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PURPOSE The aim of this study was to evaluate F-FDG PET/CT compared with conventional imaging techniques in the clinical management of patients with locally advanced gastric cancer (LAGC). METHODS A prospective study between January 2010 and December 2011 in patients with suspected LAGC was conducted in our hospital. F-FDG PET/CT, contrast-enhanced CT (CECT), endoscopic ultrasound, and laparoscopy were performed in all cases. Standard whole-body F-FDG PET/CT images were obtained centered on the stomach at 1 and 2 hours after injection of 4.0 MBq/kg of F-FDG. Findings were confirmed by histopathology or by imaging follow-up in nonoperable patients. RESULTS Fifty consecutive patients with confirmed LAGC (20 women, 30 men) with a mean ± SD age of 65.7 ± 12.1 years were included. Using Lauren classification, 24 patients were intestinal subtype, and 26 were diffuse subtype. Thirty-five patients with locoregional lymph node involvement and 22 with distant metastases were confirmed as peritoneal metastases (n = 15), retroperitoneal (n = 2) or mediastinal lymph nodes (n = 1), and liver (n = 3) or bone metastases (n = 1). Patients with signet ring carcinoma showed significantly less F-FDG uptake (P = 0.001). SUVmax correlated with tumor grading (P < 0.05). Standard and delayed F-FDG PET/CT and CECT images identified LAGC in 24, 27, and 28 of 30 patients, respectively. The sensitivity and specificity for F-FDG PET/CT and CECT to detect metastases were 68% and 100% and 64% and 93%, respectively. Contrast-enhanced CT and F-FDG PET/CT diagnosed only 6 of the 15 patients with confirmed peritoneal metastases. The impact in therapeutic management of F-FDG PET/CT and CECT was 24% and 22%, respectively. Kaplan-Meier survival curves for the LGAC showed a significant correlation between SUVmax and overall survival using an SUVmax threshold of less than 3.96 (P = 0.04). CONCLUSIONS F-FDG PET/CT should be recommended for staging of LAGC; however, F-FDG PET/CT and CECT cannot replace laparoscopy to rule out peritoneal metastases. Delayed F-FDG PET/CT images show an increase of F-FDG uptake in most cases, improving LAGC detection. The grade of F-FDG uptake represents a significant prognostic tool in this series.

INTRODUCTION Bisphosphonates may aid in treating and preventing bone loss promoted by chronic immunosuppressive treatment and secondary hyperparathyroidism in renal transplant (RT) patients. However, the effectiveness of bisphosphonates is compromised by poor patient compliance. The objective of the study was to compare the effects of once monthly ibandronate with those of weekly risedronate administration on bone mineral density (BMD) and renal function in RT patients. PATIENTS AND METHODS Sixty-nine patients were prospectively recruited who were at least 12 months post-RT and were treated with either oral ibandronate 150 mg monthly (n=35) or oral risedronate 35 mg weekly (n=34). At baseline and 1 year, creatinine, calcium, alkaline phosphatase, and i-parathyroid hormone were measured, and BMD was determined by dual-energy X-ray absorptiometry. RESULTS Group I consisted of 35 patients (28 women) treated with ibandronate who were of a mean age of 63±12 years. Group II consisted of 34 patients (30 women) treated with risedronate who were of a mean age of 64±10 years. Lumbar BMD was as follows: baseline T-score (group I vs. group II) of -1.7±0.8 versus -1.9±0.8 (P=NS); and annual T-score of -1.3±0.6 versus -1.4±0.8 (P=NS). After 1 year, lumbar BMD improved to reveal a T-score of -1.3±0.6 in the ibandronate group (P

The aim of the study was to determine if pinhole collimator-acquired images can improve the detection of hyperfunctioning parathyroid glands in patients with secondary hyperparathyroidism.Forty-two patients being treated with cinacalcet for secondary hyperparathyroidism were studied prospectively. Patients were divided into 2 groups according to their levels of parathyroid hormone (PTH), the hormone that defines response to treatment: "responders" (PTH300 pg/mL) and "nonresponders" (PTH ≥ 300 pg/mL). Double-phase scintigraphy using 888 MBq of (99m)Tc-MIBI was used to acquire early and late parallel-hole and pinhole collimator images. Neck ultrasonography was performed on all patients to identify intrathyroid nodules. All focal uptake in any of the acquired scintigraphic images was considered positive.The responder group included 24 patients, whereas 18 patients were considered as nonresponders. At least 1 parathyroid gland with (99m)Tc-MIBI uptake was detected in 33 of 42 patients, with a total of 50 parathyroid glands located. We found significant differences between the detection rates of late pinhole collimator and the late parallel-hole images (74% vs 48%, P = 0.0036). This detection rate was highest with late parallel-hole images in the nonresponder group (89%).The late pinhole collimator acquisition showed the highest detection rate of hyperfunctioning parathyroid glands using (99m)Tc-MIBI scintigraphy in secondary hyperparathyroidism patients treated with cinacalcet.

This study aimed to prospectively evaluate the usefulness of PET/CT using F-FDG in comparison to bone scan and Ga in the diagnosis of spondylodiskitis.This prospective study included 34 patients (15 women and 19 men) aged 59 (18) years with clinical symptoms of spondylodiskitis. Whole-body PET/CT and bone scan combined with planar and SPECT/CT Ga was performed in all patients. Diagnosis of spondylodiskitis was made by microbiology and/or on the basis of clinical and laboratory findings and imaging follow-up.Spondylodiskitis was confirmed in 18 of 34 patients. In the other 16 patients, spondylodiskitis was finally excluded, and the most frequent findings observed were degenerative spondyloarthropathy (n = 7), vertebral fracture (n = 3), endocarditis (n = 2), and other processes (n = 4). The sensitivity and specificity of combined bone scan and Ga were 78% and 81%, with a positive predictive value of 82%, a negative predictive value of 76%, and an overall accuracy of 79%. SPECT/CT with Ga helped identify soft tissue involvement in 10 of 18 patients. The sensitivity and specificity of PET/CT were 89% and 88%, with a positive predictive value of 89%, a negative predictive value of 87%, and an overall accuracy of 88%. Concordance between Ga and PET/CT was good (κ = 0.71; 95% confidence interval, 0.48-0.94). PET/CT was able to detect soft tissue involvement in 12 of 18 patients. In 2 patients, a multifocality was found, which was only diagnosed by PET/CT.PET/CT is useful in the diagnosis of spondylodiskitis, with more accurate results than combined bone scan and Ga. SPECT/CT with Ga is recommended, especially when planar bone scan and Ga pattern is suggestive of spondylodiskitis.

OBJECTIVE To evaluate the effect of calcimimetics with 99mTc-methoxy-isobutyl-isonitrile (MIBI) parathyroid scintigraphy in secondary hyperparathyroidism. METHODS This prospective study included 30 consecutive haemodialysis patients with inadequately controlled secondary hyperparathyroidism despite standard medical treatment. Patients were given a single daily oral dose of 30 mg of cinacalcet. A baseline and 1-year follow-up dual-phase 99mTc-MIBI scintigraphy were performed. 99mTc-MIBI uptake in each parathyroid gland was graded on a semiquantitative scale (scoring 0-3). RESULTS Twenty-one of the 30 patients responded to cinacalcet (70%). Abnormal positive glands were identified by 99mTc-MIBI scintigraphy in 27 out of 30 patients (53 glands). The sensitivity and specificity of 99mTc-MIBI in detecting cinacalcet response were 90 and 89%, respectively. The mean baseline and posttreatment grades of 99mTc-MIBI uptake were 2.9 ± 1.8 and 1.1 ± 1.2 (P < 0.0001) in the responder group and 3.1 ± 2.1 and 3.9 ± 2.2 (P = ns) in the nonresponder group. CONCLUSION 99mTc-MIBI scintigraphy is useful in monitoring the response to calcimimetics in secondary hyperparathyroidism.

Objectives To assess the usefulness of [ 1 8 F]fluorodeoxy-glucose positron emission tomography in the detection of bone marrow involvement in malignant lymphoma, and its impact in clinical management. Methods One hundred and six consecutive patients with a confirmed diagnosis of lymphoma, referred for staging or restaging of Hodgkin's lymphoma (n=18) or non-Hodgkin's lymphoma (n=88), were reviewed retrospectively. A positron emission tomography scan and bone marrow biopsy of the iliac crest were performed in all patients. The assessment of bone marrow involvement by lymphoma was confirmed by histology and/or progression of bone marrow lesions in clinical follow-up. Results In 28 of 106 patients, bone marrow involvement was found. Positron emission tomography was more sensitive (86%) than bone marrow biopsy (57%). Positron emission tomography and bone marrow biopsy were concordant by positive correlation in 12 of 28 cases (43%) and by negative correlation in 77 of 78 cases (99%). Ten cases of non-Hodgkin's lymphoma and two cases of Hodgkin's lymphoma with positive positron emission tomography results and an initial negative bone marrow biopsy showed clinical progression of the bone marrow lesions and/or subsequent positive histology. These were considered as false-negative results for bone marrow biopsy. In seven of the 12 positive cases with negative bone marrow biopsy, positron emission tomography uptake distant from the site of the biopsy was seen. In four cases of follicular lymphoma, the bone marrow biopsy was positive and the positron emission tomography scan was normal. Conclusions Positron emission tomography and bone marrow biopsy are complementary in assessing the presence of bone marrow involvement in patients with malignant lymphoma. In our series, positron emission tomography was more sensitive than bone marrow biopsy in Hodgkin's and non-Hodgkin's lymphoma, except in follicular lymphoma.

The major factor influencing scintigraphic detection of abnormal parathyroid glands seems to be their size. However, false-negative results have been reported in large glands while some very small adenomas have been identified. Other factors can influence 99mTc-MIBI and 99mTc-Tetrofosmin uptake and therefore the accurate detection of hyperfunctioning glands depends also on these. Increases in both perfusion and functional activity and targeting of abundant mitochondria-rich oxyphil cells seem to be relevant mechanisms of uptake. A relationship has been observed between the intensity of focal uptake in the parathyroid glands and the cell cycle phases for patients with secondary hyperparathyroidism. Higher uptake grades correlated with the active growing phase, showing that scintigraphy accurately reflects the functional status of the hyperplastic parathyroid glands. Serum calcium levels may modify radiotracer kinetics by influencing the membrane potential. In addition, P-glycoprotein or multidrug resistance (MDR) associated protein expression may play an important role in the false-negative results of parathyroid scintigraphy. If the lipophilic cationic radiotracers used in parathyroid scintigraphy are transported by the same mechanism as the anticancer drugs, they will be quickly eliminated from the parathyroid glands containing P-glycoprotein or MDR-related protein expression and the uptake in images will be negative. In parathyroid glands with no P-glycoprotein or MDR-related protein expression, the radiotracers remain in the cells, making it easier to detect them by scintigraphy.

The aim of this study was to establish whether tumour uptake of 99mTc-MIBI can predict response to chemotherapy in patients with breast carcinoma. Forty women suffering from breast carcinoma confirmed by tumour biopsy were studied prospectively. Fifteen patients subsequently underwent surgery and 25 were candidates for neoadjuvant chemotherapy. Breast scintigraphy was performed and planar and tomographic views (single photon emission computed tomography (SPECT)) were obtained after injection of 740 MBq of 99mTc-MIBI. The tumoural uptake was quantified by computer analysis. P-glycoprotein was evaluated by immunohistochemistry only in operable patients. The response to chemotherapy was evaluated at 3 months upon completion of treatment. The results of this study showed no relationship between 99mTc-MIBI uptake and the histological type or tumour size. There was an inverse correlation with the degree of tumour differentiation (P0.05). 99mTc-MIBI uptake in negative P-glycoprotein lesions (2.36+/-1.72) was higher than in positive P-glycoprotein lesions (1.53+/-1.29), although the difference was not statistically significant. Lesions which responded to chemotherapy (16) showed higher 99mTc-MIBI uptake (7.70+/-5.20) than non-responding lesions (nine) (2.21+/-1.0) (P0.001). In conclusion, there is a correlation between 99mTc-MIBI uptake in breast cancer and response to chemotherapy. Furthermore, 99mTc-MIBI uptake may be influenced by other factors such as the degree of tumour differentiation or tumour P-glycoprotein levels.

A 70-year-old man with operated colorectal cancer relapsed with a solitary lung metastasis. Dual time-point PET/CT performed at 60' (standard images) and after 2 hours (delayed images) showed focal uptake in the lung nodule. A second uptake in the liver dome was also visualized only in the delayed images. Radiofrequency of the lung metastasis was performed by CT-fluoroscopy guide. A PET/CT 1 month after radiofrequency showed significant reduction of activity in the delayed images, and the uptake at 3 months was virtually normal. A fine-needle biopsy of the liver lesion confirmed the final diagnosis of metastasis from adenocarcinoma.

Objectives To evaluate the usefulness of 123 I-labelled anti-vascular cell adhesion molecule-1 (VCAM-1) monoclonal antibody (MAb) scintigraphy in the assessment of colonic inflammatory damage. Design Colitis was induced by intracolonic administration of 30 mg trinitrobenzenesulphonic acid in 0.5 ml of 50% (v/v) ethanol. Rats injected with vehicle served as controls. Animals were studied at day 7 after induction of colitis. Methods Scintigraphy was performed in control and trinitrobenzenesulphonic acid-induced colitic rats 2, 4 and 24 h after intravenous administration of 123 I-anti-VCAM-1 MAb. Scintigraphic uptake was quantified in selected areas on scintigraphs. Animals were killed, tissue 1231 radioactivity accumulation was measured, and accumulation of anti-VCAM-1 MAb in each organ was calculated. 99m Tc-hexamethyl propylene amine oxime-labelled leucocyte scintigraphy was performed in additional groups of animals for comparison. Results Colonic tracer uptake was visible in scans of colitic, but not control animals. Quantification of scintigraphic uptake in the colon was significantly higher in colitic rats than in control animals (P < 0.0001). The specificity of the increase was demonstrated by lack of 123 I-labelled non-binding MAb uptake in the colon, and by displacement of 123 I-anti-VCAM-1 MAb colonic uptake by pre-treatment with unlabelled MAb. Accumulation of anti-VCAM-1 MAb in the colon of colitic rats was eightfold higher than in control animals. Strong correlations were found between quantification of scintigraphic uptake, anti-VCAM-1 MAb accumulation, histological damage and myeloperoxidase activity in the colon. Conclusion 123 I-labelled anti-VCAM-1 MAb scintigraphy allows an accurate evaluation of colonic inflammatory damage in trinitrobenzenesulphonic acid-induced colitis, suggesting a potential role for this imaging technique in the assessment of human IBD.

Most studies of prostate cancer have shown that strontium-89 chloride (89Sr) is effective in the palliation of metastatic bone pain, refractory to conventional analgesia. The aim of this study was to evaluate the usefulness of 89Sr for bone pain palliation in breast cancer patients. Forty women were treated with 148 MBq of 89Sr. Six patients were retreated, receiving two or more doses. The Karnofsky performance status was assessed and pain and analgesia were scored on scales of 9 and 5 points, respectively. The efficacy of 89Sr was evaluated at 3 months of treatment. The response was good in 60% of the patients and partial in 32%; there was no response in the remaining 8% (pre-treatment Karnofsky < or = 60). The duration of the response was 120+/-143 days. In the patients retreated, the response was good in 83% and partial in 17%, without significant differences compared with the first dose, but the pre-treatment Karnofsky and the duration of the efficacy were lower (P < 0.05). A transient and slight decrease of leukocyte and platelet counts after the first month of treatment with 59Sr was observed. In conclusion, breast cancer patients with metastatic bone pain can benefit from therapy with 89Sr. If necessary, the treatment may be repeated safely and with the same efficacy as is achieved after the first dose. A low functional performance status could be a cause of the lower effectiveness of 89Sr.

Hiatal hernia occurs when abdominal structures protrude into the thoracic cavity through a defect on the diaphragm. Few cases of hiatal hernia have been published as a casual finding using myocardial imaging agents. We present a case in which a hiatal hernia was suspected while performing a Tc-99m tetrofosmin gated-SPECT study in a patient referred to our department to rule out coronary artery disease. The study was initially suggestive of myocardial ischemia. A double-contrast thoracoabdominal CT showed the presence of a major hiatal hernia, which matched the myocardial SPECT findings.

Early detection and prompt treatment of breast cancer are the main tools to decrease mortality rates. Several diagnostic techniques such as mammography, magnetic resonance imaging, and ultrasound are used, but none of these are conclusive. The authors describe a 56-year-old woman who was suspected of having breast cancer on mammography. Tc-99m MIBI scintimammography showed a small mass with elevated radiotracer uptake located near the pectoral muscle of the patient's left breast. The possible tumor was confirmed with fine-needle aspiration biopsy. After the diagnosis was established, the patient did not allow any treatment. Eighteen months later, a second scintimammography was performed, showing a large mammary tumor with a high radiotracer uptake, a new small lesion located in the left upper quadrant, and axillary lymph node involvement. Chemotherapy treatment was instituted and after treatment, Tc-99m MIBI scintimammography was normal. This case report provides further evidence for Tc-99m MIBI scintimammography for the detection of breast cancer as well as to evaluate the response to chemotherapy.

An 85-year-old woman who had an invasive ductal carcinoma of the breast and elevated alkaline phosphatases (420 U/L) was referred for Tc-99m MDP bone scintigraphy for initial evaluation of skeletal metastases. Bone symptoms were limited to chronic pain in both knees. A bone scan revealed pagetoid findings in both calcanei. Feet and toes on plain x-rays of the calcaneus were unremarkable. Findings were stable in the 2-year follow up, excluding other potential diagnosis as extensive metastases or stress fractures.

A 35-year-old man operated on 3 years earlier for preaortic extra-adrenal paraganglioma was examined for dorsal spine pain. MRI showed metastases in the thoracic spine (at T3, T5, and T7), with a tumoral mass extending to the posterior epidural space, which was later removed. Pathologic study confirmed that it corresponded to a metastasis of paraganglioma with a high degree of malignancy. 1-123 metaiodobenzylguanidine whole-body scintigraphy and a Tc-99m MDP bone scan were performed to determine the extent of the disease.