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Disease Spotlight: Prostate Cancer

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Surgery is the treatment of choice for all primary and most metastatic liver tumors in patients without extrahepatic disease. One limitation to resection, however, is concern that the volume of liver parenchyma remaining after surgery (remnant liver) may not be sufficient to avoid lethal posthepatectomy liver failure.

Portal vein embolization provides hope in cancer

The Food and Drug Administration (FDA) has granted 510(k) clearance for AngioFlow™, an artificial intelligence (AI)-enabled perfusion imaging software that may facilitate more timely assessments of perfusion status prior to endovascular procedures.

Offering color-coded perfusion mapping that identifies regions with reduced cerebral blood flow and blood volume, 

 provides results within minutes of a cone-beam computed tomography (CT) scan, according to RapidAI, the manufacturer of AngioFlow.

In addition to potential cost savings by reducing redundant imaging, RaidAI emphasized that AngioFlow’s timely assessments may reduce long-term disability risks and facilitate life-saving interventions for patients in need of acute stroke care.

“AngioFlow by RapidAI will allow physicians to assess the need for additional imaging immediately in the interventional suite. By avoiding unnecessary scans, stroke patients can receive the timely care that can be the difference between being able to walk out of a hospital to their homes versus being discharged to a skilled nursing facility,” said Abhishek Singh, MD, DABPN, DUCNS, who is affiliated with the Creighton University School of Medicine in Omaha, Nebraska.

The company added that AngioFlow has been validated in more than 10 clinical trials.

Reportedly validated in more than 10 clinical trials, the AngioFlow perfusion imaging software enables timely identification of brain regions with cerebral blood flow reduction and those with significant hypoperfusion.

Topic

FDA Clears AI-Powered Qualitative Perfusion Mapping for Cone-Beam CT

A 7-year-old male presented with pain after falling on an outstretched hand.
 

Image IQ: 7-year-old with Pain after Fall

A 12-year-old boy presents to the emergency department with acute pain in the medial aspect of his right elbow after pitching in a baseball game. He also complains of dull lateral elbow pain that has been present for weeks. AP, oblique, and lateral radiographs of the right elbow were obtained.

Medial and lateral epicondyle avulsion fractures

Medial epicondyle avulsion fracture and osteochondritis dissecans of the capitellum

A 12-year-old boy presents to the emergency department with acute pain in the medial aspect of his right elbow after pitching in a baseball game. 

Image IQ: 12-year-old Boy With Acute Medial Elbow Pain

A 42- year-old female with recent diagnosis of stage III malignant melanoma in her leg presents for evaluation of a palpable right breast lump.

On mammography, in the patient’s area of concern in the right 8:00 position, a well-circumscribed, round mass is seen measuring 5 mm. Just adjacent to this is an additional 10 mm round, well-circumscribed mass. On physical examination, there is a palpable superficial mobile lump in the right 8:00 area of concern.  Ultrasound demonstrates a cyst measuring 4 mm, corresponding to the area of concern at 8:00. At the 8:30 position, there is a heterogeneous round mass noted measuring 12 x 9 x 6 mm.

Image IQ: 42-year-old Woman with Recent Stage III Malignant Melanoma Diagnosis

The positron emission tomography (PET) agent 18F-flotufolastat detected has a nearly 75 percent detection rate for recurrent prostate cancer in patients with prostate-specific antigen (PSA) levels of less than 1 ng/mL, according to research presented at the American Society for Radiation Oncology (ASTRO) conference.

In a recent interview, Bridget Koontz, M.D., the lead author of the post-hoc analysis from the SPOTLIGHT trial, said delayed renal clearance with 18F-flotufolastat (Posluma, Blue Earth Diagnostics) provides a unique advantage in this patient population in comparison to other imaging agents.

“Excretion into the bladder is slower (with 

F-flotufolastat) than some of the other agents out there … so you don't get sort of a cloud of urinary uptake that can blur … when we're trying to see what's happening in the prostate or in the prostate bed. That is a big advantage for low PSA patients, because they're less likely to have metastatic disease and, frankly, more likely in the post prostatectomy space to have prostate bed recurrence,” emphasized Dr. Koontz, the medical director of radiation oncology at AdventHealth Cancer Institute in Orlando, Fla.

(Editor’s note: For related content, see “

F-Flotufolastat PET Imaging Changes Treatment in 89 Percent of Patients with Prostate Cancer Recurrence

Recurrent Prostate Cancer and Low PSA Levels: Can an Emerging PSMA PET Agent Have an Impact?

Optimal Timing and Frequency of Imaging Agents Used in the Detection and Characterization of Oligometastatic Prostate Cancer

In addition to an overall 69 percent detection rate in those with a pSA level of less than 1 ng/mL, the researchers found a 74 percent detection rate of PCa recurrence in patients with PSA levels between 0.5 ng/mL 

F-flotufolastat maintained high detection rates with even lower PSA levels, noting a 67 percent rate in those with PSA levels 0.3 ng/mL 

0.5 ng/mL and a 68 percent rate when PSA levels were 0.2 ng/mL 

(Editor's note: For additional content on prostate cancer imaging, visit 

For more insights from Dr. Koontz, watch the video below.

1. Koontz BF, Lowentritt B, Jani AB, et al. 

F-flotufolastat detection rates in the pelvis region for patients with prostate cancer recurrence after radical prostatectomy and PSA levels < 1 ng/mL: data from the phase 3 SPOTLIGHT study. Presented at the American Society for Radiation Oncology (ASTRO) 2024 Annual Meeting, September 29-October 2, 2024. Available at: 

https://www.astro.org/meetings-and-education/micro-sites/2024/annual-meeting

Bridget Koontz, MD discusses recent research at the ASTRO conference that shows benefits of the PET agent 18F-flotufolastat for detecting PCa recurrence in patients with low PSA levels.

Can 18F-Floutufolastat Bolster Detection of PCa Recurrence in Patients with Low PSA Levels After Radical Prostatectomy?

In a recent interview, Bridget Koontz, M.D., discussed the capability of the PET imaging agent 18F-flotufolastat for diagnosing post-prostatectomy recurrence of prostate cancer in patients with PSA values less than 1 ng/mL, based on research presented at the American Society for Radiation Oncology (ASTRO) conference.

Clinical

Can 18F-Flotufolastat Bolster Detection of PCa Recurrence in Patients with Low PSA Levels After Radical Prostatectomy?

Case submitted by: Saeed Rad M.D., radiologist, to radRounds Radiology Network

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Jeff Geschwind, MD

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