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Westhölter D, Haubold J, Welsner M, Salhöfer L, Wienker J, Sutharsan S, Straßburg S, Taube C, Umutlu L, Schaarschmidt BM, Koitka S, Zensen S, Forsting M, Nensa F, Hosch R, Opitz M. Elexacaftor/tezacaftor/ivacaftor influences body composition in adults with cystic fibrosis: a fully automated CT-based analysis. Sci Rep 2024; 14:9465. [PMID: 38658613 PMCID: PMC11043331 DOI: 10.1038/s41598-024-59622-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
A poor nutritional status is associated with worse pulmonary function and survival in people with cystic fibrosis (pwCF). CF transmembrane conductance regulator modulators can improve pulmonary function and body weight, but more data is needed to evaluate its effects on body composition. In this retrospective study, a pre-trained deep-learning network was used to perform a fully automated body composition analysis on chest CTs from 66 adult pwCF before and after receiving elexacaftor/tezacaftor/ivacaftor (ETI) therapy. Muscle and adipose tissues were quantified and divided by bone volume to obtain body size-adjusted ratios. After receiving ETI therapy, marked increases were observed in all adipose tissue ratios among pwCF, including the total adipose tissue ratio (+ 46.21%, p < 0.001). In contrast, only small, but statistically significant increases of the muscle ratio were measured in the overall study population (+ 1.63%, p = 0.008). Study participants who were initially categorized as underweight experienced more pronounced effects on total adipose tissue ratio (p = 0.002), while gains in muscle ratio were equally distributed across BMI categories (p = 0.832). Our findings suggest that ETI therapy primarily affects adipose tissues, not muscle tissue, in adults with CF. These effects are primarily observed among pwCF who were initially underweight. Our findings may have implications for the future nutritional management of pwCF.
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Affiliation(s)
- Dirk Westhölter
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Johannes Haubold
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Matthias Welsner
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
- Adult Cystic Fibrosis Center, Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Luca Salhöfer
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Johannes Wienker
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
- Adult Cystic Fibrosis Center, Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Svenja Straßburg
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
- Adult Cystic Fibrosis Center, Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Benedikt M Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Sven Koitka
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Felix Nensa
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - René Hosch
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marcel Opitz
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany.
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
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Wienker J, Darwiche K, Rüsche N, Büscher E, Karpf-Wissel R, Winantea J, Özkan F, Westhölter D, Taube C, Kersting D, Hautzel H, Salhöfer L, Hosch R, Nensa F, Forsting M, Schaarschmidt BM, Zensen S, Theysohn J, Umutlu L, Haubold J, Opitz M. Body composition impacts outcome of bronchoscopic lung volume reduction in patients with severe emphysema: a fully automated CT-based analysis. Sci Rep 2024; 14:8718. [PMID: 38622275 PMCID: PMC11018765 DOI: 10.1038/s41598-024-58628-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/01/2024] [Indexed: 04/17/2024] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is characterized by progressive and irreversible airflow limitation, with individual body composition influencing disease severity. Severe emphysema worsens symptoms through hyperinflation, which can be relieved by bronchoscopic lung volume reduction (BLVR). To investigate how body composition, assessed through CT scans, impacts outcomes in emphysema patients undergoing BLVR. Fully automated CT-based body composition analysis (BCA) was performed in patients with end-stage emphysema receiving BLVR with valves. Post-interventional muscle and adipose tissues were quantified, body size-adjusted, and compared to baseline parameters. Between January 2015 and December 2022, 300 patients with severe emphysema underwent endobronchial valve treatment. Significant improvements were seen in outcome parameters, which were defined as changes in pulmonary function, physical performance, and quality of life (QoL) post-treatment. Muscle volume remained stable (1.632 vs. 1.635 for muscle bone adjusted ratio (BAR) at baseline and after 6 months respectively), while bone adjusted adipose tissue volumes, especially total and pericardial adipose tissue, showed significant increase (2.86 vs. 3.00 and 0.16 vs. 0.17, respectively). Moderate to strong correlations between bone adjusted muscle volume and weaker correlations between adipose tissue volumes and outcome parameters (pulmonary function, QoL and physical performance) were observed. Particularly after 6-month, bone adjusted muscle volume changes positively corresponded to improved outcomes (ΔForced expiratory volume in 1 s [FEV1], r = 0.440; ΔInspiratory vital capacity [IVC], r = 0.397; Δ6Minute walking distance [6MWD], r = 0.509 and ΔCOPD assessment test [CAT], r = -0.324; all p < 0.001). Group stratification by bone adjusted muscle volume changes revealed that groups with substantial muscle gain experienced a greater clinical benefit in pulmonary function improvements, QoL and physical performance (ΔFEV1%, 5.5 vs. 39.5; ΔIVC%, 4.3 vs. 28.4; Δ6MWDm, 14 vs. 110; ΔCATpts, -2 vs. -3.5 for groups with ΔMuscle, BAR% < -10 vs. > 10, respectively). BCA results among patients divided by the minimal clinically important difference for forced expiratory volume of the first second (FEV1) showed significant differences in bone-adjusted muscle and intramuscular adipose tissue (IMAT) volumes and their respective changes after 6 months (ΔMuscle, BAR% -5 vs. 3.4 and ΔIMAT, BAR% -0.62 vs. 0.60 for groups with ΔFEV1 ≤ 100 mL vs > 100 mL). Altered body composition, especially increased muscle volume, is associated with functional improvements in BLVR-treated patients.
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Affiliation(s)
- Johannes Wienker
- Division of Interventional Pneumology, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany.
| | - Kaid Darwiche
- Division of Interventional Pneumology, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany
| | - Nele Rüsche
- Division of Interventional Pneumology, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany
| | - Erik Büscher
- Division of Interventional Pneumology, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany
| | - Rüdiger Karpf-Wissel
- Division of Interventional Pneumology, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany
| | - Jane Winantea
- Division of Interventional Pneumology, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany
| | - Filiz Özkan
- Division of Interventional Pneumology, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany
| | - Dirk Westhölter
- Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - David Kersting
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Hubertus Hautzel
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Luca Salhöfer
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - René Hosch
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Felix Nensa
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Benedikt M Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Jens Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marcel Opitz
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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3
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Jannusch K, Dietzel F, Bruckmann NM, Morawitz J, Boschheidgen M, Minko P, Bittner AK, Mohrmann S, Quick HH, Herrmann K, Umutlu L, Antoch G, Rubbert C, Kirchner J, Caspers J. Prediction of therapy response of breast cancer patients with machine learning based on clinical data and imaging data derived from breast [ 18F]FDG-PET/MRI. Eur J Nucl Med Mol Imaging 2024; 51:1451-1461. [PMID: 38133687 PMCID: PMC10957677 DOI: 10.1007/s00259-023-06513-9] [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: 07/11/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To evaluate if a machine learning prediction model based on clinical and easily assessable imaging features derived from baseline breast [18F]FDG-PET/MRI staging can predict pathologic complete response (pCR) in patients with newly diagnosed breast cancer prior to neoadjuvant system therapy (NAST). METHODS Altogether 143 women with newly diagnosed breast cancer (54 ± 12 years) were retrospectively enrolled. All women underwent a breast [18F]FDG-PET/MRI, a histopathological workup of their breast cancer lesions and evaluation of clinical data. Fifty-six features derived from positron emission tomography (PET), magnetic resonance imaging (MRI), sociodemographic / anthropometric, histopathologic as well as clinical data were generated and used as input for an extreme Gradient Boosting model (XGBoost) to predict pCR. The model was evaluated in a five-fold nested-cross-validation incorporating independent hyper-parameter tuning within the inner loops to reduce the risk of overoptimistic estimations. Diagnostic model-performance was assessed by determining the area under the curve of the receiver operating characteristics curve (ROC-AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Furthermore, feature importances of the XGBoost model were evaluated to assess which features contributed most to distinguish between pCR and non-pCR. RESULTS Nested-cross-validation yielded a mean ROC-AUC of 80.4 ± 6.0% for prediction of pCR. Mean sensitivity, specificity, PPV, and NPV of 54.5 ± 21.3%, 83.6 ± 4.2%, 63.6 ± 8.5%, and 77.6 ± 8.1% could be achieved. Histopathological data were the most important features for classification of the XGBoost model followed by PET, MRI, and sociodemographic/anthropometric features. CONCLUSION The evaluated multi-source XGBoost model shows promising results for reliably predicting pathological complete response in breast cancer patients prior to NAST. However, yielded performance is yet insufficient to be implemented in the clinical decision-making process.
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Affiliation(s)
- Kai Jannusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, D-40225, Düsseldorf, Germany
| | - Frederic Dietzel
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, D-40225, Düsseldorf, Germany
| | - Nils Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, D-40225, Düsseldorf, Germany
| | - Janna Morawitz
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, D-40225, Düsseldorf, Germany
| | - Matthias Boschheidgen
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, D-40225, Düsseldorf, Germany
| | - Peter Minko
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, D-40225, Düsseldorf, Germany
| | - Ann-Kathrin Bittner
- Department Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Svjetlana Mohrmann
- Department of Gynecology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, D-40225, Düsseldorf, Germany
| | - Harald H Quick
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, D-45147, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, D-45141, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, D-40225, Düsseldorf, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Cologne, Germany
| | - Christian Rubbert
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, D-40225, Düsseldorf, Germany.
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, D-40225, Düsseldorf, Germany
| | - Julian Caspers
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, D-40225, Düsseldorf, Germany
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4
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Drews MA, Milosevic A, Hamacher R, Grüneisen JS, Haubold J, Opitz MK, Bauer S, Umutlu L, Forsting M, Schaarschmidt BM. Impact of CT and MRI in the diagnostic workup of malignant triton tumour-a monocentric analysis and review of the literature. Br J Radiol 2024; 97:430-438. [PMID: 38308031 DOI: 10.1093/bjr/tqad035] [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: 08/14/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES Malignant triton tumours (MTTs) are rare but aggressive subtypes of malignant peripheral nerve sheath tumours (MPNSTs) with a high recurrence rate and 5-year survival of 14%. Systematic imaging data on MTTs are scarce and mainly based on single case reports. Therefore, we aimed to identify typical CT and MRI features to improve early diagnosis rates of this uncommon entity. METHODS A systematic review on literature published until December 2022 on imaging characteristics of MTTs was performed. Based on that, we conducted a retrospective, monocentric analysis of patients with histopathologically proven MTTs from our department. Explorative data analysis was performed. RESULTS Initially, 29 studies on 34 patients (31.42 ± 22.6 years, 12 female) were evaluated: Literature described primary MTTs as huge, lobulated tumours (108 ± 99.3 mm) with central necrosis (56% [19/34]), low T1w (81% [17/21]), high T2w signal (90% [19/21]) and inhomogeneous enhancement on MRI (54% [7/13]). Analysis of 16 patients (48.9 ± 13.8 years; 9 female) from our institution revealed comparable results: primary MTTs showed large, lobulated masses (118 mm ± 64.9) with necrotic areas (92% [11/12]). MRI revealed low T1w (100% [7/7]), high T2w signal (100% [7/7]) and inhomogeneous enhancement (86% [6/7]). Local recurrences and soft-tissue metastases mimicked these features, while nonsoft-tissue metastases appeared unspecific. CONCLUSIONS MTTs show characteristic features on CT and MRI. However, these do not allow a reliable differentiation between MTTs and other MPNSTs based on imaging alone. Therefore, additional histopathological analysis is required. ADVANCES IN KNOWLEDGE This largest published systematic analysis on MTT imaging revealed typical but unspecific imaging features that do not allow a reliable, imaging-based differentiation between MTTs and other MPNSTs. Hence, additional histopathological analysis remains essential.
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Affiliation(s)
- Marcel A Drews
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Aleksandar Milosevic
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Rainer Hamacher
- West German Cancer Centre, Department of Medical Oncology, University Hospital Essen, 45147 Essen, Germany
| | - Johannes S Grüneisen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Marcel K Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Sebastian Bauer
- West German Cancer Centre, Department of Medical Oncology, University Hospital Essen, 45147 Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Benedikt M Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
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5
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Hamacher R, Pabst KM, Cheung PF, Heilig CE, Hüllein J, Liffers ST, Borchert S, Costa PF, Schaarschmidt BM, Kessler L, Miera MA, Droste M, Akbulut M, Falkenhorst J, Zarrad F, Kostbade K, Mavroeidi IA, Glimm H, Umutlu L, Schuler M, Hübschmann D, Bauer S, Fröhling S, Herrmann K, Siveke JT, Schildhaus HU, Fendler WP. Fibroblast Activation Protein α-Directed Imaging and Therapy of Solitary Fibrous Tumor. J Nucl Med 2024; 65:252-257. [PMID: 38176718 DOI: 10.2967/jnumed.123.266411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/07/2023] [Indexed: 01/06/2024] Open
Abstract
Fibroblast activation protein α (FAPα) is expressed at high levels in several types of tumors. Here, we report the expression pattern of FAPα in solitary fibrous tumor (SFT) and its potential use as a radiotheranostic target. Methods: We analyzed FAPα messenger RNA and protein expression in biopsy samples from SFT patients using immunohistochemistry and multiplexed immunofluorescence. Tracer uptake and detection efficacy were assessed in patients undergoing clinical 68Ga-FAPα inhibitor (FAPI)-46 PET,18F-FDG PET, and contrast-enhanced CT. 90Y-FAPI-46 radioligand therapy was offered to eligible patients with progressive SFT. Results: Among 813 patients and 126 tumor entities analyzed from the prospective observational MASTER program of the German Cancer Consortium, SFT (n = 34) had the highest median FAPα messenger RNA expression. Protein expression was confirmed in tumor biopsies from 29 of 38 SFT patients (76%) in an independent cohort. Most cases showed intermediate to high FAPα expression by immunohistochemistry (24/38 samples, 63%), which was located primarily on the tumor cell surface. Nineteen patients who underwent 68Ga-FAPI-46 PET imaging demonstrated significantly increased tumor uptake, with an SUVmax of 13.2 (interquartile range [IQR], 10.2), and an improved mean detection efficacy of 94.5% (SEM, 4.2%), as compared with 18F-FDG PET (SUVmax, 3.2 [IQR, 3.1]; detection efficacy, 77.3% [SEM, 5.5%]). Eleven patients received a total of 34 cycles (median, 3 cycles [IQR, 2 cycles]) of 90Y-FAPI-46 radioligand therapy, which resulted in disease control in 9 patients (82%). Median progression-free survival was 227 d (IQR, 220 d). Conclusion: FAPα is highly expressed by SFT and may serve as a target for imaging and therapy. Further studies are warranted to define the role of FAPα-directed theranostics in the care of SFT patients.
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Affiliation(s)
- Rainer Hamacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany;
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
| | - Kim M Pabst
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Phyllis F Cheung
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (Partner Site Essen) and German Cancer Research Center, Heidelberg, Germany
| | - Christoph E Heilig
- Department of Translational Medical Oncology, National Center for Tumor Diseases, Heidelberg and German Cancer Research Center, Heidelberg, Germany
- German Cancer Consortium, Core Center Heidelberg, Heidelberg, Germany
| | - Jennifer Hüllein
- Computational Oncology, Molecular Precision Oncology Program, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany
| | - Sven-Thorsten Liffers
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (Partner Site Essen) and German Cancer Research Center, Heidelberg, Germany
| | - Sabrina Borchert
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Pedro Fragoso Costa
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Benedikt M Schaarschmidt
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Lukas Kessler
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Monika A Miera
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Margret Droste
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (Partner Site Essen) and German Cancer Research Center, Heidelberg, Germany
| | - Merve Akbulut
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Johanna Falkenhorst
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
| | - Fadi Zarrad
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Karina Kostbade
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
| | - Ilektra A Mavroeidi
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
| | - Hanno Glimm
- Department for Translational Medical Oncology, National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center, Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Translational Medical Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium, Dresden, Germany; and
| | - Lale Umutlu
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
| | - Daniel Hübschmann
- German Cancer Consortium, Core Center Heidelberg, Heidelberg, Germany
- Computational Oncology, Molecular Precision Oncology Program, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine, Heidelberg, Germany
| | - Sebastian Bauer
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
| | - Stefan Fröhling
- Department of Translational Medical Oncology, National Center for Tumor Diseases, Heidelberg and German Cancer Research Center, Heidelberg, Germany
- German Cancer Consortium, Core Center Heidelberg, Heidelberg, Germany
| | - Ken Herrmann
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Jens T Siveke
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (Partner Site Essen) and German Cancer Research Center, Heidelberg, Germany
| | - Hans-Ulrich Schildhaus
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Wolfgang P Fendler
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
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6
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Kupusovic J, Kessler L, Kazek S, Chodyla MK, Umutlu L, Zarrad F, Nader M, Fendler WP, Varasteh Z, Hermann K, Dobrev D, Wakili R, Rassaf T, Siebermair J, Rischpler C. Delayed 68Ga-FAPI-46 PET/MR imaging confirms ongoing fibroblast activation in patients after acute myocardial infarction. Int J Cardiol Heart Vasc 2024; 50:101340. [PMID: 38313450 PMCID: PMC10835345 DOI: 10.1016/j.ijcha.2024.101340] [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: 08/17/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 02/06/2024]
Abstract
Purpose of the Report Combined cardiac 68Ga-Fibroblast-Activation Protein-alpha inhibitor (FAPI) positron-emission tomography (PET) and cardiac magnetic resonance imaging (MRI) constitute a novel diagnostic tool in patients for the assessment of myocardial damage after an acute myocardial infarction (AMI). Purpose of this pilot study was to evaluate simultaneous Ga-68-FAPI-46-PET/MR imaging in the delayed phase after AMI. Material and Methods Eleven patients underwent hybrid 68Ga-FAPI-46 PET/MRI post AMI. Standardized uptake values and fibroblast activation volume (FAV) were calculated and correlated with serum biomarkers and MRI parameters. Results Significant 68Ga-FAPI-46 uptake could be demonstrated in 11 (100 %) patients after a mean period of 30.9 ± 22.0 days. FAV significantly exceeded the infarction size in MRI and showed a good correlation to MRI parameters as well as to serum biomarkers of myocardial damage. Conclusions 68Ga-FAPI-46 PET/MRI offers molecular and morphological imaging of affected myocardium after AMI. This study demonstrates ongoing fibroblast activation in a delayed phase after AMI and generates hypotheses for future studies while aiming for a better understanding of myocardial remodeling following ischemic tissue damage.
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Affiliation(s)
- Jana Kupusovic
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
- Department of Medicine and Cardiology, Goethe University, Frankfurt, Germany
| | - Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sandra Kazek
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michal Kamil Chodyla
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Fadi Zarrad
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Nader
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Wolfgang P. Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Zohreh Varasteh
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Nuclear Medicine, Klinikum Rechts der Isar der TUM, Technical University of Munich, Munich, Germany
| | - Ken Hermann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, United States
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
- Department of Medicine and Cardiology, Goethe University, Frankfurt, Germany
- German Center for Cardiovascular Research DZHK, Partner site Rhine-Main, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Johannes Siebermair
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
- Department of Cardiology, Krankenhaus Göttlicher Heiland GmbH, Vienna, Austria
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Nuclear Medicine, Klinikum Stuttgart, Stuttgart, Germany
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7
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Umutlu L, Nensa F, Demircioglu A, Antoch G, Herrmann K, Forsting M, Grueneisen JS. Radiomics Analysis of Multiparametric PET/MRI for N- and M-Staging in Patients with Primary Cervical Cancer. Nuklearmedizin 2024; 63:34-42. [PMID: 38325362 DOI: 10.1055/a-2157-6867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
PURPOSE The aim of this study was to investigate the potential of multiparametric 18F-FDG PET/MR imaging as a platform for radiomics analysis and machine learning algorithms based on primary cervical cancers to predict N- and M-stage in patients. MATERIALS AND METHODS A total of 30 patients with histopathological confirmation of primary and untreated cervical cancer were prospectively enrolled for a multiparametric 18F-FDG PET/MR examination, comprising a dedicated protocol for imaging of the female pelvis. The primary tumor in the uterine cervix was manually segmented on post-contrast T1-weighted images. Quantitative features were extracted from the segmented tumors using the Radiomic Image Processing Toolbox for the R software environment for statistical computing and graphics. 45 different image features were calculated from non-enhanced as well as post-contrast T1-weighted TSE images, T2-weighted TSE images, the ADC map, the parametric Ktrans, Kep, Ve and iAUC maps and PET images, respectively. Statistical analysis and modeling was performed using Python 3.5 and the scikit-learn software machine learning library for the Python programming language. RESULTS Prediction of M-stage was superior when compared to N-stage. Prediction of M-stage using SVM with SVM-RFE as feature selection obtained the highest performance providing sensitivity of 91 % and specificity of 92 %. Using receiver operating characteristic (ROC) analysis of the pooled predictions, the area under the curve (AUC) was 0.97. Prediction of N-stage using RBF-SVM with MIFS as feature selection reached sensitivity of 83 %, specificity of 67 % and an AUC of 0.82. CONCLUSION M- and N-stage can be predicted based on isolated radiomics analyses of the primary tumor in cervical cancers, thus serving as a template for noninvasive tumor phenotyping and patient stratification using high-dimensional feature vectors extracted from multiparametric PET/MRI data. KEY POINTS · Radiomics analysis based on multiparametric PET/MRI enables prediction of the metastatic status of cervical cancers. · Prediction of M-stage is superior to N-stage. · Multiparametric PET/MRI displays a valuable platform for radiomics analyses .
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Affiliation(s)
- Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Aydin Demircioglu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Johannes Stefan Grueneisen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
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Salhöfer L, Haubold J, Gutt M, Hosch R, Umutlu L, Meetschen M, Schuessler M, Forsting M, Nensa F, Schaarschmidt BM. The importance of educational tools and a new software solution for visualizing and quantifying report correction in radiology training. Sci Rep 2024; 14:1172. [PMID: 38216664 PMCID: PMC10786897 DOI: 10.1038/s41598-024-51462-4] [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: 06/07/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024] Open
Abstract
A novel software, DiffTool, was developed in-house to keep track of changes made by board-certified radiologists to preliminary reports created by residents and evaluate its impact on radiological hands-on training. Before (t0) and after (t2-4) the deployment of the software, 18 residents (median age: 29 years; 33% female) completed a standardized questionnaire on professional training. At t2-4 the participants were also requested to respond to three additional questions to evaluate the software. Responses were recorded via a six-point Likert scale ranging from 1 ("strongly agree") to 6 ("strongly disagree"). Prior to the release of the software, 39% (7/18) of the residents strongly agreed with the statement that they manually tracked changes made by board-certified radiologists to each of their radiological reports while 61% were less inclined to agree with that statement. At t2-4, 61% (11/18) stated that they used DiffTool to track differences. Furthermore, we observed an increase from 33% (6/18) to 44% (8/18) of residents who agreed to the statement "I profit from every corrected report". The DiffTool was well accepted among residents with a regular user base of 72% (13/18), while 78% (14/18) considered it a relevant improvement to their training. The results of this study demonstrate the importance of providing a time-efficient way to analyze changes made to preliminary reports as an additive for professional training.
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Affiliation(s)
- Luca Salhöfer
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany.
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Maurice Gutt
- Central IT Services, University Hospital Essen, Essen, Germany
| | - René Hosch
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Mathias Meetschen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Maximilian Schuessler
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Felix Nensa
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Benedikt Michael Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
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9
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Lindemann ME, Gratz M, Grafe H, Jannusch K, Umutlu L, Quick HH. Systematic evaluation of human soft tissue attenuation correction in whole-body PET/MR: Implications from PET/CT for optimization of MR-based AC in patients with normal lung tissue. Med Phys 2024; 51:192-208. [PMID: 38060671 DOI: 10.1002/mp.16863] [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: 05/04/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Attenuation correction (AC) is an important methodical step in positron emission tomography/magnetic resonance imaging (PET/MRI) to correct for attenuated and scattered PET photons. PURPOSE The overall quality of magnetic resonance (MR)-based AC in whole-body PET/MRI was evaluated in direct comparison to computed tomography (CT)-based AC serving as reference. The quantitative impact of isolated tissue classes in the MR-AC was systematically investigated to identify potential optimization needs and strategies. METHODS Data of n = 60 whole-body PET/CT patients with normal lung tissue and without metal implants/prostheses were used to generate six different AC-models based on the CT data for each patient, simulating variations of MR-AC. The original continuous CT-AC (CT-org) is referred to as reference. A pseudo MR-AC (CT-mrac), generated from CT data, with four tissue classes and a bone atlas represents the MR-AC. Relative difference in linear attenuation coefficients (LAC) and standardized uptake values were calculated. From the results two improvements regarding soft tissue AC and lung AC were proposed and evaluated. RESULTS The overall performance of MR-AC is in good agreement compared to CT-AC. Lungs, heart, and bone tissue were identified as the regions with most deviation to the CT-AC (myocardium -15%, bone tissue -14%, and lungs ±20%). Using single-valued LACs for AC in the lung only provides limited accuracy. For improved soft tissue AC, splitting the combined soft tissue class into muscles and organs each with adapted LAC could reduce the deviations to the CT-AC to < ±1%. For improved lung AC, applying a gradient LAC in the lungs could remarkably reduce over- or undercorrections in PET signal compared to CT-AC (±5%). CONCLUSIONS The AC is important to ensure best PET image quality and accurate PET quantification for diagnostics and radiotherapy planning. The optimized segment-based AC proposed in this study, which was evaluated on PET/CT data, inherently reduces quantification bias in normal lung tissue and soft tissue compared to the CT-AC reference.
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Affiliation(s)
- Maike E Lindemann
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Marcel Gratz
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Hong Grafe
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Kai Jannusch
- Department of Diagnostic and Interventional Radiology, University Hospital Duesseldorf, University Duesseldorf, Duesseldorf, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Harald H Quick
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
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10
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Parmar V, Haubold J, Salhöfer L, Meetschen M, Wrede K, Glas M, Guberina M, Blau T, Bos D, Kureishi A, Hosch R, Nensa F, Forsting M, Deuschl C, Umutlu L. Fully automated MR-based virtual biopsy of primary CNS lymphomas. Neurooncol Adv 2024; 6:vdae022. [PMID: 38516329 PMCID: PMC10956963 DOI: 10.1093/noajnl/vdae022] [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] [Indexed: 03/23/2024] Open
Abstract
Background Primary central nervous system lymphomas (PCNSL) pose a challenge as they may mimic gliomas on magnetic resonance imaging (MRI) imaging, compelling precise differentiation for appropriate treatment. This study focuses on developing an automated MRI-based workflow to distinguish between PCNSL and gliomas. Methods MRI examinations of 240 therapy-naive patients (141 males and 99 females, mean age: 55.16 years) with cerebral gliomas and PCNSLs (216 gliomas and 24 PCNSLs), each comprising a non-contrast T1-weighted, fluid-attenuated inversion recovery (FLAIR), and contrast-enhanced T1-weighted sequence were included in the study. HD-GLIO, a pre-trained segmentation network, was used to generate segmentations automatically. To validate the segmentation efficiency, 237 manual segmentations were prepared (213 gliomas and 24 PCNSLs). Subsequently, radiomics features were extracted following feature selection and training of an XGBoost algorithm for classification. Results The segmentation models for gliomas and PCNSLs achieved a mean Sørensen-Dice coefficient of 0.82 and 0.80 for whole tumors, respectively. Three classification models were developed in this study to differentiate gliomas from PCNSLs. The first model differentiated PCNSLs from gliomas, with an area under the curve (AUC) of 0.99 (F1-score: 0.75). The second model discriminated between high-grade gliomas and PCNSLs with an AUC of 0.91 (F1-score: 0.6), and the third model differentiated between low-grade gliomas and PCNSLs with an AUC of 0.95 (F1-score: 0.89). Conclusions This study serves as a pilot investigation presenting an automated virtual biopsy workflow that distinguishes PCNSLs from cerebral gliomas. Prior to clinical use, it is necessary to validate the results in a prospective multicenter setting with a larger number of PCNSL patients.
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Affiliation(s)
- Vicky Parmar
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Luca Salhöfer
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Mathias Meetschen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Martin Glas
- Department of Neuropathology, University Hospital Essen, Essen, Germany
| | - Maja Guberina
- Department of Radiotherapy, University Hospital Essen, Essen, Germany
| | - Tobias Blau
- Department of Neurology and Neurooncology, University Hospital Essen, Essen, Germany
| | - Denise Bos
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Anisa Kureishi
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - René Hosch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Cornelius Deuschl
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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11
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Demircioğlu A, Bos D, Demircioğlu E, Qaadan S, Glasmachers T, Bruder O, Umutlu L, Nassenstein K. Deep learning-based scan range optimization can reduce radiation exposure in coronary CT angiography. Eur Radiol 2024; 34:411-421. [PMID: 37552254 DOI: 10.1007/s00330-023-09971-9] [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: 12/27/2022] [Revised: 04/24/2023] [Accepted: 05/28/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES Cardiac computed tomography (CT) is essential in diagnosing coronary heart disease. However, a disadvantage is the associated radiation exposure to the patient which depends in part on the scan range. This study aimed to develop a deep neural network to optimize the delimitation of scan ranges in CT localizers to reduce the radiation dose. METHODS On a retrospective training cohort of 1507 CT localizers randomly selected from calcium scoring and angiography scans and acquired between 2010 and 2017, optimized scan ranges were delimited by two radiologists in consensus. A neural network was trained to reproduce the scan ranges and was tested on two randomly selected and independent validation cohorts: an internal cohort of 233 CT localizers (January 2018-June 2020) and an external cohort from a nearby hospital of 298 CT localizers (July 2020-December 2020). Localizers where a bypass surgery was visible were excluded. The effective radiation dose to the patient was simulated using a Monte Carlo simulation. Scan ranges of radiographers, radiologists, and the network were compared using an equivalence test; likewise, the reduction in effective dose was tested using a superior test. RESULTS The network replicated the radiologists' scan ranges with a Dice score of 96.5 ± 0.02 (p < 0.001, indicating equivalence). The generated scan ranges resulted in an effective dose reduction of 10.0% (p = 0.002) in the internal cohort and 12.6% (p < 0.001) in the external cohort compared to the scan ranges delimited by radiographers in clinical routine. CONCLUSIONS Automatic delimitation of the scan range can result in a radiation dose reduction to the patient. CLINICAL RELEVANCE STATEMENT Fully automated delimitation of the scan range using a deep neural network enables a significant reduction in radiation exposure during CT coronary angiography compared to manual examination planning. It can also reduce the workload of the radiographers. KEY POINTS • Scan range delimitation for coronary computed tomography angiography could be performed with high accuracy by a deep neural network. • Automated scan ranges showed a high agreement of 96.5% with the scan ranges of radiologists. • Using a Monte Carlo simulation, automated scan ranges reduced the effective dose to the patient by up to 12.6% (0.9 mSv) compared to the scan ranges of radiographers in clinical routine.
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Affiliation(s)
- Aydin Demircioğlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ender Demircioğlu
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, 45147, Essen, Germany
| | - Sahar Qaadan
- Department of Mechatronics and Artificial Intelligence Engineering, German Jordanian University, Madaba, JO-11180, Jordan
| | - Tobias Glasmachers
- Faculty of Computer Science, Ruhr-University Bochum, 44801, Bochum, Germany
| | - Oliver Bruder
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, 45138, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Kai Nassenstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
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12
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Telli T, Desaulniers M, Pyka T, Caobelli F, Forstmann S, Umutlu L, Fendler WP, Rominger A, Herrmann K, Seifert R. What Role Does PET/MRI Play in Musculoskeletal Disorders? Semin Nucl Med 2023:S0001-2998(23)00091-0. [PMID: 38044175 DOI: 10.1053/j.semnuclmed.2023.11.004] [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: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023]
Abstract
Musculoskeletal disorders of nononcological origin are one of the most frequent reasons for consultation. Patients suffering from musculoskeletal disorders also consult more than once for the same reason. This results in multiple clinical follow-ups after several radiological and serum examinations, the main ones including X-rays targeting the painful anatomical region and inflammatory serum parameters. As part of their work up, patients suffering from musculoskeletal disorders often require multisequence, multi-parameter MRI. PET/MRI is a promising imaging modality for their diagnosis, with the added advantage of being able to be performed in a single visit. PET/MRI is particularly useful for diagnosing osteomyelitis, spondylodiscitis, arthritis, many pediatric pathologies, and a wide range of other musculoskeletal pathologies. PET/MRI is already used to diagnose malignant bone tumors such as osteosarcoma. However, current knowledge of the indications for PET/MRI in nononcological musculoskeletal disorders is based on studies involving only a few patients. This review focuses on the usefulness of PET/MRI for diagnosing nononcological musculoskeletal disorders.
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Affiliation(s)
- Tugce Telli
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany.
| | - Mélanie Desaulniers
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany; Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Thomas Pyka
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Federico Caobelli
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Sophia Forstmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Department of Radiology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Ken Herrmann
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany; Department of Nuclear Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
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13
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Demmert TT, Pomykala KL, Lanzafame H, Pabst KM, Lueckerath K, Siveke J, Umutlu L, Hautzel H, Hamacher R, Herrmann K, Fendler WP. Oncologic Staging with 68Ga-FAPI PET/CT Demonstrates a Lower Rate of Nonspecific Lymph Node Findings Than 18F-FDG PET/CT. J Nucl Med 2023; 64:1906-1909. [PMID: 37734836 DOI: 10.2967/jnumed.123.265751] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/18/2023] [Indexed: 09/23/2023] Open
Abstract
Nonspecific lymph node uptake on 18F-FDG PET/CT imaging is a significant pitfall for tumor staging. Fibroblast activation protein α expression on cancer-associated fibroblasts and some tumor cells is less sensitive to acute inflammatory stimuli, and fibroblast activation protein-directed PET may overcome this limitation. Methods: Eighteen patients from our prospective observational study underwent 18F-FDG and 68Ga fibroblast activation protein inhibitor (FAPI) PET/CT scans within a median of 2 d (range, 0-22 d). Lymph nodes were assessed on histopathology and compared with SUV measurements. Results: On a per-patient basis, lymph nodes were rated malignant in 10 (56%) versus 7 (39%) patients by 18F-FDG PET/CT versus 68Ga-FAPI PET/CT scans, respectively, with a respective accuracy of 55% versus 94% for true lymph node metastases. Five of 6 (83%) false-positive nodes on the 18F-FDG PET/CT scans were rated true negative by the 68Ga-FAPI PET/CT scans. On a per-lesion basis, tumor detection rates were similar (85/89 lesions, 96%). Conclusion: 68Ga-FAPI PET/CT imaging demonstrated higher accuracy for true nodal involvement and therefore has the potential to replace 18F-FDG PET/CT imaging for cancer staging.
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Affiliation(s)
- Tristan T Demmert
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany;
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | - Kelsey L Pomykala
- Institute for AI in Medicine, University Medicine Essen, Essen, Germany
| | - Helena Lanzafame
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | - Kim M Pabst
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | - Katharina Lueckerath
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | - Jens Siveke
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; and
| | - Hubertus Hautzel
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | - Rainer Hamacher
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
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Jannusch K, Bruckmann NM, Morawitz J, Boschheidgen M, Quick HH, Herrmann K, Fendler WP, Umutlu L, Stuschke M, Hadaschik B, Antoch G, Schimmöller L, Kirchner J. Recurrent prostate cancer: combined role for MRI and PSMA-PET in 68Ga-PSMA-11 PET/MRI. Eur Radiol 2023:10.1007/s00330-023-10442-4. [PMID: 38038758 DOI: 10.1007/s00330-023-10442-4] [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: 08/23/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES To investigate the specific strengths of MRI and PET components in 68Ga-PSMA-11 PET/MRI for staging of patients with biochemically recurrent prostate cancer (PCa). METHODS Patients with biochemical recurrence of PCa and contrast-enhanced whole-body 68Ga-PSMA-11 PET/MRI including a dedicated pelvic multiparametric MRI were included in this retrospective study. Imaging datasets of MRI and PET were evaluated separately regarding local PCa recurrence (Tr), pelvic lymph node metastases (N1), distant lymph node metastases (M1a), bone metastases (M1b), and soft tissue metastases (M1c) according to PROMISE version 1. Data evaluation was performed patient- and region-/lesion-based. Cox regression revealed a PSA of 1.69 ng/mL as a cut-off for subgroup analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were evaluated for each image component. Differences in staging accuracy were assessed using the Wilcoxon and McNemar test. RESULTS Altogether 102 patients (mean aged 68 ± 8 years, median PSA 1.33 ng/mL) were included. PCa was found in 70/102 (68%) patients. Accuracy of MRI in the detection of Tr, N1, M + , M1a, and M1b was 100%, 79%, 90%, 97%, and 95% for PSA < 1.69 ng/mL and 100%, 87%, 87%, 91%, and 96% for PSA > 1.69 ng/mL. Accuracy of 68Ga-PSMA-11 PET was 93%, 97%, 93%, 98%, and 100% for PSA < 1.69 ng/mL and 87%, 91%, 96%, 100%, and 96% for PSA > 1.69 ng/mL. CONCLUSIONS Combined assessment of 68Ga-PSMA-11 PET/MRI improves tumor localization in men with biochemical recurrence. The MRI detected local recurrence of PCa more often whereas 68 Ga-PSMA-11 PET detected lymph node metastases more often, especially for PSA < 1.69 ng/mL. CLINICAL RELEVANCE STATEMENT This study gives a scientific baseline to improve the understanding and reading of 68Ga-PSMA-11 PET/MRI imaging in patients with biochemically recurrent PCa by showing the specific strength of each imaging component. KEY POINTS • Combining the individual modality strengths of 68Ga-PSMA-11 PET/MRI improves tumor localization in men with biochemical recurrence of prostate cancer. • MRI component of 68 Ga-PSMA-11 PET/MRI shows its strength in detecting local recurrence of prostate cancer, especially at PSA < 1.69 ng/mL. • 68 Ga-PSMA-11 PET component shows its strength in detecting local and distant lymph node metastases, especially at PSA < 1.69 ng/mL.
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Affiliation(s)
- Kai Jannusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany.
| | - Nils Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Janna Morawitz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Matthias Boschheidgen
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Harald H Quick
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, 45147, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, 45141, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Martin Stuschke
- Department of Radiation Oncology, West German Cancer Center, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Boris Hadaschik
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital, Essen, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
| | - Lars Schimmöller
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
- Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
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Kessler L, Hirmas N, Pabst KM, Hamacher R, Ferdinandus J, Schaarschmidt BM, Milosevic A, Nader M, Umutlu L, Uhl W, Reinacher-Schick A, Lugnier C, Witte D, Niedergethmann M, Herrmann K, Fendler WP, Siveke JT. 68Ga-Labeled Fibroblast Activation Protein Inhibitor ( 68Ga-FAPI) PET for Pancreatic Adenocarcinoma: Data from the 68Ga-FAPI PET Observational Trial. J Nucl Med 2023; 64:1910-1917. [PMID: 37973185 DOI: 10.2967/jnumed.122.264827] [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: 02/07/2023] [Revised: 09/27/2023] [Indexed: 11/19/2023] Open
Abstract
The fibroblast activation protein (FAP) is highly expressed on carcinoma-associated fibroblasts in the stroma of pancreatic cancer and thus is a promising target for imaging and therapy. Preliminary data on PET imaging with radiolabeled FAP inhibitors (FAPIs) demonstrate superior tumor detection. Here we assess the accuracy of FAP-directed PET in patients with pancreatic cancer. Methods: Of 64 patients with suspected or proven pancreatic cancer, 62 (97%) were included in the data analysis of the 68Ga-FAPI PET observational trial (NCT04571086). All of these patients underwent contrast-enhanced CT, and 38 patients additionally underwent 18F-FDG PET. The primary study endpoint was the association of 68Ga-FAPI PET uptake intensity and histopathologic FAP expression. Secondary endpoints were detection rate, diagnostic performance, interreader reproducibility, and change in management. Datasets were interpreted by 2 masked readers. Results: The primary endpoint was met: The association between 68Ga-FAPI SUVmax and histopathologic FAP expression was significant (Spearman r, 0.48; P = 0.04). For histopathology-validated lesions, 68Ga-FAPI PET showed high sensitivity and positive predictive values (PPVs) on per-patient (sensitivity, 100%; PPV, 96.3%) and per-region (sensitivity, 100%; PPV, 97.0%) bases. In a head-to-head comparison versus 18F-FDG or contrast-enhanced CT, 68Ga-FAPI detected more tumor on a per-lesion (84.7% vs. 46.5% vs. 52.9%), per-patient (97.4% vs. 73.7% vs. 92.1%), or per-region (32.6% vs. 18.8% vs. 23.7%) basis, respectively. 68Ga-FAPI PET readers showed substantial overall agreement on the basis of the Fleiss κ: primary κ, 0.77 (range, 0.66-0.88). Minor and major changes in clinical management occurred in 5 patients (8.4%) after 68Ga-FAPI PET. Conclusion: We confirmed an association of 68Ga-FAPI PET SUVmax and histopathologic FAP expression in pancreatic cancer patients. Additionally, we found high detection rate and diagnostic accuracy, superior to those of 18F-FDG PET/CT. 68Ga-FAPI might become a powerful diagnostic tool for pancreatic cancer work-up.
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Affiliation(s)
- Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
| | - Nader Hirmas
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
| | - Kim M Pabst
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Rainer Hamacher
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Justin Ferdinandus
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Benedikt M Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
| | - Aleksandar Milosevic
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
| | - Michael Nader
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Anke Reinacher-Schick
- Department of Hematology and Oncology with Palliative Care, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Celine Lugnier
- Department of General and Visceral Surgery, Alfried Krupp Hospital, Essen, Germany
| | - David Witte
- Department of General and Visceral Surgery, Alfried Krupp Hospital, Essen, Germany
| | - Marco Niedergethmann
- Department of General and Visceral Surgery, Alfried Krupp Hospital, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany;
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany
| | - Jens T Siveke
- German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Essen, Germany;
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; and
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK) (Partner Site University Hospital Essen) and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Haubold J, Baldini G, Parmar V, Schaarschmidt BM, Koitka S, Kroll L, van Landeghem N, Umutlu L, Forsting M, Nensa F, Hosch R. BOA: A CT-Based Body and Organ Analysis for Radiologists at the Point of Care. Invest Radiol 2023:00004424-990000000-00176. [PMID: 37994150 DOI: 10.1097/rli.0000000000001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
PURPOSE The study aimed to develop the open-source body and organ analysis (BOA), a comprehensive computed tomography (CT) image segmentation algorithm with a focus on workflow integration. METHODS The BOA combines 2 segmentation algorithms: body composition analysis (BCA) and TotalSegmentator. The BCA was trained with the nnU-Net framework using a dataset including 300 CT examinations. The CTs were manually annotated with 11 semantic body regions: subcutaneous tissue, muscle, bone, abdominal cavity, thoracic cavity, glands, mediastinum, pericardium, breast implant, brain, and spinal cord. The models were trained using 5-fold cross-validation, and at inference time, an ensemble was used. Afterward, the segmentation efficiency was evaluated on a separate test set comprising 60 CT scans. In a postprocessing step, a tissue segmentation (muscle, subcutaneous adipose tissue, visceral adipose tissue, intermuscular adipose tissue, epicardial adipose tissue, and paracardial adipose tissue) is created by subclassifying the body regions. The BOA combines this algorithm and the open-source segmentation software TotalSegmentator to have an all-in-one comprehensive selection of segmentations. In addition, it integrates into clinical workflows as a DICOM node-triggered service using the open-source Orthanc research PACS (Picture Archiving and Communication System) server to make the automated segmentation algorithms available to clinicians. The BCA model's performance was evaluated using the Sørensen-Dice score. Finally, the segmentations from the 3 different tools (BCA, TotalSegmentator, and BOA) were compared by assessing the overall percentage of the segmented human body on a separate cohort of 150 whole-body CT scans. RESULTS The results showed that the BCA outperformed the previous publication, achieving a higher Sørensen-Dice score for the previously existing classes, including subcutaneous tissue (0.971 vs 0.962), muscle (0.959 vs 0.933), abdominal cavity (0.983 vs 0.973), thoracic cavity (0.982 vs 0.965), bone (0.961 vs 0.942), and an overall good segmentation efficiency for newly introduced classes: brain (0.985), breast implant (0.943), glands (0.766), mediastinum (0.880), pericardium (0.964), and spinal cord (0.896). All in all, it achieved a 0.935 average Sørensen-Dice score, which is comparable to the one of the TotalSegmentator (0.94). The TotalSegmentator had a mean voxel body coverage of 31% ± 6%, whereas BCA had a coverage of 75% ± 6% and BOA achieved 93% ± 2%. CONCLUSIONS The open-source BOA merges different segmentation algorithms with a focus on workflow integration through DICOM node integration, offering a comprehensive body segmentation in CT images with a high coverage of the body volume.
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Affiliation(s)
- Johannes Haubold
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany (J.H., G.B., V.P., B.M.S., S.K., L.K., N.v.L., L.U., M.F., F.N., R.H.); and Institute of Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H., G.B., V.P., S.K., L.U., M.F., F.N., R.H.)
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17
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Demircioğlu A, Quinsten AS, Umutlu L, Forsting M, Nassenstein K, Bos D. Determining body height and weight from thoracic and abdominal CT localizers in pediatric and young adult patients using deep learning. Sci Rep 2023; 13:19010. [PMID: 37923758 PMCID: PMC10624655 DOI: 10.1038/s41598-023-46080-5] [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: 07/19/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023] Open
Abstract
In this retrospective study, we aimed to predict the body height and weight of pediatric patients using CT localizers, which are overview scans performed before the acquisition of the CT. We trained three commonly used networks (EfficientNetV2-S, ResNet-18, and ResNet-34) on a cohort of 1009 and 1111 CT localizers of pediatric patients with recorded body height and weight (between January 2013 and December 2019) and validated them in an additional cohort of 116 and 127 localizers (acquired in 2020). The best-performing model was then tested in an independent cohort of 203 and 225 CT localizers (acquired between January 2021 and March 2023). In addition, a cohort of 1401 and 1590 localizers from younger adults (acquired between January 2013 and December 2013) was added to the training set to determine if it could improve the overall accuracy. The EfficientNetV2-S using the additional adult cohort performed best with a mean absolute error of 5.58 ± 4.26 cm for height and 4.25 ± 4.28 kg for weight. The relative error was 4.12 ± 4.05% for height and 11.28 ± 12.05% for weight. Our study demonstrated that automated estimation of height and weight in pediatric patients from CT localizers can be performed.
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Affiliation(s)
- Aydin Demircioğlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Anton S Quinsten
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Kai Nassenstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
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18
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Jannusch K, Morawitz J, Schweiger B, Weiss D, Schimmöller L, Minko P, Herrmann K, Fendler WP, Quick HH, Antoch G, Umutlu L, Kirchner J, Bruckmann NM. [ 18F]FDG PET/MRI in children suffering from lymphoma: does MRI contrast media make a difference? Eur Radiol 2023; 33:8366-8375. [PMID: 37338559 PMCID: PMC10598113 DOI: 10.1007/s00330-023-09840-5] [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: 12/27/2022] [Revised: 03/07/2023] [Accepted: 04/14/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Evaluate the influence of an MRI contrast agent application on primary and follow-up staging in pediatric patients with newly diagnosed lymphoma using [18F]FDG PET/MRI to avoid adverse effects and save time and costs during examination. METHODS A total of 105 [18F]FDG PET/MRI datasets were included for data evaluation. Two different reading protocols were analyzed by two experienced readers in consensus, including for PET/MRI-1 reading protocol unenhanced T2w and/or T1w imaging, diffusion-weighted imaging (DWI), and [18F]FDG PET imaging and for PET/MRI-2 reading protocol an additional T1w post contrast imaging. Patient-based and region-based evaluation according to the revised International Pediatric Non-Hodgkin's Lymphoma (NHL) Staging System (IPNHLSS) was performed, and a modified standard of reference was applied comprising histopathology and previous and follow-up cross-sectional imaging. Differences in staging accuracy were assessed using the Wilcoxon and McNemar tests. RESULTS In patient-based analysis, PET/MRI-1 and PET/MRI-2 both determined a correct IPNHLSS tumor stage in 90/105 (86%) exams. Region-based analysis correctly identified 119/127 (94%) lymphoma-affected regions. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for PET/MRI-1 and PET/MRI-2 were 94%, 97%, 90%, 99%, 97%, respectively. There were no significant differences between PET/MRI-1 and PET/MRI-2. CONCLUSIONS The use of MRI contrast agents in [18F]FDG PET/MRI examinations has no beneficial effect in primary and follow-up staging of pediatric lymphoma patients. Therefore, switching to a contrast agent-free [18F]FDG PET/MRI protocol should be considered in all pediatric lymphoma patients. CLINICAL RELEVANCE STATEMENT This study gives a scientific baseline switching to a contrast agent-free [18F]FDG PET/MRI staging in pediatric lymphoma patients. This could avoid side effects of contrast agents and saves time and costs by a faster staging protocol for pediatric patients. KEY POINTS • No additional diagnostic benefit of MRI contrast agents at [18F]FDG PET/MRI examinations of pediatric lymphoma primary and follow-up staging • Highly accurate primary and follow-up staging of pediatric lymphoma patients at MRI contrast-free [18F]FDG PET/MRI.
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Affiliation(s)
- Kai Jannusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Janna Morawitz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Bernd Schweiger
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Daniel Weiss
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Lars Schimmöller
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Peter Minko
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Harald H Quick
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, 45147, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, 45141, Essen, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany.
| | - Nils-Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
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19
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Kersting D, Moraitis A, Sraieb M, Zarrad F, Umutlu L, Rischpler C, Fendler WP, Herrmann K, Weber M, Conti M, Fragoso Costa P, Jentzen W. Quantification performance of silicon photomultiplier-based PET for small 18F-, 68Ga- and 124I-avid lesions in the context of radionuclide therapy planning. Phys Med 2023; 114:103149. [PMID: 37778973 DOI: 10.1016/j.ejmp.2023.103149] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/03/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE The aim of this study was to investigate conditions for reliable quantification of sub-centimeter lesions with low18F,68Ga, and124I uptake using a silicon photomultiplier-based PET/CT system. METHODS A small tumor phantom was investigated under challenging but clinically realistic conditions resembling prostate and thyroid cancer lymph node metastases (6 spheres with 3.7-9.7 mm in diameter, 9 different activity concentrations ranging from about 0.25-25 kBq/mL, and a signal-to-background ratio of 20). Radionuclides with different positron branching ratios and prompt gamma coincidence contributions were investigated. Maximum-, contour-, and oversize-based partial volume effect (PVE) correction approaches were applied. Detection and quantification performance were estimated, considering a ±30 % deviation between imaged-derived and true activity concentrations as acceptable. A standard and a prolonged acquisition time and two image reconstruction algorithms (time-of-flight with/without point spread function modelling) were analyzed. Clinical data were evaluated to assess agreement of PVE-correction approaches indicating lesion quantification validity. RESULTS The smallest 3.7-mm sphere was not visible. If the lesions were clearly observed, quantification was, except for a few cases, acceptable using contour- or oversized-based PVE-corrections. Quantification accuracy did not substantially differ between 18F, 68Ga, and 124I. No systematic differences between the analyzed reconstruction algorithms or shorter and larger acquisition times were observed. In the clinical evaluation of 20 lesions, an excellent statistical agreement between oversize- and contour-based PVE-corrections was observed. CONCLUSIONS At the lower end of size (<10 mm) and activity concentration ranges of lymph-node metastases, quantification with reasonable accuracy is possible for 18F, 68Ga, and 124I, possibly allowing pre-therapeutic lesion dosimetry and individualized radionuclide therapy planning.
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Affiliation(s)
- David Kersting
- Department of Nuclear Medicine, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
| | - Alexandros Moraitis
- Department of Nuclear Medicine, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Miriam Sraieb
- Department of Nuclear Medicine, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Fadi Zarrad
- Department of Nuclear Medicine, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany; Institute of Diagnostic and Interventional Radiology and Neuroradiology, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Wolfgang Peter Fendler
- Department of Nuclear Medicine, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | | | - Pedro Fragoso Costa
- Department of Nuclear Medicine, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Walter Jentzen
- Department of Nuclear Medicine, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
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20
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Kersting D, Sandach P, Sraieb M, Wiesweg M, Metzenmacher M, Darwiche K, Oezkan F, Bölükbas S, Stuschke M, Umutlu L, Nader M, Hamacher R, Fendler WP, Wienker J, Eberhardt WEE, Schuler M, Herrmann K, Hautzel H. 68Ga-SSO-120 PET for Initial Staging of Small Cell Lung Cancer Patients: A Single-Center Retrospective Study. J Nucl Med 2023; 64:1540-1549. [PMID: 37474272 DOI: 10.2967/jnumed.123.265664] [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: 03/06/2023] [Revised: 05/24/2023] [Indexed: 07/22/2023] Open
Abstract
PET imaging using the somatostatin receptor 2 (SSTR2) antagonist satoreotide trizoxetan (SSO-120, previously OPS-202) could offer accurate tumor detection and screening for SSTR2-antagonist radionuclide therapy in patients with SSTR2-expressing small cell lung cancer (SCLC). The aim of this single-center study was to investigate tumor uptake and detection rates of 68Ga-SSO-120 in comparison to 18F-FDG PET in the initial staging of SCLC patients. Methods: Patients with newly diagnosed SCLC who underwent additional whole-body 68Ga-SSO-120 PET/CT during the initial diagnostic workup were retrospectively included. The mean administered activity was 139 MBq, and the mean uptake time was 60 min. Gold-standard staging 18F-FDG PET/CT was evaluated if available within 2 wk before or after 68Ga-SSO-120 PET if morphologic differences in CT images were absent. 68Ga-SSO-120- or 18F-FDG-positive lesions were reported in 7 anatomic regions (primary tumor, thoracic lymph node metastases, and distant metastases including pleural, contralateral pulmonary, liver, bone, and other) according to the TNM classification for lung cancer (eighth edition). Consensus TNM staging (derived from CT, endobronchial ultrasound-guided transbronchial needle aspiration, PET, and brain MRI) by a clinical tumor board served as the reference standard. Results: Thirty-one patients were included, 12 with limited and 19 with extensive disease according to the Veterans Administration Lung Study Group classification. 68Ga-SSO-120-positive tumor was detected in all patients (100%) and in 90 of the 217 evaluated regions (41.5%). Thirteen patients (42.0%) had intense average 68Ga-SSO-120 uptake (region-based mean SUVmax ≥ 10); 28 patients (90.3%) had average 68Ga-SSO-120 uptake greater than liver uptake (region-based mean peak tumor-to-liver ratio > 1). In 25 patients with evaluable 18F-FDG PET, primary tumor, thoracic lymph node metastases, and distant metastases were detected in 100%, 92%, and 64%, respectively, of all investigated patients by 68Ga-SSO-120 and in 100%, 92%, and 56%, respectively, by 18F-FDG PET. 68Ga-SSO-120 PET detected additional contralateral lymph node, liver, and brain metastases in 1, 1, and 2 patients, respectively (no histopathology available), and 18F-FDG PET detected additional contralateral lymph node metastases in 3 patients (1 confirmed, 1 systematic endobronchial ultrasound-guided transbronchial needle aspiration-negative, and 1 without available histopathology). None of these differences altered Veterans Administration Lung Study Group staging. The region-based monotonic correlation between 68Ga-SSO-120 and 18F-FDG uptake was low (Spearman ρ = 0.26-0.33). Conclusion: 68Ga-SSO-120 PET offers high diagnostic precision with comparable detection rates and additional complementary information to the gold standard, 18F-FDG PET. Consistent uptake in most patients warrants exploration of SSTR2-directed radionuclide therapy.
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Affiliation(s)
- David Kersting
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany;
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| | - Patrick Sandach
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| | - Miriam Sraieb
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| | - Marcel Wiesweg
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Metzenmacher
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pulmonology, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Filiz Oezkan
- Department of Pulmonary Medicine, Section of Interventional Pulmonology, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Servet Bölükbas
- Department of Thoracic Surgery and Thoracic Endoscopy, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Martin Stuschke
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; and
| | - Michael Nader
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| | - Rainer Hamacher
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| | - Johannes Wienker
- Department of Pulmonary Medicine, Section of Interventional Pulmonology, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- Division of Thoracic Oncology, West German Lung Center, University Medicine Essen-Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Wilfried E E Eberhardt
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Division of Thoracic Oncology, West German Lung Center, University Medicine Essen-Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Martin Schuler
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Division of Thoracic Oncology, West German Lung Center, University Medicine Essen-Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| | - Hubertus Hautzel
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
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21
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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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22
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Jannusch K, Lindemann ME, Bruckmann NM, Morawitz J, Dietzel F, Pomykala KL, Herrmann K, Bittner AK, Hoffmann O, Mohrmann S, Umutlu L, Antoch G, Quick HH, Kirchner J. Towards a fast PET/MRI protocol for breast cancer imaging: maintaining diagnostic confidence while reducing PET and MRI acquisition times. Eur Radiol 2023; 33:6179-6188. [PMID: 37045980 PMCID: PMC10415438 DOI: 10.1007/s00330-023-09580-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To investigate the diagnostic feasibility of a shortened breast PET/MRI protocol in breast cancer patients. METHODS Altogether 90 women with newly diagnosed T1tumor-staged (T1ts) and T2tumor-staged (T2ts) breast cancer were included in this retrospective study. All underwent a dedicated comprehensive breast [18F]FDG-PET/MRI. List-mode PET data were retrospectively reconstructed with 20, 15, 10, and 5 min for each patient to simulate the effect of reduced PET acquisition times. The SUVmax/mean of all malign breast lesions was measured. Furthermore, breast PET data reconstructions were analyzed regarding image quality, lesion detectability, signal-to-noise ratio (SNR), and image noise (IN). The simultaneously acquired comprehensive MRI protocol was then shortened by retrospectively removing sequences from the protocol. Differences in malignant breast lesion detectability between the original and the fast breast MRI protocol were evaluated lesion-based. The 20-min PET reconstructions and the original MRI protocol served as reference. RESULTS In all PET reconstructions, 127 congruent breast lesions could be detected. Group comparison and T1ts vs. T2ts subgroup comparison revealed no significant difference of subjective image quality between 20, 15, 10, and 5 min acquisition times. SNR of qualitative image evaluation revealed no significant difference between different PET acquisition times. A slight but significant increase of IN with decreasing PET acquisition times could be detected. Lesion SUVmax group comparison between all PET acquisition times revealed no significant differences. Lesion-based evaluation revealed no significant difference in breast lesion detectability between original and fast breast MRI protocols. CONCLUSIONS Breast [18F]FDG-PET/MRI protocols can be shortened from 20 to below 10 min without losing essential diagnostic information. KEY POINTS • A highly accurate breast cancer evaluation is possible by the shortened breast [18F]FDG-PET/MRI examination protocol. • Significant time saving at breast [18F]FDG-PET/MRI protocol could increase patient satisfaction and patient throughput for breast cancer patients at PET/MRI.
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Affiliation(s)
- Kai Jannusch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany.
| | - Maike E Lindemann
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, D-45147, Essen, Germany
| | - Nils Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany
| | - Janna Morawitz
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany
| | - Frederic Dietzel
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany
| | - Kelsey L Pomykala
- Department for Artificial Intelligence in Medicine, University Hospital Essen, University of Duisburg-Essen, D-45131, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Ann-Kathrin Bittner
- Department Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Oliver Hoffmann
- Department Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Svjetlana Mohrmann
- Department of Gynecology, Medical Faculty, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany
| | - Harald H Quick
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, D-45147, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, D-45141, Essen, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany
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23
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Pasquier D, Bidaut L, Oprea-Lager DE, deSouza NM, Krug D, Collette L, Kunz W, Belkacemi Y, Bau MG, Caramella C, De Geus-Oei LF, De Caluwé A, Deroose C, Gheysens O, Herrmann K, Kindts I, Kontos M, Kümmel S, Linderholm B, Lopci E, Meattini I, Smeets A, Kaidar-Person O, Poortmans P, Tsoutsou P, Hajjaji N, Russell N, Senkus E, Talbot JN, Umutlu L, Vandecaveye V, Verhoeff JJC, van Oordt WMVDH, Zacho HD, Cardoso F, Fournier L, Van Duijnhoven F, Lecouvet FE. Designing clinical trials based on modern imaging and metastasis-directed treatments in patients with oligometastatic breast cancer: a consensus recommendation from the EORTC Imaging and Breast Cancer Groups. Lancet Oncol 2023; 24:e331-e343. [PMID: 37541279 DOI: 10.1016/s1470-2045(23)00286-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 08/06/2023]
Abstract
Breast cancer remains the most common cause of cancer death among women. Despite its considerable histological and molecular heterogeneity, those characteristics are not distinguished in most definitions of oligometastatic disease and clinical trials of oligometastatic breast cancer. After an exhaustive review of the literature covering all aspects of oligometastatic breast cancer, 35 experts from the European Organisation for Research and Treatment of Cancer Imaging and Breast Cancer Groups elaborated a Delphi questionnaire aimed at offering consensus recommendations, including oligometastatic breast cancer definition, optimal diagnostic pathways, and clinical trials required to evaluate the effect of diagnostic imaging strategies and metastasis-directed therapies. The main recommendations are the introduction of modern imaging methods in metastatic screening for an earlier diagnosis of oligometastatic breast cancer and the development of prospective trials also considering the histological and molecular complexity of breast cancer. Strategies for the randomisation of imaging methods and therapeutic approaches in different subsets of patients are also addressed.
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Affiliation(s)
- David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France; University of Lille and CNRS, Centrale Lille, UMR 9189-CRIStAL, Lille, France.
| | - Luc Bidaut
- College of Science, University of Lincoln, Lincoln, UK
| | - Daniela Elena Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nandita M deSouza
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - David Krug
- Department of Radiation Oncology, Universitaetsklinikum Schleswig-Holstein-Campus Kiel, Kiel, Germany
| | - Laurence Collette
- Former European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Wolfgang Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Yazid Belkacemi
- AP-HP, Radiation Oncology Department, Henri Mondor University Hospital, Créteil, France; INSERM Unit 955 (-Bio), IMRB, University of Paris-Est (UPEC), Créteil, France
| | - Maria Grazia Bau
- Azienda Ospedaliera Città della Salute e della Scienza di Torino, Ospedale Sant'Anna, Turin, Italy
| | - Caroline Caramella
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Lioe-Fee De Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands; Biomedical Photonic Imaging Group, University of Twente, Enschede, Netherlands; Department of Radiation Science and Technology, Delft University of Technology, Delft, Netherlands
| | - Alex De Caluwé
- Radiotherapy Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Olivier Gheysens
- Department of Nuclear Medicine, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, Institut du Cancer Roi Albert II, UCLouvain, Brussels, Belgium
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Isabelle Kindts
- Department of Radiation Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Michalis Kontos
- National and Kapodistrian University of Athens, Athens, Greece
| | - Sherko Kümmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany; Charité - Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Barbro Linderholm
- Department of Oncolgy, Sahlgrenska University Hospital, Gothenburg, Sweden; Institution of Clinical Sciences, Department of Oncology, Sahlgrenska Academy at Gothenburg University, Gothenburg , Sweden
| | | | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Ann Smeets
- Department of Surgical Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Orit Kaidar-Person
- Oncology Institute, Sheba Tel Hashomer, Ramat Gan, Israel; Tel-Aviv University, Tel-Aviv, Israel
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; University of Antwerp, Antwerp, Belgium
| | - Pelagia Tsoutsou
- Hôpitaux Universitaires de Genève, Site de Cluse-Roseraie, Geneva, Switzerland
| | - Nawale Hajjaji
- Medical Oncology Department, Centre Oscar Lambret, Lille, France; Laboratoire Protéomique, Réponse Inflammatoire, et Spectrométrie De Masse (PRISM), Inserm U1192, Lille, France
| | - Nicola Russell
- Department of Radiotherapy, The Netherlands Cancer Institute-Antoni Van Leeuwenhoekziekenhuis, Amsterdam, Netherlands
| | | | - Jean-Noël Talbot
- Institut National des Sciences et Techniques Nucléaires, CEA-Saclay, Paris, France
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | | | - Joost J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Helle D Zacho
- Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
| | - Laure Fournier
- Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Frederieke Van Duijnhoven
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni Van Leeuwenhoekziekenhuis, Amsterdam, Netherlands
| | - Frédéric E Lecouvet
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, Institut du Cancer Roi Albert II, UCLouvain, Brussels, Belgium
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24
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Morawitz J, Bruckmann NM, Jannusch K, Dietzel F, Milosevic A, Bittner AK, Hoffmann O, Mohrmann S, Ruckhäberle E, Häberle L, Fendler WP, Herrmann K, Giesel FL, Antoch G, Umutlu L, Kowall B, Stang A, Kirchner J. Conventional Imaging, MRI and 18F-FDG PET/MRI for N and M Staging in Patients with Newly Diagnosed Breast Cancer. Cancers (Basel) 2023; 15:3646. [PMID: 37509307 PMCID: PMC10377867 DOI: 10.3390/cancers15143646] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Background: This study compares the diagnostic potential of conventional staging (computed tomography (CT), axillary sonography and bone scintigraphy), whole-body magnetic resonance imaging (MRI) and whole-body 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/)MRI for N and M staging in newly diagnosed breast cancer. Methods: A total of 208 patients with newly diagnosed breast cancer were prospectively included in this study and underwent contrast-enhanced thoracoabdominal CT, bone scintigraphy and axillary sonography as well as contrast-enhanced whole-body 18F-FDG PET/MRI. The datasets were analyzed with respect to lesion localization and characterization. Histopathology and follow-up imaging served as the reference standard. A McNemar test was used to compare the diagnostic performance of conventional staging, MRI and 18F-FDG PET/MRI and a Wilcoxon test was used to compare differences in true positive findings for nodal staging. Results: Conventional staging determined the N stage with a sensitivity of 80.9%, a specificity of 99.2%, a PPV (positive predictive value) of 98.6% and a NPV (negative predictive value) of 87.4%. The corresponding results for MRI were 79.6%, 100%, 100% and 87.0%, and were 86.5%, 94.1%, 91.7% and 90.3% for 18F-FDG PET/MRI. 18F-FDG PET/MRI was significantly more sensitive in determining malignant lymph nodes than conventional imaging and MRI (p < 0.0001 and p = 0.0005). Furthermore, 18F-FDG PET/MRI accurately estimated the clinical lymph node stage in significantly more cases than conventional imaging and MRI (each p < 0.05). Sensitivity, specificity, PPV and NPV for the M stage in conventional staging were 83.3%, 98.5%, 76.9% and 98.9%, respectively. The corresponding results for both MRI and 18F-FDG PET/MRI were 100.0%, 98.5%, 80.0% and 100.0%. No significant differences between the imaging modalities were seen for the staging of distant metastases. Conclusions:18F-FDG PET/MRI detects lymph node metastases in significantly more patients and estimates clinical lymph node stage more accurately than conventional imaging and MRI. No significant differences were found between imaging modalities with respect to the detection of distant metastases.
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Affiliation(s)
- Janna Morawitz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Nils-Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Kai Jannusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Frederic Dietzel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Aleksandar Milosevic
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Ann-Kathrin Bittner
- Department Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Oliver Hoffmann
- Department Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Svjetlana Mohrmann
- Department of Gynecology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Eugen Ruckhäberle
- Department of Gynecology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Lena Häberle
- Institute of Pathology, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University, D-40204 Duesseldorf, Germany
| | - Wolfgang Peter Fendler
- Department of Nuclear Medicine, German Cancer Consortium (DKTK)-University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, German Cancer Consortium (DKTK)-University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Frederik Lars Giesel
- Department of Nuclear Medicine, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Bernd Kowall
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, D-45147 Essen, Germany
| | - Andreas Stang
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, D-45147 Essen, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany
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25
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Milosevic A, Styczen H, Grueneisen J, Li Y, Weber M, Fendler WP, Kirchner J, Damman P, Wrede K, Lazaridis L, Glas M, Guberina M, Eckstein A, Blau T, Herrmann K, Umutlu L, Forsting M, Deuschl C, Schaarschmidt B. Evaluation of [ 68Ga]-DOTATOC PET/MRI in Patients with Meningioma of the Subcranial and Intraorbital Space. J Nucl Med 2023:jnumed.123.265424. [PMID: 37385668 DOI: 10.2967/jnumed.123.265424] [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: 01/09/2023] [Revised: 04/20/2023] [Indexed: 07/01/2023] Open
Abstract
Meningiomas are known to express somatostatin receptor (SSTR) type 2 to a high degree. Therefore, radiolabeled somatostatin analogs, such as DOTATOC, have been introduced for PET imaging of meningiomas. However, the benefit of hybrid SSTR PET/MRI is still debated. Here, we report our experience with [68Ga]-DOTATOC PET/MRI. Methods: PET/MRI was performed in 60 patients with suspected or diagnosed meningiomas of the skull plane and eye socket. Acquired datasets were reported by 2 independent readers regarding local tumor extent and signal characteristics. Histopathologic results and follow-up imaging served as the reference standard. SUVs of target lesions were analyzed according to the corresponding maximal tracer uptake. The diagnostic accuracy of PET/MRI and conventional MRI was determined independently and compared with the reference standard. Results: In total, 60 target lesions were identified, with 54 considered to be meningiomas according to the reference standard. Sensitivity and specificity of PET/MRI versus MRI alone were 95% versus 96% and 75% versus 66%, respectively. The McNemar test was not able to distinguish any differences between PET/MRI and the reference standard or MRI and the reference standard. No differences were found between the 2 modalities with respect to local infiltration. Conclusion: SSTR PET/MRI and MRI yielded similar accuracy for the detection of meningiomas of the skull base and intraorbital space. Here, sequential low-dose SSTR PET/CT might be helpful for the planning of radioligand therapy or radiotherapy.
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Affiliation(s)
- Aleksandar Milosevic
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany;
| | - Hanna Styczen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Johannes Grueneisen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Yan Li
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, Düsseldorf, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Düsseldorf, Germany
| | - Julian Kirchner
- Institute of Radiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Philipp Damman
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Düsseldorf, Germany
| | - Karsten Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Düsseldorf, Germany
| | - Lazaros Lazaridis
- Department of Neurology and Neurooncology, University Hospital Essen, Düsseldorf, Germany
| | - Martin Glas
- Department of Neurology and Neurooncology, University Hospital Essen, Düsseldorf, Germany
| | - Maja Guberina
- Department of Radiotherapy, University Hospital Essen, Düsseldorf, Germany
| | - Anja Eckstein
- Department of Ophthalmology, University Hospital Essen, Düsseldorf, Germany; and
| | - Tobias Blau
- Department of Neuropathology, University Hospital Essen, Düsseldorf, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Düsseldorf, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Benedikt Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
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26
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Mei R, Kessler L, Pabst KM, Weber M, Schimdkonz C, Rischpler C, Zacho HD, Hope T, Schwarzenböck SM, Allen-Auerbach M, Emmett L, Ferdinandus J, Unterrainer M, Schaarschmidt BM, Umutlu L, Farolfi A, Castellucci P, Nanni C, Telo S, Fanti S, Herrmann K, Fendler WP. 68Ga-FAPI PET/CT Interobserver Agreement on Tumor Assessment: An International Multicenter Prospective Study. J Nucl Med 2023:jnumed.122.265245. [PMID: 37230530 DOI: 10.2967/jnumed.122.265245] [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: 11/23/2022] [Revised: 02/21/2023] [Indexed: 05/27/2023] Open
Abstract
68Ga-fibroblast activation protein inhibitors (FAPIs) are promising radiotracers for cancer imaging, with emerging data in the recent years. Nonetheless, the interobserver agreement on 68Ga-FAPI PET/CT study interpretations in cancer patients remains poorly understood. Methods: 68Ga-FAPI PET/CT was performed on 50 patients with various tumor entities (sarcoma [n = 10], colorectal cancer [n = 10], pancreatic adenocarcinoma [n = 10], genitourinary cancer [n = 10], and other types of cancer [n = 10]). Fifteen masked observers reviewed and interpreted the images using a standardized approach for local, local nodal, and metastatic involvement. Observers were grouped by experience as having a low (<30 prior 68Ga-FAPI PET/CT studies; n = 5), intermediate (30-300 studies; n = 5), or high level of experience (>300 studies; n = 5). Two independent readers with a high level of experience and unmasked to clinical information, histopathology, tumor markers, and follow-up imaging (CT/MRI or PET/CT) served as the standard of reference (SOR). Observer groups were compared by overall agreement (percentage of patients matching SOR) and Fleiss κ with mean and corresponding 95% CI. We defined acceptable agreement as a κ value of at least 0.6 (substantial or higher) and acceptable accuracy as at least 80%. Results: Highly experienced observers agreed substantially on all categories (primary tumor: κ = 0.71; 95% CI, 0.71-0.71; local nodal involvement: κ = 0.62; 95% CI, 0.61-0.62; distant metastasis: κ = 0.75; 95% CI, 0.75-0.75), whereas observers with intermediate experience showed substantial agreement on primary tumor (κ = 0.73; 95% CI, 0.73-0.73) and distant metastasis (κ = 0.65; 95% CI, 0.65-0.65) but moderate agreement on local nodal stages (κ = 0.55; 95% CI, 0.55-0.55). Observers with low experience had moderate agreement on all categories (primary tumor: κ = 0.57; 95% CI, 0.57-0.58; local nodal involvement: κ = 0.51; 95% CI, 0.51-0.52; distant metastasis: κ = 0.54; 95% CI, 0.53-0.54). Compared with SOR, the accuracy for readers with high, intermediate, and low experience was 85%, 83%, and 78%, respectively. In summary, only highly experienced readers showed substantial agreement and a diagnostic accuracy of at least 80% in all categories. Conclusion: The interpretation of 68Ga-FAPI PET/CT for cancer imaging had substantial reproducibility and accuracy among highly experienced observers only, especially for local nodal and metastatic assessments. Therefore, for accurate interpretation of different tumor entities and pitfalls, we recommend training or experience with at least 300 representative scans for future clinical readers.
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Affiliation(s)
- Riccardo Mei
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany;
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | - Kim M Pabst
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | | | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | | | - Thomas Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | | | - Martin Allen-Auerbach
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California
- Institute of Urologic Oncology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital, and Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Justin Ferdinandus
- Department of Internal Medicine I, University of Cologne, Cologne, Germany
| | - Marcus Unterrainer
- Department of Radiology, University Hospital LMU Munich, Munich, Germany; and
| | - Benedikt M Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andrea Farolfi
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvi Telo
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
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27
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Haueise T, Schick F, Stefan N, Schlett CL, Weiss JB, Nattenmüller J, Göbel-Guéniot K, Norajitra T, Nonnenmacher T, Kauczor HU, Maier-Hein KH, Niendorf T, Pischon T, Jöckel KH, Umutlu L, Peters A, Rospleszcz S, Kröncke T, Hosten N, Völzke H, Krist L, Willich SN, Bamberg F, Machann J. Analysis of volume and topography of adipose tissue in the trunk: Results of MRI of 11,141 participants in the German National Cohort. Sci Adv 2023; 9:eadd0433. [PMID: 37172093 PMCID: PMC10181183 DOI: 10.1126/sciadv.add0433] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This research addresses the assessment of adipose tissue (AT) and spatial distribution of visceral (VAT) and subcutaneous fat (SAT) in the trunk from standardized magnetic resonance imaging at 3 T, thereby demonstrating the feasibility of deep learning (DL)-based image segmentation in a large population-based cohort in Germany (five sites). Volume and distribution of AT play an essential role in the pathogenesis of insulin resistance, a risk factor of developing metabolic/cardiovascular diseases. Cross-validated training of the DL-segmentation model led to a mean Dice similarity coefficient of >0.94, corresponding to a mean absolute volume deviation of about 22 ml. SAT is significantly increased in women compared to men, whereas VAT is increased in males. Spatial distribution shows age- and body mass index-related displacements. DL-based image segmentation provides robust and fast quantification of AT (≈15 s per dataset versus 3 to 4 hours for manual processing) and assessment of its spatial distribution from magnetic resonance images in large cohort studies.
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Affiliation(s)
- Tobias Haueise
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich at the University of Tuebingen, Tuebingen, Germany
- German Center for Diabetes Research (DZD), Tuebingen, Germany
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Fritz Schick
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich at the University of Tuebingen, Tuebingen, Germany
- German Center for Diabetes Research (DZD), Tuebingen, Germany
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Norbert Stefan
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich at the University of Tuebingen, Tuebingen, Germany
- German Center for Diabetes Research (DZD), Tuebingen, Germany
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jakob B Weiss
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johanna Nattenmüller
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Göbel-Guéniot
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Norajitra
- Division of Medical and Biological Informatics, German Cancer Research Center, Heidelberg, Germany
| | - Tobias Nonnenmacher
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus H Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Tobias Pischon
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Core Facility Biobank, Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Annette Peters
- Department of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute of Epidemiology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- German Center for Diabetes Research (DZD), Partner Site Neuherberg, Neuherberg, Germany
| | - Susanne Rospleszcz
- Department of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute of Epidemiology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas Kröncke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Centre for Advanced Analytics and Predictive Sciences (CAAPS), University Augsburg, Augsburg, Germany
| | - Norbert Hosten
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan N Willich
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juergen Machann
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich at the University of Tuebingen, Tuebingen, Germany
- German Center for Diabetes Research (DZD), Tuebingen, Germany
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
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28
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Pomykala KL, Fendler WP, Vermesh O, Umutlu L, Herrmann K, Seifert R. Molecular Imaging of Lymphoma: Future Directions and Perspectives. Semin Nucl Med 2023; 53:449-456. [PMID: 36344325 DOI: 10.1053/j.semnuclmed.2022.10.003] [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: 11/06/2022]
Abstract
More than 250,000 patients die from Hodgkin or non-Hodgkin lymphoma each year. Currently, molecular imaging with 18F-FDG-PET/CT is the standard of care for lymphoma staging and therapy response assessment. In this review, we will briefly summarize the role of molecular imaging for lymphoma diagnosis, staging, outcome prediction, and prognostication. We discuss future directions in response assessment and surveillance with quantitative PET parameters, the utility of interim assessment, and the differences with response assessment to immunomodulatory therapy. Lastly, we will cover innovations in the field regarding novel tracers and artificial intelligence.
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Affiliation(s)
- Kelsey L Pomykala
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | - Ophir Vermesh
- Division of Nuclear Medicine in the Department of Radiology at Stanford University, Stanford, CA
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany.
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
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29
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Furtado FS, Mercaldo ND, Vahle T, Benkert T, Bradley WR, Ratanaprasatporn L, Seethamraju RT, Harisinghani MG, Lee S, Suarez-Weiss K, Umutlu L, Catana C, Pomykala KL, Domachevsky L, Bernstine H, Groshar D, Rosen BR, Catalano OA. Simultaneous multislice diffusion-weighted imaging versus standard diffusion-weighted imaging in whole-body PET/MRI. Eur Radiol 2023; 33:2536-2547. [PMID: 36460925 DOI: 10.1007/s00330-022-09275-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To compare standard (STD-DWI) single-shot echo-planar imaging DWI and simultaneous multislice (SMS) DWI during whole-body positron emission tomography (PET)/MRI regarding acquisition time, image quality, and lesion detection. METHODS Eighty-three adults (47 females, 57%), median age of 64 years (IQR 52-71), were prospectively enrolled from August 2018 to March 2020. Inclusion criteria were (a) abdominal or pelvic tumors and (b) PET/MRI referral from a clinician. Patients were excluded if whole-body acquisition of STD-DWI and SMS-DWI sequences was not completed. The evaluated sequences were axial STD-DWI at b-values 50-400-800 s/mm2 and the apparent diffusion coefficient (ADC), and axial SMS-DWI at b-values 50-300-800 s/mm2 and ADC, acquired with a 3-T PET/MRI scanner. Three radiologists rated each sequence's quality on a five-point scale. Lesion detection was quantified using the anatomic MRI sequences and PET as the reference standard. Regression models were constructed to quantify the association between all imaging outcomes/scores and sequence type. RESULTS The median whole-body STD-DWI acquisition time was 14.8 min (IQR 14.1-16.0) versus 7.0 min (IQR 6.7-7.2) for whole-body SMS-DWI, p < 0.001. SMS-DWI image quality scores were higher than STD-DWI in the abdomen (OR 5.31, 95% CI 2.76-10.22, p < 0.001), but lower in the cervicothoracic junction (OR 0.21, 95% CI 0.10-0.43, p < 0.001). There was no significant difference in the chest, mediastinum, pelvis, and rectum. STD-DWI detected 276/352 (78%) lesions while SMS-DWI located 296/352 (84%, OR 1.46, 95% CI 1.02-2.07, p = 0.038). CONCLUSIONS In cancer staging and restaging, SMS-DWI abbreviates acquisition while maintaining or improving the diagnostic yield in most anatomic regions. KEY POINTS • Simultaneous multislice diffusion-weighted imaging enables faster whole-body image acquisition. • Simultaneous multislice diffusion-weighted imaging maintains or improves image quality when compared to single-shot echo-planar diffusion-weighted imaging in most anatomical regions. • Simultaneous multislice diffusion-weighted imaging leads to superior lesion detection.
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Affiliation(s)
- Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - Nathaniel D Mercaldo
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Thomas Vahle
- MR Application Predevelopment, Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - Thomas Benkert
- MR Application Predevelopment, Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - William R Bradley
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Lisa Ratanaprasatporn
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Ravi Teja Seethamraju
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- MR Collaborations, Siemens Medical Solutions USA, Inc., 30 Jonathan Ln, Malden, MA, 02148, USA
| | - Mukesh G Harisinghani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Susanna Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Krista Suarez-Weiss
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Lale Umutlu
- Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Ciprian Catana
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | | | - Liran Domachevsky
- Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel
- Tel Aviv University, 6997801, Tel Aviv-Yafo, Israel
| | - Hanna Bernstine
- Tel Aviv University, 6997801, Tel Aviv-Yafo, Israel
- Assuta Medical Center, HaBarzel 20 St, Ramat Hahayal, Tel Aviv, Israel
| | - David Groshar
- Tel Aviv University, 6997801, Tel Aviv-Yafo, Israel
- Assuta Medical Center, HaBarzel 20 St, Ramat Hahayal, Tel Aviv, Israel
| | - Bruse R Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - Onofrio Antonio Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA.
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Jannusch K, Bittner AK, Bruckmann NM, Morawitz J, Stieglitz C, Dietzel F, Quick HH, Baba HA, Herrmann K, Umutlu L, Antoch G, Kirchner J, Kasimir-Bauer S, Hoffmann O. Correlation between Imaging Markers Derived from PET/MRI and Invasive Acquired Biomarkers in Newly Diagnosed Breast Cancer. Cancers (Basel) 2023; 15:cancers15061651. [PMID: 36980537 PMCID: PMC10046153 DOI: 10.3390/cancers15061651] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE Evaluate the diagnostic potential of [18F]FDG-PET/MRI data compared with invasive acquired biomarkers in newly diagnosed early breast cancer (BC). METHODS Altogether 169 women with newly diagnosed BC were included. All underwent a breast- and whole-body [18F]FDG-PET/MRI for initial staging. A tumor-adapted volume of interest was placed in the primaries and defined bone regions on each standard uptake value (SUV)/apparent diffusion coefficient (ADC) dataset. Immunohistochemical markers, molecular subtype, tumor grading, and disseminated tumor cells (DTCs) of each patient were assessed after ultrasound-guided biopsy of the primaries and bone marrow (BM) aspiration. Correlation analysis and group comparisons were assessed. RESULTS A significant inverse correlation of estrogen-receptor (ER) expression and progesterone-receptor (PR) expression towards SUVmax was found (ER: r = 0.27, p < 0.01; PR: r = 0.19, p < 0.05). HER2-receptor expression showed no significant correlation towards SUV and ADC values. A significant positive correlation between Ki67 and SUVmax and SUVmean (r = 0.42 p < 0.01; r = 0.19 p < 0.05) was shown. Tumor grading significantly correlated with SUVmax and SUVmean (ρ = 0.36 and ρ = 0.39, both p's < 0.01). There were no group differences between SUV/ADC values of DTC-positive/-negative patients. CONCLUSIONS [18F]FDG-PET/MRI may give a first impression of BC-receptor status and BC-tumor biology during initial staging by measuring glucose metabolism but cannot distinguish between DTC-positive/-negative patients and replace biopsy.
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Affiliation(s)
- Kai Jannusch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, 40225 Dusseldorf, Germany
| | - Ann-Kathrin Bittner
- Department Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Nils Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, 40225 Dusseldorf, Germany
| | - Janna Morawitz
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, 40225 Dusseldorf, Germany
| | - Cleo Stieglitz
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, 40225 Dusseldorf, Germany
| | - Frederic Dietzel
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, 40225 Dusseldorf, Germany
| | - Harald H Quick
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, 45141 Essen, Germany
| | - Hideo A Baba
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, 40225 Dusseldorf, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, 40225 Dusseldorf, Germany
| | - Sabine Kasimir-Bauer
- Department Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Oliver Hoffmann
- Department Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
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Hamacher R, Pabst K, Cheung P, Heilig C, Hüllein J, Liffers ST, Schaarschmidt B, Costa P, Kessler L, Falkenhorst J, Glimm H, Umutlu L, Schuler M, Hübschmann D, Bauer S, Fröhling S, Herrmann K, Siveke J, Schildhaus HU, Fendler W. 99P Fibroblast activation protein alpha (FAP) as theranostic target in solitary fibrous tumor. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101136] [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: 04/05/2023] Open
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Demircioğlu A, Nassenstein K, Umutlu L. Pediatric age estimation from thoracic and abdominal CT scout views using deep learning. Sci Rep 2023; 13:2274. [PMID: 36755075 PMCID: PMC9907877 DOI: 10.1038/s41598-023-29296-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
Age assessment is regularly used in clinical routine by pediatric endocrinologists to determine the physical development or maturity of children and adolescents. Our study investigates whether age assessment can be performed using CT scout views from thoracic and abdominal CT scans using a deep neural network. Hence, we retrospectively collected 1949 CT scout views from pediatric patients (acquired between January 2013 and December 2018) to train a deep neural network to predict the chronological age from CT scout views. The network was then evaluated on an independent test set of 502 CT scout views (acquired between January 2019 and July 2020). The trained model showed a mean absolute error of 1.18 ± 1.14 years on the test data set. A one-sided t-test to determine whether the difference between the predicted and actual chronological age was less than 2.0 years was statistically highly significant (p < 0.001). In addition, the correlation coefficient was very high (R = 0.97). In conclusion, the chronological age of pediatric patients can be assessed with high accuracy from CT scout views using a deep neural network.
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Affiliation(s)
- Aydin Demircioğlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany.
| | - Kai Nassenstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
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Afshar-Oromieh A, Eiber M, Fendler W, Schmidt M, Rahbar K, Ahmadzadehfar H, Umutlu L, Hadaschik B, Hakenberg OW, Fornara P, Kurth J, Neels O, Wester HJ, Schwaiger M, Kopka K, Haberkorn U, Herrmann K, Krause BJ. [Procedure Guideline for Prostate Cancer Imaging with PSMA-ligand PET/CT]. Nuklearmedizin 2023; 62:5-19. [PMID: 36746147 DOI: 10.1055/a-1984-8167] [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: 02/08/2023]
Abstract
PSMA-PET/CT for imaging prostate cancer (PC) has spread worldwide since its clinical introduction in 2011. The majority of experiences have been collected for PSMA-PET-imaging of recurrent PC. Data for primary staging of high-risk PC are highly promising. Meanwhile, a plethora of PSMA-ligands are available for clinical use (e. g. 68Ga-PSMA-11, 68Ga-PSMA-I&T, 68Ga-PSMA-617, 18F-DCFBC, 18F-DCFPyL, 18F-PSMA-1007, 18F-rhPSMA-7 and 18F-JK-PSMA-7). However, an official approval is available only for 68Ga-PSMA-11 (approved by the US FDA in 2020) and 18F-DCFPyL (approved by the US FDA in 2021).Recommendations for acquisition times vary from 1-2 h p. i. It has been shown that for the majority of tumour lesions, the contrast in PSMA-PET/CT increases with time. Therefore, additional late imaging can help to clarify unclear findings. PSMA-PET/CT should be performed prior to commencing an androgen deprivation therapy (ADT) since (long term) ADT reduces the visibility of PC lesions. Following injection of PSMA-ligands, hydration and forced diuresis are recommended for PSMA-ligands with primarily excretion via the kidneys in order to increase the visibility of tumour lesions adjacent to the urinary bladder.PSMA-ligands are physiologically taken up in multiple normal organs. For some 18F-labelled PSMA-ligands, presence of unspecific focal bone uptake has been reported. When using these tracers, focal bone uptake without CT-correlate should be interpreted with great caution. Besides prostate cancer, practically all solid tumors express PSMA in their neovasculature thereby taking up PSMA-ligands, although usually at a lower extent compared to PC. Also multiple benign lesions and inflammatory processes (e. g. lymph nodes) take up PSMA-ligands, also usually at lower extent compared to PC.
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Affiliation(s)
- Ali Afshar-Oromieh
- Universitätsklinikum Bern, Inselspital, Klinik für Nuklearmedizin, Universität Bern, Schweiz
| | - Matthias Eiber
- Technische Universität München, Klinik für Nuklearmedizin
| | | | - Matthias Schmidt
- Universitätsklinikum Köln, Klinik und Poliklinik für Nuklearmedizin
| | - Kambiz Rahbar
- Universitätsklinikum Münster, Klinik für Nuklearmedizin
| | | | - Lale Umutlu
- Universitätsklinikum Essen, Klinik für Radiologie
| | - Boris Hadaschik
- Universitätsklinikum Essen, Klinik und Poliklinik für Urologie, Kinderurologie und Uroonkologie
| | | | - Paolo Fornara
- Universitätsklinikum Halle, Universitätsklinik und Poliklinik für Urologie
| | - Jens Kurth
- Universitätsmedizin Rostock, Klinik und Poliklinik für Nuklearmedizin
| | - O Neels
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institut für Radiopharmazeutische Krebsforschung.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Dresden
| | | | | | - Klaus Kopka
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institut für Radiopharmazeutische Krebsforschung.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Dresden
| | - Uwe Haberkorn
- Universitätsklinikum Heidelberg, Abteilung Nuklearmedizin der Radiologischen Klinik
| | - Ken Herrmann
- Universitätsklinikum Essen, Klinik für Nuklearmedizin
| | - Bernd J Krause
- Universitätsmedizin Rostock, Klinik und Poliklinik für Nuklearmedizin
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Saner YM, Wiesenfarth M, Weru V, Ladyzhensky B, Tschirdewahn S, Püllen L, Bonekamp D, Reis H, Krafft U, Heß J, Kesch C, Darr C, Forsting M, Wetter A, Umutlu L, Haubold J, Hadaschik B, Radtke JP. Detection of Clinically Significant Prostate Cancer Using Targeted Biopsy with Four Cores Versus Target Saturation Biopsy with Nine Cores in Transperineal Prostate Fusion Biopsy: A Prospective Randomized Trial. Eur Urol Oncol 2023; 6:49-55. [PMID: 36175281 DOI: 10.1016/j.euo.2022.08.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy (TB) facilitate accurate detection of clinically significant prostate cancer (csPC). However, it remains unclear how targeted cores should be applied for accurate diagnosis of csPC. OBJECTIVE To assess csPC detection rates for two target-directed MRI/transrectal ultrasonography (TRUS) fusion biopsy approaches, conventional TB and target saturation biopsy (TS). DESIGN, SETTING, AND PARTICIPANTS This was a prospective single-center study of outcomes for transperineal MRI/TRUS fusion biopsies for 170 men. Half of the men (n = 85) were randomized to conventional TB with four cores per lesion and half (n = 85) to TS with nine cores. Biopsies were performed by three experienced board-certified urologists. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS PC and csPC (International Society of Urological Pathology grade group ≥2) detection rates for systematic biopsy (SB), TB, and TS were analyzed using McNemar's test for intrapatient comparisons and Fisher's exact test for TS versus TB. A combination of targeted biopsy (TS or TB) and SB served as the reference. RESULTS AND LIMITATIONS According to the reference, csPC was diagnosed for 57 men in the TS group and 36 men in the TB group. Of these, TS detected 57/57 csPC cases and TB detected 33/36 csPC cases (p = 0.058). Detection of Gleason grade group 1 disease was 10/12 cases with TS and 8/17 cases with TB (p = 0.055). In addition, TS detected 97% of 63 csPC lesions, compared to 86% with TB (p = 0.1). Limitations include the single-center design, the limited generalizability owing to the transperineal biopsy route, the lack of central review of pathology and radical prostatectomy correlation, and uneven distributions of csPC prevalence, Prostate Imaging-Reporting and Data System (PI-RADS) 5 lesions, men with two or more PI-RADS ≥3 lesions, and prostate-specific antigen density between the groups, which may have affected the results. CONCLUSIONS In our study, rates of csPC detection did not significantly differ between TS and TB. PATIENT SUMMARY In this study, we investigated two targeted approaches for taking prostate biopsy samples after observation of suspicious lesions on prostate scans. We found that the rates of detection of prostate cancer did not significantly differ between the two approaches.
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Affiliation(s)
| | - Manuel Wiesenfarth
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Vivienn Weru
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Boris Ladyzhensky
- Department of Anesthesia and Perioperative Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Lukas Püllen
- Department of Urology, University Hospital Essen, Essen, Germany
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Henning Reis
- Institute of Pathology, University Duisburg-Essen, Essen, Germany
| | - Ulrich Krafft
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Jochen Heß
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Christopher Darr
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Axel Wetter
- Institute of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany; Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
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Morawitz J, Sigl B, Rubbert C, Bruckmann NM, Dietzel F, Häberle LJ, Ting S, Mohrmann S, Ruckhäberle E, Bittner AK, Hoffmann O, Baltzer P, Kapetas P, Helbich T, Clauser P, Fendler WP, Rischpler C, Herrmann K, Schaarschmidt BM, Stang A, Umutlu L, Antoch G, Caspers J, Kirchner J. Clinical Decision Support for Axillary Lymph Node Staging in Newly Diagnosed Breast Cancer Patients Based on 18F-FDG PET/MRI and Machine Learning. J Nucl Med 2023; 64:304-311. [PMID: 36137756 PMCID: PMC9902847 DOI: 10.2967/jnumed.122.264138] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 03/16/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 02/04/2023] Open
Abstract
In addition to its high prognostic value, the involvement of axillary lymph nodes in breast cancer patients also plays an important role in therapy planning. Therefore, an imaging modality that can determine nodal status with high accuracy in patients with primary breast cancer is desirable. Our purpose was to investigate whether, in newly diagnosed breast cancer patients, machine-learning prediction models based on simple assessable imaging features on MRI or PET/MRI are able to determine nodal status with performance comparable to that of experienced radiologists; whether such models can be adjusted to achieve low rates of false-negatives such that invasive procedures might potentially be omitted; and whether a clinical framework for decision support based on simple imaging features can be derived from these models. Methods: Between August 2017 and September 2020, 303 participants from 3 centers prospectively underwent dedicated whole-body 18F-FDG PET/MRI. Imaging datasets were evaluated for axillary lymph node metastases based on morphologic and metabolic features. Predictive models were developed for MRI and PET/MRI separately using random forest classifiers on data from 2 centers and were tested on data from the third center. Results: The diagnostic accuracy for MRI features was 87.5% both for radiologists and for the machine-learning algorithm. For PET/MRI, the diagnostic accuracy was 89.3% for the radiologists and 91.2% for the machine-learning algorithm, with no significant differences in diagnostic performance between radiologists and the machine-learning algorithm for MRI (P = 0.671) or PET/MRI (P = 0.683). The most important lymph node feature was tracer uptake, followed by lymph node size. With an adjusted threshold, a sensitivity of 96.2% was achieved by the random forest classifier, whereas specificity, positive predictive value, negative predictive value, and accuracy were 68.2%, 78.1%, 93.8%, and 83.3%, respectively. A decision tree based on 3 simple imaging features could be established for MRI and PET/MRI. Conclusion: Applying a high-sensitivity threshold to the random forest results might potentially avoid invasive procedures such as sentinel lymph node biopsy in 68.2% of the patients.
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Affiliation(s)
- Janna Morawitz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany;
| | - Benjamin Sigl
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General Radiology, Medical University of Vienna, Vienna, Austria
| | - Christian Rubbert
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Nils-Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Frederic Dietzel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Lena J. Häberle
- Institute of Pathology, Medical Faculty, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Saskia Ting
- Institute of Pathology, University Hospital Essen, West German Cancer Center, University of Duisburg–Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Svjetlana Mohrmann
- Department of Gynecology, University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Eugen Ruckhäberle
- Department of Gynecology, University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Ann-Kathrin Bittner
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
| | - Oliver Hoffmann
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
| | - Pascal Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General Radiology, Medical University of Vienna, Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General Radiology, Medical University of Vienna, Vienna, Austria
| | - Thomas Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General Radiology, Medical University of Vienna, Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General Radiology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang P. Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg–Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg–Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg–Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Benedikt M. Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany; and
| | - Andreas Stang
- Institute of Medical Informatics, Biometry, and Epidemiology, Essen University Medical Center, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany; and
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Julian Caspers
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
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Georgi TW, Stoevesandt D, Kurch L, Bartelt JM, Hasenclever D, Dittmann H, Ferda J, Francis P, Franzius C, Furth C, Gräfe D, Gussew A, Hüllner M, Menezes LJ, Mustafa M, Stegger L, Umutlu L, Zöphel K, Zucchetta P, Körholz D, Sabri O, Mauz-Körholz C, Kluge R. Optimized Whole-Body PET MRI Sequence Workflow in Pediatric Hodgkin Lymphoma Patients. J Nucl Med 2023; 64:96-101. [PMID: 35835583 PMCID: PMC9841249 DOI: 10.2967/jnumed.122.264112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 01/28/2023] Open
Abstract
18F-FDG PET/MRI might be the diagnostic method of choice for Hodgkin lymphoma patients, as it combines significant metabolic information from PET with excellent soft-tissue contrast from MRI and avoids radiation exposure from CT. However, a major issue is longer examination times than for PET/CT, especially for younger children needing anesthesia. Thus, a targeted selection of suitable whole-body MRI sequences is important to optimize the PET/MRI workflow. Methods: The initial PET/MRI scans of 84 EuroNet-PHL-C2 study patients from 13 international PET centers were evaluated. In each available MRI sequence, 5 PET-positive lymph nodes were assessed. If extranodal involvement occurred, 2 splenic lesions, 2 skeletal lesions, and 2 lung lesions were also assessed. A detection rate was calculated dividing the number of visible, anatomically assignable, and measurable lesions in the respective MRI sequence by the total number of lesions. Results: Relaxation time-weighted (T2w) transverse sequences with fat saturation (fs) yielded the best result, with detection rates of 95% for nodal lesions, 62% for splenic lesions, 94% for skeletal lesions, and 83% for lung lesions, followed by T2w transverse sequences without fs (86%, 49%, 16%, and 59%, respectively) and longitudinal relaxation time-weighted contrast-enhanced transverse sequences with fs (74%, 35%, 57%, and 55%, respectively). Conclusion: T2w transverse sequences with fs yielded the highest detection rates and are well suited for accurate whole-body PET/MRI in lymphoma patients. There is no evidence to recommend the use of contrast agents.
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Affiliation(s)
- Thomas W. Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | | | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Jörg M. Bartelt
- Department of Radiology, University of Halle, Halle/Saale, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Helmut Dittmann
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Tuebingen, Germany
| | - Jiri Ferda
- Department of Imaging, University Hospital Pilsen, Pilsen, Czech Republic
| | - Peter Francis
- Department of Nuclear Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Christiane Franzius
- Center for Modern Diagnostics–MRI and PET/MRI and Center for Nuclear Medicine and PET/CT, Bremen, Germany
| | - Christian Furth
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt–Universität zu Berlin, and Department of Nuclear Medicine, Berlin Institute of Health, Berlin, Germany
| | - Daniel Gräfe
- Paediatric Radiology, Department of Radiology, University of Leipzig, Leipzig, Germany
| | - Alexander Gussew
- Department of Radiology, University of Halle, Halle/Saale, Germany
| | - Martin Hüllner
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Leon J. Menezes
- UCL Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Mona Mustafa
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lars Stegger
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Klaus Zöphel
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine, Padova University Hospital, Padova, Italy
| | - Dieter Körholz
- Department of Pediatric Oncology, Justus Liebig University, Giessen, Germany; and
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Christine Mauz-Körholz
- Department of Pediatric Oncology, Justus Liebig University, Giessen, Germany; and,Medical Faculty, Martin Luther University of Halle–Wittenberg, Halle/Saale, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
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37
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Seifert R, Telli T, Opitz M, Barbato F, Berliner C, Nader M, Umutlu L, Stuschke M, Hadaschik B, Herrmann K, Fendler WP. Non-specific PSMA-1007 bone uptake evaluated through PSMA-11 PET, bone scan and MRI triple validation in patients with biochemical recurrence of prostate cancer. J Nucl Med 2022; 64:738-743. [PMID: 36460340 DOI: 10.2967/jnumed.118.215434] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 08/13/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 12/04/2022] Open
Abstract
18F-PSMA-1007 PET is used in the management of patients with prostate cancer. However, recent reports indicate a high rate of unspecific bone uptake (UBU) with 18F-PSMA-1007, which may lead to a false-positive diagnosis. UBU has not been evaluated thoroughly. Here, we evaluate the frequency of UBU and bone metastases separately for 18F-PSMA-1007 and 68Ga-PSMA-11 in biochemical recurrence (interindividual comparison). Additionally, we investigate UBU seen in 18F-PSMA-1007 through follow-up examinations (intraindividual comparison) using 68Ga-PSMA-11 PET, bone scintigraphy, and MRI. Methods: First, all patients (n = 383) who underwent 68Ga-PSMA-11 PET between January 2020 and December 2020 and all patients (n = 409) who underwent 18F-PSMA-1007 PET between January 2020 and November 2021 due to biochemical recurrence were included for an interindividual comparison of bone metastases and UBU rate. In a second approach, we regarded all patients with UBU in 18F-PSMA-1007, characterized by focal bone uptake with an SUVmax > 4 and prostate-specific antigen (PSA) ≤ 5 ng/mL, who underwent additional 68Ga-PSMA-11 PET (n = 17) (interindividual comparison). Of these, 12 patients also had bone scintigraphy and whole-body MRI within a 1- to 5-wk interval. Bone uptake seen on 18F-PSMA-1007 but not on any of the other 4 modalities (CT, MRI [n = 1], bone scanning, and 68Ga-PSMA-11 PET) was recorded as false-positive. Results: Patients scanned with 18F-PSMA-1007 PET had a significantly higher rate of UBU than those scanned with 68Ga-PSMA-11 (140 vs. 64; P < 0.001); however, the rate of bone metastases was not significantly different (72 vs. 64; P = 0.7). In the intraindividual comparison group, workup by CT, MRI, bone scanning, and 68Ga-PSMA-11 PET resulted in a positive predictive value for 18F-PSMA-1007 focal bone uptake (mean SUVmax, 6.1 ± 2.9) per patient and per lesion of 8.3% and 3.6%, respectively. Conclusion: In patients with PSA ≤ 5 ng/mL and SUV > 4 at biochemical recurrence, most 18F-PSMA-1007 focal bone uptake is likely to be false-positive and therefore due to UBU. In the case of low clinical likelihood of metastatic disease, 18F-PSMA-1007 bone uptake without morphologic surrogate should be assessed carefully with regard to localization and clinical context. However, the rate of bone metastases was not higher with 18F-PSMA-1007 in the clinical routine, indicating that experienced reporting physicians adjust for UBU findings.
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Affiliation(s)
- Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany;
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Tugce Telli
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany;
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Marcel Opitz
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Francesco Barbato
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Christoph Berliner
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Michael Nader
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Martin Stuschke
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Radiation Oncology, University Hospital Essen, Essen, Germany; and
| | - Boris Hadaschik
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
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Seifert R, Kersting D, Rischpler C, Sandach P, Ferdinandus J, Fendler WP, Rahbar K, Weckesser M, Umutlu L, Hanoun C, Hüttmann A, Reinhardt HC, von Tresckow B, Herrmann K, Dührsen U, Schäfers M. Interim FDG-PET analysis to identify patients with aggressive non-Hodgkin lymphoma who benefit from treatment intensification: a post-hoc analysis of the PETAL trial. Leukemia 2022; 36:2845-2852. [PMID: 36241697 PMCID: PMC9712103 DOI: 10.1038/s41375-022-01713-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: 06/20/2022] [Revised: 08/13/2022] [Accepted: 09/16/2022] [Indexed: 11/08/2022]
Abstract
The randomized PETAL trial failed to demonstrate a benefit of interim FDG-PET (iPET)-based treatment intensification over continued standard therapy with CHOP (plus rituximab (R) in CD20-positive lymphomas). We hypothesized that PET analysis of all lymphoma manifestations may identify patients who benefitted from treatment intensification. A previously developed neural network was employed for iPET analysis to identify the highest pathological FDG uptake (max-SUVAI) and the mean FDG uptake of all lymphoma manifestations (mean-SUVAI). High mean-SUVAI uptake was determined separately for iPET-positive and iPET-negative patients. The endpoint was time-to-progression (TTP). There was a significant interaction of additional rituximab and mean-SUVAI in the iPET-negative group (HR = 0.6, p < 0.05). Patients with high mean-SUVAI had significantly prolonged TTP when treated with 6xR-CHOP + 2 R (not reached versus 52 months, p < 0.05), whereas max-SUVmanual failed to show an impact of additional rituximab. In the iPET-positive group, patients with high mean-SUVAI had a significantly longer TTP with (R-)CHOP than with the Burkitt protocol (14 versus 4 months, p < 0.01). Comprehensive iPET evaluation may provide new prognosticators in aggressive lymphoma. Additional application of rituximab was associated with prolonged TTP in iPET-negative patients with high mean-SUVAI. Comprehensive iPET interpretation could identify high-risk patients who benefit from study-specific interventions.
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Affiliation(s)
- Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany.
- West German Cancer Center, University Hospital Essen, Essen, Germany.
| | - David Kersting
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Patrick Sandach
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Justin Ferdinandus
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Matthias Weckesser
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Lale Umutlu
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Christine Hanoun
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Hüttmann
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hans Christian Reinhardt
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bastian von Tresckow
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Ulrich Dührsen
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
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Fendler WP, Pabst KM, Kessler L, Fragoso Costa P, Ferdinandus J, Weber M, Lippert M, Lueckerath K, Umutlu L, Kostbade K, Mavroeidi IA, Schuler M, Ahrens M, Rischpler C, Bauer S, Herrmann K, Siveke JT, Hamacher R. Safety and Efficacy of 90Y-FAPI-46 Radioligand Therapy in Patients with Advanced Sarcoma and Other Cancer Entities. Clin Cancer Res 2022; 28:4346-4353. [PMID: 35833949 PMCID: PMC9527500 DOI: 10.1158/1078-0432.ccr-22-1432] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE We report efficacy and safety of 90Y-labeled FAPI-46 (90Y-FAPI-46-RLT) in patients with advanced sarcoma, pancreatic cancer, and other cancer entities. EXPERIMENTAL DESIGN Up to four cycles of radioligand therapy (RLT) were offered to patients with (i) progressive metastatic malignancy, (ii) exhaustion of approved therapies, and (iii) high fibroblast activation protein (FAP) expression, defined as SUVmax ≥ 10 in more than 50% of tumor. Primary endpoint was RECIST response after RLT. Secondary endpoints included PET response (PERCIST), overall survival (OS), dosimetry, and safety of FAP-RLT. RESULTS Among 119 screened patients, 21 (18%) were found eligible [n = 16/3/1/1 sarcoma/pancreatic cancer/prostate/gastric cancer; 38% Eastern Cooperative Oncology Group (ECOG) ≥ 2] and received 47 90Y-FAPI-46-RLT cycles; 16 of 21 (76%) patients underwent repeat RLT. By RECIST, disease control was confirmed in 8 of 21 patients [38%; 8/16 (50%) of evaluable patients). There was one partial response (PR) and seven stable diseases after RLT. Disease control was associated with prolonged OS (P = 0.013). PERCIST response was noted in 8 of 21 patients [38%; 8/15 (53%) of evaluable patients]. Dosimetry was acquired in 19 (90%) patients. Mean absorbed dose was 0.53 Gy/GBq in kidney, 0.04 Gy/GBq in bone marrow, and <0.14 Gy/GBq in liver and lung. Treatment-related grade 3 or 4 adverse events were observed in 8 (38%) patients with thrombocytopenia (n = 6) and anemia (n = 6) being most prevalent. CONCLUSIONS 90Y-FAPI-46-RLT was safe and led to RECIST PR in one case as well as stable disease in about one third of patients with initially progressive sarcomas, pancreatic cancer, and other cancers. Discontinuation after the first cycle and a low rate of PR requires future improvement of FAP-RLT.
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Affiliation(s)
- Wolfgang P. Fendler
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany.,Corresponding Author: Wolfgang Peter Fendler, Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany. Phone: 201-723-2032; Fax: 201-723-5964; E-mail:
| | - Kim M. Pabst
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany
| | - Lukas Kessler
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany
| | - Pedro Fragoso Costa
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany
| | - Justin Ferdinandus
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany
| | - Maria Lippert
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Katharina Lueckerath
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Karina Kostbade
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany.,Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ilektra A. Mavroeidi
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany.,Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Schuler
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany.,Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Marit Ahrens
- Medical Clinic II, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany
| | - Sebastian Bauer
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany.,Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany
| | - Jens T. Siveke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Medicine Essen, Essen, Germany.,Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Rainer Hamacher
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany.,Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
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Chodyla M, Barbato F, Dirksen U, Kirchner J, Schaarschmidt BM, Schweiger B, Forsting M, Herrmann K, Umutlu L, Grueneisen J. Utility of Integrated PET/MRI for the Primary Diagnostic Work-Up of Patients with Ewing Sarcoma: Preliminary Results. Diagnostics (Basel) 2022; 12:diagnostics12102278. [PMID: 36291967 PMCID: PMC9600118 DOI: 10.3390/diagnostics12102278] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background: This study was conducted to evaluate the clinical applicability of integrated PET/MRI for staging and monitoring the effectiveness of neoadjuvant chemotherapy in Ewing sarcoma patients. Methods: A total of 11 juvenile patients with confirmed Ewing sarcoma, scheduled for induction polychemotherapy, were prospectively enrolled for a PET/MR examination before, during and after the end of treatment. Two experienced physicians analysed the imaging datasets. They were asked to perform a whole-body staging in all three examinations and to define treatment response according to the RECIST1.1 and PERCIST criteria for each patient. Results: In eight patients lymph node and/or distant metastases were detected at initial diagnosis. According to the reference standard, three patients achieved complete response, six patients partial response, and one patient showed stable disease while another patient showed progressive disease. RECIST1.1 categorized the response to treatment in 5/11 patients correctly and showed a tendency to underestimate the response to treatment in the remaining six patients. PERCIST defined response to treatment in 9/11 patients correctly and misclassified two patients with a PR as CR. Conclusion: PET/MRI may serve as a valuable imaging tool for primary staging and response assessment of juvenile patients with Ewing sarcoma to induction chemotherapy, accompanied by a reasonable radiation dose for the patient.
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Affiliation(s)
- Michal Chodyla
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Francesco Barbato
- Clinic of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Uta Dirksen
- Clinic for Pediatrics III, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Benedikt M. Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Bernd Schweiger
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Ken Herrmann
- Clinic of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Johannes Grueneisen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
- Correspondence: ; Tel.: +49-(0)-201-723-1501
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41
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Exner JP, Nadjm S, Hepp de los Rios R, Metzenmacher M, Hoffmann AC, Gauler T, Aigner C, Stamatis G, Oezkan F, Schulte C, Darwiche K, Taube C, Theegarten D, Plönes T, Pöttgen C, Umutlu L, Hautzel H, Schuler M, Stuschke M, Eberhardt W. EP04.01-016 First Comprehensive Lung Cancer Long-Term Survivorship Analysis - Late Toxicities and Overall Survival. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Exner JP, Nadjm S, Hepp de los Rios R, Metzenmacher M, Hoffmann AC, Gauler T, Aigner C, Stamatis G, Oezkan F, Schulte C, Darwiche K, Taube C, Theegarten D, Plönes T, Poettgen C, Umutlu L, Hautzel H, Schuler M, Stuschke M, Eberhardt W. EP04.02-005 First Comprehensive Lung Cancer Long-Term Survivorship Program - Late Toxicities and Overall Survival. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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43
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Nadjm S, Exner JP, Hepp De Los Rios R, Metzenmacher M, Hoffmann AC, Gauler T, Aigner C, Stamatis G, Oezkan F, Schulte C, Darwiche K, Taube C, Theegarten D, Plönes T, Pöttgen C, Umutlu L, Hautzel H, Schuler M, Stuschke M, Eberhardt W. EP04.02-007 First Comprehensive Lung Cancer Long-Term Survivorship Program- Competing Risks. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.1151] [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: 10/14/2022]
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Fragoso Costa P, Jentzen W, Brahmer A, Mavroeidi IA, Zarrad F, Umutlu L, Fendler WP, Rischpler C, Herrmann K, Conti M, Seifert R, Sraieb M, Weber M, Kersting D. Phantom-based acquisition time and image reconstruction parameter optimisation for oncologic FDG PET/CT examinations using a digital system. BMC Cancer 2022; 22:899. [PMID: 35978274 PMCID: PMC9387080 DOI: 10.1186/s12885-022-09993-4] [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: 12/05/2021] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background New-generation silicon-photomultiplier (SiPM)-based PET/CT systems exhibit an improved lesion detectability and image quality due to a higher detector sensitivity. Consequently, the acquisition time can be reduced while maintaining diagnostic quality. The aim of this study was to determine the lowest 18F-FDG PET acquisition time without loss of diagnostic information and to optimise image reconstruction parameters (image reconstruction algorithm, number of iterations, voxel size, Gaussian filter) by phantom imaging. Moreover, patient data are evaluated to confirm the phantom results. Methods Three phantoms were used: a soft-tissue tumour phantom, a bone-lung tumour phantom, and a resolution phantom. Phantom conditions (lesion sizes from 6.5 mm to 28.8 mm in diameter, lesion activity concentration of 15 kBq/mL, and signal-to-background ratio of 5:1) were derived from patient data. PET data were acquired on an SiPM-based Biograph Vision PET/CT system for 10 min in list-mode format and resampled into time frames from 30 to 300 s in 30-s increments to simulate different acquisition times. Different image reconstructions with varying iterations, voxel sizes, and Gaussian filters were probed. Contrast-to-noise-ratio (CNR), maximum, and peak signal were evaluated using the 10-min acquisition time image as reference. A threshold CNR value ≥ 5 and a maximum (peak) deviation of ± 20% were considered acceptable. 20 patient data sets were evaluated regarding lesion quantification as well as agreement and correlation between reduced and full acquisition time standard uptake values (assessed by Pearson correlation coefficient, intraclass correlation coefficient, Bland–Altman analyses, and Krippendorff’s alpha). Results An acquisition time of 60 s per bed position yielded acceptable detectability and quantification results for clinically relevant phantom lesions ≥ 9.7 mm in diameter using OSEM-TOF or OSEM-TOF+PSF image reconstruction, a 4-mm Gaussian filter, and a 1.65 × 1.65 x 2.00-mm3 or 3.30 × 3.30 x 3.00-mm3 voxel size. Correlation and agreement of patient lesion quantification between full and reduced acquisition times were excellent. Conclusion A threefold reduction in acquisition time is possible. Patients might benefit from more comfortable examinations or reduced radiation exposure, if instead of the acquisition time the applied activity is reduced. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09993-4.
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Affiliation(s)
- Pedro Fragoso Costa
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Walter Jentzen
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Alissa Brahmer
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Ilektra-Antonia Mavroeidi
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.,Department of Medical Oncology, University Hospital Essen, West German Cancer Center (WTZ), University Duisburg-Essen, 45147, Essen, Germany
| | - Fadi Zarrad
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.,Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, 45147, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | | | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Miriam Sraieb
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - David Kersting
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany. .,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
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Luca Alatzides G, Luisa Steinberg H, Schildhaus HU, Hamacher R, Kaths M, Grueneisen J, Treckmann J, Bauer S, Umutlu L, Schaarschmidt B. Is preoperative CT-guided biopsy a valuable tool in the diagnostic workup of patients with visceral and retroperitoneal sarcoma? Eur J Radiol 2022; 155:110470. [PMID: 35985092 DOI: 10.1016/j.ejrad.2022.110470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/12/2022] [Accepted: 08/07/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE We aimed to analyze the diagnostic accuracy of preoperative CT-guided biopsy to identify patients that might profit from neoadjuvant chemotherapy in a specialized high-volume sarcoma center. MATERIAL AND METHODS We retrospectively reviewed all patients with suspected soft tissue tumors of the abdomen cavity including the retroperitoneum, who received CT-guided biopsy followed by surgical tumor resection. Sensitivity, specificity, PPV and NPV were calculated in all patients with abdominal sarcomas at our hospital. A subgroup analysis was performed for patients with liposarcoma. RESULTS A total of 82 patients (35 female, 47 male, age: 62.0 ± 14.7) received preoperative CT-guided biopsy followed by surgical resection. Overall accordance of CT-guided biopsy to identify final histology was 77 %. CT-guided biopsy revealed the diagnosis of liposarcoma in 23 patients whereas final analysis of the surgical specimen identified liposarcoma in 29 patients. Here, sensitivity, specificity, PPV and NPV was 79.3 %, 100.0 %, 100.0 % and 89.8 % respectively. Subgroup analysis revealed a better accuracy for correctly identifying patients with well-differentiated liposarcoma than patients with dedifferentiated liposarcoma (75.0 % vs 62.5 %). In patients with other sarcoma, sensitivity, specificity, PPV, NPV and diagnostic accuracy was 87.5 %, 95.5 %, 82.4 % and 96.9 %, respectively. CONCLUSION CT-guided biopsy in a specialized high-volume sarcoma center is an accurate and effective method to assess patients with abdominal sarcoma and especially abdominal liposarcoma. Therefore, it is an indispensable tool in the pretherapeutic workup process. Nevertheless, our study underlines the previously reported difficulties in dedifferentiated liposarcoma diagnostics, whereby these patient cohort would profit the most from a neoadjuvant therapy regime.
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Affiliation(s)
- Georgios Luca Alatzides
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany.
| | - Hannah Luisa Steinberg
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Hans-Ulrich Schildhaus
- Institute of Pathology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Rainer Hamacher
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Moritz Kaths
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Johannes Grueneisen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Jürgen Treckmann
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Sebastian Bauer
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Benedikt Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
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Alatzides LG, Schaarschmidt B, Bertram S, Hamacher R, Kaths M, Grüneisen J, Schildhaus UH, Bauer S, Umutlu L. Ist die CT-gesteuerte Biopsie eine zuverlässige Modalität in der präoperativen diagnostischen Abklärung von Patienten mit peritonealem und retroperitonealem Sarkom? ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- L G Alatzides
- Universitätsklinikum Essen, Diagnostische und Interventionelle Radiologie und Neuroradio, Essen
| | - B Schaarschmidt
- Institut für Diagnostische und Interventionelle Radiologe und Neuroradiologie, Universitätsklinikum Essen, Essen
| | - S Bertram
- Institut für Pathologie, Universitätsklinikum Essen, Essen
| | - R Hamacher
- Klinik für Innere Medizin (Tumorforschung) – Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen
| | - M Kaths
- Klinik für Allgemeinchirurgie, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Essen
| | - J Grüneisen
- Institut für Diagnostische und Interventionelle Radiologe und Neuroradiologie, Universitätsklinikum Essen, Essen
| | - U H Schildhaus
- Institut für Pathologie, Universitätsklinikum Essen, Essen
| | - S Bauer
- Klinik für Innere Medizin (Tumorforschung) – Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen
| | - L Umutlu
- Institut für Diagnostische und Interventionelle Radiologe und Neuroradiologie, Universitätsklinikum Essen, Essen
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Morawitz SJ, Bruckmann MN, Dietzel F, Jannusch K, Antoch G, Herrmann K, Umutlu L, Kirchner J. Vergleich der diagnostischen Leistung des 18F-FDG PET/MRT, des MRT und der konventionellen Bildgebung beim N- und M-Staging des neu diagnostizierten Mammakarzinoms. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- S J Morawitz
- Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf
| | - M N Bruckmann
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | - F Dietzel
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | - K Jannusch
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | - G Antoch
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | - K Herrmann
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen
| | - L Umutlu
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen
| | - J Kirchner
- Institut für Diagnotische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf
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48
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Grüneisen J, Chodyla M, Schaarschmidt B, Barbato F, Kirchner J, Umutlu L. Vergleich von 18F-FDG PET- und DWI-Datensätzen zur Beurteilung des Therapieansprechens von Lymphomen unter Chemotherapie. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- J Grüneisen
- Universitätsklinikum Essen, Radiologie, Essen
| | - M Chodyla
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Uniklinik Essen, Essen
| | - B Schaarschmidt
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Uniklinik Essen, Essen
| | - F Barbato
- Klinik für Nuklearmedizin, Uniklinik Essen, Essen
| | - J Kirchner
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Düsseldorf, Düsseldorf
| | - L Umutlu
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Uniklinik Essen, Essen
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49
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Meetschen M, Haubold J, Zeng K, Farhand S, Stalke S, Steinberg H, Bos D, Kureishi A, Zensen S, Goeser T, Maier S, Forsting M, Umutlu L, Nensa F. KI als Co-Pilot: Inhaltsbasierte Bildsuche zur Erkennung seltener Krankheiten in der Thorax-CT. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M Meetschen
- Uniklinik Essen, Institut für Diagnostische und Interventionelle Radiologie u, Essen
| | - J Haubold
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen
| | - K Zeng
- Siemens Medical Solutions Inc., Malvern, PA
| | - S Farhand
- Siemens Medical Solutions Inc., Malvern, PA
| | - S Stalke
- Georg Thieme Verlag KG, Stuttgart
| | - H Steinberg
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Essen, Universitätsklinikum Essen, Essen
| | - D Bos
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen
| | - A Kureishi
- Institut für Künstliche Intelligenz in der Medizin, Universitätsklinikum Essen, Essen
| | - S Zensen
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen
| | - T Goeser
- Radiologie und Neuroradiologie, Kliniken Maria Hilf GmbH, Mönchengladbach
| | - S Maier
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen
| | - M Forsting
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen
| | - L Umutlu
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen
| | - F Nensa
- Institut für Künstliche Intelligenz in der Medizin, Universitätsklinikum Essen, Essen
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50
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Morawitz SJ, Sigl B, Rubbert C, Bruckmann MN, Dietzel F, Baltzer P, Herrmann K, Umutlu L, Antoch G, Caspers J, Kirchner J. Klinische Entscheidungshilfe für das axilläre Lymphknoten-Staging bei neu diagnostizierten Brustkrebspatientinnen auf der Grundlage von 18F-FDG PET/MRI und maschinellem Lernen. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- S J Morawitz
- Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf
| | - B Sigl
- Universitätsklinik für Radiologie und Nuklearmedizin, Universitätsklinikum Wien, Universitätsklinikum Wien, Wien
| | - C Rubbert
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | - M N Bruckmann
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | - F Dietzel
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | - P Baltzer
- Universitätsklinik für Radiologie und Nuklearmedizin, Universitätsklinikum Wien, Wien
| | - K Herrmann
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen
| | - L Umutlu
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen
| | - G Antoch
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | - J Caspers
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | - J Kirchner
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf
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