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Objectives: This practice parameter (PP) for Lutetium-177 (Lu-177) DOTATATE peptide receptor radionuclide therapy (PRRT) aims to guide authorized users in selection of appropriate adult candidates with gastroeneropancreatic neuroendocrine tumors (GEP-NETs) from foregut, midgut, and hindgut. The essential selection criteria include somatostatin receptor-positive GEP-NETs, which are usually inoperable and progressed despite standard therapy. Lu-177 DOTATATE is a radiopharmaceutical with high avidity for somatostatin receptors that are overexpressed by these tumors. This document ensures safe handling of Lu-177 DOTATATE by the authorized users and safe management of affected patients., Methods: The document was developed according to the systematic process developed by the American College of Radiology (ACR) and described on the ACR Web site (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards). The PP development was led by 2 ACR Committees on Practice Parameters (Nuclear Medicine and Molecular Imaging and Radiation Oncology) collaboratively with the American College of Nuclear Medicine, American Society of Radiation Oncology, and Society of Nuclear Medicine and Molecular Imaging., Results: The Lu-177 DOTATATE PP reviewed pharmacology, indications, adverse effects, personnel qualifications, and required clinical evaluation before starting the treatment, as well as the recommended posttherapy monitoring, quality assurance, documentation, and appropriate radiation safety instructions provided in written form and explained to the patients., Conclusions: Lu-177 DOTATATE is available for therapy of inoperable and/or advanced GEP-NETs when conventional therapy had failed. It can reduce tumor size, improve symptoms, and increase the progression free survival. The PP document provides clinical guidance for authorized users to assure an appropriate, consistent, and safe practice of Lu-177 DOTATATE., Competing Interests: Conflicts of interest and sources of funding: N.B.D. reports a grant from Boston Scientific, consulting fees from Boston Scientific, and honoraria from MedLearning. L.B. reports a grant from AAA Novartis, and participation on an advisory board for AAA Novartis. R.K.J.B. reports participation on an advisory board for Covera Health. E.C.G. reports consulting fees from Advanced Accelerator Applications. R.F.H. reports funding from National Institutes of Health/National Cancer Institute, and a leadership role as Chairman of the Radiopharmaceutical Therapy Subcommittee of the American Association of Physicists in Medicine. T.A.H. reports grants or contracts from Philips and Clovis Oncology, consulting fees from Curium and ITM, and participation on advisory boards for Ipsen and Blue Earth Diagnostics. D.A.P. reports grants from Siemens, Nordic Nanovector, Progenics, and 511 Pharma, and consulting fees from Siemens, 511 Pharma, Progenics, Actinium, and Ipsen. B.S.-B. reports a grant from Blue Earth Diagnostics, honoraria from PETNET and Blue Earth Diagnostics, and a leadership role as Society of Nuclear Medicine and Molecular Imaging (SNMMI) co-chair of outreach committee secretary of American College of Nuclear Medicine, Central Chapter SNMMI, and Academic Council SNMMI. R.M.S. reports a grant from Endocyte Inc. For the remaining authors, none were declared., (Copyright © 2022 Clinical Nuclear Medicine and American Journal of Clinical Oncology.)

A patient with stage D3 prostate cancer was given 11 separate doses of samarium-153 lexidronam (Sm-153 ethylenediaminetetramethylene phosphonate) of 1 mCi/kg (37 MBq/kg) in a period of 28 months for bone pain from metastases. With the first five doses, Sm-153 lexidronam clearly reduced his bone pain and improved his quality of life, as determined by pain-assessment scores and the patient's self-assessment of its effect on his ability to perform activities of daily living. With doses 6 through 11, pain at baseline was on average less, and as a result beneficial effects after treatment were not as apparent. Samarium-153 lexidronam produced transient decreases in the leukocyte and platelet counts, but these never became low enough to cause clinical concern. This case shows both the efficacy and the safety of Sm-153 lexidronam in repeated treatments for metastatic bone pain in patients with prostate cancer.

This study assesses the causes of colonic localization of labeled white blood cells (WBCs) in critically ill patients who had undergone leukocyte scintigraphy for suspected infection. Forty-two patients showed abdominal or pelvic WBC localization; 20 of these had a pattern of colonic localization, and some also showed a pattern of small bowel activity. Eight of the 20 patients had documented gastrointestinal bleeding. White blood cell scintigraphy in these eight patients showed a pattern of multifocal and/or regional bowel activity that changed in intensity and location from early (3-5-hour) to delayed (18-28-hour) images. In contrast, 5 of the 6 patients with documented pseudomembranous colitis (PMC) showed intense WBC localization involving most of the colon. In 3 of these 5 patients, early and delayed images were acquired and showed a relatively constant pattern of WBC localization. The sixth PMC patient had been treated with vancomycin before leukocyte scintigraphy and showed minimal distal small bowel activity on early images and only mild regional colonic activity on delayed images. As in the patients with gastrointestinal bleeding, the remaining six patients showed either focal or regional activity of variable intensity that changed over time. In critically ill patients, gastrointestinal bleeding and PMC accounted for 14 of the 20 patients in which labeled leukocyte scintigraphy exhibited colonic activity. A pattern of diffuse, intense colonic radiotracer activity which persists from early to delayed imaging strongly suggests the presence of PMC in this patient population.(ABSTRACT TRUNCATED AT 250 WORDS)

Although surgical treatment of nontoxic multinodular goiter remains the most effective therapy, I-131 is a reasonable alternative in cases where thyroidectomy is not appropriate. Selection of I-131 activity in the management of nontoxic multinodular goiter has largely been empirical. The use of dosimetric measurements in guiding I-131 therapy in the treatment of a patient with a recurrent, nontoxic, multinodular goiter is described.

Anatomic features of carotid artery stenosis, as defined angiographically, do not necessarily correlate with the hemodynamic significance of the narrowing. The concept of regional cerebral vasodilatory (or perfusion) reserve has been advocated as a means of defining the hemodynamic compromise associated with carotid lesions. We evaluated the feasibility of using SPECT imaging with 5% CO2 using I-123 IMP (N-isopropyl iodoamphetamine) or Tc-99m HMPAO (hexamethylpropylene amineoxime) to measure cerebral perfusion reserve. Imaging was performed on six asymptomatic subjects and one patient with a history of transient ischemic attacks but no evidence of carotid artery disease. A perfusion reserve index (PRI) was defined to represent the percent increase in blood flow during 5% CO2 breathing in regions supplied by the middle cerebral artery normalized for injected dose and changes in blood pressure. Significant increases in cerebral perfusion were seen in six of the seven subjects studied while breathing the 5% CO2 (P less than 0.01). The mean of the PRI values for the seven subjects was 32%, with a range of -5% to 58%. We conclude that SPECT imaging with IMP or HMPAO can be used to quantitatively measure the cerebral perfusion response to 5% CO2.

Xenon-133 washout phase imaging is often used to help determine whether the etiology of a perfusion defect is embolic or due to pulmonary parenchymal pathology, such as chronic obstructive pulmonary disease. This study was designed to evaluate the pulmonary blood flow patterns associated with isolated defects on xenon washout images. Scintigraphic lung studies were reviewed until 100 cases with abnormal ventilation results were obtained. Ventilation abnormalities were compared with the corresponding perfusion scan results at the same anatomic site. Of the 208 individual lung regions with xenon abnormalities, 111 showed isolated washout defects (that is, with normal washin). Ninety-four of these 111 sites showed either normal perfusion or a small, nonsegmental corresponding perfusion defect. Three segmental perfusion defects were noted in association with isolated xenon retention. In each of these cases, however, the patient was felt actually to have pulmonary embolism. Thus, it is recommended that, for interpretation of scintigraphic images in the assessment of pulmonary embolism, lung pathology associated with isolated xenon retention not be considered a potential cause for large or segmental perfusion defects.

Radionuclide scintigraphy is a safe and accurate means of detecting postoperative urologic complications in renal transplant recipients. Early identification of urinary leakage coupled with aggressive intervention significantly reduces the associated morbidity and mortality. Perivesical extravasate may be difficult to distinguish from adjacent or nearby bladder activity on scintiscan. Clarification of actual bladder contour and determination of its exact location within the pelvis may resolve such uncertainties. We describe imaging techniques that define the anatomic extent of the bladder and demonstrate our scintigraphic assessment of perivesical extravasation.

To determine the frequency with which liver metastases are visualized on bone scintigraphy, 425 pairs of liver and bone scans, performed within one month of each other, were reviewed. Sixty-three of the 425 liver scans showed metastases. Of these 63, five cases of carcinoma of the colon and six cases of carcinoma of the lung also visualized by Tc-99m MDP scintigraphy. This represented 46% of colon metastases and 15% of lung metastases detected on liver scan. Liver metastases from other primary tumors were not detected on bone scan, but the numbers for these tumors were small. The liver metastases which were detected on bone scan were significantly larger than those which were not. The literature was reviewed and the primary and secondary tumors of liver with uptake of Tc-99m phosphate compounds listed.