Epstein-Barr Virus-positive mucocutaneous ulcers (EBVMCU) are a rare disease entity that causes mucocutaneous ulcerations in the gastrointestinal tract, oropharynx, and skin. Typically associated with immunosuppressed patients, individuals may present with nonspecific symptoms and scan findings similar to those of malignancies. Treatment usually responds favourably to conservative management or withdrawal of immunosuppression, although rarely patients require more aggressive therapies including surgery, immuno-, chemo-, or radio-therapy. We encountered an unusual case of a patient with EBVMCU who presented with cough, dysphagia, and weight loss. Imaging features on [18F]-FDG PET/CT as well as initial biopsy results were nonspecific. The colonoscopic features were highly concerning for malignancy, with the diagnosis only finally being confirmed following surgical resection. To our knowledge, this is the first case report to describe the FDG PET/CT findings of EBVMCU within the bowel, and readers should consider this as a differential to avoid potential misdiagnosis and unnecessary intervention.

HomeCirculation: Cardiovascular ImagingVol. 15, No. 9Coronary IgG4: PET Pigs in Blankets Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessCase ReportPDF/EPUBCoronary IgG4: PET Pigs in Blankets Nicholas D. Chieng, June Yap and Michael Lin Nicholas D. ChiengNicholas D. Chieng Correspondence to: Nicholas Chieng, MBChB, FRANZCR, Department of Nuclear Medicine, Liverpool Hospital, Corner of Elizabeth and Goulburn St, Liverpool, NSW 2170, Australia. Email E-mail Address: [email protected] https://orcid.org/0000-0003-1960-8123 Department of Nuclear Medicine, Liverpool Hospital, NSW, Australia (N.D.C., J.Y., M.L.). , June YapJune Yap Department of Nuclear Medicine, Liverpool Hospital, NSW, Australia (N.D.C., J.Y., M.L.). and Michael LinMichael Lin Department of Nuclear Medicine, Liverpool Hospital, NSW, Australia (N.D.C., J.Y., M.L.). Faculty of Medicine and Health, South West Sydney Clinical School, University of New South Wales, Australia (M.L.). Western Sydney University, Liverpool Hospital, Australia (M.L.). Originally published8 Jul 2022https://doi.org/10.1161/CIRCIMAGING.122.014314Circulation: Cardiovascular Imaging. 2022;15Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: July 8, 2022: Ahead of Print 18-Fluorodeoxyglucose (18FDG) positron emission tomography (PET) coregistered with computed tomography (CT) has been well validated in staging and monitoring treatment response in a wide range of oncological conditions; however, recently, there has been emerging utility in the assessment of inflammatory conditions. Here we present an unusual and important manifestation of metabolically active IgG4 disease affecting the coronary arterial circulation incidentally detected on 18FDG-PET/CT, with a quantitative reduction in maximum standardized uptake values (SUVmax) on follow-up 18FDG-PET/CT studies and normalization of target to background ratios (TBRs) for pseudotumour lesions relative to venous blood pool1 following immunomodulatory and corticosteroid therapy. Furthermore, we suggest a protocol to optimize 18FDG-PET/CT imaging in patients with IgG4 disease with the aim of improving detection of life-threatening cardiac manifestations.Mr R is a 57-year-old man with histologically proven IgG4 disease diagnosed 5 years prior following lacrimal gland and lymph node biopsies. His IgG4 disease had been quiescent for several months managed on methotrexate and tapering oral prednisone courses for arthritis flares; however, an asymptomatic rise in monitored serum IgG4 levels over a 4-month period from 2.12 to 8.19 (reference range, 0.03–2.01) g/L and rise in serum erythrocyte sedimentation rate levels to 36 (reference range, 0–12) mm/h without obvious clinical precipitant prompted referral for an 18FDG-PET/CT scan for assessment of occult disease activity. PET/CT scanning detected moderate metabolic activity corresponding to abnormal soft tissue thickening surrounding the proximal right coronary artery (RCA) and left circumflex artery (LCx) (Figures 1 and 2). Other disease manifestations included intense 18FDG uptake localizing to concentric terminal ileal thickening (SUVmax, 14.1).Download figureDownload PowerPointFigure 1. Metabolically active right coronary artery pseudotumorous lesion revealed on investigation of asymptomatic rise in serum IgG4 levels. Axial fused electrocardiogram-gated contrast–enhanced computed tomography (CT) coronary angiogram and 18-fluorodeoxyglucose positron emission tomography images (left) and nonfused axial contrast-enhanced CT coronary angiogram images (right) demonstrate moderately 18-fluorodeoxyglucose avid lobulated periarterial soft tissue surrounding the proximal right coronary artery (white arrows).Download figureDownload PowerPointFigure 2. Metabolically active left circumflex artery pseudotumorous lesion revealed on investigation of asymptomatic rise in serum IgG4 levels. Axial fused electrocardiogram-gated contrast-enhanced computed tomography (CT) coronary angiogram and 18-fluorodeoxyglucose positron emission tomography images (left) and axial contrast-enhanced CT coronary angiogram images (right) demonstrate moderately 18-fluorodeoxyglucose avid lobulated periarterial soft tissue surrounding the proximal left circumflex artery (white arrows).Assessment of IgG4 aortitis by 18FDG-PET/CT imaging has been described in the literature in terms of TBRs for SUVmax of involved pseudotumour lesions relative to the average of right atrial and inferior vena caval background blood pool activity.1 The RCA lesion had an SUVmax of 5.2 and TBR of 2.1 while the LCx lesion demonstrated SUVmax of 6.0 with TBR of 2.4. These values are consistent with described findings of higher median SUVmax values of 3.7 (1.6–5.5) and TBRs of 2.1 (1.4–3.7) for IgG4 aortitis positive regions compared with median SUVmax of 2.1 (1.2–3.7) and TBR of 1.3 (0.9–2.3) of uninvolved vessels.18FDG-PET/CT findings prompted further investigation with a contrast-enhanced CT coronary angiogram, confirming marked multifocal lobulated soft tissue thickening encasing both the RCA (up to 20 mm thickness) and LCx arteries (up to 17 mm thickness) in keeping with pseudotumours (Figure 3). In addition, there was multifocal nonobstructive coronary artery atherosclerosis of the left main artery, RCA, ramus intermedius, and LCx artery without luminal stenosis. Moderate multifocal obstructive atherosclerosis was observed in the left anterior descending artery. Diagnostic contrast-enhanced CT abdomen/pelvis confirmed short segment enhancing ileal thickening with adjacent mesenteric lymph nodes and importantly the absence of pseudotumorous lesions surrounding the abdominal aorta.Download figureDownload PowerPointFigure 3. Electrocardiogram-gated contrast-enhanced computed tomography coronary angiogram oblique reformats demonstrating lobulated soft tissue pseudotumour surrounding the proximal (white asterisk) and mid (white arrows) right coronary artery.Given these findings, Mr R's maintenance oral dose of prednisone was increased from 1 to 25 mg daily on a 10-week down-tapering course, and induction protocol rituximab 1 g was administered intravenously for a total of 2 doses, each 2 weeks apart. Serum IgG4 levels decreased to 4.11 g/L after 2 months of this treatment regimen with normalization of serum erythrocyte sedimentation rate levels.A progress 18FDG-PET/CT scan was arranged 2 months later following a preceding 48-hour high-triglyceride, minimal carbohydrate myocardial suppression protocol diet. This was enacted to suppress background myocardial metabolic activity and optimize assessment of coronary arterial pseudotumour metabolic activity (Figure S1). This study demonstrated minor residual circumferential perivascular soft tissue at the RCA and LCx arteries without associated 18FDG avidity (TBRs of RCA and LCx both <1) and complete resolution of the previously identified active terminal ileal inflammation.IgG4 disease is a systemic fibroinflammatory disorder characterized pathologically by tissue infiltration of IgG4-positive plasma cells, storiform fibrosis in systemic organs, obliterative phlebitis, and elevated serum IgG4 levels. It primarily occurs in older age patients over 60 years and much more frequently affects men. IgG4-related vasculitis typically affects large arteries and predominantly involves the tunica adventitia with perivascular lymphocytic infiltration and adventitial thickening implicated in atherogenesis.IgG4-related coronary involvement includes periarterial fibrosclerotic thickening and aneurysmal formation with or without associated stenosis, luminal dilatation, or thrombosis. IgG4 disease can result in arterial wall remodeling and coronary aneurysm formation with potential for precipitating acute coronary syndromes and sudden cardiac death. It can manifest as pseudotumour lesions surrounding coronary arteries known as the pigs-in-a-blanket sign on contrast-enhanced CT coronary angiogram, with mural thickening demonstrating delayed contrast enhancement.2 While cardiac manifestations of IgG4 disease are relatively rare with few reported cases in the literature, several cases detail presentations with acute coronary syndrome, periarterial pseudotumour formation, coronary artery aneurysms, and multifocal stenoses on catheter angiography necessitating emergency coronary artery bypass grafting.3 Several reported cases from Japan have also been successfully treated with corticosteroids causing a marked reduction in serum IgG4 levels and pseudotumour lesion size.4For optimal visualization of potentially life-threatening cardiac manifestations of IgG4 disease, we propose that a myocardial suppression diet be instituted for 48 hours before 18FDG-PET/CT with a 12-hour fasting period immediately before scanning. 18FDG uptake in the myocardium is variable and dependent on available substrate concentration and insulin levels. Adherence to a high-fat, low-carbohydrate diet leads to preferential myocardial metabolism of fatty acids and suppression of background physiological left ventricular glucose uptake. This improves TBR of metabolically active IgG4 coronary arterial pseudotumour lesions, facilitating their visualization. Optimizing imaging techniques should improve detection of this underrecognized and potentially fatal condition as highlighted in our case, where clinically occult active coronary arterial pseudotumours were first detected on 18FDG-PET/CT. Additional benefits of PET scanning include a global assessment of involved disease sites and identifying potential amenable biopsy targets.2 Quantitative 18FDG-PET/CT assessment of disease activity using SUVmax and TBRs may play a role in assessing therapy response, as reductions in glucose metabolism and TBRs as surrogate markers of inflammation precede changes on anatomic imaging modalities such as CT.Article InformationSources of FundingNone.Supplemental MaterialFigure S1Disclosures None.FootnotesSupplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.122.014314.For Sources of Funding and Disclosures, see page 697.Correspondence to: Nicholas Chieng, MBChB, FRANZCR, Department of Nuclear Medicine, Liverpool Hospital, Corner of Elizabeth and Goulburn St, Liverpool, NSW 2170, Australia. Email nicholas.chieng@health.nsw.gov.auReferences1. Yabusaki S, Oyama-Manabe N, Manabe O, Hirata K, Kato F, Miyamoto N, Matsuno Y, Kudo K, Tamaki N, Shirato H. Characteristics of immunoglobulin G4-related aortitis/periaortitis and periarteritis on fluorodeoxyglucose positron emission tomography/computed tomography co-registered with contrast-enhanced computed tomography.EJNMMI Res. 2017; 7:20. doi: 10.1186/s13550-017-0268-1CrossrefMedlineGoogle Scholar2. Oyama-Manabe N, Yabusaki S, Manabe O, Kato F, Kanno-Okada H, Kudo K. IgG4-related cardiovascular disease from the aorta to the coronary arteries: multidetector CT and PET/CT.Radiographics. 2018; 38:1934–1948. doi: 10.1148/rg.2018180049CrossrefMedlineGoogle Scholar3. Keraliya AR, Murphy DJ, Aghayev A, Steigner ML. IgG4-related disease with coronary arteritis.Circ Cardiovasc Imaging. 2016; 9:e004583. doi: 10.1161/CIRCIMAGING.116.004583LinkGoogle Scholar4. Kusumoto S, Kawano H, Takeno M, Kawahara F, Abe K, Hayashi H, Koide Y, Maemura K. Mass lesions surrounding coronary artery associated with immunoglobulin G4-related disease.J Cardiol Cases. 2012; 5:e150–e154. doi: 10.1016/j.jccase.2012.02.006CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails September 2022Vol 15, Issue 9 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.122.014314PMID: 35862028 Originally publishedJuly 8, 2022 KeywordshumansIgG4positron emission tomographycoronary diseasePDF download Advertisement SubjectsImagingNuclear Cardiology and PET

INTRODUCTION:Noninvasive predictive quantitative biomarkers are required to guide treatment individualization in patients with locally advanced rectal cancer (LARC) in order to maximize therapeutic outcomes and minimize treatment toxicity. Magnetic resonance imaging (MRI), positron emission tomography (PET), and blood biomarkers have the potential to predict chemoradiotherapy (CRT) response in LARC.AREAS COVERED:This review examines the value of functional imaging (MRI and PET) and liquid biomarkers (circulating tumor cells (CTCs) and circulating tumor nucleic acid (ctNA)) in the prediction of CRT response in LARC. Selected imaging and liquid biomarker studies are presented and the current status of the most promising imaging (apparent diffusion coefficient (ADC), Ktrans, SUVmax, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) and liquid biomarkers (CTCs, ctNA) is discussed. The potential applications of imaging and liquid biomarkers for treatment stratification and a pathway to clinical translation are presented.EXPERT OPINION:Functional imaging and liquid biomarkers provide novel ways of predicting CRT response. The clinical and technical validation of the most promising imaging and liquid biopsy biomarkers in multicenter studies with harmonized acquisition techniques is required. This will enable clinical trials to investigate treatment escalation or de-escalation pathways in rectal cancer.

ANZ Journal of SurgeryVolume 90, Issue 12 p. E217-E218 IMAGES FOR SURGEONS Jumping the gun: traumatic splenosis mimicking 68-gallium-dotatate avid neuroendocrine tumour Elias Sachawars BMed, Elias Sachawars BMed orcid.org/0000-0001-7623-0409 Department of Nuclear Medicine, Liverpool Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorMichael Lin FRACP, FRCP (Lond), Michael Lin FRACP, FRCP (Lond) Department of Nuclear Medicine, Liverpool Hospital, Sydney, New South Wales, Australia Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia School of Medicine, Western Sydney University, Sydney, New South Wales, AustraliaSearch for more papers by this authorGeorge E. Sidhom BMed, George E. Sidhom BMed Department of Nuclear Medicine, Liverpool Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this author Elias Sachawars BMed, Elias Sachawars BMed orcid.org/0000-0001-7623-0409 Department of Nuclear Medicine, Liverpool Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorMichael Lin FRACP, FRCP (Lond), Michael Lin FRACP, FRCP (Lond) Department of Nuclear Medicine, Liverpool Hospital, Sydney, New South Wales, Australia Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia School of Medicine, Western Sydney University, Sydney, New South Wales, AustraliaSearch for more papers by this authorGeorge E. Sidhom BMed, George E. Sidhom BMed Department of Nuclear Medicine, Liverpool Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this author First published: 30 May 2020 https://doi.org/10.1111/ans.16015Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume90, Issue12December 2020Pages E217-E218 RelatedInformation

INTRODUCTION:The purpose of this study was to investigate the prognostic utility and reproducibility of a qualitative 5-point 18-fluorodeoxyglucose (FDG)-PET primary visual score (PVS) in patients with oesophageal and gastro-oesophageal junction (GOJ) cancer.METHODS:This was a retrospective review of patients with histologically proven oesophageal or GOJ cancer who received curative intent therapy. Clinical, pathological and imaging data were extracted from electronic medical records. Patients were required to have pre-treatment and post-treatment FDG-PET scans, that were evaluated with a 5-point primary visual score (prePVS, postPVS). The changes in PVS (ΔPVS) were correlated with progression-free survival and overall survival. Interobserver variability was assessed using Cohen's Kappa intraclass correlation and agreement.RESULTS:Sixty-seven patients were retrospectively identified. Two (3%), 36 (54%) and 29 (43%) of the patients had stage I, II and III disease respectively. Twenty-five (37%) patients had squamous cell carcinoma. Thirty-seven (55%) patients proceeded onto surgical resection. postPVS was associated with both PFS (P = 0.013) and OS (P = 0.0002). ΔPVS predicted for PFS (P = 0.002) and OS (P = 0.0003). When thresholds of response were considered, agreement was 80.6% (K = 0.78) and 74.6% (K = 0.69) for postPVS and ΔPVS respectively.CONCLUSION:Qualitative assessment of oesophageal and GOJ cancers utilising FDG-PET is reproducible and may be able to prognosticate outcomes in patients undergoing treatment. Prospective validation is required.

Objective: This study explored the value of serial 18-fludeoxyglucose-positron emission tomography (18F-FDG-PET/CT) in predicting disease-free survival (DFS) in locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiation (NCRT) and surgery. Methods: We prospectively studied 46 patients with LARC who underwent NCRT and surgery. 18F-FDG-PET/CT scans were performed at three time-points before surgery (pre-NCRT-PET1, during NCRT-PET2 and following completion of NCRT-PET3). The following semi-quantitative PET parameters were analysed at each time point: maximum standardized uptake value (SUVmax), SUVmean, metabolic tumour volume (MTV) and tumour lesion glycolysis (TLG). Absolute and percentage changes in these parameters were analysed between time points. Statistical analysis consisted of median tests, Cox regression and Kaplan–Meier analysis for DFS. Results: The median follow-up time was 24 months. A reduction in PET parameters showed statistically significant differences for patients with recurrence compared to those without; percentage changes in MTV between PET1 and PET3 (cut-off: 87%, p = 0.023), percentage changes in TLG between PET1 and PET3 (cut-off: 94%, p = 0.02) and absolute change in MTV PET1 and PET2 (cut-off: 10.25, p = 0.001). An absolute reduction in MTV between PET1 and PET3 (p=0.013), a percentage reduction in TLG between PET1 and PET2 (p=0.021), SUVmax and SUVmean at PET2 (p = 0.01, p = 0.027 respectively)were also prognostic indicators of recurrence. MTV percentage change between PET1 and PET2 and SUVmean percentage change between PET1 and PET3 were also trending towards significance (p = 0.052, p = 0.053 respectively). Conclusion: Serial 18F-FDG-PET/CT is a potentially reliable non-invasive method to predict recurrence in patients with LARC. Volumetric parameters were the best predictors. This could allow risk-stratification in patients who may benefit from conservative management. Advances in knowledge: This paper will add to the literature in risk-stratifying patients with LARC based on prognosis, using 18F-FDG-PET/CT. This may improve patient outcomes by selecting suitable candidates for conservative management.

Background Current guidelines highlight the importance of accurate staging in the management and prognostication of high risk primary prostate cancer. Conventional radiologic imaging techniques are insufficient to reliably detect lymph node metastases in prostate cancer. Despite promising results, there is limited published data on the diagnostic accuracy of PSMA PET-CT to assess local nodal metastases prior to radical prostatectomy. This study aims to assess the diagnostic efficacy of 68Ga PSMA PET-CT in local lymph node staging of high risk primary prostate cancer when compared to histopathological findings following radical prostatectomy with pelvic lymph node dissection. Methods We retrospectively analysed consecutive patients with high risk primary prostate cancer referred by urologists for primary staging PSMA PET-CT using a 68Ga-labeled PSMA ligand, Glu-NH-CO-NHLys-(Ahx)-[HBEDD-CC], from October 2015 to October 2017. The scans of patients who underwent radical prostatectomy with pelvic lymph node dissection were interpreted by the consensus reading of two experienced nuclear medicine physicians blinded to clinical and histopathological data. The contemporaneous records of the referring urologists were retrospectively reviewed for noteworthy unexpected PET findings that altered their personal preference for surgical management. Results Seventy-one patients were recruited and analysed. PSMA PET-CT showed findings compatible with local disease in 47 patients (66.2%), lymph node metastases in 10 patients (14.1%) and distant metastases in 14 patients (19.7%). Twenty-eight patients (twenty-seven of whom had local disease only) underwent surgery yielding 214 lymph nodes, all of which were negative on histopathological analysis. On a node-based analysis, 213 of 214 lymph nodes were accurately identified as negative for disease with a negative predictive value of 100%. 11 patients had unexpected PET findings contemporaneously documented by urologists to alter their preference for surgical management. Conclusions PSMA PET-CT appears to have a high negative predictive value for local lymph node metastases in high risk primary prostate cancer when compared to histopathological findings following radical prostatectomy with pelvic lymph node dissection.

Primary extranodal lymphomatous involvement of the genitourinary tract is rare and secondary extranodal involvement in disseminated disease occurs more frequently. Imaging of metabolic activity with 2-(fluorine-18) fluoro-2-deoxy-d-glucose (FDG) used in PET facilitates the identification of these extranodal sites of disease, particularly in the absence of structural lesions on conventional imaging modalities. Primary extranodal lymphoma affecting the genitourinary system is often caused by high-grade Non-Hodgkin's Lymphoma (NHL) with the most common subtype being diffuse large B-cell lymphoma (DLBCL). Although rare, the incidence of extranodal lymphoproliferative disease is increasing and a delay in diagnosis holds a poor prognosis. Familiarity with benign and physiological causes of FDG uptake, particularly due to the urinary tracer excretion is crucial in identifying sites of lymphomatous involvement in the genitourinary system. Additionally, non-lymphomatous malignancies are usually treated surgically, whereas lymphoma is primarily treated with chemotherapy and/or radiotherapy. Therefore, accurate identification and staging together with histological confirmation significantly impacts management of these patients. This article serves to review and illustrate the imaging findings on FDG-PET/CT of primary extranodal lymphoma affecting the genitourinary system.

Internal Medicine JournalVolume 48, Issue 7 p. 885-886 Letter to the Editor An unusual presentation: breast metastases imitating a gastric primary – first Australian case reported Sarah Khan, Sarah Khan orcid.org/0000-0002-9627-7236 Medical Oncology Department, Bankstown Hospital, New South Wales, AustraliaSearch for more papers by this authorRay Asghari, Ray Asghari Medical Oncology Department, Bankstown Hospital, New South Wales, AustraliaSearch for more papers by this authorMichael Lin, Michael Lin Department of Nuclear Medicine, Liverpool Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this author Sarah Khan, Sarah Khan orcid.org/0000-0002-9627-7236 Medical Oncology Department, Bankstown Hospital, New South Wales, AustraliaSearch for more papers by this authorRay Asghari, Ray Asghari Medical Oncology Department, Bankstown Hospital, New South Wales, AustraliaSearch for more papers by this authorMichael Lin, Michael Lin Department of Nuclear Medicine, Liverpool Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this author First published: 08 July 2018 https://doi.org/10.1111/imj.13957Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume48, Issue7July 2018Pages 885-886 RelatedInformation

Response to neoadjuvant chemoradiotherapy (CRT) of rectal cancer is variable. Accurate imaging for prediction and early assessment of response would enable appropriate stratification of management to reduce treatment morbidity and improve therapeutic outcomes. Use of either diffusion weighted imaging (DWI) or dynamic contrast enhanced (DCE) imaging alone currently lacks sufficient sensitivity and specificity for clinical use to guide individualized treatment in rectal cancer. Multi-parametric MRI and analysis combining DWI and DCE may have potential to improve the accuracy of therapeutic response prediction and assessment.

The purpose of the present study is to investigate sleep-disordered breathing and symptoms of sleepiness in a consecutive clinical cohort of multiple sclerosis (MS) patients.

We retrospectively evaluated the value of PET/CT in predicting survival and histopathological tumour-response in patients with distal oesophageal and gastric adenocarcinoma following neoadjuvant treatment.

INTRODUCTION:The aims of this study are to evaluate the prognostic value of metabolic parameters derived from (18) F-FDG PET-CT performed before definitive radiation therapy (RT) (prePET) in patients with mucosal primary head and neck squamous cell carcinoma (MPHNSCC) and to assess the additive prognostic values of FDG PET-CT performed during RT (iPET).METHODS:One hundred patients with MPHNSCC treated with radical RT underwent staging prePET and iPET performed during the third week of treatment. The maximum standardized uptake value (SUVmax ), metabolic tumour volume (MTV) and total lesional glycolysis (TLG) of primary tumour were analysed for both prePET and iPET, and results were correlated with loco-regional recurrence-free survival (LRFS), disease-free survival (DFS), metastatic failure-free survival (MFFS) and overall survival (OS), using Kaplan-Meier analysis. Optimal cut-offs (OC) for prePET and iPET were derived from Receiver Operating Characteristic curves. Patients with metabolic parameters above/below the individual OC of prePET as well as iPET (i.e. combined prePET and iPET (comPET)) were evaluated against their outcomes.RESULTS:Median age was 61 years (range 39-81), median follow-up of 20 months (range 4-70, mean 27), and AJCC 7th Edition clinical stage II, III and IV were 8, 24 and 68 patients respectively. Metabolic values below individual OC in comPET were found to be associated with statistically significant improvements (P < 0.05) in DFS, LRFS and OS. In addition, patients with SUVmax above the OC in comPET were associated with worse MFFS (P = 0.011) and confirmed on both univariate (P = 0.019) and multivariate analyses (P = 0.04).CONCLUSION:Addition of iPET significantly improves the prognostic values of all three metabolic parameters and can potentially be used in future adaptive local and systemic therapy trials.