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| 2. |
- McParland, Brian J., et al.
(författare)
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The clinical safety, biodistribution and internal radiation dosimetry of [F-18]fluciclovine in healthy adult volunteers
- 2013
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Ingår i: European Journal of Nuclear Medicine and Molecular Imaging. - : Springer Science and Business Media LLC. - 1619-7070 .- 1619-7089. ; 40:8, s. 1256-1264
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Tidskriftsartikel (refereegranskat)abstract
- We report on the biodistribution and internal radiation dosimetry in humans of [F-18]fluciclovine, a synthetic L-leucine analogue being investigated as a potential diagnostic biomarker for neoplasia. Whole-body positron emission tomography (PET) scans of 6 healthy volunteers were acquired at up to 16 time points up to about 5 h after a bolus administration of [F-18]fluciclovine (153.8 +/- 2.2 MBq). Venous blood samples were taken up to about 4 h post-injection from which F-18 activity concentrations in whole blood and plasma were measured. Urine was collected as voided up to 4 h post-injection, from which the excreted F-18 activity was measured. Absolute values of the F-18 activity contained in up to 11 source regions (brain, salivary glands, lung, heart, pancreas, spleen, liver, red bone marrow, kidneys, uterus and urinary bladder contents) were determined directly from quantitative analysis of the images. For each source region, the F-18 activity decay-corrected and normalised to that injected, as a function of time, was fit by an analytical function which was subsequently integrated to yield the cumulated activity normalised to the injected activity. These normalised cumulated activities were then used as input to the Organ Level INternal Dose Assessment/EXponential Modelling (OLINDA/EXM) package to calculate the internal radiation dosimetry of each subject following the Medical Internal Radiation Dose (MIRD) schema. An effective dose was then estimated for each subject. [F-18]Fluciclovine was clinically well tolerated in this study. Very little F-18 was excreted with only a mean value of 3.3 % present in the urine at about 4 h post-injection; no activity within the intestinal contents was noted. The highest mean initial uptakes were measured in the liver (13.8 %), red bone marrow (11.1 %) and lung (7.1 %). The highest mean radiation absorbed doses per unit administered activity were received by the pancreas (102.2 mu Gy/MBq), the cardiac wall (51.7 mu Gy/MBq) and the uterine wall (44.6 mu Gy/MBq). The mean effective dose per unit administered activity was 22.1 mu Sv/MBq. The internal radiation dosimetry of [F-18]fluciclovine appears acceptable for PET imaging.
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- Mosavi, Firas, et al.
(författare)
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Whole-Body Diffusion-Weighted MRI Compared With 18F-NaF PET/CT for Detection of Bone Metastases in Patients With High-Risk Prostate Carcinoma
- 2012
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Ingår i: American Journal of Roentgenology. - 0361-803X .- 1546-3141. ; 199:5, s. 1114-1120
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:The purpose of this study was to evaluate the accuracy of whole-body diffusion-weighted MRI (DWI) and 18F-NaF PET/CT for detection of bone metastases in patients with high-risk prostate cancer.SUBJECTS AND METHODS:Both patient- and lesion-based analyses were performed on 49 consecutive patients (median age, 67 years; age range, 57-80 years) with recently diagnosed high-risk prostate cancer. All patients underwent bone scintigraphy, whole-body MRI including DWI and 18F-NaF PET/CT before treatment. Bone scintigraphy, conventional MR images, and follow-up images were used as the standard of reference to evaluate 18F-NaF PET/CT and DWI.RESULTS:On patient-based analysis, five patients had skeletal metastases on reference imaging that both DWI and 18F-NaF PET/CT could verify, and 18F-NaF PET/CT and DWI showed false-positive findings in four and one patient, respectively. With lesion-based analysis, 18F-NaF PET/CT and DWI showed nine and five true-positive lesions, zero and four false-negative lesions, and seven and two false-positive lesions, respectively. Two patients with uncountable bone metastases were analyzed separately. In these patients, 18F-NaF PET/CT showed more bone metastases than did DWI.CONCLUSION:We believe 18F-NaF PET/CT is a sensitive modality for detection of bone metastases caused by prostate cancer. Whole-body DWI shows a higher specificity but lower sensitivity than 18F-NaF PET/CT. Future studies with a larger patient cohort along with analyses of costs and clinical availability are needed before implementation of these methods can be considered.
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| 5. |
- Regula, Naresh, et al.
(författare)
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11c-acetate pet/ct accurately predicts prostate-cancer specific survival in patients with biochemical relapse after prostatectomy
- 2016
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Ingår i: Journal of Nuclear Medicine. ; 57:supplement 2, s. 521-
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Tidskriftsartikel (refereegranskat)abstract
- 521Objectives [11C]-acetate PET/CT is clinically used for re-staging of prostate cancer (PCa) at biochemical relapse after prostatectomy, but the long-term predictive value is not known. This study analysed the prognostic value of [11C]-acetate PET/CT and evaluated PET image metrics in relation to survival.Methods All patients undergoing acetate PET/CT in one institution from 2005-2012 due to PSA-relapse after previous prostatectomy were retrospectively evaluated and clinical data were recorded. Patients were grouped as PCa-specific deaths (Cohort I) or censored (Cohort II). All previously reported findings of local recurrence, regional or distal lymph node metastases and bone metastases were counted and evaluated regarding [11C]-acetate uptake intensity (SUVmax) and tumor volume (TV). Total TV and total lesion activity (TLA, summed SUVmax[asterisk]TV) were calculated. Survival analysis in the entire material was followed by Cox-proportional hazards ratios (HR) analysis in patients with at least one PET-positive finding.Results One-hundred twenty-one patients were included and 22 PCa-specific deaths were registered. Median follow-up time was 79 ± 28 months. Mean PSA at time of PET was 2.69 ± 4.35. Post-operative Gleason score (GS) and PSA at time of PET were higher in Cohort I (both p<0.05). PET/CT identified at least one PCa lesion in 53% of patients. Five-year survival was 79% and 100% for a positive and negative PET, respectively (p<0.001). Univariate HR in PET-positive patients was significantly increased for Post-op GS (1.77, p=0.01), tertile of SUVmax (2.35, p=0.005), tertile of TTV (2.74, p=0.001), tertile of TLA (3.33, p<0.001), number of distal lymph node lesions (1.29, p=0.001) and number of bone metastases (2.16, p<0.001). Stepwise multivariate analysis in PET-positive patients showed statistical significance for post-operative GS (HR 1.85, p=0.04), tertile of TLA (HR 5.51, p=0.03) and number of bone metastases (HR 1.75, p=0.01). Survival analysis of TLA showed statistically significant separation of all tertiles (p<0.001).Conclusions [11C]-acetate PET/CT predicts survival in the setting of PSA-relapse after prostatectomy. Volumetric analysis of tumor burden and metabolic activity has incremental value over anatomical and histopathological staging. A negative scan is associated with superior outcome.
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| 6. |
- Regula, Naresh, et al.
(författare)
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Comparison of 68Ga-PSMA-11 PET/CT with 11C-acetate PET/CT in re-staging of prostate cancer relapse
- 2020
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Positron emission tomography (PET) imaging is used to localize recurrent disease in prostate cancer (PCa). The tracer 68Ga-PSMA-11 visualizes lesions overexpressing prostate-specific membrane antigen (PSMA), while 11C-acetate visualizes lesions with increased anabolic metabolism. The aim of this study was to compare the performance of PSMA-PET and acetate-PET in re-staging patients with biochemical relapse. Thirty PCa patients with prostate-specific antigen (PSA) relapse after primary curative therapy were prospectively evaluated. PET/CT examinations using 11C-acetate and 68Ga-PSMA-11 were performed. Identified lesions were categorized according to anatomical location and PET measurements were correlated with PSA at time of scan. Tumour lesions showed higher semi-quantitative uptake values on PSMA-PET than acetate-PET. PSMA-PET identified more lesions in 11 patients, fewer lesions in eight patients, and identical number of lesions in 11 patients. This study indicates better diagnostic performance of PSMA-PET, particularly in detecting lymph node (81% vs 60%, p=0.02) and bone metastasis (95% vs 61%, p=0.0001) compared to acetate-PET. However, 38% of PSMA-expressing metastases appear to be metabolically inactive and 15% of metabolically active metastases lack PSMA expression. Addition of PET with a metabolic tracer, such as 11C-acetate, might be beneficial before making treatment decisions.
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| 7. |
- Regula, Naresh, 1985-, et al.
(författare)
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Comparison of 68Ga-PSMA-11 PET/CT with 18F-fluoride PET/CT for detection of bone metastatic disease in prostate cancer
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- 18F-fluoride positron emission tomography/computed tomography (PET/CT) is considered the most sensitive technique to detect bone metastasis in prostate cancer (PCa). 68Ga-PSMA-11 PET/CT is increasingly used for staging of PCa. This study primarily aimed to compare the diagnostic performance of 18F-fluoride PET/CT and 68Ga-PSMA-11 PET/CT in identifying bone metastasis followed by a comparison of 68Ga-PSMA-11 PET/CT with diagnostic CT in identifying soft tissue lesions as a secondary objective.Methods: Twenty-eight PCa patients with high suspicion of widespread disease following curative treatment were prospectively evaluated. PET/CT examinations using 18F-fluoride and 68Ga-PSMA-11 were performed. All suspicious bone lesions were counted, and the tracer uptake was measured as standardized uptake values (SUV) for both tracers. In patients with multiple findings, ten bone lesions with highest SUVmax were selected from which identical lesions from both scans were considered for direct comparison of SUVmax. PSA at scan was correlated with findings of both scans.Results: Both scans were negative for bone lesions in 7 patients (25%). Of 699 lesions consistent with skeletal metastasis in 21 patients on 18F-fluoride PET/CT, 68Ga-PSMA-11 PET/CT identified 579 lesions (83%). In 69 identical bone lesions 18F-fluoride PET/CT showed significantly higher uptake (mean SUVmax:73.1±36.8) compared to 68Ga-PSMA-11 PET/CT (34.5±31.4; p<0.001). PSA at scan was correlated with SUVmax of PSMA-PET (r=58; p=0.01). No correlation was seen between PSA and 18F-fluoride PET/CT measurements. Compared to diagnostic CT, 68Ga-PSMA-11 PET/CT showed better diagnostic performance in locating local (96% vs 61%, p=0.004) and lymph node (94% vs 46%, p<0.001) metastasis.Conclusion: 68Ga-PSMA-11 PET/CT was able to detect majority of bone lesions that were positive on 18F-fluoride PET/CT and was better correlated with PSA at time of scan. Further, this study indicates better diagnostic performance of 68Ga-PSMA-11 PET/CT to locate soft tissue lesions compared to diagnostic CT.
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| 8. |
- Regula, Naresh Kumar, et al.
(författare)
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Comparison of Ga-68-PSMA PET/CT with fluoride PET/CT for detection of bone metastatic disease in prostate cancer
- 2022
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Ingår i: European Journal of Hybrid Imaging. - : Springer Nature. - 2510-3636. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Background F-18-NaF positron emission tomography/computed tomography (fluoride PET/CT) is considered the most sensitive technique to detect bone metastasis in prostate cancer (PCa). Ga-68-PSMA-11 (PSMA) PET/CT is increasingly used for staging of PCa. This study primarily aimed to compare the diagnostic performance of fluoride PET/CT and gallium-based PSMA PET/CT in identifying bone metastasis followed by a comparison of PSMA PET/CT with contrast-enhanced CT (CE-CT) in identifying soft tissue lesions as a secondary objective. Methods Twenty-eight PCa patients with high suspicion of disseminated disease following curative treatment were prospectively evaluated. PET/CT examinations using fluoride and PSMA were performed. All suspicious bone lesions were counted, and the tracer uptake was measured as standardized uptake values (SUV) for both tracers. In patients with multiple findings, ten bone lesions with highest SUVmax were selected from which identical lesions from both scans were considered for direct comparison of SUVmax. Soft tissue findings of local and lymph node lesions from CE-CT were compared with PSMA PET/CT. Results Both scans were negative for bone lesions in 7 patients (25%). Of 699 lesions consistent with skeletal metastasis in 21 patients on fluoride PET/CT, PSMA PET/CT identified 579 lesions (83%). In 69 identical bone lesions fluoride PET/CT showed significantly higher uptake (mean SUVmax: 73.1 +/- 36.8) compared to PSMA PET/CT (34.5 +/- 31.4; p < 0.001). Compared to CE-CT, PSMA PET/CT showed better diagnostic performance in locating local (96% vs 61%, p = 0.004) and lymph node (94% vs 46%, p < 0.001) metastasis. Conclusion In this prospective comparative study, PSMA PET/CT detected the majority of bone lesions that were positive on fluoride PET/CT. Further, this study indicates better diagnostic performance of PSMA PET/CT to locate soft tissue lesions compared to CE-CT.
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| 10. |
- Regula, Naresh, et al.
(författare)
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Malignant lipogenesis defined by 11C-acetate PET/CT predicts prostate cancer-specific survival in patients with biochemical relapse after prostatectomy
- 2016
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Ingår i: European Journal of Nuclear Medicine and Molecular Imaging. - : Springer Science and Business Media LLC. - 1619-7070 .- 1619-7089. ; 43:12, s. 2131-2138
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Tidskriftsartikel (refereegranskat)abstract
- Malignant de novo lipogenesis is strongly linked to the aggressiveness of prostate cancer (PCa) under experimental conditions. C-11-Acetate PET/CT is a potential noninvasive biomarker of malignant lipogenesis in PCa, but its prognostic value is not known. The objective of this study was to analyse C-11-acetate PET/CT image metrics in relation to survival. All patients undergoing C-11-acetate PET/CT in one university hospital from 2005 to 2011 due to PSA relapse after previous prostatectomy were retrospectively evaluated. Two groups of patients were compared: those who died from PCa and those who were censored. All previously reported findings of local recurrence, regional or distal lymph node metastases and bone metastases were counted and evaluated regarding C-11-acetate uptake intensity (SUVmax) and tumour volume. Total tumour volume and total lipogenic activity (TLA, summed SUVmax x TV) were calculated. Survival analysis in the entire study population was followed by Cox proportional hazards ratio (HR) analysis. A total of 121 patients were included, and 22 PCa-specific deaths were recorded. The mean PSA level at the time of PET was 2.69 +/- 4.35 ng/mL. The median follow-up of the study population was 79 +/- 28 months. PET identified at least one PCa lesion in 53 % of patients. Five-year PCa-specific survival after PET was 80 % and 100 % in patients with a positive and a negative PET scan, respectively (p < 0.001). Time-to-death was linearly correlated with highest SUVmax (r = -0.55, p = 0.01) and nonlinearly with TLA (r = -0.75, p < 0.001). Multivariate analysis showed statistical significance for number of bone metastases (HR 1.74, p = 0.01), tertile of TLA (HR 5.63, p = 0.029) and postoperative Gleason score (HR 1.84, p = 0.045). Malignant C-11-acetate accumulation measured with PET/CT is a strong predictor of survival in the setting of PSA relapse after prostatectomy. The study provides further evidence for a quantitative relationship between malignant de novo lipogenesis and early death. C-11-Acetate PET/CT might be useful for identifying a high-risk population of relapsing patients in which therapies targeting malignant lipogenesis might be of particular benefit.
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