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Lamba A, Roston TM, Peltenburg PJ, Kallas D, Franciosi S, Lieve KVV, Kannankeril PJ, Horie M, Ohno S, Brugada R, Aiba T, Fischbach P, Knight L, Till J, Kwok SY, Probst V, Backhoff D, LaPage MJ, Batra AS, Drago F, Haugaa K, Krahn AD, Robyns T, Swan H, Tavacova T, Atallah J, Borggrefe M, Rudic B, Sarquella-Brugada G, Chorin E, Hill A, Kammeraad J, Kamp A, Law I, Perry J, Roberts JD, Tisma-Dupanovic S, Semsarian C, Skinner JR, Tfelt-Hansen J, Denjoy I, Leenhardt A, Schwartz PJ, Ackerman MJ, Wilde AAM, van der Werf C, Sanatani S. An international multicenter cohort study on implantable cardioverter-defibrillators for the treatment of symptomatic children with catecholaminergic polymorphic ventricular tachycardia. Heart Rhythm 2024:S1547-5271(24)02323-3. [PMID: 38588993 DOI: 10.1016/j.hrthm.2024.04.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Catecholaminergic polymorphic ventricular tachycardia (CPVT) may cause sudden cardiac death (SCD) despite medical therapy. Therefore, implantable cardioverter-defibrillators (ICDs) are commonly advised. However, there are limited data on the outcomes of ICD use in children. OBJECTIVE The purpose of this study was to compare the risk of arrhythmic events in pediatric patients with CPVT with and without ICD. METHODS We compared the risk of SCD in patients with RYR2 (ryanodine receptor 2) variants and phenotype-positive symptomatic patients with CPVT with and without ICD who were younger than 19 years and had no history of sudden cardiac arrest at phenotype diagnosis. The primary outcome was SCD; secondary outcomes were composite end points of SCD, sudden cardiac arrest, or appropriate ICD shocks with or without arrhythmic syncope. RESULTS The study included 235 patients, 73 with ICD (31.1%) and 162 without ICD (68.9%). Over a median follow-up of 8.0 years (interquartile range 4.3-13.4 years), SCD occurred in 7 patients (3.0%), of whom 4 (57.1%) were noncompliant with medications and none had an ICD. Patients with ICD had a higher risk of both secondary composite outcomes (without syncope: hazard ratio 5.85; 95% confidence interval 3.40-10.09; P < .0001; with syncope: hazard ratio 2.55; 95% confidence interval 1.50-4.34; P = .0005). Thirty-one patients with ICD (42.5%) experienced appropriate shocks, 18 (24.7%) inappropriate shocks, and 21 (28.8%) device-related complications. CONCLUSION SCD events occurred only in the no ICD group and in those not on optimal medical therapy. Patients with ICD had a high risk of appropriate and inappropriate shocks, which may be reduced with appropriate device programming. Severe ICD complications were common, and risks vs benefits of ICDs need to be considered.
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Affiliation(s)
- Avani Lamba
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas M Roston
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada; Center for Cardiovascular Innovation, Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Puck J Peltenburg
- Amsterdam UMC, University of Amsterdam, Heart Centre; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Dania Kallas
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonia Franciosi
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Krystien V V Lieve
- Amsterdam UMC, University of Amsterdam, Heart Centre; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Prince J Kannankeril
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Centre, Nashville, Tennessee
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Seiko Ohno
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan; Department of Bioscience and Genetics, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Ramon Brugada
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain, Cardiovascular Genetics Center, Institut d'Investigació Biomèdica Girona (IDIBGI), University of Girona, Girona, Spain, Medical Science Department, School of Medicine, University of Girona, Girona, Spain, Cardiology Service, Hospital Josep Trueta, Girona, Spain
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Peter Fischbach
- Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Linda Knight
- Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Jan Till
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Sit-Yee Kwok
- Hong Kong Children's Hospital, Hong Kong, SAR, China
| | - Vincent Probst
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | | | | | - Anjan S Batra
- Division of Cardiology, Department of Pediatrics, Irvine and Children's Hospital of Orange County, University of California, Orange, California
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Palidoro-Rome, Italy
| | - Kristina Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway, Department of Cardiology, Karolinska University Hospital, Solna, Sweden, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tomas Robyns
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Heikki Swan
- Heart and Lung Centre, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Terezia Tavacova
- Department of Pediatric Cardiology, Children's Heart Centre, Second Faculty of Medicine, Charles University in Prague; Motol University Hospital, Prague, Czech Republic
| | - Joseph Atallah
- Cardiology, Faculty of Medicine & Dentistry - Pediatrics Department, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Martin Borggrefe
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany, German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Boris Rudic
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain, Medical Science Department, School of Medicine, Universitat de Girona, Girona, Spain
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain, Medical Science Department, School of Medicine, Universitat de Girona, Girona, Spain
| | - Ehud Chorin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Allison Hill
- Children's Hospital Los Angeles, Los Angeles, California
| | - Janneke Kammeraad
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France; Department of Pediatric Cardiology, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - Anna Kamp
- Nationwide Children's Hospital, Columbus, Ohio
| | - Ian Law
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - James Perry
- Rady Children's Hospital, San Diego, California
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada, Population Health Research Institute, Hamilton Health Sciences, and McMaster University, Hamilton, Ontario, Canada
| | | | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group New Zealand, Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand, Department of Paediatrics Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Isabelle Denjoy
- Service de Cardiologie et CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, APHP, Université de Paris Cité, Paris, France
| | - Antoine Leenhardt
- Service de Cardiologie et CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, APHP, Université de Paris Cité, Paris, France
| | - Peter J Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics; Division of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Arthur A M Wilde
- Amsterdam UMC, University of Amsterdam, Heart Centre; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Christian van der Werf
- Amsterdam UMC, University of Amsterdam, Heart Centre; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Shubhayan Sanatani
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.
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Galldiks N, Kaufmann TJ, Vollmuth P, Lohmann P, Smits M, Veronesi MC, Langen KJ, Rudá R, Albert NL, Hattingen E, Law I, Hutterer M, Soffietti R, Vogelbaum MA, Wen PY, Weller M, Tonn JC. Challenges, Limitations and Pitfalls of PET and Advanced MRI in Patients with Brain Tumors - A Report of the PET/RANO Group. Neuro Oncol 2024:noae049. [PMID: 38466087 DOI: 10.1093/neuonc/noae049] [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: 11/14/2023] [Indexed: 03/12/2024] Open
Abstract
Brain tumor diagnostics have significantly evolved with the use of PET and advanced MRI techniques. In addition to anatomical MRI, these modalities may provide valuable information for several clinical applications such as differential diagnosis, delineation of tumor extent, prognostication, differentiation between tumor relapse and treatment-related changes, and the evaluation of response to anticancer therapy. In particular, joint recommendations of the RANO group, the EANO, and major European and American Nuclear Medicine societies highlighted that the additional clinical value of radiolabeled amino acids compared to anatomical MRI alone is outstanding and that its widespread clinical use should be supported. For advanced MRI and its steadily increasing use in clinical practice, the Standardization Subcommittee of the Jumpstarting Brain Tumor Drug Development Coalition provided more recently an updated acquisition protocol for the widely used dynamic susceptibility contrast perfusion MRI. Besides amino acid PET and perfusion MRI, other PET tracers and advanced MRI techniques (e.g., MR spectroscopy) are of considerable clinical interest and are increasingly integrated into everyday clinical practice. Nevertheless, these modalities have shortcomings which should be considered in clinical routine. This comprehensive review provides an overview of potential challenges, limitations and pitfalls associated with PET imaging and advanced MRI techniques in patients with gliomas or brain metastases. Despite these issues, PET imaging and advanced MRI techniques continue to play an indispensable role in brain tumor management. Acknowledging and mitigating these challenges through interdisciplinary collaboration, standardized protocols, and continuous innovation will further enhance the utility of these modalities in guiding optimal patient care.
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Affiliation(s)
- Norbert Galldiks
- Dept. of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Inst. of Neuroscience and Medicine (INM-3, INM-4), Research Center Juelich, Juelich, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Germany
| | | | - Philipp Vollmuth
- Dept. of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
- Dept. of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Philipp Lohmann
- Inst. of Neuroscience and Medicine (INM-3, INM-4), Research Center Juelich, Juelich, Germany
| | - Marion Smits
- Dept. of Radiology and Nuclear Medicine and Brain Tumour Center, Erasmus MC, Rotterdam, The Netherlands
| | - Michael C Veronesi
- Dept. of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Karl-Josef Langen
- Inst. of Neuroscience and Medicine (INM-3, INM-4), Research Center Juelich, Juelich, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Germany
- Dept. of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Roberta Rudá
- Division of Neuro-Oncology, Dept. of Neuroscience, University of Turin, Turin, Italy
| | - Nathalie L Albert
- Dept. of Nuclear Medicine, LMU Hospital, Ludwig Maximilians-University of Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elke Hattingen
- Goethe University, Dept. of Neuroradiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Ian Law
- Dept. of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Markus Hutterer
- Dept. of Neurology with Acute Geriatrics, Saint John of God Hospital, Linz, Austria
| | - Riccardo Soffietti
- Division of Neuro-Oncology, Dept. of Neuroscience, University of Turin, Turin, Italy
| | - Michael A Vogelbaum
- Dept. of Neuro-Oncology and Neurosurgery, Moffit Cancer Center, Tampa, Florida, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Michael Weller
- Dept. of Neurology, Clinical Neuroscience Center, and University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Joerg-Christian Tonn
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Dept. of Neurosurgery, University Hospital of Munich (LMU), Munich, Germany
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Feng LR, Waldemar G, Hasselbalch SG, Vogel A, Henriksen OM, Law I, Frederiksen KS. The cingulate island sign in a mixed memory clinical cohort: Prevalence and diagnostic accuracy. Parkinsonism Relat Disord 2024; 122:106062. [PMID: 38452445 DOI: 10.1016/j.parkreldis.2024.106062] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/15/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Visual rating of the cingulate island sign (CIS) on [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) has a high specificity for dementia with Lewy bodies (DLB) in selected cohorts such as DLB versus Alzheimer's disease (AD). In a mixed memory clinical population this study aimed to uncover the prevalence of CIS, the diagnostic accuracy for DLB, and the relationship between CIS and disease severity. METHODS CIS on [18F]FDG-PET was retrospectively assessed with the visual CIS rating scale (CISRs) in 1000 patients with a syndrome diagnosis of mild cognitive impairment (MCI) or dementia with no restrictions in etiological diagnosis. RESULTS In this cohort 24.3 % had a CISRs score ≥1 and 3.5 % had a CISRs score = 4. The prevalence of a CISRs score ≥1 was highest in DLB (74.0 %, n = 57). A CISRs score ≥1 was present in at least 9 % in other diagnostic groups. The prevalence of CIS across disease severities showed no statistically significant difference (p = 0.23). To differentiate DLB from non-DLB the optimal cut-off was a CISRs score ≥1 (balanced accuracy = 77.1 %) in MCI/mild dementia and a CISRs score ≥2 (balanced accuracy = 80.6 %) in moderate/severe dementia. The positive predictive value of a CISRs score = 4 for DLB was 57.7 % in MCI/mild dementia and 33.3 % in moderate/severe dementia. CONCLUSION The CISRs is useful in differentiating DLB from other etiologies in a mixed memory clinical population. Balanced accuracy and positive predictive value may vary across disease severities in the population studied.
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Affiliation(s)
- Linda Ruohua Feng
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Steen Gregers Hasselbalch
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Asmus Vogel
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Otto Mølby Henriksen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kristian Steen Frederiksen
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
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Traub-Weidinger T, Arbizu J, Barthel H, Boellaard R, Borgwardt L, Brendel M, Cecchin D, Chassoux F, Fraioli F, Garibotto V, Guedj E, Hammers A, Law I, Morbelli S, Tolboom N, Van Weehaeghe D, Verger A, Van Paesschen W, von Oertzen TJ, Zucchetta P, Semah F. EANM practice guidelines for an appropriate use of PET and SPECT for patients with epilepsy. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06656-3. [PMID: 38393374 DOI: 10.1007/s00259-024-06656-3] [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: 11/01/2023] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
Epilepsy is one of the most frequent neurological conditions with an estimated prevalence of more than 50 million people worldwide and an annual incidence of two million. Although pharmacotherapy with anti-seizure medication (ASM) is the treatment of choice, ~30% of patients with epilepsy do not respond to ASM and become drug resistant. Focal epilepsy is the most frequent form of epilepsy. In patients with drug-resistant focal epilepsy, epilepsy surgery is a treatment option depending on the localisation of the seizure focus for seizure relief or seizure freedom with consecutive improvement in quality of life. Beside examinations such as scalp video/electroencephalography (EEG) telemetry, structural, and functional magnetic resonance imaging (MRI), which are primary standard tools for the diagnostic work-up and therapy management of epilepsy patients, molecular neuroimaging using different radiopharmaceuticals with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) influences and impacts on therapy decisions. To date, there are no literature-based praxis recommendations for the use of Nuclear Medicine (NM) imaging procedures in epilepsy. The aims of these guidelines are to assist in understanding the role and challenges of radiotracer imaging for epilepsy; to provide practical information for performing different molecular imaging procedures for epilepsy; and to provide an algorithm for selecting the most appropriate imaging procedures in specific clinical situations based on current literature. These guidelines are written and authorized by the European Association of Nuclear Medicine (EANM) to promote optimal epilepsy imaging, especially in the presurgical setting in children, adolescents, and adults with focal epilepsy. They will assist NM healthcare professionals and also specialists such as Neurologists, Neurophysiologists, Neurosurgeons, Psychiatrists, Psychologists, and others involved in epilepsy management in the detection and interpretation of epileptic seizure onset zone (SOZ) for further treatment decision. The information provided should be applied according to local laws and regulations as well as the availability of various radiopharmaceuticals and imaging modalities.
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Affiliation(s)
- Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Javier Arbizu
- Department of Nuclear Medicine, University of Navarra Clinic, Pamplona, Spain
| | - Henryk Barthel
- Department of Nuclear Medicine, Leipzig University Medical Centre, Leipzig, Germany
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Lise Borgwardt
- Department of Clinical Physiology and Nuclear Medicine, University of Copenhagen, Blegdamsvej 9, DK-2100, RigshospitaletCopenhagen, Denmark
| | - Matthias Brendel
- Department of Nuclear Medicine, Ludwig Maximilian-University of Munich, Munich, Germany
- DZNE-German Center for Neurodegenerative Diseases, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine-DIMED, University-Hospital of Padova, Padova, Italy
| | - Francine Chassoux
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, 91401, Orsay, France
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London (UCL), London, UK
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland
- NIMTLab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Center for Biomedical Imaging (CIBM), Geneva, Switzerland
| | - Eric Guedj
- APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix Marseille Univ, Marseille, France
| | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London & Guy's and St Thomas' PET Centre, King's College London, London, UK
| | - Ian Law
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Silvia Morbelli
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Nelleke Tolboom
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU Nancy, Université de Lorraine, IADI, INSERM U1254, Nancy, France
| | - Wim Van Paesschen
- Laboratory for Epilepsy Research, KU Leuven and Department of Neurology, University Hospitals, Leuven, Belgium
| | - Tim J von Oertzen
- Depts of Neurology 1&2, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine-DIMED, University-Hospital of Padova, Padova, Italy
| | - Franck Semah
- Nuclear Medicine Department, University Hospital, Inserm, CHU Lille, U1172-LilNCog-Lille, F-59000, Lille, France.
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Larsson HBW, Law I, Andersen TL, Andersen FL, Fischer BM, Vestergaard MB, Larsson TSW, Lindberg U. Brain perfusion estimation by Tikhonov model-free deconvolution in a long axial field of view PET/CT scanner exploring five different PET tracers. Eur J Nucl Med Mol Imaging 2024; 51:707-720. [PMID: 37843600 PMCID: PMC10796558 DOI: 10.1007/s00259-023-06469-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE New total-body PET scanners with a long axial field of view (LAFOV) allow for higher temporal resolution due to higher sensitivity, which facilitates perfusion estimation by model-free deconvolution. Fundamental tracer kinetic theory predicts that perfusion can be estimated for all tracers despite their different fates given sufficiently high temporal resolution of 1 s or better, bypassing the need for compartment modelling. The aim of this study was to investigate whether brain perfusion could be estimated using model-free Tikhonov generalized deconvolution for five different PET tracers, [15O]H2O, [11C]PIB, [18F]FE-PE2I, [18F]FDG and [18F]FET. To our knowledge, this is the first example of a general model-free approach to estimate cerebral blood flow (CBF) from PET data. METHODS Twenty-five patients underwent dynamic LAFOV PET scanning (Siemens, Quadra). PET images were reconstructed with an isotropic voxel resolution of 1.65 mm3. Time framing was 40 × 1 s during bolus passage followed by increasing framing up to 60 min. AIF was obtained from the descending aorta. Both voxel- and region-based calculations of perfusion in the thalamus were performed using the Tikhonov method. The residue impulse response function was used to estimate the extraction fraction of tracer leakage across the blood-brain barrier. RESULTS CBF ranged from 37 to 69 mL blood min-1 100 mL of tissue-1 in the thalamus. Voxelwise calculation of CBF resulted in CBF maps in the physiologically normal range. The extraction fractions of [15O]H2O, [18F]FE-PE2I, [11C]PIB, [18F]FDG and [18F]FET in the thalamus were 0.95, 0.78, 0.62, 0.19 and 0.03, respectively. CONCLUSION The high temporal resolution and sensitivity associated with LAFOV PET scanners allow for noninvasive perfusion estimation of multiple tracers. The method provides an estimation of the residue impulse response function, from which the fate of the tracer can be studied, including the extraction fraction, influx constant, volume of distribution and transit time distribution, providing detailed physiological insight into normal and pathologic tissue.
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Affiliation(s)
- Henrik Bo Wiberg Larsson
- Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Ian Law
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Thomas L Andersen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Flemming L Andersen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Barbara M Fischer
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Mark B Vestergaard
- Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
| | - Tanne S W Larsson
- Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
| | - Ulrich Lindberg
- Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
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Mirian C, Jensen LR, Juratli TA, Maier AD, Torp SH, Shih HA, Morshed RA, Young JS, Magill ST, Bertero L, Stummer W, Spille DC, Brokinkel B, Oya S, Miyawaki S, Saito N, Proescholdt M, Kuroi Y, Gousias K, Simon M, Moliterno J, Prat-Acin R, Goutagny S, Prabhu VC, Tsiang JT, Wach J, Güresir E, Yamamoto J, Kim YZ, Lee JH, Koshy M, Perumal K, Baskaya MK, Cannon DM, Shrieve DC, Suh CO, Chang JH, Kamenova M, Straumann S, Soleman J, Eyüpoglu IY, Catalan T, Lui A, Theodosopoulos PV, McDermott MW, Wang F, Guo F, Góes P, de Paiva Neto MA, Jamshidi A, Komotar R, Ivan M, Luther E, Souhami L, Guiot MC, Csonka T, Endo T, Barrett OC, Jensen R, Gupta T, Patel AJ, Klisch TJ, Kim JW, Maiuri F, Barresi V, Tabernero MD, Skyrman S, Broechner A, Bach MJ, Law I, Scheie D, Kristensen BW, Munch TN, Meling T, Fugleholm K, Blanche P, Mathiesen T. The importance of considering competing risks in recurrence analysis of intracranial meningioma. J Neurooncol 2024; 166:503-511. [PMID: 38336917 PMCID: PMC10876814 DOI: 10.1007/s11060-024-04572-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The risk of recurrence is overestimated by the Kaplan-Meier method when competing events, such as death without recurrence, are present. Such overestimation can be avoided by using the Aalen-Johansen method, which is a direct extension of Kaplan-Meier that accounts for competing events. Meningiomas commonly occur in older individuals and have slow-growing properties, thereby warranting competing risk analysis. The extent to which competing events are considered in meningioma literature is unknown, and the consequences of using incorrect methodologies in meningioma recurrence risk analysis have not been investigated. METHODS We surveyed articles indexed on PubMed since 2020 to assess the usage of competing risk analysis in recent meningioma literature. To compare recurrence risk estimates obtained through Kaplan-Meier and Aalen-Johansen methods, we applied our international database comprising ~ 8,000 patients with a primary meningioma collected from 42 institutions. RESULTS Of 513 articles, 169 were eligible for full-text screening. There were 6,537 eligible cases from our PERNS database. The discrepancy between the results obtained by Kaplan-Meier and Aalen-Johansen was negligible among low-grade lesions and younger individuals. The discrepancy increased substantially in the patient groups associated with higher rates of competing events (older patients with high-grade lesions). CONCLUSION The importance of considering competing events in recurrence risk analysis is poorly recognized as only 6% of the studies we surveyed employed Aalen-Johansen analyses. Consequently, most of the previous literature has overestimated the risk of recurrence. The overestimation was negligible for studies involving low-grade lesions in younger individuals; however, overestimation might have been substantial for studies on high-grade lesions.
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Affiliation(s)
- Christian Mirian
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Lasse Rehné Jensen
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tareq A Juratli
- Department of Neurosurgery, Division of Neuro-Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
- Department of Neurosurgery, Laboratory of Translational Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Andrea Daniela Maier
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Pathology, Bartholin Institute, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark
| | - Sverre H Torp
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian, University of Science and Technology (NTNU), Laboratory Centre, St. Olavs Hospital, NO-7491, Trondheim, Norway
- Department of Pathology, Laboratory Centre, St. Olavs Hospital, NO-7030, Trondheim, Norway
| | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ramin A Morshed
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jacob S Young
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Stephen T Magill
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Illinois, USA
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University and Città Della Salute E Della Scienza University Hospital of Turin, Turin, Italy
| | - Walter Stummer
- Department of Neurosurgery, University of Münster, Münster, Germany
| | | | - Benjamin Brokinkel
- Department of Neurosurgery, University of Münster, Münster, Germany
- Institute for Neuropathology, University of Münster, Münster, Germany
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center/University, Saitama, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Martin Proescholdt
- Department of Neurosurgery, University Regensburg Medical Center, Regensburg, Germany
| | - Yasuhiro Kuroi
- Department of Neurosurgery, Adachi Medical Center, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Matthias Simon
- Department of Neurosurgery, Bethel Clinic University of Bielefeld Medical Center, Bielefeld, Germany
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine Yale New Haven Hospital, Smilow Cancer Hospital, New Haven, USA
| | | | - Stéphane Goutagny
- Department of Neurosurgery, Université Paris Cité, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Vikram C Prabhu
- Department of Neurological Surgery, Loyola University Medical Center, Stritch School of Medicine, Illinois, USA
| | - John T Tsiang
- Department of Neurological Surgery, Loyola University Medical Center, Stritch School of Medicine, Illinois, USA
| | - Johannes Wach
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Junkoh Yamamoto
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Young Zoon Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Matthew Koshy
- Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Illinois, USA
| | - Karthikeyan Perumal
- Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mustafa K Baskaya
- Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Donald M Cannon
- Department of Radiation Oncology Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Dennis C Shrieve
- Department of Radiation Oncology Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Maria Kamenova
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Sven Straumann
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Ilker Y Eyüpoglu
- Department of Neurosurgery, Division of Neuro-Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
| | - Tony Catalan
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Austin Lui
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Philip V Theodosopoulos
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Michael W McDermott
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Division of Neurosurgery, Miami Neuroscience Institute, Miami, FL, USA
| | - Fang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Fuyou Guo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Pedro Góes
- Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | | | - Aria Jamshidi
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Michael Ivan
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Evan Luther
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Luis Souhami
- Division of Radiation Oncology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | | | - Tamás Csonka
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Toshiki Endo
- Division of Neurosurgery, Tohoku Medical and Pharmaceutical University, Tohoku, Japan
| | | | - Randy Jensen
- Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Tejpal Gupta
- Department of Radiation Oncology ACTREC, Tata Memorial Centre, HBNI Kharghar, Navi Mumbai, 410210, India
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX , USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX , USA
| | - Tiemo J Klisch
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX , USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Francesco Maiuri
- Department of Neurosurgery, University of Naples Federico II, Naples, Italy
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - María Dolores Tabernero
- Instituto de Investigación Biomédica de Salamanca (IBSAL), University Hospital of Salamanca, Salamanca, Spain
| | - Simon Skyrman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anders Broechner
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ian Law
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David Scheie
- Department of Pathology, Bartholin Institute, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark
| | - Bjarne Winther Kristensen
- Department of Pathology, Bartholin Institute, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark
- Department of Clinical Medicine and Biotech Research and Innovation Center (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Tina Nørgaard Munch
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Torstein Meling
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Neurological Surgery, Istituto Nazionale Neurologico "C.Besta", Milan, Italy
| | - Kåre Fugleholm
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Paul Blanche
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tiit Mathiesen
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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7
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Bakhtiari A, Benedek K, Law I, Fagerlund B, Mortensen EL, Osler M, Lauritzen M, Larsson HBW, Vestergaard MB. Early cerebral amyloid-β accumulation and hypermetabolism are associated with subtle cognitive deficits before accelerated cerebral atrophy. GeroScience 2024; 46:769-782. [PMID: 38102439 PMCID: PMC10828321 DOI: 10.1007/s11357-023-01031-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023] Open
Abstract
AIMS Alzheimer's disease (AD) is characterized by the accumulation of amyloid beta (Aβ) in the brain. The deposition of Aβ is believed to initiate a detrimental cascade, including cerebral hypometabolism, accelerated brain atrophy, and cognitive problems-ultimately resulting in AD. However, the timing and causality of the cascade resulting in AD are not yet fully established. Therefore, we examined whether early Aβ accumulation affects cerebral glucose metabolism, atrophy rate, and age-related cognitive decline before the onset of neurodegenerative disease. METHODS Participants from the Metropolit 1953 Danish Male Birth Cohort underwent brain positron emission tomography (PET) imaging using the radiotracers [11C]Pittsburgh Compound-B (PiB) (N = 70) and [18F]Fluorodeoxyglucose (FDG) (N = 76) to assess cerebral Aβ accumulation and glucose metabolism, respectively. The atrophy rate was calculated from anatomical magnetic resonance imaging (MRI) scans conducted presently and 10 years ago. Cognitive decline was examined from neurophysiological tests conducted presently and ten or 5 years ago. RESULTS Higher Aβ accumulation in AD-critical brain regions correlated with greater visual memory decline (p = 0.023). Aβ accumulation did not correlate with brain atrophy rates. Increased cerebral glucose metabolism in AD-susceptible regions correlated with worse verbal memory performance (p = 0.040). CONCLUSIONS Aβ accumulation in known AD-related areas was associated with subtle cognitive deficits. The association was observed before hypometabolism or accelerated brain atrophy, suggesting that Aβ accumulation is involved early in age-related cognitive dysfunction. The association between hypermetabolism and worse memory performance may be due to early compensatory mechanisms adapting for malfunctioning neurons by increasing metabolism.
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Affiliation(s)
- Aftab Bakhtiari
- Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet Glostrup, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
- Department of Clinical Neurophysiology, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
- Faculty of Health and Medical Sciences, Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Krisztina Benedek
- Department of Neurology, Neurophysiology, Zealand University Hospital, Roskilde, Denmark
| | - Ian Law
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, , University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Fagerlund
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | | | - Merete Osler
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Martin Lauritzen
- Department of Clinical Neurophysiology, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik B W Larsson
- Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet Glostrup, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mark B Vestergaard
- Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet Glostrup, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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8
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Bach MJ, Jakubauskaite A, Law I, Henriksen OM, Havsteen I, Henriksen AC, Rosenbaum S, Marner L. Long-term prognostic value of [ 15O]H 2O PET imaging in patients suspected for cerebral hemodynamic insufficiency. J Stroke Cerebrovasc Dis 2024; 33:107466. [PMID: 38029459 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107466] [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: 04/17/2023] [Revised: 09/20/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES Quantitative regional cerebral perfusion (rCBF) measurements using [15O]H2O PET with arterial cannulation and acetazolamide (ACZ) challenge have been reserved to identify high-risk patients that are candidates for by-pass operation. We aimed to assess the prognostic value of various parameters in quantitative [15O]H2O PET measurements in patients not subsequently undergoing surgery. METHODS We identified 32 eligible patients who underwent [15O]H2O brain PET imaging for suspicion of hemodynamic insufficiency between 2009 and 2020. Cerebrovascular events were defined as new ischemic lesions on MRI, stroke, transient ischemic attack, vascular dementia. Follow-up period was 91 months (range: 26-146). rCBF before (rCBFbase) and after (rCBFacz) ACZ challenge and the relative increase (CVR), were examined in the anterior (ACA), middle (MCA), and posterior (PCA) cerebral artery territories of the affected hemisphere, and the most recent MRI scans were scored for infarcts and white matter lesions. RESULTS Receiver operating characteristic (ROC) curve analysis showed higher prognostic accuracy for rCBFacz(AUC:0.82) compared to CVR (AUC:0.72) and rCBFbase (AUC:0.77). ROC AUC, optimal thresholds (and corresponding sensitivity/specificity/accuracy) for rCBFacz after ACZ in individual territories were 0.79 and 37.8 mL 100g-1 min-1 (0.81/0.63/0.72) for the ACA, 0.84 and 32 mL 100g-1 min-1 (0.81/0.75/0.78) for the MCA, and 0.70 and 43.9 ml/(mL 100g-1 min-1 (0.81/0.43/0,62) for the PCA. Kaplan Meier survival curve showed longer event-free survival in patients with rCBFacz below cut-off (p=0.007). In multivariate analysis rCBFacz remained a significant predictor when correcting for age. CONCLUSION Quantitative rCBF measurements after ACZ challenge with [15O]H2O PET provided high prognostic value for future cerebrovascular events.
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Affiliation(s)
- Mathias Jacobsen Bach
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Denmark
| | | | - Ian Law
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Physiology and Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Otto Mølby Henriksen
- Department of Clinical Physiology and Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Inger Havsteen
- Department of Radiology Copenhagen University Hospital Bispebjerg, Denmark
| | - Alexander Cuculiza Henriksen
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Denmark; Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Denmark
| | - Sverre Rosenbaum
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Denmark
| | - Lisbeth Marner
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Denmark.
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9
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Albert NL, Galldiks N, Ellingson BM, van den Bent MJ, Chang SM, Cicone F, de Groot J, Koh ES, Law I, Le Rhun E, Mair MJ, Minniti G, Rudà R, Scott AM, Short SC, Smits M, Suchorska B, Tolboom N, Traub-Weidinger T, Tonn JC, Verger A, Weller M, Wen PY, Preusser M. PET-based response assessment criteria for diffuse gliomas (PET RANO 1.0): a report of the RANO group. Lancet Oncol 2024; 25:e29-e41. [PMID: 38181810 DOI: 10.1016/s1470-2045(23)00525-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 01/07/2024]
Abstract
Response Assessment in Neuro-Oncology (RANO) response criteria have been established and were updated in 2023 for MRI-based response evaluation of diffuse gliomas in clinical trials. In addition, PET-based imaging with amino acid tracers is increasingly considered for disease monitoring in both clinical practice and clinical trials. So far, a standardised framework defining timepoints for baseline and follow-up investigations and response evaluation criteria for PET imaging of diffuse gliomas has not been established. Therefore, in this Policy Review, we propose a set of criteria for response assessment based on amino acid PET imaging in clinical trials enrolling participants with diffuse gliomas as defined in the 2021 WHO classification of tumours of the central nervous system. These proposed PET RANO criteria provide a conceptual framework that facilitates the structured implementation of PET imaging into clinical research and, ultimately, clinical routine. To this end, the PET RANO 1.0 criteria are intended to encourage specific investigations of amino acid PET imaging of gliomas.
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Affiliation(s)
- Nathalie L Albert
- Department of Nuclear Medicine, LMU Hospital, LMU Munich, Munich, Germany
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany; Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Susan M Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Francesco Cicone
- Nuclear Medicine Unit, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - John de Groot
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Eng-Siew Koh
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centre, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Ian Law
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Emilie Le Rhun
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Maximilian J Mair
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy; IRCCS Neuromed, Pozzilli IS, Italy
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin and City of Health and Science of Turin, Turin, Italy
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health and University of Melbourne, Melbourne, VIC, Australia; Olivia Newton-John Cancer Research Institute and School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
| | - Susan C Short
- Leeds Institute of Medical Research at St James's, The University of Leeds, Leeds, UK
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, Netherlands; Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, Netherlands; Medical Delta, Delft, Netherlands
| | - Bogdana Suchorska
- Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Nelleke Tolboom
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Antoine Verger
- Department of Nuclear Medicine & Nancyclotep Imaging Platform, CHRU Nancy and IADI INSERM UMR 1254, Universitè de Lorraine, Nancy, France
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland; Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Patrick Y Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
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10
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Montgomery ME, Andersen FL, d’Este SH, Overbeck N, Cramon PK, Law I, Fischer BM, Ladefoged CN. Attenuation Correction of Long Axial Field-of-View Positron Emission Tomography Using Synthetic Computed Tomography Derived from the Emission Data: Application to Low-Count Studies and Multiple Tracers. Diagnostics (Basel) 2023; 13:3661. [PMID: 38132245 PMCID: PMC10742516 DOI: 10.3390/diagnostics13243661] [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: 10/28/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
Recent advancements in PET/CT, including the emergence of long axial field-of-view (LAFOV) PET/CT scanners, have increased PET sensitivity substantially. Consequently, there has been a significant reduction in the required tracer activity, shifting the primary source of patient radiation dose exposure to the attenuation correction (AC) CT scan during PET imaging. This study proposes a parameter-transferred conditional generative adversarial network (PT-cGAN) architecture to generate synthetic CT (sCT) images from non-attenuation corrected (NAC) PET images, with separate networks for [18F]FDG and [15O]H2O tracers. The study includes a total of 1018 subjects (n = 972 [18F]FDG, n = 46 [15O]H2O). Testing was performed on the LAFOV scanner for both datasets. Qualitative analysis found no differences in image quality in 30 out of 36 cases in FDG patients, with minor insignificant differences in the remaining 6 cases. Reduced artifacts due to motion between NAC PET and CT were found. For the selected organs, a mean average error of 0.45% was found for the FDG cohort, and that of 3.12% was found for the H2O cohort. Simulated low-count images were included in testing, which demonstrated good performance down to 45 s scans. These findings show that the AC of total-body PET is feasible across tracers and in low-count studies and might reduce the artifacts due to motion and metal implants.
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Affiliation(s)
- Maria Elkjær Montgomery
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 København, Denmark; (M.E.M.); (N.O.); (P.K.C.); (I.L.); (B.M.F.); (C.N.L.)
| | - Flemming Littrup Andersen
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 København, Denmark; (M.E.M.); (N.O.); (P.K.C.); (I.L.); (B.M.F.); (C.N.L.)
- Department of Clinical Medicine, Copenhagen University, 2200 København, Denmark
| | - Sabrina Honoré d’Este
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 København, Denmark; (M.E.M.); (N.O.); (P.K.C.); (I.L.); (B.M.F.); (C.N.L.)
| | - Nanna Overbeck
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 København, Denmark; (M.E.M.); (N.O.); (P.K.C.); (I.L.); (B.M.F.); (C.N.L.)
| | - Per Karkov Cramon
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 København, Denmark; (M.E.M.); (N.O.); (P.K.C.); (I.L.); (B.M.F.); (C.N.L.)
| | - Ian Law
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 København, Denmark; (M.E.M.); (N.O.); (P.K.C.); (I.L.); (B.M.F.); (C.N.L.)
- Department of Clinical Medicine, Copenhagen University, 2200 København, Denmark
| | - Barbara Malene Fischer
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 København, Denmark; (M.E.M.); (N.O.); (P.K.C.); (I.L.); (B.M.F.); (C.N.L.)
- Department of Clinical Medicine, Copenhagen University, 2200 København, Denmark
| | - Claes Nøhr Ladefoged
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 København, Denmark; (M.E.M.); (N.O.); (P.K.C.); (I.L.); (B.M.F.); (C.N.L.)
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2800 Lyngby, Denmark
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11
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Bozzao A, Weber D, Crompton S, Braz G, Csaba D, Dhermain F, Finocchiaro G, Flannery T, Kramm C, Law I, Marucci G, Oliver K, Ostgathe C, Paterra R, Pesce G, Smits M, Soffietti R, Terkola R, Watts C, Costa A, Poortmans P. European Cancer Organisation Essential Requirements for Quality Cancer Care: Adult glioma. J Cancer Policy 2023; 38:100438. [PMID: 37634617 DOI: 10.1016/j.jcpo.2023.100438] [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: 06/29/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023]
Abstract
European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCCs) are explanations of the organisation and actions necessary to provide high-quality care to patients with a specific cancer type. They are compiled by a working group of European experts representing disciplines involved in cancer care, and provide oncology teams, patients, policymakers and managers with an overview of the essential requirements in any healthcare system. The focus here is on adult glioma. Gliomas make up approximately 80% of all primary malignant brain tumours. They are highly diverse and patients can face a unique cognitive, physical and psychosocial burden, so personalised treatments and support are essential. However, management of gliomas is currently very heterogeneous across Europe and there are only few formally-designated comprehensive cancer centres with brain tumour programmes. To address this, the ERQCC glioma expert group proposes frameworks and recommendations for high quality care, from diagnosis to treatment and survivorship. Wherever possible, glioma patients should be treated from diagnosis onwards in high volume neurosurgical or neuro-oncology centres. Multidisciplinary team working and collaboration is essential if patients' length and quality of life are to be optimised.
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Affiliation(s)
- Alessandro Bozzao
- NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, Rome, Italy; School of Medicine and Psychology, "Sapienza" University - Rome, Rome, Italy; European Society of Oncologic Imaging (ESOI), Rome, Italy
| | - Damien Weber
- Paul Scherrer Institute, Center for Proton Therapy, Villigen, Switzerland; European Society for Radiotherapy and Oncology (ESTRO), Villigen, Switzerland
| | | | - Graça Braz
- European Oncology Nursing Society (EONS), Oporto, Portugal; Portuguese Oncology Institute, Outpatient Clinic Department, Oporto, Portugal
| | - Dégi Csaba
- International Psycho-Oncology Society (IPOS), Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Frederic Dhermain
- European Organisation for Research and Treatment of Cancer (EORTC) Brain Tumour Group, Villejuif, France; Head of the Brain Tumor Board, Gustave Roussy University Hospital, Radiation Oncology, Villejuif, France
| | - Gaetano Finocchiaro
- Organisation of European Cancer Institutes (OECI), Milano, Italy; IRCCS Ospedale San Raffaele, Department of Neurology, Milano, Italy
| | - Thomas Flannery
- European Cancer Leagues (ECL), Belfast, Ireland; Royal Victoria Hospital Belfast, Department of Neurosurgery, Belfast, Ireland
| | - Christof Kramm
- The European Society for Paediatric Oncology (SIOPE), Goettingen, Germany; University Medical Center Goettingen, Division of Pediatric Hematology and Oncology, Goettingen, Germany
| | - Ian Law
- European Association of Nuclear Medicine (EANM), Copenhagen, Denmark; Rigshospitalet, Dept of Clinical Physiology, Nuclear Medicine & PET, Copenhagen, Denmark
| | - Gianluca Marucci
- European Society of Pathology (ESP), Milan, Italy; European Confederation of Neuropathological Societies (Euro-CNS), Milan, Italy; Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | - Rosina Paterra
- Fondazione IRCCS Istituto Neurologico Besta, Milano, Italy
| | - Gianfranco Pesce
- European School of Oncology (ESO), Bellinzona, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Marion Smits
- European Society of Radiology (ESR), Rotterdam, the Netherlands; Erasmus MC, Department of Radiology and Nuclear Medicine, University Hospital Rotterdam, Rotterdam, the Netherlands
| | - Riccardo Soffietti
- European Academy of Neurology (EAN), Turin, Italy; University and City of Health and Science Hospital, Department of Neuro-Oncology, Turin, Italy
| | - Robert Terkola
- European Society of Oncology Pharmacy (ESOP), the Netherlands; University of Groningen, University Medical Centre Groningen, the Netherlands; University of Florida College of Pharmacy, Department of Pharmacotherapy and Translational Research, Gainesville, USA
| | - Colin Watts
- European Association of Neurosurgical Societies, Birmingham, UK; Neurosurgical Oncology Section, Institute of Cancer and Genomic Sciences, Birmingham, UK
| | | | - Philip Poortmans
- European Society for Radiotherapy and Oncology (ESTRO), Antwerp, Belgium; Iridium Netwerk and University of Antwerp, Antwerp, Belgium
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12
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Veit-Haibach P, Ahlström H, Boellaard R, Delgado Bolton RC, Hesse S, Hope T, Huellner MW, Iagaru A, Johnson GB, Kjaer A, Law I, Metser U, Quick HH, Sattler B, Umutlu L, Zaharchuk G, Herrmann K. International EANM-SNMMI-ISMRM consensus recommendation for PET/MRI in oncology. Eur J Nucl Med Mol Imaging 2023; 50:3513-3537. [PMID: 37624384 PMCID: PMC10547645 DOI: 10.1007/s00259-023-06406-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
PREAMBLE The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote the science, technology, and practical application of nuclear medicine. The European Association of Nuclear Medicine (EANM) is a professional non-profit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. The merged International Society for Magnetic Resonance in Medicine (ISMRM) is an international, nonprofit, scientific association whose purpose is to promote communication, research, development, and applications in the field of magnetic resonance in medicine and biology and other related topics and to develop and provide channels and facilities for continuing education in the field.The ISMRM was founded in 1994 through the merger of the Society of Magnetic Resonance in Medicine and the Society of Magnetic Resonance Imaging. SNMMI, ISMRM, and EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine and/or magnetic resonance imaging. The SNMMI, ISMRM, and EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and/or magnetic resonance imaging and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice guideline, representing a policy statement by the SNMMI/EANM/ISMRM, has undergone a thorough consensus process in which it has been subjected to extensive review. The SNMMI, ISMRM, and EANM recognize that the safe and effective use of diagnostic nuclear medicine imaging and magnetic resonance imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by those entities not providing these services is not authorized. These guidelines are an educational tool designed to assist practitioners in providing appropriate care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the SNMMI, the ISMRM, and the EANM caution against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by the physician or medical physicist in light of all the circumstances presented. Thus, there is no implication that an approach differing from the guidelines, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the guidelines. The practice of medicine includes both the art and the science of the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognized that adherence to these guidelines will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.
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Affiliation(s)
- Patrick Veit-Haibach
- Joint Department Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Toronto General Hospital, 1 PMB-275, 585 University Avenue, Toronto, Ontario, M5G 2N2, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Håkan Ahlström
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
- Antaros Medical AB, BioVenture Hub, 431 53, Mölndal, Sweden
| | - Ronald Boellaard
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Swen Hesse
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Thomas Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Martin W Huellner
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Andrei Iagaru
- Department of Radiology, Division of Nuclear Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Geoffrey B Johnson
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen, Denmark
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Harald H Quick
- High-Field and Hybrid MR Imaging, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Essen, Germany
| | - Bernhard Sattler
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Greg Zaharchuk
- Division of Neuroradiology, Department of Radiology, Stanford University, 300 Pasteur Drive, Room S047, Stanford, CA, 94305-5105, USA
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany.
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Ladefoged CN, Anderberg L, Madsen K, Henriksen OM, Hasselbalch SG, Andersen FL, Højgaard L, Law I. Estimation of brain amyloid accumulation using deep learning in clinical [ 11C]PiB PET imaging. EJNMMI Phys 2023; 10:44. [PMID: 37450069 PMCID: PMC10348957 DOI: 10.1186/s40658-023-00562-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Estimation of brain amyloid accumulation is valuable for evaluation of patients with cognitive impairment in both research and clinical routine. The development of high throughput and accurate strategies for the determination of amyloid status could be an important tool in patient selection for clinical trials and amyloid directed treatment. Here, we propose the use of deep learning to quantify amyloid accumulation using standardized uptake value ratio (SUVR) and classify amyloid status based on their PET images. METHODS A total of 1309 patients with cognitive impairment scanned with [11C]PIB PET/CT or PET/MRI were included. Two convolutional neural networks (CNNs) for reading-based amyloid status and SUVR prediction were trained using 75% of the PET/CT data. The remaining PET/CT (n = 300) and all PET/MRI (n = 100) data was used for evaluation. RESULTS The prevalence of amyloid positive patients was 61%. The amyloid status classification model reproduced the expert reader's classification with 99% accuracy. There was a high correlation between reference and predicted SUVR (R2 = 0.96). Both reference and predicted SUVR had an accuracy of 97% compared to expert classification when applying a predetermined SUVR threshold of 1.35 for binary classification of amyloid status. CONCLUSION The proposed CNN models reproduced both the expert classification and quantitative measure of amyloid accumulation in a large local dataset. This method has the potential to replace or simplify existing clinical routines and can facilitate fast and accurate classification well-suited for a high throughput pipeline.
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Affiliation(s)
- Claes Nøhr Ladefoged
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Lasse Anderberg
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Karine Madsen
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Otto Mølby Henriksen
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Steen Gregers Hasselbalch
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Flemming Littrup Andersen
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Liselotte Højgaard
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
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14
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Feng LR, Vogel A, Mellergaard C, Waldemar G, Hasselbalch SG, Law I, Henriksen OM, Frederiksen KS. Clinical validation of the cingulate island sign visual rating scale in dementia with Lewy bodies. J Neurol Sci 2023; 451:120719. [PMID: 37421880 DOI: 10.1016/j.jns.2023.120719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/19/2023] [Accepted: 06/17/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION The cingulate island sign (CIS) is a metabolic pattern on [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) associated with dementia with Lewy bodies (DLB). The aim of this study was to validate the visual CIS rating scale (CISRs) for the diagnosis of DLB and to explore the clinical correlates. METHODS This single-center study included 166 DLB patients and 161 patients with Alzheimer's disease (AD). The CIS on [18F]FDG-PET scans was rated using the CISRs independently by three blinded raters. RESULTS The optimal cut-off to differentiate DLB from AD was a CISRs score ≥ 1 (sensitivity = 66%, specificity = 84%) whereas a CISRs score ≥ 2 (sensitivity = 58%, specificity = 92%) was optimal to differentiate amyloid positive DLB (n = 43 (82.7%)) and AD. To identify DLB with abnormal (n = 53 (72.6%)) versus normal (n = 20 (27.4%)) dopamine transporter imaging, a CISRs cut-off of 4 had a specificity of 95%. DLB with a CISRs score of 4 performed significantly better in tests on free verbal recall and picture based cued recall, but worse on processing speed compared to DLB with a CISRs score of 0. CONCLUSION This study confirms the CISRs as a valid marker for the diagnosis of DLB with a high specificity and a lower, but acceptable, sensitivity. Concomitant AD pathology does not influence diagnostic accuracy of the CISRs. In DLB patients, presence of CIS is associated with relative preserved memory function and impaired processing speed.
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Affiliation(s)
- Linda Ruohua Feng
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Asmus Vogel
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Clara Mellergaard
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Steen Gregers Hasselbalch
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Otto Mølby Henriksen
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kristian Steen Frederiksen
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
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Gursanscky J, Kelly AM, Hamad A, Tagg A, Klim S, Ritchie P, Law I, Krieser D. Outcome of reduction of paediatric forearm fracture by emergency department clinicians. Emerg Med Australas 2023; 35:347-349. [PMID: 36596645 DOI: 10.1111/1742-6723.14162] [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: 10/03/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Paediatric forearm fractures are common. Anecdotally, there is a trend towards ED reduction of selected fractures under procedural sedation. We aimed to determine the rate of subsequent operative intervention for fracture re-displacement. METHODS Retrospective observational study of children with a forearm/wrist fracture undergoing fracture reduction in ED. Outcome of interest was operative intervention for fracture re-displacement within 6 weeks. RESULTS Among 176 patients studied, operative intervention occurred in nine patients (5.1%, 95% confidence interval 2.7-9.4%). CONCLUSION Reduction of paediatric forearm fractures under procedural sedation by ED clinicians is increasingly common and results in a low rate of subsequent operative intervention.
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Affiliation(s)
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia
- Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ahmad Hamad
- School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Tagg
- Western Health, Melbourne, Victoria, Australia
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia
| | | | - Ian Law
- Western Health, Melbourne, Victoria, Australia
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Marner L, Korsholm K, Anderberg L, Lonsdale MN, Jensen MR, Brødsgaard E, Denholt CL, Gillings N, Law I, Friberg L. Correction: [ 18F]FE-PE2I PET is a feasible alternative to [ 123I]FP-CIT SPECT for dopamine transporter imaging in clinically uncertain parkinsonism. EJNMMI Res 2023; 13:19. [PMID: 36856900 PMCID: PMC9978043 DOI: 10.1186/s13550-023-00970-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Affiliation(s)
- Lisbeth Marner
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Kirsten Korsholm
- grid.411702.10000 0000 9350 8874Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, Copenhagen, Denmark ,grid.475435.4Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lasse Anderberg
- grid.475435.4Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Markus N. Lonsdale
- grid.411702.10000 0000 9350 8874Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, Copenhagen, Denmark
| | - Mads Radmer Jensen
- grid.411702.10000 0000 9350 8874Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, Copenhagen, Denmark
| | - Eva Brødsgaard
- grid.411702.10000 0000 9350 8874Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, Copenhagen, Denmark
| | - Charlotte L. Denholt
- grid.475435.4Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Nic Gillings
- grid.475435.4Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ian Law
- grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark ,grid.475435.4Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lars Friberg
- grid.411702.10000 0000 9350 8874Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, Copenhagen, Denmark
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Ladefoged CN, Andersen FL, Andersen TL, Anderberg L, Engkebølle C, Madsen K, Højgaard L, Henriksen OM, Law I. DeepDixon synthetic CT for [ 18F]FET PET/MRI attenuation correction of post-surgery glioma patients with metal implants. Front Neurosci 2023; 17:1142383. [PMID: 37090806 PMCID: PMC10115992 DOI: 10.3389/fnins.2023.1142383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/08/2023] [Indexed: 04/25/2023] Open
Abstract
Purpose Conventional magnetic resonance imaging (MRI) can for glioma assessment be supplemented by positron emission tomography (PET) imaging with radiolabeled amino acids such as O-(2-[18F]fluoroethyl)-L-tyrosine ([18F]FET), which provides additional information on metabolic properties. In neuro-oncology, patients often undergo brain and skull altering treatment, which is known to challenge MRI-based attenuation correction (MR-AC) methods and thereby impact the simplified semi-quantitative measures such as tumor-to-brain ratio (TBR) used in clinical routine. The aim of the present study was to examine the applicability of our deep learning method, DeepDixon, for MR-AC in [18F]FET PET/MRI scans of a post-surgery glioma cohort with metal implants. Methods The MR-AC maps were assessed for all 194 included post-surgery glioma patients (318 studies). The subgroup of 147 patients (222 studies, 200 MBq [18F]FET PET/MRI) with tracer uptake above 1 ml were subsequently reconstructed with DeepDixon, vendor-default atlas-based method, and a low-dose computed tomography (CT) used as reference. The biological tumor volume (BTV) was delineated on each patient by isocontouring tracer uptake above a TBR threshold of 1.6. We evaluated the MR-AC methods using the recommended clinical metrics BTV and mean and maximum TBR on a patient-by-patient basis against the reference with CT-AC. Results Ninety-seven percent of the studies (310/318) did not have any major artifacts using DeepDixon, which resulted in a Dice coefficient of 0.89/0.83 for tissue/bone, respectively, compared to 0.84/0.57 when using atlas. The average difference between DeepDixon and CT-AC was within 0.2% across all clinical metrics, and no statistically significant difference was found. When using DeepDixon, only 3 out of 222 studies (1%) exceeded our acceptance criteria compared to 72 of the 222 studies (32%) with the atlas method. Conclusion We evaluated the performance of a state-of-the-art MR-AC method on the largest post-surgical glioma patient cohort to date. We found that DeepDixon could overcome most of the issues arising from irregular anatomy and metal artifacts present in the cohort resulting in clinical metrics within acceptable limits of the reference CT-AC in almost all cases. This is a significant improvement over the vendor-provided atlas method and of particular importance in response assessment.
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Matji R, Maama L, Roscigno G, Lerotholi M, Agonafir M, Sekibira R, Law I, Tadolini M, Kak N. Policy and programmatic directions for the Lesotho tuberculosis programme: Findings of the national tuberculosis prevalence survey, 2019. PLoS One 2023; 18:e0273245. [PMID: 36893175 PMCID: PMC9997977 DOI: 10.1371/journal.pone.0273245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/04/2022] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION The Kingdom of Lesotho has one of the highest burdens of tuberculosis (TB) in the world. A national TB prevalence survey was conducted to estimate the prevalence of bacteriologically confirmed pulmonary TB disease among those ≥15 years of age in 2019. METHOD A multistage cluster-based cross-sectional survey where residents ≥15 years in 54 clusters sampled from across the country were eligible to participate. Survey participants were screened using a symptom screen questionnaire and digital chest X-ray (CXR). Respondents who acknowledged cough of any duration, fever, weight loss, night sweats and/or had any CXR abnormality in the lungs were asked to provide two spot sputum specimens. All sputum testing was conducted at the National TB Reference Laboratory (NTRL), where samples underwent Xpert MTB/RIF Ultra (1st sample) and MGIT culture (2nd sample). HIV counselling and testing was offered to all survey participants. TB cases were those with Mycobacterium tuberculosis complex-positive samples with culture; and where culture was not positive, Xpert MTB/RIF Ultra (Xpert Ultra) was positive with a CXR suggestive of active TB and no current or prior history of TB. RESULT A total of 39,902 individuals were enumerated, and of these, 26,857 (67.3%) were eligible to participate; 21,719 (80.9%) participated in the survey of which 8,599 (40%) were males and 13,120 (60%) were females. All 21,719 (100%) survey participants underwent symptom screening and a total of 21,344 participants (98.3%) had a CXR. Of the 7,584 (34.9%) participants who were eligible for sputum examination, 4,190 (55.2%) were eligible by CXR only, 1,455 (19.2%) by symptom screening, 1,630 by both, and 309 by CXR exemption. A total of 6,780 (89.4%) submitted two sputum specimens, and 311 (4.1%) submitted one sample only. From the 21,719 survey participants, HIV counseling and testing was offered to 17,048, and 3,915 (23.0%) were documented as HIV-positive. The survey identified 132 participants with bacteriologically confirmed pulmonary TB thus providing an estimated prevalence of 581 per 100,000 population (95% CI 466-696) for those ≥15 years in 2019. Using the survey results, TB incidence was re-estimated to be 654 per 100,000 (95% CI 406-959), which was comparable to the 2018 TB incidence rate of 611 per 100,000 (95% CI 395-872) reported by the World Health Organization (WHO). The highest TB burden was found in those ≥55 years and among men. The ratio of prevalence to case notification was estimated at 1.22. TB/HIV coinfection was identified in 39 (29.6%) participants. Out of the 1,825 participants who reported a cough, 50% of these participants, mostly men, did not seek care. Those who sought care predominantly went to the public health facilities. CONCLUSION The TB prevalence survey results confirmed that burden of TB and TB/HIV coinfection remains very high in Lesotho. Given that TB prevalence remains high, and there is a significant proportion of participants with confirmed TB that did not report TB suggestive symptoms. The National TB Programme will need to update its TB screening and treatment algorithms to achieve the End TB targets. A major focus will need to be placed on finding the "missing cases" i.e., undiagnosed or under-reported TB cases, or ensuring that not only TB symptomatic but also those who do not present with typical TB symptoms are promptly identified to reduce further onward transmission.
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Affiliation(s)
- R. Matji
- AQUITY Innovations, Pretoria, South Africa
| | - L. Maama
- Ministry of Health, Maseru, Lesotho
| | | | | | | | | | - I. Law
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - M. Tadolini
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - N. Kak
- AQUITY Global Inc., Bethesda, Maryland, United States of America
- * E-mail:
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19
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Hinge C, Henriksen OM, Lindberg U, Hasselbalch SG, Højgaard L, Law I, Andersen FL, Ladefoged CN. A zero-dose synthetic baseline for the personalized analysis of 2-Deoxy-2-[18F]fluoroglucose: Application in Alzheimer’s disease. Front Neurosci 2022; 16:1053783. [DOI: 10.3389/fnins.2022.1053783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
PurposeBrain 2-Deoxy-2-[18F]fluoroglucose ([18F]FDG-PET) is widely used in the diagnostic workup of Alzheimer’s disease (AD). Current tools for uptake analysis rely on non-personalized templates, which poses a challenge as decreased glucose uptake could reflect neuronal dysfunction, or heterogeneous brain morphology associated with normal aging. Overcoming this, we propose a deep learning method for synthesizing a personalized [18F]FDG-PET baseline from the patient’s own MRI, and showcase its applicability in detecting AD pathology.MethodsWe included [18F]FDG-PET/MRI data from 123 patients of a local cohort and 600 patients from ADNI. A supervised, adversarial model with two connected Generative Adversarial Networks (GANs) was trained on cognitive normal (CN) patients with transfer-learning to generate full synthetic baseline volumes (sbPET) (192 × 192 × 192) which reflect healthy uptake conditioned on brain anatomy. Synthetic accuracy was measured by absolute relative %-difference (Abs%), relative %-difference (RD%), and peak signal-to-noise ratio (PSNR). Lastly, we deployed the sbPET images in a fully personalized method for localizing metabolic abnormalities.ResultsThe model achieved a spatially uniform Abs% of 9.4%, RD% of 0.5%, and a PSNR of 26.3 for CN subjects. The sbPET images conformed to the anatomical information dictated by the MRI and proved robust in presence of atrophy. The personalized abnormality method correctly mapped the pathology of AD subjects while showing little to no anomalies for CN subjects.ConclusionThis work demonstrated the feasibility of synthesizing fully personalized, healthy-appearing [18F]FDG-PET images. Using these, we showcased a promising application in diagnosing AD, and theorized the potential value of sbPET images in other neuroimaging routines.
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20
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Quinn N, Ward G, Ong C, Krieser D, Melvin R, Makhijani A, Grindlay J, Lynch C, Colleran G, Perry V, O'Donnell SM, Law I, Varma D, Fitzgerald J, Mitchell HJ, Teague WJ. Mid‐Arm
Point
in
PAEDiatrics
(MAPPAED): An effective procedural aid for safe pleural decompression in trauma. Emerg Med Australas 2022; 35:412-419. [PMID: 36418011 DOI: 10.1111/1742-6723.14141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 09/27/2022] [Accepted: 10/21/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Life-threatening thoracic trauma requires emergency pleural decompression and thoracostomy and chest drain insertion are core trauma procedures. Reliably determining a safe site for pleural decompression in children can be challenging. We assessed whether the Mid-Arm Point (MAP) technique, a procedural aid proposed for use with injured adults, would also identify a safe site for pleural decompression in children. METHODS Children (0-18 years) attending four EDs were prospectively recruited. The MAP technique was performed, and chest wall skin marked bilaterally at the level of the MAP; no pleural decompression was performed. Radio-opaque markers were placed over the MAP-determined skin marks and corresponding intercostal space (ICS) reported using chest X-ray. RESULTS A total of 392 children participated, and 712 markers sited using the MAP technique were analysed. Eighty-three percentage of markers were sited within the 'safe zone' for pleural decompression (4th to 6th ICSs). When sited outside the 'safe zone', MAP-determined markers were typically too caudal. However, if the site for pleural decompression was transposed one ICS cranially in children ≥4 years, the MAP technique performance improved significantly with 91% within the 'safe zone'. CONCLUSIONS The MAP technique reliably determines a safe site for pleural decompression in children, albeit with an age-based adjustment, the Mid-Arm Point in PAEDiatrics (MAPPAED) rule: 'in children aged ≥4 years, use the MAP and go up one ICS to hit the safe zone. In children <4 years, use the MAP.' When together with this rule, the MAP technique will identify a site within the 'safe zone' in 9 out of 10 children.
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Affiliation(s)
- Nuala Quinn
- Department of Paediatric Emergency Medicine Children's Health Ireland at Temple Street Dublin Ireland
- Emergency Research Group Murdoch Children's Research Institute Melbourne Victoria Australia
- National Office for Trauma Services Dublin Ireland
| | - Grantley Ward
- Melbourne Medical School The University of Melbourne Melbourne Victoria Australia
| | - Cyril Ong
- Department of Medical Imaging The Royal Children's Hospital Melbourne Victoria Australia
| | - David Krieser
- Emergency Research Group Murdoch Children's Research Institute Melbourne Victoria Australia
- Melbourne Medical School The University of Melbourne Melbourne Victoria Australia
- Department of Emergency Medicine, Sunshine Hospital, Western Health Melbourne Victoria Australia
| | - Robert Melvin
- Department of Emergency Medicine, Sandringham Hospital, Alfred Health Melbourne Victoria Australia
| | - Allya Makhijani
- Department of Emergency Medicine, Sunshine Hospital, Western Health Melbourne Victoria Australia
| | - Joanne Grindlay
- Emergency Research Group Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Emergency Medicine The Royal Children's Hospital Melbourne Victoria Australia
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
| | - Catherine Lynch
- Department of Paediatric Emergency Medicine Children's Health Ireland at Temple Street Dublin Ireland
| | - Gabrielle Colleran
- Department of Paediatric Radiology Children's Health Ireland at Temple Street Dublin Ireland
- Department of Paediatrics, Trinity College Dublin and the National Maternity Hospital Dublin Ireland
| | - Victoria Perry
- Trauma Service, The Royal Children's Hospital Melbourne Victoria Australia
| | - Sinead M O'Donnell
- Emergency Research Group Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Emergency Medicine The Royal Children's Hospital Melbourne Victoria Australia
| | - Ian Law
- Department of Emergency Medicine, Sunshine Hospital, Western Health Melbourne Victoria Australia
| | - Dinesh Varma
- Department of Radiology, The Alfred Health Melbourne Victoria Australia
- Department of Surgery Monash University Melbourne Victoria Australia
| | - John Fitzgerald
- Western Health Medical Imaging, Sunshine Hospital, Western Health Melbourne Victoria Australia
| | - Hannah J Mitchell
- Mathematical Sciences Research Centre Queen's University, Belfast UK
| | - Warwick J Teague
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
- Trauma Service, The Royal Children's Hospital Melbourne Victoria Australia
- Department of Paediatric Surgery The Royal Children's Hospital Melbourne Victoria Australia
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
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21
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Pálsson S, Cerri S, Poulsen HS, Urup T, Law I, Van Leemput K. Predicting survival of glioblastoma from automatic whole-brain and tumor segmentation of MR images. Sci Rep 2022; 12:19744. [PMID: 36396681 PMCID: PMC9671967 DOI: 10.1038/s41598-022-19223-3] [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: 09/24/2021] [Accepted: 08/25/2022] [Indexed: 11/18/2022] Open
Abstract
Survival prediction models can potentially be used to guide treatment of glioblastoma patients. However, currently available MR imaging biomarkers holding prognostic information are often challenging to interpret, have difficulties generalizing across data acquisitions, or are only applicable to pre-operative MR data. In this paper we aim to address these issues by introducing novel imaging features that can be automatically computed from MR images and fed into machine learning models to predict patient survival. The features we propose have a direct anatomical-functional interpretation: They measure the deformation caused by the tumor on the surrounding brain structures, comparing the shape of various structures in the patient's brain to their expected shape in healthy individuals. To obtain the required segmentations, we use an automatic method that is contrast-adaptive and robust to missing modalities, making the features generalizable across scanners and imaging protocols. Since the features we propose do not depend on characteristics of the tumor region itself, they are also applicable to post-operative images, which have been much less studied in the context of survival prediction. Using experiments involving both pre- and post-operative data, we show that the proposed features carry prognostic value in terms of overall- and progression-free survival, over and above that of conventional non-imaging features.
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Affiliation(s)
- Sveinn Pálsson
- grid.5170.30000 0001 2181 8870Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Stefano Cerri
- grid.5170.30000 0001 2181 8870Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Hans Skovgaard Poulsen
- grid.475435.4Department of Oncology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Urup
- grid.475435.4Department of Oncology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Ian Law
- grid.475435.4Department of Clinical Physiology, Nuclear Medicine and PET, Center of Diagnostic Investigation, Rigshospitalet, Copenhagen, Denmark
| | - Koen Van Leemput
- grid.5170.30000 0001 2181 8870Department of Health Technology, Technical University of Denmark, Lyngby, Denmark ,grid.32224.350000 0004 0386 9924Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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22
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Marner L, Korsholm K, Anderberg L, Lonsdale MN, Jensen MR, Brødsgaard E, Denholt CL, Gillings N, Law I, Friberg L. [ 18F]FE-PE2I PET is a feasible alternative to [ 123I]FP-CIT SPECT for dopamine transporter imaging in clinically uncertain parkinsonism. EJNMMI Res 2022; 12:56. [PMID: 36070114 PMCID: PMC9452620 DOI: 10.1186/s13550-022-00930-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dopamine transporter (DAT) imaging of striatum is clinically used in Parkinson's disease (PD) and neurodegenerative parkinsonian syndromes (PS) especially in the early disease stages. The aim of the present study was to evaluate the diagnostic performance of the recently developed tracer for DAT imaging [18F]FE-PE2I PET/CT to the reference standard [123I]FP-CIT SPECT. METHODS Ninety-eight unselected patients referred for DAT imaging were included prospectively and consecutively and evaluated with [18F]FE-PE2I PET/CT and [123I]FP-CIT SPECT on two separate days. PET and SPECT scans were categorized independently by two blinded expert readers as either normal, vascular changes, or mixed. Semiquantitative values were obtained for each modality and compared regarding effect size using Glass' delta. RESULTS Fifty-six of the [123I]FP-CIT SPECT scans were considered abnormal (52 caused by PS, 4 by infarctions). Using [18F]FE-PE2I PET/CT, 95 of the 98 patients were categorized identically to SPECT as PS or non-PS with a sensitivity of 0.94 [0.84-0.99] and a specificity of 1.00 [0.92-1.00]. Inter-reader agreement for [18F]FE-PE2I PET with a kappa of 0.97 [0.89-1.00] was comparable to the agreement for [123I]FP-CIT SPECT of 0.96 [0.76-1.00]. Semiquantitative values for short 10-min reconstructions of [18F]FE-PE2I PET/CT were comparable to longer reconstructions. The effect size for putamen/caudate nucleus ratio was significantly increased using PET compared to SPECT. CONCLUSIONS The high correspondence of [18F]FE-PE2I PET compared to reference standard [123I]FP-CIT SPECT establishes [18F]FE-PE2I PET as a feasible PET tracer for clinical use with favourable scan logistics.
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Affiliation(s)
- Lisbeth Marner
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Kirsten Korsholm
- grid.411702.10000 0000 9350 8874Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, Copenhagen, Denmark ,grid.475435.4Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lasse Anderberg
- grid.475435.4Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Markus N. Lonsdale
- grid.411702.10000 0000 9350 8874Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, Copenhagen, Denmark
| | - Mads Radmer Jensen
- grid.411702.10000 0000 9350 8874Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, Copenhagen, Denmark
| | - Eva Brødsgaard
- grid.411702.10000 0000 9350 8874Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, Copenhagen, Denmark
| | - Charlotte L. Denholt
- grid.475435.4Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Nic Gillings
- grid.475435.4Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ian Law
- grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark ,grid.475435.4Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lars Friberg
- grid.411702.10000 0000 9350 8874Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, Copenhagen, Denmark
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23
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Maarup S, Skadborg S, Draghi A, Borch A, Hasselbalch B, Yde C, Svane I, Hadrup S, Christensen I, Law I, Skjoeth-Rasmussen J, Scheie D, Skovgaard Poulsen H, Lassen U. PL02.3.A Survival and T-cell tumor reactivity in patients treated with nivolumab and bevacizumab for recurrent glioblastoma in the clinical trial CA209-9UP. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.006] [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: 11/15/2022] Open
Abstract
Abstract
Background
Glioblastoma (GBM) is an aggressive brain tumor with a median survival of 14.6 months. We have no standard treatment for relapse and current treatment options have limited effect. Novel treatments are necessary to improve survival and quality of life.
Material and Methods
We present data from; a phase II open label, two-armed clinical trial studying nivolumab and bevacizumab in treatment of recurrent GBM, with progression after Stupp’s regime. Patients were included in two arms depending on the possibility of salvage neurosurgical resection. All patients had biopsies for genome sequencing at primary tumor and recurrence. Both arms received nivolumab and bevacizumab administrated every second week and the surgical arm also received neoadjuvant nivolumab 7 days prior to surgery. Fresh tissue samples were collected for tumor digest, TILs (tumor infiltrating lymphocytes) for phenotype exploration and intracellular staining to test reactivity. Patients were treated until progression, death, or intolerable side effects. Toxicity screens were reported, and follow-up ended in Marts 2022.
Results
Forty-four patients were included from November 2018 to January 2022; 20 in each arm (four screen-failures). Treatment was overall well tolerated. Median (m) age at inclusion was 57,5 years (arm A) and 50,5 years (arm B), and the groups had an even distribution. The surgical and non-surgical arm had an mPFS of 5.95 and 3.83 months respectively, while the mOS was 13.96 months and 6.77 months, respectively. Multivariate analysis was performed by variables such us steroid, MGMT, gender, age at diagnosis, resection extent and arm. Steroid at inclusion was a significant negative predictor of outcome (p = 0.0378). Controls from our GBM registry (N=140), which were treated with neurosurgical resection and then bevazicumab and irinotecan in recurrent setting had an mOS of 8.64 months (log-rank p=0.0181).Furthermore, reactive tumor infiltrating lymphocytes (TIL) were detected in four of the patients who presented with a longer mOS and mPFS of 16.75 months and 9.18 months, while the 16 patients without TIL reactivity had mOS and mPFS of 12.63 months and 5.13 months, respectively (not significant).
Conclusion
We found an increased mOS in patients treated with nivolumab and bevacizumab at recurrence, compared to our controls: 13.96 months and 8.64 months, respectively. Four patients with T-cell reactivity towards tumor cells showed an even longer mPFS and mOS. Though not significant, these results warrant further research evaluation in larger patient cohorts. We are currently investigating proteomics and sequencing data to identify predictive biomarkers.
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Affiliation(s)
- S Maarup
- dccc Brain Tumor Center, Oncology Department, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - S Skadborg
- Department of Health Technology, Kemitorvet, Building 204, room 154 , Kongens Lyngby , Denmark
| | - A Draghi
- National Center for Cancer Immune Therapy, Copenhagen University Hospital , Herlev , Denmark
| | - A Borch
- Department of Health Technology, Kemitorvet, Building 204, room 154 , Kongens Lyngby , Denmark
| | - B Hasselbalch
- dccc Brain Tumor Center, Oncology Department, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - C Yde
- Center of Genomic Medicine, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - I Svane
- National Center for Cancer Immune Therapy, Copenhagen University Hospital , Herlev , Denmark
| | - S Hadrup
- Department of Health Technology, Kemitorvet, Building 204, room 154 , Kongens Lyngby , Denmark
| | - I Christensen
- dccc Brain Tumor Center, Oncology Department, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen , Copenhagen , Denmark
| | - I Law
- Department of Clinical Physiology, Nuclear Medicine and pet, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - J Skjoeth-Rasmussen
- Neurosurgery Department, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - D Scheie
- Pathology Department, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - H Skovgaard Poulsen
- dccc Brain Tumor Center, Oncology Department, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - U Lassen
- dccc Brain Tumor Center, Oncology Department, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen , Copenhagen , Denmark
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24
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Daveau RS, Law I, Henriksen OM, Hasselbalch SG, Andersen UB, Anderberg L, Højgaard L, Andersen FL, Ladefoged CN. Deep learning based low-activity PET reconstruction of [ 11C]PiB and [ 18F]FE-PE2I in neurodegenerative disorders. Neuroimage 2022; 259:119412. [PMID: 35753592 DOI: 10.1016/j.neuroimage.2022.119412] [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: 02/01/2022] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Positron Emission Tomography (PET) can support a diagnosis of neurodegenerative disorder by identifying disease-specific pathologies. Our aim was to investigate the feasibility of using activity reduction in clinical [18F]FE-PE2I and [11C]PiB PET/CT scans, simulating low injected activity or scanning time reduction, in combination with AI-assisted denoising. METHODS A total of 162 patients with clinically uncertain Alzheimer's disease underwent amyloid [11C]PiB PET/CT and 509 patients referred for clinically uncertain Parkinson's disease underwent dopamine transporter (DAT) [18F]FE-PE2I PET/CT. Simulated low-activity data were obtained by random sampling of 5% of the events from the list-mode file and a 5% time window extraction in the middle of the scan. A three-dimensional convolutional neural network (CNN) was trained to denoise the resulting PET images for each disease cohort. RESULTS Noise reduction of low-activity PET images was successful for both cohorts using 5% of the original activity with improvement in visual quality and all similarity metrics with respect to the ground-truth images. Clinically relevant metrics extracted from the low-activity images deviated <2% compared to ground-truth values, which were not significantly changed when extracting the metrics from the denoised images. CONCLUSION The presented models were based on the same network architecture and proved to be a robust tool for denoising brain PET images with two widely different tracer distributions (delocalized, ([11C]PiB, and highly localized, [18F]FE-PE2I). This broad and robust application makes the presented network a good choice for improving the quality of brain images to the level of the standard-activity images without degrading clinical metric extraction. This will allow for reduced dose or scan time in PET/CT to be implemented clinically.
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Affiliation(s)
- Raphaël S Daveau
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark
| | - Otto Mølby Henriksen
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark
| | | | - Ulrik Bjørn Andersen
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark
| | - Lasse Anderberg
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark
| | - Liselotte Højgaard
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark
| | - Flemming Littrup Andersen
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark
| | - Claes Nøhr Ladefoged
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark.
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25
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Galldiks N, Langen KJ, Albert NL, Law I, Kim MM, Villanueva-Meyer JE, Soffietti R, Wen PY, Weller M, Tonn JC. Investigational PET tracers in neuro-oncology-What's on the horizon? A report of the PET/RANO group. Neuro Oncol 2022; 24:1815-1826. [PMID: 35674736 DOI: 10.1093/neuonc/noac131] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 11/14/2022] Open
Abstract
Many studies in patients with brain tumors evaluating innovative PET tracers have been published in recent years, and the initial results are promising. Here, the Response Assessment in Neuro-Oncology (RANO) PET working group provides an overview of the literature on novel investigational PET tracers for brain tumor patients. Furthermore, newer indications of more established PET tracers for the evaluation of glucose metabolism, amino acid transport, hypoxia, cell proliferation, and others are also discussed. Based on the preliminary findings, these novel investigational PET tracers should be further evaluated considering their promising potential. In particular, novel PET probes for imaging of translocator protein and somatostatin receptor overexpression as well as for immune system reactions appear to be of additional clinical value for tumor delineation and therapy monitoring. Progress in developing these radiotracers may contribute to improving brain tumor diagnostics and advancing clinical translational research.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener St. 62, 50937 Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, Germany.,Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michelle M Kim
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Javier E Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center University Hospital and University of Zurich, Zurich, Switzerland
| | - Joerg C Tonn
- Department of Neurosurgery, University Hospital of Munich (LMU), Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
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26
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Piccardo A, Albert NL, Borgwardt L, Fahey FH, Hargrave D, Galldiks N, Jehanno N, Kurch L, Law I, Lim R, Lopci E, Marner L, Morana G, Young Poussaint T, Seghers VJ, Shulkin BL, Warren KE, Traub-Weidinger T, Zucchetta P. Joint EANM/SIOPE/RAPNO practice guidelines/SNMMI procedure standards for imaging of paediatric gliomas using PET with radiolabelled amino acids and [ 18F]FDG: version 1.0. Eur J Nucl Med Mol Imaging 2022; 49:3852-3869. [PMID: 35536420 PMCID: PMC9399211 DOI: 10.1007/s00259-022-05817-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/23/2022] [Indexed: 01/18/2023]
Abstract
Positron emission tomography (PET) has been widely used in paediatric oncology. 2-Deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) is the most commonly used radiopharmaceutical for PET imaging. For oncological brain imaging, different amino acid PET radiopharmaceuticals have been introduced in the last years. The purpose of this document is to provide imaging specialists and clinicians guidelines for indication, acquisition, and interpretation of [18F]FDG and radiolabelled amino acid PET in paediatric patients affected by brain gliomas. There is no high level of evidence for all recommendations suggested in this paper. These recommendations represent instead the consensus opinion of experienced leaders in the field. Further studies are needed to reach evidence-based recommendations for the applications of [18F]FDG and radiolabelled amino acid PET in paediatric neuro-oncology. These recommendations are not intended to be a substitute for national and international legal or regulatory provisions and should be considered in the context of good practice in nuclear medicine. The present guidelines/standards were developed collaboratively by the EANM and SNMMI with the European Society for Paediatric Oncology (SIOPE) Brain Tumour Group and the Response Assessment in Paediatric Neuro-Oncology (RAPNO) working group. They summarize also the views of the Neuroimaging and Oncology and Theranostics Committees of the EANM and reflect recommendations for which the EANM and other societies cannot be held responsible.
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Affiliation(s)
- Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, Italy
| | - Nathalie L Albert
- Department of Nuclear Medicine, University Hospital of LMU Munich, Munich, Germany
| | - Lise Borgwardt
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frederic H Fahey
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Darren Hargrave
- Department of Paediatric Oncology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
| | - Nina Jehanno
- Department of Nuclear Medicine, Institut Curie Paris, Paris, France
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany.
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Lim
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS-Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Lisbeth Marner
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Giovanni Morana
- Department of Neurosciences, University of Turin, Turin, Italy
| | - Tina Young Poussaint
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Victor J Seghers
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Barry L Shulkin
- Nuclear Medicine Department of Diagnostic Imaging St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Katherine E Warren
- Department of Pediatric Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine - DIMED, University Hospital of Padova, Padua, Italy
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27
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Guedj E, Varrone A, Boellaard R, Albert NL, Barthel H, van Berckel B, Brendel M, Cecchin D, Ekmekcioglu O, Garibotto V, Lammertsma AA, Law I, Peñuelas I, Semah F, Traub-Weidinger T, van de Giessen E, Van Weehaeghe D, Morbelli S. Correction to: EANM procedure guidelines for brain PET imaging using [ 18F]FDG, version 3. Eur J Nucl Med Mol Imaging 2022; 49:2100-2101. [PMID: 35254483 PMCID: PMC9016017 DOI: 10.1007/s00259-022-05755-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Eric Guedj
- APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix Marseille Univ, Marseille, France.
- Service Central de Biophysique et Médecine Nucléaire, Hôpital de la Timone, 264 rue Saint Pierre, 13005, Marseille, France.
| | - Andrea Varrone
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Healthcare Services, Stockholm, Sweden
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, Leipzig University, Leipzig, Germany
| | - Bart van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Matthias Brendel
- Department of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany
- German Centre of Neurodegenerative Diseases (DZNE), Site Munich, Bonn, Germany
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Ozgul Ekmekcioglu
- Sisli Hamidiye Etfal Education and Research Hospital, Nuclear Medicine Dept., University of Health Sciences, Istanbul, Turkey
| | - Valentina Garibotto
- NIMTLab, Faculty of Medicine, Geneva University, Geneva, Switzerland
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Iván Peñuelas
- Department of Nuclear Medicine, Clinica Universidad de Navarra, IdiSNA, University of Navarra, Pamplona, Spain
| | - Franck Semah
- Nuclear Medicine Department, University Hospital, Lille, France
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image‑guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, Amsterdam, The Netherlands
| | | | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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28
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Dejanovic D, Specht L, Munk OL, Christensen CB, Berthelsen AK, Law I, Loft A. PET for radiotherapy planning. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00128-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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29
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Guedj E, Varrone A, Boellaard R, Albert NL, Barthel H, van Berckel B, Brendel M, Cecchin D, Ekmekcioglu O, Garibotto V, Lammertsma AA, Law I, Peñuelas I, Semah F, Traub-Weidinger T, van de Giessen E, Van Weehaeghe D, Morbelli S. EANM procedure guidelines for brain PET imaging using [ 18F]FDG, version 3. Eur J Nucl Med Mol Imaging 2021; 49:632-651. [PMID: 34882261 PMCID: PMC8803744 DOI: 10.1007/s00259-021-05603-w] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/21/2021] [Indexed: 12/13/2022]
Abstract
The present procedural guidelines summarize the current views of the EANM Neuro-Imaging Committee (NIC). The purpose of these guidelines is to assist nuclear medicine practitioners in making recommendations, performing, interpreting, and reporting results of [18F]FDG-PET imaging of the brain. The aim is to help achieve a high-quality standard of [18F]FDG brain imaging and to further increase the diagnostic impact of this technique in neurological, neurosurgical, and psychiatric practice. The present document replaces a former version of the guidelines that have been published in 2009. These new guidelines include an update in the light of advances in PET technology such as the introduction of digital PET and hybrid PET/MR systems, advances in individual PET semiquantitative analysis, and current broadening clinical indications (e.g., for encephalitis and brain lymphoma). Further insight has also become available about hyperglycemia effects in patients who undergo brain [18F]FDG-PET. Accordingly, the patient preparation procedure has been updated. Finally, most typical brain patterns of metabolic changes are summarized for neurodegenerative diseases. The present guidelines are specifically intended to present information related to the European practice. The information provided should be taken in the context of local conditions and regulations.
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Affiliation(s)
- Eric Guedj
- APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix Marseille Univ, Marseille, France. .,Service Central de Biophysique et Médecine Nucléaire, Hôpital de la Timone, 264 rue Saint Pierre, 13005, Marseille, France.
| | - Andrea Varrone
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Healthcare Services, Stockholm, Sweden
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, Leipzig University, Leipzig, Germany
| | - Bart van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Matthias Brendel
- Department of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany.,German Centre of Neurodegenerative Diseases (DZNE), Site Munich, Bonn, Germany
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Ozgul Ekmekcioglu
- Sisli Hamidiye Etfal Education and Research Hospital, Nuclear Medicine Dept., University of Health Sciences, Istanbul, Turkey
| | - Valentina Garibotto
- NIMTLab, Faculty of Medicine, Geneva University, Geneva, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Iván Peñuelas
- Department of Nuclear Medicine, Clinica Universidad de Navarra, IdiSNA, University of Navarra, Pamplona, Spain
| | - Franck Semah
- Nuclear Medicine Department, University Hospital, Lille, France
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, Amsterdam, The Netherlands
| | | | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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30
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Puig O, Henriksen OM, Andersen FL, Lindberg U, Højgaard L, Law I, Ladefoged CN. Deep-learning-based attenuation correction in dynamic [ 15O]H 2O studies using PET/MRI in healthy volunteers. J Cereb Blood Flow Metab 2021; 41:3314-3323. [PMID: 34250821 PMCID: PMC8669198 DOI: 10.1177/0271678x211029178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Quantitative [15O]H2O positron emission tomography (PET) is the accepted reference method for regional cerebral blood flow (rCBF) quantification. To perform reliable quantitative [15O]H2O-PET studies in PET/MRI scanners, MRI-based attenuation-correction (MRAC) is required. Our aim was to compare two MRAC methods (RESOLUTE and DeepUTE) based on ultrashort echo-time with computed tomography-based reference standard AC (CTAC) in dynamic and static [15O]H2O-PET. We compared rCBF from quantitative perfusion maps and activity concentration distribution from static images between AC methods in 25 resting [15O]H2O-PET scans from 14 healthy men at whole-brain, regions of interest and voxel-wise levels. Average whole-brain CBF was 39.9 ± 6.0, 39.0 ± 5.8 and 40.0 ± 5.6 ml/100 g/min for CTAC, RESOLUTE and DeepUTE corrected studies respectively. RESOLUTE underestimated whole-brain CBF by 2.1 ± 1.50% and rCBF in all regions of interest (range -2.4%- -1%) compared to CTAC. DeepUTE showed significant rCBF overestimation only in the occipital lobe (0.6 ± 1.1%). Both MRAC methods showed excellent correlation on rCBF and activity concentration with CTAC, with slopes of linear regression lines between 0.97 and 1.01 and R2 over 0.99. In conclusion, RESOLUTE and DeepUTE provide AC information comparable to CTAC in dynamic [15O]H2O-PET but RESOLUTE is associated with a small but systematic underestimation.
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Affiliation(s)
- Oriol Puig
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Otto M Henriksen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Flemming L Andersen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ulrich Lindberg
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Højgaard
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Claes N Ladefoged
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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31
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Maarup S, Skadborg S, Borch A, Draghi A, Hasselbalch B, Østrup O, Scheie D, Skjoeth-Rasmussen J, Law I, Svane IM, Poulsen H, Hadrup S, Lassen U. CTIM-22. NIVOLUMAB AND BEVACIZUMAB FOR RECURRENT GLIOBLASTOMA; T-CELL REACTIVITY AGAINST AUTOLOGOUS TUMOR CELLS. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.214] [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: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Glioblastoma is an aggressive brain tumor with a median survival of 14.6 months. We have no standard treatment for relapse and known options have limited effect. Novel treatments are necessary to improve survival and quality of life.
METHODS
We present our trial; phase II open label, two-armed translational study of Nivolumab and Bevacizumab for recurrent GBM, who have failed Stupp’s regimen. Patients are included in two arms depending on the possibility of salvage neurosurgical resection. Both arms receive Nivolumab and Bevacizumab administrated every second weekend, and the surgical arm also receive Nivolumab 7 days prior surgery. Forty-four patients were included by January 2021; 20 in each arm (four screen-failures). In the surgical arm, 20 fresh tumor samples as well as paired tissue from primary tumor were available. Tumor infiltrating lymphocytes (TILs) and tumor digest were produced in vitro from recurrent settings. Young TILs were expanded from fresh tumor fragments after minimal-culture, whereas rapidly expanded TILs (REP TILs) were obtained after massive expansion. By intracellular cytokine staining, we investigated the TIL reactivity after exposure to autologous tumor digest in order to evaluate whether the TILs were tumor-reactive, non-reactive or bystanders. RNA and whole exome sequencing were available before and after treatment.
RESULTS
Material from 19 patients was analyzed (one out of the 20 collected biopsies was limited in size, therefore no tumor digest could be produced). Four out of 19 TIL samples showed tumor reactivity after exposure to the autologous tumor digest. Tumor reactivity was ranged between 1,2 to 13,6 tox% in CD8+ TILs and between 2,8 to 10,9 tox% in CD4+ TILs. By flowcytometry we found, IgG4+ CD3+ TILS from tumor biopsies, meaning that Nivolumab were found in the brain. Currently controls are included to evaluate these results.
CONCLUSIONS
Updated results will be presented at SNO.
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Affiliation(s)
- Simone Maarup
- Rigshospitalet, DCCC-Brain Tumor Center, Copenhagen, Denmark
| | - Signe Skadborg
- DTU, Department of Health Technology, DK-2100 Copenhagen, USA
| | - Annie Borch
- Department of Health Technology, DK-2100 Copenhagen, Denmark
| | - Arianna Draghi
- Herlev Hospital, National Center for Cancer Immune Therapy, CCIT, DK-2100 Copenhagen, Denmark
| | | | - Olga Østrup
- Genomic department, DK-2100 Copenhagen, Denmark
| | - David Scheie
- Neuropathology Department, DK-2100 Copenhagen, Denmark
| | | | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, DK-2100 Copenhagen, Denmark
| | - Inge Marie Svane
- Herlev Hospital, National Center for Cancer Immune Therapy, CCIT, DK-2100 Copenhagen, Denmark
| | - Hans Poulsen
- Rigshospitalet, DCCC-Brain Tumor Center, Copenhagen, Denmark
| | - Sine Hadrup
- DTU, Health Technology, DK-2100 Copenhagen, Denmark
| | - Ulrik Lassen
- Rigshospitalet, Department of Oncology, Copenhagen, Denmark
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Wei N, Lamba A, Franciosi S, Law I, Ochoa L, Johnsrude C, Kwok S, Tan T, Dhillon S, Fournier A, Seslar S, Stephenson E, Blaufox A, Cabrera Ortega M, Escudero C, Sanatani S. SUPRAVENTRICULAR TACHYCARDIA IN INFANTS: DOES MEDICATION CHOICE MATTER? Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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33
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Karlsson WK, Højgaard JLS, Vilhelmsen A, Crone C, Andersen B, Law I, Møller LB, Nielsen TT, Nielsen EN, Krag T, Svenstrup K, Nielsen JE. Novel Homozygous Truncating Variant Widens the Spectrum of Early-Onset Multisystemic SYNE1 Ataxia. Cerebellum 2021; 21:514-519. [PMID: 34318393 DOI: 10.1007/s12311-021-01308-w] [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] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
Pathogenic variants in the SYNE1 gene are associated with a phenotypic spectrum spanning from late-onset, slowly progressive, relatively pure ataxia to early-onset, fast progressive multisystemic disease. Since its first description in 2007 as an adult-onset ataxia in French Canadian families, subsequent identification of patients worldwide has widened the clinical spectrum and increased the number of identified pathogenic variants. We report a 20-year-old Faroese female with early-onset progressive gait problems, weakness, dysphagia, slurred speech, orthostatic dizziness, and urge incontinence. Neurological examination revealed mild cognitive deficits, dysarthria, broken slow pursuit, hypometric saccades, weakness with spasticity, hyperreflexia, absent ankle reflexes, ataxia, and wide-based, spastic gait. Magnetic resonance imaging displayed atrophy of the cerebellum, brainstem, and spinal cord. Severely prolonged central motor conduction time and lower motor neuron involvement was demonstrated electrophysiologically. Fluorodeoxyglucose-positron emission tomography (FDG-PET) scan showed hypometabolism of the cerebellum and right frontal lobe. Muscle biopsy revealed chronic neurogenic changes and near-absent immunostaining for Nesprin-1. Next-generation sequencing revealed a previously undescribed homozygous truncating, likely pathogenic variant in the SYNE1 gene. The patient's mother and paternal grandfather were heterozygous carriers of the variant. Her father's genotype was unobtainable. We expand the list of likely pathogenic variants in SYNE1 ataxia with a novel homozygous truncating variant with proximity to the C-terminus and relate it to a phenotype comprising early-onset cerebellar deficits, upper and lower motor neuron involvement and cognitive deficits. Also, we report novel findings of focally reduced frontal lobe FDG-PET uptake and motor evoked potential abnormalities suggestive of central demyelination.
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Affiliation(s)
- William Kristian Karlsson
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.
| | - Joan Lilja Sunnleyg Højgaard
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Anna Vilhelmsen
- Department of Psychiatry, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | - Clarissa Crone
- Department of Neurophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgit Andersen
- Department of Neurophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth Birk Møller
- Department of Clinical Genetics, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Troels Tolstrup Nielsen
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.,Neurogenetics Clinic & Research Lab, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Emilie Neerup Nielsen
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Thomas Krag
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.,Department of Neurology, Copenhagen Neuromuscular Center, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Svenstrup
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.,Department of Neurology, Copenhagen Neuromuscular Center, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Erik Nielsen
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.,Neurogenetics Clinic & Research Lab, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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34
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Chételat G, Arbizu J, Barthel H, Garibotto V, Lammertsma AA, Law I, Morbelli S, van de Giessen E, Drzezga A. Finding our way through the labyrinth of dementia biomarkers. Eur J Nucl Med Mol Imaging 2021; 48:2320-2324. [PMID: 33876260 DOI: 10.1007/s00259-021-05301-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Gaël Chételat
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000, Caen, France.
| | - Javier Arbizu
- Department of Nuclear Medicine, University of Navarra Clinic, Pamplona, Spain
| | - Henryk Barthel
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals and NIMTlab, Geneva University, Geneva, Switzerland
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Silvia Morbelli
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elsmarieke van de Giessen
- AMC Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Alexander Drzezga
- Department of Nuclear Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn/Köln, Germany
- Institute of Neuroscience and Medicine, Molecular Organization of the Brain (INM-2), Forschungzentrum Jülich, Jülich, Germany
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35
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Galldiks N, Niyazi M, Grosu AL, Kocher M, Langen KJ, Law I, Minniti G, Kim MM, Tsien C, Dhermain F, Soffietti R, Mehta MP, Weller M, Tonn JC. Contribution of PET imaging to radiotherapy planning and monitoring in glioma patients - a report of the PET/RANO group. Neuro Oncol 2021; 23:881-893. [PMID: 33538838 DOI: 10.1093/neuonc/noab013] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The management of patients with glioma usually requires multimodality treatment including surgery, radiotherapy, and systemic therapy. Accurate neuroimaging plays a central role for radiotherapy planning and follow-up after radiotherapy completion. In order to maximize the radiation dose to the tumor and to minimize toxic effects on the surrounding brain parenchyma, reliable identification of tumor extent and target volume delineation is crucial. The use of positron emission tomography (PET) for radiotherapy planning and monitoring in gliomas has gained considerable interest over the last several years, but Class I data are not yet available. Furthermore, PET has been used after radiotherapy for response assessment and to distinguish tumor progression from pseudoprogression or radiation necrosis. Here, the Response Assessment in Neuro-Oncology (RANO) working group provides a summary of the literature and recommendations for the use of PET imaging for radiotherapy of patients with glioma based on published studies, constituting levels 1-3 evidence according to the Oxford Centre for Evidence-based Medicine.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3,-4), Research Center Juelich, Juelich, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, Cologne and Aachen, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Anca L Grosu
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | - Martin Kocher
- Institute of Neuroscience and Medicine (INM-3,-4), Research Center Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3,-4), Research Center Juelich, Juelich, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, Cologne and Aachen, Germany.,Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, University Hospital Copenhagen, Copenhagen, Denmark
| | - Giuseppe Minniti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.,IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Michelle M Kim
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Christina Tsien
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Frederic Dhermain
- Department of Radiation Therapy, Institut de Cancerologie Gustave Roussy, Villejuif, France
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jörg-Christian Tonn
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
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Bonsu F, Addo KK, Alebachew Z, Gyapong J, Badu-Peprah A, Gockah R, Hanson-Nortey NN, Law I, Tadolini M, Onozaki I, Sismanidis C, Owusu-Dabo E. National population-based tuberculosis prevalence survey in Ghana, 2013. Int J Tuberc Lung Dis 2021; 24:321-328. [PMID: 32228763 DOI: 10.5588/ijtld.19.0163] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: The prevalence of tuberculosis (TB) disease is one of the three main indicators used to assess the epidemiological burden of TB and the impact change of TB control; the other two are incidence and mortality.OBJECTIVE: To estimate the prevalence of TB disease among adults in Ghana.METHODS: A nationally representative cross-sectional survey was conducted. Participants were screened for TB using interview and chest X-ray (CXR). For those participants with cough ≥2 weeks and/or abnormal CXR, spot and morning sputum specimens were collected and examined by smear microscopy and culture.RESULTS: The study revealed that the prevalence of smear-positive TB among adults (age ≥15 years) was 111 (95%CI 76-145) and that of bacteriologically confirmed TB was 356 (95%CI 288-425) per 100 000 population. Males and older people had a higher prevalence than their counterparts. The majority of TB cases were smear-negative and had an abnormal CXR without reported chronic cough.CONCLUSION: The survey revealed much higher TB disease burden than previously estimated. This implies that the programme needs more effort and resources to find undiagnosed and unreported cases. The higher proportion of smear-negative and asymptomatic TB cases suggests the need to revise the existing screening and diagnostic algorithms.
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Affiliation(s)
- F Bonsu
- National Tuberculosis Programme, Accra
| | - K K Addo
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra
| | | | - J Gyapong
- University of Health & Allied Sciences PMB 31, Ho
| | - A Badu-Peprah
- Kwame Nkrumah University of Science and Technology, Kumasi
| | - R Gockah
- National Tuberculosis Programme, Accra
| | | | - I Law
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - M Tadolini
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - I Onozaki
- World Health Organization, Yangon, Myanmar
| | - C Sismanidis
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - E Owusu-Dabo
- Kwame Nkrumah University of Science and Technology, Kumasi
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Marner L, Lundemann M, Sehested A, Nysom K, Borgwardt L, Mathiasen R, Wehner PS, Henriksen OM, Thomsen C, Skjøth-Rasmussen J, Broholm H, Østrup O, Forman JL, Højgaard L, Law I. Diagnostic Accuracy and Clinical Impact of [ 18F]FET PET in Childhood CNS tumors. Neuro Oncol 2021; 23:2107-2116. [PMID: 33864083 DOI: 10.1093/neuonc/noab096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Central nervous system (CNS) tumors cause the highest death rates among childhood cancers, and survivors frequently have severe late effects. Magnetic resonance imaging (MRI) is the imaging modality of choice, but its specificity can be challenged by treatment-induced signal changes. In adults, O-(2-[ 18F]fluoroethyl)-L-tyrosine ([ 18F]FET) PET can assist in interpreting MRI findings. We assessed the clinical impact and diagnostic accuracy of adding [ 18F]FET PET to MRI in children with CNS tumors. METHODS A total of 169 [ 18F]FET PET scans were performed in 97 prospectively and consecutively included patients with known or suspected childhood CNS tumors. Scans were performed at primary diagnosis, before or after treatment, or at relapse. RESULTS Adding [ 18F]FET PET to MRI impacted clinical management in 8% [95% confidence interval (CI): 4-13%] of all scans (n=151) and in 33% [CI: 17-53%] of scans deemed clinically indicated due to difficult decision-making on MRI alone (n=30). Using pathology or follow-up as reference standard, the addition of [ 18F]FET PET increased specificity (1.00 [0.82-1.00] vs. 0.48 [0.30-0.70], p=0.0001) and accuracy (0.91 [CI: 0.87-0.96] vs. 0.81 [CI: 0.75-0.89], p=0.04) in 83 treated lesions and accuracy in 58 untreated lesions (0.96 [CI:0.91-1.00] vs 0.90 [CI:0.82-0.92], p<0.001). Further, in a subset of patients (n=15) [ 18F]FET uptake correlated positively with genomic proliferation index. CONCLUSIONS The addition of [ 18F]FET PET to MRI helped discriminate tumor from non-tumor lesions in the largest consecutive cohort of pediatric CNS tumor patients presented to date.
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Affiliation(s)
- Lisbeth Marner
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark.,Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Denmark
| | - Michael Lundemann
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Astrid Sehested
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Karsten Nysom
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Lise Borgwardt
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Peder S Wehner
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark
| | - Otto M Henriksen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Carsten Thomsen
- Department of Diagnostic Radiology, Copenhagen University Hospital Rigshospitalet, Denmark.,Department of Radiology, Zealand University Hospital, Denmark
| | | | - Helle Broholm
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Olga Østrup
- Department of Genomic Medicine, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Julie L Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Liselotte Højgaard
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
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Bashir A, Larsen VA, Ziebell M, Fugleholm K, Law I. Improved Detection of Postoperative Residual Meningioma with [ 68Ga]Ga-DOTA-TOC PET Imaging Using a High-resolution Research Tomograph PET Scanner. Clin Cancer Res 2021; 27:2216-2225. [PMID: 33526423 DOI: 10.1158/1078-0432.ccr-20-3362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/30/2020] [Accepted: 01/25/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE PET with somatostatin receptor ligand [68Ga]Ga-DOTA-D-Phe1-Tyr3-octreotide ([68Ga]Ga-DOTA-TOC) is an established method in radiotherapy planning because of the improved detection and delineation of meningioma tissue. We investigated the diagnostic accuracy of supplementary [68Ga]Ga-DOTA-TOC PET in patients with a 3-month postoperative MRI reporting gross-total resection (GTR). EXPERIMENTAL DESIGN Thirty-seven patients with a histologically proven meningioma and GTR on postoperative MRI were prospectively referred to [68Ga]Ga-DOTA-TOC PET. Detection and volume measurements of [68Ga]Ga-DOTA-TOC-avid lesions in relation to the primary tumor site were recorded. Residual tumor in suspicious lesions suggested by [68Ga]Ga-DOTA-TOC PET was verified by (i) tumor recurrence/progression on subsequent MRI scans according to the Response Assessment of Neuro-Oncology criteria, (ii) subsequent histology, and (iii) follow-up [68Ga]Ga-DOTA-TOC PET scan. RESULTS Twenty-three PET scans demonstrated [68Ga]Ga-DOTA-TOC-avid lesions suspicious of residual meningioma, where 18 could be verified by (i) tumor progression on subsequent MRI scans (n = 6), (ii) histologic confirmation (n = 3), and (iii) follow-up [68Ga]Ga-DOTA-TOC PET scans confirming the initial PET findings (n = 9) after an overall median follow-up time of 17 months (range, 9-35 months). In contrast, disease recurrence was seen in only 2 of 14 patients without [68Ga]Ga-DOTA-TOC-avid lesions (P < 0.0001). The sensitivity, specificity, and diagnostic accuracy of [68Ga]Ga-DOTA-TOC PET in detecting meningioma residue was 90% [95% confidence interval (CI), 67-99], 92% (95% CI, 62-100), and 90% (95% CI, 74-98; P < 0.0001), respectively. CONCLUSIONS The majority of patients with GTR on 3-month postoperative MRI may have small unrecognized meningioma residues that can be detected using [68Ga]Ga-DOTA-TOC PET.
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Affiliation(s)
- Asma Bashir
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Vibeke A Larsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Morten Ziebell
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Denmark
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Henriksen OM, Gjedde A, Vang K, Law I, Aanerud J, Rostrup E. Regional and interindividual relationships between cerebral perfusion and oxygen metabolism. J Appl Physiol (1985) 2021; 130:1836-1847. [PMID: 33830816 DOI: 10.1152/japplphysiol.00939.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Quantitative measurements of resting cerebral blood flow (CBF) and metabolic rate of oxygen (CMRO2) show large between-subject and regional variability, but the relationships between CBF and CMRO2 measurements regionally and globally are not fully established. Here, we investigated the between-subject and regional associations between CBF and CMRO2 measures with independent and quantitative PET techniques. We included resting CBF and CMRO2 measurements from 50 healthy volunteers (aged 22-81 yr), and calculated the regional and global values of oxygen delivery (Do2) and oxygen extraction fraction (OEF). Linear mixed-model analysis showed that CBF and CMRO2 measurements were closely associated regionally, but no significant between-subject association could be demonstrated, even when adjusting for arterial Pco2 and hemoglobin concentration. The analysis also showed regional differences of OEF, reflecting variable relationship between Do2 and CMRO2, resulting in lower estimates of OEF in thalami, brainstem, and mesial temporal cortices and higher estimates of OEF in occipital cortex. In the present study, we demonstrated no between-subject association of quantitative measurements of CBF and CMRO2 in healthy subjects. Thus, quantitative measurements of CBF did not reflect the underlying between-subject variability of oxygen metabolism measures, mainly because of large interindividual OEF variability not accounted for by Pco2 and hemoglobin concentration.NEW & NOTEWORTHY Using quantitative PET-measurements in healthy human subjects, we confirmed a regional association of CBF and CMRO2, but did not find an association of these values across subjects. This suggests that subjects have an individual coupling between perfusion and metabolism and shows that absolute perfusion measurements does not serve as a surrogate measure of individual measures of oxygen metabolism. The analysis further showed smaller, but significant regional differences of oxygen extraction fraction at rest.
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Affiliation(s)
- Otto M Henriksen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark
| | - Albert Gjedde
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Translational Neuropsychiatry Unit, Aarhus University and University Hospital, Aarhus, Denmark.,Department of Nuclear Medicine and PET Centre, Aarhus University and University Hospital, Aarhus, Denmark
| | - Kim Vang
- Department of Nuclear Medicine and PET Centre, Aarhus University and University Hospital, Aarhus, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark
| | - Joel Aanerud
- Department of Nuclear Medicine and PET Centre, Aarhus University and University Hospital, Aarhus, Denmark
| | - Egill Rostrup
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark.,Mental Health Center Glostrup, University of Copenhagen, Copenhagen, Denmark
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Abstract
In neurodegenerative diseases, positron emission tomography (PET) imaging plays an important role in the early identification and differential diagnosis in particular in clinically challenging patients. 18F-FDG is still the most widely used and established tracer in this patient group, with different cortical and subcortical regions being preferentially affected in different neurodegenerative diseases, such as frontotemporal dementia, Alzheimer's disease or Lewy Body dementia, resulting in typical hypometabolic patterns. Over the last decades, however, the implementation of tracers specific for the pathological deposits characteristic of the different diseases, such as amyloid and tau, has revolutionized the way of classifying and reporting cases of cognitive impairment of neurodegenerative origin, providing complementary information to 18F-FDG PET. In neuro-oncology, PET imaging can be performed in several clinical indications, as highlighted in the joint European Association of Nuclear Medicine (EANM)/European Association of Neuro-Oncology (EANO)/Response assessment in neuro-oncology (RANO) practice guidelines on imaging in neuro-oncology. For assessment of glioma, amino-acid analogues, such as 11C-methionine or 18F-FET, are used whenever clinically available, as they offer excellent tumor-to-background ratios in malignant tumors. Moreover, dynamic acquisition of amino-acid analogue tracers and assessment of the shape of the time-activity curve can be used to perform noninvasive grading of brain gliomas, differentiating low from high grade presentations. In both settings, however, thorough knowledge of the normal physiological tracer distribution and the variants and pitfalls that can occur during image acquisition, processing and interpretation is mandatory in order to provide optimal diagnostic information to referring physicians and patients. Especially in neuro-oncology, this process can be aided by the active use of coregistered magnetic resonance imaging to accurately identify the imaging correlates of developmental origin, acute and chronic stroke, inflammation, infection and seizure related activity.
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Affiliation(s)
- Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine DIMED, Padua University Hospital, Padua, Italy
| | - Valentina Garibotto
- Nuclear Medicine and Molecular Imaging Division, Diagnostic Department, University Hospitals of Geneva and NIMTLab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark
| | - Karolien Goffin
- Department of Nuclear Medicine, University Hospital Leuven, Division of Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium.
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Mirian C, Duun-Henriksen AK, Maier A, Pedersen MM, Jensen LR, Bashir A, Graillon T, Hrachova M, Bota D, van Essen M, Spanjol P, Kreis C, Law I, Broholm H, Poulsgaard L, Fugleholm K, Ziebell M, Munch T, Walter MA, Mathiesen T. Somatostatin Receptor-Targeted Radiopeptide Therapy in Treatment-Refractory Meningioma: Individual Patient Data Meta-analysis. J Nucl Med 2021; 62:507-513. [PMID: 32859705 DOI: 10.2967/jnumed.120.249607] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
Somatostatin receptor (SSTR)-targeted peptide receptor radionuclide therapy (PRRT) represents a promising approach for treatment-refractory meningiomas. Methods: We performed an individual patient data meta-analysis, including all published data on meningioma patients treated with SSTR-targeted PRRT. The main outcomes were toxicity, response to treatment, progression-free survival (PFS), and overall survival (OS). We applied the Kaplan-Meier method to estimate survival probabilities and report incidence rates per 100 person-years. We applied Cox proportional hazards models to determine the effect of covariates. Results: We screened 537 papers and identified 6 eligible cohort studies. We included a total of 111 patients who had treatment-refractory meningioma and received SSTR-targeted PRRT. Disease control was achieved in 63% of patients. The 6-mo PFS rates were 94%, 48%, and 0% for World Health Organization grades I, II, and III, respectively. The risk of disease progression decreased by 13% per 1,000-MBq increase in the total applied activity. The 1-y OS rates were 88%, 71%, and 52% for World Health Organization grades I, II, and III, respectively. The risk of death decreased by 17% per 1,000-MBq increase in the total applied activity. The main side effects comprised transient hematotoxicity, such as anemia in 22% of patients, leukopenia in 13%, lymphocytopenia in 24%, and thrombocytopenia in 17%. Conclusion: To our knowledge, this individual patient data meta-analysis represents the most comprehensive analysis of the benefits of and adverse events associated with SSTR-targeted PRRT for treatment-refractory meningioma. The treatment was well tolerated, achieved disease control in most cases, and showed promising results regarding PFS and OS.
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Affiliation(s)
- Christian Mirian
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Nuclear Medicine, University Hospital of Geneva, Geneva, Switzerland
| | | | - Andrea Maier
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Møller Pedersen
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lasse Rehné Jensen
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Asma Bashir
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Graillon
- APHM, Department of Neurosurgery, La Timone Hospital, Marseille, France
| | - Maya Hrachova
- Department of Neurology, UC Irvine Medical Center, Irvine, California
| | - Daniela Bota
- Department of Neurology, UC Irvine Medical Center, Irvine, California
- Department of Neurosurgery, UC Irvine Medical Center, Irvine, California
| | - Martjin van Essen
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Petar Spanjol
- Department of Nuclear Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Christian Kreis
- Department of Nuclear Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helle Broholm
- Department of Neuropathology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Morten Ziebell
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tina Munch
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; and
| | - Martin A Walter
- Department of Nuclear Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Tiit Mathiesen
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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42
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Gjerum L, Andersen BB, Bruun M, Simonsen AH, Henriksen OM, Law I, Hasselbalch SG, Frederiksen KS. Comparison of the clinical impact of 2-[18F]FDG-PET and cerebrospinal fluid biomarkers in patients suspected of Alzheimer's disease. PLoS One 2021; 16:e0248413. [PMID: 33711065 PMCID: PMC7954298 DOI: 10.1371/journal.pone.0248413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/26/2021] [Indexed: 12/14/2022] Open
Abstract
Background The two biomarkers 2-[18F]FDG-PET and cerebrospinal fluid biomarkers are both recommended to support the diagnosis of Alzheimer’s disease. However, there is a lack of knowledge for the comparison of the two biomarkers in a routine clinical setting. Objective The aim was to compare the clinical impact of 2-[18F]FDG-PET and cerebrospinal fluid biomarkers on diagnosis, prognosis, and patient management in patients suspected of Alzheimer’s disease. Methods Eighty-one patients clinically suspected of Alzheimer’s disease were retrospectively included from the Copenhagen Memory Clinic. As part of the clinical work-up all patients had a standard diagnostic program examination including MRI and ancillary investigations with 2-[18F]FDG-PET and cerebrospinal fluid biomarkers. An incremental study design was used to evaluate the clinical impact of the biomarkers. First, the diagnostic evaluation was based on the standard diagnostic program, then the diagnostic evaluation was revised after addition of either cerebrospinal fluid biomarkers or 2-[18F]FDG-PET. At each diagnostic evaluation, two blinded dementia specialists made a consensus decision on diagnosis, prediction of disease course, and change in patient management. Confidence in the decision was measured on a visual analogue scale (0–100). After 6 months, the diagnostic evaluation was performed with addition of the other biomarker. A clinical follow-up after 12 months was used as reference for diagnosis and disease course. Results The two biomarkers had a similar clinical value across all diagnosis when added individually to the standard diagnostic program. However, for the correctly diagnosed patient with Alzheimer’s disease cerebrospinal fluid biomarkers had a significantly higher impact on diagnostic confidence (mean scores±SD: 88±11 vs. 82±11, p = 0.046) and a significant reduction in the need for ancillary investigations (23 vs. 18 patients, p = 0.049) compared to 2-[18F]FDG-PET. Conclusion The two biomarkers had similar clinical impact on diagnosis, but cerebrospinal fluid biomarkers had a more significant value in corroborating the diagnosis of Alzheimer’s disease compared to 2-[18F]FDG-PET.
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Affiliation(s)
- Le Gjerum
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Bo Andersen
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marie Bruun
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anja Hviid Simonsen
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Otto Mølby Henriksen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steen Gregers Hasselbalch
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Steen Frederiksen
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
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43
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Vestergaard MB, Calvo OP, Hansen AE, Rosenbaum S, Larsson HBW, Henriksen OM, Law I. Validation of kinetic modeling of [ 15O]H 2O PET using an image derived input function on hybrid PET/MRI. Neuroimage 2021; 233:117950. [PMID: 33716159 DOI: 10.1016/j.neuroimage.2021.117950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/23/2021] [Accepted: 03/05/2021] [Indexed: 11/15/2022] Open
Abstract
In present study we aimed to validate the use of image-derived input functions (IDIF) in the kinetic modeling of cerebral blood flow (CBF) measured by [15O]H2O PET by comparing with the accepted reference standard arterial input function (AIF). Additional comparisons were made to mean cohort AIF and CBF values acquired by methodologically independent phase-contrast mapping (PCM) MRI. Using hybrid PET/MRI an IDIF was generated by measuring the radiotracer concentration in the internal carotid arteries and correcting for partial volume effects using the intravascular volume measured from MRI-angiograms. Seven patients with carotid steno-occlusive disease and twelve healthy controls were examined at rest, after administration of acetazolamide, and, in the control group, during hyperventilation. Agreement between the techniques was examined by linear regression and Bland-Altman analysis. Global CBF values modeled using IDIF correlated with values from AIF across perfusion states in both patients (p<10-6, R2=0.82, 95% limits of agreement (LoA)=[-11.3-9.9] ml/100 g/min) and controls (p<10-6, R2=0.87, 95% LoA=[-17.1-13.7] ml/100 g/min). The reproducibility of gCBF using IDIF was identical to AIF (15.8%). Values from IDIF and AIF had equally good correlation to measurements by PCM MRI, R2=0.86 and R2=0.84, (p<10-6), respectively. Mean cohort AIF performed substantially worse than individual IDIFs (p<10-6, R2=0.63, LoA=[-12.8-25.3] ml/100 g/min). In the patient group, use of IDIF provided similar reactivity maps compared to AIF. In conclusion, global CBF values modeled using IDIF correlated with values modeled by AIF and similar perfusion deficits could be established in a patient group.
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Affiliation(s)
- Mark B Vestergaard
- Department of Clinical Physiology, Nuclear Medicine, and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Oriol P Calvo
- Department of Clinical Physiology, Nuclear Medicine, and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Adam E Hansen
- Department of Clinical Physiology, Nuclear Medicine, and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Sverre Rosenbaum
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Henrik B W Larsson
- Department of Clinical Physiology, Nuclear Medicine, and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Otto M Henriksen
- Department of Clinical Physiology, Nuclear Medicine, and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine, and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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Tester DJ, Bombei HM, Fitzgerald KK, Giudicessi JR, Pitel BA, Thorland EC, Russell BG, Hamrick SK, Kim CSJ, Haglund-Turnquist CM, Johnsrude CL, Atkins DL, Ochoa Nunez LA, Law I, Temple J, Ackerman MJ. Identification of a Novel Homozygous Multi-Exon Duplication in RYR2 Among Children With Exertion-Related Unexplained Sudden Deaths in the Amish Community. JAMA Cardiol 2021; 5:13-18. [PMID: 31913406 DOI: 10.1001/jamacardio.2019.5400] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The exome molecular autopsy may elucidate a pathogenic substrate for sudden unexplained death. Objective To investigate the underlying cause of multiple sudden deaths in young individuals and sudden cardiac arrests that occurred in 2 large Amish families. Design, Setting, and Participants Two large extended Amish families with multiple sudden deaths in young individuals and sudden cardiac arrests were included in the study. A recessive inheritance pattern was suggested based on an extended family history of sudden deaths in young individuals and sudden cardiac arrests, despite unaffected parents. A family with exercise-associated sudden deaths in young individuals occurring in 4 siblings was referred for postmortem genetic testing using an exome molecular autopsy. Copy number variant (CNV) analysis was performed on exome data using PatternCNV. Chromosomal microarray validated the CNV identified. The nucleotide break points of the CNV were determined by mate-pair sequencing. Samples were collected for this study between November 2004 and June 2019. Main Outcomes and Measures The identification of an underlying genetic cause for sudden deaths in young individuals and sudden cardiac arrests consistent with the recessive inheritance pattern observed in the families. Results A homozygous duplication, involving approximately 26 000 base pairs of intergenic sequence, RYR2's 5'UTR/promoter region, and exons 1 through 4 of RYR2, was identified in all 4 siblings of a family. Multiple distantly related relatives experiencing exertion-related sudden cardiac arrest also had the identical RYR2 homozygous duplication. A second, unrelated family with multiple exertion-related sudden deaths and sudden cardiac arrests in young individuals, with the same homozygous duplication, was identified. Several living, homozygous duplication-positive symptomatic patients from both families had nondiagnostic cardiologic testing, with only occasional ventricular ectopy occurring during exercise stress tests. Conclusions and Relevance In this analysis, we identified a novel, highly penetrant, homozygous multiexon duplication in RYR2 among Amish youths with exertion-related sudden death and sudden cardiac arrest but without an overt phenotype that is distinct from RYR2-mediated catecholaminergic polymorphic ventricular tachycardia. Considering that no cardiac tests reliably identify at-risk individuals and given the high rate of consanguinity in Amish families, identification of unaffected heterozygous carriers may provide potentially lifesaving premarital counseling and reproductive planning.
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Affiliation(s)
- David J Tester
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hannah M Bombei
- Stead Family Children's Hospital, Division of Pediatric Cardiology, University of Iowa, Iowa City
| | - Kristi K Fitzgerald
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - John R Giudicessi
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Beth A Pitel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.,Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Erik C Thorland
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.,Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Barbara G Russell
- Division of Pediatric Cardiology, University of Louisville, Louisville, Kentucky
| | - Samantha K Hamrick
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - C S John Kim
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carla M Haglund-Turnquist
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Dianne L Atkins
- Stead Family Children's Hospital, Division of Pediatric Cardiology, University of Iowa, Iowa City
| | - Luis A Ochoa Nunez
- Stead Family Children's Hospital, Division of Pediatric Cardiology, University of Iowa, Iowa City
| | - Ian Law
- Stead Family Children's Hospital, Division of Pediatric Cardiology, University of Iowa, Iowa City
| | - Joel Temple
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Michael J Ackerman
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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45
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Bashir A, Vestergaard MB, Marner L, Larsen VA, Ziebell M, Fugleholm K, Law I. PET imaging of meningioma with 18F-FLT: a predictor of tumour progression. Brain 2020; 143:3308-3317. [DOI: 10.1093/brain/awaa267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/08/2020] [Accepted: 06/29/2020] [Indexed: 11/15/2022] Open
Abstract
Abstract
We have previously reported that PET with 3′-deoxy-3′-18F-fluorothymidine (18F-FLT) provides a non-invasive assessment of cell proliferation in vivo in meningiomas. The purpose of this prospective study was to evaluate the potential of 18F-FLT PET in predicting subsequent tumour progression in asymptomatic meningiomas. Forty-three adult patients harbouring 46 MRI-presumed (n = 40) and residual meningiomas from previous surgery (n = 6) underwent a 60-min dynamic 18F-FLT PET scan prior to radiological surveillance. Maximum and mean tumour-to-blood ratios (TBRmax, TBRmean) of tracer radioactivity were calculated. Tumour progression was defined according to the latest published trial end-point criteria for bidimensional (2D) and corresponding yet exploratory volumetric measurements from the Response Assessment of Neuro-Oncology (RANO) workgroup. Independent-sample t-test, Pearson correlation coefficient, Cox regression, and receiver operating characteristic (ROC) curve analyses were used whenever appropriate. The median follow-up time after 18F-FLT PET imaging was 18 months (range 5–33.5 months). A high concordance rate (91%) was found with regard to disease progression using 2D-RANO (n = 11) versus volumetric criteria (n = 10). Using 2D-RANO criteria, 18F-FLT uptake was significantly increased in patients with progressive disease, compared to patients with stable disease (TBRmax, 5.5 ± 1.3 versus 3.6 ± 1.1, P < 0.0001; TBRmean, 3.5 ± 0.8 versus 2.4 ± 0.7, P < 0.0001). ROC analysis yielded optimal thresholds of 4.4 for TBRmax [sensitivity 82%, specificity 77%, accuracy 78%, and area under curve (AUC) 0.871; P < 0.0001] and 2.8 for TBRmean (sensitivity 82%, specificity 77%, accuracy 78%, AUC 0.848; P = 0.001) for early differentiation of patients with progressive disease from patients with stable disease. Upon excluding patients with residual meningioma or patients with stable disease with less than 12 months follow-up, the thresholds remained unchanged with similar diagnostic accuracies. Moreover, positive correlations were found between absolute and relative tumour growth rates and 18F-FLT uptake (r < 0.513, P < 0.015) that remained similar when excluding patients with residual meningioma or patients with stable disease and shorter follow-up period. Diagnostic accuracies were slightly inferior at 76% when assessing disease progression using volumetric criteria, while the thresholds remained unchanged. Multivariate analysis revealed that TBRmax was the only independent predictor of tumour progression (P < 0.046), while age, gender, baseline tumour size, tumour location, peritumoural oedema, and residual meningioma had no influence. The study reveals that 18F-FLT PET is a promising surrogate imaging biomarker for predicting subsequent tumour progression in treatment-naïve and asymptomatic residual meningiomas.
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Affiliation(s)
- Asma Bashir
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Mark B Vestergaard
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Lisbeth Marner
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Denmark
| | - Vibeke A Larsen
- Department of Radiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Morten Ziebell
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
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46
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Chételat G, Arbizu J, Barthel H, Garibotto V, Law I, Morbelli S, van de Giessen E, Agosta F, Barkhof F, Brooks DJ, Carrillo MC, Dubois B, Fjell AM, Frisoni GB, Hansson O, Herholz K, Hutton BF, Jack CR, Lammertsma AA, Landau SM, Minoshima S, Nobili F, Nordberg A, Ossenkoppele R, Oyen WJG, Perani D, Rabinovici GD, Scheltens P, Villemagne VL, Zetterberg H, Drzezga A. Amyloid-PET and 18F-FDG-PET in the diagnostic investigation of Alzheimer's disease and other dementias. Lancet Neurol 2020; 19:951-962. [PMID: 33098804 DOI: 10.1016/s1474-4422(20)30314-8] [Citation(s) in RCA: 182] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 07/22/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022]
Abstract
Various biomarkers are available to support the diagnosis of neurodegenerative diseases in clinical and research settings. Among the molecular imaging biomarkers, amyloid-PET, which assesses brain amyloid deposition, and 18F-fluorodeoxyglucose (18F-FDG) PET, which assesses glucose metabolism, provide valuable and complementary information. However, uncertainty remains regarding the optimal timepoint, combination, and an order in which these PET biomarkers should be used in diagnostic evaluations because conclusive evidence is missing. Following an expert panel discussion, we reached an agreement on the specific use of the individual biomarkers, based on available evidence and clinical expertise. We propose a diagnostic algorithm with optimal timepoints for these PET biomarkers, also taking into account evidence from other biomarkers, for early and differential diagnosis of neurodegenerative diseases that can lead to dementia. We propose three main diagnostic pathways with distinct biomarker sequences, in which amyloid-PET and 18F-FDG-PET are placed at different positions in the order of diagnostic evaluations, depending on clinical presentation. We hope that this algorithm can support diagnostic decision making in specialist clinical settings with access to these biomarkers and might stimulate further research towards optimal diagnostic strategies.
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Affiliation(s)
- Gaël Chételat
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237, Groupement d'Intérêt Public Cyceron, Caen, France.
| | - Javier Arbizu
- Department of Nuclear Medicine, University of Navarra, Clinica Universidad de Navarra, Pamplona, Spain
| | - Henryk Barthel
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals and NIMTlab, Geneva University, Geneva, Switzerland
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Silvia Morbelli
- Nuclear Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - David J Brooks
- Institute of Neuroscience, Newcastle University, Newcastle, UK; Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bruno Dubois
- Centre des Maladies Cognitives et Comportementales, University Hospital of Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Paris, France
| | - Anders M Fjell
- Center for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Norway, Oslo; Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Giovanni B Frisoni
- Memory Clinic, Department of Rehabilitation and Geriatrics, Geneva University and University Hospitals, Geneva, Switzerland
| | - Oskar Hansson
- Clinical Memory Research Unit, Lund University, Malmö, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Karl Herholz
- Wolfson Molecular Imaging Centre, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Brian F Hutton
- Institute of Nuclear Medicine, University College London, London, UK
| | | | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Susan M Landau
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, USA
| | - Satoshi Minoshima
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Flavio Nobili
- UO Clinica Neurologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Child and Mother Health, University of Genoa, Genova, Italy
| | - Agneta Nordberg
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Rik Ossenkoppele
- Department of Neurology, Alzheimer Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Wim J G Oyen
- Humanitas University and Humanitas Clinical and Research Center, Department of Nuclear Medicine, Milan, Italy; Rijnstate, Department of Radiology and Nuclear Medicine, Arnhem, Netherlands; Radboud UMC, Department of Radiology and Nuclear Medicine, Nijmegen, Netherlands
| | - Daniela Perani
- Vita-Salute San Raffaele University, Nuclear Medicine Unit, San Raffaele Hospital, Division of Neuroscience San Raffaele Scientific Institute, Milan, Italy
| | - Gil D Rabinovici
- Departments of Neurology, Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Victor L Villemagne
- Department of Molecular Imaging & Therapy, Austin Health, Department of Medicine, University of Melbourne, Austin Health, Heidelberg, VIC, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; UK Dementia Research Institute at University College London, London, UK
| | - Alexander Drzezga
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; German Center for Neurodegenerative Diseases, Bonn-Cologne, Germany; Institute of Neuroscience and Medicine, Molecular Organization of the Brain, Forschungszentrum Jülich, Germany
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47
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Mariegaard J, Wenstrup J, Lim KZM, Bidstrup PE, von Heymann A, Johansen C, Knudsen GM, Law I, Specht L, Stenbæk DS. Prevalence of cognitive impairment and its relation to mental health in Danish lymphoma survivors. Support Care Cancer 2020; 29:3319-3328. [PMID: 33118105 DOI: 10.1007/s00520-020-05857-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/23/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE This study sought to investigate the prevalence of self-reported cognitive impairment and its relation to illness and treatment characteristics and mental health in Hodgkin lymphoma (HL) and diffuse large B cell lymphoma (DLBCL) survivors as cancer-related cognitive impairment has not been extensively studied in lymphoma survivors. METHODS One hundred fifteen HL and DLBCL survivors (mean age = 40.3 years, mean months since completed treatment = 29.6) completed questionnaires on executive function and mental health. We examined the prevalence of executive impairment and compared illness and treatment characteristics and mental health across survivors reporting impaired and non-impaired executive functioning using chi-square, Cochran-Armitage, and Mann-Whitney U tests. RESULTS We found that 39% reported executive impairment. Survivors reporting impaired executive functioning reported worse mental health (ps < .001) than survivors reporting non-impaired executive functioning. A larger proportion of the impaired group had received a high chemo dose compared to the non-impaired group although this result fell short of significance after adjustment for multiple comparisons (p = .017). CONCLUSIONS Self-reported cognitive impairment is prevalent in HL and DLBCL survivors and is associated with worse mental health and possibly high chemo dose. Future studies should investigate objective impairment and the possible dose-response relationship between chemo dose and cognitive impairment in lymphoma survivors.
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Affiliation(s)
- Johanna Mariegaard
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Jonathan Wenstrup
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark.,Psychological Aspects of Cancer, Survivorship Unit, Danish Cancer Society Research Center, DK-2100, Copenhagen, Denmark.,Department of Neurology, Bispebjerg-Frederiksberg Hospital, DK-2400, Copenhagen, Denmark
| | - Kevin Zi Ming Lim
- Psychological Aspects of Cancer, Survivorship Unit, Danish Cancer Society Research Center, DK-2100, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Survivorship Unit, Danish Cancer Society Research Center, DK-2100, Copenhagen, Denmark
| | - Annika von Heymann
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Christoffer Johansen
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Lena Specht
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Dea Siggaard Stenbæk
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark.
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48
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Morbelli S, Ekmekcioglu O, Barthel H, Albert NL, Boellaard R, Cecchin D, Guedj E, Lammertsma AA, Law I, Penuelas I, Semah F, Traub-Weidinger T, van de Giessen E, Varrone A, Garibotto V. COVID-19 and the brain: impact on nuclear medicine in neurology. Eur J Nucl Med Mol Imaging 2020; 47:2487-2492. [PMID: 32700058 PMCID: PMC7375837 DOI: 10.1007/s00259-020-04965-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy. .,Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Department of Health Sciences(DISSAL), University of Genoa, Genoa, Italy.
| | - Ozgul Ekmekcioglu
- Department of Nuclear Medicine, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Henryk Barthel
- Department of Nuclear Medicine, Leipzig University, Leipzig, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Eric Guedj
- APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix Marseille Univ, Marseille, France
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ivan Penuelas
- Department of Nuclear Medicine, Clinica Universidad de Navarra, IdiSNA, University of Navarra, Pamplona, Spain
| | - Franck Semah
- Nuclear Medicine Department, University Hospital, Lille, France
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Elsmarieke van de Giessen
- Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, Amsterdam, The Netherlands
| | - Andrea Varrone
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Valentina Garibotto
- NIMTLab, Faculty of Medicine, Geneva University, Geneva, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland
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49
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Giovannella M, Andresen B, Andersen JB, El-Mahdaoui S, Contini D, Spinelli L, Torricelli A, Greisen G, Durduran T, Weigel UM, Law I. Validation of diffuse correlation spectroscopy against 15O-water PET for regional cerebral blood flow measurement in neonatal piglets. J Cereb Blood Flow Metab 2020; 40:2055-2065. [PMID: 31665953 PMCID: PMC7786848 DOI: 10.1177/0271678x19883751] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 09/06/2019] [Accepted: 09/19/2019] [Indexed: 11/15/2022]
Abstract
Diffuse correlation spectroscopy (DCS) can non-invasively and continuously asses regional cerebral blood flow (rCBF) at the cot-side by measuring a blood flow index (BFI) in non-traditional units of cm2/s. We have validated DCS against positron emission tomography using 15O-labeled water (15O-water PET) in a piglet model allowing us to derive a conversion formula for BFI to rCBF in conventional units (ml/100g/min). Neonatal piglets were continuously monitored by the BabyLux device integrating DCS and time resolved near infrared spectroscopy (TRS) while acquiring 15O-water PET scans at baseline, after injection of acetazolamide and during induced hypoxic episodes. BFI by DCS was highly correlated with rCBF (R = 0.94, p < 0.001) by PET. A scaling factor of 0.89 (limits of agreement for individual measurement: 0.56, 1.39)×109× (ml/100g/min)/(cm2/s) was used to derive baseline rCBF from baseline BFI measurements of another group of piglets and of healthy newborn infants showing an agreement with expected values. These results pave the way towards non-invasive, cot-side absolute CBF measurements by DCS on neonates.
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Affiliation(s)
- Martina Giovannella
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Bjørn Andresen
- Department of Neonatology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Julie B Andersen
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark
| | - Sahla El-Mahdaoui
- Department of Neonatology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Davide Contini
- Politecnico di Milano-Dipartimento di Fisica, Milan, Italy
| | - Lorenzo Spinelli
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milan, Italy
| | - Alessandro Torricelli
- Politecnico di Milano-Dipartimento di Fisica, Milan, Italy
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milan, Italy
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Udo M Weigel
- HemoPhotonics S.L., Castelldefels (Barcelona), Spain
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark
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50
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Thorlacius-Ussing G, Nielsen JE, Law I, Hansen HV, Birgitte Bo A. Mania triggered by levodopa treatment in a patient with frontotemporal dementia caused by A C9orf72 repeat expansion: A case report. Clin Neurol Neurosurg 2020; 198:106147. [PMID: 32823188 DOI: 10.1016/j.clineuro.2020.106147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/22/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Gorm Thorlacius-Ussing
- Department of Neurology, Rigshospitalet, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Denmark.
| | - Jørgen E Nielsen
- Department of Neurology, Neurogenetics Clinic, Rigshospitalet, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Denmark
| | - Hanne Vibe Hansen
- Department of Neurology, Rigshospitalet, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Andersen Birgitte Bo
- Department of Neurology, Rigshospitalet, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Denmark
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