maria picchio

Università Vita-Salute San Raffaele, Nuclear Medicine, Faculty Member

Followers

Following

Co-authors

Public Views

Lucas Ferrari de Oliveira

Universidade Federal do Paraná

Vincent D . Costa

Emory University

David Sharp

Imperial College London

Nicolas A Karakatsanis

Weill Cornell Medicine

ajith joy k

Mumbai University

Evangelos Georgiou

National & Kapodistrian University of Athens

Maria Rentetzi

Friedrich-Alexander-Universität Erlangen-Nürnberg

Kevin J. Black

Washington University in St. Louis

Daniel J. Mueller (Müller)

University of Toronto

Prof. Dr. Yousif M . Y Abdallah

University of Majmaah

InterestsView All (7)

Uploads

Papers by maria picchio

Role of [68Ga]Ga-PSMA-11 PET radiomics to predict post-surgical ISUP grade in primary prostate cancer

European Journal of Nuclear Medicine and Molecular Imaging, Mar 18, 2023

Pet/Mri

Clinical and Translational Imaging, 2013

Download

Role of [68Ga]Ga-PSMA-11 PET radiomics to predict post-surgical ISUP grade in primary prostate cancer

European Journal of Nuclear Medicine and Molecular Imaging

Intratumoral Spatial Distribution of Hypoxia and Angiogenesis Assessed by 18F-FAZA and 125I-Gluco-RGD Autoradiography

Journal of Nuclear Medicine, 2008

Download

Role of Machine Learning (ML)-Based Classification Using Conventional 18F-FDG PET Parameters in Predicting Postsurgical Features of Endometrial Cancer Aggressiveness

Cancers

Purpose: to investigate the preoperative role of ML-based classification using conventional 18F-F... more Purpose: to investigate the preoperative role of ML-based classification using conventional 18F-FDG PET parameters and clinical data in predicting features of EC aggressiveness. Methods: retrospective study, including 123 EC patients who underwent 18F-FDG PET (2009–2021) for preoperative staging. Maximum standardized uptake value (SUVmax), SUVmean, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were computed on the primary tumour. Age and BMI were collected. Histotype, myometrial invasion (MI), risk group, lymph-nodal involvement (LN), and p53 expression were retrieved from histology. The population was split into a train and a validation set (80–20%). The train set was used to select relevant parameters (Mann-Whitney U test; ROC analysis) and implement ML models, while the validation set was used to test prediction abilities. Results: on the validation set, the best accuracies obtained with individual parameters and ML were: 61% (TLG) and 87% (ML) for MI; 71% (SUV...

Download

18F-FDG PET/MRI in endometrial cancer: systematic review and meta-analysis

Clinical and Translational Imaging, 2021

Purpose To present the progresses of hybrid 18 F-FDG PET/MR imaging in the staging/restaging sett... more Purpose To present the progresses of hybrid 18 F-FDG PET/MR imaging in the staging/restaging setting of endometrial cancer (EC), with particular focus on performance evaluations and biomarker analyses. Methods Original articles were searched on PubMed, EMBASE and Web of Science, until March 2021. Reports were screened to select studies using simultaneous PET/MR acquisition, discarding those using sequential protocols. Studies including heterogeneous and/or homogeneous cohorts of pelvic tumor patients were considered, while works for which the exact number of EC patients was not reported have been discarded. Evaluations of selected articles were focused on (i) performance evaluation, (ii) biomarker analysis. The quality of papers was assessed by QUADAS-2. Results Eleven articles involving 18 F-FDG PET/MRI EC-related objectives were selected. The quality of papers was generally high. Compared to other imaging techniques, PET/MRI seems to show a higher diagnostic accuracy in detecting soft tissue invasion and abdominopelvic metastases from primary EC. Among different PET- and MRI-derived biomarkers, SUV-to-ADC ratio seems to be the most informative index in differentiating EC aggressiveness. Moreover, PET/MRI provided the chance to differentiate post-therapeutic changes from local relapse, and to detect small, morphologically unsuspicious lymph node metastases in patients with recurrent EC, with better performances compared to other imaging modalities. Conclusions Preliminary results demonstrated how 18 F-FDG PET/MRI could be a valid imaging technique in patients with EC, both in staging and restaging, also considering the limited radiation exposure. From the limited availability of the existing literature, it is clear that further prospective trials on larger and homogeneous cohorts are needed.

PSMA and Choline PET for the Assessment of Response to Therapy and Survival Outcomes in Prostate Cancer Patients: A Systematic Review from the Literature

Cancers, 2022

The aims of this systematic review were to (1) assess the utility of PSMA-PET and choline-PET in ... more The aims of this systematic review were to (1) assess the utility of PSMA-PET and choline-PET in the assessment of response to systemic and local therapy, and to (2) determine the value of both tracers for the prediction of response to therapy and survival outcomes in prostate cancer. We performed a systematic literature search in PubMed/Scopus/Google Scholar/Cochrane/EMBASE databases (between January 2010 and October 2021) accordingly. The quality of the included studies was evaluated following the “Quality Assessment of Prognostic Accuracy Studies” tool (QUAPAS-2). We selected 40 articles: 23 articles discussed the use of PET imaging with [68Ga]PSMA-11 (16 articles/1123 patients) or [11C]/[18F]Choline (7 articles/356 patients) for the prediction of response to radiotherapy (RT) and survival outcomes. Seven articles (three with [68Ga]PSMA-11, three with [11C]Choline, one with [18F]Choline) assessed the role of PET imaging in the evaluation of response to docetaxel (as neoadjuvant t...

Download

Hybrid PET/MRI in Staging Endometrial Cancer

Clinical Nuclear Medicine, 2022

Aim The assessment of deep myometrial invasion (MI) and lymph node involvement is of utmost impor... more Aim The assessment of deep myometrial invasion (MI) and lymph node involvement is of utmost importance in the preoperative staging of endometrial cancer (EC). Imaging parameters derived respectively from MRI and PET have shown good predictive value. The main aim of the present study is to assess the diagnostic performance of hybrid 18F-FDG PET/MRI in EC staging, with particular focus on MI and lymphnodal involvement detection. Patients and Methods Prospective monocentric study including 35 patients with biopsy-proven EC undergoing preoperative 18F-FDG PET/MRI (December 2018–March 2021) for staging purpose. Histological examination was the reference standard. PET (SUVmax, SUVmean with a threshold of 40% of SUVmax–SUVmean40, metabolic tumor volume, total lesion glycolysis) and MRI (volume index [VI], total tumor volume, tumor volume ratio [TVR], mean apparent diffusion coefficient, minimum apparent diffusion coefficient) parameters were calculated on the primary tumor, and their role in predicting EC risk group, the presence of lymphovascular space invasion (LVSI), and MI was assessed. Receiver operating characteristics analysis was used to assess the predictive value of PET and MRI parameters on EC characteristics. Results Patients' median age was 66.57 years (SD, 10.21 years). 18F-FDG PET/MRI identified the primary tumor in all patients. Twenty-two of 35 patients had high-risk EC and 13/35 low-risk disease; 13/35 presented LVSI, 22/35 had deep MI at histological examination, and 13/35 had p53 hyperexpression. PET/MRI was able to detect lymphnodal involvement with high accuracy and high specificity (sensitivity of 0.8571, specificity of 0.9286, accuracy of 0.9143), also showing a high negative predictive value (NPV) for lymphnodal involvement (NPV of 0.9630, positive predictive value [PPV] of 0.7500). The assessment of deep MI using PET/MRI correctly staged 27 patients (77.1%; sensitivity of 0.7273, specificity of 0.8462, accuracy of 0.7714), with also a good PPV (PPV of 0.8889, NPV of 0.647). MRI-derived total tumor volume, VI, and TVR were significant in predicting EC groups (high-risk vs low-risk patients) (P = 0.0059, 0.0235, 0.0181, respectively). MRI-derived volume, VI, TVR, and PET-derived metabolic tumor volume and total lesion glycolysis were able to predict LVSI (P = 0.0023, 0.0068, 0.0068, 0.0027, 0.01394, respectively). Imaging was not able to predict grading, presence of deep MI, nor hyperexpression of p53. Conclusions 18F-FDG PET/MRI has good accuracy in preoperative staging of EC; PET and MRI parameters have synergic role in preoperatively predicting LVSI, with MRI parameters being also predictive for EC risk group.

Hybrid PET/MRI in Staging Endometrial Cancer: Diagnostic and Predictive Value in a Prospective Cohort

Purpose. Assessment of deep myometrial invasion (MI) and lymphovascular space invasion (LVSI) is ... more Purpose. Assessment of deep myometrial invasion (MI) and lymphovascular space invasion (LVSI) is of utmost importance in preoperative staging of endometrial cancer (EC). Imaging parameters derived respectively from MRI and PET have shown good predictive value. Aim of the present study is to assess the diagnostic performance of hybrid 18F-FDG PET/MRI in EC staging, with particular focus on MI and LVSI detection.Methods. Prospective monocentric study including 35 patients with biopsy-proven EC undergoing preoperative 18F-FDG PET/MRI for staging purpose. Histological examination was the reference standard. PET (SUVmax, SUVmean40, MTV40, TLG40) and MRI (volume index-VI, total tumor volume-TTV, tumor volume ratio-TVR, ADCmean, ADCmin) parameters were calculated on the primary tumor, and their role in predicting histological findings (grade, high- vs. low-risk groups, LVSI, MI, p53 hyper-expression) was assessed through a ROC analysis.Results. 18F-FDG-PET/MRI identified the primary tumor ...

Download

The Role of Positron Emission Tomography/Computed Tomography (PET/CT) for Staging and Disease Response Assessment in Localized and Locally Advanced Pancreatic Cancer

Cancers, 2021

Simple Summary Pancreatic cancer (PC) has a severe prognosis and even after radical surgery, rela... more Simple Summary Pancreatic cancer (PC) has a severe prognosis and even after radical surgery, relapse rate is very high (70–80%). The impact of PET/CT in PC clinical management has been increasingly investigated in the last decades. As regards localized and potentially resectable disease, the role of PET/CT is still controversial and international guidelines do not recommend its routine use. Despite this, PET may play a role in assessing PC stage and grade and potential resectability after neoadjuvant treatment. Aim of this review is to discuss the current use for staging and disease response assessment and future developments of PET/CT in resectable PC. Abstract Pancreatic Cancer (PC) has a poor prognosis, with a 5-year survival rate of only 9%. Even after radical surgical procedures, PC patients have poor survival rates, with a high chance of relapse (70–80%). Imaging is involved in all aspects of the clinical management of PC, including detection and characterization of primary tu...

Download

68Ga-PSMA and 68Ga-DOTA-RM2 PET/MRI in Staging of High-risk Prostate Cancer Patients: a Prospective Pilot Trial

Purpose: The aim of the present study is to investigate the synergic role of 68Ga-PSMA PET/MRI an... more Purpose: The aim of the present study is to investigate the synergic role of 68Ga-PSMA PET/MRI and 68Ga-DOTA-RM2 PET/MRI in PCa staging. Methods: Fifteen patients with biopsy-proven PCa underwent both 68Ga-PSMA PET/MRI and 68Ga-DOTA-RM2 PET/MRI within one month. TNM classification based on image findings was performed and semi-quantitative PET and quantitative MRI parameters were collected for each scan. Finally, DICE score between regions of interest manually segmented on the primary tumor on 68Ga-PSMA PET, 68Ga-DOTA-RM2 PET and on T2 MRI was computed. Results: All imaging modalities detected the primary PCa in 15 patients, with slight differences regarding the multifocality of intra-prostatic findings. Two patients presented seminal vesicles involvement on MRI, one of these was also detected by 68Ga-PSMA, with no uptake on 68Ga-DOTA-RM2 images. Regarding extra prostatic disease, 68Ga-PSMA PET, 68Ga-DOTA-RM2 PET and MRI resulted positive in 6, 2 and 4 patients at lymph-nodal level,...

Download

Deauville Criteria and International Harmonization Project Criteria at the end of 1st line therapy in lymphoma patients: response assessment and prognostic evaluation

The Journal of Nuclear Medicine, 2015

18F-FAZA PET/CT Hypoxia Imaging of High-Grade Glioma Before and After Radiotherapy

Clinical nuclear medicine, 2017

A 57 year-old man underwent MRI with dynamic susceptibility contrast and dynamic contrast-enhance... more A 57 year-old man underwent MRI with dynamic susceptibility contrast and dynamic contrast-enhanced perfusion for neurological symptoms suggesting the diagnosis of high-grade glioma. A F-FAZA PET/CT was performed because of the enrollment in a prospective clinical trial. Subsequent radiotherapy treatment has been planned based on conventional imaging; moreover, a F-FAZA PET/CT-guided treatment planning highlighting hypoxic regions has been simulated. After radiotherapy treatment, the man underwent MRI and F-FAZA PET/CT, showing partial response.

Download

1012 Evaluation of lymph node recurrent prostate cancer with integrated [11C]choline PET/CT in patients with PSA failure after radical prostatectomy: Validation by histological analysis

European Urology Supplements, 2012

INTRODUCTION AND OBJECTIVES: The aim of this study was to prospectively evaluate the accuracy of ... more INTRODUCTION AND OBJECTIVES: The aim of this study was to prospectively evaluate the accuracy of integrated [(11)C]choline-PET/CT in the diagnosis of lymph-node recurrence in patients previously treated with radical prostatectomy (RP) who experience PSA relapse. METHODS: The study included 71 patients with biochemical recurrence (BCR) and pathologic nodal [(11)C]choline-uptake at PET/CT scan suggestive of nodal recurrence. All patients were treated with either bilateral pelvic salvage lymph node dissection (sLND) alone (n 16; 22.5%) or with a combination of pelvic retroperitoneal sLND (n 55; 77.5%) between October 2002 and July 2011 at a single tertiary referral center. BCR was defined as a PSA value 0.2 ng/ml. All patients had complete clinical and pathological data, including PSA at surgery, number of lymph nodes removed, number of positive lymph nodes as well as laterality and site of nodal metastases at sLND. For the purpose of the study, LN sites were stratified in: right pelvic, left pelvic and retroperitoneal, respectively. We analyzed sensitivity, specificity, positive and negative predictive value as well as accuracy of the [(11)C]choline-PET/CT in predicting presence of nodal metastases at sLND. All the analyses were performed in the e overall patient population and after stratifying according to PSA (namely, 2 versus 2 ng/ml) and androgen deprivation therapy (ADT) status at sLND. RESULTS: The mean number of removed and positive nodes at sLND were 30.4 (median 29; range: 4-87) and 9.2 (range: 0-66), respectively. Fifty-nine out of the 71 patients (83%) with positive [(11)C]choline-PET/CT had histologically proven nodal metastases of PCa at sLND. A per-site based analysis showed that sensitivity, specificity, positive predictive value, negative predictive value and accuracy of [(11)C]choline-PET/CT in predicting nodal recurrence were 75.5%, 77.9%, 78.5%, 74.7%, and 76.6%, respectively. Table 1 shows the performance characteristics of [(11)C]choline-PET/CT after stratification according to ADT status and PSA values at sLND. CONCLUSIONS: [(11)C]Choline-PET/CT represents an accurate diagnostic tool for the detection of lymph-node metastases of clinical recurrent prostate cancer, regardless of ADT status at sLND.

11C- or 18F-Choline PET/CT for Imaging Evaluation of Biochemical Recurrence of Prostate Cancer

Journal of Nuclear Medicine, 2016

Recurrence of prostate cancer is suspected when an increase in the prostate-specific antigen leve... more Recurrence of prostate cancer is suspected when an increase in the prostate-specific antigen level is detected after radical treatment; the recurrence could be local relapse, distant relapse, or both. Differentiation between the two patterns of relapse is critical for choosing the proper treatment strategy. Choline PET/CT could be of help in discriminating patients with local, lymph node, and bone recurrences, thus having an impact on patient management.

Download

First Evaluation of PET-Based Human Biodistribution and Dosimetry of 18F-FAZA, a Tracer for Imaging Tumor Hypoxia

Journal of Nuclear Medicine, 2017

18 F-labeled fluoroazomycinarabinoside (18 F-FAZA) is a PET biomarker for noninvasive identificat... more 18 F-labeled fluoroazomycinarabinoside (18 F-FAZA) is a PET biomarker for noninvasive identification of regional tumor hypoxia. The aim of the present phase I study was to evaluate the biodistribution and dosimetry of 18 F-FAZA in non-small cell lung cancer patients. Methods: Five patients awaiting surgical resection of histologically proven or radiologically suspected non-small cell lung cancer were prospectively enrolled in the study. The patients underwent PET/CT after injection of 371 6 32 MBq of 18 F-FAZA. The protocol consisted of a 10-min dynamic acquisition of the heart to calculate the activity in blood, followed by 4 whole-body PET/CT scans, from the vertex to the mid thigh, at 10, 60, 120, and 240 min after injection. Urine samples were collected after each imaging session and at 360 min after injection. Volumes of interest were drawn around visually identifiable source organs to generate time-activity curves. Residence times were determined from time-activity curves, and effective doses to individual organs and the whole body were calculated using OLINDA/EXM 1.2 for the standard male and female phantoms. Results: Blood clearance was characterized by a rapid distribution followed by first-order elimination. The highest uptake was in muscle and liver, with respective percentage injected activity (%IA) peaks of 42.7 6 5.3 %IA and 5.5 6 0.6 %IA. The total urinary excretion was 15 %IA. The critical organ, with the highest absorbed radiation doses, was the urinary bladder wall, at 0.047 6 0.008 and 0.067 6 0.007 mGy/ MBq for the 2-and 4-h voiding intervals, respectively. The effective doses for the standard male and female phantoms were 0.013 6 0.004 and 0.014 6 0.004 mSv/MBq, respectively, depending on the voiding schedule. Conclusion: With respect to the available literature, the biodistribution of 18 F-FAZA in humans appeared to be slightly different from that in mice, with a low clearance in humans. Therefore, use of animal data may moderately underestimate radiation doses to organs in humans. Our dosimetry data showed that a 370-MBq injection of 18 F-FAZA is safe for clinical use, similar to other widely used PET ligands. In particular, the effective dose is not appreciably different from those obtained with other hypoxia tracers, such as 18 F-fluoromisonidazole.

Download

Radiation treatment of lymph node recurrence from prostate cancer: is 11C-choline PET/CT predictive of survival outcomes?

Journal of nuclear medicine : official publication, Society of Nuclear Medicine, Jan 24, 2015

Positron Emission Tomography/Computed Tomography is a valuable tool to detect lymph node (LN) met... more Positron Emission Tomography/Computed Tomography is a valuable tool to detect lymph node (LN) metastases in patients with biochemical failure after primary treatment for prostate cancer (PCa). The aim was to assess the predictive role of imaging parameters derived by (11)C-choline PET/CT (choline-PET/CT) on survival outcomes: overall survival (OS), loco regional- (lRFS), clinical- (cRFS) and biochemical relapse free survival (bRFS) in patients treated with helical tomotherapy (HTT) for LN recurrence. This retrospective study included 68 patients affected by PCa (mean age: 68 years; range: 51-81 years) with biochemical recurrence after primary treatment (median PSA0: 2.42 ng/ml; range: 0.61-27.56 ng/ml) who underwent choline-PET/CT from January 2005 to January 2013 and then treated with HTT in correspondence of the pathological choline LN uptake. PET derived parameters, including maximum/mean standardized uptake value (SUVmax/mean) and metabolic tumor volume (MTV) with a threshold of...

Download

PET/CT for radiotherapy: image acquisition and data processing

The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of Radiopharmaceutical Chemistry and Biology, 2010

This paper focuses on acquisition and processing methods in positron emission tomography/computed... more This paper focuses on acquisition and processing methods in positron emission tomography/computed tomography (PET/CT) for radiotherapy (RT) applications. The recent technological evolutions of PET/CT systems are described. Particular emphasis is dedicated to the tools needed for the patient positioning and immobilization, to be used in PET/CT studies as well as during RT treatment sessions. The effect of organ and lesion motion due to patient's respiration on PET/CT imaging is discussed. Breathing protocols proposed to minimize PET/CT spatial mismatches in relation to respiratory movements are illustrated. The respiratory gated (RG) 4D-PET/CT techniques, developed to measure and compensate for organ and lesion motion, are then introduced. Finally a description is provided of different acquisition and data processing techniques, implemented with the aim at improving: i) image quality and quantitative accuracy of PET images, and ii) target volume definition and treatment planning ...

PET/CT in diagnostic oncology

In the last years positron emission tomography (PET) with 18F-fluorodeoxyglucose ([18F]FDG) has b... more In the last years positron emission tomography (PET) with 18F-fluorodeoxyglucose ([18F]FDG) has become an established technique for the staging and follow-up of a wide variety of neoplasms. As PET imaging is based on the physiological mediated distribution of the administered tracer, rather than on anatomic and structural characteristics of tissue, the addition of CT imaging to PET improves the interpretation of PET images. Recently, integrated PET/CT scanners have been developed that can produce directly functional PET and anatomical CT data 1 session, without moving the patient and with minimal delay between the reconstruction and fusion of the 2 image data sets. In addition, CT images are also being used for attenuation correction in the reconstruction process of the PET emission data. A brief review of the most relevant technical characteristics of 3 PET/CT systems, which represent the state of the art of this technology, are described. Furthermore an overview of PET/CT acquisit...

Unusual presentation of sarcoid-like reaction on bone marrow level associated with mediastinal lymphadenopathy on 18F-FDG-PET/CT resembling an early recurrence of Hodgkin's Lymphoma

Revista Española de Medicina Nuclear e Imagen Molecular, 2012

18 F-FDG-PET/CT is widely employed to evaluate lymphoma patients. False positive results are quit... more 18 F-FDG-PET/CT is widely employed to evaluate lymphoma patients. False positive results are quite frequent, generally due to active phase of inflammation. We describe an unusual PET/CT presentation of a sarcoid-like reaction (SLR) in a patient monitored for Hodgkin Lymphoma characterized by an intense uptake in lymph nodes and multiple bone foci in a PET/CT study. The final diagnosis was obtained by biopsy. This study draws attention to the fact that multifocal bone marrow uptakes due to a sarcoideal reaction may be a possible cause of false positive results in 18 F-FDG-PET/CT studies in oncology patients.

Download

Role of [68Ga]Ga-PSMA-11 PET radiomics to predict post-surgical ISUP grade in primary prostate cancer

European Journal of Nuclear Medicine and Molecular Imaging, Mar 18, 2023

Pet/Mri

Clinical and Translational Imaging, 2013

Download

Role of [68Ga]Ga-PSMA-11 PET radiomics to predict post-surgical ISUP grade in primary prostate cancer

European Journal of Nuclear Medicine and Molecular Imaging

Intratumoral Spatial Distribution of Hypoxia and Angiogenesis Assessed by 18F-FAZA and 125I-Gluco-RGD Autoradiography

Journal of Nuclear Medicine, 2008

Download

Role of Machine Learning (ML)-Based Classification Using Conventional 18F-FDG PET Parameters in Predicting Postsurgical Features of Endometrial Cancer Aggressiveness