Revista Espanola De Medicina Nuclear E Imagen Molecular最新文献

Purpose

The aim of this study was to determine the agreement between three observers with different levels of experience using the Prostate-Specific Membrane Antigen Reporting and Data System (PSMA-RADS 2.0) criteria and the molecular imaging Tumour, Node, Metastasis (miTNM) system for the interpretation of PET-PSMA with fluorine F 18 piflufolastat in males with prostate cancer.

Materials and methods

PET-PSMA images from 114 prostate cancer patients were blindly reported twice by three different observers at intervals of 8 weeks. The evaluations were performed according to the miTNM and PSMA-RADS 2.0 criteria. We used Fleiss’ Kappa to analyse inter and intraobserver agreements.

Results

Moderate overall agreement was obtained in the assessment of the PET-PSMA results (Fleiss’k = 0.53; 95% CI 0.45-0.62; p < 0.001), with significant agreement in the miT, miN and miM reports. There was a substantial level of agreement in the reporting of prostatic disease and lymphatic involvement (Fleiss’k = 0.66 and 0.65), being lower than that observed in the reporting of metastatic disease (Fleiss’k = 0.86), especially in the M0 group (Fleiss’k = 0.99). Upon re-evaluation of the images, observer 1 had moderate overall agreement for miT (Fleiss’k = 0.51) and substantial agreement for miN and miM (Fleiss’k 0.75 and 0.63, respectively).

Conclusions

The use of a structured scoring system such as PSMA-RADS 2.0, as well as the miTNM classification system in the interpretation of PET-PSMA images in prostate cancer patients, provides a highly reproducible report format. High levels of interobserver and intraobserver agreement are found, especially when ruling out disease, which supports its use in routine clinical practice.

The application of PET/CT with radiopharmaceuticals targeting PSMA is significantly transforming the diagnostic and therapeutic strategies of patients with prostate cancer. In Spain, the availability and access to positron-emitting radiopharmaceuticals targeting Prostate-Specific Membrane Antigen (PSMA) have significantly changed in recent months. These changes are affecting their use in diagnostic procedures. As a result, its use within diagnostic protocols for patients with prostate cancer is undergoing significant modifications. In this collective and cooperative document, the authors have selected the most robust evidence accumulated to date to generate a clinical guide to achieve appropriate use of this technology. A format that presents the most frequent clinical situations and the patient profiles in which PSMA PET/CT plays a significant role or will do so in the immediate future has been chosen. It should be taken into account that regulatory restrictions mediate the current indications for its use in Spain, as well as its current cost and the production capacity of radiopharmaceuticals. The guideline presents a review of the established methodology for optimized imaging with each of the radiopharmaceutical variants targeting PSMA and recommendations for structured and accurate reporting of metabolic findings in combination with CT.

Objective

To analyse the efficacy of integrated assessment of [¹⁸F]F-PSMA-1007 PET/MRI on the early detection of local recurrence (LR) for prostate cancer patients with PSA levels < 0.5 ng/ml after radical prostatectomy.

To assess the location of recurrence so that therapy may be tailored to patient.

Methods

Prospective study including 35 patients with prostate cancer (PCa), who were referred for a [¹⁸F]F-PSMA-1007 PET/MR after prostatectomy with a very initial PSA value increase (PSA < 0,5 ng/ml).

Simultaneous acquisition in a PET/MRI hybrid equipment (SIGNA-GE), 1 hour after administration of 370 ± 10% MBq of [¹⁸F]F-PSMA-1007:

Prostate selective imaging (20 min): Multiparametric PET+MRI (MRImp): DIXON,T1,T2,diffusion sequences post-Gadolinium administration.

Whole body image (30 min): PET+MRI: DIXON,T1,T2,diffusion,STIR sequences.

A Nuclear Physician and a Radiologist jointly reviewed the studies:

In order to assess LR, the ‘Prostate Imaging for Recurrence Reporting’ system was used on MRI, as well as the Likert scale on the PET prostate imaging.

The remaining lesions were classified as N1 and M1a.

Results

PET/MRI was positive in 25 patients (71.4%) and negative in 10 patients (28.6%).

RL was detected in 15 patients (42.9%): in 2 (5.7%) MRI was superior; in 3 (8.6%) PET was superior; integrated PET/MRI showed improved results in 5 patients (14.3%) for the detection of LR.

Location of recurrences: LR in 11 patients (44.0%); N1 in 10 (40.0%); LR+N1(8.0%) in 2; LR+N1+M1a in 2 (8.0%).

In 20 patients (80%) the PET/MRI findings allowed radioguided radiotherapy implementation (11 on LR, and 9 on N1), whereas hormonal treatment was decided in 5 patients (20%) due to multimetastases/spread disease.

Conclusion

[¹⁸F]F-PSMA-1007 PET/MRI has a 71.4% recurrence detection rate after prostatectomy with PSA < 0.5 ng/ml. Its combined PET and MRI study increases the detection of LR by 14.3%, with a high N1+M1a detection rate (56%), allowing radioguided radiotherapy in 80% of patients.

Objective

This study was designed to determine the potential prognostic value of radiomic texture analysis and metabolic-volumetric parameters obtained from positron emission tomography (PET) in primary mass and metastatic hilar/mediastinal lymph nodes in stage 2-3 non-small cell lung cancer (NSCLC).

Methods

Images of patients diagnosed with stage 2-3 NSCLC who underwent 18F-FDG PET/CT imaging for staging up to 4 weeks before the start of treatment were evaluated using LIFEx software. Volume of interest (VOI) was generated from the primary tumor and metastatic lymph node separately, and volumetric and textural features were obtained from these VOIs. The relationship between the parameters obtained from PET of primary mass and the metastatic hilar/mediastinal lymph nodes with overall survival (OS) and progression-free survival (PFS) was analyzed.

Results

When radiomic features, gender and stage obtained from lymph nodes were evaluated by Cox regression analysis; GLCM_correlation (p = 0.033, HR: 4.559, 1.660-12.521, 95% CI), gender and stage were determined as prognostic factors predicting OS. In predicting PFS; stage, smoking and lymph node MTV (p = 0.033, HR: 1.008, 1.001-1.016, 95% CI) were determined as prognostic factors. However, the radiomic feature of the primary tumor could not show a significant relationship with either OS or PFS.

Conclusions

In a retrospective cohort of NSCLC patients with Stage 2 and 3 disease, volumetric and radiomic texture characteristics obtained from metastatic lymph nodes were associated with PFS and OS. Tumor heterogeneity, defined by radiomic texture features of 18F-FDG PET/CT images, may provide complementary prognostic value in NSCLC.

Introduction

The curative treatment of primary hyperparathyroidism (PPH) is surgical and today it can be performed by minimally invasive surgery (MIS) and also be radioguided (RG) if a radiopharmaceutical with affinity for the parathyroid tissue that can be detected with gamma-detector probes or with a portable gamma camera (PGC) is injected.

Aim

The objective is to assess whether intraoperative scintigraphy (GGio) with PGC can replace intraoperative pathological anatomy (APio) to determine if the removed specimen is an abnormal parathyroid.

Material and method

Ninety-two patients underwent CMI-RG-HPP with PGC after administration of a dose of 99mTc-MIBI. The information provided by the PGC in the analysis of the excised specimens is qualitatively compared (capture yes/no) with the result of the intraoperative pathological anatomy (APio). The gold standard is the definitive histology.

Results

One hundred twenty excised pieces are evaluated with GGio and APio. There were 110 agreements (95 TP and 15 TN) and 10 disagreements (3 FP and 7 FN). Of the 120 lesions, 102 were parathyroid and 18 were non-parathyroid. There was good agreement between intraoperative scintigraphy imaging (GGio) and PA, 70.1% according to Cohen's Kappa index. The GGio presented the following values of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and overall value of the test (93.1%, 83.3%, 96.9%, 68.2%, 5.59, 0.08 and 0.92 respectively).

Conclusion

GGio is a rapid and effective surgical aid technique to confirm/rule out the possible parathyroid nature of the lesions removed in PPH surgery, but it cannot replace histological study.

Objective

To assess by [¹⁸F]FDG PET/MR the biomarkers of HIV-induced inflammation at baseline and 1 year post-antiretroviral therapy (ART).

Methods

Prospective study, 14 patients, newly diagnosed HIV-positive, asymptomatic.

[¹⁸F]FDG PET/MRI (PET/MR-3.0 T, Signa.GE) whole body and heart was performed, baseline and 1 year post-ART.

Qualitative vascular assessment (hepatic reference). Quantitative assessment (SUVmax) of the whole body. T1 and T2 value estimation in 16 myocardial segments.

Results

Baseline CMR showed in 3 (21.4%) a decreased LVEF, normalising post-TAR. Fibrosis was ruled out (T1), with no signs of myocardial oedema (T2) at baseline or post-TAR.

Four (28.6%) showed baseline vascular [¹⁸F]FDG uptake, two in ascending thoracic aorta and two in ascending and descending thoracic aorta, normalising post-TAR.

All (100%) showed basal lymph-nodes activity; supra (n:14) and infradiaphragmatic (n:13), laterocervical (n:14) and inguinal (n:13), with variable number of territories (9 patients >6; 64.3%). Post-ART, 7 patients (50%) showed resolution and the other 7 reduction in extension (0 patients >5): 7 supra (100%) and 2 infradiaphragmatic (28.6%), 5 in the axilla and 2 in the groin.

All (100%) had persistent basal adenoid uptake post-ART, 9 (64.3%) splenic all resolved post-ART and 7 (50.5%) gastric, persistent 3 post-ART.

Conclusions

Cardiovascular biomarkers by [¹⁸F]FDG PET/MR have shown baseline 28.6% of patients with large vessel activity and 21.4% with low LVEF, normalising post-ART.

Inflammatory/immune biomarkers showed baseline activity in 100% of lymph-nodes, 100% adenoids, 64.3% splenic and 50.5% gastric. Post-TAR the reduction was 50% lymph-nodes, 0% adenoid, 100% splenic and 57.1% gastric.