Papers by Poul-Erik Braad
Additional file 1 of Benefits and harms of implementing [18F]FDG-PET/CT for diagnosing recurrent breast cancer: a prospective clinical study
Additional file 1: Fig. 1. Receiver operating characteristic (ROC) curve and area-under-the-recei... more Additional file 1: Fig. 1. Receiver operating characteristic (ROC) curve and area-under-the-receiver operating curve (AUC-ROC) derived from [18F]FDG-PET/CT and CE-CT for the detection of distant metastasis in 225 women suspected of first distant recurrent breast cancer
Additional file 2 of Benefits and harms of implementing [18F]FDG-PET/CT for diagnosing recurrent breast cancer: a prospective clinical study
Additional file 2. Characteristics of the primary tumor of 225 women suspected of first distant r... more Additional file 2. Characteristics of the primary tumor of 225 women suspected of first distant recurrent breast cancer, 2017–2019.
Response monitoring in metastatic breast cancer: a comparison of survival times between FDG-PET/CT and CE-CT
British Journal of Cancer, 2022
BACKGROUND We compared overall survival for metastatic breast cancer (MBC) patients monitored wit... more BACKGROUND We compared overall survival for metastatic breast cancer (MBC) patients monitored with CE-CT, FDG-PET/CT or a combination of them in an observational setting. METHODS Patients with biopsy-verified (recurrent or de novo) MBC (n = 300) who were treated at Odense university hospital (Denmark) and response monitored with FDG-PET/CT (n = 83), CE-CT (n = 144), or a combination of these (n = 73) were followed until 2019. Survival was compared between the scan groups, and were adjusted for clinico-histopathological variables representing potential confounders in a Cox proportional-hazard regression model. RESULTS The study groups were mostly comparable regarding baseline characteristics, but liver metastases were reported more frequently in CE-CT group (38.9%) than in FDG-PET/CT group (19.3%) and combined group (24.7%). Median survival was 30.0 months for CE-CT group, 44.3 months for FDG-PET/CT group and 54.0 months for Combined group. Five-year survival rates were significantly higher for FDG-PET/CT group (41.9%) and combined group (43.3%), than for CE-CT group (15.8%). Using the CE-CT group as reference, the hazard ratio was 0.44 (95% CI: 0.29-0.68, P = 0.001) for the FDG-PET/CT group after adjusting for baseline characteristics. FDG-PET/CT detected the first progression 4.7 months earlier than CE-CT, leading to earlier treatment change. CONCLUSIONS In this single-center, observational study, patients with metastatic breast cancer who were response monitored with FDG-PET/CT alone or in combination with CE-CT had longer overall survival than patients monitored with CE-CT alone. Confirmation of these findings by further, preferably randomised clinical trials is warranted.
Positron Emission Tomography for Patient Individualised Radionuclide Therapy in Oncology
Patient-specific Dosimetry for Radioiodine Therapy
Automatic PET Image Segmentation: A Cross-Platform and Cross-Method Evaluation
Effects of CT dose management in PET/CT
European Journal of Nuclear Medicine and Molecular Imaging, 2014
Impact of high radioactivity concentrations on PET image quality and quantification accuracy
Implementation, validation, and optimization of 124I-PET Monte Carlo patient specific dosimetry in radioiodine therapy
FDG-PET/CT in high-risk primary breast cancer—a prospective study of stage migration and clinical impact
Breast Cancer Research and Treatment, 2020
Purpose To investigate the clinical impact of FDG-PET/CT for staging and treatment planning in hi... more Purpose To investigate the clinical impact of FDG-PET/CT for staging and treatment planning in high-risk primary breast cancer. Methods Women with high-risk primary breast cancer were enrolled between September 2017 and August 2019 at Odense University Hospital, Denmark. Conventional mammography with/without MRI was performed before staging by FDG-PET/CT. We studied the accuracy of FDG-PET/CT for the detection of distant metastases, the effect on the change of treatment, and the prevalence of incidental findings. Biopsy and follow-up were used as a reference standard for the accuracy analysis. Results Of 103 women, 24 (23%) were diagnosed with distant metastases by FDG-PET/CT. Among these, breast surgery was omitted in 18 and could have been spared in six. Another sixteen (16%) patients were upstaged to more advanced loco-regional disease, leading to more extensive radiotherapy. Sensitivity and specificity for diagnosing distant metastases were 1.00 (95% confidence interval: 0.86–1.00) and 0.95 (0.88–0.99), respectively. Twenty-nine incidental findings were detected in 24 women (23%), leading to further examinations in 22 and diagnosis of eight (8/22, 36%) synchronous diseases: cancer ( n = 4), thyroiditis ( n = 2), aorta aneurysm ( n = 1), and meningioma ( n = 1). Conclusions FDG-PET/CT had a substantial impact on staging and change of treatment in women with high-risk primary breast cancer, and further examination of incidental findings was considered clinically relevant. Our findings suggest that FDG-PET/CT should be considered for primary staging in high-risk primary breast cancer to improve treatment planning.
250P FDG-PET/CT in high-risk primary breast cancer: A prospective study of stage migration and clinical impact
Annals of Oncology, 2020
Diagnostics, 2020
This study aimed to compare the prognostic value of quantitative measures of [18F]-fluorodeoxyglu... more This study aimed to compare the prognostic value of quantitative measures of [18F]-fluorodeoxyglucose positron emission tomography with integrated computed tomography (FDG-PET/CT) for the response monitoring of patients with metastatic breast cancer (MBC). In this prospective study, 22 patients with biopsy-verified MBC diagnosed between 2011 and 2014 at Odense University Hospital (Denmark) were followed up until 2019. A dual-time-point FDG-PET/CT scan protocol (1 and 3 h) was applied at baseline, when MBC was diagnosed. Baseline characteristics and quantitative measures of maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), corrected SUVmean (cSUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and corrected TLG (cTLG) were collected. Survival time was analyzed using the Kaplan–Meier method and was regressed on MTV, TLG, and cTLG while adjusting for clinicopathological characteristics. Among the 22 patients included (median age: 5...
Journal of Nuclear Medicine, 2020
Cancers, 2019
While current international guidelines include imaging of the target lesion for response monitori... more While current international guidelines include imaging of the target lesion for response monitoring in metastatic breast cancer, they do not provide specific recommendations for choice of imaging modality or response criteria. This is important as clinical decisions may vary depending on which imaging modality is used for monitoring metastatic breast cancer. FDG-PET/CT has shown high accuracy in diagnosing metastatic breast cancer, and the Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) have shown higher predictive values than the CT-based Response Evaluation Criteria in Solid Tumors (RECIST) for prediction of progression-free survival. No studies have yet addressed the clinical impact of using different imaging modalities or response evaluation criteria for longitudinal response monitoring in metastatic breast cancer. We present a case study of a patient with metastatic breast cancer who was monitored first with conventional CT and then with FDG-PET/CT. We ...
The international journal of cardiovascular imaging, Jan 31, 2018
Combined myocardial flow reserve (MFR) by PET and CT coronary angiography (CTA) is a promising to... more Combined myocardial flow reserve (MFR) by PET and CT coronary angiography (CTA) is a promising tool for assessment of coronary artery disease. Prior analyses of MFR/CTA has been performed as side-by-side interpretation, not as volume rendered, full hybrid analysis, with fused MFR/CTA. We aimed to: (i) establish a method for full hybrid analysis of MFR/CTA, (ii) validate the inter- and intra-observer reproducibility of MFR values, and (iii) determine the diagnostic value of side-by-side versus full hybrid MFR/CTA with 15-O-water PET. Forty-four outpatients scheduled for invasive coronary angiography (ICA) were enrolled prospectively. All underwent rest/stress 15-O-water PET/CTA with ICA as reference. Within two observers of different experience, the Pearson r at global and territorial level exceeded 0.953 for rest, stress, and MFR values, as determined by Carimas software. Within and between observers, the mean differences between rest, stress, and MFR values were close to zero and t...
Medical Physics, 2016
Purpose: CT images are used for patient specific Monte Carlo treatment planning in radionuclide t... more Purpose: CT images are used for patient specific Monte Carlo treatment planning in radionuclide therapy. The authors investigated the impact of tissue classification, CT image segmentation, and CT errors on Monte Carlo calculated absorbed dose estimates in nuclear medicine. Methods: CT errors as a function of patient size, CT reconstruction, and tube current modulation methods were assessed in a phantom experiment on a clinical CT system. The impact of tissue segmentation methods and CT number variations on EGSnrc Monte Carlo calculated absorbed dose distributions was assessed for 99m Tc and 131 I in the ICRP/ICRU male phantom and in a patient PET/CT-scanned with 124 I prior to radioiodine therapy. Results: CT number variations <20 HU were obtained for whole-body CT examinations at effective CT doses ∼2 mSv. Monte Carlo calculated absorbed doses depended on both the number of media types and accurate calibration of the CT number-to-density conversion ramp. Tissue segmentation by a 13-tissue CT conversion ramp, calibrated by a stoichiometric method, resulted in low (<4%) dose errors in selected organs for both isotopes. Conclusions: A calibrated CT scanner specific conversion ramp is required for accurate patient specific dosimetry in nuclear medicine. Accurate dosimetry was obtained with a 13-tissue ramp that included five different bone types.
Quantitative 124I-PET: Evaluation of Prompt Gamma Coincidence Correction on a Clinical PET/CT system
Impact of high 131 I-activities on quantitative 124 I-PET
Physics in Medicine and Biology, 2015
ABSTRACT Peri-therapeutic [Formula: see text]I-PET/CT is of interest as guidance for radioiodine ... more ABSTRACT Peri-therapeutic [Formula: see text]I-PET/CT is of interest as guidance for radioiodine therapy. Unfortunately, image quality is complicated by dead time effects and increased random coincidence rates from high [Formula: see text]I-activities. A series of phantom experiments with clinically relevant [Formula: see text]I/[Formula: see text]I-activities were performed on a clinical PET/CT-system. Noise equivalent count rate (NECR) curves and quantitation accuracy were determined from repeated scans performed over several weeks on a decaying NEMA NU-2 1994 cylinder phantom initially filled with 25 MBq [Formula: see text]I and 1250 MBq [Formula: see text]I. Six spherical inserts with diameters 10-37 mm were filled with [Formula: see text]I (0.45 MBq ml[Formula: see text]) and [Formula: see text]I (22 MBq ml[Formula: see text]) and placed inside the background of the NEMA/IEC torso phantom. Contrast recovery, background variability and the accuracy of scatter and attenuation corrections were assessed at sphere-to-background activity ratios of 20, 10 and 5. Results were compared to pure [Formula: see text]I-acquisitions. The quality of [Formula: see text]I-PET images in the presence of high [Formula: see text]I-activities was good and image quantification unaffected except at very high count rates. Quantitation accuracy and contrast recovery were uninfluenced at [Formula: see text]I-activities below 1000 MBq, whereas image noise was slightly increased. The NECR peaked at 550 MBq of [Formula: see text]I, where it was 2.8 times lower than without [Formula: see text]I in the phantom. Quantitative peri-therapeutic [Formula: see text]I-PET is feasible.
Quantitative myocardial perfusion by O-15-water PET: individualized vs. standardized vascular territories
European Heart Journal - Cardiovascular Imaging, 2015
Reporting of quantitative myocardial blood flow (MBF) is typically performed in standard coronary... more Reporting of quantitative myocardial blood flow (MBF) is typically performed in standard coronary territories. However, coronary anatomy and myocardial vascular territories vary among individuals, and a coronary artery may erroneously be deemed stenosed or not if territorial demarcation is incorrect. So far, the diagnostic consequences of calculating individually vs. standardly assessed MBF values have not been reported. We examined whether individual reassignment of vascular territories would improve the diagnostic accuracy of MBF with regard to the detection of significant coronary artery disease (CAD). Forty-four patients with suspected CAD were included prospectively and underwent coronary CT-angiography and quantitative MBF assessment with O-15-water PET followed by invasive, quantitative coronary angiography, which served as reference. MBF was calculated in the vascular territories during adenosine stress according to a standardized 17-segment American Heart Association model and an individualized model, using CT-angiography to adjust the coronary territories to their feeding vessels. Individually defined territories deviated from standard territories in 52% of patients. However, MBF in the three coronary territories defined by standard and individualized models did not differ significantly, except in one patient, in whom the MBF of an individualized coronary territory deviated sufficiently as to change the test from a false positive to a true negative result in this particular territory. Disparity between standardized and individualized vascular territories was present in half of the patients, but had little clinical impact. Still, caution should be taken not always to rely on standard territories, as this may at times cause misinterpretation.
PloS one, 2015
Understanding spatial and temporal patterns of bioirrigation induced by benthic fauna ventilation... more Understanding spatial and temporal patterns of bioirrigation induced by benthic fauna ventilation is critical given its significance on benthic nutrient exchange and biogeochemistry in coastal ecosystems. The quantification of this process challenges marine scientists because faunal activities and behaviors are concealed in an opaque sediment matrix. Here, we use a hybrid medical imaging technique, positron emission tomography and computed tomography (PET/CT) to provide a qualitative visual and fully quantitative description of bioirrigation in 4D (space and time). As a study case, we present images of porewater advection induced by the well-studied lugworm (Arenicola marina). Our results show that PET/CT allows more comprehensive studies on ventilation and bioirrigation than possible using techniques traditionally applied in marine ecology. We provide a dynamic three-dimensional description of bioirrigation by the lugworm at very high temporal and spatial resolution. Results obtain...
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Papers by Poul-Erik Braad