Physiologic distribution of Ga-PSMA comprises uptake in lacrimal and salivary glands, vocal cords, Waldeyer ring, liver, spleen, and kidneys as well as various parts of the intestine. Moreover, nonspecific tracer uptake is regularly found in the thyroid and the synovia of the knee. Incidental Ga-PSMA uptake can occasionally reveal nonprostate cancer-associated remodeling processes, such as fibrous dysplasia.

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BackgroundAntibodies (ABs) against the 65-kDa isoform of the intracellular enzyme glutamate decarboxylase (GAD65) have been found in limbic encephalitis (LE) and other neurological conditions. The direct significance of anti-GAD65-ABs for epilepsy is unclear. However, in histological preparations from biopsies of resective epilepsy surgeries, predominantly cytotoxic T-lymphocytes were detected making close contacts to neurons. Activated T-lymphocytes can, in turn, be selectively controlled by therapeutic interleukin-2 receptor Abs, such as basiliximab.Case presentationWe report of a 25-year-old male patient with epilepsy since the age of 18 and displaying clinical signs of LE and a high titer of GAD65 ABs in cerebrospinal fluid (CSF) and serum. Monthly, repetitive, intravenous cortisone pulse therapies that were initially administered for 6 months failed to improve his condition. Subsequent flow-cytometry analysis of CSF showed especially an increased fraction of activated HLA-DR+ CD8+ T-lymphocytes (fCD8+TL) when compared to controls. Thus, a second, intravenous cortisone pulse therapy with an additional basiliximab dose of 20 mg/month was started. After 3 months, the fCD8+TL in the CSF normalized; after 6 months, the psychological impulse-control deficits normalized; and after 11 months the patient was seizure free. However, 7 weeks later, seizures and, later on, psychological deficits recurred and fCD8+TL was once again present in the CSF. Flumazenil PET, magnetic resonance imaging-volumetry, and neuropsychological changes during therapy are described.ConclusionThe correlation of the fCD8+TL in the CSF with clinical and paraclinical measures of disease activity combined with the unambiguous response to basiliximab strongly argues in favor of the putative pathogenic role fCD8+TL in anti-GAD65 LE. The clinical relapse at the end of the observation period might be due to the formation of human anti-drug ABs, a well-known complication of therapy with chimeric ABs.

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The present work describes two radiosynthetic pathways to prepare homocysteine[ 75 Se]selenolactone 1 starting from n.c.a. [ 75 Se]selenite 2. It was achieved either by alkylation reaction of n.c.a. methyl[ 75 Se]selenide 4 or by hydrolysis of alkylated 1,3-dicyclohexyl[ 75 Se]selenourea 11. N.c.a. methyl[ 75 Se]selenide 4 is available using sulfur as non-isotopic carrier. However, the radiochemical yield of the substitution of 2-tert.-butoxycarbonylamino-4-bromobutyric acid ethylester 5 with n.c.a. methyl-[ 75 Se]selenide is only in the range of 15%-20%. Birch reduction of protected n.c.a. [ 75 Se]selenomethionine 6 formed leads to a RCY of 5%-10% homocysteine[ 75 Se]selenolactone 1. Alternatively, the synthesis of homocysteine[ 75 Se]selenolactone 1 is possible by hydrolysis of the corresponding [ 75 Se]selenouronium salt 11 available by addition of 2-tert.-butoxycarbonylamino-4-bromobutyric acid ethylester 5 to 1,3-dicyclohexyl[ 75 Se]selenourea 10. A method was developed for the synthesis of 1,3-dicyclohexyl[ 75 Se]selenourea 10 by addition of c.a. [ 75 Se]SeH 2 to 1,3-dicyclohexylcarbodiimide, which leads to 20%-30% RCY of c.a. homocysteine[ 75 Se]selenolactone 1.

Due to technological developments in positron emission tomography (PET) detectors and PET-MR integration, the simultaneous measurement of PET-MR-EEG has become feasible, offering the possibility of exploring the complementary information provided by each modality. Studies have already shown the benefits of simultaneous measurement using PET-MR, however, such achievements come with different technical and practical challenges. In this context, we aim to give an overview of the technical challenges involved in integrating electroencephalography with hybrid PET-MR scanners and demonstrate possible solutions. When acquiring simultaneous data from multiple modalities, the data acquisition protocol should be optimized in order to utilize time and complementary information most effectively. Thus, practical considerations with regard to Manuscript

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