Journal of Clinical Medicine

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12 pages, 3189 KiB

Open AccessArticle

Turbo Gradient and Spin-Echo BLADE-DWI for Extraocular Muscles in Thyroid-Associated Ophthalmopathy

by Qing Fu, Dingxi Liu, Hui Ma, Kun Zhou, Ting Yin, Chuansheng Zheng and Ziqiao Lei

J. Clin. Med. 2023, 12(1), 344; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12010344 - 1 Jan 2023

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Abstract

Purpose: To investigate feasibility and diagnostic performance of turbo gradient and spin-echo BLADE (proprietary name for Periodically Rotated Overlapping ParallEL Lines with Enhanced Reconstruction [PROPELLER] in Siemens MR systems)-diffusion weighted imaging (TGSE-BLADE-DWI) for depicting extraocular muscle (EOM) involvement and activity in thyroid-associated ophthalmopathy [...] Read more.

Purpose: To investigate feasibility and diagnostic performance of turbo gradient and spin-echo BLADE (proprietary name for Periodically Rotated Overlapping ParallEL Lines with Enhanced Reconstruction [PROPELLER] in Siemens MR systems)-diffusion weighted imaging (TGSE-BLADE-DWI) for depicting extraocular muscle (EOM) involvement and activity in thyroid-associated ophthalmopathy (TAO), and to compare TGSE-BLADE-DWI with readout-segmented echo-planar imaging (RESOLVE). Materials and methods: Thirty-five patients with identified TAO underwent the two DWI scans. Two radiologists visually scored the image quality of the two DWIs with respect to the susceptibility artifacts and geometric distortions on a three-point scale. The maximum size (Size_max) of EOMs and corresponding ADCs (cADCs) of each patient were compared between the active and inactive phases. The clinical activity score (CAS) was used as a reference to assess the diagnostic performance of EOM ADCs for grading TAO activity. ROC analysis, Pearson correlation, and Wilcoxon signed-rank test were used for statistical analyses. Results: For scores of EOMs, the image quality of TGSE-BLADE-DWI was significantly higher than that of RESOLVE. There were no statistically significant differences between the AUCs of the two DWIs, Size_max, or cADCs between the active and inactive phases. TGSE-BLADE-DWI ADCs were significantly higher than the RESOLVE ADCs in the right superior rectus, right lateral rectus, left superior rectus, and left inferior rectus. There were no statistically significant correlations between the cADC or Size_max, and CAS. The highest AUC was 0.697 for RESOLVE and 0.657 for TGSE-BLADE-DWI. The best performing ADC threshold was 1.85 × 10⁻³ mm²/s with 85.7% sensitivity, 58.8% specificity and 66.67% accuracy for RESOLVE and 1.99 × 10⁻³ mm²/s with 79.0% sensitivity, and 55.6% specificity and 65.27% accuracy for TGSE-BLADE-DWI. Conclusion: Compared to RESOLVE, TGSE-BLADE-DWI provided improved image quality with fewer susceptibility artifacts and geometric distortions for EOM visualization and showed an equivalent performance in detecting active TAO. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM - Nuclear Medicine & Radiology)

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19 pages, 4424 KiB

Open AccessArticle

A Framework of Analysis to Facilitate the Harmonization of Multicenter Radiomic Features in Prostate Cancer

by Rossana Castaldo, Valentina Brancato, Carlo Cavaliere, Francesco Trama, Ester Illiano, Elisabetta Costantini, Alfonso Ragozzino, Marco Salvatore, Emanuele Nicolai and Monica Franzese

J. Clin. Med. 2023, 12(1), 140; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12010140 - 24 Dec 2022

Cited by 4 | Viewed by 1758

Abstract

Pooling radiomic features coming from different centers in a statistical framework is challenging due to the variability in scanner models, acquisition protocols, and reconstruction settings. To remove technical variability, commonly called batch effects, different statistical harmonization strategies have been widely used in genomics [...] Read more.

Pooling radiomic features coming from different centers in a statistical framework is challenging due to the variability in scanner models, acquisition protocols, and reconstruction settings. To remove technical variability, commonly called batch effects, different statistical harmonization strategies have been widely used in genomics but less considered in radiomics. The aim of this work was to develop a framework of analysis to facilitate the harmonization of multicenter radiomic features extracted from prostate T2-weighted magnetic resonance imaging (MRI) and to improve the power of radiomics for prostate cancer (PCa) management in order to develop robust non-invasive biomarkers translating into clinical practice. To remove technical variability and correct for batch effects, we investigated four different statistical methods (ComBat, SVA, Arsynseq, and mixed effect). The proposed approaches were evaluated using a dataset of 210 prostate cancer (PCa) patients from two centers. The impacts of the different statistical approaches were evaluated by principal component analysis and classification methods (LogitBoost, random forest, K-nearest neighbors, and decision tree). The ComBat method outperformed all other methods by achieving 70% accuracy and 78% AUC with the random forest method to automatically classify patients affected by PCa. The proposed statistical framework enabled us to define and develop a standardized pipeline of analysis to harmonize multicenter T2W radiomic features, yielding great promise to support PCa clinical practice. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM - Nuclear Medicine & Radiology)

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18 pages, 3899 KiB

Open AccessArticle

A Head-to-Head Comparison of ¹⁸F-Fluorocholine PET/CT and Conventional MRI as Predictors of Outcome in IDH Wild-Type High-Grade Gliomas

by Ana María Garcia Vicente, Julián Pérez-Beteta, Mariano Amo-Salas, Jesús J. Bosque, Edel Noriega-Álvarez, Ángel María Soriano Castrejon and Víctor M. Pérez-García

J. Clin. Med. 2022, 11(20), 6065; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11206065 - 14 Oct 2022

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Abstract

(1) Aim: To study the associations between imaging parameters derived from contrast-enhanced MRI (CE-MRI) and ¹⁸F-fluorocholine PET/CT and their performance as prognostic predictors in isocitrate dehydrogenase wild-type (IDH-wt) high-grade gliomas. (2) Methods: A prospective, multicenter study (FuMeGA: Functional and Metabolic Glioma Analysis) [...] Read more.

(1) Aim: To study the associations between imaging parameters derived from contrast-enhanced MRI (CE-MRI) and ¹⁸F-fluorocholine PET/CT and their performance as prognostic predictors in isocitrate dehydrogenase wild-type (IDH-wt) high-grade gliomas. (2) Methods: A prospective, multicenter study (FuMeGA: Functional and Metabolic Glioma Analysis) including patients with baseline CE-MRI and ¹⁸F-fluorocholine PET/CT and IDH wild-type high-grade gliomas. Clinical variables such as performance status, extent of surgery and adjuvant treatments (Stupp protocol vs others) were obtained and used to discriminate overall survival (OS) and progression-free survival (PFS) as end points. Multilesionality was assessed on the visual analysis of PET/CT and CE-MRI images. After tumor segmentation, standardized uptake value (SUV)-based variables for PET/CT and volume-based and geometrical variables for PET/CT and CE-MRI were calculated. The relationships among imaging techniques variables and their association with prognosis were evaluated using Pearson’s chi-square test and the t-test. Receiver operator characteristic, Kaplan–Meier and Cox regression were used for the survival analysis. (3) Results: 54 patients were assessed. The median PFS and OS were 5 and 11 months, respectively. Significant strong relationships between volume-dependent variables obtained from PET/CT and CE-MRI were found (r > 0.750, p < 0.05). For OS, significant associations were found with SUVmax, SUVpeak, SUVmean and sphericity (HR: 1.17, p = 0.035; HR: 1.24, p = 0.042; HR: 1.62, p = 0.040 and HR: 0.8, p = 0.022, respectively). Among clinical variables, only Stupp protocol and age showed significant associations with OS and PFS. No CE-MRI derived variables showed significant association with prognosis. In multivariate analysis, age (HR: 1.04, p = 0.002), Stupp protocol (HR: 2.81, p = 0.001), multilesionality (HR: 2.20, p = 0.013) and sphericity (HR: 0.79, p = 0.027) derived from PET/CT showed independent associations with OS. For PFS, only age (HR: 1.03, p = 0.021) and treatment protocol (HR: 2.20, p = 0.008) were significant predictors. (4) Conclusions: ¹⁸F-fluorocholine PET/CT metabolic and radiomic variables were robust prognostic predictors in patients with IDH-wt high-grade gliomas, outperforming CE-MRI derived variables. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM - Nuclear Medicine & Radiology)

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Review

Jump to: Research

20 pages, 1744 KiB

Open AccessReview

Microspheres as a Carrier System for Therapeutic Embolization Procedures: Achievements and Advances

by Mick. M. Welling, Nikolas Duszenko, Maarten P. van Meerbeek, Tom J. M. Molenaar, Tessa Buckle, Fijs W. B. van Leeuwen and Daphne D. D. Rietbergen

J. Clin. Med. 2023, 12(3), 918; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12030918 - 24 Jan 2023

Cited by 5 | Viewed by 2581

Abstract

The targeted delivery of anti-cancer drugs and isotopes is one of the most pursued goals in anti-cancer therapy. One of the prime examples of such an application is the intra-arterial injection of microspheres containing cytostatic drugs or radioisotopes during hepatic embolization procedures. Therapy [...] Read more.

The targeted delivery of anti-cancer drugs and isotopes is one of the most pursued goals in anti-cancer therapy. One of the prime examples of such an application is the intra-arterial injection of microspheres containing cytostatic drugs or radioisotopes during hepatic embolization procedures. Therapy based on the application of microspheres revolves around vascular occlusion, complemented with local therapy in the form of trans-arterial chemoembolization (TACE) or radioembolization (TARE). The broadest implementation of these embolization strategies currently lies within the treatment of untreatable hepatocellular cancer (HCC) and metastatic colorectal cancer. This review aims to describe the state-of-the-art TACE and TARE technologies investigated in the clinical setting for HCC and addresses current trials and new developments. In addition, chemical properties and advancements in microsphere carrier systems are evaluated, and possible improvements in embolization therapy based on the modification of and functionalization with therapeutical loads are explored. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM - Nuclear Medicine & Radiology)

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9 pages, 807 KiB

Open AccessReview

Targeting Copper in Cancer Imaging and Therapy: A New Theragnostic Agent

by Gabriela Capriotti, Arnoldo Piccardo, Elena Giovannelli and Alberto Signore

J. Clin. Med. 2023, 12(1), 223; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12010223 - 28 Dec 2022

Cited by 13 | Viewed by 2382

Abstract

Copper is required for cancer cell proliferation and tumor angiogenesis. Copper-64 radionuclide (⁶⁴Cu), a form of copper chloride (⁶⁴CuCl₂), is rapidly emerging as a diagnostic PET/CT tracer in oncology. It may also represent an interesting alternative to [...] Read more.

Copper is required for cancer cell proliferation and tumor angiogenesis. Copper-64 radionuclide (⁶⁴Cu), a form of copper chloride (⁶⁴CuCl₂), is rapidly emerging as a diagnostic PET/CT tracer in oncology. It may also represent an interesting alternative to gallium-68 (⁶⁸Ga) as a radionuclide precursor for labelling radiopharmaceuticals used to investigate neuroendocrine tumors and prostate cancer. This emerging interest is also related to the nuclear properties of ⁶⁴CuCl₂ that make it an ideal theragnostic nuclide. Indeed, ⁶⁴CuCl₂ emits β⁺ and β^- particles together with high-linear-energy-transfer Auger electrons, suggesting the therapeutic potential of ⁶⁴CuCl₂ for the radionuclide cancer therapy of copper-avid tumors. Recently, ⁶⁴CuCl₂ was successfully used to image prostate cancer, bladder cancer, glioblastoma multiforme (GBM), and non-small cell lung carcinoma in humans. Copper cancer uptake was related to the expression of human copper transport 1 (hCTR1) on the cancer cell surface. Biodistribution, toxicology and radiation safety studies showed its radiation and toxicology safety. Based on the findings from the preclinical research studies, ⁶⁴CuCl₂ PET/CT also holds potential for the diagnostic imaging of human hepatocellular carcinoma (HCC), malignant melanoma, and the detection of the intracranial metastasis of copper-avid tumors based on the low physiological background of radioactive copper uptake in the brain. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM - Nuclear Medicine & Radiology)

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12 pages, 977 KiB

Open AccessReview

A Theranostic Approach in SIRT: Value of Pre-Therapy Imaging in Treatment Planning

by Philippe d’Abadie, Stephan Walrand, Renaud Lhommel, Michel Hesse and François Jamar

J. Clin. Med. 2022, 11(23), 7245; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11237245 - 6 Dec 2022

Cited by 3 | Viewed by 1514

Abstract

Selective internal radiation therapy (SIRT) is one of the treatment options for liver tumors. Microspheres labelled with a therapeutic radionuclide (⁹⁰Y or ¹⁶⁶Ho) are injected into the liver artery feeding the tumor(s), usually achieving a high tumor absorbed dose and [...] Read more.

Selective internal radiation therapy (SIRT) is one of the treatment options for liver tumors. Microspheres labelled with a therapeutic radionuclide (⁹⁰Y or ¹⁶⁶Ho) are injected into the liver artery feeding the tumor(s), usually achieving a high tumor absorbed dose and a high tumor control rate. This treatment adopts a theranostic approach with a mandatory simulation phase, using a surrogate to radioactive microspheres (^99mTc-macroaggregated albumin, MAA) or a scout dose of ¹⁶⁶Ho microspheres, imaged by SPECT/CT. This pre-therapy imaging aims to evaluate the tumor targeting and detect potential contraindications to SIRT, i.e., digestive extrahepatic uptake or excessive lung shunt. Moreover, the absorbed doses to the tumor(s) and the healthy liver can be estimated and used for planning the therapeutic activity for SIRT optimization. The aim of this review is to evaluate the accuracy of this theranostic approach using pre-therapy imaging for simulating the biodistribution of the microspheres. This review synthesizes the recent publications demonstrating the advantages and limitations of pre-therapy imaging in SIRT, particularly for activity planning. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM - Nuclear Medicine & Radiology)

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20 pages, 1372 KiB

Open AccessReview

PSMA Expression in Solid Tumors beyond the Prostate Gland: Ready for Theranostic Applications?

by Chiara Lauri, Lorenzo Chiurchioni, Vincenzo Marcello Russo, Luca Zannini and Alberto Signore

J. Clin. Med. 2022, 11(21), 6590; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11216590 - 7 Nov 2022

Cited by 15 | Viewed by 3276

Abstract

In the past decades, the expanding use of prostate-specific membrane antigen (PSMA) imaging for prostate cancer has led to the incidental detection of a lot of extra-prostatic malignancies showing an increased uptake of PSMA. Due to these incidental findings, the increasing amount of [...] Read more.

In the past decades, the expanding use of prostate-specific membrane antigen (PSMA) imaging for prostate cancer has led to the incidental detection of a lot of extra-prostatic malignancies showing an increased uptake of PSMA. Due to these incidental findings, the increasing amount of immunohistochemistry studies and the deeper knowledge of the mechanisms of expression of this antigen, it is now clear that “PSMA” is a misnomer, since it is not specific to the prostate gland. Nevertheless, this lack of specificity could represent an interesting opportunity to bring new insights on the biology of PSMA and its sites of expression to image and treat new conditions, particularly several cancers. In this review, we will describe the main extra-prostatic cancers that exhibit PSMA expression and that can be studied with PSMA-based positron emission tomography–computed tomography (PET/CT) as an additional or alternative tool to conventional imaging. In particular, we will focus on cancers in which a radioligand therapy with ¹⁷⁷lutetium has been attempted, aiming to provide an overview of the possible future theragnostic applications of PSMA. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM - Nuclear Medicine & Radiology)

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27 pages, 5157 KiB

Open AccessReview

Update of PSMA Theranostics in Prostate Cancer: Current Applications and Future Trends

by Chalermrat Kaewput and Sobhan Vinjamuri

J. Clin. Med. 2022, 11(10), 2738; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11102738 - 12 May 2022

Cited by 14 | Viewed by 5421

Abstract

There is now an increasing trend for targeting cancers to go beyond early diagnosis and actually improve Progression-Free Survival and Overall Survival. Identifying patients who might benefit from a particular targeted treatment is the main focus for Precision Medicine. Radiolabeled ligands can be [...] Read more.

There is now an increasing trend for targeting cancers to go beyond early diagnosis and actually improve Progression-Free Survival and Overall Survival. Identifying patients who might benefit from a particular targeted treatment is the main focus for Precision Medicine. Radiolabeled ligands can be used as predictive biomarkers which can confirm target expression by cancers using positron emission tomography (PET). The same ligand can subsequently be labeled with a therapeutic radionuclide for targeted radionuclide therapy. This combined approach is termed “Theranostics”. The prostate-specific membrane antigen (PSMA) has emerged as an attractive diagnostic and therapeutic target for small molecule ligands in prostate cancer. It can be labeled with either positron emitters for PET-based imaging or beta and alpha emitters for targeted radionuclide therapy. This review article summarizes the important concepts for Precision Medicine contributing to improved diagnosis and targeted therapy of patients with prostate cancer and we identify some key learning points and areas for further research. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM - Nuclear Medicine & Radiology)

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