Publications by authors named "Alessio Imperiale"

112 Publications

Advantages of 18F-FDG PET/CT Imaging over Modified Duke Criteria and Clinical Presumption in Patients with Challenging Suspicion of Infective Endocarditis.

Diagnostics (Basel) 2021 04 18;11(4). Epub 2021 Apr 18.

Nuclear Medicine and Molecular Imaging, ICANS, University Hospitals of Strasbourg, rue Albert Calmette, 67093 Strasbourg, France.

According to European Society of Cardiology guidelines (ESC2015) for infective endocarditis (IE) management, modified Duke criteria (mDC) are implemented with a degree of clinical suspicion degree, leading to grades such as "possible" or "rejected" IE despite a persisting high level of clinical suspicion. Herein, we evaluate the F-FDG PET/CT diagnostic and therapeutic impact in IE suspicion, with emphasis on possible/rejected IE with a high clinical suspicion. Excluding cases of definite IE diagnosis, 53 patients who underwent F-FDG PET/CT for IE suspicion were selected and afterwards classified according to both mDC (possible IE/Duke 1, rejected IE/Duke 0) and clinical suspicion degree (high and low IE suspicion). The final status regarding IE diagnosis (gold standard) was based on the multidisciplinary decision of the Endocarditis Team, including the 'imaging specialist'. PET/CT images of the cardiac area were qualitatively interpreted and the intensity of each focus of extra-physiologic F-FDG uptake was evaluated by a maximum standardized uptake value (SUVmax) measurement. Extra-cardiac F-FDG PET/CT pathological findings were considered to be a possible embolic event, a possible source of IE, or even a concomitant infection. Based on the Endocarditis Team consensus, final diagnosis of IE was retained in 19 (36%) patients and excluded in 34 (64%). With a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and global accuracy of 79%, 100%, 100%, 89%, and 92%, respectively, PET/CT performed significantly better than mDC ( 0.003), clinical suspicion degree ( = 0.001), and a combination of both ( = 0.001) for IE diagnosis. In 41 patients with possible/rejected IE but high clinical suspicion, sensitivity, specificity, PPV, NPV, and global accuracies were 78%, 100%, 100%, 85%, and 90%, respectively. Moreover, PET/CT contributed to patient management in 24 out of 53 (45%) cases. F-FDG PET/CT represents a valuable diagnostic tool that could be proposed for challenging IE cases with significant differences between mDC and clinical suspicion degree. F-FDG PET/CT allows a binary diagnosis (definite or rejected IE) by removing uncertain diagnostic situations, thus improving patient therapeutic management.
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http://dx.doi.org/10.3390/diagnostics11040720DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8073326PMC
April 2021

Variants and Pitfalls of PET/CT in Neuroendocrine Tumors.

Semin Nucl Med 2021 Apr 7. Epub 2021 Apr 7.

Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, France. Electronic address:

Management of patients with neuroendocrine neoplasms (NEN) is complex and warrants referral of these patients to high volume centers with appropriate expertise to ensure favorable outcomes. PET/CT becomes increasingly important in every step of their management and outcome. The choice of radiopharmaceutical heavily depends on tumor origin, which is intimately interconnected to embryology, grade and clinical presentation (eg, diagnostic vs theranostic settings). The aim of this review is to describe the role of SSTR, F-FDOPA, and F-FDG-PET imaging in the evaluation of NEN patients. There is emphasis on the main variants, caveats, and pitfalls that can be observed within these modalities. Nuclear physicians must be equipped with the skills to handle potential variants, caveats, and pitfalls that are commonly encountered in NEN imaging, and they should understand the expected imaging features that are encountered across various types of NENs.
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http://dx.doi.org/10.1053/j.semnuclmed.2021.03.001DOI Listing
April 2021

18F-FDG PET/CT Monitoring of Tumor Response to Tyrosine Kinase Inhibitors and Alkylating Drugs in an SDH-Deficient GIST.

Clin Nucl Med 2021 Mar 16. Epub 2021 Mar 16.

From the Departments of Nuclear Medicine and Molecular Imaging Oncology, Institut de Cancérologie de Strasbourg Europe, Strasbourg Strasbourg University, INSERM, VSDSC UMR-S 1113, IGBMC, Illkirch Molecular Imaging-DRHIM, IPHC, UMR 7178, CNRS/Strasbourg University, Strasbourg, France.

Abstract: Succinate dehydrogenase (SDH)-deficient gastrointestinal stromal tumors (GISTs) are associated with loss of function of SDH complex and represent 5% to 7.5% of GISTs. SDH-deficient GISTs usually develop in the stomach of children and young adults, and could be part of Carney triad or Carney-Stratakis syndromes including paraganglioma. SDH-deficient GISTs are often indolent despite the high rate of distant metastasis, and overall unresponsive to tyrosine kinase inhibitors. However, epigenetic inactivation of MGMT leads to potential effectiveness of alkylating agents. We report the 18F-FDG PET/CT results for monitoring response to TKI and alkylating drugs in a patient with refractory SDHB-deficient GIST.
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http://dx.doi.org/10.1097/RLU.0000000000003615DOI Listing
March 2021

Original Preoperative Localization Technique of Parathyroid Adenomas by 3-Dimensional Virtual Neck Exploration.

Surg Innov 2021 Mar 20:15533506211001236. Epub 2021 Mar 20.

Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.

. Preoperative imaging in primary hyperparathyroidism (PHPT) is essential for planning of parathyroidectomy-particularly for selection of a minimally invasive approach. The objective of this cohort study was to evaluate the diagnostic precision of 3D virtual neck exploration (3D-VNE), to evaluate its impact on choice of surgical approach, and to document the correlation with long-term outcomes. . 235 consecutive patients with PHPT were studied (January 2014 to December 2018), with 6-month follow-up. 220 patients had a preoperative computed tomography (CT), 172 of these had a 3D-VNE based on the CT, and 226 patients had a Tc-99m sestamibi scan. . Sensitivity of exact, , adenoma localization was 57.09% (95% CI: 50.85-63.10%) for nonspecialized radiologist interpretation of CT scan, 58.17% (95% CI: 51.99-64.10%) for Tc-99m sestamibi scan, and 90.21% (95% CI: 85.21-93.64%) for 3D-VNE, and thereby favoring 3D-VNE compared to CT scan alone (OR 34.5, 95% CI: 9.19-290.56%, < 2.2 × 10) and to Tc-99m sestamibi scan (OR 16.25, 95% CI: 6.05-61.42%, = 3.1 × 10). Specificity was 87.38% for CT scan, 86.36% for 3D-VNE, and 90% for Tc-99m sestamibi scan ( > .05). The cure rate was 100%. The long-term recurrence rate (RR) was 2.978%. The RR was 1.324% in the video-assisted parathyroidectomy group of 151 patients and 5.952% in the group of 84 patients with cervicotomy ( = .0459). CT-based 3D-VNE proved to be the most accurate localizing study in PHPT and aided in selecting patients for targeted minimally invasive parathyroidectomy, which was associated with the lower recurrence rate. 3D-VNE could be proposed as a first-line imaging study in patients with PHPT.
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http://dx.doi.org/10.1177/15533506211001236DOI Listing
March 2021

Middle-segment preserving pancreatectomy for multifocal neuroendocrine pancreatic tumors.

Surg Oncol 2020 Dec 14;35:466-467. Epub 2020 Oct 14.

Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.

Background: Multifocal neuroendocrine tumors (NET) usually occur in the context of a multiple neuroendocrine neoplasia type 1 (MEN1). When the proximal part of the pancreatic body is spared by NET, Miura et al. have proposed a "middle-segment preserving" pancreatectomy (MSP) as alternative to total pancreatectomy [1-3].

Video: A 28-year-old woman with MEN1 was referred for surgical resection of a multifocal pancreatic tumor with single metastasis located and a single liver metastasis in close contact with the left hepatic duct. The preoperative work-up by DOTATOC-PETSCAN revealed multifocal tumors sparing only the proximal part of the pancreatic body. Hormonal dosages were normal but Chromogranine A was elevated at 700 μg/l. At surgery pancreatic intraoperative ultrasonography confirmed the absence of tumor at the proximal part of the pancreas. A pancreaticoduodenectomy was performed first followed by a left pancreatectomy with partial splenectomy. A 3 × 5 cm remnant of the pancreatic body vascularized by a dorsal pancreatic artery was preserved (Fig. 1). A left hepatectomy was then performed (Fig. 2). Digestive reconstruction is performed by a pancreatojejunostomy with an externalized pancreatic stent (Fig. 3), hepaticojejunostomy and a gastrojejunal anastomosis.

Results: Surgery lasted 660 minutes. Postoperative course was uneventful but a late readmission was necessary because of pyelonephritis due to nephrolithiasis treated by ureteral stent insertion. At 11 months postoperative follow-up the patient was disease-free with no endocrine dysfunction under oral pancreatic enzyme supplementation. Total weight loss since surgery was 8 Kilograms.

Conclusions: A middle-segment-preserving pancreatectomy could be a valid surgical alternative to total pancreatectomy for multifocal pancreatic tumors sparing the proximal pancreatic body. This operation can achieve acceptable functional outcomes but large series with long-term follow up are needed to evaluate the advantages and results of MSP.
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http://dx.doi.org/10.1016/j.suronc.2020.10.004DOI Listing
December 2020

Intraindividual comparison of F-FDOPA and Ga-DOTATOC PET/CT detection rate for metastatic assessment in patients with ileal neuroendocrine tumours.

Clin Endocrinol (Oxf) 2021 Jan 15;94(1):66-73. Epub 2020 Sep 15.

Nuclear Medicine and Molecular Imaging, ICANS, University Hospitals of Strasbourg, Strasbourg, France.

Introduction: In patients with ileal neuroendocrine tumours (ileal NETs), head-to-head evaluation of diagnostic performances of Ga-DOTA-peptides and F-fluorodihydroxyphenylalanine ( F-FDOPA) positron emission tomography/computed tomography (PET/CT) has been performed in only few small patients' cohorts. The aim of this retrospective study was to compare Ga-DOTATOC and F-FDOPA PET/CT for metastatic disease assessment in a homogeneous large series of patients with well-differentiated ileal NETs.

Methods: All patients with ileal NETs who underwent both F-FDOPA and Ga-DOTATOC PET/CT within a 3-month period and no therapeutic change between the two studies were retrospectively included. The detection rates of both modalities were calculated using per-patient, per-region and per-lesion analyses.

Results: Forty one patients with ileal NETs were evaluated. F-FDOPA and Ga-DOTATOC showed similar detection rates according to per-patient (97% for both) and per-region analyses (94% for F-FDOPA vs 88% for Ga-DOTATOC, P = .35). For a total of 605 positive lesions, 458 (76%) were detected by both modalities, 122 (20%) exclusively by F-FDOPA PET/CT, and 25 (4%) by Ga-DOTATOC PET/CT only. In a per-lesion analysis, F-FDOPA PET/CT performed better than Ga-DOTATOC PET/CT (overall detection rates of 96% vs 80%; P < .001). F-FDOPA PET/CT detected significantly more metastases than Ga-DOTATOC PET/CT in the liver, peritoneum, abdominal and supra-diaphragmatic lymph nodes.

Conclusion: F-FDOPA PET/CT seems not inferior than Ga-DOTATOC PET/CT for the delineation of metastatic spread of ileal NETs. Therefore, according to local expertise and technical availability, F-FDOPA should be considered as a valid clinical diagnostic option for exhaustive metastatic assessment in patients with ileal NETs. Obviously, Ga-DOTATOC PET/CT remains mandatory for PRRT assessment. Further comparative studies are needed to determine the optimal approach in various clinical scenarios such as preoperative staging and primary tumour detection.
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http://dx.doi.org/10.1111/cen.14312DOI Listing
January 2021

F-Florbetaben and PET/CT Holds Promise for the Identification and Differentiation Among Cardiac Amyloidosis Entities.

JACC Cardiovasc Imaging 2021 Jan 5;14(1):256-258. Epub 2020 Aug 5.

Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, Strasbourg, France.

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http://dx.doi.org/10.1016/j.jcmg.2020.06.017DOI Listing
January 2021

F-Fluorocholine PET and Multiphase CT Integrated in Dual Modality PET/4D-CT for Preoperative Evaluation of Primary Hyperparathyroidism.

J Clin Med 2020 Jun 26;9(6). Epub 2020 Jun 26.

Nuclear Medicine and Molecular Imaging, ICANS-University Hospitals of Strasbourg, 67033 Strasbourg, France.

The present retrospective study evaluates the diagnostic value of integrated F-Fluorocholine positron emission tomography/four-dimensional contrast-enhanced computed tomography (F-FCH PET/4D-CT) as second-line imaging in preoperative work-up of primary hyperparathyroidism (pHPT), and compares F-FCH PET with 4D-CT. Patients with pHPT and negative/discordant first-line imaging addressed for integrated F-FCH PET/4D-CT were retrospectively selected. Sensitivity and detection rate (DR%) of F-FCH PET/CT, 4D-CT, and PET/4D-CT were calculated according to the per patient and per lesion analyses, and afterwards compared. Histology associated with a decrease more than 50% of perioperative parathyroid hormone (PTH) blood level was used as a gold standard. Persistent high serum PTH and calcium levels during a 6-month follow-up was considered as presence of pHPT in both operated and non-operated patients. 50 patients (55 glands) were included. 44/50 patients (88%) were surgically treated. On a per patient analysis, sensitivity was 93%, 80%, and 95%, and DR% was 82%, 68%, and 84%, respectively for PET/CT, 4D-CT, and PET/4D-CT. PET/CT was more sensitive than 4D-CT ( = 0.046). PET/4D-CT performed better than 4D-CT ( = 0.013) but was equivalent to PET/CT alone. On a per gland analysis, sensitivity PET/CT, 4D-CT, and PET/4D-CT was 88%, 66%, and 92%, and DR% was 79%, 57%, and 83%, respectively. PET/CT and PET/4D-CT were more sensitive than 4D-CT alone ( = 0.01, < 0.001, respectively). However, PET/CT and PET/4D-CT performed similarly. In conclusion, F-FCH PET provides better identification of hyperfunctioning parathyroids than 4D-CT and the combination of both did not significantly improve diagnostic sensitivity. Further investigations involving larger populations are necessary to define the role of F-FCH PET/4D-CT as a "one-stop shop" second-line imaging in preoperative work-up of pHPT, especially considering the additional patient radiation exposure due to multi-phase CT.
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http://dx.doi.org/10.3390/jcm9062005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356908PMC
June 2020

68Ga-DOTATOC PET for Treatment Efficacy Evaluation of Cardiac Sarcoidosis.

Clin Nucl Med 2020 Sep;45(9):e416-e418

Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Washington University, St Louis, MO.

Cardiac sarcoidosis (CS) has a poor prognosis related to life-threating arrhythmias and heart failure. Treatment includes anti-inflammatory therapies and implantable pacemaker and/or cardioverter defibrillator. The presence of cardiac devices and physiologic myocardial glucose uptake are major limitations of both cardiac magnetic resonance and F-FDG PET/CT, reducing their diagnostic value. Somatostatin-based PET/CT has been proposed to detect active CS. Contrarily to F-FDG uptake, which reflects nonspecific leukocyte infiltration, Ga-DOTATOC may identify active granulomatosis. Herein, we underline the specificity of Ga-DOTATOC PET in challeging clinical situations including refractory CS, and chronic CS in patients with cardiac device, or false-positive F-FDG PET/CT results.
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http://dx.doi.org/10.1097/RLU.0000000000003185DOI Listing
September 2020

Laparoscopic resection of familial interaortocaval paraganglioma.

Surg Oncol 2020 06 17;33:143-144. Epub 2020 Feb 17.

Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de La Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.

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http://dx.doi.org/10.1016/j.suronc.2020.02.019DOI Listing
June 2020

Tc-labelled bone tracer myocardial quantification: About correlation with heart function.

J Nucl Cardiol 2020 08 13;27(4):1412-1414. Epub 2020 May 13.

Nuclear Medicine, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.

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http://dx.doi.org/10.1007/s12350-020-02182-5DOI Listing
August 2020

Solid pseudopapillary tumour should be part of differential diagnosis of focal pancreatic lesions with increased F-FDOPA uptake.

Clin Endocrinol (Oxf) 2020 07 5;93(1):78-81. Epub 2020 May 5.

Nuclear Medicine and Molecular Imaging, ICANS - University Hospitals of Strasbourg, Strasbourg, France.

Objective: To assess the specificity of increased F-dihydroxyphenylalanine ( F-FDOPA) uptake in patients who underwent PET/CT for suspicion of isolated pancreatic neuroendocrine tumour (pNET). False-positive results mimicking a pNET have been investigated.

Material And Methods: Carbidopa-assisted F-FDOPA PET/CT scans performed in patients with suspicion of localized pNET were retrieved. Only patients with a definitive diagnosis were retrospectively included. When available, the histopathological result after pancreatic surgery was the gold standard. In other cases, the diagnosis was based on endoscopic ultrasonography (EUS)/cytology and/or on concordant imaging results of at least two of the following: contrast-enhanced computed tomography (CE-CT), magnetic resonance imaging (MRI) and somatostatin receptor scintigraphy (SRS).

Results: Forty-four among 731 patients were selected. Among these, 36 patients (82%) were surgically treated, revealing pNET (n = 28), solid pseudopapillary tumour (SPT) (n = 4), adenocarcinoma (n = 2), serous cystadenomas (n = 1) and solitary fibrous tumour (n = 1) cases. An additional three cases of pNET were diagnosed by EUS/cytology. In the remaining five patients, a consensus was reached on follow-up imaging results: pNET (n = 1), serous cystadenoma (n = 2) and undetermined/no pNET (n = 2). Both specificity and negative predictive value of F-FDOPA PET/CT for localized pNET were 67%. Surprisingly, all four false-positive results were SPTs showing intense F-FDOPA uptake and negative SRS. There was no significant difference in F-FDOPA uptake intensity between PET-positive pNETs and SPTs.

Conclusion: F-FDOPA PET/CT is not specific for pNET in patients with localized pancreatic lesions. SPT could mimic pNET and should be part of differential diagnosis in such a clinical situation. If these results are confirmed in a broader population, the imaging pattern F-FDOPA PET-positive/SRS-negative lesions might be considered as the imaging phenotype of SPT.
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http://dx.doi.org/10.1111/cen.14202DOI Listing
July 2020

Outcomes of Simultaneous Resection of Small Bowel Neuroendocrine Tumors with Synchronous Liver Metastases.

World J Surg 2020 07;44(7):2377-2384

Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1, Avenue Molière, 67098, Strasbourg, France.

Background: This study evaluated the short- and long-term outcomes of synchronous resection of liver metastases (LM) from small bowel neuroendocrine tumors (SB-NET).

Methods: A retrospective review of patients undergoing resection for LMs from SB-NETs from January 1997 and December 2018 was performed.

Results: There were 44 patients with synchronous SB-NET and LMs. Perioperative and 90-day mortality values were zero, and the morbidity rate was 27%. The median overall survival (OS) was 128.4 months (CI 95% 74.0-161.5 months) with 1-, 3-, 5-, and 10-year survival rates of 100%, 83%, 79%, and 60%, respectively. Not achieving surgical treatment for LM was the unique independent factor for survival (HR 6.50; CI 95% 1.54-27.28; p = 0.01) in patients with unresected LMs having OS and 10-year survival rates (42 months, 33%) versus patients undergoing liver resection (152 months, 66%)(p = 0.0008). The recurrence rate was 81.8% and associated with longer OS and 5-year survival rates when limited to the liver [223 months (61%) vs 94 months (87%)].

Conclusions: Simultaneous resection of SB-NETs with synchronous LMs was safe and associated with considerable long-term survival even in the presence of bilobar disease. However, recurrence after resection was common (81%) but associated with longer survival rates when limited to the liver.
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http://dx.doi.org/10.1007/s00268-020-05467-5DOI Listing
July 2020

Metabolomics of Small Intestine Neuroendocrine Tumors and Related Hepatic Metastases.

Metabolites 2019 Dec 11;9(12). Epub 2019 Dec 11.

Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, 67098 Strasbourg, France.

To assess the metabolomic fingerprint of small intestine neuroendocrine tumors (SI-NETs) and related hepatic metastases, and to investigate the influence of the hepatic environment on SI-NETs metabolome. Ninety-four tissue samples, including 46 SI-NETs, 18 hepatic NET metastases and 30 normal SI and liver samples, were analyzed using 1H-magic angle spinning (HRMAS) NMR nuclear magnetic resonance (NMR) spectroscopy. Twenty-seven metabolites were identified and quantified. Differences between primary NETs vs. normal SI and primary NETs vs. hepatic metastases, were assessed. Network analysis was performed according to several clinical and pathological features. Succinate, glutathion, taurine, myoinositol and glycerophosphocholine characterized NETs. Normal SI specimens showed higher levels of alanine, creatine, ethanolamine and aspartate. PLS-DA revealed a continuum-like distribution among normal SI, G1-SI-NETs and G2-SI-NETs. The G2-SI-NET distribution was closer and clearly separated from normal SI tissue. Lower concentration of glucose, serine and glycine, and increased levels of choline-containing compounds, taurine, lactate and alanine, were found in SI-NETs with more aggressive tumors. Higher abundance of acetate, succinate, choline, phosphocholine, taurine, lactate and aspartate discriminated liver metastases from normal hepatic parenchyma. Higher levels of alanine, ethanolamine, glycerophosphocholine and glucose was found in hepatic metastases than in primary SI-NETs. The present work gives for the first time a snapshot of the metabolomic characteristics of SI-NETs, suggesting the existence of complex metabolic reality, maybe characteristic of different tumor evolution.
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http://dx.doi.org/10.3390/metabo9120300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950539PMC
December 2019

Prognostic and predictive value of nuclear imaging in endocrine oncology.

Endocrine 2020 01 16;67(1):9-19. Epub 2019 Nov 16.

Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, Strasbourg University/FMTS, Strasbourg, France.

In the last few years, the role and use of medical technologies in (neuro)endocrine oncology has greatly evolved allowing not only important diagnostic information but also prognostic stratification in different clinical situations. The terms "prognostic" and "predictive" are commonly used to describe the relationships between biomarkers and patients' clinical outcomes but have quite different meaning. The present work discusses the prognostic and predictive value of nuclear medicine imaging. It critically reviews the clinical significance and potential impact of molecular examinations on follow-up and therapeutic strategies in patients with neuroendocrine neoplasms, thyroid tumors, and adrenal malignancies.
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http://dx.doi.org/10.1007/s12020-019-02131-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441826PMC
January 2020

PET/CMR: One More Step Toward Noninvasive Morphofunctional Diagnosis of Cardiac Malignancies.

JACC Cardiovasc Imaging 2020 05 11;13(5):1270-1275. Epub 2019 Oct 11.

Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, Strasbourg, France; Faculty of Medicine, FMTS, University of Strasbourg, Strasbourg; Molecular Imaging-DRHIM, IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France. Electronic address:

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http://dx.doi.org/10.1016/j.jcmg.2019.09.002DOI Listing
May 2020

Synchronous bilateral pheochromocytomas and bilobar medullary thyroid carcinoma revealed by F-FDOPA PET/CT in a MEN-2A asymptomatic patient.

Endocrine 2019 12 2;66(3):691-692. Epub 2019 Sep 2.

Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, Strasbourg, France.

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http://dx.doi.org/10.1007/s12020-019-02074-wDOI Listing
December 2019

Cardiac metastasis from medullary thyroid carcinoma: insights from multimodal molecular imaging and magnetic resonance imaging.

Eur Heart J Cardiovasc Imaging 2020 02;21(2):231-232

Department of Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, Hautepierre University Hospital, 1, Avenue Molière, 67098 Strasbourg, France.

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http://dx.doi.org/10.1093/ehjci/jez132DOI Listing
February 2020

Limited role of carbidopa-assisted F-FDOPA PET/CT in patients with sporadic non-functional gastroduodenal neuroendocrine neoplasms.

Ann Nucl Med 2019 Sep 15;33(9):697-707. Epub 2019 Jun 15.

Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Hospitals of Strasbourg, Strasbourg University, Strasbourg, France.

Objective: To evaluate F-fluorodihydroxyphenylalanine (F-FDOPA) positron emission tomography/computed tomography (PET/CT) after carbidopa premedication to localize sporadic, well-differentiated, nonfunctioning gastroduodenal neuroendocrine neoplasms (NENs).

Methods: Ten patients undergoing staging carbidopa-assisted F-FDOPA PET/CT before endoscopic or surgical resection of gastroduodenal NENs were retrospectively selected. Preoperative imaging work up also included CT, magnetic resonance imaging (MRI), and somatostatin receptor scintigraphy (SRS) single-photon emission computed tomography/computed tomography (SPECT/CT) in ten, six, and eight patients, respectively. Histopathological diagnosis of primary NEN was the diagnostic standard of truth. Metastatic spread was defined as the presence of histologically proven nodal, visceral, and/or bone metastases.

Results: Tumors were located in the duodenal bulb in five patients, in descending duodenum in three, and in the gastric fundus in two. Three patients presented with both lymph nodes and distant metastases, and two with exclusive lymphatic spread. CT and MRI detected primary tumor in one out of ten and three out of six patients, respectively. SRS failed to detect intestinal NEN in all cases. F-FDOPA PET/CT detected four primary NENs (one gastric and three duodenal tumors) and was false negative in six patients. NENs missed by F-FDOPA PET/CT were smaller than 10 mm in two cases and measured about 30 mm in three patients. The remaining tumor was detected only on blind endoscopic biopsy. Among patients who underwent both F-FDOPA PET/CT and SRS, three presented discordant results for primary tumor detection (PET/CT positive/SRS negative) and five showed concordant negative studies. F-FDOPA PET/CT correctly identified all three patients with both nodal and visceral metastatic disease and failed to detect lymph node metastases in both N+ M0 patients.

Conclusions: F-FDOPA PET/CT is not sufficiently accurate for localization of primary well-differentiated nonfunctioning sporadic gastroduodenal NENs. F-FDOPA PET/CT's value for the assessment of visceral and lymph node metastases needs to be clarified in multicenter trials including a larger number of patients.
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http://dx.doi.org/10.1007/s12149-019-01378-1DOI Listing
September 2019

Cardiac Metastases of Small-Bowel Carcinoid.

Circ Cardiovasc Imaging 2019 02;12(2):e008405

Biophysics and Nuclear Medicine (S.E.G., C.B., A.I.), University Hospitals of Strasbourg, University of Strasbourg, France.

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http://dx.doi.org/10.1161/CIRCIMAGING.118.008405DOI Listing
February 2019

F-FDOPA PET/CT Combined with MRI for Gross Tumor Volume Delineation in Patients with Skull Base Paraganglioma.

Cancers (Basel) 2019 Jan 8;11(1). Epub 2019 Jan 8.

Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, 67098 Strasbourg, France.

In this simulation study, we assessed differences in gross tumor volume (GTV) in a series of skull base paragangliomas (SBPGLs) using magnetic resonance imaging (MRI), F-dihydroxyphenylalanine (F-FDOPA) combined positron emission tomography/computed tomography (PET/CT), and F-FDOPA PET/MRI images obtained by rigid alignment of PET and MRI. GTV was delineated in 16 patients with SBPGLs on MRI (GTV), F-FDOPA PET/CT (GTV), and combined PET/MRI (GTV). GTV was the union of GTV and GTV after visual adjustment. Three observers delineated GTV and GTV independently. Excellent interobserver reproducibility was found for both GTV and GTV. GTV and GTV were not significantly different. However, there was some spatial difference between the locations of GTV, GTV, and GTV. The Dice similarity coefficient median value was 0.4 between PET/CT and MRI, and 0.8 between MRI and PET/MRI. The combined use of PET/MRI produced a larger GTV than MRI alone. Nevertheless, both the target-delivered dose and organs-at-risk conservancy were respected when treatment was planned on the PET/MRI-matched data set. Future integration of F-FDOPA PET/CT into clinical practice will be necessary to evaluate the influence of this diagnostic modality on SBPGL therapeutic management. If the clinical utility of F-FDOPA PET/CT and/or PET/MRI is confirmed, GTV should be considered for tailored radiotherapy planning in patients with SBPGL.
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http://dx.doi.org/10.3390/cancers11010054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360018PMC
January 2019

Early F-FDOPA PET/CT imaging after carbidopa premedication as a valuable diagnostic option in patients with insulinoma.

Eur J Nucl Med Mol Imaging 2019 03 7;46(3):686-695. Epub 2019 Jan 7.

Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, Strasbourg, France.

Purpose: Data on the diagnostic value of F-FDOPA PET/CT in patients with insulinoma are limited and are focused on small patient populations explored using different PET/CT protocols and the inconsistent use of carbidopa premedication. The aim of this study was to improve the current knowledge about the diagnostic value of F-FDOPA PET/CT combined with oral carbidopa premedication and early pancreatic imaging for tumour localization in patients with insulinoma-related hyperinsulinaemic hypoglycaemia (HH). The relationships among F-FDOPA quantitative uptake parameters, insulin secretion and tumour pathological features were also investigated.

Methods: Of 34 patients with suspicion of insulinoma-related HH examined by dual time-point carbidopa-assisted F-FDOPA PET/CT, 24 with histologically proven insulinoma were retrospectively included. One patient underwent two PET/CT examinations for relapsing insulinoma after surgical excision. Thus, 25 preoperative F-FDOPA PET/CT studies were finally retained and analysed. All studies were performed under carbidopa premedication (200 mg orally, 1-2 h prior to tracer injection). The PET/CT acquisition protocol included an early acquisition (5 min after F-FDOPA injection) over the upper abdomen and a delayed whole-body acquisition starting 20-30 min later. The cytological and/or histopathological diagnosis of insulinoma was the diagnostic standard of truth.

Results: F-FDOPA PET/CT localized insulinoma in 21 of the 25 studies, leading to a primary lesion detection rate of 84%. Four lesions (19%) were detected only on early acquisitions. The false-negative tumour detection rates were, respectively, 22% and 12.5% in patients receiving and not receiving treatment for hypoglycaemic symptoms at the time of PET/CT. In benign insulinomas, the early maximum standardized uptake value (SUVmax) was significantly higher than the delayed SUVmax. Compared to the 21 benign lesions, four malignant insulinomas showed significantly higher F-FDOPA uptake. Lesion size, fasting-end insulin and C-peptide levels correlated with tumour F-FDOPA uptake, dopaminergic tumour volume and metabolic burden.

Conclusion: The present study showed that F-FDOPA PET/CT combined with carbidopa premedication and early pancreatic acquisitions is a valuable diagnostic option in patients with insulinoma when GLP1R-based imaging is not available. The results also provide new insights into the relationships between tumour secretion and imaging phenotype in insulinomas.
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http://dx.doi.org/10.1007/s00259-018-4245-3DOI Listing
March 2019

Macrovascular venous invasion of pancreatic neuroendocrine tumours: impact on surgical outcomes and survival.

HPB (Oxford) 2019 06 3;21(6):653-661. Epub 2018 Dec 3.

Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France. Electronic address:

Background: This study evaluates the impact of macrovascular venous invasion (MVI) on surgical and survival outcomes of pancreatic neuroendocrine tumours (PNETs).

Methods: We retrospectively reviewed data of 125 patients operated for PNETs. Operative, pathological,and survival outcomes were compared between PNETs with and without MVI.

Results: Macrovascular venous invasion was detected in 25 of 125 PNETs (20%) presenting as tumour thrombi (n = 12) or venous wall invasion (n = 13). MVI was associated with larger tumours, a higher rate of lymph node involvement, less differentiated tumours, and a higher rate of perineural invasion. Resection of PNETS with MVI more often necessitated combined hepatic, venous and multivisceral resections, had a higher rate of intraoperative blood transfusion (p = 0.04) but similar morbidity (44% vs. 42%) and mortality (0 vs. 1%) as PNETs without MVI. PNETs with MVI had a lower median overall survival rate (60 vs. 149 months; p = 0.03). Multivariate analysis revealed that PNETs of the pancreatic head, synchronous liver metastases and higher tumour grade were prognostic factors for overall survival.

Conclusions: MVI is found in more advanced PNETs. Resection of PNETs with MVI is characterized by increased transfusion rate and reduced overall survival.
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http://dx.doi.org/10.1016/j.hpb.2018.10.010DOI Listing
June 2019

Pancreatic Actinomycosis.

J Gastrointest Surg 2019 02 5;23(2):386-388. Epub 2018 Sep 5.

Hepato-Pancreato-Biliary Surgery and Liver transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1, Avenue Moliere, 67098, Strasbourg, France.

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http://dx.doi.org/10.1007/s11605-018-3940-5DOI Listing
February 2019

Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis.

Eur J Nucl Med Mol Imaging 2019 03 9;46(3):751-765. Epub 2018 Aug 9.

Clinic of Nuclear Medicine and PET/CT Center, Ente Ospedaliero Cantonale, Oncology Institute of Southern Switzerland, Via Ospedale 12, 6500, Bellinzona, Switzerland.

Purpose: Hyperparathyroidism (HPT) is a common endocrine disorder caused by hyperfunctioning parathyroid glands (HP). The correct detection and localization of HP is challenging but crucial, as it may guide surgical treatment, particularly in patients with primary HPT. There is a growing body of data regarding the role of radiolabelled choline positron emission tomography (PET) in this setting. Therefore, we performed a systematic review and meta-analysis of the diagnostic performance of this method in detecting HP in patients with HPT.

Methods: This systematic review and meta-analysis was carried out according to PRISMA guidelines. A comprehensive computer literature search of PubMed/MEDLINE, EMBASE and Cochrane Library databases for studies published through May 2018 was performed using the following search algorithm: (a) "choline" or "fluorocholine" or "F-choline" or "C-choline" or "FCH" or "CH" or "FECH" or "FMCH" and (b) "PET" or "positron emission tomography" and (c) "parathyroid" or "hyperparathyroidism". The diagnostic performance of radiolabelled choline PET was expressed as sensitivity and positive predictive value (PPV) on a per-patient and per-lesion basis and as detection rate (DR) on a per-patient basis, with pooled proportion and 95% confidence interval (95% CI) obtained using a random-effects model.

Results: Eighteen studies were included in the systematic review. Fourteen articles (517 patients) were selected for the meta-analysis. The meta-analysis provided the following results on a per-patient analysis analysis: sensitivity 95% (95% CI: 92-97%), PPV 97% (95% CI: 95-98%) and DR 91% (95% CI: 87-94%). On a per-lesion analysis, pooled sensitivity and PPV were 92% (95% CI: 88-96) and 92% (95% CI: 89-95%), respectively. No significant heterogeneity was found among the selected studies.

Conclusions: Radiolabelled choline PET demonstrated excellent diagnostic performance in detecting HP in patients with HPT. Large multicentre studies and cost-effectiveness analyses are needed to better define the role of this imaging method in this setting.
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http://dx.doi.org/10.1007/s00259-018-4123-zDOI Listing
March 2019

18F-FDOPA Uptake Reflects the Efficacy of Dopamine Agonists Treatment in Pituitary Prolactinoma.

Clin Nucl Med 2018 Sep;43(9):e324-e325

Internal Medicine, University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France.

We report the results of F-FDOPA PET/CT in an asymptomatic MEN-1 patient with secreting pituitary prolactinoma investigated before and during dopamine agonists treatment. PET/CT showed intense and focal F-FDOPA uptake in the right part of anterior pituitary corresponding to a microadenoma on MRI imaging. Six months after the beginning of cabergoline, prolactin secretion normalized, pituitary F-FDOPA uptake completely regressed, and tumor size reduced on follow-up PET/CT and MRI, respectively.
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http://dx.doi.org/10.1097/RLU.0000000000002202DOI Listing
September 2018

Metabolic Response to BRAF-MEK Combination Therapy in Cecal Neuroendocrine Carcinoma With BRAFV600E Mutation and Refractory Lactic Acidosis.

Clin Nucl Med 2018 Sep;43(9):701-702

Department of Internal Medicine, Diabetes and Metabolic Disorders, University Hospitals of Strasbourg, Strasbourg University, Strasbourg.

We report the results of serial F-FDG PET/CT investigations in a 49-year-old woman presenting with an advanced cecal high-grade neuroendocrine carcinoma harboring a somatic BRAF mutation. Patient was refractory to standard chemotherapy regimen showing life-threatening hyperlactatemia. Early after the beginning of BRAF-MEK therapy (dabrafenib and trametinib), impressive improvement in PET/CT imaging was achieved. The pathological F-FDG uptake in cecal primary tumor as well as in nodal, hepatic, and bone metastases drastically decreased. Moreover, the reduction of total lesion glycolysis on PET/CT images was strictly related to extraordinary patient clinical response and lactic acid level normalization.
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http://dx.doi.org/10.1097/RLU.0000000000002231DOI Listing
September 2018

18F-FDOPA PET/CT of Nonfunctioning Paraganglioma of the Gastroepiploic Pedicle.

Clin Nucl Med 2018 Sep;43(9):e326-e328

Hepato-Pancreato-Biliary Surgery and Liver Transplantation.

We report the case of a 54-year-old woman with a nonfunctioning paraganglioma arising from the gastroepiploic pedicle demonstrated by F-FDOPA PET/CT. Because gastroepiploic arcade can be assimilated to the gastric mesentery, this tumor has been classified as a mesenteric paraganglioma (PGL). Neural crest cells are a multipotent population of cells characterized by effective migratory properties potentially explaining PGL atypical localization as in the mesentery. Mesenteric PGLs are often nonfunctioning and can mimic gastric, colic, or pancreatic primary tumor because of their anatomical boundaries, making more difficult the diagnosis on preoperative imaging.
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http://dx.doi.org/10.1097/RLU.0000000000002185DOI Listing
September 2018

Preoperative Imaging with F-FDOPA PET/CT for Small Bowel Neuroendocrine Tumors.

J Gastrointest Surg 2018 11 12;22(11):1992-1994. Epub 2018 Mar 12.

Biophysics and Nuclear Medicine, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, 1, Avenue Molière, 67098, Strasbourg Cedex 09, France.

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http://dx.doi.org/10.1007/s11605-018-3729-6DOI Listing
November 2018