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Results in The Quarterly Journal of Nuclear Medicine and Molecular Imaging: 1,012

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Viviana Garbaccio, Massimo Menga, Giovanni Mensa, , Antonello Galati, Alessandra Codegone, , Emanuela Pilati, , Riccardo E. Pellerito
The Quarterly Journal of Nuclear Medicine and Molecular Imaging; https://doi.org/10.23736/s1824-4785.17.03027-8

Abstract:
ROLL is a simple and safe procedure in the surgical management of DTC loco-regional relapse.
Published: 1 July 2017
by 10.23736
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 292-300; https://doi.org/10.23736/S1824-4785.17.02994-6

Abstract:
The use of positron-emission tomography (PET) with fluorodeoxyglucose (FDG), 11C-acetate and radio-labelled choline such as 11C-choline or 18F-fluorocholine in the diagnosis of hepatocellular carcinoma (HCC), for risk stratification or therapy monitoring has emerged. This review aims to summarize the published results dealing with this issue.PubMed database was searched until February 2017. Sensitivities, specificities, progression-free survival (PFS), survival and hazard ratios (HR) are reported.Seventy-one studies were included. Most studies are dealing with the diagnostic value of FDG PET (N.=21), 11C-acetate PET (N.=11), and choline PET (N.=8). The results indicate a homogenously higher sensitivity for 11C-acetate and choline PET as compared to FDG PET in the diagnosis of primary or recurrent HCC. This is particularly true for well differentiated HCC, which tend to have higher uptake of 11C-acetate and radio-labelled choline. Contrary, poorly differentiated HCC are more often FDG-positive than well differentiated HCC. Sixteen studies are evaluating the prognostic value of FDG PET for surgery or liver transplantation. The studies found a significant worse prognosis in terms of time to recurrence, PFS, and survival in FDG-positive HCC as compared to FDG-negative ones. Sixteen studies are reporting about the prognostic value of FDG PET and one about 18F-fluoroethylcholine PET for palliative treatment. Most of these studies indicate a significant shorter PFS and survival in FDG-positive HCC for various treatments.Whereas FDG PET has only a limited role in the diagnosis of HCC, it provides valuable prognostic information for liver surgery, transplantation and palliative treatment. 11C-acetate and choline PET have a higher sensitivity in the diagnosis of HCC.
Auletta Sveva, Baldoni Daniela, , Galli Filippo, Hajar Iman A, Duatti Adriano, , Trampuz Andrej,
Published: 1 February 2019
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 63, pp 37-47; https://doi.org/10.23736/S1824-4785.17.02975-2

Abstract:
Diagnosis of implant-associated infection is challenging. Several radiopharmaceuticals have been described but direct comparisons are limited. Here we compared in vitro and in an animal model 99mTc-UBI, 99mTc-Ciprofloxacin, 99mTcN-CiproCS2 and 111In-DTPA-biotin for targeting E. coli (ATCC 25922) and S. aureus (ATCC 43335).Stability controls were performed with the labelled radiopharmaceuticals during 6 h in saline and serum. The in vitro binding to viable or killed bacteria was evaluated at 37 °C and 4 °C. For in vivo studies, Teflon cages were subcutaneously implanted in mice, followed by percutaneous infection. Biodistribution of i.v. injected radiolabelled radiopharmaceuticals were evaluated during 24 h in cages and dissected tissues.Labelling efficiency of all radiopharmaceuticals ranged between 94% and 98%, with high stability both in saline and in human serum. In vitro binding assays displayed a rapid but poor bacterial binding for all tested agents. Similar binding kinetic occurred also with heat-killed and ethanol-killed bacteria. In the tissue cage model, infection was detected at different time points: 99mTc-UBI and 99mTcN-CiproCS2 showed higher infected cage/sterile cage ratio at 24 h for both E. coli and S. aureus; 99mTc-Ciprofloxacin at 24 h for both E. coli and at 4 h for S. aureus; 111In-DTPA-biotin accumulates faster in both E. coli and S. aureus infected cages.99mTc-UBI, 99mTcN-CiproCS2 showed poor in vitro binding but good in vivo binding to E. coli only. 111In-DTPA-biotin showed poor in vitro binding but good in vivo binding to S. aureus and poor to E. coli. 99mTc-Ciprofloxacin showed poor in vitro binding but good in vivo binding to all tested bacteria. The mechanism of accumulation in infected sites remains to be elucidated.
, Westman Eric, Meles Sanne K, Pereira Joana B, Massa Federico, Grazzini Matteo, Kogan Rosalie V, Leenders Klaus L
Published: 1 September 2017
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 372-385; https://doi.org/10.23736/S1824-4785.17.03018-7

Abstract:
Neuroimaging in Parkinson's disease (PD) and other primary Parkinsonian disorders has been increasingly used in the routine clinical work in the last years. The paradigm has changed from an 'exclusionary' use, i.e., to rule out causes of secondary parkinsonism, to an 'inclusionary' one, i.e., finding image and network characteristics allowing to identify a specific disease. This is allowed by analyses spanning from the commonly used visual analysis to the most sophisticated post-processing leading to the identification of covariance patterns both in morphological and functional neuroimaging. However, paralleling the advancement in covariance and connectivity analyses, the issues of standardization and harmonization of data acquisition, and image reconstruction and post-processing among centers are emerging in the scientific community. Also, the building of scientific evidence still suffers from the lack of large, formal studies and relies on relatively small cohort studies from one or few centers. Joint actions to face these issues are now ongoing in Europe, supported by specific programs, such as the Joint Programming on Neurodegenerative Diseases (JPND). In the present review, some of the most recent and relevant achievements in the field of diffusion tensor MRI, functional MRI (bold), FDG-PET, DAT SPECT and non dopaminergic imaging in PD and primary Parkinsonisms are reported.
Son Hye J, Jeong Young J, Yoon Hyun J, Kim Jae W, Choi Go-E, Park Jong H, Kang Do-Y
Published: 1 December 2019
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 63, pp 379-386; https://doi.org/10.23736/S1824-4785.17.02976-4

Abstract:
Using dual time F-18 FP-CIT, we evaluated cortical perfusion, striatal binding and neuropsychological performance simultaneously in Parkinson's disease (PD) with and without mild cognitive impairment (MCI), to investigate neural correlates between caudate and frontal cortex.According to the neuropsychological scores, subjects were classified into 26 healthy controls (HC), 38 PD-MCI (executive) (PE), 24 PD-MCI (non-executive) (PN) and 21 PD (motor) (PM). Scans were acquired at 10 minutes and 2 hours. Group differences of early perfusion and delayed binding were compared using SPM and volume of interest method. The relationships between neuropsychological variables and the striatal binding were investigated with correlation and regression analysis.Compared with PM, PE showed decreased prefrontal perfusion and binding of both caudates (Right: p = 0.0010, Left: p = 0.014), but not of both putamens. Compared with PN, PE showed decreased binding of both caudates (Right: p = 0.001, Left: p = 0.005), but not in both putamens. Binding of both caudates correlated with the Stroop z-score, but not of both putamens. Executive score was a contributing factor to binding of the caudate, and not the putamen.PE showed decreased prefrontal perfusion and caudate binding, supporting neural correlates between the caudate and the prefrontal cortex. Dopaminergic binding of the caudate, but not of the putamen, was related to executive scores. Caudate hypofunction was specific to executive domain. This is the first study that elucidated the clinical use of dual time F-18 FP-CIT for integrative evaluation of cognitive and motor function in PD.
, Fabrizio Bergesio, Stephane Chauvie, Andrea Bianchi, Massimo Menga, Federico Fallanca, , Michele Gregianin, Michel Meignan, Andrea Gallamini
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 65; https://doi.org/10.23736/s1824-4785.17.02993-4

Abstract:
Qualitative assessment using the Deauville five-point scale (DS) is the gold standard for interim and end-of treatment PET interpretation in lymphoma. In the present study we assessed the reliability and the prognostic value of different semi- quantitative (SQ) parameters in comparison with DS for interim PET (iPET) interpretation in Hodgkin lymphoma (HL).A cohort of 82 out of 260 patients with advanced stage HL enrolled in the International Validation Study (IVS), scored as 3 to 5 by the expert panel was included in the present report. Two nuclear medicine physicians blinded to patient history, clinical data and treatment outcome reviewed independently the iPET using the following parameters: DS, SUVMax, SUVPeak of the most active lesion, QMax (ratio of SUVMax of the lesion to liver SUVMax) and QRes (ratio of SUVPeak of the lesion to liver SUVMean). The optimal sensitivity, specificity, positive and negative predictive value to predict treatment outcome was calculated for all the above parameters with the Receiver Operator Characteristics analysis.The prognostic value of all parameters were similar, the best cut-off value being 4 for DS (Area Under the Curve, AUC, 0.81 CI95%: 0.72-0.90), 3.81 for SUVMax (AUC 0.82 CI95%: 0.73-0.91), 3.20 for SUVPeak (AUC 0.86 CI95%: 0.77-0.94), 1.07 for QMax (AUC 0.84 CI95%: 0.75-0.93) and 1.38 for QRes (AUC 0.84 CI95%: 0.75-0.93). The reproducibility of different parameters was similar as the inter-observer variability measured with Cohen's kappa were 0.93 (95% CI 0.84-1.01) for the DS, 0.88 (0.77-0.98) for SUVMax, 0.82 (0.70-0.95) for SUVPeak, 0.85 (0.74-0.97) for QRes and 0.78 (0.65-0.92) for QMax. Due to the high specificity of SUVPeak (0.87) and to the good sensitivity of DS (0.86), upon the use of both parameters the positive predictive value increased from 0.65 of the DS alone to 0.79. When both parameters were positive in iPET, 3-years Failure-Free Survival (FFS) was significantly lower compared to patients whose iPET was interpreted with qualitative parameters only (DS 4 or 5): 21% vs 35%. On the other hand, the FFS of patients with negative results was not significantly different (88% vs 86%).In this study we demonstrated that, combining semi-quantitative parameters with SUVPeak to a pure qualitative interpretation key with DS, it is possible to increase the positive predictive value of iPET and to identify with higher precision the patients subset with a very dismal prognosis. However, these retrospective findings should be confirmed prospectively in a larger patient cohort.
, Palombit Alessandro, , Silvestri Erica, Bui Franco, Barthel Henryk, Sabri Osama, Corbetta Maurizio, Bertoldo Alessandra
Published: 1 September 2017
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 345-359; https://doi.org/10.23736/S1824-4785.17.03008-4

Abstract:
In the last 20 years growing attention has been devoted to multimodal imaging. The recent literature is rich of clinical and research studies that have been performed using different imaging modalities on both separate and integrated Positron Emission Tomography (PET) and Magnetic Resonance (MR) scanners. However, today, hybrid PET/MR systems measure signals related to brain structure, metabolism, neurochemistry, perfusion, and neuronal activity simultaneously, i.e. in the same physiological conditions. A frequently raised question at meeting and symposia is: "Do we really need a hybrid PET/MR system? Are there any advantages over acquiring sequential and separate PET and MR scans?" The present paper is an attempt to answer these questions specifically in relation to PET combined with functional Magnetic Resonance Imaging (fMRI) and Arterial Spin Labeling.We searched (last update: June 2017) the databases PubMed, PMC, Google Scholar and Medline. We also included additional studies if they were cited in the selected articles. No language restriction was applied to the search, but the reviewed articles were all in English. Among all the retrieved articles, we selected only those performed using a hybrid PET/MR system. We found a total of 17 papers that were selected and discussed in three main groups according to the main radiopharmaceutical used: 18F-fluorodeoxyglucose (18F-FDG)(N=8), 15O-water (15O-H2O)(N=3) and neuroreceptors (N=6).Concerning studies using 18F-FDG, simultaneous PET/fMRI revealed that global aspects of functional organization (e.g. graph properties of functional connections) are partially associated with energy consumption. There are remarkable spatial and functional similarities across modalities, but also discrepant findings. More work is needed on this point. There are only a handful of papers comparing blood flow measurements with PET 15O-H2O and MR ASL measures, and they show significant regional CBF differences between these two modalities. However, at least in one study the correlation at the level of gray, white matter, and whole brain is rather good (r=0.94, 0.8, 0.81 respectively). Finally, receptor studies show that simultaneous PET/fMRI could be a useful tool to characterize functional connectivity along with dynamic neuroreceptor adaptation in several physiological (e.g. working memory) or pathological (e.g. pain) conditions, with or without drug administrations.The simultaneous acquisition of PET (using a number of radiotracers) and functional MRI (using a number of sequences) offers exciting opportunities that we are just beginning to explore. The results thus far are promising in the evaluation of cerebral metabolism/flow, neuroreceptor adaptation, and network's energetic demand.
, , Scheltens Philip
Published: 1 September 2017
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 360-371; https://doi.org/10.23736/S1824-4785.17.03011-4

Abstract:
Over the last 20 years the availability of Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) technologies as well as of CerebroSpinal Fluid (CSF) biomarkers has allowed research and clinical approach to Alzheimer's Disease (AD) to move towards the earliest manifestations of the disease. This new approach resulted in an increasing knowledge about in vivo biological and neuropathological processes of each phase of the AD-related damage from preclinical, to mild cognitive impairment, and finally to dementia due to AD. The present narrative review deals with the available data as well as with the unsolved issued related to the incorporation of AD biomarkers into the clinical practice. Ongoing research efforts aiming to better define and implement the use of imaging AD biomarkers in clinical practice according to a patient-centered approach and sustainability for clinical-care systems are also discussed.
Robertson Joanne S, Rowe Christopher C,
Published: 1 September 2017
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 405-413; https://doi.org/10.23736/S1824-4785.17.03012-6

Abstract:
Folded and misfolded tau is common to many neurodegenerative conditions, collectively termed 'tauopathies'. In recent years, many efforts have contributed toward development of tau imaging agents to allow measurement of tau deposits in vivo using Positron Emission Tomography (PET). The particularities of tau present some unique challenges for the development of tau imaging tracers. Most notably, these pertain to the predominantly intracellular nature of tau aggregations, the existence of six isoforms, multiple post-translational modification, and that tau is usually surrounded by larger concentrations of A plaques. Nevertheless, significant progress has been made towards overcoming these issues and a number of tracers are now undergoing human trials. Once validated, tau imaging with PET will be a useful tool for the differential diagnosis and disease staging, as well as therapeutic trials of AD and non-AD tauopathies.
Published: 1 September 2017
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 414-428; https://doi.org/10.23736/S1824-4785.17.03019-9

Abstract:
Molecular neuroimaging with PET is an integrated tool in psychiatry research and drug-development for as long as this modality has been available, in particular for studying neurotransmission and endogenous neurotransmitter release. Pharmacologic probes but also behavioral challenges are currently applied to induce changes in neurochemical levels that can be inferred through their effects on changes in receptor binding and related outcome measures. Based on the availability of tracers that are sensitive for measuring neurotransmitter release these experiments have focused on the brain's dopamine system, while recent developments have extended those studies to other targets such as the serotonin or choline system. With the introduction of hybrid, truly simultaneous PET/MRI systems, in vivo imaging of the dynamics of neuroreceptor signal transmission in the brain using PET and functional MRI (fMRI) has become possible. fMRI has the ability to provide information about the effects of receptor function that are complementary to the PET measurement. Dynamic acquisition of both PET and fMRI signals enables not only an in vivo real time assessment of neurotransmitter or drug binding to receptors but also dynamic receptor adaptations and receptor-specific neurotransmission. While fMRI temporal resolution is comparatively fast in relation to PET, the timescale of observable biological processes are highly dependent on the kinetics of radiotracers and study design. Overall, the combination of the specificity of PET radiotracers to neuroreceptors, fMRI signal as a functional readout and integrated study design promises to expand our understanding of the location, propagation and connections of brain activity in health and disease.
, , , , Cathrine Jonsson, Berta García-García, Maribel Morales, Laura Imaz, Marco Pagani
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 386-404; https://doi.org/10.23736/s1824-4785.17.03024-2

Abstract:
PET using 18F-2-fluoro-2-deoxy-D-glucose (FDG-PET) has been gradually introduced in the diagnostic clinical criteria of the most prevalent neurodegenerative diseases. Moreover, an increasing amount of literature have shown that the information provided by FDG-PET enhances the sensitivity of standard imaging biomarkers in less frequent disorders in which an early differential diagnosis can be of paramount relevance for patient management and outcome. Therefore emerging uses of FDG-PET may be important in prion diseases, autoimmune encephalitis and amyotrophic lateral sclerosis. Interestingly, FDG-PET findings can also be observed in early phases of these conditions, even in the presence of normal MRI scans. Thalamic hypometabolism is a common finding in sporadic Creutzfeldt-Jacob disease and fatal familiar insomnia patients, with further cortical synaptic dysfunction in the former. Limbic and extra-limbic metabolic abnormalities (more often hypermetabolism) can be observed in autoimmune encephalitis, although specific patterns may be seen within different syndromes associated with antibodies that target neuronal surface or synaptic antigens. FDG-PET shows its usefulness by discriminating patients with amyotrophic lateral sclerosis associated to upper motor neuron onset that evolve in frontotemporal dementia. Besides visual and voxel based image analysis, multivariate analysis as interregional correlation analysis and independent/principal component statistical analysis have been successfully implemented for PET images increasing the accuracy of the discrimination of neurodegenerative diseases. The clinical presentation and current diagnostic criteria of these neurologic disorders as well as the emerging usefulness of FDG-PET in the diagnostic workup are presented and discussed in this review.
Renato A Valdés Olmos, , , , Luisa F León-Ramírez, ,
Published: 1 July 2017
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 247-270; https://doi.org/10.23736/S1824-4785.17.02995-8

Abstract:
The sentinel lymph node (SLN) biopsy is probably the most well-known radioguided technique in surgical oncology. Today SLN biopsy reduces the morbidity associated with lymphadenectomy and increases the identification rate of occult lymphatic metastases by offering the pathologist the lymph nodes with the highest probability of containing metastatic cells. These advantages may result in a change in clinical management both in melanoma and breast cancer patients. The SLN evaluation by pathology currently implies tumor burden stratification for further prognostic information. The concept of SLN biopsy includes pre-surgical lymphoscintigraphy as a "roadmap" to guide the surgeon toward the SLNs and to localize unpredictable lymphatic drainage patterns. In addition to planar images, SPECT/CT improves SLN detection, especially in sites closer to the injection site, providing anatomic landmarks which are helpful in localizing SLNs in difficult to interpret studies. The use of intraoperative imaging devices allows a better surgical approach and SLN localization. Several studies report the value of such devices for excision of additional sentinel nodes and for monitoring the whole procedure. The combination of preoperative imaging and radioguided localization constitutes the basis for a whole spectrum of basic and advanced nuclear medicine procedures, which recently have been encompassed under the term "guided intraoperative scintigraphic tumor targeting" (GOSTT). Excepting SLN biopsy, GOSTT includes procedures based on the detection of target lesions with visible uptake of tumor-seeking radiotracers on SPECT/CT or PET/CT enabling their subsequent radioguided excisional biopsy for diagnostic of therapeutic purposes. The incorporation of new PET-tracers into nuclear medicine has reinforced this field delineating new strategies for radioguided excision. In cases with insufficient lesion uptake after systemic radiotracer administration, intralesional injection of a tracer without migration may enable subsequent excision of the targeted tissue. This approach has been helpful in non-palpable breast cancer and in solitary pulmonary nodules. The introduction of allied technologies like fluorescence constitutes a recent advance aimed to refine the search for SLNs and tracer-avid lesions in the operation theatre in combination with radioguidance.
Published: 1 March 2017
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 168-180; https://doi.org/10.23736/S1824-4785.17.02977-6

Abstract:
Prostate cancer (PC) is one of the most common malignancies worldwide. Prostate-specific membrane antigen (PSMA) has been found to be expressed in most PCs and represents an ideal target for diagnostic and therapeutic purposes. Numerous PSMA tracers have been recently developed. This review aims to provide an overview on the clinical influence of PSMA tracers in primary staging, biochemical recurrence (BCR) of PC and advanced, metastatic PC. Additionally, the use of PSMA tracers in systemic radioligand therapy (RLT) of metastatic castration-resistant prostate cancer (mCRPC), as well as non-prostatic specific uptake of PSMA tracers and the use of PSMA imaging to manage therapy have been described. A computerized search of the literature (PubMed) was conducted in order to find evidence on the role of PSMA tracers in the diagnosis and therapy of PC. PSMA positron-emission tomography/computed tomography (PET/CT) outperforms conventional imaging in the settings of primary PC, BCR and advanced PC. Especially in BCR of PC, PSMA PET/CT shows clinical value with significantly higher detection rates than standard modalities. The use of PSMA PET/CT resulted in a change of the therapeutic management in up to half of the cases. Regarding RLT, smaller studies were able to show positive clinical effects of 177Lu-labeled PSMA tracers without the occurrence of severe side effects. The currently available data clearly shows that PSMA targeting has a clinical impact on the diagnosis of PC, and that RLT using radiolabeled PSMA tracers has high potentiality in the settings of resistance to conventional therapeutic approaches.
Published: 1 March 2017
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 133-134; https://doi.org/10.23736/S1824-4785.17.02987-9

, Stephen Mather,
Published: 1 March 2017
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 145-152; https://doi.org/10.23736/S1824-4785.17.02974-0

Abstract:
Detection of useful cellular targets has strongly stimulated personalized tumor-targeted imaging and therapy approaches, also involving synthesis and evaluation of nuclear imaging probes with potential for clinical applications. Reviews of preclinical and translational studies concerning such probes, including radiolabeled antibodies, nanobodies, affibodies, peptides, small molecule inhibitors, and nanoparticles, are presented in this issue. As most tracers described in these articles have been developed for the field of cancer imaging and radionuclide therapy, the current article on preclinical studies will focus on cancer research as well. The main steps in developing a nuclear probe for clinical application for radionuclide imaging and therapy, after identification of a suitable molecular target on tumor cells, comprise: 1) synthesis and radiolabeling of the probe; 2) in vitro characterization, such as the evaluation of target binding affinity; 3) in vivo evaluation to assess the biodistribution and tumor targeting capability, for radionuclide therapy purposes also dosimetry studies to determine the absorbed doses and efficacy; 4) radiolabeled probes that successfully pass such tests as well as toxicological studies may enter clinical evaluation. For preclinical testing of radiolabeled probes various relevant in vitro and in vivo models dedicated to oncological research have been developed along with preclinical imaging platforms, including positron emission tomography (PET) and single photon emission computed tomography (SPECT) systems, in combination with magnetic resonance imaging (MRI) or computed tomography (CT). These developments hold great promise for fast translation of new candidate probes from preclinical validation into the clinic. This overview article describes preclinical studies typically being performed to bring a new radiopharmaceutical into clinical oncology practice. It also aims to raise awareness of confounding factors during translation of preclinical studies and ways to overcome them.
, Alicja Hubalewska-Dydejczyk, Anna Sowa-Staszczak
Published: 1 March 2017
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 153-167; https://doi.org/10.23736/S1824-4785.17.02971-5

Abstract:
Radiolabeled peptides have been the subject of research for over 20 years and during that time possibility/variety of peptide receptor imaging and later targeted radiotherapy increased significantly. The targeted receptors belong to the large family of G-protein-coupled receptors or tyrosine kinases receptors partially connected with them. They both regulate large signaling networks, control multiple cell functions and are implicated in many diseases including cancers. The essential feature of peptides used in nuclear medicine involves their ability to binding with high affinity and specify to their receptors overexpressed on tumor cells. Currently most important peptide radiotracers are somatostatin, GLP-1, bombesin, gastrin/cholecystokinin-2, neurokinin type 1, CXCR4, EGF, VEGF and integrins. These tracers are mainly based on nuclides which are radiometals or on 18F and may be used in both SPECT or PET techniques as well as for hybrid imaging. Using of chelators suitable for peptide labeling with diagnostic and therapeutic radionuclids enables the theranostic approach. In this review we will provide a brief overview over currently available radiopharmaceuticals based on different groups of peptides.
Jun Ran, John N Morelli, Ruyi Xie, Xiaoli Zhang, Xiaoqing Liang, Xuanlin Liu,
Published: 1 July 2017
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 271-282; https://doi.org/10.23736/S1824-4785.17.02981-8

Abstract:
Despite major progress in the imaging diagnosis of spondyloarthritis (SpA), the relative advantages of various available imaging techniques remain unclear. The aim of this study is to assess the current use of imaging in the diagnosis of SpA and to provide suitable recommendations for the use of imaging as an outcome measure as defined in the Assessment in SpondyloArthritis international Society (ASAS) criteria. A systematic literature search regarding imaging in SpA was performed. Articles were assessed by two reviewers to identify and summarized key information pertaining to imaging in SpA. The search identified 180 relevant articles. Conventional radiography (CR) (17 articles), ultrasound (US) (26 articles), conventional computed tomography (CT) (13 articles), spectral computed tomography (spectral CT) (2 articles), bone scintigraphy (24 articles), and magnetic resonance imaging (MRI) were assessed (98 articles). Sacroiliitis and enthesitis were the major imaging findings in SpA. Multiple studies assessed the feasibility, validity, or differences among imaging modalities for the diagnosis of SpA; however, comprehensive assessments were not available due to a paucity of prospective imaging studies. CR is a widely available, inexpensive initial approach to evaluate patients with suspected SpA. CT enables assessment of structural changes from chronic sacroiliitis including bony erosions, subchondral sclerosis, joint space narrowing, and ankyloses; however, both CR and CT modalities are insensitive for demonstrating early enthesitis and sacroiliitis in SpA. US mainly identifies appendicular enthesitis but is more limited with respect to the sacroiliac joints. Bone scintigraphy can identify sacroiliac joint lesions and semi-quantitatively assess active sacroiliitis. MRI optimally evaluates not only early enthesitis and sacroiliitis of SpA but also chronic structural changes to the sacroiliac joints. More than one modality may be required for diagnostic and assessment of SpA depending upon disease characteristics and evolution. CR is a suitable initial examination while MRI is able to detect both early and late changes of SpA. A combination of CR and MRI is recommended for the diagnosis and assessment of SpA.
Published: 1 July 2017
by 10.23736
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 283-291; https://doi.org/10.23736/S1824-4785.17.02990-9

Abstract:
Diabetic foot infection is not only the most common cause of hospitalization among diabetic patients, but is also associated with high morbidity, mortality and major utilization of the resources. Managing diabetic patients with suspected foot infection is highly dependent on an early and accurate determination of its presence and location. Medical imaging is often used in the workup of these patients, as clinical diagnosis of osteomyelitis is often difficult, and invasive bone biopsy is infrequently used due to many limitations. In this article, we review the role and accuracy of commonly used medical imaging modalities in the evaluation of diabetic patients with suspected foot infection including osteomyelitis with particular emphasis on molecular nuclear medicine imaging. The impact of imaging on patients' management is also discussed. We finally comment on possible future directions in hybrid molecular imaging techniques.
, , Leonor Chaltiel, Olivier Caselles, Séverine Brillouet, Slimane Zerdoud,
Published: 1 October 2019
by 10.23736
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 63, pp 284-291; https://doi.org/10.23736/S1824-4785.17.02912-0

Abstract:
By comparing the 2 diuretic imaging protocols, we found a significant lower urinary activity for the P90 protocol and the regression decision tree shows that the P90 protocol is mostly superior. The P30 protocol, which seems to be less well tolerated, is adequate in the group of patients with an injected activity of less than 240 MBq and older than 65 years, if P90 is not feasible. For most patients with injected activity >= 240 MBq or BMI of >=25 and a glycaemia > 120 mg/dl, a significant amount of residual urinary activity remains for both protocols.
Eduardo E Carvalho, Júlio C Crescêncio, Giovani L Santi, , Pedro V Schwartzmann, Lourenço Gallo, José A Marin-Neto,
Published: 1 October 2019
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 63, pp 302-310; https://doi.org/10.23736/S1824-4785.17.02930-2

Abstract:
In patients with PMA, reduced left ventricular inotropic reserve observed during exercise did not normalize after improving myocardial perfusion through aerobic physical training.
Published: 1 March 2017
by 10.23736
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 135-144; https://doi.org/10.23736/S1824-4785.17.02965-X

Abstract:
The development of novel radiopharmaceuticals is very rapid and highly innovative both for diagnostic and therapeutic applications. The translation into the clinic, however, is hampered by the high regulatory demands in Europe. This article describes the main rules, guidelines and guidance documents in the European Union in relation to the pharmaceutical regulatory framework. Until today a great number of radiopharmaceuticals are introduced clinically using specific national pathways outside the clinical trial regulation and examples are provided. In this context, the European Pharmacopoeia with a legal status plays an important role in defining quality standards. For clinical trials the application system and regulatory framework in Europe is currently considerably changing. Whereas the current clinical trial directive requires a lengthy and complicated national application process, the new regulation 536/2014 will introduce a streamlined and unified European application process. This new regulation also takes into account the specific properties of radioactive investigational medicinal products and has introduced exceptions for good manufacturing practices (GMP) and labelling for radiopharmaceuticals. Besides the main regulatory texts, several guidelines have been published, e.g. related to toxicity testing or first in man studies. In relation to radiopharmaceuticals professional organization, in particular the EANM, have published a number of documents in relation to GMP, documentation and toxicity studies, that support professionals in the application process. All these documents are summarized and discussed.
, , Ashutosh Dash, Weibo Cai
Published: 1 March 2017
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 181-204; https://doi.org/10.23736/S1824-4785.17.02969-7

Abstract:
Over the last few years, a plethora of radiolabeled inorganic nanoparticles have been developed and evaluated for their potential use as probes in positron emission tomography (PET) imaging of a wide variety of cancers. Inorganic nanoparticles represent an emerging paradigm in molecular imaging probe design, allowing the incorporation of various imaging modalities, targeting ligands, and therapeutic payloads into a single vector. A major challenge in this endeavor is to develop disease-specific nanoparticles with facile and robust radiolabeling strategies. Also, the radiolabeled nanoparticles should demonstrate adequate in vitro and in vivo stability, enhanced sensitivity for detection of disease at an early stage, optimized in vivo pharmacokinetics for reduced non-specific organ uptake, and improved targeting for achieving high efficacy. Owing to these challenges and other technological and regulatory issues, only a single radiolabeled nanoparticle formulation, namely "C-dots" (Cornell dots), has found its way into clinical trials thus far. This review describes the available options for radiolabeling of nanoparticles and summarizes the recent developments in PET imaging of cancer in preclinical and clinical settings using radiolabeled nanoparticles as probes. The key considerations toward clinical translation of these novel PET imaging probes are discussed, which will be beneficial for advancement of the field.
Fatemeh Asadzadeh, Veronica Ferrucci, ,
Abstract:
Medulloblastoma is an incurable cerebellar neoplasm of the central nervous system. Four molecular subgrups have been identified (MBWNT, MBSHH, MBgroup3 and MBgroup4) with distinct genetics and clinical outcome. Among these, MBgroup3-4 are highly metastatic with the worst prognosis. The current standard therapy includes surgery, radiation and chemotherapy. Thus, specific treatments adapted to treat those different molecular subgroups are needed. The use of orthotopic xenograft models, together with the non- invasive in vivo biolumiscence imaging (BLI) technology, is emerging during preclinical studies to test novel therapeutics for medulloblastoma treatment.
, , Anna Paschali, Constantinos Anagnostopoulos
Abstract:
Non-invasive imaging in the form of SPECT, PET, CT, echocardiography or MRI is a very useful tool for cardiovascular research as it allows assessment of biological processes in vivo. Nuclear imaging with SPECT and PET offers the advantage of high sensitivity, the potential for serial imaging, and reliable quantification. Currently a wide range of established as well as innovative agents is available and can be imaged with dedicated preclinical and clinical SPECT and PET imaging systems. These scanners can be equipped with CT and MRI components to form hybrid imaging systems. This review provides an outline on SPECT and PET as capable tools for translational research in cardiology as part of a "workflow" similar to the one used in clinical imaging illustrating the concept from "bench to bedside".
Naelle Lombion, , , , , Gaëlle Guillerm, Jean C Ianotto, Christian Berthou, ,
Abstract:
Advanced age is an independent poor prognostic factor of diffuse large B-cell lymphoma. PMitCEBO is an alternative to CHOP to decrease side effects in elderly patients. Many studies have shown prognostic value of an interim FDG PET-CT to predict survival. A recent consensus (ICML, Lugano 2013) has suggested using the 5-point scale Deauville criteria instead of those of the international harmonization project (IHP) to visually assess the response on interim PET. The objective of this study was to evaluate the prognostic value of an interim FDG PET-CT in patients older than 60 with treated DLBCL and to compare IHP and 5-PS Deauville visual interpretation to predict survival.
, Matteo Gramanzini, Sara Gargiulo, , Marco Salvatore,
Published: 1 January 2017
by 10.23736
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 19-32; https://doi.org/10.23736/S1824-4785.16.02943-5

Abstract:
Preclinical molecular imaging is an emerging field. Improving the ability of scientists to study the molecular basis of human pathology in animals is of the utmost importance for future advances in all fields of human medicine. Moreover, the possibility of developing new imaging techniques or of implementing old ones adapted to the clinic is a significant area. Cardiology, neurology, immunology and oncology have all been studied with preclinical molecular imaging. The functional techniques of photoacoustic imaging (PAI), fluorescence molecular tomography (FMT), positron emission tomography (PET), and single photon emission computed tomography (SPECT) in association with each other or with the anatomic reference provided by computed tomography (CT) as well as with anatomic and functional information provided by magnetic resonance (MR) have all been proficiently applied to animal models of human disease. All the above-mentioned imaging techniques have shown their ability to explore the molecular mechanisms involved in animal models of disease. The clinical translatability of most of the techniques motivates the ongoing study of their possible fields of application. The ability to combine two or more techniques allows obtaining as much information as possible on the molecular processes involved in pathologies, reducing the number of animals necessary in each experiment. Merging molecular probes compatible with various imaging technique will further expand the capability to achieve the best results.
, , , Flavia De Carlo, Marco Salvatore, ,
Published: 1 January 2017
by 10.23736
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 76-94; https://doi.org/10.23736/S1824-4785.16.02944-7

Abstract:
Several advances have been made toward understanding the biology of cancer and most of them are due to robust genetic studies that led to the scientific recognition that although many patients have the same type of cancer their tumors may have harbored different molecular alterations. Personalized therapy and the development of advanced techniques of preclinical imaging and new murine models of disease are emerging concepts that are allowing mapping of disease markers in vivo and in some cases also receptor targeted therapy. Aim of this review is to illustrate some emerging models of disease that allow patient tumor implantation in mice for subsequent drug testing and advanced approaches for therapy mediated by preclinical imaging. In particular we discuss targeted therapy mediated by high frequency ultrasound and magnetic resonance, two emerging techniques in molecular preclinical therapy.
Sara Gargiulo, Anna R Coda, Mariarosaria Panico, Matteo Gramanzini, Rosa M Moresco, ,
Published: 1 January 2017
by 10.23736
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 60-75; https://doi.org/10.23736/S1824-4785.16.02948-4

Abstract:
Neuroinflammation (NI) is an adaptive response to different noxious stimuli, involving microglia, astrocytes and peripheral immune cells. NI is a hallmark of several acute and chronic diseases of central nervous system (CNS) and contributes to both damage and repair of CNS tissue. Interventional or genetically modified rodent models mimicking human neuropathologies may provide valuable insights on basic mechanisms of NI, but also for improving the development of new diagnostic and therapeutic strategies. Preclinical positron emission tomography (PET) allows to investigate noninvasively the inflammatory response in CNS of rodent models at a molecular level, validating innovative probes for early diagnosis, and characterizing the time course of neuroinflammatory changes and their relationship with disease progression, as well as the effects of experimental treatments with high translational potential. In particular, recent efforts of preclinical PET field are intended to develop specific and selective radiotracers that target the activation of innate immune system in CNS. Here, we have reviewed the state of art for PET in relevant rodent models of acute and chronic neuropathologies associated with NI, with particular regard on imaging of activated microglia and astrocytes.
Published: 1 January 2017
by 10.23736
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 1-18; https://doi.org/10.23736/S1824-4785.16.02951-4

Abstract:
Despite the outstanding progress achieved by preclinical imaging science, laboratory animal anesthesia remains quite stationary. Ninety percent of preclinical imaging studies are carried on small rodents (mice and rats) anesthetized by outdated injectable and/or inhalation agents. A need for imaging awake (conscious) animals is questionably registered mainly for brain research, for phMRI and for accomplishing pain and analgesia studies. A need for improving current rodent anesthesia protocols and for enforcing the 3Rs paradigm is sought. Patient monitoring throughout the procedure and recovery phases, as well as vital parameter's data must be recorded in basic consciousness states and during imaging sessions. A multidrug approach is suggested to overcome the limits of monoanesthesia and well-timed physiological data are required to ground findings and to interpret imaging data.
Published: 1 January 2017
by 10.23736
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 61, pp 33-47; https://doi.org/10.23736/S1824-4785.16.02949-6

Abstract:
Preclinical imaging with radiolabeled probes became an integral part of the complex translational process that moves a newly developed compound from laboratory to clinical application. Imaging studies in animal tumor models may be undertaken to test a newly synthesized tracer, a newly developed drug or to interrogate, in the living organism, specific molecular and biological processes underlying tumor growth and progression. The aim of the present review is to outline the current knowledge and future perspectives of preclinical imaging in oncology by providing examples from recent literature. Among the biological processes and molecular targets that can be visualized with radiolabeled probes in animal tumor models, we focused on proliferation, expression of targets suitable for therapy, glycolytic phenotype, metastatic dissemination, tumor angiogenesis and survival. The major contribution of preclinical imaging emerging from these studies is the development and validation of imaging biomarkers that can be translated into the clinical context for patient selection and evaluation of tumor response to molecularly targeted agents.
Abstract:
Risk prediction through integration of clinical variables and imaging data into a prognostic model can able to identify those factors with a high impact on patient outcome. The development of a prognostic model traditionally includes the evaluation of the independent contribution of variables with consideration of covarying factors that may confound risk stratification. Several methods and metrics are available to assess the performance of a prediction model. Traditional measures for binary and survival outcomes include the concordance (C) statistic for discriminative ability, and goodness-of-fit statistics for calibration. Different prognostic approaches, including variants of the C statistic for survival data, reclassification tables, net reclassification improvement, and integrated discrimination improvement have been recently proposed to evaluate the contribution of new markers when they are added to a defined risk model and to evaluate how these variables are able to change the class of risk of the patient and the resulting diagnostic and therapeutic managements. Moreover, decision-analytic measures including decision curves analysis have been introduced to assess the net benefit obtained by making clinical decisions based on model predictions. This review provides an overview of various metrics available for risk stratification using nuclear cardiology procedures, underlying the need of choosing the appropriate prognostic model in order to justify the referral decision.
Abstract:
Radionuclide myocardial perfusion imaging (MPI) is a large component of the healthcare spending both in developed and developing countries. MPI is also responsible of a significant increase in the exposition of patients and health care operators to ionizing radiation for medical purposes. Thus, health-care systems and pertinent scientific societies were involved in developing criteria to contain the non appropriate use by implementing Appropriate Use Criteria and Clinical Indications Guidelines. The present manuscript will review the concept and limitations of such an approach.
, , Atif Alzahrani, Ali Alenazy, , Rob S Beanlands,
Abstract:
Cardiac inflammatory disorders, either primarily cardiac or secondary to a systemic process, are associated with significant morbidity and/or mortality. Their diagnosis can be challenging, especially due to significant overlap in their clinical presentation with other cardiac diseases. Recent publications have investigated the potential diagnostic role of positron emission tomography (PET) imaging in these patients. Most of the available literature is focused on Fluorine-18 fluorodeoxyglucose (FDG), a tracer which has already demonstrated its use in other inflammatory and infectious processes. PET imaging can help in the diagnosis, prognosis and follow-up in a variety of cardiac inflammatory processes, including infective endocarditis, cardiac implantable electronic device infection, pericarditis, myocarditis, sarcoidosis and amyloidosis. PET's ability to depict metabolic changes and abnormalities, sometime even before the onset of any anatomical changes, can be a significant advantage over standard anatomical imaging. PET appears to be particularly useful in cases where standard investigation is non- diagnostic or equivocal.
Abstract:
Over the last several decades, radionuclide Myocardial Perfusion Imaging (MPI) has been a mainstay for the evaluation of coronary artery disease (CAD), based on the assumption that a detailed knowledge of stenosis localization and severity is not sufficient for clinical decision making. Furthermore, radionuclide MPI diagnostic accuracy has been implemented by the assessment of Coronary Flow Reserve (CFR) and Myocardial Blood Flow (MBF), as quantitative indexes of stenosis severity and surrogates of total ischaemic burden. Several considerations indicate that these measurement actually improve description of coronary physiology with respect to conventional qualitative image analysis. However, several alternative approaches have been optimized and increasingly proposed to achieve this task in the clinical setting. The aim of the present narrative review is to discuss strengths and weaknesses of the various cardiac modalities proposed to define CFR and MBF in the era of multi-modality imaging.
Abstract:
In the setting of hypertrophic cardiomyopathy (HCM), ischemia plays a possibly under-evaluated role. In particular, a large body of evidence indicates that abnormalities in microvascular circulation and the consequent microvascular dysfunction are most important for HCM physiopathology and clinical evolution. Measurement of myocardial blood flow (MBF) at rest and under maximal hyperaemia (hMBF) by means of perfusion positron emission tomography (PET) is the most effectve way to assess microvascular dysfunction in humans. Therefore, hMBF abnormalities reflect HCM severity and correlate with other important features, such as ischemic symptoms and myocardial fibrosis. Most importantly, it is demonstrated that severely blunted hMBF implies an adverse outcome in HCM patients. Therefore, PET could be helpful for stratifying patient prognosis and should be used in selected patient subsets to identify those at risk of unfavourable evolution.
, Mariadea LaValle, Alessandro Giordano
Abstract:
Until a few years ago, myocardial perfusion imaging (MPI) the combined use of positron-emission tomography (PET) and absolute quantification of myocardial blood flow (MBF) was limited to research institutions. Following an increase in the number of PET scanner installations and in the availability of perfusion tracers that do not have to be produce by an on-site cyclotron and that do not require commercial software for MBF quantification, a more widespread clinical use of MBF quantification with PET can be expected. This article aims to provide a comprehensive overview of the advantages of MBF quantification with PET highlighting the potential applications in several clinical settings, from patients with cardiovascular risk factors and early coronary artery disease (CAD) to patients with multi-vessel or myocardial disease. Finally, using current evidence, the independent and incremental prognostic information of MBF quantification with PET in addition to the visual interpretation of MPI will also be described.
, Elena Busnardo, Luigi Gianolli,
Abstract:
Positron emission tomography (PET) is indicated for a large number of cardiac diseases: perfusion and viability studies are commonly used to evaluate coronary artery disease; PET can also be used to assess sarcoidosis and endocarditis, as well as to investigate amyloidosis. Furthermore, a hot topic for research is plaque characterization. Most of these studies are technically very challenging. High count rates and short acquisition times characterize perfusion scans while very small targets have to be imaged in inflammation/infection and plaques examinations. Furthermore, cardiac PET suffers from respiratory and cardiac motion blur. Each type of studies has specific requirements from the technical and methodological point of view, thus PET systems with overall high performances are required. Furthermore, in the era of hybrid PET/computed tomography (CT) and PET/Magnetic Resonance Imaging (MRI) systems, the combination of complementary functional and anatomical information can be used to improve diagnosis and prognosis. Moreover, PET images can be qualitatively and quantitatively improved exploiting information from the other modality, using advanced algorithms. In this review we will report the latest technological and methodological innovations for PET cardiac applications, with particular reference to the state of the art of the hybrid PET/CT and PET/MRI. We will also report the most recent advancements in software, from reconstruction algorithms to image processing and analysis programs.
Abstract:
The autonomic nervous system is the primary extrinsic control of heart rate and contractility, and is subject to adaptive and maladaptive changes in cardiovascular disease. Consequently, noninvasive assessment of neuronal activity and function is an attractive target for molecular imaging. A myriad of targeted radiotracers have been developed over the last 25 years for imaging various components of the sympathetic and parasympathetic signal cascades. While routine clinical use remains somewhat limited, a number of larger scale studies in recent years have supplied momentum to molecular imaging of autonomic signaling. Specifically, the findings of the ADMIRE HF trial directly led to United States Food and Drug Administration approval of 123I-metaiodobenzylguanidine (MIBG) for Single Photon Emission Computed Tomography (SPECT) assessment of sympathetic neuronal innervation, and comparable results have been reported using the analogous PET agent 11C-meta-hydroxyephedrine (HED). Due to the inherent capacity for dynamic quantification and higher spatial resolution, regional analysis may be better served by PET. In addition, preliminary clinical and extensive preclinical experience has provided a broad foundation of cardiovascular applications for PET imaging of the autonomic nervous system. Recent years have witnessed the growth of novel quantification techniques, expansion of multiple tracer studies, and improved understanding of the uptake of different radiotracers, such that the transitional biology of dysfunctional subcellular catecholamine handling can be distinguished from complete denervation. As a result, sympathetic neuronal molecular imaging is poised to play a role in individualized patient care, by stratifying cardiovascular risk, visualizing underlying biology, and guiding and monitoring therapy.
Alessandra Bacca, , Daniele Lorenzini, , , , Stefano Sellari Franceschini, , ,
Abstract:
The expression of vesicular catecholamine transporters (VMAT1 and 2) in pheochromocytomas (PHEOs) and paragangliomas (PGLs) and the possible relationships with [18F]FDOPA PET/CT and [123I]MIBG scintigraphy uptake are unknown. Our purpose was to investigate possible correlations of either VMAT1 and VMAT2 expression with the functional imaging in patients with PHEOs and PGLs.
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 60

, E Bombardieri
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 48

, M Leoncini, A Mennuti, R P Dabizzi, A Pupi
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 48

Abstract:
In patients with ischemic cardiomyopathy, the differentiation of dysfunctional myocardium in scarred versus hibernating is oversimplified. We evaluated a more complex classification using an imaging technique currently employed for viability detection, having as reference the postrevascularization outcome of dysfunctional segments.
, M Filesi, T Montesano, A D Di Nicola, C Pace, , G Ventroni, A Antonaci, A R Vestri
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 48

Abstract:
Retrospective studies have been carried out to estimate the survival of 96 patients with lung metastases from differentiated thyroid carcinoma, observed from 1958 to 2000.
, , M A Losi, A M Della Morte, , R Nugnez, M Chiariello,
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 48

Abstract:
The aim of the present study was to evaluate [123I] MIBG uptake and clearance in patients with hypertrophic cardiomyopathy (HCM) and to assess their relationships with left ventricular function (systolic and diastolic) and perfusion.
A Nicolato
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 48

Abstract:
The purpose of this study is to prospectively investigate the prognostic role of somatostatin receptor scintigraphy (SRS) using an 111Indium-labelled somatostatin analogue, Octreotide, in skull base meningiomas (SBMs) treated with gamma knife (GK) radiosurgery.
N Döbert, C Menzel, , W Wördehoff, W T Kranert, F Grünwald
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 48

Abstract:
In FDG-PET imaging abnormal supraclavicular and paravertebral FDG uptake is a frequent finding which recently could be demonstrated to partly represent brown fat tissue. This study was carried out to further investigate causes for this phenomenon. Patients variables such as age, gender, body mass index (BMI) and the value of sedation and delayed imaging were compared with the presence of atypical uptake in 2 distinct groups of diseases, Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL).
, A Spanu, P Solinas, G M Calia, C Lovigu, F Chessa, M Mannazzu, A Falchi, M S Mura,
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 48

Abstract:
Given the few controversial data about the effect of highly active antiretroviral therapy (HAART) on bone mass in HIV patients, we investigated whether a relationship between osteopenia/osteoporosis risk and HAART exists.
A Gugiatti, A Grimaldi, C Rossetti, , D De Marchis, E Borgonovi,
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 48

Abstract:
Increasing ageing of the population and tumor incidence, along with worldwide rationing of the resources for public health systems, spur the use of economic analyses for the choice of strategies and technologies in the assessment and management of cancer patients. Incidence and clinical managing of tumors vary in different countries even if positron emission tomography (PET) with 2-deoxy-2-[18F]-fluoro-D-glucose (FDG) is becoming a routine clinical method for diagnosis, staging, treatment monitoring and follow-up in a variety of tumors. Available data indicate that PET can be considered a superior alternative or complementary tool to other well-established methods. However, in spite of the above and of the rapidly increasing number of PET centers in Europe, USA and Japan, only a few studies have dealt with some of the economic aspects raised by the clinical use of PET because of differences in values of reimbursements and health costs. The main aim of this study is to propose and discuss an economic model of analysis for PET applications in the field of detection and management of pulmonary tumors.
, V Bettinardi, , E Pelosi, C Landoni, L Gianolli, M C Gilardi,
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 48

Abstract:
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 acquisition protocols and clinical applications of PET/CT in oncology are described. Overall, advantages of PET/CT over PET that may influence the clinical routine, have been identified as a) the shorter image acquisition time with benefit on patients throughput and on patient compliance, b) the better accuracy in anatomically localizing focal areas of abnormal tracer uptake and defining tumor extent and c) the possibility to stage a disease in 1 single step.
The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Volume 48

Abstract:
Although any patient with a suspected brain tumor, either primary or metastatic, should be studied with anatomic imaging modalities such as angiography, computerized tomagraphy (CT) or magnetic resonance imaging (MRI), nuclear medicine techniques are available to further characterize some biological features of brain lesions and help in diagnosis and therapy planning. Bloob-brain-barrier disruption can be easily assessed with single-photon emission tomography (SPET), whereas focal metabolic changes can be better demonstrated by positron emission tomography (PET) as specific radiopharmaceuticals are available to detect changes in glucose utilization and aminoacid uptake with this technique. Expression of specific tumoral antigens is the basis of imaging with radioimmunoscintigraphy, a promising technique that can be applied to brain tumor therapy. The major clinical applications of nuclear medicine in the study of brain tumors -- evaluation of the extension of a tumoral mass, differential diagnosis and evaluation of therapy and prognosis -- are discussed.
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