125 results on '"Calcagni ML"'
Search Results
2. The quantification with FDG as seen by a physician
- Author
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Galli G, Indovina L, Calcagni ML, Giordano A., MANSI, Luigi, Galli, G, Indovina, L, Calcagni, Ml, Mansi, Luigi, and Giordano, A.
- Published
- 2013
3. Granulocyte-colony Stimulating Factor in the Acute Myocardial Infarction (the Rigenera Study
- Author
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Leone, Am, Galiuto, L, Liuzzo, G, Giordano, A, Calcagni, Ml, Garramone, B, Giannico, Mb, Cirillo, F, Biasucci, Lm, Rebuzzi, Ag, and Crea, F
- Published
- 2004
4. 'Physichological stress' perfusion SPET in patients with borderline personality disorder
- Author
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Melis, I, Calcagni, Ml, Volterrani, Duccio, Di Giuda, D, Lai, C, Daini, S, and Giordano, A.
- Published
- 2004
5. Role of 18F-FDG PET-CT for evaluating the response to reduced-intensity conditioning allogeneic transplant in heavily pre-treated patients with chronic lymphocytic leukemia: preliminary results in nine patients.
- Author
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Taralli S, Calcagni ML, Rufini V, Laurenti L, Sica S, Chiusolo P, Leone G, Giordano A, Taralli, Silvia, Calcagni, Maria Lucia, Rufini, Vittoria, Laurenti, Luca, Sica, Simona, Chiusolo, Patrizia, Leone, Giuseppe, and Giordano, Alessandro
- Abstract
Objective: The aim of our preliminary study was to evaluate the potential role of 18F-FDG PET-CT in monitoring response to reduced-intensity conditioning (RIC) transplant in a small series of chronic lymphocytic leukemia (CLL) patients and to compare the results with those obtained by standard criteria.Methods: We retrospectively analyzed 9 consecutive refractory/relapsed CLL patients, who underwent RIC transplant from March 2004 until May 2009. PET-CT was planned at 6-8 months after transplant to assess response and at a mean of 6 months during follow-up. The mean long-term follow-up period was 38 months (range 12-74 months, median 29 months).Results: The first PET-CT showed abnormal 18F-FDG uptake in five patients, while by standard criteria eight patients showed persistent disease. At the end of follow-up (mean 38 months), all four patients with previously negative scan were still PET negative and in complete remission by standard criteria. All five patients with previously positive scan were still PET positive: one patient died for disease progression and four are alive with disease.Conclusions: Our preliminary data, although in a small series of CLL patients, suggest that the metabolic findings revealed at first PET-CT after transplant seem to predict the patient outcome and to assess the metabolic disease status earlier than clinical evaluation by standard criteria. PET-CT performed during follow-up may be useful to early detect disease progression. [ABSTRACT FROM AUTHOR]- Published
- 2012
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6. The role of positron emission tomography using carbon-11 and fluorine-18 choline in tumors other than prostate cancer: a systematic review
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Maria Lucia Calcagni, Davide Di Franco, Vittoria Rufini, Alessandro Giordano, Maria Picchio, Giorgio Treglia, Elisabetta Giovannini, Treglia, G, Giovannini, E, Di Franco, D, Calcagni, Ml, Rufini, V, Picchio, M, and Giordano, A.
- Subjects
medicine.medical_specialty ,Fluorine Radioisotopes ,Stereotactic biopsy ,Brain tumor ,Choline ,Prostate cancer ,Breast cancer ,Neoplasms ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Carbon Radioisotopes ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Fluorodeoxyglucose ,Bladder cancer ,medicine.diagnostic_test ,business.industry ,Cancer ,General Medicine ,medicine.disease ,CARBON-11 ,Positron emission tomography ,Positron-Emission Tomography ,Radiology ,business ,Nuclear medicine ,medicine.drug - Abstract
To systematically review published data on the role of positron emission tomography (PET) or PET/computed tomography (PET/CT) using either Carbon-11 ((11)C) or Fluorine-18 ((18)F) choline tracer in tumors other than prostatic cancer. A comprehensive literature search of studies published in PubMed/MEDLINE and Embase databases through January 2012 and regarding (11)C-choline or (18)F-choline PET or PET/CT in patients with tumors other than prostatic cancer was carried out. Fifty-two studies comprising 1800 patients were included and discussed. Brain tumors were evaluated in 15 articles, head and neck tumors in 6, thoracic tumors (including lung and mediastinal neoplasms) in 14, liver tumors (including hepatocellular carcinoma) in 5, gynecologic malignancies (including breast tumors) in 5, bladder and upper urinary tract tumors in 5, and musculoskeletal tumors in 7. Radiolabeled choline PET or PET/CT is useful to differentiate high-grade from low-grade gliomas and malignant from benign brain lesions, to early detect brain tumor recurrences and to guide the stereotactic biopsy sampling. The diagnostic accuracy of radiolabeled choline PET is superior compared to Fluorine-18 fluorodeoxyglucose ((18)F-FDG) PET in this setting. Radiolabeled choline PET or PET/CT seems to be accurate in differential diagnosis between malignant and benign thoracic lesions and in staging lung tumors; nevertheless, a superiority of radiolabeled choline compared to (18)F-FDG has not been demonstrated in this setting, except for the detection of brain metastases. Few but significant studies on radiolabeled choline PET and PET/CT in patients with hepatocellular carcinoma (HCC) and musculoskeletal tumors are reported in the literature. The combination of radiolabeled choline and (18)F-FDG PET increases the detection rate of HCC. The diagnostic accuracy of radiolabeled choline PET or PET/CT seems to be superior compared to (18)F-FDG PET or PET/CT and conventional imaging methods in patients with bone and soft tissue tumors. Limited experience exists about the role of radiolabeled choline PET and PET/CT in patients with head and neck tumors, bladder cancer and gynecologic malignancies including breast cancer.
- Published
- 2012
7. Diagnostic Performances of PET/CT Using Fibroblast Activation Protein Inhibitors in Patients with Primary and Metastatic Liver Tumors: A Comprehensive Literature Review.
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Manuppella F, Pisano G, Taralli S, Caldarella C, and Calcagni ML
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- Humans, Membrane Proteins antagonists & inhibitors, Membrane Proteins metabolism, Endopeptidases metabolism, Gelatinases metabolism, Gelatinases antagonists & inhibitors, Positron Emission Tomography Computed Tomography methods, Liver Neoplasms diagnostic imaging, Liver Neoplasms secondary, Liver Neoplasms metabolism, Radiopharmaceuticals chemistry, Fluorodeoxyglucose F18
- Abstract
PET/CT using radiolabeled fibroblast activation protein inhibitors (FAPIs) is a promising diagnostic tool in oncology, especially when non-increased and/or physiologically high [
18 F]FDG uptake (as in liver parenchyma) is observed. We aimed to review the role of PET/CT using radiolabeled FAPIs in primary and/or metastatic liver lesions, and to compare their performances with more "conventional" radiopharmaceuticals. A search algorithm based on the terms "FAPI" AND ("hepatic" OR "liver") was applied, with the last update on 1st January 2024. Out of 177 articles retrieved, 76 studies reporting on the diagnostic application of radiolabeled FAPI PET/CT in at least one patient harboring primary or metastatic liver lesion(s) were fully analyzed. Although there was some heterogeneity in clinical conditions and/or study methodology, PET/CT with radiolabeled FAPIs showed an excellent performance in common primary liver malignancies (hepatocarcinoma, intrahepatic cholangiocarcinoma) and liver metastases (mostly from the gastrointestinal tract and lungs). A higher tumor-to-background ratio for FAPIs than for [18 F]FDG was found in primary and metastatic liver lesions, due to lower background activity. Despite limited clinical evidence, radiolabeled FAPIs may be used to assess the suitability and effectiveness of FAPI-derived therapeutic agents such as [177 Lu]Lu-FAPI. However, future prospective research on a wider population is needed to confirm the excellent performance.- Published
- 2024
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8. The Role of PET Imaging in Patients with Prion Disease: A Literature Review.
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Mattoli MV, Giancipoli RG, Cocciolillo F, Calcagni ML, and Taralli S
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- Humans, Fluorodeoxyglucose F18 metabolism, Radiopharmaceuticals metabolism, Positron-Emission Tomography methods, Brain metabolism, Neurodegenerative Diseases, Prion Diseases metabolism, Prion Diseases pathology, Creutzfeldt-Jakob Syndrome diagnosis, Creutzfeldt-Jakob Syndrome metabolism, Creutzfeldt-Jakob Syndrome pathology
- Abstract
Prion diseases are rare, rapidly progressive, and fatal incurable degenerative brain disorders caused by the misfolding of a normal protein called PrPC into an abnormal protein called PrPSc. Their highly variable clinical presentation mimics various degenerative and non-degenerative brain disorders, making diagnosis a significant challenge for neurologists. Currently, definitive diagnosis relies on post-mortem examination of nervous tissue to detect the pathogenic prion protein. The current diagnostic criteria are limited. While structural magnetic resonance imaging (MRI) remains the gold standard imaging modality for Creutzfeldt-Jakob disease (CJD) diagnosis, positron emission tomography (PET) using
18 fluorine-fluorodeoxyglucose (18 F-FDG) and other radiotracers have demonstrated promising potential in the diagnostic assessment of prion disease. In this context, a comprehensive and updated review exclusively focused on PET imaging in prion diseases is still lacking. We review the current value of PET imaging with18 F-FDG and non-FDG tracers in the diagnostic management of prion diseases. From the collected data,18 F-FDG PET mainly reveals cortical and subcortical hypometabolic areas in prion disease, although fails to identify typical pattern or laterality abnormalities to differentiate between genetic and sporadic prion diseases. Although the rarity of prion diseases limits the establishment of a definitive hypometabolism pattern, this review reveals some more prevalent18 F-FDG patterns associated with each disease subtype. Interestingly, in both sporadic and genetic prion diseases, the hippocampus does not show significant glucose metabolism alterations, appearing as a useful sign in the differential diagnosis with other neurodegenerative disease. In genetic prion disease forms, PET abnormality precedes clinical manifestation. Discordant diagnostic value for amyloid tracers among different prion disease subtypes was observed, needing further investigation. PET has emerged as a potential valuable tool in the diagnostic armamentarium for CJD. Its ability to visualize functional and metabolic brain changes provides complementary information to structural MRI, aiding in the early detection and confirmation of CJD., (© 2024. The Author(s), under exclusive licence to World Molecular Imaging Society.)- Published
- 2024
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9. 3-Methoxy-Phencyclidine Induced Psychotic Disorder: A Literature Review and an 18 F-FDG PET/CT Case Report.
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Pepe M, Di Nicola M, Cocciolillo F, Chiappini S, Martinotti G, Calcagni ML, and Sani G
- Abstract
New Psychoactive Substances (NPS) are modifying the drug scenario worldwide and have become a public health concern because of their toxicological profiles and their harmful physical/psychological effects. 3-Methoxy-Phencyclidine (3-MeO-PCP), a non-competitive antagonist of glutamate N-methyl-D-aspartate (NMDA) receptors, belongs to the phencyclidine-like subfamily of arylcyclohexylamines and has gained attention for its toxic, sometimes fatal, effects. Despite several cases of intoxication and death reported in the literature, little is known about substance-induced psychotic disorders (SIP) and potential cognitive impairment following 3-MeO-PCP intake. This literature review aimed to summarize available evidence about 3-MeO-PCP mechanisms of action and physical and psychotropic effects and to spread preliminary findings about persistent psychotic symptoms and impaired cognitive functioning. Additionally, the case of an SIP is reported in a 29-year-old man with small oral intakes of 3-MeO-PCP over two weeks until a high dose ingestion. Psychometric and neuropsychological assessment and brain [
18 F]-fluorodeoxyglucose positron emission tomography integrated with computed tomography were used to support clinical description. Identifying and addressing the characteristic clinical features and neural substrates of NPS-induced psychoses might help clinicians with a more precise differentiation from other psychotic disorders. Although further studies are required, phenotyping the cognitive profile of NPS users might provide targets for tailored therapeutic approaches.- Published
- 2024
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10. Framing doctor-managers' resilience during Covid-19 pandemic: A descriptive analysis from the Italian NHS.
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Leonelli S, Morandi F, Giancipoli RG, Di Vincenzo F, and Calcagni ML
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- Humans, Pandemics, State Medicine, Reproducibility of Results, Italy, COVID-19, Resilience, Psychological
- Abstract
With the aim of providing evidence about doctor-managers' resilience during the Covid-19 pandemic, this study analyzes the characteristics of 114 doctor-managers operating within the Italian National Health Service (NHS). During the emergency, doctor-managers had to show adaptive capacities to deal with unexpected situations and develop new paradigms, procedures, and quick responses to patients' needs. This is in line with resilience, and in this perspective, it is crucial to investigate resilience determinants. The paper, therefore, provides an identikit of the resilient doctor-manager. The research was conducted between November and December 2020. Primary data were collected through an online questionnaire consisting of six sections. Participation was voluntary and anonymous. Data were analyzed using quantitative techniques and employing Stata 16. Confirmatory Factor Analysis was employed to test construct validity and scale reliability. Results show that increasing levels of individual resilience are related to increasing levels of managerial identity. Moreover, physicians' individual resilience has a positive association with commitment, knowledge diffusion, and Evidence-Based Medicine adoption. Finally, physicians' individual resilience has a negative association with their role in the university, their specialty, and their gender. The study suggests some practical implications for healtcare organizations. In general, career paths are decided primarily on competency assessment, while an important role should be devoted to behavioral characteristics. Furthermore, organizations should take care of the levels of individual commitment and encourage professional networking because both help doctor-managers cope with uncertainty. The originality of the study relies on a fresh look at all previous work. There are currently few contributions in the literature to explore and investigate resilience elements in doctor-managers during the pandemic era., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2024
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11. Correction: Lung cancer multi-omics digital human avatars for integrating precision medicine into clinical practice: the LANTERN study.
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Lococo F, Boldrini L, Diepriye CD, Evangelista J, Nero C, Flamini S, Minucci A, De Paolis E, Vita E, Cesario A, Annunziata S, Calcagni ML, Chiappetta M, Cancellieri A, Larici AR, Cicchetti G, Troost EGC, Ádány R, Farré N, Öztürk E, Van Doorne D, Leoncini F, Urbani A, Trisolini R, Bria E, Giordano A, Rindi G, Sala E, Tortora G, Valentini V, Boccia S, Margaritora S, and Scambia G
- Published
- 2023
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12. Intranasal human-recombinant NGF administration improves outcome in children with post-traumatic unresponsive wakefulness syndrome.
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Gatto A, Capossela L, Conti G, Eftimiadi G, Ferretti S, Manni L, Curatola A, Graglia B, Di Sarno L, Calcagni ML, Di Giuda D, Cecere S, Romeo DM, Soligo M, Picconi E, Piastra M, Della Marca G, Staccioli S, Ruggiero A, Cocciolillo F, Pulitanò S, and Chiaretti A
- Subjects
- Animals, Humans, Child, Brain, Electroencephalography, Administration, Intranasal, Nerve Growth Factor therapeutic use, Nerve Growth Factor metabolism, Wakefulness physiology
- Abstract
Background: Severe traumatic brain injury (TBI) is one of the most dramatic events in pediatric age and, despite advanced neuro-intensive care, the survival rate of these patients remains low. Children suffering from severe TBI show long-term sequelae, more pronounced in behavioral, neurological and neuropsychological functions leading to, in the most severe cases, an unresponsive wakefulness syndrome (UWS). Currently, no effective treatments can restore neuronal loss or produce significant improvement in these patients. In experimental animal models, human- recombinant Nerve Growth Factor (hr-NGF) promotes neural recovery supporting neuronal growth, differentiation and survival of brain cells and up-regulating the neurogenesis-associated processes. Only a few studies reported the efficacy of intranasal hr-NGF administration in children with post- traumatic UWS., Methods: Children with the diagnosis of post-traumatic UWS were enrolled. These patients underwent a treatment with intranasal hr-NGF administration, at a total dose of 50 gamma/kg, three times a day for 7 consecutive days. The treatment schedule was performed for 4 cycles, at one month distance each. Neuroradiogical evaluation by Positron Emission Tomography scan (PET), Single Photon Emission Computed Tomography (SPECT), Electroencephalography (EEG), and Power Spectral Density (PSD) was determined before the treatment and one month after the end. Neurological assessment was also deepened by using modified Ashworth Scale, Gross Motor Function Measure, and Disability Rating Scale., Results: Three children with post-traumatic UWS were treated. hr-NGF administration improved functional (PET and SPECT) and electrophysiological (EEG and PSD) assessment. Also clinical conditions improved, mainly for the reduction of spasticity and with the acquisition of voluntary movements, facial mimicry, attention and verbal comprehension, ability to cry, cough reflex, oral motility, and feeding capacity, with a significant improvement of their neurological scores. No side effects were reported., Conclusion: These promising results and the ease of administration of this treatment make it worthwhile to be investigated further, mainly in the early stages from severe TBI and in patients with better baseline neurological conditions, to explore more thoroughly the benefits of this new approach on neuronal function recovery after traumatic brain damage., (© 2023. BioMed Central Ltd., part of Springer Nature.)
- Published
- 2023
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13. The impact of intensified staging and combined therapies in locally advanced pancreatic cancer: a secondary analysis of prospective studies.
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Fiore M, Petrianni GM, Trecca P, D'Ercole G, Coppola A, La Vaccara V, Taralli S, Cimini P, Greco C, Ippolito E, Calcagni ML, Beomonte Zobel B, Caputo D, Coppola R, Ramella S, and D'Angelillo RM
- Abstract
Aim: To investigate the use of comprehensive pre-treatment staging with multiple diagnostic modalities, including functional imaging and minimally invasive surgical procedures, in locally advanced pancreatic cancer (LAPC) patients. The primary objective was to detect occult metastatic disease using staging laparoscopy and 18FFDG-PET/CT scan. The study also evaluated treatment efficacy and outcomes in LAPC patients treated with combined therapies., Materials and Methods: This study was a secondary analysis of three prospective studies of chemoradiotherapy (CRT) with or without induction chemotherapy (IC). The inclusion period was from December 2009 until February 2023. An intensified pretreatment staging was conducted for all LAPC patients. Patients without distant disease at initial staging, with borderline resectable or unresectable LAPC, were enrolled in chemoradiotherapy combination protocols (CRT with or without IC). IC regimens included GemOx or FOLFIRINOX for four cycles, followed by concurrent CRT with gemcitabine. The primary endpoint was the detection of occult metastatic disease, and secondary objectives included resection rate, treatment toxicity, overall survival (OS), progression-free survival (PFS), local control (LC), and metastasis-free survival (MFS)., Results: Out of the 134 LAPC patients, 33.5% were identified with metastatic disease. Of these, 23.1% had a positive exploratory laparoscopy. Additionally, 13.4% were identified as having distant metastases by 18-FDG PET/CT. The median PFS for all patients who completed CRT was 14.3 months, and the median OS was 17.2 months. Resected patients after the combined therapies demonstrated significantly improved outcomes compared to non-resected patients (median PFS, 22.5 mo vs. 9.5 mo, P<0.001; median OS, 38.2 mo vs. 13 mo, P<0.001). Moreover, patients treated with IC followed by CRT showed significantly better outcomes compared to upfront CRT group (median PFS, 19 mo vs. 9.9 mo, P<0.001; median OS, 19.3 mo vs. 14.6 mo, P<0.001). At univariate logistic regression analysis, the adding of IC was the only predictor for resection rate (95% CI 0.12-1.02, P=0.05), and this data was confirmed at multivariate analysis (95% CI 0.09-0.98, P=0.04). Haematological and gastrointestinal toxicities were observed during treatment, with manageable adverse events., Conclusions: The use of comprehensive pre-treatment staging, including laparoscopy and 18F-FDG-PET/CT scan, is an effective approach in identifying occult metastatic disease in LAPC patients. Our findings offer valuable insights into accurate staging and treatment efficacy, providing evidence-based support for optimal management strategies in LAPC patients., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2023
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14. Lung cancer multi-omics digital human avatars for integrating precision medicine into clinical practice: the LANTERN study.
- Author
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Lococo F, Boldrini L, Diepriye CD, Evangelista J, Nero C, Flamini S, Minucci A, De Paolis E, Vita E, Cesario A, Annunziata S, Calcagni ML, Chiappetta M, Cancellieri A, Larici AR, Cicchetti G, Troost EGC, Ádány R, Farré N, Öztürk E, Van Doorne D, Leoncini F, Urbani A, Trisolini R, Bria E, Giordano A, Rindi G, Sala E, Tortora G, Valentini V, Boccia S, Margaritora S, and Scambia G
- Subjects
- Humans, Artificial Intelligence, Multiomics, Quality of Life, Precision Medicine, Lung Neoplasms diagnosis, Lung Neoplasms genetics, Lung Neoplasms therapy
- Abstract
Background: The current management of lung cancer patients has reached a high level of complexity. Indeed, besides the traditional clinical variables (e.g., age, sex, TNM stage), new omics data have recently been introduced in clinical practice, thereby making more complex the decision-making process. With the advent of Artificial intelligence (AI) techniques, various omics datasets may be used to create more accurate predictive models paving the way for a better care in lung cancer patients., Methods: The LANTERN study is a multi-center observational clinical trial involving a multidisciplinary consortium of five institutions from different European countries. The aim of this trial is to develop accurate several predictive models for lung cancer patients, through the creation of Digital Human Avatars (DHA), defined as digital representations of patients using various omics-based variables and integrating well-established clinical factors with genomic data, quantitative imaging data etc. A total of 600 lung cancer patients will be prospectively enrolled by the recruiting centers and multi-omics data will be collected. Data will then be modelled and parameterized in an experimental context of cutting-edge big data analysis. All data variables will be recorded according to a shared common ontology based on variable-specific domains in order to enhance their direct actionability. An exploratory analysis will then initiate the biomarker identification process. The second phase of the project will focus on creating multiple multivariate models trained though advanced machine learning (ML) and AI techniques for the specific areas of interest. Finally, the developed models will be validated in order to test their robustness, transferability and generalizability, leading to the development of the DHA. All the potential clinical and scientific stakeholders will be involved in the DHA development process. The main goals aim of LANTERN project are: i) To develop predictive models for lung cancer diagnosis and histological characterization; (ii) to set up personalized predictive models for individual-specific treatments; iii) to enable feedback data loops for preventive healthcare strategies and quality of life management., Discussion: The LANTERN project will develop a predictive platform based on integration of multi-omics data. This will enhance the generation of important and valuable information assets, in order to identify new biomarkers that can be used for early detection, improved tumor diagnosis and personalization of treatment protocols., Ethics Committee Approval Number: 5420 - 0002485/23 from Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore Ethics Committee., Trial Registration: clinicaltrial.gov - NCT05802771., (© 2023. The Author(s).)
- Published
- 2023
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15. Combined treatment of nerve growth factor and transcranical direct current stimulations to improve outcome in children with vegetative state after out-of-hospital cardiac arrest.
- Author
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Curatola A, Graglia B, Granata G, Conti G, Capossela L, Manni L, Ferretti S, Di Giuda D, Romeo DM, Calcagni ML, Soligo M, Castelli E, Piastra M, Mantelli F, Marca GD, Staccioli S, Romeo T, Pani M, Cocciolillo F, Mancino A, Gatto A, and Chiaretti A
- Subjects
- Humans, Child, Persistent Vegetative State, Nerve Growth Factor therapeutic use, Brain, Out-of-Hospital Cardiac Arrest therapy, Transcranial Direct Current Stimulation methods
- Abstract
Background: Out-of-hospital cardiac arrest (OHCA) is one of the most dramatic events in pediatric age and, despite advanced neurointensive care, the survival rate remains low. Currently, no effective treatments can restore neuronal loss or produce significant improvement in these patients. Nerve Growth Factor (NGF) is a neurotrophin potentially able to counteract many of the deleterious effects triggered by OHCA. Transcranial Direct Current Stimulation (tDCS) has been reported to be neuroprotective in many neurological diseases, such as motor deficit and cognitive impairment. Children with the diagnosis of chronic vegetative state after OHCA were enrolled. These patients underwent a combined treatment of intranasal administration of human recombinant NGF (hr-NGF), at a total dose of 50 gamma/kg, and tDCS, in which current intensity was increased from zero to 2 mA from the first 5 s of stimulation and maintained constant for 20 min. The treatment schedule was performed twice, at one month distance each. Neuroradiogical evaluation with Positron Emission Tomography scan (PET), Single Photon Emission Computed Tomography (SPECT), Electroencephalography (EEG) and Power Spectral Density of the brain (PSD) was determined before the treatment and one month after the end. Neurological assessment was deepened by using modified Ashworth Scale, Gross Motor Function Measure, and Disability Rating Scale., Results: Three children with a chronic vegetative state secondary to OHCA were treated. The combined treatment with hr-NGF and tDCS improved functional (PET and SPECT) and electrophysiological (EEG and PSD) assessment. Also clinical conditions improved, mainly for the reduction of spasticity and with the acquisition of voluntary finger movements, improved facial mimicry and reaction to painful stimuli. No side effects were reported., Conclusions: These promising preliminary results and the ease of administration of this treatment make it worthwhile to be investigated further, mainly in the early stages from OHCA and in patients with better baseline neurological conditions, in order to explore more thoroughly the benefits of this new approach on neuronal function recovery after OHCA., (© 2023. The Author(s).)
- Published
- 2023
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16. PET/CT with Fibroblast Activation Protein Inhibitors in Breast Cancer: Diagnostic and Theranostic Application-A Literature Review.
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Taralli S, Lorusso M, Perrone E, Perotti G, Zagaria L, and Calcagni ML
- Abstract
Growing studies have recently reported on the promising application of radiolabeled-fibroblast activation protein inhibitors (FAPIs) as diagnostic and therapeutic agents in various oncological populations. To exclusively evaluate the current evidence on the diagnostic and therapeutic role of FAPI radiotracers in patients with breast cancer (BC), a narrative review of the available literature was performed. A search algorithm from PubMed/MEDLINE, based on the combination of "PET" OR "positron emission tomography" and "FAPI" and "cancer", with a last update in February 2022, was applied. From 233 identified articles, 33 studies conducted in BC patients and with available data on PET imaging or radiolabeled-FAPI therapy were finally considered, for a total of 191 patients. Despite some clinical and methodological heterogeneity among the reviewed articles,
68 Ga-FAPI PET/CT emerges as a valuable diagnostic tool in BC patients both at staging and restaging, also demonstrating several technical advantages and an overall better performance than18 F-FDG, especially in histotypes with well-known low18 F-FDG avidity. Moreover, although with still limited clinical evidence in BC, radiolabeled FAPIs emerge as promising therapeutic agents in a theranostic perspective, increasing the possibility of more personalized treatments. From these results, future research directions on FAPI radiotracers application in BC patients are suggested.- Published
- 2023
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17. DWI-MR and PET-CT Functional Imaging for Boost Tumor Volume Delineation in Neoadjuvant Rectal Cancer Treatment.
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Rosa C, Gasparini L, DI Guglielmo FC, Caravatta L, DI Tommaso M, Pizzi AD, Martino G, Castaldi P, Mazza R, Porreca A, DI Nicola M, Calcagni ML, and Genovesi D
- Subjects
- Humans, Neoadjuvant Therapy, Tumor Burden, Diffusion Magnetic Resonance Imaging methods, Positron-Emission Tomography methods, Fluorodeoxyglucose F18, Radiopharmaceuticals, Positron Emission Tomography Computed Tomography, Rectal Neoplasms diagnostic imaging, Rectal Neoplasms radiotherapy
- Abstract
Background/aim: T2 weighted magnetic resonance (MR) imaging is the gold standard for locally advanced rectal cancer (LARC) staging. The potential benefit of functional imaging, as diffusion-weighted MR (DWI) and positron emission tomography-computed tomography (PET-CT), could be considered for treatment intensification strategies. Dose intensification resulted in better pathological complete response (pCR) rates. This study evaluated the inter-observer agreement between two radiation oncologists, and the difference in gross tumor volume (GTV) delineation in simulation-CT, T2-MR, DWI-MR, and PET-CT in patients with LARC., Patients and Methods: Two radiation oncologists prospectively delineated GTVs of 24 patients on simul-CT (CT
GTV ), T2-weighted MR (T2GTV ), echo planar b1000 DWI (DWIGTV ) and PET-CT (PETGTV ). Observers' agreement was assessed using Dice index. Kruskal-Wallis test assessed differences between methods., Results: Mean CTGTV , T2GTV , DWIGTV , and PETGTV were 41.3±26.9 cc, 25.9±15.2 cc, 21±14.8 cc, and 37.7±27.7 cc for the first observer, and 42.2±27.9 cc, 27.6±16.9 cc, 19.9±14.9cc, and 34.8±24.3 cc for the second observer, respectively. Mean Dice index was 0.85 for CTGTV , 0.84 for T2GTV , 0.82 for DWIGTV , and 0.89 for PETGTV , representative of almost perfect agreement. Kruskal-Wallis test showed a statistically significant difference between methods (p=0.009). Dunn test showed there were differences between DWIGTV vs. PETGTV (p=0.040) and DWIGTV vs. CTGTV (p=0.008)., Conclusion: DWI resulted in smaller volume delineation compared to CT, T2-MR, and PET-CT functional images. Almost perfect agreements were reported for each imaging modality between two observers. DWI-MR seems to remain the optimal strategy for boost volume delineation for dose escalation in patients with LARC., (Copyright © 2023, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)- Published
- 2023
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18. Time-dependent recovery of brain hypometabolism in neuro-COVID-19 patients.
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Martini AL, Carli G, Kiferle L, Piersanti P, Palumbo P, Morbelli S, Calcagni ML, Perani D, and Sestini S
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- Humans, Fluorodeoxyglucose F18 metabolism, Brain diagnostic imaging, Brain metabolism, Inflammation metabolism, Positron-Emission Tomography, COVID-19 diagnostic imaging
- Abstract
Purpose: We evaluated brain metabolic dysfunctions and associations with neurological and biological parameters in acute, subacute and chronic COVID-19 phases to provide deeper insights into the pathophysiology of the disease., Methods: Twenty-six patients with neurological symptoms (neuro-COVID-19) and [
18 F]FDG-PET were included. Seven patients were acute (< 1 month (m) after onset), 12 subacute (4 ≥ 1-m, 4 ≥ 2-m and 4 ≥ 3-m) and 7 with neuro-post-COVID-19 (3 ≥ 5-m and 4 ≥ 7-9-m). One patient was evaluated longitudinally (acute and 5-m). Brain hypo- and hypermetabolism were analysed at single-subject and group levels. Correlations between severity/extent of brain hypo- and hypermetabolism and biological (oxygen saturation and C-reactive protein) and clinical variables (global cognition and Body Mass Index) were assessed., Results: The "fronto-insular cortex" emerged as the hypometabolic hallmark of neuro-COVID-19. Acute patients showed the most severe hypometabolism affecting several cortical regions. Three-m and 5-m patients showed a progressive reduction of hypometabolism, with limited frontal clusters. After 7-9 months, no brain hypometabolism was detected. The patient evaluated longitudinally showed a diffuse brain hypometabolism in the acute phase, almost recovered after 5 months. Brain hypometabolism correlated with cognitive dysfunction, low blood saturation and high inflammatory status. Hypermetabolism in the brainstem, cerebellum, hippocampus and amygdala persisted over time and correlated with inflammation status., Conclusion: Synergistic effects of systemic virus-mediated inflammation and transient hypoxia yield a dysfunction of the fronto-insular cortex, a signature of CNS involvement in neuro-COVID-19. This brain dysfunction is likely to be transient and almost reversible. The long-lasting brain hypermetabolism seems to reflect persistent inflammation processes., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)- Published
- 2022
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19. Automated detection and classification of tumor histotypes on dynamic PET imaging data through machine-learning driven voxel classification.
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Bianchetti G, Taralli S, Vaccaro M, Indovina L, Mattoli MV, Capotosti A, Scolozzi V, Calcagni ML, Giordano A, De Spirito M, and Maulucci G
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- Fluorodeoxyglucose F18, Humans, Lymph Nodes pathology, Lymphatic Metastasis pathology, Machine Learning, Positron Emission Tomography Computed Tomography methods, Positron-Emission Tomography methods, Radiopharmaceuticals, Adenocarcinoma, Lung Neoplasms diagnostic imaging, Lung Neoplasms pathology
- Abstract
2-deoxy-2-fluorine-(
18 F)fluoro-d-glucose Positron Emission Tomography/Computed Tomography (18 F-FDG-PET/CT) is widely used in oncology mainly for diagnosis and staging of various cancer types, including lung cancer, which is the most common cancer worldwide. Since histopathologic subtypes of lung cancer show different degree of18 F-FDG uptake, to date there are some diagnostic limits and uncertainties, hindering an18 F-FDG-PET-driven classification of histologic subtypes of lung cancers. On the other hand, since activated macrophages, neutrophils, fibroblasts and granulation tissues also show an increased18 F-FDG activity, infectious and/or inflammatory processes and post-surgical and post-radiation changes may cause false-positive results, especially for lymph-nodes assessment. Here we propose a model-free, machine-learning based algorithm for the automated classification of adenocarcinoma, the most common type of lung cancer, and other types of tumors. Input for the algorithm are dynamic acquisitions of PET data (dPET), providing for a spatially and temporally resolved characterization of the uptake kinetic. The algorithm consists in a trained Random Forest classifier which, relying contextually on several spatial and temporal features of18 F-FDG uptake, generates as an outcome probability maps allowing to distinguish adenocarcinoma from other lung histotype and to identify metastatic lymph-nodes, ultimately increasing the specificity of the technique. Its performance, evaluated on a dPET dataset of 19 patients affected by primary lung cancer, provides a probability 0.943 ± 0.090 for the detection of adenocarcinoma. The use of this algorithm will guarantee an automatic and more accurate localization and discrimination of tumors, also providing a powerful tool for detecting at which extent tumor has spread beyond a primary tumor into lymphatic system., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)- Published
- 2022
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20. The impact of the COVID-19 pandemic on oncological disease extent at FDG PET/CT staging: the ONCOVIPET study.
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Caldarella C, Cocciolillo F, Taralli S, Lorusso M, Scolozzi V, Pizzuto DA, Calcagni ML, Rufini V, Guido D, Palluzzi F, Giacò L, Giordano A, and Leccisotti L
- Subjects
- Communicable Disease Control, Fluorodeoxyglucose F18, Humans, Neoplasm Staging, Pandemics, Positron Emission Tomography Computed Tomography, Positron-Emission Tomography, Radiopharmaceuticals, COVID-19, Lung Neoplasms pathology
- Abstract
Purpose: To investigate whether the COVID-19 pandemic and national lockdown had an impact on the extent of cancer disease at FDG PET/CT staging as surrogate marker., Methods: Retrospective observational study including cancer patients submitted to FDG PET/CT staging from June 1 to October 31, 2020, and June 1 to October 31, 2019, respectively. Data regarding primary tumour, nodal (N) status and number of involved nodal stations, and presence and number of distant metastases (M) were collected. Each scan was classified in limited vs advanced status. Data were aggregated across the study population and tumour type. Bi-weekly frequencies of the observed events were analysed., Results: Six hundred eleven patients were included (240 in 2019 vs 371 in 2020, respectively). A significant increase of advanced disease patients (rate 1.56, P < 0.001), N + or M + patients (rate 1.84 and 2.09, respectively, P < 0.001), and patients with a greater number of involved N stations or M (rate 2.01 and 2.06, respectively, P < 0.001) were found in 2020 compared with data of 2019. Analysis by tumour type showed a significant increase of advanced disease in lymphoma and lung cancer in 2020 compared with 2019 (P < 0.001). In addition, a significant increase of nodal involvement was found in lung, gastro-intestinal, and breast cancers, as well as in lymphoma patients (P < 0.02). A significant increase of distant metastases was found in lung cancers (P = 0.002)., Conclusion: Cancer patients with advanced disease at FDG PET/CT staging increased in 2020 compared with 2019, following the national lockdown due to the COVID-19 pandemic, 1.5-fold with a significant increase of patients with N or M involvement. Targeted health interventions are needed to mitigate the effects of the pandemic on patient outcome., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2022
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21. The Prognostic Value of 18 F-FDG PET Imaging at Staging in Patients with Malignant Pleural Mesothelioma: A Literature Review.
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Taralli S, Giancipoli RG, Caldarella C, Scolozzi V, Ricciardi S, Cardillo G, and Calcagni ML
- Abstract
Malignant pleural mesothelioma (MPM) is an aggressive malignancy, frequently diagnosed at locally-advanced/metastatic stages. Due to a very poor prognosis and limited treatment options, the need to identify new prognostic markers represents a great clinical challenge. The prognostic role of metabolic information derived from Positron Emission Tomography (PET) with
18 F-Fluoro-deoxy-glucose (18 F-FDG) has been investigated in different MPM settings, however with no definitive consensus. In this comprehensive review, the prognostic value of FDG-PET imaging exclusively performed at staging in MPM patients was evaluated, conducting a literature search on PubMed/MEDLINE from 2010 to 2020. From the 19 selected studies, despite heterogeneity in several aspects, staging FDG-PET imaging emerges as a valuable prognostic biomarker, with higher tumor uptake predictive of worse prognosis, and with volumetric metabolic parameters like Metabolic Tumor Volume, (MTV) and Total Lesion Glycolisis (TLG) performing better than SUVmax. However, PET uptake parameters were not always confirmed as independent prognostic factors, especially in patients previously treated with pleurodesis and with a non-epithelioid histotype. Future prospective studies in larger and clinically homogeneous populations, and using more standardized methods of PET images analysis, are needed to further validate the value of staging FDG-PET in the prognostic MPM stratification, with a potential impact on better patient-tailored treatment planning, in the perspective of personalized medicine.- Published
- 2021
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22. Short 2-[ 18 F]Fluoro-2-Deoxy-D-Glucose PET Dynamic Acquisition Protocol to Evaluate the Influx Rate Constant by Regional Patlak Graphical Analysis in Patients With Non-Small-Cell Lung Cancer.
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Indovina L, Scolozzi V, Capotosti A, Sestini S, Taralli S, Cusumano D, Giancipoli RG, Ciasca G, Cardillo G, and Calcagni ML
- Abstract
Purpose: To test a short 2-[
18 F]Fluoro-2-deoxy-D-glucose (2-[18 F]FDG) PET dynamic acquisition protocol to calculate Ki using regional Patlak graphical analysis in patients with non-small-cell lung cancer (NSCLC). Methods: 24 patients with NSCLC who underwent standard dynamic 2-[18 F]FDG acquisitions (60 min) were randomly divided into two groups. In group 1 ( n = 10), a population-based image-derived input function (pIDIF) was built using a monoexponential trend (10-60 min), and a leave-one-out cross-validation (LOOCV) method was performed to validate the pIDIF model. In group 2 ( n = 14), Ki was obtained by standard regional Patlak plot analysis using IDIF (0-60 min) and tissue response (10-60 min) curves from the volume of interests (VOIs) placed on descending thoracic aorta and tumor tissue, respectively. Moreover, with our method, the Patlak analysis was performed to obtain Ki,s using IDIFFitted curve obtained from PET counts (0-10 min) followed by monoexponential coefficients of pIDIF (10-60 min) and tissue response curve obtained from PET counts at 10 min and between 40 and 60 min, simulating two short dynamic acquisitions. Both IDIF and IDIFFitted curves were modeled to assume the value of 2-[18 F]FDG plasma activity measured in the venous blood sampling performed at 45 min in each patient. Spearman's rank correlation, coefficient of determination, and Passing-Bablok regression were used for the comparison between Ki and Ki,s . Finally, Ki,s was obtained with our method in a separate group of patients (group 3, n = 8) that perform two short dynamic acquisitions. Results: Population-based image-derived input function (10-60 min) was modeled with a monoexponential curve with the following fitted parameters obtained in group 1: a = 9.684, b = 16.410, and c = 0.068 min-1 . The LOOCV error was 0.4%. In patients of group 2, the mean values of Ki and Ki,s were 0.0442 ± 0.0302 and 0.33 ± 0.0298, respectively ( R2 = 0.9970). The Passing-Bablok regression for comparison between Ki and Ki,s showed a slope of 0.992 (95% CI: 0.94-1.06) and intercept value of -0.0003 (95% CI: -0.0033-0.0011). Conclusions: Despite several practical limitations, like the need to position the patient twice and to perform two CT scans, our method contemplates two short 2-[18 F]FDG dynamic acquisitions, a population-based input function model, and a late venous blood sample to obtain robust and personalized input function and tissue response curves and to provide reliable regional Ki estimation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Indovina, Scolozzi, Capotosti, Sestini, Taralli, Cusumano, Giancipoli, Ciasca, Cardillo and Calcagni.)- Published
- 2021
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23. Evaluation of Age and Sex-Related Metabolic Changes in Healthy Subjects: An Italian Brain 18F-FDG PET Study.
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Allocca M, Linguanti F, Calcagni ML, Cistaro A, Gaudieri V, Guerra UP, Morbelli S, Nobili F, Pappatà S, Sestini S, Volterrani D, Berti V, and For The Neurology Study Group Of The Italian Association Of Nuclear Medicine
- Abstract
Background: 18F-fluorodeoxyglucose (18F-FDG) positron-emission-tomography (PET) allows detection of cerebral metabolic alterations in neurological diseases vs. normal aging. We assess age- and sex-related brain metabolic changes in healthy subjects, exploring impact of activity normalization methods., Methods: brain scans of Italian Association of Nuclear Medicine normative database (151 subjects, 67 Males, 84 Females, aged 20-84) were selected. Global mean, white matter, and pons activity were explored as normalization reference. We performed voxel-based and ROI analyses using SPM12 and IBM-SPSS software., Results: SPM proved a negative correlation between age and brain glucose metabolism involving frontal lobes, anterior-cingulate and insular cortices bilaterally. Narrower clusters were detected in lateral parietal lobes, precuneus, temporal pole and medial areas bilaterally. Normalizing on pons activity, we found a more significant negative correlation and no positive one. ROIs analysis confirmed SPM results. Moreover, a significant age × sex interaction effect was revealed, with worse metabolic reduction in posterior-cingulate cortices in females than males, especially in post-menopausal age., Conclusions: this study demonstrated an age-related metabolic reduction in frontal lobes and in some parieto-temporal areas more evident in females. Results suggested pons as the most appropriate normalization reference. Knowledge of age- and sex-related cerebral metabolic changes is critical to correctly interpreting brain 18F-FDG PET imaging.
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- 2021
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24. Dynamic 11 C-Methionine PET-CT: Prognostic Factors for Disease Progression and Survival in Patients with Suspected Glioma Recurrence.
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Mattoli MV, Trevisi G, Scolozzi V, Capotosti A, Cocciolillo F, Marini I, Mare V, Indovina L, Caulo M, Saponiero A, Balducci M, Taralli S, and Calcagni ML
- Abstract
Purpose: The prognostic evaluation of glioma recurrence patients is important in the therapeutic management. We investigated the prognostic value of
11 C-methionine PET-CT (MET-PET) dynamic and semiquantitative parameters in patients with suspected glioma recurrence., Methods: Sixty-seven consecutive patients who underwent MET-PET for suspected glioma recurrence at MR were retrospectively included. Twenty-one patients underwent static MET-PET; 46/67 underwent dynamic MET-PET. In all patients, SUVmax, SUVmean and tumour-to-background ratio (T/B) were calculated. From dynamic acquisition, the shape and slope of time-activity curves, time-to-peak and its SUVmax (SUVmaxTTP ) were extrapolated. The prognostic value of PET parameters on progression-free (PFS) and overall survival (OS) was evaluated using Kaplan-Meier survival estimates and Cox regression., Results: The overall median follow-up was 19 months from MET-PET. Recurrence patients (38/67) had higher SUVmax ( p = 0.001), SUVmean ( p = 0.002) and T/B ( p < 0.001); deceased patients (16/67) showed higher SUVmax ( p = 0.03), SUVmean ( p = 0.03) and T/B ( p = 0.006). All static parameters were associated with PFS (all p < 0.001); T/B was associated with OS ( p = 0.031). Regarding kinetic analyses, recurrence (27/46) and deceased (14/46) patients had higher SUVmaxTTP ( p = 0.02, p = 0.01, respectively). SUVmaxTTP was the only dynamic parameter associated with PFS ( p = 0.02) and OS ( p = 0.006). At univariate analysis, SUVmax, SUVmean, T/B and SUVmaxTTP were predictive for PFS (all p < 0.05); SUVmaxTTP was predictive for OS ( p = 0.02). At multivariate analysis, SUVmaxTTP remained significant for PFS ( p = 0.03)., Conclusion: Semiquantitative parameters and SUVmaxTTP were associated with clinical outcomes in patients with suspected glioma recurrence. Dynamic PET-CT acquisition, with static and kinetic parameters, can be a valuable non-invasive prognostic marker, identifying patients with worse prognosis who require personalised therapy.- Published
- 2021
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25. Topical delivery of nerve growth factor for treatment of ocular and brain disorders.
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Eftimiadi G, Soligo M, Manni L, Di Giuda D, Calcagni ML, and Chiaretti A
- Abstract
Neurotrophins are a family of proteins that support neuronal proliferation, survival, and differentiation in the central and peripheral nervous systems, and are regulators of neuronal plasticity. Nerve growth factor is one of the best-described neurotrophins and has advanced to clinical trials for treatment of ocular and brain diseases due to its trophic and regenerative properties. Prior trials over the past few decades have produced conflicting results, which have principally been ascribed to adverse effects of systemic nerve growth factor administration, together with poor penetrance of the blood-brain barrier that impairs drug delivery. Contrastingly, recent studies have revealed that topical ocular and intranasal nerve growth factor administration are safe and effective, suggesting that topical nerve growth factor delivery is a potential alternative to both systemic and invasive intracerebral delivery. The therapeutic effects of local nerve growth factor delivery have been extensively investigated for different ophthalmic diseases, including neurotrophic keratitis, glaucoma, retinitis pigmentosa, and dry eye disease. Further, promising pharmacologic effects were reported in an optic glioma model, which indicated that topically administered nerve growth factor diffused far beyond where it was topically applied. These findings support the therapeutic potential of delivering topical nerve growth factor preparations intranasally for acquired and degenerative brain disorders. Preliminary clinical findings in both traumatic and non-traumatic acquired brain injuries are encouraging, especially in pediatric patients, and clinical trials are ongoing. The present review will focus on the therapeutic effects of both ocular and intranasal nerve growth factor delivery for diseases of the brain and eye., Competing Interests: None
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- 2021
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26. Prevalence of interstitial pneumonia suggestive of COVID-19 at 18 F-FDG PET/CT in oncological asymptomatic patients in a high prevalence country during pandemic period: a national multi-centric retrospective study.
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Albano D, Bertagna F, Alongi P, Baldari S, Baldoncini A, Bartolomei M, Boccaletto F, Boero M, Borsatti E, Bruno A, Burroni L, Capoccetti F, Castellani M, Cervino AR, Chierichetti F, Ciarmiello A, Corso A, Cuocolo A, De Rimini ML, Deandreis D, Dottorini ME, Esposito F, Farsad M, Gasparini M, Grana CM, Gregianin M, Guerra L, Loreti F, Lupi A, Martino G, Milan E, Modoni S, Morbelli S, Muni A, Nicolai E, Palumbo B, Papa S, Papaleo A, Pellerito R, Poti C, Romano P, Rossetti C, Rossini P, Rubini G, Ruffini L, Sacchetti G, Savelli G, Schiavariello S, Sciagrà R, Sciuto R, Seregni E, Sestini S, Sicolo M, Spanu A, Storto G, Balducci MT, Trifirò G, Versari A, Vignati A, Volterrani D, Calcagni ML, Marzola MC, Garufo A, Evangelista L, Maroldi R, Schillaci O, and Giubbini R
- Subjects
- Fluorodeoxyglucose F18, Humans, Italy, Pandemics, Positron Emission Tomography Computed Tomography, Prevalence, Retrospective Studies, SARS-CoV-2, COVID-19, Lung Diseases, Interstitial diagnostic imaging, Lung Diseases, Interstitial epidemiology
- Abstract
Purpose: To assess the presence and pattern of incidental interstitial lung alterations suspicious of COVID-19 on fluorine-18-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) ([
18 F]FDG PET/CT) in asymptomatic oncological patients during the period of active COVID-19 in a country with high prevalence of the virus., Methods: This is a multi-center retrospective observational study involving 59 Italian centers. We retrospectively reviewed the prevalence of interstitial pneumonia detected during the COVID period (between March 16 and 27, 2020) and compared to a pre-COVID period (January-February 2020) and a control time (in 2019). The diagnosis of interstitial pneumonia was done considering lung alterations of CT of PET., Results: Overall, [18 F]FDG PET/CT was performed on 4008 patients in the COVID period, 19,267 in the pre-COVID period, and 5513 in the control period. The rate of interstitial pneumonia suspicious for COVID-19 was significantly higher during the COVID period (7.1%) compared with that found in the pre-COVID (5.35%) and control periods (5.15%) (p < 0.001). Instead, no significant difference among pre-COVID and control periods was present. The prevalence of interstitial pneumonia detected at PET/CT was directly associated with geographic virus diffusion, with the higher rate in Northern Italy. Among 284 interstitial pneumonia detected during COVID period, 169 (59%) were FDG-avid (average SUVmax of 4.1)., Conclusions: A significant increase of interstitial pneumonia incidentally detected with [18 F]FDG PET/CT has been demonstrated during the COVID-19 pandemic. A majority of interstitial pneumonia were FDG-avid. Our results underlined the importance of paying attention to incidental CT findings of pneumonia detected at PET/CT, and these reports might help to recognize early COVID-19 cases guiding the subsequent management.- Published
- 2021
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27. Validation of FDG-PET datasets of normal controls for the extraction of SPM-based brain metabolism maps.
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Caminiti SP, Sala A, Presotto L, Chincarini A, Sestini S, Perani D, Schillaci O, Berti V, Calcagni ML, Cistaro A, Morbelli S, Nobili F, Pappatà S, Volterrani D, and Gobbo CL
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- Brain diagnostic imaging, Brain Mapping, Humans, Fluorodeoxyglucose F18, Positron-Emission Tomography
- Abstract
Purpose: An appropriate healthy control dataset is mandatory to achieve good performance in voxel-wise analyses. We aimed at evaluating [18F]FDG PET brain datasets of healthy controls (HC), based on publicly available data, for the extraction of voxel-based brain metabolism maps at the single-subject level., Methods: Selection of HC images was based on visual rating, after Cook's distance and jack-knife analyses, to exclude artefacts and/or outliers. The performance of these HC datasets (ADNI-HC and AIMN-HC) to extract hypometabolism patterns in single patients was tested in comparison with the standard reference HC dataset (HSR-HC) by means of Dice score analysis. We evaluated the performance and comparability of the different HC datasets in the assessment of single-subject SPM-based hypometabolism in three independent cohorts of patients, namely, ADD, bvFTD and DLB., Results: Two-step Cook's distance analysis and the subsequent jack-knife analysis resulted in the selection of n = 125 subjects from the AIMN-HC dataset and n = 75 subjects from the ADNI-HC dataset. The average concordance between SPM hypometabolism t-maps in the three patient cohorts, as obtained with the new datasets and compared to the HSR-HC standard reference dataset, was 0.87 for the AIMN-HC dataset and 0.83 for the ADNI-HC dataset. Pattern expression analysis revealed high overall accuracy (> 80%) of the SPM t-map classification according to different statistical thresholds and sample sizes., Conclusions: The applied procedures ensure validity of these HC datasets for the single-subject estimation of brain metabolism using voxel-wise comparisons. These well-selected HC datasets are ready-to-use in research and clinical settings.
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- 2021
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28. 18F-FDG and 68Ga-DOTATOC PET/CT Findings in a Case of Abdominal Leiomyosarcoma.
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Lorusso M, Angelico G, Quirino M, Scolozzi V, and Calcagni ML
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- Abdominal Neoplasms pathology, Humans, Leiomyosarcoma pathology, Magnetic Resonance Imaging, Male, Middle Aged, Positron-Emission Tomography, Abdominal Neoplasms diagnostic imaging, Fluorodeoxyglucose F18, Leiomyosarcoma diagnostic imaging, Organometallic Compounds, Positron Emission Tomography Computed Tomography
- Abstract
Abstract: We report the case of a 58-year-old man with mesenteric nodule at CT performed for abdominal pain. In the suspicion of neoplastic disease, he underwent 18F-FDG PET/CT that did not show abnormal uptake. The nodule was monitored alternating CT and MRI. Two years after the first detection, MRI revealed an increase in size, and 18F-FDG PET/CT was repeated for metabolic evaluation, showing increased metabolic activity. In suspicion of neuroendocrine tumor, for anatomical site, slow growth, and clinical symptoms, 68Ga-DOTATOC PET/CT was performed showing focal uptake, indicating high expression of somatostatin receptors. The final pathology report was consistent with high-grade leiomyosarcoma., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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29. Application of Artificial Neural Network to Preoperative 18 F-FDG PET/CT for Predicting Pathological Nodal Involvement in Non-small-cell Lung Cancer Patients.
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Taralli S, Scolozzi V, Boldrini L, Lenkowicz J, Pelliccioni A, Lorusso M, Attieh O, Ricciardi S, Carleo F, Cardillo G, and Calcagni ML
- Abstract
Purpose: To evaluate the performance of artificial neural networks (aNN) applied to preoperative
18 F-FDG PET/CT for predicting nodal involvement in non-small-cell lung cancer (NSCLC) patients. Methods: We retrospectively analyzed data from 540 clinically resectable NSCLC patients (333 M; 67.4 ± 9 years) undergone preoperative18 F-FDG PET/CT and pulmonary resection with hilo-mediastinal lymphadenectomy. A 3-layers NN model was applied (dataset randomly splitted into 2/3 training and 1/3 testing). Using histopathological reference standard, NN performance for nodal involvement (N0/N+ patient) was calculated by ROC analysis in terms of: area under the curve (AUC), accuracy (ACC), sensitivity (SE), specificity (SP), positive and negative predictive values (PPV, NPV). Diagnostic performance of PET visual analysis (N+ patient: at least one node with uptake ≥ mediastinal blood-pool) and of logistic regression (LR) was evaluated. Results: Histology proved 108/540 (20%) nodal-metastatic patients. Among all collected data, relevant features selected as input parameters were: patients' age, tumor parameters (size, PET visual and semiquantitative features, histotype, grading), PET visual nodal result (patient-based, as N0/N+ and N0/N1/N2). Training and testing NN performance (AUC = 0.849, 0.769): ACC = 80 and 77%; SE = 72 and 58%; SP = 81 and 81%; PPV = 50 and 44%; NPV = 92 and 89%, respectively. Visual PET performance: ACC = 82%, SE = 32%, SP = 94%; PPV = 57%, NPV = 85%. Training and testing LR performance (AUC = 0.795, 0.763): ACC = 75 and 77%; SE = 68 and 55%; SP = 77 and 82%; PPV = 43 and 43%; NPV = 90 and 88%, respectively. Conclusions: aNN application to preoperative18 F-FDG PET/CT provides overall good performance for predicting nodal involvement in NSCLC patients candidate to surgery, especially for ruling out nodal metastases, being NPV the best diagnostic result; a high NPV was also reached by PET qualitative assessment. Moreover, in such population with low a priori nodal involvement probability, aNN better identify the relatively few and unexpected nodal-metastatic patients than PET analysis, so supporting the additional aNN use in case of PET-negative images., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Taralli, Scolozzi, Boldrini, Lenkowicz, Pelliccioni, Lorusso, Attieh, Ricciardi, Carleo, Cardillo and Calcagni.)- Published
- 2021
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30. 11 C-Methionine PET/CT in patients with primary hyperparathyroidism and inconclusive pre-operative imaging work-up: diagnostic accuracy and role of semi-quantitative analysis.
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Maccora D, Caldarella C, and Calcagni ML
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- Adult, Aged, Aged, 80 and over, Female, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Parathyroid Glands abnormalities, Parathyroid Glands pathology, Parathyroid Glands physiopathology, Reproducibility of Results, Retrospective Studies, Sensitivity and Specificity, Hyperparathyroidism, Primary diagnostic imaging, Methionine chemistry, Positron Emission Tomography Computed Tomography methods
- Abstract
Objective:
11 C-Methionine PET/CT (C-MET) is a promising method in detecting abnormal parathyroid glands in patients with primary hyperparathyroidism (PHPT). The first aim of the study was to evaluate which is the diagnostic role of C-MET in patients with PHPT and inconclusive pre-operative imaging. Second, we aimed to investigate whether C-MET semi-quantitative parameters may reflect biochemical and histological characteristics of involved glands., Methods: Patients with PHPT, undergoing C-MET after an inconclusive pre-operative imaging and having a parathyroid surgery, were retrospectively included. C-MET visual and semi-quantitative assessment was performed. Parameters, as SUVmax , SUVpeak , SUVmean , functional lesion volume (FLV) and total lesion activity (TLA), were measured for each detected lesion; SUVmean , FLV and TLA were calculated on 40-90% thresholds of SUVmax to define SUVmean40-90 , FLV40-90 and TLA40-90, respectively. Results were correlated with patients' clinical-laboratory (calcium and PTH values) and histological data (size and weight of excised glands). Mann-Whitney test was used and P value < 0.05 was considered significant., Results: Thirty-eight patients (36 female, age: 57.69 ± 15.13 years) were included. Pre-operative median calcium and PTH values were 11.1 mg/dl [interquartile range (IQR) 10.6-11.5] and 154.6 pg/ml (IQR 101.8-227.0), respectively. C-MET showed a parathyroid uptake in 30 out of thirty-eight patients (78.9%). Among 42 nodules excised, C-MET correctly detected the side of the neck (right/left) in 30/42 with sensitivity, specificity and accuracy of 79, 75 and 79%, respectively. C-MET correctly identified the exact position (superior/inferior) in 27/42 with sensitivity, specificity and accuracy of 75, 50 and 71%, respectively. SUVpeak , FLV50-70 and TLA40-70 were significantly (P < 0.05) higher in patients with higher PTH results. The histological size resulted significantly (P < 0.05) higher in abnormal glands with higher SUVmax , SUVpeak , FLV40-80 and TLA40-90 , the weight was higher in glands with higher SUVpeak , SUVmean40-50 , FLV40-80 and TLA40-90 ., Conclusions: C-MET showed a good performance in detecting hyperfunctioning parathyroid glands in PHPT patients with inconclusive pre-operative imaging. Semi-quantitative PET-derived parameters closely correlated with PTH as well as with size and weight of the excised gland, thus reflecting some biochemical and histological characteristics of involved glands.- Published
- 2021
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31. 18F-FDG-PET brain imaging may highlight brain metabolic alterations in dysautonomic syndrome after human papilloma virus vaccination.
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Vadalà M, Cistaro A, Quartuccio N, Calcagni ML, Fania P, Margotti S, Schiera IG, Laurino C, and Palmieri B
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- Adult, Autonomic Nervous System Diseases diagnostic imaging, Female, Glucose metabolism, Humans, Male, Middle Aged, Autonomic Nervous System Diseases etiology, Autonomic Nervous System Diseases metabolism, Brain diagnostic imaging, Brain metabolism, Fluorodeoxyglucose F18, Papillomavirus Vaccines adverse effects, Positron-Emission Tomography
- Abstract
Aim: The aim of this study was to evaluate brain glucose metabolism by means of [18F]-fluoro-deoxygluycose (F-FDG) PET in a group of patients presenting dysautonomic syndrome after human papilloma virus (HPV) immunization., Methods: Medical records of patients, referred to the 'Second Opinion Medical Consulting Network' Medical Centre (Modena, Italy) diagnosed with dysautonomic syndrome were searched. Inclusion criteria were presence in the medical history of adverse drug reactions following HPV vaccine; a Montreal Cognitive Assessment score <25 and good quality of a F-FDG-PET brain scan performed within 12 months from the diagnosis of dysautonomic syndrome. F-FDG-PET images of patients (HPV-group) were compared to a control group, matched for age and sex, using statistical parametric mapping (SPM)., Results: The F-FDG-PET study was available for five female patients. The SPM-group analysis revealed significant hypometabolism (P < 0.05 false discovery rate corrected) in the right superior and medial temporal gyrus (Brodmann areas 22, 21) and insula (Brodmann area 13). At a threshold of P < 0.001 (uncorrected), further hypometabolic regions were revealed in the right superior temporal gyrus (Brodmann area 42) and caudate head and in the left superior temporal gyrus (Brodmann area 22), frontal subcallosal gyrus (Brodmann area 47) and insula (Brodmann area 13). Relative hypermetabolism (P = 0.001) was revealed in the right premotor cortex (Brodmann area 6)., Conclusion: This study revealed the possibility of altered brain glucose metabolism in subjects with dysautonomic syndrome post-immunization with HPV vaccine. These results could reinforce the hypothesis of a causal relationship between HPV vaccine, or some component included in the vaccine and the development of clinical manifestations.
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- 2020
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32. Usefulness of Brain Positron Emission Tomography with Different Tracers in the Evaluation of Patients with Idiopathic Normal Pressure Hydrocephalous.
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Mattoli MV, Treglia G, Calcagni ML, Mangiola A, Anile C, and Trevisi G
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- Alzheimer Disease metabolism, Amyloid metabolism, Amyloidogenic Proteins metabolism, Cerebrovascular Circulation physiology, Fluorodeoxyglucose F18, Humans, Neurodegenerative Diseases diagnostic imaging, Neurodegenerative Diseases metabolism, Ventriculoperitoneal Shunt trends, tau Proteins metabolism, Brain diagnostic imaging, Hydrocephalus, Normal Pressure diagnostic imaging, Positron-Emission Tomography methods
- Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is the only form of dementia that can be cured by surgery. Its diagnosis relies on clinical and radiological criteria. Identifying patients who can benefit from surgery is challenging, as other neurological diseases can be concomitant or mimic iNPH. We performed a systematic review on the role of positron emission tomography (PET) in iNPH. We retrieved 35 papers evaluating four main functional aspects with different PET radiotracers: (1) PET with amyloid tracers, revealing Alzheimer's disease (AD) pathology in 20-57% of suspected iNPH patients, could be useful in predictions of surgical outcome. (2) PET with radiolabeled water as perfusion tracer showed a global decreased cerebral blood flow (CBF) and regional reduction of CBF in basal ganglia in iNPH; preoperative perfusion parameters could predict surgical outcome. (3) PET with 2-Deoxy-2-[
18 F]fluoroglucose ([18 F]FDG ) showed a global reduction of glucose metabolism without a specific cortical pattern and a hypometabolism in basal ganglia; [18 F]FDG PET may identify a coexisting neurodegenerative disease, helping in patient selection for surgery; postsurgery increase in glucose metabolism was associated with clinical improvement. (4) Dopaminergic PET imaging showed a postsynaptic D2 receptor reduction and striatal upregulation of D2 receptor after treatment, associated with clinical improvement. Overall, PET imaging could be a useful tool in iNPH diagnoses and treatment response.- Published
- 2020
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33. Is 18F-fluorodeoxyglucose positron emission tomography/computed tomography useful to discriminate metachronous lung cancer from metastasis in patients with oncological history?
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Taralli S, Scolozzi V, Triumbari EK, Carleo F, Di Martino M, De Massimi AR, Ricciardi S, Cardillo G, and Calcagni ML
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- Adult, Aged, Aged, 80 and over, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Neoplasm Metastasis, Fluorodeoxyglucose F18, Lung Neoplasms diagnostic imaging, Lung Neoplasms pathology, Positron Emission Tomography Computed Tomography
- Abstract
Background: Solitary pulmonary nodules detected during follow-up in patients with previous cancer history have a high probability of malignancy being either a metachronous lung cancer or a metastasis. This distinction represents a crucial issue in the perspective of "personalized medicine," implying different treatments and prognosis. Aim, to evaluate the role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in distinguishing whether solitary pulmonary nodules are metachronous cancers or metastases and the relationship between the nodule's characteristics and their nature., Methods: From a single-institution database, we retrospectively selected all patients with a previous cancer history who performed 18F-FDG PET/CT to evaluate pulmonary nodules detected during follow-up, ranging from 5 mm to 40 mm, and histologically diagnosed as malignant., Results: Between September 2009 and August 2017, 127 patients (80 males; mean age=70.2±8.5years) with 127 malignant nodules were included: 103/127 (81%) metachronous cancers, 24/127 (19%) metastases. In both groups, PET/CT provided good and equivalent detection rate of malignancy (81% vs. 83%). No differences between metachronous cancers and metastases were found in: patient's age (70.3±8.1 years vs. 69.5±9.7years), gender (males=63.1% vs. 62.5%), interval between previous cancer diagnosis and nodules' detection (median time=4years vs. 4.5years), location (right-lung=55% vs. 54%; upper-lobes=64% vs. 67%; central-site=31% vs. 25%), size (median size=17mm vs. 19.5mm), 18F-FDG standardized uptake value (median SUVmax=5.2 vs. 5.9)., Conclusions: In oncological patients, despite its high detection rate, 18F-FDG PET/CT, as well as any other clinico-anatomical features, cannot distinguish whether a malignant solitary pulmonary nodule is a metachronous lung cancer or a metastasis, supporting the need of histological differential diagnosis.
- Published
- 2020
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34. A Bio-Imaging Signature as a Predictor of Clinical Outcomes in Locally Advanced Pancreatic Cancer.
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Fiore M, Taralli S, Trecca P, Scolozzi V, Marinelli L, Triumbari EKA, Caputo D, Angeletti S, Ciccozzi M, Coppola A, Greco C, Ippolito E, Calcagni ML, Coppola R, and Ramella S
- Abstract
Purpose : To evaluate the predictive value of
18 F-FDG PET/CT semiquantitative parameters of the primary tumour and CA 19-9 levels assessed before treatment in patients with locally advanced pancreatic cancer (LAPC). Methods : Among one-hundred twenty patients with LAPC treated at our institution with initial chemotherapy followed by curative chemoradiotherapy (CRT) from July 2013 to January 2019, a secondary analysis with baseline18 F-FDG PET/CT was conducted in fifty-eight patients. Pre-treatment CA 19-9 level and the maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of primary tumour were measured. The receiving operating characteristics (ROC) analysis was performed to define the cut-off point of SUVmax, MTV, TLG and CA 19-9 values to use in prediction of early progression (EP), local progression (LP) and overall survival (OS). Areas under the curve (AUCs) were assessed for all variables. Post-test probability was calculated to evaluate the advantage for parameters combination. Results : For EP, CA 19-9 level > 698 U/mL resulted the best marker to identify patient at higher risk with OR of 5.96 (95% CI, 1.66-19.47; p = 0.005) and a Positive Predictive Value (PPV) of 61%. For LP, the most significant parameter was TLG (OR 9.75, 95% CI, 1.64-57.87, p = 0.012), with PPV of 83%. For OS, the most significant parameter was MTV (OR 3.12, 95% CI, 0.9-10.83, p = 0.07) with PPV of 88%. Adding consecutively each of the other parameters, PPV to identify patients at risk resulted further increased (>90%). Conclusions : Pre-treatment CA 19-9 level, as well as MTV and TLG values of primary tumour at baseline18 F-FDG PET/CT and their combination, may represent significant predictors of EP, LP and OS in LAPC patients.- Published
- 2020
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35. The role of 18 F-FDG-PET/CT in predicting the histopathological response in locally advanced cervical carcinoma treated by chemo-radiotherapy followed by radical surgery: a prospective study.
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Rufini V, Collarino A, Calcagni ML, Meduri GM, Fuoco V, Pasciuto T, Testa AC, Ferrandina G, Gambacorta MA, Campitelli M, Gui B, Zannoni G, Manfredi R, Scambia G, and Giordano A
- Subjects
- Chemoradiotherapy, Female, Glycolysis, Humans, Positron Emission Tomography Computed Tomography, Prospective Studies, Radiopharmaceuticals, Retrospective Studies, Tumor Burden, Fluorodeoxyglucose F18, Uterine Cervical Neoplasms diagnostic imaging, Uterine Cervical Neoplasms therapy
- Abstract
Purpose: This prospective study aimed to evaluate whether
18 F-FDG-PET/CT performed before, during and after neoadjuvant chemo-radiotherapy (CRT) could predict histopathological response in patients with locally advanced cervical cancer (LACC) treated with CRT followed by radical surgery., Methods: Between October 2010 and June 2014, 88 patients with LACC were enrolled. For each patient, three18 F-FDG-PET/CT scans (baseline, early and final) were acquired and evaluated by qualitative and quantitative analysis. Maximum standardized uptake value (SUVmax ), SUVmean , metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured as absolute values and their percentage variation (delta) (early vs. baseline and final vs. baseline). The role of18 F-FDG-PET/CT in predicting lymph node (LN) residual disease was evaluated by qualitative analysis only. Histopathology was the reference standard., Results: At histopathology, 40 patients had complete response (CR, pR0), 48 had partial response (PR: 21 microscopic [pR1] and 27 macroscopic [pR2]). At baseline, SUVmax and SUVmean were significantly higher in pR0 than in pR1-pR2 patients. At early evaluation, MTV and TLG were significantly higher in pR1-pR2 than in pR0 patients. At final evaluation, SUVmax , SUVmean and TLG were significantly higher in pR1-pR2 than in pR0 patients. Delta SUV parameters and delta TLG were significantly lower in PR group both during and after CRT. Delta MTV was significantly lower in patients with PR in the early phase only. In receiver operating characteristic (ROC) curve analysis, baseline SUVmean , early delta TLG, and final delta SUVmax better discriminated PR, providing 83.3%, 67.6% and 85% positive predictive value (PPV) and 60.3%, 90% and 70.8% negative predictive value (NPV), respectively. For LN assessment, high NPV was observed at early and final18 F-FDG-PET/CT (93.5% and 92.3%, respectively)., Conclusion: In LACC patients treated with CRT followed by surgery, early variations in metabolic parameters effectively discriminate histopathological PR of the primary tumor, suggesting the potential role of18 F-FDG-PET/CT in early personalized treatment. The high NPV of early and final PET/CT could enable "tailored surgery" by avoiding lymphadenectomy in selected patients.- Published
- 2020
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36. How Often Do We Fail to Classify the Treatment Response with [ 18 F]FDG PET/CT Acquired on Different Scanners? Data from Clinical Oncological Practice Using an Automatic Tool for SUV Harmonization.
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Mattoli MV, Calcagni ML, Taralli S, Indovina L, Spottiswoode BS, and Giordano A
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- Aged, Automation, Disease-Free Survival, Female, Humans, Male, Middle Aged, Treatment Outcome, Fluorodeoxyglucose F18 pharmacokinetics, Medical Oncology, Positron Emission Tomography Computed Tomography instrumentation
- Abstract
Purpose: Tumor response evaluated by 2-deoxy-2-[
18 F]fluoro-D-glucose ([18 F]FDG) positron emission tomography/computed tomography (PET/CT) with standardized uptake value (SUV) is questionable when pre- and post-treatment PET/CT are acquired on different scanners. The aims of our study, performed in oncological patients who underwent pre- and post-treatment [18 F]FDG PET/CT on different scanners, were (1) to evaluate whether EQ·PET, a proprietary SUV inter-exams harmonization tool, modifies the EORTC tumor response classification and (2) to assess which classification (harmonized and non-harmonized) better predicts clinical outcome., Procedures: We retrospectively identified 95 PET pairs (pre- and post-treatment) performed on different scanners (Biograph mCT, Siemens; GEMINI GXL, Philips) in 73 oncological patients (52F; 57.8 ± 16.3 years). An 8-mm Gaussian filter was applied for the Biograph protocol to meet the EANM/EARL harmonization standard; no filter was needed for GXL. SUVmax and SUVmaxEQ of the same target lesion in the pre- and post-treatment PET/CT were noted. For each PET pair, the metabolic response classification (responder/non-responder), derived from combining the EORTC response categories, was evaluated twice (with and without harmonization). In discordant cases, the association of each metabolic response classification with final clinical response assessment and survival data (2-year disease-free survival, DFS) was assessed., Results: On Biograph, SUVmaxEQ of all target lesions was significantly lower (p = 0.001) than SUVmax (8.5 ± 6.8 vs 12.5 ± 9.6; - 38.6 %). A discordance between the two metabolic response classifications (harmonized and non-harmonized) was found in 19/95 (20 %) PET pairs. In this subgroup (n = 19; mean follow-up, 33.9 ± 9 months), responders according to harmonized classification (n = 9) had longer DFS (47.5 months, 88.9 %) than responders (n = 10) according to non-harmonized classification (26.3 months, 50.0 %; p = 0.01). Moreover, harmonized classification showed a better association with final clinical response assessment (17/19 PET pairs)., Conclusions: The harmonized metabolic response classification is more associated with the final clinical response assessment, and it is able to better predict the DFS than the non-harmonized classification. EQ·PET is a useful harmonization tool for evaluating metabolic tumor response using different PET/CT scanners, also in different departments or for multicenter studies.- Published
- 2019
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37. Correction to: Comparison of three-parameter kinetic model analysis to standard Patlak's analysis in 18 F-FDG PET imaging of lung cancer patients.
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Laffon E, Calcagni ML, Galli G, Giordano A, Capotosti A, Marthan R, and Indovina L
- Abstract
Following publication of the original article [1], the authors flagged that the author affiliations detailed in the article are incorrect for the authors M. L. Calcagni and A. Giordano.
- Published
- 2019
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38. Response evaluation with 18 F-FDG PET/CT in metastatic breast cancer patients treated with Palbociclib: first experience in clinical practice.
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Taralli S, Lorusso M, Scolozzi V, Masiello V, Marazzi F, and Calcagni ML
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- Aged, Aged, 80 and over, Breast diagnostic imaging, Breast drug effects, Breast metabolism, Breast Neoplasms diagnostic imaging, Breast Neoplasms metabolism, Breast Neoplasms pathology, Disease Progression, Female, Humans, Middle Aged, Preliminary Data, Retrospective Studies, Treatment Outcome, Whole Body Imaging, Antineoplastic Agents therapeutic use, Breast Neoplasms drug therapy, Fluorodeoxyglucose F18, Piperazines therapeutic use, Positron Emission Tomography Computed Tomography, Pyridines therapeutic use, Radiopharmaceuticals
- Abstract
Objective: Palbociclib is a cyclin-dependent kinase 4/6 inhibitor recently approved for treatment in advanced or metastatic breast cancer (BC) patients. The use of
18 F-FDG PET/CT for chemo/endocrine therapy response assessment in BC patients is well reported in the literature, but no studies have evaluated its role for assessing Palbociclib efficacy in clinical practice. Our study aimed to evaluate the potential role of18 F-FDG PET/CT in this setting., Methods: In 12 metastatic BC patients (mean age = 62 ± 10 years) treated with Palbociclib plus endocrine therapy and who underwent a baseline and post-therapy18 F-FDG PET/CT, we retrospectively compared the Metabolic Response Evaluation (MRE, based on PET/CT) to the Standard Response Evaluation (SRE, based on clinico-laboratory and morphological data); we also assessed the influence of additional PET/CT information on the patients' management., Results: Compared to SRE, MRE increased the proportion of patients classified with progressive disease from 25 to 50% and differed from SRE in 8/12 patients: 3/8 shifted from stable disease or undetermined response to metabolic progression (more unfavorable category), 4/8 from stable disease to partial or complete metabolic response, and 1/8 from partial response to complete metabolic response (more favorable category). Additional PET/CT information led to a change in patients' management in 3/12 (25%) patients., Conclusion: In BC patients treated with Palbociclib, additional18 F-FDG PET/CT information seems clinically useful, with respect to personalized management, to early intercept patients who should discontinue Palbociclib because of progressive disease and to select patients requiring a strict monitoring of additional metabolic findings. Further studies are needed to confirm these preliminary results.- Published
- 2019
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39. Emerging topics and practical aspects for an appropriate use of amyloid PET in the current Italian context.
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Nobili F, Cagnin A, Calcagni ML, Chincarini A, Guerra UP, Morbelli S, Padovani A, Paghera B, Pappatà S, Parnetti L, Sestini S, and Schillaci O
- Subjects
- Humans, Image Processing, Computer-Assisted, Italy, Radioactive Tracers, Amyloid metabolism, Language, Positron-Emission Tomography statistics & numerical data
- Abstract
In May 2017 some representatives of the Italian nuclear medicine and neurological communities spontaneously met to discuss the issues emerged during the first two years of routine application of amyloid PET with fluorinated radiopharmaceuticals in the real world. The limitations of a binary classification of scans, the possibility to obtain early images as a surrogate marker of regional cerebral bloos flow, the need for (semi-)quantification and, thus, the opportunity of ranking brain amyloidosis, the correlation with Aβ42 levels in the cerebrospinal fluid, the occurrence and biological meaning of uncertain/boderline scans, the issue of incidental amyloidosis, the technical pittfalls leading to false negative/positive results, the position of the tool in the diagnostic flow-chart in the national reality, are the main topics that have been discussed. Also, a card to justify the examination to be filled by the dementia specialist and a card for the nuclear medicine physician to report the exam in detail have been approved and are available in the web, which should facilitate the creation of a national register, as previewed by the 2015 intersocietal recommendation on the use of amyloid PET in Italy. The content of this discussion could stimulate both public institutions and companies to support further research on these topics.
- Published
- 2019
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40. 18 F-FDG PET/CT diagnostic performance in solitary and multiple pulmonary nodules detected in patients with previous cancer history: reports of 182 nodules.
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Taralli S, Scolozzi V, Foti M, Ricciardi S, Forcione AR, Cardillo G, and Calcagni ML
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- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Fluorodeoxyglucose F18, Multiple Pulmonary Nodules diagnostic imaging, Positron Emission Tomography Computed Tomography, Solitary Pulmonary Nodule diagnostic imaging
- Abstract
Purpose: In oncological patients,
18 F-FDG PET/CT performance for pulmonary nodules' characterization is not well-established. Thus, the purpose of this study was to evaluate the18 F-FDG PET/CT diagnostic performance in pulmonary nodules detected during follow-up in oncological patients and the relationship between malignancy and nodules' characteristics., Methods: We retrospectively evaluated 182 pulmonary nodules (121 solitary, 61 multiple; mean size = 16.5 ± 8.1 mm, mean SUVmax = 5.2 ± 5.1) in 148 oncological patients (89 males; mean age = 69.5 ± 8.4 years). Final diagnosis was established by histology or radiological follow-up. Diagnostic performance of18 F-FDG visual analysis (malignancy-criterion: uptake ≥ mediastinal activity), ROC curve analysis for SUVmax and nodules' characteristics were assessed., Results: In 182 nodules, the prevalence of malignancy was 75.8%; PET/CT provided sensitivity = 79%, specificity = 81.8%, accuracy = 79.7%, PPV = 93.1%, NPV = 55.4%; ROC analysis (SUVmax cut-off = 1.7) provided sensitivity = 85.5%, specificity = 72.7%. In 121 solitary nodules, the prevalence of malignancy was 87.6%; PET/CT provided sensitivity = 82.1%, specificity = 73.3%, accuracy = 81%, PPV = 95.6%, NPV = 36.7%; ROC analysis (SUVmax cut-off = 2) provided sensitivity = 84%, specificity = 80%. In 61 multiple nodules, the prevalence of malignancy was 52.5%; PET/CT (nodule and patient-based analysis, respectively) provided sensitivity = 68.7% and 88.9%, specificity = 86.2% and 55.6%, accuracy = 77% and 77.8%, PPV = 84.4% and 80%, NPV = 71.8% and 71.5%; ROC analysis (nodule-based, SUVmax cut-off = 1.8) provided sensitivity = 71.9%, specificity = 82.8%. Malignant nodules were prevalent in males, in solitary pattern and in upper lobes, and had significantly greater size and metabolic activity (SUVmax and TLG) than benign ones, with no differences in interval-time between previous cancer diagnosis and nodule detection, patients' age or other nodules' features (lung side, central/peripheral). When comparing solitary and multiple patterns, malignant nodules had significantly greater size and metabolic activity than benign ones in both groups., Conclusions: In oncological patients,18 F-FDG PET/CT provides good diagnostic performance for ruling in the malignancy in pulmonary nodules detected during follow-up, even at small size and especially when solitary. In multiple patterns, PET seems useful in the perspective of a personalized management, for identifying the "reference" nodule deserving histological assessment.- Published
- 2019
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41. The kinetics of 18 F-FDG in lung cancer: compartmental models and voxel analysis.
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Silvestri E, Scolozzi V, Rizzo G, Indovina L, Castellaro M, Mattoli MV, Graziano P, Cardillo G, Bertoldo A, and Calcagni ML
- Abstract
Background: The validation of the most appropriate compartmental model that describes the kinetics of a specific tracer within a specific tissue is mandatory before estimating quantitative parameters, since the behaviour of a tracer can be different among organs and diseases, as well as between primary tumours and metastases. The aims of our study were to assess which compartmental model better describes the kinetics of
18 F-Fluorodeoxygluxose(18 F-FDG) in primary lung cancers and in metastatic lymph nodes; to evaluate whether quantitative parameters, estimated using different innovative technologies, are different between lung cancers and lymph nodes; and to evaluate the intra-tumour inhomogeneity., Results: Twenty-one patients (7 females; 71 ± 9.4 years) with histologically proved lung cancer, prospectively evaluated, underwent18 F-FDG PET-CT for staging. Spectral analysis iterative filter (SAIF) method was used to design the most appropriate compartmental model. Among the compartmental models arranged using the number of compartments suggested by SAIF results, the best one was selected according to Akaike information criterion (AIC). Quantitative analysis was performed at the voxel level. K1 , Vb and Ki were estimated with three advanced methods: SAIF approach, Patlak analysis and the selected compartmental model. Pearson's correlation and non-parametric tests were used for statistics. SAIF showed three possible irreversible compartmental models: Tr-1R, Tr-2R and Tr-3R. According to well-known18 F-FDG physiology, the structure of the compartmental models was supposed to be catenary. AIC indicated the Sokoloff's compartmental model (3K) as the best one. Excellent correlation was found between Ki estimated by Patlak and by SAIF (R2 = 0.97, R2 = 0.94, at the global and the voxel level respectively), and between Ki estimated by 3K and by SAIF (R2 = 0.98, R2 = 0.95, at the global and the voxel level respectively). Using the 3K model, the lymph nodes showed higher mean and standard deviation of Vb than lung cancers (p < 0.0014, p < 0.0001 respectively) and higher standard deviation of K1 (p < 0.005)., Conclusions: One-tissue reversible plus one-tissue irreversible compartmental model better describes the kinetics of18 F-FDG in lung cancers, metastatic lymph nodes and normal lung tissues. Quantitative parameters, estimated at the voxel level applying different advanced approaches, show the inhomogeneity of neoplastic tissues. Differences in metabolic activity and in vascularization, highlighted among all cancers and within each individual cancer, confirm the wide variability in lung cancers and metastatic lymph nodes. These findings support the need of a personalization of therapeutic approaches.- Published
- 2018
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42. Optic nerve glioblastoma detected by 11 C-Methionine brain PET/CT.
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Rizzo V, Mattoli MV, Trevisi G, Coli A, Calcagni ML, and Montano N
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- Aged, 80 and over, Biopsy, Feasibility Studies, Glioblastoma pathology, Humans, Male, Optic Chiasm diagnostic imaging, Optic Nerve Neoplasms pathology, Carbon Radioisotopes analysis, Glioblastoma diagnostic imaging, Magnetic Resonance Imaging methods, Methionine analysis, Multimodal Imaging methods, Neuroimaging methods, Optic Nerve Neoplasms diagnostic imaging, Positron Emission Tomography Computed Tomography, Radiopharmaceuticals analysis
- Published
- 2018
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43. Are the simplified methods to estimate Ki in 18F-FDG PET studies feasible in clinical routine? Comparison between three simplified methods.
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Calcagni ML, Indovina L, Di Franco D, Rufini V, Leccisotti L, Giordano A, and Galli G
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- Aged, Female, Humans, Male, Middle Aged, Prospective Studies, Carcinoma, Non-Small-Cell Lung diagnostic imaging, Fluorodeoxyglucose F18, Lung Neoplasms diagnostic imaging, Positron Emission Tomography Computed Tomography methods, Radiopharmaceuticals
- Abstract
Background: The aim of this study was to verify the feasibility, in clinical practice, of three simplified methods (Hunter, Sadato and another one proposed by our group) to calculate Ki and MRglu of 18F-FDG, comparing the results with those derived by the linear regression (LR) method (considered the golden standard), and also with SUV., Methods: Forty-five patients (32males, mean age 69±9years) with non-small-cell-lung cancer prospectively enrolled, underwent dynamic 18F-FDG PET-CT over the thorax. Ki was estimated as follows: from a static acquisition and performing one venous blood sampling using the Hunter method; multiplying the SUV for the average plasma clearance rate (kP(T)) and for the initial distribution volume (V0bw) without performing any blood sampling using the Sadato method; multiplying the SUV for a factor F (which encompasses the mean value of haematocrit and plasma volume, both according to patient's sex) without performing any blood sample using ours method. Wilcoxon signed rank and coefficient of determination (R2) were used for statistical analysis., Results: No significant difference was observed between the Ki and MRglu estimated by all three simplified methods and the Ki and MRglu estimated by LR. The highest P values and the lower values of mean differences were observed with our method compared with LR: Ki=0.0392±0.0178 min-1 vs. Ki=0.0392±0.0202 min-1 (P=0.897, MD=0.0001 min-1), respectively; MRglu= 4.47±2.23 ml/min/100g vs. MRglu= 4.43±2.38 ml/min/100g (P=0.839, MD= -0.0373 mL/min/100g), respectively. The highest correlation was observed between the Ki estimated by both Hunter and our methods and the Ki estimated by LR: R2=0.87, R2=0.86, respectively. A good correlation (R2=0.83) was observed between SUV and Ki estimated by LR., Conclusions: These three simplified methods represent a valid alternative to the more invasive and complex full kinetic analysis. Their "pros" are: the non-invasiveness, the feasibility, the good correlation with the golden standard; their "cons" is that full kinetic analysis provides highest accuracy in Ki determination. Therefore, in clinical oncology routine, the nuclear physicians can choose among different simplified methods especially for monitoring the response to treatment, for tumour grading, and for prognostic stratification, letting the full kinetic analysis to specific centre/studies.
- Published
- 2018
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44. Comparison of three-parameter kinetic model analysis to standard Patlak's analysis in 18 F-FDG PET imaging of lung cancer patients.
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Laffon E, Calcagni ML, Galli G, Giordano A, Capotosti A, Marthan R, and Indovina L
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Background: Patlak's graphical analysis can provide tracer net influx constant (Ki) with limitation of assuming irreversible tracer trapping, that is, release rate constant (k
b ) set to zero. We compared linear Patlak's analysis to non-linear three-compartment three-parameter kinetic model analysis (3P-KMA) providing Ki, kb , and fraction of free18 F-FDG in blood and interstitial volume (Vb )., Methods: Dynamic PET data of 21 lung cancer patients were retrospectively analyzed, yielding for each patient an18 F-FDG input function (IF) and a tissue time-activity curve. The former was fitted with a three-exponentially decreasing function, and the latter was fitted with an analytical formula involving the fitted IF data (11 data points, ranging 7.5-57.5 min post-injection). Bland-Altman analysis was used for Ki comparison between Patlak's analysis and 3P-KMA. Additionally, a three-compartment five-parameter KMA (5P-KMA) was implemented for comparison with Patlak's analysis and 3P-KMA., Results: We found that 3P-KMA Ki was significantly greater than Patlak's Ki over the whole patient series, + 6.0% on average, with limits of agreement of ± 17.1% (95% confidence). Excluding 8 out of 21 patients with kb > 0 deleted this difference. A strong correlation was found between Ki ratio (=3P-KMA/Patlak) and kb (R = 0.801; P < 0.001). No significant difference in Ki was found between 3P-KMA versus 5P-KMA, and between 5P-KMA versus Patlak's analysis, with limits of agreement of ± 23.0 and ± 31.7% (95% confidence), respectively., Conclusions: Comparison between 3P-KMA and Patlak's analysis significantly showed that the latter underestimates Ki because it arbitrarily set kb to zero: the greater the kb value, the greater the Ki underestimation. This underestimation was not revealed when comparing 5P-KMA and Patlak's analysis. We suggest that further studies are warranted to investigate the 3P-KMA efficiency in various tissues showing greater18 F-FDG trapping reversibility than lung cancer lesions.- Published
- 2018
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45. Decompressive craniectomy and hydrocephalus: proposal of a therapeutic flow chart.
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Peraio S, Calcagni ML, Mattoli MV, Marziali G, DE Bonis P, Pompucci A, Anile C, and Mangiola A
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- Humans, Hydrocephalus surgery, Intracranial Hypertension, Decompressive Craniectomy adverse effects, Hydrocephalus etiology
- Abstract
Decompressive craniectomy (DC) may be necessary to save the lives of patients suffering from intracranial hypertension. However, this procedure is not complication-free. Its two main complications are hydrocephalus and the sinking skin-flap syndrome (SSFS). The radiological findings and the clinical evaluation may be not enough to decide when and/or how to treat hydrocephalus in a decompressed patient. SSFS and hydrocephalus may be not unrelated. In fact, a patient affected by hydrocephalus, after the ventriculo-peritoneal shunt, can develop SSFS; on the other hand, SSFS per se can cause hydrocephalus. Treating hydrocephalus in decompressed patients can be challenging. Radiological findings and clinical evaluation may not be enough to define the most appropriate therapeutic strategy. Cerebrospinal fluid (CSF) dynamics and metabolic evaluations can represent important diagnostic tools for assessing the need of a CSF shunt in patients with a poor baseline neurologic status. Based on our experience, we propose a flow chart for treating decompressed patients affected by ventriculomegaly.
- Published
- 2017
- Full Text
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46. Measurement uncertainty and clinical impact of target-to-background ratios derived by interim FDG-PET/CT in Hodgkin lymphoma: reply to Laffon and Martan.
- Author
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Annunziata S, Calcagni ML, Indovina L, and Rufini V
- Subjects
- Humans, Positron Emission Tomography Computed Tomography, Positron-Emission Tomography, Radiopharmaceuticals, Tomography, X-Ray Computed, Uncertainty, Fluorodeoxyglucose F18, Hodgkin Disease
- Published
- 2017
- Full Text
- View/download PDF
47. Serial neuroimaging findings in a novel case of sporadic progressive ataxia and palatal tremor (PAPT).
- Author
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Di Blasi C, Rizzo V, Di Lella G, Modoni A, Calcagni ML, Picciotti PM, and Silvestri G
- Subjects
- Aged, Brain metabolism, Brain pathology, Cerebellar Ataxia complications, Fluorodeoxyglucose F18 metabolism, Humans, Magnetic Resonance Imaging, Male, Neuroimaging, Positron Emission Tomography Computed Tomography, Tremor complications, Tremor diagnostic imaging, Cerebellar Ataxia diagnostic imaging, Palatal Muscles physiopathology, Tremor physiopathology
- Published
- 2017
- Full Text
- View/download PDF
48. The predictive value of 18 F-FDG PET-CT for assessing the clinical outcomes in locally advanced NSCLC patients after a new induction treatment: low-dose fractionated radiotherapy with concurrent chemotherapy.
- Author
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Mattoli MV, Massaccesi M, Castelluccia A, Scolozzi V, Mantini G, and Calcagni ML
- Subjects
- Adenocarcinoma diagnostic imaging, Adenocarcinoma therapy, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Non-Small-Cell Lung diagnostic imaging, Carcinoma, Non-Small-Cell Lung therapy, Carcinoma, Squamous Cell diagnostic imaging, Carcinoma, Squamous Cell therapy, Dose Fractionation, Radiation, Female, Follow-Up Studies, Humans, Lung Neoplasms diagnostic imaging, Lung Neoplasms therapy, Male, Middle Aged, Neoplasm Staging, Prognosis, Radiopharmaceuticals, Retrospective Studies, Survival Rate, Adenocarcinoma pathology, Carcinoma, Non-Small-Cell Lung pathology, Carcinoma, Squamous Cell pathology, Chemoradiotherapy mortality, Fluorodeoxyglucose F18, Lung Neoplasms pathology, Positron Emission Tomography Computed Tomography methods
- Abstract
Background: Patients with locally advanced non-small-cell lung cancer (LA-NSCLC) have poor prognosis despite several multimodal approaches. Recently, low-dose fractionated radiotherapy concurrent to the induction chemotherapy (IC-LDRT) has been proposed to further improve the effects of chemotherapy and prognosis. Until now, the predictive value of metabolic response after IC-LDRT has not yet been investigated., Aim: to evaluate whether the early metabolic response, assessed by
18 F-fluoro-deoxyglucose positron emission-computed tomography (18 F-FDG PET-CT), could predict the prognosis in LA-NSCLC patients treated with a multimodal approach, including IC-LDRT., Methods: Forty-four consecutive patients (35males, mean age: 66 ± 7.8 years) with stage IIIA/IIIB NSCLC were retrospectively evaluated. Forty-four patients underwent IC-LDRT (2 cycles of chemotherapy, 40 cGy twice daily), 26/44 neo-adjuvant chemo-radiotherapy (CCRT: 50.4Gy), and 20/44 surgery.18 F-FDG PET-CT was performed before (baseline), after IC-LDRT (early) and after CCRT (final), applying PET response criteria in solid tumours (PERCIST). Patients with complete/partial metabolic response were classified as responders; patients with stable/progressive disease as non-responders. Progression free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meyer analysis; the relationship between clinical factors and survivals were assessed using uni-multivariate regression analysis., Results: Forty-four out of 44, 42/44 and 23/42 patients underwent baseline, early and final PET-CT, respectively. SULpeak of primary tumour and lymph-node significantly (p = 0.004, p = 0.0002, respectively) decreased after IC-LDRT with a further reduction after CCRT (p = 0.0006, p = 0.02, respectively). At early PET-CT, 20/42 (47.6%) patients were classified as responders, 22/42 (52.3%) as non-responders. At final PET-CT, 19/23 patients were classified as responders (12 responders and 7 non-responders at early PET-CT), and 4/23 as non-responders (all non-responders at early PET-CT). Early responders had better PFS and OS than early non-responders (p ≤ 0.01). Early metabolic response was predictive factor for loco-regional, distant and global PFS (p = 0.02, p = 0.01, p = 0.005, respectively); surgery for loco-regional and global PFS (p = 0.03, p = 0.009, respectively)., Conclusions: In LA-NSCLC patients,18 F-FDG metabolic response assessed after only two cycles of IC-LDRT predicts the prognosis. The early evaluation of metabolic changes could allow to personalize therapy. This multimodality approach, including both low-dose radiotherapy that increases the effects of induction chemotherapy, and surgery that removes the disease, improved clinical outcomes. Further prospective investigation of this new induction approach is warranted.- Published
- 2017
- Full Text
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49. Intranasal Nerve Growth Factor administration improves cerebral functions in a child with severe traumatic brain injury: A case report.
- Author
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Chiaretti A, Conti G, Falsini B, Buonsenso D, Crasti M, Manni L, Soligo M, Fantacci C, Genovese O, Calcagni ML, Di Giuda D, Mattoli MV, Cocciolillo F, Ferrara P, Ruggiero A, Staccioli S, Colafati GS, and Riccardi R
- Subjects
- Administration, Intranasal, Brain Injuries, Traumatic diagnostic imaging, Cerebral Cortex diagnostic imaging, Cerebral Cortex physiology, Child, Preschool, Doublecortin Domain Proteins, Doublecortin Protein, Electroencephalography, Evoked Potentials, Visual drug effects, Fluorodeoxyglucose F18 pharmacokinetics, Glasgow Coma Scale, Humans, Male, Microtubule-Associated Proteins metabolism, Neuroimaging, Neurologic Examination, Neuropeptides metabolism, Brain Injuries, Traumatic drug therapy, Cerebral Cortex drug effects, Nerve Growth Factor administration & dosage
- Abstract
Background: Nerve growth factor (NGF) promotes neural recovery after experimental traumatic brain injury (TBI) supporting neuronal growth, differentiation and survival of brain cells and up-regulating the neurogenesis-associated protein Doublecortin (DCX). Only a few studies reported NGF administration in paediatric patients with severe TBI., Methods: A four-year-old boy in a persistent unresponsive wakefulness syndrome (UWS) was treated with intranasal murine NGF administration 6 months after severe TBI. The patient received four cycles of intranasal NGF (0.1 mg/kg, twice a day for 10 consecutive days)., Results: NGF administration improved functional [Positron Emission Tomography/Computed Tomography (PET/CT); Single photon emission/Computed Tomography (SPECT/CT) and Magnetic Resonance Imaging (MRI)] assessment, electrophysiological [Electroencephalogram (EEG) and Visual Evoked Potential (VEP)] studies and clinical conditions. He showed improvements in voluntary movements, facial mimicry, phonation, attention and verbal comprehension, ability to cry, cough reflex, oral motility, feeding capacity, and bowel and urinary functions. After NGF administration, raised levels of both NGF and DCX were found in the cerebrospinal fluid of the patient. No side effects were reported., Conclusions: Although further studies are needed for better understanding the neuroprotective role of this neurotrophin, intranasal NGF administration appears to be a promising and safe rescuing strategy treatment in children with neurological impairment after TBI.
- Published
- 2017
- Full Text
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50. Interim FDG-PET/CT in Hodgkin lymphoma: the prognostic role of the ratio between target lesion and liver SUVmax (rPET).
- Author
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Annunziata S, Cuccaro A, Calcagni ML, Hohaus S, Giordano A, and Rufini V
- Subjects
- Adolescent, Adult, Aged, Biological Transport, Disease-Free Survival, Female, Hodgkin Disease metabolism, Humans, Liver metabolism, Male, Middle Aged, Predictive Value of Tests, ROC Curve, Hodgkin Disease diagnostic imaging, Liver diagnostic imaging, Positron Emission Tomography Computed Tomography
- Abstract
Objective: To evaluate the prognostic role of the ratio between target lesion and liver SUVmax (rPET) in patients with Hodgkin lymphoma (HL) undergoing interim FDG-PET/CT and to compare rPET with the 5-point Deauville Score (5p-DS)., Methods: Sixty-eight patients with HL undergoing interim FDG-PET/CT after first courses of chemotherapy were evaluated. The receiver operating characteristic (ROC) approach was applied to identify the optimal cutpoint of rPET with respect to progression free survival (PFS). The prognostic significance of rPET was compared with 5p-DS (scores 4 and 5 considered as positive). Positive predictive value (PPV) and negative predictive value (NPV) were calculated using the presence of an adverse event as the gold standard., Results: The ROC analysis for rPET as a predictor of progression showed an optimal rPET cutpoint of 1.14. Both 5p-DS and rPET were strong outcome predictors (p < 0.001). Patients with negative 5p-DS and patients with rPET <1.14 had a similar two-year PFS (86 and 87 %, respectively). Patients with a positive 5p-DS had a 2-year PFS of 27 %, while patients with rPET >1.14 had a 2-year PFS of 15 %. 5p-DS and rPET cutoff of 1.14 showed a PPV of 58 versus 70 %, and a NPV of 85 versus 86 %, respectively., Conclusions: rPET could be considered an accurate prognostic factor in patients with HL undergoing interim FDG-PET/CT. Larger prospective studies are needed to confirm these data.
- Published
- 2016
- Full Text
- View/download PDF
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