Publications by authors named "Michele Klain"

37 Publications

PET/CT in the management of differentiated thyroid cancer.

Diagn Interv Imaging 2021 Apr 26. Epub 2021 Apr 26.

Department of Advanced Biomedical Sciences, University Federico II, 80131 Naples, Italy.

The standard treatment of differentiated thyroid cancer (DTC) consists of surgery followed by iodine-131 (I) administration. Although the majority of DTC has a very good prognosis, more aggressive histologic subtypes convey a worse prognosis. Follow-up consists of periodically measurements of serum thyroglobulin, thyroglobulin antibodies and neck ultrasound and I/I whole-body scan. However, undifferentiated thyroid tumors have a lower avidity for radioiodine and the ability of DTC to concentrate I may be lost in metastatic disease. Positron emission tomography (PET)/computed tomography (CT) has been introduced in the evaluation of patients with thyroid tumors and the 2-[18F]-fluoro-2-deoxyd-glucose (F-FDG) has been largely validated as marker of cell's metabolism. According to the 2015 American Thyroid Association guidelines, F-FDG PET/CT is recommended in the follow-up of high-risk patients with elevated serum thyroglobulin and negative I imaging, in the assessment of metastatic patients, for lesion detection and risk stratification and in predicting the response to therapy. It should be considered that well-differentiated iodine avid lesions could not concentrate F-FDG, and a reciprocal pattern of iodine and F-FDG uptake has been observed. Beyond F-FDG, other tracers are available for PET imaging of thyroid tumors, such as Iodine-124 (I), F-tetrafluoroborate and Gallium-68 prostate-specific membrane antigen. Moreover, the recent introduction of PET/MRI, offers now several opportunities in the field of patients with DTC. This review summarizes the evidences on the role of PET/CT in management of patients with DTC, focusing on potential applications and on elucidating some still debating points.
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http://dx.doi.org/10.1016/j.diii.2021.04.004DOI Listing
April 2021

Long-term management of lenvatinib-treated thyroid cancer patients: a real-life experience at a single institution.

Endocrine 2021 Feb 3. Epub 2021 Feb 3.

Department of Public Health, University of Naples "Federico II", 80131, Naples, Italy.

Purpose: The efficacy of lenvatinib for advanced and progressive radioactive iodine refractory differentiated thyroid cancer is well established. Herein, we retrospectively evaluated the long-term safety and efficacy of lenvatinib in 23 patients treated at a single Institution.

Methods: Clinical data of all patients treated for a differentiated thyroid cancer with lenvatinib from April 2015 to September 2020 were retrospectively analyzed.

Results: A total of 23 patients were included. In all, 21 patients received lenvatinib as first-line systemic therapy. Median age at initiation of lenvatinib treatment was 68 (44-90) years. Median duration of the study from initiation of lenvatinib to study end was 23 (2-65) months. The indication for lenvatinib treatment was documented progression of distant metastases in 20 patients and of locally advanced disease in the other 3 and median duration of lenvatinib therapy was 15 (2-64) months. Best treatment responses were: partial response in 6 patients, stable disease in 14, progressive disease in 1, and not evaluable in 2. Median progression-free survival was 25 months (95% CI: 12-40) and median overall survival was 46 months (95% CI: 28-65). Three patients had to discontinue lenvatinib treatment due to serious adverse events and no drug-related death was observed. Ten patients continued lenvatinib for more than 24 months and the only newly registered adverse event after this period of time was one case of G2 proteinuria. Six patients continued lenvatinib treatment beyond documented tumor progression due to oligoprogression or slowly progressive disease (median time 18.5 months, 8-42 months). A total of 14 patients were alive at the end of the study: 11 showed partial response/stable disease on lenvatinib, including 3 who had a stable disease after local ablative therapy for oligoprogressive metastases; 3 had to change treatment, including 2 for lenvatinib-related serious adverse events and 1 for progressive disease.

Conclusions: Long-term lenvatinib treatment is safe and some patients may experience persistent long-term control of the disease. Late treatment-related AEs rarely occurred. Oligoprogressive and slowly progressive disease can be managed without treatment withdrawal as long as there are some clinical benefits.
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http://dx.doi.org/10.1007/s12020-021-02634-zDOI Listing
February 2021

First-line systemic therapy for metastatic castration-sensitive prostate cancer: An updated systematic review with novel findings.

Crit Rev Oncol Hematol 2021 Jan 13;157:103198. Epub 2020 Dec 13.

Regional Reference Center for Rare Tumors, Department of Oncology and Hematology, AOU Federico II of Naples, Naples, Italy; Centro di Referenza Nazionale per l'Analisi e Studio di Correlazione tra Ambiente, Animale e Uomo, Istituto Zooprofilattico Sperimentale del Mezzogiorno, 80055, Portici (Na), Italy. Electronic address:

Although both docetaxel and androgen-receptor-axis-targeted (ARAT) agents have yielded survival improvements in combination with androgen deprivation therapy (ADT) compared to ADT alone in metastatic castration-sensitive prostate cancer (mCSPC) patients, the optimal therapeutic choice remains to be established. We analyzed estimates of the hazard ratios for death (OS-HRs) in patients treated in the first-line setting enrolled in the GETUG-AFU15, CHAARTED, STAMPEDE, LATITUDE, ENZAMET, and TITAN trials. Overall, men with mCSPC receiving ADT with vs. without either an ARAT agent or docetaxel as first-line systemic therapy showed a pooled OS-HR of 0.69 (95 % CI: 0.61-0.78), with significant heterogeneity (p = 0.045, I = 52.5 %). Network meta-analysis showed an OS-HR in patients receiving an ARAT agent vs. docetaxel of 0.78 (95 %CI: 0.67-0.91). In conclusion, the evidence analysed indicates that an ARAT agent may provide improved OS outcomes compared to docetaxel. Prospective randomized trials are warranted.
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http://dx.doi.org/10.1016/j.critrevonc.2020.103198DOI Listing
January 2021

Management of differentiated thyroid cancer through nuclear medicine facilities during Covid-19 emergency: the telemedicine challenge.

Eur J Nucl Med Mol Imaging 2021 03 23;48(3):831-836. Epub 2020 Sep 23.

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

Purpose: To investigate whether a telemedicine service (TMS) carried out during the Covid-19 pandemic impacted on management of patients with differentiated thyroid cancer (DTC).

Methods: We retrospectively reviewed the number and the findings of outpatient visits in DTC subjects referred between March 11, 2020, and May 31, 2020, during the Covid-19 pandemic at the Radiometabolic Unit of the University of Naples Federico II. Office visits scheduled in March and May 2020 were converted in teleconsultation reaching all patients planned for an in-ward access to advise them to use the TMS for all clinical necessity. The number and the findings of DTC patients evaluated by in-ward access in the corresponding period of 2019 were also assessed for direct comparison.

Results: The number of outpatient visits performed by TMS during the pandemic (n = 445) and by in-ward access in the corresponding period of 2019 (n = 525) was comparable with only 15% of outpatient evaluations missed.

Conclusions: Our findings demonstrate the utility of telemedicine tools to avoid the potential negative impact of interruption or postponement of diagnostic and/or therapeutic procedures. Therefore, investments in medical network system development, including the implementation of telehealth approaches, should be encouraged at national and international levels.
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http://dx.doi.org/10.1007/s00259-020-05041-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509822PMC
March 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

Pancreatic Neuroendocrine Tumors in patients with Multiple Endocrine Neoplasia Type 1: Diagnostic Value of Different MRI Sequences.

Neuroendocrinology 2020 Jun 24. Epub 2020 Jun 24.

Background: Magnetic Resonance Imaging (MRI) is a useful imaging modality to assess the presence of Pancreatic Neuroendocrine Tumors (PNETs), allowing repeat monitoring examinations in MEN-1 patients.

Objectives: We aimed to compare the diagnostic accuracy of conventional MRI sequences identifying which better depict the presence of PNETs in MEN-1 patients.

Method: We performed a retrospective analysis of consecutive MEN-1 patients who underwent a conventional MRI protocol to monitor previously proven PNETs. MRI sequences T1-w Chemical-Shift (CS), T2-w HASTE, fat-suppressed (FS) T2-w HASTE, Diffusion Weighted Imaging (DWI), pre- and post-contrast FS T1-w sequences were independently analyzed by two experienced radiologists using a three-grade score (no lesion, uncertain lesion, certain lesion); lesion size and signal intensity were recorded. ANOVA Friedman and a Wilcoxon pairwise tests for the post-hoc analysis were used. The sensitivity of each sequence was measured; the results were analyzed with the Chi-squared test.

Results: We included 21 patients with a total of 45 PNETs proven by histology, EUS guided fine needle aspiration, CT and nuclear medicine studies. A statistically significant (p<0.01) difference was observed in the detection performance of each MRI sequence, particularly between both DWI (91%) and T2-w FS (85%) sequences in comparison to the others (T1-w CS, T2-w, pre- and post-contrast FS T1-w, ≤56% for all); no significant (p=0.5) difference was found between the detection performance of DWI and T2-w FS sequences. No correlation was observed between the qualitative score of each sequence and lesion tumor size.

Conclusions: DWI and T2-w FS sequences proved to be the most accurate in the detection of PNETs, thus suggesting a role for an abbreviated MRI protocol without contrast medium administration for monitoring MEN-1 patients.
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http://dx.doi.org/10.1159/000509647DOI Listing
June 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

Concurrent BRAF V600E mutated papillary thyroid carcinoma and Erdheim-Chester disease.

Endocrine 2020 12 21;70(3):655-656. Epub 2020 Apr 21.

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

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http://dx.doi.org/10.1007/s12020-020-02317-1DOI Listing
December 2020

Incremental Value of Sestamibi SPECT/CT Over Dual-Phase Planar Scintigraphy in Patients With Primary Hyperparathyroidism and Inconclusive Ultrasound.

Front Med (Lausanne) 2019 16;6:164. Epub 2019 Jul 16.

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

We evaluated the incremental value of [Tc]sestamibi single photon-emission computed tomography (SPECT)/computed tomography (CT) over planar imaging for localization of abnormal parathyroid tissue in patients with primary hyperparathyroidism. Forty-six patients with biochemical evidence of hyperparathyroidism and inconclusive ultrasound underwent sestamibi dual-phase planar scintigraphy and SPECT/CT for preoperative localization of parathyroid adenoma. Imaging findings were compared with histopathological data. Decision tree analysis was performed to evaluate the value of SPECT/CT over planar scintigraphy for classifying patients with or without hyperfunctioning parathyroid tissue. The added value of SPECT/CT was also evaluated by decision curve analysis. Planar scintigraphy was positive for presence of hyperfunctioning parathyroid in 52% of patients, with sensitivity of 63% and specificity of 100%. SPECT/CT was positive in 80% of patients with sensitivity of 97% and specificity of 100%. At decision tree analysis, after an initial split on planar imaging results, no further split was performed in patients with positive results, while those with negative results were further stratified by SPECT/CT. At decision curve analysis, the model including SPECT/CT was associated with the highest net benefit compared to the model including only planar technique and to a strategy considering that all patients should be treated. Sestamibi SPECT/CT provides incremental value over dual-phase scintigraphy in preoperative localization of hyperfunctioning parathyroid tissue in subjects with inconclusive ultrasound. Hybrid technique allows a better identification of pathological lesion to perform minimally invasive surgery and showed the highest net benefit, improving selection of surgical approach.
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http://dx.doi.org/10.3389/fmed.2019.00164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6646520PMC
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

Combined evaluation of regional coronary artery calcium and myocardial perfusion by Rb PET/CT in the identification of obstructive coronary artery disease.

Eur J Nucl Med Mol Imaging 2018 04 25;45(4):521-529. Epub 2018 Jan 25.

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

Purpose: Cardiac imaging with PET/CT allows measurement of coronary artery calcium (CAC), myocardial perfusion and coronary vascular function. We investigated whether the combined assessment of regional CAC score, ischemic total perfusion deficit (ITPD) and quantitative coronary vascular function would further improve the diagnostic accuracy of PET/CT in predicting obstructive coronary artery disease (CAD).

Methods: We analyzed 113 patients with suspected CAD referred to Rb PET/CT myocardial perfusion imaging with available coronary angiographic data. Obstructive CAD was defined as ≥75% stenosis. The receiver operating characteristic area under curve (AUC) was applied to evaluate the ability of CAC score, ITPD, hyperemic myocardial blood flow (MBF) and coronary flow reserve (CFR) to identify CAD.

Results: Vessels with obstructive CAD (71 vessels) had higher ITPD (4.6 ± 6.2 vs. 0.6 ± 1.3) and lower hyperemic MBF (1.01 ± 0.5 vs. 1.75 ± 0.6 ml/min/g) and CFR (1.56 ± 0.6 vs. 2.38 ± 0.7; all p < 0.001) than those without. In prediction of per-vessel CAD, the AUCs for the models including CAC/ITPD/hyperemic MBF (0.869) and CAC/ITPD/CFR (0.875) were higher (both p < 0.01) than for the model including CAC/ITPD (0.790). Compared with CAC/ITPD, continuous net reclassification improvement was 0.69 (95% bootstrap confidence interval, CI, 0.365-1.088) for the CAC/ITPD/hyperemic MBF model and 0.99 (95% bootstrap CI 0.64-1.26) for the CAC/ITPD/CFR model.

Conclusion: Hyperemic MBF and CFR provide incremental information about the presence of CAD over CAC score and perfusion imaging parameters. The combined use of CAC, myocardial perfusion imaging and quantitative coronary vascular function in may help predict more accurately the presence of obstructive CAD.
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http://dx.doi.org/10.1007/s00259-018-3935-1DOI Listing
April 2018

Treatment of refractory thyroid cancer.

Endocr Relat Cancer 2018 04 25;25(4):R209-R223. Epub 2018 Jan 25.

Department of Nuclear Medicine and Endocrine Oncology, TUTHYREF (Tumeurs de la Thyroïde Réfractaires) Network, Gustave Roussy and University Paris-Saclay, Villejuif, France.

Distant metastases from thyroid cancer of follicular origin are uncommon. Treatment includes levothyroxine administration, focal treatment modalities with surgery, external radiation therapy and thermal ablation, and radioiodine in patients with uptake of I in their metastases. Two-thirds of distant metastases become refractory to radioiodine at some point, and when there is a significant tumor burden and documented progression on imaging, a treatment with a kinase inhibitor may provide benefits.
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http://dx.doi.org/10.1530/ERC-17-0542DOI Listing
April 2018

Preclinical Imaging for the Study of Mouse Models of Thyroid Cancer.

Int J Mol Sci 2017 Dec 16;18(12). Epub 2017 Dec 16.

Istituto di Biostrutture e Bioimmagini, Consiglio Nazionale delle Ricerche-IBB, CNR, 80145 Napoli, Italy.

Thyroid cancer, which represents the most common tumors among endocrine malignancies, comprises a wide range of neoplasms with different clinical aggressiveness. One of the most important challenges in research is to identify mouse models that most closely resemble human pathology; other goals include finding a way to detect markers of disease that common to humans and mice and to identify the most appropriate and least invasive therapeutic strategies for specific tumor types. Preclinical thyroid imaging includes a wide range of techniques that allow for morphological and functional characterization of thyroid disease as well as targeting and in most cases, this imaging allows quantitative analysis of the molecular pattern of the thyroid cancer. The aim of this review paper is to provide an overview of all of the imaging techniques used to date both for diagnosis and theranostic purposes in mouse models of thyroid cancer.
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http://dx.doi.org/10.3390/ijms18122731DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5751332PMC
December 2017

The role of dynamic post-contrast T1-w MRI sequence to characterize lipid-rich and lipid-poor adrenal adenomas in comparison to non-adenoma lesions: preliminary results.

Abdom Radiol (NY) 2018 08;43(8):2119-2129

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

Purpose: The purpose of the article is to compare the features of wash-out (WO) parameters between lipid-rich and lipid-poor adrenal adenomas as well as with a group of non-adenoma adrenal lesions.

Methods: 46 patients (36 F and 10 M, median age 58 years) with unilateral adrenal lesions (35 adenomas, 7 pheochromocytomas, 1 carcinoma, and 3 metastases) were prospectively evaluated; adrenal lesions were divided into adenomas (Group 1) and non-adenomas (Group 2). MR imaging was performed with a 3-Tesla scanner using pre- and post-contrast dedicated sequences. On the basis of the evaluation of qualitative chemical-shift (CS) signal intensity (SI) loss, adrenal adenomas were, respectively, divided in Group 1A (n = 25) as lipid-rich and Group 1B (n = 10) as lipid-poor; non-adenoma adrenal lesions were grouped in Group 2 (n = 11). The following parameters were evaluated: size (mm), CS SI index (%), early (5 min), and delayed (10 min) Relative (R) and Absolute (A) WO values (%).

Results: The comparison of AWO and RWO showed significant (p ≤ 0.05) differences between Group 1A and Groups 1B and 2, both using 5- and 10-min images for calculation; conversely, no differences in these dynamic parameters were found between Group 1B and 2; AWO and RWO values were significantly lower in adrenal lesions of Groups 1B and 2 compared to Group 1A, both using 5- and 10-min images for calculation.

Conclusions: The quantitative evaluation of WO parameters could not be used to characterize lipid-poor adrenal adenomas for which alternative imaging modalities are required.
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http://dx.doi.org/10.1007/s00261-017-1429-4DOI Listing
August 2018

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

Added prognostic value of left ventricular shape by gated SPECT imaging in patients with suspected coronary artery disease and normal myocardial perfusion.

J Nucl Cardiol 2019 08 25;26(4):1148-1156. Epub 2017 Oct 25.

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

Background: Left ventricular (LV) remodeling is associated with adverse cardiovascular events. We evaluated the added prognostic value of LV shape index (SI) assessed by gated single-photon emission tomography (SPECT) in patients without known coronary artery disease (CAD).

Methods And Results: We studied 674 patients with normal myocardial perfusion and normal LV ejection fraction (EF) on stress gated SPECT imaging. An automated software program was used to calculate end-diastolic and end-systolic LVSI. An LVSI ≤ 0.54 at end-systole was considered normal. Follow-up was 96% complete with a median follow-up of 37 months. During follow-up, 25 events occurred (3.8% cumulative event rate). Event-free survival was lower in patients with abnormal end-systolic LVSI (P < .001). Age (P = .021), diabetes (P = .048), and end-systolic LVSI (P < .001) were independent predictors of events. LVSI added prognostic information increasing the global chi-square of the model including age and diabetes from 15.15 to 25.97 (P < .001). The effect of diabetes on hazard ratio increased with increasing values of end-systolic LVSI. The probability of events at 48 months predicted by Weibull analysis progressively increased with increasing values of end-systolic LVSI and was higher in patients with diabetes as compared to those without. Decision curve analyses indicate that the model including end-systolic LVSI resulted in an increased net benefit between 5% and 30% threshold probability, indicating superior estimation of outcomes at low threshold probability levels.

Conclusions: The evaluation of LVSI may identify patients with early-stage LV remodeling and at higher risk of adverse cardiac events, even in the presence of normal myocardial perfusion.
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http://dx.doi.org/10.1007/s12350-017-1090-xDOI Listing
August 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

Use of coronary artery calcium scanning as a triage for invasive coronary angiography.

J Nucl Cardiol 2019 04 16;26(2):613-615. Epub 2017 Oct 16.

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

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http://dx.doi.org/10.1007/s12350-017-1076-8DOI Listing
April 2019

Coronary vascular age comes of age.

J Nucl Cardiol 2017 12 3;24(6):1835-1836. Epub 2017 Oct 3.

Department of Translational Medical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.

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http://dx.doi.org/10.1007/s12350-017-1078-6DOI Listing
December 2017

Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation.

Arch Endocrinol Metab 2017 Jan-Feb;61(1):81-89. Epub 2017 Feb 13.

Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France.

Radioiodine (RAI)-refractory thyroid cancer is an uncommon entity, occurring with an estimated incidence of 4-5 cases/year/million people. RAI refractoriness is more frequent in older patients, in those with large metastases, in poorly differentiated thyroid cancer, and in those tumors with high 18-fluordeoxyglucose uptake on PET/CT. These patients have a 10-year survival rate of less than 10%. In recent years, new therapeutic agents with molecular targets have become available, with multikinase inhibitors (MKIs) being the most investigated drugs. Two of these compounds, sorafenib and lenvatinib, have shown significant objective response rates and have significantly improved the progression-free survival in the two largest published prospective trials on MKI use. However, no overall survival benefit has been achieved yet. This is probably related to the crossover that occurs in most patients who progress on placebo treatment to the open treatment of these studies. In consequence, the challenge is to correctly identify which patients will benefit from these treatments. It is also crucial to understand the appropriate timing to initiate MKI treatment and when to stop it. The purpose of this article is to define RAI refractoriness, to summarize which therapies are available for this condition, and to review how to select patients who are suitable for them.
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http://dx.doi.org/10.1590/2359-3997000000245DOI Listing
October 2017

Diagnostic Accuracy of Gd-EOB-DTPA for Detection Hepatocellular Carcinoma (HCC): A Comparative Study with Dynamic Contrast Enhanced Magnetic Resonance Imaging (MRI) and Dynamic Contrast Enhanced Computed Tomography (CT).

Pol J Radiol 2017 1;82:50-57. Epub 2017 Feb 1.

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

Background: To compare the diagnostic accuracy of hepato-biliary (HB) phase with gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA) with dynamic contrast-enhanced MR imaging (DCEMRI) and contrast-enhanced CT (DCECT) for hepatocellular carcinoma (HCC) detection.

Material/methods: 73 patients underwent DCECT and Gd-EOB-DTPA-3T-MR. Lesions were classified using a five-point confidence scale. Reference standard was a combination of pathological evidence and tumor growth at follow-up CT/MR at 12 months. Receiver Operating Characteristic (ROC) curves were obtained.

Results: A total of 125 lesions were confirmed in 73 patients. As many as 74 were HCCs and 51 were benign. Area under the curve (AUC) was 0.984 for DCEMRI+HB phase 0.934 for DCEMRI (<0.68) and 0.852 for DCECT (<0.001). For lesions >20 mm (n.40), AUC was 0.984 for DCEMRI+HB phase, 0.999 for DCEMRI, and 0.913 for DCECT, (=n.s.). For lesions <20 mm (n.85) AUC was 0.982 for DCEMRI+HB phase 0.910 for DCEMRI (<0.01) and 0.828 for DCECT (<0.001).

Conclusions: The addition of HB phase to DCEMRI provides an incremental accuracy of 4.5% compared to DCEMRI and DCECT for HCC detection. The accuracy of Gd-EOB-DTPA-3T-MR significantly improves for lesions <20 mm. No significant improvement is observed for lesions >20 mm and patients with Child-Pugh class B or C.
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http://dx.doi.org/10.12659/PJR.899239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5301959PMC
February 2017

Comparison between computed tomography multislice and high-field magnetic resonance in the diagnostic evaluation of patients with renal masses.

Quant Imaging Med Surg 2015 Oct;5(5):691-9

1 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy ; 2 Istituto di Biostrutture e Bioimmagini (IBB), Consiglio Nazionale delle Ricerche (CNR), Naples, Italy ; 3 IRCCS SDN, Naples, Italy.

Background: Renal masses are a common finding in diagnostic imaging; these lesions usually are solid or cystic, benign or malignant, and the correct diagnosis may be difficult. The aim of our study was the comparison of multi-slice computed tomography (MSCT) and high-field magnetic resonance (MR) in the diagnostic evaluation of renal masses.

Methods: We studied 29 patients, 16 men and 13 women aged 8-85 years (mean 61±17 years) with histo-cytological diagnosis of renal masses (n=31), of which the majority (74%; n=23) was represented by malignant lesions [renal cell carcinoma (Ca) =16, chromophobe renal cell Ca =2, squamous cell Ca =1, urothelial Ca =2, lymphoma =1, Wilms tumor =1]; the remaining 8 masses (26%) were benign (pyelonephritis =2, simple cyst =1, hematic cyst =1, lipoma =1 and oncocytoma =3). All patients underwent MSCT and MR (3.0 Tesla) before and after contrast injection; the images were evaluated in double-blind by two expert radiologists. The results of the images were then compared with the histo-cytological data to calculate the values of diagnostic accuracy for both methods in the identification and characterization of renal masses. The benign or malignant nature of the lesions was established according to the regularity of the margins, presence or absence of significant contrast enhancement, infiltration of perirenal fat and vascular invasion. The concordance of the results of the two imaging techniques was then calculated using the coefficient Kappa Cohen.

Results: For both identification and characterization of renal masses, MSCT and MR showed comparable values of diagnostic accuracy with a significant concordance (k=1); in particular, the diagnostic accuracy of MSCT/MR was 100%/100% for lesion identification, 90%/90% for lesion characterization in terms of benign or malignant nature, 97%/97% for the evaluation of lesion edges, 90%/90% for the assessment of lesion contrast enhancement, 93%/93% for the evaluation of peri-renal fat infiltration and 96%/96% for the evaluation of vascular infiltration. Only in three cases of oncocytoma the two imaging methods were both inaccurate for diagnosis of benignity classifying the lesions as probably malignant on the basis of the absence of central scar and of dynamic contrast enhancement pattern.

Conclusions: The results of our study show comparable diagnostic accuracy of computed tomography (CT) and MR for the identification and characterization of expansive renal lesions. High-field MR is, therefore, a valid alternative to MSCT in the evaluation of renal masses avoiding exposure to ionizing radiation.
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http://dx.doi.org/10.3978/j.issn.2223-4292.2015.07.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4671966PMC
October 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

Total thyroidectomy, without prophylactic central lymph node dissection, in the treatment of differentiated thyroid cancer. Clinical retrospective study on 221 cases.

Endocrine 2013 Oct 19;44(2):419-25. Epub 2013 Jan 19.

Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General and Endocrine Surgery, Second University of Naples, Via Pansini 5, Build 17, 80131, Naples, Italy,

Total thyroidectomy (TT) is the standard of care for differentiated thyroid cancer (DTC), but still there is no consensus about the role of routine use of prophylactic central lymph node dissection. The aim of this study was to analyze our results of TT without prophylactic central lymphadenectomy in the treatment of DTC. Clinical records, between January 1998 and December 2005, of 221 patients undergoing TT, without prophylactic central lymph node dissection, were retrospectively evaluated. Two hundred and eleven patients (95.47 %) also underwent radioiodine (RAI) ablation followed by thyroid stimulating hormone (TSH) suppression therapy. In patients with loco-regional lymph nodal recurrence, lateral and central lymph node dissection was performed. The incidence of permanent hypoparathyroidism (iPTH <10 pg/ml) and permanent vocal fold paralysis were, respectively, 0.91 and 0.91 %. After a 9.6 ± 3.5 years mean follow-up, the rate of loco-regional recurrence, with positive cervical lymph nodes, was 3.16 % (7/221 patients). In these cases a lateral and central lymphadenectomy was carried out without significant complications. Our results showed that TT without prophylactic central lymph node dissection, followed by RAI ablation, was associated with low morbidity and low loco-regional recurrence rate, even if the lack of a control group treated with TT plus prophylactic central lymphadenectomy suggests caution against generalization of our assumption. Such last combined procedure could be indicated in high-risk patients, in whom loco-regional recurrence is more frequent. However, given the trend in the literature toward prophylactic lymphadenectomy and the avoidance of RAI treatment, prospective randomized trials should be conducted to better clarify this issue.
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http://dx.doi.org/10.1007/s12020-013-9877-2DOI Listing
October 2013

Decreased serum vascular endothelial growth factor-D levels in metastatic patients with differentiated thyroid carcinoma.

Clin Endocrinol (Oxf) 2012 Jan;76(1):142-6

Department of Clinical and Experimental Medicine F. Magrassi and A. Lanzara, Second University of Naples, Italy.

Objective: Vascular endothelial growth factor-D (VEGF-D) has been identified as one of the lymphangiogenic growth factors involved in metastatic diffusion. The aim of this study is to evaluate the serum VEGF-D levels in patients with differentiated thyroid cancer at different conditions of disease.

Design And Patients: We studied prospectively the VEGF-D plasma levels in 96 subjects affected by differentiated thyroid cancer. The patients were divided into three groups according to the clinical and biochemical findings: patients with no evidence of disease (Cured), patients with pathological (>1 ng/ml) stimulated thyroglobulin (Tg) (Path-Tg/rhTSH) levels only after rhTSH and patients with elevated basal Tg levels (Path-Tg/LT4).

Results: The serum VEGF-D concentrations in patients of group Cured were not different from the controls, while group Path-Tg/rhTSH showed baseline serum VEGF-D levels significantly lower than group Cured and controls (P < 0·001 and P < 0·01, respectively). Moreover, the patients of group Path-Tg/LT4 showed median serum cytokine concentrations at baseline not significantly different from the patients of group Path-Tg/rhTSH. The rhTSH stimulation did not modify the difference in serum VEGF-D levels in patients of group Cured and group Path-Tg/rhTSH.

Conclusions: Our data demonstrate that the VEGF-D serum levels are reduced in patients with metastases of differentiated thyroid cancer, regardless of the degree of metastatic spread. It is possible that some other molecule produced by the tumoral tissue could affect the VEGF-D physiologically produced of from different tissues, thus conducting to a decrease in the VEGF-D found in blood of patients with evidence of metastatic differentiated thyroid cancer.
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http://dx.doi.org/10.1111/j.1365-2265.2011.04183.xDOI Listing
January 2012

Assessment of metabolic response to radioimmunotherapy with 90Y-ibritumomab tiuxetan in patients with relapsed or refractory B-cell non-Hodgkin lymphoma.

Radiology 2010 Jan;254(1):245-52

Istituto di Ricerca e Cura a Carattere Scientifico, Università Federico II, Via Pansini 5, 80131 Naples, Italy.

Purpose: To prospectively compare the assessment of metabolic response to yttrium 90 ((90)Y)-ibritumomab tiuxetan radioimmunotherapy (RIT) by using fluorine 18 ((18)F) fluorodeoxyglucose (FDG) combined positron emission tomographic-computed tomographic (PET/CT) imaging at 2 and 6 months to determine the most appropriate time to detect therapeutic response in refractory non-Hodgkin lymphoma (NHL) patients treated with RIT.

Materials And Methods: The ethical committee of the university approved the protocol and all patients signed informed consent. Twenty-three consecutive patients (10 women, 13 men; mean age, 51.8 years +/-7.3 [standard deviation]) treated by using RIT for relapsed or refractory follicular NHL were enrolled. For all patients, (18)F FDG PET/CT scanning was performed at baseline and at 2 and 6 months after RIT. Response was assessed by using the International Workshop Criteria (IWC) and revised criteria (IWC + PET) as well as the criteria of the European Organization for Research and Treatment of Cancer. One-way analysis of variance for repeated measures, receiver operator curve analysis, and Kaplan-Meier curves were used for statistical analysis.

Results: PET/CT performed at 2 months revealed complete (n = 12) or partial (n = 4) metabolic response in 16 of 23 patients with complete or partial clinical response. These findings were all confirmed at 6-month scanning. PET/CT indicated refractory or persistent disease at 2 and 6 months in the remaining seven patients. Better overall survival was observed for patients with a reduction in the maximum standard uptake value of 49% or higher (both at 2 and 6 months after RIT) when compared with those with a decrease of less than 49% (P < .05).

Conclusion: Early assessment of response to RIT by using PET/CT might be useful in the identification of patients needing additional therapeutic strategies.
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http://dx.doi.org/10.1148/radiol.09090603DOI Listing
January 2010

Bone demineralization and vertebral fractures in endogenous cortisol excess: role of disease etiology and gonadal status.

J Clin Endocrinol Metab 2006 May 7;91(5):1779-84. Epub 2006 Mar 7.

Department of Molecular, Clinical Endocrinology, and Oncology, Federico II University of Naples, via Sergia Pansini 5, 80131 Naples, Italy.

Introduction: The effects of endogenous cortisol (F) excess on bone mass and vertebral fractures have still not been thoroughly investigated. The aim of this cross-sectional case-control study was to investigate factors influencing bone demineralization and vertebral fractures in different conditions of F excess, i.e. Cushing's disease and adrenal and ectopic Cushing's syndrome.

Materials And Methods: Eighty consecutive patients and 80 controls were prospectively enrolled: 37 patients (21 females) with pituitary ACTH-secreting adenoma, 18 (14 females) with adrenocortical adenoma, 15 (11 females) with adrenal carcinoma of mixed secretion, and 10 (three females) with ectopic ACTH secretion. The groups had similar age. At diagnosis, bone mineral density (BMD) was determined by the dual-energy x-ray absorptiometry technique at the lumbar spine (L1-L4) and femoral neck; vertebral fractures were investigated by standard spinal radiographs.

Results: When comparing the groups with different etiology of F excess, the patients with ectopic ACTH secretion had higher F and lower BMD values than the other subgroups. Morning F (P = 0.03) and testosterone levels (P = 0.04) correlated with lumbar BMD. Vertebral fractures were found in 61 (76%) of the patients, were multiple in 52 (85%) of the cases, and clinically evident in 32 (52%). Only multiple fractures were more frequent in patients with ectopic ACTH hypersecretion (P < 0.05). Lumbar spine BMD was the best predictor of vertebral fractures (P < 0.01). Surprisingly, amenorrheic and eumenorrheic women had similar BMD values and fracture prevalence.

Conclusion: A high prevalence (76%) of vertebral fracture was revealed, regardless of the etiology of the patients' hypercortisolism. The harmful effects of F excess at the spine were partly counterbalanced by the increased androgen production but were not affected by gonadal status in women.
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http://dx.doi.org/10.1210/jc.2005-0582DOI Listing
May 2006

Combined therapy of Sr-89 and zoledronic acid in patients with painful bone metastases.

Bone 2006 Jul 24;39(1):35-41. Epub 2006 Jan 24.

Institute of Biostructures and Bioimages, National Council of Research, Naples, Italy.

Purpose: We evaluated the pain response and daily discomfort in patients with painful bone metastases treated by merging 89Sr-chloride and zoledronic acid. The results were compared with those of patients who received 89Sr-chloride or zoledronic acid separately.

Methods: 25 patients (12 women; mean age 65+/-13 years) chronically treated with zoledronic acid underwent bone pain palliation with 150 MBq of 89Sr-chloride at least 6 months later that bisphoshonate therapy started (group A). 13 patients (6 women; mean age 70+/-12 years) received 89Sr-chloride alone (group B) and 11 patients (5 women; mean age 69+/-12 years) were chronically treated and continued to receive only zoledronic acid therapy (group C), both constituted the control groups. Patients kept a daily pain diary assessing both their discomfort and the pain of specific sites by using a visual analog scale (VAS), rating from 0 (no d iscomfort-no pain) to 10 (worst discomfort-pain). These diaries were reviewed weekly for 2 months and three different physicians rated the pain response on a scale of -2 (considerable deterioration) to +2 (considerable improvement).

Results: Baseline characteristics were similar in the three groups. The reduction of total discomfort and of bone pain in the group A was significantly greater as compared to group B (P<0.01) and group C (P<0.01). During the monitored period, a significant improvement of clinical conditions was observed in the group A, varying the rate from -1 to 1 as compared to both groups B and C in which the rate changed from -1 to 0.

Conclusion: Our findings indicate that combined therapy of 89Sr-chloride and zoledronic acid in patients with painful bone metastases is more effective in treating pain and improving clinical conditions than 89Sr-chloride or zoledronic acid used separately.
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http://dx.doi.org/10.1016/j.bone.2005.12.004DOI Listing
July 2006

Short-term outcome of differentiated thyroid cancer patients receiving a second iodine-131 therapy on the basis of a detectable serum thyroglobulin level after initial treatment.

Eur J Nucl Med Mol Imaging 2006 Feb 5;33(2):179-83. Epub 2005 Oct 5.

Dipartimento di Scienze Biomorfologiche e Funzionali, Università degli Studi di Napoli Federico II, Napoli, Italy.

Purpose: The aim of this study was to evaluate the usefulness of high-dose 131I therapy administered only on the basis of raised serum Tg levels.

Methods: Among patients treated with total or near-total thyroidectomy and 131I ablation, 76 (54 women and 22 men) with differentiated thyroid cancer (41 with follicular and 35 with papillary cancer) showed a detectable (i.e. >1.5 ng/ml) serum Tg level on L: -thyroxine therapy during follow-up and were included in the study. In these patients, a further 131I therapy was scheduled (range 3.7-9.25 GBq, mean 6.087+/-1.705). Five to seven days after this radioiodine therapy, patients underwent 131I post-therapy whole-body scan (131I t-WBS). The serum Tg value at 12 months after 131I therapy was evaluated as an indicator of short-term response to radioiodine.

Results: At evaluation after 12 months, 21 (27.6%) of the 76 patients had a Tg value < or =1.5 ng/ml, 12 (15.8%) showed a Tg decrease of at least 50%, 22 (29%) had only a minor decrease in Tg (<50%) and 21 (27.6%) did not show any decrease in Tg. 131I t-WBS was positive in 52 patients (68%, group A) and negative in 24 (32%, group B). Normalisation of Tg was observed in 15 patients (29%) of group A and in six patients (25%) of group B. Overall, 23 (44%) patients of group A and ten (42%) of group B showed a > or =50% decrease in the Tg. Of the 52 patients of group A, 19 (36%) had local recurrence at 131I t-WBS, 18 (35%) showed lung involvement and 15, (29%) bone metastasis. On a patient basis, two (13%) of 15 patients with bone metastases, six (33%) of 18 patients with lung involvement and seven (37%) of 19 patients with local recurrence had Tg values at follow-up of < or =1.5 ng/ml (p NS). Overall, seven (37%) patients with local recurrence, eight (44%) with lung involvement and eight (53%) with bone metastases showed a > or =50% decrease in Tg.

Conclusion: The findings of the present study suggest that the administration of therapeutic 131I only on the basis of elevated Tg levels has a definite therapeutic effect, at least in the short term. In addition, the possibility of obtaining a post-therapeutic 131I WBS can lead to better strategy definition for these patients.
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http://dx.doi.org/10.1007/s00259-005-1929-2DOI Listing
February 2006