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Competing Interests: Alexander Drzezga:Research support: Siemens Healthineers, Life Molecular Imaging, GE Healthcare, AVID Radiopharmaceuticals, SOFIE, EisaiSpeaker Honorary/Advisory Boards: Siemens Healthineers, Sanofi, GE Healthcare, Biogen, Novo Nordisk, Invicro, Novartis/AAAStock: Siemens Healthineers, Lantheus HoldingPatents: Patent pending for 18F-PSMA7 (PSMA PET imaging tracer).Ken Herrmann:Personal fees from Bayer, personal fees and other from Sofie Biosciences, personal fees from SIRTEX, non-financial support from ABX, personal fees from Adacap, personal fees from Curium, personal fees from Endocyte, grants and personal fees from BTG, personal fees from IPSEN, personal fees from Siemens Healthineers, personal fees from GE Healthcare, personal fees from Amgen, personal fees from Novartis, personal fees from ymabs, personal fees from Aktis Oncology, personal fees from Theragnostics, personal fees from Pharma15, outside the submitted work.Michael C Kreißl: Bayer Healthcare: advisory board, event sponsoring; Eisai: advisory board, event sponsoring, talks; Exelixis: advisory bord, talk; GE Healthcare: talks, event sponsoring, research funding; Ipsen: talks, event sponsoring, travel funding, advisory bord; Takeda: talks; SanofiGenzyme: talks, travel, research funding; Siemens: event sponsoring; Curium: event sponsoring.

A consensus statement about indications for post-surgical radioiodine therapy (RIT) in differentiated thyroid cancer patients (DTC) was recently published by the European Thyroid Association (ETA) 1. This publication discusses indications for RIT on the basis of an individual risk assessment. Many of the conclusions of this consensus statement are well founded and accepted across the disciplines involved. However, especially from the perspective of nuclear medicine, as the discipline responsible for indicating and executing RIT, some of the recommendations may require further clarification with regard to their compatibility with established best practice and national standards of care. Assessment of the indications for RIT is strongly dependent on the weighing up of benefits and risks. On the basis of longstanding clinical experience in nuclear medicine, RIT represents a highly specific precision medicine procedure of proven efficacy with a favorable side-effect profile. This distinguishes RIT significantly from other adjuvant oncological therapies and has resulted in the establishment of this procedure as a usually well-tolerated, standard safety measure. With regard to its favorable risk/benefit ratio, this procedure should not be unnecessarily restricted, in the interest of offering reassurance to the patients. Both patients' interests and regional/national differences need to be taken into account. We would therefore like to comment on the recent consensus from the perspective of authors and to provide recommendations based on the respective published data., Competing Interests: Alexander Drzezga:Research support: Siemens Healthineers, Life Molecular Imaging, GE Healthcare, AVID Radiopharmaceuticals, SOFIE, EisaiSpeaker Honorary/Advisory Boards: Siemens Healthineers, Sanofi, GE Healthcare, Biogen, Novo Nordisk, Invicro, Novartis/AAAStock: Siemens Healthineers, Lantheus HoldingPatents: Patent pending for 18F-PSMA7 (PSMA PET imaging tracer).Ken Herrmann:Personal fees from Bayer, personal fees and other from Sofie Biosciences, personal fees from SIRTEX, non-financial support from ABX, personal fees from Adacap, personal fees from Curium, personal fees from Endocyte, grants and personal fees from BTG, personal fees from IPSEN, personal fees from Siemens Healthineers, personal fees from GE Healthcare, personal fees from Amgen, personal fees from Novartis, personal fees from ymabs, personal fees from Aktis Oncology, personal fees from Theragnostics, personal fees from Pharma15, outside the submitted work., (Thieme. All rights reserved.)

Aim:  Local recurrence of thyroid carcinomas can result in tumor infiltration in the lower region of the larynx. Since these tumors typically no longer store iodine, treatment options are greatly limited. The present study describes our experience with laryngo-tracheal resection of such cases of local recurrence., Materials and Methods:  From July 2019 to November 2020, we treated five patients with malignant infiltration of the trachea and larynx due to local recurrence of a thyroid carcinoma. We performed laryngo-tracheal resection with end-to-end anastomosis in four patients and frontolateral partial laryngectomy in one patient., Results:  The median length of hospital stay was 6 days (5-14). An R0 resection was performed in two patients. Problems with the anastomosis or bilateral recurrent laryngeal nerve paralysis was not seen in any of the patients. One patient had to be reintubated on the second postoperative day due to lung failure. He was able to be extubated after five days., Conclusion:  High tracheal resection with partial resection of the larynx was able to be performed with minimal risk. Although radical resections are rare, they expand oncological treatment options in the case of local recurrence of thyroid carcinomas that are iodine-refractory. High tracheal resection could be part of the oncological treatment spectrum in the case of local recurrence of thyroid carcinomas that no longer store iodine., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Aim: To compare the success rates of radioiodine therapy (RIT) for thyroid remnant ablation (TRA) after the administration of a high-standard activity (3700 MBq; 100 mCi) to a lower-activity regimen of 2000 MBq (54 mCi) I-131 in a cohort of differentiated thyroid carcinoma (DTC) patients (papillary, follicular, mixed, pT1a(m) - pT3, N0 - NX, R0)., Methods: 135 patients received approx. 2000 MBq I-131 (54 mCi) for thyroid remnant ablation after total thyroidectomy for DTC, 137 patients received approx. 3700 MBq (100 mCi) I-131. Ablation success was defined as thyroglobulin (TG) levels < 0.5 ng/ml after stimulation, negative I-131 whole-body scan and inconspicuous results on neck ultrasonography approximately 6 months after initial RIT., Results: In the follow-up 84.4 % of patients in the reduced-activity group and 87.6 % of the patients in the standard-activity group did not show any relevant residual I-131 uptake in the thyroid bed (p = 0.454). 90 % in the reduced-activity group and 91 % in the standard-activity group demonstrated a stimulated TG level < 0.5 ng/ml (p = 0.969). All patients were unre-markable in cervical ultrasonography. The success rate was comparable in both groups (81.5 % in the reduced-activity group vs. 83.9 % in the standard-activity group, p = 0.592). No re-therapy was required in 85.2 % of the patients in the low-activity group as compared to 87.6 % of the patients in the standard-activity group (p = 0.563)., Conclusions: We could demonstrate that irrespective of the activity administered, the patients had comparable success rates with regard to TRA as defined by our criteria. We thus consider the use of a reduced-activity regimen for TRA safe and feasible in the patient cohort examined in this study., Competing Interests: The authors declare that they have no conflict of interest., (Schattauer GmbH.)

SPECT/CT detects radioiodine-positive cervical lymph node metastases (LNMs) of differentiated thyroid carcinoma (DTC) at the time of postsurgical radioablation (RA). Preliminary evidence indicates that the majority of LNMs are successfully treated by RA. The aim of this study was to confirm this evidence in a bicentric setting and to evaluate whether size is a predictor for successful elimination., Patients and Methods: Since 01/2007 and 05/2008, respectively, SPECT/spiral-CT is performed routinely in all patients with DTC at RA in two University Clinics. The outcome of iodine-positive LNMs identified by SPECT/CT until 12/2012 was analyzed by follow-up diagnostic 131 I scans and serum thyreoglobulin (Tg) values. LNM volume and short-axis diameter were evaluated as prognostic factors by a receiver-operating characteristic (ROC) analysis., Results: 79 patients with 97 iodine-positive LNMs were included. Surgery was carried out in 8 patients with 13 LNMs due to the presence of additional iodine-negative lesions. Of the remaining 84 LNMs, 74 (88%) were successfully treated as demonstrated by radioiodine scans at follow-up. 10 LNMs persisted. 67/70 LNMs smaller than 0.9 ml were treated successfully, whereas this was the case of only 6/14 exceeding this threshold. Using this cut-off level to predict treatment success, sensitivity, specificity, positive and negative predictive value were 92%, 73%, 96%, and 57%. Results for short-axis diameter (cut-off level < 1cm) were 90%, 69%, 94% and 56%., Conclusion: RA is effective in the treatment of the majority of 131 I-positive LNMs identified in SPECT/CT images. In this study, 88% of iodine-positive LNM in DTC were successfully treated by radioiodine given at RA. Both LNM volume and diameter are reliable predictors of treatment success.

Recently, a number of positron emission tomography (PET) radiotracers have been approved for clinical use. These tracers target cerebral beta-amyloid (Aβ) plaques, a hallmark of Alzheimer's disease. Increasing use of this method implies the need for respective standards. This German Society of Nuclear Medicine guideline describes adequate procedures for Aβ plaque PET imaging. It not only discusses the tracers used for that purpose, but also lists measures for correct patient preparation, image data generation, processing, analysis and interpretation. With that, this "S1" category (according to the German Association of the Scientific Medical Societies standard) guideline aims at contributing to quality assurance of nuclear imaging in Germany.

Radioligand therapy (RLT) using 177Lu labelled inhibitors of the prostate-specific membrane antigen (177Lu-PSMA) is performed in patients with metastatic castration-resistant prostate cancer (mCRPC) after exhaustion of other options. German University Clinics offer RLT since 2013 on a compassionate use basis. The present consensus document includes recommendations for RLT with 177Lu-PSMA-617. These consensus statements were developed by an expert panel formed by the German Society of Nuclear Medicine (DGN) in December 2015. Statements include recommendations for indication, baseline tests, therapy protocol, concomitant therapy, dosimetry, and follow-up. Consensus recommendations aim to inform the attending medical staff, standardize 177Lu-PSMA-617 RLT, and improve quality of individual patient care.

Unlabelled: The aim was to analyze conventional planar scintigraphy and SPECT/CT in patients clinically suspicious for chylothorax or chylous ascites. Lymphoscintigraphy was performed for two reasons: first, to help diagnose chylothorax or -abdomen, by demonstrating diffuse uptake in fluid accumulations, and then secondly, to detect the site of leakage to test the prediction that additional use of SPECT/CT-technique improves upon the diagnostic value of planar lymphoscintigraphy in the baseline detection of thoraco-abdominal lymphatic disorders., Patients, Material, Methods: From 7/2008-7/2014 a total of 24 consecutive patients (8 woman, 16 men; age, range 31-79 years) presenting with clinical symptoms suspicious for chylothorax and/or chylous ascites were examined by planar lymphoscintigraphy (n = 26) and additional tomographic SPECT/CT- (n = 22) or SPECT-technique (n = 2)., Results: Chylothorax could be scintigraphically confirmed in n = 9, chylous ascites in n = 5 scintigraphies, and excluded in n = 10 patients. In all planar scintigraphy findings of pathological lymph drainage regions (n = 14), SPECT/CT delivered additional relevant information, notably the anatomic localization of the lymphatic leakage. For the baseline detection of thoraco-abdominal lymphatic transport disorders, lymphoscintigraphy showed sensitivity of 88%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 80%., Conclusions: Our findings show that due to the particular advantages presented by tomographic separation of overlapping sources, SPECT/CT specifies better the anatomical sites, improving the localization of lymphatic leakage in aid of planning surgical re-interventions.

Purpose: To compare the diagnostic accuracy of magnetic resonance imaging (MR-lymphangiography) and lymphoscintigraphy for assessment of focal lesions of the peripheral lymphatic system. Patients with focal lymphatic transport disorders might benefit from surgi-cal interventions., Patients, Methods: We examined by lymphoscintigraphy and MR-lymphangiography a total of 85 lower limbs in 46 consecutive patients (33 women; mean age 41 years; range 9-79 years) presenting with uni- or bilateral lymphedema. MR-lymphangiographies were obtained at isotropic sub-millimeter resolution with a 3.0 Tesla magnet after injection of gadolinium contrast medium. MR-lymphangiography was reviewed by radiologists, whereas lymphoscintigraphy was reviewed by nuclear medicine physicians. The images were examined for localization and distribution of any focal lesions of the lymphatic vessel system. Diagnostic accuracy of the MR-approach was calculated relative to the lymphoscintigraphy gold standard., Results: There was substantial correlation of results by the two modalities (κ = 0.62). MR-lymphangiography had sensitivity of 68%, specificity of 91%, positive predictive value of 82%, and negative predictive value of 83%., Conclusions: Imaging findings of both lymphoscintigraphy and MR-lymphangiography showed good diagnostic accuracy. MR-lymphangiography proved more information about anatomic location of focal lesions of the lymphatic vessels, but use of MR-lymphangiography is currently constrained due to the requirement for off-label subcutaneous injection of gadolinium chelates. Consequently, and due to its superior sensitivity lymphoscintigraphy remains the most common imaging method to assess functional lymphatic disorders of the lower limb.

Unlabelled: The aim of this study was to determine whether the additional use of SPECT/CT-technique improves the diagnostic value of planar lymphoscintigraphy in patients presenting with lymphatic transport disorders., Patients, Methods: For a defined period of two years 36 consecutive patients (27 women, 9 men; age 27-87 years) were included in our study. In addition to planar scintigraphy further acquisition of the affected extremities or of the trunk was performed using SPECT/CT-technique. In total, 48 anatomic lymph drainage areas were prospectively analysed by planar scintigraphy and tomographic SPECT/CT., Results: In 28/48 cases (58%) the SPECT/CT-imaging provided relevant additional information before treatment compared to planar technique; among them 27 regarding the exact anatomic localization of lymphatic transport disorders and 8 cases in which the dimension of the lymphatic transport disorders were estimated to a greater extent than in single use of planar lymphoscintigraphy. In 3 cases SPECT/CT provides differential diagnosis of lymph nodes versus lymphoceles. In none of the cases lymph vessels or lymph vessel grafts could be demonstrated by the morphological CT-component., Conclusions: Additionally to planar lymphoscintigraphy, SPECT/CT specifies anatomical correlation of lymphatic transport disorders and thus the assessment of the extension of the pathology. Furthermore, SPECT/CT dissipates overlapping of anatomic structures by tomographic acquisition and enables differential diagnosis of lymph nodes versus lymphoceles.

This paper describes the guideline for perfusion brain imaging with SPECT-technique published by the Association of the Scientific Medical Societies in Germany (AWMF).The purpose of this guideline is to provide practical assistance for indication, examination procedures, findings and their interpretation also reflecting the present state of the art. Information and instruction are given regarding indication, preparation of the patients and examination procedures of brain perfusion SPECT, including preparation and quality control of the tracer as well as the radiation dosimetry, technical performance of image acquisition with the gamma-camera and image processing. Also advices for interpretation of findings are given. In addition, possible pitfalls are described.

Unlabelled: The sentinel lymph node (SLN) is of considerable prognostic relevance, because extended lymph node dissection may not be performed in patients presenting with histologically negative SLN. The aim of this study was to prove the prognostic value of the SLN-concept in these patients in long term follow-up., Patients, Methods: The clinical follow-up of 202 women with histologically proven breast cancer and metastatically uninvolved (negative) SLN, as determined using Tc-99m-nanocolloid, was observed for a mean period of 43.4 months. Histological examination included standard methods (HE-Test) and special histochemical techniques (antibodies against cytokeratin). All patients underwent clinical examinations and mamography according a standardised schema; other procedures like ultrasound examination, routine blood tests, and chest X-ray scans were performed in patients considered doubtful after clinical examination or mamography., Results: Despite of negative SLN-findings in 14/202 patients (6.9%) metastases were found after a mean time period of 35.9 months. 4 patients showed local re-lapses, 3 patients presented with regional lymph node recurrences in the previously mapped (negative) SLN-basin, and 7 Patients developed distant metastases outside the primary lymphatic basin., Conclusion: In patients negative on SLN-biopsy the axillary lymph-node-recurrence-rate was low; in 3/202 patients (1.5%) a progression in the SLN-basin could be assessed, being real concept failures. Our results underline that there is no evidence to question this concept in patients presented with clinically metastatically uninvolved early stage of breast cancer.

For the primary diagnosis of brain tumours, morphological imaging by means of magnetic resonance imaging (MRI) is the current method of choice. The complementary use of functional imaging by positron emitting tomography (PET) and single photon emitting computerized tomography (SPECT) with labelled amino acids can provide significant information on some clinically relevant questions, which are beyond the capacity of MRI. These diagnostic issues affect in particular the improvement of biopsy targeting and tumour delineation for surgery and radiotherapy planning. In addition, amino acid labelled PET and SPECT tracers are helpful for the differentiation between tumour recurrence and non-specific post-therapeutic tissue changes, in predicting prognosis of low grade gliomas, and for metabolic monitoring of treatment response. The application of dynamic PET examination protocols for the assessment of amino acid kinetics has been shown to enable an improved non-invasive tumour grading. The purpose of this guideline is to provide practical assistance for indication, examination procedure and image analysis of brain PET/SPECT with labelled amino acids in order to allow for a high quality standard of the method. After a short introduction on pathobiochemistry and radiopharmacy of amino acid labelled tracers, concrete and detailed information is given on the several indications, patient preparation and examination protocols as well as on data reconstruction, visual and quantitative image analysis and interpretation. In addition, possible pitfalls are described, and the relevant original publications are listed for further information.

Aim: Fluorine-labelled choline derivatives were recently suggested as agents for visualizing vulnerable atherosclerotic plaques. We therefore aimed to evaluate the association between18F-fluoroethylcholine (FEC) uptake in the wall of large arteries, where calcification was also measured, with the presence of cardiovascular risk factors and occurrence of prior cardiovascular events., Patients, Methods: Detailed clinical information, including common cardiovascular risk factors, was obtained retrospectively in 60 prostate cancer patients examined with whole-body FEC PET-CT. In each patient, we calculated the mean blood pool-corrected SUV, as well as the mean target-to-background ratio (TBR), in addition to the sum of calcified plaques (CPsum) from six major vessels: ascending and descending aorta, aortic arch, abdominal aorta, and both iliac arteries., Results: As reported previously, the CPsum correlated significantly with cardiovascular risk factors, in contrast to mean SUV or TBR scores, which did not show any significance with the presence of cardiovascular risk factors. There was no correlation between CPsum, mean TBR or SUV, nor was there any significant association of CPsum, mean TBR or SUV with the prior occurrence of cardio- or cerebrovascular events., Conclusion: Contrary to a recent report, we found in our rather large cohort of elderly prostate cancer patients no significant association between FEC uptake in large vessels and atherosclerotic plaque burden, or the presence of cardiovascular risk factors. In line with prior reports on structural changes in vessels, increased calcified atherosclerotic plaque burden was strongly associated with the occurrence of common cardiovascular risk factors.

Aim: Assessment of the clinical benefit of i.v. contrast enhanced diagnostic CT (CE-CT) compared to low dose CT with 20 mAs (LD-CT) without contrast medium in combined [(18)F]-FDG PET/CT examinations in restaging of patients with lymphoma., Patients, Methods: 45 patients with non-Hodgkin lymphoma (n=35) and Hodgkin's disease (n=10) were included into this study. PET, LD-CT and CE-CT were analyzed separately as well as side-by-side. Lymphoma involvement was evaluated separately for seven regions. Indeterminate diagnoses were accepted whenever there was a discrepancy between PET and CT findings. Results for combined reading were calculated by rating indeterminate diagnoses according the suggestions of either CT or PET. Each patient had a clinical follow-up evaluation for >6 months., Results: Region-based evaluation suggested a sensitivity/specificity of 66/93% for LD-CT, 87%/91% for CE-CT, 95%/96% for PET, 94%/99% for PET/LD-CT and 96%/99% for PET/CE-CT. The data for PET/CT were obtained by rating indeterminate results according to the suggestions of PET, which turned out to be superior to CT. Lymphoma staging was changed in two patients using PET/CE-CT as compared to PET/LD-CT., Conclusion: Overall, there was no significant difference between PET/LD-CT and PET/CE-CT. However, PET/CE-CT yielded a more precise lesion delineation than PET/LD-CT. This was due to the improved image quality of CE-CT and might lead to a more accurate investigation of lymphoma.

Unlabelled: Squamous cell oesophageal carcinoma is the most common carcinoma of the oesophagus worldwide. The tumour stage as most important prognostic factor determines the clinical management., Aim: of this study was to evaluate the value of FDG-PET 1. in imaging the primary tumour and 2. in N- and M-staging of squamous cell oesophageal carcinoma., Patients, Methods: In 20 patients with histological proven squamous cell carcinoma of the upper and middle oesophagus, FDG-PET was performed in standard technique prior to therapy. FDG uptake in the primary was determined by calculation of the SUVmax. NM-staging due to PET findings was performed as designated by the AJCC/UICC group classification and was compared with pathological and clinically based staging. Sensitivities, specificities and accuracies were calculated., Results: In 19 of 20 patients, primary squamous cell oesopohageal carcinoma was detected by FDG-PET findings with a maximum SUV of 12.5 (mean) +/- 5.1 (median 11.5; range 4.8-23.8). One carcinoma in situ was missed. The sensitivity of FDG-PET in imaging the primary tumour was 96%. The sensitivities, specificities and accuracies were 20%, 100%, 58% for N-staging, and 60%, 86% and 93% for M-staging. PET findings caused changes of therapy in 5% (1 patient)., Conclusions: FDG-PET was excellent in imaging the primary of squamous cell oesophageal carcinoma in stage T1-T4 and was efficient in M-staging. The low sensitivity in N-staging is of inferior clinical importance. The efficacy of FDG-PET seems to be not significantly be influenced by the histological subtype of oesophageal carcinoma.

The prognosis of patients with acute myeloid leukaemia (AML) has improved considerably by introduction of aggressive consolidation chemotherapy and haematopoietic stem cell transplantation (SCT). Nevertheless, only 20-30% of patients with AML achieve long-term disease-free survival after SCT. The most common cause of treatment failure is relapse. Additionally, mortality rates are significantly increased by therapy-related causes such as toxicity of chemotherapy and complications of SCT. Including radioimmunotherapies in the treatment of AML and myelodyplastic syndrome (MDS) allows for the achievement of a pronounced antileukaemic effect for the reduction of relapse rates on the one hand. On the other hand, no increase of acute toxicity and later complications should be induced. These effects are important for the primary reduction of tumour cells as well as for the myeloablative conditioning before SCT. This paper provides a systematic and critical review of the currently used radionuclides and immunoconjugates for the treatment of AML and MDS and summarizes the literature on primary tumour cell reductive radioimmunotherapies on the one hand and conditioning radioimmunotherapies before SCT on the other hand.

Total (or near total) thyroidectomy (TE) followed by radioiodine ((131)I) ablation (RIA) of residual thyroid tissue is considered to be the ideal treatment for differentiated thyroid carcinoma. However, the actual guideline of the DGN (German Society of Nuclear Medicine) recommends for the so-called papillary micro-carcinoma of the thyroid (PMC) no further therapeutic strategy (no complete TE, no (131)I-ablation of the remaining lobe). PMC has been defined as papillary carcinoma measuring 1 cm (T1) in maximal diameter according to the World Health Organization classification system for thyroid tumours (1988). The new WHO-classification (starting in 2003) defines the T1-tumour measuring 2 cm in maximal diameter. The authors demand a new, modern guideline, following the new WHO classification. This includes, that despite the overall excellent prognosis for patients with PMC, the treatment of patients with T1-tumours of the new WHO-classification (including the "old" PMC) should be no different from the treatment of patients with conventional papillary thyroid carcinoma, i.e. complete surgery (TE and central lymph node dissection) followed by RIA of residual thyroid tissue. The authors argue that it is not appropriate to consider the tumour size as the single most important key factor for therapy and prognosis. Even small tumours may have poor prognostic factors, such as lymph node metastasis, multifocality or molecular characteristics (expression of oncogenes).

This article gives an overview on radiotracer imaging with positron emission tomography (PET) in measuring various aspects of neurotransmission. The review focuses on the dopaminergic system, the GABA/benzodiazepine system, and the opiate system. Besides dealing with the current clinical applications for brain PET studies with specific radiopharmaceuticals this article outlines an idea on potential future developments for the use of these methods in basic neuroscience.

Aim: Evaluation of the influence of histopathologic sub-types and grading of primaries of oesophageal cancer, relative to their size and location, on the uptake of (18)F-deoxyglucose (FDG) as measured by positron emission tomography (PET)., Methods: 50 consecutive patients were evaluated. There were four drop-outs due to previous surgical and/or chemotherapeutical treatments and thus in 46 patients (28 squamous cell carcinomas and 18 adenocarcinomas) a pretherapeutic PET evaluation of the primary including a standard uptake value (SUV) was obtained. In 42 cases data on tumour grading were available also., Results: Squamous cell carcinomas (SCC) were in 7/13/8 cases located in the proximal, medial and distal part of the oesophagus, respectively the grading was Gx in 3, G 2 in 12, G2-3 in 7, and G3 in 6 cases. The SUV(max) showed a mean of 6.5+/-2.8 (range 1.7-13.5). Adenocarcinomas (ACA) were located in the medial oesophagus in two cases and otherwise in its distal parts. Grading was Gx in one, G2 in 4, G2-3 in 3, G3 in 3, G3-4 in 3, and G4 in one case. The mean SUV(max) was 5.2+/-3.2 (range 1-13.6) and this was not significantly different from the SCC. Concerning the tumour grading there was a slight, statistically not relevant trend towards higher SUV(max) in more dedifferentiated cancer., Discussion: SCC and ACA of the oesophagus show no relevant differences in the FDG-uptake. While there was a significant variability of tumour uptake in the overall study group, a correlation of SUV and tumour grading was not found.

Aim: Multiple chemical sensitivity (MCS) is a controversially discussed symptom complex. Patients afflicted by MCS react to very low and generally non-toxic concentrations of environmental chemicals. It has been suggested that MCS leads to neurotoxic damage or neuroimmunological alteration in the brain detectable by position emission tomography (PET) and single photon emission computer tomography (SPECT). These methods are often applied to MCS patients for diagnosis, although they never proved appropriate., Method: We scanned 12 MCS patients with PET, hypothesizing that it would reveal abnormal findings., Results: Mild glucose hypometabolism was present in one patient. In comparison with normal controls, the patient group showed no significant functional brain changes., Conclusion: This first systematic PET study in MCS patients revealed no hint of neurotoxic or neuroimmunological brain changes of functional significance.

This article gives in his second part a critical review of the clinical applications of SPECT with perfusion markers and receptor ligands in dementing disorders and psychosis. In addition this review discusses clinical applications of SPECT investigations with perfusion markers in inflammatory diseases of the central nervous system and in brain trauma.

Single photon emission tomography is, because of its availability and the relatively low costs, the functional imaging modality currently most widely used for clinical applications in the brain. Beside the application of radiopharmaceuticals for the assessment of regional cerebral blood flow there is an increasing clinical use of more selective SPECT-radiopharmaceuticals, like amino acid analogs or receptor ligands. This article gives in his first part a critical review of the clinical applications of SPECT in neuro-oncology, epilepsy, basal ganglia disorders and cerebrovascular disease.

Functional imaging with SPECT and PET is increasingly used to prove evidence for the existence of a syndrome "Multiple Chemical Sensitivity" (MCS) and plays a major role in legal trials to justify compensation for the exposure to solvents. This paper critically reviews the literature on the use of SPECT and PET for the determination of MCS. The authors come to the conclusion that the current data are not sufficient to justify the claim of the existence of such a syndrome. The low specificity of the observed PET and especially SPECT-findings makes it very difficult to establish a cause-result relationship and therefore makes the use of these methods in legal trials on this issue doubtful.

The aim of this SPECT study was to determine whether there is a correlation between rCBF (99mTc-HMPAO) and D2 receptor binding (123I-IBZM) in disorders of the extrapyramidal system and in which situation the 99mTc-HMPAO scan could predict the outcome of the 123I-IBZM study. 13 patients with Parkinson's syndrome and 13 patients with hyperkinetic extrapyramidal disorders were studied. In all patients the two SPECT studies were performed within 2-7 days. ROIs were placed over the basal ganglia (BG), the frontal cortex (FC) and the cerebellum (CE). The ratios BG/FC and BG/CE were calculated. In both groups the scatter was lower when the frontal cortex was used as reference region. Among the patients with hyperkinetic extrapyramidal disorders the two patients with Huntington's chorea had lower rCBF and D2 receptor binding compared to other hyperkinetic extrapyramidal disorders. There was no correlation between D2 receptor binding and rCBF in the basal ganglia. The 99mTc-HMPAO studies did not provide clinically useful information, except in Huntington's chorea.

The aim of this study was to evaluate the correlation between improved Tl uptake in reinjection imaging with improvements in regional wall motion and global ejection fraction following PTCA or aorto-coronary bypass surgery. 19 patients with CHD were investigated and divided into two groups according to their thallium uptake in the reinjection studies. Group I showed additional uptake on reinjection imaging compared to the redistribution image, whereas group II showed no additional uptake. Both groups had a similar number and distribution of affected vessels and location of the leading stenosis. Stress, redistribution and reinjection images were obtained prior to revascularization and evaluated semiquantitatively from a bulls eye scheme. There was a postoperative increase in regional wall motion in group 1 from 5.3 to 8.8% whereas group II did not show a relevant change (6.3 vs 6.0%). The ejection fraction increased II from 55.0 to 66.7% in group I and dit not increase in group II (59.8 vs 58.7%). The overall predictive value of the reinjection image for improvement in wall motion (> 10%) was 91% and for the redistribution image 58%. Increased uptake in reinjection imaging predicts improved ventricular function following revascularization and indeed indicates viable myocardium with reversible functional impairment.

In cortical areas associated with an epileptic focus, there is, in the majority of cases, a correlation between decreased benzodiazepine (Bz) receptor binding, detectable with 123I-Iomazenil, and decreased blood flow. A patient with focal epilepsy due to a localized abnormality in cortical differentiation is presented who showed a marked focal decrease in Bz receptor binding and a normal 99mTc-HMPAO SPECT. Based on this case the relation between blood flow and Bz receptor binding in epileptic foci is discussed.

Dynamic hepatobiliary scintigraphy is the only method which enables non-invasive monitoring of regional function of liver parenchyma. It allows early detection of functional impairment due to radiation hepatitis. This method is simple and reproducible and is therefore suitable for follow-up of this disease.

In planning the treatment of splenomegaly in primary or secondary osteomyelofibrosis it is necessary to know whether there is any significant hematopoiesis outside the spleen. In contrast to the measurement of iron kinetics with 59Fe, which is not suitable for imaging, immunoscintigraphy with the monoclonal antibody Bw 250/183 allows specific imaging of the hematopoietic bone marrow. The diagnostic use of this method in addition to iron kinetics is illustrated and discussed in a patient with primary osteomyelofibrosis.

99mTc-HMPAO-SPECT and SPECT with the 123I-labelled benzodiazepine (Bz) receptor ligand Ro 16-0154 were performed in 10 patients suffering from partial epilepsy, without cerebral lesion in MRT or CT.2 h p.i. of Ro 16-0154 the distribution of activity correlated with the known distribution of Bz-receptors in the human brain. Perfusion and receptor-binding were found decreased in 7 patients of each study in the suspicious brain-area. 123I-labelled Ro 16-0154 is suitable for Bz-receptor mapping by SPECT. The decrease of Bz-receptor binding in epileptic foci, as described in PET-studies, was also detected by SPECT in 7 of 10 patients.