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A 70-year-old man presented with right mandibular pain and history of right mandibular third molar extraction 20 months back. Examination revealed purulence, exposed bone, and mental nerve hypoesthesia. He was previously prescribed zoledronate to treat bone metastases from pulmonary adenocarcinoma. PET/CT images taken 5 months before the first visit demonstrated increased mandibular FDG uptake. The inflammation remained symptomatic despite zoledronate discontinuation and antibiotic administration, with left mandibular bone exposure. SPECT/CT images demonstrated increased MDP uptake and bilateral mandibular bone destruction. Mandibular resection and pathological investigation revealed a sequestrum, indicating chronic osteomyelitis, leading to diagnosis of ARONJ (stages III and I).

In Japan, the Southampton method for dopamine transporter (DAT) SPECT is widely used to quantitatively evaluate striatal radioactivity. The specific binding ratio (SBR) is the ratio of specific to non-specific binding observed after placing pentagonal striatal voxels of interest (VOIs) as references. Although the method can reduce the partial volume effect, the SBR may fluctuate due to the presence of low-count areas of cerebrospinal fluid (CSF), caused by brain atrophy, in the striatal VOIs. We examined the effect of the exclusion of low-count VOIs on SBR measurement. We retrospectively reviewed DAT imaging of 36 patients with parkinsonian syndromes performed after injection of 123I-FP-CIT. SPECT data were reconstructed using three conditions. We defined the CSF area in each SPECT image after segmenting the brain tissues. A merged image of gray and white matter images was constructed from each patient’s magnetic resonance imaging (MRI) to create an idealized brain image that excluded the CSF fraction (MRI-mask method). We calculated the SBR and asymmetric index (AI) in the MRI-mask method for each reconstruction condition. We then calculated the mean and standard deviation (SD) of voxel RI counts in the reference VOI without the striatal VOIs in each image, and determined the SBR by excluding the low-count pixels (threshold method) using five thresholds: mean-0.0SD, mean-0.5SD, mean-1.0SD, mean-1.5SD, and mean-2.0SD. We also calculated the AIs from the SBRs measured using the threshold method. We examined the correlation among the SBRs of the threshold method, between the uncorrected SBRs and the SBRs of the MRI-mask method, and between the uncorrected AIs and the AIs of the MRI-mask method. The intraclass correlation coefficient indicated an extremely high correlation among the SBRs and among the AIs of the MRI-mask and threshold methods at thresholds between mean-2.0D and mean-1.0SD, regardless of the reconstruction correction. The differences among the SBRs and the AIs of the two methods were smallest at thresholds between man-2.0SD and mean-1.0SD. The SBR calculated using the threshold method was highly correlated with the MRI–SBR. These results suggest that the CSF correction of the threshold method is effective for the calculation of idealized SBR and AI values.

This study evaluated the potential of Q.Freeze algorithm for reducing motion artifacts, in comparison with ungated imaging (UG) and respiratory-gated imaging (RG).Twenty-nine patients with 53 lesions who had undergone RG F-FDG PET/CT were included in this study. Using PET list mode data, five series of PET images [UG, RG, and QF images with an acquisition duration of 3 min (QF3), 5 min (QF5), and 10 min (QF10)] were reconstructed retrospectively. The image quality was evaluated first. Next, quantitative metrics [maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), SD, metabolic tumor volume, signal to noise ratio, or lesion to background ratio] were calculated for the liver, background, and each lesion, and the results were compared across the series.QF10 and QF5 showed better image quality compared with all other images. SUVmax in the liver, background, and lesions was lower with QF10 and QF5 than with the others, but there were no statistically significant differences in SUVmean and the lesion to background ratios. The SD with UG and RG was significantly higher than that with QF5 and QF10. The metabolic tumor volume in QF3 and QF5 was significantly lower than that in UG.The Q.Freeze algorithm can improve the quality of PET imaging compared with RG and UG.

OBJECTIVE We prospectively compared the diagnostic value of PET/computed tomography (CT) findings using the tracers 4'-[methyl-11C]-thiothymidine (11C-4DST) and 2-deoxy-2-18F-fluoro-D-glucose (18F-FDG) in patients with head and neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS Thirty-eight patients with advanced HNSCC underwent 11C-4DST PET/CT and 18F-FDG PET/CT before treatment. Maximum standardized uptake values (SUVmax) were measured for both PET/CT studies; in addition, total lesion glycolysis (TLG) of 18F-FDG PET/CT and total lesion proliferation (TLP) of 11C-4DST PET/CT were measured. Absolute TLG and TLP values as well as values with various SUV thresholds were measured. All patients were followed up for 13.5±7.5 months (mean±SD) to monitor recurrence. RESULTS A statistically significant correlation was observed between the primary tumor SUVmax for 11C-4DST PET/CT and 18F-FDG PET/CT (r=0.46, P

The aims of this study were to evaluate the possibility of using (11)C-methionine ((11)C-MET) and (11)C-4'-thiothymidine ((11)C-4DST) whole-body PET/CT for the imaging of amino acid metabolism and DNA synthesis, respectively, when searching for bone marrow involvement in patients with multiple myeloma (MM) and to compare these findings with those for (18)F-FDG PET/CT and aspiration cytology.A total of 64 patients with MM, solitary plasmacytoma, monoclonal gammopathy of undetermined significance, or an unspecified diagnosis were prospectively enrolled. All the patients underwent three whole-body PET/CT examinations within a period of 1 week. First, the tracer accumulation was visually evaluated as positive, equivocal, or negative for 55 focal lytic lesions visualized using CT in 24 patients. Second, the percentages of marrow plasma cells as calculated using a bone marrow aspiration smear and tracer accumulation were evaluated in the posterior iliac crests of 36 patients.Among the 55 lytic lesions, the (11)C-MET and (11)C-4DST findings tended to reveal more positive findings than the (18)F-FDG findings. Based on the standard criteria for the diagnosis of active myeloma using the percentage of marrow plasma cells, significant differences were found between the (18)F-FDG and (11)C-MET findings and between the (18)F-FDG and (11)C-4DST findings, but no significant difference was observed between the (11)C-MET and (11)C-4DST findings.The addition of (11)C-MET and (11)C-4DST to (18)F-FDG when performing PET/CT enabled clearer evaluations of equivocal lesions. Based on cytological diagnostic criteria, (11)C-MET and (11)C-4DST were more sensitive than (18)F-FDG for the detection of active lesions. (11)C-MET and (11)C-4DST were more useful than (18)F-FDG for the detection of active lesions, especially during the early stage of disease.

Purpose To characterize the heterogeneity of metastatic neuroendocrine tumor (NET) lesions, we compared the [18F]-fluorodeoxyglucose (FDG) uptake and the 111In-pentetreotide (SRS) uptake for somatostatin receptor scintigraphy using the CT-based fusion imaging techniques of PET/CT and SPECT/CT. Methods Fifteen consecutive patients with NET lesions were examined using both FDG-PET/CT and SRS SPECT/CT prospectively. A total of 45 metastatic NET lesions were evaluated for FDG uptake according to the standardized uptake value (SUV) and for SRS uptake according to the tumor-to-muscle count ratio (T/M ratio); these values were then compared according to the grade of NET (G), also compared to the tumor volume. Results Both the SRS uptake and FDG uptake showed no significant correlation to the tumor volume, and suggested no significant artifacts in these data. The T/M ratio for the SRS uptake ranged from 192.7 to 1.9 and exhibited very wide range of distribution. The SUV for the FDG uptake ranged from 13.8 to 0.77 and exhibited narrow range of distribution. The uptake of the two tracers in individual lesions showed an inverse correlation. The G1 + 2 lesions had a higher SRS uptake than the G3 lesions, but the difference was not significant because of the large variation (40.65 ± 48.03, n = 39 vs. 8.66 ± 13.13, n = 6). However, the G1 + 2 lesions had a significantly lower FDG uptake than the G3 lesions (3.52 ± 1.84, n = 39 vs. 10.82 ± 4.50, n = 6). The tracer uptakes varied largely not only in an inter-subject manner, but also in an intra-subject manner. Conclusion An inverse correlation between SRS uptake and FDG uptake in the metastatic NET lesions observed in this study may be consistent with the opposing ideas of differentiation and proliferation in oncology. The large variations in SRS and FDG uptake by metastatic NET lesions suggest the biological heterogeneity of advanced NET. These results support the idea that combination therapy targeting both receptor-positive cells and proliferating cells may be beneficial from a functional imaging perspective.

OBJECTIVE The purpose of this study was to evaluate the cardiac sarcoidosis (CS) activity according to the classified visual uptake pattern using (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) and assess the uptake pattern based on the free fatty acid (FFA) levels. METHODS Nineteen CS subjects who underwent (18)F-FDG PET/CT examinations with heparin loading (HL) were recruited to evaluate their CS activity. The (18)F-FDG uptake in the heart was classified into five categories ("none," "diffuse" and "diffuse at base," regarded as stable CS, and "focal" and "focal on diffuse," regarded as de novo or worsening CS). The subject data were compared with the (18)F-FDG PET/CT findings in 13 healthy volunteers. The FFA serum levels were assessed in 10 patients with CS and all volunteers. RESULTS The sensitivity and specificity of (18)F-FDG PET/CT with HL were 75% (6/8) and 73% (8/11), respectively. The major pattern of cardiac (18)F-FDG uptake was "diffuse at base." Ten of the 32 subjects, including the control group, exhibited this pattern. The FFA serum levels before heparin administration were statistically significantly different between the patients with the "none" pattern and those with the "diffuse" and "diffuse at base" patterns. There were no significant correlations between the FFA serum levels after heparin administration and the (18)F-FDG uptake patterns. CONCLUSION "Diffuse at base" is the major (18)F-FDG uptake pattern associated with inadequate physiologic (18)F-FDG suppression. This pattern should be carefully interpreted when examining the (18)F-FDG PET/CT images of CS patients. Additionally, increased FFAs levels associated with HL may not completely suppress the physiologic myocardial FDG uptake.

Objectives. While there are a few reports describing 18F-fluoro-dexoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) findings in patients with adult-onset Still's disease (AOSD), no summary report has yet been published. In this study, we evaluated the usefulness of FDG-PET/CT for diagnosis and activity evaluation in patients with AOSD by summarizing the findings of our patients and those reported in the literature.Methods. Seven consecutive AOSD patients who had undergone PET/CT at our department between 2007 and 2012 were included. We evaluated FDG uptake for characteristic findings in patients with AOSD. In addition, we reviewed the literature on seven previously reported AOSD patients who had undergone PET/CT.Results. FDG accumulation was positive mainly in the bone marrow (100%), spleen (90.9%), lymph nodes (80.0%) and joints (75.0%). In addition, FDG uptake was positive in the pericardium, pleura, salivary glands, eyelids, muscle and major blood vessels. Six patien...

Mycobacterium tuberculosis (TB) is one of the most prominant diseases frequently causing false positive lesions in oncologic surveys using (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), since TB granulomas are composed of activated macrophages and lymphocytes with high affinity for glucose. These pitfalls of (18)F-FDG PET/CT are important for radiologists. Being familiar with (18)F-FDG images of TB could assist in preventing unfavorable clinical results based on misdiagnoses. In addition, (18)F-FDG PET/CT has the advantage of being able to screen the whole body, and can clearly detect harboring TB lesions as high uptake foci. This article details the spectrum and pitfalls of (18)F-FDG PET/CT imaging in TB.

Cardiac FDG uptake is known to show a variety of patterns under clinical fasting conditions. We hypothesized that focal FDG uptake in the heart (FUH) represents a sign of cardiac disease risk, especially in coronary artery disease (CAD).The aim of this study was to clarify the relationship between FUH and cardiac disease. Cases showing FUH were selected based on comments in diagnostic reports or identification on retrospective review. Quantitative analysis was performed using maximum standardized uptake value (SUVmax), with regions of interest drawn over focal uptake areas in the heart as confirmed by PET/CT and in lateral side of the same slice showing focal FDG uptake. For the 20 patients (11 men, 9 women) with confirmed FUH, coronary artery stenosis or history of treatment for coronary disease was present in 11 patients (55.0 %), and 2 patients showed apical hypertrophy. Mean SUVmax of FUH did not differ significantly between patients with confirmed cardiac disease and those with no evidence of cardiac disease (P = 0.78). FUH suggests a high likelihood of CAD in patients without myocardial symptoms. Cardiac screening or a check of the history of cardiac disease is thus worth considering when FUH is seen incidentally on FDG-PET/CT.

The aim of this study was to evaluate the interpretations of incidental colonic 18F-FDG uptake made by 10 experienced readers and to more clearly identify the pattern of suspicious colonic FDG uptake. The potential contributions of delayed FDG-PET scanning and of immune fecal occult blood testing (FOBT) in making a diagnosis were also analyzed.Visual interpretations by 10 readers were made for 147 FDG uptake sites from 126 PET scans (cancer, 38 sites; adenoma, 43 sites; and no abnormality, 66 sites) with colonic FDG uptake. Assessments for the early FDG-PET images were (1) FDG uptake pattern, (2) FDG uptake degree, and (3) likelihood of malignancy. For the delayed images, the assessments were (1) change in the FDG uptake position, (2) change in FDG uptake degree, and (3) likelihood of malignancy. The results of FOBT were analyzed independently of the visual interpretations.Interobserver agreement (κ) was 0.501 for assessing FDG uptake patterns, while agreement on assessing changes in uptake degree and changes in uptake position between early and delayed imaging were low (κ = 0.213-0.229). Logistic regression analysis indicated that 'FDG uptake patterns' and 'FDG uptake degree' were significantly related to decide on the suspicion of malignancy (p0.001) and the final result (p0.001). "Small localized" and "large irregular localized" types had a high probability of a lesion regardless of either (1) FDG uptake degree or (2) variation in the uptake between the early and the delayed image. The delayed image decreased false-positive cases for some FDG uptake patterns, but it had little impact on distinguishing clearly between "cancer or adenoma" and "normal". The addition of FOBT had little impact on the diagnosis.There was highest agreement among readers with respect to the recognition of specified colonic FDG uptake patterns, and this pattern recognition had the most influence on the diagnosis. "Small localized" and "large irregular localized" types had a high probability of a lesion. The addition of delayed imaging and of FOBT results to the early imaging did not have much impact on the diagnosis.

Resume Objectif Nous avons evalue les resultats de la tomographie par emission de positons couplee a la tomodensitometrie (TEP-TDM), utilisant comme traceur le fluorodesoxyglucose marquee au fluor 18 (18F) (FDG), dans les spondylarthropathies seronegatives (Spa), la pseudopolyarthrite rhizomelique (PPR) et la polyarthrite rhumatoide (PR). Methodes Nous avons etudie 53 patients hospitalises dans notre hopital entre 2006 et 2011 : 21 atteints de Spa, 16 atteints de PPR et 16 atteints de PR. L’activite inflammatoire de la maladie a ete evaluee en determinant l’accumulation du FDG a l’aide des scores standardized uptake values (SUVmax) et FDG, aux sites d’interet suivants : tuberosites ischiatiques, grands trochanters, apophyses epineuses, corps vertebraux, articulations sacro-iliaques. Resultats Le scores SUVmax des tuberosites ischiatiques etaient plus eleves dans la PPR par rapport aux Spa et a la PR. Les scores SUVmax des grands trochanters et des apophyses epineuses etaient significativement plus eleves dans la PPR que dans la PR (p Conclusions La detection par TEP-TDM d’anomalies inflammatoires siegeant aux tuberosites ischiatiques, aux grands trochanters et aux apophyses epineuses pourrait etre discriminante entre la PPR et la PR, mais pas entre les Spa et la PPR. Les anomalies mises en evidence par la TEP-TDM permettent de distinguer les Spa des PR et des PPR et sont utiles au diagnostic precoce des sacroiliites.

We assessed fluorine-18 ((18)F)-labelled fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) findings in patients with seronegative spondyloarthritis (SpA), polymyalgia rheumatica (PMR), and rheumatoid arthritis (RA).We studied 53 patients with SpA (n=21), PMR (n=16), or RA (n=16) admitted to our hospital between 2006 and 2011. Disease activity in the ischial tuberosities, greater trochanters, spinous processes, vertebral bodies, and sacroiliac joints (SIJ) were evaluated by determining FDG accumulation using maximum standardized uptake values (SUV(max)) and FDG scores.SUV(max) for ischial tuberosities was significantly higher in PMR than SpA or RA. SUV(max) for greater trochanters and spinous processes was significantly higher in PMR than RA (P0.001) and significantly higher in SpA than in PMR or RA for SIJ (P=0.01). No significant difference in vertebral scores was observed among groups (P=0.488). FDG scores yielded similar results. X-ray findings were consistent with PET/CT findings in 3/15 (20%) patients with sacroiliitis, whereas magnetic resonance imaging findings were consistent with PET/CT findings in 4/7 (57.1%) patients.PET/CT detection of inflammation in the ischial tuberosities, greater trochanters, and spinous processes discriminated between PMR and RA, but not between SpA and PMR. PET/CT findings can distinguish SpA from RA and PMR and are useful for the early diagnosis of sacroiliitis.

金沢大学新学術創成研究機構 / 金沢大学附属病院, A relationship between L-[methyl-11C]methionine (11C-methionine) uptake and angiogenesis has been suggested in gliomas. However, methionine uptake in myocardial ischemia and reperfusion has received little attention. We investigated the serial changes and mechanisms of 14-Cmethionine uptake in a rat model of myocardial ischemia and reperfusion. Methods: The left coronary artery was occluded for 30 min, followed by reperfusion for 1-28 d. At the time of the study, 14-Cmethionine (0.74 MBq) and 201Tl (14.8 MBq) were injected intravenously at 20 and 10 min before sacrifice, respectively. One minute before sacrifice, the left coronary artery was reoccluded, and 99mTc-hexakis-2-methoxyisobutylisonitrile (150-180 MBq) was injected to verify the area at risk. Histologic sections of the heart were immunohistochemically analyzed using anti-CD68, anti-smooth-muscle a-actin (SMA), and antitroponin I and compared with the autoradiography findings. Results: Both 14Cmethionine (uptake ratio, 0.71 ± 0.13) and 201Tl uptake were reduced in the area at risk at 1 d after reperfusion. However, 3 d after reperfusion, an increased 14-Cmethionine uptake (1.79 ± 0.23) was observed corresponding to the area of still-reduced 201Tl uptake, and the 14-Cmethionine uptake gradually declined until 28 d. The increased 14-Cmethionine uptake area at 3 and 7 d corresponded well to the macrophage infiltrations demonstrated by positive CD68 staining. Anti-SMA staining appeared at 7 d, after which CD68 staining was gradually replaced by the SMA staining, suggesting that methionine uptake in the early phase after ischemia and reperfusion might reflect inflammatory activity. Conclusion: 14-Cmethionine accumulated in the infarcted area, and its uptake corresponded closely to macrophage infiltration at 3-7 d after reperfusion. Methionine imaging may be useful for inflammatory imaging early after myocardial infarction. COPYRIGHT © 2013 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Supplemental Digital Content is available in the text, Glycemic control alone does not reduce cardiovascular events in patients with type 2 diabetes (T2D), and routine screening of all T2D patients for asymptomatic coronary artery disease (CAD) is not effective for preventing acute cardiac events. We examined the effectiveness of an aggressive screening protocol for asymptomatic CAD in T2D patients with advanced vascular complications. We designed a 3-year cohort study investigating the effectiveness of the aggressive coronary screening for T2D patients with advanced vascular complications and no known coronary events using propensity score adjusted analysis at a national center in Japan. Eligibility criteria included T2D without known coronary events and with any 1 of the following 4 complications: advanced diabetic retinopathy, advanced chronic kidney disease, peripheral artery disease, or cerebrovascular disease. In the aggressive screening group (n = 122), all patients received stress single photon emission computed tomography and those exhibiting myocardial perfusion abnormalities underwent coronary angiography. In the conventional screening group (n = 108), patients were examined for CAD at the discretion of their medical providers. Primary endpoint was composite outcome of cardiovascular death and nonfatal cardiovascular events. Asymptomatic CAD with ≥70% stenosis was detected in 39.3% of patients completing aggressive screening. The proportions achieving revascularization and receiving intensive medical therapy within 90 days after the screening were significantly higher in the aggressive screening group than in the conventional screening group [19.7% vs 0% (P

We report a case of gouty arthritis with tophi that was evaluated using 18F-fluorodeoxyglucose (FDG) positron emission tomography. A 77-year-old man with a history of gouty attacks was admitted with severe polyarticular pain and fever. 18F-FDG positron emission tomography/CT demonstrated focal uptake at multiple joints, including the juxta-articular soft-tissue-density masses of the elbows, and the bases of bilateral large toes. Gouty arthritis should be considered with focal 18F-FDG uptake in juxta-articular soft-tissue-density masses (tophi) with or without associated erosions.

Vocal cord palsy (VCP) is a potential cause of hoarseness that results in decreasing mobility of the vocal cord. VCP can arise from a variety of causes; so, systematic screening is warranted for the management of patients with VCP. Asymmetrical fluorodeoxyglucose (FDG) uptake in vocal cords is a well-known feature in patients with VCP, but no detailed analysis has been performed. This study aimed at reevaluating the 18F-FDG positron emission tomography/computed tomography (PET/CT) for patients with VCP. We retrospectively surveyed the results of FDG-PET/CT for 59 patients with VCP, compared to laryngoscopic findings. Quantitative analysis was performed using maximum standardized uptake value (SUVmax), and regions of interest were drawn over bilateral vocal cords as confirmed from the CT portion of PET/CT. Patients were divided into 3 groups: Group 1 (n = 14), in which VCP was caused by the lesion of the laryngeal area; Group 2 (n = 40), in which VCP was caused by the lesion on the root of the recurrent laryngeal nerve; and Group 3 (n = 5), in which VCP was caused by the lesion from the vagal center to the proximal vagus nerve. For Group 1, higher FDG uptake in the paralyzed vocal cord was seen in 86 % of patients (mean SUVmax 8.1 ± 5.3 vs. 2.3 ± 0.4, paralyzed vs. non-paralyzed, respectively; P

Background and objectiveThe performance of two PET examinations, one using L-[methyl-11C] methionine (MET) and one using 2-[18F] fluoro-2-deoxy-D-glucose (FDG), on the same day may offer a clinical advantage for the investigation of brain tumors or other lesions. The purpose of this study was to inv

Methotrexate-related malignant lymphoma (MTX-RML) is a type of therapy-related lymphoma, and it often occurs in patients with rheumatoid arthritis. The most distinctive characteristic of MTX-RML is a quick response to withdrawal of MTX. However, because there is a risk of recurrence without a distinctive indicator of disease, close follow-up is needed. We present F-18 2-fluoro-2-deoxyglucose (FDG) postitron emission tomography (PET) or computed tomography (CT) images of MTX-RML along with the characteristic clinical presentation of MTX-RML. FDG PET/CT has the advantage of being able to detect malignant lymphoma in patients who have undergone MTX treatment. After withdrawal of MTX, FDG uptake decreases along with a reduction in the volume of lesions. Although recurrent lesion develops independent to the initial FDG PET/CT findings, FDG PET/CT is useful for early detection of unexpected recurrent lesions. FDG PET/CT allows for the assessment of malignant lymphoma and recurrent lesions in patients who received MTX therapy, which is crucial for the management of MTX-RML.

[(18) F]Fluorodeoxyglucose (FDG) is a tracer for glucose metabolism. Its distribution is not specific to cancer cells but is also observed in inflammatory tissue, including macrophages, capillaries, and fibroblasts. Rheumatoid arthritis (RA) is a systemic, chronic inflammation of the joints resulting in synovitis. The disease is characterized by fibrovascular proliferation leading to the formation of a pannus and causing high FDG uptake. Several clinical studies of RA have demonstrated that FDG uptake in affected joints reflects the disease activity of RA, with strong correlations between uptake and various clinical parameters having been noted. Furthermore, the use of FDG PET for the sensitive detection and monitoring of the response to RA therapy has been reported. FDG PET/computed tomography (CT) enables the detailed evaluation of disease in large joints throughout the whole body, which is a unique advantage of PET/CT. FDG PET/CT can also be used to detect high-risk disease complications, such as atlanto-axial joint involvement, at an early stage. The possible contribution of FDG PET to the management of patients with RA remains to be studied in detail.

In FDG-PET for abdominal malignancy, the liver may be assumed as an internal standard for grading abnormal FDG uptake both in early images and in delayed images. However, physiological variables of FDG uptake by the liver, especially the effects of blood glucose level, have not yet been elucidated.FDG-PET studies of 70 patients examined at 50 to 70 min after injection (60 ± 10 min: early images) and of 68 patients examined at 80 to 100 min after injection (90 ± 10 min: delayed images) were analyzed for liver FDG uptake. Patients having lesions in the liver, spleen and pancreas; patients having bulk tumor in other areas; and patients early after chemotherapy or radiotherapy were excluded; also, patients with blood glucose level over 125 mg/dl were excluded.Mean standardized uptake value (SUV) of the liver, blood glucose level and sex showed no significant differences between early images and delayed images. However, liver SUV in the delayed image showed a larger variation than that in the early image and showed significant correlation to blood glucose level. The partial correlation coefficient between liver SUV and blood glucose level in the delayed image with adjustment for sex and age was 0.73 (P.0001). Multivariate regression coefficient (95% confidence interval) of blood glucose was 0.017 (0.013-0.021).Blood glucose level is an important factor affecting the normal liver FDG uptake in nondiabetic patients. In the case of higher glucose level, liver FDG uptake is elevated especially in the delayed image. This may be due to the fact that the liver is the key organ responsible for glucose metabolism through gluconeogenesis and glycogen storage.

Objective The aim of this retrospective study was to evaluate the usefulness of F-fluorodeoxyglucose (FDG) and C-choline positron emission tomography (PET)/computed tomography (CT) for detecting recurrences of nonsquamous cell head and neck malignancies after chemotherapy and radiotherapy. Method Fourteen patients (10 men and four women; mean age: 53.7 ± 14.5 years) with advanced nonsquamous cell head and neck malignancies other than squamous cell carcinoma were recruited. F-FDG and C-choline PET/CT examinations were performed in all the patients after chemotherapy and radiotherapy. The PET/CT images were evaluated using a visual analysis and a region-based analysis. After the posttreatment PET/CT examination, all the patients underwent further surveillance using the conventional imaging methods. Results Recurrences were eventually confirmed in eight patients after the posttreatment PET/CT examination. The region-based analysis showed that the maximum standardized uptake values for F-FDG and C-choline were strongly correlated with each other (R=0.84). The C-choline PET/CT clearly detected the lesions in two patients, one with severe diabetes mellitus and one with a brain lesion. Conclusion The abilities of F-FDG and C-choline PET/CT to detect lesions were almost the same in this study. In addition, choline has a superior potential for imaging skull base and intracranial lesions because the normal brain is not choline avid.

We report 2 cases of pyothorax-associated lymphoma that underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) examinations during pre- and post-treatment states. The FDG PET/CT examinations were able to define the massive lesions as areas of intensive FDG uptake. After radiotherapy, follow-up PET/CT examinations showed the disappearance of the abnormal FDG uptake, although the residual masses remained in the original regions. Finally, we concluded that these lesions had entered remission based on the PET/CT findings. These cases indicate that PET/CT is a useful modality for detecting pyothorax-associated lymphoma and for evaluating the efficacy of treatments.

The purpose of this prospective study was to evaluate the usefulness of 18F-fluorodeoxyglucose (FDG) and 11C-choline positron emission tomography (PET)/computed tomography (CT) for detecting recurrences of advanced head and neck cancer after combined intra-arterial chemotherapy and radiotherapy. Additionally, we surveyed the time period during which an effective negative predictive value could be maintained after the first follow-up PET/CT examination and estimated the optimal timing of a second PET/CT examination for detecting late recurrences. Fifty-three subjects (36 men and 17 women; mean age: 59.4 ± 11.5 years) with advanced head and neck squamous cell carcinoma were recruited. Post-treatment 18F-FDG PET/CT and 11C-choline examinations were performed in all patients between 8 and 12 weeks after combined intra-arterial chemotherapy and radiotherapy. The PET/CT images were evaluated using a patient-based analysis and a lesion-based analysis. All of the patients were prospectively followed for at least 9 months after the post-treatment PET/CT examination, with surveillance using conventional images (including CT and/or MRI) and a physical examination performed every 3 months. Recurrences, as determined using the patient-based analysis, were eventually confirmed in 18, 6 and 5 patients at 3, 4–6 and 7–9 months after the post-treatment PET/CT examination, respectively. The sensitivity and specificity of the 18F-FDG PET/CT and the 11C-choline PET/CT examinations to predict recurrence within 3 months were higher (FDG: 89 and 91%; choline: 83 and 80%, respectively) than for recurrence detection 6 months (FDG: 67 and 90%; choline: 62 and 76%, respectively) and 9 months later (FDG: 59 and 92%; choline: 55 and 75%, respectively). The lesion-based analysis showed that the maximum standardized uptake value of 18F-FDG and 11C-choline in the recurrent lesions were correlated with each other, compared with their relation in scar tissues (R 2 = 0.492 and 0.197, respectively). 11C-choline was not superior to 18F-FDG for the detection of recurrent head and neck cancer. Both modalities had difficulty identifying recurrences at 4–9 months after the post-treatment PET/CT examination. In patients with advanced head and neck cancer who have received combined therapy, a second post-treatment PET/CT examination to check for late recurrences should be performed within 4–6 months after the first post-treatment PET/CT examination.

Three patients are reported: two with acute renal failure (ARF) and acute interstitial nephritis (AIN); and one with ARF and rapidly progressive glomerulonephritis (RPGN). In the latter two cases, a percutaneous renal biopsy was performed. In both AIN cases, 2-[ 18 F] fluoro-2-deoxy-Dglucose (FDG) positron emission tomography combined with computed tomography (PET-CT) showed high and diffuse FDG uptake in the renal parenchyma without excretion. Based on the diagnosis of AIN, probable offending drugs were discontinued. Consequently, ARF and AIN recovered gradually in both cases, though haemodialysis (HD) was performed several times. On the other hand, the patient who presented with ARF and RPGN did not accumulate FDG absolutely. Maintenance HD had to be initiated in this patient. FDG-PET-CT might become an auxiliary examination for the diagnosis and follow-up of AIN in oliguric or HD patients.

This study evaluated (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) findings in patients with Kikuchi disease (KD), or histiocytic necrotizing lymphadenitis.We evaluated the (18)F-FDG PET/ CT findings of seven patients (one man, six women) with KD, ranging in age from 23 to 66 years (mean 36 years). All the patients had been diagnosed based on the pathological findings of a biopsy and clinical course.The maximum standard uptake values (SUVmax) of FDG uptake in affected lymph nodes were 2.05-13.94 (mean +/- SD, 6.25 +/- 3.32). In all the patients but two, the lymph nodes with the SUVmax were located in the neck. All the lymph nodes had a diameter of30 mm. In nonneck regions, the SUVs of the swollen lymph nodes tended to indicate lower uptake.FDG-PET/CT was capable of visualizing general regions containing lymph nodes and was useful for making clinical decisions as to biopsy sites. Together with the physical findings, consideration of the distribution and size of the affected lymph nodes, as shown using FDG-PET/CT, may be useful for suggesting the possibility of KD. KD should be considered in the differential diagnosis of FDG-avid lymph node lesions.

1283 Objectives Brain dopamine (DA) dysfunction, particularly the dopamine transporters (DAT, main targets of stimulant medications), is implicated in attention deficit/hyperactivity disorder (ADHD). Here we assessed effect of long-term stimulant medication on DAT. Methods DAT availability in 9 never-medicated ADHD subjects (30 ±10 yrs of age) was evaluated with PET and [11C]cocaine prior to and after 12 months of treatment with oral methylphenidate (MP). In parallel, DAT were measured in 5 controls (NC) who were re-tested 12 months later without stimulant medication. DAT availability (Bmax/Kd) was analyzed with ROIs. Results Prior to treatment DAT did not differ between ADHD (caudate-CA: 0.79±0.06, putamen-PU: 0.96±0.1, ventral striatum-VS: 0.75±0.15) and NC (CA: 0.74±0.12, PU: 0.87±0.1, VS: 0.8±0.1). MP treatment increased DAT in ADHD (CA: +20±25%, p Conclusions This study reveals no significant difference in DAT availability in a comparison of stimulant-naive ADHD and NC. After long-term treatment of ADHD with stimulant medication, an increased DAT was observed, and a comparison of the two groups revealed significantly higher DAT density in ADHD than NC. Upregulation of DAT during chronic treatment with MP could underlie the decrease in MP’s efficacy with chronic treatment (tolerance). Research Support NIMH/NIAAA/GCRC/DOE

Background & Aims:Evaluation of the extent of breast cancer lesions is important for selecting the appropriate surgical procedure or to determine the surgical margin. We aimed to assess the diagnostic accuracy of nipple‑centered radiate multiplanar reconstruction(NRMPRimages using multidetector row helical computed tomography (MDCTcomparing it with conventional mammography. Methods: Our subjects were 26 breast cancer patients with a total of 29 lesions who sequentially received contrast‑ enhanced MDCT imaging for preoperative evaluation. We measured the maximum diameter of the breast cancer in the direction toward the nipple on NRMPR images and mammography. All data were correlated with histopathological mapping of the specimens. Results:The tumor extent measured on NRMPR images and in pathological examinations ranged from 12.4 to 66.0mm(average28.0mmand 10 to 70mm (average27.9mmrespectively. The correlation coefficient of the two measurements was 0.898. On mammographytwo lesions were not clearly identified. The correlation coefficient of mammography and pathological measurements was 0.554. Conclusions:The addition of NRMPR images to mammography provides more information to evaluate breast cancer extension toward the nipple. Potentiallyit provides a clue for selecting the appropriate surgical procedure or surgical resection margin for breast cancer.（Kitakanto Med J 2009；59：123～129）

Tumors producing granulocyte colony stimulating factor (G-CSF), malignant lung tumors in most cases, are rare, and patients present with abnormal elevations of the white blood cell (WBC) count in the absence of any infectious disease. We present the (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) imaging findings of two cases of G-CSF-producing tumor. PET-CT showed abnormally high uptake of (18)F-FDG not only by the tumor itself but also diffusely throughout the bone marrow. Following resection of the tumor, the blood G-CSF level as well as the WBC count dropped down to normal range in both cases. Histopathological examination of the resected tumor specimens revealed the presence of an enormous number of inflammatory cells within the tumors and positive immunostaining of the tumor cells for G-CSF. The (18)F-FDG-PET/CT findings could be explained by the elevated bone marrow metabolism associated with the excessively active production of granulocytes under G-CSF stimulation, and the (18)F-FDG uptake by the inflammatory cells also contributing to the total tumor uptake of (18)F-FDG. These characteristic imaging findings are expected to be useful for the diagnosis of G-CSF-producing tumors.

To compare the fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) findings in patients with elderly-onset rheumatoid arthritis (EORA) with those in patients with polymyalgia rheumatica (PMR), two conditions with similar clinical presentations.We retrospectively analyzed the FDG-PET/CT findings in 10 patients with EORA and 27 patients with PMR admitted to our department between 2006 and 2012.No significant difference was observed in the median patient ages at the time of FDG-PET/CT scans in the EORA and PMR groups (73.5 vs. 78.0 years, respectively). Significant differences in both FDG uptake scores and standardized uptake values were observed between the two groups in the ischial tuberosities, spinous processes, and wrists. No significant differences were detected in the shoulders and hips. However, specific uptake patterns were observed in each group: circular and linear uptake patterns were observed around the humeral head in the EORA group, whereas focal and non-linear uptake patterns were observed in the PMR group. Moreover, focal uptake in front of the hip joint, indicating iliopectineal bursitis, tended to be limited to the PMR group. High sensitivity (92.6%) and specificity (90%) were observed for PMR diagnoses when at least three of the following five items were satisfied: characteristic findings of shoulder and iliopectineal bursitis, FDG uptake in ischial tuberosities and spinal spinous processes, and lack of FDG uptake in the wrists.The differences in the degree of uptake at each lesion and in uptake patterns at the shoulders and hips are potentially useful for obtaining a definitive diagnosis.

We prospectively compared the diagnostic value of PET/computed tomography (CT) findings using the tracers 4'-[methyl-11C]-thiothymidine (11C-4DST) and 2-deoxy-2-18F-fluoro-D-glucose (18F-FDG) in patients with head and neck squamous cell carcinoma (HNSCC).Thirty-eight patients with advanced HNSCC underwent 11C-4DST PET/CT and 18F-FDG PET/CT before treatment. Maximum standardized uptake values (SUVmax) were measured for both PET/CT studies; in addition, total lesion glycolysis (TLG) of 18F-FDG PET/CT and total lesion proliferation (TLP) of 11C-4DST PET/CT were measured. Absolute TLG and TLP values as well as values with various SUV thresholds were measured. All patients were followed up for 13.5±7.5 months (mean±SD) to monitor recurrence.A statistically significant correlation was observed between the primary tumor SUVmax for 11C-4DST PET/CT and 18F-FDG PET/CT (r=0.46, P0.01). TLP values with SUV thresholds strongly correlated with TLG values relative to the same thresholds (r=0.60-0.92, P0.001). Nine of the 38 patients with post-treatment recurrence were identified. Receiver operating characteristic curves for TLG3.0 and TLP2.5 showed the highest prognostic ability for recurrence; the sensitivity and specificity of TLG3.0 were 89 and 72%, respectively, and the sensitivity and specificity of TLP2.5 were 89 and 55%, respectively.In patients with advanced HNSCC, the TLP of 11C-4DST PET/CT strongly correlated with the TLG of 18F-FDG PET/CT. Although there were no large differences between these values, the receiver operating characteristic curves of the absolute TLG had slightly better prognostic ability for recurrence.

A 65-year-old woman with a complete atrioventricular block was diagnosed as having cardiac sarcoidosis. (18)F-FDG PET/CT imaging without unfractionated heparin loading revealed systemic abnormal uptake indicating sarcoidosis. However, the cardiac lesions were vague because of the physiological FDG uptake. One month later, (18)F-FDG PET/CT using heparin loading was performed to evaluate the lesion activity prior to the start of steroid administration. (18)F-FDG PET/CT imaging with heparin loading showed the cardiac lesions more clearly and suppressed the FDG uptake in normal myocardium. Heparin loading during FDG PET/CT may be useful for detecting cardiac involvement in patients with cardiac sarcoidosis.

We report a 64-year-old man with diabetic chorea whom we investigated with dopamine transporter SPECT, 18F FDG PET, 99mTc ethylcysteinate dimer (ECD) SPECT, and 123I metaiodobenzylguanidine (MIBG) scintigraphy. Dopamine transporter SPECT revealed reduced 123I ioflupane binding in the bilateral striatum. 18F FDG PET showed metabolic dysfunction in the bilateral striatum, as shown in earlier studies. 99mTc ECD SPECT revealed reduced brain perfusion in the bilateral caudate nucleus and putamen. 123I MIBG scintigraphy revealed no cardiac sympathetic nerve dysfunction. Our case suggests a possible nigrostriatal presynaptic dopaminergic involvement in diabetic chorea.

An 82-year-old man with suspected systemic amyloidosis and complete atrioventricular block underwent vascular biopsy during his pacemaker implantation with pathology showing amyloid deposits. 99mTc-aprotinin SPECT revealed increased radiotracer uptake along the left ventricular wall, consistent with cardiac amyloidosis. 11C-PiB PET/CT performed for the evaluation of amyloid deposits in the brain showed findings suggestive of Alzheimer disease without abnormal radiotracer concentration in the myocardium to match the 99mTc-aprotinin SPECT findings. Dynamic PET images showed increased 11C-PiB concentration in the left ventricular myocardium at 2 minutes after injection, with subsequent tracer clearance by approximately 5 minutes, consistent with normal 11C-PiB biodistribution.

The purpose of this study was to evaluate the cardiac sarcoidosis (CS) activity according to the classified visual uptake pattern using (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) and assess the uptake pattern based on the free fatty acid (FFA) levels.Nineteen CS subjects who underwent (18)F-FDG PET/CT examinations with heparin loading (HL) were recruited to evaluate their CS activity. The (18)F-FDG uptake in the heart was classified into five categories ("none," "diffuse" and "diffuse at base," regarded as stable CS, and "focal" and "focal on diffuse," regarded as de novo or worsening CS). The subject data were compared with the (18)F-FDG PET/CT findings in 13 healthy volunteers. The FFA serum levels were assessed in 10 patients with CS and all volunteers.The sensitivity and specificity of (18)F-FDG PET/CT with HL were 75% (6/8) and 73% (8/11), respectively. The major pattern of cardiac (18)F-FDG uptake was "diffuse at base." Ten of the 32 subjects, including the control group, exhibited this pattern. The FFA serum levels before heparin administration were statistically significantly different between the patients with the "none" pattern and those with the "diffuse" and "diffuse at base" patterns. There were no significant correlations between the FFA serum levels after heparin administration and the (18)F-FDG uptake patterns."Diffuse at base" is the major (18)F-FDG uptake pattern associated with inadequate physiologic (18)F-FDG suppression. This pattern should be carefully interpreted when examining the (18)F-FDG PET/CT images of CS patients. Additionally, increased FFAs levels associated with HL may not completely suppress the physiologic myocardial FDG uptake.

Objective Relapsing polychondritis (RPC) is relatively rare and early diagnosis is difficult. We investigated the utility of fluorodeoxyglucose (FDG)-PET/CT for the diagnosis of RPC and evaluation of disease activity. Methods Five RPC patients undergoing FDG-PET/CT in our hospital between 2006 and 2012 were studied. Eight RPC cases examined by PET reported in the literature were also assessed. Data from a total of 13 patients were analysed. Results Typical FDG accumulation was noted in the tracheobronchial trees of nine patients, the costal cartilage of five, joints of five, larynx of four, nasal cavity/paranasal sinuses of three, auricles of three, lymph nodes of three and the aorta of one. One patient showed nasal chondritis on a PET scan despite the absence of nasal changes on physical examination. Of five patients with costochondritis, four remained asymptomatic. Of nine patients with airway FDG accumulation, eight developed respiratory symptoms and all had CT abnormalities. In the other patient, airway FDG accumulation was evident despite the absence of airway symptoms and a lack of abnormalities in the respiratory function test and CT. PET also revealed bronchial chondritis in asymptomatic patients. The mean maximum standardized uptake values (SUVmax) of the upper and lower airways was 5.79 (s.d. 2.87) and 6.47 (s.d. 4.08), respectively. In five patients with a PET after treatment, FDG accumulation had diminished with symptomatic and inflammatory improvement. Conclusion FDG-PET/CT is a potentially powerful tool for the early diagnosis of RPC, especially in patients without easily biopsied organ involvement. This modality also facilitates evaluation of disease extent and disease activity during treatment.

Large vessel vasculitis (LVV) is an often-reported cause of inflammation of unknown origin (IUO) in elderly people. The objective of this study was to describe the usefulness of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and contrast-enhanced CT in early diagnosis and treatment follow-up of patients with LVV presenting as elderly onset IUO. We retrospectively compared contrast-enhanced CT findings and FDG-PET/CT findings of the patients diagnosed with LVV and 11 controls; all subjects were 50 years of age or older. We evaluated maximum standardised uptake value (SUV(max)) and PET score of the aortic wall for quantitative comparison of FDG-PET/CT findings. We measured the aortic wall thickness (W) and its ratio against the radius (W/R) for quantitative comparison of aortic wall thickening by contrast-enhanced CT. After steroid treatment, we compared these values with those pre-treatment. Of 124 patients who were hospitalised due to advanced age and IUO, 88 underwent FDG-PET/CT and contrast-enhanced CT. Abnormal findings were observed on images from 78 patients. The findings were indicative of LVV in 13 patients (10.5 %), of whom more than half had only non-specific symptoms. Patients with LVV had significantly higher aortic wall SUV(max) (3.85 vs. 1.95), PET scores by FDG-PET/CT, and aortic wall thicknesses by contrast-enhanced CT (3.8 vs. 2.6 mm) than controls. Significant improvement in aortic wall thickening was evidenced by reduced PET scores and by contrast-enhanced CT findings in patients who were followed up after treatment. LVV is an important cause of IUO with non-specific symptoms in elderly patients. Imaging examination comprising contrast-enhanced CT and FDG-PET/CT is useful for early diagnosis and early treatment evaluation of LVV, allowing for amelioration of reversible aortic wall thickening.

While there are a few reports describing 18F-fluoro-dexoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) findings in patients with adult-onset Still's disease (AOSD), no summary report has yet been published. In this study, we evaluated the usefulness of FDG-PET/CT for diagnosis and activity evaluation in patients with AOSD by summarizing the findings of our patients and those reported in the literature.Seven consecutive AOSD patients who had undergone PET/CT at our department between 2007 and 2012 were included. We evaluated FDG uptake for characteristic findings in patients with AOSD. In addition, we reviewed the literature on seven previously reported AOSD patients who had undergone PET/CT.FDG accumulation was positive mainly in the bone marrow (100%), spleen (90.9%), lymph nodes (80.0%) and joints (75.0%). In addition, FDG uptake was positive in the pericardium, pleura, salivary glands, eyelids, muscle and major blood vessels. Six patients underwent follow-up FDG PET/CT for evaluation of treatment efficacy. Follow-up PET/CT showed diminished FDG accumulation in the bone marrow, spleen and lymph nodes, with maximum standardized uptake value (SUVmax) being substantially reduced from 4.03 ± 0.95 to 2.20 ± 0.75 (p = 0.04), 4.04 ± 1.10 to 2.55 ± 1.13 (p = 0.04) and 5.63 ± 4.99 to 2.10 ± 1.91 (p = 0.11), respectively. No significant correlation was found between SUVmax in each lesion and the laboratory data, except for a significant correlation between lactate dehydrogenase (LDH) and spleen SUV.FDG-PET/CT is useful for long-term assessments of AOSD activity in individual patients. However, PET/CT findings alone are not sufficient to make a differential diagnosis of AOSD versus malignant lymphoma.

A 67-year-old woman underwent F-FDG PET/CT after developing a fever of unknown origin. PET/CT revealed intensive FDG uptake at the nasal and lung lesions. On the laboratory data, serum myeloperoxidase antineutrophil cytoplasmic antibodies (ANCA) titer was elevated, although serum directed against proteinase 3 (PR3) ANCA titer was within normal limits. One month after treatment, follow-up PET/CT revealed decreased FDG uptake at the lesions. One year later, serum PR3-ANCA titer elevated, which finally led to a diagnosis of Wegener granulomatosis (WG). WG lesions may be detected earlier by FDG PET/CT than by serum PR3-ANCA titers.

Mycobacterium tuberculosis (TB) is one of the most prominant diseases frequently causing false positive lesions in oncologic surveys using (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), since TB granulomas are composed of activated macrophages and lymphocytes with high affinity for glucose. These pitfalls of (18)F-FDG PET/CT are important for radiologists. Being familiar with (18)F-FDG images of TB could assist in preventing unfavorable clinical results based on misdiagnoses. In addition, (18)F-FDG PET/CT has the advantage of being able to screen the whole body, and can clearly detect harboring TB lesions as high uptake foci. This article details the spectrum and pitfalls of (18)F-FDG PET/CT imaging in TB.

The definitive diagnosis of amyloidosis is made histologically with Congo red stain. Noninvasive imaging techniques for amyloidosis are beneficial for early and definite diagnosis of amyloid deposition in the body. (99m)Tc-aprotinin has the benefit of detecting amyloid deposits mainly in the heart, but it can also detect a wide range of lesions in other locations. The usefulness and limitations of (99m)Tc-Aprotinin scintigraphy for amyloid imaging were re-evaluated based on results from 25 patients (15 men and 10 women; median age, 62.9 y; range, 34-83 y). In addition, other nuclear tracers for imaging amyloidosis are discussed. Of the 25 patients with suspected amyloidosis, 19 patients were proven to have amyloid deposits by histopathological diagnosis. Major (99m)Tc-aprotinin positive sites were confirmed in the myocardium, thyroid, large joints, vertebrae, colon, and lungs. If (99m)Tc-Aprotinin images showed positive findings, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of existing amyloid deposits were 94.7, 33.3, 81.8, and 66.7%, respectively. For analysis based on biopsy region, the sensitivity, specificity, PPV, and NPV of existing amyloid deposition were 30.6, 82.6, 73.3, and 43.2%, respectively. (99m)Tc-Aprotinin has a high potential for diagnosis of amyloid deposition in body; however, due to its physiological uptake, its potential is limited for detection of amyloid deposits in the liver, kidney, and spleen.

Object: The aim of this retrospective study was to clarify the potential of fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) for predicting prognosis in HIV-related malignant lymphoma (ML). Methods: Participants comprised 24 patients (23 men, 1 woman; mean age, 42.2 years; range, 25-66 years) with histologically proven ML, classified as either diffuse large B-cell lymphoma (DLBCL) or Burkitt lymphoma according to the classification of the World Health Organization. We compared relationships between overall survival (OS) and several indices, including FDG uptake into the lesion site on pretreatment PET and findings on interim PET. Diagnostic criteria for response evaluation followed International Harmonization Project criteria. Results: Negative findings on interim PET were associated with significantly longer OS (932±549 days) compared to positive cases (454±442 days, p =0.043). Cox regression analysis showed strong prognostic influences of interim PET findings (Hazard ratio 4.57, 95%CI 0.88-23.73) and Eastern Cooperative Oncology Group performance status (Hazard ratio 10.52, 95%CI 1.26-87.82) on OS. No other indices showed significant relationships with OS. No significant correlation was confirmed between OS and both age and lesion uptake of FDG on pretreatment PET. Conclusion: HIV-related ML patients with negative findings on interim FDG-PET showed longer OS than patients with positive findings. Interim FDG-PET offers a predictor of prognosis for HIV-related ML.

A 70-year-old man was brought to the emergency room in an unconscious state. A cerebrospinal fluid analysis demonstrated strongly positive autoantibody glutamate receptor epsilon 2 (GluRe2) titer, corresponding to anti-N-methyl-D-aspartate receptor (anti-NMDAR) NR2B autoantibody titers. The patient was diagnosed with limbic encephalitis. Brain MRI showed a high intensity in the left anterior-temporal lobe on T2WI/fluid attenuated inversion recovery (FLAIR) images, without enhancement. In this area, 18F-FDG PET showed a relatively decreased uptake, but 11C-methionine PET showed mildly increased uptake. Despite the patient's near-full functional recovery, similar PET findings were confirmed 6 months later. The mechanism of regional cerebral increased 11C-methionine uptake in anti-NMDAR (NR2B) receptor encephalitis is unknown.

We report a case of a large condyloma on the upper side of the penis that exhibited a high FDG uptake on PET/CT images, mimicking urine contamination. The patient was a 30-year-old, HIV-infected homosexual man, and his CD4 cell count was 163/μL. FDG PET/CT imaging was performed for a survey of occult cancer. A whole-body FDG PET/CT examination showed an intense FDG uptake on the upper side of the penis. The CT portion confirmed that the lesion was not urine contamination but a tumor with a cauliflower-like shape. The tumor was excised and a histopathological examination revealed a condyloma.

We present a case in which an amyloid lung nodule was diagnosed preoperatively by amyloid scintigraphy (99m)Tc-aprotinin. A 65-year-old man complained of marked weight loss (9 kg) over a period of 6 months. An abnormal shadow in the middle field of the right lung was detected on chest X-ray, corresponding to a 16-mm nodule in the right middle lobe on thoracic computed tomography (CT). Total protein and immunoglobulin G levels were elevated to 8.3 and 2245 mg/dl, respectively, but other blood tests including several tumor marker levels and Cryptococcus antibodies were all within normal range. Fluorodeoxyglucose positron emission tomography showed no uptake by the lung nodule, so lung amyloidosis was considered as differential diagnosis. To avoid risk of bleeding on bronchoscopy, noninvasive amyloid scintigraphy using (99m)Tc-aprotinin was first performed. A nodular, abnormal accumulation was observed in the right middle lung lobe. Diagnostic imaging strongly suggested amyloidosis, so video-assisted thoracic surgery was performed rather than bronchoscopy. Pathological samples showed positive staining with Congo red, and A-λ amyloidosis was diagnosed on the basis of immunostaining. Scintigraphy using (99m)Tc-aprotinin offers a useful, noninvasive method for assessing lung amyloidosis.

A new tracer, 4'-[methyl-(11)C]-thiothymidine ((11)C-4DST), has been developed as an in vivo cell proliferation marker based on the DNA incorporation method. This study evaluated the potential of (11)C-4DST PET/CT for imaging proliferation in non-small cell lung cancer (NSCLC), compared with (18)F-FDG PET/CT.Eighteen patients with lung lesions were examined by PET/CT using (11)C-4DST and (18)F-FDG. We constructed decay-corrected time-activity curves of 9 major regions as the mean standardized uptake value. We then compared the maximum standardized uptake value (SUVmax) of lung tumors on both (11)C-4DST and (18)F-FDG PET/CT with the Ki-67 index of cellular proliferation and with CD31-positive vessels as a marker of angiogenesis in surgical pathology.NSCLC was pathologically confirmed in 19 lesions of 18 patients. Physiologic accumulation of (11)C-4DST was high in liver, kidney, and bone marrow and low in aorta, brain, lung, and myocardium. Biodistribution of (11)C-4DST was almost stable by 20 min after injection of (11)C-4DST. Mean (11)C-4DST SUVmax for lung cancer was 2.9 ± 1.0 (range, 1.5-4.7), significantly different from mean (18)F-FDG SUVmax, which was 6.2 ± 4.5 (range, 0.9-17.3; P0.001). The correlation coefficient between SUVmax and Ki-67 index was higher with (11)C-4DST (r = 0.82) than with (18)F-FDG (r = 0.71). The correlation coefficient between SUVmax and CD31 was low with both (11)C-4DST (r = 0.21) and (18)F-FDG (r = 0.21), showing no significant difference between the tracers.A higher correlation with proliferation of lung tumors was seen for (11)C-4DST than for (18)F-FDG. (11)C-4DST PET/CT may allow noninvasive imaging of DNA synthesis in NSCLC.