Purpose Prostate-specific membrane antigen (PSMA) PET/CT is increasingly used in patients with biochemically recurrent prostate cancer (BCR), mostly using gallium-68 ( 168 Ga)-labelled radiotracers. Alternatively, fluorine-18 ( 18 F)-labelled PSMA tracers are available, such as 18 F-DCFPyL, which offer enhanced image quality and therefore potentially increased detection of small metastases. In this study we evaluate the lesion detection efficacy of 18 F-DCFPyL PET/CT in patients with BCR and determine the detection efficacy as a function of their PSA value. Methods A total of 248 consecutive patients were evaluated and underwent scanning with 18 F-DCFPyL PET/CT for BCR between November 2016 and 2018 in two hospitals in the Netherlands. Patients were examined after radical prostatectomy (52%), external-beam radiation therapy (42%) or brachytherapy (6%). Imaging was performed 120 min after injection of a median dose of 311 MBq 18 F-DCFPyL. Results In 214 out of 248 PET/CT scans (86.3%), at least one lesion suggestive of cancer recurrence was detected (‘positive scan’). Scan positivity increased with higher PSA values: 17/29 scans (59%) with PSA values <0.5 ng/ml; 20/29 (69%) with PSA 0.5 to <1.0 ng/ml; 35/41 (85%) with PSA 1.0 to <2.0 ng/ml; 69/73 (95%) with PSA 2.0 to <5.0 ng/ml; and 73/76 (96%) with PSA ≥5.0 ng/ml. Interestingly, suspicious lesions outside the prostatic fossa were detected in 39–50% of patients with PSA <1.0 ng/ml after radical prostatectomy (i.e. candidates for salvage radiotherapy). Conclusion 18 F-DCFPyL PET/CT offers early detection of lesions in patients with BCR, even at PSA levels <0.5 ng/ml. These results appear to be comparable to those reported for 68 Ga-PSMA and 18 F-PSMA-1007, with potentially increased detection efficacy compared to 68 Ga-PSMA for patients with PSA <2.0. Electronic supplementary material The online version of this article (10.1007/s00259-019-04385-6) contains supplementary material, which is available to authorized users.

There is increasing interest in PET/CT with prostate-specific membrane antigen (PSMA) tracers for imaging of prostate cancer because of the higher detection rates of prostate cancer lesions than with PET/CT with choline. For Ga-PSMA-11 tracers, late imaging at 180 min after injection instead of imaging at 45-60 min after injection improves the detection of prostate cancer lesions. ForF-DCFPyL, improved detection rates have recently been reported in a small pilot study. In this study, we report the effects of PET/CT imaging at 120 min after injection of F-DCFPyL in comparison to images acquired at 60 min after injection in a larger clinical cohort of 66 consecutive patients with histopathologically proven prostate cancer. Images were acquired 60 and 120 min after injection of F-DCFPyL. We report the positive lesions specified for anatomic locations (prostate, seminal vesicles, local lymph nodes, distant lymph nodes, bone, and others) at both time points by visual analysis, the image quality at both time points, and a semiquantitative analysis of the tracer activity in both prostate cancer lesions as well as normal tissues at both time points. Our data showed a significantly increasing uptake of F-DCFPyL between 60 and 120 min after injection in 203 lesions characteristic for prostate cancer (median, 10.78 vs. 12.86, < 0.001, Wilcoxon signed-rank test). By visual analysis, 38.5% of all patients showed more lesions using images at 120 min after injection than using images at 60 min after injection, and in 9.2% a change in TNM staging was found. All lesions seen on images 60 min after injection were also visible on images 120 min after injection. A significantly better mean signal-to-noise ratio of 11.93 was found for images acquired 120 min after injection ( < 0.001, paired test; signal-to-noise ratio at 60 min after injection, 11.15).F-DCFPyL PET/CT images at 120 min after injection yield a higher detection rate of prostate cancer characteristic lesions than images at 60 min after injection. Further studies are needed to elucidate the best imaging time point for F-DCFPyL.

Although the detection of early bone metastases in men with prostate cancer remains a challenge in today's medicine, current guidelines state that bone scintigraphy with Tc-phosphonates (Tc-BS) is the most sensitive method for assessing bone metastases in these patients. In general, it is stated that bone scintigraphy has reasonable sensitivity and low specificity. The aim of this study was to present a review of the contemporary literature on the performance of F-fluoride and C-choline or F-choline and to reconsider the arguments based on which the present European and US guidelines are founded. A literature search was conducted using the Medline database. Data were taken from eligible studies and the level of evidence was scored. Data were pooled to calculate the weighted sensitivity and specificity. Thirteen studies were eligible for inclusion in this review. On a lesion basis, we found a sensitivity and specificity of 84.0 and 97.7% for C-choline and F-choline and 88.6 and 90.7% for F-fluoride, respectively. On a patient basis, the sensitivity and specificity were 85.2 and 96.5% for C-choline and F-choline and 86.9 and 79.9% for F-fluoride, respectively. No significant differences were found between the sensitivity and specificity of C-choline or F-choline and F-fluoride. There was large inconsistency in the reported sensitivity (range 39-100%) and specificity (range 57-80%) for Tc-BS. The literature provides evidence for superior detection of bone metastases by both F-fluoride PET and F-choline or C-choline PET with or without computed tomography (CT) compared with conventional Tc-BS. Guidelines should include F-fluoride PET/CT and C-choline or F-choline PET/CT as alternatives for Tc-BS for the detection of bone metastases in patients with prostate cancer.

Infectious ileocecitits caused by yersinia, campylobacter, and salmonella -clinical, radiological and us findings Puylaert, J.B.C.M.; van der Zant, F.M.; Mutsaers, J.A.E.M. Published in: European Radiology DOI:10.1007/s003300050098Link to publication Citation for published version (APA): Puylaert, J. B. C. M., van der Zant, F. M., & Mutsaers, J. A. E. M. (1997). Infectious ileocecitits caused by yersinia, campylobacter, and salmonella -clinical, radiological and us findings. European Radiology, 7(1), 3-9. https://doi.org/10.1007/s003300050098 General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Download date: 20 Jun 2019 IntroductionIt is well known that the bacteria Yersinia enterocolitica, Campylobacter jejuni, and Salmonella enteritidis are important causes of diarrhea in humans. It is less known that the same microorganisms may also cause an appendicitis-mimicking syndrome, in which case the infection is confined to the ileocecal area [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. In these patients right lower abdominal pain is the predominant symptom, whereas diarrhea is absent or only mild. Due to this symptomatology, this otherwise innocuous and self-limiting bowel infection may lead to an unnecessary laparotomy for suspected appendicitis.The use of US with graded compression has greatly enhanced the diagnostic accuracy in patients with acute right lower abdominal pain [21][22][23][24]. In patients with the above-described appendicitis-mimicking syndrome due to Yersinia, Campylobacter, or Salmonella, a fairly characteristic US pattern can be demonstrated. This enables a rapid diagnosis and therewith exclusion of appendicitis [25][26][27][28][29][30][31]. In view of the constant clinical and morphological features and its common bacterial origin, the condition has been named bacterial ileocecitis (Table 1) [19]. Because analogous clinical, sonographic, and barium findings have also been described in viral, fungal, protozoan, and helminthic infections of the ileocecal area, the term infectious ileocecitis may be more appropriate [32][33][34][35][36].This article reflects a 9-year experience with infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella and describes its clinical, microbiological, epidemiological, radiolog...

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IntroductionTens of different Prostate Specific Membrane Antigen (PSMA) targeting radiopharmaceuticals for both imaging and therapy have been synthesized. Although variability in biodistribution and affinity for binding to the PSMA receptor between different PSMA targeting radiopharmaceuticals are known, little is known about the clinical implications of those variabilities. Therefore, in this study differences in interreader agreement and detection rate between two regularly used 18 F-labeled PSMA-receptor targeting radiopharmaceuticals [ 18 F]-DCFPyL and [ 18 F]-PSMA-1007 were analyzed. Material and methods One hundred and twenty consecutive patients scanned with [ 18 F]-PSMA-1007 were match-paired with 120 patients scanned with [ 18 F]-DCFPyL. All 240 PET/CTs were reviewed by two readers and scored according to PSMA-RADS reading criteria for PSMA PET/CT. Inter-reader agreement and detection rate of suspected lesions were scored for different anatomical locations including prostate/prostatic fossa, lymph nodes, bone, and other locations. ResultsLarge equality between [ 18 F]-DCFPyL and [ 18 F]-PSMA-1007 was found; however, some clinically relevant and statistically significant differences were observed. [ 18 F]-PSMA-1007 detected suspected prostatic/prostatic fossa lesions in a higher proportion of patients and especially in the subcohort of patients scanned for biochemical recurrence. [ 18 F]-DCFPyL and [ 18 F]-PSMA-1007 showed equal ability for detection of suspected lymph nodes, although inter-reader agreement for [ 18 F]-DCFPyL was higher. [ 18 F]-DCFPyL showed less equivocal skeletal lesions and higher inter-reader agreement for skeletal lesions.The majority of equivocal lesions found with PSMA-1007 (at least were determined to be aof nonmetastatic origin. ConclusionClinically relevant differences, which may account for diagnostic dilemmas, were observed between of [ 18 F]-DCFPyL and [ 18 F]-PSMA-1007. Those findings encourage further studies, as they may have consequences for selection of the proper PSMA targeting radiopharmaceutical.

Background 18 F-fluorocholine (FCH) PET/CT is a promising technique for visualizing hyperfunctioning parathyroid glands in hyperparathyroidism. It is still under debate whether to use this technique as a first-line imaging modality or to use it when conventional techniques such as 99m Tc-sestamibi scintigraphy or ultrasonography are inconclusive. This study evaluates FCH PET/CT as a first-line modality. Methods Patients with primary hyperparathyroidism, referred between June 2015 and December 2018 for FCH PET/CT as a first-line imaging method, were included in this study. Baseline characteristics, clinical data, scan results, and type of treatment were recorded. The rate of correct detection was calculated on a per patient-based and a per lesion-based analysis. The reference standard comprised histopathological results, intraoperative response to parathyroidectomy, and clinical follow-up. Results Two hundred and seventy-one patients were included, of which 139 patients underwent parathyroidectomy, 48 were treated with calcimimetics, and 84 patients received further follow-up without active treatment. In the surgically treated group, a single adenoma was suspected in 127 scans, double adenoma in three scans, and one scan showed evidence of three hyperfunctioning glands. In eight scans, no lesions were visualized. A total of 154 parathyroid glands were surgically removed. The rate of correct detection was calculated at 96% and 90%, on a per patient-based and per lesion-based analysis, respectively. Conclusion This retrospective study in a large cohort shows high detection rates of FCH PET/CT in primary hyperparathyroidism, which is in accordance to literature. The use of FCH PET/CT as a first-line imaging modality in preoperative planning of parathyroid surgery may therefore be a suitable choice.

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