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Hesami M, Blake M, Anderson MA, Asmundo L, Kilcoyne A, Najmi Z, Caravan PD, Catana C, Czawlytko C, Abdar Esfahani S, Kambadakone AR, Samir A, McDermott S, Domachevsky L, Ursprung S, Catalano OA. Diagnostic Anatomic Imaging for Neuroendocrine Neoplasms: Maximizing Strengths and Mitigating Weaknesses. J Comput Assist Tomogr 2024:00004728-990000000-00316. [PMID: 38657156 DOI: 10.1097/rct.0000000000001615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
ABSTRACT Neuroendocrine neoplasms are a heterogeneous group of gastrointestinal and lung tumors. Their diverse clinical manifestations, variable locations, and heterogeneity present notable diagnostic challenges. This article delves into the imaging modalities vital for their detection and characterization. Computed tomography is essential for initial assessment and staging. At the same time, magnetic resonance imaging (MRI) is particularly adept for liver, pancreatic, osseous, and rectal imaging, offering superior soft tissue contrast. The article also highlights the limitations of these imaging techniques, such as MRI's inability to effectively evaluate the cortical bone and the questioned cost-effectiveness of computed tomography and MRI for detecting specific gastric lesions. By emphasizing the strengths and weaknesses of these imaging techniques, the review offers insights into optimizing their utilization for improved diagnosis, staging, and therapeutic management of neuroendocrine neoplasms.
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Affiliation(s)
- Mina Hesami
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael Blake
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mark A Anderson
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Aoife Kilcoyne
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Zahra Najmi
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Peter D Caravan
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ciprian Catana
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Cynthia Czawlytko
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Shadi Abdar Esfahani
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Avinash R Kambadakone
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anthony Samir
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Shaunagh McDermott
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Liran Domachevsky
- Department of Nuclear Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Stephan Ursprung
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Onofrio A Catalano
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Asmundo L, Ambrosini V, Mojtahed A, Fanti S, Ferrone C, Hesami M, Sertic M, Najmi Z, Furtado FS, Dhami RS, Anderson MA, Samir A, Sharma A, Campana D, Ursprung S, Nikolau K, Domachevsky L, Blake MA, Norris EC, Clark JW, Catalano OA. Imaging of Neuroendocrine Neoplasms; Principles of Treatment Strategies. What Referring Clinicians Want to Know. J Comput Assist Tomogr 2024:00004728-990000000-00310. [PMID: 38626751 DOI: 10.1097/rct.0000000000001619] [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: 04/18/2024]
Abstract
ABSTRACT Neuroendocrine neoplasms (NENs) are a diverse group of tumors that express neuroendocrine markers and primarily affect the lungs and digestive system. The incidence of NENs has increased over time due to advancements in imaging and diagnostic techniques. Effective management of NENs requires a multidisciplinary approach, considering factors such as tumor location, grade, stage, symptoms, and imaging findings. Treatment strategies vary depending on the specific subtype of NEN. In this review, we will focus on treatment strategies and therapies including the information relevant to clinicians in order to undertake optimal management and treatment decisions, the implications of different therapies on imaging, and how to ascertain their possible complications and treatment effects.
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Affiliation(s)
| | | | - Amirkasra Mojtahed
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Cristina Ferrone
- Department of Surgery, Cedar-Sinai Health System, Los Angeles, CA
| | - Mina Hesami
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Madeleine Sertic
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Zahra Najmi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ranjodh S Dhami
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anthony Samir
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Amita Sharma
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Davide Campana
- Department of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Stephan Ursprung
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Konstantin Nikolau
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Liran Domachevsky
- Department of Nuclear Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Michael A Blake
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Evan C Norris
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jeffrey W Clark
- Department of Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Ambrosini V, Fortunati E, Fanti S, Ursprung S, Asmundo L, O'Shea A, Kako B, Lee S, Furtado FS, Blake M, Goiffon RJ, Najmi Z, Hesami M, Murakami T, Domachevsky L, Catalano OA. State-of-the-Art Hybrid Imaging of Neuroendocrine Neoplasms. J Comput Assist Tomogr 2024:00004728-990000000-00299. [PMID: 38518197 DOI: 10.1097/rct.0000000000001594] [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: 03/24/2024]
Abstract
ABSTRACT Neuroendocrine neoplasms (NENs) may be challenging to diagnose due to their small size and diverse anatomical locations. Hybrid imaging techniques, specifically positron emission tomography/computed tomography (PET/CT) and positron emission tomography/magnetic resonance imaging (PET/MRI), represent the current state-of-the-art for evaluating NENs. The preferred radiopharmaceuticals for NEN PET imaging are gallium-68 (68Ga) DOTA-peptides, which target somatostatin receptors (SSTR) overexpressed on NEN cells. Clinical applications of [68Ga]Ga-DOTA-peptides PET/CT include diagnosis, staging, prognosis assessment, treatment selection, and response evaluation. Fluorodeoxyglucose-18 (18F-FDG) PET/CT aids in detecting low-SSTR-expressing lesions and helps in patient stratification and treatment planning, particularly in grade 3 neuroendocrine tumors (NETs). New radiopharmaceuticals such as fluorine-labeled SSTR agonists and SSTR antagonists are emerging as alternatives to 68Ga-labeled peptides, offering improved detection rates and favorable biodistribution. The maturing of PET/MRI brings advantages to NEN imaging, including simultaneous acquisition of PET and MRI images, superior soft tissue contrast resolution, and motion correction capabilities. The PET/MRI with [68Ga]Ga-DOTA-peptides has demonstrated higher lesion detection rates and more accurate lesion classification compared to PET/CT. Overall, hybrid imaging offers valuable insights in the diagnosis, staging, and treatment planning of NENs. Further research is needed to refine response assessment criteria and standardize reporting guidelines.
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Affiliation(s)
| | - Emilia Fortunati
- From the Nuclear Medicine, Alma Mater Studiorum, University of Bologna
| | | | | | | | - Aileen O'Shea
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Bashar Kako
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Susanna Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael Blake
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Reece J Goiffon
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Zahra Najmi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mina Hesami
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Takaaki Murakami
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Hospital, Kyoto, Japan
| | - Liran Domachevsky
- Department of Nuclear Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Eshet Y, Eifer M, Domachevsky L, Tau N. Hypermetabolic Axillary Lymphadenopathy After Shingrix Vaccination for Varicella Zoster Virus. Clin Nucl Med 2024; 49:e127-e128. [PMID: 38271246 DOI: 10.1097/rlu.0000000000005039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
ABSTRACT A 67-year-old woman underwent staging 18 F-FDG PET/CT scan for recently diagnosed breast cancer. Her scan showed a highly hypermetabolic right breast mass, with ipsilateral hypermetabolic axillary lymph nodes. The contralateral axillary lymph nodes were also enlarged with avid FDG uptake, alongside focal increased uptake in the left deltoid muscle. Upon investigation, the patient reported receiving the new zoster recombinant adjuvanted varicella zoster vaccine (Shingrix, GlaxoSmithKline) 4 days before the scan. The lymph node uptake could be potential pitfall for cancer staging.
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Peters‐Founshtein G, Gazit L, Naveh T, Domachevsky L, Korczyn AD, Bernstine H, Shaharabani‐Gargir L, Groshar D, Marshall GA, Arzy S. Lost in space(s): Multimodal neuroimaging of disorientation along the Alzheimer's disease continuum. Hum Brain Mapp 2024; 45:e26623. [PMID: 38488454 PMCID: PMC10941506 DOI: 10.1002/hbm.26623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/02/2024] [Accepted: 01/27/2024] [Indexed: 03/18/2024] Open
Abstract
Orientation is a fundamental cognitive faculty and the bedrock of the neurologic examination. Orientation is defined as the alignment between an individual's internal representation and the external world in the spatial, temporal, and social domains. While spatial disorientation is a recognized hallmark of Alzheimer's disease (AD), little is known about disorientation beyond space in AD. This study aimed to explore disorientation in spatial, temporal, and social domains along the AD continuum. Fifty-one participants along the AD continuum performed an ecological orientation task in the spatial, temporal, and social domains while undergoing functional MRI. Disorientation in AD followed a three-way association between orientation domain, brain region, and disease stage. Specifically, patients with early amnestic mild cognitive impairment exhibited spatio-temporal disorientation and reduced brain activity in temporoparietal regions, while patients with AD dementia showed additional social disorientation and reduced brain activity in frontoparietal regions. Furthermore, patterns of hypoactivation overlapped different subnetworks of the default mode network, patterns of fluorodeoxyglucose hypometabolism, and cortical atrophy characteristic of AD. Our results suggest that AD may encompass a disorder of orientation, characterized by a biphasic process manifesting as early spatio-temporal and late social disorientation. As such, disorientation may offer a unique window into the clinicopathological progression of AD. SIGNIFICANCE STATEMENT: Despite extensive research into Alzheimer's disease (AD), its core cognitive deficit remains a matter of debate. In this study, we investigated whether orientation, defined as the ability to align internal representations with the external world in spatial, temporal, and social domains, constitutes a core cognitive deficit in AD. To do so, we used PET-fMRI imaging to collect behavioral, functional, and metabolic data from 51 participants along the AD continuum. Our findings suggest that AD may constitute a disorder of orientation, characterized by an early spatio-temporal disorientation and followed by late social disorientation, manifesting in task-evoked and neurodegenerative changes. We propose that a profile of disorientation across multiple domains offers a unique window into the progression of AD and as such could greatly benefit disease diagnosis, monitoring, and evaluation of treatment response.
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Affiliation(s)
- Gregory Peters‐Founshtein
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
- Department of Nuclear MedicineSheba Medical CenterRamat‐GanIsrael
| | - Lidor Gazit
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
- Department of NeurologyHadassah Hebrew University Medical SchoolJerusalemIsrael
| | - Tahel Naveh
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
- Department of NeurologyHadassah Hebrew University Medical SchoolJerusalemIsrael
| | - Liran Domachevsky
- Department of Nuclear MedicineSheba Medical CenterRamat‐GanIsrael
- Department of Nuclear MedicineAssuta Medical CenterTel‐AvivIsrael
| | | | - Hanna Bernstine
- Department of Nuclear MedicineAssuta Medical CenterTel‐AvivIsrael
- Department of ImagingTel‐Aviv UniversityTel‐AvivIsrael
- Department of Nuclear MedicineRabin Medical CenterPetah TikvaIsrael
| | | | - David Groshar
- Department of Nuclear MedicineAssuta Medical CenterTel‐AvivIsrael
- Department of ImagingTel‐Aviv UniversityTel‐AvivIsrael
| | - Gad A. Marshall
- Department of Neurology, Center for Alzheimer Research and Treatment, Harvard Medical School, Brigham and Women's HospitalMassachusetts General HospitalBostonMassachusettsUSA
| | - Shahar Arzy
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
- Department of NeurologyHadassah Hebrew University Medical SchoolJerusalemIsrael
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Lesman-Segev OH, Golan Shekhtman S, Springer RR, Livny A, Lin HM, Yuxia O, Zadok M, Ganmore I, Heymann A, Hoffmann C, Domachevsky L, Schnaider Beeri M. Amyloid deposition and small vessel disease are associated with cognitive function in older adults with type 2 diabetes. Sci Rep 2024; 14:2741. [PMID: 38302529 PMCID: PMC10834442 DOI: 10.1038/s41598-024-53043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/27/2024] [Indexed: 02/03/2024] Open
Abstract
Diabetes is associated with cognitive decline, but the underlying mechanisms are complex and their relationship with Alzheimer's Disease biomarkers is not fully understood. We assessed the association of small vessel disease (SVD) and amyloid burden with cognitive functioning in 47 non-demented older adults with type-2 diabetes from the Israel Diabetes and Cognitive Decline Study (mean age 78Y, 64% females). FLAIR-MRI, Vizamyl amyloid-PET, and T1W-MRI quantified white matter hyperintensities as a measure of SVD, amyloid burden, and gray matter (GM) volume, respectively. Mean hemoglobin A1c levels and duration of type-2 diabetes were used as measures of diabetic control. Cholesterol level and blood pressure were used as measures of cardiovascular risk. A broad neuropsychological battery assessed cognition. Linear regression models revealed that both higher SVD and amyloid burden were associated with lower cognitive functioning. Additional adjustments for type-2 diabetes-related characteristics, GM volume, and cardiovascular risk did not alter the results. The association of amyloid with cognition remained unchanged after further adjustment for SVD, and the association of SVD with cognition remained unchanged after further adjustment for amyloid burden. Our findings suggest that SVD and amyloid pathology may independently contribute to lower cognitive functioning in non-demented older adults with type-2 diabetes, supporting a multimodal approach for diagnosing, preventing, and treating cognitive decline in this population.
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Affiliation(s)
- Orit H Lesman-Segev
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel.
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Sapir Golan Shekhtman
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ramit Ravona Springer
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Memory Clinic, Sheba Medical Center, Tel Hashomer, Israel
| | - Abigail Livny
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Hung-Mo Lin
- Department of Population Health Science and Policy, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ouyang Yuxia
- Department of Population Health Science and Policy, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maya Zadok
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Ithamar Ganmore
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Memory Clinic, Sheba Medical Center, Tel Hashomer, Israel
| | - Anthony Heymann
- Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chen Hoffmann
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel
- Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Lesman-Segev OH, Golan S, Springer RR, Livny A, Lin HM, Yuxia O, Zadok M, Ganmore I, Heymann A, Hoffmann C, Domachevsky L, Beeri MS. Amyloid deposition and small vessel disease are associated with cognitive function in older adults with type 2 diabetes. Res Sq 2023:rs.3.rs-3373943. [PMID: 37841857 PMCID: PMC10571611 DOI: 10.21203/rs.3.rs-3373943/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Diabetes is associated with cognitive decline, but the underlying mechanisms are complex and their relationship with Alzheimer's Disease biomarkers is not fully understood. We assessed the association of small vessel disease (SVD) and amyloid burden with cognitive functioning in 47 non-demented older adults with type-2 diabetes from the Israel Diabetes and Cognitive Decline Study (mean age 78Y, 64% females). FLAIR-MRI, Vizamyl amyloid-PET, and T1W-MRI quantified white matter hyperintensities as a measure of SVD, amyloid burden, and gray matter (GM) volume, respectively. Mean hemoglobin A1c levels and duration of type-2 diabetes were used as measures of diabetic control. Cholesterol level and blood pressure were used as measures of cardiovascular risk. A broad neuropsychological battery assessed cognition. Linear regression models revealed that both higher SVD and amyloid burden were associated with lower cognitive functioning. Additional adjustments for type-2 diabetes-related characteristics, GM volume, and cardiovascular risk did not alter the results. The association of amyloid with cognition remained unchanged after further adjustment for SVD. Our findings suggest that SVD and amyloid pathology may independently contribute to lower cognitive functioning in non-demented older adults with type-2 diabetes, supporting a multimodal approach for diagnosing, preventing, and treating cognitive decline in this population.
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Eshet Y, Tau N, Levanon K, Bernstein-Molho R, Globus O, Itay A, Shapira T, Oedegaard C, Eifer M, Davidson T, Nidam M, Gal-Yam E, Domachevsky L. The Role of 68 Ga-FAPI PET/CT in Breast Cancer Response Assessment and Follow-Up. Clin Nucl Med 2023; 48:685-688. [PMID: 37339456 DOI: 10.1097/rlu.0000000000004744] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE 68 Ga-fibroblast activation protein inhibitor (FAPI), a new PET/CT radiotracer targeting cancer-associated fibroblasts in tumor microenvironment, can detect many types of cancer. We aimed to assess whether it can also be used for response assessment and follow-up. METHODS We followed up patients with FAPI-avid invasive lobular breast cancer (ILC) before and after treatment changes and correlated qualitative maximal intensity projection images and quantitative tumor volume with CT results and blood tumor biomarkers. RESULTS Six consenting ILC breast cancer patients (53 ± 8 years old) underwent a total of 24 scans (baseline for each patient and 2-4 follow-up scans). We found a strong correlation between 68 Ga-FAPI tumor volume and blood biomarkers ( r = 0.7, P < 0.01), but weak correlation between CT and 68 Ga-FAPI maximal intensity projection-based qualitative response assessment. CONCLUSIONS We found a strong correlation between ILC progression and regression (as assessed by blood biomarkers) and 68 Ga-FAPI tumor volume. 68 Ga-FAPI PET/CT could possibly be used for disease response assessment and follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Meital Nidam
- From the Department of Nuclear Imaging, Sheba Medical Center, Ramat Gan
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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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Eshet Y, Tau N, Apter S, Nissan N, Levanon K, Bernstein-Molho R, Globus O, Itay A, Shapira T, Oedegaard C, Gorfine M, Eifer M, Davidson T, Gal-Yam E, Domachevsky L. The Role of 68 Ga-FAPI PET/CT in Detection of Metastatic Lobular Breast Cancer. Clin Nucl Med 2023; 48:228-232. [PMID: 36638243 DOI: 10.1097/rlu.0000000000004540] [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: 01/15/2023]
Abstract
PURPOSE Invasive lobular breast cancer (ILC) may be hard to detect using conventional imaging modalities and usually shows less avidity to 18 F-FDG PET/CT. 68 Ga-fibroblast activation protein inhibitor (FAPI) PET/CT has shown promising results in detecting non- 18 F-FDG-avid cancers. We aimed to assess the feasibility of detecting metastatic disease in patients with non- 18 F-FDG-avid ILC. METHODS This prospective study included patients with metastatic ILC, infiltrative to soft tissues, which was not 18 F-FDG avid. The patients underwent 68 Ga-FAPI PET/CT for evaluation, which was correlated with the fully diagnostic CT performed at the same time. RESULTS Seven women (aged 57 ± 10 years) were included. Among the 30 organs and structures found to be involved by tumor, the number of findings observed by FAPI PET/CT was significantly higher than that observed by CT alone ( P = 0.022), especially in infiltrative soft tissue and serosal locations. CONCLUSIONS This small pilot trial suggests a role for 68 Ga-FAPI PET/CT in ILC, which needs to be confirmed by subsequent trials.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Malka Gorfine
- Department of Statistics and Operations Research, Tel-Aviv University, Tel Aviv, Israel
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11
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Dori A, Arad M, Wasserstrum Y, Pollak A, Nikitin V, Ben-David M, Shamash J, Nahum AH, Shavit-Stein E, Domachevsky L, Kuperstein R, Dominissini D, Shelestovich N, Sadeh M, Pras E, Greenbaum L. Ser77Tyr transthyretin amyloidosis in Israel: Initial manifestations and diagnostic features. Ann Clin Transl Neurol 2023; 10:553-567. [PMID: 36772971 PMCID: PMC10109316 DOI: 10.1002/acn3.51741] [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: 10/25/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE Amyloidosis due to the transthyretin Ser77Tyr mutation (ATTRS77Y) is a rare autosomal-dominant disorder, characterized by carpal-tunnel syndrome, poly- and autonomic-neuropathy, and cardiomyopathy. However, related symptoms and signs are often nonspecific and confirmatory tests are required. We describe the age and frequency of early symptoms and diagnostic features among individuals of Jewish Yemenite descent in Israel. METHODS Records of mutation carriers were retrospectively reviewed. ATTRS77Y diagnosis was defined by the presence of amyloid in tissue and/or amyloid-related cardiomyopathy. RESULTS We identified the Ser77Tyr mutation at the heterozygous state in 19 amyloidosis patients (mean age at diagnosis: 62 ± 5.7 years, range 49-70) and 30 amyloid-negative carriers. The probability for disease diagnosis increased from 4.4% at age 49 to 100% at 70 and occurred earlier in males. Initial symptoms preceded diagnosis by 5 ± 3.8 years (range 0-12) and were commonly sensory changes in the extremities. Erectile dysfunction predated these in 8/13 (62%) males. In two patients cardiac preceded neurological symptoms. Two patients declined symptoms. Electrophysiological studies near the time of diagnosis indicated a median neuropathy at the wrist in 18/19 (95%) and polyneuropathy in 13/19 (68%). Skin biopsy revealed epidermal denervation in 15/16 (94%) patients. Cardiomyopathy was identified in 16/19 (84%). Sensory complaints or epidermal denervations were present in 17/30 (57%) of amyloid-negative carriers and co-occurred in 10/30 (33%). INTERPRETATION ATTRS77Y symptoms commonly occur after age 50, but may begin earlier. Median neuropathy, skin denervation and cardiomyopathy are frequently identified. Symptoms may be absent in patients and common in amyloid-negative carriers.
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Affiliation(s)
- Amir Dori
- Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Arad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Yishay Wasserstrum
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Arthur Pollak
- Department of Cardiology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Vera Nikitin
- Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Ben-David
- Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jana Shamash
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - Ayelet Hashachar Nahum
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - Efrat Shavit-Stein
- Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Rafael Kuperstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Dan Dominissini
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The genomics Unit, Sheba Cancer Research Center, Sheba Medical Center, Tel Hashomer, Israel.,Wohl Institute of Translational Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Natalia Shelestovich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pathology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Menachem Sadeh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Wolfson Medical Center, Holon, Israel
| | - Elon Pras
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - Lior Greenbaum
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel.,The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel
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12
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Peters-Founshtein G, Gazit L, Naveh T, Domachevsky L, Korczyn A, Bernstine H, Groshar D, Marshall GA, Arzy S. Lost in space(s): multimodal neuroimaging of disorientation along the Alzheimer's disease continuum. bioRxiv 2023:2023.01.25.525587. [PMID: 36747783 PMCID: PMC9900945 DOI: 10.1101/2023.01.25.525587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Orientation is a fundamental cognitive faculty, allowing the behaving self to link his/her current state to their internal representations of the external world. Once exclusively linked to knowledge of the current place and present time, in recent years, the concept of orientation has evolved to include processing of social, temporal, and abstract relations. Concordantly with the growing focus on orientation, spatial disorientation has been increasingly recognized as a hallmark symptom of Alzheimer's disease (AD). However, few studies have sought to explore disorientation along the AD continuum beyond the spatial domain. 51 participants along the AD continuum performed an orientation task in the spatial, temporal and social domains. Under functional magnetic resonance imaging (fMRI), participants determined which of two familiar places/events/people is geographically/ chronologically/ socially closer to them, respectively. A series of analyses revealed disorientation along the AD- continuum to follow a three-way association between (1) orientation domain, (2) brain region, and (3) disease stage. Specifically, participants with MCI exhibited impaired spatio-temporal orientation and reduced task-evoked activity in temporoparietal regions, while participants with AD dementia exhibited impaired social orientation and reduced task-evoked activity in frontoparietal regions. Furthermore, these patterns of hypoactivation coincided with Default Mode Network (DMN) sub-networks, with spatio-temporal orientation activation overlapping DMN-C and social orientation with DMN-A. Finally, these patterns of disorientation- associated hypoactivations coincided with patterns of fluorodeoxyglucose (FDG) hypometabolism and cortical atrophy characteristic to AD-dementia. Taken together, our results suggest that AD may constitute a disorder of orientation, characterized by a biphasic process as (1) early spatio-temporal and (2) late social disorientation, concurrently manifesting in task-evoked and neurodegenerative changes in temporoparietal and parieto-frontal brain networks, respectively. We propose that a profile of disorientation across multiple domains offers a unique window into the progression of AD.
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Affiliation(s)
- Gregory Peters-Founshtein
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Nuclear Medicine, Sheba Medical Center, Ramat-Gan, Israel
| | - Lidor Gazit
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Neurology, Hadassah Hebrew University Medical School, Jerusalem, Israel
| | - Tahel Naveh
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Neurology, Hadassah Hebrew University Medical School, Jerusalem, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Sheba Medical Center, Ramat-Gan, Israel
- Department of Nuclear Medicine, Assuta Medical Center, Tel-Aviv, Israel
| | - Amos Korczyn
- Department of Neurology, Tel-Aviv University, Tel-Aviv, Israel
| | - Hanna Bernstine
- Department of Imaging, Tel-Aviv University, Tel-Aviv, Israel
- Department of Nuclear Medicine, Assuta Medical Center, Tel-Aviv, Israel
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel
| | - David Groshar
- Department of Imaging, Tel-Aviv University, Tel-Aviv, Israel
- Department of Nuclear Medicine, Assuta Medical Center, Tel-Aviv, Israel
| | - Gad A. Marshall
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Shahar Arzy
- The Computational Neuropsychiatry Lab, Department of Medical Neurobiology, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Neurology, Hadassah Hebrew University Medical School, Jerusalem, Israel
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13
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Ben Shimol J, Lewin R, Symon Z, Rosenzweig B, Leibowitz-Amit R, Eshet Y, Domachevsky L, Davidson T. The Utility of 68Ga-PSMA PET/CT in Decisions Regarding Administering Salvage Radiotherapy to Men with Prostate Cancer. Int J Environ Res Public Health 2022; 20:537. [PMID: 36612859 PMCID: PMC9819101 DOI: 10.3390/ijerph20010537] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Numerous papers have described 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT)'s sensitivity in identifying prostate cancer (PCa) recurrence. This study aimed to characterize the role of 68Ga-PSMA PET/CT in deciding to re-irradiate pelvic structures. METHODS 68Ga-PSMA PET/CT scans performed at Sheba Medical Center over seven years in 113 men were reviewed. All had undergone radiation to the prostate (70, 61.9%) or post-radical prostatectomy radiation to the prostate fossa (PF) (43, 48.1%), and had local or oligometastatic PCa recurrence and received salvage radiotherapy (SRT) based on PET/CT findings. RESULTS Mean age was 70.7 years. The mean grade group was 2.9; the mean prostate-specific antigen was 9.0. The 68Ga-PSMA PET/CT positive findings included: 37 (32.7%) in the prostate, 23 (20.4%) in seminal vesicles, 7 (6.2%) in the PF, and 3 (2.7%) in the seminal vesicle fossa. The mean standardized uptake value was 10.6 ± 10.2 (range: 1.4-61.6); the mean lesion size was 1.8 ± 3.5 mm (range: 0.5-5.1). SRT was directed toward the prostate and seminal vesicles in 48 (42.5%), PF in 18 (15.9%), and intrapelvic lymph node and bone in 47 (41.6%). Toxicities were mostly mild to moderate. CONCLUSION 68Ga-PSMA PET/CT-identified relapse with targeted SRT was well-tolerated and may result in less onerous treatments.
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Affiliation(s)
- Jennifer Ben Shimol
- Barzilai Medical Center, Ashqelon 7830604, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ron Lewin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Zvi Symon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Barak Rosenzweig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Raya Leibowitz-Amit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Oncology Institute, Shamir Medical Center, Zerifin 7033001, Israel
| | - Yael Eshet
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Liran Domachevsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Tima Davidson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
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14
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Brenner B, Kundel Y, Cohen Z, Brand H, Gordon N, Sulkes A, Morgenstern S, Menasherov N, Kashtan H, Groshar D, Domachevsky L, Bernstine H. Early prediction of residual disease after neoadjuvant chemoradiotherapy and cetuximab for locally advanced esophageal cancer using 18F-FDG PET-CT imaging: a prospective cohort study. J Gastrointest Oncol 2022; 13:2721-2735. [PMID: 36636052 PMCID: PMC9830356 DOI: 10.21037/jgo-22-352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Previous studies in locally advanced esophageal cancer (LAEC) suggested that a change in the tumor's metabolic response, i.e., decrease of its interim 18F-FDG uptake compared with baseline, may predict histopathological response. We evaluated the possible predictive correlation between various PET-CT and histopathological parameters following a neoadjuvant biological-containing chemoradiotherapy (CRT) regimen. Methods Patients with resectable LAEC received neoadjuvant cisplatin/5-fluorouracil-based CRT and cetuximab following one cycle of induction chemotherapy and cetuximab. Changes in maximum and mean standardized uptake values (ΔSUV-max and ΔSUV-mean, respectively) and metabolic tumor volume (ΔMTV), measured by PET-CT at baseline and 2 weeks after the onset of treatment, were compared with histopathological findings at surgery. Histopathological response was defined by tumor regression grade (TRG), pathological complete response (pCR) and microscopic or macroscopic residual disease (RD). Results Of 18 patients, 13 (72%) with adenocarcinoma (AC) and 5 (28%) with squamous cell carcinoma (SCC), were included. None of the changes in the parameters of PET was associated with pCR; only ΔSUV-mean was associated with TRG in the AC cohort. In contrast, both ΔSUV-mean% and ΔSUV-max% were significantly associated with RD, both in the whole cohort and in the AC cohort. Changes in FDG-uptake predicted RD2 at surgery: only patients with less than 13% decrease in SUV-mean% or less than 29% decrease in SUV-max% had RD2, while all patients with RD0 or RD1 had greater reductions [100% specificity and 100% positive predictive value (PPV)]. Conclusions Changes in ΔSUV-max and ΔSUV-mean after two weeks of onset of cetuximab-based neoadjuvant chemotherapy for LAEC may predict macroscopic RD but not TRG or pCR at surgery.
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Affiliation(s)
- Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel;,Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Yulia Kundel
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Zoya Cohen
- Felsenstein Medical Research Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Hadar Brand
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Noa Gordon
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Aaron Sulkes
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel;,Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Sara Morgenstern
- Institute of Pathology, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Nikolai Menasherov
- Department of Surgery A, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Hanoch Kashtan
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel;,Departments of Surgery A and B, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - David Groshar
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel;,Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Petach Tiqva, Israel
| | - Liran Domachevsky
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel;,Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Petach Tiqva, Israel;,Department of Nuclear Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Hanna Bernstine
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel;,Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Petach Tiqva, Israel
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15
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Lesman‐Segev OH, Golan S, Zadok M, Kishenevsky S, Ben‐Meir M, Bem‐Moshe A, Heymann A, Azuri J, Ravona‐Springer R, Hoffmann C, Domachevsky L, Beeri MS. Behavioral reaction to amyloid beta status disclosure. Alzheimers Dement 2022. [DOI: 10.1002/alz.069213] [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: 12/24/2022]
Affiliation(s)
- Orit H. Lesman‐Segev
- The Joseph Sagol Neuroscience Center, Sheba Medical Center Ramat Gan Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer Ramat Gan Israel
| | - Sapir Golan
- The Joseph Sagol Neuroscience Center, Sheba Medical Center Ramat Gan Israel
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Maya Zadok
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer Ramat Gan Israel
| | - Sarah Kishenevsky
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer Ramat Gan Israel
| | - Mery Ben‐Meir
- The Joseph Sagol Neuroscience Center, Sheba Medical Center Ramat Gan Israel
| | - Ariela Bem‐Moshe
- The Joseph Sagol Neuroscience Center, Sheba Medical Center Ramat‐Gan Israel
| | | | | | - Ramit Ravona‐Springer
- The Joseph Sagol Neuroscience Center, Sheba Medical Center Ramat Gan Israel
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
- Memory clinic, Sheba Medical Center Ramat‐Gan Israel
| | - Chen Hoffmann
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer Ramat Gan Israel
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Liran Domachevsky
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer Ramat Gan Israel
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center Ramat Gan Israel
- Icahn School of Medicine at Mount Sinai New York NY USA
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16
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Golan S, Frumer M, Zohar Y, Rosenbaum E, Yakimov M, Kedar D, Margel D, Baniel J, Steinmetz AP, Groshar D, Domachevsky L, Bernstine H. Neoadjuvant 177Lu-PSMA-I&T Radionuclide Treatment in Patients with High-risk Prostate Cancer Before Radical Prostatectomy: A Single-arm Phase 1 Trial. Eur Urol Oncol 2022; 6:151-159. [PMID: 36216740 DOI: 10.1016/j.euo.2022.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/16/2022] [Accepted: 09/20/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND High-risk localized prostate cancer (HRLPC) has a substantial risk of disease progression despite local treatment. Neoadjuvant systemic therapy before definitive local therapy may improve oncological outcomes by targeting the primary tumor and micrometastatic disease. OBJECTIVE To evaluate whether a lutetium-177 prostate-specific membrane antigen radioligand (LuPSMA) can be safely administered to patients with HRLPC before robot-assisted radical prostatectomy (RARP) and to describe immediate oncological outcomes. DESIGN, SETTING, AND PARTICIPANTS This was an open-label, single-arm clinical trial. Patients with HRLPC and elevated radioligand uptake on PSMA positron emission tomography/computed tomography were enrolled. Two or three LuPSMA radioligand doses (7.4 GBq) were given at 2-wk intervals. RARP with lymph node dissection was performed 4 wk after the last LuPSMA dose. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The rate of surgical complications, operative parameters, changes in functional and quality-of-life measures, and immediate oncological outcomes (histological findings and biochemical response) were measured. Data were analyzed descriptively. RESULTS AND LIMITATIONS Fourteen patients participated (median age 67 yr). Prostate-specific antigen decreased by 17% (interquartile range [IQR] 9-50%) after two LuPSMA doses and 34% (IQR 11-60%) after three doses. Thirteen patients underwent RARP with no identifiable anatomical changes or intraoperative complications. Four patients (30%) had postoperative complications (pneumonia, pulmonary embolism, urinary leak with urinary tract infection). At 3 mo postoperatively, 12 patients (92%) required one pad or less. Final whole-mount pathology showed positive surgical margins (PSMs) in seven patients (53%) and downgrading to International Society of Urological Pathology grade group 3 in three patients (23%). Treatment-related effects included a clear vacuolated cytoplasm and pyknotic nuclei. CONCLUSIONS LuPSMA followed by RARP appears to be surgically safe. While oncological outcomes are pending, continence recovery seems to be unaffected by LuPSMA treatment. PATIENT SUMMARY We evaluated outcomes for patients with aggressive localized prostate cancer who received treatment with a radioactive agent before surgical removal of their prostate. This approach appears to be safe and feasible, but its therapeutic efficacy is still unknown.
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17
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Eifer M, Pinian H, Klang E, Alhoubani Y, Kanana N, Tau N, Davidson T, Konen E, Catalano OA, Eshet Y, Domachevsky L. FDG PET/CT radiomics as a tool to differentiate between reactive axillary lymphadenopathy following COVID-19 vaccination and metastatic breast cancer axillary lymphadenopathy: a pilot study. Eur Radiol 2022; 32:5921-5929. [PMID: 35385985 PMCID: PMC8985565 DOI: 10.1007/s00330-022-08725-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate if radiomics with machine learning can differentiate between F-18-fluorodeoxyglucose (FDG)-avid breast cancer metastatic lymphadenopathy and FDG-avid COVID-19 mRNA vaccine-related axillary lymphadenopathy. MATERIALS AND METHODS We retrospectively analyzed FDG-positive, pathology-proven, metastatic axillary lymph nodes in 53 breast cancer patients who had PET/CT for follow-up or staging, and FDG-positive axillary lymph nodes in 46 patients who were vaccinated with the COVID-19 mRNA vaccine. Radiomics features (110 features classified into 7 groups) were extracted from all segmented lymph nodes. Analysis was performed on PET, CT, and combined PET/CT inputs. Lymph nodes were randomly assigned to a training (n = 132) and validation cohort (n = 33) by 5-fold cross-validation. K-nearest neighbors (KNN) and random forest (RF) machine learning models were used. Performance was evaluated using an area under the receiver-operator characteristic curve (AUC-ROC) score. RESULTS Axillary lymph nodes from breast cancer patients (n = 85) and COVID-19-vaccinated individuals (n = 80) were analyzed. Analysis of first-order features showed statistically significant differences (p < 0.05) in all combined PET/CT features, most PET features, and half of the CT features. The KNN model showed the best performance score for combined PET/CT and PET input with 0.98 (± 0.03) and 0.88 (± 0.07) validation AUC, and 96% (± 4%) and 85% (± 9%) validation accuracy, respectively. The RF model showed the best result for CT input with 0.96 (± 0.04) validation AUC and 90% (± 6%) validation accuracy. CONCLUSION Radiomics features can differentiate between FDG-avid breast cancer metastatic and FDG-avid COVID-19 vaccine-related axillary lymphadenopathy. Such a model may have a role in differentiating benign nodes from malignant ones. KEY POINTS • Patients who were vaccinated with the COVID-19 mRNA vaccine have shown FDG-avid reactive axillary lymph nodes in PET-CT scans. • We evaluated if radiomics and machine learning can distinguish between FDG-avid metastatic axillary lymphadenopathy in breast cancer patients and FDG-avid reactive axillary lymph nodes. • Combined PET and CT radiomics data showed good test AUC (0.98) for distinguishing between metastatic axillary lymphadenopathy and post-COVID-19 vaccine-associated axillary lymphadenopathy. Therefore, the use of radiomics may have a role in differentiating between benign from malignant FDG-avid nodes.
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Affiliation(s)
- Michal Eifer
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Hodaya Pinian
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
| | - Eyal Klang
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- ARC Center for Digital Innovation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Yousef Alhoubani
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
| | - Nayroz Kanana
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Tau
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tima Davidson
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Konen
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yael Eshet
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bauer E, Levy MS, Domachevsky L, Anaby D, Nissan N. Background parenchymal enhancement and uptake as breast cancer imaging biomarkers: A state-of-the-art review. Clin Imaging 2021; 83:41-50. [PMID: 34953310 DOI: 10.1016/j.clinimag.2021.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 12/20/2022]
Abstract
Within the past decade, background parenchymal enhancement (BPE) and background parenchymal uptake (BPU) have emerged as novel imaging-derived biomarkers in the diagnosis and treatment monitoring of breast cancer. Growing evidence supports the role of breast parenchyma vascularity and metabolic activity as probable risk factors for breast cancer development. Furthermore, in the presence of a newly-diagnosed breast cancer, added clinically-relevant data was surprisingly found in the respective imaging properties of the non-affected contralateral breast. Evaluation of the contralateral BPE and BPU have been found to be especially instrumental in predicting the prognosis of a patient with breast cancer and even anticipating their response to neoadjuvant chemotherapy. Simultaneously, further research has found a link between these two biomarkers, even though they represent different physical properties. The aim of this review is to provide an up to date summary of the current clinical applications of BPE and BPU as breast cancer imaging biomarkers with the hope that it propels their further usage in clinical practice.
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Affiliation(s)
- Ethan Bauer
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Miri Sklair Levy
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Liran Domachevsky
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Debbie Anaby
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Noam Nissan
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
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Lesman‐Segev OH, Golan S, Ravona‐Springer R, Livny A, Lin H, Ouyang Y, Zadok M, Hoffmann C, Domachevsky L, Beeri MS. Amyloid pathology, small‐vessel disease, atrophy, and cognition in normal adults with type 2 diabetes. Alzheimers Dement 2021. [DOI: 10.1002/alz.052616] [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: 11/11/2022]
Affiliation(s)
- Orit H. Lesman‐Segev
- Department of Diagnostic Imaging Sheba Medical Center Tel Hashomer Ramat Gan Israel
- The Joseph Sagol Neuroscience Center Sheba Medical Center Tel Hashomer Ramat Gan Israel
| | - Sapir Golan
- The Joseph Sagol Neuroscience Center Sheba Medical Center Tel Hashomer Ramat Gan Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Ramit Ravona‐Springer
- The Joseph Sagol Neuroscience Center Sheba Medical Center Tel Hashomer Ramat Gan Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Memory clinic Sheba Medical Center Tel Hashomer Ramat‐Gan Israel
| | - Abigail Livny
- Department of Diagnostic Imaging Sheba Medical Center Tel Hashomer Ramat Gan Israel
- The Joseph Sagol Neuroscience Center Sheba Medical Center Tel Hashomer Ramat Gan Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Hung‐Mo Lin
- Department of Population Health Science and Policy The Icahn School of Medicine at Mount Sinai New York NY USA
| | - Yuxia Ouyang
- Department of Population Health Science and Policy The Icahn School of Medicine at Mount Sinai New York NY USA
| | - Maya Zadok
- The Joseph Sagol Neuroscience Center Sheba Medical Center Tel Hashomer Ramat Gan Israel
| | - Chen Hoffmann
- Department of Diagnostic Imaging Sheba Medical Center Tel Hashomer Ramat Gan Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Liran Domachevsky
- Department of Diagnostic Imaging Sheba Medical Center Tel Hashomer Ramat Gan Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center Sheba Medical Center Tel Hashomer Ramat Gan Israel
- Department of Psychiatry The Icahn School of Medicine at Mount Sinai New York NY USA
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Esfahani SA, Torrado-Carvajal A, Amorim BJ, Groshar D, Domachevsky L, Bernstine H, Stein D, Gervais D, Catalano OA. Publisher Correction to: PET/MRI and PET/CT Radiomics in Primary Cervical Cancer: A Pilot Study on the Correlation of Pelvic PET, MRI, and CT Derived Image Features. Mol Imaging Biol 2021; 24:70. [PMID: 34811607 DOI: 10.1007/s11307-021-01671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Shadi A Esfahani
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital Boston and Harvard Medical School, Boston, MA, USA
| | - Angel Torrado-Carvajal
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital Boston and Harvard Medical School, Boston, MA, USA.,Medical Image Analysis and Biometry Lab, Universidad Rey Juan Carlos, Madrid, Spain
| | - Barbara Juarez Amorim
- Division of Nuclear Medicine, State University of Campinas (UNICAMP), Campinas, Brazil
| | - David Groshar
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Nuclear Medicine and Radiology, Assuta Medical Centers, 2021, Tel-Aviv, Israel
| | - Liran Domachevsky
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Nuclear Medicine and Radiology, Assuta Medical Centers, 2021, Tel-Aviv, Israel
| | - Hanna Bernstine
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Nuclear Medicine and Radiology, Assuta Medical Centers, 2021, Tel-Aviv, Israel
| | - Dan Stein
- Department of Nuclear Medicine and Radiology, Assuta Medical Centers, 2021, Tel-Aviv, Israel
| | - Debra Gervais
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. .,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital Boston and Harvard Medical School, Boston, MA, USA.
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21
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Esfahani SA, Torrado-Carvajal A, Amorim BJ, Groshar D, Domachevsky L, Bernstine H, Stein D, Gervais D, Catalano OA. PET/MRI and PET/CT Radiomics in Primary Cervical Cancer: A Pilot Study on the Correlation of Pelvic PET, MRI, and CT Derived Image Features. Mol Imaging Biol 2021; 24:60-69. [PMID: 34622425 DOI: 10.1007/s11307-021-01658-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate the correlation of radiomic features in pelvic [2-deoxy-2-18F]fluoro-D-glucose positron emission tomography/magnetic resonance imaging and computed tomography ([18F]FDG PET/MRI and [18F]FDG PET/CT) in patients with primary cervical cancer (CCa). PROCEDURES Nineteen patients with histologically confirmed primary squamous cell carcinoma of the cervix underwent same-day [18F]FDG PET/MRI and PET/CT. Two nuclear medicine physicians performed a consensus reading in random order. Free-hand regions of interest covering the primary cervical tumors were drawn on PET, contrast-enhanced pelvic CT, and pelvic MR (T2 weighted and ADC) images. Several basic imaging features, standard uptake values (SUVmean, SUVmax, and SUVpeak), total lesion glycolysis (TLG), metabolic tumor volume (MTV), and more advanced texture analysis features were calculated. Pearson's correlation test was used to assess the correlation between each pair of features. Features were compared between local and metastatic tumors, and their role in predicting metastasis was evaluated by receiver operating characteristic curves. RESULTS For a total of 101 extracted features, 1104/5050 pairs of features showed a significant correlation (ρ ≥ 0.70, p < 0.05). There was a strong correlation between 190/484 PET pairs of features from PET/MRI and PET/CT, 91/418 pairs of CT and PET from PET/CT, 79/418 pairs of T2 and PET from PET/MRI, and 50/418 pairs of ADC and PET from PET/MRI. Significant difference was seen between eight features in local and metastatic tumors including MTV, TLG, and entropy on PET from PET/CT; MTV and TLG on PET from PET/MRI; compactness and entropy on T2; and entropy on ADC images. CONCLUSIONS We demonstrated strong correlation of many extracted radiomic features between PET/MRI and PET/CT. Eight radiomic features calculated on PET/CT and PET/MRI were significantly different between local and metastatic CCa. This study paves the way for future studies to evaluate the diagnostic and predictive potential of radiomics that could guide clinicians toward personalized patients care.
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Affiliation(s)
- Shadi A Esfahani
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital Boston and Harvard Medical School, Boston, MA, USA
| | - Angel Torrado-Carvajal
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital Boston and Harvard Medical School, Boston, MA, USA.,Medical Image Analysis and Biometry Lab, Universidad Rey Juan Carlos, Madrid, Spain
| | - Barbara Juarez Amorim
- Division of Nuclear Medicine, State University of Campinas (UNICAMP), Campinas, Brazil
| | - David Groshar
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Nuclear Medicine and Radiology, Assuta Medical Centers, Tel-Aviv, Israel
| | - Liran Domachevsky
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Nuclear Medicine and Radiology, Assuta Medical Centers, Tel-Aviv, Israel
| | - Hanna Bernstine
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Nuclear Medicine and Radiology, Assuta Medical Centers, Tel-Aviv, Israel
| | - Dan Stein
- Department of Nuclear Medicine and Radiology, Assuta Medical Centers, Tel-Aviv, Israel
| | - Debra Gervais
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. .,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital Boston and Harvard Medical School, Boston, MA, USA.
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22
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Zhang C, O'Shea A, Parente CA, Amorim BJ, Caravan P, Ferrone CR, Blaszkowsky LS, Soricelli A, Salvatore M, Groshar D, Bernstine H, Domachevsky L, Canamaque LG, Umutlu L, Ken H, Catana C, Mahmood U, Catalano OA. Evaluation of the Diagnostic Performance of Positron Emission Tomography/Magnetic Resonance for the Diagnosis of Liver Metastases. Invest Radiol 2021; 56:621-628. [PMID: 33813576 DOI: 10.1097/rli.0000000000000782] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of this study was to compare the performance of positron emission tomography (PET)/magnetic resonance (MR) versus stand-alone PET and stand-alone magnetic resonance imaging (MRI) in the detection and characterization of suspected liver metastases. MATERIALS AND METHODS This multi-institutional retrospective performance study was approved by the institutional review boards and was Health Insurance Portability and Accountability Act compliant, with waiver of informed consent. Seventy-nine patients with confirmed solid extrahepatic malignancies who underwent upper abdominal PET/MR between February 2017 and June 2018 were included. Where focal hepatic lesions were identified, the likelihood of a diagnosis of a liver metastasis was defined on an ordinal scale for MRI, PET, and PET/MRI by 3 readers: 1 nuclear medicine physician and 2 radiologists. The number of lesions per patient, lesion size, and involved hepatic segments were recorded. Proof of metastases was based on histopathologic correlation or clinical/imaging follow-up. Diagnostic performance was assessed using sensitivity, specificity, positive and negative predictive values, and receiver operator characteristic curve analysis. RESULTS A total of 79 patients (53 years, interquartile range, 50-68; 43 men) were included. PET/MR had a sensitivity of 95%, specificity of 97%, positive predictive value of 97%, and negative predictive value of 95%. The sensitivity, specificity, positive predictive value, and negative predictive value of MRI were 88%, 98%, 98%, and 90% and for PET were 83%, 97%, 97%, and 86%, respectively. The areas under the curve for PET/MRI, MRI, and PET were 95%, 92%, and 92%, respectively. CONCLUSIONS Contrast-enhanced PET/MR has a higher sensitivity and negative predictive value than either PET or MRI alone in the setting of suspected liver metastases. Fewer lesions were characterized as indeterminate by PET/MR in comparison with PET and MRI. This superior performance could potentially impact treatment and management decisions for patients with suspected liver metastases.
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Affiliation(s)
- Caiyuan Zhang
- From The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, and Department of Radiology, Xinhua Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aileen O'Shea
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston
| | - Chiara Anna Parente
- IRCCS, Department of Radiology, The Institute for Hospitalization and Healthcare (IRCCS) SDN, Napoli, Italy
| | - Barbara Juarez Amorim
- Division of Nuclear Medicine, Department of Radiology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Peter Caravan
- The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston
| | | | | | - Andrea Soricelli
- The Institute for Hospitalization and Healthcare (IRCCS) SDN, Napoli, Italy
| | - Marco Salvatore
- Department of Radiology and Nuclear Medicine, University Suor Orsola Benincasa and SDN IRCCS, Napoli, Italy
| | - David Groshar
- Department of Radiology and Nuclear Medicine, Assuta Medical Center and School of Medicine, Tel Aviv University, TLV, Israel
| | - Hanna Bernstine
- Department of Radiology and Nuclear Medicine, Assuta Medical Center and School of Medicine, Tel Aviv University, TLV, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, The Chaim Sheba Medical Center Tel Hashomer Israel
| | | | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Herrmann Ken
- Institute of Diagnostic and Interventional Radiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ciprian Catana
- The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Umar Mahmood
- Department of Radiology and Nuclear Medicine, Massachusetts General Hospital, Boston, MA
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23
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Margel D, Bernstine H, Groshar D, Ber Y, Nezrit O, Segal N, Yakimov M, Baniel J, Domachevsky L. Diagnostic Performance of 68Ga Prostate-specific Membrane Antigen PET/MRI Compared with Multiparametric MRI for Detecting Clinically Significant Prostate Cancer. Radiology 2021; 301:379-386. [PMID: 34463555 DOI: 10.1148/radiol.2021204093] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Gallium 68 (68Ga) prostate-specific membrane antigen (PSMA) PET/MRI may improve detection of clinically significant prostate cancer (CSPC). Purpose To compare the sensitivity and specificity of 68Ga-PSMA PET/MRI with multiparametric MRI for detecting CSPC. Materials and Methods Men with prostate specific antigen levels of 2.5-20 ng/mL prospectively underwent 68Ga-PSMA PET/MRI, including multiparametric MRI sequences, between June 2019 and March 2020. Imaging was evaluated independently by two radiologists by using the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1. Sensitivity and specificity for CSPC (International Society of Urological Pathology grade group ≥ 2) were compared for 68Ga-PSMA PET/MRI and multiparametric MRI by using the McNemar test. Decision curve analysis compared the net benefit of each imaging strategy. Results Ninety-nine men (median age, 67 years; interquartile range, 62-71 years) were included; 79% (78 of 99) underwent biopsy. CSPC was detected in 32% (25 of 78). For CSPC, specificity was higher for 68Ga-PSMA PET/MRI than multiparametric MRI (76% [95% CI: 62, 86] vs 49% [95% CI: 35, 63], respectively; P < .001). Sensitivity was similar (88% [95% CI: 69, 98] vs 92% [95% CI: 74, 99], respectively; P > .99). For PI-RADS 3 lesions, specificity was also higher for 68Ga-PSMA PET/MRI than for multiparametric MRI: 86% (95% CI: 73, 95) versus 59% (95% CI: 43, 74), respectively (P = .002). Decision curve analysis showed that biopsies targeted to PSMA uptake increased the net benefit of multiparametric MRI only among PI-RADS 3 lesions. The net benefit of targeted biopsy for a PI-RADS 3 lesion with PSMA uptake was higher across all threshold probabilities over 8%. The net benefit of targeted biopsy was similar for PI-RADS 4 and 5 lesions, regardless of PSMA uptake. Conclusions Gallium 68 prostate-specific membrane antigen PET/MRI improved specificity for clinically significant prostate cancer compared with multiparametric MRI, particularly in Prostate Imaging Reporting and Data System grade 3 lesions. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Williams and Estes in this issue.
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Affiliation(s)
- David Margel
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Hanna Bernstine
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - David Groshar
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Yaara Ber
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Orian Nezrit
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Niv Segal
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Maxim Yakimov
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Jack Baniel
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Liran Domachevsky
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
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Sadetski I, Eshet Y, Kaidar-Person O, Amit U, Domachevsky L, Davidson T, Weiss I, Ben Ayun M, Symon Z. PSMA PET/CT to evaluate response to SBRT for prostate cancer bone metastases. Rep Pract Oncol Radiother 2021; 26:528-534. [PMID: 34434568 DOI: 10.5603/rpor.a2021.0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background In the current study we evaluated 68Ga PSMA PET/ CT to measure local control of bone metastasis in oligometastatic prostate cancer patients treated with SBRT. Materials and methods After the institutional review board approval, a retrospective review of medical records of consecutive prostate cancer patients treated between 2014 and 2018 was conducted. Only medical records of patients that were treated with SBRT for bone metastasis and had pre-and post-SBRT 68Ga PSMA PET/CT scans were included in our study. Data extracted from the medical files included patient-related (age), disease-related (Gleason score, site of metastasis), and treatment-related factors and outcomes. Results During the study period, a total of 12 patients (15 lesions) were included, with a median age of 73 years. The median follow-up was 26.5 months (range 13-45 months). Median time of 68Ga PSMA PET/ CT follow up was 17.0 months (range 3-39 months). The median pre-treatment PSA was 2 ng/mL (range 0.56-44 ng/mL) vs. post treatment PSA nadir of 0.01 ng/mL (0.01-4.32) with a median time to nadir of 7 months (range, 2-12). Local control was 93% during the follow up period and there was correlation with PS MA avidity on PE T. None patients developed recurrences in the treated bone. None of the patients had grade 3 or more toxicities during follow-up. Conclusions SBRT is a highly effective and safe method for treatment of prostate cancer bone metastases. More studies are required to determine if SBRT provides greater clinical benefit than standard fractionation for oligometastatic prostate cancer patients. 68Ga PSMA PET/CT should be further investigated for delineation and follow-up.
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Affiliation(s)
- Igor Sadetski
- Radiation Oncology, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Yael Eshet
- Nuclear Medicine, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Orit Kaidar-Person
- Radiation Oncology, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Uri Amit
- Radiation Oncology, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Liran Domachevsky
- Nuclear Medicine, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Tima Davidson
- Nuclear Medicine, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Ilana Weiss
- Radiation Oncology, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Maoz Ben Ayun
- Radiation Oncology, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Zvi Symon
- Radiation Oncology, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
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25
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Lewin R, Amit U, Laufer M, Berger R, Dotan Z, Domachevsky L, Davidson T, Portnoy O, Tsvang L, Ben-Ayun M, Weiss I, Symon Z. Salvage re-irradiation using stereotactic body radiation therapy for locally recurrent prostate cancer: the impact of castration sensitivity on treatment outcomes. Radiat Oncol 2021; 16:114. [PMID: 34162398 PMCID: PMC8220691 DOI: 10.1186/s13014-021-01839-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background Advances in imaging, biomaterials and precision radiotherapy provide new opportunities to salvage locally recurrent prostate cancer (PC). This study evaluates the efficacy and safety of re-irradiation using stereotactic body radiation therapy (SBRT). We hypothesized that patients with castrate-resistant PC (CRPC) would benefit less from local salvage. Methods A prospective clinical database was reviewed to extract 30 consecutive patients treated with prostate re-irradiation. Gallium prostate specific membrane antigen (PSMA) ligand positron emission tomography was performed following prostate-specific antigen failure in all patients and biopsy was obtained in 18 patients (60%). Re-irradiation was either focal (n = 13) or whole-gland (n = 17). Endo-rectal balloons were used in twenty-two patients and hydrogel spacers in eight patients. The median prescription dose was 5 fractions of 6.5 (range: 6–8) Gray (Gy). Results Median follow-up was 28 months. Failure occurred in 10 (out of 11) CRPC patients versus 6 (out of 19) castrate-sensitive patients (91% vs. 32%, p = 0.008) after a median of 13 and 23 months, respectively. Metastases occurred in 64% (n = 7) of CRPC patients versus 16% (n = 3) of castrate-sensitive patients (p = 0.007). Two patients experienced local in-field recurrence, thus local control was 93%. The 2 and 3-year recurrence-free survival were 84% and 79% for castrate-sensitive patients versus 18% and 9% for CRPC patients (p < 0.001), and 3-year metastasis-free survival was 90% versus 27% (p < 0.01) for castrate-sensitive and CRPC patients, respectively. Acute grade II and III genitourinary (GU) toxicity occurred in 27% and 3%, and late GU toxicity in 30% and 3%, respectively. No ≥ grade II acute gastrointestinal (GI) toxicity occurred, and only one patient (3%) developed late grade II toxicity. Conclusions Early delivery of salvage SBRT for local recurrence is associated with excellent 3-year disease control and acceptable toxicity in the castrate-sensitive phenotype. PSMA imaging for detection of local recurrence and the use of precision radiotherapy with rectal protective devices should be further investigated as a novel salvage strategy for radio-recurrent PC.
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Affiliation(s)
- Ron Lewin
- Radiation Oncology Department, Sheba Medical Center, 52621, Ramat-Gan, Israel.
| | - Uri Amit
- Radiation Oncology Department, Sheba Medical Center, 52621, Ramat-Gan, Israel
| | - Menachem Laufer
- Institute of Urology, Sheba Medical Center, Ramat-Gan, Israel
| | - Raanan Berger
- Institute of Oncology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Zohar Dotan
- Institute of Urology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Sheba Medical Center, Ramat-Gan, Israel
| | - Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Ramat-Gan, Israel
| | - Orith Portnoy
- Department of Radiology, Sheba Medical Center, Ramat-Gan, Israel
| | - Lev Tsvang
- Radiation Oncology Department, Sheba Medical Center, 52621, Ramat-Gan, Israel
| | - Maoz Ben-Ayun
- Radiation Oncology Department, Sheba Medical Center, 52621, Ramat-Gan, Israel
| | - Ilana Weiss
- Radiation Oncology Department, Sheba Medical Center, 52621, Ramat-Gan, Israel
| | - Zvi Symon
- Radiation Oncology Department, Sheba Medical Center, 52621, Ramat-Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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26
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Ravona-Springer R, Sharvit-Ginon I, Ganmore I, Greenbaum L, Bendlin BB, Sternberg SA, Livny A, Domachevsky L, Sandler I, Ben Haim S, Golan S, Ben-Ami L, Lesman-Segev O, Manzali S, Heymann A, Beeri MS. The Israel Registry for Alzheimer's Prevention (IRAP) Study: Design and Baseline Characteristics. J Alzheimers Dis 2021; 78:777-788. [PMID: 33044181 DOI: 10.3233/jad-200623] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Family history of Alzheimer's disease (AD) is associated with increased dementia-risk. OBJECTIVE The Israel Registry for Alzheimer's Prevention (IRAP) is a prospective longitudinal study of asymptomatic middle-aged offspring of AD patients (family history positive; FH+) and controls (whose parents have aged without dementia; FH-) aimed to unravel the contribution of midlife factors to future cognitive decline and dementia. Here we present the study design, methods, and baseline characteristics. METHODS Participants are members of the Maccabi Health Services, 40-65 years of age, with exquisitely detailed laboratory, medical diagnoses and medication data available in the Maccabi electronic medical records since 1998. Data collected through IRAP include genetic, sociodemographic, cognitive, brain imaging, lifestyle, and health-related characteristics at baseline and every three years thereafter. RESULTS Currently IRAP has 483 participants [mean age 54.95 (SD = 6.68) and 64.8% (n = 313) women], 379 (78.5%) FH+, and 104 (21.5%) FH-. Compared to FH-, FH+ participants were younger (p = 0.011), more often males (p = 0.003) and with a higher prevalence of the APOE E4 allele carriers (32.9% FH+, 22% FH-; p = 0.040). Adjusting for age, sex, and education, FH+ performed worse than FH-in global cognition (p = 0.027) and episodic memory (p = 0.022). CONCLUSION Lower cognitive scores and higher rates of the APOE E4 allele carriers among the FH+ group suggest that FH ascertainment is good. The combination of long-term historical health-related data available through Maccabi with the multifactorial information collected through IRAP will potentially enable development of dementia-prevention strategies already in midlife, a critical period in terms of risk factor exposure and initiation of AD-neuropathology.
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Affiliation(s)
- Ramit Ravona-Springer
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Memory Clinic, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Sharvit-Ginon
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ithamar Ganmore
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Memory Clinic, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel
| | - Lior Greenbaum
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Abigail Livny
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Diagnostic imaging, Seba Medical Center, Tel Hashomer, Israel
| | - Liran Domachevsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Diagnostic imaging, Seba Medical Center, Tel Hashomer, Israel
| | - Israel Sandler
- Department of Diagnostic imaging, Seba Medical Center, Tel Hashomer, Israel
| | - Simona Ben Haim
- Department of Medical Biophysics and Nuclear Medicine, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel.,Institute of Nuclear Medicine, University College London and UCL Hospitals, NHS Trust, London, UK
| | - Sapir Golan
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Liat Ben-Ami
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Department of Diagnostic imaging, Seba Medical Center, Tel Hashomer, Israel
| | - Orit Lesman-Segev
- Department of Diagnostic imaging, Seba Medical Center, Tel Hashomer, Israel
| | - Sigalit Manzali
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Department of Pathology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Anthony Heymann
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maccabi Healthcare Services, Israel
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
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27
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Eshet Y, Tau N, Alhoubani Y, Kanana N, Domachevsky L, Eifer M. Prevalence of Increased FDG PET/CT Axillary Lymph Node Uptake Beyond 6 Weeks after mRNA COVID-19 Vaccination. Radiology 2021; 300:E345-E347. [PMID: 33904778 PMCID: PMC8082565 DOI: 10.1148/radiol.2021210886] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Ipsilateral avid axillary lymph node uptake at FDG PET/CT persists in 29% (49 of
169) of patients between 7 to 10 weeks after the second dose of the mRNA-based
BNT162b2 COVID-19 vaccination.
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Affiliation(s)
- Yael Eshet
- From the Department of Diagnostic Imaging, Chaim Sheba Medical Center, Sheba Road 2, 52621 Ramat Gan, Israel (Y.E., N.T., Y.A., N.K., L.D., M.E.); and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel (Y.E., N.T., L.D., M.E.)
| | - Noam Tau
- From the Department of Diagnostic Imaging, Chaim Sheba Medical Center, Sheba Road 2, 52621 Ramat Gan, Israel (Y.E., N.T., Y.A., N.K., L.D., M.E.); and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel (Y.E., N.T., L.D., M.E.)
| | - Yousef Alhoubani
- From the Department of Diagnostic Imaging, Chaim Sheba Medical Center, Sheba Road 2, 52621 Ramat Gan, Israel (Y.E., N.T., Y.A., N.K., L.D., M.E.); and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel (Y.E., N.T., L.D., M.E.)
| | - Nayroz Kanana
- From the Department of Diagnostic Imaging, Chaim Sheba Medical Center, Sheba Road 2, 52621 Ramat Gan, Israel (Y.E., N.T., Y.A., N.K., L.D., M.E.); and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel (Y.E., N.T., L.D., M.E.)
| | - Liran Domachevsky
- From the Department of Diagnostic Imaging, Chaim Sheba Medical Center, Sheba Road 2, 52621 Ramat Gan, Israel (Y.E., N.T., Y.A., N.K., L.D., M.E.); and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel (Y.E., N.T., L.D., M.E.)
| | - Michal Eifer
- From the Department of Diagnostic Imaging, Chaim Sheba Medical Center, Sheba Road 2, 52621 Ramat Gan, Israel (Y.E., N.T., Y.A., N.K., L.D., M.E.); and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel (Y.E., N.T., L.D., M.E.)
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28
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Eifer M, Tau N, Alhoubani Y, Kanana N, Domachevsky L, Shams J, Keret N, Gorfine M, Eshet Y. Covid-19 mRNA Vaccination: Age and Immune Status and its Association with Axillary Lymph Node PET/CT Uptake. J Nucl Med 2021; 63:134-139. [PMID: 33893188 PMCID: PMC8717182 DOI: 10.2967/jnumed.121.262194] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/21/2021] [Indexed: 11/17/2022] Open
Abstract
With hundreds of millions of coronavirus disease 2019 (COVID-19) messenger RNA (mRNA)–based vaccine doses planned to be delivered worldwide in the upcoming months, it is important to recognize PET/CT findings in recently vaccinated immunocompetent or immunocompromised patients. We aimed to assess PET/CT uptake in the deltoid muscle and axillary lymph nodes of patients who received a COVID-19 mRNA-based vaccine and to evaluate its association with patient age and immune status. Methods: All consecutive adults who underwent PET/CT scans with any radiotracer at our center during the first month of a national COVID-19 vaccination rollout (between December 23, 2020, and January 27, 2021) and had received the vaccination were included. Data on clinical status, laterality, and time from vaccination were prospectively collected, retrospectively analyzed, and correlated with deltoid muscle and axillary lymph node uptake. Results: Of 426 eligible subjects (median age, 67 ± 12 y; 49% female), 377 (88%) underwent PET/CT with 18F-FDG, and positive axillary lymph node uptake was seen in 45% of them. Multivariate logistic regression analysis revealed a strong inverse association between positive 18F-FDG uptake in ipsilateral lymph nodes and patient age (odds ratio [OR], 0.57; 95% CI, 0.45–0.72; P < 0.001), immunosuppressive treatment (OR, 0.37; 95% CI, 0.20–0.64; P = 0.003), and presence of hematologic disease (OR, 0.44; 95% CI, 0.24–0.8; P = 0.021). No such association was found for deltoid muscle uptake. The number of days from the last vaccination and the number of vaccine doses were also significantly associated with increased odds of positive lymph node uptake. Conclusion: After mRNA-based COVID-19 vaccination, a high proportion of patients showed ipsilateral lymph node axillary uptake, which was more common in immunocompetent patients. This information will help with the recognition of PET/CT pitfalls and may hint about the patient’s immune response to the vaccine.
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Affiliation(s)
- Michal Eifer
- Chaim Sheba Medical Center, Ramat Gan, Israel, Israel
| | - Noam Tau
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, Israel
| | - Yousef Alhoubani
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, Israel
| | - Nayroz Kanana
- Department of Diagnostic Imaging, Chaim Sheba Medical Center,, Israel
| | - Liran Domachevsky
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, Israel
| | - Jala Shams
- Institute of Pathology, Chaim Sheba Medical Center, Ramat Gan, Israel, Israel
| | - Nir Keret
- Department of Statistics and Operations Research, Tel-Aviv University, Ramat Aviv, Israel
| | - Malka Gorfine
- Department of Statistics and Operations Research, Tel-Aviv University, Ramat Aviv, Israel
| | - Yael Eshet
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, Israel
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29
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Davidson T, Domachevsky L, Giladi Y, Fridman E, Dotan Z, Rosenzweig B, Leibowitz R, Ben Shimol J. Penile secondary lesions: a rare entity detected by PET/CT. Sci Rep 2021; 11:5912. [PMID: 33723317 PMCID: PMC7960694 DOI: 10.1038/s41598-021-85300-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/26/2021] [Indexed: 11/09/2022] Open
Abstract
While penile metastases are rare, PET/CT has facilitated their detection. We aimed to describe penile secondary lesions (PSL) identified by PET/CT. We reviewed 18F-FDG and Ga68-PSMA PET/CT records performed in a single center during May 2012-March 2020, for PSL. Of 16,774 18F-FDG and 1,963 Ga68-PSMA-PET scans, PSL were found in 24(0.13%) men with a mean age of 74. PSMA detected PSL in 12 with prostate cancer; FDG identified PSL in 4 with lymphoma, 3 with colorectal cancer, 2 with lung cancer, and one each with bladder cancer, pelvic sarcoma, and leukemia. Mean SUVmax of PSL was 7.9 ± 4.2 with focal uptake in 13(54%). Mean lesion size was 16.5 ± 6.8 mm; 8 at the penile root, 4 along the shaft, and 1 at the glans. CT detected loss of the penile texture in 15(63%). PSL were observed only during relapse or follow-up of disseminated disease. Among those with prostate cancer, PSA varied widely. Fifteen (62.5%) died, at a mean 13.3 ± 15.9 months following PSL demonstration, nine had non-prostate malignancies. PET/CT identified and characterized PSL in a fraction of cancer patients, most commonly those with prostate cancer. PSL universally surfaced in advanced disease, and signaled high mortality, especially in non-prostate cancers.
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Affiliation(s)
- Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Derech Sheba 2, 52621, Ramat Gan, Tel-Hashomer, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel.
| | - Liran Domachevsky
- Department of Nuclear Medicine, Sheba Medical Center, Derech Sheba 2, 52621, Ramat Gan, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel
| | - Yogev Giladi
- Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel
| | - Eddie Fridman
- Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel.,Department of Pathology, Sheba Medical Center, 52621, Tel Hashomer, Israel
| | - Zohar Dotan
- Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel.,Department of Urology, Sheba Medical Center, 52621, Tel Hashomer, Israel
| | - Barak Rosenzweig
- Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel.,Department of Urology, Sheba Medical Center, 52621, Tel Hashomer, Israel
| | - Raya Leibowitz
- Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel.,Oncology Institute, Shamir Medical Center, 70300, Zerifin, Israel
| | - Jennifer Ben Shimol
- Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel.,Department of Medicine, E. Wolfson Medical Center, 5822012, Holon, Israel
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30
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Golan S, Aviv T, Groshar D, Yakimov M, Zohar Y, Prokocimer Y, Nadu A, Baniel J, Domachevsky L, Bernstine H. Dynamic 68Ga-PSMA-11 PET/CT for the Primary Evaluation of Localized Renal Mass: A Prospective Study. J Nucl Med 2020; 62:773-778. [PMID: 33097628 DOI: 10.2967/jnumed.120.251272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/23/2020] [Indexed: 01/29/2023] Open
Abstract
The potential role of prostate-specific membrane antigen (PSMA) PET/CT in non-prostate cancer tumors has shown promising results. We examined the performance of dynamic 68Ga-PSMA-11 PET/CT (DPSMA) for the evaluation of localized renal mass. Methods: A prospective case series of patients with a newly diagnosed renal mass who were referred for surgery was examined. DPSMA was performed in a standardized manner before surgery. The final surgical histology served as the standard of reference. PSMA expression in the tumor vasculature was assessed and staining intensity was scored. Tracer uptake and PSMA expression were compared between benign and malignant tissue. Results: Of 29 enhancing renal masses evaluated in 27 patients, 24 (83%) were malignant lesions. The median SUVmean of benign and malignant lesions was 2.3 (interquartile range [IQR], 2.2-2.7) and 6.8 (IQR, 4.2-10.1), respectively (P = 0.009). Median SUVmax of benign and malignant lesions was 3.8 (IQR, 3.3-4.5) and 9.4 (IQR, 5.4-15.8), respectively (P = 0.015). The median washout coefficient (K 2) was significantly lower in malignant lesions than in benign lesions (0.17 vs. 0.70, P = 0.02). Positive PSMA staining was found in 20 of 24 malignant lesions and in 2 of 5 benign lesions (P = 0.04). Conclusion: This pilot study demonstrated DPSMA uptake and kinetics in localized renal masses. Increased 68Ga-PSMA-11 tracer uptake and intratumoral retention correlate with PSMA expression in malignant renal tumors compared with benign renal masses, supporting further assessment of DPSMA as a potential tool for evaluating localized renal masses.
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Affiliation(s)
- Shay Golan
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzach Aviv
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Groshar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine Rabin Medical Center, Petach Tikva, Israel
| | - Maxim Yakimov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pathology, Rabin Medical Center, Petach Tikva, Israel
| | - Yaniv Zohar
- Department of Pathology, Rambam Health Care Campus, Haifa, Israel; and
| | - Yoad Prokocimer
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Andrei Nadu
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jack Baniel
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Hanna Bernstine
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine Rabin Medical Center, Petach Tikva, Israel
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Abstract
18F-FDG PET/CT occupies a growing role in the diagnosis of large vessel vasculitis (LVV), illustrating enhanced uptake in the lining of large vessels. A retrospective single center study was conducted of patients who underwent 18F-FDG PET/CT scans between 2009 and 2019 at Sheba Medical Center, Israel. The imaging results were analyzed for evidence of LVV. We reviewed the PET/CT scans of 126 patients and identified 57 studies that either showed evidence of active LVV or that had been performed in patients previously treated for systemic vasculitis. In 6 patients with fevers of unknown origin and elevated inflammatory markers, PET/CT revealed LVV. Six of 13 patients previously treated for systemic vasculitis demonstrated persistent large vessel uptake. LVV was identified in 8 patients with other autoimmune diseases, and in 4 diagnosed with infectious aortitis. In 26 patients who underwent malignancy surveillance, PET/CT revealed more localized large vessel wall inflammation. Our results illustrate that PET/CT may identify large vessel wall inflammation in patients with a suspicion of LVV, and incidentally in patients who undergo malignancy surveillance. PET/CT may also help delineate the presence and extent of vessel inflammation in patients with LVV and in those with other autoimmune diseases.
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Affiliation(s)
- Jennifer Ben Shimol
- Department of Medicine, E. Wolfson Medical Center, Holon, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Howard Amital
- Department of Medicine, 'B' and Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Shoenfeld
- Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Saint Petersburg Research Institute of Phthisiopulmonology, Saint-Petersburg, Russian Federation
| | - Tima Davidson
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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32
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Icht O, Domachevsky L, Groshar D, Dudnik E, Rotem O, Allen AM, Peled N, Reinhorn D, Jacobi O, Shochat T, Bernstine H, Zer A. Lower tumor volume is associated with increased benefit from immune checkpoint inhibitors in patients with advanced non-small-cell lung cancer. Asia Pac J Clin Oncol 2020; 17:e125-e131. [PMID: 32762128 DOI: 10.1111/ajco.13360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/14/2020] [Indexed: 12/13/2022]
Abstract
AIM Immune checkpoint inhibitors (ICIs) have revolutionized the treatment for advanced non-small-cell lung cancer (NSCLC), yet many patients do not benefit from Programmed cell death protein 1 (PD-1) axis inhibitors, emphasizing the need for additional markers for better patient selection. Our aim was to evaluate the association between tumor volume and response to ICI. METHODS This retrospective ethically-approved study included all consecutive patients with advanced NSCLC who were evaluated with a fluorodeoxyglucose-positron emission tomography scan, prior to the first administration of a single-agent ICI between 1/2016 and 6/2017. Tumor burden was calculated based on total body metabolic tumor volume and sum of all measurable lesions (SOML). RESULTS Median SOML was 88 mm, and was inversely and significantly associated with progression-free survival (PFS) (hazard ratio [HR] 2, CI 1.28-3.37, P = .003) and overall survival (OS) (HR 2.36, CI 1.13-4.94, P = .02). SOML≤80 mm had a significantly longer PFS compared to patients with a SOML≥80 mm (median PFS 9.7 vs 3.7 months, respectively, HR for progression 2.26, CI 1.1-4.5, P = .02). Patients with a SOML≤80 also had longer median OS compared to patients with SOML≥80 (median OS 12 vs 9.8 months, respectively, HR for death 3.1, CI 1.2-8, P = .018). CONCLUSIONS Low tumor burden was associated with higher response rates (RR), and better PFS and OS in advanced NSCLC patients treated with ICI. These results may improve the selection of patients for treatment with single-agent ICI, as opposed to the combination with chemotherapy, which might be more appropriate for patients with high tumor burden. Prospective analysis is warranted.
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Affiliation(s)
- Oded Icht
- Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Groshar
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elizabeth Dudnik
- Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Rotem
- Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aaron M Allen
- Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Peled
- Soroka Cancer Institute, Soroka Medical Center, affiliated to Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniel Reinhorn
- Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Jacobi
- Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzippy Shochat
- Statistical Consulting Unit, Rabin Medical Center, affiliated to the Sackler Faculty of Medicine, Petah Tikva, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alona Zer
- Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Nissan N, Sandler I, Eifer M, Eshet Y, Davidson T, Bernstine H, Groshar D, Sklair-Levy M, Domachevsky L. Physiologic and hypermetabolic breast 18-F FDG uptake on PET/CT during lactation. Eur Radiol 2020; 31:163-170. [PMID: 32749586 DOI: 10.1007/s00330-020-07081-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the patterns of breast cancer-related and lactation-related 18F-FDG uptake in breasts of lactating patients with pregnancy-associated breast cancer (PABC) and without breast cancer. METHODS 18F-FDG-PET/CT datasets of 16 lactating patients with PABC and 16 non-breast cancer lactating patients (controls) were retrospectively evaluated. Uptake was assessed in the tumor and non-affected lactating tissue of the PABC group, and in healthy lactating breasts of the control group, using maximum and mean standardized uptake values (SUVmax and SUVmean, respectively), and breast-SUVmax/liver-SUVmean ratio. Statistical tests were used to evaluate differences and correlations between the groups. RESULTS Physiological uptake in non-breast cancer lactating patients' breasts was characteristically high regardless of active malignancy status other than breast cancer (SUVmax = 5.0 ± 1.7, n = 32 breasts). Uptake correlated highly between the two breasts (r = 0.61, p = 0.01), but was not correlated with age or lactation duration (p = 0.24 and p = 0.61, respectively). Among PABC patients, the tumors demonstrated high 18F-FDG uptake (SUVmax = 7.8 ± 7.2, n = 16), which was 326-643% higher than the mostly low physiological FDG uptake observed in the non-affected lactating parenchyma of these patients (SUVmax = 2.1 ± 1.1). Overall, 18F-FDG uptake in lactating breasts of PABC patients was significantly decreased by 59% (p < 0.0001) compared with that of lactating controls without breast cancer. CONCLUSION 18F-FDG uptake in lactating tissue of PABC patients is markedly lower compared with the characteristically high physiological uptake among lactating patients without breast cancer. Consequently, breast tumors visualized by 18F-FDG uptake in PET/CT were comfortably depicted on top of the background 18F-FDG uptake in lactating tissue of PABC patients. KEY POINTS • FDG uptake in the breast is characteristically high among lactating patients regardless of the presence of an active malignancy other than breast cancer. • FDG uptake in non-affected lactating breast tissue is significantly lower among PABC patients compared with that in lactating women who do not have breast cancer. • In pregnancy-associated breast cancer patients, 18F-FDG uptake is markedly increased in the breast tumor compared with uptake in the non-affected lactating tissue, enabling its prompt visualization on PET/CT.
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Affiliation(s)
- Noam Nissan
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel Hashomer, 5265601, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Israel Sandler
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel Hashomer, 5265601, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Eifer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Eshet
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Tima Davidson
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Hanna Bernstine
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, Israel
| | - David Groshar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, Israel
| | - Miri Sklair-Levy
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel Hashomer, 5265601, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
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Leibowitz R, Davidson T, Gadot M, Aharon M, Malki A, Levartovsky M, Oedegaard C, Saad A, Sandler I, Ben-Haim S, Domachevsky L, Berger R. A Retrospective Analysis of the Safety and Activity of Lutetium-177-Prostate-Specific Membrane Antigen Radionuclide Treatment in Older Patients with Metastatic Castration-Resistant Prostate Cancer. Oncologist 2020; 25:787-792. [PMID: 32430954 DOI: 10.1634/theoncologist.2020-0100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/10/2020] [Accepted: 04/13/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Prostate cancer is a common malignancy of the elderly, and with the aging of the population, the need is growing for therapies suitable for this age group. Lutetium-177-prostate-specific membrane antigen (Lu-PSMA), a radiolabeled small molecule, binds with high affinity to prostate-specific membrane antigen, enabling beta particle therapy targeted to metastatic castration-resistant prostate cancer (mCRPC). In a recent single-arm phase II trial and a subsequent expansion cohort, a prostate-specific antigen (PSA) decline of ≥50% was observed in approximately 60% of patients receiving Lu-PSMA. Taking into account the specific challenges and potential toxicities of Lu-PSMA administration in elderly men, we sought to retrospectively analyze the safety and activity of Lu-PSMA in men aged older than 75 years with mCRPC. PATIENTS AND METHODS The electronic medical records of 24 patients aged older than 75 years treated with Lu-PSMA "off-trial" were reviewed, and clinical data were extracted. Clinical endpoints were toxicity and activity, defined as a PSA decline ≥50%. Descriptive statistics were performed using Excel. RESULTS The median age at treatment start was 81.7 years (range 75.1-91.9). The median number of previous treatment lines was four. The number of treatment cycles ranged from one to four; the mean administered radioactivity was 6 GBq per cycle. Treatment was generally tolerable; side effects included fatigue (n = 8, 33%), anemia (n = 7, 29%), thrombocytopenia (n = 5, 21%), and anorexia/nausea (n = 3, 13%). Clinical benefit was observed in 12 of 22 patients (54%); PSA decline above 50% was observed in 11 patients (48%) and was associated with significantly longer overall survival. CONCLUSION Our results indicate that Lu-PSMA is safe and active in elderly patients with mCRPC. IMPLICATIONS FOR PRACTICE Lutetium-177-prostate-specific membrane antigen (Lu-PSMA), a radiolabeled small molecule, binds with high affinity to prostate-specific membrane antigen, enabling beta particle therapy targeted to metastatic castration-resistant prostate cancer (mCRPC). The recently published single-arm phase II trial with Lu-PSMA, describing its safety and activity, did not include patients aged older than 75 years. In this study, Lu-PSMA activity was retrospectively analyzed in patients aged older than 75 years and results indicate that treatment was tolerable and similarly active in this age group, with no new emerging safety signals. Despite the small cohort size, this analysis suggests that Lu-PSMA can serve as an advanced palliative treatment line in mCRPC in elderly patients.
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Affiliation(s)
- Raya Leibowitz
- Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Moran Gadot
- Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Margalit Aharon
- Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Avraham Malki
- Department of Nuclear Medicine, Sheba Medical Center, Tel-Hashomer, Israel
| | | | | | - Akram Saad
- Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Israel Sandler
- Department of Nuclear Medicine, Sheba Medical Center, Tel-Hashomer, Israel
| | - Simona Ben-Haim
- Department of Biophysics and Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel
- Institute of Nuclear Medicine, University College London and University College London Hospitals, National Health Service Trust, London, United Kingdom
| | - Liran Domachevsky
- Department of Nuclear Medicine, Sheba Medical Center, Tel-Hashomer, Israel
| | - Raanan Berger
- Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Gadot M, Davidson T, Aharon M, Atenafu EG, Malki A, Levartovsky M, Saad A, Domachevsky L, Berger R, Leibowitz R. Clinical Variables Associated with PSA Response to Lutetium-177-PSMA ([177Lu]-PSMA-617) Radionuclide Treatment in Men with Metastatic Castration-Resistant Prostate Cancer. Cancers (Basel) 2020; 12:cancers12051078. [PMID: 32357427 PMCID: PMC7281592 DOI: 10.3390/cancers12051078] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 02/27/2020] [Revised: 04/12/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022] Open
Abstract
Lutetium-177-PSMA ([177Lu]-PSMA-617), a radiolabeled small molecule, binds with high affinity to prostate-specific membrane antigen (PSMA), enabling targeted radiation therapy to metastatic prostate lesions. Our objective was to retrospectively analyze the activity of [177Lu]-PSMA-617 given off-trial to men with metastatic castration resistant prostate cancer (mCRPC) and identify clinical factors associated with PSA response. Electronic medical records of all men treated with [177Lu]-PSMA-617 were reviewed and analyzed. Overall survival was calculated using the Kaplan-Meier method. The association between potential variables and PSA response was analyzed by univariate analysis, using either logistic regression or χ2/Fisher's exact test. Multivariable analysis was carried out using logistic regression on all categorical variables with a P-value of <0.1 on univariate analysis. Variables found to be statistically significant were then used to define a categorical score. A total of 52 patients received at least one cycle of [177Lu]-PSMA-617. Clinical benefit was observed in 28 patients (52%). PSA decline ≥20% and ≥50% was observed in 26 (50%) and 18 patients (35%), respectively. Achievement of any PSA decline at first measurement was significantly associated with survival. There was a negative association between the number of previous chemotherapy lines and PSA decline above 20%. Univariate analysis followed by multivariable analysis showed that older age and higher hemoglobin were significantly associated with a PSA decline >20%. A score combining these two parameters was significantly associated with PSA response. In summary, [177Lu]-PSMA-617 is active in the 'real-life' setting of heavily pretreated men with mCRPC.
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Affiliation(s)
- Moran Gadot
- Oncology Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel
| | - Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Tel-Hashomer 52621, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Margalit Aharon
- Oncology Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel
| | - Eshetu G. Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Avraham Malki
- Department of Nuclear Medicine, Sheba Medical Center, Tel-Hashomer 52621, Israel
| | | | - Akram Saad
- Oncology Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Sheba Medical Center, Tel-Hashomer 52621, Israel
| | - Raanan Berger
- Oncology Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Correspondence: (R.B.); (R.L.); Tel.:+972-8-9779715 (R.L.); Fax: +972-8-9779714 (R.L.)
| | - Raya Leibowitz
- Oncology Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Correspondence: (R.B.); (R.L.); Tel.:+972-8-9779715 (R.L.); Fax: +972-8-9779714 (R.L.)
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Mazor RD, Weissman R, Luckman J, Domachevsky L, Diamond EL, Abdel-Wahab O, Shapira S, Hershkovitz-Rokah O, Groshar D, Shpilberg O. Dual BRAF/MEK blockade restores CNS responses in BRAF-mutant Erdheim-Chester disease patients following BRAF inhibitor monotherapy. Neurooncol Adv 2020; 2:vdaa024. [PMID: 32642685 PMCID: PMC7212923 DOI: 10.1093/noajnl/vdaa024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Erdheim–Chester disease (ECD), a rare inflammatory myeloid neoplasm, is known to be fundamentally reliant on the constitutive activation of the MAPK signaling pathway in the majority of patients. Consequently, inhibition of the V600E-mutant BRAF kinase has proven to be a safe and efficacious long-term therapeutic strategy for BRAF-mutant ECD patients. Nevertheless, in a subset of patients with CNS disease, the efficacy of long-term treatment may diminish, facilitating suboptimal responses or disease progression. Methods We retrospectively describe 3 BRAF-mutant ECD patients whose treatment with Vemurafenib was upgraded to Vemurafenib/Cobimetinib due to either disease progression, insufficient response, or unacceptable toxicity. CNS response to therapy was evaluated using magnetic resonance imaging (MRI) and extra-cranial disease was monitored using 18F-fludeoxyglucose positron emission tomography/computed tomography (PET/CT). Results Three patients with a mean age of 52.6 years were treated with Vemurafenib for a mean duration of 26.6 months (range: 6–52). Monotherapies were upgraded to Vemurafenib/Cobimetinib dual therapy. The combination therapy was administered for a mean duration of 21 months (range: 19–23). All patients exhibited clinical and neurological improvement. Regression of lesions on MRI was noted in 2 patients. Both patients characterized by a PET-avid disease responded to the biological treatment regimen with complete metabolic remissions. Conclusion Dual inhibition of BRAF and downstream MEK may be a safe and effective therapeutic strategy for BRAF-mutant ECD patients for whom BRAF inhibitor therapy proved insufficient and as such appropriate for the long-term management of CNS disease in ECD.
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Affiliation(s)
- Roei D Mazor
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel
| | - Ran Weissman
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel.,Department of Molecular Biology, Faculty of Natural Sciences, Ariel University, Ariel, Israel.,Translational Research Lab, Assuta Medical Centers, Tel-Aviv, Israel
| | - Judith Luckman
- Department of Imaging, Assuta Medical Center, Tel Aviv, Israel
| | - Liran Domachevsky
- Department of Imaging, Assuta Medical Center, Tel Aviv, Israel.,Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Omar Abdel-Wahab
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Shirley Shapira
- Institute of Hematology, Meir Hospital, Kfar Saba, Israel.,Maccabi Health Services, Tel Aviv, Israel
| | - Oshrat Hershkovitz-Rokah
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel.,Department of Molecular Biology, Faculty of Natural Sciences, Ariel University, Ariel, Israel.,Translational Research Lab, Assuta Medical Centers, Tel-Aviv, Israel
| | - David Groshar
- Department of Imaging, Assuta Medical Center, Tel Aviv, Israel.,Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel
| | - Ofer Shpilberg
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel.,Translational Research Lab, Assuta Medical Centers, Tel-Aviv, Israel.,Pre-Medicine Department, School of Health Sciences, Ariel University, Ariel, Israel
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Domachevsky L, Goldberg N, Gorenberg M, Bernstine H, Groshar D, Catalano OA. Prostate cancer evaluation using PET quantification in 68Ga-PSMA-11 PET/MR with attenuation correction of bones as a fifth compartment. Quant Imaging Med Surg 2020; 10:40-47. [PMID: 31956527 DOI: 10.21037/qims.2019.11.19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Tissues with low magnetic resonance (MR) signals, such as bones and lungs differ considerably in their attenuation properties, requiring special considerations for attenuation correction. We evaluated the impact of using the five-compartment segmentation model, which incorporates bones, in 68Ga-PSMA-11 PET/MR studies in patients undergoing evaluation for prostate cancer. Methods Prostate cancer patients underwent dedicated prostate 68Ga-PSMA-11 PET/MR followed by whole-body 68Ga-PSMA-11 PET/CT. Coronal µmap images of the pelvis derived from four- and five-compartment segmentation models of magnetic resonance attenuation correction (MRAC) were produced. Standardized uptake values (SUV) calculated by the four and five-compartment MRAC models and by computed tomography attenuation correction (CTAC) were compared and correlated in normal prostate tissue, gluteus muscle, sacrum, intra-prostatic lesions and metastases (i.e., bone lesions and involved lymph nodes), and prostatic lesions to gluteus (L/G) ratio. Results Twenty-six patients (mean age 69.4±9.3 years) were included in the study. Twenty-five patients presented for prostate cancer staging and one patient was evaluated for recurrent disease. There was a statistically significant difference between SUVs of the gluteus, sacrum, prostatic lesions and normal prostate tissue measured by the four-compartment vs. the five-compartment MRAC models, with a medium effect size. Very good to good correlation between SUV measured using the four-compartment MRAC model and SUV measured using the five-compartment model were noted in all lesional and non-lesional areas. Very good to good correlation was noted between four-compartment MRAC and CTAC SUVs of prostatic lesions and L/G ratio and between five-compartment MRAC and CTAC SUVs of prostatic lesions, L/G ratio and metastatic lesions. Conclusions 68Ga-PSMA-11 PET/MR using the five-compartment segmentation model affects SUV measurements in prostate lesions and in the normal prostate and therefore patient follow-up studies must be conducted using the same segmentation model.
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Affiliation(s)
- Liran Domachevsky
- Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv 6971028, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Natalia Goldberg
- Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv 6971028, Israel
| | - Miguel Gorenberg
- Department of Nuclear Medicine, Bnai Zion Medical Center and Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa 3339419, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv 6971028, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv 6971028, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Onofrio A Catalano
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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Ferrone C, Goyal L, Qadan M, Gervais D, Sahani DV, Zhu AX, Hong TS, Blaszkowsky LS, Tanabe KK, Vangel M, Amorim BJ, Wo JY, Mahmood U, Pandharipande PV, Catana C, Duenas VP, Collazo YQ, Canamaque LG, Domachevsky L, Bernstine HH, Groshar D, Shih TTF, Li Y, Herrmann K, Umutlu L, Rosen BR, Catalano OA. Management implications of fluorodeoxyglucose positron emission tomography/magnetic resonance in untreated intrahepatic cholangiocarcinoma. Eur J Nucl Med Mol Imaging 2019; 47:1871-1884. [PMID: 31705172 DOI: 10.1007/s00259-019-04558-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/25/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Intrahepatic cholangiocarcinoma (ICC) is associated with a poor prognosis with surgical resection offering the best chance for long-term survival and potential cure. However, in up to 36% of patients who undergo surgery, more extensive disease is found at time of operation requiring cancellation of surgery. PET/MR is a novel hybrid technology that might improve local and whole-body staging in ICC patients, potentially influencing clinical management. This study was aimed to investigate the possible management implications of PET/MR, relative to conventional imaging, in patients affected by untreated intrahepatic cholangiocarcinoma. METHODS Retrospective review of the clinicopathologic features of 37 patients with iCCC, who underwent PET/MR between September 2015 and August 2018, was performed to investigate the management implications that PET/MR had exerted on the affected patients, relative to conventional imaging. RESULTS Of the 37 patients enrolled, median age 63.5 years, 20 (54%) were female. The same day PET/CT was performed in 26 patients. All patients were iCCC-treatment-naïve. Conventional imaging obtained as part of routine clinical care demonstrated early-stage resectable disease for 15 patients and advanced stage disease beyond the scope of surgical resection for 22. PET/MR modified the clinical management of 11/37 (29.7%) patients: for 5 patients (13.5%), the operation was cancelled due to identification of additional disease, while 4 "inoperable" patients (10.8%) underwent an operation. An additional 2 patients (5.4%) had a significant change in their operative plan based on PET/MR. CONCLUSIONS When compared with standard imaging, PET/MR significantly influenced the treatment plan in 29.7% of patients with iCCC. TRIAL REGISTRATION 2018P001334.
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Affiliation(s)
- Cristina Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Lipika Goyal
- Department of Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Debra Gervais
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St., Boston, MA, 02114, USA
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St., Boston, MA, 02114, USA
| | - Andrew X Zhu
- Department of Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Lawrence S Blaszkowsky
- Department of Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA.,Department of Oncology, Newton-Wellesley Hospital, 2114 Washington St., Newton, MA, 02462, USA
| | - Kenneth K Tanabe
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Mark Vangel
- Department of Biostatics, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Barbara J Amorim
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St., Boston, MA, 02114, USA.,Division of Nuclear Medicine, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Jennifer Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St., Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th, Charlestown, MA, 02129, USA
| | - Pari V Pandharipande
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St., Boston, MA, 02114, USA
| | - Ciprian Catana
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th, Charlestown, MA, 02129, USA
| | - Virginia P Duenas
- Department of Nuclear Medicine and Radiology, Hospital HM Puerta del Sur, Avda Carlos V 70, 28938, Madrid, Spain
| | - Yolanda Q Collazo
- Department of Surgery, Hospital HM Sanchinarro, Avda Carlos V 70, 28938, Madrid, Spain
| | - Lina G Canamaque
- Department of Nuclear Medicine and Radiology, Hospital HM Puerta del Sur, Avda Carlos V 70, 28938, Madrid, Spain
| | - Liran Domachevsky
- Department of Radiology and Nuclear Medicine, Assuta Medical Center, HaBarzel St. 20, Tel Aviv-Yafo, Israel
| | - Hanna H Bernstine
- Department of Radiology and Nuclear Medicine, Assuta Medical Center, HaBarzel St. 20, Tel Aviv-Yafo, Israel
| | - David Groshar
- Department of Radiology and Nuclear Medicine, Assuta Medical Center, HaBarzel St. 20, Tel Aviv-Yafo, Israel
| | - Tiffany Tsing-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Rd., Taipei, 10016, Taiwan
| | - Yan Li
- Department of Radiology, Universitatsklinikum, Essen University, Hufelandstraße 55, 45147, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, Universitatsklinikum, Essen University, Hufelandstraße 55, 45147, Essen, Germany
| | - Lale Umutlu
- Department of Radiology, Universitatsklinikum, Essen University, Hufelandstraße 55, 45147, Essen, Germany
| | - Bruce R Rosen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th, Charlestown, MA, 02129, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St., Boston, MA, 02114, USA. .,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th, Charlestown, MA, 02129, USA. .,Department of Radiology, University of Naples "Parthenope", Via Acton 38, 80131, Naples, Italy.
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Frenkel Rutenberg T, Baruch Y, Ohana N, Bernstine H, Amitai A, Cohen N, Domachevsky L, Shemesh S. The Role of 18F-Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography in the Diagnosis of Postoperative Hardware-Related Spinal Infections. Isr Med Assoc J 2019; 21:532-537. [PMID: 31474015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Implant-related spinal infections are a surgical complication associated with high morbidity. Due to infection, hardware removal may be necessary, which could lead to pseudarthrosis and the loss of stability and alignment. OBJECTIVES To evaluate the accuracy and diagnostic value of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) in the workup of patients with suspected implant-related infections of the spine and to assess the clinical impact of PET/CT results on the management of these infections. METHODS The study included nine consecutive patients with a history of spinal surgery who underwent PET/CT for evaluation of suspected spinal implant related infection. All imaging studies were performed between January 2011 and December 2013. All 18F-FDG PET/CT scans were performed on an 8 slice PET/CT following an 18F-FDG injection. Images were scored both visually and semi-quantitatively by a radiology expert. Results were compared to additional imaging studies when available, which were correlated to clinical and bacteriological findings allowing calculation of sensitivity, specificity and accuracy. RESULTS Among the patients, five experienced hardware-related spinal infection. 18F-FDG PET/CT sensitivity was 80%, specificity 100%, and accuracy 88.9%. One scan produced a false negative; however, a second PET/CT scan revealed an infection. CONCLUSIONS PET/CT was found to be valuable for the diagnosis of postoperative hardware-related spinal infection, especially when other imaging modalities were uninformative or inconclusive. As such, PET/CT could be useful for management of infection treatment.
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Affiliation(s)
- Tal Frenkel Rutenberg
- Department of Orthopedics, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Baruch
- Department of Orthopedics, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nissim Ohana
- Department of Orthopedics, Meir Medical Center, Kfar Saba, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Amitai
- Department of Orthopedics, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Cohen
- Department of Orthopedics, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Shemesh
- Department of Orthopedics, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Domachevsky L, Bernstine H, Goldberg N, Nidam M, Catalano OA, Groshar D. Comparison between pelvic PSMA-PET/MR and whole-body PSMA-PET/CT for the initial evaluation of prostate cancer: a proof of concept study. Eur Radiol 2019; 30:328-336. [PMID: 31332559 DOI: 10.1007/s00330-019-06353-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/20/2019] [Accepted: 07/01/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Despite the advantages of prostate-specific membrane antigen (PSMA)-PET/MR over PSMA-PET/CT, its relatively long scanning time and suboptimal PET attenuation correction necessitate careful assessment of the most appropriate setting for this type of study. We assessed lesion agreement between PSMA-PET/MR and PSMA-PET/CT in patients undergoing initial evaluation of prostate cancer. METHODS This was a prospective study of consecutive patients with histological biopsy-proven prostate cancer who underwent pelvic PSMA-PET/MR followed by whole-body PSMA-PET/CT. All conspicuous PSMA-avid foci were counted on PSMA-PET/CT and PSMA-PET/MR with CT or MR correlation. Analysis was performed for intra-prostatic lesions, capsular invasion, seminal vesicle involvement and lymph node and bone involvement. Incidental and significant findings seen on PSMA-PET/CT outside the PSMA-PET/MR field of view were also analysed. Agreements between PSMA-PET/CT and PSMA-PET/MR findings were performed using Cohen's kappa test. RESULTS Image analysis was performed on 140 patients (mean age, 67.3 ± 8.2 years). Agreement between PSMA PET/CT and PSMA-PET/MR was very good for intra-prostatic PSMA-avid foci (K = 0.85) and pelvic lymph nodes (K = 0.98), good for PSMA-avid bone metastases (K = 0.76) and fair for prostatic capsular invasion (K = 0.25) and seminal vesicle involvement (K = 0.31). Twelve patients (8.5%) had incidental findings and two patients (1.4%) had clinically significant findings. CONCLUSION Limited pelvic PSMA-PET/MR has very good agreement with PET/CT regarding PSMA-avid prostatic, regional lymph nodes and bone lesions, and is superior to PET/CT with regard to capsular invasion and seminal vesicle involvement. KEY POINTS • Limited pelvic PSMA-PET/MR is superior to whole-body PSMA-PET/CT in detecting extensions of localised disease, mainly due to the high soft tissue resolution of MR. • Limited pelvic PSMA-PET/MR may be useful for initial evaluation of histological biopsy-proven prostate cancer. • Further studies are warranted to evaluate limited pelvic PSMA-PET/MR for screening and active surveillance in selected populations.
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Affiliation(s)
- Liran Domachevsky
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel Street, 6971028, Tel Aviv, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel Street, 6971028, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
| | - Natalia Goldberg
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel Street, 6971028, Tel Aviv, Israel
| | - Meital Nidam
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel Street, 6971028, Tel Aviv, Israel
| | - Onofrio A Catalano
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel Street, 6971028, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel.
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Vaxman I, Bernstine H, Kleinstern G, Hendin N, Shimony S, Domachevsky L, Gurion R, Groshar D, Raanani P, Gafter‐Gvili A. FDG PET/CT as a diagnostic and prognostic tool for the evaluation of marginal zone lymphoma. Hematol Oncol 2019; 37:168-175. [DOI: 10.1002/hon.2578] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/28/2019] [Accepted: 02/04/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Iuliana Vaxman
- Institute of HematologyDavidoff Cancer Center, Rabin Medical Center Petah‐Tikva Israel
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Hanna Bernstine
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
- Department of Nuclear MedicineRabin Medical Center Petah‐Tikva Israel
| | - Geffen Kleinstern
- Department of Health Sciences ResearchMayo Clinic Rochester Minnesota
| | - Natav Hendin
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Shai Shimony
- Institute of HematologyDavidoff Cancer Center, Rabin Medical Center Petah‐Tikva Israel
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Liran Domachevsky
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
- Department of Nuclear MedicineRabin Medical Center Petah‐Tikva Israel
| | - Ronit Gurion
- Institute of HematologyDavidoff Cancer Center, Rabin Medical Center Petah‐Tikva Israel
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - David Groshar
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
- Department of Nuclear MedicineRabin Medical Center Petah‐Tikva Israel
| | - Pia Raanani
- Institute of HematologyDavidoff Cancer Center, Rabin Medical Center Petah‐Tikva Israel
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Anat Gafter‐Gvili
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
- Medicine ARabin Medical Center Petah‐Tikva Israel
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42
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Khafif A, Masalha M, Landsberg R, Domachevsky L, Bernstine H, Groshar D, Azoulay O, Lockman Y. The role of F18-fluorocholine positron emission tomography/magnetic resonance imaging in localizing parathyroid adenomas. Eur Arch Otorhinolaryngol 2019; 276:1509-1516. [DOI: 10.1007/s00405-019-05301-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/16/2019] [Indexed: 11/30/2022]
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Tzelnick S, Bernstine H, Domachevsky L, Soudry E. Clinical Implications of Incidental Sinonasal Positive FDG Uptake on PET-CT. Otolaryngol Head Neck Surg 2019; 160:729-733. [DOI: 10.1177/0194599818821862] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Fluorodeoxyglucose positron emission tomography–computed tomography (FDG PET-CT) has been increasingly used in the past decade. Incidental FDG-avid findings are encountered in these studies, several of which with clinical significance. However, the significance of incidental FDG-avid sinonasal findings has not been studied to date. Study Design Retrospective cohort study. Setting A single tertiary medical center. Materials and Methods The medical records were reviewed of patients with incidental sinonasal positive FDG uptake between 2007 and 2016 who referred for further otolaryngological diagnostic workup. Results A total of 26 patients were identified, all of whom underwent a diagnostic surgical procedure. Histopathology revealed chronic inflammation (n = 12, 46.1%), malignancy (n = 7, 26.9%), inverted papilloma (n = 4, 15.5%), and fungal infections (n = 3, 11.5%). A unilateral maxillary sinus with FDG uptake was documented for 16 (61.5%) patients. CT evidence of bilateral disease and mucosal or sinus wall thickening correlated with inflammatory disease. Conclusions Incidental lesions with positive FDG uptake in the sinonasal cavities are at a high risk (40%) of being neoplastic. A diagnostic biopsy is advocated in these cases.
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Affiliation(s)
- Sharon Tzelnick
- Department of Otolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel
| | - Ethan Soudry
- Department of Otolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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44
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Domachevsky L, Kashtan H, Brenner B, Nidam M, Morgenstern S, Kundel Y, Groshar D, Bernstine H. Baseline 18F-FDG PET/CT as predictor of the pathological response to neoadjuvant therapy in esophageal cancer: A retrospective study. Medicine (Baltimore) 2018; 97:e13412. [PMID: 30544419 PMCID: PMC6310504 DOI: 10.1097/md.0000000000013412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The type of pathological response to neoadjuvant chemoradiation in patients with locally advanced esophageal cancer predicts overall survival (OS).We aimed to assess early 18F-FDG positron emission tomography/computed tomography parameters in predicting the pathological response to neoadjuvant treatment.The cohort included consecutive patients with locally advanced esophageal cancer who underwent baseline 18F-FDG positron emission tomography/computed tomography between September 2006 and February 2015. Positron emission tomography variables of maximum and average standardized uptake values (SUVmax, SUVaverage), metabolic tumor volume (MTV), and total lesion glycolysis were recorded in addition to computed tomography volume. MTV was calculated using cut-off values of 42%, 50% and 60% (MTV 0.42, 0.5, and 0.6) of the tumoral SUVmax. Receiver operating characteristic (ROC) analysis was used to determine sensitivity and specificity.Sixty-one patients (44 male, 17 female) fulfilled the inclusion criteria. Only MTV values of 13.6 mL (MTV 0.42) and 7.4 mL (MTV 0.5) remained significant on ROC analysis, with an area under the curve of 0.690 (confidence interval 0.557-0.823, p = .02] and 0.664 (confidence interval 0.527-0.802, P = .048), respectively in differentiating patients with a complete (n = 44) or incomplete (n = 17) pathological response.MTV at presentation is associated with the pathological response to neoadjuvant chemoradiation in patients with locally advanced esophageal cancer.
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Affiliation(s)
- Liran Domachevsky
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center, Beilinson Hospital
- Sackler Faculty of Medicine, Tel Aviv University
| | - Baruch Brenner
- Sackler Faculty of Medicine, Tel Aviv University
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital
| | - Meital Nidam
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital
| | - Sara Morgenstern
- Institute of Pathology, Rabin Medical Center, Beilinson Hospital, Petach Tikva
| | - Yulia Kundel
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital
| | - David Groshar
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital
- Sackler Faculty of Medicine, Tel Aviv University
- Assuta Medical Center, Tel Aviv, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital
- Sackler Faculty of Medicine, Tel Aviv University
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45
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Moore A, Ulitsky O, Ben-Aharon I, Perl G, Kundel Y, Sarfaty M, Lewin R, Domachevsky L, Bernstine H, Groshar D, Wasserberg N, Kashtan H, Gordon N, Sulkes A, Brenner B. Early PET-CT in patients with pathological stage III colon cancer may improve their outcome: Results from a large retrospective study. Cancer Med 2018; 7:5470-5477. [PMID: 30350468 PMCID: PMC6246942 DOI: 10.1002/cam4.1818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/13/2018] [Accepted: 09/15/2018] [Indexed: 12/11/2022] Open
Abstract
Background Current staging of pathological stage III colon cancer (CC) is suboptimal; many patients recur despite unremarkable preoperative staging. We previously reported that early postoperative PET‐CT can alter the stage and management of up to 15% of patients with high‐risk stage III CC. This study aimed to determine the role of the test in the general stage III CC population. Methods A retrospective study of all consecutive patients with stage III CC who underwent early postoperative PET‐CT between 2005 and 2017. Results A total of 342 patients, 166 (48.5%) males, median age 66 years (range, 29‐90), were included. Pathological stage was IIIA, IIIB, and IIIC in 18 (5.3%), 257 (75.1%), and 67 (19.6%) patients, respectively. Median number of positive lymph nodes was 2 (range, 0‐32). PET‐CT results modified the management of 46 patients (13.4%): 37 (10.8%) with overt metastatic disease and 9 (2.6%) with a second primary. The 5‐year disease‐free survival for true stage III patients was 81%. The median overall survival for the entire cohort and for true stage III patients was not reached and was 57.2 months for true stage IV. Of the 37 patients found to be metastatic, 14 (37.8%) underwent curative treatments and 9/14 (64.3%) remain disease‐free, with a median follow‐up of 83.8 months. Predictive factors for upstaging following PET‐CT were identified. Conclusion Early postoperative PET‐CT changed the staging and treatment of 13.4% of stage III CC patients and has the potential for early detection of curable metastatic disease. Outcome results are encouraging. Prospective validation is ongoing.
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Affiliation(s)
- Assaf Moore
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Olga Ulitsky
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel
| | - Irit Ben-Aharon
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gali Perl
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yulia Kundel
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Sarfaty
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Lewin
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Rabin Medical Center, Petach Tiqva, Israel
| | - Hanna Bernstine
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, Rabin Medical Center, Petach Tiqva, Israel
| | - David Groshar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, Rabin Medical Center, Petach Tiqva, Israel
| | - Nir Wasserberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Rabin Medical Center, Petach Tiqva, Israel
| | - Hanoch Kashtan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Rabin Medical Center, Petach Tiqva, Israel
| | - Noa Gordon
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel
| | - Aaron Sulkes
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zlotnik O, Bernstine H, Domachevsky L, Gutman H. Failure to identify sentinel lymph nodes for malignant melanoma - Outcome after over 10 years median follow up. Eur J Surg Oncol 2018; 45:231-234. [PMID: 30343996 DOI: 10.1016/j.ejso.2018.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/12/2018] [Accepted: 09/05/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is routinely performed during surgery for malignant melanoma, using double mapping. Still, in some cases, a sentinel lymph node identified pre-operatively by lymphoscintigraphy is not identified during surgery. We hypothesized that disease specific survival would not be significantly impacted by intra-operative lymph node mapping (IOLM) failure. METHODS The patient population study included 1300 malignant melanomas operated on by a single surgical oncologist (H.G.) after sentinel lymph node scintigraphy. Patients were included in the analysis if intra-operative lymph node (IOLM) mapping failed. RESULTS Among 1300 patients who underwent surgery for malignant melanoma during the study period and after median follow up of >10 years, 33/36 lymphatic drainage basins with failed sentinel node identification were free of disease. Disease specific survival for the entire group of 33 patients with IOLM failure was 91.0%, which is comparable to previously published disease specific survival for all melanoma patients. CONCLUSION We conclude that failure to identify a pre-operatively marked sentinel lymph node by an experienced melanoma surgeon has, generally, no impact on disease specific survival, as demonstrated in this review of a series of surgical melanoma patients.
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Affiliation(s)
- Oran Zlotnik
- Department of Surgery, Rabin Medical Center, Petah Tikva, Israel; The Sackler School of Medicine, Tel-Aviv University, Israel.
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel; The Sackler School of Medicine, Tel-Aviv University, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel; The Sackler School of Medicine, Tel-Aviv University, Israel
| | - Haim Gutman
- Department of Surgery, Rabin Medical Center, Petah Tikva, Israel; The Sackler School of Medicine, Tel-Aviv University, Israel
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47
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Icht O, Domachevsky L, Groshar D, Dudnik E, Rotem O, Peled N, Reinhorn D, Jacobi O, Shochat T, Bernstine H, Zer A. P1.04-17 Tumour Burden as a Predictive Tool of Response to Immune Checkpoint Inhibitors (ICI) in Patients with Metastatic Non-Small-Cell Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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48
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Domachevsky L, Goldberg N, Bernstine H, Nidam M, Groshar D. Quantitative characterisation of clinically significant intra-prostatic cancer by prostate-specific membrane antigen (PSMA) expression and cell density on PSMA-11. Eur Radiol 2018; 28:5275-5283. [PMID: 29846803 DOI: 10.1007/s00330-018-5484-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/26/2018] [Accepted: 04/12/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To quantitatively characterize clinically significant intra-prostatic cancer (IPC) by prostate-specific membrane antigen (PSMA) expression and cell density on PSMA-11 positron emission tomography/magnetic resonance (PET/MR). METHODS Retrospective study approved by the institutional review board with informed written consent obtained. Patients with a solitary, biopsy-proven prostate cancer, Gleason score (GS) ≥7, presenting for initial evaluation by PET/computerised tomography (PET/CT), underwent early prostate PET/MR immediately after PSMA-11 tracer injection. PET/MR [MRI-based attenuation correction (MRAC)] and PET/CT [CT-based AC (CTAC)] maximal standardised uptake value (SUVmax) and minimal and mean apparent diffusion coefficient (ADCmin, ADCmean; respectively) in normal prostatic tissue (NPT) were compared to IPC area. The relationship between SUVmax, ADCmin and ADCmean measurements was obtained. RESULTS Twenty-two patients (mean age 69.5±5.0 years) were included in the analysis. Forty-four prostate areas were evaluated (22 IPC and 22 NPT). Median MRAC SUVmax of NPT was significantly lower than median MRAC SUVmax of IPC (p < 0.0001). Median ADCmin and ADCmean of NPT was significantly higher than median ADCmin and ADCmean of IPC (p < 0.0001). A very good correlation was found between MRAC SUVmax with CTAC SUVmax (rho = -0.843, p < 0.0001). A good inverse relationship was found between MRAC SUVmax and CTAC SUVmax with ADCmin (rho = -0.717, p < 0.0001 and -0.740, p < 0.0001; respectively; Z = 0.22, p = 0.82, NS) and with MRAC SUVmax and ADCmean (rho = -0.737, p < 0.0001). CONCLUSIONS PET/MR SUVmax, ADCmin and ADCmean are distinct biomarkers able to differentiate between IPC and NPT in naïve prostate cancer patients with GS ≥ 7. KEY POINTS • PSMA PET/MR metrics differentiate between normal and tumoural prostatic tissue. • A multi-parametric approach combining molecular and anatomical information might direct prostate biopsy. • PSMA PET/MR metrics are warranted for radiomics analysis.
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Affiliation(s)
- Liran Domachevsky
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel St, 6971028, Tel-Aviv, Israel.
| | - Natalia Goldberg
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel St, 6971028, Tel-Aviv, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel St, 6971028, Tel-Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meital Nidam
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel St, 6971028, Tel-Aviv, Israel
| | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel St, 6971028, Tel-Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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49
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Stein D, Goldberg N, Domachevsky L, Bernstine H, Nidam M, Abadi-Korek I, Guindy M, Sosna J, Groshar D. Quantitative biomarkers for liver metastases: comparison of MRI diffusion-weighted imaging heterogeneity index and fluorine-18-fluoro-deoxyglucose standardised uptake value in hybrid PET/MR. Clin Radiol 2018; 73:832.e17-832.e22. [PMID: 29859634 DOI: 10.1016/j.crad.2018.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 04/18/2018] [Indexed: 01/24/2023]
Abstract
AIM To investigate the ability of apparent diffusion coefficient (ADC) heterogeneity index to discriminate liver metastases (LM) from normal-appearing liver (NAL) tissue as compared to common magnetic resonance imaging (MRI) metrics, and to investigate its correlation with 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography (PET) standardised uptake value (SUV). MATERIALS AND METHODS Thirty-nine liver metastases in 24 oncology patients (13 women, 11 men; mean age 56±13 years) with proven LM from heterogeneous sources were evaluated on a PET/MRI system. Abdominal sequences included Dixon and diffusion-weighted imaging (DWI) protocols with simultaneous PET. Tissue heterogeneity was calculated using the coefficient of variance (CV) of the ADC, and compared in LM and in NAL tissue of the same volume in an adjacent portion of the liver. The correlations between various ADC measures and PET SUV in distinguishing LM from NAL were evaluated. RESULTS A good correlation was found between ADCcv and SUVpeak (r=0.712). Moderate inverse correlation was found between ADCmin and SUVpeak (r=-0.536), and a weak inverse correlation between ADCmean and SUVpeak (r=-0.273). There was a significant difference between LM and NAL when ADCcv (p<0.0001) and ADCmin (p=0.001) were used. Receiver operating characteristic (ROC) analysis of SUV, ADCcv, ADCmin, and ADCmean produced an AUC of 0.989, 0.900, 0.742, and 0.623 respectively. CONCLUSIONS The ADCcv index is a potential biomarker of LM with better correlation to 18F-FDG PET SUVpeak than conventional MRI metrics, and may serve to quantitatively discriminate between LM and NAL.
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Affiliation(s)
- D Stein
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - N Goldberg
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Domachevsky
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Bernstine
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Nidam
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Abadi-Korek
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Guindy
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - D Groshar
- Department of Nuclear Medicine, Assuta Medical Centers, Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bernstine H, Domachevsky L, Nidam M, Goldberg N, Abadi-Korek I, Shpilberg O, Groshar D. 18F-FDG PET/MR imaging of lymphoma nodal target lesions: Comparison of PET standardized uptake value (SUV) with MR apparent diffusion coefficient (ADC). Medicine (Baltimore) 2018; 97:e0490. [PMID: 29668631 PMCID: PMC5916693 DOI: 10.1097/md.0000000000010490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To compare positron emission tomography (PET) standardized uptake value (SUV) with magnetic resonance (MR) apparent diffusion coefficient (ADC) of nodal target lesions in patients with F-fluoro-2-deoxyglucose (FDG)-avid lymphomas by simultaneous PET/MR.Patients with histologically proven Hodgkin and non-Hodgkin lymphoma underwent PET/MR limited field of view of FDG-avid target nodal lesions. For PET images, a region of interest (ROI) was drawn around the target nodal lesion and the SUVmax and SUVmean was measured. For MR ADC measurements a ROI was placed over the target nodal lesion on diffusion-weighted imaging (DWI) and ADCmin and ADCmean (mean ADC) values within the ROI were recorded.Thirty-nine patients (19 women, 20 men; 13 patients with Hodgkin lymphoma and 26 with non-Hodgkin lymphoma) were included in the analysis. Sixty-six nodal lesions detected by PET/CT (19 PET-negative and 47 PET-positive) were analyzed by PET/MR. PET/MR quantitative assessments showed that ADCmin and ADCmean were accurate for discriminating positive from negative nodal lymphoma, with an AUC of 0.927 and 0.947, respectively. The ROC curve analysis of ADCmean versus SUVmax and SUVmean was not statistically significant (difference=0.044, P = .08 and difference = 0.045, P = .07; respectively). A substantial inverse association was observed between ADCmean with SUVmean and SUVmax (rho = -0.611; -0.607; P < .0001, respectively). A moderate inverse association was found between ADCmin with SUVmean and SUVmax (rho = -0.529, -0.520; P < .0001, respectively). Interobserver variability of quantitative assessment showed very good agreement for all variables (ICC>0.87).A significant correlation between ADCs and SUVs is found in FDG avid lymphomas. ADCmean is not inferior to PET SUV in discriminating positive and negative nodal lymphomas. Further larger studies are warranted to validate quantitative PET/MR for lymphoma patient management.
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Affiliation(s)
- Hanna Bernstine
- Department of Nuclear Medicine
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | - David Groshar
- Department of Nuclear Medicine
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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