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Desmonts C, Lasnon C, Jaudet C, Aide N. PET imaging and quantification of small animals using a clinical SiPM-based camera. EJNMMI Phys 2023; 10:61. [PMID: 37804338 PMCID: PMC10560240 DOI: 10.1186/s40658-023-00583-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Small-animal PET imaging is an important tool in preclinical oncology. This study evaluated the ability of a clinical SiPM-PET camera to image several rats simultaneously and to perform quantification data analysis. METHODS Intrinsic spatial resolution was measured using 18F line sources, and image quality was assessed using a NEMA NU 4-2018 phantom. Quantification was evaluated using a fillable micro-hollow sphere phantom containing 4 spheres of different sizes (ranging from 3.95 to 7.86 mm). Recovery coefficients were computed for the maximum (Amax) and the mean (A50) pixel values measured on a 50% isocontour drawn on each sphere. Measurements were performed first with the phantom placed in the centre of the field of view and then in the off-centre position with the presence of three scattering sources to simulate the acquisition of four animals simultaneously. Quantification accuracy was finally validated using four 3D-printed phantoms mimicking rats with four subcutaneous tumours each. All experiments were performed for both 18F and 68Ga radionuclides. RESULTS Radial spatial resolutions measured using the PSF reconstruction algorithm were 1.80 mm and 1.78 mm for centred and off-centred acquisitions, respectively. Spill-overs in air and water and uniformity computed with the NEMA phantom centred in the FOV were 0.05, 0.1 and 5.55% for 18F and 0.08, 0.12 and 2.81% for 68Ga, respectively. Recovery coefficients calculated with the 18F-filled micro-hollow sphere phantom for each sphere varied from 0.51 to 1.43 for Amax and from 0.40 to 1.01 for A50. These values decreased from 0.28 to 0.92 for Amax and from 0.22 to 0.66 for A50 for 68 Ga acquisition. The results were not significantly different when imaging phantoms in the off-centre position with 3 scattering sources. Measurements performed with the four 3D-printed phantoms showed a good correlation between theoretical and measured activity in simulated tumours, with r2 values of 0.99 and 0.97 obtained for 18F and 68Ga, respectively. CONCLUSION We found that the clinical SiPM-based PET system was close to that obtained with a dedicated small-animal PET device. This study showed the ability of such a system to image four rats simultaneously and to perform quantification analysis for radionuclides commonly used in oncology.
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Affiliation(s)
- Cédric Desmonts
- Nuclear Medicine Department, University Hospital of Caen, Avenue de La Côte de Nacre, 14033, Caen Cedex 9, France.
- Normandy University, UNICAEN, INSERM 1086 ANTICIPE, Caen, France.
| | - Charline Lasnon
- Normandy University, UNICAEN, INSERM 1086 ANTICIPE, Caen, France
- Nuclear Medicine Department, UNICANCER, Comprehensive Cancer Centre F. Baclesse, Caen, France
| | - Cyril Jaudet
- Radiophysics Department, UNICANCER, Comprehensive Cancer Centre F. Baclesse, Caen, France
| | - Nicolas Aide
- Normandy University, UNICAEN, INSERM 1086 ANTICIPE, Caen, France
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Weyts K, Quak E, Licaj I, Ciappuccini R, Lasnon C, Corroyer-Dulmont A, Foucras G, Bardet S, Jaudet C. Deep Learning Denoising Improves and Homogenizes Patient [ 18F]FDG PET Image Quality in Digital PET/CT. Diagnostics (Basel) 2023; 13:diagnostics13091626. [PMID: 37175017 PMCID: PMC10177812 DOI: 10.3390/diagnostics13091626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Given the constant pressure to increase patient throughput while respecting radiation protection, global body PET image quality (IQ) is not satisfactory in all patients. We first studied the association between IQ and other variables, in particular body habitus, on a digital PET/CT. Second, to improve and homogenize IQ, we evaluated a deep learning PET denoising solution (Subtle PETTM) using convolutional neural networks. We analysed retrospectively in 113 patients visual IQ (by a 5-point Likert score in two readers) and semi-quantitative IQ (by the coefficient of variation in the liver, CVliv) as well as lesion detection and quantification in native and denoised PET. In native PET, visual and semi-quantitative IQ were lower in patients with larger body habitus (p < 0.0001 for both) and in men vs. women (p ≤ 0.03 for CVliv). After PET denoising, visual IQ scores increased and became more homogeneous between patients (4.8 ± 0.3 in denoised vs. 3.6 ± 0.6 in native PET; p < 0.0001). CVliv were lower in denoised PET than in native PET, 6.9 ± 0.9% vs. 12.2 ± 1.6%; p < 0.0001. The slope calculated by linear regression of CVliv according to weight was significantly lower in denoised than in native PET (p = 0.0002), demonstrating more uniform CVliv. Lesion concordance rate between both PET series was 369/371 (99.5%), with two lesions exclusively detected in native PET. SUVmax and SUVpeak of up to the five most intense native PET lesions per patient were lower in denoised PET (p < 0.001), with an average relative bias of -7.7% and -2.8%, respectively. DL-based PET denoising by Subtle PETTM allowed [18F]FDG PET global image quality to be improved and homogenized, while maintaining satisfactory lesion detection and quantification. DL-based denoising may render body habitus adaptive PET protocols unnecessary, and pave the way for the improvement and homogenization of PET modalities.
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Affiliation(s)
- Kathleen Weyts
- Department of Nuclear Medicine, Baclesse Cancer Centre, 14076 Caen, France
| | - Elske Quak
- Department of Nuclear Medicine, Baclesse Cancer Centre, 14076 Caen, France
| | - Idlir Licaj
- Department of Biostatistics, Baclesse Cancer Centre, 14076 Caen, France
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, 9019 Tromsø, Norway
| | - Renaud Ciappuccini
- Department of Nuclear Medicine, Baclesse Cancer Centre, 14076 Caen, France
| | - Charline Lasnon
- Department of Nuclear Medicine, Baclesse Cancer Centre, 14076 Caen, France
| | - Aurélien Corroyer-Dulmont
- Department of Medical Physics, Baclesse Cancer Centre, 14076 Caen, France
- ISTCT Unit, CNRS, UNICAEN, Normandy University, GIP CYCERON, 14074 Caen, France
| | - Gauthier Foucras
- Department of Nuclear Medicine, Baclesse Cancer Centre, 14076 Caen, France
| | - Stéphane Bardet
- Department of Nuclear Medicine, Baclesse Cancer Centre, 14076 Caen, France
| | - Cyril Jaudet
- Department of Nuclear Medicine, Baclesse Cancer Centre, 14076 Caen, France
- Department of Medical Physics, Baclesse Cancer Centre, 14076 Caen, France
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Quak E, Weyts K, Jaudet C, Prigent A, Foucras G, Lasnon C. Artificial intelligence-based 68Ga-DOTATOC PET denoising for optimizing 68Ge/68Ga generator use throughout its lifetime. Front Med (Lausanne) 2023; 10:1137514. [PMID: 36993807 PMCID: PMC10040856 DOI: 10.3389/fmed.2023.1137514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/30/2023] [Indexed: 03/14/2023] Open
Abstract
IntroductionThe yield per elution of a 68Ge/68Ga generator decreases during its lifespan. This affects the number of patients injected per elution or the injected dose per patient, thereby negatively affecting the cost of examinations and the quality of PET images due to increased image noise. We aimed to investigate whether AI-based PET denoising can offset this decrease in image quality parameters.MethodsAll patients addressed to our PET unit for a 68Ga-DOTATOC PET/CT from April 2020 to February 2021 were enrolled. Forty-four patients underwent their PET scans according to Protocol_FixedDose (150 MBq) and 32 according to Protocol_WeightDose (1.5 MBq/kg). Protocol_WeightDose examinations were processed using the Subtle PET software (Protocol_WeightDoseAI). Liver and vascular SUV mean were recorded as well as SUVmax, SUVmean and metabolic tumour volume (MTV) of the most intense tumoural lesion and its background SUVmean. Liver and vascular coefficients of variation (CV), tumour-to-background and tumour-to-liver ratios were calculated.ResultsThe mean injected dose of 2.1 (0.4) MBq/kg per patient was significantly higher in the Protocol_FixedDose group as compared to 1.5 (0.1) MBq/kg for the Protocol_WeightDose group. Protocol_WeightDose led to noisier images than Protocol_FixedDose with higher CVs for liver (15.57% ± 4.32 vs. 13.04% ± 3.51, p = 0.018) and blood-pool (28.67% ± 8.65 vs. 22.25% ± 10.37, p = 0.0003). Protocol_WeightDoseAI led to less noisy images than Protocol_WeightDose with lower liver CVs (11.42% ± 3.05 vs. 15.57% ± 4.32, p < 0.0001) and vascular CVs (16.62% ± 6.40 vs. 28.67% ± 8.65, p < 0.0001). Tumour-to-background and tumour-to-liver ratios were lower for protocol_WeightDoseAI: 6.78 ± 3.49 vs. 7.57 ± 4.73 (p = 0.01) and 5.96 ± 5.43 vs. 6.77 ± 6.19 (p < 0.0001), respectively. MTVs were higher after denoising whereas tumour SUVmax were lower: the mean% differences in MTV and SUVmax were + 11.14% (95% CI = 4.84–17.43) and −3.92% (95% CI = −6.25 to −1.59).ConclusionThe degradation of PET image quality due to a reduction in injected dose at the end of the 68Ge/68Ga generator lifespan can be effectively counterbalanced by using AI-based PET denoising.
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Affiliation(s)
- Elske Quak
- Nuclear Medicine Department, Comprehensive Cancer Centre François Baclesse, UNICANCER, Caen, France
| | - Kathleen Weyts
- Nuclear Medicine Department, Comprehensive Cancer Centre François Baclesse, UNICANCER, Caen, France
| | - Cyril Jaudet
- Nuclear Medicine Department, Comprehensive Cancer Centre François Baclesse, UNICANCER, Caen, France
- Radiophysics Department, Comprehensive Cancer Centre François Baclesse, UNICANCER, Caen, France
| | - Anaïs Prigent
- Nuclear Medicine Department, Comprehensive Cancer Centre François Baclesse, UNICANCER, Caen, France
- Radiopharmacy Department, Comprehensive Cancer Centre François Baclesse, UNICANCER, Caen, France
| | - Gauthier Foucras
- Nuclear Medicine Department, Comprehensive Cancer Centre François Baclesse, UNICANCER, Caen, France
- Radiopharmacy Department, Comprehensive Cancer Centre François Baclesse, UNICANCER, Caen, France
| | - Charline Lasnon
- Nuclear Medicine Department, Comprehensive Cancer Centre François Baclesse, UNICANCER, Caen, France
- UNICAEN, INSERM 1086 ANTICIPE, Normandy University, Caen, France
- *Correspondence: Charline Lasnon, ; orcid.org/0000-0001-5643-1668
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Lasnon C, Quak E. Fair play: towards gender equality in nuclear medicine. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Desmonts C, Aide N, Austins H, Jaudet C, Lasnon C. Feasibility of Imaging Small Animals on a 360° Whole-Body Cadmium Zinc Telluride SPECT Camera: a Phantom Study. Mol Imaging Biol 2022; 24:1018-1027. [PMID: 35835951 DOI: 10.1007/s11307-022-01753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/03/2022] [Accepted: 07/01/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Single-photon emission computed tomography has found an important place in preclinical cancer research. Nevertheless, the cameras dedicated to small animals are not widely available. The present study aimed to assess the feasibility of imaging small animals by a newly released 360° cadmium zinc telluride camera (VERITON, Spectrum Dynamics, Israel) dedicated to human patients. PROCEDURES A cylindrical phantom containing hot spheres was used to evaluate the intrinsic performance of the camera first without the presence of background activity and then with two contrasts between background and hot spheres (1/4 and 1/10). Acquisitions were repeated with different scan durations (10 and 20 min), two tested radioisotopes (Tc-99 m and I-123), and a set of reconstruction parameters (10 iterations [i] 8 subsets [s], 10i16s, 10i32s). A 3D-printed phantom mimicking a rat with four subcutaneous tumours was then used to test the camera under preclinical conditions. RESULTS The results obtained from the micro-hollow sphere phantom showed that it was possible to visualize spheres with an inner diameter of 3.95 mm without background activity. Moreover, spheres with diameters of 4.95 mm can be seen in the condition of high contrast between background and spheres (1/10) and 7.86 mm with lower contrast (1/4). The rat-sized phantom acquisitions showed that 10- and 8-mm subcutaneous tumours were visible with a good contrast obtained for the two radioisotopes tested in this study. Both Tc-99 m and I-123 measurements demonstrated that a 10-min acquisition reconstructed with an ordered subset expectation maximization algorithm applying 10i32s was optimal to obtain sufficient image quality in terms of noise, resolution, and contrast. CONCLUSION Phantom results showed the ability of the system to detect sub-centimetre lesions for various radioisotopes. It seemed feasible to image small animals using a 360° cadmium zinc telluride gamma camera for preclinical cancer research purposes.
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Affiliation(s)
- Cedric Desmonts
- Nuclear Medicine Department, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen, Cedex 9, France. .,INSERM U1086 ANTICIPE, Normandy University, UNICAEN, Caen, France.
| | - Nicolas Aide
- Nuclear Medicine Department, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen, Cedex 9, France.,INSERM U1086 ANTICIPE, Normandy University, UNICAEN, Caen, France
| | - Henry Austins
- Biomedical Department, Comprehensive Cancer Center F. Baclesse, UNICANCER, Caen, France
| | - Cyril Jaudet
- Medical Physics Department, Comprehensive Cancer Center F. Baclesse, UNICANCER, Caen, France
| | - Charline Lasnon
- INSERM U1086 ANTICIPE, Normandy University, UNICAEN, Caen, France.,Nuclear Medicine Department, Comprehensive Cancer Center F. Baclesse, UNICANCER, Caen, France
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Aide N, Weyts K, Lasnon C. Prediction of the Presence of Targetable Molecular Alteration(s) with Clinico-Metabolic 18 F-FDG PET Radiomics in Non-Asian Lung Adenocarcinoma Patients. Diagnostics (Basel) 2022; 12:diagnostics12102448. [PMID: 36292136 PMCID: PMC9601118 DOI: 10.3390/diagnostics12102448] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/30/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate if combining clinical characteristics with pre-therapeutic 18 F-fluorodeoxyglucose (18 F-FDG) positron emission tomography (PET) radiomics could predict the presence of molecular alteration(s) in key molecular targets in lung adenocarcinoma. This non-interventional monocentric study included patients with newly diagnosed lung adenocarcinoma referred for baseline PET who had tumour molecular analyses. The data were randomly split into training and test datasets. LASSO regression with 100-fold cross-validation was performed, including sex, age, smoking history, AJCC cancer stage and 31 PET variables. In total, 109 patients were analysed, and it was found that 63 (57.8%) patients had at least one molecular alteration. Using the training dataset (n = 87), the model included 10 variables, namely age, sex, smoking history, AJCC stage, excessKustosis_HISTO, sphericity_SHAPE, variance_GLCM, correlation_GLCM, LZE_GLZLM, and GLNU_GLZLM. The ROC analysis for molecular alteration prediction using this model found an AUC equal to 0.866 (p < 0.0001). A cut-off value set to 0.48 led to a sensitivity of 90.6% and a positive likelihood ratio (LR+) value equal to 2.4. After application of this cut-off value in the unseen test dataset of patients (n = 22), the test presented a sensitivity equal to 90.0% and an LR+ value of 1.35. A clinico-metabolic 18 F-FDG PET phenotype allows the detection of key molecular target alterations with high sensitivity and negative predictive value. Hence, it opens the way to the selection of patients for molecular analysis.
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Affiliation(s)
- Nicolas Aide
- UNICAEN, INSERM 1086 ANTICIPE, Normandy University, 14000 Caen, France
| | - Kathleen Weyts
- Nuclear Medicine Department, Comprehensive Cancer Centre F. Baclesse, UNICANCER, 14000 Caen, France
| | - Charline Lasnon
- UNICAEN, INSERM 1086 ANTICIPE, Normandy University, 14000 Caen, France
- Nuclear Medicine Department, Comprehensive Cancer Centre F. Baclesse, UNICANCER, 14000 Caen, France
- Correspondence: ; Tel.: +33-261-455-268; Fax: +33-231-455-101
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Lasnon C, Girault G, Lebtahi R, Ansquer C, Lequesne J, Quak E. Female Authors in Nuclear Medicine Journals: A Survey from 2014 to 2020. J Nucl Med 2022; 63:995-1000. [PMID: 34675110 PMCID: PMC9258563 DOI: 10.2967/jnumed.121.262773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/25/2021] [Indexed: 01/03/2023] Open
Abstract
Despite the feminization of the medical workforce, women do not have the same career perspectives as men. In nuclear medicine, little information is available on the sex gap regarding prominent author positions in scientific articles. Therefore, the purpose of this study was to evaluate recent trends in the sex distribution of first and last authorship of articles published in nuclear medicine journals. Methods: We conducted a bibliometric analysis of first and last author sex of articles published from 2014 to 2020 in 15 nuclear medicine journals. Manuscript title, article type, journal impact factor, date of publication, and first and last name and country of provenance of first and last authors were noted. The Gender API software was used to determine author sex. All statistics were descriptive. Results: Women represented 32.8% of first authors and 19.6% of last authors. Female authorship increased from 28.2% (428 of 1,518 articles) in 2014 to 35.5% (735 of 2,069 articles; relative increase, 72%) in 2020 (P < 0.001) for first authors and from 15.6% (237 of 1,518 articles) in 2014 to 20.5% (424 of 2,069 articles; relative increase, 79%) in 2020 (P < 0.001) for last authors. Parity was forecast for 2035 for first authors and 2052 for last authors. Female authorship increased in Europe for first authors (P = 0.014) and last authors (P < 0.001), in high-ranking journals for first authors (P = 0.004) and last authors (P < 0.001), and in other journal ranks for last authors (P = 0.01). Female first and last authorship rose for original articles (P = 0.02 and P = 0.01, respectively) and case reports (P < 0.001 and P = 0.002, respectively). Regarding collaborations, the proportion of articles produced by male first and last authors decreased from 62.2% in 2014 to 52.9% in 2020 in favor of female first and last authors (odds ratio, 1.07; P < 0.001), male first and female last authors (odds ratio, 1.05; P < 0.001), and female first and male last authors (odds ratio, 1.03; P < 0.001). Conclusion: Female first and last authorship in nuclear medicine journals increased substantially from 2014 to 2020, in particular in high-ranking journals, in Europe, and for original articles and case reports. Male-to-male collaborations decreased by 10% in favor of all other collaborations. Parity can be foreseen in a few decades.
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Affiliation(s)
- Charline Lasnon
- Nuclear Medicine Department, Comprehensive Cancer Center F. Baclesse, Unicancer, Caen, France;,Normandy University, UNICAEN, INSERM 1086 ANTICIPE, Caen, France
| | - Gilles Girault
- Medical Library, Comprehensive Cancer Center F. Baclesse, Unicancer, Caen, France
| | - Rachida Lebtahi
- Department of Nuclear Medicine, Beaujon Hospital, Clichy, France
| | - Catherine Ansquer
- Department of Nuclear Medicine, University Hospital of Nantes, Nantes, France;,University of Nantes and CNRS, INSERM, CRCINA, Nantes, France; and
| | - Justine Lequesne
- Biostatistics Department, Comprehensive Cancer Center F. Baclesse, Unicancer, Caen, France
| | - Elske Quak
- Nuclear Medicine Department, Comprehensive Cancer Center F. Baclesse, Unicancer, Caen, France
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Aide N, Lasnon C, Desmonts C, Armstrong IS, Walker MD, McGowan DR. Advances in PET-CT technology: An update. Semin Nucl Med 2021; 52:286-301. [PMID: 34823841 DOI: 10.1053/j.semnuclmed.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/11/2022]
Abstract
This article reviews the current evolution and future directions in PET-CT technology focusing on three areas: time of flight, image reconstruction, and data-driven gating. Image reconstruction is considered with advances in point spread function modelling, Bayesian penalised likelihood reconstruction, and artificial intelligence approaches. Data-driven gating is examined with reference to respiratory motion, cardiac motion, and head motion. For each of these technological advancements, theory will be briefly discussed, benefits of their use in routine practice will be detailed and potential future developments will be discussed. Representative clinical cases will be presented, demonstrating the huge opportunities given to the PET community by hardware and software advances in PET technology when it comes to lesion detection, disease characterization, accurate quantitation and quicker scans. Through this review, hospitals are encouraged to embrace, evaluate and appropriately implement the wide range of new PET technologies that are available now or in the near future, for the improvement of patient care.
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Affiliation(s)
- Nicolas Aide
- Nuclear Medicine, Caen University Hospital, Caen, France; INSERM ANTICIPE, Normandie University, Caen, France.
| | - Charline Lasnon
- INSERM ANTICIPE, Normandie University, Caen, France; François Baclesse Cancer Center, Caen, France
| | - Cedric Desmonts
- Nuclear Medicine, Caen University Hospital, Caen, France; INSERM ANTICIPE, Normandie University, Caen, France
| | - Ian S Armstrong
- Nuclear Medicine, Manchester University NHS Foundation Trust, Manchester
| | - Matthew D Walker
- Department of Medical Physics and Clinical Engineering, Oxford University Hospitals NHS FT, Oxford
| | - Daniel R McGowan
- Department of Medical Physics and Clinical Engineering, Oxford University Hospitals NHS FT, Oxford; Department of Oncology, University of Oxford, Oxford
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Quak E, Braux G, Weyts K, Lasnon C. More fat, less migration: breast density as a predictor of sentinel lymph node non-visualization in breast cancer. EJNMMI Res 2021; 11:112. [PMID: 34716507 PMCID: PMC8556450 DOI: 10.1186/s13550-021-00848-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Elske Quak
- Nuclear Medicine Department, Comprehensive Cancer Centre François Baclesse, UNICANCER, Avenue Général Harris, 14076, Caen Cedex 5, France
| | - Grégoire Braux
- Radiology Department, Caen University Hospital, 14000, Caen, France
| | - Kathleen Weyts
- Nuclear Medicine Department, Comprehensive Cancer Centre François Baclesse, UNICANCER, Avenue Général Harris, 14076, Caen Cedex 5, France
| | - Charline Lasnon
- Nuclear Medicine Department, Comprehensive Cancer Centre François Baclesse, UNICANCER, Avenue Général Harris, 14076, Caen Cedex 5, France. .,UNICAEN, INSERM 1086 ANTICIPE, Normandy University, 14000, Caen, France.
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Aide N, Lasnon C, Kesner A, Levin CS, Buvat I, Iagaru A, Hermann K, Badawi RD, Cherry SR, Bradley KM, McGowan DR. New PET technologies - embracing progress and pushing the limits. Eur J Nucl Med Mol Imaging 2021; 48:2711-2726. [PMID: 34081153 PMCID: PMC8263417 DOI: 10.1007/s00259-021-05390-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Nicolas Aide
- Nuclear medicine Department, University Hospital, Caen, France.
- INSERM ANTICIPE, Normandie University, Caen, France.
| | - Charline Lasnon
- INSERM ANTICIPE, Normandie University, Caen, France
- François Baclesse Cancer Centre, Caen, France
| | - Adam Kesner
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Craig S Levin
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, 94305, USA
| | - Irene Buvat
- Institut Curie, Université PLS, Inserm, U1288 LITO, Orsay, France
| | - Andrei Iagaru
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, CA, 94305, USA
| | - Ken Hermann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Ramsey D Badawi
- Departments of Radiology and Biomedical Engineering, University of California, Davis, CA, USA
| | - Simon R Cherry
- Departments of Radiology and Biomedical Engineering, University of California, Davis, CA, USA
| | - Kevin M Bradley
- Wales Research and Diagnostic PET Imaging Centre, Cardiff University, Cardiff, UK
| | - Daniel R McGowan
- Radiation Physics and Protection, Churchill Hospital, Oxford University Hospitals NHS FT, Oxford, UK.
- Department of Oncology, University of Oxford, Oxford, UK.
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Allioux F, Gandhi D, Vilque JP, Nganoa C, Gac AC, Aide N, Lasnon C. End-of-treatment 18F-FDG PET/CT in diffuse large B cell lymphoma patients: ΔSUV outperforms Deauville score. Leuk Lymphoma 2021; 62:2890-2898. [PMID: 34219589 DOI: 10.1080/10428194.2021.1948028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In DLBCL, the Deauville scoring system (DS) is the standard for PET/CT response assessment. An alternative system, based on the semi-quantitative change in standardized uptake values, namely ΔSUVmax, has been reported to be more objective than the DS. We aimed to compare ΔSUVmax and DS for risk stratification of DLBCL patients on end-of-treatment (EoT) PET. 108 consecutive patients were included. 2-year EFS Kaplan-Meier survival analyses and Cox regression models were performed. 2-year EFS was significantly different between favorable ΔSUVmax (favΔ < -86.5%) and unfavorable ΔSUVmax (unfavΔ ≥ -86.5%) patients: 100.0% ± 0.0 versus 58.3% ± 14.2 (p = 0.001). On Cox multivariable regression, ΔSUVmax status was the only independent predictor of 2-year EFS, outperforming DS. Therefore, ΔSUVmax should be computed for non-responder patients, especially DS4, as the 2-year EFS is not different between responders and non-responders in the case of favΔ. Further studies are needed in order to confirm this hypothesis.
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Affiliation(s)
- François Allioux
- Nuclear Medicine Department, Caen University Hospital, Caen, France
| | - Damaj Gandhi
- Haematology Institute, Caen University Hospital, Caen, France
| | - Jean-Pierre Vilque
- Haematology Institute, UNICANCER, François Baclesse Cancer Centre, Caen, France
| | - Cathy Nganoa
- Nuclear Medicine Department, Caen University Hospital, Caen, France
| | - Anne-Claire Gac
- Haematology Institute, Caen University Hospital, Caen, France
| | - Nicolas Aide
- Nuclear Medicine Department, Caen University Hospital, Caen, France
| | - Charline Lasnon
- Nuclear Medicine Department, UNICANCER, François Baclesse Cancer Centre, Caen, France
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12
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Abstract
Background Early reports show the unequal effect the COVID-19 pandemic might have on men versus women engaged in medical research. Purpose To investigate whether the COVID-19 pandemic has had an impact on scientific publishing by female physicians in medical imaging. Materials and Methods The authors conducted a descriptive bibliometric analysis of the gender of the first and last authors of manuscripts submitted to the top 50 medical imaging journals from March to May 2020 (n = 2480) compared with the same period of the year in 2018 (n = 2238) and 2019 (n = 2355). Manuscript title, date of submission, first and last names of the first and last authors, journal impact factor, and author country of provenance were recorded. The Gender-API software was used to determine author gender. Statistical analysis comprised χ2 tests and multivariable logistic regression. Results Percentages of women listed as first and last authors were 31.6% (1172 of 3711 articles) and 19.3% (717 of 3711 articles), respectively, in 2018-2019 versus 32.3% (725 of 2248 articles) and 20.7% (465 of 2248 articles) in 2020 (P = .61 and P = .21, respectively). For COVID-19-related articles, 35.2% (89 of 253 articles) of first authors and 20.6% (52 of 253 articles) of last authors were women. No associations were found between first- and last-author gender, year of publication, and region of provenance. First and last authorship of high-ranking articles was not in favor of North American women whatever the year (odds ratio [OR], 0.79 [P = .05] and 0.72 [P = .02], respectively). Higher rates of female last authorship of high-ranking articles were observed in Europe (P = .003) and of female first authorship of low-ranking publications in Asia in 2020 (OR, 1.38; 95% CI: 0.98, 1.92; P = .06). Female first and last authorship of COVID-19-related articles was overrepresented for lowest-rank publications (P = .02 and P = .01, respectively). Conclusion One in three first authors and one in five last authors were women in 2018-2019 and 2020, respectively. Although the first 2020 lockdown did not diminish the quantity of women-authored publications, the impact on the quality was variable. ©RSNA, 2021 See also the editorial by Robbins and Khosa in this issue.
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Affiliation(s)
- Elske Quak
- From the Department of Nuclear Medicine (E.Q., K.W., C.L.), Medical Library (G.G.), Department of Radiology (M.A.T.), and Department of Biostatistics (J.L.), UNICANCER, Comprehensive Cancer Centre François Baclesse, Avenue Général Harris, 14076 Caen, France; and Normandy University, UNICAEN, INSERM 1086 ANTICIPE, Caen, France (C.L.)
| | - Gilles Girault
- From the Department of Nuclear Medicine (E.Q., K.W., C.L.), Medical Library (G.G.), Department of Radiology (M.A.T.), and Department of Biostatistics (J.L.), UNICANCER, Comprehensive Cancer Centre François Baclesse, Avenue Général Harris, 14076 Caen, France; and Normandy University, UNICAEN, INSERM 1086 ANTICIPE, Caen, France (C.L.)
| | - Marie Aude Thenint
- From the Department of Nuclear Medicine (E.Q., K.W., C.L.), Medical Library (G.G.), Department of Radiology (M.A.T.), and Department of Biostatistics (J.L.), UNICANCER, Comprehensive Cancer Centre François Baclesse, Avenue Général Harris, 14076 Caen, France; and Normandy University, UNICAEN, INSERM 1086 ANTICIPE, Caen, France (C.L.)
| | - Kathleen Weyts
- From the Department of Nuclear Medicine (E.Q., K.W., C.L.), Medical Library (G.G.), Department of Radiology (M.A.T.), and Department of Biostatistics (J.L.), UNICANCER, Comprehensive Cancer Centre François Baclesse, Avenue Général Harris, 14076 Caen, France; and Normandy University, UNICAEN, INSERM 1086 ANTICIPE, Caen, France (C.L.)
| | - Justine Lequesne
- From the Department of Nuclear Medicine (E.Q., K.W., C.L.), Medical Library (G.G.), Department of Radiology (M.A.T.), and Department of Biostatistics (J.L.), UNICANCER, Comprehensive Cancer Centre François Baclesse, Avenue Général Harris, 14076 Caen, France; and Normandy University, UNICAEN, INSERM 1086 ANTICIPE, Caen, France (C.L.)
| | - Charline Lasnon
- From the Department of Nuclear Medicine (E.Q., K.W., C.L.), Medical Library (G.G.), Department of Radiology (M.A.T.), and Department of Biostatistics (J.L.), UNICANCER, Comprehensive Cancer Centre François Baclesse, Avenue Général Harris, 14076 Caen, France; and Normandy University, UNICAEN, INSERM 1086 ANTICIPE, Caen, France (C.L.)
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13
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Zimmermann PA, Houdu B, Césaire L, Nakouri I, De Pontville M, Lasnon C, Aide N. Revisiting detection of in-transit metastases in melanoma patients using digital 18F-FDG PET/CT with small-voxel reconstruction. Ann Nucl Med 2021; 35:669-679. [PMID: 33770374 DOI: 10.1007/s12149-021-01608-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/14/2021] [Indexed: 12/25/2022]
Abstract
AIM To evaluate the use of digital 18F-FDG PET/CT with small-voxels reconstruction for detecting in-transit metastases in melanoma patients with primary lesion located on the upper or lower limbs, in comparison with standard reconstruction and European Association of Nuclear Medicine Research limited (EARL)-compliant reconstruction mimicking former generation PET systems. METHODS Forty-six PET examinations acquired in list mode on a Vereos digital PET/CT system were reconstructed with (1) the standard reconstruction [2 iterations, 10 subsets (2i10s), point-spread function (PSF) modelling and time-of-flight enabled, no post-filtering and voxel size of 2 mm], (2) a small-voxel reconstruction using 1 mm voxels otherwise using the same parameters, (3) an EARL-compliant reconstruction mimicking a former generation system. Comparison of results across these reconstructions was made for a blind randomized review using a 3-point scale for the presence of in-transit metastases and image quality as well as for tumour-to-background (T/B) ratios and noise level in reference organs. RESULTS Seven of the thirty-two EARL-compliant images classified as negative moved to positive on 1mmPSF images, and 5 of the 6 EARL-compliant images classified as indeterminate moved to positive on 1mmPSF images (P = 0.01). Amongst a total of 20 PET examinations classified as positive using the 1mmPSF reconstruction, fifteen were considered true positive, five false positive results occurred. Twenty-four patients with 1 mm PSF images were classified as negative, none of those under active surveillance experienced in-transit metastases during the 17 months following their PET examination. The positive likelihood ratio for the 1 mm reconstruction was much higher than that observed for EARL-compliant images (14.7 vs 7.82). Importantly, negative likelihood ratios for the 1 mm and 1mmPSF reconstruction were almost perfect. Compared to EARL-compliant data, T/B ratios extracted from the 1mmPSF showed a 2.84-fold increase (P < 0.001). A similar pattern of statistically significant increase was observed for noise level in organs of reference. Image quality for the torso was found to be significantly lower for 1mmPSF reconstruction (P = 0.03). Image quality for the limbs was found to be better for 1mmPSF (P < 0.001). CONCLUSION Digital PET with small-voxel reconstruction brings an additional value for the detection of in-transit metastases by reducing the number of indeterminate findings and making up for falsely negative scans using former generation PET systems. An acquisition encompassing lower or upper limbs as appropriate should be performed.
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Affiliation(s)
| | - Benjamin Houdu
- Nuclear Medicine Department, University Hospital, Caen, France
| | - Laure Césaire
- Dermatology Department, University Hospital, Caen, France
| | - Ines Nakouri
- Dermatology Department, University Hospital, Caen, France
| | | | - Charline Lasnon
- Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
| | - Nicolas Aide
- Nuclear Medicine Department, University Hospital, Caen, France. .,Service de Médecine Nucléaire, CHU de Caen, Avenue Côte de Nacre, Caen, France.
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14
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Aide N, Poulain L, Elie N, Briand M, Giffard F, Blanc-Fournier C, Joly F, Lasnon C. A PSMA-targeted theranostic approach is unlikely to be efficient in serous ovarian cancers. EJNMMI Res 2021; 11:11. [PMID: 33559764 PMCID: PMC7873152 DOI: 10.1186/s13550-021-00756-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Until now, results evaluating the expression of PSMA in ovarian cancer were sparse and contradictory. The aim was to reinvestigate the feasibility of a PSMA targeted theranostic approach in epithelial ovarian cancers with data from the tumour bank of a referring cancer centre. MATERIALS AND METHODS The OvaRessources Biological Resources Center database was screened from January 2004 to December 2017 to seek patients referred for the initial management of a serous epithelial ovarian cancer and for whom peritoneal histological samples were available in the tumour bank. Immunodetection of PSMA was performed to assess its cellular and neovascular expression. Slides were controlled by a certified pathologist, recorded as tiled tiff images and processed to compute the proportion of DAB stained surface. RESULTS Of the 51 patients identified by the database screening, 32 patients were included resulting in 57 samples (32 pre-chemotherapy and 25 post-chemotherapy histological samples). Nine patients were chemo-sensitive, 10 were partially chemo-sensitive and 13 were chemo-resistant/refractory. In the entire dataset, the expression of PSMA was quasi-inexistent: %DABPSMA = 0.04 (± 0.12) %. There was no significant difference in the %DABPSMA of sensitive, partially sensitive and resistant/refractory patients. There was also no significant difference in %DABPSMA in tumours before and after chemotherapy in the 25 patients for whom both samples were available. CONCLUSION The present work demonstrates that PSMA expression is negligible and a fortiori non-sufficient to ensure its usefulness as a prognosticator or a target for a theranostic strategy in ovarian cancers.
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Affiliation(s)
- Nicolas Aide
- Nuclear Medicine Department, University Hospital, Caen, France.,UNICAEN, INSERM 1086 ANTICIPE, Normandy University, Caen, France
| | - Laurent Poulain
- UNICAEN, INSERM 1086 ANTICIPE, Normandy University, Caen, France.,Comprehensive Cancer Centre F. Baclesse, Biological Ressources Centre OvaRESSOURCES, UNICANCER, Caen, France
| | - Nicolas Elie
- UNICAEN, SF 4206 ICORE, CMABIO3, Normandy University, 14000, Caen, France
| | - Mélanie Briand
- UNICAEN, INSERM 1086 ANTICIPE, Normandy University, Caen, France.,Comprehensive Cancer Centre F. Baclesse, Biological Ressources Centre OvaRESSOURCES, UNICANCER, Caen, France
| | - Florence Giffard
- UNICAEN, INSERM 1086 ANTICIPE, Normandy University, Caen, France
| | - Cécile Blanc-Fournier
- UNICAEN, INSERM 1086 ANTICIPE, Normandy University, Caen, France.,Comprehensive Cancer Centre F. Baclesse, Biological Ressources Centre OvaRESSOURCES, UNICANCER, Caen, France.,Department of Bio-Pathology, Comprehensive Cancer Centre F. Baclesse, UNICANCER, Caen, France
| | - Florence Joly
- UNICAEN, INSERM 1086 ANTICIPE, Normandy University, Caen, France.,Department of Uro-Gynecological Oncology, Comprehensive Cancer Centre F. Baclesse, UNICANCER, Caen, France
| | - Charline Lasnon
- UNICAEN, INSERM 1086 ANTICIPE, Normandy University, Caen, France. .,Nuclear Medicine Department, Comprehensive Cancer Centre F. Baclesse, UNICANCER, Caen, France.
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15
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Prigent K, Lasnon C, Ezine E, Janson M, Coudrais N, Joly E, Césaire L, Stefan A, Depontville M, Aide N. Assessing immune organs on 18F-FDG PET/CT imaging for therapy monitoring of immune checkpoint inhibitors: inter-observer variability, prognostic value and evolution during the treatment course of melanoma patients. Eur J Nucl Med Mol Imaging 2021; 48:2573-2585. [PMID: 33432374 DOI: 10.1007/s00259-020-05103-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/28/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have significantly improved survival in advanced melanoma. There is a need for robust biomarkers to identify patients who do not respond. We analysed 14 baseline 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) metrics and their evolution to assess their correlation with patient outcome, compared with 7 established biological markers and 7 clinical variables. METHODS We conducted a retrospective monocentric observational study of 29 patients with advanced melanoma who underwent baseline 18F-FDG PET/CT, followed by an early monitoring PET/CT (iPET) scan after 1 month of treatment and follow-up studies at 3rd (M3PET) and 6th month (M6PET). 18F-FDG uptake in immune organs (spleen, bone marrow, ileocecal valve) and derived spleen-to-liver (SLR) and bone-to-liver (BLR) ratios were reviewed by two PET readers for reproducibility analysis purposes including 14 PET variables. The most reproducible indexes were used for evaluation as predictors of overall survival (OS) in comparison with PET response using imPERCIST5, whole-body metabolic active tumour volume (WB-MATV) and biological parameters (lactate dehydrogenases (LDH), reactive protein c (CRP), white blood count (WBC), absolute lymphocyte count (ALC), neutrophil to lymphocyte ratio (NLR) and derived neutrophils to lymphocyte ratio). RESULTS Strong reproducibility's (intraclass coefficients of correlation (ICC) > 0.90) were observed for spleen anterior SUVpeak, spleen MV, spleen TLG, spleen length and BLRmean. ICC for SLRmean and ileocecal SUVmean were 0.86 and 0.65, respectively. In the 1-year OS 1 group, SLRmean tended to increase at each time point to reach a significant difference at M6-PET (p = 0.019). The same trends were observed with spleen SUVpeak anterior and spleen length. In the 1-year OS 0 group, a significative increase of spleen length was found at iPET, as compared with baseline PET (p = 0.014) and M3-PET (p = 0.0239). Univariable Kaplan-Meier survival analysis found that i%var spleen length, M3%var SLRmean, baseline LDH, i%var NLR and response at M6PET were all predictors of 1-year OS. CONCLUSIONS SLRmean is recommended as a prognosticator in melanoma patients under immunotherapy: its increase greater than 25% at 3 months, compared with baseline, was associated with poor outcome after ICIs.
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Affiliation(s)
- Kevin Prigent
- Nuclear Medicine Department, University Hospital, Avenue Côte de Nacre, 14000, Caen, France
| | - Charline Lasnon
- Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
| | - Emilien Ezine
- Dermatology Department, University Hospital, Caen, France
| | | | - Nicolas Coudrais
- Nuclear Medicine Department, University Hospital, Avenue Côte de Nacre, 14000, Caen, France
| | - Elisa Joly
- Dermatology Department, University Hospital, Caen, France
| | - Laure Césaire
- Dermatology Department, University Hospital, Caen, France
| | - Andrea Stefan
- Dermatology Department, University Hospital, Caen, France
| | | | - Nicolas Aide
- Nuclear Medicine Department, University Hospital, Avenue Côte de Nacre, 14000, Caen, France. .,Normandy University, Caen, France.
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16
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Aide N, Elie N, Blanc-Fournier C, Levy C, Salomon T, Lasnon C. Hormonal Receptor Immunochemistry Heterogeneity and 18F-FDG Metabolic Heterogeneity: Preliminary Results of Their Relationship and Prognostic Value in Luminal Non-Metastatic Breast Cancers. Front Oncol 2021; 10:599050. [PMID: 33511077 PMCID: PMC7837029 DOI: 10.3389/fonc.2020.599050] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/12/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction We aimed to investigate whether 18F-FDG PET metabolic heterogeneity reflects the heterogeneity of estrogen receptor (ER) and progesterone receptor (PR) expressions within luminal non-metastatic breast tumors and if it could help in identifying patients with worst event-free survival (EFS). Materials and methods On 38 PET high-resolution breast bed positions, a single physician drew volumes of interest encompassing the breast tumors to extract SUVmax, histogram parameters and textural features. High-resolution immunochemistry (IHC) scans were analyzed to extract Haralick parameters and descriptors of the distribution shape. Correlation between IHC and PET parameters were explored using Spearman tests. Variables of interest to predict the EFS status at 8 years (EFS-8y) were sought by means of a random forest classification. EFS-8y analyses were then performed using univariable Kaplan-Meier analyses and Cox regression analysis. When appropriate, Mann-Whitney tests and Spearman correlations were used to explore the relationship between clinical data and tumoral PET heterogeneity variables. Results For ER expression, correlations were mainly observed with 18F-FDG histogram parameters, whereas for PR expression correlations were mainly observed with gray-level co-occurrence matrix (GLCM) parameters. The strongest correlations were observed between skewness_ER and uniformity_HISTO (ρ = −0.386, p = 0.017) and correlation_PR and entropy_GLCM (ρ = 0.540, p = 0.001), respectively. The median follow-up was 6.5 years and the 8y-EFS was 71.0%. Random forest classification found age, clinical stage, SUVmax, skewness_ER, kurtosis_ER, entropy_HISTO, and uniformity_HISTO to be variables of importance to predict the 8y-EFS. Univariable Kaplan-Meier survival analyses showed that skewness_ER was a predictor of 8y-EFS (66.7 ± 27.2 versus 19.1 ± 15.2, p = 0.018 with a cut-off value set to 0.163) whereas other IHC and PET parameters were not. On multivariable analysis including age, clinical stage and skewness_ER, none of the parameters were independent predictors. Indeed, skewness_ER was significantly higher in youngest patients (ρ = −0.351, p = 0.031) and in clinical stage III tumors (p = 0.023). Conclusion A heterogeneous distribution of ER within the tumor in IHC appeared as an EFS-8y prognosticator in luminal non-metastatic breast cancers. Interestingly, it appeared to be correlated with PET histogram parameters which could therefore become potential non-invasive prognosticator tools, provided these results are confirmed by further larger and prospective studies.
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Affiliation(s)
- Nicolas Aide
- Nuclear Medicine Department, University Hospital, Caen, France.,INSERM 1086 ANTICIPE, Normandy University, Caen, France
| | - Nicolas Elie
- Université de Caen Normandie, UNICAEN, SF 4206 ICORE, CMABIO3, Caen, France
| | | | - Christelle Levy
- Breast Cancer Unit, François Baclesse Cancer Centre, Caen, France
| | - Thibault Salomon
- Nuclear Medicine Department, Hospital Centre, Versailles, France
| | - Charline Lasnon
- INSERM 1086 ANTICIPE, Normandy University, Caen, France.,Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
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17
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Quak E, Lasne Cardon A, Ciappuccini R, Lasnon C, Bastit V, Le Henaff V, Lireux B, Foucras G, Jaudet C, Berchi C, Grellard JM, Lequesne J, Clarisse B, Bardet S. Upfront F18-choline PET/CT versus Tc99m-sestaMIBI SPECT/CT guided surgery in primary hyperparathyroidism: the randomized phase III diagnostic trial APACH2. BMC Endocr Disord 2021; 21:3. [PMID: 33413316 PMCID: PMC7791717 DOI: 10.1186/s12902-020-00667-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The common endocrine disorder primary hyperparathyroidism (PHPT) can be cured by surgery. Preoperative localization of parathyroid adenoma (PTA) by imaging is a prerequisite for outpatient minimally invasive parathyroidectomy (MIP). Compared to inpatient bilateral cervical exploration (BCE) which is performed if imaging is inconclusive, MIP is superior in terms of cure and complication rates and less costly. The imaging procedure F18-choline (FCH) PET/CT outperforms Tc99m-sestaMIBI (MIBI) SPECT/CT for PTA localization, but it is much costlier. The aim of this study is to identify the most efficient first-line imaging modality for optimal patient care in PHPT without added cost to society. METHODS We will conduct a multicenter open diagnostic intervention randomized phase III trial comparing two diagnostic strategies in patients with PHPT: upfront FCH PET/CT versus MIBI SPECT/CT. The primary endpoint is the proportion of patients in whom the first-line imaging method results in successful MIP and cure. Follow-up including biological tests will be performed 1 and 6 months after surgery. The main secondary endpoint is the social cost of both strategies. Other secondary endpoints are as follows: FCH PET/CT and MIBI SPECT/CT diagnostic performance, performance of surgical procedure and complication rate, FCH PET/CT inter- and intra-observer variability and optimization of FCH PET/CT procedure. Fifty-eight patients will be enrolled and randomized 1:1. DISCUSSION FCH PET/CT is a highly efficient but expensive imaging test for preoperative PTA localization and costs three to four times more than MIBI SPECT/CT. Whether FCH PET/CT improves patient outcomes compared to the reference standard MIBI SPECT/CT is unknown. To justify its added cost, FCH PET/CT-guided parathyroid surgery should lead to improved patient management, resulting in higher cure rates and fewer BCEs and surgical complications. In the previous phase II APACH1 study, we showed that second-line FCH PET/CT led to a cure in 88% of patients with negative or inconclusive MIBI SPECT/CT. BCE could be avoided in 75% of patients and surgical complication rates were low. We therefore hypothesize that upfront FCH PET/CT would improve patient care in PHPT and that the reduction in clinical costs would offset the increase in imaging costs. TRIAL REGISTRATION NCT04040946 , registered August 1, 2019. Protocol version Version 2.1 dated from 2020/04/23.
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Affiliation(s)
- Elske Quak
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
| | - Audrey Lasne Cardon
- Department of Head & Neck Surgery, Centre François Baclesse, F-14000 Caen, France
| | - Renaud Ciappuccini
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
- INSERM 1086 ANTICIPE, F-14000 Caen, France
| | - Charline Lasnon
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
- INSERM 1086 ANTICIPE, F-14000 Caen, France
| | - Vianney Bastit
- Department of Head & Neck Surgery, Centre François Baclesse, F-14000 Caen, France
| | - Véronique Le Henaff
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
| | - Barbara Lireux
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
| | - Gauthier Foucras
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
| | - Cyril Jaudet
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
| | - Celia Berchi
- INSERM 1086 ANTICIPE, F-14000 Caen, France
- Normandie Univ, UNICAEN, Caen, France
| | | | - Justine Lequesne
- Clinical Research Department, Centre François Baclesse, F-14000 Caen, France
| | - Bénédicte Clarisse
- Clinical Research Department, Centre François Baclesse, F-14000 Caen, France
| | - Stéphane Bardet
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
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18
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Lasnon C, Coudrais N, Houdu B, Nganoa C, Salomon T, Enilorac B, Aide N. How fast can we scan patients with modern (digital) PET/CT systems? Eur J Radiol 2020; 129:109144. [PMID: 32593080 DOI: 10.1016/j.ejrad.2020.109144] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/13/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To seek for the minimal duration per bed position with a digital PET system without compromising image quality and lesion detection in patients requiring fast 18F-FDG PET imaging. MATERIALS AND METHODS 19 cancer patients experiencing pain or dyspnea and 9 pediatric patients were scanned on a Vereos system. List mode data were reconstructed with decreasing time frame down to 10 s per bed position. Noise was evaluated in the liver, blood pool and muscle, and using target-to-background ratios. Five PET readers recorded image quality, number of clinically relevant foci and of involved anatomical sites in reconstructions ranging from 60 to 10 s per bed position, compared to the standard 90 s reconstruction. RESULTS The following reconstructions, which harboured a noise not significantly higher than that of the standard reconstruction, were selected for clinical evaluation: 1iterations/10 subsets/20sec (1i10 s20sec), 1i10 s30sec, and 2i10 sPSF60sec. Only the 60 s per bed acquisition displayed similar target-to-background ratios compared to the standard reconstruction, but mean ratios were still higher than 2.0 for the 30 s reconstruction. Inter-rater agreement for the number of involved anatomical sites and detected lesion was good or almost perfect (Kappa: 0.64-0.91) for all acquisitions. In particular, kappa for the 30 s per bed acquisition was 0.78 and 0.91 for lesion and anatomical sites number, respectively. Intra-rater agreement was also excellent for the 30 s reconstruction (kappa = 0.72). Median estimated total PET acquisition time for the 1i10 s30sec, and the standard reconstruction were 4 and 12 min, respectively. CONCLUSIONS Fast imaging is feasible with state-of-the-art PET systems. Acquisitions of 30 s per bed position are feasible with the Vereos system, requiring optimization of reconstruction parameters.
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Affiliation(s)
- Charline Lasnon
- Centre François Baclesse, Nuclear Medicine Department, Caen, France; INSERM ANTICIPE, Normandie University, Caen, France
| | | | - Benjamin Houdu
- CHU de Caen, Nuclear Medicine Department, Caen, France; Normandie University, France
| | | | | | | | - Nicolas Aide
- CHU de Caen, Nuclear Medicine Department, Caen, France; INSERM ANTICIPE, Normandie University, Caen, France; Normandie University, France.
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Aide N, Tainturier LE, Nganoa C, Houdu B, Kammerer J, Galais MP, Ciappuccini R, Lasnon C. HYPHYCA: a prospective study in 613 patients conducting a comprehensive analysis for predictive factors of physiological 18F-FDG anal uptake. EJNMMI Res 2020; 10:28. [PMID: 32193623 PMCID: PMC7082447 DOI: 10.1186/s13550-020-0615-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/25/2020] [Indexed: 01/20/2023] Open
Abstract
Background Anal cancer is a relatively rare tumor of which incidence increases in developed countries. 18F-FDG PET has been increasingly used for its post radio-chemotherapy evaluation. However, several authors have reported the risk of local false-positive findings leading to low specificity and positive predictive values. These false-positive results could be due to post-radiotherapy inflammation or infection but certainly also to physiological anal canal uptake that is observed on a regular basis in clinical practice. The purpose of this prospective study (NCT03506529; HYPHYCA) was therefore to seek predictive factors of physiological anal canal hypermetabolism. Materials and methods Over a 2-month period, patients aged 18 years old and more, referred for 18F-FDG PET-CT at two EARL-accredited PET centers were included, after obtaining their informed and written consent. They were asked to fill in a questionnaire including seven closed questions about usual intestinal transit, ongoing medications relative to intestinal transit, history of digestive, and anal and/or pelvic diseases. Age, gender, and body mass index (BMI) were recorded. A single nuclear medicine physician visually and quantitatively analyzed anal canal uptake (SUVmax_EARL) and assessed visual rectal content (air, feces, or both) and the largest rectal diameter (mm). Results Six hundred and thirteen patients were included (sex ratio F/M = 0.99) and 545 (89%) questionnaires were entirely completed. Significantly more males presented anal canal hypermetabolism (sex ratio (M/F) = 1.18 versus 0.85, p = 0.048). Moreover, patients with anal canal hypermetabolism had higher BMI (27.6 (5.7) kg/m2 versus 23.9 (4.5) kg/m2, p < 0.0001), higher rate of hemorrhoid history (43% versus 27%, p = 0.016), and higher rate of rectum filled with only feces (21% versus 12%, p = 0.019) as compared to patients with no anal canal uptake. On logistic regression, all these variables were found to be independent predictors of the occurrence of an anal canal hypermetabolism. Odds ratio were 1.16 (1.12–1.20) per unit of BMI (kg/m2) (p < 0.0001), 1.48 (1.04–2.11) for males (p = 0.030), 1.64 (1.10–2.45) for hemorrhoids history (p = 0.016), and 1.94 (1.147–3.22) for the rectum filled with only feces (p = 0.010). Conclusion According to our study, the predictive factors of physiological anal canal hypermetabolism are high BMI, male gender, hemorrhoid history, and rectum filled with only feces. This may pave the way to a more specific interpretation of post radio-chemotherapy PET evaluations of anal canal cancer, provided that other studies are conducted in this specific population. Trial registration This prospective study was registered at Clinicaltrial.gov: NCT03506529; HYPHYCA on April 24, 2018
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Affiliation(s)
- Nicolas Aide
- Normandie University, Caen, France. .,Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France. .,INSERM 1086 ANTICIPE, Normandie University, Caen, France.
| | - Laure-Eugénie Tainturier
- Normandie University, Caen, France.,Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France
| | - Cathy Nganoa
- Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France
| | - Benjamin Houdu
- Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France
| | - Jennifer Kammerer
- Normandie University, Caen, France.,Radiation Oncology Department, François Baclesse Cancer Centre, Caen, France
| | - Marie-Pierre Galais
- Digestive Oncology Department, François Baclesse Cancer Centre, Caen, France
| | - Renaud Ciappuccini
- Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
| | - Charline Lasnon
- INSERM 1086 ANTICIPE, Normandie University, Caen, France.,Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
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Jaudet C, Foucras G, Weyts K, Quak E, Ciappucini R, Lasnon C, Batalla A, Bardet S. 50 Counterbalancing a change of acquisition time with reconstruction parameters on numerical PET. Phys Med 2019. [DOI: 10.1016/j.ejmp.2019.09.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Aide N, Salomon T, Blanc-Fournier C, Grellard JM, Levy C, Lasnon C. Implications of reconstruction protocol for histo-biological characterisation of breast cancers using FDG-PET radiomics. EJNMMI Res 2018; 8:114. [PMID: 30594961 PMCID: PMC6311169 DOI: 10.1186/s13550-018-0466-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/10/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The aim of this study is to determine if the choice of the 18F-FDG-PET protocol, especially matrix size and reconstruction algorithm, is of importance to discriminate between immunohistochemical subtypes (luminal versus non-luminal) in breast cancer with textural features (TFs). PROCEDURES Forty-seven patients referred for breast cancer staging in the framework of a prospective study were reviewed as part of an ancillary study. In addition to standard PET imaging (PSFWholeBody), a high-resolution breast acquisition was performed and reconstructed with OSEM and PSF (OSEMbreast/PSFbreast). PET standard metrics and TFs were extracted. For each reconstruction protocol, a prediction model for tumour classification was built using a random forests method. Spearman coefficients were used to seek correlation between PET metrics. RESULTS PSFWholeBody showed lower numbers of voxels within VOIs than OSEMbreast and PSFbreast with median (interquartile range) equal to 130 (43-271), 316 (167-1042), 367 (107-1221), respectively (p < 0.0001). Therefore, using LifeX software, 28 (59%), 46 (98%) and 42 (89%) patients were exploitable with PSFWholeBody, OSEMbreast and PSFbreast, respectively. On matched comparisons, PSFbreast reconstruction presented better abilities than PSFwholeBody and OSEMbreast for the classification of luminal versus non-luminal breast tumours with an accuracy reaching 85.7% as compared to 67.8% for PSFwholeBody and 73.8% for OSEMbreast. PSFbreast accuracy, sensitivity, specificity, PPV and NPV were equal to 85.7%, 94.3%, 42.9%, 89.2%, 60.0%, respectively. Coarseness and ZLNU were found to be main variables of importance, appearing in all three prediction models. Coarseness was correlated with SUVmax on PSFwholeBody images (ρ = - 0.526, p = 0.005), whereas it was not on OSEMbreast (ρ = - 0.183, p = 0.244) and PSFbreast (ρ = - 0.244, p = 0.119) images. Moreover, the range of its values was higher on PSFbreast images as compared to OSEMbreast, especially in small lesions (MTV < 3 ml). CONCLUSIONS High-resolution breast PET acquisitions, applying both small-voxel matrix and PSF modelling, appeared to improve the characterisation of breast tumours.
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Affiliation(s)
- Nicolas Aide
- Nuclear Medicine Department, University Hospital, Caen, France.,INSERM 1199 ANTICIPE, Normandy University, Caen, France
| | | | | | - Jean-Michel Grellard
- Biostatistics and Clinical Research Unit, François Baclesse Cancer Centre, Caen, France
| | - Christelle Levy
- Breast Cancer Unit, François Baclesse Cancer Centre, Caen, France
| | - Charline Lasnon
- INSERM 1199 ANTICIPE, Normandy University, Caen, France. .,Nuclear Medicine Department, François Baclesse Cancer Centre, 3 Avenue du Général Harris, BP 45026 Cedex 5, 14076, Caen, France.
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Houdu B, Lasnon C, Licaj I, Thomas G, Do P, Guizard AV, Desmonts C, Aide N. Correction to: Why harmonization is needed when using FDG PET/CT as a prognosticator: demonstration with EARL-compliant SUV as an independent prognostic factor in lung cancer. Eur J Nucl Med Mol Imaging 2018; 46:533-534. [PMID: 30535744 DOI: 10.1007/s00259-018-4216-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An error occurred in the labelling of Fig. 3, where math symbols for SUV thresholds were inverted in panel b when the EARL threshold was applied to the PSF dataset and vice versa. This figure should read as follows: Fig. 3: Prognostic value of tumour SUVmax.
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Affiliation(s)
- Benjamin Houdu
- Nuclear Medicine Department, University Hospital, Caen, France
| | - Charline Lasnon
- Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France.,INSERM ANTICIPE, Normandie University, Caen, France
| | - Idlir Licaj
- Clinical Research Department, François Baclesse Cancer Centre, Caen, France
| | - Guy Thomas
- Medical Informatics Department, François Baclesse Cancer Centre, Caen, France
| | - Pascal Do
- Lung Cancer Unit, François Baclesse Cancer Centre, Caen, France
| | | | - Cédric Desmonts
- Nuclear Medicine Department, University Hospital, Caen, France
| | - Nicolas Aide
- Nuclear Medicine Department, University Hospital, Caen, France. .,INSERM ANTICIPE, Normandie University, Caen, France.
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Lasnon C, Enilorac B, Aide N. Reply to: "All that glitters is not gold - new reconstruction methods using Deauville criteria for patient reporting". Eur J Nucl Med Mol Imaging 2018; 45:878-881. [PMID: 29473107 DOI: 10.1007/s00259-018-3938-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Charline Lasnon
- Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France.,INSERM 1199 ANTICIPE, Normandie University, Caen, France
| | | | - Nicolas Aide
- INSERM 1199 ANTICIPE, Normandie University, Caen, France. .,Nuclear Medicine Department, University Hospital, Caen, France.
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Aide N, Lasnon C, Damaj G. Combining baseline TMTV and gene profiling for a better risk stratification in diffuse large B cell lymphoma. Eur J Nucl Med Mol Imaging 2018; 45:677-679. [PMID: 29455312 DOI: 10.1007/s00259-018-3966-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/25/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Nicolas Aide
- Nuclear Medicine Department, Caen University Hospital, Caen, France. .,Normandie University, Caen, France. .,INSERM 1086 ANTICIPE, Normandie University, Caen, France.
| | - Charline Lasnon
- INSERM 1086 ANTICIPE, Normandie University, Caen, France.,Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
| | - Gandhi Damaj
- Normandie University, Caen, France.,Haematology Institute, Caen University Hospital, Caen, France.,MICAH INSERM U1245, Rouen University, Rouen, France
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Aide N, Talbot M, Fruchart C, Damaj G, Lasnon C. Correction to: Diagnostic and prognostic value of baseline FDG PET/CT skeletal textural features in diffuse large B cell lymphoma. Eur J Nucl Med Mol Imaging 2017; 45:675. [PMID: 29288275 DOI: 10.1007/s00259-017-3915-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The formulae for Dice and Jaccard indices used to assess volumes concordance should read as follows.
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Affiliation(s)
- Nicolas Aide
- Nuclear Medicine Department, Caen University Hospital, Caen, France
- Normandie University, Caen, France
- INSERM 1086 ANTICIPE, Normandie University, Caen, France
| | | | | | - Gandhi Damaj
- Haematology Institute, Caen University Hospital, Caen, France
| | - Charline Lasnon
- INSERM 1086 ANTICIPE, Normandie University, Caen, France.
- Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France.
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Salomon T, Nganoa C, Gac AC, Fruchart C, Damaj G, Aide N, Lasnon C. Assessment of alteration in liver 18F-FDG uptake due to steatosis in lymphoma patients and its impact on the Deauville score. Eur J Nucl Med Mol Imaging 2017; 45:941-950. [PMID: 29279943 PMCID: PMC5915498 DOI: 10.1007/s00259-017-3914-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/11/2017] [Indexed: 01/04/2023]
Abstract
AIM Our aim was (1) to evaluate the prevalence of steatosis in lymphoma patients and its evolution during treatment; (2) to evaluate the impact of hepatic steatosis on 18F-FDG liver uptake; and (3) to study how hepatic steatosis affects the Deauville score (DS) for discriminating between responders and non-responders. METHODS Over a 1-year period, 358 PET scans from 227 patients [122 diffuse large B cell lymphoma (DLBCL), 57 Hodgkin lymphoma (HL) and 48 Follicular lymphoma (FL)] referred for baseline (n = 143), interim (n = 79) and end-of-treatment (EoT, n = 136) PET scans were reviewed. Steatosis was diagnosed on the unenhanced CT part of PET/CT examinations using a cut-off value of 42 Hounsfield units (HU). EARL-compliant SULmax were recorded on the liver and the tumour target lesion. DS were then computed. RESULTS Prevalence of steatosis at baseline, interim and EoT PET was 15/143 (10.5%), 6/79 (7.6%) and 16/136 (11.8%), respectively (p = 0.62).Ten out of 27 steatotic patients (37.0%) displayed a steatotic liver on all examinations. Six patients (22.2%) had a disappearance of hepatic steatosis during their time-course of treatment. Only one patient developed steatosis during his course of treatment. Liver SULmax values were significantly lower in the steatosis versus non-steatotic groups of patients for interim (1.66 ± 0.36 versus 2.15 ± 0.27) and EoT (1.67 ± 0.29 versus 2.17 ± 0.30) PET. CT density was found to be an independent factor that correlated with liver SULmax, while BMI, blood glucose level and the type of chemotherapy regimen were not. Using a method based on this correlation to correct liver SULmax, all DS4 steatotic patients on interim (n = 1) and EoT (n = 2) PET moved to DS3. CONCLUSIONS Steatosis is actually a theoretical but not practical issue in most patients but should be recognised and corrected in appropriate cases, namely, for those patients scored DS4 with a percentage difference between the target lesion and the liver background lower than 30%.
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Affiliation(s)
- Thibault Salomon
- Nuclear Medicine Department, Caen University Hospital, Caen, France
| | - Catherine Nganoa
- Nuclear Medicine Department, Caen University Hospital, Caen, France
| | - Anne-Claire Gac
- Haematology Institute, Caen University Hospital, Caen, France
| | | | - Gandhi Damaj
- Haematology Institute, Caen University Hospital, Caen, France
| | - Nicolas Aide
- Nuclear Medicine Department, Caen University Hospital, Caen, France. .,Normandie University, Caen, France. .,INSERM 1086 ANTICIPE, Normandie University, Caen, France.
| | - Charline Lasnon
- INSERM 1086 ANTICIPE, Normandie University, Caen, France.,Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
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Enilorac B, Lasnon C, Nganoa C, Fruchart C, Gac AC, Damaj G, Aide N. Does PET Reconstruction Method Affect Deauville Score in Lymphoma Patients? J Nucl Med 2017; 59:1049-1055. [PMID: 29242403 DOI: 10.2967/jnumed.117.202721] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/28/2017] [Indexed: 02/01/2023] Open
Abstract
When evaluating 18F-FDG PET images with the Deauville score (DS), the quantification of tumor and reference organs limits the problem of optical misinterpretation. Compared with conventional reconstruction algorithms, point-spread function (PSF) modeling increases SUVs significantly in tumors but only moderately in the liver, which could affect the DS. We investigated whether the choice of the reconstruction algorithm affects the DS and whether discordance affects the capability of 18F-FDG PET to stratify lymphoma patients. Methods: Overall, 126 patients with diffuse large B-cell lymphoma were included (56 female and 70 male; median age, 65 y; range, 20-88 y). PET data were reconstructed with the unfiltered PSF method. Additionally, a 6-mm filter was applied to PSF images to meet the requirements of the EANM Research Ltd. (EARL) harmonization program from the European Association of Nuclear Medicine (EANM) (PSFEARL). One hundred interim PET (i-PET) and 95 end-of-treatment PET (EoT-PET) studies were analyzed. SUVmax in the liver and aorta was determined using automatic volumes of interest and compared with SUVmax in the residual mass with the highest 18F-FDG uptake. Results: For i-PET, using PSF and PSFEARL, we classified patients as responders and nonresponders in 60 and 40 cases versus 63 and 37 cases, respectively. Five cases of major discordance (5.0%) occurred (i.e., changes from responder to nonresponder). For Eot-PET, patients were classified using PSF and PSFEARL as responders and nonresponders in 69 and 26 cases versus 72 and 23 cases, respectively. Three cases of major discordance (3.2%) occurred. Concordance (Cohen unweighted κ) between the PSF and the PSFEARL DS was 0.82 (95% confidence interval, 0.73-0.91) for i-PET and 0.89 (95% confidence interval, 0.81-0.96) for EoT-PET. The median follow-up periods were 28.4 and 27.4 mo for i-PET and EoT-PET, respectively. Kaplan-Meier analysis showed statistically significant differences in progression-free survival and overall survival among responders and nonresponders no matter which reconstruction was used for i-PET and EoT-PET. Conclusion: Neither DS nor risk stratification of diffuse large B-cell lymphoma patients is affected by the choice of PET reconstruction. Specifically, the use of PSF is not an issue in routine clinical processes or in multicenter trials. These findings have to be confirmed in escalation and deescalation procedures based on early i-PET.
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Affiliation(s)
| | - Charline Lasnon
- Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
| | - Cathy Nganoa
- Nuclear Medicine Department, Caen University Hospital, Caen, France
| | | | - Anne-Claire Gac
- Haematology Institute, Caen University Hospital, Caen, France; and
| | - Gandhi Damaj
- Haematology Institute, Caen University Hospital, Caen, France; and
| | - Nicolas Aide
- Nuclear Medicine Department, Caen University Hospital, Caen, France .,INSERM 1199 ANTICIPE, Normandie University, Caen, France
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Aide N, Talbot M, Fruchart C, Damaj G, Lasnon C. Diagnostic and prognostic value of baseline FDG PET/CT skeletal textural features in diffuse large B cell lymphoma. Eur J Nucl Med Mol Imaging 2017; 45:699-711. [PMID: 29214417 PMCID: PMC5978926 DOI: 10.1007/s00259-017-3899-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/23/2017] [Indexed: 12/20/2022]
Abstract
Purpose Our purpose was to evaluate the diagnostic and prognostic value of skeletal textural features (TFs) on baseline FDG PET in diffuse large B cell lymphoma (DLBCL) patients. Methods Eighty-two patients with DLBCL who underwent a bone marrow biopsy (BMB) and a PET scan between December 2008 and December 2015 were included. Two readers blinded to the BMB results visually assessed PET images for bone marrow involvement (BMI) in consensus, and a third observer drew a volume of interest (VOI) encompassing the axial skeleton and the pelvis, which was used to assess skeletal TFs. ROC analysis was used to determine the best TF able to diagnose BMI among four first-order, six second-order and 11 third-order metrics, which was then compared for diagnosis and prognosis in disease-free patients (BMB−/PET-) versus patients considered to have BMI (BMB+/PET-, BMB−/PET+, and BMB+/PET+). Results Twenty-two out of 82 patients (26.8%) had BMI: 13 BMB−/PET+, eight BMB+/PET+ and one BMB+/PET-. Among the nine BMB+ patients, one had discordant BMI identified by both visual and TF PET assessment. ROC analysis showed that SkewnessH, a first-order metric, was the best parameter for identifying BMI with sensitivity and specificity of 81.8% and 81.7%, respectively. SkewnessH demonstrated better discriminative power over BMB and PET visual analysis for patient stratification: hazard ratios (HR), 3.78 (P = 0.02) versus 2.81 (P = 0.06) for overall survival (OS) and HR, 3.17 (P = 0.03) versus 1.26 (P = 0.70) for progression-free survival (PFS). In multivariate analysis accounting for IPI score, bulky status, haemoglobin and SkewnessH, the only independent predictor of OS was the IPI score, while the only independent predictor of PFS was SkewnessH. Conclusion The better discriminative power of skeletal heterogeneity for risk stratification compared to BMB and PET visual analysis in the overall population, and more specifically in BMB−/PET- patients, suggests that it can be useful to identify diagnostically overlooked BMI.
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Affiliation(s)
- Nicolas Aide
- Nuclear Medicine Department, Caen University Hospital, Caen, France.,Normandie University, Caen, France.,INSERM 1086 ANTICIPE, Normandie University, Caen, France
| | | | | | - Gandhi Damaj
- Haematology Institute, Caen University Hospital, Caen, France
| | - Charline Lasnon
- INSERM 1086 ANTICIPE, Normandie University, Caen, France. .,Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France.
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Aide N, Lasnon C, Veit-Haibach P, Sera T, Sattler B, Boellaard R. EANM/EARL harmonization strategies in PET quantification: from daily practice to multicentre oncological studies. Eur J Nucl Med Mol Imaging 2017. [PMID: 28623376 PMCID: PMC5541084 DOI: 10.1007/s00259-017-3740-2] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Quantitative positron emission tomography/computed tomography (PET/CT) can be used as diagnostic or prognostic tools (i.e. single measurement) or for therapy monitoring (i.e. longitudinal studies) in multicentre studies. Use of quantitative parameters, such as standardized uptake values (SUVs), metabolic active tumor volumes (MATVs) or total lesion glycolysis (TLG), in a multicenter setting requires that these parameters be comparable among patients and sites, regardless of the PET/CT system used. This review describes the motivations and the methodologies for quantitative PET/CT performance harmonization with emphasis on the EANM Research Ltd. (EARL) Fluorodeoxyglucose (FDG) PET/CT accreditation program, one of the international harmonization programs aiming at using FDG PET as a quantitative imaging biomarker. In addition, future accreditation initiatives will be discussed. The validation of the EARL accreditation program to harmonize SUVs and MATVs is described in a wide range of tumor types, with focus on therapy assessment using either the European Organization for Research and Treatment of Cancer (EORTC) criteria or PET Evaluation Response Criteria in Solid Tumors (PERCIST), as well as liver-based scales such as the Deauville score. Finally, also presented in this paper are the results from a survey across 51 EARL-accredited centers reporting how the program was implemented and its impact on daily routine and in clinical trials, harmonization of new metrics such as MATV and heterogeneity features.
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Affiliation(s)
- Nicolas Aide
- Nuclear Medicine Department, University Hospital, Caen, France. .,Inserm U1086 ANTICIPE, Caen University, Caen, France.
| | - Charline Lasnon
- Inserm U1086 ANTICIPE, Caen University, Caen, France.,Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
| | - Patrick Veit-Haibach
- Department of Nuclear Medicine and Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.,Joint Department Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - Terez Sera
- Nuclear Medicine Department, University of Szeged, Szeged, Hungary
| | - Bernhard Sattler
- Department of Nuclear Medicine, University Hospital of Leipzig, 04103, Leipzig, Germany
| | - Ronald Boellaard
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Lasnon C, Quak E, Le Roux PY, Robin P, Hofman MS, Bourhis D, Callahan J, Binns DS, Desmonts C, Salaun PY, Hicks RJ, Aide N. EORTC PET response criteria are more influenced by reconstruction inconsistencies than PERCIST but both benefit from the EARL harmonization program. EJNMMI Phys 2017; 4:17. [PMID: 28560574 PMCID: PMC5449363 DOI: 10.1186/s40658-017-0185-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/19/2017] [Indexed: 12/13/2022] Open
Abstract
Background This study evaluates the consistency of PET evaluation response criteria in solid tumours (PERCIST) and European Organisation for Research and Treatment of Cancer (EORTC) classification across different reconstruction algorithms and whether aligning standardized uptake values (SUVs) to the European Association of Nuclear Medicine acquisition (EANM)/EARL standards provides more consistent response classification. Materials and methods Baseline (PET1) and response assessment (PET2) scans in 61 patients with non-small cell lung cancer were acquired in protocols compliant with the EANM guidelines and were reconstructed with point-spread function (PSF) or PSF + time-of-flight (TOF) reconstruction for optimal tumour detection and with a standardized ordered subset expectation maximization (OSEM) reconstruction known to fulfil EANM harmonizing standards. Patients were recruited in three centres. Following reconstruction, EQ.PET, a proprietary software solution was applied to the PSF ± TOF data (PSF ± TOF.EQ) to harmonize SUVs to the EANM standards. The impact of differing reconstructions on PERCIST and EORTC classification was evaluated using standardized uptake values corrected for lean body mass (SUL). Results Using OSEMPET1/OSEMPET2 (standard scenario), responders displayed a reduction of −57.5% ± 23.4 and −63.9% ± 22.4 for SULmax and SULpeak, respectively, while progressing tumours had an increase of +63.4% ± 26.5 and +60.7% ± 19.6 for SULmax and SULpeak respectively. The use of PSF ± TOF reconstruction impacted the classification of tumour response. For example, taking the OSEMPET1/PSF ± TOFPET2 scenario reduced the apparent reduction in SUL in responding tumours (−39.7% ± 31.3 and −55.5% ± 26.3 for SULmax and SULpeak, respectively) but increased the apparent increase in SUL in progressing tumours (+130.0% ± 50.7 and +91.1% ± 39.6 for SULmax and SULpeak, respectively). Consequently, variation in reconstruction methodology (PSF ± TOFPET1/OSEMPET2 or OSEM PET1/PSF ± TOFPET2) led, respectively, to 11/61 (18.0%) and 10/61 (16.4%) PERCIST classification discordances and to 17/61 (28.9%) and 19/61 (31.1%) EORTC classification discordances. An agreement was better for these scenarios with application of the propriety filter, with kappa values of 1.00 and 0.95 compared to 0.75 and 0.77 for PERCIST and kappa values of 0.93 and 0.95 compared to 0.61 and 0.55 for EORTC, respectively. Conclusion PERCIST classification is less sensitive to reconstruction algorithm-dependent variability than EORTC classification but harmonizing SULs within the EARL program is equally effective with either. Electronic supplementary material The online version of this article (doi:10.1186/s40658-017-0185-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charline Lasnon
- Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France.,INSERM U1086 ANTICIPE, BioTICLA, Caen University, Caen, France
| | - Elske Quak
- Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
| | - Pierre-Yves Le Roux
- Nuclear Medicine Department and EA 3878 IFR 148, University Hospital, Brest, France
| | - Philippe Robin
- Nuclear Medicine Department and EA 3878 IFR 148, University Hospital, Brest, France
| | - Michael S Hofman
- Cancer Imaging, Peter Mac Callum Cancer Institute, Parkville, Australia
| | - David Bourhis
- Nuclear Medicine Department and EA 3878 IFR 148, University Hospital, Brest, France
| | - Jason Callahan
- Cancer Imaging, Peter Mac Callum Cancer Institute, Parkville, Australia
| | - David S Binns
- Cancer Imaging, Peter Mac Callum Cancer Institute, Parkville, Australia
| | - Cédric Desmonts
- Nuclear Medicine Department, University Hospital, Caen, France
| | - Pierre-Yves Salaun
- Nuclear Medicine Department and EA 3878 IFR 148, University Hospital, Brest, France
| | - Rodney J Hicks
- Cancer Imaging, Peter Mac Callum Cancer Institute, Parkville, Australia.,The Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Australia
| | - Nicolas Aide
- INSERM U1086 ANTICIPE, BioTICLA, Caen University, Caen, France. .,Nuclear Medicine Department, University Hospital, Caen, France. .,Normandy University, Caen, France. .,Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France.
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Lasnon C, Enilorac B, Popotte H, Aide N. Impact of the EARL harmonization program on automatic delineation of metabolic active tumour volumes (MATVs). EJNMMI Res 2017; 7:30. [PMID: 28361349 PMCID: PMC5374086 DOI: 10.1186/s13550-017-0279-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/16/2017] [Indexed: 12/16/2022] Open
Abstract
Background The clinical validation of the EARL harmonization program for standardised uptake value (SUV) metrics is well documented; however, its potential for defining metabolic active tumour volume (MATV) has not yet been investigated. We aimed to compare delineation of MATV on images reconstructed using conventional ordered subset expectation maximisation (OSEM) with those reconstructed using point spread function modelling (PSF-reconstructed images), and either optimised for diagnostic potential (PSF) or filtered to meet the EANM/EARL harmonising standards (PSF7). Methods Images from 18 stage IIIA-IIIB lung cancer patients were reconstructed using all the three methods. MATVs were then delineated using both a 40% isocontour and a gradient-based method. MATVs were compared by means of Bland–Altman analyses, and Dice coefficients and concordance indices based on the unions and intersections between each pair of reconstructions (PSF vs OSEM, PSF7 vs PSF and PSF7 vs OSEM). Results Using the 40% isocontour method and taking the MATVs delineated on OSEM images as a reference standard, the use of PSF7 images led to significantly higher Dice coefficients (median value = 0.96 vs 0.77; P < 0.0001) and concordance indices (median value = 0.92 vs 0.64; P < 0.0001) than those obtained using PSF images. The gradient-based methodology was less sensitive to reconstruction variability than the 40% isocontour method; Dice coefficients and concordance indices were superior to 0.8 for both PSF reconstruction methods. However, the use of PSF7 images led to narrower interquartile ranges and significantly higher Dice coefficients (median value = 0.96 vs 0.94; P = 0.01) and concordance indices (median value = 0.89 vs 0.85; P = 0.003) than those obtained with PSF images. Conclusion This study demonstrates that automatic contouring of lung tumours on EARL-compliant PSF images using the widely adopted automatic isocontour methodology is an accurate means of overcoming reconstruction variability in MATV delineation. Although gradient-based methodology appears to be less sensitive to reconstruction variability, the use of EARL-compliant PSF images significantly improved the Dice coefficients and concordance indices, demonstrating the importance of harmonised-images, even when more advanced contouring algorithms are used. Electronic supplementary material The online version of this article (doi:10.1186/s13550-017-0279-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charline Lasnon
- Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France.,INSERM U1086 « ANTICIPE », BioTICLA, François Baclesse Cancer Centre, Caen, France
| | - Blandine Enilorac
- Nuclear Medicine Department, University Hospital, Avenue Côte de Nacre, 14000, Caen, France
| | - Hosni Popotte
- Radiation Oncology, François Baclesse Cancer Centre, Caen, France
| | - Nicolas Aide
- INSERM U1086 « ANTICIPE », BioTICLA, François Baclesse Cancer Centre, Caen, France. .,Nuclear Medicine Department, University Hospital, Avenue Côte de Nacre, 14000, Caen, France. .,Normandie University, Caen, France.
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Lasnon C, Salomon T, Desmonts C, Dô P, Oulkhouir Y, Madelaine J, Aide N. Generating harmonized SUV within the EANM EARL accreditation program: software approach versus EARL-compliant reconstruction. Ann Nucl Med 2016; 31:125-134. [PMID: 27812791 DOI: 10.1007/s12149-016-1135-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/23/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Evolutions in hardware and software PET technology, such as point spread function (PSF) reconstruction, have been shown to improve diagnostic performance, but can also lead to important device-dependent and reconstruction-dependent variations in standardized uptake values (SUVs). This may preclude the multicentre use of SUVs as a prognostic or diagnostic tool or as a biomarker of the early response to antineoplastic treatments. This study compared two SUV harmonization strategies using a newer reconstruction algorithm that improves lesion detection while maintaining comparability with older systems: (1) the use of a second reconstruction compliant with harmonization standards and (2) the use of a proprietary software tool (EQ.PET). METHODS PET data from 50 consecutive non-small cell lung cancer patients were reconstructed with PSF reconstruction for optimal tumor detection and an ordered subset expectation maximization (OSEM3D) reconstruction to mimic a former generation PET. An additional PSF reconstruction was performed with a 7 mm Gaussian filter (PSF7, first method), and, post-reconstruction, the EQ filter (same Gaussian filter) was applied to the PSF data (PSFEQ, second method) for harmonization purposes. The 7 mm kernel filter was chosen to comply with the European Association of Nuclear Medicine (EANM) standards. SUVs for all reconstructions were compared with regression analyses and/or Bland-Altman plots. RESULTS Overall, 171 lesions were analyzed: 55 lung lesions (32.2%), 87 lymph nodes (50.9%), and 29 metastases (16.9%). In these lesions, the mean PSF7/OSEM3D ratios for SUVmax and SUVpeak were 1.02 (95% CI: 0.93-1.11) and 1.04 (95% CI: 0.95-1.14), respectively. The mean PSFEQ/OSEM3D ratios for SUVmax and SUVpeak were 1.01 (95% CI: 0.91-1.11) and 1.04 (95% CI: 0.94-1.14), respectively. When comparing PSF7 and PSFEQ, Bland-Altman analysis showed that the mean PSF7/PSFEQ ratios for SUVmax and SUVpeak were 1.01 (95% CI: 0.96-1.06) and 1.01 (95% CI: 0.97-1.04), respectively. CONCLUSION The issue of reconstruction dependency in SUV values that hampers the comparison of data between different PET systems can be overcome using two reconstructions for harmonized quantification and optimal diagnosis or using the EQ.PET technology. Both technologies produce similar results, EQ.PET sparing reconstruction and interpretation time. Other manufacturers are encouraged to either emulate this solution or to produce a vendor-neutral approach.
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Affiliation(s)
- Charline Lasnon
- Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France.,INSERM 1199, François Baclesse Cancer Centre, Caen, France.,Normandie University, Caen, France
| | - Thibault Salomon
- Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France
| | - Cédric Desmonts
- Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France
| | - Pascal Dô
- Thoracic Oncology, François Baclesse Cancer Centre, Caen, France
| | | | | | - Nicolas Aide
- Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France. .,INSERM 1199, François Baclesse Cancer Centre, Caen, France. .,Normandie University, Caen, France.
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Quak E, Le Roux PY, Lasnon C, Robin P, Hofman MS, Bourhis D, Callahan J, Binns DS, Desmonts C, Salaun PY, Hicks RJ, Aide N. Does PET SUV Harmonization Affect PERCIST Response Classification? J Nucl Med 2016; 57:1699-1706. [PMID: 27283930 DOI: 10.2967/jnumed.115.171983] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/06/2016] [Indexed: 11/16/2022] Open
Abstract
Pre- and posttreatment PET comparative scans should ideally be obtained with identical acquisition and processing, but this is often impractical. The degree to which differing protocols affect PERCIST classification is unclear. This study evaluates the consistency of PERCIST classification across different reconstruction algorithms and whether a proprietary software tool can harmonize SUV estimation sufficiently to provide consistent response classification. METHODS Eighty-six patients with non-small cell lung cancer, colorectal liver metastases, or metastatic melanoma who were scanned for therapy monitoring purposes were prospectively recruited in this multicenter trial. Pre- and posttreatment PET scans were acquired in protocols compliant with the Society of Nuclear Medicine and Molecular Imaging and the European Association of Nuclear Medicine (EANM) acquisition guidelines and were reconstructed with a point spread function (PSF) or PSF + time-of-flight (TOF) for optimal tumor detection and also with standardized ordered-subset expectation maximization (OSEM) known to fulfill EANM harmonizing standards. After reconstruction, a proprietary software solution was applied to the PSF ± TOF data (PSF ± TOF.EQ) to harmonize SUVs with the OSEM values. The impact of differing reconstructions on PERCIST classification was evaluated. RESULTS For the OSEMPET1/OSEMPET2 (OSEM reconstruction for pre- and posttherapeutic PET, respectively) scenario, which was taken as the reference standard, the change in SUL was -41% ± 25 and +56% ± 62 in the groups of tumors showing a decrease and an increase in 18F-FDG uptake, respectively. The use of PSF reconstruction affected classification of tumor response. For example, taking the PSF ± TOFPET1/OSEMPET2 scenario increased the apparent reduction in SUL in responding tumors (-48% ± 22) but reduced the apparent increase in SUL in progressing tumors (+37% ± 43), as compared with the OSEMPET1/OSEMPET2 scenario. As a result, variation in reconstruction methodology (PSF ± TOFPET1/OSEMPET2 or OSEM PET1/PSF ± TOFPET2) led to 13 of 86 (15%) and 17 of 86 (20%) PERCIST classification discordances, respectively. Agreement was better for these scenarios with application of the propriety filter, with κ values of 1 and 0.95 compared with 0.79 and 0.72, respectively. CONCLUSION Reconstruction algorithm-dependent variability in PERCIST classification is a significant issue but can be overcome by harmonizing SULs using a proprietary software tool.
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Affiliation(s)
- Elske Quak
- Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
| | - Pierre-Yves Le Roux
- Nuclear Medicine Department and EA 3878 IFR 148, University Hospital, Brest, France
| | - Charline Lasnon
- Nuclear Medicine Department, University Hospital, Caen, France.,Normandy University, Caen, France.,INSERM 1199, Caen University, Caen, France
| | - Philippe Robin
- Nuclear Medicine Department and EA 3878 IFR 148, University Hospital, Brest, France
| | - Michael S Hofman
- Cancer Imaging, Peter MacCallum Cancer Institute, East Melbourne, Australia; and
| | - David Bourhis
- Nuclear Medicine Department and EA 3878 IFR 148, University Hospital, Brest, France
| | - Jason Callahan
- Cancer Imaging, Peter MacCallum Cancer Institute, East Melbourne, Australia; and
| | - David S Binns
- Cancer Imaging, Peter MacCallum Cancer Institute, East Melbourne, Australia; and
| | - Cédric Desmonts
- Nuclear Medicine Department, University Hospital, Caen, France
| | - Pierre-Yves Salaun
- Nuclear Medicine Department and EA 3878 IFR 148, University Hospital, Brest, France
| | - Rodney J Hicks
- Cancer Imaging, Peter MacCallum Cancer Institute, East Melbourne, Australia; and.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Nicolas Aide
- Nuclear Medicine Department, University Hospital, Caen, France .,Normandy University, Caen, France.,INSERM 1199, Caen University, Caen, France
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Lasnon C, Dugué AE, Briand M, Dutoit S, Aide N. Quantifying and correcting for tail vein extravasation in small animal PET scans in cancer research: is there an impact on therapy assessment? EJNMMI Res 2015; 5:61. [PMID: 26543028 PMCID: PMC4635168 DOI: 10.1186/s13550-015-0141-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/26/2015] [Indexed: 11/10/2022] Open
Abstract
Background Tail vein injection under short anesthesia is the most commonly used route for administering radiopharmaceuticals. However, the small caliber of the vein in rodents may lead to tracer extravasation and thereby compromise quantitative accuracy of PET. We aimed to evaluate a method for correction of interstitial radiotracer leakage in the context of pre-clinical therapeutic response assessment. Methods In two separate studies involving 16 nude rats, a model of human ovarian cancer was xenografted and each was treated with a Phosphoinositide 3-kinase/mammalian target of rapamycin inhibitor or used as a control. Tracer injections were performed via the tail vein by a single operator. Two observers qualitatively evaluated the resulting images and if appropriate drew a volume of interest (VOI) over the injection site to record extravasated activities. Uncorrected and corrected tumors’ mean standardized uptake value (SUV)mean was computed (corrected injected activity = calibrated activity − decay corrected residual syringe activity − decay corrected tail extravasated activity). Molecular analyses were taken as a gold standard. The frequency and magnitude of extravasation were analyzed, as well as the inter-observer agreement and the impact of the correction method on tumor uptake quantification. Results Extravasation never exceeded 20 % of the injected dose but occurred in more than 50 % of injections. It was independent of groups of animals and protocol time points with p values of 1.00 and 0.61, respectively, in the first experiment and 0.47 and 0.13, respectively, in the second experiment. There was a good inter-observer agreement for qualitative analysis (kappa = 0.72) and a moderate agreement when using quantitative analysis (ρc= 0.94). In both experiments, there was significant difference between uncorrected and corrected SUVmean. Despite this significant difference, mean percent differences between uncorrected and corrected SUVmean in the first and the second experiments were -3.61 and -1.78, respectively. Concerning therapy assessment, in both experiments, significant differences in median %SUVmean between control and treated groups were observed over all time points with either uncorrected and corrected data (p < 0.05). Conclusions Although extravasation is common and can be reproducibly corrected, this is probably not required for validation of response to drugs that induce large SUV changes. However, further studies are required to evaluate the impact of extravasation in situations where less marked metabolic responses are observed or important extravasations occur.
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Affiliation(s)
- Charline Lasnon
- BioTICLA unit, UMR INSERM 1199, François Baclesse Cancer Centre, UNICAEN, Caen, France. .,Normandie University Caen, Caen, France. .,Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France.
| | - Audrey Emmanuelle Dugué
- Biostatistics and Clinical Research Department, François Baclesse Cancer Centre, Caen, France
| | - Mélanie Briand
- BioTICLA unit, UMR INSERM 1199, François Baclesse Cancer Centre, UNICAEN, Caen, France
| | - Soizic Dutoit
- BioTICLA unit, UMR INSERM 1199, François Baclesse Cancer Centre, UNICAEN, Caen, France
| | - Nicolas Aide
- BioTICLA unit, UMR INSERM 1199, François Baclesse Cancer Centre, UNICAEN, Caen, France.,Normandie University Caen, Caen, France.,Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France
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Lasnon C, Houdu B, Kammerer E, Salomon T, Devreese J, Lebasnier A, Aide N. Patient’s weight: a neglected cause of variability in SUV measurements? A survey from an EARL accredited PET centre in 513 patients. Eur J Nucl Med Mol Imaging 2015; 43:197-199. [DOI: 10.1007/s00259-015-3214-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/01/2015] [Indexed: 11/28/2022]
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Coquan E, Lasnon C, Joly F, Lefort JM, Aide N. Diuretic ¹⁸F-FDG PET/CT for therapy monitoring in urothelial bladder cancer. Eur J Nucl Med Mol Imaging 2014; 41:1818-9. [PMID: 24893789 DOI: 10.1007/s00259-014-2800-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/02/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Elodie Coquan
- Medical Oncology, François Baclesse Cancer Centre, Caen, France
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Quak E, Hovhannisyan N, Lasnon C, Fruchart C, Vilque JP, Musafiri D, Aide N. The importance of harmonizing interim positron emission tomography in non-Hodgkin lymphoma: focus on the Deauville criteria. Haematologica 2014; 99:e84-5. [PMID: 24584350 DOI: 10.3324/haematol.2014.104125] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Elske Quak
- Department of Nuclear Medicine, François Baclesse Cancer Centre, Caen, France
| | | | - Charline Lasnon
- Department of Nuclear Medicine, François Baclesse Cancer Centre, Caen, France Normandie Université, Caen, France
| | | | - Jean-Pierre Vilque
- Department of Haematology, François Baclesse Cancer Centre, Caen, France
| | - Dada Musafiri
- Department of Haematology, François Baclesse Cancer Centre, Caen, France
| | - Nicolas Aide
- Department of Nuclear Medicine, François Baclesse Cancer Centre, Caen, France Normandie Université, Caen, France
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Lasnon C, Quak E, Briand M, Gu Z, Louis MH, Aide N. Contrast-enhanced small-animal PET/CT in cancer research: strong improvement of diagnostic accuracy without significant alteration of quantitative accuracy and NEMA NU 4-2008 image quality parameters. EJNMMI Res 2013; 3:5. [PMID: 23327687 PMCID: PMC3563455 DOI: 10.1186/2191-219x-3-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 01/09/2013] [Indexed: 02/05/2023] Open
Abstract
Background The use of iodinated contrast media in small-animal positron emission tomography (PET)/computed tomography (CT) could improve anatomic referencing and tumor delineation but may introduce inaccuracies in the attenuation correction of the PET images. This study evaluated the diagnostic performance and accuracy of quantitative values in contrast-enhanced small-animal PET/CT (CEPET/CT) as compared to unenhanced small animal PET/CT (UEPET/CT). Methods Firstly, a NEMA NU 4–2008 phantom (filled with 18F-FDG or 18F-FDG plus contrast media) and a homemade phantom, mimicking an abdominal tumor surrounded by water or contrast media, were used to evaluate the impact of iodinated contrast media on the image quality parameters and accuracy of quantitative values for a pertinent-sized target. Secondly, two studies in 22 abdominal tumor-bearing mice and rats were performed. The first animal experiment studied the impact of a dual-contrast media protocol, comprising the intravenous injection of a long-lasting contrast agent mixed with 18F-FDG and the intraperitoneal injection of contrast media, on tumor delineation and the accuracy of quantitative values. The second animal experiment compared the diagnostic performance and quantitative values of CEPET/CT versus UEPET/CT by sacrificing the animals after the tracer uptake period and imaging them before and after intraperitoneal injection of contrast media. Results There was minimal impact on IQ parameters (%SDunif and spillover ratios in air and water) when the NEMA NU 4–2008 phantom was filled with 18F-FDG plus contrast media. In the homemade phantom, measured activity was similar to true activity (−0.02%) and overestimated by 10.30% when vials were surrounded by water or by an iodine solution, respectively. The first animal experiment showed excellent tumor delineation and a good correlation between small-animal (SA)-PET and ex vivo quantification (r2 = 0.87, P < 0.0001). The second animal experiment showed a good correlation between CEPET/CT and UEPET/CT quantitative values (r2 = 0.99, P < 0.0001). Receiver operating characteristic analysis demonstrated better diagnostic accuracy of CEPET/CT versus UEPET/CT (senior researcher, area under the curve (AUC) 0.96 versus 0.77, P = 0.004; junior researcher, AUC 0.78 versus 0.58, P = 0.004). Conclusions The use of iodinated contrast media for small-animal PET imaging significantly improves tumor delineation and diagnostic performance, without significant alteration of SA-PET quantitative accuracy and NEMA NU 4–2008 IQ parameters.
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Lasnon C, Hicks RJ, Beauregard JM, Milner A, Paciencia M, Guizard AV, Bardet S, Gervais R, Lemoel G, Zalcman G, Aide N. Impact of point spread function reconstruction on thoracic lymph node staging with 18F-FDG PET/CT in non-small cell lung cancer. Clin Nucl Med 2013; 37:971-6. [PMID: 22899197 DOI: 10.1097/rlu.0b013e318251e3d1] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM The aim of the present study was to evaluate the impact of point spread function (PSF) reconstruction on quantitative values and diagnostic accuracy of FDG PET/CT for nodal staging in non-small cell lung cancer. PATIENTS AND METHODS Fifty-eight consecutive PET/CT examinations were reconstructed with both ordered subset expectation maximization (OSEM) and PSF algorithms. Two readers independently performed a randomized blinded review of PET/CT examinations and gave a nodal status (N0, N1, N2, or N3) to each PET data set. When discordant, a consensus was reached with a third reader. Sensitivity, specificity, positive and negative predictive values (NPV), and positive and negative likelihood ratios (LRs) were assessed and compared using a McNemar test. All PET data sets were then independently analyzed to extract quantitative PET values in 208 nodes and compare them using Bland-Altman analysis. RESULTS Bland-Altman analysis showed that, on average, PSF reconstruction increased SUVmax, SUVmean, and node/background ratios by 48%, 28%, and 27%, respectively. This increase was more marked for nodes less than 1 cm than for nodes 1 cm or greater (P < 0.0001 for SUVmax, SUVmean, and node/background ratios). Point spread function PET had higher sensitivity (97%) and NPV (92%) than OSEM PET (78% and 57%, respectively; P = 0.01 and P = 0.04, respectively). Negative LR was 0.04 for PSF PET and 0.31 for OSEM PET. CONCLUSIONS By improving activity recovery, especially for nonenlarged nodes, PSF significantly improves the sensitivity, NPV, and negative LR of FDG-PET for nodal staging in non-small cell lung cancer. These data suggest that preoperative invasive nodal staging may be omitted in the case of a negative PSF FDG-PET/CT.
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Affiliation(s)
- Charline Lasnon
- François Baclesse Cancer Centre and University Hospital PET unit, University Hospital, Caen, France
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Aide N, Briand M, Bohn P, Dutoit S, Lasnon C, Chasle J, Rouvet J, Modzelewski R, Vela A, Deslandes E, Vera P, Poulain L, Carreiras F. αvβ3 imaging can accurately distinguish between mature teratoma and necrosis in 18F-FDG-negative residual masses after treatment of non-seminomatous testicular cancer: a preclinical study. Eur J Nucl Med Mol Imaging 2010; 38:323-33. [PMID: 20882281 DOI: 10.1007/s00259-010-1624-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 09/09/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE We assessed whether imaging α(v)β(3) integrin could distinguish mature teratoma from necrosis in human non-seminomatous germ cell tumour (NSGCT) post-chemotherapy residual masses. METHODS Human embryonal carcinoma xenografts (six/rat) were untreated (controls) or treated to form mature teratomas with low-dose cisplatin and all-trans retinoic acid (ATRA) over a period of 8 weeks. In another group, necrosis was induced in xenografts with high-dose cisplatin plus etoposide (two cycles). (18)F-Fluorodeoxyglucose ((18)F-FDG) small animal positron emission tomography (SA PET) imaging was performed in three rats (one control and two treated for 4 and 8 weeks with cisplatin+ATRA). Imaging of α(v)β(3) expression was performed in six rats bearing mature teratomas and two rats with necrotic lesions on a microSPECT/CT device after injection of the tracer [(99m)Tc]HYNIC-RGD [6-hydrazinonicotinic acid conjugated to cyclo(Arg-Gly-Asp-D-Phe-Lys)]. Correlative immunohistochemistry studies of human and mouse α(v)β(3) expression were performed. RESULTS Cisplatin+ATRA induced differentiation of the xenografts. After 8 weeks, some glandular structures and mesenchymal cells were visible; in contrast, control tumours showed undifferentiated tissues. SA PET imaging showed that mature teratoma had very low avidity for (18)F-FDG [mean standardised uptake value (SUV(mean)) = 0.48 ± 0.05] compared to untreated embryonal carcinoma (SUV(mean) = 0.92 ± 0.13) (p = 0.005). α(v)β(3) imaging accurately distinguished mature teratoma (tumour to muscle ratio = 4.29 ± 1.57) from necrosis (tumour to muscle ratio = 1.3 ± 0.26) (p = 0.0002). Immunohistochemistry studies showed that α(v)β(3) integrin expression was strong in the glandular structures of mature teratoma lesions and negative in host stroma. CONCLUSION Imaging α(v)β(3) integrin accurately distinguished mature teratoma from necrosis following cisplatin-based treatment in human NSGCT xenografts.
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Affiliation(s)
- Nicolas Aide
- EA1772, IFR 146 ICORE, GRECAN, François Baclesse Cancer Centre and Caen University, Caen, France.
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