[en] Background: Lung hernia is a rare finding, described as the protrusion of the lung tissue outside the pleural cavity. Lung perfusion scintigraphy is used for pre-operative assessment of high-risk patients prior to pneumonectomy. Methodology: This is a case report of a 7-year old girl who presented with pulmonary tuberculosisdestroyed right lung and compensatory hyperinflated left lung. She underwent lung perfusion scintigraphy prior to her contemplated right lung pneumonectomy. Results: Her lung scan exhibited segmental/subsegmental perfusion defects in the anterior and superior lingual lobes of the left lung while the right lung appeared non-functional with demonstrable absent perfusion except for the tracer activity appreciated in its superior area. This represented the apical left lung hernia. Conclusion: The apical left lung herniation into the superior area of the right lung produced a static anterior image similar to the face of a raven. Therefore, I named it the “Raven Sign”. (author)

[en] Background: It is well known that metabolic imaging with FDG PET scan is very helpful in Hodgkin lymphoma (HL) assessment in initial staging, relapse, final and interim therapy control. Our goal was to characterize the population referred to FDG evaluation in patients with diagnosis of HL. Methodology: We analysed our database since 2003 and obtained 510 FDG scans performed in patients with HL confirmed by biopsy. Some have a metabolic control up to 7 studies. We reviewed demographic data, histological subtypes and FDG indications. Results: The group consisted of 321 patients between 3 and 83 y.o. (mean age: 31±16; 19% ≤18 y.o.); 52% females. There was no gender predominance in children. Age distribution and gender is displayed in Graphic A with a peak in younger adults. There was a significant predominance of adult females with nodular sclerosis compared with mixed cellularity in all adults and also in younger adult females (p=0.009); the association was not observed in children or adults older than 35 y.o. Graphic B.

[en] Background: Thyroid cancer represents 6.33% of all thyroid diseases and 0.89% of all cancers in Mali. If the diagnosis is made by needle biopsy or surgery, ultrasound helps to select the nodes to be punctured. This retrospective study aimed to evaluate the role of imaging techniques, especially ultrasonography in the diagnosis and follow up of thyroid cancer in our practice. Methodology: This retrospective study was done through analysing the radiologic data of patients suffering from thyroid cancer to identify those who had at least an initial and follow up neck ultrasonography. 40 out of 58 patients’ data were analysed. Results: After data analysis we found that a nodule with blurred edges without full hypothyreosis, or anechoic perinodular halo, with calcifications in it and a predominant intranodular vascularization is highly suspicious of malignancy in our practice. Additionally, in the preoperative phase, ultrasound plays a key role in helping to find locoregional lymph nodes whose presence changes the surgery (lymphadenectomy). Also, after surgery, ultrasound monitoring is essential for a local recurrence and lymph node recurrences, especially in the case of a suspicious clinical or biological pattern. In the particular case of medullary thyroid cancer (MTC), lymph node and/or distant metastatic spread is much more common. Follow-up requires multiple morphologic imaging procedures for chest (lung, mediastinum), liver, and skeleton. Conclusion: Ultrasound plays an important role in the diagnosis and monitoring of thyroid cancer in our practice. (author)

[en] Background: The objective of this study was the evaluation of the role of 68Ga-DOTA-TATE PET/CT in the diagnosis and management of neuroendocrine tumours (NET). Methodology: 27 patients with NET underwent 68Ga-DOTA-TATE PET/CT which was performed after injection of 111-259 MBq (3-7 mCi) of 68Ga-DOTA-TATE. PET/CT images were compared with conventional imaging by two experienced nuclear medicine physicians. The results of PET/CT were correlated to histopathology results, when available and with radiological data after close follow-up. Results: 68Ga-DOTA-TATE PET/CT showed sensitivity and specificity of 76% and 92%, respectively, for primary tumour and 98% and 100% for metastases. It was superior in the detection of both primary tumour and metastases when compared to conventional imaging modalities. It changed the management strategy in 6 patients (22%). Conclusion: Our analysis in this relatively small patient cohort indicates that 68Ga-DOTA-TATE PET/CT is a highly sensitive and specific modality for the detection of NET especially for metastatic lesions, with better results when compared to conventional imaging modalities. This can have a significant impact on patient management. (author)

[en] Background: Incidence of neuroendocrine tumors (NET) is increasing due to the development of diagnostic tools including nuclear medicine techniques, conventional and PET imaging. SPECT/CT 99mTc-EDDA/HYNIC-TOC could be available everywhere and have a great potential in the management of NET. The objective of this study was to assess the role of SPECT/CT 99mTc-EDDA/HYNIC-TOC in the management of NET. Methodology: A retrospective study of 110 patients with suspected or confirmed NET was done from 2010 to 2014 in the Department of Nuclear Medicine. Clinical indications were: search of the primary (35%), contribution to the strategy and assessment of therapy (48%), location of the primary site (13%) and search for relapse after surgery (4%). SPECT/CT used was a dual head gamma camera with a diagnostic CT. Double reading of reporting was done systematically for all patients. Results: In the suspected NET, SPECT/CT 99mTc-EDDA/HYNIC-TOC enabled finding the primary in 14/37 (37%) and confirmed the diagnosis in 12 out of 15 patients. All paragangliomas and pancreatic tumors were positive on SPECT/CT 99mTc-EDDA/HYNIC-TOC. For therapy assessment, SPECT/CT 99mTc-EDDA/HYNIC-TOC contributed to the therapeutic strategy in 80% of patients and showed a poor response to targeted therapy in 3 patients. Conclusion: Despite the lack of Gallium peptide PET, SPECT/CT 99mTc-EDDA/HYNIC-TOC was determinant with a great clinical impact in the management of neuroendocrine tumors. (author)

[en] Background: In 2004, the idea of exploiting the unique characteristics of 3γ annihilation as a new PET imaging modality (3γ PET) was introduced by Kacperski and Spyrou and opened a new scientific field that aims to investigate the 3γ yield in hypoxic/normoxic/hyperoxic conditions in tissues for application to oncology. 3γ annihilation is considerably higher in a hypoxic environment. Methodology: The hydration behaviour in biological samples (blood and serum) of two types of hydrophilic materials, potential candidates for the construction of radiation phantoms, was evaluated. Type A is a HEMA/VP of EWC=38% while type B is an MMA/VP of EWC=75%. The hydrophilic materials dimensions were recorded after 1, 4, 9, 21, 33, 52, 70, and 97 hours of immersion in blood and serum (at room temperature) in order to observe the changes in shape and level of hydration. Results: The results indicate that the hydration rate is generally higher in serum. The hydration rates for blood and serum were quite similar for sample A; the diffusion coefficients were found to be 0.018 g/h in blood and 0.019 g/h in serum. For sample B, the hydration rate was different for blood and serum; the diffusion coefficients were found to be 0.055 g/h in blood and 0.061 g/h in serum. Conclusion: Hydrophilic materials are potentially suitable materials for the construction of hypoxic phantoms as they are tissue equivalent structures in which the hydration level and type of liquid content can be controlled. The peak-to-peak method was applied, by using hydrophilic material as a hypoxic phantom, to study the formation and quenching process of positronium that affect the relative yield of 3- to-2 photon annihilation. (author)

[en] The International Conference on Clinical PET/CT and Molecular Imaging (IPET 2015) was held at the IAEA Headquarters in Vienna, Austria from 5 to 9 October 2015, focused on reviewing important clinical aspects and appropriate use of medical imaging in the management of an entire spectrum of diseases including cancer. It gave the opportunity to evaluate the current status of state-of-the-art medical imaging, reflect on challenges, deliver ‘know-how’ via continuing medical education, and assist in improving the performance of clinical practice. In addition, it served as a venue to exchange information and share experiences in the field of diagnostic imaging and to interact with leading clinical scientists from developed and developing countries, to identify future challenges and trends, as well as the role of the IAEA and other professional organizations in addressing these issues. The Conference was organized by the IAEA in cooperation with: American College of Nuclear Medicine (ACNM); Arab Society of Nuclear Medicine (ARSNM); Asia Oceania Federation of Nuclear Medicine and Biology (AOFNMB); Asian School of Nuclear Medicine (ASNM); Asian Regional Cooperative Council for Nuclear Medicine (ARCCNM); Australian and New Zealand Society of Nuclear Medicine (ANZSNM); British Nuclear Medicine Society (BNMS); Canadian Association of Nuclear Medicine (CANM); European Association of Nuclear Medicine (EANM); European Federation of Organisations in Medical Physics (EFOMP); European Society of Radiology (ESR); International Organization for Medical Physics (IOMP); Internationional Society of Radiolabeled Blood Elements (ISORBE); MD Anderson Cancer Center; Singapore General Hospital (SGH); Society of Nuclear Medicine and Molecular Imaging (SNMMI); Society of Radiopharmaceutical Sciences (SRS); World Association of Radiopharmaceutical and Molecular Therapy (WARMTH); World Federation of Nuclear Medicine and Biology (WFNMB); World Molecular Imaging Society (WMIS).

[en] Background: The aim of this study was to evaluate the effectiveness of 18F-FDG PET-CT in preoperative staging and assessment of the operability in patients with gall bladder cancer. Methodology: 40 patients (13 males and 27 females, age range between 30 to 74) histopathologically, clinically and radiologically diagnosed with carcinoma of gall bladder had undergone contrast enhanced 18F-FDG PET-CT before curative or explorative surgery, ranging from staging laparotomy to radical cholecystectomy or more extensive partial hepatectomy and multivisceral resection. Meticulous lymph node dissection was carried out in indicated patients with complete clearance of N1 and N2 level nodes. Suspicious lymph node stations were recorded and frozen section analysis was done as required. Mean interval between PET-CT and surgery was 24.6 (0 – 86) days. Median lymph node harvest was 14.87 (1- 29). Sensitivity, specificity and accuracy of PET scan and operative findings as compared with histopathology were analysed under separate headings of primary lesion, locoregional lymph node (N1), distant lymph node (N2---celiac, SMA, retropancreatic and para-aortic nodes) and metastatic lesions. Results: Among the 40 patients, eligible patients available for analysis were 32 for primary lesion, 29 for regional lymph nodes (N1) and distant lymph nodes (N2) and 17 for metastatic lesions. Analysis of data shows good correlation between PET-CT imaging, intraoperative findings and histopathological reports.

[en] Background: In order to validate a combined technique in detection of sentinel nodes in vulvar cancer patients, lymphoscintigraphy and patent blue were applied in fourteen patients. Methodology: Patients with vulvar malignant tumours, stages I and II, had sentinel node detection using lymphoscintigraphy and a gamma probe in surgical room, after injection of Tc99m dextran and patent blue dye. Images were acquired in a single head gamma camera with LEHR collimator. Results: Thirteen patients with epidermoid vulvar carcinoma and one with vulvar malignant melanoma, 28 to 80 years old (median 68 years), were included in the study. These were consecutive patients delivered from Oncological Gynecology to the Nuclear Medicine Center of IPEN from 2000 to 2005. Sentinel nodes were seen between one and sixty minutes after injection. All sentinel nodes were located in the superficial inguinal region. Detection rate was 100% (14/14), with bilateral drainage in 29% of patients. Three out of 14 patients with vulvar cancer showed metastases in the sentinel node. Two of them had epidermoid vulvar carcinoma and one, malignant melanoma. There were no metastases in nonsentinel nodes when sentinel nodes were negative for metastases. Conclusion: It is feasible to localize sentinel nodes in vulvar cancer, using a combined technique with Tc99m dextran and patent blue dye. (author)

[en] Background: Breast carcinoma is known as the most common cancer in women. This study was carried out to elucidate the role of 18F-FDG PET/CT in restaging of treated breast neoplasm and to determine the impact on the management of suspected recurrence. Methodology: Retrospective analysis was performed on the PET/CT examination of 35 women with a suspicion of recurrent breast cancer based on clinical examination, tumour marker values (CA 15-3) and/or negative or equivocal findings on other imaging modalities. Results: PET/CT scan could detect only locoregional recurrence (mainly lymph nodes) in 12 patients, locoregional and distant metastasis in 15 patients, and only distant metastasis in 5 patients. Three patients were without evidence of recurrent disease and did not have any recurrence during a close follow up for 6 months. PET/CT led to management modification from locoregional treatment to systemic chemotherapy in 20/35 patients (57%). Conclusion: This study demonstrates the considerable role of FDG PET/CT in restaging of breast cancer with high tumour marker values and negative or equivocal findings on other conventional imaging modalities. PET/CT led to treatment optimization mainly in cases of single recurrent lesion that could be surgically removed. In addition, PET/CT can change the management by detecting distant metastasis. (author)