Recurrent glioma and crossed cerebellar diaschisis in a patient examined with 18F-DOPA and 18F-FDG PET/CT

Two years after resection of a left parietal glioma, a 46-year-old woman underwent F-FDG and F-DOPA brain PET/CT. FDG showed left parietal hypometabolism with crossed cerebellar diaschisis. No abnormally increased FDG activity was seen. F-DOPA PET/CT scan demonstrated focal left parietal uptake. Recurrent glioma was confirmed by surgical biopsy. F-DOPA may demonstrate abnormal amino acid metabolism in evaluation of recurrence of glioma

Prognostic value of18 f-choline pet/ct in patients with metastatic castration-resistant prostate cancer treated with radium-223

We aimed to investigate the role of positron emission computed tomography (PET/CT) with F-18-choline for predicting the outcome of metastatic castration-resistant prostate cancer (mCRPC) submitted to treatment with Radium-223 (Ra-223-therapy). Clinical records of 20 mCRPC patients submitted to PET/CT with F-18-choline before Ra-223-therapy were retrospectively evaluated. The following PET-derived parameters were calculated: number of lesions, maximum and mean standardized uptake values (SUVmax, SUVmean), lean body mass corrected SUV peak (SULpeak), metabolic tumor volume (MATV), and total lesion activity (TLA). After Ra-223-therapy, all patients underwent regular follow-up until death. The predictive power of clinical and PET-derived parameters on overall survival (OS) was assessed by Kaplan-Meier analysis and the Cox proportional hazard method. All the patients showed F-18-choline-avid lesions at baseline PET/CT. Among the enrolled subjects, eleven (55%) completed all the six scheduled cycles of Ra-223-therapy; seven (35%) were responders according to imaging and biochemical parameters. Mean OS was 12.7 +/- 1.4 months: by Kaplan-Meier analysis, number of lesions, PSA level and TLA were significantly correlated with OS. In multivariate Cox analysis, TLA remained the only significant predictor of survival (p = 0.003; hazard ratio = 7.6, 95% confidence interval = 1.9-29.5 months). F-18-choline PET may be useful for patients' stratification before Ra-223-therapy. In particular, high metabolically active tumor burden (i.e., TLA) was predictive of poor outcome

Positron emission tomography (Pet) and neuroimaging in the personalized approach to neurodegenerative causes of dementia

Generally, dementia should be considered an acquired syndrome, with multiple possible causes, rather than a specific disease in itself. The leading causes of dementia are neurodegenerative and non-neurodegenerative alterations. Nevertheless, the neurodegenerative group of diseases that lead to cognitive impairment and dementia includes multiple possibilities or mixed pathologies with personalized treatment management for each cause, even if Alzheimer's disease is the most common pathology. Therefore, an accurate differential diagnosis is mandatory in order to select the most appropriate therapy approach. The role of personalized assessment in the treatment of dementia is rapidly growing. Neuroimaging is an essential tool for differential diagnosis of multiple causes of dementia and allows a personalized diagnostic and therapeutic protocol based on risk factors that may improve treatment management, especially in early diagnosis during the prodromal stage. The utility of structural and functional imaging could be increased by standardization of acquisition and analysis methods and by the development of algorithms for automated assessment. The aim of this review is to focus on the most commonly used tracers for differential diagnosis in the dementia field. Particularly, we aim to explore F-18 Fluorodeoxyglucose (FDG) and amyloid positron emission tomography (PET) imaging in Alzheimer's disease and in other neurodegenerative causes of dementia

Rare lymphoid malignancies of the breast: report of two cases illustrating potential diagnostic techniques.

Two cases of lymphoid malignancy involving the breast are herein presented. Both patients were admitted with a palpable breast mass. Ultrasound demonstrated hypoechoic, ill-defined lesions of the breast in both patients; mammogram also showed spiculated breast densities. Both patients underwent core biopsy, which revealed lymphomatous cells. Total-body evaluation was also performed by computed tomography and positron emission tomography/computed tomography revealing no other fluorodeoxyglucose-avid foci in the first case and supra and subdiaphragmatic disease in the second one

Cerebral plasticity in acute vestibular deficit

The aim of this study was to analyze the effect of acute vestibular deficit on the cerebral cortex and its correlation with clinical signs and symptoms. Eight right-handed patients affected by vestibular neuritis, a purely peripheral vestibular lesion, underwent two brain single photon emission computed tomography (SPECT) in 1 month. The first SPECT analysis revealed reduced blood flow in the temporal frontal area of the right hemisphere in seven of eight patients, independent of the right/left location of the lesion. The alteration was present always in the right, non-dominant hemisphere and was reversible in some patients 1 month after the onset, together with attenuation of signs and symptoms. It may be hypothesized that the transient reduction of cortical blood flow and subsequently of cortical activity in the non-dominant hemisphere, also the expression of cerebral plasticity, may serve as a defense mechanism aimed to attenuate the vertigo symptom

Indium(111) pentetreotide single photon emission computed tomography (In-111 pentetreotide SPECT): a new technique to evaluate somatostatin receptors in chordomas

Chordomas are rare neoplasms originating along the neuraxis. Although they do not usually show cytological atypia, metastases have been reported in 30 per cent of cases. Survival rates in cases of skull base locations are low, and local recurrence is common after local excision. Radiation therapy is used in post-operative treatment and proton radiation therapy as the primary treatment. In the present paper we present the case of a 50-year-old Caucasian man affected by chordoma of the clivus, with liver and chest metastases, relapsed after several surgical local excisions, to discuss improvements in therapeutic and imaging techniques. Indium(III) (In-III) pentetreotide single photon emission computed tomography (SPECT) was employed to assess the presence of somatostatin receptors and to treat the tumour with radiolabelled Y-90-DOTA-lanreotide. Imaging, performed 2 months afterwards, showed stable disease in the lungs but a local progression in the metastases, in comparison with pre-treatment uptake. These data suggest the usefulness of radiolabelled somatostatin analogues in the diagnosis and therapy of chordomas

MGMT promoter methylation and IDH1 mutations do not affect [18F]FDOPA uptake in primary brain tumors

The aim of our study was to investigate the effects of methylation of O-6-methylguanine-DNA methyltransferase promoter (MGMTp) and isocitrate dehydrogenase 1 (IDH 1) mutations on amino acid metabolism evaluated with 3,4-dihydroxy-6-[F-18]-fluoro-l-phenylalanine ([F-18] FDOPA) positron emission tomography/computed tomography (PET/CT). Seventy-two patients with primary brain tumors were enrolled in the study (33 women and 39 men; mean age 44 +/- 12 years old). All of them were subjected to PET/CT examination after surgical treatment. Of them, 29 (40.3%) were affected by grade II glioma and 43 (59.7%) by grade III. PET/CT was scored as positive or negative and standardized uptake value ratio (SUVr) was calculated as the ratio between SUVmax of the lesion vs. that of the background. Statistical analysis was performed with the Mann-Whitney U test. Methylation of MGMTp was detectable in 61 out of the 72 patients examinated. Mean SUVr in patients without methylation of MGMTp was 1.44 +/- 0.38 vs. 1.35 +/- 0.48 of patients with methylation (p = 0.15). Data on IDH1 mutations were available for 43 subjects; of them, 31 are IDH-mutant. Mean SUVr was 1.38 +/- 0.51 in patients IDH mutant and 1.46 +/- 0.56 in patients IDH wild type. MGMTp methylation and IDH1 mutations do not affect [F-18] FDOPA uptake in primary brain tumors and therefore cannot be assessed or predicted by radiopharmaceutical uptake parameters