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The proceedings contain 91 papers. The topics discussed include: the new approach of COVID-19 patients with deteriorating respiratory functions using perfusion SPECT/CT imaging;increasing interest in nuclear medicine: evaluation of an educational workshop;cost-benefit analysis recommends further utilization of cardiac PET/MR for sarcoidosis evaluation;development of a nomogram model for predicting the recurrence of differentiated thyroid carcinoma patients based on a thyroid cancer database from a tertiary hospital in China;multi-center validation of radiomic models in new data using ComBat-based harmonization of features;bone scan with Tc99m-MDP, the missing link in the initial staging of muscle-invasive bladder carcinoma;and comparison of absorbed doses to kidneys calculated employing three time points and employing two time points in neuroendocrine patients undergoing Lu-177 DOTATATE therapy using planar images.
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Background and Objective: The incidence of pulmonary thromboembolic disease (PTE) in COVID-19 patients has been reported from 14.8% up to 30% in various retrospective studies. The purpose of this study is to evaluate clinical and laboratory risk factors, as well as related medications such as anticoagulants, to predict the risk of thromboembolic disease and/or death in the COVID-19 patients. Method(s): Over a period of 14 months (August 2020 to September 2021), a total of 145 consecutive patients with signs and symptoms suspicious for pulmonary embolism (PE) were referred for perfusion single-photon emission computed tomography/computed tomography (Q SPECT/CT). All patients had a history of acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection diagnosed with a positive real-time polymerase chain reaction (RTPCR) test. Result(s): Among the 145 patients included in the study The risk of PE was found to be greater in elder patients (OR:1.05, p<0.001) (Odds Ratio [95% CI]: 1.05 [1.02-1.07], p<0.001) and in patients with higher maximum d-dimer levels (Odds Ratio [95% CI]: 1.14 [1.01-1.3], p=0.04). We also analyzed the utility of maximum d-dimer level for predicting acute PE with ROC curve analysis. For d-dimer = 0.5 mg/dL cut-off sensitivity is 91%, specificity is 23%, for d-dimer = 1 mg/dL cut-off sensitivity is 79%, specificity is 43% Conclusion(s): D-dimer titers were higher in the pulmonary embolism group in our study. Another significant finding was that anticoagulants did not prevent the development of pulmonary embolism in COVID-19 patients due to undergoing thromboinflamation possibly.
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Aim/Introduction: There is growing interest in the clinical management of children with persisting and debilitating symptoms after Sars-COV-2 infection (Long-COVID). Chronic effects could arise from residual clot burden and small vessel inflammation, both expressing endothelial damage that may lead to lung perfusion impairment. 99mTc-macroaggregated albumin (MAA) SPECT/ CT is a well-established tool to detect lung perfusion defects, even at the small-vessels level. This pilot study aimed at assessing lung perfusion in Long-COVID children with MAA SPECT/CT and at comparing functional patterns with clinical scenarios during acute infection and follow-up. Material(s) and Method(s): Clinical and biochemical data were collected during acute infection and follow-up in 10 children (6 males and 4 females, mean age: 13.6 years) fulfilling Long-COVID diagnostic criteria and complaining of chronic fatigue and post-exertional malaise after mild efforts. All patients underwent a cardiopulmonary test and MAA SPECT/CT scan. Dose activities were properly chosen according to the EANM guidelines for lung scintigraphy in children. Intravenous injections were administered to patients in the supine position immediately before the planar scan, which was followed by the lung SPECT/CT acquisition. Reconstructed studies were visually analyzed. Imaging results were compared with clinical scenarios during acute infection and follow-up. Result(s): The severity of acute disease was mild and moderate in 6/10 (60 %) and 2/10 (20 %) children, respectively;there were no significant symptoms in the remaining 2 cases. Persisting symptoms after the acute phase were observed in 7/10 (70%) patients. Five out of 10 (50.0%) children showed perfusion defects on MAA SPECT/CT scan, without morphological alterations on co-registered CT. In particular, 4/5 (80%) children with lung perfusion abnormalities were previously affected by a mild acute infection, whereas a single child (20%) was asymptomatic. However, during the follow-up, persisting symptoms (e.g., headache and dyspnea after the cardiopulmonary test) were detected in 5/5 (100%) patients. Conversely, among the five children without lung perfusion defects, only 2 (40%) showed persisting symptoms (in particular, headache), while 3 (60%) children had dyspnea after the cardiopulmonary test. Conclusion(s): This pilot study showed lung perfusion defects in Long-COVID children. Despite the small patient sample, perfusion abnormalities on MAA SPECT/CT seem to occur more frequently in children with persisting symptoms following the acute infection and dyspnea after the cardiopulmonary test. Larger cohort studies are needed to confirm these preliminary results, providing a better selection among children who can benefit the most from MAA SPECT/CT imaging.
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Aim/Introduction: While COVID-19 infection is associated with the increased risk of pulmonary thromboembolism (PTE), it may also affects the lungs that causes ventilation-perfusion (VQ) patterns other than PTE. Although extensive research has been done to address different anatomical patterns of COVID-19, there is a knowledge gap in terms of VQ lung scintigraphy in these patients. The purpose of this study is to demonstrate these patterns and to show how important it is to use SPECT/CT in addition to planar images to differ these patterns from PTE [1, 2, 3]. Material(s) and Method(s): We collected lung scans performed in 64 patients with history of past/recent COVID-19 infection (in the preceding 1.5 years) who were referred for VQ scintigraphy. The scan was performed using Q-SPECT/Q-planar (26.6%), Q-SPECT/CT (42.2%), VQ-SPECT (14%) and VQ-SPECT/CT (17.2%). Interpretation was based on the EANM criteria. Result(s): Of these patients 10 (15.6%) had positive scan for PTE. Moreover, in 49 (76.6%) of these patients, anatomical abnormalities were observed compatible with COVID-19 infection. The patterns seen were as follows: 1) apparent hot spot due to focal sparing of lung, 2) zones of decreased and increased perfusion, 3) zones of normal and increased perfusion, 4) small sub-segmental defects matching with CT findings, and 5) reverse mismatched defects. Also, a case of loculated pleural effusion in CT with Q abnormalities was observed. Conclusion(s): Lung perfusion abnormalities are common findings in COVID-19 patients. They are usually either due to pulmonary embolism, parenchymal infiltrates, or other causes of mosaic attenuation related to, but not specific of the pathophysiology of COVID-19 infection. The value of VQ SPECT/CT imaging to detect and differentiate the various types of Q abnormalities was noticeable.
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An eighty-year-old lady a with history of treated tuberculosis decades ago and polymerase chain reaction (PCR) proven COVID-19 pneumonia about four months ago was referred to our department for ventilation/perfusion scan due to deteriorating dyspnea to rule out P.E. Planar perfusion scan showed bilateral accentuated apical perfusion gradient and multiple segmental and non-segmental perfusion defects in both lungs, which were mismatched with relatively normal planar ventilation images. Perfusion SPECT images also showed multiple segmental, sub-segmental and semi-segmental perfusion defects, which proved to be concordant with consolidations, bilateral pleural effusion, right lung pneumothorax, and atelectasis which were consultant with CT findings. The ventilation SPECT/CT images also demonstrated uniform tracer activity throughout both lungs, with almost complete improvement in consolidations, lung pneumothorax, pleural effusion, and atelectasis. Our case highlights the importance of SPECT/CT imaging in avoiding false-positive interpretation of pulmonary embolism as well as the possibility for rapid resolution of the lung parenchymal abnormalities
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Background-Aim: The inflammatory cascade in patients (pts) with COVID-19 may lead to pulmonary embolism (PE), worsening prognosis. Lung perfusion SPECT/CT (Q-scan) in symptomatic pts discharged after COVID-19 can confirm or rule out pulmonary vascular involvement, helping the differential diagnosis with other respiratory diseases. We aim to investigate an innovative methodology, based on radiomic features and formal methods, as a virtual second look able to detect perfusion abnormalities to better define appropriate patient-centered diagnostic and therapeutic strategies. Methods: A total of 23 pts with a recent history of COVID-19, without any previous pulmonary disease (e.g. lung cancer, emphysema, or pathological findings at CT such as lung bullae) were enrolled for Q-scan for persistent dyspnea 1 month after discharge. They were classified as negative (14 pts) and positive (9 pts) for lung perfusion abnormalities by visual and semiquantitative analysis. Q-Lung® software by GE Healthcare was used to obtain percent evaluation of pulmonary lobar perfusion (cts/volume % for each lobe), assuming as a normal value any defect lower than 10% for each lobe. We analysed these data using an innovative methodology based on formal methods techniques centered on mathematical logical reasoning, to build a formal and rigorous representation of a system merging patients clinical conditions and disease-specific characteristics, to confirm or exclude the disease. Results: In a comparative analysis with Q-Scan results, the model showed concordant features in 13/23 pts, identifying perfusion defects in 8/9 pts with a positive Q-Scan, and excluding perfusion defects in 5/14 pts with a negative Q-Scan. Discordant results were observed in the remaining 10/23 pts, in particular in negative pts: however, in this sub-group, the Q-Lung semiquantitative analysis revealed perfusion defects lower than 10% per lobe, which we considered unsignificant but may deserve further evaluation. Conclusions: Although our data are still preliminary and based on a limited population, this methodology based on formal methods showed promising concordance with Q-scan results and needs to be implemented with further analyses including co-registered CT data. When compared to artificial intelligence techniques, this mathematical reasoning may enable (i) to use a reduced dataset of patients and/ or images, without having any impact on the robustness of the model;(ii) to produce an intuitive model easy to understand;(iii) to represent a rigorous and formal tool that may be used by medical specialists in a clinical setting.
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Background-Aim: Post-mortem studies showed that in patients with COVID-19 the poor prognosis is due not only to the worsening of the ventilation function but it can be related to the perfusion impairment due to massive pulmonary thrombosis or micro-thromboembolism. We aimed to investigate the clinical impact of lung perfusion (Q) scintigraphy in patients discharged after COVID-19 disease but still symptomatic for dyspnea. Methods: 33 patients (pts), discharged at least 1 month after COVID- 19, underwent Q scan at T0 (1-3 months after acute disease) and at T1 (after 6 months if lung perfusion defects were evident at T0). Inclusion criteria were (1) residual dyspnea: mild (12/33pts), at minimal motor activity (9/33) and after prolonged effort (12/33), (2) No thromboembolism at CT pulmonary angiography during hospitalization. Exclusion criteria were: previous history of lung disease (e.g. Cancer, COPD, emphysema) or abnormal pulmonary CT findings (e.g. lung bullae). Planar and Q-SPECT/CT images were obtained for evaluation of lobar or segmental or subsegmental peripheral perfusion defects for each bronchopulmonary segment. Perfusion images were qualitatively and semiquantitatively analysed. Q-lung software by GE Healthcare was used for SPECT/CT images for obtaining percent evaluation of pulmonary lobar perfusion (counts/volume % for each lobe), considering as normal a value of defect within: - 5%/each lobe, if represented in ≥ 1 lobe. Q-scan was then compared with high resolution CT (HRCT) obtained during hospitalization in the acute phase (T-acute) and repeated after 1-3 months (T0). Significant pulmonary perfusion defects at Q scan were considered for addressing targeted therapy. Results: At T0: preserved lung perfusion was observed in 17/33 pts, thus excluding the vascular cause for the symptoms. Lung perfusion defects were detected in 16/33 patients who underwent T0 and T1 control. Defects were scored as following: severe (7 pts with dyspnea at minimal motor activity), at least one wedge-shaped peripheral defect estimated as ≥ 50% of a pulmonary segment without corresponding HRCT abnormalities, suggesting a new CTPA within 3 months and an appropriate therapeutic strategy;moderate (6 pts with dyspnea after prolonged effort): consisting in multiple (>3) subsegmental defects;-mild: (3 pts with mild dyspnea ≤ 3 sub-segmental defects). At T1 lung perfusion improvement (≥ 10% vs pathological lobe in T0), was observed in a total of 8/16 pts. Conclusions: In the age of precision medicine, Q scan-SPECT/CT in pts with recent COVID-19 can address clinical knowledge and management of SARS-CoV-2-induced lung abnormalities, suggesting the differential diagnosis with respiratory disease of different etiology and the appropriate patient-centered therapeutic strategies.
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Background: As there are comparative studies between 68Ga-PSMA and 99mTc-PSMA and spectrum of PSMA expression, this is the first case report that notifies distribution of 99mTc-PSMA on COVID-19 pneumonia era on the literature. Case presentation An asymptomatic 70-Y-old male who is known case of prostate adenocarcinoma underwent initial staging. SPECT/CT of the chest region reveals bilateral peripheral multifocal ground glass opacities which shows 99mTc-PSMA uptake. Diagnosis of corona virus was confirmed by positive RT-PCR. Discussion: Unexclusive role of radiotracers in nuclear medicine has an importance for wide range of applications. Comparison between 68Ga-PSMA and 99mTc-PSMA in detection of metastatic disease in prostate cancer is also under evaluation. Conclusions: This case implicates possible role of PSMA imaging in inflammation/infection process as well as necessity for lung review in hybrid imaging especially during this recent pandemic.
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BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has made it more challenging for patients to undergo yttrium-90 (Y-90) radioembolization (RE). Same day Y-90 RE provides an opportunity to minimize logistical challenges and infection risk associated with COVID-19, thus improving patient access. AIM: To describe the use of same day Y-90 RE with routine single photon emission computed tomography/computed tomography (SPECT/CT) in order to optimize therapy. METHODS: All patients were selected for Y-90 RE through a multidisciplinary tumor board, and were screened and tested for COVID-19 infection per institutional protocol. A same day procedure was developed, consisting of angiography, imaging, and Y-90 resin particle delivery. Routine SPECT/CT after technetium-99m macroaggregated albumin (Tc-99m MAA) administration was performed for assessment of arterial supply, personalized dosimetry, and extrahepatic activity. Post-treatment Y-90 bremsstrahlung SPECT/CT was performed for confirmation of particle delivery, by utilization of energy windowing to limit signal from previously administered Tc-99m MAA particles. RESULTS: A total of 14 patients underwent same day Y-90 RE between March and June 2020. Mean lung shunt fraction was 6.13% (range 3.5%-13.1%). Y-90 RE was performed for a single lesion in 7 patients, while the remaining 7 patients had treatment of multifocal lesions. The largest lesion measured 8.3 cm. All patients tolerated the procedure well and were discharged the same day. CONCLUSION: Same day Y-90 RE with resin-based microspheres is feasible, and provides an opportunity to mitigate infection risk and logistical challenges associated with the COVID-19 pandemic and beyond. We recommend consideration of SPECT/CT, especially among patients with complex malignancies, for the potential to improve outcomes and eligibility of patients to undergo same day Y-90 RE.
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A 65-year-old woman with known diabetes and hypertension underwent a technetium methylene diphosphonate (Tc-99m MDP) bone scan with single photon emission computed tomography/computed tomography (SPECT/CT) for shoulder pain. She was initially treated for breast cancer and later for hepatocellular carcinoma. SPECT/CT showed MDP nonavid and scattered pulmonary ground-glass opacities bilaterally along with rounded nodular densities. Another 56-year-old patient who was newly diagnosed with right breast invasive ductal carcinoma underwent a bone scan with SPECT/CT, which revealed bilateral pulmonary infiltrates. Both patients later tested positive for Coronavirus Disease-2019 (COVID-19). Therefore, nuclear physicians should be watchful of findings related to COVID-19 on SPECT/CT thorax as this is becoming the new normal.