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Introduction: Tertiary hyperparathyroidism (tHP) may develop in patients treated with hemodialysis or peritoneal dialysis. Parathyroidectomy may result in a significant reduction in the severity of symptoms. For the effective surgical treatment of hyperparathyroidism, proper localization of the parathyroid glands prior to surgery is essential. The sensitivity of scintigraphy in the diagnosis of tHP is lower than in the diagnosis of primary hyperparathyroidism. In recent years, positron emission tomography (PET/CT) has been gaining importance, usually as a complementary technique. Aim: The aim of this study was to determine the usefulness of PET/CT with [11C]MET in the preoperative localization diagnosis of patients with tertiary hyperparathyroidism caused by chronic kidney disease, in whom first-line diagnostic methods did not allow the localization of pathologically parathyroid glands. Material and methods: The study was conducted in a group of 19 adult patients with severe tHP who were resistant or intolerant to non-invasive treatment, with negative results of scintigraphy and ultrasonography of the neck. The study protocol included measurement of the concentration of calcium, phosphorus, and PTH in the blood serum and performing PET/CT with [11C]MET. Results: A positive result of PET/CT was obtained in 89.5% of the patients (17/19). Parathyroidectomy was performed in 52.9% of the patients (9/17) with positive results of PET/CT with [11C]MET, which were fully consistent with the results of the histopathological examinations of the removed parathyroid glands. On this basis, the sensitivity of PET/CT with [11C]MET in the preoperative localization diagnosis of patients with tHP was found to be 100%. Multiple lesions were visualized in 57.9% of the patients (11/19). Ectopic lesions were visualized in 21.1% of the patients (4/19). Conclusions: PET/CT with [11C]MET is a sensitive technique for the second-line preoperative imaging of parathyroid glands in patients with tertiary hyperparathyroidism in whom first-line examinations, such as ultrasound and scintigraphy, has failed.

Background: About 30% of patients with disseminated differentiated thyroid cancer (DTC) may experience a loss of iodine uptake. It is associated with higher aggressiveness of the tumour and a reduced 10-year survival rate. The diagnosis of non-radioiodine avid DTC metastases remains a diagnostic challenge. A helpful technique for this diagnosis is positron emission tomography with 2-[ 18 F]fluoro-2-deoxy-D-glucose (PET/CT with [ 18 F]FDG). On the other hand, there are still discussions about the clinical value of using exogenous thyroid-stimulating hormone (TSH) stimulation before PET/CT with [ 18 F]FDG. The aim of the study was the assessment of the usefulness of PET/CT with [ 18 F]FDG under TSH suppression and stimulation of TSH performed in the detection of non-radioiodine avid DTC metastases, as well as determination of the thyroglobulin concentration under suppression and stimulation of TSH, which influences the result of PET/CT with [ 18 F]FDG in patients with non-radioiodine avid DTC. Material and methods: Retrospective analysis of 37 PET/CT with [ 18 F]FDG performed in patients with DTC diagnosed and treated at the Department of Endocrinology and Isotope Therapy of the Military Institute of Medicine from January 2018 to July 2020. Of these, PET/CT with [ 18 F]FDG under exogenous rhTSH stimulation was performed in 22 patients and PET/CT with [ 18 F]FDG under TSH suppression in 15 was performed. In all analyzed patients, the result of diagnostic whole-body scintigraphy (WBS) using 80 MBq 131 I under rhTSH stimulation was negative, and the concentration of thyroglobulin after stimulation (sTg) was greater than 1.0 ng/mL. Results: In the group of patients examined under TSH suppression, non-radioiodine avid in PET/CT with [ 18 F]FDG were found in 6 out of 15 patients (40%) and in the group of patients examined under rhTSH stimulation in 10 out of 22 patients (45%). The differences between the groups were not statistically significant. The analysis of the receiver operating characteristic (ROC) curves allowed to determine the cut-off point for the positive result of PET/CT performed under TSH suppression with sTg concentration of 11.03 ng/mL. In the group of studies performed under rhTSH stimulation, the cut-off point for sTg was 6.3 ng/mL. There was no statistically significant difference between the baseline thyroglobulin (natTg) and sTg levels and the positive PET/CT result. The administration of rhTSH before the PET/CT examination also had no statistically significant effect on the maximum standard uptake value (SUVmax) of the dominant lesion identified in the PET/CT. Conclusions: 1) PET/CT with [ 18 F]FDG is a useful tool for detection of non-radioiodine avid recurrence and/or metastases of DTC. 2) The concentration of natTg and sTg is highly correlated with a positive result of PET/CT with [ 18 F]FDG. 3) The concentration of natTg is comparable with sTg in predicting a positive result of PET/CT with [ 18 F]FDG. 4) The cut-off point for a positive result of PET/CT for natTg was 1.36 ng/mL and for sTg was 7.05 ng/mL.

We propose a new in vitro model to assess the impact of 90Y-microspheres derived low-dose beta radiation on colorectal cancer cell line under various oxygenation conditions that mimic the tumor environment. Cancer cells (HCT116) proliferation was assessed using Alamar Blue (AB) assay after 48, 72, and 96 h. FLUKA code assessed changes in cancer cell populations relative to the absorbed dose. In normoxia, mitochondrial activity measured by Alamar Blue after 48–72 h was significantly correlated with the number of microspheres (48 h: r = 0.87 and 72 h: r = 0.89, p p 90Y radioembolization effects at the micro-scale.

The aim of the study was to assess the feasibility of 18FDG PET in cardiac inflammation with a particular focus on the delayed scan. Thirty-five consecutive 18FDG PET scans of patients with suspected or confirmed cardiac inflammation were retrospectively reviewed. The patients were referred for PET because of endocarditis (n = 16) or sarcoidosis (n = 19). Among them four patients had two consecutive for follow up and treatment control (two patients with sarcoidosis, two with endocarditis). In all of the cases a standard head to mid-thigh scan was performed 45–60 min after 18FDG injection as well as a delayed heart scan 1 h after the standard imaging was performed. 18FDG PET confirmed active inflammation in 10 out of 35 scans. Delayed scans in positive cases showed SUVmax value increase, but did not have an impact on the result, neither they did in negative cases—no significant differences between standard and delayed scan were found. Interestingly in 5 out of 14 cases with suspected endocarditis PET revealed the extracardiac inflammation focus, thus changing initial diagnosis. 18FDG PET also indicated which prosthesis caused inflammation if there were many. In the sarcoidosis group the aim was to confirm or exclude heart involvement (13 scans) or to assess the response to the steroid therapy (6 scans) in patients with previously confirmed sarcoidosis. PET revealed active heart disease in 3 initial scans, and 1 follow up scan. 18FDG PET is a valuable imaging method for the cardiac inflammation assessment. It adequately localises the active inflammation site. Also, since it is a whole-body scan it may detect the extracardiac inflammation foci, which in some cases may change the initial diagnosis. In our study the delayed scans showed no added value.

A 32-year-old-man, with a history of chronic urticaria from the age of 27, diagnosed with an adult-onset Still’s disease and received a low dose of glucocorticoids, methotrexate and tocilizumab. Despite the long-term combined treatments, he suffered from chronic urticaria, low-grade fever and bone pain. He was found to have high inflammatory markers, hypogammaglobulinemia, monoclonal IgM – kappa light chain in serum and increased radiotracer uptake in the whole bone scintigraphy. No pathological variants for monogenic autoinflammatory diseases were present in the genome exome sequencing. These investigations confirmed the diagnosis of Schnitzler syndrome, which is an exception before the age of 35. Switching from tocilizumab to interleukin 1 receptor inhibitor, anakinra led to a full clinical response and normalisation of inflammatory markers. Patients with a history of fever and chronic urticaria are routinely tested for monoclonal gammopathy in the context of malignancy, but it should also be considered as a sign of the autoinflammatory syndrome. The Schnitzler syndrome and the adult-onset Still’s disease share common features, so the diagnosis requires a thorough investigation to establish an optimal treatment. In the diagnostic algorithm, monoclonal gammopathy is usually considered red flag for malignancy but might be overlooked as a criterion of Schnitzler syndrome, particularly in young adults. We confirm that the interleukin 1 inhibitor should be the first line of therapy in Schnitzler syndrome, and in the presented case we found it more effective than the interleukin 6 blockade. The main goal of this paper is to increase awareness of Schnitzler syndrome among health care professionals. We aim to present features which can be helpful in differential diagnosis.

Background The aim of the study was to compare widely used ordered subset expectation maximisation (OSEM) algorithm with a new Bayesian penalised likelihood (BPL) Q.Clear algorithm in 18F-PSMA-1007 PET/CT. Methods We retrospectively assessed 25 18F-PSMA-1007 PET/CT scans with both OSEM and Q.Clear reconstructions available. Each scan was independently reported by two physicians both in OSEM and Q.Clear. SUVmax, SUVmean and tumour-to-background ratio (TBR) of each lesion were measured. Reports were also compared for their final conclusions and the number and localisation of lesions. Results In both reconstructions the same 87 lesions were reported. Mean SUVmax, SUVmean and TBR were higher for Q.Clear than OSEM (7.01 vs 6.53 [p = 0.052], 4.16 vs 3.84 [p = 0.036] and 20.2 vs 16.8 [p p = 0.032], 3.08 vs 2.70 [p = 0.04] and 15.5 vs 12.5 [p = 0.00214], respectively). For lesions ≥ 10 mm, no significant differences were observed. Findings with higher tracer avidity (SUVmax ≥ 5) tended to have higher SUVmax, SUVmean and TBR values in Q.Clear (11.6 vs 10.3 [p = 0.00278], 7.0 vs 6.7 [p = 0.077] and 33.9 vs 26.7 [p p = 0.07). Conclusions In 18F-PSMA-1007 PET/CT, Q.Clear SUVs and TBR tend to be higher (regardless of lesion localisation), especially for small and highly avid lesions. Increase in SUVs is also higher for lesions with high tracer uptake. Still, Q.Clear does not affect 18F-PSMA-1007 PET/CT specificity and sensitivity.

Patient: Female, 17-year-old Final Diagnosis: Tuberous sclerosis complex Symptoms: No specific symptoms Medication:— Clinical Procedure: — Specialty: Nuclear Medicine Objective: Rare disease Background: Tuberous sclerosis complex (TSC; Bourneville-Pringle disease) is a multisystem genetic disorder manifesting as benign tumors that can affect any system. Malignant neoplasm may coexist in patients with TSC. In such cases, there are diagnostic difficulties in distinguishing between metastatic lesions and benign changes. We show the usefulness of positron emission tomography (PET) in resolving these difficulties. Case Report: The purpose of this article is to present the usefulness of metabolic imaging using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in distinguishing benign from neo-plastic lesions in a patient with TSC. A 17-year-old female patient with TSC was referred for 18F-FDG PET/CT with suspected lung and bone metastases. The patient underwent a bilateral nephrectomy because of multiple cysts and angiomyolipomas. A colonoscopy – performed in preparation for kidney transplantation – revealed sevearal colon polyps, one of which was found to be cancerous upon histopathologic examination. A diagnosis of adenocarcinoma G3 was made and a CT scan of the chest and abdomen performed afterwards showed multiple pulmonary nodules and sclerotic bone lesions suggestive of metastases. Two 18F-FDG PET/CT scans (performed within 6 months) showed multiple nodules of 7-15 mm in diameter and changes typical of multi-focal micronodular pneumocyte hyperplasia in both lungs. In the bones, we found multiple sclerotic lesions. All of the above findings showed FDG uptake at the level of the background activity which contradicted the lesions’ metastatic origin. Conclusions: Using the example of a 17-year-old patient with TSC, we present the usefulness of metabolic imaging using 18F-FDG PET/CT in distinguishing benign from neoplastic lesions.

The aim of the study was to prospectively evaluate diagnostic performance of 18F-PSMA-1007 PET/CT in patients with prostate cancer (PCa) after radical treatment and low but rising prostate-specific antigen (PSA) levels. We prospectively enrolled 40 consecutive patients after radical treatment (80%—radical prostatectomy, 20%—radiation beam therapy) of PCa and low (0.008 to ≤2.0 ng/ml), rising PSA. Skull to mid-thigh PET/CT imaging was performed 95 (±12) min after injection of 295.5 (±14.1) MBq 18F-PSMA-1007. Detection rate was correlated with PSA levels, Gleason score (GS) and T stage ≥ 3. PET/CT results were verified during 10.3 (±4.7) months follow-up to calculate sensitivity, specificity, negative predictive values (NPV) and positive predictive values (PPV). 18F-PSMA-1007 PET/CT was positive in 24/40 patients, which yielded overall detection rate of 60%. Detection rate was 39%, 55% and 100% for PSA

Purpose: We aimed to find the minimum feasible dose of fluorodeoxyglucose (18F-FDG) in positron emission tomography/computed tomography (PET/CT) of Hodgkin lymphoma patients performed on a camera with bismuth germanate (BGO) crystals.Methods: Ninety-one 18F-FDG PET/CT scans with decreasing time per bed position (2 min, 1.5 min, 1 min, 50 sec, 40 sec, 30 sec and 20 sec) were assessed to evaluate image quality. Mean administered dose was 3.0±0.1 MBq/kg and mean uptake time was 54.0±8.7 min. The series quality was subjectively marked in 1-10 scale and then ranked 1-7 based on the mean mark. Interobserver rank correlation and intraclass correlation within each series were calculated. Phantom studies were also performed to determine if reduced acquisition time can be directly translated into a reduced dose. Results: We show the longer the time of acquisition the higher the mark and rank. The interobserver agreement in ranking was 100% with kappa coefficient of 1.00 (95% CI [0.83-1.0]). The general intraclass correlation coefficient was 0.945 (95% CI [0,936-0,952]). Only the series with 2 min and 1.5 min acquisition time were appropriate for assessment (mean mark ≥7). In phantom studies there was a linear correlation between time per bed, administered activity and number of total prompts detected by a scanner. Hence, reduction of acquisition time of 25% (from 2 min to 1.5 min) could be directly translated into a 25% dose reduction (from 3.0 to 2.25 MBq/kg).Conclusions: In patients with HL, 18F-FDG dose can be reduced by up to 25% when using a BGO crystal camera, without substantial impact on image quality.

The aim of the study was to assess the feasibility of 18FDG PET in cardiac inflammation with a particular focus on the delayed scan. Thirty-five consecutive 18FDG PET scans of patients with suspected or confirmed cardiac inflammation were retrospectively reviewed. The patients were referred for PET because of endocarditis (n = 16) or sarcoidosis (n = 19). Among them four patients had two consecutive for follow up and treatment control (two patients with sarcoidosis, two with endocarditis). In all of the cases a standard head to mid-thigh scan was performed 45–60 min after 18FDG injection as well as a delayed heart scan 1 h after the standard imaging was performed. 18FDG PET confirmed active inflammation in 10 out of 35 scans. Delayed scans in positive cases showed SUVmax value increase, but did not have an impact on the result, neither they did in negative cases—no significant differences between standard and delayed scan were found. Interestingly in 5 out of 14 cases with suspected endocarditis PET revealed the extracardiac inflammation focus, thus changing initial diagnosis. 18FDG PET also indicated which prosthesis caused inflammation if there were many. In the sarcoidosis group the aim was to confirm or exclude heart involvement (13 scans) or to assess the response to the steroid therapy (6 scans) in patients with previously confirmed sarcoidosis. PET revealed active heart disease in 3 initial scans, and 1 follow up scan. 18FDG PET is a valuable imaging method for the cardiac inflammation assessment. It adequately localises the active inflammation site. Also, since it is a whole-body scan it may detect the extracardiac inflammation foci, which in some cases may change the initial diagnosis. In our study the delayed scans showed no added value.

BACKGROUND: Myocardial perfusion scintigraphy remains one of the substantial noninvasive diagnostic methods in coronary artery disease. Recent technological advancement allowed to create novel semiconductor, dedicated cardiac gamma camera with better spatial resolution and higher energy resolution, resulting in the reduction of radiation burden and acquisition time. The aim of this study was to evaluate the efficacy and safety of stress-only supine and prone MPS with a cardiac gamma camera in patients with suspected or known coronary artery disease. MATERIAL AND METHODS: A total number of 203 consecutive patients with suspected or known coronary artery disease, who underwent MPS were enrolled in the study. The patients without perfusion abnormalities on stress supine and prone MPS scans had no rest MPS, in the remaining patients two-day stress-rest imaging was performed. The group of 160 patients with one-year follow up was subjected to final analysis. RESULTS: Stress-only protocol of myocardial perfusion imaging was performed in 72 patients, 88 patients underwent two-day stress and rest myocardial perfusion scintigraphy. In 46 out of 72 stress-only group of patients, prone study did not affect further proceedings. However, in over 1/3 of cases (26/72), prone scans resulted in abstaining from rest imaging. One year follow-up revealed no sudden cardiac deaths or myocardial infarctions in both (stress-only and stress-rest) groups. Revascularization was performed most often in the double-positive group — patients with significant ischaemia on myocardial perfusion images and chest pain or electrocardiographic changes or both during the stress test. In this double-positive group, all 11 patients had coronary angiography (two of them prior to myocardial perfusion scintigraphy), nine of them had subsequent revascularization. CONCLUSIONS: In patients with no significant perfusion abnormalities on stress scans omitting rest study is safe with very good one-year risk prognosis of acute cardiac events and allows to limit the radiation exposure and procedure duration. Additional prone acquisitions are valuable supplements in determining the decision of safe early completion of myocardial perfusion imaging.

18-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) is currently the most valuable imaging technique in Hodgkin lymphoma. Since its first use in lymphomas in the 1990s, it has become the gold standard in the staging and end-of-treatment remission assessment in patients with Hodgkin lymphoma. The possibility of using early (interim) PET during first-line therapy to evaluate chemosensitivity and thus personalize treatment at this stage holds great promise, and much attention is now being directed toward this goal. With high probability, it is believed that in the near future, the result of interim PET-CT would serve as a compass to optimize treatment. Also the role of PET in pre-transplant assessment is currently evolving. Much controversy surrounds the possibility of detecting relapse after completed treatment with the use of PET in surveillance in the absence of symptoms suggestive of recurrence and the results of published studies are rather discouraging because of low positive predictive value. This review presents current knowledge about the role of 18-FDG-PET/CT imaging at each point of management of patients with Hodgkin lymphoma.

OBJECTIVES Sentinel lymph node (SLN) mapping is currently a routine technique in breast cancer management and preoperative scintigraphic imaging plays a crucial role in the process of SLN detection. The guidelines recommend performing planar acquisition and optional single-photon emission tomography/computed tomography (SPECT/CT) imaging. The aim of this study was to verify whether routine performing of SPECT/CT in addition to planar imaging increases the sensitivity of SLN detection in patients with early-stage breast cancer. The secondary aims were to compare radionuclide SLN imaging with intraoperative SLN detection and identify clinical and histopathological factors affecting the SLN detection rate. MATERIALS AND METHODS A total of 153 early-stage breast cancer patients underwent lymph node scintigraphy in the years 2007-2013. Breast cancer patients with staging T1-2N0M0 were included. Planar and SPECT/CT lymphoscintigraphy were performed on the day before the surgery. The data on presence or absence of SLN, their number and localization were recorded for both methods and compared with each other as well as with intraoperative blue dye staining and histopathological findings. RESULTS SPECT/CT identified SLN in 119/153 and planar scintigraphy in 114/153 patients. Identification rates were 77.7 and 74.5%, respectively. Intraoperative lymph node assessment identified SLN in 76/126 cases with an identification rate of 60.3%. Identification rates for second echelon lymph node were 34.6% for hybrid imaging and 21.2% for planar scintigraphy. Statistical analysis did not yield a significant difference in diagnostic accuracy between these methods; however, the Wilcoxon signed-rank test showed that SPECT/CT significantly increases SLN identification rate compared with planar scintigraphy and intraoperative detection. Histopathological examination of excised SLN showed that 22 nodes were metastatic. SPECT/CT visualized all of these, whereas planar imaging and intraoperative lymph node detection procedure visualized 19 and 18, respectively. No clinical and histopathological factors affecting SLN detection rate were identified. CONCLUSION Hybrid SPECT/CT lymphatic mapping yields a high SLN detection rate in patients with early-stage breast cancer and provides lymph node localization details. It identifies more SLN than planar imaging and intraoperative SLN detection. However, its limited superiority over the remaining two methods does not support its routine use for SLN localization. We suggest using SPECT/CT for SLN detection in case of equivocal planar imaging results.

PURPOSE OF THE REPORT The aim of the study was to prospectively compare performance of F-fluorocholine (FCH) and F-prostate-specific membrane antigen (PSMA)-1007 PET/CT in patients with biochemical relapse (BCR) of prostate cancer and low prostate-specific antigen levels. METHODS We prospectively enrolled 40 BCR patients after radical treatment and prostate-specific antigen levels 2.0 ng/mL or less. F-FCH and F-PSMA-1007 PET/CT imaging was performed within a mean interval of 54 ± 21 days. Scans were done 87 ± 10 and 95 ± 12 minutes after injecting 248 ± 35 and 295 ± 14 MBq of F-FCH and F-PSMA-1007, respectively. Rates of negative, equivocal, and positive scan results were compared per patient. Per lesion, findings were grouped as equivocal or highly suggestive of malignancy and then compared for their number, localization (local relapse, lymph nodes, bones), and SUVmax values. RESULTS Positive, equivocal, and negative results were reported in 60%, 27.5%, and 12.5% of F-PSMA-1007 and in 5%, 37.5%, and 57.5% of F-FCH scans, respectively. In 70% of scans, F-PSMA-1007 PET/CT upgraded F-FCH PET/CT results. F-PSMA-1007 scans also showed significantly more lesions (184 vs 63, P = 0.0006). Local relapse, lymph node, and bone lesions accounted, respectively, for 9%, 58%, and 33% of F-PSMA-1007 and 5%, 89%, and 6% F-FCH of PET/CT findings. Highly suspicious lesions accounted for 74% of F-PSMA-1007 and 11% of F-FCH PET/CT findings. In F-PSMA-1007 PET/CT SUVmax values of highly suggestive lesions were significantly higher than in equivocal lesions (median, 3.6 vs 2.5; P < 0.00001). CONCLUSIONS In early BCR patients F-PSMA-1007 showed a higher detection rate than F-FCH PET/CT. The former also showed more lesions in total, more highly suggestive lesions and less equivocal lesions.

Introduction: This study was designed to assess quantitatively a safe position of the microcatheter during the SIRT (Selective Internal Radiation Therapy) procedure, in order to minimize the risk of non-target spheres leaking. Materials and Methods: Retrospective analysis of the distance of the tip of the microcatheter from coiled or patent non-target arteries was measured during 99mTc-MAA work-up procedure. Frequency of extrahepatic leaking during work-up and SIRT procedures was evaluated. Results: There were 85 patients who underwent 98 work-up procedures. There were 64 radioembolizations. There were 44 gastroduodenal, 51 right gastric, and 54 cystic artery embolizations performed. Extrahepatic 99mTc-MAA leaking was observed in 33 cases: 16 to gallbladder, four to a gastric wall, nine to the duodenum, one to the intestinal wall, and three to the abdominal wall. Leak in 99mTc-MAA was also related to the presence of additional arteries (p = 0.009). There were 34 proximal and 31 distal to cystic artery 99mTc-MAA injections resulting in 12 vs. four leaks, respectively (p = 0.039, RR-2.5). Mean distance of the tip of the microcatheter from the origin of the cystic artery was 20 mm (minimum of 2.1 mm and maximum of 53 mm) proximally and 10 mm (minimum 1 mm and maximum 51 mm) distally (ns). Conclusions: Leaking in 99mTc-MAA (99mTc - labelled macroaggregated albumin) was related to the presence of additional arteries. Regardless of cystic artery embolization, it is 2.5 times safer to inject microspheres distal to its origin, compared to proximal injection. Cystic artery origin relative to the right hepatic artery division usually necessitates embolization of the former.

F-prostate-specific membrane antigen (PSMA) 1007 is one of the most promising radiotracers for PET imaging of relapsing prostate cancer. Minimal urinary clearance seems to be its most valuable and outstanding feature. We present images of biochemically relapsed prostate cancer where F-PSMA-1007 PET/CT (performed to verify an ambiguous finding adjacent to the urinary bladder found in F-FCH PET/CT) proved superior to radiocholine and precisely visualized site of local recurrence.

Background: Cardiovascular implantable electronic device (CIED) infection is a complication of increasing incidence. We present a protocol of an observational case control clinical trial “Positron Emission Tomography Combined With Computed Tomography (PET CT) in Suspected Cardiac Implantable Electronic Device Infection, a Pilot Study — PET Guidance I” (NCT02196753). Aim: The aim of this observational clinical trial is to assess and standardise diagnostic algorithms for CIED infections (lead-dependent infective endocarditis, generator pocket infection, fever of unknown origin) with PET CT in Poland. Methods and results: Study group will consist of 20 patients with initial diagnosis of CIED-related infection paired with a control group of 20 patients with implanted CIEDs, who underwent PET CT due to other non-infectious indications and have no data for infectious process in follow-up. All patients included in the study will undergo standard diagnostic pro­cess. Conventional/standard diagnostic and therapeutic process will consist of: medical interview, physical examination, laboratory tests, blood cultures; imaging studies: echocardiography: transthoracic (TTE), and, if there are no contraindications transoesophageal, computed tomography scan for pulmonary embolism if indicated; if there are abnormalities in other systems, decisions concerning further diagnostics will be made at the physician’s discretion. As well as standard diagnostic procedures, patients will undergo whole body PET CT scan to localise infection or inflammation. Diagnosis and therapeutic decision will be obtained from the Study Committee. Follow-up will be held within six months with control visits at three and six months. During each follow-up visit, all patients will undergo laboratory tests, two blood cultures collected 1 h apart, and TTE. In case of actual clinical suspicion of infective endocarditis or local generator pocket infection, patients will be referred for further diagnostics. Endpoints for the results assessment — primary endpoints are to standardise PET CT in the diagnostic process: sensitivity, specificity, positive predictive value, and negative predictive value of the diagnosis made by PET CT; secondary endpoints are: assessment of usefulness of PET CT for detection of remote infective complications (metastatic abscesses, infected pulmonary emboli), incidence of particular localisations of infection, influence of PET CT on therapeutic decision: confirmation or change of decision based on PET CT, safety and complications of diagnostic process of CIED-related infections with PET CT. Conclusions: Evaluation of PET CT use for device-related infections in a case control study may be conclusive and improve diagnostic pathway.

A novel cardiac SPECT camera with cadmium-zinc-telluride (CZT) based technology has a fixed array of semiconductor detectors paired with pinhole collimators focused on the heart. Image acquisition in obese patients can be challenging because of much smaller detector field of view compared to conventional gamma cameras. The aim of this study was to evaluate the impact on high body mass on the feasibility of CZT myocardial perfusion imaging (MPI). The additional aim was to investigate the mechanism of the banana-shaped/obesity artifact, as referred to in literature, and to attempt at simulating it on a phantom study.Study group consisted of 43 patients with morbid obesity (BMI ≥ 40 kg/m2). All these patients underwent myocardial perfusion imaging on both CZT cardiac camera and general purpose SPECT/CT gamma camera. Control group consisted of all patients who underwent myocardial perfusion imaging on CZT camera throughout one calendar year and whose BMI was lower than 40 kg/m2. In this group, all repeated studies were re-analyzed for estimating the frequency of heart mispositioning in the camera field of view. The number of studies performed was 1180. A static cardiac phantom was used to simulate a banana-shaped artifact. A series of phantom acquisitions during which the phantom position was altered in the camera field of view was performed.In control group, 3.7% of all cardiac scintigrams required repetition, 18.9% of which were repeated due to wrong heart positioning; median BMI in this group of patients was 36.0. A banana-shaped artifact was observed in one female patient with BMI 36.0. In morbid obesity group, 32.6% of the studies were non-diagnostic with "truncation effect" on Scan Quality Control (QC). Median BMI in patients with diagnostic scans was 42.0, while in patients with not acceptable quality control test it was 45.0 (p0.05). Banana-shaped artifacts were observed in 5 non-diagnostic studies. In a phantom study an artifact of banana shape was obtained when gantry was distant from the phantom and target was on the edge of the camera field of view and was slightly truncated.Problem with heart mispositioning during imaging on the CZT camera affects less than 1% of all performed studies. Morbid obesity is not a contraindication to perform myocardia.

The aim of this study was to evaluate a modified method of calculating the 99mTc/90Y tumor-to-normal-liver uptake ratio (mT/N) based on SPECT/CT imaging, for use in predicting the overall response of colorectal liver tumors after radioembolization. A modified phantom-based method of tumor-to-normal-liver ratio calculation was proposed and assessed. In contrast to the traditional method based on data gathered from the whole tumor, gamma counts are collected only from a 2D region of interest delineated in the SPECT/CT section with the longest tumor diameter (as specified in RECIST 1.1). The modified tumor-to-normal-liver ratio (mT/N1) and 90Y predicted tumor absorbed dose (PAD) were obtained based on 99mTc-MAA SPECT/CT, and similarly the modified tumor-to-normal-liver ratio (mT/N2) and 90Y actual tumor absorbed dose (AAD) were calculated after 90Y-SPECT/CT. Tumor response was assessed on follow-up CTs. Using the newly proposed method, a total of 103 liver colorectal metastases in 21 patients who underwent radioembolization (between June 2009 and October 2015) were evaluated in pre-treatment CT scans and 99mTc-MAA-SPECT/CT scans and compared with post-treatment 90Y-SPECT/CT scans and follow-up CT scans. The results showed that the mT/N1 ratio (p = 0.012), PAD (p < 0.001) and AAD (p < 0.001) were predictors of tumor response after radioembolization. The time to progression was significantly lengthened for tumors with mT/N1 higher than 1.7 or PAD higher than 70 Gy. The risk of progression for tumors with mT/N1 lower than 1.7 or PAD below 70 Gy was significantly higher. The mT/N2 ratio had no significant correlation with treatment results. Conclusion The mT/N1 ratio, PAD, and AAD can be used as predictors of tumor response to SIRT treatment, and SPECT/CT imaging can be used for dosimetric assessment of radioembolization.

Introduction: 99m Tc-sestamibi, a radiopharmaceutical widely used in the assessment of myocardial perfusion, can be used as an indicator of thyroid disease due to its oncophilic character. The aim of this study was to establish the usefulness of performing additional examinations of radiotracer uptake in the thyroid gland during standard stress scintigraphy with sestamibi in order to identify thyroid diseases. Material and methods: After a retrospective evaluation of 330 consecutive myocardial perfusion scintigraphies performed in our hospital during one year, 41 patients with a focal accumulation of 99m Tc-sestamibi in the thyroid were enrolled in the study. The patients underwent clinical examinations, including thyroid ultrasonography and TSH, fT4, fT3, aTPO, TRAB, calcitonin, and CEA levels. Based on the thyroid ultrasounds, 21 patients were referred for fine-needle aspiration biopsy of the thyroid. Results: An abnormal accumulation of radiotracer in the thyroid was found in 41(12.4%) of 330 patients who underwent stress cardiac scintigraphy. Thirteen (31.7%) of those patients had multinodular euthyroid goitres, 12 (29.2%) had a single thyroid nodule (including two autonomous nodules), 11 (26.8%) had autoimmune thyroid disease, and one (2.4%) had papillary thyroid carcinoma. In 12 (29.2%) with thyroid tracer uptake there was no thyroid pathology. Conclusions: Additional evaluation of radiotracer uptake in the thyroid during standard myocardial perfusion scintigraphy is a valuable tool in the detection of thyroid diseases. The additional or parallel evaluation of radiotracer uptake in the thyroid should be considered during every myocardial scintigraphy. (Endokrynol Pol 2015; 66 (6): 521–525)

BACKGROUND: Selective internal radiation therapy (SIRT) with 90Y-microspheres infusion into the hepatic artery is a novel method for palliative treatment of primary and metastatic liver cancer. The post-procedural 90Y dose estimation in the liver is very difficult because direct measurement of b particles is not possible with SPECT/CT. New methods are needed to assess the 90Y-microspheres liver distribution. In the present paper we evaluate the 90Y-PET for these purposes. MATERIALS AND METHODS: A GE Discovery ST PET/CT scanner with a copper ring protected the gantry was used for images acquisition. For SPECT/CT imaging, a GE Infinia VCHWK4 with HEPG collimators was used. The liver 90Y-microspheres (SIR-Spheres, SIRTEX, Australia) dose distribution after selective internal radiotherapy treatment was evaluated in three patients (9 lesions in total). The activity of 90Y-microspheres delivered into the liver ranged from 1.0 GBq to 2.2 GBq. The correlations between liver lesions detected with 90Y-PET, 99mTc-MAA and 90-bremsstrahlung were investigated and compared with CT images obtained before and after the procedure. RESULTS: The mean T/N ratio was 2.7 in 99mTc-MAA, 2.3 in 90Y-bremsstrahlung and 3.6 in 90Y-PET. The mean 90Y absorbed dose in tumor was 133 Gy, 112 Gy, and 187 Gy, respectively. The mean liver tissue radiation was 15.5 Gy. According to RECIST criteria, one PR (mCRC) and two SD were observed (mCRC and PC). Time to progression was 217 and 117 days in two patients with mCRC and 214 days in the patient with PC. CONCLUSIONS: 90Y-PET/CT images give crucial information regarding 90Y-microspheres distribution and dosimetry and may serve as a predictor of efficiency of radioembolisation.

Background: Pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/Q) scintigraphy or pulmonary CT angiography. One of the imaging methods used in nuclear medicine is hybrid SPECT/CT scintigraphy. Objectives: The aim of this study was to evaluate the utility of SPECT/CT(Q) scintigraphy in the diagnosis of PE and to compare SPECT/CT(Q) with planar(Q) and SPECT(Q) methods. Methods: The study group consisted of 109 consecutive patients suspected of having PE referred for performing lung scintigraphy. The inclusion criteria were: performance of perfusion planar, SPECT and SPECT/CT scans; availability of clinical data covering a 6-month follow-up period, and D-dimer level testing. The number of eligible patients was 84. PE was reported in patients with at least 1 segmental or 2 subsegmental perfusion defects without parenchymal abnormalities on CT scans. PE was excluded when there was a normal perfusion pattern or perfusion defects were caused by lung parenchymal abnormalities or were not arranged in accordance with the pulmonary vasculature. Results: Twenty-six patients (31%) had a final diagnosis of PE. The sensitivity and specificity values of each method were as follows: planar(Q) 73 and 43%, SPECT(Q) 88 and 47% and SPECT/CT(Q) 100 and 83%. SPECT/CT(Q) yielded a significantly higher diagnostic accuracy than planar(Q) (p < 0.001) and SPECT(Q) (p < 0.001) scans. Conclusions: We conclude that hybrid SPECT/CT(Q) imaging has a high diagnostic efficacy in the diagnosis of PE. Lung perfusion scintigraphy performed with a hybrid SPECT/CT device has a significantly higher sensitivity and specificity than scanning performed with the planar or SPECT technique.

Brain metastases are a rare complication of prostate cancer. They are usually diagnosed in an end-stage disease when the tumor has already spread to the other organs and tissues. We present a case of a male with castration-resistant prostate cancer with bone metastases visualized in 18 F-fluorocholine PET/CT scan.

Coronary angiography and measurement of fractional flow reserve (FFR) are used for anatomical and functional assessment of coronary stenoses. The achievement of maximal coronary hyperaemia is crucial for an accurate calculation of FFR. Although adenosine and papaverine have been well validated, their mechanisms of action as well as methods of administration have some limitations. New and better agents to induce hyperaemia are therefore still being sought. Currently regadenoson, a selective adenosine A2A receptor agonist, seems to possess the characteristics of the almost ‹ideal› hyperaemic stimulus.

Introduction Prostate cancer (PCa) is a major health concern worldwide with up to 60% of patients experiencing biochemical relapse after radical treatment. Early diagnosis of PCa recurrence is of high importance for successful salvage therapy. The need for accurate imaging has prompted the introduction of prostate-specific membrane antigen (PSMA)-based radiotracers for positron emission tomography (PET). Material and methods In this review we summarized and discussed the results of the studies analyzing the utility of 68Ga-PSMA PET/CT in patients who experienced a biochemical relapse of prostate cancer. Results PSMA-based PET scans have been proved to provide a superior diagnostic performance over other modalities for localization of the site of early PCa recurrence. 68Ga-PSMA has been also shown to have a higher sensitivity and specificity than other established PET radiotracers such as radiocholines. Conclusions The early studies show promising results and support the use of 68Ga-PSMA for PCa restaging. However, the number of studies concerning the utility of 68Ga-PSMA PET in the context of secondary PCa staging is limited and there is still a considerable scope for further research in this field.

Modern diagnostic strategy in coronary artery disease (CAD) makes it necessary not only to establish a diagnosis but also to assess the cardiovascular risk. It is not clear which strategy should be followed in the case of women with positive ECG stress test results to assess prognosis and start appropriate diagnostics and treatment.The aim of the study was to assess the prognostic value of myocardial perfusion scintigraphy in comparison with coronary angiography in women suspected of CAD and with positive ECG stress test results.The study population comprised 115 women (mean age 58.08 ± 8.8 years) suspected of CAD, with a history of chest pain and positive stress test results, who underwent myocardial perfusion scintigraphy. In 58 women coronary angiography was performed as the next step of the diagnostic procedure. All the patients were interviewed and had a physical examination, including the assessment of the cardiovascular risk in accordance with the SCORE (Systematic Coronary Risk Evaluation) scale and the probability of CAD (POST-TEST) in accordance with the ESC guidelines. The gated single photon emission computed tomography (GSPECT) with Tc-99m-MIBI was considered positive if moderate perfusion changes were observed in at least two segments or severe reversible perfusion disorders were found, regardless of the number of involved segments.The degree of coronary stenosis was assessed visually and changes greater than 50% stenosis of the luminal diameter were considered haemodynamically significant.The evaluation period covered 43.2 ± 30.8 months on average. The sensitivity of myocardial perfusion scintigraphy against cardiovascular events was 100% and the sensitivity of coronary angiography was 92.3%. The specificity was 93.1%and 88.9% respectively. The PPV of scintigraphy for cardiovascular events was 65% and of coronary angiography was 70.6%. The NPV was 100% and 97.6%respectively. The accuracy of myocardial perfusion scintigraphy for cardiovascular events was 93.9% and the accuracy of coronary angiography for cardiovascular events was 89.7%. The survival analysis confirmed the high prognostic value of SPECT and coronary angiography. However, if compared, myocardial perfusion scintigraphy was a better predictor of survival without cardiovascular events than coronary angiography was (c2 = 9.39, p0.01).The most important factors in assessing the cardiovascular risk in the study population included: positive result of myocardial perfusion scintigraphy, positive result of coronary angiography,and high SCORE and high POST-TEST values.Myocardial perfusion scintigraphy is superiorto coronary angiography in the prediction of necessary revascularisation procedures in women suspected of coronary artery disease and with positive stress test results.

BackgroundPosttreatment surveillance for the local and regional recurrence of the head and neck squamous cell carcinoma often requires a multimodality techniques that include PET combined with CT, MRI, US.AimThe purpose of this study is to compare the diagnostic performance of two imaging techniques (PET/CT and US), and their combined use for the detection of a subclinical regional recurrence in patients after HNSCC treatment.Materials and methods83 patients after completion of the HNSCC treatment underwent both US and PET/CT on the mean follow-up of 14 months after initial treatment.ResultsThe sensitivity and specificity of PET/CT were 86% and 82%, respectively; US values reached 81% and 87%, respectively. PPV was 79% for PET/CT, and 83% for US. NPV was 89% for PET/CT, and 85% for US. The overall accuracy for PET/CT and US was 84% for both methods.ConclusionUS could be regarded as complementary to PET/CT as the procedures with highest sensitivity, specificity and NPV for detecting subclinical regional recurrences after HNSCC treatment.

Purpose: To evaluate prospectively how positron emission tomography (PET) information changes treatment plans for non-small-cell lung cancer (NSCLC) patients receiving or not receiving elective nodal irradiation (ENI). Methods and Materials: One hundred consecutive patients referred for curative radiotherapy were included in the study. Treatment plans were carried out with CT data sets only. For stage III patients, mediastinal ENI was planned. Then, patients underwent PET-CT for diagnostic/planning purposes. PET/CT was fused with the CT data for final planning. New targets were delineated. For stage III patients with minimal N disease (N0-N1, single N2), the ENI was omitted in the new plans. Patients were treated according to the PET-based volumes and plans. The gross tumor volume (GTV)/planning tumor volume (PTV) and doses for critical structures were compared for both data sets. The doses for areas of potential geographical misses derived with the CT data set alone were compared in patients with and without initially planned ENI. Results: In the 75 patients for whom the decision about curative radiotherapy was maintained after PET/CT, there would have been 20 cases (27%) with potential geographical misses by using the CT data set alone. Among them, 13 patients would receive ENI; of those patients, onlymore » 2 patients had the PET-based PTV covered by 90% isodose by using the plans based on CT alone, and the mean of the minimum dose within the missed GTV was 55% of the prescribed dose, while for 7 patients without ENI, it was 10% (p = 0.006). The lung, heart, and esophageal doses were significantly lower for plans with ENI omission than for plans with ENI use based on CT alone. Conclusions: PET/CT should be incorporated in the planning of radiotherapy for NSCLC, even in the setting of ENI. However, if PET/CT is unavailable, ENI may to some extent compensate for an inadequate dose coverage resulting from diagnostic uncertainties.« less

raphy/computed tomography (PET-CT) is one of the modalities that allow for imaging the metabolism of human cells. One of the indications for PET-CT is head and neck cancer staging and restaging. Aim of study: To test the diagnostic performance of PET-CT in a single centre study for head and neck cancer patients. Materials and methods: The study involved 60 patients with head and neck cancer diagnosed and treated in our department during 2008-2010. There were 71 PET-CT examinations (in 11 patients multiple studies were performed). In 40 patients PET-CT was performed for pre-operative staging, mainly to assess the presence of lymph node metastases. In 23 cases PET-CT was performed to confirm clinical suspicion of tumour recurrence. In 8 patients, the examination was performed to find the origin of the unknown primary cancer. Results: Positron emission tomography/computed tomography results were compared with conventional imaging modalities and histopathology. In the surgical treatment group 4 false positive findings after histological examination were detected. PET-CT in 2 patients failed to show metastasis to the regional lymph nodes (false negative report). In patients with suspected recurrent tumour the diagnosis was confirmed in 14 cases. In all patients with metastases from an unknown primary origin, PET-CT was positive (4 cases were confirmed clinically). The results of PET-CT studies helped to change the method of treatment in 21 cases. Conclusion: Positron emission tomography/computed tomography may be a valuable tool in detecting, staging and monitoring of selected patients with head and neck cancer, with a significant impact on clinical decision making.

BACKGROUND: The aim of this study was to assess the prevalence of long bone metastases in renal cancer patients and to evaluate their utility as predictors of survival in this group. MATERIAL AND METHODS: This retrospective study included 20 patients with metastatic renal cancer and bone metastases. The patients were referred for regular bone scintigraphy in order to assess disease spread in the skeleton. The patients were divided into two groups: those with 1) metastases in the skeleton (including long bones) and those with 2) metastases in the axial skeleton only. RESULTS: Bone scintigraphy imaging was performed regularly up to 81 months from the first positive bone scan. During that time 11 deaths (8 among patients with long bone lesions) were recorded. Kaplan-Meyer curves showed that patients with long bone metastases tend to have lower survival probability in comparison to the ones with metastases in other bones. CONCLUSIONS: Bone metastases localization seems to influence survival in patients with renal cancer. Long bone-involving spread of the disease is associated with worse survival probability than the spread to the other bones.

A 29-year-old patient after blunt chest trauma with right lung atelectasis and pulmonary empyema was referred for lung ventilation and perfusion scintigraphy before right-sided pneumonectomy. Radionuclide imaging revealed severely reduced perfusion and lack of ventilation in the collapsed right lung. Additionally, it showed a matching lobar perfusion-ventilation defect in the lower left lobe, which, apart from consolidation area in posterior basal segment, appeared normal in computed tomography. A normal perfusion and ventilation pattern was observed in the upper left lobe. Since it was found to be the only functioning lobe, pneumonectomy was excluded from possible treatment options.

Aim: To analyse the clinical outcome and myocardial perfusion and function after transmyocardial revascularisation (TMR) in patients with normal left ventricular function and multivessel coronary artery disease non-amenable for standard revascularisation. Method and results: Twenty three severely symptomatic patients (CCS score median 4) with normal left ventricular systolic function but coronaries non-amenable for either PTCA or CABG were subjected to TMR. The angina score, left ventricular systolic and diastolic function in radionuclide ventriculography at rest, exercise tolerance and myocardial perfusion – Thallium-201 SPECT (adenosine stress 74 and 37 MBq under nitrate cover) were evaluated before and 3, 6, 12 months post-operatively. After an average of 40 ± 12 (range 14–56) TMR channels angina score decreased significantly (p< 0.0001) and the exercise tolerance increased (from 6.0 ± 4.5 to 9.1 ± 4.6 after 6 months, p< 0.05) in 21 patients. During the follow up period two patients had a myocardial infarction and one committed suicide after 6 months. Ejection fraction dropped significantly only after 1 year post-TMR from 70 ± 13 to 63 ± 0.13%, p < 0.05. The overall perfusion improved initially in 14 patients with subsequent deterioration in time. The changes in segmental perfusion were not associated with the symptomatic improvement. Conclusion: Transmyocardial revascularisation in patients with normal ejection fraction may improve the angina class, exercise tolerance and overall but not segmental perfusion and does not show any immediate effect on left ventricular function.

99mTc-sestamibi, a radiopharmaceutical widely used in the assessment of myocardial perfusion, can be used as an indicator of thyroid disease due to its oncophilic character. The aim of this study was to establish the usefulness of performing additional examinations of radiotracer uptake in the thyroid gland during standard stress scintigraphy with sestamibi in order to identify thyroid diseases.After a retrospective evaluation of 330 consecutive myocardial perfusion scintigraphies performed in our hospital during one year, 41 patients with a focal accumulation of 99mTc-sestamibi in the thyroid were enrolled in the study. The patients underwent clinical examinations, including thyroid ultrasonography and TSH, fT4, fT3, aTPO, TRAB, calcitonin, and CEA levels. Based on the thyroid ultrasounds, 21 patients were referred for fine-needle aspiration biopsy of the thyroid.An abnormal accumulation of radiotracer in the thyroid was found in 41(12.4%) of 330 patients who underwent stress cardiac scintigraphy. Thirteen (31.7%) of those patients had multinodular euthyroid goitres, 12 (29.2%) had a single thyroid nodule (including two autonomous nodules), 11 (26.8%) had autoimmune thyroid disease, and one (2.4%) had papillary thyroid carcinoma. In 12 (29.2%) with thyroid tracer uptake there was no thyroid pathology.Additional evaluation of radiotracer uptake in the thyroid during standard myocardial perfusion scintigraphy is a valuable tool in the detection of thyroid diseases. The additional or parallel evaluation of radiotracer uptake in the thyroid should be considered during every myocardial scintigraphy.

We present a case report of potential reduction of hospitalization costs due to utilization of PET/CT in a diagnostic work-up of a patient with an implantable cardioverter-defibrillator and suspicion of infective endocarditis. The PET/CT scan would have shorten hospital stay, prevented clinical complications and reduced the cost of hospitalization by 45%.

We present a case of successful peritoneal ultrafiltration (pUF) treatment in a 60 year-old patient diagnosed with diuretic-resistant congestive heart failure fulfilling the criteria for type 2 cardio-renal syndrome. Six months of pUF treatment with one daily dialysis exchange with icodextrin as an osmotic agent resulted in better functional status (from IV to II/III NYHA class), quality of life and improvement of haemodynamic parameters measured by impedance cardiography. During the follow-up (six months), pUF was well tolerated by the patient and he did not require hospitalisation for decompensated heart failure.