This document contains abstracts from presentations at the 29th Annual Northeast Regional Scientific Meeting. The abstracts describe several studies involving nuclear imaging techniques: 1. A study evaluating the reproducibility of quantitative measurements from FDG PET and gallium scans in distinguishing between interstitial nephritis and acute tubular necrosis in rats. It found the measurements to be highly reproducible. 2. A case report describing how SPECT/CT imaging with indium-111 labeled white blood cells revealed unsuspected pulmonary septic emboli in a patient with infected hemodialysis access. 3. A case report where bone SPECT/CT identified an acute pelvic fracture that was missed on other imaging in a patient

1. Abstracts for Society of Nuclear Medicine and Molecular
Imaging, Greater New York and New England Chapters,
29th Annual Northeast Regional Scientific Meeting
November 6–8, 2015
Newport, RI
Reproducibility of Quantified Indices to Distinguish Interstitial
Nephritis from Acute Tubular Necrosis
KJ Nichols,1,2
F Leveque,1
G Limoncelli, MB Tomas,1,2
CJ Palestro,1,2
and KK Bhargava.1,2
1
North Shore-LIJ Health System, Manhasset & New Hyde Park, NY;
2
Department of Radiology, Hofstra North Shore-LIJ School of
Medicine of Hofstra University, Hempstead, NY
Aim: Recently 18F-FDG PET (FDG) quantitative assessment has been
proposed to replace conventional 67
Ga (Ga) visual assessment in differenti-
ating acute interstitial nephritis (AIN) from acute tubular necrosis (ATN).
This requires tabulating standard uptake values (SUVs) within regions of in-
terest (ROI) that are manually drawn, and therefore potentially susceptible to
observer variability. This investigation was undertaken to determine reproduc-
ibility of measurements performed to distinguish ATN from AIN.
Methods: We examined data for 50 rats divided into 3 groups: 10 Controls,
20 AIN & 20 ATN, with half of the animals in each group imaged by FDG &
half by Ga. AIN was induced by injection of 150 mg/kg puromycin amino-
nucleoside and ATN by injection of 6 mg/kg cisplatin. FDG imaging was per-
formed on a micro-PET system and Ga imaging on a conventional gamma
camera with pinhole collimation. Two readers, independent of one another, de-
termined kidney SUV’s, taking 3 samples in each of the coronal, sagittal &
transaxial planes for each kidney, and drew regions of interest on Ga static im-
ages around kidneys & adjacent lumbar spine to generate kidney:spine ratios.
The Kolmogorov-Smirnov test determined whether continuous variables were
normally distributed. The t-test evaluated agreement between continuous vari-
ables. ROC analyses established optimal discrimination thresholds, which were
used to dichotomize readings. Inter-rater agreement was measured by the kappa
statistic with significance of differences determined by the McNemar test.
Results: All continuous values were normally distributed. Observers agreed
on mean values for FDG SUVs (2.29 ± 1.34 versus 2.29 ± 1.15, p = 0.98),
and Ga kidney:spine ratios (0.53 ± 0.23 versus 0.53 ± 0.21, p = 0.95). Both
readers concluded that FDG SUV’s were higher for AIN & ATN than Con-
trols (2.55 ± 1.25 versus 1.28 ± 0.22, p = 0.03), but that AIN & ATN SUV’s
were similar to one another (2.39 ± 0.90 versus 2.71 ± 1.56, p = 0.58). Both
readers also concluded that Ga kidney:spine ratios were significantly higher
for AIN than ATN & Controls (0.77 ± 0.14 versus 0.38 ± 0.03, p < 0.0001),
but that ATN & Control Ga kidney:spine ratios were similar to each other
(0.38 ± 0.03 versus 0.37 ± 0.03, p = 0.47). Agreement between readers
was “good” (κ = 0.61) with no significant difference (Δ = 8%, p = 0.62)
for FDG SUV’s, and was “excellent” (κ = 1.00) with no significant difference
(Δ = 0%, p = 1.00) for Ga kidney:spine ratios.
Conclusions: Our results indicate both FDG and Ga quantitative approaches
are highly reproducible, and that FDG-PET cannot replace Ga in differenti-
ating AIN from ATN.
Indium-111 WBC SPECT/CT Revealing Unsuspected Pulmonary
Septic Emboli – A Case Report and Review of Literature
AM Tuli,1
and L Uliel.1
1
Division of Nuclear Medicine, Department of Radiology, Mount
Sinai Hospital, New York City, New York
Case Presentation: We present a case of a 67 year old female with mul-
tiple comorbidities including end-stage renal disease on hemodialysis,
who presented with three days of fever and pleuritic chest pain. Two
months prior to admission, patient had a percutaneous balloon angioplasty
and stent placement of venous anastomosis of a arteriovenous fistula
(AVF). Upon admission, patient was found to have leukocytosis and MSSA
bacteremia. Patient was referred for an Indium-111 WBC scan to evaluate
for source of infection, with clinical concern for AVF infection or infected
hardware of a prior knee replacement.
Imaging Findings: Chest X-ray (CXR) showed lower lobes airspace
opacities. Transthoracic echocardiogram showed no vegetations. Indium-111
WBC whole body planar images demonstrated increased activity in a linear
configuration in the left upper arm. For further evaluation, SPECT/CT
imaging of the chest and left upper extremity localized the abnormal activity
to the hemodialysis vascular shunt, with more prominent focal activity
aligned within the endovascular stent. The SPECT/CT revealed multiple pe-
ripheral opacities in the upper lobes not previously seen on CXR nor the pla-
nar images. Findings were consistent with septic emboli with infected AVF
as a likely source. Subsequent chest CT confirmed pulmonary septic emboli.
Companion case of infected hemodialysis access and pulmonary septic
emboli will also be presented.
Point of Discussion: Discuss pulmonary septic emboli as a complication of
infected hemodialysis access.
1. Review the utility of SPECT/CT in diagnosis of occult infectious
processes.
2. Review of literature of pulmonary septic emboli on SPECT/CT.
Case Report: Early Detection of Pelvic Fractures
with SPECT/CT
H Mehdikhani,1
S Heiba,1
L Stempler,1
A Tuli,1
and L Kostakoglu.1
1
Department of Nuclear Medicine, Mount Sinai Health system,
New York, NY
Introduction: Pelvic ring fractures pose substantial morbidity and mortality.
Using currently available diagnostic techniques, these fractures are frequently
missed and underestimated in elderly patients.1
Bone scans, as functional tests
of assessing bone metabolism and remodeling are superior over other modal-
ities. The SPECT/CT is useful to detect the fracture, estimate the age of frac-
ture, and visualize the reactive changes within the surrounding soft tissue.2
Case Presentation: Patient was a 72-year-old female status post multilevel
lumbosacral fusion with bilateral iliac wing screws who admitted with com-
plaint of worsening right hip and groin pain for the past two weeks and
resistant to the pain medication.
Imaging Results: All imaging studies were performed at the same day.
CT of the thoracolumbar spine and pelvis revealed compression deformity
of inferior T11 with adjacent sclerosis, and a new non-displaced fracture
through the rght inferior pubic ramus. There was no evidence of other frac-
ture or complication within the visualized hardware.
MRI confirmed the acute/subacute fracture of T11 vertebral body;
However, due to the severe metal artifact from orthopedic hardware, evalu-
ation was limited.
ABSTRACTS
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2. Three-phase pelvic scan demonstrated increased perfusion and radio-
tracer activity in the right hip. Delayed images and SPECT-CT images
revealed increased radiotracer uptake in the right ischium and acetabulum,
without corresponding abnormality in the CT scan. These findings were con-
sistent with the acute fracture of the right ischium and acetabulum.
Conclusion: Combination of highly sensitive bone SPECT/CTwith highly
specific CT imaging improves the detection of acute pelvic fractures.
References
1. van Dijk WA, Poeze M, van Helden SH, et al. Ten-year mortality among
hospitalised patients with fractures of the pubic rami. Injury. 2009;41:
411–4.
2. Scheyerer MJ1, Pietsch C, Zimmermann SM, Osterhoff G, Simmen HP,
Werner CM. SPECT/CT for imaging of the spine and pelvis in clinical
routine: a physician's perspective of the adoption of SPECT/CT in a clinical
setting with a focus on trauma surgery. Eur J Nucl Med Mol Imaging.
2014 May;41 Suppl 1:S59–66.
Clinical Relevance of Focal Bone Activity on F18-FDG
PET/CT Images in Oncology Patients
G Garg,1
R DaSilva,1
C Love,1
DM Milstein,1
and T TAbraham.1
1
Albert Einstein College of Medicine, Montefiore Medical Center,
Bronx, New York.
Purpose: Focally increased bony FDG activity on FDG PET/CT (PET/CT)
in oncology patients is common but not specific for malignancy. Very few
existing reports address this subject matter. We therefore undertook this
IRB approved analysis of the incidence and clinical significance of newly
detected, focally increased bone activity in patients presenting for PET/CT
imaging for treatment strategy.
Method and Materials: Reports of 938 PET/CT scans were reviewed for
any focally increased FDG activity in bones. 57 patients were found to have
focal FDG avid bone abnormalities that were included in our study. Reports
reflecting this abnormal finding, with available follow up to explain such
finding were included in this investigation. Patients with previously known
bone metastases, and patients with significant diffuse bone marrow uptake
that precluded evaluation for focally abnormal activity, were excluded.
The presence or absence of corresponding CT abnormality in the area of
focally increased activity was also noted. Final diagnoses were based on
biopsy and/or follow up imaging.
Results: Of the 57 included patients, 21 had no corresponding CT
abnormalities: only 4 had nonmalignant causes, and all other were
true positive for malignant pathology. There were 26 patients with corre-
sponding CT abnormalities; of these, 23 had lytic changes, 8 patients had
sclerotic changes, and 5 patients had mixed lytic-sclerotic changes and only
6 of these lesions were found to be secondary to nonmalignant causes.
Conclusion: Foci of FDG uptake overlying bone structures are highly
predictive of metastatic disease when associated with bone changes on
low dose CT scan. However, as PET can detect metabolic changes earlier
than morphological changes are apparent on CT scan, a considerable num-
ber of such lesions represents malignant disease and further imaging or
pathological confirmation is warranted.
Imaging Parkinson’s Disease: Role of DAT Scan
T Yahya,1
RS Rao,1
MT Didea,1
RM Moadel,1
KJ Chun,1
and LM Freeman.1
1
Department of Radiology, Division of Nuclear Medicine, Montefiore
Medical Center, Bronx, NY
Background: Parkinson’s disease is the second most common neurodegen-
erative disorder and most common parkinsonian syndrome. Diagnosis of
Parkinson’s disease is based on clinical signs and the patients classically
present with tremor, bradykinesia and rigidity. However early in the course
of disease it can be difficult to differentiate it from benign essential tremor
and atypical presentations can pose diagnostic challenge. DAT scan (Ioflupane
iodine 123) was approved in 2011 to aid clinicians to visualize the Dopa-
mine Transporter (DAT) function in the striatum with the use of SPECT
brain imaging.
Objective: To discuss the 1) Pathophysiology of Parkinson’s disease
and role of DAT scan in its management 2) Image acquision, interpre-
tation and grading of the nigrostriatal degeneration 3) Case series from
our institution 4) Imaging Parkinson’s disease-future perspective.
Preclinical Study on PET Imaging of Adoptively Transferred
Chimeric Antigen T Cells and Their Localization in Tumors
Y Vedvyas,1,3
E Shevlin,1
A Amor-Coarasa,1
T Smith,1
S Park,1,3
M Zaman,1
S Park,1
IM Min,2
S Law,1
R Ting,1
J Babich,1
and MM Jin.1,2,3
1
Molecular Imaging Innovations Institute, Department of Radiol-
ogy, 2
Department of Surgery, Weill Cornell Medicine, New York,
NY 10065, 3
Department of Biomedical Engineering, Cornell Uni-
versity, Ithaca, NY 14850
Abstract: inability to determine the distribution and activity of adoptively
transferred t cells in the body presents a great barrier to advancement of
adoptive t cell therapy in cancer. accurate t cell imaging can be used
to predict either success or failure in t cell therapy, and to avoid sys-
temic toxicity and fatality by a timely intervention. for this purpose,
a variety of genetic reporters have been developed which are based
on intracellular enzymes (hsv thymidine kinase) and other cell surface
markers (nis, psma) along with pet tracers; however, no single reporter
marker has been widely adopted by an imaging community due to the
difficulty with finding genes that are non-immunogenic and dis-
play low-level expression in healthy tissues, and availability of suitable
imaging probes. herein, we present preclinical data using somatostatin
receptor 2 (sstr2) and radiolabeled somatostatin agonists (68
ga-dotatoc)
on pet detection of chimeric antigen receptor (car)-expressing t cells in
scid mice xenografted with human tumors. primary t cells were trans-
duced using a lentiviral vector with sstr2 and car, which displayed
antigen-specific tumor killing in vitro and in vivo. functional expression
of sstr2 was confirmed by flow cytometry and specific uptake of dotatoc,
which was inhibited by sstr2 agonists (octreotide, lanreotide). by titra-
tion of dotatoc, we determined that more than 100,000 molecules of sstr2
could be expressed in a single t cell. our pilot pet/ct imaging data con-
firmed the localization of t cells in car-specific tumor as well as t cell
homing to lymphoid organs. we present preliminary evidence that our
imaging system can be used for detection of car t cell distribution and
may greatly impact t cell immunotherapy.
Variations in Hepatic Distribution of Y-90 SIRT Compared to
Pre-treatment Tc99m MAA
J Kikut,1
C Ford,1
LM Schenck,1
A Bhave,1
J Shields,1
A Kikut,2
S Reynolds,1
and M Moore.1
1
University of Vermont, 2
Dartmouth College
Introduction: Selective internal radiation therapy (SIRT) delivers Yttrium-
90 (Y-90) microspheres into the hepatic artery. Treatment planning scintig-
raphy is performed using Tc-99 m MAA to evaluate for potential non-target
embolization, lung shunt fraction, and assessment of Planned Treatment
Volume (PTV) for dose calculations. Variations in the hepatic distribution
of SIRT from PTV can occur. We evaluated how the surrogate MAA based
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2 www.nuclearmed.com © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. This paper can be cited
using the date of access and the unique DOI number which can be found in the footnotes.

3. PTV approximated the Treated Liver Volume on Bremsstrahlung SPECT
(TLV-Y90).
Methods: 16 SIR-spheres (1 HCC, 11 colon, 4 NET) and 13 TheraSphere
treatments (12 HCC, 1 NET) were retrospectively reviewed. Subjective scor-
ing was used to compare TLV-Y90 to PTV:
• 0 - matching
• 1 - matching with varying heterogeneity
• 2 – non-matching, TLV-Y90 smaller
• 3 – non-matching, TLV-90 larger
Results: Y90 scans appeared similar or more homogenous compared
to Tc99m MAA, which was attributed to lower resolution inherent to
Bremsstrahlung. All TheraSphere cases showed matched TVL-Y90
to PTV. 4 (25%) of SIR-sphere treatments TLV-Y90 did not match PTV.
Conclusion: A sizable difference in treated liver volume compared to
treatment planning scan was seen in 25% of the SIR-sphere cases. Our
retrospective review supports recommendations for post-treatment im-
aging with both products and suggests mandated post-treatment imaging
after SIR-spheres therapies.
Score TheraSphere n = 13 SIR-sphere n = 16
0 7 (53%) 2 (12.5%)
1 6 (47%) 10 (62.5%)
2 0 3 (19%)
3 0 1 (6%)
Clinical Nuclear Medicine • Volume 00, Number 00, Month 2016 Abstracts
© 2016 Wolters Kluwer Health, Inc. All rights reserved. www.nuclearmed.com 3
Copyright © 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. This paper can be cited
using the date of access and the unique DOI number which can be found in the footnotes.