Publications by authors named "Leonardo Pace"

63 Publications

MRI to assess deep myometrial invasion in patients with endometrial cancer:A multi-reader study to evaluate the diagnostic role of different sequences.

Eur J Radiol 2021 May 4;138:109629. Epub 2021 Mar 4.

Institute of Biostructures and Bioimaging of the National Research Council, Naples, Italy.

Objective: The identification of deep myometrial invasion (DMI) represents a fundamental aspect in patients with endometrial cancer (EC) for accurate disease staging. It can be detected on MRI using T2-weighted (T2-w), diffusion weighted (DWI) and dynamic contrast enhanced sequences (DCE). Aim of the study was to perform a multi-reader evaluation of such sequences to identify the most accurate and its reliability for the best protocol.

Methods: In this multicenter retrospective study, MRI were independently evaluated by 4 radiologists (2 senior and 2 novice) with a sequence-based approach to identify DMI. The performance of the entire protocol was also evaluated. A comparison between the different sequences assessed by the same reader was performed using receiver operating curve and post-hoc analysis. Intraclass Correlation Coefficient (ICC) was used to assess inter- and intra-observer variability.

Results: A total of 92 patients were included. The performance of the readers did not show significant differences among DWI, DCE and the entire protocol. For only one senior radiologist, who reached the highest diagnostic accuracy with the entire protocol (82,6 %), both DWI (p = 0,0197) and entire protocol (p = 0,0039) were found significantly superior to T2-w. The highest inter-observer agreement was obtained with the entire protocol by expert readers (ICC = 0,77).

Conclusions: For the detection of DMI, the performances of DWI and DCE alone and that of a complete protocol do not significantly differ, even though the latter ensures the highest reliability particularly for expert readers. In cases in which T2-w and DWI are consistent, an unenhanced protocol could be proposed.
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http://dx.doi.org/10.1016/j.ejrad.2021.109629DOI Listing
May 2021

Prognostic value of 18F-FDG PET/MRI in patients with advanced oropharyngeal and hypopharyngeal squamous cell carcinoma.

Ann Nucl Med 2021 Apr 11;35(4):479-484. Epub 2021 Feb 11.

IRCCS SDN, Naples, Italy.

Objective: The aim of this study was to evaluate the prognostic value of combined positron emission tomography (PET)/magnetic resonance imaging (MRI) parameters provided by simultaneous 18F-fluorodeoxyglucose (FDG) PET/MRI in patients with locally advanced oropharyngeal and hypopharyngeal squamous cell carcinomas (OHSCC).

Methods: Forty-five patients with locally advanced OHSCC who underwent simultaneous FDG PET/MRI before (chemo)radiotherapy were retrospectively enrolled. Peak standardized uptake value (SULpeak), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the primary lesion were obtained on PET data. On MRI scans, primary tumor size, diffusion and perfusion parameters were assessed using pre-contrast and high-resolution post-contrast images. Ratios between metabolic/metabolo-volumetric parameters and ADC were calculated. Comparisons between groups were performed by Student's t test. Survival analysis was performed by univariate Cox proportional hazard regression analysis. Overall survival curves were obtained by the Kaplan-Meier method and compared with the log-rank test. Survivors were censored at the time of the last clinical control. p < 0.05 was considered statistically significant RESULTS: During follow-up (mean 31.4 ± 21 months), there were 15 deaths. Univariate analysis shows that SULpeak and SULpeak/ADCmean were significant predictors of overall survival (OS). At multivariate analysis, only SULpeak remained a significant predictor of OS. Kaplan-Meier survival analyses showed that patients with higher SULpeak had poorer outcome compared to those with lower values (HR: 3.7, p = 0.007).

Conclusion: Pre-therapy SULpeak of the primary site was predictive of overall survival in patients with oropharyngeal or hypopharyngeal cancer treated with (chemo)radiotherapy.
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http://dx.doi.org/10.1007/s12149-021-01590-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981313PMC
April 2021

MR-enterography in Crohn's disease: what MRE mural parameters are associated to one-year therapeutic management outcome?

Br J Radiol 2021 Feb 13;94(1118):20200844. Epub 2020 Nov 13.

Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.

Objective: To investigate the association of mural parameters of MR-enterography (MRE) with one-year therapeutic management of Crohn's disease (CD) patients.

Methods: CD patients, undergone MRE with diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps between January 2017 and June 2018, were retrospectively enrolled. Extramural complications represented an exclusion criterion because of their potential influence on the intrinsic characteristic of the bowel wall. Two groups of patients were defined on the base of the therapeutic management adopted at 1-year follow-up: Medical-group and surgical-group. The following MRE parameters were evaluated: wall-thickening, longitudinal-extension, T2-fat-suppression-mural-signal, ulcers, mural-oedema, wall-enhancement-rate/pattern, DWI-scores, ADC-values, strictures.

Results: 70 CD patients were enrolled. 57/70 (81.4%) were included in Medical-group and 13/70 (18.6%) in Surgical-group. ADCmean and strictures resulted to be significantly ( < 0.01) different between the two groups. The ADCmean showed to be significantly associated to conservative management [ < 0.01; OR: 0.0003; 95% CI (0.00-0.13)], while the strictures to surgical management [ < 0.01; OR: 29.7; 95% CI (4.9-179.7)]. ROC curves for ADCmean showed that AUC was 0.717 [95% CI (0.607-0.810), < 0.01] with an optimal cut-off value of 1.081 × 10 mm s. A negative predictive value of 90.2% was observed associating ADCmean values > 1.081 × 10 mm s to conservative therapy. 13/17 (76%) strictures with an ADCmean > 1.081 × 10 mm s benefited of conservative therapy.

Conclusion: ADCmean values calculated on DWI-MRE may be associated to 1-year conservative medical therapy in patients with CD without extramural complications.

Advances In Knowledge: ADC maps may be proposed to select CD patients with a lower burden of mural active inflammatory cells and/or fibrosis benefiting of 1-year conservative treatment.
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http://dx.doi.org/10.1259/bjr.20200844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934296PMC
February 2021

Comparison of simultaneous F-2-[18F] FDG PET/MR and PET/CT in the follow-up of patients with differentiated thyroid cancer.

Eur J Nucl Med Mol Imaging 2020 12 30;47(13):3066-3073. Epub 2020 Jun 30.

Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.

Aims: F-FDG PET/CT is the most accurate imaging modality in differentiated thyroid cancer (DTC) patients with either an aggressive histology, an absence of radioiodine uptake in neoplastic foci, or in the absence of imaging abnormalities in patients with an elevated serum thyroglobulin (Tg) level that progresses with time. We evaluated the diagnostic performance of FDG PET/MR in comparison with that of PET/CT.

Methods And Results: Following the injection of a single F-FDG activity, PET/MR and PET/CT were sequentially performed in 40 consecutive patients with DTC previously treated with total thyroidectomy and radioiodine ablation. All patients were then followed up for at least 6 months. PET/MR was positive in 11 patients and PET/CT in 10. PET/MR detected 33 tumor foci and PET/CT 30. During the follow-up of the 12 patients with negative initial PET studies and with a detectable serum Tg, only one patient had a neck recurrence and the administration of an empiric high activity of I in the other 11 patients did not reveal any tumor focus. In the 17 patients with an initial serum Tg level < 2 ng/mL, no recurrence occurred.

Conclusion: This study confirms the high diagnostic accuracy of FDG PET studies in DTC patients with elevated serum Tg levels and shows that PET/MR brings similar information as compared to PET/CT imaging.
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http://dx.doi.org/10.1007/s00259-020-04938-0DOI Listing
December 2020

Risk of structural persistent disease in pediatric patients with low or intermediate risk differentiated thyroid cancer.

Endocrine 2021 Feb 11;71(2):378-384. Epub 2020 Jun 11.

Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.

Purpose: In pediatric patients with differentiated thyroid cancer (DTC), the risk of recurrence is high and the indication for postoperative I administration is still debated. The aim of this study was to assess the outcome in low and intermediate risk pediatric DTC patients.

Methods: We retrospectively evaluated 45 pediatric patients with low or intermediate risk DTC, treated with surgery and I between 1992 and 2002 and with no detectable antithyroglobulin (Tg) antibodies. Follow-up was performed every 6-12 months with Tg blood level determination and imaging procedures.

Results: During follow-up (64 ± 53 months), 15 events occurred (33% cumulative event rate, with an annual event rate of 5% person years). Five of these patients were submitted to additional surgery and all these 15 patients underwent a second I treatment course. All patients were alive at the end of the follow-up. Structural persistent disease occurred more frequently in patients at intermediate risk (p < 0.01) and in those with Tg values after thyroid hormone withdrawal >10 ng/ml before I therapy (p < 0.01). At multivariate analysis, only a postoperative thyroid stimulating hormone-stimulated Tg level >10 ng/ml was an independent predictor of persistent disease.

Conclusions: In pediatric patients with DTC, postoperative high stimulated Tg values (>10 ng/ml) should be taken into account for deciding the extent of both initial treatment and follow-up.
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http://dx.doi.org/10.1007/s12020-020-02379-1DOI Listing
February 2021

Brown Adipose Tissue in Breast Cancer Evaluated by [F] FDG-PET/CT.

Mol Imaging Biol 2020 08;22(4):1111-1115

IRCCS SDN, Naples, Italy.

Purpose: Recently brown adipose tissue (BAT) activation has been proposed to have a possible role in breast cancer. The aim of this study was to evaluate BAT activation in patients with breast cancer and its relationship with molecular characteristics of tumor.

Procedures: The study group comprised 79 patients with histologically proven ductal breast carcinoma (51 ± 13 years). Data on distribution, intensity (SUVmax), and total metabolic activity (TMA) of BAT were obtained from [F] FDG-PET/CT. Clinical and biochemical data were obtained from the database.

Results: BAT activation was present in 12 of the 79 patients (15.2 %). Patients with BAT activation were younger and had a lower body mass index (BMI) (p < 0.05 and p < 0.0005, respectively) and showed less frequently metastasis (p < 0.05). No significant differences were found in estrogen receptor (ER), progesterone receptor (PgR), Ki67, grade, and in molecular subtypes. In patients younger than 55 years and with a BMI < 26, no significant differences were observed between patients with and without BAT activation. In the 12 patients with BAT activation, a significant inverse correlation was observed between TMA and BMI (r = - 0.64, p < 0.05). TMA and SUVmax were higher in grade 2 than in grade 3 patients. No significant differences were found in both TMA and SUVmax between patients with and without lymph node metastases. A significant difference in both TMA and SUVmax was observed among different molecular types, with luminal B patients showing higher values.

Conclusions: In conclusion, the present study suggests a relation between BAT activation and positive known prognostic factor in breast cancer, such as intermediate tumor grade and luminal B cancer type.
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http://dx.doi.org/10.1007/s11307-020-01482-zDOI Listing
August 2020

Visual and volumetric parameters by 18F-FDG-PET/CT: a head to head comparison for the prediction of outcome in patients with multiple myeloma.

Ann Hematol 2020 Jan 27;99(1):127-135. Epub 2019 Nov 27.

Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.

In multiple myeloma (MM) patients, 18F-FDG-PET/CT allows either the detection of disease spread by using visual parameters based on the Italian Myeloma criteria for PET Use (IMPeTUs) or the direct measurement of metabolic tumor burden by volume-based parameters such as metabolic tumor volume (MTV). The purpose is to evaluate the contribution of visual and volumetric parameters in the prediction of progression-free survival (PFS) and overall survival (OS) in MM patients. Forty-seven patients in stage IIIA who had undergone whole-body 18F-FDG-PET/CT were retrospectively evaluated. In each patient, visual parameters were determined and compared with volumetric parameters for PFS and OS prediction after a mean follow-up period of 53 months. Among the visual and volumetric parameters tested, a statistically significant difference was found between maximum standardized uptake value, MTV, total lesion glycolysis, and number of lytic lesions of patients with (n = 26) or without (n = 21) progression (p = 0.0400, p = 0.0065, p = 0.015, and p = 0.0220, respectively) and of dead (n = 24) vs survivors (n = 23) (p = 0.0171, p = 0.0037, p = 0.0060, and p = 0.0270, respectively). At univariate and multivariate analysis, MTV and hemoglobin were predictive of both PFS (p = 0.008) and OS (p = 0.0026). The best MTV discriminative value assessed by receiver operating characteristic curve analysis for predicting both PFS and OS was 39.4 ml. By Kaplan-Meier analysis and log-rank test, PFS and OS were significantly better in patients with MTV ≤ 39.4 ml (p = 0.0004 and p = 0.0001, respectively) as compared with those having an MTV higher than the cutoff. The volume-based parameter MTV determined by 18F-FDG-PET/CT may be used in the prediction of PFS and OS in myeloma patients.
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http://dx.doi.org/10.1007/s00277-019-03852-2DOI Listing
January 2020

Clinically significant prostate cancer detection on MRI: A radiomic shape features study.

Eur J Radiol 2019 Jul 7;116:144-149. Epub 2019 May 7.

Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.

Purpose: Prostate multiparametric MRI (mpMRI) is the imaging modality of choice for detecting clinically significant prostate cancer (csPCa). Among various parameters, lesion maximum diameter and volume are currently considered of value to increase diagnostic accuracy. Quantitative radiomics allows for the extraction of more advanced shape features. Our aim was to assess which shape features derived from MRI index lesions correlate with csPCa presence.

Materials And Methods: We retrospectively enrolled 75 consecutive subjects, who underwent mpMRI on a 3 T scanner, divided based on MRI index lesion Gleason Score in a csPCa group (GS > 3 + 4, n = 41) and a non-csPCa one (n = 34). Ten shape features were extracted both from axial T2-weighted and ADC maps images, after lesion tridimensional segmentation. Univariable and multivariable logistic analysis were used to evaluate the relationship between shape features and csPCa. Diagnostic performance was assessed measuring the area under the curve of the receiver operating characteristic (ROC) analysis. Diagnostic accuracy, sensitivity, and specificity were determined using the best cut-off on each ROC. A P value < 0.05 was considered statistically significant.

Results: Univariable analysis demonstrated that almost every shape feature was statistically significant between csPCa e non-csPCa groups. However, multivariable analysis revealed that the parameter defined as surface area to volume ratio (SAVR), especially when extracted from ADC maps is the strongest independent predictor of csPCa among tested shape features.

Conclusion: The radiomic shape feature SAVR, extracted from ADC maps after index lesion segmentation, appears as a promising tool for csPCa detection.
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http://dx.doi.org/10.1016/j.ejrad.2019.05.006DOI Listing
July 2019

Outcome of Patients With Differentiated Thyroid Cancer Treated With 131-Iodine on the Basis of a Detectable Serum Thyroglobulin Level After Initial Treatment.

Front Endocrinol (Lausanne) 2019 12;10:146. Epub 2019 Mar 12.

Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Napoli, Italy.

In patients with differentiated thyroid cancer (DTC) and raising serum thyroglobulin (Tg) after total or near-total thyroidectomy and I remnant ablation an empiric I therapy may be considered. However, outcome data after empiric therapy in did not show a clear evidence of improved survival. We assessed the efficacy of such empiric I therapy in patients with DTC and evaluated the long-term outcome. A total of 100 patients with DTC showing raised Tg level during follow-up after thyroidectomy and I ablation were treated with a further I therapy (6.1 ± 1.7 GBq). Whole-body scan (WBS) was performed 5-7 days after therapy. Tg value at 12 months after I therapy was considered as an indicator of treatment response: ≤1.5 ng/ml complete remission (CR), >50% decrease partial remission (PR), higher than pre-therapy progression disease (PD), all other cases stable disease (SD). Patients were followed-up for 96 ± 75 months. After 12 months, 62% of patients were in CR, 16% in PR, 8% in SD, and 14% in PD. WBS was positive in 41% of patients and negative in 59% ( = NS). Among patients with local recurrences at WBS 89% showed either CR or PR, while 71% of patients with distant metastases were in SD or PD ( < 0.001). Distant metastases at WBS ( < 0.05), CR ( < 0.0001), and CR + PR ( < 0.0001) were predictors of both progression free survival and overall survival. There is a beneficial effect of I therapy on outcome of patients with DTC treated on the basis of elevated Tg value. In these patients, survival is affected by achievement of CR or PR at 12 months evaluation after I therapy and by the presence of distant metastases at WBS.
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http://dx.doi.org/10.3389/fendo.2019.00146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6423899PMC
March 2019

Predictors of outcome in patients with de novo diagnosis of heart failure with reduced ejection fraction: Role of combined myocardial and lung Iodine-123 Meta-Iodobenzylguanidine imaging.

J Nucl Cardiol 2021 Feb 13;28(1):72-85. Epub 2019 Feb 13.

U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.

Background: The predictors of outcome in patients with de novo diagnosis of heart failure (HF) with reduced ejection fraction (HFrEF) are poorly known.

Methods And Results: All consecutive HFrEF patients admitted between October 2012 and November 2017 with their first episode of HF were scheduled for an outpatient follow-up. After 3 months, patients with confirmed HFrEF underwent Iodine-123 Meta-Iodobenzylguanidine imaging. We defined three study endpoints: HF rehospitalization, cardiac death and all-cause death. Eighty-four patients were enrolled. During follow-up (39.9 ± 18.6 months) HF rehospitalization occurred in 33 cases, cardiac death in 18 and all-cause death in 24. At multivariate analysis, systolic pulmonary arterial pressure (sPAP; HR: 1.047; p = .027) and Late lung to heart ratio (L/H; HR: 1.341; p < .001) independently predict HF rehospitalization; left ventricular end-systolic volume (LVESV; HR: 1.016; p = .017), sPAP (HR: 1.064; p = .034) and Late L/H (HR: 1.323; p = .009) were predictors of cardiac death; LVESV (HR: 1.013; p = .018) and Late L/H (HR: 1.245; p = .012) were independent predictors of all-cause death. Kaplan-Meier analysis of the individual predictors confirmed their prognostic ability during follow-up; of note, the Late L/H cut-off of 1.1 improved the risk stratification capability of echocardiographic parameters.

Conclusions: Late L/H independently predicts HF rehospitalization, cardiac death and all-cause death in patients with de novo diagnosis of HFrEF and improves the prognostic stratification capability of conventional echocardiographic parameters.
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http://dx.doi.org/10.1007/s12350-019-01637-8DOI Listing
February 2021

Performance of FDG-PET/CT in solitary pulmonary nodule based on pre-test likelihood of malignancy: results from the ITALIAN retrospective multicenter trial.

Eur J Nucl Med Mol Imaging 2018 10 7;45(11):1898-1907. Epub 2018 May 7.

Struttura Complessa di Medicina Nucleare, Ospedale San Giuseppe Moscati, Avellino, Italy.

Purpose: The aim of this study was to determine the performance of F-FDG-PET/CT in patients with solitary pulmonary nodule (SPN), stratifying the risk according to the likelihood of pulmonary malignancy.

Methods: FDG-PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. FDG uptake in SPN was assessed by a 4-point scoring system and semiquantitative analysis using the ratio between SUVmax in SPN and SUVmean in mediastinal blood pool (BP) and between SUVmax in SPN and SUVmean in liver (L). Histopathology and/or follow-up data were used as standard of reference.

Results: SPN was malignant in 180 (36%) patients, benign in 175 (35%), and indeterminate in 147 (29%). The 355 patients with a definitive SPN nature (malignant or benign) were considered for the analysis. Considering FDG uptake ≥ 2, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy were 85.6%, 85.7%, 86%, 85.2%, and 85.6% respectively. Sensitivity and PPV were higher (P < 0.05) in intermediate and high-risk patients, while specificity and NPV were higher (P < 0.05) in low-risk patients. On receiver operating characteristic curve analysis, the cut-offs for better discrimination between benign and malignant SPN were 1.56 (sensitivity 81% and specificity 87%) and 1.12 (sensitivity 81% and specificity 86%) for SUVmax/SUVmeanBP and SUVmax/SUVmeanL respectively. In intermediate and high-risk patients, including the SUVmax/SUVmeanBP, the specificity shifted from 85% and 50% to 100%.

Conclusion: Visual FDG-PET/CT has an acceptable performance in patients with SPN, but accuracy improves when SUVratios are considered, particularly in patients with intermediate and high risk of malignancy.
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http://dx.doi.org/10.1007/s00259-018-4016-1DOI Listing
October 2018

Risk-related F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule: the ITALIAN multicenter trial.

Eur J Nucl Med Mol Imaging 2018 10 5;45(11):1908-1914. Epub 2018 May 5.

Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Napoli, Italy.

Purpose: Diagnosis of solitary pulmonary nodule (SPN) is an important public health issue and F-FDG PET/CT has proven to be more effective than CT alone. Pre-test risk stratification and clinical presentation of SPN could affect the diagnostic strategy. A relevant issue is whether thoracic segmental (s)-PET/CT could be implemented in patients with SPN. This retrospective multicenter study compared the results of FDG whole-body (wb)-PET/CT to those of s-PET/CT.

Methods: F-FDG PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. The thoracic part of wb-PET/CT, considered s-PET/CT, was compared to wb-PET/CT. Clinical and PET/CT variables were investigated for SPN characterization as well as for identification of patients in whom s-PET/CT could be performed. Histopathology or follow-up data were used as a reference.

Results: In the study population, 36% had malignant, 35% benign, and 29% indeterminate SPN. F-FDG uptake indicative of thoracic and extra-thoracic lesions was detectable in 13% and 3% of the patients. All patients with extra-thoracic metastases (n = 13) had thoracic lymph node involvement and highest F-FDG uptake at level of SPN (negative predictive value 100%). Compared to wb-PET/CT, s-PET/CT could save about 2/3 of F-FDG dose, radiation exposure or scan-time, without affecting the clinical impact of PET/CT.

Conclusion: Pre-test probability of malignancy can guide the diagnostic strategy of FDG-PET/CT in patients with SPN. In subjects with low-intermediate pretest probability s-PET/CT imaging might be planned in advance, while in those at high risk and with thoracic lymph node involvement a wb-PET/CT is necessary.
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http://dx.doi.org/10.1007/s00259-018-4043-yDOI Listing
October 2018

2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography in primary extranodal lymphomas: treatment response evaluation and prognosis.

Q J Nucl Med Mol Imaging 2020 Jun 24;64(2):219-225. Epub 2018 Apr 24.

Scuola Medica Salernitana Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy.

Background: We evaluated the role of [18F]FDG PET/CT in tumor response assessment and prognosis of primary extranodal lymphoma (PEL) patients.

Methods: We examined retrospectively, 56 PEL patients: 31 with aggressive diffuse large B cell lymphoma (DLBCL) and 25 with indolent lymphoma (20 mucosa-associated lymphoid tissue lymphoma and five follicular lymphoma). All patients had undergone [18F]FDG PET/CT at diagnosis (PET-I) and 50 of them also after therapy (PET-II). Moreover, 52 patients were subjected to a mean follow-up period of 76 months.

Results: PET-I was positive in 50 (89%) patients (mean SUVmax 10.3±6.7). In the assessment of tumor response, according to Lugano classification, 45 patients showed complete metabolic response (CMR), four patients had partial metabolic response (PMR) and one had progressive metabolic disease (PMD). Based on 66% ΔSUVmax cut-off, among CMR patients, 41 showed a ΔSUVmax>66% whereas among non-responders, four patients showed a ΔSUVmax<66%. At follow-up, univariate analysis showed that age, performance status, prognostic index, ΔSUVmax and Lugano classification predicted progression-free survival (PFS) (P<0.05), while, performance status, prognostic index, ΔSUVmax and Lugano classification predicted overall survival (OS) (P<0.05). At multivariate analysis only Lugano classification was retained in the model for prediction of both PFS (P<0.05) and OS (P<0.05). By Kaplan-Meier analysis and log-rank testing both PFS and OS were significantly better in patients in CMR as compared to patients in PMR or PMD according to Lugano classification (P<0.01).

Conclusions: [18F]FDG PET/CT represents a useful tool in the detection of disease response and in the evaluation of outcome in PEL patients.
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http://dx.doi.org/10.23736/S1824-4785.18.03043-1DOI Listing
June 2020

Assessment of acute myocarditis by cardiac magnetic resonance imaging: Comparison of qualitative and quantitative analysis methods.

J Nucl Cardiol 2019 06 26;26(3):857-865. Epub 2017 Oct 26.

Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.

Background: To compare cardiac magnetic resonance (CMR) qualitative and quantitative analysis methods for the noninvasive assessment of myocardial inflammation in patients with suspected acute myocarditis (AM).

Methods: A total of 61 patients with suspected AM underwent coronary angiography and CMR. Qualitative analysis was performed applying Lake-Louise Criteria (LLC), followed by quantitative analysis based on the evaluation of edema ratio (ER) and global relative enhancement (RE). Diagnostic performance was assessed for each method by measuring the area under the curves (AUC) of the receiver operating characteristic analyses. The final diagnosis of AM was based on symptoms and signs suggestive of cardiac disease, evidence of myocardial injury as defined by electrocardiogram changes, elevated troponin I, exclusion of coronary artery disease by coronary angiography, and clinical and echocardiographic follow-up at 3 months after admission to the chest pain unit.

Results: In all patients, coronary angiography did not show significant coronary artery stenosis. Troponin I levels and creatine kinase were higher in patients with AM compared to those without (both P < .001). There were no significant differences among LLC, T2-weighted short inversion time inversion recovery (STIR) sequences, early (EGE), and late (LGE) gadolinium-enhancement sequences for diagnosis of AM. The AUC for qualitative (T2-weighted STIR 0.92, EGE 0.87 and LGE 0.88) and quantitative (ER 0.89 and global RE 0.80) analyses were also similar.

Conclusions: Qualitative and quantitative CMR analysis methods show similar diagnostic accuracy for the diagnosis of AM. These findings suggest that a simplified approach using a shortened CMR protocol including only T2-weighted STIR sequences might be useful to rule out AM in patients with acute coronary syndrome and normal coronary angiography.
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http://dx.doi.org/10.1007/s12350-017-1109-3DOI Listing
June 2019

Prognostic role of FDG PET/CT in patients with differentiated thyroid cancer treated with 131-iodine empiric therapy.

Medicine (Baltimore) 2017 Oct;96(42):e8344

Istituto di Biostrutture e Bioimmagini, CNR Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli FedericoII IRCCS - SDN, Napoli Medicina Nucleare, IRCCS - CROB, Rionero in Vulture Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana," Università degli Studi di Salerno, Salerno, Italy.

Background: To assess the long-term prognostic value of F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with differentiated thyroid carcinoma (DTC) undergoing empiric radioiodine (RAI) therapy due to raising values of thyroglobulin (Tg).

Methods: Forty-nine patients with histological diagnosis of DTC (31 with papillary and 18 with follicular carcinoma) follow-up for a mean period of 7.9 ± 5 years after empiric RAI therapy were retrospectively analyzed.

Results: FDG-PET/CT was negative in 15 (30.6%) patients and positive in 34 (69.4%), whereas postradioiodine therapy whole body scan (t-WBS) was negative in 16 (32.7%) and positive in 33 (67.3%) patients. FDG-PET/CT and t-WBS were in agreement in 32 patients (7 both negative and 25 both positive); on the contrary, in 17 patients there was disagreement between FDG-PET/CT and t-WBS (P =ns). At short-term follow-up, Tg normalized in 19 (38.8%) patients and was unchanged or increased in 30 (61.2%). Of the 15 patients with negative FDG-PET/CT, 11 (73.3%) showed Tg normalization, whereas of the 34 patients with positive FDG-PET/CT, only 8 (23.5%) had Tg normalization (χ =8.9, P < .005). At multivariate analysis, FDG-PET/CT and Tg normalization at short-term follow-up were independent predictors of disease-free survival (χ =26.3, P < .0001), while Tg normalization was the only variable associated with overall survival χ =7.2, P < .01).

Conclusion: FDG-PET/CT in association with Tg normalization at short-term follow-up may be useful for long-term prognostic stratification in DTC patients.
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http://dx.doi.org/10.1097/MD.0000000000008344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5662418PMC
October 2017

Italian Tailored Assessment of Lung Indeterminate Accidental Nodule by Proposing a Segmental Pet/Computed Tomography (s-Pet/Ct): Rationale And Study Design of a Retrospective, Multicenter Trial.

Curr Radiopharm 2018 ;11(1):46-49

University of Naples Federico II, Naples, Italy.

Background: The Italian Tailored Assessment of Lung Indeterminate Accidental Nodule (ITALIAN) is a retrospective, multicenter trial designed to compare the diagnostic information provided by segmental positron emission tomography (PET)/computed tomography (CT) (s-PET/CT) with those of whole body (wb)-PET/CT in patients with single pulmonary nodules (SPN). This report describes the details and implications of the ITALIAN trial design.

Methods And Results: Between September 2016 and May 2017, 502 consecutive patients (302 men, mean age 67±12 years) with SPN undergoing 18F-fluorodeoxyglucose (FDG) PET/CT were enrolled. PET/CT images will be visually and semiquantitatively evaluated. For visual analysis, a 4-point scoring system (1=absent; 2=mild; 3=moderate and 4=intense) will be used; for semiquantitative analysis, maximum standardized uptake value (SUV) in the SPN and mean SUV in the mediastinal blood pool and in the liver will be computed.

Conclusion: The results of this trial might help to define the role of s-PET/CT in patients with SPN. This trial will also evaluate the impact on radiobiology and costs subsequent the introduction of this alternative imaging acquisition modality.
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http://dx.doi.org/10.2174/1874471010666171002113700DOI Listing
August 2018

Evaluation of metabolic response with F-FDG PET-CT in patients with advanced or recurrent thymic epithelial tumors.

Cancer Imaging 2017 Mar 7;17(1):10. Epub 2017 Mar 7.

Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, Edificio 10, 80131, Naples, Italy.

Background: Patients with advanced or recurrent thymic epithelial tumors (TETs) often need several consecutive lines of chemotherapy. The aim of this retrospective monocentric study was to test whether F-Fluorodeoxyglucose positron emission tomography-computed tomography (F-FDG PET-CT) is able to monitor standard chemotherapy efficacy in those patients and whether metabolic response correlates with morphovolumetric response as assessed by Response Evaluation Criteria in Solid Tumor (RECIST).

Methods: We evaluated 27 consecutive patients with advanced (16 patients) or recurrent (11 patients) TETs. All patients underwent F-FDG PET-CT before and after at least 3 cycles of chemotherapy. Maximum standardized uptake value (SUV) of all detected lesions was recorded and the most F-FDG avid lesion in each patient was selected for determination of percentage change of SUV (ΔSUV) in pre- and post-treatment scans. Tumor response was assessed by contrast-enhanced computed tomography (CE-CT) using RECIST criteria. Receiver operating characteristic (ROC) curve analysis was performed to define the optimal threshold of ΔSUV discriminating responders from non-responders.

Results: Metabolic response expressed as ΔSUV was significantly correlated with morphovolumetric response (Spearman's rank correlation, r = 0.64, p = 0.001). ROC curve analysis showed that a ΔSUV value of -25% could discriminate responders from non-responders with a sensitivity of 88% and a specificity of 80%. Conversely, basal SUV values were not predictive of morphovolumetric tumor response.

Conclusions: Our findings indicate that metabolic response assessed by F-FDG PET-CT, through evaluation of ΔSUV, may allow identification of responders and non-responders thus guiding adaptation of therapy in patients with advanced or recurrent TETs.
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http://dx.doi.org/10.1186/s40644-017-0112-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5339950PMC
March 2017

The delicate balance between present and future.

Eur J Nucl Med Mol Imaging 2017 Feb 1;44(2):346-347. Epub 2016 Dec 1.

Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale, Second University of Naples, Naples, Italy.

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http://dx.doi.org/10.1007/s00259-016-3579-yDOI Listing
February 2017

Segmental F-FDG-PET/CT in a single pulmonary nodule: a better cost/effectiveness strategy.

Eur J Nucl Med Mol Imaging 2017 Jan;44(1):1-4

Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale, Second University of Naples, Napoli, Italy.

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http://dx.doi.org/10.1007/s00259-016-3532-0DOI Listing
January 2017

Contemporary Imaging in Takotsubo Syndrome.

Heart Fail Clin 2016 Oct;12(4):559-75

Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Heart Tower Room 810, Largo Città di Ippocrate, Salerno 84131, Italy; Department of Medicine and Surgery, Schola Medica Salernitana, University of Salerno, Via Salvador Allende, 84081 Baronissi (Salerno), Italy.

Transthoracic echocardiography is the first-line imaging modality for evaluating patients with Takotsubo syndrome (TTS). Beyond diagnosis, TTE enables detection of peculiar complications and is useful for risk stratification and management of patients with cardiogenic shock. Cardiac magnetic resonance can be used to detect myocardial edema typically associated with TTS and is helpful in the differential diagnosis with other disease states. Coronary computed tomography angiography can be performed as an alternative to coronary angiography to confirm coronary artery patency. Molecular imaging is a promising approach for identifying patients at increased risk of recurrence.
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http://dx.doi.org/10.1016/j.hfc.2016.06.005DOI Listing
October 2016

Progressive Supranuclear Palsy-Like Phenotype in a E326K Mutation Carrier.

Mov Disord Clin Pract 2017 May-Jun;4(3):444-446. Epub 2016 Jul 27.

Center for Neurodegenerative Diseases (CEMAND) Department of Medicine and Surgery Neuroscience section University of Salerno Salerno Italy.

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http://dx.doi.org/10.1002/mdc3.12406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353524PMC
July 2016

Diffusion volume (DV) measurement in endometrial and cervical cancer: A new MRI parameter in the evaluation of the tumor grading and the risk classification.

Eur J Radiol 2016 Jan 10;85(1):113-124. Epub 2015 Nov 10.

Dipartimento di Medicina e Chirurgia, Università degli Studi di Salerno, Salerno, Italy.

Purpose: A new MRI parameter representative of active tumor burden is proposed: diffusion volume (DV), defined as the sum of all the voxels within a tumor with apparent diffusion coefficient (ADC) values within a specific range. The aims of the study were: (a) to calculate DV on ADC maps in patients with cervical/endometrial cancer; (b) to correlate DV with histological grade (G) and risk classification; (c) to evaluate intra/inter-observer agreement of DV calculation.

Materials And Methods: Fifty-three patients with endometrial (n=28) and cervical (n=25) cancers underwent pelvic MRI with DWI sequences. Both endometrial and cervical tumors were classified on the basis of G (G1/G2/G3) and FIGO staging (low/medium/high-risk). A semi-automated segmentation procedure was used to calculate the DV. A freehand closed ROI outlined the whole visible tumor on the most representative slice of ADC maps defined as the slice with the maximum diameter of the solid neoplastic component. Successively, two thresholds were generated on the basis of the mean and standard deviation (SD) of the ADC values: lower threshold (LT="mean minus three SD") and higher threshold (HT="mean plus one SD"). The closed ROI was expanded in 3D, including all the contiguous voxels with ADC values in the range LT-HT × 10-3mm(2)/s. A Kruskal-Wallis test was used to assess the differences in DV among G and risk groups. Intra-/inter-observer variability for DV measurement was analyzed according to the method of Bland and Altman and the intraclass-correlation-coefficient (ICC).

Results: DV values were significantly different among G and risk groups in both endometrial (p<0.05) and cervical cancers (p ≤ 0.01). For endometrial cancer, DV of G1 (mean ± sd: 2.81 ± 3.21 cc) neoplasms were significantly lower than G2 (9.44 ± 9.58 cc) and G3 (11.96 ± 8.0 cc) ones; moreover, DV of low risk cancers (5.23 ± 8.0 cc) were significantly lower than medium (7.28 ± 4.3 cc) and high risk (14.7 ± 9.9 cc) ones. For cervical cancer, DV of G1 (0.31 ± 0.13 cc) neoplasms was significantly lower than G3 (40.68 ± 45.65 cc) ones; moreover, DV of low risk neoplasms (6.98 ± 8.08 cc) was significantly lower than medium (21.7 ± 17.13 cc) and high risk (62.9 ± 51.12 cc) ones and DV of medium risk neoplasms was significantly lower than high risk ones. The intra-/inter-observer variability for DV measurement showed an excellent correlation for both cancers (ICC ≥ 0.86).

Conclusions: DV is an accurate index for the assessment of G and risk classification of cervical/endometrial cancers with low intra-/inter-observer variability.
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http://dx.doi.org/10.1016/j.ejrad.2015.10.014DOI Listing
January 2016

18F-FDG PET/CT, 99mTc-MIBI, and MRI in the prediction of outcome of patients with multiple myeloma: a comparative study.

Clin Nucl Med 2015 Apr;40(4):303-8

From the *Institute of Biostructures and Bioimages, National Research Council, Naples; †Department of Medicine and Surgery, University of Salerno, Salerno; Departments of ‡Hematology, and §Advanced Biomedical Sciences, University of Federico II, Naples, Italy.

Purpose: The aim of this study was to compare the relative contribution of 18F-FDG PET/CT, 99mTc-MIBI, and MRI in predicting progression-free survival (PFS) and overall survival (OS) in multiple myeloma (MM) patients.

Patients And Methods: Thirty-three newly diagnosed MM patients had been evaluated in a previous study by 18F-FDG PET/CT, 99mTc-MIBI, and spine and pelvis MRI reporting focal lesions and diffuse bone marrow involvement. Twenty-seven patients were then subjected to a mean follow-up period of 58 months, whereas 6 patients were lost.

Results: 18F-FDG PET/CT, 99mTc-MIBI, and MRI were positive in 26, 24, and 22 patients, respectively, showing diffuse bone marrow involvement in 12, 21, and 17 patients and a total of 185, 56, and 39 focal lesions, respectively. At follow-up, 18 patients showed complete or partial remission, whereas 9 patients developed progressive disease, 7 of which died of myeloma. Univariate and subsequent multivariate analysis showed that F-FDG PET/CT focal uptake and Tc-MIBI focal and diffuse uptake predicted PFS (P = 0.0006), whereas 18F-FDG PET/CT focal uptake and 99mTc-MIBI focal uptake predicted OS (P = 0.0010). Although MRI diffuse pattern predicted PFS at univariate analysis (P = 0.0376), it was not retained in the model at multivariate analysis. Receiver operating characteristic curve analysis showed that the number of focal lesions best discriminating for PFS and OS prediction was 4 and 11 for 18F-FDG PET/CT and 2 in both cases for 99mTc-MIBI, respectively. By Kaplan-Meier analysis and log-rank testing, PFS and OS at follow-up were significantly better in patients showing a number of focal lesions at F-FDG PET/CT or Tc-MIBI lower than the respective cutoff (P = 0.03, P = 0.004, and P < 0.0001, respectively). Finally, PFS was significantly better in patients showing absent/faint diffuse Tc-MIBI uptake than in those having moderate/intense diffuse uptake (P = 0.0012).

Conclusions: 18F-FDG PET/CT and 99mTc-MIBI may be useful in predicting PFS and OS in myeloma patients.
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http://dx.doi.org/10.1097/RLU.0000000000000696DOI Listing
April 2015

Prognostic role of 18F-FDG PET/CT in the postoperative evaluation of differentiated thyroid cancer patients.

Clin Nucl Med 2015 Feb;40(2):111-5

From the *Dipartimento di Medicina e Chirurgia, Università degli Studi di Salerno, Salerno; †Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II; ‡Istituto di Biostrutture e Bioimmagini, CNR; §IRCSS SDN, Napoli; and ║IRCSS CROB, Rionero in Vulture, Italia.

Purpose: The aim of this study was to evaluate the role of F-FDG PET/CT performed after surgery but before radioiodine therapy in patients with differentiated thyroid cancer.

Procedures: FDG PET/CT was performed off l-thyroxine in 60 newly diagnosed differentiated thyroid cancer patients. Clinical and hematological evaluation as well as high-resolution neck ultrasound were performed. All patients underwent a complete follow-up (range, 6-67 months; mean [SD], 31.7 [20.6] months). The date of recurrence or the most recent office visit was recorded. Progression-free survival (PFS) is the primary end point of this study. Analysis was performed by Cox proportional hazards model. Survival curves were generated using Kaplan-Meier estimates, and the log-rank test was used to assess significance.

Results: FDG PET/CT was negative in 63% of patients, 20% had FDG thyroid bed uptake, 5% distant metastases, and 12% lymph node FDG uptake. In patients with positive FDG PET/CT scan (ie, those with distant metastases or lymph node uptake), a higher rate of recurrence was observed (50% vs 6%, P < 0.05). Thyroglobulin, neck ultrasound, stage, and FDG PET/CT correlated with PFS at univariate analysis. At multivariate analysis, only thyroglobulin and FDG PET/CT continued to be predictors of PFS. Patients with a negative FDG PET/CT scan have a better PFS either in the whole group or in those with elevated thyroglobulin level (both >2 ng/mL and >10 ng/mL).

Conclusions: FDG PET/CT was abnormal in 17% of patients. Moreover, FDG PET/CT has an independent prognostic role, with a better PFS in patients with a negative scan.
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http://dx.doi.org/10.1097/RLU.0000000000000621DOI Listing
February 2015

Comparison of whole-body PET/CT and PET/MRI in breast cancer patients: lesion detection and quantitation of 18F-deoxyglucose uptake in lesions and in normal organ tissues.

Eur J Radiol 2014 Feb 23;83(2):289-96. Epub 2013 Nov 23.

Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Italy. Electronic address:

Purpose: To compare the performance of PET/MRI imaging using MR attenuation correction (MRAC) (DIXON-based 4-segment -map) in breast cancer patients with that of PET/CT using CT-based attenuation correction and to compare the quantification accuracy in lesions and in normal organ tissues.

Methods: A total of 36 patients underwent a whole-body PET/CT scan 1h after injection and an average of 62 min later a second scan using a hybrid PET/MRI system. PET/MRI and PET/CT were compared visually by rating anatomic allocation and image contrast. Regional tracer uptake in lesions was quantified using volumes of interest, and maximal and mean standardized uptake values (SUVmax and SUVmean, respectively) were calculated. Metabolic tumor volume (MTV) of each lesion was computed on PET/MRI and PET/CT. Tracer uptake in normal organ tissue was assessed as SUVmax and SUVmean in liver, spleen, left ventricular myocardium, lung, and muscle.

Results: Overall 74 FDG positive lesions were visualized by both PET/CT and PET/MRI. No significant differences in anatomic allocation scores were found between PET/CT and PERT/MRI, while contrast score of lesions on PET/MRI was significantly higher. Both SUVmax and SUVmean of lesions were significantly higher on PET/MRI than on PET/CT, with strong correlations between PET/MRI and PET/CT data (ρ=0.71-0.88). MTVs of all lesions were 4% lower on PET/MRI than on PET/CT, but no statistically significant difference was observed, and an excellent correlation between measurements of MTV with PET/MRI and PET/CT was found (ρ=0.95-0.97; p<0.0001). Both SUVmax and SUVmean were significantly lower by PET/MRI than by PET/CT for lung, liver and muscle, no significant difference was observed for spleen, while either SUVmax and SUVmean of myocardium were significantly higher by PET/MRI. High correlations were found between PET/MRI and PET/CT for both SUVmax and SUVmean of the left ventricular myocardium (ρ=0.91; p<0.0001), while moderate correlations were found for the other normal organ tissues (ρ=0.36-0.61; p<0.05).

Conclusions: PET/MRI showed equivalent performance in terms of qualitative lesion detection to PET/CT. Despite significant differences in tracer uptake quantification, due to either methodological and biological factors, PET/MRI and PET/CT measurements in lesions and normal organ tissues correlated well. This study demonstrates that integrated whole-body PET/MRI is feasible in a clinical setting with high quality and in a short examination time.
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http://dx.doi.org/10.1016/j.ejrad.2013.11.002DOI Listing
February 2014

Impact of ¹⁸F-fluoride PET-CT on implementing early treatment of painful bone metastases with Sm-153 EDTMP.

Nucl Med Biol 2013 May 20;40(4):518-23. Epub 2013 Mar 20.

IRCCS, CROB, Rionero in Vulture, Italy.

Unlabelled: This study evaluated the diagnostic impact of using skeletal (18)F-fluoride PET/CT on patients with painful bone metastases to schedule an early palliative radionuclide treatment.

Methods: The skeletal involvement from prostate cancer metastases was assessed by both (99m)Tc-diphosphonate bone scan (BS) and (18)F-fluoride PET/CT within four weeks in 24 patients (67.7 ± 5.1 years) suffering from a borderline degree of bone pain for which radionuclide palliation was not shortly planned for administration. The BS and (18)F-fluoride PET/CT results were compared, assessing the number and extension of the skeletal sites involved. Afterward, the patients were randomly assigned either to the study group (N=12) receiving radionuclide therapy (Samarium-153 EDTMP) or to the control group (N=12) not receiving radionuclide therapy. The short-term results from the radionuclide palliation group (evaluated with a visual analogue scale) were compared with the controls.

Results: Overall, at BS, 7.6 ± 1.4 sites were considered metastatic, involving at least 5 ± 1 body regions. At (18)F-fluoride PET/CT, 116 ± 19 sites presented metastatic involvement with 12/12 body regions concerned. No differences were found in regards to either the number of metastatic sites or regions at both BS and (18)F-fluoride PET/CT between the study group and controls (p=ns). At CT, 88 blastic metastases were identified, whereas 110 were mainly lytic. Most of mainly lytic lesions were not detectable at BS. The reduction in total discomfort and bone pain in the study group was significantly greater than in the controls (p<0.0001).

Conclusion: Sm-153 EDTMP therapy should be considered for patients with early bone pain from prostate cancer even if their BS only indicates a few metastases before the initiation of a severe pain syndrome. (18)F-fluoride PET/CT may be helpful in deciding if the implementation of bone pain palliation using bone-seeking radionuclides at pain onset is necessary.
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http://dx.doi.org/10.1016/j.nucmedbio.2013.02.009DOI Listing
May 2013

Combined imaging with 18F-FDG-PET/CT and 111In-labeled octreotide SPECT for evaluation of thymic epithelial tumors.

Clin Nucl Med 2013 May;38(5):354-8

Department of Biomorphological and Functional Sciences, University of Naples Federico II, Naples, Italy.

Purpose: This study aimed to test the role of combined imaging with 18F-FDG-PET/CT and 111In-octreotide SPECT in characterizing thymic epithelial tumors (TETs).

Methods: We evaluated 20 patients with newly diagnosed TETs who had undergone concomitant 18F-FDG-PET/CT and 111In-octreotide SPECT. Thymic epithelial tumors were classified by World Health Organization (WHO) as low-risk thymomas (5), high-risk thymomas (4), and thymic carcinomas (11, among which 6 neuroendocrine tumors). Patients were staged according to Masaoka system. 18F-FDG-PET/CT was performed and SUV(max) of primary tumors was recorded. 111In-octreotide SPECT of the thorax was performed, and tumor-to-background ratio was determined on the 24-hour coronal sections.

Results: All patients showed increased 18F-FDG uptake in mediastinal lesions. SUV(max) were significantly correlated with WHO classification (r = 0.66, P < 0.01) and with Masaoka stage (r = 0.60, P < 0.01). SUV(max) of low-risk thymomas (mean [SD], 2.87 [0.83]) were significantly lower than those of high-risk thymomas (mean [SD], 7.21 [1.73], P < 0.01) and of thymic carcinomas (mean [SD], 9.39 [5.80], P < 0.05), whereas no significant difference was found between high-risk thymomas and thymic carcinomas. SUV(max) of all high-risk thymomas and thymic carcinomas was 4.5 or greater. All primary tumors were detected by In-octreotide SPECT, and tumor-to-background ratios ranged between 1.67 and 10.10. No statistically significant correlation was found between tumor-to-background ratios and WHO classification (r = 0.24, P = 0.36) and Masaoka stages (r = 0.31, P = 0.23). However tumor-to-background ratios of thymic neuroendocrine tumors (mean [SD], 5.71 [3.09]) were significantly higher than those of all other TETs with SUV(max) of 4.5 or greater (mean [SD], 2.41 [0.56]; P < 0.05).

Conclusions: 18F-FDG-PET/CT scan allows to differentiate high-risk epithelial tumors and thymic carcinomas from low-risk thymomas, whereas 111In-octreotide SPECT may identify neuroendocrine tumors among those showing high 18F-FDG uptake.
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http://dx.doi.org/10.1097/RLU.0b013e318286bd84DOI Listing
May 2013

Evidence of brown fat activity in constitutional leanness.

J Clin Endocrinol Metab 2013 Mar 7;98(3):1214-8. Epub 2013 Feb 7.

Federico II University of Naples, Department of Clinical Medicine and Surgery, Via Pansini 5, Naples, Italy.

Background: Brown adipose tissue (BAT) was considered essentially nonexistent in adults until recent evidence obtained using 18-fluorodeoxyglucose (18-FDG) positron emission tomography/computed tomography. It seems to play a role in whole body metabolism, but it has not been evaluated in underweight conditions, such as in young females with constitutional leanness (CL) or anorexia nervosa (AN).

Subjects And Methods: Thirty-eight subjects were evaluated from October 2011 to March 2012 : 7 CL (21.7 ± 3.6 y, body mass index [BMI] 16.2 ± 1.0 kg/m(2)), 7 AN (23.4 ± 4.5 y, BMI 15.5 ± 0.8), 3 of the 7 AN after stable refeeding (R-AN, 21.3 ± 1.5 y, BMI 18.8 ± 1.1), and 24 normal weight (NW) women (25.6 ± 3.9 y, BMI 22.2 ± 1.5). Fasting resting metabolic rate and respiratory quotient were measured by indirect calorimetry, body composition by bioimpedentiometry (only in CL, AN, and refed AN), and BAT activity by 18-FDG positron emission tomography/computed tomography scan, all in standardized conditions.

Results: All CL (100%), none of the AN and refed AN (0%), and 3 of the 24 NW (12%) subjects showed FDG uptake. Average FDG maximum standardized uptake value was 11.4 + 6.7 g/mL in CL and 5.5 ± 1.2 g/mL (min 3.7, max 8.3) in the 3 NW subjects. In CL, the maximum standardized uptake value was directly correlated to resting metabolic rate, corrected for fat-free mass, and inversely correlated with respiratory quotient.

Conclusion: BAT activity has been shown in CL in resting thermoneutral conditions and may exert a role against adipose tissue deposition.
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http://dx.doi.org/10.1210/jc.2012-2981DOI Listing
March 2013

Lymph node fine needle cytology in the diagnosis of infectious diseases and instrumental guides: ultrasound and computed tomography.

Infez Med 2012 ;20 Suppl 3:26-9

Istituto di Biostruttura e Bioimaging del Consiglio Nazionale della Ricerca Italiano, Napoli, Italy.

Imaging techniques, such as ultrasound imaging (US), computed tomography (CT), positron emission tomography-CT (PET-CT) or PET-magnetic resonance imaging (MRI), are highly accurate procedure in the lymph node enlargement detection, but none of them has the same sensitivity in the biological definition and in the cause of enlargement identification. Therefore, a direct evaluation of corresponding lymph nodes is necessary in much of the cases and Fine Needle Cytology (FNC) is one of the most frequently used technique for this purpose. The same imaging procedures are often used to perform targeted biopsies including FNC. This study discusses procedures, indications, advantages and limitations of imaging techniques as a support to FNC.
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April 2016

Metabolic tumor volume assessed by 18F-FDG PET/CT for the prediction of outcome in patients with multiple myeloma.

J Nucl Med 2012 Dec 15;53(12):1829-35. Epub 2012 Oct 15.

Institute of Biostructures and Bioimages-National Research Council, University Federico II, Naples, Italy.

Unlabelled: (18)F-FDG PET/CT allows the direct measurement of metabolic tumor burden in a variety of different malignancies. The aim of this study was to assess whether metabolic tumor volume (MTV) determined by (18)F-FDG PET/CT could be used in the prediction of progression-free and overall survival in multiple myeloma patients.

Methods: Forty-seven patients (18 women, 29 men; mean age ± SD, 63 ± 11 y) with stage IIIA disease who had undergone whole-body (18)F-FDG PET/CT were retrospectively evaluated. Images underwent a 3-dimensional region-of-interest analysis including all focal lesions with a maximum standardized uptake value > 2.5. The MTV of each lesion was calculated using an automated contouring program based on the standardized uptake value and developed with a threshold of 40% of the maximum standardized uptake value. The total MTV of each patient was defined as the sum of metabolic volume of all focal lesions. Patients were treated and then subjected to a mean follow-up period of 24 mo.

Results: In the 47 patients studied, MTV range was 1.3-316.3 mL, with a median of 23.7 mL. A direct, significant correlation was found between MTV and the percentage of diffuse infiltration of bone marrow by plasma cells (r = 0.46, P = 0.006), whereas hemoglobin levels were inversely correlated with MTV (r = -0.56, P = 0.0001). At follow-up, patients who developed progressive disease (n = 18) showed a significantly higher MTV (74.7 ± 19.3 vs. 29.8 ± 5.1 mL, P = 0.009) than patients without progressive disease (n = 29). Furthermore, patients who died of myeloma (n = 9) had a significantly higher MTV (123.2 ± 30.6 vs. 28.9 ± 4.2 mL, P = 0.0001) than survivors (n = 38). No differences in age, plasma cell infiltration, M protein, albumin, β2-microglobulin, performance status, International Staging System score, and presence or absence of a bone marrow transplant were found between groups. The MTV cutoff level was determined by receiver-operating-characteristic curve analysis, and the best discriminative value found for predicting progression-free and overall survival was 42.2 and 77.6 mL, respectively. By Kaplan-Meier analysis and log-rank testing, progression-free and overall survival at follow-up were significantly better in patients showing an MTV lower than the cutoff than in those having an MTV higher than the cutoff (χ(2) = 3.9, P = 0.04, and χ(2) = 56.3, P < 0.0001, respectively).

Conclusion: The direct measurement of tumor burden obtained by calculating MTV on (18)F-FDG PET/CT images may be used in the prediction of progression-free and overall survival in myeloma patients.
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http://dx.doi.org/10.2967/jnumed.112.106500DOI Listing
December 2012