[en] Over the last 20 years the availability of magnetic resonance imaging and positron-emission tomography technologies as well as of cerebrospinal fluid biomarkers has allowed research and clinical approach to Alzheimer’s disease (AD) to move towards the earliest manifestations of the disease. This new approach resulted in an increasing knowledge about in-vivo biological and neuropathological processes of each phase of the AD-related damage from preclinical, to mild cognitive impairment, and finally to dementia due to AD. The present narrative review deals with the available data as well as with the unsolved issued related to the incorporation of AD biomarkers into the clinical practice. Ongoing research efforts aiming to better define and implement the use of imaging AD biomarkers in clinical practice according to a patient-centered approach and sustainability for clinical-care systems are also discussed.

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[en] 

Purpose

We aimed to systematically review studies addressing the value of baseline FDG PET as predictive biomarker for response to RIT in patients with NHL.

Methods

We searched (last update: March 2019) the databases PubMed, PMC, Google Scholar and Medline using both as text and as MeSH (Medical Subject Headings) terms the following: “positron emission tomography—PET”, “PET/CT”, “FDG”, “¹⁸F-fluorodeoxyglucose”, and “radioimmunotherapy”, ‘⁹⁰Y-ibritumomab tiuxetan” and “non-Hodgkin lymphoma” and “follicular lymphoma”. Among all the retrieved articles, we selected only those specifically analyzing role, predictive and overall value of pretreatment FDG PET in patients with NHL submitted to RIT.

Results

The initial search retrieved seventy articles, however, only eight specifically analyzed the predictive value of pretreatment FDG PET in patients with NHL submitted to RIT and were thus discussed. Eight studies in 254 patients evaluated the role of FDG PET as a predictor of response prior to RIT. Despite several methodological issues, patients- and lesion-based analyses carried out to-date seem to suggest a relevant prognostic role of both morphological computed tomography and metabolic imaging.

Conclusions

Although it is still not possible to specifically define the best PET-based predictor (i.e. SUVmax, TLG, MTV), FDG-PET is a promising tool for a more accurate and individualized selection of NHL patients candidates to RIT. The availability of FDG PET examinations in homogenous group of patients included in already completed clinical trials might be used in the next future also to specifically assess the prognostic value of baseline FDG PET in patients treated with RIT based on the study design.

[en] Over the last several decades, radionuclide Myocardial Perfusion Imaging (MPI) has been a mainstay for the evaluation of coronary artery disease (CAD), based on the assumption that a detailed knowledge of stenosis localization and severity is not sufficient for clinical decision making. Furthermore, radionuclide MPI diagnostic accuracy has been implemented by the assessment of Coronary Flow Reserve (CFR) and Myocardial Blood Flow (MBF), as quantitative indexes of stenosis severity and surrogates of total ischaemic burden. Several considerations indicate that these measurement actually improve description of coronary physiology with respect to conventional qualitative image analysis. However, several alternative approaches have been optimized and increasingly proposed to achieve this task in the clinical setting. The aim of the present narrative review is to discuss strengths and weaknesses of the various cardiac modalities proposed to define CFR and MBF in the era of multi-modality imaging.

[en] To identify both clinical and FDG PET/CT-derived factors predicting the occurrence of relapse, or conversely, the likelihood of false positive findings in surveillance FDG-PET/CT studies (PETsv). The study included 149 asymptomatic patients with Hodgkin's lymphoma (HL) (n = 55) or diffuse large B cell lymphoma (DLBCL) (n = 94) in first remission. PETSv studies were performed 12, 18, 24 and 36 months thereafter. Logistic regression analysis was performed to identify clinical and imaging-derived predictors of either PET-detected relapse or false-positive (FP) results. Tested clinical variables were:(1) age, (2) HL vs. DLBCL, (3) stage of disease, (4) bulky disease, (5) previous radiotherapy. PET/CT-derived variables were: (1) maximum standardized uptake value at baseline, (2) size-incorporated maximum standardized uptake value (SIMaxSUV) at baseline, (3) positive interim PET(PET-2), (4) presence of hot spots likely to be unrelated to the disease in final PET, (5) residual non-FDG avid mass. Accuracy was 88 % for PETsv1, 95 % for PETsv2, 95 % for PETsv3 and 91 % for PETsv4. However, PPV was relatively low in all PETsv. Best predictors of relapse were result of interim PET, HL versus NHL type, SIMaxSUV, age ≥ 60. Best predictors of FP were previous radiotherapy and hot spots unrelated to the disease in final PET. The present study confirms the need of restricting the use of surveillance PET/CT to patients at high risk of relapse. Information derived from PET/CT performed at baseline (metabolic disease burden), in the course (PET2) and at the end of therapy (unrelated hot spots) can help to select high-risk patients and also to identify patients more likely to present equivocal findings at PETsv. (orig.)

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[en] The mechanisms underlying increased cardiovascular risk in primary hyperparathyroidism (pHPT) have not been fully defined. Recently, this issue has become the subject of renewed interest due to the increasing evidence that the endothelium and vascular wall are targets for parathyroid hormone (PTH). The aim of this study was to measure regional coronary flow reserve (CFR) to determine whether the vascular damage induced by pHPT extends to affect the coronary microvascular function. A total of 22 pHPT patients without a history of coronary artery disease and 7 age-matched control subjects were recruited. Dipyridamole myocardial blood flow (MBF) was assessed using ^99mTc-sestamibi by measuring first-transit counts in the pulmonary artery and myocardial count rate from G-SPECT images. Baseline MBF was estimated 2 h later according to the same procedure. Regional CFR was defined as the ratio between dipyridamole and baseline MBF using a 17-segment left ventricular model. Three pHPT patients showed reversible perfusion defects and were excluded from the analysis. In the remaining 19, CFR was significantly lower with respect to the control subjects (1.88 ± 0.64 vs. 3.36 ± 0.66, respectively; p < 0.01). Moreover, patients studied for more than 28 months from pHPT diagnosis showed lower CFR values than the others (1.42 ± 0.18 vs. 2.25 ± 0.64, respectively; p < 0.01). Consequently, the time from diagnosis to the nuclear study showed a reasonable correlation with the degree of CFR impairment (Spearman's rho -0.667, p < 0.02). pHPT is associated with a significant dysfunction of the coronary microcirculation. This disorder might contribute to the high cardiovascular risk of conditions characterized by chronic elevations in serum PTH levels. (orig.)

[en] This joint practice guideline or procedure standard was developed collaboratively by the European Association of Nuclear Medicine (EANM) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). The goal of this guideline is to assist nuclear medicine practitioners in recommending, performing, interpreting, and reporting the results of dopaminergic imaging in parkinsonian syndromes. Currently nuclear medicine investigations can assess both presynaptic and postsynaptic function of dopaminergic synapses. To date both EANM and SNMMI have published procedural guidelines for dopamine transporter imaging with single photon emission computed tomography (SPECT) (in 2009 and 2011, respectively). An EANM guideline for D2 SPECT imaging is also available (2009). Since the publication of these previous guidelines, new lines of evidence have been made available on semiquantification, harmonization, comparison with normal datasets, and longitudinal analyses of dopamine transporter imaging with SPECT. Similarly, details on acquisition protocols and simplified quantification methods are now available for dopamine transporter imaging with PET, including recently developed fluorinated tracers. Finally, [${}^{18}$F]fluorodopa PET is now used in some centers for the differential diagnosis of parkinsonism, although procedural guidelines aiming to define standard procedures for [${}^{18}$F]fluorodopa imaging in this setting are still lacking. All these emerging issues are addressed in the present procedural guidelines for dopaminergic imaging in parkinsonian syndromes.

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