Nuclear Oncology: From Pathophysiology to Clinical Applications

✍ Scribed by Duccio Volterrani (editor), Paola A. Erba (editor), H. William Strauss (editor), Giuliano Mariani (editor), Steven M. Larson (editor)

• Publisher: Springer
• Year: 2022
• Tongue: English
• Leaves: 2241
• Edition: 3
• Category: Library

✦ Synopsis

This book discusses the role of nuclear medicine in the diagnosis, staging, and treatment of patients with specific cancers. It presents the incidence, pathophysiologic and clinical aspects of the disease, the use of nuclear imaging in diagnosis, staging requirements, management of specific tumors, and surveillance after primary treatment of cancers. It addresses the various diagnostic/therapeutic options that are currently available or are most likely to become available in the near future according to a prioritized approach, thereby keeping to a minimum the number of diagnostic imaging procedures the patient is expected to undergo.

Topics include basic science, clinical applications, radionuclide therapy, radioguided surgery, heart disease in the cancer patient, and adverse effects of cancer therapy. Each clinical chapter discusses the radionuclide procedures within an integrated framework, thereby identifying the information required for effective treatment of specific tumors. The book concludes with a series of updated cases that define and expand the didactic material in the clinical application chapters. Thoroughly updated and revised, the third edition incorporates new clinical evidence validating the use of radionuclides for diagnosis and therapy in oncology, new radiotracers, and the growing integration of imaging modalities into different types of hybrid imaging.

With contributions from a group of internationally distinguished practitioners, Nuclear Oncology: From Pathophysiology to Clinical Applications, Third Edition, is a valuable reference for nuclear medicine physicians, radiologists, medical and surgical oncologists, and other clinicians involved in the care and management of cancer patients.

✦ Table of Contents

Preface to the Third Edition
Preface to the Second Edition
Preface to the First Edition
Acknowledgments
Contents
About the Editors
Contributors
Part I: Basic Science
1 Cancer Biology of Molecular Imaging
Introduction
The Evolving Context of Molecular Imaging: Cancer Genomics and Epigenomics
Hallmarks of Cancer
The Tumor Mass
Imaging the Tumor Mass
Neovasculature
Hypoxia
Cellular Constituents and Cell-Cell Synergism of the Tumor Mass
Immune Cell Cancer Immunotherapy
Immune Checkpoint Blockade
Imaging the Immune T Cells
The Metastatic Process
Imaging the Cancer Cell
Total Lesion Glycolysis (TLG) as a Predictive Marker of Prognosis and Tumor Responsiveness
Proliferation Imaging
18F-FLT Imaging of Proliferation After Chemotherapy
The Cancer Biology of Cellular Lineage Plasticity and the Nuclear Imaging Phenotype
Lineage Plasticity and Relevance to Molecular Imaging in Prostate Cancer
Molecular Imaging of Fibroblast-Activating Protein, a Molecule Expressed in Tumor Stroma
Oncogene and Non-oncogene Addiction
Examples of Imaging the Action Driver Mutations in Cancer Cells Indirectly Through the Effects on Metabolism
BRAF Inhibition in Advanced Melanoma with V600E Mutation
Inhibition of MEK, a Downstream Signal Transduction Molecule in the RAS/BRAF/ERK Pathway, Can Reverse 131I Resistance in Patie...
Future Applications
References
2 Principles of Molecular Targeting for Radionuclide Therapy
Introduction
The Choice of Radionuclide
Nuclear Properties
Radioisotope Production
Theranostics
Instrument Resolution and Biological Resolution
Radiobiological Properties Affecting the Choice of Radionuclide
Radiation Microdosimetry and Particle Range
The Choice of a Chemical Platform
Salts and Covalent Bonds
Chelating Agents
Coordination of Tc(V) and Re(V)
Nanoparticles
Location of the Target: The Challenges of Designing Radiotracers for Intracellular Compartments
Critical Subcellular Sites of Interaction with Ionizing Radiation (Direct Effects)
Radiation-Induced Biological Bystander Effects (RIBBEs)
Critical Subcellular Sites of Interaction with Ionizing Radiation (Indirect Effects)
Cell Membrane
Mitochondria
Transfectant Mosaic Spheroid Model
Transfectant Mosaic Xenograft Model
Media Transfer
LET and Dose Rate
Conclusion
References
3 Single-Photon Emitting Radiopharmaceuticals for Diagnostic Applications
Introduction
99mTc-Labeled Radiopharmaceuticals
99mTc-Sodium Pertechnetate
99mTc-Diphosphonates
99mTc-Radiocolloids
99mTc-Magroaggregated Albumin
99mTc-Sestamibi
99mTc-Tetrofosmin
99mTc-EDDA/HYNIC-Octreotide or Octreotate
Lung Ventilation Radiopharmaceuticals
99mTc-DTPA
99mTc-Technegas
Xenon-133
Xenon-127
Radioiodinated Agents
Sodium Iodide
Radioiodinated Metaiodobenzylguanidine
201Tl-Chloride
111In-Pentetreotide
111In-Capromab Pendetide
67Ga-Citrate
Suggested Readings
4 Positron-Emitting Radiopharmaceuticals for Diagnostic Applications in Oncology
Introduction
Positron-Emitting Radionuclides
Carbon-11 (11C)
Nitrogen-13 (13N)
Oxygen-15 (15O)
Fluorine-18 (18F)
Copper-64 (64Cu)
Gallium-68 (68Ga)
Rubidium-82 (82Rb)
PET Radiopharmaceuticals
Deoxy-[18F]fluoro-d-glucose
Nitrogen-13 Ammonia
Oxygen-15 Water
Rubidium-82 Chloride
[11C]Methionine and Other Tracers for Protein Synthesis
Choline-Based Tracers for Phospholipid Synthesis
Fluorine-18 Fluciclovine
Gallium-68 PSMA Ligands
Fluorine-18 Sodium Fluoride
Fluorine-18 Misonidazole and Other Hypoxia Tracers
Fluorine-18 Fluorothymidine and Other Substrates for DNA Synthesis
Fluorine-18 DOPA and Other Amine Precursors
Gallium-68 DOTATOC, Copper-64 DOTATATE, and Other Somatostatin Analogs
Suggested Readings
5 Radiopharmaceuticals for Therapy
Background
Alpha-Particle Emitters
Radium-223 (223Ra)
Auger Electron Emitters
Emitters of β- Particles
Iodine-131 (131I)
Yttrium-90 (90Y)
Lutetium-177 (177Lu)
Samarium-153 (153Sm)
Strontium-89 (89Sr)
Rhenium-186 (186Re) and Rhenium-188 (188Re)
Phosphorus-32 (32P)
Holmium-166 (166Ho)
Treatment of Thyroid Disease with 131I-Iodide
Treatment of Neuroendocrine Neoplasms Originating from the Neural Crest with [131I]MIBG
Peptide Receptor Radionuclide Therapy
Bone-Seeking Radiopharmaceuticals and Prostate Cancer
Radioimmunotherapy for Hematologic Malignancies
Radionuclide Therapy of Primary and Metastatic Liver Tumors
Suggested Readings
6 Novel Single-Photon-Emitting Radiopharmaceuticals for Diagnostic Applications
Introduction and Background
Peptide Receptor Targeting
99mTc-EDDA/HYNIC-TOC
99mTc-PSMA-Ligands
99mTc-CAIX
Apoptosis
99mTc-Annexin V
99mTc-Duramycin
Angiogenesis
99mTc-HYNIC-VEGF
Integrins
99mTc-αP2
99mTc-NC100692 (or 99mTc-Maraciclatide)
99mTc-3PRGD2
99mTc-RGD-BBN
Hybrid Radioactive/Fluorescent RGD
Agents Targeting the Extracellular Matrix
99mTc-AP39
Matrix Metalloproteinases
Epidermal Growth Factor Receptor (EGFR)
99mTc-ADAPT6
Folate Receptor Overexpression
99mTc-HYNIC-folate
References
7 Novel Positron-Emitting Radiopharmaceuticals
Introduction
Targeting Cellular Transport and Metabolism
Overview
Imaging Amino Acid Transport and Metabolism
[11C]Methionine
O-(2-[18F]Fluoroethyl)-L-Tyrosine ([18F]FET)
3,4-Dihydroxy-6-[18F]Fluorophenylalanine ([18F]FDOPA)
18F-Labeled Glutamine
Imaging Lipid Biosynthesis
Targeting Cell Surface Receptors
Overview
Imaging the Expression of Integrins
Imaging the Expression of Gastrin-Releasing Peptide Receptors
ImmunoPET Imaging
ImmunoPET of HER2
ImmunoPET of EGFR
ImmunoPET of PD-1/PD-L1
Targeting the Tumor Microenvironment
Overview
Imaging Tumor Hypoxia
Imaging Tumor Acidosis
Radiotheranostics
Overview
Targeting Somatostatin Receptors
Targeting Prostate-Specific Membrane Antigen
Radioimmunotherapy
Concluding Remarks
References
8 Novel Radiopharmaceuticals for Therapy
Introduction
Alpha-Emitting Agents
Radium-223 (223Ra)
Astatine-211 (211At)
Actinium-225 (225Ac)
Thorium-227 (227Th)
Bismuth-213 (213Bi)
Lead-212 (212Pb)
Agents Emitting β- Particles
Iodine-131 (131I)
Lutetium-177 (177Lu)
Holmium-166 (166Ho)
Ytterbium-175 (175Yb)
Samarium-153 (153Sm)
Thulium-170 (170Tm)
Copper-67 (67Cu)
Yttrium-90 (90Y)
Gold-198 (198Au)
Promethium-149 (149Pm)
Rhodium-105 (105Rh)
Other Radionuclides
Concluding Remarks
References
9 Physics of Nuclear Oncology
Structure of the Atom
Energy and Mass
Energy and Frequency
Energy and Mass
Radioactivity and Radiation
Electromagnetic Radiation
X-Rays
Gamma Radiation (γ)
Annihilation Radiation (γ±)
Particulate Radiations
Alpha Radiation (α)
Beta Radiation (β-)
β- Dosimetry
Positron Decay (β+) and Electron Capture (EC)
Auger Electrons
Isomeric Transition (IT) and Internal Conversion (IC)
Radioactive Decay
Interaction of Radiation with Matter
Interaction of Particulate Radiation with Matter
Interaction of Photons with Matter
Photoelectric Effect
Compton Scattering
Pair Production
Attenuation and Scattering of Photons
Photon Attenuation
Radionuclides Used in Nuclear Oncology
References
10 Instrumentation for Positron Emission Tomography
Introduction
Basic Physics and Technology of PET
Scintillation Crystals
Silicon Photomultiplier (SiPM)-Based Scintillation Detectors
Time-of-Flight (TOF) PET
Total-Body PET
PET/MRI
Concluding Remarks
References
11 Instrumentation for Single-Photon Emission Computed Tomography (SPECT)
Introduction
Radiation Detectors for SPECT
Radionuclides for SPECT
Gamma Camera Design
SPECT Data-Acquisition
Data ``Corrections´´ and Activity Quantitation
Image Reconstruction
Commercial Devices
Concluding Remarks
References
12 Instrumentation for Intraoperative Detection and Imaging
Introduction
Nuclear Counting and Imaging
Optical and Near-Infrared (NIR) Imaging
Cerenkov Imaging
Photoacoustic Imaging
Diffuse Optical Tomography
Optical Coherence Tomography
Raman Spectroscopic Imaging
Intraoperative US, CT, and MRI
Concluding Remarks
References
13 Radiobiology and Radiation Dosimetry in Nuclear Medicine
Introduction
Radiobiology
Conventional Radiobiological Models
Cell Death Mechanisms
Possible Contributing Mechanisms to RNT Tumor Responses
Low-Dose/Dose-Rate Apoptosis
Low-Dose Hyper-radiosensitivity-Increased Radioresistance
G2 Synchronization, Bystander, and Cross-Fire Effects
Adaptive Responses
Fractionated RNT and Hypoxia
Future Directions
Dosimetry: Overview on Methods
Clinical Experience
131I-Iodide Therapy of Differentiated Thyroid Carcinoma
Peptide Receptor Radionuclide Therapy
Radioimmunotherapy of Lymphoma
Dosimetry in the Radioembolization of Liver Tumors
Therapy of Neuroectodermal Neuroendocrine Malignancies
Treatment of Metastatic Bone Pain
Radionuclide Therapy in Prostate Cancer
Biological Dosimetry
Assays in Biological Dosimetry
Dicentrics
Micronuclei
Chromosome Painting
Comet Assay
γ-H2AX
Conclusions
Diagnostic Procedures
Medical Radiation Exposures: Societal Concerns
Radiation Doses in Diagnostic Nuclear Medicine
Radiopharmaceuticals
Multimodality Imaging Studies: PET/CT and SPECT/CT
Dose-Response Relationships in Radiation Carcinogenesis
Risk-Benefit Considerations
Considerations for Sensitive Populations: Prospective Parents, Pregnant Women, and Nursing Mothers
Prospective Parents
Pregnant Women
Nursing Mothers
References
14 Imaging Biomarkers: Radiomics and the Use of Artificial Intelligence in Nuclear Oncology
Introduction: Image Mining
Radiomics: Definitions and Workflow
Study Design
Sample Size
Class Imbalance
Training and Validation
A Priori Variable Selection and Missing Data
Reference Standard
Image Acquisition
Reconstruction
Test-Retest Repeatability
Resampling
Intensity Discretization
Segmentation
Features´ Computation
Modeling
Normalization
Dimensionality Reduction and Feature Selection
Model Building
Reporting
AI in Medical Imaging: Definitions and Workflow
Artificial Intelligence (AI)
Machine Learning (ML)
Artificial Neural Network (ANN)
Deep Learning (DL)
Training a Neural Network
Supervised Learning
Unsupervised Learning
Convolutional Neural Networks
Machine Learning in Image Mining
Lesion Detection
Segmentation
Statistical Learning
Outcome Prediction
Clinical Applications of Radiomics and Artificial Intelligence Methods in Nuclear Oncology
Lung Cancer
Head and Neck Cancer
Breast Cancer
Lymphoma
Prostate Cancer
Conclusions
References
Part II: Diagnostic Applications of Nuclear Medicine
15 Diagnostic Applications of Nuclear Medicine: Lymphomas
Introduction
Hodgkin Lymphoma
Epidemiology and Etiology
Pathology and HL Subtypes
Genetic Features
Clinical Presentation, Evaluation, Staging, and Prognosis
Treatment and Follow-Up
Non-Hodgkin Lymphoma
Epidemiology and Etiology
Pathology and NHL Subtypes
Genetic Features
Clinical Presentation, Evaluation and Staging, and Prognosis
Treatment and Follow-Up
Nuclear Medicine Imaging for Lymphoma
[18F]FDG-PET for Detecting and Histologic Grading of Lymphoma
[18F]FDG-PET for Initial Staging of Lymphoma
[18F]FDG-PET/CT Versus PET Alone
Post-Therapy Response Assessment by [18F]FDG-PET and PET/CT
Integration of [18F]FDG-PET and PET/CT into Tumor Response Criteria
Interim PET and Risk-Adapted Therapy
Theory and Biologic Basis
Clinical Trials of Risk-Adapted Therapy for Aggressive NHL
Clinical Trials of Risk-Adapted Therapy for Hodgkin Lymphoma
Interpretation of Interim Therapy PET Scans
Surveillance PET for Lymphoma
Tracers Beyond [18F]FDG
Additional Challenges and Limitations in the Interpretation of [18F]FDG-PET in Lymphoma
Concluding Summary
References
16 Diagnostic Applications of Nuclear Medicine: Multiple Myeloma
Introduction and Overview of the Disease
Evaluation of Disease Burden with Imaging Modalities in Multiple Myeloma
Standard Skeletal Survey (SSS)
Other Imaging Techniques
Whole-Body, Multidetector, Computed Tomography (WBMD-CT)
Dual-Energy CT (DECT)
Magnetic Resonance Imaging (MRI)
Nuclear Imaging Procedures
Bone Scintigraphy with 99mTc-Diphosphonate
Other Radiopharmaceuticals for Scintigraphy
[18F]FDG PET/CT and PET/MRI
Whole-Body Hybrid PET/MRI
Non-[18F]FDG PET Radiopharmaceuticals
Assessing Response to Treatment in Multiple Myeloma
DEXA Scanning
References
17 Diagnostic Applications of Nuclear Medicine: Leukemias
Introduction and General Background
Acute Lymphocytic Leukemia (ALL) in Adults
Imaging for Diagnosis and Staging of ALL
Imaging for the Evaluation of Treatment Response of ALL
Chronic Lymphocytic Leukemia (CLL)
Imaging for Diagnosis and Staging of CLL
Treatment Evaluation of CLL
Follow-Up and Long-Term Implications in CLL
Hairy Cell Leukemia (HCL)
Assessment of Response to Treatment
Imaging During Follow-Up of HCL
Acute Myeloid Leukemia (AML)
Imaging for Diagnosis and Staging of AML
Response Evaluation and Follow-Up in AML
Chronic Myeloid Leukemia (CML)
Imaging for Diagnosis and Staging of CML
Imaging for Monitoring Treatment of CML
References
18 Diagnostic Applications of Nuclear Medicine: Brain Tumors
Introduction
Epidemiology of Brain Tumors
Staging and Prognostic Stratification of Brain Tumors
Genetic Predisposition and Underlying Molecular Biology Changes
Clinical Presentation
Prognosis
Clinical Applications
Overall Performance of Diagnostic Imaging Other Than Nuclear Medicine
Nuclear Imaging for Staging/Prognosis of Brain Tumors
[18F]Fluorodeoxyglucose ([18F]FDG)
Radiolabeled Amino Acids
3-123I-Alpha-Methyltyrosine (123I-IMT) and O-(2-18F-Fluoroethyl)-l-Tyrosine (18F-FET)
PET/MR
Assessing the Efficacy of Treatment
Correlation of PET Studies with the New WHO Classification
Radiomics
References
19 Diagnostic Applications of Nuclear Medicine: Head and Neck Cancer
Introduction: Epidemiology and Biology of HNSCC
Treatment Strategies
Imaging of Head and Neck Cancer
Emerging Role for PET/MR Imaging
Clinical Scenarios
Neck Metastases from an Unknown Primary Tumor
Primary Tumor Staging
Lymph Node Staging
Detection of Distant Metastases and Synchronous Second Primary Malignancies
Change in Patient Management
Response Assessment After (Chemo-) Radiotherapy
Suggested Approach and PET Interpretation Criteria for Response Assessment
Imaging During Chemoradiotherapy or After Induction Chemotherapy
Recurrent Disease
Prognostic Value of [18F]FDG PET
Nasopharynx Cancer
Salivary Gland Cancers
PET for Radiotherapy Planning
Non-[18F]FDG PET Other Tracers for Imaging of HNSCC
References
20 Diagnostic Applications of Nuclear Medicine: Thyroid Tumors
Introduction and General Background
Differentiated Thyroid Cancer Derived from Follicular Cells
Histopathologic Classification and Features
Epidemiology
Risk Factors
Pathogenesis
Clinical Presentation
Diagnosis
Ultrasonography
Fine-Needle Aspiration Cytology
Thyroid Scintigraphy and Other Diagnostic Imaging Procedures
Staging
Prognostic Factors
Age
Gender
Histologic Types and Variants
Tumor Size
Multifocality
Extrathyroidal Invasion
Lymph Node Metastases
Distant Metastases
Molecular Prognostic Factors
Role of Nuclear Medicine in the Management and Follow-Up of DTC After Surgery
Anaplastic Thyroid Cancer
Histopathologic Features and Pathogenesis
Clinical Presentation and Diagnosis
Radionuclide Imaging of ATC
Medullary Thyroid Cancer
Role of Nuclear Medicine in the Management of MTC
Other Thyroid Cancers
References
21 Diagnostic Applications of Nuclear Medicine: Parathyroid Tumors
Anatomy, Physiology, and Pathophysiology
Benign Causes of Hyperparathyroidism
Diagnosis and Treatment of Benign Hyperparathyroidism
Persistent and Recurrent Hyperparathyroidism
Role of Preoperative Imaging
Non-radionuclide Imaging Techniques
Parathyroid Scintigraphy
Minimally Invasive Parathyroidectomy and Radioguided Surgery
Parathyroid Carcinoma
Pathology
Epidemiology
Etiology
Pathogenesis
Clinical Presentation
Imaging of Parathyroid Carcinoma
Management of Parathyroid Carcinoma
Surgery
Chemotherapy
External Beam Radiation Therapy
Management of Hypercalcemia
Prognosis
Concluding Remarks on Preoperative Parathyroid Imaging when Planning Minimally Invasive Parathyroidectomy
References
22 Diagnostic Applications of Nuclear Medicine: Breast Cancer
Introduction: the Epidemiology of Breast Cancer
Risk Factors
Genetic Predisposition
Underlying Breast Cancer Biology Changes
Staging Categories and Prognostic Stratification
Breast Cancer Detection and Diagnosis, Modalities Other than Nuclear Medicine for the Tumor
Nuclear Imaging for Primary Detection and Diagnosis
Nuclear Imaging for Regional Nodal Staging
Nuclear Methods for Staging of Distant Metastases
Approaches to Breast Cancer Therapy
Assessing the Efficacy of Treatment(S)
Future Directions
References
23 Diagnostic Applications of Nuclear Medicine: Lung and Mediastinal Tumors
Epidemiology of Lung Cancer
Environmental and Genetic Factors for Lung Cancer
Underlying Molecular Biology Changes
Staging and Prognostic Stratification of Lung Cancer
NSCLC Staging by TNM 8th and Management
Conventional Imaging
Solitary Pulmonary Nodule
Characterization of SPN
Follow-Up of SPN
Screening for Lung Cancer
Imaging in Staging of NSCLC
T Stage
N Stage
M Stage
Imaging in Staging of SCLC
Lung Cancer Staging by a Multidisciplinary Team
Imaging for Response Assessment in Lung Cancer
Imaging in Follow-Up of NSCLC and SCLC After Curative Treatment
Artificial Intelligence in Lung Cancer Imaging
Imaging of Mediastinal Tumors
Differential Diagnosis Between Lung Cancer and Lymphoma
Imaging of Malignant Pleural Disease
Inflammatory and Infectious Diseases
Sarcoidosis
Histoplasmosis
Coccidioidomycosis
Tuberculosis (TB)
PET/CT for Evaluation of Lung Cancer
Radionuclide Imaging for Characterization of Lung Lesions
Location
Size
Role of PET/CT in SPN
[18F]FDG Imaging for Preoperative Staging of NSCLC
T Stage
N Stage
M Stage
Value of [18F]FDG PET/CT in the Management of Lung Cancer Patients
[18F]FDG Imaging for Radiation Treatment Planning in NSCLC
Is Radical Therapy Suitable for the Patient?
Prognostic Value of SUV for Lung Cancer
[18F]FDG Imaging for Assessment of Response to Therapy in NSCLC
[18F]FDG Imaging in the Follow-Up of Lung Cancer
[18F]FDG Imaging for Detection of NSCLC Recurrence
Small-Cell Lung Cancer (SCLC)
[18F]FDG and Other PET Tracers for Imaging in Neuroendocrine Tumors
PET/CT Radiomics in Lung Cancer
[18F]FDG Imaging of Malignant Pleural Disease
[18F]FDG Imaging of Mediastinal Tumors
PET/MRI Imaging of Lung and Thoracic Malignancies
PET Imaging of Lung and Thoracic Malignancies with Non-[18F]FDG Tracers
Conclusion
References
24 Diagnostic Applications of Nuclear Medicine: Esophageal Cancers
Introduction
Epidemiology and Environmental Factors
Genetic Predisposition
Underlying Biomolecular Changes
Staging and Prognostic Classification
Conventional Diagnostic Imaging Staging
Nuclear Imaging Staging
Common Therapies
Newer Therapies
Assessing Efficacy of Treatment
Surveillance
References
25 Diagnostic Applications of Nuclear Medicine: Gastric Cancers
Introduction
Epidemiology of Gastric Cancer
Environmental Factors for Gastric Cancer
Genetic Predisposition for Gastric Cancer
Underlying Biomolecular Changes in Gastric Cancer
Staging and Prognostic Classification of Gastric Cancer
Conventional Diagnostic Staging of Gastric Cancer
Nuclear Imaging Staging of Gastric Cancer
Upcoming Imaging Applications
Common Therapies for Gastric Cancer
Newer Therapies for Gastric Cancer
Assessing Efficacy of Treatment for Gastric Cancer
Surveillance for Gastric Cancer Post-Treatment
References
26 Diagnostic Applications of Nuclear Medicine: Gastrointestinal Stromal Tumors
Introduction
Epidemiology of Gastrointestinal Stromal Tumor
Environmental Factors and Genetic Predisposition for Gastrointestinal Stromal Tumor
Underlying Biomolecular Changes of Gastrointestinal Stromal Tumor
Staging and Prognostic Stratification of Gastrointestinal Stromal Tumor
Conventional Diagnostic Imaging Staging for Gastrointestinal Stromal Tumor
Nuclear Imaging Staging for Gastrointestinal Stromal Tumor
Traditional Therapies for Gastrointestinal Stromal Tumor
Molecular Therapy for Gastrointestinal Stromal Tumor
Assessing Response to Treatment for Gastrointestinal Stromal Tumor
Assessing Resistance to Treatment for Gastrointestinal Stromal Tumor
Surveillance for Gastrointestinal Stromal Tumor Post-Treatment
References
27 Diagnostic Applications of Nuclear Medicine: Tumors of the Liver and Biliary Tract
Introduction
Metastatic Tumors
Colorectal Metastases
Neuroendocrine Metastases
Primary Tumors
Hepatocellular Carcinoma
Cholangiocarcinoma
[18F]FDG-PET in the Diagnosis and Staging of Cholangiocarcinomas
Gallbladder Carcinoma
References
28 Diagnostic Applications of Nuclear Medicine: Pancreatic Cancer
Introduction
Epidemiology
Environmental Factors and Genetic Predisposition
Clinical Manifestations and Diagnosis of Pancreatic Cancer
Staging, Prognostic Classification, and Common Therapies
Diagnostic Imaging and Role of Nuclear Medicine in Pancreatic Cancers
Primary Lesion Detection and Characterization
Pancreatic Cancer Staging
Therapy Response Evaluation
Prognostic Significance
Suspect of Relapse
Radiotherapy (RT) Planning
[18F]FDG PET/CT-Guided Biopsy
Other Radiopharmaceuticals
Pancreatic Neuroendocrine Tumors
Somatostatin Receptor Scintigraphy
Metaiodobenzylguanidine (MIBG) Scintigraphy
Gastrin Receptor Scintigraphy
Glucagon-Like Peptide 1 Receptor Imaging
Vasoactive Intestinal Peptide Receptor Scintigraphy
PET/CT Using 68Ga-DOTA-Labeled SSAs
[18F]FDG PET/CT
[18F]FDOPA PET/CT
[11C]5-HTP
PET/MR
Future Directions
Radiomics and Texture Analysis
Artificial Intelligence (AI)
References
29 Diagnostic Applications of Nuclear Medicine: Colorectal Cancer
Overview of Colorectal Cancer: Incidence and Mortality
Prognostic Factors
Staging Classification and Prognosis
Clinical Objectives in Colorectal Cancer
Role of Nuclear Medicine in Colorectal Cancer
Presurgical Staging
Restaging and Follow-Up
Radiotherapy Volume Planning
Treatment Response Evaluation
PET/MRI in CRC
Therapy with Transarterial 90Y-Microspheres
Neuroendocrine Tumors in Large Bowel
References
30 Diagnostic Applications of Nuclear Medicine: Neuroendocrine Tumors
Introductory Background
Generalities on Neuroendocrine Tumors
Biomorphology
Incidence
Histopathological Classification
Clinical Presentation
Gastroenteropancreatic NETs
Bronchopulmonary NETs
Chromaffin Cell NETs
Biochemical Profile
Diagnostic Imaging Techniques
Radiological techniques
Nuclear Medicine Techniques
Rationale of Nuclear Medicine Techniques
Somatostatin Receptor Scintigraphy
Clinical Application
Technique
Interpretation
Meta-iodo-benzylguanidine
Clinical Application
Technique
Interpretation
PET/CT
Clinical Application
Somatostatin Receptor PET/CT
Clinical Application
Technique
Interpretation
18F-DOPA
[11C]C-5-HTP
References
31 Diagnostic Applications of Nuclear Medicine: Kidney and Bladder Cancer
Introduction
Kidney Cancer
Epidemiology
Environmental and Genetic Factors
Symptoms and Diagnosis
Staging of Renal Cell Carcinoma
Overall Performance of Diagnostic Imaging Other Than Nuclear Medicine for Kidney Cancer
[18F]FDG PET/CT for Staging/Prognosis of Renal Cell Carcinoma
PET Radiopharmaceuticals Other Than [18F]FDG
Common Therapies
Bladder Cancer
Epidemiology of Bladder Cancer
Environmental and Genetic Factors
Molecular Biology
Symptoms and Diagnosis
Staging and Prognostic Stratification of Bladder Cancer
Overall Performance of Diagnostic Imaging Other Than Nuclear Medicine for the Tumor
[18F]FDG PET/CT for Staging and Prognosis of Bladder Cancer
PET Radiopharmaceuticals Other Than [18F]FDG
Common Therapies
Treatment of Superficial Bladder Cancer
Treatment of Muscle-Invasive Bladder Cancer
References
32 Diagnostic Applications of Nuclear Medicine: Prostatic Cancer
Introduction: Epidemiology of Prostate Cancer
Prostate Cancer Screening
Primary Diagnosis of Prostate Cancer
Pathology
TNM Classification of Prostate Cancer
Histopathological Grade of Prostate Cancer
Risk Stratification for Prostate Cancer
Management Strategies for Prostate Cancer
Active Surveillance and Watchful Waiting
Radical Prostatectomy (with or without Lymphadenectomy)
External Beam Radiation Therapy
Brachytherapy
High-Intensity Focused Ultrasound Therapy and Cryotherapy
The Role of Radiation Therapy in the Treatment of Metastatic Disease: Beyond Palliation
Prostate-Directed Therapy
Metastasis-Directed Therapy (MDT) for Oligometastatic Disease
Hormone Therapy of Prostate Cancer
Systemic Treatments in Metastatic Prostate Cancer
Metastatic Hormone-Sensitive PCa (mHSPC)
Non-metastatic Castration-Resistant PCa (nmCRPC)
Metastatic Castration-Resistant PCa (mCRPC)
Immunotherapy
Treatment of Skeletal Metastases from Prostate Cancer
Biochemical and Diagnostic Modalities for Prostate Cancer
Laboratory Tests
Radiological Imaging of Prostate Cancer
Nuclear Medicine Modalities for Prostate Cancer
99mTc-Biphosphonates Scintigraphy for Bone-Metastatic Prostate Cancer
18F-Sodium Fluoride PET/CT
[11C]Choline and 18F-Choline PET/CT in Prostate Cancer
PET/CT with 68Ga-PSMA-Ligand and PSMA Derivatives in Prostate Cancer
Perspectives for Therapy of Metastatic Prostate Cancer with Radiolabeled PSMA-Ligands
18F-FACBC PET/CT in Prostate Cancer
[18F]FDG PET/CT in Prostate Cancer
Clinical Considerations
References
33 Diagnostic Applications of Nuclear Medicine: Testicular Cancer
Introduction: Epidemiology of Testicular Cancer
Risk Factors for Testicular Cancer
Genetic Predisposition
Underlying Molecular Biology Changes
Histopathology of Testicular Cancer
Serum Biomarkers
Clinical Presentation, Staging, and Prognostic Stratification
Histologic Grade (G)
Overall Performance of Diagnostic Imaging Other than Nuclear Medicine
Nuclear Imaging for Diagnosis and Staging
Common Therapies
Assessing the Efficacy of Treatment(s)
Assessing Recurrent GCT
Surveillance in Seminomas
Pure Seminoma Stages IA and IB
Follow-Up During Active Surveillance
Follow-Up After Adjuvant Treatment
Pure Seminomas Stages IIA and IIB
Surveillance in NSGCT
References
34 Diagnostic Applications of Nuclear Medicine: Penile Cancer
Epidemiology of Penile Cancer and Environmental Risk Factors
Risk Factors for Penile Cancer and Association with Other Conditions
Prevention of Penile Cancer
Genetic Predisposition
Underlying Molecular Biology Changes for Penile Cancer
Staging and Prognostic Stratification of Penile Cancer
Grading of Penile Cancer
Pathologic Prognostic Factors of Penile Cancer
Lymphatic Involvement in Penile Cancer
Performance of Diagnostic Imaging Other Than Nuclear Medicine
Primary Lesion
Evaluation of Regional Lymph Nodes in Penile Cancer
Distant Metastases from Penile Cancer
Performance of Nuclear Imaging for Staging and Prognosis of Penile Cancer
Staging of Penile Cancer
Follow-Up and Restaging of Penile Cancer
Treatment Options for Penile Cancer
References
35 Diagnostic Applications of Nuclear Medicine: Vulvar Cancer
Introduction
Epidemiology of Vulvar Cancer
Environmental Factors and Genetic Predisposition for Vulvar Cancer
Histopathologic Categories of Vulvar Cancer
Staging and Prognosis of Vulvar Cancer
Clinical Presentation and Management of Vulvar Cancer
Role of Imaging for Vulvar Cancer
Radionuclide Imaging of Vulvar Cancer
[18F]FDG PET Imaging
Lymphoscintigraphy
References
36 Diagnostic Applications of Nuclear Medicine: Uterine Cancers
Cervical Cancer
Epidemiology of Cervical Cancer
Pathophysiology and Clinical Presentation of Cervical Cancer
Diagnosis of Cervical Cancer
Role of Conventional Imaging for Cervical Cancer
[18F]FDG PET/CT Imaging for Cervical Cancer
[18F]FDG PET/CT for Primary Diagnosis Cervical Cancer
[18F]FDG PET/CT for Staging of Cervical Cancer
[18F]FDG PET/CT for Pelvic and Para-Aortic Lymph Node Assessment at Initial Staging, in Locally Advanced and Advanced Cervical...
Prognostic Value of PET/CT in Cervical Cancer
Impact of [18F]FDG PET/CT on Management and Treatment Planning for Cervical Cancer
[18F]FDG PET/CT in Recurrent Cervical Cancer
Endometrial Cancers
Epidemiology of Endometrial Cancers
Pathophysiology and Clinical Presentation of Endometrial Cancers
Role of Conventional Imaging for Endometrial Cancers
Role of [18F]FDG PET/CT in Endometrial Carcinoma
Lymphoscintigraphy for Sentinel Lymph Node Mapping in Endometrial Cancers
References
37 Diagnostic Applications of Nuclear Medicine: Ovarian Cancer
Introduction and Epidemiology of Ovarian Cancer
Pathogenesis of Ovarian Cancer
Pathology of Ovarian Cancer
Staging of Ovarian Cancer
Diagnosis of Ovarian Cancer
Role of Conventional Imaging in Primary Ovarian Cancer
[18F]FDG PET Imaging of Ovarian Cancer
Impact of [18F]FDG PET/CT on Management at Staging of Ovarian Cancer
Imaging in Recurrent Ovarian Cancer
Impact of [18F]FDG PET/CT on Management of Recurrent Ovarian Cancer
Role of [18FFDG PET/CT in Assessment Before Second-Look Laparotomy or Secondary Debulking
[18F]FDG PET/CT for Response Assessment and Prognostication of Ovarian Cancer
PET/MRI in Ovarian Cancer
References
38 Diagnostic Applications of Nuclear Medicine: Sarcomas
Introduction
Osteosarcoma
[18F]FDG PET/CT as a Tool for Staging
Can [18F]FDG PET/CT Be Used to Predict Prognosis in Osteosarcoma?
Conclusion
Ewing Sarcoma
[18F]FDG PET/CT as a Tool for Staging
Can [18F]FDG PET/CT Be Used for Surveillance and to Predict Outcome in Ewing Sarcoma?
Combination of [18F]FDG PET/CT and Circulating Tumor DNA for Ewing Sarcoma
Conclusion
Rhabdomyosarcoma
[18F]FDG PET/CT as a Tool for Staging
Can [18F]FDG PET/CT Be Used to Predict Prognosis in Rhabdomyosarcoma?
Conclusion
Non-rhabdomyosarcoma Soft Tissue Sarcoma
Overall Conclusions
References
39 Diagnostic Applications of Nuclear Medicine: Malignant Melanoma
Introduction
Epidemiology
Risk Factors
Phenotypic
Environmental and Other
Familial/Genetic
Pathogenesis
MAPK (Mitogen-Activated Protein Kinase) Pathway
Tumor Histology
Growth Phases
Histological Patterns
Staging Systems for Melanoma
Breslow Staging, Eighth Ed. AJCC Classification
T Stage
N Stage
M Stage
Prognostic Factors
Treatment for Local and Regional Melanoma
Adjuvant Therapy
Treatment of Metastatic Malignant Melanoma
Novel Therapeutic Approaches
Anti-Angiogenic Therapy
Combined Immunotherapy and Targeted Agents
Role of Nuclear Medicine in Melanoma Patients
Initial Staging of Primary Melanoma
Staging Nodal Metastases
Staging of Metastatic Disease
Initial Staging
Recurrent Metastatic Disease
[18F]FDG PET
Monitoring Treatment Response
Management Impact of [18F]FDG PET/CT
Surveillance
Non-[18F]FDG PET Tracers in Melanoma
Conclusions
References
40 Diagnostic Applications of Nuclear Medicine: Pediatric Cancers
Introduction
Pediatric Brain Tumors
Epidemiology
Symptoms
Role of MRI in Pediatric Brain Tumors
Dosimetric Considerations for PET Scanning
Imaging of Pediatric Brain Tumors with [18F]FDG and with Other PET Tracers
Childhood Lymphomas
Hodgkin´s Lymphoma
Non-Hodgkin´s Lymphoma
Role of Nuclear Medicine Techniques in Lymphomas
[18F]FDG-PET/CT and PET/MRI for Lymphomas
Indications for [18F]FDG PET/CT in Pediatric Lymphomas
Hodgkin´s Lymphoma
Initial Staging
Monitoring of Response to Therapy
Non-Hodgkin´s Lymphoma
Limitations of [18F]FDG PET/CT in Pediatric Lymphomas
False-Negative Results
Physiologic Uptake, Pitfalls, and False-Positive Results
False-Positive Results Can Also Be Treatment-Induced
Prospects
Wilms´ Tumor
Neuroblastoma
MIBG Scintigraphy in Neuroblastoma
Bone Scintigraphy in Neuroblastoma
Positron-Emission Tomography in Neuroblastoma
Morphological and Multimodality Imaging for Neuroblastoma
Conclusion
Pediatric Osseous and Soft-Tissue Sarcomas
Bone Sarcomas
Soft-Tissue Sarcomas
Langerhans Cell Histiocytosis
Role of Imaging in Pediatric Osseous and Soft-Tissue Sarcomas
Three-Phase Bone Scintigraphy
Primary Bone Tumors and Tumor-Like Lesions
Osseous Metastases
Langerhans Cell Histiocytosis
References
Part III: Radionuclide Therapy
41 Radionuclide Therapy of Lymphomas
Rationale and Mechanism of Action
Efficacy and Safety of RIT in Recurrent NHL
Frontline and Consolidation Therapy of Lymphomas with RIT
Logistics of RIT Regimens for Lymphomas and Practical Considerations
Repeat Therapies
Barriers to the Use of RIT
Other Settings for RIT
[18F]FDG-PET for Evaluation of Response to RIT
Other Radiolabeled Monoclonal Antibodies and Strategies for Lymphomas
References
42 Radionuclide Therapy of Leukemias and Multiple Myeloma
Introduction: Overview on Treatment of Leukemias
Treatment of Acute Lymphocytic Leukemia (ALL) in Adults
Treatment of Chronic Lymphocytic Leukemia
Treatment of Hairy Cell Leukemia
Treatment of Acute Myeloid Leukemia (AML)
Treatment of Chronic Myeloid Leukemia (CML)
Therapy of Leukemias with Radiolabeled Antibodies
Therapies with Radiolabeled Anti-CD33 MAb
Therapy of Leukemias with Radiolabeled Anti-CD45 MAb
Therapy of Leukemias with Radiolabeled Anti-CD66 MAb
Treatment of Multiple Myeloma
Radioimmunotherapy in Multiple Myeloma
Radiotherapy of Multiple Myeloma with Bone-Seeking Radionuclides
References
43 Radionuclide Therapy of Thyroid Tumors
Introduction
Primary Treatment of Differentiated Thyroid Cancer
Surgery
Adjuvant/Ablation of Postsurgical Thyroid Remnants with 131I-Iodide
Side Effects of Radioiodide Therapy
Evaluation of Success of Initial Therapy
Levothyroxine Therapy
Follow-Up
Measurement of Serum Tg
Whole-Body Scintigraphy with 131I-Iodide
Neck Ultrasound
Other Diagnostic Procedures
Management of Locoregional Recurrences
Management of Distant Metastases
Advanced DTC Refractory to Radioiodide Treatment
Reinduction of the Ability to Take Up Iodine
Conventional Chemotherapy
New Targeted Therapies
External Beam Radiation Therapy
Treatment of Anaplastic Thyroid Cancer
Initial Treatment of Medullary Thyroid Cancer
Follow-Up of Medullary Thyroid Cancer
Radionuclide Imaging in Recurrent MTC
Treatment for Recurrent or Persistent MTC
References
44 Neuroendocrine Tumors: Therapy with Radiolabeled Peptides
Introduction: Overall Therapeutic Strategy
Peptide Receptor Radionuclide Therapy (PRRT)
Safety of PRRT
Renal Toxicity of PRRT
Hematological Toxicity of PRRT
Dosimetry in PRRT
Efficacy of PRRT
Experience with 111InOctreotide
Experience with 90Y-DOTATOC
GEP NET Tumors
Other Endocrine and EndocrineRegulated Tumors
Experience with 177Lu-DOTATATE in GEP NETs
Efficacy of PRRT in Skeletal Involvement
Efficacy of PRRT in Different Types of NETs
Pancreatic NETs
Small Intestinal NETs
Efficacy of Repeated PRRT Treatments: Salvage Therapy
Efficacy of PRRT in Combination with Chemotherapy or Biomolecular Agents
Efficacy of Combinations of 90Y- and 177Lu-Peptides
Prediction and Monitoring of Response to PRRT
Conclusions
References
45 Neuroendocrine Tumors: Therapy with 131I-MIBG
Introduction
Radionuclide Properties of 131I-MIBG
Low Versus High Specific Activity 131I-MIBG
General Treatment Logistics of 131I-MIBG Therapy
System Requirements
Patient Preparation Prior to 131I-MIBG Therapy
Administration of 131I-MIBG Therapy
Toxicity of 131I-MIBG Therapy
131I-MIBG Therapy for Pheochromocytoma and Paraganglioma
131I-MIBG Therapy for Neuroblastoma
131I-MIBG Therapy for Other Neuroendocrine Tumors
Carcinoid Tumor
Medullary Thyroid Cancer
Future Directions
References
46 Targeted Radionuclide Therapy for Bone Metastasis
Introduction
Pathophysiology of Bone Metastasis
Prevention of Bone Resorption
Radiation Therapy
Radiopharmaceutical Therapy
Mechanism of Action
32P-Orthophosphate
89Sr-Chloride
153Sm-EDTMP (Lexidronam)
Radium-223 Dichloride (223RaCl2)
Other Agents
Rhenium-Labeled Radiopharmaceuticals: 186Re-HEDP and 188Re-HEDP
117mSn-Pentetate and 177Lu-EDTMP
Patient Identification and Referral
Administration of Radiopharmaceutical Agent
Summary
References
47 Radionuclide Therapy of Tumors of the Liver and Biliary Tract
Introduction
Rationale of Radioembolization Therapy for Liver Tumors
Radiolabeled Lipiodol
Radiolabeled Microsphere Devices
90Y-Microspheres
166Ho-Microspheres
Role of Imaging for Planning TARE/SIRT of Liver Tumors
Pre-treatment Imaging for TARE/SIRT
Radiodosimetric Aspects of TARE/SIRT
90Y-/166Ho-Microspheres Administration
Radiation Segmentectomy with TARE/SIRT
Radiation Lobectomy with TARE/SIRT
Bilobar Treatment with TARE/SIRT
Post-TARE/SIRT Scan
Patient Follow-up and Assessment of Response to TARE/SIRT
TARE/SIRT Combined with Other Therapies
Patient Selection for TARE/SIRT
Indications for TARE/SIRT
TARE/SIRT for Primary Liver Tumors
Hepatocellular Carcinoma
Intrahepatic Cholangiocarcinoma
TARE/SIRT for Metastatic Liver Tumors
Metastatic Colorectal Carcinoma
Metastatic Neuroendocrine Tumors
Absolute and Relative Contraindications of TARE/SIRT
Early and Late Toxicities of TARE/SIRT
Perspectives on Radioembolization for Primary and Metastatic Liver Tumors
References
Part IV: Radioguided Surgery
48 Radioguided Surgery for Breast Cancer
Introduction
General Background
Radioguided Surgery for Breast Cancer
Sentinel Lymph Node in Breast Cancer
Pathophysiological Aspects
Indications for Sentinel Lymph Node Biopsy in Breast Cancer
Procedures in Nuclear Medicine for Sentinel Lymph Node Mapping
Radiopharmaceuticals for Sentinel Lymph Node Mapping
Activities and Volumes of Radiopharmaceuticals for Sentinel Lymph Node Mapping
Injection Procedure for Sentinel Lymph Node Mapping
Imaging Procedures for Sentinel Lymph Node Mapping
Timing of Imaging for Sentinel Lymph Node Mapping
Gamma Camera Parameters for Lymphoscintigraphy
Image Interpretation for Sentinel Lymph Node Mapping
Procedures in the Surgical Suite for Sentinel Lymph Node Biopsy
Blue Dye Lymph Node Localization
Radioguided Sentinel Lymph Node Biopsy
SLN Nonvisualization or Failed Intraoperative Detection
Histopathology of SLNs
Qualifications and Responsibilities of Personnel for Radioguided Sentinel Lymph Node Biopsy in Breast Cancer
Clinical Controversial Aspects
Indications for Sentinel Lymph Node Biopsy in Breast Cancer
T3-T4 Tumors
Multiple (Multifocal/Multicentric) Tumors
Ductal Carcinoma In Situ (DCIS) and Breast-Conserving Surgery
Suspicious Palpable Axillary Nodes
Evaluation of Internal Mammary and Other Extra-Axillary Nodes
Previous Surgery
Axillary Lymph Node Dissection
Neoadjuvant Chemotherapy
Recurrence
Pregnancy
Primary Localizing Techniques
Radioguided Occult Lesion Localization (ROLL)
Sentinel Lymph Node and Occult Lesion Localization (SNOLL)
Radioactive Seeds
Added Value of Intraoperative Portable Gamma Cameras for Radioguided Sentinel Lymph Node Biopsy
Radioprotection in Radioguided Surgery for Breast Cancer
Future Perspectives for Radioguided Surgery in Breast Cancer
Concluding Remarks
References
49 Radioguided Surgery for Malignant Melanoma
Introduction
The Clinical Problem
Lymphatics in Cutaneous Melanoma
Indications and Advantages of SLN Biopsy in Melanoma
Technical Issues
Radiotracers
Activity and Injection
Pre-Surgical Lymphoscintigraphy
Additional SPECT/CT Imaging
Clinical Impact of SPECT/CT in Melanoma
Surgery
Sentinel Lymph Node Analysis and Its Importance for Clinical Decision
Refinements to the Conventional Technique
Portable Gamma Cameras
Free-Hand SPECT
Fluorescent and Hybrid Tracers
Particular Issues for SLN Mapping in Melanoma
In-Transit, Aberrant, or Ectopic Lymph Nodes
Head and Neck Location
Clinical Impact of Sentinel Lymph Node Biopsy
Sentinel Node Biopsy in Thin and Thick Melanomas
Role of PET/CT Imaging for Radioguided Surgery
References
50 Radioguided Surgery for Head and Neck Cancer
Introduction
The Sentinel Lymph Node Head and Neck Approach in Melanoma and Oral Cavity Cancer
Lymphatic Drainage and Lymph Node Anatomy of the Neck
Radiotracers and Injection Modalities
Acquisition of Preoperative Lymphoscintigraphy and SPECT/CT
Contribution of SPECT/CT
Reporting Preoperative SLN Mapping
Reporting Common and Rare Variants
Intraoperative SLN Detection
Intraoperative Imaging
Accuracy of Radioguided SLN Biopsy
SLN Mapping to Personalize Neck Irradiation
Current Indications of SLN Biopsy
Other Clinical Head and Neck GOSTT Applications
Thyroid Cancer
Parathyroid Adenoma
References
51 Radioguided Surgery: New Applications, Approaches, and Strategies
Introduction
Working GOSTT Approaches in Interventional Imaging and Radioguided Surgery
General Background of SLN Biopsy
The Evolution of Intraoperative Instrumentation for SLN Biopsy and Other GOSTT Applications
Preoperative Imaging: From Planar Images to Hybrid Computed Tomography
Radiopharmaceuticals for Interventional Molecular Imaging and Radioguided Surgery
Interventional SPECT/CT and PET/CT for GOSTT
Retrieving SPECT/CT and PET/CT Findings in the Operating Room
Novel Technologies and Clinical GOSTT Applications
Urological Malignancies
Gynecological Malignancies
Gastrointestinal Cancer
GOSTT Applications in Other Malignancies
New Strategies Combining Interventional Nuclear Medicine Procedures
Future GOSTT Scenarios
References
52 Molecular Guidance for Planning External Beam Radiation Therapy in Oncology
Introduction
Dose Painting
Image Acquisition and Analysis
Imaging the Radiation-Induced Changes
Central Nervous System
Head and Neck
Bone Marrow
Heart
Lungs
Liver
EBRT Planning Using [18F]FDG PET/CT
EBRT Planning Using [18F]FDG-PET/CT: Head and Neck Cancers
EBRT Planning Using [18F]FDG-PET/CT: Lung Cancers
EBRT Planning Using [18F]FDG-PET/CT: Gastrointestinal Tumors
Esophageal Cancer
Anorectal Cancer
EBRT Planning Using [18F]FDG-PET/CT: Cervical Carcinoma
EBRT Planning Using Non-[18F]FDG PET/CT Tracers
Amino Acids
Phospholipid Metabolism
Peptides
Cellular Proliferation
Hypoxia
Enzymatic Activity
Miscellaneous Tracers of Potential Interest
Use of Non-[18F]FDG Tracers for EBRT Planning in Specific Malignancies
Brain Tumors
Meningiomas
Head and Neck Cancers
Prostate Cancer
Molecular Imaging and EBRT: Future Perspectives
References
Part V: Heart Disease in the Cancer Patient
53 Imaging the Cardiovascular System in the Cancer Patient
Introduction
Cardiac Risk in Noncardiac Surgery
Background
Events
Perioperative Beta-Blockers
Interval Between Stent Placement and Surgery
Determination of Preoperative Cardiovascular Risk
Evaluation of the Presurgical Patient with Intermediate Cardiovascular Risk
Myocardial Perfusion Imaging (MPI) in Preoperative Assessment
Myocardial and Pericardial Tumor Involvement
Cardiac Amyloidosis
Cardiac Function
Chronic Cardiotoxicity
Type I CRCD
Noninvasive Monitoring of Anthracycline Toxicity
Risk Factors for Type 1 CRCD
Late-Onset Cardiomyopathy and the Pediatric Population
Type II CRCD
Monitoring and Management
Reducing Cardiotoxicity
Techniques for Monitoring Cardiac Function
Recommendations
References
Part VI: Adverse Effects of Cancer Therapy
54 Nuclear Medicine in the Assessment of Adverse Effects of Cancer Therapy in the Lung, Kidney, Gastrointestinal Tract, and Ce...
Introduction
Lungs
Chemotherapy-Associated Pulmonary Toxicity
Radiation Pneumonitis
Ventilation/Perfusion Changes Induced by Thoracic Irradiation
Kidney
Chemotherapy-Induced Tubular Injury
Radiation Nephropathy
Digestive Tract
Radiation Damage of the Small Bowel
Liver Damage
Other Injuries of the Digestive Tract
Central Nervous System
Immunotherapy-Related Adverse Effects and [18F]FDG PET/CT
References
Part VII: Teaching Cases in Nuclear Oncology
55 Teaching Cases in Nuclear Oncology: Lymphomas
Diffuse Large B-Cell Lymphoma
Presentation
Findings
Follow-Up
Discussion
Diffuse Large B-Cell Lymphoma
Presentation
Findings
Follow-Up
Discussion
Diffuse Large B-Cell Lymphoma
Presentation
Findings
Follow-Up
Discussion
Hodgkin´s Lymphoma
Presentation
Findings
Hodgkin´s Lymphoma
Presentation
Findings
Follow-Up
Discussion
Hodgkin´s Lymphoma
Presentation
Findings
Discussion
Follicular Lymphoma
Presentation
Findings and Follow-Up
Discussion
Burkitt Lymphoma
Presentation
Findings
Follow-Up
Discussion
Interim PET Evaluation and DLBCL
Determination of ΔSUVmax [7]
ΔSUVmax Interpretation Criteria [7, 8]
Example
Discussion
References
56 Teaching Cases in Nuclear Oncology: Multiple Myeloma
Case No. 1
Presentation
Findings
Follow-Up
Case No. 2
Presentation
Findings
Follow-Up
Discussion
Case No. 3
Presentation
Findings
Discussion
Case No. 4
Presentation
Findings
Follow-Up
References
57 Teaching Cases in Nuclear Oncology: Brain Tumors
Meningioma
Presentation
Findings
Discussion
Meningioma
Presentation
Findings
Discussion
Brain Tumor
Presentation
Findings
Follow-Up
Brain Lymphoma
Presentation
Findings
Discussion
Leptomeningeal Metastasis from NSCLC
Presentation
Findings
Follow-Up and Teaching Point
Multifocal Glioblastoma
Presentation
Findings
Follow-Up
References
58 Teaching Cases in Nuclear Oncology: Head and Neck Cancers
Case No. 1
Presentation
Findings
Follow-Up
Discussion
Case No. 2
Presentation
Findings
Follow-Up
Discussion
Case No. 3
Presentation
Findings
Follow-Up
Discussion
Case No. 4
Case 5
Presentation
Case No. 6
Presentation
Findings
Follow-Up
Case No. 7
Presentation
Findings
Follow-Up
Discussion
Case No. 8
Presentation
Findings
Discussion
References
59 Teaching Cases in Nuclear Oncology: Thyroid Tumors
Case No. 1
Presentation
Findings
Discussion
Case No. 2
Presentation
Findings
Discussion
Case No. 3
Presentation
Findings
Follow-Up
Case No. 4
Presentation
Findings
Discussion
Case No. 5
Presentation
Findings
Follow-Up
Case No. 6
Presentation
Findings
Follow-Up
60 Teaching Cases in Nuclear Oncology: Parathyroid Tumors
Parathyroid Adenocarcinoma
Presentation
Findings
Follow-Up
Discussion
Paraganglioma
Presentation
Findings
61 Teaching Cases in Nuclear Oncology: Breast Cancer
Case No. 1
Presentation
Findings
Discussion
Case No. 2
Presentation
Findings
Discussion
Case No. 3
Presentation
Findings
Discussion
Case No. 4
Presentation
Findings
Discussion
Case No. 5
Presentation
Findings
Discussion
Case No. 6
Presentation
Findings
Discussion
Case No. 7
Presentation
Findings
Follow-Up
Case No. 8
Presentation
Findings
Discussion
References
62 Teaching Cases in Nuclear Oncology: Lung and Mediastinal Tumors
Case No. 1
Presentation
Findings
Discussion
Case No. 2
Presentation
Findings
Discussion
Case No. 3
Presentation
Findings
Discussion
Case No. 4
Presentation
Findings
Follow-Up
Case No. 5
Presentation
Findings
Follow-Up
Case No. 6
Presentation
Findings
Discussion
Case No. 7
Presentation
Findings
Discussion
Case No. 8
Presentation
Findings
Discussion
Case No. 9
Presentation
Findings
Discussion
Case No. 10
Presentation
Findings
Follow-Up
Discussion
Case No. 11
Presentation
Findings
Discussion
63 Teaching Cases in Nuclear Oncology: Esophageal Cancers
Case No. 1
Case No. 2
Case No. 3
Case No. 4
Case No. 5
64 Teaching Cases in Nuclear Oncology: Gastric Cancers
Case No. 1
Presentation
Findings
Follow-Up
Teaching Point
Case No. 2
Presentation
Findings
Teaching Point
Case No. 3
Presentation
Findings
Follow-Up
Teaching Point
Case No. 4
Presentation
Findings
Follow-Up
Teaching Point
Case No. 5
Presentation
Findings
Follow-Up
Teaching Point
65 Teaching Cases in Nuclear Oncology: Small Bowel Cancers
Case No. 1
Presentation
Findings
Teaching Point
Case No. 2
Presentation
Findings
Follow-Up
Teaching Point
Case No. 3
Presentation
Findings
Discussion
Teaching Point
Case No. 4
Presentation
Findings
Discussion
Small Bowel Tumors: Case No. 5
Presentation
Findings
Follow-Up
Discussion
Case No. 6
Presentation
Findings
Follow-Up
Teaching Point
Case No. 7
Presentation
Findings
Follow-Up
Teaching Point
Case No. 8
Presentation
Findings
Management
Teaching Point
66 Teaching Cases in Nuclear Oncology: Tumors of the Liver and Biliary Tract
Case No. 1
Presentation
Findings
Follow-Up
Teaching Point
Case No. 2
Presentation
Findings
Teaching Point
Case No. 3
Presentation
Findings
Follow-Up
Teaching Point
Case No. 4
Presentation
Findings
Follow-Up
Teaching Point
Case No. 5
Presentation
Findings
Follow-Up
Teaching Point
Case No. 6
Presentation
Findings
Follow-Up
Teaching Point
Case No. 7
Presentation
Findings
Follow-Up
Teaching Point
67 Teaching Cases in Nuclear Oncology: Pancreatic Cancer
Case No. 1
Presentation
Findings
Discussion
Case No. 2
Presentation
Findings
Discussion
Case No. 3
Presentation
Follow-Up
Case No. 4
Presentation
Findings
Case No. 5
Presentation
Findings
Case No. 6
Presentation
Findings
Case No. 7
Presentation
Findings
Teaching Point
Case No. 8
Presentation
Findings
68 Teaching Cases in Nuclear Oncology: Colorectal Cancer
Case No. 1
Presentation
Findings
Discussion
Case No. 2
Presentation
Findings
Discussion
Case No. 3
Presentation
Findings
Discussion
Case No. 4
Presentation
Findings
Discussion
Case No. 5
Presentation
Findings
Case No. 6
Presentation
Findings
Discussion
Case No. 7
Presentation
Findings
Discussion
Case No. 8
Presentation
Findings
69 Teaching Cases in Nuclear Oncology: Neuroendocrine Tumors
Case No. 1
Presentation
Findings
Discussion
Case No. 2
Presentation
Findings
Discussion
Case No. 3
Presentation
Findings
Discussion
Case No. 4
Presentation
Findings
Teaching Point
Case No. 5
Presentation
Findings
Follow-Up
Case No. 6
Presentation
Follow-up
Case No. 7
Presentation
Findings
Follow-Up
Case No. 8
Presentation
Findings
Discussion
Case No. 9
Presentation
Findings
Discussion
Case No. 10
Presentation
Findings
Discussion
70 Teaching Cases in Nuclear Oncology: Kidney and Bladder Cancers
Case No. 1
Presentation
Findings
Discussion
Case No. 2
Presentation
Findings
Follow-Up
Discussion
Case No. 3
Presentation
Findings
Follow-Up
Teaching Points
Case No. 4
Presentation
Findings
Management
Teaching Points
Case No. 5
Presentation
Findings
Follow-Up
Teaching Points
Case No. 6
Presentation
Findings
Teaching Points
Case No. 7
Presentation
Findings
Follow-Up
Teaching Points
Case No. 8
Presentation
Findings
Management
Teaching Points
Case No. 9
Presentation
Findings
Follow-Up
Teaching Point
Case No. 10
Presentation
Findings
Follow-Up
Teaching Point
Case No. 11
Presentation
Findings
Follow-Up
Discussion
71 Teaching Cases in Nuclear Oncology: Prostatic Cancer
Case No. 1
Presentation
Findings
Teaching Points
Case No. 2
Presentation
Findings
Teaching Points
Case No. 3
Presentation
Findings
Follow-Up
Teaching Points
Case No. 4
Presentation
Findings
Follow-Up
Teaching Point
Case No. 5
Presentation
Findings
Follow-Up
Teaching Point
Case No. 6
Presentation
Findings
Follow-Up
Teaching Point
Case No. 7
Presentation
Findings
Follow-Up
Teaching Points
Case No. 8
Presentation
Findings
Teaching Points
Case No. 9
Presentation
Findings
Teaching Point
Case No. 10
Presentation
Findings
Follow-Up
Teaching Point
Case No. 11
Presentation
Findings
Follow-Up
Teaching Points
Case No. 12
Presentation
Findings
Teaching Points
Case No. 13
Presentation
Findings
Teaching Point
Case No. 14
Presentation
Findings
Follow-Up
Teaching Point
72 Teaching Cases in Nuclear Oncology: Testicular Cancer
Case No. 1
Presentation
Findings
Discussion
Case No. 2
Presentation
Findings
Case No. 3
Presentation
Findings
Discussion
References
73 Teaching Cases in Nuclear Oncology: Penile Cancer
Case No. 1
Presentation
Findings
Discussion
Case No. 2
Presentation
Findings
Follow-Up
Discussion
Case No. 3
Presentation
Findings and Follow-Up
Discussion
Case No. 4
Presentation
Findings
Discussion
References
74 Teaching Cases in Nuclear Oncology: Vulvar Cancer
Case No. 1
Presentation
Findings
Discussion
Case No. 2
Presentation
Findings
Discussion
Case No. 3
Presentation
Findings
Discussion
Case No. 4
Presentation
Findings
Discussion
75 Teaching Cases in Nuclear Oncology: Uterine Cancers
Case No. 1
Presentation
Findings
Discussion
Case No. 2
Presentation
Findings
Discussion
Case No. 3
Presentation
Findings
Discussion
Case No. 4
Presentation
Findings
Discussion
Case No. 5
Presentation
Findings
Discussion
Case No. 6
Presentation
Findings
Discussion
Case No. 7
Presentation
Findings
Follow-Up
Discussion
Case No. 8
Presentation
Findings
Radiation Therapy Planning
Case No. 9
Presentation
Findings
Follow-Up
Case No. 10
Presentation
Findings
Discussion
References
76 Teaching Cases in Nuclear Oncology: Ovarian Cancer
Case No. 1
Findings
Discussion
Case No. 2
Presentation
Findings
Discussion
Case No. 3
Presentation
Findings
Discussion
Case No. 4
Presentation
Findings
Discussion
Suggested Readings
77 Teaching Cases in Nuclear Oncology: Sarcomas
Case No. 1
Presentation
Findings
Discussion
Case No. 2
Presentation
Findings
Case No. 3
Presentation
Findings
Discussion
Case No. 4
Presentation
Findings
Discussion
Case No. 5
Presentation
Findings
Discussion
Case No. 6
Presentation
Findings
Follow-Up
Discussion
Case No. 7
Presentation
Findings
Follow-Up
Case No. 8
Presentation
Findings
Discussion
78 Teaching Cases in Nuclear Oncology: Malignant Melanoma
Case No. 1
Presentation
Findings
Discussion
Case No. 2
Presentation
Findings
Discussion
Case No. 3
Presentation
Findings
Discussion
Case No. 4
Presentation
Findings
Discussion
Case No. 5
Presentation
Findings
Discussion
Case No. 6
Presentation
Findings
Discussion
Case No. 7
Presentation
Findings
Discussion
Case No. 8
Presentation
Findings
Discussion
Case No. 9
Presentation
Findings
Follow-Up
Discussion
Case No. 10
Presentation
Findings
Discussion
Case No. 11
Presentation
Discussion
Case No. 12
Presentation
Discussion
79 Teaching Cases in Nuclear Oncology: Pediatric Cancers
Neuroblastoma: Case No. 1
Presentation
Findings
Follow-Up
Teaching Point
Neuroblastoma: Case No. 2
Presentation
Findings
Follow-Up
Teaching Point
Neuroblastoma: Case No. 3
Presentation
Findings
Follow-Up
Teaching Point
Neuroblastoma: Case No. 4
Presentation
Findings
Management
Teaching Point
Neuroblastoma: Case No. 5
Presentation
Findings
Management
Teaching Points
Neuroblastoma: Case No. 6
Presentation
Findings
Management
Teaching Points
Neuroblastoma: Case No. 7
Presentation
Findings
Management
Teaching Point
Neuroblastoma: Case No. 8
Presentation
Findings
Management
Teaching Point
Neuroblastoma: Case No. 9
Presentation
Findings
Follow-Up
Teaching Point
Ewing Sarcoma
Presentation
Findings
Follow-Up
Lymphoma: Case No. 1
Presentation
Findings
Follow-Up
Teaching Points
Lymphoma: Case No. 2
Presentation
Findings
Follow-Up
Teaching Point
Lymphoma: Case No. 3
Presentation
Findings
Teaching Point
80 Teaching Cases in Nuclear Oncology: Investigating the Heart in Cancer Patients
Introduction
Case No. 1
Presentation
Procedure
Findings
Comments
Outcome
Case No. 2
Presentation
Procedure
Findings
Comments
Case No. 3
Presentation
Procedure
Image Findings
Impression
Comment
Case No. 4
Presentation and Procedure
Comments
Case No. 5
Presentation
Procedure
Image Findings
Comment
Case No. 6
Presentation
Procedure
Comments
Case No. 7
Presentation
Procedure and Findings
Teaching Point
Case No. 8
Presentation
Procedure and Findings
Follow-Up
Teaching Point
Case No. 9
Presentation
Procedure and Findings
Follow-Up
Teaching Point
Takeaway
References
Index