Eighth Asia and Oceania Congress of Nuclear Medicine and Biology

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                                                 INTERNATIONAL                         HIGHLIGHTS

Eighth Asia and Oceania
Congress of Nuclear Medicine
and Biology, October 9 –13, 2004,
Beijing, China
       he Eighth Asia and Oceania Congress of Nuclear           The 2004 AOCNMB saw an increase in the percent-

T      Medicine and Biology (AOCNMB) was held Oc-
       tober 9 –13 in Beijing, China. Of the 456 partici-
pants, 230 were from China, and the remaining 226
                                                            ages of papers in oncology, basic nuclear medicine, ra-
                                                            diotherapy, radiochemistry, and nuclear instrumentation
                                                            over the percentages for these presentations at the previ-
represented more than 30 other countries. Twenty-three      ous congress in 2000. At the same time, there was a
exhibitors participated in the technical area of the con-   significant decrease in the numbers of presentations on
gress. The congress featured 384 presentations (141 oral    general nuclear medicine and smaller decreases in nuclear
and 243 posters). The major contributing country was        cardiology and neurology. Among the 86 oral presenta-
China, with 198 presentations (50%), followed by India      tions on oncology, PET and SPECT were almost equally
with 24 (6%), Korea with 19 (5%), Japan with 17 (4%),       represented. Among 44 papers classified as PET presen-
Taipei with 15 (4%), Pakistan with 14 (4%), Kuwait with     tations 52% were on stand-alone PET, 25% were on
12 (3%), the United States with 10 (3%), Iran with 10       PET/CT, and 23% were on molecular coincidence detec-
(3%), Serbia and Montenegro with 10 (3%), Bangladesh        tion (MCD) SPECT, indicating a growing increase in the
with 8 (2%), the Philippines with 6 (2%), and 43 (11%)      use of PET/CT in Asia. Clinical applications of PET or
from other countries, including Australia, Vietnam, Sri     PET/CT covered a wide range of topics, including diag-
Lanka, Thailand, Armenia, Finland, Hungary, Poland, the     nosis of malignant tumors, tumor staging and restaging,
United Kingdom, Austria, Bolivia, Canada, Cuba, the         differentiation between tumor recurrence and necrosis,
Czech Republic, Germany, Indonesia, Italy, Macedonia,       and cancer screening. 18F-FDG was reported on as a tracer
Malaysia, Mongolia, Romania, Russia, and South Africa.      in pulmonary solid nodules, lymphoma, nasopharyngeal
Two satellite meetings held in Shanghai and Hong Kong,      carcinoma, and brain, head and neck, thyroid, breast, esoph-
October 15–17, also met with exceptional success (see       ageal, skin, digestive, and gynecologic tumors. A few papers
Newsline, page 6).                                          dealt with the use of 11C-choline for brain, bone, soft tissue,
                                                            head and neck, and lung cancers; 11C-acetate for meningi-
                                                            oma; and 13NH3 for astrocytoma and pituitary diseases.
                                                                A 10-year retrospective study of 117 patients with
                                                            irradiated brain tumors showed that 18F-FDG PET imag-
    A delegation from the Society of Nuclear Medi-
                                                            ing had good predictive value, with longer survival times
    cine, led by SNM President Mathew Thakur,
                                                            after negative than positive PET imaging. PET was also
    attended the 8th AOCNMB, where they were
                                                            able to differentiate between recurrence and radiation
    welcomed with warm collegiality by their Chi-
                                                            necrosis and inflammation, especially when compared
    nese hosts. Chengmo Zhu, MD, a member of the
                                                            with CT and MR imaging (Wang and Boethus; Fig. 1).
    congress scientific committee, forwarded this re-
                                                            This group also suggested that PET images should be
    port outlining various topics addressed in pre-
                                                            repeated within 31 weeks if recurrence is suspected.
    sentations during the 5-day event to Heinrich
                                                                Head and neck tumors also present imaging chal-
    Schelbert, MD, editor-in-chief of The Journal of
                                                            lenges to CT and MR because of the complicated anat-
    Nuclear Medicine. We are pleased to include it
                                                            omy and its susceptibility to change after surgery and
    for the readers of Newsline.
                                                            irradiation. 18F-FDG PET is useful in the management of
                                 Conrad Nagle, MD
                                                            head and neck cancer and was reported to detect residual,
                                   Editor, Newsline
                                                            recurrent, and remote metastases with sensitivity, speci-
                                                            ficity, and accuracy of 100%, 87.5%, and 93.5%, respec-

                                                                                                         Newsline       13N

                   FIGURE 1. Recurrence in glioblastoma. (A) 18F-FDG PET         FIGURE 2. 18F-FDG coincidence imaging in suspected ma-
                   image of 46-year-old man was negative on September 8,         lignant pleural effusion or atelectasis shows high uptake in
                   1999; (B) Repeat imaging on October 18, 1999, showed          lung cancer complicated by (A) atelectasis and (B) pleural
                   recurrence. Recurrence confirmed at autopsy in January         effusion. Study reported by H.Q. Wang (Shanghai Pulmonary
                   2000. Study from a 10-year summary of the efficacy of 18F-     Hospital, China).
                   FDG in assessing irradiated brain tumors reported by Shuxia
                   Wang (Guangdong Provincial Hospital, China) and Jorgen¨       Other positron pharmaceuticals were reported on and
                   Boethius (Karolinska Hospital, Stockholm, Sweden).
                                                                                 compared with 18F-FDG in specific applications. 11C-
                   tively. Malignant lung lesions can also be found by 18F-      choline showed higher contrast than 18F-FDG in PET
                   FDG coincidence imaging in suspected malignant pleural        imaging of head and neck, bone, lung, and soft tissue
                   effusion or atelectasis with sensitivity, specificity, and     tumors. 11C-acetate showed higher uptake and a better
                   accuracy reaching 97%, 78%, and 85%, respectively, a          ability to precisely delineate tumor margins than did
                                                                                 18F-FDG in PET imaging of meningiomas, as well as an
                   process that needs differentiation between metastasis and
                   tuberculosis (Wang et al.; Fig. 2). Another group reported    ability to distinguish recurrent from residual tumors (Liu
                   that concordance between 18F-FDG PET and 111In-               et al.; Fig. 3). Another group reported on the use of 13NH3
                   antiCD20 antibody imaging may predict outcomes in             PET for pituitary imaging.
                   radioimmunotherapy (RIT) for lymphoma. More lesions
                   found on 111In-antiCD20 imaging than in 18F-FDG will
                   have a favorable response to treatment, and 18F-FDG PET
                   in a follow-up study can be used for therapeutic monitor-
                   ing in lymphoma. 18F-FDG PET also was reported to have
                   significant value in cancer screening. One group reported
                   an excellent cancer detection rate by 18F-FDG PET in
                   3,631 routine physical examinees, with an 80.9% true-
                   positive rate among those identified. In another 4,803
                   physical examinees, thyroid incidentalomas were found
                   as hypermetabolic areas in 60, of whom 50 were further
                   investigated by fine-needle aspiration, showing 43 benign
                   and 7 papillary carcinomas.
                       All of these disparate findings presented at the con-      FIGURE 3. Imaging of meningioma with (A) 11C-acetate
                   gress illustrate that 18F-FDG PET is routinely and effec-     PET, (B) MR, and (C) 18F-FDG PET. 11C-acetate PET and MR
                                                                                 imaging yielded positive results, but uptake was not seen on
                   tively used in tumor diagnosis and therapy monitoring.        18F-FDG PET. Study reported by Ren-Shyan Liu (Taipei Vet-
                   Currently a great emphasis is placed on PET/CT, because       erans General Hospital, National Yang-Ming University Med-
                   more lesions can be detected and localized accurately.        ical School).

                  14N    THE JOURNAL    OF   NUCLEAR MEDICINE • Vol. 45 • No. 12 • December 2004
                                                                                                                                N E W S L I N E
                                                                detect more lesions. 99mTc-sulfur colloid was reported to
                                                                be useful for sentinel lymph node (SLN) detection in
                                                                cancer of the cervix and 99mTc-nanocolloid was reported
                                                                to be effective in detection of penile cancer, with detec-
                                                                tion rates of 100% and 94.7%, respectively. 131I-vascular
                                                                endothelial growth factor-165 receptor imaging for visu-
                                                                alization of tumor angiogenesis in overexpressed vascular
                                                                endothelial cell tumors, such as gastrointestinal and dif-
                                                                ferentiated thyroid tumors and osteosarcoma, was re-
                                                                ported. Sodium iodide symporters (NIS), alone or
                                                                combined with thyroid peroxidase gene transfer, are be-
                                                                ing successfully studied using adenovirus or baculovirus
                                                                transfection to cancer cells with low iodine uptake, with
FIGURE 4. After primary application of 99mTc-ethylenedi-        initial results showing suppression of tumor cell growth.
amine deoxyglucose in tumor, high uptake of 18F-FDG was              In cardiology, myocardial perfusion imaging (MPI)
seen in lesions at both lung and mediastinal lymph node.
                                                                studies are used in Asia and Oceania for diagnosis of
Study reported by J. Tang (Second Hospital of Suzhou Med-
ical School, China).                                            ischemia, prognostic prediction, assessment of myocar-
                                                                dial viability, therapy monitoring, and other applications.
                                                                99mTc-sestamibi stress–rest MPI was shown to have good
    SPECT imaging is used routinely for tumor detection
in Asia and Oceania, including high-sensitivity 99mTc-          prognostic value in suspected coronary artery disease
tetrofosmin SPECT imaging in breast and brain tumor             (CAD). As many as 65% of reversible defects identified
and 99mTc-sestamibi in breast cancer and nasopharyngeal         with this technique resulted in cardiac events over a
carcinomas and for indication of disease activity in mul-       32.25      14.95-month follow-up study. In symptomatic
tiple myeloma. The preliminary use of 99mTc-labeled eth-        hypertension with recent onset of left bundle branch
ylenediamine deoxyglucose SPECT in 18 patients                  block, an isolated septal reversible defect identified by
showed satisfactory results, with the identification of 14       adenosine 99mTc-sestamibi was a valid criterion for refer-
true-positive tumors, although differences with 18F-FDG         ral to cardiac angiography and also carried a negative
were noted, including slow blood clearance and nonvisu-         predictive value for CAD.
alization of the brain (Tang et al.; Fig. 4). In somatostatin        In myocardial ischemia or infarction, 201Tl and 99mTc-
receptor–positive tumors, 99mTc-hydrazinonicotinyl-             labeled HL91 dual-isotope perfusion and hypoxia imag-
Tyr3-octreotide (99mTc-HYNIC-TOC) SPECT imaging
was reported to yield a high detection rate in neuroendo-
crine tumors (Jing et al.; Fig. 5). However, the use of
99mTc-HYNIC-ethylenediamine pentaacetic acid seems

more effective, and its use was suggested instead of 111In-
octreoscan or 131I-metaiodobenzylguanidine (MIBG) be-
cause of its higher tumor-to-nontumor ratio and ability to

FIGURE 5. Diagnosis of somatostatin receptor–positive tu-       FIGURE 6. 201Tl and 99mTc-HL91 dual-isotope imaging to
mors using 99mTc-HYNIC-TOC. Clinical evaluation of pheo-        simultaneously evaluate myocardial perfusion and hypoxia.
chromocytoma in 17-year-old boy. (A) Negative 131I-MIBG         201Tl defects on apex and septal wall were refilled by 99mTc-

imaging. (B) 99mTc-TOC imaging before surgery. (C) 99mTc-       HL91, but those on the inferior wall were not. Study reported
TOC after surgery. Study reported by H.L. Jing (Peking Union    by B. Zhang (First Hospital of Suzhou Medical School,
Medical College, Beijing, China).                               China).

                                                                                                           Newsline       15N

                   ing can be acquired simultaneously and successfully differ-
                   entiate between hypoxic but viable myocardium in 201Tl
                   defects refilled by 99mTc-HL91 and in nonviable old infarct
                   areas with no refilling (Zhang et al.; Fig. 6). In addition, the
                   use of 123I-MIBG myocardial receptor imaging was reported
                   in differentiation among Parkinson disease, pure autonomic
                   failure, and multiple system atrophy, with nonvisualization
                   of the myocardium and decreasing heart-to-mediastinum
                   ratio in the former 2 but normal visualization and normal
                   heart-to-mediastinum ratio in the last.
                        Another report focused on 99mTc-antisense oligonu-
                   cleotide molecular imaging of atherosclerotic plaques in
                   hyperlipidemic rabbits. In these rabbits, the abdominal
                   artery could be seen immediately after injection of the
                   99mTc-labeled antisense oligonucleotide, and the athero-          FIGURE 7. Abnormality of cerebral cortical glucose me-
                                                                                     tabolism in temporal lobe epilepsy with cognitive function
                   sclerotic plaque was visualized in ex vivo imaging, but           impairment. (A) Precentral gyrus of the right frontal lobe
                   not in c-myc sense oligonucleotide, bel-2, or c-myc               (Brodmann area 4). (B) cingulate gyrus of the right limbic lobe
                   control groups. Another experimental study evaluated              (Brodmann area 32). Study reported by B.H. Yang (Taipei
                   myocardial preconditioning and adenosine effects in car-          Veterans General Hospital, National Yang-Ming University).
                   dioprotection of rat hearts with ischemic perfusion injury
                   using 99mTc-glucarate imaging. Cardiac protection from            are now considered the hallmarks of Alzheimer’s disease
                   ischemic perfusion injury could be simulated by adeno-            (AD). One group reported on the purification and screen-
                   sine receptor A1 agonist cyclopentyladenosine or blocked          ing of a single-chain monoclonal antibody against amy-
                   by antagonist sulfophenyl theophylline, with the conclu-          loid -peptide 40 that has potential as an amyloid probe
                   sion that 99mTc-glucarate is quite valuable for detecting         for AD imaging.
                   the effects of protection.                                             Reports at the meeting made it clear that general and
                        In neurology and psychiatry, cerebral perfusion im-          basic nuclear medicine are also making progress. One
                   aging using 99mTc-ethylcysteinate dimer (ECD) or 99mTc-           example is in nuclear pediatrics, where simplicity and
                   hexamethylpropyleneamine oxime (99mTc-HMPAO) was                  noninvasiveness, as well as utility, play important roles in
                   reported to be effective in evaluating cerebral blood flow         continued expansion. Procedures such as furosemide
                   (CBF) abnormalities in cerebrovascular diseases, demen-           renography in neonates are reliable and safe for differen-
                   tia, and alcohol or nicotine dependence. 18F-FDG PET              tiation of obstructive and nonobstructive urinary diseases
                   imaging also was used to evaluate glucose metabolism in           and serve as a guide for surgery. Renal imaging was also
                   cognitive impairment and parkinsonism. Adenosine-                 shown to be effective in detection of chronic infection.
                   stressed cerebral perfusion imaging can raise the positive             Ventilation/perfusion lung SPECT imaging can effi-
                   results of rest perfusion imaging from 68.3% to 92.07%.           ciently find peripheral small pulmonary embolisms in
                   Using statistical parametric mapping analysis, regional           cases in which helical CT proves nondiagnostic. Skeletal
                   CBF (rCBF) studied with 99mTc-ECD in alcohol-                     SPECT/PET fusion imaging was reported to be more
                   dependent individuals demonstrated hypoperfused rCBF              sensitive than whole-body scintigraphy, SPECT, or CT
                   in frontal, cingulate gyrus, caudate body, and cerebellum,        alone for differentiation of benign and malignant osseous
                   but hyperperfused rCBF in temporal, parahippocampal               lesions in the spine. A 15-mer phosphrothiote antisense
                   and precentral gyrus, and left thalamus. In chronic to-           oligonucleotide labeled with 131I and then linked to va-
                   bacco users, rCBF changes were observed in frontal,               sointestinal peptide before injection into HT29 human
                   temporal, parietal, and occipital regions with 99mTc-             colon tumor– bearing nude mice showed that vasointesti-
                   HMPAO imaging. Increased 18F-FDG uptake was re-                   nal peptide carriers greatly increase tumor cell uptake and
                   ported in verbal and figure memory Brodmann areas 4,               retard growth rate.
                   32, and 18 and posterior cerebellum in temporal lobe                   Other reports focused on the technology of reading,
                   epilepsy with cognitive function impairment (Yang et al.;         displaying, archiving, and transmitting nuclear medicine
                   Fig. 7). In patients with suspected X-linked dystonia             data. Multimodality image archival and communication
                   parkinsonism, 18F-FDG PET imaging revealed decreased              systems in nuclear medicine departments are now con-
                   uptake in putamen and caudate nuclei. A PET study with            nected with large picture archiving and communication
                   continuous infusion of 11C-raclopride demonstrated a              systems. In the institutional example presented, 3
                   temporal change of striatal dopamine release while and            modalities––CT, nuclear medicine, and digital mammog-
                   after a subject played a video game with the expectation          raphy–– could be accessed at more than 15 workstations
                   of a monetary reward. Finally, amyloid -peptide accu-             and were reported to be effective in facilitating consulta-
                   mulation and the appearance of plaque in the human brain                                               (Continued on page 19N)

                  16N     THE JOURNAL     OF   NUCLEAR MEDICINE • Vol. 45 • No. 12 • December 2004
                                                                                                                                  N E W S L I N E
(Continued from page 16N)
tion, postprocessing, tele- and remote evaluation, and
   In data processing, standard uptake values of 18F-FDG
imaging in dual-head SPECT can also be obtained by
calculation of pixel counts, although with somewhat low-
ered values. In addition, measurement of rCBF using
123I-iodoamphetamine SPECT with partial volume effect

correction in single-point arterial blood samples was re-
   The fields of radionuclide therapy and dosimetry have
made great strides in recent years, and experience was
summarized at the meeting. In a multi-institutional study
of 11,442 thyrotoxic patients treated with 131I and fol-
lowed for up to 25 years, 59.3% became euthyroid, 39.4%
                                                               FIGURE 8. Pharmacokinetics and tumor uptake of 125I-
were found to have hypothyroidism, and only 1.3% re-           recombinant human plasminogen kringle 5. Radioactivtity at
mained hyperthyroid, with an average dose of 6.8 1.9           tumor site in tumor-bearing nude mice at 3 hours after in-
mCi 131I. In another study, patients with pulmonary met-       jection. (A) 131I-rhK5. (B) 99mTc-rhK5. Study reported by B. Li
astatic thyroid cancer were treated with 75–150 mCi 131I       (Shanghai Ruijin Hospital, China).
at intervals of 6 months. The overall 5- and 10-year
survival rates reached 95% and 85%, respectively. One
report also suggested that during 131I therapy of differen-    of radioactive material and experimental studies for la-
tiated thyroid cancer, that B- and T-lymphocytes, NK           beling new compounds. Reports on the production of 65Zn
cells, and subsets CD4 and CD8 are all affected, but these     for medical and agricultural applications and the purifi-
effects are temporary and reversible. A large group of         cation of 18O water were presented. New radiolabeled
patients with bone metastases from lung, breast, prostate,     compounds discussed included 99mTc- or 131I-rh-kringle V
and nasopharyngeal cancers were treated with 153Sm-            (tumor angiogenesis suppressor) (Li et al.; Fig. 8), 99mTc-
ethylenediamine tetramethylenephosphonate or 89SrCl2,          HYNIC-transferrin-chitosan conjugates (transferrin gene
with improvement in pain relief and prolonged survival         receptor binding), 99mTc-Arg-Gly-Asp (RGD) containing
rate, with only rare occurrences of bone marrow depres-        peptide-GY11 (ligands of integrin for angiogenesis),
                                                               99mTc-diethylenediamine pentaacetic acid-2SN (disulfa-
   New radionuclide therapies being applied clinically         nilamide) and 18F-fluoroethylcholine for tumor imaging,
include intrahepatic arterial injection of 188Re-lipiodol in   positively charged lipophilic 99mTc-labeled N, N -desub-
hepatic cell carcinoma, with favorable results and mini-       stituted N2S2 derivatives for myocardial SPECT imaging,
                                                               99mTc-mercaptoacetyltriglycine-2-nitroimidazole for hy-
mal side effects, and new 90Sr/90Y -ray applicators for
                                                               poxic      imaging,      and     18 F-2-(1-[6-[(2-fluoro-
treatment of benign prostate hyperplasia through the
urethra or rectum, with remarkable symptom improve-            ethyl)(methyl)amino]-2-naphthyl]ethylidene)malononitrile
ment and shrinkage of prostate volume. Finally, locore-        for senile plaque and neurofibrillary tangle imaging in pa-
gional injection of 18F-FDG was found to be more               tients with AD.
effective than 18F-NaF in suppressing tumor xenograft
growth in tumor-bearing rats, mainly because of the rapid      Conclusion
dissipation of 18F-NaF.                                            The Eighth Congress was truly a successful, fruitful,
   In dosimetry, absorbed dose calculation at the cellular     friendly, and progressive event, showing to all attendees
level in radionuclide therapy was a focus of interest.         the bright prospects for the future in nuclear medicine.
Using FOTELP code based on Monte Carlo simulations             We all anticipate continued leaps forward when we meet
of photon and electron transport in a 3-dimensional solid      in New Delhi, India, for the ninth congress in 2008.
tumor model, absorbed dose histograms were derived for
67Cu, 131I, 153Sm, 90Y, and 188Re. Dose calculation at the                                          Chengmo Zhu, MD
cellular level leads to better planning for radionuclide                        Professor, Nuclear Medicine Department
therapy.                                                                                                Ruijin Hospital
   New discoveries in radiopharmacy and radiochemistry                                 Shangahi 2nd Medical University
were reported, including new methods for the production                                                Shanghai, China

                                                                                                            Newsline        19N
                                                                                                                           N E W S L I N E
AOCNMB Satellite Conference
in Hong Kong
        he largest nuclear medicine conference in Hong      Dr. Henry N. Wagner, Jr., Dr. Steven M. Larson, Dr.

T       Kong’s history was held on October 16 and 17,
        with about 200 local participants and overseas
delegates. The conference was organized as a satellite
                                                            Heinrich R. Schelbert, and Dr. C. Oliver Wong. Invited
                                                            faculty from London (UK) included Dr. Ignac Fogelman
                                                            and Dr. John Buscombe. With contributions from the
meeting of the Eighth Asia and Oceania Congress of          local/regional faculty, including Dr. Yat-Yin Yau and Dr.
Nuclear Medicine and Biology (AOCNMB), which took           Kevin Tse, the conference offered not only an interna-
place in Beijing, China, from October 9 to 13. The Hong     tional platform for scientific exchange but also constituted
Kong Society of Nuclear Medicine (HKSNM) co-                a cultural network where East met West––part of the
organized the event with the Hong Kong College of           fundamental spirit of the Hong Kong Special Adminis-
Radiologists (HKCR) under the auspices of the Asia and      trative Region of the People’s Republic of China.
Oceania Federation of Nuclear Medicine and Biology               The meeting would not be considered successful with-
(AOFNMB).                                                   out a wonderful social program unique to Asian culture.
     The event started on a beautiful Saturday with an      A splendid welcoming dinner cruise took attendees to a
interactive PET/CT workshop in the newly established        picturesque outlying island, where freshwater and ocean
PET center in Queen Elizabeth Hospital, the largest         seafood were served in traditional preparations; to the
public-funded tertiary hospital in Hong Kong. Partici-      stunning Tsing Ma Bridge, the world’s longest road-and-
pants were able to gain basic knowledge and hands-on        rail suspension bridge, and to Victoria Harbour, renowned
experience in a fresh and elegantly decorated environ-      worldwide for spectacular night scenes and the setting in
ment.                                                       which Hong Kong is called the “Pearl of the Orient.” The
     A scientific symposium on recent advances in clinical   final social event was a banquet at the Marriott. Sparkling
nuclear medicine was held on Sunday in the Marriott         cocktail, fine wines, and a sumptuous Cantonese feast
Hotel and was officiated by Dr. William Tong, vice-          were enjoyed together with the laughter of happy mo-
president of the Eighth AOCNMB and chair of the satel-      ments. The entire satellite meeting and social function in
lite conference, Dr. Lilian Leong, president of the HKCR    Hong Kong brought many memorable times for both
and immediate past president of the Asian and Oceanian      overseas guests and local residents who participated in the
Society of Radiology (AOSR), Professor Xiu-Jie Liu,         AOCNMB in Beijing and the congress’s satellite confer-
president of the Eighth AOCNMB, and Dr. Frankie Choi,       ences.
president of the HKSNM. Transpacific and transatlantic                              Frankie Choi, FHKAM(Radiology)
speakers and eminent local experts drew the attention of                                            Hong Kong, China
attendees to cutting-edge advances and visions for future                                   C. Oliver Wong, MD, PhD
development in nuclear medicine in areas including on-                                           Royal Oak, Michigan
cology, cardiology, radionuclide therapies, and osteopo-                           William Tong, FHKAM(Radiology)
rosis. Among the U.S. representatives on the faculty were                                           Hong Kong, China

                                            November 2004 Newsline
       A portion of the information in the article about Roger W. Howell, PhD, recipient of the Loevinger–Berman
   Award for Excellence in Medical Internal Radiation Dosimetry, was erroneous. A corrected version of the
   article now appears in the Newsline section of the SNM journals Web site at
   reprint/45/11/27N. The Newsline editor regrets this error and again congratulates Dr. Howell on receipt of this
   prestigious award.

                                                                                                      Newsline       21N

                                                                               SNM         LEADERSHIP                     UPDATE

                   SNM’s Reach Should Exceed Its Grasp
                       An essential element of SNM’s strategic plan is to            ties. SNM will reach out to academic
                   communicate the value of nuclear medicine/molecular               institutions to offer nuclear medicine
                   imaging in patient care, the value of achieving significant        presentations or lectures and will
                   growth in science and utilization, and the value of its own       work to increase the number of
                   role as a premier professional society. To accomplish             workshops and seminars at nonimag-
                   these goals, we must bring our messages clearly to the            ing meetings.
                   medical community and the general public. In essence,                  Our outreach efforts must extend
                   SNM’s communications reach should exceed its grasp.               to recruiting first- and second-year
                       As the undeniable leader in the nuclear medicine com-         medical students by maintaining
                                                                                                                            Virginia Pappas, CAE
                   munity, SNM must proactively reach out, make connections,         nuclear medicine information on SNM Executive Director
                   and bring our services and knowledge to other like-minded         our Web site, conducting nuclear
                   organizations, to universities, to the government, to patient     medicine conferences on campuses, and informing med-
                   advocacy groups, and to the general public.                       ical students about on-campus activities— our Young
                       How should SNM do this? SNM’s Board of Directors              Professionals Committee will play an important role here.
                   has grappled with this question over a series of meetings              We will examine our role with patient advocacy or-
                   and believes that the Society needs to implement a num-           ganizations and programs, such as the American Cancer
                   ber of outreach activities, with increasing emphasis on           Society, the National Patient Advocacy Foundation, the
                   public relations.                                                 Association of Community Cancer Centers, and the
                                                                                     Men’s Health Network. SNM has many overlapping con-
                   Increase Collaborative Efforts                                    cerns with advocacy groups, which are important for
                       SNM places high priority on developing and estab-             setting standards of care for patients.
                   lishing partnerships with like-minded professional orga-
                   nizations. For example, SNM leaders have met twice with           Reaching Globally
                   Radiological Society of North America (RSNA) officers                  In the coming year, SNM will examine its international
                   this year, and SNM presented “the best of” SNM abstracts          policy and determine what role the Society should have with
                   at this month’s RSNA meeting. We will also work jointly           other international organizations or countries, such as the Eu-
                   on an SNM summit meeting,                                         ropean Association of Nuclear Medicine, the World Federation
                       SNM is working with the American College of Radi-             of Nuclear Medicine and Biology, and the International Atomic
                   ology on joint PET/CT guidelines, on government                   Energy Agency. SNM, which has a growing and diverse inter-
                   relations and reimbursement activities, and on the devel-         national membership, may organize courses for future interna-
                   opment of a Nuclear Medicine Carrier Advisory Commit-             tional meetings, thereby increasing the Society’s visibility.
                   tee. SNM also sponsored a symposium with the American             SNM is helping physicians in developing countries by donating
                   Society of Nuclear Cardiology this year.                          subscriptions to The Journal of Nuclear Medicine.
                       This past summer, SNM’s Board of Directors and                Build SNM’s Visibility
                   leaders of the oncology community discussed finding                    To increase SNM’s visibility with our many audi-
                   areas of mutual concern and collaboration. SNM leaders            ences (like-minded organizations, referring physicians,
                   also plan to meet with the leadership of organizations            universities, the government, patient advocacy groups,
                   such as the American College of Cardiology, the Amer-             and the general public), we are undertaking a proactive
                   ican Board of Nuclear Medicine, and the American Board            outreach/public relations effort beginning in the 2004 – 05
                   of Radiology. Society leadership has also made commu-             fiscal year. The plan will focus on achieving greater
                   nication and partnerships with industry a high priority.          awareness on the part of referring physicians, regulators,
                                                                                     and the public in general.
                   Support Education Efforts, Advocacy Groups
                      In addition, SNM will determine what outreach activities       See You at the Mid-Winter Meeting
                   we should initiate with oncologists, with radiation therapists,      Come join us at the 2005 SNM Mid-Winter Educational
                   and through a physician’s outreach program. The Board also        Symposium, January 29 and 30, at Saddlebrook Resort in
                   wants to extend its outreach efforts to nurse practitioners and   Tampa, FL. Complete information, including the continuing
                   physician assistants by providing essential training opportuni-   education program, can be found at

                  22N     THE JOURNAL     OF   NUCLEAR MEDICINE • Vol. 45 • No. 12 • December 2004
                                                                                                                               N E W S L I N E
                                                       FROM           THE        SNM         PRESIDENT

SNM to Establish Center of
Molecular Imaging as New Field
Emerges, Grows Rapidly
         ollowing through on an integral part of its strategic   deep in the body. Radionuclides

F        plan, SNM’s leadership appointed a task force to
         explore the possibility of forming a Center of
Molecular Imaging. As a member of this task force, I
                                                                 not used previously are being in-
                                                                 vestigated for applications both in
                                                                 diagnosis and therapy. Many
believe that the center’s goals should be to disseminate         novel and specific molecular
information on our understanding of biological processes         probes—such as peptides, peptide
of diseases at the molecular level and to promote the            nucleic acids, cytokines, and their
application of that information to diagnose diseases non-        analogues— have drawn increas-
invasively at an early stage and to treat them effectively.      ing attention for newer or im-
     Molecular imaging (MI) is an emerging field that is          proved applications, not only to
growing rapidly. Recent technological innovations have           target events in oncology, but also
enabled magnetic resonance, bioluminescence, optical             in cardiology, neurology, and en- Mathew Thakur, PhD
fluorescence and ultrasound to make exciting contribu-            docrinology.                         SNM President
tions to the field of MI. At its March 2004 meeting in                Investigators have considered
Chicago, IL, SNM’s board of directors conceived a new            for decades that genomic modulations at a cellular
Center of Molecular Imaging designed to keep its mem-            level are the genesis of most oncologic diseases. These
bership abreast of progress made on these technologies;          genetic modulations lead to the expression of charac-
this center clearly gives MI a home in SNM.                      teristic biomolecules, not only exogenously but also
     It is generally considered that radioactive tracer tech-    endogenously. Generally known as receptors and on-
niques, the hallmark of nuclear medicine, are more               cogenes, respectively, these fingerprints arise well
sensitive and less invasive than the other modalities in         ahead of the modulations in cell morphology that,
tracing molecular events that form the basis of diseases.        today, form the primary basis for oncologic diagnosis.
Imaging cellular function, cell cycle progression, apopto-       These fingerprints provide themselves as excellent tar-
sis, hypoxia, response to interventions, synaptic transmis-      gets for noninvasive and early determination of onco-
sion, and degenerative neurochemical processes, using            logic processes. The field of cell biology is rich in
novel biomolecules labeled with suitable radioactive trac-       providing both such targets and specific probes that
ers will contribute greatly to the field of MI in general and     will complement MI.
to the field of nuclear medicine in particular. In just a             The next decade should witness applications in indi-
handful of years, striking progress has been made in             vidualized or customized imaging. Genomic chips will
imaging instruments such as PET or SPECT that has                permit characterization of an individual’s disease, and
enhanced our ability to detect minute abnormalities seated       protein profiling will allow the use of radioactive probes
                                                                 that are specific to an individual’s cancer or other fatal
                                                                 disorders. MI will then not only permit localizing the
                                                                 lesions but also enable physicians to determine the effec-
     ... using novel biomolecules labeled with suit-             tiveness of therapeutic interventions on their shape, size,
     able radioactive tracers will contribute greatly            function, and biochemistry.
     to the field of MI in general and to the field of                 The time for SNM to establish a center for MI could
     nuclear medicine in particular.                             not have been more appropriate than now. The center,
                            Mathew L. Thakur, PhD                as guided by the expert members of a task force ap-
                                     SNM President               pointed by the SNM leadership, intends to focus on
                                                                 such topics as surrogate makers, drug development, tar-
                                                                                                   (Continued on page 32N)

                                                                                                           Newsline      23N


                   Alzheimer’s Neuroimaging                   cal information from these partici-       pecially in France and the United
                   Initiative Launched                        pants, seeking correlations among the     Kingdom. The study also cited both
                       A consortium of federal agencies,      data that will track the progression of   strict and confusing reimbursement
                   private companies, and professional        memory loss from its earliest stages.     policies in many European nations as
                   organizations announced on October             “The key challenge here is to         limiting factors. In addition to assess-
                                                              identify critical markers that respond    ing the current situation, the study
                   13 the launch of the Alzheimer’s Dis-
                                                              to treatments aimed at slowing the        predicted an increase in mergers and
                   ease (AD) Neuroimaging Initiative, a
                                                              progression of MCI and Alzheimer’s        acquisitions among companies seek-
                   $60 million, 5-year public–private
                                                              disease,” said Michael W. Weiner,         ing to consolidate their shares of the
                   partnership to test whether serial MR
                                                              MD, the study’s principal investiga-      market and cited the recent acquisi-
                   imaging, PET, other biological mark-
                                                              tor and professor of medicine, radiol-    tion of Amersham plc by GE Medical
                   ers, and clinical and neuropsycholog-
                                                              ogy, and psychiatry at the University     Systems as an example.
                   ical assessments can be combined to
                                                              of California at San Francisco and                              Frost & Sullivan
                   measure the progression of mild cog-
                                                              director of the magnetic resonance
                   nitive impairment (MCI) and early          unit at the Department of Veterans        NCI Launches New
                   AD. The project is the most compre-        Affairs Medical Center in San Fran-       Integrative Cancer
                   hensive effort to date to find neuro-       cisco.
                   imaging and other biomarkers for the                                                 Biology Program
                                                                  Information about participating            The National Cancer Institute
                   cognitive changes associated with          research sites and co-investigators
                   MCI and AD.                                                                          (NCI), part of the National Institutes
                                                              leading various aspects of research       of Health (NIH), announced on
                       Participants from the federal gov-     may be obtained from the NIA. Al-
                   ernment include the National Insti-                                                  October 26 $14.9 million in funding
                                                              though recruitment for the study will     for a new Integrative Cancer Biology
                   tute on Aging (NIA), the National          not begin until spring 2005, individ-     Program (ICBP), a unique initiative
                   Institute of Biomedical Imaging and        uals interested in participating in the   designed to gain insights into the de-
                   Bioengineering, and the Food and           study can contact the NIA’s Alzhei-       velopment and progression of cancer
                   Drug Administration. The Founda-           mer’s Disease Education and Referral      through a systems-wide approach.
                   tion for NIH is managing corporate         (ADEAR) Center at 800-438-4380 for        According to an NCI media release,
                   and other private participation and        additional information.                   an integrative and multidisciplinary
                   has received commitments totaling                   National Institutes of Health    effort among all fields of cancer re-
                   more than $20 million in contribu-
                                                                                                        search will be applied, incorporating
                   tions from industry and professional       PET Radiopharmaceuticals                  a spectrum of new technologies such
                   organizations. “This is an extraordi-      Drive Market in Europe                    as genomics, proteomics, and molec-
                   nary pooling of talent and resources           Significant changes in the Euro-       ular imaging, to generate computer
                   toward a common goal— delaying or          pean radiopharmaceuticals market          and mathematical models that could
                   preventing Alzheimer’s disease,”           were reported in October by health        predict the cancer process.
                   said Richard J. Hodes, MD, director        care analysts Frost & Sullivan. Re-            The ICBP initiative includes 9
                   of NIA.                                    searchers found production and sales      integrative biology centers. These cen-
                       The study will take place at ap-       of PET agents growing at much faster      ters will provide the nucleus for the
                   proximately 50 sites across the            rates than other segments. The Euro-      design and validation of computational
                   United States and Canada. In April         pean radiopharmaceuticals market          and mathematical cancer models. The
                   2005, investigators will begin recruit-    generated revenue of $415.9 million       models will simulate complex cancer
                   ing participants, with a goal of enroll-   in 2003 and is forecast to grow at a      processes and will be used to address
                   ing about 800 adults, ages 55 to 90        compound annual growth rate of            all stages of cancer, from the basic cel-
                   (200 cognitively normal older indi-        6.4% in the near future. Only MR          lular processes through tumor growth
                   viduals to be followed for 3 years,        imaging contrast agents matched           and metastasis. “The key aspect that
                   400 individuals with MCI to be fol-        PET agents in growth in the contrast      sets the ICBP effort apart from others
                   lowed for 3 years, and 200 individu-       media and radiopharmaceuticals mar-       is the focus on building predictive can-
                   als with early AD to be followed for       kets. The study noted that one limit-     cer models and not just analyzing
                   2 years). The study will compare           ing factor is the slow rate of adoption   data,” said Daniel Gallahan, PhD, as-
                   neuroimaging, biological, and clini-       of new technology by physicians, es-                      (Continued on page 26N)

                  24N    THE JOURNAL     OF   NUCLEAR MEDICINE • Vol. 45 • No. 12 • December 2004

                   (Continued from page 24N)                        The Blueprint effort began by iden-        components that contribute to drug
                   sociate director, Division of Cancer        tifying cross-cutting neuroscience re-          abuse, addiction, and other compulsive
                   Biology, NCI. The ICBP centers also         search that relates to the missions of all      disorders; and the exploration of effec-
                   will serve as training and outreach         of the NIH participants. Three unifying         tive treatments for adolescent smokers,
                   programs, enabling developing tech-         scientific themes emerged as critical            particularly in minority populations.
                   nologies to be communicated to other        for accelerating progress:                      “NIDA is delighted that our intramural
                   scientists in the cancer research com-                                                      research program will be moving into
                   munity. A complete list of the ICBP           ●   Development of the nervous system
                                                                                                               this state-of-the-art facility,” said Nora
                                                                     throughout the life span;
                   centers and their foci is available at                                                      D. Volkow, MD, director of the NIDA.
                                                                 ●   Neurodegeneration from disease and
                   the NCI Web site at www.nci.nih.                  aging; and                                “It will allow us to continue to develop
                   gov.                                          ●   Plasticity of the nervous system (the     and use neuroimaging and other novel
                                National Cancer Institute            ability of the nervous system to          technologies to learn more about pre-
                                                                     change in response to the environ-        venting and treating drug addiction.”
                   NIH Neuroscience                                  ment, experience, injury, and disease).           The Johns Hopkins University
                   Blueprint to Shape Intra-                       Information about the Neuro-
                   Agency Research                             science Blueprint can be found online           SCAR Workshop on
                   Cooperation                                 at        Crisis in Medical Imaging
                        On October 24 National Institutes                National Institutes of Health             The Society for Computer Appli-
                   of Health Director (NIH) Elias A.                                                           cations in Radiology (SCAR) will be
                   Zerhouni, MD, announced a new intra-        NIDA, NIA, and JHU                              sponsoring a conference and work-
                   agency partnership to accelerate neuro-     Partner in Research                             shop, “Transforming Medical Imag-
                   science research. Dubbed the NIH                The National Institutes of Health           ing,” on January 31 and February 1,
                   Blueprint for Neuroscience Research,        (NIH) and The Johns Hopkins Uni-                2005, in Bethesda, MD. Partially fi-
                   the agreement reinforces ongoing NIH        versity (JHU) celebrated on October             nanced with support from the National
                   efforts to increase collaborative re-       12 the beginning of construction of             Institute of Biomedical Imaging and
                   search and information sharing among        the new Biomedical Research Center              Bioengineering, the 2-day meeting is a
                   14 NIH institutes and centers that con-     (BRC) on the Johns Hopkins Bay-                 part of the SCAR Transforming the
                   duct or support research on the brain       view campus in Baltimore, MD. The               Radiology Interpretation Process
                   and nervous system.                         BRC, which is slated for occupancy              (TRIP) initiative, which focuses on re-
                        “The extraordinary scientific con-      in the fall of 2006, will house major           search, education, and discovery of in-
                   vergence in the fields of inquiry of         components of the intramural research           novative solutions to the problem of
                   these 14 institutes and centers and the     programs of the National Institute on           health care information and image data
                   rising public health impact of disor-       Aging (NIA) and the National Institute          overload. The workshop will explore
                   ders of the nervous system make neu-        on Drug Abuse (NIDA). Once com-                 effective ways to better understand the
                   roscience one of the most important         pleted, the BRC will include 500,000            issues and to facilitate exchanges of
                   and dynamic scientific frontiers for         square feet of laboratory, vivarium, and        ideas between researchers and end-user
                   biomedical and behavioral research          administrative space and will house             clinicians, between researchers and in-
                   in this century,” said Zerhouni.            nearly 1,000 scientists and support staff       dustry partners, and between scientists
                   “Greater synergy and cross fertiliza-       for both basic and clinical research pro-       inside and outside of medicine who
                   tion across research disciplines will       grams.                                          struggle with similar issues in their use
                   be needed for progress in our under-            NIA researchers in the new facility         of image data. Intended participants in-
                   standing of this complex system and         will continue their work in a range of          clude radiologists and other physicians,
                   new discoveries of benefit to our pa-        areas, including studies of normal ag-          biomedical engineers, biomedical im-
                   tients.”                                    ing as a risk factor for heart disease;         aging scientists, computer scientists,
                        The NIH neuroscience institutes        animal studies of caloric restrictions in       imaging informatics scientists, imaging
                   and centers have increasingly joined        the development and potential preven-           physicists, information technology pro-
                   forces over the past few years through      tion of disease; and investigations of          fessionals, medical imaging industry
                   initiatives and working groups on           stability of personality in adulthood           personnel, and any other students or
                   specific disorders. More than 60 co-         and later. NIDA scientists who will             professionals interested in the problem
                   operative programs have focused on          occupy the BRC plan to pursue re-               of very large medical image data sets.
                   resources and scientific issues, including   search directions related to the identi-        For additional information about the
                   predoctoral training, gene expression,      fication of genes that contribute to drug        meeting or to register, visit the TRIP
                   pain, stem cells, neurodegeneration,        addiction; development and use of neu-          website at
                   and integrating intramural neuro-           roimaging techniques (including PET)               Society for Computer Applications
                   science research.                           to better understand the neurological                                     in Radiology

                  26N     THE JOURNAL     OF   NUCLEAR MEDICINE • Vol. 45 • No. 12 • December 2004
                                                                                                                                  N E W S L I N E
Cornell to Mediate NRC                      from the NRC Web site. During this        ing the whale.” The center agreed to
Disputes                                    review, ADAMS, the NRC’s online           examine the head as part of a “com-
     The Nuclear Regulatory Commis-         document library, will not be available   munity effort,” said Moore. The
sion (NRC) announced on October 28          to the public. In addition, access to     small whale was presumed to be the
that it has contracted with Cornell Uni-    documents on the NRC’s Electronic         offspring of the larger whale that
versity’s Institute on Conflict Resolution   Hearing Docket and NRC staff docu-        died during the same week, and re-
to act as a neutral administrator in the    ments relative to the high-level waste    searchers hope to learn more about
agency’s alternative dispute resolution     repository were also suspended pend-      the cause of death. Although beaked
program (ADR) for addressing discrimi-      ing further review. The agency empha-     whale carcasses have washed up on
nation complaints and other allegations     sized that no classified or safeguards     shore before, the animals are seldom
of wrongdoing. The institute will make      material has ever been permitted on the   seen alive. The images were sent to
its nationwide roster of expert mediators   NRC Web site, but that the agency         scientists at the National Marine Fish-
available to the NRC, its licensees, and    is widening its review to remove ad-      eries Service headquarters in Silver
their employees to facilitate quick and     ditional information that could poten-    Spring, MD, after initial interpreta-
amicable resolution of workplace dis-       tially be of use to a terrorist. Imme-    tion by staff at the imaging center.
putes. The agency’s ADR program, an-        diately after September 11, 2001, the
nounced in August, aims to promote a        NRC took down its Web site and
                                            removed more than 1,000 documents
                                                                                      CERN Celebrates Fiftieth
safety-conscious work environment by
                                            that contained information deemed         Birthday
providing a means for prompt and fair
                                            sensitive. As part of its ongoing ef-          Scientists and European leaders
resolution of worker complaints and
                                            forts to strengthen security, the NRC     gathered in Geneva, Switzerland, on
timely and effective resolution of en-
                                            also has been holding meetings with       October 19 to celebrate 50 years of
forcement issues.
                                            the nuclear industry to advise them       groundbreaking science. French Presi-
     The NRC program aims to use
                                            on what information should be sub-        dent Jacques Chirac, King Juan Carlos
ADR in 2 potential scenarios: (1) be-
                                            mitted to the NRC for public viewing      of Spain, and Swiss President Joseph
fore initiation of an NRC investigation
                                            and how to mark information now           Diess were among those who attended
(so-called “early ADR”), when those
involved would be the employee and          deemed too sensitive to post. The         ceremonies marking the founding of
the licensee; and (2) after comple-         NRC handles a large volume of doc-        the European Organization for Nuclear
tion of an investigation, when the          uments. About 200 official agency          Research, which goes by its original
parties would be the NRC and the            records, some generated by the NRC        French initials, CERN. In his remarks,
licensee. The aim is to reach settle-       and others from external sources, are     King Juan Carlos reminded attendees
ment within 90 days of agreeing to          posted daily to the NRC Web site          that at its founding in 1954 CERN was
mediation. “Cornell University’s            through ADAMS, which holds hun-           intended to stop the postwar brain drain
participation will enhance our pro-         dreds of thousands of documents.          from Europe to the United States and
gram for responding to disputes by          Given this volume, it is expected that    to help European science regain its pre-
reassuring both workers and licens-         ADAMS will not be even partially          viously strong footing.
ees that their complaints or con-           restored until at least December 1.            CERN’s founding convention em-
cerns will be considered by a truly              Nuclear Regulatory Commission        phasized that the organization should
neutral person if they choose the                                                     foster international collaboration and
early ADR approach,” said Frank                                                       promote contacts between and inter-
                                            A Whale of a PET/CT                       change of scientists. The organization
Congel, director of the NRC’s Of-
fice of Enforcement.
                                            Image                                     is also charged with making its results
     More information about the NRC’s           On October 20 the Providence          freely available, providing advanced
ADR program is available on the agen-       Imaging Center in Anchorage, AK,          training, and working in close collabo-
cy’s Web site at          put its new PET/CT unit to novel use      ration with other research institutions.
we-do/regulatory/enforcement.html.          in imaging the head of a rare             “When the 12 founding Member States
     Nuclear Regulatory Commission          Stejneger’s beaked whale. The mam-        ratified the CERN convention on 29
                                            mal was 1 of 2 whales that died near      September 1954,” said CERN’s Direc-
                                            Whittier, AK, within 3 days of one        tor General Robert Aymar, “They gave
NRC Tightens Controls                       another in mid October. “We’ve            the new organization a mission to pro-
on Web Documents                            never done an animal before,” said        vide first class facilities, to coordinate
    On October 25, agency experts at        Jeanette Anderson Moores, an im-          fundamental research in particle phys-
the Nuclear Regulatory Commission           aging center official. Radiologist         ics, and to help reunite the countries of
(NRC) initiated a security review of        Christopher Kottra, MD, told a lo-        Europe after 2 world wars.”
publicly available documents to re-         cal reporter, “I can tell you my               Today, CERN’s unique facilities
move potentially sensitive information      work is pro bono. I won’t be charg-       play host to almost half the world’s

                                                                                                             Newsline       27N

                   particle physicists, its membership has      are offered as a monthly window on the       PET in Detection of
                   grown to 20 European states, and its         broad arena of medical and scientific         Salmonella Vectors in
                   Member States have pooled their re-          endeavor in which nuclear medicine           Tumors
                   sources to make CERN their national          now plays an essential role.
                                                                                                                  Several live attenuated recombi-
                   laboratory for particle physics. “It is no
                                                                                                             nant Salmonella vaccines are now in
                   accident that many of the countries
                   about to join the European Union are                                                      human clinical trials, and, if such treat-
                                                                Therapy                                      ments are to enter the mainstream, a
                   already members of CERN,” said
                   Aymar. “Scientific collaboration has                                                       reliable method is needed for assessing
                   proved to be a valuable step on the way                                                   both appropriate individuals for treat-
                                                                Radiolabeled mAb
                   to collaboration at the political level.”                                                 ment and ongoing efficacy. On Octo-
                                                                Targeting of Dead Cells                      ber 22 Soghomonyan et al. from the
                       CERN is currently focusing on
                   the Large Hadron Collider (LHC),
                                                                in Melanoma                                  Memorial Sloan–Kettering Cancer
                   which will be the world’s largest and             In a study published in the October     Center (New York, NY) reported
                   most complex scientific instrument            12 issue of the Proceedings of the Na-       ahead of print in Cancer Gene Therapy
                   when it switches on in 2007. Exper-          tional Academy of Sciences USA               on a study designed to determine the
                   iments at the LHC may provide the            (2004;101:14865–14870), Dadachova            efficacy of PET in noninvasively de-
                   answers to crucial questions about           and colleagues from the Albert Ein-          tecting Salmonella delivery vectors
                   gravity. LHC experiments will also           stein College of Medicine (Bronx, NY)        within tumors. In this study the authors
                   probe the mysterious missing mass            reported on a study assessing the fea-       used a genetically modified Salmo-
                   and dark energy of the universe.             sibility of targeting melanin to deliver     nella, VNP20009, that expresses the
                   They will investigate the reason for         cytotoxic radiation to human mela-           herpes simplex thymidine kinase
                   nature’s preference for matter over          noma cells, using a melanin-binding          (HSV1-tk) reporter gene. They selec-
                   antimatter and probe matter as it ex-        monoclonal antibody (mAb). This nu-          tively localized the Salmonella within
                   isted at the very beginning of time.         clear medicine–led research focused on       murine tumor models and labeled it
                       CERN’s reputation is based on            nude mice bearing MNT1-pigmented             with 14C to yield 14C-2’-fluoro-1-
                   fundamental research, but the organi-        human melanoma tumors. The mice              beta- D -arabino-furanosyl-5-iodo-
                   zation is also an important source of        were injected with mAb 6D2 labeled           uracil (14C-FIAU). A number of their
                   new technologies. The World Wide             with 55.5 GBq of 188Re, with resulting       results supported the use of PET in
                   Web was invented at CERN, and today          inhibition of tumor growth and pro-          imaging Salmonella vectors. First,
                   the organization is at the forefront of      longed survival. The targeting involved      they showed a quantitative relation-
                   the effort to develop the globally dis-      mAb binding to extracellular melanin         ship between the level of accumu-
                   tributed computing system currently          released during tumor cell turnover or       lated radioactivity and the number of
                   known simply as “the Grid.” Learn            to dying cells with permeable mem-           bacteria in tumor. Quantitative auto-
                   more about CERN, its current projects,       branes, with radioactivity delivered by      radiography of tumor cross-sections
                   and history at                 crossfire effect to adjacent viable tumor     showed that 14C-FIAU accumulated
                                                      CERN      cells. The authors concluded that “our       significantly less in the tumor periph-
                                                                results establish the feasibility of tar-    ery than in internal regions. Next,
                    From the Literature                         geting melanin released from dead            124I-FIAU PET images were com-

                                                                melanoma cells in tumors with radio-         pared with tissue radioactivity and
                        Each month the editor of Newsline       labeled antibodies to achieve a thera-       bacterial concentration measure-
                   selects articles on therapeutic, diag-       peutic effect.” They noted that melanin      ments, and a log–log relationship was
                   nostic, research, and practice issues        carries substantial advantages over          found, indicating that PET could
                   from a range of international publica-       conventional tumor antigens, because         identify multiple tumor sites. The au-
                   tions. Most selections come from out-        it is insoluble, resistant to degradation,   thors concluded that “the ability to
                   side the standard canon of nuclear           and can be expected to accumulate in         noninvasively detect Salmonella vec-
                   medicine and radiology journals. Note        targeted tissues. These characteristics      tors by PET imaging has the potential
                   that although we have divided the ar-        suggest that the efficacy of this type of     to be conducted in a clinical setting
                   ticles into diagnostic and therapeutic
                                                                therapy might increase with each sub-        and could aid in development of
                   categories, these lines are increasingly
                                                                sequent treatment cycle.                     these vectors by demonstrating the
                   blurred as nuclear medicine capabili-
                   ties rapidly expand. Many diagnostic                                                      efficiency and duration of targeting
                   capabilities are now enlisted in direct                                                   as well as indicating the locations of
                   support of and, often, in real-time con-              Proceedings of the National         tumors.”
                   junction with, therapies. These briefs                 Academy of Sciences USA                            Cancer Gene Therapy

                  28N     THE JOURNAL     OF   NUCLEAR MEDICINE • Vol. 45 • No. 12 • December 2004
                                                                                                                                         N E W S L I N E
18F-Ciprofloxacin            as PET           Kartachova et al. from The Netherlands        cer. Twenty-four hours before therapy,
Tracer                                       Cancer Institute/Antoni van Leeuwen-          35 patients were administered 0.3 mg
     Widespread international attention      hoek Hospital (Amsterdam) reported on         rhTSH, and a placebo was administered
has been focused on ciprofloxacin ad-         an investigation correlating visual pat-      to the remaining patients. Expected 131I
ministration, both for its possible use as   terns from tumor uptake on 99mTc-Hynic-       activity was calculated using thyroid ra-
a remedy in criminal biological attacks      rh-Annexin V scintigraphy (TAVS) with         dioactive iodine uptake (RAIU) at 24 and
and for its more routine use as a potent     treatment response, as an assessment of       96 hours after administration of a tracer
antibiotic. Brunner et al. from the Med-     the technique’s value in predicting the       dose of 0.5 MBq 131I. After 131I therapy,
ical University of Vienna (Austria) re-      success of treatment-induced apoptosis.       24-hour and 96-hour RAIU measure-
ported in the October issue of Antimi-       The study included 33 patients (26 with       ments were repeated for an exact assess-
crobial Agents and Chemotherapy              malignant lymphoma; 1 with leukemia; 2        ment of the actual absorbed thyroid dose.
(2004;48:3850 –3857) on a study using        with non–small cell lung cancer
                                                                                           The authors compared the expected and
18F-ciprofloxacin PET to study biodis-        [NSCLC], and 1 with head and neck
                                                                                           actual absorbed thyroid doses in the 2
tribution and pharmacokinetics of the        small cell lung cancer). All patients were
                                                                                           groups of patients and found a mean in-
fluoroquinolone in humans, with a spe-        scheduled for therapy (27 for radiother-
                                                                                           crease of 36.4% in the rhTSH group and
cial focus on assessing distribution to      apy; 5 for platinum-based chemotherapy,
                                             and 1 for concurrent chemoradiation           a decrease of 21.5% in the placebo group
target tissues. The study included 12                                                      (P 0.001), equivalent to an increase of
healthy volunteers who were pretreated       therapy) and underwent TAVS before
                                             and early after the start of treatment.       73.8% in the absorbed thyroid dose in the
for 5 days with standard therapeutic                                                       rhTSH-treated group. These results indi-
                                             99mTc-Hynic-rh-Annexin V uptake in tu-
doses of ciprofloxacin. On the sixth
                                             mor was assessed visually on planar and       cate that “stimulation with rhTSH before
day each patient received a tracer dose                                                    131I therapy not only hinders the decrease
of approximately 700 MBq of 18F-             SPECT images. In the 29 patients who
                                             remained available for follow-up, a sta-      in the thyroid RAIU observed with con-
ciprofloxacin intravenously. The ad-
                                             tistically significant correlation was         ventional 131I therapy, but in fact signifi-
ministration contained about 0.6 mg of
                                             found between changes in 99mTc-Hynic-         cantly enhances the absorbed thyroid
unlabeled ciprofloxacin. All volunteers
underwent serial PET imaging and ve-         rh-Annexin V tumor uptake and clinical        dose.” The authors noted that additional
nous blood sampling. The authors             response (P 0.001). The authors found         research is necessary to determine
identified 2 different tissue compart-        that complete or partial tumor response       whether this also leads to a significant
ments of radiotracer distribution: kid-      was associated with a marked increase in      increase in goiter reduction.
                                             99mTc-Hynic-rh-Annexin V accumula-
ney, heart, and spleen, from which the                                                        Journal of Clinical Endocrinology
radiotracer was washed out relatively        tion early in treatment compared with                                 and Metabolism
quickly, and liver, muscle, and lung         baseline values. In patients with stable or
tissue, which showed prolonged radio-        progressive disease, pretreatment scans
                                             showed low 99mTc-Hynic-rh-Annexin V           Human Anti-CEA mAbs
tracer retention. The highest concentra-
tions of radioactivity were in the liver     uptake and no significant increase early       for RIT in Colorectal
and kidney, and the lowest concentra-        after treatment. The authors concluded        Cancer
tions were in the brain. By transform-       that “these results indicate that TAVS             Garambois et al. from INSERM
ing standard uptake values on PET into       might be useful as a predictive test for      (Grenoble and Montpellier, France) re-
absolute concentrations (in micro-           treatment response.”                          ported ahead of print in the October 15
grams per milliliter), the authors corre-              Radiotherapy and Oncology
                                                                                           issue of BMC Cancer (2004;4:75) on
lated concentrations at target sites with                                                  the development of human anti-
the susceptibilities of bacterial patho-     Recombinant Human                             carcinoembryonic antigen (anti-CEA)
gens. They noted that this technique                                                       monoclonal antibodies (mAbs) for co-
                                             Thyrotropin in 131I
shows promise for assessing the poten-                                                     lon cancer radioimmunotherapy (RIT).
tial efficacy and monitoring treatment        Therapy
                                                 Results of a study on the effects         The study was conducted in mice that
with ciprofloxacin in a variety of infec-                                                   were immunized with CEA to produce
tions.                                       of recombinant human thyrotropin
                                             (rhTSH) on 131I therapy in patients with      antibodies, 2 of which, VG-IgG2 and
             Antimicrobial Agents and                                                      VG-IgM, were selected for character-
                          Chemotherapy       nodular goiter were reported on Octo-
                                             ber 19 ahead of print in the Journal of       ization in vitro and in vivo in human
                                             Clinical Endocrinology and Metabo-            colon carcinoma LS174T– bearing
Apoptosis Imaging with                       lism by Nielsen et al. from the Odense        nude mice. The authors measured
99mTc-Annexin V and
                                             University Hospital (Denmark). The            binding of mAbs on CEA-expressing
Treatment Response                           randomized double-blinded study in-           cells and no binding on nonspecific
   In the September issue of Radiother-      cluded 63 patients who were scheduled         cross-reacting antigen– expressing hu-
apy and Oncology (2004;72:333–339),          to undergo 131I therapy for nodular can-      man granulocytes. In a competitive

                                                                                                                   Newsline        29N

                   binding assay using 5 reference MAbs        Diagnosis                                  99m Tc-N(5)-folate   is stable under
                   directed against the 5 gold CEA                                                        physiologic conditions for at least 24
                   epitopes, VG-IgG2 and VG-IgM                Thyroid Cancer After                       hours after radiocomplexation. Re-
                   were shown to be directed against the                                                  ceptor binding has been established
                   gold 4 epitope. In the in vivo portion of                                              in human tumor cell lines expressing
                                                                   Cherenko et al. from the Trans-
                   the study, 125 I-labeled VG-IgG2                                                       folate-binding protein. Studies in
                                                               plantation of Endocrine Organs and
                   showed high tumor uptake at 24 hours                                                   mice showed 70% clearance from
                                                               Tissues Public Health Ministry
                   after injection and was still concen-                                                  circulation within 5 minutes of injec-
                                                               (Kiev, Ukraine) reported ahead of
                   trated in the tumor at 72 hours after                                                  tion, and gamma camera imaging
                                                               print in the October 21 issue of The
                   injection (28.4      11.0 %ID/g). The                                                  showed accumulation in liver, kid-
                                                               World Journal of Surgery on a large-
                   radiolabeled mAbs did not accumulate                                                   neys, and intestines, with tumor-to-
                                                               scale clinical analysis of thyroid can-
                   in normal tissue. (Biodistribution of                                                  blood ratios reaching 2.68         0.52
                                                               cer in individuals who were adults
                   VG-IgM biodistribution in the mouse                                                    and 5.5       1.47 at 1 and 4 hours,
                                                               ( 18 years of age) when exposed to
                   model was not measured because of                                                      respectively, after injection. The au-
                                                               ionizing radiation after the Chernobyl
                   the very short half-life.) The authors                                                 thors noted that “the 99mTc-N(5)-
                                                               nuclear accident. The study included
                   concluded that “our human anti-CEA                                                     folate conjugate has promising utility
                                                               records from 2,674 patients. Group A
                   IgG2 is a promising candidate for                                                      as a receptor-specific radiopharma-
                                                               included 2,363 with no evidence of
                   RIT in intact form, as F(ab’)2 frag-                                                   ceutical for imaging neoplastic tissues
                                                               radiation influence in their histories
                   ments, or as a bispecific antibody.”                                                    known to overexpress folate-binding
                                                               who had undergone surgery for thy-
                                              BMC Cancer                                                  protein.”
                                                               roid nodules. Group B included 311
                                                                                                                  Cancer Biology and Therapy
                                                               patients with evidence of Chernobyl
                                                               irradiation (as recovery operation
                   Radiometals as RIT                          workers, evacuees from the restricted      123I-Ioflupane SPECT in
                   Payloads in Lymphoma                        area, or inhabitants of contaminated       Clinically Uncertain
                       An October supplement to Clini-         areas) who had undergone surgery
                                                                                                          Parkinsonian Syndromes
                   cal Lymphoma was devoted to the             for thyroid nodules. The rate of thy-
                                                                                                              In the October issue of Movement
                   topic of 90Y-ibritumomab tiuxetan           roid cancer was significantly higher
                                                                                                          Disorders (2004;October 19), which is
                   (Zevalin; Biogen IDEC, Inc.) therapy        in group B than in group A (32.8%
                                                                                                          devoted to nuclear imaging of Parkin-
                   for non-Hodgkin’s lymphoma (NHL),           and 27.2%, respectively). In group B,
                                                                                                          son disease and parkinsonian syn-
                   with an introduction provided by            recovery workers and evacuees
                                                                                                          drome, Catafau and Tolosa, from the
                   Gerald L. DeNardo (University of            showed the highest rates (54.8% and
                                                                                                          Hospital de Sant Pau (Barcelona,
                   California Davis Medical Center;            47.8%, respectively). The most inva-
                                                                                                          Spain), reported on pages 1175–1182
                   Sacramento). The table of contents          sive form of cancer (staged at T4)
                                                                                                          on the use of 123I-ioflupane SPECT as a
                   and online access to the journal are        was significantly higher in group B
                                                                                                          marker of nigrostriatal neuronal integ-
                   available at:        than in group A (39% and 23%, re-
                                                                                                          rity to differentiate of parkinsonism
                   JournalEZ/toc.cfm?code 3956002.             spectively), as were regional metas-
                                                                                                          with loss of dopaminergic terminals
                   One article contributed by DeNardo          tases and frequency of multifocality.
                                                                                                          (presynaptic Parkinson syndrome [PS])
                   and others, appearing on pages S5–          The authors concluded that “our re-
                                                                                                          from parkinsonism without nigrostria-
                   S10 of the issue, reviewed previously       sults suggest irradiation as a cause of
                                                                                                          tal degeneration. The study included
                   published investigations on radiomet-       thyroid cancer in adult victims of Cher-
                                                                                                          118 patients with clinically uncertain
                   als as RIT payloads in lymphoma and         nobyl and confirm the increasing ag-
                                                                                                          parkinsonian syndromes who under-
                   discussed the search for effective RIT      gressiveness of such tumors.”
                                                                                                          went 123I-ioflupane SPECT. Imaging
                   strategies in carcinomas. They noted               The World Journal of Surgery
                                                                                                          results were not consistent with origi-
                   that radiometals have been shown to                                                    nal diagnoses in 36% of patients with
                   have residualizing properties that          Tracer for Folate-                         presynaptic PS and 54% with non-
                   carry advantages when targeted              Receptor Positive Tumors                   presynaptic PS. Imaging findings led to
                   monoclonal antibodies are localized             Reporting on October 2 ahead of        a change in diagnosis in 52% of all
                   in malignant tissue. After reviewing        print in Cancer Biology and Therapy,       patients and changes in clinical man-
                   data from the phase III trial of 90Y-       Panwar et al. from the Institute of        agement in 72% of patients. Imaging
                   ibritumomab tiuxetan in patients with       Nuclear Medicine and Allied Sci-           differentiated clearly between final di-
                   NHL, they concluded that “RIT has           ences and the University of Delhi (In-     agnoses: all patients with final diag-
                   emerged as a safe and efficient              dia) reported on the synthesis and         noses of presynaptic PS had abnormal
                   method for treatment of NHL, espe-          evaluation of a new 99mTc-labeled          scans, whereas 94% of patients with
                   cially in specific settings.”                folate derivative for the detection of     nonpresynaptic PS had normal scan.
                                     Clinical Lymphoma         folate-receptor positive tumors.           The authors concluded that “visual as-

                  30N     THE JOURNAL     OF   NUCLEAR MEDICINE • Vol. 45 • No. 12 • December 2004
                                                                                                                                 N E W S L I N E
sessment by 123I-ioflupane SPECT may         from postmortem samples of affected        may also be overconfident in inter-
have a significant impact on the clinical    cortex and cerebellum from patho-          preting PET and use it as the final
management of patients with clinically      logically confirmed AD patients and         arbiter after an extensive evaluation
uncertain parkinsonian syndromes.”          age-matched controls. 125I-IMPY and        in lieu of tissue biopsy.”
                 Movement Disorders         3H-SB-13 showed abundant binding                   Journal of Clinical Oncology
                                            capacity with high binding affinities
PET Brain Imaging and                       for amyloid plaques in affected cor-
                                            tical regions of AD brains but not in      PET SLN Biopsy in Oral
the Mechanisms of                                                                      and Oropharyngeal
                                            cerebellar homogenates. The location
Depression                                  and density of specific signal de-          Cancer
    Reivich et al. from the University      tected by 125I-IMPY and 3H-SB-13               Kovacs et al. from the Johann
of Pennsylvania School of Medicine          correlated with the distribution of        Wolfgang Goethe-University Medi-
(Philadelphia) reported in the Octo-        amyloid plaques in these brain spec-       cal School (Frankfurt am Main, Ger-
ber 15 issue of the Journal of Affec-       imens, as confirmed by thioflavin-S          man) reported in the October issue of
tive Disorders (2004;82:321–327) on         staining. The authors concluded that       the Journal of Clinical Oncology
a study using the selective brain se-       “these properties suggest that when        (2004;22:3973–3980) on a study to
rotonin (5-HT) transporter site ligand
11C-( )McN5652 and PET to inves-
                                            labeled with 123I or 11C, these 2 li-      assess the impact of the diagnostic
                                            gands may be useful to quantitate          combination of 18F-FDG PET and
tigate alterations in 5-HT transporter      amyloid plaque burdens in living AD        lymphoscintigraphy-guided sentinel
levels in selected regions of the brain     patients.”                                 lymph node (SLN) biopsy on treat-
in depressed patients. The study in-                             Brain Research        ment in patients with oral and oro-
cluded 4 drug-free depressed patients                                                  pharyngeal squamous cell carcinoma
and 4 healthy volunteers who under-                                                    (OOSCC). The study included 62 pa-
went 11C-( )McN5652 PET imaging.            PET and Effect on                          tients with resectable stage T1–3
Patients showed significantly larger         Routine Clinical Decision                  OOSCC who underwent CT and PET
distribution volume ratios in the left      Making                                     imaging. Thirty-eight patients with-
frontal cortex and right cingulate cor-         In the October 15 issue of the Jour-   out neck uptake on PET were re-
tex than did control subjects. The au-      nal of Clinical Oncology (2004;22:         ferred for SLN biopsy, and results
thors concluded that despite the small      4147– 4156), Hillner et al. from Vir-      were correlated with histopathology.
sample size, “these findings suggest         ginia Commonwealth University              Sensitivity, specificity, validity, and
that 5-HT transporter sites may be in-      (Richmond) reported on a study eval-       positive and negative predictive val-
creased in the frontal and cingulate cor-   uating the effect of 18F-FDG PET           ues were 72%, 82%, 79%, 62%, and
tices of depressed patients” and that       imaging on patient management in rou-      88%, respectively, for PET and 89%,
these “alterations in 5-HT transporter      tine practice. The authors provided        77%, 80.5%, 61.5%, and 94.5%, re-
sites may be of pathophysiologic sig-
                                            questionnaires to the physicians of pa-    spectively, for CT. PET in combina-
nificance in the etiology of depression
                                            tients referred for nonresearch PET at a   tion with SLN biopsy spared 59 neck
and its treatment.”
                                            university medical center. Seventy-one     dissections, and 41 of 124 neck sides
       Journal of Affective Disorders
                                            physicians responded with data on 248      underwent neck dissection as a result
                                            patients, of whom 40% had new or           of PET staging, SLN biopsy, and in-
Potential Agents for                        suspected cancer and 60% were im-          traoperative decision. The authors
Alzheimer’s Imaging                         aged for restaging or suspected recur-     concluded that the use of PET in
    In the October 29 issue of Brain        rence. Lung, lymphoma, and head and        combination with lymphoscintigraphy-
Research (2004;1025;98 –105), Kung          neck cancers accounted for two thirds      guided SLN biopsy “considerably re-
et al. from the University Pennsylva-       of cases. PET imaging was responsible      duced the number of extensive neck
nia (Philadelphia) reported on the          for a change in management in 61% of       dissections in OOSCC as compared
amyloid plaque binding potential of 2       patients. If the pre-imaging treatment     with CT, without locoregional hazard.”
radiolabeled ligands in postmortem          plan involved more testing or biopsy,              Journal of Clinical Oncology
brain tissues from patients with            PET was associated with a man-
Alzheimer’s disease (AD), as an as-         agement change in 90 (79%) of 114          18F-FDG
sessment of in vivo potential for the       patients. In 32% of all patients, phy-            PET and Therapy
agents. In vitro binding studies were       sicians changed to a treatment from        Response in Head and
carried out with 125I-6-iodo-2-(4’-         a nontreatment strategy. The authors       Neck Cancer
dimethylamino-)phenyl-imidazo[1,2]          concluded that these results confirm            In the October issue of Head and
pyridine (125I-IMPY) and 3H-4-N-            that “physicians often change their        Neck (2004;26:890 – 896), McCollum
methylamino-4’-hydroxystilbene              decision making based on PET.”             et al. reported on a study of the accu-
(3H-SB-13) in homogenates prepared          They speculated that “physicians           racy and efficacy of 18F-FDG PET in

                                                                                                            Newsline       31N

                   restaging disease in 40 patients with     Early 18F-FDG PET after                   Radiation-induced inflammatory
                   small cell cancer of the head and neck    Radical Radiotherapy in                   change and metabolic tumor response
                   after induction chemotherapy followed                                               were assessed. Results indicated that
                   by definitive chemoradiotherapy (CRT).                                               increased 18F-FDG uptake in normal
                                                                 Hicks et al. from the Peter
                   They found that after induction che-                                                tissues was associated with a greater
                   motherapy, PET imaging had a sen-         MacCallum Cancer Centre (Mel-             likelihood of complete or partial tu-
                   sitivity of 100% and specificity of        bourne, Australia) reported in the        mor response as indicated on both
                   65% for detecting persistent disease      October 1 issue of the International      PET and CT. The authors concluded
                   at the primary tumor site. After both     Journal of Radiation Oncology, Bi-        that “postradiotherapy inflammatory
                   ICT and CRT were complete, the            ology, Physics (2004;60:412– 418)         changes detected by 18F-FDG PET
                   sensitivity and specificity of PET im-     on the relationship and predictive sig-   are positively correlated with tumor
                   aging were 67% and 53%, respec-           nificance of inflammatory changes de-       response, suggesting that tumor ra-
                   tively, for detecting occult disease in   tected by 18F-FDG PET in irradiated       dioresponsiveness and normal tissue
                   cervical lymph nodes. The authors         normal tissues and metabolic re-          radiosensitivity may be linked” and
                   concluded that 18F-FDG PET imag-          sponse at tumor sites in patients after   that “prognostic stratification pro-
                   ing showed some correlation with          radical radiotherapy for non–small        vided by PET is not compromised by
                   pathologic response after ICT and         cell lung cancer (NSCLC). The study       inflammatory changes if a meticulous
                   CRT in these patients and that addi-      included 73 patients with NSCLC           visual response assessment technique
                   tional investigation in this setting is   who underwent 18F-FDG PET imag-           is used.”
                   needed.                                   ing at an average of 70 days after           International Journal of Radiation
                                          Head and Neck      completion of radical radiotherapy.                 Oncology, Biology, Physics

                   (Continued from page 23N)                                          Working with academic or industry-based organiza-
                   geted diagnosis and therapies and—most importantly—            tions as well as federal agencies, the center will offer
                   on training. The task force will build a program, with input   basic training courses and advanced research seminars at
                   from MI experts from all disciplines, to promote research,     SNM gatherings. It will also serve as a forum to exchange
                   education, and applications that will be beneficial to physi-   knowledge, open dialogues, and advance the field of
                   cians, scientists, and technologists alike. Working in         molecular imaging.
                   harmony with other research organizations in imaging, in                                        Mathew L. Thakur, PhD
                   academia, or industry will be an important goal.                                                          President, SNM

                  32N    THE JOURNAL     OF   NUCLEAR MEDICINE • Vol. 45 • No. 12 • December 2004

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