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Aim: During our daily clinical practice using 11C-Choline PET/CT for restaging patients affected by relapsing prostate cancer (rPCa) we noticed an unusual but significant occurrence of hypodense hepatic lesions with a different tracer uptake. Thus, we decided to evaluate the possible correlation between rPCa and these lesions as possible hepatic metastases. Materials and methods: We retrospectively enrolled 542 patients diagnosed with rPCa in biochemical relapse after a radical treatment (surgery and/or radiotherapy). Among these, patients with a second tumor or other benign hepatic diseases were excluded. All patients underwent 11C-Choline PET/CT during the standard restaging workup of their disease. We analyzed CT images to evaluate the presence of hypodense lesions and PET images to identify the relative tracer uptake. In accordance to the subsequent oncological history, five clinical scenarios were recognized [Table 1]: normal low dose CT (ldCT) and normal tracer distribution (Group A); evidence of previously unknown hepatic round hypodense areas at ldCT with normal rim uptake (Group B); evidence of previously known hepatic round hypodense areas at ldCT stable over time and with normal rim uptake (Group C); evidence of previously known hepatic round hypodense areas at ldCT, in a previous PET/CT scan, with or without rim uptake and significantly changing over time in terms of size and/or uptake (Group D); evidence of hepatic round hypodense areas at ldCT with or without rim uptake confirmed as prostate liver metastases by histopathology, triple phase ceCT, ce-ultra sound (CEUS) and clinical/biochemical evaluation (Group E). We evaluated the correlation with PSA level at time of scan, rim SUVmax and association with local relapse or non-hepatic metastases (lymph nodes, bone, other parenchyma). Results: Five hundred and forty-two consecutive patients were retrospectively enrolled. In 140 of the 542 patients more than one 11C-choline PET/CT had been performed. A total of 742 11C-Choline PET/CT scans were analyzed. Of the 542 patients enrolled, 456 (84.1%) had a normal appearance of the liver both at ldCT and PET (Group A). 19/542 (3,5%) belonged to Group B, 13/542 (2.4%) to Group C, 37/542 (6.8%) to Group D and 18/542 (3.3%) to Group E. Mean SUVmax of the rim was: 4.5 for Group B; 4.2 for Group C; 4.8 for Group D; 5.9 for Group E. Mean PSA level was 5.27 for Group A, 7.9 for Group B, 10.04 for Group C, 10.01 for Group D, 9.36 for Group E. Presence of positive findings at 11C-Choline PET/CT in any further anatomical area (local relapse, lymph node, bone, other extra hepatic sites) correlated with an higher PSA (p = 0.0285). In both the univariate and multivariate binary logistic regression analyses. PSA, SUVmax of the rim, local relapse, positive nodes were not associated to liver mets (Groups D-E) (p > 0.05). On the contrary, a significant correlation was found between the presence of liver metG (group D-E) and bone lesions (p= 0.00193). Conclusion: Our results indicate that liver metastases in relapsing prostate cancer may occur frequently. The real incidence evaluation needs more investigations. In this case and despite technical limitations, Choline PET/CT shows alterations of tracer distribution within the liver that could eventually be mistaken for simple cysts but can be suspected when associated to high trigger PSA, concomitant bone lesions or modification over time. In this clinical setting an accurate analysis of liver tracer distribution (increased or decreased uptake) by the nuclear medicine physician is, therefore, mandatory. more...

Background Small-cell lung cancer (SCLC) may express somatostatin transmembrane receptors (SSTRs) in 50-75% of cases. We evaluated the accuracy and prognostic significance of somatostatin receptor scintigraphy (SSRS) in staging compared with conventional radiological procedures. Patients and methods Newly diagnosed SCLC patients underwent scintigraphy with the radiolabeled somatostatin analog indium-111 (In)-pentetreotide (OctreoScan). Histological data were available for 20 (38%) patients for immunohistochemical analysis of SSTR-2 expression. Results From May 2007 to December 2011 we analyzed 52 SCLC patients. In comparison with standard radiologic staging, the sensitivity and specificity of SSRS were 63 and 100% for primary pulmonary tumor (T), 51 and 100% for mediastinal lymph node (N), and 23 and 91% for metastatic disease (M), respectively. The overall SSRS accuracy was 65% for T, 62% for N, and 52% for M. Patients with positive SSRS achieved a disease control rate of 97 versus 84% in those with negative exam results; median progression-free survival was 9.5 months versus 11.0 and median overall survival was 15.3 versus 14.5 months for patients with positive SSRS versus those with a negative result. Notably, seven (78%) patients with a positive quantitative analysis for SSTR-2 had a positive SSRS; at semiquantitative analysis this correlation was found in eight (73%) patients. Conclusion SSRS has a lower accuracy in comparison with standard radiological staging in SCLC. However, patients with a positive SSRS given standard treatments showed better disease control compared with those with a negative SSRS, but similar progression-free survival and overall survival. more...

Primary degenerative dementia syndromes are an increasingly relevant problem worldwide because of the progressive aging of the population. Their diagnosis is often a challenge for clinicians and, even in the best cases, only a possible or probable diagnosis can be reached. Molecular neuroimaging techniques can be very useful in dementia patients, especially for obtaining a diagnosis in the early stage of disease. The most diffuse and widely available nuclear medicine method for neurological studies is F-fluoro-deoxy-glucose (F-FDG)-PET, which allows the quantification of glucose gray matter metabolism and helps visualize typical, adequately specific, patterns for many kinds of degenerative dementia, not only for the well-known and well-studied Alzheimer's disease. This paper aims to describe the clinical and F-FDG-PET profiles of the principal non-Alzheimer type of degenerative dementias. more...

Epithelial ovarian carcinoma is a major form of cancer affecting women in the western world. The silent nature of this disease results in late presentation at an advanced stage in many patients. It is therefore important to assess the role of imaging techniques in the management of these patients. This article presents a review of the literature on the role of (18)F-FDG-PET/CT in the different stages of management of epithelial ovarian cancer. Moreover, a comparison with other imaging techniques has been made and the relationship between (18)F-PET/CT and the assay of serum CA-125 levels has been discussed. more...

A 76-year-old woman was referred to our centre to perform (18)F-FDG PET/CT with the clinical suspicion of vasculitis. Whole body PET was negative for vasculitis but it depicted moderate hypermetabolism in several lymph nodes of the mediastinum and intense uptake of the tracer in the parotid glands. Since the patient referred skin lesion on both legs a particular acquisition of the lower extremities was performed which showed diffuse uptake on the perimalleolar region of both legs. On the basis of the PET/CT findings that were suggestive for sarcoidosis the patient performed bronchoalveolar lavage (BAL) and biopsy of a mediastinal lymph node which confirmed the suspicion of sarcoidosis. more...

A 67-year-old man, previously operated for a pancreatic neuroendocrine tumor (NET), had progressive increase of serum chromogranin A during follow-up. Sequential 68Ga-DOTA-NOC and F-18 FDG PET/CT were performed. 68Ga-DOTA-NOC imaging was negative, whereas F-18 FDG PET/CT showed 2 hypermetabolic hepatic lesions demonstrated at CT-guided biopsy as metastatic deposits from a high-grade (G3) aggressive NET. Despite the large consensus of SPECT or PET with radiolabeled somatostatin analogs as first choice in functional imaging for detecting NETs metastasis, F-18 FDG may occasionally be the right tracer to provide accurate diagnostic and prognostic information in aggressive G3 NET. more...

In the present review we reported the value of 18F-fluorodeoxyglucose (FDG) PET/CT in face of uterine cancer, in terms of sensitivity, specificity and accuracy. Moreover, we made a comparison with the other imaging techniques currently used to evacuate these tumors including contrast-enhanced CT, contrast enhanced-MRI and transvaginal ultrasonography. FDG PET/CT has been reported to be of particular value in detecting occult metastatic lesions, in prediction of response to treatment and as a pro-gnostic factor. more...

This is a case of a 48-year-old man treated with surgery and (131)I for papillary thyroid carcinoma: a follow-up (18)F-FDG PET/CT incidentally evidenced pituitary uptake, also seen in (111)In-octreoscan as increased uptake in the sellar area. MRI confirmed a pituitary mass. The patient did not show any signs or symptoms related to this lesion; 1 year later, both PET/CT and MRI findings remained unchanged. Surgery confirmed nonfunctioning benign pituitary adenoma. This single case observed in 12,873 consecutive patients scanned in our center confirms the possibility that nonfunctioning benign pituitary adenomas may be FDG-avid: uptake mechanisms remain unknown, and targeted studies are needed. more...

of F-FDG-PET/CT Gaia Grassetto, Carlo Capirci, Maria Cristina Marzola, Lucia Rampin, Sotirios Chondrogiannis, Alessandra Musto, Giorgio Crepaldi, Anna Maria Minicozzi, Arianna Massaro, Domenico Rubello Department of Nuclear Medicine—PET/CT Centre, Santa Maria della Misericordia Hospital, Via Tre Martiri 89, 45100 Rovigo, Italy Radiotherapy Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy Oncology Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy Clinical Surgery, University of Verona, Verona, Italy more...

Objectives To review the published data in literature on patients affected by gynaecological malignancies to establish the role of 18 F-FDG positron emission tomography (PET) and PET/CT in comparison to conventional imaging (CI). Materials and methods All papers specifically addressed to the role of 18 F-FDG PET and PET/CT in gynaecological malignancies published on PubMed/Medline, in abstracts from the principal international congresses, in the guidelines from national Societies that had appeared in literature until November 2009 were considered for the purpose of the present study. Results and conclusions The use of 18 F-FDG PET, and even more of 18 F-FDG PET/CT, is increasing in the follow up of patients with gynaecologic malignancies and suspected recurrent disease: there is evidence in the literature that 18 F-FDG PET/CT has a higher sensitivity than CI in depicting occult metastatic spread. An interesting issue is represented by patients with ovarian cancer with an increase of the specific biomarker, CA-125, and negative/inconclusive findings at CI. The use of 18 F-FDG PET in differential diagnosis and staging is more controversial, but there is some evidence that a baseline PET examination performed before commencing therapy, for staging purpose, is also useful to evaluate the response to chemoradiation treatment. In several papers it has been suggested a relevant role of 18 F-FDG PET/CT in evaluating the entity of response to treatment and therefore to plan the subsequent therapeutic strategy. more...

INTRODUCTION AND AIM: Ovarian carcinoma (OC) is a common cancer in the Western Countries, and an important cause of death in patients suffering with gynaecologic malignancies. The majority of patients present with advanced disease at the time of diagnosis. Treatment with debulking surgery followed by chemotherapy is the standard approach while chemotherapy is contemplated when surgery is not possible. A correct pre-operative staging is important to ensure a most appropriate management. Laparoscopy (LPS) is the standard diagnostic tool for the assessment of intraperitoneal infiltration but is invasive and requires general anaesthesia. FDG-PET/CT is increasingly used for staging different types of cancer, and the aim of this study is to assess the value of FDG-PET/CT in staging advanced OC and its sensitivity to detect lesions in different quadrants of the abdominal-pelvic area compared to laparoscopy. MATERIALS AND METHODS: From September 2004 till April 2008, 40 patients with high suspicion of OC were referred to our hospital for diagnostic LPS to explore the possibility of optimal debulking surgery. Those who were not suitable for surgery were referred for chemotherapy. Before chemotherapy, the patients underwent an FDG-PET/CT scan. The findings in 9 quadrants of abdominal-pelvic area (total 360 quadrants) for PET/CT and LPS were recorded and compared. RESULTS: In 14/360 areas (3.8%), surgical evaluation was not possible because of presence of adhesions, thus the number of areas explored by laparoscopy was 346. Tumour was found in 308 quadrants (38 quadrants free of disease). PET/CT was positive in all 40 patients with true negative results in 26/346 quadrants (7.5%), and true positives results in 243/346 quadrants (70.2%). False positive and negative PET/CT results were found in 12/346 and 65/346 quadrants, respectively. False positive PET/CT findings were evenly present in all quadrants. False negative PET/CT findings were present in 31/109 (28.4%) upper abdominal quadrants (epigastrium and diaphragmatic areas). Final analysis showed a sensitivity and specificity for PET/TC of 78.9 and 68.4% respectively with a positive predictive value of 95.3%. A significant difference was noted between mean SUVmax associated with lesions smaller or larger than 0.5 cm (p=0.006). CONCLUSION: Our results suggest that PET/CT may prove a useful tool for pre-surgical staging of ovarian cancer with a sensitivity and specificity of 78 and 68%, respectively. However, it may be used in combination with laparoscopy for better results. PET/CT showed an adequate correlation between SUVmax values and laparoscopy findings of lesions>5mm, but a high rate of false negative results in lesions more...

BACKGROUND: A pathologic complete response (pCR) and minimal residual disease (pMRD) after preoperative chemotherapy (PCT) for early stage or locally advanced breast cancer (BC) correlates with a good prognosis. METHODS: Patients who received from 6 to 8 cycles of PCT for BC were monitored by 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET), and the maximal standardized uptake value (SUVmax) was calculated at baseline, after 2 cycles, after 4 cycles, and at the end of PCT. SUVmax percentage changes (Δ-SUV) were compared with the pathologic response rate. Patients who had a pCR or pMRD in the tumor and an absence of cancer cells in ipsilateral axillary lymph nodes were defined as having obtained an optimal pathologic response (pR), whereas all the other conditions were classified as a pathologic nonresponse (pNR). RESULTS: Of 34 patients, 7 (21%) achieved a pR (3 patients had a pCR, and 4 patients had pMRD). After the second cycle, the Δ-SUV threshold with optimal negative predictive value to predict a pR was 50%. Twenty-six patients (76%) had a Δ-SUV >50%, including all 7 patients who had a pR and 19 patients who had a pNR. Conversely, all 8 patients who had a Δ-SUV ≤50% had a pNR. All 8 of those patients had estrogen recepetor-positive tumors. CONCLUSIONS: Early evaluation of metabolic response by 18F-FDG-PET during PCT was able to identify 30% of patients, all with estrogen receptor-positive tumors, who would not obtain pR after completion of chemotherapy program. Cancer 2010. © 2010 American Cancer Society. more...

Background Conventional imaging techniques [computed tomography (CT), ultrasound, magnetic resonance] and somatostatin receptor scintigraphy are often insufficient to make a conclusive diagnosis of bronchial carcinoid (BC). PET is commonly used for the assessment of lung cancer but 18F-fluorodeoxyglucose, the most frequently used PET tracer, presents a low sensitivity for the detection of neuroendocrine tumours (NETs). New PET radiopharmaceuticals such as 68Ga-DOTA peptides, which directly bind to somatostatin receptors and are usually expressed on NET cell surfaces, have been reported to be superior to both morphological and somatostatin receptor scintigraphy imaging for gastroenteropancreatic NETs. However, their role in BC has never been evaluated. Our aim is to evaluate the role of 68Ga-DOTA-NOC (68Ga-labelled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-Nal3-octreotide) PET for the assessment of BC patients. Methods Ten patients with pathologically proven well-differentiated BC and one patient with highly suggestive CT images for BC were studied by 68Ga-DOTA-NOC PET/CT. PET findings were compared with clinical follow-up, pathology and contrast-enhanced CT findings. Results 68Ga-DOTA-NOC PET/CT detected at least one lesion in nine of 11 patients and was negative in two. PET/CT and contrast-enhanced CT were discordant in eight of 11 patients, whereas in only three patients both provided similar results. PET/CT detected a higher number of lesions in five patients and excluded malignancy at sites considered positive on CT in three of 11; follow-up confirmed PET/CT findings in all patients. In PET/CT-positive patients, the mean maximal standardized uptake value was 25.9 [4.4-60.5]. On a clinical basis, PET/CT provided additional information in nine of 11 patients leading to the changes in the clinical management of three of nine patients. Conclusion PET/CT with Ga-DOTA-NOC was useful in BC patients because it led to a better evaluation of the extent of the disease. more...

The role of (18)F-FDG PET in the management of gynaecologic malignancies remains unclear mainly due to the failure of clinicians to appreciate the significance of this imaging tool. However, this under utilisation is being actively re-addressed with a large number of reviews and studies, particularly in the last few years.PET has been shown to have high sensitivity and specificity in the evaluation of relapse and nodal disease in cervical cancer, while other uses such as staging and monitoring response to therapies being under further investigation. Similarly, promising results have been published in the use of PET in patients affected by endometrial cancer and uterine sarcomas for detecting lymph nodes metastasis and recurrent disease. In ovarian cancer, PET appears to have a great potential in staging and assessment of disease relapse. An important utility of PET in gynaecologic tumours, which is shared with a large number of other malignancies, is its value in positively changing the patients' management.The surge in studies using PET in gynaecological malignancies is in its early stages, and further studies are required to optimise the role of PET in these conditions. more...

15039 Background: Early evaluation of response to primary chemotherapy (PSC) in epithelial ovarian cancer (EOC) pts could allow to administer a proper number of cycles in order to obtain optimal results. Arianna Project 02 is aimed to investigate early tumor response to PSC correlating a set of routine and experimental hystological, biological and gene-expression profile data with clinical data before, during and after PSC. Methods: Stage III-IV EOC received 6 cycles of carboplatin AUC 5 and paclitaxel 175 mg/m2 and are evaluated at baseline and before each cycle by 18FDG-PET, CA 125, circulating tumor cells and experimental circulating bio-markers. Ultrasounds, CT scan and pelvic MRI are done at baseline and every other cycle. This preliminary report is focused on the correlation between changes of PET and CA 125 serum levels and pathological response. Results: Up to now 6 out of 11 pts completed PSC and surgery. Baseline tumoral 18FDG uptake expressed as Standardized Uptake Value (SUV) and CA125 were abnormal in all pts (SUVmax range: 12.1–20; CA 125 range: 416–2026 U/ml, upper normal limit 35 U/ml). One complete and 4 partial pathological remissions > 90% and one no change were observed. Mean (with range) SUVmax and CA125 decrease (Δ SUV and Δ CA125) measured after the 1st, 2nd, 3rd and last cycle of PSC in the 5 responders are similar (table). In the non-responder SUV decreased by 63% after the 1st cycle of PSC, but increased to baseline value after the 2nd cycle and remained unchanged until surgery, while CA 125 progressively decreased from 416 U/ml to 47 U/ml. Conclusions: These preliminary findings indicate that the behaviour of PET and CA 125 in responders are similar. More data are necessary to define the role of PET in the early evaluation of response to PSC in EOC pts. The study is still ongoing and the relationship between evaluation performed by PET and CA125 and by CT scan, ultrasound and pelvic MRI will be presented at ASCO meeting. [Table: see text] No significant financial relationships to disclose. more...