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Bagni O.,PET CT Unit | Filippi L.,PET CT Unit | Pelle G.,Santa Maria Goretti Hospital | Scopinaro F.,Section Nuclear Medicine
Hellenic Journal of Nuclear Medicine | Year: 2014

A 72 years old patient was referred to us with ileal adenocarcinoma after surgical desection. Fluorine-18- fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging showed massive portal vein, tumor thrombosis. Clinical examination and laboratory tests did not support the diagnosis of septic thrombus. To the best of our knowledge, this is the first reported case in the literature of a massive tumor thrombus in the right portal system from ileal carcinoma, detected by 18F-FDG PET/CT. Source


Filippi L.,Santa Maria Goretti Hospital | Scopinaro F.,SantAndrea Hospital | Pelle G.,Santa Maria Goretti Hospital | Cianni R.,Santa Maria Goretti Hospital | And 3 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2016

Purpose: We investigated the prognostic role of 68Ga-DOTANOC in patients affected by hepatic metastases from neuroendocrine tumours (NET) undergoing 90Y radioembolization (90Y-RE). Methods: A group of 15 consecutive patients with unresectable NET liver metastases underwent 68Ga-DOTANOC PET at baseline and 6 weeks after 90Y-RE. Molecular response was defined as a reduction of >50 % in the tumour-to-spleen ratio (ΔT/S). The patients were divided into two groups (responders with ΔT/S >50 % and nonresponders with ΔT/S <50 %) Patients were followed up by imaging and laboratory tests every 3 months until death or for at least 36 months following 90Y-RE. Statistical analysis was performed to identify factors predicting overall survival (OS) and progression-free survival (PFS). Results: A decrease in T/S ratio was seen in all patients on 68Ga-DOTANOC PET scans performed after 90Y-RE. Nine patients were classified as responders and six as nonresponders. The mean OS in all patients was 31.0 months. Responders had a significantly (p < 0.001) longer OS (mean 36.0 ± 2.5 months) and PFS (mean 29.7 ± 3.4 months) than nonresponders. In a multivariate analysis, none of the other examined variables including age, unilobar vs. bilobar locations, bilirubin levels, radiological response or the presence of extrahepatic disease significantly predicted patient outcome. Conclusion: Molecular response assessed with 68Ga-DOTANOC PET might be a useful predictor of survival in patients affected by NET liver metastases treated with 90Y-RE. © 2015, Springer-Verlag Berlin Heidelberg. Source


Filippi L.,Santa Maria Goretti Hospital | Pelle G.,Santa Maria Goretti Hospital | Cianni R.,Santa Maria Goretti Hospital | Scopinaro F.,SantAndrea Hospital | Bagni O.,Santa Maria Goretti Hospital
Nuclear Medicine and Biology | Year: 2015

Introduction: Our aim was to assess the prognostic value of post-treatment decrease in total lesion glycolysis (δTLG) assessed by 2-[18F]-fluorodeoxyglucose ([18F] FDG) PET-CT performed 6weeks after 90Y radioembolization (90Y RE) in patients affected by intrahepatic cholangiocarcinoma (ICC). Methods: A total of 18 patients were accepted into our department for 90Y RE. Before the procedure, all patients underwent [18F] FDG PET-CT, and total lesion glycolysis was calculated. Six weeks after 90Y administration, PET scan was performed, and δTLG was determined. Patients underwent follow up by imaging and laboratory at quarterly intervals until death or for at least 24months from 90Y RE. Furthermore, subjects were divided in 2 groups (group 1: 6weeks δTLG>50%, group 2: δTLG<50%). Kaplan-Meier method was used to achieve time to progression (TTP) and overall survival (OS) curves for each group. TTP and OS curves were compared to demonstrate eventual relevant differences between the 2 groups. Results: Seventeen patients underwent 90Y RE, and one subject was considered ineligible. According to PET Response Criteria in Solid Tumors, partial response was found in 14 patients (82.4%), stable disease in 3 (17.6%). No patient showed complete metabolic response. The mean OS for all patients was 64.5±5.0weeks. Subjects with a δTLG>50% and δTLG<50% had a mean OS of 79.6±3.6 and 43.1±2.0weeks, respectively (p<0.001). TTP resulted of 28.9±3.8weeks for the whole cohort. Patients with δTLG>50% had a significantly longer TTP (mean 36.9±3.6weeks) than those with δTLG<50% (mean 13.7±1.7weeks, p=0.001). Conclusion: Our results indicate that 90Y RE can be an effective and safe therapy for ICC. δTLG calculated on post-treatment [18F] FDG PET-CT agrees with patients' final outcome. © 2014 Elsevier Inc. Source


D'Arienzo M.,ENEA | D'Arienzo M.,University of Rome La Sapienza | Filippi L.,Santa Maria Goretti Hospital | Chiaramida P.,General Electric | And 5 more authors.
Annals of Nuclear Medicine | Year: 2013

A 54-year-old woman with metastatic colorectal carcinoma underwent liver radioembolization with 90Y resin microspheres. Microsphere biodistribution was assessed 2 h after the treatment through a 20-min long 90Y PET scan. Isodose map and lesion dose-volume histogram (DVH) were then evaluated using a MATLAB-based code. Response to therapy was assessed performing a 18F-FDG PET 6 months after the treatment. At 90Y PET the patient showed a well-defined horseshoe-shaped hepatic lesion with hot margins and a cold core. The lesion presented a heterogeneous DVH with a hot margin receiving an average radiation dose as high as 287 Gy and a cold area receiving an average radiation dose of 70 Gy approximately. Six months after the treatment the patient reported a complete remission of tumour areas which received a high radiation dose, while progression of metastases was observed in the area that presented scarce microsphere localization at 90Y PET. According to our experience, the use of 90Y PET voxel dosimetry may provide a useful tool to assess possible correlations between microsphere biodistribution and clinical outcome of the treatment. In agreement with current literature findings, an average radiation dose greater than approximately 100 Gy may be required to sterilize liver metastases. © 2013 The Japanese Society of Nuclear Medicine. Source


Bagni O.,Santa Maria Goretti Hospital | D'Arienzo M.,SantAndrea Hospital | D'Arienzo M.,ENEA | Chiaramida P.,General Electric | And 6 more authors.
Nuclear Medicine Communications | Year: 2012

OBJECTIVES: To demonstrate the feasibility of 90Y-PET imaging for biodistribution assessment after selective internal radiotherapy treatments with 90Y-microspheres, comparing the results with 99mTc-macroaggregated albumin (MAA) images obtained with single-photon emission computed tomography. METHODS: Preliminary studies were performed with the aim of evaluating the imaging system spatial resolution and scanner sensitivity for detecting annihilation photons. Subsequently, microsphere distribution was evaluated in 10 patients who underwent liver selective internal radiotherapy treatment. 99mTc-MAA and 90Y-microsphere were simultaneously injected for immediate monitoring after treatment. For each patient, the metastases detected with 90Y-PET and 99mTc-MAA were assessed and compared with F-fluorodeoxyglucose-PET (F-FDG-PET) obtained before treatment and used as an imaging benchmark procedure. The correlation between these techniques was thus investigated in terms of matching lesions. Lesions were considered true positive in the case of matching with F-FDG-PET. The sensitivity of both techniques was evaluated as the true-positive fraction of detected spots in the treated liver sectors. RESULTS: With our experimental setup, a maximum scanner sensitivity of 0.577 and 0.077 cps/MBq was obtained for three-dimensional and two-dimensional acquisitions, respectively. A good correlation was obtained between images obtained before and after treatment, with 90Y-PET being by far the most accurate technique in detecting microsphere distribution and tumor nonhomogeneity areas. A sensitivity as high as 0.91 was obtained with 90Y-PET, whereas 99mTc-MAA imaging showed a SE of 0.75. CONCLUSION: 90Y-PET is a promising and reliable technique for microsphere biodistribution evaluation after liver selective internal radiotherapy treatment. Because of the better resolution and the possibility to perform computed tomography fusion, 90Y-PET images are more accurate than 99mTc-MAA single-photon emission computed tomography, which is now considered the gold standard for biodistribution assessment. © 2012 Wolters Kluwer Health | Lippincott Williams &Wilkins. Source

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