Mattia Bertoli

Brescia University, Dept. Molecular and Translational Medicine, Graduate Student

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Papers by Mattia Bertoli

Case Report: 18F-PSMA PET/CT Scan in Castration Resistant Prostate Cancer With Aggressive Neuroendocrine Differentiation

Frontiers in Oncology

The development of a neuroendocrine phenotype as a mechanism of resistance to hormonal treatment ... more The development of a neuroendocrine phenotype as a mechanism of resistance to hormonal treatment is observed in up to 20% of advanced prostate cancer patients. High grade neuroendocrine prostate cancer (NEPC) is associated to poor prognosis and the therapeutic armamentarium is restricted to platinum-based chemotherapy. Prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET)/computed tomography (CT) imaging has recently emerged as a potential new standard for the staging of prostate cancer and PSMA-based radioligand therapy (RLT) as a therapeutic option in advanced metastatic castration resistant prostate cancer (mCRPC). PSMA-based theranostic is not currently applied in the staging and treatment of NEPC since PSMA expression on neuroendocrine differentiated cells was shown to be lost. In this case series, we present 3 consecutive mCRPC patients with histologically proven high grade neuroendocrine differentiation who underwent PSMA-PET/CT and surprisingly s...

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Incidental thymoma detection during myocardial perfusion imaging by CZT camera

Journal of Nuclear Cardiology

Erdheim-Chester Disease: The power of nuclear medicine imaging

Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)

Cardiac amyloidosis incidentally detected by 18F-FDG PET/CT

Journal of Nuclear Cardiology

Comparison between N13NH3-PET and 99mTc-Tetrofosmin-CZT SPECT in the evaluation of absolute myocardial blood flow and flow reserve

Journal of Nuclear Cardiology

Prognostic role of pretreatment 18F-FDG PET/CT in primary brain lymphoma

Annals of Nuclear Medicine

Ethmoidal and extranodal Burkitt lymphoma in a child with bilateral kidney Burkitt lymphoma lesions incidentally detected by 18F-FDG PET/CT

Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)

Pulmonary mucosa-associated lymphoid tissue lymphoma: (18)F-FDG PET/CT and CT findings in 28 patients

The British journal of radiology, 2017

The aim of the study was to evaluate the CT and fluorine-18-fluorodeoxyglucose positron emission ... more The aim of the study was to evaluate the CT and fluorine-18-fluorodeoxyglucose positron emission tomography/CT ((18)F-FDG PET/CT) imaging findings of lung mucosa associated lymphoid tissue (MALT) lymphoma. 28 patients with histologically confirmed pulmonary MALT lymphoma who underwent a chest CT and (18)F-FDG PET/CT for staging were retrospectively analysed. The CT images were evaluated to determine morphological pattern of appearance, laterality, localization, number, size, presence of thoracic lymphadenopaties and secondary/combined findings. PET images were analysed visually and semi-quantitatively by measuring the maximum standardized uptake value (SUVmax), lesion-to-liver SUVmax ratio and lesion-to-blood pool SUVmax ratio. The relationship between qualitative and semi-quantitative features at (18)F-FDG PET/CT and CT findings were also analysed. A total of 57 pulmonary lesions were identified by CT: 37 areas of consolidation, 4 masses, 12 nodules and 4 ground-glass opacities. So...

18F-FDG PET/CT in primary brain lymphoma

Journal of neuro-oncology, Jan 17, 2017

The actual role of 18F-FDG PET/CT in evaluating primary brain lymphoma is still an open issue. Br... more The actual role of 18F-FDG PET/CT in evaluating primary brain lymphoma is still an open issue. Brain lymphoma usually show elevated 18F-FDG uptake, often higher than other brain tumors or inflammatory processes, but the metabolic behavior of this lymphoma is not still understood. Our aim was to investigate the particular metabolic behavior of this lymphoma. Forty six patients (21 female, 25 male) with histologically-confirmed brain lymphoma who underwent 18F-FDG PET/CT from vertex to the mid-thigh for initial staging were retrospectively evaluated. The PET images were analyzed visually and semi-quantitatively by measuring the maximum standardized uptake value (SUVmax), lesion-to-liver SUVmax ratio, lesion-to-blood pool SUVmax ratio and the tumor to normal brain uptake ratio (T/N ratio) and compared with epidemiological (age, sex, HIV infection) and morphological (tumor size, MRI appearance) characteristics. Thirty-eight patients (83%) had positive 18F-FDG PET/CT (average SUVmax was ...

Hepatosplenic Candidiasis Detected by (18)F-FDG-PET/CT

Asia Oceania journal of nuclear medicine & biology, 2016

Hepatosplenic candidiasis is a fungal infection, which mostly affects patients with hematologic m... more Hepatosplenic candidiasis is a fungal infection, which mostly affects patients with hematologic malignancies such as leukemia. The pathogenesis of this infection is not clear yet, and the liver is the most commonly affected organ. Diagnosis of hepatosplenic candidiasis can be only established via biopsy, since computed tomography (CT) scan, ultrasonography, and magnetic resonance imaging (MRI) yield non-specific results. The role of fluorine-18 fluorodeoxyglucose positron emission tomography /computed tomography ((18)F-FDG PET/CT) in diagnosis of hepatosplenic candidiasis remains undetermined, considering a few evidences in the literature. In this case report, we present the case of a 47-year-old patient, affected by acute myeloid leukemia, which was treated with three cycles of chemotherapy, resulting in the development of neutropenia and fever following the last cycle. The (18)F-FDG PET/CT scan showed some foci of intense FDG uptake in the liver and spleen. The subsequent diagnost...

Comparison between the summed difference score and myocardial blood flow measured by 13N-ammonia

Journal of Nuclear Cardiology, 2017

Both the myocardial perfusion pattern and myocardial blood flow (MBF) are used to assess patients... more Both the myocardial perfusion pattern and myocardial blood flow (MBF) are used to assess patients with suspected coronary artery disease (CAD). The aim of this study was to compare the perfusion pattern (using the summed difference score [SDS]) to MBF in a consecutive group of patients undergoing PET/CT with 13 N-ammonia ((13)NH3). 47 consecutive patients, aged 65 ± 12 years (42 men) with known or suspected CAD, underwent vasodilator stress/rest PET/CT with (13)NH3 for clinical indications. The SDS was determined by a commercially available software based on a 17-segment model. MBF was measured at rest and during hyperemia by dynamic acquisition and single-compartment model analysis. From the rest and stress MBF, the absolute difference (stress-rest) in myocardial blood flow defined as difference in myocardial blood flow (DMBF) was derived. There were no significant differences between patients with no ischemia (SDS ≤ 1) and those with ischemia (SDS &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 1) in CFR (2.84 ± 0.73 vs 2.63 ± 0.89, P = NS) and DMBF (1.34 ± 0.45 vs 1.24 ± 0.53 mL·minute(-1)·g(-1), P = NS). There were however significant regional differences (141 different vascular territories in 47 patients) between these two groups (CFR: 2.84 ± 0.95 vs 2.16 ± 0.57, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001 and DMBF: 1.39 ± 0.6 vs 0.87 ± 0.39, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). The correlation between regional CFR and regional DMBF with SDS was significant (y = 2.7145e(-0.059x) R = 0.358 and y = 1.2769e(-0.119x) R = 0.44) CONCLUSION: The SDS is the difference between two measurements (stress-rest) and it correlates better with regional DMBF, which is another measurement that reflects the difference between stress and rest. The correlation is better on regional than global basis.

Differentiated Thyroid Cancer lymph-node relapse. Role of adjuvant radioactive iodine therapy after lymphadenectomy

European journal of nuclear medicine and molecular imaging, Jan 14, 2016

Our purpose as to evaluate the impact of adjuvant radioactive iodine therapy (RAI) on prognosis, ... more Our purpose as to evaluate the impact of adjuvant radioactive iodine therapy (RAI) on prognosis, as assessed by progression-free survival (PFS) and overall survival (OS), in patients affected by differentiated thyroid carcinoma (DTC) lymph-node relapse and previously treated with lymphadenectomy. We retrospectively evaluated DTC patients treated with lymph-node dissection for disease relapse. All patients had previously undergone total thyroidectomy and radioiodine remnant ablation (RRA). We used clinical and histological data obtained during follow-up to assess response and outcome. By means of univariate and multivariate time-to-event analyses, we assessed the impact of RAI on outcome (PFS and OS) and the prognostic role of thyroglobulin (Tg) levels under suppression with levothyroxine (Tg-on) measured 1-3 months after lymphadenectomy and of other risk factors. We evaluated 113 patients (age at diagnosis: median 41 years, interquartile range: 31-59), 64 of whom were treated with R...

Incidental 18F-FDG PET/CT bilateral breast uptake due to carcinoma

Nuclear Medicine Review, 2016

We report a case of 71-year-old female patient, previously treated with chemotherapy and surgical... more We report a case of 71-year-old female patient, previously treated with chemotherapy and surgical resection of sigmoid tract of the large bowel for adenocarcinoma (pT3N1M0), who underwent a 18 F-FDG PET/CT for a suspicious hepatic lesion detected at CT scan during follow-up. 18 F-FDG PET/CT showed no abnormal uptake in the liver both at 60 minutes and 120 minutes after injection but revealed a pathological uptake in two breast nodules, (one localized in upper-internal-quadrant of the right breast and the other in the upper-external-quadrant of the left breast). The patient underwent breast MRI, which confirmed the suspicious nature of both lesions; subsequently she underwent a trucut biopsy of both lesions witch demonstrated a bilateral localization of papillary carcinoma (both lesion were classified as pT1c). The patient underwent bilateral mastectomy and the final biopsy confirmed the presence of breast cancer, while bilateral sentinel nodes biopsy showed no lymph-nodes metastases.

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18F-FDG PET/CT in gastric MALT lymphoma: a bicentric experience

European Journal of Nuclear Medicine and Molecular Imaging, 2016

Incidental 11C-Choline PET/CT Uptake Due to Esophageal Carcinoma in a Patient Studied for Prostate Cancer

Clinical Nuclear Medicine, 2014

A 75-years-old patient with a history of prostate cancer, previously treated with radical prostat... more A 75-years-old patient with a history of prostate cancer, previously treated with radical prostatectomy, underwent C-choline PET/CT for restaging due to a rise in the prostate-specific antigen level. The study revealed a focal uptake of C-choline in the esophagus. A subsequent endoscopic examination showed the presence of an esophageal lesion, and after surgery, the histologic diagnosis was mildly differentiated squamous cell carcinoma. In our case, the incidental esophageal uptake revealed by C-choline PET/CT allowed the early diagnosis of an unsuspected esophageal carcinoma.

Pulmonary mucosa-associated lymphoid tissue lymphoma: CT and pathologic findings

American Journal of Roentgenology, 1999

The objective of this study was to determine the CT findings in pulmonary mucosa-associated lymph... more The objective of this study was to determine the CT findings in pulmonary mucosa-associated lymphoid tissue lymphoma and to correlate these CT findings with histologic specimens. In the 11 patients reviewed, the most common CT appearance of pulmonary mucosa-associated lymphoid tissue lymphoma was consolidation with air bronchograms, correlating histologically with a cellular lymphocytic infiltrate expanding the interstitium and compressing adjacent alveoli, producing air bronchograms.

Multicentre study of 18F-FDG-PET/CT prostate incidental uptake

Japanese Journal of Radiology, 2015

The purpose of our study was to establish the prevalence and pathological nature of fluorine-18-f... more The purpose of our study was to establish the prevalence and pathological nature of fluorine-18-fluorodeoxyglucose (18F-FDG) prostate incidental uptake (PIU) among patients studied for non-prostate-malignant purposes in three nuclear medicine centres. We retrospectively evaluated 20,422 scans performed on male patients; all patients underwent 18F-FDG-PET/CT for purposes not related to prostate disease. Among 20,422 patients PIU was identified for 280 (1.4 %) with an average age of 70 ± 10.7 years. Sixty-three of the 280 patients with PIU (22.5 %) underwent PSA dosage and biopsy to determine the nature of the incidental uptake. Thirty-five of the 63 (55.5 %) PIU were malignant whereas 28/63 (44.5 %) were benign. The average value of PSA for patients with benign PIU was 3.7 ± 2.8 ng/ml whereas it was 7.8 ± 8.2 ng/ml in patients with malignant PIU; this difference was statistically significant. For malignant lesions, the average lesion-to-liver SUVmax ratio was 2.9 ± 2.5 and the averag...

1-23I-MIBG thyroid uptake: Implications for MIBG imaging of the heart

by Mattia Bertoli and Federica Motta

Journal of Nuclear Cardiology, 2015

123I-MIBG has been widely used in patients with heart failure and neurological disorders. The pat... more 123I-MIBG has been widely used in patients with heart failure and neurological disorders. The patients are pre-treated with Lugol&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s oral solution or potassium perchlorate to prevent thyroid uptake of unlabeled 123I to limit the thyroid radiation exposure. However, despite the inhibition of the iodide pump, the thyroid is frequently visualized. The aim of this study was to study the pattern of thyroid uptake. We reviewed the 123I-MIBG images of 57 patients studied in three different centers in Italy for cardiac (n = 42) or neurological (n = 15) indications. They were imaged at 15 minutes and 4 hours after injection and in all patients, the thyroid was included in the imaging field of view. In 2 of the 3 centers, the patients were pre-treated with Lugol&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s oral solution and/or potassium perchlorate (group 1) but in the third center, they were not (group 2). The following imaging parameters were evaluated: heart-to-mediastinum ratio (H/M), thyroid-to-mediastinum ratio (T/M) at 4 hours, and tracer wash out from the heart (HWO) and from the thyroid (TWO). In the cardiac patients, the HWO was 22.98 ± 7.16% and TWO was 11.4 ± 11.86% (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). The TWO was 12.2 ± 13.1% in group 1 and 10.05 ± 8.97% in group 2 (P = NS). In the neurological patients the HWO was 26 ± 8.1% and the TWO was 20.32 ± 6.41 (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). The difference in TWO was statistically significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01) between cardiac and neurological patients, whereas the HWO was not. The 4-hour H/M was 1.49 ± 0.23 in cardiac patients vs 1.4 ± 0.39 in neurological patients (P = NS). The 4-hour T/M was 1.33 ± 0.3 in cardiac patients vs 1.15 ± 0.13 in neurological patients (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The thyroid visualization in MIBG imaging is likely an expression of thyroid sympathetic innervation. The differences in TWO and T/M ratio in cardiac and neurological patients probably express differences in thyroid dopaminergic receptors. Thus, pre-treatment with potassium perchlorate or Lugol&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s solution may not be justified in patients undergoing 123I-MIBG imaging in whom the risk of side effects due to pre-treatment could be higher than the risk due to thyroid radiation exposure.

Diagnostic role of radiolabelled choline PET or PET/CT in hepatocellular carcinoma: a systematic review and meta-analysis

by Mattia Bertoli and Giovanni Bosio

Hepatology International, 2014

The role of fluorine-18-fluorodeoxygluose positron emission tomography/computed tomography ((18)F... more The role of fluorine-18-fluorodeoxygluose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in hepatocellular carcinoma (HCC) has not been firmly established yet and its sensitivity has been reported to be in the range of 40-60 %. Because of this relatively low sensitivity alternative tracers have been proposed. The aim of our review is to analyse the literature data on the diagnostic role of (18)F/(11)C-choline PET/CT in the evaluation of HCC. A comprehensive computer literature search of PubMed/MEDLINE, Embase and Scopus databases was conducted to find relevant published articles about the role of whole-body (18)F-choline or (11)C-choline PET or PET/CT in patients with HCC. Furthermore, a meta-analysis about the detection rate of this method in HCC was performed. Six articles were included in this systematic review and discussed. The meta-analysis of five out of six articles showed a DR of 84 % (95 % CI 79-89 %). The DR increased when poorly differentiated HCC was excluded from the analysis. Radiolabelled choline PET or PET/CT could be a valuable tool in detecting HCC and it is better than (18)F-FDG PET/CT, especially in well to moderately differentiated lesions; on the other hand, poorly differentiated and higher-stage HCC could be better evaluated with (18)F-FDG and dual tracer imaging should be considered and could be potentially useful to increase accuracy.

Multicentric study on 18F-FDG-PET/CT breast incidental uptake in patients studied for non-breast malignant purposes

by Mattia Bertoli and Giovanni Bosio

Revista Española de Medicina Nuclear e Imagen Molecular, 2015

Our study has aimed to establish the prevalence and pathological nature of fluorine-18-fluorodeox... more Our study has aimed to establish the prevalence and pathological nature of fluorine-18-fluorodeoxyglucose ((18)F-FDG) breast incidental uptake (BIU) in patients studied for non-malignant breast tumours and then to compare our data obtained in three Italian nuclear medicine centres with those available in literature. We retrospectively evaluated 42,927 (18)F-FDG-PET/CT scans performed on patients studied in three Italian Nuclear Medicine Centres. All patients underwent (18)F-FDG-PET/CT for oncologic purposes not related to breast disease. Among 42,927 scans, a BIU was identified in 79 (0.18%) patients, 75 (95%) female and 4 (5%) male with an average age of 62 ± 17 years. Twenty-five out of 35 (71.5%) BIUs were malignant and 10/35 (28.5%) benign. Among the 25/35 incidentalomas that were malignant, 12/25 (48%) were infiltrating ductal carcinoma, 5/25 (20%) ductal carcinoma (infiltrating and in situ), 4/25 (16%) lobular carcinoma, 2/25 (8%) ductal carcinoma in situ and 2/25 (8%) were metastases from the primary tumour under investigation. Of the 10 BIUs that were benign in the histological examination, after further investigations it was found that 9/10 (90%) were fibroadenomas and 1/10 (10%) was a benign lesion not better specified. The lesion to liver or to blood-pool SUVmax ratio in malignant lesions is significantly higher than in benign ones. Our multicenter study demonstrates that, although they are uncommon, BIUs show a high percentage of malignancy and therefore requires further research.

Mattia Bertoli

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