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Despite their relative quiescence, pancreatic neuro-endocrine tumors (pNET) can correspond to various presentations and outcomes. Several prognostic factors have been identified, including maximal standardized uptake value of the most intense focus (maxSUVmax) on Positron Emission Tomography (PET) with a somatostatin analogue. Herein, we investigate the prognostic value on progression free-survival of the total functional tumor volume (TFTV) measured by 68Ga-DOTATOC PET. From patients who underwent 68Ga-DOTATOC PET from 2008 to 2014, we selected consecutive patients with G1 or G2 pNET (2010 World Health Organization classification), at least one abnormal focus on PET and available follow-up data. TFTV was computed by summing the volumes of all pathological foci, delineated use of 41% of its SUVmax for each threshold focus. Fifty patients were included. During the follow-up period, 33 patients had stable or responsive disease (66%; median duration 28.5 months; range 6.3-77.7 months) and 17 patients experienced disease progression (34%; median progression time 21 months; range 6.7-44.7 months). Median PFS was 43.5 months. The best TFTV cut-off for predicting progression within 24 months was 13.8 cm3. Multivariate analysis determined that TFTV greater than 13.8 cm3 was the only criterion considered a significant risk factor for tumor progression (HR 2.9; p=0.0003). A significant difference in PFS was observed for TFTV (

International audience; Introduction: Since April 201, we have introduced PET/CT using a ligand of prostate-specific membrane antigen labeled with gallium-68 (PSMA-11). We aimed to evaluate its positivity rate and impact in patients presenting biochemical recurrence of prostate cancer whose 18F-fluorocholine (FCH) PET/CT was non-contributive.Patients and method: Patients were prospectively included between April and December 2016. PET/CT was performed 60 min after injection of 2 MBq/kg of body mass of 68Ga-PSMA-11. Three anatomical areas were considered: prostatic lodge, pelvic lymph nodes and distant locations. The impact of PSMA-11 PET/CT was assessed by comparing changes in therapeutic strategy decided during multidisciplinary meeting.Results: Thirty-three patients were included. The mean PSA serum level measured on the month of the PSMA-11 PET/CT was 2,8 ng/mL. Twenty-five (76%) PSMA-11 PET/CT were positive, 7 (21%) negative and 1 (3%) equivocal. Of 11 patients whose FCH PET/CT showed equivocal foci, PSMA-11 PET/CT confirmed those foci in 5 cases. Follow-up was available for 18 patients (55%). PSMA-11 PET/CT results led to a change in management in 12 patients (67%).Conclusion: 68Ga-PSMA-11 PET/CT is useful in detecting recurrence of prostate cancer, by identifying residual disease which was not detected on other imaging modalities and by changing management of 2 patients out of 3.Level of evidence: 5.; Introduction: Depuis avril 2016, nous avons introduit la TEP/TDM avec ligand de l’antigène membranaire spécifique de la prostate marqué au gallium-68 (PSMA-11). Nous avons évalué son taux de positivité et son impact chez les patients en récidive biologique de cancer de prostate, sans lésion affirmable en TEP/TDM à la 18F-fluorocholine (FCH).Patients et méthodes: Ces patients ont été prospectivement inclus d’avril à décembre 2016. La TEP/TDM a été effectuée 60 min après injection de 2 MBq/kg de 68Ga-PSMA-11. Trois sites anatomiques ont été considérés : loge prostatique, ganglions pelviens, et localisations à distance. L’impact des résultats de la TEP/TDM-PSMA-11 sur la prise en charge a été évalué en comparant les stratégies thérapeutiques proposées lors des réunions de concertation pluridisciplinaires.Résultats: Trente-trois patients ont été inclus. La concentration sérique moyenne du PSA mesurée au cours du mois de la TEP/TDM-PSMA-11 était de 2,8 ng/mL. Vingt-cinq TEP/TDM-PSMA-11 (76 %) étaient positives, 7 (21 %) négatives et 1 (3 %) douteuse. Sur 11 patients dont la TEP/TDM-FCH était douteuse, la TEP/TDM-PSMA-11 a confirmé les lésions douteuses dans 5 cas. Un suivi était disponible pour 18 patients (55 %). Les résultats des TEP/TDM-PSMA-11 ont conduit à un changement de la prise en charge chez 12 patients (67 %).Conclusion: La TEP/TDM au 68Ga-PSMA-11 est efficace dans la localisation de la récidive du cancer de la prostate, identifiant des cibles de maladie résiduelle non visualisées par les autres méthodes d’imagerie, changeant ainsi la prise en charge de 2 patients sur 3.Niveau de preuve: 5.

BACKGROUND Metabolic syndrome (MS) is a cluster of proatherogenic risk factors (RF) (abdominal obesity, atherogenic dyslipidemia, impaired fasting glucose or type 2 diabetes mellitus, higher blood pressure or antihypertensive therapy) that move patients into a higher risk for development of cardiovascular disease (CVD) and type 2 diabetes. The preclinical (subclinical) target organ diseases (SOD) are early signs of atherosclerosis. An increased aortic stiffness characterised by an increased pulse wave velocity in aorta (PWV Ao) is one of SOD.The aim of the present study was to assess the impact of metabolic syndrome (MS) on aortic wall stiffness and the risk profile in premenopausal women. METHODS The aortic stiffness was measured using Arteriograph-Tensiomed, based on oscillometric measurement and analysis of the shape of brachial pulse wave, giving the PWV Ao. The results of measurements characterise a global aortic stiffness. RESULTS We examined 81 premenopausal women (without history of CVD). The MS (according to the 2009 "harmonizing" definition) was present in 31 women (mean age 41.5 y), in the control group, there were 50 women (39 y). The most frequent components of MS were abdominal obesity (93 % vs 42%), arterial hypertension (68 % vs 10 %) and dyslipidemia (29 % vs 8 %). The PWV Ao was significantly higher in women with MS (9.26 m/s) compared to the control group (7.44 m/s). CONCLUSION The aortic stiffness in women with MS compared to controls was significantly higher despite a presumed general protective hormonal effect on cardiovascular system in women with child-bearing potential (Tab. 4, Ref. 25).

Table of contents A1 68Ga-PSMA PET/CT in staging and restaging of Prostate Cancer Patients: comparative study with 18F-Choline PET/CT W Langsteger, A Rezaee, W Loidl, HS Geinitz, F Fitz, M Steinmair, G Broinger, L Pallwien-Prettner, M Beheshti A2 F18 Choline PET – CT: an accurate diagnostic tool for the detection of parathyroid adenoma? L Imamovic, M Beheshti, G Rendl, D Hackl, O Tsybrovsky, M Steinmair, K Emmanuel, F Moinfar, C Pirich, W Langsteger A3 [18F]Fluoro-DOPA-PET/CT in the primary diagnosis of medullary thyroid carcinoma A Bytyqi, G Karanikas, M Mayerhöfer, O Koperek, B Niederle, M Hartenbach A4 Variations of clinical PET/MR operations: An international survey on the clinical utilization of PET/MRI T Beyer, K Herrmann, J Czernin A5 Standard Dixon-based attenuation correction in combined PET/MRI: Reproducibility and the possibility of Lean body mass estimation I Rausch, P Rust, MD DiFranco, M Lassen, A Stadlbauer, ME Mayerhöfer, M Hartenbach, M Hacker, T Beyer A6 High resolution digital FDG PET/MRI imaging for assessment of ACL graft viability K Binzel, R Magnussen, W Wei, MU Knopp, DC Flanigan, C Kaeding, MV Knopp A7 Using pre-existing hematotoxicity as predictor for severe side effects and number of treatment cycles of Xofigo therapy A Leisser, M Nejabat, M Hartenbach, G Kramer, M Krainer, M Hacker, A Haug A8 QDOSE – comprehensive software solution for internal dose assessment Wencke Lehnert, Karl Schmidt, Sharok Kimiaei, Marcus Bronzel, Andreas Kluge A9 Clinical impact of Time-of-Flight on next-generation digital PET imaging of Yttrium-90 radioactivity following liver radioembolization CL Wright, K Binzel, J Zhang, Evan Wuthrick, Piotr Maniawski, MV Knopp A10 Snakes in patients! Lessons learned from programming active contours for automated organ segmentation M Blaickner, E Rados, A Huber, M Dulovits, H Kulkarni, S Wiessalla, C Schuchardt, RP Baum, B Knäusl, D Georg A11 Influence of a genetic polymorphism on brain uptake of the dual ABCB1/ABCG2 substrate [11C]tariquidar M Bauer, B Wulkersdorfer, W Wadsak, C Philippe, H Haslacher, M Zeitlinger, O Langer A12 Outcome prediction of temporal lobe epilepsy surgery from P-glycoprotein activity. Pooled analysis of (R)-[11C]-verapamil PET data from two European centres M Bauer, M Feldmann, R Karch, W Wadsak, M Zeitlinger, MJ Koepp, M-C Asselin, E Pataraia, O Langer A13 In-vitro and in-vivo characterization of [18F]FE@SNAP and derivatives for the visualization of the melanin concentrating hormone receptor 1 M Zeilinger, C Philippe, M Dumanic, F Pichler, J Pilz, M Hacker, W Wadsak, M Mitterhauser A14 Reducing time in quality control leads to higher specific radioactivity of short-lived radiotracers L Nics, B Steiner, M Hacker, M Mitterhauser, W Wadsak A15 In vitro 11C-erlotinib binding experiments in cancer cell lines with epidermal growth factor receptor mutations A Traxl, Thomas Wanek, Kushtrim Kryeziu, Severin Mairinger, Johann Stanek, Walter Berger, Claudia Kuntner, Oliver Langer A16 7-[11C]methyl-6-bromopurine, a PET tracer to measure brain Mrp1 function: radiosynthesis and first PET evaluation in mice S Mairinger, T Wanek, A Traxl, M Krohn, J Stanek, T Filip, M Sauberer, C Kuntner, J Pahnke, O Langer A17 18F labeled azidoglucose derivatives as “click” agents for pretargeted PET imaging D Svatunek, C Denk, M Wilkovitsch, T Wanek, T Filip, C Kuntner-Hannes, J Fröhlich, H Mikula A18 Bioorthogonal tools for PET imaging: development of radiolabeled 1,2,4,5-Tetrazines C Denk, D Svatunek, T Wanek, S Mairinger, J Stanek, T Filip, J Fröhlich, H Mikula, C Kuntner-Hannes A19 Preclinical evaluation of [18F]FE@SUPPY- a new PET-tracer for oncology T Balber, J Singer, J Fazekas, C Rami-Mark, N Berroterán-Infante, E Jensen-Jarolim, W Wadsak, M Hacker, H Viernstein, M Mitterhauser A20 Investigation of Small [18F]-Fluoroalkylazides for Rapid Radiolabeling and In Vivo Click Chemistry C Denk, D Svatunek, B Sohr, H Mikula, J Fröhlich, T Wanek, C Kuntner-Hannes, T Filip A21 Microfluidic 68Ga-radiolabeling of PSMA-HBED-CC using a flow-through reactor S Pfaff, C Philippe, M Mitterhauser, M Hartenbach, M Hacker, W Wadsak A22 Influence of 24-nor-ursodeoxycholic acid on hepatic disposition of [18F]ciprofloxacin measured with positron emission tomography T Wanek, E Halilbasic, M Visentin, S Mairinger, B Stieger, C Kuntner, M Trauner, O Langer A23 Automated 18F-flumazenil production using chemically resistant disposable cassettes P Lam, M Aistleitner, R Eichinger, C Artner A24 Similarities and differences in the synthesis and quality control of 177Lu-DOTA-TATE, 177Lu -HA-DOTA-TATE and 177Lu-DOTA-PSMA (PSMA-617) H Eidherr, C Vraka, A Haug, M Mitterhauser, L Nics, M Hartenbach, M Hacker, W Wadsak A25 68Ga- and 177Lu-labelling of PSMA-617 H Kvaternik, R Müller, D Hausberger, C Zink, RM Aigner A26 Radiolabelling of liposomes with 67Ga and biodistribution studies after administration by an aerosol inhalation system U Cossío, M Asensio, A Montes, S Akhtar, Y te Welscher, R van Nostrum, V Gómez-Vallejo, J Llop A27 Fully automated quantification of DaTscan SPECT: Integration of age and gender differences F VandeVyver, T Barclay, N Lippens, M Troch A28 Lesion-to-background ratio in co-registered 18F-FET PET/MR imaging – is it a valuable tool to differentiate between low grade and high grade brain tumor? L Hehenwarter, B Egger, J Holzmannhofer, M Rodrigues-Radischat, C Pirich A29 [11C]-methionine PET in gliomas - a retrospective data analysis of 166 patients N Pötsch, I Rausch, D Wilhelm, M Weber, J Furtner, G Karanikas, A Wöhrer, M Mitterhauser, M Hacker, T Traub-Weidinger A30 18F-Fluorocholine versus 18F-Fluorodeoxyglucose for PET/CT imaging in patients with relapsed or progressive multiple myeloma: a pilot study T Cassou-Mounat, S Balogova, V Nataf, M Calzada, V Huchet, K Kerrou, J-Y Devaux, M Mohty, L Garderet, J-N Talbot A31 Prognostic benefit of additional SPECT/CT in sentinel lymph node mapping of breast cancer patients S Stanzel, G Pregartner, T Schwarz, V Bjelic-Radisic, B Liegl-Atzwanger, R Aigner A32 Evaluation of diagnostic value of TOF-18F-FDG PET/CT in patients with suspected pancreatic cancer S Stanzel, F Quehenberger, RM Aigner A33 New quantification method for diagnosis of primary hyperpatahyroidism lesions and differential diagnosis vs thyropid nodular disease in dynamic scintigraphy A Koljević Marković, Milica Janković, V Miler Jerković, M Paskaš, G Pupić, R Džodić, D Popović A34 A rare case of diffuse pancreatic involvement in patient with merkel cell carcinoma detected by 18F-FDG MC Fornito, D Familiari A35 TSH-stimulated 18F-FDG PET/CT in the diagnosis of recurrent/metastatic radioiodine-negative differentiated thyroid carcinomas in patients with various thyroglobuline levels P Koranda, H Polzerová, I Metelková, L Henzlová, R Formánek, E Buriánková, M Kamínek A36 Breast Dose from lactation following I131 treatment WH Thomson, C Lewis A37 A new concept for performing SeHCAT studies with the gamma camera WH Thomson, J O’Brien, G James, A Notghi A38 Whole body F-18-FDG-PET and tuberculosis: sensitivity compared to x-ray-CT H Huber, I Stelzmüller, R Wunn, M Mandl, F Fellner, B Lamprecht, M Gabriel A39 Emerging role 18F-FDG PET-CT in the diagnosis and follow-up of the infection in heartware ventricular assist system (HVAD) MC Fornito, G Leonardi A40 Validation of Poisson resampling software WH Thomson, J O’Brien, G James A41 Protection of PET nuclear medicine personnel: problems in satisfying dose limit requirements J Hudzietzová, J Sabol, M Fülöp

Resume L’utilite de la scintigraphie preoperatoire des parathyroides en cas d’hyperparathyroidie secondaire est parfois mise en doute. Un examen permettant de mettre en evidence par leurs caracteristiques fonctionnelles toutes les glandes hyperplasiques, y compris en position ectopique, est surement utile chez ces patients a l’etat general fragile. Cependant, la scintigraphie a dans certains cas une sensibilite limitee. Nous avons recherche si l’un des facteurs suivants permettait d’identifier un groupe de patients ou le taux de detection serait meilleur : âge, sexe, dialyse en cours, anciennete de la dialyse et concentration plasmatique de parathyrine (PTH). Methodes Etude retrospective de 38 patients adresses pour une scintigraphie des parathyroides du fait d’une hyperparathyroidie secondaire non operee et qui ont eu ensuite une parathyroidectomie. La scintigraphie a ete pratiquee 20 minutes puis trois heures apres injection de 8 MBq/kg de sestamibi (99mTc) precedee trois heures avant par l’ingestion de 0,1 MBq/kg d’iode-123. Resultat Aucune correlation n’a ete observee entre le nombre de glandes decelees et confirmees a l’histologie postoperatoire et la PTHemie avant l’examen (r = −0,17). Une faible correlation positive non significative (r = +0,34) a ete notee dans le groupe de six patients non hemodialyses. Aucune relation significative entre ce nombre de glandes decelees et les parametres cliniques n’a ete relevee. Conclusion Dans notre experience, les parametres etudies ne permettent pas de selectionner, parmi les patients atteints d’hyperparathyroidie secondaire, ceux qui devraient beneficier d’une scintigraphie avant parathyroidectomie.

Resume La tomographie par emission de positons (TEP) a la fluoroethyltyrosine (FET), analogue de l’acide amine, a ete pratiquee depuis le debut de la decennie, en Allemagne, pour l’imagerie moleculaire metabolique des tumeurs cerebrales, car le fluorodesoxyglucose (FDG), analogue du glucose et traceur de reference en TEP clinique, presente l’inconvenient d’etre fixe intensement par le cortex cerebral sain. Dans cette etude preliminaire, notre equipe a compare les TEP/TDM a la FET et au FDG chez dix patients evaluables, presentant une lesion cerebrale, lors du diagnostic ou apres traitement. Pour tenter d’obtenir une specificite optimale, la TEP/TDM a la FET a ete acquise une heure apres injection, alors que la pratique rapportee est une acquisition dynamique sur 40 minutes commencant a l’injection de la FET. Dans ces conditions, les performances pour la FET sont : sensibilite = 88 % ; exactitude = 80, contre 13 % et 30 % respectivement pour le FDG. Conclusion La FET est un radiopharmaceutique utile pour le diagnostic, la determination d’extension et le suivi des tumeurs cerebrales. L’association avec le FDG permet de mieux definir les lesions ou contingents de haut grade, mais pourrait ne plus etre necessaire lorsque les conditions d’acquisition et de quantification de la TEP a la FET auront ete mieux optimisees et standardisees.

Resume Le fluorodesoxyglucose ( 18 F) ou FDG, analogue radioactif du glucose et radiopharmaceutique de reference en TEP cancerologique, n’est pas adapte a la detection des metastases du cancer de la prostate dont le metabolisme glucidique n’est que peu augmente. Le fluorure ( 18 F) s’accumule dans l’os cortical, de facon franche et precoce en cas de reaction a une metastase. Il vient d’obtenir, en 2008, une autorisation de mise sur le marche (AMM) en France, incluant l’imagerie des metastases osseuses dans le cancer de la prostate. Nous presentons des cas cliniques originaux pour illustrer ses performances cliniques. L’imagerie par resonance magnetique (IRM) du « corps-entier » se developpe et a egalement la capacite de detecter les metastases osseuses. Recemment, l’IRM de diffusion a ete proposee pour ameliorer la detection des metastases du squelette axial qui sont largement predominantes dans le cancer de la prostate. Dans les deux cas, TEP couplee a la TDM ou IRM, on mobilise des moyens moins disponibles et plus couteux que la classique scintigraphie du squelette, afin d’obtenir des performances diagnostiques superieures. Le STIC qui vient d’etre accepte vise donc a preciser l’impact d’une detection plus precoce et plus exacte de la premiere metastase osseuse macroscopique sur la prise en charge du patient et l’efficacite des strategies diagnostiques incluant ces innovations, individuellement et associees. En cas de cancer de la prostate a haut risque metastatique, mais alors qu’aucune metastase osseuse n’est averee et que la scintigraphie du squelette n’est pas evocatrice de lesions secondaires, on ajoutera la TEP/TDM au fluorure ( 18 F) de sodium a l’IRM corps-entier. L’histologie et/ou un suivi de six mois serviront d’etalon de verite pour juger la pertinence de l’impact sur la prise en charge du patient et le rapport benefice/cout additionnel de ces examens. Nous esperons grâce a cette etude multicentrique prospective demontrer dans le monde reel la place de ce radiopharmaceutique qui date de plusieurs decennies mais dont les potentialites sont tres accrues grâce a l’essor recent de l’imagerie TEP/TDM.

Small cell lung carcinomas (SCLC) express neuroendocrine markers, and dihydroxyphenylalanine (DOPA) is known to accumulate in neuroendocrine tumours. This study was performed with the aim of evaluating the uptake of 3,4-dihydroxy-6-(18)F-fluoro-phenylalanine ([(18)F]FDOPA) by SCLC, based on comparison with the results of fluorine-18 fluorodeoxyglucose ([(18)F]FDG) positron emission tomography (PET) and standard imaging procedures. [(18)F]FDG PET and [(18)F]FDOPA PET were performed on four patients with newly diagnosed SCLC. There was agreement between the results of [(18)F]FDOPA PET and [(18)F]FDG PET in four tumoural sites out of 11, whereas [(18)F]FDG PET and standard imaging procedures were in full agreement. A semi-quantitative analysis based on standardised uptake values (SUVs) was performed in order to compare [(18)F]FDG and [(18)F]FDOPA tumour uptake. The median [(18)F]FDG SUV(max) was 5.9 (with a 95% confidence interval from 4.4 to 9.2), while the median [(18)F]FDOPA SUV(max) was 1.9 (with a 95% confidence interval from 1.6 to 3.8). The difference between [(18)F]FDG SUV(max) and [(18)F]FDOPA SUV(max) was significant ( P0.01). [(18)F]FDOPA PET appeared less sensitive than [(18)F]FDG PET and standard imaging procedures in the staging of SCLC. No clear relation between [(18)F]FDOPA uptake and positivity of neuroendocrine markers on immunohistochemistry emerged from these preliminary results; however, since [(18)F]FDOPA uptake may reflect better differentiation of the tumour, and possibly a better prognosis, this point warrants clarification in a larger study.

Purpose: Diverse radionuclide imaging techniques are available for the diagnosis, staging, and follow-up of phaeochromocytoma and paraganglioma (PPGL). Beyond their ability to detect and localise the disease, these imaging approaches variably characterise these tumours at the cellular and molecular levels and can guide therapy. Here we present updated guidelines jointly approved by the EANM and SNMMI for assisting nuclear medicine practitioners in not only the selection and performance of currently available single-photon emission computed tomography and positron emission tomography procedures, but also the interpretation and reporting of the results. Methods: Guidelines from related fields and relevant literature have been considered in consultation with leading experts involved in the management of PPGL. The provided information should be applied according to local laws and regulations as well as the availability of various radiopharmaceuticals. Conclusion: Since the European Association of Nuclear Medicine 2012 guidelines, the excellent results obtained with gallium-68 (68Ga)-labelled somatostatin analogues (SSAs) in recent years have simplified the imaging approach for PPGL patients that can also be used for selecting patients for peptide receptor radionuclide therapy as a potential alternative or complement to the traditional theranostic approach with iodine-123 (123I)/iodine-131 (131I)-labelled meta-iodobenzylguanidine. Genomic characterisation of subgroups with differing risk of lesion development and subsequent metastatic spread is refining the use of molecular imaging in the personalised approach to hereditary PPGL patients for detection, staging, and follow-up surveillance.