European Journal of Nuclear Medicine and Molecular Imaging最新文献

Purpose: We performed a cost-utility analysis, using prospectively gathered trial data, comparing two imaging strategies for localizing parathyroid adenomas in primary hyperparathyroidism (pHPT) to determine the most cost-effective approach. Additionally, we provide customizable open-source R-script enabling other centres to identify their optimal imaging strategy based on local diagnostic accuracy and cost data.

Methods: An evaluation of the diagnostic accuracy was performed for five imaging modalities: first-line cervical ultrasound (cUS) and [^99mTc]Tc-methoxy isobutyl isonitrile-single-photon-emission-computed- tomography/computed-tomography (MIBI SPECT/CT), and second-line [¹¹C]choline positron-emitting-tomography/CT (PET/CT), [¹¹C]methionine PET/CT, and 4 dimensional (4D)-CT. A decision-tree-model, constructed in R-studio, compared two diagnostic pathways: (1) The comparator pathway: a stepwise approach starting with cUS and MIBI SPECT/CT escalating to one of three second-line imaging modalities if needed, and (2) use of only one second-line imaging. Costs and quality-adjusted life years (QALYs) were evaluated across pathways, and cost-utility ratios (€/QALY) were calculated for a centre specific perspective with a 24-year time horizon based on life expectancy. In addition, to test the joint parameter uncertainty of the model, a probabilistic Monte-Carlo analysis was performed. One- and two-way sensitivity analyses were conducted to assess model robustness.

Results: [¹¹C]choline PET/CT had a total costs of €10,394 and a QALY gain of 16.66. In contrast, the current standard, cUS + MIBI SPECT/CT with, when necessary, second-line imaging, costs €10,907 and yields 16.63 QALYs. The incremental cost-utility ratio (ICUR) for [¹¹C]choline PET/CT was -€18,846/QALY, indicating dominance with lower cost and greater effectiveness. Sensitivity analyses showed that cost-effectiveness was most sensitive to variations in costs of [¹¹C]choline PET/CT.

Conclusion: This centre-specific model supports first-line [¹¹C]choline PET/CT as a cost-effective first-line strategy for localization of parathyroid adenomas, depending on [¹¹C]choline PET/CT costs. Additionally, the provided cost-utility model, enables other centres to determine their optimal imaging strategy.

Objective: The aim of this evaluation was to identify the safety and efficacy for [²²⁵Ac]Ac-labeled prostate-specific membrane antigen-617 therapy in a retrospectively analyzed group of patients after [¹⁷⁷Lu]Lu-PSMA therapy.

Methods: Metastatic castration-resistant prostate cancer patients after [¹⁷⁷Lu]Lu-PSMA were selected for treatment with 1 ~ 5 cycles of [²²⁵Ac]Ac-PSMA-617. Prostate-specific antigen and blood cell count were measured at the 2nd, 4th, and 8th week after treatment. [⁶⁸Ga]Ga-PSMA-11 PET/CT was used for baseline staging and imaging follow-up at the 2nd month. Safety was assessed according to the Common Terminology Criteria for Adverse Events version 5.0.

Results: Eighteen patients were treated per protocol with a mean activity of 6.1 MBq in each cycle. 72.22% had a PSA decline at any degree, 55.56% had a PSA decline at more than 50%, and 38.89% had a PSA decline at more than 80%. According to PSMA PET progression criteria, disease control was achieved in 38.89% of the patients. The median progression-free survival under [²²⁵Ac]Ac-PSMA-617 after [¹⁷⁷Lu]Lu-PSMA therapy was 4 mo; the median overall survival was 17 mo. Any decline in PSA, a decline in PSA of ≥ 50%, prior treatment with at least 2 cycles and at least 3 cycles of [¹⁷⁷Lu]Lu-PSMA were all significantly associated with PFS. The median PFS was significantly longer for patients receiving ≥ 2 cycles of [¹⁷⁷Lu]Lu-PSMA therapy (4.8 mo, 95% CI: 3.7-5.9) compared to those receiving only 1 cycle (2.4 mo, 95% CI: 1.6-3.2). Median PFS was 5.3 mo (95% CI: 4.0-6.5) with ≥ 3 cycles of [¹⁷⁷Lu]Lu-PSMA therapy, compared to 3 mo (95% CI: 2.0-4.0) in those receiving < 3 cycles.Toxic reactions and adverse effects were mostly grade I ~ III and anemia is the most common hematological toxic reaction. The change in hemoglobin levels before and after [²²⁵Ac]Ac-PSMA treatment was statistically significant (p = 0.006). All patients experienced xerostomia to varying degrees.

Conclusion: For metastatic castration-resistant prostate cancer patients intolerant or unresponsive to [¹⁷⁷Lu]Lu-PSMA treatment, [²²⁵Ac]Ac-PSMA-617 demonstrated significant and safe antitumor effects with relatively low treatment-related toxicity.

Purpose: Positron emission tomography (PET) with amyloid-binding tracers was shown to have high sensitivity for the detection of both transthyretin (ATTR) and light-chain (AL) cardiac amyloidosis (CA). Recent studies describe prognostic value of imaging biomarkers from bone scintigraphy and ¹⁸F-Florbetapir. The aim of this study was to evaluate the value of imaging biomarkers from ¹⁸F-Florbetaben PET, cardiac magnetic resonance (CMR), and echocardiography imaging for prediction of major adverse cardiac events (MACE) in comparison to serum biomarkers in patients with different types of CA.

Methods: Patients who underwent cardiac ¹⁸F-Florbetaben PET/MRI were prospectively enrolled and received clinical follow-up for up to 36 months and MACE were reported (NCT07154381). Scans were reported by two blinded, nuclear medicine physicians. Imaging biomarkers including average retention index (RI), T1 mapping/ extracellular volume (ECV) and serological markers were estimated and their association with MACE free survival was analyzed.

Results: Twenty-one patients with confirmed CA were enrolled. MACEs were reported in 14 of 21 patients (66.7%). Higher average RI was the only imaging biomarker that was a significant predictor for MACE in uni- and multivariate analysis (HR = 4.02, 95%CI: 1.25-12.9, p < 0.05). N-terminal pro-B-type natriuretic peptide (NT-proBNP) was a significant predictor in uni- but not in multivariate analysis. Patients with AL-CA showed a higher rate of MACE than patients with other subtypes.

Conclusion: Integrated ¹⁸F-Florbetaben PET/MR allows diagnosis, subtype differentiation and outcome predication of CA. The average RI was the only significant and independent prognostic imaging biomarker of MACE. Future prospective studies are warranted to investigate benefits for patient management and risk assessment in larger cohorts.