Claudia Ortega

Background/Objectives: While MRI is effective for glioma diagnosis, it has limitations in grading, treatment planning, and prognostication. Since hypoxia is associated with higher-grade gliomas and poorer outcomes, PET imaging with hypoxia-specific tracers has been shown to improve glioma assessment. This systematic review and meta-analysis aimed to evaluate the performance of hypoxia PET imaging in glioma diagnosis and prognostication. Methods: Systematic searches were conducted across PubMed, Web of Science, and Scopus through 31 January 2025. Only studies assessing the diagnostic or prognostic value of PET with ¹⁸F-labelled nitroimidazole (¹⁸F-FMISO, ¹⁸F-FAZA, ¹⁸F-FRP170, or ¹⁸F-FETNIM) or ⁶²Cu-labelled ATSM hypoxia tracers in patients with gliomas were included. Hierarchical models were used to evaluate pooled performance on differentiating glioblastoma from lower-grade gliomas. Results: Thirty-eight articles (n = 1156 patients) were eligible for inclusion, and eleven articles (n = 296 patients) were suitable for meta-analytical calculations. The extent of hypoxia on PET imaging was generally correlated with isocitrate dehydrogenase (IDH) mutation status and histological angiogenesis. Hypoxia PET was effective at differentiating glioblastoma from lower-grade gliomas and at predicting overall and progression-free survival. In a pooled analysis, ¹⁸F-FMISO PET displayed high sensitivity (98%) and specificity (94%) for differentiating glioblastoma from lower-grade gliomas. Conclusions: Hypoxia PET has the potential to predict tumour biology, and it may be a reliable modality in combination with MRI to provide complementary information for glioma diagnosis, grading, treatment planning, and prognostication. It may be particularly useful for ruling out glioblastoma in patients with otherwise equivocal imaging; however, this would need to be validated prospectively with standardized image acquisition and interpretation criteria.

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Purpose: The purposes was to build model incorporating PET + computed tomography (CT) radiomics features from baseline PET/CT + clinical parameters to predict outcomes in patients with non-Hodgkin lymphomas. Methods: Cohort of 138 patients with complete clinical parameters and follow up times of 25.3 months recorded. Textural analysis of PET and manual correlating contouring in CT images analyzed using LIFE X software. Defined outcomes were overall survival (OS), disease free-survival, radiotherapy, and unfavorable response (defined as disease progression) assessed by end of therapy PET/CT or contrast CT. Univariable and multivariable analysis performed to assess association between PET, CT, and clinical. Results: Male (P = 0.030), abnormal lymphocytes (P = 0.030), lower value of PET entropy (P = 0.030), higher value of SHAPE sphericity (P = 0.002) were significantly associated with worse OS. Advanced stage (III or IV, P = 0.013), abnormal lymphocytes (P = 0.032), higher value of CT gray-level run length matrix (GLRLM) LRLGE mean (P = 0.010), higher value of PET gray-level co-occurrence matrix energy angular second moment (P < 0.001), and neighborhood gray-level different matrix (NGLDM) busyness mean (P < 0.001) were significant predictors of shorter DFS. Abnormal lymphocyte (P = 0.033), lower value of CT NGLDM coarseness (P = 0.082), and higher value of PET GLRLM gray-level nonuniformity zone mean (P = 0.040) were significant predictors of unfavorable response to chemotherapy. Area under the curve for the three models (clinical alone, clinical + PET parameters, and clinical + PET + CT parameters) were 0.626, 0.716, and 0.759, respectively.

Purpose: The aims of this study were to perform a comprehensive review and meta-analyses and to report pooled diagnostic results on CXCR4-targeted PET, particularly considering detection, visualization, and prognostication. Patients and Methods: This study followed PRISMA-DTA. A systematic search was conducted on major medical literature databases up to March 1, 2024. The search strategy was designed to include CXCR4 PET studies in hematologic malignancies. A random-effects model combined sensitivity values derived from 2-by-2 contingency tables. Pooled means for SUV_max were computed. Analyses were performed by R software. Results: The initial search resulted in a total of 1428 studies. Ultimately, 18 were eligible for systematic review and meta-analytic calculations. Twelve studies (320 patients) included B-cell lymphoma. The pooled detection rate of CXCR4 PET was 99.4% (95% confidence interval [CI]: 88.3%–100%). Marginal zone lymphoma was investigated in 5 studies (209 patients), with a pooled sensitivity of 97.6% (95% CI: 79.7%–99.8%). In studies on central nervous system lymphoma, CXCR4 PET demonstrated 100% accuracy at both patient and lesion levels. Also, it demonstrated a significantly higher tumor-to-background ratio than ¹⁸F-FDG PET. For multiple myeloma, 5 studies (116 patients) showed a patient-level pooled sensitivity of 77.8% (95% CI: 64.4%–87.2%), whereas ¹⁸F-FDG PET had 65.0% (95% CI: 55.2%–73.7%). The pooled SUV_max for CXCR4 PET was 13.6 (95% CI: 9.3–17.8) versus 9.0 (95% CI: 6.3–11.7) for ¹⁸F-FDG PET. Additionally, CXCR4 PET-derived parameters were significant predictors of survival in multiple myeloma. Conclusions: CXCR4 PET can be a helpful imaging tool for evaluating hematologic malignancies, particularly in B-cell lymphoma and multiple myeloma patients. In specific clinical scenarios, it appears to be superior compared with the current standard-of-care imaging.

Tumor hypoxia is a negative prognostic factor in many tumors and is predictive of metastatic spread and poor responsiveness to both chemotherapy and radiotherapy. Purpose: To assess the feasibility of using ¹⁸F-Fluoroazomycin arabinoside (FAZA) PET/MR to image tumor hypoxia in patients with locally advanced rectal cancer (LARC) prior to and following neoadjuvant chemoradiotherapy (nCRT). The secondary objective was to compare different reference tissues and thresholds for tumor hypoxia quantification. Patients and Methods: Eight patients with histologically proven LARC were included. All patients underwent ¹⁸F-FAZA PET/MR prior to initiation of nCRT, four of whom also had a second scan following completion of nCRT and prior to surgery. Tumors were segmented using T₂-weighted MR. Each voxel within the segmented tumor was defined as hypoxic or oxic using thresholds derived from various references: ×1.0 or ×1.2 SUVmean of blood pool [BP] or left ventricle [LV] and SUVmean +3SD for gluteus maximus. Correlation coefficient (CoC) between HF and tumor SUVmax/reference SUVmean TRR for the various thresholds was calculated. Hypoxic fraction (HF), defined as the % hypoxic voxels within the tumor volume was calculated for each reference/threshold. Results: For all cases, baseline and follow-up, the CoCs for gluteus maximus and for BP and LV (×1.0) were 0.241, 0.344, and 0.499, respectively, and HFs were (median; range) 16.6% (2.4–33.8), 36.8% (0.3–72.9), and 30.7% (0.8–55.5), respectively. For a threshold of ×1.2, the CoCs for BP and LV as references were 0.611 and 0.838, respectively, and HFs were (median; range) 10.4% (0–47.6), and 4.3% (0–20.1%), respectively. The change in HF following nCRT ranged from (−18.9%) to (+54%). Conclusions: Imaging of hypoxia in LARC with ¹⁸F-FAZA PET/MR is feasible. Blood pool as measured in the LV appears to be the most reliable reference for calculating the HF. There is a wide range of HF and variable change in HF before and after nCRT.

We aimed to determine if clinical parameters and radiomics combined with sarcopenia status derived from baseline ¹⁸F-FDG-PET/CT could predict developing metastatic disease and overall survival (OS) in gastroesophageal cancer (GEC). Patients referred for primary staging who underwent ¹⁸F-FDG-PET/CT from 2008 to 2019 were evaluated retrospectively. Overall, 243 GEC patients (mean age = 64) were enrolled. Clinical, histopathology, and sarcopenia data were obtained, and primary tumor radiomics features were extracted. For classification (early-stage vs. advanced disease), the association of the studied parameters was evaluated. Various clinical and radiomics models were developed and assessed. Accuracy and area under the curve (AUC) were calculated. For OS prediction, univariable and multivariable Cox analyses were performed. The best model included PET/CT radiomics features, clinical data, and sarcopenia score (accuracy = 80%; AUC = 88%). For OS prediction, various clinical, CT, and PET features entered the multivariable analysis. Three clinical factors (advanced disease, age ≥ 70 and ECOG ≥ 2), along with one CT-derived and one PET-derived radiomics feature, retained their significance. Overall, ¹⁸F-FDG PET/CT radiomics seems to have a potential added value in identifying GEC patients with advanced disease and may enhance the performance of baseline clinical parameters. These features may also have a prognostic value for OS, improving the decision-making for GEC patients.

This study aimed to compare the detection of neuroendocrine tumor liver metastases (NLMs) in hepatobiliary-specific contrast-enhanced MRI (pMR) versus ⁶⁸Ga-DOTATATE PET/CT (DT-PET). This retrospective study cohort included 30 patients with well-differentiated neuroendocrine tumors who underwent both DT-PET and pMR. Two readers independently assessed NLMs count, SUVmax on DT-PET, and signal characteristics on pMR. A consensus review by two additional readers resolved discrepancies between the modalities. Results showed concordance between DT-PET and pMR NLM count in 14/30 patients (47%). pMR identified more NLMs in 12/30 patients (40%), of which 4 patients showed multiple deposits on pMR but only 0–1 lesions on DT-PET. DT-PET detected more in 4/30 patients (13%). Overall, pMR detected more metastases than DT-PET (p = 0.01). Excluding the four outliers, there was excellent agreement between the two methods (ICC: 0.945, 95%CI: 0.930, 0.958). Notably, pMR had a higher NLM detection rate than DT-PET, with correlations found between lesion size on pMR and DT-PET detectability, as well as diffusion restriction on pMR and SUVmax on DT-PET. In conclusion, in consecutive patients with well-differentiated NETs, the detection rate of NLM is higher with pMR than with DT-PET. However, when excluding patients whose tumors do not overexpress somatostatin receptors (13% of the cohort), high concordance in the detection of NLM is observed between DT PET and pMR.

To assess the impact of the COVID-19 pandemic on the diagnosis, staging and outcome of a selected population throughout the first two years of the pandemic, we evaluated oncology patients undergoing PET/CT at our institution. A retrospective population of lung cancer, melanoma, lymphoma and head and neck cancer patients staged using PET/CT during the first 6 months of the years 2019, 2020 and 2021 were included for analysis. The year in which the PET was performed was our exposure variable, and our two main outcomes were stage at the time of the PET/CT and overall survival (OS). A total of 1572 PET/CTs were performed for staging purposes during the first 6 months of 2019, 2020 and 2021. The median age was 66 (IQR 16), and 915 (58%) were males. The most prevalent staged cancer was lung cancer (643, 41%). The univariate analysis of staging at PET/CT and OS by year of PET/CT were not significantly different. The multivariate Cox regression of non-COVID-19 significantly different variables at univariate analysis and the year of PET/CT determined that lung cancer (HR 1.76 CI95 1.23–2.53, p < 0.05), stage III (HR 3.63 CI95 2.21–5.98, p < 0.05), stage IV (HR 11.06 CI95 7.04–17.36, p < 0.05) and age at diagnosis (HR 1.04 CI95 1.02–1.05, p < 0.05) had increased risks of death. We did not find significantly higher stages or reduced OS when assessing the year PET/CT was performed. Furthermore, OS was not significantly modified by the year patients were staged, even when controlled for non-COVID-19 significant variables (age, type of cancer, stage and gender).

Lung cancer remains the leading cancer-related death across North America. Imaging is fundamental. Recently, healthcare disparities came into research focus. Our aim was to explore disparity from an imaging, genetic, and outcome perspective. We utilized the AACR Project GENIE Biopharma Consortium (BPC) dataset v 1.1 to build a collated NSCLC dataset. Descriptive and analytical statistics were applied according to data characteristics. From 1849 patients, mean age was 64.4 y (±10.5), 58% (n = 1065) were female, 23% (n = 419) never smoked, 84% (n = 1545) were of white race, and 57% (n = 1052) were < stage III. No difference (p > 0.05) was found for baseline imaging by race. White race showed higher 3-month surveillance imaging (p = 0.048) and a baseline stage < IV (OR 0.61). KRAS (33.3 vs. 17.9%), STK11 (14.8 vs. 7.3%), and KEAP1 (13.3 vs. 5.3%) mutations were predominant among white patients while EGFR mutation (19.2 vs. 44.1%) was less predominant. Mutations in TP53 or KEAP1 had worse PFS and OS. The latter was also reduced in STK11, KRAS + STK11, and KRAS + KEAP1 mutations. Meanwhile, EGFR mutation had increased OS. Multivariate analysis showed that progression on imaging at 3 or 6 months (HR 1.69 and 1.43, respectively), TP53 (HR 1.37) and KRAS (HR 1.26) had lower OS while EGFR and LRP1B (HR 0.69 and 0.39, respectively) had higher OS. No racial disparity at baseline imaging was observed. Higher initial stages among non-white patients might reflect inequalities in accessing healthcare. However, race wasn’t associated to OS. Finally, progression in imaging at 3 or 6 months showed the higher hazard ratios for death.

Purpose: The aim of the study is to evaluate the prognostic value of a joint evaluation of PET and CT radiomics combined with standard clinical parameters in patients with HL. Methods: Overall, 88 patients (42 female and 46 male) with a median age of 43.3 (range 21–85 years) were included. Textural analysis of the PET/CT images was performed using freely available software (LIFE X). 65 radiomic features (RF) were evaluated. Univariate and multivariate models were used to determine the value of clinical characteristics and FDG PET/CT radiomics in outcome prediction. In addition, a binary logistic regression model was used to determine potential predictors for radiotherapy treatment and odds ratios (OR), with 95% confidence intervals (CI) reported. Features relevant to survival outcomes were assessed using Cox proportional hazards to calculate hazard ratios with 95% CI. Results: albumin (p = 0.034) + ALP (p = 0.028) + CT radiomic feature GLRLM GLNU mean (p = 0.012) (Area under the curve (AUC): 95% CI (86.9; 100.0)—Brier score: 3.9, 95% CI (0.1; 7.8) remained significant independent predictors for PFS outcome. PET-SHAPE Sphericity (p = 0.033); CT grey-level zone length matrix with high gray-level zone emphasis (GLZLM SZHGE mean (p = 0.028)); PARAMS XSpatial Resampling (p = 0.0091) as well as hemoglobin results (p = 0.016) remained as independent factors in the final model for a binary outcome as predictors of the need for radiotherapy (AUC = 0.79). Conclusion: We evaluated the value of baseline clinical parameters as well as combined PET and CT radiomics in HL patients for survival and the prediction of the need for radiotherapy treatment. We found that different combinations of all three factors/features were independently predictive of the here evaluated endpoints.