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ABSTRACT Objectives Methods Results Conclusions Deauville scores (DS) from PET/CT imaging are increasingly being used to direct response‐adjusted treatment strategies in lymphoma, including large B cell lymphomas (LBCL).We aimed to investigate the outcome of allogeneic haematopoietic stem cell transplantation (alloHSCT) in LBCL and the role played by pre‐transplant disease status, as determined by DS.We performed a retrospective, observational study of adults treated with a T‐cell depleted alloHSCT for de novo DLBCL or high‐grade transformation.Sixty‐four patients received an alloHSCT. Forty‐four had acute GvHD (38 had Grade 1–2). Overall non‐relapse mortality (NRM) at 1 year was 20.31%. Patients ≥ 55 years had a higher cumulative incidence of NRM (66.67%) than those who were < 55 years (25.08%) (p = 0.00660). A 4‐year relapse risk was 22.5%. Fourteen patients had disease relapse. The 4‐year overall survival (OS) was 49.80%; median OS was 3.7 years (1.4–7.1). Patients with a pre‐alloHSCT DS of 1–2 had a higher OS than a DS of 3–5 (61.97% vs. 34.23%; p = 0.0167); this was confirmed on multivariate analysis. Younger patients (< 55 years) had a higher OS than those ≥ 55 years (60.91% vs. 18.75%; p = 0.0246).The pre‐transplant Deauville score was predictive of the clinical outcome and patients with an absence of metabolically active disease pre‐transplant had superior outcomes. [ABSTRACT FROM AUTHOR]

This article explores the challenges faced by nuclear medicine departments in strategic planning for the future of imaging. It emphasizes the importance of identifying potential risks and uncertainties, such as economic downturns and technological changes, and proposes a different approach to decision-making. The article suggests using tools like risk assessment and scenario planning, as well as maintaining flexibility, adaptability, clear vision, effective communication, and ongoing monitoring and evaluation. It also discusses the significance of continuous process, defining extreme but plausible scenarios, and identifying strategic options and hedges. The article provides a practical model for strategy development and performance monitoring. [Extracted from the article]

Keywords: Spleen; Biopsy; Pyrexia of unknown origin; FDG PET-CT; Diagnostic yield EN Spleen Biopsy Pyrexia of unknown origin FDG PET-CT Diagnostic yield e15 e18 4 04/19/21 20210415 NES 210415 A proportion of patients with pyrexia of unknown origin (PUO), or inflammation of unknown origin (IUO), are without a diagnosis following extensive clinical and laboratory evaluation.1-3 The outcome in this group of patients is variable; those with significant systemic inflammation may have prolonged hospital stays and a high mortality rate. Despite these limitations, the present study demonstrates the utility of image-guided splenic core biopsy in people with an inflammatory or infectious presentation and splenic imaging abnormalities who do not have a diagnosis despite extensive investigation. 2018; 48: 100 - 7. 8 Patel N, Dawe G, Tung K. Ultrasound-guided percutaneous splenic biopsy using an 18-G core biopsy needle: our experience with 52 cases. Of the other three patients, one was diagnosed by bone marrow aspirate and trephine biopsy (BMAT) one had no diagnosis on BMAT as well and one was diagnosed by liver biopsy I TableComparing histopathology of splenic biopsy with the final diagnosis. [Extracted from the article]

Summary: This phase II trial was designed to determine the safety and efficacy of a modified paediatric risk‐stratified protocol in young adults (18–30 years) with classical Hodgkin Lymphoma. The primary end‐point was neurotoxicity rate. The incidence of grade 3 neurotoxicity was 11% (80% CI, 5–19%); a true rate of neuropathy of >15% cannot be excluded. Neuropathy and associated deterioration in quality of life was largely reversible. The overall response rate was 100% with 40% complete remission (CR) rate. Twelve months disease‐free survival (DFS) was 91%. We demonstrate that a risk‐stratified paediatric combined modality treatment approach can be delivered to young adults without significant irreversible neuropathy. [ABSTRACT FROM AUTHOR]

Introduction. Currently, there is a lack of data on the role of combined positron emission tomography-computed tomography (PET-CT) in the staging of early invasive primary breast cancer. We therefore evaluated the role of 18F-fluorodeoxyglucose (18F-FDG)-PET-CT in this patient population. Methods. We prospectively recruited 70 consecutive patients (69 women, one man; mean age, 61.9 8.1 years) with early primary breast cancer for staging with 18FFDG- PET-CT. All PET-CT images were interpreted by two readers (independently of each other). A third reader adjudicated any discrepancies. All readers had≥5 years of specific experience. Ethics board approval and informed consent were obtained. Results. The mean clinical follow-up was 22.7±12.6 months. The primary tumor was identified with PET-CT in 64 of 70 patients. Of the unidentified lesions, surgical pathology revealed two intraductal carcinomas, one invasive tubular carcinoma, and three invasive lobular carcinomas. Undiagnosed multifocal breast disease was shown in seven of 70 patients. PET-CT identified avid axillary lymph nodes in 19 of 70 patients, compared with 24 of 70 confirmed during surgery. There were four patients who were axillary node positive on PET but had no axillary disease at surgery. Five patients were reported with avid metastases. Two of those patients were treated for metastatic disease (nodal, lung, and liver in one and bone metastases in the other) following further imaging and clinical assessment. In the other three patients, lesions (lung, n=1; pleural, n=1; paratrachael node, n=1) were subsequently diagnosed as benign lesions. Conclusion. Integrated 18F-FDG-PET-CT may have a role in staging patients presenting with early breast cancer. [ABSTRACT FROM AUTHOR]

We prospectively investigated the potential of positron emission tomography (PET) using the somatostatin receptor (SSTR) analogue 68Ga-DOTATATE and 2-deoxy-2[18F] fluoro-D-glucose (18F-FDG) in diffuse parenchymal lung disease (DPLD). Twenty-six patients (mean age 68.9 ± 11.0 years) with DPLD were recruited for 68 Ga-DOTATATE and 18F-FDG combined PET/high-resolution computed tomography (HRCT) studies. Ten patients had idiopathic pulmonary fibrosis (IPF), 12 patients had nonspecific interstitial pneumonia (NSIP), and 4 patients had other forms of DPLD. Using PET, the pulmonary tracer uptake (maximum standardized uptake value [SUVmax]) was calculated. The distribution of PET tracer was compared to the distribution of lung parenchymal changes on HRCT. All patients demonstrated increased pulmonary PET signal with 68Ga-DOTATATE and 18F-FDG. The distribution of parenchymal uptake was similar, with both tracers corresponding to the distribution of HRCT changes. The mean SUVmax was 2.2 ± 0.7 for 68 Ga-DOTATATE and 2.8 ± 1.0 (t-test, p = .018) for 18F-FDG. Themean 68Ga-DOTATATE SUVmax in IPF patients was 2.5 ± 0.9, whereas it was 2.0 ± 0.7 (p = .235) in NSIP patients. The correlation between 68 Ga-DOTATATE SUVmax and gas transfer (transfer factor of the lung for carbon monoxide [TLCO]) was r = -.34 (p = .127) and r = -.49 (p = .028) between 18 F-FDG SUVmax and TLCO. We provide noninvasive in vivo evidence in humans showing that SSTRs may be detected in the lungs of patients with DPLD in a similar distribution to sites of increased uptake of 18 F-FDG on PET. [ABSTRACT FROM AUTHOR]

Purpose: Noninvasive markers of disease activity in patients with idiopathic pulmonary fibrosis (IPF) are lacking. We performed this study to investigate the reproducibility of pulmonary F-FDG PET/CT in patients with IPF. Methods: The study group comprised 13 patients (11 men, 2 women; mean age 71.1 ± 9.9 years) with IPF recruited for two thoracic F-FDG PET/CT studies performed within 2 weeks of each other. All patients were diagnosed with IPF in consensus at multidisciplinary meetings as a result of typical clinical, high-resolution CT and pulmonary function test features. Three methods for evaluating pulmonary F-FDG uptake were used. The maximal F-FDG pulmonary uptake (SUVmax) in the lungs was determined using manual region-of-interest placement. An F-FDG uptake intensity histogram was automatically constructed from segmented lungs to evaluate the distribution of SUVs. Finally, mean SUV was determined for volumes-of-interest in pulmonary regions with interstitial lung changes identified on CT scans. Processing included correction for tissue fraction effects. Bland-Altman analysis was performed and interclass correlation coefficients (ICC) were determined to assess the reproducibility between the first and second PET scans, as well as the level of intraobserver and interobserver agreement. Results: The mean time between the two scans was 6.3 ± 4.3 days. The interscan ICCs for pulmonary SUVmax analysis and mean SUV corrected for tissue fraction effects were 0.90 and 0.91, respectively. Intensity histograms were different in only 1 of the 13 paired studies. Intraobserver agreement was also excellent (0.80 and 0.85, respectively). Some bias was observed between observers, suggesting that serial studies would benefit from analysis by the same observer. Conclusion: This study demonstrated that there is excellent short-term reproducibility in pulmonary F-FDG uptake in patients with IPF. [ABSTRACT FROM AUTHOR]

Purpose: In this study we investigate the relationship between F-fluorodeoxyglucose (FDG) metabolism and future aneurysm expansion measured by serial duplex ultrasound. Current screening programmes are increasing the identification of patients with abdominal aortic aneurysm (AAA). The management of these patients remains challenging and methods of risk stratification are sought. Methods: Thirty-four consecutive patients [31 men, 3 women, median age 75 years, interquartile range (IQR) 71-78] with aortic aneurysms under routine surveillance with serial ultrasound were prospectively recruited for F-FDG positron emission tomography (PET)/CT. A whole vessel type analysis was performed measuring the highest aortic wall F-FDG uptake (standardized uptake value or SUV), and target to background ratio (TBR) for each axial image and median SUV and TBR value were calculated. Institutional Review Board permission and informed patient consent were obtained. Results: Nine patients failed to undergo 12-month follow-up study (deceased n = 2, withdrew n = 1, failed to attend ultrasound scan n = 5, emergency aneurysm repair n = 1) leaving 25 patients for analysis. The median whole vessel SUV was 1.70 (IQR 1.45-2.08). The median whole vessel TBR was 1.15 (IQR 1.00-1.40). The median aneurysm expansion at 12 months was 2.0 mm (IQR 0.5-5.0). The correlation ( r) between F-FDG SUV and ultrasound expansion at 1 year was −0.501 ( p = 0.011). Conclusion: The preliminary findings from this observational longitudinal pilot study suggest that there is an inverse trend between F-FDG uptake on PET and future AAA expansion. Aortic aneurysms with lower metabolic activity may therefore be more likely to expand. [ABSTRACT FROM AUTHOR]

This was a retrospective study to detect and map the extent of disease in recurrent medullary thyroid carcinoma (MTC) using the novel PET somatostatin analogue 68Ga-DOTATATE and conventional 18F-FDG positron emission tomography/computed tomography (PET/CT). Eighteen patients (13 men, 5 women, median age: 54 years) who had previously been operated on for MTC and presented with biochemical (raised calcitonin levels) and/or imaging evidence of recurrence underwent both 68Ga-DOTATATE and 18F-FDG PET/CT within a maximum interval of 4 weeks (median interval of 1 week). 68Ga-DOTATATE- and 18F-FDG-avid lesions were recorded per patient as well as per region in six distinct regions: (1) thyroid bed—local recurrence, (2) cervical lymph nodes, (3) mediastinum, (4) lungs, (5) liver and (6) bones. The 68Ga-DOTATATE and 18F-FDG PET/CT findings were classified as positive or negative on visual interpretation. These findings were further characterised as concordant or discordant, depending on whether there was agreement or discrepancy in imaging with the two radiotracers. A separate analysis of the unenhanced CT component of the examination was performed. Verification of the lesions was achieved by histopathological analysis, further imaging studies and clinical follow-up. 68Ga-DOTATATE PET/CT imaging achieved disease detection in 13 of 18 and 18F-FDG PET/CT in 14 of 18 patients. These results corresponded to per-patient sensitivities of 72.2% [95% confidence interval (CI): 46.4–89.3%] for 68Ga-DOTATATE versus 77.8% (95% CI: 51.9–92.6%) for 18F-FDG (non-significant difference). 18F-FDG revealed a total of 28 metastatic MTC regions and 68Ga-DOTATATE 23 regions. In ten patients a discordant tracer pattern of per-region and/or per-lesion distribution of recurrent disease was observed, while in four patients a concordant pattern was noted (no lesions were detected by either modality in the remaining four patients). Neither 18F-FDG nor 68Ga-DOTATATE PET/CT can fully map the extent of disease in patients with recurrent MTC, although 18F-FDG PET/CT may identify more lesions. However, 68Ga-DOTATATE PET/CT can be a useful complementary imaging tool and may identify patients suitable for consideration of targeted radionuclide somatostatin analogue therapy. [ABSTRACT FROM AUTHOR]

Background: The aim was to assess the relevant distribution of the novel PET tracer (68)Ga-DOTATATE in neuroendocrine tumors (NETs) with combined positron emission tomography / computed tomography (PET/CT) and compare its performance with that of (18)F-FDG PET/CT. Methods: The imaging findings with (68)Ga-DOTATATE and (18)F-FDG on 38 consecutive patients with a diagnosis of primary or recurrent NET were compared and correlated with tumor grade on histology based on ki67 and mitotic index. Results: The sensitivity of (68)Ga-DOTATATE PET/CT was 82% (31 of 38) and that of (18)F-FDG PET/CT was 66% (25 of 38). The sensitivity of combined (68)Ga-DOTATATE and (18)F-FDG PET/CT was 92% (35 of 38). There was greater uptake of (68)Ga-DOTATATE than (18)F-FDG in low-grade NET (median SUV 29 vs 2.9, P < .001). In high-grade NET there was higher uptake of (18)F-FDG over (68)Ga-DOTATATE (median SUV 11.7 vs 4.4, P = .03). There was a significant correlation with predominant tumor uptake of (68)Ga-DOTATATE or (18)F-FDG and tumor grade on histology (P < .0001). Conclusions: (68)Ga-DOTATATE PET/CT is a useful novel imaging modality for NETs and is superior to (18)F-FDG for imaging well-differentiated NET. Functional imaging with both (68)Ga-DOTATATE and (18)F-FDG has potential for a more comprehensive tumor assessment in intermediate- and high-grade tumors. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the performance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) versus dedicated contrast-enhanced CT (CECT) in the detection of metastatic liver disease. All patients that presented to our Institution with suspected metastatic liver disease who underwent 18F-FDG PET/CT and CECT within 6 weeks of each other, were retrospectively analyzed, covering a 5-year period. One hundred and thirty-one patients (67 men, 64 women; mean age 62) were identified. Seventy-five had colorectal carcinoma and 56 had other malignancies. The performance of CECT and that of 18F-FDG-PET/CT in detecting liver metastases were compared. The ability of each to detect local recurrence, extrahepatic metastases and to alter patient management was recorded. The final diagnosis was based on histology, clinical and radiological follow-up (mean 23 months). In detecting hepatic metastases, 18F-FDG-PET/CT yielded 96% sensitivity and 75% specificity, whilst CECT showed 88% sensitivity and 25% specificity. 18F-FDG-PET/CT and CECT were concordant in 102 out of 131 patients (78%). In the colorectal group 18F-FDG-PET/CT showed 94% sensitivity and 75% specificity, whilst CECT had 91% sensitivity and 25% specificity. In the noncolorectal group 18F-FDG-PET/CT showed 98% sensitivity and 75% specificity whilst CECT had 85% sensitivity and 25% specificity. Overall, 18F-FDG-PET/CT altered patient management over CECT in 25% of patients. CECT did not alter patient management over 18F-FDG-PET/CT alone in any patients. 18F-FDG-PET/CT performed better in detecting metastatic liver disease than CECT in both colorectal and noncolorectal malignancies, and frequently altered patient management. The future role of CECT in these patients may need to be re-evaluated to avoid potentially unnecessary duplication of investigation where 18F-PET/CT is readily available. [ABSTRACT FROM AUTHOR]