18F-前列腺特异性膜抗原-1007 PET/CT显像、11C-胆碱PET/CT显像及单光子发射计算机断层成像术骨显像对前列腺癌骨转移的诊断价值比较

目的探讨¹⁸F-前列腺特异性膜抗原(PSMA)-1007标记的正电子发射体层显像融合计算机体层显像技术(PET/CT)显像、11C-胆碱(11C-CHO)PET/CT显像及单光子发射计算机断层成像术(SPECT)骨显像在前列腺癌骨转移诊断上的差异。方法回顾性分析2018年9月至2020年7月北部战区总医院核医学科收治的43例男性前列腺癌患者的临床资料,年龄(77.47±11.87)岁,年龄范围为55~89岁。所有患者行¹⁸F-PSMA-1007 PET/CT显像、11C-CHO PET/CT显像及SPECT骨显像检查。分别统计¹⁸F-PSMA-1007 PET/CT显像、11C-CHO PET/CT及SPECT骨显像诊断骨转移的阳性例数和阴性例数,计算三种方法各自的灵敏度、特异度、准确性、阳性预测值、阴性预测值,绘制受试者工作特征(ROC)曲线,计算并比较各自曲线下面积(AUC),评价三种检查方法对前列腺癌骨转移的诊断效能。结果 43例前列腺癌患者中,27例患者出现骨转移。¹⁸F-PSMA-1007 PET/CT显像示26例患者发生骨转移,漏诊1例;11C-CHO PET/CT显像示24例患者发生骨转移,误诊1例,漏诊4例;SPECT骨显像示23例患者发生骨转移,误诊3例,漏诊7例,三者诊断前列腺癌骨转移的灵敏度、特异度、准确性分别为96.3%(26/27)、100%(16/16)、97.7%(42/43);85.2%(23/27)、93.8%(15/16)、88.4%(38/43);74.1%(20/27)、81.3%(13/16)、76.7%(33/43)。¹⁸F-PSMA-1007 PET/CT显像、11C-CHO PET/CT和SPECT骨显像ROC曲线的AUC和95%CI分别为0.981(0.885~1.000)、0.913(0.763~0.967)、0.777(0.624~0.889)。三种检查的AUC曲线下面积进行两两比较,差异均有统计学意义(P<0.05)。采用Wilcoxon秩和检验对27例患者三种方法检出的骨转移灶的数量进行两两比较发现,¹⁸F-PSMA-1007 PET/CT显像与SPECT骨显像比较,差异有统计学意义(Z=-2.484,P=0.013),¹⁸F-PSMA-1007 PET/CT显像与11C-CHO PET/CT显像比较,差异无统计学意义(Z=-0.160,P=0.873);11C-CHO PET/CT显像与SPECT骨显像比较,差异有统计学意义(Z=-2.085,P=0.037)。结论 PET/CT显像较SPECT骨显像能发现更多的骨转移灶。¹⁸F-PSMA-1007 PET/CT显像对前列腺癌骨转移诊断的灵敏度、特异度及准确性高于其他两种检查方式。在低前列腺特异性抗原(PSA)的情况下,能够精确地对前列腺癌骨转移做出诊断。     

The role of F18-fluorodeoxyglucose positron emission tomography in identifying patients at high risk for lethal arrhythmias from cardiac sarcoidosis and the use of serial scanning to guide therapy

Substantial literature exists linking inflammation with arrhythmia, in particular with regards to serological markers of systemic inflammation. Regional inflammation can be identified using positron emission tomography (PET) with the radiotracer F18-fluorodeoxyglucose (F18-FDG). In the current series, we demonstrate novel applications of cardiac PET using F18-FDG and N13-ammonia radiotracers in the evaluation and treatment of arrhythmia associated with cardiac sarcoidosis. These applications include defining the cause of arrhythmia, identifying arrhythmias that will be amenable to medical management, and guiding therapy using serial scanning. Though these applications are promising, prospective multicenter studies are needed to provide better understanding of the utility of PET imaging in the diagnosis and treatment of arrhythmias.     

Cardiac Metabolic Implications of Fat Depot Imaging

Purpose of Review

This article reviews recent developments in the application of positron emission tomography (PET) for personalized cardiac imaging.

Recent Findings

PET imaging has improved our understanding of various cardiovascular pathologies by probing the molecular pathways associated with specific cardiovascular diseases. The use of PET can improve disease detection and influence management strategies.

Summary

PET has improved our understanding of the pathophysiology of atherosclerosis by imaging several key features including calcification, inflammation, apoptosis, and hypoxia. Molecular imaging of myocardial inflammation and cardiac sympathetic innervation is well established and several new promising PET radiotracers have been developed. Roles for the molecular imaging of aortic valve disease and mitochondrial function are also emerging.

     

PSMA-Based [<Superscript>18</Superscript>F]DCFPyL PET/CT Is Superior to Conventional Imaging for Lesion Detection in Patients with Metastatic Prostate Cancer

Purpose

Current standard of care conventional imaging modalities (CIM) such as X-ray computed tomography (CT) and bone scan can be limited for detection of metastatic prostate cancer and therefore improved imaging methods are an unmet clinical need. We evaluated the utility of a novel second-generation low molecular weight radiofluorinated prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) radiotracer, [¹⁸F]DCFPyL, in patients with metastatic prostate cancer.

Procedures

Nine patients with suspected prostate cancer recurrence, eight with CIM evidence of metastatic prostate cancer and one with biochemical recurrence, were imaged with [¹⁸F]DCFPyL PET/CT. Eight of the patients had contemporaneous CIM for comparison. A lesion-by-lesion comparison of the detection of suspected sites of metastatic prostate cancer was carried out between PET and CIM. Statistical analysis for estimated proportions of inter-modality agreement for detection of metastatic disease was calculated accounting for intra-patient correlation using general estimating equation (GEE) intercept-only regression models.

Results

One hundred thirty-nine sites of PET positive [¹⁸F]DCFPyL uptake (138 definite, 1 equivocal) for metastatic disease were detected in the eight patients with available comparison CIM. By contrast, only 45 lesions were identified on CIM (30 definite, 15 equivocal). When lesions were negative or equivocal on CIM, it was estimated that a large portion of these lesions or 0.72 (95 % confidence interval (CI) 0.55–0.84) would be positive on [¹⁸F]DCFPyL PET. Conversely, of those lesions negative or equivocal on [¹⁸F]DCFPyL PET, it was estimated that only a very small proportion or 0.03 (95 % CI 0.01–0.07) would be positive on CIM. Delayed 2-h-post-injection time point PET yielded higher tumor radiotracer uptake and higher tumor-to-background ratios than an earlier 1-h-post-injection time point.

Conclusions

A novel PSMA-targeted PET radiotracer, [¹⁸F]DCFPyL, was able to a large number of suspected sites of prostate cancer, many of which were occult or equivocal by CIM. This study provides strong preliminary evidence for the use of this second-generation PSMA-targeted PET radiotracer for detection of metastatic prostate cancer and lends further support for the importance of PSMA-targeted PET imaging in prostate cancer.

     

Positron emission tomography with 2-deoxy-2-[(18)F]fluoro-D-glucose for evaluating local and distant disease in patients with cervical cancer.

PURPOSE: To assess the accuracy of positron emission tomography (PET) with 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG) for evaluating local and distant disease in patients with cervical cancer. METHODS: The PET imaging database maintained at our institution was used to identify patients who received FDG-PET scans for the clinical indication of cervical cancer for the past four years. Patients were followed for a minimum of six months following the PET study. Results of the FDG-PET studies were correlated with surgical pathology, biopsy results, and/or clinical follow up to assess the accuracy of FDG-PET in evaluating local and distant disease. RESULTS: A total of 61 FDG-PET studies performed in 41 patients were included in this retrospective study. Nine FDG-PET studies were performed for initial staging of cervical cancer, and 52 PET scans were performed in 35 different patients as restaging studies following therapy. For the initial staging, the local primary disease was identified in all nine FDG-PET studies, and PET distinguished the patients which had localized disease (four patients) from those with distant metastases on follow-up (five patients) with 100% accuracy. For restaging cervical cancer, FDG-PET had a sensitivity of 0.82 and specificity of 0.97 (accuracy 0.92) for evaluation of local recurrence. For evaluating distant disease in these patients, PET had a sensitivity of 1.00 and specificity of 0.90 (accuracy 0.94). In the evaluation of local disease, focal rectal activity caused false-positive results in two cases. Three false-positive studies for distant disease were caused by inflammatory adenopathy. CONCLUSION: FDG-PET is an accurate modality both for initial staging and restaging of patients with cervical cancer. PET is particularly sensitive for detecting distant metastases, allowing stratification of patients into those with locally confined disease and those with distant disease. These results were achieved by using a standardized PET imaging protocol without the use of bowel preparations, lasix administration, or Foley catheter drainage. Evaluation of local disease can be challenging due to adjacent rectal and bladder activity, and the use of hybrid PET/computed tomography (CT) scanners in the future may further improve evaluation of local disease.     

多发性骨髓瘤的影像学评估

多发性骨髓瘤具有独特的骨病表现,由于破骨细胞激活和成骨细胞功能抑制导致溶骨性破坏和严重骨质疏松。骨病严重程度对患者生活质量和生存均有负面影响。普通X线检出骨病的灵敏度很低,CT的灵敏度虽明显提高,但难以检出骨外病变。功能性影像方法(主要包括磁共振弥散加权成像和正电子发射断层显像/计算机体层成像)不仅能发现早期溶骨病灶,且在评估全身肿瘤负荷和缓解后微小残留病变方面更有优势。本文将对这些方面的进展进行综述。     

PET/CT-Guided Interventions in Oncology Patients: A Nursing Perspective

In the past 5 years, the utilization of positron emission tomography/computerized tomography (PET/CT) guidance is more commonly used for cancer patients undergoing biopsy and ablations at this National Cancer Institute-designated cancer center. The interventional use of PET/CT imaging requires nurses to have a thorough understanding of the mechanisms involved to provide the best care in an environment that is safe for patients and staff. Evidence suggests cohesive care, and safe practice measures are achieved when patients actively participate and understand their care. This article will discuss how a collaborative patient-centered approach in caring for oncologic patients undergoing PET/CT interventions is necessary for achieving quality patient outcomes.     

Metabolic imaging using F18-fluorodeoxyglucose to assess myocardial viability

Over the past 10 years, F18-fluorodeoxyglucose (FDG) imaging with positron emission tomography (PET) has emerged as an important technique in the delineation of myocardial viability. Using this technique it has become possible to predict recovery of ventricular function after revascularization in patients with chronic coronary artery disease. Data from long-term (although retrospective) follow-up studies have demonstrated that patients with viable myocardium on FDG PET who do not undergo revascularization are prone to cardiac events, including cardiac death and non-fatal infarction. The same studies have pointed out that patients with viable tissue on FDG PET, who do undergo revascularization, improve substantially in symptoms related to congestive heart failure. To allow FDG imaging in centers without PET equipment, recent studies have evaluated the use of FDG imaging with single photon emission computed tomography (SPECT) and 511 keV collimators. Preliminary data using this alternative approach are promising, but need further confirmation. In this review the experience with FDG imaging (using either PET or SPECT) in the assessment of tissue viability in patients with coronary artery disease will be discussed.     

Noninvasive Positron Emission Tomography Imaging of Coronary Arterial Inflammation

The importance of inflammation to atherothrombosis has led to the pursuit of noninvasive imaging methods to measure inflammation within the arterial wall. There is substantial evidence supporting the use of ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging for evaluation of atherosclerotic plaque inflammation. However, coronary imaging with this technique has been limited, due to several technical hurdles. Nonetheless, early experiences in coronary FDG-PET imaging have been encouraging. This review outlines the development of vascular PET imaging and its potential use for evaluation of coronary artery disease.     

Spectrum of PET–CT pelvic pitfalls in patients with gynecologic malignancies

Integrated positron emission tomography?Ccomputed tomography (PET?CCT) represents a major technologic advance in oncologic imaging of patients with gynecologic malignancies, since it improves localization of regions of increased 18F-fluorodeoxyglucose (FDG) uptake and staging/restaging accuracy by allowing a near-simultaneous acquisition of co-registered, spatially matched metabolic and anatomic data in the same examination. However, physiologic processes, normal variants, and many benign lesions within the pelvis can accumulate FDG and may be confused with malignant neoplasms. Conversely, false-negative results due to malignancies with low FDG uptake can pose a diagnostic challenge in patients with gynecologic cancer. With the increased use of PET?CCT in patients with gynecologic malignancies, misinterpretation of these potential pitfalls can have significant implications and alter staging/restaging and patient management. In this article, we review these potential pitfalls in integrated PET?CCT of the pelvis in patients with gynecologic cancer.     

The promise of PET in clinical management and as a sensitive test for drug cytotoxicity in sarcomas

Positron emission tomography (PET) is a noninvasive functional imaging technique that allows assessment of key biological processes important in cancer development and progression. It provides information complementary to conventional anatomic imaging, demonstrating utility in a range of cancer settings from diagnosis, biopsy guidance, tumor stratification and prognostication, and staging and surveillance of disease recurrence. Its ability to evaluate vital processes in tumor biology also makes it a potentially valuable and sensitive tool for assessing therapeutic response. The development of novel PET tracers and improvements in technology will only continue to augment the potential of PET and enhance its attractiveness as an instrument to facilitate drug development. This article will discuss the above issues, using the setting of sarcomas as an example.     

Overview of radiopharmaceuticals for diagnosis of central nervous disorders

There are two types of imaging instruments, single-photon emission computed tomography (SPECT) and positron emission tomography (PET) that use radiopharmaceuticals for the diagnosis of brain disorders. Brain perfusion imaging agents, labeled either with 123I or 99mTc, are useful in detecting various cerebral vascular abnormalities, such as stroke and transient ischemia with SPECT. The management of other neurological disorders (i.e., in Alzheimer's, epilepsy, schizophrenia, and head trauma patients) may also be benefitted by these agents. The exact trapping mechanisms and their relationships with potential clinical applications still remain to be elucidated. Imaging studies using 18F fluorodeoxyglucose with PET is currently the most promising diagnostic tool for the evaluation of local glucose metabolism related to various disease states, such as Alzheimer's disease, brain tumor, and epilepsy. In the past few years significant progress has been made in the design and characterization of new CNS neuronal and postsynaptic receptor imaging agents for PET and SPECT. The new diagnostic agents are aimed at measurements of localization and changes of neuronal function. It is likely that these types of agents have potential for clinical application, especially in the diagnosis of psychiatric disorders that do not involve morphological changes.     

The Current Role of Microfluidics in Radiofluorination Chemistry

The current utilization of positron emission tomography (PET) imaging is limited due to the high costs associated with production facility start-up and operations; subsequently, there has been a movement towards microfluidic synthesis of radiolabeled imaging pharmaceuticals (tracers). In this review, we summarize the current status of microfluidic radiosynthesis units for producing fluorine-18 labeled PET imaging tracers, including a discussion of the relative strengths and weaknesses of such devices. In addition, we provide a brief overview of the radiotracers that have been produced using microfluidic devices to date. Finally, we discuss the prospects for the future of this field, including the potential of newly envisioned devices developed that may allow operators to easily synthesize specialized tracers for individual patient doses.

     

Semiquantitative Parameters in PSMA-Targeted PET Imaging with [18F]DCFPyL: Intrapatient and Interpatient Variability of Normal Organ Uptake

Molecular Imaging and Biology - Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) imaging has impacted the management of patients with prostate cancer (PCa) in...     

The Use of F-18 Choline PET in the Assessment of Bone Metastases in Prostate Cancer: Correlation with Morphological Changes on CT

Aim  

F-18 fluor choline-positron emission tomography/computed tomography (FCH-PET/CT) has emerged as a new diagnostic tool for the imaging of prostate cancer. In this study, we have evaluated the potential role of FCH-PET/CT for the assessment of bone metastases in patients with prostate cancer. Furthermore, we assessed the pattern of metabolic uptake by FCH in relation to morphologic changes on CT.     

Role of Radiomics-Based Baseline PET/CT Imaging in Lymphoma: Diagnosis,Prognosis, and Response Assessment

Radiomic analysis provides information on the underlying tumour heterogeneity in lymphoma, reflecting the real-time evolution of malignancy. 2-Deoxy-2-[¹⁸F] fluoro-D-glucose positron emission tomography ([¹⁸F] FDG PET/CT) imaging is recommended before, during, and at the end of treatment for almost all lymphoma patients. This methodology offers high specificity and sensitivity, which can aid in accurate staging and assist in prompt treatment. Pretreatment [¹⁸F] FDG PET/CT-based radiomics facilitates improved diagnostic ability, guides individual treatment regimens, and boosts outcome prognosis based on heterogeneity as well as the biological, pathological, and metabolic status of the lymphoma. This technique has attracted considerable attention given its numerous applications in medicine. In the current review, we will briefly describe the basic radiomics workflow and types of radiomic features. Details of current applications of baseline [¹⁸F] FDG PET/CT-based radiomics in lymphoma will be discussed, such as differential diagnosis from other primary malignancies, diagnosis of bone marrow involvement, and response and prognostic prediction. We will also describe how this technique provides a unique noninvasive platform to assess tumour heterogeneity. Newly emerging PET radiotracers and multimodality technology will improve diagnostic specificity and further clarify tumor biology and even genetic variations in lymphoma, potentially promoting the development of precision medicine.

     

The Use of F-18 Choline PET in the Assessment of Bone Metastases in Prostate Cancer: Correlation with Morphological Changes on CT

Aim  

F-18 fluor choline-positron emission tomography/computed tomography (FCH-PET/CT) has emerged as a new diagnostic tool for the imaging of prostate cancer. In this study, we have evaluated the potential role of FCH-PET/CT for the assessment of bone metastases in patients with prostate cancer. Furthermore, we assessed the pattern of metabolic uptake by FCH in relation to morphologic changes on CT.     

Positron emission tomography and drug discovery: contributions to the understanding of pharmacokinetics, mechanism of action and disease state characterization.

As an imaging modality, positron emission tomography (PET) provides unique quantitative in vivo information of value to drug discovery studies. These non-invasive studies span the pharmacokinetic/pharmacodynamic evaluation of potential drug candidates, receptor occupancy as an important determinant of efficacy, the pharmacological characterization of potential mechanisms of action, and the biological characterization of disease with well-characterized PET ligands. PET techniques are also being applied to the assessment of gene-level activities and the longitudinal evaluation of disease progression and therapeutic intervention. As the availability of PET scanners, cyclotrons, and specific PET ligands grows, the techniques highlighted in this review will become central to target validation, drug candidate selection, pharmacokinetic characterization, and clinical evaluation.     

Animal Models of Neurodegenerative Disease: Insights from <Emphasis Type="Italic">In vivo</Emphasis> Imaging Studies

Animal models have been used extensively to understand the etiology and pathophysiology of human neurodegenerative diseases, and are an essential component in the development of therapeutic interventions for these disorders. In recent years, technical advances in imaging modalities such as positron emission tomography (PET) and magnetic resonance imaging (MRI) have allowed the use of these techniques for the evaluation of functional, neurochemical, and anatomical changes in the brains of animals. Combining animal models of neurodegenerative disorders with neuroimaging provides a powerful tool to follow the disease process, to examine compensatory mechanisms, and to investigate the effects of potential treatments preclinically to derive knowledge that will ultimately inform our clinical decisions. This article reviews the literature on the use of PET and MRI in animal models of Parkinson’s disease, Huntington’s disease, and Alzheimer’s disease, and evaluates the strengths and limitations of brain imaging in animal models of neurodegenerative diseases.     

Imaging Techniques in Nuclear Cardiology for the Assessment of Myocardial Viability

The assessment of myocardial viability has become an important aspect of the diagnostic and prognostic work-up of patients with ischemic cardiomyopathy. Although revascularization may be considered in patients with sufficient viable myocardium, patients with predominantly scar tissue should be treated medically. Patients with left ventricular dysfunction who have viable myocardium are the patients at highest risk because of the potential for ischemia but at the same time benefit most from revascularization. It is important to identify viable myocardium in these patients, and radionuclide myocardial scintigraphy is an excellent tool for this. Single-photon emission computed tomography perfusion scintigraphy (SPECT), whether using ²⁰¹thallium, ^99mTc-sestamibi, or ^99mTc-tetrofosmin, in stress and/or rest protocols, has consistently been shown to be an effective modality for identifying myocardial viability and guiding appropriate management. Metabolic and perfusion imaging with positron emission tomography (PET) radiotracers frequently adds additional information and is a powerful tool for predicting which patients will have an improved outcome from revascularization. New techniques in the nuclear cardiology field, like attenuation corrected SPECT, dual isotope simultaneous acquisition (DISA) SPECT and gated FDG PET are promising and will further improve the detection of myocardial viability. Also the combination of multislice computed tomography scanners with PET opens possibilities of adding coronary calcium scoring and non-invasive coronary angiography to myocardial perfusion imaging and quantification. Evaluation of the clinical role of these creative new possibilities warrants investigation.