scholarly journals Recent Updates on Molecular Imaging Reporting and Data Systems (MI-RADS) for Theranostic Radiotracers—Navigating Pitfalls of SSTR- and PSMA-Targeted PET/CT

2019 ◽  
Vol 8 (7) ◽  
pp. 1060 ◽  
Author(s):  
Rudolf A. Werner ◽  
James T. Thackeray ◽  
Martin G. Pomper ◽  
Frank M. Bengel ◽  
Michael A. Gorin ◽  
...  
Keyword(s):  
Molecular Imaging ◽  
Somatostatin Receptor ◽  
False Negative ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Subsequent Treatment ◽  
Targeted Imaging ◽  
Data Systems ◽  
Pet Ct ◽  
Framework System

The theranostic concept represents a paradigmatic example of personalized treatment. It is based on the use of radiolabeled compounds which can be applied for both diagnostic molecular imaging and subsequent treatment, using different radionuclides for labelling. Clinically relevant examples include somatostatin receptor (SSTR)-targeted imaging and therapy for the treatment of neuroendocrine tumors (NET), as well as prostate-specific membrane antigen (PSMA)-targeted imaging and therapy for the treatment of prostate cancer (PC). As such, both classes of radiotracers can be used to triage patients for theranostic endoradiotherapy using positron emission tomography (PET). While interpreting PSMA- or SSTR-targeted PET/computed tomography scans, the reader has to navigate certain pitfalls, including (I.) varying normal biodistribution between different PSMA- and SSTR-targeting PET radiotracers, (II.) varying radiotracer uptake in numerous kinds of both benign and malignant lesions, and (III.) resulting false-positive and false-negative findings. Thus, two novel reporting and data system (RADS) classifications for PSMA- and SSTR-targeted PET imaging (PSMA- and SSTR-RADS) have been recently introduced under the umbrella term molecular imaging reporting and data systems (MI-RADS). Notably, PSMA- and SSTR-RADS are structured in a reciprocal fashion, i.e., if the reader is familiar with one system, the other system can readily be applied. Learning objectives of the present case-based review are as follows: (I.) the theranostic concept for the treatment of NET and PC will be briefly introduced, (II.) the most common pitfalls on PSMA- and SSTR-targeted PET/CT will be identified, (III.) the novel framework system for theranostic radiotracers (MI-RADS) will be explained, applied to complex clinical cases and recent studies in the field will be highlighted. Finally, current treatment strategies based on MI-RADS will be proposed, which will demonstrate how such a generalizable framework system truly paves the way for clinically meaningful molecular imaging-guided treatment of either PC or NET. Thus, beyond an introduction of MI-RADS, the present review aims to provide an update of recently published studies which have further validated the concept of structured reporting systems in the field of theranostics.

scholarly journals Neuroendocrine differentiation of prostate cancer leads to PSMA suppression

2019 ◽  
Vol 26 (2) ◽  
pp. 131-146 ◽  
Author(s):  
Martin K Bakht ◽  
Iulian Derecichei ◽  
Yinan Li ◽  
Rosa-Maria Ferraiuolo ◽  
Mark Dunning ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Molecular Imaging ◽  
Case Reports ◽  
Somatostatin Receptor ◽  
Neuroendocrine Differentiation ◽  
Transcript Abundance ◽  
Marker Genes ◽  
Targeted Imaging ◽  
Significant Suppression ◽  
Protein Alterations

Prostate-specific membrane antigen (PSMA) is overexpressed in most prostate adenocarcinoma (AdPC) cells and acts as a target for molecular imaging. However, some case reports indicate that PSMA-targeted imaging could be ineffectual for delineation of neuroendocrine (NE) prostate cancer (NEPC) lesions due to the suppression of the PSMA gene (FOLH1). These same reports suggest that targeting somatostatin receptor type 2 (SSTR2) could be an alternative diagnostic target for NEPC patients. This study evaluates the correlation between expression of FOLH1, NEPC marker genes and SSTR2. We evaluated the transcript abundance for FOLH1 and SSTR2 genes as well as NE markers across 909 tumors. A significant suppression of FOLH1 in NEPC patient samples and AdPC samples with high expression of NE marker genes was observed. We also investigated protein alterations of PSMA and SSTR2 in an NE-induced cell line derived by hormone depletion and lineage plasticity by loss of p53. PSMA is suppressed following NE induction and cellular plasticity in p53-deficient NEPC model. The PSMA-suppressed cells have more colony formation ability and resistance to enzalutamide treatment. Conversely, SSTR2 was only elevated following hormone depletion. In 18 NEPC patient-derived xenograft (PDX) models we find a significant suppression of FOLH1 and amplification of SSTR2 expression. Due to the observed FOLH1-supressed signature of NEPC, this study cautions on the reliability of using PMSA as a target for molecular imaging of NEPC. The observed elevation of SSTR2 in NEPC supports the possible ability of SSTR2-targeted imaging for follow-up imaging of low PSMA patients and monitoring for NEPC development.

scholarly journals Clinical relevance of 18F-FDG PET/CT in the postoperative follow-up of patients with history of medullary thyroid cancer

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Jelena Saponjski ◽  
Djuro Macut ◽  
Dragana Sobic Saranovic ◽  
Branislava Radovic ◽  
Vera Artiko
Keyword(s):  
Predictive Value ◽  
Fdg Pet ◽  
Somatostatin Receptor ◽  
False Negative ◽  
Standardized Uptake Value ◽  
True Negative ◽  
Medullary Thyroid ◽  
Pet Ct ◽  
Fdg Pet Ct

AbstractBackgroundThe aim of the study was evaluation of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography with computed tomography (PET/CT) in the detection of active disease in the patients with suspected recurrence of the medullary thyroid carcinoma (MTC).Patients and methods18F-FDG PET/CT investigation was performed in 67 patients, investigated from 2010 to 2019. _ Follow up was performed from 6 to 116 months after surgery (median 16.5 months, x± SD = 29±28.9 months). Twenty five of 67 patients underwent 99mTc-dimercaptosuccinic acid (99mTc-DMSA) scintigraphy, 11 underwent somatostatin receptor scintigraphy (SRS) with 99mTc-HYNIC TOC while 11 123I-metaiodobenzylguanidine (MIBG) scintigraphy.ResultsFrom 67 patients, 35 (52.2%) had true positive 18F-FDG PET/CT findings (TP). Average maximal standardized uptake value (SUVmax) for all TP lesions was 5.01+3.6. In 25 (37.3%) patients findings were true negative (TN). Four (6%) patients had false positive (FP) findings while three (4.5%) were false negative (FN). Thus, sensitivity of the 18F-FDG PET/ CT was 92.11%, specificity 86.21%, positive predictive value 89.74%, negative predictive value 89.29% and accuracy 89.55%. In 27 patients (40%) 18F-FDG PET/CT finding influenced further management of the patient.Conclusions18F-FDG PET/CT has high accuracy in the detection of metastases/recurrences of MTC in patients after thyroidectomy as well as in evaluation and the appropriate choice of the therapy.

scholarly journals Somatostatin Receptor PET/CT Imaging for the Detection and Staging of Pancreatic NET: A Systematic Review and Meta-Analysis

Diagnostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 598 ◽  
Author(s):  
Matteo Bauckneht ◽  
Domenico Albano ◽  
Salvatore Annunziata ◽  
Giulia Santo ◽  
Priscilla Guglielmo ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Somatostatin Receptor ◽  
False Negative ◽  
Primary Lesion ◽  
Index Test ◽  
True Negative ◽  
Positron Emission ◽  
Pet Ct ◽  
Initial Staging

We investigated the diagnostic performance of Somatostatin Receptor Positron Emission Tomography/Computed Tomography (SSR-PET/CT) for the detection of primary lesion and initial staging of pancreatic neuroendocrine tumors (pNETs). A comprehensive literature search up to January 2020 was performed selecting studies in presence of: sample size ≥10 patients; index test (i.e., 68Ga-DOTATOC or 68Ga-DOTANOC or 68Ga-DOTATATE PET/CT); and outcomes (i.e., detection rate (DR), true positive, true negative, false positive, and false-negative). The methodological quality was evaluated with QUADAS-2. Pooled DR and pooled sensitivity and specificity for the identification of the primary tumor were assessed by a patient-based and a lesion-based analysis. Thirty-eight studies were selected for the qualitative analysis, while 18 papers were included in the meta-analysis. The number of pNET patients ranged from 10 to 142, for a total of 1143 subjects. At patient-based analysis, the pooled sensitivity and specificity for the assessment of primary pNET were 79.6% (95% confidence interval (95%CI): 71–87%) and 95% (95%CI: 75–100%) with a heterogeneity of 59.6% and 51.5%, respectively. Pooled DR for the primary lesion was 81% (95%CI: 65–90%) and 92% (95%CI: 80–97%), respectively, at patient-based and lesion-based analysis. In conclusion, SSR-PET/CT has high DR and diagnostic performances for primary lesion and initial staging of pNETs.

Clinical PET/CT imaging

2005 ◽  
Vol 44 (S 01) ◽  
pp. S18-S23 ◽  
Author(s):  
M. A. Auerbach ◽  
J. Czernin
Keyword(s):  
Molecular Imaging ◽  
Cancer Patients ◽  
State Of The Art ◽  
Equipment Design ◽  
Individualized Therapy ◽  
Targeted Imaging ◽  
Imaging Tool ◽  
Technological Advances ◽  
Pet Ct ◽  
Imaging Probes

Summary:PET/CT is now established as the most important imaging tool in oncology. PET/CT stages and restages cancer with a higher accuracy than PET or CT alone. The sometimes irrational approach to combine state of the art PET with the highest end CT devices should give way to a more reasonable equipment design tailored towards the specific clinical indications in well-defined patient populations. The continuing success of molecular PET/CT now depends more upon advances in molecular imaging with the introduction of targeted imaging probes for individualized therapy approaches in cancer patients and less upon technological advances of imaging equipment.

scholarly journals Better way to image and manage Neuroendocrine Tumours: Role of 68Gallium DOTA-Peptide PET-CT scan

2018 ◽  
Vol 20 (2) ◽  
pp. 136
Author(s):  
Shankar Kumar Dey
Keyword(s):  
Molecular Imaging ◽  
Ct Scan ◽  
Significant Role ◽  
Neuroendocrine Tumours ◽  
Somatostatin Receptor ◽  
Somatostatin Receptors ◽  
Somatostatin Analogues ◽  
Pet Ct ◽  
Receptor Scintigraphy ◽  
Pet Ct Scan

<p>Neuroendocrine tumours (NETs) are special entity of neoplasms arising from nervous and endocrine systems and involving variety of organs. Over expression of somatostatin receptors is an unique characteristic of these tumours. This allows molecular imaging to play a significant role in evaluation of NETs using somatostatin analogues. <sup>111</sup> In Pentetreotide scintigraphy has been playing a significant role as molecular imaging of choice to locate the primary tumor, evaluate extent of disease and plan for surgical management. Recently <sup>68 </sup>Ga labelled peptides have emerged as promising PET tracers for scintigraphy of these tumours. Several recent studies have demonstrated the superiority of <sup>68</sup>Ga DOTA- Peptide PET-CT scan with a number of advantages over conventional somatostatin receptor scintigraphy.</p><p>Bangladesh J. Nuclear Med. 20(2): 136-142, July 2017</p>

Molecular Imaging of Late Somatostatin Receptor–Positive Metastases of Renal Cell Carcinoma in the Pancreas by 68Ga DOTATOC PET/CT

2014 ◽  
Vol 39 (8) ◽  
pp. 713-716 ◽  
Author(s):  
Luisa Peter ◽  
Jörg Sänger ◽  
Merten Hommann ◽  
Richard Paul Baum ◽  
Daniel Kaemmerer
Keyword(s):  
Renal Cell Carcinoma ◽  
Molecular Imaging ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Somatostatin Receptor ◽  
Pet Ct
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