PET/CT Imaging in Oncology: Clinical Updates and Perspectives

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: closed (30 April 2023) | Viewed by 28930

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Guest Editor
Nuclear Medicine Unit, E.O. Ospedali Galliera, Genoa, Italy
Interests: nuclear medicine; radioactive iodine therapy; differentiated thyroid cancer; PET/CT; pediatrics; neuroblastoma; 131I MIBG therapy
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
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

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Published Papers (15 papers)

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Editorial

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3 pages, 205 KiB  
Editorial
Diagnostic and Prognostic Role of 18F-Fluoroestradiol PET in Metastatic Breast Cancer: The Second Youth of an Older Theranostic Concept
by Francesco Fiz, Gianluca Bottoni, Giorgio Treglia, Pierpaolo Trimboli and Arnoldo Piccardo
J. Clin. Med. 2022, 11(13), 3589; https://doi.org/10.3390/jcm11133589 - 22 Jun 2022
Viewed by 1153
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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9 pages, 5001 KiB  
Article
Tumor Burden of Iodine-Avid Bone Metastatic Thyroid Cancer Identified via 18F-Sodium Fluoride PET/CT Imaging
by Carmela Nappi, Emilia Zampella, Valeria Gaudieri, Fabio Volpe, Leandra Piscopo, Carlo Vallone, Leonardo Pace, Andrea Ponsiglione, Simone Maurea, Emanuele Nicolai, Alberto Cuocolo and Michele Klain
J. Clin. Med. 2024, 13(2), 569; https://doi.org/10.3390/jcm13020569 - 19 Jan 2024
Cited by 1 | Viewed by 1085
Abstract
Background: Patients with differentiated thyroid cancer (DTC) are referred to radioactive 131I (RAI) therapy and post-therapy 131I whole-body scintigraphy (WBS) to identify local and/or remote metastases. Positron emission tomography (PET)/computed tomography (CT) imaging with 18F-fluoro-D-glucose (FDG) or 18F-sodium fluoride [...] Read more.
Background: Patients with differentiated thyroid cancer (DTC) are referred to radioactive 131I (RAI) therapy and post-therapy 131I whole-body scintigraphy (WBS) to identify local and/or remote metastases. Positron emission tomography (PET)/computed tomography (CT) imaging with 18F-fluoro-D-glucose (FDG) or 18F-sodium fluoride (NaF) may also be used with these patients for the evaluation of bone metastases. We compared the role of 18F-NaF PET/CT and 18F-FDG-PET/CT in patients with DTC and documented bone metastases at post-therapy WBS. Methods: Ten consecutive DTC patients with iodine avid bone metastasis at post-therapy WBS referred to 18F-NaF PET/CT and 18F-FDG PET/CT were studied. The findings of the three imaging procedures were compared for abnormal detection rates and concordance. Results: At post-therapy 131I WBS, all patients had skeletal involvement with a total of 21 bone iodine avid lesions. At 18F-FDG PET/TC, 19 bone lesions demonstrated increased tracer uptake and CT pathological alterations, while 2 lesions did not show any pathological finding. At 18F-NaF PET/CT, the 19 bone lesions detected at 18F-FDG PET/TC also demonstrated abnormal tracer uptake, and the other 2 bone iodine avid foci did not show any pathological finding. Conclusions: In patients with DTC, 18F-NaF PET/CT did not obtain more information on the metastatic skeletal involvement than post-therapy 131I WBS and 18F-FDG PET/CT. Full article
(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)
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16 pages, 3084 KiB  
Article
Diagnostic Performance of Dynamic Whole-Body Patlak [18F]FDG-PET/CT in Patients with Indeterminate Lung Lesions and Lymph Nodes
by Matthias Weissinger, Max Atmanspacher, Werner Spengler, Ferdinand Seith, Sebastian Von Beschwitz, Helmut Dittmann, Lars Zender, Anne M. Smith, Michael E. Casey, Konstantin Nikolaou, Salvador Castaneda-Vega and Christian la Fougère
J. Clin. Med. 2023, 12(12), 3942; https://doi.org/10.3390/jcm12123942 - 9 Jun 2023
Cited by 2 | Viewed by 1555
Abstract
Background: Static [18F]FDG-PET/CT is the imaging method of choice for the evaluation of indeterminate lung lesions and NSCLC staging; however, histological confirmation of PET-positive lesions is needed in most cases due to its limited specificity. Therefore, we aimed to evaluate the [...] Read more.
Background: Static [18F]FDG-PET/CT is the imaging method of choice for the evaluation of indeterminate lung lesions and NSCLC staging; however, histological confirmation of PET-positive lesions is needed in most cases due to its limited specificity. Therefore, we aimed to evaluate the diagnostic performance of additional dynamic whole-body PET. Methods: A total of 34 consecutive patients with indeterminate pulmonary lesions were enrolled in this prospective trial. All patients underwent static (60 min p.i.) and dynamic (0–60 min p.i.) whole-body [18F]FDG-PET/CT (300 MBq) using the multi-bed-multi-timepoint technique (Siemens mCT FlowMotion). Histology and follow-up served as ground truth. Kinetic modeling factors were calculated using a two-compartment linear Patlak model (FDG influx rate constant = Ki, metabolic rate = MR-FDG, distribution volume = DV-FDG) and compared to SUV using ROC analysis. Results: MR-FDGmean provided the best discriminatory power between benign and malignant lung lesions with an AUC of 0.887. The AUC of DV-FDGmean (0.818) and SUVmean (0.827) was non-significantly lower. For LNM, the AUCs for MR-FDGmean (0.987) and SUVmean (0.993) were comparable. Moreover, the DV-FDGmean in liver metastases was three times higher than in bone or lung metastases. Conclusions: Metabolic rate quantification was shown to be a reliable method to detect malignant lung tumors, LNM, and distant metastases at least as accurately as the established SUV or dual-time-point PET scans. Full article
(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)
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9 pages, 5264 KiB  
Article
Functional Investigation of the Tumoural Heterogeneity of Intrahepatic Cholangiocarcinoma by In Vivo PET-CT Navigation: A Proof-of-Concept Study
by Luca Viganò, Egesta Lopci, Luca Di Tommaso, Annarita Destro, Alessio Aghemo, Lorenza Rimassa, Luigi Solbiati, Arturo Chiti, Guido Torzilli and Francesco Fiz
J. Clin. Med. 2022, 11(18), 5451; https://doi.org/10.3390/jcm11185451 - 16 Sep 2022
Cited by 1 | Viewed by 1368
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 [...] Read more.
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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14 pages, 2333 KiB  
Article
Primary Staging of Prostate Cancer Patients with [18F]PSMA-1007 PET/CT Compared with [68Ga]Ga-PSMA-11 PET/CT
by Manuela A. Hoffmann, Jonas Müller-Hübenthal, Florian Rosar, Nicolas Fischer, Finn Edler von Eyben, Hans-Georg Buchholz, Helmut J. Wieler and Mathias Schreckenberger
J. Clin. Med. 2022, 11(17), 5064; https://doi.org/10.3390/jcm11175064 - 29 Aug 2022
Cited by 8 | Viewed by 2059
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 (18 [...] Read more.
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 (SUVmax) 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 SUVmax of 8.95, whereas sensitivity was 54%, specificity 91%, PPV 93%, and accuracy 66% for 68Ga-PSMA (SUVmax 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 SUVmax 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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12 pages, 1933 KiB  
Article
Multiparametric Dual-Time-Point [18F]FDG PET/MRI for Lymph Node Staging in Patients with Untreated FIGO I/II Cervical Carcinoma
by Matthias Weissinger, Stefan Kommoss, Johann Jacoby, Stephan Ursprung, Ferdinand Seith, Sascha Hoffmann, Konstantin Nikolaou, Sara Yvonne Brucker, Christian La Fougère and Helmut Dittmann
J. Clin. Med. 2022, 11(17), 4943; https://doi.org/10.3390/jcm11174943 - 23 Aug 2022
Cited by 1 | Viewed by 1211
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. [...] Read more.
[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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9 pages, 459 KiB  
Article
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
by Marta Opalińska, Anna Sowa-Staszczak, Kamil Wężyk, Jeremiasz Jagiełła, Agnieszka Słowik and Alicja Hubalewska-Dydejczyk
J. Clin. Med. 2022, 11(6), 1537; https://doi.org/10.3390/jcm11061537 - 11 Mar 2022
Cited by 2 | Viewed by 2162
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 [...] Read more.
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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12 pages, 1408 KiB  
Article
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
by Christian Philipp Reinert, Regine Mariette Perl, Christoph Faul, Claudia Lengerke, Konstantin Nikolaou, Helmut Dittmann, Wolfgang A. Bethge and Marius Horger
J. Clin. Med. 2022, 11(6), 1522; https://doi.org/10.3390/jcm11061522 - 10 Mar 2022
Cited by 7 | Viewed by 2203
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. [...] Read more.
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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11 pages, 1306 KiB  
Article
Prognostic Role of Pre-Treatment Metabolic Parameters and Sarcopenia Derived by 2-[18F]-FDG PET/CT in Elderly Mantle Cell Lymphoma
by Domenico Albano, Nadia Pasinetti, Francesco Dondi, Raffaele Giubbini, Alessandra Tucci and Francesco Bertagna
J. Clin. Med. 2022, 11(5), 1210; https://doi.org/10.3390/jcm11051210 - 23 Feb 2022
Cited by 9 | Viewed by 1593
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 [...] Read more.
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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13 pages, 1644 KiB  
Article
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
by Kgomotso M. G. Mokoala, Ismaheel O. Lawal, Letjie C. Maserumule, Khanyisile N. Hlongwa, Honest Ndlovu, Janet Reed, Meshack Bida, Alex Maes, Christophe van de Wiele, Johncy Mahapane, Cindy Davis, Jae Min Jeong, Gbenga Popoola, Mariza Vorster and Mike M. Sathekge
J. Clin. Med. 2022, 11(4), 962; https://doi.org/10.3390/jcm11040962 - 12 Feb 2022
Cited by 6 | Viewed by 1776
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 68 [...] Read more.
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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18 pages, 1557 KiB  
Article
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
by Francesco Dondi, Nadia Pasinetti, Roberto Gatta, Domenico Albano, Raffaele Giubbini and Francesco Bertagna
J. Clin. Med. 2022, 11(3), 615; https://doi.org/10.3390/jcm11030615 - 26 Jan 2022
Cited by 12 | Viewed by 3379
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 [...] Read more.
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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16 pages, 8492 KiB  
Review
Assessment of Response to Immunotherapy in Patients with Hodgkin Lymphoma: Towards Quantifying Changes in Tumor Burden Using FDG-PET/CT
by Francesca Tutino, Elisabetta Giovannini, Silvia Chiola, Giampiero Giovacchini and Andrea Ciarmiello
J. Clin. Med. 2023, 12(10), 3498; https://doi.org/10.3390/jcm12103498 - 16 May 2023
Cited by 2 | Viewed by 1889
Abstract
Immune checkpoint inhibitors are currently the standard of care for many advanced solid tumors, and they have been recently approved for the treatment of relapsed/refractory Hodgkin lymphoma and primary mediastinal B cell lymphoma. Assessments of the response to immunotherapy may be complicated by [...] Read more.
Immune checkpoint inhibitors are currently the standard of care for many advanced solid tumors, and they have been recently approved for the treatment of relapsed/refractory Hodgkin lymphoma and primary mediastinal B cell lymphoma. Assessments of the response to immunotherapy may be complicated by the occurrence of the flare/pseudoprogression phenomenon, consisting of initial tumor enlargement and even the appearance of new lesions, followed by a response, which may initially be indistinguishable from true progression. There have been efforts to characterize and capture the new patterns of response observed during immunotherapy, namely, pseudoprogression and delayed response, and several immune-related response criteria have been proposed. Confirming progression on a subsequent scan and measuring the total tumor burden are both common in immune-related criteria. Due to the peculiarity of hematologic malignancies, lymphoma-specific immune-related criteria have been developed (LYRIC), and they have been evaluated in research studies in comparison to the Lugano Classification. In this review work, we illustrate the evolution of the response criteria in lymphomas from the first CT-based criteria to the development of the PET-based Lugano Classification, further refined to take into account the flare phenomenon encountered during immunotherapy. We also describe the additional contribution of PET-derived volumetric parameters to the interpretation of responses during immunotherapy. Full article
(This article belongs to the Special Issue PET/CT Imaging in Oncology: Clinical Updates and Perspectives)
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9 pages, 2444 KiB  
Review
Intracranial Solitary Fibrous Tumor: A “New” Challenge for PET Radiopharmaceuticals
by Angela Sardaro, Paolo Mammucci, Antonio Rosario Pisani, Dino Rubini, Anna Giulia Nappi, Lilia Bardoscia and Giuseppe Rubini
J. Clin. Med. 2022, 11(16), 4746; https://doi.org/10.3390/jcm11164746 - 14 Aug 2022
Cited by 4 | Viewed by 1644
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 [...] Read more.
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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9 pages, 273 KiB  
Review
The Current Role of Peptide Receptor Radionuclide Therapy in Meningiomas
by 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 6 | Viewed by 1655
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. [...] Read more.
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)
12 pages, 1277 KiB  
Review
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
by Arnoldo Piccardo, Francesco Fiz, Giorgio Treglia, Gianluca Bottoni and Pierpaolo Trimboli
J. Clin. Med. 2022, 11(7), 1919; https://doi.org/10.3390/jcm11071919 - 30 Mar 2022
Cited by 10 | Viewed by 2414
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; [...] Read more.
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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