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Publisher: Springer-Verlag   (Total: 2290 journals)

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Dialectical Anthropology     Hybrid Journal   (Followers: 8, SJR: 0.314, h-index: 9)
Die Weltwirtschaft     Hybrid Journal   (Followers: 2)
Differential Equations     Hybrid Journal   (Followers: 2, SJR: 0.364, h-index: 15)
Differential Equations and Dynamical Systems     Hybrid Journal   (Followers: 1, SJR: 0.63, h-index: 7)
Digestive Diseases and Sciences     Hybrid Journal   (Followers: 5, SJR: 1.19, h-index: 89)
Directieve therapie     Hybrid Journal  
Discrete & Computational Geometry     Hybrid Journal   (Followers: 2, SJR: 1.269, h-index: 40)
Discrete Event Dynamic Systems     Hybrid Journal   (Followers: 2, SJR: 0.42, h-index: 32)
Distributed and Parallel Databases     Hybrid Journal   (Followers: 4, SJR: 0.766, h-index: 30)
Distributed Computing     Hybrid Journal   (Followers: 2, SJR: 1.41, h-index: 31)
DNP - Der Neurologe und Psychiater     Full-text available via subscription  
Documenta Ophthalmologica     Hybrid Journal   (Followers: 2, SJR: 0.946, h-index: 40)
Doklady Biochemistry and Biophysics     Hybrid Journal   (Followers: 2, SJR: 0.2, h-index: 10)
Doklady Biological Sciences     Hybrid Journal   (SJR: 0.248, h-index: 10)
Doklady Botanical Sciences     Hybrid Journal  
Doklady Chemistry     Hybrid Journal   (SJR: 0.272, h-index: 12)
Doklady Earth Sciences     Hybrid Journal   (SJR: 0.48, h-index: 17)
Doklady Mathematics     Hybrid Journal   (SJR: 0.345, h-index: 13)
Doklady Physical Chemistry     Hybrid Journal   (SJR: 0.299, h-index: 12)
Doklady Physics     Hybrid Journal   (Followers: 1, SJR: 0.293, h-index: 17)
Douleur et Analg├ęsie     Hybrid Journal   (SJR: 0.113, h-index: 6)
Drug Delivery and Translational Research     Hybrid Journal   (Followers: 2, SJR: 0.607, h-index: 8)
Drug Safety - Case Reports     Open Access  
Drugs : Real World Outcomes     Hybrid Journal   (Followers: 1)
Dynamic Games and Applications     Hybrid Journal   (Followers: 2, SJR: 0.481, h-index: 5)
Dysphagia     Hybrid Journal   (Followers: 83, SJR: 0.822, h-index: 52)
e & i Elektrotechnik und Informationstechnik     Hybrid Journal   (Followers: 9, SJR: 0.279, h-index: 9)
e-Neuroforum     Hybrid Journal  
Early Childhood Education J.     Hybrid Journal   (Followers: 14, SJR: 0.466, h-index: 16)
Earth Science Informatics     Hybrid Journal   (Followers: 3, SJR: 0.282, h-index: 7)
Earth, Moon, and Planets     Hybrid Journal   (Followers: 7, SJR: 0.303, h-index: 29)
Earthquake Engineering and Engineering Vibration     Hybrid Journal   (Followers: 7, SJR: 0.482, h-index: 21)
Earthquake Science     Hybrid Journal   (Followers: 8, SJR: 0.418, h-index: 9)
East Asia     Hybrid Journal   (Followers: 7, SJR: 0.18, h-index: 9)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 9, SJR: 0.362, h-index: 27)
EcoHealth     Hybrid Journal   (Followers: 2, SJR: 0.88, h-index: 26)
Ecological Research     Hybrid Journal   (Followers: 8, SJR: 0.847, h-index: 43)
Economia e Politica Industriale     Hybrid Journal  
Economia Politica     Hybrid Journal   (SJR: 0.375, h-index: 6)
Economic Botany     Hybrid Journal   (Followers: 8, SJR: 0.527, h-index: 44)
Economic Bulletin     Hybrid Journal   (Followers: 4)
Economic Change and Restructuring     Hybrid Journal   (Followers: 1, SJR: 0.264, h-index: 9)
Economic Theory     Hybrid Journal   (Followers: 9, SJR: 2.557, h-index: 34)
Economic Theory Bulletin     Hybrid Journal   (Followers: 2)
Economics of Governance     Hybrid Journal   (Followers: 2, SJR: 0.408, h-index: 14)
Ecosystems     Hybrid Journal   (Followers: 19, SJR: 1.909, h-index: 93)
Ecotoxicology     Hybrid Journal   (Followers: 9, SJR: 1.333, h-index: 56)
Education and Information Technologies     Hybrid Journal   (Followers: 79, SJR: 0.366, h-index: 16)
Educational Assessment, Evaluation and Accountability     Hybrid Journal   (Followers: 19, SJR: 0.374, h-index: 15)
Educational Psychology Review     Hybrid Journal   (Followers: 17, SJR: 2.776, h-index: 61)
Educational Research for Policy and Practice     Hybrid Journal   (Followers: 8, SJR: 0.273, h-index: 9)
Educational Studies in Mathematics     Hybrid Journal   (Followers: 11, SJR: 0.825, h-index: 32)
Educational Technology Research and Development     Partially Free   (Followers: 71, SJR: 1.785, h-index: 52)
Electrical Engineering     Hybrid Journal   (Followers: 15, SJR: 0.336, h-index: 18)
Electrocatalysis     Hybrid Journal   (SJR: 0.883, h-index: 10)
Electronic Commerce Research     Hybrid Journal   (Followers: 3, SJR: 0.582, h-index: 16)
Electronic Markets     Hybrid Journal   (Followers: 5, SJR: 0.411, h-index: 8)
Electronic Materials Letters     Hybrid Journal   (Followers: 3, SJR: 1.407, h-index: 15)
Elemente der Mathematik     Hybrid Journal   (Followers: 1)
Emergency Radiology     Hybrid Journal   (Followers: 4, SJR: 0.678, h-index: 25)
Emission Control Science and Technology     Hybrid Journal   (Followers: 1)
Empirica     Hybrid Journal   (Followers: 3, SJR: 0.319, h-index: 16)
Empirical Economics     Hybrid Journal   (Followers: 8, SJR: 0.489, h-index: 31)
Empirical Software Engineering     Hybrid Journal   (Followers: 7, SJR: 1.285, h-index: 39)
Employee Responsibilities and Rights J.     Hybrid Journal   (Followers: 3, SJR: 0.361, h-index: 15)
Endocrine     Hybrid Journal   (Followers: 6, SJR: 0.878, h-index: 57)
Endocrine Pathology     Hybrid Journal   (Followers: 2, SJR: 0.638, h-index: 31)
Energy Efficiency     Hybrid Journal   (Followers: 12, SJR: 0.732, h-index: 14)
Energy Systems     Hybrid Journal   (Followers: 11, SJR: 1.176, h-index: 7)
Engineering With Computers     Hybrid Journal   (Followers: 5, SJR: 0.433, h-index: 30)
Entomological Review     Hybrid Journal   (Followers: 3, SJR: 0.144, h-index: 5)
Environment Systems & Decisions     Hybrid Journal   (Followers: 2)
Environment, Development and Sustainability     Hybrid Journal   (Followers: 29, SJR: 0.419, h-index: 29)
Environmental and Ecological Statistics     Hybrid Journal   (Followers: 5, SJR: 0.458, h-index: 32)
Environmental and Resource Economics     Hybrid Journal   (Followers: 17, SJR: 1.632, h-index: 54)
Environmental Biology of Fishes     Hybrid Journal   (Followers: 4, SJR: 0.725, h-index: 58)
Environmental Chemistry Letters     Hybrid Journal   (Followers: 2, SJR: 0.741, h-index: 28)
Environmental Earth Sciences     Hybrid Journal   (Followers: 12, SJR: 0.724, h-index: 63)
Environmental Economics and Policy Studies     Hybrid Journal   (Followers: 5, SJR: 0.524, h-index: 4)
Environmental Evidence     Open Access   (Followers: 1)
Environmental Fluid Mechanics     Hybrid Journal   (Followers: 2, SJR: 0.437, h-index: 24)
Environmental Geochemistry and Health     Hybrid Journal   (Followers: 2, SJR: 1.013, h-index: 36)
Environmental Geology     Hybrid Journal   (Followers: 11)
Environmental Health and Preventive Medicine     Hybrid Journal   (Followers: 3, SJR: 0.522, h-index: 19)
Environmental Management     Hybrid Journal   (Followers: 32, SJR: 0.942, h-index: 66)
Environmental Modeling & Assessment     Hybrid Journal   (Followers: 10, SJR: 0.533, h-index: 31)
Environmental Monitoring and Assessment     Hybrid Journal   (Followers: 9, SJR: 0.685, h-index: 52)
Environmental Science and Pollution Research     Hybrid Journal   (Followers: 14, SJR: 0.885, h-index: 46)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 4, SJR: 1.4, h-index: 17)
Epileptic Disorders     Hybrid Journal   (SJR: 0.608, h-index: 38)
EPJ A - Hadrons and Nuclei     Hybrid Journal   (Followers: 1, SJR: 1.287, h-index: 63)
EPJ B - Condensed Matter and Complex Systems     Hybrid Journal   (Followers: 2, SJR: 0.731, h-index: 89)
EPJ direct     Hybrid Journal  
EPJ E - Soft Matter and Biological Physics     Hybrid Journal   (Followers: 1, SJR: 0.641, h-index: 62)
EPMA J.     Open Access   (SJR: 0.284, h-index: 6)
ERA-Forum     Hybrid Journal   (Followers: 2, SJR: 0.128, h-index: 3)
Erkenntnis     Hybrid Journal   (Followers: 13, SJR: 0.621, h-index: 16)
Erwerbs-Obstbau     Hybrid Journal   (SJR: 0.206, h-index: 9)
Esophagus     Hybrid Journal   (SJR: 0.311, h-index: 10)
Estuaries and Coasts     Hybrid Journal   (Followers: 6, SJR: 1.332, h-index: 67)

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Journal Cover   European Journal of Nuclear Medicine and Molecular Imaging
  [SJR: 2.056]   [H-I: 118]   [7 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  [2290 journals]
  • Very high coronary artery calcium score with normal myocardial perfusion
           SPECT imaging is associated with a moderate incidence of severe coronary
           artery disease
    • Abstract: Purpose Myocardial perfusion imaging (MPI) has limitations in the presence of balanced multivessel disease (MVD) and left main (LM) coronary artery disease, occasionally resulting in false-normal results despite the high cardiovascular risk associated with this condition. The purpose of this study was to assess the incidence of severe coronary artery disease (CAD) in the presence of a very high Agatston coronary artery calcium (CAC) score (>1,000) in stable symptomatic patients without known CAD but with normal MPI results. Methods A total of 2,659 prospectively acquired consecutive patients were referred for MPI and evaluation of CAC score by CT. Of this patient population, 8 % (222/2,659) had ischemia without myocardial infarction (MI) on MPIand 11 % (298/2,659) had abnormal MPI (MI and/or ischemia). On presentation 1 % of the patients (26/2,659) were symptomatic, had a CAC score >1,000 and normal MPI results. The definition of normal MPI was strict and included a normal hemodynamic response without ischemic ECG changes and normal imaging, particularly absence of transient ischemic dilation. All of these 26 patients with a CAC score >1,000 and normal MPI findings underwent cardiac catheterization. Results Of these 26 patients, 58 % (15/26) had severe disease (≥70 % stenosis) leading to revascularization. Of this group, 47 % (7/15) underwent percutaneous intervention, and 53 % (8/15) underwent coronary artery bypass grafting. All of these 15 patients had either MVD (14/15) or LM coronary artery disease (1/15), and represented 0.6 % (15/2,659) of all referred patients (95 % CI 0.3 – 0.9 %). The majority, 90 % (8/9), had severe CAD with typical chest pain. Conclusion A very high CAC score (>1,000) with normal MPI in a small subset of symptomatically stable patients was associated with a moderate incidence of severe CAD (95 % CI 37 – 77 %). Larger studies and/or a meta-analysis of small studies are needed to more precisely estimate the incidence of CAD in this population. This study also supports the concept that a normal MPI result in patients with severe CAD may be due to balanced MVD.
      PubDate: 2015-07-04
       
  • Amyloid PET in European and North American cohorts; and exploring age as a
           limit to clinical use of amyloid imaging
    • Abstract: Purpose Several radiotracers that bind to fibrillar amyloid-beta in the brain have been developed and used in various patient cohorts. This study aimed to investigate the comparability of two amyloid positron emission tomography (PET) tracers as well as examine how age affects the discriminative properties of amyloid PET imaging. Methods Fifty-one healthy controls (HCs), 72 patients with mild cognitive impairment (MCI) and 90 patients with Alzheimer’s disease (AD) from a European cohort were scanned with [11C]Pittsburgh compound-B (PIB) and compared with an age-, sex- and disease severity-matched population of 51 HC, 72 MCI and 84 AD patients from a North American cohort who were scanned with [18F]Florbetapir. An additional North American population of 246 HC, 342 MCI and 138 AD patients with a Florbetapir scan was split by age (55–75 vs 76–93 y) into groups matched for gender and disease severity. PET template-based analyses were used to quantify regional tracer uptake. Results The mean regional uptake patterns were similar and strong correlations were found between the two tracers across the regions of interest in HC (ρ = 0.671, p = 0.02), amyloid-positive MCI (ρ = 0.902, p < 0.001) and AD patients (ρ = 0.853, p < 0.001). The application of the Florbetapir cut-off point resulted in a higher proportion of amyloid-positive HC and a lower proportion of amyloid-positive AD patients in the older group (28 and 30 %, respectively) than in the younger group (19 and 20 %, respectively). Conclusions These results illustrate the comparability of Florbetapir and PIB in unrelated but matched patient populations. The role of amyloid PET imaging becomes increasingly important with increasing age in the diagnostic assessment of clinically impaired patients.
      PubDate: 2015-07-02
       
  • Repeatability of hypoxia PET imaging using [ 18 F]HX4 in lung and head and
           neck cancer patients: a prospective multicenter trial
    • Abstract: Purpose Hypoxia is an important factor influencing tumor progression and treatment efficacy. The aim of this study was to investigate the repeatability of hypoxia PET imaging with [18F]HX4 in patients with head and neck and lung cancer. Methods Nine patients with lung cancer and ten with head and neck cancer were included in the analysis (NCT01075399). Two sequential pretreatment [18F]HX4 PET/CT scans were acquired within 1 week. The maximal and mean standardized uptake values (SUVmax and SUVmean) were defined and the tumor-to-background ratios (TBR) were calculated. In addition, hypoxic volumes were determined as the volume of the tumor with a TBR >1.2 (HV1.2). Bland Altman analysis of the uptake parameters was performed and coefficients of repeatability were calculated. To evaluate the spatial repeatability of the uptake, the PET/CT images were registered and a voxel-wise comparison of the uptake was performed, providing a correlation coefficient. Results All parameters of [18F]HX4 uptake were significantly correlated between scans: SUVmax (r = 0.958, p < 0.001), SUVmean (r = 0.946, p < 0.001), TBRmax (r = 0.962, p < 0.001) and HV1.2 (r = 0.995, p < 0.001). The relative coefficients of repeatability were 15 % (SUVmean), 17 % (SUVmax) and 17 % (TBRmax). Voxel-wise analysis of the spatial uptake pattern within the tumors provided an average correlation of 0.65 ± 0.14. Conclusion Repeated hypoxia PET scans with [18F]HX4 provide reproducible and spatially stable results in patients with head and neck cancer and patients with lung cancer. [18F]HX4 PET imaging can be used to assess the hypoxic status of tumors and has the potential to aid hypoxia-targeted treatments.
      PubDate: 2015-07-02
       
  • 18  F-Alfatide II PET/CT in healthy human volunteers and patients
           with brain metastases
    • Abstract: Purpose We report the biodistribution and radiation dosimetry of an integrin αvβ3 specific PET tracer 18 F-AlF-NOTA-E[PEG4-c(RGDfk)]2) (denoted as 18 F-Alfatide II). We also assessed the value of 18 F-Alfatide II in patients with brain metastases. Methods A series of torso (from the skull to the thigh) static images were acquired in five healthy volunteers (3 M, 2 F) at 5, 10, 15, 30, 45, and 60 min after injection of 18 F-Alfatide II (257 ± 48 MBq). Regions of interest (ROIs) were drawn manually, and the time-activity curves (TACs) were obtained for major organs. Nine patients with brain metastases were examined by static PET imaging with 18 F-FDG (5.55 MBq/kg) and 18 F-Alfatide II. Results Injection of 18 F-Alfatide II was well tolerated in all healthy volunteers, with no serious tracer-related adverse events found. 18 F-Alfatide II showed rapid clearance from the blood pool and kidneys. The total effective dose equivalent (EDE) and effective dose (ED) were 0.0277 ± 0.003 mSv/MBq and 0.0198 ± 0.002 mSv/MBq, respectively. The organs with the highest absorbed dose were the kidneys and the spleen. Nine patients with 20 brain metastatic lesions identified by MRI and/or CT were enrolled in this study. All 20 brain lesions were visualized by 18 F-Alfatide II PET, while only ten lesions were visualized by 18 F-FDG, and 13 by CT. Conclusion F-Alfatide II is a safe PET tracer with a favorable dosimetry profile. The observed ED suggests that 18 F-Alfatide II is feasible for human studies. 18 F-Alfatide II has potential value in finding brain metastases of different cancers as a biomarker of angiogenesis.
      PubDate: 2015-07-01
       
  • Specific efficacy of peptide receptor radionuclide therapy with 177
           Lu-octreotate in advanced neuroendocrine tumours of the small intestine
    • Abstract: Purpose Increasing evidence supports the value of peptide receptor radionuclide therapy (PRRT) in patients with metastatic neuroendocrine tumours (NET), but there are limited data on its specific efficacy in NET of small intestinal (midgut) origin. This study aims to define the benefit of PRRT with 177Lu-octreotate for this circumscribed entity derived by a uniformly treated patient cohort. Methods A total of 61 consecutive patients with unresectable, advanced small intestinal NET G1–2 stage IV treated with 177Lu-octreotate (4 intended cycles at 3-month intervals, mean activity per cycle 7.9 GBq) were analysed. Sufficient tumour uptake on baseline receptor imaging and either documented tumour progression (n = 46) or uncontrolled symptoms (n = 15) were prerequisites for treatment. Response was evaluated according to modified Southwest Oncology Group (SWOG) criteria and additionally with Response Criteria in Solid Tumors (RECIST) 1.1. Assessment of survival was performed using Kaplan-Meier curves and Cox proportional hazards model for uni- and multivariate analyses. Toxicity was assessed according to standardized follow-up laboratory work-up including blood counts, liver and renal function, supplemented with serial 99mTc-diethylenetriaminepentaacetic acid (DTPA) clearance measurements. Results The median follow-up period was 62 months. Reversible haematotoxicity (≥ grade 3) occurred in five patients (8.2 %). No significant nephrotoxicity (≥ grade 3) was observed. Treatment response according to modified SWOG criteria consisted of partial response in 8 (13.1 %), minor response in 19 (31.1 %), stable disease in 29 (47.5 %) and progressive disease in 5 (8.2 %) patients. The disease control rate was 91.8 %. Median progression-free survival (PFS) and overall survival (OS) was 33 [95 % confidence interval (CI) 25–41] and 61 months (95 % CI NA), respectively. Objective response was associated with longer survival (p = 0.005). Independent predictors of shorter PFS were functionality [hazard ratio (HR) 2.1, 95 % CI 1.0–4.5, p = 0.05] and high plasma chromogranin A (CgA) levels > 600 ng/ml (HR 2.9, 95 % CI 1.5–5.5, p < 0.001) at baseline. Conclusion PRRT is well tolerated and very effective in advanced well-differentiated small intestinal (midgut) NET. A high disease control rate and long PFS can be achieved with this modality after failure of standard biotherapy with somatostatin analogues. Tumour functionality and high plasma CgA appear to be independent predictors of unfavourable patient outcome.
      PubDate: 2015-07-01
       
  • Defining a rational step-care algorithm for managing thyroid carcinoma
           patients with elevated thyroglobulin and negative on radioiodine
           scintigraphy (TENIS): considerations and challenges towards developing an
           appropriate roadmap
    • PubDate: 2015-07-01
       
  • Thoracic staging of non-small-cell lung cancer using integrated 18 F-FDG
           PET/MR imaging: diagnostic value of different MR sequences
    • Abstract: Purpose To compare the accuracy of different MR sequences in simultaneous PET/MR imaging for T staging in non-small-cell lung cancer in relation to histopathology. Methods The study included 28 patients who underwent dedicated thoracic PET/MR imaging before tumour resection. Local tumour staging was performed separately by three readers with each of the following MR sequences together with PET: transverse T2 BLADE, transverse non-enhanced and contrast-enhanced T1 FLASH, T1 3D Dixon VIBE in transverse and coronal orientation, coronal T2 HASTE, and coronal TrueFISP. The staging results were compared with histopathology after resection as the reference standard. Differences in the accuracy of T staging among the MR sequences were evaluated using McNemar’s test. Due to multiple testing, Bonferroni correction was applied to prevent accumulation of α errors; p < 0.0024 was considered statistically significant. Results Compared with histopathology, T-staging accuracy was 69 % with T2 BLADE, 68 % with T2 HASTE, 59 % with contrast-enhanced T1 FLASH, 57 % with TrueFISP, 50 % with non-enhanced T1 FLASH, and 45 % and 48 % with T1 3D Dixon VIBE in transverse and coronal orientation, respectively. Staging accuracy with T2 BLADE was significantly higher than with non-enhanced T1 FLASH and with T1 3D Dixon VIBE in transverse and coronal orientations (p < 0.0024). T2 HASTE had a significantly higher T-staging accuracy than transverse T1 3D-Dixon-VIBE (p < 0.0024). Conclusion Transverse T2 BLADE images provide the highest accuracy for local tumour staging and should therefore be included in dedicated thoracic PET/MR protocols. As T1 3D Dixon VIBE images acquired for attenuation correction performed significantly worse, this sequence cannot be considered sufficiently accurate for local tumour staging in the thorax.
      PubDate: 2015-07-01
       
  • 131 I treatment for thyroid cancer and the risk of developing salivary and
           lacrimal gland dysfunction and a second primary malignancy: a nationwide
           population-based cohort study
    • Abstract: Objective The aim of this study was to determine the prevalence of salivary and lacrimal gland dysfunction and a second primary malignancy in patients from Taiwan with thyroid cancer after radioiodine therapy. Methods This nationwide population-based cohort study was based on data obtained from the Taiwan National Health Insurance Database from 2000 to 2011. A total of 1,834 thyroid cancer patients treated with 131I therapy and 1,834 controls (thyroid cancer without 131I therapy) selected by 1:1 matching on a propensity score were enrolled. The cumulative 131I dose in each patient was calculated. A Cox proportional hazards model was applied to estimate the effect of radiation from the 131I therapy on the risk of salivary and lacrimal gland impairment as well as second primary malignancies in terms of hazard ratios (HRs) and 95 % confidence intervals (CIs). Results In patients treated with 131I therapy and in controls, the incidence rates of salivary gland dysfunction were 6.76 and 1.01 per 10,000 person-years, respectively (HR 6.81, 95 % CI 0.74 – 55.3), the incidence rates of keratoconjunctivitis sicca (KCS) were 13.6 and 16.3 per 10,000 person-years, respectively (HR 0.84, 95 % CI 0.41 – 1.73), and the incidence rates of second primary malignancy were 76.7 and 62.4 per 10,000 person-years, respectively (HR 1.23, 95 % CI 0.88 – 1.72). The risk of salivary secretion impairment significantly increased with increasing administered doses (HR 14.3, 95 % CI 1.73 – 119.0). However, there was no increase in the incidence of KCS or secondary cancer in patients treated with higher doses. Conclusion 131I therapy insignificantly increased the risk of salivary gland dysfunction and second primary malignancy. In patients with higher cumulative doses, an increase in the incidence of salivary gland dysfunction was observed. By contrast, we did not find an association between 131I treatment and KCS development.
      PubDate: 2015-07-01
       
  • Peptide receptor radionuclide therapy with 90 Y/ 177 Lu-labelled peptides
           for inoperable head and neck paragangliomas (glomus tumours)
    • Abstract: Purpose Head and neck paragangliomas (HNPGLs) are rare tumours arising from autonomic nervous system ganglia. Although surgery offers the best chance of complete cure, there is associated morbidity due to the crucial location of these tumours. Radiotherapy arrests tumour growth and provides symptomatic improvement, but has long-term consequences. These tumours express somatostatin receptors (SSTR) and hence peptide receptor radionuclide therapy (PRRT) is now a treatment option. We assessed the molecular, morphological and clinical responses of inoperable HNPGLs to PRRT. Methods Nine patients with inoperable HNPGL assessed between June 2006 and June 2014 were included. Four patients had a solitary lesion, four had multifocal involvement and one had distant metastases (bone and lungs). The patients were treated with PRRT using 90Y/177Lu-labelled peptides after positive confirmation of SSTR expression on 68Ga-DOTATOC PET/CT. All patients received two to four courses of PRRT. Subsequent serial imaging with 68Ga-DOTATOC PET/CT was carried out every 6 months to assess response to treatment. Clinical (symptomatic) response was also assessed. Results Based on molecular response (EORTC) criteria, four of the nine patients showed a partial molecular response to treatment seen as significant decreases in SUVmax, accompanied by a reduction in tumour size. Five patients showed stable disease on both molecular and morphological criteria. Six out of nine patients were symptomatic at presentation with manifestations of cranial nerve involvement, bone destruction at the primary site and metastatic bone pain. Molecular responses were correlated with symptomatic improvement in four out of these six patients; while two patients showed small reductions in tumour size and SUVmax. The three asymptomatic patients showed no new lesions or symptomatic worsening. Conclusion PRRT was effective in all patients, with no disease worsening seen, either in the form of neurological symptoms or distant spread. Though these are preliminary results, PRRT shows promise as a good treatment option for HNPGL, and hence study in a larger patient cohort is essential to establish its place in the management algorithm.
      PubDate: 2015-07-01
       
  • Radioembolization with 90 Y-loaded microspheres: high clinical impact of
           treatment simulation with MAA-based dosimetry
    • PubDate: 2015-07-01
       
  • Role of perfusion SPECT in prediction and measurement of pulmonary
           complications after radiotherapy for lung cancer
    • Abstract: Purpose The purpose of the study was to evaluate the ability of baseline perfusion defect score (DS) on SPECT to predict the development of severe symptomatic radiation pneumonitis (RP) and to evaluate changes in perfusion on SPECT as a method of lung perfusion function assessment after curative radiotherapy (RT) for non-small-cell lung cancer (NSCLC). Methods Patients with NSCLC undergoing curative RT were included prospectively. Perfusion SPECT/CT and global pulmonary function tests (PFT) were performed before RT and four times during follow-up. Functional activity on SPECT was measured using a semiquantitative perfusion DS. Pulmonary morbidity was graded by the National Cancer Institute’s Common Terminology Criteria for Adverse Events version 4 for pneumonitis. Patients were divided into two groups according to the severity of RP. Results A total of 71 consecutive patients were included in the study. Baseline DS was associated with chronic obstructive pulmonary disease. A significant inverse correlation was found between baseline DS and forced expiratory volume in 1 s and diffusing capacity of the lung for carbon monoxide. Patients with severe RP had significantly higher baseline total lung DS (mean 5.43) than those with no or mild symptoms (mean DS 3.96, p < 0.01). PFT results were not different between these two groups. The odds ratio for total lung DS was 7.8 (95 % CI 1.9 – 31) demonstrating the ability of this parameter to predict severe RP. Adjustment for other potential confounders known to be associated with increased risk of RP was performed and did not change the odds ratio. The median follow-up time after RT was 8.4 months. The largest DS increase of 13.3 % was associated with severe RP at 3 months of follow-up (p < 0.01). The development of severe RP during follow-up was not associated with changes in PFT results. Conclusion Perfusion SPECT is a valuable method for predicting severe RP and for assessing changes in regional functional perfusion after curative RT comparable with global PFT.
      PubDate: 2015-07-01
       
  • Usefulness of MRI-assisted metabolic volumetric parameters provided by
           simultaneous 18 F-fluorocholine PET/MRI for primary prostate cancer
           characterization
    • Abstract: Purpose The aim of this study was to determine the usefulness of MRI-assisted positron emission tomography (PET) parameters provided by simultaneous 18F-fluorocholine (FCH) PET/MRI for characterization of primary prostate cancer. Methods Thirty patients with localized prostate cancer (mean age 69.4 ± 6.7 years) confirmed by biopsy were prospectively enrolled for simultaneous PET/MRI imaging. The patients underwent 18F-FCH PET/MRI 1 week before undergoing total prostatectomy. Multiple parameters of diffusion-weighted MRI [minimum and mean apparent diffusion coefficient (ADCmin and ADCmean)], metabolic PET [maximum and mean standardized uptake value (SUVmax and SUVmean)], and metabolic volumetric PET [metabolic tumor volume (MTV) and uptake volume product (UVP)] were compared with laboratory, pathologic, and immunohistochemical (IHC) features of the prostate cancer specimen. PET parameters were divided into two categories as follows: volume of interest (VOI) of prostate by SUV cutoff 2.5 (SUVmax, SUVmean, MTVSUV, and UVPSUV) and MRI-assisted VOI of prostate cancer (SUVmaxMRI, SUVmeanMRI, MTVMRI, and UVPMRI). Results The rates of prostate cancer-positive cases identified by MRI alone, 18F-FCH PET alone, and 18F-FCH PET/MRI were 83.3, 80.0, and 93.3 %, respectively. Among the multiple PET/MRI parameters, MTVMRI showed fair correlation with serum prostate-specific antigen (PSA; r = 0.442, p = 0.014) and highest correlation with tumor volume (r = 0.953, p < 0.001). UVPMRI showed highest correlation with serum PSA (r = 0.531, p = 0.003), good correlation with tumor volume (r = 0.908, p < 0.001), and it was significantly associated with Gleason score (p = 0.041). High MTVMRI and UVPMRI values were significant for perineural invasion, lymphatic invasion, extracapsular extension, seminal vesicle invasion, and positive B-cell lymphoma 2 (Bcl-2) expression (all p < 0.05). Conclusion Simultaneous 18F-FCH PET/MRI demonstrated a better diagnostic value for localized prostate cancer detection than each individual modality. MRI-assisted metabolic volumetric PET parameters (MTVMRI and UVPMRI) provided more accurate characterization of prostate cancer than conventional PET and MRI parameters.
      PubDate: 2015-07-01
       
  • ImmunoPET of tissue factor expression in triple-negative breast cancer
           with a radiolabeled antibody Fab fragment
    • Abstract: Purpose To date, there is no effective therapy for triple-negative breast cancer (TNBC), which has a dismal clinical outcome. Upregulation of tissue factor (TF) expression leads to increased patient morbidity and mortality in many solid tumor types, including TNBC. Our goal was to employ the Fab fragment of ALT-836, a chimeric anti-human TF mAb, for PET imaging of TNBC, which can be used to guide future TNBC therapy. Methods ALT-836-Fab was generated by enzymatic papain digestion. SDS-PAGE and FACS studies were performed to evaluate the integrity and TF binding affinity of ALT-836-Fab before NOTA conjugation and 64Cu-labeling. Serial PET imaging and biodistribution studies were carried out to evaluate the tumor targeting efficacy and pharmacokinetics in the MDA-MB-231 TNBC model, which expresses high levels of TF on the tumor cells. Blocking studies, histological assessment, as well as RT-PCR were performed to confirm TF specificity of 64Cu-NOTA-ALT-836-Fab. Results ALT-836-Fab was produced with high purity, which exhibited superb TF binding affinity and specificity. Serial PET imaging revealed rapid and persistent tumor uptake of 64Cu-NOTA-ALT-836-Fab (5.1 ± 0.5 %ID/g at 24 h post-injection; n = 4) and high tumor/muscle ratio (7.0 ± 1.2 at 24 h post-injection; n = 4), several-fold higher than that of the blocking group and tumor models that do not express significant level of TF, which was confirmed by biodistribution studies. TF specificity of the tracer was also validated by histology and RT-PCR. Conclusion 64Cu-NOTA-ALT-836-Fab exhibited prominent tissue factor targeting efficiency in MDA-MB-231 TNBC model. The use of a Fab fragment led to fast tumor uptake and good tissue/muscle ratio, which may be translated into same-day immunoPET imaging in the clinical setting to improve TNBC patient management.
      PubDate: 2015-07-01
       
  • Towards tailored radiopeptide therapy
    • Abstract: Purpose Somatostatin receptor-targeted radiopeptide therapy is commonly performed using single radioisotopes. We evaluated the benefits and harms of combining radioisotopes in radiopeptide therapy in patients with neuroendocrine tumor. Methods Using multivariable-adjusted survival analyses and competing risk analyses we evaluated outcomes in patients with neuroendocrine tumor receiving 90Y-DOTATOC, 177Lu-DOTATOC or their combination. Results 90Y-DOTATOC plus 177Lu-DOTATOC treatment was associated with longer survival than 90Y-DOTATOC (66.1 vs. 47.5 months; n = 1,358; p < 0.001) or 177Lu-DOTATOC alone (66.1 vs. 45.5 months; n = 390; p < 0.001). 177Lu-DOTATOC was associated with longer survival than 90Y-DOTATOC in patients with solitary lesions (HR 0.3, range 0.1 – 0.7; n = 153; p = 0.005), extrahepatic metastases (HR 0.5, range 0.3 – 0.9; n = 256; p = 0.029) and metastases with low uptake (HR 0.1, range 0.05 – 0.4; n = 113; p = 0.001). 90Y-DOTATOC induced higher hematotoxicity rates than combined treatment (9.5 % vs. 4.0 %, p = 0.005) or 177Lu-DOTATOC (9.5 % vs. 1.4 %, p = 0.002). Renal toxicity was similar among the treatments. Conclusions Using 90Y and 177Lu might facilitate tailoring radiopeptide therapy and improve survival in patients with neuroendocrine tumors.
      PubDate: 2015-07-01
       
  • 18 F-Fluorocholine PET/CT for early response assessment in patients with
           
    • Abstract: Purpose We investigated the role of 18F-methylcholine (FCH) PET/CT in the early evaluation of patients with metastatic castration-resistant prostate cancer (mCRPC) treated with enzalutamide. Methods The study group comprised 36 patients with a median age of 72 years (range 48–90 years) who were treated with enzalutamide 160 mg once daily after at least one chemotherapeutic regimen with docetaxel. Patients were evaluated monthly for serological prostate-specific antigen (PSA) response. FCH PET/CT was performed at baseline and repeated after 3–6 weeks. Univariate and multivariate Cox regression models addressed potential predictors of progression-free survival (PFS) and overall survival (OS). Results At a median follow-up of 24.2 months (range 1.8–27.3 months), 34 patients were evaluable for early FCH PET/CT evaluation of response, and of these 17 showed progressive disease (PD) and 17 had stable disease or a partial response. A decrease in PSA level of more than 50 % was observed in 21 patients. Early FCH PET/CT PD predicted radiological PD 3 months in advance of CT in 12 of 18 patients (66 %) and was discordant with the decrease in PSA level in 13 patients. In 6 of these, biochemical PD was confirmed in 2 months. In multivariate analysis, only decrease in PSA level and FCH PET/CT were significant predictors of PFS (p = 0.0005 and p = 0.029, respectively), whereas decrease in PSA level alone was predictive of OS (p = 0.007). Conclusion This is one of the first studies to evaluate the role of FCH PET/CT as an early predictor of outcome in mCRPC patients treated with enzalutamide. Our preliminary results suggest that the combination of FCH PET/CT and decrease in PSA level could be a valid tool to predict PFS in mCRPC patients. PSA remains the single most important prognostic factor, while FCH PET/CT does not add more information on OS beyond that obtained from PSA. Further studies in larger populations are needed to confirm these data and to clarify the role of FCH PET/CT in predicting response to enzalutamide in mCRPC patients.
      PubDate: 2015-07-01
       
  • Endotracheal metastasis from colorectal cancer
    • PubDate: 2015-07-01
       
  • V/P SPECT as a diagnostic tool for pregnant women with suspected pulmonary
           embolism
    • Abstract: Purpose The purpose of the study was to assess the prevalence of pulmonary embolism (PE) and other lung diseases among pregnant women with suspected PE and to calculate the radiation exposure to patient and fetus in this population. As a secondary aim, we evaluated the negative predictive value of a normal ventilation/perfusion single photon emission computed tomography (V/P SPECT) examination in pregnancy. Methods We studied all 127 pregnant women who had suspected PE and had undergone V/P SPECT at our institution in the course of a 5-year period. Radiation exposure to patient and fetus and the negative predictive value of a normal V/P SPECT examination were also measured. Results V/P SPECT identified PE in 11 women (9 %). Moreover, in 15 women (12 %) the examination revealed pneumonia (in 2 cases in addition to PE) and in 1 woman signs of airway obstruction were revealed. Among the 116/127 women (91 %) where PE was ruled out by V/P SPECT, none was diagnosed subsequently with PE or deep venous thrombosis (DVT) during the same pregnancy or puerperal period. For P SPECT, the calculated fetal absorbed dose was < 0.6 mGy,and the calculated breast absorbed dose 0.6 mGy. For V SPECT, the calculated fetal absorbed dose was < 0.014 mGy and the breast absorbed dose 0.25 mGy. Conclusion The prevalence of PE was low (9 %) among pregnant women with suspected disease. Pneumonia was diagnosed in 12 % of patients. The negative predictive value of V/P SPECT was high, and the radiation exposure from V/P SPECT was low both for fetus and patient.
      PubDate: 2015-07-01
       
  • Erratum to: 18 F-Fluorocholine PET/CT for early response assessment in
           patients with metastatic castration-resistant prostate cancer treated with
           enzalutamide
    • PubDate: 2015-07-01
       
  • FDG PET/CT for bone and soft-tissue biopsy
    • PubDate: 2015-07-01
       
  • Joseph F. Quinn (ed): Neurology in Practice: Dementia
    • PubDate: 2015-07-01
       
 
 
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