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European Journal of Nuclear Medicine and Molecular Imaging

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ISSN (Print) 1619-7089 - ISSN (Online) 1619-7070
Published by Springer-Verlag

[2218 journals]

Cumali Aktolun and Stanley J. Goldsmith (eds): Nuclear Medicine Therapy
- PubDate: 2013-07-01
Accuracy of ADC estimates: response to letter by Priola et al. re Diffusion-weighted MRI of lymphoma: prognostic utility and implications for PET/MRI'
- PubDate: 2013-07-01
Guidelines for the use of ¹⁸F-FDG in infection and inflammation: a new step in cooperation between the EANM and SNMMI
- PubDate: 2013-07-01
Diagnostic accuracy of ¹⁸F-FDG PET/CT for detecting recurrence in patients with primary skeletal Ewing sarcoma
- Abstract: Purpose To evaluate the diagnostic accuracy of 18F-FDG PET/CT for detecting recurrence in patients with primary skeletal Ewing sarcoma. Methods We retrospectively analysed data from 53 patients (age 20.1 ± 10.5 years, 39 male) who had undergone 71 18F-FDG PET/CT studies for suspected recurrence (52 studies) or for routine follow-up (19 studies) after primary therapy of skeletal Ewing sarcoma. 18F-FDG PET/CT studies were evaluated qualitatively and quantitatively (maximum standardized uptake value, SUVmax) by two nuclear medicine physicians in consensus. Sensitivity, specificity, predictive values and accuracy were calculated on per study basis. Clinical/imaging follow-up (minimum 6 months) and/or histopathology (when available) were taken as the reference standard. Results Of the total of 71 18F-FDG PET/CT studies, 42 (59.1 %) were positive for recurrence and 29 (40.9 %) were negative for recurrence. Local recurrence was most common (38 studies) followed by bone metastasis (9 studies), and node and lung metastasis (2 studies each). Of the 71 studies, 38 were true-positive, 27 were true-negative, 4 were false-positive and 2 were false-negative. Overall per study based sensitivity was 95 %, specificity was 87 %, PPV was 90 %, NPV was 93 % and accuracy was 91.5 %. No significant difference was found in the accuracy of PET/CT between the suspected recurrence group and the routine follow-up group (94 % vs. 84 %; P = 0.390). Overall mean lesion SUVmax was 7.8 ± 4.1 (range 1.9–17.2). No site-based difference was found in SUVmax. Conclusion 18F-FDG PET/CT demonstrates high diagnostic accuracy for detecting recurrence in patients with primary skeletal Ewing sarcoma, when it is suspected (clinically or on imaging) or during routine follow-up.
  PubDate: 2013-07-01
Reply to comment by Treglia and Bertagna: FDG PET/CT for detection of infectious endocarditis
- PubDate: 2013-07-01
A series of noninvasive evaluations for bilateral adrenal tumor
- PubDate: 2013-07-01
Congenital isolated H-type tracheo-oesophageal fistula identified by milk scan
- PubDate: 2013-07-01
Factors influencing the sensitivity of ¹⁸F-FDG PET/CT in the detection of infective endocarditis
- PubDate: 2013-07-01
Utility of ¹⁸F-FDG PET(/CT) in patients with systemic and localized amyloidosis
- Abstract: Purpose Amyloidosis is a group of diseases characterized by deposition of fibrils and this deposition may be localized or systemic. The presence of giant cells is typical of localized AL amyloidosis in contrast to systemic amyloidosis. Because of this presence of giant cells we hypothesize that 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) may show uptake in localized amyloidosis but not in systemic amyloidosis. The aim of the study was to evaluate the utility of 18F-FDG PET/CT in distinguishing systemic amyloidosis from localized amyloidosis. Methods A retrospective search in the hospital computer system showed 21 patients with histologically proven systemic or localized amyloidosis who recently had undergone 18F-FDG PET/CT. Twenty patients also had undergone 123I-serum amyloid P component (SAP) scintigraphy. Results Of 11 patients with localized amyloidosis, 10 showed markedly increased FDG uptake at the amyloid site, whereas one showed slightly increased FDG uptake. 123I-SAP scintigraphy (in ten patients) was positive in three patients at the amyloid site and negative for any other specific organ involvement in nine patients, with a weakly positive spleen in one other patient. In ten patients with systemic amyloidosis, increased FDG uptake was not found in any affected organ containing amyloid, whereas 123I-SAP scintigraphy was positive for specific organ involvement in nine patients. Conclusion 18F-FDG PET/CT may be supportive of the usual diagnostic tests in differentiating between systemic amyloidosis (no increased FDG uptake at the amyloid site) and localized amyloidosis (increased FDG uptake at the amyloid site). Apart from diagnosis, this finding has potential clinical application in therapy evaluation and follow-up.
  PubDate: 2013-07-01
Interventional nuclear medicine
- PubDate: 2013-07-01
Optimisation and harmonisation: two sides of the same coin'
- PubDate: 2013-07-01
Myocardial perfusion imaging and coronary calcium scoring with a two-slice SPECT/CT system: can the attenuation map be calculated from the calcium scoring CT scan'
- Abstract: Purpose Coronary artery calcium scoring can complement myocardial perfusion imaging (MPI). The purpose of this study was to evaluate the feasibility and accuracy of using the CalciumScore-CT derived from a combined SPECT/CT device also for SPECT attenuation correction (AC). Methods The study group comprised 99 patients who underwent both post-stress and rest MPI using a two-slice SPECT/CT system. For AC, one of the two scans was accompanied by a CalciumScore-CT scan (CalciumScore-CTAC) and the other by a conventional spiral CT (AttenCorr-CT) scan (AttenCorr-CTAC). In 48 patients the CalciumScore-CT scan was acquired with the post-stress scan and the AttenCorr-CT scan with the rest scan, and in 51 patients the order was reversed. The accuracy of the images based on AC was determined qualitatively by consensus reading with respect to the clinical diagnoses as well as quantitatively by comparing the perfusion summed stress scores (SSS) and the summed rest scores (SRS) between attenuation-corrected and uncorrected images. Results In comparison to the uncorrected images CalciumScore-CTAC led to regional inaccuracies in 14 of 51 of studies (27.5 %) versus 12 of 48 studies (25 %) with AttenCorr-CTAC for the stress studies and in 5 of 48 (10 %) versus 1 of 51 (2 %) for the rest studies, respectively. This led to intermediate and definite changes in the final diagnosis (ischaemia and/or scarring) in 12 % of the studies (12 of 99) and in 7 % of the studies (7 of 99) with CalciumScore-CTAC and in 9 % of the studies (9 of 99) and 4 % of the studies (4 of 99) with AttenCorr-CTAC. Differences in SSS and SRS with respect to the uncorrected images were greater for the CalciumScore-CTAC images than for the AttenCorr-CTAC images (ΔSSS 4.5 ± 5.6 and 2.1 ± 4.4, p = 0.023; ΔSRS 4.2 ± 4.9 and 1.6 ± 3.2, p = 0.004, respectively). Conclusion Using the same CT scan for calcium scoring and SPECT AC is feasible. Image interpretation must, however, include uncorrected images since CT-based AC relatively often introduces artefacts into the myocardial perfusion images. This effect is somewhat more pronounced with CalciumScore-CTAC than with AttenCorr-CTAC.
  PubDate: 2013-07-01
Ethical, green and sustainable nuclear medicine
- PubDate: 2013-07-01
Discrepant uptake of the radiolabeled norepinephrine analogues hydroxyephedrine (HED) and metaiodobenzylguanidine (MIBG) in rat hearts
- Abstract: Purpose 11C-Hydroxyephedrine (HED) and radioiodinated metaiodobenzylguanidine (123I/131I-MIBG) are catecholamine analogue tracers for sympathetic nerve positron emission tomography/single photon emission computed tomography (PET/SPECT) imaging. In contrast to humans, rat hearts demonstrate high nonneural catecholamine uptake-2 in addition to neural uptake-1, the contributions of which to tracer accumulation are not fully elucidated. Methods Wistar rats were studied using the following pretreatments: uptake-1 blockade with desipramine 2 mg/kg IV, both uptake-1 and -2 blockade with phenoxybenzamine 50 mg/kg IV, or control with saline IV. HED or 123I-MIBG was injected 10 min after pretreatment, and rats were sacrificed 10 min later. Heart to blood tissue count ratio (H/B ratio) was obtained using a gamma counter. To determine regional tracer uptake, dual-tracer autoradiography was performed with HED and 131I-MIBG in Wistar rats with chronic infarction by transient coronary occlusion and reperfusion and in healthy control rats. Local tracer distributions were analyzed, and the infarcted rats’ local tracer distributions were compared with histology. Results The H/B ratios in control hearts were 34.4 ± 1.7 and 25.5 ± 2.1 for HED and 123I-MIBG, respectively. Desipramine led to a significant decrease in HED (3.2 ± 0.5, p < 0.0001), while there was no change in 123I-MIBG (25.5 ± 6.4, p = n.s.). Phenoxybenzamine led to a significant decrease in both HED and 123I-MIBG (3.5 ± 0.02, 4.3 ± 0.7, p < 0.0001). Only HED showed a subepicardium-subendocardium gradient in healthy control hearts which is consistent with physiological innervation, while 131I-MIBG was evenly distributed throughout the myocardium. 131I-MIBG uptake defect closely matched the scar area determined by histology [3.8 ± 2.3 % (131I-MIBG defect) vs 4.0 ± 2.4 % (scar)]. However, the scar area was clearly exceeded by the HED uptake defect (9.1 ± 2.2 %, p < 0.001). Conclusion HED uptake showed high specificity to neural uptake-1 in rat hearts. On the other hand, 123I/131I-MIBG demonstrated distinct characters of regional tracer distribution and uptake mechanism that are compatible with significant contribution of nonneural uptake-2.
  PubDate: 2013-07-01
Appropriate use criteria for amyloid PET imaging cannot replace guidelines: On behalf of the European Association of Nuclear Medicine
- PubDate: 2013-07-01
Initial multicentre experience of high-speed myocardial perfusion imaging: comparison between high-speed and conventional single-photon emission computed tomography with angiographic validation
- Abstract: Purpose High-speed (HS) single-photon emission computed tomography (SPECT) with a recently developed solid-state camera shows comparable myocardial perfusion abnormalities to those seen in conventional SPECT. We aimed to compare HS and conventional SPECT images from multiple centres with coronary angiographic findings. Methods The study included 50 patients who had sequential conventional SPECT and HS SPECT myocardial perfusion studies and coronary angiography within 3 months. Stress and rest perfusion images were visually analysed and scored semiquantitatively using a 17-segment model by two experienced blinded readers. Global and coronary territorial summed stress scores (SSS) and summed rest scores (SRS) were calculated. Global SSS ≥3 or coronary territorial SSS ≥2 was considered abnormal. In addition the total perfusion deficit (TPD) was automatically derived. TPD >5 % and coronary territorial TPD ≥3 % were defined as abnormal. Coronary angiograms were analysed for site and severity of coronary stenosis; ≥50 % was considered significant. Results Of the 50 patients, 13 (26 %) had no stenosis, 22 (44 %) had single-vessel disease, 6 (12 %) had double-vessel disease and 9 (18 %) had triple-vessel disease. There was a good linear correlation between the visual global SSS and SRS (Spearman’s ρ 0.897 and 0.866, respectively; p < 0.001). In relation to coronary angiography, the sensitivities, specificities and accuracies of HS SPECT and conventional SPECT by visual assessment were 92 % (35/38), 83 % (10/12) and 90 % (45/50) vs. 84 % (32/38), 50 % (6/12) and 76 % (38/50), respectively (p < 0.001). The sensitivities, specificities and accuracies of HS SPECT and conventional SPECT in relation to automated TPD assessment were 89 % (31/35), 57 % (8/14) and 80 % (39/49) vs. 86 % (31/36), 77 % (10/13) and 84 % (41/49), respectively. Conclusion HS SPECT allows fast acquisition of myocardial perfusion images that correlate well with angiographic findings with overall accuracy by visual assessment better than conventional SPECT. Further assessment in a larger patient population may be needed to confirm this observation.
  PubDate: 2013-07-01
Influence of selected b values on ADC quantification in diffusion-weighted MRI. Comment on Punwani et al.: Diffusion-weighted MRI of lymphoma: prognostic utility and implications for PET/MRI'
- PubDate: 2013-07-01
Glucose corrected standardized uptake value (SUVgluc) in the evaluation of brain lesions with 18F-FDG PET
- Abstract: Purpose To retrospectively assess the utility of 18F fluorodeoxyglucose (FDG) positron emission tomography (PET) images of standardized uptake values corrected for blood glucose (SUVgluc), and to compare this to various quantitative methods to identify the presence or absence of high grade malignancy. Methods A retrospective review in 42 patients, found 81 central nervous system (CNS) lesions. Fifty one were malignant and 30 were benign or post treatment changes based on pathology (n = 32) and on clinical outcome (n = 49). Dynamic FDG PET scans were processed to generate parametric images of SUVgluc, SUV, glucose metabolic rate (GMR), and lesion to cerebellum ratios (SUVRc), and contralateral white matter ratios (SUVRw). The SUVgluc was calculated from $ {{{\mathrm{SU}{{\mathrm{V}}_{\max }}*\mathrm{BG}}} \left/ {{\left[ {100\,\mathrm{mg}/\mathrm{dl}} \right]}} \right.} $ , where SUVmax is the maximum SUV and BG is the blood glucose level (mg/dL). Results Using a malignant threshold for SUVgluc of 4.5 and GMR of 13.0 μmole/min/100 g, the accuracies were similar for the SUVgluc (80 %) and GMR (81 %) and were higher than the conventional SUVmax (73 %). The area under the receiver operating characteristic (ROC) curve for the SUVgluc (0.8661) was better than that for the SUVmax (0.7955) (p < 0.02) and was similar to those of the GMR (0.8694), SUVRc (0.8278), and SUVRw (0.8559). Conclusion These results suggest that the SUVgluc may assist in the interpretation of FDG PET brain images in patients with CNS lesions. The SUVgluc method avoids the complexity of kinetic modeling and the definition of a reference region.
  PubDate: 2013-07-01
The value of ¹⁸F-FDG PET/CT in diagnosing infectious endocarditis
- Abstract: Purpose Early detection of infectious endocarditis is challenging. For diagnosing infectious endocarditis, the revised Duke criteria are the gold standard. Evidence of endocardial involvement on echocardiography is a major criterion, but sensitivity and specificity of echocardiography are not optimal. Here we investigated the utility of 18F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) to diagnose infectious endocarditis in patients with gram-positive bacteraemia. Methods Seventy-two patients with gram-positive bacteraemia were prospectively included. Patients with a positive blood culture growing Staphylococcus aureus, Streptococcus species or Enterococcus species were eligible when a risk factor for developing metastatic infectious foci was present. Infectious endocarditis was defined according to the revised Duke criteria. All patients underwent 18F-FDG PET/CT and echocardiography. 18F-FDG uptake in or around the heart valves was evaluated independently by two nuclear medicine physicians. Results Sensitivity for diagnosing infectious endocarditis with 18F-FDG PET/CT was 39 % and specificity was 93 %. The positive predictive value was 64 % and negative predictive value was 82 %. The mortality rate in patients without infectious endocarditis and without increased 18F-FDG uptake in or around the heart valves was 18 %, and in patients without infectious endocarditis but with high 18F-FDG uptake in or around the heart valves the mortality rate was 50 % (p = 0.181). Conclusion 18F-FDG PET/CT is currently not sufficiently adequate for the diagnosis of infectious endocarditis because of its low sensitivity. Improvements such as patient preparation with low carbohydrate–fat allowed diet and technical advances in the newest PET/CT scanners may increase sensitivity in future studies.
  PubDate: 2013-07-01
Nuclear medicine training and practice in Portugal
- Abstract: Abstract Nuclear medicine in Portugal has been an autonomous speciality since 1984. In order to obtain the title of Nuclear Medicine Specialist, 5 years of training are necessary. The curriculum is very similar to the one approved under the auspices of the European Union of Medical Specialists, namely concerning the minimum recommended number of diagnostic and therapeutic procedures. There is a final assessment, and during the training the resident is in an approved continuing education programme. Departments are accredited by the Medical College in order to verify their capacity to host nuclear medicine residencies.
  PubDate: 2013-07-01