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Review of the PET/CT imaging patterns of treatment response in lymphoma [Meeting Abstract]
Karambelkar, A; Ghesani, M; Friedman, K
Objectives Learning objectives: 1. To review morphologic and functional imaging changes on PET/CT following various lymphoma treatment regimens. 2. To evaluate various circumstances under which the morphologic and functional imaging changes are concordant or discordant. The World Health Organization International Classification of Disease (2008) identifies numerous types of lymphoma based on histopathologic, immunohistochemical, cytogenetic, and molecular analyses. Practically, only a few subtypes of lymphoma account for the majority of cases such as diffuse large B cell lymphoma. Many of the lymphomas are potentially curable when treated with chemotherapy alone or in combination with radiation therapy; remainder are only potentially curable with stem cell transplantation. Nowadays PET/CT imaging is crucial in staging and treatment response assessment for most of these lymphomas. On PET/CT there are multiple imaging patterns of the treatment response. Additionally, there have been continuing efforts to establish the response criteria on PET/CT to help aid optimal treatment decisions. This exhibit is designed to review and understand the various imaging patterns observed on the PET/CT on treatment of the lymphoma following simple and complex treatment regimens
EMBASE:72335092
ISSN: 0161-5505
CID: 2187992
Does Fluorodeoxyglucose Positron Emission Tomography With Computed Tomography Facilitate Treatment of Medication-Related Osteonecrosis of the Jaw?
Fleisher, Kenneth E; Pham, Sabrina; Raad, Roy A; Friedman, Kent P; Ghesani, Munir; Chan, King Chong; Amintavakoli, Niloufar; Janal, Malvin; Levine, Jamie P; Glickman, Robert S
PURPOSE: There is considerable controversy over the treatment of medication-related osteonecrosis of the jaw (MRONJ) and growing interest and debate related to the timing, type, technique, and goals of surgical intervention. The specific aim was to evaluate the predictive value of fluorodeoxyglucose (FDG) positron emission tomography (PET) with computed tomography (CT) on healing outcomes in patients undergoing surgery for MRONJ of the mandible. MATERIALS AND METHODS: A retrospective cohort study of 31 patients with 33 MRONJ lesions of the mandible who had undergone surgery using FDG PET-CT was conducted. Data were collected on FDG uptake patterns, healing, follow-up, demographics, lesion characteristics, antiresorptive therapy, and adjunctive therapy. Panoramic and periapical radiographs were used to identify non-restorable teeth and PET-CT images were used to identify sequestra and FDG uptake. Above the mandibular canal, surgery consisted of marginal resection or debridement of clinically involved bone and exposure of clinically uninvolved bone identified by FDG uptake. Below the mandibular canal, mobile segments of bony sequestra were removed, but areas of clinically uninvolved bone with FDG uptake were not. Patients who did not heal underwent segmental resection and reconstruction with rigid fixation and a local or regional soft tissue flap or free fibular flap. The primary predictor variable was the FDG uptake pattern for each patient. The outcome variable was postoperative healing defined by mucosal closure without signs of infection or exposed bone at the time of evaluation. RESULTS: Two risk groups were identified based on FDG uptake pattern. The low-risk group, type A, included 22 patients with activity limited to the alveolus, torus, and basal bone superior to the mandibular canal. The high-risk group, type B, included 11 patients with type A FDG activity with extension inferior to the mandibular canal. Treatment of type A MRONJ lesions was more successful than treatment of type B MRONJ lesions (100 vs 27%; P < .001). Seven of the type B failures were successfully retreated by segmental resection and reconstruction (1 patient refused further treatment). CONCLUSION: These results showed that low-risk FDG PET-CT findings predicted successful healing with surgery above the mandibular canal. In contrast, high-risk FDG findings were associated with a greater than 50% risk of failure for treatment that extended below the mandibular canal. Although these failures suggest that FDG uptake indicates infected tissue, further research is needed to identify which high-risk patients are most likely to benefit from a conservative treatment protocol.
PMID: 26657395
ISSN: 1531-5053
CID: 1877702
Phase II trial of exemestane with immunomodulatory oral cyclophosphamide in metastatic hormone receptor (HR)-positive breast cancer: Prolonged progression-free survival (PFS) in patients with distinct T regulatory cell (Treg) profile [Meeting Abstract]
Kwa, M; Novik, Y; Oratz, R; Jhaveri, K; Wu, J; Gu, P; Meyers, M; Muggia, F; Bonakdar, M; Abidoglu, C; Kozhaya, L; Li, X; Joseph, B; Iwano, A; Friedman, K; Goldberg, JD; Unutmaz, D; Adams, S
ISI:000375622400315
ISSN: 1538-7445
CID: 2411072
Outcome of small lung nodules missed on hybrid PET/MRI in patients with primary malignancy
Raad, Roy A; Friedman, Kent P; Heacock, Laura; Ponzo, Fabio; Melsaether, Amy; Chandarana, Hersh
PURPOSE: To assess outcomes of lung nodules missed on simultaneous positron emission tomography and magnetic resonance imaging (PET/MRI) compared to the reference standard PET and computed tomography (PET/CT) in patients with primary malignancy. MATERIALS AND METHODS: In all, 208 patients with primary malignancy undergoing clinically indicated (18 F) fluorodeoxyglucose (FDG) PET/CT followed by PET/MRI were independently reviewed by two readers. Upon review of the thoracic station on PET/MRI and PET/CT, 89 non-FDG avid small lung nodules in 43 patients were detected (by reader 1) only on the CT component of the PET/CT but were not identified on PET/MRI. Overall, 84 of these 89 nodules were examined on follow-up imaging with PET/CT or chest CT. The remaining five nodules had no follow-up imaging but had remote imaging available for comparison. RESULTS: Among the 84 nodules with follow-up, three nodules (3%) in one patient progressed, 10 (12%) nodules partially/completely resolved, whereas 71 nodules (85%) remained stable. The five nodules without follow-up were all stable since prior imaging of over 21 months. CONCLUSION: The vast majority (97%) of small non-FDG avid lung nodules missed on PET/MRI either resolved or remained stable on follow-up, suggestive of benignity. PET/MRI remains a viable alternative imaging modality in oncology patients, despite its low sensitivity in detecting small lung nodules. J. Magn. Reson. Imaging 2015.
PMID: 26192731
ISSN: 1522-2586
CID: 1683732
In Thyroidectomized Thyroid Cancer Patients, False-Positive I-131 Whole Body Scans Are Often Caused by Inflammation Rather Than Thyroid Cancer
Garger, Yana Basis; Winfeld, Mathew; Friedman, Kent; Blum, Manfred
Objective. To show that I-131 false-positive results on whole-body scans (WBSs) after thyroidectomy for thyroid cancer may be a result of inflammation unassociated with the cancer. Methods. We performed a retrospective image analysis of our database of thyroid cancer patients who underwent WBS from January 2008 to January 2012 to identify and stratify false positives. Results. A total of 564 patients underwent WBS during the study period; 96 patients were referred for 99 I-131 single-photon emission computed tomography (SPECT/CT) scans to better interpret cryptic findings. Among them, 73 scans were shown to be falsely positive; 40/73 or 54.7% of false-positive findings were a result of inflammation. Of the findings, 17 were in the head, 1 in the neck, 4 in the chest, 3 in the abdomen, and 14 in the pelvis; 1 had a knee abscess. Conclusions. In our series, inflammation caused the majority of false-positive WBSs. I-131 SPECT/CT is powerful in the differentiation of inflammation from thyroid cancer. By excluding metastatic disease, one can properly prognosticate outcome and avoid unnecessary, potentially harmful treatment of patients with thyroid cancer.
PMCID:4776247
PMID: 26977418
ISSN: 2324-7096
CID: 2031392
Current Status of Hybrid PET/MRI in Oncologic Imaging
Rosenkrantz, Andrew B; Friedman, Kent; Chandarana, Hersh; Melsaether, Amy; Moy, Linda; Ding, Yu-Shin; Jhaveri, Komal; Beltran, Luis; Jain, Rajan
OBJECTIVE: This review article explores recent advancements in PET/MRI for clinical oncologic imaging. CONCLUSION: Radiologists should understand the technical considerations that have made PET/MRI feasible within clinical workflows, the role of PET tracers for imaging various molecular targets in oncology, and advantages of hybrid PET/MRI compared with PET/CT. To facilitate this understanding, we discuss clinical examples (including gliomas, breast cancer, bone metastases, prostate cancer, bladder cancer, gynecologic malignancy, and lymphoma) as well as future directions, challenges, and areas for continued technical optimization for PET/MRI.
PMCID:4915069
PMID: 26491894
ISSN: 1546-3141
CID: 1810582
A phase I trial of ganetespib (heat shock protein 90 inhibitor) in combination with paclitaxel and trastuzumab in patients with human epidermal growth factor receptor-2 positive (HER2+) metastatic breast cancer (MBC) [Meeting Abstract]
Jhaveri, K; Teplinsky, E; Chandarlapaty, S; Solit, D; Cadoo, K; Speyer, J; D'Andrea, G; Adams, S; Patil, S; Haque, S; Friedman, K; Neville, D; Esteva, F; Hudis, C; Modi, S
ISI:000375622403294
ISSN: 1538-7445
CID: 2146992
Quantitative impact of Dixon mumap variability in dual-time-point brain PET/MR
Jackson, Kimberly; Bartlett, Rachel; Friedman, Kent; Shepherd, Timothy; Koesters, Thomas; Teruel, Jose; Fenchel, Mathias; Hermosillova-Valadez, Gerardo; Faul, David; Boada, Fernando
PMCID:4798694
PMID: 26956335
ISSN: 2197-7364
CID: 2023522
Tru-Cut Biopsy in Gynecologic Surgery
El Hachem, L; Mathews, S; Pereira, E; Momeni, M; Friedman, K; Chuang, L C; Gretz, H F 3rd
PMID: 27679040
ISSN: 1553-4669
CID: 2317052
Whole-body FDG PET-MR oncologic imaging: pitfalls in clinical interpretation related to inaccurate MR-based attenuation correction
Attenberger, Ulrike; Catana, Ciprian; Chandarana, Hersh; Catalano, Onofrio A; Friedman, Kent; Schonberg, Stefan A; Thrall, James; Salvatore, Marco; Rosen, Bruce R; Guimaraes, Alexander R
Simultaneous data collection for positron emission tomography and magnetic resonance imaging (PET/MR) is now a reality. While the full benefits of concurrently acquiring PET and MR data and the potential added clinical value are still being evaluated, initial studies have identified several important potential pitfalls in the interpretation of fluorodeoxyglucose (FDG) PET/MRI in oncologic whole-body imaging, the majority of which being related to the errors in the attenuation maps created from the MR data. The purpose of this article was to present such pitfalls and artifacts using case examples, describe their etiology, and discuss strategies to overcome them. Using a case-based approach, we will illustrate artifacts related to (1) Inaccurate bone tissue segmentation; (2) Inaccurate air cavities segmentation; (3) Motion-induced misregistration; (4) RF coils in the PET field of view; (5) B0 field inhomogeneity; (6) B1 field inhomogeneity; (7) Metallic implants; (8) MR contrast agents.
PMID: 26025348
ISSN: 1432-0509
CID: 1603872