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1.
Ho KC Lai CH Wu TI Ng KK Yen TC Lin G Chang TC Wang CC Hsueh S Huang HJ 《European journal of nuclear medicine and molecular imaging》2008,35(3):484-492
Purpose Uterine carcinosarcomas clinically confined to the uterus usually harbor occult metastases. We conducted a pilot study to
evaluate the value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in uterine carcinosarcoma.
Methods Patients with histologically confirmed uterine carcinosarcoma were enrolled. Abdominal and pelvic magnetic resonance imaging
(MRI)/whole-body computed tomography (CT) scan, and whole-body 18F-FDG PET or PET/CT were undertaken for primary staging, evaluating response, and restaging/post-therapy surveillance. The
clinical impact of 18F-FDG PET was determined on a scan basis.
Results A total of 19 patients were recruited and 31 18F-FDG PET scans (including 8 scans performed on a PET/CT scanner) were performed. Positive impacts of scans were found in
36.8% (7/19) for primary staging, 66.7% (2/3) for monitoring response, and 11.1% (1/9) for restaging/post-therapy surveillance.
PET excluded falsely inoperable disease defined by MRI in two patients. Aggressive treatment applying to three patients with
PET-defined resectable stage IVB disease seemed futile. Two patients died of disease shortly after salvage therapy restaged
by PET. With PET monitoring, one stage IVB patient treated by targeted therapy only was alive with good performance. Using
PET did not lead to improvement of overall survival of this series compared with the historical control (n = 35) (P = 0.779).
Conclusions The preliminary results suggest that 18F-FDG PET is beneficial in excluding falsely inoperable disease for curative therapy and in making a decision on palliation
for better quality of life instead of aggressive treatment under the guidance of PET. PET seems to have limited value in post-therapy
surveillance or restaging after failure. 相似文献
2.
Min-Yu Chen Hung-Hsueh Chou Feng-Yuan Liu Chao-Yu Chen Gigin Lin Lan-Yan Yang Yu-Bin Pan Shih-Ming Jung Ren-Chin Wu Yi-Ting Huang Jason Chien-Sheng Tsai Tzu-Chen Yen Chyong-Huey Lai Ting-Chang Chang 《European journal of nuclear medicine and molecular imaging》2016,43(4):663-674
Purpose
Small-cell cervical cancer (SCCC) is rare and prone to metastasize. We conducted a prospective study to evaluate the role of 18F-FDG PET in the management of this aggressive malignancy.Methods
Patients with untreated primary, histologically confirmed SCCC were enrolled. 18F-FDG PET (or PET/CT) was performed immediately after MRI or CT, for primary staging, monitoring response to treatment or restaging when there was suspicion of recurrence. The clinical impact of PET was determined on a scan basis.Results
A total of 25 patients were recruited and 43 PET scans were performed. The PET images were obtained for primary staging (25 patients), monitoring response (10 patients) and restaging when there was suspicion of recurrence (8 patients). The median follow-up time in event-free patients was 109.3 months (range 97.5 – 157.7 months). A positive impact of PET was found in 8 (18.6 %) of the 43 scans, which included detection of additional regions of distal lymph node (LN) metastasis (one primary staging scan, two restaging scans), bone metastasis (two primary staging scans, one monitoring response scan), and exclusion of false-positive lesions on MRI (one primary staging scan, one restaging scan). On the other hand, one negative impact was recorded as one false-positive lesion on a restaging PET scan. One positive impact was noted for monitoring response (bone metastasis). The impact of three scans was indeterminate. The positive impact of down-staging in avoiding overtreatment but finding additional distal LN (except one on restaging) or bone metastases had no beneficial effect on long-term survival.Conclusion
The results of this preliminary study suggest that PET is useful in the management of SCCC. PET could have more value in detecting occult metastases if future novel therapies are able to offer better control of extensive SCCC.3.
Miederer M Seidl S Buck A Scheidhauer K Wester HJ Schwaiger M Perren A 《European journal of nuclear medicine and molecular imaging》2009,36(1):48-52
Purpose In clinical routine somatostatin analogue positron emission tomography/computed tomography (PET/CT) such as 68Ga-DOTA-Tyr-octreotide (DOTATOC)-PET/CT could substitute conventional 111In-Octreotide scintigraphy. Immunohistochemistry (IHC) for somatostatin receptor 2 (SSTR2) might be a tool to predict positivity
of 68Ga-DOTATOC in patients where initial staging was not performed, e.g., in incidental findings. We therefore compared a score
of SSTR2-IHC with the in vivo standard uptake value (SUV) of preoperative or prebiopsy 68Ga-DOTATOC PET/CT.
Materials and methods In 18 patients, 68Ga-DOTATOC PET/CT scans were quantified with SUV calculations and correlated to a cell membrane-based SSTR2-IHC score (ranging
from 0 to 3).
Results Negative IHC scores were consistent with SUV values below 10. Furthermore, all score 2 and 3 specimens corresponded with high
SUV values (above 15).
Conclusion SSTR2-IHC scores correlated well with SUV values and we propose to use SSTR2 immunohistochemistry in patients missing a preoperative
PET scan to indicate 68Ga-DOTATOC-PET/CT as method for restaging and follow-up in individual patients. 相似文献
4.
Franz Buchegger Valentina Garibotto Thomas Zilli Laurent Allainmat Sandra Jorcano Hansjörg Vees Olivier Rager Charles Steiner Habib Zaidi Yann Seimbille Osman Ratib Raymond Miralbell 《European journal of nuclear medicine and molecular imaging》2014,41(1):68-78
Purpose
18F-Fluorocholine (FCH) and 11C-acetate (ACE) PET are widely used for detection of recurrent prostate cancer (PC). We present the first results of a comparative, prospective PET/CT study of both tracers evaluated in the same patients presenting with recurrence and low PSA to compare the diagnostic information provided by the two tracers.Methods
The study group comprised 23 patients studied for a rising PSA level after radical prostatectomy (RP, 7 patients, PSA ≤3 ng/ml), curative radiotherapy (RT, 7 patients, PSA ≤5 ng/ml) or RP and salvage RT (9 patients, PSA ≤5 ng/ml). Both FCH and ACE PET/CT scans were performed in a random sequence a median of 4 days (range 0 to 11 days) apart. FCH PET/CT was started at injection (307?±?16 MBq) with a 10-min dynamic acquisition of the prostate bed, followed by a whole-body PET scan and late (45 min) imaging of the pelvis. ACE PET/CT was performed as a double whole-body PET scan starting 5 and 22 min after injection (994?±?72 MBq), and a late view (45 min) of the prostate bed. PET/CT scans were blindly reviewed by two independent pairs of two experienced nuclear medicine physicians, discordant subgroup results being discussed to reach a consensus for positive, negative end equivocal results.Results
PET results were concordant in 88 out of 92 local, regional and distant findings (Cohen’s kappa 0.929). In particular, results were concordant in all patients concerning local status, bone metastases and distant findings. Lymph-node results were concordant in 19 patients and different in 4 patients. On a per-patient basis results were concordant in 22 of 23 patients (14 positive, 5 negative and 3 equivocal). In only one patient was ACE PET/CT positive for nodal metastases while FCH PET/CT was overall negative; interestingly, the ACE-positive and FCH-negative lymph nodes became positive in a second FCH PET/CT scan performed a few months later.Conclusion
Overall, ACE and FCH PET/CT showed excellent concordance, on both a per-lesion and a per-patient basis, suggesting that both tracers perform equally for recurrent prostate cancer staging. 相似文献5.
[18F]fluorocholine PET/CT imaging for the detection of recurrent prostate cancer at PSA relapse: experience in 100 consecutive patients 总被引:6,自引:6,他引:0
Cimitan M Bortolus R Morassut S Canzonieri V Garbeglio A Baresic T Borsatti E Drigo A Trovò MG 《European journal of nuclear medicine and molecular imaging》2006,33(12):1387-1398
Purpose We evaluated the potential of PET/CT and [18F]fluoromethylcholine (FCH) in the assessment of suspected recurrence of prostate cancer after treatment.
Methods One hundred consecutive prostate cancer patients with a persistent increase in serum PSA (>0.1 ng/ml) after radical prostatectomy
(58 cases), radiotherapy (21 cases) or hormonal therapy alone (21 cases) were investigated. After injection of 3.7–4.07 MBq/kg
of FCH, both early (at <15 min) and delayed (at >60 min) PET/CT scans were performed in 43 patients, delayed PET/CT scans
in 53 patients and early PET/CT scans in four patients.
Results Of the 100 patients, 54 (PSA 0.22–511.79 ng/ml) showed positive FCH PET/CT scans. Thirty-seven patients had bone and/or abdominal
lymph node uptake, while 17 showed pelvic activity. Malignant disease was confirmed in all but one. Delayed SUVmax of bone metastases was significantly higher (p<0.0001 by paired t test) than that measured at <15 min, whereas no differences were observed between early and delayed SUVs of malignant lymph
nodes or pelvic disease. Forty-six patients (PSA 0.12–14.3 ng/ml) showed negative FCH PET/CT scans. Of the negative PET/CT
scans, 89% were obtained in patients with serum PSA <4 ng/ml and 87% in patients with a Gleason score <8. In none of these
cases could recurrent tumour be proven clinically during a follow-up of 6 months.
Conclusion FCH PET/CT is not likely to have a significant impact on the care of prostate cancer patients with biochemical recurrence
until PSA increases to above 4 ng/ml. However, in selected patients, FCH PET/CT helps to exclude distant metastases when salvage
local treatment is intended. 相似文献
6.
Purpose
Whole-body integrated 11C-choline PET/MR might provide advantages compared to 11C-choline PET/CT for restaging of prostate cancer (PC) due to the high soft-tissue contrast and the use of multiparametric MRI, especially for detection of local recurrence and bone metastases.Materials and methods
Ninety-four patients with recurrent PC underwent a single-injection/dual-imaging protocol with contrast-enhanced PET/CT followed by fully diagnostic PET/MR. Imaging datasets were read separately by two reader teams (team 1 and 2) assessing the presence of local recurrence, lymph node and bone metastases in predefined regions using a five-point scale. Detection rates were calculated. The diagnostic performance of PET/CT vs. PET/MR was compared using ROC analysis. Inter-observer and inter-modality variability, radiation exposure, and mean imaging time were evaluated. Clinical follow-up, imaging, and/or histopathology served as standard of reference (SOR).Results
Seventy-five patients qualified for the final image analysis. A total of 188 regions were regarded as positive: local recurrence in 37 patients, 87 regions with lymph node metastases, and 64 regions with bone metastases. Mean detection rate between both readers teams for PET/MR was 84.7% compared to 77.3% for PET/CT (p > 0.05). Local recurrence was identified significantly more often in PET/MR compared to PET/CT by team 1. Lymph node and bone metastases were identified significantly more often in PET/CT compared to PET/MR by both teams. However, this difference was not present in the subgroup of patients with PSA values ≤2 ng/ml.Inter-modality and inter-observer agreement (K > 0.6) was moderate to substantial for nearly all categories. Mean reduction of radiation exposure for PET/MR compared to PET/CT was 79.7% (range, 72.6–86.2%). Mean imaging time for PET/CT was substantially lower (18.4 ± 0.7 min) compared to PET/MR (50.4 ± 7.9 min).Conclusions
11C-choline PET/MR is a robust imaging modality for restaging biochemical recurrent PC and interpretations between different readers are consistent. It provides a higher diagnostic value for detecting local recurrence compared to PET/CT with the advantage of substantial dose reduction. Drawbacks of PET/MR are a substantially longer imaging time and a slight inferiority in detecting bone and lymph node metastases in patients with PSA values >2 ng/ml. Thus, we suggest the use of 11C-choline PET/MR especially for patients with low (≤2 ng/ml) PSA values, whereas PET/CT is preferable in the subgroup with higher PSA values.7.
Strobel K Skalsky J Kalff V Baumann K Seifert B Joller-Jemelka H Dummer R Steinert HC 《European journal of nuclear medicine and molecular imaging》2007,34(9):1366-1375
Purpose To evaluate the usefulness of PET/CT in melanoma patients with an elevated serum S-100B tumour marker level.
Methods Out of 165 consecutive high-risk melanoma patients referred for PET/CT imaging, 47 had elevated (>0.2 μg/l) S-100B serum levels
and a contemporaneous 18F-FDG PET/CT scan. PET/CT scans were evaluated for the presence of metastases. To produce a composite reference standard,
we used cytological, histological, MRI and PET/CT follow-up findings as well as clinical and S-100B follow-up.
Results Among the 47 patients with increased S-100B levels, PET/CT correctly identified metastases in 38 (30 distant metastases and
eight lymph node metastases). In one patient with cervical lymph node metastases, PET/CT was negative. Eight patients had
no metastases and PET/CT correctly excluded metastases in all of them. Overall sensitivity for metastases was 97% (38/39),
specificity 100% (8/8) and accuracy 98% (46/47). S-100B was significantly higher in patients with distant metastases (mean
1.93 μg/l, range 0.3–14.3 μg/l) than in patients with lymph node metastases (mean 0.49 μg/l, range 0.3–1.6 μg/l, p = 0.003) or patients without metastases (mean 0.625 μg/l, range 0.3–2.6 μg/l, p = 0.007). However, 6 of 14 patients with a tumour marker level of 0.3 μg/l had no metastases.
Conclusion In melanoma patients with elevated S-100B tumour marker levels, FDG-PET/CT accurately identifies lymph node or distant metastases
and reliably excludes metastases. Because of the significant number of false positive S-100B tumour marker determinations
(17%), we recommend repetition of tumour marker measurements if elevated S-100B levels occur before extensive imaging is used. 相似文献
8.
Tiziano Graziani Francesco Ceci Paolo Castellucci Giulia Polverari Giacomo Maria Lima Filippo Lodi Alessio Giuseppe Morganti Andrea Ardizzoni Riccardo Schiavina Stefano Fanti 《European journal of nuclear medicine and molecular imaging》2016,43(11):1971-1979
Purpose
To evaluate 11C-choline PET/CT as a diagnostic tool for restaging prostate cancer (PCa), in a large, homogeneous and clinically relevant population of patients with biochemical recurrence (BCR) of PCa after primary therapy. The secondary aim was to assess the best timing for performing 11C-choline PET/CT during BCR.Methods
We retrospectively analysed 9,632 11C-choline PET/CT scans performed in our institution for restaging PCa from January 2007 to June 2015. The inclusion criteria were: (1) proven PCa radically treated with radical prostatectomy (RP) or with primary external beam radiotherapy (EBRT); (2) PSA serum values available; (3) proven BCR (PSA >0.2 ng/mL after RP or PSA >2 ng/mL above the nadir after primary EBRT with rising PSA levels). Finally, 3,203 patients with recurrent PCa matching all the inclusion criteria were retrospectively enrolled and 4,426 scans were analysed.Results
Overall, 52.8 % of the 11C-choline PET/CT scans (2,337/4,426) and 54.8 % of the patients (1,755/3,203) were positive. In 29.4 % of the scans, at least one distant finding was observed. The mean and median PSA values were, respectively, 4.9 and 2.1 ng/mL at the time of the scan (range 0.2 – 50 ng/mL). In our series, 995 scans were performed in patients with PSA levels between 1 and 2 ng/mL. In this subpopulation the positivity rate in the 995 scans was 44.7 %, with an incidence of distant findings of 19.2 % and an incidence of oligometastatic disease (one to three lesions) of 37.7 %. The absolute PSA value at the time of the scan and ongoing androgen deprivation therapy were associated with an increased probability of a positive 11C-choline PET/CT scan (p?<?0.0001). In the ROC analysis, a PSA value of 1.16 ng/mL was the optimal cut-off value. In patients with a PSA value <1.16 ng/mL, 26.8 % of 1,426 11C-choline PET/CT scans were positive, with oligometastatic disease in 84.7 % of positive scans.Conclusion
In a large cohort of patients, the feasibility of 11C-choline PET/CT for detecting the sites of metastatic disease in PCa patients with BCR was confirmed. The PSA level was the main predictor of a positive scan with 1.16 ng/mL as the optimal cut-off value. In the majority of positive scans oligometastatic disease, potentially treatable with salvage therapies, was observed.9.
Objective This study was performed to evaluate the effects of intravenous (i.v.) contrast agent on semi-quantitative values and lymph
node (LN) staging of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with lung cancer.
Methods Thirty-five patients with lung cancer were prospectively included. Whole-body PET and nonenhanced CT images were acquired
60 min following the i.v. injection of 370 MBq 18F-FDG and subsequently, enhanced-CT images were acquired with the i.v. administration of 400 mg iodinated contrast agent without
positional change. PET images were reconstructed with both nonenhanced and enhanced CTs, and the maximum and average standardized
uptake values (SUVmax and SUVave) calculated from lung masses, LNs, metastatic lesions, and normal structures were compared. To evaluate the effects of the
i.v. contrast agent on LN staging, we compared the LN status on the basis of SUVs (cut-offs; SUVmax = 3.5, SUVave = 3.0).
Results The mean differences of SUVmax in normal structures between enhanced and nonenhanced PET/CT were 15.23% ± 13.19% for contralateral lung, 8.53% ± 6.11% for
aorta, 5.85% ± 4.99% for liver, 5.47% ± 6.81% for muscle, and 2.81% ± 3.05% for bone marrow, and those of SUVave were 10.17% ± 9.00%, 10.51% ± 7.89%, 4.95% ± 3.89%, 5.66% ± 9.12%, and 2.49% ± 2.50%, respectively. The mean differences
of SUVmax between enhanced and nonenhanced PET/CT were 5.89% ± 3.92% for lung lesions (n = 41), 6.27% ± 3.79% for LNs (n = 76), and 3.55% ± 3.38% for metastatic lesions (n = 35), and those of SUVave were 3.22% ± 3.01%, 2.86% ± 1.71%, and 2.33% ± 3.95%, respectively. Although one LN status changed from benign to malignant
because of contrast-related artifact, there was no up- or down-staging in any of the patients after contrast enhancement.
Conclusions An i.v. contrast agent may be used in PET/CT without producing any clinically significant artifact. 相似文献
10.
Beheshti M Vali R Waldenberger P Fitz F Nader M Loidl W Broinger G Stoiber F Foglman I Langsteger W 《European journal of nuclear medicine and molecular imaging》2008,35(10):1766-1774
Purpose The aim of this prospective study was to compare the potential value of 18F fluorocholine (FCH) and 18F fluoride positron emission tomography (PET)–CT scanning for the detection of bony metastases from prostate cancer.
Methods Thirty-eight men (mean age, 69 ± 8 years) with biopsy-proven prostate cancer underwent both imaging modalities within a maximum
interval of 2 weeks. Seventeen patients were evaluated preoperatively, and 21 patients were referred for post-operative evaluation
of suspected recurrence or progression based on clinical algorithms. The number, sites and morphological patterns of bone
lesions on 18F FCH and 18F fluoride PET–CT were correlated: Concordant lesions between the two modalities with corresponding changes on CT were considered
to be positive for malignancy; discordant lesions were verified by follow-up examinations. The mean follow-up interval was
9.1 months.
Results Overall, 321 lesions were evaluated in this study. In a lesion-based analysis, a relatively close agreement was found between these two imaging modalities for detection of malignant bone lesions
(kappa = 0.57), as well as in a patient-based analysis (kappa = 0.76). Sixteen malignant sclerotic lesions with a high density were negative in both 18F FCH and 18F fluoride PET–CT [mean Hounsfield unit (HU), 1,148 ± 364]. There was also a significant correlation between tracer intensity
by SUV and density of sclerotic lesions by HU both in 18F FCH PET–CT (r = −0.28, p < 0.006) and 18F fluoride PET–CT (r = −0.20, p < 0.05).
The sensitivity, specificity and accuracy of PET–CT in the detection of bone metastases in prostate cancer was 81%, 93% and
86% for 18F fluoride, and 74% (p = 0.12), 99% (p = 0.01) and 85% for FCH, respectively.
18F FCH PET–CT led to a change in the management in two out of 38 patients due to the early detection of bone marrow metastases.
18F fluoride PET–CT identified more lesions in some patients when compared with 18F FCH PET–CT but did not change patient management.
Conclusion FCH PET–CT may be superior for the early detection (i.e. bone marrow involvement) of metastatic bone disease. In patients
with FCH-negative suspicious sclerotic lesions, a second bone-seeking agent (e.g. 18F fluoride) is recommended. 18F fluoride PET–CT demonstrated a higher sensitivity than 18F FCH PET–CT, but the difference was not statistically significant. Furthermore, 18F fluoride PET could be also negative in highly dense sclerotic lesions, which presumably reflects the effect of treatment.
It will be important to clarify in future studies whether these lesions are clinically relevant when compared with metabolically
active bone metastases. 相似文献
11.
Iwata M Kasagi K Misaki T Matsumoto K Iida Y Ishimori T Nakamoto Y Higashi T Saga T Konishi J 《European journal of nuclear medicine and molecular imaging》2004,31(4):491-498
The usefulness of fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in differentiated thyroid cancer (DTC) has been demonstrated by many investigators, but in only a small number of studies have FDG-PET images been compared with those obtained using other non-iodine tumour-seeking radiopharmaceuticals. In most of the studies, planar imaging was performed for comparison using thallium-201 chloride or technetium-99m 2-methoxyisobutylisonitrile (99mTc-MIBI). Furthermore, FDG-PET studies were not always performed in the hypothyroid state with increased levels of thyroid stimulating hormone (TSH), which are known to increase FDG uptake by DTC. The aim of this study was to compare the ability of FDG-PET to detect metastatic DTC with that of 99mTc-MIBI whole-body single-photon emission tomography (SPET) and post-therapeutic iodine-131 scintigraphy, evaluated under TSH stimulation. Nineteen patients (8 men, 11 women; age range, 38–72 years, mean 60 years; 17 thyroidectomised and 2 inoperable patients following 131I ablation of the remaining thyroid tissue; 16 papillary and 3 follicular carcinomas) with metastatic DTC underwent FDG-PET whole-body scan (WBS) and 99mTc-MIBI SPET WBS at an interval of less than 1 week, followed by 131I therapy. The SPET images were reconstructed using the maximum likelihood expectation maximisation (ML-EM) method. All patients were hypothyroid at the time of each scan. 131I WBS was performed 3–5 days after oral administration of the therapeutic dose. A total of 32 lesions [10 lymph node (LN), 15 lung, 6 bone, 1 muscle] were diagnosed as metastases, as confirmed by histopathology and/or other imaging modalities (X-ray, US, CT, MRI, bone, 201Tl and 131I scans). FDG-PET, 99mTc-MIBI SPET and post-therapeutic 131I scintigraphy respectively revealed a total of 26 (81.3%), 20 (62.5%) and 22 (68.8%) lesions. These techniques respectively demonstrated nine (90.0%), eight (80.0%) and six (60.0%) LN metastases, and eleven (73.3%), seven (46.7%) and ten (66.7%) lung metastases. They each demonstrated five of the six bone metastases (83.3%). FDG-PET and 99mTc-MIBI SPET were positive in 17 (78.3%) and 14 (63.6%) of the 22 131I-positive lesions, respectively, and also in nine (90.0%) and six (60.0%) of the ten 131I-negative lesions, respectively. Three of the five 131I-positive and FDG-PET-negative lesions were miliary type lung metastases with a maximal nodular diameter of less than 10 mm. Comparison of FDG-PET with 99mTc-MIBI SPET revealed concordant results in 24 lesions, and discordant results in eight lesions (seven with positive FDG-PET alone and one with positive 99mTc-MIBI SPET alone). In conclusion: (a) even using whole-body SPET, FDG PET is superior to 99mTc-MIBI in terms of ability to detect metastases of DTC; (b) the higher sensitivity of FDG-PET compared with the previous studies could partly be due to increased serum TSH. 相似文献
12.
Albrecht S Buchegger F Soloviev D Zaidi H Vees H Khan HG Keller A Bischof Delaloye A Ratib O Miralbell R 《European journal of nuclear medicine and molecular imaging》2007,34(2):185-196
Purpose The first aim of the study was to investigate the diagnostic potential of 11C-acetate PET in the early detection of prostate cancer recurrence. A second aim was the evaluation of early and late PET
in this context.
Methods The study population comprised 32 prostate cancer patients with early evidence of relapse after initial radiotherapy (group
A) or radical surgery (group B). The median PSA of group A (n=17) patients was 6 ng/ml (range 2.6–30.2) while that of group B (n=15) was 0.4 ng/ml (range 0.08–4.8). Pelvic-abdominal-thoracic PET was started 2 min after injection of 11C-acetate and evaluated after fusion with CT.
Results
Group A: Taking a SUVmax≥2 as the cut-off, PET showed local recurrences in 14/17 patients and two equivocal results. Distant disease was observed
in six patients and an equivocal result was obtained in one. Endorectal MRI was positive in 12/12 patients. Biopsy confirmed
local recurrence in six of six (100%) patients. PET was positive in five of the six patients with biopsy-proven recurrences,
the result in the remaining patient being equivocal. Group B: Among the 15 patients, visual interpretation was positive for local recurrences in five patients and equivocal in four.
One obturator lymph node was positive. Endorectal MRI was positive in 11/15 patients and equivocal in two. Positional correlation
of positive/equivocal results on PET and endorectal MRI was observed in seven of nine patients. PSA decreased significantly
after salvage radiotherapy in 8/14 patients, providing strong evidence for local recurrence. PET of the eight patients responding
to RT was positive in three and equivocal in two.
Conclusion
11C-acetate PET was found to be valuable in the early evaluation of prostate cancer relapse. Optimising scanning time and use
of modern PET-CT equipment might allow further improvement. 相似文献
13.
Purpose
We investigated the role of 18F-methylcholine (FCH) PET/CT in the early evaluation of patients with metastatic castration-resistant prostate cancer (mCRPC) treated with enzalutamide.Methods
The study group comprised 36 patients with a median age of 72 years (range 48–90 years) who were treated with enzalutamide 160 mg once daily after at least one chemotherapeutic regimen with docetaxel. Patients were evaluated monthly for serological prostate-specific antigen (PSA) response. FCH PET/CT was performed at baseline and repeated after 3–6 weeks. Univariate and multivariate Cox regression models addressed potential predictors of progression-free survival (PFS) and overall survival (OS).Results
At a median follow-up of 24.2 months (range 1.8–27.3 months), 34 patients were evaluable for early FCH PET/CT evaluation of response, and of these 17 showed progressive disease (PD) and 17 had stable disease or a partial response. A decrease in PSA level of more than 50 % was observed in 21 patients. Early FCH PET/CT PD predicted radiological PD 3 months in advance of CT in 12 of 18 patients (66 %) and was discordant with the decrease in PSA level in 13 patients. In 6 of these, biochemical PD was confirmed in 2 months. In multivariate analysis, only decrease in PSA level and FCH PET/CT were significant predictors of PFS (p?=?0.0005 and p?=?0.029, respectively), whereas decrease in PSA level alone was predictive of OS (p?=?0.007).Conclusion
This is one of the first studies to evaluate the role of FCH PET/CT as an early predictor of outcome in mCRPC patients treated with enzalutamide. Our preliminary results suggest that the combination of FCH PET/CT and decrease in PSA level could be a valid tool to predict PFS in mCRPC patients. PSA remains the single most important prognostic factor, while FCH PET/CT does not add more information on OS beyond that obtained from PSA. Further studies in larger populations are needed to confirm these data and to clarify the role of FCH PET/CT in predicting response to enzalutamide in mCRPC patients.14.
Alexander Haug Christoph J. Auernhammer Björn Wängler Reinhold Tiling Gerwin Schmidt Burkhard Göke Peter Bartenstein Gabriele Pöpperl 《European journal of nuclear medicine and molecular imaging》2009,36(5):765-770
Aim To compare the diagnostic impact of 68Ga-DOTA-TATE and 18F-DOPA PET in the diagnosis of well-differentiated metastatic neuroendocrine tumours (NET).
Methods PET/CT using both 68Ga-DOTA-TATE and 18F-DOPA was performed in 25 patients with histologically proven metastatic NET (nine gut, five pancreas, six lung, one paranasal
sinus, four with unknown primary). Analyses of PET examinations were patient-based (pathological uptake: yes/no), and based
on tumour regions (primary tumour if present and metastases of liver, lung, bones and lymph nodes). The results were compared
with the results of contrast enhanced CT, and with plasma serotonin levels, which were available in 24 of the 25 patients.
Results Patient-based sensitivities were 96% for 68Ga-DOTA-TATE PET and 56% for 18F-DOPA PET. 68Ga-DOTA-TATE PET delineated metastases in 54 of 55 positive metastatic tumour regions in contrast to 29 of 55 delineated by
18F-DOPA PET. Overall, 68Ga-DOTA-TATE was superior to 18F-DOPA in 13 patients (two patients showed fewer positive tumour regions with 18F-DOPA PET). The results were comparable in 12 patients. In 13 of 24 patients, plasma serotonin levels were elevated, and
11 of these 13 patients showed pathological uptake of 18F-DOPA. Of the 11 patients with normal levels of serotonin, 3 also showed positive 18F-DOPA uptake. In patients positive for 18F-DOPA uptake the maximum tumour SUVs were correlated with the levels of serotonin (r=0.66, p=0.01).
Conclusion In this study 68Ga-DOTA-TATE PET proved clearly superior to 18F-DOPA PET for detection and staging of NET. 18F-DOPA uptake tended to be increased in those patients with elevated plasma serotonin. We conclude that 18F-DOPA PET should be employed in patients with NET with negative 68Ga-DOTA-TATE PET and elevated plasma serotonin. 相似文献
15.
Yamamoto Y Nishiyama Y Ishikawa S Nakano J Chang SS Bandoh S Kanaji N Haba R Kushida Y Ohkawa M 《European journal of nuclear medicine and molecular imaging》2007,34(10):1610-1616
Purpose The nucleoside analogue 3′-deoxy-3′-18F-fluorothymidine (FLT) has recently been introduced for imaging cell proliferation with positron emission tomography (PET).
We prospectively evaluated whether FLT uptake reflects proliferative activity as indicated by the Ki-67 index in non-small
cell lung cancer (NSCLC), in comparison with 2-deoxy-2-18F-fluoro-D-glucose (FDG).
Methods A total of 18 patients with newly diagnosed NSCLC were examined with both FLT PET and FDG PET. PET imaging was performed at
60 min after each radiotracer injection. Tumour lesions were identified as areas of focally increased uptake, exceeding background
uptake in the lungs. For semi-quantitative analysis, the maximum standardised uptake value (SUV) was calculated. Proliferative
activity as indicated by the Ki-67 index was estimated in tissue specimens. Immunohistochemical findings were correlated with
SUVs.
Results The sensitivity of FLT and FDG PET for the detection of lung cancer was 72% and 89%, respectively. Four of the five false-negative
FLT PET findings occurred in bronchiolo-alveolar carcinoma. The mean FLT SUV was significantly lower than the mean FDG SUV.
A significant correlation was observed between FLT SUV and Ki-67 index (r = 0.77; p < 0.0002) and for FDG SUV (r = 0.81; p < 0.0001).
Conclusion The results of this preliminary study suggest that, compared with FDG, FLT may be less sensitive for primary staging in patients
with NSCLC. Although FLT uptake correlated significantly with proliferative activity in NSCLC, the correlation was not better
than that for FDG uptake. 相似文献
16.
Freudenberg LS Antoch G Frilling A Jentzen W Rosenbaum SJ Kühl H Bockisch A Görges R 《European journal of nuclear medicine and molecular imaging》2008,35(5):950-957
Purpose This study sought to compare iodine-124 positron emission tomography/computed tomography (124I-PET/CT) and 2-[18F]fluoro-2-deoxy-d-glucose- (FDG-) PET in the detection of recurrent differentiated thyroid carcinoma (DTC) lesions in patients with increasing
serum thyroglobulin (Tg), Tg-antibodies, or both, but without pathological cervical ultrasonography. We assessed the lesion
detection accuracy of 124I-PET alone, CT alone, 124I-PET/CT, FDG-PET, and all these modalities combined.
Material and methods The study included 21 patients (9 follicular, 12 papillary DTC) who had been rendered disease-free by thyroidectomy and radioiodine
treatment (RIT) and followed up for 21–275 months after the last RIT. In all patients, FDG-PET was performed first. Within
1 week, 124I-PET/CT was performed 24 h after oral administration of 43 ± 11 MBq 124I. Imaging results were correlated with further clinical follow-up with (n = 12) or without (n = 9) post-study histology as the reference standard.
Results The sensitivities for DTC lesion detection were: 124I-PET, 49%; CT, 67%; 124I-PET/CT, 80%; FDG-PET, 70%; and all modalities combined, 91%. For local recurrences (distant metastases), the sensitivities
were: 124I-PET, 60% (45%); CT, 20% (84%); and FDG-PET, 65% (71%). One-third of lesions demonstrated pathological tracer uptake with
both 124I- and FDG-PET, while two-thirds were positive with only one of these modalities.
Conclusion Used together, 124I-PET and CT allow localization of foci of highly specific 124I uptake as well as non-iodine-avid lesions. The combination of 124I-PET/CT and FDG-PET improves restaging in recurrent DTC by enabling detection on whole-body scans of local recurrence or
metastases that are often not found if only one of the methods or other imaging modalities are applied. 相似文献
17.
Paola?Caroli Israel?Sandler Federica?Matteucci Ugo?De?Giorgi Licia?Uccelli Monica?Celli Flavia?Foca Domenico?Barone Antonino?Romeo Anna?Sarnelli Giovanni?Paganelli
Purpose
We studied the usefulness of 68Ga-prostate-specific membrane antigen (PSMA) PET/CT for detecting relapse in a prospective series of patients with biochemical recurrence (BCR) of prostate cancer (PCa) after radical treatment.Methods
Patients with BCR of PCa after radical surgery and/or radiotherapy with or without androgen-deprivation therapy were included in the study. 68Ga-PSMA PET/CT scans performed from the top of the head to the mid-thigh 60 min after intravenous injection of 150?±?50 MBq of 68Ga-PSMA were interpreted by two nuclear medicine physicians. The results were correlated with prostate-specific antigen (PSA) levels at the time of the scan (PSApet), PSA doubling time, Gleason score, tumour stage, postsurgery tumour residue, time from primary therapy to BCR, and patient age. When available, 68Ga-PSMA PET/CT scans were compared with negative 18F-choline PET/CT scans routinely performed up to 1 month previously.Results
From November 2015 to October 2017, 314 PCa patients with BCR were evaluated. Their median age was 70 years (range 44–92 years) and their median PSApet was 0.83 ng/ml (range 0.003–80.0 ng/ml). 68Ga-PSMA PET/CT was positive (one or more suspected PCa lesions detected) in 197 patients (62.7%). Lesions limited to the pelvis, i.e. the prostate/prostate bed and/or pelvic lymph nodes (LNs), were detected in 117 patients (59.4%). At least one distant lesion (LNs, bone, other organs, separately or combined with local lesions) was detected in 80 patients (40.6%). PSApet was higher in PET-positive than in PET-negative patients (P?<?0.0001). Of 88 patients negative on choline PET/CT scans, 59 (67%) were positive on 68Ga-PSMA PET/CT.Conclusion
We confirmed the value of 68Ga-PSMA PET/CT in restaging PCa patients with BCR, highlighting its superior performance and safety compared with choline PET/CT. Higher PSApet was associated with a higher relapse detection rate.18.
Frederik A. Verburg David Pfister Axel Heidenreich Andreas Vogg Natascha I. Drude Stefan Vöö Felix M. Mottaghy Florian F. Behrendt 《European journal of nuclear medicine and molecular imaging》2016,43(3):397-403
Purpose
To examine the relationship between the extent of disease determined by [68Ga]PSMA-HBED-CC-PET/CT and the important clinical measures prostate-specific antigen (PSA), PSA doubling time (PSAdt) and Gleason score.Methods
We retrospectively studied the first 155 patients with recurrent prostate cancer (PCA) referred to our university hospital for [68Ga]PSMA-HBED-CC PET/CT.Results
PET/CT was positive in 44 %, 79 % and 89 % of patients with PSA levels of ≤1, 1 – 2 and ≥2 ng/ml, respectively. Patients with high PSA levels showed higher rates of local prostate tumours (p?<?0.001), and extrapelvic lymph node (p?=?0.037) and bone metastases (p?=?0.013). A shorter PSAdt was significantly associated with pelvic lymph node (p?=?0.026), extrapelvic lymph node (p?=?0.001), bone (p?<?0.001) and visceral (p?=?0.041) metastases. A high Gleason score was associated with more frequent pelvic lymph node metastases (p?=?0.039). In multivariate analysis, both PSA and PSAdt were independent determinants of scan positivity and of extrapelvic lymph node metastases. PSAdt was the only independent marker of bone metastases (p?=?0.001). Of 20 patients with a PSAdt <6 months and a PSA ≥2 ng/ml, 19 (95 %) had a positive scan and 12 (60 %) had M1a disease. Of 14 patients with PSA <1 ng/ml and PSAdt >6 months, only 5 (36 %) had a positive scan and 1 (7 %) had M1a disease.Conclusion
[68Ga]PSMA-HBED-CC PET/CT will identify PCA lesions even in patients with very low PSA levels. Higher PSA levels and shorter PSAdt are independently associated with scan positivity and extrapelvic metastases, and can be used for patient selection for [68Ga]PSMA-HBED-CC PET/CT.19.
Purpose
The aims of this retrospective analysis were to compare 68Ga-PSMA PET findings and low-dose CT findings (120 kV, 30 mA), and to obtain semiquantitative and quantitative 68Ga-PSMA PET data in patients with prostate cancer (PC) bone metastases.Methods
In total, 152 PET/CT scans from 140 patients were evaluated. Of these patients, 30 had previously untreated primary PC, and 110 had biochemical relapse after treatment of primary PC. All patients underwent dynamic PET/CT scanning of the pelvis and lower abdomen as well as whole-body PET/CT with 68Ga-PSMA-11. The PET/CT scans were analysed qualitatively (visually), semiquantitatively (SUV), and quantitatively based on a two-tissue compartment model and a noncompartmental approach leading to the extraction of the fractal dimension. Differences were considered significant for p values <0.05.Results
In total, 168 68Ga-PSMA-positive and 113 CT-positive skeletal lesions were detected in 37 patients (8 with primary PC, 29 with biochemical recurrence). Of these 168 lesions, 103 were both 68Ga-PSMA PET-positive and CT-positive, 65 were only 68Ga-PSMA-positive, and 10 were only CT-positive. The Yang test showed that there were significantly more 68Ga-PSMA PET-positive lesions than CT-positive lesions. Association analysis showed that PSA plasma levels were significantly correlated with several 68Ga-PSMA-11-associated parameters in bone metastases, including the degree of tracer uptake (SUVaverage and SUVmax), its transport rate from plasma to the interstitial/intracellular compartment (K1), its rate of binding to the PSMA receptor and its internalization (k3), its influx rate (Ki), and its distribution heterogeneity.Conclusion
68Ga-PSMA PET/CT is a useful diagnostic tool in the detection of bone metastases in PC. 68Ga-PSMA PET visualizes more bone metastases than low-dose CT. PSA plasma levels are significantly correlated with several 68Ga-PSMA PET parameters.20.