Nuclear Oncology: From Pathophysiology to Clinical Applications

Description

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. 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