Annals of Nuclear Medicine (v.27, #10)

Usefulness of partial volume effect-corrected F-18 FDG PET/CT for predicting I-131 accumulation in the metastatic lymph nodes of patients with thyroid carcinoma by Yasuhiro Maruoka; Koichiro Abe; Shingo Baba; Takuro Isoda; Yoshiyuki Kitamura; Noriko Mizoguchi; Go Akamatsu; Masayuki Sasaki; Hiroshi Honda (873-879).
The purpose of this study was to evaluate the clinical usefulness of partial volume effect (PVE)-corrected F-18 FDG PET/CT for predicting I-131 accumulation in metastatic lymph nodes (mLNs) during I-131 therapy for papillary thyroid carcinoma (PTC).Sixty-five mLNs in 31 PTC patients who underwent F-18 FDG PET/CT in an initial radioiodine therapy (RIT) were retrospectively evaluated. Of these, 25 mLNs were I-131-positive and 40 were I-131-negative. SUVmax and SUVmax with PVE correction (cSUVmax) were measured for each mLN, where PVE correction was performed utilizing a simple table lookup correction method. Then, SUVmax/cSUVmax was compared between I-131-positive and I-131-negative mLNs, including the analyses for the mLNs with small-sized (<1 cm) and weak FDG accumulation (SUVmax <3.5). The predictability for I-131 accumulation with SUVmax/cSUVmax was also compared.For all 65 mLNs, SUVmax/cSUVmax was significantly higher in I-131-negative than I-131-positive mLNs (p < 0.0001). Only in cSUVmax, I-131-negative mLNs were significantly higher than I-131-positive, in terms of the 30 small-sized mLNs (p = 0.0001) and 14 mLNs with weak FDG uptake (p = 0.007). The highest accuracy in predictability for I-131 accumulation was significantly better with cSUVmax (92 %) than SUVmax (62 %) (p < 0.0001).PVE-corrected F-18 FDG PET/CT is a valuable predictor of I-131 accumulation in mLNs during RIT.
Keywords: Partial volume effect correction; F-18 FDG PET/CT; Thyroid carcinoma; Radioiodine therapy; I-131 accumulation

Limitation of 2-deoxy-2-[F-18]fluoro-d-glucose positron emission tomography (FDG-PET) to detect early synchronous primary cancers in patients with untreated head and neck squamous cell cancer by Atsushi Hanamoto; Yukinori Takenaka; Eku Shimosegawa; Yoshifumi Ymamamoto; Tadashi Yoshii; Susumu Nakahara; Jun Hatazawa; Hidenori Inohara (880-885).
Patients with head and neck squamous cell carcinoma (HNSCC) often develop synchronous multiple primary cancers. It is important to detect second primary cancer in HNSCC patients, because it influences treatment selection of primary cancer. The aim of this study was to evaluate the utility of 2-deoxy-2-[F-18]fluoro-d-glucose (FDG)-positron emission tomography (PET) for detecting synchronous primary cancers at the initial staging of patients with HNSCC.Three hundred and forty-seven patients with untreated HNSCC underwent FDG-PET with or without computed tomography fusion and other routine workups, including upper gastrointestinal Lugol chromoendoscopy, for the initial staging. We examined the prevalence of second primary cancer in these patients and the utility of PET.We identified 57 synchronous primary cancers in 53 patients, of which only 33 % were detected with PET. The most common site for the second primary cancer was the esophagus (49 %), followed by stomach (14 %) and head and neck (11 %). Most early-stage esophageal cancers and stomach cancers were detected using Lugol chromoendoscopy but not PET.Although PET is useful for detecting synchronous primary cancers, it is not a sensitive technique for detecting early esophageal cancers and gastric cancers. Therefore, Lugol chromoendoscopy is indispensable for detecting synchronous upper gastrointestinal cancers in HNSCC patients.
Keywords: FDG-PET; Head and neck cancer; Second primary cancer; Chromoendoscopy; Synchronous esophageal cancer; Synchronous gastric cancer

The effect of short-term vitamin E against radioiodine-induced early lacrimal gland damage by Ugur Acar; Hasan Ikbal Atilgan; Damla Erginturk Acar; Zuleyha Yalniz-Akkaya; Nihat Yumusak; Meliha Korkmaz; Gökhan Koca (886-891).
Radioiodine (RAI) is a well-known radionuclide which is used in vivo both for diagnostic and therapeutic purposes, particularly for the treatment of hyperthyroidism and thyroid cancer. Vitamin E is a well-known antioxidant vitamin. The aim of this study was to evaluate whether there was a protective effect of short-term vitamin E on RAI-induced lacrimal gland early damage in experimental animal models.Twentyfour rats were randomly divided into two groups. The first group (RAI group) was administreted 3 mCi 131I by gastric gavage and 1 mL physiological saline intraperitoneally. The second group (RAI + Vitamin E) was administrated 3 mCi 131I by gastric gavage and 1 mL vitamin E intraperitoneally. After 24 h of the last dose being administered on the 7th day, the animals were decapitated. The lacrimal glands [Intraorbital (IG), extraorbital (EG) and harderian glands (HG)] of the rats were removed for histopathological examination.Periductal and/or periacinar fibrosis in all lacrimal glands were observed to be statistically significantly less frequent in the RAI + Vitamin E group compared to the RAI group. The existence of the abnormal lobular pattern and peripheral basophilia and irregular nucleus shape in IG and in EG, the poorly defined acidophilic cell outline and periductal infiltration in IG and in HG were observed to be statistically significantly less frequent in the RAI + Vitamin E group than in the RAI group.According to study results, histopathological examinations revealed that vitamin E protects rat lacrimal glands against RAI-related early damage.
Keywords: Radioiodine; Radioprotection; Vitamin E; Lacrimal gland

ELR-containing peptides targeting CXCR2 could be the excellent candidate for targeting ligand of molecular tumor imaging. In this study, we had developed two ELR-containing 6-mer peptides and evaluated the diagnostic performance of Tc-99m labeled 6-mer peptides as a molecular imaging agent in murine models bearing KB epidermoid carcinoma.Peptides were synthesized using Fmoc solid phase peptide synthesis. Radiolabeling efficiency with Tc-99m was evaluated using instant thin-layer chromatography. In KB epidermoid cancer-bearing mice, gamma images had acquired and tumor-to-muscle uptake ratio was calculated. Competition and biodistribution studies had performed.Two 6-mer peptides, ELR-ECG and ECG-ELR were successfully synthesized. After radiolabeling procedures with Tc-99m, the complex Tc-99m ELR-ECG and Tc-99m ECG-ELR were prepared in high yield. In the gamma camera imaging of murine model, Tc-99m ELR-ECG was substantially accumulated in the subcutaneously engrafted tumor and tumor uptake had been suppressed by the free ELR co-injection. However, Tc-99m ECG-ELR was minimally accumulated in the tumor.Two ELR-containing 6-mer peptides, ELR-ECG and ECG-ELR, were developed as a molecular imaging agent to target CXCR2 of epidermoid carcinoma. Tc-99m ELR-ECG had showed significant uptake in tumor and it was good candidate for a tumor imaging.
Keywords: CXC chemokine; Glutamic acid-leucine-arginine; ELR; CXCR2; Tc-99m

Prediction of outcomes in MCI with 123I-IMP-CBF SPECT: a multicenter prospective cohort study by Kengo Ito; Etsuro Mori; Hidenao Fukuyama; Kazunari Ishii; Yukihiko Washimi; Takashi Asada; Satoru Mori; Kenichi Meguro; Shin Kitamura; Haruo Hanyu; Seigo Nakano; Hiroshi Matsuda; Yasuo Kuwabara; Kazuo Hashikawa; Toshimitsu Momose; Yoshitaka Uchida; Jun Hatazawa; Satoshi Minoshima; Kenji Kosaka; Tatsuo Yamada; Yoshiharu Yonekura (898-906).
The multicenter prospective cohort study (Japan Cooperative SPECT Study on Assessment of Mild Impairment of Cognitive Function: J-COSMIC) aimed to examine the value of 123I-N-isopropyl-4-iodoamphetamine cerebral blood flow (IMP-CBF) SPECT in regards to early diagnosis of Alzheimer’s disease (AD) in patients with mild cognitive impairment (MCI).Three hundred and nineteen patients with amnestic MCI at 41 participating institutions each underwent clinical and neuropsychological examinations and 123I-IMP-CBF SPECT at baseline. Subjects were followed up periodically for 3 years, and progression to dementia was evaluated. SPECT images were classified as AD/DLB (dementia with Lewy bodies) pattern and non-AD/DLB pattern by central image interpretation and automated region of interest (ROI) analysis, respectively. Logistic regression analyses were used to assess whether baseline 123I-IMP-CBF SPECT was predictive of longitudinal clinical outcome.Ninety-nine of 216 amnestic MCI patients (excluding 3 cases with epilepsy (n = 2) or hydrocephalus (n = 1) and 100 cases with incomplete follow-up) converted to AD within the observation period. Central image interpretation and automated ROI analysis predicted conversion to AD with 56 and 58 % overall diagnostic accuracy (sensitivity, 76 and 81 %; specificity, 39 and 37 %), respectively. Multivariate logistic regression analysis identified SPECT as a predictor, which distinguished AD converters from non-converters. The odds ratio for a positive SPECT to predict conversion to AD with automated ROI analysis was 2.5 and combining SPECT data with gender and mini-mental state examination (MMSE) further improved classification (joint odds ratio 20.08). 123I-IMP-CBF SPECT with both automated ROI analysis and central image interpretation was sensitive but relatively nonspecific for prediction of clinical outcome during the 3-year follow-up in individual amnestic MCI patients. A combination of statistically significant predictors, both SPECT with automated ROI analysis and neuropsychological evaluation, may increase predictive utility.
Keywords: Alzheimer’s disease; Mild cognitive impairment; SPECT; Cerebral blood flow; Prospective study

Integration of 2-deoxy-2-[18F] fluoro-d-glucose PET/CT into clinical management of patients with Wegener’s granulomatosis by Ozlem Ozmen; Ebru Tatci; Atila Gokcek; Deniz Koksal; Yeliz Dadali; Esra Ozaydin; Nuri Arslan (907-915).
Wegener’s granulomatosis (WG) is a rare disorder characterized by granulomatous necrotizing vasculitis which mainly affects small- and medium-sized vessels. While the classical triad of involvement is upper and lower respiratory system and glomerulonephritis, WG may involve any organ or system in the body. The aim of our study was to investigate the role of positron emission tomography/computerized tomography (PET/CT) both in the initial evaluation and follow-up of patients with WG.We retrospectively evaluated PET/CT data from 13 patients (6 males; 7 females) with a mean age of 45 ± 12.4 years (range 28–63) who underwent either initial evaluation (n = 12) or response evaluation (n = 2) by conventional imaging methods and FDG with PET/CT. PET/CT images were both visually and quantitatively evaluated. The demographic data, clinical and laboratory findings of each patient were also recorded from the hospital files.Lung (n = 13), parapharyngeal space (n = 8), nose (n = 8), and ear (n = 3) were the most common disease sites detected on PET/CT. The entire initial evaluation patients had either solitary or multiple pulmonary nodular/mass lesions with marked increased FDG uptake (mean SUVmax 12 ± 4, range 3.53–19.51) on PET/CT. There was no significant pathological FDG uptake in patients consistent with complete treatment response after appropriate immunosuppressive therapy. PET/CT clearly demonstrated unexpected disease sites besides the respiratory system, with WG involvement except kidneys. Possibly due to physiological urinary excretion of FDG, urine analysis, BUN and creatinine levels were accepted still the best way for diagnosis of renal involvement.FDG with PET/CT is a valuable tool in the management of patients with WG for a more accurate clinical evaluation regarding disease extension and treatment response.
Keywords: PET/CT; Wegener’s granulomatosis; Vasculitis

Clinical outcome prediction of percutaneous cementoplasty for metastatic bone tumor using 18F-FDG PET-CT by Yong-il Kim; Hyun Guy Kang; Seok-ki Kim; June Hyuk Kim; Han Soo Kim (916-923).
Percutaneous cementoplasty (PC) is used for metastatic bone tumor. Bone metastases patients who are unable to avail regular surgery, because of their poor general condition, undergo PC to gain mechanical stability and pain relief. We evaluated the effect of PC using 18F-FDG PET-CT and investigated the correlation and predictability between quantitative parameters of 18F-FDG PET-CT and pain status after PC.Subjects comprised 18 patients (total 32 sites) who had undergone PC for the metastatic bone tumors. Pain degree of the patients was obtained by visual analog scale (VAS) in the pre-PC, immediate post-PC, and follow-up post-PC state. As PET-CT parameters, maximum and mean standardized uptake value (MaxSUV and MeanSUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured. Receiver operator characteristic curve analysis was performed for pre-PC, post-PC PET-CT, and delta (Δ) values of PET-CT parameters to correlate and predict the good pain improvement (VAS pain ≤2) after the PC procedure.Patients’ pain status improved significantly in immediate post-PC and follow-up post-PC pain (all p < 0.001). Among PET-CT parameters, MaxSUV (p = 0.004) and MeanSUV (p = 0.007) showed significant interval decrease after PC procedure. All of the post-PC PET-CT and ΔPET-CT values showed significant prediction of pain improvement for follow-up post-PC pain, especially ΔTLG (AUC = 0.804, p = 0.0003) and ΔMTV (AUC = 0.804, p = 0.0004).There was significant reduction of patients’ pain after PC, and ΔTLG and ΔMTV of PET-CT parameters showed best predictability for follow-up post-PC pain improvement. PET-CT can be the useful parameter to predict treatment response of PC.
Keywords: Positron emission tomography; Percutaneous cementoplasty; Bone metastasis; Visual analog scale; Standardized uptake value; Total lesion glycolysis

Recovery coefficients determination for partial volume effect correction in oncological PET/CT images considering the effect of activity outside the field of view by Alexandre R. Krempser; Roberto M. Ichinose; Antonio M. F. L. Miranda de Sá; Silvia M. Velasques de Oliveira; Michel P. Carneiro (924-930).
The partial volume effect (PVE) has a great impact in quantitative PET/CT imaging. Correction methods have been recently proposed by many authors to make the image quantification more accurate. This work presents a methodology for determining the recovery coefficients (RCs) for PVE correction in PET/CT images. It was taken into account the radioactivity outside the field of view (FOV), which is expected in a patient image acquisition.The NEMA image quality phantom and the NEMA scatter phantom were used. The phantoms were filled with 18F-FDG for different sphere-to-background ratios. The RCs have been determined from image acquisitions in a Siemens Biograph 16 Hi-Rez PET/CT scanner with and without the scatter phantom.The RC values that ranged from 0.38 to 1.00 without the scatter phantom exhibited a wider variation when this latter was taken into account (from 0.27 to 1.02). This more realistic estimation must be considered if one takes into account that an incorrect SUV measure in tumors leads to errors in the evaluation of the response to therapy based on PET/CT images.The activity outside the FOV should be considered in RCs determination to improve the RC-based PVE correction method.
Keywords: PET/CT; Partial volume effect correction; Recovery coefficient; Activity quantification

Increased 18F-fluoroestradiol uptake in radiation pneumonia by Zhongyi Yang; Yifei Sun; Zhifeng Yao; Jing Xue; Yongping Zhang; Yingjian Zhang (931-934).
A 54-year-old metastatic breast cancer patient who had undergone chemotherapy and radiotherapy was transferred to our hospital for further treatment. We utilized 18F-fluoroestradiol (FES) to assess the estrogen receptor (ER) status of metastatic lesions. Interestingly, high accumulation of 18F-FES in pneumonia caused by radiation was detected. Hence, this draws oncologists’ attention to the possible false-positive result of 18F-FES, which may lead to inappropriate endocrine therapy.
Keywords: Breast cancer; 18F-FES PET; Radiation pneumonitis

Massive accumulation of 11C-Pittsburg compound B in the occipital lobes of a patient with early-onset dementia accompanied by muscle weakness and hypertonicity by Kimiteru Ito; Terunori Sano; Kouhei Kamiya; Yasuhiro Nakata; Yoko Shigemoto; Noriko Sato; Yasushi Oya; Hiroshi Matsuda (935-941).
A 44-year-old woman underwent 11C-Pittsburg compound B (11C-PiB), 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT), 99mTc-ethyl-cysteinate-dimer single photon emission computed tomography, and magnetic resonance imaging after presenting with progressive dementia, muscle weakness, and hypertonicity. Some of her family members had died of muscle weakness with early-onset dementia of unknown etiology. Neurological and psychological examinations revealed moderate dementia in general fields and muscle weakness in her upper limbs. 11C-PiB PET/CT revealed abnormal accumulations of amyloid in the bilateral occipital lobes, while physiological uptakes of 11C-PiB in areas that normally show high uptake, such as white matter, appeared relatively decreased. Meanwhile, cerebrospinal fluid (CSF) amyloid-β was decreased, and CSF total and phosphorylated tau proteins were increased. This case may be representative of a new category of amyloid deposition disease characterized by early-onset dementia, muscle weakness, and hypertonicity, or at least, a new uptake pattern of PiB in variant AD.
Keywords: Occipital lobe; 11C-PiB; 18F-FDG; Early-onset dementia; Muscle weakness

Radio-guided sentinel lymph node identification by lymphoscintigraphy fused with an anatomical vector profile: clinical applications by A. Niccoli Asabella; F. Antonica; M. A. Renna; D. Rubini; A. Notaristefano; A. Nicoletti; G. Rubini (942-950).
To develop a method to fuse lymphoscintigraphic images with an adaptable anatomical vector profile and to evaluate its role in the clinical practice.We used Adobe Illustrator CS6 to create different vector profiles, we fused those profiles, using Adobe Photoshop CS6, with lymphoscintigraphic images of the patient. We processed 197 lymphoscintigraphies performed in patients with cutaneous melanomas, breast cancer or delayed lymph drainage.Our models can be adapted to every patient attitude or position and contain different levels of anatomical details ranging from external body profiles to the internal anatomical structures like bones, muscles, vessels, and lymph nodes. If needed, more new anatomical details can be added and embedded in the profile without redrawing them, saving a lot of time. Details can also be easily hidden, allowing the physician to view only relevant information and structures. Fusion times are about 85 s. The diagnostic confidence of the observers increased significantly. The validation process showed a slight shift (mean 4.9 mm).We have created a new, practical, inexpensive digital technique based on commercial software for fusing lymphoscintigraphic images with built-in anatomical reference profiles. It is easily reproducible and does not alter the original scintigraphic image. Our method allows a more meaningful interpretation of lymphoscintigraphies, an easier recognition of the anatomical site and better lymph node dissection planning.
Keywords: Fusion; Vector; Planar; Scintigraphy; Clinical; Adaptable; Profile