Insular monoaminergic deficits in prodromal α-synucleinopathies.

Methods: This study assessed data from two cohorts of patients with alpha-synucleinopathies (University of Brescia and University of Rome Tor-Vergata cohorts). Consecutive participants with video-polysomnography-confirmed iRBD, Parkinson's disease (PD), dementia with Lewy bodies (DLB) and controls underwent neurological, clinical and I-FP-CIT SPECT imaging assessments. Individuals with iRBD were longitudinally monitored to collect clinical phenoconversion to PD or DLB.

Critical Appraisal of the Current Role of Myocardial Perfusion Imaging in the Management of Acute Chest Pain.

This paper describes the evolution of nuclear cardiology techniques in the setting of acute coronary syndromes. Since the 1970s, the contribution of nuclear cardiology has been fundamental in delineating the physiopathology and diagnosis of acute myocardial infarction, when electrocardiogram (ECG) did not provide the diagnosis and when cardiac enzyme assessments were at a very early stage. In this clinical situation, at that time the role of pyrophosphate scintigraphy and antimyosin antibodies was important in ensuring diagnostic precision.

Atypical brain FDG-PET patterns increase the risk of long-term cognitive and motor progression in Parkinson's disease.

Introduction: Brain hypometabolism patterns have been previously associated with cognitive decline in Parkinson's disease (PD). Our aim is to evaluate the impact of single-subject fluorodeoxyglucose (FDG)-PET brain hypometabolism on long-term cognitive and motor outcomes in PD.

Methods: Forty-nine non-demented PD patients with baseline brain FDG-PET data underwent an extensive clinical follow-up for 8 years.

Dopaminergic connectivity reconfiguration in the dementia with Lewy bodies continuum.

Introduction: The impairment of nigrostriatal dopaminergic network is a core feature of dementia with Lewy bodies (DLB). The involvement and reconfiguration of extranigrostriatal dopaminergic circuitries in the DLB continuum is still theme of debate. We aim to investigate in vivo the dynamic changes of local and long-distance dopaminergic networks across DLB continuum.

Correlation between brain glucose metabolism (F-FDG) and cerebral blood flow with amyloid tracers (F-Florbetapir) in clinical routine: Preliminary evidences.

Objective: This study compared the performance of F-Florbetapir PET/CT early acquisitions to F-FDG PET/CT.

Methods: We included 12 patients who underwent F-FDG PET/CT and a dual-time F-Florbetapir PET/CT (1-6 min early-scan and 50 min late-scan). PET/CT were analyzed visually by three nuclear medicine physicians with different experience using a four-point scale (0 = no reduction, 1 = slight, 2 = moderate, 3 = severe reduction) for F-Florbetapir early-phase and F-FDG images in 10 cortical regions (bilateral frontal, temporal, parietal, occipital, posterior cingulate/precuneus), and F-Florbetapir late-phase in the same cortical regions using a three-point scale (0 = normal, 1 = abnormal with minor plaques, 2 = abnormal with major plaques).

In vivo human molecular neuroimaging of dopaminergic vulnerability along the Alzheimer's disease phases.

Background: Preclinical and pathology evidence suggests an involvement of brain dopamine (DA) circuitry in Alzheimer's disease (AD). We in vivo investigated if, when, and in which target regions [123I]FP-CIT-SPECT regional binding and molecular connectivity are damaged along the AD course.

Methods: We retrospectively selected 16 amyloid-positive subjects with mild cognitive impairment due to AD (AD-MCI), 22 amyloid-positive patients with probable AD dementia (AD-D), and 74 healthy controls, all with available [123I]FP-CIT-SPECT imaging.

18F-FDG PET/CT in the Diagnosis and Follow-up of Balint Syndrome.

Balint syndrome is a rare neurological disorder characterized by simultanagnosia, optic ataxia, and ocular apraxia, and its etiology can be very heterogeneous. Diagnosis is based on neuropsychological evaluation, but brain radiological and nuclear medicine imaging also plays an important role. Because few case reports have been published in literature, in this work, we present 2 patients affected by Balint syndrome in which 18F-FDG PET/CT helped in the diagnosis and follow-up.

Transcranial magnetic stimulation and amyloid markers in mild cognitive impairment: impact on diagnostic confidence and diagnostic accuracy.

Background: The development of diagnostic tools capable of accurately identifying the pathophysiology of mild cognitive impairment (MCI) has become a crucial target considering the claim that disease-modifying treatments should be administered as early as possible in the disease course. Transcranial magnetic stimulation (TMS) protocols have demonstrated analytical validity in discriminating different forms of dementia; however, its value in daily clinical practice in MCI subjects is still unknown.

Objective: To evaluate the clinical value of TMS compared to amyloid markers on diagnostic confidence and accuracy in MCI subjects, considering clinicians' expertise.

Comparison between NNH-PET and Tc-Tetrofosmin-CZT SPECT in the evaluation of absolute myocardial blood flow and flow reserve.

Background: PET/CT is the standard for quantitative assessments of myocardial blood flow (MBF), but it requires short-lived-tracers, costly, and not widely available. SPECT with Cadmium Zinc Telluride (CZT) detectors allows dynamic acquisition and quantitation of MBF. The study aims were to compare MBF measurements by Tc-tetrofosmin-CZT to NNH PET/CT after regadenoson-induced coronary hyperemia and to evaluate the effect of attenuation correction (AC).

Extrastriatal dopaminergic and serotonergic pathways in Parkinson's disease and in dementia with Lewy bodies: a I-FP-CIT SPECT study.

Purpose: The aim of the study was to evaluate extrastriatal dopaminergic and serotonergic pathways in patients with Parkinson's disease (PD) and dementia with Lewy bodies (DLB) using I-FP-CIT SPECT imaging.

Methods: The study groups comprised 56 PD patients without dementia, 41 DLB patients and 54 controls. Each patient underwent a standardized neurological examination and I-FP-CIT SPECT.

Comparison of visual criteria for amyloid-PET reading: could criteria merging reduce inter-rater variability?

Background: Three different amyloid tracers labeled with 18-flourine have been introduced into clinical use. The leaflets of tracers indicate different visual criteria for PET reporting. In clinical practice, it is not yet ascertained whether these criteria are equivalent in terms of diagnostic accuracy or if anyone is better than another.

The impact of transcranial magnetic stimulation on diagnostic confidence in patients with Alzheimer disease.

Background: Cholinergic dysfunction is a key abnormality in Alzheimer disease (AD) that can be detected in vivo with transcranial magnetic stimulation (TMS) protocols. Although TMS has clearly demonstrated analytical validity, its clinical utility is still debated. In the present study, we evaluated the incremental diagnostic value, expressed in terms of diagnostic confidence of Alzheimer disease (DCAD; range 0-100), of TMS measures in addition to the routine clinical diagnostic assessment in patients evaluated for cognitive impairment as compared with validated biomarkers of amyloidosis.

Emerging topics and practical aspects for an appropriate use of amyloid PET in the current Italian context.

In May 2017 some representatives of the Italian nuclear medicine and neurological communities spontaneously met to discuss the issues emerged during the first two years of routine application of amyloid PET with fluorinated radiopharmaceuticals in the real world. The limitations of a binary classification of scans, the possibility to obtain early images as a surrogate marker of regional cerebral bloos flow, the need for (semi-)quantification and, thus, the opportunity of ranking brain amyloidosis, the correlation with Aβ42 levels in the cerebrospinal fluid, the occurrence and biological meaning of uncertain/boderline scans, the issue of incidental amyloidosis, the technical pittfalls leading to false negative/positive results, the position of the tool in the diagnostic flow-chart in the national reality, are the main topics that have been discussed. Also, a card to justify the examination to be filled by the dementia specialist and a card for the nuclear medicine physician to report the exam in detail have been approved and are available in the web, which should facilitate the creation of a national register, as previewed by the 2015 intersocietal recommendation on the use of amyloid PET in Italy.

Single-subject SPM FDG-PET patterns predict risk of dementia progression in Parkinson disease.

Objective: To evaluate the statistical parametric mapping (SPM) procedure for fluorodeoxyglucose (FDG)-PET imaging as a possible single-subject marker of progression to dementia in Parkinson disease (PD).

Methods: Fifty-four consecutive patients with PD without dementia (age at onset of 59.9 ± 10.

Attenuation correction in myocardial perfusion imaging affects the assessment of infarct size in women with previous inferior infarct.

Background: Myocardial perfusion imaging is a well-established diagnostic tool in patients with known or suspected coronary artery disease. Numerous clinical trials have shown that attenuation correction (AC) in single photon emission computed tomography (SPECT) improves the diagnostic accuracy of myocardial perfusion imaging over non-AC SPECT, differentiating between scar and attenuation artifacts. We have previously shown that attenuation artifacts produce an overestimation of the size of inferior infarcts in the male population.

Cerebral PET glucose hypometabolism in subjects with mild cognitive impairment and higher EEG high-alpha/low-alpha frequency power ratio.

In Alzheimer's disease (AD) research, both 2-deoxy-2-(F)fluoro-D-glucose (FDG) positron emission tomography (PET) and electroencephalography (EEG) are reliable investigational modalities. The aim of this study was to investigate the associations between EEG High-alpha/Low-alpha (H-alpha/L-alpha) power ratio and cortical glucose metabolism. A total of 23 subjects with mild cognitive impairment (MCI) underwent FDG-PET and EEG examinations.

Altered brain metabolic connectivity at multiscale level in early Parkinson's disease.

To explore the effects of PD pathology on brain connectivity, we characterized with an emergent computational approach the brain metabolic connectome using [18F]FDG-PET in early idiopathic PD patients. We applied whole-brain and pathology-based connectivity analyses, using sparse-inverse covariance estimation in thirty-four cognitively normal PD cases and thirty-four age-matched healthy subjects for comparisons. Further, we assessed high-order resting state networks by interregional correlation analysis.

Assessment of the Incremental Diagnostic Value of Florbetapir F 18 Imaging in Patients With Cognitive Impairment: The Incremental Diagnostic Value of Amyloid PET With [18F]-Florbetapir (INDIA-FBP) Study.

Importance: Cerebral amyloidosis is a key abnormality in Alzheimer disease (AD) and can be detected in vivo with positron emission tomography (PET) ligands. Although amyloid PET has clearly demonstrated analytical validity, its clinical utility is debated.

Objective: To evaluate the incremental diagnostic value of amyloid PET with florbetapir F 18 in addition to the routine clinical diagnostic assessment of patients evaluated for cognitive impairment.

Association of brain amyloidosis with pro-inflammatory gut bacterial taxa and peripheral inflammation markers in cognitively impaired elderly.

The pathway leading from amyloid-β deposition to cognitive impairment is believed to be a cornerstone of the pathogenesis of Alzheimer's disease (AD). However, what drives amyloid buildup in sporadic nongenetic cases of AD is still unknown. AD brains feature an inflammatory reaction around amyloid plaques, and a specific subset of the gut microbiota (GMB) may promote brain inflammation.

Comparison Between 99mTc-Sulesomab and 18F-FDG PET/CT in a Patient With Suspected Prosthetic Joint Infection.

Diagnosing prosthetic joint infection is difficult; clinical signs and symptoms, laboratory tests, radiography, and joint aspiration are less sensitive and specific. We report a patient with fever and painful bilateral hip prosthesis, who underwent Tc-sulesomab scan showing moderate tracer uptake at the lateral surface of the right thigh and no signs of prosthesis infection. The F-FDG-PET/CT showed high uptake at the soft tissue of the right hip prosthesis and detected a fistula.

Do Beliefs about the Pathogenetic Role of Amyloid Affect the Interpretation of Amyloid PET in the Clinic.

Background: Beliefs of dementia experts about the pathogenic role of amyloid in Alzheimer's disease (AD) may affect the use of amyloid positron emission tomography (PET).

Objective: To assess the role attributed to amyloid in AD pathogenesis by Italian dementia experts, and whether this modulates the impact of amyloid PET results in their diagnostic workup.

Methods: 22 dementia experts rated their beliefs about the pathogenic role of amyloid.

1-23I-MIBG thyroid uptake: Implications for MIBG imaging of the heart.

Background: 123I-MIBG has been widely used in patients with heart failure and neurological disorders. The patients are pre-treated with Lugol's oral solution or potassium perchlorate to prevent thyroid uptake of unlabeled 123I to limit the thyroid radiation exposure. However, despite the inhibition of the iodide pump, the thyroid is frequently visualized.