European Journal of Nuclear Medicine and Molecular Imaging, 2021
Purpose To assess the presence and pattern of incidental interstitial lung alterations suspicious... more Purpose To assess the presence and pattern of incidental interstitial lung alterations suspicious of COVID-19 on fluorine-18-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) ([18F]FDG PET/CT) in asymptomatic oncological patients during the period of active COVID-19 in a country with high prevalence of the virus. Methods This is a multi-center retrospective observational study involving 59 Italian centers. We retrospectively reviewed the prevalence of interstitial pneumonia detected during the COVID period (between March 16 and 27, 2020) and compared to a pre-COVID period (January–February 2020) and a control time (in 2019). The diagnosis of interstitial pneumonia was done considering lung alterations of CT of PET. Results Overall, [18F]FDG PET/CT was performed on 4008 patients in the COVID period, 19,267 in the pre-COVID period, and 5513 in the control period. The rate of interstitial pneumonia suspicious for COVID-19 was significantly higher during the...
PURPOSE The primary aim of this multicenter retrospective analysis is to examine the role of F-ch... more PURPOSE The primary aim of this multicenter retrospective analysis is to examine the role of F-choline PET/CT as a diagnostic tool for staging and restaging prostate cancer (PCa) in a large population in the light of 10 years of clinical experience. A secondary aim of the study is to produce data on the predictors of a positive F-choline PET/CT result in the setting of PCa primaries and biochemical recurrences. MATERIALS AND METHODS This multicenter retrospective cohort study is based on data collected by 9 Italian nuclear medicine departments. Between October 2008 and September 2019, 3343 men underwent F-choline PET/CT scans before receiving definitive treatments for a primary PCa or biochemical recurrence. Inclusion criteria were (1) histologically proven PCa (on surgical specimens or prostate biopsies from patients not treated surgically) and (2) availability of clinical and pathological data, including serum prostate specific antigen (PSA) level at the time of PET/CT scanning. RESULTS F-choline PET/CT was performed in 545 cases (16.4%) for cancer staging and in 2798 (83.6%) for restaging purposes, and the result was positive in 540 (99.1%) for the former and 1993 (71.2%) for the latter. A positive PET/CT result was always associated with a high Gleason score (>7) and high PSA levels (P < 0.01). The percentage of patients with a PSA threshold less than 1.0 ng/mL for performing PET/CT was higher in the years 2014 to 2019 (n = 341, 25% of cases) than during the previous period (n = 148, 16%; in 2008-2013). When used for staging purposes, receiver operating characteristic analysis showed that PSA levels of 9.2, 16.4, and 16.6 ng/mL were the optimal cutoffs for distinguishing between positive and negative PET/CT findings for local disease, lymph node involvement, and metastasis, respectively. In the restaging setting, a PSA level of 1.27 ng/mL was the optimal cutoff for distinguishing between a positive and negative PET/CT scan. CONCLUSIONS F-choline PET/CT can help identify early recurrences, even in the case of low PSA levels (<1 ng/mL). Our data suggest that important improvements have been made in the interpretation of F-choline images and in patient selection in the last 5 years.
European Journal of Nuclear Medicine and Molecular Imaging
The objective of this review was to explore the potential clinical application of unconventional ... more The objective of this review was to explore the potential clinical application of unconventional non-amino acid PET radiopharmaceuticals in patients with gliomas. A comprehensive search strategy was used based on SCOPUS and PubMed databases using the following string: (“perfusion” OR “angiogenesis” OR “hypoxia” OR “neuroinflammation” OR proliferation OR invasiveness) AND (“brain tumor” OR “glioma”) AND (“Positron Emission Tomography” OR PET). From all studies published in English, the most relevant articles were selected for this review, evaluating the mostly used PET radiopharmaceuticals in research centers, beyond amino acid radiotracers and 2-[18F]fluoro-2-deoxy-d-glucose ([18F]FDG), for the assessment of different biological features, such as perfusion, angiogenesis, hypoxia, neuroinflammation, cell proliferation, tumor invasiveness, and other biological characteristics in patients with glioma. At present, the use of non-amino acid PET radiopharmaceuticals specifically designed to assess perfusion, angiogenesis, hypoxia, neuroinflammation, cell proliferation, tumor invasiveness, and other biological features in glioma is still limited. The use of investigational PET radiopharmaceuticals should be further explored considering their promising potential and studies specifically designed to validate these preliminary findings are needed. In the clinical scenario, advancements in the development of new PET radiopharmaceuticals and new imaging technologies (e.g., PET/MR and the application of the artificial intelligence to medical images) might contribute to improve the clinical translation of these novel radiotracers in the assessment of gliomas.
Purpose The regional quantification of amyloid burden is crucial for the clinical diagnosis of Al... more Purpose The regional quantification of amyloid burden is crucial for the clinical diagnosis of Alzheimer’s disease [1]. The best method to evaluate regional amyloid deposition in PET is through the use MR imaging for brain space normalization. However, since MR imaging is not always available in the clinical practice, a MR-less methodology is needed in order to compute semi-quantitative and analyze regional amyloid burden. Methods Forty-four patients with clinical evidence of dementia, underwent 18F-Florbetaben PET (FBB-PET), FDG-PET, neuropsychological assessment and cerebrospinal fluid analysis. We implemented a methodology that uses SPM12 to import and normalize the FBB-PET images in Montreal Neurological Institute (MNI) space without MRI, and the Automated Anatomical Labeling (AAL) atlas [2] in order to extract regional uptake from normalized FBB-PET. SUVR has been computed by using cerebellum as control region (‘ Cerebelum _ 4 _ 5 ’ of AAL atlas). We then computed Receiver Operating Characteristic (ROC) curve in order to find best thresholds for identifying clinical subgroups in our patients. Results Semi-quantitative evaluation of FBB-PET images and ROC analysis stated that SUVR value of 1,006 in the bilateral inferior frontal cortex and a SUVR of 1.03 in the precuneus region were the best cutoff (AUC 0.883 and 0.826, respectively). Box-Plot analysis showed a trend distribution of elevated SUVR levels in bilateral frontal cortex, angular girus, occipital, parietal, precuneus and paracentral lobule, among AD patients. Conclusion MR-less methodology based on Tissue Probability Map and AAL atlas provide regional quantification of amyloid burden. The ROC analysis is able to retrieve useful thresholds for the classification of AD versus non-AD thus providing a tool in clinical practice. We will perform the study on a larger sample in order to confirm the results.
Atypical Parkinsonian disorders (APD) frequently overlap in clinical presentations, making the di... more Atypical Parkinsonian disorders (APD) frequently overlap in clinical presentations, making the differential diagnosis challenging in the early stages. The present study aimed to evaluate the accuracy of the [18F]fluoro‐deoxy‐glucose positron emission tomography Statistical Parametric Mapping (SPM) optimized procedure in supporting the early and differential diagnosis of APD.
Prostate cancer (PCa) represents the fourth most common cancer and the fifth leading cause of can... more Prostate cancer (PCa) represents the fourth most common cancer and the fifth leading cause of cancer death of men worldwide. Multiparametric MRI (mp-MRI) has high sensitivity and specificity in the detection of PCa, and it is currently the most widely used imaging technique for tumor localization and cancer staging. mp-MRI plays a key role in risk stratification of naïve patients, in active surveillance for low-risk patients, and in monitoring recurrence after definitive therapy. Radiomics is an emerging and promising tool which allows a quantitative tumor evaluation from radiological images via conversion of digital images into mineable high-dimensional data. The purpose of radiomics is to increase the features available to detect PCa, to avoid unnecessary biopsies, to define tumor aggressiveness, and to monitor post-treatment recurrence of PCa. The integration of radiomics data, including different imaging modalities (such as PET-CT) and other clinical and histopathological data, ...
Introduction Large-scale worldwide COVID-19 vaccination programs are being rapidly deployed, and ... more Introduction Large-scale worldwide COVID-19 vaccination programs are being rapidly deployed, and high-risk patients with comorbidity are now receiving the first doses of the vaccine. Physicians should be, therefore, aware of new pitfalls associated with the current pandemic vaccination program, also in the case of [18F]Florbetaben PET/CT. Case Presentation We described the first image of [18F]Florbetaben PET/CT in the evaluation of a 70-year-old male with suspicious Alzheimer disease and unclear history of heart disease. We detailed the diagnostic imaging PET/CT workup with different findings. Conclusion In this case, [18F]Florbetaben PET/CT can demonstrate potential beta-amyloid immune-reactivity and deposition associated with the current COVID-19 pandemic vaccination programs.
We investigated the diagnostic performance of Somatostatin Receptor Positron Emission Tomography/... more We investigated the diagnostic performance of Somatostatin Receptor Positron Emission Tomography/Computed Tomography (SSR-PET/CT) for the detection of primary lesion and initial staging of pancreatic neuroendocrine tumors (pNETs). A comprehensive literature search up to January 2020 was performed selecting studies in presence of: sample size ≥10 patients; index test (i.e., 68Ga-DOTATOC or 68Ga-DOTANOC or 68Ga-DOTATATE PET/CT); and outcomes (i.e., detection rate (DR), true positive, true negative, false positive, and false-negative). The methodological quality was evaluated with QUADAS-2. Pooled DR and pooled sensitivity and specificity for the identification of the primary tumor were assessed by a patient-based and a lesion-based analysis. Thirty-eight studies were selected for the qualitative analysis, while 18 papers were included in the meta-analysis. The number of pNET patients ranged from 10 to 142, for a total of 1143 subjects. At patient-based analysis, the pooled sensitivity...
e17593 Background: The increased incidence of bone fractures found in pts who received the AA-RA2... more e17593 Background: The increased incidence of bone fractures found in pts who received the AA-RA223 combination compared to those treated with AA alone in the ERA223 trial led to restrictive recommendations by the European Medicines Agency which limited the use of RA223 to pts who have received at least two previous treatments for mCRPC or who cannot receive any other treatment. Moreover, clinicians started to debate the risk of RA223-related fractures associated with the sequential administration of AA and RA223. The aim of this retrospective study was to assess the safety of administering RA223 to pts who have progressed during AA treatment mainly in terms of the rate of skeletal fractures. Methods: We retrospectively reviewed the records of mCRPC pts who received RA223 after progressing during an AA treatment line in everyday clinical practice in ten Italian Hospitals. Results: We reviewed data of a consecutive series of 94 mCRPC pts. Most of the pts (85.1%) received RA223 as sec...
European Journal of Nuclear Medicine and Molecular Imaging, 2021
Purpose To assess the presence and pattern of incidental interstitial lung alterations suspicious... more Purpose To assess the presence and pattern of incidental interstitial lung alterations suspicious of COVID-19 on fluorine-18-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) ([18F]FDG PET/CT) in asymptomatic oncological patients during the period of active COVID-19 in a country with high prevalence of the virus. Methods This is a multi-center retrospective observational study involving 59 Italian centers. We retrospectively reviewed the prevalence of interstitial pneumonia detected during the COVID period (between March 16 and 27, 2020) and compared to a pre-COVID period (January–February 2020) and a control time (in 2019). The diagnosis of interstitial pneumonia was done considering lung alterations of CT of PET. Results Overall, [18F]FDG PET/CT was performed on 4008 patients in the COVID period, 19,267 in the pre-COVID period, and 5513 in the control period. The rate of interstitial pneumonia suspicious for COVID-19 was significantly higher during the...
PURPOSE The primary aim of this multicenter retrospective analysis is to examine the role of F-ch... more PURPOSE The primary aim of this multicenter retrospective analysis is to examine the role of F-choline PET/CT as a diagnostic tool for staging and restaging prostate cancer (PCa) in a large population in the light of 10 years of clinical experience. A secondary aim of the study is to produce data on the predictors of a positive F-choline PET/CT result in the setting of PCa primaries and biochemical recurrences. MATERIALS AND METHODS This multicenter retrospective cohort study is based on data collected by 9 Italian nuclear medicine departments. Between October 2008 and September 2019, 3343 men underwent F-choline PET/CT scans before receiving definitive treatments for a primary PCa or biochemical recurrence. Inclusion criteria were (1) histologically proven PCa (on surgical specimens or prostate biopsies from patients not treated surgically) and (2) availability of clinical and pathological data, including serum prostate specific antigen (PSA) level at the time of PET/CT scanning. RESULTS F-choline PET/CT was performed in 545 cases (16.4%) for cancer staging and in 2798 (83.6%) for restaging purposes, and the result was positive in 540 (99.1%) for the former and 1993 (71.2%) for the latter. A positive PET/CT result was always associated with a high Gleason score (>7) and high PSA levels (P < 0.01). The percentage of patients with a PSA threshold less than 1.0 ng/mL for performing PET/CT was higher in the years 2014 to 2019 (n = 341, 25% of cases) than during the previous period (n = 148, 16%; in 2008-2013). When used for staging purposes, receiver operating characteristic analysis showed that PSA levels of 9.2, 16.4, and 16.6 ng/mL were the optimal cutoffs for distinguishing between positive and negative PET/CT findings for local disease, lymph node involvement, and metastasis, respectively. In the restaging setting, a PSA level of 1.27 ng/mL was the optimal cutoff for distinguishing between a positive and negative PET/CT scan. CONCLUSIONS F-choline PET/CT can help identify early recurrences, even in the case of low PSA levels (<1 ng/mL). Our data suggest that important improvements have been made in the interpretation of F-choline images and in patient selection in the last 5 years.
European Journal of Nuclear Medicine and Molecular Imaging
The objective of this review was to explore the potential clinical application of unconventional ... more The objective of this review was to explore the potential clinical application of unconventional non-amino acid PET radiopharmaceuticals in patients with gliomas. A comprehensive search strategy was used based on SCOPUS and PubMed databases using the following string: (“perfusion” OR “angiogenesis” OR “hypoxia” OR “neuroinflammation” OR proliferation OR invasiveness) AND (“brain tumor” OR “glioma”) AND (“Positron Emission Tomography” OR PET). From all studies published in English, the most relevant articles were selected for this review, evaluating the mostly used PET radiopharmaceuticals in research centers, beyond amino acid radiotracers and 2-[18F]fluoro-2-deoxy-d-glucose ([18F]FDG), for the assessment of different biological features, such as perfusion, angiogenesis, hypoxia, neuroinflammation, cell proliferation, tumor invasiveness, and other biological characteristics in patients with glioma. At present, the use of non-amino acid PET radiopharmaceuticals specifically designed to assess perfusion, angiogenesis, hypoxia, neuroinflammation, cell proliferation, tumor invasiveness, and other biological features in glioma is still limited. The use of investigational PET radiopharmaceuticals should be further explored considering their promising potential and studies specifically designed to validate these preliminary findings are needed. In the clinical scenario, advancements in the development of new PET radiopharmaceuticals and new imaging technologies (e.g., PET/MR and the application of the artificial intelligence to medical images) might contribute to improve the clinical translation of these novel radiotracers in the assessment of gliomas.
Purpose The regional quantification of amyloid burden is crucial for the clinical diagnosis of Al... more Purpose The regional quantification of amyloid burden is crucial for the clinical diagnosis of Alzheimer’s disease [1]. The best method to evaluate regional amyloid deposition in PET is through the use MR imaging for brain space normalization. However, since MR imaging is not always available in the clinical practice, a MR-less methodology is needed in order to compute semi-quantitative and analyze regional amyloid burden. Methods Forty-four patients with clinical evidence of dementia, underwent 18F-Florbetaben PET (FBB-PET), FDG-PET, neuropsychological assessment and cerebrospinal fluid analysis. We implemented a methodology that uses SPM12 to import and normalize the FBB-PET images in Montreal Neurological Institute (MNI) space without MRI, and the Automated Anatomical Labeling (AAL) atlas [2] in order to extract regional uptake from normalized FBB-PET. SUVR has been computed by using cerebellum as control region (‘ Cerebelum _ 4 _ 5 ’ of AAL atlas). We then computed Receiver Operating Characteristic (ROC) curve in order to find best thresholds for identifying clinical subgroups in our patients. Results Semi-quantitative evaluation of FBB-PET images and ROC analysis stated that SUVR value of 1,006 in the bilateral inferior frontal cortex and a SUVR of 1.03 in the precuneus region were the best cutoff (AUC 0.883 and 0.826, respectively). Box-Plot analysis showed a trend distribution of elevated SUVR levels in bilateral frontal cortex, angular girus, occipital, parietal, precuneus and paracentral lobule, among AD patients. Conclusion MR-less methodology based on Tissue Probability Map and AAL atlas provide regional quantification of amyloid burden. The ROC analysis is able to retrieve useful thresholds for the classification of AD versus non-AD thus providing a tool in clinical practice. We will perform the study on a larger sample in order to confirm the results.
Atypical Parkinsonian disorders (APD) frequently overlap in clinical presentations, making the di... more Atypical Parkinsonian disorders (APD) frequently overlap in clinical presentations, making the differential diagnosis challenging in the early stages. The present study aimed to evaluate the accuracy of the [18F]fluoro‐deoxy‐glucose positron emission tomography Statistical Parametric Mapping (SPM) optimized procedure in supporting the early and differential diagnosis of APD.
Prostate cancer (PCa) represents the fourth most common cancer and the fifth leading cause of can... more Prostate cancer (PCa) represents the fourth most common cancer and the fifth leading cause of cancer death of men worldwide. Multiparametric MRI (mp-MRI) has high sensitivity and specificity in the detection of PCa, and it is currently the most widely used imaging technique for tumor localization and cancer staging. mp-MRI plays a key role in risk stratification of naïve patients, in active surveillance for low-risk patients, and in monitoring recurrence after definitive therapy. Radiomics is an emerging and promising tool which allows a quantitative tumor evaluation from radiological images via conversion of digital images into mineable high-dimensional data. The purpose of radiomics is to increase the features available to detect PCa, to avoid unnecessary biopsies, to define tumor aggressiveness, and to monitor post-treatment recurrence of PCa. The integration of radiomics data, including different imaging modalities (such as PET-CT) and other clinical and histopathological data, ...
Introduction Large-scale worldwide COVID-19 vaccination programs are being rapidly deployed, and ... more Introduction Large-scale worldwide COVID-19 vaccination programs are being rapidly deployed, and high-risk patients with comorbidity are now receiving the first doses of the vaccine. Physicians should be, therefore, aware of new pitfalls associated with the current pandemic vaccination program, also in the case of [18F]Florbetaben PET/CT. Case Presentation We described the first image of [18F]Florbetaben PET/CT in the evaluation of a 70-year-old male with suspicious Alzheimer disease and unclear history of heart disease. We detailed the diagnostic imaging PET/CT workup with different findings. Conclusion In this case, [18F]Florbetaben PET/CT can demonstrate potential beta-amyloid immune-reactivity and deposition associated with the current COVID-19 pandemic vaccination programs.
We investigated the diagnostic performance of Somatostatin Receptor Positron Emission Tomography/... more We investigated the diagnostic performance of Somatostatin Receptor Positron Emission Tomography/Computed Tomography (SSR-PET/CT) for the detection of primary lesion and initial staging of pancreatic neuroendocrine tumors (pNETs). A comprehensive literature search up to January 2020 was performed selecting studies in presence of: sample size ≥10 patients; index test (i.e., 68Ga-DOTATOC or 68Ga-DOTANOC or 68Ga-DOTATATE PET/CT); and outcomes (i.e., detection rate (DR), true positive, true negative, false positive, and false-negative). The methodological quality was evaluated with QUADAS-2. Pooled DR and pooled sensitivity and specificity for the identification of the primary tumor were assessed by a patient-based and a lesion-based analysis. Thirty-eight studies were selected for the qualitative analysis, while 18 papers were included in the meta-analysis. The number of pNET patients ranged from 10 to 142, for a total of 1143 subjects. At patient-based analysis, the pooled sensitivity...
e17593 Background: The increased incidence of bone fractures found in pts who received the AA-RA2... more e17593 Background: The increased incidence of bone fractures found in pts who received the AA-RA223 combination compared to those treated with AA alone in the ERA223 trial led to restrictive recommendations by the European Medicines Agency which limited the use of RA223 to pts who have received at least two previous treatments for mCRPC or who cannot receive any other treatment. Moreover, clinicians started to debate the risk of RA223-related fractures associated with the sequential administration of AA and RA223. The aim of this retrospective study was to assess the safety of administering RA223 to pts who have progressed during AA treatment mainly in terms of the rate of skeletal fractures. Methods: We retrospectively reviewed the records of mCRPC pts who received RA223 after progressing during an AA treatment line in everyday clinical practice in ten Italian Hospitals. Results: We reviewed data of a consecutive series of 94 mCRPC pts. Most of the pts (85.1%) received RA223 as sec...
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