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Hôpital-Camfrout, France

Hodolic M.,University of Ljubljana | Michaud L.,Medecine Nucleaire | Michaud L.,University Pierre and Marie Curie | Huchet V.,Medecine Nucleaire | And 8 more authors.
Radiology and Oncology | Year: 2014

Background. Fluorocholine(18F) (FCH) was introduced at the beginning of April 2010 in France, Slovenia and threeother EU member states fo r the localisation of bone metastases of prostate cancer with PET. The aim of the study was to compare the evolution of diagnostic imaging in patients with prostate cancer using a new radiopharmaceutical FCH, observed in France and in Slovenia, and to quantify the consequence of the results of new imaging modality on the detection rate of abnormal metastases and recurrences of prostate cancer. Patients and methods. In two centres (France/Slovenia), a survey of the number of nuclear medicine examinations in patients with prostate cancer was performed, covering 5 quarters of the year since the introduction of FCH. For each examination, the clinical and biological circumstances were recorded, as well as the detection of bone or soft tissue foci. Results. Six hundred and eighty-eight nuclear medicine examinations were performed impatients with prostate cancer. Nuclear medicine examinations were performed for therapy monitoring and follow-up in 23% of cases. The number of FCH PET/CT grew rapidly between the 1st and 5th period of the observation (+220%), while the number of bone scintigraphies (BS) and fluoride(18F) PET/CTs decreased (-42% and -23% respectively). Fluorodeoxyglucose(18F) (FDG) PET/CT remained limited to few cases of castrate-resistant or metastatic prostate cancer in Paris. The proportion of negative results was significantly lower with FCH PET/CT (14%) than with BS (49%) or fluoride(18F) PET/CT (54%). For bone metastases, the detection rate was similar, but FCH PET/CT was performed on average at lower prostate-specific antigen (PSA) levels and was less frequently doubtful (4% vs. 28% for BS). FCH PET/CT also showed foci in prostaticbed (53% of cases) or in soft tissue (35% of cases). Conclusions. A rapid development of FCH PET/CT was observed in both centres and led to a higher detection rate of prostate cancer lesions. Source

Balogova S.,Medecine Nucleaire | Balogova S.,Comenius University | Cussenot O.,Urologie | Cussenot O.,University Pierre and Marie Curie | And 11 more authors.
Medecine Nucleaire | Year: 2012

This patient had been treated by radical prostatectomy for adenocarcinoma. Fifteen years later, he was referred to us due to occult biochemical recurrence (PSA. =. 1.56. ng/mL). Fluoride (18F) PET/CT and then fluorocholine (18F) (FCH) PET/CT were performed. On fluoride (18F) PET/CT, only one focus in the left iliac crest was suspicious but the biopsy of an osteoblastic anomaly had been performed 5 months before, with a negative result. On FCH PET/CT, a diffuse and intense uptake of bone marrow was noted, as well as a focus corresponding to a right external iliac lymph node, which had already been visualised on the previous FCH PET/CT and prompted endoscopic resection of three lymph nodes, which proved to be non-malignant. The osteomedullary uptake was attributed to a very recent treatment by pegfilgrastim, a recombinant human granulocyte colony stimulating factor (G-CSF). It was concluded that the recurrence was electively located in this lymphatic basin and IMRT was performed which led to a fourfold reduction in PSA serum levels. This observation illustrates the risk, never mentioned yet, of false-positive results concerning osteomedullary cancer spread, in case of treatment by G-CSF. It also confirms the role of FCH PET/CT in case of occult recurrence of prostate cancer, including verification of resection of a suspicious lymph node detected on a previous FCH PET/CT, and its capacity to guide IMRT. © 2012 Elsevier Masson SAS. Source

The registration of a new PET radiopharmaceutical by medicines agencies is infrequent and it seemed interesting to follow its consequences on the prescription of alternative nuclear medicine (NM) examinations by the referring physicians. Fluorocholine (18F) (FCH) was registered in France for localisation of bone metastases of prostate cancer (PC) on April 2nd 2010. Methods: A survey of the prescription of NM examinations in patients with PC was performed at Hôpital Tenon, covering eight quarters since the registration of FCH. Results: During that period of time, 721 NM examinations were performed in PC patients. Demand for FCH PET/CT grew rapidly, from 11% of the NM examinations during the first quarter to 37% during the second quarter and to 56% during the eighth quarter. The total number of NM examinations requested for PC also grew over that period. Overall, the share of FCH PET/CT was 42%, 27% for bone PET/CT with fluoride (18F) (F Na), 25% for bone scintigraphy (BS). FDG PET/CT remained limited to few cases of castrate-resistant or metastatic PC (6% of NM examinations). Examinations limited to the detection of bone metastases (F Na and BS) were predominantly demanded for initial staging while FCH was more frequently requested in case of occult recurrence, at lower PSA serum levels. Therapy monitoring and follow-up appeared to be promising settings requiring assessment; 19% of NM examinations were prescribed in this context, same proportion as restaging prior to treatment resuming. Conclusion: The introduction of FCH resulted in a rapid demand for this PET/CT examination, in particular in case of occult recurrence, with an overall increase in PC patients referred to NM imaging, of +. 11% comparing the two successive years. © 2012 Elsevier Masson SAS. Source

Cross T.,Radiopharmacie | Rose J.,Radiopharmacie | Mai Ba C.U.,Radiopharmacie | Montravers F.,Service de Medecine Nucleaire | And 2 more authors.
Medecine Nucleaire | Year: 2012

Radiopharmacists of the Nuclear Medicine department of hospital Tenon have prepared and controlled the 68Ga-labeled DOTATOC, for 4years, as part of a clinical research study. The aim of this article is to share our experience, since this activity is not yet developed in France. Radiolabelling of DOTATOC ( 68Ga) requires the settling of a 68Ge/ 68Ga generator, which is connected to an automated PC-controlled radiopharmaceutical labelling device (Elusynth 68Ga, Iason) and comprises several steps. Performed quality controls (QC) are those commonly used for radiopharmaceuticals including: appearance, pH, radiochemical purity (RCP), radionuclide purity (PRN) and determination of the physical half-life. Bacterial endotoxins and sterility tests are systematically done. We obtained a mean value of radiolabelling yield around 45%. The results of QC are always in accordance with the specifications. The preparation failed in 7% of the 195 DOTATOC ( 68Ga), over the last 4years. It is important to note that the preparation of DOTATOC ( 68Ga) monopolizes the radiopharmacist during 3hours. This radiolabelling technique can be easily applied to other peptides, in order to develop other 68Ga-labelled PET tracers. © 2012 . Source

Following administration in January 2010 of a commercial preparation of FDG containing between 5 and 10% of fluoride (18F), our aim was to evaluate by means of a retrospective study the consequences of this content of free 18F on the visual and semi-quantitative approaches of the skeletal uptake on PET/CT. Methods: Two groups of 30 patients (princeps and control) were matched for pathology, age, sex and glycaemia. The group " princeps" received the FDG preparation containing more than 5% of fluoride (18F). All examinations were done according to the standard protocol of FDG PET/CT. The SUVmax was determined in six regions of interest (ROI) in visually normal bone. For pathologic foci, we calculated a ratio of SUVmax between the focus and healthy bone (T/NTR). Results: The analysis of normal bone showed, for the spine, a significant difference in SUVmax between the two groups and a significant correlation with the time elapsed between FDG preparation and injection. Concerning the pathologic foci, the T/NTR of two groups were significantly different (. P=. 0.04). Conclusion: We observed a slight increase of the SUVmax in the healthy spine of patients who received more than 5% of fluoride (18F), explained in part by a longer delay before imaging. The pathologic foci showed a T/NTR lower in the group princeps, however metastases were detected in both groups. Thus, a preparation of FDG close to the end of its shelf life can be used without real consequences for the quality of images for a given patient; in contrast, an accurate quantification of the FDG uptake in the spine requires a minimal proportion of fluoride (18F). © 2012 . Source

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