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Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest.

Aim: Our aim was to analyse the performance of [ 11 C]choline PET/CT in prostate cancer (PCa) surveillance, especially in patients with prostate specific antigen (PSA) < 1 ng/mL., Material and Methods: Three hundred and twenty-nine [ 11 C]choline PET/CT examinations from 191 patients (68.2 ± 7.2 years) submitted for PCa surveillance or biochemical recurrence were retrospectively evaluated. PSA at study was 13.0 ± 84.2 ng/mL. Main initial treatment was radical prostatectomy (RP) in 81 patients, and other treatments (radiotherapy, chemotherapy, hormonotherapy) in 110. PET/CT was acquired 20' after injection of 555-740 MBq of [ 11 C]choline. Minimum follow-up was 12 months., Results: Two hundred and nineteen (66.6%) out of the 329 PET/CT examinations were positive. The percentage of positive examinations was significantly higher in patients with other initial treatment than RP compared to patients with RP (85.6% vs. 43.6%, respectively). One hundred and thirty PET/CT (59.4%) showed local recurrence, 48 (21.9%) distant recurrence, and 41 (18.7%) local plus distant recurrence. Initial therapeutic approach was changed in 139 cases (63.5%). In the subgroup of 81 [ 11 C]choline PET/CT scans performed with PSA < 1 ng/mL, 23 (28.4%) showed a positive result. Initial therapeutic approach was changed in 9 (11.1%). Three (4.8%) out of 63 patients died as per PCa., Conclusion: [ 11 C]choline PET/CT demonstrated its effectiveness in PCa surveillance and restaging, even in patients with serum PSA < 1 ng/mL. The diagnostic performance was different depending on the initial treatment, been higher in patients with non-surgical treatment., (Copyright © 2022 Sociedad Española de Medicina Nuclear e Imagen Molecular. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: The aim of this study was to evaluate the cerebral amyloid distribution in patients with mild cognitive impairment (MCI), assessed by carbon-11-Pittsburgh compound B (C-PIB) PET/CT, after 5 years of follow-up., Patients and Methods: Ten amnestic MCI (A-MCI) and four nonamnestic (NA-MCI) patients were studied by C-PIB PET/CT and re-evaluated 5 years later by a new C-PIB PET/CT. PET/CT scans were acquired 60-90 min after the administration of 555 MBq C-PIB and analyzed visually, to obtain a score of the cerebral cortical C-PIB retention in the frontal, basal ganglia (BG), temporoparietal (TP), occipital, posterior cingulate, and cerebellum areas. Initial and 5-year follow-up C-PIB retentions were compared., Results: Initially, 9/10 A-MCI patients were C-PIB positive and one was C-PIB negative. All four NA-MCI patients were C-PIB negative. Of the C-PIB-positive A-MCI patients, seven progressed to Alzheimer's disease dementia (AD-D), one to mixed dementia and one remained as A-MCI. The C-PIB-negative A-MCI patient remained as A-MCI. Of the four C-PIB-negative NA-MCI, one progressed to semantic dementia. All changes in C-PIB retention were of low intensity. The A-MCI patients who progressed to AD-D (n=7) showed an increase in C-PIB retention in the frontal (5/7), BG (3/7), TP (3/7), occipital (1/7), and posterior cingulate (1/7) regions. The A-MCI patient who progressed to mix dementia showed an increase in C-PIB retention in the frontal region. The C-PIB-positive A-MCI patient who remained as A-MCI showed an increase in C-PIB retention in the frontal, BG, and TP areas. The amyloid deposition in the anterior part of the brain (frontal, TP, and BG) increased more than that in the posterior part (occipital and precuneus) (7/9 vs. 2/9; P<0.05)., Conclusion: PIB retention increased predominantly in the frontal, BG, and TP areas. C-PIB-positive A-MCI patients mostly progressed to AD-D, showing similar topographic changes in their cerebral C-PIB pattern than the patient who remained as A-MCI.

Objective: Carbon-11-(C)-choline PET/computed tomography (CT) has shown good results in re-staging of prostate cancer (PCa) with raised serum levels of prostate-specific antigen. Our aim was to evaluate the effect of positive C-choline PET/CT results in the therapeutic management of patients with PCa with biochemical relapse (BR) after curative intention treatment., Patients and Methods: A total of 112 patients with PCa BR and positive C-choline PET/CT were retrospectively evaluated. PET/CT was acquired 20 min after intravenous administration of 555-740 MBq of C-choline. The therapeutic management after C-choline PET/CT was obtained from the clinical records. The minimum follow-up time was 18 months., Results: In 80 (71.4%) of 112 patients, C-choline PET/CT showed local recurrence of PCa; in 17 (15.2%) patients, distant recurrence; and in 15 (13.4%) patients, local plus distant recurrence. A second malignancy was detected in five (4.5%) patients. The planned therapeutic management was changed as per positive C-choline PET/CT result in 74 (66.1%) patients and were treated as follows: 31 (27.7%) patients with HT, combined with other treatments in eight (7.1%), 17 (15.2%) with BT, 13 (11.6%) with external beam radiotherapy, one (0.9%) with RP, and four (3.6%) with chemotherapy. Treatment approach was not modified in 37 (33%) patients. No data was available from one (0.9%) patient., Conclusion: Positive C-choline PET/CT result had an important effect in the therapeutic management of patients with PCa and BR, leading to a change in the planned approach in two (66.1%) out of three patients. In addition, in 4.5% of the patients, the C-choline PET/CT allowed the detection of a second malignancy.

Objective: To establish an automated procedure for the preparation of sodium fluoride (18)F injection using the resources available in our laboratory for the preparation of (18)FDG and to analyze the repercussion of the conditioning column of the fluoride ion entrapment on the characteristics of the final product., Material and Method: The sequence of an (18)FDG synthesis module prepared so that it traps the fluoride ion from the cyclotron in ion-exchange resin diluted with 0.9% sodium chloride. The final solution was dosified and sterilized in a final vial in an automatized dispensing module. Three different column conditioning protocols within the process were tested. Quality controls were run according to USP 32 and EurPh 6, adding control of ethanol levels of residual solvent and quality controls of the solution at 8 h post-preparation., Results: Activation of the resin cartridges with ethanol and water was the chosen procedure, with fluoride ion trapping > 95% and pH around 7. Ethanol levels were < 5.000 ppm. Quality controls at 8 h indicated that the solution was in compliance with the USP 32 and EurPh 6 specifications., Conclusion: This is an easy, low-cost, reliable automated method for sodium fluoride preparation in PET facilities with existing equipment for (18)FDG synthesis and quality control., (Copyright © 2010 Elsevier España, S.L. y SEMNIM. All rights reserved.)

Aim: to study the expression of cyclin B1 and its possible relationship with the maximum SUV in FDG-PET and MIB1 expression in patients with NSCLC., Materials and Methods: 49 patients (15 adenocarcinomas, 27 squamous cell carcinomas and 7 bronchoalveolar carcinomas) were included in this study; the immunohistochemical expression of cyclin B1 was determined using the tissue-array technique. Each PET was performed 60 minutes after the i.v. administration of 350-518 MBq of FDG on an Advance system (GE) in 2D acquisition mode., Results: cyclin B1 expression was detected in 40 out of 45 cases. The SUV values were higher (p=0.04) in the cyclin B1+ cases than in the negative cases (16.4+/-8.1 vs 10.9+/-6.2). Cyclin B1 expression and SUV values were not correlated with the clinical stage. The expression of cyclin B1+ correlated positively (p<0.0001) with that of MIB1. After univariate analysis, only the cellular proliferation was a prognostic factor (p=0.037)., Conclusions: our results suggest that there is a direct correlation between cyclin B1 expression and max-SUV values in the PET of NSCLC patients. When the association of cyclin B1 with positive MIB1 is also considered, our results support the role of cell proliferation in FDG uptake by the tumour.

Objective: To study the expression of COX-2 and its possible relationship with the maximum standardized uptake value (SUV) in FDG-PET, and EGFR, p16 and MIB1 expression in patients with NSCLC., Material and Method: 45 patients (12 adenocarcinomas and 33 squamous cell carcinomas) were included in this study; the immunohistochemical expression of COX-2, MIB-1, p16 and EGFR was determined using tissue-array. Each PET was performed 60 minutes after the i.v. administration of 350-518 MBq of FDG on an Advance system (GE) in 2D acquisition mode., Results: COX-2 expression was detected in 35 out of 45 cases, and was very significant (> ++) in 12 of them. SUV values were lower in the COX-2 > ++ cases that in the remaining cases (13.4 +/- 1.2 vs. 12.9 vs. 17.1 +/- 1.5; p = 0.059). COX-2 > ++ expression and maxSUV values were not correlated with the clinical stage. The expression of COX-2 > ++ was correlated positively with p16 (r = 0.36; p = 0.014) and negatively with MIB1 (r = -0.32; p = 0.041) expression, whereas the SUV was correlated positively with EGFR (r = 0.44; p = 0.004) and negatively with p16 (r = -0.29; p = 0.041) expression., Conclusions: Our results suggest that: a) the expression of COX-2 > ++ is often found in this kind of lung cancer and is not associated with the clinical stage; b) the maxSUVs were not related to the stage and were lower in COX-2 > ++ tumours than in the other cases; and c) the different behaviour of both parameters can be explained by their correlation with cell proliferation (MIB1), EGFR and p16 expression.

Background and Objective: To study the behaviour of 18F-FDG-PET in patients with in situ breast carcinomas., Patients and Method: The study group included 19 women with a tumor size between 0.8 and 2.2 cm. An uptake in breast with a SUV > 1.9 was considered as positive., Results: 18F-FDG-PET was positive in 8 patients (SUV; range 0.6-2.8; 1.64 [0.59]) and only when the tumor size was higher than 1 cm. Likewise, only in the PET-positive tumors, an inverse (r = -0.637) and positive (p < 0.05) correlation between SUV and weight of patients was observed. When we compared the results with those obtained in 28 patients having infiltrating ductal carcinomas of the breast, we observed that the 18F-FDG-PET was positive only in tumors > 1 cm also, but the percentages of positives (89%) were higher than those obtained in in-situ carcinoma, regardless of tumor size., Conclusions: The percentage of positive results of 18F-FDG-PET in in-situ breast carcinomas and the SUV are lower than those observed in infiltrating ductal carcinomas, regardless of tumor size. Those carcinomas can be a source of false negative results with such imaging technique.

In order to evaluate the influence of hormone dependence on the features of infiltrating ductal carcinoma of the breast we have assayed the cytosolic levels of estrogen receptor (ER), progesterone receptor (PR), pS2 and cathepsin D in 53 women aged over 70 years and in 95 women aged between 55 and 70 years. Tumor size, axillary involvement, distant metastasis, histological grade, ploidy and S-phase were taken into account. Carcinomas of women aged over 70 did not show higher concentrations or higher positive results for ER and PR than those of women in the 55-70-year age group. In older patients, negativity for ER was associated only with higher S-phase fraction, while negativity for PR was not associated with any of the parameters analyzed. In the younger subgroup, negativity for ER was associated with larger tumor size, higher S-phase fraction, lymph node involvement, histological grade 3 and lower pS2 values. Negativity for PR was associated with the same parameters, as well as with a higher frequency of recurrence. Our results suggest a reduced influence of hormone dependence on the clinicopathological features of breast carcinomas in patients older than 70 years compared with women aged between 55 and 70 years.

Objective: To study the possible correlations between the preoperative CA15.3 serum levels and the cellular proliferation, measured by S-phase (SP), in patients having infiltrating ductal carcinomas (IDC) of the breast, Material and Methods: The study group included 79 patients with an age ranged between 39 and 86 yrs (64,8 +/- 11,8). Ploidy and S-phase were measured by cytometry (Fascam. Beckton Dikinson. USA) in fresh samples, Results: Using as cut-off for SP the value of 7 %, which represents the median obtained previously in 321 patients with IDC (r: 0,8-51,2; 9,3 +/- 7,9; percentiles 25 y 75; 4,3 y 11,8 %), we can observed that the antigenic levels were higher (p:0,015) in the tumors with low SP. These same behavior was noted when 30U/ml was used as cut-off for CA15.3. Likewise, the levels of the tumor marker increased significantly (p:0,007) when the SP moved from < 4,3 % to 7,1 %, to decrease later (p:0,010) when the SP value was comprised between 7,11 % and 11,8 %. The same behavior of this tumor marker in relation to the SP was noted in tumors without axillary involvement tumors, as well as in aneuploid carcinomas., Conclusion: a) Release of CA15.3 happens when SP increases to rise the 7,1 % value, to decrease later although that goes on increasing, and b) The same behaviour of this marker with the S-phase was observed in tumors without axillary involvement, as well as in aneuploid carcinomas.

Positron Emission Tomography (PET) has become a very useful tool for monitoring Hodgkin's disease patients in the last years. When there is suspicion of disease persistence after treatment, this technique makes it possible to evaluate treatment activity of the residual lesions observed in the CT scan. Furthermore, due to the whole body study, new tumor sites, which very often change the therapeutic option, can be detected. We must take into account, however, that 18F-FDG is a very sensitive but not very specific tumor marker, since some inflammatory or infectious conditions may be associated to significant radiopharmaceutical uptakes. Thus, in order to increase specificity it is mandatory to correlate the PET information with the rest of the conventional imaging and clinical data and evolution of the patient. We present the case of a woman with Hodgkin's disease in which 18F-FDG PET was included in the follow-up. Both conditions, tumor and infection, were present in different times of the course. The integration of all the x-ray, clinical, laboratory and metabolic information allowed for a better and correct management of this patient.

The management of gastrointestinal stromal tumors, usually defined as c-KIT-positive mesenchymal neoplasias, has evolved very rapidly in the last five years. Imatinib mesylate (Glivec(R)) is the standard treatment in unresectable or metastatic gastrointestinal stromal tumors. Imatinib should be given until development of intolerance or progressive disease. It is not uncommon for gastrointestinal stromal tumors to become larger during the early post-treatment phase and conventional response to treatment criteria in solid tumors have a limited value for evaluation the efficiency of imatinib in this period. FDG-PET has proven to be highly sensitive in detecting early response tumor. A 53-year old woman was diagnosed of relapsed gastrointestinal stromal tumor 18 months after adyuvant imatinib mesylate finished. Imatinib was started and 72 hours later the tumor showed a decrease of fluorodeoxyglucose F18 uptake on positron emission tomography scan.

Positron emission tomography (PET) is a non-invasive nuclear medicine technology which uses radiotracers and cameras slightly different from the ones used in other nuclear medicine tests. Most current indications are for oncological diseases; in nephrology-urology its use has been reduced because of the characteristics of the most commonly used radiotracer, 18F-fluor deoxiglucose (18F-FDG, a glucose analogue), which is excreted by the kidney, limiting the interpretation of the study in urologic malignancies. Currently, 18F-choline is a promising radiotracer for both staging and restaging, especially if hybrid PET/CT scan devices are used. New radiotracers will be needed in the evolution of PET to obtain information about more specific aspects of prostate carcinoma that will modify therapy and follow-up.

New oncologic procedures are currently more focused on the biological features of tumors. The ideal objective is the administration of personalized effective treatments for each patient that affects not just the location and spread of disease but also special metabolic characteristics of tumoral cells. Radiologic diagnostic methods are extremely important in the management of the patient for staging, restaging, and evaluation of treatment response, and clinicians are avid for some additional functional and metabolic information. Further, they need more dynamic methods for follow-up. Nuclear Medicine and positron emission tomography (PET) in many cases can meet this requirement, although it is not perfect, at least at the present time. Currently 2-((18)F)fluoro-2-desoxi-D: -glucose positron emission tomography is being widely used for oncologic purposes. Its information can be very useful in abdominal diseases and must be taken into account with the results of radiologic imaging. Thus, many changes in the choice of treatment are seen. However, it is very important to know that sometimes there is a lack of specificity that has to be considered.

Objective: The trefoil factor 1 (TFF1/pS2) is an estrogen-induced molecule in breast tumours. We wanted to study its expression in ER+ and PgR+ infiltrating ductal carcinomas of the breast (IDCs), and to correlate it with other clinical-biological parameters and the outcome., Material and Methods: Cytosolic pS2 levels were measured using an IRMA (CIS. Biointernational. France) in 170 tumors. Likewise we determined the cytosolic levels of cathepsin D and tissue-type plasminogen activator (t-PA), as well as the concentrations of the epidermal growth factor receptor (EGFR), erbB2 oncoprotein, CD44v5 and CD44v6 on cell surfaces. Also the tumour size, histological grade (HG), axillary lymph node involvement, distant metastasis, ploidy, DNA index and of cellular synthesis phase (SP) was taken in account., Results: The pS2-positive (> 5 ng/mg prot.) tumours showed higher concentrations of cathepsin D (p: 0.0043) and t-PA (p: 0.0089) than the pS2-negative ones. Likewise, they were less frequently HG3 (p: 0.0231), SP > 7 % (p: 0.0005) and SP > 14% (p:0.0014). During the follow-up time (r: 1-147; 50,1+/-31,7; median 37 months) the pS2-positive tumors showed a less number of recurrences (5/101 vs 6/69; p: 0.059) but not of deaths by the tumor (1/101 vs 2/69)., Conclusions: These results support an inverse relationship between pS2 positivity and cellular proliferation in IDCs and suggest a new role of this protein (different of the hormone dependence) in the biology of these breast carcinomas, while further studies will be required to establish the impact of this finding on their outcome.

Introduction: CA125 is a useful serum tumor marker in patients with non-mucinous ovarian cancer, but there may be high serum levels in other malignant tumors, among them the non-small cell lung cancers. We decided to study the cytosolic levels of CA125 in lung adenocarcinomas and compare them with pS2, CD44s, CD44v5 and CD44v6, all of them with biological interest in this subtype of lung carcinomas., Subjects and Methods: The study group included 55 patients (33 males) having lung adenocarcinomas. CA125 and cytostolic pS2 were measured by both IRMAS methods (CIS. Biointernational. France). The concentrations of CD44 standard (CD44s), CD44v5 and CD44v6 on cell surfaces were dosed by EIAS (Bender Diagnostics. Austria). Clinical stage, ploidy and S-phase cellular fraction were also taken into account., Results: In the 55 lung adenocarcinomas, cytosolic CA125 levels ranged between 1 and 225 U/mg prot. (median 80.5) and were higher (p:0.002) than those observed in 16 normal lung tissues from the same patients (r: 1-32.5; median 6.7 U/mg prot.). When the 25th (7.2 U/mg prot.) and 75th (320 U/mg prot.) percentiles were used as clinical cut-offs, we found that the cases with high antigenic levels showed a greater positivity for CD44v6 (p:0.002) and a reduced positivity for CD44 standard (p:0.053). Likewise, they showed a tendency towards being pS2 + (p:0.09) more frequently., Conclusions: Our results lead us to draw the following conclusions: 1) Cytosolic CA125 levels in lung adenocarcinomas were higher than those observed in normal tissues from the same patients. 2) Lung adenocarcinomas with high cytosolic CA125 concentrations had a greater positivity for CD44v6, a reduced positivity for CD44s and were more frequently pS2 +. These associations support the usefulness of the cytosolic CA125 levels as an indicator of poor outcome in this subtype of lung carcinomas.

We present the case of a 42 year old man, with a history of multiple fractures and generalized pain for two years. A three phase bone scan, demonstrated multiple fractures involving the ribs, both ankles and feet. After going through a battery of tests which included an FDG PET scan (to exclude an occult malignancy), the patient was diagnosed with osteomalacia and hyperparathyroidism. The FDG PET scan, demonstrated multiple foci of increased FDG uptake throughout the axial skeleton, in a pattern highly suggestive of pseudofractures, rather than osseous metastases.