Annals of Nuclear Medicine (v.30, #9)

New section in EJNMMI and Annals of Nuclear Medicine by Ignasi Carrió; Seigo Kinuya (593-593).

One year of nuclear cardiology in Europe by Olivier Lairez; Denis Agostini (594-599).
99m-technetiumIodine-123-β-methyl iodo-phenyl-pentadecanoic acidCoronary artery diseaseCardiac resynchronization therapyCadmium zinc tellurideExtra-domain B of fibronectinMyocardial perfusion imagingSingle-photon emission computed tomography

Clinical usefulness of post-treatment FDG PET/CT in patients with ovarian malignancy by Eun Ji Han; Hye Lim Park; Yong Seok Lee; Eun Kyung Park; Min Jong Song; Ie Ryung Yoo; Sung Hoon Kim; Woo Hee Choi (600-607).
We aimed to evaluate the diagnostic and prognostic value of post-treatment fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in patients treated for ovarian malignancy.We retrospectively reviewed post-treatment PET/CT images of patients treated for histologically confirmed ovarian malignancy. The diagnostic accuracy of PET/CT for detection of disease recurrence or second primary malignancy was calculated, and the impact of PET/CT on patient management was evaluated. The association between PET/CT result and overall survival (OS) was assessed using Cox regression analysis.In total, 416 PET/CT cases of 268 ovarian malignancy patients (mean age, 50 ± 13 years) were included. Of 416 cases, 87 (21 %) were interpreted as PET/CT positive and 329 as negative. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 98.8, 98.2, 98.3, 93.1 and 99.7 %, respectively. Of 362 cases for surveillance, changes in management occurred based on PET/CT in 38 (11 %). Of 54 cases with clinical suspicion, PET/CT ruled out disease recurrence in 9 (17 %). The median follow-up period from PET/CT imaging was 26.7 months, and 24 patients (9 %) died during the follow-up period. In univariate analyses, age, FIGO stage, history of prior recurrence and PET/CT results were significantly associated with OS. PET/CT results remained significantly associated with OS in the multivariate analysis (p < 0.05).Post-treatment PET/CT was a useful modality for the detection of disease recurrence or second primary malignancy that could improve the likelihood of proper treatment and help predict outcome in patients with ovarian malignancy.
Keywords: FDG PET/CT; Recurrent ovarian malignancy; Diagnostic accuracy; Prognosis

Phase IIa clinical study of [18F]fluciclovine: efficacy and safety of a new PET tracer for brain tumors by Akihide Kondo; Hisato Ishii; Shigeki Aoki; Masaru Suzuki; Hidekazu Nagasawa; Kazuo Kubota; Ryogo Minamimoto; Atsushi Arakawa; Masato Tominaga; Hajime Arai (608-618).
[18F]Fluciclovine (anti-[18F]FACBC) has demonstrated diagnostic efficacy for cancers of the brain where [18F]fludeoxyglucose has limitations. We conducted a phase IIa study of anti-[18F]FACBC to assess its accumulation pattern and safety in patients with malignant glioma.Five patients with glioma scheduled for brain tumor resection received anti-[18F]FACBC. Brain positron emission tomography (PET) was performed following intravenous administration of anti-[18F]FACBC, and subsequently, preoperative gadolinium contrast-enhanced T1-weighted (CE-T1W) magnetic resonance imaging (MRI) was performed for surgery. Specimens for histopathological evaluation were collected during surgery, and their location was precisely determined on CE-T1W MRI and anti-[18F]FACBC PET/CT images. In addition, tumor extent defined on the MRI and PET/CT images was compared. To determine time–activity curves for anti-[18F]FACBC uptake in brain tumor and normal tissues, regions of interest were set in the brain tumor, contralateral normal tissue and the cerebellum, and their standardized uptake values (SUV) were calculated. The safety of anti-[18F]FACBC was assessed based on subjective symptoms and objective findings, electrocardiograms, vital signs, laboratory results, and the incidence of adverse events. Anti-[18F]FACBC accumulated in the malignant gliomas of all patients. CE-T1W MRI detected gliomas in all patients, but anti-[18F]FACBC PET/CT generally delineated wider regions of tumor extent than CE-T1W MRI. Two of the histopathologically confirmed tumors were located in regions that were defined using anti-[18F]FACBC PET/CT, but not using CE-T1W MRI. Two patients experienced three mild adverse events: one complained of a dull headache and later a mild headache, and the other showed general malaise. These symptoms resolved spontaneously without treatment. Only the mild headache could not be ruled out from having a causal relationship with anti-[18F]FACBC. Favorable T/N ratios regarding anti-[18F]FACBC uptake between tumors and normal control tissues were demonstrated in this trial.It is suggested that anti-[18F]FACBC PET/CT has the ability to delineate glioma spread that is undetectable using CE-T1W MRI. Anti-[18F]FACBC is safe in patients with malignant glioma.This study was registered in the Japan Pharmaceutical Information Center Clinical Trials Information, which is one of the World Health Organization registries (registration number: JapicCTI-111387).
Keywords: Clinical trial; [18F]Fluciclovine; Glioblastoma; Positron emission tomography; Magnetic resonance imaging

Incidental focal 18F-FDG uptake in the frontal process of the maxilla on PET/CT: prevalence and clinical significance by Soo Bin Park; Joon Young Choi; Hyung-Jin Kim; Hye Jeong Kim; Kyung-Han Lee; Byung-Tae Kim (619-623).
We investigated the prevalence and clinical significance of incidental focal 18F-FDG uptake in the frontal process of the maxilla, mimicking malignancy on PET/CT.From a total of 32,834 patients who underwent 18F-FDG PET/CT, patients with focal uptake in the frontal process of the maxilla were selected by a database search. For those patients, medical records including relevant imaging studies were reviewed.Thirty-nine patients (0.12 %) demonstrated focal uptake on PET/CT. On CT of PET/CT, all lesions showed ground-glass attenuation with or without bony expansion, consistent with fibrous dysplasia. When comparing previous PET/CT, follow-up PET/CT, and CT, a significant difference in degree of 18F-FDG uptake was noted, with no associated change in the size of maxillary lesions. There were no patients who had symptoms or signs related to maxillary lesions during follow-up.Focal 18F-FDG uptake in the frontal process of the maxilla is a rare, incidental, and persistent finding with variable uptake and can represent a benign condition.
Keywords: Maxilla; 18F-fluorodeoxyglucose; PET/CT; Fibrous dysplasia

The purpose of this study was to evaluate the degree of cytological radiation damage to lymphocytes occurring after I-131 metaiodobenzylguanidine (MIBG) therapy as determined by the cytokinesis-blocked micronucleus assay. The chromosomal damage to lymphocytes induced by I-131 in vivo should result in augmentation of the number of cells with micronuclei.We studied 15 patients with pheochromocytoma (14/15) or ganglioneuroma (1/15), who were treated initially with 7.4 GBq of I-131-MIBG. Isolated lymphocytes collected from patients 10 days after the therapy were harvested and treated according to the cytokinesis-blocked method of Fenech and Morley. Serial blood samples were obtained periodically only from two patients for 2 years after therapy. Micronucleus number of micronuclei per 500 binucleated cells was scored by visual inspection. As controls, lymphocytes from the same patients before the therapy were also studied. In an in vitro study, lymphocytes from eight normal volunteers were exposed to doses varying from 0.5 to 2 Gy and studied with the same method.The mean number (mean ± SD) of micronuclei after treatment was significantly increased (p < 0.001) as compared to control subjects (49.4 ± 8.2 vs. 11.3 ± 6.4). Internal radiation absorbed doses estimated for the 15 patients were 1.6 ± 0.3 Gy in this external irradiation study. The frequency of micronuclei post-administration of I-131-MIBG gradually decreased to near baseline (i.e., pre-therapy) levels by 2 years.The relatively low frequency of lymphocyte micronuclei induced by I-131-MIBG in vivo and reversal of the increasing frequency of lymphocyte micronuclei after therapy suggest that the short-term non-stochastic damage induced by this therapy with 7.4 GBq of I-131-MIBG in pheochromocytoma or ganglioneuroma patients is limited and reversible.
Keywords: Micronucleus assay; MIBG therapy; Radiotoxicity; Lymphocyte

Metformin discontinuation less than 72 h is suboptimal for F-18 FDG PET/CT interpretation of the bowel by Suk Hyun Lee; Soyoung Jin; Hyo Sang Lee; Jin-Sook Ryu; Jong Jin Lee (629-636).
Metformin-induced [F-18] fluorodeoxyglucose (FDG) bowel uptake can hinder positron emission tomography/computed tomography (PET/CT) evaluation of the bowel. This study aimed to investigate the segmental bowel uptake of FDG according to metformin discontinuation times up to 72 h.We retrospectively divided 240 diabetic patients into four groups: metformin discontinuation <24 h (group A; n = 86), 24–48 h (group B; n = 40), 48–72 h (group C; n = 12), and no metformin (control group; n = 102). Segmental FDG bowel uptakes were measured visually (four-point scale) and semi-quantitatively (maximum standardized uptake value).Compared with the control group, FDG uptake increased significantly from the ileum to the rectosigmoid colon in group A, from the transverse to the rectosigmoid colon in group B, and from the descending colon to the rectosigmoid colon in group C in both visual and semi-quantitative analyses.Metformin discontinuation for <72 h is likely suboptimal for PET/CT image interpretation, especially with respect to the distal segments of the colon.
Keywords: FDG PET/CT; Metformin; Bowel uptake; Diabetes

Optimal ROI setting on the anatomically normalized I-123 FP-CIT images using high-resolution SPECT by Masanari Nonokuma; Yasuo Kuwabara; Kosuke Hida; Tomonobu Tani; Koichi Takano; Kengo Yoshimitsu (637-644).
The aim of this study is to establish the optimal regions of interest (ROIs) in anatomically normalized I-123 FP-CIT SPECT images for the quantification of dopamine transporter binding.The subjects comprised 16 normal controls and 14 Parkinsonian patients. All of the normal control subjects underwent I-123 FP-CIT SPECT and MRI. The SPECT device used in this study was a Toshiba GCA-9300R with triple head detectors. I-123 FP-CIT (148 MBq) was intravenously administered as a bolus, and the SPECT scan started 4 h after the administration. The data were collected over 20 min for each subject, and reconstructed using a 3D-OSEM algorithm. The data were analyzed using SPM8. I-123 FP-CIT SPECT images were anatomically normalized to the MNI space using an I-123 FP-CIT template, and then divided by the background counts automatically measured using the ROIs set for the cerebral cortices.In the normal control subjects, the specific binding ratios of the MRI-based ROIs were lowest in the caudate nucleus, while the ratios of the I-123 FP-CIT-based ROIs were almost the same throughout all three parts. In contrast, in Parkinsonian patients, the specific binding ratios of the I-123 FP-CIT-based ROIs revealed rostrocaudal decline, while those of the MRI-based ROIs were highest in the anterior putamen.We created an ROI template on the anatomically normalized MRI and I-123 FP-CIT images, and concluded that I-123 FP-CIT-based ROIs are more suitable for obtaining quantitative values than MRI-based ones.
Keywords: I-123 FP-CIT; SPECT; Specific binding ratio; Statistical parametric mapping; ROI

Effects of left ventricular size on the accuracy of diastolic parameters derived from myocardial perfusion SPECT: comparison with tissue Doppler echocardiography by Satoshi Kurisu; Yoji Sumimoto; Hiroki Ikenaga; Noriaki Watanabe; Ken Ishibashi; Yoshihiro Dohi; Takayuki Hidaka; Yukihiro Fukuda; Yasuki Kihara (645-651).
Impaired left ventricular (LV) diastolic function is a sensitive and early sign of myocardial ischemia. We evaluated the effects of LV size on the accuracy of diastolic parameters derived from SPECT.The study population consisted of 151 patients with known or suspected coronary artery disease who underwent both SPECT and transthoracic echocardiography. Peak filling rate (PFR), one-third mean filling rate (1/3 MFR) and the ratio of time to PFR to the RR interval (TPFR/RR) were calculated by quantitative gated SPECT. Peak early mitral annular velocity (e′) was used as the reference standard of LV diastolic function.There were 43 patients with end-systolic volume (ESV) of ≤10 ml, 43 patients with ESV of 11–20 ml and 65 patients with ESV of >20 ml. There were significant differences in PFR (p < 0.001), 1/3 MFR (p < 0.001) or TPFR/RR (p = 0.01) among the 3 groups. These diastolic parameters were increased with decreased LV size. In overall patients, PFR (r = 0.24, p = 0.003) and 1/3 MFR (r = 0.31, p < 0.001) were positively, and TPFR/RR (r = −0.23, p = 0.004) was inversely correlated with e′. Multivariate linear regression analyses showed that male gender (β = −0.14, p = 0.07; β = −0.16, p = 0.04), ESV (β = −0.63, p < 0.001; β = −0.45, p < 0.001) and e′ (β = 0.36, p < 0.001; β = 0.40, p < 0.001) were significant factors associated with PFR or 1/3 MFR. Multivariate linear regression analysis also showed that ESV (β = −0.17, p = 0.03) and e′ (β = −0.21, p = 0.01) were significant factors associated with TPFR/RR.Our data suggest that PFR, 1/3 MFR and TPFR/RR derived from SPECT are correlated with e′ as the reference standard of LV diastolic function, but are overestimated in small-sized heart. LV size should be taken into consideration when interpreting these diastolic parameters.
Keywords: Left ventricle; Diastolic function; Diastolic parameter; Small heart; SPECT

Dual-time-point 18F-FDG PET/CT in the diagnosis of solitary pulmonary lesions in a region with endemic granulomatous diseases by Yu-Erh Huang; Yu-Jie Huang; Mary Ko; Chien-Chin Hsu; Chih-Feng Chen (652-658).
Granulomatous diseases (GDs) can be metabolically active and indistinguishable from lung cancer on 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) imaging. Evaluation of solitary pulmonary lesions remains a diagnostic challenge in regions with endemic GD. This study sought to determine the efficacy of dual-time-point (DTP) 18F-FDG PET/computed tomography (CT) imaging in diagnosing solitary pulmonary lesions from such regions.A total of 50 patients with solitary pulmonary nodules or masses with confirmed histopathological diagnoses underwent DTP 18F-FDG PET/CT imaging at 1 and 3 h after tracer injection. The maximum standardized uptake value (SUVmax) on early and delayed scans (SUV1h and SUV3h, respectively) and retention index (RI) were calculated for each pulmonary lesion. Receiver operating characteristic analysis was performed to evaluate the discriminating validity of the parameters.There were 37 malignant and 13 benign solitary pulmonary lesions. Eight of the 13 (62 %) benign lesions were GDs. The sensitivity/specificity/accuracy of SUV1h, SUV3h and RI were 84/69/80 %, 84/85/84 %, and 81/54/74 %, respectively. SUV3h had the best diagnostic performance, especially regarding specificity. The values of SUV1h and SUV3h were significantly different between malignant lesions and GD, while the RI values of malignant lesions and GD were both high (18.6 ± 19.5 and 18.7 ± 15.3 %, respectively; P = not significant).SUV3h appeared to improve the diagnostic specificity of 18F-FDG PET/CT in evaluating solitary pulmonary lesions from regions with endemic GD.
Keywords: 18F-fluorodeoxyglucose; Positron emission tomography; Standardized uptake value; Pulmonary

Carbidopa-assisted 18F-fluorodihydroxyphenylalanine PET/CT for the localization and staging of non-functioning neuroendocrine pancreatic tumors by Mehdi Helali; Pietro Addeo; Céline Heimburger; Julien Detour; Bernard Goichot; Philippe Bachellier; Izzie Jacques Namer; David Taïeb; Alessio Imperiale (659-668).
CD premedication was found to increase the value of 18F-fluorodihydroxyphenylalanine (18F-FDOPA) PET/CT imaging in the detection of adult insulinoma. The aim of this study was to evaluate the performance of CD-assisted 18F-FDOPA PET/CT in the diagnosis and staging of non-functioning pNETs.Twenty consecutive patients with low-grade pNETs who underwent CD-assisted 18F-FDOPA PET/CT imaging and 111In-somatostatin receptor scintigraphy (SRS) were evaluated. Histology was considered as the gold standard. In case where no surgical resection was performed, the diagnosis of pNET was made by the confrontation of the different available imaging modalities.CD-assisted 18F-FDOPA PET/CT was positive in 18/20 cases (90 %), whereas SRS was positive in 13/19 cases (68 %). When considered the 19 patients underwent both nuclear medicine examinations, 18F-FDOPA PET/CT was significantly more sensitive then SRS for primary tumor detection (p = 0.049). False-negative results of both 18F-FDOPA PET/CT and SRS were observed in 2 cystic pNETs. SRS failed to detect one additional cystic tumor and 3 pNETs of 10, 12 and 17 mm, respectively. 18F-FDOPA PET/CT correctly identified all patients with lymphatic, visceral and bone metastases. SRS failed to detect lymphatic spread and was falsely negative in one patient with splenic metastasis.Contrary to widely held assumptions, our study further expands the application of CD-assisted 18F-FDOPA PET/CT for non-functioning pNETs when 68Ga-radiolabeled somatostatin analogs are not available.
Keywords: 18F-FDOPA; Carbidopa; PET/CT; Pancreas; Neuroendocrine tumors

Cerebral hyperperfusion syndrome resulting in subarachnoid hemorrhage after carotid artery stenting by Makoto Isozaki; Yoshikazu Arai; Yoshifumi Higashino; Hidehiko Okazawa; Ken-ichiro Kikuta (669-674).
A 64-year-old, right-handed man underwent endovascular treatment for internal carotid artery stenosis after experiencing a left-hemispheric transient ischemic attack. 15O-gas and H 2 15 O positron emission tomography revealed slightly reduced cerebral blood flow (CBF), elevated cerebral blood volume, and severely reduced cerebral vasoreactivity in the ipsilateral hemisphere as determined by an acetazolamide challenge test. The patient underwent left carotid artery stenting (CAS) via a prefemoral approach under local anesthesia without any complications. Follow-up examinations performed 20 h postoperatively showed subarachnoid hemorrhage (SAH) and cerebral hyperperfusion syndrome (CHS) in the left frontal lobe. Although it is a relatively rare phenomenon, SAH resulting from CHS was determined to be specifically caused by CAS. In this case, the causes of SAH may have been related to multiple factors including increased regional CBF, loss of cerebrovascular autoregulation, contrast agent-mediated disruption of major cerebral vessels, and strong antiplatelet therapy.
Keywords: Carotid artery stenting; Cerebral hyperperfusion syndrome; Subarachnoid hemorrhage