Background: We studied the added value of digital FDG-PET/CT in disease staging and restaging compared to the standard work-up with contrast enhanced CT (ceCT) and CA19-9 in patients with... Show moreBackground: We studied the added value of digital FDG-PET/CT in disease staging and restaging compared to the standard work-up with contrast enhanced CT (ceCT) and CA19-9 in patients with resectable or borderline resectable pancreatic cancer who received neo-adjuvant therapy. Primary endpoints were tumor response compared to ceCT and CA19.9 as well as the ability to detect distant metastatic disease.Methods: 35 patients were included in this dual-center prospective study. FDG-PET using digital photon counting technology combined with CT scans were acquired before (T1) and after neo-adjuvant therapy (T2). Patients were staged and restaged based on standard protocol with ceCT and CA 19.9, while all PET/CT scans were stored securely and not included in clinical decision making. After the pancreatic resection, an expert team retro-spectively assessed the CT tumor diameter, CA19-9, tumor FDG-uptake, and appearance of metastatic disease of all patients for both time points.Results: CA19-9 levels, CT tumor diameter, and tumor FDG-uptake on PET significantly decreased from T1 to T2 (p = 0.017, p = 0.001, and p < 0.0001). The change in FDG-uptake values showed a strong positive correlation with the change in CT tumor diameter and change in CA19-9 (R = 0.75 and R = 0.73, respectively). In addition, small-volume liver lesions were detected on digital PET/CT in 5/35 patients (14%), 4 of which were pathology confirmed at laparotomy. Only one of these five cases was detected on baseline staging ceCT (3%). Conclusion: We found that adding digital PET/CT strengthens restaging after neo-adjuvant therapy based on the observed strong correlation with ceCT tumor diameter and Ca19.9. Also, digital PET/CT was found to detect occult metastatic disease not visualized on ceCT, that would have resulted in altered disease staging and ther-apeutic strategy in a substantial proportion of patients. Show less
In locally or locally advanced solid tumors, surgery still remains a fundamental treatment method. However, conservative resection is associated with high collateral damage and functional... Show moreIn locally or locally advanced solid tumors, surgery still remains a fundamental treatment method. However, conservative resection is associated with high collateral damage and functional limitations of the patient. Furthermore, the presence of residual tumor tissue following conservative surgical treatment is currently a common cause of locally recurrent cancer or of distant metastases. Reliable intraoperative detection of small cancerous tissue would allow surgeons to selectively resect malignant areas: this task can be achieved by means of image-guided surgery, such as beta radioguided surgery (RGS). In this paper, a comprehensive review of beta RGS is given, starting from the physical .principles that differentiate beta from gamma radiation, that already has its place in current surgical practice. Also, the recent clinical feasibility of using Cerenkov radiation is discussed. Despite being first proposed several decades ago, only in the last years a remarkable interest in beta RGS has been observed, probably driven by the diffusion of PET radiotracers. Today several different approaches are being pursued to assess the effectiveness of such a technique, including both beta+ and beta- emitting radiophannaceuticals. Beta RGS shows some peculiarities that can present it as a very promising complementary technique to standard procedures. Good results are being obtained in several tests, both ex vivo and in vivo. This might however be the time to initiate the trials to demonstrate the real clinical value of these technologies with seemingly clear potential. Show less
Within interventional nuclear medicine (iNM) a prominent role is allocated for the sub-discipline of radioguided surgery. Unique for this discipline is the fact that an increasing number of... Show moreWithin interventional nuclear medicine (iNM) a prominent role is allocated for the sub-discipline of radioguided surgery. Unique for this discipline is the fact that an increasing number of clinical indications (e.g. lymphatic mapping, local tumor demarcation and/or tumor receptor targeted applications) have been adopted into routine care. The clinical integration is further strengthened by technical innovations in chemistry and engineering that enhance the translational potential of radioguided procedures in iNM. Together, these features not only ensure ongoing expansion of iNM but also warrant a lasting clinical impact for the sub-discipline of radioguided surgery. Show less
Noortman, W.A.; Vriens, D.; Grootjans, W.; Tao, Q.; Geus-Oei, L.F. de; Velden, F.H. van 2020
In recent years, radiomics, defined as the extraction of large amounts of quantitative features from medical images, has gained emerging interest. Radiomics consists of the extraction of... Show moreIn recent years, radiomics, defined as the extraction of large amounts of quantitative features from medical images, has gained emerging interest. Radiomics consists of the extraction of handcrafted features combined with sophisticated statistical methods or machine learning algorithms for modelling, or deep learning algorithms that both learn features from raw data and perform modelling. These features have the potential to serve as non-invasive biomarkers for tumor characterization, prognostic stratification and response prediction. thereby contributing to precision medicine. However, especially in nuclear medicine, variable results are obtained when using radiomics for these purposes. Individual studies show promising results, but due to small numbers of patients per study and little standardization, it is difficult to compare and validate results on other datasets. This review describes the radiomic pipeline, its applications and the increasing role of artificial intelligence within the field. Furthermore, the challenges that need to be overcome to achieve clinical translation are discussed, so that, eventually, radiomics, combined with clinical data and other biomarkers, can contribute to precision medicine, by providing the right treatment to the right patient, with the right dose. at the right time. Show less
Welling, M.M.; Hensbergen, A.W.; Bunschoten, A.; Velders, A.H.; Roestenberg, M.; Leeuwen, F.W.B. van 2019
Background Bacterial infections are still a major global healthcare problem. To combat the increasing antimicrobial resistance, early diagnosis of bacterial infection-including the identification... Show moreBackground Bacterial infections are still a major global healthcare problem. To combat the increasing antimicrobial resistance, early diagnosis of bacterial infection-including the identification of bacterial specie-is needed to improve antibiotic stewardship and to help reduce the use of broad-spectrum antibiotics. To aid successful targeted antibiotic treatment, specific detection and localisation of infectious organisms is warranted. Nuclear medicine imaging approaches have been successfully used to diagnose bacterial infections and to differentiate between pathogen induced infections and sterile inflammatory processes.Aim In this comprehensive review we present an overview of recent developments in radiolabelled bacterial imaging tracers.Methods The PubMed/MEDLINE and Embase (OvidSP) literature databases were systematically searched for publications on SPECT and PET on specific imaging of bacterial using specific guidelines with MeSH-terms, truncations, and completion using cross-references. Tracers in literature that was extensively reviewed before 2016 were not included in this update. Where possible, the chemical structure of the radiolabelled compounds and clinical images were shown.Results In 219 original articles pre-clinical and clinical imaging of bacterial infection with new tracers were included. In our view, the highest translational potential lies with tracers that are specific to target the pathogens: e.g., Tc-99m- and Ga-68-labelled UBI29-41, Tc-99m-vancomycin, m-[F-18]-fluoro-PABA, [methyl-C-11]-D-methionine, [F-18]-FDS, [F-18]-maltohexaose and [F-18]-maltotriose. An encouraging note is that some of these tracers have already been successfully evaluated in clinical settings.Conclusion This review summarises updates in tracer development for specific (pre-clinical and clinical) imaging of bacterial infections. We propsed some promising tracers that are likely to become innovative standards in the clinical setting in the near feature. Show less
KleinJan, G.H.; Werkhoven, E. van; Berg, N.S. van den; Karakullukcu, M.B.; Zijlmans, H.J.M.A.A.; Hage, J.A. van der; ... ; Leeuwen, F.W.B. van 2018
