AIM: Rectocele can cause chronic constipation and altered quality of life. In the presence of severe symptomatology and lack of response to conservative treatment, gastrointestinal motor function should be assessed. The...AIM: Rectocele can cause chronic constipation and altered quality of life. In the presence of severe symptomatology and lack of response to conservative treatment, gastrointestinal motor function should be assessed. The aim of this study was to assess the utility of gastrointestinal transit scintigraphy in this pathology, analyzing its position in international guidelines. MATERIAL AND METHODS: We retrospectively evaluated twelve women with rectocele and chronic constipation, range of 31-74 years, referred for scintigraphic study as an assessment prior to prolapse treatment. Defecography was altered in 12 and anorectal manometry in 8. Following international guidelines, a dose of [In]In-DTPA (37 MBq) was administered together with standardized food to assess liquid gastric emptying and small-bowel and colonic transit. Areas of interest were defined in these locations to calculate the geometric center. RESULTS: In 3 patients the radioisotopic study was normal, 3 showed a pattern of outlet obstruction, 3 colonic inertia, 2 slow small-bowel transit and 1 slow generalized transit. Thus, 50% of patients presented transit alterations not located in the rectosigmoid area. CONCLUSION: Scintigraphy study provided useful information for the evaluation of patients with rectocele and constipation, influencing the diagnosis and therapeutic management. It proved to be a physiological method, providing both global and regional quantitative information. Like other authors, it is considered appropriate to use the study at the same level as the tests for the assessment of defecatory dynamics.
PURPOSE: In this study we aimed to investigate prediction of response with [68Ga]Ga-PSMA PET-derived parameters and the effectiveness of RECIP criteria and PSA response in predicting survival after [177Lu]Lu-PSMA therapy...PURPOSE: In this study we aimed to investigate prediction of response with [68Ga]Ga-PSMA PET-derived parameters and the effectiveness of RECIP criteria and PSA response in predicting survival after [177Lu]Lu-PSMA therapy. METHODS: Patients who received at least 2 cycles of [177Lu]Lu-PSMA therapy were retrospectively included in the study. All lesions in the PET images were segmented and PSMA PET-based parameters were extracted. The treatment response was evaluated according to RECIP and PSA criteria. ROC analyses were performed to assess their discriminatory power in predicting response. Correlation of overall survival with RECIP and PSA-based response was evaluated using Kaplan-Meier survival analysis. RESULTS: A total of 41 patients were included in the study. SUVmax, SUVpeak, SUVmean, qPSG-max and qPSG-mean values were significant factors in predicting PSA response. However, in predicting RECIP response (CR + PR), the AUC values for the SUV parameters were not significantly higher than 0.5. In predicting RECIP disease control (CR + PR + SD), the AUC values for SUVmax, SUVpeak, and SUVmean were 0.742(p = 0.002), 0.742(p = 0.002), and 0.722(p = 0.006). In the RECIP-responder and non-responder groups, the median survival was 33.5 and 15.2 months (p = 0.005). In patients with RECIP-disease control and progressive disease, the median survival was 25.1 and 15.2 months (p = 0.002). However, the survival difference between PSA-responder and non-responders groups did not reach significance (p = 0.127). CONCLUSION: PSMA PET imaging is a useful method to select patients who will most likely to benefit from [177Lu]Lu-PSMA treatment. Also, it has been shown that RECIP has significantly performed better than PSA-based response evaluation in terms of predicting overall survival.
Rodríguez-Díaz L, Zaragoza-Ballester P, Torras I
… +8 more, Mensión E, Cebrecos I, Cases X, Vega M, Cordón J, Ribera-Perianes J, Vidal-Sicart S, Clínic Barcelona Nuclear Medicine (CBNM) Group
INTRODUCTION AND OBJECTIVES: 5-10% of breast tumor patients develop local breast tumor recurrence. The absence of axillary re-staging could increase future local recurrence and mortality risk in these patients. The lymph...INTRODUCTION AND OBJECTIVES: 5-10% of breast tumor patients develop local breast tumor recurrence. The absence of axillary re-staging could increase future local recurrence and mortality risk in these patients. The lymphoscintigraphy for sentinel lymph node biopsy in recurrences (rSLNB) using a radiotracer injection, can be an option to evaluate axillar status, but other factors known to alter the usual behaviour of SLN migration have to be taken into account, such as previous axillary surgery, breast surgery or adjuvant treatments. Our objective was to evaluate the relationship between these factors and the success rate of rSLNB (overall and aberrant drainage rates, metastases ratio). MATERIALS AND METHODS: 1102 patients were retrospectively evaluated in a tertiary hospital between 10/2018-04/2022. 52 patients with ipsilateral breast tumor recurrence who underwent rSLNB were included. Demographic data, tumor characteristics, previous treatments, drainage rates and characteristics were collected and analyzed (R statistical software). RESULTS: Overall drainage rate was 83%, in which excision was performed in 91%. Overall migration rate was significantly higher in patients with previous SLNB (92% vs 60%, p-value=0.012) and aberrant drainage was significantly higher in patients with previous axillar lymphadenectomy (ALND) (53% vs 24%, p-value=0.047). No statistical differences were observed in breast surgery or adjuvant radiotherapy. The percentage of positivity found was 13% (3 micrometastases and 2 macrometastases). 20% of metastases were found in aberrant drainage territories. CONCLUSIONS: rSLNB is a feasible and applicable technique in ipsilateral breast tumor recurrence, providing key information in locorregional recurrence management. A considerable percentage of metastases are located in aberrant drainage territories, which would have been missed without rSLNB. Therefore, rSLNB is essential for a correct axillary evaluation in order to trace them.
BACKGROUND: Parathyroid adenoma (PA) is the most common cause of primary hyperparathyroidism (PHPT). Tc-methoxyisobutylisonitrile (Tc-MIBI) imaging is widely applied in PA diagnosis and location. However, since the indiv...BACKGROUND: Parathyroid adenoma (PA) is the most common cause of primary hyperparathyroidism (PHPT). Tc-methoxyisobutylisonitrile (Tc-MIBI) imaging is widely applied in PA diagnosis and location. However, since the individual heterogeneity and adenoma function differences, the diagnostic efficacy of Tc-MIBI imaging is limited, which often leads to misdiagnosis and even mistreatment of PA. METHODS: In the present study, we established a novel dynamic nomogram model to assist the nuclear imaging diagnosis of PA. A total of 96 PA patients, with 65 cases in the positive group and 31 cases in the negative group, were enrolled for further analyzing. RESULTS: Univariate analysis showed there were no statistically significant differences between the two groups in terms of gender, age, and adenoma location. The patients in the positive group had significantly higher levels in PTH, serum calcium, longest diameter and shortest diameter of adenoma, compared to those in the negative group. But the serum phosphorus levels were lower in the positive group than in the negative group. Binary logistic regression analysis indicated that serum phosphorus and adenoma longest diameter were independent positive predictors. The dynamic nomogram model was generated by R software and logistic regression analysis (https://zhenglong-1988.shinyapps.io/dynnomapp/). The receiver operating characteristics curve (ROC curve) analysis revealed that the cut-off probability for the model to diagnose PA was 59.1%, with AUC values of 0.965. CONCLUSIONS: The novel dynamic nomogram diagnostic model integrating serum phosphorus levels and longest diameter could effectively improve the diagnostic accuracy of radionuclide imaging for PA.
OBJECTIVE: To determine the prognostic value of [F]FDG PET/CT in follicular lymphoma (FL) patients in our routine clinical practice. MATERIAL AND METHODS: Retrospective study of FL patients assessed with PET/CT in our ce...OBJECTIVE: To determine the prognostic value of [F]FDG PET/CT in follicular lymphoma (FL) patients in our routine clinical practice. MATERIAL AND METHODS: Retrospective study of FL patients assessed with PET/CT in our centre from 01/06/2008 to 01/06/2020. This study aimed to investigate the prognostic value of quantitative parameters (MTV, TLG, ΔSUV max) and qualitative criteria (Lugano classification), and its relationships with progression-free survival (PFS) and overall survival (OS). RESULTS: Among patients with available staging PET/CT, the 5-year OS was 90.4% for those with lower MTV and 89.7% for those with higher MTV (p = 0.3). The PFS was 77.6% for those with lower MTV and 53.2% for those with higher MTV (p = 0.001). TLG yielded statistically similar results. A ΔSUV max ≥ 66% was associated with higher OS and PFS at 5 years, at both interim and final PET/CT studies (iPET and fPET). The 5-year OS for patients with complete metabolic response was 86.3% in iPET and 89.0% in fPET, compared to 84.1% and 79.0%, respectively, for those positive in iPET (p = 0.3) and fPET (p = 0.1). The 5-year PFS for patients with complete metabolic response was 76.9% in iPET and 73.1% in fPET, compared to 58.7% and 62.2%, respectively, for those positive in iPET (p = 0.04) and fPET (p = 0.09). CONCLUSIONS: PET/CT is valuable as a prognostic factor in FL, both during staging (providing parameters with independent prognostic value such as MTV and TLG) and during and after treatment (as it correlates with survival).
The use of theragnostics in nuclear medicine has significantly advanced, particularly peptide receptor radionuclide therapy (PRRT) in neuroendocrine tumors. Meningiomas often overexpress somatostatin receptors (SSTR), ma...The use of theragnostics in nuclear medicine has significantly advanced, particularly peptide receptor radionuclide therapy (PRRT) in neuroendocrine tumors. Meningiomas often overexpress somatostatin receptors (SSTR), making them potential candidates for PRRT. However, the lack of large-scale standardized trials limits its clinical application. Meningiomas are the most common primary intracranial tumors; the treatment of choice for which is surgical resection or, if that's not possible, radiotherapy. However, some cases are refractory to standard treatments, leading to the exploration of other therapeutic options, such as targeted therapy with radioligands. Studies have demonstrated promising results with [Lu]Lu-DOTATATE in meningiomas expressing SSTR2, improving progression-free survival (PFS) in refractory cases. Current evidence suggests that PRRT is a viable option for refractory meningiomas with high SSTR expression. However, further clinical trials are needed to establish standardized protocols, optimize patient selection criteria, and explore combination therapy strategies to improve outcomes. This review highlights the mechanisms, clinical applications, and future perspectives of [Lu]Lu-DOTATATE in meningiomas, providing insights into its expanding role in this pathology.
Breast cancer is one of the most prevalent neoplasms worldwide, with molecular subtypes that influence prognosis and therapeutic strategies. PET/CT with different radiopharmaceuticals has revolutionized diagnosis, stagin...Breast cancer is one of the most prevalent neoplasms worldwide, with molecular subtypes that influence prognosis and therapeutic strategies. PET/CT with different radiopharmaceuticals has revolutionized diagnosis, staging, and treatment monitoring. [F]-Fluorodeoxyglucose remains the most widely used radiotracer, but it has limitations in certain subtypes, such as invasive lobular carcinoma, where 16α-[F] fluoro-17β-estradiol and [Ga]-FAPI (fibroblast activation protein inhibitors) have demonstrated greater utility. Today, HER2-targeted radiopharmaceuticals, such as [Zr]-trastuzumab, allow for a precise assessment of tumor heterogeneity. PET/CT also plays a key role in detecting bone metastases using [F]-NaF and in identifying new therapeutic targets, such as PSMA (prostate-specific membrane antigen) and GRPR (gastrin-releasing peptide receptor). These advancements establish molecular imaging as an essential tool for personalizing breast cancer treatment, optimizing clinical decision-making, and improving diagnostic accuracy.
OBJECTIVE: This study aimed to assess the predictive value of metastatic distribution patterns on Ga-PSMA-11 PET/CT in patients with chemotherapy- and castration-resistant prostate cancer undergoing ¹⁷⁷Lu-PSMA-617 radiol...OBJECTIVE: This study aimed to assess the predictive value of metastatic distribution patterns on Ga-PSMA-11 PET/CT in patients with chemotherapy- and castration-resistant prostate cancer undergoing ¹⁷⁷Lu-PSMA-617 radioligand therapy. MATERIALS AND METHODS: A retrospective analysis was conducted on 48 patients who received ¹⁷⁷Lu-PSMA-617 therapy between April 2019 and August 2023. Demographic, clinical, and laboratory data, along with pre- and post-treatment Ga-PSMA-11 PET/CT images, were evaluated for associations with molecular response and progression. Whole-body PET/CT segmentation was performed using METAVOL software. Treatment response was classified using RECIP 1.0 criteria, and predictive values were analyzed using SPSS 22.0, with statistical significance set at p < 0.05. RESULTS: Based on RECIP 1.0 criteria, 58.3% (n = 28) responded to therapy, while 41.7% (n = 20) did not. Disease progression was observed in 29.2% (n = 14), and 70.8% (n = 34) showed no progression. Molecular response was significantly associated with parotid SUVmean (OR = 1.137, p = 0.047) and highest miM1 stage (OR = 0.241, p = 0.046). Molecular progression was significantly associated with lymph node metastasis (OR = 0.144, p = 0.006), bone-only metastasis (OR = 4.333, p = 0.030), ln/metTL-PSMA ratio (OR = 0.070, p = 0.042), b/metTL-PSMA ratio (OR = 13.085, p = 0.040), and TL-PSMA-based lymph node dominance over bone metastases (OR = 0.385, p = 0.044). CONCLUSION: This study highlights the predictive value of metastatic burden distribution on Ga-PSMA PET/CT in determining treatment outcomes of ¹⁷⁷Lu-PSMA therapy.