Volum Rezumate ZMN 2023 1

ABSTRACTS E-BOOK
10th Edition of The Balkan Congress of Nuclear Medicine

&
5th Romanian Congress of Nuclear Medicine
Coordinators:
Dr. Raluca Mititelu
Prof. Dr. Doina Piciu
Prof. dr. Cipriana Stefanescu
Prof. Dr. Mirela Gherghe
ISSN 2734 – 7303 ISSN-L 2668 – 3717

Nr.3/2023, Bucharest, 2023
15th-18th March 2023, Romania

2
TABLE OF CONTENT
INVITED LECTURES
1. EVALUATION OF CHANG ATTENUATION CORRECTION METHOD IN SINGLE PHOTON EMISSION COMPUTED
TOMOGRAPHY ................................................................................................................................................................. 8
MILENA DIMCHEVA1, TEODOR SOFIYANSKI1, SONYA SERGIEVA1, BOZHIL ROBEV2 .................................................................................. 8
2. SPECT-CT IN FOOT AND ANKLE PATHOLOGY ............................................................................................................. 9
DR. DIANA ENE ....................................................................................................................................................................... 9
3. OLDIES BUT GOODIES. LOST CONVENTIONAL NUCLEAR MEDICINE EXAMS.............................................................. 9
DR. DIANA ENE ....................................................................................................................................................................... 9
3. SOMATOSTATIN RECEPTOR ANALOGUES SPECT- CT : IS IT STILL A FEASIBLE CHOICE FOR DIAGNOSING
GASTROENTEROPANCREATIC NETS?............................................................................................................................... 10
MIRELA GHERGHE .................................................................................................................................................................. 10
4. COMPARISON OF THE IMPACT OF TWO VERSIONS OF REAGENT AND ANCILLARY SETS ON THE [18F]FDG
RADIOCHEMICAL YIELD .................................................................................................................................................. 11
KATERINA KOLEVSKA1, MAJA CHOCHEVSKA1, MARIJA ATANASOVA LAZAREVA1, MAJA VELICHKOVSKA1, FILIP JOLEVSKI1, JASMINA RAZMOSKA1,
ANA UGRINSKA1 .................................................................................................................................................................... 11
5. ROLE OF GA68-PSMA PET/CT IN DETECTING EARLY RELAPSE OF DISEASE IN PATIENTS OF INTERMEDIATE AND HIGH
RISK PROSTATE CANCER WITH BIOCHEMICAL RECURRENCE AFTER DEFINITE RADICAL THERAPY. .................................. 12
RAKESH KUMAR1, SANJAY KUMAR2, CHETAN PATEL1, ANIL KUMAR PANDEY1. .................................................................................... 12
6. 18F-FDG PET-CT ROLE IN MANAGEMENT OF MALIGNANT MELANOMA ................................................................ 13
7. DIFFERENTIATED THYROID CANCER- NEW APPROACH FOR APPLICATION OF I-131 ................................................ 14
JASNA MIHAILOVIC1,2 .............................................................................................................................................................. 14
8. RADIOLABELING OF DOXYCYCLINE WITH 177LU AND BIODISTRIBUTION IN TUMOR-BEARING MICE ....................... 15
Z. MILANOVIĆ, M. RADOVIĆ, D. STANKOVIĆ, M. PERIĆ, A. VUKADINOVIĆ, D. JANKOVIĆ , S. VRANJEŠ ĐURIĆ, M. MIRKOVIĆ ..................... 15
9. 18F-FDG PET-CT IN LUNG CANCER ......................................................................................................................... 16
10. LEAD FREE POLYMER COMPOSITES FOR RADIATION SHIELDING ........................................................................ 17
M. PERIĆ1, G. VUKOVIĆ2, S. KNEŽEVIĆ1, M. NIKOLIĆ3, M. SULJAGIĆ4, LJ. ANDJELKOVIĆ4, S. NENADOVIĆ1, M. IVANOVIĆ1, M. MIRKOVIĆ1, V.B.
PAVLOVIĆ5 ............................................................................................................................................................................ 17
11. QUANTITATIVE PET/CT – HOW HUGE A SMALL ERROR CAN BE .......................................................................... 18
CLAUDIU PESTEAN .................................................................................................................................................................. 18
12. PROPHYLACTIC LYMPH NODE DISSECTION AND ITS INFLUENCE ON THE DECISION OF RADIOACTIVE IODINE
TREATMENT IN CLINICALLY NODE NEGATIVE PAPILLARY THYROID CARCINOMA ............................................................ 19
MARINA POPOVIC KRNETA1, BILJANA BAZIC DJOROVIC1, MARKO BUTA2,3, MILICA STOJILJKOVIC3,4, DRAGANA SOBIC SARANOVIC,3,4, LJILJANA
MIJATOVIC TEODOROVIC1,5 ...................................................................................................................................................... 19
3
13. CLINICAL APPLICATION OF SLN MAPPING WITH SUBSEQUENT SPECT/CT TOPOGRAPHY IN MALIGNANT
MELANOMA................................................................................................................................................................... 20
PROFESSOR SONYA SERGIEVA.................................................................................................................................................... 20
14. CHOOSING THE PROTOCOL OF PARATHYROID SCINTIGRAPHY - A CHALLENGE BETWEEN SENSITIVITY AND
DOSIMETRY ................................................................................................................................................................... 21
DIANA TEODORESCU-PERIJOC 1, MIHAELA-GEANINA GUȚU1, ANDREEA BABAN3,4, DIMITRIE-CRISTIAN SIRIOPOL1,5, MIHAI-MARIUS GUȚU1,2 21
ORAL PRESENTATION
1. BACILLUS CALMETTE–GUÉRIN INSTILLATIONS–INDUCED LYMPHADENITIS MIMICS DISEASE PROGRESSION ON 18F-
FDG PET/CT, IN A CASE OF BLADDER CARCINOMA. A CASE REPORT. .............................................................................. 23
IULIA ALMĂȘAN1,2, ANDRA PICIU3,4, ROXANA RADU4, DOINA PICIU 1,2,4 ........................................................................................... 23
2. THE ROLE OF LYMPHOSCINTIGRAPHY IN THE ASSESSMENT OF LYMPHANGIOGENESIS AFTER VASCULARIZED LYMPH
NODE TRANSFER IN PATIENTS WITH LYMPHEDEMA. ...................................................................................................... 24
3. DPD SCINTIGRAPHY FOR CARDIAC AMYLOIDOSIS: A SINGLE CENTRE EXPERIENCE AND REVIEW OF ITS PAST,
PRESENT AND POSSIBLE FUTURE USE ............................................................................................................................ 25
SIMONA F. GRIGORE1, EMMA WILSON1, ROSARIO CORONADO1, HELEN J. LACHMANN1, JULIAN D. GILLMORE1, ASHUTOSH D. WECHALEKAR1,
CAROL J. WHELAN1, BRENDAN WISNIOWSKI1, MARIANNA FONTANA1, ANA MARTINEZ DE AZCONA NAHARRO1, SHAMEEM MAHMOOD1, AND
DAVID F. HUTT1 ..................................................................................................................................................................... 25
4. PATIENTS’ HISTORY: A GLIMPSE FOR A POSSIBLE DIAGNOSIS OF ATTR CARDIAC AMYLOIDOSIS ............................. 26
IONESCU TEODOR MARIAN1, JALLOUL WAEL1, STOLNICEANU CATI RALUCA1, GRIEROSU IRENA1,2, IACOB ROXANA3, CIOCOIU MANUELA1,
LUPUȘORU RAOUL VASILE1, CLEMENT ALEXANDRA1,4, SASCĂU RADU-ANDY1,4, PETRIȘ OCTAVIAN ANTONIU1,5, ȘTEFĂNESCU CIPRIANA1,2 ..... 26
5. NUCLEAR MEDICINE TIES THE KNOT BETWEEN BROWN ADIPOSE TISSUE AND PARATHYROID PATHOLOGIES ........ 27
WAEL JALLOUL1, IRENA CRISTINA GRIEROSU1,2, TEODOR IONESCU1, CATI STOLNICEANU1,2, VLAD GHIZDOVAT1, MIHAELA MOSCALU1, MIHAI
GUTU1, CIPRIANA STEFANESCU1,2 .............................................................................................................................................. 27
6. COULD A COMBINATION OF RADIONUCLIDE VENTRICULOGRAPHY AND CARDIAC BIOMARKERS PREDICT
CARDIOTOXICITY IN BREAST CANCER PATIENTS TREATED WITH HER2-INHIBITORS? ....................................................... 28
ALEXANDRA MARIA LAZAR1, MARIO-DEMIAN MUTULEANU1,2, IONELA-NICOLETA IRIMESCU1, ROBERT MAAZ1, CRISTINA PETROIU 1, MIRELA
GHERGHE1,2 .......................................................................................................................................................................... 28
7. QUANTITATIVE 99MTC-PYP SPECT/CT IN PATIENTS SUSPECTED WITH TRANSTHYRETIN-RELATED CARDIAC
AMYLOIDOSIS: FEASIBILITY AND CORRELATION WITH SEMIQUANTITATIVE INDICES. ..................................................... 29
ALEXANDRA MARIA LAZAR1, MARIO-DEMIAN MUTULEANU1,2, ANDREEA JERCAN3, SORINA NICOLETA BADELITA3, DANIEL CORIU3,4, MIRELA
GHERGHE1,2 .......................................................................................................................................................................... 29
8. EVALUATION OF THERAPY RESPONSE IN SOLID BONE TUMOR METASTASES BY QUANTITATIVE SPECT-CT HYBRID
IMAGING ....................................................................................................................................................................... 30
M.MUTULEANU1,2, A.LAZAR2, M.GHERGHE1,2 ............................................................................................................................ 30
99M
9. TC PYROPHOSPHATE SPECT/CT IN CARDIAC AMILOIDOSIS ................................................................................ 31
ALBERT OGUM(1), LILLA EVA VAS(2), ILDIKO GARAI (3,4) SÁNDOR BARNA (4) ................................................................................. 31
10. CLINICAL SIGNIFICANCE OF DYNAMIC 99MTC-DTPA RENAL SCINTIGRAPHY WITH SUBSEQUENT SPECT/CT
IMAGING ....................................................................................................................................................................... 32
TEODOR SOFIYANSKI1, MILENA DIMCHEVA1, SONYA SERGIEVA1, BOZHIL ROBEV2 ................................................................................ 32
4
11. PANCREATIC NEUROENDOCRINE TUMORS: CASE REPORT ................................................................................. 33
CR STOLNICEANU1,3, TM IONESCU2, I.GRIEROSU1,3, W JAOULL1, C STEFANESCU1,3 ............................................................................ 33
12. A MULTIDISCIPLINARY APPROACH IN HEPATIC ONCOLOGY - SIRT BY 90-YTTRIUM LABELLED MICROSPHERES ... 34
RUXANDRA TIBU1,2, LAURENTIU AGRIGOROAIE1, TAREK KAMOUN1, MARIAGIULIA LONGO1, LAURA POLIXENIA GRECU BODNARIUC1,2, CAMILO
GARCIA1 ............................................................................................................................................................................... 34
13. PREOPERATIVE FDG PET/CT AND SENTINEL LYMPH NODE LYMPHOSCINTIGRAPHY FINDINGS IN BREAST CANCER
PATIENTS WITH CLINICALLY NEGATIVE IPSILATERAL AXILLARY LYMPH NODE STATUS ..................................................... 35
TODOROVA-STEFANOVSKI D1,BOZHINOVIC M1, JANKULOVSKA A2, ANGJELESKA M1, KONDOV B3, SPIROV G1, TASEVSKI S1, BESHLIEV S1 ,
KONDOV G 3 , STOJANOSKI S2, UGRINSKA A1. .............................................................................................................................. 35
E-POSTER
1. 18F-FDG PET-CT IN DIFFERENTIATED THYROID CARCINOMA .................................................................................. 37
2. INCIDENTAL FINDINGS IN NUCLEAR MEDICINE PRACTICE. CLASSIC SCINTIGRAPHY. ............................................... 38
ANDREEA BABAN1,2, VALENTINA NASTAS1,2, TEODORESCU-PERIJOC DIANA4, STATESCU ANA-MARIA1,3, ................................................. 38
3. 18F-FDG BRAIN PET IN A PATIENT WITH FRONTO-TEMPORAL LOBAR DEGENERATION: CASE REPORT ................... 39
4. CORRELATION BETWEEN EMISSION CHARACTERISTICS OF RADIOISOTOPES AND PET IMAGING QUALITY ............. 41
LIVIA E. CHILUG1, ILIE A. NECŞOIU1,2, SIMONA I. BĂRUȚĂ1, RADU A. LEONTE1, ALINA RAICU1, BOGDAN G. BURGHELEA1, DANA
NICULAE1 ........................................................................................................................................................................... 41
5. FDG PET-CT IN MERKEL CELL CARCINOMA: CASE REPORT ...................................................................................... 42
6. PHARMACEUTICAL GRADE PROCESSING OF 89ZR AND 64CU MEDICAL RADIOISOTOPES.......................................... 44
DIANA COCIOABĂ1,2, RADU LEONTE1, BOGDAN BURGHELEA1,2, ROXANA CORNOIU1,3, RADU ȘERBAN1,4, ALINA RAICU1, SIMONA BĂRUTĂ1,
ANDREI NECȘOIU1,2 AND DANA NICULAE1 ................................................................................................................................... 44
7. RADIOLABELING OF PEPTIDES WITH COPPER-64 AS PART OF DRUG DEVELOPMENT PROCESS .............................. 45
ROXANA CORNOIU1,2, LIVIA CHILUG1, RADU ȘERBAN1,4, RADU LEONTE1, DIANA COCIOABĂ1,3, BOGDAN BURGHELEA1, ALINA RAICU1 AND
DANA NICULAE1..................................................................................................................................................................... 45
8. SOLITARY PULMONARY NODULES. A PET-CT DIAGNOSTIC ANALYSIS...................................................................... 46
9. HIDE AND SEEK – RENAL AGENESIS BETWEEN STRUCTURAL AND FUNCTIONAL IMAGING ..................................... 48
LARISA-ELENA RĂU1, IRENA CRISTINA GRIEROSU1,3, RAREȘ STAMATE1, DIANA-ALEXANDRA RĂILEANU1, VIORICA CERNOV1, RUXANDRA ȚIBU1,
MAGDALENA STÂRCEA2,3, ANA-MARIA STĂTESCU1, CIPRIANA ȘTEFĂNESCU1,3 .................................................................................... 48
10. IN VITRO ASSESSMENT OF CELLULAR RESPONSE TO THE INTERNAL RADIOTHERAPY DELIVERED BY AUGER-
ELECTRON AND BETA EMISSIONS OF COPPER-64 ........................................................................................................... 49
RADU MARIAN SERBAN1,2, DRAGOS ANDREI NICULAE3, IONELA VICTORIA NEAGOE4, MARIA-ROXANA CORNOIU1, DIANA SILVIA
COCIOABA1, MIHAELA TEMELIE1, GINA MANDA4, ANCA DINISCHIOTU2 AND DANA NICULAE1 ................................................. 49
11. PROGNOSTIC SIGNIFICANCE OF 18F-FDG PET-CT IN ENDOMETRIAL CANCER ..................................................... 50
99M
12. TC-EDDA/HYNIC-TOC (TEKTROTYD) SCAN RAISING DIAGNOSTIC SUSPICION IN MISCHARACTERIZED
MENINGIOMA - A CASE REPORT .................................................................................................................................... 51
MARIA-CARLA STEREA1, ALEXANDRA MARIA LAZAR1, MARIO MUTULEANU1,2, IONELA IRIMESCU1, MIRELA GHERGHE1,2 ........................... 51
13. 18F-FDG PET/CT IN THE FOLLOW-UP OF COLORECTAL CANCER .......................................................................... 52
14. A FALSE NEGATIVE SPECT-CT BONE SCAN IN A 20-YEAR-OLD PATIENT WITH TRIPLE-NEGATIVE METASTATIC
BREAST CANCER ............................................................................................................................................................. 53
5
TATIANA LUCIA ȘUTA1, JAMAL RABAH1, MIRELA GHERGHE1,2 ......................................................................................................... 53
15. ARTIFICIAL INTELLIGENCE GUIDED SOFTWARE USED FOR MASKING THE BLADDER FROM WHOLE-BODY BONE
SCANS 54
IULIAN-ALEXANDRU TACIUC1, CĂTĂLIN-FLORIN BLAJ2, ADRIAN COSTACHE1, MIRELA GHERGHE1,2 .......................................................... 54
16. SPECT-CT DATA QUANTIFICATION IN MONITORING METASTATIC NEUROENDOCRINE TUMOURS – CASE REPORT
55
IULIAN-ALEXANDRU TACIUC1, ION-ALEXANDRU IOANA2, IULIANA DORDE2, ALEXANDRA-MARIA LAZAR2, MIRELA GHERGHE1,2 ................... 55
17. PITFALLS AND ARTIFACTS IN RADIOISOTOPE NEPHROGRAPHY? THINK OUTSIDE THE BOX! ............................... 56
6
INVITED LECTURES

& 5th Romanian Congress of Nuclear Medicine
Coordinators:
Dr. Raluca Mititelu
Prof. Dr. Cipriana Ștefănescu
7
1. EVALUATION OF CHANG ATTENUATION CORRECTION METHOD IN
SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY
Milena Dimcheva1, Teodor Sofiyanski1, Sonya Sergieva1, Bozhil Robev2
1
Department of Nuclear Medicine, Sofia Cancer Center, Sofia, Bulgaria
2
Department of Medical Oncology, University Hospital St. Ivan Rilski, Sofia Bulgaria
Objectives: The algorithm proposed by L. T. Chang, for attenuation correction after tomographic reconstruction,
is implemented in most of the commercial image processing systems in Nuclear Medicine. The aim of this study
was to evaluate the influences of reconstruction and attenuation correction obtained by the tomographic images
of the Jaszczak phantom.
Methods: All images of a Jaszczak phantom, were acquired on a dual-head SPECT-CT system Symbia T2,
Siemens. For evaluation, we used the visual analysis, the count profiles in the images before and after correction,
and the matrices of correction. Image acquisition was performed using a 180° non circular orbit for each detector,
with 120 projection angles, 500 000 counts per projections 128 × 128 matrix size, zoom = 1 and pixel size of 4.8
mm. The different type of filter using FBP reconstructions was also considered. The images reconstructed with
OSEM were filtered with a symmetric 3-D Gaussian function having a full width at half maximum of 1. Iterative
reconstruction of these images was halted after 12 iterations using 4 subsets. The linear attenuation correction
was set to µ = 0.15 cm-1. Reconstructed transaxial slices and non-corrected images of the phantom were
attenuation corrected by Chang's.
Results: It was observed that this method leads to over-correction in some areas of the image and in other under-
correction. According to Chang, when accuracy is essential the second correction is needed.
Conclusions: The Chang's attenuation correction technique can be used for attenuation correction of non-
corrected Jaszczak phantom images.
Key words: Single-photon emission computed tomography, Chang’s attenuation correction, Jaszczak phantom
8
2. SPECT-CT IN FOOT AND ANKLE PATHOLOGY
Dr. Diana Ene
CHU St-Pierre Bruxelles
Pain of the foot and ankle is a very common occurence, experienced by many people at some point in their life.
The foot and the ankle are complex parts of the human body, all involved in different ways in the movements or
in the body support and balance. The foot may be affected by multiple diseases at the same time. The pain could
be the result of one or several abnormalities, in the soft tissues or in the bone.
Bone scintigraphy is highly sensitive in detecting bone pathology and the single-photon emission computed
tomography/computed tomography (SPECT-CT) will improve the lesions localization and will add important
anatomical details.
We will see the role of the bone SPECT-CT in acute post-traumatic settings but also in the evaluation of the
chronic foot pain which is often challenging: degenerative disease, osteochondral lesions, tarsal coalition, diabetic
foot, infection and inflammation, soft tissues pathologies, post-operative evaluation of joints fusion. Tumors are
a rare finding at the level of the foot or the ankle but they must be known.
In daily clinical practice, the use of SPECT-CT is increasing in the management of foot and ankle pathology.
3. OLDIES BUT GOODIES. LOST CONVENTIONAL NUCLEAR

MEDICINE EXAMS.
Dr. Diana Ene
CHU St-Pierre Bruxelles
Forgotten indications for very common nuclear medicine exams like the bone scintigraphy.
Forgotten or underused parameters for common nuclear exams like the renal scintigraphy.
Forgotten nuclear techniques which can still be useful.
Forgotten exams, revived by the rise of new nuclear therapies.
They are old but good; don’t lose them on the way.
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3. SOMATOSTATIN RECEPTOR ANALOGUES SPECT- CT : IS IT STILL A
FEASIBLE CHOICE FOR DIAGNOSING
GASTROENTEROPANCREATIC NETS?
Mirela Gherghe
Institute of Oncology Bucharest, ”Carol Davila” University of Medicine and Pharmacy
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a group of heterogenous tumors that account for
about 60% of the total number of NETs. The diagnostic algorithm for GEP-NETs is based on five main pillars:
morphological imaging, endoscopic procedures, pathology, functional imaging, and circulating biomarkers.
Functional imaging studies are based on the ability of NETs to overexpress SSTRs on their cell surface.
Our study included retrospective data from 173 consecutive patients who were referred to the Nuclear Department
of Oncology Institute “Prof. Dr. Alexandru Trestioreanu”, Bucharest, Romania, for a 99mTcEDDA/HYNIC-TOC
scan as part of their clinical management, between November 2015 and March 2022.
Diagnosis was made according to both whole-body planar and SPECT/CT examinations and in concordance with
results from previous CT, MRI, and endoscopic tests. Out of the 173 examinations performed, 121 were assessed
as positive. True positive (TP) results were found in 105 cases, false positive (FP) results in 16 cases, true negative
(TN) in 41 cases, and false negative (FN) in 11 cases. We obtained a sensitivity of the method of 90.5% and a
specificity of 71.9%. The accuracy of 99mTc-EDDA/HYNIC-TOC SRS was 84.3%, with a PPV of 86.7% and a
NPV of 78.8%.
We concluded that 99mTc-EDDA/HYNIC-TOC, a receptor-based radiopharmaceutical could represent a good

alternative to 68Ga-labeled peptides in the diagnosis and management of patients with gastroenteropancreatic
neuroendocrine tumors. Our results show a lower sensitivity (90.5%) than 68Ga-DOTA-peptides, but with good
specificity, accuracy, and positive and negative predictive values.
Given the continuous development of the SPECT/CT and the software used to analyze the obtained data, 99mTc-
EDDA/HYNIC-TOC SRS offers prospects for treatment monitoring through SUV-based evaluations, that could
represent a cheaper and widely available method for assessing disease progression and recovery.
10
4. COMPARISON OF THE IMPACT OF TWO VERSIONS OF REAGENT
AND ANCILLARY SETS ON THE [18F]FDG RADIOCHEMICAL YIELD
Katerina Kolevska1, Maja Chochevska1, Marija Atanasova Lazareva1, Maja Velichkovska1, Filip Jolevski1,
Jasmina Razmoska1, Ana Ugrinska1
1
University Institute of Positron Emission Tomography, Skopje, North Macedonia
Aim: The purpose of this study is to compare the impact of the optimised versus standard version of the reagent
set and ancillary kit on the [18F]FDG radiochemical yield.
Materials and Methods: [18F]F- radioisotope is produced in a cyclotron (GE PETtrace 16.5 MeV) by irradiating
enriched 18O water with protons.
[18F]FDG radiosynthesis (a nucleophilic 18F-fluorination followed by base-catalyzed hydrolysis) is conducted
using an automated synthesizer IBA Synthera V2 module and a single-use disposable system – Integrated Fluid
Processor (IFP) as well as reagents and ancillary set. There are two commercially available versions of these sets.
In the new version of the reagents set, the molar ratio acetonitrile-water in the cryptand solution is 4:1 instead of
1:1. As the separation cartridge in the new version of the ancillary kit is used QMA Carbonate Plus Light, instead
of QMA Plus Light. A modification is also made in the purification cartridges, Oasis HLB in place of the C18
cartridge.
In this study, 100 [18F]FDG batches in total are analyzed. 50 batches were synthesized using the standard version
of the reagent and ancillary kits, while the other 50 batches were with the optimised version.
The mean radiochemical yield (RCY), decay-corrected, and relevant standard deviation (SD) are calculated for
both types of analyzed batches.
Results: [18F]FDG batches produced using the optimised version of reagents and ancillary kit has higher RCY
(65.01% ± 4.52%) compared to the batches produced using the standard version (57.83% ± 3.61%).
Conclusion: This study confirms that the optimisation of the reagent and ancillary sets contributes to a higher
radiochemical yield of the produced [18F]FDG.
Keywords: [18F]FDG, radiochemical yield, synthesis
11
5. ROLE OF GA68-PSMA PET/CT IN DETECTING EARLY RELAPSE OF
DISEASE IN PATIENTS OF INTERMEDIATE AND HIGH RISK
PROSTATE CANCER WITH BIOCHEMICAL RECURRENCE AFTER
DEFINITE RADICAL THERAPY.
Rakesh Kumar1, Sanjay Kumar2, Chetan Patel1, Anil Kumar Pandey1.

Department of Nuclear Medicine1 and Department of Urology2, All India Institute of Medical Sciences, New
Delhi, India.
Introduction: The biochemical recurrence (BR) is defined as increasing the value of serum PSA after radical
therapy, it is a common occurrence and occurs in about 20-30% of patients treated with radical prostatectomy
(RP) and up to 60% in patients treated primary with external beam radiotherapy (EBRT). Conventional imaging,
including computed tomography (CT), bone scintigraphy (BS) and magnetic resonance (MR), showed low
accuracy values for restaging patients being BR. Positron emission tomography-computed tomography (PET/CT)
with choline showed a suboptimal sensitivity if performed in patients with early biochemical recurrence. Prostate-
specific membrane antigene (PSMA) PET/CT demonstrated better sensitivity in the diagnosis of early disease
recurrence when compared with 18F-choline PET/CT. The present study was aimed to evaluate role of Ga68-
PSMA PET/CT in detecting early relapse of disease.
Methods: Forty-five patients with histopathologically proven PCa with Gleason’s score of ≥7 who have undergone
primary treatment in the form of radical prostatectomy or radiation therapy with rising serum PSA less than or
equal to 4 ng/ml were recruited in the study. All patients underwent Ga68- PSMA PET/CT 45-60 minutes after
intravenous injection 2 – 5 mCi (74-185MBq).
Results: Mean age was 66.16 ± 7.36 years (range: 50-81 years). Out of 45 patients, Ga68-PSMA PET/CT was
positive in 21 patients and negative in 24 patients. The mean serum PSA levels were 1.70±1.937 ng/ml and
0.88±1.72 ng/ml in PSMA positive and negative cases, respectively. Prostate bed recurrence was seen in 6
patients, mean SUVmax18.26 ± 25.35 (range: 2.25-112). Local lymph nodal invasion was found in 12 patients
with total 19 measurable lymph nodes. Mean SUVmax for lymph nodes was 19.20 ± 16.03 (range: 1.62-64).
Fourteen bone lesions were present in 9 patients with mean SUVmax of 28.58 ± 33.20 (range: 1.92-133).
Conclusion: Ga68-PSMA PET/CT can detect early relapse of disease in patients of in patients of intermediate
and high risk prostate cancer with rising PSA after definite radical therapy.
Key Words: Prostate Cancer, PSMA-PET/CT, Recurrence
12
6. 18F-FDG PET-CT ROLE IN MANAGEMENT OF MALIGNANT
MELANOMA
Dr. C.Mazilu
Central Emergency Universitary Military Hospital “Dr Carol Davila” Bucharest, Affidea Bucharest
PURPOSE: To evaluate the diagnostic performance of positron emission tomography/computed tomography

(PET/CT) full-body acquisition using (18) F-fluorodeoxyglucose (FDG) in management of patients with
malignant melanoma
MATHERIAL AND METHOD: Retrospective study of patients who underwent full-body FDG-PET/CT for
staging and subsequent follow-up of melanoma with different locations (cutaneous, digestive, ocular, ear) at
different time points in the course of disease, between 2018-2023. Whole-body FDG-PET/CT was performed at
60 minutes following injection of 2 -3 MBq/kgbw FDG using GE Discovery IQ and GE Discovery MI-DR
scanners. Unexpected lesions were classified according to primary origin and site of metastases or recurrence,
RESULTS: Most of the discovered lesions were confirmed either by pathology or clinico-imaging follow-up.
Accuracy of PET/CT was significantly higher than that of CT and MRI for M-staging and significantly higher
than that of CT for N-Staging. Change of treatment according to PET/CT findings occurred in patients. PET-CT
revealed unknown lesions which were confirmed as secondary cancer and also progressive disease in unexpected
cases, with several unusual locations (heart, bladder).
CONCLUSION: The diagnostic performance of full-body FDG-PET/CT for N- and M-staging of melanoma
patients suggests its useful role for whole-body tumor staging. A huge potential is due also to detection or
exclusion of distant metastases and possible to discovery of unknown primary cancers.
13
7. DIFFERENTIATED THYROID CANCER- NEW APPROACH FOR
APPLICATION OF I-131
Jasna Mihailovic1,2
1
Department of Nuclear Medicine, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
2
Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
There is still an ongoing debate on the management of differentiated thyroid carcinoma (DTC), particularly on
the use of radioactive iodine for diagnosis and therapy. Beside the American Thyroid Association guidelines that
was released in 2015, recently new guidelines were published: the SNMMI and EANM have published joint
practice guidelines on the nuclear medicine evaluation and therapy of DTC; the ETA also released a Consensus
Statement on indications for post-surgical RAI therapy in DTC, while German position paper was published in
reaction to the ETA Consensus Statement with a very different perspective. However, the use of radioactive iodine
in DTC treatment differs significantly between countries in Europe and overseas. According to the
SNMMI/EANM joint practice guidelines, postoperative treatment with radioactive iodine (I-131) in differentiated
thyroid carcinoma (DTC) is administered for the following reasons: to eliminate normal thyroid tissue remnant
in low-risk patients ensuring undetectable or minimal serum thyroglobulin levels (in the absence of neoplastic
tissue), which facilitates follow-up (remnant ablation); to irradiate suspected but unproven sites of neoplastic cells
in low-intermediate and intermediate risk patients reducing the risk of disease recurrence (adjuvant treatment);
and to treat persistent or recurrent disease in patients with demonstrated metastatic disease (treatment of known
disease). Usually, the radioiodine treatment is performed in low-risk patients by adjusting empiric 131 activity.
However, distant metastatic disease should be treated by dosimetric studies and determining the maximum
tolerated therapeutic 131-I activity with aim to avoid myelotoxic radiation effect. SNMMI/EANM guidelines
recommends postoperative Dx radioiodine scan in intermediate- and high-risk thyroid cancer for planning
radioiodine therapy using SPECT/CT. Dynamic risk re-stratification is performed during the first 2 years of
follow-up after initial therapy. The risk re-stratification criteria are: excellent response to therapy, biochemical
incomplete response, biochemical indeterminate response, and structural incomplete response. Monitoring of
DTC patients is life-long to maintain adequate suppressive/supstitutive therapy, early detection and treatment of
recurrent/persistent disease.
Key words: differentiated thyroid carcinoma, radioactive iodine, treatment, risk stratification, radioiodine scan
14
177
8. RADIOLABELING OF DOXYCYCLINE WITH Lu AND
BIODISTRIBUTION IN TUMOR-BEARING MICE
Z. Milanović, M. Radović, D. Stanković, M. Perić, A. Vukadinović, D. Janković , S. Vranješ Đurić, M.

Mirković
„VINČA” Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001
Belgrade, Serbia(zoranamilanovic89@gmail.com)
.
Doxycycline as adjuvant therapy to conventional chemotherapy has shown promising results in cancer therapy.
177
Lu is β− radionuclide with perfect physicochemical characteristics for therapy due to particulate emission (β−or
Auger electron) and accompanying γ-emission used for diagnostic evaluation and dosimetry. We aimed to
examine the capability of 177Lu-labeled doxycycline hyclate, as anticancer agent. The chemical structure of
doxycycline is closely related to the structure of chemotherapeutic doxorubicin which binds to DNA, so it was
supposed its similar behaviour. Therefore, complex formation and DNA binding of doxycycline was investigated
using spectrophotometric and electrochemical studies. Radiolabeling yield of 177Lu-doxycycline applying
proposed radiolabeling method was over 99%. 177Lu-doxycycline was stable in vitro in saline and human serum
over 72 h. Non-radioactive Lu-doxycycline complex formation was demonstrated electrochemically as well. The
results of lipophilicity measurements of 177Lu-doxycycline complex showed that partition coefficient was found
to be 1.35, highlighting the lipophilic character of the complex. The binding of 177Lu-doxycycline complex to
HSA, an important constituent of human blood, which could affect its biological behavior was in low percentage,
therefore it could be supposed that fast clearance of complex from the blood lead to its fast arrival at the site of
action. Biodistribution studies of 177Lu-doxycycline complex in BALB/c mice bearing CT26 murine colon
carcinoma 3 h after intraperitoneal injection showed significant tumor accumulation of 177Lu-doxycycline
(2.88±0.85% ID/g). 177Lu-doxycycline complex, due to its excellent electrochemical and biological
characteristics, and significant accumulation in the tumor, is promising for further in vivo investigation of its
potential use in cancer treatment.
Keywords: Doxycycline, 177Lu-radiolabeling, biodistribution
15
9. 18F-FDG PET-CT IN LUNG CANCER
R Mititelu
University of Medicine and Pharmacy Dr Carol Davila
Central Universitary Emergency Military Hospital Bucharest
PET-CT with 18-Fluoro-2-deoxy-d-glucose (18F-FDG) represents the standard of care in the management of non-
small-cell lung carcinoma (NSCLC), with an unreplaceable role in the initial evaluation (stanging), follow-up,
therapy monitoring, restaging and – more recent for the radiotherapy planning (an evolving indication). Moreover,
FDG PET-CT is a remarkable tool for the characterization of solitary lung nodules (SLN), with a very important
role in risk stratification for malignancy and subsequent management.
The increased uptake of 18F- FDG PET-CT in lung cancer cells is the result of the changes in glucose metabolism:
increased levels of glycolytic enzymes and overexpression of glucose transporters (GLUT1 and 3). Besides,
adaptation to hypoxia results in increased dependency on glycolysis as an energy source; this phenomenon is
characteristic for rapidly growing tumors.
In this paper, we`ll present latest advances in the use of FDG PET-CT in the NSCLC, particularly in the therapy
monitoring and radiotherapy planning
Key-words: lung cancer, PET-CT, 18-Fluoro-2-deoxy-d-glucose
16
10. LEAD FREE POLYMER COMPOSITES FOR RADIATION SHIELDING
M. Perić1, G. Vuković2, S. Knežević1, M. Nikolić3, M. Suljagić4, Lj. Andjelković4, S. Nenadović1, M. Ivanović1,

M. Mirković1, V.B. Pavlović5
1
University of Belgrade, Vinča Institute of Nuclear Sciences, Serbia
2
University of Wisconsin-Madison, USA
3
University of Kragujevac, Faculty of Agronomy, Serbia
4
University of Belgrade, Department of Chemistry, IChTM, Serbia
5
University of Belgrade, Faculty of Agriculture
Radiation shielding is a crucial precautionary measure in decreasing the dose of exposure medical personnel
experience. The physical dimensions of these shields, specifically thickness and shape, are dependent on the type
of radiation, energy and specific radioactivity. Currently, the most common radiation shielding equipment is made
of lead, tungsten or uranium. Although these heavy metals have favorable shielding properties against ionizing
radiation, protective garments such as lead aprons are heavy to wear and can pose significant health risks. Taking
this into account, the primary goal of this study is to understand the radiation shielding properties of lead-free
polymer geopolymer-polyurethane based composites. The geopolymer was synthesized using an 80%-20%
mixture of fly ash and a bio-polyol substrate which was subsequently homogenized using MDI44. As a result, 6
samples of the geopolymer-polyurethane based composites were fabricated of which 5 were 90%-10%
compositions between the mixture and varying concentrations of BaSO4 and Bi2O3 respectively. The last sample
consisted of the pure fly ash/bio-polyol mixture. XRF and ICP analysis was used to chemically characterize the
fly ash. The composite structures were analyzed using XRD, while the microstructural morphology was
investigated using SEM techniques. Utilizing an energy-dispersive x-ray spectrometer (EDS), elemental
abundance and agglomerating behavior was analyzed for each composite variant. The X-ray attenuation
measurements pointed out that the obtained composites have the potential for a design of lead-free protective
clothing against X-ray shielding in medical applications.
Keywords: Radiation shielding, geopolymer, dosimetry
17
11. QUANTITATIVE PET/CT – HOW HUGE A SMALL ERROR CAN BE
Claudiu Pestean
University of Medicine and Pharmacy “Iuliu Hațieganu” Cluj-Napoca
Affidea - CT Clinic Cluj-Napoca
Oncology Institute “Ion Chiricuțã”Cluj-Napoca
Introduction: The SUV (Standardized Uptake Value) in PET-CT is the one of the greatest achievements
of PET-CT technique, having impact on the primary tumor evaluation, disease progression evaluation and
treatment response assessment. It is necessary to optimally choose the right SUV normalization type, calculated
by the body weight, body surface area, or, as recommended by most specialists, by lean body mass (SUVlbm).
The SUV SUVlbm formula depends on the administrated radiopharmaceutical activity, disintegration time,
patient weight and height. Aim: We evaluated the SUVlbm variation when input data errors occurred due to
misregistration. Materials and methods: we evaluated three types of malignant lesions findings, 10 with low, 10
with medium and 10 with high SUVlbm values (the median SUVlbm value being 3.78, 6.66 and 20.21). We
calculated the SUVlbm of the lesions having an error of 10%, 20%, 30% and 50% in the input data, respectively
administrated activity, patient height and weight, named as SUVlbm10, SUVlbm20, SUVlbm30 and respectively,
SUVlbm50. We expressed the changings of SUVlbm as percentage of the correct SUVlbm to correlate the impact
of the SUVlbm changings with the errors of the input data. Results: The SUVlbm variations in the case of height
errors ranged between 6.08% and 27.63%, the highest error occurring in lesions with medium SUVlbm. The
SUVlbm variations when weight errors were simulated ranged between 4.35% and 24.87%, the highest impact
being noticed in lesions with low SUVlbm. The SUVlbm variations ranged between -9.16% and -33.48% in the
case of administrated activity error simulations, with highest impact in lesions with medium uptake. Conclusions:
The SUVlbm is changed when input data are misregistrated, the changes occur at any type of uptake and at any
level of error and the variations are significant in SUVlbm evaluations. Discussions: SUV is a predictable
parameter highly correlated with tumor aggressiveness, commonly used in comparative studies, a specific
indicator for treatment response and its standardizations and accuracy is mandatory.
18
12.PROPHYLACTIC LYMPH NODE DISSECTION AND ITS INFLUENCE
ON THE DECISION OF RADIOACTIVE IODINE TREATMENT IN
CLINICALLY NODE NEGATIVE PAPILLARY THYROID CARCINOMA
Marina Popovic Krneta1, Biljana Bazic Djorovic1, Marko Buta2,3, Milica Stojiljkovic3,4, Dragana Sobic
Saranovic,3,4, Ljiljana Mijatovic Teodorovic1,5
1
Department of Nuclear Medicine, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
2
Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
3
University of Belgrade, Faculty of Medicine, Belgrade, Serbia
4
Center for Nuclear Medicine with PET, University Clinical Center of Serbia, Belgrade, Serbia
5
University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
Introduction: The use of prophylactic central lymph node dissection (pCLND) in the treatment of papillary thyroid
carcinoma (PTC) patients is still a subject of debate and controversy. The objective of our study was to evaluate
the impact of pCLND on PTC patients' risk management and identification of those who may benefit from
postoperative radioiodine therapy (RAIT).
Methods: We retrospectively reviewed the medical records of 259 T1-T2, clinically node-negative PTC patients
treated with total thyroidectomy and pCLND between 2015-2021. The risk factors for predicting CLNM were
also analyzed.
Results: Our findings showed that several factors contribute to the risk of central lymph node metastasis in patients
with papillary thyroid carcinoma. Through univariate analysis, we found that factors such as younger age, larger
tumor size, multifocality, bilaterality, microscopic extrathyroidal extension, and lymphovascular invasion all
contributed to the risk of central lymph node metastasis. 104 patients (40.2%) had central CLNM, with 28.8% of
them being reclassified to an intermediate-risk category based on the evaluated risk factors. Furthermore, in seven
patients (6.7%), the information on CLNM led to a change in the risk classification, separate from other
characteristics. Finally, after adjusting for multiple variables, our study found that CLNM metastasis was an
independent factor in determining the need for postoperative RAIT.
Conclusion: Our study highlights the importance of pCLND in improving the risk stratification in PTC, but this
benefit must be balanced with the risk of CLND in order to avoid the cost and morbidity of neck dissection in
patients without pathologic nodal disease.
Keywords: papillary thyroid carcinoma, prophylactic central lymph node dissection, radioiodine therapy
19
13. CLINICAL APPLICATION OF SLN MAPPING WITH SUBSEQUENT
SPECT/CT TOPOGRAPHY IN MALIGNANT MELANOMA
Professor Sonya Sergieva

Department of Nuclear Medicine
Sofia Cancer Center
Bulgaria
Lymphoscintigraphic imaging of SLN with subsequent intraoperative ɣ-detection and biopsy is an established
standard in clinical practice for N-status of early stages in breast carcinoma and malignant melanoma.
This method was first introduced in 1992 year from Morton et al., which reported their first results from the
intraoperative biopsy of blue-dye colored SLN, in 223 patients with melanoma as minimally invasive alternative
operating techniques for N-staging and detection of clinical occult nodal metastases.
Correct determination of the number and exact location of SLN is a key moment in the correct N-staging of
malignant melanoma and diagnosis of occult lymphogeneous metastases. The criteria for carrying out SNL
biopsy are regulated on the basis of histopathological characteristics of the melanoma lesion, the thickness of the
primary tumor, the presence of surface ulceration, high mitotic index> 1/mm2, intralymphatic (transit or satellite)
embolism. Over the last 10 years the importance of SPECT-CT imaging and exact location of SLN is intensively
investigated. According to literary data, this new technology improves the sensitivity of conventional
lymphoscintography, which ranges between 72 and 94% to 89-100% due to better resolution and contrast
detection.
Identification of SLN in volume body structures, e.g. in melanoma, localized in the field of thorax, head and neck,
sometimes leads to atypical lymph drainage and topography of regional groups of lymph nodes that are not SLN
but are subject to follow-up.
SPECT/CT studies increase the diagnostic accuracy of lymphoscintigraphy topography by visualizing the number
and the exact location of the deeper SLNs, which is essential to determine the therapeutic behavior and to perform
a selective SLN biopsy.
The multidisciplinary approach to SNL biopsy is a procedure that includes close cooperation between nuclear
medics, surgeons and pathologists for the exact predictive and intraoperative localization of SNL and the
subsequent histopathological study.
Key words: SPECT/CT , Malignant Melanoma, SLN
20
14.CHOOSING THE PROTOCOL OF PARATHYROID SCINTIGRAPHY - A
CHALLENGE BETWEEN SENSITIVITY AND DOSIMETRY
Diana Teodorescu-Perijoc 1, Mihaela-Geanina Guțu1, Andreea Baban3,4, Dimitrie-Cristian Siriopol1,5, Mihai-

Marius Guțu1,2
1
“Sfântul Ioan cel Nou” County Emergency Hospital, Nuclear Medicine Laboratory, Suceava
2
“Gr. T. Popa” University of Medicine and Pharmacy, Iaşi
3
Neolife Medical Center, Nuclear Medicine Laboratory, Iași
4
“Al. I. Cuza” University, Faculty of Physics, Iași
5
“Ștefan cel Mare” University, Faculty of Medicine and Biological Sciences, Suceava
Parathyroid scintigraphy is the gold-standard method for localization of parathyroid adenomas or hyperplasia in
patients with primary or secondary hyperparathyroidism (HPT).
The aim of this paper is to analyze the most suitable protocol for a specific patient in order to obtain the best
image with the best dosimetry possible since the guidelines recommend several variants of acquisition protocols.
The study is based on 136 parathyroid scintigraphies that were performed during 18 months at "Sfântul Ioan cel
Nou" County Emergency Hospital Suceava, where 98 were based on the double isotope 99mTc-pertechnetate and
Tc99m-MIBI - double phase - 1 day protocol (DI-DP) plus SPECT/CT and 38 were done just with Tc99m-MIBI
double phase (DP) plus SPECT/CT. Based on the type of patient’s hyperparathyroidism they were placed into
two groups.
The dosimetry parameters were higher for the SHPT groups (90% of them being under hemodialysis). We found
a better sensitivity for the DI-DP protocol if only the planar acquisitions were considered, but the SPECT/CT
itself increased sensitivity significantly in the both types of protocols that justify the use of DP protocol plus
SPECT/CT for these patients, while the protocol for PHPT remains to be analyzed in a clinical context.
Conclusion: Our study highlights an improved sensitivity/dosimetry ratio for the DP plus SPECT/CT protocol in
the case of the SHPT while the DI-DP – one day protocol may be a choice for planar studies.
Keywords: parathyroid scintigraphy, dual isotope, dual phase
21
ORAL PRESENTATIONS

Coordinators:
Dr. Raluca Mititelu
22
1. BACILLUS CALMETTE–GUÉRIN INSTILLATIONS–INDUCED
LYMPHADENITIS MIMICS DISEASE PROGRESSION ON 18F-FDG
PET/CT, IN A CASE OF BLADDER CARCINOMA. A CASE REPORT.
Iulia Almășan1,2, Andra Piciu3,4, Roxana Radu4, Doina Piciu 1,2,4
1
Department of Endocrine Tumors and Nuclear Medicine, Institute of Oncology, 400012 Cluj‐Napoca, Romania
2
Ph.D. School of Iuliu Hatieganu, University of Medicine and Pharmacy, 400012 Cluj‐Napoca, Romania
3
Department of Medical Oncology Iuliu Hatieganu, University of Medicine and Pharmacy, 400012 Cluj‐Napoca,
Romania
4
“Prof. Dr. Ion Chiricuta” Institute of Oncology, Cluj-Napoca, Romania
Keywords: 18F-FDG PET/CT, urinary bladder cancer, BCG, lymphadenitis.

Introduction: Intravesical instillation of Bacillus Calmette–Guérin (BCG) is the most effective adjuvant therapy
after transurethral resection of bladder tumors in patients with non-muscle invasive bladder cancer. BCG is
generally well tolerated, even though local and systemic infectious complications may arise. Regional
granulomatous lymphadenitis, following intravesical BCG therapy, can pose a diagnostic dilemma in cancer
imaging as it mimics metastatic disease in patients with bladder cancer.
Materials and Methods: We report a case of a 57-year-old male with a history of endoscopic resection of non-
muscular invasive bladder carcinoma, stage pTa, undergoing weekly intravesical instillation of BCG for 6 weeks
post-resection, followed by BCG instillation every 3 months for a year. The patient was referred to 18F-FDG
PET/CT scan for restaging, 1 month after completion of the 6-week induction BCG therapy.
Results: The 18F-FDG PET/CT scan revealed pathologic 18F-FDG uptake (SUVlbm 6,5) in an enlarged left
external iliac lymph node and no other pathological finding. In this scenario, the observed lymphadenopathy
couldn’t undoubtedly be attributed to the immunogenic reaction, nor the disease progression.
After analyzing these findings, a pelvic contrast MRI was performed, with no significant pathological findings.
A second 18F-FDG PET/CT was performed 3 months after the last BCG instillation, to decide the opportunity for
laparoscopic evaluation of the pathologic pelvic lymph node. The second 18F-FDG PET/CT revealed complete
remission without any evidence of pathologic 18F-FDG uptake or malignancy.
Conclusion: The phenomenon of immunogenic-induced lymphadenitis is especially relevant in patients with a
history of malignancy undergoing imaging studies, as it can contribute to diagnostic errors. Physicians treating
patients with intravesical instillation of BCG should be familiar with the related complications, and their adequate
management, while informing patients about the potential side effects accordingly. In addition, systematically
collecting patients’ clinical data and medical history regarding prior BCG therapy before imaging are crucial
steps in avoiding confusion, and future invasive procedures.
References: None.
23
2. THE ROLE OF LYMPHOSCINTIGRAPHY IN THE ASSESSMENT OF
LYMPHANGIOGENESIS AFTER VASCULARIZED LYMPH NODE
TRANSFER IN PATIENTS WITH LYMPHEDEMA.
Gîrlovanu Constantin, Maximilian Munteanu, Elena Olariu, Doina Piciu
Lymphedema is a chronic disease that affects the quality of life in breast cancer patients that underwent radical
surgery. In light of the new microsurgery advancement, autologous healthy lymph nodes are transferred to the
affected area to induce lymphangiogenesis and promote lymphedema resorption. Lymphoscintigraphy could be a
valuable tool for assessing the success of vascularized lymph node transfer (VLNT).
A 67-year-old female presented with right arm lymphedema caused by right mastectomy with radical
axillary lymph node resection. A healthy vascularized lymph node was transferred from the right inguinal region
to the right axillary area to promote lymphangiogenesis. The axillary lymphatic drainage was evaluated before
and after VLNT using lymphoscintigraphy (LS). The interdigital II and III areas of both hands were injected, at
the same time, with 99mTc-Nanoalbumin (37Mbq/hand). The protocol of the planar image acquisition was as
follows: dynamic acquisition (20sec/frame,10 minutes) and static acquisitions at 15-20-60-80 minutes and 24
hours post-injection, and SPECT/CT image at 60 minutes.
The LS dynamic acquisition before VLNT showed: normal bilaterally forearm and left arm lymphatic
drainage. The static acquisitions before VLNT revealed no right axillary lymph node with minimal right-arm
lymphatic drainage, as opposed to the left part, where the axillary lymph node was present and the lymphatic
drainage of the left arm was normal.
The LS dynamic acquisition performed at 3 months after VLNT showed bilaterally normal lymph
drainage with clinical improvement of the lymphedema.
This case report emphasizes the role of lymphoscintigraphy with 99mTc-Nanoalbumin in the evaluation
of lymphangiogenesis after VLNT, essential procedure for the improvement of the quality of life of breast cancer
patients.
Key words: lymphoscintigraphy, vascularized lymph node transfer, lymphedema, breast cancer
24
3. DPD SCINTIGRAPHY FOR CARDIAC AMYLOIDOSIS: A SINGLE
CENTRE EXPERIENCE AND REVIEW OF ITS PAST, PRESENT AND
POSSIBLE FUTURE USE
Simona F. Grigore1, Emma Wilson1, Rosario Coronado1, Helen J. Lachmann1, Julian D. Gillmore1, Ashutosh D.
Wechalekar1, Carol J. Whelan1, Brendan Wisniowski1, Marianna Fontana1, Ana Martinez De Azcona Naharro1,
Shameem Mahmood1, and David F. Hutt1
1
National Amyloidosis Centre, Royal Free London NHS Foundation Trust, London, UK
The National Amyloidosis Centre in London, United Kingdom has been performing bone scintigraphy with
technetium-99m labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) for the investigation of
cardiac amyloidosis (CA) since 2010. Since its inception, the number of patients diagnosed in the centre,
especially with the transthyretin (ATTR) sub-type, has risen sharply.
Although still not fully understood to this day, DPD’s ability to bind to amyloid was already known although
colleagues in Italy were the first to publish their findings in a cohort of patients. This suggested that DPD
scintigraphy was an exquisitely sensitive test for ATTR cardiomyopathy and led to the development of the
Perugini grading method which is now widely utilised as a means for scoring the degree of myocardial tracer
uptake.
With over 6000 DPD scans performed in our centre to date, our experience has led to the important publication
of a non-biopsy algorithm for the diagnosis of ATTR-CA. Used extensively throughout the world, DPD
scintigraphy has resulted in increased awareness and diagnosis of this disease at a time when treatments are now
becoming available. Over the years we have refined and clarified the role and limitations of DPD scintigraphy
including in the diagnosis of other forms of cardiac amyloidosis, especially light-chain (AL). We have also
realised the importance of protocol selection and seen the impact of operator variability on scan interpretation.
With three tracers currently being validated for this clinical indication, ongoing work and early indications suggest
that although similar, they do not all perform the same. Questions must now be asked as to what future role DPD
scintigraphy has in the follow-up and management of these patients.
25
4. PATIENTS’ HISTORY: A GLIMPSE FOR A POSSIBLE DIAGNOSIS OF
ATTR CARDIAC AMYLOIDOSIS
Ionescu Teodor Marian1, Jalloul Wael1, Stolniceanu Cati Raluca1, Grierosu Irena1,2, Iacob Roxana3, Ciocoiu
Manuela1, Lupușoru Raoul Vasile1, Clement Alexandra1,4, Sascău Radu-Andy1,4, Petriș Octavian Antoniu1,5,
Ștefănescu Cipriana1,2
University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania

Nuclear Medicine Laboratory, “Sf. Spiridon” Emergency County Clinical Hospital Iasi, Romania
Nuclear Medicine Laboratory, Regional Institute of Oncology Iasi, Romania
Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu” Iasi, Romania
Cardiology Department, “Sf. Spiridon” Emergency County Clinical Hospital Iasi, Romania
Introduction
Transthyretin cardiac amyloidosis (ATTR-CA) is a protein deposition disease characterized by progressive
thickening of both ventricles, inter-atrial-ventricular septum and atrioventricular valves. Detection of this rare
disease represents a challenge for the practicing physician, nevertheless a properly investigated background may
offer an insight for a possible ATTR cardiac amyloidosis diagnosis.
Material and Method
We evaluated 60 patients over the course of 4 years suspected, confirmed or accidentally diagnosed with ATTR-
CA. Patients’ history was acquired in the initial consultation or as feedback in case of accidental diagnosis. Family
history criteria included: presence of ATTR in first-degree family member; death of a first-degree family member
at a young age apparently in perfect health; presence of cardiovascular pathology in any family member. All
patients underwent bone scan with a Siemens Dual-Head Gamma Camera and image processing-interpretation
was based on the Perugini visual score and a personalised semiquantitative methode on delayed images.
Results
14 patients presented high radiopharmaceutical uptake – ATTR-CA. Family history correlated with the bone scan
results revealed that 4 patients had at least one criteria that was met.
Discussion
ATTR is a rare and challenging disease for the practicing physician. Gold standard method, endomyocardial
biopsy, is not widely available and presents certain risks. Alternative methods include: red flags,
electrocardiography, echocardiography and bone scintigraphy. However, a thorough investigated family history
may offer a possible diagnosis supposition even before other methods. A positive ATTR-CA diagnoses of an
ancestor or sudden death of a first-degree family member at a young age apparently healthy may constitute the
first step in the diagnosis process.
Conclusion
Investigation of the family history may represent the turning point in the diagnostic algorithm for patients with
heart failure of unknown origin or suspected of cardiac amyloidosis.
Keywords: ATTR, family history, bone scintigraphy
26
5. NUCLEAR MEDICINE TIES THE KNOT BETWEEN BROWN ADIPOSE
TISSUE AND PARATHYROID PATHOLOGIES
Wael Jalloul1, Irena Cristina Grierosu1,2, Teodor Ionescu1, Cati Stolniceanu1,2, Vlad Ghizdovat1, Mihaela
Moscalu1, Mihai Gutu1, Cipriana Stefanescu1,2
1. University of Medicine and Pharmacy „Grigore T. Popa” Iasi, Romania

2. Nuclear Medicine Laboratory, County Emergency Hospital „Sf. Spiridon” Iasi, Romania
Introduction: Brown adipose tissue (BAT) regulates the whole-body’s metabolism by producing a variety of
adipokines. This work investigates the BAT pattern and the clinical aspects of overweight and obese (OOB) vs.
non-obese (NO) hyperparathyroidism (HPT) patients with the aim of assessing the impact of BAT and obesity on
HPT.
Methods: After investigating the Parathyroid Scans performed on HPT patients, between 2015-2020, we selected
the images with active BAT. Considering their Body Mass Index (BMI), the patients with active BAT were divided
into OOB vs. NO.
Results: The results showed that BAT was recorded in cervical and supraclavicular regions, with a single
localization, especially among NO vs. multiple sites among OOB. The (total counts/pixels)BAT/(total
counts/pixels)non-BAT ratio in the right cervical localization showed a significant difference between the groups
with higher values in OOB. Parameters like BMI, PTH, FT4, vitamin D, magnesium, creatinine, and urea had
significant correlations with BAT ratios. PTH and creatinine were higher in NO. The predictive values showed
that right cervical ratios higher than 1.52 and right supraclavicular ratios lower than 1.15 indicated an increased
probability of being OOB.
Conclusions: HPT severity or stage/duration of its evolution may have an impact, by activating BAT, on the
patient’s weight status and implicitly on the treatment of obesity. Due to these correlations, BAT activation
represents a candidate for a potential prospective therapeutic method/algorithm for obesity, in the context of
certain types of parathyroid pathologies.
27
6. COULD A COMBINATION OF RADIONUCLIDE
VENTRICULOGRAPHY AND CARDIAC BIOMARKERS PREDICT
CARDIOTOXICITY IN BREAST CANCER PATIENTS TREATED WITH
HER2-INHIBITORS?
Alexandra Maria Lazar1, Mario-Demian Mutuleanu1,2, Ionela-Nicoleta Irimescu1, Robert Maaz1, Cristina
Petroiu 1, Mirela Gherghe1,2
1
Nuclear Medicine Department, Institute of Oncology “Professor Doctor Alexandru Trestioreanu”, Bucharest,
Romania
2
Nuclear Medicine Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania
Aim/Introduction: Human epidermal growth factor receptor 2 (HER2) is overexpressed in 15–20% of the breast
cancers diagnosed nowadays, its presence being associated with poor prognosis. The main HER2 inhibitors used
to treat this type of tumors are the monoclonal antibodies trastuzumab and pertuzumab, mainly associated with
taxanes or anthracyclines. The clinical benefits of HER2-inhibitors are well documented, however the possibility
of cardiac adverse reactions must be considered. The aim of our study was to determine whether monitoring
cardiac function through radionuclide ventriculography (RNV) and cardiac biomarkers could predict the cardiac
impact of combined therapy with trastuzumab, pertuzumab and docetaxel, regularly used for HER2-positive
breast cancer treatment.
Materials and Methods: This prospective study included 22 patients diagnosed with HER2-positive breast
cancer, who had their left ventricular ejection fractions (LVEF) and cardiac biomarkers evaluated both at the
beginning of their treatment and after 6 months. Among all of the enrolled patients, two blood specimens were
collected to assess circulating cardiac biomarkers: cardiac troponin I, NT-proBNP, NT-proANP, ST2/IL33, GDF-
15. After “in vivo” radiolabeling of the erythrocytes with 99mTc-pyrophospate, RNV was performed in each patient
on a General Electric Healthcare Discovery 670 DR gamma camera, for both of timepoints. Obtained results were
statistically correlated.
Results: The average LVEF decrease between the two timepoints was approximately 4%. NT-proBNP correlated
with the LVEF values obtained both in the baseline study and after 6 months of follow-up (r = −0.615 for T0 and
r = −0.751 for T1, p<0.05 for both). The suppression of tumorigenicity 2 protein/interleukin-33R (ST2/IL-33R)
proved statistically significant at the T1 time point (r = −0.547, p<0.05).
Conclusion: Our study revealed that a combination of LVEF, NT-proBNP and ST2/IL-33R assessment may be
useful for early detection of cardiac impairment in breast cancer patients treated with trastuzumab, pertuzumab
and docetaxel.
Key words: cardiotoxicity, radionuclide ventriculography, HER2-inhibitors.
28
7. QUANTITATIVE 99MTC-PYP SPECT/CT IN PATIENTS SUSPECTED
WITH TRANSTHYRETIN-RELATED CARDIAC AMYLOIDOSIS:
FEASIBILITY AND CORRELATION WITH SEMIQUANTITATIVE
INDICES.
Alexandra Maria Lazar1, Mario-Demian Mutuleanu1,2, Andreea Jercan3, Sorina Nicoleta Badelita3, Daniel
Coriu3,4, Mirela Gherghe1,2
1
Nuclear Medicine Department, Institute of Oncology “Professor Doctor Alexandru Trestioreanu”, Bucharest,
Romania
2
Nuclear Medicine Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania
3
Hematology Department, Fundeni Clinical Institute, Bucharest, Romania
4
Hematology Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania
Aim/Introduction: Bone scintigraphy using 99mTc-labelled bisphosphonates is currently used for imaging
assessment of patients with transthyretin-related cardiac amyloidosis (ATTR). Although present-day diagnosis is
primarily based on visual scoring and semiquantitative indices, the introduction of new potential life-prolonging
drugs for ATTR has raised the need for a better evaluation of the cardiac amyloid burden, thus raising the
opportunity for its estimation through single photon emission computed tomography (SPECT) quantification. The
present study evaluates whether quantitative SPECT measurements of absolute 99mTc-pyrophosphate (99mTc-PYP)
uptake can diagnose patients suspected for ATTR.
Materials and Methods: This study evaluated 14 patients, mean age 47.93±8 years old, with suspected cardiac
ATTR, who underwent 99mTc-PYP scintigraphy, a planar acquisition 1 hour post 99mTc-PYP administration and
SPECT/CT imaging of the chest 3 hours post-injection. Images were then independently analysed by two
physicians and semiquantitative planar indices and body-weight adjusted standardized uptake values (SUV),
SUVmax and SUVpeak, were measured. A cardiac SUV retention index (CRI) was also calculated. Obtained results
were statistically correlated.
Results: Out of the 14 patients evaluated, 11 had myocardial uptake positive for ATTR on the planar scans,
presenting a visual Perugini score over 2, and were then confirmed on the SPECT examination. We found
statistically positive correlations between the Perugini score and SUVpeak and CRI (p<0.05 for each) and between
heart to contralateral lung ratio (H/CL) and SUVmax, SUVpeak and CRI (p<0.05 for all). A receiver operating curve
analysis was performed for all the measured quantitative parameters and CRI presented the best area under curve
(AUC=0.797), obtaining a diagnostic CRI threshold of 0.492.
Conclusion: Quantitative SPECT parameters can be used to diagnose and evaluate patients with suspected cardiac
ATTR, for a more accurate assessment of myocardial uptake. CRI is the most feasible method for evaluation and
monitoring of the cardiac amyloid burden.
Key words: cardiac amyloidosis, ATTR, quantitative SPECT/CT.
29
8. EVALUATION OF THERAPY RESPONSE IN SOLID BONE TUMOR
METASTASES BY QUANTITATIVE SPECT-CT HYBRID IMAGING
M.Mutuleanu1,2, A.Lazar2, M.Gherghe1,2
1.Nuclear Medicine Department, University of Medicine and Pharmacy Carol Davila Bucharest, Romania;
2.Nuclear Medicine Department, Institute of Oncology “Prof.Dr. Alexandru Trestioreanu”, Bucharest 022328,
Romania;
Keywords:metastatic bone lesions, quantitative analysis, patient follow-up, quantitative SPECT-CT
Background: Cancer represents one of the major cause of death particularly through its ability to spread to other
organs, thus emphasizing the need of metastatic disease diagnosis and accurate follow up for patient treatment
management. Although until now the main method for imaging interpretation was represented by qualitative
imaging interpretation methods, quantitative analysis of SPECT-CT data represents a reliable method for imaging
evaluation.
Materials and Methods: This is a prospective study in which we collected the data from 113 SPECT-CT studies
acquired on 52 cancer patients, 39 breast cancer female patients, 8 prostate and 5 lung cancer male patients, with
a mean age of 59.17±11.06, presenting metastatic bone disease, who underwent at least two Bone SPECT-CT
studies using [99mTc]- hydroxydiphosphonate (HDP), between November 2019 to April 2022, in the Department
of Nuclear Medicine of the National Institute of Oncology “Prof. Dr. Alexandru Trestioreanu” Bucharest,
Romania.
Results: Qualitative and quantitative analyses were performed to determine the disease state in the follow-up
study compared to baseline. By performing statistical analysis of the data, specific correlation coefficients were
determined between qualitative assessment of planar whole-body and qualitative SPECT-CT compared to
quantitative analysis of the SPECT-CT data. A correlation coefficient of 0.712 was determined between qualitative
assessment of planar whole-body and quantitative SPECT-CT. Another correlation coefficient was determined
between qualitative and quantitative analysis of the SPECT-CT, with a value of 0.863, suggesting that accurate,
objective and reproductible methods for imaging interpretation have the potential to provide additional data that
can influence patient management by performing quantitative follow-up studies and offers the possibility for
standardized multicentric research.
Conclusions: Quantitative evaluation of the SPECT-CT data has the potential to be the first choice of imaging
interpretation for patient follow-up, treatment response evaluation and multicentric research purposes through its
objectivity in radiotracer uptake changes evaluation.
30
99M
9. TC PYROPHOSPHATE SPECT/CT IN CARDIAC AMILOIDOSIS
Albert Ogum(1), Lilla Eva Vas(2), Ildiko Garai (3,4) Sándor Barna (4)
(1) University of Oradea, Romania
(2) Gróf Tisza Istvan Hospital, Berettyóújfalu, Hungary
(3) University of Debrecen, Dept. of Medical Imaging, ScanoMed Ltd.
(4) ScanoMed Ltd, Hungary
Key words: cardiac amyloidosis, SPECT/CT, Tc99m Pyrophosphate

Background: Systemic amyloidosis is a rare disease in which cardiac involvement is relatively common and has
a significant impact on survival. New diagnostic techniques allow to recognise cardiac involvement early and
start treatment in time. Besides echocardiography and cardiac MRI, a simple nuclear medicine method is available
to diagnose ATTR (transthyretin) cardiac amyloidosis.
We present the importance of Tc99m pyrophosphate SPECT/CT in diagnosis of cardiac amyloidosis.
Patients and Method: We examined four patients with suspected cardiac amyloidosis. 600 MBq 99mTc
pyrophosphate was injected intravenously and a static planar chest scan was performed in three time points (1,2,3
hours post injection). At the latest time a chest SPECT/CT was also made. Heart to contralateral lung (H/CL)
ratio as calculated on planar scans at 3 time points and we visually and semi-quantitatively analysed the
SPECT/CT images. We reviewed the value of SPECT/CT in imaging of cardiac amyloidosis in relation of recently
published guidelines.
Results: Of all patients, only one was found to have an increased heart-to-contralateral lung ratio. In this case,
intense myocardial wall uptake was seen on SPECT/CT. In negative cases there was no myocardial wall uptake.
Heart to contralateral lung values was <1.5 in all negative cases, and higher in positive case. However, the values
of the ratios decreased in time. Diagnostic confidence was better in evaluation of SPECT/CT. A positive case was
confirmed by histological analysis.
Conclusion: In accordance with published data and guidelines, SPECT/CT improved visual and quantitative
results compared to planar scan. Planar imaging and H/CL ratio alone are insufficient for the diagnosis of ATTR
cardiac amyloidosis. SPECT imaging is necessary to identify myocardial uptake of 99mTc-pyrophosphate.
31
10.CLINICAL SIGNIFICANCE OF DYNAMIC 99MTC-DTPA RENAL
SCINTIGRAPHY WITH SUBSEQUENT SPECT/CT IMAGING
Teodor Sofiyanski1, Milena Dimcheva1, Sonya Sergieva1, Bozhil Robev2
1
Department of Nuclear Medicine, Sofia Cancer Center, Sofia, Bulgaria
2
Department of Medical Oncology, UH “St. Ivan Rilski”, Sofia Bulgaria
Introduction: Dynamic 99mTechnetium diethylenetriaminepentaacetic acid (99mTc-DTPA) renal scintigraphy is a

generally used imaging technique for evaluating renal function of patients with various nephro-urological
diseases. Clinical application of SPECT/CT nephroscintigraphy has rarely been discussed.
Objective: The aim of the study was to emphasize the diagnostic benefits of dynamic renal scintigraphy with
subsequent SPECT/CT imaging.
Materials and Methods: Twenty four patients /13 females and 11 males, aged 19-75 years/ underwent dynamic
nephroscintigraphy with subsequent SPECT/CT studies. A dose of 185MBq (5mCi) 99mTc-DTPA was
administered i.v. to perform dynamic planar imaging followed by SPEC/CT. The CT scan was performed with a
low dose protocol.
Results: Our analysis demonstrated impaired relative renal function in various degrees of left kidney in 15
patients, of right kidney in 8 patients and normal function in both kidneys in 1 patient. SPECT/CT imaging
revealed the specific cause, responsible for the renal dysfunction in most of the cases. The hybrid imaging
demonstrated calculosis in 9 patients, tumor formations of kidney or ureter in 4 patients, postoperative strictures
or ureter in 3 patients and external compression of ureter (i.e. ovarian cyst) in 1 patient as a possible obstructive
cause. In 4 patients congenital renal anomalies were the identified causes of impaired renal function – hypoplastic
kidney in 2 patients, aberrant vessel obstructing the pyelo-ureteral segment in 1 patient and ren arcuatus in 1
patient.
Conclusion: The combination of conventional 99mTc-DTPA renal dynamic scintigraphy with SPECT/CT could
provide not only functional and anatomical information of kidneys and ureters in the evaluation of obstructive
uropathies, but may also show the causes of the disease. Our study indicated the usefulness of hybrid imaging in
renal scintigraphy that can change the clinical management.
Key words: 99mTc-DTPA dynamic renal scintigraphy, SPECT/CT.
32
11. PANCREATIC NEUROENDOCRINE TUMORS: CASE REPORT
CR Stolniceanu1,3, TM Ionescu2, I.Grierosu1,3, W Jaoull1, C Stefanescu1,3
1Department of Biophysics and Medical Physics-Nuclear Medicine,

“Grigore T. Popa” University of Medicine and Pharmacy, 16 University Str, 700115 Iasi, Romania;
2Department of Physiopathology -Nuclear Medicine,
“Grigore T. Popa” University of Medicine and Pharmacy, 16 University Str, 700115 Iasi, Romania
3Department of Nuclear Medicine, “Sf Spiridon” Clinical Hospital Iasi
Background
Pancreatic neuroendocrine tumors (pNET) are a heterogeneous group of neoplasms. Treatment options are
complicated, depending on a multitude of factors such as clinical staging, pathological grade, presence of
somatostatin receptor, etc.
Material & method:
A 50-year-old male diagnosed with pNET G2 for 3 years (2019 - cephalic duodenopancreatectomy, pancreatico-
gastric anastomosis, Ki 67 - 15%, chemotherapy), presented very high CgA-level and some structural imaging
findings. The patient underwent 99mTc-Tektrotyde – SRS to assess the extent of the disease as well avidity for
SSTR at the pathological lesion level. He received 702,80 MBq 99mTc Tektrotyde dose. Study design: static (10
minutes/image, 256x256 matrix, Zoom 1), whole body (WB) and SPECT images were acquired at 2 and 4 hours.
Uptake was quantified (counts/pixel) in order to assess quantitatively S RS images for the pathological uptakes
and regions of interest for each hot pathological area were defined.
Result:
We quantified an area of pathological uptake of the radiopharmaceutical (Krenning grade 4), evident on both
planar and SPECT images in the abdominal area, in the liver projection area.
Discussion
The literature brings many clinical evidences regarding the effectiveness of PRRT related to tumor control,
improvement of the quality of life, to which is added a lower risk of disease progression or death. It is very
important to perform a correct selection of patients for PRRT, as a complex medical expertise is needed to evaluate
both the specific characteristics of each patient, relevant clinical context, effectiveness, toxicity of PRRT.
Conclusion:
The NET personalized approach is to select the most effective and safe treatment for each patient in the NETs
treatment planning. PRRT is an important treatment option for overexpressing somatostatin receptors NETs.
33
12.A MULTIDISCIPLINARY APPROACH IN HEPATIC ONCOLOGY - SIRT
BY 90-YTTRIUM LABELLED MICROSPHERES
Ruxandra Tibu1,2, Laurentiu Agrigoroaie1, Tarek Kamoun1, Mariagiulia Longo1, Laura Polixenia Grecu
Bodnariuc1,2, Camilo Garcia1
Institut Gustave Roussy, Paris, France

Spitalul Clinic Judetean de Urgenta „Sf. Spiridon” Iasi, Romania
Introduction: Hepatic malignancies represent the third cause of worldwide cancer-linked deaths, with
increasing rates of early detection but still an overall poor prognosis. First-line treatments according to
clinical setting include surgery, interventional techniques for local ablation, transarterial
chemoembolization (TACE) and systemic therapy. However, in carefully selected cases,
radioembolization (SIRT-selective internal radionuclide therapy) by yttrium-90 labeled microspheres is
an effective option, maybe even better than other loco-regional treatments.
Aim: Radioembolization is a technique requiring close collaboration between multiple medical
specialties to reach the planned therapeutical objective. From the tumor board decision, to the pre-
treatment work-up to the actual treatment day, there are multiple decisional layers to overcome. SIRT is
a minimally invasive procedure that exploits the difference in blood supply of liver tumors by delivering
beta-emitting radiolabeled microspheres through a selective/super-selective cathetherization of hepatic
arterial branches to the tumoral targets.
This therapeutic technique becomes ever more used in clinical practice and validated in well-designed
prospective clinical trials, with increasingly better patient outcomes, particularly since personalized
dosimetric planning’s advent. Albeit currently the sole confirmed advantage of SIRT being low toxicity
versus TACE or systemic therapy, new milestones in overall survival were reached by recent studies.
Moreover, its efficacy might increase by integration in treatment sequences alongside immune
checkpoint inhibitors or other systemic therapies.
Discussions: The main objectives for SIRT are curative, downstage to liver transplantation/surgery, or
palliative. Although the treatment itself seems rather straightforward, the challenges stem from the
periprocedural multidisciplinary work-up, involving various medical specialties like nuclear medicine,
interventional radiology, oncology and surgery, but also medical physicists, nuclear medicine
technologists and radiopharmacists.
Conclusions: Aiming for a personalized oncological treatment we will fathom the different steps of
yttrium-90 microspheres SIRT, underlining the multidisciplinary effort to achieve good overall tolerance
and results using this effective alternative to other liver tumor treatments.
Key words: SIRT, hepatic cancer, radioembolization
34
13. PREOPERATIVE FDG PET/CT AND SENTINEL LYMPH NODE
LYMPHOSCINTIGRAPHY FINDINGS IN BREAST CANCER PATIENTS
WITH CLINICALLY NEGATIVE IPSILATERAL AXILLARY LYMPH
NODE STATUS
Todorova-Stefanovski D1,Bozhinovic M1, Jankulovska A2, Angjeleska M1, Kondov B3, Spirov G1, Tasevski S1,
Beshliev S1 , Kondov G 3 , Stojanoski S2, Ugrinska A1.
1
University Institute of Positron Emission Tomography, Skopje, North Macedonia.
2
Institute of Patophysiollogy and Nuclear Medicine, Skopje, North Macedonia
3
University Clinic of Thoracic and Vascular Surgery,Skopje, North Macedonia
INTRODUCTION
Preoperative detection of axillary nodal disease is very important for staging and therapy in breast cancer patients.
Positive axillary FDG PET/CT is a good predictor of axillary involvement and it correlates positively with sentinel
lymph node (SLN) biopsy findings. Preoperative SLN lymphoscintigraphy with gamma probe guided biopsy
offers minimally invasive surgery reducing morbidity and more comprehensive histopathology. The aim of this
study was to compare the results of preoperative FDG PET/CT and SLN lymphoscintigraphy findings with
histopathological reports on nodal status in early stage breast cancer patients.
MATERIALS AND METHODS
This retrospective study included 16 female patients aged 43-73 (mean age 59.68 ± 10.08 years) recently
diagnosed with breast cancer,who were referred for primary PET/CT staging before proceeding to surgery. All
patients underwent lymphoscintigraphy and SPECT/CT on the day of surgery. Including criteria were female sex,
unilateral disease, primary lesion T-stage Т1-Т2, clinically negative axillary lymph nodes and no prior
oncological therapy.
Two nuclear medicine physicians reviewed the PET/CT findings for axillary lymph nodes in correlation with the
findings of lymphoscintigraphy and SPECT/CT, as well as any other relevant PET/CT findings. All findings were
finally compared to histopathological report on nodal status.
RESULTS
Axillary lymph nodes with increased metabolic activity above the background were detected in 6 patients (37.5%)
on PET/CT and SLN metastatic deposits on histopathology were confirmed in 4 of them (66.6%). False positive
PET/CT findings for axillary lymph nodes were detected in 2 patients (12,5%). As a part of the primary staging
PET/CT detected pulmonary metastasis in 2 patients and sarcoidosis in one patient.
CONCLUSION
In our study FDG PET/CT performed with high sensitivity, identifying all positive lesions in the axilla that were
detected on lymphoscintigraphy and confirmed on pathology reports. Additionally PET/CT upstaged 2 patients
detecting distant metastasis .
Key words: FDG PET/CT, SLN, lymphoscintigraphy, breast cancer
35
E-POSTER BOOK

Coordinators:
Dr. Raluca Mititelu
36
1. 18F-FDG PET-CT in differentiated thyroid carcinoma
M Alexa1, C Mazilu1, A Mazilu1, M Oancea1, A Goldstein2, G Voicu2, D Neagu2, C Patriche1, A Zaharia1, A
Militaru1, C Mateescu1, L Micu1, R Mititelu1,3
1
Central Universitary Emergency Military Hospital
2
Institute of Endocrinology CI Parhon
3
University of Medicine and Pharmacy Carol Davila Bucharest
Introduction
Differentiated thyroid cancer accounts for about 90% of all thyroid tumors. Positron emission
tomography combined with computer tomography (PET/CT) with [18F]Fluoro-2-deoxy-d-glucose
(18F-FDG) plays an important role in detecting local recurrences and distant metastases in patients with
negative iodine-131 scintigraphy and increased levels of thyroglobulin.
The purpose of this study is to assess the sensitivity of this diagnostic method.
Material and method

17 consecutive patients (14 women and 3 men) with morphological and/or biochemical persistence of disease
after total thyroidectomy, who performed a PET/CT exam in the Nuclear Medicine Department of the Military
Emergency University Hospital “Carol Davila” Bucharest, were retrospectively analyzed.
The metabolically active lesions were evaluated visually and semi-quantitatively using the maximum
value of the radiotracer uptake, corrected for lean body (SULmax).
Results
In the 17 patients 14 were women and 3 men, their average age was 59 ±20.9 years, the average number
of I-131 doses administered was 2.35 (average per dose of 114.45 mCi), with an average stimulated
thyroglobulin value of 708.75 ng/dl (median 340 ng/dl). The histopathological type was represented by
76.4% papillary thyroid carcinoma (n=13) and 23.6% follicular thyroid carcinoma (n=4).
PET/CT detected active metabolic lesions suggestive of local disease recurrence, lymph node metastases
or other organ in 82.3% of cases (n=14, 7 pulmonary metastases, 6 lymph node metastases and/or local
recurrences, 1 bone metastases), thus demonstrating high sensitivity of the method.
Conclusions
The sensitivity of the PET/CT exam in this small patient sample is comparable to that described in the literature.
The role of PET/CT in detecting recurrences and metastases in patients with negative "whole-body" scintigraphy
post-therapy with I-131 and increased levels of thyroglobulin is very important, helping to modify the therapeutic
management.
37
2. INCIDENTAL FINDINGS IN NUCLEAR MEDICINE PRACTICE.
CLASSIC SCINTIGRAPHY.
Andreea Baban1,2, Valentina Nastas1,2, Teodorescu-Perijoc Diana4, Statescu Ana-Maria1,3,
1
Neolife Medical Center, Nuclear Medicine laboratory, Bld. Carol I, Iasi
2
“Al. I. Cuza” University, Faculty of Physics, Iasi
3
“Sf. Spiridon” County Emergency Clinical Hospital, Iaşi
4
“Sf Ioan cel Nou” County Emergency Hospital, Suceava
Keywords: Incidental findings, Nuclear Medicine, Scintigraphy

The purpose of this study was to highlight the significant incidental findings during the classical scintigraphy and
the role of using the SPECT-CT examination in daily practice. The presented cases emphasize the importance of
detecting some significant incidental findings that can lead to the improvement of the therapeutic management of
patients.
We present four cases evaluated by scintigraphy in the interval 01.01.2021-31.12.2021, in which the nuclear
medicine imaging, apart from the main indication, revealed an important, concomitant and undiagnosed
pathology. The associated pathology highlighted by classical scintigraphic examination and SPECT was
represented by: sphenoidal sinusitis, mammary nodule, calcified meningioma, cardiac amyloidosis. In the case 1,
a bone scan, performed by a 79-year-old man, for the staging of the prostate neoplasm, allowed the diagnosis of
a sphenoidal sinusitis. In the case 2, a parathyroid scintigraphy performed for the evaluation of a primary
hyperparathyroidism, highlighted fixation of 99mTcMIBI at the level of a left breast nodule. In the case 3, a bone
scintigraphy performed by a 66-year-old man showed a right temporal hyperfixation site (calcified meningioma).
In the case 4, from the analysis of the bone scintigraphy of a patient with a prostate neoplasm, an extremely
intense extraosseous fixation of the radiopharmaceutical at the level of the heart was noted, an aspect suggestive
of cardiac amyloidosis with ATTR.
The role of the nuclear medicine physician and the medical physicist, and last but not least, the interdisciplinary
communication with other specialists, are very important in deciding whether an incidental discovery is to be
considered for a complete and complex treatment of the patient.
38
3. 18F-FDG BRAIN PET IN A PATIENT WITH FRONTO-TEMPORAL
LOBAR DEGENERATION: CASE REPORT
A. Bajenaru1, L. Mititelu2, C. Mazilu3, D. Cuzino4,5, C Sirbu 4,6, R. Mititelu3,4
1
Oncologic Institute “Al Trestioreanu” Bucharest, Nuclear Medicine department
2
Institute of Military Medicine
3
Clinic of Nuclear Medicine, Central University Emergency Military Hospital Bucharest
4
University of Medicine and Pharmacy dr Carol Davila Bucharest
5
Clinic of Radiology, Central University Emergency Military Hospital Bucharest
6
Clinic of Neurology, Central University Emergency Military Hospital Bucharest
Introduction: Fronto-temporal lobar degeneration (FTLD) is a heterogenous syndrome associated with the
degeneration of the frontal and anterior temporal lobes, being responsible for 5% of all cases of dementia based
on autopsy studies. The condition is usually underdiagnosed [1].
Case report: We present the case of a 55-year-old patient suffering from severe cognitive impairment with
delirium that occurred in 2020 in a context of negative emotional stress. The cognitive decline was progressive
and manifested in a polymorphic psychotic disorder with pregnancy ideation. Her behavior is consistent with a
possible frontal lobe disorder manifested by abulia, sometimes associated with dromomania, apraxia and
disinhibition. Her symptoms also include impoverished speech, decreased appetite, decreased self-care, sleep
disturbances and sphincter incontinence, without sensorimotor or coordination deficits. An electroencephalogram
performed in April 2021 showed brief, sharp and non-sustained discharges of slow waves, particularly in the left
temporal region, without clinical correspondence. A subsequent MRI scan showed a dilated ventricular system,
symmetrical, on the median line, with increased volume in the pericerebral fluid and brain atrophy without signal
abnormalities in the brain parenchyma. Approximately 1 year after symptom onset, we performed cerebral PET
/CT with 18F-FDG. After visual assessment of the brain images, we used CortexID Suite software for reporting
the degree of cerebral regional metabolism compared to a normal database. Z-scores below -2 were considered
pathologic. Hypometabolic areas were found in the lateral and medial prefrontal cortical areas and in the anterior
cingulate cortex, bilaterally. We also found increased metabolic activity in the temporal and parietal cortex
(especially on the right side) and in the occipital area.
Results and discussion: Frontal lobe syndrome is a broad term used to describe impairment of higher brain
functioning such as motivation, planning, social behavior and speech/language production. The frontal lobes are
involved in the regulation of emotions, social interactions and personality. They are also critical for the more
difficult decisions and interactions that are essential to human behavior [2]. Differentiating FTLD from
Alzheimer's disease (AD) often proves difficult [3]. Even if no treatment is available, differential diagnosis with
AD is important because of differences in management; cholinesterase inhibitors should be avoided because of
exacerbation of symptoms [4]. The 18F-FDG PET/CT provides important metabolic information that can aid
diagnosis in different types of dementia. It shows different patterns of hypometabolism that can help in the
differential diagnosis between FTLD and AD [5]. EANM supports the use of FDG-PET in clinical practice when
neurodegenerative disease is suspected [6]. Considering the clinical manifestations of our patient, FTLD should
be considered as a possible diagnosis. Patients with FTLD are characterized by hypometabolism, which is mainly
seen in the frontal, anterior temporal and anterior cingulate cortex [7]. No secondary cause for these symptoms
has been identified. The presence of hypermetabolic areas is atypical of dementia but has been previously
documented in FTLD associated with mutations of the C9orf72 gene [8]. It is also noteworthy that a previous
study found abnormal FDG-PET findings in approximately one-third of FTLD patients [9]. Some studies
suggested that in some cases neurodegenerative diseases (particularly Alzheimer's disease) may show
hypermetabolism in the temporal lobes and hyperactivation on fMRI scans, especially in the early stages of the
disease. These changes were a predictor of lower cognitive scores and also faster progression of the disease
[10][11].
39
Conclusions: PET/CT with 18F-FDG is a useful investigation to evaluate brain metabolism and determine
hypometabolic areas in the brain responsible for a variety of behavioral changes, as well as to differentiate
between Alzheimer's disease and fronto-temporal lobar degeneration.
Keywords: frontal lobe syndrome, 18F-FDG Brain PET, Alzheimer’s disease, fronto-temporal lobar
degeneration.
References:
1. Barker WW, Luis CA, Kashuba A, et al. Relative frequencies of Alzheimer disease, Lewy body, vascular and
frontotemporal dementia, and hippocampal sclerosis in the State of Florida Brain Bank. Alzheimer Dis Assoc
Disord. 2002;16:203–12.
2. Letitia Pirau; Forshing Lui; Frontal Lobe Syndrome; Treasure Island (FL): StatPearls Publishing; 2022 Jan.
2022 Jul 19.
3. Chidambaram Natrajan Balasubramanian Harisankar, Bhagwant Rai Mittal, Kanhaiya Lal
Agrawal, Mohammed Labeeb Abrar, Anish Bhattacharya, Baljinder Singh, Manish Modi; FDG-PET findings
in fronto-temporal dementia: A case report and review of literature; Indian J Nucl Med. 2011 Apr-Jun; 26(2): 96–
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4. Di Lazzaro V, Pilato F, Dileone M, Saturno E, Oliviero A, Marra C, Daniele A, Ranieri F, Gainotti G, Tonali
PA. In vivo cholinergic circuit evaluation in frontotemporal and Alzheimer dementias. Neurology. 2006 Apr
11;66(7):1111-3.
5. Norman L. Foster, Judith L. Heidebrink, Christopher M. Clark, William J. Jagust, Steven E.
Arnold, Nancy R. Barbas, Charles S. DeCarli, R. Scott Turner, Robert A. Koeppe, Roger Higdon, Satoshi
Minoshima; FDG-PET improves accuracy in distinguishing frontotemporal dementia and Alzheimer’s disease;
Brain, Volume 130, Issue 10, October 2007, Pages 2616–2635.
6. Nobili, F, et al. European Association of Nuclear Medicine and European Academy of Neurology
recommendations for the use of brain 18 F-fluorodeoxyglucose positron emission tomography in
neurodegenerative cognitive impairment and dementia: Delphi consensus. Eur. J. Neurol. 2018, 25, 1201–1217.
7. Ishii K, Sakamoto S, Sasaki M, Kitagaki H, Yamaji S, Hashimoto M, et al. Cerebral glucose metabolism in
patients with frontotemporal dementia. J Nucl Med. 1998;39:1875–8.
8. Jake P. Levy, Christian Bocti, Dominique Elie, Nancy Paquet, Jean-Paul Soucy, Simon Ducharme;
Bifrontal Hypermetabolism on Brain FDG-PET in a Case of C9orf72-Related Behavioral Variant of
Frontotemporal Dementia; Published Online: 8 Nov 2018 doi.org/10.1176/appi.neuropsych.18050114.
9. Vijverberg EG, Wattjes MP, Dols A, et al.: Diagnostic accuracy of MRI and additional [18F]FDG-
PET for behavioral variant frontotemporal dementia in patients with late onset behavioral changes. J
Alzheimers Dis 2016; 53:1287–1297.
10. Anna Rubinski, Nicolai Franzmeier, Julia Neitzel, Michael Ewers, et al.: FDG-PET hypermetabolism is
associated with higher tau-PET in mild cognitive impairment at low amyloid-PET levels. Alzheimer's Research
& Therapy volume 12, Article number: 133 (2020).
11. B.C. Dickerson, D.H. Salat, D.N. Greve, E.F. Chua, E. Rand-Giovannetti, D.M. Rentz, L. Bertram, K.
Mullin, R.E. Tanzi, D. Blacker, M.S. Albert, and R.A. Sperling; Increased hippocampal activation in mild
cognitive impairment compared to normal aging and AD; Neurology. 2005 Aug 9; 65(3): 404–411.
doi: 10.1212/01.wnl.0000171450.97464.49.
40
4. CORRELATION BETWEEN EMISSION CHARACTERISTICS OF
RADIOISOTOPES AND PET IMAGING QUALITY
Livia E. CHILUG1, Ilie A. NECŞOIU1,2, Simona I. BĂRUȚĂ1, Radu A. LEONTE1, Alina RAICU1, Bogdan G.
BURGHELEA1, Dana NICULAE1
1
Horia Hulubei National Institute for Physics and Nuclear Engineering, Radiopharmaceutical Research Centre,
Măgurele, Romania
2
University of Bucharest, Doctoral School of Physics, Faculty of Physics, Bucharest, Romania
E-mail: andrei.necsoiu@nipne.ro
Keywords: PET imaging, acquisition parameters, phantoms
The aim of this work is to assess the influence of the physical characteristics of the radioisotopes over the imaging
parameters and image quality produced by Positron Emission Tomography (PET) scanner. The studies were
performed at the Radiopharmaceutical Research Centre (CCR, IFIN-HH, Romania) using 18F, 68Ga, 89Zr, 64Cu
(positron emission energy range 0.633-1.899 MeV). MicroPET4-CT (MILabs – The Netherlands) scanner is
designed for small animals imaging (mice and rats), therefore being able to provide resolutions up to 0.03 mm
(PET 0.45-0.5 mm and CT 0.03 mm, respectively), better than the ones provided by regular PET scanners
designed for human use. We assessed the influence of physical characteristics of the above-mentioned
radioisotopes, along with the injected activity over the image quality. The next step was to adjust the acquisition
factors, namely injected activity, uptake and acquisition time, in order to improve the reconstruction and provide
better images. For this purpose, we used dedicated phantoms, provided by the manufacturer. The radioisotopes
were produced, purified and radiochemically processed at the moment of use at CCR.
In conclusion, precise localization of the lesions and their geometry determination are very important when design
the therapy. Assessing and correlation of the emission characteristics to acquisition parameters and image-to-noise
ratio are parts of the quality assurance in any clinical set-up. Direct influence of positron energy on its range in
tissue translates in image resolution, while injected activity is related to acquisition time. These correlations will
further serve in clinical setup and to optimize the impact on the patient and quality assurance of the investigational
procedures.
This work was supported by a grant of the Romanian Ministry of Research, Innovation and Digitalization project
number PN 23210201.
41
5. FDG PET-CT IN MERKEL CELL CARCINOMA: CASE REPORT
A. Ciocan1, L. Mititelu2,3, C. Mazilu4, T. Mititelu2,3, A. Mazilu5, D. Cuzino2,6, M. Oancea4, D. Zob7, R.
Mititelu2,4
1Oncologic Institute “Al Trestioreanu” Bucharest, Nuclear Medicine department
2University of Medicine and Pharmacy dr Carol Davila Bucharest
3Institute of Military Medicine
4Clinic of Nuclear Medicine, Central University Emergency Military Hospital Bucharest
5Clinic of Endocrinology, Central University Emergency Military Hospital Bucharest
6Clinic of Radiology, Central University Emergency Military Hospital Bucharest
7Oncologic Institute “Al Trestioreanu” Bucharest, Oncology department
Introduction: Merkel cell carcinoma (MCC) is a rare but highly aggressive skin cancer with neuroendocrine
features that usually presents as a solitary cutaneous or subcutaneous nodule in the areas most exposed to the sun.
MCC polyomavirus and chronic exposure to UV radiation represent the most common etiology. Staging and
degree of extension can be assessed by FDG PET CT, which provides valuable images and quantification tools.
Material and methods: We present the case of an 89-year-old man who presented with a laterocervical tumor. The
patient's personal pathologic history, biochemical values, and physical examination did not reveal any unusual
features. The laterocervical tumor was excised and was found to be a lymph node with the histopathologic features
of Merkel cell carcinoma (MCC). Positive immunohistochemical markers AE1/AE3, CK20, chromogranin, and
neurofilament confirmed the diagnosis of MCC. The patient was then referred to FDG-PET-CT for staging, in
part because the primary MCC lesion was not found on physical examination.
The PET-CT scan showed intense uptake of 18F-FDG in the lymph nodes in the left laterocervical region,
mediastinum, and lung hilum with a SULmax of up to 15.81 (subcarinal); no other foci of pathologic uptake were
detected in other organs.
The absence of the primary skin lesion and distant metastases led to the hypothesis that this was a case of MCC
with spontaneous regression.
Discussion: As far as we know, this is the first reported case of MCC that initially presented as carcinoma of
unknown primary, with no evidence of the primary lesion and with later reccurence with distant disease. Usually,
spontaneous regression of MCC has a good prognosis compared to other skin cancers, such as malignant
melanoma (1).
In 1986, the first case of spontaneous regression of MCC was described in the literature by O'Rourke and Bell
(2). To date, less than 60 cases of spontaneous regression have been reported (3). Several theories related to the
mechanism of spontaneous regression have been described, such as signs of chronic inflammation with humoral
and cellular immune responses, as well as apoptosis.
Two cases have been published so far in which spontaneous regression was followed by recurrence, one distant
at the level of the vertex, and one regional, with the primary tumor atypically located on the foot (1,4).
Our case, as shown by histopathology and PET-CT, can be established as a spontaneous regression of an MCC
that presented atypically as carcinoma unknown primary with distant metastatic recurrence.
Conclusions: Even if the spontaneous regression in MCC is usually associated with a good prognosis, there can
be situations, such as the case of our patient, that can be followed by distant recurrence. FDG PET CT can be a
valuable tool for managing MCC patients and help identify the real extent of highly aggressive variants.
Key words: Merkel cell carcinoma, spontaneous regression, recurrence, FDG PET-CT
REFERENCES:
42
1. Kobayashi Y, Nakamura M, Kato H, Morita A. Distant recurrence of Merkel cell carcinoma after
spontaneous regression. J Dermatol. 2019;46(4):e133–e134. doi:10.1111/1346-8138.14652.
2. O’Rourke MG, Bell JR. Merkel cell tumor with spontaneous regression. J Dermatol Surg Oncol 1986;
12(9): 994–996, 1000.
3. Bystricky B, Kohutek F, Miklatkova Z, et al Spontaneous Regression of Merkel Cell Carcinoma: Case
Report. Int Med Case Rep J. 2021;14:711-717 https://doi.org/10.2147/IMCRJ.S329545
4. Jansen SCP, Groeneveld-Haenen CPM, Klinkhamer P J J M, et al. BMJ Case Rep 2015, doi:10.1136/
bcr-2014-208344
43
89 64
6. PHARMACEUTICAL GRADE PROCESSING OF ZR AND CU
MEDICAL RADIOISOTOPES
Diana Cocioabă1,2, Radu Leonte1, Bogdan Burghelea1,2, Roxana Cornoiu1,3, Radu Șerban1,4, Alina Raicu1,
Simona Bărută1, Andrei Necșoiu1,2 and Dana Niculae1
1
Horia Hulubei National Institute for Physics and Nuclear Engineering, Radiopharmaceutical Research Centre,
Magurele, Romania
2
3
University Politehnica of Bucharest, Doctoral School of Applied Chemistry and Materials Science, Faculty of
Chemical Engineering and Biotechnologies, Bucharest, Romania
4
University of Bucharest, Doctoral School of Biology, Faculty of Biology, Bucharest, Romania
Corresponding author: diana.cocioaba@nipne.ro
Keywords: medical radioisotopes, cyclotron, nuclear reactions
PET imaging with 89Zr-based agents has been a dynamic field of research, radiopharmaceuticals based
on 89Zr-labeled antibodies are intended for use in the early detection, screening and monitoring of
malignant tumors, such as breast, prostate, ovarian and intestinal cancer. Its disintegration mechanism
exhibits 76.6% electron uptake and 22.3% positron emission, while the half-life of 78 hours matches the
longer distribution and uptake time required by monoclonal antibodies use in molecular imaging.
64
Cu is of a particular interest due to its “triple” emissions of Auger electrons, β+ (17.86%) and β-
(39.03%). 64Cu can be used as imaging and/or theragnostic radioisotope in different types of cancer and
also for various diseases including arteriosclerosis and Alzheimer's disease. Its 12.7 hours half-time
allows a good uptake and distribution of 64CuCl2 to obtain qualitative images and high contrast, also
enough to trigger a therapeutic effect during its intracellular residency.
The processes involve the irradiation of natY foils and electrodeposited 64Ni targets respectively, via
89
Y(p,n)89Zr and 64Ni(p,n)64Cu nuclear reactions, performed at TR-19 cyclotron (ACSI, Canada)
installed at Radiopharmaceutical Research Centre (IFIN-HH). Irradiations were conducted on a fully
automated solid target irradiation system (Alceo, Comecer, Italy). The irradiated targets were dissolved
and processed to obtain pharmaceutical grade products.
6 hours of irradiation lead to 15.42 ± 1.85 GBq in form of purified [64Cu]CuCl2; 4 hours of irradiation
lead to 2.5 ± 0.3 GBq of purified 89Zr-oxalate, values decay-corrected to the end of bombardment. The
radiochemical and the radionuclide purities of both 64Cu and 89Zr solutions, assessed by radio-TLC,
radio-HPLC and gamma spectrometry, were higher than 99.99% after purification, matching
pharmaceutical requirements. The activity of obtained solution are used for PET scanning of small
animals in preclinical studies, processes being scaled-up for clinical use – batches of 35 investigational
procedures with 64Cu and 5 with 89Zr are envisaged.
Acknowledgements: This work was supported by a grant of the Romanian Ministry of Research,
Innovation and Digitalization project number PN23210201 and IOSIN-Ciclotron TR19.
44
7. RADIOLABELING OF PEPTIDES WITH COPPER-64 AS PART OF DRUG
DEVELOPMENT PROCESS
Roxana Cornoiu1,2, Livia Chilug1, Radu Șerban1,4, Radu Leonte1, Diana Cocioabă1,3, Bogdan Burghelea1, Alina
Raicu1 and Dana Niculae1
1
Horia Hulubei National Institute for Physics and Nuclear Engineering (IFIN-HH), Radiopharmaceutical Research
Centre, Magurele, Romania
2
University Politehnica of Bucharest, Doctoral School of Applied Chemistry and Materials Science, Faculty of
Chemical Engineering and Biotechnologies, Bucharest, Romania
3
4
University of Bucharest, Doctoral School of Biology, Faculty of Biology, Bucharest, Romania
Corresponding author: roxana.cornoiu@nipne.ro
Keywords: theranostic, cancer, peptides

Introduction: In addition to a convenient half-life of 12.7 hours, 64Cu has a profitable complex decay scheme,
adding to its biochemical implications in oncogenesis a huge potential to be exploit in nuclear medicine
applications. One of the pathways to address targeted radiotherapy of cancer implies to reach specific receptors
on the surface of the tumour cells using peptide carriers, to which 64Cu binds covalently via a bifunctional chelator
(e.g. DOTA). The resulted radiopharmaceuticals should preserve the high specificity for their targets and have to
prove sufficient in vivo stability to deliver in situ the ionizing radiation (Auger electrons and -).
Methods: The current study focused on the radiolabelling with 64Cu of two DOTA-derivatised peptides
Neuromedin N (NMN) and Neurotensin short chain 8-13 (DOTA-NT(8-13)), respectively. The process involves
certain reaction conditions, including high temperature (over 95C), pH 3.8-4.0, and 20-30 min reaction time.
After the radiolabeling, the solution was purified by using a specific cartridge PD10. The radiolabelling yield,
radiochemical purity (in vitro stability were determined by radio-TLC and radio-HPLC, while the uptake-
retention profiles were assessed by Ligand-Tracer method, using colon tumour cell lines.
Results: The radiochemical purity of the radiolabelled peptides was higher than 99.95% after purification. Both
64
Cu-DOTA-NMN and 64Cu-DOTA-NT(8-13) were stable at 72 hrs from the end of the synthesis. The process
parameters, such as the quantity of peptides, molar ratios, radioactive concentration and molar activity, were
optimized, resulting in over 60% yield of the radiolabelling.
Conclusions: The 64Cu radiometal radiolabelling processes using bifunctional DOTA chelator were successfully
optimized for DOTA-NT(8-13) and DOTA-NMN peptides. Therefore, the synthesized 64Cu-DOTA-NMN and
64
Cu-DOTA-NT(8-13) proved a rapid and stable in vitro binding to tumour cells. Further investigations are needed
to advance the application of proposed agents in targeted radiotherapy and PET follow-up imaging.
Acknowledgement: This work was supported by PN23210201
45
8. Solitary pulmonary nodules. A PET-CT diagnostic analysis
A Mitoi1, C Mazilu1, M Oancea1, S Serbanescu1, D Craciun1, R Vasile1, M Matei1, R Mititelu1,2
1
Nuclear Medicine Department, Central Universitary Emergency Military Hospital Bucharest, Romania
2
University of Medicine and Pharmacy Dr Carol Davila Bucharest
Introduction
The solitary pulmonary nodule (SPN) is a round-oval radiographic opacity no more than 3 cm in diameter,
necessarily surrounded by healthy lung parenchyma.[1] Compared with conventional imaging techniques,
positron emission tomography combined with computed tomography (PET-CT) with [18F]fluoro-2-deoxy-d-
glucose (18F-FDG) provides information on the metabolic activity of glucose at the lesion level in addition to
morphologic features.
The aim of this study was to evaluate the diagnostic value and risk stratification of SPN by PET /CT with 18F-
FDG.[2]
Material and method
We performed a retrospective review of 31 consecutive patients presenting to PET-CT for evaluation of an SPN.
Lesions were assessed visually and by semiquantitative measurement of nodule metabolic activity, using the
maximum standardized value of uptake corrected with injected activity and body mass, and normalized by lean
body mass (SULmax)[3]. Reconstructions were generated using Q.Clear software, a reconstruction algorithm
from GE Healthcare that excels at assessing subcentimetric lesions.[4] Subsequently, the data obtained were
correlated with patient age and nodule diameter and compared with data from the literature.
Results/Outcomes
This study enrolled 31 patients (24 men and 7 women) who had pulmonary nodules ranging in size from 6 to 30
mm and age from 45 to 86 years at the time of diagnosis.
Patients were divided into 3 risk groups according to the diameter of the SPN. Group I SPN between 6 and 10
mm in diameter (5 patients), group II nodules between 11 and 20 mm in diameter (11 patients), and group III
nodules between 21-30 mm (15 patients).
The average age in group I was 58.6 ±12.98 years, the mean node diameter of 7.2 ±1.44 mm and an average
SULmax of 1.85 ±1.49. Group II was composed of patients with an average age of 70.36 ±5.91 years, with the
mean node diameter of 14.09 ±1.80 mm and an average SULmax of 3.88 ±1.65. In group III the average age of
patients was 63.4 ±4.87 years with an average SPN diameter of 25.66 ±1.72 mm and an average SULmax of 9.09
±3.36.
Of the 31 patients, 23% (n=7) were diagnosed with SPN without or with minimal metabolic activity, and the
decision to follow up the imaging at 12 months through LDCT was taken.[5], [6]
In our study, 77% (n=24) of SPN were considered suspect or malignant based on visual evaluation of metabolic
activity and SULmax measurement relative to the diameter of the nodule (SULmax/diameter> 1). All patients
were advised to perform a transthoracic puncture-biopsy under CT guidance or surgical excision to establish
histopathological diagnosis.[6]
Discussion
The information obtained in our study was comparable to literature data across all risk groups.
There is a direct proportional relationship between the diameter of the SPN and its metabolic activity[7]. It should
be remembered that there are situations in which certain malignant lesions have lower uptake of 18F-FDG
(adenocarcinoma, lymphoma, carcinoid tumors), the tumor size is too small (partial volume effect) to allow
correct interpretation[8][9].Moreover, a solitary lung nodule with intense metabolic activity may also be benign,
46
with inflammatory and/or infectious causes for the strong uptake (tuberculosis, sarcoidosis, granulomatosis,
pneumonia, etc.)[9][5].
Currently, there are no PET /CT imaging criteria or cut-off values for SUV to make a definite diagnosis for
malignancy, especially for patients in the risk group II (11-19 mm). However, the SULmax value in conjunction
with nodule size can provide a guide for risk stratification and help the clinician make the optimal therapeutic
decision - biopsy, surgical excision, or imaging follow-up.[1], [5]
Conclusions
18F-FDG PET/CT has the ability to stratify for the risk of malignancy, helping clinicians to make optimal
therapeutic decision (CT guided biopsy puncture or imaging tracking), depending on the patient's risk group.
Advances in radiomic and radiogenomic analysis open new horizons for accurate diagnosis and stratification of
patients with SPN.
Bibliography
[1] S. Fernandes et al., “Solitary pulmonary nodule imaging approaches and the role of optical fibre-based
technologies,” European Respiratory Journal, vol. 57, no. 3, p. 2002537, Mar. 2021, doi:
10.1183/13993003.02537-2020.
[2] K. Tang, L. Wang, J. Lin, X. Zheng, and Y. Wu, “The value of 18F-FDG PET/CT in the diagnosis of
different size of solitary pulmonary nodules,” Medicine, vol. 98, no. 11, p. e14813, Mar. 2019, doi:
10.1097/MD.0000000000014813.
[3] T. Halsne et al., “The Effect of New Formulas for Lean Body Mass on Lean-Body-Mass–Normalized
SUV in Oncologic 18 F-FDG PET/CT,” J Nucl Med Technol, vol. 46, no. 3, pp. 253–259, Sep. 2018, doi:
10.2967/jnmt.117.204586.
[4] E. J. Teoh, D. R. McGowan, K. M. Bradley, E. Belcher, E. Black, and F. v. Gleeson, “Novel penalised
likelihood reconstruction of PET in the assessment of histologically verified small pulmonary nodules,” Eur
Radiol, vol. 26, no. 2, pp. 576–584, Feb. 2016, doi: 10.1007/s00330-015-3832-y.
[5] J. Mortensen, “Assessing nodules detected in lung cancer screening: the value of positron emission
tomography,” European Respiratory Journal, vol. 45, no. 2, pp. 314–316, Feb. 2015, doi:
10.1183/09031936.00192714.
[6] D. Groheux et al., “FDG PET-CT for solitary pulmonary nodule and lung cancer: Literature review,”
Diagn Interv Imaging, vol. 97, no. 10, pp. 1003–1017, Oct. 2016, doi: 10.1016/j.diii.2016.06.020.
[7] Z. Ruilong, X. Daohai, G. Li, W. Xiaohong, W. Chunjie, and T. Lei, “Diagnostic value of 18F-FDG-
PET/CT for the evaluation of solitary pulmonary nodules,” Nucl Med Commun, vol. 38, no. 1, pp. 67–75, Jan.
2017, doi: 10.1097/MNM.0000000000000605.
[8] J. H. O, I. R. Yoo, S. H. Kim, H. S. Sohn, and S. K. Chung, “Clinical significance of small pulmonary
nodules with little or no 18F-FDG uptake on PET/CT images of patients with nonthoracic malignancies.,” J Nucl
Med, vol. 48, no. 1, pp. 15–21, Jan. 2007.
[9] Y.-C. Lai et al., “Differentiation Between Malignant and Benign Pulmonary Nodules by Using Automated
Three-Dimensional High-Resolution Representation Learning With Fluorodeoxyglucose Positron Emission
Tomography-Computed Tomography,” Front Med (Lausanne), vol. 9, Mar. 2022, doi:
10.3389/fmed.2022.773041.
47
9. HIDE AND SEEK – RENAL AGENESIS BETWEEN STRUCTURAL AND
FUNCTIONAL IMAGING
Larisa-Elena Rău1, Irena Cristina Grierosu1,3, Rareș Stamate1, Diana-Alexandra Răileanu1, Viorica Cernov1,
Ruxandra Țibu1, Magdalena Stârcea2,3, Ana-Maria Stătescu1, Cipriana Ștefănescu1,3
Nuclear Medicine Laboratory, County Emergency Hospital „Sf. Spiridon” Iasi, Romania
Pediatric Nephrology Department, Saint Maria Hospital, Iasi, Romania
University of Medicine and Pharmacy U.M.F „Grigore T. Popa” Iasi, Romania
Introduction. Unilateral renal agenesis is often caused by a gene mutation and usually, children don’t have
symptoms and don’t need treatment. It is estimated that from the general population, 1 in 2000 babies has
unilateral renal agenesis. The prenatal diagnosis is first realized by ultrasonography but for the postnatal imaging
confirmation, a 99mTc-DMSA renal scan completes the picture for a more accurate diagnosis and localization of
the renal anomaly. However, hypertension, proteinuria and renal failure may develop in time.
Material and method. In this retrospective analysis, we aimed to share our 20 years of experience in renal
agenesis in the North-Eastern Region of Romania. In total there were 77 pediatric cases, with ages between 4
months and 18 years. All patients underwent renal ultrasonography followed by 99mTc-DMSA renal scan using a
Siemens DIACAM double headed Gamma camera.
Results and discussions. From all the suspected cases, 64 were confirmed with renal agenesis after a 99mTc-
DMSA renal scan. We noticed a higher incidence in males (59.4 %) and also a higher incidence of left renal
agenesis (62.5%). The predominance of left renal agenesis was observed in both males (24 cases from 38) and
females (16 cases from 26). The rest of 13 patients represented cases of renal malformation (renal fusion (6.5%)
and renal ectopy (10.4%)).
Conclusions. 99mTc-DMSA renal scan brings invaluable additional details to structural imaging, with very low
radiation exposure and minimal invasibility, hence being of great use in guiding the therapeutic plan for a
personalized approach for each pediatric patient.
Key words: renal agenesis, 99mTc-DMSA, isotopic nephrography
48
10.IN VITRO ASSESSMENT OF CELLULAR RESPONSE TO THE
INTERNAL RADIOTHERAPY DELIVERED BY AUGER-ELECTRON
AND BETA EMISSIONS OF COPPER-64
Radu Marian SERBAN1,2, Dragos Andrei NICULAE3, Ionela Victoria NEAGOE4, Maria-Roxana CORNOIU1,
Diana Silvia COCIOABA1, Mihaela TEMELIE1, Gina MANDA4, Anca DINISCHIOTU2 and Dana NICULAE1
1
Horia Hulubei National Institute for Physics and Nuclear Engineering (IFIN-HH), Radiopharmaceutical Research
Centre, 30 Reactorului Street, 077125 Magurele Ilfov, Romania
2
University of Bucharest, Faculty of Biology, 91-95 Splaiul Independentei, 050095 Bucharest, Romania
3
University of Medicine and Pharmacy Carol Davila, Faculty of Pharmacy, 37 Dionisie Lupu street, 020021,
Bucharest, Romania
4
National Institute of Pathology "Victor Babes", 99-101 Splaiul Independentei, Bucharest, Romania
Key words: radiotoxicity, radiotherapy, Auger-electrons
In internal radiotherapy using radioisotopes with high linear energy transfer emissions (alpha particles, Auger
electrons or low energy beta- particles), the effectiveness of the treatment is increased by improvements to the
delivery methods and the specificity of isotope carriers for relevant biological targets. The use of biocompatible
molecules to ensure improvements in the dose delivered to afflicted cells increases the cellular damage caused by
radiation and triggers the innate cell death mechanisms, all the while having a lesser impact to surrounding healthy
tissue.
Given the short-range penetration of tissue, within one cellular diameter, low energy Auger (…) electrons emitted
during nuclear decay by electron capture are viable candidates for damaging key internal cellular structures, such
as the genetic material in cancerous cells, either by direct interactions or through the increased oxidative stress.
64
Cu was chosen for study given the importance of copper ions as a cofactor for enzymatic mechanisms involved
in DNA replication and cellular division.
We assessed the in vitro effects of 64Cu on different cell lines, both cancerous and a reference normal one, testing
for oxidative stress induced by the radioisotope by measuring the GSH and MDA content and activation of certain
gene involved in cells oxidative stress response and protection. Cellular viability was tested using the MTS and
LDH assays. A morphological staining method was used to analyse the cell death by apoptosis. Genotoxicity was
investigated using comet assay. In vitro experiments with [64Cu]CuCl2 incubation indicate that cells with higher
proliferation rate are more susceptible to Auger electron exposure.
The results demonstrate the capacity of the short-range Auger electrons and associated emissions of copper-64 to
act as damaging internal radiotherapy. Understanding the mechanism through which such radiations triggers cells
responses and induces cell death contributes to developing therapeutic strategies for tumour treatment.
49
11.PROGNOSTIC SIGNIFICANCE OF 18F-FDG PET-CT IN
ENDOMETRIAL CANCER
Paula Monica Spiridon1, Cătălin Mazilu2, Dragoș Cuzino2,3, Teodora Mititelu4, Florentina Ionita Radu2,3, Mariana
Jinga2,3, Raluca Mititelu2,3
1
Nuclear Medicine Department, Oncologic Institute „Prof. Dr. Alexandru Trestioreanu” Bucharest, Romania
2
Nuclear Medicine Department, Central Universitary Emergency Military Hospital Bucharest, Romania
3
University of Medicine and Pharmacy Dr Carol Davila Bucharest
4
Institute of Military Medicine, Bucharest, Romania
Aim/Introduction: The aim of this study was to investigate the relationship between tumor differentiation and
glucose metabolism in patients with confirmed endometrial cancer.
Materials and Methods We perform a retrospective review of 24 consecutive patients (ages 41-84) with
histopathological confirmed endometrial cancer who underwent PET-CT in our department between January 2021
and January 2023. Quantitative data on glucose metabolism were collected using the maximum standardized
uptake value normalized by lean body mass (SULmax). PET-CT examination was performed with a dedicated
equipment, with the patient fasting for at least 6 hours before the examination and following a low-carbohydrate
diet for 24 hours before the examination. PET-CT images were examined for primary tumors, locoregional spread,
and distant organ metastases.
Results: We reviewed a total of 24 patients with a mean age of: 61±9 years, median 63. Of these, 11 patients had
well-differentiated cancer, 5 had moderately differentiated cancer and the remaining 8 patients had poorly
differentiated cancer.
The mean SULmax value of all lesions in the whole group was 7.87 ±5.85, with a mean SULmax value of
5.99±3.23 in well-differentiated cancer, 7.74±4.31 in moderately differentiated cancer, and 9.64±7.50 in poorly
differentiated cancer indicating, higher glucose metabolism in poorly differentiated tumors, as expected.
When we analyezd the age of the patients and the SULmax values we found that in patients younger than 60 years
old the mean SULmax value was 6.55± 4.90 and in patients older than 60 years it was 8.32±6.07.
Conclusions: This study revealed that glucose metabolism correlates not only with the degree of tumor
differentiation but also with age, with high levels in patients over 60 years of age diagnosed with endometrial
cancer. Considering the correlation between tumor aggressiveness and glucose consumption, this may be helpful
in the prognostic evaluation of patients with malignant endometrial cancer.
Keywords: Endometrial cancer, tumor differentiation, glucose metabolism
50
12.99MTC-EDDA/HYNIC-TOC (TEKTROTYD) SCAN RAISING
DIAGNOSTIC SUSPICION IN MISCHARACTERIZED MENINGIOMA -
A CASE REPORT
Maria-Carla Sterea1, Alexandra Maria Lazar1, Mario Mutuleanu1,2, Ionela Irimescu1, Mirela Gherghe1,2
1
Nuclear Medicine Department, Institute of Oncology “Professor Doctor Alexandru Trestioreanu”,
Bucharest, Romania
2
Nuclear Medicine Department, University of Medicine and Pharmacy “Carol Davila” Bucharest,
Romania
Introduction: Atypical meningiomas are responsible for up to 15-20% of all meningioma cases. This type of
brain tumor is considered to be mid-grade as they cannot be classified as being neither benign nor malignant,
exhibiting a tendency towards rapid growth and recurrence.
Materials and Methods: In the current study we are introducing the case of a 57 year old male who presented in
our department for a 99mTc-EDDA/HYNIC-TOC SPECT/CT scan in order to identify the primary tumoral site
after being initially diagnosed with frontoparietal cutaneous metastasis of neuroendocrine tumor subsequent to
the excision of a subcutaneous rapid growing mass. Prior colonoscopy and upper gastrointestinal endoscopy were
inconclusive, thus further evaluation was needed.
Results: 99mTc-EDDA/HYNIC-TOC SPECT scans revealed a focal area in the frontal region of the brain with
increased uptake of the radiotracer, corresponding to a high-density mass on the native CT study, morphologically
compatible with the aspect of a meningioma, thus raising suspicion in a new direction. After subtotal tumoral
resection was performed, postoperative histopathological analysis revealed an atypical meningioma histological
grade II WHO.
Conclusion/Discussions: We chose to introduce this case considering meningiomas may mimic other intracranial
tumors, including brain metastasis of neuroendocrine tumors. Both neoplasms exhibit somatostatin receptors, but
with important prognostic and therapeutic differences, therefore an accurate diagnostic is imperative in such cases.
Keywords: atypical meningioma, 99mTc-EDDA/HYNIC-TOC, neuroendocrine scintigraphy.
51
13. 18F-FDG PET/CT IN THE FOLLOW-UP OF COLORECTAL CANCER
Irina Maria Strugari, Catalin Mazilu, Alina Gherman, Dragos Cuzino, Cezar Calin, Mariana Jinga, Florentina Ionita-
Radu, Raluca Mititelu
Central Universitary Emergency Military Hospital, Bucharest, Romania
Aim: Colorectal cancer is the third most common cancer worldwide. The aim of this study is to evaluate the value
of 18F- FDG PET /CT in the follow-up of patients with colorectal carcinoma, considering clinical conditions and
therapeutic options.
Materials and Methods: We retrospectively evaluated 150 consecutive patients with histopathologically
confirmed colorectal carcinoma who underwent PET-CT scan in our department from January 2020 to December
2021. Inclusion criteria were relevant findings of progressive disease. Patient data included age, sex, tumor
location, histologic grading and stage of tumor, and treatment modalities. We excluded patients with incomplete
medical history and patients who had not received anti-tumor treatment before the PET-CT scan. Thus, 119
patients (79 M; 40 F) were included in the study.
Results: Patients were predominantly male with an age range of 42 to 84 years. In all cases, 18F- FDG PET /CT
was performed in patients previously treated with neoadjuvant chemotherapy followed by surgery. The follow-up
examinations with 18F- FDG PET /CT revealed positive findings (locoregional recurrences and distant
metastases) in 70% of cases and negative findings in 30% of cases. Some factors predictive of recurrence and
metastasis were: tumor location (rectosigmoid tumor), histologic grading (moderately and poorly differentiated),
and treatment modalities.
CONCLUSION: This study highlights the role of 18F- FDG PET /CT in the follow-up of patients with colorectal
carcinoma and also emphasizes the importance of clinical features in the management of recurrence and
metastasis.
52
14.A FALSE NEGATIVE SPECT-CT BONE SCAN IN A 20-YEAR-OLD
PATIENT WITH TRIPLE-NEGATIVE METASTATIC BREAST CANCER
Tatiana Lucia Șuta1, Jamal Rabah1, Mirela Gherghe1,2
1
Oncology Institute of Bucharest “Professor Doctor Alexandru Trestioreanu”
2
“Carol Davila” University of Medicine and Pharmacy, Bucharest
Introduction: Triple-negative breast cancer (TNBC) is defined by the absence of estrogen receptors (ER),
progesterone receptors (PR) and human epidermal growth factor 2 expression (HER2). The prognosis is very poor
due to treatment impediments and the aggressive traits of these tumors compared to other breast carcinoma
subtypes. TNBC patients with higher clinical stage and larger tumor size (>5 cm) were more predisposed to distant
metastasis. Breast cancer frequently metastasizes to the skeleton, alterating bone remodeling process resulting in
osteolytic lesions.
Diagnosis and discussion: We present the case of a 20-year-old patient diagnosed with TNBC, debuting with
severe enlargement of the left breast, in August 2022. Initial ultrasound examination reveals a tumoral mass
infiltrating the entire volume of the mammary gland (BI-RADS 5), associating tumor-like lymphadenopathies in
the I-III axillary stations. Tissue biopsy with pathologic and immunohistochemical tests establish the diagnosis
of invasive ductal carcinoma NOS G3, ER, PR and HER2 negative; CT examination confirms the original
ultrasound findings emphasising no evidence of metastatic lesions in the scanned areas.
By January 2023, the patient undergoes 4 chemotherapeutic cycles of Epirubicine and Cyclophosphamide,
continued with 4 cycles of neoadjuvant therapy with Paclitaxel and Carboplatin. Pre-operative assessment is
performed. CT examination shows significant dimensional regression of both tumor and regional
lymphadenopathies, but new bone lesions are detected. Tc-99m diphosphonate scintigraphy and SPECT-CT
examinations highlight multiple osteoblastic lesions with none or minimal uptake of the bone-seeking
radiopharmaceutical. The patient develops severe cefalea; cerebral MRI scan shows leptomeningeal lesion
adjacent to cerebellar sulci.
Conclusions: The peculiarity of the case was that despite the aggressiveness and high tumoral grade of TNBC in
a very young patient, the osteoblastic bone metastases presented as false negative on SPECT-CT bone scan.
Key words: triple-negative breast cancer, SPECT-CT scan, bone metastasis.
53
15.ARTIFICIAL INTELLIGENCE GUIDED SOFTWARE USED FOR
MASKING THE BLADDER FROM WHOLE-BODY BONE SCANS
Iulian-Alexandru Taciuc1, Cătălin-Florin Blaj2, Adrian Costache1, Mirela Gherghe1,2
1
„Carol Davila” University of Medicine and Pharmacy Bucharest, Romania
2
Institute of Oncology “Professor Doctor Alexandru Trestioreanu”, Bucharest, Romania
Introduction: In the technique of bone scans with Tc-99m-bisphosphonates the bladder accumulates large
amounts of activity due to rapid urinary excretion of the labelled radiopharmaceutical. This accumulation may
obscure pelvic lesions and therefore, the guides recommend to void the bladder. Beside this, the standard
procedure of image processing requires the bladder to be masked. Starting from this recommendation, we have
developed an artificial intelligence assisted software that is able to automatically cut off the bladder from the
whole-body bone scintigraphy.
Method: We have used Python as programming language and PyCharm as development environment and 100
patients (in preliminary study) with a total of 200 images (2 images per patient – anterior and posterior incidence)
used individually for the automatic bladder identification (the machine learning process). The scans were made
with the GE Healthcare system and processed using a Xeleris Workstation, “WB & Spots Bone Review”
application.
Results: The artificial intelligence part is used to detect the region of interest (which in our case is represented
by bladder) and after that, the most intense pixels of that ROI are masked. Though the whole process has
promising results, the AI needs more patients (examples) to boost the accuracy of ROI detection.
Conclusions: The program needs additional training if is it to be used routinely in medical practice. In this state
it is possible to mask a pelvic lesion by mistake from the image. The program is still in experimental phase but it
will open a path for the automated detection of metastases with high tracer uptake, in patients with multiple
lesions.
Key words: artificial intelligence software, bone scintigraphy, bladder
54
16.SPECT-CT DATA QUANTIFICATION IN MONITORING METASTATIC
NEUROENDOCRINE TUMOURS – CASE REPORT
Iulian-Alexandru Taciuc1, Ion-Alexandru Ioana2, Iuliana Dorde2, Alexandra-Maria

Lazar2, Mirela Gherghe1,2
1
„Carol Davila” University of Medicine and Pharmacy Bucharest, Romania
2
Institute of Oncology “Professor Doctor Alexandru Trestioreanu”, Bucharest, Romania
Introduction: Neuroendocrine tumours (NETs) G1 and G2 express somatostatin receptors (SSTRs) which can
be used as targets for radionuclide imaging and therapy. Quantitative analysis of SPECT-CT data is a useful tool
for disease monitoring in patients with NETs.
Case report: We present the case of a 69-year-old female with history of urothelial carcinoma, who was found
with a single liver tumoral mass during a follow up CT scan for her known disease. The hepatic mass was
surgically removed and the pathology showed a NET G2 metastasis with unknown primary origin, the patient
being recommended for a somatostatin receptor scintigraphy (SRS) to determine the original site. The patient
undergone four 99mTcEDDA/HYNIC-TOC SRS at a 6-month interval, with quantification of radiotracer uptake
using the new Q.Volumetrix AI software (Xeleris V, GE Healthcare). The first SRS (04.2021), revealed two
pancreatic foci (head – SUVmax = 21.3 and tail – SUVmax = 10.6) and one hepatic focus (segment IV) of
increased radiotracer uptake. Second SRS showed increased SUVmax values compared to the first scintigraphy,
highlighting a new hepatic lesion (segment VII – SUVmax 17.1). After confirming the pancreatic primary tumoral
site on biopsy, treatment with somatostatin analogues was started. Under treatment, the third SRS showed a stable
disease (with similar SUVmax values to the second one). The last SRS showed a decrease in the radiotracer uptake
in both pancreatic (SUVmax = 5.91) and hepatic lesions (SUVmax up to 10.3), with the resolution of the cephalic
pancreatic mass; however, new osseous and lymph node metastases with affinity for the radiotracer were
discovered, classifying the patient as progressive disease.
Conclusions: This was one of the first cases of NETs in which quantification of 99mTcEDDA/HYNIC-TOC
uptake on SPECT/CT data was used to monitor the treatment response. This follow-up method could represent a
good alternative in the facilities that do not benefit from 68Ga-DOTA-peptides for PET-CT, further
guiding the treatment.
Keywords: SPECT-CT data quantification, 99mTcEDDA/HYNIC-TOC, pancreatic neuroendocrine tumour
55
17.PITFALLS AND ARTIFACTS IN RADIOISOTOPE NEPHROGRAPHY?
THINK OUTSIDE THE BOX!
Ruxandra Țibu1, Irena Cristina Grierosu1,3, Ana Maria Stătescu1, Magdalena Stârcea2,3, Cipriana Ștefănescu1,3
Nuclear Medicine Laboratory, County Emergency Hospital „Sf. Spiridon” Iasi, Romania
Pediatric Nephrology Department, Saint Maria Hospital, Iasi, Romania
University of Medicine and Pharmacy U.M.F „Grigore T. Popa” Iasi, Romania
Introduction. Pitfalls and artifacts are a very common occurrence in nuclear medicine. They can be related to the
technique used, the patient or even with eventual technical defects of the gamma camera.
Material and methods. Incidentally there was noticed a suspicious heart fixation during a standard
99m
Tc-DTPA radioisotopic nephrography. Henceforth, in this prospective study, we added a
supplementary five minutes static thoracic image to the standard protocol. The group of patients is
represented by 48 patients, aged between 17 and 68 years. All images were acquired using a dual headed
Siemens gamma camera.
Results. There were observed different types of extra-renal fixation, as following: heart, major vessels, breasts,
cutaneous, etc. Each atypical fixation noticed needs to be correlated with the known diagnosis of the patient or
further investigations for unknown pathologies should be performed. Moreover, a thorough clinical examination
and a proper anamnesis could be vital to a correct interpretation of an unusual and bizarre image.
Conclusion. In nuclear medicine, an image is more than a black and white, still view inside the human body. We
need to always think outside the box and treat the patient as a complex mechanism, where radiotracer kinetics,
imaging technique, anamnesis and clinical inspection represent the pillars of a reliable diagnosis.
Key words: nephrogram, artifact, DTPA
56

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ABSTRACTS E-BOOK

10th Edition of The Balkan Congress of Nuclear Medicine

ISSN 2734 – 7303 ISSN-L 2668 – 3717

15th-18th March 2023, Romania

10th Edition of The Balkan Congress of Nuclear Medicine

15th-18th March 2023, Romania

Milena Dimcheva1, Teodor Sofiyanski1, Sonya Sergieva1, Bozhil Robev2

CHU St-Pierre Bruxelles

3. OLDIES BUT GOODIES. LOST CONVENTIONAL NUCLEAR

CHU St-Pierre Bruxelles

Institute of Oncology Bucharest, ”Carol Davila” University of Medicine and Pharmacy

We concluded that 99mTc-EDDA/HYNIC-TOC, a receptor-based radiopharmaceutical could represent a good

Keywords: [18F]FDG, radiochemical yield, synthesis

Rakesh Kumar1, Sanjay Kumar2, Chetan Patel1, Anil Kumar Pandey1.

Key Words: Prostate Cancer, PSMA-PET/CT, Recurrence

PURPOSE: To evaluate the diagnostic performance of positron emission tomography/computed tomography

Z. Milanović, M. Radović, D. Stanković, M. Perić, A. Vukadinović, D. Janković , S. Vranješ Đurić, M.

M. Perić1, G. Vuković2, S. Knežević1, M. Nikolić3, M. Suljagić4, Lj. Andjelković4, S. Nenadović1, M. Ivanović1,

Professor Sonya Sergieva

Key words: SPECT/CT , Malignant Melanoma, SLN

Diana Teodorescu-Perijoc 1, Mihaela-Geanina Guțu1, Andreea Baban3,4, Dimitrie-Cristian Siriopol1,5, Mihai-

10th Edition of The Balkan Congress of Nuclear Medicine

15th-18th March 2023, Romania

Keywords: 18F-FDG PET/CT, urinary bladder cancer, BCG, lymphadenitis.

Gîrlovanu Constantin, Maximilian Munteanu, Elena Olariu, Doina Piciu

University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania

Keywords: ATTR, family history, bone scintigraphy

1. University of Medicine and Pharmacy „Grigore T. Popa” Iasi, Romania

M.Mutuleanu1,2, A.Lazar2, M.Gherghe1,2

Keywords:metastatic bone lesions, quantitative analysis, patient follow-up, quantitative SPECT-CT

Key words: cardiac amyloidosis, SPECT/CT, Tc99m Pyrophosphate

Teodor Sofiyanski1, Milena Dimcheva1, Sonya Sergieva1, Bozhil Robev2

Introduction: Dynamic 99mTechnetium diethylenetriaminepentaacetic acid (99mTc-DTPA) renal scintigraphy is a

Key words: 99mTc-DTPA dynamic renal scintigraphy, SPECT/CT.

CR Stolniceanu1,3, TM Ionescu2, I.Grierosu1,3, W Jaoull1, C Stefanescu1,3

1Department of Biophysics and Medical Physics-Nuclear Medicine,

Institut Gustave Roussy, Paris, France

10th Edition of The Balkan Congress of Nuclear Medicine

15th-18th March 2023, Romania

Material and method

Andreea Baban1,2, Valentina Nastas1,2, Teodorescu-Perijoc Diana4, Statescu Ana-Maria1,3,

Keywords: Incidental findings, Nuclear Medicine, Scintigraphy

Keywords: PET imaging, acquisition parameters, phantoms

Corresponding author: diana.cocioaba@nipne.ro

Keywords: medical radioisotopes, cyclotron, nuclear reactions

Corresponding author: roxana.cornoiu@nipne.ro

Keywords: theranostic, cancer, peptides

Key words: renal agenesis, 99mTc-DMSA, isotopic nephrography

Key words: radiotoxicity, radiotherapy, Auger-electrons

Keywords: atypical meningioma, 99mTc-EDDA/HYNIC-TOC, neuroendocrine scintigraphy.

Tatiana Lucia Șuta1, Jamal Rabah1, Mirela Gherghe1,2

Key words: triple-negative breast cancer, SPECT-CT scan, bone metastasis.

Iulian-Alexandru Taciuc1, Cătălin-Florin Blaj2, Adrian Costache1, Mirela Gherghe1,2

Key words: artificial intelligence software, bone scintigraphy, bladder

Iulian-Alexandru Taciuc1, Ion-Alexandru Ioana2, Iuliana Dorde2, Alexandra-Maria

Keywords: SPECT-CT data quantification, 99mTcEDDA/HYNIC-TOC, pancreatic neuroendocrine tumour

Key words: nephrogram, artifact, DTPA

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