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See detailDobutamine Stress Echocardiography Versus Quantitative Technetium-99m Sestamibi Spect for Detecting Residual Stenosis and Multivessel Disease after Myocardial Infarction
LANCELLOTTI, Patrizio ULg; Benoit, T.; Rigo, Pierre ULg et al

in Heart (2001), 86(5), 510-5

OBJECTIVE: To compare the relative accuracy of dobutamine stress echocardiography (DSE) and quantitative technetium-99m sestamibi single photon emission computed tomography (mibi SPECT) for detecting ... [more ▼]

OBJECTIVE: To compare the relative accuracy of dobutamine stress echocardiography (DSE) and quantitative technetium-99m sestamibi single photon emission computed tomography (mibi SPECT) for detecting infarct related artery stenosis and multivessel disease early after acute myocardial infarction. DESIGN: Prospective study. SETTING: University hospital. METHODS: 75 patients underwent simultaneous DSE and mibi SPECT at (mean (SD)) 5 (2) days after a first acute myocardial infarct. Quantitative coronary angiography was performed in all patients after imaging studies. RESULTS: Significant stenosis (> 50%) of the infarct related artery was detected in 69 patients. Residual ischaemia was identified by DSE in 55 patients and by quantitative mibi SPECT in 49. The sensitivity of DSE and mibi SPECT for detecting significant infarct related artery stenosis was 78% and 70%, respectively, with a specificity of 83% for both tests. The combination of DSE and mibi SPECT did not change the specificity (83%) but increased the sensitivity to 94%. Mibi SPECT was more sensitive than DSE for detecting mild stenosis (73% v 9%; p = 0.008). The sensitivity of DSE for detecting moderate or severe stenosis was greater than mibi SPECT (97% v 74%; p = 0.007). Wall motion abnormalities with DSE and transient perfusion defects with mibi SPECT outside the infarction zone were sensitive (80% v 67%; NS) and highly specific (95% v 93%; NS) for multivessel disease. CONCLUSIONS: DSE and mibi SPECT have equivalent accuracy for detecting residual infarct related artery stenosis of >/= 50% and multivessel disease early after acute myocardial infarction. DSE is more predictive of moderate or severe infarct related artery stenosis. Combined imaging only improves the detection of mild stenosis. [less ▲]

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See detailPositron Emission Tomography (PET) for Staging Low-Grade Non-Hodgkin's Lymphomas (NHL)
Najjar, F.; Hustinx, Roland ULg; Jerusalem, Guy ULg et al

in Cancer Biotherapy & Radiopharmaceuticals (2001), 16(4), 297-304

Although positron emission tomography (PET) imaging is now recognized as a useful tool for staging intermediate and high-grade non-Hodgkin's lymphoma (NHL), few data are available regarding its accuracy ... [more ▼]

Although positron emission tomography (PET) imaging is now recognized as a useful tool for staging intermediate and high-grade non-Hodgkin's lymphoma (NHL), few data are available regarding its accuracy in low grade NHL. We therefore studied 36 patients with histologically proven low-grade NHL. Whole-body 2-(fluorine-18) fluoro-2-deoxy-D-glucose (FDG) PET was performed at the time of initial diagnosis (n = 21) or for disease recurrence (n = 15) prior to any treatment. PET results were compared to those of physical examination and computed tomography (CT). PET studies were read without knowledge of any clinical data. Any focus of increased activity was described and given a probability of malignancy using a 5 point-scale (0: normal to 4: definitively malignant). An individual biopsy was available for a total of 31 lesions. The sensitivity and specificity were 87% and 100% for FDG-PET, 100% and 100% for physical examination and 90% and 100% for CT respectively. In addition, 42 of 97 peripheral lymph node lesions observed by FDG-PET were clinically undetected, whereas the physical examination detected 23 additional nodal lesions. PET and CT both indicated 12 extranodal lymphomatous localizations. FDG-PET showed 7 additional extranodal lesions while 5 additional unconfirmed lesions were observed on CT. Regarding bone marrow infiltration, PET and biopsy were concordant in 24 patients with 11 true positive (TP) and 13 true negative (TN). However PET was FN in 11 patients and no biopsy was performed in one patient. The combination PET/CT/physical examination seems to be more sensitive than the conventional approach for staging low grade NHL. Its sensitivity however is unacceptably low for diagnosing bone marrow infiltration. [less ▲]

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See detailApport de la tomographie par émission de positons pour la détection des tumeurs primitives lors de la découverte de métastases
Albérini, Jean-Louis; Belhocine, Tarik; Daenen, Frédéric ULg et al

in Bulletin du Cancer (2001), 88(5), 518-519

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See detailWhole-body positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures for staging patients with Hodgkin's disease.
Jerusalem, Guy ULg; Beguin, Yves ULg; Fassotte, Marie-France ULg et al

in Haematologica (2001), 86(3), 266-73

BACKGROUND AND OBJECTIVES: Accurate staging is essential in order to determine appropriate treatment in Hodgkin's disease (HD). (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) offers ... [more ▼]

BACKGROUND AND OBJECTIVES: Accurate staging is essential in order to determine appropriate treatment in Hodgkin's disease (HD). (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) offers the advantage of metabolic imaging that is largely independent of morphologic criteria. In the present study we evaluated the role of (18)F-FDG PET compared to routine procedures for the staging of patients with HD. DESIGN AND METHODS: Thirty-three patients with HD underwent standard staging procedures (clinical examination, laboratory screening, chest X-ray, computed tomography (CT) of the chest and abdomen and bilateral bone marrow biopsies) and a whole-body (18)F-FDG PET study. In clinical examination, an isolated lymph node > 1 cm or multiple lymph nodes > or = 1 cm in size were considered abnormal. Positive findings at both clinical examination or CT and (18)F-FDG PET were regarded as actual locations of disease. Negative findings with both methods were regarded as true negative (no involvement by HD). In cases of discrepancy, response to treatment and follow-up data were used to assess the overall accuracy of the patient's original evaluation. RESULTS: Completely concordant results in lymph node staging were observed in 20 patients. The two staging procedures indicated complementary information in 1 patient. Conventional staging indicated more pathologic lymph node areas in 6 patients (at least 1 false positive). (18)F-FDG PET showed more sites in 6 patients. The sensitivity of (18)F-FDG PET in detecting all known pathologic lymph nodes was 83% for peripheral lymph nodes, 91% for thoracic lymph nodes and 75% for abdominal and pelvic lymph nodes. Conventional staging procedures and (18)F-FDG PET indicated the same tumor stage in 26 patients. Based on (18)F-FDG PET, downstaging was suggested in 4 patients, including a biopsy-proven case. However in 1 of these cases this was incorrect. (18)F-FDG PET suggested upstaging in 3 patients. Based on conventional staging or (18)F-FDG PET the same treatment strategy was defined in 32 patients. In one patient (18)F-FDG PET downstaged disease extension (stage IIIA-->IIA) that would have suggested radiotherapy as a possible treatment option. INTERPRETATION AND CONCLUSIONS: (18)F-FDG PET provides an easy and efficient whole-body method for the evaluation of patients with HD. (18)F-FDG PET never missed tumor masses >1 cm. (18)F-FDG PET detected additional sites of disease not seen by conventional procedures and identified absence of disease in some sites suspected to be involved. However, in our patients this did not translate into changes in treatment strategy. [less ▲]

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See detailPositron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) for the staging of low-grade non-Hodgkin's lymphoma (NHL).
Jerusalem, Guy ULg; Beguin, Yves ULg; Najjar, F. et al

in Annals of Oncology (2001), 12(6), 825-30

BACKGROUND: Although PET has been shown to be highly sensitive in the primary staging of lymphoma, previous studies with small numbers of patients indicated that low-grade NHL may not always be adequately ... [more ▼]

BACKGROUND: Although PET has been shown to be highly sensitive in the primary staging of lymphoma, previous studies with small numbers of patients indicated that low-grade NHL may not always be adequately detected by PET. We undertook this study to determine factors influencing the detection of lesions by PET in low-grade NHL and to evaluate the utility of PET in this indication. PATIENTS AND METHODS: Forty-two patients underwent conventional staging procedures (clinical examination, oto-rhino-laryngologic examination, computed tomography of the chest, abdomen and pelvis, gastroscopy and bone marrow biopsy as well as whole-body non-attenuation corrected 18F-FDG-PET RESULTS: PET detected 40% more abnormal lymph node areas than conventional staging in follicular lymphoma but was inappropriate for the staging of small lymphocytic lymphoma where it detected less than 58% of abnormal lymph node areas. PET showed more lesions than conventional staging for peripheral (34% more lymph node areas detected) and thoracic lymph node (39% more) areas but not for abdominal or pelvic lymph nodes (26% fewer areas detected). The sensitivity to detect bone marrow infiltration was unacceptably low for PET. In contrast, PET was as effective as standard procedures for the detection of other extranodal localizations, although a few localizations were detected only by PET and a few others only by conventional procedures. CONCLUSIONS: PET may contribute to the management of patients with low-grade follicular NHL. For the other low-grade lymphoma subtypes, the role of PET is less evident. Further studies using PET to evaluate the results of treatment or to diagnose disease recurrence are warranted in low-grade follicular NHL. [less ▲]

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See detailPlace de la tomographie d'émission de positons dans le suivi thérapeutique du cancer du sein
Jerusalem, Guy ULg; Belhocine, Tarik; Silvestre, Rose-Marie et al

in Médecine Nucléaire : Imagerie Fonctionnelle et Métabolique (2001), 25(6), 341-346

La tomographie à émission de positons (TEP) au 18F-fluorodeoxyglucose (FDG) fait l'objet d'un nombre croissant d'applications cliniques en oncologie surtout dans le bilan d'extension et le bilan de fin de ... [more ▼]

La tomographie à émission de positons (TEP) au 18F-fluorodeoxyglucose (FDG) fait l'objet d'un nombre croissant d'applications cliniques en oncologie surtout dans le bilan d'extension et le bilan de fin de traitement. Un domaine très prometteur mais peu étudié est l'utilisation de la TEP dans l'évaluation thérapeutique précoce. Nous passons en revue les données de la littérature concernant la place de la TEP dans l'évaluation précoce de la réponse thérapeutique chez des patientes atteintes de cancer du sein. La TEP permet d'identifier précocement les patientes qui ont une grande probabilité de présenter une réponse tumorale facorable à une chimiothérapie néoadjuvante (chimiothérapie première). Cependant, non propres travaux chez des patientes atteintes de cancer du sein métastatique sont moins prometteurs. La poursuite des travaux de recherche est indispensable pour mieux connaître le bénéfice réel et les limites d'une évaluation thérapeutique précoce. [less ▲]

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See detailTypical Appearance of Mesothelioma on an F-18 Fdg Positron Emission Tomograph
Belhocine, T. Z.; Daenen, Frédéric ULg; Duysinx, Bernard ULg et al

in Clinical Nuclear Medicine (2000), 25(8), 636

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See detailIntérêt de la tomographie à émission de positons dans la prise en charge du cancer broncho-pulmonaire
Bury, Thierry ULg; Rigo, Pierre ULg

in Revue de Pneumologie Clinique (2000), 56(2), 125-31

18 FDG- PET is an imagining technique based on metabolic criteria rather than morphological criteria. (18) FDG- PET can demonstrate accelerated glycosis in cancer tissue related to increased transporter ... [more ▼]

18 FDG- PET is an imagining technique based on metabolic criteria rather than morphological criteria. (18) FDG- PET can demonstrate accelerated glycosis in cancer tissue related to increased transporter and glycolytic enzyme activity. Whole body PET is currently under validation in a growing number of indications during diagnostic and therapeutic assessment phases of cancer treatment. In the field of pulmonary oncology, (18) FDG- PET has already demonstrated its performance capacity to: 1) discriminate the malignant nature of a solitary pulmonary nodule, 2) improve sensitivity over CT for mediastinal assessment in small-cell lung cancer, 3) acquire whole body imaging to search for distant metastasis in patients with small-cell lung cancer; PET is particularly useful for evaluation of an adrenal mass, 4) complement CT imaging to better dissociate tumor residue or recurrence from post-therapeutic sequelae in small-cell lung cancer. Information provided by (18) FDG- PET is thus clinically relevant as it allows better dissociation of a benign process from a malignant process and better precision of small-cell lung cancer extension without necessitating systematic invasive exploration. [less ▲]

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See detailTomographie a emission de positons au 18FDG et adenocarcinome pancreatique
Daenen, Frédéric ULg; Hustinx, Roland ULg; Belhocine, Tarik et al

in Revue Médicale de Liège (2000), 55(2), 89-94

FDG-PET imaging non invasively studies the glucose metabolism which is usually increased in malignant lesions. We evaluated the clinical performance of PET for detecting pancreatic cancer and its ... [more ▼]

FDG-PET imaging non invasively studies the glucose metabolism which is usually increased in malignant lesions. We evaluated the clinical performance of PET for detecting pancreatic cancer and its recurrence. In our series of 24 studies, PET appears to complement other imaging modalities. As compared to CT, in particular, it demonstrated fewer false positive results in the pancreas and it was also more sensitive. Moreover, whole-body FDG-PET allows for the entire staging of the disease. [less ▲]

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See detailTEP et tumeurs endocrines
Rigo, Pierre ULg; Belhocine, Tarik; Hustinx, Roland ULg et al

in Médecine Nucléaire : Imagerie Fonctionnelle et Métabolique (2000), 24(5), 275-282

Les auteurs passent en revue les indications de la TEP et en particulier du 18FDG dans l'évaluation des diverses tumeurs endocrines de la thyroïde, des parathyroïdes, des surrénales et de l'hyophyse. Les ... [more ▼]

Les auteurs passent en revue les indications de la TEP et en particulier du 18FDG dans l'évaluation des diverses tumeurs endocrines de la thyroïde, des parathyroïdes, des surrénales et de l'hyophyse. Les tumeurs neuroendocrines, gastroentéropancréatiques et carcinoïdes, sont également analysées. Habituellement, les tumeurs différenciées ayant une faible activité métabolique et proliférative, elles ne fixent que peu le FDG. Dans l'évaluation des tumeurs endocrines, la TEP au FDG n'intervient en général pas en première intention mais elle joue un rôle complémentaire d'autres scintigraphies spécifiques. [less ▲]

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See detailComment j'explore ... un cancer broncho-pulmonaire par imagerie metabolique (TEP-18-FDG).
Bury, Thierry ULg; DUYSINX, Bernard ULg; CORHAY, Jean-Louis ULg et al

in Revue Médicale de Liège (2000), 55(3), 178-83

Continuing advances in PET imaging have resulted in an improved ability to evaluate thoracic malignancies. Published reports demonstrate that PET provides accurate noninvasive detection of malignancy that ... [more ▼]

Continuing advances in PET imaging have resulted in an improved ability to evaluate thoracic malignancies. Published reports demonstrate that PET provides accurate noninvasive detection of malignancy that is useful in the characterization of a pulmonary solitary nodule and in the mediastinal or extrathoracic staging of known lung cancer. Preliminary studies suggest that PET may also be able to assess the therapeutic response after surgery or radiation therapy. [less ▲]

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See detailEvaluation thérapeutique précoce par tomographie à émission de positons
Jerusalem, Guy ULg; Beguin, Yves ULg; Fassotte, Marie-France ULg et al

in Médecine et Hygiène (2000), 58

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See detailPersistent tumor 18F-FDG uptake after a few cycles of polychemotherapy is predictive of treatment failure in non-Hodgkin's lymphoma.
Jerusalem, Guy ULg; Beguin, Yves ULg; Fassotte, Marie-France ULg et al

in Haematologica (2000), 85(6), 613-8

BACKGROUND AND OBJECTIVE: Early recognition of the ineffectiveness of chemotherapy could result in lower cumulative drug toxicity and tumor burden at the start of salvage therapy, which might improve ... [more ▼]

BACKGROUND AND OBJECTIVE: Early recognition of the ineffectiveness of chemotherapy could result in lower cumulative drug toxicity and tumor burden at the start of salvage therapy, which might improve clinical outcome. Therefore, we studied the value of (18)F-FDG PET for early evaluation of response in patients with non-Hodgkin's lymphoma (NHL). DESIGN AND METHODS: We studied 28 patients by (18)F-FDG PET after a median of 3 cycles of polychemotherapy. The presence or absence of abnormal (18)F-FDG uptake was correlated to clinical outcome (median follow-up: 17.5 months, range 4-47 months). RESULTS: Five of 28 patients still had increased (18)F-FDG uptake in one or more sites previously shown to be involved by lymphoma at baseline evaluation. Only one of these five patients entered complete remission (CR), whereas among the 23 patients with negative (18)F-FDG PET studies, two died of toxicity during chemotherapy and all the others entered clinical CR (p<0.00001). All five patients with and 7/21 patients without residual abnormal (18)F-FDG uptake relapsed or reprogressed (positive predictive value for relapse: 100%, negative predictive value: 67%). By Kaplan-Meier analysis, progression-free survival (PFS) at 1 and 2 years was respectively 20+/-18% and 0% for (18)F-FDG PET positive patients and 81+/-9% and 62+/-12% for (18)F-FDG PET negative patients (p=0.0001). Overall survival (OS) at 1 and 2 years was respectively 20+/-18% and 0% for (18)F-FDG PET positive and 87+/-7% and 68+/-11% for (18)F-FDG PET negative patients (p<0.0001). INTERPRETATION AND CONCLUSIONS: Persistent tumoral (18)F-FDG uptake after a few cycles of polychemotherapy is predictive of CR, PFS and OS in NHL. Further studies are warranted to determine whether (18)F-FDG PET has a predictive value independent from conventional prognostic factors. However, the sensitivity of qualitative (18)F-FDG PET imaging in identifying patients with a poor outcome was insufficient. Earlier evaluation after only one cycle of chemotherapy and quantitative analysis might increase the sensitivity of 18F-FDG PET is predicting treatment failure. [less ▲]

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See detailPET for carcinomas of the genitourinary system
Belhocine, Tarik; Hustinx, Roland ULg; Devillers, Céline ULg et al

in Khakhali, I.; Laublant, J.; Goldsmith, S. J. (Eds.) NUCLEAR ONCOLOGY : DIAGNOSIS AND THERAPY (2000)

This book is intended to provide the state-of-the-art in the present knowledge of the fast growing field of nuclear oncology. The enormous sum of data it gathers is presented by the leading authors in ... [more ▼]

This book is intended to provide the state-of-the-art in the present knowledge of the fast growing field of nuclear oncology. The enormous sum of data it gathers is presented by the leading authors in their respective fields. Recent breakthrough as well as validated techniques are explained in details. Among the most stimulating issues, it becomes clear that the long awaited era of radioimmunotherapy is finally coming to reality and is close to enter into routine clinical use. Several chapters are devoted to this future important aspect of our practice. They should allow the reader to become quickly and completely informed about the main results of the recent trials and also to comprehend the expected evolutions in this field. Positron emission tomography (PET) also occupies a large place. Numerous illustrations help the reader to appreciate the wide capabilities of this technique. The more usual radiopharmaceuticals labeled by single photons emitters are not forgotten and all the aspects of the daily practice of nuclear oncology are covered, from thyroid and bone imaging to sentinel lymph node detection. The first part of the book covers transversally the field of nuclear oncology. A radiopharmaceuticals chapter provides an in-depth review of the properties and chemistry of the single-photon and positron emitters radionuclides. The various mechanisms of localization are also described at the membrane level as well as for metabolic substrates. The properties of the agents aiming at hormone receptors and tumor antigens are excellently described, as well as the recently introduced gene expression imaging. Multidrug resistance (MDR) is divided in two parts. The breast cancer chapter retraces the history and background of sestamibi in the detection of MDR. It also describes the methodology and clinical results of the most important scintigraphic studies that have demonstrated the possibility to detect the early development of resistance to chemotherapy. An interesting series of other agents with a high potential in this indication, particularly positron emitters, is discussed. The role of technetium and positron agents for MDR detection in other tumor localisations, especially in the lung, is also well covered. An instrumentation chapter goes through the fundamentals of planar and SPECT imaging, and also presents the new reconstruction and correction algorithms. A large section is occupied by positron imaging. The pros and cons of dedicated detector and camera coincidence are very well detailed. This part should definitely help to decide those who are trying to make a choice between these two options. The general principles of radiolabeled monoclonal antibodies imaging and therapy are covered in two very interesting chapters. Then radiotherapy of painful bone metastases compares the capabilities of the various agents available. A large chapter deals with pediatric nuclear oncology, in particular neuroblastoma, bone and central nervous system tumors. Finally, the often forgotten role of nuclear medicine in the detection, and possibly in the prevention, of the cardiotoxicity and nephrotoxicity resulting from cancer therapy are addressed at the end of that first part. The second part of the book goes by organ and begins by addressing brain tumors. A vast chapter is devoted to PET imaging. Besides the tracers and instrumentation issues, patient management occupies a central place, in particular with discussion on the role of nuclear medicine in tissue characterization, treatment planning and assessment of treatment response. Cerebrospinal fluid and shunt imaging are described, with particular attention paid to ventriculoperitoneal shunts. After PET imaging of head and neck carcinoma, a chapter extensively reviews thyroid carcinoma. Iodine therapy and long-term monitoring are covered with great details and useful practical recommendations are provided. Emerging radioimmunotherapy is discussed apart. Parathyroid scintigraphy also occupies a large and well documented chapter. PET imaging of lung carcinoma is particularly well illustrated by several cases. The potential of peptide scintigraphy is presented. Breast cancer occupies five chapters, namely, scintimammography, PET imaging, lymphatic mapping, monoclonal antibody imaging and radionuclide therapy. This provides an extensive review of the present and potential possibilities of nuclear medicine in one of the most frequent tumors. Then the role of PET imaging and the capabilities of radioimmunotherapy for maligancies of the gastrointestinal and genitourinary tracts are presented, in particular in two chapters entirely dedicated to prostate carcinoma and in two others to ovarian carcinoma. Radiolabeled somatostatin analogues and their value in the diagnosis and treatment of the neuroendocrine tumors are reviewed. Hepatic neoplasia are addressed through the utilization of technetium-labeled galactosyl neoglycoalbumin and hepatic artery infusion. For lymphomas, besides gallium and PET imaging, a very complete chapter is devoted to monoclonal antibody therapy. The extremely promising results obtained with several radiolabeled-anti-CD monoclonal antibodies in the treatment of B-cell non-Hodgkin’s lymphomas are reviewed in depth. Additional chapters cover adrenal tumors, melanoma, musculoskeletal tumors, in particular imaging of bone metastases. This comprehensive, didactic, up-to-date, well illustrated review of nuclear oncology should help nuclear medicine physicians as well as oncologists to optimize their practice. This book is intended to provide the state-of-the-art in the present knowledge of the fast growing field of nuclear oncology. The enormous sum of data it gathers is presented by the leading authors in their respective fields. Recent breakthrough as well as validated techniques are explained in details. Among the most stimulating issues, it becomes clear that the long awaited era of radioimmunotherapy is finally coming to reality and is close to enter into routine clinical use. Several chapters are devoted to this future important aspect of our practice. They should allow the reader to become quickly and completely informed about the main results of the recent trials and also to comprehend the expected evolutions in this field. Positron emission tomography (PET) also occupies a large place. Numerous illustrations help the reader to appreciate the wide capabilities of this technique. The more usual radiopharmaceuticals labeled by single photons emitters are not forgotten and all the aspects of the daily practice of nuclear oncology are covered, from thyroid and bone imaging to sentinel lymph node detection. The first part of the book covers transversally the field of nuclear oncology. A radiopharmaceuticals chapter provides an in-depth review of the properties and chemistry of the single-photon and positron emitters radionuclides. The various mechanisms of localization are also described at the membrane level as well as for metabolic substrates. The properties of the agents aiming at hormone receptors and tumor antigens are excellently described, as well as the recently introduced gene expression imaging. Multidrug resistance (MDR) is divided in two parts. The breast cancer chapter retraces the history and background of sestamibi in the detection of MDR. It also describes the methodology and clinical results of the most important scintigraphic studies that have demonstrated the possibility to detect the early development of resistance to chemotherapy. An interesting series of other agents with a high potential in this indication, particularly positron emitters, is discussed. The role of technetium and positron agents for MDR detection in other tumor localisations, especially in the lung, is also well covered. An instrumentation chapter goes through the fundamentals of planar and SPECT imaging, and also presents the new reconstruction and correction algorithms. A large section is occupied by positron imaging. The pros and cons of dedicated detector and camera coincidence are very well detailed. This part should definitely help to decide those who are trying to make a choice between these two options. The general principles of radiolabeled monoclonal antibodies imaging and therapy are covered in two very interesting chapters. Then radiotherapy of painful bone metastases compares the capabilities of the various agents available. A large chapter deals with pediatric nuclear oncology, in particular neuroblastoma, bone and central nervous system tumors. Finally, the often forgotten role of nuclear medicine in the detection, and possibly in the prevention, of the cardiotoxicity and nephrotoxicity resulting from cancer therapy are addressed at the end of that first part. The second part of the book goes by organ and begins by addressing brain tumors. A vast chapter is devoted to PET imaging. Besides the tracers and instrumentation issues, patient management occupies a central place, in particular with discussion on the role of nuclear medicine in tissue characterization, treatment planning and assessment of treatment response. Cerebrospinal fluid and shunt imaging are described, with particular attention paid to ventriculoperitoneal shunts. After PET imaging of head and neck carcinoma, a chapter extensively reviews thyroid carcinoma. Iodine therapy and long-term monitoring are covered with great details and useful practical recommendations are provided. Emerging radioimmunotherapy is discussed apart. Parathyroid scintigraphy also occupies a large and well documented chapter. PET imaging of lung carcinoma is particularly well illustrated by several cases. The potential of peptide scintigraphy is presented. Breast cancer occupies five chapters, namely, scintimammography, PET imaging, lymphatic mapping, monoclonal antibody imaging and radionuclide therapy. This provides an extensive review of the present and potential possibilities of nuclear medicine in one of the most frequent tumors. Then the role of PET imaging and the capabilities of radioimmunotherapy for maligancies of the gastrointestinal and genitourinary tracts are presented, in particular in two chapters entirely dedicated to prostate carcinoma and in two others to ovarian carcinoma. Radiolabeled somatostatin analogues and their value in the diagnosis and treatment of the neuroendocrine tumors are reviewed. Hepatic neoplasia are addressed through the utilization of technetium-labeled galactosyl neoglycoalbumin and hepatic artery infusion. For lymphomas, besides gallium and PET imaging, a very complete chapter is devoted to monoclonal antibody therapy. The extremely promising results obtained with several radiolabeled-anti-CD monoclonal antibodies in the treatment of B-cell non-Hodgkin’s lymphomas are reviewed in depth. Additional chapters cover adrenal tumors, melanoma, musculoskeletal tumors, in particular imaging of bone metastases. This comprehensive, didactic, up-to-date, well illustrated review of nuclear oncology should help nuclear medicine physicians as well as oncologists to optimize their practice. [less ▲]

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See detailAn Appraisal of 18-Fluorodeoxyglucose Positron Emission Tomography for Melanoma Staging
Paquet, Philippe ULg; Henry, Frédérique ULg; Belhocine, Tarik et al

in Dermatology : International Journal for Clinical & Investigative Dermatology (2000), 200(2), 167-9

BACKGROUND: Positron emission tomography (PET scan) using fluorodeoxyglucose (FDG) is increasingly recognized as a reliable diagnostic method to detect metastases of malignant melanoma (MM). OBJECTIVE: To ... [more ▼]

BACKGROUND: Positron emission tomography (PET scan) using fluorodeoxyglucose (FDG) is increasingly recognized as a reliable diagnostic method to detect metastases of malignant melanoma (MM). OBJECTIVE: To compare the diagnostic performance of 18-FDG PET scan to that of conventional imaging. METHODS: A total of 28 assessments were conducted in 24 patients at risk of metastatic MM. Results: The diagnostic accuracy was over 80% and similar for PET scan and conventional imaging. CONCLUSION: Both the specificity and sensitivity of PET scan are high although not perfect. Confrontation of data with anatomical location and clinicopathological findings remains mandatory. [less ▲]

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See detailIntérêt de la tomographie a émission de positons dans l'évaluation des tumeurs digestives
Hustinx, Roland ULg; Paulus, Patrick; Daenen, Frédéric ULg et al

in Revue Médicale de Liège (1999), 54(12), 925-30

Imaging and endoscopic techniques have taken an increasing part in the management of gastroenterological disorders. Among these techniques, FDG-PET imaging has emerged as a powerful tool in the management ... [more ▼]

Imaging and endoscopic techniques have taken an increasing part in the management of gastroenterological disorders. Among these techniques, FDG-PET imaging has emerged as a powerful tool in the management of several cancer diseases, including tumors of the digestive tract. In particular, the role of PET for diagnosing and staging recurrent colorectal cancers, and for differentiating mass forming pancreatitis from carcinoma is now well established. In this review, we will briefly discuss the place of PET imaging in the work-up of the tumors of the digestive tract. [less ▲]

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See detailInteret clinique de la tomographie a emission de positons dans la detection et le bilan d'extension des recidives des cancers colorectaux
Hustinx, Roland ULg; Paulus, P.; Daenen, Frédéric ULg et al

in Gastroentérologie Clinique et Biologique (1999), 23(3), 323-9

BACKGROUND: Positron emission tomography (PET) has been shown useful for the staging of patients with various carcinomas. METHODS: We have applied this technique to 54 cases of colorectal carcinoma and ... [more ▼]

BACKGROUND: Positron emission tomography (PET) has been shown useful for the staging of patients with various carcinomas. METHODS: We have applied this technique to 54 cases of colorectal carcinoma and compared it to conventional imaging techniques. RESULTS: PET had moderately higher sensitivity and specificity than conventional techniques to detect individual lesion sites (75% vs 70.8% and 63% vs 21% respectively). It detected the same number of patients with recurrences (35/39) but overestimated disease less frequently (5 cases vs 12). PET favorably influenced therapeutic management in 17 patients, indicating different or additional surgery in 9 while avoiding surgery with curative intent or unnecessary surgery in 8. In 5 cases, erroneous information provided by PET could be corrected by conventional imaging techniques. CONCLUSION: We conclude that PET appears to provide complementary information useful for staging patients with colorectal carcinomas. It can significantly modify patients management. These data should be confirmed by a prospective study. [less ▲]

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See detailWhole-Body 18f-Fdg Pet for the Evaluation of Patients with Hodgkin's Disease and Non-Hodgkin's Lymphoma
Jerusalem, Guy ULg; Warland, V.; Najjar, F. et al

in Nuclear Medicine Communications (1999), 20(1), 13-20

Whole-body metabolic information provided by 18F-FDG PET could help in the evaluation of lymphoma patients at diagnosis and follow-up. We studied 60 patients, 42 at initial presentation and 18 for disease ... [more ▼]

Whole-body metabolic information provided by 18F-FDG PET could help in the evaluation of lymphoma patients at diagnosis and follow-up. We studied 60 patients, 42 at initial presentation and 18 for disease recurrence (23 aggressive non-Hodgkin's lymphoma, 21 low-grade non-Hodgkin's lymphoma and 16 Hodgkin's disease). All patients underwent a clinical examination, computed tomography (CT) and a non-attenuated PET scan within 1 week. The patients received 222-296 MBq (6-8 mCi) 18F-FDG intravenously and emission scans were recorded 45-90 min later. 18F-FDG PET detected more lymph nodes than the clinical examination or CT, but this rarely resulted in upstaging (two patients). The concordance between PET and CT for the evaluation of the spleen, liver and digestive tract was quite good. Discordance was noted in 12 patients for the evaluation of bone marrow infiltration, but confirmation by MRI or focal biopsy was not always obtained. We conclude that non-attenuated 18F-FDG PET is an easy and efficient whole-body method for the evaluation of patients with lymphomas. Compared with conventional techniques, however, it does not appear to offer much improvement for staging but provides a satisfactory base for follow-up. [less ▲]

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See detailIntérêt de la tomographie à émission de positons dans l'évaluation des tumeurs gastro-intestinales
Rigo, Pierre ULg; Albérini, Jean-Louis; Hustinx, Roland ULg et al

in Acta Endoscopica (1999), 29(2), 129-138

La TEP au 18FDG présente de nombreuses indications dans l'évaluation des tumeurs digestives. Son rôle principal concerne le bilan d'extension des récidives tumorales démontrées ou suspectées mais des ... [more ▼]

La TEP au 18FDG présente de nombreuses indications dans l'évaluation des tumeurs digestives. Son rôle principal concerne le bilan d'extension des récidives tumorales démontrées ou suspectées mais des indications plus ponctuelles concernent évalement le diagnostic différentiel des masses pancréatiques et le bilan du cancer de l'oesophage. Le principal avantage de la TEP résulte de la nature métabolique du signal indépendant et complémentaire des modifications anatomiques visibles en imagerie classique. Un autre avantage est lié à l'examen du corps entier aujourd'hui pratiqué systématiquement. La TEP trouve dès lors sa place en première ligne dans ses différentes indications. [less ▲]

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See detailValue of FDG-PET in detecting residual or recurrent nonsmall cell lung cancer
Bury, Thierry ULg; Corhay, Jean-Louis ULg; Duysinx, Bernard ULg et al

in European Respiratory Journal (1999), 14(6), 1376-1380

In order to evaluate the usefulness of 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) in the assessment of therapeutic effects, a study was performed before and after therapy in 126 ... [more ▼]

In order to evaluate the usefulness of 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) in the assessment of therapeutic effects, a study was performed before and after therapy in 126 patients with non-small cell lung cancer (NSCLC) codified stage I to stage IIIB. Treatment with an early curative result was given in 58 patients, whereas in 68 cases it was limited to palliation. During the treatment follow-up period (8-40 months), each patient was evaluated every 3 months by clinical examination and ≤6 months by imaging techniques (PET and computed tomography (CT)). A diagnosis of persistent or recurrent tumour was established by means of pathological analysis in 31 patients and by clinical evolution and subsequent imaging progression in 29 other patients. PET showed increased FDG uptake in all cases (n=60) of persistent or recurrent tumour, whereas CT was nonspecific in 17 cases. Conversely, there were five false positive cases via PET imaging and three via CT. In detecting residual or recurrent NSCLC, PET had a sensitivity of 100% and specificity of 92%, whereas CT had a sensitivity and specificity of 71% and 95% respectively. In conclusion, 18-fluorodeoxyglucose positron emission tomography correctly identified response to therapy in 96% (121 of 126) of patients. Positron emission tomography appears to be more accurate (p=0.05) than conventional imaging in distinguishing persistent or recurrent tumour from fibrotic scar in patients undergoing treatment for non-small cell lung cancer. [less ▲]

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