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Berliner C, Steinhelfer L, Chantadisai M, Kroenke M, Koehler D, Pose R, Bannas P, Knipper S, Eiber M, Maurer T. Delayed Imaging Improves Lesion Detectability in [ 99mTc]Tc-PSMA-I&S SPECT/CT in Recurrent Prostate Cancer. J Nucl Med 2023:jnumed.122.265252. [PMID: 37230531 DOI: 10.2967/jnumed.122.265252] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/07/2023] [Indexed: 05/27/2023] Open
Abstract
Our objective was to compare the ability to detect histopathologically confirmed lymph node metastases by early and delayed [99mTc]Tc-PSMA-I&S SPECT/CT in early biochemically recurrent prostate cancer. Methods: We retrospectively analyzed 222 patients selected for radioguided surgery using [99mTc]Tc-PSMA-I&S SPECT/CT at different time points after injection (≤4 h and >15 h). In total, 386 prostate-specific membrane antigen (PSMA) PET predetermined lesions were analyzed on SPECT/CT using a 4-point scale, and the results were compared between early and late imaging groups, with uni- and multivariate analyses performed including prostate-specific antigen, injected [99mTc]Tc-PSMA-I&S activity, Gleason grade group, initial TNM stage, and, stratified by size, PSMA PET/CT-positive lymph nodes. PSMA PET/CT findings served as the standard of reference. Results: [99mTc]Tc-PSMA-I&S SPECT/CT had a significantly higher positivity rate for detecting lesions in the late than the early imaging group (79%, n = 140/178, vs. 27%, n = 12/44 [P < 0.05] on a patient basis; 60%, n = 195/324, vs. 21%, n = 13/62 [P < 0.05] on a lesion basis). Similar positivity rates were found when lesions were stratified by size. Multivariate analysis found that SUVmax on PSMA PET/CT and the uptake time of [99mTc]Tc-PSMA-I&S were independent predictors for lesion detectability on SPECT/CT. Conclusion: Late imaging (>15 h after injection) should be preferred when [99mTc]Tc-PSMA-I&S SPECT/CT is used for lesion detection in early biochemical recurrence of prostate cancer. However, the performance of PSMA SPECT/CT is clearly inferior to that of PSMA PET/CT.
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Affiliation(s)
- Christoph Berliner
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany;
- Department of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany
| | - Lisa Steinhelfer
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Maythinee Chantadisai
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Markus Kroenke
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Daniel Koehler
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Randi Pose
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; and
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sophie Knipper
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; and
| | - Matthias Eiber
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; and
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; and
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Kroenke M, Schweiger L, Horn T, Haller B, Schwamborn K, Wurzer A, Maurer T, Wester HJ, Eiber M, Rauscher I. Validation of 18F-rhPSMA-7 and 18F-rhPSMA-7.3 PET Imaging Results with Histopathology from Salvage Surgery in Patients with Biochemical Recurrence of Prostate Cancer. J Nucl Med 2022; 63:1809-1814. [PMID: 35393348 PMCID: PMC9730917 DOI: 10.2967/jnumed.121.263707] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/28/2022] [Indexed: 01/11/2023] Open
Abstract
18F-rhPSMA-7, and its single diastereoisomer form, 18F-rhPSMA-7.3, are prostate-specific membrane antigen (PSMA)-targeting radiopharmaceuticals. Here, we investigated their accuracy for the assessment of lymph node (LN) metastases validated by histopathology. Methods: Data from 58 patients with biochemical recurrence of prostate cancer after radical prostatectomy receiving salvage surgery after PET imaging with 18F-rhPSMA-7 or 18F-rhPSMA-7.3 were retrospectively reviewed. Two nuclear medicine physicians reviewed all PET scans and morphologic imaging in consensus. Readers were masked from the results of histopathology. PET and morphologic imaging were correlated with histopathology from resected LNs. Results: In 75 of 150 resected regions in 54 of 58 patients, tumor lesions were present in histopathology. The template-based specificity of PET (18F-rhPSMA-7 and 18F-rhPSMA-7.3 combined) and morphologic imaging was 93.3% and 100%, respectively. However, 18F-rhPSMA-7 and 18F-rhPSMA-7.3 PET detected metastases in 61 of 75 histopathologically proven metastatic LN fields (81.3%) whereas morphologic imaging was positive in only 9 of 75 (12.0%). The positive predictive value was 92.4% for 18F-rhPSMA-7 and 18F-rhPSMA-7.3 PET and 100% for morphologic imaging. 18F-rhPSMA-7 and 18F-rhPSMA-7.3 PET performance was significantly superior to morphologic imaging (difference in the areas under the receiver-operating-characteristic curves, 0.222; 95% CI, 0.147-0.298; P < 0.001). The mean size of PET-positive and histologically confirmed LN metastases was 6.3 ± 3.1 mm (range, 2-15 mm) compared with a mean size of 9.8 ± 2.5 mm (range, 7-15 mm) on morphologic imaging. Conclusion: 18F-rhPSMA-7 and 18F-rhPSMA-7.3 PET offer a high positive predictive value comparable to that reported for 68Ga-PSMA-11 and represent a valuable tool for guiding salvage lymphadenectomy.
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Affiliation(s)
- Markus Kroenke
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;,Department of Radiology and Nuclear Medicine, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Lilit Schweiger
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;,Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Thomas Horn
- Department of Urology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kristina Schwamborn
- Department of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Wurzer
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;,Chair of Radiopharmacy, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Tobias Maurer
- Martini-Klinik and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Jürgen Wester
- Chair of Radiopharmacy, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;,Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;,Bavarian Cancer Research Center (BZKF), Munich, Germany
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Ilhan H, Kroenke M, Wurzer A, Unterrainer M, Heck M, Belka C, Knorr K, Langbein T, Rauscher I, Schmidt-Hegemann NS, Schiller K, Bartenstein P, Wester HJ, Eiber M. 18F-rhPSMA-7 PET for the Detection of Biochemical Recurrence of Prostate Cancer After Curative-Intent Radiation Therapy: A Bicentric Retrospective Study. J Nucl Med 2022; 63:1208-1214. [PMID: 35273094 PMCID: PMC9364349 DOI: 10.2967/jnumed.121.262861] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/02/2021] [Indexed: 02/03/2023] Open
Abstract
This bicentric, retrospective analysis investigated the efficacy of PET/CT with a novel theranostic prostate-specific membrane antigen (PSMA)--targeting ligand, 18F-rhPSMA-7, in patients with biochemical recurrence (BCR) of prostate cancer after curative-intent primary radiotherapy. Methods: Datasets from patients with BCR of prostate cancer after external-beam radiation therapy or brachytherapy who underwent 18F-rhPSMA-7 PET/CT at either Technical University Munich or Ludwig-Maximilians-University Munich were retrospectively reviewed by experienced nuclear medicine physicians and radiologists at both centers. The median injected activity was 299 MBq (range, 204-420 MBq), and the median uptake time was 77 min (range, 46-120 min). All lesions suggestive of recurrent prostate cancer were noted. Detection rates were correlated with patients' prostate-specific antigen (PSA) level, primary Gleason score, and prior use of androgen-deprivation therapy (ADT). Results: Ninety-seven patients were included (65 at Technical University Munich and 32 at Ludwig-Maximilians-University Munich). The median prescan PSA was 4.19 ng/mL (range, 0.1-159 ng/mL). The primary Gleason score was ≤6 in 19 patients, 7 in 25, ≥8 in 33, and unknown in 20. Thirty patients received ADT in the 6 mo preceding PET/CT. 18F-rhPSMA-7 identified lesions in 91 of 97 (94%) patients. Detection rates stratified by PSA were 88% (22/25), 97% (30/31), 90% (19/21), and 100% (20/20) for a PSA of <2, 2-<5, 5-<10, and ≥10 ng/mL, respectively. Detection rates in the subgroup of patients not meeting the Phoenix criteria for BCR were 80% (4/5), 90% (9/10), 100% (4/4), and 83% (5/6) for a PSA of <0.5, 0.5-<1, 1-<1.5, and 1.5-2 ng/mL, respectively. There were no significant differences in detection rates between patients with and without prior ADT (100% vs. 91%, P = 0.173) or patients with a Gleason score of ≤7 and a Gleason score of ≥8 (98% vs. 91%, P = 0.316).18F-rhPSMA-7 revealed local recurrence in 80% (78/97); pelvic lymph node metastases in 38% (37/97); retroperitoneal and supradiaphragmatic lymph node metastases in 9% (9/97) and 4% (4/97), respectively; bone metastases in 27% (26/97); and visceral metastases in 3% (3/97). In the subgroup of patients with a PSA of <2 ng/mL above nadir, local recurrence occurred in 76% (19/25) and pelvic lymph node metastases in 36% (9/25). Conclusion:18F-rhPSMA-7 PET/CT demonstrates high detection rates in prostate cancer patients with BCR after primary radiation therapy, even at low PSA values. Its diagnostic efficacy is comparable to published data for other PSMA ligands.
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Affiliation(s)
- Harun Ilhan
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany;,Die Radiologie, Munich, Germany
| | - Markus Kroenke
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Wurzer
- Chair of Pharmaceutical Radiochemistry, Technical University of Munich, Garching, Germany
| | - Marcus Unterrainer
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany;,Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Heck
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; and
| | - Karina Knorr
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Langbein
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Kilian Schiller
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Hans-Jürgen Wester
- Chair of Pharmaceutical Radiochemistry, Technical University of Munich, Garching, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
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Tchao N, Sarkar N, Hu X, Zhang R, Milmont C, Shi Jin Y, Chow V, Kroenke M, Gorski K, Furie R, Kivitz A, Cohen S. AB0432 EFAVALEUKIN ALFA, A NOVEL IL-2 MUTEIN, SELECTIVELY EXPANDS REGULATORY T CELLS IN PATIENTS WITH SLE: FINAL RESULTS OF A PHASE 1B MULTIPLE ASCENDING DOSE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundDefects in regulatory T cell (Treg) number and function are associated with autoimmune diseases including SLE. Interleukin (IL)-2 is essential for the development and suppressive function of Treg, and therapies that exploit the ability of IL-2 to expand Treg have shown disease-modifying potential in SLE1. However, low-dose IL-2 has a short half-life and narrow selectivity for Treg over conventional CD4+ T cells (Tcon) and natural killer (NK) cells. Efavaleukin alfa is an IL-2 mutein Fc fusion protein; an introduced mutation decreases binding to IL-2Rβ and increases dependence on IL-2Rα (CD25). This preferential binding to the high-affinity IL-2R, constitutively expressed at high levels on Treg, leads to increased cell surface retention and sustained Treg signaling compared with recombinant IL-2. In healthy subjects, a single dose of efavaleukin alfa was well tolerated and led to robust and selective Treg expansion2.ObjectivesThis final analysis of a phase 1b, double-blind, placebo-controlled, multiple ascending dose study (NCT03451422) reports the safety, tolerability, pharmacokinetics (PK), and pharmacodynamic effects of efavaleukin alfa in patients with SLE.MethodsThe study included five ascending dose cohorts (cohort 1=lowest dose; cohort 5=highest dose). A total of 35 patients with SLE (age 24–71 years; 85.7% female; SLE diagnosed using SLICC or ACR criteria with ANA ≥1:80 and/or elevated anti-dsDNA antibodies) were randomized to receive efavaleukin alfa or placebo (5:2 ratio for cohorts 1–3; 3:1 ratio for cohorts 4–5) subcutaneously every 2 weeks (Q2W; cohorts 1, 2, 4, and 5) or every week (QW; cohort 3) in addition to standard of care therapy for a total of 12 weeks, with 6 weeks of follow-up. The primary endpoint was the incidence of treatment-emergent adverse events (TEAEs). Additional endpoints included serum PK of efavaleukin alfa and changes in numbers of Treg, CD4+ Tcon, CD8+ T cells, and NK cells in peripheral blood.ResultsThe most commonly reported TEAEs (occurring in ≥25% of efavaleukin alfa-treated subjects) included non-serious, mild or moderate (grade 1–2) injection site reactions. No grade 4 TEAEs or deaths occurred. Two serious AEs were reported in efavaleukin alfa-treated subjects: one event of syncope (grade 3) was observed in cohort 2 and was not considered related to treatment, and one case of eosinophilia (grade 2) was observed in cohort 5 and was considered related to treatment. Efavaleukin alfa PK was generally linear and dose-proportional, with a terminal half-life ranging from 18–30 hours. Peak Foxp3+ Treg expansion was observed at 8 days post-dose, and the magnitude of the peak was generally sustained after multiple QW or Q2W doses. The mean peak increases in Foxp3+ Treg were 14.8-, 17.4-, 5.7-, 2.4-, and 1.1-fold above baseline for efavaleukin alfa Q2W dosing cohorts 5, 4, 2, and 1 and placebo, respectively. At the final study assessment (42 days after the last dose), the mean Treg count was 1.3-fold above baseline (95% CI, 0.9–1.9). Treatment with efavaleukin alfa also expanded CD25bright Treg (peak 53.8-fold change) and CD31+ recent thymic emigrant (RTE), naïve, and memory Treg subsets. At the highest dose (cohort 5), low-level increases in numbers of CD4+ Tcon (peak 2.3-fold), CD8+ T cells (peak 2.1-fold), and NK cells (peak 2.9-fold) were observed.ConclusionMultiple ascending doses of efavaleukin alfa were safe and well tolerated and led to selective and prolonged Treg expansion in SLE patients. Results at the highest dose suggest a plateau in Treg expansion with low-level increases in other IL-2–responsive cells, although interpretation is limited due to small subject numbers. The highest tested dose may be outside the therapeutic window and thus will not be assessed in phase 2 clinical studies. These findings confirm and extend previous results in healthy subjects and support the ongoing phase 2b adaptive randomized controlled trial in patients with SLE.References[1]Humrich J. Arthritis Rheumatol. 2016;68 (suppl 10);2Tchao N. Blood. 2017;130 (suppl 1).AcknowledgementsFunding: Amgen IncDisclosure of InterestsNadia Tchao Shareholder of: Amgen Inc., Employee of: Amgen Inc., Nandita Sarkar Shareholder of: Amgen Inc., Employee of: Amgen Inc., Xuguang Hu Shareholder of: Amgen Inc., Employee of: Amgen Inc., Rong Zhang Shareholder of: Amgen Inc., Employee of: Amgen Inc., Cassandra Milmont Shareholder of: Amgen Inc., Employee of: Amgen Inc., Yan Shi Jin Shareholder of: Amgen Inc., Employee of: Amgen Inc., Vincent Chow Shareholder of: Amgen Inc., Employee of: Amgen Inc., Mark Kroenke Shareholder of: Amgen Inc., Employee of: Amgen Inc., Kevin Gorski Shareholder of: Amgen Inc., Employee of: Amgen Inc., Richard Furie Consultant of: Amgen Inc, Grant/research support from: Amgen Inc, Alan Kivitz Shareholder of: Amgen Inc., Gilead, GlaxoSmithKline, Novartis, Pfizer, and Sanofi, Speakers bureau: AbbVie, Celgene, Flexion, Genzyme, GSK, Horizon, Lilly, Merck, Novartis, Pfizer, Sanofi, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Flexion, Gilead, Janssen, Pfizer, Sanofi, and Sun Pharma, Stanley Cohen Consultant of: Amgen Inc., AbbVie, Eli Lilly, Pfizer, Genentech, and Gilead, Grant/research support from: Amgen Inc., AbbVie, Eli Lilly, Pfizer, Genentech, and Gilead
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Kroenke M, Mirzoyan L, Horn T, Peeken JC, Wurzer A, Wester HJ, Makowski M, Weber WA, Eiber M, Rauscher I. Matched-Pair Comparison of 68Ga-PSMA-11 and 18F-rhPSMA-7 PET/CT in Patients with Primary and Biochemical Recurrence of Prostate Cancer: Frequency of Non-Tumor-Related Uptake and Tumor Positivity. J Nucl Med 2020; 62:1082-1088. [PMID: 33277394 DOI: 10.2967/jnumed.120.251447] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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: 06/11/2020] [Accepted: 11/12/2020] [Indexed: 11/16/2022] Open
Abstract
Radiohybrid prostate-specific membrane antigen (rhPSMA) ligands are a new class of prostate cancer theranostic agents. 18F-rhPSMA-7 offers the advantages of 18F labeling and low urinary excretion compared with 68Ga-PSMA-11. Here, we compare the frequency of non-tumor-related uptake and tumor positivity with 68Ga-PSMA-11 and 18F-rhPSMA-7 in patients with primary or recurrent prostate cancer. Methods: This retrospective matched-pair comparison matched 160 18F-rhPSMA-7 with 160 68Ga-PSMA-11 PET/CT studies for primary staging (n = 33) and biochemical recurrence (n = 127) according to clinical characteristics. Two nuclear medicine physicians reviewed all scans, first identifying all PET-positive lesions and then differentiating lesions suggestive of prostate cancer from those that were benign, on the basis of known pitfalls and ancillary information from CT. For each region, the SUVmax of the lesion with the highest PSMA ligand uptake was noted. Tumor positivity rates were determined, and SUVmax was compared separately for each tracer. Results: 18F-rhPSMA-7 and 68Ga-PSMA-11 PET revealed 566 and 289 PSMA ligand-positive lesions, respectively. Of these, 379 and 100 lesions, equaling 67.0% and 34.6%, respectively, of all PSMA-positive lesions, were considered benign. The distribution of their etiology was similar (42%, 24%, and 25% with 18F-rhPSMA-7 vs. 32%, 24%, and 38% with 68Ga-PSMA-11 for ganglia, bone, and unspecific lymph nodes, respectively). All primary tumors were positive with both agents (n = 33 each), whereas slightly more metastatic lesions were observed with 68Ga-PSMA-11 in both disease stages (113 for 18F-rhPSMA-7 and 124 for 68Ga-PSMA-11). The SUVmax of 18F-rhPSMA-7 and 68Ga-PSMA-11 did not differ (P > 0.05) in local recurrence or primary prostate cancer; however, the tumor-to-bladder ratio was significantly higher with 18F-rhPSMA-7 (4.9 ± 5.3 vs. 2.2 ± 3.7, P = 0.02, for local recurrence; 9.8 ± 9.7 vs. 2.3 ± 2.6, P < 0.001, for primary prostate cancer). Conclusion: The tumor positivity rate was consistently high for 68Ga-PSMA-11 and 18F-rhPSMA-7. Both tracers revealed a considerable number of areas of uptake that were reliably identified as benign by trained physicians making use of corresponding morphologic imaging and known PSMA pitfalls. These were more frequent with 18F-rhPSMA-7. However, the matched-pair comparison could have introduced a source of bias. Adequate reader training can allow physicians to differentiate benign uptake from disease and be able to benefit from the logistical and clinical advantages of 18F-rhPSMA-7.
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Affiliation(s)
- Markus Kroenke
- Institute of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lilit Mirzoyan
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Horn
- Department of Urology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan C Peeken
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, Munich, Germany.,Institute of Radiation Medicine, Department of Radiation Sciences, Helmholtz Zentrum München, Neuherberg, Germany; and
| | - Alexander Wurzer
- Pharmaceutical Radiochemistry, School of Medicine, Technical University of Munich. Munich, Germany
| | - Hans-Jürgen Wester
- Pharmaceutical Radiochemistry, School of Medicine, Technical University of Munich. Munich, Germany
| | - Marcus Makowski
- Institute of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Wolfgang A Weber
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;
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Peeken JC, Shouman MA, Kroenke M, Rauscher I, Maurer T, Gschwend JE, Eiber M, Combs SE. A CT-based radiomics model to detect prostate cancer lymph node metastases in PSMA radioguided surgery patients. Eur J Nucl Med Mol Imaging 2020; 47:2968-2977. [PMID: 32468251 PMCID: PMC7680305 DOI: 10.1007/s00259-020-04864-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 02/26/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE In recurrent prostate carcinoma, determination of the site of recurrence is crucial to guide personalized therapy. In contrast to prostate-specific membrane antigen (PSMA)-positron emission tomography (PET) imaging, computed tomography (CT) has only limited capacity to detect lymph node metastases (LNM). We sought to develop a CT-based radiomic model to predict LNM status using a PSMA radioguided surgery (RGS) cohort with histological confirmation of all suspected lymph nodes (LNs). METHODS Eighty patients that received RGS for resection of PSMA PET/CT-positive LNMs were analyzed. Forty-seven patients (87 LNs) that received inhouse imaging were used as training cohort. Thirty-three patients (62 LNs) that received external imaging were used as testing cohort. As gold standard, histological confirmation was available for all LNs. After preprocessing, 156 radiomic features analyzing texture, shape, intensity, and local binary patterns (LBP) were extracted. The least absolute shrinkage and selection operator (radiomic models) and logistic regression (conventional parameters) were used for modeling. RESULTS Texture and shape features were largely correlated to LN volume. A combined radiomic model achieved the best predictive performance with a testing-AUC of 0.95. LBP features showed the highest contribution to model performance. This model significantly outperformed all conventional CT parameters including LN short diameter (AUC 0.84), LN volume (AUC 0.80), and an expert rating (AUC 0.67). In lymph node-specific decision curve analysis, there was a clinical net benefit above LN short diameter. CONCLUSION The best radiomic model outperformed conventional measures for detection of LNM demonstrating an incremental value of radiomic features.
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Affiliation(s)
- Jan C Peeken
- Department of Radiation Oncology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany.
- Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany.
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.
| | - Mohamed A Shouman
- Department of Radiation Oncology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany
| | - Markus Kroenke
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Institute for Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Tobias Maurer
- Institute for Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Department of Urology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology and Martini-Klinik, University Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Eiber
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany
- Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
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Hiroshima Y, Manabe O, Naya M, Tomiyama Y, Magota K, Obara M, Aikawa T, Oyama-Manabe N, Yoshinaga K, Hirata K, Kroenke M, Tamaki N, Katoh C. Quantification of myocardial blood flow with 11C-hydroxyephedrine dynamic PET: comparison with 15O-H 2O PET. J Nucl Cardiol 2020; 27:1118-1125. [PMID: 29270771 DOI: 10.1007/s12350-017-1140-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND 11C-hydroxyephedrine (HED) PET has been used to evaluate the myocardial sympathetic nervous system (SNS). Here we sought to establish a simultaneous approach for quantifying both myocardial blood flow (MBF) and the SNS from a single HED PET scan. METHODS Ten controls and 13 patients with suspected cardiac disease were enrolled. The inflow rate of 11C-HED (K1) was obtained using a one-tissue-compartment model. We compared this rate with the MBF derived from 15O-H2O PET. In the controls, the relationship between K1 from 11C-HED PET and the MBF from 15O-H2O PET was linked by the Renkin-Crone model. RESULTS The relationship between K1 from 11C-HED PET and the MBF from 15O-H2O PET from the controls' data was approximated as follows: K1 = (1 - 0.891 * exp(- 0.146/MBF)) * MBF. In the validation set, the correlation coefficient demonstrated a significantly high relationship for both the whole left ventricle (r = 0.95, P < 0.001) and three coronary territories (left anterior descending artery: r = 0.96, left circumflex artery: r = 0.81, right coronary artery: r = 0.86; P < 0.001, respectively). CONCLUSION 11C-HED can simultaneously estimate MBF and sympathetic nervous function without requiring an additional MBF scan for assessing mismatch areas between MBF and SNS.
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Affiliation(s)
- Yuji Hiroshima
- Faculty of Health Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 060-8638, Hokkaido, Japan.
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yuuki Tomiyama
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 060-8638, Hokkaido, Japan
| | - Keiichi Magota
- Division of Medical Imaging and Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Masahiko Obara
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tadao Aikawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Keiichiro Yoshinaga
- Diagnostic and Therapeutic Nuclear Medicine, National Institute of Radiological Science, Chiba, Japan
| | - Kenji Hirata
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 060-8638, Hokkaido, Japan
| | - Markus Kroenke
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 060-8638, Hokkaido, Japan
- Department of Nuclear Medicine, Klinikumrechts der Isar, Technical University of Munich, Munich, Germany
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 060-8638, Hokkaido, Japan
| | - Chietsugu Katoh
- Faculty of Health Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Eiber M, Kroenke M, Wurzer A, Ulbrich L, Jooß L, Maurer T, Horn T, Schiller K, Langbein T, Buschner G, Wester HJ, Weber W. 18F-rhPSMA-7 PET for the Detection of Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy. J Nucl Med 2019; 61:696-701. [PMID: 31836682 DOI: 10.2967/jnumed.119.234914] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [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: 08/08/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023] Open
Abstract
18F-labeled prostate-specific membrane antigen (PSMA) PET tracers are increasingly used in preference to 68Ga-PSMA-11 for restaging biochemical recurrence (BCR) of prostate cancer. They are associated with longer half-lives, larger-scale production, and lower positron range than their 68Ga-labeled counterparts. Here, we describe the efficacy of an 18F-labeled radiohybrid PSMA, rhPSMA-7, a novel theranostic PSMA-targeting agent for imaging BCR of prostate cancer. Methods: Datasets from 261 consecutive patients with noncastrate BCR after radical prostatectomy who underwent 18F-rhPSMA-7 PET/CT at our institution between June 2017 and March 2018 were reviewed retrospectively. All lesions suspected of being recurrent prostate cancer were recorded. The detection rate for sites of presumed recurrence was correlated with patients' prostate-specific antigen (PSA) level, primary Gleason score, and prior therapy (androgen deprivation therapy and external-beam radiation therapy). Results: The 261 patients had a median PSA level of 0.96 ng/mL (range, 0.01-400 ng/mL). The median injected activity of 18F-rhPSMA-7 was 336 MBq, with a median uptake time of 76 min. In total, 211 patients (81%) showed pathologic findings on 18F-rhPSMA-7 PET/CT. The detection rates were 71% (42/59), 86% (44/51), 86% (42/49), and 95% (76/80) at PSA levels of 0.2 to <0.5 ng/mL, 0.5 to <1 ng/mL, 1 to <2 ng/mL, and ≥2 ng/mL, respectively. In 32% patients (7/22) with a PSA of less than 0.2 ng/mL, suggestive lesions were present. 18F-rhPSMA-7 PET/CT revealed local recurrence in 43% of patients (113). Lymph node metastases were present in the pelvis in 42% of patients (110), in the retroperitoneum in 17% (45), and in a supradiaphragmatic location in 8.0% (21). Bone and visceral metastases were detected in 21% (54) and 3.8% (10), respectively. Detection efficacy was not influenced by prior external-beam radiation therapy (79.1% vs. 82.1%, P = 0.55), androgen deprivation therapy within the 6 mo preceding imaging (80.6% vs. 80.9%, P = 0.54), or primary Gleason score (77.9% for ≤7 vs. 82.6% for ≥8, P = 0.38). Conclusion: 18F-rhPSMA-7 PET/CT offers high detection rates in early BCR after radical prostatectomy, especially among patients with low PSA values.
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Affiliation(s)
- Matthias Eiber
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Markus Kroenke
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Wurzer
- Chair of Radiopharmacy, Technical University of Munich, Munich, Germany
| | - Lena Ulbrich
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lena Jooß
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Maurer
- Department of Urology and Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Horn
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; and
| | - Kilian Schiller
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Langbein
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gabriel Buschner
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Wolfgang Weber
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Kroenke M, Wurzer A, Schwamborn K, Ulbrich L, Jooß L, Maurer T, Horn T, Rauscher I, Haller B, Herz M, Wester HJ, Weber WA, Eiber M. Histologically Confirmed Diagnostic Efficacy of 18F-rhPSMA-7 PET for N-Staging of Patients with Primary High-Risk Prostate Cancer. J Nucl Med 2019; 61:710-715. [PMID: 31836681 DOI: 10.2967/jnumed.119.234906] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 08/08/2019] [Accepted: 12/03/2019] [Indexed: 01/06/2023] Open
Abstract
18F-rhPSMA-7 (radiohybrid prostate-specific membrane antigen [PSMA]) is a novel ligand for PET imaging. Here, we present data from a retrospective analysis using PET/CT and PET/MRI examinations to investigate the efficacy of 18F-rhPSMA-7 PET for primary N-staging of patients with prostate cancer (PC) compared with morphologic imaging (CT or MRI) and validated by histopathology. Methods: Data from 58 patients with high-risk PC (according to the D'Amico criteria) who were staged with 18F-rhPSMA-7 PET/CT or PET/MRI at our institution between July 2017 and June 2018 were reviewed. The patients had a median prescan prostate-specific antigen value of 12.2 ng/mL (range, 1.2-81.6 ng/mL). The median injected activity of 18F-rhPSMA-7 was 327 MBq (range, 132-410 MBq), with a median uptake time of 79.5 min (range, 60-153 min). All patients underwent subsequent radical prostatectomy and extended pelvic lymph node dissection. The presence of lymph node metastases was determined by an experienced reader independently for both the PET and the morphologic datasets using a template-based analysis on a 5-point scale. Patient-level and template-based results were both compared with histopathologic findings. Results: Lymph node metastases were present in 18 patients (31.0%) and were located in 52 of 375 templates (13.9%). Receiver-operating-characteristic analyses showed 18F-rhPSMA-7 PET to perform significantly better than morphologic imaging on both patient-based and template-based analyses (areas under curve, 0.858 vs. 0.649 [P = 0.012] and 0.765 vs. 0.589 [P < 0.001], respectively). On patient-based analyses, the sensitivity, specificity, and accuracy of 18F-rhPSMA-7 PET were 72.2%, 92.5%, and 86.2%, respectively, and those of morphologic imaging were 50.0%, 72.5%, and 65.5%, respectively. On template-based analyses, the sensitivity, specificity, and accuracy of 18F-rhPSMA-7 PET were 53.8%, 96.9%, and 90.9%, respectively, and those of morphologic imaging were 9.6%, 95.0%, and 83.2%, respectively. Conclusion: 18F-rhPSMA-7 PET is superior to morphologic imaging for N-staging of high-risk primary PC. The efficacy of 18F-rhPSMA-7 is similar to published data for 68Ga-PSMA-11.
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Affiliation(s)
- Markus Kroenke
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Kristina Schwamborn
- Institute of Pathology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lena Ulbrich
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lena Jooß
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Maurer
- Martini-Klinik and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Horn
- Department of Urology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; and
| | - Isabel Rauscher
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael Herz
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Wolfgang A Weber
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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10
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Shouman M, Peeken J, Kroenke M, Maurer T, Gschwend J, Weber W, Eiber M, Combs S. CT-Based Radiomics Can Improve the Prediction of Recurrent Prostate Cancer-Positive Lymph Nodes. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Manabe O, Kroenke M, Aikawa T, Murayama A, Naya M, Masuda A, Oyama-Manabe N, Hirata K, Watanabe S, Shiga T, Katoh C, Tamaki N. Volume-based glucose metabolic analysis of FDG PET/CT: The optimum threshold and conditions to suppress physiological myocardial uptake. J Nucl Cardiol 2019; 26:909-918. [PMID: 29243072 DOI: 10.1007/s12350-017-1122-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/24/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE FDG PET/CT plays a significant role in the diagnosis of inflammatory heart diseases and cardiac tumors. We attempted to determine the optimal FDG uptake threshold for volume-based analyses and to evaluate the relationship between the myocardial physiological uptake volume in FDG PET and several clinical factors. METHODS A total of 190 patients were retrospectively analyzed. The cardiac metabolic volume (CMV) was defined as a volume within the boundary determined by a threshold (SUVmean of blood pool × 1.5). RESULTS The SUVmean of the blood pool measured in the descending aorta (DA) (r = 0.86, intraclass correlation coefficient [ICC] = 0.93, P < 0.0001) and that in the left ventricle (LV) cavity (r = 0.87, ICC = 0.90, P < 0.0001) showed high inter-operator reproducibility. However, the SUVmean in the LV cavity showed a significant correlation with the CMV (P = 0.0002, r = 0.26). The CMV in the patients who fasted < 18 hours were significantly higher (49.7 ± 73.2 vs. 18.0 ± 53.8 mL, P = 0.0013) compared to the patients with > 18-hour fasting. The multivariate analysis demonstrated that only the fasting period > 18 hours was independently associated with CMV = 0. CONCLUSION Our findings revealed that the DA is suitable to decide the threshold for the volume-based analysis. The fasting time was significantly associated with the cardiac FDG uptake.
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Affiliation(s)
- Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan.
| | - Markus Kroenke
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tadao Aikawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Atsuto Murayama
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Atsuro Masuda
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Kenji Hirata
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan
| | - Shiro Watanabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan
| | - Tohru Shiga
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan
| | - Chietsugu Katoh
- Faculty of Health Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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12
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Maurer* T, Kroenke M, Wurzer A, Schwamborn K, Ulbrich L, Jooß L, Horn T, Haller B, Weber W, Wester HJ, Eiber M. PD17-04 DIAGNOSTIC EFFICACY OF 18F-RHPSMA7 POSITRON EMISSION TOMOGRAPHY FOR N-STAGING OF PATIENTS WITH HIGH RISK PRIMARY PROSTATE CANCER. J Urol 2019. [DOI: 10.1097/01.ju.0000555564.39848.f8] [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: 11/25/2022]
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13
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Kroenke M, Hirata K, Gafita A, Watanabe S, Okamoto S, Magota K, Shiga T, Kuge Y, Tamaki N. Voxel based comparison and texture analysis of 18F-FDG and 18F-FMISO PET of patients with head-and-neck cancer. PLoS One 2019; 14:e0213111. [PMID: 30818360 PMCID: PMC6394953 DOI: 10.1371/journal.pone.0213111] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 11/23/2018] [Accepted: 02/14/2019] [Indexed: 12/22/2022] Open
Abstract
Background Hypoxia can induce radiation resistance and is an independent prognostic marker for outcome in head and neck cancer. As 18F-FMISO (FMISO), a hypoxia tracer for PET, is far less common than 18F-FDG (FDG) and two separate PET scans result in doubled cost and radiation exposure to the patient, we aimed to predict hypoxia from FDG PET with new techniques of voxel based analysis and texture analysis. Methods Thirty-eight patients with head-and-neck cancer underwent consecutive FDG and FMISO PET scans before any treatment. ROIs enclosing the primary cancer were compared in a voxel-by-voxel manner between FDG and FMISO PET. Tumour hypoxia was defined as the volume with a tumour-to-muscle ratio (TMR) > 1.25 in the FMISO PET and hypermetabolic volume was defined as >50% SUVmax in the FDG PET. The concordance rate was defined as percentage of voxels within the tumour which were both hypermetabolic and hypoxic. 38 different texture analysis (TA) parameters were computed based on the ROIs and correlated with presence of hypoxia. Results Within the hypoxic tumour regions, the FDG uptake was twice as high as in the non-hypoxic tumour regions (SUVmean 10.9 vs. 5.4; p<0.001). A moderate correlation between FDG and FMISO uptake was found by a voxel-by-voxel comparison (r = 0.664 p<0.001). The average concordance rate was 25% (± 22%). Entropy was the TA parameter showing the highest correlation with hypoxia (r = 0.524 p<0.001). Conclusion FDG uptake was higher in hypoxic tumour regions than in non-hypoxic regions as expected by tumour biology. A moderate correlation between FDG and FMISO PET was found by voxel-based analysis. TA yielded similar results in FDG and FMISO PET. However, it may not be possible to predict tumour hypoxia even with the help of texture analysis.
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Affiliation(s)
- Markus Kroenke
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,Department of Nuclear Medicine, Graduate School of Medicine of Hokkaido University, Sapporo, Japan
| | - Kenji Hirata
- Department of Nuclear Medicine, Graduate School of Medicine of Hokkaido University, Sapporo, Japan
| | - Andrei Gafita
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Shiro Watanabe
- Department of Nuclear Medicine, Graduate School of Medicine of Hokkaido University, Sapporo, Japan
| | - Shozo Okamoto
- Department of Nuclear Medicine, Graduate School of Medicine of Hokkaido University, Sapporo, Japan
| | - Keiichi Magota
- Department of Nuclear Medicine, Graduate School of Medicine of Hokkaido University, Sapporo, Japan
| | - Tohru Shiga
- Department of Nuclear Medicine, Graduate School of Medicine of Hokkaido University, Sapporo, Japan
| | - Yuji Kuge
- Central Institute of Isotope Science, of Hokkaido University, Sapporo, Japan
| | - Nagara Tamaki
- Department of Nuclear Medicine, Graduate School of Medicine of Hokkaido University, Sapporo, Japan
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Abstract
We herein report a rare case of mucinous tubular and spindle cell carcinoma (MTSCC) in an 80-year-old woman. A well circumscribed tumor located on the right kidney was discovered incidentally as a result of screening non-contrast CT. Fluorodeoxyglucose positron emission tomography (FDG PET)/CT showed the increased tracer accumulation in the tumor. The histological diagnosis was MTSCC, which is a rare and only recently established subtype of the malignant renal cell carcinoma (RCC). The present case suggests the clinical benefit of a high uptake of FDG combined with enhanced contrast CT in the differentiation of MTSCCs and other RCCs.
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Affiliation(s)
- Sho Furuya
- Department of Radiology, Otaru General Hospital, Japan
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Japan
| | | | | | | | - Kiyoshi Kasai
- Department of Diagnostic Pathology, Otaru General Hospital, Japan
| | - Markus Kroenke
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Japan
- Department of Nuclear Medicine, Rechts Der Isar Hospital, Technical University of Munich, Germany
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Japan
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Homma T, Manabe O, Ichinokawa K, Yamashita H, Oyama-Manabe N, Kato F, Hirata K, Kroenke M, Tamaki N. Breast cancer detected as an incidental finding on 99mTc-MIBI scintigraphy. Acta Radiol Open 2017; 6:2058460117715665. [PMID: 28804641 PMCID: PMC5533265 DOI: 10.1177/2058460117715665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/24/2017] [Indexed: 11/29/2022] Open
Abstract
We report a case of breast cancer detected as an incidental finding on 99mTc-MIBI scintigraphy. 99mTc-MIBI scintigraphy is usually used to evaluate cardiac perfusion or to detect ectopic parathyroid adenomas; however, it is also known to sensitively detect breast cancer. Accordingly, a few reports have described the incidental detection of breast cancer by 99mTc-MIBI scintigraphy performed to detect parathyroid adenoma. Our present case underscores the importance of attending to any incidental findings when searching for parathyroid adenomas using 99mTc-MIBI scintigraphy.
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Affiliation(s)
- Toshihiro Homma
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuomi Ichinokawa
- Department of Breast Surgery, Division of Surgery, Hokkaido University, Sapporo, Japan
| | - Hiroko Yamashita
- Department of Breast Surgery, Division of Surgery, Hokkaido University, Sapporo, Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Fumi Kato
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Kenji Hirata
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Markus Kroenke
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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16
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Manabe O, Naya M, Aikawa T, Obara M, Magota K, Kroenke M, Oyama-Manabe N, Hirata K, Shinyama D, Katoh C, Tamaki N. PET/CT scanning with 3D acquisition is feasible for quantifying myocardial blood flow when diagnosing coronary artery disease. EJNMMI Res 2017; 7:52. [PMID: 28585219 PMCID: PMC5459776 DOI: 10.1186/s13550-017-0296-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 03/30/2017] [Accepted: 05/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background The quantification of myocardial blood flow (MBF) and coronary flow reserve (CFR) are useful approaches for evaluating the functional severity of coronary artery disease (CAD). 15O-water positron emission tomography (PET) is considered the gold standard method for MBF quantification. However, MBF measurements in 15O-water PET with three-dimensional (3D) data acquisition, attenuation correction using computed tomography (CT), and time of flight have not been investigated in detail or validated. We conducted this study to evaluate the diagnostic potential of MBF measurements using PET/CT for a comparison of a control group and patients suspected of having CAD. Results Twenty-four patients with known or suspected CAD and eight age-matched healthy volunteers underwent rest and pharmacological stress perfusion studies with 15O-water PET/CT. The whole and three regional (left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) territory) MBF values were estimated. The CFR was computed as the ratio of the MBF during adenosine triphosphate-induced stress to the MBF at rest. The inter-observer variability was assessed by two independent observers. PET/CT using a 15O-water dose of 500 MBq and 3D data acquisition showed good image quality. A strong inter-observer correlation was detected in both the whole MBF analysis and the regional analysis with high intra-class correlation coefficients (r > 0.90, p < 0.001). Regional MBF at rest (LAD, 0.82 ± 0.15 ml/min/g; LCX, 0.83 ± 0.17 ml/min/g; RCA, 0.71 ± 0.20 ml/min/g; p = 0.74), MBF at stress (LAD, 3.77 ± 1.00 ml/min/g; LCX, 3.56 ± 1.01 ml/min/g; RCA, 3.27 ± 1.04 ml/min/g; p = 0.62), and CFR (LAD, 4.64 ± 0.90; LCX, 4.30 ± 0.64; RCA, 4.64 ± 0.96; p = 0.66) of the healthy volunteers showed no significant difference among the three regions. The global CFR of the patients was significantly lower than that of the volunteers (2.75 ± 0.81 vs. 4.54 ± 0.66, p = 0.0002). The regional analysis of the patients demonstrated that the CFR tended to be lower in the stenotic region compared to the non-stenotic region (2.43 ± 0.81 vs. 2.95 ± 0.92, p = 0.052). Conclusions 15O-water PET/CT with 3D data acquisition can be reliably used for the quantification of functional MBF and CFR in CAD patients.
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Affiliation(s)
- Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Tadao Aikawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Masahiko Obara
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Keiichi Magota
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Markus Kroenke
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Kenji Hirata
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Chietsugu Katoh
- Faculty of Health Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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