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aims: To investigate whether the midbrain SERT uptake of F-18 FP-CIT along with striatal DAT uptake could be applied in differentiation of parkinsonism. background: Parkinsonism is a term used for the collection of clinical features that cause movement disorders similar to those in Parkinson’s disease. Accurate differentiation of these disorders is critical for the treatment and prognosis of any disease. Fluorine-18 N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane (F-18 FP-CIT) has been used in the evaluation of parkinsonism by its uptake in the dopamine active transporter (DAT) of the striatum. Its uptake in other areas of the brain, such as serotonin transporters (SERT) in the midbrain or thalamus, is also known. objective: To investigate whether midbrain SERT uptake of F-18 FP-CIT could be applied to the differentiation of parkinsonism in combination with striatal DAT uptake. method: This retrospective study included 56 clinically diagnosed parkinsonism patients (3 essential tremor (ET), 21 idiopathic Parkinson’s disease (IPD), 6 multiple system atrophy – cerebellar type (MSA-C), 7 multiple system atrophy - parkinsonian type (MSA-P), 8 vascular parkinsonism (VP), and 11 drug-induced parkinsonism (DIP)) and 16 healthy controls. The patient group consisted of 29 men and 27 women (age mean ± SD years, 69.9 ± 8.5 and 69.2 ± 8.9, respectively), and the healthy controls consisted of 8 men and 8 women (age mean ± SD years, 64.5 ± 8.2 and 64.3 ± 7.6, respectively). Mean standardized uptake values (SUVs) and activity volumes were measured from the visualized FP-CIT uptake of the midbrain (substantia nigra and dorsal raphe nucleus) as well as the striatum (caudate nucleus and putamen). The mean SUVs of the occipital region were measured as the background activity. The semiquantitative binding ratio (BR) was calculated using the following formula: BR = (SUVmean of the region of interest − SUVmean of background)/SUVmean of the background. SUV, volume, and BR in each type of parkinsonism were compared with those in healthy controls using both nonparametric and parametric methods. The correlation between the visual score of the qualitative analysis and the BR was examined. result: Generally, BRs of the midbrain showed a statistically significant decrease compared to those of healthy controls, except in the ET and dorsal raphe nucleus in the VP. The BRs of the striatum were significantly decreased only in patients with IPD or MSA-P, and a greater decrease in BR was identified in the substantia nigra of the midbrain in patients with MSA-P than in those with IPD (p < 0.05). ET did not show any statistical difference in BRs between patients and healthy controls. The BRs of the substantia nigra of the midbrain in patients with MSA-C, VP, and DIP were significantly different from those of healthy controls, whereas striatal BRs did not. Finally, four patterns of uptake were identified:1) no significant decrease in striatal and midbrain uptake for ET, 2) significant decrease in striatal and midbrain uptake for IPD and MSA-P, 3) no decreased striatal uptake with decreased midbrain uptake (both substantia nigra and dorsal raphe nucleus) for MSA-C and DIP, and 4) no decreased striatal uptake with decreased substantia nigra uptake without a decrease in the dorsal raphe nucleus for VP. conclusion: The possible differential diagnoses were split into two groups when only striatal uptake was considered but they were divided into four groups after adding midbrain uptake. Although additional midbrain F-18 FP-CIT uptake still could not make a definitive diagnosis, it could provide another piece of information and specific diagnostic guidelines for the differentiation of parkinsonism. other: Accurate diagnosis for parkinsonism patients is essential for their treatment and prognosis, however, it is not achieved simply on clinical grounds. F-18 FP-CIT imaging is one of the several methods to aid in diagnosis mainly by evaluating FP-CIT uptake in the dopamine transporters (DAT) of striatum. FP-CIT is also known to be taken up by serotonin transporters (SERT) of other areas of brain. We conducted this retrospective study to investigate whether the midbrain SERT uptake of F-18 FP-CIT along with striatal DAT uptake could be applied in differentiation of parkinsonism.

Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT), a functional imaging method, is usually performed on the entire torso, and regions of unexpected suspicious focal hypermetabolism are not infrequently observed. Among the regions, colon, thyroid, and prostate were found to be the common organs in a recent umbrella review. Some studies reported that a high rate of malignancy was shown in incidentally identified focal hypermetabolic regions and suggested that further examinations should not be ignored.To investigate the malignancy rate of incidental focal FDG uptake, useful PET parameters and their cutoffs in discrimination between malignant and benign lesions.Retrospectively, the final reports of 16510 F-18 FDG PET/CT scans performed at our hospital between January 2016 and March 2022 were reviewed to identify incidentally observed FDG uptake in the colon/rectum, thyroid, and prostate. The scans of patients with current or prior malignancies at each corresponding location, without the final reports of histopathology or colonoscopy (for colon and rectum) for the corresponding hypermetabolic regions, or with diffuse (not focal) hypermetabolism were excluded. Finally, 88 regions of focal colorectal hypermetabolism in 85 patients (48 men and 37 women with mean age 67.0 ± 13.4 years and 63.4 ± 15.8 years, respectively), 48 focal thyroid uptakes in 48 patients (12 men and 36 women with mean age 62.2 ± 13.1 years and 60.8 ± 12.4 years, respectively), and 39 focal prostate uptakes in 39 patients (mean age 71.8 ± 7.5 years) were eligible for this study. For those unexpected focal hypermetabolic regions, rates of malignancy were calculated, PET parameters, such as standardized uptake value (SUV), capable of distinguishing between malignant and benign lesions were investigated, and the cutoffs of those PET parameters were determined by plotting receiver operating characteristic curves.In the colon and rectum, 29.5% (26/88) were malignant and 33.0% (29/88) were premalignant lesions. Both SUVmax and SUVpeak differentiated malignant/premalignant from benign lesions, however, no parameters could distinguish malignant from premalignant lesions. Higher area under the curve was shown with SUVmax (0.752, 95%CI: 0.649-0.856,Approximately 60% of the incidentally observed focal F-18 FDG uptake in the colon/rectum, thyroid, and prostate were found to be malignant. Of the several PET parameters, SUVmax was superior to others in distinguishing between malignant/premalignant and benign lesions. Based on these findings, incidental focal hypermetabolism should not be ignored and lead physicians to conduct further investigations with greater confidence.

Colon and rectal cancers are among the top five cancers worldwide in terms of their incidence and mortality rates. As the treatment options for cure include surgery even in specific advanced-stage cases, the early detection of lesions is important for applying active treatment methods. Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) is an established imaging study for many types of cancers; however, physiologic uptake in the gastrointestinal tract is a frequent finding and may interfere with lesion identification. Nevertheless, as unexpectedly observed focal colorectal F-18 FDG uptake may harbor malignant lesions, further examination must not be avoided.To assess the clinical implications of unexpected focal colorectal F-18 FDG uptake by analyzing FDG PET parameters.A total of 15143 F-18 FDG PET/CT scans performed at our hospital between January 2016 and September 2021 were retrospectively reviewed to identify incidentally observed focal colorectal FDG uptake. Finally, 83 regions showing focal colorectal FDG uptake with final histopathological reports from 80 patients (45 men and 35 women with mean ages of 66.9 ± 10.7 years and 63.7 ± 15.3 years, respectively) were eligible for inclusion in the present study. Each focal hypermetabolic colorectal region was classified as malignant, premalignant, or benign according to the histopathological report. PET parameters such as maximum and peak standardized uptake value (SUVmax and SUVpeak), metabolic tumor volume (MTV), mean SUV of the metabolic tumor volume (mSUVmtv), and total lesion glycolysis (TLG) were measured or calculated for the corresponding hypermetabolic regions. Parametric and non-parametric statistical comparisons of these parameters were performed among the three groups. Receiver operating characteristic curves were plotted to identify cut-off values.The detection rate of incidental focal colorectal uptake was 0.53% (80/15,143). Of the 83 regions with unexpected focal colorectal hypermetabolism, 28.9% (24/83) were malignant, 32.5% (27/83) were premalignant, and 38.6% (32/83) were benign. Overall, 61.4% of the regions had malignant or premalignant lesions. SUVmax, SUVpeak, and mSUVmtv differentiated malignant and/or premalignant lesions from benign lesions with statistical significance (Approximately two-thirds (61.4%) of incidental focal hypermetabolic colorectal regions were malignant/premalignant lesions, for which SUVmax was an independent diagnostic parameter. Unexpected suspicious focal colorectal FDG uptake should not be avoided and consideration for further evaluation is strongly recommended not to miss the two-thirds.

BACKGROUND Incidentally found thyroid tumor (thyroid incidentaloma, TI) on F-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is reported in 2.5%-5% of patients being investigated for non-thyroid purposes. Up to 50% of these cases have been diagnosed to be malignant by cytological/histological results. Ultrasonography (US) and fine-needle aspiration cytology are recommended for thyroid nodules with high FDG uptake (hypermetabolism) that are 1 cm or greater in size. It is important to accurately determine whether a suspicious hypermetabolic TI is malignant or benign. AIM To distinguish malignant hypermetabolic TIs from benign disease by analyzing F-18 FDG PET-CT parameters and to identify a cut-off value. METHODS Totally, 12761 images of patients who underwent F-18 FDG PET-CT for non-thyroid purposes at our hospital between January 2016 and December 2020 were retrospectively reviewed, and 339 patients [185 men (mean age: 68 ± 11.2) and 154 women (mean age: 63 ± 15.0)] were found to have abnormal, either focal or diffuse, thyroid FDG uptake. After a thorough review of their medical records, US, and cytological/histological reports, 46 eligible patients with focal hypermetabolic TI were included in this study. The TIs were categorized as malignant and benign according to the cytological/histological reports, and four PET parameters [standardized uptake value (SUV)max, SUVpeak, SUVmean, and metabolic tumor volume (MTV)] were measured on FDG PET-CT. Total lesion glycolysis (TLG) was calculated by multiplying the SUVmean by MTV. Both parametric and non-parametric methods were used to compare the five parameters between malignant and benign lesions. Receiver operating characteristic (ROC) curve analysis was performed to identify a cut-off value. RESULTS Each of the 46 patients [12 men (26.1%; mean age: 62 ± 13.1 years) and 34 women (73.9%; mean age: 60 ± 12.0 years)] with focal hypermetabolic TIs had one focal hypermetabolic TI. Among them, 26 (56.5%) were malignant and 20 (43.5%) were benign. SUVmax, SUVpeak, SUVmean, and TLG were all higher in malignant lesions than benign ones, but the difference was statistically significant (P = 0.012) only for SUVmax. There was a positive linear correlation (r = 0.339) between SUVmax and the diagnosis of malignancy. ROC curve analysis for SUVmax revealed an area under the curve of 0.702 (P < 0.05, 95% confidence interval: 0.550-0.855) and SUVmax cut-off of 8.5 with a sensitivity of 0.615 and a specificity of 0.789. CONCLUSION More than half of focal hypermetabolic TIs on F-18 FDG PET-CT were revealed as malignant lesions, and SUVmax was the best parameter for discriminating between malignant and benign disease. Unexpected focal hypermetabolic TIs with the SUVmax above the cut-off value of 8.5 may have a greater than 70% chance of malignancy; therefore, further active assessment is required.

Background and Purpose Evaluation of dorsal nigral hyperintensity on MRI can help detect nigrostriatal degeneration. We aimed to compare the diagnostic performance between susceptibility map-weighted imaging (SMWI) and N-3-fluoropropyl-2-β-carbomethoxy-3-β-(4-iodophenyl) nortropane (18F-FP-CIT) positron emission tomography (PET) as an initial diagnostic tool of parkinsonism. Materials and methods This local ethics committee-approved retrospective study enrolled 223 patients with parkinsonism and 15 healthy subjects (mean age, 69.7 years; 135 females) who underwent both SMWI at 3T and 18F-FP-CIT PET. The diagnostic performances of the two tests for nigrostriatal degeneration were compared by evaluating whether the 90% confidence interval (CI) of the difference between the two tests was within the equivalence margin by using the DTComPair package of R. The concordance rate was tested by Cohen's kappa. Results The diagnostic sensitivities of SMWI and 18F-FP-CIT PET were 94.5% and 100% per SN and 100% and 100% per participant, respectively; their specificities were 95.3% and 86.7% per SN and 94.4% and 84.0% per participant, respectively. While the diagnostic sensitivity was comparable between the two tests for each SN and participant, the lower 90% CI of the differences in the specificity were −0.086 per SN and −0.104 per participant, indicating a higher diagnostic specificity of SMWI than that of 18F-FP-CIT PET. When excluding 20 participants with basal ganglia lesions, the two tests exhibited similar diagnostic performance and had excellent agreement (k = 0.899 per SN; k = 0.945 per participant). Conclusion For patients with parkinsonism, SMWI and 18F-FP-CIT PET exhibit similar diagnostic performance.

Purpose: This study was to evaluate changes of the mechanical loading pattern after anatomic anterior cruciate ligament (ACL) reconstruction by analyzing uptake patterns using combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT). Materials and Methods: On SPECT/CT, high signal intensity of the articular surface which shows biological activity and mean increase of mechanical loading was compared with that of the tibiofemoral shaft as a comparative signal. The proportion of positive signals was evaluated in all compartments of the operated knee. Analysis was performed according to combined injury. Results: A relatively high proportion of positive signals was detected in the posterior zone of the lateral tibial plateau (23.5%) and trochlear groove (23.5%) although increased signal intensity was detected in all compartments. There was no statistical difference depending on the presence of combined injury and between single-bundle and double-bundle ACL reconstruction. Conclusions: Following anatomic ACL reconstruction, higher signal intensity was detected, particularly in the posterior part of the lateral tibial plateau and trochlear groove. Close observation for further signal changes or osteoarthritic changes would be required even if there was no combined injury and anatomic reconstruction was performed.

The sol–gel nanoporous capturing technology represents a powerful approach where the sol–gel matrix constrains the motion of the encapsulated biomolecules (proteins, peptides, chemicals, antibodies, nucleotides, etc.) without physical adsorption or any modifications. This technology can be applied to multiplex immunoassay platform because several disease markers can be immobilized and tested at once. In this study, we have tested several thousand specimens using Hi3-1 Multiplex human immunodeficiency virus (HIV) 1/2 and hepatitis C virus (HCV) antibody detection kit at two clinical trials institutes. These results showed a highest sensitivity (100%, n = 500 HIV-positive specimens and n = 400 HCV-positive) and specificity (99.99% for HIV and 99.83% for HCV, n = 7706 negative specimens) by using Hi3-1 kit, which screens HIV1/2 and HCV antibodies simultaneously. Finally, we suggested that our screening technology was successfully utilized as a multiplex HIV and HCV diagnostic tool for blood bank screening.

To determine whether treatment response in patients with knee pain could be predicted using uptake patterns on single-photon emission computed tomography/computed tomography (SPECT/CT) images.Ninety-five patients with knee pain who had undergone SPECT/CT were included in this retrospective study. Subjects were divided into three groups: increased focal uptake (FTU), increased irregular tracer uptake (ITU), and no tracer uptake (NTU). A numeric rating scale (NRS-11) assessed pain intensity. We analyzed the association between uptake patterns and treatment response using Pearson's chi-square test and Fisher's exact test. Uptake was quantified from SPECT/CT with region of interest (ROI) counting, and an intraclass correlation coefficient (ICC) calculated agreement. We used Student's t-test to calculate statistically significant differences of counts between groups and the Pearson correlation to measure the relationship between counts and initial NRS-1k1. Multivariate logistic regression analysis determined which variables were significantly associated with uptake.The FTU group included 32 patients; ITU, 39; and NTU, 24. With conservative management, 64 % of patients with increased tracer uptake (TU, both focal and irregular) and 36 % with NTU showed positive response. Conservative treatment response of FTU was better than NTU, but did not differ from that of ITU. Conservative treatment response of TU was significantly different from that of NTU (OR 3.1; p = 0.036). Moderate positive correlation was observed between ITU and initial NRS-11. Age and initial NRS-11 significantly predicted uptake.Patients with uptake in their knee(s) on SPECT/CT showed positive treatment response under conservative treatment.

Recently, the structured data format in RDF/OWL has played an increasingly vital role in the semantic web. We converted pediatric and oncologic nuclear medicine imaging reports in free text into RDF/OWL format and evaluated the usefulness of nuclear medicine imaging reports in RDF/OWL by comparing SPARQL query results with the manually retrieved results by physicians from the reports in free text. SPARQL query showed 95% recall for simple queries and 91% recall for dedicated queries. In total, SPARQL query retrieved 93% (51 lesions of 55) recall and 100% precision for 20 clinical query items. All query results missed by SPARQL query were of some inference. Nuclear medicine imaging reports in the format of RDF/OWL were very useful for retrieving simple and dedicated query results using SPARQL query. Further study using more number of cases and knowledge for inference is warranted.

Recently, new gamma camera systems enabling low radiation dose imaging have been developed. We reviewed the recent development of these low dose gamma camera systems including high sensitivity detectors, device structures, noise reduction filters, efficient image reconstruction algorithms, low dose protocols, and so on. It is expected that further technological advances reduce both radiation dose and imaging time in gamma camera imaging especially for radiation-sensitive patients such as pediatric patients.

Background context Superior vena cava (SVC) obstruction can cause the development of collateral vessels. During contrast-enhanced thoracic computed tomography (CT), contrast material may reflux into the collaterals such as paravertebral venous plexus. However, an unusual pseudopathologic vertebral body enhancement on CT in the presence of SVC obstruction has not been studied previously. Purpose To demonstrate clinical presentation and imaging findings of pseudopathologic vertebral body enhancement in patients with SVC obstruction. Study design Retrospective study of diagnostic CT images examined at our clinic. Patient sample From March, 2009 to September, 2012, a retrospective radiologic database review was performed to identify patients with obstruction of SVC causing contrast reflux into collateral vessels and presented with an unusual vertebral body enhancement on thoracic CT. Thirteen patients (11 men, mean age 51.4 years) with vertebral body enhancement were enrolled. Outcome measures Enhancement patterns of vertebral bodies were classified as nodular enhancement with round shape occupying less than one-third of vertebral body or polygonal enhancement occupying greater than or equal to one-third of vertebral body on axial image. The locations of enhanced areas within vertebral bodies were described using right lateral/central/left lateral, anterior/posterior, and upper/middle/lower in the x-, y-, or z-axis directions, respectively. Materials and methods Enhancement patterns, locations, and the presence of a connection between vertebral body enhancement and the paravertebral venous plexus were evaluated. Results A total of 39 vertebral body enhancements were found in the 13 patients, involving cervical (n=12), thoracic (n=25), or lumbar (n=2) vertebrae. Vertebral body enhancements showed a nodular (n=19) or a polygonal (n=20) pattern. The central portions of vertebral bodies were more frequently involved. The connection to the paravertebral venous plexus was observed in 34 lesions (87.2%). Conclusions Patients with SVC obstruction with extensive collateral vessels might exhibit a pseudopathologic vertebral enhancement. They tended to involve the central portion of the vertebral body, and most of them showed connection to the paravertebral venous plexus.

Rib fractures are one of main causes of chest or flank pain when related to an osteoporotic vertebral compression fracture (OVCF). The authors investigated the incidence and risk factors of rib fracture in 284 patients with OVCF using bone scans and evaluated the feasibility as to whether bone scans could be utilized as a useful screening tool. Hot uptake lesions on ribs were found in 122 cases (43.0%). The factors analyzed were age, sex, number and locations of fractured vertebrae, BMD, and compression rates as determined using initial radiography. However, no statistical significances were found. In 16 cases (5.6%), there were concurrent multiple fractures of both the thoracic and lumbar spines not detected by single site MRI. Sixty cases (21.1%) of OVCF with the a compression rate of less than 15% could not be identified definitely by initial plain radiography, but were confirmed by bone scans. It is concluded that a bone scan has outstanding ability for the screening of rib fractures associated with OVCF. Non-adjacent multiple fractures in both thoracic and lumbar spines and fractures not identified definitely by plain radiography were detected on bone scans, which provided a means for determining management strategies and predicting prognosis. Graphical Abstract

Purpose The aim of this study was to investigate the relationship between the maximum standardized uptake values (SUVmax) of primary renal cancers with and without metastatic lesions, if any. We also studied the relationship between the size of primary renal cancers and their SUVmax, and tried to find a clinical value of 18F-FDG PET-CT for the initial evaluation of renal cell carcinoma (RCC). Methods The cases of 23 patients, 16 men and 7 women, who underwent PET-CT examination before operation were retrospectively reviewed. We measured the SUVmax of the primary renal cancers and those of any existing metastatic lesions, and the size of the primary renal cancers. We compared the SUVmax of primary RCCs with metastases and those without metastases, SUVmax of primary RCC and those of metastases, and studied the correlation between the size and SUVmax of primary RCCs. Results The SUVmax of primary RCC of the 16 patients without metastasis ranged from 1.1 to 5.6 with a median value of 2.6. Those of the patients with metastasis ranged from 2.9 to 7.6 with a median of 5.0. The size of the all 23 primary renal cancers ranged from 1.7 cm to 13.5 cm, with a median of 4.5 cm, and their SUVmax ranged from 1.1 to 7.6, with a median of 2.9. There was a statistically significant difference between the SUVmax of the primary RCC with metastasis (5.3 ± 1.7) and those without metastasis (2.9 ± 1.0). There was a moderate positive correlation between the sizes and SUVmax of all 23 primary RCCs. However, there was no statistically significant correlation between the sizes and SUVmax of primary RCCs with metastatic lesions and the same for RCCs without metastasis. The cutoff value of SUVmax for predicting extra-renal lesion was 4.4 and that for size was 5.8 cm according to the receiver operating characteristic curves. Conclusions Those who have primary RCC with high SUVmax are suggested to have a likelihood of metastasis. Also, there was a moderate trend of increasing value of SUVmax of primary RCC as their size increases. Physicians should beware of missing extra-renal lesions elsewhere.

As the use of positron emission tomography-computed tomography (PET-CT) has increased rapidly, there is a need to retrieve relevant medical images that can assist image interpretation. However, the images themselves lack the explicit information needed for query. We constructed a semantically structured database of nuclear medicine images using the Annotation and Image Markup (AIM) format and evaluated the ability the AIM annotations to improve image search. We created AIM annotation templates specific to the nuclear medicine domain and used them to annotate 100 nuclear medicine PET-CT studies in AIM format using controlled vocabulary. We evaluated image retrieval from 20 specific clinical queries. As the gold standard, two nuclear medicine physicians manually retrieved the relevant images from the image database using free text search of radiology reports for the same queries. We compared query results with the manually retrieved results obtained by the physicians. The query performance indicated a 98 % recall for simple queries and a 89 % recall for complex queries. In total, the queries provided 95 % (75 of 79 images) recall, 100 % precision, and an F1 score of 0.97 for the 20 clinical queries. Three of the four images missed by the queries required reasoning for successful retrieval. Nuclear medicine images augmented using semantic annotations in AIM enabled high recall and precision for simple queries, helping physicians to retrieve the relevant images. Further study using a larger data set and the implementation of an inference engine may improve query results for more complex queries.

Background Multidetector CT (MDCT) is being increasingly used for patients with traumatic injuries in the emergency room. This is the first study to evaluate the diagnostic performance of MDCT for sternal fracture. Patients and methods For 87 patients who had motor vehicle accidents, we evaluated the diagnostic performance of MDCT for the sternal fractures. For 31 patients who underwent both MDCT and lateral radiography for the sternum, we compared the diagnostic performance of two examinations for the evaluation of sternal fracture. Results Thirty-two patients had sternal fractures and all the sternal fractures (sensitivity = 100%) were detected on MDCT, especially on the sagittal reconstruction images. However, the axial and coronal images detected 65% and 59% of all sternal fractures, respectively. For 31 patients who underwent both MDCT and lateral radiography for the sternum, MDCT showed superior diagnostic performance compared to that of radiography (accuracy = 97% and 77%, respectively, P = .02). For the one case that showed false positivity for sternal fracture on MDCT due to respiratory artifact, the lateral radiography enabled making the correct diagnosis. Conclusion Sternal fracture is frequently seen in patients who have blunt trauma injury secondary to motor vehicle accidents. MDCT, particularly sagittal images detect all of the sternal fractures, is superior to lateral radiography for diagnosis of sternal fracture. In the limited case that CT has severe motion artifact, additional radiography could help the diagnosis of sternal fracture.

Until now, serum tumor markers, physical examination, and conventional imaging modalities, such as CT or MRI, have been used in assessment of recurrence of cervical cancer after treatment. However, CT and MRI provide only anatomical data, which makes analysis of post-treatment change difficult. This study aims to explore the effectiveness of PET/CT, a new scanning device that combines PET and CT, in evaluation of cervical cancer lesions in patients with suspected recurrence.We studied 51 patients suspected of recurrence among those who underwent F-18 FDG PET/CT for cervical cancer follow-up at Gachon University Gil Hospital between June 2006 and August 2009. Patients were considered to be at risk for recurrence if they reported symptoms that were clinically suggestive of recurrence, or if physical examination showed abnormalities, serum tumor marker levels rose, or follow-up images revealed changes, such as new lesions or swelling of previous sites. Sensitivity, accuracy, specificity, and positive and negative predictive values of PET/CT were measured.A total of 37 patients were confirmed with recurrence or metastasis, 13 of whom were diagnosed histologically. Measured across all patients, PET/CT scored 97.3% on sensitivity, 71.4% on specificity, a positive predictive value of 90%, a negative predictive value of 90.9%, and an accuracy of 90.2%. PET/CT yielded only one false negative diagnosis and four false positives.As F-18 FDG PET/CT has high sensitivity and negative predictive value in diagnosis of recurrent cervical cancers, it is expected that it will be useful for clinical determination of recurrence and prevention of unnecessary additional treatments. The hope is that a future study on a larger scale will contribute further to determination of the efficacy of PET/CT.

It is well known that [(18)F]FDG PET has a low sensitivity in the detection of hepatocellular carcinoma (HCC). We prospectively compared [(11)C]acetate PET/CT results with those of [(18)F]FDG PET/CT in patients with HCCs. Thirteen patients (M:F=11:2, mean age of 51+/-12) with suspicious or confirmed HCCs underwent [(11)C]acetate PET/CT with or without [(18)F]FDG PET/CT (both [(11)C]acetate and [(18)F]FDG PET/CT were performed in 10 patients). HCC was confirmed by histopathology or clinical criteria in 12 patients and one benign liver lesion. Both PET/CT images were interpreted by two experienced nuclear physicians, supported by standardized uptake value (SUV). A total of 12 patients were confirmed to have initial or recurrent HCCs. [(18)F]FDG PET/CT showed markedly increased uptake in only two patients, moderately increased uptake in another two and negative in six. [(11)C]acetate PET/CT demonstrated markedly increased uptake in seven patients, moderately increased uptake in three and negative in only two. One HCC metastatic lesion was detected only by [(11)C]acetate PET/CT. For detection of HCC, [(11)C]acetate PET/CT showed a high sensitivity of 83%, whereas [(18)F]FDG PET/CT only of 40%. The study results demonstrated that [(18)F]FDG PET/CT has a limitation in detection of HCC and [(11)C]acetate PET/CT has a complementary role to [(18)F]FDG PET/CT. When primary HCC showed low [(18)F]FDG uptake, it was [(11)C]acetate-avid, and vice versa. It may be useful to combine both [(18)F]FDG and [(11)C]acetate PET/CT for detection of HCCs.

The purpose of this study was to investigate coronary endothelial dysfunction in young healthy smokers by measuring myocardial blood flow (MBF) using [(15)O]H(2)O-PET. The study population was 18 young male volunteers consisted of 9 smokers (age: 23.8+/-1.1yr) and 9 non-smokers (age: 25.0+/-2.5yr). The smokers had been smoking cigarettes for 6.6+/-2.5 pack years. Myocardial [(15)O]H(2)O-PET was performed at rest, during cold (5 degrees C) pressor stimulation and during adenosine infusion. Left ventricular (LV) input function and tissue time-activity curves were obtained by drawing region of interest (ROI) on the LV blood pool and myocardium images obtained by non-negative matrix factorization (NMF) of dynamic [(15)O]H(2)O-PET data, and MBF was calculated using these time-activity curves and single compartmental model. There were no significant difference in resting MBF between two groups (smokers: 1.43+/-0.41 and non-smokers: 1.37+/-0.41ml/g/min; P=NS). However, during cold pressor stimulation, MBF in smokers was significantly lower than that in non-smokers (1.25+/-0.33 vs. 1.59+/-0.29ml/g/min; P=0.019). MBF changed to 90+/-24% of resting MBF in smokers and 122+/-28% in non-smokers. The difference in the ratio of cold pressor MBF to basal MBF between two groups was also significant (P=0.024). During adenosine infusion, however, hyperemic MBF did not differ significantly between smokers and non-smokers (5.81+/-1.99 vs. 5.03+/-1.27ml/g/min; P=NS). This study shows that [(15)O]H(2)O PET analysis can reveal that endothelial dysfunction occurs in even young smokers of about 6 pack years.

Here, a growth-factor-integrated natural extracellular matrix of type I collagen is presented that induces angiogenesis. The developed matrix adapts type I collagen nanofibers integrated with synthetic colloidal particles of recombinant bacteriophages that display vascular endothelial growth factor (VEGF). The integration is achieved during or after gelation of the type I collagen and the matrix enables spatial delivery of VEGF into a desired region. Endothelial cells that contact the VEGF are found to invade into the matrix to form tube-like structures both in vitro and in vivo, proving the angiogenic potential of the matrix.

Purpose: The aim of this study was to evaluate the clinical value of whole body F-fluorodeoxyglucose positron emission tomography (FDG-PET) in the patient with a recurrence of a previously treated colorectal malignancy. Materials and Methods: Fifty-eight cases were scanned using PET at the PET Center of Seoul National University Hospital between May 1995 and Aug 2002. All the patients had had a previous operation for a colorectal malignancy. The PET scans were performed for the following reasons: - investigation of a recurrence (n=12), investigation of the operability (n=38) and clinical follow up (n=8). In these 58 cases, 47 of the CT scans and 55 of the CEA (Carcinoembryonic antigen) were checked prior to the FDG- PET. The accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the PET scans were calculated, and compared with those of conventional CT scan and CEA, which were also compared with the previous reported data. Eight cases, whose managements were influenced by the PET findings, were analyzed. Results: Recurrences, or metastases, of colorectal cancer developed in 51 cases, with 49 of these being detected by the PET. The accuracy, sensitivity and specificity of the PET were 96.6 (56/58), 96.1 (49/51) and 100% (7/7), respectively. The PPV and NPV of the PET were 100 (49/49) and 77.8% (7/9), respectively. The accuracy and sensitivity of the PET were higher than those of the CT (85.1 and 88.1%), with the differences being statistically significant (p-value 0.001 and 0.003, respectively). Conclusion: It is concluded that a FDG-PET scan is a more accurate and sensitive diagnostic tool than a CT scan for the detection of a recurrence or metastasis in a colorectal malignancy. In addition, a FDG-PET may alter the management of patients with recurrent colorectal cancer. Therefore, it is recommended that a PET should be considered when a tumor recurrence is suspected during conventional follow up.

The authors report myocardial perfusion imaging of a patient showing reverse redistribution (RR) and a 64-slice multidetector-row computed tomography (MDCT) with corresponding findings. The patient had subendocardial myocardial infarction (MI) with positive electrocardiogram (EKG) findings and elevated levels of cardiac isoenzymes. Experiencing this case emphasizes the importance of complementary correlation of a new diagnostic modality that helps us to understand the nature of RR.

The purpose of this study was to evaluate the prognostic value of metabolic tumor volume (MTV) measured by (18)F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) in patients with diffuse large B-cell lymphoma (DLBCL) treated with rituximab-containing immunochemotherapy.Patients with newly diagnosed DLBCL who underwent pre-treatment torso FDG-PET/CT scan taken within 10 days before treatment were included. MTV was defined as the volume of hypermetabolic tissue with a standardized uptake value (SUV) greater than a threshold value of 2.5 and calculated using volume viewer software. Association of MTV with patient characteristics and survival were compared.A total of 96 patients were evaluated. During a median follow-up period of 27.8 months, 3-year event-free survival (EFS) and overall survival was 69.5 % and 72.9 %, respectively. The Ann Arbor staging showed a limitation of prognosis because there was no difference of EFS between patients with Ann Arbor stage II and those with stage III. On the contrary, among patients with Ann Arbor stage II or III disease (n = 53), the higher MTV group showed significantly inferior EFS compared with the lower MTV group.In the current study, we identified the pre-treatment MTV measured by FDG-PET/CT as a potential predictor of survival in patients with DLBCL treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP), at least in Ann Arbor stage II and III disease.

Biological materials with surface-active proteins can be genetically modified to bind target materials. In particular, filamentous-shaped M13 bacteriophages (M13 phage) are attractive scaffolds for functional nanostructures due to their highly ordered protein-coat surface. This paper demonstrates a simple method for fabricating silica nanocables along a modified M13 phage. The M13 phage was genetically engineered to display the amino acid serine on the surface to provide hydroxyl groups for a sol-gel reaction. This M13 phage mutant offers homogeneous molecular templates for forming silica coated coaxial nanocables. Silica shell formation was confirmed by transmission electron microscopy (TEM) and electron dispersive X-ray (EDX) analysis. The core-shell structures were clearly distinguishable in the TEM analysis, and the synthesized shells were observed by EDX analysis. In addition, we investigated the adsorption properties of M13 phages on the pretreated substrate as a function of concentration. The effect of the relative concentration of M13 phages on the substrate was observed by using atomic force microscopy (AFM). We also fabricated top electrodes on the extremely dense network for measuring electrical properties of the M13 phage. The experimental DC measurement indicated that the wild-type phage has very low electrical conductance, similar to insulating material.

To assess the usefulness of (18)F-fluorodeoxyglucose PET/CT in the detection of bone marrow (BM) involvement of high-grade non-Hodgkin's lymphoma (NHL).One hundred twenty patients with newly diagnosed diffuse large B-cell lymphoma or peripheral T-cell lymphoma between January 2007 and June 2011, who received BM trephine biopsy and (18)F-FDG PET/CT before chemotherapy, were included in this retrospective study. We reviewed their (18)F-FDG PET/CT images and bone marrow biopsy (BMB) results. After reviewing the images, we reviewed the medical records and radiological findings of interesting patients.There were 23 (18)F-FDG PET/CT scans in which the marrow was considered to be abnormal (either positive or equivocal), and 97 (18)F-FDG PET/CT scans were regarded as having negative FDG uptake. Of 120 patients, 100 (83.3 %) had a concordant result of BM interpretation between (18)F-FDG PET/CT and BMB, and the remaining 20 patients had discordant results. Among 23 patients with either positive or equivocal (18)F-FDG PET/CT scans, 1 of 12 patients with 'positive' (18)F-FDG PET/CT had a lymphomatous involvement on BMB. In contrast, 10 of 11 patients with 'equivocal' BM hypermetabolism were reported as having positive involvement by BMB. Patients with abnormal (18)F-FDG PET/CT had significantly higher mSUVhighest than those with normal FDG-PET/CT.(18)F-FDG PET/CT and BMB are complementary techniques in assessing the presence of BM involvement in patients with high-grade NHL. The increasing availability of (18)F-FDG PET/CT will raise the need for additional biopsy for FDG-avid lesions, especially in patients with negative standard BMBs. (18)F-FDG PET/CT can be useful as a decision-making tool for determining whether to perform a standard BMB or targeted biopsy to the FDG-avid lesion as an initial staging procedure. A direct bone biopsy for FDGpositive bone lesions should be included in staging guidelines in future. In (18)F-FDG PET/CT-negative cases, BMB is still a powerful procedure, but BMB alone is insufficient for full evaluation of BM.

To evaluate the role of FDG-PET/CT in detecting bone marrow (BM) involvement, pre-treatment bilateral bone marrow biopsies (BMBs) and FDG-PET/CT scans of 89 patients with diffuse large B-cell lymphoma (DLBCL) treated with rituximab–CHOP were reviewed and analyzed. Fourteen patients (15.7%) had lymphomatous involvement based on BMB (BMB+), and 17 patients (19.1%) had the possibility of BM involvement on FDG-PET/CT (FDG-PET/CT+). Seventy-two patients (80.8%) had concordant results between BMB and FDG-PET/CT (seven patients were positive for both, and 65 patients were negative for both), but 17 patients (19.2%) had a discordant interpretation (seven patients were BMB+ and FDG-PET/CT−, and ten were BMB− and FDG-PET/CT+). Although BMB+ patients had an inferior 2-year EFS (37.0% vs. 79.8%, p < 0.001) and OS (36.3% vs. 81.0%, p < 0.001) compared to BMB− patients, no differences in EFS (62.6% vs. 72.7%, p = 0.185) and OS (59.4% vs. 78.0%, p = 0.146) were shown between FDG-PET/CT+ and FDG-PET/CT− patients. Whereas six of seven patients with diffuse hypermetabolism were BMB+, only one of ten patients with focal hypermetabolism was BMB+. The results suggest that FDG-PET/CT had a limited value to detect BM involvement in patients with DLBCL. Focal hypermetabolism of hematopoietic BM in FDG-PET/CT had no impact on survival.

Tc-99m ciprofloxacin is available for imaging infection. However, there has been no study on employing single photon emission computed tomography (SPECT) with using Tc-99m ciprofloxacin to image active pulmonary tuberculosis. Therefore, we conducted this study to assess the efficacy of Tc-99m ciprofloxacin SPECT for imaging active pulmonary tuberculosis.Twenty-one participants were enrolled in this prospective study. They were divided into two groups according to the clinical and radiological assessment. Group one (Gr. 1) consisted of five normal volunteers and six patients with inactive pulmonary tuberculosis. Group two (Gr. 2) consisted of ten patients with active pulmonary tuberculosis. SPECT was performed 3 h after injecting 555 MBq (15 mCi) of Tc-99m ciprofloxacin. The findings of Tc-99m ciprofloxacin SPECT were interpreted by a nuclear medicine specialist and then the results were analyzed according to the patients' clinical and radiological classifications.The results of Tc-99m ciprofloxacin SPECT were as follows: eight true-positive cases, ten true-negative cases, one false-positive case and two false-negative cases. The sensitivity and specificity was 80.0% and 90.9%, respectively. The positive predictive value was 88.9% and the negative predictive value was 83.3%.Tc-99m ciprofloxacin SPECT is feasible for imaging active pulmonary tuberculosis. It is a useful nuclear-imaging method for discriminating between the active and inactive tuberculosis states in patients with a past medical history of pulmonary tuberculosis.

The fast segmentation of the liver in the CT images is the important but difficult procedure for subsequent image processing and analysis. We applied the pseudocolorization and connected component labeling methods to segment the upper dome area of the liver in the transeverse CT slice images. Arterial phase transeverse CT slice images including the upper dome area of the liver was used for segmentation by the methods. The original transverse slice CT images were pseudocolorized and the color component images including the liver were separated. And the connected component labeling algorithm was performed and the upper dome area of the liver was segmented. The segmentation of the remaining portion of the liver in the neighboring CT slice images can be done effectively with active contouring or region growing with interslice reference to the previously segmented liver CT image.

OBJECTIVE: The purpose of our study was to assess the effect on image quality and radiation dose of chest multidetector computed tomography (CT) examinations with low-kilovoltage protocols for adults. METHODS: This study was approved by the institutional review board of our medical center. Two hundred ten patients (83 women, 127 men; mean age, 56.1 years) requiring contrast-enhanced chest CT examination were randomly assigned to 1 of 3 protocol groups: (1) protocol A, the standard protocol, with 120 kilovolt (peak) (kV[p]) and 100 effective milliampere-second (eff mA s); (2) protocol B, with 100 kV(p) and 140 eff mA s; and (3) protocol C, with 80 kV(p) and 180 eff mA s. Each group included 70 patients. Contrast material injection protocols were standardized for all groups. Three radiologists blinded to the CT parameters used assessed images in random order for 20 items from 4 anatomical regions. They ranked the subjective image quality using a 4-point scale. The volume computed tomography dose index (CTDIvol) and dose length product (DLP) were displayed by the CT unit after the automatic exposure control-driven acquisition was recorded for each group; the differences were analyzed for statistical significance. RESULTS: When the overall agreement was pooled from the 3 observers, the qualitative score analysis revealed no significant difference between the 100-kV(p) and the standard protocols (P > 0.05). However, when the scores were compared between the 80-kV(p) and the standard protocols, a marginal significance (P = 0.054) was observed. When the patients in the group with an 80-kV(p) protocol were subcategorized according to body mass index (BMI), the image quality scores of all BMI subgroups, of the 80-kV(p) protocol, were not significantly different from those of the standard protocol. However, an increase in the BMI tended to be associated with a decrease in the subjective image quality. The mean values of CTDIvol for 120-, 100-, and 80-kV(p) protocols were 5.042, 4.507, and 2.883, respectively. The mean values of DLP for each protocol were 187.5, 158.7, and 105.8, respectively. The CTDIvol and DLP of the low-kilovoltage protocols were significantly lower than those of the standard protocol (P < 0.01). The DLP of the 100- and 80-kV(p) protocols were reduced radiation exposure doses in 15.36% and 43.57%, respectively, as compared with the standard protocol. CONCLUSIONS: The use of low-kilovoltage protocol resulted in a significant reduction in the radiation exposure at chest CT, with image qualities comparable with those of the standard protocols.

A RPxIP-RP HPLC separation scheme was combined with on-line ESI-IT tandem MS or off-line MALDI tandem TOF MS and applied to the analysis of eukaryotic subcellular proteomes. Previous proteomic studies [1] were complemented by the approval of the approach to eukaryotic proteomes using the fission yeast Schizosaccharomyces pombe. The major focus was set to the analysis of primary human hepatocyte microsomes, representing a compartment of high interest due to its involvement in xenobiotic detoxification and cholesterol homeostasis. Of the 588 proteins identified from two donors, 24% are involved in cholesterol homeostasis or xenobiotic/lipid metabolism. Up to 50% of the identified proteins belong to the group of membrane proteins, difficult to investigate using gel-based proteomic approaches. We further demonstrated the reproducibility and comparability of the approach and reduced the amount of sample load by almost 70% with only minor loss of information about the proteins identified in the samples. The presented study clearly demonstrates the good applicability of the experimental setup to the analysis of subcellular proteomes including large membrane fractions, where only low amounts of sample material are available.

DMSA renal scan has been used to evaluate renal parenchymal lesions such as pyelonephritis. However, it is frequently difficult to differentiate pelvocalyectatic defects from true cortical defects. We investigated whether DMSA renal scan images could be effectively evaluated by computer-assisted texture analysis such as fractal texture analysis. We retrospectively analyzed 35 DMSA renal scan images - 12 normal kidneys, 11 with pelvocalyectatic cortical defects and 12 with true cortical defects. The kidneys on DMSA scan images were segmented by the binary threshold and subtraction techniques, and the texture analysis was done using a fractal texture analysis tool (Image-J). The values from the texture analysis were compared between the three groups using student’s t-test and ROC curve analysis. In addition, patients’ urinanalysis laborotary data was added to the texture analysis values and analyzed using discriminant analysis. The kidney images with true cortical defects showed higher fractal texture values than those of normal or pelvocalyectatic kidneys, but was not statistically significant. There was a significant difference in fractal texture values only between normal and pelvocalyectatic kidneys (p

An increased aldosterone concentration can lead to a progression of heart diseases and to myocardial fibrosis. These fatal processes can be prevented by e.g. inhibiting the mineralocorticoid receptor (MR), which is nowadays part of a commonly applied standard therapy. Moreover, selective inhibition of aldosterone synthase (CYP11B2) is a straightforward goal whereby CYP11B1, a key enzyme in glucocorticoid biosynthesis exhibiting a high structure identity with CYP11B2 should not be inhibited. Therefore, effective test systems have been developed and rather potent and selective CYP11B2 compounds like SIAS-1 have been identified by our group. In addition to finding new inhibitors, we investigated which proteins are directly influenced by aldosterone focussing on non-genomic effects. Schizosaccharomyces pombe was chosen as a model organism, since this yeast does not contain nuclear steroid receptors, but many genes and regulatory mechanisms that are close to those of mammals. Besides creating a reference map for this organism, protein spots affected by aldosterone as well as deoxycorticosterone (DOC) and corticosterone have been identified. In case of aldosterone, a regulatory effect of proteins that are connected with structural proteins, signal cascades, osmoregulation and calcium pathway as well as to general metabolism have been discovered. DOC causes overlapping but also different effects compared with aldosterone. As shown exemplarily for GAPDH, the aldosterone-mediated effects in S. pombe can also be verified in mammalian cells. These and further investigations contribute to a deeper understanding of so-called non-genomic aldosterone effects.

The fission yeast Schizosaccharomyces pombe (S. pombe) is a unicellular eukaryote and contains many genes and regulatory mechanisms that are close to those of mammals. In this study, we performed a global proteomic analysis of the fission yeast S. pombe wild type h(-S) L 972 proteome. More than 1,500 protein spots were visualized on silver stained 2-D gels in the 3-10 pI range with a high resolution and high reproducibility. Protein identification was carried out by MALDI-TOF-MS and/or nanoLC-MS/MS. Advantage of the complementarity of these two MS approaches was used to enhance the identification quality. So far, 364 proteins (representing 157 different proteins) have been identified. We report here the identification of 117 new proteins on our 2-D reference map of this yeast compared to the first reference map. Of these identified proteins, 40.1% were involved in metabolism. The present work provides a very useful tool for all studies relying on S. pombe as a model organism and is a considerable complement to the first reference map of S. pombe published recently by Sun and coworkers (Sun, N., Jang, J., Lee, S., Kim, S. et al.., Proteomics 2005, 5, 1574-1579).

Both breast ultrasonography (US) and scintimammography (SMM) shows limited diagnostic accuracy in the differential diagnosis of breast cancer. We investigated whether the diagnostic performance of computer-aided diagnosis (CAD) of US was improved by adding SMM results. We retrospectively reviewed 40 breast US images and corresponding SMM images from 40 patients who presented with breast masses (21 malignant and 19 benign tumors). The morphologic features of the breast lesions on US were extracted and quantitated using the automated CAD software program (So no Eye, CAD Impact, Inc., Seoul, Korea), which calculated the probability of malignancy based on the stored database. The quantitative data of SMM were obtained as the uptake ratio of lesion to contralateral normal breast on SMM SPECT. The diagnostic accuracy of CAD of US and SMM was determined using ROC curve analysis, respectively. The best discriminating function combining the CAD results of US and SMM uptake value was created using linear discriminant analysis and the diagnostic performance was compared to that using only one diagnostic modality. Both US and SMM showed a relatively good diagnostic accuracy (area under curve=0.831 and 0.846, respectively). Combining CAD results of US and SMM resulted in improved diagnostic accuracy (area under curve =0.860), but it was not statistically significant. The diagnostic performance of CAD of breast US in the differential diagnosis of the breast mass was not significantly improved by adding SMM. However, SMM SPECT may be complementary to CAD of US in differential diagnosis of breast cancer.

The authors report brain images of 18F-FDG-PET in a case of schizophrenia. The images showed strikingly increased bilateral uptake in the locus ceruleus. The locus ceruleus is called the blue spot and known to be a center of the norepinephrinergic system.

The authors evaluated the utility of F-18 fluorodeoxyglucose (FDG) coincidence detection (CoDe) positron emission tomography (PET) for staging, post-treatment evaluation, and follow-up assessment of patients with malignant lymphomas.Fifty-eight patients with histologically proved malignant lymphomas (4 Hodgkin's disease, 54 non-Hodgkin's lymphoma) underwent CoDe PET using F-18 FDG. CoDe PET was performed using a dual-head gamma camera equipped with coincidence detection circuitry. Of the 87 CoDe PET studies, 26 were performed for staging, 38 for post-treatment evaluation, and 23 for follow-up evaluation of recurrence. The entire trunk, from the cervical to the inguinal regions, or selected regions were scanned with the patient in the supine position. No attenuation correction was made and reconstruction was performed using filtered back-projection rather than iterative reconstruction. CoDe PET findings were compared with corresponding results of computed tomographic (CT) and magnetic resonance imaging (MRI), tissue biopsy, or clinical follow-up.For staging, 52 sites were positive on CoDe PET or CT-MRI. CoDe PET detected 49 sites (94%), and CT-MRI showed 47 sites (90%). CoDe PET detected five more lymphomatous lesions and missed three lesions. For post-treatment evaluation, CoDe PET showed a positive predictive value of 100% and a negative predictive value of 83%, but the validated cases numbered only 11. For follow-up for recurrence, CoDe PET had a negative predictive value of 90%, but frequent false-positive findings were noted in the head and neck region as a result of underlying inflammatory changes.For staging, FDG CoDe PET alone without attenuation correction is not sensitive enough to be used as an independent imaging method, especially for small abdominal lesions. However, it appears to be an accurate method for assessing residual disease and for patient follow-up.

A 7-year-old boy presented with an undifferentiated embryonal sarcoma of the liver (UESL), which is a rare pediatric neoplasm that originates from the mesenchyme. F-18 FDG PET/CT associated with a separately acquired contrast-enhanced CT was performed to evaluate the status of the tumor during postoperative chemotherapy, which followed the initial neoadjuvant chemotherapy (vincristine, cisplatin, adriamycin, cyclophosphamide, and actinomycin-D) and radical tumor resection. Evaluation of the F-18 FDG PET/CT demonstrated the presence of a highly metabolic lesion in the liver (primary site) and the presence of distinct foci of FDG uptake as a result of tumor metastases, with 3 foci being observed in both lungs and one being observed in the right adrenal gland. This case gives a suggestion that F-18 FDG PET/CT can be valuable method for evaluation of the status of UESL.

Abstract 5204 Backgrounds: As a bone marrow bopsy (BMB) is a painful and invasive procedure with a restrictive reliability as only a limited area of the bone marrow (BM) can be evaluated, role of FDG-PET/CT to demonstrate lymphomatous BM involvement as an alternative or at least a complementary to BMB is an area of interest. Several previous studies exist but most of them included heterogeneous types of lymphomas with various treatments. Patients and methods: To evaluate the role of FDG-PET/CT in detecting BM involvement, pre-treatment bilateral BMBs and FDG-PET/CT scans of 89 patients with diffuse large B-cell lymphoma (DLBCL) treated with standard immunochemotherapy, rituximab-CHOP were reviewed and analyzed. Uptake more than liver parenchyma intensity on FDG-PET/CT was interpreted as 'with a possibility' of involvement. The final interpretation on the possibility of BM involvement in each patient was reported after discussion among three nuclear medicine physicians and results of BMB were blinded at the time of FDG-PET/CT review. Fourteen patients (15.7%) had lymphomatous involvement based on BMB (BMB+) and 17 patients (19.1%) had the possibility of BM involvement on FDG-PET/CT (FDG-PET/CT+). Seventy-two patients (80.8%) had concordant results between BMB and FDG-PET/CT (7 patients were positive for both and 65 patients were negative for both), but 17 patients (19.2%) had a discordant interpretation (7 patients were BMB+ and FDG-PET/CT-, and 10 for BMB- and FDG-PET/CT+; table 1). Although BMB+ patients had an inferior 2-year EFS (37.0% vs. 79.8%, p < 0.001) and OS (36.3% vs. 81.0%, p < 0.001) compared to BMB- patients, no differences in EFS (62.6% vs. 72.7%, p = 0.185) and OS (59.4% vs. 78.0%, p = 0.146) were shown between FDG-PET/CT+ and FDG-PET/CT- patients. Six of 7 patients with BMB+ and FDG-PET/CT+ had a diffuse involvement on FDG-PET/CT whereas 9 of 10 patients with BMB- and FDG-PET/CT+ had a focal BM involvement on FDG-PET/CT (table 2). Six of 7 patients with diffuse involvement on FDG-PET/CT were BMB+ whereas only 1 of 10 patients with focal BM involvement on FDG-PET/CT were BMB+ (table 2). It is likely therefore that patients with diffuse BM involvement on FDG-PET/CT had higher probability for BMB+ and they might have poorer survival than those with focal BM involvement. Conclusion: The results suggest that FDG-PET/CT had a limited value to detect BM involvement in patients with DLBCL. It may not be justified to upgrade patient's Ann Arbor stage to IV according to focal hypermetabolic BM lesion on FDG-PET/CT. Until additional results on the role of FDG-PET/CT in detecting BM involvement available, FDG-PET/CT should be used as an adjuvant rather than an alternative in detecting BM involvement in patients with newly diagnosed DLBCL. Disclosures: No relevant conflicts of interest to declare.