Clinical and Translational Imaging最新文献

Purpose

Contrast-enhanced computed tomography (CECT) underestimates the response to targeted therapy in metastatic renal cell cancer (mRCC) using Response Assessment Criteria In Solid Tumors (RECIST) v1.1, creating an unmet need for better imaging biomarkers for early response assessment. This study explores the feasibility of early response assessment to targeted therapy in metastatic clear cell RCC (ccRCC) using ⁶⁸Ga-PSMA-11 PET/CT.

Methods

After informed consent, adult patients with biopsy-proven metastatic ccRCC planned for targeted therapy were recruited in this prospective observational pilot study from May 2021 to December 2022. ⁶⁸Ga-PSMA-11 PET/CT was conducted at baseline and one and three months post-treatment. The concordance between PET and CT responses at one and three months was analysed. Follow-up and comparison of progression-free survival (PFS) between responders and non-responders on PET and CT was done.

Results

Twenty-one metastatic ccRCC patients were included in the final analysis. The response assessment on PET and CT was discordant in 15 out of 21 patients (~ 71%) at one month and in nine out of 21 patients (~ 43%) at three months. There was no significant difference between the median PFS of responders vs non-responders on CT at one (14 m vs. 12 m, p = 0.9) and three months (14 m vs. 12 m, p = 0.6). However, a higher difference in median PFS was observed between responders and non-responders on PET at one (PFS 14 m vs. 1 m, p < 0.001) and three months (PFS 14 m vs. 3 m, p = 0.28), respectively.

Conclusion

Early response assessment with ⁶⁸Ga-PSMA-11 PET/CT is feasible and provides more accurate prognostic information than CECT in metastatic clear cell RCC patients undergoing targeted therapy.

Trial registration number

CTRI/2021/05/033805 (date of registration: 25/05/21)

The annual incidence of spinal infections has been rising significantly over the last years and is expected to increase even further. Spinal infections may include infection of the vertebral body and intervertebral disc (spondylodiscitis), paravertebral abscess, epidural abscess and septic arthritis of the facet joints. Positron emission tomography (PET) with [¹⁸F]FDG has high sensitivity for detecting spinal infections, may help in differentiating between spinal infection subtypes and is able to detect dissemination of infection outside the spine. [¹⁸F]FDG PET/CT is especially indicated if MRI is inconclusive, in patients with contra-indications for MRI, in postoperative patients with or without spinal hardware and in patients with bacteremia to find foci of infection. Here, we present a concise overview of the spectrum of [¹⁸F]FDG PET/CT imaging findings in spinal infections.

Pediatric congenital pulmonary malformations are rare abnormalities which may affect airways, pulmonary parenchyma, and vasculature and diagnostic imaging plays a significant role in their identification and characterization. Although, nowadays, often the diagnosis of this heterogeneous group of malformations is performed prenatally by ultrasound and/or fetal magnetic resonance, after birth, computed tomography represents the main technique. Radiographs are often used as first line diagnostic tool while magnetic resonance demonstrated to be especially beneficial to investigate some malformations such as bronchogenic cysts. Therefore, radiologists should be aware of the main features associated with such alterations to guarantee a prompt diagnosis and, if necessary, guide towards the optimal treatment. Aim of this pictorial review is to provide a comprehensive overview of the typical features of congenital pulmonary malformations at imaging supporting general and pediatric radiologists in the diagnostic process.

Purpose

Prostate-specific membrane antigen (PSMA) PET/CT has an established reliable diagnostic performance for detecting metastases in prostate cancer. However, there are increasing instances of scans demonstrating equivocal bone lesions, with non-specific uptake and without a definite benign or malignant CT correlate. To date, the prevalence, malignancy rate, and relationship with radioligand type ([¹⁸F] PSMA-1007 vs. others ([⁶⁸Ga]Ga-PSMA-11 and [¹⁸F] DCFPyL) for these equivocal lesions have not been extensively established.

Methods

A systematic review and meta-analysis was conducted on equivocal bone lesions. Pubmed and EMBASE were searched up to December 11, 2023. Quality of the studies was evaluated using QUADAS-2. The following proportions were pooled using random-effects model: (1) prevalence of equivocal bone lesions (i.e., number of patients with one or more equivocal bone lesions/number of patients with PSMA PET/CT) and (2) their malignancy rates (i.e., number of metastases/number of equivocal bone lesions). Subgroup analyses based on radioligand type, clinical setting, and definition of equivocal bone lesion were performed.

Results

Twenty-five studies (4484 patients) were included. Pooled prevalence of equivocal bone lesions was 20% (95%CI, 12–31%). [¹⁸F]PSMA-1007 was associated with a greater prevalence of equivocal lesions compared with other radioligands: 36% (95%CI 26–48%) vs. 8% (95%CI, 4–14%), respectively, p < 0.01. Pooled malignancy rate of equivocal bone lesions was 14% (95%CI, 7–25%). [¹⁸F]PSMA-1007 was associated with a lower malignancy rate compared to other radioligands: 8% (95%CI, 3–19%) vs. 29% (95%CI, 17–44%), respectively, p = 0.01. There were no signficant difference in prevalence or malignancy rate between subgroups stratified to clinical setting or definition of equivocal bone lesions (p = 0.32–0.60).

Conclusions

Equivocal bone lesions are often encountered on PSMA PET/CT but exihibit a low malignancy rate. Compared to other radioligands, [¹⁸F]PSMA-1007 requires special attention as it is associated with a higher frequency and lower rate of metastasis.

Positron emission tomography (PET) plays an important role in the diagnosis and surveillance of neoplastic diseases. PET images may show higher noise levels than other imaging modalities, especially in a dose- or time-saving approach. Artificial Intelligence techniques can improve the signal-to-noise ratio in PET image reconstruction. Deep learning approaches have made significant advances in comprehensive data retrieval and de-noising. Artificial Intelligence de-noising in PET is a very promising approach that could allow shorter scan times or lower radiopharmaceutical dose administration. We reviewed studies about the de-noising AI-driven PET images, i.e., by SubtlePET™ AI tool, according to the following items: (1) retrieval of complete PET data acquired with reduced scan time; (2) reconstruction of PET images with low-count statistics by reducing radiopharmaceutical doses; (3) impact of artificial intelligence-based de-noising on PET radiomics. We evaluated their implementability in PET image reconstruction to increase the signal-to-noise ratio and image definition. This approach seems promising to positively impact patient healthcare—especially in pediatric patients—and overall diagnostic procedures reducing the cost of radiopharmaceuticals and increasing productivity and efficiency.

Purpose

This study aims to investigate the role of bone marrow (BM) FDG uptake distribution in assessing pathological status of BM with diffusely increased FDG uptake.

Methods

We retrospectively analyzed one hundred and thirty-four PET/CT scans with diffusely hypermetabolic BM, which involved forty-nine patients with BM malignant infiltration (BMI) and eighty-five patients with benign BM disorders. The maximum standardized uptake values (SUVmax) of axial skeletons, appendicular skeletons, and the range of humerus FDG uptake were measured. The clinical and laboratory data were collected. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve were used to evaluate the risk factors for BMI and discriminative ability of above indicators for the pathology status of BM.

Results

In patients with diffusely hypermetabolic BM, both the glucose metabolism of axial and appendicular skeletons was higher in BMI than BM benign disorders. The multivariate logistic regression analysis (stepwise) revealed age (odds ratio [OR] 1.073; 95%CI, 1.031–1.117; P = 0.001), femurs SUVmax (OR 2.058; 95%CI, 1.317–3.218; P = 0.002), neutrophil count (OR 0.805; 95%CI, 0.718–0.902; P < 0.001) and range of humerus FDG uptake (OR 11.335; 95%CI, 2.831–45.377; P = 0.001) were associated with BMI. Combined diagnosis had the highest ROC value (AUC 0.918; 95%CI, 0.864–0.973; P < 0.001) with a sensitivity of 89.8% and specificity of 85.9%.

Conclusion

The BM activity of the appendicular skeleton was more significant in distinguishing BM malignant and benign disorders. Range of humerus FDG uptake combined femurs SUVmax, neutrophil count and age was reliable for assessing diffuse BM involvement.

Abstract

Abstract

Abstract

Reaching equity in the distribution of opportunity between men and women is in the agenda of premier international agencies worldwide, and in the last decades a significant improvement in women’s access to care and education as well as in terms of equality in the labor market has been achieved. In the medical field and, in particular, in radiology, the number of women progressively increased but still much has to be done to guarantee equal opportunities. Aiming to provide an overview of the European musculoskeletal imaging community regarding gender equity, we developed a 39-item survey addressed to the 2481 members of the European Society of Musculoskeletal Imaging (ESSR). The responses of the 74 participants (3%) demonstrated that for most of the addressed clinical, academic, and ESSR-related questions, no statistically significant differences gender-related occurred except for instance for the experienced gender discrimination, which affected women more often (55% of women vs 21.9% of men; p = 0.017). Despite the low participation rate, our results suggest that there is hope of ‘suffrage’ with leadership and steering roles in the Executive Committee and Subcommittees and a real-time reduction in the gender gap.

Background

Soft-tissue sarcomas (STS) represent a diverse group of rare malignancies, underscoring the need for precise risk stratification. [¹⁸F]fluoro‑2‑deoxy‑2‑d‑glucose positron emission tomography ([¹⁸F]FDG PET) imaging parameters have been proposed as potential prognostic indicators in several cancer types, yet their significance in STS remains under investigation. This study aimed to synthesize the available evidence and assess the prognostic value of these parameters.

Methods

A systematic review and meta-analysis was conducted, employing a comprehensive literature search across multiple databases. The prognostic value of [¹⁸F]FDG PET parameters, including pre- and post- treatment standardized uptake values (SUV1, SUV2), pretreatment metabolic tumor volume (MTV1) and total lesion glycolysis (TLG1) on event-free survival (EFS) and overall survival (OS) in patients with STS was examined.

Results

Thirty-one studies with 1,932 patients were identified. The analyses demonstrated significant relationships between higher SUV1 (hazard ratio, HR 1.68 for EFS and 3.07 for OS, p < 0.001), SUV2 (HR 3.13 for EFS and 2.09 for OS, p < 0.001 and p = 0.001 respectively), MTV1 (HR 2.29 for EFS and 3.05 for OS, p = 0.011 and p < 0.001 respectively), TLG1 (HR 2.85 for EFS and 3.23 for OS, p = 0.032 and p = 0.002 respectively) and poorer survival outcomes. However, the association of these parameters with survival outcomes was non-significant in pediatric patients.

Conclusion

This study suggests that [¹⁸F]FDG PET parameters could serve as important prognostic markers in adults with STS, but not in pediatric patients. Future studies with larger cohorts and uniform methodologies are critical to confirm and build upon these findings.