Bio

Bio


Dr. Iagaru is an Assistant Professor of Radiology - Nuclear Medicine and the Co-Chief of the Division of Nuclear Medicine and Molecular Imaging at Stanford University Medical Center. He completed medical school at Carol Davila University of Medicine, Bucharest, Romania, and an internship at Drexel University College of Medicine, Graduate Hospital, in the Department of Medicine in Philadelphia. He began his residency at the University of Southern California (USC) Keck School of Medicine, Los Angeles, in the Division of Nuclear Medicine, where he was the chief resident. Dr. Iagaru finished his residency and completed a PET/CT fellowship at Stanford University's School of Medicine in the Division of Nuclear Medicine. His research interests include PET/MRI and PET/CT for early cancer detection; clinical translation of novel PET radiopharmaceuticals; peptide-based diagnostic imaging and therapy; and radioimmunotherapy.

Over the past six years since joining the faculty at Stanford, Dr. Iagaru has received several awards including the Society of Nuclear Medicine (SNM) 2009 Image of the Year Award; American College of Nuclear Medicine (ACNM) Mid-Winter Conference 2010 Best Essay Award; 2009 Western Regional SNM Scientist Award; 2011 SNM Nuclear Oncology Council Young Investigator Award; and a Stanford Cancer Center 2009 Developmental Cancer Research Award in Translational Science. Dr. Iagaru presented more than 90 abstracts at national and international meetings and published more than 50 papers in peer-reviewed journals, as well as 7 book chapters.

Clinical Focus


  • Radioimmunotherapy
  • Positron-Emission Tomography
  • Nuclear Medicine
  • Breast Cancer
  • Sarcoma
  • Thyroid Cancer
  • GBM
  • Lymphoma

Academic Appointments


Administrative Appointments


  • Program Director, Nuclear Medicine Residency Program (2011 - Present)
  • Member, Department of Radiology Education Committee (2009 - Present)
  • Member, Clinical Radiation Safety Committee (2009 - Present)
  • Member, Scientific Review Committee, Stanford Cancer Institute (2012 - Present)

Honors & Awards


  • Fellow Award, American College of Nuclear Medicine (2013)
  • Nuclear Oncology Council Young Investigator Award - Second Place, Society of Nuclear Medicine and Molecular Imaging (2011)
  • Radiopharmaceutical Sciences Council Travel Grant, Society of Nuclear Medicine and Molecular Imaging (2011)
  • Young Professionals Tournament - First Place, SNMMI & Chinese Society of Nuclear Medicine Joint Meeting (2011)
  • Best Essay Award, American College of Nuclear Medicine (2011)
  • Alavi-Mandell Award, Society of Nuclear Medicine and Molecular Imaging (2010)
  • Best Essay Award, American College of Nuclear Medicine (2010)
  • Norman D. Poe Memorial Scholarship Award, Western Regional Society of Nuclear Medicine (2009)
  • Developmental Cancer Research Award, Stanford Cancer Center (2009)
  • Image of the Year, Society of Nuclear Medicine and Molecular Imaging (2009)
  • Alavi-Mandell Award, Society of Nuclear Medicine and Molecular Imaging (2009)
  • Clinician Educator of the Year Award, Stanford Radiology Residency Program (2008)
  • Alavi-Mandell Award, Society of Nuclear Medicine and Molecular Imaging (2008)
  • Best Essay Award, American College of Nuclear Physicians (2008)
  • Travel Grant, American College of Nuclear Physicians (2007)

Boards, Advisory Committees, Professional Organizations


  • Board of Directors, PET Center of Excellence, Society of Nuclear Medicine and Molecular Imaging (2013 - Present)
  • Co-Chair, PET/MRI Task Force, Society of Nuclear Medicine and Molecular Imaging (2013 - Present)
  • Co-Chair, Targeted Radionuclide Therapy Working Group, Society of Nuclear Medicine and Molecular Imaging (2012 - Present)
  • Co-Chair, Outreach Committee, Society of Nuclear Medicine and Molecular Imaging (2011 - Present)
  • Co-Chair, Oncology Working Group, Society of Nuclear Medicine and Molecular Imaging (2013 - Present)
  • Member, Committee on Public Relations, Society of Nuclear Medicine and Molecular Imaging (2012 - Present)
  • Member, National Comprehensive Cancer Network Thyroid Cancer Panel (2013 - Present)

Professional Education


  • Residency:Stanford University Medical Center (2006) CA
  • Fellowship:Stanford University Medical Center (2007) CA
  • Board Certification: Nuclear Medicine, American Board of Nuclear Medicine (2006)
  • Residency:USC - Keck School of Medicine (2005) CA
  • Internship:Graduate Hospital (2004) PA
  • Medical Education:Carol Davila University of Medicine (2000) Romania

Research & Scholarship

Current Research and Scholarly Interests


Current research projects include:
1) PET/MRI and PET/CT for Early Cancer Detection
2) Targeted Radionuclide Therapy
3) Clinical Translation of Novel PET Radiopharmaceuticals;

Clinical Trials


  • Combined F18 and F18 FDG PET/CT for Evaluation of Malignancy Recruiting

    Fluorine-18 Fluorodeoxyglucose (F-18 FDG) PET/CT is established as a powerful imaging tool for cancer detection and monitoring response to therapy. However, not all cancers are identified reliably due to variable rates of glucose metabolism. Sodium Fluorine-18 (F-18) was used in the 1970s for bone scanning and can be used as a skeletal tracer in current PET/CT scanners. The combined administration of F-18 and F-18 FDG in a single PET/CT scan for cancer detection was not attempted to date. However, such an approach has the potential to improve cancer diagnosis, staging, prognosis, and therapy monitoring. The combination of these technologies may also allow for shorter imaging times, lower costs, as well as improved screening or earlier cancer detection. The investigators will attempt a pilot study with 10 patients to acquire the preliminary results needed to proceed with additional 90 subjects.

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  • Study for Women With Platinum Resistant Ovarian Cancer Evaluating EC145 in Combination With Doxil® (PROCEED) Recruiting

    The purpose of this study is to compare progression-free survival (PFS) (based upon investigator assessment using RECIST v1.1) in participants with platinum-resistant ovarian cancer who receive combination therapy with EC145 and pegylated liposomal doxorubicin (EC145+PLD) with that in participants who receive PLD and placebo.

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  • PET/CT and Whole-Body MRI for Detection of Skeletal and Soft Tissue Metastases Recruiting

    Fluorine-18 Fluorodeoxyglucose (F-18 FDG) PET/CT is established as a powerful imaging tool for cancer detection and monitoring response to therapy. However, not all cancers are identified reliably due to variable rates of glucose metabolism. Whole-body MRI emerges currently as an excellent modality for morphological characterization of soft tissue and skeletal lesions. Sodium Fluorine-18 (F-18) was used in the 1970's for bone scanning and can be used as a skeletal tracer in current PET/CT scanners. The direct comparison of F-18/F-18 FDG PET/CT and whole-body MRI for skeletal metastases detection was not attempted to date. However, such an approach has the potential to improve cancer diagnosis, staging, prognosis, and therapy monitoring. The combination of these technologies may also allow for improved screening or earlier cancer detection. We will attempt a pilot study with 10 patients to acquire the preliminary results needed to proceed with additional 90 subjects.

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  • A Study Comparing Treatment With 177Lu-DOTA0-Tyr3-Octreotate to Octreotide LAR in Patients With Inoperable, Progressive, Somatostatin Receptor Positive Midgut Carcinoid Tumours Recruiting

    The purpose of this study is to - compare Progression Free Survival (PFS) after treatment with 177Lu-DOTA0-Tyr3-Octreotate plus best supportive care (30 mg Octreotide LAR) to treatment with high dose (60 mg) Octreotide LAR in patients with inoperable, progressive (as determined by Response Evaluation Criteria in Solid Tumors [RECIST] Criteria), somatostatin receptor positive, well-differentiated neuroendocrine tumours of the small bowel (midgut carcinoid tumours). - compare the Objective Response Rate (ORR) between the two study arms - compare the Overall Survival (OS) between the two study arms - compare the Time to Tumour Progression (TTP) between the two study arms - evaluate the safety and tolerability of 177Lu-DOTA0-Tyr3-Octreotate - evaluate the health related quality of life (QoL) as measured by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-G.I.NET21 questionnaire - explore the correlation of toxicity outcomes and administered radiation doses corrected for body weight and body surface area - explore the correlation of clinical efficacy outcomes with the levels of the biomarkers Chromogranin-A (CgA) in the serum and 5-Hydroxyindoleacetic acid (5-HIAA) in the urine - evaluate dosimetry, pharmacokinetics (PK) and ECG in a subset of 20 patients - explore the correlation of clinical efficacy outcomes with OctreoScan® tumour uptake score - explore the correlation of clinical outcomes with serum levels of Alkaline Phosphatase (AP)

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  • Phase I Pilot Study to Evaluate the Prognostic Value of Perfusion CT for Primary Cervical Cancer Not Recruiting

    The investigators hope to learn whether perfusion CT is a useful way to assess primary cervical tumor microenvironment and whether there is a relationship between pretreatment perfusion CT measurements and primary cervical tumor size, lymph node involvement (as assessed by standard of care pretreatment fludeoxyglucose Positron emission tomography/CT (FDG-PET/CT)), and treatment response (as assessed by standard of care 3-month post-therapy FDG-PET/CT).

    Stanford is currently not accepting patients for this trial. For more information, please contact Jacob Wynne, 650-723-8843.

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  • Assessing Response to Treatment in Non-Hodgkin's Lymphoma Patients Using 64Cu-DOTA-Rituximab PET/CT Not Recruiting

    Rituximab is an antibody targeted against the CD20 antigen found primarily on B-cells. Therefore, an imaging agent targeting CD20 expression may provide a more accurate evaluation of extent of disease and response to therapy than the current standard of care, F-18 FDG PET/CT. The main purpose of the study is to investigate a new PET/CT imaging probe for detection and follow up of lymphoma. Following are the 3 aims of the study: a) Phase I testing in lymphoma patients of Cu-64 labelled Rituxan for defining normal tracer biodistribution, stability, pharmacokinetics and radiation dosimetry; b) comparison of Cu-64 Rituxan and F-18 FDG PET/CT in lymphoma patients; c) evaluation of changes in uptake of Cu-64 Rituxan in response to rituximab-based treatment in CD20-positive B-cell NHL

    Stanford is currently not accepting patients for this trial. For more information, please contact Lindee Burton, (650) 725 - 4712.

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  • Exploration of Tumor Accumulation of BAY94-9392 in Patients With Cancer Not Recruiting

    The study will be conducted as an open label, single-dose, explorative study with patients with histologically proven cancer and, preferably, tumor positive lesions in previously performed nuclear medicine imaging examinations. The investigational drug will be given as a single administration in a dose of </= 0.1 mg BAY94-9392 (300 MBq, +/- 10%). The total duration of the study for each patient will be approximately 8 days.

    Stanford is currently not accepting patients for this trial. For more information, please contact Lindee Burton, (650) 725 - 4712.

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  • 18F FPPRGD2 Positron Emission Tomography/Computed Tomography in Predicting Early Response in Patients With Cancer Receiving Anti-Angiogenesis Therapy Recruiting

    This phase I/II trial studies fluorine 18 2-fluoropropionyl-labeled pegylated dimeric arginine-glycine-aspartic acid (RGD) peptide (18F FPPRGD2) positron emission tomography (PET)/computed tomography (CT) in predicting early response in patients with cancer receiving anti-angiogenesis therapy. Diagnostic procedures, such as 18F FPPRGD2 PET/CT, may be a less invasive method of finding cancer early and determining response to treatment

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  • Radium-223 Dichloride (BAY88-8223) in Castration-Resistant (Hormone-Refractory) Prostate Cancer Patients With Bone Metastases Recruiting

    This study is a prospective, interventional, open-label, multi-center early access program for the use of Ra-223 Cl2 in HRPC/CRPC patients diagnosed with symptomatic bone metastasis and to collect additional short and long term safety data on the product.

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Teaching

2013-14 Courses


Publications

Journal Articles


  • 18F-FDG PET/CT in the management of patients with post-transplant lymphoproliferative disorder. Nuclear medicine communications Takehana, C. S., Twist, C. J., Mosci, C., Quon, A., Mittra, E., Iagaru, A. 2014; 35 (3): 276-281

    Abstract

    Post-transplant lymphoproliferative disorder (PTLD) is a rare but serious complication in transplant patients. Although fluorine-18 2-fluoro-2-deoxyglucose PET and computed tomography (F-FDG PET/CT) has been used for the evaluation and management of patients with PTLD, its utility has yet to be documented. We were therefore prompted to review our experience with F-FDG PET/CT in PTLD.We retrospectively reviewed the records of consecutive patients who had undergone F-FDG PET/CT for evaluation of PTLD from January 2004 to June 2012 at our institution. F-FDG PET/CT scans were compared with other imaging modalities performed concurrently. A chart review of pertinent clinical information was also conducted.A total of 30 patients were identified (14 female and 16 male; 1.7-76.7 years of age, average: 23.8 years). Twenty-seven participants had biopsy-proven PTLD and another three had been treated for PTLD because of high clinical suspicion of disease and positive F-FDG PET/CT findings in the absence of histological diagnosis. Eighty-three percent of these PTLD patients had extranodal involvement. In 57% of the cases, F-FDG PET/CT detected occult lesions not identified on other imaging modalities or suggested PTLD in equivocal lesions. The more aggressive PTLD histological subtypes demonstrated higher SUVmax compared with the less aggressive subtypes.F-FDG PET/CT is beneficial in the diagnostic evaluation of patients with PTLD. F-FDG PET/CT has the ability to detect occult lesions not identified on other imaging modalities, particularly extranodal lesions. In addition, F-FDG PET/CT may predict the PTLD subtype, as the lesions with higher pathologic grade presented with significantly higher SUVmax compared with the less aggressive forms.

    View details for DOI 10.1097/MNM.0000000000000050

    View details for PubMedID 24296883

  • The Clinical Use of PET/CT in the Evaluation of Melanoma. Methods in molecular biology (Clifton, N.J.) Keu, K. V., Iagaru, A. H. 2014; 1102: 553-580

    Abstract

    Positron emission tomography combined with computed tomography (PET/CT) has emerged in the last decade as a dominant imaging modality used for staging, monitoring response and surveillance of various cancers, including melanoma. Using 2-deoxy-2-((18)F)fluoro-D-glucose ((18)F-FDG) as the radiopharmaceutical, PET/CT has demonstrated its efficacy and its utility in the management of patients with advanced melanoma. Nonetheless, challenges remain in the early stage evaluation of melanoma and in the development of novel radiotracers to better characterize lesions found on PET/CT. This chapter focuses on the advantages and limitations of this imaging modality in melanoma. We also detail and describe the approach to perform (18)F-FDG PET/CT, the methods to accurately quantify lesions, as well as the pearls/pitfalls of image interpretation. Finally, an overview of preclinical and investigational clinical radiopharmaceuticals is presented.

    View details for DOI 10.1007/978-1-62703-727-3_30

    View details for PubMedID 24258999

  • Prognostic utility of 90Y radioembolization dosimetry based on fusion 99mTc-macroaggregated albumin-99mTc-sulfur colloid SPECT. Journal of nuclear medicine : official publication, Society of Nuclear Medicine Lam, M. G., Goris, M. L., Iagaru, A. H., Mittra, E. S., Louie, J. D., Sze, D. Y. 2013; 54 (12): 2055-2061

    Abstract

    Planning hepatic (90)Y radioembolization activity requires balancing toxicity with efficacy. We developed a dual-tracer SPECT fusion imaging protocol that merges data on radioactivity distribution with physiologic liver mapping.Twenty-five patients with colorectal carcinoma and bilobar liver metastases received whole-liver radioembolization with resin microspheres prescribed as per convention (mean administered activity, 1.69 GBq). As part of standard treatment planning, all patients underwent SPECT imaging after intraarterial injection of 37 MBq of (99m)Tc-macroaggregated albumin ((99m)Tc-MAA) to simulate subsequent (90)Y distribution. Immediately afterward, patients received 185 MBq of labeled sulfur colloid ((99m)Tc-SC) intravenously as a biomarker for normal hepatic reticuloendothelial function and SPECT was repeated. The SPECT images were coregistered and fused. A region-based method was used to predict the (90)Y radiation absorbed dose to functional liver tissue (DFL) by calculation of (99m)Tc-MAA activity in regions with (99m)Tc-SC uptake. Similarly, the absorbed dose to tumor (DT) was predicted by calculation of (99m)Tc-MAA activity in voxels without (99m)Tc-SC uptake. Laboratory data and radiographic response were measured for 3 mo, and the survival of patients was recorded. SPECT-based DT and DFL were correlated with parameters of toxicity and efficacy.Toxicity, as measured by increase in serum liver enzymes, correlated significantly with SPECT-based calculation of DFL at all time points (P < 0.05) (mean DFL, 27.9 Gy). Broad biochemical toxicity (>50% increase in all liver enzymes) occurred at a DFL of 24.5 Gy and above. In addition, in uni- and multivariate analysis, SPECT-based calculation of DT (mean DT, 44.2 Gy) correlated with radiographic response (P < 0.001), decrease in serum carcinoembryonic antigen (P < 0.05), and overall survival (P < 0.01). The cutoff value of DT for prediction of 1-y survival was 55 Gy (area under the receiver-operating-characteristic curve = 0.86; P < 0.01). Patients who received a DT of more than 55 Gy had a median survival of 32.8 mo, compared with 7.2 mo in patients who received less (P < 0.05).Dual-tracer (99m)Tc-MAA-(99m)Tc-SC fusion SPECT offers a physiology-based imaging tool with significant prognostic power that may lead to improved personalized activity planning.

    View details for DOI 10.2967/jnumed.113.123257

    View details for PubMedID 24144563

  • Root cause analysis of gastroduodenal ulceration after yttrium-90 radioembolization. Cardiovascular and interventional radiology Lam, M. G., Banerjee, S., Louie, J. D., Abdelmaksoud, M. H., Iagaru, A. H., Ennen, R. E., Sze, D. Y. 2013; 36 (6): 1536-1547

    Abstract

    INTRODUCTION: A root cause analysis was performed on the occurrence of gastroduodenal ulceration after hepatic radioembolization (RE). We aimed to identify the risk factors in the treated population and to determine the specific mechanism of nontarget RE in individual cases. METHODS: The records of 247 consecutive patients treated with yttrium-90 RE for primary (n = 90) or metastatic (n = 157) liver cancer using either resin (n = 181) or glass (n = 66) microspheres were reviewed. All patients who developed a biopsy-proven microsphere-induced gastroduodenal ulcer were identified. Univariate and multivariate analyses were performed on baseline parameters and procedural data to determine possible risk factors in the total population. Individual cases were analyzed to ascertain the specific cause, including identification of the culprit vessel(s) leading to extrahepatic deposition of the microspheres. RESULTS: Eight patients (3.2 %) developed a gastroduodenal ulcer. Stasis during injection was the strongest independent risk factor (p = 0.004), followed by distal origin of the gastroduodenal artery (p = 0.004), young age (p = 0.040), and proximal injection of the microspheres (p = 0.043). Prolonged administrations, pain during administration, whole liver treatment, and use of resin microspheres also showed interrelated trends in multivariate analysis. Retrospective review of intraprocedural and postprocedural imaging showed a probable or possible culprit vessel, each a tiny complex collateral vessel, in seven patients. CONCLUSION: Proximal administrations and those resulting in stasis of flow presented increased risk for gastroduodenal ulceration. Patients who had undergone bevacizumab therapy were at high risk for developing stasis.

    View details for DOI 10.1007/s00270-013-0579-1

    View details for PubMedID 23435742

  • Prognostic Utility of Y-90 Radioembolization Dosimetry Based on Fusion Tc-99m-Macroaggregated Albumin-Tc-99m-Sulfur Colloid SPECT JOURNAL OF NUCLEAR MEDICINE Lam, M. G., Goris, M. L., Iagaru, A. H., Mittra, E. S., Louie, J. D., Sze, D. Y. 2013; 54 (12): 2055-2061
  • Combined F-18-fluoride and F-18-FDG PET/CT: a response based on actual data from prospective studies EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING Iagaru, A., Mosci, C., Dick, D. W., Sathekge, M., Lapa, P., de Lima, J. M., Gambhir, S. S. 2013; 40 (12): 1922-1924

    View details for DOI 10.1007/s00259-013-2556-y

    View details for Web of Science ID 000326690600017

    View details for PubMedID 24057457

  • Safety of repeated yttrium-90 radioembolization. Cardiovascular and interventional radiology Lam, M. G., Louie, J. D., Iagaru, A. H., Goris, M. L., Sze, D. Y. 2013; 36 (5): 1320-1328

    Abstract

    PURPOSE: Repeated radioembolization (RE) treatments carry theoretically higher risk of radiation-induced hepatic injury because of the liver's cumulative memory of previous exposure. We performed a retrospective safety analysis on patients who underwent repeated RE. METHODS: From 2004 to 2011, a total of 247 patients were treated by RE. Eight patients (5 men, 3 women, age range 51-71 years) underwent repeated treatment of a targeted territory, all with resin microspheres (SIR-Spheres; Sirtex, Lane Cove, Australia). Adverse events were graded during a standardized follow-up. In addition, the correlation between the occurrence of RE-induced liver disease (REILD) and multiple variables was investigated in univariate and multivariate analyses in all 247 patients who received RE. RESULTS: Two patients died shortly after the second treatment (at 84 and 107 days) with signs and symptoms of REILD. Both patients underwent whole liver treatment twice (cumulative doses 3.08 and 2.66 GBq). The other 6 patients demonstrated only minor toxicities after receiving cumulative doses ranging from 2.41 to 3.88 GBq. All patients experienced objective tumor responses. In the whole population, multifactorial analysis identified three risk factors associated with REILD: repeated RE (p = 0.036), baseline serum total bilirubin (p = 0.048), and baseline serum aspartate aminotransferase (p = 0.043). Repeated RE proved to be the only independent risk factor for REILD in multivariate analysis (odds ratio 9.6; p = 0.002). Additionally, the administered activity per target volume (in GBq/L) was found to be an independent risk factor for REILD, but only in whole liver treatments (p = 0.033). CONCLUSION: The risk of REILD appears to be elevated for repeated RE. Objective tumor responses were observed, but establishment of safety limits will require improvement in dosimetric measurement and prediction.

    View details for DOI 10.1007/s00270-013-0547-9

    View details for PubMedID 23354961

  • Imaging Tumor Angiogenesis: The Road to Clinical Utility AMERICAN JOURNAL OF ROENTGENOLOGY Iagaru, A., Gambhir, S. S. 2013; 201 (2): W183-W191

    Abstract

    OBJECTIVE. Tumor growth and progression require the formation of new blood vessels from preexisting vasculature, a process called angiogenesis. The ability to noninvasively visualize angiogenesis may provide new opportunities to more appropriately select patients for antiangiogenesis treatment and to monitor treatment efficacy. CONCLUSION. The superior molecular sensitivity of PET and the lack of radiation from MRI and contrast-enhanced ultrasound put these techniques at the forefront of clinical translation.

    View details for DOI 10.2214/AJR.12.8568

    View details for Web of Science ID 000322225400003

    View details for PubMedID 23883233

  • An Observational Study of Circulating Tumor Cells and F-18-FDG PET Uptake in Patients with Treatment-Naive Non-Small Cell Lung Cancer PLOS ONE Nair, V. S., Keu, K. V., Luttgen, M. S., Kolatkar, A., Vasanawala, M., Kuschner, W., Bethel, K., Iagaru, A. H., Hoh, C., Shrager, J. B., Loo, B. W., Bazhenova, L., Nieva, J., Gambhir, S. S., Kuhn, P. 2013; 8 (7)

    Abstract

    We investigated the relationship of circulating tumor cells (CTCs) in non-small cell lung cancer (NSCLC) with tumor glucose metabolism as defined by (18)F-fluorodeoxyglucose (FDG) uptake since both have been associated with patient prognosis.We performed a retrospective screen of patients at four medical centers who underwent FDG PET-CT imaging and phlebotomy prior to a therapeutic intervention for NSCLC. We used an Epithelial Cell Adhesion Molecule (EpCAM) independent fluid biopsy based on cell morphology for CTC detection and enumeration (defined here as High Definition CTCs or "HD-CTCs"). We then correlated HD-CTCs with quantitative FDG uptake image data calibrated across centers in a cross-sectional analysis.We assessed seventy-one NSCLC patients whose median tumor size was 2.8 cm (interquartile range, IQR, 2.0-3.6) and median maximum standardized uptake value (SUVmax) was 7.2 (IQR 3.7-15.5). More than 2 HD-CTCs were detected in 63% of patients, whether across all stages (45 of 71) or in stage I disease (27 of 43). HD-CTCs were weakly correlated with partial volume corrected tumor SUVmax (r = 0.27, p-value = 0.03) and not correlated with tumor diameter (r = 0.07; p-value = 0.60). For a given partial volume corrected SUVmax or tumor diameter there was a wide range of detected HD-CTCs in circulation for both early and late stage disease.CTCs are detected frequently in early-stage NSCLC using a non-EpCAM mediated approach with a wide range noted for a given level of FDG uptake or tumor size. Integrating potentially complementary biomarkers like these with traditional patient data may eventually enhance our understanding of clinical, in vivo tumor biology in the early stages of this deadly disease.

    View details for DOI 10.1371/journal.pone.0067733

    View details for Web of Science ID 000321425300025

    View details for PubMedID 23861795

  • Pilot prospective evaluation of 99mTc-MDP scintigraphy, 18F NaF PET/CT, 18F FDG PET/CT and whole-body MRI for detection of skeletal metastases. Clinical nuclear medicine Iagaru, A., Young, P., Mittra, E., Dick, D. W., Herfkens, R., Gambhir, S. S. 2013; 38 (7): e290-6

    Abstract

    The aim of this study was to compare Tc-MDP bone scanning, F NaF PET/CT, F FDG PET/CT, and whole-body MRI (WBMRI) for detection of known osseous metastases.This prospective pilot trial (September 2007-April 2009) enrolled 10 participants (5 men, 5 women, 47-81 years old) diagnosed with cancer and known osseous metastases. F NaF PET/CT, F FDG PET/CT, and WBMRI were performed within 1 month for each participant.The image quality and evaluation of extent of disease were superior by F NaF PET/CT compared to Tc-MDP scintigraphy in all patients with skeletal lesions and compared to F FDG PET/CT in 3 of the patients with skeletal metastases. F NaF PET/CT showed osseous metastases where F FDG PET/CT was negative in another 3 participants. Extraskeletal metastases were identified by F FDG PET/CT in 6 participants. WBMRI with the combination of iterative decomposition of water and fat with echo asymmetry and least-squares estimation, short tau inversion recovery, and diffusion-weighted imaging pulse sequences showed fewer lesions than F NaF PET/CT in 5 patients, same number of lesions in 2 patients, and more lesions in 1 patient. WBMRI showed fewer lesions than F FDG in 3 patients and same lesions in 6 patients.Our pilot phase prospective trial demonstrated superior image quality and evaluation of skeletal disease extent with F NaF PET/CT compared to Tc-MDP scintigraphy and F FDG PET/CT, as well as the feasibility of multisequence WBMRI. In addition, F FDG PET/CT provided valuable soft-tissue information that can change disease management. Further evaluation of these findings using the recently introduced PET/MRI scanners is warranted.

    View details for DOI 10.1097/RLU.0b013e3182815f64

    View details for PubMedID 23455520

  • Second Sino-American Conference on Nuclear Medicine JOURNAL OF NUCLEAR MEDICINE Delbeke, D., Alessio, A., Iagaru, A. 2013; 54 (4): 15N-16N

    View details for Web of Science ID 000316939200001

    View details for PubMedID 23546927

  • Combined F-18-Fluoride and F-18-FDG PET/CT Scanning for Evaluation of Malignancy: Results of an International Multicenter Trial JOURNAL OF NUCLEAR MEDICINE Iagaru, A., Mittra, E., Mosci, C., Dick, D. W., Sathekge, M., Prakash, V., Iyer, V., Lapa, P., Isidoro, J., de Lima, J. M., Gambhir, S. S. 2013; 54 (2): 176-183

    Abstract

    (18)F-FDG PET/CT is used in a variety of cancers, but because of variable rates of glucose metabolism, not all cancers are reliably identified. (18)F(-) PET/CT allows for the acquisition of highly sensitive and specific images of the skeleton. We prospectively evaluated combined (18)F(-)/(18)F-FDG as a single PET/CT examination for evaluation of cancer patients and compared it with separate (18)F(-) PET/CT and (18)F-FDG PET/CT scans.One hundred fifteen participants with cancer were prospectively enrolled in an international multicenter trial evaluating (18)F(-) PET/CT, (18)F-FDG PET/CT, and combined (18)F(-)/(18)F-FDG PET/CT. The 3 PET/CT scans were performed sequentially within 4 wk of one another for each patient.(18)F(-)/(18)F-FDG PET/CT allowed for accurate interpretation of radiotracer uptake outside the skeleton, with findings similar to those of (18)F-FDG PET/CT. In 19 participants, skeletal disease was more extensive on (18)F(-) PET/CT and (18)F(-)/(18)F-FDG PET/CT than on (18)F-FDG PET/CT. In another 29 participants, (18)F(-) PET/CT and (18)F(-)/(18)F-FDG PET/CT showed osseous metastases where (18)F-FDG PET/CT was negative. The extent of skeletal lesions was similar in 18 participants on all 3 scans.This trial demonstrated that combined (18)F(-)/(18)F-FDG PET/CT shows promising results when compared with separate (18)F(-) PET/CT and (18)F-FDG PET/CT for evaluation of cancer patients. This result opens the possibility for improved patient care and reduction in health-care costs, as will be further evaluated in future trials.

    View details for DOI 10.2967/jnumed.112.108803

    View details for Web of Science ID 000314691200016

    View details for PubMedID 23243299

  • 18F-FDG PET/CT Demonstration of Diffuse Lymphohistiocytic Granulomatous Vasculitis. Clinical nuclear medicine Kumar, M., Iagaru, A. 2013

    Abstract

    Surveillance FDG PET/CT was performed in a 75-year-old woman with history of melanoma and colon cancer. She had rash and erythematous papules on the forearms, elbows, knees, and thighs and then developed right-leg weakness, difficulty with fine motor movement, and ptosis. Chest CT identified a right-lung spiculated nodule. Skin and pulmonary nodule biopsies showed lymphohistiocytic infiltrate with granulomatous features, without lymphoid cells, metastatic carcinoma or melanoma cells, or microorganisms. Epstein-Barr immunostain result was negative, making lymphomatoid granuloma unlikely. The inflammatory process involved the peripheral vasculature on FDG PET, and given the related neuropathy, findings were compatible with granulomatous vasculitis.

    View details for PubMedID 23510876

  • Initial investigation of F-18-NaF PET/CT for identification of vertebral sites amenable to surgical revision after spinal fusion surgery EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING Quon, A., Dodd, R., Iagaru, A., de Abreu, M. R., Hennemann, S., Alves Neto, J. M., Sprinz, C. 2012; 39 (11): 1737-1744

    Abstract

    A pilot study was performed in patients with recurrent back pain after spinal fusion surgery to evaluate the ability of (18)F-NaF PET/CT imaging to correctly identify those requiring surgical intervention and to locate a site amenable to surgical intervention.In this prospective study 22 patients with recurrent back pain after spinal surgery and with equivocal findings on physical examination and CT were enrolled for evaluation with (18)F-NaF PET/CT. All PET/CT images were prospectively reviewed with the primary objective of identifying or ruling out the presence of lesions amenable to surgical intervention. The PET/CT results were then validated during surgical exploration or clinical follow-up of at least 15 months.Abnormal (18)F-NaF foci were found in 16 of the 22 patients, and surgical intervention was recommended. These foci were located at various sites: screws, cages, rods, fixation hardware, and bone grafts. In 6 of the 22 patients no foci requiring surgical intervention were found. Validation of the results by surgery (15 patients) or on clinical follow-up (7 patients) showed that (18)F-NaF PET/CT correctly predicted the presence of an abnormality requiring surgical intervention in 15 of 16 patients and was falsely positive in 1 of 16.In this initial investigation, (18)F-NaF PET/CT imaging showed potential utility for evaluation of recurrent symptoms after spinal fusion surgery by identifying those patients requiring surgical management.

    View details for DOI 10.1007/s00259-012-2196-7

    View details for Web of Science ID 000309562600010

    View details for PubMedID 22895860

  • Positron Emission Tomography of Cu-64-DOTA-Rituximab in a Transgenic Mouse Model Expressing Human CD20 for Clinical Translation to Image NHL MOLECULAR IMAGING AND BIOLOGY Natarajan, A., Gowrishankar, G., Nielsen, C. H., Wang, S., Iagaru, A., Goris, M. L., Gambhir, S. S. 2012; 14 (5): 608-616

    Abstract

    This study aims to evaluate (64)Cu-DOTA-rituximab (PETRIT) in a preclinical transgenic mouse model expressing human CD20 for potential clinical translation.(64)Cu was chelated to DOTA-rituximab. Multiple radiolabeling, quality assurance, and imaging experiments were performed. The human CD20 antigen was expressed in B cells of transgenic mice (CD20TM). The mice groups studied were: (a) control (nude mice, n?=?3) that received 7.4 MBq/dose, (b) with pre-dose (CD20TM, n?=?6) received 2 mg/kg pre-dose of cold rituximab prior to PETRIT of 7.4 MBq/dose, and (c) without pre-dose (CD20TM, n?=?6) PETRIT alone received 7.4 MBq/dose. Small animal PET was used to image mice at various time points (0, 1, 2, 4, 24, 48, and 72 h). The OLINDA/EXM software was used to determine the human equivalent dose for individual organs.PETRIT was obtained with a specific activity of 545?±?38.91 MBq/nmole, radiochemical purity >95%, and immunoreactivity >75%. At 24 h, spleenic uptake of PETRIT%ID/g (mean?±?STD) with and without pre-dose was 1.76?±?0.43% and 16.5?±?0.45%, respectively (P value?=?0.01). Liver uptake with and without pre-dose was 0.41?±?0.51% and 0.52?±?0.17% (P value?=?0.86), respectively. The human equivalents of highest dose organs with and without pre-dose are osteogenic cells at 30.8?±?0.4 ?Sv/MBq and the spleen at 99?±?4 ?Sv/MBq, respectively.PET imaging with PETRIT in huCD20 transgenic mice provided human dosimetry data for eventual applications in non-Hodgkins lymphoma patients.

    View details for DOI 10.1007/s11307-011-0537-8

    View details for Web of Science ID 000308819300011

    View details for PubMedID 22231277

  • F-18-FDG PET/CT Demonstration of a Liver Metastasis in a Patient With Papillary Thyroid Cancer CLINICAL NUCLEAR MEDICINE Mosci, C., McDougall, I. R., Jeffrey, R. B., Iagaru, A. 2012; 37 (9): E234-E236

    Abstract

    A 51-year-old woman with papillary thyroid cancer had recurrent disease. An unexpected FDG-avid hepatic metastasis was identified. Follow-up contrast-enhanced CT scan showed a hepatic lesion, compatible with malignancy. Histopathologic examination demonstrated metastatic carcinoma, consistent with thyroid primary. Few studies reported liver metastases originating from thyroid cancer on FDG PET. These were medullary thyroid carcinomas (MTC) or poorly differentiated cancers. There are no reports describing liver metastasis from PTC diagnosed by FDG PET/CT.

    View details for DOI 10.1097/RLU.0b013e318262ae07

    View details for Web of Science ID 000307808000007

    View details for PubMedID 22889801

  • Validation that metabolic tumor volume predicts outcome in head-and-neck cancer. International journal of radiation oncology, biology, physics Tang, C., Murphy, J. D., Khong, B., La, T. H., Kong, C., Fischbein, N. J., Colevas, A. D., Iagaru, A. H., Graves, E. E., Loo, B. W., Le, Q. 2012; 83 (5): 1514-1520

    Abstract

    We have previously reported that metabolic tumor volume (MTV) obtained from pretreatment (18)F-fluorodeoxydeglucose positron emission tomography (FDG PET)/ computed tomography (CT) predicted outcome in patients with head-and-neck cancer (HNC). The purpose of this study was to validate these results on an independent dataset, determine whether the primary tumor or nodal MTV drives this correlation, and explore the interaction with p16(INK4a) status as a surrogate marker for human papillomavirus (HPV).The validation dataset in this study included 83 patients with squamous cell HNC who had a FDG PET/CT scan before receiving definitive radiotherapy. MTV and maximum standardized uptake value (SUV(max)) were calculated for the primary tumor, the involved nodes, and the combination of both. The primary endpoint was to validate that MTV predicted progression-free survival and overall survival. Secondary analyses included determining the prognostic utility of primary tumor vs. nodal MTV.Similarly to our prior findings, an increase in total MTV of 17 cm(3) (difference between the 75th and 25th percentiles) was associated with a 2.1-fold increase in the risk of disease progression (p = 0.0002) and a 2.0-fold increase in the risk of death (p = 0.0048). SUV(max) was not associated with either outcome. Primary tumor MTV predicted progression-free (hazard ratio [HR] = 1.94; p < 0.0001) and overall (HR = 1.57; p < 0.0001) survival, whereas nodal MTV did not. In addition, MTV predicted progression-free (HR = 4.23; p < 0.0001) and overall (HR = 3.21; p = 0.0029) survival in patients with p16(INK4a)-positive oropharyngeal cancer.This study validates our previous findings that MTV independently predicts outcomes in HNC. MTV should be considered as a potential risk-stratifying biomarker in future studies of HNC.

    View details for DOI 10.1016/j.ijrobp.2011.10.023

    View details for PubMedID 22270174

  • Prognostic Value of Metabolic Tumor Volume and Velocity in Predicting Head-and-Neck Cancer Outcomes INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Chu, K. P., Murphy, J. D., La, T. H., Krakow, T. E., Iagaru, A., Graves, E. E., Hsu, A., Maxim, P. G., Loo, B., Chang, D. T., Quynh-Thu Le, Q. T. 2012; 83 (5): 1521-1527

    Abstract

    We previously showed that metabolic tumor volume (MTV) on positron emission tomography-computed tomography (PET-CT) predicts for disease recurrence and death in head-and-neck cancer (HNC). We hypothesized that increases in MTV over time would correlate with tumor growth and biology, and would predict outcome. We sought to examine tumor growth over time in serial pretreatment PET-CT scans.From 2006 to 2009, 51 patients had two PET-CT scans before receiving HNC treatment. MTV was defined as the tumor volume ? 50% of maximum SUV (SUV(max)). MTV was calculated for the primary tumor, nodal disease, and composite (primary tumor + nodes). MTV and SUV velocity were defined as the change in MTV or SUV(max) over time, respectively. Cox regression analyses were used to examine correlations between SUV, MTV velocity, and outcome (disease progression and overall survival).The median follow-up time was 17.5 months. The median time between PET-CT scans was 3 weeks. Unexpectedly, 51% of cases demonstrated a decrease in SUV(max) (average, -0.1 cc/week) and MTV (average, -0.3 cc/week) over time. Despite the variability in MTV, primary tumor MTV velocity predicted disease progression (hazard ratio 2.94; p = 0.01) and overall survival (hazard ratio 1.85; p = 0.03).Primary tumor MTV velocity appears to be a better prognostic indicator of disease progression and survival in comparison to nodal MTV velocity. However, substantial variability was found in PET-CT biomarkers between serial scans. Caution should be used when PET-CT biomarkers are integrated into clinical protocols for HNC.

    View details for DOI 10.1016/j.ijrobp.2011.10.022

    View details for Web of Science ID 000306128100047

    View details for PubMedID 22270168

  • Prospective Evaluation of Tc-99m MDP Scintigraphy, F-18 NaF PET/CT, and F-18 FDG PET/CT for Detection of Skeletal Metastases MOLECULAR IMAGING AND BIOLOGY Iagaru, A., Mittra, E., Dick, D. W., Gambhir, S. S. 2012; 14 (2): 252-259

    Abstract

    Technetium (Tc) methylene diphosphonate (MDP) has been the standard method for bone scintigraphy for three decades. (18)F sodium fluoride ((18)F NaF) positron emission tomography (PET)/computed tomography (CT) has better resolution and is considered superior. The role of 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F FDG) PET/CT is proven in a variety of cancers, for which it has changed the practice of oncology. There are few prospective studies comparing these three methods of detection of skeletal metastases. Thus, we were prompted to initiate this prospective pilot trial.This is a prospective study (Sep 2007-Dec 2010) of 52 patients with proven malignancy referred for evaluation of skeletal metastases. There were 37 men and 15 women, 19-84 years old (average, 55.6?±?15.9). Technetium-99m ((99m)Tc) MDP bone scintigraphy, (18)F NaF PET/CT, and (18)F FDG PET/CT were subsequently performed within 1 month.Skeletal lesions were detected by (99m)Tc MDP bone scintigraphy in 22 of 52 patients, by (18)F NaF PET/CT in 24 of 52 patients, and by (18)F FDG PET/CT in 16 of 52 patients. The image quality and evaluation of extent of disease were superior by (18)F NaF PET/CT over (99m)Tc MDP scintigraphy in all 22 patients with skeletal lesions on both scans and over (18)F FDG PET/CT in 11 of 16 patients with skeletal metastases on (18)F FDG PET/CT. In two patients, (18)F NaF PET/CT showed skeletal metastases not seen on either of the other two scans. Extraskeletal lesions were identified by (18)F FDG PET/CT in 28 of 52 subjects.Our prospective pilot-phase trial demonstrates superior image quality and evaluation of skeletal disease extent with (18)F NaF PET/CT over (99m)Tc MDP scintigraphy and (18)F FDG PET/CT. At the same time, (18)F FDG PET detects extraskeletal disease that can significantly change disease management. As such, a combination of (18)F FDG PET/CT and (18)F NaF PET/CT may be necessary for cancer detection. Additional evaluation with larger cohorts is required to confirm these preliminary findings.

    View details for DOI 10.1007/s11307-011-0486-2

    View details for Web of Science ID 000301584100013

    View details for PubMedID 21479710

  • Demonstration of peripheral nerve root involvement by non-Hodgkin's lymphoma on F-18-FDG PET/CT EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING Guo, H., Mosci, C., Iagaru, A. 2012; 39 (4): 729-730

    View details for DOI 10.1007/s00259-011-2000-0

    View details for Web of Science ID 000302287500024

    View details for PubMedID 22124779

  • Prospective comparison of combined F-18-FDG and F-18-NaF PET/CT vs. F-18-FDG PET/CT imaging for detection of malignancy EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING Lin, F. I., Rao, J. E., Mittra, E. S., Nallapareddy, K., Chengapa, A., Dick, D. W., Gambhir, S. S., Iagaru, A. 2012; 39 (2): 262-270

    Abstract

    Typically, (18)F-FDG PET/CT and (18)F-NaF PET/CT scans are done as two separate studies on different days to allow sufficient time for the radiopharmaceutical from the first study to decay. This is inconvenient for the patients and exposes them to two doses of radiation from the CT component of the examinations. In the current study, we compared the clinical usefulness of a combined (18)F-FDG/(18)F-NaF PET/CT scan with that of a separate (18)F-FDG-only PET/CT scan.There were 62 patients enrolled in this prospective trial. All had both an (18)F-FDG-alone PET/CT scan and a combined (18)F-FDG/(18)F-NaF PET/CT scan. Of the 62 patients, 53 (85%) received simultaneous tracer injections, while 9 (15%) received (18)F-NaF subsequent to the initial (18)F-FDG dose (average delay 2.2 h). Images were independently reviewed for PET findings by two Board-Certified nuclear medicine physicians, with discrepancies resolved by a third reader. Interpreters were instructed to only report findings that were concerning for malignancy. Reading the (18)F-FDG-only scan first for half of the patients controlled for order bias.In 15 of the 62 patients (24%) neither the (18)F-FDG-only PET/CT scan nor the combined (18)F-FDG/(18)F-NaF PET/CT scan identified malignancy. In the remaining 47 patients who had PET findings of malignancy, a greater number of lesions were detected in 16 of 47 patients (34%) using the combined (18)F-FDG/(18)F-NaF PET/CT scan compared to the (18)F-FDG-only PET/CT scan. In 2 of these 47 patients (4%), the (18)F-FDG-only scan demonstrated soft tissue lesions that were not prospectively identified on the combined study. In 29 of these 47 patients (62%), the combined scan detected an equal number of lesions compared to the (18)F-FDG-only scan. Overall, 60 of all the 62 patients (97%) showed an equal or greater number of lesions on the combined scan than on the (18)F-FDG-only scan.The current study demonstrated that (18)F-FDG and (18)F-NaF can be combined in a single PET/CT scan by administering the two radiopharmaceuticals simultaneously or in sequence on the same day. In addition to patient convenience and reduced radiation exposure from the CT component, the combined (18)F-FDG/(18)F-NaF PET/CT scan appeared to increase the sensitivity for detection of osseous lesions compared to the (18)F-FDG-only PET/CT scan in the studied population.

    View details for DOI 10.1007/s00259-011-1971-1

    View details for Web of Science ID 000302286600009

    View details for PubMedID 22065013

  • Response to Intra-Arterial Oncolytic Virotherapy with the Herpes Virus NV1020 Evaluated by [F-18]Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography HUMAN GENE THERAPY Sze, D. Y., Iagaru, A. H., Gambhir, S. S., de Haan, H. A., Reid, T. R. 2012; 23 (1): 91-97

    Abstract

    Oncolytic virotherapy poses unique challenges to the evaluation of tumor response. We hypothesized that the addition of [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) to standard computed tomography (CT) evaluation would improve diagnostic and prognostic power of the measurement of tumor response to oncolytic virotherapy. A phase I/II trial was conducted to investigate treatment of hepatic metastases from colorectal carcinoma using intra-arterial administration of the oncolytic herpes virus NV1020. Both contrast-enhanced CT and FDG PET were obtained on each patient at each time point. Quantitative FDG PET and CT responses were correlated with each other and with clinical outcome metrics. A majority of patients showed initial post-viral infusion increases in tumor size (69%) or in standardized uptake value (SUV) (80%) large enough to qualify as progressive disease. Most showed subsequent decreases in tumor size (64%) or SUV (83%) enough to be reclassified as partial response or stable disease. Late PET and CT imaging results correlated well with each other and with clinical outcomes, but results from early in the treatment scheme did not correlate with each other, with later results, or with clinical outcomes. The addition of FDG PET to the evaluation of tumor response to the oncolytic virus NV1020 did not provide useful diagnostic or prognostic data. More sophisticated molecular imaging will need to be developed to monitor the effects of this novel class of antineoplastic agents.

    View details for DOI 10.1089/hum.2011.141

    View details for Web of Science ID 000299604000011

    View details for PubMedID 21895536

  • Correlation between metabolic tumor volume and pathologic tumor volume in squamous cell carcinoma of the oral cavity RADIOTHERAPY AND ONCOLOGY Murphy, J. D., Chisholm, K. M., Daly, M. E., Wiegner, E. A., Truong, D., Iagaru, A., Maxim, P. G., Loo, B. W., Graves, E. E., Kaplan, M. J., Kong, C., Le, Q. 2011; 101 (3): 356-361

    Abstract

    To explore the relationship between pathologic tumor volume and volume estimated from different tumor segmentation techniques on (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in oral cavity cancer.Twenty-three patients with squamous cell carcinoma of the oral tongue had PET-CT scans before definitive surgery. Pathologic tumor volume was estimated from surgical specimens. Metabolic tumor volume (MTV) was defined from PET-CT scans as the volume of tumor above a given SUV threshold. Multiple SUV thresholds were explored including absolute SUV thresholds, relative SUV thresholds, and gradient-based techniques.Multiple MTV's were associated with pathologic tumor volume; however the correlation was poor (R(2) range 0.29-0.58). The ideal SUV threshold, defined as the SUV that generates an MTV equal to pathologic tumor volume, was independently associated with maximum SUV (p=0.0005) and tumor grade (p=0.024). MTV defined as a function of maximum SUV and tumor grade improved the prediction of pathologic tumor volume (R(2)=0.63).Common SUV thresholds fail to predict pathologic tumor volume in head and neck cancer. The optimal technique that allows for integration of PET-CT with radiation treatment planning remains to be defined. Future investigation should incorporate biomarkers such as tumor grade into definitions of MTV.

    View details for DOI 10.1016/j.radonc.2011.05.040

    View details for Web of Science ID 000298894700003

    View details for PubMedID 21665308

  • PET/CT Imaging of Thyroid Cancer CLINICAL NUCLEAR MEDICINE Mosci, C., Iagaru, A. 2011; 36 (12): E180-E185

    Abstract

    Positron emission tomography (PET) is a highly sensitive, low invasive technology for cancer biology imaging. The role of F-18 FDG PET/CT in differentiated thyroid cancer (DTC) is well established, particularly in patients presenting with elevated Tg levels and negative radioactive iodine WBS. It has been demonstrated that F-18 FDG uptake represents less differentiated thyroid cancer cells or dedifferentiated cells and PET positive lesions are more likely to be resistant to I treatment. The uptake of F-18 FDG is related to tumor size, thyroid capsule invasion and histological variants with a poor prognosis. As in other cancers, early detection of recurrences improves outcomes and survival. I PET/CT can also be used to image the patients with DTC, similarly to I WBS. Compared with F-18 FDG PET/CT, its spatial resolution is only slightly degraded but increasing the imaging time reduces this difference. In addition, F-18 FDG PET/CT has been found helpful in the management of patients with anaplastic and medullary thyroid cancer. Other radiopharmaceuticals such as Ga-DOTATOC and F-18 DOPA may provide complimentary information to F-18 FDG PET/CT in the detection of recurrent thyroid cancer.

    View details for DOI 10.1097/RLU.0b013e3182291d03

    View details for Web of Science ID 000296796800001

    View details for PubMedID 22064103

  • Pilot Pharmacokinetic and Dosimetric Studies of F-18-FPPRGD2: A PET Radiopharmaceutical Agent for Imaging alpha(v)beta(3) Integrin Levels RADIOLOGY Mittra, E. S., Goris, M. L., Iagaru, A. H., Kardan, A., Burton, L., Berganos, R., Chang, E., Liu, S., Shen, B., Chin, F. T., Chen, X., Gambhir, S. S. 2011; 260 (1): 182-191

    Abstract

    To assess the safety, biodistribution, and dosimetric properties of the positron emission tomography (PET) radiopharmaceutical agent fluorine 18 ((18)F) FPPRGD2 (2-fluoropropionyl labeled PEGylated dimeric RGD peptide [PEG3-E{c(RGDyk)}2]), which is based on the dimeric arginine-glycine-aspartic acid (RGD) peptide sequence and targets ?(v)?(3) integrin, in the first volunteers imaged with this tracer.The protocol was approved by the institutional review board, and written informed consent was obtained from all participants. Five healthy volunteers underwent whole-body combined PET-computed tomography 0.5, 1.0, 2.0, and 3.0 hours after tracer injection (mean dose, 9.5 mCi ± 3.4 [standard deviation] [351.5 MBq ± 125.8]; mean specific radioactivity, 1200 mCi/mmol ± 714 [44.4 GBq/mmol ± 26.4]). During this time, standard vital signs, electrocardiographic (ECG) readings, and blood sample values (for chemistry, hematologic, and liver function tests) were checked at regular intervals and 1 and 7 days after the injection. These data were used to evaluate tracer biodistribution and dosimetric properties, time-activity curves, and the stability of laboratory values. Significant changes in vital signs and laboratory values were evaluated by using a combination of population-averaged generalized estimating equation regression and exact paired Wilcoxon tests.The administration of (18)F-FPPRGD2 was well tolerated, with no marked effects on vital signs, ECG readings, or laboratory values. The tracer showed the same pattern of biodistribution in all volunteers: primary clearance through the kidneys (0.360 rem/mCi ± 0.185 [0.098 mSv/MBq ± 0.050]) and bladder (0.862 rem/mCi ± 0.436 [0.233 mSv/MBq ± 0.118], voiding model) and uptake in the spleen (0.250 rem/mCi ± 0.168 [0.068 mSv/MBq ± 0.046]) and large intestine (0.529 rem/mCi ± 0.236 [0.143 mSv/MBq ± 0.064]). The mean effective dose of (18)F-FPPRGD2 was 0.1462 rem/mCi ± 0.0669 (0.0396 mSv/MBq ± 0.0181). With an injected dose of 10 mCi (370 MBq) and a 1-hour voiding interval, a patient would be exposed to an effective radiation dose of 1.5 rem (15 mSv). Above the diaphragm, there was minimal uptake in the brain ventricles, salivary glands, and thyroid gland. Time-activity curves showed rapid clearance from the vasculature, with a mean 26% ± 17 of the tracer remaining in the circulation at 30 minutes and most of the activity occurring in the plasma relative to cells (mean whole blood-plasma ratio, 0.799 ± 0.096).(18)F-FPPRGD2 has desirable pharmacokinetic and biodistribution properties. The primary application is likely to be PET evaluation of oncologic patients-especially those with brain, breast, or lung cancer. Specific indications may include tumor staging, identifying patients who would benefit from antiangiogenesis therapy, and separating treatment responders from nonresponders early.

    View details for DOI 10.1148/radiol.11101139

    View details for Web of Science ID 000291932300021

    View details for PubMedID 21502381

  • FDG-PET/CT in Cancers of the Head and Neck: What is the Definition of Whole Body Scanning? MOLECULAR IMAGING AND BIOLOGY Iagaru, A., Mittra, E. S., Gambhir, S. S. 2011; 13 (2): 362-367

    Abstract

    The role of 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET) was studied in a variety of cancers, including head and neck squamous cell carcinomas (HNSCC) and nasopharyngeal carcinomas (NPC), with several presentations indicating that for these clinical entities a "whole-body" (i.e., eyes to thighs) may yield little additional information. Therefore, we were prompted to review our experience with PET/computed tomography (CT) in the management of patients with HNSCC and NPC.This is a retrospective study of 133 patients with HNSCC, 23-90 years old (average: 58.2?±?12.7) and 26 patients with NPC, ages 16-75 (average: 47.3?±?17.1), who had whole body PET/CT at our institution from Jan 2003 to Nov 2006. Reinterpretation of the imaging studies for accuracy and data analysis from medical records was performed. Lesions identified on PET/CT below the level of the adrenal glands were recorded and tabulated.Lesions were identified below the adrenal glands in seven patients (5.2%) with HNSCC. These included hepatic and osseous metastases from HNSCC in two patients (1.5%), a new renal cancer (0.75%), a new pancreatic cancer (0.75%), a new colon cancer (0.75%) and findings proven benign on follow-up (focal colon uptake in one patient and an inflammatory inguinal lymph node in another patient; 1.5%). Lesions were identified below the adrenal glands in three patients (11.5%) with NPC. These included osseous metastases from NPC in two patients (7.7%) and findings proven benign on follow-up (focal colon uptake in one patient; 3.84%).This study suggests that whole body PET/CT imaging in HNSCC has a relatively low yield (3%, 95% CI: 1.33-8.42) of significant findings below the level of the adrenal glands. Therefore, implementing a more limited protocol (through the level of adrenal glands), especially in low-risk cases of HNSCC, may be considered. However, whole body PET/CT imaging in NPC may have a significant yield (7.7%, 95% CI: 1.02-25.26) of medically relevant findings below the level of the adrenal glands. Thus, the whole body (i.e., vertex to thighs) PET/CT scan of NPC patients appears to be the appropriate imaging protocol for this population. This recommendation requires further evaluation and validation in larger prospective studies.

    View details for DOI 10.1007/s11307-010-0343-8

    View details for Web of Science ID 000288177700021

    View details for PubMedID 20495879

  • Thyroid Stunning: Fact or Fiction? SEMINARS IN NUCLEAR MEDICINE McDougall, I. R., Iagaru, A. 2011; 41 (2): 105-112

    Abstract

    Stunning of thyroid tissue by diagnostic activities of (131)I has been described by some investigators and refuted by others. The support both for and against stunning has at times been enthusiastic and vigorous. We present the data from both sides of the debate in an attempt to highlight the strengths and deficiencies in the investigations cited. Clinical, animal, and in vitro studies are included. There are considerable differences in clinical practice, such as the administered activity for diagnostic whole-body scan, delay between diagnostic scan and treatment, time between treatment and posttherapy scanning, and timing of follow-up studies, that have to be analyzed with care. Other factors that often cannot be judged, such as levels of thyroid-stimulating hormone and serum iodine at time of diagnostic testing versus treatment could have an influence on stunning. Larger diagnostic doses and longer delays to therapy appear to increase the likelihood of stunning. The stunning effect of early-absorbed radiation from the therapy should also be considered.

    View details for DOI 10.1053/j.semnuclmed.2010.10.004

    View details for Web of Science ID 000287263600006

    View details for PubMedID 21272684

  • Case 166: Metastatic Left Pulmonary Artery Sarcoma RADIOLOGY Mittra, E. S., Iagaru, A. H., Leung, A. N. 2011; 258 (2): 645-648

    View details for DOI 10.1148/radiol.10082169

    View details for Web of Science ID 000286653700037

    View details for PubMedID 21273527

  • (18)F-FDG PET/CT: timing for evaluation of response to therapy remains a clinical challenge. American journal of nuclear medicine and molecular imaging Iagaru, A. 2011; 1 (1): 63-64

    Abstract

    Utilizing novel imaging modalities for defining response and predicting long-term outcome after treatment may have a significant impact on cancer patient management. (18)F-FDG PET/CT has great potential for use in early assessment of response to cancer therapy. However, the lack of a general consensus on a specific set of response criteria makes adoption of PET difficult for the oncology community. The optimal time after initiating therapy for assessing response to treatment also has yet to be clearly determined.

    View details for PubMedID 23133796

  • Current concepts and future directions in radioimmunotherapy. Current drug discovery technologies Lin, F. I., Iagaru, A. 2010; 7 (4): 253-262

    Abstract

    Radioimmunotherapy relies on the principles of immunotherapy, but expands the cytotoxic effects of the antibody by complexing it with a radiation-emitting particle. If we consider radioimmunotherapy as a step beyond immunotherapy of cancer, the step was prompted by the (relative) failure of the latter. The conventional way to explain the failure is a lack of intrinsic killing effect and a lack of penetration into poorly vascularized tumor masses. The addition of a radioactive label (usually a ?-emitter) to the antibody would improve both. Radiation is lethal and the type of radiation used (beta rays) has a sufficient range to overcome the lack of antibody penetration. At present, the most successful (and FDA approved) radioimmunotherapy agents for lymphomas are anti-CD20 monoclonal antibodies. Rituximab (Rituxan(®)) is a chimeric antibody, used as a non-radioactive antibody and to pre-load the patient when Zevalin(®) is used. Zevalin(®) is the Yttrium-90 ((90)Y) or Indium-111 ((111)In) labeled form of Ibritumomab Tiuxetan. Bexxar(®) is the Iodine-131 ((131)I) labeled form of Tositumomab. Ibritumomab Tiuxetan and Tositumomab are murine anti-CD20 monoclonal antibodies, not chimeric antibodies. Promising research is being done to utilize radioimmunotherapy earlier in the treatment algorithm for lymphoma, including as initial, consolidation, and salvage therapies. However, despite more than 8 years since initial regulatory approval, radioimmunotherapy still has not achieved widespread use due to a combination of medical, scientific, logistic, and financial barriers. Other experimental uses for radioimmunotherapy include other solid tumors to treat infections. Optimization can potentially be done with pre-targeting and bi-specific antibodies. Alpha particle and Auger electron emitters show promise as future radioimmunotherapy agents but are mostly still in pre-clinical stages.

    View details for PubMedID 21034409

  • F-18 FDG PET/CT Demonstration of Lymphohistiocytic Meningitis CLINICAL NUCLEAR MEDICINE Mansouri, M. A., Iagaru, A. 2010; 35 (8): 633-634

    View details for Web of Science ID 000279892100023

    View details for PubMedID 20631522

  • I-131-Tositumomab (BexxarA (R)) vs. Y-90-Ibritumomab (ZevalinA (R)) Therapy of Low-Grade Refractory/Relapsed Non-Hodgkin Lymphoma MOLECULAR IMAGING AND BIOLOGY Iagaru, A., Mittra, E. S., Ganjoo, K., Knox, S. J., Goris, M. L. 2010; 12 (2): 198-203

    Abstract

    The American Cancer Society estimated 66,120 new cases of non-Hodgkin lymphoma (NHL) in the USA in 2008. Radioimmunotherapy has been shown in clinical trials to be an effective treatment for refractory/relapsed NHL. The available agents are Bexxar, a (131)I radiolabeled murine monoclonal antibody, and Zevalin, a (90)Y radiolabeled murine antibody. Both target CD20 receptors present on the surface of lymphocytes. We present our clinical experience with Bexxar and Zevalin in the management of low-grade refractory or relapsed NHL.This is a retrospective study (Jan 2000-Jul 2006) of 67 patients with NHL, who were treated with Bexxar (31 patients, group A) or Zevalin (36 patients, group B) for refractory/relapsed disease. Group A included 16 men and 15 women, 35-81 years old (average, 59.3 +/- 13.4). Group B included 27 men and nine women, 36-85 years old (average, 55.4 +/- 13.8). Therapeutic doses ranged 40-138 mCi (average, 78.1 +/- 28.2) for Bexxar and 17-34 mCi (average, 28.8 +/- 4.37) for Zevalin.Objective responses were induced in 22 of the 31 patients (70.9%) in group A and 28 of the 36 patients (77.8%) in group B. Complete response was noted in 11 patients (35.5%), partial response in seven patients (22.6%), and mixed response in four patients (12.9%) in group A. There were five patients (16.1%) with stable disease and four patients (12.9%) with disease progression in the same group. Complete response was noted in 15 patients (41.7%), partial response in nine patients (25%), and mixed response in four patients (11.1%) in group B. There were four patients (11.1%) with stable disease and another four patients (11.1%) with disease progression in the same group. The average decreases at posttherapy nadir were 36.9% +/- 0.33 (group A) and 52.6% +/- 0.32 (group B) for platelets, 27.8% +/- 0.27 (group A) and 34.2% +/- 0.38 (group B) for leukocytes, and 4.9% +/- 0.15 (group A) and 7.6% +/- 0.11 (group B) for hemoglobin. Grades 3 and 4 hematological toxicity occurred in 14 patients (45.2%) treated with Bexxar and 22 patients (61.1%) treated with Zevalin, but was reversible.Our study suggests that clinical practice of Bexxar and Zevalin radioimmunotherapy is an effective and safe adjunctive treatment for patients with NHL refractory/relapsed to conventional treatment. However, due to the small number of subjects, it was not possible to determine whether differences in the outcomes or toxicities from the two agents were statistically significant.

    View details for DOI 10.1007/s11307-009-0245-9

    View details for Web of Science ID 000275974900010

    View details for PubMedID 19543946

  • Combined F-18-FDG and Fluoride Approach in PET/CT Imaging: Is There a Clinical Future? REPLY JOURNAL OF NUCLEAR MEDICINE Iagaru, A., Mittra, E., Goris, M. L., Gambhir, S. S. 2010; 51 (1): 166-167
  • Efficacy of F-18-FDG PET/CT in the evaluation of patients with recurrent cervical carcinoma EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING Mittra, E., El-Maghraby, T., Rodriguez, C. A., Quon, A., McDougall, I. R., Gambhir, S. S., Iagaru, A. 2009; 36 (12): 1952-1959

    Abstract

    Only a limited number of studies have evaluated the efficacy of 18F-FDG PET/CT for recurrent cervical carcinoma, which this study seeks to expand upon.This is a retrospective study of 30 women with cervical carcinoma who had a surveillance PET/CT after initial therapy. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated using a 2 × 2 contingency table with pathology results (76%) or clinical follow-up (24%) as the gold standard. The Wilson score method was used to perform 95% confidence interval estimations.The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT for the detection of local recurrence at the primary site were 93, 93, 93, 86, and 96%, respectively. The same values for the detection of distant metastases were 96, 95, 95, 96, and 95%, respectively. Seventy-one percent of the scans performed in symptomatic patients showed true-positive findings. In comparison, 44% of scans performed in asymptomatic patients showed true-positive findings. But, all patients subsequently had a change in their management based on the PET/CT findings such that the effect was notable. The maximum standardized uptake value ranged from 5 to 28 (average: 13 ± 7) in the primary site and 3 to 23 (average: 8 ± 4) in metastases which were significantly different (p = 0.04).This study demonstrates favorable efficacy of 18F-FDG PET/CT for identification of residual/recurrent cervical cancer, as well as for localization of distant metastases.

    View details for DOI 10.1007/s00259-009-1206-x

    View details for Web of Science ID 000271979300004

    View details for PubMedID 19585114

  • Evaluation by F-18-FDG-PET of patients with anal squamous cell carcinoma HELLENIC JOURNAL OF NUCLEAR MEDICINE Iagaru, A., Kundu, R., Jadvar, H., Nagle, D. 2009; 12 (1): 26-29

    Abstract

    Anal squamous cell carcinoma (ASCC) is a rare cancer of the gastrointestinal tract, representing less than 5% of the digestive malignancies. The cytological and/or histological confirmation of a suspected lesion should be followed by a complete imaging evaluation to determine the extent of disease. We are presenting our experience with (18)F-FDG PET in ASCC. This is a retrospective case series of patients diagnosed and treated for ASCC at our institution(s). A total of 14 (18)F-FDG PET scans (8 for initial staging, 6 for evaluation of response to chemotherapy and radiation therapy) were performed in 8 patients (6 men, 2 women). The patients were 33-60 years old (average: 44+/-9). Our results showed that PET demonstrated the primary lesion at initial evaluation in 7 of 8 anal cancers and showed FDG- avid lymph nodes in 4 patients. Metastatic nodal involvement was confirmed by pathology in 2 patients; in the other 2 patients pathology showed reactive follicular hyperplasia. In another patient, follow-up PET demonstrated progression of disease despite treatment, prompting a change in disease management. In the remaining 5 patients with follow-up PET, the scans confirmed interval resolution of the (18)F-FDG uptake in the primary lesion, suggesting good treatment response. In conclusion, PET provides valuable diagnostic information in initial staging and evaluation of treatment response in ASCC that may significantly alter the clinical management. The emergence of the combined PET/CT scanner enhanced the accuracy of the imaging procedure in view of the precise anatomic localization of metabolic abnormalities.

    View details for Web of Science ID 000265034600007

    View details for PubMedID 19330178

  • Tumor Metabolic Phenotypes on F-18 FDG PET REPLY JOURNAL OF NUCLEAR MEDICINE Iagaru, A. H., Gambhir, S. S., Goris, M. L. 2009; 50 (6): 1011-1012
  • Incorporating Cone-beam CT into the Treatment Planning for Yttrium-90 Radioembolization JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Louie, J. D., Kothary, N., Kuo, W. T., Hwang, G. L., Hofmann, L. V., Goris, M. L., Iagaru, A. H., Sze, D. Y. 2009; 20 (5): 606-613

    Abstract

    To prepare for yttrium-90 ((90)Y) microsphere radioembolization therapy, digital subtraction angiography (DSA) and technetium- 99m-labeled macroaggregated albumin ((99m)Tc MAA) scintigraphy are used for treatment planning and detection of potential nontarget embolization. The present study was performed to determine if cone-beam computed tomography (CBCT) affects treatment planning as an adjunct to these conventional imaging modalities.From March 2007 to August 2008, 42 consecutive patients (21 men, 21 women; mean age, 59 years; range, 21-75 y) who underwent radioembolization were evaluated by CBCT in addition to DSA and (99m)Tc MAA scintigraphy during treatment planning, and their records were retrospectively reviewed. The contrast-enhanced territories shown by CBCT with selective intraarterial contrast agent administration were used to predict intrahepatic and possible extrahepatic distribution of microspheres.In 22 of 42 cases (52%), extrahepatic enhancement or incomplete tumor perfusion seen on CBCT affected the treatment plan. In 14 patients (33%), the findings were evident exclusively on CBCT and not detected by DSA. When comparing CBCT versus (99m)Tc MAA scintigraphy, CBCT showed eight cases of extrahepatic enhancement (19%) that were not evident on (99m)Tc MAA imaging. CBCT findings directed the additional embolization of vessels or repositioning of the catheter for better contrast agent and microsphere distribution. One case of gastric ulcer from nontarget embolization caused by reader error was observed.CBCT can provide additional information about tumor and tissue perfusion not currently detectable by DSA or (99m)Tc MAA imaging, which should optimize (90)Y microsphere delivery and reduce nontarget embolization.

    View details for DOI 10.1016/j.jvir.2009.01.021

    View details for Web of Science ID 000265700900007

    View details for PubMedID 19345589

  • Novel Strategy for a Cocktail F-18-Fluoride and F-18-FDG PET/CT Scan for Evaluation of Malignancy: Results of the Pilot-Phase Study JOURNAL OF NUCLEAR MEDICINE Iagaru, A., Mittra, E., Yaghoubi, S. S., Dick, D. W., Quon, A., Goris, M. L., Gambhir, S. S. 2009; 50 (4): 501-505

    Abstract

    (18)F-FDG PET/CT is used for detecting cancer and monitoring cancer response to therapy. However, because of the variable rates of glucose metabolism, not all cancers are identified reliably. Sodium (18)F was previously used for bone imaging and can be used as a PET/CT skeletal tracer. The combined administration of (18)F and (18)F-FDG in a single PET/CT study for cancer detection has not been reported to date.This is a prospective pilot study (November 2007-November 2008) of 14 patients with proven malignancy (6 sarcoma, 3 prostate cancer, 2 breast cancer, 1 colon cancer, 1 lung cancer, and 1 malignant paraganglioma) who underwent separate (18)F PET/CT and (18)F-FDG PET/CT and combined (18)F/(18)F-FDG PET/CT scans for the evaluation of malignancy (a total of 3 scans each). There were 11 men and 3 women (age range, 19-75 y; average, 50.4 y).Interpretation of the combined (18)F/(18)F-FDG PET/CT scans compared favorably with that of the (18)F-FDG PET/CT (no lesions missed) and the (18)F PET/CT scans (only 1 skull lesion seen on an (18)F PET/CT scan was missed on the corresponding combined scan). Through image processing, the combined (18)F/(18)F-FDG scan yielded results for bone radiotracer uptake comparable to those of the (18)F PET/CT scan performed separately.Our pilot-phase prospective trial demonstrates that the combined (18)F/(18)F-FDG administration followed by a single PET/CT scan is feasible for cancer detection. This combined method opens the possibility for improved patient care and reduction in health care costs.

    View details for DOI 10.2967/jnumed.108.058339

    View details for Web of Science ID 000272487200003

    View details for PubMedID 19289439

  • F-18-FDG PET/CT evaluation of patients with ovarian carcinoma NUCLEAR MEDICINE COMMUNICATIONS Iagaru, A. H., Mittra, E. S., McDougall, I. R., Quon, A., Gambhir, S. S. 2008; 29 (12): 1046-1051

    Abstract

    The role of F-FDG PET has been studied in ovarian carcinoma, but its sensitivity and specificity calculations are based on dedicated PET acquisition, not PET/CT in the majority of the published studies. Therefore, we were prompted to review our experience with PET/CT in the management of patients with ovarian carcinoma.This is a retrospective study of 43 women with ovarian carcinoma, 27-80 years old (average: 53.9+/-7.8), who had whole-body PET/CT at our institution from 1 January 2003 to 31 August 2006. We reviewed the patients' outcomes from medical records and compared them to the interpretation of the PET/CT scans. Sensitivity and specificity were calculated using a 2 x 2 table with pathology results (79.1% of the patients) or clinical follow-up (20.9% of the cases) as the 'gold standard'. Confidence interval (CI) estimations were performed using the Wilson score method.All patients had advanced stage ovarian cancer and the study was requested for re-staging. A total of 60 scans were performed: 30 patients had one scan, nine patients had two scans and four patients had three scans. The administered doses of F-FDG ranged from 381.1 to 769.6 MBq (average: 569.8+/-73.3). PET/CT had a sensitivity of 88.4% (95% CI: 75.1-95.4) and a specificity of 88.2% (95% CI: 64.4-97.9) for detection of ovarian cancer. The SUV max of the detected lesions ranged from 3 to 27 (average: 9.4+/-5.9). The CA-125 tumor marker ranged from 3 to 935 kU/ml (average: 265.2) in patients with positive scans and 4-139 kU/ml (average: 17.1) in patients with negative scans. This difference was statistically significant (P value: 0.0242).This study confirms the good results of F-FDG PET/CT for identification of residual/recurrent ovarian cancer, as well as for distant metastases localization. PET/CT should be an integral part in evaluation of patients with high-risk ovarian cancer or rising values of tumor markers (CA-125), prior to selection of the most appropriate therapy.

    View details for DOI 10.1097/MNM.0b013e32831089cb

    View details for Web of Science ID 000261164200004

    View details for PubMedID 18987524

  • Y-90-Ibritumomab Therapy in Refractory Non-Hodgkin's Lymphoma: Observations from In-111-Ibritumomab Pretreatment Imaging JOURNAL OF NUCLEAR MEDICINE Iagaru, A., Gambhir, S. S., Goris, M. L. 2008; 49 (11): 1809-1812

    Abstract

    Radioimmunotherapy is an effective treatment for non-Hodgkin's lymphoma (NHL). 90Y-ibritumomab is an antibody targeting CD20 receptors on the surface of lymphocytes. We present observations from our clinical experience with 90Y-ibritumomab in the management of NHL.This was a retrospective study of 28 NHL patients treated with 90Y-ibritumomab. There were 21 men and 7 women, 36-85 y old. A diagnostic dose of 111In-ibritumomab was administered on day 0, and imaging followed immediately and at 24, 48, and 72 h. The doses of 90Y-ibritumomab ranged from 629 to 1,258 MBq (17-34 mCi). Outcomes were compared with the findings of the 111In-ibritumomab scans.90Y-ibritumomab induced objective responses in 22 of 28 patients. A complete response was noted in 9 patients, a partial response in 9 patients, and a mixed response in 4 patients. Three patients had stable disease, and 3 patients had disease progression. 111In-ibritumomab findings were positive in 19 patients and negative in 9 patients. A complete response was noted in 2 of 19 patients with positive findings and 7 of 9 with negative findings. A partial response was seen in 7 of 19 patients with positive findings and 1 of 9 with negative findings. Disease progression was observed in 3 of 19 patients with positive findings and 0 of 9 with negative findings. The remaining patients had a mixed response or no changes.A higher rate of complete response after 90Y-ibritumomab treatment was seen in patients with negative 111In-ibritumomab findings, whereas a higher rate of disease progression despite therapy was noted in patients with positive 111In-ibritumomab findings. This observation suggests that patients with bulky disease may require more aggressive management.

    View details for DOI 10.2967/jnumed.108.052928

    View details for Web of Science ID 000260846600019

    View details for PubMedID 18927323

  • Rhabdomyosarcoma diffusely metastatic to the bone marrow: suspicious findings on Tc-99m-MDP bone scintigraphy confirmed by F-18-18 FDG PET/CT and bone marrow biopsy EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING Iagaru, A., Goris, M. L. 2008; 35 (9): 1746-1746

    View details for DOI 10.1007/s00259-008-0864-4

    View details for Web of Science ID 000258673800026

    View details for PubMedID 18648808

  • F-18-FDG-PET/CT evaluation of response to treatment in lymphoma: when is the optimal time for the first re-evaluation scan? HELLENIC JOURNAL OF NUCLEAR MEDICINE Iagaru, A., Wang, Y., Mari, C., Quon, A., Goris, M. L., Horning, S., Gambhir, S. S. 2008; 11 (3): 153-156

    Abstract

    Assessing the response to treatment as soon after treatment initiation is one of the key reasons for imaging lymphoma patients. The optimal time after initiating treatment for assessing response to treatment has yet to be determined. Therefore, we were prompted to review our experience with serial (18)F-FDG PET/CT in patients undergoing treatment for Hodgkin's disease (HD) and non Hodgkin's lymphoma (NHL). This is a retrospective study (Feb 2003 - Oct 2004) of 20 patients, 11 men and 9 women, with age range of 7-75 years with diagnosis of HD (10) and NHL (10), who had PET/CT at our institution prior, during and at the completion of therapy. Restaging PET/CT was done after 2 cycles of chemotherapy in 10 patients (group A) and after 4 cycles of chemotherapy in 10 pts (group B). A total of 60 scans were reviewed. The DeltaSUV from baseline to first PET/CT was on average 67.6% in group A and 75.1% in group B. This had no statistical significance (P value: 0.31). The DeltaSUV from baseline to post-therapy PET/CT was on average 72.9% in group A and 79.8% in group B. This difference also had no statistical significance (P value: 0.24). The correlation coefficient was 0.98 in group A and 0.80 in group B. Results of PET/CT after 2 cycles of chemotherapy did not statistically differ from the results of PET/CT after 4 cycles of chemotherapy. These results need to be confirmed in larger, prospective, randomized trials.

    View details for Web of Science ID 000262093600003

    View details for PubMedID 19081857

  • Perspectives of molecular imaging and radioimmunotherapy in lymphoma RADIOLOGIC CLINICS OF NORTH AMERICA Iagaru, A., Goris, M. L., Gambhir, S. S. 2008; 46 (2): 243-252

    Abstract

    Successful treatment of Hodgkin lymphomas and non-Hodgkin lymphomas depends on accurate staging and prognostic estimations, as well as evaluation of response to therapy as early after initiation as possible. We focus on several aspects of molecular imaging and therapy that affect the management of patients who have lymphoma. First, we review prior use of gallium-67 citrate for evaluation of lymphoma patients, mainly from a historical perspective, since it was the mainstream lymphoma functional imaging tracer for decades. Next, we review current clinical uses of 18F Fluoro-2-Deoxyglucose (18F FDG) PET and PET/CT for evaluation of lymphoma patients and use of radioimmunotherapy in lymphoma. Finally, we discuss advances in molecular imaging that may herald the next generation of PET radiotracers after 18F FDG.

    View details for DOI 10.1016/j.rcl.2008.03.007

    View details for Web of Science ID 000258543500006

    View details for PubMedID 18619379

  • I-123 MIBG mapping with intraoperative gamma probe for recurrent neuroblastoma MOLECULAR IMAGING AND BIOLOGY Iagaru, A., Peterson, D., Quon, A., Dutta, S., Twist, C., Daghighian, F., Gambhir, S. S., Albanese, C. 2008; 10 (1): 19-23

    Abstract

    Intraoperative gamma probe guidance has become widely utilized for sentinel lymph node dissection in patients with breast cancer and melanoma, using (99m)Tc sulfur colloid. However, new indications are possible and need to continue to be investigated. We report the use during a wedge liver biopsy of a new hand-held gamma probe designed for (123)I intraoperative guidance. The patient studied is a 5-year-old boy with history of stage 4 high-risk neuroblastoma. Anatomic imaging (CT, MRI), (99m)Tc bone scintigraphy and 2-deoxy-2-[F-18]fluoro-d-glucose-positron emission tomography/computed tomography (FDG-PET/CT) were negative, but the (123)I MIBG scintigraphy suggested recurrent liver disease. A decision was made to biopsy these lesions to obtain histopathological confirmation. Intraoperative gamma probe mapping of the liver identified areas with signal above the background, but these were prove to be hemosiderin deposits on histo-pathology examination.

    View details for DOI 10.1007/s11307-007-0116-1

    View details for Web of Science ID 000252107800002

    View details for PubMedID 17975716

  • F-18FDG PET and PET/CT evaluation of response to chemotherapy in bone and soft tissue sarcomas CLINICAL NUCLEAR MEDICINE Iagaru, A., Masamed, R., Chawla, S. P., Menendez, L. R., Fedenko, A., Conti, P. S. 2008; 33 (1): 8-13

    Abstract

    F-18 FDG PET has been used to grade sarcomas and assess response to therapy in advanced disease. Certain chemotherapy agents are thought to induce an inflammatory response in the tumor bed that can make interpretation of post-therapy FDG PET scans difficult. A review of our experience with PET in assessing therapy response in osseous and soft tissue sarcomas (OSTS) is presented.This is a retrospective study (January 1999 to December 2004) of 14 patients with histologic diagnosis of OSTS, who had 2 consecutive PET examinations for evaluation of chemotherapy response. The group included 8 men and 6 women, with age range of 18 to 56 years (average, 36 +/- 14). Semiquantitative assessment of FDG uptake was performed by calculating maximum standard uptake value (SUVmax) before and after treatment. The response to therapy was assessed independently by tumor necrosis at post-therapy surgery and according to European Organization for Research and Treatment of Cancer (EORTC) criteria for PET. The follow-up PET examinations were performed at an interval of 28 to 166 days (average, 90 +/- 45). All patients ended the ifosfamide regimen at 7 to 36 (average, 16 +/- 9) days before the follow-up PET scans. Five of them received methotrexate, adriamycin, and/or cisplatin as well.Based on the EORTC criteria alone, 3 patients (21.4%) had progression of disease (increase in SUVmax of 29%-69%; mean, 48% +/- 20%), 5 patients (35.7%) had stable disease, and 6 patients (42.8%) had partial response (decrease in SUVmax of 27%-84%; mean, 62% +/- 23%). Across all patients, the tumor necrosis postchemotherapy ranged from 5% to 100% (mean, 64% +/- 34%). In 8 patients (57.1%) the tumor necrosis correlated with the SUVmax changes. However, for 3 patients, the SUVmax changes indicated partial response despite necrosis of fewer than 90% of the surgical specimens, whereas 3 patients with >90% tumor necrosis had SUVmax changes indicative of stable disease.The pathologically determined degree of necrosis postneoadjuvant chemotherapy was concordant with PET-assessed EORTC classification of response in 57.1% of the cases. However, a significant number of patients had discrepancies, which may be in part explained by chemotherapy-induced inflammation. The latter should be considered during post-therapy PET interpretation in OSTS.

    View details for Web of Science ID 000252074200003

    View details for PubMedID 18097248

  • Molecular imaging can accelerate anti-angiogenic drug development and testing NATURE CLINICAL PRACTICE ONCOLOGY Lagaru, A., Chen, X., Gambhir, S. S. 2007; 4 (10): 556-557

    View details for DOI 10.1038/ncponc0929

    View details for Web of Science ID 000249708800002

    View details for PubMedID 17726490

  • F-18 FDG PET/CT in the management of thyroid cancer CLINICAL NUCLEAR MEDICINE Iagaru, A., Kalinyak, J. E., McDougall, I. R. 2007; 32 (9): 690-695

    Abstract

    There are approximately 32,000 new cases of thyroid carcinoma annually in the United States. F-18 FDG PET/CT has an established role in cancer management, including thyroid cancer, usually in patients who are thyroglobulin (Tg) positive/iodine negative. We reviewed our experience with F-18 FDG PET/CT in thyroid cancer, with an emphasis on correlation with Tg, and maximum standardized uptake values (SUV). We also analyzed the role of thyroid stimulating hormone (TSH) on PET/CT results.This is a retrospective study (January 2003 to December 2006) of 76 patients with differentiated thyroid cancer, who had F-18 FDG PET/CT scans. There were 44 women and 32 men, with age range of 20 to 81 years (average, 51.1 +/- 18.1). The administered doses of F-18 FDG ranged from 396 to 717 MBq (15.8-19.4 mCi) (average, 566 +/- 74.8) (15.3 +/- 2). Reinterpretation of the imaging studies for accuracy and data analysis from medical records were performed.A total of 98 PET/CT scans were analyzed (59 patients had 1 scan, 12 patients had 2, and 5 patients had 3). PET/CT was 88.6% sensitive (95% CI: 78.-94.3) and 89.3% specific (95% CI: 71.9-97.1). Mean Tg level was 1203 ng/mL (range, 0.5-28,357) in patients with positive PET/CT and 9.72 ng/mL (range, 0.5-123.0) in patients with negative PET/CT scans (P = 0.0389). Mean SUV max was 10.8 (range, 2.5-32) in the thyroid bed recurrence/residual disease and 7.53 (range, 2.5-26.2) in metastatic lesions (P = 0.0114). Mean SUV max in recurrent/residual disease in patients with TSH 30 mIU/L was 8.1 (range, 2.6-32) (P = 0.2994).F-18 FDG PET/CT had excellent sensitivity (88.6%) and specificity (89.3%) in this patient population. Metastatic lesions were reliably identified, but were less F-18 FDG avid than recurrence/residual disease in the thyroid bed. TSH levels at the time of PET/CT did not appear to impact the FDG uptake in the lesions or the ability to detect disease. In the setting of high or rising levels of Tg, our study confirms that it is indicated to include PET/CT in the management of patients with differentiated thyroid cancer.

    View details for Web of Science ID 000248959000004

    View details for PubMedID 17710020

  • Advances in metabolic imaging for surgical oncology SURGICAL ONCOLOGY CLINICS OF NORTH AMERICA Iagaru, A., Quon, A. 2007; 16 (2): 273-?

    Abstract

    This review focuses on several aspects of molecular imaging. First, current positron emission tomography (PET)/CT scanner technology and several novel imaging techniques that are being developed are briefly discussed. Next, current clinical indications for (18)F FDG PET and PET/CT that are relevant to the surgical oncologist are discussed. Finally, advances in molecular imaging that may herald the next generation of PET radiotracers beyond (18)F FDG are reviewed.

    View details for DOI 10.1016/j.soc.2007.03.007

    View details for Web of Science ID 000247901000003

    View details for PubMedID 17560512

  • Detection of occult medullary thyroid cancer recurrence with 2-deoxy-2-[F-18]fluoro-D-glucose-PET and PET/CT MOLECULAR IMAGING AND BIOLOGY Iagaru, A., Masamed, R., Singer, P. A., Conti, P. S. 2007; 9 (2): 72-77

    Abstract

    2-deoxy-2-[F-18]fluoro-D-glucose (FDG)-positron emission tomography (PET) has an established role in restaging of various cancers, including papillary and undifferentiated thyroid carcinoma. However, controversies exist regarding its ability to reliably assess recurrent medullary thyroid cancer (MTC). We were therefore prompted to review our experience with FDG-PET for detection of occult MTC.This is a retrospective study (Apr 1, 1997-Mar 31, 2004) of 13 patients with histologic diagnosis of MTC, who had PET examinations. The group included six men and seven women, 15-62 years old (average: 48+/-13). The PET scan request was triggered by rising levels of calcitonin and negative anatomical imaging studies.Recurrent/metastatic disease was identified by PET in seven (54%) of the 13 patients. The lesions were located in superior mediastinum (4), cervical lymph nodes (3), thyroid bed (2), lung (1) and liver (1). The calcitonin levels ranged from 52 to 5,090 pg/ml (average: 1,996 pg/ml) in patients with negative PET scans and from 132 to 9,500 pg/ml (average: 3,757 pg/ml) in patients with positive studies. The sensitivity and specificity of FDG-PET for disease detection in this cohort were 85.7% (95% CI: 48.7-97.4) and 83.3% (95% CI: 43.6-96.9), respectively.Our findings suggest a significant role for FDG-PET in patients with suspected MTC recurrence, with sensitivity of 85.7% and specificity of 83.3% for disease detection. FDG-PET provides additional information in a significant fraction of cases (54%) and could be used for restaging of patients with MTC and elevated levels of biomarkers (calcitonin). Additional studies are necessary to further evaluate the role of FDG-PET in MTC.

    View details for DOI 10.1007/s11307-006-0072-1

    View details for Web of Science ID 000244866700003

    View details for PubMedID 17186139

  • Treatment of thyrotoxicosis JOURNAL OF NUCLEAR MEDICINE Iagaru, A., McDougall, I. R. 2007; 48 (3): 379-389

    Abstract

    In this review, the causes of thyrotoxicosis and the treatment of syndromes with increased trapping of iodine are discussed. The benefits and the potential side effects of 3 frequently used therapies--antithyroid medications, thyroidectomy, and (131)I treatment--are presented. The different approaches to application of (131)I treatment are described. Treatment with (131)I has been found to be cost-effective, safe, and reliable.

    View details for Web of Science ID 000244937400016

    View details for PubMedID 17332615

  • F-18 FDG PET visualization of urinary leak after nephrostomy tube removal CLINICAL NUCLEAR MEDICINE Iagaru, A., Gamie, S., Segall, G. 2007; 32 (2): 168-169

    View details for Web of Science ID 000243782800025

    View details for PubMedID 17242582

  • Follicular dendritic sarcoma within a focus of Castleman's disease. Serial FDG PET/CT in the follow up of recurrence with histopathologic confirmation REVISTA ESPANOLA DE MEDICINA NUCLEAR Iagaru, A., Mari, C., Gambhir, S. S. 2007; 26 (1): 40-45

    Abstract

    We report the case of a 30 year-old man with previous history of melanoma and new diagnoses of localized abdominal Castleman's disease with a focus of follicular dendritic sarcoma within the Castleman's tumor. He presented soon after with a single enlarged abdominal lymph node characterized and followed-up by FDG PET/CT as a low grade malignancy consistent with Castleman's recurrence. However, other imaging techniques raised the possibility of sarcoma/ melanoma recurrence. Final surgical resection allowed histological confirmation of the FDG PET/CT findings. To our knowledge, this is one of the few cases in the literature of Castleman's disease and follicular dendritic sarcoma association in the same focus. This is the first paper to our knowledge to use FDG PET/CT as the follow-up imaging tool for serial characterization of recurrence of Castleman's disease and follicular dendritic sarcoma. FDG PET/CT may be useful in the differentiation between Castleman's disease and malignancies associated with this disease.

    View details for Web of Science ID 000254133000006

    View details for PubMedID 17286947

  • 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography/computed tomography in the management of melanoma MOLECULAR IMAGING AND BIOLOGY Iagaru, A., Quon, A., Johnson, D., Gambhir, S. S., McDougall, I. R. 2007; 9 (1): 50-57

    Abstract

    2-Deoxy-2-[F-18]fluoro-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) is widely available as a powerful imaging modality, combining the ability to detect active metabolic processes and their morphologic features in a single exam. The role of FDG-PET is proven in a variety of cancers, including melanoma, but the estimates of sensitivity and specificity are based in the majority of the published studies on dedicated PET, not PET/CT. Therefore, we were prompted to review our experience with FDG-PET/CT in the management of melanoma.This is a retrospective study on 106 patients with melanoma (20-87 years old; average: 56.8 +/- 15.9), who had whole-body FDG-PET/CT at our institution from January 2003 to June 2005. Thirty-eight patients (35.9%) were women and 68 patients (64.1%) were men. Reinterpretation of the imaging studies for accuracy and data analysis from medical records were performed.All patients had the study for disease restaging. The primary tumor depth (Breslow's thickness) at initial diagnosis was available for 76 patients (71.7%) and ranged from 0.4 to 25 mm (average: 3.56 mm). The anatomic level of invasion in the skin (Clark's level) was determined for 70 patients (66%): 3, level II; 13, level III; 43, level IV; 11, level V. The administered dose of (18)F FDG ranged from 9.8 to 21.6 mCi (average: 15.4 +/- 1.8 mCi). FDG-PET/CT had a sensitivity of 89.3% [95% confidence interval (CI): 78.5-95] and a specificity of 88% (95% CI: 76.2-94.4) for melanoma detection.This study confirms the good results of FDG-PET/CT for residual/recurrent melanoma detection, as well as for distant metastases localization. PET/CT should be an integral part in evaluation of patients with high-risk melanoma, prior to selection of the most appropriate therapy.

    View details for DOI 10.1007/s11307-006-0065-0

    View details for Web of Science ID 000243545600007

    View details for PubMedID 17051322

  • F-18FDG PET/CT demonstration of an adrenal metastasis in a patient with anaplastic thyroid cancer CLINICAL NUCLEAR MEDICINE Iagaru, A., McDougall, I. R. 2007; 32 (1): 13-15

    Abstract

    An adrenal metastasis was identified on an F-18 FDG PET/CT scan in a patient with anaplastic thyroid cancer. There are very few reports of thyroid cancer, even anaplastic thyroid cancer, metastasizing to the adrenal.

    View details for Web of Science ID 000243200800004

    View details for PubMedID 17179796

  • Breast MRI and F-18 FDG PET/CT in the management of breast cancer ANNALS OF NUCLEAR MEDICINE Iagaru, A., Masamed, R., Keesara, S., Conti, P. S. 2007; 21 (1): 33-38

    Abstract

    18F FDG PET/CT is used for diagnosis, staging and establishing the response to therapy in various malignancies, including breast cancer (BC). Dedicated breast MRI (BMRI) is gaining a role in the management of BC patients (pts), demonstrating high sensitivity and specificity for detection of small lesions. We were therefore prompted to review our experience with PET and BMRI in BC.This is a retrospective study of 21 women with BC, 30-76 years old, who had BMRI and whole-body FDG PET/CT at our institution from Jun 2002 to May 2005. A total of 6 patients (group A) had BMRI and PET/CT in the preoperative period and 15 patients (group B) had BMRI and PET/CT after surgery. Reinterpretation of the imaging studies for accuracy and data analysis from medical records were performed.For group A, BMRI identified breast lesions in 4 patients, while PET/CT was able to identify breast lesions in 5 patients. All these were proven to be malignancy on pathology examination. In group B, BMRI detected recurrent breast lesions in 8 patients, with 88.9% sensitivity and 83.3% specificity. In the same patient population, PET/CT was 33.3% sensitive and 91.7% specific. As a whole body examination, PET/CT revealed metastatic disease in 6 patients (100% sensitive and 90% specific). Overall, sensitivities and specificities for breast disease detection were 85.7% and 85.7% for BMRI, and 75% and 92.3% for 18F FDG PET/ CT.As expected, BMRI is more sensitive than PET/CT in the detection of breast lesions. However, PET/CT as a whole-body examination changed the management of disease by detection of distant lesions in 6 of the 21 patients. Our study suggests that 18F FDG PET/CT and BMRI should be considered as complimentary imaging tools in the pre- and postoperative work-up of patients diagnosed with breast cancer.

    View details for Web of Science ID 000244431300005

    View details for PubMedID 17373334

  • F-18FDG PET/CT evaluation of osseous and soft tissue sarcomas CLINICAL NUCLEAR MEDICINE Iagaru, A., Quon, A., McDougall, T. R., Gambhir, S. S. 2006; 31 (12): 754-760

    Abstract

    Osseous and soft tissue sarcomas (OSTS) represent a histologic heterogeneous group of malignant tumors. Most of the current clinical data on the role of F-18 FDG PET in sarcomas come from patients studied with dedicated PET and less frequently with hardware fusion PET/CT. Therefore, we were prompted to review our experience with F-18 FDG PET/CT in OSTS.This is a retrospective study (January 2003-December 2005) of 44 patients with histologic diagnoses of OSTS who had F-18 FDG PET/CT at our institution. The group included 22 men and 22 women with an age range of 2 of 84 years (average, 37 +/- 20.2 years). The administered doses of F-18 FDG range 4.1 to 19.5 mCi (average, 14.3 +/- 3 mCi). Reinterpretation of the imaging studies for accuracy and data analysis from medical records was performed.The sensitivity and specificity of combined F-18 FDG PET/CT were 100% (95% confidence interval [CI] = 75.7-100) and 93.3% (95% CI = 78.7-98.1) for the primary OSTS, and 80% (95% CI = 58.4-91.9) and 86.4% (95% CI = 66.7-95.2) for metastases. When interpreted separately, CT outperformed PET for pulmonary metastases detection: CT was 76.5% sensitive and 88% specific, whereas PET was only 57.1% sensitive but 96.4% specific. For detection of other metastases, CT was 82.3% sensitive and 76% specific, with PET demonstrating 78.6% sensitivity and 92.8% specificity.Relatively similar results (except better specificity for PET and PET/CT) were noted when examining the rate of metastases detection, excluding pulmonary lesions. However, CT had a better detection rate for pulmonary metastases when compared with PET alone. A negative PET scan in the presence of suspicious CT findings in the chest cannot reliably exclude pulmonary metastases from OSTS.

    View details for Web of Science ID 000242481400004

    View details for PubMedID 17117068

  • F-18-FDG PET and PET/CT for detection of pulmonary metastases from musculoskeletal sarcomas NUCLEAR MEDICINE COMMUNICATIONS Iagaru, A., Chawla, S., Menendez, L., Conti, P. S. 2006; 27 (10): 795-802

    Abstract

    Sarcomas represent a significant therapeutic challenge and their potential for distant pulmonary metastases is well known. [(18)F]Fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) has a role in differentiating sarcomas from benign tumours and assessing the response to therapy in advanced sarcomas. However, PET appears to be less accurate in detection of pulmonary metastases. We were therefore prompted to review our experience with PET and PET/computed tomography (CT) in osseous and soft tissue sarcomas (OSTSs).This is a retrospective study (January 1995 to December 2004) of 106 patients with histological diagnosis of OSTS, who had PET and PET/CT at our institution. The group included 52 men and 54 women, aged 12-92 years (average, 45+/-20 years).For all the patients in the analysis, the sensitivity and specificity were 68.3% (95% CI: 53-80.4) and 98.4% (95% CI: 91.8-99.7) for PET, with 95.1% sensitivity (95% CI: 83.8-98.6) and 92.3% specificity (95% CI: 83.2-96.7) for CT. Pulmonary metastases were seen in 40 patients. CT identified 17 lesions larger than 1.0 cm, while PET identified 13 of them (76.5%).Chest CT is more sensitive than PET in detecting pulmonary metastases from OSTS. A significant portion of known pulmonary metastases greater than 1.0 cm on CT, are PET negative. Sub-centimetre CT lesions should not be considered false positive if inactive on PET. A negative PET scan in the presence of suspicious CT findings in the chest cannot reliably exclude pulmonary metastases from OSTS.

    View details for Web of Science ID 000241089000008

    View details for PubMedID 16969262

  • 2-Deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography and positron emission tomography/computed tomography diagnosis of patients with recurrent papillary thyroid cancer MOLECULAR IMAGING AND BIOLOGY Iagaru, A., Masamed, R., Singer, P. A., Conti, P. S. 2006; 8 (5): 309-314

    Abstract

    2-Deoxy-2-[F-18]fluoro-D-glucose positron emission tomography (FDG-PET) has an established role in restaging of various cancers, including papillary and undifferentiated thyroid carcinoma, but detection rates are variable in the published literature. We were therefore prompted to review our experience with FDG-PET in detection of recurrent papillary thyroid cancer (PTC).This is a retrospective study (April 1, 1995-March 31, 2005) of 21 patients with histologic diagnosis of PTC who had PET examinations. The group included seven men and 14 women, with age range of 26-75 years (average 50 +/- 16). The PET scan request was triggered by rising levels of thyroglobulin (Tg) in the presence of a negative iodine-131 scan.Recurrent/metastatic disease was identified by PET in 16 (76%) of the 21 patients with PTC. The sensitivity and specificity of FDG-PET for disease detection in this cohort were 88.2% [95% confidence interval (CI), 65.7-96.7] and 75% (95% CI, 30.1-95.4), respectively. The Tg levels were 1.0-10.4 ng/ml (average, 4.52 ng/ml) in the patients with negative PET scans and 1.0-38 ng/ml (average, 16.8 ng/ml) in patients with positive scans. The lesions were located in the cervical lymph nodes (8), thyroid bed (4), lungs (4), and mediastinal lymph nodes (2).Our study confirms the feasibility of PET in detection of residual/recurrence of PTC, with sensitivity of 88.2% (95% CI, 65.7-96.7) and specificity of 75% (95% CI, 30.1-95.4). Detectable levels of Tg, even in the presence of negative I-131 scan or anatomic imaging, should prompt restaging with FDG-PET.

    View details for DOI 10.1007/s11307-006-0046-3

    View details for Web of Science ID 000240560800008

    View details for PubMedID 16758370

  • Demonstration of an ectopic mediastinal parathyroid adenoma on Tc-99m sestamibi myocardial perfusion scintigraphy JOURNAL OF NUCLEAR CARDIOLOGY Iagaru, A., Hachamovitch, R., Colletti, P. M., Wassef, H. 2006; 13 (5): 719-721
  • PET/CT follow-up in nonossifying fibroma AMERICAN JOURNAL OF ROENTGENOLOGY Iagaru, A., Henderson, R. 2006; 187 (3): 830-832

    View details for DOI 10.2214/AJR.05.0264

    View details for Web of Science ID 000240259300040

    View details for PubMedID 16928954

  • F-18FDG PET imaging of urinary bladder oat cell carcinoma with widespread osseous metastases CLINICAL NUCLEAR MEDICINE Iagaru, A., Gamie, S., Segall, G. 2006; 31 (8): 476-478

    View details for Web of Science ID 000241026700010

    View details for PubMedID 16855436

  • Merkel cell carcinoma: Is there a role for 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography/computed tomography? MOLECULAR IMAGING AND BIOLOGY Iagaru, A., Quon, A., McDougall, I. R., Gambhir, S. S. 2006; 8 (4): 212-217

    Abstract

    2-Deoxy-2-[F-18]fluoro-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) is becoming widely available as a powerful imaging modality, combining the ability to detect active metabolic processes and their morphologic features in a single study. The role of FDG-PET/CT is proven in lymphoma, melanoma, colorectal carcinoma, and other cancers. However, there are rare malignancies such as Merkel cell carcinoma that can potentially be evaluated with PET/CT. We were therefore prompted to review our experience with FDG-PET/CT in the management of patients with Merkel cell carcinoma.This is a retrospective case series of six patients with Merkel cell carcinoma, 58-81 years old (average 69 +/- 8.3), who had whole-body PET/CT at our institution from January 1st, 2003 to August 31st, 2005. Two patients were women and four were men. Reinterpretation of the imaging studies for accuracy and data analysis from medical records were performed.Twelve examinations were acquired for the six patients (one patient had six PET/CT, one patient had two PET/CT, and four patients had one PET/CT). The injected FDG doses ranged 381.1-669.7 MBq (average 573.5 +/- 70.3). Four patients had the PET/CT as part of initial staging, and two patients had the exam for restaging (after surgery and XRT). A total of six Merkel lesions (pancreas, adrenal, lip, submandibular lymph nodes, cervical lymph nodes, and parapharyngeal soft tissue) were identified in three patients and confirmed on histopathological examination. The FDG uptake in these areas was intense, with maximum standardized uptake value (SUVmax) values of 5-14 (average 10.4 +/- 3.8). In one patient, the PET/CT scan identified abnormal focal distal sigmoid uptake that was biopsied and diagnosed as adenocarcinoma. Two patients had negative scans and had no clinical evidence of disease on follow-up office visits (up to one year after PET/CT).This case series suggests that FDG-PET/CT may have a promising role in the management of patients with Merkel cell carcinoma.

    View details for DOI 10.1007/s11307-006-0047-2

    View details for Web of Science ID 000239124800003

    View details for PubMedID 16724293

  • F-18FDG PET evaluation of bronchial plasmacytoma with CT and MRI correlation CLINICAL NUCLEAR MEDICINE Iagaru, A., Mari, C., Segall, G. 2006; 31 (5): 279-280

    View details for Web of Science ID 000237077700009

    View details for PubMedID 16622337

  • Demonstration of a right inguinal hernia containing urinary bladder diverticulum on whole-body bone scan and pelvic CT EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING Iagaru, A., Siegel, M. E. 2006; 33 (2): 234-234

    View details for DOI 10.1007/s00259-005-1977-7

    View details for Web of Science ID 000234934800021

    View details for PubMedID 16344994

  • Failed atrial septal defect repair versus pulmonary hypertension with right ventricular failure CLINICAL NUCLEAR MEDICINE Iagaru, A., Wassef, H., Henderson, R. 2005; 30 (11): 767-768

    View details for Web of Science ID 000232741900021

    View details for PubMedID 16237312

  • FDG PET-CT demonstration of Sjogren's sialoadenitis CLINICAL NUCLEAR MEDICINE Jadvar, H., Bonyadlou, S., Iagaru, A., Colletti, P. M. 2005; 30 (10): 698-699

    Abstract

    We report the positron emission tomography-computed axial tomography (PET-CT) appearance of the inflammatory involvement of the salivary glands of a 69-year-old female with a history of lymphoma and known primary Sjogren's syndrome. Hybrid PET-CT was performed 5 months after completion of chemotherapy using a Siemens Biograph scanner (Knoxville, TN) 45 minutes after intravenous administration of 15 mCi of F-18 fluorodeoxyglucose (FDG). CT transmission scan was obtained for attenuation correction. PET-CT demonstrated no evidence of hypermetabolic nodal disease but showed symmetric intensely hypermetabolic submandibular and parotid salivary glands.

    View details for Web of Science ID 000232048400016

    View details for PubMedID 16166849

Conference Proceedings


  • The Impact of Partial Volume Correction in the Evaluation of Solitary Pulmonary Nodules by FDG PET/CT in a Population at Intermediate Risk of Lung Cancer Keu, K., Nair, V. S., Mittra, E., Gambhir, S. S., Iagaru, A. SPRINGER. 2012: S455-S455
  • Efficacy of F-18-FDG PET/CT for Breast Cancer Mittra, E., Quon, A., Gambhir, S. S., Iagaru, A. SPRINGER. 2009: S176-S176

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