Paola Castaldi

Università Cattolica del Sacro Cuore, Milano, Lombardy, Italy

Are you Paola Castaldi?

Claim your profile

Publications (34)76.21 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Study Design. Retrospective study. To evaluate, in a pediatric population, F-FDG metabolic activity of normal spinal cord and to assess the correlation with demographic, clinical and environmental variables. F-FDG uptake of normal spinal cord is variable in children. The knowledge of physiological metabolism of spinal cord is essential to distinguish normal from pathological findings on PET-CT. We retrospectively evaluated F-FDG PET-CT scans from a total of 167 pediatric patients (97 males; 3.9-18.9 years) divided into four age groups (0-4.9 years, 5-9.9 years, 10-14.9 years, 15-18.9 years), excluding those submitted to previous or recent therapeutic procedures influencing spinal cord metabolism or with central nervous system diseases. Spinal cord was divided into three levels (C1-C7; D1-D6; D7-L1) and maximum standardized uptake value (SUVmax) of each cord level was measured. Correlations between SUVmax and spinal cord level, age, body weight, gender, type of disease and season were statistically assessed. Median SUVmax was similar and significantly (p< 0.01) higher at C1-C7 and D7-L1 levels than at D1-D6 level and it significantly (p< 0.01) increased with age in all spinal cord levels. A positive and significant association between SUVmax and body weight, female gender and Hodgkin lymphoma was found. No significant association with season was observed. By multivariate analysis, only weight and female gender remained significant. Knowledge of physiological F-FDG spinal cord activity in children is essential for a correct interpretation of PET imaging, especially in oncologic pediatric patients to avoid potential pitfalls.
    No preview · Article · Mar 2015 · Spine
  • Vittoria Rufini · Paola Castaldi · Valerio Lanni
    [Show abstract] [Hide abstract]
    ABSTRACT: Nuclear medicine plays an important role in the diagnostic management of pancreatic neuroendocrine tumors (NETs). Specific radiopharmaceuticals based on the various biological properties of NETs have been developed, both for conventional scintigraphy and positron emission tomography (PET). In the clinical practice, the choice of the most appropriate radiopharmaceutical depends on several factors, including the biologic characteristics of the tumor (somatostatin receptor status, glucose metabolism, amine metabolism), the clinical information needed (diagnostic or prognostic), and practical issues such as availability and costs. For diagnostic purposes, the choice should be guided by tumor differentiation and grading. In well-differentiated NETs (G1 and low G2), functional imaging with radiolabeled peptides should be performed for lesion identification; in this context, 68Ga-DOTA-peptide PET/CT is considered the nuclear medicine technique of choice. 111In-DTPA-octreotide (OctreoScan®) SPECT/CT should be considered obsolete for diagnostic purposes and maintains a role only for evaluating the receptor status prior to therapy. 18F-FDG is the tracer of choice for imaging poorly differentiated NETs (high G2 and G3), where a loss of NET features is expected, and to obtain prognostic information, since the presence of 18F-FDG-positive lesions correlates with a poor prognosis independently from tumor grading. Other radiopharmaceuticals with a more limited use in pancreatic NETs, i.e., 18F-DOPA and 11C-5-HTP, are also shortly discussed.
    No preview · Article · Jan 2015
  • Source
    Paola Castaldi · Giorgio Treglia · Vittoria Rufini

    Full-text · Article · Sep 2013
  • Source

    Full-text · Article · Jun 2013 · Nuclear Medicine and Molecular Imaging
  • Source
    V Rufini · G Treglia · P Castaldi · G Perotti · A Giordano
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim: The aim of this paper was to systematically review published data about the comparison of radiolabelled metaiodobenzylguanidine (MIBG) scintigraphy and positron emission tomography (PET) with different radiopharmaceuticals in patients with pheochromocytoma and paraganglioma (Pheo/PGL). Methods: A comprehensive literature search of studies published in PubMed/MEDLINE and Embase databases through September 2012 and regarding MIBG scintigraphy and PET imaging with different radiopharmaceuticals in patients with Pheo/PGL was carried out. Results: Twenty-eight studies comprising 852 patients who underwent both MIBG scintigraphy and PET or PET/CT with different radiopharmaceuticals were included and discussed. Three studies evaluated carbon-11-hydroxyephedrine ([11C]HED) as PET radiopharmaceutical, nine studies fluorine-18-dopamine ([18F]DA), eight studies fluorine-18-dihydroxyphenylalanine ([18F]DOPA), twelve studies fluorine-18-fluorodeoxyglucose ([18F]FDG) and five studies gallium-68-somatostatin analogues. Conclusions: Despite the heterogeneity of the studies included in the analysis, it can be concluded that the diagnostic performance of PET with various agents is clearly superior to that of MIBG scintigraphy in patients with Pheo/PGL, mainly for familial, extra-adrenal and metastatic diseases; however, MIBG maintains a unique role in selecting patients suitable for 131I-MBG therapy. Further larger prospective studies comparing MIBG and different PET tracers in patients with Pheo/PGL as well as a cost-effectiveness analysis of the two techniques are needed.
    Full-text · Article · Jun 2013 · 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...
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A 33-year old man underwent an F-FDG PET/CT searching for the cause of a fever of unknown origin. F-FDG PET/CT incidentally detected a focal area of markedly increased radiopharmaceutical uptake corresponding to a 2.5-cm nodule in the right adrenal gland. Laboratory data ruled out the presence of a functioning adrenal lesion. All these findings were suggestive of adrenal malignancy. After right adrenalectomy, histology showed a benign solitary fibrous tumor of the adrenal gland. This case highlights that benign solitary fibrous tumor should be considered as possible false-positive F-FDG PET/CT finding for malignancy in evaluating adrenal incidentalomas.
    Full-text · Article · May 2013 · Clinical nuclear medicine
  • Source

    Full-text · Article · Mar 2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: In 2007, sorafenib was the first drug able to improve overall survival in patients with advanced hepatocellular carcinoma. AIM: In 2005 we designed a phase II study to assess safety and efficacy of sunitinib. METHODS: This is a single arm, open-label, single-centre phase II trial. Eligibility criteria were advanced hepatocellular carcinoma; no prior chemotherapy, performance status 0-1; and Child≤B8. The treatment schedule was 50mg each day orally, 4 weeks on, 2 weeks off. RESULTS: Between 10/2007 and 10/2010, 34 patients were enrolled. A significant worsening of liver functional reserve after sunitinib was observed. Grade 3/4 adverse effects occurred in 80% of patients and included fatigue (47%), nausea (15%), liver failure (15%), encephalopathy (12%) and upper gastrointestinal bleeding (12%). Six patients (18%) died within 60 days of enrolment. A partial response was observed in 4 patients (12%). Median time to tumour progression was 2.8 months and median overall survival was 5.8 months. CONCLUSION: A dose of 50mg/d induces a high rate of severe adverse events. Toxicity remains a key concern also at the dose of 37.5mg/d. However, sunitinib is able to induce a prolonged response in some patients. Positron Emission Tomography/Computed Tomography scans may select good responders.
    No preview · Article · Feb 2013 · Digestive and Liver Disease
  • Source
    P Castaldi · L Leccisotti · F Bussu · F Miccichè · V Rufini
    [Show abstract] [Hide abstract]
    ABSTRACT: The role of PET-CT imaging in head and neck squamous cell carcinoma during pre-treatment staging, radiotherapy planning, treatment response assessment and post-therapy follow-up is reviewed with focus on current evidence, controversial issues and future clinical applications. In staging, the role of (18)F-FDG PET-CT is well recognized for detecting cervical nodal involvement as well as for exclusion of distant metastases and synchronous primary tumours. In the evaluation of treatment response, the high negative predictive value of (18)F-FDG PET-CT performed at least 8 weeks from the end of radio-chemotherapy allows prevention of unnecessary diagnostic invasive procedures and neck dissection in many patients, with a significant impact on clinical outcome. On the other hand, in this setting, the low positive predictive value due to possible post-radiation inflammation findings requires special care before making a clinical decision. Controversial data are currently available on the role of PET imaging during the course of radio-chemotherapy. The prognostic role of (18)F-FDG PET-CT imaging in head and neck squamous cell carcinoma is recently emerging, in addition to the utility of this technique in evaluation of the tumour volume for planning radiation therapy. Additionally, new PET radiopharmaceuticals could provide considerable information on specific tumour characteristics, thus overcoming the limitations of (18)F-FDG.
    Full-text · Article · Feb 2013 · Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale
  • Source
    Giorgio Treglia · Paola Castaldi · Vittoria Rufini

    Full-text · Article · Dec 2012 · Endocrine
  • Source

    Full-text · Article · Oct 2012 · Nuclear Medicine Communications
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Several morphological and functional imaging techniques are usually used to detect residual/recurrent medullary thyroid carcinoma (MTC) with variable results; currently, there is growing interest in positron emission tomography (PET) methodology. Herein, we report our experience of and a literature review about the comparison of different positron emission tomography (PET) tracers in patients with residual/recurrent MTC. (18)F-DOPA PET/CT seems to be the most useful imaging method to detect recurrent MTC lesions, performing better than (18)F-FDG and (68)Ga-somatostatin analogs PET/CT. (18)F-FDG may complement (18)F-DOPA in patients with aggressive tumors. (68)Ga-somatostatin analogs PET/CT may be useful to select patients who could benefit from radioreceptor therapy. The information provided by the various PET tracers reflects different metabolic pathways, and may help to select the most appropriate treatment.
    Full-text · Article · Aug 2012 · Recent results in cancer research. Fortschritte der Krebsforschung. Progrès dans les recherches sur le cancer
  • [Show abstract] [Hide abstract]
    ABSTRACT: The assessment of hepatobiliary and pancreatic tumors is commonly achieved by ultrasound, computed tomography (CT), and magnetic resonance. The 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) detects increased glucose metabolism associated with neoplastic lesions, provides high accuracy in most cancer imaging applications and is now widely used in clinical practice. However, PET is not always useful and accurate knowledge of appropriate indications is essential for a proper clinical management. 18F-FDG is transported into cells and phosphorylated by the enzyme hexokinase to 18F-FDG-6-phosphate, which cannot proceed down the glycolytic pathway and therefore is accumulated in the malignant tissue. PET allows accurate quantification of FDG uptake in tissue, and previous studies have demonstrated that standardized uptake values provide highly reproducible parameters of tumor glucose use (Weber et al., J Nucl Med 40:1771–1777, 1999). The recent development and diffusion of hybrid PET–CT scanners allows functional and anatomic data to be obtained in a single examination, improving lesion localization and resulting in significant diagnostic improvement (Wahl, J Nucl Med 45:82S–95S, 2004). Moreover, CT can be performed diagnostically with the use of intravenous and oral contrast and simultaneous PET–contrast-enhanced CT scanning appears to be an efficient method in cancer evaluation. However, in most centers, a low-dose CT is routinely performed without contrast media infusion. Proper patient preparation, scanning protocol, combined assessment of PET and CT data, and the evaluation of conventional imaging findings are essential to define disease and to avoid diagnostic pitfalls. The role of PET and PET–CT in malignancies of the liver, biliary tract, and pancreas is here reviewed; normal patterns, representative cases, and common pitfalls are also presented.
    No preview · Article · Apr 2012 · Abdominal Imaging
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A 64-year-old man was referred to our center for metabolic characterization of 2 bilateral pulmonary lesions, incidentally detected at computed tomography (CT). F-FDG PET/CT scan showed a weak radiopharmaceutical uptake in both pulmonary lesions. A subsequent Ga-DOTANOC PET/CT showed intense radiopharmaceutical uptake in both pulmonary lesions. Subsequently, the patient underwent histopathological examinations of both lesions, which showed a synchronous well-differentiated pulmonary neuroendocrine carcinoma (typical carcinoid tumor). This case reports a rare occurrence of synchronous pulmonary carcinoid, highlighting the role of different PET tracers for metabolic characterization of pulmonary nodules.
    Full-text · Article · Apr 2012 · Clinical nuclear medicine
  • Source

    Full-text · Article · Apr 2012
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the prognostic value of "early" and "late" Fluorine-18-Fluorodeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET-CT) in patients with head and neck squamous cell carcinoma (HNSCC) treated with radio-chemotherapy (RTCT). Twenty-six patients treated with RTCT for HNSCC were included. All patients underwent (18)F-FDG PET-CT at baseline ("staging" PET-CT), after 2 weeks of treatment ("early" PET-CT) and 8-12 weeks after treatment ("late" PET-CT). Changes in FDG uptake in the primary tumor (T) and lymph nodes (N) were correlated with local and regional control, respectively; overall metabolic response was correlated with relapse free survival (RFS) and disease specific survival (DSS). After a median follow-up of 29.2 months, 19/26 patients were living and 17/19 had no evidence of disease. When comparing "staging", "early" and "late" PET results, a significant decrease of FDG SUV(max) in T and N was documented. When correlating changes in FDG uptake in T and N with local and regional control, a statistically significant correlation only with the "late" reduction was found. Statistical analysis failed to demonstrate any correlation between the "early" metabolic response and the patient clinical outcome while the "late" metabolic response revealed a strong correlation with RFS (p = 0.01) and DSS (p = 0.009). In patients with HNSCC, PET-CT performed after RTCT predicts the clinical outcome, since it strongly correlates with RFS and DSS. On the other hand, the predictive role of "early" metabolic response was not confirmed by this study.
    Full-text · Article · Mar 2012 · Radiotherapy and Oncology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Endocrine pancreatic tumors (EPTs) are a heterogeneous group of neoplasms with variable clinical and biological features and prognosis, ranging from very slow-growing tumors to highly aggressive and very malignant ones. As other neuroendocrine tumors, EPTs are characterized by the presence of neuroamine uptake mechanisms and/or peptide receptors at the cell membrane and these features constitute the basis of the clinical use of specific radiolabeled ligands, both for imaging and therapy. The more widespread use of hybrid machines, i.e., positron emission tomography/computed tomography (PET/CT), allows to perform imaging with high resolution and high diagnostic accuracy especially for small lesions, and to correlate anatomic location with function. The recent WHO recommendations for classification and prognostic factors help the selection of tracers likely to show a positive image on PET; therefore, tracers exploiting specific metabolic patterns ((18)F-DOPA and (11)C-5-HTP) or specific receptor expression ((68)Ga-DOTA-peptides) are suited to well-differentiated tumors, while the use of (18)F-FDG is preferred for poorly-differentiated neoplasms with high proliferative activity and loss of neuroendocrine features. In differentiated EPTs, (11)C-5-HTP performs better than (18)F-DOPA even though its use is hampered by its complex production and limited availability and experience; (68)Ga-peptides are indicated for all type of gastroenteropancreatic (GEP) neuroendocrine tumors, regardless of their functional activity. In addition, (68)Ga-DOTA-peptides play a distinctive role in planning peptide receptor radionuclide therapy.
    Full-text · Article · Mar 2012 · Abdominal Imaging
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to systematically review and conduct a meta-analysis of published data about the diagnostic performance of (18)F-dihydroxyphenylalanine (DOPA) positron emission tomography (PET) in patients with paraganglioma (PG). A comprehensive computer literature search of studies published through 30 June 2011 regarding (18)F-DOPA PET or PET/computed tomography (PET/CT) in patients with PG was performed in PubMed/MEDLINE, Embase and Scopus databases. Pooled sensitivity and specificity of (18)F-DOPA PET or PET/CT in patients with PG on a per patient- and on a per lesion-based analysis were calculated. The area under the receiver-operating characteristic (ROC) curve was calculated to measure the accuracy of (18)F-DOPA PET or PET/CT in patients with PG. Furthermore, a sub-analysis taking into account the different genetic mutations in PG patients was also performed. Eleven studies comprising 275 patients with suspected PG were included in this meta-analysis. The pooled sensitivity of (18)F-DOPA PET and PET/CT in detecting PG was 91% [95% confidence interval (CI) 87-94%] on a per patient-based analysis and 79% (95% CI 76-81%) on a per lesion-based analysis. The pooled specificity of (18)F-DOPA PET and PET/CT in detecting PG was 95% (95% CI 86-99%) on a per patient-based analysis and 95% (95% CI 84-99%) on a per lesion-based analysis. The area under the ROC curve was 0.95 on a per patient- and 0.94 on a per lesion-based analysis. Heterogeneity between the studies about sensitivity of (18)F-DOPA PET or PET/CT was found. A significant increase in sensitivity of (18)F-DOPA PET or PET/CT was observed when a sub-analysis excluding patients with succinate dehydrogenase subunit B (SDHB) gene mutations was performed. In patients with suspected PG (18)F-DOPA PET or PET/CT demonstrated high sensitivity and specificity. (18)F-DOPA PET or PET/CT are accurate methods in this setting. Nevertheless, possible sources of false-negative results should be kept in mind. Furthermore, SDHB gene mutations could influence (18)F-DOPA PET or PET/CT diagnostic performance.
    Full-text · Article · Feb 2012 · European Journal of Nuclear Medicine
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Gallium-68 somatostatin receptor (SMSR) positron emission tomography (PET) and positron emission tomography/computed tomography (PET/CT) are valuable diagnostic tools for patients with neuroendocrine tumours (NETs). To date, a meta-analysis about the diagnostic accuracy of these imaging methods is lacking. Aim of our study is to meta-analyse published data about the diagnostic performance of SMSR PET or PET/CT in patients with thoracic and/or gastroenteropancreatic (GEP) NETs. A comprehensive computer literature search of studies published in PubMed/MEDLINE, Scopus and Embase databases through October 2011 and regarding SMSR PET or PET/CT in patients with NETs was carried out. Only studies in which SMSR PET or PET/CT were performed in patients with thoracic and/or GEP NETs were selected (medullary thyroid tumours and neural crest derived tumours were excluded from the analysis). Pooled sensitivity, pooled specificity and area under the ROC curve were calculated to measure the diagnostic accuracy of SMSR PET and PET/CT in NETs. Results: Sixteen studies comprising 567 patients were included in this meta-analysis. The pooled sensitivity and specificity of SMSR PET or PET/CT in detecting NETs were 93% (95% confidence interval [95% CI]: 91-95%) and 91% (95% CI: 82-97%), respectively, on a per patient-based analysis. The area under the ROC curve was 0.96. In patients with suspicious thoracic and/or GEP NETs, SMSR PET and PET/CT demonstrated high sensitivity and specificity. These accurate techniques should be considered as first-line diagnostic imaging methods in patients with suspicious thoracic and/or GEP NETs.
    Full-text · Article · Feb 2012 · Endocrine
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To retrospectively evaluate and compare (18)F-FDG, (18)F-DOPA and (68)Ga-somatostatin analogues for PET/CT in patients with residual/recurrent medullary thyroid carcinoma (MTC) suspected on the basis of elevated serum calcitonin levels. Included in the study were 18 patients with recurrent MTC in whom functional imaging with the three tracers was performed. The PET/CT results were compared on a per-patient basis and on a per-lesion-basis. At least one focus of abnormal uptake was observed on PET/CT in 13 patients with (18)F-DOPA (72.2% sensitivity), in 6 patients with (68)Ga-somatostatin analogues (33.3%) and in 3 patients with (18)F-FDG (16.7%) (p < 0.01). There was a statistically significant difference in sensitivity between (18)F-DOPA and (18)F-FDG PET/CT (p < 0.01) and between (18)F-DOPA and (68)Ga-somatostatin analogue PET/CT (p = 0.04). Overall, 72 lesions were identified on PET/CT with the three tracers. (18)F-DOPA PET/CT detected 85% of lesions (61 of 72), (68)Ga-somatostatin analogue PET/CT 20% (14 of 72) and (18)F-FDG PET/CT 28% (20 of 72). There was a statistically significant difference in the number of lymph node, liver and bone lesions detected with the three tracers (p < 0.01). In particular, post-hoc tests showed a significant difference in the number of lymph node, liver and bone lesions detected by (18)F-DOPA PET/CT and (18)F-FDG PET/CT (p < 0.01 for all the analyses) and by (18)F-DOPA PET/CT and (68)Ga-somatostatin analogue PET/CT (p < 0.01 for all the analyses). The PET/CT results led to a change in management of eight patients (44%). (18)F-DOPA PET/CT seems to be the most useful imaging method for detecting recurrent MTC lesions in patients with elevated serum calcitonin levels, performing better than (18)F-FDG and (68)Ga-somatostatin analogue PET/CT. (18)F-FDG may complement (18)F-DOPA in patients with an aggressive tumour.
    Full-text · Article · Jan 2012 · European Journal of Nuclear Medicine