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British Nuclear Medicine Society 47 Annual Spring Meeting, Oxford 1 St Abstracts British Nuclear Medicine Society 47th Annual Spring Meeting, Oxford 1st–3rd April 2019 Nuclear Medicine Communications 2019, 00:000–000 1. Imaging patients with possible cardiac sarcoidosis: aOxford University Hospitals NHS Foundation Trust, Review of initial experience Oxford, United Kingdom and bUniversity of Oxford, Oxford, Pamela Moyade and Sobhan Vinjamuri United Kingdom Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, United Kingdom The aim of the study was to investigate the threshold value of the estimated GFR (eGFR) which would predict Aim: To evaluate the adequacy of patient preparation for a measured GFR (mGFR) of ≤ 25 ml/min/1.73 m2 in order cardiac FDG scans and to assess concurrence between to determine if the patient requires a 24 h single blood blinded interpreters for image interpretation. sample (SS), following the new BNMS guidelines, or Materials and methods: 31 patients with clinical suspicion of alternatively use the slope intercept (SI) method to mea- cardiac sarcoidosis who underwent 18F-FDG PET/CT scans sure their GFR. Data from 1956 patient studies were used were retrospectively evaluated. All patients were instructed to calculate SI and SS values of the mGFR. A sub-data ≤ 2 to follow a high fat – low carbohydrate diet for 18 h, followed set of 241 patients with a mGFR of 80 ml/min/1.73 m by a water only fast for 18 h. The study was conducted only if and an eGFR measurement taken within 28 days was the patient’s blood glucose was <11.0. Each scan was inter- selected. preted separately by three blinded and experienced Nuclear ThereisalargevariationintheaccuracyofusingtheeGFR Medicine Physicians. In addition, semi-quantification was to predict the mGFR value. The absolute percentage performed using a myocardium to blood pool ratio for all difference for the SI method is 22% (range −141% to 63%), patients. We also invited a renowned expert to review our the SS method has an absolute percentage difference of 23% practice and interpretation criteria. (range −165% to 86%). Receiver operator characteristic Results: 30 of 31 patients complied with pre-scan instructions (ROC) curves comparing sensitivity and specificity demon- ≤ 2 (one patient had to be re-appointed). strated that an eGFR threshold value of 40 ml/min/1.73 m is used to predict mGFRs of ≤ 25 ml/min/1.73 m2 in order to In 29 patients, there was agreement on the image quality optimise the likelihood of identifying all such patients. and suitability for interpretation. st In all patients, there was good inter-observer agreement This threshold has been used at our Trust since 1 between at least 2 observers on image interpretation for 3 December. To date only 13% of GFRs have required SI- possible categories (i.e. positive, negative or equivocal). GFR (due to low eGFR) and so we have had an 87% In 22 patients all 3 observers agreed, while in 9 patients at reduction in blood samples taken compared to our previous least 2 observers agreed (majority were between normal technique of SI for all patients. This has saved staff time both and abnormal rather than equivocal patterns). External in terms of taking the blood samples and in processing them. review concurred with majority interpretation. Conclusion: There is good patient compliance with diet 3. Appropriateness of bone scan imaging referrals in restriction and fasting in preparation for cardiac FDG scans. prostate cancer: Preliminary data from a quality There is good inter-observer agreement for the interpreta- improvement project Riddhika Chakravarttya, Sandeep Singha,b, tion of these scans. Review of our initial experience con- b b b firms that our approach is scientifically sound. Monica Pugsley , Ralf Clauss , James Scuffham and Vineet Prakashb aAshford and St Petes Hospital, Chertsey, United Kingdom and 2. Moving to single sample GFRs: Variability in using bRoyal Surrey County Hospital, Guildford, United Kingdom estimated GFR to predict measured GFR and the time saved by using a single sample GFR method Purpose of study: EAU-ESTRO-SIOG guidelines (Mottet Lawrence Huttona, Amany S. Amina, N. 2017, 71:618– 629. Eur Urol) recommend imaging for Stephanie J. Jewitta, Charlotte Portera, bone metastases only for prostate cancer patients with Andrew J. Morgana, Kevin M. Bradleya and high metastatic risk and advise against bone scintigraphy Daniel R. McGowana,b after treatment. As part of a quality improvement project, 0143-3636 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/01.mnm.0000553743.87961.ed Copyright r 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 2 Nuclear Medicine Communications 2019, Vol 00 No 00 we assessed appropriateness of bone scan referrals against The principal measure of success was the number of these guidelines. patients that would have received a different diagnosis, based on NICE diagnostics guidance (2012), had the Methods used: This retrospective audit included all refer- predicted Day 1 result been used instead of the mea- rals for whole body bone scans in prostate cancer patients sured result. No patients received a different diagnosis over a 3-month period between July and September based on the measured abdominal thickness, and 4 2017. Using the EAU-ESTRO-SIOG guidelines as a received a different diagnosis based on BMI. standard, referrals were categorised as either low or high risk. When localised disease was staged, PSA level > 20 Average percentage difference between measured and ng/ml or Gleason Score > 7 was considered high risk. All predicted Day 1 result was 2.24% for thickness and 3.41% locally advanced cancer was deemed high risk. Patients for BMI. with biochemical evidence of recurrence, PSA > 10 ng/ml Conclusion: This is an encouraging result which should or bone pains were considered high risk. Bone scan prompt further investigation. A larger cohort of patients is reports were reviewed for the presence of metastases. required to determine the relationship between thick- Summary of results: A total of 190 men were included in ness and Day 1 result with greater confidence. the analysis (mean age 74 years, range 47 to 94 years). Of these, 103 patients (54%) were categorised as low risk; no bony metastases were detected in this group. 84 patients 5. A review of incidental cardiac uptake on Ga-68 DOTA (44%) were categorised as high risk; 18 of these (21%) peptide PET/CT scans showed metastases. 3 patients were referred to assess Pamela Moyade and Sobhan Vinjamuri treatment response. Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, United Kingdom Conclusion: The majority of prostate cancer patients referred for bone scans are low risk with no bone metastases detected. Aim: To evaluate the frequency and relative significance A flow chart based on the EAU guidelines to aid referring of incidental cardiac uptake/manifestations on Ga-68 clinicians may be useful in reducing inappropriate referrals DOTA peptide scans. and making best use of imaging resources. Materials and methods: Scans of 1463 patients who underwent Ga-68 DOTA peptide PET/CT scans in our 4. A clinical audit investigating the possibility of department between 2013 and 2018 were retrospectively predicting the result of SeHCAT Day 1 scan evaluated for the presence of uptake in the heart and/or Paul Gape, Emma Wroe, Victoria Lindsay, its appendages. Sabina Dizdarevic and Mark Aplin Results: 19/1463 patients (around 1.3%) demonstrated Brighton and Sussex University Hospitals NHS Trust, uptake in the heart and/or its appendages. Brighton, United Kingdom In 18/19 patients, the clinicians were unaware of possible Purpose: To establish whether the result of SeHCAT Day cardiac involvement by disease (1 patient was a known 1 scan can be predicted accurately from the patient’s BMI case of cardiac paraganglioma). or abdominal thickness. This would allow patients to The most common pattern was focal activity in the ven- forego the Day 1 scan, thus reducing the patient burden tricles, with some lesions noted in pericardium, inter- and saving up to 0.5 days of camera time/week. ventricular septum and atrium as well. Echocardiography + Methods: The patients had a Day 1 scan. Their height, weight /- MRI correlation was performed where possible, but and abdominal thickness were also measured. Thickness was not always insisted upon. measured at the height of the umbilicus using calipers by the Our results are in agreement with established literature. technologist administering the capsule. Conclusion: Ga-68 DOTA peptide PET/CT scans are Empirical relationships between the measured Day 1 sensitive for the detection of possible cardiac metastases/ result and patient thickness/BMI were determined from involvement in patients with neuroendocrine tumors. the group data. These may be easily missed if careful scrutiny while reporting these scans is not conducted. It is our hypothesis Predicted Day 1 result was calculated, based on the that, early detection/confirmation of cardiac metastases in empirical relationship described above. The measured these patients by means of Echocardiography/ MRI could Day 7 result was used to calculate the patient’s measured lead to more effective treatment strategies and contribute and predicted retention. to better patient outcomes. However, since this is a rela- Results: Thirty-two patients undergoing routine SeHCAT tively less well studied issue, we recommend further studies at Brighton and Sussex University Hospitals NHS detailed multi-centre studies with good
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