Abstract 4004 Introduction Although conventional radiography is still the standard staging procedure for newly diagnosed and relapsed multiple myeloma (MM) patients in clinical practice, magnetic resonance imaging (MRI) using T2- and T1-weighted contrasted enhanced images has proved to have advantages over a conventional skeletal survey. Fluoro-desoxy-glucose positron emission tomography (18F-FDG PET) is not yet validated as an imaging method for MM evaluation. The purpose of this study was to prospectively compare MRI and 18F-FDG PET for short-term evaluation of the response in newly diagnosed MM patients and to correlate the imaging assessment with the biological response. Materials and methods A group of 15 newly diagnosed myeloma patients were treated in a single center. After induction with bortezomib-lenalidomide-dexamethasone (VRD), they all received high dose cyclophosphamide and G-SCF prior to peripheral stem cell collection. The patients were then randomized to either autologous stem cell transplantation (ASCT) with 2 consolidation VRD cycles or 5 VRD cycles. All patients subsequently received maintenance treatment with low dose lenalidomide for 1 year. Imaging was performed at diagnosis, after the first three VRD cycles and immediately before initiating maintenance treatment. The spinal and pelvic MRI protocol consisted of sagittal T1-weighted (T1-w) spin echo and fat-suppressed T2-weighted (T2-w) STIR sequences of the spine, axial and coronal T1-w spin echo and fat-suppressed T2-w STIR sequences of the pelvis and upper parts of the lower limbs and finally a fat-suppressed T1-w sequence after intravenous gadolinium covering the spine, pelvis and upper parts of the lower limbs. The biological response was evaluated according to IMWG criteria. The presence or absence of diffuse bone marrow infiltration (DI), diffuse patchy bone marrow infiltration (DPI) and focal bone marrow lesions (FL) was recorded prospectively. A hypointense T1, hyperintense STIR and enhanced fat-suppressed T1 lesion were scored as FL on MRI scans. The presence of extra-medullary disease (EMD) and the SUVmax of FDG-avid focal lesions were assessed. Complete response (CR) and partial response (PR) were determined by MRI and 18F-FDG PET after induction and before maintenance. CR was defined as the absence of diffuse infiltration or focal lesions for MRI and as the absence of diffuse and/or focal uptake for 18F-FDG PET. The response was considered to be partial if the image differed from CR. We compared the results of the two techniques with the biological response for every patient. Results The 15 patients (5 females, 10 males; age: 55 ± 6 years (mean, SD)) were classified according to the ISS (1, n=6; 2, n=8; 3, n=1) and DSS (IIIA, n=14; IIIB, n=1). At baseline, MRI showed DI, DPI and FL in 3, 7 and 189 cases respectively; the 18F-FDG PET uptake displayed a diffuse homogeneous pattern in 4 patients and a diffuse heterogeneous pattern in 11 patients with only 55 focal uptakes. Five cases of extra-medullary uptake were observed on baseline 18F-FDG PET scans and remained at the follow-up. On the basis of the biological response, the patients were classified as MR (n=1), PR (n=7), VGPR (n=5) and CR (n=2) after induction and as MR (n=1), PR (n=6), VGPR (n=3) and CR (n=5) before maintenance treatment. Differences in focal lesion detection were observed between MRI and 18F-FDG PET for small lesions ( The status assessment showed concordant results between the two techniques in only 5/15 (CR, n=2; PR, n=3) and 8/15 (CR, n= 2; PR, n=6) cases at induction and before maintenance respectively. MRI showed residual disease in 7/15 patients before the initiation of maintenance treatment. Conclusion At diagnosis and during treatment evaluation, both 18-FDG PET and MRI provide information about the extent of the disease, allowing for a more comprehensive assessment of persisting or recurrent myeloma. The morphologic MRI can often be falsely positive due to persistent non-viable lesions. Hence 18-FDG PET might be more suitable than morphologic MRI for determination of the remission status. Disclosures: No relevant conflicts of interest to declare.

After thyroidectomy and 131I ablation for differentiated thyroid cancer (DTC), serum thyroglobulin (Tg) became a sensitive marker of residual disease. It is not uncommon to find patients at follow-up with persistent serum Tg levels and no other clinical or imaging evidence for the disease. The vast majority of these patients, most probably, have occult foci of disease, often in minute cervical lymph nodes. A review of the literature including papers published on PubMed/Medline until June 2010 was made. In this study we speculated that a minority of patients who had undergone surgery for differentiated thyroid cancer might have benign sources of Tg secretion at follow-up. These sources may be foci of radio-resistant ectopic thyroid tissue or a thyroid stimulating hormone-stimulated thymus.

18F-FDG is the most widely used PET radiopharmaceutical. Nevertheless, no data for 18F-FDG uptake in the human placenta have been reported. We recently reported on embryo dosimetry in a woman who underwent an 18F-FDG PET/CT scan during early pregnancy. In the present work we attempt an in vivo quantification of the 18F-FDG uptake by the placenta. The 27-y-old woman received 320 MBq of 18F-FDG for a follow-up study for Hodgkin’s lymphoma and was later discovered to be pregnant (embryo age = 8 wk). Imaging started 1 h after injection. The maximum placental tissue uptake (SUVmax) was 2.5. This value was conservatively attributed to the entire placental volume, i.e., 45 mL, a value representative of the average dimensions of a normal placenta at 8 wk. On the basis of these measurements, placenta 18F-FDG uptake in our patient was 0.19% of the injected activity. A Monte Carlo simulation was used to derive the photon dose to the embryo from the placenta (0.022 × 10−2 mGy per MBq of injected 18F-FDG) and from the surrounding amniotic fluid (0.017 × 10−2 mGy MBq−1). This increases our previously calculated dose (3.3 × 10−2 mGy MBq−1) by only a small fraction (1.18%), which does not justify modifying the previous estimate given the overall uncertainties.

Rapid-onset dystonia-parkinsonism (RDP) is a rare, autosomal-dominantly inherited syndrome characterized by abrupt onset, over hours to days, of dystonic and parkinsonian symptoms. To date, RDP has been described in a small number of families, and in only four sporadic cases.Methods: We here report a new sporadic case of RDP who has a novel de novel mutation in the ATP1A3 gene. Striatal dopamine transporters have been assessed quantitatively using [I-123]-FP-CIT SPECT. A volume of interest (VOI) was drawn within the occipital cortex to obtain non-specific activity and specific to nonspecific binding ratios (BR) were calculated. A single template of predefined VOI 3D-drawn on right and left caudate nucleus and putamen was applied to the spatially normalized BR images. BR values were compared to those obtained from an age-matched control group and from a group of patients suffering from Parkinson's disease (Hoehn and Yahr score 2 or 3). A [Tc-99m]-HMPAO cerebral blood flow study was also performed.Results: In the control group, BR values (mean Standard Deviation) were 3.5 +/- 0.4 for the left striatum and 3.3 +/- 0.3 for the right one. RDP patient's values were 3 and 2.7, respectively. In the Parkinson group, values were 1.6 +/- 0.3 and 1.7 +/- 0.4, respectively. [Tc-99m]-HMPAO scan showed homogeneous cortical and sub-cortical perfusion.Conclusion: Quantification of striatal [I-123]-FP-CIT uptake in a new Sporadic case of RDP with a novel mutation in the ATP1A3 gene showed values just within the range of normality. [Tc-99m]-HMPAO scan was normal. (c) 2008 Elsevier B.V. All rights reserved.

UNLABELLED:Although 18F-FDG examinations are widely used, data are lacking on the dose to human embryo tissues in cases of exposure in early pregnancy. Although the photon component can easily be estimated from available data on the pharmacokinetics of 18F-FDG in female organs and from phantom measurements (considering the uterus as the target organ), the intensity of embryo tissue uptake, which is essential for deriving the beta+ dose, is not known. We report the case of a patient who underwent 18F-FDG PET/CT for tumor surveillance and who was later found to have been pregnant at the time of the examination (embryo age, 8 wk).METHODS:The patient received 320 MBq of (18)F-FDG. Imaging started with an unenhanced CT scan 1 h after the injection, followed by PET acquisition. PET images were used to compute the total number of beta+ emissions in embryo tissues per unit of injected activity, from standardized uptake value (SUV) measurements corrected for partial-volume effects. A Monte Carlo track structure code was then used to derive the beta+ self-dose and the beta+ cross-dose from amniotic fluid. The photon and CT doses were added to obtain the final dose received by the embryo.RESULTS:The mean SUV in embryo tissues was 2.7, after correction for the partial-volume effect. The mean corrected SUV of amniotic fluid was 1.1. Monte Carlo simulation showed that the beta+ dose to the embryo (self-dose plus cross-dose from amniotic fluid) was 1.8E-2 mGy per MBq of injected 18F-FDG. Based on MIRD data for the photon dose to the uterus, the estimated photon dose to the embryo was 1.5E-2 mGy/MBq. Thus, the specific 18F-FDG dose to the embryo was 3.3E-2 mGy/MBq (10.6 mGy in this patient). The CT scan added a further 8.3 mGy.CONCLUSION:The dose to the embryo is 3.3E-2 mGy/MBq of 18F-FDG. The beta+ dose contributes 55% of the total dose. This value is higher than previous estimates in late nonhuman-primate pregnancies.

In the present preliminary study, we developed a protocol for the acquisition and fusion of dual-isotope tomographic (SPECT) images (In-111-Octreotide SPECT and Tc-99m-HMDP SPECT). This procedure was performed in ten consecutive patients, and the first results were encouraging: it proved to be a simple and accurate method to improve the anatomic localization of In-111-Octreotide SPECT positive foci for the staging and followup of tumours expressing somatostatin receptors (Octreotide is an analog of somatostatin), particularly in discriminating bone metastases from soft tissue metastases located near to bone itself.

Involvement of the dopaminergic system in orthostatic tremor is controversial. The aim of this study was to detect possible dopaminergic denervation in primary orthostatic tremor (OT). Twelve consecutive patients with a firm diagnosis of primary orthostatic tremor were compared with age-matched normal controls. All the patients had a neurological examination, surface polymyography, and quantification of striatal dopamine transporters with (123)I-FP-CIT SPECT imaging. There was no significant difference in (123)I-FP-CIT SPECT findings between controls and patients with OT. Longstanding primary orthostatic tremor is not necessarily associated with (123)I-FP-CIT SPECT abnormalities, as 8 of our patients had more than a 10-year history of OT. Primary orthostatic tremor without dopaminergic denervation remains a valid entity, although representing only a subtype of high-frequency OT. A new role may emerge for (123)I-FP-CIT SPECT in distinguishing between patients whose symptoms will be restricted to OT throughout the disease course and patients at an increased risk of developing PD. (c) 2008 Movement Disorder Society.

Recurrences are frequent in thyroid cancer patients and long-term follow-up is therefore necessary. We evaluated the yield of rhTSH stimulation in three groups of patients, classified according to the UICC/TNM risk stratification and the results of first follow-up testing.

Bone is the second most frequent target of distant metastases in patients with differentiated thyroid cancer, and such forms carry a very poor prognosis. The impact of (131)I therapy in this setting is controversial. We describe the diagnostic circumstances and outcome of patients with bone metastases recently managed in two institutions. Among 921 consecutive thyroid cancer patients who had total thyroidectomy and (131)I ablation between January 2000 and December 2004 and who were subsequently monitored, bone metastases had been diagnosed in 16 patients. In three cases, the bone metastases were non-functioning (negative (131)I uptake) . These patients were treated with surgery and radiotherapy but progressed rapidly. The other 13 patients had functioning (positive (131)I uptake) bone metastases. In five of them, thyroid cancer was revealed by signs of distant involvement (bone pain, n = 4; dyspnea, n = 1). The bone metastases progressed in these five patients, despite local therapy and multiple courses of (131)I. The bone metastases in the remaining eight patients were discovered on the post-surgery (131)I therapy scan. Complementary radiological studies were negative except in one patient in whom one of the metastases (a 5 mm lesion of the right humerus) was visible on magnetic resonance imaging (MRI). Six of these patients showed a good response to (131)I therapy, with (131)I uptake and Tg levels becoming undetectable or showing a sharp fall. One patient refused (131)I therapy; bone metastases became visible on MRI within 1 year and the Tg level rose tenfold. The disease progressed in one patient despite (131)I therapy. Post-surgical (131)I ablation can contribute to early detection of bone metastases at a time when the Tg level may be only moderately elevated, when other radiological studies are negative, and when the disease is potentially curable by (131)I therapy.

FDG PET can detect thyroid cancer in patients referred for exploration of a different cancer Because of its lock of specificity however this modality is not indicated for examination of thyroid nodules: ultrasonogrophy and fine needle biopsy with cytology allow histologic of diagnosis, which con be completed by iodine-123 scintigraphy when on autonomous nodule is suspected. No information is currently available about the utility of FDG PET in preoperative staging. in follow-up of patients undergoing thyroidectomy for adenocarcinoma, FOG PET is useful for detecting recurrence in cases where serum thyroglobulin levels rise and iodine-131 scintigraphy is negative: surgical resection may be appropriate. Nonetheless FDG PET should be performed more widely and earlier. The initial presence of foci positive for FDG is a major predictor of shorter survival, and most cancer lesions take up either iodine or FDG.In follow-up of medullary carcinoma, FDG PET detects residual tissue better than any other scintigraphic procedures, especially when serum levels of CEA (carcinoembryonic antigen) ore rising rapidly FDOPA PET seems to have better sensitivity than FDG-PET Grid may be useful in occult recurrence, as three case reports indicate.

FDG PET can detect thyroid cancer in patients referred for exploration of a different cancer. Because of its lack of specificity, however, this modality is not indicated for examination of thyroid nodules: ultrasonography and fine needle biopsy with cytology allow histological diagnosis, which can be completed by iodine-123 scintigraphy when an autonomous nodule is suspected. No information is currently available about the utility of FDG PET in preoperative staging. In follow-up of patients undergoing thyroidectomy for adenocarcinoma, FDG PET is useful for detecting recurrence in cases where serum thyroglobulin levels rise and iodine-131 scintigraphy is negative: surgical resection may be appropriate. Nonetheless FDG PET should be performed more widely and earlier: the initial presence of foci positive for FDG is a major predictor of shorter survival, and most cancer lesions take up either iodine or FDG. In follow-up of medullary carcinoma, FDG PET detects residual tissue better than any other scintigraphic procedures, especially when serum levels of CEA (carcinoembryonic antigen) are rising rapidly. FDOPA PET seems to have better sensitivity than FDG-PET and may be useful in occult recurrence, as three case reports indicate.

Objective  The American consensus statement on patients with low‐risk thyroid cancer, published in 2003, suggests repeat 131I therapy if the thyroglobulin value is elevated at first follow‐up. We evaluated this strategy in our practice.

AIMS:Systemic sclerosis (SSc) is a connective tissue disorder characterized by frequent myocardial involvement. Alteration in left ventricular (LV) function is reported to be rare; however, it may be underestimated by conventional measurements. Our aim was to prospectively investigate LV function in SSc patients, using Tissue Doppler echocardiography (TDE), a modern and accurate method of assessing myocardial function.METHODS AND RESULTS:Seventeen consecutive SSc patients with normal cardiac examination, pulmonary artery pressure (PAP) and radionuclide LV ejection fraction (EF) were prospectively investigated. Myocardial perfusion was investigated using single-photon-emission computerized tomography (SPECT). Echocardiography (ECHO), systolic and diastolic strain-rate (SR) measured in the posterior wall by TDE were used to investigate myocardial function, and compared with results of 15 matched controls. All patients (53+/-8 years; 14 women; systolic PAP 33+/-6 mmHg; LVEF 67+/-8%) had myocardial SPECT perfusion abnormalities. Despite normal ECHO, they had lower systolic SR than controls (1.7+/-0.5 versus 3.8+/-1.7 cm-1, p<0.0001), and lower diastolic SR (3.7+/-1.5 versus 5.6+/-1.2 cm-1, p=0.0004). Ten SSc patients had reduced systolic SR<1.7 cm-1 and 11 reduced diastolic SR<3.5 cm-1.CONCLUSION:Frequent abnormal myocardial perfusion is confirmed in SSc patients. Reduced contractility is also frequent as detected by TDE, despite normal radionuclide LVEF.