Towards improved diagnosis: radiomics and quantitative biomarkers in 18F-PSMA-1007 and 18F-fluorocholine PET/CT for prostate cancer recurrence.

OBJECTIVE: This study compared the radiomic features and quantitative biomarkers of 18F-PSMA-1007 [prostate-specific membrane antigen (PSMA)] and 18F-fluorocholine (FCH) PET/computed tomography (CT) in prostate cancer patients with biochemical recurrence (BCR) enrolled in the phase 3, prospective, multicenter BIO-CT-001 trial. METHODS: A total of 106 patients with BCR, who had undergone primary definitive treatment for prostate cancer, were recruited to this prospective study. All patients underwent one PSMA and one FCH PET/CT examination in randomized order within 10 days. They were followed up for a minimum of 6 months. Pathology, prostate-specific antigen (PSA), PSA doubling time, PSA velocity, and previous or ongoing treatment were analyzed. Using LifeX software, standardized uptake value (SUV) maximum, SUVmean, PSMA and choline total volume (PSMA-TV/FCH-TV), and total lesion PSMA and choline (TL-PSMA/TL-FCH) of all identified metastatic lesions in both tracers were calculated. RESULTS: Of the 286 lesions identified, the majority 140 (49%) were lymph node metastases, 118 (41.2%) were bone metastases and 28 lesions (9.8%) were locoregional recurrences of prostate cancer. The median SUVmax value was significantly higher for 18F-PSMA compared with FCH for all 286 lesions (8.26 vs. 4.99, respectively, P < 0.001). There were statistically significant differences in median SUVmean, TL-PSMA/FCH, and PSMA/FCH-TV as per table 2 between the two radiotracers (4.29 vs. 2.92, 1.97 vs. 1.53, and 7.31 vs. 4.37, respectively, P < 0.001). The correlation between SUVmean/SUVmax and PSA level was moderate, both for 18F-PSMA (r = 0.44, P < 0.001; r = 0.44, P < 0.001) and FCH (r = 0.35, P < 0.001; r = 0.41, P < 0.001). TL-PSMA/FCH demonstrated statistically significant positive correlations with both PSA level and PSA velocity for both 18F-PSMA (r = 0.56, P < 0.001; r = 0.57, P < 0.001) and FCH (r = 0.49, P < 0.001; r = 0.51, P < 0.001). While patients who received hormone therapy showed higher median SUVmax values for both radiotracers compared with those who did not, the difference was statistically significant only for 18F-PSMA (P < 0.05). CONCLUSION: Our analysis using both radiomic features and quantitative biomarkers demonstrated the improved performance of 18F-PSMA-1007 compared with FCH in identifying metastatic lesions in prostate cancer patients with BCR.

Review of artificial intelligence clinical applications in Nuclear Medicine.

This paper provides an in-depth analysis of the clinical applications of artificial intelligence (AI) in Nuclear Medicine, focusing on three key areas: neurology, cardiology, and oncology. Beginning with neurology, specifically Alzheimer's disease and Parkinson's disease, the paper examines reviews on diagnosis and treatment planning. The same pattern is followed in cardiology studies. In the final section on oncology, the paper explores the various AI applications in multiple cancer types, including lung, head and neck, lymphoma, and pancreatic cancer.

Comparison of 18F-PSMA-1007 and 18F-Choline PET/CT in prostate cancer patients with biochemical recurrence: a phase 3, prospective, multicenter, randomized study.

OBJECTIVES: This prospective, multicenter, open-label, randomized, crossover trial study was to evaluate the diagnostic performance of 18F-PSMA-1007 (PSMA) vs. 18F-Choline PET/CT (FCH) in prostate cancer (PCa) patients (pts) with biochemical recurrence (BCR). METHODS: One hundred eighty-six pts, who have undergone primary definitive treatment for PCa with BCR, were recruited to this prospective study. All pts underwent one PSMA and one FCH PET/CT examination in randomized order within a time frame of 8 days and were followed up for at least 6 months (182 ±â€…10 days). RESULTS: Recurrence of PCa was observed in 176 out of 186 pts. The overall correct detection rate (DR) was 84% (95% CI 0.7967-0.8830) for PSMA and 69% (95% CI 0.6191-0.7489) for FCH, yielding a difference in proportion of 16% ( P  < 0.0001). PSMA had a sensitivity of 0.8464 and FCH 0.6857 with an odds ratio of 2.5259 ( P  < 0.0001), with statistically significant greater sensitivity of PSMA (ORs, 2.7877 and 2.1283 respectively) ( P  < 0.0001). PET/CT imaging led to a more accurate diagnosis in 166 (89.2%) pts, of which PSMA had contributed more than FCH in 91 (54.8%) of them. The DR for cutoff point PSA ≤ 1 ng/ml was higher for PSMA compared to FCH (61.8% vs. 39.5%). DR value of 51.6% for PSMA reached at PSA ≤ 0.3 ng/ml, while FCH reached that DR value with PSA ≤ 2.2 ng/ml. CONCLUSION: 18F-PSMA-1007 is more efficacious than 18F-Choline for the identification metastatic lesions both in patient and in regional level analysis in PCa patients with BCR.

Spleen visualization in both TTR and AL amyloidosis during 99mTc-DPD scintigraphy. Do we have to deal with a different than the myocardial uptake mechanism?

Technetium-99m- diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) is currently used in Europe for the diagnosis of cardiac amyloidosis, being able to distinguish light chain (AL) from transthyretin (TTR) type. We are reporting obvious spleen visualization in two patients suffering the first from proven TTR and the second from AL type of cardiac amyloidosis, with myocardial uptake-as anticipated-only in the first one. We raise the hypothesis that a common uptake mechanism exists for the spleen amyloid regardless of the type of the disease (AL or TTR), and is possibly different than the cardiac uptake mechanism.

A 4.000 € way to improve perceived quality and meet expectations of thyroid cancer patients receiving therapeutic dose of Iodine-131.

BACKGROUND: Thyroid cancer is the most common malignant disease of the endocrine system and radioiodine therapy (RAIT) is still very often used, resulting in patients staying hospitalized for a few days alone and without visitors, augmenting their stress and discomfort. Our objective was to find simple ways of improving RAIT patients' feelings and perceived quality of the nuclear medicine (NM) department services. MATERIAL AND METHODS: We designed a two-year study in order to enhance RAIT patients' perceived quality of the nuclear medicine (NM) department services and expectations' fulfillment. A questionnaire was used in order to capture patients' perceived quality and expectations from their RAIT. RESULTS: 549 replies were collected. Many intrinsic and extrinsic determinants were found to be positively or negatively related to the perceived quality and fulfillment of patients' expectations of receiving RAIT. A 1% increase could be achieved by spending 110 € per RAIT room. CONCLUSIONS: In this article, we present some easily implemented changes in both personnel behavior and room amenities that could, at least in theory and based on our results, offer a 37.9% improvement in RAIT patients' perceived quality and expectations' fulfillment at a cost of 4169 €.

The modifications brought about by the COVID-19 pandemic to Nuclear Medicine practice.

Nearly 19.9 million cases and more than 730 thousand disease-related deaths have been confirmed in the months that followed WHO's assessment that the novel coronavirus COVID-19, first emerged in Wuhan China on December 2019, could be characterized as a pandemic. The aforementioned coronavirus affected 188 countries as of 8.10.2020. Despite the continually increasing number of COVID-19 cases reported to CDC, at national level, the percentage of visits to outpatient providers and emergency departments has decreased and mortality rates attributed to COVID-19 have declined compared to the previous weeks, still above the baseline. It is common knowledge that the coronavirus pandemic has reshaped societies and economies around the globe, affecting all aspects of everyday life. Public health systems as a whole have been globally affected since they had to face extraordinary demands over a long period of time, which, in turn, required rapid adjustments in the operating procedures that were already in use, in order to provide high-standard health services, while respecting patients quality of life. Over half of deaths in low-income countries are caused by communicable diseases, maternal causes, conditions arising during pregnancy and childbirth, and nutritional deficiencies. On the contrary, this percentage is less than 7% in high-income countries. Noncommunicable diseases cause 71% of deaths globally, ranging from 37% in low-income countries to 88% in high-income countries. However, in terms of absolute number of deaths, 78% of global NCD deaths occurred in low-and middle-income countries. This partially explains why recent developments in medicine were mostly focused on chronic illnesses, including cardiovascular disease, cancer, chronic respiratory diseases and type 2 diabetes, rather than focusing on infection and inflammation progress. The COVID-19 pandemic and the subsequent burden it placed upon health systems to deal with infectious and non-infectious diseases in a poor environment, can become an opportunity to update the field of medical research and change the governmental policies in place that have been stagnant and/or inefficient and ill-managed. This way, health systems will be equipped with better and faster protocols and best practices in order to manage efficiently any other pandemic that might emerge in the future. In this context, Nuclear Medicine departments should reconsider and update their practices, by altering routines and workflows in order to comply with the new sanitary standards, triaging their appointments, or introducing new diagnostic methods like Tele-Medicine / Tele Nuclear Medicine and Artificial Intelligence applications. This special edition of Hellenic Journal of Nuclear Medicine has as its main purpose to introduce and communicate those new practices and protocols/standard operating procedures, in order for the scientific community, health public institutions, affected individuals and their families to be duly informed.

Nuclear thyroidology in pandemic times: The paradigm shift of COVID-19.

Since its outbreak in Wuhan, China the SARS-CoV-2 has become a public health emergency of international concern, impacting all areas of daily life, including medical care. Although not in the front line nuclear medicine practice should adjust their standard operating procedures. The adaptations and the flexibility that nuclear thyroidology, among other fields of nuclear medicine, should show during the pandemic, must focus not only in minimizing the risk of infection to staff, patients, and family members, but also in controlling the transmission of the virus while continuing to provide health care services which do not jeopardize patients' prognosis and quality of life. Favorable prognosis and indolent symptoms of most cases of thyroid diseases, allows postponements and rescheduling as well as alternative procedures, provided that they are cautiously considered for each case individually. The objective of the current paper is to provide guidance on how diagnostic and therapeutic management of patients with thyroid diseases can be safely and effectively adjusted during pandemic, in nuclear medicine settings.

A new era for nuclear medicine.

The coronavirus COVID-19 pandemic is the defining global health crisis of our time. Health care systems globally are amid an unprecedented challenge. Since its emergence in December 2019 in Wuhan, China, the virus has spread to 185 countries worldwide, with more than 2.63 million cases confirmed and more than 183 thousand related deaths (as of 23/04/2020). According to current evidence, the novel coronavirus is transmitted from human-to-human mainly via respiratory droplets of different sizes, contact with bodily fluids, or from contaminated surfaces. In the context of COVID-19, airborne transmission may be possible in specific circumstances and settings in which procedures that generate aerosols are performed. The common clinical symptoms of the highly pathogenic and large-scale epidemic virus include fever, cough, fatigue, ageusia and anosmia and in some patients, gastrointestinal infection symptoms. The elderly and patients with comorbidities are susceptible to infection and prone to severe complications, which may be associated with acute respiratory distress syndrome (ARDS) and cytokines storm. Currently, there are few specific antiviral strategies, but several potent candidates of antivirals and repurposed drugs are under urgent investigation. Under these circumstances, it is critical for health care settings, including nuclear medicine departments to take infection control measures, to prevent a potential spread not just among patients but also to staff members as well as to reconsider the performance of randomized clinical trials. There have already been papers on the radiology preparedness that should be applied to radiology and nuclear medicine departments to support the care of patients with COVID-19 and maintain radiologic diagnostic and interventional support for the entirety of the hospital and healthcare system, particularly for emergencies, without jeopardizing an outbreak in the units. Since most nuclear medicine diagnostic and therapeutic interventions are non-urgent, the general guidance from the International Atomic Energy Agency (IAEA) for infection prevention and control is to postpone scheduled procedure after cautious risk assessment, with certain exceptions. Individualized approach of each case is a sine qua non of ensuring low transmission of COVID-19 as well as effective and safe management of patients admitted to nuclear medicine departments. Another major issue raised is the possible impact COVID-19 on the transport of medical radioisotopes. By the 1st of April 2020, the Euratom Supply Agency (ESA) co-chaired the European Observatory on Supply of Medical Radioisotope expressing their concerns related to the impact of COVID-19 on the supply chain and inconsequence on the availability of the most vital medical radioisotopes used in nuclear medicine. Due to the current lockdown situation, extended border controls, reductions and elimination of many commercial passenger flights, competition and cost of cargo and charter options, required appropriate additional support. The new era of nuclear medicine practice worldwide coincides with a new era for the Hellenic Society of Nuclear Medicine (HSNM) and the Hellenic Journal of Nuclear Medicine (HJNM). The founder and Editor in Chief for more than 28 consecutive years, Professor Emeritus Philip Grammaticos, resigned leaving behind a benchmark for the presidencies and editors to come. His commitment to the conservation of a high level of scientific excellence of the published papers is the legacy which we wish to maintain in the future publications. The interim Editor in Chief of the current issue, would like to express her gratitude to Professor Emeritus Philip Grammaticos for his contribution to the global scientific community as well as to the incoming Editor in Chief Konstantinos Anagnostopoulos, MD, PhD, FRCP, FESC for accepting this new role. We wholeheartedly welcome the new Editor in Chief and the new members of the Editorial Board, wishing them an active, attentive and successful mandate. Hellenic Journal of Nuclear Medicine will remain true to the set principles, values and past and prepared to cope with future challenges in the scientific and clinical setting.

Associating radioiodine therapy in hyperthyroidism with cancer mortality: robust or random results of a statistical analysis?

Dear Editor, Recently, Kitahara et al. (2019) published an article in JAMA Internal Medicine entitled "Association of radioactive iodine treatment with cancer mortality in patients with hyperthyroidism". This publication was based on organ dosimetry calculations from 18,805 patients with hyperthyroidism treated with radioiodine treatment (RAI) followed for nearly 7 decades. The results of the work suggest that solid cancer mortality increases in hyperthyroid patients treated with RAI, with greater absorbed doses to exposed organs being associated with increased risk of death. As expected, these -undoubtedly interesting- findings have raised serious concerns in both physicians and patients regarding the safety profile of RAI. Driven by this, we aim to critically read the article and highlight some of the limitations of the study. First of all, the authors provide data on the association of RAI with cancer mortality and not with cancer incidence, which may be an interesting approach, but constitutes at the same time a weakness of the study. The authors' choice to investigate RAI as a progression and not as an actual risk factor for the onset of malignancies in hyperthyroid patients may be interpreted as an inability to document a causal relationship between them. It would be methodologically more correct either to examine as confounders -among others- cancer stage, patients' age and other co-morbidities, previous treatment administered, or to declare the absence of these data as a major limitation of the conducted analysis. Moreover, the negligence of the role of thyroid hormone levels is another fundamental limitation of this analysis, since a large body of the literature has documented the association of increased thyroid hormone levels with carcinogenicity. In their introduction, the authors state that RAI has declined in favor of antithyroid drugs (ATD). This trend is attempted to be explained by the "increased awareness" of an association between RAI and Graves ophthalmopathy exacerbation as well as radiation-induced secondary malignancies. This argument has however little supporting evidence, since several studies demonstrate that ATD remain the least commonly used agents through the last decades. Moreover, the authors neglect that ATD carry a statistically significant and more obvious cancer death risk than RAI. On the other hand, the use of RAI as index therapy has been doubled through the decades, influenced by several causes including patient-, disease-, physician- and health system- related factors and, of course, not only patients' and physicians' "increased awareness". In addition, concerns are raised regarding organ dosimetry calculations with large uncertainties introduced in the analysis due to reported errors in measured thyroid uptake and mass as well as same model parameters used for patients with different thyroid entities. As Tulchinsky and Bertrand Brill -the Nuclear Medicine physician coauthors of the JAMA paper- state, 'the Kitahara et al. (2019) publication provides a numerical estimate of excess cancer deaths after RAI using assumptive model-based calculations' but 'no excess cancer deaths were actually observed after RAI relative to that predicted in contemporaneous population (using standardized mortality ratio analyses)'. Further, the authors report that "Malignancy was the primary cause for 2,366 deaths (15.3%)" without mentioning other causes of death. However, it would be appropriate to provide some data at least on cardiovascular disease (CVD)-related mortality given that thyrotoxicosis has been associated with CVD by a large number of studies. Some other methodological limitations include the lack of more appropriate control groups for comparison, such as hyperthyroid patients treated with other treatments (surgery, ATD or both), hyperthyroid patients without treatment, as well as euthyroid patients. Finally, the lack of multivariate analyses for all the aforementioned confounders as well as the lack of detailed description of "Other risk factors (x)" in the applied model: "background (a, s, b, x)[1+ßd*f(y)]" constitute methodological drawbacks of the analysis. The key-point of the analysis-thankfully mentioned by the authors- is summarized by the phrase: "some results may be because of chance; therefore, the results should be interpreted with caution." And we could not agree more.

A Mobile App for Thyroid Cancer Patients Aiming to Enhance Their Quality of Life: Protocol for a Quasiexperimental Interventional Pilot Study.

BACKGROUND: Thyroid cancer (TC) is one of the fastest growing cancers all over the world. Differentiated thyroid cancer (DTC) is the most frequent subtype of TC. When appropriate treatment is given, the prognosis for the patient is generally excellent. Despite the generally good prognosis of thyroid carcinomas, the symptoms may range from emotional to physical discomfort, depending on the thyroid hormone status, which can severely affect the patient. Moreover, the diagnostic and therapeutic procedures that DTC patients have to undergo, such as thyroidectomy and radioiodine therapy, significantly affect their mental and physical well-being. Often, the physician only addresses the favorable prognosis of DTC compared with other cancer types and neglects to assess issues related to the quality of life (QoL) of the patient; this was the reason we decided to design a mobile app for DTC patients and their caregivers. OBJECTIVE: The aim of this study is to research the feasibility and applicability of an mHealth app tailored to DTC patients, as reflected in their QoL. The main features of the developed app offer access to useful information about thyroid cancer, diagnostic tests, and the appropriate therapy administered to DTC patients. METHODS: Based on the existing literature, we created an up-to-date information platform regarding TC and especially DTC. In order to develop an effective app that can be implemented in current health care, we designed a section where the patient and physician can keep a medical record in an effort to enable access to such information at any time. Finally, we designed a user-friendly notification program, including pill prescription, follow-up tests, and doctor visit reminders in order to equally facilitate the lives of the patient and physician. RESULTS: Having developed this mobile app, we aim to conduct a pilot quasiexperimental interventional trial. Our intention is to enroll at least 30 TC patients and assign them to intervention or control groups. Both groups will receive standard care for treating and monitoring TC, and the intervention group will also receive and use the DTC app. TC patients' QoL will be assessed for both control and intervention groups in order to examine the effectiveness of the DTC app. QoL will be assessed through the QoL core questionnaire European Organisation for Research and Treatment of Cancer (EORTC) QLQ-THY34 in combination with the EORTC QLQ-C30 questionnaire through quantitative statistical analysis. CONCLUSIONS: The use of mHealth apps can play a significant role in patient education, disease self-management, remote monitoring of patients, and QoL improvement. However, the main limitation of the majority of existing studies has been the lack of assessing their usefulness as well as the absence of specific instruments to carry out this assessment. In light of those considerations, we developed a mobile app tailored to the needs of DTC patients. Furthermore, we evaluated its contribution to the QoL of the patients by using the EORTC QLQ-THY34 questionnaire, an accurate and safe instrument for the evaluation of the QoL in TC patients, while supporting future planned endeavors in the field. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/13409.

Predictive Value of 99MTC-hynic-toc Scintigraphy in Lung Neuroendocrine Tumor Diagnosis.

BACKGROUND: Νeuroendocrine tumors of the lungs are rare arising in the thymus and gastro-entero-pancreatic tract and belonging to foregut of neuroendocrine tumors. The aim of the present prospective study was to estimate the potential impact of single-photon emission computed tomography somatostatin receptor scintigraphy using 99mTc-Tektrotyd on diagnosis, treatment response, and prognosis in patients with neuroendocrine tumors of the lungs. METHODS: Thirty-six patients with neuroendocrine tumors of the lungs were evaluated by using 99mTc-HYNIC-TOC scintigraphy. The scintigraphic results were compared to liver tissue uptake (Krenning score). Likewise, the functional imaging results were compared with biochemical indices including chromogranin A, neuroendocrine-specific enolase, and insulin-like growth factor 1 at the time of diagnosis (baseline) and disease progression. RESULTS: The number of somatostatin receptors, expressed with Krenning score, did not show any correlation with the survival of patients both at baseline ( P = .08) and at disease progression ( P = .24), and scintigraphy results did not relate significantly to progression-free survival. Comparing the results of 99mTc-HYNIC-TOC scintigraphy according to the response of patients in the initial treatment, a statistically significant negative correlation was observed both in the first and in the second scintigraphy with patients' response ( P = .001 and P < .001, respectively). The concentrations of biochemical markers were in accordance with scintigraphy results in the diagnosis. CONCLUSION: This study indicates that 99mTc-HYNIC-TOC scintigraphy appears to be a reliable, noninvasive technique for detection of primary neuroendocrine tumors and their locoregional or distant metastases, although it cannot be used as a neuroendocrine tumors of the lungs predictive technique.

Rib Fractures Mimicking Bone Metastases in 18F-PSMA-1007 PET/CT for Prostate Cancer.

Prostate-specific membrane antigen (PSMA) is a membrane glycoprotein that is overexpressed in prostate cancer cells. It is also expressed in other normal tissues and several other malignant and benign diseases. We present a case of a 69-year-old man with history of prostate adenocarcinoma who underwent F-PSMA-1007 PET/CT due to suspected biochemical recurrence. PET/CT showed F-PSMA-1007 uptake in healing rib fractures with no other pathologic findings. Clinicians reporting F-PSMA-1007 PET/CT should be aware of this potential pitfall, especially in nontypical trauma pattern (eg, solitary osseous lesion) mimicking bone metastases.

[Neuroendocrine tumors: Peptide receptors radionuclide therapy (PRRT)].

Neuroendocrine tumors (neuroendocrine tumors-NET) are a heterogeneous group of neoplasms with a common embryological origin and diverse biological behavior, derived from cells of the neuroendocrine system, the system APUD (amine precursor uptake and decarboxylation). They are characterized by overexpression of all five somatostatin receptors (SSTR1-SSTR5), particularly type 2 (SST2). Surgical resection of the tumor is the treatment option, with a possibility of complete remission in patients with limited disease. Somatostatin analogs (octreotide and lanreotide) are the treatment of choice in patients with residual disease, particularly when it comes to NET non-pancreatic origin. Systemic chemotherapy is administered primarily to patients with poorly differentiated carcinomas. PRRT treatment is recommended in case of non-responsiveness of the disease. The ideal candidates for PRRT are patients with unresectable disease of high and intermediate differentiation. Somatostatine analogs radiolabelled with Indium-111 ((111)In), Yttrium-90 ((90)Y), Lutetium-177 ((177)Lu) and Bismuth-213 ((213)Bi), are selectively concentrated in the tumor cells, causing maximum tissue damage to tumors and with fewer effects on healthy tissue and the immune system. In the current review, it was demonstrated that patients with unresectable grade 1 or 2 disease showed increased PFS (progression free survival) and OS (overall survival), while quality of life was improved after PRRT treatment as compared to somatostatin analogs, chemotherapy and other targeted therapies.

[Risk factors and the progression of thyroid malignancies].

OBJECTIVE: Thyroid cancer is the most common endocrine malignancy and the fifth most common malignant neoplasm of the female sex. During the past several decades, an increasing incidence of thyroid cancer has been reported. The mortality from thyroid cancer is comparatively low and remains almost stable showing a slight increase. It is currently unclear whether the observed increase in thyroid cancer is real or is due to overdiagnosis, as clinical and pathology findings may be sometimes doubtful in diagnosing the incidence and mortality of thyroid cancer. The cancer has different distribution depending on gender, race, age and environmental conditions. Despite considerable progress in the understanding of the biology and molecular pathways of carcinogenesis in the thyroid gland, less progress has been made in terms of defining a risk profile for thyroid cancer. The only risk factor which is systematically documented as carcinogenic for thyroid is exposure to ionizing radiation during childhood. Recently several studies are examining as risk factors diet and exercise, benign thyroid diseases as well as a genetic factors that influence the incidence and mortality of the disease. To the best of our knowledge there are only few epidemiological studies examining the effects of exposure to chemical agents on thyroid cancer's "behavior". CONCLUSION: The effect of risk factors for the onset and progression of malignant thyroid tumors constitutes a field that requires further study in order to provide answers on the pathogenesis of the disease, so as to take preventing measures and finally manage to decrease thyroid cancer incidence and mortality.

[The role of positron emission tomography in in lymphoma diagnosis and treatment].

UNLABELLED: Objective and description of the review: To describe the role of PET and PET/CT as a better technique than gallium-67-citric or radiology in diagnosing histotypes of lymphoma and in following treatment. Lugano system is indicated for the specific diagnosis of histotypes, except in cases who do not take-up the radioactive agents such as the external lymphadenic border line B-lymphoma, lymphoma from small B- cells and spongoid mycosis. Treatment results are estimated by the PET/CT scans especially in Hodgkin's lymphoma. Favourable treatment in all lymphomas is estimated by the higher uptake of the radiopharmaceutical. In resistant cases, negative PET/CT scan suggests possible bone-marrow cells transplantation. CONCLUSION: The PET/CT scan can identify the stages and evaluate treatment results, of lymphomas.