Clinicopathological correlation of pre-biopsy quantitative PSMA uptake in patients with persistently raised serum PSA: initial experience in 74 patients with simultaneous 68-Ga PSMA PET/MRI

Objective: To analyze 68-Ga prostate-specific membrane antigen (PSMA) uptake pattern of the prostate and its correlation with prostate-specific antigen (PSA), digital rectal examination (DRE), and Gleason’s score in the diagnosis of carcinoma of the prostate (CaP). Methods: This was a retrospective study conducted between June 2015 and August 2017. Patients who had undergone whole body 68-Ga PSMA HBED-CC simultaneous positron emission tomography (PET) or magnetic resonance imaging (MRI) for the diagnosis or staging of CaP were eligible. Patients who presented with persistently raised serum PSA (>4 ng/mL) and normal urine routine and negative culture were included in the study. Results: A total of 74 patients were included in the study. Significant positive correlation was observed between PSMA delayed uptake with the Prostate Imaging Reporting and Data System (PI-RADS) score ( p<0.001, ρ=0.750), PSA level ( p<0.001, ρ=0.414), DRE ( p<0.002, ρ=0.400), and Gleason’s score ( p<0.300, ρ=0.02). There was a significant difference between early and delayed phase of PSMA uptake in malignant prostatic lesions ( p<0.001). Delayed phase of PSMA uptake was able to characterize prostate lesions with an area under curve (AUC) of 0.91. Combined receiver operating characteristic analysis of PI-RADS score derived from multiparametric MRI and differential PSMA uptake to characterize prostatic lesions improved AUC to 0.94. Conclusion: Results demonstrated that the correlation with clinicopathological features (PSA, DRE, and Gleason’s score) could be used in prognostication of prostatic lesion along with PSMA PET/MRI.

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Scatter Artifact with Ga-68-PSMA-11 PET: Severity Reduced With Furosemide Diuresis and Improved Scatter Correction

Molecular Imaging ◽

10.1177/1536012118811741 ◽

2018 ◽

Vol 17 ◽

pp. 153601211881174 ◽

Cited By ~ 2

Author(s):

Courtney Lawhn-Heath ◽

Robert R. Flavell ◽

David E. Korenchan ◽

Timothy Deller ◽

Spencer Lake ◽

...

Keyword(s):

Scatter Correction ◽

Emission Tomography ◽

Whole Body ◽

Correction Algorithm ◽

Resonance Imaging ◽

Positron Emission ◽

Psma Pet ◽

Magnetic Resonance Imaging Mri ◽

Specific Membrane

Purpose: To assess the utility of furosemide diuresis and the role of an improved scatter correction algorithm in reducing scatter artifact severity on Ga-68- Prostate-specific membrane antigen (PSMA)-11 positron emission tomography (PET). Materials and Methods: A total of 139 patients underwent Ga-68-PSMA-11 PET imaging for prostate cancer: 47 non-time-of-flight (non-TOF) PET/computed tomography, 51 PET/magnetic resonance imaging (MRI) using the standard TOF scatter correction algorithm, and 41 PET/MRI using an improved TOF scatter correction algorithm. Whole-body PET acquisitions were subdivided into 3 regions: around kidneys; between kidneys and bladder; and around bladder. The images were reviewed, and scatter artifact severity was rated using a Likert-type scale. Results: The worst scatter occurred when using non-TOF scatter correction without furosemide, where 42.1% of patients demonstrated severe scatter artifacts in 1 or more regions. Improved TOF scatter correction resulted in the smallest percentage of studies with severe scatter (6.5%). Scatter ratings by region were lowest using improved TOF scatter correction. Furosemide reduced mean scatter severity when using non-TOF and standard TOF. Conclusions: Both furosemide and scatter correction algorithm play a role in reducing scatter in PSMA PET. Improved TOF scatter correction resulted in the lowest scatter severity.

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Cervical Cancer: Associations between Metabolic Parameters and Whole Lesion Histogram Analysis Derived from Simultaneous 18F-FDG-PET/MRI

Contrast Media & Molecular Imaging ◽

10.1155/2018/5063285 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Hans-Jonas Meyer ◽

Sandra Purz ◽

Osama Sabri ◽

Alexey Surov

Keyword(s):

Cervical Cancer ◽

Fdg Pet ◽

Metabolic Tumor Volume ◽

Total Lesion Glycolysis ◽

Histogram Analysis ◽

Whole Body ◽

Standardized Uptake Values ◽

Positron Emission ◽

18F Fdg ◽

Magnetic Resonance Imaging Mri

Multimodal imaging has been increasingly used in oncology, especially in cervical cancer. By using a simultaneous positron emission (PET) and magnetic resonance imaging (MRI, PET/MRI) approach, PET and MRI can be obtained at the same time which minimizes motion artefacts and allows an exact imaging fusion, which is especially important in anatomically complex regions like the pelvis. The associations between functional parameters from MRI and 18F-FDG-PET reflecting different tumor aspects are complex with inconclusive results in cervical cancer. The present study correlates histogram analysis and 18F-FDG-PET parameters derived from simultaneous FDG-PET/MRI in cervical cancer. Overall, 18 female patients (age range: 32–79 years) with histopathologically confirmed squamous cell cervical carcinoma were retrospectively enrolled. All 18 patients underwent a whole-body simultaneous 18F-FDG-PET/MRI, including diffusion-weighted imaging (DWI) using b-values 0 and 1000 s/mm2. Apparent diffusion coefficient (ADC) histogram parameters included several percentiles, mean, min, max, mode, median, skewness, kurtosis, and entropy. Furthermore, mean and maximum standardized uptake values (SUVmean and SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were estimated. No statistically significant correlations were observed between SUVmax or SUVmean and ADC histogram parameters. TLG correlated inversely with p25 (r=−0.486,P=0.041), p75 (r=−0.490,P=0.039), p90 (r=−0.513,P=0.029), ADC median (r=−0.497,P=0.036), and ADC mode (r=−0.546,P=0.019). MTV also showed significant correlations with several ADC parameters: mean (r=−0.546,P=0.019), p10 (r=−0.473,P=0.047), p25 (r=−0.569,P=0.014), p75 (r=−0.576,P=0.012), p90 (r=−0.585,P=0.011), ADC median (r=−0.577,P=0.012), and ADC mode (r=−0.597,P=0.009). ADC histogram analysis and volume-based metabolic 18F-FDG-PET parameters are related to each other in cervical cancer.

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Comparison of 68Ga-PSMA-11 PET/CT with 11C-acetate PET/CT in re-staging of prostate cancer relapse

Scientific Reports ◽

10.1038/s41598-020-61910-6 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 2

Author(s):

Naresh Regula ◽

Vasileios Kostaras ◽

Silvia Johansson ◽

Carlos Trampal ◽

Elin Lindström ◽

...

Keyword(s):

Prostate Cancer ◽

Specific Antigen ◽

Anatomical Location ◽

Curative Therapy ◽

Psa Relapse ◽

Positron Emission ◽

Psma Pet ◽

Pet Ct ◽

Prostate Cancer Relapse ◽

Identical Number

AbstractPositron emission tomography (PET) imaging is used to localize recurrent disease in prostate cancer (PCa). The tracer 68Ga-PSMA-11 visualizes lesions overexpressing prostate-specific membrane antigen (PSMA), while 11C-acetate visualizes lesions with increased anabolic metabolism. The aim of this study was to compare the performance of PSMA-PET and acetate-PET in re-staging patients with biochemical relapse. Thirty PCa patients with prostate-specific antigen (PSA) relapse after primary curative therapy were prospectively evaluated. PET/CT examinations using 11C-acetate and 68Ga-PSMA-11 were performed. Identified lesions were categorized according to anatomical location and PET measurements were correlated with PSA at time of scan. Tumour lesions showed higher semi-quantitative uptake values on PSMA-PET than acetate-PET. PSMA-PET identified more lesions in 11 patients, fewer lesions in eight patients, and identical number of lesions in 11 patients. This study indicates better diagnostic performance of PSMA-PET, particularly in detecting lymph node (81% vs 60%, p = 0.02) and bone metastasis (95% vs 61%, p = 0.0001) compared to acetate-PET. However, 38% of PSMA-expressing metastases appear to be metabolically inactive and 15% of metabolically active metastases lack PSMA expression. Addition of PET with a metabolic tracer, such as 11C-acetate, might be beneficial before making treatment decisions.

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Automatic Prediction and Assessment of Treatment Response in Patients with Hodgkin’s Lymphoma Using a Whole-Body DW-MRI Based Approach

Diagnostics ◽

10.3390/diagnostics10090702 ◽

2020 ◽

Vol 10 (9) ◽

pp. 702

Author(s):

Valentina Brancato ◽

Marco Aiello ◽

Roberta Della Pepa ◽

Luca Basso ◽

Nunzia Garbino ◽

...

Keyword(s):

Treatment Response ◽

Hodgkin’S Lymphoma ◽

Hodgkin's Lymphoma ◽

Response To Treatment ◽

Whole Body ◽

Positron Emission ◽

End Of Treatment ◽

Tumor Load ◽

Magnetic Resonance Imaging Mri

The lack of validation and standardization represents the main drawback for a clear role of whole-body diffusion weighted imaging (WB-DWI) for prediction and assessment of treatment response in Hodgkin’s lymphoma (HL). We explored the reliability of an automatic approach based on the WB-DWI technique for prediction and assessment of response to treatment in patients with HL. The study included 20 HL patients, who had whole-body positron emission tomography (PET)/ magnetic resonance Imaging (MRI) performed before, during and after chemotherapy. Using the syngo.via MR Total Tumor Load tool, we automatically extracted values of diffusion volume (DV) and its associated histogram features by WB-DWI images, and evaluated their utility in predicting and assessing interim and end-of-treatment (EOT) response. The Mann–Whitney test followed by receiver operator characteristic (ROC) analysis was performed between features and their inter-time point percentage differences for patients having a complete or partial treatment response, revealing that several WB-DWI associated features allowed for prediction of interim response and both prediction and assessment of EOT response. Our proposed method offers huge advantages in terms of saving time and work, enabling clinicians to draw conclusions relating to HL treatment response in a fully automatic way, and encloses, also, all DWI advantages compared to PET/ computed tomography (CT).

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Brown Adipose Tissue - role in metabolic disorders

IMC Journal of Medical Science ◽

10.3329/imcjms.v13i1.42049 ◽

2019 ◽

Vol 13 (1) ◽

pp. 002

Author(s):

Tahniyah Haq ◽

Frank Joseph Ong ◽

Sarah Kanji

Keyword(s):

Adipose Tissue ◽

Brown Adipose Tissue ◽

Metabolic Diseases ◽

Uncoupling Protein ◽

Whole Body ◽

Positron Emission ◽

Brown Adipose ◽

Magnetic Resonance Imaging Mri ◽

Fdg Pet Ct ◽

Body Energy

Brown adipose tissue, a thermogenic organ, previously thought to be present in only small mammals and children has recently been identified in adult humans. Located primarily in the supraclavicular and cervical area, it produces heat by uncoupling oxidative phosphorylation due to the unique presence of uncoupling protein 1 by a process called nonshivering thermogenesis. BAT activity depends on many factors including age, sex, adiposity and outdoor temperature. Positron-emission tomography using 18F-fluorodeoxyglucose and computed tomography (18F-FDG PET–CT), magnetic resonance imaging (MRI) and thermal imaging (IRT) are among several methods used to detect BAT in humans. The importance of BAT is due to its role in whole body energy expenditure and fuel metabolism. Thus it is postulated that it may be useful in the treatment of metabolic diseases. However, there are still many unanswered questions to the clinical usefulness of this novel tissue. IMC J Med Sci 2019; 13(1): 002

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Peripheral Zone Enlargement: a newly described entity on MRI

10.1101/2020.04.03.20052290 ◽

2020 ◽

Author(s):

Neil F. Wasserman ◽

Paari Murguan ◽

Ben Spilseth ◽

Gregory J. Metzger ◽

Tina Sanghvi

Keyword(s):

Transition Zone ◽

Specific Antigen ◽

Elevated Serum ◽

Digital Rectal Examination ◽

Inflammatory Cells ◽

Peripheral Zone ◽

Prostatic Specific Antigen ◽

Prostatic Enlargement ◽

Magnetic Resonance Imaging Mri ◽

Microscopic Pathology

AbstractPurposeA retrospective study was performed to describe and characterize a previously unreported finding on T2-weighted magnetic resonance imaging (MRI) of peripheral zone enlargement (PZE) associated with total prostatic enlargement without necessary association with benign prostatic hyperplasia (BPH) or lower urinary tract symptoms.MethodsT2-weighted MRI were reviewed from 2012-2018. Patients were referred for elevated serum prostatic specific antigen (PSA) levels, prostatic enlargement, or abnormal digital rectal examination (DRE) suggestive of adenocarcinoma. Enlargement of the thickness of the peripheral zone (PZ) was defined as a measurement of postero-lateral thickness (PLPZ) of ≥ 15.8 mm in the maximal transaxial plane. Endorectal coils were used in 2 patients. Microscopic pathology was described in 3 patients.ResultsThere were 22 patients who met the criteria out of 2871 subjects (<1%). Mean age was 63 years, Mean PLPZ was 17.7 mm (CI=0.45, range, 15.8-21.3). mean total prostatic volume was 55.1 cc (range, 19.9-127.2 cc), mean transition zone volume was 20.6 cc (range, 2.7-71.9 cc), mean transition zone index (TZI) was 0.34 (range, 0.31-0.68), mean prostatic specific antigen (PSA) was 13.9 ng/mL (range, 0.28-144.7), mean body mass index was 28.9 (range 23.0-36.3).. Enlargement was described in 14 of 20 (70%). Pathological findings showed marked glandular distention and atrophy with interstitial edema and chronic inflammatory cells. Significance of these results is discussed.

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Added Value of Contrast Medium in Whole-Body Hybrid Positron Emission Tomography/Magnetic Resonance Imaging: Comparison between Contrast-Enhanced and Non-Contrast-Enhanced Protocols

Medical Principles and Practice ◽

10.1159/000501497 ◽

2019 ◽

Vol 29 (1) ◽

pp. 54-60

Author(s):

Filiz Celebi ◽

Emetullah Cindil ◽

Dauren Sarsenov ◽

Bulent Unalan ◽

Cem Balcı

Keyword(s):

Fdg Pet ◽

Emission Tomography ◽

Whole Body ◽

Resonance Imaging ◽

Diagnostic Ability ◽

Positron Emission ◽

Contrast Enhanced ◽

Significant Difference ◽

Mri Protocol ◽

Upper Abdomen

Objective: To compare the diagnostic ability and time efficiency of contrast-enhanced (CE) whole body fluorodeoxyglucose (FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) protocol and non-CE (NCE) protocol. Subjects and Methods: Ninety-three patients with known primary tumors underwent whole-body hybrid FDG PET/MRI during the follow-up of their malignancies with the use of NCE and CE protocols. The NCE PET/MRI protocol consisted of diffusion-weighted (b = 0 and 800 s/mm2) and T1-weighted Turbo Flash in the axial plane and T2-weighted HASTE sequence in the coronal planes (Σ = 25 min). The CE PET/MRI protocol was performed by acquiring axial serial CE 3D FS VIBE images in the upper abdomen, completing the whole body in the late phase in the axial plane (Σ = 30 min). Results: There was a statistically significant difference between the total number of lesions detected by the CE protocol (median 2, interquartile range (IQR) 0–14) and that detected by the NCE protocol (median 1, IQR 0–5; p < 0.001). More malignancies were detected in the abdomen (p < 0.001) and brain (p < 0.001) with the CE PET/MRI protocol, whereas no significant difference was present when comparing the 2 protocols in the detection of malignancies in the head and neck (p = 0.356), thorax (p = 0.09), lymph nodes (p = 0.196), and bone (p = 0.414). Conclusion: The CE FDG PET/MRI protocol enables fast and accurate detection of malignancies compared to the NCE FDG PET/MRI protocol, particularly in the upper abdomen and brain. Diagnostic ability and time efficiency can be increased with the proposed short CE protocol in place of the whole body PET/MRI protocol including both NCE and CE imaging sequences.

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Empiric antibiotics therapy for mildly elevated prostate specific antigen: Helpful to avoid unnecessary biopsies?

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2014.3.202 ◽

2014 ◽

Vol 86 (3) ◽

pp. 202 ◽

Cited By ~ 3

Author(s):

Andrea Fandella ◽

Sara Benvenuto ◽

Elisa Guidoni ◽

Marco Giampaoli ◽

Alessandro Bertaccini

Keyword(s):

Prostate Specific Antigen ◽

Prostate Biopsy ◽

Specific Antigen ◽

Digital Rectal Examination ◽

Treated Group ◽

Control Group ◽

Empiric Antibiotics ◽

Prostate Biopsies ◽

Significant Difference ◽

Baseline Psa

Purpose: The management of mildly elevated (4.0-10.0 ng/ml) prostate specific antigen (PSA) is uncertain. Immediate prostate biopsy, antibiotic treatment, or monitoring PSA level for 1-3 months is still in controversy. Materials and Methods: We retrospectively analysed the effect of empiric antibiotics on an increased PSA in a mono-institutional study. We analysed the data of 100 patients with a PSA of 4-10 ng/ml and normal digital rectal examination undergoing their first prostate biopsy. Patients were divided in two different cohorts. One cohort was submitted to antibiotic therapy (Levoxacin 500 mg daily for 20 days) and both cohort had a re-dosing of PSA before the prostate biopsy. Results: Average age of the whole group of patients was 66.48 ± 8.32 years and their average initial PSA level was 6.67 ± 1.57 ng/mL. In the treated group (N = 49) 29 patients had a decreasing PSA value from mean baseline PSA value of 6.6 ± 1.54 ng/ml to the re-dosed mean PSA level of 5.4 ± 1,61 ng/ml (p = 0.7); 20 patients didn’t experience a decrease PSA value, with a mean PSA level of 6.9 ± 1.68 ng/ml. In the control group (N = 51), 30 patients had a decrease of PSA level from mean baseline PSA level of 6.5 ± 1,59 ng/ml to a re-dosed PSA level of 5.5 ± 1.57 ng/ml; 21 patients didn’t experience a decrease of PSA value, with a mean PSA level of 6.7 ± 1.71 ng/ml. Multivariate analysis of age, PSA changes, antibiotics therapy and biopsy results (presence or absence of cancer) revealed no significant difference between the two cohorts. Sepsis after biopsy occurred in 3 patient in the antibiotics group (6%) and in one of the control group (2%). Conclusions: The study, even with some limitations, does not seem to show an advantage due to the administration of antibacterial therapy to reduce PSA values before prostate biopsy and subsequently to reduce unnecessary prostate biopsies.

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PET/MRI Imaging in High-Risk Sarcoma: First Findings and Solving Clinical Problems

Case Reports in Oncological Medicine ◽

10.1155/2013/793927 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Markus K. Schuler ◽

Stephan Richter ◽

Bettina Beuthien-Baumann ◽

Ivan Platzek ◽

Jörg Kotzerke ◽

...

Keyword(s):

Clinical Decision Making ◽

Imaging Technique ◽

Clinical Decision ◽

Whole Body ◽

Mri Imaging ◽

Cross Sectional ◽

Positron Emission ◽

Magnetic Resonance Imaging Mri ◽

Sarcoma Treatment ◽

Clinical Problems

Simultaneous positron emission tomography (PET) and magnetic resonance imaging (MRI) is a new whole-body hybrid PET/MR imaging technique that combines metabolic and cross-sectional diagnostic imaging. Since the use of MRI in imaging of soft-tissue sarcoma is extremely beneficial, investigation of the combined PET/MRI is of great interest. In this paper, we present three cases and first data. Combined PET/MRI technique can support the process of clinical decision-making and give answers to some meaningful questions when treating patients with STS. Therefore, the combined modality of simultaneous PET/MRI offers new pieces to the puzzle of sarcoma treatment.

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Combination of FDG-PET and FMISO-PET as a treatment strategy for patients undergoing early-stage NSCLC stereotactic radiotherapy

EJNMMI Research ◽

10.1186/s13550-019-0578-6 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Shiro Watanabe ◽

Tetsuya Inoue ◽

Shozo Okamoto ◽

Keiichi Magota ◽

Ayumi Takayanagi ◽

...

Keyword(s):

Univariate Analysis ◽

Standardized Uptake Value ◽

Whole Body ◽

Study Endpoint ◽

Tumor Diameter ◽

Characteristic Analysis ◽

Cell Lung Carcinoma ◽

Pet Ct ◽

Significant Difference ◽

The Impact

Abstract Background We investigated the prognostic predictive value of the combination of fluorodeoxyglucose (FDG)- and fluoromisonidazole (FMISO)-PET in patients with non-small cell lung carcinoma (NSCLC) treated with stereotactic body radiation therapy (SBRT). Patients and methods We prospectively examined patients with pathologically proven NSCLC; all underwent FDG and FMISO PET/CT scans before SBRT. PET images were acquired using a whole-body time-of-flight PET-CT scanner with respiratory gating. We classified them into recurrent and non-recurrent groups based on their clinical follow-ups and compared the groups' tumor diameters and PET parameters (i.e., maximum of the standardized uptake value (SUVmax), metabolic tumor volume, tumor-to-muscle ratio, and tumor-to-blood ratio). We performed univariate analysis to evaluate the impact of the PET variables on the patients' progression-free survival (PFS). We divided the patients by thresholds of FDG SUVmax and FMISO SUVmax obtained from receiver operating characteristic analysis for assessment of recurrence rate and PFS. Results Thirty-two NSCLC patients (19 male and 13 females; median age, 83 years) were enrolled. All received SBRT. At the study endpoint, 23 patients (71.9%) were non-recurrent and nine patients (28.1%) had recurrent disease. Significant between-group differences were observed in tumor diameter and all the PET parameters, demonstrating that those were significant predictors of the recurrence in all patients. In the 22 patients with tumors > 2 cm, tumor diameter and FDG SUVmax were not significant predictors. Thirty-two patients were divided into three patterns from the thresholds of FDG SUVmax (6.81) and FMISO SUVmax (1.89); A, low FDG and low FMISO (n = 14); B, high FDG and low FMISO (n = 8); C, high FDG and high FMISO (n = 10). No pattern A patient experienced tumor recurrence, whereas two pattern B patients (25%) and seven pattern C patients (70%) exhibited recurrence. A Kaplan-Meier analysis of all patients revealed a significant difference in PFS between patterns A and B (p = 0.013) and between patterns A and C (p < 0.001). In the tumors > 2 cm patients, significant differences in PFS were demonstrated between pattern A and C patients (p = 0.002). Conclusion The combination of FDG- and FMISO-PET can identify patients with a baseline risk of recurrence and indicate whether additional therapy might be performed to improve survival.

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