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Among currently used cancer imaging methods, nuclear medicine modalities provide metabolic information, whereas modalities in radiology provide anatomical information. However, different modalities, having different acquisition times in separate machines, decrease the specificity and accuracy of images. To solve this problem, hybrid imaging modalities were developed as a new era, especially in the cancer imaging field. With widespread usage of hybrid imaging modalities, specific contrast agents are essentially needed to use in both modalities, such as single-photon emission computed tomography/computed tomography (SPECT/CT). Liposomes are one of the most desirable drug delivery systems, depending on their suitable properties. The aim of this study was to develop a liposomal contrast agent for the diagnosis and molecular imaging of tumor by SPECT/CT. Liposomes were prepared nanosized, coated with polyethylene glycol to obtain long blood circulation, and modified with monoclonal antibody 2C5 for specific tumor targeting. Although DTPA-PE and DTPA-PLL-NGPE (polychelating amphilic polymers; PAPs) were loaded onto liposomes for stable radiolabeling for SPECT imaging, iopromide was encapsulated into liposomes for CT imaging. Liposomes [(DPPC:PEG2000-PE:Chol:DTPA-PE), (PL 90G:PEG2000-PE:Chol:DTPA-PE), (DPPC:PEG2000-PE:Chol:PAPs), (PL 90G:PEG2000-PE:Chol:PAPs), (60:0.9:39:0.1% mol ratio)] were characterized in terms of entrapment efficiency, particle size, physical stability, and release kinetics. Additionally, in vitro cell-binding studies were carried out on two tumor cell lines (MCF-7 and EL 4) by counting radioactivity. Tumor-specific antibody-modified liposomes were found to be effective multimodal contrast agents by designating almost 3-8 fold more uptake than nonmodified ones in different tumor cell lines. These results could be considered as an important step in the development of tumor-targeted SPECT/CT contrast agents for cancer imaging. [ABSTRACT FROM AUTHOR]

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Copyright of Nuclear Medicine Seminars is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Amaç: FDG PET/BT, non-hodgkin lenfoma (NHL) tanılı hastalarda tedavi yanıtının değerlendirmesinde kullanılan önemli bir araçtır. Tedaviye cevabı değerlendirmede kullanılan Deauville skorlama sisteminin (DSS) kişi bağımlı olması ve geri plan aktivitesinden etkilenmesi gibi kısıtlılıkları nedeniyle kantitatif değerlendirme metodları geliştirilmiştir. Bu metotlardan biri de kantitatif PET (qPET) değeridir. Bu çalışmanın amacı DSS'nin deneyimli ve deneyimsiz okuyucular arasındaki tutarlılığını değerlendirmek, DSS ile qPET değerlerinin ilişkisini saptamaktır. Yöntem: Ocak 2014-2018 tarihleri arasında FDG PET/BT çekilmiş 38 NHL tanılı pediatrik hastanın 25 interim ve 30 tedavi sonu görüntüleri, iki deneyimli uzman ve bir araştırma görevlisi tarafından DSS ile tedavi cevabı açısından ayrı ayrı değerlendirildi. Tüm hastalarda karaciğere ve hastalık bölgesine ilgi alanı çizilerek sırasıyla Suvmean ve SUVpeak ölçümleri yapıldı. Lezyon bölgesi SUVpeak/karaciğer Suvmean oranı kullanılarak qPET değerleri hesaplandı. DSS ayırımında eşik qPET değerini saptamak için ROC yöntemi kullanıldı. DSS ile qPET arasındaki korelasyon ve tedaviye yanıt ve DSS açısından değerlendiriciler arası uyum değerlendirildi. Bulgular: Çalışmaya 3-18 yaşları arasındaki (medyan yaş: 11) 38 hasta dahil edildi (E/K: 25/13). Hastalar 8 prekürsör B hücreli lenfoblastik lenfoma, 8 burkitt lenfoma ve 7 anaplastik büyük T hücreli lenfoma, 15 diğer NHL türleri tanısı almıştı. Okuyucular arasında DSS'de mükemmel uyum saptandı [sınıfiçi katsayısı (KK): interim: 0,966 ve tedavi sonunda: 0,905]. Benzer şekilde farklı deneyimli okuyucular arasında interim ve tedavi sonu değerlendirmede mükemmel uyum mevcuttu (kappa KK: 0,832 ve 0,82). Tecrübeli okuyucuların DSS ile qPET değeri arasındaki korelasyonu interim (spearman KK: 0,79) ve tedavi sonu değerlendirme (spearman KK: 0,658) için kuvvetli düzeydeydi. DS1-3 (hastalık yok) ve DS4-5'i (hastalık var) ayıran qPET değeri, interim ve tedavi sonu PET'lerde 1,5 olarak bulundu. FDG PET/BT'de deneyimli okuyucular tarafından DS4 olarak değerlendirilen 1 hasta, deneyimsiz okuyucu tarafından DS3 olarak değerlendirildi. Bu hastada qPET değeri deneyimli okuyucuları destekleyecek şekilde 2,7 olarak saptandı. Sonuç: NHL hastalarda tedaviye cevabı değerlendirmede DSS farklı deneyimli okuyucularda yüksek uyum sağlamaktadır. qPET ölçümleri DSS'de arada kalınan hastalarda yardımcı olabilir. Çalışmamızın bulgularının daha çok hasta sayısı ile desteklenmesi gerekmektedir. [ABSTRACT FROM AUTHOR]

The European Association of Nuclear Medicine (EANM) has responded to the European Thyroid Association's (ETA) clinical practice guidelines for thyroid nodule management. The EANM argues that the guidelines did not adequately address important aspects of nuclear medicine approaches and that nuclear medicine physicians were not included in the authors' panel. They believe there is a substantial gap in the guidelines, given that many European countries rely on nuclear medicine physicians for secondary care after nodule detection. The EANM also highlights concerns about the use of TIRADS systems, the lack of focus on nuclear medicine diagnostics, and the downgrading of radioiodine therapy. They suggest that the guidelines are unbalanced and biased, lacking adequate evidence in some sections. [Extracted from the article]

An editorial is presented which argues American Thyroid Association guidelines was released in 2015, there has been an intense debate on the management of thyroid cancer with particular emphasis on the use of radioactive iodine for diagnostic and therapeutic purposes. It discusses that Radioiodine therapy is known to be beneficial and it is recommended in both publications for patients with known persistent disease after surgery or with a high risk of recurrence.

Competing Interests: Declarations. Competing interests: The authors have no relevant financial or non-financial interests to disclose.

Background: Trastuzumab emtansine (T-DM1) is a novel therapy for human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer, combining the targeted action of trastuzumab with the cytotoxic effects of emtansine. Although T-DM1 has demonstrated greater efficacy and safety compared to traditional therapies, concerns about hepatotoxicity and spleen-related complications have arisen., Methods: We conducted a retrospective study of 64 HER2-positive metastatic breast cancer patients treated with T-DM1 at our institution. Patients underwent computed tomography or magnetic resonance imaging at baseline and during treatment cycles. Spleen volume, portal vein diameter, and laboratory values were compared between baseline and 12 months after T-DM1 treatment., Results: Median spleen volume significantly increased from 201 cm3 (IQR, 157-275) at baseline to 291 cm3 (IQR, 215-420) after 12 months of T-DM1 treatment (P < 0.001). Spleen enlargement was observed in 87.5% of patients, while no significant alteration was detected in portal vein diameter. The change in spleen volume was positively correlated with changes in serum globulin levels, liver enzymes, and bilirubin levels, but did not impact survival outcomes., Conclusions: T-DM1 therapy in HER2-positive metastatic breast cancer leads to significant spleen enlargement and systemic biochemical changes. Future studies should focus on elucidating the long-term implications of these findings and optimizing monitoring strategies for spleen-related complications., (© The Author(s) 2024. Published by Oxford University Press.)

Molecular imaging is pivotal in evaluating and managing patients with different thyroid cancer histotypes. The existing, pathology-based, risk stratification systems can be usefully refined, by incorporating tumor-specific molecular and molecular imaging biomarkers with theranostic value, allowing patient-specific treatment decisions. Molecular imaging with different radioactive iodine isotopes (ie, I 131 , I 123 , I 124 ) is a central component of differentiated carcinoma (DTC)'s risk stratification while [ 18 F]F-fluorodeoxyglucose ([ 18 F]FDG) PET/CT is interrogated about disease aggressiveness and presence of distant metastases. Moreover, it is particularly useful to assess and risk-stratify patients with radioiodine-refractory DTC, poorly differentiated, and anaplastic thyroid cancers. [ 18 F]F-dihydroxyphenylalanine (6-[ 18 F]FDOPA) PET/CT is the most specific and accurate molecular imaging procedure for patients with medullary thyroid cancer (MTC), a neuroendocrine tumor derived from thyroid C-cells. In addition, [ 18 F]FDG PET/CT can be used in patients with more aggressive clinical or biochemical (ie, serum markers levels and kinetics) MTC phenotypes. In addition to conventional radioiodine therapy for DTC, new redifferentiation strategies are now available to restore uptake in radioiodine-refractory DTC. Moreover, peptide receptor theranostics showed promising results in patients with advanced and metastatic radioiodine-refractory DTC and MTC, respectively. The current appropriate role and future perspectives of molecular imaging and theranostics in thyroid cancer are discussed in our present review., Competing Interests: Declaration of competing interest Luca Giovanella reports a relationship with Roche Diagnostics International, Rotkreuz, Switzerland that includes: board membership. Luca Giovanella reports a relationship with Synlab Switzerland SA that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Abstract: A 56-year-old man with thoracal mass suspected of solitary plasmacytoma was referred for 18 F-FDG PET-CT scan. His PET-CT revealed FDG-avid rib mass and cervical lesion at level 2. He also underwent 18 F-fluorocholine (FCH) PET-CT to evaluate possible metastatic spread of the disease. FCH PET-CT showed increased uptake at the rib mass, while the cervical lesion was not FCH-avid. Biopsies confirmed rib lesion was a solitary plasmacytoma; however, the cervical lesion was an amyloid deposited lymph node. This case showed FCH PET-CT is a valuable companion of FDG scan for the evaluation of plasma cell dyscrasias with a better specificity., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Lymphoscintigraphy is a safe, minimally invasive, and well-established imaging modality for evaluating lymphatic drainage in patients with suspected lymphedema. We report a case of an 8-year-old girl with lymphangioma circumscriptum of the labium majora. She was referred to lymphoscintigraphy for swelling of the lower extremities. Scintigraphy showed widespread dermal backflow at bilateral lower limbs, aberrant uptake in the abdominal lymph nodes, and unexpected uptake in the right axillary lymph nodes., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Metastatic castration-resistant prostate cancer (mCRPC) is characterized by heterogeneity among patients as well as therapy responses due to diverse genetic, epigenetic differences, and resistance mechanisms. At this stage of the disease, therapy modalities should be individualized in light of the patients' clinical state, symptoms, and genetic characteristics. In this prospective study, we aimed to evaluate the outcome of patients with mCRPC treated with 177 Lutetium labeled PSMA-617 therapy (PSMA-RLT), as well as baseline and therapy-related parameters associated with survival., Methods: This prospective study included 52 patients who received two to six cycles of PSMA-RLT. Primary endpoints were overall survival (OS) and prostate-specific antigen (PSA)-progression-free survival (PFS). 18 F-Fluorodeoxyglucose (FDG) and 68 Ga-PSMA (PSMA) Positron Emission Tomography/Computer Tomography (PET/CT) scans were performed for a comprehensive assessment of tumor burden and heterogeneity. Biochemical, imaging, clinical, and therapy-related parameters were analyzed with the Kaplan-Meier, log-rank, and Cox regression analyses to predict OS and PFS., Results: Median OS and PSA-PFS were 17.7 (95% confidence interval [CI]: 15.2-20.2) and 6.6 months (95% CI: 4.5-8.8), respectively. Primary resistance to PSMA-RLT (hazard ratio [HR]: 12.57, 95% CI: 2.4-65.2, p: 0.003), <30% PSA response rate after first cycle of PSMA-RLT (HR: 1.016, 95% CI: 1.006-1.03, p: 0.003), FDG > PSMA disease (HR: 4.9, 95% CI: 1.19-20.62, p: 0.03), PSA doubling time (PSA DT) of ≤2.4 months (HR: 15.7, 95% CI: 3.7-66.4, p: <0.0001), and low hemoglobin levels (HR: 0.59, 95% CI: 0.41-0.83, p: 0.003) were correlated with poor OS in the multivariate analysis. Bone scintigraphy >  PSMA disease (HR: 5.6; 95% CI: 1.8-17, p: 0.002) and high C-reactive protein (HR: 1.4, 95% CI: 1.1-1.7, p: 0.001) were significant predictive biomarkers for PFS in the multivariate analysis., Conclusion: PSA response rate and pattern to PSMA-RLT are the most important predictors of survival in patients receiving PSMA-RLT. Being a strong predictive biomarker, combined FDG and PSMA PET can be helpful for the decision of PSMA-RLT eligibility., (© 2023 The Authors. The Prostate published by Wiley Periodicals LLC.)

Introduction: Postoperative complications following thoracic procedures are a major cause of morbidity and mortality. Alveolar air leaks and/or bronchopleural fistulas are associated with increased risk of infection, prolonged chest tube, and hospital stay duration and therefore generate economical concern for health care providers. A variety of surgical sealants or adhesives have been introduced to overcome this complication. Since intraoperative BioGlue® application can also cause an inflammatory reaction and mimic tumor recurrence on FDG PET-CT, in the present study we aimed to investigate its potential role in false-positive PET-CT results in patients operated for NSCLC., Materials and Methods: Data of six patients who underwent resection for primary NSCLC at our institution (Department of Thoracic Surgery, Hacettepe University Medical Faculty) between January 2015 and December 2018 and had false positivity, due to BioGlue® application, at the bronchial stump in follow-up FDG PET-CT were retrospectively analyzed from a prospectively collected database., Result: One of the 6 patients was female and 5 were male. The mean age was 68 years (range, 56-79 years). The average time interval between operation and postoperative FDG-PET imaging was 4.3 months (range, 4-6 months). Follow-up FDG-PET imaging SUVmax values ranged between 3.0 and 9.0 (median: 5.33). All patients have been evaluated by FDG-PET scan following the detection of soft tissue densities at the surgical site suspicious for recurrence at their follow-up chest CT scans. Four patients underwent a bronchoscopic examination, bronchial stumps were examined and multiple biopsies were taken from suspicious nodules or tissues and sent for pathologic examination. Histopathological results revealed inflammation which is compatible with foreign body granuloma, without any suspicion for malignancy, in all cases. Two patients were solely followed-up and subsequent FDG-PET imaging after 3 months revealed complete resolution of FDG uptake., Conclusions: To avoid unnecessary biopsies or surgical procedures, the possibility of false-positive results due to surgical adhesive product use should be taken into account while interpreting follow-up FDG-PET imaging results and the operative reports should be written in detail, describing which surgical materials used and their exact application sites.

Background: Non-Hodgkin's lymphomas arising from the tissues other than primary lymphatic organs are named primary extranodal lymphoma. Most of the studies evaluated metabolic tumor parameters in different organs and histopathologic variants of this disease generally for treatment response. We aimed to evaluate the prognostic value of metabolic tumor parameters derived from initial FDG-PET/CT in patients with a medley of primary extranodal lymphoma in this study., Patients and Methods: There were 67 patients with primary extranodal lymphoma for whom FDG-PET/CT was requested for primary staging. Quantitative PET/CT parameters: maximum standardized uptake value (SUVmax), average standardized uptake value (SUVmean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were used to estimate disease-free survival and overall survival., Results: SUVmean, MTV and TLG were found statistically significant after multivariate analysis. SUVmean remained significant after ROC curve analysis. Sensitivity and specificity were calculated as 88% and 64%, respectively, when the cut-off value of SUVmean was chosen as 5.15. After the investigation of primary presentation sites and histo-pathological variants according to recurrence, there is no difference amongst the variants. Primary site of extranodal lymphomas however, is statistically important (p = 0.014). Testis and central nervous system lymphomas have higher recurrence rate (62.5%, 73%, respectively)., Conclusions: High SUVmean, MTV and TLG values obtained from primary staging FDG-PET/CT are potential risk factors for both disease-free survival and overall survival in primary extranodal lymphoma. SUVmean is the most significant one amongst them for estimating recurrence/metastasis.

Purpose: The recent addition of single photon emission computed tomography (SPECT)-CT into bone scintigraphy (BS), increased the accuracy of the test. The objective of this study was to define the main problematic scintigraphic patterns that were solved with the contribution of SPECT-CT and serve as a guide to the medical oncologist who will refer their patients to BS., Methods: Two hundred and ten patients (median age 62 years, range 12-80, F/M:122/ 88) with diagnosis of cancer (breast 109;52%, prostate 63;30%, lung 15;7% and others 20;11%) were referred for BS. Subsequent SPECT-CT images (231 images from 210 patients) were obtained from the related body regions where suspicious skeletal radioactivity uptake had been observed. BS and SPECT-CT images were classified into groups according to the BS, clinical history and other imaging results in consideration with the role of SPECT-CT for more accurate diagnosis., Results: SPECT-CT studies resulted in the emergence of 6 main patterns that helped improve the interpretation of the whole-body BS for more accurate diagnosis. Pattern 1: Extraskeletal uptake and/or incidental findings (14/231;6%); Pattern 2: Identification of skeletal trauma and degenerative osteoarthritic diseases (147/231;64%); Pattern 3: Benign bone tumors and reactions (12/231;5%); Pattern 4: Sclerotic-mixed type metastases (32;14%); Pattern 5: Lytic/ bone marrow metastases (12/231;5%); Pattern 6: Metabolically inactive metastases (14/231;6%)., Conclusion: SPECT-CT is a revolutionary technique that improved the interpretation of BS. Recognition of patterns of disease that may be resolved with SPECT-CT will help significantly to better understanding the patient's bone disease.