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Otis-Chapados S, Goulet CR, Dubois G, Lavallée É, Dujardin T, Fradet Y, Lacombe L, Lodde M, Tiguert R, Toren P, Fradet V, Beauregard JM, Buteau FA, Pouliot F. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is accurate for high-grade prostate cancer bone staging when compared to bone scintigraphy. Can Urol Assoc J 2021; 15:301-307. [PMID: 33750523 DOI: 10.5489/cuaj.7107] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In this study, we compared 18F-FDG-postron emission tomography/computed tomography (PET/CT) and bone scintigraphy accuracies for the detection of bone metastases for primary staging in high-grade prostate cancer (PCa) patients to determine if 18F-FDG-PET/CT could be used alone as a staging modality. METHODS Men with localized high-grade PCa (n=256, Gleason 8-10, International Society of Urological Pathology [ISUP] grades 4 or 5) were imaged with bone scintigraphy and 18F-FDGPET/CT. We compared on a per-patient basis the accuracy of the two imaging modalities, taking intermodality agreement as the standard of truth (SOT). RESULTS 18F-FDG-PET/CT detected at least one bone metastasis in 33 patients compared to only 26 with bone scan. Of the seven false-negative bone scintigraphies, four (57.1%) were solitary metastases (monometastatic), three (42.9%) were oligometastatic (2-4 lesions), and none were plurimetastatic (>4 lesions). Compared to SOT, 18F-FDG-PET/CT showed higher sensitivity and accuracy than bone scintigraphy (100% vs. 78.8%, and 98.7% vs. 98.2%) for the detection of skeletal lesions. CONCLUSIONS 18F-FDG-PET/CT appears similar or better than conventional bone scans to assess for bone metastases in patients newly diagnosed with high-grade PCa. Since intraprostatic FDG-uptake is also a biomarker of failure to radical prostatectomy and that FDG-PET/CT has been shown to be accurate in detecting PCa lymph node metastasis, FDG-PET/CT has the potential to be used as the sole preoperative staging modality in high-grade PCa.
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Affiliation(s)
- Samuel Otis-Chapados
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Cassandra Ringuette Goulet
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Gabriel Dubois
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | | | - Thierry Dujardin
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Yves Fradet
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Louis Lacombe
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Michele Lodde
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Rabi Tiguert
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Paul Toren
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Vincent Fradet
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Jean-Mathieu Beauregard
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada.,Department of Medical Imaging, CHU de Québec, Quebec, QC, Canada
| | - François-Alexandre Buteau
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada.,Department of Medical Imaging, CHU de Québec, Quebec, QC, Canada
| | - Frédéric Pouliot
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
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Huot Daneault A, Desaulniers M, Beauregard JM, Beaulieu A, Arsenault F, April G, Turcotte É, Buteau FA. Highly Symptomatic Progressing Cardiac Paraganglioma With Intracardiac Extension Treated With 177Lu-DOTATATE: A Case Report. Front Endocrinol (Lausanne) 2021; 12:705271. [PMID: 34367072 PMCID: PMC8339957 DOI: 10.3389/fendo.2021.705271] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Primary cardiac paragangliomas are rare tumors. Metastatic disease is even rarer. Surgical management is technically challenging, and sometimes even impossible. Available therapeutic modalities for metastatic disease include external beam radiation therapy as well as systemic treatments, namely 131I-MIBG and more recently, peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE. To our knowledge, this is the first case of progressive unresectable cardiac paraganglioma with intracardiac extension treated with dosimetry based personalized PRRT to be reported. This case is of particular interest since it documents for the first time the efficacy, and especially the safety of the 177Lu-DOTATATE PRRT in this precarious context for which therapeutic options are limited. CASE PRESENTATION A 47-year-old man with no medical history consulted for rapidly decreasing exercise tolerance. The investigation demonstrated an unresectable progressing metastatic cardiac paraganglioma with intracardiac extension. The patient was treated with personalized 177Lu-DOTATATE PRRT and showed complete symptomatic and partial anatomical responses, with a progression-free survival of 13 months. CONCLUSIONS PRRT with 177Lu-DOTATATE should be considered for inoperable cardiac paraganglioma. No major hemodynamic complications were experienced. Therapy resulted in safety and substantially improved quality of life.
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Affiliation(s)
- Alexis Huot Daneault
- Département de médecine nucléaire et radiobiologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Mélanie Desaulniers
- Département de médecine nucléaire et radiobiologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Mathieu Beauregard
- Département d’imagerie médicale, Division médecine nucléaire, CHU de Québec, Québec, QC, Canada
| | - Alexis Beaulieu
- Département d’imagerie médicale, Division médecine nucléaire, CHU de Québec, Québec, QC, Canada
| | - Frédéric Arsenault
- Département d’imagerie médicale, Division médecine nucléaire, CHU de Québec, Québec, QC, Canada
| | - Geneviève April
- Département d’imagerie médicale, Division médecine nucléaire, CHU de Québec, Québec, QC, Canada
| | - Éric Turcotte
- Département de médecine nucléaire et radiobiologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - François-Alexandre Buteau
- Département d’imagerie médicale, Division médecine nucléaire, CHU de Québec, Québec, QC, Canada
- *Correspondence: François-Alexandre Buteau,
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Pouliot F, Meizou S, Ringuette Goulet C, Hovington H, Lefebvre V, Lavallée E, Bergeron M, Brisson H, Champagne A, Neveu B, Lacombe D, Beauregard JM, Buteau FA, Riopel J. GLUT1 expression in high-risk prostate cancer: Correlation with 18F-FDG-PET/CT and clinical outcome. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.291] [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
291 Background: Tumour FDG-uptake is of prognostic value in high-risk and metastatic prostate cancer (PCa). The aim of this study is to investigate the underlying glucose metabolism mechanisms of 18F-FDG-uptake on PET/CT imaging in PCa. Methods: Retrospective analysis was conducted for 94 patients diagnosed with a Gleason sum ≥8 at biopsy who underwent 18F-FDG-PET/CT imaging before radical prostatectomy. GLUT1, GLUT12 and HK2 expression were blindly scored after immunohistochemistry on radical prostatectomy specimens by 3 pathologists. 18F-FDG-uptake in primary lesion was measured by a blinded reader using maximum standardized uptake value (SUVmax). Correlations between GLUT1, GLUT12 and HK2 and SUVmax were assessed using Spearman’s rank correlation test. Survival probabilities were based on the Kaplan-Meier method. Results: With a median follow-up of 4.5 years, 56% (n=53) of patients had biochemical recurrence, 7% (n=7) progressed to castration-resistant PCa (CRPC) disease, 13% (n=12) developed metastasis and 6% (n=6) died. Correlation was found between GLUT1 expression and SUVmax level (r=0.2512, p=0.0182). In addition, SUVmax was significantly higher in tumours with high GLUT1 expression (n=17, 5.74±1.67) than tumours with low GLUT1 expression (n=71, 2.68±0.31, P=0.0037). Also, contrary to GLUT12 and HEX2 expression, a significant association was found between GLUT-1 expression levels and SUVmax index (p=0.004), lymph node status (p=0.046), volume of cancer (P=0.013), CRPC-free survival (p=0.02) and metastasis-free survival (p=0.04). Conclusions: GLUT1 expression in PCa tumours correlates with 18F-FDG-uptake and poor prognostic factors. These results suggest that this transporter is involved in the molecular mechanism of 18F-FDG-uptake in high-risk PCa and raise interest in targeting metabolic dependencies of PCa cells as a selective anticancer strategy.
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Affiliation(s)
- Frederic Pouliot
- Cancer Research Center, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | | | - Cassandra Ringuette Goulet
- Cancer Research Center, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Helene Hovington
- Cancer Research Center, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Veronique Lefebvre
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Etienne Lavallée
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Michelle Bergeron
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Hervé Brisson
- Cancer Research Center, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Audrey Champagne
- Cancer Research Center, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Bertrand Neveu
- Cancer Research Center, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Didier Lacombe
- Cancer Research Center, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | | | | | - Julie Riopel
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
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Meziou S, Ringuette Goulet C, Hovington H, Lefebvre V, Lavallée É, Bergeron M, Brisson H, Champagne A, Neveu B, Lacombe D, Beauregard JM, Buteau FA, Riopel J, Pouliot F. GLUT1 expression in high-risk prostate cancer: correlation with 18F-FDG-PET/CT and clinical outcome. Prostate Cancer Prostatic Dis 2020; 23:441-448. [PMID: 31932660 DOI: 10.1038/s41391-020-0202-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/17/2019] [Accepted: 01/06/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Tumour 18F-FDG-uptake is of prognostic value in high-risk and metastatic prostate cancer (PCa). The aim of this study is to investigate the underlying glucose metabolism mechanisms of 18F-FDG-uptake on PET/CT imaging in PCa. METHODS Retrospective analysis was conducted for 94 patients diagnosed with a Gleason sum ≥8 adenocarcinoma of the prostate at biopsy between July 2011 and July 2014 who underwent 18F-FDG-PET/CT imaging before radical prostatectomy (RP). 18F-FDG-uptake in primary lesion was measured by a blinded reader using maximum standardised uptake value (SUVmax). GLUT1, GLUT12 and HK2 expression were blindly scored after immunohistochemistry on specimens RP by three pathologists. Correlations between GLUT1, GLUT12 and HK2, and SUVmax were assessed using Spearman's rank correlation test. Survival probabilities were based on the Kaplan-Meier method. RESULTS With a median follow-up of 4.5 years, 56% (n = 53) of patients had biochemical recurrence (BCR), 7% (n = 7) progressed to castration-resistant prostate cancer (CRPC) disease, 13% (n = 12) developed metastasis and 6% (n = 6) died. Correlation was found between GLUT1 expression and SUVmax level (r = 0.25, p = 0.02). In addition, SUVmax was significantly higher in tumours with high GLUT1 expression (n = 17, 5.74 ± 1.67) than tumours with low GLUT1 expression (n = 71, 2.68 ± 0.31, p = 0.004). Moreover, a significant association was found between GLUT1 expression levels and SUVmax level (p = 0.005), lymph node status (p = 0.05), volume of cancer (p = 0.01), CRPC disease progression (p = 0.02) and metastasis development (p = 0.04). No significant difference between GLUT12 and HEX2 expression and SUVmax have been found. CONCLUSIONS GLUT1 expression in PCa tumours correlates with 18F-FDG-uptake and poor prognostic factors. These results suggest that this transporter is involved in the molecular mechanism of 18F-FDG-uptake in high-risk PCa and raise interest in targeting metabolic dependencies of PCa cells as a selective anticancer strategy.
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Affiliation(s)
- Salma Meziou
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada.,Department of Pathology, CHU de Québec, Québec, QC, Canada
| | - Cassandra Ringuette Goulet
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Hélène Hovington
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | | | - Étienne Lavallée
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Michelle Bergeron
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Hervé Brisson
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Audrey Champagne
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Bertrand Neveu
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Didier Lacombe
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Jean-Mathieu Beauregard
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada.,Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Québec, QC, Canada.,Department of Medical Imaging, CHU de Québec, Québec, QC, Canada
| | - François-Alexandre Buteau
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Québec, QC, Canada.,Department of Medical Imaging, CHU de Québec, Québec, QC, Canada
| | - Julie Riopel
- Department of Pathology, CHU de Québec, Québec, QC, Canada
| | - Frédéric Pouliot
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada. .,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada.
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5
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Schneider JR, Shatzkes DR, Scharf SC, Tham TM, Kulason KO, Buteau FA, Del Prete M, Chakraborty S, Anderson TA, Asiry S, Beauregard JM, Langer DJ, Costantino PD, Boockvar JA. Neuroradiological and Neuropathological Changes After 177Lu-Octreotate Peptide Receptor Radionuclide Therapy of Refractory Esthesioneuroblastoma. Oper Neurosurg (Hagerstown) 2019; 15:100-109. [PMID: 29554305 DOI: 10.1093/ons/opy028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/29/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Olfactory neuroblastoma, also known as esthesioneuroblastoma (ENB), is a malignant neoplasm with an unpredictable behavior. Currently, the widely accepted treatment is inductive chemotherapy, with or without surgery, followed by radiotherapy. Since data on genetics and molecular alterations of ENB are lacking, there is no standard molecularly targeted therapy. However, ENB commonly expresses the somatostatin receptor (SSTR) that is also expressed by neuroendocrine tumors. Peptide receptor radionuclide therapy (PRRT) using radiolabeled somatostatin analogues, such as 177Lu-octreotate, is an effective treatment for the latter. We present the complex neuroradiological and neuropathological changes associated with 177Lu-octreotate treatment of a patient with a highly treatment-resistant ENB. CLINICAL PRESENTATION A 60-yr-old male presented with an ENB that recurred after chemotherapy, surgery, stereotactic radiosurgery, and immunotherapy. Pathology revealed a Hyams grade 3 ENB and the tumor had metastasized to lymph nodes. Tumor SSTR expression was seen on 68Ga-octreotate positron emission tomography (PET)/computed tomography (CT), suggesting that PRRT may be an option. He received 4 cycles of 177Lu-octreotate over 6 mo, with a partial response of all lesions and symptomatic improvement. Four months after the last PRRT cycle, 2 of the lesions rapidly relapsed and were successfully resected. Three months later, 68Ga-octreotate PET/CT and magnetic resonance imaging indicate no progression of the disease. CONCLUSION We describe imaging changes associated with 177Lu-octreotate PRRT of relapsing ENB. To our knowledge, this is the first report describing neuropathological changes associated with this treatment. PRRT is a promising therapeutic option to improve the disease control, and potentially, the survival of patients with refractory ENB.
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Affiliation(s)
- Julia R Schneider
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Deborah R Shatzkes
- Department of Radiology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,New York Head and Neck Institute, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Stephen C Scharf
- Department of Nuclear Medicine, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Tristan M Tham
- Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,New York Head and Neck Institute, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Kay O Kulason
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | | | - Michela Del Prete
- Department of Medical Imaging, CHU de Québec-Université Laval, Quebec City, Canada
| | - Shamik Chakraborty
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Todd A Anderson
- Department of Pathology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Saeed Asiry
- Department of Pathology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | | | - David J Langer
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Radiology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Peter D Costantino
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,New York Head and Neck Institute, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - John A Boockvar
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,New York Head and Neck Institute, Zucker School of Medicine at Hofstra/Northwell, New York, New York
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Del Prete M, Buteau FA, Arsenault F, Saighi N, Bouchard LO, Beaulieu A, Beauregard JM. Personalized 177Lu-octreotate peptide receptor radionuclide therapy of neuroendocrine tumours: initial results from the P-PRRT trial. Eur J Nucl Med Mol Imaging 2018; 46:728-742. [PMID: 30506283 DOI: 10.1007/s00259-018-4209-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [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: 07/24/2018] [Accepted: 10/30/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE Peptide receptor radionuclide therapy (PRRT) is mostly administered using a fixed injected activity (IA) per cycle. This empiric regime results in highly variable absorbed doses to the critical organs and undertreatment of the majority of patients. We conceived a personalized PRRT protocol in which the IA is adjusted to deliver a prescribed absorbed dose to the kidney, with the aim to safely increase tumour irradiation. We herein report on the initial results of our prospective study of personalized PRRT, the P-PRRT Trial (NCT02754297). METHODS PRRT-naïve patients with progressive and/or symptomatic neuroendocrine tumour (NET) were scheduled to receive a four-cycle induction course of 177Lu-octreotate with quantitative SPECT/CT-based dosimetry. The IA was personalized according to the glomerular filtration rate and the body surface area for the first cycle, and according to the prior renal Gy/GBq for the subsequent cycles. The prescribed renal absorbed dose of 23 Gy was reduced by 25-50% in case of significant renal or haematological impairment. Responders were allowed to receive consolidation or maintenance cycles, for each of which 6 Gy to the kidney were prescribed. We simulated the empiric PRRT regime by fixing the IA at 7.4 GBq per cycle, with the same percentage reductions as above. Radiological, molecular imaging, biochemical, and quality of life responses, as well as safety, were assessed. RESULTS Fifty-two patients underwent 171 cycles. In 34 patients who completed the induction course, a median cumulative IA of 36.1 (range, 6.3-78.6) GBq was administered, and the median cumulative kidney and maximum tumour absorbed doses were 22.1 (range, 8.3-24.3) Gy and 185.7 (range: 15.2-443.1) Gy respectively. Compared with the simulated fixed-IA induction regime, there was a median 1.26-fold increase (range, 0.47-2.12 fold) in the cumulative maximum tumour absorbed dose, which was higher in 85.3% of patients. In 39 assessable patients, the best objective response was partial response in nine (23.1%), minor response in 14 (35.9%), stable disease in 13 (33.3%) and progressive disease in three patients (7.7%). In particular, 11 of 13 patients (84.6%) with pancreatic NET had partial or minor response. The global health status/quality of life score significantly increased in 50% of patients. Acute and subacute side-effects were all of grade 1 or 2, and the most common were nausea (in 32.7% of patients) and fatigue (in 30.8% of patients) respectively. Subacute grade 3 or 4 toxicities occurred in less than 10% of patients, with the exception of lymphocytopenia in 51.9% of patients, without any clinical consequences however. No patient experienced severe renal toxicity. CONCLUSIONS Personalized PRRT makes it possible to safely increase tumour irradiation in the majority of patients. Our first results indicate a favourable tolerance profile, which appears similar to that of the empiric regime. The response rates are promising, in particular in patients with NET of pancreatic origin.
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Affiliation(s)
- Michela Del Prete
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada.,Division of Nuclear Medicine, Department of Medical Imaging, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, G1R 2J6, Canada.,Cancer Research Center, Université Laval, Quebec City, Canada.,Oncology Branch, CHU de Québec - Université Laval Research Center, Quebec City, Canada
| | - François-Alexandre Buteau
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada.,Division of Nuclear Medicine, Department of Medical Imaging, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, G1R 2J6, Canada
| | - Frédéric Arsenault
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada.,Division of Nuclear Medicine, Department of Medical Imaging, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, G1R 2J6, Canada.,Cancer Research Center, Université Laval, Quebec City, Canada.,Oncology Branch, CHU de Québec - Université Laval Research Center, Quebec City, Canada
| | - Nassim Saighi
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada.,Division of Nuclear Medicine, Department of Medical Imaging, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, G1R 2J6, Canada.,Cancer Research Center, Université Laval, Quebec City, Canada.,Oncology Branch, CHU de Québec - Université Laval Research Center, Quebec City, Canada
| | - Louis-Olivier Bouchard
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada.,Division of Radiology, Department of Medical Imaging, CHU de Québec - Université Laval, Quebec City, Canada
| | - Alexis Beaulieu
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada.,Division of Nuclear Medicine, Department of Medical Imaging, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, G1R 2J6, Canada
| | - Jean-Mathieu Beauregard
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada. .,Division of Nuclear Medicine, Department of Medical Imaging, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, G1R 2J6, Canada. .,Cancer Research Center, Université Laval, Quebec City, Canada. .,Oncology Branch, CHU de Québec - Université Laval Research Center, Quebec City, Canada.
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7
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Del Prete M, Arsenault F, Saighi N, Zhao W, Buteau FA, Celler A, Beauregard JM. Accuracy and reproducibility of simplified QSPECT dosimetry for personalized 177Lu-octreotate PRRT. EJNMMI Phys 2018; 5:25. [PMID: 30318563 PMCID: PMC6186532 DOI: 10.1186/s40658-018-0224-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/01/2018] [Indexed: 12/22/2022] Open
Abstract
Background Routine dosimetry is essential for personalized 177Lu-octreotate peptide receptor radionuclide therapy (PRRT) of neuroendocrine tumors (NETs), but practical and robust dosimetry methods are needed for wide clinical adoption. The aim of this study was to assess the accuracy and inter-observer reproducibility of simplified dosimetry protocols based on quantitative single-photon emission computed tomography (QSPECT) with a limited number of scanning time points. We also updated our personalized injected activity (IA) prescription scheme. Methods Seventy-nine NET patients receiving 177Lu-octreotate therapy (with a total of 279 therapy cycles) were included in our study. Three-time-point (3TP; days 0, 1, and 3) QSPECT scanning was performed following each therapy administration. Dosimetry was obtained using small volumes of interest activity concentration sampling for the kidney, the bone marrow and the tumor having the most intense uptake. Accuracy of the simplified dosimetry based on two-time-point (2TP; days 1 and 3, monoexponential fit) or a single-time-point (1TPD3; day 3) scanning was assessed, as well as that of hybrid methods based on 2TP for the first cycle and 1TP (day 1 or 3; 2TP/1TPD1 and 2TP/1TPD3, respectively) or no imaging at all (based on IA only; 2TP/no imaging (NI)) for the subsequent induction cycles. The inter-observer agreement was evaluated for the 3TP, 2TP, and hybrid 2TP/1TPD3 methods using a subset of 60 induction cycles (15 patients). The estimated glomerular filtration rate (eGFR), body size descriptors (weight, body surface area (BSA), lean body weight (LBW)), and products of both were assessed for their ability to predict IA per renal absorbed dose at the first cycle. Results The 2TP dosimetry estimates correlated highly with those from the 3TP data for all tissues (Spearman r > 0.99, P < 0.0001) with small relative errors between the methods, particularly for the kidney and the tumor, with median relative errors not exceeding 2% and interdecile ranges spanning over less than 6% and 4%, respectively, for the per-cycle and cumulative estimates. For the bone marrow, the errors were slightly greater (median errors < 6%, interdecile ranges < 14%). Overall, the strength of correlations of the absorbed dose estimates from the simplified methods with those from the 3TP scans tended to progressively decrease, and the relative errors to increase, in the following order: 2TP, 2TP/1TPD3, 1TPD3, 2TP/1TPD1, and 2TP/NI. For the tumor, the 2TP/NI scenario was highly inaccurate due to the interference of the therapeutic response. There was an excellent inter-observer agreement between the three observers, in particular for the renal absorbed dose estimated using the 3TP and 2TP methods, with mean errors lesser than 1% and standard deviations of 5% or lower. The eGFR · LBW and eGFR · BSA products best predicted the ratio of IA to the renal dose (GBq/Gy) for the first cycle (Spearman r = 0.41 and 0.39, respectively; P < 0.001). For the first cycle, the personalized IA proportional to eGFR · LBW or eGFR · BSA decreased the range of delivered renal absorbed dose between patients as compared with the fixed IA. For the subsequent cycles, the optimal personalized IA could be determined based on the prior cycle renal GBq/Gy with an error of less than 21% in 90% of patients. Conclusions A simplified dosimetry protocol based on two-time-point QSPECT scanning on days 1 and 3 post-PRRT provides reproducible and more accurate dose estimates than the techniques relying on a single time point for non-initial or all cycles and results in limited patient inconvenience as compared to protocols involving scanning at later time points. Renal absorbed dose over the 4-cycle induction PRRT course can be standardized by personalizing IA based on the product of eGFR with LBW or BSA for the first cycle and on prior renal dosimetry for the subsequent cycles.
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Affiliation(s)
- Michela Del Prete
- Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Quebec City, Canada.,Department of Medical Imaging and Oncology Branch of CHU de Québec Research Center, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, QC, G1R 2J6, Canada
| | - Frédéric Arsenault
- Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Quebec City, Canada.,Department of Medical Imaging and Oncology Branch of CHU de Québec Research Center, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, QC, G1R 2J6, Canada
| | - Nassim Saighi
- Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Quebec City, Canada.,Department of Medical Imaging and Oncology Branch of CHU de Québec Research Center, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, QC, G1R 2J6, Canada
| | - Wei Zhao
- Medical Imaging Research Group, University of British Columbia, Vancouver, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - François-Alexandre Buteau
- Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Quebec City, Canada.,Department of Medical Imaging and Oncology Branch of CHU de Québec Research Center, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, QC, G1R 2J6, Canada
| | - Anna Celler
- Medical Imaging Research Group, University of British Columbia, Vancouver, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - Jean-Mathieu Beauregard
- Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Quebec City, Canada. .,Department of Medical Imaging and Oncology Branch of CHU de Québec Research Center, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, QC, G1R 2J6, Canada.
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Lavallée E, Bergeron M, Buteau FA, Blouin AC, Duchesnay N, Dujardin T, Tiguert R, Lacombe L, Fradet V, Makao-Nguile M, Fradet Y, Beauregard JM, Pouliot F. Increased Prostate Cancer Glucose Metabolism Detected by 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Localised Gleason 8-10 Prostate Cancers Identifies Very High-risk Patients for Early Recurrence and Resistance to Castration. Eur Urol Focus 2018; 5:998-1006. [PMID: 29609897 DOI: 10.1016/j.euf.2018.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/19/2018] [Accepted: 03/14/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) to stage prostate cancer (PCa) is limited. However, Gleason 8-10 PCa and more aggressive metastatic PCa have been shown to exhibit a higher glycolytic activity. OBJECTIVE To evaluate the potential of intraprostatic FDG uptake to prognose Gleason 8-10 PCa patients prior to prostatectomy, based on tumour intrinsic biology. DESIGN, SETTING, AND PARTICIPANTS FDG-PET/CT and a bone scan were performed as a staging procedure prior to prostatectomy in 148 consecutive patients diagnosed with PCa with a Gleason sum of ≥8 at biopsy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The FDG-PET/CT images were blind reviewed. Lymph node (LN) metastasis and intraprostatic FDG uptake were systematically recorded, and correlated with the patients' clinicopathological characteristics. RESULTS AND LIMITATIONS FDG-PET/CT detected foci of intraprostatic FDG uptake in 66% of patients. An intraprostatic FDG uptake of maximum intraprostatic standardised uptake value (SUVmax) of ≥4.6 was statistically significantly associated with a higher pathological Gleason ≥8, extracapsular extension, seminal vesicle invasion, and pathological LN metastasis. In multivariate analysis, an intraprostatic SUVmax of ≥4.6 was associated with a two-fold increased risk of biochemical recurrence in the year following surgery. Patients with an intraprostatic SUVmax of ≥4.6 had estimated median biochemical recurrence-free survival (BFS) of 11.3mo compared with 49.5mo for those with a lower SUVmax. Finally, high intraprostatic FDG uptake was associated with shorter time to castration resistance following radical prostatectomy (RP). CONCLUSIONS Preoperative intraprostatic FDG uptake is an integrator of adverse pathological prognostic factors, predicting BFS and castration resistance following RP in patients with a Gleason score ≥8 PCa at biopsy. These results support the use of preoperative FDG-PET/CT as a tool to distinguish at diagnosis very high-risk Gleason 8-10 PCa patients in whom novel neoadjuvant or adjuvant therapies should be explored. PATIENT SUMMARY This study shows that an increased use of glucose by prostate cancer cells detected by 18F-fluorodeoxyglucose positron emission tomography molecular imaging can identify aggressive prostate cancers.
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Affiliation(s)
- Etienne Lavallée
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Michelle Bergeron
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - François-Alexandre Buteau
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Annie-Claude Blouin
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Nicolas Duchesnay
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Thierry Dujardin
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Rabi Tiguert
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Louis Lacombe
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Vincent Fradet
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Molière Makao-Nguile
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Yves Fradet
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Jean-Mathieu Beauregard
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Frédéric Pouliot
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada.
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Bensaïdane MR, Beauregard JM, Poulin S, Buteau FA, Guimond J, Bergeron D, Verret L, Fortin MP, Houde M, Bouchard RW, Soucy JP, Laforce R. Clinical Utility of Amyloid PET Imaging in the Differential Diagnosis of Atypical Dementias and Its Impact on Caregivers. J Alzheimers Dis 2017; 52:1251-62. [PMID: 27104896 DOI: 10.3233/jad-151180] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 11/15/2022]
Abstract
Recent studies have supported a role for amyloid positron emission tomography (PET) imaging in distinguishing Alzheimer's disease (AD) pathology from other pathological protein accumulations leading to dementia. We investigated the clinical utility of amyloid PET in the differential diagnosis of atypical dementia cases and its impact on caregivers. Using the amyloid tracer 18F-NAV4694, we prospectively scanned 28 patients (mean age 59.3 y, s.d. 5.8; mean MMSE 21.4, s.d. 6.0) with an atypical dementia syndrome. Following a comprehensive diagnostic workup (i.e., history taking, neurological examination, blood tests, neuropsychological evaluation, MRI, and FDG-PET), no certain diagnosis could be arrived at. Amyloid PET was then conducted and classified as positive or negative. Attending physicians were asked to evaluate whether this result led to a change in diagnosis or altered management. They also reported their degree of confidence in the diagnosis. Caregivers were met after disclosure of amyloid PET results and completed a questionnaire/interview to assess the impact of the scan. Our cohort was evenly divided between positive (14/28) and negative (14/28) 18F-NAV4694 cases. Amyloid PET resulted in a diagnostic change in 9/28 cases (32.1%: 17.8% changed from AD to non-AD, 14.3% from non-AD to AD). There was a 44% increase in diagnostic confidence. Altered management occurred in 71.4% (20/28) of cases. Knowledge of amyloid status improved caregivers' outcomes in all domains (anxiety, depression, disease perception, future anticipation, and quality of life). This study suggests a useful additive role for amyloid PET in atypical cases with an unclear diagnosis beyond the extensive workup of a tertiary memory clinic. Amyloid PET increased diagnostic confidence and led to clinically significant alterations in management. The information gained from that test was well received by caregivers and encouraged spending quality time with their loved ones.
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Affiliation(s)
| | | | - Stéphane Poulin
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, QC, Canada
| | | | - Jean Guimond
- Département d'imagerie médicale, CHU de Québec, QC, Canada
| | - David Bergeron
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, QC, Canada
| | - Louis Verret
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, QC, Canada.,Département des Sciences Neurologiques, Université Laval, QC, Canada
| | | | - Michèle Houde
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, QC, Canada
| | - Rémi W Bouchard
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, QC, Canada.,Département des Sciences Neurologiques, Université Laval, QC, Canada
| | | | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, QC, Canada.,Département des Sciences Neurologiques, Université Laval, QC, Canada
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