In last years, newer and more advanced imaging modalities have been developed in the effort to improve the management of neoplastic patients in a non-invasive manner. Combined multimodal imaging, in fact, can be of aid in obtaining a more accurate assessment of cancer patients in order to improve staging, prognostic stratification and therapeutic procedures. One of these methods, 18F-FDG-PET/CT is a whole-body imaging technique, capable to provide both morphological and functional information on the status of cancer patients and is used in the staging and follow-up of a number of neoplastic diseases. Our research is focused, therefore, on multimodal imaging of cancer patients in order to compare 18F-FDG-PET/CT to other morphologic or functional imaging modalities in the evaluation and prognosis of solid tumors and lymphoproliferative diseases.
In one of these studies we compared 18F-FDG-PET/CT, 99mTc-MIBI and MRI in the evaluation of patients with multiple myeloma at diagnosis showing that in the whole-body analysis, 18F-FDG-PET/CT and 99mTc-MIBI provide complementary information on the status of these patients by detecting focal and diffuse disease, respectively, while, in the spinal and pelvic regions, MRI is comparable to 18F-FDG-PET/CT and 99mTc-MIBI in the detection of focal and diffuse patterns, respectively. Therefore, MRI should be reserved to the evaluation of bone marrow involvement of the spine and pelvis, whereas 18F-FDG-PET/CT can significantly contribute to an accurate whole-body evaluation of myeloma patients. We also compared the relative contribution on 18F-FDG-PET/CT, 99mTc-MIBI and MRI in the prediction of prognosis in the same series of myeloma patients showing that the number of focal lesions detected by 18F-FDG PET/CT or 99mTc-MIBI scan is an independent predictor of both progression free and overall survival therefore providing complementary information on the prognosis of these patients.
In further studies on combined imaging in neuroendocrine tumors, we showed that 18F-FDG-PET/CT scan allows to differentiate high-risk epithelial tumors and thymic carcinomas from low-risk thymomas, whereas 111In-octreotide SPECT may identify neuroendocrine tumors among those showing high 18F-FDG uptake. While in a study on patients with medullary thyroid carcinoma we showed that 18F-FDG-PET/CT provides a useful contribution mainly in evaluating lymph node involvement whereas 111In-octreotide SPECT can contribute to the detection and receptor characterization of bone lesions.We also used imaging methodologies such as 18F-FDG-PET/CT to develop imaging biomarkers of tumor response and prognosis. One of these biomarkers is the metabolic tumor volume (MTV) representing the active tumor burden through the entire body, obtained by computer analysis of PET/CT images on the basis of both functional and morphological information. We showed that MTV is and independent prognostic factor and could be useful in the prediction of progression-free and overall survival in patients with multiple myeloma and in selecting patients who may need more aggressive treatments.
Fonti R, Pace L, Cerchione C, Catalano L, Salvatore B, De Luca S, Pane F, Salvatore M, Del Vecchio S. 18F-FDG PET/CT, 99mTc-MIBI, and MRI in the prediction of outcome of patients with multiple myeloma: a comparative study. Clin Nucl Med. 2015;40:303-308.
Pace L, Klain M, Salvatore B, Nicolai E, Zampella E, Assante R, Pellegrino T, Storto G, Fonti R, Salvatore M. Prognostic role of 18F-Fluorodeoxyglucose Positron Emission Tomography/CT in the postoperative evaluation of differentiated thyroid cancer patients. Clin Nucl Med. 2015;40:111-115.
Salvatore B, Caprio MG, Fonti R, D’Amico D, Fraioli F, Salvatore M, Pace L. Is 2-deoxy-2-18Fluoro-D-glucose PET/CT acquisition from the upper thigh to the vertex of skull useful in oncological patients? Transl Med UniSa. 2014;11:34-38.
L Camera, R Severino, A Faggiano, S Masone, G Mansueto, S Maurea, R Fonti, M Salvatore. Contrast enhanced multi-detector CT and MR findings of a well-differentiated pancreatic vipoma. World J Radiol. 2014; 6:840-845.
De Luca S, Fonti R, Palmieri G, Federico P, Del Prete G, Pacelli R, Pace L, De Placido S, Salvatore M, Del Vecchio S. Combined Imaging With 18F-FDG-PET/CT and 111In-Labeled Octreotide SPECT for Evaluation of Thymic Epithelial Tumors. Clin Nucl Med. 2013;38:354-358.
Pasanisi F, Pace L, Fonti R, Marra M, Sgambati D, De Caprio C, De Filippo E, Vaccaro A, Salvatore M, Contaldo F. Evidence of brown fat activity in constitutional leanness. J Clin Endocrinol Metab. 2013;98:1214-1218.
Marotta V, Ramundo V, Camera L, Del Prete M, Fonti R, Esposito R, Palmieri G, Salvatore M, Vitale M, Colao A, Faggiano A. Sorafenib in advanced iodine-refractory differentiated thyroid cancer: efficacy, safety and exploratory analysis of role of serum thyroglobulin and FDG-PET. Clin Endocrinol. 2013;78:760-767.
Fonti R, Larobina M, Del Vecchio S, De Luca S, Fabbricini R, Catalano L, Pane F, Salvatore M, Pace L. Metabolic Tumor Volume Assessed by 18F-FDG PET/CT for the Prediction of Outcome in Patients with Multiple Myeloma. J Nucl Med. 2012;53:1829-1835.
Fonti R, Salvatore B, Quarantelli M, Sirignano C, Segreto S, Petruzziello F, Catalano L, Liuzzi R, Rotoli B, Del Vecchio S, Pace L, Salvatore M. 18F-FDG-PET/CT, 99mTc-MIBI and MRI in the evaluation of patients with multiple myeloma. J Nucl Med 2008;49:195-200.
Catalano L, Del Vecchio S, Petruzziello F, Fonti R, Salvatore B, Martorelli C, Califano C, Caparrotti G, Segreto S, Pace L, Rotoli B. Sestamibi and FDG-PET scans to support diagnosis of jaw osteonecrosis. Ann Hematol 2007;86:415-423.