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BACKGROUND Mostly, the removal rate of glioblastoma has been discussed in the Gd enhanced area, but tumor cells are surely infiltrated beyond the Gd enhanced edge. Although Methionine-PET (MET) and Thallium-SPECT (Tl) are useful for preoperative tumor invasion range identification, they are off-label use in most countries, and their respective accumulation ranges do not match completely. In this study, Gd-MRI, MET, and Tl were performed, and the accumulation range was compared from the fusion images, and the prediction method of the tumor cell infiltration range was examined. MATERIAL AND METHODS The mean interval period between MET and Tl administration was 16.3 days in 21 cases of glioblastoma (12 male and 9 female, average age 59.1 ± 17.8 years). Fusion images were generated using iPlan Cranial 3.0.The MET-area, Tl-area, Overlap-area where MET and Tl overlap, and Accumulation-area where MET and Tl are maximally accumulated were measured in the same cross section as the Gd-enhanced maximum area (Gd-area, X cm2) in axial view. Each volume was also measured similarly. RESULTS Gd-area was correlated with all of MET-area, Tl-area, Overlap-area, and Accumulation-area (p ≦0.0001).Gd-volume (X’cm3) showed correlation with all of MET-volume, Tl-volume, Overlap-volume, and Accumulation-volume (p ≦0.0001). The linear approximation was calculated as follows. Overlap-area = 1.942X + 1.0208 (R = 0.937), Accumulation-area = 1.3299X + 6.098 (R = 0.889), Overlap-volume = 1.1539X ‘+ 7.0573 (R = 0.927), Accumulation-volume = 1.8668X ‘+30.06 (R = 0.893). CONCLUSION These linear approximations can be used to predict the tumor invasion range from the Gd-enhanced maximum area or Gd-enhanced volume without using off-label use drugs.

Background FDG-PET/CT and Thallium SPECT (TL) which are radioisotope examination are inspection used as diagnostic imaging in the malignant tumors conventionally, and it is reported when useful for a stage diagnosis of the lung cancer. It was common to use the CT imaging according to the RECIST criteria for the effect judgment of cytotoxic agents and molecular target agents. In determining the efficacy of immune checkpoint inhibitors (ICIs), we often experienced that the assessment on CT imaging and the true effect do not match. Therefore, we planned a prospective study to evaluate whether FDG-PET/CT and TL examination is useful for ICI effect judgment. We examined the correlation between SUV differences on PET examination before treatment and 2 months after treatment initiation and RECIST evaluation. Methods A total of 18 advanced NSCLC patients treated at Kansai Medical University Hospital from September 2017 to September 2018 using ICI monotherapy were enrolled in this study. We examined the correlation with a PERCIST response rate and the response rate that went to the CT evaluation using RECIST1.1. Results The median age was 74 years. There were 15 men and three women. 15 cases were evaluable both before and two months after treatment initiatoin. There were CR/PR/SD/PD;0/3/7/5 by RECIST evaluation, and the curative effect judgment by FDG-PET were CMR/PMR/SMD/PMD; 1/3/6/5. 1 case was PD in RECIST, but was PMR in FDG-PET.The PR case tended to be higher in Tl accumulation after the treatment than an SD and PD cases. Conclusions The effect measurement by FDG-PET showed usefulness with more than that of RECIST evaluation and Tl-SPECT seems to have the potential to be useful in determining the effect of ICIs. Legal entity responsible for the study Takayasu Kurata. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Coronary angiography is the "gold standard" for the diagnosis of coronary artery disease (CAD). The aim of this work was to compare 201Thallium SPECT with different coronary angiographic cutoff values.Data pertaining to 145 patients were tabulated. All patients underwent stress ECG, 201Thallium SPECT and coronary angiography. To assess the cutoff impact, two criteria for coronary angiography diagnosis were used: a)or = 50% and b)or = 75% stenosis, and applied to data from patients and vessels.On a patient basis, 201Thallium SPECT sensitivity, specificity and accuracy were 87%, 57% and 81% withor = 50% cutoff and 93%, 51% and 79% withor = 75% cutoff, respectively (NS). When performing individual vessel analysis, sensitivity, specificity and accuracy were 59%, 78% and 68% foror = 50% cutoff and 70%, 75% and 74% foror = 75% cutoff, respectively (p0.029 for sensitivity). As expected, the severer the stenosis the higher the detection rate. There were 19 patients who had stenosis between 50% and 74%. Of these, 21% had abnormal stress ECG and 58% abnormal Thallium-201 SPECT.201Thallium SPECT results support the use ofor = 50% stenosis cutoff criteria for CAD diagnosis and evaluation. Combined with coronary angiography, myocardial SPECT offers an excellent management strategy to patients.

To test the benefit of hydroxyurea in the treatment of recurrent and non-resectable slow-growing meningiomas.Twelve patients with regrowing non-malignant meningiomas, were enrolled for a protocol of 2 years with continuous chemotherapy with hydroxyurea, 20 mg/kg/day. Response to treatment was evaluated both clinically and by diagnostic imaging using computed tomography (CT) and 201-Thallium single photon emission CT. One minimal response was documented by CT, accompanied by clinical stabilization. Nine patients showed progressive disease, at least by one imaging procedure, with a median time to progression of 13 months (range 4-24). Two other patients were not available for response due to early removal from the study, following abrupt manifestation of grades 3-4 hematological toxicity.In this series hydroxyurea has not shown effectiveness in the treatment of non-resectable slow-growing meningiomas: neither for achieving response, nor for arresting disease progression.

A 70-year-old man underwent a thallium-201 brain SPECT in the work-up and characterization of a frontotemporal mass. SPECT images were performed on cadmium zinc telluride system during only 5 minutes and after the injection of only 2 mCi. Images demonstrated high thallium uptake in frontotemporal areas considered as a potential malignant tumor. Surgical removal confirmed the diagnosis of malignant glioblastoma. The thallium SPECT fast acquisition imaging on cadmium zinc telluride systems is feasible with reduced injected dose. This method allows a significantly decrease of patient radiation exposure without compromising the image quality. This initial experience needs to be confirmed and optimized in larger clinical studies.

The convergence of radionuclide imaging and genetics requires the development of high-resolution imaging devices to provide detailed information about the distribution of receptors and the synthesis of proteins in very small objects. A recent review article by Weber and Ivanovic 1 suggested that positron emission tomography and single photon emission computed tomography (SPECT) devices that will have spatial resolution of 1 to 2 mm are being developed to provide this information in small animals. In this issue of the Journal, Hirai et al 2 describe the validation of a 4-pinhole SPECT camera designed to image small animals. The investigators tested the instrument by correlating the size of myocardial infarction determined from analysis of thallium SPECT images to the results of histologic evaluation in rats with a 24-day-old coronary occlusion. The pinhole imaging device used four 1-mm tungsten pinhole collimators, each mounted on a separate detector, to provide a system spatial resolution of 1.65 mm at full width half maximum at a sensitivity of 22.2 kilocycles/sec/kBq per milliliter. With an aperture to detector distance of 140 mm with a 40-mm radius of rotation, each detector magnified the object by approximately 3.5-fold. The correlation between SPECT-calculated infarct size and histologic infarct size was an impressive r 2 = 0.94. Although this study establishes the quantitative ability of pinhole SPECT imaging in rats, significant challenges remain before useful data can be obtained in

Objective: To assess the use of 201 Thallium SPECT and of Thallium (Tl) uptake indices in the detection and follow-up of cerebral tumors. Material and methods: Two-hundred eighty 201 Tl, 135 99m Tc-HMPAO scintigraphies and 280 MRI studies were acquired in 135 patients with cerebral tumors. Three types of Tl uptake indices were calculated by establishing the ratio of the lesion activity to an homologous ROI (I 1 ), the contralateral hemisphere (I 2 ), and the contralateral scalp (I 3 ). Intermodal co-registration between Tl-SPECT and MRI when used, was performed using Pietrzyk visual interactive method. Results: Tl uptake indices showed mean values of 2.0 ± 0.5 (I 1 ); 1.77 ± 0. 57 (I 2 ) and 1.11 ± 0.40 (I 3 ) in positive scans, and of 1.05 ± 0.22 (I 1 ), 0.88 ± 0.22 (I 2 ) and 0.50 ± 0.15 (I 3 ) in negative scans, respectively. A linear combination of the two less correlated indices lead to a more powerful discrimination between positive and negative studies. Longitudinal follow-up studies in the same patients showed good concordance between the index values and the course of the disease. Conclusion: The use of Tl uptake indices improves the accuracy of Tl-SPECT in the follow-up of brain tumors.

Quantitative single-photon emission tomographic (SPECT) thallium 201 (201Tl) cardiac studies are frequently used to improve test accuracy. One common technique uses polar mapping of relative tracer distribution to compare patient data to emplates from "normal" patient data. Commercial software does not correct for cardiac size variations. This study's purpose was to determine the effect of uncorrected variations in heart size on the variance of the normal population, which is the basis of template significance levels. Twenty-one male volunteers with low probability (< 5%) for coronary disease underwent SPECT-Tl stress test. Data analysis with and without size correction was performed. Data were corrected for size by use of a three-dimensional compression/expansion algorithm. Quantitative data were generated by radial search to maximum activity in short-axis reconstructions. The mean activity and its variance was calculated from 288 points encompassing the myocardium. Mean and variance differences were analyzed by paired t test. There was no difference in activity means (pT > .9), indicating that size correction does not distort the data. The corrected data had, however, significantly lower variance (pT < .0001). This shows that ventricular size variation contributes significantly to "normal" template variance and may adversely affect diagnostic accuracy in the absence of volume correction.

Background:It is clinically important to evaluate myocardial viability after acute myocardial infarction. There are several methods like dobutamine stress echocardiography(DSE) and thallium scan to identify viable myocardium. Thallium SPECT assesses cellular integrity, and dobutamine stress echocardiography assesses the contractile reserve of myocardium. Method:Between March and August 1995, 30 consecutive patients(27 men and 3 women; mean age 52±12 years) within 3 weeks after acute myocardial infarction were admitted to Asan Medical Center. Each underwent two-dimensional echocardiography before and during dobutamine infusion 8.6±6.5 days after acute myocardial infarction and thallium scan with rest-redistribution or stressredistribution-reinjection protocol 8.1±6.4 days after acute myocardial infarction. Myocardial viability was considered if there were improvements in regional wall motion during dobutamine infusion(5, 10μg/kg/min for 5min and 20, 30μg/kg/min for 3min). With thallium SPECT, myocardial viability was considered if regional wall motion was normal, if perfusion defects were either completely or partial mildly reversible,or if myocardial perfusion decreasedly or moderately and if irreversible perfusion was defected. Follow-up echocardiography was performed 3±1 months after acute myocardial infarction. Recovery of regional function was identified when follow-up echocardiography showed improvement of wall motion. We evaluated the accuracy of dobutamine stress echocardiography and thallium scan by concordant interpretation in acute and follow-up studies. Results:Among the enrolled 30 patients, 27 patients had Q-wave MI. Thrombolysis was performed

Each volume in the Atlases of Clinical Nuclear Medicine covers one anatomic region or system. Extensively illustrated with superb quality images, each atlas reveals the spectrum of normal scintigraphic findings as well as examples of both common and unusual conditions. Detailed figure legends describe the findings within each image, and most discuss the image's important teaching point. The text, which is descriptive yet concise, covers such topics as procedure technique, dosimetry, physiology, and scan interpretation. The Atlases of Clinical Nuclear Medicine fulfill equally the needs of practicing radiologists, nuclear medicine physicians, and residents seeking to utilize this helpful diagnostic modality more effectively. Selected Atlases of Cardiovascular Nuclear Medicine is comprised of five individual atlases in the areas of Myocardial Perfusion Images, Artifacts in 201 Thallium Spect Cardiac Perfusion Imaging, Artifacts in 99m Technetium Sestamibi SPECT Cardiac Perfusion Imaging, Cardiac Positron Emission Tomography, and Indium-111 Antimyosin Imaging of Myocardial Necrosis.

This is the first case that demonstrates that the specificity of a SPECT thallium study may be improved by imaging the patient prone instead of supine. Improved specificity is most likely due to better separation of the diaphragm and inferior wall, similar to the improvement seen in planar studies when patients are imaged in the right lateral decubitus position.

Objectives To compare 201Tl (201-Thallium) single photon emission CT (SPECT) and cardiac MRI (cMRI) for identifying regions of reversible myocardial dysfunction. Methods We conducted an experimental study to compare both modalities by finding the area under ROC curve and coefficient of variability in 42 cases (714 cardiac segments) after a pilot study on 16 cases. We also compared the two modalities by an ingenious method validated in pilot study with common physiological variable, regional wall motion abnormality vs viability assessed independently by both the modalities. Results The correlation coefficient in the detection of perfusion defects by both the diagnosing modalities was 0.89 and diagnostic region of operating characteristics was 0.97. The sensitivity was 0.96 by 201Tl-SPECT and 0.98 by cMRI, whereas the specificity 0.84 by 201Tl-SPECT and 0.85 by cMRI. The positive and negative predictive value was 0.95 and 0.85 by 201Tl-SPECT, 0.97 and 0.90 by cMRI, respectively. The accuracy of evaluating the viability was 93.15 and 95.69 by the 201Tl-SPECT and cMRI respectively with a ‘p’ value of Conclusion The study shows a good sensitivity and correlation of both 201Tl-SPECT and cMRI in diagnosing the extent and number of perfusion defects in the myocardium. cMRI is more accurate than 201Tl-SPECT in not only diagnosing myocardial infarcts but also shows its exact location and extent; this is likely to be of use in patients with equivocal 201Tl-SPECT studies. The results were concordant with the other international studies. This is one of the largest study ever carried on comparison of these two modalities.