Multiple myeloma (MM) frequently evades complete evaluation with 18 F-FDG-PET/CT due to variable hexokinase expression, leading to false-negative findings. 18 F-fluorocholine-PET/CT (FCH) targets membrane phospholipid synthesis and has been proposed as an alternative imaging strategy to address this limitation. In this single-center retrospective study, 35 adult MM patients underwent dual-tracer PET/CT within four weeks. Lesions were scored using Deauville-based criteria (IMPeTUs), and exploratory composite scores (hTepe and myPET) were calculated. Laboratory markers, including M-protein, free light chains, and bone marrow infiltration, were collected within four weeks of imaging. The cohort (22 men, 13 women; mean age 62.2 ± 10.9 years) included 19 patients at initial staging and 16 at restaging. FDG detected active disease in 49

OBJECTIVES:Neuroblastoma often demonstrates high uptake of MIBG, which is used for imaging and therapy. This retrospective observational study aimed to assess the prognostic significance of modified Curie scores (mCS) and SIOPEN scores (SS) derived from post-treatment 131I-MIBG scans in relapsed/refractory neuroblastoma. Additionally, the impact of SPECT-CT imaging on these scores was investigated as a secondary goal. MATERIAL AND METHODS:Pediatric patients with relapsed/refractory neuroblastoma, who underwent 131I-MIBG treatment, were included (n=35). mCS and SS were calculated from planar images of post-treatment 131I-MIBG scans. Patients were then categorized based on the cut-off values obtained from these scans, and survival analysis was conducted. To investigate the impact of SPECT-CT imaging on scores, mCS and SS were also calculated from both planar and SPECT-CT images of diagnostic 123I-MIBG scans separately. RESULTS:Patients with mCS>12 or SS>23 on post-treatment 131I-MIBG scans had significantly worse overall survival. mCS and SS from SPECT-CT were significantly higher than planar images in pre- and post-treatment diagnostic 123I-MIBG scans. SPECT-CT caused changes in mCS for 61% and SS for 55% of patients, predominantly in axial and appendicular skeleton regions. CONCLUSIONS:Both mCS and SS from post-treatment 131I-MIBG planar scans correlated significantly with overall survival in relapsed/refractory neuroblastoma. Patients with mCS>12 or SS>23 had poorer survival. SPECT-CT imaging influenced scores for a substantial portion of patients, emphasizing its value alongside planar imaging. Larger, comprehensive studies are warranted to validate these findings and refine prognostic cut-offs. Incorporating SPECT-CT in relevant body regions is recommended for improved disease assessment.

To investigate whether metabolic and volumetric 18F-FDG PET parameters are associated with histopathological response, metastatic disease at diagnosis, overall survival (OS), and progression-free survival (PFS) in pediatric osteosarcoma (OST) patients. Additionally, to compare absolute and relative threshold methods for metabolic tumor volume (MTV) calculation. This single-center retrospective study included 26 pediatric OST patients who underwent 18F-FDG PET/CT at diagnosis and, when available, after neoadjuvant chemotherapy. SUVmax, SUVpeak, MTV, total lesion glycolysis (TLG) and anatomic tumor volume of the primary tumor, along with whole-body MTV (wb-MTV) and whole-body TLG encompassing all FDG-avid metastatic lesions, were measured and their percentage changes (∆) between PET scans were calculated. MTV and TLG were calculated using absolute (SUV 2.0) and relative (40

Differentiated thyroid cancers (DTC) is a rare cancer in children and adolescents, having features of different clinical presentation, biological behavior, and treatment from adult population. Most of the patient management guidelines are based on literature on adult population and the literature on children and adolescents still limited. There are still unsettled issues regarding both patient management and the therapy. However, the current approach for treatment of DTC includes thyroidectomy, lymph node dissection in patients with nodal metastases and possible use of Iodine-131 radiotherapy. The incidence of DTC is low in pediatric population, and the characteristics of the disease vary among different age groups within this population. Therefore, the literature depends on small cohorts and heterogeneous retrospective studies. This paper aims to review the current literature and give an overview to the approach in the management of DTC in pediatric population. DTC in pediatric population, has an aggressive nature, however the patient's overall survival is excellent. A multidisciplinary approach in the management of pediatric DTC patients would yield fewer side effects and a better life quality.

Objectives: This prospective study was planned to compare the predictive value of dynamic 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in locally advanced breast cancer patients (LABC) receiving neoadjuvant chemotherapy (NAC). Methods: Twenty seven patients with LABC [median age: 47, (26-66)] underwent a dynamic 18F-FDG PET study at baseline, and after 2-3 cycles of (NAC) were included (interim). Maximum standardized uptake value (SUVmax) values and SUV ratios for the 2nd, 5th, 10th, and 30th minutes and dynamic curve slope (SL) values and SL ratios were measured using 18F-FDG dynamic data. In addition, the values of SUVmean (2minSUVmean), SULpeak (2minSULpeak), metabolic volume (2minVol), and total lesion glycolysis (2minTLG) were measured for the first 2 min. Percent changes between baseline and interim studies were calculated and compared with the pathological results as the pathological complete response (PCR) or the pathological non-complete response (non-PCR). Receiver operating characteristic curves were obtained to calculate the area under the curve to predict PCR. Optimal threshold values were calculated to discriminate between PCR and non-PCR groups. Results: Baseline study SUV 30 (p=0.044), SUV 30/2 (p=0.041), SUV 30/5 (p=0.049), SUV 30/10 (p=0.021), SL 30/2 (p=0.029) and SL 30/5 (p=0.027) values were statistically significant different between PCR and non-PCR groups. The percentage changes of 2minVol between PCR and non-PCR groups were statistically significant. For the threshold value of-67.6% change in 2minVol, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 87.2%, 77.8%, 63.6%, 93.3%, and 80.7%, respectively (area under the curve: 0.826, p=0.009). Conclusion: Semiquantitative parameters for dynamic 18F-FDG PET can predict PCR. % changes in 2minVol can identify non-responding patients better than other parameters.

The theranostics concept using the same target for both imaging and therapy dates back to the middle of the last century, when radioactive iodine was first used to treat thyroid diseases. Since then, radioiodine has become broadly established clinically for diagnostic imaging and therapy of benign and malignant thyroid disease, worldwide. However, only since the approval of SSTR2-targeting theranostics following the NETTER-1 trial in neuroendocrine tumours and the positive outcome of the VISION trial has theranostics gained substantial attention beyond nuclear medicine. The roll-out of radioligand therapy for treating a high-incidence tumour such as prostate cancer requires the expansion of existing and the establishment of new theranostics centres. Despite wide global variation in the regulatory, financial and medical landscapes, this guide attempts to provide valuable information to enable interested stakeholders to safely initiate and operate theranostics centres. This enabling guide does not intend to answer all possible questions, but rather to serve as an overarching framework for multiple, more detailed future initiatives. It recognizes that there are regional differences in the specifics of regulation of radiation safety, but common elements of best practice valid globally.

We investigated the prognostic value of interim and post-neoadjuvant chemotherapy (NAC) 18F FDG PET/CT and the complete pathological and metabolical response after NAC for disease-free survival (DFS) and overall survival (OS) in patients with locally advanced breast cancer (LABC) receiving NAC. Patients who were decided to receive NAC were evaluated with baseline (PET1), after 2-3 cycles of chemotherapy (interim-PET2), and after NAC-before surgery (PET3) with 18F FDG PET/CT. The primary tumor SUV and the total metabolic tumor volume (MTV) of the primary tumor+axillary lymph nodes were calculated and defined for PET1-2-3 as SUV1-2-3 and MTV1-2-3. We also calculated ??%SUV and ??%MTV for PET1-2 and PET1-3. The relation between parameters and survival was evaluated with Cox regression analysis. Patients were grouped as a complete metabolic response or not (metCR/nonmetCR) according to PET3 and as PCR/non-PCR according to the presence of residual invasive tumor as a result of pathology after NAC. Forty-two patients were analyzed (46.36??10.4 years old). The median follow-up time was 94.3 months. For DFS and OS, only MTV from post-NAC PET/CT was an independent predictor. For MTV3 ??? 2.1 mL vs. > 2.1 mL, 7-year DFS and OS were 81.3% - 50%, (p= 0.038) and 88.2% and 55.6%, (p= 0.042) respectively. Survival was statistically significantly different in the PCR/non-PCR patient groups. There was no difference in DFS between patients with metCR/non-metCR, only between groups for OS (Log-rank). MTV (??? 2.1mL vs. > 2.1mL) obtained from 18F FDG PET/CT after NAC-pre-surgery and complete pathological response might distinguish patients with poor prognosis.

GirişNöroblastom, pediyatrik hasta grubunda en sık izlenen solid ekstrakraniyal tümör olup, nükleer tıp tanıda, evrelemede, tedavide, tedavi yanıt değerlendirilmesinde ve uzun dönem takipte önemli rol oynamaktadır.Nöroektodermal tümörler, sempatik sinir sisteminin köken aldığı primitif nöral krestten gelişirler.Nöroblastom malign nöroektodermal bir tümör olup, çocukluk çağının en sık izlenen ekstrakraniyal solid tümörüdür.Hastalığın doğru evrelenmesi, prognoz ve tedavi açısından önemlidir.Hastaların %80'i metastaz (evre 4) ile teşhis edildiğinden, hastalığın yaygınlığının değerlendirilmesi için tüm lezyonların doğru tanımlanması önem taşımaktadır (1). I.AmaçBu kılavuzun amacı nöroblastom tanılı çocuklarda meta-iyodobenzilguanidin (MIBG) sintigrafisi uygulamaları yanı sıra yeni geliştirilen F-18-florodeoksiglukoz (FDG), F-18 DOPA ve Ga-68 DOTA peptidlerin rolü konusunda nükleer tıp hekimlerine yardımcı olmak ve bu tetkiklerinThe aim of this procedure guideline is the standardization of I-123 metaiodobenzylguanidine scintigraphy, F-18 fluorodeoxyglucose, F-18 fluoropheniylalanine, Ga-68 DOTA peptide positron emission tomography/computerized tomography imaging protochols in pediatric neuroblastoma patients.

Girişİdrar yolu enfeksiyonları çocukluk çağında sık görülmekte olup, tanısı sıklıkla klinik ve laboratuvar testleri ile konmaktadır.Ancak hastalarda belirgin komorbidite varsa, tekrarlayan idrar yolu enfeksiyonları izleniyorsa, tedaviye direnç izlenmişse ya da Escherichia coli dışındaki etkenlerin sorumlu olduğu tespit edilirse çocuklarda ileri inceleme gerekli olmaktadır

A girl diagnosed with neuroblastoma at 33 months underwent I-MIBG scan after surgery and chemoradiotherapy. Although MIBG scan showed complete response, the bone marrow biopsy showed refractory disease. Therefore, she underwent Ga-DOTATATE PET/CT, which revealed bone marrow involvement and Ga-DOTATATE-avid brain metastasis. Rare physiological pineal gland uptake was also depicted. Ga-DOTATATE PET/CT showed active progressive disease earlier, before it was detectable with MIBG scan. For patients with MIBG-negative relapsed/refractory disease, Ga-DOTATATE may have an important role in restaging, detecting unsuspected metastasis, therapy planning.

Carney Complex (CNC) is a multiple neoplasia syndrome characterized by skin tumors and pigmented lesions, myxomas, and various endocrine tumors. The aim of this case report was to describe a case of CNC with a novel PRKAR1A mutation. A man aged 46 years with a medical history of surgery for cardiac myxomas at the age of 39 was admitted to our hospital because of four newly-developed heart masses. The histologic examination confirmed cardiac myxomas. He had many presentations of CNC such as growth hormone (GH) and prolactin (PRL)-secreting mixed pituitary adenoma, benign thyroid nodule, large-cell calcifying Sertoli cell tumor (LCCST), and superficial angiomyxoma. A bilateral adrenalectomy was performed because the laboratory findings suggested primary pigmented nodular adrenocortical disease (PPNAD). The pathologic examination revealed a focal unilateral PPNAD, unilateral nonpigmented adrenocortical nodule, and bilateral adrenal medullary hyperplasia. Two years after the second cardiac operation, an interatrial septum-derived tumor was detected. An atrial myxoma was confirmed with histologic studies. Based on these findings, the patient was confirmed to have CNC. A novel insertion mutation in the type 1A regulatory subunit of the cAMP-dependent protein kinase A gene (PRKAR1A) in exon 2 was detected in our patient through genetic analysis. The presence of multiple myxomas and endocrine abnormalities should be an indication to physicians to further investigate for CNC. Herein, we described a case of CNC with a novel mutation in exon 2 of the PRKAR1A gene with typical and atypical clinical features.

Nuclear medicine has an important role in the management of many cancers in pediatric age group with multiple imaging modalities and radiopharmaceuticals targeting various biological uptake mechanisms. 18-Flourodeoxyglucose is the radiotracer of choice especially in patients with sarcoma and lymphoma. 18FDG-PET, for sarcoma and lymphomas, is proved to be superior to conventional imaging in staging and therapy response. Although studies are limited in pediatric population, 18FDG-PET/CT has found its way through international guidelines. Limitations and strengths of PET imaging must be noticed before adapting PET imaging in clinical protocols. Established new response criteria using multiple parameters derived from 18FDG-PET would increase the accuracy and repeatability of response evaluation. Current data suggest that I-123 metaiodobenzylguanidine (MIBG) remains the tracer of choice in the evaluation of neuroblastoma (NB) because of its high sensitivity, specificity, diagnostic accuracy, and prognostic value. It is valuable in determining the response to therapy, surveillance for disease recurrence, and in selecting patients for I-131 therapy. SPECT/CT improves the diagnostic accuracy and the interpretation confidence of MIBG scans. 18FDG-PET/CT is an important complementary to MIBG imaging despite its lack of specificity to NB. It is valuable in cases of negative or inconclusive MIBG scans and when MIBG findings underestimate the disease status as determined from clinical and radiological findings. F-18 DOPA is promising tracer that reflects catecholamine metabolism and is both sensitive and specific. F-18 DOPA scintigraphy provides the advantages of PET/CT imaging with early and short imaging times, high spatial resolution, inherent morphologic correlation with CT, and quantitation. Regulatory and production issues currently limit the tracer’s availability. PET/CT with Ga-68 DOTA appears to be useful in NB imaging and may have a unique role in selecting patients for peptide receptor radionuclide therapy with somatostatin analogues. C-11 hydroxyephedrine PET/CT is a specific PET tracer for NB, but the C-11 label that requires an on-site cyclotron production and the high physiologic uptake in the liver and kidneys limit its use. I-124 MIBG is useful for I-131 MIBG pretherapeutic dosimetry planning. Its use for diagnostic imaging as well as the use of F-18 labeled MIBG analogues is currently experimental. PET/MR imaging is emerging and is likely to become an important tool in the evaluation. It provides metabolic and superior morphological data in one imaging session, expediting the diagnosis and lowering the radiation exposure. Radioactive iodines not only detect residual tissue and metastatic disease but also are used in the treatment of differentiated thyroid cancer. However, these are not well documented in pediatric age group like adult patients. Use of radioactivity in pediatric population is very important and strictly controlled because of the possibility of secondary malignities; therefore, management of oncological cases requires detailed literature knowledge. This article aims to review the literature on the use of radionuclide imaging and therapy in pediatric population with thyroid cancer, sarcomas, lymphoma, and NB.

The purpose of this procedure guideline is to provide information to nuclear medicine specialists in their daily practice about F-18 fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/ CT) acquisitions in pediatric population.This guideline contains information, which is supported by the current literature and technology, about the indications, acquisition parameters, processing, and interpretation of FDG PET/CT in pediatric oncology.

Bu kılavuzda kısaca çocuklarda radyonüklid sistografi çalışmasının nasıl yapılması gerektiği konusunda bugünkü bilgilerimiz ve Türkiye Nükleer Tıp Derneği tarafından oluşturulan Nefroüroloji ve Pediatri İlgi grubunun düşünceleri özetlenmiştir.Bu kılavuzun amacı radyonüklid sistografi

This guideline summarizes briefly the opinions of the Nephrourology and Paediatric Interest group, generated by the Turkish Society of Nuclear Medicine, on how to perform renal cortical scintigraphy in children.The aim of this guideline is to help physicians yield comparable results by providing a standardized approach in imaging with common protocols and report sampling.This guideline contains the information of previous guidelines by both the Turkish Society of Nuclear Medicine and the European Association of Nuclear Medicine, last version.The information about the applications and reporting details are summarized in this guideline, and the recommendations are composed according to the laws and regulations in our country.