FDG-PET in Chimeric Antigen Receptor T-Cell (CAR T-Cell) Therapy Toxicity: A Systematic Review.

The utilization of chimeric antigen receptor (CAR) T-cell therapy to target cluster of differentiation (CD)19 in cancer immunotherapy has been a recent and significant advancement. Although this approach is highly specific and selective, it is not without complications. Therefore, a systematic review was conducted to assess the current state of positron emission tomography (PET) in evaluating the adverse effects induced by CAR T-cell therapy. A thorough search of relevant articles was performed in databases such as PubMed, Scopus, and Web of Science up until March 2024. Two reviewers independently selected articles and extracted data, which was then organized and categorized using Microsoft Excel. The risk of bias and methodological quality was assessed. In total, 18 articles were examined, involving a total of 753 patients, in this study. A wide range of utilities were analyzed, including predictive, correlative, and diagnostic utilities. While positive outcomes were observed in all the mentioned areas, quantitative analysis of the included studies was hindered by their heterogeneity and use of varying PET-derived parameters. This study offers a pioneering exploration of this promising field, with the goal of encouraging further and more focused research in upcoming clinical trials.

The Diagnostic Value of Fibroblast Activation Protein Imaging in Hepatocellular Carcinoma and Cholangiocellular Carcinoma.

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy with worldwide high incidence and mortality. In more than 90% of cases, HCC arise from a cirrhotic liver that is mostly induced by viral diseases and especially in developed countries alcoholic steatohepatitis and non-alcoholic steatohepatitis. In contrast, cholangiocellular carcinoma (CCC) is a very rare cancer entity with a high mortality due to insidious onset. The only curative option for both cancer entities is a timely and definitive surgical therapy, which mandates an accurate early diagnosis. To this end, [18F]FDG PET/CT scan could demonstrate only little benefit, as there is an unmet clinical need for an alternative, pan-cancer agent for initial diagnostic work-up of CCC or evaluation of Milan criteria for HCC patients.

Diagnostic accuracy of fine needle aspiration biopsy versus postoperative histopathology for diagnosing thyroid malignancy.

INTRODUCTION: Ultrasound-guided fine needle aspiration biopsy (FNAB) is currently widely used for the initial screening of patients with thyroid nodules enabling prevention of unnecessary surgery. The purpose of this study was to retrospectively analyse the diagnostic accuracy of thyroid FNAB compared with postoperative histopathology of a large cohort from Azerbaijan. METHODS: We evaluated the FNAB results of 738 patients who underwent thyroid surgery at the National Centre of Oncology in Azerbaijan. The measures of diagnostic accuracy were calculated for the ultrasound-guided preoperative FNAB results (based on the six diagnostic categories of the Bethesda classification) compared with postoperative histopathologic results (benign or malignant) for correspondent areas. RESULTS: Considering both DC V and DC VI categories (387 cases) as 'cytologic-positive' and DC II category (72 cases) as 'cytologic-negative', we found 14 false-positive and 10 false-negative results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 97.4%, 86.1%, 96.4%, 81.6% and 94.8%, respectively. Conversely, when considering only the DC VI category as 'cytologic-positive', the sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNA were 93.2%, 100%, 100%, 81.6% and 97.1%, respectively. CONCLUSIONS: The results of our cohort demonstrated high levels of diagnostic accuracy, supporting FNAB's role as a reliable diagnostic tool in the preoperative evaluation of thyroid nodules. The sensitivity, specificity, NPV, PPV and accuracy of thyroid FNAB in our institution were comparable with those of other institutions.

Diagnostic Performance and Clinical Impact of 68Ga-PSMA-11 PET/CT Imaging in Early Relapsed Prostate Cancer After Radical Therapy: A Prospective Multicenter Study (IAEA-PSMA Study).

Biochemical recurrence (BCR) is a clinical challenge in prostate cancer (PCa) patients, as recurrence localization guides subsequent therapies. The use of PET with prostate-specific membrane antigen (PSMA) provides better accuracy than conventional imaging practice. This prospective, multicenter, international study was performed to evaluate the diagnostic performance and clinical impact of PSMA PET/CT for evaluating BCR in PCa patients in a worldwide scenario. Methods: Patients were recruited from 17 centers in 15 countries. Inclusion criteria were histopathologically proven prostate adenocarcinoma, previous primary treatment, clinically established BCR, and negative conventional imaging (CT plus bone scintigraphy) and MRI results for patients with PSA levels of 4-10 ng/mL. All patients underwent PET/CT scanning with 68Ga-PSMA-11. Images and data were centrally reviewed. Multivariate logistic regression analysis was applied to identify the independent predictors of PSMA-positive results. Variables were selected for this regression model on the basis of significant associations in the univariate analysis and previous clinical knowledge: Gleason score, the PSA level at the time of the PET scan, PSA doubling time, and primary treatment strategy. All patients were monitored for a minimum of 6 mo. Results: From a total of 1,004 patients, 77.7% were treated initially with radical prostatectomy and 22.3% were treated with radiotherapy. Overall, 65.1% had positive PSMA PET/CT results. PSMA PET/CT positivity was correlated with the Gleason score, PSA level at the time of the PET scan, PSA doubling time, and radiotherapy as the primary treatment (P < 0.001). Treatment was modified on the basis of PSMA PET/CT results in 56.8% of patients. PSMA PET/CT positivity rates were consistent and not statistically different among countries with different incomes. Conclusion: This multicenter, international, prospective trial of PSMA PET/CT confirmed its capability for detecting local and metastatic recurrence in most PCa patients in the setting of BCR. PSMA PET/CT positivity was correlated with the Gleason score, PSA level at the time of the PET scan, PSA doubling time, and radiotherapy as the primary treatment. PSMA PET/CT results led to changes in therapeutic management in more than half of the cohort. The study demonstrated the reliability and worldwide feasibility of PSMA PET/CT in the workup of PCa patients with BCR.

The value of [68Ga]Ga-DOTA-TATE PET/CT in diagnosis and management of suspected pituitary tumors.

BACKGROUND: Gallium 68-tetraazacyclododecane-tetraacetic acid-octreotate ([68Ga]Ga-DOTA-TATE) is a selective somatostatin analogue ligand, which shows increased affinity for somatostatin receptor subtype (SSTR) 2 and has been used routinely for imaging neuroendocrine tumors with PET/CT. We investigated the utility of [68Ga]Ga-DOTA-TATE positron emission tomography/computed tomography (PET/CT) in patients with suspected pituitary pathology. We reviewed imaging for twenty consecutive patients (8 men, 12 women, mean age of 48.2, range 14-78) with suspected pituitary pathology who were referred for [68Ga]Ga-DOTA-TATE PET/CT. RESULTS: Nine patients presented with recurrent Cushing's syndrome following surgical resection of pituitary adenomas due to recurrent Cushing's disease (seven patients) and ectopic ACTH secreting tumor (2 patients). All seven patients with recurrent Cushing's disease showed positive pituitary [68Ga]Ga-DOTA-TATE uptake while both cases of ectopic hormonal secretion had absented pituitary uptake. In 1 of these 2 patients, [68Ga]Ga-DOTA-TATE was able to localize the source of ectopic ACTH tumor. Six patients presented de novo with Cushing's due to ectopic ACTH secretion; [68Ga]Ga-DOTA-TATE PET/CT was able to localize ectopic tumors in six of eight patients (3 lungs, 2 pancreases, 1 mid-gut) There was high uptake [68Ga]Ga-DOTA-TATE in 3 cases of recurrent central hyperthyroidism (SUVmax 6.6-14.3) and 2 cases of prolactinoma (SUVmax 5.5 and 11.3). CONCLUSION: Absent [68Ga]Ga-DOTA-TATE activity in the pituitary fossa is useful in excluding pituitary disease in recurrent Cushing's. Recurrent pituitary thyrotropinomas and prolactinomas showed moderate to high pituitary activity. In addition, in Cushing's syndrome, [68Ga]Ga-DOTA-TATE is useful for detection of ectopic sources of ACTH production, especially where anatomic imaging is negative.

The use of multiparametric 18F-fluoro-L-3,4-dihydroxy-phenylalanine PET/MRI in post-therapy assessment of patients with gliomas.

PURPOSE: To determine the utility of F-fluoro-L-3,4-dihydroxy-phenylalanine (F-DOPA) PET/MRI versus cross-sectional MRI alone in glioma response assessment and identify whether the two techniques demonstrate different tumour features. METHODS: F-DOPA PET/MRI studies from 40 patients were analysed. Quantitative PET parameters and conventional MRI features were recorded. Tumour volume was assessed on both PET and MRI. Using dynamic susceptibility contrast perfusion-weighted imaging, maps of cerebral blood flow (CBF) and cerebral blood volume (CBV) were obtained. Within volume of tumours of tumour features and normal-appearing white matter (NAWM) drawn on MRI, standardised uptake value (SUV)max, CBF and CBV were recorded. Presence of residual active tumour was assessed by qualitative visual assessment. Receiver operating characteristic analysis was performed univariately and on parameter combination to analyse ability to determine presence/absence of disease. Reference standard for presence of viable tissue was biopsy or clinical follow-up. RESULTS: Median SUVmax was 3.4 for low-grade glioma (LGG) and 3.3 for high-grade glioma (HGG). There was a significant correlation between PWI parameters and WHO grade (P < 0.001), but no correlation with SUVmax. Median F-DOPA volume was 8216.88 mm for HGG and 6284.94 mm for LGG; MRI volume was 6316.57 mm and 5931.55 mm, respectively. SUVmax analysis distinguished enhancing and nonenhancing components from necrosis and NAWM and demonstrated active disease in nonenhancing regions. Visually, the modalities were concordant in 37 patients. Combining the multiparametric PET/MRI approach with all available data-enhanced detection of the presence of tumour (area under the curve 0.99, P < 0.01). CONCLUSION: MRI and F-DOPA are complementary modalities for assessment of tumour burden. Matching F-DOPA and MRI in assessing residual tumour volume may better delineate the radiotherapy target volume.

The impact of Ga-68 DOTATATE PET/CT imaging on management of patients with paragangliomas.

OBJECTIVE: Paragangliomas are rare tumours of neural crest origin that express high levels of somatostatin receptor. Ga-68 DOTATATE PET/CT is a widely accepted method for imaging of neuroendocrine tumours. This study was performed to review a Ga-68 DOTATATE PET/CT patient database and to establish the impact of the modality on patient treatment. METHODS: Demographic data, imaging data and change in management after Ga-68 DOTATATE PET/CT were evaluated. RESULTS: Ga-68 DOTATATE PET/CT scans were performed in 21 patients in whom paragangliomas had been confirmed after biopsy or surgery and in one patient with suspected paraganglioma. In most patients, the primary site was the organ of Zuckerkandl (12/22). Of the 22 Ga-68 DOTATATE PET/CT scans completed, 19 (86.4%) were positive and three (13.6%) negative. In 12 of 14 recurrent cases (90.9%), the treatment plan was changed after the Ga-68 DOTATATE PET/CT scan owing to new, unexpected findings, while it remained unchanged in two (9.1%). Regarding the change in treatment plan, in most instances the new treatment comprised peptide receptor radionuclide therapy (PRRT). CONCLUSION: Ga-68 DOTATATE PET/CT findings led to a change in the scheduled treatment plan in 90.9% of patients with suspected recurrence. The most frequent change consisted in initiation of PRRT due to disease recurrence or progression or detection of multiple metastases.

Metastatic Insulinoma Controlled by Targeted Radionuclide Therapy With 177Lu-DOTATATE in a Patient With Solitary Kidney and MEN-1 Syndrome.

A 54-year-old man with multiple endocrine neoplasia type 1 had previous history of parathyroid surgery and left thyroid lobectomy 5 years earlier, and was referred for recurrent hypoglycemic episodes. Ga-DOTATATE PET/CT had showed multiple lesions in the right lung, liver, and pancreas. Biopsy from pancreas revealed low-grade neuroendocrine neoplasia. After 2 fractions of Lu-DOTATATE therapy, the size of lesions and its activity reduced on the Ga-DOTATATE scan and the hypoglycemic episodes manifested every day have scaled down to 1 time over 1-year follow-up. Herein, we report a case of malignant insulinoma successfully treated with radiolabeled somatostatin receptor therapy using Lu-DOTATATE.

The use of 18F-FDG PET ratios in the differential diagnosis of common malignant brain tumors.

OBJECTIVE: This study examined the use of positron emission tomography (PET) ratios to improve the diagnostic ability of 18F-FDG PET/computed tomography (CT) in the differentiation of enhancing brain metastases, central nervous system lymphomas, and gliomas. MATERIALS AND METHODS: Seventy-six patients with malignant brain tumors and available magnetic resonance imaging and PET/CT examinations were included. RESULTS: Among standardized uptake value (SUV)-related parameters tested, tumor maximum SUV to ipsilateral cortex maximum SUV ratio (Tmax:WMimax) and maximum SUV (SUVmax) proved to be the two most valuable parameters for differential diagnosis. CONCLUSION: In addition to SUVmax, Tmax:WMimax also seems to provide helpful information for the differential diagnosis of lymphomas from other malignant brain tumors.

The use of (68)Ga DOTATATE PET/CT for diagnostic assessment and monitoring of (177)Lu DOTATATE therapy in pituitary carcinoma.

A 68-year-old man, with a history of pituitary surgery and radiation therapy for pituitary macroadenoma 20 years earlier, presented with a pituitary mass and enlarging lesions within the posterior fossa and spinal canal. Biopsy revealed low-grade pituitary carcinoma. PET/CT scan showed multiple foci of increased Ga DOTATATE activity including pituitary and posterior fossa lesions. After 3 fractions of Lu DOTATATE therapy, the tumor remained stable over 4 years on MRI and Ga DOTATATE scans. This case illustrates the benefit of Ga DOTATATE PET/CT in malignant pituitary disease to assess potential for somatostatin receptor therapy with Lu DOTATATE and monitor treatment.

Radiation accidents and their management: emphasis on the role of nuclear medicine professionals.

Large-scale radiation accidents are few in number, but those that have occurred have subsequently led to strict regulation in most countries. Here, different accident scenarios involving exposure to radiation have been reviewed. A triage of injured persons has been summarized and guidance on management has been provided in accordance with the early symptoms. Types of casualty to be expected in atomic blasts have been discussed. Management at the scene of an accident has been described, with explanation of the role of the radiation protection officer, the nature of contaminants, and monitoring for surface contamination. Methods for early diagnosis of radiation injuries have been then described. The need for individualization of treatment according to the nature and grade of the combined injuries has been emphasized, and different approaches to the treatment of internal contamination have been presented. The role of nuclear medicine professionals, including physicians and physicists, has been reviewed. It has been concluded that the management of radiation accidents is a very challenging process and that nuclear medicine physicians have to be well organized in order to deliver suitable management in any type of radiation accident.

Evaluation of neck pain with (18)F-NaF PET/CT.

AIM: (18)F-Sodium fluoride ((18)F-NaF) PET/computed tomography (CT) has improved spatial resolution in the cervical spine compared with single photon emission computed tomography/CT techniques using traditional tracers. Limited data are available, however, on its effectiveness in the management of the symptomatic cervical spine, and the aim of this study was therefore to elucidate this issue. PATIENTS AND METHODS: A retrospective study was carried out between April 2011 and April 2012. Across this period, 66 patients were referred to the department for the assessment of neck pain, of whom 58 were included in the study. (18)F-NaF was used as the tracer and images were acquired on an integrated PET/CT scanner. All studies were evaluated by either consultant nuclear medicine physicians or by a radiologist. Two consultant neurosurgeons correlated the imaging reports with the clinical data from the patient notes to give an overall impression as to how beneficial the test had been with regard to patient management. RESULTS: In 49/58 (84.5%) cases, the (18)F-NaF PET/CT report was thought to have been clinically useful in patient management. In 9/58 (15.5%) cases, the report was thought not to have been clinically beneficial, generally because of high background vertebral uptake of (18)F-fluoride secondary to degenerative disease. CONCLUSION: As our experience with (18)F-NaF PET/CT broadens, we believe that it will become an increasingly important tool in the evaluation and management of the symptomatic cervical spine.