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Lung cancer is nowadays one of the most common malignancies and the leading cause of cancer mortality worldwide. Its early diagnosis and treatment is therefore the target of extensive research. Although radiologic imaging methods, especially CT, are the most widely used, they have well known constraints, including solitary pulmonary nodule characterisation, mediastinal lymph node staging, characterisation of the remaining tissue after chemo- or radiotherapy and early diagnosis of relapse. The main reason for these drawbacks is that radiologic methods primarily rely upon morphologic and anatomic criteria, which usually have little relevance to the biological status of a pulmonary lesion. The radiopharmaceuticals used in nuclear medicine, exploit special pathophysiologic localization mechanisms and provide unique functional information for their target tissues. Thus, many of the above mentioned problems can be elucidated. This is obvious in the published figures of sensitivity and specificity of the radionuclidic methods, which are often superior to those of CT [Table 1: see text]. In this article the main nuclear medicine procedures in the field of lung cancer imaging are reviewed. Emphasis is given in newer developments such as (99m)Tc-sestamibi, labeled somatostatin analogues and positron emission tomography with (18)F-FDG. We especially describe the "weaknesses" of the anatomic-radiologic imaging modalities and how the attending physicians, i.e. the pneumonologists, oncologists and thoracic surgeons can overcome them, by using the functional imaging methods of nuclear medicine.
Hell J Nucl Med
PMID:[Nuclear medicine procedures in lung cancer imaging]. 1584 Dec 89

In case new diagnostic procedures for Alzheimer's dementia (AD) appear, Nuclear Medicine (NM) would like to be aware of them in order to evaluate its own contribution to diagnose AD by SPET and PET brain studies. Recently, sleep disturbances were studied in AD and tend to be diagnostic for early AD. In AD the actual time of night sleep was found to be 5.7 h, while awakeness time for the same night sleep increased to 2.7 h. Also in AD, the REM and the slow wave stage (SWS) during sleep are shorter and hypopnea and apnea phases are abundant. Internal body temperature during night sleep is only slightly increased in AD, while in temporofrontal dementia and in normal individuals this increase is significant. The circadian rhythm of melatonin is disturbed in AD. The normal duration of inspiration and expiration during daytime which is reversed during normal night sleep, has not been studied in patients with AD. However, this reverse condition favoring inspiration is expected to provide more oxygen to the brain. Chronic but not acute stress causes memory loss and is currently being studied by us as a possible causative factor for memory loss in AD. Tomographic SPET and PET brain studies can locate the site of brain damage in AD. This is important since memory has recently been classified into four categories, namely episodic, semantic, procedural and working memory. In early AD only procedural memory remains intact. This means that these patients may drive a car, do computer word processing and play some games at home or/and in the field. This memory is located in specific nuclei in the cerebellum and the occipital frontal area which do not relate to sites of other kinds of memory. This difference could be well identified by tomographic SPET or PET studies. Thus NM may also diagnose the early stage of AD. Another issue refers to the indications that the unified Medicare and Medicaid system in the USA has issued on September 15, 2004 for performing a PET (18)F-FDG study for AD. These indications are fully described in this editorial.
Hell J Nucl Med
PMID:[Alzheimer's dementia, sleep disorders and nuclear medicine]. 1588 44

Infection imaging is a field of intense interest in medicine because, despite the great advances in our understanding of microorganisms and the development of new antimicrobial agents, infection remains a major cause of patient morbidity and mortality. Nuclear Medicine for many years has an important role in this field. The significance of this role varies in different clinical situations, in some cases being complementary to other imaging modalities as in postoperative patients, and in some cases being the method of choice as in orthopaedic infections after implants have been placed. Today there are many agents in Nuclear Medicine capable in imaging infection. Each of them has its own advantages and drawbacks. In recent years there is an increased research in the field with new methods tested. Among them are labelled antibacterial agents, labelled antimicrobial peptides, monoclonal antibodies for leukocyte labelling, labelled liposomes, and (18)F-FDG-PET. In this short article there is an effort to briefly review these agents and their possible role in infection imaging.
Hell J Nucl Med
PMID:[Current trends in infection imaging]. 1588 46

The incidence of congestive heart failure (CHF) has progressively increased over the last 25 years with coronary artery disease being the aetiology in 66% of patients with CHF. Assessment of myocardial perfusion and glucose uptake using PET imaging with 18F-FDG for metabolism and 13-N-ammonia or 82-rubidium for coronary flow has proven to be the gold standard for predicting the recovery of regional and global left ventricular (LV) function following revascularization. Patients with viable ischemic myocardium identified by a flow/metabolism mismatch, represent an especially high risk subgroup for hard coronary events within one year, in the absence of myocardial revascularization. The state of the art assessment of myocardial viability in the new millennium is an optimally glucose loaded PET myocardial perfusion/metabolic study. For patients with critically depressed LV function with LVEF <20% at rest assessment of contractile reserve, in addition to 18F-FDG-PET viability imaging, may help predict a favourable surgical outcome.
Hell J Nucl Med
PMID:PET imaging in cardiology. 1639 17

Positron emission tomography (PET) with the glucose analogue (18)F-FDG is increasingly used to monitor tumour response in patients undergoing chemotherapy, radiotherapy or new therapeutic schemes including antiangiogenesis and molecular targeted cancer treatment. PET as a functional imaging technology provides timely, quantitative, cross-sectional, non invasive assessment of several biologic processes targeted by the above-mentioned therapies. Tests by the camera PET can be useful in distinguishing between radiation necrosis or scarring and tumour recurrence, thus evaluating response to therapy. The information provided by this technique is more sensitive and specific than that provided by conventional anatomic imaging modalities such as computerised tomography, magnetic resonance imaging or ultrasound and superior in evaluating the effectiveness of various treatment regimens early during therapy or after the completion of therapy. With this information in hand, physicians can modify ineffective therapy and consequently improve patient's outcome and reduce the cost of treatment. In the present review article we discuss the contribution of tests performed by the PET camera, mainly using (18)F-FDG as a radiotracer, in the evaluation of treatment response in patients with brain tumours, lymphomas and breast cancer.
Hell J Nucl Med
PMID:[Positron emission tomography in evaluating the response to treatment of brain tumors, lymphomas and breast cancer]. 1689 21

Several mechanisms may influence the enhanced glucose uptake in cancer cells, including upregulation of glucose transporters, increase in the hexokinase activity and the protein kinase B, also called Akt, which appears to play key role in the control of glucose metabolism together with proteins which are involved in the signal cascade pathway, such as the mammalian target of rapamycin (mTOR). It has been demonstrated in patients with gastrointestinal stromal tumors (GIST) and other sarcomas who received treatment with imatinib that PET with 18F-FDG is appropriate for treatment monitoring. Data suggest that 18F-FDG monitoring may be used for monitoring not only imatinib but also other kinase inhibitors. A 36-year-old female patient with metastasized desmoplastic small round cells tumor after a broad surgical resection of the tumor area and due to related enzyme findings, was treated with the mTOR-inhibitor everolimus (Certican, Novartis, Basel, Switzerland) at an initial dose of 3 x 0.5 mg per day targeting at a blood level of >11 ng/ml. A baseline 18F-FDG-PET demonstrated an enhanced FDG uptake in three large liver metastases and in another metastatic lesion in the pelvic area. A dynamic 18F-FDG-PET study performed six weeks later, demonstrated non-response to the mTOR-inhibitor. Despite the antiproliferative activity of mTOR-inhibitors in experimental model systems, its antitumor activity in patients may be limited. In conclusion, 18F-FDG-PET seems to be a promising method for monitoring the therapeutic effect of mTOR-inhibitors.
Hell J Nucl Med
PMID:A recent application of fluoro-18-deoxyglucose positron emission tomography, treatment monitoring with a mammalian target of rapamycin inhibitor: an example of a patient with a desmoplastic small round cell tumor. 1768 80

The aim of our study was to analyze how many oncology patients might benefit from a) integrated positron emission tomography - multidetector computed tomography (PET/MDCT) and additionally b) clinically relevant information provided by either the CT scan or PET scan. A total of 285 consecutive patients 164 male and 121 female, age range 17-84 years, 153 lung cancer, 112 lymphoma, 20 miscellaneous, referred for PET and separate CT scan, were included. The CT scan was performed after the intravenous injection of a soluble contrast media. Patients were retrospectively classified into six Groups: Group I: No pathological uptake on the PET scan, Group II: Suspected lesions were correctly identified by the PET scan alone, Group III: Side-by-side evaluation of PET and CT appeared sufficient to assess the localization of lesions, Group IV: Side-by-side reading was not sufficient and integrated PET/CT was considered beneficial. Additionally all patients with a CT scan with additional clinical relevant information (not visualized by the PET scan) were classified in Group V. Group VI was set for lesions detected by PET alone (not visualized by the CT scan). The CT scan was used as the gold standard to confirm or disprove PET lesion localization. Our results showed: A number of 77 patients, (Group I: 77/285, 27%) had no pathologic fluorine-18-fluorodeoxyglucose (18F-FDG)-uptake. Lesions were correctly localized by either conventional PET alone (Group II: 76/285, 27%) or side-by-side evaluation of PET and CT scans (Group III: 44/285, 15%). Integrated PET/CT or software fusion, was considered beneficial in 31% (88/285) of the patients with pathological 18F-FDG-uptake (Group IV). Additionally to the above, in 15% of all patients clinically relevant information, referring to disseminated small pulmonary lesions, abdominal aortic aneurysms >5 cm, thrombi or pulmonary emboli, was also provided by the CT scan (Group V). Also, in 7% of all patients, unsuspected pathological lesions, mainly bone metastases, were correctly detected by PET alone (Group VI). In conclusion, in 54% of all oncologic patients, PET alone was diagnostic. In 46% of all patients side-by-side reading (15%) or integrated PET/CT images (31%) were considered beneficial for more accurate anatomical localization of the lesions. Additionally, the CT scan added clinically relevant information in 15% of all patients and the PET scan showed unsuspected metastases in 7% of all studied patients. Therefore, integrated reading of PET and MDCT images by nuclear physicians and radiologists may gain quality in the staging of oncology patients.
Hell J Nucl Med
PMID:Diagnostic evaluation of separately acquired PET and CT images by nuclear medicine physicians and radiologists in cancer patients. 1768 86

In patients with penile cancer, positron emission tomography (PET) is important for identifying metastatic lesions and for therapeutic strategy planning. By using PET/computerised tomography -CT scanning, more precise localization and attenuation correction is provided by CT as an additional advantage for diagnosis. A 78-year-old man with squamous cell cancer of the glans penis diagnosed after histopathological examination was referred to our Nuclear Medicine Department PET/CT unit by the Urology Department of our Hospital, for investigation of metastases and for therapeutic strategy planning. There was significantly increased focal fluoro-18 fluorodeoxyglucose (18F-FDG) activity (SUV: 18.2) in the glans penile area and slightly increased activity in the right inguinal region which was described as inflammation by the histopathological examination. There was no other increased abnormal 18F-FDG activity. 18F-FDG PET or PET/CT may be used in squamous cell cancer of the penis for the detection of metastases and for therapeutic strategy planning. Finally, invasive procedures such as total bilateral inguinal lymphadenectomy, having a high morbidity, may be avoided.
Hell J Nucl Med
PMID:Fluoro-18 fluorodeoxyglucose positron emission tomography/computerized tomography scans in a patient with penile cancer for appropriate therapeutic strategy. 1768 88

We report a case of a multicentric form of Castleman's disease (CD). A thoracic computerized tomography (CT) scan showed multiple mediastinal and bilateral axillary lymph nodes. Fluoro-18 fluoro deoxyglucose ((18)F-FDG) positron emission tomography-PET/CT scan demonstrated increased (18)F-FDG accumulation in multiple lymphatic regions and in bilateral pleural areas. The histopathological sampling of an excised left axillary lymph node revealed a multicentric form of CD, of an intermediate (mixed) cell type. The disease, its differential diagnosis and the diagnostic contribution of nuclear medicine imaging, are described.
Hell J Nucl Med
PMID:PET/CT findings in a multicentric form of Castleman's disease. 1808 59

PET and PET/CT are the procedures of choice for molecular imaging in the head and neck area. The current data of the literature show, that functional imaging with fluorine-18-deoxyglucose ((18)F-FDG) provides the possibility to obtain information about the viability of malignant lesions. The use of hybrid systems, PET/CT, enables physicians to assess both, morphology and function, and achieve a high diagnostic accuracy exceeding 90%. PET with (18)F-FDG is the most sensitive method to detect tumor recurrence. However, false positive results must be considered due to unspecific changes following treatment, especially radiotherapy. The use of quantitative PET scans as well as the application of a second tracer, enhance the capability of PET to assess questionable masses more accurately. Follow up examinations with PET and (18)F-FDG provide data about early changes in the tumor metabolism due to chemotherapeutic treatment. Studies in patients undergoing surgery and radiotherapy demonstrated, that PET with (18)F-FDG can be used for the prediction of individual survival.
Hell J Nucl Med
PMID:The role of PET in head and neck cancer. 1839 19


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