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Showing 1201 - 1400 of 2335 Journals sorted alphabetically
J. of Community Genetics     Hybrid Journal   (Followers: 1, SJR: 0.727, h-index: 14)
J. of Community Health     Hybrid Journal   (Followers: 8, SJR: 0.921, h-index: 44)
J. of Comparative Physiology A: Neuroethology, Sensory, Neural, and Behavioral Physiology     Hybrid Journal   (Followers: 7, SJR: 1.087, h-index: 74)
J. of Comparative Physiology B : Biochemical, Systemic, and Environmental Physiology     Hybrid Journal   (Followers: 4, SJR: 1.126, h-index: 59)
J. of Compassionate Health Care     Open Access   (Followers: 1)
J. of Computational Analysis and Applications     Hybrid Journal   (SJR: 0.291, h-index: 19)
J. of Computational Electronics     Hybrid Journal   (Followers: 3, SJR: 0.511, h-index: 20)
J. of Computational Neuroscience     Hybrid Journal   (Followers: 19, SJR: 1.068, h-index: 60)
J. of Computer and Systems Sciences Intl.     Hybrid Journal   (SJR: 0.27, h-index: 13)
J. of Computer Science and Technology     Open Access   (Followers: 5, SJR: 0.437, h-index: 31)
J. of Computer Virology and Hacking Techniques     Hybrid Journal   (Followers: 7, SJR: 0.151, h-index: 2)
J. of Computer-Aided Molecular Design     Hybrid Journal   (Followers: 4, SJR: 0.995, h-index: 78)
J. of Computers in Education     Hybrid Journal   (Followers: 7)
J. of Computing in Higher Education     Hybrid Journal   (Followers: 12, SJR: 0.363, h-index: 21)
J. of Consumer Policy     Hybrid Journal   (Followers: 4, SJR: 0.704, h-index: 30)
J. of Contemporary Mathematical Analysis     Hybrid Journal   (SJR: 0.237, h-index: 5)
J. of Contemporary Physics (Armenian Academy of Sciences)     Hybrid Journal   (Followers: 1, SJR: 0.197, h-index: 6)
J. of Contemporary Psychotherapy     Hybrid Journal   (Followers: 4, SJR: 0.397, h-index: 23)
J. of Control Theory and Applications     Hybrid Journal   (Followers: 2, SJR: 0.359, h-index: 19)
J. of Control, Automation and Electrical Systems     Hybrid Journal   (Followers: 7, SJR: 0.231, h-index: 9)
J. of Crop Science and Biotechnology     Hybrid Journal   (Followers: 7)
J. of Cross-Cultural Gerontology     Hybrid Journal   (Followers: 3, SJR: 0.631, h-index: 29)
J. of Cryptographic Engineering     Partially Free   (Followers: 5, SJR: 0.989, h-index: 11)
J. of Cryptology     Hybrid Journal   (Followers: 2, SJR: 1.443, h-index: 55)
J. of Cultural Economics     Hybrid Journal   (Followers: 2, SJR: 0.539, h-index: 29)
J. of Database Marketing & Customer Strategy Management     Hybrid Journal   (Followers: 8, SJR: 0.149, h-index: 8)
J. of Derivatives & Hedge Funds     Hybrid Journal   (Followers: 7, SJR: 0.114, h-index: 5)
J. of Developmental and Physical Disabilities     Hybrid Journal   (Followers: 8, SJR: 0.574, h-index: 29)
J. of Digital Imaging     Hybrid Journal   (Followers: 8, SJR: 0.578, h-index: 35)
J. of Direct Data and Digital Marketing Practice     Hybrid Journal   (Followers: 7, SJR: 0.154, h-index: 6)
J. of Dynamical and Control Systems     Hybrid Journal   (Followers: 2, SJR: 0.4, h-index: 26)
J. of Dynamics and Differential Equations     Hybrid Journal   (SJR: 1.418, h-index: 31)
J. of Earth Science     Hybrid Journal   (Followers: 8, SJR: 0.483, h-index: 16)
J. of Earth System Science     Open Access   (Followers: 40, SJR: 0.448, h-index: 32)
J. of East Asian Linguistics     Hybrid Journal   (Followers: 5, SJR: 0.537, h-index: 20)
J. of Echocardiography     Hybrid Journal   (Followers: 4, SJR: 0.22, h-index: 3)
J. of Economic Growth     Hybrid Journal   (Followers: 23, SJR: 3.273, h-index: 63)
J. of Economic Interaction and Coordination     Hybrid Journal   (SJR: 0.263, h-index: 12)
J. of Economics     Hybrid Journal   (Followers: 9, SJR: 0.418, h-index: 23)
J. of Economics and Finance     Hybrid Journal   (Followers: 6, SJR: 0.272, h-index: 19)
J. of Educational Change     Hybrid Journal   (Followers: 7, SJR: 0.961, h-index: 21)
J. of Elasticity     Hybrid Journal   (Followers: 5, SJR: 0.851, h-index: 45)
J. of Electroceramics     Hybrid Journal   (SJR: 0.577, h-index: 57)
J. of Electronic Materials     Hybrid Journal   (Followers: 3, SJR: 0.609, h-index: 75)
J. of Electronic Testing     Hybrid Journal   (Followers: 2, SJR: 0.372, h-index: 27)
J. of Electronics (China)     Hybrid Journal   (Followers: 4, SJR: 0.112, h-index: 9)
J. of Elementary Science Education     Hybrid Journal   (Followers: 8)
J. of Engineering Mathematics     Hybrid Journal   (SJR: 0.347, h-index: 37)
J. of Engineering Physics and Thermophysics     Hybrid Journal   (Followers: 1, SJR: 0.288, h-index: 11)
J. of Engineering Research     Open Access   (SJR: 0.145, h-index: 5)
J. of Engineering Thermophysics     Hybrid Journal   (Followers: 1, SJR: 0.763, h-index: 9)
J. of Environmental Studies and Sciences     Partially Free   (Followers: 2)
J. of Ethology     Hybrid Journal   (Followers: 2, SJR: 0.609, h-index: 25)
J. of Evolution Equations     Hybrid Journal   (SJR: 0.826, h-index: 26)
J. of Evolutionary Biochemistry and Physiology     Hybrid Journal   (SJR: 0.145, h-index: 11)
J. of Evolutionary Economics     Hybrid Journal   (Followers: 8, SJR: 0.492, h-index: 52)
J. of Experimental and Theoretical Physics     Hybrid Journal   (Followers: 4, SJR: 0.458, h-index: 39)
J. of Experimental Criminology     Hybrid Journal   (Followers: 30, SJR: 1.445, h-index: 28)
J. of Failure Analysis and Prevention     Hybrid Journal   (Followers: 5, SJR: 0.261, h-index: 15)
J. of Family and Economic Issues     Hybrid Journal   (Followers: 6, SJR: 0.396, h-index: 32)
J. of Family Violence     Hybrid Journal   (Followers: 17, SJR: 0.639, h-index: 56)
J. of Financial Services Marketing     Hybrid Journal   (Followers: 3, SJR: 0.273, h-index: 10)
J. of Financial Services Research     Hybrid Journal   (Followers: 16, SJR: 0.572, h-index: 36)
J. of Fixed Point Theory and Applications     Hybrid Journal   (SJR: 0.644, h-index: 13)
J. of Fluorescence     Hybrid Journal   (Followers: 3, SJR: 0.465, h-index: 56)
J. of Food Measurement and Characterization     Hybrid Journal   (SJR: 0.307, h-index: 4)
J. of Food Science and Technology     Hybrid Journal   (Followers: 5, SJR: 0.441, h-index: 29)
J. of Forest Research     Hybrid Journal   (Followers: 3, SJR: 0.495, h-index: 27)
J. of Forestry Research     Hybrid Journal   (Followers: 6, SJR: 0.304, h-index: 14)
J. of Fourier Analysis and Applications     Hybrid Journal   (Followers: 1, SJR: 1.18, h-index: 42)
J. of Friction and Wear     Hybrid Journal   (Followers: 6, SJR: 0.373, h-index: 7)
J. of Fusion Energy     Hybrid Journal   (Followers: 3, SJR: 0.387, h-index: 19)
J. of Gambling Studies     Hybrid Journal   (Followers: 4, SJR: 1.171, h-index: 57)
J. of Gastroenterology     Hybrid Journal   (Followers: 12, SJR: 1.651, h-index: 88)
J. of Gastrointestinal Cancer     Hybrid Journal   (Followers: 3, SJR: 0.304, h-index: 39)
J. of Gastrointestinal Surgery     Hybrid Journal   (Followers: 5, SJR: 1.64, h-index: 99)
J. of General Internal Medicine     Hybrid Journal   (Followers: 13, SJR: 1.804, h-index: 134)
J. of General Plant Pathology     Hybrid Journal   (SJR: 0.554, h-index: 22)
J. of Genetic Counseling     Hybrid Journal   (Followers: 4, SJR: 0.902, h-index: 39)
J. of Genetics     Open Access   (Followers: 4, SJR: 0.458, h-index: 28)
J. of Geodesy     Hybrid Journal   (Followers: 8, SJR: 2.173, h-index: 56)
J. of Geographical Sciences     Hybrid Journal   (Followers: 1, SJR: 0.8, h-index: 23)
J. of Geographical Systems     Hybrid Journal   (Followers: 3, SJR: 0.822, h-index: 39)
J. of Geometric Analysis     Hybrid Journal   (SJR: 1.491, h-index: 27)
J. of Geometry     Hybrid Journal   (Followers: 1, SJR: 0.272, h-index: 15)
J. of Global Optimization     Hybrid Journal   (Followers: 4, SJR: 0.992, h-index: 60)
J. of Global Policy and Governance     Hybrid Journal   (Followers: 8)
J. of Grid Computing     Hybrid Journal   (SJR: 1.414, h-index: 37)
J. of Hand and Microsurgery     Hybrid Journal   (Followers: 1)
J. of Happiness Studies     Hybrid Journal   (Followers: 15, SJR: 0.881, h-index: 39)
J. of Hematopathology     Hybrid Journal   (Followers: 3, SJR: 0.2, h-index: 13)
J. of Heuristics     Hybrid Journal   (Followers: 5, SJR: 1.308, h-index: 50)
J. of High Energy Physics     Hybrid Journal   (Followers: 5, SJR: 1.052, h-index: 153)
J. of Homotopy and Related Structures     Hybrid Journal   (SJR: 0.232, h-index: 2)
J. of Housing and the Built Environment     Hybrid Journal   (Followers: 6, SJR: 0.648, h-index: 28)
J. of Huazhong University of Science and Technology [Medical Sciences]     Hybrid Journal   (SJR: 0.344, h-index: 19)
J. of Ichthyology     Hybrid Journal   (Followers: 4, SJR: 0.304, h-index: 10)
J. of Immigrant and Minority Health     Hybrid Journal   (Followers: 8, SJR: 0.759, h-index: 37)
J. of Inclusion Phenomena and Macrocyclic Chemistry     Hybrid Journal   (Followers: 1, SJR: 0.331, h-index: 46)
J. of Indian Philosophy     Hybrid Journal   (Followers: 11, SJR: 0.127, h-index: 12)
J. of Indian Prosthodontic Society     Open Access   (SJR: 0.164, h-index: 7)
J. of Industrial Microbiology and Biotechnology     Hybrid Journal   (Followers: 12, SJR: 0.966, h-index: 80)
J. of Industry, Competition and Trade     Hybrid Journal   (Followers: 6, SJR: 0.327, h-index: 15)
J. of Infection and Chemotherapy     Hybrid Journal   (Followers: 1, SJR: 0.673, h-index: 46)
J. of Information Technology     Hybrid Journal   (Followers: 49, SJR: 1.474, h-index: 55)
J. of Information Technology Teaching Cases     Hybrid Journal   (Followers: 6)
J. of Infrared, Millimeter and Terahertz Waves     Hybrid Journal   (Followers: 1, SJR: 1.25, h-index: 36)
J. of Inherited Metabolic Disease     Hybrid Journal   (Followers: 2, SJR: 1.389, h-index: 77)
J. of Inorganic and Organometallic Polymers and Materials     Partially Free   (Followers: 7, SJR: 0.338, h-index: 33)
J. of Insect Behavior     Hybrid Journal   (Followers: 9, SJR: 0.569, h-index: 39)
J. of Insect Conservation     Hybrid Journal   (Followers: 10, SJR: 0.872, h-index: 43)
J. of Intelligent and Robotic Systems     Hybrid Journal   (Followers: 2, SJR: 0.629, h-index: 43)
J. of Intelligent Information Systems     Hybrid Journal   (Followers: 1, SJR: 0.691, h-index: 43)
J. of Intelligent Manufacturing     Hybrid Journal   (Followers: 4, SJR: 1.397, h-index: 54)
J. of Interventional Cardiac Electrophysiology     Hybrid Journal   (SJR: 0.93, h-index: 43)
J. of Intl. Business Studies     Hybrid Journal   (Followers: 27, SJR: 4.208, h-index: 130)
J. of Intl. Entrepreneurship     Hybrid Journal   (Followers: 8, SJR: 0.549, h-index: 23)
J. of Intl. Migration and Integration / Revue de l integration et de la migration internationale     Hybrid Journal   (Followers: 12, SJR: 0.308, h-index: 13)
J. of Intl. Relations and Development     Hybrid Journal   (Followers: 20, SJR: 0.793, h-index: 22)
J. of Labor Research     Hybrid Journal   (Followers: 15, SJR: 0.394, h-index: 27)
J. of Logic, Language and Information     Hybrid Journal   (Followers: 6, SJR: 0.288, h-index: 25)
J. of Low Temperature Physics     Hybrid Journal   (Followers: 2, SJR: 0.531, h-index: 52)
J. of Machinery Manufacture and Reliability     Hybrid Journal   (Followers: 2, SJR: 0.203, h-index: 7)
J. of Mammalian Evolution     Hybrid Journal   (Followers: 5, SJR: 1.134, h-index: 37)
J. of Mammary Gland Biology and Neoplasia     Hybrid Journal   (Followers: 1, SJR: 2.252, h-index: 83)
J. of Management and Governance     Hybrid Journal   (Followers: 12, SJR: 0.805, h-index: 33)
J. of Management Control     Hybrid Journal   (Followers: 4, SJR: 0.605, h-index: 6)
J. of Marine Science and Application     Hybrid Journal   (Followers: 3, SJR: 0.439, h-index: 11)
J. of Marine Science and Technology     Hybrid Journal   (Followers: 3, SJR: 0.235, h-index: 19)
J. of Maritime Archaeology     Hybrid Journal   (Followers: 21, SJR: 0.228, h-index: 8)
J. of Market-Focused Management     Hybrid Journal   (Followers: 2)
J. of Marketing Analytics     Hybrid Journal   (Followers: 3)
J. of Material Cycles and Waste Management     Hybrid Journal   (Followers: 3, SJR: 0.449, h-index: 22)
J. of Materials Engineering and Performance     Hybrid Journal   (Followers: 24, SJR: 0.544, h-index: 40)
J. of Materials Science     Hybrid Journal   (Followers: 19, SJR: 0.836, h-index: 123)
J. of Materials Science : Materials in Electronics     Hybrid Journal   (Followers: 3)
J. of Materials Science : Materials in Medicine     Hybrid Journal   (Followers: 4)
J. of Mathematical Biology     Hybrid Journal   (Followers: 12, SJR: 1.011, h-index: 71)
J. of Mathematical Chemistry     Hybrid Journal   (Followers: 5, SJR: 0.497, h-index: 45)
J. of Mathematical Fluid Mechanics     Hybrid Journal   (Followers: 5, SJR: 1.22, h-index: 22)
J. of Mathematical Imaging and Vision     Hybrid Journal   (Followers: 3, SJR: 0.901, h-index: 53)
J. of Mathematical Modelling and Algorithms     Hybrid Journal   (Followers: 2, SJR: 0.414, h-index: 23)
J. of Mathematical Sciences     Hybrid Journal   (SJR: 0.272, h-index: 23)
J. of Mathematics Teacher Education     Hybrid Journal   (Followers: 13, SJR: 1.062, h-index: 20)
J. of Maxillofacial and Oral Surgery     Hybrid Journal   (Followers: 2)
J. of Mechanical Science and Technology     Hybrid Journal   (Followers: 5, SJR: 0.589, h-index: 26)
J. of Medical and Biological Engineering     Hybrid Journal   (Followers: 1, SJR: 0.387, h-index: 18)
J. of Medical Humanities     Hybrid Journal   (Followers: 19, SJR: 0.299, h-index: 18)
J. of Medical Systems     Hybrid Journal   (Followers: 1, SJR: 0.717, h-index: 44)
J. of Medical Toxicology     Hybrid Journal   (Followers: 4, SJR: 0.874, h-index: 28)
J. of Medical Ultrasonics     Hybrid Journal   (Followers: 2, SJR: 0.18, h-index: 13)
J. of Medicine and the Person     Hybrid Journal  
J. of Membrane Biology     Hybrid Journal   (Followers: 1, SJR: 0.738, h-index: 82)
J. of Micro-Bio Robotics     Hybrid Journal   (SJR: 0.28, h-index: 3)
J. of Microbiology     Hybrid Journal   (Followers: 7, SJR: 0.741, h-index: 43)
J. of Mining Science     Hybrid Journal   (Followers: 5, SJR: 0.317, h-index: 16)
J. of Molecular Evolution     Hybrid Journal   (Followers: 9, SJR: 0.952, h-index: 108)
J. of Molecular Histology     Hybrid Journal   (Followers: 2, SJR: 0.755, h-index: 48)
J. of Molecular Medicine     Hybrid Journal   (Followers: 15, SJR: 2.165, h-index: 113)
J. of Molecular Modeling     Hybrid Journal   (Followers: 4, SJR: 0.466, h-index: 50)
J. of Molecular Neuroscience     Partially Free   (Followers: 9, SJR: 0.988, h-index: 69)
J. of Mountain Science     Hybrid Journal   (Followers: 3, SJR: 0.418, h-index: 15)
J. of Muscle Research and Cell Motility     Hybrid Journal   (Followers: 1, SJR: 1.264, h-index: 55)
J. of Nanoparticle Research     Hybrid Journal   (Followers: 3, SJR: 0.583, h-index: 84)
J. of Natural Medicines     Hybrid Journal   (SJR: 0.602, h-index: 28)
J. of Near-Death Studies     Hybrid Journal   (Followers: 2)
J. of Nephrology     Hybrid Journal   (Followers: 5, SJR: 0.689, h-index: 55)
J. of Network and Systems Management     Hybrid Journal   (SJR: 0.466, h-index: 26)
J. of Neural Transmission     Hybrid Journal   (Followers: 2, SJR: 1.034, h-index: 86)
J. of Neuro-Oncology     Hybrid Journal   (Followers: 3, SJR: 1.274, h-index: 90)
J. of Neuroimmune Pharmacology     Hybrid Journal   (Followers: 1, SJR: 1.662, h-index: 45)
J. of Neurology     Hybrid Journal   (Followers: 13, SJR: 1.429, h-index: 105)
J. of NeuroVirology     Hybrid Journal   (Followers: 1, SJR: 0.979, h-index: 69)
J. of Nondestructive Evaluation     Hybrid Journal   (Followers: 9, SJR: 0.863, h-index: 27)
J. of Nonlinear Science     Hybrid Journal   (Followers: 1, SJR: 1.887, h-index: 42)
J. of Nonverbal Behavior     Hybrid Journal   (Followers: 3, SJR: 0.723, h-index: 47)
J. of Nuclear Cardiology     Hybrid Journal   (SJR: 1.024, h-index: 68)
J. of Nutrition, Health and Aging     Hybrid Journal   (Followers: 18, SJR: 0.919, h-index: 60)
J. of Obstetrics and Gynecology of India     Hybrid Journal   (Followers: 7, SJR: 0.214, h-index: 6)
J. of Occupational Rehabilitation     Hybrid Journal   (Followers: 12, SJR: 0.811, h-index: 51)
J. of Ocean Engineering and Marine Energy     Hybrid Journal   (Followers: 1)
J. of Ocean University of China (English Edition)     Hybrid Journal   (Followers: 1, SJR: 0.237, h-index: 11)
J. of Oceanography     Hybrid Journal   (Followers: 7, SJR: 0.796, h-index: 52)
J. of Ocular Biology, Diseases, and Informatics     Hybrid Journal   (SJR: 0.183, h-index: 11)
J. of Optical and Fiber Communications Reports     Hybrid Journal   (Followers: 3)
J. of Optics     Hybrid Journal   (Followers: 5, SJR: 0.214, h-index: 8)
J. of Optimization Theory and Applications     Hybrid Journal   (Followers: 3, SJR: 0.898, h-index: 65)
J. of Ornithology     Hybrid Journal   (Followers: 22)
J. of Orofacial Orthopedics / Fortschritte der Kieferorthopädie     Hybrid Journal   (SJR: 0.574, h-index: 33)
J. of Orthopaedic Science     Hybrid Journal   (Followers: 5, SJR: 0.708, h-index: 48)
J. of Paleolimnology     Hybrid Journal   (Followers: 5, SJR: 0.984, h-index: 64)
J. of Parasitic Diseases     Hybrid Journal   (Followers: 2, SJR: 0.298, h-index: 9)
J. of Pediatric Neuropsychology     Hybrid Journal   (Followers: 1)
J. of Pest Science     Hybrid Journal   (Followers: 2, SJR: 1.341, h-index: 28)
J. of Pharmaceutical Health Care and Sciences     Open Access  
J. of Pharmaceutical Innovation     Hybrid Journal   (Followers: 8, SJR: 0.524, h-index: 17)
J. of Pharmaceutical Investigation     Hybrid Journal   (Followers: 1, SJR: 0.331, h-index: 6)
J. of Pharmacokinetics and Pharmacodynamics     Hybrid Journal   (Followers: 21, SJR: 0.708, h-index: 46)
J. of Phase Equilibria and Diffusion     Hybrid Journal   (Followers: 19, SJR: 0.433, h-index: 36)
J. of Philosophical Logic     Hybrid Journal   (Followers: 8, SJR: 0.704, h-index: 26)

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Journal Cover European Journal of Nuclear Medicine and Molecular Imaging
  [SJR: 2.08]   [H-I: 106]   [9 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1619-7089 - ISSN (Online) 1619-7070
   Published by Springer-Verlag Homepage  [2335 journals]
  • 18 F-FDG-PET/CT for systemic staging of newly diagnosed triple-negative
           breast cancer
    • Authors: Gary A. Ulaner; Raychel Castillo; Debra A. Goldman; Jonathan Wills; Christopher C. Riedl; Katja Pinker-Domenig; Maxine S. Jochelson; Mithat Gönen
      Pages: 1937 - 1944
      Abstract: Purpose National Comprehensive Cancer Network guidelines recommend 18F-FDG-PET/CT, in addition to standard staging procedures, for systemic staging of newly diagnosed stage III breast cancer patients. However, factors in addition to stage may influence PET/CT utility. As breast cancers that are negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor (triple-negative breast cancer, or TNBC) are more aggressive and metastasize earlier than other breast cancers, we hypothesized that receptor expression may be one such factor. This study assesses 18F-FDG-PET/CT for systemic staging of newly diagnosed TNBC. Methods In this Institutional Review Board-approved retrospective study, our Healthcare Information System was screened for patients with TNBC who underwent 18F-FDG-PET/CT in 2007–2013 prior to systemic or radiation therapy. Initial stage was determined from mammography, ultrasound, magnetic resonance imaging, and/or surgery, if performed prior to 18F-FDG-PET/CT. 18F-FDG-PET/CT was evaluated to identify unsuspected extra-axillary regional nodal and distant metastases, as well as unsuspected synchronous malignancies. Kaplan Meier survival estimates were calculated for initial stage IIB patients stratified by whether or not stage 4 disease was detected by 18F-FDG-PET/CT. Results A total of 232 patients with TNBC met inclusion criteria. 18F-FDG-PET/CT revealed unsuspected distant metastases in 30 (13 %): 0/23 initial stage I, 4/82 (5 %) stage IIA, 13/87 (15 %) stage IIB, 4/23 (17 %) stage IIIA, 8/14 (57 %) stage IIIB, and 1/3 (33 %) stage IIIC. Twenty-six of 30 patients upstaged to IV by 18F-FDG-PET/CT were confirmed by pathology, with the remaining four patients confirmed by follow-up imaging. In addition, seven unsuspected synchronous malignancies were identified in six patients. Initial stage 2B patients who were upstaged to 4 by 18F-FDG-PET/CT had significantly shorter survival compared to initial stage 2B patients who were not (3-year Kaplan Meier estimate 0.33, 95 % CI 0.13-0.55 versus 0.97, CI 0.76-0.93, p < .0001). Conclusion F-FDG-PET/CT revealed distant metastases in 15 % of patients with stage IIB TNBC. Stage IIB patients upstaged to 4 by 18F-FDG-PET/CT had significantly shorter survival than those who were not, consistent with 18F-FDG-PET/CT detecting an increased burden of disease. This study provides further evidence that populations of patients with stage IIB breast cancer, such as TNBC, should be considered for systemic staging with 18F-FDG-PET/CT at the time of initial diagnosis.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3402-9
      Issue No: Vol. 43, No. 11 (2016)
  • Comparison of RECIST, EORTC criteria and PERCIST for evaluation of early
           response to chemotherapy in patients with non-small-cell lung cancer
    • Authors: Jingjie Shang; Xueying Ling; Linyue Zhang; Yongjin Tang; Zeyu Xiao; Yong Cheng; Bin Guo; Jian Gong; Li Huang; Hao Xu
      Pages: 1945 - 1953
      Abstract: Purpose To compare the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, the European Organization for Research and Treatment of Cancer (EORTC) criteria and the Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) 1.0 using PET volume computer-assisted reading (PET VCAR) for response evaluation in patients with advanced non-small-cell lung cancer (NSCLC) treated with chemotherapy. Methods A total of 35 patients with NSCLC were included in this prospective study. All patients received standard chemotherapy and underwent 18F-FDG PET/CT scans before and after treatment. With the assistance of PET VCAR, the chemotherapeutic responses were evaluated according to the RECIST 1.1, EORTC criteria and PERCIST 1.0. Concordance among these protocols was assessed using Cohen’s κ coefficient and Wilcoxon’s signed-ranks test. Progression-free survival (PFS) was calculated using the Kaplan-Meier test. Results RECIST 1.1 and EORTC response classifications were discordant in 20 patients (57.1 %; κ = 0.194, P < 0.05), and RECIST 1.1 and PERCIST 1.0 classifications were discordant in 22 patients (62.9 %; κ = 0.139, P < 0.05). EORTC and PERCIST 1.0 classifications were discordant in only 4 patients (11.4 %), resulting in better concordance (κ = 0.804, P > 0.05). Patients with a partial remission according to RECIST 1.1 had significantly longer PFS (P < 0.001) than patients with progressive disease, but not significantly longer than patients with stable disease (P = 0.855). According to both the EORTC criteria and PERCIST 1.0, patients with a partial metabolic response had a significantly longer PFS than those with stable metabolic disease and those with progressive metabolic disease (P = 0.020 and P < 0.001, respectively, for EORTC; both P < 0.001 for PERCIST 1.0). Conclusion EORTC criteria and PERCIST 1.0 are more sensitive and accurate than RECIST 1.1 for the detection of an early therapeutic response to chemotherapy in patients with NSCLC. Although EORTC criteria and PERCIST 1.0 showed similar results, PERCIST 1.0 is preferred because detailed and unambiguous definitions are given. We also found that response evaluations with PERCIST 1.0 using a single lesion and multiple lesions gave similar response classifications.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3420-7
      Issue No: Vol. 43, No. 11 (2016)
  • Correlation of metabolic information on FDG-PET with tissue expression of
           immune markers in patients with non-small cell lung cancer (NSCLC) who are
           candidates for upfront surgery
    • Authors: Egesta Lopci; Luca Toschi; Fabio Grizzi; Daoud Rahal; Laura Olivari; Giovanni Francesco Castino; Silvia Marchetti; Nina Cortese; Dorina Qehajaj; Daniela Pistillo; Marco Alloisio; Massimo Roncalli; Paola Allavena; Armando Santoro; Federica Marchesi; Arturo Chiti
      Pages: 1954 - 1961
      Abstract: Purpose Eliciting antitumor T-cell response by targeting the PD-1/PD-L1 axis with checkpoint inhibitors has emerged as a novel therapeutic strategy in non-small cell lung cancer (NSCLC). The identification of predictors for sensitivity or resistance to these agents is, therefore, needed. Herein, we investigate the correlation of metabolic information on FDG-PET with tissue expression of immune-checkpoints and other markers of tumor-related immunity in resected NSCLC patients. Materials and methods All patients referred to our institution for upfront surgical resection of NSCLC, who were investigated with FDG-PET prior to surgery, were consecutively included in the study. From January 2010 to May 2014, 55 patients (stage IA-IIIB; M:F = 42:13; mean age 68.9 years) were investigated. Sampled surgical tumor specimens were analyzed by immunohistochemistry (IHC) for CD68-TAMs (tumor-associated macrophages), CD8-TILs (tumor infiltrating lymphocytes), PD-1-TILs, and PD-L1 tumor expression. Immunoreactivity was evaluated, and scores were compared with imaging findings. FDG-PET images were analyzed to define semi-quantitative parameters: SUVmax and SUVmean. Metabolic information on FDG-PET was correlated with tissue markers expression and disease-free survival (DFS) considering a median follow-up of 16.2 months. Results Thirty-six adenocarcinomas (ADC), 18 squamous cell carcinomas (SCC), and one sarcomatoid carcinoma were analyzed. All tumors resulted positive at FDG-PET: median SUVmax 11.3 (range: 2.3–32.5) and SUVmean 6.4 (range: 1.5–13) both resulted significantly higher in SCC compared to other NSCLC histotypes (p = 0.007 and 0.048, respectively). IHC demonstrated a median immunoreactive surface covered by CD68-TAMs of 5.41 % (range: 0.84–14.01 %), CD8-TILs of 2.9 % (range: 0.11–11.92 %), PD-1 of 0.65 % (range: 0.02–5.87 %), and PD-L1 of 0.7 % (range: 0.03–10.29 %). We found a statistically significant correlation between SUVmax and SUVmean with the expression of CD8 TILs (rho = 0.31; p = 0.027) and PD-1 (rho = 0.33; p = 0.017 and rho = 0.36; p = 0.009, respectively). The other tissue markers correlated as follows: CD8 TILs and PD-1 (rho = 0.45; p = 0.001), CD8 TILs and PD-L1 (rho = 0.41; p = 0.003), CD68-TAMs and PD-L1 (rho = 0.30; p = 0.027), PD-1 and PD-L1 (rho = 0.26; p = 0.059). With respect to patients’ outcome, SUVmax, SUVmean, and disease stage showed a statistically significant correlation with DFS (p = 0.002, 0.004, and <0.001, respectively). Conclusions The present study shows a direct association between metabolic parameters on FDG-PET and the expression of tumor-related immunity markers, suggesting a potential role for FDG-PET to characterize the tumor microenvironment and select NSCLC patients candidate to checkpoint inhibitors.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3425-2
      Issue No: Vol. 43, No. 11 (2016)
  • Biodistribution and radiation dosimetry of 68 Ga-PSMA HBED CC—a PSMA
           specific probe for PET imaging of prostate cancer
    • Authors: Christian H. Pfob; Sibylle Ziegler; Frank Philipp Graner; Markus Köhner; Sylvia Schachoff; Birgit Blechert; Hans-Jürgen Wester; Klemens Scheidhauer; Markus Schwaiger; Tobias Maurer; Matthias Eiber
      Pages: 1962 - 1970
      Abstract: Purpose Positron emission tomography (PET) agents targeting the prostate-specific membrane antigen (PSMA) are currently under broad clinical and scientific investigation. 68Ga-PSMA HBED-CC constitutes the first 68Ga-labelled PSMA-inhibitor and has evolved as a promising agent for imaging PSMA expression in vivo. The aim of this study was to evaluate the whole-body distribution and radiation dosimetry of this new probe. Methods Five patients with a history or high suspicion of prostate cancer were injected intravenously with a mean of 139.8 ± 13.7 MBq of 68Ga-PSMA HBED-CC (range 120–158 MBq). Four static skull to mid-thigh scans using a whole-body fully integrated PET/MR-system were performed 10 min, 60 min, 130 min, and 175 min after the tracer injection. Time-dependent changes of the injected activity per organ were determined. Mean organ-absorbed doses and effective doses (ED) were calculated using OLINDA/EXM. Results Injection of a standard activity of 150 MBq 68Ga-PSMA HBED-CC resulted in a median effective dose of 2.37 mSv (Range 1.08E-02 – 2.46E-02 mSv/MBq). The urinary bladder wall (median absorbed dose 1.64E-01 mGv/MBq; range 8.76E-02 – 2.91E-01 mGv/MBq) was the critical organ, followed by the kidneys (median absorbed dose 1.21E-01 mGv/MBq; range 7.16E-02 – 1.75E-01), spleen (median absorbed dose 4.13E-02 mGv/MBq; range 1.57E-02 – 7.32E-02 mGv/MBq) and liver (median absorbed dose 2.07E-02 mGv/MBq; range 1.80E-02 – 2.57E-02 mGv/MBq). No drug-related pharmacological effects occurred. Conclusion The use of 68Ga-PSMA HBED-CC results in a relatively low radiation exposure, delivering organ doses that are comparable to those of other 68Ga-labelled PSMA-inhibitors used for PET-imaging. Total effective dose is lower than for other PET-agents used for prostate cancer imaging (e.g. 11C- and 18F-Choline).
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3424-3
      Issue No: Vol. 43, No. 11 (2016)
  • 11 C-Choline PET/CT for restaging prostate cancer. Results from 4,426
           scans in a single-centre patient series
    • Authors: Tiziano Graziani; Francesco Ceci; Paolo Castellucci; Giulia Polverari; Giacomo Maria Lima; Filippo Lodi; Alessio Giuseppe Morganti; Andrea Ardizzoni; Riccardo Schiavina; Stefano Fanti
      Pages: 1971 - 1979
      Abstract: Purpose To evaluate 11C-choline PET/CT as a diagnostic tool for restaging prostate cancer (PCa), in a large, homogeneous and clinically relevant population of patients with biochemical recurrence (BCR) of PCa after primary therapy. The secondary aim was to assess the best timing for performing 11C-choline PET/CT during BCR. Methods We retrospectively analysed 9,632 11C-choline PET/CT scans performed in our institution for restaging PCa from January 2007 to June 2015. The inclusion criteria were: (1) proven PCa radically treated with radical prostatectomy (RP) or with primary external beam radiotherapy (EBRT); (2) PSA serum values available; (3) proven BCR (PSA >0.2 ng/mL after RP or PSA >2 ng/mL above the nadir after primary EBRT with rising PSA levels). Finally, 3,203 patients with recurrent PCa matching all the inclusion criteria were retrospectively enrolled and 4,426 scans were analysed. Results Overall, 52.8 % of the 11C-choline PET/CT scans (2,337/4,426) and 54.8 % of the patients (1,755/3,203) were positive. In 29.4 % of the scans, at least one distant finding was observed. The mean and median PSA values were, respectively, 4.9 and 2.1 ng/mL at the time of the scan (range 0.2 – 50 ng/mL). In our series, 995 scans were performed in patients with PSA levels between 1 and 2 ng/mL. In this subpopulation the positivity rate in the 995 scans was 44.7 %, with an incidence of distant findings of 19.2 % and an incidence of oligometastatic disease (one to three lesions) of 37.7 %. The absolute PSA value at the time of the scan and ongoing androgen deprivation therapy were associated with an increased probability of a positive 11C-choline PET/CT scan (p < 0.0001). In the ROC analysis, a PSA value of 1.16 ng/mL was the optimal cut-off value. In patients with a PSA value <1.16 ng/mL, 26.8 % of 1,426 11C-choline PET/CT scans were positive, with oligometastatic disease in 84.7 % of positive scans. Conclusion In a large cohort of patients, the feasibility of 11C-choline PET/CT for detecting the sites of metastatic disease in PCa patients with BCR was confirmed. The PSA level was the main predictor of a positive scan with 1.16 ng/mL as the optimal cut-off value. In the majority of positive scans oligometastatic disease, potentially treatable with salvage therapies, was observed.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3428-z
      Issue No: Vol. 43, No. 11 (2016)
  • Effect of adjuvant lithium on thyroxine (T4) concentration after
           radioactive iodine therapy
    • Authors: Emmanuel NiiBoye Hammond; Mboyo-Di-Tamba Heben Willy Vangu
      Pages: 1980 - 1987
      Abstract: Purpose To study the effect of adjuvant lithium on serum thyroxine (T4) concentrations in patients treated with radioactive iodine (RAI) therapy in our environment. Methods This was a prospective simple randomized comparative, experimental cohort study of patients with hyperthyroidism referred for RAI ablation therapy in the two main academic hospitals in Johannesburg between February 2014 and September 2015. Results Amongst the 163 participants in the final analysis, 75 received RAI alone and 88 received RAI with lithium. The difference in mean T4 concentrations at 3 months between the RAI-only group (17.67 pmol/l) and the RAI with lithium group (11.55 pmol/l) was significant with a small effect size (U = 2328.5, Z = −2.700, p = 0.007, r = 0.01). Significant decreases in T4 concentrations were observed as early as 1 month after RAI (p = 0.0001) in the RAI with lithium group, but in the RAI-only group, significant decreases in T4 concentrations were observed only at 3 months after RAI therapy (p = 0.000). Women and patients with Graves’ disease who received RAI with adjuvant lithium also showed significant decreases in T4 concentrations at 1 month (p = 0.002 and p = 0.003, respectively). Conclusion Adjuvant lithium leads to an earlier and better response to RAI therapy with lower T4 concentrations that are achieved earlier. This earlier response and decrease in T4 concentrations were noted in patients with Graves’ disease and nodular goitre, and in women with hyperthyroidism who received adjuvant lithium therapy.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3388-3
      Issue No: Vol. 43, No. 11 (2016)
  • Prognostic impact of incomplete surgical clearance of radioiodine
           sensitive local lymph node metastases diagnosed by post-operative 124
           I-NaI-PET/CT in patients with papillary thyroid cancer
    • Authors: Amir Sabet; Ina Binse; Hong Grafe; Samer Ezziddin; Rainer Görges; Thorsten D. Poeppel; Andreas Bockisch; Sandra J. Rosenbaum-Krumme
      Pages: 1988 - 1994
      Abstract: Purpose Nodal involvement is an independent risk factor of recurrence in papillary thyroid cancer (PTC). Neither the international guidelines nor the recently introduced ongoing risk adaptation concept consider the extent of initial surgical clearance of radioiodine sensitive lymph node metastases in their stratification systems. We investigated the prognostic relevance of incomplete initial surgical clearance in patients with purely lymphogeneous metastatic PTC (pN1 M0) despite successful radioiodine therapy. Accurate assessment of pre-ablative nodal status was attempted using PET/CT studies with both 124I-NaI and 18F-FDG along with high-resolution cervical ultrasound. Methods Sixty-five patients with histologically diagnosed lymph node metastases (pN1 M0) were retrospectively analyzed. Patients with iodine-negative lymph node metastases diagnosed by 18F-FDG PET/CT or distant metastases were excluded from the analysis. The association of disease recurrence with the pre-ablative nodal status, as well as other baseline characteristics, were examined applying nonparametric tests for independent samples and multiple regression analysis. Patients with persistent lymph node metastases in 124I-NaI PET/CT were further divided according to the additional presence or absence of FDG-uptake in 18F-FDG PET/CT. Survival analyses were performed using Kaplan–Meier curves and the Cox proportional hazards model for uni- and multivariate analyses to assess the influence of prognostic factors on progression free survival (PFS). Results Incomplete metastatic lymph node resection captured by 124I-NaI PET/CT (n = 33) was an independent risk factor for recurrence (61 % vs 25 %, p = 0.006) and shorter PFS (46 months vs not reached, HR 4.0 [95 %-CI, 1.7–9.2], p = 0.001). Ultrasound could detect lymph node metastases only in 19/33 patients (58 %). Among patients with positive nodal status, FDG-avidity of metastatic iodine positive lymph nodes worsened the outcome (16 vs 69 months, p = 0.047). From all other investigated factors including age, N-stage (N1a vs N1b), and T-Stage (T4 vs T1-3), only large tumor size (pT4) had a significant impact on PFS (HR 2.9 [95 %-CI, 1.3–6.4], p = 0.007). Conclusions Incomplete initial surgical clearance of lymph node metastases even after successful radioiodine therapy may increase the chances of recurrence and is an independent risk factor for impaired survival of patients with PTC. Pre-ablative (dual tracer PET/CT) imaging with 124I-Na and 18F provides a prognostic tool for these patients and may considerably complement the current risk stratification systems.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3400-y
      Issue No: Vol. 43, No. 11 (2016)
  • 18F-fluorocholine versus 18F-fluorodeoxyglucose for PET/CT imaging in
           patients with suspected relapsing or progressive multiple myeloma: a pilot
    • Authors: Thibaut Cassou-Mounat; Sona Balogova; Valérie Nataf; Marie Calzada; Virginie Huchet; Khaldoun Kerrou; Jean-Yves Devaux; Mohamad Mohty; Jean-Noël Talbot; Laurent Garderet
      Pages: 1995 - 2004
      Abstract: Purpose Hybrid positron emission tomography/computed tomography (PET/CT) has now become available, as well as whole-body, low-dose multidetector row computed tomography (MDCT) or magnetic resonance imaging (MRI). The radioactive glucose analogue 18F-fluorodeoxyglucose (FDG) is the most widely used tracer but has a relatively low sensitivity in detecting multiple myeloma (MM). We compared FDG with a more recent metabolic tracer, 18F-fluorocholine (FCH), for the detection of MM lesions at time of disease relapse or progression. Methods We analyzed the results of FDG and FCH imaging in 21 MM patients undergoing PET/CT for suspected relapsing or progressive MM. For each patient and each tracer, an on-site reader and a masked reader independently determined the number of intraosseous and extraosseous foci of tracer and the intensity of uptake as measured by their SUVmax and the corresponding target/non-target ratio (T/NT). Results In the skeleton of 21 patients, no foci were found for two cases, uncountable foci were observed in four patients, including some mismatched FCH/FDG foci. In the 15 patients with countable bone foci, the on-site reader detected 72 FDG foci vs. 127 FCH foci (+76 %), whereas the masked reader detected 69 FDG foci vs. 121 FCH foci (+75 %), both differences being significant. Interobserver agreement on the total number of bone foci was very high, with a kappa coefficient of 0.81 for FDG and 0.89 for FCH. Measurement of uptake in the matched foci that took up both tracers revealed a significantly higher median SUVmax and T/NT for FCH vs. FDG. Almost all unmatched foci were FCH-positive FDG-negative (57/59 = 97 % on-site and 56/60 = 93 % on masked reading); they were more frequently observed than matched foci in the head and neck region. Conclusions These findings suggest that PET/CT performed for suspected relapsing or progressive MM would reveal more lesions when using FCH rather than FDG.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3392-7
      Issue No: Vol. 43, No. 11 (2016)
  • [ 68 Ga]NODAGA-RGD – Metabolic stability, biodistribution, and dosimetry
           data from patients with hepatocellular carcinoma and liver cirrhosis
    • Authors: Roland Haubner; Armin Finkenstedt; Armin Stegmayr; Christine Rangger; Clemens Decristoforo; Heinz Zoller; Irene J. Virgolini
      Pages: 2005 - 2013
      Abstract: Purpose This study was designed to determine safety, tolerability, and radiation burden of a [68Ga]NODAGA-RGD-PET for imaging integrin αvβ3 expression in patients with hepatocellular carcinoma (HCC) and liver cirrhosis. Moreover, metabolic stability and biokinetic data were compiled. Methods After injection of 154–184 MBq [68Ga]NODAGA-RGD three consecutive PET/CT scans were acquired starting 8.3 ± 2.1, 36.9 ± 2.8, and 75.1 ± 3.4 min after tracer injection. For metabolite analysis, blood and urine samples were analyzed by HPLC. For dosimetry studies, residence time VOIs were placed in the corresponding organs. The OLINDA/EXM program was used to estimate the absorbed radiation dose. Results The radiopharmaceutical was well tolerated and no drug-related adverse effects were observed. No metabolites could be detected in blood (30 and 60 min p.i.) and urine (60 min p.i.). [68Ga]NODAGA-RGD showed rapid and predominantly renal elimination. Background radioactivity in blood, intestine, lung, and muscle tissue was low (%ID/l 60 min p.i. was 0.56 ± 0.43, 0.54 ± 0.39, 0.22 ± 0.05, and 0.16 ± 0.8, respectively). The calculated effective dose was 21.5 ± 5.4 μSv/MBq, and the highest absorbed radiation dose was found for the urinary bladder wall (0.26 ± 0.09 mSv/MBq). No increased uptake of the tracer was found in HCC compared with the background liver tissue. Conclusions [68Ga]NODAGA-RGD uptake in the HCCs lesions was not sufficient to use this tracer for imaging these tumors. [68Ga]NODAGA-RGD was well tolerated and metabolically stable. Due to rapid renal excretion, background radioactivity was low in most of the body, resulting in low radiation burden and indicating the potential of [68Ga]NODAGA-RGD PET for non-invasive determination of integrin αvβ3 expression.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3396-3
      Issue No: Vol. 43, No. 11 (2016)
  • Potential role of 68 Ga-DOTATOC PET/CT in screening for pancreatic
           neuroendocrine tumour in patients with von Hippel-Lindau disease
    • Authors: Vikas Prasad; Nikolaus Tiling; Timm Denecke; Winfried Brenner; Ursula Plöckinger
      Pages: 2014 - 2020
      Abstract: Purpose Neuroendocrine tumours of the pancreas (pNET) are observed in 8 – 17 % of patients with von Hippel-Lindau disease (vHLD), and 11 – 20 % of these patients develop metastatic disease. MRI and CT have a very high resolution; however, their sensitivity and specificity for the detection of pNET amongst cystic lesions in the pancreas of vHLD patients are generally considered insufficient. In contrast, 68Ga-DOTATOC PET/CT demonstrates a high sensitivity for the diagnosis and staging of neuroendocrine tumours. In this study we investigated the potential role of 68Ga-DOTATOC PET/CT in screening of patients with vHLD. Method 68Ga-DOTATOC PET/three-phase contrast-enhanced CT was performed according to guidelines in all consecutive vHLD patients between January 2012 and November 2015. All patients underwent additional MRI imaging of the abdomen, spine, and head. Chromogranin A (CgA) was determined at the time of the PET/CT examination. A lesion seen on 68Ga-DOTATOC PET in the pancreas was defined as positive if the uptake was visually higher than in the surrounding tissues. Lesions were quantified using maximum SUV. Results Overall, 20 patients (8 men, 12 women; mean age 44.7 ± 11.1 years) were prospectively examined. Genetically, 12 patients had type 1 vHLD and 8 had type 2 vHLD. 68Ga-DOTATOC PET/CT detected more pNET than morphological imaging (CT or MRI): 11 patients (55 %; 8 type 1, 3 type 2) vs. 9 patients (45 %; 6 type 1, 3 type 2). The concentration of CgA was mildly elevated in 2 of 11 patients with pNET. The mean SUVmax of the pancreatic lesions was 18.9 ± 21.9 (range 5.0 – 65.6). Four patients (36.4 %) had multiple pNETs. The mean size of the lesions on CT and/or MRI was 10.4 ± 8.3 mm (range 4 – 38 mm), and 41.1 % were larger than 10 mm. In addition, somatostatin receptor-positive cerebellar and spinal haemangioblastomas were detected in three patients (SUVmax 2.1 – 10.1). One patient presented with a solitary somatostatin receptor-positive lymph node metastasis. pNETs were observed more frequently in vHLD type 1 than type 2 (66.7 % vs. 37.5 %, p = 0.089). None of the patients showed progressive disease during follow-up. Conclusion In this study, 68Ga-DOTATOC PET detected pNETs in a higher proportion of patients with vHLD than found in previous studies with 111In-octreoscan, the imaging method recommended by the NCCN. We therefore suggest 68Ga-DOTATOC PET/CT as the more sensible screening tool.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3421-6
      Issue No: Vol. 43, No. 11 (2016)
  • One registration multi-atlas-based pseudo-CT generation for attenuation
           correction in PET/MRI
    • Authors: Hossein Arabi; Habib Zaidi
      Pages: 2021 - 2035
      Abstract: Purpose The outcome of a detailed assessment of various strategies for atlas-based whole-body bone segmentation from magnetic resonance imaging (MRI) was exploited to select the optimal parameters and setting, with the aim of proposing a novel one-registration multi-atlas (ORMA) pseudo-CT generation approach. Methods The proposed approach consists of only one online registration between the target and reference images, regardless of the number of atlas images (N), while for the remaining atlas images, the pre-computed transformation matrices to the reference image are used to align them to the target image. The performance characteristics of the proposed method were evaluated and compared with conventional atlas-based attenuation map generation strategies (direct registration of the entire atlas images followed by voxel-wise weighting (VWW) and arithmetic averaging atlas fusion). To this end, four different positron emission tomography (PET) attenuation maps were generated via arithmetic averaging and VWW scheme using both direct registration and ORMA approaches as well as the 3-class attenuation map obtained from the Philips Ingenuity TF PET/MRI scanner commonly used in the clinical setting. The evaluation was performed based on the accuracy of extracted whole-body bones by the different attenuation maps and by quantitative analysis of resulting PET images compared to CT-based attenuation-corrected PET images serving as reference. Results The comparison of validation metrics regarding the accuracy of extracted bone using the different techniques demonstrated the superiority of the VWW atlas fusion algorithm achieving a Dice similarity measure of 0.82 ± 0.04 compared to arithmetic averaging atlas fusion (0.60 ± 0.02), which uses conventional direct registration. Application of the ORMA approach modestly compromised the accuracy, yielding a Dice similarity measure of 0.76 ± 0.05 for ORMA-VWW and 0.55 ± 0.03 for ORMA-averaging. The results of quantitative PET analysis followed the same trend with less significant differences in terms of SUV bias, whereas massive improvements were observed compared to PET images corrected for attenuation using the 3-class attenuation map. The maximum absolute bias achieved by VWW and VWW-ORMA methods was 06.4 ± 5.5 in the lung and 07.9 ± 4.8 in the bone, respectively. Conclusions The proposed algorithm is capable of generating decent attenuation maps. The quantitative analysis revealed a good correlation between PET images corrected for attenuation using the proposed pseudo-CT generation approach and the corresponding CT images. The computational time is reduced by a factor of 1/N at the expense of a modest decrease in quantitative accuracy, thus allowing us to achieve a reasonable compromise between computing time and quantitative performance.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3422-5
      Issue No: Vol. 43, No. 11 (2016)
  • Recommended administered activities for 68 Ga-labelled peptides in
           paediatric nuclear medicine
    • Authors: J. Soares Machado; S. Beykan; K. Herrmann; M. Lassmann
      Pages: 2036 - 2039
      Abstract: Purpose The aim of this study was to establish a method for determining administered activities for 68Ga-labelled peptides. Dose calculations were based on the weight-independent effective dose model proposed by the EANM paediatric dosage card for use in paediatric nuclear medicine. Methods Previously published time-integrated activity coefficients for 68Ga-DOTATATE, 68Ga-DOTATOC and 68Ga-pentixafor were used to calculate age-independent effective doses. Consequently, the corresponding weight-dependent effective dose coefficients were rescaled according to the formalism of the EANM dosage card to determine the radiopharmaceutical class of  68Ga-labelled peptides (“multiples”) and to calculate the baseline activities based on an upper limit for administered activity (185 MBq) in an adult. Results All calculated normalization factors suggest that the 68Ga-labelled peptides are class “B” radiopharmaceuticals. The baseline activity for all compounds is 12.8 MBq. In analogy to 18F-fluoride, we recommend a minimum activity of 14 MBq. Conclusion For paediatric nuclear medicine applications involving 68Ga-labelled peptides, we suggest determining administered activities based on the formalism proposed in this work. The corresponding effective doses from these procedures will remain age-independent.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-015-3289-x
      Issue No: Vol. 43, No. 11 (2016)
  • Cerebrospinal fluid lactate levels and brain [18F]FDG PET hypometabolism
           within the default mode network in Alzheimer’s disease
    • Authors: Claudio Liguori; Agostino Chiaravalloti; Giuseppe Sancesario; Alessandro Stefani; Giulia Maria Sancesario; Nicola Biagio Mercuri; Orazio Schillaci; Mariangela Pierantozzi
      Pages: 2040 - 2049
      Abstract: Purpose It has been suggested that neuronal energy metabolism may be involved in Alzheimer’s disease (AD). In this view, the finding of increased cerebrospinal fluid (CSF) lactate levels in AD patients has been considered the result of energetic metabolism dysfunction. Here, we investigated the relationship between neuronal energy metabolism, as measured via CSF lactate levels, and cerebral glucose metabolism, as stated at the 2-deoxy-2-(18F)fluoro-D-glucose positron emission tomography ([18F]FDG PET) in AD patients. Methods AD patients underwent lumbar puncture to measure CSF lactate levels and [18F]FDG PET to assess brain glucose metabolism. CSF and PET data were compared to controls. Since patients were studied at rest, we specifically investigated brain areas active in rest-condition owing to the Default Mode Network (DMN). We correlated the CSF lactate concentrations with the [18F]FDG PET data in brain areas owing to the DMN, using sex, age, disease duration, Mini Mental State Examination, and CSF levels of tau proteins and beta-amyloid as covariates. Results AD patients (n = 32) showed a significant increase of CSF lactate levels compared to Control 1 group (n = 28). They also showed brain glucose hypometabolism in the DMN areas compared to Control 2 group (n = 30). Within the AD group we found the significant correlation between increased CSF lactate levels and glucose hypometabolism in Broadman areas (BA) owing to left medial prefrontal cortex (BA10, mPFC), left orbitofrontal cortex (BA11, OFC), and left parahippocampal gyrus (BA 35, PHG). Conclusion We found high CSF levels of lactate and glucose hypometabolism within the DMN in AD patients. Moreover, we found a relationship linking the increased CSF lactate and the reduced glucose consumption in the left mPFC, OFC and PHG, owing to the anterior hub of DMN. These findings could suggest that neural glucose hypometabolism may affect the DMN efficiency in AD, also proposing the possible role of damaged brain energetic machine in impairing DMN.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3417-2
      Issue No: Vol. 43, No. 11 (2016)
  • Amyloid- and FDG-PET imaging in amyotrophic lateral sclerosis
    • Authors: Jordi A. Matías-Guiu; Vanesa Pytel; María Nieves Cabrera-Martín; Lucía Galán; María Valles-Salgado; Antonio Guerrero; Teresa Moreno-Ramos; Jorge Matías-Guiu; José Luis Carreras
      Pages: 2050 - 2060
      Abstract: Purpose We aimed to study brain metabolism and presence of beta-amyloid deposits using positron emission tomography (PET) in patients with amyotrophic lateral sclerosis (ALS). Methods This prospective cross-sectional study included 18 patients with definite or probable ALS according to the revised El Escorial diagnostic criteria, and 24 healthy controls. Patients underwent neurological and neuropsychological assessments, PET with 18F-fluorodeoxyglucose (FDG), and amyloid-PET with 18F-florbetaben. Results Patients with ALS showed hypometabolism in the frontal area and hypermetabolism in the cerebellum compared to healthy controls. Four patients (22 %) displayed cognitive impairment and decreased metabolism in the frontal area extending bilaterally to the parietal regions, and increased metabolism in the posterior area of the cerebellum. In patients with no cognitive impairment, metabolism was lower in the left superior frontal gyrus and higher in the anterior and posterior lobes of the cerebellum. In the individual analysis, six patients (35 %) displayed more anterior involvement with hypometabolism affecting the superior frontal, medial, and inferior gyri; six patients (35 %) exhibited a more posterior pattern with hypometabolism in the precentral and postcentral gyri and in the superior and inferior parietal lobules; two patients (11 %) showed a mixed pattern; and three patients (17 %) showed no alterations in brain metabolism. Three (16 %) showed increased 18F-florbetaben uptake compared to controls. Conclusions We have identified two main patterns of brain metabolism with an association to cognitive status. Only a subgroup of patients showed an increased uptake of the amyloid tracer. Our results suggest that ALS is heterogeneous from a clinical, metabolic, and molecular standpoint.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3434-1
      Issue No: Vol. 43, No. 11 (2016)
  • A PET/CT approach to spinal cord metabolism in amyotrophic lateral
    • Authors: Cecilia Marini; Angelina Cistaro; Cristina Campi; Andrea Calvo; Claudia Caponnetto; Flavio Mariano Nobili; Piercarlo Fania; Mauro C. Beltrametti; Cristina Moglia; Giovanni Novi; Ambra Buschiazzo; Annalisa Perasso; Antonio Canosa; Carlo Scialò; Elena Pomposelli; Anna Maria Massone; Maria Caludia Bagnara; Stefania Cammarosano; Paolo Bruzzi; Silvia Morbelli; Gianmario Sambuceti; Gianluigi Mancardi; Michele Piana; Adriano Chiò
      Pages: 2061 - 2071
      Abstract: Purpose In amyotrophic lateral sclerosis, functional alterations within the brain have been intensively assessed, while progression of lower motor neuron damage has scarcely been defined. The aim of the present study was to develop a computational method to systematically evaluate spinal cord metabolism as a tool to monitor disease mechanisms. Methods A new computational three-dimensional method to extract the spinal cord from 18F-FDG PET/CT images was evaluated in 30 patients with spinal onset amyotrophic lateral sclerosis and 30 controls. The algorithm identified the skeleton on the CT images by using an extension of the Hough transform and then extracted the spinal canal and the spinal cord. In these regions, 18F-FDG standardized uptake values were measured to estimate the metabolic activity of the spinal canal and cord. Measurements were performed in the cervical and dorsal spine and normalized to the corresponding value in the liver. Results Uptake of 18F-FDG in the spinal cord was significantly higher in patients than in controls (p < 0.05). By contrast, no significant differences were observed in spinal cord and spinal canal volumes between the two groups. 18F-FDG uptake was completely independent of age, gender, degree of functional impairment, disease duration and riluzole treatment. Kaplan-Meier analysis showed a higher mortality rate in patients with standardized uptake values above the fifth decile at the 3-year follow-up evaluation (log-rank test, p < 0.01). The independence of this value was confirmed by multivariate Cox analysis. Conclusion Our computational three-dimensional method enabled the evaluation of spinal cord metabolism and volume and might represent a potential new window onto the pathophysiology of amyotrophic lateral sclerosis.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3440-3
      Issue No: Vol. 43, No. 11 (2016)
  • Current knowledge on the sensitivity of the 68 Ga-somatostatin receptor
           positron emission tomography and the SUV max reference range for
           management of pancreatic neuroendocrine tumours
    • Authors: Irene Virgolini; Michael Gabriel; Alexander Kroiss; Elisabeth von Guggenberg; Rupert Prommegger; Boris Warwitz; Bernhard Nilica; llanos Geraldo Roig; Margarida Rodrigues; Christian Uprimny
      Pages: 2072 - 2083
      Abstract: Abstract Physiologically increased pancreatic uptake at the head/uncinate process is observed in more than one-third of patients after injection of one of the three 68Ga-labelled octreotide-based peptides used for somatostatin (sst) receptor (r) imaging. There are minor differences between these 68Ga-sstr-binding peptides in the imaging setting. On 68Ga-sstr-imaging the physiological uptake can be diffuse or focal and usually remains stable over time. Differences in the maximal standardised uptake values (SUVmax) reported for the normal pancreas as well as for pancreatic neuroendocrine tumour (PNET) lesions may be related to several factors, including (a) differences in the peptide binding affinities as well as differences in sstr subtype expression of pancreatic α- and β-cells, and heterogeneity / density of tumour cells, (b) differences in scanner resolution, image reconstruction techniques and acquisition protocols, (c) mostly retrospective study designs, (d) mixed patient populations, or (e) interference with medications such as treatment with long-acting sst analogues. The major limitation in most of the studies lies in the lack of histopathological confirmation of abnormal findings. There is a significant overlap between the calculated SUVmax-values for physiological pancreas and PNET-lesions of the head/uncinate process that do not favour the use of quantitative parameters in the clinical setting. Anecdotal long-term follow-up studies have even indicated that increased uptake in the head/uncinate process still can turn out to be malignant over years of follow up. SUVmax-data for the pancreatic body and tail are limited. Therefore, any visible focal tracer uptake in the pancreas must be considered as suspicious for malignancy irrespective of quantitative parameters. In general, sstr-PET/CT has significant implications for the management of NET patients leading to a change in treatment decision in about one-third of patients. Therefore, follow-up with 68Ga-sstr-PET/CT is mandatory in the clinical setting if uptake in the head/uncinate process is observed.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3395-4
      Issue No: Vol. 43, No. 11 (2016)
  • Clinical utility of F-18 FDG PET-CT in the initial evaluation of lung
    • Authors: Poul Henning Madsen; Paw Christian Holdgaard; Janne Buck Christensen; Poul Flemming Høilund-Carlsen
      Pages: 2084 - 2097
      Abstract: Purpose Positron emission tomography-computed tomography (PET-CT) is a resource-demanding imaging modality with increasing popularity in the workup of patients with suspected or proven lung cancer. Methods To review the clinical usefulness of this imaging modality in the diagnosis, staging, and pre-operative evaluation, we conducted a systematic literature search, review, and quality assessment using the rapid evidence assessment toolkit and the Oxford Centre for Evidence-Based Medicine methodology. The literature search resulted in 4,208 records including 918 reviews, of which 139 met the predefined criteria and were read in full to identify relevant original articles on F-18 FDG PET-CT (1) in the evaluation of solitary pulmonary nodules (n = 14), (2) in curative-intent treatment trials (n = 9), and (3) in planning of invasive procedures (n = 18). Results We found the following important results from the literature review: PET-CT can rule out malignancy in most solitary pulmonary nodules due to high sensitivity (recommendation level A). PET-CT reduces the number of futile treatment trials (recommendation level A). The sensitivity of PET-CT in general is insufficient to rule out mediastinal lymph node metastasis (recommendation level A). Conclusions ᅟ With few exceptions, solitary pulmonary nodules can safely be considered benign if the PET-CT scan is negative. Exceptions consist of small (<1 cm) and non-solid, solitary pulmonary nodules. These abnormalities should be followed up by CT in a structured programme. No curative-intent treatment should be commenced until a PET-CT scan has excluded occult distant metastases. In general, lymph node metastasis in the mediastinum cannot be ruled out on the basis of a negative PET-CT, and confirmative invasive staging should be performed in most patients before mediastinal metastasis is confirmed or ruled out.
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3407-4
      Issue No: Vol. 43, No. 11 (2016)
  • Interest of multi-modal imaging in bilateral lesions of basal ganglia: A
           case report of a post-anoxic dystonia
    • Authors: Pierre-Maxime David; Nicolas Icard; Jean-Yves Gauvrit; Marc Vérin; Florence Le Jeune
      Pages: 2098 - 2099
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3413-6
      Issue No: Vol. 43, No. 11 (2016)
  • Ik-Kyung Jang (Ed): Cardiovascular OCT Imaging
    • Authors: Valeria Gaudieri; Luigi Mansi
      Pages: 2100 - 2100
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3410-9
      Issue No: Vol. 43, No. 11 (2016)
  • 2016 Young Investigators Meeting
    • Pages: 2101 - 2101
      PubDate: 2016-10-01
      DOI: 10.1007/s00259-016-3472-8
      Issue No: Vol. 43, No. 11 (2016)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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Fax: +00 44 (0)131 4513327
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