BACKGROUND & AIMS: Survival times vary among patients with neuroendocrine tumors (NETs)-even among those with the same site, stage, and grade of primary tumor. This makes it difficult to select treatment for patients with unresectable NETs, because some patients can survive decades without treatment. (68)Gallium-DOTATATE positron emission tomography with computed tomography ((68)Ga-DOTATATE PET/CT) is a sensitive imaging technique for detection of NETs. We investigated the prognostic accuracy of (68)Ga-DOTATATE PET/CT analysis of tumor volume in patients with NETs.
METHODS: We performed a prospective study of 184 patients with NETs (128 [69.6%] with metastases and 11 patients [6.0%] with locally advanced disease) at the National Institutes of Health Clinical Center from 2013 through 2017. All patients underwent (68)Ga-DOTATATE PET/CT image analysis and total (68)Ga-DOTATATE-Avid tumor volume ((68)Ga-DOTATATE TV) was determined. We also measured fasting serum chromogranin A, neuron-specific enolase, gastrin, glucagon, vasoactive intestinal peptide, pancreatic polypeptide, and 24-hour urinary 5-hydroxyindoleacetic acid levels in all patients. Disease progression was defined as a new lesion or a growth of a known lesion, during the interval between baseline (68)Ga-DOTATATE PET/CT scan and follow-up imaging (14.0±6.1 months; range 1-35 months). The primary outcomes were progression-free survival (PFS) and disease-specific mortality during a median follow-up time of 18 months (range 4-35 months).
RESULTS: We found an inverse correlation between quartiles of (68)Ga-DOTATATE TV and PFS (P=.001) and disease-specific survival (P=.002). A (68)Ga-DOTATATE TV of 7.0 mL or more was associated with higher odds of disease progression (hazard ratio, 3.0; P=.04). A (68)Ga-DOTATATE TV of 35.8 mL or more was associated with increased risk of disease-specific death (hazard ratio, 10.6) in multivariable analysis (P=.01), as well as in subgroup analysis of patients with pancreatic NETs.
CONCLUSIONS: In a prospective study, we demonstrated the prognostic utility of (68)Ga-DOTATATE TV in a large cohort of patients with NETs, in terms of PFS and disease-specific mortality.
OBJECTIVE: The purpose was to validate the prognostic value of an early optimal morphological response on CT in patients treated with bevacizumab-containing chemotherapy for unresectable colorectal cancer liver metastases (CLM). It also evaluated the prognostic value of size-based criteria and the association of optimal morphological response with the receipt of bevacizumab.
DESIGN: 141 patients treated first using bevacizumab and 142 patients from a randomised study evaluating the addition of bevacizumab to oxaliplatin-based chemotherapy were retrospectively analysed. Radiologists evaluated pretreatment and restaging CT scans using morphological response criteria. Responses were also assessed with size-based criteria: Response Evaluation Criteria in Solid Tumors (RECIST), early tumour shrinkage (ETS) and deepness of response (DpR). The ability of each criterion to predict progression-free survival (PFS), overall survival (OS) and postprogression survival (PPS) was determined using a univariate Cox proportional hazards model.
RESULTS: In both populations, median PFS was significantly longer for patients achieving an optimal morphological response (10.4 vs 6.8 months, p=0.03; and 8.3 vs 4.9 months, p<00001, respectively). Neither RECIST nor ETS responses were associated with a prolonged PFS. Median OS was longer for those with an optimal morphological response but only at second restaging in the first population (n=141, 20.8 vs 12.3 months, p=0.002). DpR but not optimal morphological response was associated with PPS. In the randomised study, an optimal morphological response was 6.2 times more likely among patients receiving bevacizumab (p<0.0001).
CONCLUSION: In patients with unresectable CLM, early morphological response may be a better predictor of PFS than size-based response. The addition of bevacizumab improves morphological response rate.
Oncology (3) Colorectal Neoplasms (3), Neoplasms (1), more mentions
... than did those with SD and had longer OS than did those with PD AbstractText: For patients with advanced RCC for which prior therapies have failed, the prognostic value of various imaging-based tumor response criteria differs on the basis of the MSKCC clinical risk status Keyword: clinical risk factors.
Oncology (1) Neoplasms (7), Renal Cell Carcinoma (3), more mentions
OBJECTIVE: The purpose of this study is to discuss the imaging modalities and response criteria used for assessing hepatocellular carcinoma (HCC) response to (90)Y radioembolization, as well as the imaging appearances of treated tumors.
CONCLUSION: An understanding of the appearance of HCC after (90)Y radioembolization is crucial for accurate evaluation of treatment response. Residual tumor necrosis and enhancement are essential for assessing response. Multiparametric MRI, including DWI and perfusion imaging, plays an emerging role in response assessment and outcome prediction.
Hepatocellular Carcinoma (3), Necrosis (1), Carcinoma (1), more mentions
OBJECTIVE: The purposes of this study were to assess whether CT texture analysis and CT features are predictive of pancreatic neuroendocrine tumor (PNET) grade based on the World Health Organization (WHO) classification and to identify features related to disease progression after surgery.
MATERIALS AND METHODS: Preoperative contrast-enhanced CT images of 101 patients with PNETs were assessed. The images were evaluated for tumor location, tumor size, tumor pattern, predominantly solid or cystic composition, presence of calcification, presence of heterogeneous enhancement on contrast-enhanced images, presence of pancreatic duct dilatation, presence of pancreatic atrophy, presence of vascular involvement by the tumor, and presence of lymphadenopathy. Texture features were also extracted from CT images. Surgically verified tumors were graded according to the WHO classification, and patients underwent CT or MRI follow-up after surgical resection. Data were analyzed with chi-square tests, kappa statistics, logistic regression analysis, and Kaplan-Meier curves.
RESULTS: The CT features predictive of a more aggressive tumor (grades 2 and 3) were size larger than 2.0 cm (odds ratio [OR], 3.3; p = 0.014), presence of vascular involvement (OR, 25.2; p = 0.003), presence of pancreatic ductal dilatation (OR, 6.0; p = 0.002), and presence of lymphadenopathy (OR, 6.8; p = 0.002). The texture parameter entropy (OR, 3.7; p = 0.008) was also predictive of more aggressive tumors. Differences in progression-free survival distribution were found for grade 1 versus grades 2 and 3 tumors (χ(2) [df, 1] = 21.6; p < 0.001); for PNETs with vascular involvement (χ(2) [df, 1] = 20.8; p < 0.001); and for tumors with entropy (spatial scale filter 2) values greater than 4.65 (χ(2) (df, 1) = 4.4; p = 0.037).
CONCLUSION: CT texture analysis and CT features are predictive of PNET aggressiveness and can be used to identify patients at risk of early disease progression after surgical resection.
Image-directed biopsy determined the presence or absence of prostate cancer at positive imaging sites AbstractText: PET/CT imaging was performed with [18F]-FDHT and [18F]-FDG; select individual lesions were biopsied to correlate imaging phenotype with histologic findings AbstractText: All metabolically active lesions were interpreted as [18F]-FDHT-positive ...
Oncology (4) Prostatic Neoplasms (3), Neoplasms (2), more mentions
BACKGROUND: Screening tests are generally not recommended in patients with advanced cancer and limited life expectancy. Nonetheless, screening mammography still occurs and may lead to follow-up testing.
OBJECTIVE: We assessed the frequency of downstream breast imaging following screening mammography in patients with advanced colorectal or lung cancer.
DESIGN: Population-based study.
PARTICIPANTS: The study included continuously enrolled female fee-for-service Medicare beneficiaries ≥65 years of age with advanced colorectal (stage IV) or lung (stage IIIB-IV) cancer reported to a Surveillance, Epidemiology, and End Results (SEER) registry between 2000 and 2011.
MAIN MEASURES: We assessed the utilization of diagnostic mammography, breast ultrasound, and breast MRI following screening mammography. Logistic regression models were used to explore independent predictors of utilization of downstream tests while controlling for cancer type and patient sociodemographic and regional characteristics.
KEY RESULTS: Among 34,127 women with advanced cancer (23% colorectal; 77% lung cancer; mean age at diagnosis 75 years), 9% (n = 3159) underwent a total of 5750 screening mammograms. Of these, 11% (n = 639) resulted in at least one subsequent diagnostic breast imaging examination within 9 months. Diagnostic mammography was most common (9%; n = 532), followed by ultrasound (6%; n = 334) and MRI (0.2%; n = 14). Diagnostic mammography rates were higher in whites than African Americans (OR, 1.6; p <0.05). Higher ultrasound utilization was associated with more favorable economic status (OR, 1.8; p <0.05).
CONCLUSIONS: Among women with advanced colorectal and lung cancer, 9% continued screening mammography, and 11% of these screening studies led to at least one additional downstream test, resulting in costs with little likelihood of meaningful benefit.
OBJECTIVE: The purpose of this article is to review how fat is detected on imaging and to discuss the differential diagnosis of fat-containing liver lesions.
CONCLUSION: Fat is a highly useful feature in characterizing liver lesions on imaging. Although a variety of liver lesions can show fat on cross-sectional imaging, the presence of fat usually indicates that the lesion is of hepatocellular origin. Less commonly, nonhepatocellular fatty lesions may be distinguished by ancillary clinical and imaging features.
Hepatocellular Carcinoma (1), Liver Cell Adenoma (1), more mentions
Abstract: The use of [(18)F]- and [(68)Ga]-labeled inhibitors of prostate-specific membrane antigen (PSMA) for positron emission tomography (PET) imaging of prostate cancer is now widespread. We have proposed a reporting and data system called PSMA-RADS version 1.0, which is a framework for classifying PSMA-targeted PET scans and individual findings into categories that reflect the ...
The baseline computational model was validated using 3D nuclearimaging to provide flow velocities at the inlet holes and through the catheter. RESULTS The optimized catheter design achieved through use of the automated simulation framework improved significantly on previous attempts to reach a uniform inlet flow rate distribution using the standard catheter hole configuration as a baseline.