Nuclear cardiology - Current status of the clinical application.

Guidance and Best Practices for Nuclear Cardiology Laboratories During the COVID-19 Pandemic: An Information Statement From ASNC and SNMMI.

Positron Emission Tomography—the Promise of Metabolic Imaging

The prognostic value of positron emission tomography in the evaluation of suspected cardiac sarcoidosis

The value and appropriateness of positron emission tomography: An evolving tale

The joint position paper of the working community "Cardiovascular Nuclear Medicine" of the German Society of Nuclear Medicine (DGN) and the working group "Nuclear Cardiology Diagnostics" of the German Cardiac Society (DKG) updates the former 2009 paper. It is the purpose of this paper to provide an overview about the application fields, the state-of-the-art and the current value of nuclear cardiology imaging. The topics covered are chronic coronary artery disease, including viability imaging, furthermore cardiomyopathies, infective endocarditis, cardiac sarcoidosis and amyloidosis.

The Alzheimer's Association and the Society of Nuclear Medicine and Molecular Imaging convened a multidisciplinary workgroup to update appropriate use criteria (AUC) for amyloid positron emission tomography (PET) and to develop AUC for tau PET. The workgroup identified key research questions that guided a systematic literature review on clinical amyloid/tau PET. Building on this review, the workgroup developed 17 clinical scenarios in which amyloid or tau PET may be considered. A modified Delphi approach was used to rate each scenario by consensus as "rarely appropriate," "uncertain," or "appropriate." Ratings were performed separately for amyloid and tau PET as stand-alone modalities. For amyloid PET, seven scenarios were rated as appropriate, two as uncertain, and eight as rarely appropriate. For tau PET, five scenarios were rated as appropriate, six as uncertain, and six as rarely appropriate. AUC for amyloid and tau PET provide expert recommendations for clinical use of these technologies in the evolving landscape of diagnostics and therapeutics for Alzheimer's disease. A multidisciplinary workgroup convened by the Alzheimer's Association and the Society of Nuclear Medicine and Molecular Imaging updated the appropriate use criteria (AUC) for amyloid positron emission tomography (PET) and to develop AUC for tau PET. The goal of these updated AUC is to assist clinicians in identifying clinical scenarios in which amyloid or tau PET may be useful for guiding the diagnosis and management of patients who have, or are at risk for, cognitive decline These updated AUC are intended for dementia specialists who spend a significant proportion of their clinical effort caring for patients with cognitive complaints, as well as serve as a general reference for a broader audience interested in implementation of amyloid and tau PET in clinical practice.

The American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice Guidelines regularly reviews existing guidelines to determine when an update or full revision is needed. Guidelines for the Clinical Use of Cardiac Radionuclide Imaging were originally published in 1986

Message from the New Editor-in-Chief.

Occult Malignancy in Patients With Suspected Paraneoplastic Neurologic Syndromes: Value of Positron Emission Tomography in Diagnosis

4055 Background: The value of PET after definitive chemoradiotherapy is still unclear. We hypothesized that the post-treatment pSUV and the percentage decrease SUV from baseline (dSUV) would correlate with patient outcome. Methods: We performed retrospective study, selecting patients with advanced E-GEC who had pre- and post-treatment PET, endoscopic ultrasonography (EUS) and were treated with definitive chemoradiation at MD Anderson Cancer Center between 2002 to early 2008. Correlations were performed between clinical variables, pSUV, and dSUV. Results: We analyzed 209 consecutive E-GEC patients treated with definitive chemoradiation for outcome; of these 180 had baseline PET and 161 had post-treatment PET performed 5 to 6 weeks after the completion of definitive chemoradiotherapy for additional analyses. The median OS and relapse free survival (RFS) for all patients was 20.7 months (95% CI; 18.8 to 26.3) and 11.2 months (95% CI; 9.44 to 14.34). Patients with clinical complete response (cCR, 68.9%) which assessed by EUS, PET and clinical parameters lived longer than those not achieving a cCR (P < 0.001). The median pSUV and dSUV were 4.3 (range, 0 to 19.9) and 76.85% (range -177 to 100), respectively. In the univariate analysis, continuous pSUV and dichotomized pSUV cut off by median were associated with OS (Cox model, P = 0.01; log-rank test, P = 0.01) and RFS (Cox model P=0.0004, log-rank test, P = 0.0004). In the multivariate model, continuous pSUV was an independent prognosticator of OS (p = 0.003) and RFS (p < 0.001). dSUV were not associated with OS (P = 0.096) and RFS (P = 0.082) in the univariate analysis. Conclusions: The higher SUV after chemoradiotherapy, the poorer are OS and RFS of gastroesophageal cancer patients treated with definitive chemoradiotherapy. Post chemoradiation PET may become useful in guiding individualized therapy.

Pitfalls in lymph node staging with positron emission tomography in non-small cell lung cancer patients

The value of positron emission tomography (PET) and magnetic resonance imaging (MRI) in cardiac diseases has been affirmed by the corresponding guidelines of the European Society of Cardiology (ESC). Hybrid PET/MR combines the functional imaging data from PET with those from multiple MRI sequences, the use of which is recommended by clinical consensus in assessing myocardial viability, cardiac masses, cardiac sarcoidosis (CS), myocarditis, and cardiac amyloidosis (CA). This review summarizes recent applications of PET/MR cardiac imaging in coronary heart disease (CHD), cardiomyopathies, cardiac masses, valvular heart disease (VHD) and endocarditis, with an emphasis on CHD and cardiomyopathies. In CHD, PET/MR enables the assessment of high-risk plaques, myocardial perfusion imaging, myocardial viability imaging, and myocardial fibroblast activation imaging. In cardiomyopathies, the applications of PET/MR focus on four specific types of disorders: CA, CS, Anderson-Fabry disease, and myocarditis. In summary, PET/MR can acquire qualitative and quantitative information through a single scan, reflecting multiple dimensions of cardiac status, including morphology, function, perfusion, inflammation, edema, calcification, and fibrosis, thereby facilitating diagnosis and assessment of various cardiac diseases.

Patients with papillary thyroid carcinoma (PTC) may suffer recurrence despite thyroidectomy and complete radioiodine (RAI) ablation. Reoperation is vitally dependent on accurate and complete disease localization, typically utilizing cervical ultrasonography (US) and/or computed tomography. Our aim was to determine the comparative value of F18-fluorodeoxyglucose positron emission tomography (PET) to US for localization of locoregional recurrence in patients who underwent reoperation for recurrent PTC. From 1999 to 2004, 30 patients who underwent re-exploration and 100 nonoperated patients who were investigated with PET for possible recurrent PTC were reviewed. The surgical group [9 males, 21 females; mean age=50 years (range=18-84 years)] all had received RAI ablation. Preoperative thyroid-stimulating hormone (TSH), thyroglobulin (Tg), and location of metastasis were recorded for each imaging study and surgical exploration. All separate sites that contained disease pathologically must have been identified by imaging for a patient to be considered true positive (TP). PET scans were TP in 43%, false positive in 7%, false negative (FN) in 50%, and had a sensitivity of 46%. Comparable US results were 86%, 10%, 3%, and 96%. Of the 15 patients with FN PET scans, 13 had lymph node metastasis less than 2 cm in diameter, 11 had Tg<or=10 microg/L, and the TSH<20 in 13. In only 3 of the 30 (10%) patients was PET deemed to add value. At least with suppressed TSH, PET scanning in reoperative PTC patients appears to offer modest benefit beyond high-resolution US.

Cardiac Sarcoidosis: There Is No Instant Replay

Oesophageal cancer is a disease with a dismal prognosis and high mortality. There were an estimated 482,000 new cases and 407,000 patients died of the disease worldwide in 2008 [1]. Concurrent chemotherapy and radiotherapy is now considered the neoadjuvant treatment of choice in patients with operable oesophageal cancer, as has been demonstrated by the Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS) trial [2]. However, not all patients benefit from this treatment. In the CROSS trial, as much as 39 % of patients had no histopathological tumour regression (tumour regression defined as <10 % viable tumour cells in the resected specimen). Yet, toxicity due to chemotherapy occurs in 11–90 % and there is also a risk of radiation-induced complications [2, 3]. In patients who respond insufficiently, inefficient chemoradiotherapy should be discontinued, and surgery should not be delayed. On the other hand, patients who respond favourably may benefit from additional preoperative treatment and surgery may be delayed or even refrained from. Therefore, there is a need for a method which can differentiate responders from nonresponders early in the course of neoadjuvant treatment. In clinical practice, integrated F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) already has a well-established role in the diagnosis and staging of oesophageal cancer [4]. The change in F-FDG uptake at PET performed before and after the start of neoadjuvant therapy may be used to predict which tumours respond to treatment. To date, there are only a few published prospective studies investigating the value of F-FDG PET in early prediction of tumour response to neoadjuvant therapy in oesophageal cancer. Two subsequent studies in independent study populations by researchers from Munich demonstrated that early metabolic tumour response, as measured by F-FDG PET, is correlated to histopathological response and better overall survival (OS) [5, 6]. However, these studies [5, 6] were performed in patients who only received neoadjuvant chemotherapy, whereas concurrent chemoradiotherapy is now considered the standard neoadjuvant treatment [2]. Increased F-FDG uptake caused by radiation-induced inflammation may limit the use of FFDG PET, because F-FDG PET is unable to distinguish whether tracer uptake is associated with inflammatory cells or residual viable tumour cells [7, 8]. To our knowledge, there are only three published prospective studies [7–9] in which the predictive value of early interim F-FDG PET in patients who received concurrent neoadjuvant chemoradiotherapy has been investigated. These studies all demonstrated an association between a decrease in tumour standardized uptake value (SUV) 14 days after start of neoadjuvant treatment and histopathological tumour response [7–9]. The study by Wieder et al. [7], in 38 patients with squamous cell carcinoma, also found an association between metabolic tumour response and OS. In contrast, the study by Malik et al. [8], in 37 patients with adenocarcinoma, did not find a significant association. The study by Cuenca et al. [10] in the present issue of the European Journal of Nuclear Medicine and Molecular Imaging adds further evidence that early interim F-FDG PET may be used to predict tumour response to chemoradiotherapy. Cuenca et al. [10] retrospectively analysed 59 patients with locally advanced oesophageal cancer (T3/T4, N1 M1a) who underwent an integrated F-FDG PET/CT scan before and 5 weeks after the beginning of chemotherapy This commentary refers to an article that can be found at doi 10.1007/ s00134-012-2325-3.