PET Imaging of Tumor Perfusion: A Potential Cancer Biomarker?

Johnson, Geoffrey B.; Harms, Hendrik J.; Johnson, Derek R.; Jacobson, Mark

doi:10.1053/j.semnuclmed.2020.07.001

Cited by 11 publications

(12 citation statements)

References 89 publications

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“…The present case series demonstrates various malignant and benign coincidental findings with increased perfusion, detected during clinical O-15-H 2 O PET MPI. PET imaging of tumour perfusion has been proposed as a potential cancer biomarker 10 and has been studied with O-15-H 2 O PET in various malignancies including brain, 11 , 12 head and neck, 13 , 14 lung, 15 breast, 16 , 17 pancreas, 18 cervix uteri, 19 abdominal, 20 and prostate cancer. 21 , 22 Furthermore, increased perfusion has been described in studies using 82 Rb PET in primary brain tumours, 23 – 28 brain metastases from breast cancer 29 and prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

Extracardiac findings with increased perfusion during clinical O-15-H2O PET/CT myocardial perfusion imaging: A case series

Jochumsen

Overgaard

Vendelbo

et al. 2023

Journal of Nuclear Cardiology

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Background Coincidental extracardiac findings with increased perfusion were reported during myocardial perfusion imaging (MPI) with various retention radiotracers. Clinical parametric O-15-H 2 O PET MPI yielding quantitative measures of myocardial blood flow (MBF) was recently implemented at our facility. We aim to explore whether similar extracardiac findings are observed using O-15-H 2 O. Methods and results All patients (2963) were scanned with O-15-H 2 O PET MPI according to international guidelines and extracardiac findings were collected. In contrast to parametric O-15-H 2 O MBF images, extracardiac perfusion was assessed using summed images. Biopsy histopathology and other imaging modalities served as reference standards. Various malignant lesions with increased perfusion were detected, including lymphomas, large-celled neuroendocrine tumour, breast, and lung cancer plus metastases from colonic and renal cell carcinomas. Furthermore, inflammatory and hyperplastic benign conditions with increased perfusion were observed: rib fractures, gynecomastia, atelectasis, sarcoidosis, pneumonia, chronic lung inflammation and fibrosis, benign lung nodule, chronic diffuse lung infiltrates, pleural plaques and COVID-19 infiltrates. Conclusions Malignant and benign extracardiac coincidental findings with increased perfusion are readily visible and frequently seen on O-15-H 2 O PET MPI. We recommend evaluating the summed O-15-H 2 O PET images in addition to the low-dose CT attenuation images. Supplementary Information The online version contains supplementary material available at 10.1007/s12350-022-03156-5.

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Section: Discussionmentioning

confidence: 99%

Extracardiac findings with increased perfusion during clinical O-15-H2O PET/CT myocardial perfusion imaging: A case series

Jochumsen

Overgaard

Vendelbo

et al. 2023

Journal of Nuclear Cardiology

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“…Of note, PET has long been used to measure rCBV in both normal and abnormal tissue, including cancer [15]. The optimal way to measure rCBV using PET is with 15 O-labelled carbon monoxide [16]. In principle, however, rCBV can be measured with any PET radiotracer administered intravenously as long as data acquisition begins at the time of injection [15].…”

Section: Introductionmentioning

confidence: 99%

“…The optimal way to measure rCBV using PET is with 15 O-labelled carbon monoxide [16]. In principle, however, rCBV can be measured with any PET radiotracer administered intravenously as long as data acquisition begins at the time of injection [15]. Dynamic acquisition of 18 F-FET uptake is part of the standard protocol used at the Forschungszentrum Jülich because the evaluation of time-activity curves in the tumour provides additional information for grading and for differential diagnosis of brain lesions [17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Assessment of brain tumour perfusion using early-phase 18F-FET -PET: comparison with perfusion-weighted MRI

Filß

Cramer

Löher

et al. 2023

Preprint

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Background: Morphological imaging using MRI is essential for brain tumour diagnostics. Dynamic susceptibility contrast (DSC) perfusion-weighted MRI (PWI), as well as amino acid PET, may provide additional information in ambiguous cases. Since PWI is not always performed as part of standard MRI in brain tumours, we explored whether maps of relative cerebral blood volume (rCBV) in brain tumours can be extracted from the early phase of PET using O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET). Using a hybrid BrainPET/MRI scanner, PWI and dynamic 18F-FET PET were performed in 33 patients with cerebral glioma and in four patients with highly vascularized meningiomas. Based on the dynamic PET data in meningiomas, the time interval from 0 – 2 min p.i. was selected to best reflect the blood pool phase in 18F-FET PET. For each patient, maps of MR-rCBV, early 18F-FET PET (0-2 min p.i.) and late 18F-FET PET (20-40 min p.i.) were generated and coregistered. Volumes of interest were placed on the tumour (VOI-TU) and on the normal-appearing contralateral brain tissue (VOI-REF). The correlation between the tumour-to-brain ratios (TBR) of the different parameters was analyzsed. In addition, three independent observers evaluated the MR-rCBV and early 18F-FET maps (18F-FET-rCBV) for concordance in signal intensity, tumour extent and intratumoural distribution. Results: TBRs calculated from MR-rCBV and 18F-FET-rCBV showed a significant correlation (r = 0.89, p < 0.001), while there was no correlation between late 18F-FET PET and MR-rCBV (r = 0.24, p = 0.16) or 18F-FET-rCBV (r = 0.27, p = 0.11). Visual rating yielded widely agreeing findings or only minor differences between the MR-rCBV maps and 18F-FET-rCBV maps in 93 % of the tumours (range of three independent raters 91–94%, kappa among raters 0.78-1.0). Conclusion: Early 18F-FET-maps (0-2min p.i.) in gliomas provide similar information to MR-rCBV maps and may be helpful when PWI is not possible or available. Further studies in recurrent gliomas are needed to evaluate whether 18F-FET-rCBV provides the same clinical information as MR-rCBV.

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“…Prostate cancer (PCa) is a heterogeneous disease, and consequently, an important challenge in PCa management is differentiation of clinically significant PCa from insignificant PCa that will not cause symptoms or affect the patient's lifetime [1]. Multiple potential predictive and prognostic biomarkers have been evaluated in studies for assessment of the tumour's biological potential, including genetic profiling, and various imaging modalities [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

“…Blood flow is an essential physiologic parameter for cancer growth, and, hence, tumour blood flow (TBF) has been measured for characterization of tumours of various origins [3], amongst others in prostate- [15][16][17] lung- [18,19], breast- [20][21][22][23], head and neck- [24], colorectal- [19,25], and brain cancer [26].…”

Section: Introductionmentioning

confidence: 99%

Potential synergy between PSMA uptake and tumour blood flow for prediction of human prostate cancer aggressiveness

et al. 2021

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Background Both prostate-specific membrane antigen (PSMA) uptake and tumour blood flow (TBF) correlate with International Society of Urological Pathology (ISUP) Grade Group (GG) and hence prostate cancer (PCa) aggressiveness. The aim of the present study was to evaluate the potential synergistic benefit of combining the two physiologic parameters for separating significant PCa from insignificant findings. Methods From previous studies of [82Rb]Rb positron emission tomography (PET) TBF in PCa, the 43 patients that underwent clinical [68Ga]Ga-PSMA-11 PET were selected for this retrospective study. Tumours were delineated on [68Ga]Ga-PSMA-11 PET or magnetic resonance imaging. ISUP GG was recorded from 52 lesions. Results [68Ga]Ga-PSMA-11 maximum standardized uptake value (SUVmax) and [82Rb]Rb SUVmax correlated moderately with ISUP GG (rho = 0.59 and rho = 0.56, both p < 0.001) and with each other (r = 0.65, p < 0.001). A combined model of [68Ga]Ga-PSMA-11 and [82Rb]Rb SUVmax separated ISUP GG > 2 from ISUP GG 1–2 and benign with an area-under-the-curve of 0.85, 96% sensitivity, 74% specificity, and 95% negative predictive value. The combined model performed significantly better than either tracer alone did (p < 0.001), primarily by reducing false negatives from five or six to one (p ≤ 0.025). Conclusion PSMA uptake and TBF provide complementary information about tumour aggressiveness. We suggest that a combined analysis of PSMA uptake and TBF could significantly improve the negative predictive value and allow non-invasive separation of significant from insignificant PCa.

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PET Imaging of Tumor Perfusion: A Potential Cancer Biomarker?

Cited by 11 publications

References 89 publications

Extracardiac findings with increased perfusion during clinical O-15-H2O PET/CT myocardial perfusion imaging: A case series

Extracardiac findings with increased perfusion during clinical O-15-H2O PET/CT myocardial perfusion imaging: A case series

Assessment of brain tumour perfusion using early-phase 18F-FET -PET: comparison with perfusion-weighted MRI

Potential synergy between PSMA uptake and tumour blood flow for prediction of human prostate cancer aggressiveness

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