Spatial and temporal variability of intratumoral 18F-FDG distribution in patients with cancer.

e21149 Background: We previously reported that in mice models, tumor microenvironment is complex and intratumoral 18F-FDG distribution is heterogeneous. There were apparent spatial and temporal intratumoral 18F-FDG distribution changes occurring even within 24-48 hour interval in human cancer cell xenografts grown in nude mice. We hypothesized that what was documented in mice models may also be applicable to human patients with cancer. The objective of this study was to investigate the intratumoral spatial and temporal distribution of 18F-FDG in cancer patients. Methods: Five patients who had repeat PET/CT scans within 1-28 days and with no interval therapy were identified. All patients had fasted overnight and had blood glucose level of less than 200 mg/dl. They were injected with 8.0-14.0mCi of 18F-FDG intravenously, and whole body PET/CT scans were performed 60-80 minutes later utilizing a Siemens PET/CT scanner. Each patient’s intratumoral FDG activity distributions were mapped and compared to each other utilizing magnified digital images of the tumors. Results: Intratumoral FDG activity is very heterogeneous. Within the same tumor, there is a wide range of high and low FDG uptake variations. Apparent change in intratumoral FDG distribution was found within as short as a 24 hour interval in the same patient. Although the global tumoral FDG activity and liver FDG activity measured as SUVmaximum and SUVaverage were not significantly different from one PET/CT to another, there were significant spatial changes and variations of the tumor FDG activity between the two PET/CT images. Conclusions: Intratumoral 18F-FDG uptake is very heterogeneous and manifests both temporal and spatial changes within as short as 24 hours even in untreated cancer patients. This should be taken into consideration during FDG PET based therapy decisions, for example in tumor and nodal staging or radiation therapy planning.

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Simple and effective bacterial-based intratumoral cancer immunotherapy

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2021-002688 ◽

2021 ◽

Vol 9 (9) ◽

pp. e002688

Author(s):

Christina S E Carroll ◽

Erin R Andrew ◽

Laeeq Malik ◽

Kathryn F Elliott ◽

Moira Brennan ◽

...

Keyword(s):

Immune System ◽

Tumor Growth ◽

Cancer Immunotherapy ◽

Cancer Patients ◽

Immune Cell ◽

Human Cancer ◽

Intratumoral Injection ◽

Ct Scans ◽

Antitumor Effects ◽

Wide Range

BackgroundWe describe intratumoral injection of a slow-release emulsion of killed mycobacteria (complete Freund’s adjuvant (CFA)) in three preclinical species and in human cancer patients.MethodsEfficacy and safety were tested in mammary tumors in mice, in mastocytomas in mice and dogs, and in equine melanomas. In mice, survival, tumor growth, and tumor infiltration by six immune cell subsets (by flow cytometry) were investigated and analyzed using Cox proportional hazards, a random slopes model, and a full factorial model, respectively. Tumor growth and histology were investigated in dogs and horses, as well as survival and tumor immunohistochemistry in dogs. Tumor biopsies were taken from human cancer patients on day 5 (all patients) and day 28 (some patients) of treatment and analyzed by histology. CT scans are provided from one patient.ResultsSignificantly extended survival was observed in mouse P815 and 4T1 tumor models. Complete tumor regressions were observed in all three non-human species (6/186 (3%) of mouse mastocytomas; 3/14 (21%) of canine mastocytomas and 2/11 (18%) of equine melanomas). Evidence of systemic immune responses (regression of non-injected metastases) was also observed. Analysis of immune cells infiltrating mastocytoma tumors in mice showed that early neutrophil infiltration was predictive of treatment benefit. Analysis of the site of mastocytoma regression in dogs weeks or months after treatment demonstrated increased B and T cell infiltrates. Thus, activation of the innate immune system alone may be sufficient for regression of some injected tumors, followed by activation of the acquired immune system which can mediate regression of non-injected metastases. Finally, we report on the use of CFA in 12 human cancer patients. Treatment was well tolerated. CT scans showing tumor regression in a patient with late-stage renal cancer are provided.ConclusionOur data demonstrate that intratumoral injection of CFA has major antitumor effects in a proportion of treated animals and is safe for use in human cancer patients. Further trials in human cancer patients are therefore warranted. Our novel treatment provides a simple and inexpensive cancer immunotherapy, immediately applicable to a wide range of solid tumors, and is suitable to patients in developing countries and advanced care settings.

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The role of 18-FDG PET/CT assessment of functional brain metabolism in cancer patients after chemotherapy

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00403-y ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Shady Mohamed Tarek Gamal ◽

Amr Osama M. A. Azab ◽

Sherif Mohamed El Refaei ◽

Mohamed Houseni

Keyword(s):

Glucose Uptake ◽

Cancer Patients ◽

Brain Metabolism ◽

Imaging Techniques ◽

Ct Scans ◽

Fdg Uptake ◽

Speed Of Information Processing ◽

Pet Ct ◽

The Brain

Abstract Background Most neuropsychological studies on chemotherapy (CHT)-treated cancer survivors reported cognitive impairments in multiple domains such as executive functions, learning, memory, attention, verbal fluency, and speed of information processing. The CHT effects range from small to moderate, involving mostly the cognitive functions sub-served by frontal lobe. This study aimed to evaluate the role of PET/CT in the assessment of the effect of chemotherapy on the glucose metabolism in the brain in cancer patients after the chemotherapy treatment. Results This was a prospective study carried out in 2 years for patients who have done PET/CT scans for assessment of the change of the glucose uptake in the brain in pre- and in post-therapeutic state. A total number of 30 patients, 8 males and 22 females, were examined. The age of the patients ranged from 29 to 79 years (mean 57.9). Each patient underwent at least two PET/CT scans, first before the initiation of the therapy, and second was at least 3 months after starting the chemotherapy regimen. This study employed an adaptive threshold method, SCENIUM version 2.0.1. Automatic ROI identification was performed through around 10 regions of the brain. After segmentation of FDG uptake in the different brain regions of each subject, we measured average glucose uptake (SUVmean), registered by SCENIUM software. Conclusion There was significant reduction in the brain metabolism “FDG uptake” in all regions of the brain, mainly at the mesial temporal lobes as well as the frontal lobes. This metabolic change proves that chemotherapy has an adverse effect on the brain that can be objectively assessed with modern imaging techniques.

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The use of alternate vertebral levels to L3 in computed tomography scans for skeletal muscle mass evaluation and sarcopenia assessment in patients with cancer: a systematic review

British Journal Of Nutrition ◽

10.1017/s0007114521001446 ◽

2021 ◽

pp. 1-49

Author(s):

Belinda Vangelov ◽

Judy Bauer ◽

Damian Kotevski ◽

Robert I. Smee

Keyword(s):

Computed Tomography ◽

Skeletal Muscle ◽

Ct Scan ◽

Cancer Patients ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Whole Body ◽

Ct Scans ◽

Cross Sectional ◽

Patients With Cancer

ABSTRACT Body composition measurement using diagnostic computed tomography (CT) scans has emerged as a method to assess sarcopenia (low muscle mass) in oncology patients. Assessment of skeletal muscle mass (SMM) using the cross-sectional area (CSA) of a single vertebral slice (at lumbar L3) in a CT scan is correlated to whole body skeletal muscle volume. This method is used to assess CT-defined sarcopenia in patients with cancer, with low SMM effecting outcomes. However, as diagnostic scans are based on tumour location, not all include L3. We evaluated the evidence for the use of alternate vertebral CT slices for SMM evaluation when L3 is not available. Five electronic databases were searched from Jan 1996-April 2020 for studies using CT scan vertebral slices above L3 for SM measurement in adults with cancer (solid tumours). Validation with whole body SMM, rationale for the chosen slice, and sarcopenia cut-off values were investigated. Thirty-two studies were included, all retrospective and cross-sectional in design. Cervical, thoracic, and lumbar slices were used (from C3-L1), with no validation of whole body SMM using CT scans. Alternate slices were used in lung, and head and neck cancer patients. Sarcopenia cut-off values were reported in 75% of studies, with differing methods, with or without sex-specific values, and a lack of consensus. Current evidence is inadequate to provide definitive recommendations for alternate vertebral slice use for SMM evaluation in cancer patients. Variation in sarcopenia cut-offs warrants more robust investigation, in order for risk stratification to be applied to all patients with cancer.

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Traumatic myositis ossificans: multifocal lesions suggesting malignancy on FDG-PET/CT—a case report

Skeletal Radiology ◽

10.1007/s00256-020-03521-w ◽

2020 ◽

Vol 50 (1) ◽

pp. 249-254

Author(s):

Miho Sasaki ◽

Yuka Hotokezaka ◽

Reiko Ideguchi ◽

Masataka Uetani ◽

Shuichi Fujita

Keyword(s):

Case Report ◽

Fdg Pet ◽

Myositis Ossificans ◽

Whole Body ◽

Left Cheek ◽

Multiple Fractures ◽

Fdg Uptake ◽

Pet Ct ◽

Multiple Regions ◽

Fdg Pet Ct

AbstractMyositis ossificans (MO) is a benign soft-tissue lesion characterized by the heterotopic formation of the bone in skeletal muscles, usually due to trauma. MO is occasionally difficult to diagnose because of its clinical and radiological similarities with malignancy. We report a case of traumatic MO (TMO) in the masseter and brachial muscles of a 37-year-old man who presented with painless swelling in the left cheek and severe trismus. Due to the absence of a traumatic history at the first consultation and identification of a tumorous lesion in the left masseter muscle by magnetic resonance imaging (MRI), the lesion was suspected to be a malignant tumor. Subsequently, 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG-PET/CT) showed multiple regions of high FDG uptake across the whole body, suggestive of multiple metastases or other systemic diseases. However, intramuscular calcifications were also observed in the left masseter and brachial muscles, overlapping the areas with high FDG uptake. Moreover, multiple fractures were seen in the rib and lumbar spine, also overlapping the areas with high FDG uptake. Based on these imaging findings, along with a history of jet-ski trauma, TMO was suspected. The left cheek mass was surgically excised and histologically diagnosed as TMO. In this case report, FDG-PET/CT could detect multiple TMOs across the whole body. To the best of our knowledge, cases of multiple TMOs located far apart in different muscles are rare, and this may be the first report.

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Clinical Translational Evaluation of Al18F-NOTA-FAPI for Fibroblast Activation Protein Targeted Tumour Imaging

10.21203/rs.3.rs-231262/v1 ◽

2021 ◽

Author(s):

Shuailiang Wang ◽

Xin Zhou ◽

Xiaoxia Xu ◽

Jin Ding ◽

Song Liu ◽

...

Keyword(s):

Cancer Patients ◽

Fibroblast Activation Protein ◽

Ct Imaging ◽

Whole Body ◽

Tumour Imaging ◽

Tumour Detection ◽

Fibroblast Activation ◽

Tumour Bearing ◽

Pet Ct ◽

18F Fdg

Abstract PurposeIn this study, a novel Al18F-NOTA-FAPI probe was developed for fibroblast activation protein (FAP) targeted tumour imaging, which was available to achieve curie level radioactivity by automatic synthesizer. The tumour detection efficacy of Al18F-NOTA-FAPI was further validated both in preclinical and clinical translational studies. MethodsThe radiolabeling procedure of Al18F-NOTA-FAPI was optimized. Cell uptake and competitive binding assay were completed with U87MG and A549 cell lines, to evaluate the affinity and specificity of Al18F-NOTA-FAPI probe. The biodistribution, pharmacokinetics, radiation dosimetry and tumour imaging efficacy of Al18F-NOTA-FAPI probe were researched with healthy Kunming (KM) and/or U87MG model mice. After the approval of ethical committee, Al18F-NOTA-FAPI probe was translated into clinical for the PET/CT imaging of first 10 cancer patients. ResultsThe radiolabeling yield of Al18F-NOTA-FAPI was 33.8 ± 3.2% through manually operation (n = 10), with the radiochemical purity over than 99% and the specific activity of 9.3-55.5 MBq/nmol. Whole body effective dose of Al18F-NOTA-FAPI was estimated to be 1.24E-02 mSv/MBq, lower than several other FAPI probes ( 68Ga-FAPI-04, 68Ga-FAPI-46 and 68Ga-FAPI-74). In U87MG tumour bearing mice, Al18F-NOTA-FAPI showed good tumor detection efficacy from the results of micro PET/CT imaging and biodistribution studies. In organ biodistribution study of human patients, Al18F-NOTA-FAPI showed lower SUVmean than 2-[18F]FDG in most organs, especially in liver (1.1 ± 0.2 vs. 2.0 ± 0.9), brain (0.1 ± 0.0 vs. 5.9 ± 1.3), and bone marrow (0.9 ± 0.1 vs. 1.7 ± 0.4). Meanwhile, Al18F-NOTA-FAPI do not show extensive bone uptakes, and was able to find out more tumour lesions than 2-[18F]FDG in the PET/CT imaging of several patients. ConclusionAl18F-NOTA-FAPI probe was successfully fabricated and applied in fibroblast activation protein targeted tumour PET/CT imaging, which showed excellent imaging quality and tumour detection efficacy in U87MG tumour bearing mice as well as in human cancer patients.

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High Grade tumor vs stroke. Utility of PET and MRI corregistration

ANALES RANM ◽

10.32440/ar.2021.138.02.cc01 ◽

2021 ◽

Vol 138 (138(02)) ◽

pp. 176-179

Author(s):

M.N. Cabrera-Martín ◽

P. Romero Fernández ◽

M.K. Meneses Navas ◽

P. Pérez-Segura ◽

M. Yus Fuertes ◽

...

Keyword(s):

Clinical Presentation ◽

High Grade Glioma ◽

Whole Body ◽

High Grade ◽

Mr Images ◽

Fdg Uptake ◽

Area Of Interest ◽

Pet Ct ◽

Adjacent Brain

Sometimes, the clinical presentation of a brain tumour mimics that of stroke or viceversa. In these cases it is useful to evaluate follow-up with MR. The coregistration of PET and MR images improves the diagnostic performance of both techniques. In the area of interest, FDG uptake of any degree, with reference to the adjacent brain tissue uptake, should be considered suggestive of tumor if it corresponds to brain injury in MR, even when the FDG uptake is equal to or lower than that of the normal cerebral cortex. We present a case in which coregistration of images from both techniques contributed to the differential diagnosis of stroke and high-grade glioma, whole-body PET/CT ruled out metastatic etiology, and the results led to surgery.

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