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11C-Acetate-PET/CT in Primary Staging of High-Risk Prostate Cancer
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Prostate cancer (PC) is the second most common cancer in men worldwide, affecting ~12%. Although most are clinically insignificant low-risk cancers, the more aggressive high-risk cancers require correct staging, prior to curative radiotherapy or surgery. Standard staging procedures and tools include clinical examination, estimated nomogram risk of pelvic lymph node (LN) metastases, and bone scintigraphy (BS). Additional staging information can be obtained with magnetic resonance imaging (MRI), computed tomography (CT) and positron-emission tomography/computed tomography (PET/CT). PET/CT can provide information on both functional and morphological changes.

The aims of the present thesis were to investigate the diagnostic and prognostic value of 11C-acetate (ACE)-PET/CT in high-risk PC, and to optimize the ACE-PET protocol. In study I and II, higher detection rates of LN metastases and bone metastases were found with ACE-PET/CT, than with standard methods nomogram risk and BS. The higher ACE uptake in the prostate (prostate lipogenic tumor burden), the higher the risk of suspected LN metastases (N+ disease) on PET/CT. ACE-PET/CT findings correlated better than BS with follow-up data, and influenced therapy in 11-43%. In study III, PET reconstruction algorithm with resolution recovery showed more accurate functional tumor volumes compared to CT, and higher measurements of lipogenic activity, than reconstruction algorithm without resolution recovery. Study IV was part of an interventional radiotherapy study (PARAPLY) on high-risk PC, with addition of image-guided simultaneous integrated boost to delineated prostate tumors and pelvic LN metastases reported in ACE-PET/CT and MRI. Comparative analyses of clinical risk parameters and baseline ACE-PET/CT parameters showed significant associations between nomogram risk and prostate lipogenic tumor burden, between N+ disease on PET/CT and prostate lipogenic tumor burden, but surprisingly not between nomogram risk and N+ disease on PET/CT. PET with resolution recovery was superior in detection of N+ disease.

In conclusion, ACE-PET/CT showed a higher detection rate of suspected metastases compared to standard methods clinical nomogram and BS, in high-risk PC. PET reconstruction with resolution recovery seems to improve the diagnostic added value of ACE-PET/CT. Prostate lipogenic tumor burden could serve as a predictor of N+ disease. The prognostic value of ACE-PET/CT remains to be investigated in future studies.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2020. , p. 84
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2072
National Category
Radiology, Nuclear Medicine and Medical Imaging
Research subject
Radiology; Oncology
Identifiers
URN: urn:nbn:se:umu:diva-168499ISBN: 978-91-7855-207-8 (electronic)ISBN: 978-91-7855-206-1 (print)OAI: oai:DiVA.org:umu-168499DiVA, id: diva2:1404199
Public defence
2020-03-27, Sal 260, byggnad 3A, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2020-03-06 Created: 2020-02-28 Last updated: 2020-03-03Bibliographically approved
List of papers
1. 11C-acetate PET/CT in pre-therapeutic lymph node staging in high-risk prostate cancer patients and its influence on disease management: a retrospective study
Open this publication in new window or tab >>11C-acetate PET/CT in pre-therapeutic lymph node staging in high-risk prostate cancer patients and its influence on disease management: a retrospective study
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2014 (English)In: EJNMMI Research, ISSN 2191-219X, E-ISSN 2191-219X, Vol. 4, no 55, p. 1-9Article in journal (Refereed) Published
Abstract [en]

Background: Radiation treatment with simultaneous integrated boost against suspected lymph node metastases may be a curative therapeutic option in patients with high-risk prostate cancer (>15% estimated risk of pelvic lymph node metastases according to the Cagiannos nomogram). 11C-acetate positron emission tomography/computed tomography (PET/CT) can be used for primary staging as well as for detection of suspected relapse of prostate cancer. The aims of this study were to evaluate the association between positive 11C-acetate PET/CT findings and the estimated risk of pelvic lymph node metastases and to assess the impact of 11C-acetate PET/CT on patient management in high-risk prostate cancer patients.

Methods: Fifty consecutive prostate cancer patients referred for primary staging with 11C-acetate PET/CT prior to radiotherapy with curative intention were enrolled in this retrospective study.

Results: All patients showed increased 11C-acetate uptake in the prostate. Pelvic lymph node uptake was seen in 42% (21/50) of the patients, with positive external iliac lymph nodes in 71% (15/21) of these. The overall observed proportion of PET/CT-positive pelvic lymph nodes at patient level was higher than the average estimated risk, especially in low-risk groups (<15%). There was a significant association between observed proportion and estimated risk of pelvic lymph node metastases in groups with ≤45 and >45% estimated risk. Treatment strategy was altered due to 11C-acetate PET/CT findings in 43% (20/47) of the patients.

Conclusions: The observed proportion of 11C-acetate PET/CT findings suggestive of locoregional metastases was higher than the estimated risk, suggesting that the Cagiannos nomogram underestimates the risk for metastases. The imaging results with 11C-acetate PET/CT have a considerable impact on patient management.

Place, publisher, year, edition, pages
Springer, 2014
Keywords
Prostatic neoplasms, PET/CT, C-11-acetate, Neoplasm staging, Lymphatic metastasis
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-106804 (URN)10.1186/s13550-014-0055-1 (DOI)000358122600001 ()26116118 (PubMedID)
Funder
Västerbotten County Council
Available from: 2015-08-18 Created: 2015-08-07 Last updated: 2020-02-28Bibliographically approved
2. C-11-Acetate-PET/CT Compared to Tc-99m-HDP Bone Scintigraphy in Primary Staging of High-risk Prostate Cancer
Open this publication in new window or tab >>C-11-Acetate-PET/CT Compared to Tc-99m-HDP Bone Scintigraphy in Primary Staging of High-risk Prostate Cancer
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2016 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 36, no 12, p. 6475-6479Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to evaluate the detection rate of bone metastases and the added value of C-11-acetate (ACE) positron-emission tomography/computed tomography (PET/CT) compared to bone scintigraphy (BS) in high-risk prostate cancer (PC).

Materials and Methods: A total of 66 untreated patients with high-risk PC with ACE-PET/CT and planar BS findings within 3 months of each other were retrospectively enrolled. Findings were compared and verified with follow-up data after an average of 26 months.

Results: The rate of detection of bone metastases was superior with ACE-PET/CT compared to BS (p<0.01). Agreement between the methods and between BS and follow-up was moderate (Cohen's kappa coefficient of 0.64 and 0.66, respectively). Agreement between ACE-PET/CT and follow-up was excellent (kappa coefficient of 0.95). Therapy was changed in 11% of patients due to ACE-PET/CT results.

Conclusion: ACE-PET/CT performed better than planar BS in detection of bone metastases in high-risk PC. ACE-PET/CT findings influenced clinical management.

Place, publisher, year, edition, pages
International Institute of Anticancer Research, 2016
Keywords
Prostate cancer, PET/CT, [C-11]-acetate, bone scintigraphy, bone metastasis
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-130998 (URN)10.21873/anticanres.11246 (DOI)000390946700032 ()27919970 (PubMedID)
Available from: 2017-02-16 Created: 2017-02-16 Last updated: 2020-03-02Bibliographically approved
3. Optimization of PET reconstruction algorithm, SUV thresholding algorithm and PET acquisition time in clinical 11C-acetate PET/CT
Open this publication in new window or tab >>Optimization of PET reconstruction algorithm, SUV thresholding algorithm and PET acquisition time in clinical 11C-acetate PET/CT
2018 (English)In: PLoS ONE, E-ISSN 1932-6203, Vol. 13, no 12, article id e0209169Article in journal (Refereed) Published
Abstract [en]

Introduction 11C-acetate (ACE)-PET/CT is used for staging of high-risk prostate cancer. PET data is reconstructed with iterative algorithms, such as VUEPointHD ViP (VPHD) and VUEPoint HD Sharp IR (SharpIR), the latter with additional resolution recovery. It is expected that the resolution recovery algorithm should render more accurate maximum and mean standardized uptake values (SUVmax and SUVmean) and functional tumor volumes (FTV) than the ordinary OSEM. Performing quantitative analysis, choice of volume-of-interest delineation algorithm (SUV threshold) may influence FTV. Optimizing PET acquisition time is justified if image quality and quantitation do not deteriorate. The aim of this study is to identify the optimal reconstruction algorithm, SUV threshold and acquisition time for ACE-PET/CT. Methods ACE-PET/CT data acquired with a General Electric Discovery 690 PET/CT from 16 consecutive high-risk prostate cancer patients was reconstructed with VPHD and SharpIR. Forty pelvic lymph nodes (LNs) and 14 prostate glands were delineated with 42% and estimated threshold. SUVmax, SUVmean, FTV and total lesion uptake were measured. Default acquisition time was four minutes per bed position. In a subset of lesions, acquisition times of one, two and four minutes were evaluated. Structural tumor volumes (STV) of the LNs were measured with CT for correlation with functional volumetric parameters. To validate SUV quantification under different conditions with SharpIR 42%, recovery coefficients (RCs) of SUVmean and FTV were calculated from a phantom with 18F-fluoro-deoxy-glucose (FDG)-filled volumes 0.1–9.2cm3 and signal-to-background (S/B) ratios 4.3–15.9. Results With SharpIR, SUVmax and SUVmean were higher and FTV lower compared with VPHD, regardless of threshold method, in both prostates and LNs. Total lesion uptake determined with both threshold methods was lower with SharpIR compared with VPHD with both threshold methods, except in subgroup analysis of prostate targets where estimated threshold returned higher values. Longer acquisition times returned higher FTV for both threshold methods, regardless of reconstruction algorithm. The FTV difference was most pronounced with one minute’s acquisition per bed position, which also produced visually the highest noise. SUV parameters were unaffected by varying acquisition times. FTV with SharpIR 42% showed the best correspondence with STV. SharpIR 42% gave higher RCs of SUVmean and FTV with increasing phantom size and S/B-ratio, as expected. Conclusions Delineation with SharpIR 42% seems to provide the most accurate combined information from SUVmax, SUVmean, FTV and total lesion uptake. Acquisition time may be shortened to two minutes per bed position with preserved image quality.

Place, publisher, year, edition, pages
Public Library Science (PLOS), 2018
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-154811 (URN)10.1371/journal.pone.0209169 (DOI)000453247500076 ()30543705 (PubMedID)
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2020-02-28Bibliographically approved
4. Baseline 11C-acetate-PET/CT-derived parameters compared with clinical pre-treatment risk parameters in primary staging of high-risk prostate cancer – possible prognostic implications
Open this publication in new window or tab >>Baseline 11C-acetate-PET/CT-derived parameters compared with clinical pre-treatment risk parameters in primary staging of high-risk prostate cancer – possible prognostic implications
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-168474 (URN)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2020-02-28

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