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Biomedicines
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State of the Art and Future Perspectives in Oncologic Imaging
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State of the Art and Future Perspectives in Oncologic Imaging

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Cancer Biology and Oncology".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 7406

Special Issue Editors

Dr. Adrien Holzgreve

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Guest Editor
Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
Interests: oncology; neuro-oncology; hybrid imaging; theranostics; translational research
Dr. Lena M. Unterrainer

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Guest Editor
Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
Interests: oncology; uro-oncology; hybrid imaging; theranostics; innovative tracers
Prof. Dr. Wolfgang Kunz

E-Mail Website
Guest Editor
Department of Radiology, University Hospital, LMU Munich, Munich, Germany
Interests: oncology; stroke; hybrid imaging; AI; health economics

Special Issue Information

Dear Colleagues,

Imaging has a fundamental role in oncology. Staging studies are indispensable for selecting a therapy or making a prognosis. Hardly any tumor surgery or radiotherapy is performed without prior image-guided planning. Likewise, we depend heavily on imaging to assess response to therapy. However, in contrast to its long-standing tradition in oncology, imaging is also one of the most exciting and dynamic fields: due to the constant relevance of imaging in the course of the disease, imaging is an omnipresent companion that mirrors the rapid and groundbreaking developments in the field of oncology. On the other hand, developments in the field of oncologic imaging are a genuine contributor to advances in the treatment of cancer patients. Thus, response criteria are based on imaging and are constantly refined, new theranostic targets can be addressed with the advances in imaging (e.g., using hybrid imaging techniques such as PET/CT or PET/MRI), and artificial intelligence imaging methods broaden the horizon even more.

The scope of this Special Issue is to reflect the double role of oncologic imaging as an established indispensable tool in clinical routine on the one hand, and as a thriving innovator pushing boundaries on the other. Therefore, we encourage the submission of articles both on state-of-the-art and future perspectives of oncologic imaging, including but not restricted to clinical and preclinical imaging studies and comprehensive reviews.

Kind regards,

Dr. Adrien Holzgreve
Dr. Lena M. Unterrainer
Prof. Dr. Wolfgang Kunz
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Biomedicines is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • imaging response criteria
  • hybrid imaging
  • PET/CT
  • PET/MRT
  • immunotherapy
  • artificial intelligence
  • machine learning
  • radiomics
  • decision making
  • theranostics

Published Papers (6 papers)

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Research

17 pages, 7770 KiB  
Article
The Traumatic Inoculation Process Affects TSPO Radioligand Uptake in Experimental Orthotopic Glioblastoma
by Lukas Gold, Enio Barci, Matthias Brendel, Michael Orth, Jiying Cheng, Sabrina V. Kirchleitner, Laura M. Bartos, Dennis Pötter, Maximilian A. Kirchner, Lena M. Unterrainer, Lena Kaiser, Sibylle Ziegler, Lorraine Weidner, Markus J. Riemenschneider, Marcus Unterrainer, Claus Belka, Joerg-Christian Tonn, Peter Bartenstein, Maximilian Niyazi, Louisa von Baumgarten, Roland E. Kälin, Rainer Glass, Kirsten Lauber, Nathalie L. Albert and Adrien Holzgreveadd Show full author list remove Hide full author list
Biomedicines 2024, 12(1), 188; https://doi.org/10.3390/biomedicines12010188 - 15 Jan 2024
Viewed by 1115
Abstract
Background: The translocator protein (TSPO) has been proven to have great potential as a target for the positron emission tomography (PET) imaging of glioblastoma. However, there is an ongoing debate about the potential various sources of the TSPO PET signal. This work investigates [...] Read more.
Background: The translocator protein (TSPO) has been proven to have great potential as a target for the positron emission tomography (PET) imaging of glioblastoma. However, there is an ongoing debate about the potential various sources of the TSPO PET signal. This work investigates the impact of the inoculation-driven immune response on the PET signal in experimental orthotopic glioblastoma. Methods: Serial [18F]GE-180 and O-(2-[18F]fluoroethyl)-L-tyrosine ([18F]FET) PET scans were performed at day 7/8 and day 14/15 after the inoculation of GL261 mouse glioblastoma cells (n = 24) or saline (sham, n = 6) into the right striatum of immunocompetent C57BL/6 mice. An additional n = 25 sham mice underwent [18F]GE-180 PET and/or autoradiography (ARG) at days 7, 14, 21, 28, 35, 50 and 90 in order to monitor potential reactive processes that were solely related to the inoculation procedure. In vivo imaging results were directly compared to tissue-based analyses including ARG and immunohistochemistry. Results: We found that the inoculation process represents an immunogenic event, which significantly contributes to TSPO radioligand uptake. [18F]GE-180 uptake in GL261-bearing mice surpassed [18F]FET uptake both in the extent and the intensity, e.g., mean target-to-background ratio (TBRmean) in PET at day 7/8: 1.22 for [18F]GE-180 vs. 1.04 for [18F]FET, p < 0.001. Sham mice showed increased [18F]GE-180 uptake at the inoculation channel, which, however, continuously decreased over time (e.g., TBRmean in PET: 1.20 at day 7 vs. 1.09 at day 35, p = 0.04). At the inoculation channel, the percentage of TSPO/IBA1 co-staining decreased, whereas TSPO/GFAP (glial fibrillary acidic protein) co-staining increased over time (p < 0.001). Conclusion: We identify the inoculation-driven immune response to be a relevant contributor to the PET signal and add a new aspect to consider for planning PET imaging studies in orthotopic glioblastoma models. Full article
(This article belongs to the Special Issue State of the Art and Future Perspectives in Oncologic Imaging)
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13 pages, 9993 KiB  
Article
PSMA-Expression Is Highly Associated with Histological Subtypes of Renal Cell Carcinoma: Potential Implications for Theranostic Approaches
by Vinh Ngoc Bui, Lena M. Unterrainer, Matthias Brendel, Sophie C. Kunte, Adrien Holzgreve, Fabian Allmendinger, Peter Bartenstein, Frederick Klauschen, Marcus Unterrainer, Michael Staehler and Stephan Ledderose
Biomedicines 2023, 11(11), 3095; https://doi.org/10.3390/biomedicines11113095 - 20 Nov 2023
Viewed by 972
Abstract
In renal cell carcinoma (RCC), accurate imaging methods are required for treatment planning and response assessment to therapy. In addition, there is an urgent need for new therapeutic options, especially in metastatic RCC. One way to combine diagnostics and therapy in a so-called [...] Read more.
In renal cell carcinoma (RCC), accurate imaging methods are required for treatment planning and response assessment to therapy. In addition, there is an urgent need for new therapeutic options, especially in metastatic RCC. One way to combine diagnostics and therapy in a so-called theranostic approach is the use of radioligands directed against surface antigens. For instance, radioligands against prostate-specific membrane antigen (PSMA) have already been successfully used for diagnosis and radionuclide therapy of metastatic prostate cancer. Recent studies have demonstrated that PSMA is expressed not only in prostate cancer but also in the neovasculature of several solid tumors, which has raised hopes to use PSMA-guided theranostic approaches in other tumor entities, too. However, data on PSMA expression in different histopathological subtypes of RCC are sparse. Because a better understanding of PSMA expression in RCC is critical to assess which patients would benefit most from theranostic approaches using PSMA-targeted ligands, we investigated the expression pattern of PSMA in different subtypes of RCC on protein level. Immunohistochemical staining for PSMA was performed on formalin-fixed, paraffin-embedded archival material of major different histological subtypes of RCC (clear cell RCC (ccRCC)), papillary RCC (pRCC) and chromophobe RCC (cpRCC). The extent and intensity of PSMA staining were scored semi-quantitatively and correlated with the histological RCC subtypes. Group comparisons were calculated with the Kruskal–Wallis test. In all cases, immunoreactivity was detected only in the tumor-associated vessels and not in tumor cells. Staining intensity was the strongest in ccRCC, followed by cpRCC and pRCC. ccRCC showed the most diffuse staining pattern, followed by cpRCC and pRCC. Our results provide a rationale for PSMA-targeted theranostic approaches in ccRCC and cpRCC. Full article
(This article belongs to the Special Issue State of the Art and Future Perspectives in Oncologic Imaging)
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15 pages, 3167 KiB  
Article
Diagnostic Impact of Dual-Time PET/CT with 68Gallium-PSMA in Prostate Cancer and 68Gallium-DOTATOC in Neuroendocrine Tumors
by Damiano Librizzi, Friederike Eilsberger, Stefan Ottenthaler, Ali Ebrahimifard, Markus Luster and Behrooz H. Yousefi
Biomedicines 2023, 11(4), 1052; https://doi.org/10.3390/biomedicines11041052 - 29 Mar 2023
Viewed by 1198
Abstract
Background: The timing of imaging for 68gallium (68Ga)-PSMA and 68Ga-DOTATOC are stated to be around 60 min post-injection (p.i.). In some lesions, late imaging (3–4 h p.i.) showed advantages. The aim of our evaluation was to demonstrate the relevance [...] Read more.
Background: The timing of imaging for 68gallium (68Ga)-PSMA and 68Ga-DOTATOC are stated to be around 60 min post-injection (p.i.). In some lesions, late imaging (3–4 h p.i.) showed advantages. The aim of our evaluation was to demonstrate the relevance of an “early” late acquisition. Methods: We retrospectively evaluated 112 patients who underwent 68Ga-DOTATOC-PET/CT and 82 patients who underwent 68Ga-PSMA-PET/CT. The first scan was acquired 60 min (±15 min) after application. In cases of diagnostic ambiguity, a second scan was performed 30–60 min later. Pathological lesions were analyzed. Results: Almost half of all 68Ga-DOTATOC cases and about one-third of all 68Ga-PSMA examinations showed a change in findings due to the second acquisition. In total, 45.5% of neuroendocrine tumor (NET) patients and 66.7% of prostate cancer (PCa) patients showed relevant TNM classification changes. For 68Ga-PSMA, there were significant increases in sensitivity and specificity from 81.8% to 95.7% and from 66.7% to 100%, respectively. Statistically significant improvements in sensitivity (from 53.3% to 93.3%) and specificity (from 54.6% to 86.4%) were demonstrated for NET patients. Conclusion: Early second images can improve diagnostics with 68Ga-DOTATOC and 68Ga-PSMA PET/CT. Full article
(This article belongs to the Special Issue State of the Art and Future Perspectives in Oncologic Imaging)
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10 pages, 248 KiB  
Article
Application of the American Thyroid Association Risk Assessment in Patients with Differentiated Thyroid Carcinoma in a German Population
by Friederike Eilsberger, Michael C. Kreissl, Christoph Reiners, Adrien Holzgreve, Markus Luster and Andreas Pfestroff
Biomedicines 2023, 11(3), 911; https://doi.org/10.3390/biomedicines11030911 - 15 Mar 2023
Cited by 1 | Viewed by 1172
Abstract
Background: The American Thyroid Association (ATA) uses criteria to assess the risk for persistent disease in differentiated thyroid carcinoma (DTC) after radioiodine therapy (RAI). There are no data available showing that this classification can be adopted unadjusted by Germany. Aim: The aim of [...] Read more.
Background: The American Thyroid Association (ATA) uses criteria to assess the risk for persistent disease in differentiated thyroid carcinoma (DTC) after radioiodine therapy (RAI). There are no data available showing that this classification can be adopted unadjusted by Germany. Aim: The aim of our study is to investigate whether the ATA classification can be applied to a German population for short-term prognosis. Furthermore, we investigated the influence of an age cutoff value. Methods: We retrospectively analyzed 121 patients who were referred to our tertiary referral center. Patients were classified into risk categories, and the therapy response was determined according to ATA. Results: A total of 73/83 (88%) ATA low-risk patients and 12/19 (63%) intermediate-risk patients showed an excellent response; 2/19 (11%) high-risk patients had a biochemical, and 6 (31%) had a structural incomplete response. Of all 39 patients ≥55 years, 84% had an excellent response. Using a cut off of 50 years, 50/62 (81%) of the older patients showed an excellent response. Conclusion: The ATA risk classification is able to estimate the response to RAI therapy in a German population. A shift from 55 to 50 years as an age cutoff value does not result in any relevant change in the treatment response. Full article
(This article belongs to the Special Issue State of the Art and Future Perspectives in Oncologic Imaging)
13 pages, 2676 KiB  
Article
Treatment Assessment of pNET and NELM after Everolimus by Quantitative MRI Parameters
by Maria Ingenerf, Sophia Kiesl, Michael Winkelmann, Christoph J. Auernhammer, Johannes Rübenthaler, Freba Grawe, Matthias P. Fabritius, Jens Ricke and Christine Schmid-Tannwald
Biomedicines 2022, 10(10), 2618; https://doi.org/10.3390/biomedicines10102618 - 18 Oct 2022
Cited by 1 | Viewed by 1186
Abstract
Assessment of treatment response to targeted therapies such as everolimus is difficult, especially in slow-growing tumors such as NETs. In this retrospective study, 17 patients with pancreatic neuroendocrine tumors (pNETs) and hepatic metastases (NELMs) (42 target lesions) who received everolimus were analyzed. Intralesional [...] Read more.
Assessment of treatment response to targeted therapies such as everolimus is difficult, especially in slow-growing tumors such as NETs. In this retrospective study, 17 patients with pancreatic neuroendocrine tumors (pNETs) and hepatic metastases (NELMs) (42 target lesions) who received everolimus were analyzed. Intralesional signal intensities (SI) of non-contrast T1w, T2w and DCE imaging, and apparent diffusion coefficients (ADCmean and ADCmin) of DWI, were measured on baseline and first follow-up MRI after everolimus initiation. Response assessment was categorized according to progression-free survival (PFS), with responders (R) showing a PFS of ≥11 months. ADCmin of NELMs decreased in Rs whereas it increased in non-responders (NR). Percentual changes of ADCmin and ADCmean differed significantly between response groups (p < 0.03). By contrast, ADC of the pNETs tended to increase in Rs, while there was no change in NRs. Tumor-to-liver (T/L) ratio of T1 SI of NELMs increased in Rs and decreased in NRs, and percentual changes differed significantly between response groups (p < 0.02). T1 SI of the pNETs tended to decrease in Rs and increase in Ns. The quotient of pretherapeutic and posttherapeutic ADCmin values (DADCmin) and length of everolimus treatment showed significant association with PFS in univariable Cox analysis. In conclusion, quantitative MRI, especially DWI, seems to allow treatment assessment of pNETs with NELMs under everolimus. Interestingly, the responding NELMs showed decreasing ADC values, and there might be an opposite effect on ADC and T1 SI between NELMs and pNETs. Full article
(This article belongs to the Special Issue State of the Art and Future Perspectives in Oncologic Imaging)
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11 pages, 479 KiB  
Article
Real-Life Performance of F-18-FDG PET/CT in Patients with Cervical Lymph Node Metastasis of Unknown Primary Tumor
by Friederike Eilsberger, Friederike Elisabeth Noltenius, Damiano Librizzi, Joel Wessendorf, Markus Luster, Stephan Hoch and Andreas Pfestroff
Biomedicines 2022, 10(9), 2095; https://doi.org/10.3390/biomedicines10092095 - 27 Aug 2022
Cited by 3 | Viewed by 1090
Abstract
Background: Neoplasms in the head and neck region possess higher glycolytic activity than normal tissue, showing increased glucose metabolism. F-18-Flourodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) can identify an unknown primary tumor (CUP). Aim: The aim of this study was to assess the [...] Read more.
Background: Neoplasms in the head and neck region possess higher glycolytic activity than normal tissue, showing increased glucose metabolism. F-18-Flourodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) can identify an unknown primary tumor (CUP). Aim: The aim of this study was to assess the real-life performance of F-18-FDG-PET/CT in detecting primary sites in patients with cervical lymph node metastasis of CUP. Methods: A retrospective data analysis of 31 patients who received FDG-PET/CT between June 2009 and March 2015 in a CUP context with histologically confirmed cervical lymph node metastasis was included. Results: In 48% of the patients (15/31), PET/CT showed suspicious tracer accumulation. In 52% of the patients (16/31), there was no suspicious radiotracer uptake, which was confirmed by the lack of identification of any primary tumor in 10 cases until the end of follow-up. FDG-PET/CT had a sensitivity of 67%, specificity of 91%, PPV of 92%, and NPV of 63% in detecting the primary tumor. Additionally, PET/CT showed suspicious tracer accumulation according to further metastasis in 32% of the patients (10/31). Conclusion: FDG-PET/CT imaging is a useful technique for primary tumor detection in patients in a cervical CUP context. Furthermore, it provides information on the ulterior metastasis of the disease. Full article
(This article belongs to the Special Issue State of the Art and Future Perspectives in Oncologic Imaging)
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