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Coronary artery calcification (CAC) on body CT imaging is considered a coincidental finding in cancer patients. In order to determine the significance of CAC in cancer patients we evaluated the prognostic utility of CAC detected on oncology FDG-PET/CT studies. A retrospective study was performed of consecutive FDG-PET/CT studies from January to March 2011. CAC was identified on the CT portion of FDG/PET-CT studies. Chart review documented statin use, the Framingham risk score (FRS) (includes age, diabetes, hypertension, dyslipidemia and smoking), the primary malignancy and metastases. The primary end point was a composite of death and cardiovascular (CV) events (non-fatal myocardial infarction (MI), PCI or coronary artery bypass surgery (CABG)). 266 patients had a median follow up of 41 months (95% CI 31–56 months). CAC was noted in 140 patients. Based on CAC, potentially 84 patients would have had a change in statin prescribing (p < 0.01). CAC was associated with the primary end point on univariable and multivariable analysis (OR 2.6 (95% CI 1.42–4.77) (p < 0.01). On univariable Kaplan–Meier survival analysis, CAC was associated with decreased survival only in the absence of metastases (p < 0.01). Cox proportional hazard modelling demonstrated CAC was associated with mortality and cardiac events in patients without metastases, whereas FRS was not (For CAC: HR 1.69 (95% CI 1.22–2.35), p = 0.002). CAC is commonly detected with oncology FDG-PET/CT. In cancer patients CAC was associated with an increased risk of clinical events. CAC reduced survival free time in patients without metastases. CAC might therefore be considered more than a coincidentaloma in patients without metastases.

Cardiac sarcoidosis is a potentially fatal complication of sarcoidosis. The 1993 guidelines of the Ministry of Health, Labour, and Welfare (MHLW) of Japan have been used as the diagnostic gold standard and for comparison with imaging modalities. (18)F-FDG PET is not currently included in the guidelines. However, studies have shown promising data using (18)F-FDG PET. We conducted a systematic review of studies that evaluated the accuracy of (18)F-FDG PET for the diagnosis of cardiac sarcoidosis compared with MHLW guidelines. Data from a prospective Ontario provincial registry are also reported and included in the metaanalysis. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies that satisfied predetermined criteria. Quality evaluation using the Quality Assessment for Diagnostic Accuracy Studies was performed by 2 independent masked observers. Data were extracted and analyzed to measure study-specific and pooled accuracy for (18)F-FDG PET compared with the MHLW as the reference. A total of 519 titles was identified; 7 studies, including the Ontario registry, were selected for inclusion. Metaanalysis of these 7 studies was conducted, with a total of 164 patients, most of whom had been diagnosed with systemic sarcoidosis. The prevalence of cardiac sarcoidosis was 50% in the whole population. Pooled estimates for (18)F-FDG PET yielded 89% sensitivity (95% confidence interval [CI], 79%-96%), 78% specificity (95% CI, 68%-86%), a 4.1 positive likelihood ratio (95% CI, 1.7-10), and a 0.19 negative likelihood ratio (95% CI, 0.1-0.4). The overall diagnostic odds ratio was 25.6 (95% CI, 7.3-89.5), and the area under the summary receiver operator characteristic curve was 93% ± 3.5. The Ontario study yielded sensitivity and specificity of 79% and 70%, respectively. The high diagnostic accuracy determined for (18)F-FDG PET in this metaanalysis suggests potential value for diagnosis of cardiac sarcoidosis compared with the MHLW guidelines. These results may affect patient care by providing supportive evidence for more effective use of (18)F-FDG PET in the diagnosis of cardiac sarcoidosis. Large-scale multicenter studies are required to further evaluate this role.

BackgroundInflammation is a key mediator in the development and progression of the atherosclerotic disease process as well as its resultant complications, like myocardial infarction (MI), stroke and cardiovascular (CV) death, and is emerging as a novel treatment target. Trials involving anti-inflammatory medications have demonstrated outcome benefit in patients with known CV disease. In this regard, colchicine appears to hold great promise. However, there are potential drawbacks to colchicine use, as some studies have identified an increased risk of infection, and a non-significant trend for increased all-cause mortality. Thus, a more thorough understanding of the underlying mechanism of action of colchicine is needed to enable a better patient selection for this novel CV therapy.ObjectiveThe primary objective of the Canadian Study of Arterial Inflammation in Patients with Diabetes and Recent Vascular Events, Evaluation of Colchicine Effectiveness (CADENCE) trial is to assess the effect of colchicine on vascular inflammation in the carotid arteries and ascending aorta measured with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT in patients with type 2 diabetes mellitus (T2DM) or pre-diabetes who have experienced a recent vascular event (acute coronary syndrome (ACS)/MI, transient ischaemic attack (TIA) or stroke). Secondary objectives include determining colchicine’s effect on inflammatory biomarkers (high-sensitivity C reactive protein (hs-CRP) and interleukin-6 (IL-6)). Additionally, we will assess if baseline inflammation imaging or biomarkers are associated with a treatment response to colchicine determined by imaging. Exploratory objectives will look at: (1) the difference in the inflammatory response to colchicine in patients with coronary events compared with patients with cerebral events; (2) the difference in the inflammatory response to colchicine in different vascular beds; (3) the relationship of FDG-PET imaging markers with serum biomarkers and (4) assessment of quality-of-life changes.Methods and designCADENCE is a multicentre, prospective, randomised, double-blinded, placebo-controlled study to determine the effect of colchicine on arterial inflammation as assessed with imaging and circulatory biomarkers, specifically carotid arteries and aortic FDG uptake as well as hs-CRP and IL-6 among others. Patients with T2DM or pre-diabetes who have recently experienced a CV event (within 30–120 days after an ACS (ie, ST-elevation MI (STEMI) or non-STEMI)) or TIA/stroke with documented large vessel atherosclerotic disease will be randomised to treatment with either colchicine 0.6 mg oral daily or placebo. Participants will undergo baseline clinical evaluation including EQ5D assessment, blood work for inflammatory markers and FDG PET/CT scan of the ascending aorta and left and right carotid arteries. Patients will undergo treatment for 6 months and have repeat clinical evaluation including EQ5D assessment, blood work for inflammatory markers and FDG PET/CT scan at the conclusion of the study. The primary outcome will be the change in the maximum target to background ratio (TBRmax) in the ascending aorta (or carotid arteries) from baseline to follow-up on FDG PET/CT imaging.DiscussionColchicine is an exciting potential new therapy for CV risk reduction. However, its use is associated with side effects and greater understanding of its underlying mechanism of action is needed. Importantly, the current study will determine whether its anti-inflammatory action is an indirect systemic effect, or a more local plaque action that decreases inflammation. The results will also help identify patients who will benefit most from such therapy.Trial registration numberNCT04181996.

Background2-deoxy-2-[18F]fluoro-d-glucose’s (FDG) biodistribution limits the evaluation of cardiac sarcoidosis (CS) and neurosarcoidosis (NS). While protocols for cardiac suppression exist, they can be inconvenient for patients and lead to incomplete cardiac suppression in many cases. Furthermore, FDG PET is limited in the detection of neurosarcoidosis due to an inability to suppress high level of physiological uptake within the brain. 3′-deoxy-3′-[18F]fluorothymidine (FLT) has been shown to accumulate in sarcoidosis lesions and this tracer lacks significant physiological myocardial and brain uptake, suggesting that this tracer may be useful for the assessment of sarcoidosis, including CS and NS, without the need for patient preparation. This prospective pilot study examined the performance of FLT vs FDG PET for systemic sarcoidosis, including cardiac and neural involvement.Materials and methodsFourteen subjects with sarcoidosis were prospectively recruited and imaged with FDG- and FLT-PET. Two blinded, experienced readers independently reviewed the FLT-PET and FDG-PET images. Lesion distribution was compared between FLT and FDG. Agreement between FLT- and FDG-PET was determined using Cohen’s kappa and the intra-class correlation coefficient. Inter-observer variability of FLT and FDG-PET was assessed.ResultsTwelve subjects had CS as per Heart Rhythm Society criteria and 1 had NS. FLT-PET was positive in 12 (86%), and FDG-PET in 11 (79%), with cardiac uptake present in 6 (50%) and 7 (58%) of subjects with CS, respectively. The subject with NS demonstrated uptake on both FLT and FDG-PET, with more lesions on FLT. There were no significant differences in the anatomical distribution of lesions between FLT and FDG. SUVs were significantly (p < 0.001) higher for FDG than FLT (5.8 ± 3.0 vs 2.3 ± 1.1, respectively), but not (p = 0.90) after adjusting for blood pool activity (2.8 ± 1.4 vs 2.8 ± 1.1, respectively). Agreement between FLT- and FDG-PET was good to excellent for the diagnosis of sarcoidosis, lung involvement, CS, and NS (κ = 0.76, 0.69, 0.86, and 1.0, respectively). Inter-observer agreement for FLT was excellent for diagnosing sarcoidosis, CS and NS (κ = 0.81, 0.85, and 1.0, respectively) and comparable to that of FDG.ConclusionsFLT-PET may be useful for the assessment of systemic sarcoidosis, as well as cardiac and neural involvement.

 Residency and fellowship training in nuclear medicine aims to equip specialists with diagnostic, technical, clinical, and research skills essential for clinical and academic roles. This study evaluates the effectiveness of a nuclear medicine training program as perceived by former trainees, focusing on mentorship, resources, curriculum content, and professional development. The objective of the study was to evaluate the perceived impact of nuclear medicine training programs on clinical competence, professional development, and career readiness, based on feedback from former trainees.  In 2024, an online survey was administered to former trainees of the nuclear medicine training program of the University of Ottawa, Canada, across multiple countries, including Canada, Saudi Arabia, Iran, and Oman. Responses from the 11 participants assessed satisfaction with mentorship, facilities, off-service rotations, and skill application post-training. Statistical analysis, including analysis of variance (ANOVA), evaluated the program's impact.  The program received high ratings for overall quality (45% (n=5) excellent, 35% (n=4) very good) and its contribution to professional success (85% (n=9) significantly or very significantly). The program was rated very effective by 65% (n=7) of respondents. Key strengths included hands-on training, access to technology, and diagnostic skill development. Areas for improvement included mentorship consistency, advanced equipment access, and structured leadership training.  The nuclear medicine residency and fellowship program effectively enhances diagnostic and clinical competencies. Enhancing mentorship, technology access, leadership development, and research support will optimize training outcomes.

Despite the profound prevalence and fracture risk of osteoporosis, access to the gold standard DXA scans remains limited, especially in rural communities. Rho is an artificial intelligence software that can identify individuals at risk of low BMD and osteoporosis using radiographs. This study will independently validate Rho software by evaluating its performance against DXA in a retrospective cohort of patients. We conducted a retrospective study of 4878 patients (mean age 70 ± 10, 80% female), with DXA acquired within 1 yr of a radiograph. The area under the curve (AUC) was calculated to evaluate the performance of Rho in identifying patients at risk for low BMD (T-Score < −1) and osteoporosis (T-Score ≤ −2.5). Further subgroup analyses were performed based on radiograph location, sex, and rural vs urban populations. The overall AUC for predicting low BMD was 0.840 (95% CI: 0.831-0.848), with an optimal Rho score threshold of 6. For osteoporosis prediction, the AUC was 0.815 (95% CI: 0.806-0.824), with an optimal Rho score threshold of 7. Rural and urban populations have strong AUCs for low BMD (AUC = 0.873; 0.873) and osteoporosis (AUC = 0.865; 0.812). Likewise, Rho demonstrated strong, comparable (p > .25) performance in both men and women for prediction of low BMD. Although, optimal cutoffs differed between females and males for both low BMD and osteoporosis. Rho demonstrated high effectiveness in identifying patients at risk for low BMD and osteoporosis. The findings support Rho as an opportunistic screening tool and may fill a clinical gap in communities lacking access to DXA.Lay Summary Low BMD and osteoporosis greatly increases the risk of bone fractures, so it is important to identify people with these conditions. We tested Rho, a new software program that can help identify those at high risk using a standard X-ray. We found that Rho was able to predict with a high level of accuracy individuals with low BMD or osteoporosis. These findings support using Rho as a screening tool, especially for individuals who have limited access to more specialized testing.

Despite the profound prevalence and fracture risk of osteoporosis, access to the gold standard dual-energy x-ray absorptiometry (DXA) scans remains limited, especially in rural communities. Rho™ is an artificial intelligence software that can identify individuals at risk of low bone mineral density and osteoporosis using radiographs. This study will independently validate Rho software by evaluating its performance against DXA in a retrospective cohort of patients. We conducted a retrospective study of 4,878 patients (mean age 70±10, 80% female), with DXA acquired within 1 year of a radiograph. The area under the curve was calculated to evaluate the performance of Rho in identifying patients at risk for low bone mineral density (T-Score <-1) and osteoporosis (T-Score ≤-2.5). Further subgroup analyses were performed based on radiograph location, sex, and rural versus urban populations. The overall AUC for predicting low BMD was 0.840 (95% CI: 0.831-0.848), with an optimal Rho score threshold of 6. For osteoporosis prediction, the AUC was 0.815 (95% CI: 0.806-0.824), with an optimal Rho score threshold of 7. Rural and urban populations have strong AUCs for low BMD (AUC=0.873; 0.873) and osteoporosis (AUC=0.865; 0.812). Likewise, Rho demonstrated strong, comparable (p>0.25) performance in both men and women for prediction of low BMD. Although, optimal cutoffs differed between females and males for both low BMD (6, 5) and osteoporosis (8, 6). Rho demonstrated high effectiveness in identifying patients at risk for low BMD and osteoporosis. The findings support Rho as an opportunistic screening tool and may fill a clinical gap in communities lacking access to DXA.

Multidisciplinary cancer conferences (MCCs) are essential forums for collaborative oncology decision-making. However, existing literature has primarily examined the role of attending specialists and has rarely differentiated effects by specialty. The contributions of trainees, particularly in nuclear medicine, have been largely overlooked, leaving a gap in understanding how their participation influences both educational outcomes and patient management. This study addresses this gap by systematically evaluating the perceived impact of nuclear medicine trainees in MCCs. A cross-sectional survey was distributed to 73 healthcare professionals at a tertiary medical center, including nuclear medicine specialists, trainees, and clinicians from surgery, oncology, and radiology. The survey included Likert-scale and multiple-choice questions to assess perceptions of trainee contributions to interprofessional collaboration, clinical decision-making, and patient outcomes. Descriptive statistics were calculated, and analysis of variance (ANOVA) and chi-square tests were applied to analyze Likert-scale responses and compare responses between nuclear medicine and non-nuclear medicine specialists. P-values < 0.05 were considered statistically significant. Of the 73 respondents, 57 (78.1%) indicated that nuclear medicine trainees enhanced interprofessional collaboration, while 56 (76.7%) reported a positive influence on patient care. Additionally, 60 (82.2%) perceived an educational benefit through enriched clinical knowledge. Chi-square analysis revealed no significant differences in perceptions across professional groups (p = 0.568). Reported barriers included inconsistent attendance, limited clinical experience, and time constraints. Nuclear medicine trainees play a valuable role in MCCs by enriching clinical discussions, supporting patient care, and contributing to professional development. To maximize their impact, structured learning opportunities, increased mentorship, and improved logistical support are recommended. These findings emphasize the importance of formally integrating trainees into MCC workflows to enhance both educational and clinical outcomes.

Purpose Cardiac sarcoidosis (CS) is a cause of conduction system disease (CSD). 18 F-Fluorodeoxyglucose-positron emission tomography (FDG PET) and cardiac magnetic resonance (CMR) are used for detection of CS. The relative diagnostic value of these has not been well studied. The aim was to compare these imaging modalities in this population. Methods We recruited steroid-naive patients with newly diagnosed CSD due to CS. All CS patients underwent both imaging studies within 12 weeks of each other. Patients were classified into two groups: group A with chronic mild CSD (right bundle branch block and/or axis deviation), and group B with new-onset atrioventricular block (AVB, Mobitz type II or third-degree AVB). Results Thirty patients were included. Positive findings on both imaging studies were seen in 72 % of patients (13/18) in group A and in 58 % of patients (7/12) in group B. The remainder (28 %) of the patients in group A were positive only on CMR. Of the patients in group B, 8 % were positive only on CMR and 33 % were positive only on FDG PET. Patients in group A were more likely to be positive only on CMR, and patients in group B were more likely to be positive only on FDG PET ( p  = 0.02). Patients in group B positive only on FDG PET underwent CMR earlier relative to their symptomatology than patients positive only on CMR (median 7.0, IQR 1.5 – 34.3, vs. 72.0, IQR 25.0 – 79.5 days; p  = 0.03). Conclusion The number of positive FDG PET and CMR studies was different in patients with CSD depending on their clinical presentation. This study demonstrated that CMR can adequately detect cardiac involvement associated with chronic mild CSD. In patients presenting with new-onset AVB and a negative CMR study, FDG PET may be useful for detecting cardiac involvement due to CS.

Cardiac sarcoidosis (CS) is a cause of conduction system disease (CSD). (18)F-Fluorodeoxyglucose-positron emission tomography (FDG PET) and cardiac magnetic resonance (CMR) are used for detection of CS. The relative diagnostic value of these has not been well studied. The aim was to compare these imaging modalities in this population. We recruited steroid-naive patients with newly diagnosed CSD due to CS. All CS patients underwent both imaging studies within 12 weeks of each other. Patients were classified into two groups: group A with chronic mild CSD (right bundle branch block and/or axis deviation), and group B with new-onset atrioventricular block (AVB, Mobitz type II or third-degree AVB). Thirty patients were included. Positive findings on both imaging studies were seen in 72 % of patients (13/18) in group A and in 58 % of patients (7/12) in group B. The remainder (28 %) of the patients in group A were positive only on CMR. Of the patients in group B, 8 % were positive only on CMR and 33 % were positive only on FDG PET. Patients in group A were more likely to be positive only on CMR, and patients in group B were more likely to be positive only on FDG PET (p = 0.02). Patients in group B positive only on FDG PET underwent CMR earlier relative to their symptomatology than patients positive only on CMR (median 7.0, IQR 1.5 - 34.3, vs. 72.0, IQR 25.0 - 79.5 days; p = 0.03). The number of positive FDG PET and CMR studies was different in patients with CSD depending on their clinical presentation. This study demonstrated that CMR can adequately detect cardiac involvement associated with chronic mild CSD. In patients presenting with new-onset AVB and a negative CMR study, FDG PET may be useful for detecting cardiac involvement due to CS.