MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Seminars in Nuclear Medicine' source. Thu, 09 Feb 2012 03:37:53 +0100 http://www.medworm.com/index.php?rid=5652096&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811001541%2Fabstract%3Frss%3Dyes The gold standard technique for measuring gastric emptying is scintigraphy using radiolabeled test meals. Recently, a standardized radiolabeled solid meal has been proposed and adopted by many centers. There is still a need for alternative meals, and several such meals with demonstrated radiolabel stability have been evaluated in small numbers of subjects. Updated radiation dosimetry associated with these meals has been calculated for adult males and adult females with normal gastrointestinal transit as well as transit abnormalities. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5652096 Fri, 03 Feb 2012 08:29:31 +0100 5652096 http://www.medworm.com/index.php?rid=5652095&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811001383%2Fabstract%3Frss%3Dyes This article reviews current knowledge on liver function studies and focuses on those nuclear medicine tests available to study the whole liver and regional liver function. The clinical application driving these tests, prediction of remnant liver function after partial hepatectomy for primary liver malignancy or metastatic disease, is addressed here in detail. The test was recently validated for this specific application and was shown to be better than the current standard of practice (computed tomography volumetry), particularly in patients with hepatic comorbidities like cirrhosis, steatosis, or cholestasis. Furthermore, early assessment of regional liver function increase after preoperative portal vein embolization becomes possible with this technology. The limiting factor to a wider ac... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5652095 Fri, 03 Feb 2012 08:29:31 +0100 5652095 http://www.medworm.com/index.php?rid=5652094&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811001516%2Fabstract%3Frss%3Dyes Transit assessment of the small intestine and colon is relevant in the study of physiology, pathophysiology, and pharmacodynamics, and there is increasing use of small-bowel and colonic transit measurements in clinical practice as well. The main methods that are applied in clinical practice are substrate-hydrogen breath tests for small-bowel transit and radiopaque markers for colonic transit. Over the past 2-3 decades, scintigraphy has become the preferred standard in research studies, particularly for studies of pathophysiology and pharmacodynamics. New approaches include experimental stable isotope measurement of orocecal transit and the recently approved method using a wireless motility capsule that is validated as an accurate measurement of small-bowel and colonic transit. (Source: Sem... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5652094 Fri, 03 Feb 2012 08:29:31 +0100 5652094 http://www.medworm.com/index.php?rid=5652093&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS000129981100136X%2Fabstract%3Frss%3Dyes For many years, gastric emptying (GE) studies were performed using various local protocols and different radiolabeled meals. This lack of standardization and normal values made the test results unreliable and difficult to compare from one site to another. A recent consensus has been published that now provides guidance and standardization on how to perform a radiolabeled solid-meal GE study. It is widely recognized, however, that simple measurement of total GE of a solid meal often does not provide an answer to the etiology of symptoms for a large number of patients who present with functional dyspepsia. Advances in our understanding of the different roles of the fundus and antrum and their complex interaction with the proximal small bowel and central nervous system have led to the develop... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5652093 Fri, 03 Feb 2012 08:29:31 +0100 5652093 http://www.medworm.com/index.php?rid=5652092&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811001528%2Fabstract%3Frss%3Dyes Hepatobiliary scintigraphy is a mature imaging technique for evaluation of patients with acute cholecystitis (AC). It is effective in calculous and acalculous forms of AC. The test is used in contemporary medical practice as the arbiter when the findings from screening abdominal ultrasound do not fit a clinical picture. It is also performed in severely ill patients who have AC suspected on other testing, but whose frail condition and high operative risk demand the highest level of certainty. This review, therefore, examines all technique variations of hepatobiliary scintigraphy, offering an approach that may best fit a variety of clinical situations and philosophies on AC. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5652092 Fri, 03 Feb 2012 08:29:31 +0100 5652092 http://www.medworm.com/index.php?rid=5652091&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811001371%2Fabstract%3Frss%3Dyes Sincalide cholescintigraphy was first reported to have clinical utility in 1980. Since then, many publications have found that a reduced gallbladder ejection fraction (GBEF) can confirm the clinical diagnosis of acalculous chronic gallbladder disease and predict symptomatic relief with cholecystectomy. However, some publications had not found the test clinically predictive. Many different sincalide infusion methods and normal values have been used. It had been suspected that the different infusion methods and normal values might account for the variability in reported utility. Furthermore, clinical review articles have raised questions about the evidence-based quality of the published data on the diagnostic utility of sincalide cholescintigraphy. A recently published multicenter trial has ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5652091 Fri, 03 Feb 2012 08:29:31 +0100 5652091 http://www.medworm.com/index.php?rid=5652090&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS000129981100153X%2Fabstract%3Frss%3Dyes This article discusses a physician's perspective on evaluating GI transit in patients with suspected GI disorders, particularly those involving the stomach for gastroparesis and the colon in patients with constipation. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5652090 Fri, 03 Feb 2012 08:29:31 +0100 5652090 http://www.medworm.com/index.php?rid=5652089&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811001553%2Fabstract%3Frss%3Dyes In my last guest editorial on gastrointestinal (GI) nuclear medicine in the Seminars in Nuclear Medicine in October 1995, I pointed out that there are few, if any, other nuclear medicine studies, such as gastric emptying, that are considered a gold standard with which other methods need to be compared. I stressed, however, that there was the need for continued efforts within the nuclear medicine community to prevent tarnishing this gold standard. Since then, we have made significant progress especially in standardizing gastric emptying. Additional progress, however, still needs to be made to prevent new imaging and nonimaging technologies from replacing scintigraphy as the primary modality for assessing gastric emptying. In this edition of Seminars, I have brought together several leaders ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5652089 Fri, 03 Feb 2012 08:29:31 +0100 5652089 http://www.medworm.com/index.php?rid=5652088&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811001644%2Fabstract%3Frss%3Dyes As pointed out by Dr. Alan Maurer in his guest editorial, it has been more than 15 years since he guest edited another Seminars issue, a two-part review of gastrointestinal (GI) nuclear imaging. A significant portion of the progress that has been made relates to attempted standardization of several of these studies. In particular, cooperative efforts between GI, radiology, and nuclear medicine societies have resulted in standardized methodology for gastric emptying studies. Whereas, half-time of emptying (T1/2) was previously considered the accepted key value or “gold standard,” current thoughts center more on the retention values at specific time intervals; particularly four hours post-ingestion of a labeled solid egg meal. Additionally, several alternative test meals yielding similar... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5652088 Fri, 03 Feb 2012 08:29:31 +0100 5652088 http://www.medworm.com/index.php?rid=5444183&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811001036%2Fabstract%3Frss%3Dyes Fusion of tomographic radionuclide studies with anatomical examinations has become standard practice in positron emission tomography (PET) and single photon emission computed tomography (SPECT) imaging. Nonetheless, fusion of planar scintigraphic images with an anatomical modality remains distinctly uncommon, although methods to do so have appeared sporadically in the literature during the past 2 decades. In this article we review several techniques that have been used to combine planar scintigraphic images with radiographs and visual (photographic) images. Rigid or affine transformations have been performed to co-register the planar images with each other using custom, commercial, or public domain software. Display of the hybrid images has been achieved primarily with nonselective color-f... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5444183 Fri, 25 Nov 2011 20:44:57 +0100 5444183 http://www.medworm.com/index.php?rid=5444182&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS000129981100095X%2Fabstract%3Frss%3Dyes The thyroid gland was one of the first organs imaged in nuclear medicine, beginning in the 1940s. Thyroid scintigraphy is based on a specific phase or prelude to thyroid hormone synthesis, namely trapping of iodide or iodide analogues (ie, Tc99m pertechnetate), and in the case of radioactive iodine, eventual incorporation into thyroid hormone synthesis within the thyroid follicle. Moreover, thyroid scintigraphy is a reflection of the functional state of the gland, as well as the physiological state of any structure (ie, nodule) within the gland. Scintigraphy, therefore, provides information that anatomical imaging (ie, ultrasound, computed tomography [CT], magnetic resonance imaging) lacks. Thyroid scintigraphy plays an essential role in the management of patients with benign or malignant ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5444182 Fri, 25 Nov 2011 20:44:57 +0100 5444182 http://www.medworm.com/index.php?rid=5444181&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001637%2Fabstract%3Frss%3Dyes This Guidance Document for structured reporting of diuresis renography in adults was developed by the International Scientific Committee of Radionuclides in Nephro-urology (ISCORN; http://www.iscorn.org). ISCORN chose diuresis renography for its first structured report Guidance Document because suspected obstruction is the most common reason for referral, most radionuclide renal studies are conducted at institutions that perform fewer than 3 studies per week, and a large percentage of studies are interpreted by physicians with limited training in nuclear medicine. Ten panelists were asked to categorize specific reporting elements as essential, recommended, optional (without sufficient data to support a higher ranking), and unnecessary (does not contribute to scan interpretation or quality ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5444181 Fri, 25 Nov 2011 20:44:57 +0100 5444181 http://www.medworm.com/index.php?rid=5444180&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000973%2Fabstract%3Frss%3Dyes In the last 30 years, nuclear medicine has paralleled other imaging fields with the development of 3-dimensional techniques, including single-photon emission computed tomography and positron emission tomography. However, conventional nuclear medicine planar scintigraphy remains a common procedure at most imaging centers. Gastrointestinal studies constitute a significant portion of these planar procedures. The most common gastrointestinal studies, including hepatobiliary, gastric emptying, and gastrointestinal bleeding evaluations, resemble their original protocol. However, serial improvements have optimized the diagnostic efficacy of these procedures. Conventional Technetium-99m sulfur colloid liver/spleen imaging and hepatic blood pool imaging with labeled red blood cells now mainly serve... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5444180 Fri, 25 Nov 2011 20:44:57 +0100 5444180 http://www.medworm.com/index.php?rid=5444179&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000985%2Fabstract%3Frss%3Dyes The concept of brain death has gained importance in the past few decades to prevent futile attempts to sustain ventilation and blood circulation when the brain has lost all function and to procure beneficial tissues or life-saving organs for transplantation. However, differences remain among professional societies and various study group recommendations, as well as among individual legal statutes, in how brain death is defined and the methodology for which the diagnosis is attained. Furthermore, reports have appeared both in the medical literature and the lay press concerning quality assurance measures in brain death documentation. Scintigraphy is a commonly used technique in the evaluation of brain death and can be performed with the use of either nonspecific tracers, such as Tc99m diethy... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5444179 Fri, 25 Nov 2011 20:44:57 +0100 5444179 http://www.medworm.com/index.php?rid=5444178&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000961%2Fabstract%3Frss%3Dyes Bone imaging continues to be the second greatest-volume nuclear imaging procedure, offering the advantage of total body examination, low cost, and high sensitivity. Its power rests in the physiological uptake and pathophysiologic behavior of 99m technetium (99m-Tc) diphosphonates. The diagnostic utility, sensitivity, specificity, and predictive value of 99m-Tc bone imaging for benign conditions and tumors was established when only planar imaging was available. Currently, nearly all bone scans are performed as a planar study (whole-body, 3-phase, or regional), with the radiologist often adding single-photon emission computed tomography (SPECT) imaging. Here we review many current indications for planar bone imaging, highlighting indications in which the planar data are often diagnostically ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5444178 Fri, 25 Nov 2011 20:44:57 +0100 5444178 http://www.medworm.com/index.php?rid=5444177&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000948%2Fabstract%3Frss%3Dyes Single-photon emission computed tomography (SPECT) has been a significant advancement in scintigraphy, impacting many areas of diagnosis. It has begun to find use in ventilation-perfusion (V/Q) scintigraphy. However, its utility has been limited in the United States because of a lack of an optimal and Food and Drug Administration-approved SPECT ventilatory agent. Although SPECT V/Q can show more and smaller mismatches than planar studies, there is persistent debate regarding the clinical significance of these smaller pulmonary emboli (PE); they may be neither clinically significant nor require treatment. Available data suggest that planar V/Q, SPECT V/Q, and computed tomographic pulmonary angiography (CTPA) have similar false-negative rates and thus have a similar impact on outcomes. In mo... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5444177 Fri, 25 Nov 2011 20:44:57 +0100 5444177 http://www.medworm.com/index.php?rid=5444176&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811001255%2Fabstract%3Frss%3Dyes We live in an age of high technology with incredible advances almost every day. The computer and the smart phone have become essentials of daily life. Very few people hold on to these devices for more than a few years, replacing them with rapidly advancing new technology. In many ways this has been true of nuclear medicine. The introduction of single-photon emission computed tomography (SPECT) has led to its wide acceptance. Most general diagnostic imaging procedures are done now with SPECT imaging devices. More recently, the addition of computed tomography (CT) to SPECT provides the capability of performing attenuation correction using the CT part of the device, and fusion imaging for the increased specificity and correlative benefits that they offer. Does this technological advance mean ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5444176 Fri, 25 Nov 2011 20:44:57 +0100 5444176 http://www.medworm.com/index.php?rid=5288907&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS000129981100119X%2Fabstract%3Frss%3Dyes (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5288907 Thu, 06 Oct 2011 20:05:49 +0100 5288907 http://www.medworm.com/index.php?rid=5288906&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811001188%2Fabstract%3Frss%3Dyes (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5288906 Thu, 06 Oct 2011 20:05:49 +0100 5288906 http://www.medworm.com/index.php?rid=5288905&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000730%2Fabstract%3Frss%3Dyes The process of image review and interpretation has become increasingly complex and challenging for today's nuclear medicine physician from many perspectives, especially with regard to workstation integration and reading room ergonomics. With the recent proliferation of hybrid imaging systems, this complexity has increased rapidly, along with the number of studies performed. At the same time, clinicians throughout the health care enterprise are expecting remote access to nuclear medicine images whereas nuclear medicine physicians require reliable access at the point of care to the electronic medical record and to medical images from radiology and cardiology. The authors discuss the background and challenges related to integration of nuclear medicine into the health care enterprise and provi... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5288905 Thu, 06 Oct 2011 20:05:49 +0100 5288905 http://www.medworm.com/index.php?rid=5288904&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000742%2Fabstract%3Frss%3Dyes Computer-aided diagnosis (CAD) is rapidly entering the radiology mainstream. It has already become a part of the routine clinical work for the detection of breast cancer with mammograms. The computer output is used as a “second opinion” in assisting radiologists' image interpretations. The computer algorithm generally consists of several steps that may include image processing, image feature analysis, and data classification via the use of tools such as artificial neural networks (ANN). In this article, we will explore these and other current processes that have come to be referred to as “artificial intelligence.” One element of CAD, temporal subtraction, has been applied for enhancing interval changes and for suppressing unchanged structures (eg, normal structures) between 2 succe... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5288904 Thu, 06 Oct 2011 20:05:49 +0100 5288904 http://www.medworm.com/index.php?rid=5288903&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000912%2Fabstract%3Frss%3Dyes This article is a conjoint effort of 3 groups that have joined together to review results from work that they and others have performed. The techniques we review include (1) substitution of lesions into a preexisting image matrix (either using actual prior patient-derived lesions or mathematically modeled artificial lesions), (2) addition of images (either in the attenuation-corrected image space or at an earlier stage before image reconstruction), and (3) simulation of the entire patient image. A judicious combination of the techniques discussed in this review may represent the most efficient pathway of simulating statistically varied but realistic appearing lesions. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5288903 Thu, 06 Oct 2011 20:05:49 +0100 5288903 http://www.medworm.com/index.php?rid=5288902&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000894%2Fabstract%3Frss%3Dyes Most academic radiologists will be familiar with receiver operating characteristic (ROC) studies. Fundamental studies of human observer performance are now usually performed by forced-choice methods. Both methods are based on signal detection theory. The ROC method gives an operating curve of true-positive versus false-positive probabilities. The area under the curve, AZ, can be used a summary performance measure. In the forced-choice method, observers are given 2 or more images with one containing the signal. The observer's task is to select the option most likely to contain the signal. The percentage of correct responses, PC, is a summary performance measure. Precise comparison of the 2 methods is limited to very controlled experiments in which signals (simulated lesions for example) are... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5288902 Thu, 06 Oct 2011 20:05:49 +0100 5288902 http://www.medworm.com/index.php?rid=5288901&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000924%2Fabstract%3Frss%3Dyes A common task in medical imaging is assessing whether a new imaging system, or a variant of an existing one, is an improvement over an existing imaging technology. Imaging systems are generally quite complex, consisting of several components—for example, image acquisition hardware, image processing and display hardware and software, and image interpretation by radiologists- each of which can affect performance. Although it may appear odd to include the radiologist as a “component” of the imaging chain, because the radiologist's decision determines subsequent patient care, the effect of the human interpretation has to be included. Physical measurements such as modulation transfer function, signal-to-noise ratio, are useful for characterizing the nonhuman parts of the imaging chain und... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5288901 Thu, 06 Oct 2011 20:05:49 +0100 5288901 http://www.medworm.com/index.php?rid=5288900&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000687%2Fabstract%3Frss%3Dyes The accurate and efficient interpretation of medical images relies on a host of factors. Clearly the technologies and methods used to acquire, process, transmit, store, and display the image and associated data are critical, but they are only one-half of the equation. In the end, the final diagnostic interpretation and recommendations for further action lie with the clinician. Ideally we would like to believe that all decisions rendered by competent clinicians are correct, but the interpretation task is not always easy or black and white. Thus, decisions are not always absolutely conclusive, are often formulated with plausible alternatives, and errors in interpretation can and do occur regularly. The discipline of medical image perception seeks an improved understanding of the perceptual f... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5288900 Thu, 06 Oct 2011 20:05:49 +0100 5288900 http://www.medworm.com/index.php?rid=5288899&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000900%2Fabstract%3Frss%3Dyes Perception is the element of the diagnostic process that we are most likely to ignore. Indeed, by its very nature, deficiency of perception is imperceptible. It is also culturally difficult for a trained professional to admit that he or she is consistently and predictably fallible. Only through rigorous and systematic inquiry can shortcomings in perception be appreciated and strategies to improve accuracy devised. There are many aspects to perception, and they interface with clinical imaging in a myriad of ways. We have endeavored to include major topics, especially those that relate to nuclear medicine, in this issue of Seminars. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5288899 Thu, 06 Oct 2011 20:05:49 +0100 5288899 http://www.medworm.com/index.php?rid=5288898&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000936%2Fabstract%3Frss%3Dyes In this issue of Seminars in Nuclear Medicine, we depart from our usual path of discussing clinical applications and methodology and, instead, delve into the fascinating area of perception and how it relates to our image interpretation. Perception may be defined in several ways. In humans, it describes the process whereby sensory stimulation is translated into organized experience. That experience or percept is the joint product of the stimulation and of the process itself. Another way of stating the definition is to call it the process by which an organism detects and interprets information from the external world by means of the sensory receptors. As pointed out by Dr. Lionel Zuckier in his following guest editorial, there are many aspects to perception as they interface with clinical im... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5288898 Thu, 06 Oct 2011 20:05:49 +0100 5288898 http://www.medworm.com/index.php?rid=5082761&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000432%2Fabstract%3Frss%3Dyes Cardiac autonomic innervation plays a key role in maintaining hemodynamic and electrophysiologic harmony. Cardiac sympathetic function is adversely altered in many disease states, such as congestive heart failure, myocardial ischemia, and diabetes. 123I-mIBG, a sympathetic neurotransmitter radionuclide analog, aids in the detection of sympathetic innervation abnormalities and can be imaged with planar and single-photon emission computed tomographic techniques. Cardiac 123I-mIBG uptake can be assessed by the heart mediastinal ratio (H/M), tracer washout rate, and focal uptake defects. These parameters have been widely studied and shown to correlate strongly and independently with congestive heart failure progression, cardiac arrhythmias, cardiac death, and all-cause mortality. There is accu... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5082761 Mon, 01 Aug 2011 22:44:07 +0100 5082761 http://www.medworm.com/index.php?rid=5082760&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000705%2Fabstract%3Frss%3Dyes Targeted systemic radiotherapy constitutes the systemic administration of a radioactive agent that targets a molecule expressed preferentially on cancer cells. The archetypal such therapy is 131-iodine (131I) therapy for differentiated thyroid cancers. Radiotherapy typically delivers a calculated radiation-absorbed dose to tumor that takes into account (contiguous) normal tissue. Systemic radiotherapy development currently uses schema more analogous to chemotherapy—a radioactivity estimate that does not cause any irreversible toxicity. Historically, arbitrary amounts of radioactivity shown to be effective, on the basis of retrospective review, were used for thyroid cancer therapy with 131I as well as for neuroendocrine tumor therapy with 131I-labeled meta-iodo-benzylguanidine (MIBG). The... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5082760 Mon, 01 Aug 2011 22:44:07 +0100 5082760 http://www.medworm.com/index.php?rid=5082759&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000407%2Fabstract%3Frss%3Dyes Despite early reports of excellent diagnostic characteristics of [131I]/[123I]-metaiodobenzylguanidine (MIBG) in the evaluation of pheochromocytomas/paragangliomas (PHEOs/PGLs) or medullary thyroid cancer as experience with it was accumulated, the sensitivity dropped. Nevertheless, this modality is still useful in the diagnostic work-up of PHEOs/PGLs because it is widely available, and in case of positive scans it might indicate patients who are potential candidates for [131I]MIBG therapy. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5082759 Mon, 01 Aug 2011 22:44:07 +0100 5082759 http://www.medworm.com/index.php?rid=5082758&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000717%2Fabstract%3Frss%3Dyes Patients with high-risk neuroblastoma have a poor prognosis, especially in cases of recurrent or relapsed disease. Iodine-131–labeled meta-iodobenzylguanidine (131I-MIBG) can be an effective and relatively well-tolerated agent for the treatment of refractory neuroblastoma. Establishing an MIBG therapy program requires a great deal of planning, availability of hospital resources, and the commitment of individuals with training and expertise in multiple disciplines. Providing 131I-MIBG therapy requires physical facilities and procedures that permit patient care in compliance with the standards for occupational and community exposure to radiation. Establishment of a successful 131I-MIBG therapy program also requires a detailed operational plan and appropriate education for caregivers, paren... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5082758 Mon, 01 Aug 2011 22:44:07 +0100 5082758 http://www.medworm.com/index.php?rid=5082757&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000547%2Fabstract%3Frss%3Dyes Neuroblastoma is the most common pediatric extracranial soft-tissue tumor, accounting for approximately 8% of childhood malignancies. Its prognosis is widely variable, ranging from spontaneous regression to fatal disease despite multimodality therapy. Multiple imaging and clinical tests are needed to accurately assess patient risk with risk groups based on disease stage, patient age, and biological tumor factors. Approximately 60% of patients with neuroblastoma have metastatic disease, most commonly involving bone marrow or cortical bone. Metaiodobenzylguanidine (mIBG) scintigraphy plays an important role in the assessment of neuroblastoma, allowing whole-body disease assessment. mIBG is used to define extent of disease at diagnosis, assess disease response during therapy, and detect resid... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5082757 Mon, 01 Aug 2011 22:44:06 +0100 5082757 http://www.medworm.com/index.php?rid=5082756&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000419%2Fabstract%3Frss%3Dyes By virtue of its high affinity for the norepinephrine transporter (NET), [131I]metaiodobenzylguanidine ([131I]MIBG) has been used for the therapy of tumors of neuroectodermal origin for more than 25 years. Although not yet universally adopted, [131I]MIBG targeted radiotherapy remains a highly promising means of management of neuroblastoma, pheochromocytoma, and carcinoids. Appreciation of the mode of conveyance of [131I]MIBG into malignant cells and of factors that influence the activity of the uptake mechanism has indicated a variety of means of increasing the effectiveness of this type of treatment. Studies in model systems revealed that radiolabeling of MIBG to high specific activity reduced the amount of cold competitor, thereby increasing tumor dose and minimizing pressor effects. Inc... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5082756 Mon, 01 Aug 2011 22:44:06 +0100 5082756 http://www.medworm.com/index.php?rid=5082755&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000699%2Fabstract%3Frss%3Dyes As an analogue of adrenergic neurotransmitter norepinephrine (NE), metaiodobenzylguanidine (MIBG) demonstrates high uptake both in normal sympathetically innervated tissues, such as the heart and salivary glands, and in tumors that express the NE transporter (NET), specifically those of neural crest and neuroendocrine origin. In 1994, 131I-MIBG, also known as iobenguane I-131 intravenous, received Food and Drug Administration (FDA) approval as an imaging agent. In 2008, 123I-MIBG was also approved by FDA as a tumor imaging agent. Commercial formulations of radioiodinated MIBG are prepared on the basis of radioiodide exchange reaction with unlabeled MIBG as a precursor and contain large mass amounts of unlabeled MIBG, or “cold carrier,” molecules. Because the cold MIBG molecules competi... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5082755 Mon, 01 Aug 2011 22:44:05 +0100 5082755 http://www.medworm.com/index.php?rid=5082754&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000729%2Fabstract%3Frss%3Dyes A single radiopharmaceutical reaches a point periodically where its clinical applications are important enough to justify a full issue of Seminars. This is the case for the current issue, which is devoted to radioiodinated meta-iodobenzylguanidine (MIBG). Uptake of MIBG is high both in normal tissue that is rich in sympathetic innervation (heart and salivary glands), and in abnormal tissues (neuroendocrine tumors associated with expression of neurohormone transporters). Two decades elapsed since its initial development by Dr. Donald Wieland in Ann Arbor, Michigan, before its FDA approval in 1994. It was originally approved for use with an iodine-131 label for the study of pheochromocytoma in adults and neuroblastoma in children. More recently in 2008 the I-123 label for MIBG was approved a... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=5082754 Mon, 01 Aug 2011 22:44:05 +0100 5082754 http://www.medworm.com/index.php?rid=4880123&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000304%2Fabstract%3Frss%3Dyes In this review we give an overview of current knowledge of 68Ga-labeled pharmaceuticals, with focus on imaging receptor-mediated processes. A major advantage of a 68Ge/68Ga generator is its continuous source of 68Ga, independently from an on-site cyclotron. The increase in knowledge of purification and concentration of the eluate and the complex ligand chemistry has led to 68Ga-labeled pharmaceuticals with major clinical impact. 68Ga-labeled pharmaceuticals have the potential to cover all today's clinical options with 99mTc, with the concordant higher resolution of positron emission tomography (PET) in comparison with single photon emission computed tomography. 68Ga-labeled analogs of octreotide, such as DOTATOC, DOTANOC, and DOTA-TATE, are in clinical application in nuclear medicine, and ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4880123 Tue, 31 May 2011 17:46:44 +0100 4880123 http://www.medworm.com/index.php?rid=4880122&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS000129981100033X%2Fabstract%3Frss%3Dyes Myocardial perfusion imaging (MPI) with thallium 201 (201Tl) or 99mTc based imaging agents has become a major tool for noninvasive identification of coronary artery disease (CAD). However, single photon emission computed tomography (SPECT) imaging with the current agents is vulnerable to artifacts associated with soft tissue attenuation, proximal gastrointestinal activity, image quality, and suboptimal sensitivity and is limited by the degree of first-pass myocardial extraction. The development of 18F-based flurpiridaz F-18 takes advantage of positron emission tomography (PET) to overcome many of the imaging issues and structural design to achieve an ideal MPI agent profile. Flurpiridaz F-18 was designed to bind to mitochondrial complex I with high affinity and demonstrates high heart upta... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4880122 Tue, 31 May 2011 17:46:44 +0100 4880122 http://www.medworm.com/index.php?rid=4880121&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000353%2Fabstract%3Frss%3Dyes Florbetapir F-18 is a molecular imaging agent combining high affinity for β-amyloid, pharmacokinetic properties that allow positron emission tomography (PET) imaging within a convenient time after dose administration, and the wide availability of the radionuclide fluorine-18. Florbetapir F-18 is prepared by nucleophilic radiofluorination in approximately 60 minutes with a decay-corrected yield of 20%-40% and with a specific activity typically exceeding 100 Ci/mmol. The florbetapir F-18 dissociation constant (Kd) for binding to β-amyloid in brain tissue from Alzheimer's disease (AD) patients was 3.7 ± 0.3 nmol/L, and the maximum binding capacity (Bmax) was 8800 ± 1600 fmol/mg protein. Autoradiography studies have shown that florbetapir F-18 selectively binds to β-amyloid aggregates in ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4880121 Tue, 31 May 2011 17:46:44 +0100 4880121 http://www.medworm.com/index.php?rid=4880120&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000341%2Fabstract%3Frss%3Dyes This article provides a brief review of the amyloid biology and chemistry of Aβ-specific 11C and 18F-PET radiopharmaceuticals. Clinical trials have clearly documented that PET radiopharmaceuticals capable of assessing Aβ content in vivo in the brains of AD subjects and subjects with mild cognitive impairment will be important as diagnostic agents to detect in vivo amyloid brain pathology. In addition, PET amyloid imaging will also help test the amyloid cascade hypothesis of AD and as an aid to assess the efficacy of antiamyloid therapeutics currently under development in clinical trials. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4880120 Tue, 31 May 2011 17:46:44 +0100 4880120 http://www.medworm.com/index.php?rid=4880119&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000316%2Fabstract%3Frss%3Dyes Although 18F-fluorodeoxyglucose (18F-FDG) is still the most widely used positron emission tomography (PET) radiotracer, there are a few well-known limitations to its use. The last decade has seen the development of new PET probes for in vivo visualization of specific molecular targets, along with important technical advances in the production of positron-emitting radionuclides and their related labeling methods. As such, a broad range of new PET tracers are in preclinical development or have recently entered clinical trials. The topics covered in this review include labeling methods, biological targets, and the most recent preclinical or clinical data of some of the next generation of PET radiopharmaceuticals. This review, which is by no means exhaustive, has been separated into sections r... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4880119 Tue, 31 May 2011 17:46:43 +0100 4880119 http://www.medworm.com/index.php?rid=4880118&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000328%2Fabstract%3Frss%3Dyes Positron emission tomography (PET)/computed tomography (CT) is a rapidly expanding imaging modality, thanks to the availability of compact medical cyclotrons and automated chemistry synthesis modules for the production of PET radiopharmaceuticals. Despite the availability of many radiotracers, [18F]fluorodeoxyglucose (FDG) is currently the most widely used radiopharmaceutical in PET, and the field of molecular imaging is anxiously awaiting the introduction of new PET radiopharmaceuticals for routine clinical use. During the last five years, several proprietary PET radiopharmaceuticals have been developed by major companies, and these new agents are in different stages of clinical evaluation. These new PET drugs are designed for imaging brain beta amyloid, myocardial perfusion, amino acid t... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4880118 Tue, 31 May 2011 17:46:43 +0100 4880118 http://www.medworm.com/index.php?rid=4880117&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000390%2Fabstract%3Frss%3Dyes Despite the availability of hundreds of positron-emission tomography (PET) radiotracers and successful documentation of their clinical usefulness, [18F]fluorodeoxyglucose (FDG) is currently the most widely used radiopharmaceutical. The field of molecular imaging is anxiously awaiting the introduction of new-generation of PET radiopharmaceuticals for routine clinical use. The editors of Seminars in Nuclear Medicine have wisely chosen the most appropriate time to dedicate this July issue to provide a broad overview of new PET radiopharmaceuticals. It has been a privilege and an honor to be a guest editor for this special volume and assemble 6 major manuscripts from senior investigators in academic research as well as in pharmaceutical industry. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4880117 Tue, 31 May 2011 17:46:43 +0100 4880117 http://www.medworm.com/index.php?rid=4880116&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299811000420%2Fabstract%3Frss%3Dyes The Editors are greatly indebted to Dr. Shankar Vallabhajosula for his work as the Guest Editor of this issue of the Seminars in Nuclear Medicine. Dr. Vallabhajosula has a special relationship with the Editors and the Department of Nuclear Medicine at the Albert Einstein College of Medicine. His first published article originated from the laboratory of Dr. Lakshman Chervu, who was the Director of the Radiochemistry Laboratory in Nuclear Medicine at the Albert Einstein College of Medicine from 1971 to 1988. Even at this stage in his career, Shankar was already a valuable and productive contributor to the field of nuclear medicine. This early article was a report entitled “Quality Control of Technetium Labelled Lung Imaging Agents,” which he coauthored with Dr. Chervu and one of us (Dr. ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4880116 Tue, 31 May 2011 17:46:43 +0100 4880116 http://www.medworm.com/index.php?rid=4647934&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001625%2Fabstract%3Frss%3Dyes Conventional mammography is a screening procedure constrained by low specificity in the detection of breast cancer. Approximately 40% of women undergoing mammography screening have dense breast tissue, and conventional mammographic imaging has a sensitivity range of only 50%-85% for malignant lesions. Magnetic resonance imaging (MRI) is now recommended for breast cancer screening in high-risk patients. However, approximately 15% of patients cannot tolerate MRI. These are the clinical situations in which positron emission mammography (PEM) and breast-specific gamma (BSG) camera systems fulfill a need for primary breast cancer imaging. Because breast cancer is the most common malignancy and the second most common cause of cancer death among women, many nuclear medicine imaging techniques are... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4647934 Tue, 29 Mar 2011 22:22:04 +0100 4647934 http://www.medworm.com/index.php?rid=4647933&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001595%2Fabstract%3Frss%3Dyes Conventional radiographic methods allow physicians to visualize bone structure. However, they do not offer information on the bone mineral density (BMD), which can facilitate early diagnosis and treatment of osteoporosis. Bone densitometry, by contrast, helps to detect bone mineral loss at an early stage because it provides accurate quantitative measurement of BMD. With an emphasis on quantification, shorter scanning time and precision, scientists have been developing BMD measurement devices that use absorption technique. They first developed single-energy absorptiometry (single-photon absorptiometry) by using I-125, which could measure BMD of peripheral bones. Single-photon absorptiometry was replaced by dual-energy absorptiometry (dual photon absorptiometry [DPA]) that used gadolinium-15... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4647933 Tue, 29 Mar 2011 22:22:04 +0100 4647933 http://www.medworm.com/index.php?rid=4647932&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001583%2Fabstract%3Frss%3Dyes Computed tomography (CT) and static magnetic resonance imaging (MRI) are now the most common imaging modalities used for anatomic evaluation of pathologic processes affecting the brain. By contrast, radionuclide-based methods, including planar imaging, single-photon emission computed tomography (SPECT), and positron emission tomography (PET), are the most widely used methods for evaluating brain function. SPECT and PET have been evolving for a longer time than CT and MRI and have made significant contributions to understanding brain function. The pioneering work on cerebral flow early in the last century laid the foundation of measurement with radioactive gases. This was initially performed with scintillation counters, which gave way to single, then multiple scintillation and multiprobe de... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4647932 Tue, 29 Mar 2011 22:22:03 +0100 4647932 http://www.medworm.com/index.php?rid=4647931&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001649%2Fabstract%3Frss%3Dyes Cardiac imaging with radiotracers plays an important role in patient evaluation, and the development of suitable imaging instruments has been crucial. While initially performed with the rectilinear scanner that slowly transmitted, in a row-by-row fashion, cardiac count distributions onto various printing media, the Anger scintillation camera allowed electronic determination of tracer energies and of the distribution of radioactive counts in 2D space. Increased sophistication of cardiac cameras and development of powerful computers to analyze, display, and quantify data has been essential to making radionuclide cardiac imaging a key component of the cardiac work-up. Newer processing algorithms and solid state cameras, fundamentally different from the Anger camera, show promise to provide hi... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4647931 Tue, 29 Mar 2011 22:22:03 +0100 4647931 http://www.medworm.com/index.php?rid=4647930&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001613%2Fabstract%3Frss%3Dyes Gamma probes are now an important, well-established technology in the management of cancer, particularly in the detection of sentinel lymph nodes. Intraoperative sentinel lymph node as well as tumor detection may be improved under some circumstances by the use of beta (negatron or positron), rather than gamma detection, because the very short range (∼1 mm or less) of such particulate radiations eliminates the contribution of confounding counts from activity other than in the immediate vicinity of the detector. This has led to the development of intraoperative beta probes. Gamma camera imaging also benefits from short source-to-detector distances and minimal overlying tissue, and intraoperative small field-of-view gamma cameras have therefore been developed as well. Radiation detectors fo... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4647930 Tue, 29 Mar 2011 22:22:03 +0100 4647930 http://www.medworm.com/index.php?rid=4647929&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001601%2Fabstract%3Frss%3Dyes Imaging devices for small animals have emerged in the past 10 years as extraordinarily useful tools in translational research and drug development. The Food and Drug Administration requires animal testing after in vitro drug discovery but before human application. Many small animal instruments have been developed in analogy to human scale devices, including positron emission tomography, single-photon emission computed tomography, computed tomography, magnetic resonance imaging, and ultrasound. Conversely, optical imaging with fluorescent and bioluminescent tracer technology, originating in single-cell in vitro studies, has been scaled up to whole-body animal imaging. Imaging that uses multiple devices permits a comparison of different aspects of function, anatomy, gene expression, and phen... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4647929 Tue, 29 Mar 2011 22:22:03 +0100 4647929 http://www.medworm.com/index.php?rid=4647928&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS000129981100002X%2Fabstract%3Frss%3Dyes This issue of the Seminars is unique in its authorship. When the editors first agreed to create Seminars in Nuclear Medicine, we also agreed that we would provide a wide authorship and would not use it as a platform for our own interests. We believe that we have fulfilled this responsibility and that during more than 40 years of publication, Seminars has reflected a wide range of interests and many varying views reflecting nuclear medicine at large. With this issue, we decided to make an exception: this is the first all Einstein/Montefiore authored issue of Seminars in Nuclear Medicine during our 40 year history. Members of the Department of Nuclear Medicine from the Albert Einstein College of Medicine and Montefiore Medical Center have authored many articles throughout the years, but we h... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4647928 Tue, 29 Mar 2011 22:22:03 +0100 4647928 http://www.medworm.com/index.php?rid=4408574&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001376%2Fabstract%3Frss%3Dyes The prognosis of patients with surgically unresectable differentiated thyroid tumors deteriorates significantly if radioiodine therapy is or becomes ineffective, considering the limited role of conventional chemotherapies in these patients. Several alternative approaches have been investigated for the treatment of patients with advanced thyroid malignancies in recent years. Among targeted therapies, tyrosine kinase inhibitors have resulted in the most encouraging responses and could soon be, along with redifferentiation therapy, the possible palliative strategies. Radiopeptide therapy, especially with beta emitter-labeled DOTANOC, which shows a great affinity to the somatostatin receptors expressed by thyroid tumor cells, might also be an attractive approach considering its comparatively l... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4408574 Fri, 28 Jan 2011 19:56:27 +0100 4408574 http://www.medworm.com/index.php?rid=4408573&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001388%2Fabstract%3Frss%3Dyes Although thyroid cancer is a comparatively rare malignancy, it represents the vast majority of endocrine cancers and its incidence is increasing. Most differentiated thyroid cancers have an excellent prognosis if diagnosed early and treated appropriately. Aggressive histologic subtypes and variants carry a worse prognosis. During the last 2 decades positron emission tomography (PET) and PET/computed tomography (CT), mostly with fluorodeoxyglucose (FDG), has been used increasingly in patients with thyroid cancers. Currently, the most valuable role FDG-PET/CT exists in the work-up of patients with differentiated thyroid cancer status post thyroidectomy who present with increasing thyroglobulin levels and a negative 131I whole-body scan. FDG-PET/CT is also useful in the initial (post thyroide... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4408573 Fri, 28 Jan 2011 19:56:27 +0100 4408573 http://www.medworm.com/index.php?rid=4408572&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001340%2Fabstract%3Frss%3Dyes The available data upon which to act in caring for patients with functioning thyroid cancer and thyroglobulin elevation/negative iodine scintigraphy (TENIS) are imperfect, almost never coming from randomized, blinded studies. When the serum thyroglobulin exceeds 2-10 ng/mL, one should use the latest imaging equipment available to find metastatic disease, especially in areas in which it is potentially resectable, ie, neck, bone, and occasionally brain, and collaborate with an experienced surgeon in removing such metastases. If one cannot locate operable metastases and/or tumor location remains elusive, empiric high-dose 131I therapy, preceded by dosimetry, should be considered. There are no randomized studies to prove that this treatment prolongs life, although there is definite evidence of... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4408572 Fri, 28 Jan 2011 19:56:26 +0100 4408572 http://www.medworm.com/index.php?rid=4408571&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001364%2Fabstract%3Frss%3Dyes We present the data from both sides of the debate in an attempt to highlight the strengths and deficiencies in the investigations cited. Clinical, animal, and in vitro studies are included. There are considerable differences in clinical practice, such as the administered activity for diagnostic whole-body scan, delay between diagnostic scan and treatment, time between treatment and posttherapy scanning, and timing of follow-up studies, that have to be analyzed with care. Other factors that often cannot be judged, such as levels of thyroid-stimulating hormone and serum iodine at time of diagnostic testing versus treatment could have an influence on stunning. Larger diagnostic doses and longer delays to therapy appear to increase the likelihood of stunning. The stunning effect of early-absor... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4408571 Fri, 28 Jan 2011 19:56:26 +0100 4408571 http://www.medworm.com/index.php?rid=4408570&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001467%2Fabstract%3Frss%3Dyes Ablation of residual thyroid tissue after total or near-total thyroidectomy is widely accepted by many practitioners and endorsed by relevant professional societies in the United States and the international community for patients with defined risk factors, including age greater than 45 years, large tumors; tumors with undesirable histopathology; lymph node involvement; positive surgical margins; gross and possibly microscopic extrathyroidal extension; and, of course, evidence or suspicion of distal metastases, including mediastinal lymphadenopathy, pulmonary or osseous metastases or involvement of other organs. 131I therapy doses of 3.7-5.5 GBq (100-150 mCi) should be used, and additional activity should be used in the event there are additional findings on pretreatment whole-body scans. ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4408570 Fri, 28 Jan 2011 19:56:26 +0100 4408570 http://www.medworm.com/index.php?rid=4408569&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001339%2Fabstract%3Frss%3Dyes The management of thyroid cancer has become more refined and complex over the last thirty years. In an effort to provide guidance to both clinicians and patients, several organizations have developed clinical management guidelines that provide specific advice regarding the diagnosis, treatment and follow-up of differentiated thyroid cancer. In this review, we compare and contrast the major management recommendations provided in the guidelines of the European Thyroid Association with those published by thyroid cancer specialty organizations in the United States (American Thyroid Association and National Comprehensive Cancer Network). By carefully examining treatment and management approaches that are applied in other areas of the world, we can identify equally effective alternative treatmen... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4408569 Fri, 28 Jan 2011 19:56:26 +0100 4408569 http://www.medworm.com/index.php?rid=4408568&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001352%2Fabstract%3Frss%3Dyes The management of papillary thyroid carcinoma continues to evolve. Although the debate over the extent of thyroidectomy has largely faded, the role of elective neck dissection in the surgical management of papillary thyroid cancer has become a topic of contention. The current standard of care for patients with papillary thyroid cancer includes total thyroidectomy and a therapeutic lymph node dissection for patients presenting with clinically evident nodal disease. However, many surgeons advocate prophylactic central neck lymph node dissections in patients who present with no clinical or radiographic evidence of lymph node involvement. Proponents of prophylactic central compartment neck dissection argue that the incidence of central neck metastases is high and the sensitivity of preoperativ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4408568 Fri, 28 Jan 2011 19:56:26 +0100 4408568 http://www.medworm.com/index.php?rid=4408567&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS000129981000139X%2Fabstract%3Frss%3Dyes Alexander Gottschalk, MD, died peacefully at age 78 on October 5, 2010 after a five-year battle with prostate cancer. Alex was born in Chicago in 1932 to illustrious parent educators. Both were professors at the University of Chicago. Louis was a historian and president of the American Historical Society who specialized in the French Revolution and Fruma Kasden Gottschalk, a Russian immigrant, was professor of Slavic languages and literature. Alex received his baccalaureate degree Magna Cum Laude from Harvard in 1954 and his MD degree from Washington University of St. Louis in 1958 where he was elected to Alpha Omega Alpha. He returned to Chicago for an internship at the University of Illinois and a radiology residency at the University of Chicago which he completed in 1962. At that time, ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4408567 Fri, 28 Jan 2011 19:56:25 +0100 4408567 http://www.medworm.com/index.php?rid=4408566&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001455%2Fabstract%3Frss%3Dyes The treatment of differentiated cancer of the thyroid is one of the more challenging and controversial areas in nuclear medicine. Since Seidlins original description in 1946, this important part of nuclear medicine practice has stimulated a great deal of discussion and differences of opinion in the philosophy of management. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4408566 Fri, 28 Jan 2011 19:56:25 +0100 4408566 http://www.medworm.com/index.php?rid=4204837&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000966%2Fabstract%3Frss%3Dyes Under the auspices of the International Atomic Energy Agency, a new-generation, platform-independent, and x86-compatible software package was developed for the analysis of scintigraphic renal dynamic imaging studies. It provides nuclear medicine professionals cost-free access to the most recent developments in the field. The software package is a step forward towards harmonization and standardization. Embedded functionalities render it a suitable tool for education, research, and for receiving distant expert's opinions. Another objective of this effort is to allow introducing clinically useful parameters of drainage, including normalized residual activity and outflow efficiency. Furthermore, it provides an effective teaching tool for young professionals who are being introduced to dynamic ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4204837 Sat, 27 Nov 2010 10:46:54 +0100 4204837 http://www.medworm.com/index.php?rid=4204836&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000760%2Fabstract%3Frss%3Dyes The objective of this work is to compare the characteristics of various techniques for functional renal imaging, with a focus on nuclear medicine and magnetic resonance imaging. Even with low spatial resolution and rather poor signal-to-noise ratio, classical nuclear medicine has the advantage of linearity and good sensitivity. It remains the gold standard technique for renal relative functional assessment. Technetium-99m (99mTc)-labeled diethylenetriamine penta-acetate remains the reference glomerular tracer. Tubular tracers have been improved: 123I- or 131I-hippuran, 99mTc-MAG3 and, recently, 99mTc-nitrilotriacetic acid. However, advancement in molecular imaging has not produced a groundbreaking tracer. Renal magnetic resonance imaging with classical gadolinated tracers probably has pote... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4204836 Sat, 27 Nov 2010 10:46:54 +0100 4204836 http://www.medworm.com/index.php?rid=4204835&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000954%2Fabstract%3Frss%3Dyes Radiological techniques are now able to provide morphologic, functional, and structural information relative to kidney diseases. Many of these approaches have been proposed experimentally, but validation studies in patients still remain mandatory. Contrast-enhanced ultrasound allows for the measurement of perfusion parameters. Multidetector computed tomography and magnetic resonance imaging make it possible to measure the differential function of filtration. Measurement of absolute glomerular filtration rate is still under development. Finally, magnetic resonance imaging is also able to provide information on the level of intrarenal oxygenation by the use of blood oxygenation level-dependent sequences and on cell density and water exchanges by the use of diffusion-sensitive acquisitions. (... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4204835 Sat, 27 Nov 2010 10:46:54 +0100 4204835 http://www.medworm.com/index.php?rid=4204834&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000784%2Fabstract%3Frss%3Dyes Prostate cancer is a common cancer in men and continues to be a major health problem. Imaging plays an important role in the clinical management of patients with prostate cancer. An important goal for prostate cancer imaging is more accurate disease characterization through the synthesis of anatomic, functional, and molecular imaging information. Positron emission tomography (PET)/computed tomography (CT) in oncology is emerging as an important imaging tool. The most common radiotracer for PET/CT in oncology, 18F-fluorodeoxyglucose (FDG), is not very useful in the imaging of prostate cancer. However, in recent years other PET tracers have improved the accuracy of PET/CT imaging of prostate cancer. Among these, choline labeled with 18F or 11C, 11C-acetate, and 18F-fluoride has demonstrated ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4204834 Sat, 27 Nov 2010 10:46:53 +0100 4204834 http://www.medworm.com/index.php?rid=4204833&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000978%2Fabstract%3Frss%3Dyes Radionuclide imaging of the kidneys with gamma cameras involves the use of labeled molecules seeking functionally critical molecular mechanisms to detect the pathophysiology of the diseased kidneys and achieve an early, sensitive, and accurate diagnosis. The most recent imaging technology, positron emission tomography, permits quantitative imaging of the kidney at a spatial resolution appropriate for the organ. H215O, 82RbCl, and [64Cu] ETS are the most important radiopharmaceuticals for measuring renal blood flow. The renin angiotensin system is the most important regulator of renal blood flow; this role is being interrogated by detecting angiotensin receptor subtype angiotensin subtype 1 receptor by the use of in vivo positron emission tomography. Membrane organic anion transporters are ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4204833 Sat, 27 Nov 2010 10:46:53 +0100 4204833 http://www.medworm.com/index.php?rid=4204832&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000735%2Fabstract%3Frss%3Dyes Although renography has been used for half a century to evaluate the function of the infant kidney, there are still important disagreements among the specialists involved in this particular pathology. Each department of nuclear medicine has his own way to acquire and process a renogram; to interpret the obtained images, curves, and quantitative parameters; and to make recommendations for the referring physician. The urologist has his or her part of responsibilities because the decision for operating or not operating varies from one center to another and is generally determined by a series of unproven assumptions. The aim of the present work is to focus on the main controversies involving both the nuclear medicine physician and the urologist.Concerning the technique of renography. The bladd... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4204832 Sat, 27 Nov 2010 10:46:52 +0100 4204832 http://www.medworm.com/index.php?rid=4204831&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS000129981000098X%2Fabstract%3Frss%3Dyes was held in Mikulov, Czech Republic, May 11 to 14, 2010. The venue chosen for the symposium is one of the most picturesque towns on the Czech-Austrian border, reflecting a long-lasting multicultural history and wine production in the area. Among the famous people who were native to the region are the scientists Johann Gregor Mendel, Sigmund Freud, and Kurt Gödel; composers Bohuslav Martinů and Leoš Janáček; businessman Tomáš Bat’a; and the dramatist Tom Stoppard. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4204831 Sat, 27 Nov 2010 10:46:52 +0100 4204831 http://www.medworm.com/index.php?rid=4204830&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001054%2Fabstract%3Frss%3Dyes The use of radionuclides in nephrourology has gone through several dramatic periods. Initially, physicians were captivated with the unique opportunity that the renogram provided to measure individual renal function. So intense was this interest that, for many years after its introduction in 1956, the use of radionuclides for renal studies was synonymous with renography. This was during a period when many additional renal techniques were introduced, including clearance measurement, imaging, residual urine determination, identification of reflux, and numerous variations on these themes. However, the use of radionuclides in nephrology is not a simple endeavor. It requires sophisticated knowledge of renal function, a large range of radiopharmaceuticals, and of various methodologies. The cause ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4204830 Sat, 27 Nov 2010 10:46:52 +0100 4204830 http://www.medworm.com/index.php?rid=4029497&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001157%2Fabstract%3Frss%3Dyes (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4029497 Tue, 05 Oct 2010 06:09:22 +0100 4029497 http://www.medworm.com/index.php?rid=4029496&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810001145%2Fabstract%3Frss%3Dyes (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4029496 Tue, 05 Oct 2010 06:09:22 +0100 4029496 http://www.medworm.com/index.php?rid=4029495&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000759%2Fabstract%3Frss%3Dyes The safe and accurate diagnosis of acute pulmonary embolism (PE) remains challenging, and many PE-related deaths still occur before the detection of PE. Current techniques detect PE as “negative images,” ie, the absence of contrast or downstream perfusion. There would be advantages to obtaining “positive images” of PE, by targeting imaging agents to components that are present primarily on thromboemboli. In addition to providing alternative means of diagnosing acute PE, they would also enable acute PE to be distinguished from other types of pulmonary arterial obstruction, such as unresolved intravascular defects attributable to previous PE. Positive images of PE require imaging agents to bind onto target antigens that are present predominantly on thromboemboli. The “D dimer” re... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4029495 Tue, 05 Oct 2010 06:09:20 +0100 4029495 http://www.medworm.com/index.php?rid=4029494&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000693%2Fabstract%3Frss%3Dyes Single-photon emission computed tomography (SPECT) is being increasingly used as a tool in respiratory research, in particular ventilation SPECT. Much of the basic understanding of pulmonary physiology has been derived from inhaled radioactive inert gases because, as the lung behaves in an asymmetric manner, the nature of regional differences in ventilation is ideally studied with the use of imaging. It is well known to clinicians that ventilation is patchy in patients who have airways disease. However, the relevance to the disease mechanisms itself only started to be studied with the use of 3-dimensional imaging and with advances in quantitative image analysis. The measurements of both ventilation distribution and nonventilation (airway closure) have become very topical in the study of as... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4029494 Tue, 05 Oct 2010 06:09:20 +0100 4029494 http://www.medworm.com/index.php?rid=4029493&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000681%2Fabstract%3Frss%3Dyes Combining the functional data provided by single-photon emission computed tomography (SPECT) with the anatomical information provided by CT has been shown to improve overall diagnostic accuracy in many areas of nuclear medicine. Although planar lung scans have often relied on correlation with a chest x-ray to help optimize scan interpretation, the advent of 3D lung imaging with SPECT provides the opportunity to combine lung perfusion data with CT images. This can be done by performing the study on a hybrid SPECT/CT scanner, with the CT acquisition typically performed with the use of low-dose parameters, rather than full diagnostic quality settings, or by software fusion with a fully diagnostic CT or a contrast-enhanced CT pulmonary angiogram. Such an approach has been shown to improve spec... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4029493 Tue, 05 Oct 2010 06:09:20 +0100 4029493 http://www.medworm.com/index.php?rid=4029492&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS000129981000070X%2Fabstract%3Frss%3Dyes When considering the investigation of the patient with possible pulmonary embolism, one needs to balance the likelihood of disease and the diagnostic utility of the test against the risks associated with the investigation. Both computed tomography pulmonary angiography (CTPA) and the ventilation/perfusion (V/Q) scan involve exposure to ionizing radiation. The effect of low-level ionizing radiation remains an issue of some controversy. CTPA delivers a greater effective dose and, in particular, greater doses to breast tissue, than the V/Q scan (typically 10-70 mGy for CTPA vs (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4029492 Tue, 05 Oct 2010 06:09:20 +0100 4029492 http://www.medworm.com/index.php?rid=4029491&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000747%2Fabstract%3Frss%3Dyes Planar ventilation and perfusion (V/Q) scintigraphy has been largely displaced by computed tomography pulmonary angiography (CTPA) in recent years for the diagnosis of pulmonary embolism (PE). This change can be attributed to multiple studies that demonstrate CTPA has a reasonable sensitivity and good prognostic value in negative cases, associated with the ability to deliver few indeterminate results and provide an alternate diagnosis in a significant number of patients. However, the technique has significant limitations. The Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) study has shown a sensitivity of 83%, which is not optimal. However, CT technology has greatly progressed since this time, and therefore it is likely that this number has improved. The PIOPED II ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4029491 Tue, 05 Oct 2010 06:09:19 +0100 4029491 http://www.medworm.com/index.php?rid=4029490&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000656%2Fabstract%3Frss%3Dyes Ventilation/perfusion single-photon emission computed tomography (V/Q SPECT) is the scintigraphic technique of choice for the diagnosis of pulmonary embolism and many other disorders that affect lung function. Data from recent ventilation studies show that the theoretic advantages of Technegas over radiolabeled liquid aerosols are not restricted to the presence of obstructive lung disease. Radiolabeled macroaggregated human albumin is the imaging agent of choice for perfusion scintigraphy. An optimal combination of nuclide activities and acquisition times for ventilation and perfusion, collimators, and imaging matrix yields an adequate V/Q SPECT study in approximately 20 minutes of imaging time. The recommended protocol based on the patient remaining in an unchanged position during the ini... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4029490 Tue, 05 Oct 2010 06:09:19 +0100 4029490 http://www.medworm.com/index.php?rid=4029489&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000668%2Fabstract%3Frss%3Dyes In this article we review protocols for ventilation-perfusion (V/Q) imaging with current generation technology. Although many groups have expressed interest in moving from planar lung V/Q imaging to single-photon emission computed tomography (SPECT) methods, few resources or guidelines exist for suggested protocols. Here, we provide an introduction to help establish protocols for planar and SPECT V/Q imaging and display that should be readily transferable into a clinical department's routine practice. We emphasize, in particular, the need for a good ventilation study and that acquiring planar images as well as SPECT can be negated by producing acceptable planar-like images from the SPECT data. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4029489 Tue, 05 Oct 2010 06:09:19 +0100 4029489 http://www.medworm.com/index.php?rid=4029488&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS000129981000067X%2Fabstract%3Frss%3Dyes Compared with planar imaging, ventilation/perfusion scintigraphy performed with single-photon emission computed tomography (SPECT) has a greater sensitivity and specificity, greater accuracy, improved reproducibility, and a lower number of inconclusive reports in the detection of pulmonary embolism. Despite these improvements, there are several challenges that must be overcome for the transition from planar imaging to SPECT imaging to be successful, including a lack of familiarity with 3D imaging of the lungs by some reporting specialists, the selection of a ventilation agent appropriate for SPECT acquisitions, and a different approach in the image reporting. The transition to SPECT imaging can be facilitated by generating planar-like images from the SPECT data, with which many reporting s... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4029488 Tue, 05 Oct 2010 06:09:19 +0100 4029488 http://www.medworm.com/index.php?rid=4029487&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000644%2Fabstract%3Frss%3Dyes Radionuclide lung scanning has been used clinically for the diagnosis of pulmonary embolism (PE) for many decades. The original perfusion scan technique introduced by Henry Wagner and others has been enhanced over time by the addition of a complementary radioactive gas or aerosol ventilation scan, which permitted the detection of mismatch between normally ventilated and underperfused lung regions, indicating an acute disruption to the vascular supply potentially attributable to an embolus. Underlining the significance of its role, planar lung ventilation/perfusion (V/Q) scanning with the use of the gamma camera has been the most frequently indicated scan requested out of normal hours of operation for nuclear medicine services because of the importance in rapidly and accurately determining ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4029487 Tue, 05 Oct 2010 06:09:19 +0100 4029487 http://www.medworm.com/index.php?rid=4029486&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000772%2Fabstract%3Frss%3Dyes The introduction of the radionuclide perfusion lung scan (Q) in the mid 1960s and the Xenon ventilation study (V) in the late 1960s and early 1970s were very significant advances in our ability to confirm the often elusive diagnosis of pulmonary embolism (PE). The second issue of Seminars almost 40 years ago was devoted to this subject. As pointed out in our editorial in that issue, the radionuclide study “has noticeably bridged the diagnostic gap between the clinical suspicion of PE and the performance of more tedious and risky examinations, such as pulmonary angiography and cardiac catheterization.” In many institutions in the 1980s and 1990s, radiolabeled particles, such as aerosolized Tc-99m DTPA, replaced Xenon-133 for the ventilation part of the study. (Source: Seminars in Nuclea... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=4029486 Tue, 05 Oct 2010 06:09:19 +0100 4029486 http://www.medworm.com/index.php?rid=3819460&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000309%2Fabstract%3Frss%3Dyes Several ethical transgressions involving human subjects in scientific research during the last century have led to guidelines for acceptable research conduct and oversight. Thoughtful examination of these events yielded ethical documents whose principles eventually became codified into federal regulations governing research. These regulations specify the composition and function of the institutional review board (IRB), as well as the criteria by which the IRB judges the acceptability of proposed research. Continuous advances in medicine and technology generate the need to test new and potentially viable interventions for safety and efficacy. These advances in medical science rely heavily on the altruism and sometimes heroism of individuals who put their own well being at risk for the benef... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3819460 Thu, 05 Aug 2010 07:03:27 +0100 3819460 http://www.medworm.com/index.php?rid=3819459&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000474%2Fabstract%3Frss%3Dyes In March 2004, the Food and Drug Administration (FDA) published a report entitled Challenge and Opportunity on the Critical Path to New Medical Products in which it explained the critical path to medical product development and called for a nationwide effort to modernize the critical-path sciences with the aim of moving medical product development and patient care into the 21st century. The report identified medical imaging and imaging biomarkers as potential clinical development tools to facilitate medical product development and to help minimize drug attritions and development timelines. Also, in recent years, basic research on receptor-based imaging has led to an increase in the new investigational radiopharmaceuticals, many of which are in basic research stages in academic institutions... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3819459 Thu, 05 Aug 2010 07:03:27 +0100 3819459 http://www.medworm.com/index.php?rid=3819458&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000322%2Fabstract%3Frss%3Dyes This article provides an overview of the basic statistical approaches for analyzing clinical trials with binary, continuous or time-to-event outcomes as well as methods for handling protocol deviations due to noncompliance and early drop-out. Issues surrounding the determination of sample size and power of clinical trials are also discussed. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3819458 Thu, 05 Aug 2010 07:03:27 +0100 3819458 http://www.medworm.com/index.php?rid=3819457&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000498%2Fabstract%3Frss%3Dyes Clinical investigations of radiopharmaceuticals are undertaken to advance promising compounds toward approval by the Food and Drug Administration (FDA) as “legend drugs.” This FDA approval requires that the safety and efficacy of the investigational drug (ID) be demonstrated through clinical trials. The investigational radiopharmaceutical drug service (IRDS) is a pharmacy service that plays a critical role in the acquisition, preparation, accountability, and distribution of radiopharmaceuticals used in clinical research. Due to their radioactive and other unique properties, and their potential role as biomarkers or tools in clinical trials of other therapeutic drugs, radiopharmaceutical drugs must be managed by a qualified IRDS rather than by a typical pharmacy-based investigational dr... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3819457 Thu, 05 Aug 2010 07:03:27 +0100 3819457 http://www.medworm.com/index.php?rid=3819456&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000176%2Fabstract%3Frss%3Dyes The incorporation of imaging biomarkers and clinical trials is now common. Because of the multiple technical, clinical, and regulatory demands to ensure high-quality quantitative information, the core laboratory serves as a critical intermediary between the study sponsor and the site. It provides unique expertise not found in typical clinical research organizations. This expertise goes far beyond the passive receipt of images for conductance of central reads of data and includes the proactive and early involvement in the selection of sites for imaging, the qualification and assistance for managing the local site logistics, on-the-fly and active quality control of imaging data in close working relationship with sites, and preparation for and conductance of central image reads or quantificat... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3819456 Thu, 05 Aug 2010 07:03:27 +0100 3819456 http://www.medworm.com/index.php?rid=3819455&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000188%2Fabstract%3Frss%3Dyes Clinical trial design for nuclear medicine diagnostic imaging radiopharmaceuticals must include a design for preclinical safety studies. These studies should establish that the investigational product (IP) does not have a toxic effect. As a further requirement, radiopharmaceutical clinical trials include a human study (phase 1) that provides biodistribution, pharmacokinetics, and radiation dosimetry information. These studies demonstrate to the Food and Drug Administration that the IP either meets or exceeds the toxicology and radiation exposure safety limits. Satisfying this requirement can result in the Food and Drug Administration approving the performance of late-phase (phase 2/3) clinical trials that are designed to validate the clinical efficacy of the diagnostic imaging agent in pat... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3819455 Thu, 05 Aug 2010 07:03:27 +0100 3819455 http://www.medworm.com/index.php?rid=3819454&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000218%2Fabstract%3Frss%3Dyes was formed to provide quality assurance of both imaging and radiopharmaceutical manufacturing in clinical trials. The intention is to register and qualify a large number (>200) of sites, both in the United States and internationally, to be able to do the positron emission tomography imaging part of clinical trials. Initially, the types of trials to be supported include evaluation of novel radiopharmaceuticals and trials that use approved or experimental radiopharmaceuticals for early assessment of tumor response to novel chemotherapy agents. The Clinical Trials Network is organized into 7 committees that provide overall oversight and strategic guidance, database management, site qualification and monitoring, scanner validation, clinical site orientation, technologist education, trial desi... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3819454 Thu, 05 Aug 2010 07:03:26 +0100 3819454 http://www.medworm.com/index.php?rid=3819453&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000462%2Fabstract%3Frss%3Dyes In the last few years there has been a remarkable increase in the amount of clinical data in the average hospital chart, and more and more problem-solving algorithms have been developed. We need better “thinking tools” to help us handle the flow of information. The term “clinical decision making” is used to describe a systematic way to handle data and algorithms to decide on a best course of action. This introductory article discusses some of the problems in establishing a decision criterion, both for a population and for an individual patient. Comparing the probabilities and utilities of various diagnostic outcomes (true positive, false positive, etc.) leads to a diagnostic strategy. The article also discusses conditional probability. Bayes' theorem, and likelihood ratios. (Source... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3819453 Thu, 05 Aug 2010 07:03:26 +0100 3819453 http://www.medworm.com/index.php?rid=3819452&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000486%2Fabstract%3Frss%3Dyes Nuclear medicine is one of the areas of medicine that is particularly dependent on basic science. Chemistry, radiochemistry and physics, as well as physiology and biochemistry, are essential ingredients to understand and generate the images that we review. Regardless of this strong basic science component, when we begin to interpret the meaning of the images we see, nuclear medicine becomes as much a part of the “art of medicine” as any other specialty. A very significant component of medical practice is based on clinical experience. Decisions about diagnosis, treatment, and interpretation of images are strongly influenced by the “experience” of the practitioner and his or her intuitive sense of the meaning of the observation and the patient's complaint. This classic “practice of... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3819452 Thu, 05 Aug 2010 07:03:26 +0100 3819452 http://www.medworm.com/index.php?rid=3613112&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000139%2Fabstract%3Frss%3Dyes A routine feature of positron emission tomography/computed tomography (PET/CT) imaging is whole-body acquisition that results in many unexpected findings identified outside of the primary region of abnormality. Furthermore, 18F-fluorodeoxyglucose (FDG) is a marker of glycolysis and does not specifically accumulate in malignancy. Understanding the physiology and pathophysiology of normal FDG distribution and common incidental findings is therefore essential to the physician interpreting whole-body FDG-PET/CT studies. Whereas many incidental findings are benign and of limited clinical significance, others represent uncommon manifestations of the primary malignancy, second malignancies, or various clinically significant pathologic processes. Patients with a single malignancy are at greater ri... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3613112 Mon, 31 May 2010 14:16:25 +0100 3613112 http://www.medworm.com/index.php?rid=3613111&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000048%2Fabstract%3Frss%3Dyes 18F-fluorodeoxyglucose (FDG) is the radiotracer used in the vast majority of positron emission tomography (PET) cancer studies. FDG is a powerful radiotracer that provides valuable data in many cancer types. Normal FDG biodistribution is easily identified. In the PET-only era, physiological uptake provided important anatomical landmarks. However, the normal biodistribution of FDG is often variable and can be altered by intrinsic or iatrogenic factors. Recognizing these patterns of altered biodistribution is important for optimal FDG-PET interpretation. Altered FDG uptake in muscles, brown adipose tissue, bone marrow, the urinary tract, and the bowel is demonstrated in a significant proportion of patients, which can hide underlying malignant foci or mimic malignant lesions. The introduction... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3613111 Mon, 31 May 2010 14:16:25 +0100 3613111 http://www.medworm.com/index.php?rid=3613110&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS000129981000019X%2Fabstract%3Frss%3Dyes Gallium-67 citrate and labeled leukocyte imaging are established procedures for diagnosing inflammation and infection. Knowledge of the normal biodistribution of these tracers, variations, and unusual disease presentations improves the accuracy of their interpretation. During the first 24 hours after injection, the principal excretory pathway of gallium is renal; subsequently, excretion is primarily colonic. By 72 hours, approximately 75% remains in the body, equally distributed among soft tissues, liver, and bone/bone marrow. This normal distribution is subject to considerable variation. Nasopharyngeal and lacrimal gland uptake can be prominent. Breast uptake, generally faint and symmetric, is intense in hyperprolactinemic states such as pregnancy. Colonic uptake is very variable. Normall... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3613110 Mon, 31 May 2010 14:16:24 +0100 3613110 http://www.medworm.com/index.php?rid=3613109&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000206%2Fabstract%3Frss%3Dyes Myocardial perfusion studies routinely are performed to evaluate for the presence and extent of coronary artery disease. The findings have prognostic and therapeutic implications. Routine display of the raw projection images allows visualization of regions adjacent to the heart in which there may be incidental findings that are nonsignificant but in other instances are clinically important. Such incidental findings may cause artifacts and therefore need to be considered when interpreting the perfusion images. These findings may also indicate other cardiovascular conditions and sometimes show important noncardiac pathology. To properly interpret these findings, one must be familiar with normal uptake and kinetics of the cardiac perfusion tracers and have a solid understanding of image acqui... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3613109 Mon, 31 May 2010 14:16:24 +0100 3613109 http://www.medworm.com/index.php?rid=3613108&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000140%2Fabstract%3Frss%3Dyes Uptake in nonosseous, nonurologic tissues is occasionally found in the performance of bone scintigraphy. Proper interpretation of these cases depends on identifying the involved organs and appreciating the significance of the uptake. Because of the rarity of these findings and a relative de-emphasis of planar imaging in radiologic imaging, current era trainees may exhibit difficulty in identifying organs on planar projections. The first section of this work consists of an image atlas depicting uptake by various nonosseous, nonurologic organs on planar scintigraphy. In the second section, we discuss the etiologies of soft-tissue uptake, organized according to mechanisms of accretion: (1) metastatic calcification, (2) dystrophic calcification, (3) metabolic uptake, and (4) compartmental sequ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3613108 Mon, 31 May 2010 14:16:24 +0100 3613108 http://www.medworm.com/index.php?rid=3613107&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000152%2Fabstract%3Frss%3Dyes We present here an overall summary of altered biodistribution of radiopharmaceuticals with a special emphasis on the molecular mechanisms involved. Important factors affecting the biodistribution of radiopharmaceuticals can be described in 5 major categories and include (1) radiopharmaceutical preparation and formulation problems; (2) problems caused by radiopharmaceutical administration techniques and procedures; (3) by changes in biochemical and pathophysiology; (4) previous medical procedures, such as surgery, radiation therapy and dialysis; and finally (5) by drug interactions. The altered biodistribution of 99mTc radiopharmaceuticals are generally associated with increased amounts of 99mTc radiochemical impurities, such as free 99mTcO4− and particulate impurities, such as 99mTc coll... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3613107 Mon, 31 May 2010 14:16:24 +0100 3613107 http://www.medworm.com/index.php?rid=3613106&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000425%2Fabstract%3Frss%3Dyes In the above-referenced article, on pages 205 and 207 the subheading “Actinium-211” should have read “Astatine-211” (ie, 211At). (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3613106 Mon, 31 May 2010 14:16:24 +0100 3613106 http://www.medworm.com/index.php?rid=3613105&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000310%2Fabstract%3Frss%3Dyes It is imperative in all areas of diagnostic imaging that interpreting physicians are well trained to recognize not only the considerable variation that exists in the “normal” study, but also the many deviations that may occur from a variety of technical factors. This may be more pertinent for radionuclide imaging than other areas of diagnostic imaging. The radiopharmaceuticals that we administer go through a fairly elaborate process related to their preparation. Even slight deviations can lead to radiochemical or radiopharmaceutical impurities. Labeling problems and variants associated with administration technique can significantly change the distribution of activity on a radionuclide image. Patient preparation, such as fasting, blood glucose levels, etc, play an important role as wel... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3613105 Mon, 31 May 2010 14:16:24 +0100 3613105 http://www.medworm.com/index.php?rid=3413860&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809001147%2Fabstract%3Frss%3Dyes In the 1980s, the 111In-labeled somatostatin analog OctreoScan (Covidien, Hazelwood, MO) was developed for imaging of somatostatin receptor subtype 2 (sst2) overexpressing tumors. On the basis of this success, peptide receptor radionuclide therapy (PRRT) was developed using similar somatostatin analogs with different therapeutic radionuclides. Clinical application of PRRT demonstrated impressive results on tumor response, overall survival, and quality of life in patients with gastroenteropancreatic neuroendocrine tumors. The peptides 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA), Tyr3-octreotate (DOTATATE) and DOTA, Tyr3-octreotide (DOTATOC) (brand name Onalta), predominantly targeting sst2, have been granted Orphan Drug status by the European Medicines Agency and the US ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3413860 Mon, 29 Mar 2010 14:40:07 +0100 3413860 http://www.medworm.com/index.php?rid=3413859&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000036%2Fabstract%3Frss%3Dyes Actively targeted α-particles offer specific tumor cell killing action with less collateral damage to surrounding normal tissues than β-emitters. During the last decade, radiolabeled peptides that bind to different receptors on the tumors have been investigated as potential therapeutic agents both in the preclinical and clinical settings. Advantages of radiolabeled peptides over antibodies include relatively straightforward chemical synthesis, versatility, easier radiolabeling, rapid clearance from the circulation, faster penetration and more uniform distribution into tissues, and less immunogenicity. Rapid internalization of the radiolabeled peptides with equally rapid re-expression of the cell surface target is a highly desirable property that enhances the total delivery of these radio... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3413859 Mon, 29 Mar 2010 14:40:07 +0100 3413859 http://www.medworm.com/index.php?rid=3413858&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809001159%2Fabstract%3Frss%3Dyes The selective delivery of therapeutic radionuclides is a promising approach for treating cancer. Antibody-targeted radionuclides are of particular interest, with 2 products approved for the treatment of certain forms of non-Hodgkin lymphoma. However, for many other cancers, radioimmunotherapy has been ineffective, being limited by prolonged exposure to the highly radiosensitive bone marrow. An alternative approach, known as pretargeting, separates radionuclide from the antibody, allowing the radiation to be delivered on a small molecule that can quickly and efficiently migrate into the tumor, and then rapidly clear from the body with minimal retention in tissues. Several pretargeting methods have been developed that differ in the way they selectively capture the radionuclide. This review f... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3413858 Mon, 29 Mar 2010 14:40:06 +0100 3413858 http://www.medworm.com/index.php?rid=3413857&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809001172%2Fabstract%3Frss%3Dyes Positron emission tomography (PET) is playing an increasingly important role in the diagnosis, staging, and monitoring response to treatment in a variety of cancers. Recent efforts have focused on immuno-PET, which uses antibody-based radiotracers, to image tumors based on expression of tumor-associated antigens. It is postulated that the specificity afforded by antibody targeting should both improve tumor detection and provide phenotypic information related to primary and metastatic lesions that will guide therapy decisions. Advances in antibody-engineering are providing the tools to develop antibody-based molecules with pharmacokinetic properties optimized for use as immuno-PET radiotracers. Coupled with technical advances in the design of PET scanners, immuno-PET holds promise to improv... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3413857 Mon, 29 Mar 2010 14:40:06 +0100 3413857 http://www.medworm.com/index.php?rid=3413856&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809001184%2Fabstract%3Frss%3Dyes Noninvasive molecular imaging approaches include nuclear, optical, magnetic resonance imaging, computed tomography, ultrasound, and photoacoustic imaging, which require accumulation of a signal delivered by a probe at the target site. Monoclonal antibodies are high affinity molecules that can be used for specific, high signal delivery to cell surface molecules. However, their long circulation time in blood makes them unsuitable as imaging probes. Efforts to improve antibodies pharmacokinetics without compromising affinity and specificity have been made through protein engineering. Antibody variants that differ in antigen binding sites and size have been generated and evaluated as imaging probes to target tissues of interest. Fast clearing fragments, such as single-chain variable fragment (... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3413856 Mon, 29 Mar 2010 14:40:06 +0100 3413856 http://www.medworm.com/index.php?rid=3413855&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299810000024%2Fabstract%3Frss%3Dyes Throughout the years, the Editors have tried to maintain a balanced approach to content for Seminars in Nuclear Medicine. We have presented topics that range from the most basic clinical material to somewhat esoteric basic science issues. The majority of our readers are clinicians, but we believe that in order to practice medicine in a modern and comprehensive fashion it is necessary to be conversant with more than the basic applied clinical aspects of the practice. It is important to be aware of the ongoing research areas which, as they are applied to routine clinical medicine, can be applied in a knowledgeable and efficient manner. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3413855 Mon, 29 Mar 2010 14:40:06 +0100 3413855 http://www.medworm.com/index.php?rid=3218941&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809001135%2Fabstract%3Frss%3Dyes This article outlines the current status, results, and methodological improvements of 131I-MIBG therapy. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3218941 Fri, 29 Jan 2010 15:14:19 +0100 3218941 http://www.medworm.com/index.php?rid=3218940&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809001044%2Fabstract%3Frss%3Dyes This article deals with the current options of optimal therapy regimens in differentiated thyroid carcinoma. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3218940 Fri, 29 Jan 2010 15:14:19 +0100 3218940 http://www.medworm.com/index.php?rid=3218939&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809001032%2Fabstract%3Frss%3Dyes Although most patients with locoregional cancer are cured by surgery, radiotherapy, chemotherapy, and combinations thereof, those with distant metastases are not despite systemic chemotherapy. These patients respond to local radiotherapy but generally need systemic therapy. Non-Hodgkin's lymphoma (NHL) provides a paradigm for the role of molecular targeted radiotherapy (MTRT) because these patients have multifocal disease in most cases. Although patients with NHL achieve remissions after multiple cycles of chemotherapy, less than one half of those with aggressive NHL are cured and almost none of those with low grade NHL. Furthermore, NHL, like other cancers, becomes chemoresistant, yet remains responsive to radiotherapy. MTRT, radiation targeted by molecules, is a good strategy for the tre... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3218939 Fri, 29 Jan 2010 15:14:19 +0100 3218939 http://www.medworm.com/index.php?rid=3218938&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS000129980900107X%2Fabstract%3Frss%3Dyes This article reviews the basis for dose selection, the nuclear medicine procedures involved, the results obtained to date, and issues related to patient and staff safety. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3218938 Fri, 29 Jan 2010 15:14:19 +0100 3218938 http://www.medworm.com/index.php?rid=3218937&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809001056%2Fabstract%3Frss%3Dyes This article focuses on procedural and technical aspects for selection, preparation, and performance of treatment as well as post-therapeutic monitoring and response assessment. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3218937 Fri, 29 Jan 2010 15:14:18 +0100 3218937 http://www.medworm.com/index.php?rid=3218936&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809001019%2Fabstract%3Frss%3Dyes Bone pain due to skeletal metastases constitutes the most common type of chronic pain among patients with cancer. It significantly decreases the patient's quality of life and is associated with comorbidities, such as hypercalcemia, pathologic fractures and spinal cord compression. Approximately 65% of patients with prostate or breast cancer and 35% of those with advanced lung, thyroid, and kidney cancers will have symptomatic skeletal metastases. The management of bone pain is extremely difficult and involves a multidisciplinary approach, which usually includes analgesics, hormone therapies, bisphosphonates, external beam radiation, and systemic radiopharmaceuticals. In patients with extensive osseous metastases, systemic radiopharmaceuticals should be the preferred adjunctive therapy for ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3218936 Fri, 29 Jan 2010 15:14:18 +0100 3218936 http://www.medworm.com/index.php?rid=3218935&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809001020%2Fabstract%3Frss%3Dyes Somatostatin receptor imaging with [111In-DTPA0)octreotide has proven its role in the diagnosis and staging of gastroenteropancreatic neuroendocrine tumors. Treatment with radiolabeled somatostatin analogues is a promising new tool in the management of patients with inoperable or metastasized, well-differentiated neuroendocrine tumors. Symptomatic improvement may occur with all 111In, 90Y, or 177Lu-labeled somatostatin analogues that have been used for peptide receptor radionuclide therapy. The results that were obtained with [90Y-DOTA0, Tyr3]octreotide and [177Lu-DOTA0, Tyr3]octreotate are very encouraging in terms of tumor regression. Also, if kidney protective agents are used, the side effects of this therapy are few and mild, and the median duration of the therapy response for these ra... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3218935 Fri, 29 Jan 2010 15:14:18 +0100 3218935 http://www.medworm.com/index.php?rid=3218934&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809001123%2Fabstract%3Frss%3Dyes Nuclear medicine offers both diagnostic and therapeutic procedures. Up to 10 years ago, the therapeutic spectrum primarily covered benign and malignant thyroid diseases. Additionally, relatively few patients were treated with 89Sr for bone pain palliation or with radioactive colloids for malignant pleural or peritoneal metastatic spread. However, the last years have witnessed a proliferation of additional techniques that have enhanced our therapeutic capabilities. With the advent of Zevalin, 90Y DOTATOC, and selective internal radiation therapy (SIRT), the importance of nuclear medicine therapy has increased considerably. This issue of Seminars in Nuclear Medicine will summarize the progress and potential of therapeutic radioisotopes. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3218934 Fri, 29 Jan 2010 15:14:18 +0100 3218934 http://www.medworm.com/index.php?rid=3218933&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809001160%2Fabstract%3Frss%3Dyes Dr Hans Biersack has put together a stellar group of investigators in this issue to review some of the important therapeutic radionuclide applications and to present some exciting recent developments. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3218933 Fri, 29 Jan 2010 15:14:18 +0100 3218933 http://www.medworm.com/index.php?rid=3050745&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000671%2Fabstract%3Frss%3Dyes Dual-energy x-ray absorptiometry (DXA) scans to measure bone mineral density at the spine and hip have an important role in the evaluation of individuals at risk of osteoporosis, and in helping clinicians advise patients about the appropriate use of antifracture treatment. Compared with alternative bone densitometry techniques, hip and spine DXA examinations have several advantages that include a consensus that bone mineral density results should be interpreted using the World Health Organization T score definition of osteoporosis, a proven ability to predict fracture risk, proven effectiveness at targeting antifracture therapies, and the ability to monitor response to treatment. This review discusses the evidence for these and other clinical aspects of DXA scanning. Particular attention i... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3050745 Thu, 03 Dec 2009 15:14:12 +0100 3050745 http://www.medworm.com/index.php?rid=3050744&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000683%2Fabstract%3Frss%3Dyes The diphosphonate bone scan is ideally suited to assess many global, focal or multifocal metabolic bone disorders and there remains a role for conventional bone scintigraphy in metabolic bone disorders at diagnosis, investigation of complications, and treatment response assessment. In contrast, the role of bone scintigraphy in the evaluation of primary malignant bone tumors has reduced with the improvement of morphologic imaging, such as computed tomography and magnetic resonance imaging. However, an increasing role for 18F-fluorodeoxyglucose positron emission tomography and positron emission tomography/computed tomography is emerging as a functional assessment at diagnosis, staging, and neoadjuvant treatment response assessment. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3050744 Thu, 03 Dec 2009 15:14:12 +0100 3050744 http://www.medworm.com/index.php?rid=3050743&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000701%2Fabstract%3Frss%3Dyes Disorders of the ankle and foot are common and given the complex anatomy and function of the foot, they present a significant clinical challenge. Imaging plays a crucial role in the management of these patients, with multiple imaging options available to the clinician. The American College of radiology has set the appropriateness criteria for the use of the available investigating modalities in the management of foot and ankle pathologies. These are broadly classified into anatomical and functional imaging modalities. Recently, single-photon emission computed tomography and/or computed tomography scanners, which can elegantly combine functional and anatomical images have been introduced, promising an exciting and important development. This review describes our clinical experience with sin... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3050743 Thu, 03 Dec 2009 15:14:12 +0100 3050743 http://www.medworm.com/index.php?rid=3050742&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000932%2Fabstract%3Frss%3Dyes Bone scintigraphy is a sensitive tool to evaluate the musculoskeletal system in children. Hybrid imaging using computed tomography (CT) in combination with conventional bone scan and single photon emission computed tomography improves specificity and diagnostic accuracy. It also improves laboratory efficiency and may save the patient an additional visit to the hospital for a separate cross-sectional imaging study. We have found this technique to be particularly helpful in localizing a cause for pain in children who are nonverbal and to better delineate small bone and soft-tissue lesions that can occur with diagnoses of trauma, infection, and tumor. Special attention to technique of positioning the patient for potential CT examination is an adaptation that must be made by the technologist. ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3050742 Thu, 03 Dec 2009 15:14:12 +0100 3050742 http://www.medworm.com/index.php?rid=3050741&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000725%2Fabstract%3Frss%3Dyes Bone scintigraphy is one of the mainstays of molecular imaging. It has retained its relevance in the imaging of acute and chronic trauma and sporting injuries in particular. The basic reasons for its longevity are the high lesional conspicuity and technological changes in gamma camera design. The implementation of hybrid imaging devices with computed tomography scanners colocated with the gamma camera has revolutionized the technique by allowing a host of improvements in spatial resolution and anatomical registration. Both bone and soft-tissue lesions can be visualized and identified with greater and more convincing accuracy. The additional benefit of detecting injury before anatomical changes in high-level athletes has cost and performance advantages over other imaging modalities. The app... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3050741 Thu, 03 Dec 2009 15:14:11 +0100 3050741 http://www.medworm.com/index.php?rid=3050740&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000713%2Fabstract%3Frss%3Dyes Conclusions: SPECT/computed tomography (CT) with 111In-WBC combined with 99mTc-MDP or 99mTc-sulfur colloid seems to be the best imaging technique for diagnosis of bone and joint infections. FDG-PET is also useful for diagnosis of osteomyelitis with improved spatial resolution over SPECT imaging, allowing more accurate localization. Localization can be further improved by adding CT. Diagnosis of orthopedic implant infections with FDG-PET depends strongly on the localization of the implant and the criteria used to diagnose infection. Confirmation of well defined criteria to diagnose infection on FDG-PET in patients with metallic implants is thus of paramount importance for optimal diagnosis. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3050740 Thu, 03 Dec 2009 15:14:11 +0100 3050740 http://www.medworm.com/index.php?rid=3050739&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000695%2Fabstract%3Frss%3Dyes We hope that you enjoyed reading Part I of the bone update series. In Part II, we turn our attention away from malignant conditions and focus on the rapidly expanding indications relating to benign disorders. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3050739 Thu, 03 Dec 2009 15:14:11 +0100 3050739 http://www.medworm.com/index.php?rid=3050738&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000944%2Fabstract%3Frss%3Dyes This issue represents the second part of a comprehensive update on the evolution and current status of skeletal scintigraphy. As was evident from Part I of this seminar, the current use of fusion imaging with both positron emission tomography/computed tomography (CT) and single-photon emission computed tomography/CT has greatly enhanced the specificity of these sensitive imaging modalities. Doctors Gnanasegaran and Fogelman, in their guest editorial, provide specific details on the content of the individual articles in this issue. Although it is now a radiographic rather than a radionuclide procedure, the editors have included a current status report on bone densitometry. This frequently performed study originated with an isotope source and was replaced with a dual energy x-ray source 10-1... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=3050738 Thu, 03 Dec 2009 15:14:10 +0100 3050738 http://www.medworm.com/index.php?rid=2860997&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000804%2Fabstract%3Frss%3Dyes (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2860997 Mon, 05 Oct 2009 17:40:08 +0100 2860997 http://www.medworm.com/index.php?rid=2860996&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000798%2Fabstract%3Frss%3Dyes (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2860996 Mon, 05 Oct 2009 17:40:08 +0100 2860996 http://www.medworm.com/index.php?rid=2860995&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000592%2Fabstract%3Frss%3Dyes Nuclear medicine has entered a new era of multimodality imaging. Dedicated multislice single-photon emission computed tomography/computed tomography (SPECT/CT) cameras are relatively new additions to the diagnostic armamentarium in nuclear medicine. The integration of SPECT and CT provides precise anatomical localization and may enable characterization of abnormalities identified on planar or SPECT imaging by providing structural information by CT. The evidence in support of SPECT/CT is rapidly amounting but still relatively limited. To date, studies have suggested improved diagnostic confidence and specificity in the diagnosis of bone pathology. The combination of functional information and anatomical localization has the potential to influence medical practice with newer imaging algorith... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2860995 Mon, 05 Oct 2009 17:40:08 +0100 2860995 http://www.medworm.com/index.php?rid=2860994&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000476%2Fabstract%3Frss%3Dyes In this review, we assess the current role of single-photon emission computed tomography (SPECT) and positron emission tomography (PET) in the imaging of skeletal metastatic disease from a miscellaneous group of malignancies, including lung, thyroid, and renal carcinomas; multiple myeloma; and neuroendocrine tumors, and consider how recent advances may enhance their effectiveness in this area. Bone scintigraphy using technetium-labeled diphosphonates has long been the mainstay of functional imaging of bony metastases, but is of limited value in myeloma and aggressive osteolytic metastases, and has the limitation of relatively poor specificity. SPECT, as a tomographic imaging technique, produces three-dimensional images of tracer distribution from multiplanar images. Its application to bone... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2860994 Mon, 05 Oct 2009 17:40:08 +0100 2860994 http://www.medworm.com/index.php?rid=2860993&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000415%2Fabstract%3Frss%3Dyes Breast cancer is the most common cause of bone metastases in women. Imaging studies are useful to identify bone involvement and associated complications, for follow-up of disease spread and for the assessment of response to therapy. Bone scintigraphy with 99mtechnetium-labeled diphosphonates is most widely used, due to its availability, high sensitivity, and low cost, despite the relatively low specificity. The addition of single-photon emission computed tomography and recently single-photon emission computed tomography/computed tomography improves the diagnostic accuracy of this modality. Serial follow-up scans can demonstrate disease progression, but this method is less accurate in determining response to treatment. Positron emission tomography (PET), a tomographic modality with improved... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2860993 Mon, 05 Oct 2009 17:40:08 +0100 2860993 http://www.medworm.com/index.php?rid=2860992&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000427%2Fabstract%3Frss%3Dyes In prostate cancer, bone is the second most common site of metastatic disease after lymph nodes. This is related to a poor prognosis and is one of the major causes of morbidity and mortality in such patients. Early detection of metastatic bone disease and the definition of its extent, pattern, and aggressiveness are crucial for proper staging and restaging; it is particularly important in high-risk primary disease before initiating radical prostatectomy or radiation therapy. Different patterns of bone metastases, such as early marrow-based involvement, osteoblastic, osteolytic, and mixed changes can be seen. These types of metastases differ in their effect on bone, and consequently, the choice of imaging modalities that best depict the lesions may vary. During the last decades, bone scinti... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2860992 Mon, 05 Oct 2009 17:40:08 +0100 2860992 http://www.medworm.com/index.php?rid=2860991&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000579%2Fabstract%3Frss%3Dyes Bone scintigraphy is one of the most common investigations performed in nuclear medicine and is used routinely in the evaluation of patients with cancer for suspected bone metastases and in various benign musculoskeletal conditions. Innovations in equipment design and other advances, such as single-photon emission computed tomography (SPECT), positron emission tomography, positron emission tomography/computed tomography (CT), and SPECT/CT have been incorporated into the investigation of various musculoskeletal diseases. Bone scans frequently show high sensitivity but specificity, which is variable or limited. Some of the limited specificity can be partially addressed by a thorough knowledge and experience of normal variants and common patterns to avoid misinterpretation. In this review, we... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2860991 Mon, 05 Oct 2009 17:40:08 +0100 2860991 http://www.medworm.com/index.php?rid=2860990&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000403%2Fabstract%3Frss%3Dyes This article reviews methods of quantifying 99mTc-methylene diphosphonate (99mTc-MDP) kinetics based on a standard bone scan examination by measuring the plasma clearance of tracer to the whole skeleton and/or selected ROIs drawn on the bone scan image. Although the measurement of bone plasma clearance requires blood sampling to find the input curve for free (eg, nonprotein bound) 99mTc-MDP, we argue that plasma clearance studies give a more physiological approach in a better accord with the underlying changes in bone turnover than conventional measurements of whole-body retention or bone uptake. We describe 3 methods of measuring whole-skeleton 99mTc-MDP plasma clearance (Kbone): (1) the area under the curve (AUC) method based on taking 6 blood samples at 5, 15, 60, 120, 180, and 240 minu... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2860990 Mon, 05 Oct 2009 17:40:08 +0100 2860990 http://www.medworm.com/index.php?rid=2860989&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000464%2Fabstract%3Frss%3Dyes The endpoint of an efficient and accurate diagnosis of musculoskeletal pathology can take many different routes. Currently, conventional radiological techniques, such as plain radiography, ultrasonography, computed tomography, and magnetic resonance imaging are used in the assessment of patients with benign and malignant bone disease. An understanding of the advantages and limitations of the modalities available will help expedite diagnosis, and hence treatment. In this review, we discuss the advantages and limitations of the modalities available in investigating benign and malignant musculoskeletal pathology. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2860989 Mon, 05 Oct 2009 17:40:08 +0100 2860989 http://www.medworm.com/index.php?rid=2860988&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000580%2Fabstract%3Frss%3Dyes We have had the privilege of previously editing single volumes of Seminars in Nuclear Medicine, but to edit a double volume seems a rare treat indeed. This provides us with the opportunity to address, in considerable depth, many of the topics that we are passionate about and that we hope will provide a source of reference, which will stand the test of time. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2860988 Mon, 05 Oct 2009 17:40:08 +0100 2860988 http://www.medworm.com/index.php?rid=2860987&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS000129980900066X%2Fabstract%3Frss%3Dyes The radionuclide bone scan has been one of the cornerstones of nuclear medicine practice during the past 4 decades. It became clear in the 1960s that strontium-85, with its long physical half-life of 64 days and its very limited administered dose allowance of 100-200 μCu, was superior to plain radiographs for the detection of metastatic bone disease. Because of the high dosimetry, regulatory bodies restricted the use of strontium-85 to suspected malignant disease in adults and proven malignant disease in children. Although promising reports on its non-neoplastic applications were available from outside the United States, that indication was not allowed in the United States. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2860987 Mon, 05 Oct 2009 17:40:06 +0100 2860987 http://www.medworm.com/index.php?rid=2655912&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000452%2Fabstract%3Frss%3Dyes I write to provide clarification with respect to the article by Gemmel et al in the January 2009 issue of Seminars in Nuclear Medicine. In their article entitled “Future Diagnostic Agents,” Table 4 suggests several potential problems with using radiolabeled FIAU for imaging bacterial infection. They state that it is for late imaging, that the synthesis and purification are elaborate and, most importantly, that there is a risk of liver failure with this agent. We have only used this agent for late imaging in the one clinical trial we performed, but suspect it will perform even better in acute, untreated infections. The synthesis is very easy—one step from a commercially available precursor (FAU)—as is the purification, both of which are highly amenable to automation, as for other ra... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2655912 Fri, 31 Jul 2009 11:37:08 +0100 2655912 http://www.medworm.com/index.php?rid=2655911&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000142%2Fabstract%3Frss%3Dyes Multimodality imaging with positron emission tomography/computed tomography (PET/CT) and single-photon emission computed tomography (SPECT)/CT has become commonplace in clinical practice and in preclinical and basic biomedical research. Do other combinations of imaging modalities have a similar potential to impact medical science and clinical medicine? Presently, the combination of PET or SPECT with magnetic resonance imaging (MRI) is an area of active research, while other, perhaps less obvious combinations, including CT/MRI and PET/optical also are being studied. In addition to the integration of the instrumentation, there are parallel developments in synthesizing imaging agents that can be viewed by multiple imaging modalities. Is the fusion of PET and SPECT with CT the ultimate answer ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2655911 Fri, 31 Jul 2009 11:37:08 +0100 2655911 http://www.medworm.com/index.php?rid=2655910&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS000129980900018X%2Fabstract%3Frss%3Dyes The past few years have witnessed impressive advances in the field of noninvasive cardiac imaging. For example, computed tomography (CT) coronary angiography has been adopted into daily clinical routine and, at least in some patient populations, is challenging the role of invasive angiography as the anatomic standard of reference. This is because the latter is associated with a nonnegligible periprocedural morbidity and mortality, which suggests confining its use to patients who will benefit from a revascularization procedure. Many factors that are beyond the quantification of anatomic narrowing and therefore cannot be fully appreciated with morphologic assessment will eventually determine whether or not a given lesion produces stress-induced ischemia. Myocardial perfusion imaging with sin... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2655910 Fri, 31 Jul 2009 11:37:08 +0100 2655910 http://www.medworm.com/index.php?rid=2655909&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000154%2Fabstract%3Frss%3Dyes The incremental diagnostic value of integrated positron emission tomography–computed tomography (PET/CT) or single-photon emission computed tomography (SPECT)/CT images compared with PET or SPECT alone, or PET or SPECT correlated with a CT obtained at a different time includes the following: (1) improvement in lesion detection on both CT and PET or SPECT images, (2) improvement in the localization of foci of uptake resulting in better differentiation of physiological from pathologic uptake, (3) precise localization of the malignant foci, for example, in the skeleton vs soft tissue or liver vs adjacent bowel or node (4) characterization of serendipitous lesions, and (5) confirmation of small, subtle, or unusual lesions. The use of these techniques can occur at the time of initial diagnosi... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2655909 Fri, 31 Jul 2009 11:37:08 +0100 2655909 http://www.medworm.com/index.php?rid=2655908&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000440%2Fabstract%3Frss%3Dyes The availability of hybrid devices that combine the latest single-photon emission computed tomography (SPECT) imaging technology with multislice computed tomography (CT) scanning has allowed us to detect subtle, nonspecific abnormalities on bone scans and interpret them as specific focal areas of pathology. Abnormalities in the spine can be separated into those caused by pars fractures, facet joint arthritis, or osteophyte formation on vertebral bodies. Compression fractures can be distinguished from severe degenerative disease, both of which can cause intense activity across the spine on either planar or SPECT imaging. Localizing activity in patients who have had spinal fusion can provide tremendous insight into the causes of therapeutic failures. Infections of the spine now can be diagno... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2655908 Fri, 31 Jul 2009 11:37:07 +0100 2655908 http://www.medworm.com/index.php?rid=2655907&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000439%2Fabstract%3Frss%3Dyes This second part of the Hybrid Imaging Anniversary Issue rounds out our review of the contribution of computed tomography (CT) to single-photon emission computed tomography (SPECT) and positron emission tomography (PET) imaging. In addition, it directs us toward the future and the potential role of PET/magnetic resonance imaging (MRI) as another example of the benefits and complimentary roles of metabolic and imaging devices. MRI provides an even more complex potential because it is a molecular imaging method which, as part of a hybrid device, would allow us to look at two different aspects of metabolism and an aspect of anatomy during the same patient examination. For the present, as Dr Thakur has pointed out, there are several needs, challenges, and potential solutions to improve hybrid ... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2655907 Fri, 31 Jul 2009 11:37:07 +0100 2655907 http://www.medworm.com/index.php?rid=2482452&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000166%2Fabstract%3Frss%3Dyes The last decade has seen the development of hybrid imaging technologies combining positron emission tomography (PET) or single-photon emission computed tomography (SPECT) with x-ray computed tomography (CT). Numerous studies demonstrate the superiority of PET/CT and SPECT/CT over stand-alone PET and SPECT in terms of diagnostic accuracy. For PET with 18F-fluorodeoxyglucose (FDG), this has been demonstrated for bronchial carcinomas, high-grade lymphomas, melanomas, and head and neck tumors, to name a few. Combined imaging of structure and biochemistry is expected to be even more important for tracers such as 124I that are more specific for tumor tissue. Similarly, SPECT/CT has revolutionized the field of conventional nuclear medicine. Available evidence indicates that this hybrid imaging te... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2482452 Wed, 17 Jun 2009 08:05:38 +0100 2482452 http://www.medworm.com/index.php?rid=2482451&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000178%2Fabstract%3Frss%3Dyes In-line combined systems, single-photon emission computed tomography (SPECT)/computed tomography (CT) and positron emission tomography (PET)/CT, allow an instant generation of fused images of scintigraphy and CT data. The accumulated clinical data on the use of these systems in various clinical scenarios indicate that this hybrid technology improves the diagnostic accuracy as compared to scintigraphy and CT alone and even to side-by-side interpretation of scintigraphy and CT, which were acquired separately. The improved diagnostic accuracy is reflected by improving image quality of SPECT and PET, detection of more clinically relevant lesions, better localization of disease and differentiation between physiologic and pathologic uptake, characterization of disease by its functional and morph... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2482451 Wed, 17 Jun 2009 08:05:38 +0100 2482451 http://www.medworm.com/index.php?rid=2482450&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000191%2Fabstract%3Frss%3Dyes Early in the history of nuclear medicine imaging it was realized that the nature of physiological mechanisms associated with the use of radiotracers prevented the identification of anatomic structures with a high degree of accuracy. This limitation often created difficulties in accurate interpretations of acquired images and caused investigators to seek methods of obtaining accurate anatomic correlations. Initial work centered on the use of software tools to combine anatomic and physiological data. Limitations in the use of these techniques, coupled with the development and refinements of anatomic imaging technologies (computed tomography [CT] and magnetic resonance imaging [MRI]), resulted in the development of hybrid imaging systems that combined CT with single-photon emission computed t... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2482450 Wed, 17 Jun 2009 08:05:36 +0100 2482450 http://www.medworm.com/index.php?rid=2482449&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000208%2Fabstract%3Frss%3Dyes This article briefly describes this approach and gives specific examples that depict the ability of molecular imaging to detect occult lesions not detectable by current scintigraphic approaches. The article also outlines a few examples predicting other possible applications of targeting such specific probes not yet used. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2482449 Wed, 17 Jun 2009 08:05:29 +0100 2482449 http://www.medworm.com/index.php?rid=2482448&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS0001299809000038%2Fabstract%3Frss%3Dyes One of the challenges of healthcare in the 21st century is to diagnose and treat diseases in their infancy. Imaging plays an important role in achieving this goal. In nuclear medicine we have the privilege of being able to detect disease-related dysfunction that can occur before anatomic changes can be appreciated. With the emergence of molecular imaging, we are now developing targeted diagnostic and therapeutic agents that are able to visualize functional changes at (sub)cellular levels. (Source: Seminars in Nuclear Medicine) Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2482448 Wed, 17 Jun 2009 08:05:25 +0100 2482448 http://www.medworm.com/index.php?rid=2482447&cid=s_38658_37_f&fid=38658&url=http%3A%2F%2Fwww.seminarsinnuclearmedicine.com%2Farticle%2FPIIS000129980900021X%2Fabstract%3Frss%3Dyes This issue, and the following issue of Seminars in Nuclear Medicine in September, are devoted to hybrid imaging. This year marks the 10th anniversary of the introduction of hybrid imaging into clinical practice. Drs. Martin Sandler and Ora Israel have been pioneers in this exciting technological development. The editors are delighted that they have agreed to work together to produce a special anniversary issue of Seminars. Drs. Sandler and Israel have assembled an outstanding team of investigators and clinicians to formulate this seminar. The articles contained in this issue and the subsequent publication in September cover a wide range of applications, technological developments, and speculation on the future development of this technology. Drs. Sandler and Israel have provided detailed a... Seminars in Nuclear Medicine journals http://www.medworm.com/rss/comments.php?id=2482447 Wed, 17 Jun 2009 08:05:24 +0100 2482447