99mTc-HYNIC-rh-annexin-V scintigraphy: visual and quantitative evaluation of early treatment-induced apoptosis to predict treatment outcome.

AIM: To determine the reliability of visual analysis of 99mTc-HYNIC-rh-annexin-V tumour uptake (ATU) compared to quantitative tracer uptake evaluation. METHODS: Thirty-eight patients (22 male, 16 female, mean age 57) with histologically proved lymphoma (n=31), non-small cell lung cancer (NSCLC) (n=4) and head and neck squamous cell carcinoma (H&NSCC) (n=3) were examined. 99mTc-HYNIC-rh-annexin-V scintigraphy (TAS) was acquired before and within 2 days after the start of anti-cancer treatment. Maximal counts per pixel in the tumour volume (Cmax) were calculated for every target lesion. To match the quantitative and visual ATU, both were expressed as a four-grade score. Cmax as percentages of baseline values: grade 1, decrease >25%; grade 0, 1-25% decrease; grade 1, 1-25% increase; grade 2, >25% increase. Visual analysis: 0=absent, 1=weak, 2=moderate, 3=intense. Intra-observer and inter-observer variability and methodological agreement between visual and quantitative evaluation of ATU was expressed by computing Cohen's kappa statistics. RESULTS: A statistically highly significant correlation was found between the changes in ATU and therapy outcome: r=0.97 (P <0.0001) and r=0.99 (P <0.0001) for visual and quantitative analysis, respectively. Good intra-observer reproducibility, with a high kappa of 0.82 for observer 1 and a kappa of 0.90 for observer 2, was determined. Inter-observer variability was 0.82. CONCLUSION: Visual evaluation of ATU after image co-registration appears to be a reliable and reproducible method for preliminary assessment of early treatment-induced apoptosi

18F-DCFPyL PET/CT in primary staging of prostate cancer

Abstract Background Correct primary staging is mandatory for therapy selection and to determine prognosis in prostate cancer patients. Commonly used diagnostic procedures including Computed Tomography (CT), Magnetic Resonance Imaging, Choline Positron Emission Tomography/Computed Tomography (PET/CT) and extended lymph node dissection (ePLND) have suboptimal diagnostic accuracy for primary staging. PSMA targeting radiopharmaceuticals have shown better diagnostic accuracy than commonly used imaging procedures. This study presents data of a retrospective cohort of patients that received PET/CT with 18F-DCFPyL for staging of primary prostate cancer. Methods From November 2016 until April 1018 all consecutive patients that received 18F-DCFPyL PET/CT for primary staging of prostate cancer were included in the study. 18F-DCFPyL PET findings in the primary tumour were scored. Detection rates of metastases were calculated for different clinical parameters, including PSA, Gleason score, clinical T-stage and risk on having lymph node metastases according to established prediction models. Subsequently, for lymph nodes, 18F-DCFPyL PET findings were compared to morphological features on the co-registered contrast enhanced CT and, for patients with risk on lymph node metastases > 5% according to prediction models, it was scored whether 18F-DCFPyL positive lymph nodes were present at locations that would be resected during ePLND, as well as presence of positive nodes or other metastases outside this area. Results One hundred thirty-three patients were analysed. Increased 18F-DCFPyL uptake the in primary tumour was found in 98% of the patients. In 69 patients increased 18F-DCFPyL uptake was found in lymph nodes, of which 48 and 45% had unsuspicious morphological characteristics on CT (size cut-off ≤6 mm short axis), for locoregional and distant nodes, respectively. In 43% of patients 18F-DCFPyL PET/CT detected lesions suspicious for metastases outside the ePLND area. 18F-DCFPyL PET/CT detection rates are in line with established prediction models of risk on lymph node metastases. Conclusion 18F-DCFPyL PET/CT shows more lymph nodes with pathological characteristics as compared to the co-registered contrast enhanced CT alone. 18F-DCFPyL PET/CT detects lesions suspicious for metastases outside the ePLND area in 43% of patients, with risk on lymph node metastases exceeding 5%, which therefore may be excluded for ePLND. 18F-DCFPyL PET/CT detection rates are in line with established prediction models of risk on lymph node metastases. Large prospective trials that compare 18F-DCFPyL findings with histopathological findings after ePLND are needed in order elucidate sensitivity of 18F-DCFPyL PET/CT and to position 18F-DCFPyL PET/CT in the staging algorithm for primary prostate cancer

Mapping of treatment-induced apoptosis in normal structures:99mTc-Hynic-rh-annexin V SPECT and CT image fusion

PURPOSE: The purpose of this study was to map treatment-induced (99m)Tc-Hynic-rh-annexin V uptake in normal tissues using co-registration of SPECT and CT. METHODS: Nineteen patients (11 male, 8 female, mean age 57 years) with various malignant tumours (12 lymphomas, four non-small cell lung cancers and three head and neck squamous cell carcinomas) underwent (99m)Tc-Hynic-rh-annexin V scintigraphy and CT before and within 48 h after the start of anticancer therapy. SPECT and CT were performed separately, with the patient in a reproducible position. Volume-based automated and manual methods were used to match functional and anatomical data. SPECT/CT co-registration was used to evaluate treatment-induced changes in the normal structures. RESULTS: A significant radiation field-related increase in early post-treatment (99m)Tc-Hynic-rh-annexin V uptake in salivary glands and bone marrow was detected in eight of nine patients. Radiation field-related increase in bone marrow activity above the baseline value was detected in all 13 irradiated patients. A minimal, symmetrical increase in activity in the salivary glands was detected after the initial course of platinum-based chemotherapy, and a diffuse prominent increase in (99m)Tc-Hynic-rh-annexin V in the bone marrow was detected in all cases. Precise delineation between the tumour and normal tissue tracer accumulation was accomplished in all cases using SPECT/CT co-registered volumes, enhanced by the "colourwash" technique. CONCLUSION: Mapping of early treatment-related changes in annexin V uptake by SPECT/CT co-registration permits accurate evaluation of tracer distribution in normal structures and precise delineation from tumour uptake. The associations between tracer distribution in the normal tissues and treatment regimen found in this study may contribute to the evaluation of dose-effect relations in various treatment schedule