Bone Marrow and NOT Bone Metastases Is What 21st-Century Diagnostic Imaging Must Focus on When Looking for Skeletal Metastases

[18F]F-AraG imaging reveals association between neuroinflammation and brown- and bone marrow adipose tissue

Brown and brown-like adipose tissues have attracted significant attention for their role in metabolism and therapeutic potential in diabetes and obesity. Despite compelling evidence of an interplay between adipocytes and lymphocytes, the involvement of these tissues in immune responses remains largely unexplored. This study explicates a newfound connection between neuroinflammation and brown- and bone marrow adipose tissue. Leveraging the use of [18F]F-AraG, a mitochondrial metabolic tracer capable of tracking activated lymphocytes and adipocytes simultaneously, we demonstrate, in models of glioblastoma and multiple sclerosis, the correlation between intracerebral immune infiltration and changes in brown- and bone marrow adipose tissue. Significantly, we show initial evidence that a neuroinflammation-adipose tissue link may also exist in humans. This study proposes the concept of an intricate immuno-neuro-adipose circuit, and highlights brown- and bone marrow adipose tissue as an intermediary in the communication between the immune and nervous systems. Understanding the interconnectedness within this circuitry may lead to advancements in the treatment and management of various conditions, including cancer, neurodegenerative diseases and metabolic disorders.

The role of microscopic bone marrow examination and [123I]MIBG scintigraphy in detection of bone marrow involvement in patients with neuroblastoma

OBJECTIVES

For the detection of bone marrow (BM) metastases in patients with neuroblastoma, microscopic BM examination and [¹²³I]MIBG scintigraphy are advised. The aims of this study were to assess the concordance of [¹²³I]MIBG and microscopic BM examination (aspirate and biopsy) in detecting BM involvement and to compare invasive disease in BM biopsies and aspirates, both at diagnosis and before autologous stem cell collection (ASCC).

METHODS

Fifty-five patients with stage 4 or stage 4S disease were included, and 37 of them received an autologous hematopoietic stem cell transplantation (AHSCT). The concordance rate was measured and paired binary data were analysed by the McNemar test to look for a systematic difference between diagnostic tests.

RESULTS

At diagnosis and before ASCC, we found acceptable concordance rates for [¹²³I]MIBG versus microscopic BM examination (77.1% and 85.3% respectively). Discordant results were found in both directions and at both time points. The concordance rate for biopsy versus aspirate at diagnosis was 80.6%, however, before ASCC a much higher concordance rate between both microscopic examinations was found (94.1%). While none of the aspirates showed neuroblastoma cells before ASCC, two biopsies still showed tumor invasion.

CONCLUSION

For patients with neuroblastoma, a [¹²³I]MIBG scintigraphy and a microscopic examination of BM aspirate and its biopsy should be used as complementary tools in the evaluation of BM involvement, and this both at diagnosis and during treatment (before ASCC).

Clinical utility of dual-energy CT used as an add-on to 18F FDG PET/CT in the preoperative staging of resectable NSCLC with suspected single osteolytic metastases

OBJECTIVE

To determine the clinical value of ¹⁸F-FDG-PET/CT and dual-energy virtual noncalcium CT to detect and identify single osteolytic metastases (SOM) in participants with non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

Forty-two participants (mean age, 63.5 years ± 10.1; range, 41-81 years) with suspected SOM diagnosed by whole-body ¹⁸F-FDG-PET/CT underwent non-enhanced dual-energy CT. All images were visually and quantitatively evaluated by two nuclear medicine physicians (R1 and R2) and two radiologists (R3 and R4) independently. The results of visual and quantitative analysis of ¹⁸F-FDG-PET/CT and dual-energy CT were compared with pathological results.

RESULTS

In the visual analysis, the specificity and positive predictive value of dual-energy CT for reader 1 and reader 2 is larger than the corresponding figures of¹⁸F-FDG-PET/CT for reader 3 and reader 4 (94.1% each vs 82.4%/76.5%; 95.2%/95.0% vs 88.9%/86.2%). The sensitivity and negative predictive value of dual-energy CT is relatively lower than the number of ¹⁸F-FDG-PET/CT for readers (80.0%/76.0% vs 96.0%/100.0%; 76.2%/72.7% vs 93.3%/100.0%, respectively). ROI-based analysis of SUV_max on PET/CT images and CT numbers on VNCa images showed a significant difference between metastases and non-metastases (P < 0.001 each).

CONCLUSIONS

Pre-surgical evaluation by combination of whole-body ¹⁸F-FDG-PET/CT and dual-energy CT could improve the classification of SOM and may further guide the surgical decision-making in participants with NSCLC.

18F-Fluoromethylcholine-positron emission tomography/computed tomography for diagnosing bone and lymph node metastases in patients with intermediate- or high-risk prostate cancer

Background

The use of molecular imaging in staging of prostate cancer (PC) is debated. In patients with newly diagnosed PC we investigated the diagnostic value of ¹⁸F-flouromethylcholine positron emission tomography/computed tomography (¹⁸F-FCH-PET/CT) for the detection of bone and lymph node metastases compared to whole-body bone scintigraphy (WBS) with technetium-99-methylene diphosphonate (^99mTc-MDP) and results of extended pelvic lymph node dissection, respectively.

Materials and methods

Between January 2013 and April 2016, 143 patients, aged 49-83, mean 69, years with newly diagnosed PC and disease characteristics necessitating WBS underwent both WBS and ¹⁸F-FCH-PET/CT using magnetic resonance imaging as standard. Eighty of these patients underwent pelvic lymph node dissection as part of radical prostatectomy or prior to external beam radiation and in these results of ¹⁸F-FCH-PET/CT were compared to histologic findings.

Results

Bone metastases were detected in 8/143 patients and sensitivity and specificity of WBS were 37.5% and 85.2% versus 100.0% and 96.3% with ¹⁸F-FCH-PET/CT, P=0.63 and 0.002, respectively. Histologically confirmed metastases to regional lymph nodes were found in 25/80 patients. Suspicious choline uptake on PET/CT in pelvic lymph nodes was found in 35 patients. Sensitivity, specificity, PPV, NPV and accuracy of ¹⁸F-FCH-PET/CT in detection of lymph node metastases were 62.5%, 69.6%, 46.9%, 81.3% and 67.5%, respectively.

Conclusions

Findings in this study suggested that ¹⁸F-FCH-PET/CT is a more sensitive and specific method for detection of bone metastases from PC than WBS and could potentially reduce the need for confirmatory imaging if used instead of WBS. However, ¹⁸F-FCH-PET/CT performs sub-optimally in pre-operative staging of lymph node metastases in patients undergoing extended pelvic lymph node dissection.

68Ga-PSMA-PET/CT in comparison with 18F-fluoride-PET/CT and whole-body MRI for the detection of bone metastases in patients with prostate cancer: a prospective diagnostic accuracy study

OBJECTIVES

To determine the diagnostic accuracy of ⁶⁸gallium prostate-specific membrane antigen (PSMA)-based positron emission tomography/computed tomography (PET/CT) in comparison with ¹⁸F-fluoride-based PET/CT (NaF-PET/CT) and whole-body magnetic resonance imaging (WB-MRI) for the detection of bone metastases in patients with prostate cancer.

METHODS

Sixty patients with prostate cancer were included in the period May 2016 to June 2017. The participants underwent three scans (index tests) within 30 days: a NaF-PET/CT, a WB-MRI and a PSMA-PET/CT. Experienced specialists assessed the scans. In the absence of a histological reference standard, the final diagnosis was determined as a panel diagnosis. Measures of the diagnostic performances of the index tests were calculated from patient-based dichotomous outcomes (0 or ≥ 1 bone metastasis) and pairwise compared (McNemar test). For each index test, the agreement with the final diagnosis with regard to the number of bone metastases detected (0, 1-5, > 5) and the inter-reader agreement was calculated (kappa coefficients).

RESULTS

Fifty-five patients constituted the final study population; 20 patients (36%) were classified as having bone metastatic disease as their final diagnosis. The patient-based diagnostic performances were (sensitivity, specificity, overall accuracy) PSMA-PET/CT (100%, 100%, 100%), NaF-PET/CT (95%, 97%, 96%) and WB-MRI (80%, 83%, 82%). The overall accuracy of PSMA-PET/CT was significantly more favourable compared to WB-MRI (p = 0.004), but not to NaF-PET/CT (p = 0.48). PSMA-PET/CT classified the number of bone metastases reliably compared to the final diagnosis (kappa coefficient 0.97) and with an "almost perfect" inter-reader agreement (kappa coefficient 0.93).

CONCLUSIONS

The overall accuracy of PSMA-PET/CT was significantly more advantageous compared to WB-MRI, but not to NaF-PET/CT.

KEY POINTS

• PSMA-PET/CT assessed the presence of bone metastases correctly in all 55 patients • PSMA-PET/CT was more advantageous compared to WB-MRI • No difference was found between PSMA-PET/CT and NaF-PET/CT.