European Association Of Nuclear Medicine Research Articles

SUV Harmonization Between Different Hybrid PET/CT Systems.

Current PET/CT lutetium oxyorthosilicate (LSO) or lutetium-yttrium oxyorthosilicate crystal scanners are equipped with sophisticated softwares including point-spread function (PSF) and time-of-flight (TOF) image reconstruction. These softwares are associated with increased SUVs compared with 3D-OSEM reconstructions associated with older BGO PET/CT scanners. The European Association of Nuclear Medicine (EANM) identified the problem of SUV harmonization since 2010 through the EANM Research Ltd European Association of Nuclear Medicine Research Ltd [EARL] FDG PET/CT accreditation program. This required processing 2 reconstructions, one optimized for maximum spatial lesion detection and one for harmonized quantitation. We investigated an alternative single reconstruction method for both qualitative and quantitative analysis optimized to maximize spatial lesion detectability, followed by an intrinsic postreconstruction algorithm for SUV harmonization. Phantom and "in vivo" patient data analysis were acquired and analyzed on (a) a Siemens Biograph mCT system with LSO crystals and PSF and TOF algorithms, and on (b) a General Electric Discovery STE system with BGO crystals, without PSF and TOF. A dedicated algorithm (EQ.filter) was tested to harmonize SUV between the 2 scanners compared with EANM/EARL specifications. NEMA IQ phantom and a Jaszczak cylindrical phantom equipped with small fillable spheres (lesion to background ratios of 8:1 and 4:1) were used. Phantom data were validated on 7 oncologic patients with 39 hyperactive lesions ranging from 3 mm to 26 mm. The main benefit of PSF + TOF LSO PET/CT systems was increased contrast for small active lesions. Recovery coefficients measured according to NEMA standards exceeded those obtained by 3D-OSEM reconstruction. SUVmax discrepancies between the 2 PET/CT systems were as high as 149%, dropping to below 10% when optimized by EQ.filter. A single reconstruction optimized by EQ.filter for maximum spatial lesion detectability is an easy and precise solution to harmonize SUVs between different PET/CT scanners, avoiding a second reconstruction with an additional smoothing filter as requested by EANM/EARL.

The SNMMI and EANM practice guideline for renal scintigraphy in adults.

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote the science, technology, and practical application of nuclear medicine. The European Association of Nuclear Medicine (EANM) is a professional nonprofit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. SNMMI and EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine. The SNMMI and EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary, or sooner, if indicated. Each practice guideline, representing a policy statement by the SNMMI/EANM, has undergone a thorough consensus process in which it has been subjected to extensive review. The SNMMI and EANM recognize that the safe and effective use of diagnostic nuclear medicine imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by entities not providing these services is not authorized.

Post-operative radioiodine therapy (RaIT) as adjuvant therapy in low–intermediate risk differentiated thyroid cancer

For many years, thyroid surgery and radioiodine therapy for thyroid remnant ablation (i.e. post-operative RaIT) have been the first-line therapeutic approaches in differentiated thyroid carcinoma (DTC). In the latest American Thyroid Association Guidelines (ATA), post-operative RaIT is not indicated in low-risk DTC, while no clear indication is postulated regarding low- to intermediate-risk patients, even if it is discouraged in most of them. The European Association of Nuclear Medicine did not endorse ATA guidelines since the role of nuclear medicine was marginalized in patients affected by low- or low- to intermediate-risk cancers. The present review evaluates the adjuvant role of post-operative RaIT in low and low- to intermediate-risk DTC patients. The terms radioiodine adjuvant therapy, radioiodine adjuvant treatment, thyroid remnant ablation, radioiodine thyroid remnant ablation, radioiodine therapy and radioiodine treatment were used to search MEDLINE for papers published from January 2008 to May 2018. Among 895 papers, we considered 8 in which patients underwent post-operative RaIT and the results of post-therapy whole body scans (pT-WBS) were reported. pT-WBS identified metastases in 282 out of 1622 patients (17.4%). All except 28 metastatic patients were affected by either low- or low- to intermediate-risk DTC. Metastases were confirmed by (targeted)-morphological and/or morphofunctional and/or morphometabolic studies in about 40% of patients. According to the presented data, slightly less than 20% of low- or low- to intermediate-risk DTC patients showed metastases at pT-WBS. Thus, in our opinion post-operative RaIT should be considered as an adjuvant therapy also in low and low- to intermediate-risk DTC patients.

I122] Quantitative molecular imaging: Can we trust the SUV?

Metabolic activity can be measured using FDG PET/CT. Quantification of FDG PET/CT studies is often based on so-called standardised uptake values (SUV). SUVs or other metabolic parameters, such as metabolic volume and total lesion glycolysis can be used for metabolic phenotyping of the tumor. These quantitative metrics are affected by various sources of bias [1] . Factor influencing tracer uptake can be described as technical, imaging physics related or biological uncertainties. Effects of the above mentioned factors on SUV should be mitigated and/or harmonized as much as possible [2] . Harmonization of PET/CT examinations aims at making SUV reads as exchangeable (comparable) and reproducible as possible by harmonizing imaging procedures, image quality and quantitation and harmonizing data analysis methods and interpretation. The main challenge of harmonisation arises from differences in PET/CT imaging procedures and in technology across multiple sites and users. To this end the European Association of Nuclear Medicine published FDG PET/CT imaging guidelines [2] and started a multicentre accreditation program. Moreover, continuous monitoring of the FDG PET/CT data quality is warranted [3] . In this lecture the principles of metabolic imaging with PET, the mechanism of FDG uptake, various factors affecting FDG PET/CT tracer uptake and its quantification by SUV will be discussed. Moreover, the need for validation of simplified uptake metrics, such as SUV, against full kinetic analysis and use of FDG PET as quantitative metabolic imaging biomarker will be addressed. Finally, it will be shown that by standardisation of imaging procedures and by ongoing quality control of the PET/CT systems, FDG uptake can be reliably quantified.

European Association of Nuclear Medicine and European Academy of Neurology recommendations for the use of brain 18 F-fluorodeoxyglucose positron emission tomography in neurodegenerative cognitive impairment and dementia: Delphi consensus.

Recommendations for using fluorodeoxyglucose positron emission tomography (FDG-PET) to support the diagnosis of dementing neurodegenerative disorders are sparse and poorly structured. Twenty-one questions on diagnostic issues and on semi-automated analysis to assist visual reading were defined. Literature was reviewed to assess study design, risk of bias, inconsistency, imprecision, indirectness and effect size. Critical outcomes were sensitivity, specificity, accuracy, positive/negative predictive value, area under the receiver operating characteristic curve, and positive/negative likelihood ratio of FDG-PET in detecting the target conditions. Using the Delphi method, an expert panel voted for/against the use of FDG-PET based on published evidence and expert opinion. Of the 1435 papers, 58 papers provided proper quantitative assessment of test performance. The panel agreed on recommending FDG-PET for 14 questions: diagnosing mild cognitive impairment due to Alzheimer's disease (AD), frontotemporal lobar degeneration (FTLD) or dementia with Lewy bodies (DLB); diagnosing atypical AD and pseudo-dementia; differentiating between AD and DLB, FTLD or vascular dementia, between DLB and FTLD, and between Parkinson's disease and progressive supranuclear palsy; suggesting underlying pathophysiology in corticobasal degeneration and progressive primary aphasia, and cortical dysfunction in Parkinson's disease; using semi-automated assessment to assist visual reading. Panellists did not support FDG-PET use for pre-clinical stages of neurodegenerative disorders, for amyotrophic lateral sclerosis and Huntington disease diagnoses, and for amyotrophic lateral sclerosis or Huntington-disease-related cognitive decline. Despite limited formal evidence, panellists deemed FDG-PET useful in the early and differential diagnosis of the main neurodegenerative disorders, and semi-automated assessment helpful to assist visual reading. These decisions are proposed as interim recommendations.

Current Status of Molecular Imaging in Infections.

There is an increased need to find non-invasive tools for early diagnosis and follow-up of infections. Nuclear medicine techniques may be used to diagnose, localize and evaluate the severity and the extent of infections before the occurrence of anatomical abnormalities. This review focuses on different approaches based on radiolabelled cells, peptides and antibodies or [18F]FDG to image infective diseases in agreement with what is being jointly evaluated by the European Association of Nuclear Medicine (EANM). This is particularly relevant, since the EANM has strated a wide program of collaboration with other European clinical societies to define common diagnostic flow-charts in many of these infective diseases. It emerges the role of radiolabelled WBC by SPECT/CT for prosthetic joint infections and of FDG by PET/CT for spondylodiscitis. Comparable values of accuracy have been described for WBC and FDG in the diagnosis of vascular fgraft infections, diabetic gfoot, endocarditis and peripheral bone osteomyelitis, with some exceptions.

Diagnostic utility of FDG-PET in the differential diagnosis between different forms of primary progressive aphasia

PurposeA joint effort of the European Association of Nuclear Medicine (EANM) and the European Academy of Neurology (EAN) aims at clinical guidance for the use of FDG-PET in neurodegenerative diseases. This paper addresses the diagnostic utility of FDG-PET over clinical/neuropsychological assessment in the differentiation of the three forms of primary progressive aphasia (PPA).MethodsSeven panelists were appointed by the EANM and EAN and a literature search was performed by using harmonized PICO (Population, Intervention, Comparison, Outcome) question keywords. The studies were screened for eligibility, and data extracted to assess their methodological quality. Critical outcomes were accuracy indices in differentiating different PPA clinical forms. Subsequently Delphi rounds were held with the extracted data and quality assessment to reach a consensus based on both literature and expert opinion.ResultsCritical outcomes for this PICO were available in four of the examined papers. The level of formal evidence supporting clinical utility of FDG-PET in differentiating among PPA variants was considered as poor. However, the consensual recommendation was defined on Delphi round I, with six out of seven panelists supporting clinical use.ConclusionsQuantitative evidence demonstrating utility or lack thereof is still missing. Panelists decided consistently to provide interim support for clinical use based on the fact that a typical atrophy or metabolic pattern is needed for PPA according to the diagnostic criteria, and the synaptic failure detected by FDG-PET is an earlier phenomenon than atrophy. Also, a normal FDG-PET points to a non-neurodegenerative cause.

Clinical utility of FDG-PET for the clinical diagnosis in MCI.

We aim to report the quality of accuracy studies investigating the utility of [18F]fluorodeoxyglucose (FDG)-PET in supporting the diagnosis of prodromal Alzheimer's Disease (AD), frontotemporal lobar degeneration (FTLD) and prodromal dementia with Lewy bodies (DLB) in mild cognitive impairment (MCI) subjects, and the corresponding recommendations made by a panel of experts. Seven panellist, four from the European Association of Nuclear Medicine, and three from the European Academy of Neurology, produced recommendations taking into consideration the incremental value of FDG-PET, as added on clinical-neuropsychological examination, to ascertain the aetiology of MCI (AD, FTLD or DLB). A literature search using harmonized population, intervention, comparison, and outcome (PICO) strings was performed, and an evidence assessment consistent with the European Federation of Neurological Societies guidance was provided. The consensual recommendation was achieved based on Delphi rounds. Fifty-four papers reported the comparison of interest. The selected papers allowed the identification of FDG patterns that characterized MCI due to AD, FTLD and DLB. While clinical outcome studies supporting the diagnosis of MCI due to AD showed varying accuracies (ranging from 58 to 100%) and varying areas under the receiver-operator characteristic curves (0.66 to 0.97), no respective data were identified for MCI due to FTLD or for MCI due to DLB. However, the high negative predictive value of FDG-PET and the existence of different disease-specific patterns of hypometabolism support the consensus recommendations for the clinical use of this imaging technique in MCI subjects. FDG-PET has clinical utility on a fair level of evidence in detecting MCI due to AD. Although promising also in detecting MCI due to FTLD and MCI due to DLB, more research is needed to ultimately judge the clinical utility of FDG-PET in these entities.

Will 68Ga PSMA-radioligands be the only choice for nuclear medicine in prostate cancer in the near future? A clinical update.

Prostate Cancer (PCa) represents the most common malignant tumor in men but according to the European Association of Urology (EAU) guidelines, a mass screening for PCa diagnosis should not be performed due to over-diagnosis and over-treatment related problems. An early clinical diagnosis is possible, mainly based on digital rectal examination and Prostatic Specific Agent (PSA) testing. However, the only mandatory test to define the presence of PCa is ultrasound guided-biopsy, obtained on multiple samples, which has also a high prognostic value. In this context, diagnostic imaging plays an important role as confirmed by EAU that in a 2016 update of their guidelines on PCa stated the importance of Positron Emission Tomography (PET) with 11C- or 18F-choline combined with computed tomography (CT) to identify local relapse, lymph node involvement and metastatic spread at all stages. Consequently, in 2017, the European Association of Nuclear Medicine (EANM) together with the Society of Nuclear Medicine and Molecular Imaging (SNMMI) published new guidelines for 68Ga-Prostate Specific Membrane Antigen (PSMA) PET/CT to help physicians in the recommendation, execution and interpretation of PET/CT scans in patients with PCa. Thus, the aim of this 'evidence paper' is to define the current diagnostic algorithm in PCa in order to increase the general level of confidence in approaching such a crucial topic.

Somatostatin receptor PET/CT (SSTR-PET/CT)

The present guideline is focused on quality assurance of somatostatin receptor PET/CT (SSTR-PET/CT) in oncology patients. The document has been developed by a multidisciplinary board of specialists providing consensus of definitions, prerequisites, methodology, operating procedures, assessment, and standardized reporting. In particular, imaging procedures for the two most commonly used radioligands of human SSTR, i. e. 68Ga-DOTATOC and 68Ga-DOTATATE are presented. Overall, SSTR-PET/CT requires close interdisciplinary communication and cooperation of referring and executing medical disciplines, taking into account existing guidelines and recommendations of the European and German medical societies, including the European Association of Nuclear Medicine (EANM), German Society for Endocrinology (DGE), German Society for Nuclear Medicine (DGN) and German Society for Radiology (DRG).

Will 68Ga PSMA-radioligands be the only choice for nuclear medicine in prostate cancer in the near future? A clinical update

Prostate Cancer (PCa) represents the most common malignant tumor in men but according to the European Association of Urology (EAU) guidelines, a mass screening for PCa diagnosis should not be performed due to over-diagnosis and over-treatment related problems. An early clinical diagnosis is possible, mainly based on digital rectal examination and Prostatic Specific Agent (PSA) testing. However, the only mandatory test to define the presence of PCa is ultrasound guided-biopsy, obtained on multiple samples, which has also a high prognostic value. In this context, diagnostic imaging plays an important role as confirmed by EAU that in a 2016 update of their guidelines on PCa stated the importance of Positron Emission Tomography (PET) with 11C- or 18F-choline combined with computed tomography (CT) to identify local relapse, lymph node involvement and metastatic spread at all stages. Consequently, in 2017, the European Association of Nuclear Medicine (EANM) together with the Society of Nuclear Medicine and Molecular Imaging (SNMMI) published new guidelines for 68Ga-Prostate Specific Membrane Antigen (PSMA) PET/CT to help physicians in the recommendation, execution and interpretation of PET/CT scans in patients with PCa. Thus, the aim of this “evidence paper” is to define the current diagnostic algorithm in PCa in order to increase the general level of confidence in approaching such a crucial topic.

31st Annual Meeting of the European Association of Nuclear Medicine. Düsseldorf, Germany - October 13-17, 2018

31st Annual Meeting of the European Association of Nuclear Medicine. Düsseldorf, Germany - October 13-17, 2018

Global Trends Survey for Targeted Radionuclide Therapy

Radionuclide therapy has been used to help manage a range of diseases and has a role of growing importance, with an increasing impact on clinical practice globally. A survey in the field of Radionuclide therapy was conducted by reviewing 4199 science abstracts of main conference (Japanese Society of Radiological Technology, Japanese Society of Nuclear Medicine, Japanese Society of Nuclear Medicine Technology, Society of Nuclear Medicine and Molecular Imaging, European Association of Nuclear Medicine) held in 2016. This survey consisted of research content, modality for evaluation, dosimetry, radionuclide, and researcher's country. There tend to be a lot of studies related to targeted radionuclide therapy more than Japan (4%) in the United States (11%) or Europe (13%). Radiopharmaceuticals still un-approving in Japan were used in some of these studies. And many studies on dosimetry using PET or SPECT imaging were confirmed in the United States (37%) or in Europe (25%) compared with in Japan (14%). This survey has clarified the current status of Japan and global trend in the field of radionuclide therapy.

Does PET Reconstruction Method Affect Deauville Score in Lymphoma Patients?

When evaluating 18F-FDG PET images with the Deauville score (DS), the quantification of tumor and reference organs limits the problem of optical misinterpretation. Compared with conventional reconstruction algorithms, point-spread function (PSF) modeling increases SUVs significantly in tumors but only moderately in the liver, which could affect the DS. We investigated whether the choice of the reconstruction algorithm affects the DS and whether discordance affects the capability of 18F-FDG PET to stratify lymphoma patients. Methods: Overall, 126 patients with diffuse large B-cell lymphoma were included (56 female and 70 male; median age, 65 y; range, 20-88 y). PET data were reconstructed with the unfiltered PSF method. Additionally, a 6-mm filter was applied to PSF images to meet the requirements of the EANM Research Ltd. (EARL) harmonization program from the European Association of Nuclear Medicine (EANM) (PSFEARL). One hundred interim PET (i-PET) and 95 end-of-treatment PET (EoT-PET) studies were analyzed. SUVmax in the liver and aorta was determined using automatic volumes of interest and compared with SUVmax in the residual mass with the highest 18F-FDG uptake. Results: For i-PET, using PSF and PSFEARL, we classified patients as responders and nonresponders in 60 and 40 cases versus 63 and 37 cases, respectively. Five cases of major discordance (5.0%) occurred (i.e., changes from responder to nonresponder). For Eot-PET, patients were classified using PSF and PSFEARL as responders and nonresponders in 69 and 26 cases versus 72 and 23 cases, respectively. Three cases of major discordance (3.2%) occurred. Concordance (Cohen unweighted κ) between the PSF and the PSFEARL DS was 0.82 (95% confidence interval, 0.73-0.91) for i-PET and 0.89 (95% confidence interval, 0.81-0.96) for EoT-PET. The median follow-up periods were 28.4 and 27.4 mo for i-PET and EoT-PET, respectively. Kaplan-Meier analysis showed statistically significant differences in progression-free survival and overall survival among responders and nonresponders no matter which reconstruction was used for i-PET and EoT-PET. Conclusion: Neither DS nor risk stratification of diffuse large B-cell lymphoma patients is affected by the choice of PET reconstruction. Specifically, the use of PSF is not an issue in routine clinical processes or in multicenter trials. These findings have to be confirmed in escalation and deescalation procedures based on early i-PET.

Dosimetry-based treatment planning for molecular radiotherapy: a summary of the 2017 report from the Internal Dosimetry Task Force

BackgroundThe European directive on basic safety standards (Council directive 2013/59 Euratom) mandates dosimetry-based treatment planning for radiopharmaceutical therapies. The directive comes into operation February 2018, and the aim of a report produced by the Internal Dosimetry Task Force of the European Association of Nuclear Medicine is to address this aspect of the directive. A summary of the report is presented.ResultsA brief review of five of the most common therapy procedures is included in the current text, focused on the potential to perform patient-specific dosimetry. In the full report, 11 different therapeutic procedures are included, allowing additional considerations of effectiveness, references to specific literature on quantitative imaging and dosimetry, and existing evidence for absorbed dose-effect correlations for each treatment. Individualized treatment planning with tracer diagnostics and verification of the absorbed doses delivered following therapy is found to be scientifically feasible for almost all procedures investigated, using quantitative imaging and/or external monitoring. Translation of this directive into clinical practice will have significant implications for resource requirements.ConclusionsMolecular radiotherapy is undergoing a significant expansion, and the groundwork for dosimetry-based treatment planning is already in place. The mandated individualization is likely to improve the effectiveness of the treatments, although must be adequately resourced.

Development and Validation of a High-Pressure Liquid Chromatography Method for the Determination of Chemical Purity and Radiochemical Purity of a [68Ga]-Labeled Glu-Urea-Lys(Ahx)-HBED-CC (Positron Emission Tomography) Tracer.

Background: Prostate-specific membrane antigen (PSMA) has gained high attention as a useful biomarker in the imaging evaluation of prostate cancer with positron emission tomography (PET) during recent years. [68Ga]-labeled Glu-urea-Lys(Ahx)-HBED-CC ([68Ga]-PSMA-HBED-CC) is a novel PSMA inhibitor radiotracer which has demonstrated its suitability in detecting prostate cancer. Preparation conditions may influence the quality and in vivo behavior of this tracer, and no standard procedure for the quality control (QC) is available. The aim of this study was to develop a new rapid and simple high-pressure liquid chromatography method of analysis for the routine QCs of [68Ga]-PSMA-HBED-CC to guarantee the high quality of the radiopharmaceutical product before release. Methods: A stepwise approach was used based on the quality by design concept of the International Conference of Harmonisation Q2 (R1) and Q8 (Pharmaceutical Development) guidelines in accordance with the regulations and requirements of European Association of Nuclear Medicine, Society of Nuclear Medicine, International Atomic Energy Agency, World Health Organization, and Italian Association of Nuclear Medicine and Molecular Imaging. The developed analytical test method was validated because a specific monograph in the pharmacopoeia is not available for [68Ga]-PSMA-HBED-CC. Results: The purity and quality of the radiopharmaceutical obtained according to the proposed method resulted high enough to safely administrate it to patients. An excellent linearity was found between 0.8 and 5 μg/mL, with a detection limit of 0.2 μg/mL. Assay imprecision (% CV) was <2%. Conclusions: The developed method to assess the radiochemical and chemical purity of [68Ga]-PSMA-HBED-CC is rapid, accurate, and reproducible, allowing routinely the use of this PET tracer as a diagnostic tool for imaging prostate cancer and also assuring patient safety.

Strategies for radiation dose reduction in nuclear cardiology and cardiac computed tomography imaging: a report from the European Association of Cardiovascular Imaging (EACVI), the Cardiovascular Committee of European Association of Nuclear Medicine (EANM), and the European Society of Cardiovascular Radiology (ESCR).

Strategies for radiation dose reduction in nuclear cardiology and cardiac computed tomography imaging: a report from the European Association of Cardiovascular Imaging (EACVI), the Cardiovascular Committee of European Association of Nuclear Medicine (EANM), and the European Society of Cardiovascular Radiology (ESCR).

Appropriate Use Criteria for Somatostatin Receptor PET Imaging in Neuroendocrine Tumors.

Somatostatin receptor positron emission tomography (SSTR-PET) is an imaging modality for patients with neuroendocrine tumors (NETs) that has demonstrated a significant improvement over conventional imaging (CI). SSTR-PET should replace In-111 pentetreotide scintigraphy (OctreoScan) in all indications in which SSTR scintigraphy is currently being used. These appropriate use criteria (AUC) are intended to aid referring medical practitioners in the appropriate use of SSTR-PET for imaging of patients with NETs, and the indications were evaluated in well-differentiated NETs. Of the 12 clinical scenarios evaluated, nine were graded as appropriate: initial staging after the histologic diagnosis of NET, evaluation of an unknown primary, evaluation of a mass suggestive of NET not amenable to endoscopic or percutaneous biopsy, staging of NET prior to planned surgery, monitoring of NET seen predominantly on SSTR-PET, evaluation of patients with biochemical evidence and symptoms of a NET, evaluation of patients with biochemical evidence of a NET without evidence on CI or a prior histologic diagnosis, restaging at time of clinical or laboratory progression without progression on CI, and new indeterminate lesion on CI with unclear progression. Representatives from the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the American College of Radiology (ACR), the American Society of Clinical Oncology (ASCO), the North American Neuroendocrine Tumor Society (NANETS), the European Association of Nuclear Medicine (EANM), the Endocrine Society, the Society of Surgical Oncology, the National Comprehensive Cancer Network (NCCN), the American College of Physicians (ACP), the American Gastroenterological Association (AGA), and the World Conference on Interventional Oncology (WCIO) assembled under the auspices of an autonomous workgroup to develop the following AUC.

A joint procedural position statement on imaging in cardiac sarcoidosis: from the Cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine, the European Association of Cardiovascular Imaging, and the American Society of Nuclear Cardiology.

This joint position paper illustrates the role and the correct use of echocardiography, radionuclide imaging with 18F-fluorodeoxyglucose positron emission tomography, radionuclide myocardial perfusion imaging and cardiovascular magnetic resonance imaging for the evaluation and management of patients with known or suspected cardiac sarcoidosis. This position paper will aid in standardizing imaging for cardiac sarcoidosis and may facilitate clinical trials and pooling of multi-centre data on cardiac sarcoidosis. Proposed flow charts for the work up and management of cardiac sarcoidosis are included.

Quality assessment of positron emission tomography scans: recommendations for future multicentre trials

Background: Standardization protocols and guidelines for positron emission tomography (PET) in multicenter trials are available, despite a large variability in image acquisition and reconstruction parameters exist. In this study, we investigated the compliance of PET scans to the guidelines of the European Association of Nuclear Medicine (EANM). From these results, we provide recommendations for future multicenter studies using PET.Material and methods: Patients included in a multicenter randomized phase II study had repeated PET scans for early response assessment. Relevant acquisition and reconstruction parameters were extracted from the digital imaging and communications in medicine (DICOM) header of the images. The PET image parameters were compared to the guidelines of the EANM for tumor imaging version 1.0 recommended parameters.Results: From the 223 included patients, 167 baseline scans and 118 response scans were available from 15 hospitals. Scans of 19% of the patients had an uptake time that fulfilled the Uniform Protocols for Imaging in Clinical Trials response assessment criteria. The average quality score over all hospitals was 69%. Scans with a non-compliant uptake time had a larger standard deviation of the mean standardized uptake value (SUVmean) of the liver than scans with compliant uptake times.Conclusions: Although a standardization protocol was agreed on, there was a large variability in imaging parameters. For future, multicenter studies including PET imaging a prospective central quality review during patient inclusion is needed to improve compliance with image standardization protocols as defined by EANM.