Publications by authors named "Austin J Borja"

43 Publications

F-FDG-PET/CT in radiation therapy-induced parotid gland inflammation.

Eur J Hybrid Imaging 2020 Dec 1;4(1):22. Epub 2020 Dec 1.

Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.

Background: F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is used in the clinical management of oncologic and inflammatory pathologies. It may have utility in detecting radiotherapy (RT)-induced damage of oral tissues. Thus, the aim of the present study was to use FDG-PET/CT to evaluate parotid gland inflammation following RT in patients with head and neck cancer (HNC).

Methods: This retrospective study included patients with HNC treated with photon, proton, or combined photon/proton RT, in addition to chemotherapy. All patients received FDG-PET/CT imaging pre-treatment and 3 months post-treatment. The average mean standardized uptake value (Avg SUVmean) and the average maximum standardized uptake value (Avg SUVmax) of the left and right parotid glands were determined by global assessment of FDG activity using OsiriX MD software. A two-tailed paired t test was used to compare Avg SUVmean and Avg SUVmax pre- and post-RT.

Results: Forty-seven HNC patients were included in the study. Parotid gland Avg SUVmean was significantly higher at 3 months post-treatment than pre-treatment (p < 0.05) in patients treated with photon RT, but no significant differences were found between pre- and post-treatment Avg SUVmean in patients treated with proton RT or combined photon/proton RT.

Conclusion: Our results suggest that photon RT may cause radiation-induced inflammation of the parotid gland, and that proton RT, which distributes less off-target radiation, is a safer treatment alternative.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s41824-020-00091-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218117PMC
December 2020

Outcomes Following Discectomy for Far Lateral Disc Herniation Are Not Predicted by Obstructive Sleep Apnea.

Cureus 2021 May 9;13(5):e14921. Epub 2021 May 9.

Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.

Introduction Previous studies have demonstrated that obstructive sleep apnea (OSA) is associated with adverse postoperative outcomes, but few studies have examined OSA in a purely spine surgery population. This study investigates the association of the STOP-Bang questionnaire, a screening tool for undiagnosed OSA, with adverse events following discectomy for far lateral disc herniation (FLDH). Methods All adult patients (n = 144) who underwent FLDH surgery at a single, multihospital, academic medical center (2013-2020) were retrospectively enrolled. Univariate logistic regression was performed to evaluate the relationship between risk of OSA (low- or high-risk) according to STOP-Bang score and postsurgical outcomes, including unplanned hospital readmissions, ED visits, and reoperations. Results Ninety-two patients underwent open FLDH surgery, while 52 underwent endoscopic procedures. High risk of OSA according to STOP-Bang score did not predict risk of readmission, ED visit, outpatient office visit, or reoperation of any kind within either 30 days or 30-90 days of surgery. High risk of OSA also did not predict risk of reoperation of any kind or repeat neurosurgical intervention within 30 days or 90 days of the index admission (either during the same admission or after discharge). Conclusion The STOP-Bang questionnaire is not a reliable tool for predicting post-operative morbidity and mortality for FLDH patients undergoing discectomy. Additional studies are needed to assess the impact of OSA on morbidity and mortality in other spine surgery populations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.14921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189272PMC
May 2021

Venous thromboembolism detected by FDG-PET/CT in cancer patients: a common, yet life-threatening observation.

Am J Nucl Med Mol Imaging 2021 15;11(2):99-106. Epub 2021 Apr 15.

Department of Radiology, Hospital of The University of Pennsylvania Philadelphia, PA, USA.

Cancer patients are at markedly increased risk for venous thromboembolism (VTE). Early detection of VTE may decrease morbidity and mortality in this population. We conducted this study to evaluate the ability of FDG-PET/CT to detect thrombosis in cancer patients. This retrospective study included 131 cancer patients with a history of deep vein thrombosis (DVT) or pulmonary embolism (PE) referred for 2-deoxy-2-[F]-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT). All subjects underwent PET/CT imaging 60 minutes after FDG injection. Images were visually assessed for increased FDG uptake within the venous lumen. For positive cases, clinical follow-up and Doppler ultrasonography and/or contrast-enhanced CT scans were reviewed. FDG-PET/CT revealed abnormal uptake in the venous system of 26 (19.8%) patients. Eighteen (69.2%) had a history of DVT, and 13 (50%) had a history of PE. The most common site of thrombosis was the inferior vena cava (IVC) (n=14, 53.8%), followed by lower extremities veins (n=9, 34.6%), jugular veins (n=2, 7.7%), and superior vena cava (n=1, 3.8%). The presence of thrombi was confirmed by reviewing clinical follow-up in 6 (23.1%) patients. Among this group, thrombosis was detected in lower extremity veins (n=4, 15.8%), jugular veins (n=1, 3.8%), and IVC (n=1, 3.8%). Our study demonstrates that thrombi prior to their clinical manifestation can be detected by FDG-PET/CT in cancer patients. Moving forward, physicians must carefully consider the venous system when reporting FDG-PET/CT for cancer patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165725PMC
April 2021

Charlson Comorbidity Index score predicts adverse post-operative outcomes after far lateral lumbar discectomy.

Clin Neurol Neurosurg 2021 Jul 19;206:106697. Epub 2021 May 19.

Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, PA, USA. Electronic address:

Introduction: The Charlson Comorbidity Index (CCI) score has been shown to predict 10-year all-cause mortality and post-neurosurgical complications but has never been examined in a far lateral disc herniation (FLDH) population. This study aims to correlate CCI score with adverse outcomes following FLDH repair.

Patients And Methods: All patients (n = 144) undergoing discectomy for FLDH at a single, multihospital academic medical system (2013-2020) were retrospectively analyzed. CCI scores were determined for all patients. Univariate logistic regression was used to determine the ability of CCI score to predict adverse outcomes.

Results: Mean age of the population was 61.72 ± 11.55 years, 69 (47.9%) were female, and 126 (87.5%) were non-Hispanic white. Patients underwent either open (n = 92) or endoscopic (n = 52) FLDH repair. Average CCI score among the patient population was 2.87 ± 2.42. Each additional point in CCI score was significantly associated with higher rates of readmission (p = 0.022, p = 0.014) in the 30-day and 30-90-day post-surgery window, respectively, and emergency department visits (p = 0.011) within 30-days. CCI score also predicted risk of reoperation of any kind (p = 0.013) within 30 days of the index operation. In addition, CCI score was predictive of risk of reoperation of any kind (p = 0.008, p < 0.001; respectively) and repeat neurosurgical intervention (p = 0.027, p = 0.027) within 30-days and 90-days of the index admission (either during the same admission or after discharge).

Conclusions: This study suggests that CCI score is a useful metric to predict of numerous adverse postoperative outcomes following discectomy for FLDH.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clineuro.2021.106697DOI Listing
July 2021

Carotid artery molecular calcification assessed by [F]fluoride PET/CT: correlation with cardiovascular and thromboembolic risk factors.

Eur Radiol 2021 Apr 17. Epub 2021 Apr 17.

Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.

Objectives: There is growing evidence that sodium fluoride ([F]fluoride) PET/CT can detect active arterial calcifications at the molecular stage. We investigated the relationship between arterial mineralization in the left common carotid artery (LCC) assessed by [F]fluoride PET/CT and cardiovascular/thromboembolic risk.

Methods: In total, 128 subjects (mean age 48 ± 14 years, 51% males) were included. [F]fluoride uptake in the LCC was quantitatively assessed by measuring the blood-pool-corrected maximum standardized uptake value (SUVmax) on each axial slice. Average SUVmax (aSUVmax) was calculated over all slices and correlated with 10-year risk of cardiovascular events estimated by the Framingham model, CHA2DS2-VASc score, and level of physical activity (LPA).

Results: The aSUVmax was significantly higher in patients with increased risk of cardiovascular (one-way ANOVA, p < 0.01) and thromboembolic (one-way ANOVA, p < 0.01) events, and it was significantly lower in patients with greater LPA (one-way ANOVA, p = 0.02). On multivariable linear regression analysis, age ( = 0.07, 95% CI 0.05 - 0.10, p < 0.01), body mass index ( = 0.02, 95% CI 0.01 - 0.03, p < 0.01), arterial hypertension ( = 0.15, 95% CI 0.08 - 0.23, p < 0.01), and LPA ( = -0.10, 95% CI -0.19 to -0.02, p=0.02) were independent associations of aSUVmax.

Conclusions: Carotid [F]fluoride uptake is significantly increased in patients with unfavorable cardiovascular and thromboembolic risk profiles. [F]fluoride PET/CT could become a valuable tool to estimate subjects' risk of future cardiovascular events although still major trials are needed to further evaluate the associations found in this study and their potential clinical usefulness.

Key Points: • Sodium fluoride ([F]fluoride) PET/CT imaging identifies patients with early-stage atherosclerosis. • Carotid [F]fluoride uptake is significantly higher in patients with increased risk of cardiovascular and thromboembolic events and inversely correlated with the level of physical activity. • Early detection of arterial mineralization at a molecular level could help guide clinical decisions in the context of cardiovascular risk assessment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-021-07917-7DOI Listing
April 2021

Duration of overlap during lumbar fusion does not predict outcomes.

Clin Neurol Neurosurg 2021 Mar 25;205:106610. Epub 2021 Mar 25.

Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Electronic address:

Introduction: The relationship between degree of surgical overlap and adverse postoperative outcomes remains poorly defined. This study aims to evaluate the impact of increasing duration of overlap on lumbar fusion outcomes.

Patients And Methods: 1302 adult patients undergoing overlapping surgery during single-level, posterior-only lumbar fusion at a multi-hospital, university health system were retrospectively assessed. Amount of overlap was calculated as a percentage of total overlap time. Patients were separated into groups with the most (top 10% of patients) and least amounts of overlap (bottom 40% of patients). Using Coarsened Exact Matching, patients with the most and least amounts of overlap were matched on demographics alone, then on both demographics and attending surgeon. Univariate analysis was performed for the whole population and both matched cohorts to compare amount of overlap to risk of adverse postsurgical events. Significance for all analyses was p-value < 0.05.

Results: Duration of overlap was not associated with outcomes in the whole population, demographic-matched, or surgeon-matched analyses. Before exact matching, patients with the most amount of overlap had a significantly higher CCI score (p = 0.031) and shorter length of surgery (p = 0.006). In the demographic matched cohort, patients with increased overlap had a significantly shorter length of surgery (p = 0.001) only. In the surgeon matched cohort, there were no differences in length of surgery or CCI score.

Conclusions: Duration of surgical overlap does not predict adverse outcomes following lumbar fusion. These results suggest that overlapping surgery is a safe practice within this common neurosurgical indication.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clineuro.2021.106610DOI Listing
March 2021

Emerging role of 18F-FDG PET/CT in Castleman disease: a review.

Insights Imaging 2021 Mar 11;12(1):35. Epub 2021 Mar 11.

Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.

Castleman disease (CD) describes a group of rare hematologic conditions involving lymphadenopathy with characteristic histopathology and a spectrum of clinical abnormalities. CD is divided into localized or unicentric CD (UCD) and multicentric CD (MCD) by imaging. MCD is further divided based on etiological driver into human herpesvirus-8-associated MCD, POEMS-associated MCD, and idiopathic MCD. There is notable heterogeneity across MCD, but increased level of pro-inflammatory cytokines, particularly interleukin-6, is an established disease driver in a portion of patients. FDG-PET/CT can help determine UCD versus MCD, evaluate for neoplastic conditions that can mimic MCD clinico-pathologically, and monitor therapy responses. CD requires more robust characterization, earlier diagnosis, and an accurate tool for both monitoring and treatment response evaluation; FDG-PET/CT is particularly suited for this. Moving forward, future prospective studies should further characterize the use of FDG-PET/CT in CD and specifically explore the utility of global disease assessment and dual time point imaging.Trial registration ClinicalTrials.gov, NCT02817997, Registered 29 June 2016, https://clinicaltrials.gov/ct2/show/NCT02817997.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13244-021-00963-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952491PMC
March 2021

An understanding of the atherosclerotic molecular calcific heterogeneity between coronary, upper limb, abdominal, and lower extremity arteries as assessed by NaF PET/CT.

Am J Nucl Med Mol Imaging 2021 15;11(1):40-45. Epub 2021 Feb 15.

Department of Radiology, University of Pennsylvania Philadelphia, United States.

We aimed to quantify the heterogeneity of atherosclerosis in upper and lower limb vessels using F-NaF-PET/CT and compare calcification in coronary arteries to peripheral arteries. 68 healthy controls (42±13.5 years, 35 females, 33 males) and 40 patients at-risk for cardiovascular disease (55±11.9 years, 22 females, 18 males) underwent PET/CT imaging 90 minutes after the injection of F-NaF (2.2 Mbq/Kg). The following arteries were examined: coronary artery (CA), ascending aorta (AS), arch of aorta (AR), descending aorta (DA), abdominal aorta (AA), common iliac artery (CIA), external iliac artery (EIA), femoral artery (FA), popliteal artery (PA). Average SUVmean (aSUVmean) was calculated for each arterial segment. A paired t-test compared the aSUVmean between CA vs. AS, AR, DA, AA, CIA, EIA, FA, and PA. CA aSUVmean in the at-risk group was higher than the healthy control group (0.74±0.04 vs. 0.67±0.04, P=0.03). Furthermore, the F-NaF uptake in the CA was lower than in AS, AR, DA, AA, CIA, EIA, FA, and PA in both healthy (all P≤0.0001) and at-risk (all P≤0.0001). Higher F-NaF uptake in non-cardiac arteries in both healthy controls and patients at-risk suggests CA calcification is a late manifestation of atherosclerosis. This differential expression of atherosclerosis is likely due to interaction of hemodynamic parameters specific to the vascular bed and systemic factors related to the development of atherosclerosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936246PMC
February 2021

F-FDG-PET/CT in the assessment of atherosclerosis in lung cancer.

Am J Nucl Med Mol Imaging 2021 15;11(1):1-9. Epub 2021 Feb 15.

Department of Radiology, University of Pennsylvania Philadelphia, PA, USA.

The aim of this study was to assess the risk of atherosclerosis in patients with lung cancer compared to patients with extrapulmonary malignancies using F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT). We hypothesized that patients with lung cancer would demonstrate increased FDG uptake in the thoracic aorta compared to patients with extrapulmonary cancers. Thirty-four lung cancer patients (21 male, 13 female, 64.1 ± 12.9 yo) were retrospectively compared to seventy-eight patients with extrapulmonary malignancies (46 male, 32 female, 59.6 ± 12.8 yo). Average maximum standardized uptake value (avgSUVmax) and maximum target-to-blood pool ratio (TBRmax) were measured by mapping regions of interest of the ascending aorta, aortic arch, and descending aorta. Two-tailed Student's t-test was used to assess the differences in avgSUVmax and TBRmax between the two groups and between smokers and non-smokers. Age and gender distribution between the groups were not statistically different. AvgSUVmax and TBRmax were statistically significant increase in lung cancer patients compared to extrapulmonary cancer patients in the ascending aorta, aortic arch, and descending aorta, suggesting a lung cancer-associated increased risk of atherosclerosis development. AvgSUVmax was not significantly different between smokers and non-smokers in all sections of the thoracic aorta. Moving forward, large, prospective studies that directly compare PET data between different malignancies of different stages will help determine the role of FDG-PET/CT in assessing paraneoplastic vascular disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936247PMC
February 2021

Tau Imaging in Head Injury.

PET Clin 2021 Apr;16(2):249-260

Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, Oslo 0315, Norway. Electronic address:

Tau proteins play a significant role in a variety of degenerative neurologic conditions. Postmortem neuropathology studies of victims of repeat and severe head trauma have defined a unique spatial expression of neurologic tauopathies in these individuals, known as chronic traumatic encephalopathy. Established and newly developed radiotracers are now being applied to head injury populations with the intent of diagnosis and disease monitoring. This review assesses the role of tau in head injury, the state of tau radiotracer development, and the potential clinical value of tau-PET as derived from head injury studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cpet.2020.12.009DOI Listing
April 2021

Novel Musculoskeletal and Orthopedic Applications of F-Sodium Fluoride PET.

PET Clin 2021 Apr 12;16(2):295-311. Epub 2021 Feb 12.

Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, Oslo 0315, Norway. Electronic address:

PET imaging with F-sodium fluoride (NaF), combined with computed tomography or magnetic resonance, is a sensitive method of assessing bone turnover. Although NaF-PET is gaining popularity in detecting prostate cancer metastases to bone marrow, osseous changes represent secondary effects of cancer cell growth. PET tracers more appropriate for assessing prostate cancer metastases directly portray malignant activity and include F-fluciclovine and prostatic specific membrane antigen ligands. Recent studies investigating NaF-PET suggest utility in the assessment of benign musculoskeletal disorders. Emerging applications in assessing traumatic injuries, joint disease, back pain, orthopedic complications, and metabolic bone disease are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cpet.2020.12.006DOI Listing
April 2021

Non-F-FDG/F-NaF Radiotracers Proposed for the Diagnosis and Management of Diseases of the Heart and Vasculature.

PET Clin 2021 Apr 12;16(2):273-284. Epub 2021 Feb 12.

Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. Electronic address:

F-fluorodeoxyglucose (F-FDG) and F-sodium fluoride (F-NaF) are front-runners in PET. However, these tracers have limitations in the imaging of diseases in the heart. A multitude of other radiotracers have been identified as potentially useful PET agents in the identification of cardiovascular disease. This critical review examines recent studies with the use of non-F-FDG/F-NaF radiotracers in the identification and surveillance of cardiovascular diseases. We highlight the need for further investigation into alternative PET radiotracers to demonstrate their clinical value in the management of these pathologies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cpet.2020.12.005DOI Listing
April 2021

A Critical Review of PET Tracers Used for Brain Tumor Imaging.

PET Clin 2021 Apr 13;16(2):219-231. Epub 2021 Feb 13.

Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. Electronic address:

The brain is a common site for metastases as well as primary tumors. Although evaluation of these malignancies with contrast-enhanced MR imaging defines current clinical practice, F-fluorodeoxyglucose (FDG)-PET has shown considerable utility in this area. In addition, many other tracers targeting various aspects of tumor biology have been developed and tested. This article discusses recent developments in PET imaging and the anticipated role of FDG and other tracers in the assessment of brain tumors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cpet.2020.12.004DOI Listing
April 2021

Letter to the Editor. Cushing the artist: neurosurgery and the liberal arts.

J Neurosurg 2021 Feb 12:1-2. Epub 2021 Feb 12.

3Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2020.12.JNS204148DOI Listing
February 2021

Assessment of atherosclerosis in multiple myeloma and smoldering myeloma patients using F- sodium fluoride PET/CT.

J Nucl Cardiol 2021 Jan 3. Epub 2021 Jan 3.

Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.

Background: To compare the NaF uptake in the thoracic aorta and whole heart, as an early indicator of atherosclerosis, in multiple myeloma (MM) and smoldering multiple myeloma (SMM) patients with a healthy control (HC) group.

Methods: Forty-four untreated myeloma patients (35 MM and nine SMM) and twenty-six age and gender-matched HC subjects were collected. Each individual's NaF uptake in three parts of the aorta (AA: ascending aorta, AR: aortic arch, DA: descending aorta) and the whole heart was segmented. Average global standardized uptake value means were derived by sum of the product of each slice area divided by the sum of those slice areas. Results were reported as target to background ratio (TBR).

Results: There was a significant difference between the NaF uptake in the thoracic aorta of myeloma and HC groups [AA (myeloma = 1.82 ± 0.21, HC = 1.24 ± 0.02), AR (myeloma = 1.71 ± 0.19, HC = 1.28 ± 0.03) and DA (myeloma = 1.96 ± 0.28, HC = 1.38 ± 0.03); P-values < 0.001]. The difference in the whole heart NaF uptake between two groups was also significant (P < 0.001).

Conclusions: We observed a higher uptake of NaF in the thoracic aorta and whole heart of myeloma patients in comparison to the matched control group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12350-020-02446-0DOI Listing
January 2021

Development of an Intraoperative Pipeline for Holographic Mixed Reality Visualization During Spinal Fusion Surgery.

Surg Innov 2020 Dec 31:1553350620984339. Epub 2020 Dec 31.

Department of Neurosurgery, 6572University of Pennsylvania Health System Penn Presbyterian Medical Center, Philadelphia, PA, USA.

. Holographic mixed reality (HMR) allows for the superimposition of computer-generated virtual objects onto the operator's view of the world. Innovative solutions can be developed to enable the use of this technology during surgery. The authors developed and iteratively optimized a pipeline to construct, visualize, and register intraoperative holographic models of patient landmarks during spinal fusion surgery. The study was carried out in two phases. In phase 1, the custom intraoperative pipeline to generate patient-specific holographic models was developed over 7 patients. In phase 2, registration accuracy was optimized iteratively for 6 patients in a real-time operative setting. In phase 1, an intraoperative pipeline was successfully employed to generate and deploy patient-specific holographic models. In phase 2, the registration error with the native hand-gesture registration was 20.2 ± 10.8 mm (n = 7 test points). Custom controller-based registration significantly reduced the mean registration error to 4.18 ± 2.83 mm (n = 24 test points, < .01). Accuracy improved over time (B = -.69, < .0001) with the final patient achieving a registration error of 2.30 ± .58 mm. Across both phases, the average model generation time was 18.0 ± 6.1 minutes (n = 6) for isolated spinal hardware and 33.8 ± 8.6 minutes (n = 6) for spinal anatomy. A custom pipeline is described for the generation of intraoperative 3D holographic models during spine surgery. Registration accuracy dramatically improved with iterative optimization of the pipeline and technique. While significant improvements and advancements need to be made to enable clinical utility, HMR demonstrates significant potential as the next frontier of intraoperative visualization.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1553350620984339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8243385PMC
December 2020

Association between atherosclerotic cardiovascular disease risk score estimated by pooled cohort equation and coronary plaque burden as assessed by NaF-PET/CT.

Am J Nucl Med Mol Imaging 2020 15;10(6):312-318. Epub 2020 Dec 15.

Department of Radiology, University of Pennsylvania Philadelphia, PA, USA.

Pooled Cohort Equations (PCE) combines metabolic and non-metabolic parameters to predict the 10-year risk of atherosclerotic cardiovascular disease (ASCVD). Therefore, we hypothesize that ASCVD risk score is correlated to global cardiac microcalcification, as assessed by F-sodium fluoride-positron emission tomography/computed tomography (NaF-PET/CT). Sixty-one individuals (53.4±8.9 years, 32 females, 100% Caucasian) without known ASCVD underwent NaF-PET/CT imaging. Global cardiac average SUVmean (aSUVmean), also known as the Alavi-Carlsen Calcification Score, was calculated across manually defined regions of interest on each axial slice for each individual. The 10-year ASCVD risk score was determined for each individual using the PCE as per ACC/AHA guidelines, and then individuals were categorized into low-, borderline-, intermediate-, and high-risk groups based on their score. Linear regression analysis was applied to compare each individual's ASCVD score and aSUVmean. Global cardiac aSUVmean stratified by groups estimated by 10-year ASCVD risk score were 0.67±0.09 for low risk (n=32), 0.70±0.11 for borderline risk (n=10), 0.72±0.10 for intermediate risk (n=17), and 0.78±0.10 for high risk (n=2). ASCVD risk score was significantly correlated to aSUVmean (r=0.27, P=0.03). This is among the first studies to compare ASCVD risk scores to cardiac plaque burden as assessed by NaF-PET/CT. Large, prospective studies are needed to further investigate the potential of NaF uptake in ASCVD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724277PMC
December 2020

Utilization of NaF-PET/CT in assessing global cardiovascular calcification using CHADS and CHADS-VASc scoring systems in high risk individuals for cardiovascular disease.

Am J Nucl Med Mol Imaging 2020 15;10(6):293-300. Epub 2020 Dec 15.

Department of Radiology, University of Pennsylvania Philadelphia, United States.

CHADS and CHADS-VASc scores are used to estimate the risk of strokes in patients with atrial fibrillation. We sought to determine the global quantification of cardiovascular molecular calcification in high risk individuals by NaF-PET/CT and compare it with CHADS and CHADS-VASc scores. We identified 40 high risk individuals for cardiovascular disease from the Cardiovascular Molecular Calcification Assessed by F-NaF PET CT (CAMONA) trial and calculated CHADS and CHADS-VASc scores for each. Ninety minutes after NaF injection (2.2 Mbq/kg), PET/CT imaging was performed. CT imaging was done for attenuation correction and anatomic correlation. The global cardiac uptake was calculated from regions of interest manually drawn on axial PET/CT images made in OsirixMD. Global cardiac average SUVmean (aSUVmean) values were calculated, and linear regression analysis was employed for statistical purposes. Subjects had mean age of 55 ± 11.9 SD years, (Range: 23-73 years), female 55%. The sample consisted of subjects with a mean aSUVmax of 2.9 ± 1.4, aSUVmean was 0.8 ± 0.2, CHADS 0.9 ± 0.6 (Range: 0-3), CHADS-VASc 1.8 ± 1.3 (Range: 0-5). Based on the linear regression models, we found a direct correlation between global cardiac aSUVmean and CHADS score (r=0.58, P≤0.0001) and also between global cardiac aSUVmean and CHADS-VASc (r=0.37, P=0.01). Based on the results of our study we conclude that patients with a higher CHADS and CHADS-VASc scores had a higher atherosclerotic burden and could be at greater risk of cardiovascular events. These scoring systems can help with risk stratification for predicting future adverse atherosclerotic events.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724281PMC
December 2020

Comparison of atherosclerotic burden in non-lower extremity arteries in patients with and without peripheral artery disease using F-NaF-PET/CT imaging.

Am J Nucl Med Mol Imaging 2020 15;10(6):272-278. Epub 2020 Dec 15.

Department of Radiology, University of Pennsylvania Philadelphia, United States.

Atherosclerosis is the most common cause of peripheral artery disease (PAD). We compared the atherosclerotic burden in non-lower extremity arteries in patients with and without PAD using F-sodium fluoride (NaF)-PET/CT. We identified five individuals (61.8±6.6 years, one male, four females) with PAD and matched to five individuals without PAD based on age and gender from the unfavorable cardiovascular risk profile group of the CAMONA trial (60±7.2 years, one male, four females). Individuals underwent PET/CT imaging 90 minutes after the injection of NaF (2.2 Mbq/Kg). CT imaging was conducted to account for attenuation correction and anatomic referencing. The NaF uptake was measured by manually defining regions of interest on each axial slice on the following arteries: coronary artery (CA), carotid artery (CR), ascending aorta (AS), arch of aorta (AR), descending aorta (DA), and abdominal aorta (AA). Average SUVmean (aSUVmean) was calculated for each segment. Wilcoxon's signed rank test was used for statistical analysis. The total aSUVmean was higher in the PAD group compared to the non-PAD group (6.54±0.9 vs. 5.03±0.45, P=0.043). Comparison revealed higher NaF uptake in CR, AS, AR, and DA in the PAD group compared to the non-PAD group (0.93±0.25 vs. 0.54±0.14, P=0.01; 1.28±0.20 vs. 0.86±1.19, P<0.01; 1.18±0.17 vs. 0.90±0.19, P=0.03; 1.32±0.24 vs. 0.91±0.15, P=0.01). The NaF uptake in CA and AA was similar between the two groups (0.77±0.04 vs. 0.71±0.05, P=0.11; 1.07±0.28 vs. 1.12±0.30, P=0.82). We found individuals with PAD had higher atherosclerotic burden in the carotid arteries and thoracic aorta compared to non-PAD subjects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724274PMC
December 2020

Global brain glucose uptake on 18F-FDG-PET/CT is influenced by chronic cardiovascular risk.

Nucl Med Commun 2021 Apr;42(4):444-450

Department of Radiology, Hospital of the University of Pennsylvania.

Purpose: The goal of this study was to assess global cerebral glucose uptake in subjects with known cardiovascular risk factors by employing a quantitative 18F-fluorodeoxyglucose-PET/computed tomography (FDG-PET/CT) technique. We hypothesized that at-risk subjects would demonstrate decreased global brain glucose uptake compared to healthy controls.

Methods: We compared 35 healthy male controls and 14 male subjects at increased risk for cardiovascular disease (CVD) as assessed by the systematic coronary risk evaluation (SCORE) tool. All subjects were grouped into two age-matched cohorts: younger (<50 years) and older (≥50 years). The global standardized uptake value mean (Avg SUVmean) was measured by mapping regions of interest of the entire brain across the supratentorial structures and cerebellum. Wilcoxon's rank-sum test was used to assess the differences in Avg SUVmean between controls and at-risk subjects.

Results: Younger subjects demonstrated higher brain Avg SUVmean than older subjects. In addition, in both age strata, the 10-year risk for fatal CVD according to the SCORE tool was significantly greater in the at-risk groups than in healthy controls (younger: P = 0.0304; older: P = 0.0436). In the younger cohort, at-risk subjects demonstrated significantly lower brain Avg SUVmean than healthy controls (P = 0.0355). In the older cohort, at-risk subjects similarly had lower Avg SUVmean than controls (P = 0.0343).

Conclusions: Global brain glucose uptake appears to be influenced by chronic cardiovascular risk factors. Therefore, FDG-PET/CT may play a role in determining the importance of CVD on brain function and has potential for monitoring the efficacy of various therapeutic interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MNM.0000000000001349DOI Listing
April 2021

Magnetic resonance imaging-based partial volume-corrected 18F-sodium fluoride positron emission tomography in the femoral neck.

Nucl Med Commun 2021 Apr;42(4):416-420

Department of Radiology, Hospital of the University of Pennsylvania.

Objectives: 18F-sodium fluoride (NaF) is a radiotracer used in PET that reflects calcium metabolism and osteoblastic activity. In this study, we assessed the construct validity of a novel application of global assessment to measure NaF uptake in the femoral neck as a method of evaluating physiologic changes in osteoblastic metabolism with age.

Methods: Whole-body NaF-PET/computed tomography (CT) images and MRI of 24 male patients with a history of nonmetastatic prostate cancer between the ages of 36 and 82 years (67.8 ± 9.6) were analyzed. A region of interest delineated the entire femoral neck on the PET/CT image to determine the mean standardized uptake value (SUVmean). Correction for the partial volume effect was performed by measuring the volume of inert yellow bone marrow by MRI segmentation. Multiple linear regression was used to assess the relationship of uptake with age and body weight.

Results: The SUVmean with and without partial volume correction decreased with respect to age (P = 0.001 and P = 0.002, respectively). Body weight was not significantly related to any measured PET parameter.

Conclusion: Our results support the use of global NaF uptake with magnetic resonance-derived partial volume correction in the femoral neck. Because osteoblastic metabolism is known to decrease with normal aging, the observed decrease in NaF uptake constitutes evidence for convergent validity, indicating that the proposed methodology likely reflects systemic osteoblastic activity. Future studies of this methodology are warranted in other instances of varying osteoblastic activity such as in metabolic bone diseases and for the evaluation of therapy targeting osteoblastic metabolism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MNM.0000000000001344DOI Listing
April 2021

Utility of FDG-PET/CT in clinical psoriasis grading: the PET-PASI scoring system.

Am J Nucl Med Mol Imaging 2020 15;10(5):265-271. Epub 2020 Oct 15.

Department of Radiology, Hospital of The University of Pennsylvania Philadelphia, PA, USA.

Psoriatic skin lesions are metabolically active, which makes them candidates for imaging with 18-F fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). The aim of our study was to correlate FDG-PET findings with Psoriasis Area and Severity Index (PASI) scores, the most widely-used grading system for psoriasis. Thirty-three subjects and a total of 84 FDG-PET/CT scans from a prospective clinical trial [NCT01553058] with >2 months moderate-to-severe psoriasis were included. Subjects underwent whole-body FDG-PET/CT imaging 60 min after intravenous FDG administration, prior to the start of treatment. Scans were repeated 12 weeks and 52 weeks after baseline scans were conducted and after treatment or placebo administration was initiated. Each subject and scan was graded by our "PET-PASI" scoring system, a qualitative review of multi-plane reconstructions for both attenuation-corrected (AC) and non-attenuation-corrected (NAC) PET images. PASI and PET-PASI scores were correlated using Spearman's rho analysis. Our study demonstrated a significant positive correlation between each subject's corresponding PET-PASI and PASI scores before and during treatment or placebo administration (r=0.53, P<0.001). We also found positive correlations between PET-PASI and PASI scores across different regions of the body (head and neck: r=0.22, upper extremities: r=0.26, trunk: r=0.48, and lower extremities: r=0.58). In conclusion, AC and NAC FDG-PET/CT images may be utilized to evaluate lesions in subjects with moderate-to-severe psoriasis. Our methodology could have future implications in the diagnosis and therapeutic management of psoriasis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675113PMC
October 2020

Correlation of whole-bone marrow dual-time-point F-FDG, as measured by a CT-based method of PET/CT quantification, with response to treatment in newly diagnosed multiple myeloma patients.

Am J Nucl Med Mol Imaging 2020 15;10(5):257-264. Epub 2020 Oct 15.

Department of Radiology, Hospital of The University of Pennsylvania PA, USA.

The practical application of dual-time-point-imaging (DTPI) technique still remains controversial. One of the issues is that current parameters of DTPI quantification suffer from some deficiencies, mainly limited sampling of the diseased sites by confining measurements to specific locations. We aimed to examine the correlation between the percent change from early to delayed scans in whole-bone marrow (WBM) F-FDG uptake, as measured by a CT-based method of PET/CT quantification, and response to treatment in multiple myeloma (MM) patients. Pre-treatment F-FDG-PET/CT scans of 36 newly diagnosed MM patients were collected in a prospective study at 1 h and 3 h post tracer injection (NCT02187731). A threshold algorithm based on bone Hounsfield units on CT was applied to segment and quantify WBM F-FDG uptake. Patients were separated into two treatment groups: high-dose therapy with autologous stem cell transplant (HDT) and non-high dose therapy (non-HDT). The International Response Criteria for MM patients was used to determine each patient's response to treatment. In the HDT group, WBM F-FDG uptake increased significantly in patients that had a poor response to treatment, from a median of 1.31 (IQR: 1.13-1.64) at 1 h to a median of 1.85 (1.45-2.10) at 3 h. The median percent change was 37.77% (IQR: 23.47-46.4), with a range of 6.10-50.73 ( = 0.003). However, no significant change in uptake was observed in patients with a complete response ( = 0.24). The same trend was observed for the non-HDT group. WBM uptake of F-FDG assessed with dual-time-point imaging may have a role in predicting treatment response in MM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675111PMC
October 2020

Imaging Atherosclerosis by PET, With Emphasis on the Role of FDG and NaF as Potential Biomarkers for This Disorder.

Front Physiol 2020 22;11:511391. Epub 2020 Oct 22.

Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.

Molecular imaging has emerged in the past few decades as a novel means to investigate atherosclerosis. From a pathophysiological perspective, atherosclerosis is characterized by microscopic inflammation and microcalcification that precede the characteristic plaque buildup in arterial walls detected by traditional assessment methods, including anatomic imaging modalities. These processes of inflammation and microcalcification are, therefore, prime targets for molecular detection of atherosclerotic disease burden. Imaging with positron emission tomography/computed tomography (PET/CT) using 18F-fluorodeoxyglucose (FDG) and 18F-sodium fluoride (NaF) can non-invasively assess arterial inflammation and microcalcification, respectively. FDG uptake reflects glucose metabolism, which is particularly increased in atherosclerotic plaques retaining macrophages and undergoing hypoxic stress. By contrast, NaF uptake reflects the exchange of hydroxyl groups of hydroxyapatite crystals for fluoride producing fluorapatite, a key biochemical step in calcification of atherosclerotic plaque. Here we review the existing literature on FDG and NaF imaging and their respective values in investigating the progression of atherosclerotic disease. Based on the large volume of data that have been introduced to the literature and discussed in this review, it is clear that PET imaging will have a major role to play in assessing atherosclerosis in the major and coronary arteries. However, it is difficult to draw definitive conclusions on the potential role of FDG in investigating atherosclerosis given the vast number of studies with different designs, image acquisition methods, analyses, and interpretations. Our experience in this domain of research has suggested that NaF may be the tool of choice over FDG in assessing atherosclerosis, especially in the setting of coronary artery disease (CAD). Specifically, global NaF assessment appears to be superior in detecting plaques in tissues with high background FDG activity, such as the coronary arteries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fphys.2020.511391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642524PMC
October 2020

Prognostic significance of F-sodium fluoride in newly diagnosed multiple myeloma patients.

Am J Nucl Med Mol Imaging 2020 25;10(4):151-160. Epub 2020 Aug 25.

Department of Radiology, Hospital of The University of Pennsylvania PA, USA.

Focal bone lesions and fractures due to weakened bone are associated with higher morbidity and mortality of multiple myeloma (MM) patients. F-sodium fluoride (F-NaF) is a sensitive PET radiotracer for detection of abnormal bone metabolism and, therefore, is particularly suited to assess the degree of bone involvement in MM patients. We aimed to investigate the prognostic significance of metabolic active volume (MAV) of F-NaF-avid lesions in MM patients. In addition to MAV, conventional methods of PET quantification, namely SUVmean and SUVmax, were measured in each patient for the purpose of comparison. Thirty-seven newly diagnosed MM patients were included. PET imaging was performed after intravenous administration of 200 MBq NaF. Active bone lesions and fractures on whole-body F-NaF-PET/CT scans were identified. An adaptive thresholding algorithm automatically calculated the total MAV, SUVmean and SUVmax for each patient (ROVER, ABX, Radeberg, Germany). The patients were followed for a median of 39.8 months after treatment (range: 17.8-55.4). The overall survival (OS) of patients with F-NaF-MAV value > 38.65 (36.36% [N of Events/Total N: 4/11]) was significantly shorter than that of patients with F-NaF-MAV value < 38.65 (3.85% [1/26]; = 0.002). In multivariate forward stepwise (conditional LR) Cox regression analysis of prognostic factors of OS (including F-NaF-MAV (> 38.65 or < 38.65), age, gender, beta-2 microglobulin, and revised international staging system), F-NaF-MAV remained the only significant factor (HR: 14.39, = 0.02). The results for PFS were not significant. Moreover, Kaplan-Meier analyses of conventional methods of PET quantification did not reveal any statistically significant log-rank -values. MM patients with high F-NaF-MAV had shorter overall survival, compared to those with low F-NaF-MAV levels (NCT02187731).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486550PMC
August 2020

Association of triglyceride to high density lipoprotein ratio with global cardiac microcalcification to evaluate subclinical coronary atherosclerosis in non-diabetic individuals.

Am J Cardiovasc Dis 2020 15;10(3):241-246. Epub 2020 Aug 15.

Department of Radiology, University of Pennsylvania Philadelphia, United States.

Objective: Triglycerides (TG) to high density lipoprotein (HDL) ratio has been proposed as a marker of insulin resistance and atherosclerosis. We hypothesize that TG/HDL ratio correlates positively with global cardiac microcalcification as assessed by NaF-PET/CT as a surrogate marker for coronary atherosclerosis in healthy non-diabetic individuals.

Method: We identified 68 healthy, non-diabetic individuals (age 41.7 ± 13.5 years; 35/33 female/male) from the CAMONA trial. All underwent PET/CT imaging 90 minutes after NaF injection (2.2 Mbq/Kg). Global cardiac average SUVmean (aSUVmean) was calculated by a trained physician for each individual. Fasting plasma lipid profile (total cholesterol (TC), low-density lipoprotein (LDL), HDL, and TG) and fasting plasma glucose were recorded. TG/HDL ratio was calculated for every individual. Univariate and multivariate linear regression models were used to assess the association between TG/HDL ratio and global cardiac aSUVmean.

Result: On univariate analysis, there was a positive linear association of TG/HDL ratio and global cardiac aSUVmean (r=0.244, B=0.047, P=0.045). On multivariate analysis adjusted for age, gender, systolic blood pressure, diastolic blood pressure, smoking status, total cholesterol, low-density lipoprotein, and fasting plasma glucose, TG/HDL ratio was found to be independently associated with global cardiac aSUVmean (B=0.060, 95% CI: 0.007-0.114, P=0.027).

Conclusion: There was a positive correlation between TG/HDL ratio with global cardiac microcalcification assessed by NaF-PET/CT imaging.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486520PMC
August 2020

Applications of Hybrid PET/Magnetic Resonance Imaging in Central Nervous System Disorders.

PET Clin 2020 Oct 21;15(4):497-508. Epub 2020 Jul 21.

Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. Electronic address:

PET with 18F-fluorodeoxyglucose (FDG) is used to assess a wide array of inflammatory and neoplastic disorders. FDG-PET has shown particular utility in the evaluation of disorders of the central nervous system (CNS). Although fused PET/computed tomography (CT) is frequently used across the globe for these diseases, recent evidence has pointed to PET/magnetic resonance (MR) imaging as a more sensitive and specific molecular imaging modality. This article reviews the literature regarding the advantages of PET/MR imaging compared with PET/CT imaging, especially in CNS disease. It also introduces a new concept for PET-based evaluation of patients with neurodegenerative disorders: global disease assessment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cpet.2020.06.004DOI Listing
October 2020

An Update on the Role of Total-Body PET Imaging in the Evaluation of Atherosclerosis.

PET Clin 2020 Oct 21;15(4):477-485. Epub 2020 Jul 21.

Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. Electronic address:

Fused PET/computed tomography has demonstrated success in the detection and quantification of atherosclerotic plaques. Recently, total-body PET imaging has demonstrated increased sensitivity and specificity in atherosclerosis. This article reviews the literature regarding this novel imaging technique. Moreover, evidence that has pointed toward 18F-sodium fluoride as the radiotracer of choice over 18F-fluorodeoxyglucose for evaluation of plaque burden is discussed. Finally, a global disease assessment is introduced as an adjunct tool for vascular PET imaging.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cpet.2020.06.006DOI Listing
October 2020

Diagnosis and Monitoring of Osteoporosis with Total-Body F-Sodium Fluoride-PET/CT.

PET Clin 2020 Oct 4;15(4):487-496. Epub 2020 Aug 4.

Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.

In recent years, F-Sodium Fluoride (NaF)-PET/CT has seen its role in the detection and management of osteoporosis increase. This article reviews the extent of this application in the literature, its efficacy compared with other comparable imaging tools, and how total-body PET/CT combined with global disease assessment can revolutionize measurement of total osteoporotic disease activity. NaF-PET/CT eventually can be the modality of choice for metabolic bone disorders, especially with these advances in technology and computation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cpet.2020.06.011DOI Listing
October 2020

PET/MR Imaging in Musculoskeletal Precision Imaging - Third wave after X-Ray and MR.

PET Clin 2020 Oct 4;15(4):521-534. Epub 2020 Aug 4.

Department of Radiology, Keck School of Medicine, University of Southern California (USC), Health Sciences Campus, 1500 San Pablo Street, Los Angeles, CA 90033, USA. Electronic address:

18F-Fluorodeoxyglucose PET has been used to evaluate a wide array of inflammatory and neoplastic pathologies. MR imaging has great soft tissue resolution and high accuracy for detection of edema. Combining PET with MR imaging offers substantial advantages in musculoskeletal imaging. Specifically, evidence demonstrates the potential of imaging of bone marrow, soft tissue, and synovia by PET/MR imaging. Because of inherent limitations of H-MR to image cortical bone, there are some challenges; however, the use of 18F-sodium fluoride for PET/MR imaging could change the landscape. This article reviews the literature regarding PET/MR imaging in identification and management of many musculoskeletal diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cpet.2020.06.001DOI Listing
October 2020
-->