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Purpose Positron emission tomography (PET) with the first and only tau targeting radiotracer of F-18-flortaucipir approved by FDA has been increasingly used in depicting tau pathology deposition and distribution in patients with cognitive impairment. The goal of this international consensus is to help nuclear medicine practitioners procedurally perform F-18-flortaucipir PET imaging. Method A multidisciplinary task group formed by experts from various countries discussed and approved the consensus for F-18-flortaucipir PET imaging in Alzheimer's disease (AD), focusing on clinical scenarios, patient preparation, and administered activities, as well as image acquisition, processing, interpretation, and reporting. Conclusion This international consensus and practice guideline will help to promote the standardized use of F-18-flortaucipir PET in patients with AD. It will become an international standard for this purpose in clinical practice.

Purpose Positron emission tomography (PET) with F-18-fluorodeoxyglucose ([F-18]-FDG) has been increasingly applied in precise localization of epileptogenic focus in epilepsy patients, including pediatric patients. The aim of this international consensus is to provide the guideline and specific considerations for [F-18]-FDG PET in pediatric patients affected by epilepsy. Methods An international, multidisciplinary task group is formed, and the guideline for brain [F-18]-FDG PET/CT in pediatric epilepsy patients has been discussed and approved, which include but not limited to the clinical indications, patient preparation, radiopharmaceuticals and administered activities, image acquisition, image processing, image interpretation, documentation and reporting, etc. Conclusion This is the first international consensus and practice guideline for brain [F-18]-FDG PET/CT in pediatric epilepsy patients. It will be an international standard for this purpose in clinical practice.

Background Impulse control disorders (ICD) are a common and disrupting complication of Parkinson's disease (PD) treatment. Although their relationship with dopaminergic activity is well studied, their brain metabolic correlates are mostly unknown. Methods In this work we studied brain metabolism using brain F-18-FDG-PET. We performed a case-control study nested within a cohort of PD patients free of ICD at baseline to compare ICD patients right after ICD diagnosis and prior to any treatment modification with matched ICD-free patients. We also compared both PD groups with healthy controls. Results When compared with ICD-free PD patients, PD patients with recently diagnosed ICD showed higher glucose metabolism in widespread areas comprising prefrontal cortices, both amygdalae and default mode network hubs (p < 0.05, corrected). When compared to healthy controls, they did not show hypermetabolism, and the only hypometabolic region was the right caudate. In turn, ICD-free patients showed diffuse hypometabolism when compared to healthy controls. Conclusion Our results suggest brain metabolism is more preserved in PD patients with ICD than patients without ICD. This metabolic preservation could be related to ICD development.

The correct administered activity of 18F-FCH is 0.1-0.14 mCi/Kg, which is equivalent to 3.7-5.2 MBq/kg.

Background: Apathy is the most prevalent and characteristic neuropsychiatric feature of Huntington's disease. Congruent with the main early pathological changes, apathy is primarily associated with subcortical damage in frontal-striatal circuits. However, little is known about its precise subserving mechanisms and the contribution of regions other than the basal ganglia. Objectives: We aimed to define the neural correlates of apathy in Huntington's disease based on gray matter volume and PET/CT of F-18-fluorodeoxyglucose metabolism. Methods: We rated the severity of apathy in 40 mild Huntington's disease participants using the Problem Behaviors Assessment for Huntington's disease. Voxelwise regression analysis was performed, controlling for effects of potential confounders, and PET/CT results were corrected for the effects of gray matter atrophy. Results: Apathy was strongly associated with decreased gray matter within a spatially distributed cortico-subcortical network, with major compromise of the bilateral amygdala and temporal cortex. PET metabolism was significantly decreased in frontotemporal and parietal regions. Metabolic uptake and gray matter values in the identified clusters showed significant correlations with multiple clinical measures. Conclusions: Our findings indicate that apathy in Huntington's disease is not exclusively a consequence of basal ganglia and related frontal-executive alterations. It is subserved by a complex cortico-subcortical network where critical reward and emotional-related prefrontal, temporal, and limbic nodes contribute strongly to its severity. This highlights the contribution of damage in regions other than the basal ganglia to the clinical expression of Huntington's disease. (C) 2018 International Parkinson and Movement Disorder Society

Rapid developments in imaging and treatment with radiopharmaceuticals targeting prostate cancer pose issues for the development of guidelines for their appropriate use. To tackle this problem, international experts representing medical oncologists, urologists, radiation oncologists, radiologists, and nuclear medicine specialists convened at the European Association of Nuclear Medicine Focus 1 meeting to deliver a balanced perspective on available data and clinical experience of imaging in prostate cancer, which had been supported by a systematic review of the literature and a modified Delphi process. Relevant conclusions included the following: diphosphonate bone scanning and contrast-enhanced CT are mentioned but rarely recommended for most patients in clinical guidelines; MRI (whole-body or multiparametric) and prostate cancer-targeted PET are frequently suggested, but the specific contexts in which these methods affect practice are not established; sodium fluoride-18 for PET-CT bone scanning is not widely advocated, whereas gallium-68 or fluorine-18 prostate-specific membrane antigen gain acceptance; and, palliative treatment with bone targeting radiopharmaceuticals (rhenium-186, samarium-153, or strontium-89) have largely been replaced by radium-223 on the basis of the survival benefit that was reported in prospective trials, and by other systemic therapies with proven survival benefits. Although the advances in MRI and PET-CT have improved the accuracy of imaging, the effects of these new methods on clinical outcomes remains to be established. Improved communication between imagers and clinicians and more multidisciplinary input in clinical trial design are essential to encourage imaging insights into clinical decision making.

I-123-mIBG planar image heart-to-mediastinum ratios effectively risk-stratify heart failure (HF) patients. The value of single-photon emission computed tomographic (SPECT) imaging for identifying increased risk of ventricular arrhythmias is less clear. This study sought to determine if findings from simultaneous interpretation of I-123-mIBG and Tc-99m-tetrofosmin SPECT are predictive of arrhythmic events (ArEs). I-123-mIBG SPECT images from 622 patients with ischemic HF were presented in standard displays alongside Tc-99m-tetrofosmin images. Consensus interpretations using a 17-segment model produced summed scores. Cox proportional hazards analyses related findings to adjudicated ArEs over 2 years. 471 patients had images adequate for total 17-segment scoring. There were 48 ArEs (10.2%). Neither I-123-mIBG nor Tc-99m-tetrofosmin SPECT summed scores were univariate predictors. On multivariate proportional hazards analysis, the I-123-mIBG SPECT score was independently predictive of ArEs (HR: 0.975, 95% CI 0.951-0.999, P = 0.042), but HR < 1 indicated that risk decreased with increasing score. This occurred because patients with intermediately abnormal SPECT studies had a higher likelihood of ArEs compared to patients with extensive abnormalities. The presumption of a monotonic increase in ArE risk with increasing summed I-123-mIBG SPECT score may not be correct as ischemic HF patients with abnormalities of intermediate extent appear at highest risk.

Painful bone metastases are common in prostate cancer, with current treatments including non-steroidal analgesics and opiates, surgery, external beam radiotherapy and bone-targeting beta-emitting radiopharmaceuticals. The a-emitting isotope Ra-223-dichloride (Ra-223) has been associated with improved overall survival and increased time to first skeletal-related events in patients with castration-resistant prostate cancer (CRPC) presenting with symptomatic bone metastases. The current study reports the case of a 70-year-old male patient, who was diagnosed with prostate cancer in 1999 upon presentation with increased prostate-specific antigen (PSA) levels and painful bone metastases in the context of CRPC. In November 2010, subsequent to undergoing hormonal blockage, the patient was treated with ketoconazole (200 mg/8 h) followed by 10 cycles of docetaxel (75 mg/m(2) every 3 weeks). Following disease progression, the patient received 6 doses of Ra-223 (50 kBq/kg; 1 dose/4 weeks). During this treatment period, an improvement in the patient's symptoms, and levels of bone alkaline phosphatase (BAP) and PSA were noted. Furthermore, Ra-223 was well-tolerated without any relevant bone marrow toxicity. However, 2 months after the administration of the final dose of Ra-223, PSA and BAP levels increased again, and bone pain deteriorated. A bone scan showed stable disease in the previously observed metastatic lesions; however, new lesions simultaneously appeared in different locations, indicating progressive disease.

To assess metabolic changes in cerebral F-18-FDG PET/CT in premanifest and manifest Huntington's disease (HD) subjects compared to a control group and to correlate F-18-FDG uptake patterns with different disease stages. Thirty-three gene-expanded carriers (Eight males; mean age: 43 y/o; CAG > 39) were prospectively included. Based on the Unified Huntington's Disease Rating Scale Total Motor Score and the Total Functional Capacity, subjects were classified as premanifest (preHD = 15) and manifest (mHD = 18). Estimated time disease-onset was calculated using the Langbehn formula, which allowed classifying preHD as far-to (preHD-A) and close-to (PreHD-B) disease-onset. Eighteen properly matched participants were included as a control group (CG). All subjects underwent brain F-18-FDG PET/CT and MRI. F-18-FDG PET/CT were initially assessed by two nuclear medicine physicians identifying qualitative metabolic changes in the striatum. Quantitative analysis was performed using SPM8 with gray matter atrophy correction using the BPM toolbox. Visual analysis showed a marked striatal hypometabolism in mHD. A normal striatal distribution of F-18-FDG uptake was observed for most of the preHD subjects. Quantitative analysis showed a significant striatal hypometabolism in mHD subjects compared to CG (p < 0.001 uncorrected, k = 50 voxels). In both preHD groups we observed a significant striatal hypometabolism with respect to CG (p < 0.001 uncorrected, k = 50 voxels). In mHD subjects we observed a significant striatal hypometabolism with respect to both preHD groups (p < 0.001 uncorrected, k = 50 voxels). F-18-FDG PET/CT might be a helpful tool to identify patterns of glucose metabolism in the striatum across the stages of HD and might be relevant in assessing the clinical status of gene-expanded HD carriers due to the fact that dysfunctional glucose metabolism begins at early preHD stages of the disease. F-18-FDG PET/CT appears as a promising method to monitor the response to disease-modifying therapies even if applied in premanifest subjects.

Objectives The aim of the study was to address the need for quantifying the global cancer time evolution magnitude from a pair of time-consecutive positron emission tomography-computed tomography (PET-CT) scans. In particular, we focus on the computation of indicators using image-processing techniques that seek to model non-Hodgkin's lymphoma (NHL) progression or response severity. Materials and methods A total of 89 pairs of time-consecutive PET-CT scans from NHL patients were stored in a nuclear medicine station for subsequent analysis. These were classified by a consensus of nuclear medicine physicians into progressions, partial responses, mixed responses, complete responses, and relapses. The cases of each group were ordered by magnitude following visual analysis. Thereafter, a set of quantitative indicators designed to model the cancer evolution magnitude within each group were computed using semiautomatic and automatic image-processing techniques. Performance evaluation of the proposed indicators was measured by a correlation analysis with the expert-based visual analysis. Results The set of proposed indicators achieved Pearson's correlation results in each group with respect to the expert-based visual analysis: 80.2% in progressions, 77.1% in partial response, 68.3% in mixed response, 88.5% in complete response, and 100% in relapse. In the progression and mixed response groups, the proposed indicators outperformed the common indicators used in clinical practice [changes in metabolic tumor volume, mean, maximum, peak standardized uptake value (SUVmean, SUVmax, SUVpeak), and total lesion glycolysis] by more than 40%. Conclusion Computing global indicators of NHL response using PET-CT imaging techniques offers a strong correlation with the associated expert-based visual analysis, motivating the future incorporation of such quantitative and highly observer-independent indicators in oncological decision making or treatment response evaluation scenarios. Nucl Med Commun 36: 328-333 Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.

With the current advances in genomics and proteomics, cardiovascular molecular imaging techniques such as PET and SPECT, in combination with other cardiac molecular imaging techniques, will identify new markers of disease activity and will play a central role in screening of patients, diagnosis, prognosis and patient management. The complexity of the development process of vulnerable atherosclerotic plaques provides an excellent example of the need for combined molecular imaging. Predicting outcome by molecular imaging of atherosclerotic plaques should offer new paradigms for the management of coronary artery disease. In cardiac neurotransmission, molecular imaging can offer insights and provide better understanding of pathophysiologic mechanisms and help to improve patient management, in particular in patients with heart failure or at risk of arrhythmias. A recent important advance in the area of cardiovascular molecular imaging is reporter gene imaging. The concept has been validated in animal models, where reporter genes are only expressed by living stem cells, offering a means to track stem cell survival. Reporter genes are passed on to daughter cells, making assessment of cell proliferation possible. Reporter gene imaging can be applied to a variety of stem cells or therapeutic genes of interest in stem cell or gene based therapy in cardiovascular medicine.