The Role of PET/CT Molecular Imaging in the Diagnosis of Recurrence and Surveillance of Patients Treated for Non-Small Cell Lung Cancer.

Non-small cell lung cancer (NSCLC) is the leading cause of cancer mortality worldwide and its prognosis remains poor. Molecular imaging with 18F-FDG PET/CT can metabolically characterize the nature of lesions as benign or malignant, allowing a better staging at the diagnosis of this kind of patient. This advantage can also be applied in the re-staging due to the suspicion of recurrent disease. Many patients have a recurrence of the disease, including surgically treated patients. In the current context, with new personalized oncological treatments, the surveillance for recurrence and its accurate diagnosis are crucial to improve their survival. In this paper, we revise the current knowledge about the clinical and molecular factors related to the recurrent disease. In the context of new, promising, available personalized treatments, the role of molecular imaging with PET/CT and 18F-FDG and non-18F-FDG radiotracers in the follow-up of NSCLC-treated patients is especially attractive and interesting.

11C-Choline and 18F-FDG PET/CT in the Detection of Occult Prostate Cancer in the Context of a Paraneoplastic Syndrome.

In a 73-year-old man, an occult neoplasm was suspected after 2 consecutive deep venous thrombosis, the latter under anticoagulant therapy and previous axonopathy. After normal CT and MRI findings, a requested (18)F-FDG PET/CT showed a focal uptake in the prostate. Because FDG uptake in the prostate is infrequent, a (11)C-choline PET/CT was indicated revealing a focal uptake in the same location. No other abnormalities were detected in the rest of the body. A guided biopsy by ultrasonography was performed revealing a prostate carcinoma and inflammation in both prostatic lobes.

Diagnosis of mantle-cell lymphoma relapse by 18F-FDG PET/CT after water gastric distention.

Proper gastric distention with oral contrast agents is a well-recognized CT technique for imaging of the stomach. We present the basal and after water ingestion F-FDG PET/CT images that show abnormal focal FDG uptake in a clinically unsuspected gastric relapse of mantle-cell lymphoma. The patient had achieved complete remission after chemoradiotherapy and autologous stem-cell transplantation 3 years before. The images obtained after the distention of the stomach with water were crucial to confirm the presence of an FDG-avid lesion in the antrum and to distinguish between physiological and pathological radiotracer uptake. Histological analysis confirmed mantle-cell lymphoma infiltration.

Olfaction and imaging biomarkers in premotor LRRK2 G2019S-associated Parkinson disease.

OBJECTIVE: To ascertain in a cross-sectional study whether substantia nigra (SN) echogenicity, olfaction, and dopamine transporter (DaT)-SPECT are reliable premotor biomarkers in a cohort of asymptomatic carriers of the LRRK2 G2019S mutation (AsG2019S+). METHODS: These biomarkers were evaluated in 49 AsG2019S+ patients, and we also studied olfaction and SN echogenicity in 29 patients with G2019S-associated Parkinson disease (PD-G2019S), 47 relatives who were noncarriers of the LRRK2 G2019S mutation (AsG2019S-), 50 patients with idiopathic Parkinson disease (iPD), and 50 community controls. RESULTS: Eighty-five percent of unaffected mutation carriers (AsG2019S+) showed pathologic SN hyperechogenicity, with a similar proportion observed among both PD-G2019S and iPD cases, and 41% of AsG2019S- also showing increased SN echogenicity. The proportion of hyposmic individuals was not statistically different in patients with PD-G2019S (50%) and iPD (82%), but hyposmia was significantly less common in both AsG2019S+ (26%) and AsG2019S- (28%). In AsG2019S+ cases, reduced striatal uptake in DaT-SPECT was observed in 43.7%. CONCLUSIONS: Independently of age at examination, the most frequently altered premotor biomarker in LRRK2 G2019S-associated PD was SN hyperechogenicity, whereas abnormal DaT-SPECT predominated in older, unaffected mutation carriers.

Implementación de la biopsia selectiva del ganglio centinela en pacientes con cáncer de mama tratadas en hospitales comarcales de la Comunidad Autónoma de Cantabria / Implementation of sentinel lymph node biopsy in patients with breast cancer treated in district hospitals in the autonomous region of Cantabria (Spain)

Objetivo. Evaluar los resultados de la biopsia selectiva del ganglio centinela (GC) en mujeres con cáncer de mama tratadas en hospitales sin servicio de Medicina Nuclear. Sujetos y métodos. El estudio incluyó 88 mujeres con cáncer de mama no avanzado tratadas en 2 hospitales comarcales entre febrero 2007 y julio 2010. El día previo a la cirugía se realizó una linfogammagrafía en el hospital especializado. Para la localización intraoperatoria del GC se utilizaron una sonda radiodetectora y una gammacámara manual. Resultados. El GC se localizó quirúrgicamente en 97,7% de pacientes. La media de ganglios linfáticos extraídos por cada procedimiento y equipo quirúrgico fue 2,1±1,4 y 2,5±1,2. En 27,2% de pacientes se practicó linfadenectomía axilar. Hubo un resultado falso negativo y un falso positivo. Conclusiones. La implementación de la biopsia selectiva del GC en hospitales comarcales proporciona los mismos resultados que los obtenidos en el hospital supervisor (AU)

Objective. To evaluate the results of sentinel lymph node (SLN) biopsy in women with breast cancer treated in hospitals without a nuclear medicine unit. Subjects and methods. Eighty-eight patients with early-stage breast cancer treated in two district hospitals between February 2007 and July 2010 were included. The day before surgery a lymphoscintigraphy was performed in the specialized hospital. Intraoperative localization of the SLN was accomplished by the combined use of a hand-held gamma probe and a manual gamma-camera. Results. Surgical localization of the SLN was successful in 97.7% of the patients. The mean number of lymph nodes excised by each procedure and each surgical team was 2.1±1.4 and 2.5±1.2. Axillary lymph node dissection was performed in 27.2% of the patients. There was one false-negative result and one false-positive result. Conclusion. The implementation of SLN biopsy in district hospitals provides similar results to those obtained in the supervising hospital (AU)

Comparison of sequential planar 177Lu-DOTA-TATE dosimetry scans with 68Ga-DOTA-TATE PET/CT images in patients with metastasized neuroendocrine tumours undergoing peptide receptor radionuclide therapy.

PURPOSE: The aim of the study was to compare sequential (177)Lu-DOTA-TATE planar scans ((177)Lu-DOTA-TATE) in patients with metastasized neuroendocrine tumours (NET) acquired during peptide receptor radionuclide therapy (PRRT) for dosimetry purposes with the pre-therapeutic (68)Ga-DOTA-TATE positron emission tomography (PET)/CT ((68)Ga-DOTA-TATE) maximum intensity projection (MIP) images obtained in the same patients concerning the sensitivity of the different methods. METHODS: A total of 44 patients (59 ± 11 years old) with biopsy-proven NET underwent (68)Ga-DOTA-TATE and (177)Lu-DOTA-TATE imaging within 7.9 ± 7.5 days between the two examinations. (177)Lu-DOTA-TATE planar images were acquired at 0.5, 2, 24, 48 and 72 h post-injection; lesions were given a score from 0 to 4 depending on the uptake of the radiopharmaceutical (0 being lowest and 4 highest). The number of tumour lesions which were identified on (177)Lu-DOTA-TATE scans (in relation to the acquisition time after injection of the therapeutic dose as well as with regard to the body region) was compared to those detected on (68)Ga-DOTA-TATE studies obtained before PRRT. RESULTS: A total of 318 lesions were detected; 280 (88%) lesions were concordant. Among the discordant lesions, 29 were (68)Ga-DOTA-TATE positive and (177)Lu-DOTA-TATE negative, whereas 9 were (68)Ga-DOTA-TATE negative and (177)Lu-DOTA-TATE positive. The sensitivity, positive predictive value and accuracy for (177)Lu-DOTA-TATE as compared to (68)Ga-DOTA-TATE were 91, 97 and 88%, respectively. Significantly more lesions were seen on the delayed (72 h) (177)Lu-DOTA-TATE images (91%) as compared to the immediate (30 min) images (68%). The highest concordance was observed for bone metastases (97%) and the lowest for head/neck lesions (75%). Concordant lesions (n = 77; mean size 3.8 cm) were significantly larger than discordant lesions (n = 38; mean size 1.6 cm) (p < 0.05). No such significance was found for differences in maximum standardized uptake value (SUV(max)). However, concordant liver lesions with a score from 1 to 3 in the 72-h (177)Lu-DOTA-TATE scan had a lower SUV(max) (n = 23; mean 10.9) than those metastases with a score of 4 (n = 97; mean SUV(max) 18) (p < 0.05). CONCLUSION: Although (177)Lu-DOTA-TATE planar dosimetry scans exhibited a very good sensitivity for the detection of metastases, they failed to pick up 9% of lesions seen on the (68)Ga-DOTA-TATE PET/CT. Three-dimensional dosimetry using single photon emission computed tomography/CT could be applied to investigate this issue further. Delayed (72 h) images are most suitable for drawing regions of interest for dosimetric calculations.

Early planar and early SPECT Tc-99m sestamibi imaging: can it replace the dual-phase technique for the localization of parathyroid adenomas by omitting the delayed phase?

PURPOSE: To evaluate whether an early protocol (EP) (early planar and early SPECT) with Tc-99m sestamibi could demonstrate the delayed image of the established dual-phase scintigraphy unnecessary without any decrease in sensitivity for the localization of parathyroid adenomas. MATERIALS AND METHODS: A study was carried out in 80 consecutive patients with primary hyperparathyroidism (65 women; mean age, 61.8±14.2 years). Final diagnosis by surgery was possible in 79 patients and confirmed parathyroid adenoma in 76 patients, 1 hyperplasic gland in 1 patient, 2 hyperplasic glands in 1 patient, and differentiated thyroid carcinoma in another patient. Ten minutes after intravenous injection of 740 MBq (20 mCi) of Tc-99m sestamibi, a planar image followed by a SPECT and a 2 to 3 hours delayed planar image were acquired. Two sets of images were evaluated, one without (EP) and the other with the delayed image (dual-phase protocol [DPP]). An abnormality rating of 0 to 4 was given to each set and was compared with the final diagnosis. RESULTS: When any focal uptake, no matter the intensity, was considered positive, that is setting the threshold in the abnormality rating 1, 71 of the 76 adenomas were correctly localized by DPP and EP (sensitivity: 93.4%). CONCLUSIONS: The delayed planar image could be omitted without any loss in sensitivity for the localization of parathyroid adenomas, and therefore EP could replace DPP.

Hepatorenal polycystic disease and fever: diagnostic contribution of gallium citrate Ga 67 scan and fluorine F 18 FDG-PET/CT.

A cyst infection was suspected in a patient who was on haemodialysis for renal failure secondary to hepatorenal polycystic disease with persistent fever and pain in right hypochondrium despite antibiotherapy. Radiologic exams (ultrasonography, computed tomography [CT]), however, did not show signs of infection. For surgical removal of the infected cyst, a precise location was required. This report shows how functional imaging, gallium citrate Ga 67 scan, and fluorine F 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) revealed which cyst was infected; however, the fused image provided by PET/CT showed the precise, required location. The infected cyst was located on the right kidney. A week later, after nephrectomy, all symptoms disappeared.

Temporal hypoperfusion assessed by cerebral blood flow SPECT and long-term clinical outcome in patients with eating disorders.

OBJECTIVE: To evaluate the relationship between temporal hypoperfusion in the acute phase of patients with eating disorders and the long-term clinical outcome. METHOD: Brain perfusion was studied using Tc-99m HMPAO SPECT in 17 patients with eating disorders (ED) and compared with 12 controls (C). Semiquantitative analysis was carried out by left/right indexes. Clinical records were reviewed 15 years later and the patients were classified into 2 groups: bad outcome in 10 patients and good outcome in 4. The results of the basal SPECT were compared with the clinical outcome. RESULTS: The mean of the differences of temporal perfusion in the lower slice was 0.1476 +/- 0.1121 in ED and 0.03 +/- 0.019 in C (P < 0.001). Comparisons between C and bad outcome showed a significant difference (P < 0.01). There was no significant difference between good outcome and C. CONCLUSIONS: The temporal hypoperfusion in the acute phase of patients with ED showed a correlation with the long-term clinical outcome and suggested a prognostic value of temporal hypoperfusion.

In-111 ibritumomab scintigraphy (planar and SPECT) and FDG PET/CT before Y-90 ibritumomab treatment in a patient with mantle cell lymphoma.

We report the case of a 75-year-old man, in whom Y-90 ibritumomab was requested because of relapse of blastoid variant mantle cell lymphoma diagnosed in 1995. Before Y-90 ibritumomab treatment, FDG PET and In-111 ibritumomab scintigraphy with planar views at 24 hours, 48 hours, and 5 days, including SPECT, were performed. Discordant information between both examinations was observed as, in addition to the lesions detected by In-111 ibritumomab imaging, FDG PET detected lesions that did not take up the ibritumomab. The discrepancy shown by both radiotracers has to be kept in mind before planning treatment with Y-90 ibritumomab, and for the correct evaluation of treatment response.

Bilateral adrenocortical uptake of Ga-67 SPECT during septicemia in a heart transplant patient.

Gallium-67 scintigraphy is a valuable agent in the management of fever of unknown origin. The use of SPECT increases its sensitivity and may demonstrate unexpected findings. We report on a heart-transplanted 55-year-old man with postsurgical fever of unknown origin. Ga-67 SPECT showed bilateral abnormal adrenal gland uptake that disappeared after intensive antibiotic therapy as assessed by a new Ga-67 scintigraphy obtained 3 months later. Unilateral and bilateral adrenal uptake of gallium has been reported in several clinical settings, ranging from adrenocortical adenomas to malignant disease such as lymphoma or adrenal metastases. Only one similar case, septicemia with transient adrenal uptake of gallium, has been previously reported.

1994-2004: Una década clave para la Medicina Nuclear en el cáncer de mama / 1994-2004: A key decade for Nuclear Medicine in breast cancer

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La Medicina Nuclear actual, fruto de un sólido y laborioso pasado / Current nuclear medicine, the result of a solid and laborious past

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