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Emerging topics and practical aspects for an appropriate use of amyloid PET in the current Italian context.
Nobili, F, Cagnin, A, Calcagni, ML, Chincarini, A, Guerra, UP, Morbelli, S, Padovani, A, Paghera, B, Pappatà, S, Parnetti, L, et al
The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of.... 2019;(1):83-92
Abstract
In May 2017 some representatives of the Italian nuclear medicine and neurological communities spontaneously met to discuss the issues emerged during the first two years of routine application of amyloid PET with fluorinated radiopharmaceuticals in the real world. The limitations of a binary classification of scans, the possibility to obtain early images as a surrogate marker of regional cerebral bloos flow, the need for (semi-)quantification and, thus, the opportunity of ranking brain amyloidosis, the correlation with Aβ42 levels in the cerebrospinal fluid, the occurrence and biological meaning of uncertain/boderline scans, the issue of incidental amyloidosis, the technical pittfalls leading to false negative/positive results, the position of the tool in the diagnostic flow-chart in the national reality, are the main topics that have been discussed. Also, a card to justify the examination to be filled by the dementia specialist and a card for the nuclear medicine physician to report the exam in detail have been approved and are available in the web, which should facilitate the creation of a national register, as previewed by the 2015 intersocietal recommendation on the use of amyloid PET in Italy. The content of this discussion could stimulate both public institutions and companies to support further research on these topics.
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Selectivity of probes for PET imaging of dopamine D3 receptors.
Doot, RK, Dubroff, JG, Labban, KJ, Mach, RH
Neuroscience letters. 2019;:18-25
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Abstract
Dopamine D3 receptors have key roles in behavioral reward, addiction, Parkinson's disease, and schizophrenia, and there is interest in studying their role in these disorders using PET. However, current PET radiotracers for studying D3 receptors in humans all bind to both D2 and D3 due to similarities between the two receptors. Selective D2 and D3 radioligands would aid investigation of the differences between D2 and D3 circuitry in the central nervous system. While there are currently in vitro measures of ligand D3/D2 selectivity, there is a need for an in vivo PET measure of D3/D2 selectivity. This review discusses current PET imaging of dopamine D2/D3 receptors and proposes methodology for quantitating in vivo selectivity of probes for PET imaging of dopamine D3 receptors.
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Review of 18F-Fluciclovine PET for Detection of Recurrent Prostate Cancer.
Gusman, M, Aminsharifi, JA, Peacock, JG, Anderson, SB, Clemenshaw, MN, Banks, KP
Radiographics : a review publication of the Radiological Society of North America, Inc. 2019;(3):822-841
Abstract
Fluorine 18 (18F) fluciclovine (anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid [FACBC]) is a radiolabeled amino acid analog that takes advantage of the amino acid transport upregulation in several types of cancer cells. FACBC is taken up to a greater extent in prostate cancer cells than in surrounding normal tissue, providing an opportunity for its use in cases of this common cancer. In 2016, the U.S. Food and Drug Administration found the accuracy of FACBC PET to be superior to that of other molecular imaging techniques and subsequently granted approval for its use in PET of recurrent prostate cancer. As FACBC is an 18F radiotracer, an on-site cyclotron is not required for its production. This feature enables the widespread clinical availability of this agent and, in turn, an opportunity for improved patient care. The clinical pharmacology and imaging features of FACBC are reviewed, and the role of this agent in the imaging of recurrent prostate cancer, within the context of research that supports its effectiveness, is discussed. The administration of and image acquisition facilitated by using FACBC, as compared with 18F fluorodeoxyglucose, which is more widely used, are described. In addition, the criteria for interpreting FACBC imaging findings are outlined, with emphasis on common causes of false-positive and false-negative findings. ©RSNA, 2019.
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Utility of Molecular Imaging with 2-Deoxy-2-[Fluorine-18] Fluoro-DGlucose Positron Emission Tomography (18F-FDG PET) for Small Cell Lung Cancer (SCLC): A Radiation Oncology Perspective.
Sager, O, Dincoglan, F, Demiral, S, Uysal, B, Gamsiz, H, Elcim, Y, Gundem, E, Dirican, B, Beyzadeoglu, M
Current radiopharmaceuticals. 2019;(1):4-10
Abstract
BACKGROUND AND OBJECTIVE Although accounting for a relatively small proportion of all lung cancers, small cell lung cancer (SCLC) remains to be a global health concern with grim prognosis. Radiotherapy (RT) plays a central role in SCLC management either as a curative or palliative therapeutic strategy. There has been considerable progress in RT of SCLC, thanks to improved imaging techniques leading to accurate target localization for precise delivery of RT. Positron emission tomography (PET) is increasingly used in oncology practice as a non-invasive molecular imaging modality. METHODS Herein, we review the utility of molecular imaging with 2-deoxy-2-[fluorine-18] fluoro-Dglucose PET (18F-FDG PET) for SCLC from a radiation oncology perspective. RESULTS There has been extensive research on the utility of PET for SCLC in terms of improved staging, restaging, treatment designation, patient selection for curative/palliative intent, target localization, response assessment, detection of residual/recurrent disease, and prediction of treatment outcomes. CONCLUSION PET provides useful functional information as a non-invasive molecular imaging modality and may be exploited to improve the management of patients with SCLC. Incorporation of PET/CT in staging of patients with SCLC may aid in optimal treatment allocation for an improved therapeutic ratio. From a radiation oncology perspective, combination of functional and anatomical data provided by integrated PET/CT improves discrimination between atelectasis and tumor, and assists in the designation of RT portals with its high accuracy to detect intrathoracic tumor and nodal disease. Utility of molecular imaging for SCLC should be further investigated in prospective randomized trials to acquire a higher level of evidence for future potential applications of PET.
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Fluorodeoxyglucose PET for Monitoring Response to Embolotherapy (Transarterial Chemoembolization) in Primary and Metastatic Liver Tumors.
Schobert, I, Chapiro, J, Pucar, D, Saperstein, L, Savic, LJ
PET clinics. 2019;(4):437-445
Abstract
Response to transarterial chemoembolization (TACE) in patients with liver cancer is commonly assessed on MRI or CT to quantify tumor necrosis and morphologic changes that occur gradually. However, the efficacy of embolotherapies remains limited because of local recurrence, as treated tumors demonstrate individual molecular characteristics that alter susceptibility and response to embolotherapies. Upregulation of cancer cell glycolysis can be detected by fluorine-18-fluorodeoxyglucose PET. Therefore, the combination of functional (PET) with commonly used cross-sectional imaging techniques (MRI, CT) can help characterize and monitor liver tumors with the potential to improve TACE toward becoming a more personalized and tumor microenvironment-directed therapy.
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How we read: the combined use of MRI and novel PET tracers for the characterisation and treatment planning of masses in neuro-oncology.
Lasocki, A, Hicks, RJ
Cancer imaging : the official publication of the International Cancer Imaging Society. 2019;(1):57
Abstract
Technical advances in imaging are well demonstrated by MRI (Magnetic Resonance Imaging) and PET (Positron Emission Tomography). Excellent anatomical detail and a lack of ionising radiation make MRI the standard of care for most neuroimaging indications, and advanced sequences are providing an ever-growing ability for lesion characterisation. PET utilising the tracer fluorine-18 fluorodeoxyglucose is widely used in oncology, while newer PET tracers are able to target a growing number of metabolic pathways and cell membrane receptors. The sequential use of these modalities harnesses the strengths of both, providing complementary diagnostic and therapeutic information.Here we outline the ways in which we use MRI and PET in a complementary manner to improve lesion characterisation in neuro-oncology. Most commonly, an abnormality is detected on either PET or MRI, and the addition of the other modality allows a more confident diagnosis and/or demonstrates additional lesions, guiding treatment decisions and, in some cases, obviating the need for biopsy. These modalities may also be combined to guide the treatment of intracranial masses for which the diagnosis is known, such as neuro-endocrine tumour metastases or meningiomas refractory to conventional therapies.
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Neuroimaging in Dementias.
Mahalingam, S, Chen, MK
Seminars in neurology. 2019;(2):188-199
Abstract
Dementia is a global health issue, the burden of which will worsen with an increasingly aging population. Alzheimer's disease (AD) is the most common dementia, with 50 to 60% of all dementias attributable to AD alone, while the rest are mostly due to frontotemporal lobar dementia, dementia with Lewy bodies, Parkinson's disease dementia, and vascular dementia. Diagnosis of dementias is made clinically with the aid of other testing modalities including neuroimaging. While the role of imaging has traditionally been to exclude reversible causes of dementia, positron emission tomography (PET) with 18-fluorine fluorodeoxyglucose and magnetic resonance imaging now are increasingly used more for definitive diagnosis of dementia in the prodromal stages and to aid with formulating the differential diagnoses. Introduction of molecular imaging modalities such as amyloid PET and tau PET have improved diagnostic certainty in the clinical trial setting and promise to find their way into the clinic in the near future. In this review, we will focus on the multimodality imaging of dementias especially AD and its differential diagnoses.
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Principles and current trends in the correlative evaluation of glioma with advanced MRI techniques and PET.
Tsiouris, S, Bougias, C, Fotopoulos, A
Hellenic journal of nuclear medicine. 2019;(3):206-219
Abstract
Cerebral gliomas comprise a heterogeneous group of primary neoplasms of the central nervous system, representing a signifcant cause of cancer morbidity and mortality. Contrast-enhanced magnetic resonance imaging (MRI) is paramount for identifying structural brain abnormalities related to the development of gliomas. Although morphological MRI remains the current standard of care for initial diagnostic workup, surgical planning, monitoring therapy response and surveillance during follow-up, it is rather diffcult to define tumor grade and boundaries and to assess response to radiochemotherapy solely by contrast-enhancement, due to a variety of factors influencing blood-brain barrier (BBB) permeability and contrast agent distribution. The nature of a lesion lies beyond often misleading gross structural patterns, down to the cellular and molecular level, hence the imaging techniques of advanced multimodal MRI and positron emission tomography (PET) have emerged to provide critical non-invasive insight into the underlying biology of primary brain cancer. Out of the various PET radiotracers, labeled amino acids are of particular significance due to their non-dependency on BBB disruption to reach glioma cells and their excellent tumor-to-background contrast. After discussing the basic imaging principles of MR perfusion, diffusion, spectroscopy and PET in glioma, this review focuses on the correlative imaging with amino acid PET and advanced MRI techniques in tumor grading and staging, in guiding stereotactic biopsy and surgical excision and in assessing therapy response, post-therapy surveillance and prognosis. Lastly, a reference is made on the expanding availability of integrated PET/MRI systems and the resulting benefits of simultaneous image acquisition.
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Evolving Role of MR Imaging and PET in Assessing Osteoporosis.
Austin, AG, Raynor, WY, Reilly, CC, Zadeh, MZ, Werner, TJ, Zhuang, H, Alavi, A, Rajapakse, CS
PET clinics. 2019;(1):31-41
Abstract
An imbalance in bone remodeling results in many metabolic bone diseases, such as osteoporosis. fluorine-18 sodium fluoride PET imaging allows the assessment of bone remodeling process in a anatomy specific manner. On the other hand structural imaging modalities such as MRI can now generate high resolution images of bone including the trabecular and cortical microstructure. Molecular (functional) imaging with PET in conjunction with structural imaging has the potential to improve the way metabolic bone diseases are managed in the clinic.
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The Deauville criteria cannot differentiate between responding and non-responding non-Hodgkin lymphoma patients.
Adams, HJA, Kwee, TC
Annals of hematology. 2018;(4):719-720