Thomas S. C. Ng, Mofei Liu, Matthew Robertson, Arda Könik, Su Chun Cheng, Martin K. Bakht, Kristen Harrington, Andrew Wolanski, Lauren Gilbert, Mark Preston, Matthew Mossanen, Himisha Beltran, Michelle S. Hirsch, Guru Sonpavde, Heather A. Jacene
{"title":"[18F]氟氯荧光正电子发射断层扫描/计算机断层扫描对肌肉浸润性膀胱癌根治性膀胱切除术前分期的初步研究","authors":"Thomas S. C. Ng, Mofei Liu, Matthew Robertson, Arda Könik, Su Chun Cheng, Martin K. Bakht, Kristen Harrington, Andrew Wolanski, Lauren Gilbert, Mark Preston, Matthew Mossanen, Himisha Beltran, Michelle S. Hirsch, Guru Sonpavde, Heather A. Jacene","doi":"10.1007/s00259-025-07287-y","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Aim</h3><p>To assess the ability of [<sup>18</sup>F]F-fluciclovine-PET/CT to stage muscle invasive bladder cancer (MIBC) before radical cystectomy.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This single-site prospective pilot study enrolled patients with MIBC and T2-T4, N0 disease on CT/MRI slated to undergo radical cystectomy (RC). Dynamic and static [<sup>18</sup>F]F-fluciclovine-PET/CT images were acquired. Clinical readers assessed for confirmation of the primary bladder lesion on imaging and the presence of pelvic nodal metastases. Findings were compared to pathology at RC. Kinetic parameters from dynamic PET/CT were compared across bladder lesions of different clinical stages.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The study enrolled sixteen patients (median age: 73 years, range: 57–88 years, 11 males, 5 females), twelve receiving neoadjuvant chemotherapy before RC. There was high specificity amongst all three readers for detecting lymph node metastases (overall specificity: 0.91, 95%CI: 0.81–1.00) with good overall agreement rate with pathology (0.67, 95%CI: 0.44–0.83). The overall PPV for all readers for identifying node-positive disease was 0.4 (95%CI: 0–1.00), and the overall sensitivity was 0.13 (95%CI: 0–0.44). The overall PPV for detecting the primary tumor was 0.69 (95%CI: 0.47–0.88), and the sensitivity was 0.89 (95%CI: 0.78–1.00), with NPV and specificity being 0.70 (95%CI: 0.33, 1.00) and 0.39 (95%CI: 0.33, 0.50), respectively. Compartmental analysis of the primary bladder tumor revealed that k<sub>1</sub> and v<sub>b</sub> parameters significantly differentiated between low (pT0-pT1) and high (pT2-pT4) risk disease (<i>p</i> < 0.05). Immunohistochemical assessment showed no significant correlation of tumor [<sup>18</sup>F]F-fluciclovine uptake nor kinetic parameter with amino acid transporter expression.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>[<sup>18</sup>F]F-fluciclovine demonstrates good specificity and agreement rate for MIBC staging, with sensitivity like CT/MRI. Kinetic parameters such as k<sub>1</sub> was able to delineate higher-stage ( ≥ = pT2) primary lesions. Heterogeneous amino acid transporter expression can be seen across lesions. Further studies are warranted to understand [<sup>18</sup>F]F-fluciclovine PET/CT use in the context of other imaging modalities in this disease.</p><h3 data-test=\"abstract-sub-heading\">Clinical trial registration</h3><p>NCT04018053 Registered 2/26/2020.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"108 1","pages":""},"PeriodicalIF":8.6000,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A pilot study of [18F]F-fluciclovine positron emission tomography/computed tomography for staging muscle invasive bladder cancer preceding radical cystectomy\",\"authors\":\"Thomas S. C. Ng, Mofei Liu, Matthew Robertson, Arda Könik, Su Chun Cheng, Martin K. Bakht, Kristen Harrington, Andrew Wolanski, Lauren Gilbert, Mark Preston, Matthew Mossanen, Himisha Beltran, Michelle S. Hirsch, Guru Sonpavde, Heather A. Jacene\",\"doi\":\"10.1007/s00259-025-07287-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Aim</h3><p>To assess the ability of [<sup>18</sup>F]F-fluciclovine-PET/CT to stage muscle invasive bladder cancer (MIBC) before radical cystectomy.</p><h3 data-test=\\\"abstract-sub-heading\\\">Methods</h3><p>This single-site prospective pilot study enrolled patients with MIBC and T2-T4, N0 disease on CT/MRI slated to undergo radical cystectomy (RC). Dynamic and static [<sup>18</sup>F]F-fluciclovine-PET/CT images were acquired. Clinical readers assessed for confirmation of the primary bladder lesion on imaging and the presence of pelvic nodal metastases. Findings were compared to pathology at RC. Kinetic parameters from dynamic PET/CT were compared across bladder lesions of different clinical stages.</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>The study enrolled sixteen patients (median age: 73 years, range: 57–88 years, 11 males, 5 females), twelve receiving neoadjuvant chemotherapy before RC. There was high specificity amongst all three readers for detecting lymph node metastases (overall specificity: 0.91, 95%CI: 0.81–1.00) with good overall agreement rate with pathology (0.67, 95%CI: 0.44–0.83). The overall PPV for all readers for identifying node-positive disease was 0.4 (95%CI: 0–1.00), and the overall sensitivity was 0.13 (95%CI: 0–0.44). The overall PPV for detecting the primary tumor was 0.69 (95%CI: 0.47–0.88), and the sensitivity was 0.89 (95%CI: 0.78–1.00), with NPV and specificity being 0.70 (95%CI: 0.33, 1.00) and 0.39 (95%CI: 0.33, 0.50), respectively. Compartmental analysis of the primary bladder tumor revealed that k<sub>1</sub> and v<sub>b</sub> parameters significantly differentiated between low (pT0-pT1) and high (pT2-pT4) risk disease (<i>p</i> < 0.05). Immunohistochemical assessment showed no significant correlation of tumor [<sup>18</sup>F]F-fluciclovine uptake nor kinetic parameter with amino acid transporter expression.</p><h3 data-test=\\\"abstract-sub-heading\\\">Conclusions</h3><p>[<sup>18</sup>F]F-fluciclovine demonstrates good specificity and agreement rate for MIBC staging, with sensitivity like CT/MRI. Kinetic parameters such as k<sub>1</sub> was able to delineate higher-stage ( ≥ = pT2) primary lesions. Heterogeneous amino acid transporter expression can be seen across lesions. Further studies are warranted to understand [<sup>18</sup>F]F-fluciclovine PET/CT use in the context of other imaging modalities in this disease.</p><h3 data-test=\\\"abstract-sub-heading\\\">Clinical trial registration</h3><p>NCT04018053 Registered 2/26/2020.</p>\",\"PeriodicalId\":11909,\"journal\":{\"name\":\"European Journal of Nuclear Medicine and Molecular Imaging\",\"volume\":\"108 1\",\"pages\":\"\"},\"PeriodicalIF\":8.6000,\"publicationDate\":\"2025-04-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Nuclear Medicine and Molecular Imaging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00259-025-07287-y\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Nuclear Medicine and Molecular Imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00259-025-07287-y","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
A pilot study of [18F]F-fluciclovine positron emission tomography/computed tomography for staging muscle invasive bladder cancer preceding radical cystectomy
Aim
To assess the ability of [18F]F-fluciclovine-PET/CT to stage muscle invasive bladder cancer (MIBC) before radical cystectomy.
Methods
This single-site prospective pilot study enrolled patients with MIBC and T2-T4, N0 disease on CT/MRI slated to undergo radical cystectomy (RC). Dynamic and static [18F]F-fluciclovine-PET/CT images were acquired. Clinical readers assessed for confirmation of the primary bladder lesion on imaging and the presence of pelvic nodal metastases. Findings were compared to pathology at RC. Kinetic parameters from dynamic PET/CT were compared across bladder lesions of different clinical stages.
Results
The study enrolled sixteen patients (median age: 73 years, range: 57–88 years, 11 males, 5 females), twelve receiving neoadjuvant chemotherapy before RC. There was high specificity amongst all three readers for detecting lymph node metastases (overall specificity: 0.91, 95%CI: 0.81–1.00) with good overall agreement rate with pathology (0.67, 95%CI: 0.44–0.83). The overall PPV for all readers for identifying node-positive disease was 0.4 (95%CI: 0–1.00), and the overall sensitivity was 0.13 (95%CI: 0–0.44). The overall PPV for detecting the primary tumor was 0.69 (95%CI: 0.47–0.88), and the sensitivity was 0.89 (95%CI: 0.78–1.00), with NPV and specificity being 0.70 (95%CI: 0.33, 1.00) and 0.39 (95%CI: 0.33, 0.50), respectively. Compartmental analysis of the primary bladder tumor revealed that k1 and vb parameters significantly differentiated between low (pT0-pT1) and high (pT2-pT4) risk disease (p < 0.05). Immunohistochemical assessment showed no significant correlation of tumor [18F]F-fluciclovine uptake nor kinetic parameter with amino acid transporter expression.
Conclusions
[18F]F-fluciclovine demonstrates good specificity and agreement rate for MIBC staging, with sensitivity like CT/MRI. Kinetic parameters such as k1 was able to delineate higher-stage ( ≥ = pT2) primary lesions. Heterogeneous amino acid transporter expression can be seen across lesions. Further studies are warranted to understand [18F]F-fluciclovine PET/CT use in the context of other imaging modalities in this disease.
期刊介绍：
The European Journal of Nuclear Medicine and Molecular Imaging serves as a platform for the exchange of clinical and scientific information within nuclear medicine and related professions. It welcomes international submissions from professionals involved in the functional, metabolic, and molecular investigation of diseases. The journal's coverage spans physics, dosimetry, radiation biology, radiochemistry, and pharmacy, providing high-quality peer review by experts in the field. Known for highly cited and downloaded articles, it ensures global visibility for research work and is part of the EJNMMI journal family.
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