Annual Congress of the European Association of Nuclear Medicine October 13 -17, 2018 Düsseldorf, Germany - eanm18.eanm.org - EANM 2018
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Annual Congress of the
European Association of Nuclear Medicine
October 13 – 17, 2018
Düsseldorf, Germany
Continuing Medical Education
eanm18.eanm.org
Extended Abstracts
EANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
TABLE O F CONT E NTS
Introduction by the Congress Chair 5
CME Sessions Overview 6
SUNDAY, OCTOBER 14, 2018
CME 1 – Inflammation & Infection: Fever of Unknown Origin
The Infectiologist’s Point of View
Alastair McGregor (London, United Kingdom) 9
Role of Nuclear Medicine in FUO Diagnosis: When and How to Use WBC Scintigraphy
Elena Lazzeri (Pisa, Italy) 10
Role of Nuclear Medicine in FUO Diagnosis: When and How to Use FDG-PET
Lioe-Fee de Geus-Oei (Leiden, Netherlands) 11
CME 2 – Thyroid: New Guidelines on Nuclear Thyroidology
EANM-SNMMI Joined Guidelines on Thyroid Molecular Imaging
Luca Giovanella (Bellinzona, Switzerland) 13
EANM Guidelines on Medullary Thyroid Carcinoma
Giorgio Treglia (Bellinzona, Switzerland) 14
EANM Guidelines on Radioiodine Therapy of Benign Thyroid Diseases - Recent Novel Aspects
Frederik A. Verburg (Marburg, Germany) 15
CME 3 – Cardiovascular: SPECT or PET?
Detection of CAD
Frank Bengel (Hannover, Germany) 18
Myocardial Blood Flow Quantification
Alain Manrique (Caen, France) 19
Infection
Fabien Hyafil (Paris, France) 20
Innervation
Hein Verberne (Amsterdam, Netherlands) 21
CME 4 – Paediatrics: PET/MR in Paediatrics – Sharing Experiences
PET/MR in Paediatrics - Brain Tumours
Lise Borgwardt (Copenhagen, Denmark) 23
PET/MR in Paediatrics - Extra-Cranic Solid Tumours
Regine Kluge (Leipzig, Germany) 24
PET/MR in Paediatrics - Non-Oncologic Applications and Future Developments
Pietro Zucchetta (Padua, Italy) 25
MONDAY, OCTOBER 15, 2018
CME 5 – Radiopharmacy / EDQM: Validation of Radioanalytical Methods
General Principles on Validation of (Radio)Analytical Methods
Sergio Todde (Monza, Italy) 27
EANM Guidelines – Practical Examples
Nicholas Gillings (Copenhagen, Denmark) 28
European Pharmacopoeia Guide for the Elaboration of Monographs for
Radiopharmaceutical Preparations – Validation of Radioanalytical Methods
Ellen Pel (EDQM, Strasbourg, France) 29
2 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N Y
EANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
CME 6 – Dosimetry: Alpha Particle Dosimetry – When, Why and How?
Introducing Alpha-Particle Emitter into the Clinic, Does Dosimetry Answer all Questions?
James Nagaraja (Nijmegen, Netherlands) 31
Small Scale Dosimetry Models, a Universal Answer for Personalized Alpha-Therapy?
Rob Hobbs (Baltimore, United States of America) 32
The Significance of Radium - 223 in the Therapy Landscape of Advanced Prostate Cancer
Alexander Haug (Vienna, Austria) 33
The Role of Dosimetry to Predict Biological Effect in Patients Treated with Ra-233
Lidia Strigari (Rome, Italy) / Rosa Sciuto (Rome, Italy) 34
CME 7 – Radiation Protection / Paediatrics:
Optimization of Diagnostic Reference Levels in Hybrid Imaging in Paediatric Nuclear Medicine
Dose Reduction Techniques in Hybrid Imaging
Diego De Palma (Varese, Italy) 36
Practical Implementation of Dose Reduction Techniques
Ana Isabel Santos (Almada, Portugal) 37
Harmonization Between European and North American Administered Activities
Michael Lassmann (Würzburg, Germany) 38
CME 8 – Oncology: Different Strategies in the Management of Hepatic Metastases in NEN
Nuclear Medicine Physicians´ View (PRRT; SIRT)
Samer Ezziddin (Homburg, Germany) 40
Oncologists´ View
Nicola Fazio (Milan, Italy) 41
Surgeons´ View
Andrea Frilling (London, United Kingdom) 42
TUESDAY, OCTOBER 16, 2018
CME 9 – Translational Molecular Imaging & Therapy / Oncology: Imaging Targets for Cancer Immunotherapy
Role of Imaging in Cancer Immunotherapy
Nicolas Aide (Caen, France) 44
SPECT-CT Imaging of PD-L1 Expression in Cancer
Sandra Heskamp (Nijmegen, Netherlands) 45
PET Imaging of Targets for Immunotherapy: Implications for Radiotherapy
Gabriele Niedermann (Freiburg, Germany) 46
CME 10 – Bone & Joint | Interactive: How Much Radiology Do We Need in Bone and Joint Multi-Modality Imaging?
How Much CT is Needed for Bone & Joint SPECT/CT?
Klaus Strobel (Lucerne, Switzerland)
How to Settle Anatomic and Functional Discrepancies in SPECT/CT and PET/CT?
Frédéric Paycha (Paris, France)
The Role of PET/MR in MSK Imaging
Lars Stegger (Münster, Germany)
3 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N YEANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
CME 11 – Oncology: Update on PET/MR in Oncology
Update on PET/MR Technical Developments
Harald Quick (Essen, Germany) 50
Update on PET/MR in Paediatric Oncology
Juergen Schaefer (Tübingen, Germany) 51
Update on PET/MR in Abdominal Oncological Diseases
Patrick Veit-Haibach (Toronto, Canada) 52
Update on PET/MR in Thoracic Oncological Diseases
Geoffrey Johnson (Rochester, United States of America) 53
CME 12 – Oncology: PET Guided Biopsy
PET Guided Biopsy - Soft Tissues and Organs
Juliano Cerci (Couritiba, Brasil) 55
PET Guided Biopsy - Lymphoma and Bone
Cristina Nanni (Bologna, Italy) 56
New Perspectives by Combining Advanced Tools and Navigation with Radio-Guided Surgery
Fijs van Leeuwen (Leiden, Netherlands) 58
WEDNESDAY, OCTOBER 17, 2018
CME 13 – Neuroimaging / Cardiovascular: Myocardial 123I-mIBG Imaging in Neurology – Is it Ready for Prime Time?
Introduction on the Essentials of Myocardial 123I-mIBG Imaging
Hein Verberne (Amsterdam, Netherlands) 60
Myocardial 123I-mIBG Imaging for the Differential Diagnosis of Parkinsonian Syndrome:
The Nuclear Neurologist's Perspective
Giorgio Treglia (Bellinzona, Switzerland) 61
Myocardial 123I-mIBG Imaging in Dementia with Lewy bodies (DLB) and Prodromal DLB:
The Neurologist's Perspective
Pietro Tiraboschi (Milan, Italy) 62
CME 14 – Physics / Dosimetry: Quantitative Multimodality Imaging
Advances in SPECT/CT Quantitation
Brian Hutton (London, United Kingdom) 64
Advances in PET/CT Quantitation
Dimitris Visvikis (Brest, France) 65
Advances in PET/MRI Quantitation
Bernhard Sattler (Leipzig, Germany) 66
Advances in Radionuclide Image Based Dosimetry
Yuni Dewaraja (Ann Arbor, United States of America) 67
Imprint 68
4 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N YEANM’18 WORLD LEADING MEETING WORLD LEADING MEETING EANM’18
CME EXTENDED ABSTRACT BOOK CME EXTENDED ABSTRACT BOOK
Dear colleagues,
dear friends,
On behalf of the European Association of Nuclear have the possibility to enhance their knowledge of
multimodality imaging. A careful evaluation proce-
high-quality research through interaction between
basic and translational clinical scientists and to
Medicine, it is my great pleasure and honour to dure relating to the speakers will be implemented present the latest achievements and develop-
welcome you to the 31st Annual EANM’18 Congress in order to gain feedback and ensure that future
interactive sessions continue to enjoy a positive
ments in the fields of clinical molecular imaging
and nuclear medicine therapy. During plenary lec-
in Düsseldorf, Germany. response. With similar pedagogic intent, numerous tures, distinguished speakers will address the state
multidisciplinary joint symposia, organised by sev- of the art and new developments in clinical and
eral EANM Committees in collaboration with our allied sciences, covering a broad range of topics
sister societies, will offer an integrative approach with the goal of fostering the provision of the best
to various topics relevant to the state of the art of possible care for our patients. In particular, it is a
our discipline. I would like to take this opportunity pleasure and an honour for me to announce the
to make a special appeal to young specialists, who contribution to our congress of Prof. Bernard L. Fer-
will probably benefit most from the academic ses- inga, from Groningen, Netherlands, Nobel Prize in
sions. You represent the future of our discipline and Chemistry 2016, with a lecture on the “Fascinating
it is you who should begin to shape yourself for a World of Molecules”.
brighter tomorrow in our community!
At the end of the meeting, the traditional High-
Of course, all this will not reduce the predom- lights lecture will provide a broad overview of the
inant role of our congress, namely to deliver oral science presented at EANM’18. I am delighted
and electronic-poster presentations on the latest that two young but very motivated and highly
achievements in clinical nuclear medicine, science respected members of our European Nuclear Med-
and technology. On the contrary, the oral sessions icine community, Prof. Ken Hermann from Essen,
will be enriched. Rapid Fire sessions will draw Germany, and Dr. Fijs van Leeuwen from Leiden,
attention to the highly rated abstracts in specific Netherlands, have agreed to take on this task.
comprehensive topics, with a panel of top-level For all these reasons, I cordially invite you to
presentations followed by extensive discussions; EANM’18 to actively participate in our 31st Annual
this will provide attendees with an integrated and Congress, to meet and interact with friends and
coherent view on a wide variety of topics. Fur- colleagues from all over the world, to discuss sci-
thermore, the concept of featured oral sessions in ence, to learn about the exciting developments in
The EANM meeting is now definitively the tional track, implemented with the collaboration which an invited speaker places the presentations nuclear medicine, to break away from the daily rou-
world-reference congress in nuclear medicine. of the European School of Multimodality Imag- into a broader perspective will be generalised to tine and to enjoy everything that the city of Düssel-
In order to maintain our congress at its excellent ing and Therapy, will include up-to-date teaching all the other oral presentations. The now well-es- dorf has to offer.
level, the meeting will build on the traditions that sessions, enriched pitfalls seminars and Continu- tablished tracks M2M – Molecule to Man (basic
are highly appreciated by all the attendees, with ous Medical Education interactive sessions. In all and translational science) and Do.MoRe (radionu- Francesco Giammarile,
the expansion of newer features. A specific educa- these active learning conferences, attendees will clide therapy and dosimetry) promise to promote EANM Congress Chair 2017–2019
5 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N Y D Ü S S E L D O R F, G E R M A N Y | O C T O B E R 1 3 – 1 7 , 2 0 1 8 5EANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
SESSION OVER V I E W
Sunday, Monday, Tuesday, Wednesday,
October 14 October 15 October 16 October 17
101 601 1101 1601
CME 1 CME 5 CME 9 CME 13
Inflammation & Radiopharmacy / Translational Neuroimaging /
08:00 - 09:30
08:00 - 09:30
Infection EDQM Molecular Imaging Cardiovascular
Fever of Validation of & Therapy / Myocardial
Unknown Origin Radioanalytical Oncology 123
I-mIBG Imaging
Methods Imaging Targets in Neurology – Is
for Cancer it Ready for Prime
Immunotherapy Time?
1701
CME 14
Physics /
10:00 - 11:30
10:00 - 11:30
Dosimetry
Quantitative
Multimodality
Imaging
301 801 1301
CME 2 CME 6 CME 10 -
Thyroid Dosimetry Interactive
11:30 - 13:00
11:30 - 13:00
New Guidelines Alpha Particle Bone & Joint
in Nuclear Dosimetry - When, How Much
Thyroidology Why and How? Radiology
Do We Need in Bone
and Joint Multi-
Modality Imaging?
401 901 1401
CME 3 CME 7 CME 11
Cardiovascular Radiation Protection Oncology
14:30 - 16:00
14:30 - 16:00
SPECT or PET? / Paediatrics Update on
Optimization of PET/MR in Oncology
Diagnostic Reference
Levels in Hybrid
Imaging in Paediatric
Nuclear Medicine
501 1001 1501
CME 4 CME 8 CME 12
Paediatrics Oncology Oncology
16:30 - 18:00
16:30 - 18:00
PET/MR in Different Strategies PET Guided Biopsy
Paediatrics – Sharing in the Management
Experiences of Hepatic
Metastases in NEN
6 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N YW O R L D L E A D I N G M E E T I N G
EANM΄18
EVALUATION
Give us your feedback!
The evaluation for CME Sessions will be done by paper sheets only.
Please complete the evaluation form you receive upon entry
into the CME lecture hall and return it when you are leaving the
room after each CME Session. Together with the scan of your
name badge, your personal CME points are allocated.
E VA L U AT I O N . E A N M . O R GEANM’18
WORLD LEADING MEETING EANM’18
CME EXTENDED ABSTRACT BOOK
1 CME EXTENDED ABSTRACT BOOK
WORLD LEADING MEETING
CME SESSION 1
Oc tober 14, 2018 | 08:00 – 09:30
Fever of Unknown Origin
O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N Y 8EANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
Fever of Unknown Origin:
The infectiologist’s point of view
Alastair McGregor (London, UK)
Fever of unknown origin (FUO) is a widely but inaccu- The choice of investigations is usually guided by the
CME Session
1
rately used term. This reflects imprecision in the defi- presence of clinical abnormalities that coexist with
nition, which is now nearly 50 years old(1). the fever. Early investigations include standard blood
The causes of FUO can be divided into infec- tests and autoantibodies, microbiologic examination
tious, malignant, inflammatory, miscellaneous and of clinical samples, such as blood and sputum, and
unknown. There is some evidence that the epidemi- cross sectional imaging. Computed Tomography (CT)
ology of FUO has changed since the classical defini- scanning, in particular, is an important component
October 14, tion was proposed. The available data suggest a fall of an FUO workup and can help identify pulmonary
08:00 - 09:30 in the proportion of FUO that is caused by infection lesions, occult abscesses, lymphadenopathy and
and a rise in those cases where a diagnosis is not tumors. The value of augmenting standard CT with
made(2). Some of this change is likely to have been FDG-PET for the investigation of FUO has not been
driven by patient factors such as ageing populations, adequately quantified.
increasing travel and the increasing prevalence (and Fortunately, the prognosis in cases of FUO that defy
new types) of immunosuppression. However, the diagnosis after extensive investigation is good. Two
epidemiology of FUO will also have been affected by studies show mortality at 2 and 6 months respectively
the introduction of new technologies and improved of only 3% and recovery in a significant proportion(3,
accessibility of out-of-hospital diagnostics, allowing 4)
. It is therefore likely that exclusion of infection and
the identification of pathologies before they quality malignancy with standard microbiological and radio-
as “true” fever of unknown origin. logical testing, followed by assessment for inflamma-
A universal strategy for investigating patients with tory conditions and clinical observation, is adequate
FUO has not emerged, which is unsurprising for a syn- in the majority of cases.
drome with such a vast number of potential causes.
References:
1. Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore) 1961; 40:1.
2. Mourad O, Palda V, Detsky AS. A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med. 2003 Mar 10;163(5):545-51.
3. Knockaert DC, Dujardin KS, Bobbaers HJ. Long-term follow-up of patients with undiagnosed fever of unknown origin. Arch Intern Med 1996;
156:618.
4. Bleeker-Rovers CP, Vos FJ, de Kleijn EM, et al. A prospective multicenter study on fever of unknown origin: the yield of a structured diagnostic
protocol. Medicine (Baltimore) 2007; 86:26.
9 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N YEANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
Role of Nuclear Medicine in
FUO Diagnosis: When and
How to Use WBC Scintigraphy
Elena Lazzeri (Pisa, Italy)
The most common causes of Fever of Unknown Ori- FUO are high (60-85% and 78-94% for 111In-oxine and
CME Session
1
gin (FUO) can be infections (28.4%), and non-infec- 96% and 92% for 99m Tc-HMPAO labelling), this proce-
tious inflammatory diseases (25.7%). The diagnostic dure can be however considered as the first choice
work-up of FUO should include the complete history only in patients with FUO with an history, physical
of the patient, physical examination, laboratory tests examination and laboratory tests consistent with
and finally diagnostic investigations. high probability of infection disease. There are also
Nuclear medicine imaging is often a second-line reports on the use of radiolabelled anti-granulocyte
October 14, diagnostic procedure although it can be considered monoclonal antibody in FUO with comparable diag-
08:00 - 09:30 as complementary diagnostic tool to improve the nostic accuracy as for WBC.
diagnostic accuracy of radiologic imaging. Func- A negative WBC scintigraphy virtually excludes an
tional imaging, as labelled leukocytes (WBC) scintig- infection as the cause of the fever.
raphy, with corrected acquisition and interpretation Although WBC imaging accurately localizes infec-
of images (according to EANM guidelines) can local- tion, in all the cases of patients with FUO with low
ize infection focus and provide information about the probability of infection (low erithrosedimentation
extension and activity of the disease, moreover WBC rate and C Reactive Protein, normal white blood cells
scintigraphy, with total-body imaging acquisition, count) and suspected neoplastic or miscellaneous
can also evaluate the presence of septic embolism. origin, this test is not helpful in identifying the source
The sensitivity and specificity values of WBC scin- of the fever and other radiopharmaceuticals, as 67Gal-
tigraphy for the diagnosis of infection in patients with lium citrate or [18F]FDG are suggested.
References:
1. Mulders-Manders C et al Fever of unknown origin. Clinical Medicine 2015;15:280-4
2. A. Signore, F. Jamar, O. Israel, J. Buscombe, J. Martin-Comin, E. Lazzeri Clinical indications, image acquisition and data interpretation for white
blood cells and anti-granulocyte monoclonal antibody scintigraphy Eur J Nucl Med and Mol Imaging 2018;in press
3. Bleeker-Rovers CP, Vos FJ, de Kleinjn EM et al A prospective multi-center study on Fever of unknown origin: the yeld of a structured diagnostic
protocol. Medicine (Baltimore) 2007;86:26-38
4. Kjaer A and Lebech AM Diagnostic value of 111In granulocyte scintigraphy in patients with fever of unknown origin. J Nucl Med 2002;43:140-44
5. Xavier Hanin F, Jamar F. Nuclear medicine imaging of fever of unknown origin. In: Diagnostic imaging of infections and inflammatory diseases: a
multi-disciplinary approach. A. Signore and AM. Quintero Eds. John Wiley & Sons Inc Pbl, New York, 2013; pp 273-290.
6. Seshadri N, SolankiCK, Balan K. Utility of 111In-labeelled leukocyte scintigraphy in patients with fever of unknown origin in an era of changing
disease spectrum and investigational techniques. Nucl Med Commun. 2008; 29:277-82.
10 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N YEANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
Role of Nuclear Medicine in FUO Diagnosis:
When and How to Use FDG-PET
L.F. de Geus-Oei, I.J.E. Kouijzer, W.J.G. Oyen, C.P. Bleeker-Rovers;
(Leiden and Nijmegen, Netherlands)
Fever of unknown origin (FUO) is a challenging evaluation of FUO, by depicting anatomical localiza-
CME Session
1
problem in clinical medicine. FUO is defined as fever tion of focally increased FDG uptake and guiding fur-
higher than 38.3°C on several occasions during at ther diagnostic tests to achieve a final diagnosis. FDG-
least 3 weeks with uncertain diagnosis after a num- PET/CT should become a routine procedure in the
ber of obligatory investigations. The differential diag- work-up of FUO when diagnostic clues are absent.
nosis of FUO can be subdivided in four categories: FDG-PET/CT appears to be a cost-effective routine
infections, malignancies, non-infectious inflamma- imaging technique in FUO by avoiding unnecessary
October 14, tory diseases (NIID), and miscellaneous causes. In investigations and reducing the duration of hospital-
08:00 - 09:30 most cases of FUO, there is an uncommon presenta- ization.
tion of a common disease. Important for diagnosing This lecture will provide an overview of the value of
FUO is a search for potentially diagnostic clues (PDCs) FDG-PET/CT in FUO including the most relevant liter-
in a complete and repeated history-taking, physical ature of FUO and provide recommendations on the
examination, and the essential investigations. FDG- usage of FDG-PET/CT in patients with FUO.
PET/CT is a valuable diagnostic technique for the
References:
1. Kouijzer IJE, Mulders-Manders CM, Bleeker-Rovers CP, Oyen WJG. Fever of unknown origin: the value of FDG-PET/CT. Semin Nucl Med
2018;48:100-107
2. Bleeker-Rovers CP, Vos FJ, de Kleijn EM, et al. A prospective multicenter study on fever of unknown origin: the yield of a structured diagnostic
protocol. Medicine 2007; 86(1): 26-38.
3. Balink H, Veeger NJ, Bennink RJ, et al. The predictive value of C-reactive protein and erythrocyte sedimentation rate for 18F-FDG PET/CT out-
come in patients with fever and inflammation of unknown origin. Nucl Med Comm 2015; 36(6): 604-9.
4. Nakayo EMB, Vicente AMG, Castrejon AMS, et al. Analysis of cost-effectiveness in the diagnosis of fever of unknown origin and the role of F-18-
FDG PET-CT: a proposal of diagnostic algorithm. Rev Esp Med Nucl Ima 2012; 31(4): 178-86.
5. Balink H, Tan SS, Veeger NJ, et al. (1)(8)F-FDG PET/CT in inflammation of unknown origin: a cost-effectiveness pilot-study. Eur J Nucl Med Mol
Imaging 2015; 42(9): 1408-13.
11 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N YEANM’18
WORLD LEADING MEETING EANM’18
CME EXTENDED ABSTRACT BOOK
2 CME EXTENDED ABSTRACT BOOK
WORLD LEADING MEETING
CME SESSION 2
Oc tober 14, 2018 | 11:30 – 13:00
New Guidelines on
Nuclear Thyroidology
O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N Y 12EANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
EANM-SNMMI Joined Guidelines
on Thyroid Molecular Imaging
Luca Giovanella (Bellinzona, Switzerland)
Nuclear medicine techniques were first employed inconclusive thyroid nodules. There are currently no
CME Session
2
in clinical practice for the diagnosis and therapy of practice EANM guidelines on thyroid imaging while
thyroid diseases in the 1950s and are still an integral SNMMI guidelines exclusively focused on conven-
part of thyroid nodules work-up. Thyroid imaging with tional thyroid scintigraphy and radioiodine uptake
iodine or iodine-analogue isotopes is the only exam- test. The EANM Thyroid Committee and SNMMI
ination able to prove the presence of autonomously decided, with the involvement of external experts, to
functioning thyroid tissue, which excludes malig- develop evidence-based recommendations to assist
October 14, nancy in thyroid nodules with a very high probability. imaging specialists and clinicians in recommending,
11:30 - 13:00 In addition, thyroid scan with Technetium-99m-me- performing and interpreting thyroid molecular imag-
thoxyisobutylisonitrile scan and 18F-FDG can avoid ing with different radiopharmaceuticals.
unnecessary surgical procedures for cytologically
References:
1. ACR–SNM–SPR Practice guidelines for the performance of thyroid scintigraphy and uptake measurements (revised version 2009) http://interac-
tive.snm.org/docs/Thyroid_Scintigraphy.pdf.
2. Treglia G, Trimboli P, Verburg FA, Luster M, Giovanella L. Prevalence of normal TSH value among patients with autonomously functioning thyroid
nodule. Eur J Clin Invest. 2015;45(7):739-44
3. Campennì A, Siracusa M, Ruggeri RM, Laudicella R, Pignata SA, Baldari S, Giovanella L. Differentiating malignant from benign thyroid nodules
with indeterminate cytology by 99mTc-MIBI scan: a new quantitative method for improving diagnostic accuracy. Sci Rep. 2017 Jul 21;7(1):6147.
doi: 10.1038/s41598-017-06603-3.
4. Giovanella L, Campenni A, Treglia G, Verburg FA, Trimboli P, Ceriani L, Bongiovanni M. Molecular imaging with (99m)Tc-MIBI and molecular
testing for mutations in differentiating benign from malignant follicular neoplasm: a prospective comparison. Eur J Nucl Med Mol Imaging. 2016
Jun;43(6):1018-26
5. Piccardo A, Puntoni M, Treglia G, Foppiani L, Bertagna F, Paparo F, Massollo M, Dib B, Paone G, Arlandini A, Catrambone U, Casazza S, Pastorino A,
Cabria M, Giovanella L. Thyroid nodules with indeterminate cytology: prospective comparison between 18F-FDG-PET/CT, multiparametric neck
ultrasonography, 99mTc-MIBI scintigraphy and histology. Eur J Endocrinol. 2016 May;174(5):693-703
13 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N YEANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
EANM Guidelines on
Medullary Thyroid Carcinoma
Giorgio Treglia (Bellinzona, Switzerland), Luca Giovanella (Bellinzona, Switzerland)
Medullary thyroid carcinoma (MTC) is a frequently rodeoxyglucose (18F-FDG), Fluorine-18 dihydroxyphe-
CME Session
2
aggressive neuroendocrine tumour originating from nylalanine (18F-FDOPA) and somatostatin analogues
the parafollicular C cells of the thyroid gland, occur- labelled with Gallium-68[1-9].
ring either sporadically or in a hereditary form. Differ- There are currently no practice guidelines focused
ent morphological and functional imaging methods on the use of PET/CT with different radiopharma-
may be used to address therapy in patients with MTC ceuticals in MTC. The EANM Thyroid Committee with
both in the preoperative staging and in detecting involvement of external experts will develop evi-
October 14, persistent/recurrent disease. dence-based recommendations to assist imaging
11:30 - 13:00 In particular, several positron emission tomogra- specialists and clinicians in recommending, perform-
phy (PET) radiopharmaceuticals, evaluating different ing and interpreting the results of PET/CT with differ-
metabolic pathways or receptor status, can be used ent radiopharmaceuticals in patients with MTC.
in detecting MTC lesions, including Fluorine-18 fluo-
References:
1. Slavikova K, Montravers F, Treglia G, et al. What is currently the best radiopharmaceutical for the hybrid PET/CT detection of recurrent medullary
thyroid carcinoma? Curr Radiopharm. 2013;6:96-105.
2. Treglia G, Castaldi P, Villani MF, et al. Comparison of different positron emission tomography tracers in patients with recurrent medullary thyroid
carcinoma: our experience and a review of the literature. Recent Results Cancer Res. 2013;194:385-93.
3. Treglia G, Rufini V, Salvatori M, et al. PET Imaging in Recurrent Medullary Thyroid Carcinoma. Int J Mol Imaging. 2012;2012:324686.
4. Treglia G, Villani MF, Giordano A, et al. Detection rate of recurrent medullary thyroid carcinoma using fluorine-18 fluorodeoxyglucose positron
emission tomography: a meta-analysis. Endocrine. 2012;42:535-45.
5. Treglia G, Castaldi P, Villani MF, et al. Comparison of 18F-DOPA, 18F-FDG and 68Ga-somatostatin analogue PET/CT in patients with recurrent
medullary thyroid carcinoma. Eur J Nucl Med Mol Imaging. 2012;39(4):569-80.
6. Treglia G, Cocciolillo F, Di Nardo F, et al. Detection rate of recurrent medullary thyroid carcinoma using fluorine-18 dihydroxyphenylalanine
positron emission tomography: a meta-analysis. Acad Radiol. 2012;19(10):1290-9.
7. Treglia G, Tamburello A, Giovanella L. Detection rate of somatostatin receptor PET in patients with recurrent medullary thyroid carcinoma: a
systematic review and a meta-analysis. Hormones. 2017;16(4):262-72.
8. Wong KK, Laird AM, Moubayed A, et al. How has the management of medullary thyroid carcinoma changed with the advent of 18F-FDG and
non-18F-FDG PET radiopharmaceuticals. Nucl Med Commun. 2012 ;33:679-88.
9. Treglia G, Aktolun C, Chiti A, et al.; EANM and the EANM Thyroid Committee. The 2015 Revised American Thyroid Association guidelines for the
management of medullary thyroid carcinoma: the "evidence-based" refusal to endorse them by EANM due to the "not evidence-based" mar-
ginalization of the role of Nuclear Medicine. Eur J Nucl Med Mol Imaging. 2016;43(8):1486-90.
14 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N YEANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
EANM Guidelines on Radioiodine
Therapy of Benign Thyroid Diseases:
Recent Novel Aspects
Frederik A. Verburg (Marburg, Germany)
The 2010 EANM guidelines provided a solid, state- in some respects. Most noteworthy of these are the
CME Session
2
of-the-art overview of the indications and proce- newer insights pertaining to the need for glucocor-
dures for radioiodine therapy of benign thyroid dis- ticoid therapy during radioiodine therapy of Graves‘
ease. However, this document was written by EANM disease. Here, the indication for prophylactic glu-
members for EANM members. Recently, representa- cocorticoid steroid therapy is much more narrow,
tives of the EANM met with representatives of the restricted to patients with active Graves‘ eye disease
Society of Nuclear Medicine and Molecular Imaging, and smokers.
October 14, the European Thyroid Association and the American Furthermore, some new insights surrounding
11:30 - 13:00 Thyroid Association. While this meeting was primar- dosimetric aspects in radioiodine therapy of benign
ily geared towards thyroid cancer, it was also agreed thyroid disease have arisen. Whereas it was already
that benign thyroid disease should also be dealt with shown in multiple studies that the total delivered
in joint efforts. Therefore, the next iteration of the dose is not an independent determinant of therapy
guideline on radioiodine therapy of benign thyroid success, dosimetric parameters predicting this out-
disease will be a joint effort between the aforemen- come remained elusive for a long time. Currently,
tioned societies. some novel indicators such as the maximum dose
In the years that have passed since the publi- rate look like promising alternatives as explanatory
cation of the EANM guideline, insights pertaining variable.
some aspects of radioiodine therapy have changed
15 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N YLevel
European School of Multimodality Imaging and Therapy
1
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WORLD LEADING MEETING EANM’18
CME EXTENDED ABSTRACT BOOK
3 CME EXTENDED ABSTRACT BOOK
WORLD LEADING MEETING
CME SESSION 3
Oc tober 14, 2018 | 14:30 – 16:00
SPECT or PET?
O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N Y 17EANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
Detection of CAD
Abtract Title: SPECT or PET? Coronary Artery Disease
Frank Bengel (Hannover, Germany)
During the past ten years, cardiac imaging has ben- ologic complexity, and high costs, it has long been
CME Session
3
efited from important technological developments seen as a research tool and as a reference method for
in gamma cameras and positron emission tomogra- validation of other diagnostic approaches. This per-
phy (PET) imaging systems. Cardiac-centred gamma ception, fortunately, has changed significantly within
cameras have dramatically increased the sensitivity recent years thanks to a continuous growth of the
of single-photon emission computed tomography number of installed PET systems stimulated by their
(SPECT)[1] translating into high image quality and success in oncology. Methodologic advances as well
October 14, allowing for a significant decrease in the activity of as improved radiotracer availability have further con-
14:30 - 16:00 radionuclide injected to patients in comparison to tributed to more widespread use of PET for cardiac
conventional Na/I-based cameras[2]. SPECT myocar- imaging[4,5]. In addition, PET technology allows for
dial perfusion scintigraphy (MPS) offers the advan- accurate attenuation correction[6] and the possibility
tage of combined evaluation of patient’s symptoms of absolute quantification of radiotracer concentra-
during exercise and the extent of myocardial isch- tion and myocardial blood flow using appropriate
emia in patient with coronary artery disease (CAD) compartmental models[7]. Despite higher costs of a
at relatively low costs in comparison to PET. Never- single study, some studies suggest overall cost-effec-
theless, increasing diversity of diagnostic options tiveness of the technique because unnecessary fol-
for patients with CAD, has resulted in a clinical need low-up procedures can be avoided.
for more accurate and specific diagnostic tech- This lecture will review and compare the advan-
niques than SPECT[3]. PET is a powerful, quantitative tages and current limitations of myocardial perfusion
imaging modality that has been used for decades imaging with SPECT and PET for the detection of
to noninvasively investigate cardiovascular biology CAD.
and physiology. Due to limited availability, method-
References:
1. Imbert L, Poussier S, Franken PR, et al. Compared performance of high-sensitivity cameras dedicated to myocardial perfusion SPECT:
a comprehensive analysis of phantom and human images. J Nucl Med. Dec 2012;53(12):1897-1903.
2. Agostini D, Marie PY, Ben-Haim S, et al. Performance of cardiac cadmium-zinc-telluride gamma camera imaging in coronary artery disease:
a review from the cardiovascular committee of the European Association of Nuclear Medicine (EANM). Eur J Nucl Med Mol Imaging. Dec
2016;43(13):2423-2432.
3. Bengel FM, Higuchi T, Javadi MS, Lautamaki R. Cardiac positron emission tomography. J Am Coll Cardiol. Jun 30 2009;54(1):1-15.
4. Schepis T, Gaemperli O, Treyer V, et al. Absolute quantification of myocardial blood flow with 13N-ammonia and 3-dimensional PET. J Nucl Med.
Nov 2007;48(11):1783-1789.
5. Knesaurek K, Machac J, Krynyckyi BR, Almeida OD. Comparison of 2-dimensional and 3-dimensional 82Rb myocardial perfusion PET imaging.
J Nucl Med. Aug 2003;44(8):1350-1356.
6. Le Guludec D, Lautamaki R, Knuuti J, Bax JJ, Bengel FM, European Council of Nuclear C. Present and future of clinical cardiovascular PET imaging
in Europe--a position statement by the European Council of Nuclear Cardiology (ECNC). Eur J Nucl Med Mol Imaging. Sep 2008;35(9):1709-1724.
7. Sciagra R, Passeri A, Bucerius J, et al. Clinical use of quantitative cardiac perfusion PET: rationale, modalities and possible indications. Posi-
tion paper of the Cardiovascular Committee of the European Association of Nuclear Medicine (EANM). Eur J Nucl Med Mol Imaging. Jul
2016;43(8):1530-1545.
18 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N YEANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
Myocardial Blood Flow Quantification
Alain Manrique (Caen, France)
Myocardial perfusion imaging with PET provides radiotracer kinetics and quantification of myocar-
CME Session
3
superior diagnostic accuracy and lower radiation dial flow and MFR. Preliminary data demonstrated
exposure of patients than with SPECT thanks to that dynamic CZT estimate of MFR in patients with
high myocardial extraction of perfusion PET tracers, multi-vessel CAD correlated well with angiographic
increased spatial resolution, coincidence detection findings[3]. In the recently published WATERDAY study,
and attenuation correction[1]. In addition, myocardial dynamic 99mTc-sestamibi CZT-SPECT provided simi-
blood flow (MBF) and myocardial flow reserve (MFR) lar MFR values compared to the ones obtained from
October 14, can be approached based on dynamic PET acqui- 15O–water PET as well as high diagnostic value for
14:30 - 16:00 sitions and modeling of the myocardial extraction detecting impaired MFR and abnormal fractional
of radiotracers. Non-invasive quantification of MBF flow reserve (FFR) in patients with stable coronary
provides incremental diagnostic and prognostic artery disease[4]. However, these promising and excit-
information in patients with known or suspected ing results are the first step of a long road to full clin-
coronary artery disease. For example, patients with ical acceptance. The roadmap of clinical research in
high-grade luminal stenosis and low MFR benefit the field will include the assessment of attenuation
the most from coronary revascularization[2]. Unfor- correction, test-retest repeatability, post-processing,
tunately, the access to PET perfusion radiopharma- endothelial function and finally the assessment of the
ceuticals is limited in Europe to only a few number incremental diagnostic and prognostic value before
of research centers. The use of SPECT to quantify dynamic CZT measurement of MFR become a routine
myocardial blood flow based represents therefore alternative to PET imaging.
an attractive option to increase the availability of This lecture will present the advantages and draw-
MBF parameters to a larger number of centers. Car- backs of SPECT and PET imaging approaches to quan-
diac-centered CZT-SPECT cameras provide a dra- tify myocardial blood flow and discuss the potential
matic increase in the detection of myocardial counts role of flow quantification in the detection and strati-
allowing for the acquisition of dynamic tomographic fication of patients with coronary artery disease.
images of the heart suitable for in vivo modeling of
References:
1. Chow BJW, Dorbala S, Di Carli MF, Merhige ME, Williams BA, Veledar E, et al. Prognostic value of PET myocardial perfusion imaging in obese
patients. JACC Cardiovasc Imaging. 2014;7(3):278‑87
2. Taqueti VR, Hachamovitch R, Murthy VL, Naya M, Foster CR, Hainer J, et al. Global coronary flow reserve is associated with adverse cardiovascular
events independently of luminal angiographic severity and modifies the effect of early revascularization. Circulation. 2015;131(1):19‑27.
3. Ben Bouallègue F, Roubille F, Lattuca B, Cung TT, Macia J-C, Gervasoni R, et al. SPECT Myocardial Perfusion Reserve in Patients with Multivessel
Coronary Disease: Correlation with Angiographic Findings and Invasive Fractional Flow Reserve Measurements. J Nucl Med. 2015;56(11):1712‑7.
4. Agostini D, Roule V, Nganoa C, Roth N, Baavour R, Parienti J-J, et al. First validation of myocardial flow reserve assessed by dynamic 99mTc-sesta-
mibi CZT-SPECT camera: head to head comparison with 15O-water PET and fractional flow reserve in patients with suspected coronary artery
disease. The WATERDAY study. Eur J Nucl Med Mol Imaging. 2018;45(7):1079‑90
19 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N YEANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
SPECT or PET?
Infection
Fabien Hyafil (Paris, France)
The diagnosis of infective endocarditis is often chal- techniques using 18F-fluorodeoxyglucose positron
CME Session
3
lenging and based on careful integration of clinical, emission tomography (FDG-PET) or white blood
microbiological and imaging findings. The classical cell single photon emission computed tomography
diagnostic scores (e.g. Duke criteria) have drawbacks (WBC SPECT) are very sensitive to pick-up inflamma-
as they leave clinicians with a considerable number tory cells. They have shown incremental diagnostic
of uncertain cases, in which further management is value for detecting PVE[3-5] and CIED infection[6]. Cur-
unclear and important therapeutic actions possibly rent European Society of Cardiology guidelines[7] rec-
October 14, delayed. Transesophageal echocardiography is the ommend the use of FDG PET/CT or WBC SPECT/CT in
14:30 - 16:00 preferred imaging technique for the diagnosis of IE as the case of uncertain PVE.
it can visualize valvular vegetations and paravalvular This lecture will compare the diagnostic perfor-
complications with high accuracy. However, transe- mance, the advantages and pitfalls of FDG PET/CT
sophageal echocardiography has limitations in the and WBC SPECT/CT for the detection of valvular[8] or
case of device-associated endocarditis (i.e. prosthetic device infection and discuss their respective role in
valve (PVE) or cardiovascular implantable electronic the evaluation of patients with a suspicion of infec-
device (CIED) infection[1,2]. Radionuclide imaging tive endocarditis[9].
References:
1. Sarrazin JF, Philippon F, Tessier M, et al. Usefulness of fluorine-18 positron emission tomography/computed tomography for identification of
cardiovascular implantable electronic device infections. J Am Coll Cardiol. May 1 2012;59(18):1616-1625.
2. Erba PA, Sollini M, Conti U, et al. Radiolabeled WBC scintigraphy in the diagnostic workup of patients with suspected device-related infections.
JACC Cardiovasc Imaging. Oct 2013;6(10):1075-1086.
3. Hyafil F, Rouzet F, Lepage L, et al. Role of radiolabelled leucocyte scintigraphy in patients with a suspicion of prosthetic valve endocarditis and
inconclusive echocardiography. Eur Heart J Cardiovasc Imaging. Jun 2013;14(6):586-594.
4. Erba PA, Conti U, Lazzeri E, et al. Added value of 99mTc-HMPAO-labeled leukocyte SPECT/CT in the characterization and management of
patients with infectious endocarditis. J Nucl Med. Aug 2012;53(8):1235-1243.
5. Saby L, Laas O, Habib G, et al. Positron emission tomography/computed tomography for diagnosis of prosthetic valve endocarditis: increased
valvular 18F-fluorodeoxyglucose uptake as a novel major criterion. J Am Coll Cardiol. Jun 11 2013;61(23):2374-2382.
6. Ahmed FZ, James J, Cunnington C, et al. Early diagnosis of cardiac implantable electronic device generator pocket infection using (1)(8)F-FDG-
PET/CT. Eur Heart J Cardiovasc Imaging. May 2015;16(5):521-530.
7. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management
of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS),
the European Association of Nuclear Medicine (EANM). Eur Heart J. Nov 21 2015;36(44):3075-3128.
8. Rouzet F, Chequer R, Benali K, et al. Respective performance of 18F-FDG PET and radiolabeled leukocyte scintigraphy for the diagnosis of pros-
thetic valve endocarditis. J Nucl Med. Dec 2014;55(12):1980-1985.
9. Hyafil F, Rouzet F, Le Guludec D. Nuclear imaging for patients with a suspicion of infective endocarditis: Be part of the team! J Nucl Cardiol. Feb
2017;24(1):207-211.
20 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N YEANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
SPECT or PET:
Innervation
Hein J. Verberne (Amsterdam, Netherlands)
The cardiac sympathetic system is one of the neu- Fortunately, cardiac sympathetic activity can be
CME Session
3
ro-hormonal compensation mechanisms that plays non-invasively visualised by nuclear techniques. To
an important role in the pathogenesis of chronic date, most commonly used tracers are norepineph-
heart failure (CHF) with impaired left ventricular ejec- rine analogues (123I-mIBG) for single photon emission
tion fraction (LVEF). Patients with CHF have increased tomography (SPECT) and 11C-hydroxyephedrine for
cardiac sympathetic activity with increased exocyto- positron emission tomography (PET). Both radio-
sis of norepinephrine from the presynaptic vesicles. In tracers are resistant to metabolic enzymes and show
October 14, addition, the norepinephrine re-uptake via uptake-1 high affinity for presynaptic norepinephrine uptake-1
14:30 - 16:00 in the sympathetic terminal nerve axons is decreased (NET) allowing the visualisation of presynaptic sym-
resulting in elevated synaptic levels of norepineph- pathetic nerve function. Other presynaptic PET trac-
rine. Eventually this results in increased plasma and ers include 11C-epinephrine, 11C-phenylephrine, and
urinary levels of norepinephrine concomitant with 18
F-LMI1195. 11C-CGP12177 is the most commonly
the severity of left ventricular dysfunction[1-3]. Initially, used tracer for postsynaptic β-ARs[6-8].
β-AR stimulation by increased norepinephrine levels However, unlike 123I-mIBG, which can be cen-
helps to compensate for impaired myocardial func- trally manufactured and then distributed, most PET
tion, but long-term norepinephrine excess has det- agents are labelled with short half-life isotopes and
rimental effects on myocardial structure and gives are therefore only available in institutions with an
rise to a downregulation and decrease in the sensi- on-site cyclotron. Although the development of an
tivity of post-synaptic β-AR [4,5]. This downregulation 18
F-labelled compound for sympathetic PET imaging
leads to left ventricular remodelling and is associated is continuing[9], for the foreseeable future 123I-mIBG
with increased mortality and morbidity. Increased scintigraphy will remain the only widely available
norepinephrine plasma levels are associated with nuclear imaging method for assessing global and
poor prognosis in CHF[2]. Though, these levels do not regional myocardial sympathetic innervation. In addi-
specifically reflect the sympathetic activity at a car- tion, myocardial 123I-mIBG scintigraphy is easily imple-
diac level. In addition, these measurements are time mented in any department of nuclear medicine and
consuming and there is a high variability in measure- thereby readily available for CHF patients[10].
ments.
References:
1. Hasking et al. Norepinephrine spillover to plasma in patients with congestive heart failure: evidence of increased overall and cardiorenal sympa-
thetic nervous activity. Circulation. 1986;73(4):615-21.
2. Cohn et al. Plasma Norepinephrine as a Guide to Prognosis in Patients with Chronic Congestive Heart Failure. N Engl J Med. 1984;311(13):819-23.
3. Rundqvist et al. Increased cardiac adrenergic drive precedes generalized sympathetic activation in human heart failure. Circulation.
1997;95(1):169-75.
4. Merlet et al. Positron emission tomography with 11C CGP-12177 to assess beta-adrenergic receptor concentration in idiopathic dilated cardio-
myopathy. Circulation. 1993;87(4):1169-78.
5. Bristow et al. Decreased Catecholamine Sensitivity and β-Adrenergic-Receptor Density in Failing Human Hearts. N Engl J Med. 1982;307(4):205-
11.
6. Werner et al. Retention Kinetics of the 18F-Labeled Sympathetic Nerve PET Tracer LMI1195: Comparison with 11C-Hydroxyephedrine and
123I-MIBG. J Nucl Med. 2015;56(9):1429-33.
7. Thackeray et al. Assessment of cardiac autonomic neuronal function using PET imaging. J Nucl Cardiol. 2013;20(1):150-65.
8. Travin. Cardiac autonomic imaging with SPECT tracers. J Nucl Cardiol. 2013;20(1):128-43.
9. Sinusas et al. Biodistribution and radiation dosimetry of LMI1195: first-in-human study of a novel 18F-labeled tracer for imaging myocardial
innervation. J Nucl Med. 2014;55(9):1445-51.
10. Flotats et al. Proposal for standardization of 123I-metaiodobenzylguanidine (MIBG) cardiac sympathetic imaging by the EANM Cardiovascular
Committee and the European Council of Nuclear Cardiology. Eur J Nucl Med and Mol Imaging. 2010;37(9):1802-12.
21 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N YEANM’18
WORLD LEADING MEETING EANM’18
CME EXTENDED ABSTRACT BOOK
4 CME EXTENDED ABSTRACT BOOK
WORLD LEADING MEETING
CME SESSION 4
Oc tober 14, 2018 | 16:30 – 18:00
PET/MRI in Paediatrics –
Sharing Experiences
O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N Y 22EANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
PET/MRI in Paediatrics:
Brain Tumours
Lise Borgwardt (Copenhagen, Denmark)
PET and MRI are the methods of choice for the imag- Especially for the analysis of brain function, com-
CME Session
4
ing of neurologic neoplastic diseases. Both modalities bined PET/MR—with the possibility of simultaneous
provide complementary information about the func- data acquisition—allows an improved in vivo assess-
tion, metabolism, and anatomy of the brain. The out- ment of processes and a more precise description of
standing role of PET imaging in detecting biochemical functional, molecular, and morphologic interactive
and molecular changes much earlier, before struc- pathways. Combined PET/MR is expected to improve
tural changes or clinical symptoms appear, has been diagnostic accuracy and to help guide biopsy, sur-
October 14, described in numerous studies fMR with DWI and MR gery, or radiation therapy planning through the pre-
16:30 - 18:00 spectroscopy has become an important noninvasive cise localization of hypermetabolic, vital tumor tissue
and nonradioactive tool for measuring brain activity and the accurate definition of the target volume. Fur-
by detecting, for instance, hemodynamic changes thermore, the simultaneous acquisition of PET and
(in blood oxygenation and flow) induced by regional MR data provides precise information about tumor
changes in neuronal activity. Numerous PET tracers, biology and the tumor response after antitumoral
mostly 18F- or 11C-labeled radiopharmaceuticals, are therapy. For brain tumors, radiolabeled amino acids
available to assess different aspects of brain function. such as O-(2-18F-fluoroethyl)-L-tyrosine, 18F-DOPA,
For instance, for brain tumors, an 18F-labeled amino and 11C-methionine or the tumor proliferation marker
acid such as O-(2-18F-fluoroethyl)-L-tyrosine (FET) or 3´-deoxy-3-18F-fluorothymidine or even FDG have
11
C-methionine (MET) has been well described or in been described as sensitive and specific indicators
guiding biopsies in patients with brain masses that of improved delineation of brain tumors for therapy
are undefined on MR scans. planning and biopsy guidance, information on grad-
Until the advent of combined PET/MR, PET and MR ing and prognosis, differentiation of recurrent tumor
were performed in separate examinations, mostly from unspecific post therapeutic changes and ther-
with secondary coregistration of MR and PET data. apy monitoring.
References:
1. FDG PET of the brain in pediatric patients: imaging spectrum with MR imaging correlation. Stanescu L, Ishak GE, Khanna PC, Biyyam DR, Shaw
DW, Parisi MT. Radiographics. 2013 Sep-Oct;33(5):1279-303.
2. PET/MRI in cancer patients: first experiences and vision from Copenhagen. Kjær A, Loft A, Law I, Berthelsen AK, Borgwardt L, Löfgren J, Johnbeck
CB, Hansen AE, Keller S, Holm S, Højgaard L. MAGMA. 2013 Feb;26(1):37-47.
3. Increased fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG) uptake in childhood CNS tumors is correlated with malignancy grade: a study with
FDG positron emission tomography/magnetic resonance imaging coregistration and image fusion. Borgwardt L, Højgaard L, Carstensen H,
Laursen H, Nowak M, Thomsen C, Schmiegelow K. J Clin Oncol. 2005 May 1;23(13):3030-7.
4. Nuclear medicine in pediatric neurology and neurosurgery: epilepsy and brain tumors. Patil S, Biassoni L, Borgwardt L. Semin Nucl Med. 2007
Sep;37(5):357-81. Review.
23 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N YEANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
PET/MR in Paediatrics -
Extra-Cranic Solid Tumours
Abtract Title: PET/MR in paediatrics: extra-cranic tumors
Regine Kluge (Leipzig, Germany)
Hybrid PET/MR imaging systems have recently aspect of the presentation will be the optimization
CME Session
4
become available for clinical practice. This method of the scan procedures. Currently, a wide variety of
simultaneously combines two outstanding imaging T1- and T2-weighted pulse sequences have been
methods: PET enables a sensitive functional imaging proposed for anatomical co-registration of FDG-PET
with a very low detection limit in the range of 10-12 in children[3]. The balance between an acceptable
mol/l, the MRI contributes high-definition anatom- acquisition time and delivery of the full required diag-
ical imaging with excellent soft-tissue contrast and nostic accuracy of the MRI is challenging. Another
October 14, may add complementary functional information. The critical point is the diagnostic accuracy of the method
16:30 - 18:00 combination of both modalities is clinically prom- to detect pulmonary nodules. To date MRI scans do
ising since MRI plays a crucial role especially for the not reach the sensitivity of CT scans in detection of
preoperative evaluation of many primary tumours small lung metastases but this information is clinically
and PET(/CT) is widely used for whole-body staging crucial for correct staging and treatment stratifica-
of lymph node or distant metastases. PET/MR offers tion. Improvements can be achieved with appropri-
reduction of imaging procedures, radiation exposure, ate respiratory gating procedures. Special aspects of
time and anaesthesia. The presentation will focus on potential additional gains from the combined PET/
the main clinical indications soft tissue and bone sar- MR in the future like improved delineation of tumour
coma and lymphoma with a perspective on incipient borders and tissue infiltration or improved accuracy
use in neuroblastoma and Wilms tumour. One key of treatment response assessment will be discussed.
References:
1. Purz S, Sabri O, Viehweger A, Barthel H, Kluge R, Sorge I, Hirsch FW. Potential Pediatric Applications of PET/MR. J Nucl Med.;55(Supplement
2):32S-39S.
2. Hirsch FW, Sattler B, Sorge I, Kurch L, Viehweger A, Ritter L, Werner P, Jochimsen T, Barthel H, Bierbach U, Till H, Sabri O, Kluge R. PET/MR in chil-
dren. Initial clinical experience in paediatric oncology using an integrated PET/MR scanner. Pediatr Radiol. 2013;43:860-75.
3. Daldrup-Link H. How PET/MR Can Add Value For Children With Cancer. Curr Radiol Rep. 2017 Mar;5(3). pii: 15. doi: 10.1007/s40134-017-0207-y.
4. Burris NS, Johnson KM, Larson PE, Hope MD, Nagle SK, Behr SC, Hope TA. Detection of Small Pulmonary Nodules with Ultrashort Echo Time
Sequences in Oncology Patients by Using a PET/MR System. Radiology. 2016;278:239-46.
5. Kirchner J, Deuschl C, Schweiger B, Herrmann K, Forsting M, Buchbender C, Antoch G, Umutlu L. Imaging children suffering from lymphoma: an
evaluation of different 18F-FDG PET/MRI protocols compared to whole-body DW-MRI. Eur J Nucl Med Mol Imaging. 2017;44:1742-1750.
6. Schäfer, J. F.; Gatidis, S.; la Fougère, C.; Claussen, C. D.; Tsiflikas, I.: Principles of MR-Imaging Including Whole-Body MRI in Pediatric Oncology.
Nuklearmediziner2014;37:109-18.
7. Kurch, L.; Sabri, O.; Christiansen, H.; Bühligen, U.; Preuss, M.; Werner, P.; Barthel, H.; Kluge, R.; Sorge, I.: Use of PET/MRI in Paediatric Oncology.
Nuklearmediziner2014;37:258-63.
24 O C T O B E R 1 3 – 1 7 , 2 0 1 8 | D Ü S S E L D O R F, G E R M A N YEANM’18 WORLD LEADING MEETING
CME EXTENDED ABSTRACT BOOK
PET/MR in Paediatrics -
Non-Oncologic Applications
and Future Developments
Pietro Zucchetta (Padova, Italy)
PET/MR with 18FDG has been proposed mostly Nevertheless, many studies have shown excellent
CME Session
4
for pediatric oncologic patients, where the synergy sensitivity and specificity for FDG imaging; additional
of metabolic imaging and soft-tissue detail is most data on disease activity and extension may help to
evident[1,2]. tailor the treatment and to stratify patients. PET/MR
Nevertheless, the combination of reduced radia- offers the opportunity of a significant reduction in
tion exposure and soft-tissue contrast is promising radiation exposure when compared to PET/CT, due
also for non-oncologic indications, as is the case to the lack of CT-related exposure and the high sen-
October 14, of surveillance for pre-cancerous conditions. For sitivity of PET/MR detectors. Therefore, 18FDG PET/
16:30 - 18:00 instance, neurofibromatosis patients can be mon- MR could be the “one-stop shop” in this group of
itored by PET/MR, taking advantage of multiple patients[4].
parameters (metabolism, DWI, etc.)[3]. Congenital heart disease represents another field
PET/MR with 18FDG has a high sensitivity for infec- where PET/MR has a high potential, whether in case
tion/inflammation foci, combined with total body of suspected infection (implanted devices, valvular
exploration, which is particularly relevant when the prosthesis, etc.) or during the follow-up: the combi-
site of infection is not clinically evident, as frequently nation of molecular and morpho-functional informa-
observed in pediatric oncologic patients. Malignancy tion could lead to better risk stratification and early
per se or anti-neoplastic and/or immunosuppres- detection of myocardial dysfunction.
sive treatment often cause infection in this group of On the technical side, PET/MR sees the develop-
patients and PET/MR can be used not only for identi- ment of many research lines. Solid state detectors are
fication of the site(s) of disease but also for treatment already evolving from APD to SiPM, with better per-
evaluation and follow-up. formances and the possibility of TOF imaging.
The same holds true for fever of unknown origin Attenuation correction models are evolving, with
(FUO), which is particularly challenging to manage in the addition of bone, at least skull, spine, and pelvis,
children, because fever is a common finding and is to the attenuation maps, improving uptake evalua-
related to infection in more than 50% of cases, com- tion in the brain, bone marrow and lesions located in
pared to 35% in adults. In this setting, PET/MR appear immediate proximity of compact bone[5].
as a promising tool for diagnosis, biopsy guidance, Moreover, MR technology is steadily improving,
and treatment response monitoring, particularly for and new sequences will allow not only better bone
mycotic infections. evaluation. Many improvements are foreseen, for
Magnetic resonance enterography is the mainstay instance in the study of lung parenchyma, imaging of
imaging modality for inflammatory bowel disease fibrosis or faster, low-noise imaging, improving scan
(IBD), which has a peak of incidence in adolescents. tolerance.
References:
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dren. Initial clinical experience in paediatric oncology using an integrated PET/MR scanner. Pediatr Radiol. 2013 Jul;43(7):860-75
2. Gatidis S, Bender B, Reimold M, Schäfer JF. PET/MRI in children. Eur J Radiol. 2017 Sep;94:A64-A70
3. Yang M, Zhou Y, Hoxworth JM, Porter AB, Roarke MC. Hybrid whole body (18)F-FDG PET/MR in evaluation of plexiform neurofibromatosis type 1.
Rev Esp Med Nucl Imagen Mol. 2017 Aug 10
4. Signore A, Glaudemans AWJM, Gheysens O, Lauri C, Catalano OA. Nuclear Medicine Imaging in Pediatric Infection or Chronic Inflammatory
Diseases. Semin Nucl Med. 2017 May;47(3):286-303
5. Paulus DH, Quick HH, Geppert C, Fenchel M, Zhan Y, Hermosillo G, Faul D, Boada F, Friedman KP, Koesters T. Whole-Body PET/MR Imaging: Quan-
titative Evaluation of a Novel Model-Based MR Attenuation Correction Method Including Bone. J Nucl Med. 2015 Jul;56(7):1061-6
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