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The diagnostic power of an integrated positron emission tomography/computed tomography (PET/CT) system for whole-body 2-fluoro-2-deoxy-d-glucose (FDG) imaging is clearly demonstrated in this case report. The precise anatomic localization of FDG uptake with CT in a PET/CT scan of a patient with known breast carcinoma helped identify a contralateral breast tumor with axillary lymph node metastasis despite the presence of extensive physiologic brown fat FDG uptake. Accordingly, the patient received appropriate surgical management and pathologic confirmation of the disease. [ABSTRACT FROM AUTHOR]

Comments on a study conducted by M. Bangard and colleagues on the detection of somatostain receptor-positive tumors with the use of a somatostatin analogue. Importance of the co-ligand used in the labeling procedure of a derivatized somatostatin analogue; Major advantages of ethylene diamine diacetic acid as a co-ligand.

Objective: To determine whether [ 18 F]FDG PET/CT and hematological parameters provide supportive data to determine HPV status in HNSCC patients., Methods: Retrospective analysis of clinical and diagnostic data from 106 patients with HNSCC: 26.4% HPV-positive and 73.6% HPV-negative was performed. The following semiquantitative PET/CT parameters for the primary tumor and hottest lymph node and liver were evaluated: SUV max , SUV mean , TotalSUV, MTV, TLG, maximum, mean and TLG tumor-to-liver ratio (TLR max , TLR mean ,TLR TLG ) and heterogeneity index (HI). Following hematological variables were assessed: white blood cell (WBC); lymphocyte (LYMPH); neutrophil (NEU),monocyte (MON); platelet (PLT); neutrophil-to-lymphocyte ratio (NRL); lymphocyte-to-monocyte ratio (LMR); platelet-to lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR). Conventional statistical analyses were performed in parallel with an artificial neural network analysis (Neural Analyzer, v. 2.9.5)., Results: Significant between-group differences were observed for two of the semiquantitative PET/CT parameters, with higher values in the HPV-negative group: primary tumor MTV (22.2 vs 9.65; p=0.023), and TLR max (3.50 vs 2.46; p=0.05). The HPV-negative group also had a significantly higher NEU count (4.84 vs. 6.04; p=0.04), NEU% (58.2 vs. 66.2; p=0.007), and NRL% (2.69 vs. 3.94; p=0.038). Based on ROC analysis (sensitivity 50%, specificity 80%, AUC 0.5), the following variables were independent predictors of HPV-negativity: primary tumor with SUV max >10; TotalSUV >2800; MTV >23.5; TLG >180; TLR max >3.7; TLR TLG >5.7; and oropharyngeal localization., Conclusion: Several semiquantitative parameters derived from [ 18 F]FDG PET/CT imaging of the primary tumor (SUV max , TotalSUV, MTV, TLG, TLR max and TLR TLG ) were independent predictors of HPV-negativity., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: The aim of this retrospective study was to assess the value of 18 F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ([ 18 F]FDG PET/CT parameters in cN1-cN3 non-small cell lung cancer (NSCLC) patients., Materials and Methods: 59 consecutive patients (35 M, 24 F) with NSCLC who underwent pretreatment [ 18 F]FDG PET/CT were enrolled to this study. Several primary tumor PET parameters, including the maximum and mean standardized uptake value (SUV max and SUV mean) , the metabolic active tumor volume (MTV) and the total lesion glycolysis (TLG = MTVxSUV mean ), were extracted and analysed. Overall survival was defined as time from primary diagnosis to death or the last info., Results: In the whole analysed group 44 patients underwent curative treatment, while 15, because of the severity of the disease, were classified for palliative treatment. Univariate Cox analysis of clinical and metric PET parameters revealed that MTV was a significant prognostic factor for OS (p = 0.024), while TLG and curative treatment showed a trend for significance (p < 0.1). In multivariate Cox regression (MTV and curative treatment) MTV remained a significant factor (p = 0.047)., Conclusions: Metabolic tumor volume of the primary tumor was the only independent prognostic factor for cN1-cN3 NSCLC patients., Competing Interests: Conflicts of interest: Authors declare no conflict of interest., (© 2024 Greater Poland Cancer Centre.)

Competing Interests: Conflict of interest None declared.

Purpose: PET-derived metabolic tumor volume (MTV) and total lesion glycolysis of the primary tumor are known to be prognostic of clinical outcome in head and neck cancer (HNC). Including evaluation of lymph node metastases can further increase the prognostic value of PET but accurate manual delineation and classification of all lesions is time-consuming and prone to interobserver variability. Our goal, therefore, was development and evaluation of an automated tool for MTV delineation/classification of primary tumor and lymph node metastases in PET/CT investigations of HNC patients., Methods: Automated lesion delineation was performed with a residual 3D U-Net convolutional neural network (CNN) incorporating a multi-head self-attention block. 698 [Formula: see text]F]FDG PET/CT scans from 3 different sites and 5 public databases were used for network training and testing. An external dataset of 181 [Formula: see text]F]FDG PET/CT scans from 2 additional sites was employed to assess the generalizability of the network. In these data, primary tumor and lymph node (LN) metastases were interactively delineated and labeled by two experienced physicians. Performance of the trained network models was assessed by 5-fold cross-validation in the main dataset and by pooling results from the 5 developed models in the external dataset. The Dice similarity coefficient (DSC) for individual delineation tasks and the primary tumor/metastasis classification accuracy were used as evaluation metrics. Additionally, a survival analysis using univariate Cox regression was performed comparing achieved group separation for manual and automated delineation, respectively., Results: In the cross-validation experiment, delineation of all malignant lesions with the trained U-Net models achieves DSC of 0.885, 0.805, and 0.870 for primary tumor, LN metastases, and the union of both, respectively. In external testing, the DSC reaches 0.850, 0.724, and 0.823 for primary tumor, LN metastases, and the union of both, respectively. The voxel classification accuracy was 98.0% and 97.9% in cross-validation and external data, respectively. Univariate Cox analysis in the cross-validation and the external testing reveals that manually and automatically derived total MTVs are both highly prognostic with respect to overall survival, yielding essentially identical hazard ratios (HR) ([Formula: see text]; [Formula: see text] vs. [Formula: see text]; [Formula: see text] in cross-validation and [Formula: see text]; [Formula: see text] vs. [Formula: see text]; [Formula: see text] in external testing)., Conclusion: To the best of our knowledge, this work presents the first CNN model for successful MTV delineation and lesion classification in HNC. In the vast majority of patients, the network performs satisfactory delineation and classification of primary tumor and lymph node metastases and only rarely requires more than minimal manual correction. It is thus able to massively facilitate study data evaluation in large patient groups and also does have clear potential for supervised clinical application., (© 2023. The Author(s).)

The objective of this study was to assess the prognostic value of asphericity (ASP) and standardized uptake ratio (SUR) in cervical cancer patients. Retrospective analysis was performed on a group of 508 (aged 55 ± 12 years) previously untreated cervical cancer patients. All patients underwent a pretreatment [ 18 F]FDG PET/CT study to assess the severity of the disease. The metabolic tumor volume (MTV) of the cervical cancer was delineated with an adaptive threshold method. For the resulting ROIs the maximum standardized uptake value (SUV max ) was measured. In addition, ASP and SUR were determined as previously described. Univariate Cox regression and Kaplan-Meier analysis with respect to event free survival (EFS), overall survival (OS), freedom from distant metastasis (FFDM) and locoregional control (LRC) was performed. Additionally, a multivariate Cox regression including clinically relevant parameters was performed. In the survival analysis, MTV and ASP were shown to be prognostic factors for all investigated endpoints. Tumor metabolism quantified with the SUV max was not prognostic for any of the endpoints (p > 0.2). The SUR did not reach statistical significance either (p = 0.1, 0.25, 0.066, 0.053, respectively). In the multivariate analysis, the ASP remained a significant factor for EFS and LRC, while MTV was a significant factor for FFDM, indicating their independent prognostic value for the respective endpoints. The alternative parameter ASP has the potential to improve the prognostic value of [ 18 F]FDG PET/CT for event-free survival and locoregional control in radically treated cervical cancer patients., (© 2023. The Author(s).)

Lung cancer is the leading cause of cancer-related death worldwide. Planar radiography and computed tomography are the most common imaging modalities used in diagnosis, staging, and therapy response assessment. However, the role of nuclear methods in assessing the severity of the disease and the effectiveness of treatment has increased in recent years. Introducing these diagnostic modalities into standard practice in lung cancer may contribute to the personalization of treatment. In this review, we summarize the current knowledge of nuclear medicine techniques in the diagnosis and treatment of lung cancer.

Purpose: 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is utilized for staging and treatment planning of head and neck squamous cell carcinomas (HNSCC). Some older publications on the prognostic relevance showed inconclusive results, most probably due to small study sizes. This study evaluates the prognostic and potentially predictive value of FDG-PET in a large multi-center analysis., Methods: Original analysis of individual FDG-PET and patient data from 16 international centers (8 institutional datasets, 8 public repositories) with 1104 patients. All patients received curative intent radiotherapy/chemoradiation (CRT) and pre-treatment FDG-PET imaging. Primary tumors were semi-automatically delineated for calculation of SUV max , SUV mean , metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Cox regression analyses were performed for event-free survival (EFS), overall survival (OS), loco-regional control (LRC) and freedom from distant metastases (FFDM)., Results: FDG-PET parameters were associated with patient outcome in the whole cohort regarding clinical endpoints (EFS, OS, LRC, FFDM), in uni- and multivariate Cox regression analyses. Several previously published cut-off values were successfully validated. Subgroup analyses identified tumor- and human papillomavirus (HPV) specific parameters. In HPV positive oropharynx cancer (OPC) SUV max was well suited to identify patients with excellent LRC for organ preservation. Patients with SUV max of 14 or less were unlikely to develop loco-regional recurrence after definitive CRT. In contrast FDG PET parameters deliver only limited prognostic information in laryngeal cancer., Conclusion: FDG-PET parameters bear considerable prognostic value in HNSCC and potential predictive value in subgroups of patients, especially regarding treatment de-intensification and organ-preservation. The potential predictive value needs further validation in appropriate control groups. Further research on advanced imaging approaches including radiomics or artificial intelligence methods should implement the identified cut-off values as benchmark routine imaging parameters., Competing Interests: In the past 5 years, MBau received funding for his research projects and for educational grants to the University of Dresden by Bayer AG (2016–2018), Merck KGaA (2014-open) and Medipan GmbH (2014–2018). He is on the supervisory board of HI-STEM gGmbH (Heidelberg) for the German Cancer Research Center (DKFZ, Heidelberg) and also member of the supervisory body of the Charité University Hospital, Berlin. As former chair of OncoRay (Dresden) and present CEO and Scientific Chair of the German Cancer Research Center (DKFZ, Heidelberg), he has been or is responsible for collaborations with a multitude of companies and institutions, worldwide. In this capacity, he has discussed potential projects and signed contracts for research funding and/or collaborations with industry and academia for his institute(s) and staff, including but not limited to pharmaceutical companies such as Bayer, Boehringer Ingelheim, Bosch, Roche and other companies such as Siemens, IBA, Varian, Elekta, Bruker, etc. In this role, he was/is also responsible for the commercial technology transfer activities of his institute(s), including the creation of start-ups and licensing. This includes the DKFZ-PSMA617 related patent portfolio [WO2015055318 (A1), ANTIGEN (PSMA)] and similar IP portfolios. MBau confirms that, to the best of his knowledge, none of the above funding sources were involved in the preparation of this paper. In the past 5 years, MK received funding for her research projects by IBA (2016), Merck KGaA (2014-2018 for preclinical study; 2018-2020 for clinical study), Medipan GmbH (2014–2018). She is involved in an ongoing publicly funded (German Federal Ministry of Education and Research) project with the companies Medipan, Attomol GmbH, GA Generic Assays GmbH, Gesellschaft für medizinische und wissenschaftliche genetische Analysen, Lipotype GmbH and PolyAn GmbH (2019–2021). For the present manuscript, MK confirms that none of the above funding sources were involved in the preparation of this paper. HA declares research grants, travel grants, and lecture fees from Sirtex Medical Europe; HA confirms that none of the above funding sources were involved in the preparation of this paper. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer FH declared a past co-authorship with one of the authors ET to the handling Editor., (Copyright © 2022 Zschaeck, Weingärtner, Lombardo, Marschner, Hajiyianni, Beck, Zips, Li, Lin, Amthauer, Troost, van den Hoff, Budach, Kotzerke, Ferentinos, Karagiannis, Kaul, Gregoire, Holzgreve, Albert, Nikulin, Bachmann, Kopka, Krause, Baumann, Kazmierska, Cegla, Cholewinski, Strouthos, Zöphel, Majchrzak, Landry, Belka, Stromberger and Hofheinz.)

One of the most critical elements in the palatine tonsils (PT) patients' management is to distinguish chronic tonsillitis and malignant tumor. The single-time-point (STP) 2-deoxy-2-[ 18 F]fluoro-D-glucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) examination offers the most significant sensitivity and specificity in the head and neck (H&N) region evaluation among commonly used methods of imaging. However, introducing dual-time-point (DTP) scanning might improve the specificity and sensitivity of the technique, limited by the 18 F-FDG non-tumor-specific patterns, especially when comparing different metabolic parameters. The study aims to compare several surrogates of the maximal standardized uptake value (SUVmax), obtained in 36 subjects, divided into confirmed by pathologic study PT cancer and tonsillitis in patients who underwent DTP 18 F-FDG PET/CT scanning. In this study, we observed the increased sensitivity and the specificity of the DTP 18 F-FDG PET/CT when compared with the standard PET/CT protocol. It could be concluded that DTP 18 F-FDG PET/CT improves the PT cancer and chronic tonsillitis differential diagnosis.

Background: The aim of this article was to evaluate the usefulness of sequential dual-time-point 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (DTP [18F]FDG PET/CT) in distinguishing physiologic, inflammatory and malignant palatine tonsils as difficult to differentiate in the oncological practice., Methods: A total of 90 patients before the treatment underwent sequential DTP [18F]FDG PET/CT examinations. We analyzed 104 structures in 90 patients: 31 physiologic tonsils, 28 histopathologically confirmed inflammatory tonsils of non-specified origin, 31 histopathologically confirmed palatine tonsils cancer and 14 non-malignant contralateral tonsils in patients with histopathologically confirmed unilateral palatine tonsil malignancy. Patients underwent sequential [18F]FDG PET/CT examinations at 60 and 90 minutes post-injection of the [18F]FDG. We analyzed the SUVmax and SUVmean values at 60 and 90 minutes post-injection changes over time and the Retention Index (RI-SUVmax). To find the predictive SUV value and the RI cut-off between physiology, inflammatory and malignancy, we used the ROC analysis., Results: The average SUVmax values at 60 and 90minutes post-injection within physiologic palatine tonsils were 1.36±0.26 and 1.31±0.26, respectively, P>0.05. The average SUVmax values at 60 and 90 minutes post-injection within inflammatory and malignant tonsils were 3.74±1.45, 3.80±1.47 (P>0.05) and 5.19±2.19, 5.81±2.50 (P<0.05), respectively. The RI-SUVmax fluctuation over time were 5±28% within physiologic, -4±11% within contralateral non-malignant tonsils in patients with one tonsil involved, 2±11% within inflammatory and 13±13% within malignant tonsils., Conclusions: The sequential dual-time-point [18F]FDG PET/CT examinations may increase the sensitivity and the specificity of the PET/CT method in differential palatine tonsils diagnosis.

Aim: To evaluate whether the sequential dual-time-point fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (DTP 18F-FDG PET/CT) study improves the differential diagnosis in the larynx., Background: In some cases, the clinical and metabolic similarity of laryngitis and larynx cancer make differential diagnostics difficult when performing standard 18F-FDG PET/CT examinations; therefore, an additional study protocol performance seems to be of reasonable value., Materials and Methods: 90 patients (mean age: 61 ± 11 years, range: 41-84 years): 23 women (mean age: 63 ± 10 years, range: 51-84 years) and 67 men (mean age: 61 ± 11 years, range: 41-80 years) underwent delayed 18F-FDG PET/CT examinations at 60 and 90 min post intravenous injection (p.i.) of the radiopharmaceutical 18F-FDG. We compared the metabolic activity of 90 structures divided into following groups: normal larynx (30 patients), laryngitis (30 lesions) and larynx cancer (30 tumors) with maximal and mean standardized uptake value (SUVmax, SUVmean) and the retention index (RI-SUVmax). We used the receiver operating characteristics (ROC) curve to evaluate the SUVmax cut-off values., Results: The SUVmax cut-off value at 60 and 90 min p.i. of 2.3 (sensitivity/specificity: 96.4%/100%) and 2.4 (94.2%/100%), respectively, distinguished normal and abnormal metabolic activity in the larynx. When laryngitis and tumors were compared, the SUVmax cut-off values obtained after initial and delayed imaging were 3.6 (87.5%/52.0%) and 6.1 (58.3%/84%), respectively. The RI-SUVmax of 1.3% (71.4%/88.1%) suggested abnormality, while RI-SUVmax of 6.6%, malignant etiology (75.0%/80.0%)., Conclusions: In this study, the sequential DTP scanning protocol improved the sensitivity and specificity of the PET/CT method in terms of differential diagnosis within the larynx., (© 2020 Greater Poland Cancer Centre. Published by Elsevier B.V. All rights reserved.)

This study aimed to evaluate the usefulness of the biphasic 2-deoxy-2-[18 F]fluoro-D-glucose positron emission tomography/computed tomography ([18 F]FDG PET/CT) examinations in terms of distinguishing benign and malignant lesions within the pharynx. 139 patients underwent sequential biphasic [18 F]FDG PET/CT examinations at 60 and 90 minutes (min) post intravenous injection (p.i.) of the [18 F]FDG. We evaluated the metabolic activity of 93 malignant lesions and 59 benign findings within pharynx as well as 70 normal blood vessels. We evaluated the maximal and mean standardized uptake value (SUVmax, SUVmean) and the retention index (RI-SUVmax). We used the receiver operating characteristics (ROC) analysis to obtain the prognostic metabolic indices cut-off which may differentiate between benign and malignant lesions. The SUVmax value cut-off at 60 and 90 min p.i. differentiating between normal and abnormal metabolic activity in the pharynx was 1.9 and 2.0, respectively. When compared benign and malignant lesions, the SUVmax on initial and delayed scans were 3.1 and 3.6, respectively. In this material, the increase of the SUVmax value over time of 1.7% suggested abnormality, while RI-SUVmax of 5.7% indicated malignant etiology. The biphasic [18 F]FDG PET/CT study protocol is useful in better stratification of normal and abnormal glucose metabolism activity in the pharynx.

Objective: Several genetic analyses have identified tumor diversity not only among tumors from different patients (intertumor heterogeneity) but also within individual tumors (intratumor heterogeneity). The aim of this study was to analyze the intratumor heterogeneity and other biological parameters based on in vivo distribution in triple-tracer positron emission tomography with computed tomography (PET/CT) study in patients with newly diagnosed head and neck (H&N) cancer., Methods: Thirty-six patients with newly diagnosed H&N cancer were included in the study. Institutional Bioethical Committee approved the study protocol and informed consent was received from every participant. All patients underwent series of 3 PET/CT scans with [ 18 F]Fluorodeoxyglucose ( 18 F-FDG-PET), [ 18 F]Fluorothymidine ( 18 F-FLT-PET), and [ 18 F]Fluoromisonidazole ( 18 F-FMISO-PET) before treatment. Scans were performed on separate days, within a timeframe of 2 weeks. Several PET/CT parameters grading tumor biology including maximum standardized uptake value (SUV max ), total lesion glycolysis (TLG), its equivalent (total hypoxic lesion [TLH] and total proliferative lesion [TLP]), and heterogeneity (area under the curve-cumulative SUV histogram) for the primary tumor were compared., Results: All patients showed increased uptake of 18 F-FDG in primary tumor, ranging from 2.29 to 14.89 SUV max . Respectively, SUV max values for 18 F-FLT ranged from 0.93 to 16.11 and for 18 F-FMISO 0.36-4.07. Based on 3-year follow-up, we divided patients in terms of survival forecasts (first with good prognosis and second with worse). Higher values of TLG/TLP/TLH and SUV max were observed in the second group in all 3 tracers (for 18 F-FDG: 167.40 vs 100.32, 11.15 vs 8.95; for 18 F-FLT: 116.61 vs 60.67, 7.09 vs 5.47; for 18 F-FMISO: 37.34 vs 22.30, 1.70 vs 1.61 respectively). Statistically significant differences were shown in SUV max in 18 F-FDG and 18 F-FLT ( P <0.034, P <0.034, respectively; in TLG, P =0.05; TLP, P =0.04; and TLH, P =0.05)., Conclusion: Our preliminary results suggest worse prognosis in patients with higher heterogeneity values of primary tumor in proliferation and hypoxia images and combination of metabolic and volumetric parameters in TLG and its equivalent and heterogeneity of primary tumor seems to be a prognostic factor.

Objective: The aim of the study was to assess the feasibility of multitracer positron emission tomography (PET) imaging before and during chemoradiation and to evaluate the predictive value of image-based factors for outcome in locally advanced head and neck cancers treated with chemoradiation., Methods: In the week prior to the treatment [ 18 F]-2-flu-2-deoxy-D-glucose (FDG), [ 18 F]-3'-flu-3'deoxythymidine (FLT) and [ 18 F]-flumisonidazole (FMISO) imaging was performed. FLT scans were repeated at 14 and 28 Gy and FMISO at 36 Gy. Overall survival, disease-free survival and local control were correlated with subvolume parameters, and with tumour-to-muscle ratio for FMISO. For every tracer, total metabolic tumour volume was calculated., Results: 33 patients were included. No correlation was found between pre-treatment maximum standardised uptake value for FDG, FLT, FMISO and outcomes. Tumour volume measured on initial CT scans and initial FLT volume correlated with disease-free survivall ( p = 0.007 and 0.04 respectively). FDG and FLT metabolic tumour volumes correlated significantly with local control ( p = 0.005 and 0.02 respectively). In multivariate Cox analysis only individual initial TMRmax correlated with overall survival., Conclusion: PET/CT imaging is a promising tool. However, various aspects of image analysis need further clinical validation in larger multicentre study employing uniform imaging protocol and standardisation, especially for hypoxia tracer., Advances in Knowledge: Monitoring of biological features of the tumour using multitracer PET modality seems to be a feasible option in daily clinical practice.Evaluation of hypoxic subvolumes is more patient dependent; thus, exploration of individual parameters of hypoxia is needed. tumour-to-muscle ratio seems to be the most promising so far.

Aim: The aim of this study was to estimate the influence of biological parameters assessed in [F]FDG PET/CT on overall survival (OS) in cervical cancer patients., Methods: Retrospective analysis was performed on a group of 371 patients with newly diagnosed and histologically confirmed cervical cancer. PET biological parameters in primary tumor including SUVmax, SUVmean, total lesion glycolysis (TLG), metabolic tumor volume (MTV), heterogeneity, and parameters referring both to primary tumor and metastatic lesions: SUVtotal, TLGtotal, and MTVtotal, were analyzed., Results: Based on PET/CT results, 3 subgroups were identified: cervical only-with disease limited only to the cervix (38%), +regional nodes-where increased glucose accumulation in addition to the cervical area was also observed in regional lymph nodes (36%), and +distal metastases-where PET scan showed a disseminated disease (26%). Depending on the stage of the disease, in the cervical-only group, 5-year survival rate was 86%; in the +regional nodes group, it was 80%; whereas in the +distal metastases group, 5-year survival rate was only 55%. However, based on Cox regression model, significant influence on OS was found only in heterogeneity of primary tumor; more inhomogeneous tumors suggest worse prognosis (0.25 ± 0.04 vs 0.16 ± 0.09, P < 0.001), SUVtotal (76.6 ± 130.1 vs 45.4 ± 73.4, P = 0.002), and MTVtotal (79.03 ± 88.27 vs 63.00 ± 83.80 cm, P = 0.03). For heterogeneity, cutoff point suggesting worse prognosis was 0.18; for SUVtotal, 52.3; and for MTVtotal, 66.55 cm., Conclusions: Stage of disease assessed in [F]FDG PET/CT significantly influences survival rate in patients with cervical cancer. SUVtotal, MTVtotal, and heterogeneity of primary tumor are independent prognostic factors on OS in cervical cancer patients.

Aim: Cervical cancer is one of the most common cancers of the female reproductive system. The aim of the study was to assess the usefulness of the 18 F-FDG-PET/CT study in staging of cervical cancer, with focus on the primary tumor parameters., Material & Methods: 105 patients (mean age 56 ± 11y) with newly diagnosed cervical cancer underwent PET/CT examination which was performed 60 min after IV injection of 18 F-FDG with a mean activity of 364 ± 75MBq. 68 patients were diagnosed with stage IIIA/IIIB, 19 patients with IIB, 10 patients with IB, 8 patients with stage IVA/IVB. Wilcoxon-Mann-Whitney test and ROC curves were used for statistical analysis., Results: In 35 cases 18 F-FDG-PET/CT did not show active proliferative process outside the cervix. In 38 cases metastases were found in iliac lymph nodes and in 32 patients scans showed metastases above the aortic bifurcation including lymph nodes and other organs. The largest volumes of primary tumor occurred in patients with distant metastases, while the lowest in patients with disease limited only to cervix. In 63 % of the patients PET/CT result was compatible with FIGO classification, in 20 % patients PET/CT result showed less advanced disease and in 17 % of the patients PET/CT results were higher than FIGO classification., Conclusion: PET/CT using 18 F-FDG has an important impact on the assessment of the stage of cervical cancer. In over 30 % of patients, this study resulted in a radical change in the treatment plan., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: The objective was to compare the efficacy of 99mTc-MDP-BS, 18F-FDG-PET/CT and 18F-FCH-PET/CT in detecting bone metastases in prostate cancer patients., Materials and Methods: 56 patients diagnosed with prostate cancer underwent 99mTc-methylendiphosphonates bone scintigraphy (99mTc-MDP-BS) and fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) or fluorine-18-fluorocholine PET/CT (18F-FCH-PET/CT) within six weeks. There were 27 patients examined with 99mTc-MDP-BS + 18F-FDG (mean age 67.96 ± 9.04 years) and 29 patients examined with 99mTc-MDP-BS + 18F-FCH (mean age 73.93 ± 8.75 years). The R factor in scintigraphy and semi- quantitative analysis with Standardized Uptake Value (SUV) in the PET/CT were used using semi - automatic methods of bone lesions' contouring. The R factor was calculated as the total count rate in bone metastasis and the total count rate in contralateral area ratio. For further analysis, the mean pixel and the total surface of lesion product in scintigraphy, the Total Lesion Glycolysis (TLG) in the 18F-FDG-PET/CT and the Total Lesion Activity (TLA)in the 18F-FCH-PET/CT were evaluated., Results: The average maximal SUV (SUVmax) value was significantly higher in patients who underwent 18F-FCH-PET/CT than in 18F-FDG-PET/CT (5.17 ± 2.24, 3.71 ± 1.56, P < .05). The R factor differences in both groups (patients who underwent BS and 18F-FDG-PET/CT, BS and 18F-FCH-PET/CT) were insignificant (1.92± 0.87, 2.03 ± 0.57, respectively, P > .05). There was no statistically significant correlation (Pearsons' correlationcoefficient - Rp) between the R factor and the SUVmax within examined groups (Rp = .42; P = .31) and between the R factor and the SUVmean (Rp = .43; P = .28). A high Rp between measured total surface in the BS and volume in the PET/CT of the metastatic lesion was found. In patients who underwent BS + 18F-FDG-PET/CT and BS +18F-FCH-PET/CT, Rp equaled .95 and .70., Conclusion: 99mTc-MDP-BS, 18F-FDG-PET/CT and 18F-FCH-PET/CT occurred as comparable imaging methods in bone metastases detection in the prostate cancer patients and provide complementary clinical conclusions.

Hodgkin's lymphoma and lung adenocarcinoma as second primary cancers in prostate cancer (PC) patients although are rare should be considered as important for the future of the PC patients.

The present study, discussed a rare case of a 50-year-old woman who was treated for malignant melanoma and underwent 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) examination for evaluation of disease. 18 F-FDG-PET/CT examination was performed from the top of the head down to the knee using a Gemini TF PET/CT scanner 60 min following intravenous injection of radiotracer with mean activity of 364±75 MBq. Previous performed laboratory test and clinical examination was irrelevant. By abdominal ultrasound no abnormalities in abdominal organs beside the liver cyst were found. The 18 F-FDG PET/CT exam showed an increased glucose metabolism in the anterior pole of the spleen, which was considered as melanoma metastasis. Splenectomy was performed and histopathology examination tuberculous lesion in the spleen was revealed. Histopathology examination showed epithelioid granuloma and in correlation with the patient's history allowed to establish tuberculous-like lesions in the spleen. In the present study, authors used 18 F-FDG PET/CT examination to detect the melanoma metastasis of a 50-year-old woman, and found that abnormal focal accumulation of radiotracer with limited cancer specificity in PET/CT examination in cancer patients should not be unambiguously taken as a metastatic lesion.

Objective: The aim of this study was to compare the metabolic activity of metastatic foci from breast and prostate cancer patients as scanned by fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) and by technetium-99m methyl diphosphonate ( 99m Tc-MDP) bone scan (BS)., Subjects and Methods: Forty one patients were studied, divided into 2 groups based on histologically confirmed diagnosis: a) Breast cancer group, 23 women, mean age: 61±12 years, range: 37-79 years and, b) Prostate cancer group, 18 men, mean age 68±8 years, range: 52-82 years. Another group of 17 non cancer atherosclerotic subjects 9 women and 8 men, of mean age and age range similar to the above were also studied for comparison. The R index (the total count rate in bone metastases divided by the total count rate in a contralateral area), the maximum semi-quantitative standardized uptake value (SUVmax) of BS lesions and the mean number of metastases were evaluated. For the metastatic findings in the PET/CT scans the automatic method of contouring with 50% background cut-off was used, while for the 99m Tc-MDP BS metastases were delineated manually., Results: The mean R index of the bone metastatic foci studied by 18 F-FDG PET/CT was 1.89±0.69 for Groups I and II patients. There was no significant difference of the R index between prostate cancer and breast cancer metastases (1.95±0.86 vs 1.83±0.52). The average SUVmax value was significantly higher in breast cancer patients than in prostate cancer patients (5.15±2.54 vs 4.01±1.71; P<0.05). There was no significant correlation in both cancer groups between R index and SUVmax values. The number of metastatic foci diagnosed by the 99m Tc-MDP BS scan was much less than by the 18 F-FDG PET/CT., Conclusion: No significant correlation was noticed in the metabolic activity-glucose utilization of metastatic bone foci between breast and prostate cancer cases. This observation validates the independent value of analyzed diagnostic methods and suggests negligible influence of glucose utilization in bone re-modeling in the above metastatic cancer cells. The 18 F-FDG PET/CT bone scan was much better in diagnosing metastases compared to the 99m Tc-MDP scan.

Objective: The aim of this study was to differentiate between benign and malignant head and neck lymph nodes by sequential imaging., Subjects and Methods: The total of 56 retrospectively analysed patients with suspected or histopathologically confirmed head and neck malignancy (nasopharyngeal cancers mainly; 28 patients), before any treatment, underwent sequential fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) examinations for staging purposes. Remaining 28 patients with physiologic and histopathologically confirmed inflammatory (of non-specified origin) lymph nodes were included into this analysis. Patients underwent sequential PET/CT scans 60 and 90min post injection (p.i.) of the 18 F-FDG. Semi-quantitative analysis of metabolic activity within lymph nodes was based on the standardized uptake value (SUV) evaluation. To compare the metabolic activity fluctuation over time, the retention index (RI) was used. For SUV value and RI cut-off evaluation, the receiver operating characteristic (ROC) analysis was performed., Results: The SUVmax value at 60min p.i. of physiologic, inflammatory and malignant (metastatic) lymph nodes were 1.09±0.33, 2.36±0.60 and 6.31±2.74, respectively. The SUVmax value at 90min p.i. were: 1.01±0.32, 2.48±0.61, and 7.17±2.91, respectively, and there was statistically significant difference between physiologic and inflammatory and physiologic and the metastatic lymph nodes (P<0.001). The values of early and delayed SUVmax were significantly different between physiologic and inflammatory and physiologic and metastatic lymph nodes (P<0.001). The SUVmax, SUVmean values at 60 and at 90min p.i. between malignant and inflammatory lymph nodes were statistically insignificant (P=0.33). The RI at 60 and at 90min p.i. was: -6%±16% for physiologic, 6%±14% for inflammatory and 15%±13% for the metastatic lymph nodes. The SUVmax changes over time (the RI) were statistically significant for physiologic and metastatic and physiologic and inflammatory lymph nodes (P<0.001) and significant between malignant and inflammatory lymph nodes (P=0.02)., Conclusion: Sequential delayed 18 F-FDG PET/CT examinations may increase specificity of this scan and provide information for the differentiation benign and malignant lymph nodes in the cases of head and neck cancer.

Aims: To assess the safety and efficacy of transendocardial delivery of muscle-derived stem/progenitor cells with connexin-43 overexpression (Cx-43-MDS/PC) in advanced heart failure (HF)., Methods and Results: Thirteen subjects with advanced HF, New York Heart Association (NYHA) class II-III were enrolled and treated with targeted injection of Cx-43-MDS/PCs and then monitored for at least 6 months. Overexpression of Cx43 (Cx43+) was significantly higher in all but one subject (Cx43-). Injection of MDS/PCs was associated with significant improvement of exercise capacity: NYHA (3 ± 0 vs. 1.8 ± 0.7, P = 0.003), exercise duration (388.69 ± 141.83 s vs. 462.08 ± 176.69 s, P = 0.025), peak oxygen consumption (14.38 ± 3.97 vs. 15.83 ± 3.74 ml/kg.min, P = 0.022) and oxygen pulse (10.58 ± 2.89 vs. 18.88 ± 22.63 mLO 2 /heart rate, P = 0.012). Levels of BNP, left ventricular (LV) ejection fraction and LV end-diastolic volumes tended to improve. There was a significant improvement of the mean unipolar voltage amplitudes measured for the injected segments and the entire left ventricle (9.62 ± 2.64 vs. 11.62 ± 3.50 mV, P = 0.014 and 8.83 ± 2.80 vs. 10.22 ± 3.41 mV, P = 0.041, respectively). No deaths were documented, Cx43+ (n = 12) subjects presented no significant ventricular arrhythmia; one Cx43- subject suffered from ventricular tachycardia (successfully treated with amiodarone)., Conclusions: Injection of Cx-43-MDS/PCs in patients with severe HF led to significant improvement in exercise capacity and myocardial viability of the injected segments while inducing no significant ventricular arrhythmia. This may arise from improved electrical coupling of the injected cells and injured myocardium and thus better in-situ mechanical cooperation of both cell types. Therefore, further clinical studies with Cx43+ MDS/PCs are warranted., (© 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.)

A 37-year-old man with multiple myeloma in remission underwent routine fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) study for disease restaging. Both FDG-PET and CT images showed focal abnormalities in the region of the T6 vertebra, but the fused images that are routinely provided with PET/CT could precisely localize the FDG active lesion to a soft tissue focus in the epidural space, away from a lytic nonactive vertebral body lesion despite their close proximity. The PET/CT scan identified a few other metabolically active osseous lesions out of many lytic bony changes throughout the skeleton. Accordingly, the patient received the correct management for an impending spinal cord compression at the appropriate time, in addition to systemic therapy for disease relapse.