Multidisciplinary Approach to Chronic Thromboembolic Pulmonary Hypertension: Role of Radiologists.

Management of chronic thromboembolic pulmonary hypertension (CTEPH) should be determined by a multidisciplinary team, ideally at a specialized CTEPH referral center. Radiologists contribute to this multidisciplinary process by helping to confirm the diagnosis of CTEPH and delineating the extent of disease, both of which help determine a treatment decision. Preoperative assessment of CTEPH usually employs multiple imaging modalities, including ventilation-perfusion (V/Q) scanning, echocardiography, CT pulmonary angiography (CTPA), and right heart catheterization with pulmonary angiography.

Improved Prognosis of Treatment Failure in Cervical Cancer with Nontumor PET/CT Radiomics.

Radiomics has been applied to predict recurrence in several disease sites, but current approaches are typically restricted to analyzing tumor features, neglecting nontumor information in the rest of the body. The purpose of this work was to develop and validate a model incorporating nontumor radiomics, including whole-body features, to predict treatment outcomes in patients with previously untreated locoregionally advanced cervical cancer. We analyzed 127 cervical cancer patients treated definitively with chemoradiotherapy and intracavitary brachytherapy.

Variant allele fraction of genomic alterations in circulating tumor DNA (%ctDNA) correlates with SUV in PET scan.

The relationship between higher variant allele fraction (VAF) of genomic alterations in circulating tumor DNA (%ctDNA), an indicator of poor outcome, and maximum standardized uptake value (SUV), the most commonly used semi-quantitative parameter in F-FDG PET/CT, has not been studied. Overall, 433 cancer patients had blood-based next generation sequencing. Maximum and sum of %ctDNA alterations (%ctDNA and %ctDNA, respectively) represent the maximum and sum of VAF, reported as a percentage.

Gated single-photon emission computed tomography myocardial perfusion imaging phase analysis as an imaging biomarker for mortality prediction in heart failure patients undergoing cardiac resynchronization therapy.

Objective: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in heart failure patients. The purpose of this study was to assess the value of gated myocardial perfusion single-photon emission computed tomography (GMPS) phase analysis for predicting survival in heart failure patients undergoing CRT.

Methods: This retrospective cohort study evaluated heart failure patients who underwent GMPS prior to CRT.

Rosai-Dorfman-Destombes (RDD) disease presenting as palindromic rheumatism.

Background: Rosai-Dorfman-Destombes (RDD) disease, is a rare proliferative and inflammatory disorder of non-Langerhans cell histiocytes.

Case Presentation: We report a 35-year-old woman, who originally presented with recurrent episodes of lower extremity joint/bone pain and chronic nasal stuffiness and congestion. Her worsening nasal congestion was due to an obstructing nasal cavity lesion which was subsequently biopsied.

Relationship between tumor mutational burden and maximum standardized uptake value in 2-[F]FDG PET (positron emission tomography) scan in cancer patients.

Purpose: Deriving links between imaging and genomic markers is an evolving field. 2-[F]FDG PET/CT (F-fluorodeoxyglucose positron emission tomography-computed tomography) is commonly used for cancer imaging, with maximum standardized uptake value (SUV) as the main quantitative parameter. Tumor mutational burden (TMB), the quantitative variable obtained using next-generation sequencing on a tissue biopsy sample, is a putative immunotherapy response predictor.

Standardized uptake value (SUV) in F-FDG PET/CT is correlated with the total number of main oncogenic anomalies in cancer patients.

Cancer diagnosis and therapy is quickly moving from the traditional histology-based approaches to genomic stratification, providing a huge opportunity for radiogenomics, associating imaging features with genomic data. Genome sequencing is time consuming, expensive and invasive whereas F-FDG PET/CT is readily available, fast and noninvasive. The aim of this study was to determine the relationship between the maximum standardized uptake value (SUV) and the frequency of 11 common oncogenic anomalies determined by specific common genomic alterations in tissue biopsies from patients with cancer.

A receptor-binding radiopharmaceutical for imaging of traumatic brain injury in a rodent model: [Tc]Tc-tilmanocept.

Introduction: Blood-brain barrier (BBB) disruption and subsequent neuro-inflammation occur following traumatic brain injury (TBI), resulting in a spectrum of human nervous system disorders. [Tc]Tc-tilmanocept is a receptor-binding radiopharmaceutical FDA-approved for sentinel lymph node mapping. We hypothesize that after an intravenous (i.

Glucose-corrected standardized uptake value (SUV) is the most accurate SUV parameter for evaluation of pulmonary nodules.

Standardized uptake values (SUVs) of F-fluorodeoxyglucose positron emission tomography (FDG PET) are widely used to help characterize pulmonary nodules. The purpose of this study is to assess the accuracy of the SUV corrected by blood glucose levels (SUV), compared to four other commonly used semi-quantitative methods: maximal SUV normalized to body weight (SUV), ratio of SUV of nodule to cerebellum (SUV), SUV normalized to body surface area (SUV) and SUV normalized to body mass index (SUV). 52 patients with lung nodules had FDG PET scans, consecutively imaged between 7/1/2015 and 6/7/2016.

Molecular Imaging of the Glomerulus via Mesangial Cell Uptake of Radiolabeled Tilmanocept.

An unmet need for the clinical management of chronic kidney disease is a predictive tool of kidney function during the first decade of the disease, when there is silent loss of glomerular function. The objective of this study was to demonstrate receptor-mediated binding of tilmanocept to CD206 within the kidney and provide evidence of kinetic sensitivity of this binding to renal function. Rats were positioned in a PET scanner with the liver and kidneys within the field of view.

Perfusion Scintigraphy in Diagnosis and Management of Thromboembolic Pulmonary Hypertension.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening complication of acute pulmonary embolism (PE). Because the treatment of CTEPH is markedly different from that of other types of pulmonary hypertension, lung ventilation-perfusion (V/Q) scintigraphy is recommended for the workup of patients with unexplained pulmonary hypertension. Lung V/Q scintigraphy is superior to CT pulmonary angiography for detecting CTEPH.

Molecular Imaging of endometrial sentinel lymph nodes utilizing fluorescent-labeled Tilmanocept during robotic-assisted surgery in a porcine model.

Molecular imaging with a fluorescent version of Tilmanocept may permit an accurate and facile detection of sentinel nodes of endometrial cancer. Tilmanocept accumulates in sentinel lymph nodes (SLN) by binding to a cell surface receptor unique to macrophages and dendritic cells. Four female Yorkshire pigs underwent cervical stromal injection of IRDye800-Tilmanocept, a molecular imaging agent tagged with near-infrared fluorescent dye and radiolabeled with gallium-68 and technetium-99m.

mutations and number of alterations correlate with maximum standardized uptake value (SUVmax) determined by positron emission tomography/computed tomography (PET/CT) [F] fluorodeoxyglucose (F-FDG PET).

Background: Our study explored the relationship between the molecular changes in cancer and the maximum standardized uptake value (SUVmax) determined by positron emission tomography/computed tomography (PET/CT) with [F] fluorodeoxyglucose (F-FDG).

Results: A higher SUVmax correlated with alterations, but not with histologic diagnosis or other gene/pathway mutations or copy number alterations. In data from breast, lung and colon cancer, patients with the highest SUVmax show more genomic anomalies compared to those with the lowest SUVmax ( < 0.

Feasibility of atlas-based active bone marrow sparing intensity modulated radiation therapy for cervical cancer.

Background: To test the hypothesis that atlas-based active bone marrow (ABM)-sparing intensity modulated radiation therapy (IMRT) yields similar dosimetric results compared to custom ABM-sparing IMRT for cervical cancer patients.

Methods: We sampled 62 cervical cancer patients with pre-treatment FDG-PET/CT in training (n=32) or test (n=30) sets. ABM was defined as the subvolume of the pelvic bone marrow (PBM) with standardized uptake value (SUV) above the mean on the average FDG-PET image (ABM) vs.

Longitudinal Changes in Active Bone Marrow for Cervical Cancer Patients Treated With Concurrent Chemoradiation Therapy.

Purpose: To quantify longitudinal changes in active bone marrow (ABM) distributions within unirradiated (extrapelvic) and irradiated (pelvic) bone marrow (BM) in cervical cancer patients treated with concurrent chemoradiation therapy (CRT).

Methods And Materials: We sampled 39 cervical cancer patients treated with CRT, of whom 25 were treated with concurrent cisplatin (40 mg/m) and 14 were treated with cisplatin (40 mg/m) plus gemcitabine (50-125 mg/m) (C/G). Patients underwent F-fluorodeoxyglucose positron emission tomographic/computed tomographic imaging at baseline and 1.

Fluorescence-Based Molecular Imaging of Porcine Urinary Bladder Sentinel Lymph Nodes.

The primary objective was to test the ability of a laparoscopic camera system to detect the fluorescent signal emanating from sentinel lymph nodes (SLNs) approximately 2 d after injection and imaging of a positron-emitting molecular imaging agent into the submucosa of the porcine urinary bladder. Three female pigs underwent a submucosal injection of the bladder with fluorescent-tagged tilmanocept, radiolabeled with both Ga and Tc. One hour after injection, a pelvic PET/CT scan was acquired for preoperative SLN mapping.

Prognostic value of post-Yttrium 90 radioembolization therapy 18F-fluorodeoxyglucose positron emission tomography in patients with liver tumors.

Objective: This study assessed the benefit of post-therapy F-FDG PET/CT versus CT alone in identifying malignant liver tumor progression following radioembolization with Y-90 microspheres.

Methods: 24 patients with 44 liver tumors underwent CT imaging pre-radioembolization and PET/CT post-radioembolization. Predictive value of Response Evaluation Criteria in Solid Tumors (RECIST 1.

Hepatopulmonary Shunting: A Prognostic Indicator of Survival in Patients with Metastatic Colorectal Adenocarcinoma Treated with Y Radioembolization.

Purpose To determine if high lung shunt fraction (LSF) is an independent prognostic indicator of poor survival in patients who undergo yttrium 90 radioembolization for unresectable liver-dominant metastatic colorectal cancer. Materials and Methods Retrospective data were analyzed from 606 patients (62% men; mean age, 62 years) who underwent radioembolization to treat liver metastases from colorectal adenocarcinoma between July 2002 and December 2011 at 11 U.S.

Staging of fibrosis in experimental non-alcoholic steatohepatitis by quantitative molecular imaging in rat models.

Objectives: The aim of this study was to test the ability of hepatocyte-specific functional imaging to stage fibrosis in experimental rat models of liver fibrosis and progressive NASH. Using ROC analysis we tested the ability of a functional imaging metric to discriminate early (F1) from moderate (F2) fibrosis in the absence and presence of non-alcoholic steatohepatitis, which has not been achieved by any modality other than biopsy.

Methods: Galactosyl Human Serum Albumin (GSA) was radiolabeled with the positron-emitter, (68)Ga, and injected (i.

[(18)F]Fluoro-2-deoxy-2-d-glucose versus 3'-deoxy-3'-[(18)F]fluorothymidine for defining hematopoietically active pelvic bone marrow in gynecologic patients.

Background And Purpose: We compared [(18)F]fluoro-2-deoxy-2-d-glucose (FDG) versus 3'-deoxy-3'-[(18)F]fluorothymidine (FLT) for the purpose of identifying active pelvic bone marrow (BM), quantifying its locational variation, and determining which technique is likely to be better for BM-sparing radiation planning.

Material And Methods: We sampled 41 patients, of which 25 underwent FDG-PET/CT only, 7 underwent FLT-PET/CT only, and 9 underwent both. Active BM subvolumes were defined as subsets of the pelvic BM with the highest standardized uptake values comprising 40%, 50%, and 60% of the total pelvic BM volume.

A tri-modal molecular imaging agent for sentinel lymph node mapping.

Introduction: We report an "instant kit" method to radiolabel fluorescent-tilmanocept with (68)Ga and (99m)Tc for tri-modal molecular imaging of sentinel lymph nodes (SLNs).

Methods: Solutions of sodium acetate, (68)GaCl(3) and Na(99m)TcO(4) were added successively to a "kit vial" containing lyophilized 800CW-tilmanocept, SnCl(2), trehalose and ascorbic acid. After a 30-min incubation, the pH was neutralized with PBS.

Comparison of Post-injection Site Pain Between Technetium Sulfur Colloid and Technetium Tilmanocept in Breast Cancer Patients Undergoing Sentinel Lymph Node Biopsy.

Background: No prior studies have examined injection pain associated with Technetium-99m Tilmanocept (TcTM).

Methods: This was a randomized, double-blinded study comparing postinjection site pain between filtered Technetium Sulfur Colloid (fTcSC) and TcTM in breast cancer lymphoscintigraphy. Pain was evaluated with a visual analogue scale (VAS) (0-100 mm) and the short-form McGill Pain Questionnaire (SF-MPQ).

Glucose-corrected standardized uptake value in the differentiation of high-grade glioma versus post-treatment changes.

Background: Standardized uptake values (SUVs) of fluorine-18 fluorodeoxyglucose PET ((18)F-FDG PET) are used widely to differentiate residual or recurrent high-grade gliomas from post-treatment changes in patients with brain tumors. The aim of this study is to assess the accuracy of SUV corrected by blood glucose level (SUV(gluc)) compared with various quantitative methods in this role.

Materials And Methods: In 55 patients with dynamic F-FDG PET scans, there were 97 glioma lesions: glioblastoma (n=60), grade III gliomas (n=22), grade III or IV gliomas (n=6), grade I/II (n=7), and prebiopsy lesions (n=2).

Circulating tumor microemboli diagnostics for patients with non-small-cell lung cancer.

Introduction: Circulating tumor microemboli (CTM) are potentially important cancer biomarkers, but using them for cancer detection in early-stage disease has been assay limited. We examined CTM test performance using a sensitive detection platform to identify stage I non-small-cell lung cancer (NSCLC) patients undergoing imaging evaluation.

Methods: First, we prospectively enrolled patients during 18F-FDG PET-CT imaging evaluation for lung cancer that underwent routine phlebotomy where CTM and circulating tumor cells (CTCs) were identified in blood using nuclear (DAPI), cytokeratin (CK), and CD45 immune-fluorescent antibodies followed by morphologic identification.