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1.
Glucagon-like peptide-1 receptor imaging for the localisation of insulinomas: a prospective multicentre imaging study.
Christ, E, Wild, D, Ederer, S, Béhé, M, Nicolas, G, Caplin, ME, Brändle, M, Clerici, T, Fischli, S, Stettler, C, et al
The lancet. Diabetes & endocrinology. 2013;(2):115-22
Abstract
BACKGROUND Small benign insulinomas are hard to localise, leading to difficulties in planning of surgical interventions. We aimed to prospectively assess the insulinoma detection rate of single-photon emission CT in combination with CT (SPECT/CT) with a glucagon-like peptide-1 receptor avid radiotracer, and compare detection rates with conventional CT/MRI techniques. METHODS In our prospective imaging study, we enrolled adults aged 25-81 years at centres in Germany, Switzerland, and the UK. Eligible patients had proven clinical and biochemical endogenous hyperinsulinaemic hypoglycaemia and no evidence for metastatic disease on conventional imaging. CT/MRI imaging was done at referring centres according to standard protocols. At three tertiary nuclear medicine centres, we used whole body planar images and SPECT/CT of the abdomen up to 168 h after injection of (111)In-[Lys40(Ahx-DTPA-(111)In)NH2]-exendin-4 ((111)In-DTPA-exendin-4) to identify insulinomas. Consenting patients underwent surgery and imaging findings were confirmed histologically. FINDINGS Between Oct 1, 2008, and Dec 31, 2011, we recruited 30 patients. All patients underwent (111)In-DTPA-exendin-4 imaging, 25 patients underwent surgery (with histological analysis), and 27 patients were assessed with CT/MRI. (111)In-DTPA-exendin-4 SPECT/CT correctly detected 19 insulinomas and four additional positive lesions (two islet-cell hyperplasia and two uncharacterised lesions) resulting in a positive predictive value of 83% (95% CI 62-94). One true negative (islet-cell hyperplasia) and one false negative (malignant insulinoma) result was identified in separate patients by (111)In-DTPA-exendin-4 SPECT/CT. Seven patients (23%) were referred to surgery on the basis of (111)In-DTPA-exendin-4 imaging alone. For 23 assessable patients, (111)In-DTPA-exendin-4 SPECT/CT had a higher sensitivity (95% [95% CI 74-100]) than did CT/MRI (47% [27-68]; p=0.011). INTERPRETATION (111)In-DTPA-exendin-4 SPECT/CT could provide a good second-line imaging strategy for patients with negative results on initial imaging with CT/MRI. FUNDING Oncosuisse, the Swiss National Science Foundation, and UK Department of Health.
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2.
Utility of preoperative [(18)]f fluorodeoxyglucose-positron emission tomography scanning in high-risk melanoma patients.
Brady, MS, Akhurst, T, Spanknebel, K, Hilton, S, Gonen, M, Patel, A, Larson, S
Annals of surgical oncology. 2006;(4):525-32
Abstract
BACKGROUND [(18)]F Fluorodeoxyglucose-positron emission tomography (PET) scanning provides functional imaging based on glucose uptake by tumors. Melanoma is a glucose-avid malignancy, and preoperative PET scanning in melanoma patients has the potential to guide appropriate treatment. METHODS We performed a prospective trial to evaluate the clinical utility of whole-body fluorine 18-labeled deoxyglucose-PET scanning used in addition to standard imaging (contrast-enhanced computed tomographic [CT] imaging of the chest, abdomen, and pelvis) in preoperative stage IIC (T4N0M0), III (any T, N1 to N3, M0), and IV (any T, any N, M1) melanoma patients. Pathologic or clinical follow-up within 4 to 6 months of the imaging studies was used to determine the accuracy of preoperative PET and CT scan findings. RESULTS Preoperative imaging findings led to a change in clinical management in 36 (35%) of 103 patients. In 32 (89%) of these patients, the information was accurate. Findings on PET scan alone (14 of 36; 39%) or in combination with CT (20 of 36; 56%) resulted in a treatment change in most patients (34 of 36; 94%). The most common decision was to cancel the operation (19 of 36; 53%). PET scanning was more sensitive than CT scanning in detecting occult disease (68% vs. 48%; P=.05), but both tests were highly specific (92% vs. 95%; P=.7, PET vs. CT). CONCLUSIONS PET scanning facilitates the appropriate management of high-risk melanoma patients being considered for operative intervention. PET imaging in addition to CT scanning should be strongly considered before operation in patients at high risk for occult metastatic disease.
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3.
Breast imaging. Preoperative breast cancer staging: comparison of USPIO-enhanced MR imaging and 18F-fluorodeoxyglucose (FDC) positron emission tomography (PET) imaging for axillary lymph node staging--initial findings.
Stadnik, TW, Everaert, H, Makkat, S, Sacré, R, Lamote, J, Bourgain, C
European radiology. 2006;(10):2153-60
Abstract
Magnetic resonance (MR) imaging after ultra-small super paramagnetic iron oxide (USPIO) injection and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for preoperative axillary lymph node staging in patients with breast cancer were evaluated using histopathologic findings as the reference standard. USPIO-enhanced MR and FDG-PET were performed in ten patients with breast cancer who were scheduled for surgery and axillary node resection. T2-weighted fast spin echo, T1-weighted three-dimensional (3D) gradient echo, T2*-weighted gradient echo and gadolinium-enhanced T1-weighted 3D gradient echo with spectral fat saturation were evaluated. MR imaging before USPIO infusion was not performed. The results were correlated with FDG-PET (acquired with dedicated PET camera, visual analysis) and histological findings. The histopathologic axillary staging was negative for nodal malignancy in five patients and positive in the remaining five patients. There was one false positive finding for USPIO-enhanced MR and one false negative finding for FDG-PET. A sensitivity (true positive rate) of 100%, specificity (true negative rate) of 80%, positive predictive value of 80%, and negative predictive value of 100% were achieved for USPIO-enhanced MR and of 80%, 100%, 100%, 80% for FDG-PET, respectively. The most useful sequences in the detection of invaded lymph nodes were in the decreasing order: gadolinium-enhanced T1-weighted 3D gradient echo with fat saturation, T2*-weighted 2D gradient echo, T1-weighted 3D gradient echo and T2-weighted 2D spin echo. In our study, USPIO-enhanced T1 gradient echo after gadolinium injection and fat saturation emerged as a very useful sequence in the staging of lymph nodes. The combination of USPIO-enhanced MR and FDG-PET achieved 100% sensitivity, specificity, PPV and NPV. If these results are confirmed, the combination of USPIO MR with FDG-PET has the potential to identify the patient candidates for axillary dissection versus sentinel node lymphadenectomy.
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4.
Use of stereotactic PET images in dosimetry planning of radiosurgery for brain tumors: clinical experience and proposed classification.
Levivier, M, Massager, N, Wikler, D, Lorenzoni, J, Ruiz, S, Devriendt, D, David, P, Desmedt, F, Simon, S, Van Houtte, P, et al
Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2004;(7):1146-54
Abstract
UNLABELLED We developed a technique that allows the routine integration of PET in stereotactic neurosurgery, including radiosurgery. We report our clinical experience with the combined use of metabolic (i.e., PET) and anatomic (i.e., MRI and CT) images for the radiosurgical treatment of brain tumors. We propose a classification describing the relative role of the information provided by PET in this multimodality image-guided approach. METHODS Between December 1999 and March 2003, 57 patients had stereotactic PET as part of their image acquisition for the planning of gamma knife radiosurgery. Together with stereotactic MRI and CT, stereotactic PET images were acquired on the same day using either (18)F-FDG or (11)C-methionine. PET images were imported in the planning software for the radiosurgery dosimetry, and the target volume was defined using the combined information of PET and MRI or CT. To analyze the specific contribution of the PET findings, we propose a classification that reflects the strategy used to define the target volume. RESULTS The patients were offered radiosurgery with PET guidance when their tumor was ill-defined and we anticipated some limitation of target definition on MRI alone. This represents 10% of the radiosurgery procedures performed in our center during the same period of time. There were 40 primary brain lesions, 7 metastases, and 10 pituitary adenomas. Abnormal PET uptake was found in 62 of 72 targets (86%), and this information altered significantly the MRI-defined tumor in 43 targets (69%). CONCLUSION The integration of PET in radiosurgery provides additional information that opens new perspectives for the optimization of the treatment of brain tumors.
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5.
FDG PET imaging for grading and prediction of outcome in chondrosarcoma patients.
Brenner, W, Conrad, EU, Eary, JF
European journal of nuclear medicine and molecular imaging. 2004;(2):189-95
Abstract
The aims of this study were to assess the potential of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) for tumor grading in chondrosarcoma patients and to evaluate the role of standardized uptake value (SUV) as a parameter for prediction of patient outcome. FDG PET imaging was performed in 31 patients with chondrosarcoma prior to therapy. SUV was calculated for each tumor and correlated to tumor grade and size, and to patient outcome in terms of local relapse or metastatic disease with a mean follow-up period of 48 months. Chondrosarcomas were detectable in all patients. Tumor SUV was 3.38 +/- 1.61 for grade I (n = 15), 5.44 +/- 3.06 for grade II (n = 13), and 7.10 +/- 2.61 for grade III (n =3). Significant differences were found between patients with and without disease progression: SUV was 6.42 +/- 2.70 (n = 10) in patients developing recurrent or metastatic disease compared with 3.74 +/- 2.22 in patients without relapse (P = 0.015). Using a cut-off of 4 for SUV, sensitivity, specificity, and positive and negative predictive values for a relapse were 90%, 76%, 64%, and 94%, respectively. Combining tumor grade and SUV, these parameters improved to 90%, 95%, 90%, and 95%, respectively. Pretherapeutic tumor SUV obtained by FDG PET imaging was a useful parameter for tumor grading and prediction of outcome in chondrosarcoma patients. The combination of SUV and histopathologic tumor grade further improved prediction of outcome substantially, allowing identification of patients at high risk for local relapse or metastatic disease.
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6.
PET and SPECT for detection of tumor progression in irradiated low-grade astrocytoma: a receiver-operating-characteristic analysis.
Henze, M, Mohammed, A, Schlemmer, HP, Herfarth, KK, Hoffner, S, Haufe, S, Mier, W, Eisenhut, M, Debus, J, Haberkorn, U
Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2004;(4):579-86
Abstract
UNLABELLED Differentiation between tumor progression and radiation necrosis is one of the most difficult tasks in oncologic neuroradiology. Functional imaging of tumor metabolism can help with this task, but the choice of tracer is still controversial. This prospective study following up irradiated low-grade astrocytoma (LGA) was, to our knowledge, the first receiver-operating-characteristic (ROC) analysis that intraindividually evaluated the diagnostic performance of the SPECT tracers 3-[(123)I]iodo-alpha-methyl-L-tyrosine (IMT) and (99m)Tc(I)-hexakis(2-methoxyisobutylisonitrile) (MIBI) and the PET tracer (18)F-FDG. METHODS We examined 17 patients, initially with histologically proven LGA and treated by stereotactic radiotherapy, who presented with new gadolinium-diethylenetriaminepentaacetic acid-enhancing lesions (n = 26) on MRI. At that time, MRI could not differentiate between progressive tumor and nonprogressive tumor. This MRI examination was closely followed by (18)F-FDG PET and by (99m)Tc-MIBI and (123)I-IMT SPECT. Lesions were classified as progressive tumor (n = 17) or nonprogressive tumor (n = 9) on the basis of prospective follow-up (through clinical examination, MRI, and proton MR spectroscopy) for 26.6 +/- 6.6 mo after PET or SPECT. RESULTS (123)I-IMT yielded the best ROC characteristics and was the most accurate for classification, with an area under the ROC curve (A(z)) of 0.991. The A(z) of (18)F-FDG (0.947) was not significantly lower than that of (123)I-IMT. The difference in the A(z) of (99m)Tc-MIBI (0.713) from the A(z) of the other tracers used in our study was highly significant (P ≤ 0.01). (99m)Tc-MIBI SPECT was of low accuracy and, especially, of poor sensitivity even at modest specificity values. CONCLUSION (123)I-IMT SPECT imaging of amino acid transport accurately detects tumor progression in patients with irradiated LGA. In contrast to (123)I-IMT, (18)F-FDG PET was slightly less accurate for classification, and (99m)Tc-MIBI SPECT was of limited value. Imaging of amino acid transport with (123)I-IMT is a valuable additional tool for the follow-up of LGA, allowing early, noninvasive differentiation of lesions with ambiguous morphology after irradiation.
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7.
Baseline/post-nitrate Tc-99m tetrofosmin mismatch for the assessment of myocardial viability in patients with severe left ventricular dysfunction: comparison with baseline Tc-99m tetrofosmin scintigraphy/FDG PET imaging.
Giorgetti, A, Marzullo, P, Sambuceti, G, Di Quirico, S, Kusch, A, Landi, P, Salvadori, PA, Pisani, P, L'abbate, A
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology. 2004;(2):142-51
Abstract
BACKGROUND Positron emission tomography (PET) flow/metabolic mismatch is considered the nuclear medicine gold standard for the assessment of myocardial viability. The aim of this study was to investigate whether baseline/nitrate technetium 99m tetrofosmin single photon emission computed tomography (SPECT) mismatch may provide equivalent clinical information. METHODS AND RESULTS We studied 23 patients (aged 62 +/- 10 years, 19 men) with previous myocardial infarction (16 anterior, 4 inferior, and 3 anterior plus inferior) and postischemic heart failure (gated SPECT [G-SPECT] ejection fraction, 26% +/- 8%). All patients underwent Tc-99m tetrofosmin G-SPECT at rest and after nitrates (intravenous isosorbide dinitrate, 0.2 mg/mL, 10 mL/h) as well as a fluorine 18 fluoro-2-deoxy-d-glucose (FDG) PET scan. Regional wall motion analysis was performed with quantitative G-SPECT (QGS). Myocardial dysfunction was defined as a regional QGS score of 2 or greater. Regional perfusion was assessed by quantitative perfusion score (QPS) providing percent Tc-99m tetrofosmin uptake in a 20-segment model. Semiquantitative analysis of FDG uptake was performed by use of polar maps generated by Siemens ECAT HR + software. In areas with a perfusion rate lower than 80%, PET viability was identified by a normalized FDG percent uptake/baseline Tc-99m tetrofosmin percent uptake ratio greater than 1.2. We analyzed 460 segments; 298 (64%) were dysfunctional by QGS analysis. Of these, 170 were viable by PET imaging whereas 128 were nonviable. Regional Tc-99m tetrofosmin uptake was higher in viable than in nonviable segments both at rest (60% +/- 24% vs 42% +/- 12%, P <.01) and after nitrates (67% +/- 20% vs 41% +/- 18%, P <.01). According to receiver operating characteristic curve analysis, a cutoff value of 63% for resting as well as post-nitrate G-SPECT provided the highest diagnostic accuracy for the detection of myocardial viability (67% and 72% at rest and after nitrates, respectively). When the same algorithm used for the comparison with PET (normalized nitrate percent uptake/baseline percent uptake) was applied to G-SPECT, we obtained the highest agreement with PET (accuracy, 93%; sensitivity, 95%; specificity, 92%). CONCLUSIONS In patients with severe left ventricular dysfunction, perfusion data alone, both at rest and after nitrates, do not allow an accurate estimate of myocardial viability. In dysfunctioning segments, the analysis of rest/post-nitrate Tc-99m tetrofosmin mismatch provides results similar to those obtained by PET flow/metabolic mismatch.
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8.
Early therapy monitoring with FDG-PET in aggressive non-Hodgkin's lymphoma and Hodgkin's lymphoma.
Torizuka, T, Nakamura, F, Kanno, T, Futatsubashi, M, Yoshikawa, E, Okada, H, Kobayashi, M, Ouchi, Y
European journal of nuclear medicine and molecular imaging. 2004;(1):22-8
Abstract
This study was designed to determine the value of 2-[fluorine-18]-fluoro-2-deoxy- d-glucose positron emission tomography (FDG-PET) in the early assessment of therapy response in lymphoma patients. We studied 20 patients with pathologically proven lymphoma, including 17 patients with aggressive non-Hodgkin's lymphoma and three patients with Hodgkin's lymphoma. All patients underwent whole-body FDG-PET imaging at baseline and after 1-2 cycles of chemotherapy. PET images were analysed visually and quantitatively by calculating the standardised uptake value (SUV). In each patient, we measured the SUV of the tumour demonstrating the highest FDG uptake at baseline study and the SUV of the same tumour after 1-2 cycles of therapy. The achievement of complete response was assessed on the basis of a combination of clinical findings and the results of conventional imaging modalities. Follow-up of progression-free survival (PFS) was obtained for the validation of PET data. Of the 20 patients, ten achieved complete remission at the completion of chemotherapy and the other ten did not respond to chemotherapy. Of the ten responders, four are still in remission (PFS 24-34 months) while the other six have relapsed (PFS 8-16 months). For the prediction of 24-month clinical outcome, visual analysis of PET after 1-2 cycles showed high sensitivity (87.5%) and accuracy (80%) but low specificity (50%). Comparison with the baseline SUVs revealed that the responders showed a significantly greater percent reduction in SUV after 1-2 cycles of therapy as compared with the non-responders (81.2%+/-9.5% vs 35.0%+/-20.2%, P<0.001). In addition, using 60% reduction as a cut-off value, the responders were clearly separated from the non-responders, with the exception of one non-responder. In conclusion, when performed early during chemotherapy, FDG-PET may be predictive of clinical outcome and allows differentiation of responders from non-responders in cases of aggressive lymphoma.
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9.
[18F]FDG in recurrent breast cancer: diagnostic performances, clinical impact and relevance of induced changes in management.
Grahek, D, Montravers, F, Kerrou, K, Aide, N, Lotz, JP, Talbot, JN
European journal of nuclear medicine and molecular imaging. 2004;(2):179-88
Abstract
Prognosis and management of patients with recurrent breast cancer depend on the spread of the disease. The aim of this study was to evaluate the performance of fluorine-18 fluorodeoxyglucose gamma camera positron emission tomography (FDG-GPET) in detecting breast cancer recurrence, its clinical impact and the relevance of induced changes in management. Patients (n = 134) with suspicion of recurrence either clinically or on conventional imaging (suspected recurrence: SR) or with an isolated increase in tumour marker levels (occult recurrence: OR) underwent FDG-GPET on a coincidence gamma camera. The reference standard for evaluation of accuracy, either histology (n = 26) or follow-up for 1 year (n = 49), was available in 75 (56%) patients. A questionnaire was sent to the referring clinician to evaluate the impact of FDG on management. Responses were obtained for 75 patients. Information regarding both approaches was available for 46 patients (46/134 = 34%). At the patient level, the sensitivity of FDG-GPET was 84%, significantly higher than the 63% sensitivity for conventional modalities, and the specificity was 78% versus 61%. The values for FDG-GPET were 81% and 86% respectively in the SR group and 90% and 73% respectively in the OR group, without any significant difference between these settings. The rate of change in management was 44% overall, 43% in the SR group and 45% in the OR group. Within the two groups, intermodality (major) changes were more frequent than intramodality (minor) changes. In the 46 patients for whom both approaches were available, 93% of management modifications were relevant (validated by biopsy or clinical follow-up). The results of this retrospective study show that FDG-GPET has an important role to play in patient management by confirming and evaluating the extent of recurrence or by localising occult recurrence.
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10.
[18F]FDG PET as a substitute for second-look laparotomy in patients with advanced ovarian carcinoma.
Kim, S, Chung, JK, Kang, SB, Kim, MH, Jeong, JM, Lee, DS, Lee, MC
European journal of nuclear medicine and molecular imaging. 2004;(2):196-201
Abstract
The aim of this study was to compare the prognostic value of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) with that of second-look laparotomy (SLL) in patients with advanced ovarian carcinoma following primary chemotherapy. Fifty-five patients who had undergone cytoreductive surgery and adjuvant chemotherapy for advanced ovarian carcinoma were enrolled in the study. Thirty patients underwent SLL after primary treatment (SLL group), while 25 underwent FDG PET after primary treatment without SLL (PET group) We retrospectively reviewed the medical records of the 55 patients for comparison of progression-free interval and disease-free interval between the two groups. Ovarian carcinomas recurred in 37 of the 55 patients. When the progression-free interval and the disease-free interval in patients in the PET group were compared with those in the SLL group, no significant differences were observed. The progression-free interval in the PET and SLL groups were 28.8 +/- 12.7 months and 30.6 +/- 13.7 months, respectively (P = 0.29). The disease-free interval in the negative PET group was 40.5 +/- 11.6 months, and that in the negative SLL group was 48.6 +/- 12.1 months (P = 0.12). In conclusion, FDG PET has a similar prognostic value to SLL, and can substitute for SLL in the follow-up of patients who have had ovarian carcinoma, especially when there is a high risk for recurrence.