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Introduction Renal scintigraphy (RS) is occasionally performed to assess the risk of persistent renal failure (PRF) in patients with acute kidney disease (AKD). However, its diagnostic performance has never been assessed. Methods We identified all patients with AKD for whom RS was performed in our institution between 2010 and 2017. PRF was defined as persistently low ( Results Among 97 patients included, 57 (59%) fulfilled the criteria for PRF. The PRF score was able to predict PRF with an AUC of 0.63. Similarly, the accumulation index and accumulation slope respective AUCs were 0.64 and 0.63. None of these parameters were able to improve the performance of the clinical model. Among new parameters, the 3rd/2nd minute activity ratio and 3rd/2nd minute activity slope had fair diagnostic performance (AUC 0.72 and 0.74, respectively) and improved the performance of the clinical model. Results were confirmed in sensitivity analyses. Conclusion Conventional renal scintigraphy can identify patients at high risk of PRF with a high specificity but a low sensitivity. New parameters, with comparable diagnostic abilities can be obtained within three minutes of injection. Graphical abstract

The aim of this prospective pilot study was to evaluate the feasibility of a new hybrid imaging modality, free-hand single-photon computed tomography/ultrasonography (fhSPECT/US), for preoperative localization of parathyroid adenomas and to compare its performance with conventional ultrasonography and SPECT/CT. Twelve patients diagnosed with primary hyperparathyroidism underwent sequentially US and parathyroid scintigraphy, including SPECT/CT, followed by fhSPECT/US, allowing for real-time fusion between US and freehand-generated gamma-camera images. The fhSPECT/US detection rates were correlated with histopathology, when available, or with the imaging modality showing the most lesions. Based on a per patient analysis, the detection rate was significantly different when comparing SPECT/CT to fhSPECT/US (p = 0.03), and not significantly different when comparing SPECT/CT to US (p = 0.16) and US to fhSPECT/US (p = 0.08). Based on a per-lesion analysis, the detection rate of SPECT/CT was significantly higher than that of US (p = 0.01) and fhSEPCT/US (p = 0.003), and there was no significant difference in detection rate when comparing US to fhSPECT/US (p = 0.08). The main perceived limitations of fhSPECT/US in lesion detection were: (i) lesions localized at a depth ≥4.5 cm; (ii) imperfect image fusion due to tissue compression; (iii) limited spatial manipulation ability of the SPECT mobile camera handheld probe; and (iv) a wide spread of detected activity. In conclusion, clinical use of fhSPECT/US for localization of parathyroid adenomas is feasible, but shows lower sensitivity than conventional modalities and requires technical improvements.

Background Gliomas are the most frequent malignant brain tumors and are heterogeneous in histology, genetics, and outcome. Mutations in isocitrate dehydrogenase (IDH) have been described by several studies as an independent predictor of better survival. We aimed at evaluating the respective value of O-(2-[18F]fluoroethyl)-L-tyrosine (18F-FET) PET/CT dynamic and texture analysis in patients with untreated glioma to assess grade and IDH mutation status. Methods In total, 73 patients (male: 48, median age: 47 [36–59]) who underwent an 18F-FET PET/CT for initial glioma evaluation were retrospectively included. Twenty patients had a WHO grade II and forty-one a grade III-IV glioma. IDH status was available in 61 patients. Time-activity-curve (TAC) type and 20 parameters (conventional, texture, shape and histogram derived) obtained from static analysis using the LIFEx© software were recorded. Respective performance was assessed using receiver operating characteristic (ROC) curve analysis and stepwise multivariate regression analysis. Results TAC type and several texture parameters derived from static parameters showed satisfactory to good performance to predict glioma grade and IDH status. Both TAC type (stepwise OR: 28.8 [95%CI: 4.73-175.14], p 19 [95%CI: 1.47–6.5 x 1039], p = 0.048) were independent predictors of glioma grade. However, only TAC type was an independent predictor of IDH status (OR: 3.74 [95%CI: 1.17-12.0], p = 0.026). Conclusions 18F-FET PET/CT dynamic and texture analysis may help predict both glioma grade and IDH status, especially in low-grade tumors.

Background The primary aims of this study were to compare in patients with esophageal or esophagogastric junction cancers the potential of 68Ga-NODAGA-RGD PET/CT with that of 18F-FDG PET/CT regarding tumoral uptake and distribution, as well as histopathologic examination. Methods Ten 68Ga-NODAGA-RGD and ten 18F-FDG PET/CT were performed in nine prospectively included participants (1 woman; aged 58 ± 8.4 y, range 40–69 y). Maximum SUV (SUVmax) and metabolic tumor volumes (MTV) were calculated. The Mann–Whitney U test and Spearman correlation analysis (ρ) were used. Results 68Ga-NODAGA-RGD PET/CT detected positive uptake in 10 primary sites (8 for primary tumors and 2 for local relapse suspicion), 6 lymph nodes and 3 skeletal sites. 18F-FDG PET/CT detected positive uptake in the same sites but also in 16 additional lymph nodes and 1 adrenal gland. On a lesion-based analysis, SUVmax of 18F-FDG was significantly higher than those of 68Ga-NODAGA-RGD (4.9 [3.7–11.3] vs. 3.2 [2.6–4.2] g/mL, p = 0.014). Only one participant showed a higher SUVmax in an osseous metastasis with 68Ga-NODAGA-RGD as compared to 18F-FDG (6.6 vs. 3.9 g/mL). Correlation analysis showed positive correlation between 18F-FDG and 68Ga-NODAGA-RGD PET parameters (ρ = 0.56, p = 0.012 for SUVmax, ρ = 0.78, p ρ = 0.58, p = 0.024 for MTV). We observed that 18F-FDG uptake was homogenous inside all the confirmed primary sites (n = 9). In contrast, 68Ga-NODAGA-RGD PET showed more heterogenous uptake in 6 out of the 9 confirmed primary sites (67%), seen mostly in the periphery of the tumor in 5 out of the 9 confirmed primary sites (56%), and showed slight extensions into perilesional structures in 5 out of the 9 confirmed primary sites (56%). Conclusions In conclusion, 68Ga-NODAGA-RGD has lower potential in the detection of esophageal or esophagogastric junction malignancies compared to 18F-FDG. However, the results suggest that PET imaging of integrin αvβ3 expression may provide complementary information and could aid in tumor diversity and delineation. Trial registration: Trial registration: NCT02666547. Registered January 28, 2016—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02666547.

Background The most reliable quantitative variable on Rubidium-82 (82Rb) cardiac PET/CT for predicting major adverse cardiovascular events (MACE) has not been characterized with low-dose silicon photomultipliers (SiPM) technology, which allows halving injected activity and radiation dose delivering less than 1.0 mSv in a 70-kg individual. Methods and Results We prospectively enrolled 234 consecutive participants with suspected myocardial ischemia. Participants underwent 82Rb cardiac SiPM PET/CT (5 MBq/kg) and were followed up for MACE over 652 days (interquartile range 559-751 days). For each participant, global stress myocardial blood flow (stress MBF), global myocardial flow reserve (MFR), and regional severely reduced myocardial flow capacity (MFCsevere) were measured. The Youden index was used to select optimal thresholds. In multivariate analysis after adjustments for clinical risk factors, reduced global stress MBF severe > 3.2% of left ventricle emerged all as independent predictors of MACE (HR 4.5, 3.1, and 3.67, respectively, p severe impairments (HR 2.81, p = 0.027). Conclusion Using the latest SiPM PET technology with low-dose 82Rb halving the standard activity to deliver Graphical Abstract

BackgroundThere is no consensus on how to predict post-transplant function of donation after circulatory death (DCD) kidneys. Thus, we aimed to identify renal scintigraphy parameters that could predict 1-year kidney function.MethodsIn this single center study, we included all consecutive DCD kidney recipients between 2013 and 2021 (n = 29). Patients who did not have a scintigraphy within 10 days of transplantation (n = 3), recipients of multiple organs and less than 18 years old were excluded (n = 1). Primary endpoint was the estimated glomerular filtration rate (eGFR).ResultsMedian eGFR and serum creatinine at 1 year were 67 µmol/L (56–81) and 111 ml/min (99–132), respectively. Among parameters tested, the 3rd/2nd-minute activity ratio had the best diagnostic performance (AUC: 0.74 and 0.71, for eGFR and creatinine) 1 year post transplantation. Using 1.21 as the best cut off, the 3rd/2nd-minute activity ratio specificity and sensitivity to predict eGFR >60 ml/min was 0.82 and 0.83. Renal function was significantly better at 1 week, 3, 6, and 12 months after transplantation in patients with 3rd/2nd-minute activity ratios above 1.21.ConclusionThis study suggests that the 3rd/2nd-minute activity ratio can predict graft function at 1 year. The benefit of post-transplant scintigraphy should be further validated in a prospective cohort.

Background The primary aims of this study were to compare in patients with esophageal or esophagogastric junction cancers the potential of 68Ga-NODAGA-RGD PET/ CT with that of 18F-FDG PET/CT regarding tumoral uptake and distribution, as well as histopathologic examination. Methods Ten 68Ga-NODAGA-RGD and ten 18F-FDG PET/CT were performed in nine prospectively included participants (1 woman; aged 58±8.4 y, range 40–69 y). Maximum SUV (SUVmax) and metabolic tumor volumes (MTV) were calculated. The Mann-Whitney U test and Spearman correlation analysis (ρ) were used. Results 68Ga-NODAGA-RGD PET/CT detected positive uptake in 10 primary sites (8 for primary tumors and 2 for local relapse suspicion), 6 lymph nodes and 3 skeletal sites. 18F-FDG PET/CT detected positive uptake in the same sites but also in 16 additional lymph nodes and 1 adrenal gland. On a lesion-based analysis, SUVmax of 18F-FDG were significantly higher than those of 68Ga-NODAGA-RGD (4.9 [3.7–11.3] vs. 3.2 [2.6–4.2] g/mL, p = 0.014). Only 1 participant showed a higher SUVmax in an osseous metastasis with 68Ga-NODAGA-RGD as compared to 18F-FDG (6.6 vs. 3.9 g/mL). Correlation analysis showed positive correlation between 18F-FDG and 68Ga-NODAGA-RGD PET parameters (ρ = 0.56, p = 0.012 for SUVmax, ρ = 0.78, p < 0.001 for lesion-to-background ratios and ρ = 0.58, p = 0.024 for MTV). We observed that 18F-FDG uptake was homogenous inside all the confirmed primary sites (n = 9). In contrast, 68Ga-NODAGA-RGD PET showed more heterogenous uptake in 6 out of the 9 confirmed primary sites (67%), seen mostly in the periphery of the tumor in 5 out of the 9 confirmed primary sites (56%), and showed slight extensions into perilesional structures in 5 out of the 9 confirmed primary sites (56%). Conclusions In conclusion, 68Ga-NODAGA-RGD has lower potential in the detection of esophageal or esophagogastric junction malignancies compared to 18F-FDG. However, the results suggest that PET imaging of integrin αvβ3 expression may provide complementary information and could aid in tumor diversity and delineation. Trial registration: Trial registration: NCT02666547. Registered January 28, 2016 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02666547

Background Integrin alpha-V-beta-3 (αvβ3) pathway is involved in intraplaque angiogenesis and inflammation and represents a promising target for molecular imaging in cardiovascular diseases such as atherosclerosis. The aim of this study was to assess the clinical correlates of arterial wall accumulation of 68Ga-NODAGA-RGD, a specific αvβ3 integrin ligand for PET. Materials and methods The data of 44 patients who underwent 68Ga-NODAGA-RGD PET/CT scans were retrospectively analyzed. Tracer accumulation in the vessel wall of major arteries was analyzed semi-quantitatively by blood-pool-corrected target-to-background ratios. Tracer uptake was compared with clinically documented atherosclerotic cardiovascular disease, cardiovascular risk factors and calcified plaque burden. Data were compared using the Mann–Whitney U test, Pearson correlation and Spearman correlation. Results 68Ga-NODAGA-RGD arterial uptake was significantly higher in patients with previous clinically documented atherosclerotic cardiovascular disease (mean TBR 2.44 [2.03–2.55] vs. 1.81 [1.56–1.96], p = 0.001) and showed a significant correlation with prior cardiovascular or cerebrovascular event (r = 0.33, p = 0.027), BMI (ρ = 0.38, p = 0.01), plaque burden (ρ = 0.31, p = 0.04) and hypercholesterolemia (r = 0.31, p = 0.04). Conclusions 68Ga-NODAGA-RGD holds promise as a non-invasive marker of disease activity in atherosclerosis, providing information about intraplaque angiogenesis.

Background Physiological focal radiopharmaceutical uptake in the head and uncinate process of the pancreas may be seen on somatostatin receptor-based PET/CT and might lead to false-positive results for neuroendocrine tumours (NETs). We aimed to perform a systematic review and a meta-analysis about the prevalence of this finding. Methods We performed a comprehensive computer literature search across several databases until July 2020. Pooled prevalence of physiological focal uptake on somatostatin receptor-based PET/CT in the pancreas was calculated on a per-examination-based analysis and 95% confidence interval values (95% CI) were reported. Results Six studies (684 patients and 829 PET/CT scans) were included. The pooled prevalence of physiological uptake in the head and uncinate process of the pancreas on somatostatin receptor-based PET/CT imaging was 34% (95% CI 19.5–48.7%) with average SUVmax values ranging from 5 to 12.6. Heterogeneity was seen across the selected studies. Conclusions High radiopharmaceutical uptake in the head and uncinate process of the pancreas is frequent at somatostatin receptor-based PET/CT and it should be recognized by nuclear medicine physicians to prevent unnecessary additional investigations. In addition, next generation PET/CT tomographs might increase the prevalence of this finding.

Background and purpose Prophylactic cranial irradiation (PCI) in small-cell lung cancer (SCLC) patients improves survival. However, it is also associated with cognitive impairment, although the underlying mechanisms remain poorly understood. Our study aims to evaluate the impact of PCI and potential benefit of hippocampal sparing (HS) on brain metabolism assessed by 18F-Fluoro-Deoxy-Glucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT). Materials and methods We retrospectively included 22 SCLC patients. 50% had hippocampal-sparing (HS) PCI. 18F-FDG PET/CT was performed 144.5 ± 73 days before and 383 ± 451 days after PCI. Brain 18F-FDG PET scans were automatically segmented in 12 regions using Combined-AAL Atlas from MI-Neurology Software (Syngo.Via, Siemens Healthineers). For all atlas regions, we computed SUV Ratio using brainstem as a reference region (SUVR = SUVmean/Brainstem SUVmean) and compared SUVR before and after PCI, using a Wilcoxon test, with a level of significance of p Results We found significant decreases in 18F-FDG brain metabolism after PCI in the basal ganglia (p = 0.004), central regions (p = 0.001), cingulate cortex ( p ), corpus striata (p = 0.003), frontal cortex ( p ), parietal cortex (p = 0.001), the occipital cortex (p = 0.002), precuneus (p = 0.001), lateral temporal cortex (p = 0.001) and cerebellum ( p ). Conversely, there were no significant changes in the mesial temporal cortex (MTC) which includes the hippocampi (p = 0.089). The subgroup who received standard PCI showed a significant decrease in metabolism of the hippocampi (p = 0.033). Contrastingly, the subgroup of patients who underwent HS-PCI showed no significant variation in metabolism of the hippocampi (p = 0.783). Conclusion PCI induced a diffuse decrease in 18F-FDG brain metabolism. HS-PCI preserves metabolic activity of the hippocampi.

Incidental 18F-FDG uptake in the pituitary may be detected during PET examinations. We aimed to perform a systematic review and a meta-analysis about prevalence and clinical significance of this finding. A comprehensive computer literature search, using several databases, was performed until March 2020. Pooled prevalence and rate of malignancy, including 95% confidence interval values (95% CI), were calculated on a per-examination based analysis. Five studies (180 cases of incidental 18F-FDG uptake in the pituitary) were included; most of the cases were further evaluated with MRI. The pooled prevalence of incidental 18F-FDG uptake in the pituitary was 0.33% (95% CI 0.07–0.78%). Adenomas were the most frequent lesions underlying an incidental 18F-FDG uptake in the pituitary when further evaluated with MRI (pooled prevalence: 66%; 95% CI 42–86%). The pooled rate of malignancy in cases of incidental 18F-FDG uptake further evaluated with MRI was 13% (95%CI 3–31%). Notably, a significant heterogeneity among the selected studies was found. Of note, in the available series, there were not patients with incidental 18F-FDG uptake in the pituitary treated with immunotherapy. Clinicians, radiologists and nuclear medicine physicians should be aware that incidental 18F-FDG uptake in the pituitary is an infrequent finding corresponding to benign lesions in most of the cases. Nevertheless, if the patient has normal life expectancy, MRI pituitary examination should be performed to better characterize these incidental findings due to possible clinical consequences of some pituitary incidentalomas if untreated. Further well-designed studies are needed on this topic, especially in view of the increasing frequency of immunotherapy, whose side-effects can be seen by increased 18F-FDG uptake in the pituitary.

On conventional PET/CT, and under physiological conditions, the volume of the pituitary gland (PG) is small, and its metabolic activity is commonly comparable to the surrounding background level in 18F-FDG imaging. We compared the physiological 18F-FDG uptake of the PG in patients imaged with digital PET (dPET) and with conventional PET (cPET). Additionally, we performed phantom experiments to characterize signal recovery and detectability of small structures. We retrospectively included 10 dPET and 10 cPET patients and measured PG SUVmax, SUVmean and SUVratio (using cerebellum as reference). We imaged a modified NEMA/IEC phantom with both dPET and cPET (background activity 5 kBq/mL, and 3× and 5× higher concentrations in ∅2–20-mm spherical inserts). Mean recovery coefficients (RCmean) and signal-difference-to-noise-ratio (SDNR) were computed to assess lesion detectability. Patients imaged with dPET presented higher PG SUVmax and SUVratio (SUVR) compared to patients imaged with cPET (4.7 ± 2.05 vs. 2.9 ± 0.64, p = 0.004; and 0.62 ± 0.25 vs 0.39 ± 0.09, p = 0.029, respectively), while there was no difference for SUVmean (2.7 ± 1.32 vs 2.1 ± 0.44, p = 0.39). Thus, with a SUV readout scale of 0–5 g/mL, normal PG appeared abnormally hot with dPET, but not with cPET. Phantom evidenced higher RCmean in dPET compared to cPET. For both 3x and 5x measurements, lesion detectability according to size was systematically superior with dPET. In conclusion, patients imaged with dPET presented higher 18F-FDG physiological uptake of the PG as compared to patients imaged with cPET. These findings were supported by phantom experiments demonstrating superior signal recovery and small region detectability with dPET. Awareness of this new “higher” SUV of the normal 18F-FDG uptake of the PG is important to avoid potential pitfalls in image interpretation, notably in oncologic patients treated with immunotherapy, who are at increased risk to develop hypophysitis.

Oligometastatic disease (OMD) is an emerging state of disease with limited metastatic tumor burden. It should be distinguished from polymetastatic disease due the potential curative therapeutic options of OMD. Imaging plays a pivotal role in the diagnosis and follow-up of patients with OMD. The imaging tools needed in the case of OMD will differ according to different parameters, which include primary tumor type, timing between measurement and treatment, potential metastatic location and the patient’s individual risk for metastasis. In this article, OMD is defined and the use of different imaging modalities in several oncologic situations are described in order to better understand OMD and its specific implication for radiologists.

Chronic osteomyelitis is an inflammatory process of the bone caused by an infectious agent. This condition leads to altered bone vascularization and thus to bone destruction and formation of necrotic bone fragments (sequestrum). The treatment of chronic osteomyelitis is primarily based on surgical management, which includes debridement of the sequestrum and sampling of bone tissue for microbiological analysis in order to initiate a targeted antibiotic therapy. A multidisciplinary approach is essential, involving expertise in orthopedic surgery, musculoskeletal imaging and nuclear medicine, infectious diseases, as well as plastic or vascular surgery for complex cases with soft tissue and/or vascular defects.L’ostéomyélite chronique est un processus inflammatoire osseux causé par un agent infectieux. Cette pathologie provoque une altération de la vascularisation intraosseuse et périostée donnant lieu à des fragments d’os nécrotiques (séquestres). Le traitement de l’ostéomyélite chronique repose sur une prise en charge chirurgicale permettant de débrider les séquestres et de réaliser des prélèvements osseux pour des analyses microbiologiques afin d’instaurer une antibiothérapie ciblée sur l’agent pathogène. Une approche multidisciplinaire doit impliquer une expertise en chirurgie orthopédique, en imagerie musculosquelettique et médecine nucléaire, en maladies infectieuses, ainsi qu’en chirurgie plastique ou vasculaire pour les cas avec perte des tissus mous ou défaut de vascularisation.

Purpose The aim of this study was to assess the most reliable quantitative variable on Rubidium-82 (82Rb) cardiac PET/CT for predicting major adverse cardiovascular events (MACE), on the latest PET camera using silicon photomultipliers digital readout (SiPM) technology. Methods We prospectively enrolled 274 consecutive participants with suspected myocardial ischemia. Participants underwent 82Rb cardiac SiPM PET/CT and were followed-up for MACE over 652 days (interquartile range: 559 to 751 days). For each participant, global and regional myocardial flow reserve (MFR), stress myocardial blood flow (stress MBF) and their combination as myocardial flow capacity radius (MFC radius) were measured. Results On receiver operator curve analysis, MACE prediction was similar for global and regional MFR, stress MBF, and MFC radius (area under the curve; (i) Global: 0.70 vs. 0.71 and 0.73, and (ii) Regional: 0.71 vs. 0.71 and 0.73, respectively, p > 0.1 for all pairwise comparisons). On multivariable analysis, (i) Global: MFR < 1.98, stress MBF < 1.94 mL/g/min, and MFC radius < 3.12, as well as (ii) Regional: MFR < 1.75, stress MBF < 1.75 mL/g/min, and MFC radius < 2.7, emerged all as similar independent predictors of MACE (p < 0.001 for all). Conclusions Using the latest SiPM PET technology with 82Rb, global and regional MFR, stress MBF, and MFC radius are similar powerful predictors of cardiovascular event.

Anti-PD-1/PD-L1 blockade can restore tumour-specific T-cell immunity and is an emerging therapy in non-small-cell lung cancer (NSCLC). We investigated the correlation between 18F-FDG PET/CT-based markers and tumour tissue expression of PD-L1, necrosis and clinical outcome in patients receiving checkpoint inhibitor treatment. PD-Li expression in biopsy or resection specimens from 49 patients with confirmed NSCLC was investigated by immunohistochemistry. Maximum standardized uptake value (SUVmax), mean SUV (SUVmean), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) were obtained from 18F-FDG PET/CT images. The ratio of metabolic to morphological lesion volumes (MMVR) and its association with PD-L1 expression in each lesion were calculated. The associations between histologically reported necrosis and 18F-FDG PET imaging patterns and radiological outcome (evaluated by iRECIST) following anti-PD-1/PD-L1 therapy were also analysed. In 14 patients, the association between necrosis and MMVR and tumour immune contexture were analysed by multiple immunofluorescent (IF) staining for CD8, PD-1, granzyme B (GrzB) and NFATC2. In total, 25 adenocarcinomas and 24 squamous cell carcinomas were analysed. All tumours showed metabolic 18F-FDG PET uptake. MMVR was correlated inversely with PD-L1 expression in tumour cells. Furthermore, PD-L1 expression and low MMVR were significantly correlated with clinical benefit. Necrosis was correlated negatively with MMVR. Multiplex IF staining showed a greater frequency of activated CD8+ cells in necrotic tumours than in nonnecrotic tumours in both stromal and epithelial tumour compartments. This study introduces MMVR as a new imaging biomarker and its ability to noninvasively capture increased PD-L1 tumour expression and predict clinical benefit from checkpoint blockade in NSCLC should be further evaluated.

The management of patients with breast cancer during their pregnancy is challenging. A good coordination is required between the oncology and obstetrics teams in order to ensure appropriate care, while providing a reassuring environment during this stressful period. Most often, the pregnancy can continue without delaying the initiation of oncological treatments, offering a prognosis similar to non-pregnant women. Surgery and chemotherapy can be done during pregnancy, unlike endocrine therapy, radiotherapy and antibody treatments which can only be given postpartum. While some imaging techniques are compatible, others require special measures or are contraindicated. We discuss these points in the context of a clinical situation.La prise en charge des patientes présentant un cancer du sein durant leur grossesse est un challenge. Elle exige une bonne coordination entre les équipes oncologique et obstétricale afin d’assurer des soins appropriés tout en offrant un cadre rassurant en cette période de grand stress. Le plus souvent, la grossesse peut être poursuivie sans retarder l’initiation des traitements oncologiques, avec un pronostic similaire aux femmes non enceintes. La chirurgie et la chimiothérapie peuvent être entreprises en cours de grossesse, contrairement à l’hormonothérapie, la radiothérapie et les traitements par anticorps qui ne peuvent être administrés qu’en post-partum. Si certaines techniques d’imagerie sont compatibles, d’autres requièrent des mesures particulières ou sont contre-indiquées. Nous discutons de ces points dans le cadre d’une situation clinique.

Prophylactic cranial irradiation (PCI) in small-cell lung cancer (SCLC) patients improves survival. However, it is also associated with cognitive impairment, although the underlying mechanisms remain poorly understood. Our study aims to evaluate the impact of PCI and potential benefit of hippocampal sparing (HS) on brain metabolism assessed byWe retrospectively included 22 SCLC patients. 50% had hippocampal-sparing (HS) PCI.We found significant decreases inPCI induced a diffuse decrease in

Infectious endocarditis is a life-threatening disease, requiring prompt and accurate diagnosis. The aim of this article is to perform a systematic review and meta-analysis of the literature to estimate the performance of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) for the diagnosis of native valve endocarditis (NVE). Selected articles evaluating the diagnostic accuracy of 18 F-FDG PET/CT in patients with suspected NVE, resulting from a comprehensive literature search through the PubMed/MEDLINE and Cochrane library databases until April 2020, were included for the systematic review and meta-analysis. Seven studies (351 episodes of suspected NVE) were included. 18 F-FDG PET/CT yielded a pooled sensitivity of 36.3% and a pooled specificity of 99.1% for the diagnosis of NVE. The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 8.3, 0.6, and 15.3, respectively. The sensitivity increased using contemporary PET/CT device with state-of-the-art patient preparation as well as innovative image acquisitions or adding the results of 18 F-FDG PET/CT in a multimodality strategy. In our systematic review and meta-analysis, 18 F-FDG PET/CT yielded a poor pooled sensitivity with an otherwise excellent pooled specificity for the diagnosis of NVE; however, several factors may increase the sensitivity without affecting the specificity and these factors should be better evaluated in future studies.

This chapter summarizes 15 meta-analyses published in the literature on the use of PET for cardiac diseases, with the majority (n = 8) concerning the diagnosis of coronary artery disease (CAD) using myocardial perfusion imaging (MPI) in comparison to other modalities. Second in the number of published meta-analyses, three studies concentrated on the prognostic value of MPI for adverse cardiovascular events. Finally, one meta-analysis was published on the use of PET for four indications among myocardial viability assessment, the presence of microvascular disease (impaired coronary vascular function in absence of obstructive, epicardial CAD), the use of cardiac hybrid imaging and the diagnostic of cardiac amyloidosis.

Purpose Bone scintigraphy with 99mTc-labeled diphosphonates can identify prostate cancer bone metastases with high sensitivity, but relatively low specificity, because benign conditions such as osteoarthritis can also trigger osteoblastic reactions. We aimed to investigate the diagnostic performance of 99mTc-2,3-dicarboxy propane-1,1-diphosphonate (99mTc-DPD) uptake quantification by single-photon emission computed tomography coupled with computed tomography (SPECT/CT) for distinguishing prostate cancer bone metastases from spinal and pelvic osteoarthritic lesions. Methods We retrospectively assessed 26 bone scans from 26 patients with known prostate cancer bone metastases and 13 control patients with benign spinal and pelvic osteoarthritic changes without known neoplastic disease. Quantitative SPECT/CT (xSPECT, Siemens Symbia Intevo, Erlangen, Germany) was performed and standardized uptake values (SUVs) were quantified with measurements of SUVmax and SUVmean (g/mL) in all bone metastases for the prostate cancer group and in spinal and pelvic osteoarthritic changes for the control group. We used receiver operating characteristics (ROC) curves to determine the optimum SUVmax cutoff value to distinguish between bone metastases and benign spinal and pelvic lesions. Results In total, 264 prostate cancer bone metastases were analyzed, showing a mean SUVmax and SUVmean of 34.6 ± 24.6 and 20.8 ± 14.7 g/mL, respectively. In 24 spinal and pelvic osteoarthritic lesions, mean SUVmax and SUVmean were 14.2 ± 3.8 and 8.9 ± 2.2 g/mL, respectively. SUVmax and SUVmean were both significantly different between the bone metastases and osteoarthritic groups (p ≤ 0.0001). Using a SUVmax cutoff of 19.5 g/mL for prostate cancer bone metastases in the spine and pelvis, sensitivity, specificity, positive and negative predictive values were 87, 92, 99 and 49%, respectively. Conclusion This study showed significant differences in quantitative 99mTc-DPD uptake on bone SPECT/CT between prostate cancer bone metastases and spinal and pelvic osteoarthritic changes, with higher SUVmax and SUVmean in metastases. Using a SUVmax cutoff of 19.5 g/mL, high specificity and positive predictive value for metastases identification in the spine and pelvis were found, thus increasing accuracy of bone scintigraphy.

Purpose To compare the value of pretreatment functional and morphological imaging parameters for predicting survival in patients undergoing transarterial radioembolization using yttrium-90 (90Y-TARE) for unresectable hepatocellular carcinoma (uHCC).

The aim of this study was to compare survival of patients treated for unresectable hepatocellular carcinoma (uHCC) with Yttrium-90 (90Y) transarterial radioembolization (TARE) using pretreatment partition model dosimetry (PMD). Methods: We performed a retrospective analysis of prospectively collected data on 77 consecutively treated (mean age 66.4 12.2 y) for uHCC (36 uni-nodular, 5 multi-nodular, 36 diffuse) with 90Y TARE (41 resin, 36 glass) using pretreatment PMD. Study endpoints were progression-free survival (PFS) and overall survival (OS) assessed by Kaplan-Meier estimates. Several variables including Barcelona Clinic Liver Cancer (BCLC) staging system, tumor size and serum alpha-fetoprotein (AFP) level) were investigated using Cox proportional hazards regression. Results: Characteristics of two groups were comparable in regard to demographic data, comorbidities, Child-Pugh score, BCLC, serum AFP level and 90Y global administered activity. Median follow-up time was 7.7 months (range 0.4-50.1). Relapse occurred in 44 patients (57%) at a median of 6 mo (range 0.4-27.9) after 90Y TARE and 41 patients (53%) died from tumor progression. Comparison between resin and glass microspheres revealed a higher but not statistically significantly PFS and OS rates in 90Y resin group compared to 90Y glass group (resin PFS 6.1 mo [95% Confidence interval CI 4.7-7.4] and glass PFS 5 mo [95% CI 0.9-9.2], P = 0.53; resin OS 7.7 mo [95% CI 7.2-8.2] and glass OS 7 mo [95% CI 1.6-12.4], P = 0.77). No significant survival difference between both types of 90Y microspheres was observed in any subgroups of patients with early/intermediate or advanced BCLC stages. Among the variables investigated Cox analyses showed that only in the glass group, the BCLC staging system and the serum AFP level were associated with PFS (P = 0.04) and OS (P = 0.04). Tumor size was a prognostic factor without significant influence on PFS and OS after 90Y TARE. Conclusion: Comparison between resin and glass microspheres revealed no significant survival difference in patients treated for uHCC with 90Y TARE using pretreatment PMD. Further larger prospective studies are warranted to confirm these findings.

See the associated article on page [570][1]. Ionizing radiation dose optimization aims at ensuring that the patient dose is suitable for the medical purpose and that unnecessary radiation is avoided. This principle of dose optimization is a general radiation protection principle applied in nuclear

Background: Tumor-induced or oncogenic osteomalacia (TIO) is a rare paraneoplastic syndrome in which osteomalacia is a consequence of fibroblast growth factor 23 (FGF23) secretion by a mesenchymal tumor. The localization of the culprit lesion in patients with TIO is often challenging. Several studies have evaluated the detection rate (DR) of these tumors using somatostatin receptor positron emission tomography (SSTR-PET/CT). We aimed to summarize literature findings on this topic providing pooled estimates of DR. Methods: A comprehensive literature search by screening PubMed, Embase and Cochrane library electronic databases through August 2019 was performed. The pooled DR of culprit tumors using SSTR-PET/CT in patients with TIO was calculated using a random-effects statistical model. Results: Fourteen studies on the use of SSTR-PET/CT in detecting the culprit tumor in patients with TIO were included in the qualitative analysis. The pooled DR of SSTR-PET/CT on a per-patient-based analysis calculated using eleven studies (166 patients) was 87.6% (95% confidence interval (95% CI) 80.2–95.1%). Statistical heterogeneity among studies was detected (I-square = 63%), likely due to the use of different radiolabeled somatostatin analogues, as demonstrated by a subgroup analysis. Conclusions: Despite limited literature data due to the rarity of the disease, SSTR-PET/CT demonstrated a very high DR of culprit tumors in patients with TIO and it could be used as first-line imaging method for this indication.

On conventional PET/CT, and under physiological conditions, the volume of the pituitary gland (PG) is small, and its metabolic activity is commonly comparable to the surrounding background level in 18F-FDG imaging. We compared the physiological 18F-FDG uptake of the PG in patients imaged with digital PET (dPET) and with conventional PET (cPET). Additionally, we performed phantom experiments to characterize signal recovery and detectability of small structures. We retrospectively included 10 dPET and 10 cPET patients and measured PG SUVmax, SUVmean and SUVratio (using cerebellum as reference). We imaged a modified NEMA/IEC phantom with both dPET and cPET (background activity 5 kBq/mL, and 3× and 5× higher concentrations in ∅2–20-mm spherical inserts). Mean recovery coefficients (RCmean) and signal-difference-to-noise-ratio (SDNR) were computed to assess lesion detectability. Patients imaged with dPET presented higher PG SUVmax and SUVratio (SUVR) compared to patients imaged with cPET (4.7 ± 2.05 vs. 2.9 ± 0.64, p = 0.004; and 0.62 ± 0.25 vs 0.39 ± 0.09, p = 0.029, respectively), while there was no difference for SUVmean (2.7 ± 1.32 vs 2.1 ± 0.44, p = 0.39). Thus, with a SUV readout scale of 0–5 g/mL, normal PG appeared abnormally hot with dPET, but not with cPET. Phantom evidenced higher RCmean in dPET compared to cPET. For both 3x and 5x measurements, lesion detectability according to size was systematically superior with dPET. In conclusion, patients imaged with dPET presented higher 18F-FDG physiological uptake of the PG as compared to patients imaged with cPET. These findings were supported by phantom experiments demonstrating superior signal recovery and small region detectability with dPET. Awareness of this new “higher” SUV of the normal 18F-FDG uptake of the PG is important to avoid potential pitfalls in image interpretation, notably in oncologic patients treated with immunotherapy, who are at increased risk to develop hypophysitis.

Background: Diagnostic performance of positron emission tomography using white blood cells labeled with fluorine-18-fluorodeoxyglucose (18F-FDG-WBC PET or PET/CT) in patients with suspicious infectious diseases has been evaluated in several studies; however, there is no consensus about the diagnostic accuracy of this method. Therefore, a systematic review and meta-analysis was carried out on this topic. Methods: A comprehensive computer literature search screening PubMed/MEDLINE, Embase and Cochrane library databases through March 2019 was performed. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR−), and diagnostic odds ratio (DOR) of 18F-FDG-WBC PET or PET/CT in patients with infectious diseases were calculated. Results: Eight studies on the use of 18F-FDG-WBC PET or PET/CT in suspicious infectious diseases were discussed in the systematic review. The meta-analysis of seven studies (236 patients) provided these pooled results on a per patient-based analysis: sensitivity was 86.3% [95% confidence interval (95%CI) 75−92.9%], specificity 92% (95%CI 79.8−97.1%), LR+ 6.6 (95%CI: 3.1−14.1), LR− 0.2 (95%CI: 0.12−0.33), DOR 43.5 (95%CI: 12.2−155). A statistically significant heterogeneity was not detected. Conclusions: Despite limited literature data, 18F-FDG-WBC PET or PET/CT demonstrated a good diagnostic accuracy for the diagnosis of infectious diseases; nevertheless, larger studies are needed.

Background: Diagnostic performance of positron emission tomography using white blood cells labeled with fluorine-18-fluorodeoxyglucose (18F-FDG-WBC PET or PET/CT) in patients with suspicious infectious diseases has been evaluated in several studies; however, there is no consensus about the diagnostic accuracy of this method. Therefore, a systematic review and meta-analysis was carried out on this topic. Methods: A comprehensive computer literature search screening PubMed/MEDLINE, Embase and Cochrane library databases through March 2019 was performed. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR−), and diagnostic odds ratio (DOR) of 18F-FDG-WBC PET or PET/CT in patients with infectious diseases were calculated. Results: Eight studies on the use of 18F-FDG-WBC PET or PET/CT in suspicious infectious diseases were discussed in the systematic review. The meta-analysis of seven studies (236 patients) provided these pooled results on a per patient-based analysis: sensitivity was 86.3% [95% confidence interval (95%CI) 75–92.9%], specificity 92% (95%CI 79.8–97.1%), LR+ 6.6 (95%CI: 3.1–14.1), LR− 0.2 (95%CI: 0.12–0.33), DOR 43.5 (95%CI: 12.2–155). A statistically significant heterogeneity was not detected. Conclusions: Despite limited literature data, 18F-FDG-WBC PET or PET/CT demonstrated a good diagnostic accuracy for the diagnosis of infectious diseases; nevertheless, larger studies are needed.

This is the first described case of effective and durable cytoreduction after PRRT with 177Lu-DOTATATE in a 75-year-old female, with B cell chronic lymphoid leukemia, and well-differentiated metastatic neuroendocrine tumor.

This is the first described case of effective and durable cytoreduction after PRRT with

Different imaging methods have been used to detect hepatocellular carcinoma (HCC). As there are increasing literature data about the role of radiolabelled choline PET/CT in this setting, we aimed to perform an updated meta-analysis about the detection rate (DR) of this imaging method in HCC. A comprehensive computer literature search of studies published through December 2018 in PubMed/MEDLINE, Embase and Cochrane library databases regarding the DR of radiolabelled choline PET or PET/CT in patients with HCC was carried out. Pooled DR were calculated on a per patient- and on a per lesion-based analysis. Subgroup analyses taking into account the radiopharmaceutical used were performed. Nine studies (283 HCC patients) were included in the pooled analysis. The pooled DR of radiolabelled choline PET or PET/CT on a per patient- and on a per lesion-based analysis was 83% [95% confidence interval (95% CI) 75–89%] and 79% (95% CI 72–86%), respectively. A significant heterogeneity among the studies was found on a per lesion-based analysis only. No significant publication bias was found. The subgroup analysis demonstrated a trend towards a higher DR when using 18F-choline compared to 11C-choline, without a statistically significant difference. Pooled DR of HCC using dual-tracer PET/CT (radiolabelled choline and 18F-FDG) on a per patient- and a per lesion-based analysis was 91% (95% CI 87–95%) and 89% (95% CI 80–95%), respectively, without significant heterogeneity. Radiolabelled choline PET/CT demonstrated good ability in detecting HCC. The DR increased when dual-tracer PET/CT was performed. Large multicenter studies and cost-effectiveness analyses are warranted.

To generate a predictive whole-liver radiomics scoring system for progression-free survival (PFS) and overall survival (OS) in patients undergoing transarterial radioembolization using Yttrium-90 ( 90 Y-TARE) for unresectable hepatocellular carcinoma (uHCC). The generated pPET-RadScores were significantly correlated with survival for PFS (median of 11.4 mo [95% confidence interval CI: 6.3-16.5 mo] in low-risk group [PFS-pPET-RadScore < 0.09] vs. 4.0 mo [95% CI: 2.3-5.7 mo] in high-risk group [PFS-pPET-RadScore > 0.09]; P = 0.0004) and OS (median of 20.3 mo [95% CI: 5.7-35 mo] in low-risk group [OS-pPET-RadScore < 0.11] vs. 7.7 mo [95% CI: 6.0-9.5 mo] in high-risk group [OS-pPET-RadScore > 0.11]; P = 0.007). The multivariate analysis confirmed PFS-pPET-RadScore ( P = 0.006) and OS-pPET-RadScore ( P = 0.001) as independent negative predictors. Pretreatment 18 F-FDG PET whole-liver radiomics signature appears as an independent negative predictor for PFS and OS in patients undergoing 90 Y-TARE for uHCC. Pretreatment 18 F-FDG PET of 47 consecutive patients undergoing 90 Y-TARE for uHCC (31 resin spheres, 16 glass spheres) were retrospectively analyzed. For each patient, based on PET radiomics signature from whole-liver semi-automatic segmentation, PFS and OS predictive PET-radiomics scores (pPET-RadScores) were obtained using LASSO Cox regression. Using X-tile software, the optimal score to predict PFS (PFS-pPET-RadScore) and OS (OS-pPET-RadScore) served as cutoff to separate high and low-risk patients. Survival curves were estimated using the Kaplan-Meier method. The prognostic value of PFS and OS-pPET-RadScore, Barcelona-Clinic Liver Cancer staging system and serum alpha-fetoprotein level was analyzed to predict PFS and OS in multivariate analysis.