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FROM THE LITERATURE

Each month the editor of Newsline patients. Higher PSA levels at the time SUVRs and years of play were 0.58, selects articles on diagnostic, therapeutic, of imaging were statistically associated 0.45, and 0.50, respectively. No asso- research, and practice issues from a with having PSMA-avid disease outside ciation was identified between tau de- range of international publications. of standard nodal fields. The authors position and scores on cognitive and Most selections come from outside the concluded that not only does 68Ga-PSMA- neuropsychiatric tests. A single former standard canon of nuclear medicine and 11 PET imaging detect disease in a player showed levels of amyloid-b de- radiology journals. These briefs are majority of patients after radical prosta- position similar to those in individuals offered as a monthly window on the tectomy with PSA levels ,2ng/mL,but with Alzheimer disease. The authors broad arena of medical and scientific nearly a third of the patients in this study concluded that these innovative in vivo endeavor in which nuclear medicine had PSMA-avid disease that would not studies showed that this group of NFL now plays an essential role. The lines becoveredbystandardradiationfields. players with cognitive and neuropsy- between diagnosis and therapy are some- They added that ‘‘this imaging modality chiatric symptoms had higher PET- times blurred, as radiolabels are increas- may dramatically impact the design assessed tau levels in brain regions ingly used as adjuncts to therapy and/or and use of post–radical prostatectomy affected by CTE but did not show el- as active agents in therapeutic regimens, salvage radiotherapy.’’ evated amyloid-b levels. They noted and these shifting lines are reflected in Urology that additional studies are needed to the briefs presented here. We have also determine whether elevated CTE-as- added a small section on noteworthy In Vivo PET and CTE sociated tau can be routinely detected. reviews of the literature. In an article e-published on April This method for assessing tau deposi- 10 ahead of print in the New England tion in living brains opens the door 68 Ga-PSMA-11 PET, PCa Journal of Medicine andcoveredexten- for potential early (as opposed to post- Recurrence, and Salvage sively in the media, Stern et al. from mortem) identification of degenera- Radiotherapy the Boston University School of Medicine tion associated with traumatic brain Boreta et al. from the University of (MA), the Boston University School injury. California San Francisco and the San of Public Health (MA), Brigham and New England Journal of Medicine Francisco Veterans Affairs Medical Center Women’s Hospital (Boston, MA), (CA) reported on March 27 ahead of Harvard Medical School (Boston, MA), Somatostatin Receptor PET/CT print in Urology on a study using 68Ga– the Veterans Affairs Boston Healthcare in Metastatic NETs prostate-specific membrane antigen (68Ga- System (MA), the Mayo Clinic Arizona De Dosso et al. from the Oncology PSMA)-11 PET imaging to visualize (Scottsdale), Banner Alzheimer’s Institute Institute of Southern Switzerland, the locations of prostate cancer recurrence (Phoenix, AZ), Arizona State University Imaging Institute of Southern Switzerland, after radical prostatectomy in men with (Tempe), and Avid Radiopharmaceuticals and the Ente Ospedaliero Cantonale prostate-specific antigen (PSA) levels (Philadelphia, PA) reported on a study (all in Bellinzona, Switzerland), Lausanne ,2ng/mLandtoassessthecoverage using 18F-flortaucipir (18F-AV-1451) University Hospital/University of Lau- of standard radiation treatment fields in and 18F-florbetapir for in vivo detection sanne (Switzerland), Ente Ospedaliero such recurrences. The retrospective study of patterns of tau and amyloid-b depo- Cantonale (Lugano, Switzerland), Johns included 125 patients imaged for bio- sition, respectively, in individuals at risk Hopkins University School of Medicine chemical recurrence after radical pros- for chronic traumatic encephalopathy (Baltimore, MD), and Medical University tatectomy with a median PSA at imaging (CTE). The study included 26 former Innsbruck (Austria) reported on April of 0.40 ng/mL. PET showed PSMA-avid National Football League (NFL) players 19 ahead of print in Endocrine on a disease in 66 (53%) men. Twenty-five (ages, 40–69 y) with cognitive and neu- metaanalysis of reports on somatostatin (38%) of these patients were found to ropsychiatric symptoms and 31 asymp- receptor–targeted PET/CT in patients have PSMA-avid disease outside of tomatic controls. Regional tau SUV ratios with metastatic neuroendocrine tumors the pelvis, 33 (50%) had tracer uptake (SUVRs) in the 2 groups were compared, and unknown primary tumors. The au- confined to the pelvic lymph nodes and and the relationship between SUVRs thors conducted a comprehensive search prostate bed, and 8 (12%) had PSMA- and symptom severity and years of football of the literature using major databases, avid recurrence only in the prostate bed. play in the former players was analyzed. looking at reports of detection rates and In a comparison of these locations with The researchers found that the mean resulting changes in management. A total standard radiation therapy fields, salvage flortaucipir SUVR was higher among of 12 studies met the metaanalysis criteria radiation (including standard intensity- former players than controls in the bilateral and included 383 patients with metastatic modulated radiation therapy) pelvic superior frontal, bilateral medial temporal, neuroendocrine tumors and unknown nodal volumes would not have covered and left parietal regions. Correlation primaries who underwent PET/CT im- PSMA-avid nodal disease in 38 (30%) coefficients in these 3 regions between aging. Per-patient analysis showed a

Newsline 25N primary tumor detection rate of 56%, effective to predict the response of renal Journal of Pediatric Hematology/ with the most common locations be- cell carcinoma to nivolumab,’’ but called Oncology ing the bowel and pancreas. Imaging for larger studies to validate these results. resulted in a change in management BMC Cancer Reviews in 20% of patients in the study. The Review articles provide an impor-

NEWSLINE authors concluded that somatostatin re- Correlation in PET/MR and tant way to stay up to date on the latest ceptor PET/CT is quite useful in detect- PET/CT Pediatric Imaging topics and approaches through valu- ing unknown primaries in patients with Uslu-Besli et al. from the Istanbul able summaries of pertinent literature. metastatic neuroendocrine tumor disease. University–Cerrahpasxa, Gazi Univer- The Newsline editor recommends sev- They called for additional studies on sity Medical Faculty (Ankara), and the eral general reviews accessioned into imaging factors affecting changes in man- Istanbul Sultan Abd¨ulhamid Han Train- the PubMed database in April. In an agement in this setting. ing and Research Hospital (all in Turkey) article e-published on April 14 ahead Endocrine reported on March 29 ahead of print in of print in Clinical Gastroenterology the Journal of Pediatric Hematology/ and Hepatology, Allocca et al. from Renal Cell Carcinoma, Oncology on a comparison of 18F-FDG Humanitas Clinical and Research Center Nivolumab Treatment, and PET/MR and 18F-FDG PET/CT imag- (Milan, Italy) and the University Hospital 18F-FDG PET/CT ing in pediatric oncology patients. The of Nancy/Lorraine University (Nancy, In an article e-published on April 2 group looked specifically at anatomic France) provided an overview of ‘‘Non- ahead of print in BMC Cancer, Tabei correlation of tracer-positive lesions with invasive multi-modal methods to differ- et al. from the Yokohama City Univer- the 2 modalities and also compared entiate inflamed vs. fibrotic strictures sity Graduate School of Medicine, the diffusion-weighted MR imaging (DWI) in patients with Crohn’s disease.’’ Kim Yokosuka Kyosai Hospital, and the with PET to assess correlations between et al. from the Sungkyunkwan University Yokohama Minami Kyosai Hospital apparent diffusion coefficients and School of Medicine (Seoul, Korea) re- (all in Yokohama, Japan) reported on SUVs. The retrospective study included ported on ‘‘Diffusely increased 18F-FDG a study of the utility of 18F-FDG PET/ sequential PET/CT and PET/MR uptake in the thyroid gland and risk of CT before and after initiation of nivolu- images and/or whole-body DWI and ap- thyroid dysfunction: A cohort study’’ mab therapy in patients with renal cell parent diffusion coefficient mapping on April 2 ahead of print in the Jour- 18 carcinoma. The work builds on previous in 34 pediatric patients. F-FDG–positive nal of Clinical Medicine. In an article 18 reports by the group on F-FDG PET/ lesions were assessed visually on the e-published on April 19 ahead of print CT in prediction in renal cell carcinoma CT,T1-weighted,T2-weighted,and in Head & Neck, Zafareo et al., repre- treated with molecular-targeting agents. DWI images for the 2 modalities for senting a multiinstitutional committee The current study included 9 patients anatomic correlation. Additional cor- of subject-matter experts, presented an with metastatic disease (total of 30 le- relation analyses were performed for ‘‘American Head and Neck Society sions) who underwent PET/CT imaging SUV parameters and apparent diffu- Endocrine Surgery Section update on at baseline and at 1 mo after treatment sion coefficient values. Of the 47 18F- parathyroid imaging for surgical candi- initiation and CT imaging at 4 mo. The FDG–positive lesions identified on both dates with primary hyperthyroidism.’’ 3 imaging points were used to assess and PET/CTandPET/MRimaging,37were Hanssen et al. from the Centre Hospi- evaluate potential imaging predictors. positive on CT and 46 were positive on talier Universitaire de Li`ege and the Lesions with diameters decreased $30% at least 1 MR sequence. In the 32 18F- Universit´edeLi`ege (Belgium) reviewed at 4-mo CT were defined as responding, FDG–positive lesions for which DWI data 18F-FDG positron emission tomography and those that did not decrease $30% were available, 31 could be clearly visu- were defined as nonresponding. Eighteen alized on DWI, resulting in a significant in non-oncological renal pathology: lesions were classified as responding difference compared with CT alone in Current indications and perspectives’’ and 12 as nonresponding. All lesions detection of 18F-FDG–positive lesions. (in French) on April 11 ahead of print with decreased diameter and elevated No correlations were identified between in Nephrologie & Therapeutique.In an article e-published on April 15 ahead SUVmax at 1-mo PET/CT were classi- apparent diffusion coefficients and fied as responding at 4-mo CT imaging, SUVs. Because 18F-FDG PET/MR im- of print in Hormones (Athens, Greece) whereas most lesions with increased di- aging showed better performance than Bertagna et al. from the University of ameter and decreased SUVmax at 1-mo PET/CT in terms of anatomic correla- Brescia/Spedali Civili di Brescia (Italy), PET/CT were nonresponders at 4-mo tion of 18F-FDG–avid lesions, the au- the Oncology Institute of Southern CT. Multivariate analyses showed ele- thors concluded that ‘‘PET/MRI may Switzerland (Bellinzona), Lausanne vation of SUVmax at 1 mo to be the sole be more advantageous than PET/CT, University Hospital (Switzerland) independent predictor among a variety not only due to reduced ionizing radia- and the Ente Ospedaliero Cantonale of factors. The authors concluded that tion dose but also for a better depiction (Bellinzona, Switzerland) presented a ‘‘our findings suggest that the early as- of FDG-avid lesions in pediatric PET systematic review on ‘‘68Ga-PSMA sessment using FDG PET/CT can be imaging.’’ PET thyroid incidentalomas.’’

26N THE JOURNAL OF NUCLEAR MEDICINE • Vol. 60 • No. 6 • June 2019