(L) Page 89-102 Abstracts Thursday S 84 to 97

CME 15 - IAEA: Updates in Paediatric Nuclear Medicine Oncology and Therapy

1153Updates in the Utility of F18 FDG PET/CT in Childhood Lymphomas

966Application of PET/CT in uncommon paediatric malignancy

Endocrinology (END-2)

1027Beta cell imaging and insulitis imaging in type 1 diabetes: where are we now?

716Detection of neuroendocrine tumors with 99mTc-TEKTROTYD

Barry ShulkinSt. Jude Children's Research Hospital

Abstract not available

Robert Howman-Giles Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Australia

18F FDG PET/CT has been well shown to be a valuable diagnostic tool in the evaluation of many adult malignancies. There is increasing application of PET/CT and now is standard of care in many paediatric solid malignancies in particular all forms of paediatric and adolescent lymphoma and bone and soft tissue sarcomas and brain tumours. There is little data except for case reports or publications of small numbers of patients in uncommon and rare solid tumours in paediatrics. This presentation will review these tumours and the current literature relating to them. Examples of the application of FDG PET/CT at initial staging, response to treatment, detection of recurrence and surveillance will be shown. The tumours that will be discussed will include neuroblastoma, Langerhan cell histiocytosis, malignant peripheral nerve tumours, uncommon and primitive sarcomas, sacro-coccygeal teratomas and germ cell tumours, renal malignancies and malignant rhabdoid tumours. The application in non-lymphomatous head and neck tumours will also be reviewed.

18F FDG PET/CT plays a valuable role in the investigation and management of the majority of paediatric solid tumours including the uncommon and rare conditions.

Alberto SignoreSapienza University of Roma And University Medical Center Groningen


a a b Vera Artiko , Dragana Šobić , Svetozar Damjanović and aVladimir Obradovic

a Centre for Nuclear Medicine, Clinical Center of Serbia, b Belgrade, Serbia; Clinic for Nuclear Medicine, Clinical Center of

Serbia, Belgrade, Serbia

Aim: The aim of the study is detection of neuroendocrine tumors 99mwith Tc-Tektrotyd. Patients and Methods: Whole body

scintigraphy was performed in 107 patients, 2h-24h after i.v. 99madministration of 740MBq Tc-Tektrotyd, as well as SPECT of

particular regions. Results: From 26 patients with

neuroendocrine tumors of unknown origin there were 21 true positive findings (TP) (9 with liver metastases, 6 with lung metastases, 4 with bone metastases and one with mediastinal gland metastases), 3 false negative findings (FN) (two with poorly differentiated liver metastases and one with very small lung metastases < 1 cm), one FP (vague uptake in lung inflammation) and one TN. In 17 patients scintigraphy contributed to the further management of the patients. From 38 patients with gut carcinoids there were 16 TP (16 with liver metastases), 17 true negative findings (TN) (after surgery), 4 FN (in 2 small metastases < 1cm, necrosis) and 1 FP (physiological accumulation of the activity in the bowel). In 8 patients scintigraphy contributed to the further management of the patients. From 23 patients with neuroendocrine pancreatic carcinomas there were 16 TP (6 with liver metastases and one with metastases in paraortal lymph nodes), one FP (physiological activity in the bowel), 3 TN (somatostatinoma, insulinoma and carcinoid after surgery) and 3 FN (poorly differentiated). In 11 patients scintigraphy contributed to the further management of the patients. From 14 lung neuroendocrine tumors (10 carcinoids and 4 lung neuroendocrine tumors) there were 11 TP (6 with liver, 3 with lung metastases and 2 with bone metastases), two FP (inflammation) and one TN (after surgery). In 9 patients scintigraphy contributed to the further management of the patients. From 6 patients with gastrinomas (jejunal, paraduodenal and pancreatic) there were 3 TP findings, 2 TN and one FN (poorly differentiated). In 4 patients scintigraphy contributed to the further management of the patients. Sensitivity was 86%, specificity 83%, positive predictive value 93%, negative predictive value 69% and accuracy 86%.

99mConclusion: Tc-Tektrotyd scintigraphy is useful in diagnosis, staging and follow up of the NET patients as well as in the appropriate choice and monitoring of the therapy.

a a aVladimir Obradovic , Vera Artiko , Dragana Sobic , Djuro b bMacut , Svetozar Damjanovic

a Centre for Nuclear Medicine Clinical Center of Serbia, Belgrade, b Serbia; Clinic for Endocrinilogy, Clinical Center of Serbia,

Belgrade, Serbia

Aim: The aim of the study is presentation of the preliminary results of the therapy of radionuclide therapy of neuroendocrine tumors (NETs). Patients and methods: The therapy was applied in 15 patients with various neuroendocrine tumors (5 unknown origin, 6 pancreatic NE carcinoma, one pancreatic gastrinoma, one gut carcinoid, one bronchial carcinoid, one lung NET). Five of them received all 4 cycles of the therapy,3 received 3 cycles, another 3 received 2 cycles, while remaining 4 received only one cycle. In all of them, together with other laboratory analyses and imaging methods, scintigraphy with somatostatin analogues was performed and high tumor uptake (gr III-IV) was observed. The

90therapy was performed with 2-4,5 GBq Y DOTA TATE /patient/cycle.Between the cycles, there was a time delay of 6-8 weeks. The infusion of amino acids have been applied 30 min before the therapy, and 4h after. Results: Analysis of the "b remss t rah lung" images showed up take o f the radiopharmaceutical in the liver, but the most of the activity was observed in the regions of the "hot spots" grade 3 and 4 (planar T/B= 1,70±0.9, SPECT T/B=2.9±0.8) registered with previous 99m 111Tc Tektrotyd and/or In Octreoscan images. After one year, in four patients occured progressive disease (PD - 4 with neuroendocrine pancreatic carcinoma with liver mets. In the majority of patients (n=8), stable disease (SD) was registered (one

714Peptide receptor radionuclide therapy with 90Y - DOTA TATE - first results

THURSDAY: 23SEPTEMBER 2010

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Abstracts

with bronchial carcinoid and liver mets, one with pancreatic gastrinoma, one with NET of unknown origin and liver lung and bone mets, two with neuroendocrine pancreatic carcinomas with liver mets, one with NET of unknown origin with liver mets, one with lung neuroendocrine carcinoma with liver and bone mets, one with NET of unknown origin with bone and skin metastases), and in three partial remission (PR – coecal carcinoid with liver mets and 2 with NET of unknown origin with liver mets). Up to now, there were no major clinical side effects hepatic function. Transient pancytopenia occurred in two patients, and impairment

90of kidney function in one. Conclusion: Treatment with Y DOTA TATE might be useful for the management of patients with inoperable or disseminated neuroendocrine tumors.

a a b Jolanta Kunikowska , Leszek Krolicki , Dariusz Pawlak , a Malgorzta Kobylecka

aNuclear Medicine Department, Medical University of Warsaw, bPOLAND; IEA POLATOM, Åšwierk, POLAND

Neuroendocrine tumors (NETs) have distinct biological and clinical characteristics, in particular a high density of somatostatin receptors at the cell membrane. This property allows use of radiolabeled somatostatin analogs for imaging of these tumors.

68New techniques PET/CT with Ga-DOTATATE open possibilities in the diagnosis of patients with NET. The aim of this study was to evaluate the diagnostic usefulness of a new

68somatostatin analog, Ga-DOTATATE, for PET/CT in patients with diagnosis of neuroendocrine tumors. METHODS: 55 patients with NET were examined (24 men, 31 women; age range, 18-86 y; mean 51.4 +/- 12.5 y). For analysis, patients were divided into 3 groups: detection of unknown primary tumor (13 patients), follow-up after surgery (23 patients), staging of disease (19). PET imaging was performed on PET/CT scanner Biograph 64, 60

68minutes post injection of 120-185 MBq Ga-DOTATATE. 68RESULTS:In the group with unknown primary tumors, Ga-

DOTATATE revealed 9 primary foci. 7 were not visible in CT (intestinum-4, pancreas-3) and 2 foci observed in CT - small nodule in lung. In 4 cases primary tumors were not found. In the cases of patients after surgery, examination shown new foci in 5 patients (liver-3, lymph nodes in abdominal cavity-2, peritoneum-1, pancreas-1).In the group of staging of disease in 12/19 cases

68PET and CT shown the same foci. In 7/19 patients in Ga-DOTATATE examination was revealed new lesions (intestinum-1, liver-3, bone-1, pancreas-4, lymph nodes in abdominal cavity-2)

68CONCLUSION: The Ga-DOTATATE PET/CT is very useful non-invasive techniques in diagnosis of patients with NET, can be successfully use for staging and restaging of disease and gives more clinically useful information than CT.

a b b Zlatko Petrovski , Jovan Gjorgievski , Keti Trajkovska , Meri bTashkovska

aDepartment of Nuclear Medicine, Clinical Hospital - Bitola, bRepublic of Macedonia; Department of Nuclear Medicine

Objectives:The aim of the study was to evaluate late follow-up results in surgery and radioiodine treatment of autonomous thyroid adenoma and compare incidence of hypothyroidism and reccurence hyperthyroidism in treated patients. Methods:We observed 93 treated patients (77 female, 26 male, age range 18-76 yrs) with adenoma toxicum. 29(32,2%) pts underwent surgery (adenectomia), while 64(67,8%) pts received 131-iodine therapy (555-1100 MBq).The long term results of the treatment were

192PET/CT investigations with 68Ga-DOATATE in

neuroendocrine tumors - first clinical experience

121Therapeutic outcome after radioiodine and surgery treatment of toxic thyroid adenoma

followe 1-15 years after therapy (median 9,2 yrs). Results:Reccurent hyperthyroidism occurred in 4/29 (13,8%) pts after surgery adenectomia in comparison to 5/64 (7,8%) pts after radioiodine therapy.The patients after enucleation of autonomous nodule of the thyroid show increase incidence of late recurrent hyperthyroidism.These results are likely to be due to persistent functional autonomy in the parenchyma surronding the autonomous adenoma.Apparently this persistent autonomy could be succesfully removed by radioiodine.Appear of hypothyroidism was observed in 6/64 (9,3%) pts treated with J-131, while after surgery had in 3/29 (10,3%) pts.Incidence of hypothyroidism between operated patients and radioiodine treated patients was approximately the same. Conclusions:Radioiodine therapy is useful, economical and effective treatment of toxic thyroid adenoma that provides a safe protection in preventing late reccurent hyperthyroidism and is more successful therapy that surgery treatment.

Abdelhamid ElgazzarKuwait University


John BuscombeNuclear Medicine, Addenbrooke's Hospital, Cambridge, UK

The treatment of neuroendocrine tumours (NETs) can be complex, many tumours present late with extensive disease, though their slow growing nature can be an advantage. Like many tumours the only cure can be surgical though with NETs it is possible to take out metastases and still obtain cure. Biotherapy with somatostatins has been shown not only to improve symptom control in syndromic patients but does appear to have a tumour static effect in all NETs. Chemotherapy has limited use in NETs but has some activity in tumours of fore-gut origin. Though recent studies suggest Sunitinib may have activity against all NETs. About 40% of patients respond to Chemotherapy with a median progression free survival of about 12-13 months. Radionuclide therapy is now normally done with Lu-177 or Y-90 octreotide derivatives, though a few patients may benefit from I-131 mIBG. A series of studies have shown these treatments are well tolerated with a 60-70% response rate with a median progression free survival of 2-5 years in many studies. Though there is a choice in the treatment of NETs a quick guide is surgery if possible, all patients to have biotherapy, possible chemotherapy in foregut tumours and almost all patients can benefit from radionuclide therapy.

Shaunak Navalkissoor, Ann-Marie Quigley, John BuscombeDepartment of Nuclear Medicine, Royal Free Hospital, London, United Kingdom

Objectives: To evaluate whether In-111-pentetreotide SPECT/CT provides further information compared to SPECT in suspected neuroendocrine tumour (NET) patients. Methods: Images were reviewed on 2 separate sessions: initially with whole-body and SPECT images and secondly with the addition of SPECT/CT. Lesions were categorised as NET, equivocal or not NET. Analysis was done on an overall patient basis and a lesion by lesion basis.

1062Diabetic foot disease: Role of Nuclear Medicine

Oncology (ONC-15)

917Neuroendocrine Tumours: Biotherapy? Surgery? Chemo-therapy? Radionuclide therapy?

221Does In-111-pentetreotide SPECT/CT add value in patients with suspected neuroendocrine tumours?

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The final diagnosis was based on histology/ imaging follow up. Results: A total of 33 patients were identified, 26(79%) of whom were found to have NET on follow up. There were 54 areas of abnormal uptake of In-111-pentetreotide seen. SPECT correctly classified 36/54(67%) lesions. SPECT/CT correctly classified 51/54(94%) lesions (28% improvement over SPECT). There were 6 lesions not identified on SPECT (4 bone, 1 soft tissue and 1 pelvic lymph node) and 3 false positives. The false positives included a lesion classified as a rib metastasis (found to be costochondritis), a 2nd lesion thought to be disease was re-classified as splenic uptake, and a 3rd presumed liver metastasis was found to be bowel uptake. Equivocal uptake was seen in 9 lesions on SPECT, 7 of which were correctly characterised on SPECT/CT. SPECT/CT showed 1 false positive (low-grade uptake in the pancreatic uncinate process) and 2 areas of equivocal uptake: an 8mm liver metastasis that had low grade tracer uptake and a thyroid nodule (benign histology). In the overall patient analysis, the sensitivity of SPECT was 21/26(81%), whilst SPECT/CT was 22/26(85%), whilst the specificity of SPECT was 5/7(71%) and SPECT/CT was 7/7(100%) Conclusion: SPECT/CT provides additional value by both correctly identifying more NET lesions and in overall patient classification.

Suman Jangra, Swati Rach, Sandip BasuRadiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, India

Introduction: Neuroendocrine tumours are rare slow growing tumours derived from the neural crest. The high sensitivity and

131specificity of I-MIBG in pheochromo-cytoma and neuroblastoma led to its therapeutic use. It has been used in various stages of treatment of neuroendocrine tumors to improve the treatment outcomes. We tried to assess the response of 131IMIBG therapy in patients with MIBG-positive residual neuroendocrine tumor and assess the quality of life of these patients who are still on follow up. Aim: To evaluate the response

131of I-MIBG therapy in patients with neuroendocrine tumours and assess the quality of life of the patients who are still on follow up after MIBG therapy. Materials and Methods: 32 patients diagnosed of neuroendocrine tumours and treated with MIBG from 2000 to 2009 were included in the analysis. All patients who

131had I-MIBG positive residual/metastatic disease after the completion of the frontline modalities were considered for MIBG therapy. Patients were followed up 2-3 months after therapy for response evaluation. Response was evaluated objectively by comparing pre therapy & post therapy biochemical markers,

131radiological investigations and I-MIBG scan. Symptomatic response was also evaluated and quality of life assessed using Functional assessment of Cancer Therapy General (FACT-G) quality of life questionnaire. Results: The objective response was seen in 57% of patients with stage III Neuroblastoma, 27% of patients with stage IV Neuroblastoma and 8% of patients with pheochromocytoma. The patients with carcinoid and medullary carcinoma of thyroid showed no objective response. The symptomatic improvement was seen in 29% of patients with stage III Neuroblastoma, 36% of patients with stage IV Neuroblastoma, 75% of patients with pheochromocytoma and 100% in patients with carcinoid and medullary carcinoma of thyroid. Quality of life improved in all 11 patients who are still on follow up. Conclusion: 131I-MIBG therapy is of proven value in the treatment of stage III and IV neuroblastoma. MIBG therapy has the potential to stabilize the disease and provide symptomatic improvement in majority of the patients especially in pheochromocytoma. Also an improved quality of life is observed in patients treated with MIBG therapy.

790Role of 131I-metaiodobenzylguanidine (131I-MIBG) therapy in metastatic neural crest cell tumours and assess the quality of life in these patients

21Detection of local prostate carcinoma with 11C- acetate and PET/CT

849Establishment of a Novel Chinese Human Lung

Adenocarcinoma Cell Line CPA-Yang3 and its Real Bone Metastasis Clone CPA-Yang3BM in Immunodeficient Mice

1,2 3 4 1,5Jukka Kemppainen , I. Jambor , R. Borra , V. Lepomäki , R. 3,4 6 1,7Parkkola , K. Alanen and H. Minn

1 2 Turku PET Centre, University of Turku, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine,

3University Hospital, Turku, Finland; 2nd Department of Radiology, Comenius University, Bratislava, Slovakia4 Department of Diagnostic Radiology, University of Turku,

5Turku, Finland; Medical Imaging Centre of Southwest Finland, 6Turku University Hospital, Turku, Finland; Department of

Pathology, Turku University Hospital, Turku, Finland7Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland

11Background and aim: C-Acetate has shown potential to image prostate cancer metastases and recurrence after radical surgery but

11the role of C-acetate in depicting intraprostatic cancer is not well characterized. The aim of the present study was to assess the

11applicability of C-acetate and PET/CT in localizing prostate carcinoma and detection of tumor aggressiveness. Methods: 21 patients with clinical stage T1c-T3aN0 prostate cancer were

11investigated with PET/CT and C-acetate. The average PSA was 10.1 and Gleason score 6.3 (range 4-9), respectively. Standard uptake values (SUV) were determined for intraprostatic hotspots. The laterality of the primary prostate cancer leason was

11determined using three different imaging modalities: C-acetate 1 1PET/CT, MRI and H MRS with a surface coil. H MRS metabolic

maps were calculated using the Choline+Creatine+Polyamines-to-Citrate (CCP/C) ratios. The detected laterality of the main leason was compared to histopathological findings obtained by transrectal ultrasound-guided biopsies. Results: The accuracies

11for detection of prostate cancer primary leason by C-acetate 1PET/CT, H MRS and contrast enhanced MRI were 71%, 67% and

71%, respectively. The average maxSUV in primary leasons was 5.5±2.0. Gleason score, PSA or PSA velocity did not correlate

11with observed SUV values or CCP/C ratios. Conclusion: Both C-1acetate PET/CT and H MRS allowed for detection of localized

prostate cancer with reasonable accuracy but failed to provide information on cancer aggressiveness. This is likely to be related to overlap of metabolic activity in regions with cancer and hyperplasia.

a b a bShunfang Yang , Meiping Shi , Jie Cao , Lanxiang Zhao , Jianding c aYe , Wenhui Xie

aDepartment of Nuclear Medicine, Shanghai Chest Hospital of b Shanghai Jiaotong University, Shanghai, China; Department of

Pathology, Shanghai Chest Hospital of Shanghai Jiaotong cUniversity, Shanghai, China; Department of Radiology,

Shanghai Chest Hospital of Shanghai Jiaotong University, Shanghai, China

Objective The recurrence and metastasis in lung cancer is a tough problem worldwidely. Establish a novel Chinese lung adenocarcinoma cell line and its real bone –seeking clone subline for exploring the mechanism of occurrence and development in Chinese lung cancer. Methods The cell came from the pleural effusion of a sixty-five years old female patient with lung adenocarcinoma and supraclavicular lymph node metastases.

thTumorigenicity of immunodeficient mice was confirmed in 4 passage. The cell growth curve was mappinged. Analysis of chromosome karyotype was tested. Intracardiac injection of the cells into nude mice was performed and in vivo imaging was

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obtained by micropinhole bone scintigraphy and conventional radiography. Bone metastases were determined on bone scintigraphy and then the lesions were resected under deep anesthesia for bone metastasis cancer cell culture. The process was repeated for four cycles to obtain a real bone-seeking clone

thsubline. The gene expression was compared its 4 bone metastasis subline with parental generation by Affymetrix GeneChip U133 plus2.0. Results The tumorigenesis rate started at 4th passage in 6/6 immunodeficient mice via subcutaneously and as well as later passages. Under the microscope, the cell showed as adherence

6growth. Approximately 110 cancerous cells were injected into left cardiac ventricle of immunodeficient mice resulted bone metastasis sites were successfully revealed by micropinhole bone scintigraphy and final pathological diagnosis. The results of bone metastasis were the mandible(100%), scapula(33%), humerus(50%), vertebral column(50%), femur(66.7%) and accompanied invasion with other organs, the adrenal gland(17%), pulmonary(33%),liver(50%),submaxillary gland(33%) in the mice after inoculation two-three weeks. The chromosome karyotype analysis of the cells was subdiploid to hypotriploid. SERPINE2, IL-6, AF1Q, VEGF-C, Bcl-2, Survivin, Cx43, ECM1, VEGF-D, SVIL, VEGF-A, ESM1, ETV5, AR, EGFR, PTHLH, SRC, FN1, etc. genes were overexpress by paired comparsion. The novel cell was named CPA-Yang3. The femur metastasis cell was repeated in vivo-in vitro-in vivo with three cycles and harvested a real bone metastasis clone subline and no other organs. It was called CPA-Yang3BM. Conclusion Tne characteristics of novel strain CPA-Yang3 is a highly metastasis cell line of Chinese lung adenocarcinoma and CPA-Yang3BM is a real bone metastasis clone.

Stanley J. Goldsmith New York-Presbyterian Hospital/Weill Medical College of Cornell University New York, USA

While it is possible to image Prostate Ca with PET tracers such as 18 18F-FDG and F-FluoroCholine, these tracers are not specific for prostate Ca. In recent years, monoclonal antibodies and small molecules that recognize Prostate Specific Membrane Antigen [PSMA], an epitope with increased expression on prostate cancer, somewhat proportional to the degree of malignancy. PSMA is useful for the identification of disease in patients suspected of recurrent disease in soft tissue, bone marrow, skeleton or even the

stpost-surgical or irradiated prostate bed. The 1 imaging agent to 111become available is an In-labeled intact antibody [7E11] that

recognizes the intracellular epitope of PSMA [Prostascint®]. Imaging of an intact antibody is performed 3-5 days after the initial infusion to allow for clearance of background. Computer display of SPECT images and SPECT/CT has improved overall accuracy. SPECT/CT has also reduced the time required to acquire images since a second set of images representing the vascular pool are not necessary. Prostascint® was initially approved to determine extent of disease in patients with a high Gleason score and to detect the source rising PSA in patients following prostatectomy. Subsequently, it has been used to plan both external beam radiation therapy and brachytherapy, as well as to detect recurrence in the prostate gland or metastatic disease in patients who have not had surgical prostatectomy. There are many reports of impressive contributions to prostate ca management but the technique is controversial within the clinical urology community. Recently, our group has evaluated another antibody,

111J591 labeled with In, which recognizes the external epitope of PSMA. In a small group of patients, soft tissue and skeletal lesions have been identified. Use of a smaller molecule or an antibody fragment would allow for use of short-lived radionuclides with

123 99mbetter imaging characteristics such as I or Tc since the small

953Imaging Prostate ca with radiolabeled Abs and small

molecules

molecules would clear more rapidly via renal excretion. Successful imaging depends on high affinity specific binding to PSMA. Recently, small molecules became available with high affinity for PSMA in cell suspensions and rapid uptake in animal xenograft models. Early clinical trials demonstrate soft tissue and skeletal metastatic prostate ca. Additional trials are underway

111comparing these small molecules to In labeled antiPSMA.

Azu OwunwanneKuwait University


Heather PattersonUniversity of Sydney, Australia

Nuclear medicine technologists have varied training, often limited opportunities or resources and remote practices are even more marginalized. Distance Assisted Training in Nuclear Medicine (DAT) has introduced the harmonization of training through the implementation of competency based training and assessment. However, to meet the needs of evolving imaging technology will require a shift in responsibilities and adaptation to new specialized skills with understanding, to ensure safe and efficient practice. DAT* is a structured and formalized work integrated learning program following a sequence in problem solving learning from basic science, clinical applications through to SPECT and PET/CT. Initially delivered as 'paper-based' self learning modules and followed by understanding and competency evaluation thus providing an assessed common basic standard. With the advent of internet technologies, DAT is now on-line (DATOL) and as traditional e-Learning evolves towards e-Training it supports integration with e-Knowledge as well as the forming of virtual communities which can provide real "continuous lifelong learning and working". The provision of an on-line integrated web-based educational platform permits complimentary visual and interactive teaching aids to assist the understanding of difficult concepts, automatic feedback and ease of monitoring progress. Creating a community for users, developers, researchers, and organizations to improve the exchange of expertise, knowledge, experiences also encourages provision of additional educational materials. Job-training under an effective e-learning environment can improve and harmonize professional skills and competencies in nuclear medicine technology. More than 25 countries globally have participated in DAT and through the adoption of a standardized curriculum and assessment several countries in the Asia Pacific region offer DAT as their National training program for technologists. The ability to offer education and training via e-learning to sub-groups of nuclear medicine professionals will increasingly provide an opportunity to empower individuals and enable them to exchange information and knowledge in ways never before possible. * DAT program developed / managed in Australia under auspices of RCA / IAEA, Vienna

Lutfun Nisa

Education (EDU-2)

1172Postgraduate Nuclear Medicine Residency Training: More than Two decades of Experience from Kuwait

244Harmonizing technologist training in Asia and Pacific region

372Need Based Education and Training in Nuclear Medicine in Developing Countries

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Institute of Nuclear Medicine & Ultrasound, Dhaka, Bangladesh Nuclear Medicine, as a clinical discipline, is doing quite well in developing countries. Even though all the nuclear medicine centers may not have the latest leading edge technology, most contain the basic instrumentation and radiopharmaceuticals for routine functioning. Nevertheless, there is increasing demand for improving services with the most recent state of the art technology, from clinicians and patients who are more aware of new trends in imaging because of highly developed information technology. To meet these demands and to keep pace with current developments, more and more centers are prompted to improve their facilities. Acquiring modern sophisticated equipment and technology is only one part of the upgradation process. The other more important part is education and training, which are the two well recognized key factors for assimilating emerging technologies. Indeed, in the light of significant developments in instumentations, radipharmaceuticals and procedures, training of new would -be- specialists as well as continuing education of physicians already working in nuclear medicine is essential for a clear understanding of the physiological and technological basis of evolving nuclear medicine studies. This is true for both developed or developing countries. The need and type of training may however differ, because what goes for the developed countries may not be appropriate for the developing ones. At the same time it is very important to keep up the standards of the training programmes at par with advanced nuclear medicine centres in developed countries in order to promote uniform competence and excellence. Clearly it is most pertinent to design and develop appropriate educational and standard setting activities so as to obtain the best possible need based outcome for the nuclear medicine specialists, for the patients and for national health services of the developing countries. This presentation aims to examine the training needs of physicians, physicists and technologists in developing countries with particular reference to Bangladesh and elaborates coherent elastic training proposals that can adapt to different regional facilities.

Durre SabihMultan Institute Of Nuclear Medicine And Radiotherapy, Pakistan

Country profile related to nuclear medicine: Pakistan is a country of 170 million; there are 20 nuclear medical centres, out of which, 13 are being run by the Pakistan Atomic energy Commission, another 6 are at an advanced stage of planning and will be operational in 12- 18 months. One PET machine is being operated at a non-PAEC hospital and another is being installed at a PAEC hospital. The human resource situation: 140 nuclear medicine physicians who have qualified a 2 year taught programme leading to an MS degree. A 5 year post graduation has recently been launched with about a dozen graduates. The challenges ahead: Nuclear medicine faces a challenge of attrition in Pakistan. Out of 19 students who got admission in the MS Nuclear Medicine programme, only 5 opted to stay on; almost 10% of the nuclear medicine physicians have opted to go for a second degree in radiotherapy and have changed their specialty. I am unsure if such an erosion in any other medical specialization has ever taken place in the country. The nuclear medicine community in Pakistan needs to take notice and come-up with solutions; I can think of no quick fixes but a multi dimensional policy optimization is certainly in order. I can think of a few problems that need immediate address: Competition from radiology: In many cases radiological modalities are at least as informative, easier to do and are cosmetically more appealing too. The strength of nuclear medicine presently is PET, obviously fused to CT; so a turf war is being waged, on who will control PET and the resources that are involved. Financial attractiveness: Radiologists have a lot of tools

251Nuclear Medicine in Pakistan; Which Way to Go?

to make money so in most cases a nuclear medicine physician suffers from intellectual inadequacy when it comes to answering common medical questions and an absence of infrastructure to make money through private practice. Setting up a private nuclear medicine lab is much more difficult financially than a radiology lab. Pure Nuclear Medicine Physicians: the pure nuclear medicine physicians now being created in Pakistan are obsolete even on graduation, not really knowing, through their courses, what other modalities have to offer and how to factor in Nuclear Medicine into a particular clinical condition. The solutions that occur to me are: a) Deal with the academic frustration: Strengthen the Nuclear Medicine training programme to a 4 year major diploma; add other imaging modalities so that we create whole body imaging experts (read radiologists) with special interest in nuclear medicine. b) Deal with the financial frustration: Encourage after-hours private practice in Nuclear Medicine at existing locations; we have started this at our own institute with considerable success and the model. At this meeting I hope to initiate a discussion comparing the recent experience of nuclear medicine training and if the problems are unique to Pakistan or have these been experienced and dealt with elsewhere

a bAbdul Khader Mohamed Ali , Shuaib Ibrahim Lutfi , Wan b a Abdullah Wan Kamil , Amir Hassan Siti Zarina

aDepartment of Nuclear Medicine, Penang HospitalbUniversiti Sains Malaysia

The nuclear medicine service in Malaysia has its humble beginning in the early 1960s. At present there are 14 nuclear medicine centres in Malaysia providing varying degree of nuclear medicine services ranging from diagnostic, therapeutic, interventional and PET-CT. From the 1960s to 2007 there was no structured local programme for nuclear medicine specialist. In May 2002, the Ministry of Health, Malaysia (MOH) with the blessing of the Director General of Health, a decision was undertaken to spearhead the development of Nuclear Medicine in line with the vision, mission of MOH. A conference â€œ Wayforward Plan For the Nuclear Medicine Servicesâ€� was held in 5-8th May 2002. The outcome of this meeting was endorsed by the MOH and the implementation of its resolutions was being carried out progressively in MOH hospitals over the years. One of the resolutions is to develop the structured nuclear medicine training for all categories of staff including NM specialists. This presentation will detail out the structured training programme for nuclear medicine specialists including the syllabus, entry criteria and assessment.

a b a a CFonyuy Nyuyki , R. Graf , D. Fahdt , R. Michel , L. Geworski , W. a aBrenner , M. Plotkin

aDepartment for Nuclear Medicine, Charité, Universitäts-medizin bBerlin, Germany; Department for Radiation Therapy, Campus

Virchow-Klinikum, Charité, Universitätsmedizin Berlin, cGermany; Department for Radiation Safety and Medical Physics,

Medizinische Hochschule Hannover, Germany

Purpose: MRI and CT are used routinely for planning the RT in scull base meningiomas, but are often inconclusive for tumor delineation. We assessed a possible additional value of Ga-68-DOTATOC PET/CT for this aim. Materials: Prior to RT, 48 pat.

306Nuclear medicine specialty training in a service hospital and university set up: Malaysian experience

Free Abstracts (FA-2)

254The use of Ga-68-DOTATOC PET/CT for planning stereotactic RT in skull base meningiomas

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(31f, 17m, 21-79 y) with 54 scull base (SB) meningiomas were studied by both MRI and Ga-68-DOTATOC PET/CT. 34 of them were pretreated by surgery and/or RT. PET/CT data were acquired using the Biograph 16 scanner (Siemens) and fused with MRI

TMusing Brain SCAN 5.1 workstation. The GTV were defined first using CT and MRI data (GTV ), and then based on PET data MRI/CT

(GTV ). The overlapping regions of GTV and GTVPET PET MRI/CT

resulted in the GTV , which was enlarged to the GTV by common final

addition of volumes definable in only one of the complementing modalities. The contribution of conventional imaging modalities (MRI, CT) and Ga-68-DOTATOC PET to the GTV was final

evaluated. Results: 48 of 54 SB menigiomas in 45 patients showed DOTATOC uptake and were further analyzed. The addition of Ga-68-DOTATOC PET resulted in modification GTV in 32/54 meningiomas. The acquisition of PET data on a PET/CT scanner allowed detection of osseous infiltration. There were also intratumoral areas (as identified in CT+MRI) showing no SR-expression (38% of mean GTV ). The mean additional GTV, final

obtained as result of PET, was 9 % of the mean GTV . final

Conclusions: Ga-68-DOTATOC PET delivers additional information to both CT and MRI, representing a promising

method for planning the stereotactic RT in scull base meningiomas. Further studies with histological verification of the

PET data are necessary to estimate the sensitivity and specificity of the Ga-68-DOTATOC uptake.

a a bLjiljana Jaukovic , Boris Ajdinovic , Snezana Cerovic , Mirjana a cJoksimovic , Zivko Soldatovic

aInstitute of Nuclear Medicine, Military Medical Academy, bBelgrade, Serbia; Center of Pathology and Forensic Medicine,

cMMA, Belgrade, Serbia; Clinic of Urology, Military Medical Academy, MMA, Belgrade, Serbia

Objective: To determine weather prebioptic serum PSA and total Gleason score (GS) on biopsy in newly diagnosed prostate cancer (PCa) in patients can predict osseous metastases and eliminate the need for a bone scan as a routine imaging technique in initial staging. Patients and methods: The retrospective assessment of 155 patients (range 51–87 years, median of 72) with newly diagnosed previously untreated prostate cancer who underwent bone scintigraphy. Serum PSA measurement was performed prior of the biopsy using fluoroimunessey. Prostate cancer was diagnosed by pathological examination of specimens obtained by core needle biopsy and evaluated according to the Gleason grading system. Patients were stratified on the basis of PSA level, Gleason score, histological grade of prostate tumor and clinical stage. Comparison of the detection rate of bone metastases in different groups was performed using Chi-square test and Fisher's test with p < 0.01 being statistically significant. The relationship between total serum PSA, Gleason score and bone metastases was examined. Sensitivity, specificity, likelihood ratio (LR) and diagnostic odds ratio (DOR) were calculated with corresponding 95% confidence interval. The posttest probability for the disease (bone metastases) was made for different combination of PSA values and total GS. Results: Thirty of all bone scans (30/155) were positive for metastases. This proportion was significantly higher in patients with PSA >= 20μg/l (31.66%, p = 0.002) vs. PSA <= 10 μg/l (13.5%). The rate of positive bone scans was insignificantly higher when PSA was 10 μg/l < PSA < 20 μg/l compared with PSA <= 10 μg/l (p = 0.0339). Serum PSA <= 10 μg/l as well as 10 μg/l < PSA < 20 μg/l was not a predictor of bone metastases (OR = 0.36; OR = 0.55). PSA >= 20 μg/l (OR = 3.53) changes the likelihood of for bone metastases due to PCa by 13%. The proportion of positive scintigraphy finding was significantly lower in patients with GS <= 7 (11.47%) vs. GS >= 8 (48.48%, p <

723Bone scintigraphy in patients with newly diagnosed prostate cancer - is it necessary?

0.0001). Gleason score was highly predictive for bone metastases in PCa (OR = 7.260 (2.733 to 19.157)). Likelihood ratio positive was 3,921 (2,225 to 6,726) indicating that Gleason score >=8 as the morphological variable increases the chance of bone metastases by 29%.Conclusion: Bone scintigraphy is not necessary in asymptomatic patients with localized disease, Gleason score at biopsy <= 7, and PSA values < 10 μg/l, because of the negligible risk of bone metastatic spread. The combination of Gleason score and PSA level enhances predictability of bone scan in newly diagnosed prostate cancer patients.

2 1 2Zhiming Yao , Hairong He Wanying Qu 1Dept. of Nucl Med., Central Hospital, China company of

2petroleum and natural gas, Weifang, China; Dept. of Nucl Med., Beijing Hospital, Beijing, China

Aim: Lower diaphragm metastasis, which is easy to be missed by common image, usually implies advanced cancer. The aim of this paper is to analyze the value of FDG PET/CT in differential diagnosis of malignant crura diaphragm lesions from benign. Methods and Materials: The lesion of crura diaphragm with hypermetabolism on FDG PET or abnormal structure on CT is defined as “lesion”. Twenty seven patients with “lesion” of crura diaphragm on the FDG PET/CT were researched. Of 27 patients, there are 24 patients with cancer, and 3 without cancer. The striped hypermetabolic “lesion” or normal metabolic “lesion” is considered as benign “lesion” by PET, and nodule hypermetabolic “lesion” or hypermetabolic “lesion” is invaded by tumor near the “lesion” is considered as malignant “lesion” by PET. Similarly, the “lesion” with normal structure or striped thickening is considered as benign “lesion” by CT, and nodule “lesion” or the “lesion” invaded by tumor is considered as malignant “lesion” by CT. All patients were following up at least 1 year, and the diaphragm “lesion” are divided into benign or malignant “lesion” according to follow-up. Results: 1. General results There are 8 patients and 19 patients with benign and malignant “lesion”, the SUVmaxs are 5.04±2.06 and 7.46±2.88, respectively (P<0.05), and the SUVmeans are 3.10±1.05 and 5.08±2.53, respectively (P<0.05). There is good correspondance between CT and PET on the morphology of “lesion”, Kappa value is 0.73, P value is 0.000. 2. Follow-up in PET and CT The judgments of benign and malignant of “lesion” by PET and CT have high correspond with the follow-up results, the Kappas are 1.00 and 0.669 respectively, both P values are 0.00000. However, PET diagnoses more correctly than CT does, P value is0.00000. 1) Follow-up in PET. One patient's with normal metabolic “lesion” (showed as a nodule on CT), 7 patients with striped hypermetabolic “lesion”s, their “lesion” are benign. Twelve patients with nodule hypermetabolic “lesion” and 7 patients with “lesion” invaded by tumor, their “lesion” are malignant. 2) Follow-up in CT Both “lesion” with normal structure on CT (1 is nodule hypermetabolic another is invaded by tumor on PET) are malignant. 11 patients with nodule “lesion” on CT, 1 “lesion” with normal metabolism is benign and 10 are malignant. Among 8 patients with striped thickening, 7 “lesion” are benign and 1 “lesion” is malignant. Six patients with “lesion” invaded by tumor, the “lesion” are malignant. Conclusion: FDG PET/CT is a good method in differential diagnosis of malignant crura diaphragm lesions from benign

a b a aMartin Nieuwoudt , Wiggett WS , Malfeld S , van der Merwe SWa Bioengineering unit, Hepatology Research laboratory,

bUniversity of Pretoria, South Africa; Department of Surgery,

428FDG PET/CT In Differential Diagnosis Of Malignant crura diaphragm Lesions From Benign

897Imaging glucose metabolism in perfluorocarbon-perfused hepatocyte bioreactors using positron emission tomography

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Abstracts

Steve Biko Hospital, Pretoria, South AfricaIn vitro hepatocyte bioreactor functionality depends particularly on maintaining appropriate oxygen levels and exposure to non-parenchymal cells. An attractive solution without immunological consequences to a patient includes incorporating a perfluorocarbon oxygen carrier in the circulating medium and co-culturing hepatocytes with stellate cells. Since bioreactors are normally sealed sterile units, demonstrating metabolic functionality is hindered by limited access to the cells after their aggregation in the matrix. A novel possibility is to use positron emission tomography (PET) to image cellular radioactive glucose uptake under O -limited circumstances. In this study primary cell 2

isolation procedures were exercised on 8 pigs. Pairs of cell-seeded and cell-free (control) bioreactors with and without perfluorocarbon were cultured under identical circumstances and oxygenated using hypoxic (5 % O ) and ambient (20 % O ) gas 2 2

mixes. 16 PET scans were conducted 24 hours after cell isolation, i.e. the 'short-term', the same time-scale as would occur in treating a liver failure patient with a primary-cell bioreactor. In all cases, cell-seeded bioreactors without perfluorocarbon were more radioactive, i.e. more glycolytic, than those with. This was significant in the hypoxic but not ambient pairs. Additionally, in the same hypoxic bioreactors, circulating extracellular 'steady-state' glucose levels were lower and lactate levels were higher, significantly so in the former. Similar findings have been made in other in vitro hepatocyte studies investigating perfluorocarbons. The attractiveness of PET for studying in situ O -dependent 2

bioreactor metabolism is owing to its visual and numerically quantifiable outputs. Longer term, e.g. 5 - 10 day, metabolic studies investigating the effect of perfluorocarbon on bioreactor longevity will compliment these findings in the future.

a b c Leif Perbeck , Rimma Axelsson , Leif SvenssonaDepartment of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; bDivision of Radiology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet,

cKarolinska University Hospital; Medical Physics, Karolinska University Hospital Huddinge Sweden

Introduction: Theoretically reduction mammaplasty might result in a change in lymph drainage, which e.g. implies that the sentinel node biopsy technique in breast cancer can not be used routinely after reduction mammaplasty. The aim of the study was to measure the lymph drainage by lymphoscintigraphy before the operation and one month postoperatively when the breast still were swollen using two types of isotopes. Material and methods: Nine patients (median age 41.6 year, range 26.7-52.7) who were operated by reduction mammplasty by the evelation of the nipple-areola complex by a medial horizontal pedicle, were measured by

99mlymphoscintigraphy with two types of isotopes, Tc-nanocolloid 99mand Tc-dextran. Measurement were performed in four areas

during 3 hours and expressed in percent of the amount isotope injected. One month postoperative the measurements were repeated. Results: A median of the four areas were calculated.

99mAfter 2 hours 77 percent of the injected of Tc-nanocolloid remained in the tissue measured preoperatively and 79 percent

99mpostoperatively. Corresponding results using Tc-dextran showed 74 percent and 74 percent, respectively. Conclusion: The results implies that one month postoperatively after a reduction mammaplasty there was no difference in lymph drainage studied

99m 99mby lymphoscintigraphy using either Tc-nanocolloid or Tc-dextran compared with the preoperative values despite of a swollen tissue.

176Lymph drainage studied by lymphoscintigraphy in the breast after reduction mammaplasty

847Volume of distribution and half-life measurements from

glomerular filtration rate: Investigation of reference ranges in a normal population

656Absolute 99mTc-DMSA renal uptake in adults: A new

simplified technique

a b b aJennifer Holness , A. Malaroda , J.Fleming and J.Warwicka Nuclear Medicine, Tygerberg Hospital and Stellenbosch

b University, Cape Town, South Africa; Nuclear Medicine, Southampton General Hospital, Southampton, UK

Objectives: Although quality control checks are performed at various steps during glomerular filtration rate (GFR) studies, there remain a number of areas where errors can be introduced. Errors in methodology not detected by conventional quality control measures are likely to be reflected by an abnormal volume of distribution (Vd) and/or half-life (t½). While the 2004 British Nuclear Medicine Society (BNMS) guidelines provide reference ranges for Vd and t½, to our knowledge, data supporting these reference ranges has not been published. The aim of this study is to determine reference ranges for Vd and t½ for the South African population and compare this to ranges provided in BNMS Guidelines. Methods: Sixty-four GFR studies performed on healthy adult potential kidney donors were reviewed retrospectively over a 37-month period (February 2007 - February 2010). All prospective donors were screened using blood creatinine levels and a 24-hour creatinine clearance. All studies were performed according to 2004 BNMS guidelines. Vd values were derived from Brochner-Mortenson corrected GFR values. The range of Vd and t½ values was determined and compared to predicted ranges. Results: The normal range for corrected Vd values was found to be similar to the suggested range of 8 times body surface area +/- 25%. Values for t½ were however found to be more variable, with many being significantly shorter than suggested by the guidelines. Conclusion: The Vd and t½ can be a useful quality control measures during GFR studies. To the authors' knowledge this is the first study to define a Vd and t½ range in normal adults using this methodology.

Miguel Gorenberg., Lea Radan, Ronen Kosakov, and Israel AmiravDepartment of Nuclear Medicine, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel.

Purpose and Aim: Radionuclide imaging of the kidneys using 99mTc-DMSA is a well established method to evaluate the extent of kidney parenchymal involvement in the scenario of urinary tract infection and to estimate the functional renal mass.We have developed a simplified technique "Bnai Zion Planar

99mMethod"(BZPM) to estimate absolute technetium-99m ( Tc-DMSA) uptake by the kidneys (ARU) that use a shorter time of acquisition and does not require cumbersome calculations of attenuation correction (AC). The aim of this study was to validate this technique by comparing it to QDMSA SPECT measurements as the reference method. Methods: One hundred and six adults, age 53.57±16.83 (Mean+SD), (range 19-89 years) were included in the study. ARU of the radiopharmaceutical by the kidneys was measured using previously described QDMSA SPECT methods with data acquisition of 20 minutes. For the BZPM, ARU was measured using a planar posterior view of the kidneys acquired for one minute, at the end of the QDMSA SPECT study. Results: A significant strong correlation between the two methods was observed. BZPM measurements were very similar to those obtained using the validated QDMSA SPECT method, as determined by linear regression analysis (Pearson's r=0.87, p<0.001), r squared = 0.75. The uptake according to QDMSA SPECT can be predicted by the uptake measured by the BZPM

S-90


Abstracts

using the following regression equation: QDMSA =1.14+1.07 BZPM. Conclusion: ARU estimation in adults using the newly proposed planar method was found to be nearly identical to the validated QDMSA SPECT method.

Muhammad Umar Khan, Z. S. Abdullah, S. K. Kodali, A. Dafalla, E. HabibDepartment of Nuclear Medicine, Al-Jahra Hospital, Kuwait

Introduction: Hybrid imaging with the advent of SPECT/CT systems has contributed to provision of both functional and anatomical information, resulting in improved patient management. We aim to present our preliminary one-year experience of the first SPECT/CT scanning system in Kuwait, evaluating as to how its introduction made a difference to the services and patient management. Materials & Methods: From April 2009 to March 2010, 93 SPECT/CT procedures were performed on 92 patients (Mean age 42.2y; Range: 19days-70y). 54 females; 38 males. SPECT/CT was performed for 48-bone (35 Three-phase; 13 Delayed), 38-Parathyroid, 4-Cardiac, 1 each for Gallium, MIBG and labelled RBC scintigraphy procedures. Mean activity of Tc-99m radiopharmaceutical used was 811.6MBq(21.9mCi). Acquisition parameters SPECT/CT (matrix size:128 x 128, zoom-1.00, Rotation clockwise, Degree of rotation 180-degree x 2 detectors, Orbit: non-circular, Time 20sec/view, Number of views: 64, Mode: Step-and-Shoot; Low-dose CT acquired at variable mA depending upon the site and 130KVp post SPECT images). Five different categories were devised to evaluate information gathered after SPECT/CT (I: Better anatomical localization; II: Additional information-relevant to query/incidental; III: Ruled out a possibility; IV: Alteration in patient's management; V: No significant contribution). Summed set analysis into the preceding categories was also done. Results: In 59(63.4%) procedures SPECT/CT provided better anatomical localization. In 53(56.9%) it helped by providing additional information either relevant to clinical query or an incidental finding. There were 29(31.1%) procedures in which it helped rule out a possibility. Results of 11(11.8%) procedures resulted in alteration in patient's management while in 7(7.5%) procedures SPECT/CT information did not contribute significantly. Conclusion: In our preliminary experience the addition of SPECT/CT has assisted in making a major difference to Nuclear Medicine service resulting in improvement of diagnostic services in Kuwait.

Alan PerkinsAcademic Medical Physics, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK.

The death of Alexander Litvinenko in London on 23 November 2006 was an unprecedented event in the UK that was not the work of an amateur assassin. The poison was probably administered in a small volume of liquid or powder added to a cup of tea taken at a London hotel. Dispersal of radioactivity resulted in widespread contamination that was detected across London. The surreptitious nature of this act almost escaped detection. Surprisingly this was not the first such poisoning that has been recorded. Other cases include the use of Tl-201, H-3 and P-32. In 1995 the US Nuclear Regulatory Commission confirmed that a pregnant scientist in a lab at the National Institutes of Health had been deliberately poisoned with P-32 receiving and estimated dose of 80-120mSv.

507Making a difference: 1-year preliminary experience of the first SPECT/CT scanning system in Kuwait

The World Around Us!

1011Past poisoning events

Further investigation showed that 26 of her co-workers were subsequently contaminated. The perpetrator was not identified and no motive was established. In November 2009, 92 employees at the Kaiga Nuclear Power Plant, situated on the west coat of India, were poisoned with radioactive tritium by a “disgruntled” worker. It is thought that the perpetrator added the tritiated water through the 'overflow tube' of the drinking water container. Evidence of tritium ingestion was noticed after abnormal levels of the radionuclide were found following routine health screening of plant workers. The plant managers admitted to the incident only after it caused public concern and had been reported in the media. The Nuclear Power Corporation India Ltd. stated that two workers received a dose exceeding 30 mSv. Surprisingly this was not the first known event of this kind. A similar incident that took place in 1990, at the Point Lepreau Nuclear Generating Station, New Brunswick in Canada. Records show that an assistant plant operator Daniel Maston took a sample of heavy water from the moderator system and loaded it into a "sport mix" drink dispenser in an industrial lunch zone. It is believed that this act was carried out as a practical joke! These incidents are a pertinent reminder of the serious nature of deliberate radiation poisonings. Medical and scientific staff should be aware of the potential scenarios and understand the implications of such events.

Irene Virgolini, Remigius Orjiukwu, Margot Staudinger, Daniel Putzer, Michael Gabriel

Radionuclide peptide receptor based therapy (PRRT) can be considered in patients with inoperable metastatic neuroendocrine tumours (NETs) and a positive somatostatin (SST) receptor scan. According to the protocol used at our department for PRRT only few side effects are observed. PRRT is generally very well tolerated, and the results favour the combined use of radiolabelled SST analogues providing a customized therapy strategy for tumour control in advanced stages. Overall response rates (minor response, partial remission, stable disease) to PRRT are more than 75%, and even in patients with progressive disease palliation of tumour related symptoms may be observed. In patients with advanced disease stages, older age, poor Karnovsky performance index and diminished organ function due to pre-treatment with chemotherapy, radioactivity doses should be adapted to the individual situation. An improvement of quality of life parameters is documented in many of the NET patients reported by the EORTC questionnaire which covers the global well-being of the patient. NET patients undergoing PRRT are mostly heavily metastasized and put a lot of hope into this new therapy modality. However, the treatment with high dose radioactivity is not so commonly known and may cause a certain anxiety level. A correlation between music and human biology has been described and „music therapy“ has been applied in different medical treatments. In a randomized controlled study we examined the influence of systematic application of music via MP3 players on the psyche of NET patients undergoing PRRT. In both groups of patients receiving music or not, a statistically significant difference could be measured for the global severity index (i.e. a measure for the self-reported clinically relevant psychological symptoms) between the day of admittance and the day of remission from our therapy unit, but the effect was more pronounced in the music group. Furthermore, during application of PRRT a significant reduction of the acute anxiety level was observed in both groups, and this effect was more pronounced in the patient group receiving music, and was statistically significant after application of radioactivity between the music group and the control group. We conclude that selected music positively influences patient care by reducing the acute anxiety level during application of PRRT as well as by reducing clinically relevant psychological symptoms.

666Effects of Music on the Psyche of Neuroendocrine Tumour Patients Undergoing Peptide Receptor Radionuclide Therapy

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Abstracts

Academic Medical Physics, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK.

The potential use of radioactive materials for criminal and terrorist actions has recently received increased attention. Most countries have high security control over radionuclide production and transportation. Even in some hospital radiotherapy and nuclear medicine department security has been reviewed in view of the potential terrorist use of radioactivity for extortion or construction of a “dirty bomb”. It is therefore important that departments handling large amounts of diagnostic or therapeutic radiopharmaceuticals have effective security measures in place. Illicit trafficking of nuclear material across national borders was first detected in the early 1990s. In 1995 the IAEA set up a database to monitor unauthorised possession, use and transport of nuclear and radioactive material. A technical security report published in 2006 states that by the end of 2005 there had been 823 cases of nuclear smuggling most with a criminal dimension (1). This requires nuclear forensic investigations to characterise intercepted illicit sources in order to gain evidence on their identification and production history. Illicit use of radioactivity may involve one or a combination of theft, smuggling, poisoning, attack or placement of materials. The main types of nuclear scenario include:— Attack on a nuclear reactor— Improvised nuclear device (IND)— Radiation poisoning— Radioactive contamination of food or water— “Dirty bomb” or Radiological Dispersal Device (RDD)— Radiological Emplaced Device (RED)Even with the rigorous training of medical teams in the emergency services it is difficult to envisage the consequences of all possible events. A criminal act involving the production of nuclear material would require some degree of skill and knowledge, however the theft of sources held in hospital, academic or commercial premises would be a great deal easier. The range of illicit uses of radioactive materials is broad and whilst recent attention has been on preparing for the consequences of potential terrorist activities it is clear that other actions such as extortion, assassination and murder are real possibilities. Any such event will have political, and socioeconomic consequences and will inevitably attract a plethora of media attention. It is important that medical practitioners, clinical scientists and researchers involved with therapeutic radionuclides should be aware of these issues.Reference1. Nuclear Forensics Support. IAEA Nuclear Security Series No. 2. IAEA Vienna 2006

a b b aMohammad Eftekhari , S. Farzanefar , S. Izadyar , B. Fallahi , A. a a a aFard-Esfahani , D. Beiki , A. Takavar , M. Saghari

a Research Institute for Nuclear Medicine, Tehran University of bMedical Sciences, Tehran, Iran; Vali Asr Hospital, Faculty of

Medicine, Tehran University of Medical Sciences, Tehran, Iran

Radiation synovectomy using different types of radioisotopes is becoming an appropriate cost-effective option in treatment of different inflammatory joint diseases especially when standard treatment methods fail. This approach is applied for treatment of rheumatoid arthritis, psoriatic joint disease, pigmented villonodular synovitis and hemophilic arthropathy. Several beta

1012Review of terrorist scenarios and how to deal with them Alan Perkins

Musculo-skeletal (MS-3)

936Radiation synovectomy, effectiveness of P32 in treatment of chronic haemophilic synovitis

emitters are used depending on underlying pathology and joint size. P-32 has been one of the first radioisotopes used but because of radiation concerns other agents namely yttrium (Y-90), dysprosium (Dy-165), erbium Er-169, samarium (Sm-153), holmium (Ho-166), and rhenium (Re-186) has been used experimentally and in clinical practice. P-32 chromic phosphate however still remains one of the choices for treatment of hemophilic arthropathies. In this presentation, different options of radiation synovectomy and effectiveness of P-32 in treatment of chronic hemophilic synovitis are discussed.

Abdelhamid ElgazzarKuwait University


Izak GartyDepartment of Nuclear Medicine, Emek Medical Center, Afula, Israel

The technique of radiation synovectomy has been available for more than forty years in the management of joint diseases. Recently, there has been renewed interest in radiation synovectomy following the introduction of some new and efficient radiopharmaceuticals. We present here our experience with RS together with a brief review of the literature. A special emphasis will be placed on the following topics:1. Different methods for treating inflammatory arthritis.2. Indications and contra-indications for RS.3. Goals and mechanism of RS.4. Common radionuclides in use for RS.5. The clinical efficacy of particulate versus colloid

radiopharmceuticals for RS.6. Radionuclide versus surgical synovectomy.7. Ten tips for successful RS.8. RS for treating hemophilic arthritis.9. The value of bone scintigraphy for the follow-up of patients

post RS.In summary:1. RS offers an efficient, safe and cost effective alternative

method for treating inflammatory arthritis when standard methods of treatment fail.

2. No serious side effects have been recorded in our series during ten years of follow-up.

3. RS is an effective and safe alternative to surgical synovectomy.

Victoria SoroaCntr.Nucl.Med,Htal.Clinicas,UBA,CNEA, IAEA, Hemophiliac Foundation, Buenos Aires, Argentina

Our objective was to determine the therapeutic efficacy of our locally sterile produced P-32 colloidal suspension in knee synovitic inflammations of hemophiliac patients and compare its results to chemical synovectomy evaluating its cost/benefit ratio. We joined an IAEA CRP & with the cooperation of the orthopaedists from the Argentinian Hemophiliac Foundation, we treated n 100 male patients, ages: 4-51, with P32 colloid. The majority were enrolled for knee radiosynovectomy, and were compared with chemical synovectomy with Riphampicinn (antibiotic) . Either patients or parent's informed consent and

1064Heterotopic bone formation

951Radiation synovectomy

1036Radiosinovectomies in hemophiliacs - the Argentinian

experience

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Abstracts

routine procedures were obtained: haematological laboratory, X-ray, US, a previous 3-Phase bone scan, plus three consecutive monthly MDP controls. Admission only if they had several previous knee episodes, excluding those with bone destruction & big Baker's cyst. Joint aspiration if necessary. Administered activity not surpassing 74 MBq, depending on body weight, age & articular volume. Instillation strictly intra-articularly, 1 cc of saline flushed before needle withdrawal. P-32 Bremsstrahlung emission was used in the gamma camera for early, 1-h and late 24 or 48-h acquisitions to certify leakage absence. In order to get images in the alternative intra-articular Riphampicin injection sinovectomy, 4 MBq of Tc-99m MAA (20/100) were added. Plaster post- immobilization and relative rest for 72-h. Final medical evaluation, blind to either procedure. Follow-up of state of joint involvement, pain, motility and requirements of concentrates of antihemophilic factors (AHF) were registered. Neither local, systemic effects or leakage from knees encountered during P-32 radiosynovectomy. Riphampicin procedures require consecutive injections. Comparison of RoIs while applying them to the Remission Index formula, drawn in base scans & 3 month MDP controls of treated knees, during soft tissue scintigraphies, showed that results over 1, meant improvement. The follow-up evaluation demonstrated greater range of articular movement, diminished volume and less requirement and frequency use of AHF in 86% of the radiosynoviorthesis, thus lowering health costs. One intraarticular knee radiosynoviorthesis in haemophilic patients provides 3-6 months symptom relief with our Argentinian produced P-32 colloid. Proofed to be a safe, economic alternative procedure for both patient and operator, in emerging countries where the high cost & availability of AHF is difficult.

Stanley J. GoldsmithNew York-Presbyterian Hospital/Weill Medical College of Cornell University New York, USA

18F-FDG PET/CT has become essential in the management of patients with Hodgkin's and non-Hodgkin's lymphoma. The utility

18of F-FDG PET/CT imaging is based upon increased anaerobic metabolism of neoplastic tissue. The degree of hypermetabolism is somewhat proportional to lymphoma grade. Based on the ability

18of F-FDG PET/CT to identify hypermetabolic tissue, it has greater sensitivity and specificity for the detection of tumor in general and lymphoma in particular compared to CT or MRI. It has made a significant impact in lymphoma management in the following instances:1. Extent of disease in patients already diagnosed with lymphoma. 2. Identification of hypermetabolic disease in lymphadenopathy identified by other means. 3. Evaluation of response to therapy – with greater specificity than CT alone. 4. Early detection of recurrent disease. 5. Identification of transformation from low grade to high grade lymphoma. 6. Prediction of response to

18therapy and prognosis. In many clinical trials, F-FDG PET/CT has replaced CT as the standard for assessment of residual disease. It has become standard procedure at the time of initial diagnosis and following completion of therapy as well at 6-24 month intervals during follow-up or upon recurrence of symptoms suggestive of relapse. On an investigational basis, we have demonstrated that resolution of lymph node hypermetabolism, as early as following a single cycle of chemotherapy, is predictive of a prolonged disease-free interval whereas failure to respond after a single cycle indicated that even if resolution of disease occurs after completion of a full course of treatment, it will be short-lived. If confirmed by

18additional studies, early F-FDG PET/CT evaluation of response

Oncology (ONC-16)

952Role of F18 FDG PET/CT in Lymphoma

may provide a basis to select patients for more aggressive or alternate therapy.

Giuliano Mariani Regional Center of Nuclear Medicine, University of Pisa Medical

School, Italy Abstract not available

Sandy McEwanAlberta Health Services, Canada


Salah Eddine BouyoucefDepartment Of Nuclear Medicine, CHU Bab El Oued, Algiers


Dahiru S Mshelia, AN Hatutale, NP Mokgoro, ME Nchabeleng and MM SathekgeDepartment Of Nuclear Medicine, Steve Biko Academic Hospital, Pretoria, South Africa.

Background: In patients with primary hyperparath-yroidism, 99mTc-methoxyisobutylisonitrite(MIBI) scintigraphy is required for preoperative localization of parathyroid adenoma. However, the sensitivity of the scintigraphy is influenced by various factors, including histology and biochemical factors. Aim and Objective: The aim of the current study is to correlate serum calcium levels with the results of the dual phase 99mTc-sestamibi parathyroid scintigraphy in order to find the best cut-off serum calcium level that correlate with scintigraphy before surgery. Materials and Methods: We retrospectively reviewed 100 patients(82 females and 28 males; age ranging from 8yrs to 88yrs, mean age 53.388+15.110yrs) who underwent a dual-phase 99mTc-sestamibi parathyroid scintigraphy in our department, because they were suspected of having primary hyperparathyroidism due to elevated parathyroid hormone(PTH) levels(range from 11 to 2500ng/L, normal values 16.0 to 87.0ng/L) and calcium levels(range from 2.10 to 3.29mmol/L; normal values 2.05 to 2.56mmol/L). We correlated the serum calcium and PTH levels with percentage of positive or negative results on the parathyroid scintigraphy and we then tried to find a cut-off calcium level above which we may include most of the positive scans and exclude the majority of negative ones for both early and late images. Results: The mean+SD serum calcium in positive MIBI scans was higher, 2 . 7 9 4 + 0 . 2 4 0 m m o l / L , t h a n i n n e g a t i v e s t u d i e s , 2.550+0.259mmol/L, p<000002, which means that there is a statistically significant difference between the two groups. Similarly the mean+SD PTH in positive scans was higher, 4 2 0 . 3 3 + 4 4 8 . 1 9 5 n g / L , t h a n i n n e g a t i v e s c a n s , 171.327+131.812ng/L, p<0.0003, also showed a statistically significant difference between them. MIBI positive scans were identified on early images in 28(54.90%) while it was identified

984Added value of SPECT/CT in oncology and in infection/ inflammation

992Imaging Biomarkers

Endocrinology (END-3)

1071Limitations and opportunities of the use of recombinant TSH in Differenciated Thyroid Cancer

795Correlation between serum calcium levels and dual-phase 99mTc-Sestamibi parathyroid scintigraphy in primary hyperparathyroidism

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Abstracts

only on late images I 20(39.22%) of the 51 positive results. The mean+SD serum calcium scans identified on early images, 2.877+0.169mmol/L, was higher than that of those identified only on late images, 2.686+0.267mmol/L, p<0.000001, which means that there is a statistically significant difference between them. Similarly, the mean+SD PTH, 494.956+4334.237ng/L, in positive MIBI scans identified on early images was higher than in those identified only on late images, 222.882+134.560ng/L, p<0.0004, showing a statistically significant difference between the groups. Conclusions: In our study parathyroid scintigraphy performed in patients with suspected primary hyperparathyroidism and serum calcium level <2.56mmol/L rarely present positive scan results(only 15% of the 51 positive results). This suggests that in patients with elevated serum PTH levels, serum calcium levels should be higher than 2.56mmol/L and preferably >2.70mmol/L.

Jose Manuel Carril, I. Martínez-Rodríguez, I. Banzo, R. Quirce, J. Jiménez-Bonilla, H. Portilla-Quattrociocchi, P. Medina-Quiroz, M. De Arcocha, A. Rubio-Vasallo, R. Del Castillo MatosServicio de Medicina Nuclear. Hospital Universitario Marqués de Valdecilla. Universidad de Cantabria. Santander, Spain

Aim. To evaluate if an early protocol based on an early planar and 99mearly SPECT imaging with Tc-sestamibi could make

unnecessary the delayed image of the standard dual phase scintigraphy without any decrease in the sensitivity for the localization of parathyroid adenomas. Methods. A prospective study was carried out in 79 patients with primary hyperparathyroidism who had surgical treatment. Two sets of images were evaluated. One set included the early planar, the early SPECT and the delayed planar images (dual phase protocol, DPP), and the other set included only the early planar and the early SPECT images (early protocol, EP). An abnormality rating from 0 to 4 was given to each set of images. The analysis of the abnormality data was done in two ways: a simplified analysis considered positive any focal uptake with an abnormality rating of 1 or more and a detailed analysis considered positive each of the abnormality ratings. The final histopathological diagnosis was: 76 adenomas, 2 hyperplasia and 1 differentiated thyroid carcinoma. Results. Simplified analysis: The sensitivity (S) was the same for both protocols, DPP and EP, localizing correctly 71 of the 76 adenomas (S: 93.4%). Detailed analysis: When the threshold for positive was set at 1 and 2, both protocols correctly localized 71 of the 76 adenomas (S: 93.4%). When the threshold was 3, S decreased to 86.8% for DPP and to 71% for EP. When it was 4, S decreased to 60.5% for DPP and to 47.4% for EP. In 42 of the 76 adenomas the abnormality rating given for both protocols was the same. However, in the other 34 adenomas there was at least 1 grade difference. Conclusions. Our results suggest that the delayed planar image could be omitted without any loss in S for the localization of parathyroid adenomas and therefore the EP could replace the DPP.

a b b c Edmund Kim E , Yoo-Sung Song , Dong-Soo Lee , Nancy PerrieraUT MD Anderson Cancer Center, Houston,TX,USA, and Seoul

bNational University, Seoul, Korea; Seoul National University cHospital, Seoul,Korea; UT MD Anderson Cancer Center,

Houston, TX, USA

Objectives: To correlate uptake of Tc-99m sestamibi in parathyroid adenoma with serum levels of calcium, parathyroid hormone and vitamine D as well as size and weight of adenoma

758Early planar and early SPECT 99mTc-sestamibi imaging can make unnecessary the delayed image of the dual phase technique for the localization of parathyroid adenomas

147Factors influencing uptake of Tc-99m sestamibi in parathyroid adenoma

Methods: 80 patients who had parathyroid adenoma based on greater than 50% drop of baseline PTH levels at 5 or 10 min after parathyroidectomy were retrospectively reviewed to correlate uptake of Tc-99m sestamibi on SEPCT/CT with serum levels of calcium, PTH and vitamine D as well as size and weight of adenoma. Results: SPECT/CT found 86 of 94 parathyroid adenomas (91%). Serum level of 1,25 dihydroxycholecalciferol vitamine D, size and weight of adenoma showed positive correlation with sestamibi uptakes, while serum calcium, PTH and 25 hydroxycholecalciferol vitamine D levels had no correlation. Conclusions: 1,25 dihydroxycholeclaciferol vitamine D serum level, size and weight of parathyroid adenoma had positive correlations with uptakes of Tc-99m sestamibi in adenomas on SPECT/CT.

a a a aMilena Rajic , Slobodan Ilic , Marina Vlajkovic , Goran Lilic , a a a aMilos Stevic , Marko Kojic , Ivana Misic , Marija Mihajlovic ,

bTijana StrahinjicaDepartment of Nuclear MedicineClinical Center, Nis, Serbia; bClinic for Endocrinology, Clinical Center, Nis, Serbia

Aim: To assess influence of enormously prolonged continual treatment with antithyroid drugs (ATDs) before radioiodine therapy (RIT) on therapy response in patients with Graves' hyperthyroidism, since there are no data in literature on this topic. Methods: 47 patients (39 women), mean age 48.0±12.6 yrs.,

131treated with one dose of I-NaI were reviewed. ATDs were discontinued 3-5 days before RIT and continued, if it was necessary, more than two weeks after RIT. Patients received ATDs ≤2 yrs. (first group, n=16), >2-3 yrs. (second group, n=13) and >3 yrs. (third group, n=18). Results: After one year, in the first and the second group no significant difference was found in the number of responders (euthyroid or hypothyroid) and nonresponders (hyperthyroid) (50.0% vs. 50.0% and 53.8% vs. 46.2%). Between responders and nonresponders insignificant difference in age (48.9±9.01 vs. 45.6±12.0 and 41.4±17.7 vs. 49.0±13.7 yrs.), TSH

131levels at the time of RIT, and I-NaI dose (7.05±4.18 vs. 8.10±2.57 and 9.12±1.98 vs. 9.18±4.51 mCi) were showed. On the contrary, in the third group, there was a significantly higher percentage of nonresponders (61.1% vs. 38.9%, p<0.05) and nonresponders were older than responders (56.0±10.3 vs. 42.6±10.3 yrs., p<0.02). TSH levels at the time of RIT (0.256±0.331 vs. 1.38±2.25 mU/l) and radioiodine dose (6.76±2.32 vs. 9.10±2.98 mCi) did not differ significantly between them. Conclusion: Extremely prolonged treatment with antithyroid drugs (over 3 years) before radioiodine therapy, associated with elderly age seems to adversely affect therapy outcome in Graves' hyperthyroidism.

Jose Manuel CarrilServicio de Medicina Nuclear. Hospital Universitario Marqués de Valdecilla. Universidad de Cantabria. Santander, Spain


Guillermo Casale, J.O.Nicolini*; G.B.Baró*; R.Caro*; M.Nicolini*; L.O. Silva*; G. Orlandino* P. Apolinario*; G. Oviedo*;

489Influence of extremely prolonged continual treatment with antithyroid drugs before 131I-NaI therapy on therapy outcome in Graves' hyperthyroidism

918Parathyroid radionuclide imaging in 2010

Free Abstracts (FA-3)

898The digital 99Mo-99mTc generator

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*Laboratorios BACON S.A.I.C. Uruguay 136 (1603) Villa Martelli, Buenos Aires Argentina

The Mo-99/Tc-99m has been useful for more than 40 years as a practical tool used in Nuclear Medicine for diagnostic purposes. However, there are possibilities to increase its usefulness. The equipment descr ibed here (pat 04705585.0-2204-US2004002073) is based on the classical generator to which a digitalized system is added, which controls, verifies and register all the operations performed with the Mo-99/Tc-99m generator by means of a PC to which it is connected. The system calculates second by second radiochemical parameters of the generator such as remaining Tc-99m activity, specific activity, remaining Mo-99 activity, number of elutions performed with the generator since the beginning of its use, etc. It can also give radionuclide information of the quality of the eluted product as well as pharmaceutical information of the product such as production batch, production controls, and pages to help the radiopharmacist to solve several problems. In this way this system is a good help to satisfy the GMP regulations for radiopharmacies and Nuclear Medicine Centers. It is a good tool to get the maximum generator capacity in times of shortage of Mo-99.

Advantages:· It allows the user to know the activity available in the generator

at any given time without having to consult tables or to recall the last elution performed with the generator, especially if generator elutions are conducted by more than one technical personnel .

· It automatically logs the day and hour of elution, saving it in an electronic file; it records the eluted activity and the identification of the operator.

· It automatically measures the activity of the eluted Tc-99m and determines its nuclear purity (Ci Mo-99 per mCi Tc-99m).

· It computes the specific activity of Tc-99m in Ci/ug or MBq/ug which is important to determine the suitability of an eluate for labeling some radiopharmaceuticals, such as ECD and others known to those skilled in the art.

· In the case of the dry Mo-99/Tc-99m generator the information regarding the residual humidity of the generator is fundamental to secure the next elution, since the elution performance drops drastically in case the generator remains “wet”. The system guides the user to solve the problem. If the user fails to log the solution, the producer may remotely access to the data and call the user to help him to solve the problem.

· The log system records the operations conducted on all the generators for the operator's review according to GMP regulations for radiopharmacies.

· The log system allows conducting statistical analysis on the use of Tc-99m by the Nuclear Medicine Unit.

The software is directly connected with internet by which the following operations can be performed:- A “watchdog”, alerts the responsible in case of possible

unauthorized elutions.- -The producer knows in real time the performance of each

generator and the user´s profile; the software also can help the user in problems such as humidity in the column.

817PET-CT and PET-MRI in the evaluation of dementia: a study from memory clinic

216Patterns of regional cerebral blood flow abnormalities in relapsing-remitting multiple sclerosis: SPECT, MRI and cognitive functions

b aRamanathapuram V. Parameswaran ,Kumar K.S , Ratnavalli c a a aE , Ananthasivan R , Ingole S And Uthappa M.C

aDepartment of Radiology, Manipal Hospital, Bangalore, India; bDepartment of Nuclear medicine & PET-CT, Manipal Hospital,

cBangalore, India; Department of Neurology, Manipal Hospital, Bangalore, India.

Background: Dementia is a clinical term describing a global impairment in cognition, as well as impairments in social and occupational functioning. It includes a number of entities which have clinical overlap. It is important to differentiate dementia subtypes for treatment and prognosis. Neuroimaging is frequently used to support clinical diagnosis. Various investigative procedures are therefore available for supporting the diagnosis and differentiating the subtypes like CT, MRI and PET. PET-CT fusion has been an evolving modality for past few years. PET-MR fusion with its superior functional and structural correlation increases the confidence level of diagnosing the subtype of dementia. Aim: To evaluate PET-CT versus PET-MRI fusion in the diagnosis of the subtype of dementia. Patients and methods: 26 consecutive patients attending the memory clinic underwent a detailed neurological examination and routine blood tests. All the patients underwent PET-CT (GE DISCOVERY STE) after injection of 10 mci of FDG. Standard sequences of MRI were performed, including thin coronal sections on a HDX 1.5T twinspeed MRI unit. All the cases had a PET-CT fusion. 13 cases had a PET-MRI fusion after acquiring additional software. The images were read by a double blinded radiologist and the results tabulated and compared. Results: Of the 26 patients, there were 13 men and 13 women and age at diagnosis ranged from 42 to 85yrs (mean 68 yrs). Clinically 8 were characterized as Alzheimer's disease (AD), 4 as Fronto-temporal dementia and 11 as Mild cognitive impairment (MCI). PET-CT was especially useful in supporting diagnosis of 11 suspected cases of early AD/MCI in which it characterized 7 cases as having AD. PET-MRI in addition, characterized the rest of the 4 cases as having small vessel ischemic disease (3) & non pressure hydrocephalus (1). PET-MRI also helped in the diagnosis of one suspected case dementia associated with lewy body. Conclusion: PET-CT fusion helps in functional and structural correlation and hence aids in the characterization and evaluation of various subtypes of dementias. But PET-MRI with its superior spatial resolution improves confidence levels particularly in characterizing early MCI/AD.

Nese Ilgin Karabacak, Bijen Nazliel, O Akdemir, Nahide Gokcora

Gazi University, Nuclear Medicine, Ankara, Turkey

Gray matter (GM) damage is an important pathophysiological feature in multiple sclerosis (MS), and may be related to clinical, including cognitive, deficits. Prevalence studies have shown cognitive and affective disorders to be common in multiple sclerosis (MS) while thalamic and hippocampal GM pathology are important features of (progressive) MS. The objective of this study was to investigate cognitive function in relation to SPECT and MRI image patterns of brain areas in MS patients. Methods:Thirteen patients with relapsing remitting multiple sclerosis (MS) and mild physical disabi l i ty had neuropsychological testing, magnetic resonance imaging (MRI) and single photon emission computerised tomography (SPECT) using (99mTc) ECD. SPECT Images acquired (Optima) were

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analysed qualitatively as well as semiquantitatively via obtaining region/cerebellum ratios for cortical regions using Neurogam program. Results: In MS patients with cognitive symptoms relatively lower regional cerebral blood flow ratios (rCBF) were observed at frontal and frontoparietal regions (rCBF ratios with varying values 0.70-0.90). On the other hand, a subgroup of patients (5 subjects)revealed focal hyperperfused regions in various junctional cortical-subcortical locations. Conclusion: Low GM perfusion could reflect decreased metabolism secondary to neuronal and axonal loss or dysfunction with a predilection for progressive forms of MS. Focally increased junctional cortical/subcortical perfusion may indicate increased metabolic activity possibly due to increased cellularity and/or inflammation. Functional techniques may provide a clearer picture of the dynamics of cognitive and affective processes in MS. Improved methodology and longitudinal studies may enable further investigation of regional and temporal changes, and their relationship with physical and cognitive impairment.

a aGeorge Gerasimou , Anna Gotzamani-Psarrakou , Sevasti b aBonstanjiopoulou , Marianthi Arnaoutoglou , Emmanuel

a a aPapanastasiou , Efstratios Moralidis , Theodora Aggelopoulou , a a aGeorge Liaros , Ilias Hilidis , Nikolaos Taskos

a bAHEPA University Hospital; G.Papanikolaou Hospital

A small percentage of essential tremor (ET) patients present symptoms and signs of Parkinson'sdisease (PD) and progress finally to the typical pattern of the disease. Ioflupane, N-u-fluoropropyl-2a-carbomethoxy-3a-(4-iodophenyl) nortropane, also called FP-CIT, labelled with 123I (DATSCAN) has been proven to be useful in the diagnosis of PD and the differential diagnosis between PD and ET. The aim of this study is to clarify link between PD and ET using semi-quantitative SPECT- DATSCAN data of normal volunteers (NV) with the respective ones of patients suffering from ET, and of patients with a definite PD diagnosis at an initial stage with a unilateral presentation of motor signs. Twenty-eight patients with ET (10 males plus 18 females) plus 28 NV (12 males and 16 females) are enrolled in the study. In addition 33 patients (11 males and 22 females) with an established diagnosis of PD and a unilateral insult of the limbs (12 on the left-hemi-body and 21 on the right hemi-body) are included in order to compare data from them with the respective ones of patients with ET. We investigated the radiopharmaceutical uptake in the striatum (S) and its parts (caudate nucleus-CN and putamen-P) in all groups. A significant difference between NV and ET patients was mentioned at the level of all parts of the striatum, more prominent at the higher limits of the values. There was also a significant difference of the radiopharmaceutical accumulation at the level of the left putamen in patients with right hemi-parkinsonism compared to ET patients, as well as at the level of the right putamen in patients with left hemi-parkinsonism, compared again to ET. Clinical re-evaluation of 20 patients with ET did not reveal any signs of PD, and a follow-up DATSCAN performed to 11 of them, was negative to all but one. It seems to be controversial whether there is a link between essential tremor and Parkinson'sdisease. There may be some influence due to higher upper values in normal individuals compared to patients with essential tremor. Follow up studies of essential tremor patients are warranted to assess progression in this population.

Mohammad Eftekhari, B. Fallahi, F. Pooyafard, D. Beiki, A.

25Possible evolution of essential tremor to Parkinson's disease evaluated by 123I-Ioflupane (DaTSCAN)

554The brain perfusion pattern in non-medicated schizophrenic patients

Fard-Esfahani, M. SaghariResearch Institute for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran

Objectives: The results on regional cerebral blood flow (rCBF) using single photon emission computed tomography (SPECT) in schizophrenic patients are not consistent across studies. Some studies investigated the relationship between rCBF and psychopathology, positive and negative symptoms in treated patients. There is little information about the pattern of rCBF in drug-free or never-treated schizophrenic patients. A study was conducted to evaluate the pattern of rCBF in these patients. Methods: Thirty-three patients with schizophrenia participated in the study. For each case, the regional brain perfusion was evaluated using Tc-99m ECD SPECT. The patient's clinical state was also assessed according to standard scoring systems in a medication-free state. Also a group of 12 cases without any history of neurological/psychological disorder was enrolled as the control for evaluating the SPECT data. Regional perfusion indices (RPI) were defined as mean count per pixel (MCPP) in each of 25 brain regions normalized to the MCPP of the whole brain. The RPI were compared in control and patient groups in relation to symptom scores. Results: The anterior cingulate, inferior prefrontal and temporal cortices in schizophrenic patients showed a higher RPI while the occipital and parietal regions revealed a unilateral lower RPI as compared to control group. Different schizophrenic patients showed hyperperfusion as well as normal or hypoperfusion in different regions of the brain cortex. However, hyperperfusion rather than hypoperfusion was mainly seen in the inferior prefrontal and temporal regions related to positive symptoms, while hypoperfusion pattern was more prominent in the cerebellar, occipital, parietal and dorsolateral prefrontal cortices and was probably associated with negative symptoms. Conclusion: Different patterns of brain perfusion are seen in drug-free or drug-naïve patients with schizophrenia. Hyperperfusion in the frontal and temporal regions and hypoperfusion in the cerebellar, parietal and dorsolateral prefrontal cortices are the most predominant abnormal patterns in these cases.

a a aAmburanjan Santra , Rakesh Kumar , Chandrasekhar Bal , b aPramod Julka and A. Malhotra

a Department of Nuclear Medicine, All India Institute of Medical bSciences, New Delhi, India; Department of Radiotherapy, All

India Institute of Medical Sciences, New Delhi, India

18 Purpose of this study was to evaluate the role of F-FDG PET-CT in prediction of survival in recurrent glioma patients.

Methods: Eighty one patients of glioma (GBM-13, Grade III –26, Grade II -34, Grade I- 4 and others –4) with clinical suspected and

MRI proven recurrence underwent FDG PET-CT scan. Tumor to gray mater (T/G) and tumor to white mater (T/W) uptake ratio

calculated. PET SCORE given on the basis of uptake (0: no uptake orT/W≤ 1, 1: T/W>1 but T/G<1, 2: T/G≥ 1). Treatment given

accordingly. Patients were followed up clinically and/or by MRI and PET-CT whenever possible. Survival was defined as the time between the first PET scan and the date of death or the end of the

study. Age, sex, size and grade of tumor, previous treatment, clinical symptoms, treatment for recurrence and PET score were

taken into account. Survival curves were calculated with Kaplan–Meier product-limit estimation, survival in the distributions were compared with the log rank test for stratified covariates and Cox regression analysis done. Results: PET score

770To predict survival in recurrent glioma by 18F-FDG PET-CT: A prospective study in 81 patients of clinically suspected and MRI proven recurrence

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was 0 in 31 patients, 1in 29 patients and 2 in 21 patients. Within the median follow up period of 16.33 months, 30 patients died (4 of PET Score 0, 11 of Score 1, 15 of Score 2). There is no statistically significant difference noted between score 0 and 1(p=0.073) but events in score 2 is much higher from both score 0 and 1(statistically significant, p=0.000 and p=0.004 respectively). Median survival was 26.06 month among score 0 patients and 23.06 months among score 1, whereas it is significantly reduced to 9.96 months among score 2 patients. It was also found by

univariate analysis, that poor survival is common with increasing size of tumor, debilitating clinical symptoms and single modality

primary treatment. In multivariateanalysis, significant correlation shown only by PET score and primary treatment received. Conclusions: FDG PET/CT is a strong predictor of survival in the

patientsof recurrent glioma. Patients having score 2 (tumor uptake more than contra lateral grey matter) showing significantly poor survival than score 0 and score 1.

a b c d d cB. Paghera, Lutfun Nisa, B. Borroni, E. Puta, F. Caobelli, E. c dPremi, A. Padovani, R. Giubbini

aNuclear Medicine Department, Brescia Hospital, University of bBrescia, Italy; Institute of Nuclear Medicine & Ultrasound, BSM

cMedical University Campus, Dhaka, Bangladesh; Department of Neurological Sciences, Neurologic Clinic, University of Brescia,

dItaly, Chair of Nuclear Medicine, University of Brescia (Italy)

Introduction: Creutzfeldt Jacob disease (CJD) is a subacute spongiform encephalopathy characterized by rapidly progressive dementia with a variety of neurological disorders. Diagnosis during life is difficult because it is rare and, particularly in its early stages, it may simulate other common forms of dementia. We

99mpresent here two sequential brain perfusion SPECT ( Tc-ECD-SPECT) of a patient with an autopsy proven sporadic form of Creutzfeldt Jacob disease (sCJD), in which all initial diagnostic tests were negative. Case A 55 years-old man was admitted at the Neurologic Clinic of the Spedali Civili of Brescia, with a six months history of progressively worsening visual disturbances and depression followed by gradual slowing of cognitive function. The patient underwent a thorough clinical and neuropsychological

99mevaluation. Two Tc-ECD-SPECT, at admission and two months later, were performed. At time of first SPECT, general physical examination and routine laboratory findings were normal. Cerebrospinal fluid 14-3-3 protein examination was unremarkable as well as electrophysiological and anatomical

99mneuroimaging findings. The first Tc-ECD-SPECT revealed slight and heterogeneous hypoperfusion in left hemisphere prominent in temporal cortex, but also evident to a lesser extent in parieto-occipital cortex and in frontal inferior gyrus. Perfusion was normal in most of the right hemisphere, basal ganglia, thalamus, cerebellum and brainstem. The further course of the patient was determined by rapid deterioration with severe aphasia

99mand frequent myoclonic jerks. At this time, a second Tc-ECD-SPECT showed a significant worsening of brain blood flow with more diffuse and severe pattern of hypoperfusion now present in both hemispheres still with a little prevalence on the left; the changes were more pronounced in both temporal poles, in the mesial part of temporal lobes and severe in the whole left temporal lobe, cerebellum and pons. The patient developed bilateral decerebrate posturing and myoclonic jerking of all four extremities and succumbed six months later. The final diagnosis was obtained by autopsy which revealed pathological spongiform encephalopathy typical for sCJD. Conclusions Our case demonstrates that perfusion brain SPECT can be an useful additional tool to other findings for investigation of patients with probable CJD and their

647Two sequential 99mTc-ECD SPECT studies in a case of

sporadic Creutzfeldt Jacob disease confirmed at autopsy

differentiation from other neurodegenerative disorders.

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(L) Page 89-102 Abstracts Thursday S 84 to 97

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