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Sundin, Anders
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Publications (10 of 167) Show all publications
Dam, G., Grønbæk, H., Sørbye, H., Thiis-Evensen, E., Paulsson, B., Sundin, A., . . . Tiensuu Janson, E. (2018). A Prospective Nordic Study on the Use of Chromogranin A for the Prediction of Progression in Patients with Pancreatic and Small Intestinal Neuroendocrine Tumors. Paper presented at 15th Annual ENETS Conference for the Diagnosis and Treatment of Neuroendocrine Tumor Disease, MAR 07-09, 2018, Barcelona, SPAIN. Neuroendocrinology, 106(Supplement: 1), 152-152
Open this publication in new window or tab >>A Prospective Nordic Study on the Use of Chromogranin A for the Prediction of Progression in Patients with Pancreatic and Small Intestinal Neuroendocrine Tumors
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2018 (English)In: Neuroendocrinology, ISSN 0028-3835, E-ISSN 1423-0194, Vol. 106, no Supplement: 1, p. 152-152Article in journal, Meeting abstract (Other academic) Published
Keywords
gep-net, ct, cga, correlation
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-355840 (URN)10.1159/000487699 (DOI)000427285300150 ()
Conference
15th Annual ENETS Conference for the Diagnosis and Treatment of Neuroendocrine Tumor Disease, MAR 07-09, 2018, Barcelona, SPAIN
Note

Meeting Abstract: F05

Available from: 2018-07-13 Created: 2018-07-13 Last updated: 2018-07-13Bibliographically approved
Uludag, N., Tötterman, A., Beckman, M. O. & Sundin, A. (2018). Anatomic distribution of hematoma following pelvic fracture. British Journal of Radiology, 91(1085), Article ID 20170840.
Open this publication in new window or tab >>Anatomic distribution of hematoma following pelvic fracture
2018 (English)In: British Journal of Radiology, ISSN 0007-1285, E-ISSN 1748-880X, Vol. 91, no 1085, article id 20170840Article in journal (Refereed) Published
Abstract [en]

Objective: To Assess The Extent Of Pelvic Hemorrhage On Ct And To Estimate Its Significance On Outcome In Patients With Blunt High-Energy Pelvic Trauma.

Methods: Test And Fisher'S Exact Test.

Results: Pelvic Hemorrhage Extended Beyond The Pelvis To The Abdominal Area In 47% Of The Patients, To The Thighs In 25% And To The Gluteal Areas In 81%. The Extent Of Hemorrhage Was Significantly Associated With The Need For Blood Transfusions (P = 0.011) And Angiography (P < 0.001), But Not With 30-Day Mortality.

Conclusion: Traumatic Pelvic Bleeding Frequently Extends Beyond The True Pelvis. Extrapelvic Hemorrhage Correlates With An Increased Need Of Transfusions, But Not With 30-Day Mortality. Further Studies Are Needed To Assess Whether Present Techniques To Control Pelvic Bleeding Need To Be Modified In Order To Further Reduce Mortality In Traumatic Pelvic Hemorrhage.

Advances In Knowledge: The Study Shows Localization Of Pelvic Hemorrhage In Trauma Patients. It May Help To Select Patients In Need Of Further Interventions To Control Bleeding.

National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-343528 (URN)10.1259/bjr.20170840 (DOI)000432584200027 ()29419325 (PubMedID)
Available from: 2018-02-28 Created: 2018-02-28 Last updated: 2018-08-24Bibliographically approved
Lindström, E., Sundin, A., Trampal, C., Lindsjö, L., Ilan, E., Danfors, T., . . . Lubberink, M. (2018). Evaluation of penalized likelihood estimation reconstruction on a digital time-of-flight PET/CT scanner for 18F-FDG whole-body examinations. Journal of Nuclear Medicine, 59(7), 1152-1158
Open this publication in new window or tab >>Evaluation of penalized likelihood estimation reconstruction on a digital time-of-flight PET/CT scanner for 18F-FDG whole-body examinations
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2018 (English)In: Journal of Nuclear Medicine, ISSN 0161-5505, E-ISSN 1535-5667, Vol. 59, no 7, p. 1152-1158Article in journal (Refereed) Published
Abstract [en]

The resolution and quantitative accuracy of PET are highly influenced by the reconstruction method. Penalized-likelihood estimation algorithms allow for fully convergent iterative reconstruction, generating a higher image contrast than ordered-subsets expectation maximization (OSEM) while limiting noise. In this study, a type of penalized reconstruction known as block-sequential regularized expectation maximization (BSREM) was compared with time-of-flight OSEM (TOF OSEM). Various strengths of noise penalization factor β were tested along with various acquisition durations and transaxial fields of view (FOVs) with the aim of evaluating the performance and clinical use of BSREM for 18F-FDG PET/CT, both quantitatively and in a qualitative visual evaluation. Methods: Eleven clinical whole-body 18F-FDG PET/CT examinations acquired on a digital TOF PET/CT scanner were included. The data were reconstructed using BSREM with point-spread function recovery and β-factors of 133, 267, 400, and 533—and using TOF OSEM with point-spread function—for various acquisition times per bed position and various FOVs. Noise level, signal-to-noise ratio (SNR), signal-to-background ratio (SBR), and SUV were analyzed. A masked evaluation of visual image quality, rating several aspects, was performed by 2 nuclear medicine physicians to complement the analysis. Results: The lowest levels of noise were reached with the highest β-factor, resulting in the highest SNR, which in turn resulted in the lowest SBR. A β-factor of 400 gave noise equivalent to TOF OSEM but produced a significant increase in SUVmax (11%), SNR (22%), and SBR (12%). BSREM with a β-factor of 533 at a decreased acquisition duration (2 min/bed position) was comparable to TOF OSEM at a full acquisition duration (3 min/bed position). Reconstructed FOV had an impact on BSREM outcome measures; SNR increased and SBR decreased when FOV was shifted from 70 to 50 cm. The evaluation of visual image quality resulted in similar scores for reconstructions, although a β-factor of 400 obtained the highest mean whereas a β-factor of 267 was ranked best in overall image quality, contrast, sharpness, and tumor detectability. Conclusion: In comparison with TOF OSEM, penalized BSREM reconstruction resulted in an increased tumor SUVmax and an improved SNR and SBR at a matched level of noise. BSREM allowed for a shorter acquisition than TOF OSEM, with equal image quality.

Keywords
FDG, Image Reconstruction, Molecular Imaging, PET/CT, block-sequential regularized expectation maximization, image reconstruction, penalization factor
National Category
Medical and Health Sciences Medical Image Processing
Identifiers
urn:nbn:se:uu:diva-343272 (URN)10.2967/jnumed.117.200790 (DOI)000437237200037 ()29449445 (PubMedID)
Available from: 2018-02-26 Created: 2018-02-26 Last updated: 2018-09-18Bibliographically approved
Norlén, O., Montan, H., Hellman, P., Stålberg, P. & Sundin, A. (2018). Preoperative Ga-68-DOTA-Somatostatin Analog-PET/CT Hybrid Imaging Increases Detection Rate of Intra-abdominal Small Intestinal Neuroendocrine Tumor Lesions. World Journal of Surgery, 42(2), 498-505
Open this publication in new window or tab >>Preoperative Ga-68-DOTA-Somatostatin Analog-PET/CT Hybrid Imaging Increases Detection Rate of Intra-abdominal Small Intestinal Neuroendocrine Tumor Lesions
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2018 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, no 2, p. 498-505Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Small intestinal neuroendocrine tumors (SI-NETs) are the most common form of neoplasm in the small bowel. Radiological identification of primary tumors (PT), which may be multiple, is difficult, and therefore palpation of the entire small bowel is routinely performed during laparotomy. The aim was to determine detection rates of PT and peritoneal carcinomatosis (PC) with 68Ga-DOTATOC/TATE-PET/CT in comparison with i.v. contrast-enhanced computed tomography (CE-CT) and thus to clarify whether modern functional imaging can mitigate the need for palpation of bowel during surgery enabling oncologically adequate laparoscopic resection.

METHODS:

A total of 28 patients with SI-NET who preoperatively underwent both 68Ga-DOTATOC/TATE-PET/CT and CE-CT were included. The detection rates of PT and PC for PET/CT and CE-CT were compared to the findings in the surgical and histopathological reports. Appropriate statistical tests were used, and significance was set to p < 0.05.

RESULTS:

Out of 82 PT, 43 PT were not detected by any imaging modality. More PT lesions were detected with PET/CT (n = 39 [47.5%]) than with CE-CT (n = 10 [12.2%], p < 0.001). Also, PET/CT identified significantly more PC lesions than CE-CT (78 and 38%, p = 0.004, respectively).

CONCLUSION:

PET/CT detected more PT and PC lesions than CE-CT. Some PTs and PC lesions were only detected by one of the modalities, and CT performed in conjunction with PET/CT should therefore be performed as a fully diagnostic CE-CT for optimal results. Palpation of the small bowel remains crucial during surgery in these patients because several PTs escaped detection by both PET/CT and CE-CT.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-335510 (URN)10.1007/s00268-017-4364-1 (DOI)000419886700027 ()29159606 (PubMedID)
Available from: 2017-12-06 Created: 2017-12-06 Last updated: 2018-02-28Bibliographically approved
Garske, U., Sandström, M., Fröss-Baron, K., Lundin, L., Hellman, P., Welin, S., . . . Granberg, D. (2018). Prospective observational study of 177Lu-DOTA-octreotate therapy in 200 patients with advanced metastasized neuroendocrine tumours (NETs): feasibility and impact of a dosimetry-guided study protocol on outcome and toxicity. European Journal of Nuclear Medicine and Molecular Imaging, 45(6), 970-988
Open this publication in new window or tab >>Prospective observational study of 177Lu-DOTA-octreotate therapy in 200 patients with advanced metastasized neuroendocrine tumours (NETs): feasibility and impact of a dosimetry-guided study protocol on outcome and toxicity
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2018 (English)In: European Journal of Nuclear Medicine and Molecular Imaging, ISSN 1619-7070, E-ISSN 1619-7089, Vol. 45, no 6, p. 970-988Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Peptide receptor radionuclide therapy in patients with neuroendocrine tumours has yielded promising results. This prospective study investigated the feasibility of dosimetry of the kidneys and bone marrow during therapy and its impact on efficacy and outcome.

METHODS: Lu-DOTA-octreotate with co-infusion of a mixed amino acid solution, and cycles were repeated until the absorbed dose to the kidneys reached 23 Gy or there were other reasons for stopping therapy. The Ki-67 index was ≤2% in 47 patients (23.5%), 3-20% in 121 (60.5%) and >20% in 16 (8%).

RESULTS: In 123 patients (61.5%) the absorbed dose to the kidneys reached 23 Gy with three to nine cycles during first-line therapy; in no patient was a dose to the bone marrow of 2 Gy reached. The best responses (according to RECIST 1.1) were a complete response (CR) in 1 patient (0.5%), a partial response (PR) in 47 (23.5%), stable disease (SD) in 135 (67.5%) and progressive disease (PD) in 7 (3.5%). Median progression-free survival was 27 months (95% CI 22-30 months) in all patients, 33 months in those in whom the absorbed dose to the kidneys reached 23 Gy and 15 months in those in whom it did not. Median overall survival (OS) was 43 months (95% CI 39-53 months) in all patients, 54 months in those in whom the absorbed dose to the kidneys reached 23 Gy and 25 months in those in whom it did not. Median OS was 60 months in patients with a best response of PR or CR, 42 months in those with SD and 16 months in those with PD. Three patients (1.5%) developed acute leukaemia, 1 patient (0.5%) chronic leukaemia (unconfirmed) and 30 patients (15%) grade 3 or 4 bone marrow toxicity. Eight patients (4%) developed grade 2 kidney toxicity and one patient (0.5%) grade 4 kidney toxicity.

CONCLUSIONS: Lu-DOTA-octreotate is feasible. Patients in whom the absorbed dose to the kidneys reached 23 Gy had a longer OS than those in whom it did not. Patients with CR/PR had a longer OS than those with SD. Bone marrow dosimetry did not predict toxicity.

Keywords
177Lu-DOTA-octreotate, Dosimetry, Neuroendocrine tumour, Outcome, PRRT, Toxicity
National Category
Radiology, Nuclear Medicine and Medical Imaging Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-346995 (URN)10.1007/s00259-018-3945-z (DOI)000430832400010 ()29497803 (PubMedID)
Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2018-08-02Bibliographically approved
Lamarca, A., Crona, J., Ronot, M., Opalinska, M., Lopez Lopez, C., Pezzutti, D., . . . Dromain, C. (2018). Value of Tumor Growth Rate (TGR) as an Early Predictor of Patients' Outcome in Patients Diagnosed with Well-Differentiated Neuroendocrine Tumors (NETs): The Greponet Study. Paper presented at 15th Annual ENETS Conference for the Diagnosis and Treatment of Neuroendocrine Tumor Disease, MAR 07-09, 2018, Barcelona, SPAIN. Neuroendocrinology, 106(Supplement: 1), 178-178
Open this publication in new window or tab >>Value of Tumor Growth Rate (TGR) as an Early Predictor of Patients' Outcome in Patients Diagnosed with Well-Differentiated Neuroendocrine Tumors (NETs): The Greponet Study
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2018 (English)In: Neuroendocrinology, ISSN 0028-3835, E-ISSN 1423-0194, Vol. 106, no Supplement: 1, p. 178-178Article in journal, Meeting abstract (Other academic) Published
Keywords
tumor growth rate, response, progression-free survival, follow-up, neuroendocrine tumor, prognosis, tgr, recist, radiology
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-355843 (URN)10.1159/000487699 (DOI)000427285300176 ()
Conference
15th Annual ENETS Conference for the Diagnosis and Treatment of Neuroendocrine Tumor Disease, MAR 07-09, 2018, Barcelona, SPAIN
Note

Meeting Abstract: G12

Selected For Oral Presentation

Available from: 2018-07-13 Created: 2018-07-13 Last updated: 2018-07-13Bibliographically approved
Sundin, A., Uhlén, N. & Axelsson, R. (2017). 18F-FDG PET/CT Diagnosis of Bronchopulmonary Carcinoids Versus Pulmonary Hamartomas: Reply. [Letter to the editor]. Clinical Nuclear Medicine, 42(1), 81-82
Open this publication in new window or tab >>18F-FDG PET/CT Diagnosis of Bronchopulmonary Carcinoids Versus Pulmonary Hamartomas: Reply.
2017 (English)In: Clinical Nuclear Medicine, ISSN 0363-9762, E-ISSN 1536-0229, Vol. 42, no 1, p. 81-82Article in journal, Letter (Refereed) Published
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-305764 (URN)10.1097/RLU.0000000000001338 (DOI)000390855000042 ()27607160 (PubMedID)
Available from: 2016-10-21 Created: 2016-10-21 Last updated: 2017-11-29Bibliographically approved
Sundin, A., Arnold, R., Baudin, E., Cwikla, J. B., Eriksson, B., Fanti, S., . . . Vullierme, M.-P. (2017). ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Radiological, Nuclear Medicine & Hybrid Imaging.. Neuroendocrinology, 105(3), 212-244
Open this publication in new window or tab >>ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Radiological, Nuclear Medicine & Hybrid Imaging.
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2017 (English)In: Neuroendocrinology, ISSN 0028-3835, E-ISSN 1423-0194, Vol. 105, no 3, p. 212-244Article in journal (Refereed) Published
Abstract [en]

Contrast-enhanced computed tomography (CT) of the neckthorax-abdomen and pelvis, including 3-phase examination of the liver, constitutes the basic imaging for primary neuroendocrine tumor (NET) diagnosis, staging, surveillance, and therapy monitoring. CT characterization of lymph nodes is difficult because of inadequate size criteria (short axis diameter), and bone metastases are often missed. Contrast-enhanced magnetic resonance imaging (MRI) including diffusion-weighted imaging is preferred for the examination of the liver, pancreas, brain and bone. MRI may miss small lung metastases. MRI is less well suited than CT for the examination of extended body areas because of the longer examination procedure. Ultrasonography (US) frequently provides the initial diagnosis of liver metastases and contrast-enhanced US is excellent to characterize liver lesions that remain equivocal on CT/MRI. US is the method of choice to guide the biopsy needle for the histopathological NET diagnosis. US cannot visualize thoracic NET lesions for which CTguided biopsy therefore is used. Endocopic US is the most sensitive method to diagnose pancreatic NETs, and additionally allows for biopsy. Intraoperative US facilitates lesion detection in the pancreas and liver. Somatostatin receptor imaging should be a part of the tumor staging, preoperative imaging and restaging, for which 68 Ga-DOTA-somatostatin analog PET/CT is recommended, which is vastly superior to somatostatin receptor scintigraphy, and facilitates the diagnosis of most types of NET lesions, for example lymph node metastases, bone metastases, liver metastases, peritoneal lesions, and primary small intestinal NETs. (18)FDG-PET/CT is better suited for G3 and high G2 NETs, which generally have higher glucose metabolism and less somatostatin receptor expression than low-grade NETs, and additionally provides prognostic information.

Keywords
Neuroendocrine tumor, Computed tomography, Magnetic resonance imaging, Ultrasound, Positron emission tomography, Scintigraphy, Single photon emission computed tomography, Somatostatin receptor imaging
National Category
Medical and Health Sciences Endocrinology and Diabetes Neurosciences
Identifiers
urn:nbn:se:uu:diva-319611 (URN)10.1159/000471879 (DOI)000411501200004 ()28355596 (PubMedID)
Available from: 2017-04-06 Created: 2017-04-06 Last updated: 2018-01-13Bibliographically approved
Knigge, U., Capdevila, J., Bartsch, D. K., Baudin, E., Falkerby, J., Kianmanesh, R., . . . Vullierme, M.-P. -. (2017). ENETS Consensus Recommendations for the Standards of Care in Neuroendocrine Neoplasms: Follow-Up and Documentation. Neuroendocrinology, 105(3), 310-319
Open this publication in new window or tab >>ENETS Consensus Recommendations for the Standards of Care in Neuroendocrine Neoplasms: Follow-Up and Documentation
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2017 (English)In: Neuroendocrinology, ISSN 0028-3835, E-ISSN 1423-0194, Vol. 105, no 3, p. 310-319Article in journal (Refereed) Published
Abstract [en]

ENETS consensus recommendations for the standards of care in neuroendocrine neoplasms (NEN) concerning follow-up and documentation are considered in this review. The documentation of patients with NEN should include the most relevant data characterizing an individual patient from the first contact with his/her physician/hospital until his/her last presentation during follow-up. It is advocated that follow-up occurs in specialized NEN centers with regular NEN tumor boards with expert panels. The follow-up should be in accordance with the ENETS consensus guidelines from 2011 and 2016, the present and coming WHO classification and ENETS/UICC recommendations for TNM staging. The recommendations for follow-up in patients with thymic, bronchopulmonary and gastroenteropancreatic NEN are given in Table 1. However, it should be stressed that evidence-based studies for follow-up are largely missing.

Keywords
Neuroendocrine neoplasm, Neuroendocrine tumor, Neuroendocrine carcinoma, Follow up, TNM staging, Chromogranin A, Neuron specific enolase, 5-Hydroxyindoleacetic acid, NT-pro-brain natriuretic peptide, Functional imaging, Somatostatin receptor imaging
National Category
Neurology Neurosciences Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-336666 (URN)10.1159/000458155 (DOI)000411501200010 ()28222443 (PubMedID)
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-01-13Bibliographically approved
Bozkurt, M. F., Virgolini, I., Balogova, S., Beheshti, M., Rubello, D., Decristoforo, C., . . . Fanti, S. (2017). Guideline for PET/CT imaging of neuroendocrine neoplasms with Ga-68-DOTA-conjugated somatostatin receptor targeting peptides and F-18-DOPA. European Journal of Nuclear Medicine and Molecular Imaging, 44(9), 1588-1601
Open this publication in new window or tab >>Guideline for PET/CT imaging of neuroendocrine neoplasms with Ga-68-DOTA-conjugated somatostatin receptor targeting peptides and F-18-DOPA
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2017 (English)In: European Journal of Nuclear Medicine and Molecular Imaging, ISSN 1619-7070, E-ISSN 1619-7089, Vol. 44, no 9, p. 1588-1601Article in journal (Refereed) Published
Abstract [en]

Purpose & Methods Neuroendocrine neoplasms are a heterogenous group of tumours, for which nuclear medicine plays an important role in the diagnostic work-up as well as in the targeted therapeutic options. This guideline is aimed to assist nuclear medicine physicians in recommending, performing, reporting and interpreting the results of somatostatin receptor (SSTR) PET/CT imaging using Ga-68-DOTA-conjugated peptides, as well as F-18-DOPA imaging for various neuroendocrine neoplasms. Results & Conclusion The previous procedural guideline by EANM regarding the use PET/CT tumour imaging with Ga-68-conjugated peptides has been revised and updated with the relevant and recent literature in the field with contribution of distinguished experts.

Place, publisher, year, edition, pages
SPRINGER, 2017
Keywords
Neuroendocrine tumours, Neuroendocrine neoplasms, Pet/Ct, Ga-68-DOTATATE, Ga-68-DOTATOC, Ga-68-DOTANOC, F-18-DOPA, F-18-FDG, Thyroid medullary cancer, Pheochromoacytoma, Paraganglioma, Foregut-NET, Midgut-NET, Hindgut-NET, Hyperinsulism in infants
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-347354 (URN)10.1007/s00259-017-3728-y (DOI)000405459500019 ()28547177 (PubMedID)
Note

An erratum to this article is available at https://doi.org/10.1007/s00259-017-3807-0

Eur J Nucl Med Mol Imaging (2017) 44: 2150

Professor Anders Sundin’s name was not included among the authors’ list even though he contributed to the article with all the great efforts and valuable expertise on the field, which all of the authors of this article absolutely agree with and approve that his name should have been among the authors for this article.

Available from: 2018-03-29 Created: 2018-03-29 Last updated: 2018-03-29Bibliographically approved
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