicated no statistical significance in either group. The incidental findings detected by CECT but not UECT were important for clinical management but not sufficient to alter lymphoma treatment strategy. Conclusion: According to our results, it might be possible to exclude CECT examination of 18F-FDG-avid lymphoma from staging and treatment response assessment, with the consequent advantages of reducing radiation exposure and potential contrast-related risks.
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Affiliation(s)
- Lara Marchetti
- Department of Interventional and Diagnostic Radiology, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
| | - Luca Perrucci
- Section of Diagnostic Imaging, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Fabio Pellegrino
- Section of Diagnostic Imaging, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy;
| | - Luca Baroni
- Section of Diagnostic Imaging, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Annalisa Merlo
- Section of Diagnostic Imaging, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Massimo Tilli
- Ferrara Department of Interventional and Diagnostic Radiology, Ospedale di Lagosanto, Azienda AUSL, Ferrara, Italy
| | - Ilaria Rambaldi
- Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy; and
| | - Elisa Maietti
- Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - Aldo Carnevale
- Department of Interventional and Diagnostic Radiology, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
| | - Mirco Bartolomei
- Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy; and
| | - Melchiore Giganti
- Section of Diagnostic Imaging, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
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El-Galaly TC, Øvlisen AK, Cheah CY. Routine imaging for disease surveillance in follicular lymphoma-To comfort the patients or their doctors? Cancer 2021; 127:3298-3301. [PMID: 34157785 DOI: 10.1002/cncr.33659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/07/2021] [Accepted: 05/01/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Tarec Christoffer El-Galaly
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Andreas Kiesbye Øvlisen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Chan Yoon Cheah
- Department of Hematology, Sir Gairdner Hospital, Perth, Western Australia, Australia.,Medical School, University of Western Australia, Perth, Western Australia, Australia
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Ferrero A, Takahashi N, Vrtiska TJ, Krambeck AE, Lieske JC, McCollough CH. Understanding, justifying, and optimizing radiation exposure for CT imaging in nephrourology. Nat Rev Urol 2019; 16:231-244. [PMID: 30728476 PMCID: PMC6447446 DOI: 10.1038/s41585-019-0148-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
An estimated 4-5 million CT scans are performed in the USA every year to investigate nephrourological diseases such as urinary stones and renal masses. Despite the clinical benefits of CT imaging, concerns remain regarding the potential risks associated with exposure to ionizing radiation. To assess the potential risk of harmful biological effects from exposure to ionizing radiation, understanding the mechanisms by which radiation damage and repair occur is essential. Although radiation level and cancer risk follow a linear association at high doses, no strong relationship is apparent below 100 mSv, the doses used in diagnostic imaging. Furthermore, the small theoretical increase in risk of cancer incidence must be considered in the context of the clinical benefit derived from a medically indicated CT and the likelihood of cancer occurrence in the general population. Elimination of unnecessary imaging is the most important method to reduce imaging-related radiation; however, technical aspects of medically justified imaging should also be optimized, such that the required diagnostic information is retained while minimizing the dose of radiation. Despite intensive study, evidence to prove an increased cancer risk associated with radiation doses below ~100 mSv is lacking; however, concerns about ionizing radiation in medical imaging remain and can affect patient care. Overall, the principles of justification and optimization must remain the basis of clinical decision-making regarding the use of ionizing radiation in medicine.
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Affiliation(s)
- Andrea Ferrero
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Amy E Krambeck
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John C Lieske
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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Arleo EK. An article to ADMIRE. Acad Radiol 2015. [PMID: 26215855 DOI: 10.1016/j.acra.2015.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Elizabeth Kagan Arleo
- Department of Radiology, New York-Presbyterian, Weill Cornell Imaging, 425 East 61st St, 9th Floor, New York, NY 10065.
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