Publications by authors named "Ken Herrmann"

332 Publications

[Impact of COVID-19 on Nuclear Medicine Procedures in Germany 2020 - Results of a National Survey].

Nuklearmedizin 2021 Apr 1. Epub 2021 Apr 1.

Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Germany.

Introduction:  The COVID-19 pandemic imposed an unimaginable challenge to the healthcare systems worldwide. This online survey captured the impact of the COVID-19 pandemic on nuclear medicine services in Germany comparing 2020 to 2019.

Materials And Methods:  A web-based questionnaire was developed to record the 2020 numbers of nuclear medicine procedures and, in particular, the change compared with 2019. The changes in nuclear medicine diagnostics and therapy were queried, as well as the extent to which "Coronavirus SARS-CoV-2" recommendations provided by the DGN were implemented.

Results:  91 complete responses were recorded and evaluated. This corresponds to about 20 % of all German nuclear medicine facilities. Nuclear medicine diagnostic tests showed a decrease in scintigraphies for thyroid (15.9 %), bone (8.8 %), lung (7.6 %), sentinel lymph nodes (5.5 %), and myocardium (1.4 %) with small increases in PET/CT examinations (1.2 %) compared with 2019. Among nuclear medicine therapies, reductions were highest for benign indications (benign thyroid 13.3 %, RSO 7.7 %), while changes from 2019 were less pronounced for malignant indications (PRRT: + 2.2 %, PSMA: + 7.4 %, SIRT: -5.9 %, and RJT for thyroid carcinoma -2.4 %). The DGN recommendations for action were fully or partially applied in 90 %.

Conclusions:  The initial significant reduction in nuclear medicine procedures in the first three weeks of the COVID-19 pandemic did not continue, but there was no compensation of the previously not performed services. The decrease in diagnostics and therapy procedures of benign diseases was particularly severe.
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http://dx.doi.org/10.1055/a-1446-7641DOI Listing
April 2021

Evaluation of the Diagnostic Performance of Positron Emission Tomography/Magnetic Resonance for the Diagnosis of Liver Metastases.

Invest Radiol 2021 Mar 25. Epub 2021 Mar 25.

From The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, and Department of Radiology, Xinhua Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston IRCCS, Department of Radiology, The Institute for Hospitalization and Healthcare (IRCCS) SDN, Napoli, Italy Division of Nuclear Medicine, Department of Radiology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston Department of Surgery, Massachusetts General Hospital, Boston Department of Medicine, Massachusetts General Hospital, Boston The Institute for Hospitalization and Healthcare (IRCCS) SDN, Napoli, Italy Department of Radiology and Nuclear Medicine, University Suor Orsola Benincasa and SDN IRCCS, Napoli, Italy Department of Radiology and Nuclear Medicine, Assuta Medical Center and School of Medicine, Tel Aviv University, TLV, Israel Department of Nuclear Medicine, The Chaim Sheba Medical Center Tel Hashomer Israel Departamento de Medicina Nuclear, HM Hospitales, Madrid, Spain Institute of Diagnostic and Interventional Radiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany Department of Radiology and Nuclear Medicine, Massachusetts General Hospital, Boston, MA.

Objective: The aim of this study was to compare the performance of positron emission tomography (PET)/magnetic resonance (MR) versus stand-alone PET and stand-alone magnetic resonance imaging (MRI) in the detection and characterization of suspected liver metastases.

Materials And Methods: This multi-institutional retrospective performance study was approved by the institutional review boards and was Health Insurance Portability and Accountability Act compliant, with waiver of informed consent. Seventy-nine patients with confirmed solid extrahepatic malignancies who underwent upper abdominal PET/MR between February 2017 and June 2018 were included. Where focal hepatic lesions were identified, the likelihood of a diagnosis of a liver metastasis was defined on an ordinal scale for MRI, PET, and PET/MRI by 3 readers: 1 nuclear medicine physician and 2 radiologists. The number of lesions per patient, lesion size, and involved hepatic segments were recorded. Proof of metastases was based on histopathologic correlation or clinical/imaging follow-up. Diagnostic performance was assessed using sensitivity, specificity, positive and negative predictive values, and receiver operator characteristic curve analysis.

Results: A total of 79 patients (53 years, interquartile range, 50-68; 43 men) were included. PET/MR had a sensitivity of 95%, specificity of 97%, positive predictive value of 97%, and negative predictive value of 95%. The sensitivity, specificity, positive predictive value, and negative predictive value of MRI were 88%, 98%, 98%, and 90% and for PET were 83%, 97%, 97%, and 86%, respectively. The areas under the curve for PET/MRI, MRI, and PET were 95%, 92%, and 92%, respectively.

Conclusions: Contrast-enhanced PET/MR has a higher sensitivity and negative predictive value than either PET or MRI alone in the setting of suspected liver metastases. Fewer lesions were characterized as indeterminate by PET/MR in comparison with PET and MRI. This superior performance could potentially impact treatment and management decisions for patients with suspected liver metastases.
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http://dx.doi.org/10.1097/RLI.0000000000000782DOI Listing
March 2021

Complete metabolic response in patients with advanced nonsmall cell lung cancer with prolonged response to immune checkpoint inhibitor therapy.

J Immunother Cancer 2021 Mar;9(3)

Department of Medical Oncology/Haematology, Kliniken Essen-Mitte, Essen, Nordrhein-Westfalen, Germany.

Introduction: Immunotherapy is the new standard of care in advanced nonsmall cell lung cancer (NSCLC). Recently published data show that treatment discontinuation after 12 months of nivolumab treatment is associated with shorter survival. Therefore, the ideal duration of immunotherapy remains unclear, and finding markers of beneficial outcomes is of great importance. Here, we determine the proportion of complete metabolic responses (CMR) in patients who have not progressed after 24 months of immunotherapy.

Methods: This is a retrospective analysis of 45 patients with positron emission tomography using 2-[18F]fluoro-2-deoxy-D-glucose imaging for assessment of residual metabolic activity after at least 24 months. CMR was defined as uptake in tumor lesions below background levels, using mediastinum as a reference. Out of 45 patients, 29 patients had a CMR (64%). CMR was observed more frequently in non-first-line patients. Patients with CMR were younger (median 65.7 vs 75.5, p=0.03). Fourteen patients with CMR have discontinued therapy and have not progressed until time of analysis; however, median follow-up was only 5.6 (range 0.8-17.0) months.

Conclusion: After a minimum of 24 months of palliative immunotherapy for NSCLC, CMR occurred in almost two thirds of patients. Potentially, achievement of CMR might identify patients, for whom palliative immunotherapy may be safely discontinued.
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http://dx.doi.org/10.1136/jitc-2020-002262DOI Listing
March 2021

Positron Emission Tomography and Whole-body Magnetic Resonance Imaging for Metastasis-directed Therapy in Hormone-sensitive Oligometastatic Prostate Cancer After Primary Radical Treatment: A Systematic Review.

Eur Urol Oncol 2021 Mar 6. Epub 2021 Mar 6.

Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy.

Context: Next-generation imaging includes positron emission tomography (PET) imaging and whole-body magnetic resonance imaging (wbMRI) including diffusion-weighted imaging. Accurate quantification of oligometastatic disease using next-generation imaging is important to define the role and value of metastasis-directed therapy (MDT).

Objective: To perform a review of next-generation imaging modalities in the detection of recurrent oligometastatic hormone-sensitive prostate cancer in men who received prior radical treatment for localized disease.

Evidence Acquisition: MEDLINE, Scopus, Cochrane Libraries, and Web of Science databases were systematically searched for studies reporting next-generation imaging and oncological outcomes. An expert panel of urologists, radiation oncologists, radiologists, and nuclear medicine physicians performed a nonsystematic review of strengths and limitations of currently available imaging options for detecting the presence and extent of recurrent oligometastatic disease.

Evidence Synthesis: From 370 articles identified, three clinical trials and 21 observational studies met the following inclusion criteria: metachronous oligometastatic recurrence after radical treatment for prostate cancer, MDT, and hormone-sensitive patients. Androgen deprivation therapy (ADT) was allowed before MDT. Next-generation imaging modalities included PET/computed tomography and/or PET/MRI with the following tracers: choline (n = 1), NaF (n = 1), and prostate-specific membrane antigen (PSMA; n = 1) for clinical trials; choline (n = 7) or PSMA (n = 11) or both (n = 3) for observational studies. The number of metastases ranged from two to five lesions in most studies. In PSMA-based studies, progression-free survival ranged from 19% to 100%, whereas in studies employing choline, progression-free survival ranged from 16% to 93%. Overall, ADT-free survival ranged from 48% to 79%, while local control was reported as 75-100% and prostate-specific antigen response as 23-94%. Among the different PET tracers and wbMRI, PSMA PET is emerging as the most accurate imaging technique in defining the oligometastatic status.

Conclusions: PSMA and choline PET contribute to guiding MDT in men with hormone-sensitive oligometastatic prostate cancer. Further studies are warranted to ascertain their role and optimize the timing of imaging for such patients.

Patient Summary: We looked at the evidence regarding the use of modern imaging techniques to direct additional treatments in men with early spread of prostate cancer after they receive their initial radical treatment. We found that next-generation imaging, in particular prostate-specific membrane antigen and choline positron emission tomography, can successfully guide metastasis-directed therapies, and further trials should evaluate which modalities are best suited to improve outcomes for our patients.
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http://dx.doi.org/10.1016/j.euo.2021.02.003DOI Listing
March 2021

The disappearance act of Nuclear Medicine in the Netherlands: Just a new trick by the great Harry Houdini?

J Nucl Med 2021 Mar 12. Epub 2021 Mar 12.

Department of Nuclear Medicine, Universitätsklinikum Essen, Germany.

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http://dx.doi.org/10.2967/jnumed.121.262190DOI Listing
March 2021

Factors predicting biochemical response and survival benefits following radioligand therapy with [Lu]Lu-PSMA in metastatic castrate-resistant prostate cancer: a review.

Eur J Nucl Med Mol Imaging 2021 Mar 6. Epub 2021 Mar 6.

Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University, Salzburg, Austria.

Background: Prostate cancer (PC) is one of the most common cancers in men. Although the overall prognosis is favorable, the management of metastatic castration-resistant prostate cancer (mCRPC) patients is challenging. Usually, mCRPC patients with progressive disease are considered for radioligand therapy (RLT) after exhaustion of other standard treatments. The prostate-specific membrane antigen (PSMA) labeled with Lutetium-177 ([Lu]Lu-PSMA) has been widely used, showing favorable and successful results in reducing prostate-specific antigen (PSA) levels, increasing quality of life, and decreasing pain, in a multitude of studies. Nevertheless, approximately thirty percent of patients do not respond to [Lu]Lu-PSMA RLT. Here, we only reviewed and reported the evaluated factors and their impact on survival or biochemical response to treatment to have an overview of the potentialprognostic parameters in [Lu]Lu-PSMA RLT.

Methods: Studies were retrieved by searching MEDLINE/PubMed and GoogleScholar. The search keywords were as follows: {("177Lu-PSMA") AND ("radioligand") AND ("prognosis") OR ("predict")}. Studies discussing one or more factors which may be prognostic or predictive of response to [Lu]Lu-PSMA RLT, that is PSA response and survival parameters, were included.

Results: Several demographic, histological, biochemical, and imaging factors have been assessed as predictive parameters for the response to thistreatment; however, the evaluated factors were diverse, and the results mostly were divergent, except for the PSA level reduction after treatment, which unanimously predicted prolonged survival.

Conclusion: Several studies have investigated a multitude of factors to detect those predicting response to [Lu]Lu-PSMA RLT. The results wereinconsistent regarding some factors, and some were evaluated in only a few studies. Future prospective randomized trials are required to detect theindependent prognostic factors, and to further determine the clinical and survival benefits of [Lu]Lu-PSMA RLT.
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http://dx.doi.org/10.1007/s00259-021-05237-yDOI Listing
March 2021

Just another "Clever Hans"? Neural networks and FDG PET-CT to predict the outcome of patients with breast cancer.

Eur J Nucl Med Mol Imaging 2021 Mar 5. Epub 2021 Mar 5.

Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital, Hufelandstraße 55, 45147, Essen, Germany.

Background: Manual quantification of the metabolic tumor volume (MTV) from whole-body F-FDG PET/CT is time consuming and therefore usually not applied in clinical routine. It has been shown that neural networks might assist nuclear medicine physicians in such quantification tasks. However, little is known if such neural networks have to be designed for a specific type of cancer or whether they can be applied to various cancers. Therefore, the aim of this study was to evaluate the accuracy of a neural network in a cancer that was not used for its training.

Methods: Fifty consecutive breast cancer patients that underwent F-FDG PET/CT were included in this retrospective analysis. The PET-Assisted Reporting System (PARS) prototype that uses a neural network trained on lymphoma and lung cancer F-FDG PET/CT data had to detect pathological foci and determine their anatomical location. Consensus reads of two nuclear medicine physicians together with follow-up data served as diagnostic reference standard; 1072 F-FDG avid foci were manually segmented. The accuracy of the neural network was evaluated with regard to lesion detection, anatomical position determination, and total tumor volume quantification.

Results: If PERCIST measurable foci were regarded, the neural network displayed high per patient sensitivity and specificity in detecting suspicious F-FDG foci (92%; CI = 79-97% and 98%; CI = 94-99%). If all FDG-avid foci were regarded, the sensitivity degraded (39%; CI = 30-50%). The localization accuracy was high for body part (98%; CI = 95-99%), region (88%; CI = 84-90%), and subregion (79%; CI = 74-84%). There was a high correlation of AI derived and manually segmented MTV (R = 0.91; p < 0.001). AI-derived whole-body MTV (HR = 1.275; CI = 1.208-1.713; p < 0.001) was a significant prognosticator for overall survival. AI-derived lymph node MTV (HR = 1.190; CI = 1.022-1.384; p = 0.025) and liver MTV (HR = 1.149; CI = 1.001-1.318; p = 0.048) were predictive for overall survival in a multivariate analysis.

Conclusion: Although trained on lymphoma and lung cancer, PARS showed good accuracy in the detection of PERCIST measurable lesions. Therefore, the neural network seems not prone to the clever Hans effect. However, the network has poor accuracy if all manually segmented lesions were used as reference standard. Both the whole body and organ-wise MTV were significant prognosticators of overall survival in advanced breast cancer.
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http://dx.doi.org/10.1007/s00259-021-05270-xDOI Listing
March 2021

Imaging Inflammation with Positron Emission Tomography.

Biomedicines 2021 Feb 19;9(2). Epub 2021 Feb 19.

Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Hufelandstraße 55, D-45147 Essen, Germany.

The impact of inflammation on the outcome of many medical conditions such as cardiovascular diseases, neurological disorders, infections, cancer, and autoimmune diseases has been widely acknowledged. However, in contrast to neurological, oncologic, and cardiovascular disorders, imaging plays a minor role in research and management of inflammation. Imaging can provide insights into individual and temporospatial biology and grade of inflammation which can be of diagnostic, therapeutic, and prognostic value. There is therefore an urgent need to evaluate and understand current approaches and potential applications for imaging of inflammation. This review discusses radiotracers for positron emission tomography (PET) that have been used to image inflammation in cardiovascular diseases and other inflammatory conditions with a special emphasis on radiotracers that have already been successfully applied in clinical settings.
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http://dx.doi.org/10.3390/biomedicines9020212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922638PMC
February 2021

Insights into immunometabolism: A dataset correlating the FDG PET/CT maximum standard uptake value of the primary tumor with the CCL18 serum level in non-small cell lung cancer.

Data Brief 2021 Apr 18;35:106859. Epub 2021 Feb 18.

Department of Thoracic Surgery and Endoscopy, Ruhrlandklinik, West German Cancer Center, University Hospital, University of Duisburg-Essen, Essen, Germany.

Non-small cell lung cancer (NSCLC) is one of the most common malignancies in the western world [1]. Despite multiple therapeutic and diagnostic advances, the overall survival is low and recurrence of NSCLC is a common problem with different treatment regimens. The inclusion of fluorine fluorodeoxyglucose (FDG) positron emission tomography (PET) in combination with computed tomography (CT) in clinical practice was revolutionary for the staging of NSCLC [2]. FDG-PET/CT provides morphological, functional, and metabolic information about the tumor, which is usually highly, metabolically active. Due to the increased glucose uptake, FDG is actively accumulatedin the tumor tissues, resulting in an increased standardized uptake value (SUV). The tumor tissue itself consists of neoplastic cells, extracellular matrix, fibroblasts, and various immune cells. These immune cells include tumor-infiltrating lymphocytes, regulatory T cells, and macrophages. Macrophages have different activation patterns and play an essential role in inflammation and cancer. In particular, tumor-associated macrophages (TAMs) are a specialized group of alternatively activated or M2 macrophages. TAMs release several chemokines that are different from those released by classically activated macrophages found in an inflammatory environment. One of the most important chemokines released by TAMs is CC-chemokine ligand 18 (CCL18). Although CCL18 is present in healthy subjects, its levels are significantly elevated in the serum of patients with NSCLC. It correlates with overall survival and tumor stage in several malignant diseases [3,4]. A recurring problem is that increased glucose metabolism can be found in the inflammatory tissue, which can also lead to an increased SUV in FDG PET/CT, lowering its oncological specificity [5]. In a previous study, we demonstrated that serum CCL18 levels can be used to differentiate between patients with NSCLC and healthy subjects [3]. Hence, we investigated the correlation between serum CCL18 levels and the maximum standardized uptake value (SUV) of the primary tumor using FDG-PET/CT. We found a significant correlation between the SUV of the primary tumor and the serum CCL18 level. The data are important because they can be used to draw conclusions about immunometabolism. Furthermore, they can serve as basis for future prospective clinical studies.
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http://dx.doi.org/10.1016/j.dib.2021.106859DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905341PMC
April 2021

The influence of 68Ga-prostate-specific membrane antigen PET/computed tomography on prostate cancer staging and planning of definitive radiation therapy.

Nucl Med Commun 2021 Mar 1. Epub 2021 Mar 1.

Departments of Nuclear Medicine Radiation Oncology Medical Oncology Surgical Oncology, Amman, Jordan Department of Radiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA Department of Nuclear Medicine, University Clinic Essen, Essen, Germany.

Objectives: Prostate-specific membrane antigen (PSMA) PET/computed tomography (CT) is a novel imaging tool with an evolving role in the management of prostate cancer. This study aims to retrospectively evaluate the impact of 68Ga-PSMA PET/CT on prostate cancer staging and definitive radiation therapy planning.

Methods: Between April 2015 and June 2020, 366 men with prostate cancer were evaluated with 68Ga-PSMA PET/CT. Of these, 108 patients had PSMA PET/CT before radiation therapy. Radiation was given as primary treatment in 58 (54%) and as salvage radiation therapy for biochemical recurrence after primary surgery in 50 (46%) patients, respectively. Patient and disease characteristics were analyzed, and impact of PSMA PET/CT on disease staging and radiotherapy planning was evaluated in comparison to conventional imaging.

Results: Median age at presentation was 69 years, and median prostate-specific antigen was 18 ng/mL (3.6-400) for primary and 0.4 ng/mL (0.1-4.6) for salvage radiation, respectively. The combined change of disease stage rate was 36% (39/108) with 45% (26/58) in the subgroup of primary radiation and 26% (13/50) in the patients intended for salvage radiation. Upstaging was found in 24 (22%) and downstaging in 15 (14%) patients. Radiation planning was changed based on PSMA PET/CT in 34 (31%) patients, including 7 (6.4%) patients in which stereotactic body radiotherapy (SBRT) was added to oligometastatic sites. The radiation field was extended to include pelvic lymph node involvement in 21 patients.

Conclusions: 68Ga-PSMA PET/CT changed the prostate cancer stage in around one-third of men. PSMA PET/CT significantly impacted radiation planning. Further prospective studies are still required.
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http://dx.doi.org/10.1097/MNM.0000000000001394DOI Listing
March 2021

Mental Health Burden of German Cancer Patients before and after the Outbreak of COVID-19: Predictors of Mental Health Impairment.

Int J Environ Res Public Health 2021 02 26;18(5). Epub 2021 Feb 26.

Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany.

The aim of this study was to analyze individual changes in cancer patients' mental health before and after the COVID-19 outbreak, and to explore predictors of mental health impairment. Over a two-week period (16-30 March 2020), 150 cancer patients in Germany participated in this study. Validated instruments assessed demographic and medical data, depression and anxiety symptoms (PHQ-2, GAD-2), distress (DT), and health status (EQ-5D-3L). All instruments were adapted to measure the individual mental health before the COVID-19 outbreak. COVID-19-related fear, trust in governmental actions to face COVID-19, and the subjective level of information regarding COVID-19 were measured. Cancer patients showed a significant increase in depression and anxiety symptoms and distress, while health status deteriorated since the COVID-19 outbreak. Increased depression and generalized anxiety symptoms were predicted by COVID-19-related fear. Trust in governmental actions to face COVID-19 and COVID-19-related fear predicted increases in distress. Higher subjective levels of information predicted less increasing anxiety symptoms and distress. Present data suggests that cancer patients experienced a significant increase in mental health burden since the COVID-19 outbreak. Observed predictors of mental health impairment and protective factors should be addressed, and appropriate interventions established, to maintain mental health of cancer patients during the pandemic.
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http://dx.doi.org/10.3390/ijerph18052318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967708PMC
February 2021

Evaluation of [Ga]Ga-PSMA PET/CT images acquired with a reduced scan time duration in prostate cancer patients using the digital biograph vision.

EJNMMI Res 2021 Feb 28;11(1):21. Epub 2021 Feb 28.

Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany.

Aim: [Ga]Ga-PSMA-11 PET/CT allows for a superior detection of prostate cancer tissue, especially in the context of a low tumor burden. Digital PET/CT bears the potential of reducing scan time duration/administered tracer activity due to, for instance, its higher sensitivity and improved time coincidence resolution. It might thereby expand [Ga]Ga-PSMA-11 PET/CT that is currently limited by Ge/Ga-generator yield. Our aim was to clinically evaluate the influence of a reduced scan time duration in combination with different image reconstruction algorithms on the diagnostic performance.

Methods: Twenty prostate cancer patients (11 for biochemical recurrence, 5 for initial staging, 4 for metastatic disease) sequentially underwent [Ga]Ga-PSMA-11 PET/CT on a digital Siemens Biograph Vision. PET data were collected in continuous-bed-motion mode with a mean scan time duration of 16.7 min (reference acquisition protocol) and 4.6 min (reduced acquisition protocol). Four iterative reconstruction algorithms were applied using a time-of-flight (TOF) approach alone or combined with point-spread-function (PSF) correction, each with 2 or 4 iterations. To evaluate the diagnostic performance, the following metrics were chosen: (a) per-region detectability, (b) the tumor maximum and peak standardized uptake values (SUVmax and SUVpeak), and (c) image noise using the liver's activity distribution.

Results: Overall, 98% of regions (91% of affected regions) were correctly classified in the reduced acquisition protocol independent of the image reconstruction algorithm. Two nodal lesions (each ≤ 4 mm) were not identified (leading to downstaging in 1/20 cases). Mean absolute percentage deviation of SUVmax (SUVpeak) was approximately 9% (6%) for each reconstruction algorithm. The mean image noise increased from 13 to 21% (4 iterations) and from 10 to 15% (2 iterations) for PSF + TOF and TOF images.

Conclusions: High agreement at 3.5-fold reduction of scan time in terms of per-region detection (98% of regions) and image quantification (mean deviation ≤ 10%) was demonstrated; however, small lesions can be missed in about 10% of patients leading to downstaging (T1N0M0 instead of T1N1M0) in 5% of patients. Our results suggest that a reduction of scan time duration or administered [Ga]Ga-PSMA-11 activities can be considered in metastatic patients, where missing small lesions would not impact patient management. Limitations include the small and heterogeneous sample size and the lack of follow-up.
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http://dx.doi.org/10.1186/s13550-021-00765-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914332PMC
February 2021

Correlation between contrast enhancement, standardized uptake value (SUV), and diffusion restriction (ADC) with tumor grading in patients with therapy-naive neuroendocrine neoplasms using hybrid Ga-DOTATOC PET/MRI.

Eur J Radiol 2021 Apr 19;137:109588. Epub 2021 Feb 19.

University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.

Objectives: To investigate a correlation between Ga-DOTATOC PET/MR imaging parameters such as arterial and venous contrast enhancement, diffusion restriction, and maximum standardized uptake value (SUVmax) with histopathological tumor grading in patients with neuroendocrine neoplasms (NEN).

Material And Methods: A total of 26 patients with newly diagnosed, therapy-naive neuroendocrine neoplasms (NEN) were enrolled in this prospective study and underwent Ga-DOTATOC PET/MRI. Images were evaluated regarding NEN lesion number and location, predominant tumor signal intensity on precontrast T1w and T2w images and on postcontrast arterial and portal venous phase T1w images, apparent diffusion coefficient (ADC) and SUVmax. Histopathological tumor grading was assessed and related to PET/MRI features using Pearson's correlation coefficient and Fisher's exact t-test. A binary logistic regression analysis was performed to evaluate a potential relation with an aggressive tumor biology and odds ratios (OR) were calculated.

Results: There was a moderate negative correlation between arterial contrast enhancement and tumor grading (r=-0.35, p = 0.005), while portal venous enhancement showed a weak positive correlation with the Ki-67 index (r = 0.28, p = 0.008) and a non-significant positive correlation with tumor grading (r = 0.19, p = 0.063). Features that were significantly associated with an aggressive tumor biology were the presence of liver metastases (OR 2.6, p = 0.042), T1w hyperintensity in comparison to muscle (OR 12.7, p = 0.0001), arterial phase hyperenhancement (OR 1.4, p = 0.001), diffusion restriction (OR 2.8, p = 0.02) and SUVmax above the hepatic level (OR 7.0, p = 0.001).

Conclusion: The study reveals that PET/MRI features might be useful for prediction of NEN grading and thus provide a preliminary assessment of tumor aggressiveness.
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http://dx.doi.org/10.1016/j.ejrad.2021.109588DOI Listing
April 2021

Diagnostic accuracy of routine calcitonin measurement for the detection of medullary thyroid carcinoma in the management of patients with nodular thyroid disease: a meta-analysis.

Endocr Connect 2021 Mar;10(3):358-370

Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.

Objective: The usefulness of routine calcitonin measurement for early detection of medullary thyroid carcinoma (MTC) in patients with nodular thyroid disease (NTD) has been investigated in various studies. Recently, a Cochrane review has been published on this issue, but a meta-analysis is lacking yet. Therefore, we performed this meta-analysis.

Methods: We performed an electronic search using PubMed/Medline, Embase and the Cochrane Library. Studies assessing the diagnostic accuracy of routine calcitonin measurement for detecting MTC in patients with NDT were selected. Statistics were performed by using Stata software, risk of bias was assessed using Review Manager version 5.3.

Results: Seventeen studies, involving 74,407 patients were included in the study. Meta-analysis, using the bivariate random effects model and the hierarchical summary receiver operating characteristic (HSROC) curve revealed the following pooled estimates: sensitivity 0.99 (95% CI, 0.81-1.00), specificity 0.99 (95% CI, 0.97-0.99), positive likelihood ratio (L+) 72.4 (95% CI, 32.3-162.1), and negative likelihood ratio (L-) 0.01 (95% CI, 0.00-0.23). Meta-regression analysis showed that the threshold of basal calcitonin is an independent factor, but in particular performing stimulation test is not an independent factor.

Conclusions: We showed that routine basal serum calcitonin measurement in the management of patients with thyroid nodules is valuable for the detection of MTC. However, the published cut-off values should be considered and, if applicable, the patients monitored in a wait-and-see strategy by experienced physicians to avoid overtreatment.
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http://dx.doi.org/10.1530/EC-21-0030DOI Listing
March 2021

EANM Focus 3: The International Conference on Molecular Imaging and Theranostics in Neuroendocrine Tumours-the consensus in a nutshell.

Eur J Nucl Med Mol Imaging 2021 Feb 24. Epub 2021 Feb 24.

Department of Nuclear Medicine, Universitätsklinikum, Essen, Germany.

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http://dx.doi.org/10.1007/s00259-021-05262-xDOI Listing
February 2021

An international expert opinion statement on the utility of PET/MR for imaging of skeletal metastases.

Eur J Nucl Med Mol Imaging 2021 Feb 22. Epub 2021 Feb 22.

Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.

Background: MR is an important imaging modality for evaluating musculoskeletal malignancies owing to its high soft tissue contrast and its ability to acquire multiparametric information. PET provides quantitative molecular and physiologic information and is a critical tool in the diagnosis and staging of several malignancies. PET/MR, which can take advantage of its constituent modalities, is uniquely suited for evaluating skeletal metastases. We reviewed the current evidence of PET/MR in assessing for skeletal metastases and provided recommendations for its use.

Methods: We searched for the peer reviewed literature related to the usage of PET/MR in the settings of osseous metastases. In addition, expert opinions, practices, and protocols of major research institutions performing research on PET/MR of skeletal metastases were considered.

Results: Peer-reviewed published literature was included. Nuclear medicine and radiology experts, including those from 13 major PET/MR centers, shared the gained expertise on PET/MR use for evaluating skeletal metastases and contributed to a consensus expert opinion statement. [18F]-FDG and non [18F]-FDG PET/MR may provide key advantages over PET/CT in the evaluation for osseous metastases in several primary malignancies.

Conclusion: PET/MR should be considered for staging of malignancies where there is a high likelihood of osseous metastatic disease based on the characteristics of the primary malignancy, hight clinical suspicious and in case, where the presence of osseous metastases will have an impact on patient management. Appropriate choice of tumor-specific radiopharmaceuticals, as well as stringent adherence to PET and MR protocols, should be employed.
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http://dx.doi.org/10.1007/s00259-021-05198-2DOI Listing
February 2021

E-PSMA: the EANM standardized reporting guidelines v1.0 for PSMA-PET.

Eur J Nucl Med Mol Imaging 2021 Feb 19. Epub 2021 Feb 19.

Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany.

Rationale: The development of consensus guidelines for interpretation of Prostate-Specific Membrane Antigen (PSMA)-Positron Emission Tomography (PET) is needed to provide more consistent reports in clinical practice. The standardization of PSMA-PET interpretation may also contribute to increasing the data reproducibility within clinical trials. Finally, guidelines in PSMA-PET interpretation are needed to communicate the exact location of findings to referring physicians, to support clinician therapeutic management decisions.

Methods: A panel of worldwide experts in PSMA-PET was established. Panelists were selected based on their expertise and publication record in the diagnosis or treatment of PCa, in their involvement in clinical guidelines and according to their expertise in the clinical application of radiolabeled PSMA inhibitors. Panelists were actively involved in all stages of a modified, nonanonymous, Delphi consensus process.

Results: According to the findings obtained by modified Delphi consensus process, panelist recommendations were implemented in a structured report for PSMA-PET.

Conclusions: The E-PSMA standardized reporting guidelines, a document supported by the European Association of Nuclear Medicine (EANM), provide consensus statements among a panel of experts in PSMA-PET imaging, to develop a structured report for PSMA-PET in prostate cancer and to harmonize diagnostic interpretation criteria.
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http://dx.doi.org/10.1007/s00259-021-05245-yDOI Listing
February 2021

Consensus on molecular imaging and theranostics in neuroendocrine neoplasms.

Eur J Cancer 2021 Mar 12;146:56-73. Epub 2021 Feb 12.

Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Nuclear medicine plays an increasingly important role in the management neuroendocrine neoplasms (NEN). Somatostatin analogue (SSA)-based positron emission tomography/computed tomography (PET/CT) and peptide receptor radionuclide therapy (PRRT) have been used in clinical trials and approved by the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA). European Association of Nuclear Medicine (EANM) Focus 3 performed a multidisciplinary Delphi process to deliver a balanced perspective on molecular imaging and radionuclide therapy in well-differentiated neuroendocrine tumours (NETs). NETs form in cells that interact with the nervous system or in glands that produce hormones. These cells, called neuroendocrine cells, can be found throughout the body, but NETs are most often found in the abdomen, especially in the gastrointestinal tract. These tumours may also be found in the lungs, pancreas and adrenal glands. In addition to being rare, NETs are also complex and may be difficult to diagnose. Most NETs are non-functioning; however, a minority present with symptoms related to hypersecretion of bioactive compounds. NETs often do not cause symptoms early in the disease process. When diagnosed, substantial number of patients are already found to have metastatic disease. Several societies' guidelines address Neuroendocrine neoplasms (NENs) management; however, many issues are still debated, due to both the difficulty in acquiring strong clinical evidence in a rare and heterogeneous disease and the different availability of diagnostic and therapeutic options across countries. EANM Focus 3 reached consensus on employing gallium-labelled somatostatin analogue ([Ga]Ga-DOTA-SSA)-based PET/CT with diagnostic CT or magnetic resonance imaging (MRI) for unknown primary NET detection, metastatic NET, NET staging/restaging, suspected extra-adrenal pheochromocytoma/paraganglioma and suspected paraganglioma. Consensus was reached on employing fluorine-fluoro-2-deoxyglucose ([F]FDG) PET/CT in neuroendocrine carcinoma, G3 NET and in G1-2 NET with mismatched lesions (CT-positive/[Ga]Ga-DOTA-SSA-negative). Peptide receptor radionuclide therapy (PRRT) was recommended for second line treatment for gastrointestinal NET with [Ga]Ga-DOTA-SSA uptake in all lesions, in G1/G2 NET at disease progression, and in a subset of G3 NET provided all lesions are positive at [F]FDG and [Ga]Ga-DOTA-SSA. PRRT rechallenge may be used for in patients with stable disease for at least 1 year after therapy completion. An international consensus is not only a prelude to a more standardised management across countries but also serves as a guide for the direction to follow when designing new research studies.
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http://dx.doi.org/10.1016/j.ejca.2021.01.008DOI Listing
March 2021

Comparing lesion detection efficacy and image quality across different PET system generations to optimize the iodine-124 PET protocol for recurrent thyroid cancer.

EJNMMI Phys 2021 Feb 15;8(1):14. Epub 2021 Feb 15.

Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.

Background: In recurrent differentiated thyroid cancer patients, detectability in I PET is limited for lesions with low radioiodine uptake. We assess the improvements in lesion detectability and image quality between three generations of PET scanners with different detector technologies. The results are used to suggest an optimized protocol.

Methods: Datasets of 10 patients with low increasing thyroglobulin or thyroglobulin antibody levels after total thyroidectomy and radioiodine therapies were included. PET data were acquired and reconstructed on a Biograph mCT PET/CT (whole-body, 4-min acquisition time per bed position; OSEM, OSEM-TOF, OSEM-TOF+PSF), a non-TOF Biograph mMR PET/MR (neck region, 4 min and 20 min; OSEM), and a new generation Biograph Vision PET/CT (whole-body, 4 min; OSEM, OSEM-TOF, OSEM-TOF+PSF). The 20-min image on the mMR was used as reference to calculate the detection efficacy in the neck region. Image quality was rated on a 5-point scale.

Results: All detected lesions were in the neck region. Detection efficacy was 8/9 (Vision OSEM-TOF and OSEM-TOF+PSF), 4/9 (Vision OSEM), 3/9 (mMR OSEM and mCT OSEM-TOF+PSF), and 2/9 (mCT OSEM and OSEM-TOF). Median image quality was 4 (Vision OSEM-TOF and OSEM-TOF+PSF), 3 (Vision OSEM, mCT OSEM-TOF+PSF, and mMR OSEM 20-min), 2 (mCT OSEM-TOF), 1.5 (mCT OSEM), and 1 (mMR OSEM 4 min).

Conclusion: At a clinical standard acquisition time of 4 min per bed position, the new generation Biograph Vision using a TOF-based image reconstruction demonstrated the highest detectability and image quality and should, if available, be preferably used for imaging of low-uptake lesions. A prolonged acquisition time for the mostly affected neck region can be useful.
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http://dx.doi.org/10.1186/s40658-021-00361-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884562PMC
February 2021

Impact of EBUS-TBNA in addition to [F]FDG-PET/CT imaging on target volume definition for radiochemotherapy in stage III NSCLC.

Eur J Nucl Med Mol Imaging 2021 Feb 5. Epub 2021 Feb 5.

Department of Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.

PURPOSE/INTRODUCTION: [F]FDG-PET/CT is the standard imaging-technique for radiation treatment (RT) planning in locally advanced non-small cell lung cancer (NSCLC). The purpose of this study was to examine the additional value of endobronchial-ultrasound transbronchial needle aspiration (EBUS-TBNA) to standard PET/CT for mediastinal lymph-node (LN) staging and its impact on clinical target volume (CTV).

Materials And Methods: All consecutive patients with primary stage III NSCLC who underwent [F]FDG-PET/CT and EBUS-TBNA prior to RT were analyzed from 12/2011 to 06/2018. LN-stations were assessed by an expert-radiologist and a nuclear medicine-physician. CTV was evaluated by two independent radiation oncologists. LNs were grouped with increasing distance along the lymphatic chains from primary tumor into echelon-1 (ipsilateral hilum), echelon-2 (LN-station 7 and ipsilateral 4), and echelon-3 (remaining mediastinum and contralateral hilum).

Results: A total of 675 LN-stations of which 291 were positive for tumor-cells, were sampled by EBUS-TBNA in 180 patients. The rate of EBUS-positive LNs was 43% among all sampled LNs. EBUS-positivity in EBUS-probed LNs decreased from 85.8% in echelon-1 LNs to 42.4%/ 9.6% in echelon-2/ -3 LNs, respectively (p < 0.0001, Fisher's exact test). The false discovery rate of PET in comparison with EBUS results rose from 5.3% in echelon-1 to 32.9%/ 69.1% in echelon-2/ -3 LNs, respectively (p < 0.0001, Fisher's exact test). Sensitivity and specificity of FDG-PET/CT ranged from 85 to 99% and 67 to 80% for the different echelons. In 22.2% patients, EBUS-TBNA finding triggered changes of the treated CTV, compared with contouring algorithms based on FDG-avidity as the sole criterion for inclusion. CTV was enlarged in 6.7% patients due to EBUS-positivity in PET-negative LN-station and reduced in 15.5% by exclusion of an EBUS-negative but PET-positive LN-station.

Conclusion: The false discovery rate of [F]FDG-PET/CT increased markedly with distance from the primary tumor. Inclusion of systematic mediastinal LN mapping by EBUS-TBNA in addition to PET/CT has the potential to increase accuracy of target volume definition, particularly in echelon-3 LNs. EBUS-TBNA is recommended as integral part of staging for radiochemotherapy in stage III NSCLC.
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http://dx.doi.org/10.1007/s00259-021-05204-7DOI Listing
February 2021

[Ga]Ga-PSMA-11 PET/CT improves tumor detection and impacts management in patients with hepatocellular carcinoma (HCC).

J Nucl Med 2021 Jan 28. Epub 2021 Jan 28.

Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany.

Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer and the third most frequent cause of cancer-related death. A growing number of local and systemic therapies are available, and accurate staging is critical for management decisions. We assessed the impact of neovasculature imaging by Ga-Ga-PSMA-11 PET/CT on disease staging, prognostic groups and management of patients with HCC compared to staging with computed tomography (CT). Forty patients who received imaging with Ga-Ga-PSMA-11 PET/CT for HCC staging between September 2018 and September 2019 were retrospectively included. Management pre- and post-PET scan was assessed by standardized surveys. Presence of HCC was evaluated by three blinded readers on a per-patient and per-region basis for PET/CT (PET criteria) and multi-phase contrast-enhanced CT (CT criteria) in separate sessions. Lesions were validated by follow-up imaging or histopathology, and progression-free survival (PFS) was recorded. Endpoints were detection rate and positive predictive value (PPV) for Ga-Ga-PSMA-11 PET vs. CT, inter-reader reproducibility, and changes in stage, prognostic groups and management plans. Median age was 65 years (range, 37-81), median Child-Pugh score was 5 (range, 5-9). Most patients were treatment naïve (27 of 40, 67.5%). The sensitivity of PET vs. CT to identify liver lesions for patients with lesion validation was 31/32 (97%) for both modalities, while it was 6/6 (100%) vs. 4/6 (67%) for extra-hepatic lesions. PET and CT each had a PPV of 100% at the liver level. PET vs. CT stage was congruent in 30/40 (75%) patients; upstaging was seen in 8/40 patients (20%), while 2/40 (5%) had downstaging by PET. Intended management changed in 19/40 patients (47.5%); 9/19 of these patients were found to have detectable distant metastases (47.4%) and assigned stage 4 disease, the majority of whom were shifted to systemic therapy (8 of 9, 89%). Two patients underwent Lu-Lu-PSMA-617 radioligand therapy. Median PFS was 5.2 months for the entire cohort; 5.3 months for PET M0, and 4.7 months for PET M1 patients, respectively. Ga-Ga-PSMA-11 PET demonstrated higher accuracy than CT in the detection of HCC metastases and was associated with management change in about half of the patient cohort.
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http://dx.doi.org/10.2967/jnumed.120.257915DOI Listing
January 2021

Machine learning-based differentiation between multiple sclerosis and glioma WHO II°-IV° using O-(2-[18F] fluoroethyl)-L-tyrosine positron emission tomography.

J Neurooncol 2021 Apr 27;152(2):325-332. Epub 2021 Jan 27.

Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.

Introduction: This study aimed to test the diagnostic significance of FET-PET imaging combined with machine learning for the differentiation between multiple sclerosis (MS) and glioma II°-IV°.

Methods: Our database was screened for patients in whom FET-PET imaging was performed for the diagnostic workup of newly diagnosed lesions evident on MRI and suggestive of glioma. Among those, we identified patients with histologically confirmed glioma II°-IV°, and those who later turned out to have MS. For each group, tumor-to-brain ratio (TBR) derived features of FET were determined. A support vector machine (SVM) based machine learning algorithm was constructed to enhance classification ability, and Receiver Operating Characteristic (ROC) analysis with area under the curve (AUC) metric served to ascertain model performance.

Results: A total of 41 patients met selection criteria, including seven patients with MS and 34 patients with glioma. TBR values were significantly higher in the glioma group (TBRmax glioma vs. MS: p = 0.002; TBRmean glioma vs. MS: p = 0.014). In a subgroup analysis, TBR values significantly differentiated between MS and glioblastoma (TBRmax glioblastoma vs. MS: p = 0.0003, TBRmean glioblastoma vs. MS: p = 0.0003) and between MS and oligodendroglioma (ODG) (TBRmax ODG vs. MS: p = 0.003; TBRmean ODG vs. MS: p = 0.01). The ability to differentiate between MS and glioma II°-IV° increased from 0.79 using standard TBR analysis to 0.94 using a SVM based machine learning algorithm.

Conclusions: FET-PET imaging may help differentiate MS from glioma II°-IV° and SVM based machine learning approaches can enhance classification performance.
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http://dx.doi.org/10.1007/s11060-021-03701-1DOI Listing
April 2021

Prostate-specific Membrane Antigen-based Imaging of Castration-resistant Prostate Cancer.

Eur Urol Focus 2021 Mar 20;7(2):279-287. Epub 2021 Jan 20.

West German Cancer Center; Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.

Context: Positron emission tomography (PET) targeting prostate-specific membrane antigen (PSMA) has unprecedented accuracy for localization of initial or recurrent prostate cancer (PC). There is now growing evidence regarding the value of PSMA-PET in patients with advanced PC.

Objective: To review the value of PSMA-PET/computed tomography (CT) in the context of castration-resistant PC (CRPC).

Evidence Acquisition: A search of the PubMed database using the terms "PSMA PET castration resistant prostate cancer" (years 2011-2020) was performed. Reviews, case reports/series, non-English articles, preclinical studies, access-restricted studies, and studies on PSMA radioligand therapy without further analysis of PSMA-PET parameters were subsequently excluded.

Evidence Synthesis: Compared to conventional imaging, PSMA-PET better identifies the true extent of CRPC, especially nonmetastatic CRPC. The clinical benefit of this stage migration is still unclear and needs to be evaluated in further studies. High accuracy of PSMA-PET holds promise for better, PET-guided metastasis-directed treatment in patients with oligometastatic CRPC. PSMA-PET is an essential eligibility criterion for [Lu]-PSMA theranostic applications. Preliminary evidence indicates the value of PSMA-PET for the assessment of treatment responses.

Conclusions: Among other applications, PSMA-PET offers more precise staging for nonmetastatic CRPC. In particular, target localization for metastasis-directed therapy and target expression assessment for PSMA radioligand therapy also hold promise. Potential translation of this diagnostic tool into an oncologic benefit needs to be defined in future trials.

Patient Summary: This review describes how prostate-specific membrane antigen positron emission tomography (PSMA-PET), a new sensitive imaging tool for prostate cancer, might help to guide clinicians in making treatment decisions for advanced prostate cancer.
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http://dx.doi.org/10.1016/j.euf.2021.01.002DOI Listing
March 2021

Evaluation of F-FDG PET/CT images acquired with a reduced scan time duration in lymphoma patients using the digital biograph vision.

BMC Cancer 2021 Jan 14;21(1):62. Epub 2021 Jan 14.

Department of Nuclear Medicine, University of Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany.

Background: The superior accuracy and sensitivity of F-FDG-PET/CT in comparison to morphological imaging alone leads to an upstaging in up to 30% of lymphoma patients. Novel digital PET/CT scanners might enable to reduce administered tracer activity or scan time duration while maintaining diagnostic performance; this might allow for a higher patient throughput or a reduced radiation exposure, respectively. In particular, the radiation exposure reduction is of interest due to the often young age and high remission rate of lymphoma patients.

Methods: Twenty patients with (suspected) lymphoma (6 for initial staging, 12 after systemic treatment, 2 in suspicion of recurrence) sequentially underwent F-FDG-PET/CT examinations on a digital PET/CT (Siemens Biograph Vision) with a total scan time duration of 15 min (reference acquisition protocol) and 5 min (reduced acquisition protocol) using continuous-bed-motion. Both data sets were reconstructed using either standalone time of flight (TOF) or in combination with point spread function (PSF), each with 2 and 4 iterations. Lesion detectability by blinded assessment (separately for supra- and infradiaphragmal nodal lesions and for extranodal lesions), lesion image quantification, and image noise were used as metrics to assess diagnostic performance. Additionally, Deauville Score was compared for all patients after systemic treatment.

Results: All defined regions were correctly classified in the images acquired with reduced emission time, and therefore, no changes in staging were observed. Lesion quantification was acceptable, that is, mean absolute percentage deviation of maximum and peak standardized uptake values were 6.8 and 6.4% (derived from 30 lesions). A threefold reduction of scan time duration led to an increase in image noise from 7.1 to 11.0% (images reconstructed with 4 iterations) and from 4.7 to 7.2% (images reconstructed with 2 iterations). No deviations in Deauville Score were observed.

Conclusion: These results suggest that scan time duration or administered tracer activity can be reduced threefold without compromising diagnostic performance. Especially a reduction of administered activity might allow for a lower radiation exposure and better health economics. Larger trials are warranted to confirm our results.
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http://dx.doi.org/10.1186/s12885-020-07723-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807699PMC
January 2021

Practical recommendations for the management of patients with gastroenteropancreatic and thoracic (carcinoid) neuroendocrine neoplasms in the COVID-19 era.

Eur J Cancer 2021 02 25;144:200-214. Epub 2020 Dec 25.

Department of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada. Electronic address:

Neuroendocrine neoplasms (NENs) are a heterogeneous family of uncommon tumours with challenging diagnosis, clinical management and unique needs that almost always requires a multidisciplinary approach. In the absence of guidance from the scientific literature, along with the rapidly changing data available on the effect of COVID-19, we report how 12 high-volume NEN centres of expertise in 10 countries at different stages of the evolving COVID-19 global pandemic along with members of international neuroendocrine cancer patient societies have suggested to preserve high standards of care for patients with NENs. We review the multidisciplinary management of neuroendocrine neoplasms during the COVID-19 pandemic, and we suggest potential strategies to reduce risk and aid multidisciplinary treatment decision-making. By sharing our joint experiences, we aim to generate recommendations for proceeding to other institutions facing the same challenges.
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http://dx.doi.org/10.1016/j.ejca.2020.11.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836777PMC
February 2021

Prospective Correlation of Prognostic Immunohistochemical Markers With SUV and ADC Derived From Dedicated Hybrid Breast 18F-FDG PET/MRI in Women With Newly Diagnosed Breast Cancer.

Clin Nucl Med 2021 03;46(3):201-205

From the Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf.

Purpose: The aim of this study was to correlate prognostically relevant immunohistochemical parameters of breast cancer with simultaneously acquired SUVs and apparent diffusion coefficient (ADC) values derived from hybrid breast PET/MRI.

Patients And Methods: Fifty-six women with newly diagnosed, therapy-naive, histologically proven breast cancer (mean age, 54.1 ± 12.0 years) underwent dedicated prone 18F-FDG breast PET/MRI. Diffusion-weighted imaging (b-values: 0, 500, 1000 s/mm2) was performed simultaneously with the PET acquisition. A region of interest encompassing the entire primary tumor on each patient's PET/MRI scan was used to determine the glucose metabolism represented by maximum and mean SUV as well as into corresponding ADC maps to assess tumor cellularity represented by mean and minimum ADC values. Histopathological tumor grading and prognostically relevant immunohistochemical markers, that is, Ki67, progesterone receptor, estrogen receptor, and human epidermal growth factor receptor 2 (HER2), were assessed. Pearson correlation coefficients were calculated to compare SUV and ADC values as well as the immunohistochemically markers and molecular subtype. For the comparison with the tumor grading, a Wilcoxon test was used.

Results: A significant inverse correlation between SUV and ADC values derived from breast PET/MRI (r = -0.49 for SUVmean vs ADCmean; r = -0.43 for SUVmax vs ADCmin; both P's < 0.001) was found. Tumor grading and Ki67 both showed a positive correlation with SUVmean from breast PET/MRI (r = 0.37 and r = 0.32, P < 0.01). For immunohistochemical markers, HER2 showed an inverse correlation with ADC values from breast PET/MRI (r = -0.35, P < 0.01). Molecular subtypes significantly correlate with SUVmax and SUVmean (r = 0.52 and r = 0.42, both P's < 0.05). In addition, estrogen receptor expression showed an inverse correlation with SUVmax and SUVmean from breast PET/MRI (r = -0.45 and r = -0.42, P < 0.001).

Conclusions: The present data show a correlation between increased glucose metabolism, cellularity, tumor grading, estrogen and HER2 expression, as well as molecular subtype of breast cancer primaries. Hence, simultaneous 18F-FDG PET and diffusion-weighted imaging from hybrid breast PET/MRI may serve as a predictive tool for identifying high-risk breast cancer patients in initial staging and guide-targeted therapy.
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http://dx.doi.org/10.1097/RLU.0000000000003488DOI Listing
March 2021

Irène Buvat and Ken Herrmann Talk with Alexander Stremitzer, Kevin Tobia, and Aileen Nielsen.

J Nucl Med 2021 Jan;62(1):3-5

ETH Zurich Center for Law and Economics, Zurich, Switzerland; and.

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http://dx.doi.org/10.2967/jnumed.120.260505DOI Listing
January 2021

Correlation of the apparent diffusion coefficient (ADC) and standardized uptake values (SUV) with overall survival in patients with primary non-small cell lung cancer (NSCLC) using F-FDG PET/MRI.

Eur J Radiol 2021 Jan 19;134:109422. Epub 2020 Nov 19.

Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany.

Objectives: To investigate if the combined analysis of the apparent diffusion coefficient (ADC) and standardized uptake values (SUV) measured in F-fluoro-deoxy-glucose-positron emission tomography/magnetic resonance imaging (F-FDG PET/MRI) examinations correlates with overall survival in non-small cell lung cancer (NSCLC).

Material And Methods: A total of 92 patients with newly diagnosed, histopathologically proven NSCLC (44 women and 48 men, mean age 63.1 ± 9.9y) underwent a dedicated thoracic F-FDG PET/MRI examination. A manually drawn polygonal region of interest (ROI), encompassing the entire primary tumor mass, was placed over the primary tumor on fused PET/MR images to determine the maximum and mean standardized uptake values (SUV; SUV) as well as on the ADC maps to quantify the mean and minimum ADC values (ADC, ADC). The impact of these parameters to predict patient's overall survival was tested using hazard ratios (HR). Pearson's correlation coefficients were calculated to assess dependencies between the different values. A p-value < 0.05 indicated statistical significance.

Results: In all 92 patients (n = 59 dead at time of retrospective data collection, mean time till death: 19 ± 16 month, n = 33 alive, mean time to last follow-up: 56 ± 22 month) the Hazard ratios (HR) as independent predictors for overall survival (OS) of SUV were 2.37 (95 % CI: 1.23-4.59, p = 0.008) and for SUV 1.85 (95 % CI: 1.05-3.26, p = 0.03) while ADC showed a HR of 0.95 (95 % CI: 0.57-1.59, p = 0.842) and ADC a HR of 2.01 (95 % CI: 1.2-3.38, p = 0.007). Furthermore, a combined analysis for SUV/ADC, SUV / ADC and SUV/ADC revealed a HR of 2.01 (95 % CI: 1.10-3.67, p = 0.02), 1.75 (95 % CI: 0.97-3.15, p = 0.058) and 1.78 (95 % CI: 1.02-3.10, p = 0.04).

Conclusion: SUV and SUV of the primary tumor are predictors for OS in therapy-naive NSCLC patients, whereas the combined analysis of SUV and ADC values does not improve these results. Therefore, ADC values do not further enhance the diagnostic value of SUV as a prognostic biomarker in NSCLC.
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http://dx.doi.org/10.1016/j.ejrad.2020.109422DOI Listing
January 2021