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Gondry O, Caveliers V, Xavier C, Raes L, Vanhoeij M, Verfaillie G, Fontaine C, Glorieus K, De Grève J, Joris S, Luyten I, Zwaenepoel K, Vandenbroucke F, Waelput W, Thyparambil S, Vaneycken I, Cousaert J, Bourgeois S, Devoogdt N, Goethals L, Everaert H, De Geeter F, Lahoutte T, Keyaerts M. Phase II Trial Assessing the Repeatability and Tumor Uptake of [ 68Ga]Ga-HER2 Single-Domain Antibody PET/CT in Patients with Breast Carcinoma. J Nucl Med 2024; 65:178-184. [PMID: 38302159 PMCID: PMC10858381 DOI: 10.2967/jnumed.123.266254] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/03/2023] [Indexed: 02/03/2024] Open
Abstract
Human epidermal growth factor receptor 2 (HER2) status is used for decision-making in breast carcinoma treatment. The status is obtained through immunohistochemistry or in situ hybridization. These two methods have the disadvantage of necessitating tissue sampling, which is prone to error due to tumor heterogeneity or interobserver variability. Whole-body imaging might be a solution to map HER2 expression throughout the body. Methods: Twenty patients with locally advanced or metastatic breast carcinoma (5 HER2-positive and 15 HER2-negative patients) were included in this phase II trial to assess the repeatability of uptake quantification and the extended safety of the [68Ga]Ga-NOTA-anti-HER2 single-domain antibody (sdAb). The tracer was injected, followed by a PET/CT scan at 90 min. Within 8 d, the procedure was repeated. Blood samples were taken for antidrug antibody (ADA) assessment and liquid biopsies. On available tissues, immunohistochemistry, in situ hybridization, and mass spectrometry were performed to determine the correlation of HER2 status with uptake values measured on PET. If relevant preexisting [18F]FDG PET/CT images were available (performed as standard of care), a comparison was made. Results: With a repeatability coefficient of 21.8%, this imaging technique was repeatable. No clear correlation between PET/CT uptake values and pathology could be established, as even patients with low levels of HER2 expression showed moderate to high uptake. Comparison with [18F]FDG PET/CT in 16 patients demonstrated that in 7 patients, [68Ga]Ga-NOTA-anti-HER2 shows interlesional heterogeneity within the same patient, and [18F]FDG uptake did not show the same heterogeneous uptake in all patients. In some patients, the extent of disease was clearer with the [68Ga]Ga-NOTA-anti-HER2-sdAb. Sixteen adverse events were reported but all without a clear relationship to the tracer. Three patients with preexisting ADAs did not show adverse reactions. No new ADAs developed. Conclusion: [68Ga]Ga-NOTA-anti-HER2-sdAb PET/CT imaging shows similar repeatability to [18F]FDG. It is safe for clinical use. There is tracer uptake in cancer lesions, even in patients previously determined to be HER2-low or -negative. The tracer shows potential in the assessment of interlesional heterogeneity of HER2 expression. In a subset of patients, [68Ga]Ga-NOTA-anti-HER2-sdAb uptake was seen in lesions with no or low [18F]FDG uptake. These findings support further clinical development of [68Ga]Ga-NOTA-anti-HER2-sdAb as a PET/CT tracer in breast cancer patients.
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Affiliation(s)
- Odrade Gondry
- Department of Medical Imaging, Vrije Universiteit Brussel, Brussels, Belgium;
- Department of Nuclear Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Vicky Caveliers
- Department of Medical Imaging, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Nuclear Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Catarina Xavier
- Department of Medical Imaging, Vrije Universiteit Brussel, Brussels, Belgium
| | - Laurens Raes
- Department of Nuclear Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Marian Vanhoeij
- Department of Surgical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Guy Verfaillie
- Department of Surgical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Christel Fontaine
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Katrien Glorieus
- Department of Surgical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jacques De Grève
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Sofie Joris
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Ine Luyten
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Karen Zwaenepoel
- Centre for Oncological Research, University of Antwerp, Wilrijk, Belgium
| | | | - Wim Waelput
- Department of Pathology, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Experimental Pathology, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Ilse Vaneycken
- Department of Nuclear Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Julie Cousaert
- Department of Nuclear Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Sophie Bourgeois
- Department of Nuclear Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nick Devoogdt
- Department of Medical Imaging, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lode Goethals
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Hendrik Everaert
- Department of Nuclear Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Frank De Geeter
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge Oostende, Bruges, Belgium
| | - Tony Lahoutte
- Department of Medical Imaging, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Nuclear Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Marleen Keyaerts
- Department of Medical Imaging, Vrije Universiteit Brussel, Brussels, Belgium;
- Department of Nuclear Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
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2
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Debonnaire P, Claeys M, De Paepe P, Christiaen E, Geerts B, De Geeter F, Trenson S, Hoste D, Van Droogenbroeck J, Verhoeven K, Vantomme N, Tavernier R. Prospective Screening for Transthyretin Cardiac Amyloidosis in Spinal Stenosis Surgery Patients: Results of the CASS Study. JACC CardioOncol 2023; 5:836-838. [PMID: 38204999 PMCID: PMC10774779 DOI: 10.1016/j.jaccao.2023.05.012] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
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Van de Kerkhof J, Bijnens J, De Geeter F, Dick C, De Paepe P, Van den Bruel A. Parathyroid adenoma apoplexy mimicking a thyroid bleeding cyst: a seemingly innocent condition that can be life-threatening. Endocrinol Diabetes Metab Case Rep 2023; 2023:22-0385. [PMID: 38064892 PMCID: PMC10762588 DOI: 10.1530/edm-22-0385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/07/2023] [Indexed: 01/05/2024] Open
Abstract
Summary Primary hyperparathyroidism most commonly presents with hypercalcaemia. Rarely, parathyroid apoplexy or haemorrhage mimicking a thyroid bleeding cyst is the first presentation of a parathyroid adenoma. A woman presented with a sudden-onset painful 'goitre'. Ultrasound showed a cystic nodule located posterior to rather than in the right thyroid lobe, suggesting parathyroid adenoma bleeding. Biochemistry showed mild primary hyperparathyroidism. 99mTc-pertechnetate/sestamibi showed no uptake in the nodule, which was interpreted as a cold thyroid nodule. 18F-fluorocholine PET/CT showed uptake in the nodule, suggestive of a parathyroid adenoma. Persistent mild primary hyperparathyroidism complicated by nephrolithiasis and osteopenia favoured parathyroidectomy over a wait-and-see approach. The patient was referred for parathyroidectomy along with right thyroid lobectomy. Pathology showed an adenoma, with an eccentrically located cystic structure filled with red blood cells surrounded by a thickened fibrous capsule. In conclusion, cervical pain/haemorrhage with hypercalcaemia points to the diagnosis of parathyroid apoplexy, mimicking a thyroid bleeding cyst. Workup with ultrasound and, if available, 18F-choline PET/CT allows for timely surgery, minimizing the risk of recurrent and severe bleeding. Learning points A bleeding cyst may be located posterior to rather than in the thyroid, suggesting a parathyroid haemorrhage. Neck pain and/or haemorrhage along with primary hyperparathyroidism point to parathyroid apoplexy. A two-step presentation has been described, with a first phase of local symptoms to be followed by visible and possibly life-threatening compressing bleeding. Therefore, an expedited workup is needed, allowing for timely surgery.
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Affiliation(s)
| | - Jacqueline Bijnens
- Department of ENT, H&N Surgery, General Hospital Sint-Jan, Bruges, Belgium
| | - Frank De Geeter
- Department of Nuclear Medicine, General Hospital Sint-Jan, Bruges, Belgium
| | - Catherine Dick
- Department of ENT, H&N Surgery, General Hospital Sint-Jan, Bruges, Belgium
| | - Pascale De Paepe
- Department of Anatomopathology, General Hospital Sint-Jan, Bruges, Belgium
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4
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Van den Bruel A, Bijnens J, Van Haecke H, Vander Poorten V, Dick C, Vauterin T, De Geeter F. Preoperative imaging for hyperparathyroidism often takes upper parathyroid adenomas for lower adenomas. Sci Rep 2023; 13:7568. [PMID: 37160895 PMCID: PMC10169799 DOI: 10.1038/s41598-023-32707-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/31/2023] [Indexed: 05/11/2023] Open
Abstract
We retrospectively evaluated how accurately preoperative imaging localizes parathyroid adenoma in superior versus inferior parathyroids. Over 6 years, 104 patients with primary hyperparathyroidism underwent parathyroid surgery in a single centre. Of these, 103 underwent ultrasound, 97 [99mTc]pertechnetate/MIBI SPECT/CT and 30 [18F]fluorocholine (FCH) PET/CT. One patient with a unilateral double adenoma was excluded from the analysis. Surgical findings with histopathologic confirmation of adenoma were used as the standard. Ultrasound misjudged 5 of 48 detected lower adenomas as upper, but 14 of 29 upper adenomas as lower (error rate 10 vs 48%, p = 0.0002). The corresponding error rates for [99mTc]pertechnetate/MIBI SPECT/CT were 3 versus 55% (p = 0.000014), and for [18F]FCH PET/CT 17 versus 36% (p = 0.26). Our results suggest that about half of the superior parathyroid adenomas which are detected, are erroneously assigned to the inferior position by both ultrasound and SPECT/CT imaging whereas the opposite mistake is significantly less frequent with ultrasound and SPECT/CT.
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Affiliation(s)
| | - Jacqueline Bijnens
- Otorhinolaryngology-Head and Neck Surgery, AZ Sint Maarten, Mechelen, Belgium
| | | | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Section Head and Neck Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Catherine Dick
- Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Bruges, Belgium
| | - Tom Vauterin
- Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Bruges, Belgium
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De Mey L, Vermeulen S, Bourgeois S, Goethals L, De Geeter F. 18F-FDG PET/CT in Waldenström associated amyloidosis. Hell J Nucl Med 2023; 26:70-72. [PMID: 37031424 DOI: 10.1967/s002449912557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 04/10/2023]
Abstract
Amyloidoisis in patients with Waldenström macroglobulinemia (WM) mostly involves the heart, peripheral nerves and kidneys. Retroperitoneal amyloidosis is a rare finding. We describe a 62-year-old man with an incidental finding of a monoclonal gammopathy and elevated inflammatory parameters. Bilateral moderately active retroperitoneal infiltration with punctiform calcifications was found on fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging. Taken together, these findings are suggestive of Waldenström associated amyloidosis. Computed tomography-guided retroperitoneal biopsy confirmed the diagnosis.
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Affiliation(s)
- Lynn De Mey
- Department of Nuclear Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101-103, 1090 Brussels, Belgium.
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6
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Debonnaire P, Claeys M, De Smet M, Trenson S, Lycke M, Demeester C, Van Droogenbroeck J, De Vriese AS, Verhoeven K, Vantomme N, Van Meirhaeghe J, Willandt B, Lambert M, de Paepe P, Delanote J, De Geeter F, Tavernier R. Trends in diagnosis, referral, red flag onset, patient profiles and natural outcome of de novo cardiac amyloidosis and their multidisciplinary implications. Acta Cardiol 2022; 77:791-804. [PMID: 34565298 DOI: 10.1080/00015385.2021.1976450] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cardiac amyloidosis (CA) is often overlooked or misdiagnosed. Effects of growing disease awareness, diagnostic ameliorations and novel treatment options on CA diagnosis and management are scarcely reported. OBJECTIVE To report trends in diagnosis, referral routes, clinical presentation, early onset diagnostic red flags and outcome in de novo CA subjects. METHODS An unselected cohort of 139 de novo CA patients over an 8-year period in a tertiary referral hospital was recruited. RESULTS Transthyretin (ATTR, 82%, n = 114) was the most common CA form; Light-chain (AL, 15%, n = 21) and secondary (AA, 3%, n = 4) are less prevalent. Increased awareness over time led to a marked ATTR diagnostic surge, steep non-invasive diagnostic approach increment and increased nuclear medicine and external cardiologist referrals (all p < 0.001). A total of 41% (n = 57/139) of patients were referred by non-cardiology specialist disciplines. Specific referral to rule out CA (24-36%) and diagnostic time lag from symptom onset (9 ± 12 to 8 ± 14 months), however, did not improve (all p > 0.050). Multiple early red flag events preceded CA diagnose several years in ATTR: Left ventricular hypertrophy (LVH, 60%, 4.9 ± 4.3 y), heart failure (54%, 2.5 ± 3.5 y), atrial fibrillation (47%, 5.9 ± 6.7 y), bilateral carpal tunnel syndrome (43%, 9.5 ± 5.7 y) and spinal stenosis (40%, 7.4 ± 6.5 y). LVH ≥ 12 mm was absent in 11% ATTR (n = 13/114) and 5% AL (n = 1/21) patients. Hypertension was common in both ATTR (n = 70/114, 62%) and AL (n = 10/21, 48%). 56% (n = 78/139) of CA presented with heart failure. Cumulative 1 and 5-year mortality of 10%/66%, 40%/52% and 75%/75% for ATTR, AL, and AA, respectively, remains high. CONCLUSIONS Although CA diagnostic uptake and referral improve, specialist-specific disease and diagnostic red flag ignorance result in non-timely diagnosis and unfavourable outcome.
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Affiliation(s)
- Philippe Debonnaire
- Departments of Cardiology, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Mathias Claeys
- Departments of Cardiology, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium.,Department of Cardiology, University Hospital Leuven, Belgium
| | - Maarten De Smet
- Departments of Cardiology, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium.,Department of Cardiology, University Hospital Ghent, Belgium
| | - Sander Trenson
- Departments of Cardiology, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Michelle Lycke
- Departments of Cardiology, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Catherine Demeester
- Departments of Cardiology, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Jan Van Droogenbroeck
- Department of Haematology, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - An S De Vriese
- Department of Nephrology, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Kristof Verhoeven
- Department of Neurology, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Nikolaas Vantomme
- Department of Neurosurgery, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Jan Van Meirhaeghe
- Department of Orthopaedic surgery, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Barbara Willandt
- Department of Gastroenterology, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Margareta Lambert
- Department of Geriatry, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Pascale de Paepe
- Departments of Pathology, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Joost Delanote
- Departments of Radiology, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Frank De Geeter
- Departments of Nuclear Medicine, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Rene Tavernier
- Departments of Cardiology, Bruges Amyloidosis Centre, Sint-Jan Hospital Bruges, Bruges, Belgium
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Bijnens J, Van den Bruel A, Vander Poorten V, Goethals I, Van Schandevyl S, Dick C, De Geeter F. Retrospective real-life study on preoperative imaging for minimally invasive parathyroidectomy in primary hyperparathyroidism. Sci Rep 2022; 12:17427. [PMID: 36261462 PMCID: PMC9581917 DOI: 10.1038/s41598-022-18219-3] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 08/08/2022] [Indexed: 01/12/2023] Open
Abstract
The objective of this study was to retrospectively evaluate preoperative imaging modalities for localization of parathyroid adenomas with a view to enable minimally invasive parathyroidectomy and in particular, to consider the contribution of 18F-fluorocholine-PET/CT. 104 patients with primary hyperparathyroidism, who underwent parathyroid surgery in a single centre during a 6-year period were included. Of these, 103 underwent ultrasound, 97 99mTc-Pertechnetate/SestaMIBI-SPECT, 20 MRI and 30 18F-fluorocholine-PET/CT. Based on surgical findings, sensitivities and specificities for correct lateralisation in orthotopic locations were: for ultrasound 0.75 (0.65-0.83) and 0.89 (0.81-0.94), for 99mTc-MIBI-SPECT 0.57 (0.46-0.67) and 0.97 (0.91-0.99), for MRI 0.60 (0.36-0.81) and 0.83 (0.59-0.96) and for 18F-fluorocholine-PET/CT 0.90 (0.73-0.98) and 0.90 (0.73-0.98). Correctly lateralized adenomas were significantly larger than those not found with ultrasound (p = 0.03) and SPECT (p = 0.002). Pre-operative PTH-levels were higher in single adenomas detected by scintigraphy than in those not (p = 0.02). 64 patients could be treated with a minimally invasive procedure. Cure after parathyroidectomy was obtained in 94% of patients. 18F-Fluorocholine-PET/CT could be shown to be a highly accurate modality to localize parathyroid adenomas preoperatively, obviating the need for total exploration in the majority of patients in whom ultrasound and scintigraphic results are discordant or both negative.
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Affiliation(s)
- Jacqueline Bijnens
- grid.420036.30000 0004 0626 3792Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Bruges, Belgium
| | - Annick Van den Bruel
- grid.420036.30000 0004 0626 3792Internal Medicine, Endocrinology, AZ Sint-Jan, Bruges, Belgium
| | - Vincent Vander Poorten
- grid.410569.f0000 0004 0626 3338Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Oncology, Section Head and Neck Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Ingeborg Goethals
- grid.410566.00000 0004 0626 3303Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Steven Van Schandevyl
- grid.410566.00000 0004 0626 3303Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Catherine Dick
- grid.420036.30000 0004 0626 3792Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Bruges, Belgium
| | - Frank De Geeter
- grid.420036.30000 0004 0626 3792Nuclear Medicine, AZ Sint-Jan, Bruges, Belgium
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8
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Soffers F, Helsen N, Van den Wyngaert T, Carp L, Hoekstra OS, Goethals L, Martens M, Deben K, Spaepen K, De Bree R, De Geeter F, Zwezerijnen GJC, Van Laer C, Maes A, Lenssen O, Stroobants S. Dual time point imaging in locally advanced head and neck cancer to assess residual nodal disease after chemoradiotherapy. EJNMMI Res 2022; 12:34. [PMID: 35695940 PMCID: PMC9192834 DOI: 10.1186/s13550-022-00905-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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background FDG-PET/CT has a high negative predictive value to detect residual nodal disease in patients with locally advanced squamous cell head and neck cancer after completing concurrent chemoradiotherapy (CCRT). However, the positive predictive value remains suboptimal due to inflammation after radiotherapy, generating unnecessary further investigations and possibly even surgery. We report the results of a preplanned secondary end point of the ECLYPS study regarding the potential advantages of dual time point FDG-PET/CT imaging (DTPI) in this setting. Standardized dedicated head and neck FDG-PET/CT images were obtained 12 weeks after CCRT at 60 and 120 min after tracer administration. We performed a semiquantitative assessment of lymph nodes, and the retention index (RI) was explored to optimize diagnostic performance. The reference standard was histology, negative FDG-PET/CT at 1 year, or > 2 years of clinical follow-up. The time-dependent area under the receiver operator characteristics (AUROC) curves was calculated. Results In total, 102 subjects were eligible for analysis. SUV values increased in malignant nodes (median SUV1 = 2.6 vs. SUV2 = 2.7; P = 0.04) but not in benign nodes (median SUV1 = 1.8 vs. SUV2 = 1.7; P = 0.28). In benign nodes, RI was negative although highly variable (median RI = − 2.6; IQR 21.2), while in malignant nodes RI was positive (median RI = 12.3; IQR 37.2) and significantly higher (P = 0.018) compared to benign nodes. A combined threshold (SUV1 ≥ 2.2 + RI ≥ 3%) significantly reduced the amount of false-positive cases by 53% (P = 0.02) resulting in an increased specificity (90.8% vs. 80.5%) and PPV (52.9% vs. 37.0%), while sensitivity (60.0% vs. 66.7%) and NPV remained comparably high (92.9% vs. 93.3%). However, AUROC, as overall measure of benefit in diagnostic accuracy, did not significantly improve (P = 0.62). In HPV-related disease (n = 32), there was no significant difference between SUV1, SUV2, and RI in malignant and benign nodes, yet this subgroup was small. Conclusions DTPI did not improve the overall diagnostic accuracy of FDG-PET/CT to detect residual disease 12 weeks after chemoradiation. Due to differences in tracer kinetics between malignant and benign nodes, DTPI improved the specificity, but at the expense of a loss in sensitivity, albeit minimal. Since false negatives at the 12 weeks PET/CT are mainly due to minimal residual disease, DTPI is not able to significantly improve sensitivity, but repeat scanning at a later time (e.g. after 12 months) could possibly solve this problem. Further study is required in HPV-associated disease.
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Affiliation(s)
- Frederik Soffers
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.
| | - Nils Helsen
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Otto S Hoekstra
- Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Michel Martens
- Department of Radiotherapy, AZ Turnhout, Turnhout, Belgium
| | - Kristof Deben
- Department of Otolaryngology, Jessa Hospital, Hasselt, Belgium
| | - Karoline Spaepen
- Department of Nuclear Medicine, Sint Augustinus, Wilrijk, Belgium
| | - Remco De Bree
- Faculty of Medicine and Health Sciences, Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium.,Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank De Geeter
- Department of Nuclear Medicine, AZ Sint Jan, Brugge, Belgium
| | - G J C Zwezerijnen
- Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Carl Van Laer
- Department Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Alex Maes
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
| | - Olivier Lenssen
- Department of Oral and Maxillofacial Surgery, ZNA Middelheim, Antwerp, Belgium
| | - Sigrid Stroobants
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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9
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Haemels M, Vandendriessche D, De Geeter J, Velghe J, Vandekerckhove M, De Geeter F. Quantitative Effect of Metal Artefact Reduction on CT-based attenuation correction in FDG PET/CT in patients with hip prosthesis. EJNMMI Phys 2021; 8:67. [PMID: 34626242 PMCID: PMC8502194 DOI: 10.1186/s40658-021-00414-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/17/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Metal artefact reduction (MAR) techniques still are in limited use in positron emission tomography/computed tomography (PET/CT). This study aimed to investigate the effect of Smart MAR on quantitative PET analysis in the vicinity of hip prostheses. MATERIALS AND METHODS Activities were measured on PET/CT images in 6 sources with tenfold activity concentration contrast to background, attached to the head, neck and the major trochanter of a human cadaveric femur, and in the same sources in similar locations after a hip prosthesis (titanium cup, ceramic head, chrome-cobalt stem) had been inserted into the femur. Measurements were compared between PET attenuation corrected using either conventional or MAR CT. In 38 patients harbouring 49 hip prostheses, standardized uptake values (SUV) in 6 periprosthetic regions and the bladder were compared between PET attenuation corrected with either conventional or MAR CT. RESULTS Using conventional CT, measured activity decreased with 2 to 13% when the prosthesis was inserted. Use of MAR CT increased measured activity by up to 11% compared with conventional CT and reduced the relative difference with the reference values to under 5% in all sources. In all regions, to the exception of the prosthesis shaft, SUVmean increased significantly (p < 0.001) by use of MAR CT. Median (interquartile range) percentual increases of SUVmean were 1.4 (0.0-4.2), 4.0 (1.8-7.8), 7.8 (4.1-12.4), 1.5 (0.0-3.2), 1.4 (0.8-2.8) in acetabulum, lateral neck, medial neck, lateral diaphysis and medial diaphysis, respectively. Except for the shaft, the coefficient of variation did not increase significantly. Except for the erratic changes in the prosthesis shaft, decreases in SUVmean were rare and small. Bladder SUVmean increased by 0.9% in patients with unilateral prosthesis and by 4.1% in patients with bilateral prosthesis. CONCLUSIONS In a realistic hip prosthesis phantom, Smart MAR restores quantitative accuracy by recovering counts in underestimated sources. In patient studies, Smart MAR increases SUV in all areas surrounding the prosthesis, most markedly in the femoral neck region. This proves that underestimation of activity in the PET image is the most prevalent effect due to metal artefacts in the CT image in patients with hip prostheses. Smart MAR increases SUV in the urinary bladder, indicating effects at a distance from the prosthesis.
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Affiliation(s)
- Maarten Haemels
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende, Ruddershove 10, 8000, Brugge, Belgium
| | - Delphine Vandendriessche
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende, Ruddershove 10, 8000, Brugge, Belgium
| | - Jeroen De Geeter
- ELEC Department, Faculty of Applied Sciences, Vrije Universiteit Brussel, Building K - Room K.6.55/D2, Pleinlaan 2, 1050, Brussel, Belgium
| | - James Velghe
- Nuclear Technology Center, UHasselt, Campus Diepenbeek, Agoralaan Building D, 3590, Diepenbeek, Belgium
| | - Maxence Vandekerckhove
- Department of Orthopedics, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende, Ruddershove 10, 8000, Brugge, Belgium
| | - Frank De Geeter
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende, Ruddershove 10, 8000, Brugge, Belgium.
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Helsen N, Van den Wyngaert T, Carp L, De Bree R, VanderVeken OM, De Geeter F, Maes A, Cambier JP, Spaepen K, Martens M, Hakim S, Beels L, Hoekstra OS, Van den Weyngaert D, Stroobants S, Van Laer C, Specenier P, Maes A, Debruyne P, Hutsebaut I, Van Dinter J, Homans F, Goethals L, Lenssen O, Deben K. Quantification of 18F-fluorodeoxyglucose uptake to detect residual nodal disease in locally advanced head and neck squamous cell carcinoma after chemoradiotherapy: results from the ECLYPS study. Eur J Nucl Med Mol Imaging 2020; 47:1075-1082. [PMID: 32040611 DOI: 10.1007/s00259-020-04710-4] [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] [Received: 12/29/2019] [Accepted: 01/28/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Hopkins criteria were introduced for nodal response evaluation after therapy in head and neck cancer, but its superiority over quantification is not yet confirmed. METHODS SUVbody weight thresholds and lesion-to-background ratios were explored in a prospective multicenter study of standardized FDG-PET/CT 12 weeks after CRT in newly diagnosed locally advanced head and neck squamous cell carcinoma (LAHNSCC) patients (ECLYPS). Reference standard was histology, negative FDG-PET/CT at 12 months after treatment or ≥ 2 years of negative follow-up. Area under the receiver operator characteristics curves (AUROC) were estimated and obtained thresholds were validated in an independent cohort of HNSCC patients (n = 127). RESULTS In ECLYPS, 124 patients were available for quantification. With a median follow-up of 20.4 months, 23 (18.5%) nodal neck recurrences were observed. A SUV70 threshold of 2.2 (AUROC = 0.89; sensitivity = 79.7%; specificity = 80.8%) was identified as optimal metric to identify nodal recurrence within 1 year after therapy. For lesion-to-background ratios, an SUV50/SUVliver threshold of 0.96 (AUROC = 0.89; sensitivity = 79.7%; specificity = 82.8%) had the best performance. Compared with Hopkins criteria (AUROC = 0.81), SUV70 and SUV50/SUVliver provided a borderline significant (p = 0.040 and p = 0.094, respectively) improvement. Validation of thresholds yielded similar AUROC values (SUV70 = 0.93, SUV50/SUVliver = 0.95), and were comparable to the Hopkins score (AUROC = 0.91; not statistically significant). CONCLUSION FDG quantification detects nodal relapse in LAHNSCC patients. When using EARL standardized PET acquisitions and reconstruction, absolute SUV metrics (SUV70 threshold 2.2) prove robust, yet ratios (SUV50/SUVliver, threshold 0.96) may be more useful in routine clinical care. In this setting, the diagnostic value of quantification is comparable to the Hopkins criteria. TRIAL REGISTRATION US National Library for Medicine, NCT01179360. Registered 11 August 2010, https://clinicaltrials.gov/ct2/show/NCT01179360.
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Affiliation(s)
- Nils Helsen
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium.
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium
| | - Remco De Bree
- Amsterdam UMC, Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Olivier M VanderVeken
- Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium.,Department Otorhinolaryngology, and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Frank De Geeter
- Department of Nuclear Medicine, AZ Sint Jan, Brugge, Belgium
| | - Alex Maes
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
| | | | - Karoline Spaepen
- Department of Nuclear Medicine, Sint Augustinus, Wilrijk, Belgium
| | - Michel Martens
- Department of radiotherapy, AZ Turnhout, Turnhout, Belgium
| | - Sara Hakim
- Amsterdam UMC, Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Laurence Beels
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
| | - Otto S Hoekstra
- Amsterdam UMC, Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Sigrid Stroobants
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium
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11
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Vandendriessche D, Uribe J, Bertin H, De Geeter F. Performance characteristics of silicon photomultiplier based 15-cm AFOV TOF PET/CT. EJNMMI Phys 2019; 6:8. [PMID: 31076884 PMCID: PMC6510743 DOI: 10.1186/s40658-019-0244-0] [Citation(s) in RCA: 19] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 04/12/2019] [Indexed: 02/08/2023] Open
Abstract
Background This paper describes the National Electrical Manufacturers Association (NEMA) system performance of the Discovery MI 3-ring PET/CT (GE Healthcare) installed in Bruges, Belgium. This time-of-flight (TOF) PET camera is based on silicon photomultipliers instead of photomultiplier tubes. Methods The NEMA NU2-2012 standard was used to evaluate spatial resolution, sensitivity, image quality (IQ) and count rate curves of the system. Timing and energy resolution were determined. Results Full width at half maximum (FWHM) of spatial resolution in radial, tangential and axial direction was 4.69, 4.08 and 4.68 mm at 1 cm; 5.58, 4.64 and 5.83 mm at 10 cm; and 7.53, 5.08 and 5.47 mm at 20 cm from the centre of the field of view (FOV) for the filtered backprojection reconstruction. For non-TOF ordered subset expectation maximization (OSEM) reconstruction without point spread function (PSF) correction, FWHM was 3.87, 3.69 and 4.15 mm at 1 cm; 4.80, 3.81 and 4.87 mm at 10 cm; and 7.38, 4.16 and 3.98 mm at 20 cm. Sensitivity was 7.258 cps/kBq at the centre of the FOV and 7.117 cps/kBq at 10-cm radial offset. Contrast recovery (CR) using the IQ phantom for the TOF OSEM reconstruction without PSF correction was 47.4, 59.3, 67.0 and 77.0% for the 10-, 13-, 17- and 22-mm radioactive spheres and 82.5 and 85.1% for the 28- and 37-mm non-radioactive spheres. Background variability (BV) was 16.4, 12.1, 9.1, 6.6, 5.1 and 3.8% for the 10-, 13-, 17-, 22-, 28- and 37-mm spheres. Lung error was 8.5%. Peak noise equivalent count rate (NECR) was 102.3 kcps at 23.0 kBq/ml with a scatter fraction of 41.2%. Maximum accuracy error was 3.88%. Coincidence timing resolution was 375.6 ps FWHM. Energy resolution was 9.3% FWHM. Q.Clear reconstruction significantly improved CR and reduced BV compared with OSEM. Conclusion System sensitivity and NECR are lower and IQ phantom’s BV is higher compared with larger axial FOV (AFOV) scanners like the 4-ring discovery MI, as expected from the smaller solid angle of the 3-ring system. The other NEMA performance parameters are all comparable with those of the larger AFOV scanners.
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Affiliation(s)
- Delphine Vandendriessche
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende, Ruddershove 10, 8000, Brugge, Belgium
| | - Jorge Uribe
- GE Healthcare, 3000 N Grandview Blvd W-1250, Waukesha, WI, 53188, USA
| | - Hugo Bertin
- GE Healthcare, Kouterveldstraat 20, 1831, Diegem, Belgium
| | - Frank De Geeter
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende, Ruddershove 10, 8000, Brugge, Belgium.
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12
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Willekens I, Vandecasteele SJ, Verhoeven K, De Geeter F. Bone scan findings in erythromelalgia. Hell J Nucl Med 2018; 21:151-152. [PMID: 30006649 DOI: 10.1967/s002449910807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/09/2018] [Indexed: 11/18/2022]
Abstract
The use of hyaluronic acid nanoshells has been proposed to encapsulate prodrugs and exploit the mechanisms of interactions between living cells, like endocytes or cancer cells and hyaluronic acid, which is a natural component of the extracellular matrix. In this review we describe the potential and the limits of this promising research trend and discuss the theoretical advantages of such an engineering approach. Is it a possible scalability to increase the efficacy and biodegradability of molecules like contrast media and radiotracers especially for neuroradiology and nuclear medicine studies.
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Affiliation(s)
- Inneke Willekens
- Dept. of Radiology, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende, Ruddershove 10, B-8000 Brugge, Belgium.
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13
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Van Damme K, De Coster L, Mermuys K, Van den Eeckhaut A, Walgraeve N, De Geeter F. Bone scan findings in calcific tendinitis at the gluteus maximus insertion: some illustrative cases. Radiol Case Rep 2017; 12:168-174. [PMID: 28228904 PMCID: PMC5310380 DOI: 10.1016/j.radcr.2016.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 11/14/2016] [Accepted: 11/22/2016] [Indexed: 12/30/2022] Open
Abstract
We describe the bone scan and single-photon emission computed tomography/computed tomography findings in calcific tendinitis of the gluteus maximus and discuss its pathophysiology. Although this tendinopathy is mostly self-limiting, awareness of this disease is important for 2 reasons. First, it may explain acute hip symptoms in patients in the resorptive phase of the calcifications. Second, it should be considered as a differential diagnosis for bone scan hot spots in the vicinity of the gluteus maximus tendon and for cortical erosion seen in that region on X-rays or CT.
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Affiliation(s)
- Karel Van Damme
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende Belgium, Ruddershove 10, Brugge 8000, Belgium
| | - Liesbeth De Coster
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende Belgium, Ruddershove 10, Brugge 8000, Belgium
| | - Koen Mermuys
- Department of Radiology, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende Belgium, Ruddershove 10, Brugge 8000, Belgium
| | - Anja Van den Eeckhaut
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende Belgium, Ruddershove 10, Brugge 8000, Belgium
| | - Natascha Walgraeve
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende Belgium, Ruddershove 10, Brugge 8000, Belgium
| | - Frank De Geeter
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende Belgium, Ruddershove 10, Brugge 8000, Belgium
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14
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Bourgeois S, Van Den Berghe I, De Geeter F. Incidental finding of silent appendicitis on (18)F-FDG PET/CT in a patient with small cell lung adenocarcinoma. Hell J Nucl Med 2016; 19:164-6. [PMID: 27331212 DOI: 10.1967/s002449910372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/20/2016] [Indexed: 11/18/2022]
Abstract
We report the incidental diagnosis of acute asymptomatic appendicitis on a fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography ((18)F-FDG PET/CT) performed for staging of a non small cell lung carcinoma. The patient was asymptomatic and laboratory tests were normal. The case illustrates: a) the possibility to diagnose appendicitis on (18)F-FDG PET/CT and b) the possibility of silent acute appendicitis, although this is a rare occurrence.
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Affiliation(s)
- Sophie Bourgeois
- Dept. of Nuclear Medicine, Algemeen Ziekenhuis, Sint-Jan Brugge-Oostende, Ruddershove 10, B-8000 Brugge, Belgium.
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15
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De Geeter F, Gykiere P. (18)F-FDG PET imaging of granulomatosis with polyangiitis -Wegener's Syndrome. Hell J Nucl Med 2016; 19:53-6. [PMID: 26929942 DOI: 10.1967/s002449910339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/08/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Granulomatosis with polyangiitis (GPA), formerly called Wegener's syndrome, is a vasculitis associated with antineutrophil cytoplasmic antibody and may occur in all ages but mostly in order adults. The organs most frequently involved are the ear, nose and throat (rhinitis, sinusitus, oral ulcers, chondritis), the lungs (nodules, sometimes cavitating, infiltrates, hilar adenopathy) and the kidneys (glomerulonephritis). As patients typically present with constitutional symptoms, the diagnosis can be challenging. We report the findings on position emission tomography/computed tomography (PET/CT) with fluorine-18-fluorodeoxyglucose ((18)F-FDG) in a patient with a limited form of GPA. CONCLUSION None of the findings on PET are specific for GPA, but in a given clinical context, they may contribute to early diagnosis. They may guide biopsy taking, and may determine the extent of the disease. During and after treatment, PET can be used to monitor disease activity.
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Affiliation(s)
- Frank De Geeter
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende Ruddershove 10, B-8000 Brugge, Belgium.
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16
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Abstract
The paper gives an overview of the literature data on uptake of fluorine-18-fluorodeoxyglucose ((18)F-FDG) into the different tissue lesions which may occur in granulomatosis with polyangiitis (formerly called Wegener's syndrome). It discusses the cellular mechanisms of such (18)F-FDG uptake, which provide a basis for its interpretation in the context of (18)F-FDG positron emission tomography (PET) for inflammatory conditions.
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Affiliation(s)
- Frank De Geeter
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan, Brugge-Oostende Ruddershove 10, B-8000 Brugge, Belgium.
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17
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Lauwyck J, Piette Y, Van Walleghem L, De Geeter F. IgG4-related disease: The utility of (18)F-FDG PET/CT in diagnosis and treatment. Hell J Nucl Med 2015; 18 Suppl 1:155-159. [PMID: 26672716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/01/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE IgG4-related disease (IgG4-RD) is a systemic mass-forming fibro-inflammatory condition which can affect nearly every organ system. Its pathophysiology remains incompletely understood, but affected tissues are characterized by a lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells which cause chronic inflammation, storiform fibrosis and phlebitis. These findings on histopathological specimens are considered the gold standard for the diagnosis. Clinical signs and symptoms largely depend upon organ involvement which can be singular or multiple, synchronous or metachronous. The organs most frequently involved are the pancreas (autoimmune pancreatitis (AIP), salivary and lacrimal glands (Mickulicz disease and sclerosing sialadenitis), biliary tree (sclerosing cholangitis or cholecystitis), retroperitoneum (retroperitoneal fibrosis), aorta (periaortic fibrosis), kidneys (interstitial nephritis) and thyroid (Riedel thyroiditis). Presentation is mostly subacute and general symptoms such as weight loss, asthenia or fever are moderate, but more prevalent in multi-organ disease. Lesions often mimic malignancy, but most respond well to steroid therapy. CONCLUSION In this contribution we present a rare entity of IgG4-RD and discuss the utility of fluorine-18-fluorodeoxyglucose ((18)F-FDG) Positron emission tomography/computed tomography (PET/CT) in the diagnosis and treatment of this condition.
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Affiliation(s)
- Justine Lauwyck
- Department of Rheumatology, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende, Ruddershove 10, B-8000 Brugge, Belgium.
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Willekens I, Walgraeve N, Goethals L, De Geeter F. Correlative bone imaging in a case of Schnitzler's syndrome and brief review of the literature. Hell J Nucl Med 2015; 18:71-73. [PMID: 25840575] [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] [Received: 02/15/2015] [Accepted: 03/20/2015] [Indexed: 06/04/2023]
Abstract
UNLABELLED Schnitzler's syndrome is a rare disease characterized by a monoclonal IgM (or IgG) paraprotein, a nonpruritic urticarial skin rash, and 2 (or 3) of the following: recurrent fever, objective signs of abnormal bone remodeling, elevated CRP level or leukocytosis, and a neutrophilic infiltrate on skin biopsy. It responds well to treatment with the interleukine-1-inhibitor anakinra. We report the bone scintigraphy and MRI findings in a 45 years old man with this syndrome and compare them with data from the literature. CONCLUSION None of the imaging findings are specific, but they lead to a differential diagnosis including infiltrative diseases (e.g. systemic mastocytosis or Erdheim-Chester disease) and dysplastic diseases (e.g. melorheostosis, Camurati-Engelmann disease or van Buchem disease). The bone scintigraphy pattern may be very suggestive of the correct diagnosis and of bone involvement in this syndrome.
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Affiliation(s)
- Inneke Willekens
- Department of Nuclear Medicine Algemeen Ziekenhuis, Sint-Jan Brugge-Oostende Ruddershove 10, B-8000 Brugge, Belgium.
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Decock A, De Geeter F, De Vriese A, Depaepe P, Van den Bruel A. A bone scan, no mistake! J Clin Endocrinol Metab 2014; 99:4447-8. [PMID: 25250637 DOI: 10.1210/jc.2014-2915] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Amelie Decock
- Division of Endocrinology, Department of Internal Medicine (A.D., A.V.d.B.), Department of Nuclear Medicine (F.D.G.), Division of Nephrology, Department of Internal Medicine (A.D.V.), and Department of Pathology (P.D.), General Hospital Sint-Jan, 8000 Bruges, Belgium
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Goethals LR, Bos TJ, Baeyens L, De Geeter F, Devoogdt N, Lahoutte T. Camelid reporter gene imaging: a generic method for in vivo cell tracking. EJNMMI Res 2014; 4:32. [PMID: 25024930 PMCID: PMC4086443 DOI: 10.1186/s13550-014-0032-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 03/20/2014] [Accepted: 06/03/2014] [Indexed: 11/17/2022] Open
Abstract
Background To combine the sensitivity of bioluminescent imaging (BLI) with the 3D and quantitative properties of pinhole single-photon emission computed tomography (SPECT)/micro-computed tomography (CT) (phSPECT/micro-CT), we generated stable cell lines that express a yellow-fluorescent protein (YFP) and Gaussia luciferase (GLuc) fusion protein (YFP/GLuc). For in vivo phSPECT detection of this YFP/GLuc protein, a nanobody, targeted against yellow and green fluorescent proteins (anti-YFP-Nb), was site specifically labelled with 99mTc. Methods Human embryonic kidney cells (HEK293T) were cultured and passaged every 3 days. 10E5 cells were transduced with YFP/GLuc-containing vector: both membrane-targeted (MT-YFP/GLuc) and non-targeted (YFP/GLuc) fusion proteins were developed. These vectors were compared against a SKOV-3 cell line stably expressing green fluorescent-firefly luciferase (GFP/Fluc) and HEK293T cells expressing red fluorescent protein in combination with a Gaussia luciferase (Red/GLuc). Transduction efficiencies were scored by fluorescence microscopy, and transduced cells were enriched by fluorescence-activated cell sorting (FACS). GLuc and FLuc functionality was tested in vitro by list-mode BLI. Subsequently, cells were transplanted subcutaneously in athymic (nu/nu) mice (MT-YFP/GLuc: n = 4, YFP/GLuc: n = 6, GFP/FLuc: n = 6, Red/GLuc: n = 4). Labelling efficiency of anti-YFP-Nb was measured using instant thin layer chromatography. One week after transplantation, 99mTc-labelled anti-YFP-Nb was injected intravenously and pinhole (ph) SPECT/micro-CT was performed, followed by in vivo BLI. Results Cells showed high levels of fluorescence after transduction. The cells containing the MT-YFP/GLuc were positive on fluorescence microscopy, with the fluorescent signal confined to the cell membrane. After cell sorting, transduced cells were assayed by BLI and showed a significantly higher light output both in vitro and in vivo compared with non-transduced HEK293T cells. The anti-YFP-Nb labelling efficiency was 98%, and subsequent phSPECT/micro-CT demonstrated visible cell binding and significantly higher transplant-to-muscle ratio for both the MT-YFP/GLuc and YFP/GLuc transplanted cells, compared with the GFP/FLuc and Red/GLuc group. Conclusion This study provides a proof of principle for a nanobody-based cell tracking method, using a YFP/GLuc fusion protein and anti-YFP-Nb in a model of subcutaneously transplanted transduced HEK293T cells.
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Affiliation(s)
- Lode Ry Goethals
- In Vivo Cellular and Molecular Imaging Laboratory, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette 1090, Belgium ; Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Jette 1090, Belgium
| | - Tomas J Bos
- Department of Cellular and Molecular Medicine, UC San Diego, 9500 Gilman Drive, La Jolla 92093, CA, USA
| | - Luc Baeyens
- Beta Cell Neogenesis, Vrije Universiteit Brussel, Laarbeeklaan103, Jette 1090, Belgium
| | - Frank De Geeter
- In Vivo Cellular and Molecular Imaging Laboratory, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette 1090, Belgium
| | - Nick Devoogdt
- In Vivo Cellular and Molecular Imaging Laboratory, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette 1090, Belgium
| | - Tony Lahoutte
- In Vivo Cellular and Molecular Imaging Laboratory, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette 1090, Belgium ; Department of Nuclear Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Jette 1090, Belgium
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Goethals LR, De Geeter F, Vanhove C, Roosens B, Devos H, Lahoutte T. Improved quantification in pinhole gated myocardial perfusion SPECT using micro-CT and ultrasound information. Contrast Media Mol Imaging 2012; 7:167-74. [PMID: 22434629 DOI: 10.1002/cmmi.477] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Absolute quantification using single photon emission computed tomography (SPECT) was demonstrated in vitro and in large immobile organs in vivo. To determine the feasibility of in vivo quantification of myocardial perfusion in pinhole gated SPECT, we added an ultrasound derived partial volume correction factor to attenuation and scatter corrections, in combination with gated acquisitions. In nine male Wistar rats, cardiac ultrasound was performed prior to SPECT/CT scans to determine the myocardial wall thickness. SPECT/CT scans were then performed 30 min after injection of (99m) Tc Tetrofosmin. Animals were killed and six midventricular segments of the left ventricle were excised and counted in a γ-well counter. Using AMIDE, regional myocardial activity was measured after combined scatter correction (SC) and attenuation correction (AC). These image derived activities were compared with the ex vivo counted activity. To correct for the partial volume effect, a recovery coefficient was determined from a phantom study, to determine the thickness specific partial volume effect. Combined AC and SC led to a significant underestimation of activity compared with ex vivo data (root mean squared error = 0.145 mCi g(-1)). The recovery coefficient calculated from the phantom study showed a linear relationship with object size from 1 to 6 mm, positioned in the vicinity of the center of the field of view (R(2) = 0.98). Correction of nongated SPECT images with a recovery coefficient derived from the diastolic phase results in a global overestimation with root mean squared error = 0.04 mCi g(-1). Nongated SPECT images corrected with a recovery coefficient with a weighted average ratio diastolic and systolic phase led to an improved root mean squared error of 0.03 mCi g(-1). Combining attenuation correction with scatter correction and a gated partial volume correction yields the best correlation with ex vivo counting (root mean squared error = 0.021 mCi g(-1) (systolic) and 0.025 mCi g(-1) (diastolic). This study demonstrates a method for improved segmental myocardial perfusion quantification in pinhole gated SPECT, using combined attenuation-, scatter- and ultrasound-derived partial volume effect corrections.
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Affiliation(s)
- Lode R Goethals
- Department of Radiology, University Hospital Brussels, Brussels, Belgium.
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Debonnaire P, De Backer O, De Geeter F, Delanote J, Vandekerckhove Y, Muyldermans L. Multimodality Imaging of Cardiac Involvement in Neurofibromatosis. J Am Coll Cardiol 2011; 57:e209. [DOI: 10.1016/j.jacc.2010.08.651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 08/05/2010] [Accepted: 08/10/2010] [Indexed: 11/28/2022]
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Goethals L, Wilgenhof S, De Geeter F, Everaert H, Neyns B. 18F-FDG PET/CT imaging of an anti-CTLA-4 antibody-associated autoimmune pancolitis. Eur J Nucl Med Mol Imaging 2011; 38:1390-1. [PMID: 21365253 DOI: 10.1007/s00259-011-1749-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 01/31/2011] [Indexed: 02/07/2023]
Affiliation(s)
- Lode Goethals
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
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De Geeter F, Goethals L. Unilateral breast uptake of 99mTc-pertechnetate. Hell J Nucl Med 2011; 14:76-77. [PMID: 21512675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Goethals LR, Santos I, Caveliers V, Paulo A, De Geeter F, Lurdes PG, Fernandes C, Lahoutte T. Rapid hepatic clearance of 99mTc-TMEOP: a new candidate for myocardial perfusion imaging. Contrast Media Mol Imaging 2010; 6:178-88. [DOI: 10.1002/cmmi.413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 06/29/2010] [Accepted: 07/29/2010] [Indexed: 11/06/2022]
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De Geeter F, Goethals L. Utility of pelvic bone SPET in imaging urinary bladder filling defects in urinary bladder carcinoma. Hell J Nucl Med 2010; 13:59-62. [PMID: 20411174] [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] [Received: 11/29/2009] [Accepted: 01/04/2010] [Indexed: 05/29/2023]
Abstract
Urinary bladder carcinoma sometimes can be recognized on bone scans as a filling defect in the bladder. This paper illustrates in three patients that the filling defects of urinary bladder on pelvic bone single photon emission tomography (SPET) scans in cases of bladder carcinoma correspond to those on computerized tomography (CT). In one patient, the void sign could only be discerned on the SPET images, but not on the planar images. In the same patient, the filling defect was almost entirely surrounded by urinary activity, suggesting an intrinsic bladder lesion. The differential diagnosis of filling defects is presented. The above findings are compared to other related studies, although we have found no similar cases in the literature. When compared with CT, pelvic SPET is more sensitive than planar imaging in recognizing bladder filling defects on bone scans and may allow distinguish between intrinsic and extrinsic bladder lesions.
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Affiliation(s)
- Frank De Geeter
- Department of Nuclear Medicine, Saint-John's General Hospital, 8000 Brugge, Belgium.
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Goethals LR, Weytjens CD, De Geeter F, Droogmans S, Caveliers V, Keyaerts M, Vanhove C, Van Camp G, Bossuyt A, Lahoutte T. Regional quantitative analysis of small animal myocardial sympathetic innervation and initial application in streptozotocin induced diabetes. Contrast Media Mol Imaging 2009; 4:174-82. [DOI: 10.1002/cmmi.278] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hollevoet K, Bernard D, De Geeter F, Walgraeve N, Van den Eeckhaut A, Vanholder R, Van de Wiele C, Stove V, van Meerbeeck JP, Delanghe JR. Glomerular filtration rate is a confounder for the measurement of soluble mesothelin in serum. Clin Chem 2009; 55:1431-3. [PMID: 19406915 DOI: 10.1373/clinchem.2008.121913] [Citation(s) in RCA: 27] [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] [Indexed: 11/06/2022]
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Coenegrachts K, De Geeter F, ter Beek L, Walgraeve N, Bipat S, Stoker J, Rigauts H. Comparison of MRI (including SS SE-EPI and SPIO-enhanced MRI) and FDG-PET/CT for the detection of colorectal liver metastases. Eur Radiol 2008; 19:370-9. [PMID: 18795299 DOI: 10.1007/s00330-008-1163-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 08/21/2008] [Accepted: 08/23/2008] [Indexed: 12/21/2022]
Abstract
Fluoro-18-deoxyglucose positron emission tomography computed tomography (FDG-PET/CT) and magnetic resonance imaging (MRI), including unenhanced single-shot spin-echo echo planar imaging (SS SE-EPI) and small paramagnetic iron oxide (SPIO) enhancement, were compared prospectively for detecting colorectal liver metastases. Twenty-four consecutive patients suspected for metastases underwent MRI and FDG-PET/CT. Fourteen patients (58%) had previously received chemotherapy, including seven patients whose chemotherapy was still continuing to within 1 month of the PET/CT study. The mean interval between PET/CT and MRI was 10.2+/-5.2 days. Histopathology (n=18) or follow-up imaging (n=6) were used as reference. Seventy-seven metastases were detected. In nine patients, MRI and PET/CT gave concordant results. Sensitivities for unenhanced SS SE-EPI, MRI without SS SE-EPI and FDG-PET/CT were, respectively, 100% (p=9 x 10(-10) vs PET, p=8 x 10(-3) vs MRI without SS SE-EPI), 90% (p=2 x 10(-7) vs PET) and 60%. PET/CT sensitivity dropped significantly with decreasing size, from 100% in lesions larger than 20 mm (identical to MRI), over 54% in lesions between 10 and 20 mm (p=3 x 10(5) versus unenhanced SS SE-EPI), to 32% in lesions under 10 mm (p=6 x 10(-5) versus unenhanced SS SE-EPI). Positive predictive value of PET was 100% (identical to MRI). MRI, particularly unenhanced SS SE-EPI, has good sensitivity and positive predictive value for detecting liver metastases from colorectal carcinoma. Its sensitivity is better than that of FDG-PET/CT, especially for small lesions.
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Affiliation(s)
- Frank De Geeter
- Department of Nuclear Medicine, Saint-John's General Hospital, Brugge, Belgium.
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De Geeter F. Visualization of an insect bite on a bone scan. Clin Nucl Med 2006; 32:51-2. [PMID: 17179807 DOI: 10.1097/01.rlu.0000249626.11115.2a] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Frank De Geeter
- Department of Nuclear Medicine, Saint-John's General Hospital, Brugge, Belgium.
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Wuyts B, Bernard D, Van den Noortgate N, Van de Walle J, Van Vlem B, De Smet R, De Geeter F, Vanholder R, Delanghe JR. Reevaluation of formulas for predicting creatinine clearance in adults and children, using compensated creatinine methods. Clin Chem 2003; 49:1011-4. [PMID: 12766016 DOI: 10.1373/49.6.1011] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Birgitte Wuyts
- Department of Clinical Chemistry, Ghent University Hospital, De Pintelaan 185, B9000 Gent, Belgium
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Vanhove C, Walgraeve N, De Geeter F, Franken PR. Gated myocardial perfusion tomography versus gated blood pool tomography for the calculation of left ventricular volumes and ejection fraction. Eur J Nucl Med Mol Imaging 2002; 29:735-41. [PMID: 12029546 DOI: 10.1007/s00259-002-0792-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/26/2022]
Abstract
Left ventricular (LV) volume, and not only ejection fraction (EF), is a crucial parameter for assessing the severity of cardiac disease and determining the patient's prognosis. The purpose of this study was to compare LV volumes and EF computed automatically from gated blood pool tomography (gBPT), using QUBE, and from gated myocardial perfusion tomography (gMPT), using QGS, in the same patients with a known history of myocardial infarction. The effects of the extent and severity of the myocardial perfusion defects were investigated. Thirty-seven patients were injected in a random sequence with 740 MBq of technetium-99m human serum albumin and 925 MBq of (99m)Tc-tetrofosmin, within an interval of 2 days. gBPT and gMPT were acquired on the same triple-head gamma camera using the following acquisition parameters: 360 degrees step-and shoot rotation, 32 stops (96 projections), 30 s per stop, 64x64 matrix (pixel size 5.8 mm), 8 time bins (75% forward/backward framing). Projection data were reconstructed by filtered back-projection using a Butterworth filter. LV volumes calculated from gBPT correlated well with LV volumes measured on gMPT ( r=0.93 for end-diastolic volume and 0.95 for end-systolic volume). Volumes above 200 ml, however, were substantially higher with gMPT than with gBPT. These discrepancies were related to the severity, but not the extent, of the perfusion defects. There was also good agreement between gBPT and gMPT for the LVEF ( r=0.91). On the Bland-Altman plot, no trend but a systematic error of 5.57% and a random error of 6.85% could be found. For the LVEF, the differences between the gated tomographic techniques were related neither to the extent nor to the severity of the perfusion defects. In conclusion, LV volumes and EF computed on gMPT correlated well with those measured on gBPT. Discrepancies were observed for large volumes presumably because of inaccuracies of gMPT in patients with severe perfusion defects.
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Affiliation(s)
- Christian Vanhove
- Division of Nuclear Medicine, University Hospital, Free University of Brussels (AZ VUB), 101 Laarbeeklaan, 1090 Brussels, Belgium.
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Geeter FD, Franken PR, Defrise M, Andries H, Saelens E, Bossuyt A. Optimal collimator choice for sequential iodine-123 and technetium-99m imaging. Eur J Nucl Med 1996; 23:768-74. [PMID: 8662115 DOI: 10.1007/bf00843705] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Dual-isotope studies with technetium-99m and iodine-123 may be useful for various organs, including brain and myocardium. For the images obtained with each of the tracers to be comparable, it is important that activity ratios (activity in one part of the image/reference activity in the image) are preserved by the imaging method. We have used a Rollo phantom to study how collimator response affects such ratios. All investigations were performed with 123I(p,5n) and on a Siemens Orbiter 3700 camera fitted with either a low-energy high-resolution (LEHR) or a medium-energy (ME) collimator. Images were made of a Rollo phantom filled with an aqueous solution of either 99Tc or 123I, and placed on the collimator surface with 8 cm of methyl-methacrylate interposed. Count densities were measured in ROIs drawn in each cell of the phantom, and normalised to the maximal ROI value in the image. The mean square error (MSE) was used to assess how well the ratios of count densities approximated the known activity ratios based on the dimensions of the cells of the phantom. For 99mTc, regardless of the collimator used, the count density ratios approximated the activity ratios fairly well (LEHR: MSE=0.008; ME: MSE=0.020). For 123I, count density ratios obtained with the LEHR were consistently higher than activity ratios (MSE=0. 235), whereas the differences between the measured and the theoretical values were less with the ME collimator (MSE=0.013). Contrast fidelity of the 123I images obtained with the LEHR collimator could be improved with Jaszczak scatter correction with k=1, but this led to unfavourable signal-to-noise ratios. For sequential 99mTc/123I studies with extended sources, ME is to be preferred because of its higher contrast accuracy. Spatial resolution is less for the ME than for the LEHR collimator (FWHM with scatter: LEHR/99mTc=6.9 mm, LEHR/123I=7.4 mm, ME/99mTc= 10.1 mm, ME/123I=11.1 mm), but remains similar for both tracers when the ME is used.
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Affiliation(s)
- F D Geeter
- Department of Nuclear Medicine, University Hospital, Free University of Brussels (VUB), Brussels, Belgium
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