EANM/EARL harmonization strategies in PET quantification: from daily practice to multicentre oncological studies

Quantitative positron emission tomography/computed tomography (PET/CT) can be used as diagnostic or prognostic tools (i.e. single measurement) or for therapy monitoring (i.e. longitudinal studies) in multicentre studies. Use of quantitative parameters, such as standardized uptake values (SUVs), metabolic active tumor volumes (MATVs) or total lesion glycolysis (TLG), in a multicenter setting requires that these parameters be comparable among patients and sites, regardless of the PET/CT system used. This review describes the motivations and the methodologies for quantitative PET/ CT performance harmonization with emphasis on the EANM Research Ltd. (EARL) Fluorodeoxyglucose (FDG) PET/CT accreditation program, one of the international harmonization programs aiming at using FDG PET as a quantitative imaging biomarker. In addition, future accreditation initiatives will be discussed. The validation of the EARL accreditation program to harmonize SUVs and MATVs is described in a wide range of tumor types, with focus on therapy assessment using either the European Organization for Research and Treatment of Cancer (EORTC) criteria or PET Evaluation Response Criteria in Solid Tumors (PERCIST), as well as liver-based scales such as the Deauville score. Finally, also presented in this paper are the results from a survey across 51 EARL-accredited centers reporting how the program was implemented and its impact on daily routine and in clinical trials, harmonization of new metrics such as MATV and heterogeneity features

Contrast-enhanced small-animal PET/CT in cancer research: strong improvement of diagnostic accuracy without significant alteration of quantitative accuracy and NEMA NU 4–2008 image quality parameters

Abstract Background The use of iodinated contrast media in small-animal positron emission tomography (PET)/computed tomography (CT) could improve anatomic referencing and tumor delineation but may introduce inaccuracies in the attenuation correction of the PET images. This study evaluated the diagnostic performance and accuracy of quantitative values in contrast-enhanced small-animal PET/CT (CEPET/CT) as compared to unenhanced small animal PET/CT (UEPET/CT). Methods Firstly, a NEMA NU 4–2008 phantom (filled with 18F-FDG or 18F-FDG plus contrast media) and a homemade phantom, mimicking an abdominal tumor surrounded by water or contrast media, were used to evaluate the impact of iodinated contrast media on the image quality parameters and accuracy of quantitative values for a pertinent-sized target. Secondly, two studies in 22 abdominal tumor-bearing mice and rats were performed. The first animal experiment studied the impact of a dual-contrast media protocol, comprising the intravenous injection of a long-lasting contrast agent mixed with 18F-FDG and the intraperitoneal injection of contrast media, on tumor delineation and the accuracy of quantitative values. The second animal experiment compared the diagnostic performance and quantitative values of CEPET/CT versus UEPET/CT by sacrificing the animals after the tracer uptake period and imaging them before and after intraperitoneal injection of contrast media. Results There was minimal impact on IQ parameters (%SDunif and spillover ratios in air and water) when the NEMA NU 4–2008 phantom was filled with 18F-FDG plus contrast media. In the homemade phantom, measured activity was similar to true activity (−0.02%) and overestimated by 10.30% when vials were surrounded by water or by an iodine solution, respectively. The first animal experiment showed excellent tumor delineation and a good correlation between small-animal (SA)-PET and ex vivo quantification (r 2 = 0.87, P &lt; 0.0001). The second animal experiment showed a good correlation between CEPET/CT and UEPET/CT quantitative values (r 2 = 0.99, P &lt; 0.0001). Receiver operating characteristic analysis demonstrated better diagnostic accuracy of CEPET/CT versus UEPET/CT (senior researcher, area under the curve (AUC) 0.96 versus 0.77, P = 0.004; junior researcher, AUC 0.78 versus 0.58, P = 0.004). Conclusions The use of iodinated contrast media for small-animal PET imaging significantly improves tumor delineation and diagnostic performance, without significant alteration of SA-PET quantitative accuracy and NEMA NU 4–2008 IQ parameters. </jats:sec

Nuclear medicine in the assessment and prevention of cancer therapy-related cardiotoxicity:prospects and proposal of use by the European Association of Nuclear Medicine (EANM)

Abstract: Cardiotoxicity may present as (pulmonary) hypertension, acute and chronic coronary syndromes, venous thromboembolism, cardiomyopathies/heart failure, arrhythmia, valvular heart disease, peripheral arterial disease, and myocarditis. Many of these disease entities can be diagnosed by established cardiovascular diagnostic pathways. Nuclear medicine, however, has proven promising in the diagnosis of cardiomyopathies/heart failure, and peri- and myocarditis as well as arterial inflammation. This article first outlines the spectrum of cardiotoxic cancer therapies and the potential side effects. This will be complemented by the definition of cardiotoxicity using non-nuclear cardiovascular imaging (echocardiography, CMR) and biomarkers. Available nuclear imaging techniques are then presented and specific suggestions are made for their application and potential role in the diagnosis of cardiotoxicity.</p

Ensemble Modeling of the Likely Public Health Impact of a Pre-Erythrocytic Malaria Vaccine

Using an ensemble modeling approach, Thomas Smith and colleagues find that targeted mass vaccination with a pre-erythrocytic malaria vaccine RTS,S in low-transmission settings might have better health effects than vaccination through national EPI programs

EANM/EARL harmonization strategies in PET quantification: from daily practice to multicentre oncological studies

Quantitative positron emission tomography/computed tomography (PET/CT) can be used as diagnostic or prognostic tools (i.e. single measurement) or for therapy monitoring (i.e. longitudinal studies) in multicentre studies. Use of quantitative parameters, such as standardized uptake values (SUVs), metabolic active tumor volumes (MATVs) or total lesion glycolysis (TLG), in a multicenter setting requires that these parameters be comparable among patients and sites, regardless of the PET/CT system used. This review describes the motivations and the methodologies for quantitative PET/CT performance harmonization with emphasis on the EANM Research Ltd. (EARL) Fluorodeoxyglucose (FDG) PET/CT accreditation program, one of the international harmonization programs aiming at using FDG PET as a quantitative imaging biomarker. In addition, future accreditation initiatives will be discussed. The validation of the EARL accreditation program to harmonize SUVs and MATVs is described in a wide range of tumor types, with focus on therapy assessment using either the European Organization for Research and Treatment of Cancer (EORTC) criteria or PET Evaluation Response Criteria in Solid Tumors (PERCIST), as well as liver-based scales such as the Deauville score. Finally, also presented in this paper are the results from a survey across 51 EARL-accredited centers reporting how the program was implemented and its impact on daily routine and in clinical trials, harmonization of new metrics such as MATV and heterogeneity features

Impact d'un algorithme de reconstruction intégrant la fonction de dispersion linéique du système sur les performances diagnostiques de la tomographie par émission de positons au fluoro-désoxyglucose pour la détermination du statut ganglionnaire des cancers broncho-pulmonaires non à petites cellules

CAEN-BU Médecine pharmacie (141182102) / SudocSudocFranceF

Predicting the Presence of Targetable Molecular Alteration(s) With Clinico-metabolic 18F-FDG PET Radiomics in Non-Asian Lung Adenocarcinoma Patients.

Abstract PurposeTo investigate if combining clinical characteristics with pre-therapeutic 18F-FDG PET radiomics could predict the presence of molecular alteration(s) in key molecular targets in lung adenocarcinoma in order to screen patients who are more likely to benefit from a tumoral molecular analysis. MethodsThis non-interventional mono-centric study prospectively included patients with newly-diagnosed lung adenocarcinoma referred for baseline PET and who had tumoral molecular analyses for the following targets: EGFR, BRAF, KRAS, NRAS, MET, STK11, PIK3CA, ALK and ROS1. Tumoral volumes of interest were analysed using LifeX software. A logistic regression was performed, including sex, age, smoking history, AJCC stage and thirty-one PET variables. A validation process was used by randomly splitting the data in training and validation datasets.ResultsEighty-seven patients were analysed. Forty-seven patients (54.0%) had at least one molecular alteration. Using the training dataset (n=67), five variables were included in the logit model: age, sex, AJCC stage, correlation_GLCM and GLNU_GLZLM. More molecular alterations were observed in women: 88.0% in women versus 40.3% in men (p&lt;0.0001). Other clinical and PET variables were not different between patients with and without molecular alterations. There was a moderate correlation between correlation_GLCM and GLNU_GLZLM (p &lt;0.0001, ρ = 0.591). The ROC analysis for molecular alteration prediction using this model found an area under the curve equal to 0.891 (p&lt;0.0001). A cut-off value set to 0.38 led to a sensitivity of 97.4%, a negative predictive value of 80.4% and a LR+ equal to 3.1. When applying this cut-off value in the validation dataset of patients (n=20), the test presented a sensitivity equal to 88.9%, a NPV equal to 87.5% and a LR+ = 2.4. ConclusionsA clinico-metabolic 18F-FDG PET phenotype allows detecting key molecular target alterations with high sensitivity and NPV thus opens the way to the selection of patients for molecular analysis.</jats:p