[Show abstract][Hide abstract] ABSTRACT: Rationale:
to investigate the role of (68)Ga-DOTA-NOC SUVmax as a potential prognostic factor in patients with pancreatic neuroendocrine tumour (pNET).
Among the patients who underwent (68)Ga-DOTANOC PET/CT, we retrospectively collected data of those with pNET G1 or G2 (2010 WHO classification), presenting disease at PET/CT and CT, with at least 6 months follow-up. MEN patients were excluded.
Overall, 43 patients were included. No significant differences in the SUVmax values were observed with respect to gender, tumour syndrome, stage, WHO classification and Ki67. During follow-up (median 20 months), 11 patients (35.6%; median: 33 months; IQR: 20-48 months) had stable disease (SD) while 32 (74.4%) had progressive disease (PD, median: 19 months; IQR, 14-26 months). SUVmax was significantly higher (P = 0.022) in patients with SD at 24 months follow-up as compared to patients with PD. The best SUVmax cut-off ranged from 37.8 to 38.0. The major risk factors for progression included a SUVmax ≤ 37.8 (HR=3.09, P = 0.003), Ki67>5% (HR=2.89, P = 0.009) and medical therapy alone (HR=2.36, P = 0.018). Advanced (IV) stage (P = 0.026), SUVmax<37.8 (P = 0.043), medical therapy alone (P = 0.015) were also confirmed at multivariate analysis. Overall, median progression-free survival (PFS) was 23 months. Significant differences in PFS were observed in relationship to Ki67 (median: 45 months for Ki67≤5%; 20 months for ki67>5%; P = 0.005; ), SUVmax (<37.8 vs > 38.0: 16.0 vs 27.0 months P = 0.002) and type of therapy (medical vs PRRT: 16.0 vs 26.0 months; P = 0.014).
(68)Ga-DOTA-NOC SUVmax is a relevant prognostic factor in patients with pNET G1 and G2 and its routine employment will improve the characterization and management of these patients that may present with a heterogenous clinical behaviour.
Full-text · Article · Sep 2015 · Journal of Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: Purpose:
This study evaluates the use of sequential I PET/CT for predicting absorbed doses to metastatic lesions in patients with differentiated thyroid cancer undergoing I therapy.
From July 2011 until July 2013, 30 patients with metastatic differentiated thyroid cancer were enrolled. Each participant underwent PET/CT at 4, 24, 48, and 72 hours with 74 MBq of I. Blood samples and whole-body exposure measurements were obtained to calculate blood and red marrow doses. Activity concentrations and lesion volumes obtained from PET/CT were used to evaluate tumor doses with medical internal radiation dose formalism and spheres modeling. Mean administered I therapeutic dose was 5994 MBq (range, 1953-11,455 MBq).
I PET/CT demonstrated all lesions detected by posttherapy I whole-body scans. Mean dose rates for blood, red marrow, and lesions were as follows: 0.07 ± 0.02 mGy/MBq, 0.05 ± 0.02 mGy/MBq, and 46.5 ± 117 mGy/MBq, respectively. Despite the high level of thyroid-stimulating hormone and CT detectable lesions, 15 of 30 patients did not show any abnormal I uptake.
The quantitative value of I PET/CT allows simple and accurate evaluation of lesion dosimetry following medical internal radiation dose formalism. Negative I PET/CT predicts absence of iodine avidity, potentially allowing avoidance of therapeutically ineffective I administration.
Full-text · Article · Jun 2014 · Clinical Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: When an intense intestinal FDG accumulation is present, especially if focal, it can be referred to either physiological intestinal activity or bowel disease, thus leading to a radical change in patient's prognosis. Within a year, we recommended a colonoscopy to 103 of 7365 patients who were subjected to a total body FDG PET/CT and in a case-series study we re-evaluated the patients and their lesions if already investigated with colonoscopy and biopsy. Only 18 patients were included in our study, but in none of them biopsy was negative and 3 adenocarcinomas, 8 adenomas, 5 inflammatory pattern, 1 hyperplastic polyp and 1 eosinophylic infiltrate were diagnosed. In 16 patients, no suspicion was present and diagnosis was absolutely incidental. Besides, among the three major groups (adenocarcinomas, adenomas and phlogosis), SUVmax values were significantly different. Adenocarcinomas are mainly linked with SUVmax higher than 8 and size larger than 15 mm. In detecting inflammatory localizations, FDG PET SE is of 100% if SUVmax is higher than 4. SE is lower in detecting adenomas, being 71.4% if they are larger than 6 mm and 50% if SUVmax is lower than 4.9. CCR is still the second leading cause of cancer death, for this reason in many countries screening programs have been approved and colonoscopy is considered the golden standard. PET/CT cannot be considered as a screening test, but if it incidentally reveals intestinal abnormalities, this data cannot be underestimated and colonoscopy is highly recommended.
No preview · Article · Jun 2014 · Current Radiopharmaceuticals
[Show abstract][Hide abstract] ABSTRACT: Testicular tumour is the most common malignancy in young men. The diagnostic work-up is mainly based on morphological imaging. The aim of our study was to evaluate the clinical impact of (18)F-FDG PET/CT in patients with testicular tumour.
We retrospectively evaluated all patients studied by (18)F-FDG PET/CT at our centre. Inclusion criteria were: pathological confirmation of testicular tumour, contrast-enhanced CT scan performed within a month of the PET/CT scan, and clinical/imaging follow-up performed at the Oncology Unit of our hospital. Overall, 56 patients were enrolled and 121 PET/CT scans were evaluated. (18)F-FDG PET/CT was performed following standard procedures and the results were compared with clinical, imaging and follow-up data. Clinicians were contacted to enquire whether the PET/CT scan influenced the patient's management. Answers were scored as follows: start/continue chemotherapy or radiotherapy, indication for surgery of secondary lesions, and clinical surveillance.
On a scan basis, 51 seminoma and 70 nonseminoma (NS) cases were reviewed. Of the 121 cases. 32 were found to be true-positive, 74 true-negative, 8 false-positive and 6 false-negative by PET/CT. PET/CT showed good sensitivity and specificity for seminoma lesion detection (92 % and 84 %, respectively), but its sensitivity was lower for NS forms (sensitivity and specificity 77 % and 95 %, respectively). The PET/CT scan influenced the clinical management of 47 of 51 seminomas (in 6 chemotherapy was started/continued, in 3 radiotherapy was started/continued, in 2 surgery of secondary lesions was performed, and in 36 clinical surveillance was considered appropriate), and 59 of 70 NS (in 18 therapy/surgery was started/continued, and in 41 clinical surveillance was considered appropriate).
Our preliminary data demonstrate the potential usefulness of PET/CT for the assessment of patients with testicular tumour. It provides valuable information for the clinical management, particularly for clinical surveillance, post-therapy assessment and when relapse is suspected.
Full-text · Article · Nov 2013 · European Journal of Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: Aim: The aim of this work was the evaluation of the usefulness of 124I PET/CT sequential scans to predict absorbed doses to metastatic thyroid cancer in patients undergoing 131I therapy. Methods: From July 2011 until April 2012 8 patients affected by metastatic thyroid cancer were enrolled. Each patient underwent 4 PET/CT scans at 4, 24, 48, 72 h after the administration of about 74 MBq of 124I. Blood samples and whole body exposure measurements were obtained to calculate blood and red marrow doses. Activity concentrations and lesion volumes obtained from PET/CT images were used to evaluate tumour doses with MIRD formalism and spheres model. The average administered 131I therapeutic activity was 6475 MBq (range: 3700-9250 MBq). Results: 124I PET/CT images showed, with a very good resolution, all 131I avid lesions detected by post therapy whole body scans. The average dose rates for blood, red marrow and lesions were respectively: 6.58E-02±1.64E-02 mGy/MBq, 5.73E-02±1.57E-02 mGy/MBq, 2.22E+01±1.62E+01 mGy/MBq. Three out of eight patients did not show any uptake of 124I in all PET/CT scans, despite high level of TSH and CT detectable lesions. Post-therapy 131I whole body scan confirmed the absence of focal iodine uptake. Conclusion: Negative 124I PET/CT images probably could be used as predictive of real absence of iodine avidity, avoiding all toxicity from useless 131I therapy. A higher number of patients is necessary to validate these preliminary results and a project is ongoing to compare MIRD results to voxel dosimetry based on Monte Carlo simulation.
Full-text · Article · Dec 2012 · 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...
[Show abstract][Hide abstract] ABSTRACT: The aim of this review is to evaluate clinical applications of (11)C-acetate positron emission tomography (PET). Acetate is quickly metabolized into acetyl-CoA in human cells. In this form it can either enter into the tricarboxylic acid cycle, thus producing energy, as happens in the myocardium, or participate in cell membrane lipid synthesis, as happens in tumor cells. (11)C-acetate PET was originally employed in cardiology, to study myocardial oxygen metabolism. More recently it has also been used to evaluate myocardial perfusion, as well as in oncology. The first studies of (11)C-acetate focused on its use in prostate cancer. Subsequently, (11)C-acetate was studied in other urological malignancies, as well as renal cell carcinoma and bladder cancer. Well differentiated hepatocellular carcinoma represents an (18)F-fluoro-deoxyglucose ((18)F-FDG) PET pitfall, so many authors have proposed to use (11)C-acetate in addition to (18)F-FDG in studying this tumor. (11)C-acetate PET has also been used in other malignancies, such as brain tumors and lung carcinoma. Some authors reported a few cases in which (11)C-acetate PET incidentally found multiple myeloma or rare tumors, such as thymoma, multicentric angiomyolipoma of the kidney and cerebellopontine angle schwannoma. Lastly, (11)C-acetate PET was also employed in a differential diagnosis case between glioma and encephalitis. The numerous studies on (11)C-acetate have demonstrated that it can be used in cardiology and oncology with no contraindications apart from pregnancy and the necessity of a rapid scan. Despite its limited availability, this tracer can surely be considered to be a promising one, because of its versatility and capacity to even detect non (18)F-FDG-avid neoplasm, such as differentiated lung cancer or hepatocellular carcinoma.
Full-text · Article · Nov 2012 · American Journal of Nuclear Medicine and Molecular Imaging
[Show abstract][Hide abstract] ABSTRACT: A case of Erdheim-Chester disorder, a rare non-Langerhans' cell histiocytosis, was referred for restaging by F-18 FDG PET/CT more than 10 years after initial diagnosis. The patient presented diabetes insipidus, hypergondotropic hypogonadism, and osteosclerotic lesions. Previous bone scintigraphy documented pathognomonic long bones' involvement. Chronic steroid and hormone replacement therapy was administered, and the patient was asymptomatic. F-18 FDG PET/CT was useful for disease restaging at cardiac and soft tissues level.
No preview · Article · Feb 2012 · Clinical nuclear medicine
[Show abstract][Hide abstract] ABSTRACT: Ovarian carcinoma (OC) is a common cancer in the Western Countries, and an important cause of death in patients suffering with gynaecologic malignancies. The majority of patients present with advanced disease at the time of diagnosis. Treatment with debulking surgery followed by chemotherapy is the standard approach while chemotherapy is contemplated when surgery is not possible. A correct pre-operative staging is important to ensure a most appropriate management. Laparoscopy (LPS) is the standard diagnostic tool for the assessment of intraperitoneal infiltration but is invasive and requires general anaesthesia. FDG-PET/CT is increasingly used for staging different types of cancer, and the aim of this study is to assess the value of FDG-PET/CT in staging advanced OC and its sensitivity to detect lesions in different quadrants of the abdominal-pelvic area compared to laparoscopy.
From September 2004 till April 2008, 40 patients with high suspicion of OC were referred to our hospital for diagnostic LPS to explore the possibility of optimal debulking surgery. Those who were not suitable for surgery were referred for chemotherapy. Before chemotherapy, the patients underwent an FDG-PET/CT scan. The findings in 9 quadrants of abdominal-pelvic area (total 360 quadrants) for PET/CT and LPS were recorded and compared.
In 14/360 areas (3.8%), surgical evaluation was not possible because of presence of adhesions, thus the number of areas explored by laparoscopy was 346. Tumour was found in 308 quadrants (38 quadrants free of disease). PET/CT was positive in all 40 patients with true negative results in 26/346 quadrants (7.5%), and true positives results in 243/346 quadrants (70.2%). False positive and negative PET/CT results were found in 12/346 and 65/346 quadrants, respectively. False positive PET/CT findings were evenly present in all quadrants. False negative PET/CT findings were present in 31/109 (28.4%) upper abdominal quadrants (epigastrium and diaphragmatic areas). Final analysis showed a sensitivity and specificity for PET/TC of 78.9 and 68.4% respectively with a positive predictive value of 95.3%. A significant difference was noted between mean SUVmax associated with lesions smaller or larger than 0.5 cm (p=0.006).
Our results suggest that PET/CT may prove a useful tool for pre-surgical staging of ovarian cancer with a sensitivity and specificity of 78 and 68%, respectively. However, it may be used in combination with laparoscopy for better results. PET/CT showed an adequate correlation between SUVmax values and laparoscopy findings of lesions>5mm, but a high rate of false negative results in lesions<5mm such as in carcinomatosis. PET/CT should be used carefully in early stage disease, with low risk of peritoneal infiltration, because of high rate of false positive results, to avoid unnecessary therapy procedures.
No preview · Article · Nov 2011 · European journal of radiology
[Show abstract][Hide abstract] ABSTRACT: A 37-year-old man was admitted for sudden onset of palpitation and chest X-ray detected a parahilar lung mass. Thoracic CT was suggestive of sarcoidosis (multiple lung nodules and mediastinal nodes) while abdominal ultrasound showed enlarged liver and spleen. Liver and lung biopsies showed sarcoid granulomas. 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT was performed for staging and detected the presence of hypermetabolic lung nodules [maximum standardized uptake value (SUVmax )3 .7], lymph nodes (cervical, mediastinal, abdominal, inguinal), liver (SUVmax 3) and spleen (SUVmax 9.7). Moreover, PET/ CT documented multiple hypermetabolic cystic lesions at bone level (SUVmax 12), involving almost all skeletal segments included in the field of view. Sarcoidosis is a granulomatous disorder of unknown cause, commonly affecting young and middle-aged adults . Although mostly limited to the lungs, systemic manifestations of sarcoidosis may occur. Cases presenting with heart, central nervous system and eye involvement or pulmonary hypertension are associated with poorer prognosis and systemically treated . Bone involvement is relatively rare (1–14%) [3, 4] and often asymptomatic. 18 F-FDG PET/CT may be helpful for the assessment of active disease sites in sarcoidosis patients, especially to identify extrapulmonary involvement performing a single imaging procedure, and to guide bioptical sampling in cases needing pathological confirmation.
Full-text · Article · May 2011 · European Journal of Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: Patients treated for ovarian cancer are usually referred for 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (FDG PET/CT) in case of increased Carcinoma Antigen 125 (CA125) but negative conventional imaging. However, there is not enough in the literature to support the value of FDG PET/CT in this context. This study aimed to assess role of FDG PET/CT in a cohort of patients with treated ovarian cancer and correlate the results with serum levels of CA125.
We retrospectively studied 175 patients, mean age 65.2 years (range 24-88 years) who had radical treatment for ovarian cancer (chemotherapy, surgery or combination). The patients had a standard FDG PET/CT and measurement of serum CA125 within a month of the scan. PET/CT was considered positive if demonstrated areas of abnormally increased metabolic activity unrelated to physiological distribution, on the basis of a visual analysis. The results of PET/CT imaging were compared to the level of CA125, and receiver operating characteristic (ROC) curves were plotted and area-under-the curve (AUC) statistics were computed. Cytologic or histologic data or clinical and imaging follow-up were taken as gold standard.
Patients were divided into five groups based on CA125 values. The average level of CA125 was 107.7 (range 3-867, SD 166.1). PET/CT was positive in 125/175 cases (71.4%), mean value of CA125 132.2 (SD 182.9) and negative in 50/175 (28.6%), mean value of CA125 46.4 (SD 89.3). In descriptive ROC analyses, the discriminatory power of this marker was relatively high (AUC statistics 0.77, range = 0.703-0.8). The optimal cut-off point of CA125 after treatment to reflect active disease on PET/CT was 18 U/mL achieving a detection rate of 85.6%. There was no relation between PET/CT negativity and the histological type of the tumor.
PET/CT was able to detect active disease at relatively low levels of CA125, thereby facilitating the early diagnosis of recurrence or residual disease. Also in patients with low CA125 levels (<30), PET/CT had a relatively high detection rate (53%). According to our preliminary results, the use of FDG PET/CT in this setting is justified even with low serum CA125 levels.
No preview · Article · Feb 2011 · Molecular imaging and biology: MIB: the official publication of the Academy of Molecular Imaging
[Show abstract][Hide abstract] ABSTRACT: We observed a 34-year-old man who was incidentally found to have an adrenal mass during surgical follow-up for perforated ulcer. The patient was subjected to I-123 MIBG scintigraphy, 68Ga-DOTANOC PET/CT, and F-18 DOPA PET/CT. Only F-18 DOPA PET/CT showed evidence of an avid adrenal mass. A CT-guided biopsy was performed and it was suggestive for pheochromocytoma. He underwent surgery and a pheochromocytoma, about 40 mm in diameter, was detected. Traditionally, I-123 MIBG scintigraphy has been used in detecting chromaffin cell tumors, but more recently it had been demonstrated that a certain part of pheochromocytoma could be false-negative on scintigraphy.
No preview · Article · Feb 2011 · Clinical nuclear medicine
[Show abstract][Hide abstract] ABSTRACT: Spine infections require a multidisciplinary approach to be treated and solved. A guide line to drive physicians in the deep complexity of such a disease is extremely helpful. SIMP suggests a flow-chart built up on clear concepts such as right and well managed antibiotic therapy, sound stability of the spine, correct and smart use of the standard and functional imaging techniques, such as f18 FDG PET/CT. In 16 months a total of 41 patients have been treated for spondylodiscitis, discitis and vertebral osteomyelitis by our team of physicians and 25 patients have been enrolled in a prospective study whose target is the assessment of the SIMP flow-chart and of every single aspect that characterize it.
No preview · Article · Jan 2011 · International journal of immunopathology and pharmacology
[Show abstract][Hide abstract] ABSTRACT: A case of Von-Hippel Lindau (VHL) disease has been studied using 68Ga-DOTA-NOC PET/CT. PET/CT demonstrated the presence of somatostatin receptors within 2 focal areas in the cerebellum corresponding to the lesions detected by MRI. Considering the heterogeneous lesions localizations in VHL disease, PET/CT may be a useful imaging modality for diagnosing lesions of central nervous system and neuroendocrine lesions and for direct demonstration of somatostatin receptors for targeted treatment.
No preview · Article · Jan 2011 · Clinical nuclear medicine