Positron emission tomography in oncology with use of radiotracers alternative to 18F-fluorodeoxyglucose

Celem pracy jest prezentacja najistotniejszych klinicznie zastosowań onkologicznych badania metodą pozytonowej tomografii emisyjnej z użyciem radioznaczników alternatywnych do 18F-fluorodeoksyglukozy. Badania te zyskują obecnie coraz szersze zastosowanie, także w przypadkach zmian o niedostatecznym dla obrazowania diagnostycznego gromadzeniu radiofarmaceutyku glukozowego. Pozytonowa tomografia emisyjna z użyciem18F-fluorodeoksyglukozy pozwala na ocenę poziomu metabolizmu w wielu często występujących nowotworach.W przypadkach niskiego poziomu lub dużej zmienności wychwytu 18F-fluorodeoksyglukozy w celu oceny pobudzenia metabolicznego konieczne jest wykorzystanie alternatywnych radiofarmaceutyków, z których najważniejsze to znakowane izotopowo aminokwasy, elementy budulcowe kwasów nukleinowych lub błon komórkowych oraz substraty cyklu Krebsa. Radiofarmaceutyki alternatywne do 18F-fluorodeoksyglukozy pozwalają także na ocenę parametrów czynnościowych innych niż metabolizm komórkowy, takich jak gęstość receptorowa czy poziom hipoksji.The objective of the article is to present of clinically most relevant oncological applications of positron emission tomography with use of radiotracers alternative to 18F-fluorodeoxyglucose. These studies are applied with increasing frequency also in the case of lesions demonstrating low, insufficient for imaging uptake of glucose-basedradiotracer. 18F-fluorodeoxyglucose positron emission tomography allows assessment of metabolic rate in many frequently occurring neoplasms. In case of low-level or highly variable 18F-fluorodeoxyglucose uptake alternative radiotracers must be used. Clinically most relevant are isotopically labeled amino acids, nucleic acids components, cell membrane components or Krebs cycle substrates. Radiotracers alternative to 18F-fluorodeoxyglucose enable also evaluation of functional parameters other than metabolic such as e.g. receptor density or hypoxia level

Zastosowania pozytronowej tomografii emisyjnej z użyciem fluorodeoksyglukozy w onkologii

The aim of the article is presentation of clinically significant oncologic applications of positron emission tomography (PET) performed with radiotracer 18F-fluorodeoxyglucose. This imaging study gains currently wide application in diagnosis of neoplastic disease and, as a functional study, is important adjunct to other imaging modalities primarily focused on morphological changes.Celem pracy jest przedstawienie ważnych klinicznie zastosowań onkologicznych badania pozytronową tomografią emisyjną (PET) z użyciem radioznacznika 18F-fluorodeoksyglukozy. Badanie to zyskuje obecnie coraz szersze zastosowanie w diagnostyce chorób nowotworowych i jako badanie czynnościowe oferuje istotne dopełnienie innych metod obrazowania skoncentrowanych głównie na morfologii zmian

BRONCO: Automated modelling of the bronchovascular bundle using the Computed Tomography Images

Segmentation of the bronchovascular bundle within the lung parenchyma is a key step for the proper analysis and planning of many pulmonary diseases. It might also be considered the preprocessing step when the goal is to segment the nodules from the lung parenchyma. We propose a segmentation pipeline for the bronchovascular bundle based on the Computed Tomography images, returning either binary or labelled masks of vessels and bronchi situated in the lung parenchyma. The method consists of two modules, modeling of the bronchial tree and vessels. The core revolves around a similar pipeline, the determination of the initial perimeter by the GMM method, skeletonization, and hierarchical analysis of the created graph. We tested our method on both low-dose CT and standard-dose CT, with various pathologies, reconstructed with various slice thicknesses, and acquired from various machines. We conclude that the method is invariant with respect to the origin and parameters of the CT series. Our pipeline is best suited for studies with healthy patients, patients with lung nodules, and patients with emphysema

Leczenie niedrobnokomórkowego raka płuca inhibitorami BRAF i MEK: trudności diagnostyczne i terapeutyczne

Niedrobnokomórkowy rak płuca stanowi bardzo różnorodną grupę nowotworów pod względem cech molekularnych. W wyniku rozwoju badań i terapii ukierunkowanych molekularnie oraz inhibitorów punktów kontrolnych układu immunologicznego w wybranych grupach chorych czas przeżycia chorych uległ istotnej poprawie. W ostatnich latach dzięki poznaniu nowych czynników predykcyjnych możliwe było wprowadzenie kolejnych terapii. Jedną z nich jest leczenie ukierunkowane molekularnie inhibitorami BRAF i MEK w przypadku mutacji genu BRAF. W niniejszym artykule opisano przypadek chorej z zaawansowanym niedrobnokomórkowym rakiem płuca z obecnością wyżej wymienionej mutacji, która w wyniku leczenia inhibitorami BRAF/MEK odniosła długotrwałą korzyść kliniczną

Efficacy and Safety of Gadopiclenol for Contrast-Enhanced MRI of the Central Nervous System: The PICTURE Randomized Clinical Trial

Objectives: Developing new high relaxivity gadolinium-based contrast agents (GBCAs) for magnetic resonance imaging (MRI) allowing dose reduction while maintaining similar diagnostic efficacy is needed, especially in the context of gadolinium retention in tissues. This study aimed to demonstrate that contrast-enhanced MRI of the central nervous system (CNS) with gadopiclenol at 0.05 mmol/kg is not inferior to gadobutrol at 0.1 mmol/kg, and superior to unenhanced MRI. Materials and methods: PICTURE is an international, randomized, double-blinded, controlled, cross-over, phase III study, conducted between June 2019 and September 2020. Adult patients with CNS lesions were randomized to undergo 2 MRIs (interval, 2-14 days) with gadopiclenol (0.05 mmol/kg) then gadobutrol (0.1 mmol/kg) or vice versa. The primary criterion was lesion visualization based on 3 parameters (border delineation, internal morphology, and contrast enhancement), assessed by 3 off-site blinded readers. Key secondary outcomes included lesion-to-background ratio, enhancement percentage, contrast-to-noise ratio, overall diagnostic preference, and adverse events. Results: Of the 256 randomized patients, 250 received at least 1 GBCA administration (mean [SD] age, 57.2 [13.8] years; 53.6% women). The statistical noninferiority of gadopiclenol (0.05 mmol/kg) to gadobutrol (0.1 mmol/kg) was achieved for all parameters and all readers (n = 236, lower limit 95% confidence interval of the difference ≥-0.06, above the noninferiority margin [-0.35], P < 0.0001), as well as its statistical superiority over unenhanced images (n = 239, lower limit 95% confidence interval of the difference ≥1.29, P < 0.0001).Enhancement percentage and lesion-to-background ratio were higher with gadopiclenol for all readers ( P < 0.0001), and contrast-to-noise ratio was higher for 2 readers ( P = 0.02 and P < 0.0001). Three blinded readers preferred images with gadopiclenol for 44.8%, 54.4%, and 57.3% of evaluations, reported no preference for 40.7%, 21.6%, and 23.2%, and preferred images with gadobutrol for 14.5%, 24.1%, and 19.5% ( P < 0.001).Adverse events reported after MRI were similar for gadopiclenol (14.6% of patients) and gadobutrol (17.6%). Adverse events considered related to gadopiclenol (4.9%) and gadobutrol (6.9%) were mainly injection site reactions, and none was serious. Conclusions: Gadopiclenol at 0.05 mmol/kg is not inferior to gadobutrol at 0.1 mmol/kg for MRI of the CNS, confirming that gadopiclenol can be used at half the gadolinium dose used for other GBCAs to achieve similar clinical efficacy

L'Athlète : journal hebdomadaire de tous les sports

29 janvier 19301930/01/29 (N663)-1930/01/29.Appartient à l’ensemble documentaire : Aquit

Real-World Experience in Treatment of Patients with Non-Small-Cell Lung Cancer with BRAF or cMET Exon 14 Skipping Mutations

BRAF and cMET exon 14 skipping are rare mutations of NSCLC. The treatment sequence in these cases for the first and second line is not clear. An international registry was created for patients with advanced NSCLC harboring BRAF or cMET exon 14 skipping mutations, diagnosed from January 2017 to June 2022. Clinicopathological and molecular data and treatment patterns were recorded. Data on 58 patients, from eight centers across five countries, were included in the final analysis. We found that 40 patients had the cMET exon 14 skipping mutation and 18 had the BRAF V600E mutation. In total, 53 and 28 patients received first- and second-line treatments, respectively, among which 52.8% received targeted therapy (TT) in the first line and 53.5% in the second line. The overall response rate (ORR) and disease control rate (DCR) for first-line treatment with TT vs. other treatment such as immune checkpoint inhibitors ± chemotherapy (IO ± CT) were 55.6% vs. 21.7% (p = 0.0084) and 66.7% vs. 39.1% (p = 0.04), respectively. The type of treatment in first-line TT vs. other affected time to treatment discontinuation (TTD) was 11.6 m vs. 4.6 m (p= 0.006). The overall survival for the whole group was 15.4 m and was not statistically affected by the type of treatment (19.2 m vs. 13.5 m; p = 0.83)