Nuklearmedizin Nuklearmedizin nuk de-de Tue, 24 Apr 18 20:05:27 +0200 Ewing sarcoma during follow-up Aim: To evaluate the performance of a prospectively defined follow-up imaging protocol that includes FDG-PET(/CT) to detect tumour recurrence in Ewing sarcoma (EwS) before becoming symptomatic. Methods: Imaging results and clinical data during follow-up were retrospectively analysed from all patients treated successfully within the EURO E.W.I.N.G. 99 trial at the University Hospital Münster, Germany. All patients received follow-up imaging according to a comprehensive protocol that included regular X-ray, CT, MRI, bone scan and PET(/CT), albeit not all on the same day and with varying intervals for the different modalities. Results: 80 of 105 patients underwent follow-up at our institution after complete remission. 30 patients had recurrent tumour during the follow-up period of 3.6 years on average. 19 recurrences (63%) were detected by scheduled imaging before the advent of clinical symptoms. The majority of these recurrences (8 out of 19; 42%) was detected first by PET/CT (and confirmed with additional imaging thereafter), even though the total number of PET/CTs was comparatively low (138) and PET/CT was not systematically scheduled before other imaging techniques. Recurrences detected by bone scan were also detectable by PET. Conclusions: The implemented follow-up protocol was effective in the detection of EwS recurrence before the advent of symptoms. Most cases of those detected before onset of symptoms were detected by PET/CT first. This hybrid imaging modality should therefore be considered in the routine follow-up of EwS patients, as is standard in our hospital. In combination with PET, low-dose chest CT seems to be sufficient in the detection of small pulmonary nodules.... M. Heinemann (1, 2), A. Ranft (3, 2), H. Jürgens (2), T. Langer (4), V. Vieth (5), B. Timmermann (6), M. Weckesser (1), U. Dirksen (3, 2), L. Stegger (1) 28000 2017-10-11 17:59:42 Association between active brown adipose tissue and coronary artery calcification in healthy men Aim: We compared various clinical factors between persons with active brown adipose tissue (ABAT) and matched controls, and investigated the relationship between the presence of ABAT and coronary artery calcification (CAC) with respect to arterial inflammation. Methods: We retrospectively reviewed fluorine-18-labeled fluoro-2-deoxy-D-glucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) data from men who underwent general health check-ups. Sixty-seven men with ABAT were identified and were matched with controls at a 1:1 ratio. Peripheral blood samples were obtained and the levels of various laboratory parameters were measured just before FDG PET/CT studies. Arterial inflammation was measured in the ascending aorta, venous mean standardized uptake value (SUV) was collected from the superior vena cava as FDG uptake on PET, and background-corrected SUV was calculated as the target-to-background ratio (TBR) and blood-subtracted SUVmax (bsSUVmax). CAC was assessed using CT images acquired from a PET/CT scanner. Results: The prevalence of fatty liver (p = 0.048) and CAC (p = 0.026) was lower in men with ABAT compared to matched controls. Arterial SUVmax (1.72 ± 0.23 vs. 1.88 ± 0.23, p ... H.-Y. Nam (1), S. Jun (2) 27854 2017-08-29 14:11:02 Different patterns of dopaminergic and serotonergic dysfunction in manic, depressive and euthymic... A variety of alterations in brain neurotransmitter systems has been proposed as the cause of bipolar disorder (BD). We conducted a PUBMED search, which provided a total of 45 in vivo investigations with PET and SPECT, in which binding to serotonin transporter (SERT), 5-HT1A receptor (R), 5-HT2AR, dopamine transporter (DAT), vesicular monoamine transporter (VMAT2), D1R, D2R, muscarinic M2R and nicotinic ß2-nAChR as well as dopamine synthesis and/or dopamine release were assessed in BD patients in the manic (6 studies, 39 patients, 77 controls), depressive (15 studies, 248 patients, 488 controls) or euthymic condition (18 studies, 265 patients, 293 controls) and in mixed collectives of BD patients (6 studies, 55 patients, 80 controls). The retrospective analysis revealed a complex pattern of dysregulations within and between neurotransmitter systems, which is causally linked to the acute and euthymic states of BD. While increased mesencephalic, limbic and parietotemporoccipital serotonin and increased frontal dopamine underlie mania, the depressive state is characterized by decreased frontal and limbic serotonin, increased frontal and limbic acetylcholine and increased frontal dopamine. Also in euthymia, no normalization of receptor and transporter densities was observed. Alterations of regulation states of bindings sites, however, act together to achieve a normalization of mesencephalic, limbic and cortical serotonin.... S. Nikolaus (1), H. W. Müller (1), H. Hautzel (1) 27818 2017-08-10 16:08:59 Fragen zum Thema "Myocard-Perfusion-SPECT" 27812 2017-08-08 16:37:34 Added value of SPECT/spiral CT versus SPECT or CT alone in diagnosing solitary skeletal lesions Aim: The aim of this study was to investigate the added value of SPECT/spiral CT versus SPECT or CT alone in the differential diagnosis of solitary skeletal lesions. Methods: This was a retrospective study on a total of 69 patients who had a solitary skeletal “hot spot” that could not be definitively diagnosed using planar scintigraphy. Thus, SPECT/spiral CT was performed on the indeterminate lesions. SPECT, CT and SPECT/spiral CT images were independently interpreted by two experienced doctors who have both identification of CT and nuclear medicine. Each lesion was graded on a 4-point diagnostic scale (1: benign, 2: likely benign, 3: likely malignant, 4: malignant). The final diagnosis of each lesion was based on pathological confirmation after surgery within 3 weeks of the bone scan. Results: Final diagnoses based on the pathological results revealed that 43 of the 69 patients were diagnosed with malignancy, and the remaining 26 patients were diagnosed as having benign lesions. For SPECT and CT scans, both of the reviewers rated 55.1 % (38/69) and 37.7 % (26/69) of lesions as equivocal, with the help of SPECT/CT, 33.3 % (23/69) of lesions were rated as equivocal. The diagnostic accuracies of SPECT, CT alone and SPECT/CT were 66.7 % (46/69) ,82.6 % (57/69) and 85.5 %(59/69), respectively. The kappa scores for the degree of agreement between SPECT, CT alone or SPECT/CT with pathological results were 0.185 (p = 0.054) , 0.612 (p < 0.001) and 0.671 (p < 0.001), respectively. Conclusion: Compared with SPECT or imaging alone, SPECT/spiral CT imaging was more accurate and valuable in the differential diagnosis of solitary skeletal lesions and resulted in significantly fewer equivocal findings.... Y. Zhang (1, 2, 3), B. Li (1, 2, 3), H. Shi (1, 2, 3), H. Yu (1, 2, 3), Y. Gu (1, 2, 3), Y. Xiu (1, 2, 3) 27731 2017-07-18 14:30:52 Diagnostischer Stellenwert der multiparametrischen MRT mit gezielter Fusionsbiopsie der Prostata bei... Ziel: Die multiparametrische MRT (mpMRT) in Verbindung mit einer perinealen gezielten Ultraschall (US)-Fusionsbiopsie soll die diagnostische Präzision bei der Diagnose des klinisch signifikanten Prostatakarzinoms steigern und die Überdiagnose niedrigmaligner Karzinome reduzieren. Methoden: Bei 99 Männern mit vorherigen negativen Standardbiopsien und erhöhtem PSA wurde eine mpMRT durchgeführt und anschließend ultraschallgestützte gezielte perineale Fusionsbiopsien entnommen. Die mittels mpMRT gewonnenen PI-RADS-Daten (PS) und der histopathologisch erhobene Gleason Score (GS) wurden miteinander verglichen. Ergebnisse: Bei der mpMRT wurden bei 72/99 Patienten (73 %) Läsionen des PS 4 oder 5 gefunden. Histopathologisch zeigte sich bei 33/99 Patienten (33 %) kein Anhaltspunkt für Malignität. Bei 66 Patienten wurde trotz vorheriger negativer konventioneller Stanzbiopsien in 42 Fällen (64 %) ein low-grade- (GS 6, ≤ 7a) und in 24 Fällen (36 %) ein High-grade-Karzinom (GS ≥ 7b) entdeckt. Bei 21/24 high-grade-Karzinomen (88 %) war auch bei der mpMRT ein Karzinom detektiert worden (PS 4–5). Bei einer Sensitivität von 88 % fand sich ein negativer prädiktiver Wert (NPV) von 85 % (p = 0,002). Darüber hinaus wurde bei 35 von 42 low-grade-Karzinomen (83 %) in der mpMRT ein Karzinom-Befund (PS 4–5) erhoben (p < 0,001). Die Sensitivität für eine Differenzierung zwischen low- und high-grade-Karzinomen (GS ≤ 7a vs. ≥ 7b) mittels PS betrug 88 % bei einem NPV von 70 % (p = 0,74). Schlussfolgerung: Die Ergebnisse der vorliegenden Studie weisen darauf hin, dass die mpMRT-gestützte US-Fusionsbiopsie erheblich höhere Detektionsraten zum Nachweis klinisch signifikanter Prostatakarzinome aufweist als die bislang gebräuchlichen Diagnoseverfahren. Jedoch konnte keine statistische Signifikanz bezüglich der Differenzierung zwischen high- und low-grade-Karzinomen gezeigt werden. Es ist zu hoffen, dass die Hybridverfahren PSMA-PET/CT bzw. PSMA-PET/MRT in der bis jetzt nicht befriedigenden Signifikanz bei der Differenzierung zwischen high- und low-grade-Karzinomen den nächsten Optimierungsschritt herbeiführen werden.... M. Hoffmann (1), M. A. Hoffmann (2, 3), H. J. Wieler (4), F. M. Jakobs (5), K. Taymoorian (6), A. Gerhards (7), M. Miederer (3), M. Schreckenberger (3) 27729 2017-07-17 14:40:43 Geschmacksstörung (Dysgeusie) und Radioiodtherapie des Schilddrüsenkarzinoms Geschmacksstörungen (Hypo-, Dysgeusie) nach Radioiodtherapie des Schilddrüsenkarzinoms stellen in der Abgrenzung zur Xerostomie eine separate Komorbidität dar. Bei der Hypogeusie handelt es sich um die Folge einer Sialadenitis kleiner muköser Speicheldrüsen – der Geschmacksdrüsen – in Nachbarschaft zu den Geschmacksknospen. Klinisch relevant werden die Hypo- und Dysgeusie zumeist durch Wechselwirkungen mit einer Begleitmedikation, zuvorderst Psychopharmaka und Tranquilizer. Sofern medizinisch vertretbar, sollten bei Dysgeusie nebenwirkungsbehaftete Medikamente ersetzt werden. Weitere Noxen sollten eliminiert werden (Nikotinkarenz, Wechsel der Zahnpflegeprodukte). Mit Bezug auf eine Radioiodtherapie mit relativer Indikation sollte die Patientenaufklärung mögliche Behandlungsalternativen benennen. Die Risikoaufklärung sollte die möglichen klinischen Konsequenzen aus einer Sialadenitis (Xerostomie, Dysgeusie, Kariesanfälligkeit, trockenes Auge, Tränenträufeln durch Obstruktion des Tränenkanals) komplett beschreiben. Die Möglichkeiten der 131I-Aktivitätsreduktion sollten risikoadaptiert genutzt werden. Ob darüber hinaus die Anwendung von rhTSH zur Risikominimierung des Dysgeusie hilfreich ist, bleibt aufgrund heterogener Beobachtungsdaten unklar. Der Nuklearmediziner sollte um die multifaktoriellen Zusammenhänge in der Genese einer Dysgeusie wissen, falls sich der Patient nach Radioiodtherapie ratsuchend an den Nuklearmediziner wendet.... M. Dietlein (1), A. Drzezga (1) 27728 2017-07-17 14:36:13 Evaluation der Intra- und Interobserverübereinstimmung von 99mTc-MIBI-Szintigraphien bei... Ziele: Neben der Feinnadelpunktion ist die Szintigraphie mit Tc99m-Sestamibi (99mTc-MIBI) ein ergänzendes Diagnostikum bei der Beurteilung von hypofunktionellen Knoten. Um die Frage nach der Verlässlichkeit dieses Diagnostikums zu beantworten, wurde in dieser Studie die Intra- und Interobserverübereinstimmung bei der Beurteilung hypofunktioneller Knoten von 99mTc-MIBI-Szintigrammen bestimmt. Methoden: In eine retrospektive Studie wurden 284 Patienten (16–85 Jahre, 194 w, 90 m) mit mindestens einem hypofunktionellen Knoten, einer Szintigraphie mit Technetium-99m-Pertechnetat und mindestens einer Szintigraphie mit 99mTc-MIBI eingeschlossen. Acht Nuklearmediziner beurteilten die Szintigramme an zwei Terminen und wurden per Fragebogen angewiesen, die Kombination der Bilder als „match“, „mismatch“ oder „unentschieden“ einzustufen. Zudem wurde jeweils abgefragt, ob die Früh- oder die Spätaufnahme der 99mTc-MIBI-Szintigraphie besser verwertbar war oder ob kein Unterschied bestand. Ergebnisse: Die Intraobserverübereinstimmung reichte von κ = 0,56 (mittelmäßig) bis κ = 0,78 (überzeugend). Die Interobserverübereinstimmung lag bei κ = 0,44 und κ = 0,53 (mittelmäßig). Die Interobserverübereinstimmung von Untersuchern mit mehr als 5 Jahren Berufserfahrung in der Nuklearmedizin lag bei κ = 0,61 und κ = 0,70 (überzeugend), mit 2–5 Jahren bei κ = 0,53 (mittelmäßig) und κ = 0,61 (überzeugend), und mit weniger als 2 Jahren bei κ = 0,47 (mittelmäßig) und κ = 0,61 (überzeugend). In 26 % der Fälle in Sitzung 1 bzw. 20 % in Sitzung 2 wurde die Frühaufnahme als besser verwertbar eingestuft, in 4 bzw. 3 % die Spätaufnahme und in 70 bzw. 77 % „kein Unterschied“. Schlussfolgerung: Die Werte der Interobserverübereinstimmung aller acht Untersucher zeigen, dass die Beurteilung der 99mTc-MIBI-Szintigramme einer gewissen Varianz unterliegen kann. Somit sollten diese von einem Untersucher mit mindestens 5 Jahren Berufserfahrung abschließend beurteilt werden. Berufsanfänger benötigen mehr Zeit zur Beurteilung von 99mTc-MIBI-Szintigrammen als Erfahrene und sollten Rücksprache halten.... J. Baumgarten (1), C. Happel (1), H. Ackermann (2), F. Grünwald (1) 27690 2017-06-22 15:51:30 Myokard-Perfusions-SPECT Die S1-Leitlinie Myokard-Perfusions-SPECT wurde überarbeitet und bei der Arbeitsgemeinschaft der wissenschaftlichen Fachgesellschaften (AWMF) online publiziert. Sie ist in ihrer aktuellen Fassung bis 2/2022 gültig. Dieser Beitrag gibt in gekürzter Form und mit Kommentaren versehen die Kapitel und Unterkapitel wieder, in denen Änderungen und Ergänzungen vorgenommen wurden. O. Lindner (1), F. Bengel (2), W. Burchert (1), R. Dörr (3), M. Hacker (4), W. Schäfer (5), M. A. Schäfers (6), M. Schmidt (7), M. Schwaiger (8), J. vom Dahl (9), R. Zimmermann (10) 27606 2017-06-08 10:01:22 Differences in sodium fluoride-18 uptake in the normal skeleton depending on the location and... Aim: The aim of this study was to evaluate the normal distribution of sodium fluoride-18 (NaF-18) and to clarify the differences in uptake according to location and the type of the bone using positron emission tomography (PET) / computed tomography (CT). Methods: We retrospectively reviewed NaF-18 PET/CT images from 30 patients with hip joint disorders. PET/CT scans were performed 40 min after injection of approximately 185 MBq of NaF-18. To evaluate the relationship between the distribution of NaF-18 uptake and bone density, we compared the maximum standardised uptake values (SUVmax) on PET and the Hounsfield Units (HUs) on CT of the lumbar vertebra, ilium, and proximal and distal femurs. Regions of interests were defined both outside and inside the cortical bone to measure whole bone and cancellous bone only, respectively. Results: The distribution of NaF-18 differed according to the skeletal site. The lumbar vertebra showed the highest SUVmax for both whole bone and cancellous bone, followed by the ilium, proximal femur, and distal femur. The bones differed significantly in SUVmax. The distal femur showed the highest HU, followed by the proximal femur, ilium, and vertebra. Profile curve analyses demonstrated that the cancellous bones showed higher SUVmax and lower HU than the cortical bones. Conclusions: Our results demonstrate the difference in NaF-18 uptake between cancellous and cortical bones, which may explain differences in uptake by location. NaF-18 uptake does not appear to be strongly correlated with bone density, but rather with bone turnover and blood flow.... S. Nawata (1), T. Kaneta (1), M. Ogawa (1), Y. Ishiwata (1), N. Kobayashi (2), A. Shishikura-Hino (1), K. Yoshida (1), Y. Inaba (2), T. Saito (2), T. Inoue (1) 27515 2017-05-10 12:56:21 Prediction of renal cortical defect and scar using neutrophil-to-lymphocyte ratio in children with... Aim: This study is aimed to evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) for cortical defect on initial and follow-up Tc-99m dimercaptosuccinic acid (DMSA) scan in children with the first febrile urinary tract infection (UTI). Methods: We retrospectively enrolled 179 children with the first febrile UTI who underwent DMSA scan and laboratory tests. In patients with abnormal DMSA scan findings, follow-up DMSA scan was performed at least 6 months after the initial scan. All DMSA scans were classified as negative and positive cortical defects. Multiple logistic regression analyses were performed to identify the risk factors for cortical defect on initial and follow-up DMSA scan. Results: Cortical defects on initial DMSA scan were noted in 133 patients. Vesicoureteral reflux (VUR), white blood cell count, absolute neutrophil count, NLR, and serum C-reactive protein level were independent predictive factors for positive cortical defect on initial DMSA scan (p < 0.050). On follow-up DMSA scan, 24 of the 133 patients showed persistent cortical defects, and only VUR was significantly associated with persistent cortical defect (p = 0.002). In 84 patients who showed cortical defect on initial scan and absence of VUR, only NLR was significantly associated with persistent cortical defect on follow-up scan (p = 0.025). Conclusion: NLR was significantly associated with persistent cortical defect on follow-up DMSA scan in patients without VUR, as well as positive cortical defect on initial scan.... J. W. Lee (1, 2), J. S. Park (3), K. B. Park (3), G. H. Yoo (3), S. S. Kim (3), S. M. Lee (4) 27514 2017-05-10 12:55:06 A rare case of Marine-Lenhart syndrome with unilateral endocrine orbitopathy and Hürthle cell... S. Stanzel (1), P. Gyürüs (2), E. Kresnik (3), R. Aigner (1) 27513 2017-05-10 09:47:55 Cancer vaccination causes prolonged FDG accumulation in subcutaneous tissue K. Kahnert (1), D. Kauffmann-Guerrero (1), A. Tufman (1), A. Borgmeier (1), R. M. Huber (2), F. Berger (3) 27457 2017-04-21 11:20:28 Integrated 68Ga-HBED-CC-PSMA-PET/MRI in patients with suspected recurrent prostate cancer Aim: Evaluate the diagnostic accuracy of 68Ga-labeled HBED-CC-PSMA-PET/MRI for detection of recurrent PCa in comparison to PET/CT. Methods: 48 patients with suspected recurrent PCa underwent PET/CT after injection of the 68Ga-HBED-CC-PSMA ligand followed by integrated PET/MRI. Image analysis was performed by nuclear medicine physicians and radiologists with respect to the detection of lymph node metastases, bone metastases and local recurrence of the tumour. Image quality was evaluated visually based on a three-point ordinal scale. Results: From 48 patients initially examined, 25 were finally eligible for qualitative and quantitative image evaluation. In 14 patients, neither PET/CT nor PET/MRI found tumour lesions, and 9 patients were excluded from image analysis due to a pronounced extinction artifact around the urinary bladder (halo). In comparison to 68Ga-HBED-CC-PSMA-PET/CT, 68Ga-HBED-CC-PSMA-PET/MRI identified 14 vs. 9 local recurrences in the prostate bed and 23 vs. 20 PET-positive lymph nodes, and 4 vs. 4 PET-positive bone lesions, respectively. While the improved detection of suspicious lymph nodes was primarily attributable to the PET component, the advantageous detection of tumour recurrences in the prostate bed was chiefly referable to the superior soft-tissue contrast of the MR component of integrated PET/MRI. Analysis of SUVmax revealed that 68Ga-HBED-CC-PSMA-PET/MRI provided significantly higher SUVmax compared to 68Ga-HBED-CC-PSMA-PET/CT (17.6, range 2.0–49.6, and 15.1, range 3.5–36.8, respectively, p = 0.0019). Conclusion: 68Ga-HBED-CC-PSMA-PET/MRI was found to be superior as compared to 68Ga-HBED-CC-PSMA-PET/CT in the detection of PSMA-expressing prostate bed recurrences.... S. Lütje (1), J. Cohnen (1), B. Gomez (1), J. Grüneisen (2), M. Sawicki (3), H. Rübben (4), A. Bockisch (1), L. Umutlu (2), T. D. Pöppel (1), A. Wetter (2) 27421 2017-04-12 10:07:12 Extraction of 223Radium by haemodialysis after treatment of metastatic castration-resistant prostate... Aim: 223Radium-dichloride (223Ra) administration is an upcoming therapeutic option in patients with castration-resistant metastatic prostate cancer (mCRPC), whose renal and faecal excretion of 223Ra has been primarily estimated from data of a phase-I clinical trial in patients with normal renal function. In the rare case of concomitant renal insufficiency requiring haemodialysis (HD), an estimation of the contamination of dialysate would be beneficial. Methods: The excretion of 223Ra and its concentration in the dialysate in a patient with mCRPC and end-stage renal disease was examined for six consecutive treatment cycles. Dialysate samples were measured using a commercial system with NaI-scintillation detector. Results: HD showed a residual activity level in the remaining dialysate. The excreted activity was a median of 46.1 kBq (range = 42.0– 83.4 kBq) and 11.2 kBq (range = 8.4– 19.9 kBq) for the first (24 h post injection p.i.) and second HD (96 h p.i.), respectively. The activity concentration decreased significantly from a median of 4.18 kBq/l (range = 2.98–5.14 kBq/l) to 0.85 kBq/l (range = 0.69– 1.31 kBq/l, p ... O. S. Großer (1), H. Wissel (1), T. Wallbaum (1), P. Genseke (1), D. Kupitz (1), J. Ricke (1), J. Ruf (2), H. Amthauer (1, 3) 27395 2017-04-06 13:47:32 56. Jahrestagung der Deutschen Gesellschaft für Nuklearmedizin 27385 2017-04-05 10:08:16 Repeated peptide receptor radiotherapy in multiple recurrences of a metastasized neuroendocrine... C. Brogsitter (1), K. Zöphel (1), G. Folprecht (2), G. Eisenhofer (3), J. Kotzerke (1) 27374 2017-03-30 14:11:21 Nuklearmedizin in Deutschland Ziel: Aktualisierte Darstellung des Spektrums nuklearmedizinischer in-vivo-Untersuchungen und Therapien aus offiziellen Statistiken zur ambulanten und stationären Patientenversorgung sowie von Trends in der Struktur der nuklearmedizinischen Versorgung in Deutschland. Methoden: Die Gesundheitsberichterstattung des Bundes, die Frequenzstatistik der Kassenärztlichen Bundesvereinigung und Statistiken der Bundesärztekammer wurden abgefragt und durch selektive Literaturrecherchen ergänzt. Ergebnisse: Weiterhin werden vornehmlich Schilddrüsen, Knochen und Herzen nuklearmedizinisch untersucht. Bei deutlich gestiegenem Einsatz von PET/CT und SPECT/CT sind einfache Szintigraphieleistungen rückläufig. Myokard-, Lungen-, Lymph- und Hirn-Szintigraphien werden zunehmend angefordert, Skelett- sowie Schilddrüsenszintigraphien gehen zurück. Die Inanspruchnahme nuklearmedizinischer Vertragsärzte stieg jährlich im Schnitt um 4 % (2009: 2 164 664; 2015: 2 687 359). Die Zahl vertragsärztlich tätiger Nuklearmediziner stieg deutlich an (2009: 756; 2015: 939; Zuwachs 24 %) und ist nach der Niederlassungssperre seit 2013 konstant. Der Frauenanteil bei nuklearmedizinischen Facharztanerkennungen nimmt zu (Anteil aktuell 46 %). In Krankenhäusern werden mehr PET(/CT)-Scanner (2009: 97; 2015: 125) und weniger Gammakameras (2009: 594; 2015: 550) betrieben. Die Zahl extrathyreoidaler (auch ambulanter) Therapien stieg weiter. Schlussfolgerung: Bei vermehrter Nutzung von Hybridtechnologien zeigt das nuklearmedizinische Spektrum positive Trends besonders bei Nuklearkardiologie, Neuronuklearmedizin und extrathyreoidalen Therapien. Diese Entwicklungen sind bei der Novellierung der Weiterbildungsordnung und der studentischen Lehre zu beachten.... D. Hellwig (1), J. Marienhagen (1), K. Menhart (1), J. Grosse (1) 27293 2017-03-07 08:00:52 Incremental value of 99mTc-HYNIC-TOC SPECT/CT over whole-body planar scintigraphy and SPECT in... Aim: The aim of this study was to evaluate the additional value of 99mTc-HYNIC-TOC SPECT/CT over planar whole-body (WB) scintigraphy and SPECT alone in the detection and accurate localisation of neuroendocrine tumour (NET) lesions. Methods: This study included 65 patients with a definitive histological diagnosis of NET prior to scintigraphy. Planar WB scintigraphy, SPECT, and SPECT/CT images were acquired at 4 h post-administration of 670 MBq 99mTc-HYNIC-TOC. Additional SPECT images at 10 min after tracer administration were also acquired. Clinical and imaging follow-up findings were considered as the reference standards (minimum follow-up period, 15 months). Patient and lesion-based analyses of the efficacies of the imaging modalities were performed. Results: While 38 patients exhibited metastasis of NETs, 27 presented no evidence of metastasis. Upon patient-based analysis, the sensitivity and specificity of SPECT/CT were found to be 88.9 and 79.3 %, respectively. The diagnostic accuracies of WB scintigraphy, 4h-SPECT, and SPECT/CT were 72.3, 73.8, and 84.6 %, respectively. The area under curve (AUC) value for SPECT/CT (0.84) was the highest, followed by those for 4h-SPECT (0.75) and WB scintigraphy (0.74). The accuracy and AUC values of SPECT/CT were significantly better compared to those of WB scintigraphy (p ... M. Trogrlic (1), S. Težak (1) 27128 2017-02-06 08:16:32 18F-FDG PET/CT in the detection of asymptomatic malignant melanoma recurrence Aim: To evaluate the diagnostic accuracy of FDG PET/CT in the detection of asymptomatic recurrence in patients with malignant melanoma who have had resection of their primary lesion. We also aimed to determine the pattern and factors predisposing to disease recurrence. Methods: Patients with malignant melanoma who have had surgical resection of their disease and without any clinical evidence of disease recurrence were followed-up with FDG PET/CT. The diagnostic accuracy of FDG PET/CT, pattern of recurrence and factors predictive of disease recurrence were determined. Results: A total of 144 patients were followed-up for a median period of 50.50 months. Asymptomatic recurrence was seen in 37 patients (25.7 %) with a median time to recurrence of 20 months. Lymph node was the commonest site of asymptomatic recurrence. Sex, tumour depth, histology type and presence of nodal metastasis were significant predictors of tumour recurrence. Age, race, site of primary lesion, type of lymph node resection were not significant predictors of disease recurrence. Race has a significant effect on the histological subtype of tumour (nodular maligna was more common in Caucasian while acral lentiginous was more prevalent in the Blacks) and the site of the primary lesion (lower limb in Blacks and trunk in Caucasians). Sensitivity, specificity and accuracy of FDG PET/CT for the detection of disease recurrence were 94.5 %, 87.6 % and 89.6 % respectively. Conclusion: FDG PET/CT is a suitable modality for early detection of asymptomatic recurrence of malignant melanoma. Asymptomatic recurrence most commonly occurs in lymph nodes. Sex, nodal metastasis and tumour pathologic features are predictors of recurrence.... I. Lawal (1), T. Lengana (1), K. Ololade (1), T. Boshomane (1), F. Reyneke (1), M. Modiselle (1), M. Vorster (1), M. Sathekge (1) 27127 2017-02-03 09:18:31 Twins in spirit part IV – [177Lu] high affinity DOTATATE Aim: Besides the use of somatostatin analogues, small molecules like sunitinib and everolimus as well as conventional chemotherapy, peptide receptor radiotherapy (PRRT) using radiolabelled somatostatin analogues has gained an important role in the treatment of inoperable, metastasized neuroendocrine tumours (NET). There are various radiotracers in use. Based on our experience with the PET tracer [68Ga]DOTA-3-iodo-Tyr3-octreotate ([68Ga]HA-DOTATATE), a DOTATATE derivative with an increased binding affinity to hsst5, the current retrospective analysis is exploring the therapeutic potential of [177Lu]HA-DOTATATE. Methods: Eighteen patients with metastatic NET (G1/G2) were treated using [177Lu]DOTATATE and/or [177Lu]HA-DOTATATE, and dosimetric results of both tracers were compared. Results: Using [177Lu]HA-DOTATATE, a mean tumour dose of 5.34 Gy/GBq (median 2.53 Gy/GBq; range 0.89–33.3 Gy/GBq) was achieved, while [177Lu]DOTATATE delivered a tumour dose of 5.53 Gy/GBq (median 2.70 Gy/GBq; range 0.44–15.3 Gy/GBq). Organ doses for [177Lu]HA-DOTATATE vs. [177Lu]DOTATATE were as follows: kidney 2.31 ± 0.85 vs. 2.03 ± 0.96 Gy/GBq, liver 1.06 ± 0.79 vs. 1.67 ± 1.73 Gy/GBq, spleen 3.89 ± 4.04 vs. 4.50 ± 3.69 Gy/GBq and whole body 0.16 ± 0.10 Gy/GBq vs. 0.15 ± 0.08 Gy/GBq. Tumour-to-kidney dose ratio was slightly higher for [177Lu]DOTATATE (2.4 ± 5.6) compared to [177Lu]HA-DOTATATE (1.5 ± 3.6). Conclusion: Both tracers showed marked inter-patient variation in their dosimetry, and no significant differences in dosimetry of [177Lu]HA-DOTATATE and [177Lu]DOTATATE were observed when taking all patients into account. Thus, [177Lu]HA-DOTATATE appears viable for PRRT, although it was marginally inferior regarding kidney dose and tumour-to-kidney dose ratio compared to the established [177Lu]DOTATATE.... C. Brogsitter (1), H. Hartmann (1), G. Wunderlich (1), M. Schottelius (2), H.-J. Wester (2), J. Kotzerke (1) 27099 2017-01-31 08:45:54 Prevalence of thyroid disorders in elderly people in Germany Aim: In a screening study on people of working age the prevalence of morphological thyroid disorders was 33.1 %. It is not known precisely whether this further increases after retirement. The present study aimed to establish whether the increase in the prevalence of morphological and functional thyroid disorders continues beyond working age in elderly citizens. Methods: 223 participants were recruited in an institute for geriatric rehabilitative medicine. All patients were screened by thyroid ultrasound, measurement of serum levels of thyroid hormones and thyroid related autoantibodies as well as measurement of urinary iodine excretion. Results: The median thyroid volume was 17 ml (range 4–41 ml) in men and 16 ml (range 0.4–73 ml) in women. 27/59 (46 %) of the men (median age [range]: 77 [58–87] years) and 85/139 (61 %) of the women (median age [range]: 77 [52–97] years), or a total of 112/198 (57 %) residents, showed morphological thyroid abnormalities. There was no clear increase with age. 85 % of the participants without a history of thyroid treatment were euthyroid. 12 % showed a subclinical hyperthyroidism whereas 1 % showed a biochemically manifest hyperthyroidism. 2 % were biochemically hypothyroid. Tg-antibodies was elevated in 10 (5 %) and TPO-antibodies in 18 (9 %) of the patients. Median iodine excretion was 129 µg/l. 41.5 % of the patients showed iodine excretion values below 100 µg/l whereas only 7 % of the patients showed a severe iodine deficiency with an excretion below 50 µg/l. Conclusion: Compared to a previously described population of working age, the prevalence of morphological thyroid disorders does not further increase above the age of 65; thyroid function abnormalities in this iodine sufficient screening population were relatively rare.... F. A. Verburg (1, 2), I. Grelle (1), K. Tatschner (3), C. Reiners (1), M. Luster (2) 27092 2017-01-26 08:29:12 Diagnostic value of additional 68Ga-PSMA-PET before 223Ra-dichloride therapy in patients with... Purpose: Medical imaging plays an important role in selecting patients with metastatic castration-resistant prostate cancer for 223Ra-dichloride therapy of bone metastases. The purpose of this study was to investigate whether 68Ga-PSMA-PET has incremental value over conventional imaging for selecting patients suitable for 223Ra-dichloride therapy. Methods: In 27 consecutive patients referred for 223Ra-dichloride therapy additional 68Ga-PSMA-PET/CT was performed and tracer distribution was evaluated systematically with respect to the detection of visceral metastases and bone metastases with inadequate uptake on bone scintigraphy. Results: In 4 patients (15 %) 68Ga-PSMA-PET revealed previously unknown visceral metastases (3 liver, 1 adrenal gland), which changed the therapeutic decision in 2 cases. PET revealed more extended tumour involvement in the bone compared to bone scintigraphy in 9 patients (33 %). In 3 of these, the mismatch was extensive enough to question suitability for 223Ra-dichloride therapy. Conclusions: Additional 68Ga-PSMA-PET as a gatekeeper between conventional staging and 223Ra-dichloride therapy can provide valuable additional information with regard to visceral metastases and tumour manifestations without adequate bone mineral turnover. It may lead to a change in therapeutic management in a significant number of patients and should therefore be considered in future clinical trials.... A. Bräuer (1), K. Rahbar (1), J. Konnert (1), M. Bögemann (2), L. Stegger (1) 27035 2017-01-11 09:15:26 Polymyalgia rheumatica detected by SPECT/CT using 99mTc-labeled monoclonal antibody Fab'-fragments A. Frölich (1), I. Schwarze (2), C. Neumann (1) 27027 2016-12-22 13:20:32 Fragen zum Beitrag „Radioiodtherapie bei benignen Schilddrüsenerkrankungen“ 26966 2016-12-06 10:28:56