Devaki Shilpa Surasi

¹⁸F-FDG PET and PET/CT patient preparation: a review of the literature.

For many types of cancer, 18F-FDG PET/CT is commonly used in evaluation and management, including tumor diagnosis, staging, restaging, treatment monitoring, and radiation therapy planning. Meticulous patient preparation including restrictions of diet and activity and management of blood glucose levels in diabetic patients, as well as an awareness of the effect of medications and environmental conditions, plays an important role toward obtaining good-quality images, which are essential for accurate interpretation. Protocol guidelines for performing PET/CT have been proposed by various societies and groups, including the Society of Nuclear Medicine and Molecular Imaging, the European Association of Nuclear Medicine, the American College of Radiology, and the National Cancer Institute. Standardization of the PET/CT procedure is necessary to enable use of metabolic parameters as imaging biomarkers in routine clinical decision making and to ensure reproducibility and allow comparison examinations across different sites. Though several published articles, including various society guidelines, have addressed the relevant patient preparation variables individually, we believe there is need for further clarification. This article summarizes existing data and proposes a standard patient preparation protocol.

PET/CT in the Management of Thyroid Cancers

OBJECTIVE Thyroid cancer is the most common endocrine cancer. This review evaluates the established use of (18)F-FDG PET/CT in papillary, follicular, Hürthle cell, anaplastic, and medullary thyroid cancers. The significance of incidental diffuse and focal thyroid FDG uptake is discussed. The evolving value of non-FDG radiotracers, including (124)I, (18)F-dihydroxyphenylalanine, and (68)Ga somatostatin analogs, is summarized. CONCLUSION PET/CT is a valuable imaging test, in the appropriate clinical context, for the management of thyroid cancers.

99mTc-Tilmanocept: A Novel Molecular Agent for Lymphatic Mapping and Sentinel Lymph Node Localization

Preoperative lymphatic mapping in conjunction with intraoperative γ-probe detection is widely used for sentinel node localization in melanoma, breast cancer, and other malignancies. 99mTc-radiocolloids have been the standard radiotracers used for sentinel node mapping. 99mTc-tilmanocept is a receptor-binding molecular imaging agent approved by the U.S. Food and Drug Administration for lymphatic mapping and lymph node localization in breast cancer, melanoma, clinically node-negative squamous cell carcinoma of the oral cavity, and other solid tumors. It has several advantages over conventional radiocolloids, including rapid injection site clearance, high sentinel node extraction, and low distal node accumulation, which can lead to efficient resource use.

Dopamine Transporter SPECT Imaging in Parkinson Disease and Dementia

The clinical diagnosis of Parkinson disease (PD) is difficult, as several other neurodegenerative and basal ganglia disorders have similar clinical presentations. Dopamine transporter single-photon emission computed tomography has been proposed as possible diagnostic tool to help differentiate idiopathic PD from essential tremor and other disorders that present with parkinsonian symptoms. In addition, it is valuable in the diagnosis of dementia with Lewy bodies, differentiating it from other causes of dementia such as Alzheimer disease.

18F-FDG PET/CT Findings in Portal Vein Thrombosis and Liver Metastases

18F-FDG PET/CT is a valuable noninvasive tool in oncologic imaging, and its application in the diagnosis of liver metastases has been very convincing. Both the sensitivity and the specificity of 18F-FDG PET/CT are high for detecting liver metastases from various tumors including colorectal, breast, and lung. Such liver metastases are typically 18F-FDG–avid. We present atypical 18F-FDG PET findings in a lung cancer patient with known liver metastases and PVT.

Role of multimodality imaging including Thallium-201 myocardial perfusion imaging in the diagnosis and monitoring of treatment response in cardiac sarcoidosis

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology that can involve any organ in the body including the heart. The clinical manifestation of cardiac sarcoidosis is variable and includes asymptomatic state, conduction abnormalities, ventricular arrhythmias, heart failure and sudden death. Advanced imaging modalities like cardiac MRI and PET are increasingly being utilized in the work-up. PET is not widely available and MRI may not be an option in patients with pacemaker and/or implantable defibrillator (ICD). Myocardial perfusion imaging with Thallium201 or Tc-99m Sestamibi remains an alternative approach especially to monitor therapy as illustrated in our patient. In institutions not equipped with PET CT, diagnosis of cardiac sarcoidosis can be made by following the revised guidelines of the Japanese society of granulomatous disorders, which are based on the clinical findings, myocardial perfusion imaging and cardiac MR, elaborated at the bottom of our discussion. CLINICAL SUMMARY

Lung perfusion imaging in hepatopulmonary syndrome using 99mTc macroaggregated albumin

Abstract Hepatopulmonary syndrome is a serious pulmonary vascular complication in patients with chronic liver disease. It constitutes a triad of chronic liver disease, increased alveolar-arterial oxygen gradient, and evidence of intrapulmonary shunt (IPS). The diagnosis of IPS can be made by bubble echocardiography, technetium-99m-labeled macroaggregated albumin (99mTc-MAA) scintigraphy or pulmonary arteriography. Though echocardiography is a sensitive screening test, MAA scintigraphy can also quantify the extent of shunting.