Clinical and Translational Imaging最新文献

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.

Abstract

Purpose

This study aimed to compare the diagnostic accuracy of [¹⁸F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/ magnetic resonance imaging (MRI) and [¹⁸F]FDG PET/ computed tomography (CT) in tumor–node–metastasis staging of non-small-cell lung cancer.

Methods

The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Diagnostic Test Accuracy (PRISMA-DTA) guidelines and retrieved all accessible studies from the Embase, PubMed, and Web of Science databases up to December 2022. Only studies in which both [¹⁸F]FDG PET/MRI and [¹⁸F]FDG PET/CT were conducted on each individual patient were included. Two researchers independently extracted data on study characteristics and assessed the methodological quality using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.

Results

A total of 539 patients in eight studies were included in this analysis. For T staging, the pooled sensitivity of [¹⁸F]FDG PET/CT was 0.90 (95% confidence interval [CI]: 0.81–0.96) and specificity of 0.97 (95% CI: 0.89–1.00), with corresponding values for [¹⁸F]FDG PET/MRI of 0.88 (95% CI: 0.78–0.94) and 0.95 (95% CI: 0.87–0.99), respectively. For N staging, the pooled sensitivity of [¹⁸F] FDG PET/CT was 0.70 (95% CI: 0.63–0.76), the specificity of 0.92 (95% CI: 0.88–0.95), and the area under the curve (AUC) was 0.90 (standard error [SE] = 0.06). The corresponding values for [¹⁸F]FDG PET/MRI were 0.71 (95% CI: 0.65–0.77), 0.91 (95% CI: 0.87–0.94) and 0.88 (SE = 0.06), respectively. For M staging, the pooled sensitivity was 0.79 (95% CI: 0.62–0.91), the specificity was 0.94 (95% CI: 0.90–0.97), and AUC was 0.96 (SE = 0.03) for [¹⁸F]FDG PET/CT. The corresponding values were 0.82 (95% CI: 0.70–0.91), 0.96 (95% CI: 0.93–0.98), and 0.94 (SE = 0.03), respectively, for [¹⁸F]FDG PET/MRI.

Conclusions

According to the pooled data, [¹⁸F]FDG PET/CT performed slightly better in terms of T staging than [¹⁸F]FDG PET/MRI. In contrast, with regard to N staging and M staging the staging accuracy of both imaging techniques was comparable. To ensure that results are reliable, more high-level investigations will be required to assess these imaging modalities, in addition to optimized PET/MRI procedures.