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Peters‐Founshtein G, Gazit L, Naveh T, Domachevsky L, Korczyn AD, Bernstine H, Shaharabani‐Gargir L, Groshar D, Marshall GA, Arzy S. Lost in space(s): Multimodal neuroimaging of disorientation along the Alzheimer's disease continuum. Hum Brain Mapp 2024; 45:e26623. [PMID: 38488454 PMCID: PMC10941506 DOI: 10.1002/hbm.26623] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/02/2024] [Accepted: 01/27/2024] [Indexed: 03/18/2024] Open
Abstract
Orientation is a fundamental cognitive faculty and the bedrock of the neurologic examination. Orientation is defined as the alignment between an individual's internal representation and the external world in the spatial, temporal, and social domains. While spatial disorientation is a recognized hallmark of Alzheimer's disease (AD), little is known about disorientation beyond space in AD. This study aimed to explore disorientation in spatial, temporal, and social domains along the AD continuum. Fifty-one participants along the AD continuum performed an ecological orientation task in the spatial, temporal, and social domains while undergoing functional MRI. Disorientation in AD followed a three-way association between orientation domain, brain region, and disease stage. Specifically, patients with early amnestic mild cognitive impairment exhibited spatio-temporal disorientation and reduced brain activity in temporoparietal regions, while patients with AD dementia showed additional social disorientation and reduced brain activity in frontoparietal regions. Furthermore, patterns of hypoactivation overlapped different subnetworks of the default mode network, patterns of fluorodeoxyglucose hypometabolism, and cortical atrophy characteristic of AD. Our results suggest that AD may encompass a disorder of orientation, characterized by a biphasic process manifesting as early spatio-temporal and late social disorientation. As such, disorientation may offer a unique window into the clinicopathological progression of AD. SIGNIFICANCE STATEMENT: Despite extensive research into Alzheimer's disease (AD), its core cognitive deficit remains a matter of debate. In this study, we investigated whether orientation, defined as the ability to align internal representations with the external world in spatial, temporal, and social domains, constitutes a core cognitive deficit in AD. To do so, we used PET-fMRI imaging to collect behavioral, functional, and metabolic data from 51 participants along the AD continuum. Our findings suggest that AD may constitute a disorder of orientation, characterized by an early spatio-temporal disorientation and followed by late social disorientation, manifesting in task-evoked and neurodegenerative changes. We propose that a profile of disorientation across multiple domains offers a unique window into the progression of AD and as such could greatly benefit disease diagnosis, monitoring, and evaluation of treatment response.
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Affiliation(s)
- Gregory Peters‐Founshtein
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
- Department of Nuclear MedicineSheba Medical CenterRamat‐GanIsrael
| | - Lidor Gazit
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
- Department of NeurologyHadassah Hebrew University Medical SchoolJerusalemIsrael
| | - Tahel Naveh
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
- Department of NeurologyHadassah Hebrew University Medical SchoolJerusalemIsrael
| | - Liran Domachevsky
- Department of Nuclear MedicineSheba Medical CenterRamat‐GanIsrael
- Department of Nuclear MedicineAssuta Medical CenterTel‐AvivIsrael
| | | | - Hanna Bernstine
- Department of Nuclear MedicineAssuta Medical CenterTel‐AvivIsrael
- Department of ImagingTel‐Aviv UniversityTel‐AvivIsrael
- Department of Nuclear MedicineRabin Medical CenterPetah TikvaIsrael
| | | | - David Groshar
- Department of Nuclear MedicineAssuta Medical CenterTel‐AvivIsrael
- Department of ImagingTel‐Aviv UniversityTel‐AvivIsrael
| | - Gad A. Marshall
- Department of Neurology, Center for Alzheimer Research and Treatment, Harvard Medical School, Brigham and Women's HospitalMassachusetts General HospitalBostonMassachusettsUSA
| | - Shahar Arzy
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
- Department of NeurologyHadassah Hebrew University Medical SchoolJerusalemIsrael
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Durham BH, Hershkovitz-Rokah O, Abdel-Wahab O, Yabe M, Chung YR, Itchaki G, Ben-Sasson M, Asher-Guz VA, Groshar D, Doe-Tetteh SA, Alano T, Solit DB, Shpilberg O, Diamond EL, Mazor RD. Mutant PIK3CA is a targetable driver alteration in histiocytic neoplasms. Blood Adv 2023; 7:7319-7328. [PMID: 37874915 PMCID: PMC10711187 DOI: 10.1182/bloodadvances.2022009349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 09/21/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasm characterized by the accumulation of clonal mononuclear phagocyte system cells expressing CD1a and CD207. In the past decade, molecular profiling of LCH as well as other histiocytic neoplasms demonstrated that these diseases are driven by MAPK activating alterations, with somatic BRAFV600E mutations in >50% of patients with LCH, and clinical inhibition of MAPK signaling has demonstrated remarkable clinical efficacy. At the same time, activating alterations in kinase-encoding genes, such as PIK3CA, ALK, RET, and CSF1R, which can activate mitogenic pathways independent from the MAPK pathway, have been reported in a subset of histiocytic neoplasms with anecdotal evidence of successful targeted treatment of histiocytoses harboring driver alterations in RET, ALK, and CSF1R. However, evidence supporting the biological consequences of expression of PIK3CA mutations in hematopoietic cells has been lacking, and whether targeted inhibition of PI3K is clinically efficacious in histiocytic neoplasms is unknown. Here, we provide evidence that activating mutations in PIK3CA can drive histiocytic neoplasms in vivo using a conditional knockin mouse expressing mutant PIK3CAH1047R in monocyte/dendritic cell progenitors. In parallel, we demonstrate successful treatment of PIK3CA-mutated, multisystemic LCH using alpelisib, an inhibitor of the alpha catalytic subunit of PI3K. Alpelisib demonstrated a tolerable safety profile at a dose of 750 mg per week and clinical and metabolic complete remission in a patient with PIK3CA-mutated LCH. These data demonstrate PIK3CA as a targetable noncanonical driver of LCH and underscore the importance of mutational analysis-based personalized treatment in histiocytic neoplasms.
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Affiliation(s)
- Benjamin H. Durham
- Molecular Pharmacology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oshrat Hershkovitz-Rokah
- Department of Molecular Biology, Faculty of Natural Sciences, Ariel University, Ariel, Israel
- Translational Research Lab, Assuta Medical Centers, Tel Aviv, Israel
| | - Omar Abdel-Wahab
- Molecular Pharmacology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mariko Yabe
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Young Rock Chung
- Molecular Pharmacology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gilad Itchaki
- Department of Hematology, Rabin Medical Center, Petah Tikva, Israel
| | - Maayan Ben-Sasson
- The Institute for Pain Medicine, Rambam Medical Center, Haifa, Israel
- The Rappaport School of Medicine, Technion, Haifa, Israel
- Meuhedet Health Maintenance Organization, Zikhron Ya'akov, Israel
| | - Vered A. Asher-Guz
- Department of Molecular Biology, Faculty of Natural Sciences, Ariel University, Ariel, Israel
- Translational Research Lab, Assuta Medical Centers, Tel Aviv, Israel
| | - David Groshar
- Department of Imaging, Assuta Medical Center, Tel Aviv, Israel
| | - Seyram A. Doe-Tetteh
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tina Alano
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David B. Solit
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ofer Shpilberg
- Translational Research Lab, Assuta Medical Centers, Tel Aviv, Israel
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel
- The Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Eli L. Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roei D. Mazor
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel
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Furtado FS, Mercaldo ND, Vahle T, Benkert T, Bradley WR, Ratanaprasatporn L, Seethamraju RT, Harisinghani MG, Lee S, Suarez-Weiss K, Umutlu L, Catana C, Pomykala KL, Domachevsky L, Bernstine H, Groshar D, Rosen BR, Catalano OA. Simultaneous multislice diffusion-weighted imaging versus standard diffusion-weighted imaging in whole-body PET/MRI. Eur Radiol 2023; 33:2536-2547. [PMID: 36460925 DOI: 10.1007/s00330-022-09275-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To compare standard (STD-DWI) single-shot echo-planar imaging DWI and simultaneous multislice (SMS) DWI during whole-body positron emission tomography (PET)/MRI regarding acquisition time, image quality, and lesion detection. METHODS Eighty-three adults (47 females, 57%), median age of 64 years (IQR 52-71), were prospectively enrolled from August 2018 to March 2020. Inclusion criteria were (a) abdominal or pelvic tumors and (b) PET/MRI referral from a clinician. Patients were excluded if whole-body acquisition of STD-DWI and SMS-DWI sequences was not completed. The evaluated sequences were axial STD-DWI at b-values 50-400-800 s/mm2 and the apparent diffusion coefficient (ADC), and axial SMS-DWI at b-values 50-300-800 s/mm2 and ADC, acquired with a 3-T PET/MRI scanner. Three radiologists rated each sequence's quality on a five-point scale. Lesion detection was quantified using the anatomic MRI sequences and PET as the reference standard. Regression models were constructed to quantify the association between all imaging outcomes/scores and sequence type. RESULTS The median whole-body STD-DWI acquisition time was 14.8 min (IQR 14.1-16.0) versus 7.0 min (IQR 6.7-7.2) for whole-body SMS-DWI, p < 0.001. SMS-DWI image quality scores were higher than STD-DWI in the abdomen (OR 5.31, 95% CI 2.76-10.22, p < 0.001), but lower in the cervicothoracic junction (OR 0.21, 95% CI 0.10-0.43, p < 0.001). There was no significant difference in the chest, mediastinum, pelvis, and rectum. STD-DWI detected 276/352 (78%) lesions while SMS-DWI located 296/352 (84%, OR 1.46, 95% CI 1.02-2.07, p = 0.038). CONCLUSIONS In cancer staging and restaging, SMS-DWI abbreviates acquisition while maintaining or improving the diagnostic yield in most anatomic regions. KEY POINTS • Simultaneous multislice diffusion-weighted imaging enables faster whole-body image acquisition. • Simultaneous multislice diffusion-weighted imaging maintains or improves image quality when compared to single-shot echo-planar diffusion-weighted imaging in most anatomical regions. • Simultaneous multislice diffusion-weighted imaging leads to superior lesion detection.
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Affiliation(s)
- Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - Nathaniel D Mercaldo
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Thomas Vahle
- MR Application Predevelopment, Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - Thomas Benkert
- MR Application Predevelopment, Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - William R Bradley
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Lisa Ratanaprasatporn
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Ravi Teja Seethamraju
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- MR Collaborations, Siemens Medical Solutions USA, Inc., 30 Jonathan Ln, Malden, MA, 02148, USA
| | - Mukesh G Harisinghani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Susanna Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Krista Suarez-Weiss
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Lale Umutlu
- Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Ciprian Catana
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | | | - Liran Domachevsky
- Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel
- Tel Aviv University, 6997801, Tel Aviv-Yafo, Israel
| | - Hanna Bernstine
- Tel Aviv University, 6997801, Tel Aviv-Yafo, Israel
- Assuta Medical Center, HaBarzel 20 St, Ramat Hahayal, Tel Aviv, Israel
| | - David Groshar
- Tel Aviv University, 6997801, Tel Aviv-Yafo, Israel
- Assuta Medical Center, HaBarzel 20 St, Ramat Hahayal, Tel Aviv, Israel
| | - Bruse R Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - Onofrio Antonio Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA.
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Peters-Founshtein G, Gazit L, Naveh T, Domachevsky L, Korczyn A, Bernstine H, Groshar D, Marshall GA, Arzy S. Lost in space(s): multimodal neuroimaging of disorientation along the Alzheimer's disease continuum. bioRxiv 2023:2023.01.25.525587. [PMID: 36747783 PMCID: PMC9900945 DOI: 10.1101/2023.01.25.525587] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Orientation is a fundamental cognitive faculty, allowing the behaving self to link his/her current state to their internal representations of the external world. Once exclusively linked to knowledge of the current place and present time, in recent years, the concept of orientation has evolved to include processing of social, temporal, and abstract relations. Concordantly with the growing focus on orientation, spatial disorientation has been increasingly recognized as a hallmark symptom of Alzheimer's disease (AD). However, few studies have sought to explore disorientation along the AD continuum beyond the spatial domain. 51 participants along the AD continuum performed an orientation task in the spatial, temporal and social domains. Under functional magnetic resonance imaging (fMRI), participants determined which of two familiar places/events/people is geographically/ chronologically/ socially closer to them, respectively. A series of analyses revealed disorientation along the AD- continuum to follow a three-way association between (1) orientation domain, (2) brain region, and (3) disease stage. Specifically, participants with MCI exhibited impaired spatio-temporal orientation and reduced task-evoked activity in temporoparietal regions, while participants with AD dementia exhibited impaired social orientation and reduced task-evoked activity in frontoparietal regions. Furthermore, these patterns of hypoactivation coincided with Default Mode Network (DMN) sub-networks, with spatio-temporal orientation activation overlapping DMN-C and social orientation with DMN-A. Finally, these patterns of disorientation- associated hypoactivations coincided with patterns of fluorodeoxyglucose (FDG) hypometabolism and cortical atrophy characteristic to AD-dementia. Taken together, our results suggest that AD may constitute a disorder of orientation, characterized by a biphasic process as (1) early spatio-temporal and (2) late social disorientation, concurrently manifesting in task-evoked and neurodegenerative changes in temporoparietal and parieto-frontal brain networks, respectively. We propose that a profile of disorientation across multiple domains offers a unique window into the progression of AD.
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Affiliation(s)
- Gregory Peters-Founshtein
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Nuclear Medicine, Sheba Medical Center, Ramat-Gan, Israel
| | - Lidor Gazit
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Neurology, Hadassah Hebrew University Medical School, Jerusalem, Israel
| | - Tahel Naveh
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Neurology, Hadassah Hebrew University Medical School, Jerusalem, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Sheba Medical Center, Ramat-Gan, Israel
- Department of Nuclear Medicine, Assuta Medical Center, Tel-Aviv, Israel
| | - Amos Korczyn
- Department of Neurology, Tel-Aviv University, Tel-Aviv, Israel
| | - Hanna Bernstine
- Department of Imaging, Tel-Aviv University, Tel-Aviv, Israel
- Department of Nuclear Medicine, Assuta Medical Center, Tel-Aviv, Israel
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel
| | - David Groshar
- Department of Imaging, Tel-Aviv University, Tel-Aviv, Israel
- Department of Nuclear Medicine, Assuta Medical Center, Tel-Aviv, Israel
| | - Gad A. Marshall
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Shahar Arzy
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Neurology, Hadassah Hebrew University Medical School, Jerusalem, Israel
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Brenner B, Kundel Y, Cohen Z, Brand H, Gordon N, Sulkes A, Morgenstern S, Menasherov N, Kashtan H, Groshar D, Domachevsky L, Bernstine H. Early prediction of residual disease after neoadjuvant chemoradiotherapy and cetuximab for locally advanced esophageal cancer using 18F-FDG PET-CT imaging: a prospective cohort study. J Gastrointest Oncol 2022; 13:2721-2735. [PMID: 36636052 PMCID: PMC9830356 DOI: 10.21037/jgo-22-352] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Previous studies in locally advanced esophageal cancer (LAEC) suggested that a change in the tumor's metabolic response, i.e., decrease of its interim 18F-FDG uptake compared with baseline, may predict histopathological response. We evaluated the possible predictive correlation between various PET-CT and histopathological parameters following a neoadjuvant biological-containing chemoradiotherapy (CRT) regimen. Methods Patients with resectable LAEC received neoadjuvant cisplatin/5-fluorouracil-based CRT and cetuximab following one cycle of induction chemotherapy and cetuximab. Changes in maximum and mean standardized uptake values (ΔSUV-max and ΔSUV-mean, respectively) and metabolic tumor volume (ΔMTV), measured by PET-CT at baseline and 2 weeks after the onset of treatment, were compared with histopathological findings at surgery. Histopathological response was defined by tumor regression grade (TRG), pathological complete response (pCR) and microscopic or macroscopic residual disease (RD). Results Of 18 patients, 13 (72%) with adenocarcinoma (AC) and 5 (28%) with squamous cell carcinoma (SCC), were included. None of the changes in the parameters of PET was associated with pCR; only ΔSUV-mean was associated with TRG in the AC cohort. In contrast, both ΔSUV-mean% and ΔSUV-max% were significantly associated with RD, both in the whole cohort and in the AC cohort. Changes in FDG-uptake predicted RD2 at surgery: only patients with less than 13% decrease in SUV-mean% or less than 29% decrease in SUV-max% had RD2, while all patients with RD0 or RD1 had greater reductions [100% specificity and 100% positive predictive value (PPV)]. Conclusions Changes in ΔSUV-max and ΔSUV-mean after two weeks of onset of cetuximab-based neoadjuvant chemotherapy for LAEC may predict macroscopic RD but not TRG or pCR at surgery.
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Affiliation(s)
- Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel;,Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Yulia Kundel
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Zoya Cohen
- Felsenstein Medical Research Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Hadar Brand
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Noa Gordon
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Aaron Sulkes
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel;,Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Sara Morgenstern
- Institute of Pathology, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Nikolai Menasherov
- Department of Surgery A, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Hanoch Kashtan
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel;,Departments of Surgery A and B, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - David Groshar
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel;,Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Petach Tiqva, Israel
| | - Liran Domachevsky
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel;,Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Petach Tiqva, Israel;,Department of Nuclear Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Hanna Bernstine
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel;,Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Petach Tiqva, Israel
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Golan S, Frumer M, Zohar Y, Rosenbaum E, Yakimov M, Kedar D, Margel D, Baniel J, Steinmetz AP, Groshar D, Domachevsky L, Bernstine H. Neoadjuvant 177Lu-PSMA-I&T Radionuclide Treatment in Patients with High-risk Prostate Cancer Before Radical Prostatectomy: A Single-arm Phase 1 Trial. Eur Urol Oncol 2022; 6:151-159. [PMID: 36216740 DOI: 10.1016/j.euo.2022.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/16/2022] [Accepted: 09/20/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND High-risk localized prostate cancer (HRLPC) has a substantial risk of disease progression despite local treatment. Neoadjuvant systemic therapy before definitive local therapy may improve oncological outcomes by targeting the primary tumor and micrometastatic disease. OBJECTIVE To evaluate whether a lutetium-177 prostate-specific membrane antigen radioligand (LuPSMA) can be safely administered to patients with HRLPC before robot-assisted radical prostatectomy (RARP) and to describe immediate oncological outcomes. DESIGN, SETTING, AND PARTICIPANTS This was an open-label, single-arm clinical trial. Patients with HRLPC and elevated radioligand uptake on PSMA positron emission tomography/computed tomography were enrolled. Two or three LuPSMA radioligand doses (7.4 GBq) were given at 2-wk intervals. RARP with lymph node dissection was performed 4 wk after the last LuPSMA dose. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The rate of surgical complications, operative parameters, changes in functional and quality-of-life measures, and immediate oncological outcomes (histological findings and biochemical response) were measured. Data were analyzed descriptively. RESULTS AND LIMITATIONS Fourteen patients participated (median age 67 yr). Prostate-specific antigen decreased by 17% (interquartile range [IQR] 9-50%) after two LuPSMA doses and 34% (IQR 11-60%) after three doses. Thirteen patients underwent RARP with no identifiable anatomical changes or intraoperative complications. Four patients (30%) had postoperative complications (pneumonia, pulmonary embolism, urinary leak with urinary tract infection). At 3 mo postoperatively, 12 patients (92%) required one pad or less. Final whole-mount pathology showed positive surgical margins (PSMs) in seven patients (53%) and downgrading to International Society of Urological Pathology grade group 3 in three patients (23%). Treatment-related effects included a clear vacuolated cytoplasm and pyknotic nuclei. CONCLUSIONS LuPSMA followed by RARP appears to be surgically safe. While oncological outcomes are pending, continence recovery seems to be unaffected by LuPSMA treatment. PATIENT SUMMARY We evaluated outcomes for patients with aggressive localized prostate cancer who received treatment with a radioactive agent before surgical removal of their prostate. This approach appears to be safe and feasible, but its therapeutic efficacy is still unknown.
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Geiger KR, Pasvolsky O, Berger T, Raanani P, Shochat T, Gurion R, Anati T, Groshar D, Gafter-Gvili A, Bernstine H. Effect of steroid treatment on the diagnostic yield of baseline 18f-fluorodeoxyglucose positron emission tomography in aggressive B cell lymphoma. EJNMMI Res 2022; 12:59. [PMID: 36104603 PMCID: PMC9474759 DOI: 10.1186/s13550-022-00924-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/17/2022] [Indexed: 01/18/2023] Open
Abstract
Aggressive B cell lymphoma often requires prompt steroid treatment, even before baseline 18f-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and definitive treatment, to alleviate symptoms or prevent organ damage. Since lymphoma is a steroid-sensitive malignancy, there are concerns that steroids might affect the results of FDG PET/CT and decrease its diagnostic yield. The aim of the current study was to evaluate the effect of steroids administered before baseline PET/CT on the maximum standardized uptake value (SUVmax) and additional PET/CT parameters. Retrospective review of the database in a tertiary medical center yielded 178 patients newly diagnosed with aggressive B cell lymphoma between January 2017 and May 2020 who had an available baseline FDG PET/CT scan. The cohort was divided into patients who received steroids before PET/CT (n = 47) and those who did not (n = 131), and the groups were compared for SUVmax and additional PET/CT parameters. The steroid-treated group had a higher disease stage and lactate dehydrogenase level compared to the steroid-naïve group, with a trend toward a higher international prognostic index. There was no significant between-group difference in SUVmax (P = 0.61). This finding remained consistent across steroid treatment durations and dosage regimens. Further evaluation revealed a significantly larger mean tumor volume and a trend toward a higher tumor metabolic burden in the steroid-treated group, yet no between-group difference in SUV mean or other PET/CT parameters. In this retrospective analysis of patients with aggressive B cell lymphoma, steroid prophase prior to baseline PET/CT did not decrease the diagnostic yield of the scan. However, further studies are required to fully appreciate the impact of steroids on PET CT parameters.
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Kagan KBT, Guz D, Buchrits S, Gurion R, Vaxman I, Priss M, Groshar D, Catalano OA, Sherban A, Raanani P, Gafter-Gvili A, Bernstine H. Clinical and pathological predictors for FDG-PET/CT avidity in patients with marginal zone lymphoma-a retrospective cohort study. Eur J Nucl Med Mol Imaging 2022; 49:2290-2299. [PMID: 35079846 DOI: 10.1007/s00259-022-05683-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/09/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The clinical value of FDG-PET/CT for staging and monitoring treatment response in patients with aggressive lymphoma is well established. Conversely, its role in the assessment and management of marginal zone lymphoma (MZL) is less conclusive. We aimed to assess clinical, laboratory, and pathological predictors for FDG uptake in these patients, in an attempt to identify MZL patients whose management will benefit from this imaging modality. METHODS In this single-center, retrospective cohort study, we included all adult patients diagnosed with MZL at the Rabin Medical Center between January 2006 and December 2020 who underwent FDG-PET/CT at the time of diagnosis. Primary outcomes were FDG avidity (defined as a visual assessment of at least moderate intensity), SUVmax, and SUVliver. Variables such as advanced clinical stage, primary disease site, hemoglobin level (Hb), platelet count (Plt), serum albumin, LDH level, β-2 microglobulin, and Ki 67 index were evaluated univariate and multivariate analysis using logistic and linear regression models. Association between FDG avidity and progression-free and overall survival was evaluated using Kaplan-Meier curves and Cox regression analysis. RESULTS A total of 207 MZL patients were included in this study, 76 of whom (36.7%) had FDG-avid disease. Baseline patients' characteristics such as age, gender, and comorbid conditions were similar between patients with and without significant FDG uptake. In a multivariate logistic regression model, non-gastric MALT (OR 4.2, 95% CI 1.78-10), Ki 67 index ≥ 15% (OR 3.64, 95% CI 1.36-9.76), and elevated LDH level (OR 8.6, 95% CI 3.2-22.8) were all associated with positive FDG avidity. In a multivariate linear regression model, a combination of advanced clinical stage, specific disease subtypes, LDH level, and Ki 67 index predicted the value of SUVmax (P value < 0.001; adjusted R2 = 33.8%) and SUVmax/SUVliver (P value < 0.001; adjusted R2 = 27%). Baseline FDG avidity was associated to PFS and OS only in univariate analyses. CONCLUSIONS In this retrospective cohort study, we present prediction models for positive FDG uptake and SUVmax in MZL patients. These models aim to help clinicians choose patients suitable for incorporation of FDG-PET/CT for staging and monitoring disease and reduce the costs of redundant tests.
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Affiliation(s)
| | - Dmitri Guz
- Rabin Medical Center, Medicine A, Jabotinsky 39, Petah Tikva, Israel
| | - Shira Buchrits
- Rabin Medical Center, Medicine A, Jabotinsky 39, Petah Tikva, Israel
| | - Ronit Gurion
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Iuliana Vaxman
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Miriam Priss
- Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - David Groshar
- Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
- Department of Nuclear Medicine Rabin Medical Center, Petah Tikva, Israel
| | - Onofrio A Catalano
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Adi Sherban
- Rabin Medical Center, Medicine A, Jabotinsky 39, Petah Tikva, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Anat Gafter-Gvili
- Rabin Medical Center, Medicine A, Jabotinsky 39, Petah Tikva, Israel
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Hanna Bernstine
- Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
- Department of Nuclear Medicine Rabin Medical Center, Petah Tikva, Israel
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Esfahani SA, Torrado-Carvajal A, Amorim BJ, Groshar D, Domachevsky L, Bernstine H, Stein D, Gervais D, Catalano OA. Publisher Correction to: PET/MRI and PET/CT Radiomics in Primary Cervical Cancer: A Pilot Study on the Correlation of Pelvic PET, MRI, and CT Derived Image Features. Mol Imaging Biol 2021; 24:70. [PMID: 34811607 DOI: 10.1007/s11307-021-01671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Shadi A Esfahani
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital Boston and Harvard Medical School, Boston, MA, USA
| | - Angel Torrado-Carvajal
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital Boston and Harvard Medical School, Boston, MA, USA.,Medical Image Analysis and Biometry Lab, Universidad Rey Juan Carlos, Madrid, Spain
| | - Barbara Juarez Amorim
- Division of Nuclear Medicine, State University of Campinas (UNICAMP), Campinas, Brazil
| | - David Groshar
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Nuclear Medicine and Radiology, Assuta Medical Centers, 2021, Tel-Aviv, Israel
| | - Liran Domachevsky
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Nuclear Medicine and Radiology, Assuta Medical Centers, 2021, Tel-Aviv, Israel
| | - Hanna Bernstine
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Nuclear Medicine and Radiology, Assuta Medical Centers, 2021, Tel-Aviv, Israel
| | - Dan Stein
- Department of Nuclear Medicine and Radiology, Assuta Medical Centers, 2021, Tel-Aviv, Israel
| | - Debra Gervais
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. .,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital Boston and Harvard Medical School, Boston, MA, USA.
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10
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Esfahani SA, Torrado-Carvajal A, Amorim BJ, Groshar D, Domachevsky L, Bernstine H, Stein D, Gervais D, Catalano OA. PET/MRI and PET/CT Radiomics in Primary Cervical Cancer: A Pilot Study on the Correlation of Pelvic PET, MRI, and CT Derived Image Features. Mol Imaging Biol 2021; 24:60-69. [PMID: 34622425 DOI: 10.1007/s11307-021-01658-1] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate the correlation of radiomic features in pelvic [2-deoxy-2-18F]fluoro-D-glucose positron emission tomography/magnetic resonance imaging and computed tomography ([18F]FDG PET/MRI and [18F]FDG PET/CT) in patients with primary cervical cancer (CCa). PROCEDURES Nineteen patients with histologically confirmed primary squamous cell carcinoma of the cervix underwent same-day [18F]FDG PET/MRI and PET/CT. Two nuclear medicine physicians performed a consensus reading in random order. Free-hand regions of interest covering the primary cervical tumors were drawn on PET, contrast-enhanced pelvic CT, and pelvic MR (T2 weighted and ADC) images. Several basic imaging features, standard uptake values (SUVmean, SUVmax, and SUVpeak), total lesion glycolysis (TLG), metabolic tumor volume (MTV), and more advanced texture analysis features were calculated. Pearson's correlation test was used to assess the correlation between each pair of features. Features were compared between local and metastatic tumors, and their role in predicting metastasis was evaluated by receiver operating characteristic curves. RESULTS For a total of 101 extracted features, 1104/5050 pairs of features showed a significant correlation (ρ ≥ 0.70, p < 0.05). There was a strong correlation between 190/484 PET pairs of features from PET/MRI and PET/CT, 91/418 pairs of CT and PET from PET/CT, 79/418 pairs of T2 and PET from PET/MRI, and 50/418 pairs of ADC and PET from PET/MRI. Significant difference was seen between eight features in local and metastatic tumors including MTV, TLG, and entropy on PET from PET/CT; MTV and TLG on PET from PET/MRI; compactness and entropy on T2; and entropy on ADC images. CONCLUSIONS We demonstrated strong correlation of many extracted radiomic features between PET/MRI and PET/CT. Eight radiomic features calculated on PET/CT and PET/MRI were significantly different between local and metastatic CCa. This study paves the way for future studies to evaluate the diagnostic and predictive potential of radiomics that could guide clinicians toward personalized patients care.
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Affiliation(s)
- Shadi A Esfahani
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital Boston and Harvard Medical School, Boston, MA, USA
| | - Angel Torrado-Carvajal
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital Boston and Harvard Medical School, Boston, MA, USA.,Medical Image Analysis and Biometry Lab, Universidad Rey Juan Carlos, Madrid, Spain
| | - Barbara Juarez Amorim
- Division of Nuclear Medicine, State University of Campinas (UNICAMP), Campinas, Brazil
| | - David Groshar
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Nuclear Medicine and Radiology, Assuta Medical Centers, Tel-Aviv, Israel
| | - Liran Domachevsky
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Nuclear Medicine and Radiology, Assuta Medical Centers, Tel-Aviv, Israel
| | - Hanna Bernstine
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Nuclear Medicine and Radiology, Assuta Medical Centers, Tel-Aviv, Israel
| | - Dan Stein
- Department of Nuclear Medicine and Radiology, Assuta Medical Centers, Tel-Aviv, Israel
| | - Debra Gervais
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. .,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital Boston and Harvard Medical School, Boston, MA, USA.
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11
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Zhang C, O'Shea A, Parente CA, Amorim BJ, Caravan P, Ferrone CR, Blaszkowsky LS, Soricelli A, Salvatore M, Groshar D, Bernstine H, Domachevsky L, Canamaque LG, Umutlu L, Ken H, Catana C, Mahmood U, Catalano OA. Evaluation of the Diagnostic Performance of Positron Emission Tomography/Magnetic Resonance for the Diagnosis of Liver Metastases. Invest Radiol 2021; 56:621-628. [PMID: 33813576 DOI: 10.1097/rli.0000000000000782] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of this study was to compare the performance of positron emission tomography (PET)/magnetic resonance (MR) versus stand-alone PET and stand-alone magnetic resonance imaging (MRI) in the detection and characterization of suspected liver metastases. MATERIALS AND METHODS This multi-institutional retrospective performance study was approved by the institutional review boards and was Health Insurance Portability and Accountability Act compliant, with waiver of informed consent. Seventy-nine patients with confirmed solid extrahepatic malignancies who underwent upper abdominal PET/MR between February 2017 and June 2018 were included. Where focal hepatic lesions were identified, the likelihood of a diagnosis of a liver metastasis was defined on an ordinal scale for MRI, PET, and PET/MRI by 3 readers: 1 nuclear medicine physician and 2 radiologists. The number of lesions per patient, lesion size, and involved hepatic segments were recorded. Proof of metastases was based on histopathologic correlation or clinical/imaging follow-up. Diagnostic performance was assessed using sensitivity, specificity, positive and negative predictive values, and receiver operator characteristic curve analysis. RESULTS A total of 79 patients (53 years, interquartile range, 50-68; 43 men) were included. PET/MR had a sensitivity of 95%, specificity of 97%, positive predictive value of 97%, and negative predictive value of 95%. The sensitivity, specificity, positive predictive value, and negative predictive value of MRI were 88%, 98%, 98%, and 90% and for PET were 83%, 97%, 97%, and 86%, respectively. The areas under the curve for PET/MRI, MRI, and PET were 95%, 92%, and 92%, respectively. CONCLUSIONS Contrast-enhanced PET/MR has a higher sensitivity and negative predictive value than either PET or MRI alone in the setting of suspected liver metastases. Fewer lesions were characterized as indeterminate by PET/MR in comparison with PET and MRI. This superior performance could potentially impact treatment and management decisions for patients with suspected liver metastases.
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Affiliation(s)
- Caiyuan Zhang
- From The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, and Department of Radiology, Xinhua Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aileen O'Shea
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston
| | - Chiara Anna Parente
- IRCCS, Department of Radiology, The Institute for Hospitalization and Healthcare (IRCCS) SDN, Napoli, Italy
| | - Barbara Juarez Amorim
- Division of Nuclear Medicine, Department of Radiology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Peter Caravan
- The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston
| | | | | | - Andrea Soricelli
- The Institute for Hospitalization and Healthcare (IRCCS) SDN, Napoli, Italy
| | - Marco Salvatore
- Department of Radiology and Nuclear Medicine, University Suor Orsola Benincasa and SDN IRCCS, Napoli, Italy
| | - David Groshar
- Department of Radiology and Nuclear Medicine, Assuta Medical Center and School of Medicine, Tel Aviv University, TLV, Israel
| | - Hanna Bernstine
- Department of Radiology and Nuclear Medicine, Assuta Medical Center and School of Medicine, Tel Aviv University, TLV, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, The Chaim Sheba Medical Center Tel Hashomer Israel
| | | | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Herrmann Ken
- Institute of Diagnostic and Interventional Radiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ciprian Catana
- The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Umar Mahmood
- Department of Radiology and Nuclear Medicine, Massachusetts General Hospital, Boston, MA
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12
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Margel D, Bernstine H, Groshar D, Ber Y, Nezrit O, Segal N, Yakimov M, Baniel J, Domachevsky L. Diagnostic Performance of 68Ga Prostate-specific Membrane Antigen PET/MRI Compared with Multiparametric MRI for Detecting Clinically Significant Prostate Cancer. Radiology 2021; 301:379-386. [PMID: 34463555 DOI: 10.1148/radiol.2021204093] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Gallium 68 (68Ga) prostate-specific membrane antigen (PSMA) PET/MRI may improve detection of clinically significant prostate cancer (CSPC). Purpose To compare the sensitivity and specificity of 68Ga-PSMA PET/MRI with multiparametric MRI for detecting CSPC. Materials and Methods Men with prostate specific antigen levels of 2.5-20 ng/mL prospectively underwent 68Ga-PSMA PET/MRI, including multiparametric MRI sequences, between June 2019 and March 2020. Imaging was evaluated independently by two radiologists by using the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1. Sensitivity and specificity for CSPC (International Society of Urological Pathology grade group ≥ 2) were compared for 68Ga-PSMA PET/MRI and multiparametric MRI by using the McNemar test. Decision curve analysis compared the net benefit of each imaging strategy. Results Ninety-nine men (median age, 67 years; interquartile range, 62-71 years) were included; 79% (78 of 99) underwent biopsy. CSPC was detected in 32% (25 of 78). For CSPC, specificity was higher for 68Ga-PSMA PET/MRI than multiparametric MRI (76% [95% CI: 62, 86] vs 49% [95% CI: 35, 63], respectively; P < .001). Sensitivity was similar (88% [95% CI: 69, 98] vs 92% [95% CI: 74, 99], respectively; P > .99). For PI-RADS 3 lesions, specificity was also higher for 68Ga-PSMA PET/MRI than for multiparametric MRI: 86% (95% CI: 73, 95) versus 59% (95% CI: 43, 74), respectively (P = .002). Decision curve analysis showed that biopsies targeted to PSMA uptake increased the net benefit of multiparametric MRI only among PI-RADS 3 lesions. The net benefit of targeted biopsy for a PI-RADS 3 lesion with PSMA uptake was higher across all threshold probabilities over 8%. The net benefit of targeted biopsy was similar for PI-RADS 4 and 5 lesions, regardless of PSMA uptake. Conclusions Gallium 68 prostate-specific membrane antigen PET/MRI improved specificity for clinically significant prostate cancer compared with multiparametric MRI, particularly in Prostate Imaging Reporting and Data System grade 3 lesions. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Williams and Estes in this issue.
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Affiliation(s)
- David Margel
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Hanna Bernstine
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - David Groshar
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Yaara Ber
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Orian Nezrit
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Niv Segal
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Maxim Yakimov
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Jack Baniel
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Liran Domachevsky
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
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Furtado FS, Suarez-Weiss KE, Vangel M, Clark JW, Cusack JC, Hong T, Blaszkowsky L, Wo J, Striar R, Umutlu L, Daldrup-Link HE, Groshar D, Rocco R, Bordeianou L, Anderson MA, Mojtahed A, Qadan M, Ferrone C, Catalano OA. Clinical impact of PET/MRI in oligometastatic colorectal cancer. Br J Cancer 2021; 125:975-982. [PMID: 34282295 DOI: 10.1038/s41416-021-01494-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/08/2021] [Accepted: 07/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Oligometastatic colorectal cancer (CRC) is potentially curable and demands individualised strategies. METHODS This single-centre retrospective study investigated if positron emission tomography (PET)/magnetic resonance imaging (MR) had a clinical impact on oligometastatic CRC relative to the standard of care imaging (SCI). Adult patients with oligometastatic CRC on SCI who also underwent PET/MR between 3/2016 and 3/2019 were included. The exclusion criterion was lack of confirmatory standard of reference, either surgical pathology, intraoperative gross confirmation or imaging follow-up. SCI consisted of contrast-enhanced (CE) computed tomography (CT) of the chest/abdomen/pelvis, abdominal/pelvic CE-MR, and/or CE whole-body PET/CT with diagnostic quality (i.e. standard radiation dose) CT. Follow-up was evaluated until 3/2020. RESULTS Thirty-one patients constituted the cohort, 16 (52%) male, median patient age was 53 years (interquartile range: 49-65 years). PET/MR and SCI results were divergent in 19% (95% CI 9-37%) of the cases, with PET/MR leading to management changes in all of them. The diagnostic accuracy of PET/MR was 90 ± 5%, versus 71 ± 8% for SCI. In a pairwise analysis, PET/MR outperformed SCI when compared to the reference standard (p = 0.0412). CONCLUSIONS These findings suggest the potential usefulness of PET/MR in the management of oligometastatic CRC.
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Affiliation(s)
- Felipe S Furtado
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, USA
| | | | - Mark Vangel
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, USA.,Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey W Clark
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James C Cusack
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Theodore Hong
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lawrence Blaszkowsky
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Newton-Wellesley Hospital, Newton, MA, USA
| | - Jennifer Wo
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robin Striar
- Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, USA
| | | | | | - David Groshar
- Assuta Medical Centers, Tel Aviv, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ricciardi Rocco
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Mark A Anderson
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Motaz Qadan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cristina Ferrone
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Onofrio A Catalano
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, USA.
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14
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Tschernichovsky R, Perl G, Finkel I, Peretz I, Jacobi O, Sternschuss M, Ulitsky O, Kundel Y, Sulkes A, Bernstine H, Groshar D, Brenner B. Postoperative PET-CT in patients (pts) with pathological stage III colon cancer (CC): Interim results from the first prospective validation study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e15599] [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] [Indexed: 11/20/2022] Open
Abstract
e15599 Background: A substantial number of pts with pathological stage III CC recur despite the absence of metastatic disease on pre-operative CT. In a previous large retrospective study from our institution on 348 pts, we reported that early postoperative PET-CT modified the staging and management of 13.4% of assumed stage III CC pts. The aim of the current study was to prospectively validate these results. Methods: A prospective, single-center study of pts with pathological stage III CC who underwent early postoperative PET-CT between the years 2013-2021. Results: 83 pts were accrued and 81 (48.1% males, median age 66y) were evaluable for the primary endpoint i.e. PET-CT results. Pathological stage was IIIA, IIIB and IIIC in 7 (8.6%), 56 (69.1%) and 17 (21%) of pts, respectively. Median number of lymph nodes examined and of positive nodes were 17 (range, 9-134) and 2 (range, 0-15), respectively. Post-operative PET-CT findings were significant in 7 pts (8.6%): 4 pts (4.9%) were upstaged to stage IV, 2 (2.5%) were diagnosed with a second primary malignancy, and 1 (1.2%) was both upstaged and diagnosed with another cancer. Three additional pts (3.7%) are currently undergoing evaluation for suspicious PET-CT findings. At a median follow-up of 30.6 months (range, 6.2-92), 13 of the 71 pts with true stage III CC recurred; the estimated 3y disease-free survival rate was 81%. The estimated 5y overall survival rates for the entire cohort and for true stage III pts were 82% and 90%, respectively. Of the 5 pts found to have metastatic disease based on PET-CT findings, one is scheduled to undergo potentially curative surgical removal of a solitary liver metastasis. Conclusions: Interim results from the first prospective study to evaluate the impact of early postoperative PET-CT in pts with pathological stage III CC seem to support earlier retrospective data: the use of PET-CT in this setting changed the staging and management of 8.6% of pts, including the possibility for early detection of potentially curable metastatic disease. Additional data, with more pts and longer follow-up, will be presented at the meeting.
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Affiliation(s)
| | - Gali Perl
- Davidoff Cancer Center, Petach Tikva, Israel
| | - Inbar Finkel
- Davidoff Cancer Center Rabin Medical Center, Petah Tikva, Israel
| | - Idit Peretz
- Thoracic Oncology Service, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | | | - Michal Sternschuss
- Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Olga Ulitsky
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | | | - Aaron Sulkes
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | | | - David Groshar
- Department of Nuclear Medicine, Rabin Medical Center, Affiliated to the Sackler Faculty of Medicine, Petah Tikva, Israel
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15
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Bernstine H, Priss M, Anati T, Turko O, Gorenberg M, Steinmetz AP, Groshar D. Axillary Lymph Nodes Hypermetabolism After BNT162b2 mRNA COVID-19 Vaccination in Cancer Patients Undergoing 18F-FDG PET/CT: A Cohort Study. Clin Nucl Med 2021; 46:396-401. [PMID: 33782299 DOI: 10.1097/rlu.0000000000003648] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Recognition of the pattern of FDG uptake in hypermetabolic axillary lymph nodes (HALs) and association with recent messenger RNA (mRNA) vaccination are important to prevent patient anxiety and further needless examinations or costly biopsies in cancer patients. MATERIALS AND METHODS This study was a retrospective cohort study in a single tertiary care institution. We investigate the occurrence and pattern of HAL on FDG PET/CT scans from 650 consecutive cancer patients with recent BNT162b2 mRNA COVID-19 vaccination. RESULTS Between December 20, 2020, and February 8, 2021, 650 patients (351 female patients [54%]; mean age, 68.9 years) had recent mRNA COVID-19 vaccination and an FDG PET/CT scan. HALs were found in 57 (14.5%) of 394 patients (95% confidence interval [CI], 10.9%-18.7%) 12.3 ± 5.9 (1-22) days after dose 1 and in 111 (43.3%) of 256 patients (95% CI, 35.3%-52.2%; P < 0.0001) after 7.5 ± 5.4 (1-22) days after dose 2. There was no difference between dose 1 and dose 2 concerning SUVmax (3.7 ± 1.8 [1.3-11.3] and 4.5 ± 3.9 [1.4-26.3], P = 0.13, respectively), SUVmean (2.1 ± 1.0 [0.7-6.5] and 2.7 ± 2.4 [0.8-17], P = 0.08, respectively), and reactogenicity volume (2.7 ± 2.3 [0.2-11.6] cm3 and 2.7 ± 2.4 [0.2-15.5] cm3, P = 0.98, respectively). There was no difference in number and in size of positive lymph nodes between dose 1 and dose 2: 3.2 ± 2.2 (1-10) and 3.7 ± 2.4 (1-12) (P = 0.18), and 1.4 ± 0.4 cm (0.7-2.5 cm) and 1.5 ± 0.4 cm (0.6-3.2 cm) (P = 0.75), respectively. CONCLUSIONS A cluster pattern of hypermetabolic ipsilateral small axillary lymph nodes is common after mRNA COVID-19 vaccination, mainly after the second injection.
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Affiliation(s)
| | - Miriam Priss
- From the Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva
| | - Tamer Anati
- From the Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva
| | - Olga Turko
- From the Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva
| | - Miguel Gorenberg
- Department of Nuclear Medicine, Bnai Zion Medical Center and Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
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16
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Husseini JS, Amorim BJ, Torrado-Carvajal A, Prabhu V, Groshar D, Umutlu L, Herrmann K, Cañamaque LG, Garzón JRG, Palmer WE, Heidari P, Shih TTF, Sosna J, Matushita C, Cerci J, Queiroz M, Muglia VF, Nogueira-Barbosa MH, Borra RJH, Kwee TC, Glaudemans AWJM, Evangelista L, Salvatore M, Cuocolo A, Soricelli A, Herold C, Laghi A, Mayerhoefer M, Mahmood U, Catana C, Daldrup-Link HE, Rosen B, Catalano OA. An international expert opinion statement on the utility of PET/MR for imaging of skeletal metastases. Eur J Nucl Med Mol Imaging 2021; 48:1522-1537. [PMID: 33619599 PMCID: PMC8240455 DOI: 10.1007/s00259-021-05198-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/10/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND MR is an important imaging modality for evaluating musculoskeletal malignancies owing to its high soft tissue contrast and its ability to acquire multiparametric information. PET provides quantitative molecular and physiologic information and is a critical tool in the diagnosis and staging of several malignancies. PET/MR, which can take advantage of its constituent modalities, is uniquely suited for evaluating skeletal metastases. We reviewed the current evidence of PET/MR in assessing for skeletal metastases and provided recommendations for its use. METHODS We searched for the peer reviewed literature related to the usage of PET/MR in the settings of osseous metastases. In addition, expert opinions, practices, and protocols of major research institutions performing research on PET/MR of skeletal metastases were considered. RESULTS Peer-reviewed published literature was included. Nuclear medicine and radiology experts, including those from 13 major PET/MR centers, shared the gained expertise on PET/MR use for evaluating skeletal metastases and contributed to a consensus expert opinion statement. [18F]-FDG and non [18F]-FDG PET/MR may provide key advantages over PET/CT in the evaluation for osseous metastases in several primary malignancies. CONCLUSION PET/MR should be considered for staging of malignancies where there is a high likelihood of osseous metastatic disease based on the characteristics of the primary malignancy, hight clinical suspicious and in case, where the presence of osseous metastases will have an impact on patient management. Appropriate choice of tumor-specific radiopharmaceuticals, as well as stringent adherence to PET and MR protocols, should be employed.
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Affiliation(s)
- Jad S Husseini
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Bárbara Juarez Amorim
- Division of Nuclear Medicine, Department of Radiology, School of Medical Sciences,, State University of Campinas, Campinas, Brazil
| | - Angel Torrado-Carvajal
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Medical Image Analysis and Biometry Laboratory, Universidad Rey Juan Carlos, Madrid, Spain
| | - Vinay Prabhu
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Lina García Cañamaque
- Department of Nuclear Medicine, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | | | - William E Palmer
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Pedram Heidari
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Tiffany Ting-Fang Shih
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Cristina Matushita
- Department of Nuclear Medicine, Hospital São Lucas of Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliano Cerci
- Department of Nuclear Medicine, Quanta Diagnóstico Nuclear, Curitiba, Brazil
| | - Marcelo Queiroz
- Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valdair Francisco Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, Hospital Clinicas, University of São Paulo, Ribeirão Prêto, Brazil
| | - Marcello H Nogueira-Barbosa
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School. University of São Paulo (USP), Ribeirão Prêto, Brazil
| | - Ronald J H Borra
- Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura Evangelista
- Department of Clinical and Experimental Medicine, University of Padova, Padua, Italy
| | - Marco Salvatore
- Department of Radiology and Nuclear Medicine, Università Suor Orsola Benincasa di Napoli, Naples, Italy
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
| | - Alberto Cuocolo
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Andrea Soricelli
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
- Department of Movement and Wellness Sciences, Parthenope University of Naples, Naples, Italy
| | - Christian Herold
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Andrea Laghi
- Department of Radiology, University of Rome "La Sapienza", Rome, Italy
| | - Marius Mayerhoefer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ciprian Catana
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Bruce Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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17
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Gorenberg M, Agbarya A, Groshar D, Volovik I, Avitan O, Sukhotnik I. Novel nanotech antioxidant cocktail prevents medical diagnostic procedures ionizing radiation effects. Sci Rep 2021; 11:5315. [PMID: 33674660 PMCID: PMC7935885 DOI: 10.1038/s41598-021-84596-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)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/11/2021] [Indexed: 11/15/2022] Open
Abstract
Ionizing radiation (IR) exposure results in oxidative damage causing cytotoxic and genotoxic effects. Double-strand breaks (DSBs) are considered the most significant DNA lesions induced by ionizing radiation. The present study evaluates the radio protective effect of a novel antioxidant cocktail through quantification of DSB in peripheral blood lymphocytes (PBL) in vivo. The study included 16 consecutive patients who were divided into 2 groups, 6 patients received the novel antioxidant cocktail and 10 control patients. Blood samples were drawn from the patients undergoing bone scan, before the injection of the 99mTc MDP tracer and 2 h after the injection. Quantification of the IR damage was done by Immunofluorescence analysis of the phosphorylated histone, γ-H2AX, used to monitor DSB induction and repair in PBL. The radiation effect of the control group was measured by 2 variables, the average DBSs foci per nucleus and the percent of the DSB bearing cells in PBL. The findings showed a significant increase in the DSBs after isotope injection with an average increment of 0.29 ± 0.13 of foci/nucleus and 17.07% ± 7.68 more DSB bearing cells (p < 0.05). The cocktail treated group showed a lower difference average of − 2.79% ± 6.13 DSB bearing cells. A paired t-test revealed a significant difference between the groups (p < 0.005) confirming the cocktail’s protective effect. The novel anti-oxidant treatment decreases the oxidative stress-induced DNA damage and can be considered as a preventative treatment before radiation exposure.
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Affiliation(s)
- Miguel Gorenberg
- Department of Nuclear Medicine, Bnai-Zion Medical Center, Golomb 47, P.O.B 4940, Haifa, Israel. .,Technion-Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel.
| | - Abed Agbarya
- Oncology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - David Groshar
- Department of Nuclear Medicine, Belinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Ilya Volovik
- Medical Imaging Department, Bnai-Zion Medical Center, Haifa, Israel
| | - Ofir Avitan
- Urology Department, Bnai-Zion Medical Center, Haifa, Israel
| | - Igor Sukhotnik
- Department of Pediatric Surgery, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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18
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Ward RD, Amorim B, Li W, King J, Umutlu L, Groshar D, Harisinghani M, Catalano O. Abdominal and pelvic 18F-FDG PET/MR: a review of current and emerging oncologic applications. Abdom Radiol (NY) 2021; 46:1236-1248. [PMID: 32949272 DOI: 10.1007/s00261-020-02766-2] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022]
Abstract
Positron emission tomography (PET) using fluorodeoxyglucose (18F-FDG) combined with magnetic resonance imaging (MR) is an emerging hybrid modality that has shown utility in evaluating abdominal and pelvic disease entities. Together, the high soft tissue contrast and metabolic/functional imaging capabilities make this modality ideal for oncologic imaging in many organ systems. Its clinical utility continues to evolve and future research will help solidify its role in oncologic imaging. In this manuscript, we aim to (1) provide an overview of the various PET/MR systems, describing the strengths and weaknesses of each system, and (2) review the oncologic applications for 18F-FDG PET/MR in the abdomen and pelvis.
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Affiliation(s)
- Ryan D Ward
- Cleveland Clinic, Department of Abdominal Imaging, 9500 Euclid Ave, L10, Cleveland, OH, 44195, USA
| | - Barbara Amorim
- Division of Nuclear Medicine, University of Campinas, Rua Vital Brasil 251, Campinas, Brazil
| | - Weier Li
- Department of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Joseph King
- Department of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - David Groshar
- Assuta Medical Center, Habrzel 20, 6971028, Tel-Aviv, Israel
- Sackler School of Medicine, Tel-Aviv, Israel
| | - Mukesh Harisinghani
- Department of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Onofrio Catalano
- Department of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
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19
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Suarez-Weiss KE, Herold A, Gervais D, Palmer E, Amorim B, King JD, Weier L, Shahein T, Bernstine H, Domachevsk L, Cañamaque LG, Herrmann K, Umutlu L, Groshar D, Catalano OA. Hybrid imaging of the abdomen and pelvis. Radiologe 2021; 60:80-89. [PMID: 32424463 DOI: 10.1007/s00117-020-00661-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Accurate imaging is crucial for lesion detection in abdominal organs, for the noninvasive characterization of focal and diffuse abnormalities, and for surgical planning. To accomplish these tasks, several imaging modalities such as multidetector computer tomography (MDCT), magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) are used for abdominal imaging, providing important morphological, functional or metabolic information. More recently, PET/MRI has been gaining attention due to the possibility of combining high-resolution imaging with metabolic imaging. PET/MRI is a novel hybrid imaging technology that in the near future might play a pivotal role in the clinical management of oncologic and inflammatory abdominopelvic diseases. Despite the still limited number of published clinical studies, PET/MRI has been proven to be at least equivalent to PET/CT and to standalone MRI in a variety of oncologic disease. Moreover, in selected and focused clinical studies, it has been proven to outperform current standard of care imaging, for example, in evaluating cholangiocarcinomas, liver metastases, untreated and treated rectal cancer. This has also had an impact on therapeuticmanagement in some studies. Therefore in some institutions, including those of the authors, PET/MRI is becoming the new standard imaging modality in staging treatment-naïve intrahepatic massforming cholangiocarcinomas and prior to complicated hepatic surgery.
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Affiliation(s)
| | | | - Debra Gervais
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Edwin Palmer
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Joseph D King
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Li Weier
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Tajmir Shahein
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | | | | | - Onofrio A Catalano
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA.
- University of Naples Parthenope, Naples, Italy.
- Harvard Medical School, Massachusetts General Hospital, 55 Fruits St, Boston, MA, USA.
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20
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Biondetti P, Vangel MG, Lahoud RM, Furtado FS, Rosen BR, Groshar D, Canamaque LG, Umutlu L, Zhang EW, Mahmood U, Digumarthy SR, Shepard JAO, Catalano OA. PET/MRI assessment of lung nodules in primary abdominal malignancies: sensitivity and outcome analysis. Eur J Nucl Med Mol Imaging 2021; 48:1976-1986. [PMID: 33415433 DOI: 10.1007/s00259-020-05113-1] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/08/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate PET/MR lung nodule detection compared to PET/CT or CT, to determine growth of nodules missed by PET/MR, and to investigate the impact of missed nodules on clinical management in primary abdominal malignancies. METHODS This retrospective IRB-approved study included [18F]-FDG PET/MR in 126 patients. All had standard of care chest imaging (SCI) with diagnostic chest CT or PET/CT within 6 weeks of PET/MR that served as standard of reference. Two radiologists assessed lung nodules (size, location, consistency, position, and [18F]-FDG avidity) on SCI and PET/MR. A side-by-side analysis of nodules on SCI and PET/MR was performed. The nodules missed on PET/MR were assessed on follow-up SCI to ascertain their growth (≥ 2 mm); their impact on management was also investigated. RESULTS A total of 505 nodules (mean 4 mm, range 1-23 mm) were detected by SCI in 89/126 patients (66M:60F, mean age 60 years). PET/MR detected 61 nodules for a sensitivity of 28.1% for patient and 12.1% for nodule, with higher sensitivity for > 7 mm nodules (< 30% and > 70% respectively, p < 0.05). 75/337 (22.3%) of the nodules missed on PET/MR (follow-up mean 736 days) demonstrated growth. In patients positive for nodules at SCI and negative at PET/MR, missed nodules did not influence patients' management. CONCLUSIONS Sensitivity of lung nodule detection on PET/MR is affected by nodule size and is lower than SCI. 22.3% of missed nodules increased on follow-up likely representing metastases. Although this did not impact clinical management in study group with primary abdominal malignancy, largely composed of extra-thoracic advanced stage cancers, with possible different implications in patients without extra-thoracic spread.
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Affiliation(s)
- Pierpaolo Biondetti
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Mark G Vangel
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, 60 Staniford St, Boston, MA, USA
| | - Rita M Lahoud
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Bruce R Rosen
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.,Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lina G Canamaque
- Department of Nuclear Medicine. Grupo HM Hospitales, Madrid, Spain
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Eric W Zhang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.,Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Subba R Digumarthy
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Jo-Anne O Shepard
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA. .,Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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21
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Golan S, Aviv T, Groshar D, Yakimov M, Zohar Y, Prokocimer Y, Nadu A, Baniel J, Domachevsky L, Bernstine H. Dynamic 68Ga-PSMA-11 PET/CT for the Primary Evaluation of Localized Renal Mass: A Prospective Study. J Nucl Med 2020; 62:773-778. [PMID: 33097628 DOI: 10.2967/jnumed.120.251272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/10/2020] [Accepted: 09/23/2020] [Indexed: 01/29/2023] Open
Abstract
The potential role of prostate-specific membrane antigen (PSMA) PET/CT in non-prostate cancer tumors has shown promising results. We examined the performance of dynamic 68Ga-PSMA-11 PET/CT (DPSMA) for the evaluation of localized renal mass. Methods: A prospective case series of patients with a newly diagnosed renal mass who were referred for surgery was examined. DPSMA was performed in a standardized manner before surgery. The final surgical histology served as the standard of reference. PSMA expression in the tumor vasculature was assessed and staining intensity was scored. Tracer uptake and PSMA expression were compared between benign and malignant tissue. Results: Of 29 enhancing renal masses evaluated in 27 patients, 24 (83%) were malignant lesions. The median SUVmean of benign and malignant lesions was 2.3 (interquartile range [IQR], 2.2-2.7) and 6.8 (IQR, 4.2-10.1), respectively (P = 0.009). Median SUVmax of benign and malignant lesions was 3.8 (IQR, 3.3-4.5) and 9.4 (IQR, 5.4-15.8), respectively (P = 0.015). The median washout coefficient (K 2) was significantly lower in malignant lesions than in benign lesions (0.17 vs. 0.70, P = 0.02). Positive PSMA staining was found in 20 of 24 malignant lesions and in 2 of 5 benign lesions (P = 0.04). Conclusion: This pilot study demonstrated DPSMA uptake and kinetics in localized renal masses. Increased 68Ga-PSMA-11 tracer uptake and intratumoral retention correlate with PSMA expression in malignant renal tumors compared with benign renal masses, supporting further assessment of DPSMA as a potential tool for evaluating localized renal masses.
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Affiliation(s)
- Shay Golan
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzach Aviv
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Groshar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine Rabin Medical Center, Petach Tikva, Israel
| | - Maxim Yakimov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pathology, Rabin Medical Center, Petach Tikva, Israel
| | - Yaniv Zohar
- Department of Pathology, Rambam Health Care Campus, Haifa, Israel; and
| | - Yoad Prokocimer
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Andrei Nadu
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jack Baniel
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Hanna Bernstine
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine Rabin Medical Center, Petach Tikva, Israel
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22
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Catalano OA, Lee SI, Parente C, Cauley C, Furtado FS, Striar R, Soricelli A, Salvatore M, Li Y, Umutlu L, Cañamaque LG, Groshar D, Mahmood U, Blaszkowsky LS, Ryan DP, Clark JW, Wo J, Hong TS, Kunitake H, Bordeianou L, Berger D, Ricciardi R, Rosen B. Improving staging of rectal cancer in the pelvis: the role of PET/MRI. Eur J Nucl Med Mol Imaging 2020; 48:1235-1245. [PMID: 33034673 DOI: 10.1007/s00259-020-05036-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 08/03/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The role of positron emission tomography/magnetic resonance (PET/MR) in evaluating the local extent of rectal cancer remains uncertain. This study aimed to investigate the possible role of PET/MR versus magnetic resonance (MR) in clinically staging rectal cancer. METHODS This retrospective two-center cohort study of 62 patients with untreated rectal cancer investigated the possible role of baseline staging PET/MR versus stand-alone MR in determination of clinical stage. Two readers reviewed T and N stage, mesorectal fascia involvement, tumor length, distance from the anal verge, sphincter involvement, and extramural vascular invasion (EMVI). Sigmoidoscopy, digital rectal examination, and follow-up imaging, along with surgery when available, served as the reference standard. RESULTS PET/MR outperformed MR in evaluating tumor size (42.5 ± 21.03 mm per the reference standard, 54 ± 20.45 mm by stand-alone MR, and 44 ± 20 mm by PET/MR, P = 0.004), and in identifying N status (correct by MR in 36/62 patients [58%] and by PET/MR in 49/62 cases [79%]; P = 0.02) and external sphincter infiltration (correct by MR in 6/10 and by PET/MR in 9/10; P = 0.003). No statistically significant differences were observed in relation to any other features. CONCLUSION PET/MR provides a more precise assessment of the local extent of rectal cancers in evaluating cancer length, N status, and external sphincter involvement. PET/MR offers the opportunity to improve clinical decision-making, especially when evaluating low rectal tumors with possible external sphincter involvement.
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Affiliation(s)
- Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA. .,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA. .,Department of Radiology, University of Naples "Parthenope", Naples, Italy.
| | - Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA
| | | | - Christy Cauley
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Robin Striar
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Andrea Soricelli
- Department of Radiology, University of Naples "Parthenope", Naples, Italy.,SDN IRCCS, Naples, Italy
| | - Marco Salvatore
- SDN IRCCS, Naples, Italy.,University of Naples Suor Orsola Benincasa, Napoli, NA, Italy
| | - Yan Li
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | | | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Lawrence S Blaszkowsky
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Vernon Cancer Center, Newton-Wellesley Hospital, 2014 Washington Street, Newton, MA, 02462, USA
| | - David P Ryan
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey W Clark
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jennifer Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Hiroko Kunitake
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Liliana Bordeianou
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - David Berger
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Rocco Ricciardi
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Bruce Rosen
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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23
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Icht O, Domachevsky L, Groshar D, Dudnik E, Rotem O, Allen AM, Peled N, Reinhorn D, Jacobi O, Shochat T, Bernstine H, Zer A. Lower tumor volume is associated with increased benefit from immune checkpoint inhibitors in patients with advanced non-small-cell lung cancer. Asia Pac J Clin Oncol 2020; 17:e125-e131. [PMID: 32762128 DOI: 10.1111/ajco.13360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/10/2019] [Accepted: 04/14/2020] [Indexed: 12/13/2022]
Abstract
AIM Immune checkpoint inhibitors (ICIs) have revolutionized the treatment for advanced non-small-cell lung cancer (NSCLC), yet many patients do not benefit from Programmed cell death protein 1 (PD-1) axis inhibitors, emphasizing the need for additional markers for better patient selection. Our aim was to evaluate the association between tumor volume and response to ICI. METHODS This retrospective ethically-approved study included all consecutive patients with advanced NSCLC who were evaluated with a fluorodeoxyglucose-positron emission tomography scan, prior to the first administration of a single-agent ICI between 1/2016 and 6/2017. Tumor burden was calculated based on total body metabolic tumor volume and sum of all measurable lesions (SOML). RESULTS Median SOML was 88 mm, and was inversely and significantly associated with progression-free survival (PFS) (hazard ratio [HR] 2, CI 1.28-3.37, P = .003) and overall survival (OS) (HR 2.36, CI 1.13-4.94, P = .02). SOML≤80 mm had a significantly longer PFS compared to patients with a SOML≥80 mm (median PFS 9.7 vs 3.7 months, respectively, HR for progression 2.26, CI 1.1-4.5, P = .02). Patients with a SOML≤80 also had longer median OS compared to patients with SOML≥80 (median OS 12 vs 9.8 months, respectively, HR for death 3.1, CI 1.2-8, P = .018). CONCLUSIONS Low tumor burden was associated with higher response rates (RR), and better PFS and OS in advanced NSCLC patients treated with ICI. These results may improve the selection of patients for treatment with single-agent ICI, as opposed to the combination with chemotherapy, which might be more appropriate for patients with high tumor burden. Prospective analysis is warranted.
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Affiliation(s)
- Oded Icht
- Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Groshar
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elizabeth Dudnik
- Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Rotem
- Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aaron M Allen
- Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Peled
- Soroka Cancer Institute, Soroka Medical Center, affiliated to Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniel Reinhorn
- Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Jacobi
- Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzippy Shochat
- Statistical Consulting Unit, Rabin Medical Center, affiliated to the Sackler Faculty of Medicine, Petah Tikva, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alona Zer
- Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Nissan N, Sandler I, Eifer M, Eshet Y, Davidson T, Bernstine H, Groshar D, Sklair-Levy M, Domachevsky L. Physiologic and hypermetabolic breast 18-F FDG uptake on PET/CT during lactation. Eur Radiol 2020; 31:163-170. [PMID: 32749586 DOI: 10.1007/s00330-020-07081-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/10/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the patterns of breast cancer-related and lactation-related 18F-FDG uptake in breasts of lactating patients with pregnancy-associated breast cancer (PABC) and without breast cancer. METHODS 18F-FDG-PET/CT datasets of 16 lactating patients with PABC and 16 non-breast cancer lactating patients (controls) were retrospectively evaluated. Uptake was assessed in the tumor and non-affected lactating tissue of the PABC group, and in healthy lactating breasts of the control group, using maximum and mean standardized uptake values (SUVmax and SUVmean, respectively), and breast-SUVmax/liver-SUVmean ratio. Statistical tests were used to evaluate differences and correlations between the groups. RESULTS Physiological uptake in non-breast cancer lactating patients' breasts was characteristically high regardless of active malignancy status other than breast cancer (SUVmax = 5.0 ± 1.7, n = 32 breasts). Uptake correlated highly between the two breasts (r = 0.61, p = 0.01), but was not correlated with age or lactation duration (p = 0.24 and p = 0.61, respectively). Among PABC patients, the tumors demonstrated high 18F-FDG uptake (SUVmax = 7.8 ± 7.2, n = 16), which was 326-643% higher than the mostly low physiological FDG uptake observed in the non-affected lactating parenchyma of these patients (SUVmax = 2.1 ± 1.1). Overall, 18F-FDG uptake in lactating breasts of PABC patients was significantly decreased by 59% (p < 0.0001) compared with that of lactating controls without breast cancer. CONCLUSION 18F-FDG uptake in lactating tissue of PABC patients is markedly lower compared with the characteristically high physiological uptake among lactating patients without breast cancer. Consequently, breast tumors visualized by 18F-FDG uptake in PET/CT were comfortably depicted on top of the background 18F-FDG uptake in lactating tissue of PABC patients. KEY POINTS • FDG uptake in the breast is characteristically high among lactating patients regardless of the presence of an active malignancy other than breast cancer. • FDG uptake in non-affected lactating breast tissue is significantly lower among PABC patients compared with that in lactating women who do not have breast cancer. • In pregnancy-associated breast cancer patients, 18F-FDG uptake is markedly increased in the breast tumor compared with uptake in the non-affected lactating tissue, enabling its prompt visualization on PET/CT.
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Affiliation(s)
- Noam Nissan
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel Hashomer, 5265601, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Israel Sandler
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel Hashomer, 5265601, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Eifer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Eshet
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Tima Davidson
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Hanna Bernstine
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, Israel
| | - David Groshar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, Israel
| | - Miri Sklair-Levy
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel Hashomer, 5265601, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
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25
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Amorim BJ, Torrado-Carvajal A, Esfahani SA, Marcos SS, Vangel M, Stein D, Groshar D, Catalano OA. PET/MRI Radiomics in Rectal Cancer: a Pilot Study on the Correlation Between PET- and MRI-Derived Image Features with a Clinical Interpretation. Mol Imaging Biol 2020; 22:1438-1445. [PMID: 32270337 DOI: 10.1007/s11307-020-01484-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/16/2022]
Abstract
PURPOSE The aim of this study was to explore possible correlations among different imaging features from 2-deoxy-2-[18F]fluoro-D-Glucose positron emission tomography/magnetic resonance imaging (PET/MRI) in rectal cancer (RC). PROCEDURES RC patients who underwent PET/MRI were enrolled. A region of interest (ROI) was drawn around each primary RC on PET/MRI images (PET, pelvic axial T2w, and apparent diffusion coefficient maps (ADC)). Multiple imaging features were assessed, and Pearson's correlation was used to explore possible correlations among them. RESULTS A total of 13 patients were included, mean age 56.1 years old, 6 females. A strong inverse correlation was observed between SUVpeak and ADCmean values, MTV and T2 sphericity, MTV and ADC sphericity, MTV and T2 entropy, and TLG and ADC sphericity. There was also strong direct correlation between PET entropy and ADC sphericity. CONCLUSIONS In conclusion, several clinically relevant correlations were observed between PET and MRI imaging features. These findings show how the use of both modalities provides complementary information.
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Affiliation(s)
- Barbara Juarez Amorim
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.,Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Division of Nuclear Medicine, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Angel Torrado-Carvajal
- Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Medical Image Analysis and Biometry Laboratory, Universidad Rey Juan Carlos, Madrid, Spain
| | - Shadi A Esfahani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Sara S Marcos
- Division of Nuclear Medicine, Puerta de Hierro, University Hospital, Madrid, Spain
| | - Mark Vangel
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.,Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Dan Stein
- Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA. .,Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. .,Department of Radiology, University of Naples "Parthenope", Naples, Italy.
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26
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Suarez-Weiss KE, Herold A, Gervais D, Palmer E, Amorim B, King JD, Weier L, Shahein T, Bernstine H, Domachevsk L, Cañamaque LG, Umutlu L, Herrmann K, Groshar D, Catalano OA. [Hybrid imaging of the abdomen and pelvis. German version]. Radiologe 2020; 60:394-404. [PMID: 32232543 DOI: 10.1007/s00117-020-00660-y] [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: 11/28/2022]
Abstract
Accurate imaging is crucial for lesion detection in abdominal organs, for the noninvasive characterization of focal and diffuse abnormalities, and for surgical planning. To accomplish these tasks, several imaging modalities such as multidetector computer tomography (MDCT), magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) are used for abdominal imaging, providing important morphological, functional or metabolic information. More recently, PET/MRI has been gaining attention due to the possibility of combining high-resolution imaging with metabolic imaging. PET/MRI is a novel hybrid imaging technology that in the near future might play a pivotal role in the clinical management of oncologic and inflammatory abdominopelvic diseases. Despite the still limited number of published clinical studies, PET/MRI has been proven to be at least equivalent to PET/CT and to stand-alone MRI in a variety of oncologic disease. Moreover, in selected and focused clinical studies, it has been proven to outperform current standard of care imaging, for example, in evaluating cholangiocarcinomas, liver metastases, untreated and treated rectal cancer. This has also had an impact on therapeutic management in some studies. Therefore in some institutions, including those of the authors, PET/MRI is becoming the new standard imaging modality in staging treatment-naïve intrahepatic mass-forming cholangiocarcinomas and prior to complicated hepatic surgery.
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Affiliation(s)
- Krista Elise Suarez-Weiss
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | | | - Debra Gervais
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | - Edwin Palmer
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | | | - Joseph D King
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | - Li Weier
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | - Tajmir Shahein
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | | | | | | | | | | | | | - Onofrio A Catalano
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA. .,University of Naples Parthenope, Neapel, Italien.
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27
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Mazor RD, Weissman R, Luckman J, Domachevsky L, Diamond EL, Abdel-Wahab O, Shapira S, Hershkovitz-Rokah O, Groshar D, Shpilberg O. Dual BRAF/MEK blockade restores CNS responses in BRAF-mutant Erdheim-Chester disease patients following BRAF inhibitor monotherapy. Neurooncol Adv 2020; 2:vdaa024. [PMID: 32642685 PMCID: PMC7212923 DOI: 10.1093/noajnl/vdaa024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 12/14/2022] Open
Abstract
Background Erdheim–Chester disease (ECD), a rare inflammatory myeloid neoplasm, is known to be fundamentally reliant on the constitutive activation of the MAPK signaling pathway in the majority of patients. Consequently, inhibition of the V600E-mutant BRAF kinase has proven to be a safe and efficacious long-term therapeutic strategy for BRAF-mutant ECD patients. Nevertheless, in a subset of patients with CNS disease, the efficacy of long-term treatment may diminish, facilitating suboptimal responses or disease progression. Methods We retrospectively describe 3 BRAF-mutant ECD patients whose treatment with Vemurafenib was upgraded to Vemurafenib/Cobimetinib due to either disease progression, insufficient response, or unacceptable toxicity. CNS response to therapy was evaluated using magnetic resonance imaging (MRI) and extra-cranial disease was monitored using 18F-fludeoxyglucose positron emission tomography/computed tomography (PET/CT). Results Three patients with a mean age of 52.6 years were treated with Vemurafenib for a mean duration of 26.6 months (range: 6–52). Monotherapies were upgraded to Vemurafenib/Cobimetinib dual therapy. The combination therapy was administered for a mean duration of 21 months (range: 19–23). All patients exhibited clinical and neurological improvement. Regression of lesions on MRI was noted in 2 patients. Both patients characterized by a PET-avid disease responded to the biological treatment regimen with complete metabolic remissions. Conclusion Dual inhibition of BRAF and downstream MEK may be a safe and effective therapeutic strategy for BRAF-mutant ECD patients for whom BRAF inhibitor therapy proved insufficient and as such appropriate for the long-term management of CNS disease in ECD.
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Affiliation(s)
- Roei D Mazor
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel
| | - Ran Weissman
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel.,Department of Molecular Biology, Faculty of Natural Sciences, Ariel University, Ariel, Israel.,Translational Research Lab, Assuta Medical Centers, Tel-Aviv, Israel
| | - Judith Luckman
- Department of Imaging, Assuta Medical Center, Tel Aviv, Israel
| | - Liran Domachevsky
- Department of Imaging, Assuta Medical Center, Tel Aviv, Israel.,Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Omar Abdel-Wahab
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Shirley Shapira
- Institute of Hematology, Meir Hospital, Kfar Saba, Israel.,Maccabi Health Services, Tel Aviv, Israel
| | - Oshrat Hershkovitz-Rokah
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel.,Department of Molecular Biology, Faculty of Natural Sciences, Ariel University, Ariel, Israel.,Translational Research Lab, Assuta Medical Centers, Tel-Aviv, Israel
| | - David Groshar
- Department of Imaging, Assuta Medical Center, Tel Aviv, Israel.,Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel
| | - Ofer Shpilberg
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel.,Translational Research Lab, Assuta Medical Centers, Tel-Aviv, Israel.,Pre-Medicine Department, School of Health Sciences, Ariel University, Ariel, Israel
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28
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Domachevsky L, Goldberg N, Gorenberg M, Bernstine H, Groshar D, Catalano OA. Prostate cancer evaluation using PET quantification in 68Ga-PSMA-11 PET/MR with attenuation correction of bones as a fifth compartment. Quant Imaging Med Surg 2020; 10:40-47. [PMID: 31956527 DOI: 10.21037/qims.2019.11.19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/06/2022]
Abstract
Background Tissues with low magnetic resonance (MR) signals, such as bones and lungs differ considerably in their attenuation properties, requiring special considerations for attenuation correction. We evaluated the impact of using the five-compartment segmentation model, which incorporates bones, in 68Ga-PSMA-11 PET/MR studies in patients undergoing evaluation for prostate cancer. Methods Prostate cancer patients underwent dedicated prostate 68Ga-PSMA-11 PET/MR followed by whole-body 68Ga-PSMA-11 PET/CT. Coronal µmap images of the pelvis derived from four- and five-compartment segmentation models of magnetic resonance attenuation correction (MRAC) were produced. Standardized uptake values (SUV) calculated by the four and five-compartment MRAC models and by computed tomography attenuation correction (CTAC) were compared and correlated in normal prostate tissue, gluteus muscle, sacrum, intra-prostatic lesions and metastases (i.e., bone lesions and involved lymph nodes), and prostatic lesions to gluteus (L/G) ratio. Results Twenty-six patients (mean age 69.4±9.3 years) were included in the study. Twenty-five patients presented for prostate cancer staging and one patient was evaluated for recurrent disease. There was a statistically significant difference between SUVs of the gluteus, sacrum, prostatic lesions and normal prostate tissue measured by the four-compartment vs. the five-compartment MRAC models, with a medium effect size. Very good to good correlation between SUV measured using the four-compartment MRAC model and SUV measured using the five-compartment model were noted in all lesional and non-lesional areas. Very good to good correlation was noted between four-compartment MRAC and CTAC SUVs of prostatic lesions and L/G ratio and between five-compartment MRAC and CTAC SUVs of prostatic lesions, L/G ratio and metastatic lesions. Conclusions 68Ga-PSMA-11 PET/MR using the five-compartment segmentation model affects SUV measurements in prostate lesions and in the normal prostate and therefore patient follow-up studies must be conducted using the same segmentation model.
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Affiliation(s)
- Liran Domachevsky
- Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv 6971028, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Natalia Goldberg
- Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv 6971028, Israel
| | - Miguel Gorenberg
- Department of Nuclear Medicine, Bnai Zion Medical Center and Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa 3339419, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv 6971028, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv 6971028, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Onofrio A Catalano
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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29
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Ferrone C, Goyal L, Qadan M, Gervais D, Sahani DV, Zhu AX, Hong TS, Blaszkowsky LS, Tanabe KK, Vangel M, Amorim BJ, Wo JY, Mahmood U, Pandharipande PV, Catana C, Duenas VP, Collazo YQ, Canamaque LG, Domachevsky L, Bernstine HH, Groshar D, Shih TTF, Li Y, Herrmann K, Umutlu L, Rosen BR, Catalano OA. Management implications of fluorodeoxyglucose positron emission tomography/magnetic resonance in untreated intrahepatic cholangiocarcinoma. Eur J Nucl Med Mol Imaging 2019; 47:1871-1884. [PMID: 31705172 DOI: 10.1007/s00259-019-04558-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 06/14/2019] [Accepted: 09/25/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Intrahepatic cholangiocarcinoma (ICC) is associated with a poor prognosis with surgical resection offering the best chance for long-term survival and potential cure. However, in up to 36% of patients who undergo surgery, more extensive disease is found at time of operation requiring cancellation of surgery. PET/MR is a novel hybrid technology that might improve local and whole-body staging in ICC patients, potentially influencing clinical management. This study was aimed to investigate the possible management implications of PET/MR, relative to conventional imaging, in patients affected by untreated intrahepatic cholangiocarcinoma. METHODS Retrospective review of the clinicopathologic features of 37 patients with iCCC, who underwent PET/MR between September 2015 and August 2018, was performed to investigate the management implications that PET/MR had exerted on the affected patients, relative to conventional imaging. RESULTS Of the 37 patients enrolled, median age 63.5 years, 20 (54%) were female. The same day PET/CT was performed in 26 patients. All patients were iCCC-treatment-naïve. Conventional imaging obtained as part of routine clinical care demonstrated early-stage resectable disease for 15 patients and advanced stage disease beyond the scope of surgical resection for 22. PET/MR modified the clinical management of 11/37 (29.7%) patients: for 5 patients (13.5%), the operation was cancelled due to identification of additional disease, while 4 "inoperable" patients (10.8%) underwent an operation. An additional 2 patients (5.4%) had a significant change in their operative plan based on PET/MR. CONCLUSIONS When compared with standard imaging, PET/MR significantly influenced the treatment plan in 29.7% of patients with iCCC. TRIAL REGISTRATION 2018P001334.
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Affiliation(s)
- Cristina Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Lipika Goyal
- Department of Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Debra Gervais
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St., Boston, MA, 02114, USA
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St., Boston, MA, 02114, USA
| | - Andrew X Zhu
- Department of Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Lawrence S Blaszkowsky
- Department of Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA.,Department of Oncology, Newton-Wellesley Hospital, 2114 Washington St., Newton, MA, 02462, USA
| | - Kenneth K Tanabe
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Mark Vangel
- Department of Biostatics, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Barbara J Amorim
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St., Boston, MA, 02114, USA.,Division of Nuclear Medicine, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Jennifer Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St., Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th, Charlestown, MA, 02129, USA
| | - Pari V Pandharipande
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St., Boston, MA, 02114, USA
| | - Ciprian Catana
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th, Charlestown, MA, 02129, USA
| | - Virginia P Duenas
- Department of Nuclear Medicine and Radiology, Hospital HM Puerta del Sur, Avda Carlos V 70, 28938, Madrid, Spain
| | - Yolanda Q Collazo
- Department of Surgery, Hospital HM Sanchinarro, Avda Carlos V 70, 28938, Madrid, Spain
| | - Lina G Canamaque
- Department of Nuclear Medicine and Radiology, Hospital HM Puerta del Sur, Avda Carlos V 70, 28938, Madrid, Spain
| | - Liran Domachevsky
- Department of Radiology and Nuclear Medicine, Assuta Medical Center, HaBarzel St. 20, Tel Aviv-Yafo, Israel
| | - Hanna H Bernstine
- Department of Radiology and Nuclear Medicine, Assuta Medical Center, HaBarzel St. 20, Tel Aviv-Yafo, Israel
| | - David Groshar
- Department of Radiology and Nuclear Medicine, Assuta Medical Center, HaBarzel St. 20, Tel Aviv-Yafo, Israel
| | - Tiffany Tsing-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Rd., Taipei, 10016, Taiwan
| | - Yan Li
- Department of Radiology, Universitatsklinikum, Essen University, Hufelandstraße 55, 45147, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, Universitatsklinikum, Essen University, Hufelandstraße 55, 45147, Essen, Germany
| | - Lale Umutlu
- Department of Radiology, Universitatsklinikum, Essen University, Hufelandstraße 55, 45147, Essen, Germany
| | - Bruce R Rosen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th, Charlestown, MA, 02129, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St., Boston, MA, 02114, USA. .,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th, Charlestown, MA, 02129, USA. .,Department of Radiology, University of Naples "Parthenope", Via Acton 38, 80131, Naples, Italy.
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Amorim BJ, Hong TS, Blaszkowsky LS, Ferrone CR, Berger DL, Bordeianou LG, Ricciardi R, Clark JW, Ryan DP, Wo JY, Qadan M, Vangel M, Umutlu L, Groshar D, Cañamaques LG, Gervais DA, Mahmood U, Rosen BR, Catalano OA. Clinical impact of PET/MR in treated colorectal cancer patients. Eur J Nucl Med Mol Imaging 2019; 46:2260-2269. [PMID: 31359108 DOI: 10.1007/s00259-019-04449-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 04/29/2019] [Accepted: 07/16/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE The primary aim of the present study was to evaluate if PET/MR induced management changes versus standard of care imaging (SCI) in treated colorectal cancer patients. The secondary aim was to assess the staging performance of PET/MR and of SCI versus the final oncologic stage. METHODS Treated CRC patients who underwent PET/MR with 18F-FDG and SCI between January 2016 and October 2018 were enrolled in this retrospective study. Their medical records were evaluated to ascertain if PET/MR had impacted on their clinical management versus SCI. The final oncologic stage, as reported in the electronic medical record, was considered the true stage of disease. RESULTS A total of 39 patients who underwent 42 PET/MR studies were included, mean age 56.7 years (range 39-75 years), 26 males, and 13 females. PET/MR changed clinical management 15/42 times (35.7%, standard error ± 7.4%); these 15 changes in management were due to upstaging in 9/42 (21.5%) and downstaging in 6/42 (14.2%). The differences in management prompted by SCI versus PET/MR were statistically significant, and PET/MR outperformed SCI (P value < 0.001; odds ratio = 2.8). In relation to the secondary outcome, PET/MR outperformed the SCI in accuracy of oncologic staging (P value = 0.016; odds ratio = 4.6). CONCLUSIONS PET/MR is a promising imaging tool in the evaluation of treated CRC and might change the management in these patients. However, multicenter prospective studies with larger patient samples are required in order to confirm these preliminary results.
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Affiliation(s)
- Barbara J Amorim
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Nuclear Medicine, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lawrence S Blaszkowsky
- Department of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cristina R Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David L Berger
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Liliana G Bordeianou
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rocco Ricciardi
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey W Clark
- Department of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David P Ryan
- Department of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Vangel
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Debra A Gervais
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruce R Rosen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA. .,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Radiology, University of Naples "Parthenope", Naples, Italy.
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31
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Domachevsky L, Bernstine H, Goldberg N, Nidam M, Catalano OA, Groshar D. Comparison between pelvic PSMA-PET/MR and whole-body PSMA-PET/CT for the initial evaluation of prostate cancer: a proof of concept study. Eur Radiol 2019; 30:328-336. [PMID: 31332559 DOI: 10.1007/s00330-019-06353-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 01/07/2019] [Revised: 06/20/2019] [Accepted: 07/01/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Despite the advantages of prostate-specific membrane antigen (PSMA)-PET/MR over PSMA-PET/CT, its relatively long scanning time and suboptimal PET attenuation correction necessitate careful assessment of the most appropriate setting for this type of study. We assessed lesion agreement between PSMA-PET/MR and PSMA-PET/CT in patients undergoing initial evaluation of prostate cancer. METHODS This was a prospective study of consecutive patients with histological biopsy-proven prostate cancer who underwent pelvic PSMA-PET/MR followed by whole-body PSMA-PET/CT. All conspicuous PSMA-avid foci were counted on PSMA-PET/CT and PSMA-PET/MR with CT or MR correlation. Analysis was performed for intra-prostatic lesions, capsular invasion, seminal vesicle involvement and lymph node and bone involvement. Incidental and significant findings seen on PSMA-PET/CT outside the PSMA-PET/MR field of view were also analysed. Agreements between PSMA-PET/CT and PSMA-PET/MR findings were performed using Cohen's kappa test. RESULTS Image analysis was performed on 140 patients (mean age, 67.3 ± 8.2 years). Agreement between PSMA PET/CT and PSMA-PET/MR was very good for intra-prostatic PSMA-avid foci (K = 0.85) and pelvic lymph nodes (K = 0.98), good for PSMA-avid bone metastases (K = 0.76) and fair for prostatic capsular invasion (K = 0.25) and seminal vesicle involvement (K = 0.31). Twelve patients (8.5%) had incidental findings and two patients (1.4%) had clinically significant findings. CONCLUSION Limited pelvic PSMA-PET/MR has very good agreement with PET/CT regarding PSMA-avid prostatic, regional lymph nodes and bone lesions, and is superior to PET/CT with regard to capsular invasion and seminal vesicle involvement. KEY POINTS • Limited pelvic PSMA-PET/MR is superior to whole-body PSMA-PET/CT in detecting extensions of localised disease, mainly due to the high soft tissue resolution of MR. • Limited pelvic PSMA-PET/MR may be useful for initial evaluation of histological biopsy-proven prostate cancer. • Further studies are warranted to evaluate limited pelvic PSMA-PET/MR for screening and active surveillance in selected populations.
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Affiliation(s)
- Liran Domachevsky
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel Street, 6971028, Tel Aviv, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel Street, 6971028, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
| | - Natalia Goldberg
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel Street, 6971028, Tel Aviv, Israel
| | - Meital Nidam
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel Street, 6971028, Tel Aviv, Israel
| | - Onofrio A Catalano
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel Street, 6971028, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel.
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32
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Rubinstein E, Salhov M, Nidam-Leshem M, White V, Golan S, Baniel J, Bernstine H, Groshar D, Averbuch A. Unsupervised tumor detection in Dynamic PET/CT imaging of the prostate. Med Image Anal 2019; 55:27-40. [DOI: 10.1016/j.media.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 03/30/2019] [Accepted: 04/05/2019] [Indexed: 02/07/2023]
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33
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Vaxman I, Bernstine H, Kleinstern G, Hendin N, Shimony S, Domachevsky L, Gurion R, Groshar D, Raanani P, Gafter‐Gvili A. FDG PET/CT as a diagnostic and prognostic tool for the evaluation of marginal zone lymphoma. Hematol Oncol 2019; 37:168-175. [DOI: 10.1002/hon.2578] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/28/2019] [Accepted: 02/04/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Iuliana Vaxman
- Institute of HematologyDavidoff Cancer Center, Rabin Medical Center Petah‐Tikva Israel
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Hanna Bernstine
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
- Department of Nuclear MedicineRabin Medical Center Petah‐Tikva Israel
| | - Geffen Kleinstern
- Department of Health Sciences ResearchMayo Clinic Rochester Minnesota
| | - Natav Hendin
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Shai Shimony
- Institute of HematologyDavidoff Cancer Center, Rabin Medical Center Petah‐Tikva Israel
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Liran Domachevsky
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
- Department of Nuclear MedicineRabin Medical Center Petah‐Tikva Israel
| | - Ronit Gurion
- Institute of HematologyDavidoff Cancer Center, Rabin Medical Center Petah‐Tikva Israel
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - David Groshar
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
- Department of Nuclear MedicineRabin Medical Center Petah‐Tikva Israel
| | - Pia Raanani
- Institute of HematologyDavidoff Cancer Center, Rabin Medical Center Petah‐Tikva Israel
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Anat Gafter‐Gvili
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
- Medicine ARabin Medical Center Petah‐Tikva Israel
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34
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Khafif A, Masalha M, Landsberg R, Domachevsky L, Bernstine H, Groshar D, Azoulay O, Lockman Y. The role of F18-fluorocholine positron emission tomography/magnetic resonance imaging in localizing parathyroid adenomas. Eur Arch Otorhinolaryngol 2019; 276:1509-1516. [DOI: 10.1007/s00405-019-05301-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/16/2019] [Indexed: 11/30/2022]
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35
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Domachevsky L, Kashtan H, Brenner B, Nidam M, Morgenstern S, Kundel Y, Groshar D, Bernstine H. Baseline 18F-FDG PET/CT as predictor of the pathological response to neoadjuvant therapy in esophageal cancer: A retrospective study. Medicine (Baltimore) 2018; 97:e13412. [PMID: 30544419 PMCID: PMC6310504 DOI: 10.1097/md.0000000000013412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Indexed: 12/22/2022] Open
Abstract
The type of pathological response to neoadjuvant chemoradiation in patients with locally advanced esophageal cancer predicts overall survival (OS).We aimed to assess early 18F-FDG positron emission tomography/computed tomography parameters in predicting the pathological response to neoadjuvant treatment.The cohort included consecutive patients with locally advanced esophageal cancer who underwent baseline 18F-FDG positron emission tomography/computed tomography between September 2006 and February 2015. Positron emission tomography variables of maximum and average standardized uptake values (SUVmax, SUVaverage), metabolic tumor volume (MTV), and total lesion glycolysis were recorded in addition to computed tomography volume. MTV was calculated using cut-off values of 42%, 50% and 60% (MTV 0.42, 0.5, and 0.6) of the tumoral SUVmax. Receiver operating characteristic (ROC) analysis was used to determine sensitivity and specificity.Sixty-one patients (44 male, 17 female) fulfilled the inclusion criteria. Only MTV values of 13.6 mL (MTV 0.42) and 7.4 mL (MTV 0.5) remained significant on ROC analysis, with an area under the curve of 0.690 (confidence interval 0.557-0.823, p = .02] and 0.664 (confidence interval 0.527-0.802, P = .048), respectively in differentiating patients with a complete (n = 44) or incomplete (n = 17) pathological response.MTV at presentation is associated with the pathological response to neoadjuvant chemoradiation in patients with locally advanced esophageal cancer.
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Affiliation(s)
- Liran Domachevsky
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center, Beilinson Hospital
- Sackler Faculty of Medicine, Tel Aviv University
| | - Baruch Brenner
- Sackler Faculty of Medicine, Tel Aviv University
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital
| | - Meital Nidam
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital
| | - Sara Morgenstern
- Institute of Pathology, Rabin Medical Center, Beilinson Hospital, Petach Tikva
| | - Yulia Kundel
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital
| | - David Groshar
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital
- Sackler Faculty of Medicine, Tel Aviv University
- Assuta Medical Center, Tel Aviv, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital
- Sackler Faculty of Medicine, Tel Aviv University
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Shmuely H, Brenner B, Groshar D, Hadari N, Purim O, Nidam M, Eligalashvili M, Yahav J, Bernstine H. The Association of Helicobacter pylori Seropositivity and Colorectal Cancer. Isr Med Assoc J 2018; 20:726. [PMID: 30430810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Haim Shmuely
- Department of Internal Medicine D and Helicobacter Research Institute, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Groshar
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Hadari
- Dan District, Clalit Health Services, Or Yehuda, Israel
| | - Ofer Purim
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meital Nidam
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merab Eligalashvili
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Yahav
- Department of Internal Medicine D and Helicobacter Research Institute, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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37
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Moore A, Ulitsky O, Ben-Aharon I, Perl G, Kundel Y, Sarfaty M, Lewin R, Domachevsky L, Bernstine H, Groshar D, Wasserberg N, Kashtan H, Gordon N, Sulkes A, Brenner B. Early PET-CT in patients with pathological stage III colon cancer may improve their outcome: Results from a large retrospective study. Cancer Med 2018; 7:5470-5477. [PMID: 30350468 PMCID: PMC6246942 DOI: 10.1002/cam4.1818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/01/2018] [Revised: 09/13/2018] [Accepted: 09/15/2018] [Indexed: 12/11/2022] Open
Abstract
Background Current staging of pathological stage III colon cancer (CC) is suboptimal; many patients recur despite unremarkable preoperative staging. We previously reported that early postoperative PET‐CT can alter the stage and management of up to 15% of patients with high‐risk stage III CC. This study aimed to determine the role of the test in the general stage III CC population. Methods A retrospective study of all consecutive patients with stage III CC who underwent early postoperative PET‐CT between 2005 and 2017. Results A total of 342 patients, 166 (48.5%) males, median age 66 years (range, 29‐90), were included. Pathological stage was IIIA, IIIB, and IIIC in 18 (5.3%), 257 (75.1%), and 67 (19.6%) patients, respectively. Median number of positive lymph nodes was 2 (range, 0‐32). PET‐CT results modified the management of 46 patients (13.4%): 37 (10.8%) with overt metastatic disease and 9 (2.6%) with a second primary. The 5‐year disease‐free survival for true stage III patients was 81%. The median overall survival for the entire cohort and for true stage III patients was not reached and was 57.2 months for true stage IV. Of the 37 patients found to be metastatic, 14 (37.8%) underwent curative treatments and 9/14 (64.3%) remain disease‐free, with a median follow‐up of 83.8 months. Predictive factors for upstaging following PET‐CT were identified. Conclusion Early postoperative PET‐CT changed the staging and treatment of 13.4% of stage III CC patients and has the potential for early detection of curable metastatic disease. Outcome results are encouraging. Prospective validation is ongoing.
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Affiliation(s)
- Assaf Moore
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Olga Ulitsky
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel
| | - Irit Ben-Aharon
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gali Perl
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yulia Kundel
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Sarfaty
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Lewin
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Rabin Medical Center, Petach Tiqva, Israel
| | - Hanna Bernstine
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, Rabin Medical Center, Petach Tiqva, Israel
| | - David Groshar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, Rabin Medical Center, Petach Tiqva, Israel
| | - Nir Wasserberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Rabin Medical Center, Petach Tiqva, Israel
| | - Hanoch Kashtan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Rabin Medical Center, Petach Tiqva, Israel
| | - Noa Gordon
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel
| | - Aaron Sulkes
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Icht O, Domachevsky L, Groshar D, Dudnik E, Rotem O, Peled N, Reinhorn D, Jacobi O, Shochat T, Bernstine H, Zer A. P1.04-17 Tumour Burden as a Predictive Tool of Response to Immune Checkpoint Inhibitors (ICI) in Patients with Metastatic Non-Small-Cell Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.732] [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: 10/28/2022]
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Golan S, Nidam M, Bernstine H, Baniel J, Groshar D. Dynamic 11C-Choline PET / CT for the primary diagnosis of prostate cancer. Int Braz J Urol 2018; 44:900-905. [PMID: 30088719 PMCID: PMC6237539 DOI: 10.1590/s1677-5538.ibju.2018.0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/31/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To test the ability of dynamic 11C-PET / CT to discriminate cancerous tissue from background tissue in patients with localized prostate cancer. MATERIALS AND METHODS Twenty-four consecutive patients with prostate cancer were prospectively evaluated with dynamic 11C-choline PET / CT prior to radical prostatectomy. The PET / CT scan was divided into 18 sequences of 5 seconds each, followed by 9 sequences of 60 seconds each. Whole-mount sections of harvested prostates served as reference standards. Volumes of interest were positioned on the dynamic PET / CT images and the following quantitative variables were calculated: perfusion coefficient (K1), washout constant (K2), area under the curve (AUC) at 175 and 630 seconds, and average and maximum standardized uptake values (SUVavg, and SUVmax). Wilcoxon signed-ranks test was used to compare benign and cancerous areas of the prostate. RESULTS Areas of cancerous tissue were characterized by higher SUVavg and SUVmax than areas of benign tissue (3.67 ± 2.7 vs. 2.08 ± 1.3 and 5.91 ± 4.4 vs. 3.71 ± 3.7, respectively, P < 0.001), in addition to a higher K1 (0.95 ± 0.58 vs. 0.43 ± 0.24, P < 0.001) and greater cumulative tracer uptake, represented by the AUC at 175 and 630 seconds (P <0.001). No associations were found between dynamic parameters and preoperative prostate specific antigen level or Gleason score. CONCLUSIONS In this pilot study, 11C-choline PET / CT demonstrated increased tracer uptake with higher values of static and dynamic parameters in areas of prostate cancer compared to areas of benign tissue. Larger studies are warranted to validate these results and examine the potential applicability of 11C-choline dynamic PET / CT for the diagnosis of prostate cancer.
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Affiliation(s)
- Shay Golan
- Institute of Urology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Israel
| | - Meital Nidam
- Department of Nuclear Medicine, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Israel
| | - Jack Baniel
- Institute of Urology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Israel
| | - David Groshar
- Department of Nuclear Medicine, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Israel
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Shmuely H, Brenner B, Groshar D, Hadari N, Purim O, Nidam M, Eligalashvili M, Yahav J, Bernstine H. The Association of Helicobacter pylori Seropositivity with All-Cause Mortality among Colorectal Cancer Patients Undergoing PET/CT Scans. Isr Med Assoc J 2018; 20:504-508. [PMID: 30084577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Evidence has been emerging that Helicobacter pylori may also impact colorectal cancer (CRC). Positron emission tomography/computed tomography (PET/CT) imaging can predict overall survival in CRC patients. OBJECTIVES To determine a possible association between H. pylori seropositivity and all-cause mortality among CRC patients evaluated by PET/CT scans. METHODS This prospective cohort study was comprised of 110 consecutive CRC patients who had undergone a PET/CT evaluation in a tertiary academic medical center. Data included demographics, body mass index (BMI), tumor node metastasis stage at diagnosis, treatment, time from diagnosis to PET/CT, and PET/CT findings. All patients were tested for anti-H. pylori immunoglobulin G (IgG) antibodies and followed for 36 months from the day of the PET/CT scan. Mortality was documented. Univariate and multivariate Cox regression was used to estimate the hazard ratio (HR) of H. pylori serological status. RESULTS During the follow-up period, of the 110 CRC patients 41 (37.3%) died and 69 (62.7%) survived. Of the 41 patients, 26 (63.4%) were H. pylori seropositive and 15 (36.6%) were seronegative. Multivariate analysis showed that H. pylori seropositivity was associated with increased mortality (HR 3.46, 95% confidence interval 1.63-7.32), stage IV at diagnosis, metastatic disease found on PET/CT, longer time from diagnosis to PET/CT, lower BMI, and older age. CONCLUSIONS Our findings suggest that H. pylori infection may be a risk factor for all-cause mortality among CRC patients who are evaluated by PET/CT. Multicenter studies with larger patient groups are needed to confirm our findings.
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Affiliation(s)
- Haim Shmuely
- Department of Internal Medicine D and Helicobacter Research Institute, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Groshar
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Hadari
- Dan District, Clalit Health Services, Or Yehuda, Israel
| | - Ofer Purim
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meital Nidam
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merab Eligalashvili
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Yahav
- Department of Internal Medicine D and Helicobacter Research Institute, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Domachevsky L, Goldberg N, Bernstine H, Nidam M, Groshar D. Quantitative characterisation of clinically significant intra-prostatic cancer by prostate-specific membrane antigen (PSMA) expression and cell density on PSMA-11. Eur Radiol 2018; 28:5275-5283. [PMID: 29846803 DOI: 10.1007/s00330-018-5484-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 12/28/2017] [Revised: 03/26/2018] [Accepted: 04/12/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To quantitatively characterize clinically significant intra-prostatic cancer (IPC) by prostate-specific membrane antigen (PSMA) expression and cell density on PSMA-11 positron emission tomography/magnetic resonance (PET/MR). METHODS Retrospective study approved by the institutional review board with informed written consent obtained. Patients with a solitary, biopsy-proven prostate cancer, Gleason score (GS) ≥7, presenting for initial evaluation by PET/computerised tomography (PET/CT), underwent early prostate PET/MR immediately after PSMA-11 tracer injection. PET/MR [MRI-based attenuation correction (MRAC)] and PET/CT [CT-based AC (CTAC)] maximal standardised uptake value (SUVmax) and minimal and mean apparent diffusion coefficient (ADCmin, ADCmean; respectively) in normal prostatic tissue (NPT) were compared to IPC area. The relationship between SUVmax, ADCmin and ADCmean measurements was obtained. RESULTS Twenty-two patients (mean age 69.5±5.0 years) were included in the analysis. Forty-four prostate areas were evaluated (22 IPC and 22 NPT). Median MRAC SUVmax of NPT was significantly lower than median MRAC SUVmax of IPC (p < 0.0001). Median ADCmin and ADCmean of NPT was significantly higher than median ADCmin and ADCmean of IPC (p < 0.0001). A very good correlation was found between MRAC SUVmax with CTAC SUVmax (rho = -0.843, p < 0.0001). A good inverse relationship was found between MRAC SUVmax and CTAC SUVmax with ADCmin (rho = -0.717, p < 0.0001 and -0.740, p < 0.0001; respectively; Z = 0.22, p = 0.82, NS) and with MRAC SUVmax and ADCmean (rho = -0.737, p < 0.0001). CONCLUSIONS PET/MR SUVmax, ADCmin and ADCmean are distinct biomarkers able to differentiate between IPC and NPT in naïve prostate cancer patients with GS ≥ 7. KEY POINTS • PSMA PET/MR metrics differentiate between normal and tumoural prostatic tissue. • A multi-parametric approach combining molecular and anatomical information might direct prostate biopsy. • PSMA PET/MR metrics are warranted for radiomics analysis.
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Affiliation(s)
- Liran Domachevsky
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel St, 6971028, Tel-Aviv, Israel.
| | - Natalia Goldberg
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel St, 6971028, Tel-Aviv, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel St, 6971028, Tel-Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meital Nidam
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel St, 6971028, Tel-Aviv, Israel
| | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel St, 6971028, Tel-Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Stein D, Goldberg N, Domachevsky L, Bernstine H, Nidam M, Abadi-Korek I, Guindy M, Sosna J, Groshar D. Quantitative biomarkers for liver metastases: comparison of MRI diffusion-weighted imaging heterogeneity index and fluorine-18-fluoro-deoxyglucose standardised uptake value in hybrid PET/MR. Clin Radiol 2018; 73:832.e17-832.e22. [PMID: 29859634 DOI: 10.1016/j.crad.2018.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 04/18/2018] [Indexed: 01/24/2023]
Abstract
AIM To investigate the ability of apparent diffusion coefficient (ADC) heterogeneity index to discriminate liver metastases (LM) from normal-appearing liver (NAL) tissue as compared to common magnetic resonance imaging (MRI) metrics, and to investigate its correlation with 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography (PET) standardised uptake value (SUV). MATERIALS AND METHODS Thirty-nine liver metastases in 24 oncology patients (13 women, 11 men; mean age 56±13 years) with proven LM from heterogeneous sources were evaluated on a PET/MRI system. Abdominal sequences included Dixon and diffusion-weighted imaging (DWI) protocols with simultaneous PET. Tissue heterogeneity was calculated using the coefficient of variance (CV) of the ADC, and compared in LM and in NAL tissue of the same volume in an adjacent portion of the liver. The correlations between various ADC measures and PET SUV in distinguishing LM from NAL were evaluated. RESULTS A good correlation was found between ADCcv and SUVpeak (r=0.712). Moderate inverse correlation was found between ADCmin and SUVpeak (r=-0.536), and a weak inverse correlation between ADCmean and SUVpeak (r=-0.273). There was a significant difference between LM and NAL when ADCcv (p<0.0001) and ADCmin (p=0.001) were used. Receiver operating characteristic (ROC) analysis of SUV, ADCcv, ADCmin, and ADCmean produced an AUC of 0.989, 0.900, 0.742, and 0.623 respectively. CONCLUSIONS The ADCcv index is a potential biomarker of LM with better correlation to 18F-FDG PET SUVpeak than conventional MRI metrics, and may serve to quantitatively discriminate between LM and NAL.
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Affiliation(s)
- D Stein
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - N Goldberg
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Domachevsky
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Bernstine
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Nidam
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Abadi-Korek
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Guindy
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - D Groshar
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bernstine H, Domachevsky L, Nidam M, Goldberg N, Abadi-Korek I, Shpilberg O, Groshar D. 18F-FDG PET/MR imaging of lymphoma nodal target lesions: Comparison of PET standardized uptake value (SUV) with MR apparent diffusion coefficient (ADC). Medicine (Baltimore) 2018; 97:e0490. [PMID: 29668631 PMCID: PMC5916693 DOI: 10.1097/md.0000000000010490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Indexed: 12/12/2022] Open
Abstract
To compare positron emission tomography (PET) standardized uptake value (SUV) with magnetic resonance (MR) apparent diffusion coefficient (ADC) of nodal target lesions in patients with F-fluoro-2-deoxyglucose (FDG)-avid lymphomas by simultaneous PET/MR.Patients with histologically proven Hodgkin and non-Hodgkin lymphoma underwent PET/MR limited field of view of FDG-avid target nodal lesions. For PET images, a region of interest (ROI) was drawn around the target nodal lesion and the SUVmax and SUVmean was measured. For MR ADC measurements a ROI was placed over the target nodal lesion on diffusion-weighted imaging (DWI) and ADCmin and ADCmean (mean ADC) values within the ROI were recorded.Thirty-nine patients (19 women, 20 men; 13 patients with Hodgkin lymphoma and 26 with non-Hodgkin lymphoma) were included in the analysis. Sixty-six nodal lesions detected by PET/CT (19 PET-negative and 47 PET-positive) were analyzed by PET/MR. PET/MR quantitative assessments showed that ADCmin and ADCmean were accurate for discriminating positive from negative nodal lymphoma, with an AUC of 0.927 and 0.947, respectively. The ROC curve analysis of ADCmean versus SUVmax and SUVmean was not statistically significant (difference=0.044, P = .08 and difference = 0.045, P = .07; respectively). A substantial inverse association was observed between ADCmean with SUVmean and SUVmax (rho = -0.611; -0.607; P < .0001, respectively). A moderate inverse association was found between ADCmin with SUVmean and SUVmax (rho = -0.529, -0.520; P < .0001, respectively). Interobserver variability of quantitative assessment showed very good agreement for all variables (ICC>0.87).A significant correlation between ADCs and SUVs is found in FDG avid lymphomas. ADCmean is not inferior to PET SUV in discriminating positive and negative nodal lymphomas. Further larger studies are warranted to validate quantitative PET/MR for lymphoma patient management.
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Affiliation(s)
- Hanna Bernstine
- Department of Nuclear Medicine
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | - David Groshar
- Department of Nuclear Medicine
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Landman Y, Nidam M, Domachevsky L, Dudnik E, Peled N, Groshar D, Bernstein H, Zer A. P3.13-030 Metabolic Parameters of FDG PET at Early Evaluation of NSCLC Differ with Histological Subtypes. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1765] [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: 11/16/2022]
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45
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Domachevsky L, Bernstine H, Goldberg N, Nidam M, Stern D, Sosna J, Groshar D. Early 68GA-PSMA PET/MRI acquisition: assessment of lesion detectability and PET metrics in patients with prostate cancer undergoing same-day late PET/CT. Clin Radiol 2017; 72:944-950. [DOI: 10.1016/j.crad.2017.06.116] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/07/2017] [Accepted: 06/12/2017] [Indexed: 11/28/2022]
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Groshar D, Bernstine H, Goldberg N, Nidam M, Stein D, Abadi-Korek I, Domachevsky L. Reproducibility and repeatability of same-day two sequential FDG PET/MR and PET/CT. Cancer Imaging 2017; 17:11. [PMID: 28381292 PMCID: PMC5381130 DOI: 10.1186/s40644-017-0113-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 12/05/2016] [Accepted: 03/08/2017] [Indexed: 01/08/2023] Open
Abstract
Background To determine PET/CT and PET/MR reproducibility and PET/MR repeatability of fluorine 18 fluorodeoxyglucose (FDG) uptake measurements in tumors in cancer patients. Methods This IRB approved prospective study was performed between October 2015 and February 2016 in consecutive patients who performed same day PET/CT and two sequential PET/MR. Thirty three patients with visible tumors (N = 63) were included. SUV for body weight (SUV) and lean body mass (SUL) were obtained. Volume of interest (VOI) with a threshold of 40% was used and SUV/L’s, metabolic tumor volume (MTV) and tumor to liver ratio (T/L) were calculated. Measurements were plotted in a scattered diagram to visually identify correlation, a regression line was drawn and the equation of the line was calculated. Bland-Altman plots expressed as percentages were constructed to assess the agreement between measurements. The maximal clinically acceptable limits range was defined as ±30%. Results Lesional SUV’s, SUL’s and MTV corrected to body weight (BW) and lean body mass (LBM) demonstrated strong positive linear correlation between PET/CT and PET/MR and between two sequential PET/MR. The 95% limits of agreement ranged from -27.7 to 17.5 with a mean of -5.1 and -27.6 to 17.9 with a mean of -4.9 for SUVpeak and SULpeak, respectively for sequential PET/MR. Other PET metrics demonstrated limits range that is above ±30% between PET/CT and PET/MR and between two sequential PET/MR. Conclusion PET/MR SUV/L peak has a clinically acceptable repeatability performance and can be used to evaluate the response to treatment.
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Affiliation(s)
- David Groshar
- Department of Nuclear Medicine, Assuta Medical Center, 20 habarzel st., 6971028, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Assuta Medical Center, 20 habarzel st., 6971028, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Natalia Goldberg
- Department of Nuclear Medicine, Assuta Medical Center, 20 habarzel st., 6971028, Tel-Aviv, Israel
| | - Meital Nidam
- Department of Nuclear Medicine, Assuta Medical Center, 20 habarzel st., 6971028, Tel-Aviv, Israel
| | - Dan Stein
- Department of Nuclear Medicine, Assuta Medical Center, 20 habarzel st., 6971028, Tel-Aviv, Israel
| | - Ifat Abadi-Korek
- Department of Nuclear Medicine, Assuta Medical Center, 20 habarzel st., 6971028, Tel-Aviv, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Assuta Medical Center, 20 habarzel st., 6971028, Tel-Aviv, Israel.
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Popovtzer A, Burnstein H, Stemmer S, Limon D, Hili O, Bachar G, Sopov V, Feinmesser R, Groshar D, Shvero J. Phase II organ-preservation trial: Concurrent cisplatin and radiotherapy for advanced laryngeal cancer after response to docetaxel, cisplatin, and 5-fluorouracil-based induction chemotherapy. Head Neck 2016; 39:227-233. [PMID: 27556178 DOI: 10.1002/hed.24571] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 06/09/2016] [Accepted: 07/22/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The optimal treatment for locally advanced laryngeal cancer remains controversial. The purpose of this trial was to determine if the response to induction chemotherapy could select patients for organ preservation protocols, and improve larynx-preservation rates without compromising overall survival (OS). METHODS The cohort comprised 12 patients with T3 disease and 14 with T4. Induction chemotherapy consisted of docetaxel, cisplatin, and 5-fluorouracil (TPF). Response to the first cycle was determined by examination and positron emission tomography (PET)-CT. Responders (>50% tumor reduction) underwent chemoradiation, whereas nonresponders underwent laryngectomy. RESULTS Eighty-three percent of the patients had a response and 17% had stable or progressive disease. At 2 years, the median OS was 80%, the larynx-preservation rate was 83%, and the disease-specific survival rate was 86%. Response to a single TPF cycle was associated with 2-year OS (92% vs 50%; p = .02). The T classification was not predictive of survival. CONCLUSION Response to a single TPF-based cycle may identify patients with advanced laryngeal cancer who are amenable to organ preservation treatment. © 2016 Wiley Periodicals, Inc. Head Neck 39: 227-233, 2017.
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Affiliation(s)
- Aron Popovtzer
- Head and Neck Tumor Unit, Davidoff Cancer Center, Beilinson Hospital, Petach Tikva, Israel
| | - Hanna Burnstein
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Salomon Stemmer
- Head and Neck Tumor Unit, Davidoff Cancer Center, Beilinson Hospital, Petach Tikva, Israel
| | - Dror Limon
- Head and Neck Tumor Unit, Davidoff Cancer Center, Beilinson Hospital, Petach Tikva, Israel
| | - Ohad Hili
- Department of Otolaryngology - Head and Neck, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otolaryngology - Head and Neck, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vladamir Sopov
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Raphael Feinmesser
- Department of Otolaryngology - Head and Neck, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Groshar
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Jacob Shvero
- Department of Otolaryngology - Head and Neck, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shemesh S, Kosashvili Y, Groshar D, Bernstine H, Sidon E, Cohen N, Luria T, Velkes S. The value of 18-FDG PET/CT in the diagnosis and management of implant-related infections of the tibia: a case series. Injury 2015; 46:1377-82. [PMID: 25801065 DOI: 10.1016/j.injury.2015.03.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/02/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Positron emission tomography (PET) combined with Computerised Tomography (CT) is gaining ground in clinical settings due to its added value of combined metabolic and anatomical imaging. PET/CT has shown promising results in diagnosing both acute and chronic infection of the axial and appendicular skeleton. PET imaging has an advantage in patients with metallic implants because FDG uptake, in contrast to magnetic resonance imaging (MRI) and standard computed tomography (CT), is not hampered by metallic artifacts. The role of PET/CT in the evaluation of implant-related infections involving the tibia in particular has not been thoroughly studied. PURPOSE To investigate the usefulness of 18-FDG PET/CT in the diagnosis and treatment of implant-related infections of the tibia following osteosynthesis. METHODS We reviewed 10 patients who underwent internal fixation to the tibia following trauma (4 open fractures, 6 closed fractures) and presented later with clinical signs of a possible implant-related infection. In evaluating the patients we used standard work-up methods (standard radiographs, lab tests) as well as advanced imaging techniques (PET/CT) in order to confirm the diagnosis and decide upon the preferred treatment. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were then calculated for PET/CTs ability to predict presence of infection using intraoperative cultures as the gold standard. RESULTS PET/CT validated our working diagnosis 9 out of 10 patients. In particular, it helped distinguish between: infected nonunion (n=4), aseptic nonunion (n=1), soft tissue infection (n=2) and chronic osteomyelitis (n=3). The overall sensitivity and specificity of PET/CT for identifying an osseous infection were 85.7% and 100%, respectively. The PPV and NPV were 100% and 75%, respectively. CONCLUSION PET/CT is a promising imaging modality that can aid in the work up of patients with suspected implant-related infections of the tibia following osteosynthesis, and may be used as a supportive measure in clinical decision making.
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Affiliation(s)
- S Shemesh
- Department of Orthopedic Surgery, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Y Kosashvili
- Department of Orthopedic Surgery, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - D Groshar
- Department of Nuclear Medicine, Rabin Medical Center, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - H Bernstine
- Department of Nuclear Medicine, Rabin Medical Center, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - E Sidon
- Department of Orthopedic Surgery, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - N Cohen
- Department of Orthopedic Surgery, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - T Luria
- Department of Orthopedic Surgery, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - S Velkes
- Department of Orthopedic Surgery, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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Domachevsky L, Groshar D, Galili R, Saute M, Bernstine H. Survival Prognostic Value of Morphological and Metabolic variables in Patients with Stage I and II Non-Small Cell Lung Cancer. Eur Radiol 2015; 25:3361-7. [PMID: 25929940 DOI: 10.1007/s00330-015-3754-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 01/03/2015] [Revised: 03/22/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The prognosis of patients with non-small cell lung cancer (NSCLC) is important, as patients with resectable disease and poor prognostic variables might benefit from neoadjuvant therapy. The goal of this study is to evaluate SUVmax, SUVmax ratio, CT volume (CTvol), metabolic tumour volume (MTV) and total lesion glycolisis (TLG) as survival prognostic markers. In addition, we defined two variables; MTV x SUVmax (MTVmax) and CTvol x SUVmax (CTvolmax) and assessed whether they can be used as prognostic markers. METHODS Patients with stage I-II NSCLC who underwent 18 F FDG PET/CT and surgery were evaluated. Cox proportional-hazard model was used to determine the association between variables and survival. Similar analysis was performed in cases with no lymph node (LN) involvement. RESULTS One hundred and eighty-one patients were included (at the end of the study, 140 patients were alive). SUVmax with a cut-off value of 8.2 was significant survival prognostic factor regardless of LN involvement (P = 0.012). In cases with no LN involvement, SUVmax and CTvol (≥7.1 ml) were significant survival prognostic factors with P = 0.004 and 0.03, respectively. CONCLUSIONS SUVmax may be a useful prognostic variable in stage I-II NSCLC while morphologic tumour volume might be useful in cases with no lymph node involvement. KEY POINTS • Identifying variables that predict the prognosis of patients with NSCLC is important. • SUVmax in primary lung tumour is a useful independent prognostic variable. • (CTvol) is an independent prognostic variable if no lymph nodes are involved.
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Affiliation(s)
- L Domachevsky
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel. .,Beilinson Hospital, 39 Jabotinski St., Petah Tikva, Israel, 4941492.
| | - D Groshar
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Galili
- Department of Cardiothoracic Surgery, Lady Davis-Carmel Medical Center, Haifa, Israel
| | - M Saute
- Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tiqva, Israel
| | - H Bernstine
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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50
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Gafter-Gvili A, Raibman S, Grossman A, Avni T, Paul M, Leibovici L, Tadmor B, Groshar D, Bernstine H. [18F]FDG-PET/CT for the diagnosis of patients with fever of unknown origin. QJM 2015; 108:289-98. [PMID: 25208896 DOI: 10.1093/qjmed/hcu193] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIMS The diagnosis of patients with fever of unknown origin (FUO) remains a challenging medical problem. We aimed to assess the diagnostic contribution of 18-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET)/computed tomography (CT) for the evaluation of FUO. METHODS We performed a 4-year retrospective single-center study of all hospitalized patients that underwent FDG-PET/CT for evaluation of FUO. The final diagnosis of the febrile disease was based on clinical, microbiological, radiological and pathological data available at the final follow-up. Predictors for a contributory exam were sought. RESULTS One hundred and twelve patients underwent FDG-PET/CT for the investigation of FUO in the years 2008-2012 and were included in the study. A final diagnosis was determined in 83 patients (74%) and included: infectious disease in 49 patients (43%), non-infectious inflammatory disease in 17 patients (16%), malignancies in 15 patients (14%), other diagnoses in 2 patients (1.7%), FUO resolved with no diagnosis and no evidence of disease during a 6-month follow-up in 23 patients (20%), and death with fever and with no diagnosis in 6 patients (5%). Seventy-four FDG-PET/CT studies (66%) were considered clinically helpful and contributory to diagnosis (46% positive contributory value and 20.5% contributory to exclusion of diagnosis). PET/CT had a sensitivity of 72.2%, a specificity of 57.5%, a positive predictive value (PPV) of 74.2% and a negative predictive value (NPV) of 53.5%. On multivariable analysis, significant predictors of a positive PET/CT contributory to diagnosis were a short duration of fever and male gender. CONCLUSIONS PET/CT is an important diagnostic tool for patients with FUO.
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Affiliation(s)
- A Gafter-Gvili
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - S Raibman
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - A Grossman
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - T Avni
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - M Paul
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - L Leibovici
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - B Tadmor
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - D Groshar
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - H Bernstine
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
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