From the Literature

FROM THE LITERATURE

Each month the editor of Newsline be evaluated with CTA-based FFR. study, a larger investigation initiated to selects articles on diagnostic, thera- CTA-based FFR had per-vessel diagnos- discover key pathologic mechanisms

NEWSLINE peutic, research, and practice issues tic accuracy, sensitivity, and specificity in AD and other neurodegenerative dis- from a range of international publica- of 87%, 90%, and 86%, respectively. eases such as parkinsonian disorders. tions. Most selections come from out- Corresponding per-patient percentages Thirty-three of this study’s participants side the standard canon of nuclear were 78%, 96%, and 63%. The area had preclinical AD (i.e., were b-amyloid– medicine and radiology journals. These under the receiver operating character- positive and cognitively normal), 25 had briefs are offered as a monthly window istic curve (AUC) for identification of prodromal AD (i.e., were b-amyloid– on the broad arena of medical and sci- ischemia-causing lesions was signifi- positive with mild cognitive impairment), entific endeavor in which nuclear med- cantly greater for CTA-derived FFR and 48 had probable AD dementia. All icine now plays an essential role. The than for coronary CTA and SPECT, on underwent18F-flortaucipir PET imag- lines between diagnosis and therapy both per-vessel and per-patient analyses. ing for tau and structural MR imaging are sometimes blurred, as radiolabels CTA-derived FFR also outperformed for cortical thickness. In addition, 88 are increasingly used as adjuncts to PET on a per-vessel basis but not on of the 106 participants underwent 18F- therapy and/or as active agents in ther- per-patient assessment. PET showed flutemetamol PET for b-amyloid. Re- apeutic regimens, and these shifting the highest per-patient and per-vessel sults were analyzed for associations lines are reflected in the briefs pre- AUC on intention-to-diagnose analy- between 7 regions of interest and 7 neu- sented here. We have also added a ses. The authors concluded that al- ropsychological tests for all 3 imaging small section on noteworthy reviews though CTA-derived FFR showed modalities. of the literature. ‘‘higher diagnostic performance than 18F-flortaucipir uptake (but neither standard coronary CTA, SPECT, and 18F-flutemetamol uptake nor cortical Fractional Flow Reserve from PET for vessel-specific ischemia,’’ this thickness) was associated with decreased CTA Data in CAD was dependent on whether standard global cognition, memory, and process- Driessen et al. from the VU Medical coronary CTA images were evaluable ing speed in preclinical AD. In both pro- Center (Amsterdam, The Netherlands), by CTA-derived FFR (17% were not). dromal AD and AD dementia groups, the University of British Columbia Despite PET’s superior performance increased 18F-flortaucipir uptake and re- (Vancouver, Canada), Turku University in per-patient and intention-to-diagnose duced cortical thickness were associated Hospital/University of Turku (Finland), analyses, they concluded that CTA-de- with worse outcomes on neuropsycho- the Royal Brompton Hospital (London, rived FFR ‘‘holds clinical potential to logical tests. Increased 18F-flutemetamol UK), and Stanford University (CA) provide anatomic and hemodynamic uptake was specifically associated with reported in the January 22 issue of the significance of coronary lesions.’’ lower scores on a delayed recall memory Journal of the American College of Journal of the American College of task assessment. The strongest rela- Cardiology (2019;73:161–173) on an Cardiology tionships between both 18F-flortaucipir evaluation of the diagnostic performance and cortical thickness and cognition of fractional flow reserve (FFR) cal- PET-Assessed Factors and were identified in the lateral and medial culated from coronary CT angiogra- Cognition in AD parietal cortices and lateral temporal phy (CTA) datasets and compared In an article e-published ahead of cortex. 18F-flutemetamol associations results with the diagnostic perfor- print in the January 9 issue of Neurol- with cognition were weaker and less re- mances of CTA, SPECT, and PET in ogy, Ossenkoppele et al. from Lund gion specific. The authors concluded ischemia to assess the hemodynamic University (Sweden), VU University that their findings suggest that ‘‘tau severity of coronary artery disease (Amsterdam, The Netherlands), Sk˚ane PET is more sensitive than b-amyloid (CAD). The study included 208 pa- University Hospital (Malmö, Sweden), PET and measures of cortical thickness tients with suspected stable CAD, each and the Veterans Affairs Medical Cen- for detecting early cognitive changes in of whom underwent 256-slice coro- ter (San Francisco, CA) reported on preclinical AD’’ and that ‘‘both 18F-flor- nary CTA, 99mTc-tetrofosmin SPECT, correlations among factors including taucipir PET and cortical thickness show 15 O-H2O PET, and routine 3-vessel in- regional tau, b-amyloid, and cortical strong cognitive correlates at the clinical vasive FFR assessments. CTA-based thickness and related associations with stages of AD.’’ FFR values were derived retrospec- neuropsychological function in both Neurology tively. Interpretations of images from preclinical and clinical Alzheimer dis- other modalities were compared using ease (AD). The study included 106 in- PET/CT 1 US and Primary invasively measured FFR # 0.80 as dividuals from the Swedish Biomarkers Tumors in Malignant Ascites the reference standard. Of a total of for Identifying Neurodegenerative Dis- Liu et al. from the Affiliated Hos- 612 vessels assessed, 505 (83%) could orders Early and Reliably (BioFINDER) pital of Chengdu Medical College and

10N THE JOURNAL OF NUCLEAR MEDICINE • Vol. 60 • No. 3 • March 2019 NEWSLINE the Nanchong City Central Hospital PET/CT with histories of neck surgery analyses, and these data led to the con- (both in China) reported on December and indications for reoperation. All pa- clusion that the 2 tracers have a similar 26 ahead of print in Cancer Biotherapy tients also underwent parathyroid ultra- accuracy in patients with high-grade gli- and Radiopharmaceuticals on a study sound and 99mTc-sestamibi scintigraphy, oma.Thecaseseriesstudyfromthere- designed to determine the clinical value with a subset of 20 also undergoing 4D searchers’ own institution included 29 of PET/CT imaging combined with ul- CT. Results were compared against patients who had undergone either 18F- trasound in detection of primary tumors pathology findings and/or ultrasound- DOPA or 18F-FET PET/CT for suspicion in patients with malignant ascites. The guided fine-needle aspiration products. of recurrent disease, with a final confir- study included 122 patients with malig- 18F-fluorocholine PET/CT identified mation/rule-out of recurrence made by nant tumors and ascites as an initial 34 abnormal foci, including 19 ectopic MR imaging and/or clinical decision. symptom and 48 patients with benign localizations. In the 4D-CT subset 11 Analysis of these data found that the ascites. All participants underwent PET/ abnormal glands were initially detected, sensitivity, specificity, and accuracy of CT and abdominal B-ultrasound imag- with 6 more identified under 18F-fluoro- 18F-DOPA PET/CT in high-grade gli- ing. The results were compared with pa- choline PET/CT guidance. Ultrasound oma were 100%, 63%, and 62%, re- thology findings as the gold standard. and scintigraphy identified concordant spectively. Corresponding results for PET alone detected primary disease foci foci in 8 of the 29 patients. On a per- 18F-FET PET/CT were all 100%. 18F- in 79.5% of patients, with the detection lesion basis, the sensitivity, specificity, FET PET/CT was true-positive in 4 and rate highest in individuals with gastric and positive and negative predictive val- true-negative in 4 patients. The authors cancer. The corresponding percentage ues were 96%, 13%, 77%, and 50%, noted that 18F-DOPA PET/CT imaging for B-ultrasound was 62.5%, with the respectively, for 18F-fluorocholine PET/ results may be affected by inflamma- detection rate highest in individuals with CT and 75%, 40%, 80% and 33% for tion and that ‘‘large comparative trials ovarian cancer. B-ultrasound had the 4D CT. On a per-patient analysis, sen- are warranted in order to better understand highest specificity for primary foci asso- sitivity was 85% for 18F-fluorocholine the utility of 18F-DOPA or 18F-FET PET/ ciated with malignant ascites at 73.2%, PET/CT and 63% for 4D CT. 18F-fluo- CT in patients with high-grade glioma.’’ whereas PET/CT had the highest sen- rocholine PET/CT enabled successful Current Radiopharmaceuticals sitivity in diagnosing primary foci of removal of an abnormal gland in 21 pa- malignant ascites at 91.7%. PET/CT tients, including 12 with negative or dis- PSMA PET/CT in PCa combined with abdominal B-ultra- cordant ultrasound/scintigraphy findings, Salvage RT Planning sound had the highest sensitivity and producing a global cure rate of 73%. The In an article in the January 7 issue accuracy in diagnosing primary foci authors concluded that ‘‘18F-fluorocho- of BMC Cancer (2019;19[1]:18), Calais (98.1% and 89.1%, respectively). The line PET/CT is a promising tool in et al. from the University of California, diagnostic accuracy rate for B-ultra- the challenging population of reopera- Los Angeles, University Hospital Essen sound was highest in tumors .5cm tive patients with primary hyperpara- (Germany), and the Veterans Affairs (77.0%), and PET/CT was highest in thyroidism,’’ with parathyroid 4D CT Greater Los Angeles Healthcare System detecting 3–5-cm tumors (84.2%). The au- appearing to serve as a confirmatory (CA) reported on initiation of a random- thors concluded that ‘‘PET/CT combined imaging modality. ized prospective phase III trial designed with ultrasound is conducive to improving World Journal of Surgery to explore whether 68Ga-PSMA-11 PET/ the diagnostic efficiency for primary tu- CT–guided treatment planning can im- 18 18 mors in patients with malignant ascites.’’ F-DOPA and F-FET prove outcomes in salvage radiotherapy Cancer Biotherapy and PET/CT in Recurrent in prostate cancer patients with biochem- Radiopharmaceuticals High-Grade Glioma ical recurrence after prostatectomy. The Evangelista et al. from the Veneto rationale for the study is that salvage 18 F-FCH PET/CT and Institute of Oncology IOV–IRCCS radiotherapy is routinely started in 4D CT in Primary (Padua, Italy) reported on January 15 patients with prostate-specific antigen Hyperparathyroidism ahead of print in Current Radiophar- (PSA) levels ,1 ng/mL, when conven- In an article e-published on January maceuticals on a systematic analysis tional imaging is not likely to identify 18 ahead of print in the World Journal of the literature exploring the utility recurrence. The result is that salvage ra- of Surgery, Amadou et al. from the of L-3,4-dihydroxy-6-18F-fluoropheny- diotherapy treatment planning volumes Pitié-Salpêtrière Hospital/Sorbonne lalanine (18F-DOPA) and O-(2-18F-flu- may be delineated without the guidance University (Paris, France) reported on oroethyl)-L-tyrosine (18F-FET) PET/ of visible disease on imaging. The pur- a study evaluating 18F-fluorocholine CT in patients with high-grade glioma, pose of this trial is to evaluate the suc- PET/CT and parathyroid 4D CT in guiding followed by experiential results with cess rate of salvage radiotherapy with surgery in patients with primary hyper- both tracers in a series of patients with and without 68Ga-PSMA-11 PET/CT– parathyroidism and previous neck sur- recurrent disease. Although the literature guided planning for cancer recurrence gery. The retrospective study included search of keywords yielded 51 articles, after prostatectomy. The prospective 29 patients referred for 18F-fluorocholine only 2 were eligible for the comparison study targets enrollment of 193 men

Newsline 11N who will be randomized to standard- lignancies, highlighting the importance tive utility of 18F-FDG PET/CT for of-care planning (control arm, 90 of staging evaluations, in particular PET sarcoidosis in patients with uveitis and patients) or 68Ga-PSMA-11 PET/CT and bone marrow biopsy.’’ normal thoracic CT. The retrospective before planning (investigational arm, Leukemia and Lymphoma study included 67 patients with uveitis 103 patients). Biochemical progres- of unknown etiology or suspected in-

NEWSLINE sion-free survival (with progression de- Incidental PET Findings in traocular sarcoidosis. Patients with nor- fined as PSA $ 0.2 ng/mL and rising) Psoriasis mal thoracic CT underwent 18F-FDG after initiation of salvage radiotherapy In an article e-published on Janu- PET/CT imaging. Nineteen of the 67 will be assessed as the primary end- ary 14 in the Journal of the American patients (28.4%) were found on PET/ point. The treating radiation oncologist Academy of Dermatology, Wan et al. CT to have mediastinal hypermetabolic will choose whether the prostate bed from the University of Pennsylvania/ foci consistent with sarcoidosis. In ad- alone or the prostate bed and pelvic University of Pennsylvania Perelman dition, PET/CT identified a biopsy site lymph nodes are irradiated, with or School of Medicine (Philadelphia) and in 2 cases, consistent with sarcoidosis. without androgen deprivation therapy, the National Heart, Lung, and Blood In- Overall, 6 patients (10%) had a proven and may choose to refine the radiation stitute (Bethesda, MD) reported on a sarcoidosis, 6 (9%) had a presumed sar- plan based on 68Ga-PSMA-11 PET/CT study designed to assess the frequency coidosis, and 18 (26.9%) had an indeter- in the investigational arm. Patients of incidentalomas and malignancies minate sarcoidosis. Results suggested will be followed for 5 y after random- identified by 18F-FDG PET/CT in clin- that an older age at diagnosis and the ization or until biochemical progres- ical trial patients with moderate-to- presence of synechiae were significantly sion, diagnosis of metastatic disease, severe psoriasis. The study included 259 associated with positive 18F-FDG PET/ initiation of any additional salvage ther- healthy individuals with moderate-to- CT imaging, with a trend toward signif- apy, or death. severe psoriasis, each of whom under- icance for elevated serum angiotensin- BMC Cancer went 18F-FDG PET/CT imaging. Of converting enzyme (ACE). The authors these, 31 (11.97%) were found to have included a nomogram to estimate the Staging in Newly Diagnosed clinically significant incidentalomas on probability of positive findings on 18F- Lymphomatous Brain Lesions baseline imaging. Additional analysis FDG PET/CT based on different predic- Malani et al. from Memorial Sloan showed that every 10-y increase in par- tive factors. They summarized their Kettering Cancer Center and Weill Cor- ticipant age was accompanied by an observations that ‘‘18F-FDG PET/CT nell Medical College (both in New York, ;30% increased risk of incidentaloma enabled the diagnosis of intraocular NY) reported on January 10 ahead of identification on PET/CT. Findings sus- sarcoidosis even in patients with a nor- print in Leukemia and Lymphoma on a picious for malignancy were identified mal CT scan’’ and that ‘‘older age at study characterizing staging evaluations in 28 patients on PET/CT; these were diagnosis, presence of synechiae, and el- in patients with newly diagnosed brain confirmed in 6 patients, for an overall evated ACE are associated with positive lymphomas and focusing on the fre- 2.31% prevalence of malignancy and a findings on 18F-FDG PET/CT consistent quency of secondary central nervous positive predictive value for true cancer with sarcoidosis.’’ system lymphoma and secondary ma- of 31.58% (range, 21%–54%). The au- British Journal of Ophthalmology lignancies. The study included 262 thors concluded that incidentalomas on patients with lymphomatous central 18F-FDG PET/CT imaging ‘‘are com- PET and Salvage nervous system lesions. PET was used mon in otherwise healthy, asymptomatic Hysterectomy After CRT for staging in 180 (69%) patients, clinical trial patients with moderate-to- In an article e-published on January chest/abdomen/pelvis CT imaging in severe psoriasis’’ and that these results 10 ahead of print in the International 195 (74%), and bone marrow biopsies ‘‘can help inform clinical trials safety Journal of Gynecological Cancer, in 177 (68%). Abnormal scans were re- data interpretation and emphasize the Rajasooriyar et al. from the Peter Mac- ported in 34 of 180 (19%) patients un- importance of compliance with cancer Callum Cancer Centre (Melbourne, dergoing PET, in 50 of 195 (26%) screening recommendations.’’ Australia), the Jaffna Teaching Hospital patients undergoing CT, and in 15 of Journal of the American Academy (Sri Lanka), and the Royal Women’s 177 (8.5%) patients undergoing bone of Dermatology Hospital (Melbourne, Australia) reported marrow biopsy. Staging with these mo- on the role of 18F-FDG in patient selec- dalities identified 24 (11.8%) non–central PET and Intraocular tion for salvage hysterectomy. The retro- nervous system malignancies (19 sys- Sarcoidosis spective study included 49 women with temic lymphomas, 5 secondary malig- Chauvelot and Skanjeti et al. from cervical cancer who were eligible for nancies). The authors concluded that the Université Claude Bernard Lyon salvage hysterectomy after treatment. in ‘‘patients with new lymphomatous (France) reported on January 18 ahead Patients were assigned to 1 of 3 groups: brain lesions, performing initial sys- of print in the British Journal of Oph- (1) those who underwent planned hyster- temic staging procedures can identify thalmology on a study designed to ectomy based on clinical, cytologic, or systemic lymphoma and additional ma- determine the diagnostic and predic- histologic suspicion (n 5 15); (2) those

12N THE JOURNAL OF NUCLEAR MEDICINE • Vol. 60 • No. 3 • March 2019 NEWSLINE who underwent posttreatment 18F-FDG treatment were found to have worse myositis as detected by MR imaging. PET/CT 3–6 mo after completion of overall and shorter disease-free sur- A significant positive correlation was chemoradiotherapy, either for suspicion vival times than those without PET- noted between lung HRCT score and of recurrence on examination or at high positive nodes. These node-positive SUVmax in each lung. Serum Krebs risk of recurrence at the primary site patients also had worse node and met- von den Lungen-6 levels were also (n 5 13); and (3) thosewho showed iso- astatic relapse-free survival. Patients positively correlated with total SUVmax lated tracer uptake at the primary site staged as N2 had significantly worse for both lungs. Total SUVmax in the on PET at 6 mo (n 5 21). In group 1, outcomes than those staged at N1–N0 muscles was significantly correlated 3(20%)patientswerefoundtohavere- but better survival if the involved nodes with serum cytokeratin levels. The sidual disease on histology. Eight of were closer to the esophageal tumor. In- authors concluded that these results 18 the patients in group 2 underwent hyster- volved node location on PET was also suggest that F-FDG uptake (SUVmax) ectomy, and 4 showed positive histology associated with global, nodal, and meta- may be ‘‘useful for not only the de- 18 for residual tumor. In group 3, an F- static relapse. Increasing SUVmax values tection of malignant tumors but FDG PET/CT scan after 3 months were correlated with increased relative also the evaluation of the location showed disease progression in 7 and risk of death and relative risk of node and activity of interstitial lung dis- complete metabolic response in 14. Sur- and metastatic relapses. The most fre- ease and myositis in dermatomyositis gery was avoided in all group 3 patients. quent relapse was metastatic recurrence, patients.’’ The authors concluded that 18F-FDG followed by local recurrence. The major- The Journal of Dermatology PET/CT at 6 mo after radiotherapy is ity represented ‘‘in-field’’ locoegional re- ‘‘a good tool for assessing treatment recurrence. The number of PET-positive PET/CT and Lymphoma in sponse in patients with cervical cancer’’ nodes was an independent and signifi- Sjogren ¨ Syndrome and that in patients with ‘‘persistent up- cant predictor for relapse. The authors Keraen et al. from the Hôpitaux take on 6 mo posttreatment 18F-FDG concluded that their results ‘‘show that Universitaires Paris-Sud (Le Kremlin PET/CT, repeat imaging at a 3-mo inter- only FDG PET/CT can provide prognos- Bicêtre, France), the Centre Chirurgicale val helps in selecting patients for salvage tic information in esophageal cancer’’ Marie Lannelongue (Le Plessis-Robin- hysterectomy.’’ and that nodal PET/CT uptake is associ- son, France), the Université Paris Saclay/ International Journal of ated with outcome and relapse location Université Paris Sud (Orsay, France), and Gynecological Cancer among these patients. Université Paris Descartes/Sorbonne Paris Clinical and Translational Cité (France) reported on January 7 ahead Prognostic Nodal PET Uptake Oncology of print in Arthritis and Rheumatology on Before Treatment a study intended to compare abnormali- Jimenez-Jimenez et al. from the PET/CT for Interstitial Lung ties in 18F-FDG PET/CT imaging be- Complejo Hospitalario Universitario Disease/Myositis in tween patients with Sjögren syndrome de Albacete (Spain), the Clinica IMQ Dermatomyositis with and without lymphoma to determine Zorrotzaurre (Bilbao, Spain), and the In an article e-published on January whether specific patterns are associated Hospital Universitari Son Espases 4 ahead of print in The Journal of Der- with lymphoma. The retrospective study (Palma de Mallorca, Spain) reported matology, Motegi et al. from the Gunma included data from 45 patients, all of on January 29 ahead of print in Clini- University Graduate School of Medicine whom had undergone 18F-FDG PET/ cal and Translational Oncology on a (Maebashi, Japan) reported on a study CTand15ofwhomhadlymphoma. 18 study assessing whether pretreatment evaluating the clinical utility of F-FDG Mean size and SUVmax in the parotid lymph node uptake in patients with PET/CT for detection of inflammatory glands were found to be higher in pa- esophageal cancer is associated with lesions and disease activity associated tients with lymphoma. Tracer lymph survival and regional relapses or relapse with both myopathy and interstitial node uptake was seen in 53.3% of pa- patterns after radio/chemotherapy. The lung disease in patients with dermato- tients with lymphoma and 43.3% with- study included 18F-FDG PET/CT image myositis. The study included 22 such out, with no observed difference in datasets from patients who underwent patients who underwent 18F-FDG PET/ number of nodes, repartition, or mean imaging before definitive or neoadju- CT, including assessment of SUVmax in SUVmax. Focal pulmonary uptake was vant radio/chemotherapy. All patients muscle and lung. These measurements observed in 5 (33.3%) patients with suffering from persistent or recurrent were compared with MR and high-res- lymphoma and 1 (3.3%) without. An local/regional–only disease after treat- olution CT (HRCT) imaging results in SUVmax $4.7 in the parotid gland and/ ment were considered for salvage re- the same muscle and lung regions and or identification of focal pulmonary le- section. Patients with adenocarcinoma were also correlated with clinical find- sions were highly suggestive of lym- without metastatic disease were con- ings. The location of increased 18F-FDG phoma, with a sensitivity of 80% and sidered for planned resection (usually uptake was found to be nearly consistent specificity 83.3%. The authors concluded within 3 mo after treatment). Patients with the regions of interstitial lung dis- that although pulmonary, lymphadenopa- with PET-positive lymph nodes before ease as detected by HRCT score and thy, and salivary gland involvements can

Newsline 13N be visualized by 18F-PET/CT in Sj¨ogren South Korea) reported on January 2 and at correlations between tau accu- syndrome, lymph nodes and parotid ahead of print in the Journal of Cancer mulation and cortical atrophy. The gland involvement is seen at similar Research and Clinical Oncology on study included 61 patients: 42 older rates in patients with and without lym- the value of 18F-FDG PET/CT as a adults (age, 77.6 6 4.6 y; 25 women, phoma. An SUVmax $4.7 in the parotid complementary imaging modality for 17 men; 21 of whom had been found

NEWSLINE glands and/or focal lung lesions, how- predicting successful outcomes after to be Pittsburgh compound B–positive ever, were associated with lymphoma endoscopic submucosal dissection in [PiB1]) and 19 patients with AD (age, diagnosis. early gastric cancer. The retrospective 63.1 6 10.3 y; 12 women, 7 men; all Arthritis and Rheumatology study included the records of 199 pa- of whom were PiB1). Participants un- tients (mean age, 67 6 10 y; total of derwent 2 18F-flortaucipir PET and 18F-FCH PET in PCa 210 tumors) with well or moderately MR scans over a period of 1–3 y. Over Biochemical Recurrence differentiated adenocarcinoma who the duration of the study voxelwise In an article e-published on Janu- had undergone 18F-FDG PET/CT for 18F-flortaucipir change in the group ary 17 ahead of print in Medicina initial routine staging of gastric can- with AD showed the greatest increases Clinica (Barcelona), Trivino-Ib´~ anez~ cer. PET/CT data were analyzed for in the lateral and medial frontal lobes. et al. from the Hospital Universitario primary tumor/background gastric up- Atrophy during this time period was Virgen de las Nieves and the Insti- take ratios, with each patient’s case more widespread and included poster- tuto de Investigación Biosanitaria categorized as curable by endoscopic omedial cortical areas where tau accu- de Granada (both in Granada, Spain) submucosal dissection (no discrete mulation rates were lower. In the older reported on a study evaluating the ability radioactivity) or not curable by this adult group 18F-flortaucipir binding in- of 18F-fluorocholine (18F-FCH) PET/CT procedure (discrete radioactivity). 18F- creased in the bilateral temporal lobe to identify biochemical recurrence in pa- FDG PET/CT showed an overall detec- and retrosplenial cortex, accompanied tients with prostate cancer and inves- tion rate for early gastric cancer of by atrophy in the same regions. No tigating correlated prostate-specific 37.1% (identifying 78 lesions with associations were identified between antigen (PSA) kinetics and antian- discrete radioactivity out of 210). In voxelwise change in 18F-flortaucipir drogen hormone therapy. The retro- the group identified on PET as not cur- and sex, PiB status, or apolipoprotein spective study included 203 men with able by endoscopic submucosal dissec- E. Regional 18F-flortaucipir uptake prostate cancer who met European As- tion, however, the sensitivity, specificity, significantly increased at follow-up in sociation of Urology criteria for bio- positive and negative predictive values, both older adults and patients with chemical recurrence and/or resistance and area under the receiver operating AD, but additional analyses indicated to chemical castration. Imaging results characteristic curve with 95% confi- greater 18F-flortaucipir increases in were classified as positive or negative, dence intervals were 79%, 91%, 81%, AD and no differences within older using pathology, other imaging, and/or 89%, and 0.85, respectively. The authors adults based on PiB status. The au- clinical follow-up as comparative data. concluded that 18F-FDG PET/CT may thors concluded that these findings 18F-FCH detected recurrence in 43.3% be a ‘‘useful complementary imaging indicate that ‘‘tau accumulates even of patients. Patients with positive 18F- modality to endoscopy’’ to predict the in amyloid-negative healthy older FCH PET/CT results had more aggres- success of endoscopic submucosal adults’’ and that ‘‘this process can sive PSA kinetics. In the subgroup of dissection in technical cures of early be measured with in vivo tau PET’’ patients with castration-resistant disease, gastric cancer. and that ‘‘tau accumulation and atro- the 18F-FCH PET/CT detection rate Journal of Cancer Research and phy share similar brain topographies was 89.1%, significantly higher than Clinical Oncology in older adults, whereas tau increases the 29.9% in those with radical treat- more rapidly in AD and in frontal re- ment. The authors concluded that Tau Accumulation in Aging gions not yet undergoing significant 18F-FCH ‘‘is useful to detect biochem- and AD atrophy.’’ ical recurrence of prostate cancer, espe- In an article e-published on De- Annals of Neurology cially in patients who receive hormone cember 31 ahead of print in Annals therapy or more aggressive PSA of Neurology, Harrison et al. from the 99m kinetics.’’ University of California, Berkeley, the Tc-HDP SPECT SUVmax in Medicina Clinica (Barcelona) University of California, San Fran- Accessory Navicular Bone cisco, the German Center for Neuro- Bae et al. from the Seoul National Predictive PET/CT in degenerative Diseases (Magdeburg, University Bundang Hospital and Endoscopic Resection Germany), and the Lawrence Berkeley Seoul National University/Seoul Na- Chung et al. from the Konkuk Uni- National Laboratory (CA) reported on tional University College of Medicine versity Medical Center/Konkuk Uni- a study looking at the rate of tau accu- (all in South Korea) reported in the versity School of Medicine and the mulation in healthy older adults and January issue of Medicine (Baltimore) Seoul Medical Center (both in Seoul, patients with Alzheimer disease (AD) (2019;98:e14022) on a study designed

14N THE JOURNAL OF NUCLEAR MEDICINE • Vol. 60 • No. 3 • March 2019 NEWSLINE to provide quantitative assessment of Whole-Body PET/CT After follow-up and endoscopy during the 99mTc-hydroxymethylene diphosphonate Sinonasal Cancer Therapy posttreatment period.’’ (99mTc-HDP) as a biomarker in acces- In an article e-published on January 2 European Archives of sory navicular bone (ANB). The retro- ahead of print in the European Archives Oto-Rhino-Laryngology spective study included 105 patients of Oto-Rhino-Laryngology,Ozturketal. (median age, 32.0 y, range, 11–81 y; from the University of Minnesota Medi- Reviews 61 female, 44 male). These included cal Center (Minneapolis) reported on a Review articles provide an impor- 31 controls without and 74 patients study of whole-body 18F-FDG PET/CT tant way to stay up to date on the latest with ANB (7 unilateral and 67 bilateral). for posttreatment surveillance of local topics and approaches through valu- The researchers measured SUVmax in tumor recurrence, regional lymph node able summaries of pertinent literature. 99m quantitative bone Tc-HDP SPECT/ metastasis, and distant metastasis in pa- The Newsline editor recommends sev- CT studies of the foot. ANBs were clas- tients previously treated for sinonasal eral general reviews accessioned into sified into types I, II, III (Geist classifi- malignancies. The retrospective study the PubMed database in December and cation), and 0 (contralateral navicular or included data from 80 patients (53 men, January. In an article in the December 5 unilateral ANB). Type II ANBs were 27 women; mean age, 60 y, range, issue of The Journal of the Endocrine further subclassified into II-1 (with bony 28–92 y) who had undergone a total Society (2018;3[1]:222–234) Martin et abnormality) or II-0 (without bony ab- of 197 posttreatment whole-body 18F- al. from the Universidad Nacional de normality). All patients were assigned to FDG PET/CT scans. The researchers cat- Córdoba and the Consejo Nacional de ´ observation, conservative treatment, or egorized the imaging findings as positive Investigaciones Cientıficas y Técnicas surgery. On 99mTc-HDP SPECT/CT pa- (both in Córdoba, Argentina) provided or negative separately for local tumor re- tients with type II-1 ANB had the high- insights into ‘‘Implications of Na1/I– currence, regional lymph node metastasis, est SUV . Across all patients, SUV symporter transport to the plasma mem- max max and distant metastasis and compared im- in symptomatic ANB was greater than brane for thyroid hormonogenesis and aging results with final diagnoses from that for asymptomatic ANB. The SUV radioiodide therapy.’’ Sgouros, from the max histologic data or clinical follow-up for the surgically resected ANB group Johns Hopkins University School of over a minimum of 12 mo. PET/CT was also significantly higher than that Medicine (Baltimore, MD), reviewed re- identified 37 of 44 local recurrences, for the observation-only or conserva- cent developments in ‘‘Radiopharmaceu- tive treatment groups. Subtype II-1 21 of 23 regional lymph node metasta- tical therapy’’ in the February issue of ses,and30of37distantmetastases.The had a significantly higher SUVmax Health Physics (2019;116:175–178). In than subtype II-0. Additional analy- sensitivity, specificity, and positive and an overview e-published on January 11 ses in type II ANB showed that young negative predictive values for local recur- ahead of print in Molecular Psychiatry, rence were 84%, 95%, 84%, and 95%, age and higher SUVmax were signifi- Leuzy et al. from the Karolinska cant predictors for proceeding to sur- respectively. For regional lymph node me- Institutet, Stockholm University, tastases, the corresponding values were gery. An SUVmax cutoff of 5.27 was and Karolinska University Hospital, found to be optimal for predicting final 91%, 99%, 91%, and 99%. For distant all in Stockholm, Sweden, wrote surgical treatment. The authors con- metastases, the corresponding values were about ‘‘Tau PET imaging in neuro- 81%, 99%, 97%, and 96%. Whole-body cluded that because ‘‘SUVmax derived degenerative tauopathies—still a from quantitative bone SPECT/CT 18F-FDG PET/CT was found to have af- challenge.’’ Reddy et al. from Texas was strongly associated with symp- fected changes in management for 85% A&M University/University Health Sci- tom, surgical treatment, and a known of patients with recurrences. The authors ence Center (College Station/Bryan, high-risk type of ANB,’’ that ‘‘risk concluded that ‘‘whole-body 18F-FDG TX) described ‘‘Neuroimaging bio- stratification for final surgical treat- PET/CT is a suitable surveillance tool markers of experimental epilepto- ment of ANB can be achieved using for sinonasal malignancies in detecting genesis and refractory epilepsy’’ in the SUVmax from quantitative bone locoregional and distant recurrences in theJanuary8issueoftheInterna- SPECT/CT.’’ asymptomatic patients without any tional Journal of Molecular Science Medicine (Baltimore) evidence of recurrence on regular (2019;20[1]).

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