Bone turnover prediction in patients with chronic kidney disease (CKD) undergoing hemodialysis using shortened dynamic 18F-NaF PET/CT Ki-Patlak.

This study investigated whether Ki-Patlak derived from a shortened scan time for dynamic 18F-NaF PET/CT in chronic kidney disease (CKD) patients undergoing hemodialysis can provide predictive accuracy comparable to that obtained from a longer scan. Twenty-seven patients on chronic hemodialysis, involving a total of 42 scans between December 2021 and August 2023 were recruited. Dynamic 18F-NaF PET/CT scans, lasting 60-90 min, were immediately acquired post-injection, covering the mid-twelfth thoracic vertebra to the pelvis region. Ki-Patlak analysis was performed on bone time-activity curves at 15, 30, 45, 60, and 90 min in the lumbar spine (L1-L4) and both anterior iliac crests. Spearman's rank correlation (rs) and interclass correlation coefficient were used to assess the correlation and agreement of Ki-Patlak between shortened and standard scan times. Bone-specific alkaline phosphatase (BsAP) and tartrate-resistant acid phosphatase isoform 5b (TRAP5b) were tested for their correlation with individual Ki-Patlak. Strong correlations and good agreement were observed between Ki-Patlak values from shortened 30-min scans and longer 60-90-min scans in both lumbar spine (rs = 0.858, p < 0.001) and anterior iliac crest regions (rs = 0.850, p < 0.001). The correlation between BsAP and Ki-Patlak in the anterior iliac crests was weak and statistically insignificant. This finding suggests that a proposed shortened dynamic 18F-NaF PET/CT scan is effective in assessing bone metabolic flux in CKD patients undergoing hemodialysis, offering a non-invasive alternative approach for bone turnover prediction.

Dual-time-point dynamic 68Ga-PSMA-11 PET/CT for parametric imaging generation in prostate cancer.

PURPOSE: To investigate the optimal dual-time-point (DTP) approaches using dynamic 68Ga-PSMA-11 PET/CT imaging to generate parametric images for prostate cancer patients. METHODS: Fifteen patients with prostate cancer were intravenously administered 68Ga-PSMA-11 of 181.9 ± 47.2 MBq, followed by an immediate 60 min dynamic PET/CT scan. List-mode data were reconstructed into 25 timeframes (6 × 10 s, 8 × 30 s, and 11 × 300 s) and corrected for motion and partial volume effect. DTP parametric images were generated using different interval time points of 5 min and 10 min, with a minimum of 30 min time interval. Net influx rates (Ki) were calculated through the fitting of a single irreversible two-tissue compartmental model. Intraclass correlation coefficient (ICC) values between DTP protocols and 60 min Ki were obtained. Lesion-to-background ratios (LBRs) of Ki and standardized uptake value (SUV) images in each DTP protocol were determined. RESULTS: The DTP protocol of 5-10 min with a 40-45 min interval showed the highest ICC of 0.988 compared with the 60 min Ki, whereas the ICC values for the intervals of 0-5 min with 55-60 min and 0-10 min with 50-60 min were 0.941. The LBRs of the 60 min Ki, 5-10 min with 40-45 min Ki, 0-5 min with 55-60 min Ki, 0-10 min with 50-60 min Ki, SUVmean, and SUVmax images were 29.53 ± 27.33, 13.05 ± 15.28, 45.15 ± 53.11, 45.52 ± 70.31, 19.77 ± 23.43, and 25.06 ± 30.07, respectively. CONCLUSION: The 0-5 min with 55-60 min DTP parametric imaging exhibits a comparable Ki to 60 min parametric imaging and remarkable image quality and contrast than SUV imaging, enhancing prostate cancer diagnosis while maintaining time efficiency.

Comparison of absorbed doses to the tumoral and non-tumoral liver in HCC patients undergoing 99mTc-MAA and 90Y-microspheres radioembolization.

PURPOSE: This study aimed to determine the absorbed doses in the tumoral-liver and non-tumoral liver of hepatocellular carcinoma (HCC) patients undergoing radioembolization with Yttrium-90 (90Y) resin microspheres, and compared with those derived from 99mTc-MAA using the partition model. METHODS: A total of 42 HCC patients (28 males and 14 females, mean age 65 ± 11.51 years) who received 45 treatment sessions with 90Y-microspheres between 2016 and 2021 were included. Pre-treatment 99mTc-MAA and post-treatment 90Y-bremsstrahlung SPECT/CT were acquired for each patient. Semi-automated segmentation of regions of interest (ROIs) was performed using MIM Encore software to determine the tumor-liver ratio (TLR) encompassing the liver volume, tumoral-liver, and lungs, and verified by both nuclear medicine physician and interventional radiologist. A partition dosimetry model was used to estimate the administered activity of 90Y-microspheres and the absorbed doses to the tumoral-liver and non-tumoral liver. The student's paired t test and Bland-Altman plot were used for the statistical analysis. RESULTS: The mean TLR values obtained from 99mTc-MAA SPECT/CT and 90Y-bremsstrahlung SPECT/CT were 4.78 ± 3.51 and 2.73 ± 1.18, respectively. The mean planning administered activity of 90Y-microspheres based on 99mTc-MAA SPECT/CT was 1.56 ± 0.80 GBq, while the implanted administered activity was 2.53 ± 1.23 GBq (p value < 0.001). The mean absorbed doses in the tumoral-liver estimated from 99mTc-MAA and 90Y-bremsstrahlung SPECT/CT were 127.44 ± 4.36 Gy and 135.98 ± 6.30 Gy, respectively. The corresponding mean absorbed doses in the non-tumoral liver were 34.61 ± 13.93 Gy and 55.04 ± 16.36 Gy. CONCLUSION: This study provides evidence that the administered activity of 90Y-microspheres, as estimated from 90Y-bremsstrahlung SPECT/CT, was significantly higher than that estimated from 99mTc-MAA SPECT/CT resulted in increased absorbed doses in both the tumoral-liver and non-tumoral liver. However, 99mTc-MAA SPECT/CT remains a valuable planning tool for predicting the distribution of 90Y-microspheres in liver cancer treatment.

Prospective evaluation of plasma phosphorylated tau in a real-life memory clinic in Thailand.

INTRODUCTION: Despite the substantial accuracy of plasma p-tau in diagnosing Alzheimer's disease (AD) in research cohorts, data on real-life memory clinic patients are lacking. METHODS: Memory clinic patients at their early symptomatic stages were prospectively enrolled to undergo routine clinical assessment, plasma p-tau181 quantification (Simoa), amyloid and tau-positron emission tomography (PET). The diagnostic performance of plasma p-tau181, neurocognitive specialists, and regional tau-PET were compared head-to-head using amyloid-PET as the reference standard. RESULTS: Plasma p-tau181 has the area under the curve (AUC), sensitivity, specificity, and accuracy of 0.84 (95% confidence interval [CI] 0.73-0.94), 0.80 (95% CI 0.64-0.90), 0.75 (95% CI 0.51-0.90), and 0.78 (95% CI 0.65-0.88) for detecting amyloid-PET positivity in early symptomatic patients, respectively. The AUC of clinical diagnosis and tau-PET were 0.70 (95% CI 0.56-0.85) and 0.88 (95% CI 0.79-0.97), respectively. DISCUSSION: Plasma p-tau181 also performed well in real-life memory clinic settings and its role in clinical practice is supported.

Agreement between Thai Cardiovascular Risk Scores and Myocardial Perfusion Imaging: Exploring Associations and Clinical Implications.

Purpose: This study aimed to assess the agreement between the Thai cardiovascular (CV) risk score or pretest probability (PTP), and myocardial perfusion imaging (MPI), and to explore the association between abnormal MPI results and higher Thai CV risk scores or PTP risk. Materials and Methods: The study was conducted between March 2017 and December 2021, and included 128 patients. Myocardial perfusion gated single photon emission computed tomography imaging was performed on all patients, and agreement between the Thai CV risk score, PTP, and MPI was measured using weighted Cohen's kappa statistic. Logistic regression was used to calculate odds ratios (OR) and explore the association. Results: Fair agreement was observed between MPI and the Thai CV risk score (κ =0.269, P = 0.010), including patients with clinical chest pain (κ =0.367, P < 0.001). Subgroup analysis of patients with intermediate PTP revealed moderate agreement between MPI and the Thai CV risk score (κ =0.428, P = 0.002). Patients with intermediate (OR = 3.25, P = 0.010) or high (OR = 4.78, P = 0.001) Thai CV risk scores had significantly higher odds of having intermediate or high MPI results compared to those with low Thai CV risk scores. Conclusion: This study highlights the agreement between MPI and the Thai CV risk score and PTP. Higher Thai CV risk scores are associated with increased odds of abnormal MPI results. These findings provide valuable insights for clinical decision-making and patient management.

Brain perfusion single photon emission computed tomography abnormality in MRI-negative stroke-like patients post COVID-19 vaccination.

Stroke-like symptoms after COVID-19 vaccination was thought to be functional if there was no anatomical image abnormality. We aimed to analyze brain perfusion changes in these patients. A case-control study of brain perfusion single photon emission computed tomography (SPECT) of 12 vaccinated patients with left-sided stroke-like symptoms were compared with 12 age- and gender-matched normal interictal brain SPECTs using voxel-based analysis. Significant hyperperfusion was seen on the right side in postcentral, inferior parietal, mid temporal, parahippocampal, and caudate regions, and on the left side in the thalamus, hippocampus, and mid temporal areas. In addition, there were hypoperfused bilateral superior frontal gyri and right mid/posterior cingulate cortex (Family-wise-error corrected p-values  < .05). Both hypoperfusion and hyperperfusion in the brain are demonstrated. We hypothesize that these findings might be the result of the functional neurological disorder. However, based on other previous studies, circulating spike protein in the patients' plasma early after vaccination might also be the cause.

A Novel method of seizure onset zone localization by serial Tc-99 m ECD brain perfusion SPECT clearance patterns.

In this prospective study, we postulate that there is a difference between clearance of [99mTc]Tc- ethyl cysteinate dimer (ECD) in the seizure onset zone (SOZ) and other brain areas and thus SOZ localization by clearance patterns might become a potential novel method for SOZ localization in epilepsy. The parametric images of brain ECD clearance were generated by linear regression model analysis from serial brain SPECT scans from 30 to 240 min after ECD injection (7-times point) in 7 patients with drug-resistant epilepsy and 3 normal volunteers. Clearance patterns of the SOZ confirmed by good surgical outcome or consensus with other investigations were analyzed quantitatively and semi-quantitatively by visual grading (slower or faster washout than contralateral brain regions). The average [99mTc]Tc-ECD clearance rates of SOZs were + 1.08% ± 2.57%/hr (wash in), -7.02% ± 2.56%/hr (washout), and -5.37% ± 1.71%/hr (washout) in ictal, aura and interictal states, respectively. Paired t-tests between the SOZ and contralateral regions showed statistically significant difference (p = 0.039 in interictal state). Clearance patterns that can define the SOZs were 1) wash in and slow washout on ictal slope, 2) fast washout on aura slope and interictal slope with 100% (6/6), 100% (2/2) and 75% (6/8) localization using ictal, aura, and interictal slope maps, respectively. Our study provided the evidence that clearance pattern methods are potential additive diagnostic tools for SOZ localization when routine one-time point SPECT are unable to define the SOZ.

Nuclear imaging for localization and surgical outcome prediction in epilepsy: A review of latest discoveries and future perspectives.

Background: Epilepsy is one of the most common neurological disorders. Approximately, one-third of patients with epilepsy have seizures refractory to antiepileptic drugs and further require surgical removal of the epileptogenic region. In the last decade, there have been many recent developments in radiopharmaceuticals, novel image analysis techniques, and new software for an epileptogenic zone (EZ) localization. Objectives: Recently, we provided the latest discoveries, current challenges, and future perspectives in the field of positron emission tomography (PET) and single-photon emission computed tomography (SPECT) in epilepsy. Methods: We searched for relevant articles published in MEDLINE and CENTRAL from July 2012 to July 2022. A systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis was conducted using the keywords "Epilepsy" and "PET or SPECT." We included both prospective and retrospective studies. Studies with preclinical subjects or not focusing on EZ localization or surgical outcome prediction using recently developed PET radiopharmaceuticals, novel image analysis techniques, and new software were excluded from the review. The remaining 162 articles were reviewed. Results: We first present recent findings and developments in PET radiopharmaceuticals. Second, we present novel image analysis techniques and new software in the last decade for EZ localization. Finally, we summarize the overall findings and discuss future perspectives in the field of PET and SPECT in epilepsy. Conclusion: Combining new radiopharmaceutical development, new indications, new techniques, and software improves EZ localization and provides a better understanding of epilepsy. These have proven not to only predict prognosis but also to improve the outcome of epilepsy surgery.