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Special Issue "PET/CT Imaging in Oncology: Clinical Updates and Perspectives"

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nuclear Medicine & Radiology".

Deadline for manuscript submissions: 30 April 2023 | Viewed by 14232

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Prof. Dr. Arnoldo Piccardo

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Guest Editor

Department of Nuclear Medicine, E.O. Ospedali Galliera, Genoa, Italy
Interests: nuclear medicine; radioactive iodine therapy; thyroid disease; differentiated thyroid cancer; PET/CT; pediatrics; brain tumors; neuroblastoma; 131I MIBG therapy; prostate cancer; ovarian cancer; hyperparathyroidism
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Dr. Francesco Fiz

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Nuclear Medicine Unit, E.O. Ospedali Galliera, Genoa, Italy
Interests: nuclear medicine; radioisotope therapy; PET/CT; hematology; plaque imaging; image segmentation; texture analysis; radiomics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

PET/CT has been the fastest-growing image modality in recent decades. This growth has been bolstered, on one hand, by the approval of new radiotracers, which were instrumental in addressing the known limitations of FDG. On the other hand, the constant research of new possible indications of FDG-PET has led to the implementation of this tracer in many new clinical settings (e.g., image-guided surgery). Finally, advanced image analysis (including, but not limited to radiomics, machine learning, automatic target segmentation, computer vision, augmented reality etc.) has given new value to the acquired data and has the potential to increase the amount of information that the imaging specialist and the clinicians can extract from the images. These aspects represent the pillars that will support the further growth of nuclear medicine. This Special Issue aims to include a selection of high-quality papers on the clinical and research applications of FDG and non-FDG tracers. Moreover, it will include scientific reports of advanced methods of image analysis, with a particular focus on image-based dosimetry and quantification, automatic segmentation, tumor burden calculation, computer-assisted diagnosis, and machine learning methods. The overall goal of this issue is to provide an overview on the future directions of molecular imaging research, and, more in general, of innovative image analysis techniques.

Dr. Arnoldo Piccardo
Dr. Francesco Fiz
Guest Editors

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Keywords

Non FDG radiopharmaceuticals
Segmentation
Tumor burden calculation
Machine learning
Neural networks
Deep learning
Artificial Intelligence

Published Papers (13 papers)

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Editorial

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Diagnostic and Prognostic Role of ¹⁸F-Fluoroestradiol PET in Metastatic Breast Cancer: The Second Youth of an Older Theranostic Concept

and

J. Clin. Med. 2022, 11(13), 3589; https://doi.org/10.3390/jcm11133589 - 22 Jun 2022

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Abstract

Since the discovery of the role of female hormones in breast cancer (BC) pathophysiology, in vivo detection of oestrogen receptor (ER) distribution has been one of the major goals of nuclear medicine and molecular imaging [...] Full article

(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)

Research

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Open AccessArticle

Prospective Evaluation of Different Methods for Volumetric Analysis on [¹⁸F]FDG PET/CT in Pediatric Hodgkin Lymphoma

Christine Mauz-Koerholz

and

Maurizio Mascarin

J. Clin. Med. 2022, 11(20), 6223; https://doi.org/10.3390/jcm11206223 - 21 Oct 2022

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Abstract

Rationale: Therapy response evaluation by ¹⁸F-fluorodeoxyglucose PET/CT (FDG PET) has become a powerful tool for the discrimination of responders from non-responders in pediatric Hodgkin lymphoma (HL). Recently, volumetric analyses have been regarded as a valuable tool for disease prognostication and biological characterization in cancer. Given the multitude of methods available for volumetric analysis in HL, the AIEOP Hodgkin Lymphoma Study Group has designed a prospective analysis of the Italian cohort enrolled in the EuroNet-PHL-C2 trial. Methods: Primarily, the study aimed to compare the different segmentation techniques used for volumetric assessment in HL patients at baseline (PET1) and during therapy: early (PET2) and late assessment (PET3). Overall, 50 patients and 150 scans were investigated for the current analysis. A dedicated software was used to semi-automatically delineate contours of the lesions by using different threshold methods. More specifically, four methods were applied: (1) fixed 41% threshold of the maximum standardized uptake value (SUVmax) within the respective lymphoma site (V41%), (2) fixed absolute SUV threshold of 2.5 (V2.5); (3) SUVmax(lesion)/SUVmean liver >1.5 (Vliver); (4) adaptive method (AM). All parameters obtained from the different methods were analyzed with respect to response. Results: Among the different methods investigated, the strongest correlation was observed between AM and Vliver (rho > 0.9; p < 0.001 for SUVmean, MTV and TLG at all scan timing), along with V2.5 and AM or Vliver (rho 0.98, p < 0.001 for TLG at baseline; rho > 0.9; p < 0.001 for SUVmean, MTV and TLG at PET2 and PET3, respectively). To determine the best segmentation method, we applied logistic regression and correlated different results with Deauville scores at late evaluation. Logistic regression demonstrated that MTV (metabolic tumor volume) and TLG (total lesion glycolysis) computation according to V2.5 and Vliver significantly correlated to response to treatment (p = 0.01 and 0.04 for MTV and 0.03 and 0.04 for TLG, respectively). SUVmean also resulted in significant correlation as absolute value or variation. Conclusions: The best correlation for volumetric analysis was documented for AM and Vliver, followed by V2.5. The volumetric analyses obtained from V2.5 and Vliver significantly correlated to response to therapy, proving to be preferred thresholds in our pediatric HL cohort. Full article

(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)

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Open AccessArticle

Functional Investigation of the Tumoural Heterogeneity of Intrahepatic Cholangiocarcinoma by In Vivo PET-CT Navigation: A Proof-of-Concept Study

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J. Clin. Med. 2022, 11(18), 5451; https://doi.org/10.3390/jcm11185451 - 16 Sep 2022

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Abstract

Intra-tumoural heterogeneity (IH) is a major determinant of resistance to therapy and outcomes but remains poorly translated into clinical practice. Intrahepatic cholangiocarcinoma (ICC) often presents as large heterogeneous masses at imaging. The present study proposed an innovative in vivo technique to functionally assess the IH of ICC. Preoperative 18F-FDG PET-CT and intraoperative ultrasonography were merged to perform the intraoperative navigation of functional tumour heterogeneity. The tumour areas with the highest and the lowest metabolism (SUV) at PET-CT were selected, identified during surgery, and sampled. Three consecutive patients underwent the procedure. The areas with the highest uptake at PET-CT had higher proliferation index (KI67) values and higher immune infiltration compared to areas with the lowest uptake. One of the patients showed a heterogeneous presence of FGFR2 translocation within the samples. Tumour heterogeneity at PET-CT may drive biopsy to sample the most informative ICC areas. Even more relevant, these preliminary data show the possibility of achieving a non-invasive evaluation of IH in ICC, paving the way for an imaging-based precision-medicine approach. Full article

(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)

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Open AccessArticle

Primary Staging of Prostate Cancer Patients with [¹⁸F]PSMA-1007 PET/CT Compared with [⁶⁸Ga]Ga-PSMA-11 PET/CT

Manuela A. Hoffmann

Jonas Müller-Hübenthal

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Mathias Schreckenberger

J. Clin. Med. 2022, 11(17), 5064; https://doi.org/10.3390/jcm11175064 - 29 Aug 2022

Cited by 1 | Viewed by 989

Abstract

Background: Hybrid imaging with prostate-specific membrane antigen (PSMA) is gaining importance as an increasingly meaningful tool for prostate cancer (PC) diagnostics and as a guide for therapy decisions. This study aims to investigate and compare the performance of [¹⁸F]PSMA-1007 (¹⁸F-PSMA) and [⁶⁸Ga]Ga-PSMA-11 positron emission tomography/computed tomography (⁶⁸Ga-PSMA) in the initial staging of PC patients. Methods: The data of 88 biopsy-proven patients were retrospectively evaluated. PSMA-avid lesions were compared with the histopathologic Gleason Score (GS) for prostate biopsies, and the results were plotted by receiver operating characteristic (ROC)-curve. Optimal maximum standardized uptake value (SUV_max) cut-off values were rated using the Youden index. Results: ¹⁸F-PSMA was able to distinguish GS ≤ 7a from ≥7b with a sensitivity of 62%, specificity of 85%, positive predictive value (PPV) of 92%, and accuracy of 67% for a SUV_max of 8.95, whereas sensitivity was 54%, specificity 91%, PPV 93%, and accuracy 66% for ⁶⁸Ga-PSMA (SUV_max 8.7). Conclusions: Both methods demonstrated a high concordance of detected PSMA-avid lesions with histopathologically proven PC. ¹⁸F-PSMA and ⁶⁸Ga-PSMA are both suitable for the characterization of primary PC with a comparable correlation of PSMA-avid lesions with GS. Neither method showed a superior advantage. Our calculated SUV_max thresholds may represent valuable parameters in clinical use to distinguish clinically significant PC (csPC) from non-csPC. Full article

(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)

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Open AccessArticle

Multiparametric Dual-Time-Point [¹⁸F]FDG PET/MRI for Lymph Node Staging in Patients with Untreated FIGO I/II Cervical Carcinoma

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J. Clin. Med. 2022, 11(17), 4943; https://doi.org/10.3390/jcm11174943 - 23 Aug 2022

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Abstract

[¹⁸F]FDG PET/MRI was shown to have limited sensitivity for N-staging in FIGO I/II cervical carcinoma. Therefore, this prospective study aimed to investigate the additional value of multiparametric dual-time-point PET/MRI and to assess potential influencing factors for lymph node metastasis (LNM) detection. A total of 63 patients underwent whole-body dual-time-point [¹⁸F]FDG PET/MRI 60 + 90 min p.i., and 251 LN were evaluated visually, quantified multiparametrically, and correlated with histology. Grading of the primary tumor (G2/G3) had a significant impact on visual detection (sens: 8.3%/31%). The best single parameter for LNM detection was SUVavg, however, with a significant loss of discriminatory power in G2 vs. G3 tumors (AUC: 0.673/0.901). The independent predictors SUVavg, ∆SUVpeak, LN sphericity, ADC, and histologic grade were included in the logistic-regression-based malignancy score (MS) for multiparametric analysis. Application of MS enhanced AUCs, especially in G2 tumors (AUC: G2:0.769; G3:0.877) and improved the accuracy for single LNM from 34.5% to 55.5% compared with the best univariate parameter SUVavg. Compared with visual analysis, the use of the malignancy score increased the overall sensitivity from 31.0% to 79.3% (Youden optimum) with a moderate decrease in specificity from 98.3% to 75.6%. These findings indicate that multiparametric evaluation of dual-time-point PET/MRI has the potential to improve accuracy compared with visual interpretation and enables sufficient N-staging also in G2 cervical carcinoma. Full article

(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)

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Open AccessArticle

Additional Value of [18F]FDG PET/CT in Detection of Suspected Malignancy in Patients with Paraneoplastic Neurological Syndromes Having Negative Results of Conventional Radiological Imaging

and

Alicja Hubalewska-Dydejczyk

J. Clin. Med. 2022, 11(6), 1537; https://doi.org/10.3390/jcm11061537 - 11 Mar 2022

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Abstract

Background: Paraneoplastic neurological syndromes (PNS) affecting the CNS (central nervous system) are rare, presenting in less than 1% of all those with cancer. The pathogenesis of paraneoplastic neurological syndromes is not fully understood, but it is presumed to result from an immune attack on the underlying malignancy. The presence of different types of onconeural antibodies may occur in different tumors and can lead to different clinical manifestations, making the early detection of cancers challenging. Aim: An evaluation of [18F]FDG PET/CT in neoplastic tumor detection in patients with paraneoplastic neurological syndromes having negative or unremarkable results of conventional radiological imaging. Methods: Among all patients diagnosed with paraneoplastic neurological syndromes in the Neurology Department in 2016–2020, 15 patients with unremarkable conventional radiological findings who underwent [18F]FDG PET/CT were included in the study. Results: [18F]FDG PET/CT enabled localization of suspected malignancy in 53% (8 of 15) of PNS cases with previous unremarkable conventional radiological findings. Conclusion: [18F]FDG PET/CT may be considered as a useful tool for neoplastic tumor detection in patients with paraneoplastic neurological syndromes, accelerating the diagnostic process and enabling faster initiation of appropriate treatment. Full article

(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)

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Open AccessArticle

Value of CT-Textural Features and Volume-Based PET Parameters in Comparison to Serologic Markers for Response Prediction in Patients with Diffuse Large B-Cell Lymphoma Undergoing CD19-CAR-T Cell Therapy

Christian Philipp Reinert

and

J. Clin. Med. 2022, 11(6), 1522; https://doi.org/10.3390/jcm11061522 - 10 Mar 2022

Cited by 2 | Viewed by 1417

Abstract

The goal of this study was to investigate the value of CT-textural features and volume-based PET parameters in comparison to serologic markers for response prediction in patients with diffuse large B-cell lymphoma (DLBCL) undergoing cluster of differentiation (CD19)-chimeric antigen receptor (CAR)-T cell therapy. We retrospectively analyzed the whole-body (WB)-metabolic tumor volume (MTV), the WB-total lesion glycolysis (TLG) and first order textural features derived from ¹⁸F-FDG-PET/CT, as well as serologic parameters (C-reactive protein [CRP] and lactate dehydrogenase [LDH], leucocytes) prior and after CAR-T cell therapy in 21 patients with DLBCL (57.7 ± 14.7 year; 7 female). Interleukin 6 (IL-6) and IL-2 receptor peaks were monitored after treatment onset and compared with patient outcome judged by follow-up ¹⁸F-FDG-PET/CT. In 12/21 patients (57%), complete remission (CR) was observed, whereas 9/21 patients (43%) showed partial remission (PR). At baseline, WB-MTV and WB-TLG were lower in patients achieving CR (35 ± 38 mL and 319 ± 362) compared to patients achieving PR (88 ± 110 mL and 1487 ± 2254; p < 0.05). The “entropy” proved lower (1.81 ± 0.09) and “uniformity” higher (0.33 ± 0.02) in patients with CR compared to PR (2.08 ± 0.22 and 0.28 ± 0.47; p < 0.05). Patients achieving CR had lower levels of CRP, LDH and leucocytes at baseline compared to patients achieving PR (p < 0.05). In the entire cohort, WB-MTV and WB-TLG decreased after therapy onset (p < 0.01) becoming not measurable in the CR-group. Leucocytes and CRP significantly dropped after therapy (p < 0.01). The IL-6 and IL-2R peaks after therapy were lower in patients with CR compared to PR (p > 0.05). In conclusion, volume-based PET parameters derived from PET/CT and CT-textural features have the potential to predict therapy response in patients with DLBCL undergoing CAR-T cell therapy. Full article

(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)

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Open AccessArticle

Prognostic Role of Pre-Treatment Metabolic Parameters and Sarcopenia Derived by 2-[¹⁸F]-FDG PET/CT in Elderly Mantle Cell Lymphoma

and

J. Clin. Med. 2022, 11(5), 1210; https://doi.org/10.3390/jcm11051210 - 23 Feb 2022

Cited by 4 | Viewed by 937

Abstract

The goal of this retrospective study was to analyze and compare the prognostic role of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (2-[¹⁸F]-FDG PET/CT) features and sarcopenia, estimated by CT of PET in elderly (≥65 years) Mantle Cell Lymphoma (MCL). We recruited 53 patients, who underwent pre-treatment 2-[¹⁸F]-FDG PET/CT and end-of-treatment PET/CT, and the main semiquantitative parameters were calculated. Sarcopenia was measured as skeletal muscle index (SMI, cm²/m²) and derived by low-dose PET/CT images at the L3 level. Specific cut-offs for SMI were calculated by receiver operator curve and divided by gender. Metabolic response was evaluated at end-of-treatment PET/CT, applying the Deauville score. Progression Free Survival (PFS) and Overall Survival (OS) were calculated for the whole population and for different subgroups, defined as per different sarcopenia cut-off levels. The specific cut-offs to define sarcopenia were 53 cm²/m² for male and 45.6 cm²/m² for female. Thirty-two (60%) patients were defined as sarcopenic. The 3-year and 5-year PFS rates were 29% and 23%, while the 3-year and 5-year OS rates were 43% and 33%. Metabolic response, total metabolic tumor volume (tMTV), total lesion glycolysis (tTLG) and sarcopenia were independent prognostic factors for PFS. Considering OS, no variable was significantly associated. Combination between PET features and sarcopenia may help to predict PFS. Full article

(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)

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Open AccessArticle

A Prospective Investigation of Tumor Hypoxia Imaging with ⁶⁸Ga-Nitroimidazole PET/CT in Patients with Carcinoma of the Cervix Uteri and Comparison with ¹⁸F-FDG PET/CT: Correlation with Immunohistochemistry

Kgomotso M. G. Mokoala

Ismaheel O. Lawal

Letjie C. Maserumule

Khanyisile N. Hlongwa

Christophe van de Wiele

and

J. Clin. Med. 2022, 11(4), 962; https://doi.org/10.3390/jcm11040962 - 12 Feb 2022

Cited by 2 | Viewed by 993

Abstract

Hypoxia in cervical cancer has been associated with a poor prognosis. Over the years ⁶⁸Ga labelled nitroimidazoles have been studied and have shown improved kinetics. We present our initial experience of hypoxia Positron Emission Tomography (PET) imaging in cervical cancer with ⁶⁸Ga-Nitroimidazole derivative and the correlation with ¹⁸F-FDG PET/CT and immunohistochemistry. Twenty women with cervical cancer underwent both ¹⁸F-FDG and ⁶⁸Ga-Nitroimidazole PET/CT imaging. Dual-point imaging was performed for ⁶⁸Ga-Nitroimidazole PET. Immunohistochemical analysis was performed with hypoxia inducible factor-1α (HIF-1α). We documented SUVmax, SUVmean of the primary lesions as well as tumor to muscle ratio (TMR), tumor to blood (TBR), metabolic tumor volume (MTV) and hypoxic tumor volume (HTV). There was no significant difference in the uptake of ⁶⁸Ga-Nitroimidazole between early and delayed imaging. Twelve patients had uptake on ⁶⁸Ga-Nitroimidazole PET. Ten patients demonstrated varying intensities of HIF-1α expression and six of these also had uptake on ⁶⁸Ga-Nitroimidazole PET. We found a strong negative correlation between HTV and immunohistochemical staining (r = −0.660; p = 0.019). There was no correlation between uptake on PET imaging and immunohistochemical analysis with HIF-1α. Two-thirds of the patients demonstrated hypoxia on ⁶⁸Ga-Nitroimidazole PET imaging. Full article

(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)

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Open AccessArticle

Comparison between Two Different Scanners for the Evaluation of the Role of ¹⁸F-FDG PET/CT Semiquantitative Parameters and Radiomics Features in the Prediction of Final Diagnosis of Thyroid Incidentalomas

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J. Clin. Med. 2022, 11(3), 615; https://doi.org/10.3390/jcm11030615 - 26 Jan 2022

Cited by 7 | Viewed by 1909

Abstract

The aim of this study was to compare two different tomographs for the evaluation of the role of semiquantitative PET/CT parameters and radiomics features (RF) in the prediction of thyroid incidentalomas (TIs) at ¹⁸F-FDG imaging. A total of 221 patients with the presence of TIs were retrospectively included. After volumetric segmentation of each TI, semiquantitative parameters and RF were extracted. All of the features were tested for significant differences between the two PET scanners. The performances of all of the features in predicting the nature of TIs were analyzed by testing three classes of final logistic regression predictive models, one for each tomograph and one with both scanners together. Some RF resulted significantly different between the two scanners. PET/CT semiquantitative parameters were not able to predict the final diagnosis of TIs while GLCM-related RF (in particular GLCM entropy_log2 e GLCM entropy_log10) together with some GLRLM-related and GLZLM-related features presented the best predictive performances. In particular, GLCM entropy_log2, GLCM entropy_log10, GLZLM SZHGE, GLRLM HGRE and GLRLM HGZE resulted the RF with best performances. Our study enabled the selection of some RF able to predict the final nature of TIs discovered at ¹⁸F-FDG PET/CT imaging. Classic semiquantitative and volumetric PET/CT parameters did not reveal these abilities. Furthermore, a good overlap in the extraction of RF between the two scanners was underlined. Full article

(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)

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Review

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Open AccessReview

Intracranial Solitary Fibrous Tumor: A “New” Challenge for PET Radiopharmaceuticals

Angela Sardaro

Paolo Mammucci

Antonio Rosario Pisani

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J. Clin. Med. 2022, 11(16), 4746; https://doi.org/10.3390/jcm11164746 - 14 Aug 2022

Cited by 1 | Viewed by 689

Abstract

Solitary fibrous tumor (SFT) of the central nervous system, previously named and classified with the term hemangiopericytoma (HPC), is rare and accounts for less than 1% of all intracranial tumors. Despite its benign nature, it has a malignant behavior due to the high rate of recurrence and distant metastasis, occurring in up to 50% of cases. Surgical resection of the tumor is the treatment of choice. Radiotherapy represents the gold standard in the case of post-surgery residual disease, relapse, and distant metastases. In this context, imaging plays a crucial role in identifying the personalized therapeutic decision for each patient. Although the referring imaging approach in SFT is morphologic, an emerging role of positron emission tomography (PET) has been reported in the literature. However, there is still a debate on which radiotracers have the best accuracy for studying these uncommon tumors because of the histological or biological heterogeneity of SFT. Full article

(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)

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Open AccessReview

The Current Role of Peptide Receptor Radionuclide Therapy in Meningiomas

Christina-Katharina Fodi

Jens Schittenhelm

Jürgen Honegger

Salvador Guillermo Castaneda-Vega

and

Felix Behling

J. Clin. Med. 2022, 11(9), 2364; https://doi.org/10.3390/jcm11092364 - 23 Apr 2022

Cited by 2 | Viewed by 804

Abstract

Meningiomas are the most common primary intracranial tumors. The majority of patients can be cured by surgery, or tumor growth can be stabilized by radiation. However, the management of recurrent and more aggressive tumors remains difficult because no established alternative treatment options exist. Therefore, innovative therapeutic approaches are needed. Studies have shown that meningiomas express somatostatin receptors. It is well known from treating neuroendocrine tumors that peptide radioreceptor therapy that targets somatostatin receptors can be effective. As yet, this therapy has been used for treating meningiomas only within individual curative trials. However, small case series and studies have demonstrated stabilization of the disease. Therefore, we see potential for optimizing this therapeutic option through the development of new substances and specific adaptations to the different meningioma subtypes. The current review provides an overview of this topic. Full article

(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)

Open AccessReview

Head-to-Head Comparison between ¹⁸F-FES PET/CT and ¹⁸F-FDG PET/CT in Oestrogen Receptor-Positive Breast Cancer: A Systematic Review and Meta-Analysis

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J. Clin. Med. 2022, 11(7), 1919; https://doi.org/10.3390/jcm11071919 - 30 Mar 2022

Cited by 4 | Viewed by 1339

Abstract

¹⁸F-FDG PET/CT is a powerful diagnostic tool in breast cancer (BC). However, it might have a reduced sensitivity in differentiated, oestrogen receptor-positive (ER+) BC. In this setting, specific molecular imaging with fluorine-oestradiol (¹⁸F-FES) PET/CT could help in overcoming these limitations; however, the literature on the diagnostic accuracy of this method is limited. We therefore planned this systematic review and meta-analysis to compare ¹⁸F-FDG and ¹⁸F-FES PET/CT in ER+ BC patients. We performed a literature search to identify all studies performing a head-to-head comparison between the two methods; we excluded review articles, preclinical studies, case reports and small case series. Finally, seven studies were identified (overall: 171 patients; range: 7–49 patients). A patients-based analysis (PBA) showed that ¹⁸F-FDG and ¹⁸F-FES PET/CT had a similar high pooled sensitivity (97% and 94%, respectively) at the lesion-based analysis (LBA), ¹⁸F-FES performed slightly better than ¹⁸F-FDG (pooled sensitivity: 95% vs. 85%, respectively). Moreover, when we considered only the studies dealing with the restaging setting (n = 3), this difference in sensitivity was even more marked (98% vs. 81%, respectively). In conclusion, both tracers feature an excellent sensitivity in ER+ BC; however, ¹⁸F-FES PET/CT could be preferred in the restaging setting. Full article

(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)

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