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Background: The major challenge in diagnosing infective endocarditis using fluorine-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) is the high physiological myocardial F-FDG uptake, which may interfere with the detection of pathological uptake. Our aim was to retrospectively analyse the impact of a low-carbohydrate, high-protein, high-fat (LCHPHF) diet starting 72 h before the examination with classic overnight fasting., Methods: We included 92 patients (51 with LCHPHF diet 72 h before the examination and 41 with overnight fast only). Left ventricular (LV) myocardial F-FDG uptake was visually evaluated, to estimate the effect of LCHPHF on myocardial F-FDG uptake, we used a three-point visual scale: 0, negligible uptake and evaluable examination; 1, mild uptake and doubtful examination and 2, intense uptake and not evaluable examination. SUVmax and SUVmean were calculated putting a region of interest on LV myocardium at the level of the largest cardiac footprint and on the site of suspected lesion. Thus, a ratio between SUV of the suspect lesion and SUV of LV was calculated as SUV ratio., Results: By visual assessment, in LCHPHF diet group 46 patients (96.1%) had score 0, 3 patients (5.9%) had score 1 and nobody had score 2. In control group, 23 patients (56.1%) had a score 2, 12 (29.3%) patients obtained a score 1 with a doubtful examination and 6 patients (14.6%) were classified with a score 0 with reportable examination., Conclusion: We demonstrated that an LCHPHF diet can adequately suppress the physiological myocardial uptake leading to a significant improvement in the interpretability and diagnostic accuracy of F-FDG PET/CT in infective endocarditis.

Background: Radium-223 was a treatment approved for patients with metastatic castrate-resistant prostate cancer, symptomatic bone metastases and no-visceral metastases, in progression after at least two prior lines of systemic therapy, or ineligible for any available systemic treatment. The aim of this study was to provide further characterization and sub-selection of patients who would benefit most with Radium-223 treatment., Methods: We retrospectively analysed 38 patients treated with Radium-223 between 2015 and 2018. All patients underwent a baseline visit and a bone scintigraphy. Bone scan, ALP and PSA levels were repeated after third and after the end of therapy. All patients were re-evaluated after 2 months from the end of therapy. Survival curves were plotted according to the Kaplan-Meier method and differences between groups were analysed by using a two-tailed log-rank test., Results: The response to the treatment in term of change in pain was reduction in 16 patients; no change in 14 and increased in eight. We arbitrarily established a cut-off 10 bone lesions to evaluate the response: patients with less than 10 metastasis had significant differences in PFS (P < 0.001) compared to patients with more than 10, no statistical significance was found considering the OS (P = 0.23) between the two groups. The same results were founded in patients with baseline ALP <220 U/L with a PFS (P < 0.001) and OS (P = 0.027)., Conclusion: The most important finding was the correlation between the number of bone metastasis and ALP with outcome survival and efficacy of Radium-223 treatment.

Purpose: The purpose was to report our experience in the use of radiotracer localization and resection of small, indistinct, or nonpalpable pulmonary lesions. We developed an innovative technique implementing a fluoroscopy system on a single-photon emission computed tomography/computed tomography (SPECT/CT) scan that allowed to perform CT-guided injection of radiotracer directly on SPECT/CT., Patients and Methods: Patients were selected for the radiotracer procedure in presence of difficulties in locating nodules with video-assisted thoracoscopic surgery (VATS). Overall, 0.2 ml of technetium-99m macroaggregated albumin and 0.3 ml of nonionic iodinated contrast were injected under CT guidance. During the VATS procedure, an endoscopic gamma detecting probe was introduced to scan the lung surface. The area of major radioactivity, which matched with the area of the nodule, was resected., Results: Between January 2016 and October 2018, 37 patients underwent CT-guided radiotracer injection. The mean nodule size was 11 mm. CT nodule morphology characteristics were as follows: 15 nodules were ground glass, 12 were solid, and 10 were partly solid. No significant adverse events occurred. In one patient, the surgeons decided for an open thoracotomy after unsuccessfully VATS. Overall, lobectomy was performed in two patients, segmentectomy in one, and wedge resection in 33 patients. No mortality occurred. The pathological diagnosis was 15 (42%) primary lung cancer, eight (22%) metastases, and 13 (36%) benign lesions., Conclusion: Radioguided pulmonary nodule localization is a reliable procedure with a high rate of success, minimal complications, and lower risk of failures, with no associated mortality or significant morbidity. Our SPECT/CT system is the first to benefit from the technological improvement with successfully implementation and application of fluoroscopy to SPECT/CT.

Background: Myocardial perfusion imaging is a well-established diagnostic tool in patients with known or suspected coronary artery disease. Numerous clinical trials have shown that attenuation correction (AC) in single photon emission computed tomography (SPECT) improves the diagnostic accuracy of myocardial perfusion imaging over non-AC SPECT, differentiating between scar and attenuation artifacts. We have previously shown that attenuation artifacts produce an overestimation of the size of inferior infarcts in the male population. It is assumed that women are less affected by inferior attenuation artifacts than men., Purpose: The aim of this study is to evaluate the role of AC in the assessment of infarct size in female patients with a history of myocardial inferior infarct., Patients and Methods: We studied a population of 66 consecutive women, with a history of previous inferior myocardial infarct, by SPECT/computed tomography (CT) with 370+370 MBq of technetium-99m labeled compounds by a 2-day stress-rest protocol. Both AC and uncorrected gated-SPECT/CT studies were reconstructed after scatter and motion correction by ordered-subset expectation maximization iterative reconstruction and resolution recovery. The coregistration of the transmission and emission scans was verified for all patients; any misalignment was realigned manually. Uncorrected and corrected SPECT images were analyzed by software QPS/QGS package using a 17-segment model. For each segment, perfusion and wall motion were quantified using a five-point score according to the American Society of Nuclear Cardiology guidelines. Summed stress, summed rest score (SRS), and summed difference score of the inferior left ventricle wall (inferior, inferoseptal, inferolateral, and apical inferior segments) were calculated. A linear correlation was used to assess the relationship between perfusion and the regional wall motion score as determined by uncorrected gated-SPECT., Results: The results of quantitative analysis of non-AC and CT-AC SPECT images, respectively, were as follows: summed stress score: 9.47±5.01 and 6.58±4.77% (P<0.001); SRS was 6.05±5.02 and 4.14±4.12% (P<0.001); the summed difference score was 2.92±2.74 and 2.52±2.63% (P=NS), respectively. The correlation between corrected and uncorrected SRS and the regional summed wall motion score of the same segment was R=0.31 versus R=0.34., Conclusion: In the female population, like in men, attenuation artifacts affect the calculation of the infarct size of the inferior wall, with overestimation of the infarct size in uncorrected images. The AC regional perfusion score (SRS) better correlates with the regional wall motion score of the inferior wall in women with previous inferior infarct.