OBJECTIVE MPI can provide valuable information in the investigation of patients with known or suspected coronary artery disease. The stress component of the studies can be conducted with regadenoson, which was approved for clinical use in Greece in 2016. We investigated the performance and safety profile of regadenoson MPI based on our 7 months institutional experience. PATIENTS AND METHODS We studied 96 consecutive patients (59 males, 37 females, mean age 70.35y.o, range: 46-87y.o.) referred to our department for a clinically indicated MPI study with pharmacological stress. Eleven patients suffered from chronic obstructive pulmonary disease. Patients underwent regadenoson stress test, combined with both stress and rest imaging. Data on the symptoms and electrocardiographic changes due to regadenoson administration were recorded. Symptoms were graded as 1-mild: a symptom that did not distress the patient, 2-moderate: a symptom that distressed the patient but it was self-limiting, or 3-severe: a symptom that distressed the patient requiring medical intervention. RESULTS Regadenoson-related symptoms were reported in 56 patients and were: dyspnea, discomfort, dizziness, chest pain, epigastric pain, neck pain, headache, flushing, nausea, heartburn, weakness, and upper limbs numbness. The severity of symptoms was recorded as grade 1 in 30 patients, grade 2 in 25 patients, and grade 3 in 1 patient. Two or more different symptoms were reported in 28 patients. Ischemic electrocardiographic changes and arrhythmias were observed in 8 patients. CONCLUSION Our findings support previously published data indicating the optimal safety profile of regadenoson MPI, even in the group of patients suffering from chronic obstructive pulmonary disease.

Whole-body bone scintigraphy using technetium-99m-methylene-diphosphonate ((99m)Tc-MDP) is the most widely used radionuclide imaging modality applied in patients with prostate cancer. With this technique, the choice of methods to estimate the extend of the metastatic disease on the skeletal system includes various different approaches, classified in two main categories: First, the quantitative measurements of tracer uptake, defined either as the percentage of the injected dose of tracer, or as the more complicated plasma clearance techniques and second, the various semi-quantitative scoring systems of the bone scan images. These scoring systems can be based either on visual counting of bone lesions, or on the estimation of a numerical index that expresses the fractional involvement of each bone by tumour, called "Bone Scan Index" (BSI); the latter can be produced either visually (manually) or by the more sophisticated techniques of fully- or semi-automated (computerized) forms. In this review, a brief chronological overview of the aforementioned methods is presented, along with the main advantages, drawbacks and the prognostic implications of each method. There remains, however, the challenge of defining, developing and validating the optimal measurement methodology in order these scoring systems to obtain a wider clinical use.

Aim. In this study, a new method has been used to predict pain response to Re-186-HEDP therapy in patients suffering from painful osseous metastases, on the basis of a modified bone scan index and pre-therapy pain scoring.Methods. Forty five patients received a total of 73 doses of Re-186-HEDP during a period of pain relapse without extra-osseous disease progression. All patients were under stable regimen of zoledronic acid, far off other therapeutic manipulations. Imaging studies regarding a modified estimation of bone scan index, were applied; the value of the largest bony lesion (called mBSI), provided that it also corresponded to the most prominent site of osseous pain was taken into account, and a new semi-quantitative index called Double Product Value (DPV), equal to pre-therapy pain score times mBSI was entered in the result analyses, to investigate any possible correlations with response endpoints.Results. Favourable response occurred in 35/47 evaluated therapeutic doses of Re-186-HEDP (74.5%; excellent response in 12 doses, 25.5%). Responders had significantly lower DPV (3.4 +/- 2.3 vs. 10.2 +/- 6.2, P=0.0029, for non-responders). Patients with pre-therapy DPV < or =4, had higher probability for considerably better (HR 2.29; P < 0.0001) and excellent (HR 7.46; P=0.009) pain response versus those with DPV > 4, and also a longer median period of pain relief (respective mean values 5.9 versus 2.1 months, HR 2.82; P=0.0001).Conclusions. DPV, as developed and implemented in this study proved a valuable and reproducible pre-therapy tool for assessing degree and duration of pain response after Re-186-HEDP therapy.

The importance of the bone microenvironment to the pathophysiology and morbidity associated with prostate cancer bone metastasis is becoming increasingly apparent. Significant alterations take place in the microenvironment of bone, which disturb the normal coupling that exists between bone resorption and bone formation. Consequently, a better understanding of the mechanisms that interact at the molecular level will definitely result in more effective therapy for patients with this devastating complication of prostatic carcinoma. This review will discuss the diagnostic and predictive implications of various collagenous and non-collagenous bone markers, along with the novel markers of osteoclastogenesis and other matrix enzymes such as metalloproteinases and growth factors responsible for the complex biochemical mechanisms that upregulate bone resorption/formation during the development of metastasis. Further prospective studies are needed to determine whether any of these markers measured longitudinally in prostate cancer patients without bone scan evidence of skeletal disease will ultimately predict those patients who will develop bone metastases from their malignancy. Nonetheless, from the clinical point of view it is important to know that these novel markers carry the potential to provide meaningful information for daily practice by using upper normal reference values as cut-offs for identifying patients with an increased risk of developing progressive bone disease or skeletal related events.

To prospectively evaluate the predictive value of various bone formation and resorption markers in patients with bone metastases from prostate cancer after palliative treatment with 186Re-1,1-hydroxyethylidene diphosphonate (186Re-HEDP).