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The aim of this study was to assess coronary artery and aortic calcification in healthy controls, angina pectoris patients, and prostate cancer patients using 18F-sodium fluoride PET/computed tomography (NaF-PET/CT). A retrospective analysis compared 33 prostate cancer patients with 33 healthy subjects and 33 patients with angina pectoris. Increased target-to-background ratio (TBR) of the coronary arteries, ascending aorta, aortic arch, and descending aorta was observed in cancer patients compared to healthy controls but not compared to angina pectoris patients. These results demonstrate the feasibility of assessing vascular microcalcification with NaF-PET/CT, with significant differences in uptake according to comorbidities., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Metastatic Klebsiella pneumoniae (MKP) is a rare, atypical presentation of Klebsiella syndrome. The disease primarily affects patients with underlying immunocompromised status, but its prevalence in immunocompetent patients without any underlying illness is rare. We present a rare case of MKP in a 41-year-old Caucasian male without prior comorbidities who presented with blurry vision and was found to have MKP. The current case report also discusses the diagnostic modalities, complications, and treatment options of MKP., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Choi et al.)

Depending on the host's immunological and respiratory systems, Aspergillus can induce infectious and allergic diseases. Most of the spread occurs in immunocompromised people, whereas aggressive disorder in immunocompetent patients is unusual. We report the case of a 19-year-old female who had shortness of breath, right-sided chest discomfort, and intermittent hemoptysis for six months before being diagnosed with pulmonary aspergilloma. The initial chest x-ray revealed a massive right pneumothorax and a 7.2 cm rounded opacity in the right lower lung. A subsequent computed tomography (CT) chest with contrast revealed a 6.7 cm cavitating mass occupying the right lower lobe. An open right thoracotomy and right lower lobectomy showed a cavitary fungus ball with septate branching hyphae and subsequent methenamine silver staining consistent with Aspergillus in conjunction with a positive Aspergillus antigen. We strongly suggest that pulmonary aspergillosis should be suspected regardless of age or immunocompetence in patients with prolonged cough, hemoptysis, unilateral chest discomfort, and pneumothorax., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Rasheed et al.)

Colorectal cancer (CRC) is more prevalent in south-central Asian countries, particularly the Afghan population. Screening for CRC in the Afghan population has always been challenging, primarily due to the tribal and social cultures, lack of facilities, and lack of education. The United States (US) will soon face a significantly massive influx of Afghan refugees. It becomes imperative to initiate and implement effective measures regarding CRC screening in these refugee populations. The current review article aims to identify the most likely challenges faced for CRC screening in this Afghan refugee population in the US and address the possible measures to overcome these challenges., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Waheed et al.)

We measured changes in 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) images in the lung parenchyma to quantify the degree of lung inflammation in patients with locally advanced non-small cell lung cancer (NSCLC) who received radiotherapy (RT). The goal of this study was to demonstrate successful implementation of this imaging methodology on NSCLC patients and to report quantitative statistics between pre-RT and post-RT. Seventy-one patients with NSCLC underwent FDG-PET/CT imaging before and after RT in a prospective study (ACRIN 6668/RTOG 0235). Comparisons between pre-RT and post-RT PET/CT were conducted for partial volume corrected (PVC)-mean standardized uptake value (SUVmean), PVC-global lung parenchymal glycolysis (GLPG), and lung volume for both ipsilateral and contralateral lungs using the nonparametric Wilcoxon signed-rank test. Regression modeling was conducted to associate clinical characteristics with post-RT PET/CT parameters. There was a significant increase in average SUVmean and GLPG of the ipsilateral lung (relative change 40% and 20%) between pre-RT and post-RT PET/CT scans (P<0.0001 and P=0.004). Absolute increases in PVC-SUVmean and PVC-GLPG were more pronounced (ΔPVC-SUVmean 0.32 versus ΔSUVmean 0.28; ΔPVC-GLPG 463.34 cc versus ΔGLPG 352.90 cc) and highly significant (P<0.0001). In contrast, the contralateral lung demonstrated no significant difference between pre-RT to post-RT in either GLPG (P=0.12) or SUVmean (P=0.18). The only clinical feature significantly associated with post-RT PET/CT parameters was clinical staging. Our study demonstrated inflammatory response in the ipsilateral lung of NSCLC patients treated with photon RT, suggesting that PET/CT parameters may serve as biomarkers for radiation pneumonitis (RP)., Competing Interests: None., (AJNMMI Copyright © 2021.)

Cancer patients are at markedly increased risk for venous thromboembolism (VTE). Early detection of VTE may decrease morbidity and mortality in this population. We conducted this study to evaluate the ability of FDG-PET/CT to detect thrombosis in cancer patients. This retrospective study included 131 cancer patients with a history of deep vein thrombosis (DVT) or pulmonary embolism (PE) referred for 2-deoxy-2-[ 18 F]-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT). All subjects underwent PET/CT imaging 60 minutes after FDG injection. Images were visually assessed for increased FDG uptake within the venous lumen. For positive cases, clinical follow-up and Doppler ultrasonography and/or contrast-enhanced CT scans were reviewed. FDG-PET/CT revealed abnormal uptake in the venous system of 26 (19.8%) patients. Eighteen (69.2%) had a history of DVT, and 13 (50%) had a history of PE. The most common site of thrombosis was the inferior vena cava (IVC) (n=14, 53.8%), followed by lower extremities veins (n=9, 34.6%), jugular veins (n=2, 7.7%), and superior vena cava (n=1, 3.8%). The presence of thrombi was confirmed by reviewing clinical follow-up in 6 (23.1%) patients. Among this group, thrombosis was detected in lower extremity veins (n=4, 15.8%), jugular veins (n=1, 3.8%), and IVC (n=1, 3.8%). Our study demonstrates that thrombi prior to their clinical manifestation can be detected by FDG-PET/CT in cancer patients. Moving forward, physicians must carefully consider the venous system when reporting FDG-PET/CT for cancer patients., Competing Interests: None., (AJNMMI Copyright © 2021.)

Objectives: 18F-sodium fluoride (NaF) is a radiotracer used in PET that reflects calcium metabolism and osteoblastic activity. In this study, we assessed the construct validity of a novel application of global assessment to measure NaF uptake in the femoral neck as a method of evaluating physiologic changes in osteoblastic metabolism with age., Methods: Whole-body NaF-PET/computed tomography (CT) images and MRI of 24 male patients with a history of nonmetastatic prostate cancer between the ages of 36 and 82 years (67.8 ± 9.6) were analyzed. A region of interest delineated the entire femoral neck on the PET/CT image to determine the mean standardized uptake value (SUVmean). Correction for the partial volume effect was performed by measuring the volume of inert yellow bone marrow by MRI segmentation. Multiple linear regression was used to assess the relationship of uptake with age and body weight., Results: The SUVmean with and without partial volume correction decreased with respect to age (P = 0.001 and P = 0.002, respectively). Body weight was not significantly related to any measured PET parameter., Conclusion: Our results support the use of global NaF uptake with magnetic resonance-derived partial volume correction in the femoral neck. Because osteoblastic metabolism is known to decrease with normal aging, the observed decrease in NaF uptake constitutes evidence for convergent validity, indicating that the proposed methodology likely reflects systemic osteoblastic activity. Future studies of this methodology are warranted in other instances of varying osteoblastic activity such as in metabolic bone diseases and for the evaluation of therapy targeting osteoblastic metabolism., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Atherosclerosis is the most common cause of peripheral artery disease (PAD). We compared the atherosclerotic burden in non-lower extremity arteries in patients with and without PAD using 18 F-sodium fluoride (NaF)-PET/CT. We identified five individuals (61.8±6.6 years, one male, four females) with PAD and matched to five individuals without PAD based on age and gender from the unfavorable cardiovascular risk profile group of the CAMONA trial (60±7.2 years, one male, four females). Individuals underwent PET/CT imaging 90 minutes after the injection of NaF (2.2 Mbq/Kg). CT imaging was conducted to account for attenuation correction and anatomic referencing. The NaF uptake was measured by manually defining regions of interest on each axial slice on the following arteries: coronary artery (CA), carotid artery (CR), ascending aorta (AS), arch of aorta (AR), descending aorta (DA), and abdominal aorta (AA). Average SUVmean (aSUVmean) was calculated for each segment. Wilcoxon's signed rank test was used for statistical analysis. The total aSUVmean was higher in the PAD group compared to the non-PAD group (6.54±0.9 vs. 5.03±0.45, P=0.043). Comparison revealed higher NaF uptake in CR, AS, AR, and DA in the PAD group compared to the non-PAD group (0.93±0.25 vs. 0.54±0.14, P=0.01; 1.28±0.20 vs. 0.86±1.19, P<0.01; 1.18±0.17 vs. 0.90±0.19, P=0.03; 1.32±0.24 vs. 0.91±0.15, P=0.01). The NaF uptake in CA and AA was similar between the two groups (0.77±0.04 vs. 0.71±0.05, P=0.11; 1.07±0.28 vs. 1.12±0.30, P=0.82). We found individuals with PAD had higher atherosclerotic burden in the carotid arteries and thoracic aorta compared to non-PAD subjects., Competing Interests: None., (AJNMMI Copyright © 2020.)

Aim: To compare the effects of high-dose therapy (HDT consisting of high-dose chemotherapy followed by autologous stem cell transplantation) and conventional-dose chemotherapy (non-HDT) on the uptake of 18 F-sodium fluoride (NaF) in the whole bone, pelvis, and femoral neck of multiple myeloma (MM) patients., Method: The data of 19 MM patients who received HDT (61.5 (SD 5.6) years) and 11 MM patients who received conventional-dose chemotherapy (70.9 (SD 7.2) years) were collected in a prospective study. NaF PET/CT imaging was performed at baseline, and 8 weeks and 2 weeks after treatment for the HDT group and the non-HDT group, respectively. A CT-based algorithm was applied to segment the bones, and the global mean SUV (GSUVmean) of the whole bone and pelvis was calculated (OsiriX MD v.9.0, Pixmeo SARL; Bernex, Switzerland). In addition, regions of interest for the whole, medial, and lateral femoral neck were delineated bilaterally. Whole bone and pelvis measurements were replicated by two observers., Results: The average GSUVmean in the whole bone and pelvis of the patients who underwent HDT significantly decreased from before to after treatment (- 16.27%, p = 0.02 and - 16.54%, p = 0.01, respectively). A significant decrease in the whole and lateral femoral neck was also observed bilaterally in the HDT group. No significant decrease in average GSUVmean was observed in the non-HDT group. A high level of inter-observer reliability was found in intra-class correlation (ICC for pre-treatment whole bone 0.983, post-treatment whole bone 0.989, pre-treatment whole pelvis 0.998, post-treatment whole pelvis 0.996)., Conclusion: NaF uptake significantly decreased after treatment in patients who received high-dose therapy. A high level of agreement was observed between two operators for whole bone and pelvis measurements.

In recent years, 18 F-Sodium Fluoride (NaF)-PET/CT has seen its role in the detection and management of osteoporosis increase. This article reviews the extent of this application in the literature, its efficacy compared with other comparable imaging tools, and how total-body PET/CT combined with global disease assessment can revolutionize measurement of total osteoporotic disease activity. NaF-PET/CT eventually can be the modality of choice for metabolic bone disorders, especially with these advances in technology and computation., Competing Interests: Disclosure No conflicts of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Focal bone lesions and fractures due to weakened bone are associated with higher morbidity and mortality of multiple myeloma (MM) patients. 18 F-sodium fluoride ( 18 F-NaF) is a sensitive PET radiotracer for detection of abnormal bone metabolism and, therefore, is particularly suited to assess the degree of bone involvement in MM patients. We aimed to investigate the prognostic significance of metabolic active volume (MAV) of 18 F-NaF-avid lesions in MM patients. In addition to MAV, conventional methods of PET quantification, namely SUVmean and SUVmax, were measured in each patient for the purpose of comparison. Thirty-seven newly diagnosed MM patients were included. PET imaging was performed after intravenous administration of 200 MBq NaF. Active bone lesions and fractures on whole-body 18 F-NaF-PET/CT scans were identified. An adaptive thresholding algorithm automatically calculated the total MAV, SUVmean and SUVmax for each patient (ROVER, ABX, Radeberg, Germany). The patients were followed for a median of 39.8 months after treatment (range: 17.8-55.4). The overall survival (OS) of patients with 18 F-NaF-MAV value > 38.65 (36.36% [N of Events/Total N: 4/11]) was significantly shorter than that of patients with 18 F-NaF-MAV value < 38.65 (3.85% [1/26]; P = 0.002). In multivariate forward stepwise (conditional LR) Cox regression analysis of prognostic factors of OS (including 18 F-NaF-MAV (> 38.65 or < 38.65), age, gender, beta-2 microglobulin, and revised international staging system), 18 F-NaF-MAV remained the only significant factor (HR: 14.39, P = 0.02). The results for PFS were not significant. Moreover, Kaplan-Meier analyses of conventional methods of PET quantification did not reveal any statistically significant log-rank p -values. MM patients with high 18 F-NaF-MAV had shorter overall survival, compared to those with low 18 F-NaF-MAV levels (NCT02187731)., Competing Interests: None., (AJNMMI Copyright © 2020.)

Background: We used 18 F-sodium fluoride (NaF) to assess early atherosclerosis in the global heart in asymptomatic individuals with a coronary calcium score of zero and without a formal diagnosis of hypertension. We hypothesized that these individuals might present with subclinical atherosclerosis that correlates with systolic, diastolic and mean arterial pressure (SBP, DBP, and MAP)., Methods: We identified 20 asymptomatic individuals (41.6 ± 13.8 years, 8 females) from the CAMONA trial with C-reactive protein ≥3 mg/L, no smoking history, diabetes (fasting blood glucose <126 mg/dl) and dyslipidemia per the Adult Treatment Panel III Guidelines: untreated LDL <160 mg/dL, total cholesterol <240 mg/dL, HDL >40 mg/dL. All underwent PET/CT imaging 90 minutes after NaF injection (2.2 Mbq/Kg). The global cardiac average SUVmean (aSUVmean) was calculated for each individual. Correlation coefficients and linear regression models were employed for statistical analysis., Results: Significant positive correlation was revealed between global cardiac NaF uptake and all blood pressures: SBP (r=0.44, P=0.05), DBP (r=0.64, P=0.002), and MAP (r=0.59, P=0.007). After adjusting for age and gender, DBP and MAP were independent predictors of higher global cardiac NaF uptake., Conclusion: NaF-PET/CT for detecting and quantifying subclinical atherosclerosis in asymptomatic individuals revealed that cardiac NaF uptake correlated independently with DBP and MAP., Competing Interests: None., (AJCD Copyright © 2020.)

Objective: We aimed to determine whether NaF-PET/CT or FDG-PET/CT can detect abdominal aortic molecular calcification and inflammation in patients with rheumatoid arthritis (RA)., Methods: In this study, 18 RA patients (4 women, 14 men; mean age 56.0 ± 11.7) and 18 healthy controls (4 women, 14 men; mean age 55.8 ± 11.9) were included. The controls were matched to patients by sex and age (± 4 years). All subjects of this study underwent NaF-PET/CT scanning 90 min following the administration of NaF. FDG-PET/CT imaging was performed 180 min following intravenous FDG injection. Using OsiriX software, the global mean standardized uptake value (global SUVmean) in abdominal aorta was calculated for both FDG and NaF. The NaF SUVmean and FDG SUVmean were divided by the blood pool activity providing target-to-background ratios (TBR) namely, NaF-TBRmean and FDG-TBRmean. The CT calcium volume score was obtained using a growing region algorithm based on Hounsfield units., Results: The average NaF-TBRmean score among RA patients was significantly greater than that of healthy controls (median 1.61; IQR 1.49-1.88 and median 1.40; IQR 1.23-1.52, P = 0.002). The average CT calcium volume score among RA patients was also significantly greater than that of healthy controls (median 1.96 cm 3 ; IQR 0.57-5.48 and median 0.004 cm 3 ; IQR 0.04-0.05, P < 0.001). There was no significant difference between the average FDG-TBRmean scores in the RA patients when compared to healthy controls (median 1.29; IQR 1.13-1.52 and median 1.29; IQR 1.13-1.52, respectively, P = 0.98)., Conclusion: Quantitative assessment with NaF-PET/CT identifies increased molecular calcification in the wall of the abdominal aorta among patients with RA as compared with healthy controls, while quantitative assessment with FDG-PET/CT did not identify a difference in aortic vessel wall FDG uptake between the RA and healthy control groups.

The role of fluorodeoxyglucose (FDG)-PET/computed tomography (CT) in tuberculosis (TB) continues to expand in disease detection, assessment of the extent of the disease, and treatment response monitoring. This article reviews available data regarding the use of FDG-PET/CT in patients with TB. A new method of quantification for patients with TB is introduced. This method produces robust parameters that represent the total disease burden., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Aortic valve calcification is a slow and progressive pathological process that can manifest in various degrees from mild thickening of the valve known as aortic sclerosis to severe calcification that hinders the leaflet motion, known as aortic stenosis. The evolving concept of aortic calcification is thought to result from infiltration of macrophages and T-lymphocytes. Moreover, the incidence of aortic valve calcification increases with age, in particular over the age of 50. In this study, we aimed to assess 18 F-sodium fluoride ( 18 F-NaF) uptake by the aortic valve on PET/CT scans performed in two age groups; 25-35 and 50-75 years of age. We hypothesized that patients aged 50-75, comprising of both healthy and high risk for cardiovascular disease (CVD), would have higher uptake of 18 F-NaF than patients aged 25-35 and further that in the former group those who were at high risk for CVD had also higher 18 F-NaF uptake. The 25-35-year group comprised of 6 males and 6 females, mean age 30 ± 3.5 years, while the 50-75-year group included 18 males and 20 females, mean age 61 ± 6.2 years. All underwent PET/CT imaging 90 minutes following the injection of 2.2 MBq of 18 F-NaF per kg body weight. Aortic valve analysis was performed on axial sections using standard guided computer software (OsiriX MD software, version 9.0.02). The average aortic valve SUVmean was calculated for each patient. Univariate regression models stratified by age group were employed to determine the association of SUVmean with age. In the 50-75-year group, explanatory multivariable regression modeling was applied using available demographic and baseline information. SUVmean was found to be higher in the 50-75 age group than in the 25-35 age group: 0.91 ± 0.25 and 0.86 ± 0.26, respectively. The association of SUVmean with age was much stronger in individuals aged 50-75 years (r = 0.64, P<0.001) than individuals aged 25-35 years (r = 0.20, P = 0.53). In addition, in the 50-75 age group the association was much stronger in subjects with a high risk of CVD than in individuals without: r = 0.68, P = 0.001 versus r = 0.48, P = 0.042. Furthermore, the SUVmean was found to be higher in the high-risk group aged 50-75 than in the low-risk healthy group aged 50-75: 0.98 ± 0.32 and 0.83 ± 0.13. Aortic valve 18 F-NaF uptake was higher in patients belonging to the age group of 50-75 years and correlated positively with age and high risk of CVD. These data provide evidence for a potential role of 18 F-NaF PET/CT in identifying calcific changes in the aortic valve and may help direct therapeutic intervention prior to the development of symptomatic valvular disease., Competing Interests: None., (AJNMMI Copyright © 2020.)

Ocular prosthesis is used as a replacement in the orbit following enucleation or evisceration of the eye. Polymethyl methacrylate (PMMA), hydroxyapatite (HA) and porous polyethylene (PP) are some examples of the materials used in ocular prosthesis. We present a case of an 82-year-old man with prostate cancer who underwent F-NaF PET/CT imaging for evaluation of bone metastases and was incidentally found to have increased NaF uptake in the ocular prosthesis.

For decades, conventional nuclear medicine techniques have been utilized for the assessment of many infectious and inflammatory diseases. Most of these techniques have limitations such as the relatively low spatial resolution, being time consuming and low sensitivity or specificity. In recent years, FDG-PET/CT has shown promising role in the management of such diseases. An expanding set of studies illustrate the multifarious roles of FDG-PET/CT in the assessment of these conditions, both systemic diseases and more regional. Specifically, PET can provide vital information at a molecular level and consequently detect the disease activity at their earliest manifestation. With the continuing research on the diagnosis and treatment monitoring of patients with infectious and inflammatory diseases, the role of PET/CT can be further extended., Competing Interests: None., (AJNMMI Copyright © 2019.)

This study aimed to determine the prognostic value of pretreatment FDG-PET in patients with metastatic liver disease undergoing Yttrium 90 ( 90 Y) radio-embolization using global disease assessment measures. Data from 16 patients with metastatic liver disease (8 males, 8 females) aged 55-97 years (mean: 67±12) were retrospectively collected. On PET, active malignant lesions in the liver were segmented with an adaptive thresholding system (ROVER software, ABX GmbH, Radeberg, Germany). Conventional measures of PET quantification such as SUVmean, SUVmax, and partial volume-corrected SUVmean (pvcSUVmean) and volumetric parameters including metabolic tumor volume (MTV), total lesion glycolysis (TLG) and pvcTLG were measured. Receiver operating characteristic (ROC) was used to determine the optimal cutoffs for Kaplan-Meier analyses. Kaplan-Meier analysis was performed to estimate progression-free survival (PFS) and overall survival (OS). In addition, Cox regression analysis was used to determine predictors of PFS and OS. There was no correlation between pretreatment conventional parameters of FDG-PET and PFS or OS. In contrast, in the univariate Cox regression analyses, pretreatment volumetric parameters were significant predictors for PFS [TLG (HR: 6.1, P =0.02), pvcTLG (HR: 3.9, P =0.03) and MTV (HR: 5.8, P =0.02)]. Moreover, TLG (HR: 6.1, P =0.03), pvcTLG (HR: 5.2, P <0.01) and MTV (HR: 10.7, P <0.01) were significant prognostic factors for OS. Pretreatment volumetric FDG-PET parameters are prognostic factors for PFS and OS in patients with liver metastasis receiving radio-embolization with 90 Y., Competing Interests: None., (AJNMMI Copyright © 2019.)

Interventional radiology procedures have revolutionized the treatment of cancer and interventional oncology is now the fourth pillar of cancer care. The article discusses the importance of fluorodeoxyglucose (FDG)-PET imaging, and dual time-point imaging in the context of PET/computed tomography as applied to treatments of liver malignancy. The necessary paradigm shift in the adoption of novel segmentation methodologies to express global disease burden is explored., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Interventional oncology treatments have profound effects on tumor immunity. Quantitative molecular imaging with FDG-PET has the potential to aid in understanding baseline tumor characteristics that can predict response to interventional oncology treatments and immunotherapy. This review highlights some of the evidence for immune activation in the setting of locoregional therapies, and the patterns of treatment response that may be expected in the setting of immune induction. Also presented is an argument for measuring global disease metabolic activity over conventional methods of PET quantitation to circumvent challenges in correlating conventional methods of PET quantification to overall disease activity., (Copyright © 2019 Elsevier Inc. All rights reserved.)

PET with fluorodeoxyglucose and sodium fluoride (NaF) radiotracers has shown a great promise in assessing patients with multiple myeloma (MM). However, the standardization of PET/computed tomography scans interpretation in patients with myeloma in clinical practice is still debatable. This article reviews available data regarding the use of fluorodeoxyglucose and NaF PET in patients with MM. Introduced is a novel method of PET quantification as applied to patients with MM. A new concept for PET-based evaluation of patients with MM is also discussed: dual time point imaging. Finally, the role of NaF in assessment of cardiovascular complications of MM is described., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to explore the rate of elimination of fluorine-18-fluorodeoxyglucose (F-FDG) from the liver and assess the impact of hepatic fat and obesity on F-FDG clearance in early and delayed PET scans. We hypothesized that an increase in liver fat may cause a decline in hepatic F-FDG elimination with potential consequences as measured by dual time-point F-FDG PET/CT imaging., Patients and Methods: A total of 32 patients from the Cardiovascular Molecular Calcification Assessed by F-NaF PET/CT (CAMONA) clinical trial (17 males, 15 females; mean age: 47.2 years, range: 23-69 years, mean BMI: 27.2 kg/m) were enrolled and underwent F-FDG PET/CT 90 and 180 min after tracer injection. Global mean standardized uptake value (SUVmean) (i.e. the average of SUVmean in segmented liver slices) and average maximum standardized uptake value (SUVmax) (i.e. the average of the SUVmax values recorded in same slices) were calculated for semiquantification of liver F-FDG uptake at both time-points. Percentage difference in global SUVmean and average SUVmax were also calculated to yield respective retention indices (RImean and RImax). Changes in global SUVmean, average SUVmax, RImean, and RImax from 90 to 180 min were correlated with BMI and liver fat content as measured by CT Hounsfield units., Results: There was a 12.2±3.5 percent reduction in global liver SUVmean and a 4.1±5.8 percent reduction in average SUVmax at 180 min scan as compared with the 90 min time-point. RImean and RImax were inversely correlated with liver fat content and positively correlated with BMI., Conclusion: We observed a time-dependent decrease in global hepatic SUVmean and average SUVmax, which was affected by the amount of liver fat. Patients with higher BMI and hepatic fat content tended to retain F-FDG.

Heterotopic ossification (HO) is a benign condition characterized by the abnormal formation of mature lamellar bone in extraskeletal soft tissues. Most frequently, HO is observed around the hip joint after fractures or surgical procedures such as open reduction internal fixation or total hip arthroplasties. We are presenting a case of HO as detected by F-NaF PET/CT in a 68-year-old woman with multiple myeloma and a history of internal fixation of the right hip. Many previous publications have reported F-NaF uptake portraying calcification in soft tissue; the present report demonstrates the feasibility of F-NaF PET/CT to assess extraosseous calcification.

The applications of 2-deoxy-2-[ 18 F]fluoro-D-glucose positron emission tomography/X-ray computed tomography (PET/CT) in the management of patients with breast cancer have been extensively studied. According to these studies, PET/CT is not routinely performed for the diagnosis of primary breast cancer, although PET/CT in specific subtypes of breast cancer correlates with histopathologic features of the primary tumor. PET/CT can detect metastases to mediastinal, axial, and internal mammary nodes, but it cannot replace the sentinel node biopsy. In detection of distant metastases, this imaging tool may have a better accuracy in detecting lytic bone metastases compared to bone scintigraphy. Thus, PET/CT is recommended when advanced-stage disease is suspected, and conventional modalities are inconclusive. Also, PET/CT has a high sensitivity and specificity to detect loco-regional recurrence and is recommended in asymptomatic patients with rising tumor markers. Numerous studies support the future role of PET/CT in prediction of response to neoadjuvant chemotherapy (NAC). PET/CT has a higher diagnostic value for prognostic risk stratification in comparison with conventional modalities. With the continuing research on the treatment planning and evaluation of patients with breast cancer, the role of PET/CT can be further extended.

Objective: We aimed to assess the feasibility of quantifying fluorine-18-fluorodexoglucose ( 18 F-FDG) and 18 F-sodium fluoride ( 18 F-NaF) uptake in abdominal aorta and examine their association with age and cardiovascular risk factors., Subjects and Methods: Our study comprised 123 subjects (48±14 years of age, 62 men) including 78 healthy volunteers and 45 patients with chest pain syndrome, who originally enrolled in the CAMONA study in Odense, Denmark (NCT01724749). All subjects underwent 18 F-FDG positron emission tomography/computed tomography (PET/CT) and 18 F-NaF PET/CT on separate days, 180min and 90min after administration of tracers, respectively. The global tracer uptake value (GTUV) in the abdominal aorta was determined as sum of the product of each slice area and its corresponding average standardized uptake value (SUV mean), divided by the sum of those slice areas. In addition, for each subject, the 10 years Framingham risk score (FRS) was calculated. The correlations between 18 F-NaF and 18 F-FDG GTUV with age and 10 years FRS were assessed in all, healthy and patient subjects., Results: There was a significant, positive correlation between subjects' age and 18 F-NaF GTUV (r=0.35, P<0.001), but not 18 F-FDG GTUV (r=0.06, P=0.53). Also, there was a significant, positive correlation between 10 years FRS and 18 F-NaF GTUV (r=0.30, P<0.001), but not 18 F-FDG GTUV (r=0.01, P=0.95). Individual differences in 18 F-FDG and 1 18 F-NaF uptake were large in both healthy subjects and patients., Conclusion: In this study, the global uptake of 18 F-NaF in abdominal aorta was positively associated with age and 10 years FRS in all subjects, healthy and patient groups, whereas the global uptake of 18 F-FDG was not.

Conventional modalities, such as bone scintigraphy, are commonly used to assess osseous abnormalities in skeletal metastasis. Fluorine-18 ( 18 F)-sodium fluoride (NaF) PET similarly portrays osteoblastic activity but with improved spatial and contrast resolution and more accurate anatomic localization. However, these modalities rely on indirect evidence for tumor activity. PET imaging with 18 F-fluorodeoxyglucose (FDG) and tumor-specific tracers may have an increased role by directly portraying the metabolic activity of cancer cells, which are often seeded in bone marrow and cause osseous disease after initial latency. This article describes the utility and limitations of these modalities in assessing skeletal metastases., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The role of fluorodeoxyglucose-positron emission tomography (FDG-PET) has been well established in assessment of lymphoma, including non-Hodgkin lymphoma (NHL). The aim of this study was to compare changes and survival predictive values of various quantification parameters of FDG-PET/CT in patients with relapsing/refractory lymphoma before and after radioimmunotherapy (RIT). Data from 17 patients with relapsing/refractory NHL, treated with targeted RIT after chemotherapy/radiotherapy, were retrospectively collected. FDG-PET/CT scans were performed approximately three months before and six months after RIT. An adaptive contrast-oriented thresholding algorithm was used to segment lesions on the FDG-PET images. Wilcoxon signed-rank tests were used to assess changes in SUVmax, SUVmean, partial volume-corrected SUVmean (pvcSUVmean), total lesion glycolysis (TLG), and pvcTLG before and after treatment. The patients were followed up after completing RIT for up to 10 years. Kaplan-Meier and Cox regression analyses evaluated the association between the quantification parameters and survival data. In the survived group, the decrease in mean percentage of change for TLG and pvcTLG was greater than SUVmax, SUVmean and pvcSUVmean [TLG: 253.9 to 106.9, -81.4%; P = 0.052 and pvcTLG: 368.9 to 153.3, -58.4%; P = 0.04]. In addition, overall survival (OS) was shorter in patients with pre-RIT pvcTLG more than 644 compared to those below this value (log-rank P < 0.01). In univariate Cox regression for OS, a higher baseline pvcTLG was a significant prognostic factor (HR: 6.8, P = 0.02). Our results showed that pre-treatment pvcTLG was the best predictor of OS in patients with relapsing/refractory NHL following RIT., Competing Interests: None.

Pulmonary valve (PV) infective endocarditis (IE) is an extremely rare disease that involves normal as well as abnormal valves. This condition mostly occurs in patients with underlying predisposing factors. It could be missed if patients do not present with typical features of right-sided endocarditis or in the absence of classic risk factors. The case presented here did not have any known risk factors for IE until surgery and presented mainly with fever, weight loss, and musculoskeletal symptoms., Competing Interests: No potential conflict of interest was reported by the authors.

Aim: To reduce readmissions and improve patient outcomes in cirrhotic patients through better understanding of readmission predictors., Methods: We performed a single-center retrospective study of patients admitted with decompensated cirrhosis from January 1, 2011 to December 31, 2013 ( n = 222). Primary outcomes were time to first readmission and 30-d readmission rate due to complications of cirrhosis. Clinical and demographic data were collected to help describe predictors of readmission, along with care coordination measures such as post-discharge status and outpatient follow-up. Univariate and multivariate analyses were performed to describe variables associated with readmission., Results: One hundred thirty-two patients (59.4%) were readmitted at least once during the study period. Median time to first and second readmissions were 54 and 93 d, respectively. Thirty and 90-d readmission rates were 20.7 and 30.1 percent, respectively. Predictors of 30-d readmission included education level, hepatic encephalopathy at index, ALT more than upper normal limit and Medicare coverage. There were no statistically significant differences in readmission rates when stratified by discharge disposition, outpatient follow-up provider or time to first outpatient visit., Conclusion: Readmissions are challenging aspect of care for cirrhotic patients and risk continues beyond 30 d. More initiatives are needed to develop enhanced, longitudinal post-discharge systems., Competing Interests: Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.

Background: Gastrointestinal bleeding is a well-known risk of systemic anticoagulation. However, bleeding in the setting of supratherapeutic anticoagulation may have a milder natural history than unprovoked bleeding. It is a common clinical gestalt that endoscopy is common, but bleeding source identification or intervention is uncommon, yet few data exist to inform this clinical impression. Consequently, we sought to examine our institutional experience with gastrointestinal bleeding in the setting of supratherapeutic international normalized ratio (INR) with the aim of identifying predictors of endoscopically identifiable lesions, interventions, and outcomes., Methods: A retrospective review was conducted at a tertiary referral academic medical center to identify patients presenting with gastrointestinal bleeding in the setting of warfarin and a supratherapeutic INR (>3.5) who underwent an endoscopic procedure. Relevant clinical covariates, endoscopic findings, need for intervention, and outcomes were collected by review of the medical record. Logistic regression adjusting for potential confounders identified predictors of endoscopically significant lesions as well as intervention and outcomes., Results: A total of 134 patients with INR 3.5 or greater (mean 5.5, range 3.5-17.1) presented with symptoms of gastrointestinal bleeding, most commonly as melena or symptomatic anemia. Antiplatelet agents were used by 54% of patients, and 60% of patients were on concomitant acid suppression on admission. Procedures included esophagogastroduodenoscopy (upper endoscopy; EGD) (n = 128), colonoscopy (n = 73), and video capsule endoscopy (n = 32). Active bleeding at first EGD or colonoscopy was found in only 19 patients (18%), with endoscopic intervention in only 26 patients (25%). At a critical threshold of INR 7.5 at presentation, the likelihood of finding an endoscopically significant lesion fell to <20%. On multivariate logistic regression, concomitant antiplatelet therapy (odds ratio [OR] 2.59; 95% confidence interval [CI], 1.13-5.94), timing of EGD within 12 hours of presentation (OR 3.71; 95% CI, 1.05-13.08), and INR level (OR 0.79; 95% CI, 0.64-0.98) were the only significant independent predictors of identifying a source of bleeding. A risk score incorporating these covariates performed modestly in identifying risk of significant finding on EGD (area under the curve 0.68). We found no association between identification of a significant lesion at EGD and future readmission for gastrointestinal bleeding., Conclusion: This study demonstrates that the relationship between INR elevation and identification of a bleeding source or endoscopic intervention at EGD are indeed antiparallel. Concomitant antiplatelet therapy increases the likelihood of bleeding source identification and intervention, as does EGD within 12 hours of presentation. However, regardless of source identification or endoscopic intervention, important clinical outcomes were unchanged, suggesting that decisions about endoscopy should be made on a case-by-case basis, particularly in patients with INR > 7.5. Future prospective studies on appropriate indications and timing of endoscopy in such patients are warranted., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: We define electronic consultations ("e-consults") as asynchronous, consultative, provider-to-provider communications within a shared electronic health record (EHR) or web-based platform. E-consults are intended to improve access to specialty expertise for patients and providers without the need for a face-to-face visit. Our goal was to systematically review and summarize the literature describing the use and effects of e-consults., Methods: We searched PubMed, EMBASE, the Cochrane Library, and CINAHL for studies related to e-consults published between 1990 through December 2014. Three reviewers identified empirical studies and system descriptions, including articles on systems that used a shared EHR or web-based platform, connected providers in the same health system, were used for two-way provider communication, and were text-based., Results: Our final review included 27 articles. Twenty-two were research studies and five were system descriptions. Eighteen originated from one of three sites with well-developed e-consult programs. Most studies reported on workflow impact, timeliness of specialty input, and/or provider perceptions of e-consults. E-consultations are used in a variety of ways within and across medical centers. They provide timely access to specialty care and are well-received by primary care providers., Discussion: E-consults are feasible in a variety of settings, flexible in their application, and facilitate timely specialty advice. More extensive and rigorous studies are needed to inform the e-consult process and describe its effect on access to specialty visits, cost and clinical outcomes., (© The Author(s) 2015.)

Objective: Torque teno virus (TTV) infects patients at risk for parenteral exposure and chronic blood transfusion, such as those with β-thalassemic. This study aimed to assess the prevalence of TTV infection and co-infection of TTV and hepatitis C virus (HCV) in pediatric thalassemia patients receiving chronic blood transfusion., Material and Methods: The study included 90 pediatric thalassemia patients receiving chronic blood transfusion that presented to the Mofid Children's Hospital, Tehran, Iran. The control group included 90 healthy volunteer children. Serum TTV DNA detection via semi-nested PCR and HCV Ab were performed in all the participants. Demographic characteristics and clinical data were collected from each participant for statistical analysis., Results: In all, 64.4% of the patients had TTV infection, versus 24.4% of the controls (P < 0.01). The thalassemia patients had a greater probability of having TTV and HCV infections than the controls, with a common OR of 5.60 (95% CI: 2.94-10.69) and 2.15 (95% CI: 1.83-2.50), respectively. In total, 17.2% (10/58) of the patients that were TTV positive were also HCV positive, whereas 6.3% (2/32) of the TTV-negative patients were anti-HCV antibody (Ab) positive (P = 0.14)., Conclusion: The prevalence of TTV and HCV infection was higher in the Iranian thalassemia patients on chronic transfusion therapy than in the controls. The high prevalence of TTV in pediatric thalassemia patients on chromic transfusion therapy may indicate the superiority of the parenteral route compared to other routs of TTV transmission.

In this study, we investigated the prevalence of human papilloma virus (HPV) infection and TP53 expression in patients with squamous cell carcinoma (SCC) of the tongue and, subsequently, its significance in cervical lymph node metastases and tumor differentiation. Sections of formalin-fixed, paraffin-embedded tissue blocks from 94 histologically confirmed tongue SCC cases were investigated in this study. Immunohistochemistry was used to study TP53 expression, and polymerase chain reaction (PCR) was performed for the detection of high risk HPV types (16 and 18). The frequency of HPV-16 and HPV-18 infection was 10.6% and 16%, respectively. Overexpression of TP53 was observed in 70.2% of patients. Young patients (aged below 45 years) comprised 20% of all patients. There was no significant association between TP53, HPV-16, or HPV 18 presence and higher stages of the tumor, tumor differentiation, or presence of nodal metastasis. Although an association between head and neck SCC and HPV infection is being recognized and reported, our data implicate that HPV infection or TP53 expression does not play a significant role in oral tongue SCC pathogenesis, differentiation, or metastasis, as seen in our patients., (Copyright © 2011 Elsevier GmbH. All rights reserved.)