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Annals of Nuclear Medicine (v.22, #7)

Three-dimensional SPECT reconstruction with transmission-dependent scatter correction by Antti Sohlberg; Hiroshi Watabe; Hidehiro Iida (pp. 549-556).

The quality of single-photon emission computed tomography (SPECT) imaging is hampered by attenuation, collimator blurring, and scatter. Correction for all of these three factors is required for accurate reconstruction, but unfortunately, reconstruction-based compensation often leads to clinically unacceptable long reconstruction times. Especially, efficient scatter correction has proved to be difficult to achieve. The objective of this article was to extend the well-known transmission-dependent convolution subtraction (TDCS) scatter-correction approach into a rapid reconstruction-based scatter-compensation method and to include it into a fast 3D reconstruction algorithm with attenuation and collimator-blurring corrections.Ordered subsets expectation maximization algorithm with attenuation, collimator blurring, and accelerated transmission-dependent scatter compensation were implemented. The new reconstruction method was compared with TDCS-based scatter correction and with one other transmission-dependent scatter-correction method using Monte Carlo simulated projection data of ^99mTc-ECD and ¹²³I-FP-CIT brain studies.The new reconstruction-based scatter compensation outperformed the other two scatter-correction methods in terms of quantitative accuracy and contrast measured with normalized mean-squared error, gray-to-white matter and striatum-to-background ratios, and also in visual quality. Highest accuracy was achieved when all the corrections (i.e., attenuation, collimator blurring, and scatter) were applied.The developed 3D reconstruction algorithm with transmission-dependent scatter compensation is a promising alternative to accurate and efficient SPECT reconstruction.

Keywords: Statistical reconstruction; Scatter correction; Collimator-blurring correction; Attenuation correction

Usefulness of rCBF analysis in diagnosing Parkinson’s disease: supplemental role with MIBG myocardial scintigraphy by Shigeki Nagamachi; Hideyuki Wakamatsu; Shogo Kiyohara; Seigo Fujita; Shigemi Futami; Shozo Tamura; Masamitsu Nakazato; Syuichi Yamashita; Hideo Arita; Ryuichi Nishii; Keiichi Kawai (pp. 557-564).

¹²³I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is a useful tool for differentiating idiopathic Parkinson’s disease (PD) from parkinsonism (PS) caused by other disorders. However, cardiac MIBG uptake is affected by various causes. Alternatively, hypoperfusion in the occipital lobe of PD is reported recently.The objective is to clarify the correlation between regional cerebral blood flow (rCBF) alteration and cardiac MIBG uptake in PD. In addition, we examined whether additional brain perfusion analysis improved the differential diagnostic ability for PD from PS when compared with MIBG scintigraphy alone.Forty-nine patients with PD (27 mild groups: Hoehn and Yahr stages I, II; 22 severe groups: Hoehn and Yahr stages III, IV) and 28 patients with PS participated. We compared absolute rCBF values between PD and PS. In addition, we determined correlation between MIBG parameters and each rCBF value. Finally, we compared the diagnostic ability for the differentiation of PD from PS between two diagnostic criteria, each MIBG index abnormality alone [heart-to-mediastinum ratio, H/M (E) < 1.9, H/E (D) < 1.7, washout rate > 40%] and each MIBG index abnormality or occipital lobe hypoperfusion (<36 ml/100 g per min).Absolute rCBF value of occipital lobe was significantly lower in severe PD as compared with PS or mild PD. In the correlation analysis, rCBF of occipital lobe correlated positively with MIBG parameters (H/M). Regarding the diagnostic ability, sensitivity improved by accounting for occipital hypoperfusion as compared with MIBG indices alone. In contrast, neither specificity nor accuracy improved by adding occipital lobe analysis.MIBG parameters (H/M) correlated positively with occipital hypoperfusion in PD. In the differential diagnosis between PD and PS, although its usefulness might be limited, analysis of rCBF in the occipital lobe added to ¹²³I-MIBG myocardial imaging can be recommended.

Keywords: ¹²³I-MIBG; ^99mTc-HMPAO; 3D-SSP; 3D-SRT; Parkinson’s disease

QRS complex duration and dipyridamole gated SPECT findings in the left bundle branch block by Sabahat Inanir; Billur Caliskan; Sena Tokay; Ahmet Oktay (pp. 565-570).

The aim of this study was to investigate the relationship between QRS duration, artifactual perfusion abnormalities, and left ventricular function in patients with left bundle branch block (LBBB) using dipyridamole technetium-99m sestamibi electrocardiography-gated single-photon emission computed tomography (SPECT).Twenty-three patients (62 ± 12.2 years, 18 women, 5 men) with complete LBBB were analyzed. All patients underwent rest-dipyridamole gated SPECT (1-day protocol). To exclude patients with true myocardial ischemia and clearly define artifactual abnormalities owing to LBBB, only patients with normal end-diastolic stress images were involved. Four sets of SPECT images representing ungated rest, ungated stress, and end-diastolic and end-systolic stress images were generated, and the summed defect scores were obtained for each [summed rest score (SRS), summed stress score (SSS), end-diastolic score (EDS), and end-systolic score (ESS), respectively]. QRS durations were measured for both rest and dipyridamole stress.The patients with perfusion abnormalities on ungated rest, ungated stress, or end-systolic stress images had significantly longer minimum QRS duration at rest. These QRS values correlated with SRS and SSS (r: 0.528, P: 0.01 and r: 0.47, P: 0.024, respectively). Analysis of perfusion and functional data demonstrated an inverse correlation between left ventricular ejection fraction (LVEF) and ESS (r: −0.671, P < 0.0001). The patients with end-systolic perfusion abnormalities had significantly lower LVEF rates when compared with the patients with normal perfusion on end-systolic images.Our results demonstrated that the presence and severity of artifactual perfusion abnormalities owing to LBBB were significantly related to minimum QRS duration. The magnitude of perfusion abnormalities especially on the end-systolic phase seems to adversely affect systolic function of the left ventricle.

Keywords: Left bundle branch block; Gated single-photon emission computed tomography; QRS complex

Diagnostic performance of PET/CT in differentiation of malignant and benign non-solid solitary pulmonary nodules by Yukio Tsushima; Ukihide Tateishi; Hajime Uno; Masahiro Takeuchi; Takashi Terauchi; Tomoyuki Goya; Edmund E. Kim (pp. 571-577).

To evaluate whether [F-18] fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) can distinguish benign from malignant solitary pulmonary nodules (SPNs) with non-solid components.[F-18] FDG-PET/CT scans were performed on 53 consecutive patients (30 men, 23 women; mean age 65 years) who had SPNs with non-solid components identified by CT screening for lung cancer. All patients underwent surgical resection, and all lesions were pathologically proved. Visual score, maximal, and mean standardized uptake value (SUV), and maximal and mean lesion-to-normal tissue count density ratio (LNR) were calculated in all lesions. In addition, clinical characteristics, laboratory test results, and CT findings were assessed.Benign SPNs with non-solid components had a higher uptake on [F-18] FDG-PET/CT. Visual score, maximal and mean SUV, and maximal and mean LNR were significantly higher in the benign when compared with the malignant SPNs (P < 0.001). When the cutoff of 1.5 was assigned for maximal SUV, the diagnostic performance of [F-18] FDG-PET/CT in predicting benign SPN revealed 100.0% sensitivity, 96.4% specificity, and 100.0% accuracy.[F-18] FDG-PET/CT is useful for the differential diagnosis of SPNs with non-solid components.

Keywords: PET/CT; Solitary pulmonary nodule; Lung cancer

Static and moving phantom studies for radiation treatment planning in a positron emission tomography and computed tomography (PET/CT) system by Mitsuru Okubo; Yasumasa Nishimura; Kiyoshi Nakamatsu; Masahiko Okumura; Toru Shibata; Shuichi Kanamori; Kouhei Hanaoka; Makoto Hosono (pp. 579-586).

To determine an appropriate threshold value for delineation of the target in positron emission tomography (PET) and to investigate whether PET can delineate an internal target volume (ITV), a series of phantom studies were performed.An ellipse phantom (background) was filled with 1028 Bq/ml of [¹⁸F] fluoro-2-deoxyglucose (¹⁸FDG), and six spheres of 10 mm, 13 mm, 17 mm, 22 mm, 28 mm, and 37 mm in diameter inside it were filled with ¹⁸FDG activity to achieve source-to-background (S/B) ratios of 10, 15, and 20. In static phantom experiments, an appropriate threshold value was determined so that the size of PET delineation fits to an actual sphere. In moving phantom experiments with total translations of 10 mm, 20 mm, and 30 mm and a period of oscillation of 4 s, the maximum size of PET delineation with the appropriate threshold value was measured in both the axial and sagittal planes.In the static phantom experiments, the measured maximum ¹⁸FDG activities of spheres of less than 22 mm were lower than 80% of the injected ¹⁸FDG activity, and those for the larger spheres ranged from 90% to 110%. Appropriate threshold values determined for the spheres of 22 mm or more ranged from 30% to 40% of the maximum ¹⁸FDG activity, independent of the S/B ratio. Therefore, we adopted an appropriate threshold value as 35% of the measured maximum ¹⁸FDG activity. In moving phantom experiments, the maximum ¹⁸FDG activity of spheres decreased significantly, dependent on the movement distance. Although the sizes of PET delineation with 35% threshold value tended to be slightly smaller (<3 mm) than the actual spheres in the axial plane, the longest sizes in the sagittal plane were larger than the actual spheres.When a threshold value of 35% of the measured maximum ¹⁸FDG activity was adopted, the sizes of PET delineation were almost the same for static and moving phantom spheres of 22 mm or more in the axial plane. In addition, PET images have the potential to provide an individualized ITV.

Keywords: Phantom experiments; Appropriate threshold values; Positron emission tomography (PET); Radiation treatment planning; Internal target volume (ITV)

¹⁸F-FDG accumulation in the oral cavity is associated with periodontal disease and apical periodontitis: an initial demonstration on PET/CT by Hiroaki Shimamoto; Mitsuaki Tatsumi; Naoya Kakimoto; Seiki Hamada; Eku Shimosegawa; Shumei Murakami; Souhei Furukawa; Jun Hatazawa (pp. 587-593).

The objective of this study was to prospectively investigate the relationship between high accumulation of 2-deoxy-2-[¹⁸F] fluoro-d-glucose (FDG) in the oral cavity and dental infections on positron emission tomography/computed tomography (PET/CT).FDG-PET/CT scans of 103 patients who underwent a health screening were evaluated. The dental examination was performed prior to each PET/CT scan, and dental infections were assessed. Dental infections were classified into six blocks. The severity of dental caries was classified into five grades, and periodontal disease and apical periodontitis were classified into three grades. Two radiologists classified the PET images in the same manner as the dental examination. They evaluated the intensity of FDG uptake by a four-point visual PET image score for each block. The comparison of the dental examination, as a gold standard, and the visual PET image score was performed on a patient or block basis.On a patient-based analysis, 21 of 103 patients (20.4%) showed PET positive findings in the oral cavity; 18 of the 21 patients (85.7%) had dental infections. On a block-based analysis, 25 of 605 blocks (4.1%) showed PET positive findings in the oral cavity; 22 of the 25 blocks (88.0%) had dental infections. On a detailed block-based analysis, a significant difference was observed between the presence of periodontal disease, or apical periodontitis and the positivity of the visual PET image findings (P < 0.01). Their severity correlated with the visual PET image score (P < 0.05).Periodontal disease or apical periodontitis, but not dental caries, caused FDG accumulation in the oral cavity. This finding should be taken into account when a head and neck FDG-PET study is interpreted.

Keywords: FDG-PET; PET/CT; Dental caries; Periodontal disease; Apical periodontitis

Accuracy of whole-body FDG-PET/CT for detecting brain metastases from non-central nervous system tumors by Kazuhiro Kitajima; Yuji Nakamoto; Hiromi Okizuka; Yumiko Onishi; Michio Senda; Narufumi Suganuma; Kazuro Sugimura (pp. 595-602).

Positron emission tomography (PET) using ¹⁸F-fluoro-2-deoxy-d-glucose (FDG) has a limitation in detecting cerebral metastases; however, the feasibility of detection by inline PET/computed tomography (CT) system remains unknown. We evaluated the accuracy of FDG-PET/CT of body imaging protocol for the detection of cerebral metastases when compared with PET alone and CT alone.Fifty patients underwent whole-body FDG-PET/CT scanning including the brain and contrastenhanced brain MR (magnetic resonance) scan. PET-only, CT-only, and the fused images were interpreted, and the confidence of presence of cerebral metastases was recorded using a five-point grading scale. Area under the receiver-operating characteristic (ROC) curve (Az) was calculated. Differences among the three modalities were tested with the Cochran-Q test, followed by multiple comparisons using the McNemar test with Bonferroni adjustment.Magnetic resonance imaging revealed 70 cerebral metastatic lesions in 20 patients. Patient-based analysis showed that the sensitivity, specificity, accuracy, and Az of PET-alone interpretation were 45%, 80%, 66%, and 0.6025, respectively, those of CT-alone interpretation were 50%, 97%, 78%, and 0.7158, respectively, and those of fused-image interpretation were 50%, 93%, 76%, and 0.7242, respectively. ROC analysis revealed significant differences among the three interpretation methods (P = 0.0238) and between PET and PET/CT (P = 0.0129). The sensitivity of PET, CT, and fused-image interpretation for detecting 70 lesions was 13%, 20%, and 20%, respectively.Even with an integrated PET/CT scanner of body imaging protocol, the sensitivity of cerebral metastases remained unsatisfactory. To assess intracranial lesions, MR scanning should still be considered.

Keywords: Brain; Metastasis; FDG; PET; CT

The clinical efficacy of ¹⁸F-FDG-PET/CT in benign and malignant musculoskeletal tumors by Duk-Seop Shin; Oog-Jin Shon; Dong-Sung Han; Joon-Hyuk Choi; Kyung-Ah Chun; Ihn-Ho Cho (pp. 603-609).

Most of the current clinical data on the role of 2-[¹⁸F]fluoro-2-deoxy-d-glucose positron emission tomography (¹⁸F-FDG-PET) in musculoskeletal tumors come from patients studied with PET and less frequently with hardware fusion PET/computed tomography (CT). And the number of cases in each report is too small to clarify the exact clinical efficacy of PET or PET/CT. This prompted us to analyze our experience with ¹⁸F-FDG-PET/CT in a relatively large group of patients with musculoskeletal tumors. ¹⁸F-FDG-PET/CT was performed on 91 patients from May 2004 to June 2007. The final diagnosis was obtained from surgical biopsy in 83 patients (91%) and clinical follow-up in 8 (9%). We analyzed the characteristics and amount of ¹⁸F-FDG uptake in soft tissue and bone tumors, and investigated the ability of ¹⁸F-FDG-PET/CT to differentiate malignant from benign tumors. The cutoff maximum standardized uptake value (SUV_max) was calculated using the receiver-operation characteristic curve method. Sensitivity, specificity, and diagnostic accuracy were calculated with cutoff SUV_max and the final diagnosis. Unpaired t test was used for the statistical analysis.Final diagnosis revealed 19 benign soft tissue tumors (mean SUV_max 4.7), 27 benign bone tumors (5.1), 25 malignant soft tissue tumors (8.8), and 20 malignant bone tumors (10.8). There was a significant difference in SUV_max between benign and malignant musculoskeletal tumors in total (P < 0.002), soft tissue tumors (P < 0.05), and bone tumors (P < 0.02). Sensitivity, specificity, and diagnostic accuracy were 80%, 65.2%, and 73% in total with cutoff SUV_max 3.8, 80%, 68.4%, and 75% in the soft tissue tumors with cutoff SUV_max 3.8, and 80%, 63%, and 70% in the bone tumors with cutoff SUV_max 3.7. ¹⁸F-FDG-PET/CT reliably differentiated malignant soft tissue and bone tumors from benign ones, although there were many false-positive and falsenegative lesions. Further studies with all kinds of musculoskeletal tumors in large numbers are needed to improve the diagnostic accuracy of ¹⁸F-FDG-PET/CT.

Keywords: Musculoskeletal tumors; ¹⁸F-FDG; PET/CT

Could the simplified ¹⁴C urea breath test be a new standard in noninvasive diagnosis of Helicobacter pylori infection? by Elif Özdemir; Neşe I. Karabacak; Bülent Deḡertekin; Meltem Cırak; Ayşe Dursun; Doruk Engin; Selahattin Ünal; Mustafa Ünlü (pp. 611-616).

The carbon-14 (¹⁴C) urea breath test (UBT) is a reliable and noninvasive technique for the diagnosis of Helicobacter pylori (HP) infection. The diagnostic performance of a new practical and low dose ¹⁴C UBT system (Heliprobe, Stockholm, Sweden) was compared with those of other diagnostic tests, namely, rapid urease test (RUT), histopathology, and DNA detection using polymerase chain reaction (PCR).Eighty-nine patients (mean age = 45 ± 13, 30 men) with dyspeptic complaints who underwent an endoscopic procedure were studied. Biopsy specimens acquired during the procedure were subjected to RUT, histopathological examination using hematoxylin and eosin (HP-HE) and PCR. All patients underwent UBT using the Heliprobe system on a different day. The gold standard for HP positivity was defined as any two of the three tests being positive, excluding UBT, and the sensitivity and specificity of any single test alone were determined using this gold standard. Whenever only one test was positive, it was considered to be a false-positive one.With the gold standard used in this study, 59 (66%) patients were diagnosed HP positive. The Heliprobe method detected HP infection with 96.6% sensitivity and 100% specificity and had the best diagnostic performance when compared with all the other methods. The sensitivity and specificity of the other methods for the detection of HP positivity were 89.8% and 100% for RUT, 93.2% and 63.3% for PCR, and 93.2% and 76.6% for HP-HE, respectively. Areas under the receiver-operating characteristic were 0.977 for UBT, 0.947 for RUT, 0.84 for HP-HE, and 0.775 for PCR.Using a combination of invasive diagnostic tests as the gold standard, Heliprobe UBT was found to be highly sensitive and specific for the diagnosis of HP infection in patients with dyspeptic complaints.

Keywords: Urea breath test; Helicobacter pylori ; Rapid urease test

Monocationic radiotracer kinetics and myocardial infarct size: a perfused rat heart study by David R. Okada; Zhonglin Liu; Delia Beju; Robert D. Okada; Gerald Johnson III (pp. 617-627).

To compare the myocardial kinetics of three ^99mtechnetium-labeled monocationic tracers [methoxy-isobutylisonitrile (MIBI), tetrofosmin, and Q12] in a model of ischemia-reperfusion (IR) to determine their abilities to assess myocardial viability.Isolated perfused rat hearts (n = 30) were studied in control and IR groups for each tracer. IR hearts were treated with 120 min global no-flow followed by 5 min reflow, then 60 min tracer uptake/clearance. Tracer kinetics were monitored using a scintillation detector.This model produced significant myocardial injury, without significant differences in the percentage of injured myocardium by triphenyltetrazolium chloride (TTC) staining and creatine kinase (CK) assay. Transmission electron microscopy analysis also confirmed necrosis with abundant mitochondrial damage in the IR hearts. All three IR groups exhibited significantly less mean (±standard error of the mean) tracer retention than matched controls (MIBI 73.4 ± 4.9% vs. 96.9 ± 1.76%, tetrofosmin 38.7 ± 4.6% vs. 82.2 ± 3.5%, and Q12 23.0 ± 2.5% vs. 43.8 ± 1.8%, respectively; P < 0.05). Tetrofosmin IR hearts exhibited 54 ± 9% of control myocardial retention, which was significantly less than either MIBI (86 ± 5%, P < 0.05) or Q12 (63 ± 6%, P < 0.05); thus, tetrofosmin provided the best differentiation between nonviable and normal myocardium. Furthermore, tetrofosmin end activity (%id/g) in controls was significantly higher than Q12 (4.09 ± 0.04 vs. 1.71 ± 0.06, respectively, P < 0.05), and tetrofosmin end activity (%id/g) in IR hearts was significantly higher than Q12 (2.19 ± 0.37 vs. 1.06 ± 0.12, respectively, P < 0.05). The correlation between end activity and viable myocardium determined by TTC staining was r = 0.66 (P < 0.05) for MIBI, r = 0.94 (P < 0.05) for tetrofosmin, and r = 0.91 (P < 0.05) for Q12. The correlation between myocardial end activity and myocardial CK leak was r = −0.62 (P < 0.05) for MIBI, r = −0.87 (P < 0.05) for tetrofosmin, and r = −0.89 (P < 0.05) for Q12.Nonviable myocardium can be distinguished from normal myocardium by the retention kinetics of all three monocationic tracers studied. Tetrofosmin and Q12 end activities demonstrate the best correlation with infarct size. However, tetrofosmin kinetics may combine the greatest differentiation between nonviable and normal myocardium, while still retaining adequate activity for imaging.

Keywords: ^99mTechnetium; Perfusion imaging agents; Myocardial viability; Ischemia; Reperfusion

Central photopenic lesions on FDG-PET scan in a patient with peripheral T cell lymphoma by Ayse Mavi; Thiruvenkatasamy Dhuriraj; Tevfik F. Cermik; Muammer Urhan; Mariusz Wasik; Sandip Basu; Rakesh Kumar; Drew Torigian; Abass Alavi (pp. 629-633).

Central necrosis in lymphoma lesions as demonstrated in [¹⁸F] fluoro-2-deoxyglucose positron emission tomography (FDG-PET) studies is a rare phenomenon, and the clinical significance of this observation has not been described in the literature. The role of FDG-PET in the management of peripheral T cell lymphoma (PTCL) is also still unclear at this time. We present a case of a patient newly diagnosed with PTCL who underwent both computed tomography (CT) and FDG-PET examinations prior to and following therapy. CT showed pulmonary cavitary lesions in both lungs, and PET demonstrated multiple large confluent masses with intense FDG uptake in the corresponding lung fields with central photopenia suggestive of necrosis. Post-treatment FDG-PET images showed a significant improvement in the previously described lesions with some residual, recurrent, and new lesions. Central necrosis shown by PET may be associated with the advanced stage of the disease and may have prognostic implications because of central necrosis caused by hypoxia.

Keywords: Peripheral T cell lymphoma; FDG-PET; Central necrosis; Hypoxia

¹⁸F-FDG-PET/CT findings of granulocyte colony stimulating factor (G-CSF)-producing lung tumors by Miyako Morooka; Kazuo Kubota; Yuji Murata; Hitoshi Shibuya; Kimiteru Ito; Makoto Mochizuki; Takumi Akashi; Tetsuma Chiba; Tomokiyo Nomura; Hideyuki Ito; Takatomo Morita (pp. 635-639).

Tumors producing granulocyte colony stimulating factor (G-CSF), malignant lung tumors in most cases, are rare, and patients present with abnormal elevations of the white blood cell (WBC) count in the absence of any infectious disease. We present the ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) imaging findings of two cases of G-CSF-producing tumor. PET-CT showed abnormally high uptake of ¹⁸F-FDG not only by the tumor itself but also diffusely throughout the bone marrow. Following resection of the tumor, the blood G-CSF level as well as the WBC count dropped down to normal range in both cases. Histopathological examination of the resected tumor specimens revealed the presence of an enormous number of inflammatory cells within the tumors and positive immunostaining of the tumor cells for G-CSF. The ¹⁸F-FDG-PET/CT findings could be explained by the elevated bone marrow metabolism associated with the excessively active production of granulocytes under G-CSF stimulation, and the ¹⁸F-FDG uptake by the inflammatory cells also contributing to the total tumor uptake of ¹⁸F-FDG. These characteristic imaging findings are expected to be useful for the diagnosis of G-CSF-producing tumors.

Keywords: G-CSF; FDG-PET; Bone marrow; WBC; Lung cancer

Detection of a suspected bronchobiliary fistula by hepatobiliary scintigraphy by Alessio Annovazzi; Giovanni Viceconte; Luisa Romano; Rosa Sciuto; Carlo L. Maini (pp. 641-643).

Bronchobiliary fistula (BBF) represents a rare but severe complication in patients affected by liver metastases. Although a clinical suspicion can arise when specific clinical signs, in particular biliptysis, are present, conventional imaging modalities often fail to confirm the diagnosis. We present a case of a patient affected by colon cancer with liver metastases previously treated with partial right-sided hepatectomy and multiple thermo-ablative treatments combined with chemotherapy, who manifested a septic fever associated with productive cough and biliptysis. Diagnosis of BBF was confirmed only by hepatobiliary scintigraphy with ^99mTc-heptoiminodiacetic acid.

Keywords: Biliary fistula; Scintigraphy; ^99mTc-HIDA

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Annals of Nuclear Medicine (v.22, #7)

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Annals of Nuclear Medicine (v.22, #7)