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By correcting the effect of tumor size on metabolic activity, the maximum standardized uptake value-to-tumor size (SUV :tumor size) ratio on fluorodeoxyglucose F18 positron emission tomography ( F-FDG PET)/computed tomography (CT) scans can be a prognostic parameter of non-small cell lung cancer (NSCLC). The current study evaluates the prognostic value of SUV :tumor size ratio on pretreatment F-FDG PET/CT scans in patients with NSCLC. Furthermore, the SUV :tumor size ratio is compared with other established PET parameters. This study included 108 patients with NSCLC who underwent pretreatment F-FDG PET/CT scans and curative lung surgery. The associations between the SUV :tumor size ratio and other conventional PET parameters were investigated. The recurrence-free survival according to the SUV :tumor size ratio was also analyzed. In addition, the SUV :tumor size ratio was compared according to postoperative pathologic findings. In total, 72 (66.7%) of the 108 participants presented with adenocarcinoma (ADC). Nineteen (17.6%) patients experienced recurrence during a median follow-up period of 32.3 months. The median SUV max:tumor size ratio was 2.37 (1.23 for ADCs and 3.90 for other histologic types). The SUV :tumor size ratio was associated with SUV and mean SUV, as well as metabolic tumor volume and total lesion glycolysis. Patients with an SUV :tumor size ratio higher than the median had a worse recurrence outcome than those with an SUV :tumor size ratio lower than the median. Participants with ADC who presented with lymphovascular invasion had a higher SUV :tumor size ratio than those without. The presence of lymph node metastasis and advanced histologic grade were associated with a high SUV :tumor size ratio in patients with ADC. The SUV :tumor size ratio on pretreatment F-FDG PET/CT scans was associated with aggressive tumor behavior and poor outcome in NSCLCs, particularly ADC. The SUV :tumor size ratio on pretreatment F-FDG PET/CT scans has a prognostic value in patients with NSCLCs, especially ADC.

Introduction: Systemic chemotherapy is typically administered following radical gastrectomy for advanced stage. To attenuate systemic side effects, we evaluated the effectiveness of regional chemotherapy using paclitaxel, albumin-paclitaxel, and liposome-encapsulated albumin-paclitaxel via subserosal injection in rat models employing nuclear medicine and molecular imaging technology. Method: Nine Sprague Dawley rats were divided into three groups: paclitaxel ( n = 3), albumin-paclitaxel nano-particles (APNs; n = 3), and liposome-encapsulated APNs ( n = 3). [ 123 I]Iodo-paclitaxel ([ 123 I]I-paclitaxel) was synthesized by conventional electrophilic radioiodination using tert -butylstannyl substituted paclitaxel as the precursor. Albumin-[ 123 I]iodo-paclitaxel nanoparticles ([ 123 I]APNs) were prepared using a desolvation technique. Liposome-encapsulated APNs (L-[ 123 I]APNs) were prepared by thin-film hydration using DSPE-PEG2000, HSPC, and cholesterol. The rats in each group were injected with each test drug into the subserosa of the stomach antrum. After predetermined times (30 min, 2, 4, 8 h, and 24 h), molecular images of nuclear medicine were acquired using single-photon emission computed tomography/computed tomography. Results: Paclitaxel, APNs, and L-APNs showed a high cumulative distribution in the stomach, with L-APNs showing the largest area under the curve. Most drugs administered via the gastric subserosal route are distributed in the stomach and intestines, with a low uptake of less than 1% in other major organs. The time to reach the maximum concentration in the intestine for L-APNs, paclitaxel, and APNs was 6.67, 5.33, and 4.00 h, respectively. Conclusion: These preliminary results imply that L-APNs have the potential to serve as a novel paclitaxel preparation method for the regional treatment of gastric cancer.

PURPOSE :Bone tracers have been validated for many years in detecting transthyretin cardiac amyloidosis (TTR-CA). However, several new studies suggest conflicting results. Our study aimed to systematically evaluate the accuracy of bone radiotracers for diagnosis and differentiation of TTR-CA via a systematic review and meta-analysis.METHODS:We retrieved articles assessing the performance of bone tracer in diagnosing and differentiating TTR-CA from PubMed, the Cochrane Library, ScienceDirect, and DOAJ databases, dating up to 10 July 2020. The meta-analysis was conducted through Stata 16 software, and the risk of bias for the included studies was assessed by the QUADAS-2 tool. Moreover, we made a comprehensive review.RESULTS:Fourteen articles were included in the systematic review, and 9 in the meta-analysis. The pooled sensitivity was 0.97 (95% confidence interval [95% CI] 0.85–0.99) with heterogeneity (I2=73.5, 95% CI 55.6–91.2), and the specificity was 0.92 (95% CI 0.82–0.96) with heterogeneity (I2=42.0, 95% CI 0.0–86.9). The pooled positive and negative likelihood ratios were 11.49 (95% CI 5.07–26.0) and 0.03 (95% CI 0.01–0.18), respectively. The diagnostic odds ratio was 341 (95% CI 53–2194), and the area under the receiver operating characteristic curve was 0.96 (95% CI 0.94–0.97).CONCLUSION:The findings evidence that the bone radiotracer is a valuable noninvasive approach that provides high accuracy for diagnosing TTR-CA and plays a modest role in differentiating TTR-CA from immunoglobulin amyloid light-chain cardiac amyloidosis. 99mTc-HMDP may be more accurate than 99mTc-PYP, 99mTc-DPD, and 18F-NaF in the TTR-CA detecting process, and 18F-NaF is a promising bone tracer to diagnose and differentiate TTR-CA.

This study aimed to evaluate the jaw pathologies of patients with bone metastases using a computer program to assess the bone scan index (BSI) for Tc-99m hydroxymethylene diphosphonate (HMDP) with single-photon emission computed tomography/computed tomography (SPECT/CT). Ninety-seven patients with jaw pathologies (24 with bone metastases and 73 without) were evaluated. High-risk hot spots and BSI in the patients were evaluated using the VSBONE BSI (ver.1.1) analysis software for Tc-99m HMDP that scanned SPECT/CT and automatically defined the data. The two groups were compared using the Pearson chi-square test and Mann-Whitney U test for high-risk hot spots and BSI, respectively. A P value of <0.05 was considered statistically significant. High-risk hot spot occurrence was significantly correlated to bone metastases [sensitivity, 21/24 (87.5%); specificity, 40/73 (54.8%); accuracy, 61/97 (62.9%); < 0.001]. The number of high-risk hot spots was higher in patients with bone metastases (5.96 ± 10.30) than in those without (0.90 ± 1.50; < 0.001). Furthermore, the BSI for patients with bone metastases (1.44 ± 2.18%) was significantly higher than for those without (0.22 ± 0.44%; < 0.001). A computer program that assessed BSI for Tc-99m HMDP may be useful in the evaluation of patients with bone metastases using SPECT/CT.

We aimed to determine the feasibility and accuracy of digital breast tomosynthesis-guided vacuum-assisted breast biopsy (DBT-VAB) for noncalcified lesions without a sonographic correlate and to assess the concordance of imaging and pathology findings. A retrospective review of our institutional biopsy database between December 11, 2015, and August 31, 2016, identified 72 consecutive women with 73 noncalcified lesions on digital breast tomosynthesis who underwent attempted DBT-VAB. Relevant imaging was reviewed in consensus by 3 fellowship-trained breast radiologists for imaging features and biopsy parameters. Medical records were reviewed for histopathology and imaging follow-up. The target lesion was successfully sampled by DBT-VAB in 99% (72 of 73) of cases. The median time to complete DBT-VAB was 16 minutes. No major complications were reported. Findings included 3 focal asymmetries (4%), 7 asymmetries (10%), 21 masses (29%), and 41 architectural distortions (ADs) (57%). Final histopathology was malignant in 24% (17 of 72), actionable high-risk in 4% (3 of 72), and benign in 72% (52 of 72). VAB pathology was concordant in 86% (62 of 72): 21% malignant, 6% high risk, and 60% benign. VAB pathology was discordant in 14% (10 of 72). One malignancy and 4 complex sclerosing lesions were missed after DBT-VAB of AD, which was confirmed on surgical excision. Therefore, the misdiagnosis rate for DBT-VAB was 7% (5 of 72). DBT-VAB is a quick and feasible biopsy method for targeting noncalcified mammographic lesions without a sonographic correlate. The 24% malignancy rate reaffirms that biopsy is necessary for suspicious mammographic lesions occult on ultrasound. Although DBT-VAB shows high accuracy for noncalcified lesions, meticulous radiology-pathology correlation is required in the interpretation of DBT-VAB results, with surgical excision of discordant cases.

PURPOSE Inflammation is known to induce prostatic growth and lower urinary tract symptoms (LUTS) progression in patients with benign prostatic hyperplasia (BPH), but clinical indicators for intraprostatic inflammation other than biopsy have not yet been established. While 2-deoxy- 2-[18F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) is a useful tool for investigating inflammatory conditions, prostatic FDG uptake in patients with BPH has not been elucidated. Therefore, we evaluated the association between prostatic FDG uptake and LUTS. METHODS A total of 391 men in their 50s who underwent FDG PET/CT during health examinations were included. Mean and maximal prostatic standard uptake values (SUVs) on FDG PET/CT were measured. Prostatic volume, focal FDG uptake, and calcification were also evaluated. The International Prostate Symptom Score (IPSS) for LUTS was collected at baseline and follow- ups. The correlation between IPSS and other variables was analyzed. RESULTS The mean age of the study participants was 51.7 years, and the mean follow-up interval was 39.7 months. The average of the mean and maximal SUV for prostatic FDG uptake was 1.8 and 2.6, respectively. The prostate volume was 18.5 cm3. The mean IPSS was 4.82 at baseline and 5.46 at follow-ups. Neither the mean SUV nor the maximal SUV of prostatic FDG uptake was correlated with IPSS at baseline or follow-ups. Conversely, prostate volume was associated with baseline IPSS and follow-up IPSS. CONCLUSION Prostatic FDG uptake did not show a significant association with IPSS on FDG PET/CT as well as at follow-ups. FDG uptake may not reflect prostatic growth in nonmalignant cases.

We aimed to evaluate the role of fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) involving care-dose unenhanced CT to detect extranodal involvement in patients with non-Hodgkin and Hodgkin lymphoma. Lymphoma patients (35 Hodgkin lymphoma, 75 non-Hodgkin lymphoma) who were referred for 18F-FDG PET-CT imaging, following a diagnostic contrast-enhanced CT (CE-CT) performed within the last month, were included in our study. A total of 129 PET-CT images, and all radiologic, clinical, and pathological records of these patients were retrospectively reviewed. In total, 137 hypermetabolic extranodal infiltration sites were detected by 18F-FDG PET-CT in 62 of 110 patients. There were no positive findings by CE-CT that reflected organ involvement in 40 of 137 18F-FDG-positive sites. The κ statistics revealed fair agreement between PET-CT and CE-CT for the detection of extranodal involvement (κ=0.60). The organs showing a disagreement between the two modalities were the spleen, bone marrow, bone, and thyroid and prostate glands. In all lesions that were negative at CE-CT, there was a diffuse 18F-FDG uptake pattern in the PET-CT images. The frequency of extranodal involvement was 51% and 58% in Hodgkin and non-Hodgkin lymphoma patients, respectively. There was a high positive correlation between the maximum standardized uptake values of the highest 18F-FDG-accumulating lymph nodes and extranodal sites (r=0.67) in patients with nodal and extranodal involvement. 18F-FDG PET-CT is a more effective technique than CE-CT for the evaluation of extranodal involvement in Hodgkin and non-Hodgkin lymphoma patients. PET-CT has a significant advantage for the diagnosis of diffusely infiltrating organs without mass lesions or contrast enhancement compared to CE-CT.

The present article has investigated the added value of ultrasound (US) guidance on improving the efficacy of local triamcinolone injection via comparing two US-guided methods versus a conventional landmark-guided approach. Eighty-one subjects with mild or moderate CTS were included and randomly assigned into three categories including landmark-guided, conventional US-guided midline approach and US-guided ulnar in-plane method. Primarily, participants in the three groups were relatively similar in terms of demographics and their clinical variables comprising visual analog scale (VAS) for pain, pain-free grip strength (PFGS), Boston CTS questionnaire (BCTQ), EDX parameters, and cross-sectional area (CSA) of median nerve measured by ultrasonography. Ten weeks after injection, the changes of clinical and para-clinical outcomes were reassessed for 76 patients who finished the study. Our findings showed that all three injection methods were associated with a significant and relatively similar improvement in clinical and electrodiagnostic parameters. The post-injection evaluation showed a statistically significant change in all variables except for symptom severity score (SSS) of BCTQ. The best effect-size values were observed for VAS [56%] and functional severity scale (FSS) of BCTQ [42%], both reported in the US-guided midline group. However, no significant difference was found between the groups regarding their improvement in any of the outcome variables (P value >0.05). Based on the current data, all three injection methods were effective in improving electrodiagnostic findings and clinical symptoms of CTS. Although all approaches were relatively similar, US-guided midline approach was associated with slightly better outcomes.

Transient global amnesia (TGA) is characterized by sudden loss of memory of recent events, transient inability to retain new information, and retrograde amnesia. We investigated the changes of regional cerebral blood flow in patients with TGA shortly after symptom onset and after recovery using Tc-99m-ethyl cysteinate dimer single-photon emission computed tomography (Tc-99m ECD SPECT) and statistical parametric mapping (SPM) analysis. Six right-handed patients with TGA were studied using Tc-99m ECD SPECT shortly after symptom onset and after recovery. As a control group, six healthy individuals were also studied. Images were analyzed using SPM8 using voxel-based analysis to estimate the differences between TGA patients and controls. There was significant hypoperfusion in the left hippocampus, left thalamus, and bilateral cerebellum. In the follow-up SPECT scan, hypoperfusion in hippocampus and thalamus were restored, while hypoperfusion was noted in the temporoparietal region. Our results suggest that the underlying mechanism of TGA may be temporary ischemia in the hippocampus and thalamus. There was significant restoration of perfusion in the hippocampus and thalamus after recovery from TGA.