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The World Health Organization classification divides thymomas according to morphology, epithelial component, and cell atypia. They are grouped into 3 large subgroups: low-risk thymomas (types A, AB, and B1), high-risk thymomas (types B2 and B3), and thymic carcinomas. Tumor subtype represents an independent prognostic factor, which determines therapeutic decision. All thymomas show some degree of (18)F-FDG uptake, which tends to increase with the grade of malignancy; this is related to glucose transporter 1 (GLUT1) expression. This review collects all types of thymomas with illustrative images and provides a guide to get familiar with histological characteristics of the lesions and have them in mind because, even imaging findings can overlap among subtypes, certain characteristics can be combined to make an accurate diagnosis based on (18)F-FDG PET-CT findings.

The purpose of this study was to determine the prognostic value of metabolic volumetric parameters as a quantitative index on pre-treatment 18F-FDG PET/CT in addition to the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) in patients with diffuse large B-cell lymphoma (DLBCL). A total of 103 consecutive patients with DLBCL and baseline FDG PET/CT were retrospectively evaluated. Quantitative metabolic parameters, including total metabolic tumour volume (TMTV) using a standardized uptake value (SUV) of ≥2.5 as the threshold, were estimated. Receiver operating characteristic curve analysis was used to determine the optimal cut-off values for the metabolic parameters. The relationships between study variables and patient survival were tested using Cox regression analysis. Patient survival rates were derived from Kaplan-Meier curves and compared using the log-rank test. Median follow-up was 34 months. In patients with a low TMTV (

Predicting biochemical recurrence of prostate cancer is imperative for initiating early treatment, which can improve the outcome of cancer treatment. However, because of inter- and intrareader variability in interpretation of F-18 fluciclovine positron emission tomography/computed tomography (PET/CT), it is difficult to reliably discern between necrotic tissue owing to radiation therapy and tumor tissue. Our goal is to develop a computational methodology using Haralick texture analysis that can be used as an adjunct tool to improve and standardize the interpretation of F-18 fluciclovine PET/CT to identify biochemical recurrence of prostate cancer. Four main textural features were chosen by variable selection procedure using least absolute shrinkage and selection operator logistic regression and bootstrapping, and then included as predictors in subsequent logistic ridge regression model for prediction (n = 28). Age at prostatectomy, prostate-specific antigen (PSA) level before the PET/CT imaging, and number of days between the prostate-specific antigen measurement and PET/CT imaging were also included in the prediction model. The overfitting-corrected area under the curve and Brier score of the proposed model were 0.94 (95% CI: 0.81, 1.00) and 0.12 (95% CI: 0.03, 0.23), respectively. Compared with a model with textural features (TI model) and that with only clinical information (CI model), the proposed model achieved 2% and 32% increase in AUC and 8% and 48% reduction in Brier score, respectively. Combining Haralick textural features based on the PET/CT imaging data with clinical information shows a high potential of enhanced prediction of the biochemical recurrence of prostate cancer.

Objective To analyze the performance of sequential naïve pinhole bone scan (nPBS) and gamma correction pinhole bone scan (GCPBS), reinforced by ImageJ densitometry and pixelized microfracture measurement, for making specific diagnoses of bone marrow edema (BME), bone marrow hemorrhage (BMH), and trabecular microfractures (TMF). Methods We prospectively examined BME, BMH, TMF, and normal trabeculae in 10 patients using sequential nPBS and GCPBS. The intensity of 99mtechnetium-hydroxydiphosphonate (99mTc-HDP) uptake was measured using a pixelized method and calculated using ImageJ densitometry in terms of arbitrary units (AU). This overall method was termed a visuospatial-mathematic assay (VSMA). We analyzed the ability of the calculated AU values to discriminate between the four states using GraphPad Prism software, with reference to previous morphological data. Results The calculated values were categorized as ≤50 AU for normal trabecula, 51–100 AU for BME, 101–150 AU for BMH, and ≥151 AU for TMF. The difference in uptake between normal trabecula and BME was significant and the differences among BME, BMH, and TMF were highly significant. Conclusion VSMA is a useful technique for refining objective individual diagnoses and for differentiating and quantitating BME, BMH, and TMF.

Renal metastasis of thyroid cancer is extremely rare. We report the case of a 62-year-old woman with Hürthle cell thyroid cancer (HCTC) with lungs, bones, and bilateral kidneys metastases. The renal metastatic lesions were clearly demonstrated by 131I whole body scan (WBS) with SPECT/CT. However, they exhibited false-negative results in 18F-FDG PET/CT, kidney ultrasonography, and contrast-enhanced CT scan. The findings imply that tumors have low glucose metabolism and are able to accumulate radioiodine, which is not commonly found in the relatively aggressive nature of HCTC. The patient received two sessions of 200 mCi 131I therapy within 6 months duration. There was complete treatment response as evaluated by the second post-therapeutic 131I SPECT/CT and serum thyroglobulin. To our knowledge, renal metastasis from HCTC with positive 131I but negative 18F-FDG uptake has not been reported in the literature. This case suggests that 131I SPECT/CT is useful for lesion localization and prediction of 131I therapy response.

Dopaminergic degeneration is a hallmark of Parkinson's disease (PD), which causes various symptoms affected by corticostriatal circuits. So far, the relationship between cortical changes and dopamine loss in the striatum is unclear. Here, we evaluate the gray matter (GM) changes in accordance with striatal dopaminergic degeneration in PD using hybrid PET/MR. Sixteen patients with idiopathic PD underwent (18) F-FP-CIT PET/MR. To measure dopaminergic degeneration in PD, binding ratio (BR) of dopamine transporter in striatum was evaluated by (18) F-FP-CIT. Voxel-based morphometry (VBM) was used to evaluate GM density. We obtained voxelwise correlation maps of GM density according to the striatal BR. Voxel-by-voxel correlation between BR maps and GM density maps was done to evaluate region-specific correlation of striatal dopaminergic degeneration. There was a trend of positive correlation between striatal BR and GM density in the cerebellum, parahippocampal gyri, and frontal cortex. A trend of negative correlation between striatal BR and GM density in the medial occipital cortex was found. Voxel-by-voxel correlation revealed that the positive correlation was mainly dependent on anterior striatal BR, while posterior striatal BR mostly showed negative correlation with GM density in occipital and temporal cortices. Decreased GM density related to anterior striatal dopaminergic degeneration might demonstrate degeneration of dopaminergic nonmotor circuits. Furthermore, the negative correlation could be related to the motor circuits of posterior striatum. Our integrated PET/MR study suggests that the widespread structural progressive changes in PD could denote the cortical functional correlates of the degeneration of striatal dopaminergic circuits. Hum Brain Mapp 37:1710-1721, 2016. © 2016 Wiley Periodicals, Inc.

PURPOSE We conducted a meta-analysis to evaluate the prognostic value of the SUVmax measured in pretreatment primary lesions and metastatic lymph nodes (LNs) on 18F-FDG PET scans in patients with uterine cervical cancer. METHODS A systematic search of EMBASE and MEDLINE was performed using the keywords "positron emission tomography (PET)," "uterine cervical cancer," and "prognosis." Event-free survival and overall survival were evaluated as outcomes. The impact of SUVmax on survival was measured by the effect size of the hazard ratio (HR). RESULTS Fourteen eligible studies including 1150 patients were analyzed. Patients with a high primary SUVmax showed a worse prognosis, with an HR of 2.66 (95% confidence interval [CI], 1.90-3.74; P < 0.00001) for adverse events and an HR of 2.45 (95% CI, 1.74-3.45; P < 0.00001) for death. Patients with high SUVmax in metastatic pelvic LN (PLN) showed a worse prognosis, with an HR of 2.92 (95% CI, 1.94-4.39; P < 0.00001) for adverse events and an HR of 2.66 (95% CI, 1.60-4.43; P = 0.0002) for SUVmax in PLN for death. In addition, high SUVmax in metastatic para-aortic LN was associated with a worse prognosis, with an HR of 4.41 (95% CI, 2.32-8.38; P < 0.00001) for death. CONCLUSIONS Patients with uterine cervical cancer and a high SUVmax primary lesion, PLN, or para-aortic LN are at higher risk of adverse events or death.

The purpose of this study was to determine the prognostic value of metabolic volumetric parameters as a quantitative index on pre-treatmentA total of 103 consecutive patients with DLBCL and baseline FDG PET/CT were retrospectively evaluated. Quantitative metabolic parameters, including total metabolic tumour volume (TMTV) using a standardized uptake value (SUV) of ≥2.5 as the threshold, were estimated. Receiver operating characteristic curve analysis was used to determine the optimal cut-off values for the metabolic parameters. The relationships between study variables and patient survival were tested using Cox regression analysis. Patient survival rates were derived from Kaplan-Meier curves and compared using the log-rank test.Median follow-up was 34 months. In patients with a low TMTV (249 cmPretreatment TMTV was an independent predictor of survival in patients with DLBCL. Importantly, TMTV had an additive prognostic value in patients with a high-risk NCCN-IPI. Thus, the combination of baseline TMTV with NCCN-IPI may improve the prognostication and may be helpful guide the decision for intensive therapy and clinical trials, especially in DLBCL patients with a high-risk NCCN-IPI.

Objective.99mTc-ethylenedicysteine-glucosamine (99mTc-EC-G) was developed as a potential alternative to18F-FDG for cancer imaging. A Phase 2 study was conducted to compare18F-FDG PET/CT and99mTc-EC-G SPECT/CT in the detection and staging of patients with non-small cell lung cancer (NSCLC). This study was aimed to demonstrate that99mTc-EC-G SPECT/CT was not inferior to18F-FDG PET/CT in patients with confirmed NSCLC.Methods.Seventeen patients with biopsy proven NSCLC were imaged with99mTc-EC-G and18F-FDG to detect and stage their cancers. Imaging with PET/CT began 45–60 minutes after injection of18F-FDG. Imaging with99mTc-EC-G began at two hours after injection (for 5 patients) or three hours (for 12 patients). SPECT/CT imaging devices from the three major vendors of SPECT/CT systems were used at 6 participating study sites. The image sets were blinded to all clinical information and interpreted by independent PET and SPECT expert readers at a central independent core laboratory.Results.100% concordance between99mTc-EC-G and18F-FDG for primary lesion detection, lesion location and size, and confidence that the biopsied lesion was malignant. There was 70% agreement between99mTc-EC-G and18F-FDG for metastatic lesion detection, location and size, and confidence that the suspicious lesions were malignant.Conclusions.Evaluation of primary and suspicious metastatic lesions detected by99mTc-EC-G and18F-FDG on 17 patients resulted in excellent agreement for detection of primary and metastatic lesions. The study results indicated that99mTc-EC-G SPECT/CT has the potential to be a clinically viable alternative to18F-FDG PET/CT and99mTc-EC-G is not inferior to18F-FDG PET/CT.

Attenuation correction (AC) with an ultrashort echo time (UTE) sequence has recently been used in combination with segmentation for cortical bone identification for brain PET/MR studies. The purpose of this study was to evaluate the quantification of (18)F-fluoropropyl-carbomethoxyiodophenylnortropane ((18)F-FP-CIT) binding in brain PET/MR, particularly focusing on effects of UTE-based AC including bone segmentation.Sixteen patients with initially suspected parkinsonism were prospectively enrolled. An emission scan was acquired 110 min after (18)F-FP-CIT injection on a dedicated PET/MR scanner, immediately followed by another emission scan using a PET/CT scanner 120 min after the injection. A UTE-based attenuation map was used to classify the voxels into 3 tissues: bone, soft tissue, and air. All PET images were spatially normalized, and a specific-to-nonspecific dopamine transporter (DAT) binding ratio (BR) was calculated using statistical probabilistic anatomic mapping. The level of agreement was assessed with intraclass correlation coefficients (ICCs). Voxelwise comparison between PET images acquired from PET/MR and PET/CT was performed. We compared non-attenuation-corrected images to analyze UTE-based AC effects on DAT quantification.BR in the putamen obtained from PET/MR and PET/CT showed low interequipment variability, whereas BR in the caudate nucleus showed significant variability (ICC = 0.967 and 0.682 for putamen and caudate nucleus, respectively). BR in the caudate nucleus was significantly underestimated by PET/MR, compared with PET/CT (mean difference of BR = 0.66, P0.0001). Voxelwise analysis revealed that PET/MR showed significantly low BR in the periventricular regions, which was caused by a misclassification of the ventricle as air on the attenuation map. We also compared non-AC images, revealing low interequipment variability even in the caudate nucleus (ICC = 0.937 and 0.832 for putamen and caudate nucleus, respectively).Our data demonstrate spatial bias of the DAT BR on (18)F-FP-CIT PET/MR. Voxelwise analysis and comparison to non-AC images identified the misclassification of ventricle as air to be the cause of bias. To obtain reliable quantification for brain PET/MR studies including (18)F-FP-CIT PET, alternative and more reliable segmentation strategies are required.

We conducted a comprehensive systematic review of the literature on volumetric parameters and a meta-analysis of the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients with head and neck cancer (HNC). Methods: A systematic search of MEDLINE and EMBASE was performed using the key words PET, head and neck, and volume. Inclusion criteria were 18 F-FDG PET used as an initial imaging tool; studies limited to HNC; patients who had not undergone surgery, chemotherapy, or radiotherapy before PET scans; and studies reporting survival data. Event-free survival and overall survival were considered markers of outcome. The impact of MTV or TLG on survival was measured by the effect size hazard ratio (HR). Data from each study were analyzed using Review Manager. Results: Thirteen studies comprising 1,180 patients were included in this study. The combined HR for adverse events was 3.06 (2.33–4.01, P , 0.00001) with MTV and 3.10 (2.27–4.24, P , 0.00001) with TLG, meaning that tumors with high volumetric parameters were associated with progression or recurrence. Regarding overall survival, the pooled HR was 3.51 (2.62–4.72, P , 0.00001) with MTV and 3.14 (2.24–4.40, P , 0.00001) with TLG. There was no evidence of significant statistical heterogeneity at an I2 of 0%. Conclusion: MTV and TLG are prognostic predictors of outcome in patients with HNC. Despite clinically heterogeneous HNC and the various methods adopted between studies, we can confirm that patients with a high MTV or TLG have a higher risk of adverse events or death.

W.J. Lee Dordrecht, The Netherlands: Springer Nature BV, 2019, 184 pages, $169.99 Vitamin C is an antioxidant and very important in maintaining our life and a healthy body. It is produced in the liver and excreted through the proximal tubules of the kidneys. It can be transported through several

D.S. Lee (ed.) Cham, Switzerland: Springer International Publishing AG, 2018, 446 pages, $159.99 Nuclear medicine is practiced every day in the clinic by nuclear physicians in collaboration with nuclear biologists, chemists, and physicists. Nanomedicine is a medical application of nanotechnology

Purpose The new modality of an integrated positron emission tomography/magnetic resonance imaging (PET/MRI) has recently been introduced but not validated. Our objective was to evaluate clinical performance of 18F-fluoro-2-deoxyglucose (18F-FDG) PET/MRI in patients with head and neck cancer. Methods This retrospective study was conducted between January 2013 and February 2013. Ten patients (eight men, two women; mean age, 61.4 ± 13.4 years) with histologically proven head and neck tumors were enrolled. Whole-body PET/MRI and regional positron emission tomography (PET) with dedicated MRI were sequentially obtained. Maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume, total lesion glycolysis and contrast enhancement were analyzed. A total of ten whole-body positron emission tomography (PET), ten regional positron emission tomography (PET), ten dedicated MRI and ten regional PET/gadolinium-enhanced T1-weighted (Gd)-MRI images were analyzed for initial staging. Two nuclear medicine physicians analyzed positron emission tomography (PET) and PET/MRI with a consensus. One radiologist analyzed dedicated MRI. The primary lesions and number of metastatic lymph nodes analyzed from each image were compared. Results Eight patients were diagnosed with head and neck cancer (one tongue cancer, four tonsillar cancers, one nasopharyngeal cancer and two hypopharyngeal cancers) by histological diagnosis. Two benign tumors (pleomorphic adenoma and Warthin tumor) were diagnosed with surgical operation. Whole-body positron emission tomography (PET) and regional positron emission tomography (PET) attenuated by MRI showed good image quality for the lesion detection. Whole-body positron emission tomography (PET) and regional positron emission tomography (PET) detected ten primary sites and compensated for a missed lesion on dedicated MRI. A discordant number of suspicious lymph node metastases was noted according to the different images; 22, 16, 39 and 40 in the whole-body positron emission tomography (PET) only, dedicated MR, regional positron emission tomography (PET) only and regional PET/Gd-MRI, respectively. There was no distant metastasis based on analysis of whole-body positron emission tomography (PET) and whole-body PET/Dixon-volume interpolated breathhold examination (VIBE) MRI. Regional PET/Gd-MRI combined with whole-body PET/MRI modified staging in three patients. Lesions of primary tumor and suspicious metastasis were well detected on both value of SUVmax and visual analysis. The regional PET/Gd-MRI combined with whole-body PET/MRI showed convenient clinical staging performance compared with positron emission tomography (PET) and MRI alone. Conclusion In this preliminary study, PET attenuated by MRI showed good image quality to detect lesions. And whole-body PET/MRI as a single modality was feasible for staging in a clinical setting. Whole-body positron emission tomography (PET), regional positron emission tomography (PET), dedicated MRI and regional PET/Gd-MRI showed discordant results in lesion detection. These discordant results might be synergistic effect for accurate staging.

Twenty patients with neuroblastoma who undertook pretreatment FDG PET/CT at our institute between 2008 and 2015 and showed MIBG avidity were retrospectively enrolled in the present study. Clinical information-including histopathology, and serum markers-and several PET parameters-including SUVmax of the primary lesion (Psuv), target-to-background ratio (TBR), metabolic tumor volume (MTV), and coefficient of variation (CV)-were analyzed. The prognostic effect of PET parameters was evaluated in terms of progression-free survival (PFS).Total 20 patients (4.5 ± 3.5 years) were divided as two groups by disease progression. Six patients (30.0 %) experienced disease progression and one patient (5.0 %) died during follow-up period. There were not statistically significant in age, stage, MYCN status, primary tumor size, serum lactate dehydrogenase (LDH), neuron-specific enolase (NSE), and ferritin level between two groups with progression or no progression. However, Psuv (FDG-PET parameters were significantly related with progression of neuroblastoma. FDG-PET/CT may have the potential as a valuable modality for evaluating prognosis in the patients with MIBG-avid pediatric neuroblastoma.

Movement impairments in Parkinson’s disease (PD) are caused by the degeneration of dopaminergic neurons and the consequent disruption of connectivity in the cortico-striatal-thalamic loop. This study evaluated brain metabolic connectivity in a 6-Hydroxydopamine (6-OHDA)-induced mouse model of PD using 18F-fluorodeoxy glucose positron emission tomography (FDG PET). Fourteen PD-model mice and ten control mice were used for the analysis. Voxel-wise t-tests on FDG PET results yielded no significant regional metabolic differences between the PD and control groups. However, the PD group showed lower correlations between the right caudoputamen and the left caudoputamen and right visual cortex. Further network analyses based on the threshold-free persistent homology framework revealed that brain networks were globally disrupted in the PD group, especially between the right auditory cortex and bilateral cortical structures and the left caudoputamen. In conclusion, regional glucose metabolism of PD was preserved, but the metabolic connectivity of the cortico-striatal-thalamic loop was globally impaired in PD.

PURPOSE We performed pretreatment angiogenesis imaging (Ga-NOTA-arginyl-glycyl-aspartic acid [RGD] PET/CT) to compare its prognostic value to dynamic contrast-enhanced (DCE) MRI in breast cancer patients. METHODS Forty-four female patients with stage II or III breast cancer (aged 47.3 ± 8.1 years) were prospectively enrolled and underwent Ga-NOTA-RGD PET/CT and DCE-MRI imaging. All patients received neoadjuvant chemotherapy and underwent surgery. With pretreatment Ga-NOTA-RGD PET/CT, SUVmax of the tumor in the torso (-T) and regional (-R) images were measured. With pretreatment DCE-MRI, the largest diameter of the tumor and maximum enhancement index (EImax; EImax = [highest signal / baseline signal] - 1) of the tumor were assessed. RESULTS Ten patients (22.7%) were found to have breast cancer recurrence after 17.9 ± 11.2 months. The SUVmax-R (P = 0.017, cutoff >2.79) of Ga-NOTA-RGD PET/CT, the largest diameter of tumor (P = 0.017, cutoff >6.3 cm), and the EImax (P = 0.008, cutoff >5.38) of DCE-MRI showed significant results by univariate analysis. The 3-year disease-free survival of SUVmax-R was 91.7% versus 59.1% by Kaplan-Meier analysis (hazard ratio, 5.379). Multivariable analysis demonstrated that SUVmax-R with tumor diameter or EImax were the significant parameters. In addition, the combined parameters of SUVmax-R and EImax revealed better predictive value for prediction of breast cancer recurrence (75.0%) than each parameter of SUVmax-R (64.2%) and EImax (68.7%). CONCLUSIONS Increased angiogenic activity of regional Ga-NOTA-RGD PET/CT (SUVmax-R) can be an early prognostic marker for the prediction of breast cancer recurrence.

Until now, there was no single standardized regional segmentation method of planar lung perfusion scan. We compared planar scan based two segmentation methods, which are frequently used in the Society of Nuclear Medicine, with reference to the lung perfusion single photon emission computed tomography (SPECT)/computed tomography (CT) derived values in lung cancer patients.Fifty-five lung cancer patients (male:female, 37:18; age, 67.8 ± 10.7 years) were evaluated. The patients underwent planar scan and SPECT/CT after injection of technetium-99 m macroaggregated albumin (Tc-99 m-MAA). The % uptake and predicted postoperative percentage forced expiratory volume in 1 s (ppoFEV1%) derived from both posterior oblique (PO) and anterior posterior (AP) methods were compared with SPECT/CT derived parameters. Concordance analysis, paired comparison, reproducibility analysis and spearman correlation analysis were conducted.The % uptake derived from PO method showed higher concordance with SPECT/CT derived % uptake in every lobe compared to AP method. Both methods showed significantly different lobar distribution of % uptake compared to SPECT/CT. For the target region, ppoFEV1% measured from PO method showed higher concordance with SPECT/CT, but lower reproducibility compared to AP method. Preliminary data revealed that every method significantly correlated with actual postoperative FEV1%, with SPECT/CT showing the best correlation.The PO method derived values showed better concordance with SPECT/CT compared to the AP method. Both PO and AP methods showed significantly different lobar distribution compared to SPECT/CT. In clinical practice such difference according to different methods and lobes should be considered for more accurate postoperative lung function prediction.

After the huge success of hybrid positron emission tomography/computed tomography (PET/CT), there has been a continuous effort to develop a hybrid positron emission tomography/magnetic resonance image (PET/MR) machine. Recently, a magnetic field–compatible PET component has been developed by a substituting photomultiplier tube (PMT) for an avalanche photodiode (APD) or silicon multiplier (SiPM). This enables development and commercialization of PET/MR. Commercial simultaneous PET/MR is now seeking clinical validation. A simultaneous PET/MR system has several intrinsic advantages over a PET/CT system, including a lower radiation dose, higher soft tissue resolution of anatomic images, and the possibility of using a novel multifunctional PET/MR probe. In addition, there is the potential for the simultaneous acquisition of an anatomic image and PET. PET/MR has a higher soft tissue resolution than PET/CT; therefore the image reader should be well trained in reading normal anatomy and abnormal findings in MR for the proper reading of PET/MR. There are many MR books and atlases available to help understand and read MR images; however, there are few PET/MR atlases. This chapter includes typical PET/MR cases of patients with malignant tumors in the area of the brain, head and neck, chest, abdomen, pelvis, and musculoskeletal system. In each case, pathologic findings and essential surrounding normal structures for interpretation are indicated and named [1–4].

Breast cancer is the most common cancer in women worldwide. Molecular imaging plays an important role in breast cancer diagnosis, staging, and treatment response evaluation. Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are the main clinical molecular imaging modalities that are based on the detection of radiotracers. This article discusses the typical radiotracers used for breast cancer imaging by PET and SPECT. In addition, radiotracers that are currently applied for human breast cancer imaging or under clinical trials are also reviewed in compliance with the categories of tumor-specific targets to which they are aimed at.

The aim of the present study was to determine whether metabolic reduction is capable of reflecting the histopathologic response and outcome after neoadjuvant chemotherapy in patients with high-grade sarcoma.Forty-two patients with histologically proven high-grade sarcoma underwent neoadjuvant chemotherapy followed by surgical resection. Quantitative F-18 fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET)/computed tomography scans were acquired before and after the first cycle and after completion of neoadjuvant chemotherapy. Standardized uptake values (SUVs) and metabolic reduction rates were compared with histopathologic response, progression-free survival, and overall survival.Baseline SUVmax was 10.9 ± 3.6 (range, 3.8-19.6). Therapeutic effect resulted in 10 patients (24%) with a satisfactory response and in 32 patients (76%) with an unsatisfactory response after completion of neoadjuvant chemotherapy. The SUV decreased to 7.8 ± 3.4 after the first cycle (t1) of chemotherapy and to 5.2 ± 3.4 after completion (t2) of chemotherapy. Histopathologic response and percentage SUV (t2) reduction rate were independent predictors of progression-free survival and overall survival in the multivariate analyses.Metabolic reduction after neoadjuvant chemotherapy evaluated by F-18 FDG PET or computed tomography can be used for stratification of the histopathologic response in patients with high-grade sarcoma.

1487 Objectives: There has been an increasing need for the development of a more specific and sensitive diagnostic probe to increase the detection of biochemical recurrence of prostate cancer (BCR PCa) before transformation into castrate resistant PCa (CRPC) and potentially metastatic CRPC. This need has motivated the development of a novel PET radiotracer, F-18-fluciclovine, which was approved by the FDA in 2016 for PCa patients with BCR after initial therapy. F-18-fluciclovine proved to be effective in altering management plans when conventional anatomical imaging fails to identify the site of disease [1]. With additional data, F-18-fluciclovine may be integrated in clinical algorithms for treatment planning in post-treatment biologically proven recurrent PCa. The aim of this study was to assess the diagnostic performance and impact on additional therapy plans in post-therapy PCa patients with rising PSA. Methods: In this retrospective data analysis, the patients were included if they met the criteria of >18 years old, history of PCa, received prior therapy (radical prostatectomy, local radiotherapy, brachytherapy) and found to have a rising PSA on consecutive measurements. Patients were excluded if there was no initial therapy (excluding initial staging scans), ongoing therapy or received prostate specific therapy within 3 months of imaging. The results of F-18-fluciclovine PET/CT were correlated with prior treatments, recent PSA levels, PSA velocity, findings on other imaging modalities, histopathological results and change in the management. Evaluation of the F-18-fluciclovine PET/CT was conducted blindly. The results of the scans were confirmed either by histopathology or follow-up data using PSA and imaging changes. The statistical analysis used a receiver-operator characteristic (ROC) curve was examined to assess the accuracy of fluciclovine relative to PSA. Sensitivity and specificity were calculated at a cutoff determined by maximizing the Youden index (J = sensitivity + specificity - 1). Results: This retrospective data analysis was conducted between January 2017 and October 2017, reviewing F-18-fluciclovine PET/CT post-therapy scans of 83 PCa patients with a rising PSA. Initially a total of 83 patients with a total of 86 F-18-fluciclovine scans were initially included in the study, with 3 patients having 2 scans within the study time. There were 8 patients excluded from further analysis; 7 due to no prior therapy (initial staging scan) and one currently receiving hormonal therapy. A final total of 75 patients were included with analysis of 78 scans. The study showed a detection rate of 71.8% (56/78). The ROC of the PSA was calculated from 70 of 78 patients with an optimal PSA cut-off of 1.41 ng/mL. The change in management with a positive scan was 83.9% (47/56). The patient demographics, detection rate, lesion demographics are listed in the table below. [asterisk]low rate of positivity is probably due to the small size and attendant sampling errors Conclusion: F-18-Fluciclovine showed improved performance of detecting biochemical recurrent prostate cancer when compared to other previously reported tracers. There was also significant impact on the management of patients with evidence of biochemical recurrent prostate cancer. REFERENCES: Akin-Akintayo OO, Jani AB, Odewole O et al. Change in Salvage Radiotherapy Management Based on Guidance With FACBC (Fluciclovine) PET/CT in Postprostatectomy Recurrent Prostate Cancer. Clinical Nuclear Medicine. 2017;42(1):322-e28.

R. Gupta, R. Matthews, L. Bangiyev, D. Franceschi, and M. Schweitzer, Eds. New York, NY: Springer, 2018, 351 pages, $179.99 PET/MRI is an exciting novel diagnostic imaging modality that combines the precise anatomic and functional information provided by MRI with the molecular data obtained with

The aim of this study was to assess the diagnostic performance of (18)F-Fluoride positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) compared with bone scintigraphy (BS) planar or BS planar and single photon emission computed tomography (SPECT) in evaluating patients with metastatic bone tumor.We performed a meta-analysis of all available studies addressing the diagnostic accuracy of (18)F-Fluoride PET, (18)F-Fluoride PET/CT, BS planar, and BS planar and SPECT for detecting the metastatic bone tumor. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios, and drew summary receiver operating characteristic curves using hierarchical regression models. We also compared the effective dose and cost-effectiveness estimated by data from the enrolled studies between (18)F-Fluoride PET or PET/CT and BS planar or BS planar and SPECT.When comparing all studies with data on (18)F-Fluoride PET or PET/CT, sensitivity and specificity were 96.2% [95% confidence interval (CI) 93.5-98.9%] and 98.5% (95% CI 97.0-100%), respectively, on a patient basis and 96.9% (95% CI 95.9-98.0%) and 98.0% (95% CI 97.1-98.9%), respectively, on a lesion basis. The Az values of (18)F-Fluoride PET or PET/CT were 0.986 for the patient basis and 0.905 for the lesion basis, whereas those of BS or BS and SPECT were 0.866 for the patient basis and 0.854 for the lesion basis. However, the estimated effective dose and average cost-effective ratio were poorer for (18)F-Fluoride PET or PET/CT than those of BS planar or BS planar and SPECT.(18)F-Fluoride PET or PET/CT has excellent diagnostic performance for the detection of metastatic bone tumor, but the estimated effective dose and average cost-effective ratio are at a disadvantage compared with BS planar or BS planar and SPECT.

e19536Background: Diffuse large B-cell lymphoma (DLBCL) and mantle cell lymphoma (MCL) represent the most common and most aggressive forms of Non-Hodgkin lymphoma (NHL) respectively. Previous work ...

H. Jadvar, H. Jacene, and M. Graham, Eds. Cambridge, U.K.: Cambridge University Press, 2017, 82 pages, $49.99 Molecular imaging is a relatively recent term. In 2007, the Society of Nuclear Medicine and Molecular Imaging formed a task force to develop standard definitions for this term and to

The practice of molecular imaging in the clinics is examined across various imaging modalities to assess the current status of clinical molecular imaging. The various physiologic and scientific bases of clinical molecular imaging are surveyed to assess the possibilities and opportunities for the deployment of the different imaging modalities in the near future. The requisites for successful candidate(s) of clinical molecular imaging are reviewed for future development.

Early detection of cellular events is important to predict the outcome of the patients. This study was aimed to use (99m)Tc EC-annexin V to image tumor cells undergoing apoptosis.In 10 patients with breast cancer, scintigraphic images and dosimetric estimates were obtained after administering (99m)Tc EC-annexin V.Nine of the 10 cases showed detectable (99m)Tc EC-annexin V uptake in tumor. Higher values of T/N ratios are associated with patient after treatment.Apoptosis can be quantified using (99m)Tc EC-annexin V.

To retrospectively compare the diagnostic accuracy of positron emission tomography (PET)/computed tomography (CT), PET, conventional imaging, and combined PET/CT and conventional imaging for tumor staging of bone and soft-tissue sarcomas, by using histologic or follow-up imaging findings as the reference standard.Institutional review board approval was received for this HIPAA-compliant study; informed consent was obtained. Integrated PET/CT was performed in 117 patients (69 male patients, 48 female patients; mean age, 42 years +/- 21 [standard deviation]; range, 9-86 years). Conventional imaging consisted of magnetic resonance imaging of the primary site, chest radiography, whole-body contrast material-enhanced CT, and bone scintigraphy. A total of four reviewers assessed all images. Overall and T staging were evaluated in 69 (59%) patients who underwent surgical removal of the primary tumors and had pathologically proved results. N and M staging were evaluated in all patients, and their reference methods were based on histologic findings (n = 101) and follow-up CT findings (n = 16).Interpretations based on combined PET/CT and conventional imaging findings correctly staged tumors in 60 (87%) of 69 patients, overstaged tumors in eight (12%) patients, and understaged tumors in one (1%) patient. Overall staging accuracy of combined PET/CT and conventional imaging was significantly higher than that at PET (P.0001). Combined PET/CT and conventional imaging resulted in correct N staging in 114 (97%) of 117 patients and M staging in 109 (93%) of 117 patients. Combined PET/CT and conventional imaging helped reduce overstaging in three (4%) patients and helped change tumor diagnosis from unresectable to resectable in two (2%) patients compared with PET/CT.The combination of PET/CT and conventional imaging is accurate in preoperative staging of bone and soft-tissue sarcoma.

Rationale and Objectives Endometriosis is a common women’s health problem. Animal models provide an invaluable tool to study the natural history of endometriosis. We previously have reported that 99mTc-labeled glutamate peptide-estradiol (99mTc-GAP-EDL) is a useful agent for imaging functional estrogen receptor (ER) via an ER-mediated process. This study was to evaluate the feasibility of using radiolabeled GAP-EDL to image ER-positive (ER +) endometriosis in nonprimate animal models. Materials and Methods 3-Aminoethyl estradiol (EDL) was conjugated to glutamate peptide (GAP) to yield GAP-EDL. In vitro cellular uptake studies of 99mTc and 68Ga-GAP-EDL inhibition with cold estrone were conducted in 13,762 rat mammary tumor cells. To create a rabbit model with endometriosis, part of uterine tissue was dissected and grafted in the peritoneal wall. Eight weeks after surgery, scintigraphic images were obtained after intravenous injection of 99mTc-GAP-EDL (1 mCi/rabbit, intravenous) at 0.5–2.0 hours, and 68Ga-GAP-EDL at 45 minutes. We also performed 68Ga-GAP-EDL blocking study in rabbit model by using tamoxifen. The rabbits were sacrificed and the grafts were excised for histologic examination. Results In vitro uptake study of 99mTc- and 68Ga-GAP-EDL in 13,762 rat breast cancer cells showed gradually increasing uptake of both tracers. Accumulation of 68Ga-GAP-EDL in 13,762 cells was inhibited with cold estrone in a dose-dependent manner. In the endometriosis model, the grafted uterine tissue could be visualized by 99mTc-GAP-EDL. Necropsy was performed at 2.5 hours after injection time. Four follicular endometrial lesions in eight implanted endometrial tissues were detected, and all lesions could be detected by 99mTc-GAP-EDL. Planar scintigraphy of uterus, ovary and implants of necropsy specimen revealed an increased uptake of 99mTc-GAP-EDL in comparison with surrounding abdominal wall tissue. Microscopic examinations support that 99mTc-GAP-EDL was accumulated in the microinvasive endometrial tissue. After blocking with tamoxifen, 68Ga-GAP-EDL accumulation in the endometrial grafts could not be visualized, and endometrial tissue-to-normal tissue count ratios were statistically higher in a nonblocked image than that in the blocked image. Conclusions Endometriosis uptake of radiolabeled GAP-EDL was via an estrogen receptor-mediated process. Radiolabeled-GAP-EDLs are useful agents for imaging endometriosis.

Neuroendocrine tumors may arise from a wide range of organs and may occur in various locations in the body. They include carcinoid tumors, paragangliomas (pheochromocytomas), medullary thyroid carcinomas, and islet cell tumors of the pancreas. In this article the authors focus on the more common tumors with origins primarily in the abdomen, namely carcinoid, paraganglioma, and pancreatic islet cell tumors. Imaging assists in delineating the sites and extent of disease, in preoperative planning for resection of the primary tumor and metastatic disease, and in follow-up. Discussion is restricted to the main imaging modalities used in these tumors: cross-sectional imaging, namely CT and MRI, and nuclear medicine studies.