Východiska: Pozitronová emisní tomografie (PET) je moderní diagnostickou metodou z oboru nukleární medicíny, která je používaná k diagnostice různých patologických stavů organizmu, především pak v onkologii. První analýza využití a potenciálního využití PET v ČR byla publikována v roce 2013. V následujících letech došlo ke skokovému nárůstu počtu PET/CT a PET/MRI kamer v ČR, mezi lety 2013–2021 na dvojnásobek. Ruku v ruce s narůstajícím počtem vyšetření se rozšiřovala také škála v ČR dostupných registrovaných radiofarmak. Materiál a metody: Studie analyzuje počet a skladbu výkonů PET, PET/CT a PET/MRI v letech 2013–2021 s použitím pseudonymizovaných dat získaných z Všeobecné zdravotní pojišťovny ČR, extrapolovaných na celou populaci ČR. Data byla vyhodnocena podle řady zvolených kvalitativních a kvantitativních ukazatelů (počet vyšetření, rozložení diagnóz, využití různých radiofarmak, dostupnost vyšetření). Výsledky: Ve sledovaném období došlo k praktickému zdvojnásobení počtu prováděných výkonů, a to jak díky zvýšení počtu instalovaných kamer, tak rozšíření škály radiofarmak, která jsou k dispozici. Procentuální zastoupení onkologických a neonkologických výkonů v čase zůstává víceméně zachováno. Přetrvávají nicméně regionální rozdíly v počtu provedených vyšetření a s tím související dostupnosti péče. Závěr: Metoda PET je v ČR stále dynamicky se rozvíjející metodou molekulárního zobrazování. Analýza počtu a složení výkonů s využitím metody PET poskytuje cenný pohled na rozvoj této metody v ČR jak v rovině časové, tak v rovině diagnóz, využití radiofarmak či geografického rozdělení výkonů. Zjištěné skutečnosti jsou motivací k dalším analýzám.

Background: Positron emission tomography (PET) is a state-of-the-art diagnostic method of nuclear medicine, used for diagnostics of many pathological states in the organism, first and foremost in oncological issues. The first analysis of utilization and potential utilization of PET in the Czech Republic was published in 2013. In the following years, there was a sharp increase in a number of PET/CT and PET/MRI scanners in the country; in 2013–2021, it doubled. Simultaneously with the increase in scans performed, the range of available radiopharmaceuticals also broadened. Material and methods: The study analyses the numbers and structure of PET, PET/CT and PET/MRI scans in the 2013–2021 period, using the pseudonymized data acquired from the General Health Insurance Company of the Czech Republic. The data was evaluated through a series of qualitative and quantitative indicators (number of scans performed, structure of diagnoses, use of different tracers, and availability of a scan for a patient). Results: In the observed interval of time, the number of scans performed practically doubled, both thanks to more scanners installed and more radiopharmaceuticals available. The percentage of oncological and non-oncological scans remains more or less the same. Nevertheless, the regional differences in a number of scans performed persist, as does the availability of the scan for patients. Conclusion: PET is still a dynamically developing molecular imaging method in the Czech Republic. The analysis of a number and structure of scans performed offers a priceless overview of the development of the method over the years, in regard to diagnoses, utilization of individual radiopharmaceuticals or geographic distribution of scans performed. The observed findings are a motivation for further analyses.

• MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   MeSH
• Positron Emission Tomography Computed Tomography methods   MeSH
• Positron-Emission Tomography * methods   statistics & numerical data   MeSH
• Radiopharmaceuticals MeSH
• Check Tag
• Humans MeSH
• Publication type
• Clinical Study MeSH
• Geographicals
• Czech Republic MeSH

Existence cyklotronu a PET centra ÚJV Řež, a.s., v Masarykově onkologickém ústavu umožňuje výzkumníkům z RECAMO a Masarykova onkologického ústavu zapojit se do výzkumu, vývoje a využití nových radiofarmak včetně látek označených krátce žijícími pozitronovými zářiči (zejména [11C]). V současnosti zde vstupuje do I. fáze klinického hodnocení [11C]-značený tracer L-[methyl-11C]methionin a na oddělení nukleární medicíny jsou prováděny skeny s jinými PET radiofarmaky než fluordeoxyglukózou. Spolupráce by měla pokračovat i nadále a v budoucnu vyústit ve zpřístupnění více možností pro PET zobrazování v České republice.

The existence of the cyclotron & PET centre of ÚJV Řež, a.s., at Masaryk Memorial Cancer Institute allows the Masaryk Memorial Cancer Institute and RECAMO researchers to engage in the research, development and application of new radiopharmaceuticals including compounds labelled by short-living positron emitters (especially [11C]). Currently, a [11C]-labelled tracer, L-[methyl-11C]methionine, is entering phase I clinical evaluation, and scans with PET radiopharmaceuticals other than fluorodeoxyglucose are performed at the Department of Nuclear Medicine. Continued cooperation will bring new possibilities for PET in the Czech Republic in the future.

• Keywords
• L-[methyl-11C]methionin, [18F]fluorid sodný, [18F]fluorocholin, 3‘-deoxy-3‘[18F]fluorothymidin,
• MeSH
• Choline analogs & derivatives   diagnostic use   MeSH
• Dideoxynucleosides diagnostic use   MeSH
• Sodium Fluoride diagnostic use   MeSH
• Humans MeSH
• Methionine diagnostic use   MeSH
• Neoplasms * MeSH
• Positron-Emission Tomography * methods   MeSH
• Radiopharmaceuticals * diagnostic use   MeSH
• Fluorine Radioisotopes diagnostic use   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

Východiska: V Masarykově onkologickém ústavu v Brně (MOÚ) se za spolupráce projektu RECAMO s aplikační sférou v posledních letech intenzivně pracuje na klinických hodnoceních moderních PET radiofarmak vedoucích k jejich budoucímu zpřístupnění pro české lékaře a jejich pacienty. Na základě této spolupráce byla v uplynulých letech vyvinuta mimo jiné radiofarmaka [11C]methionin či [18F]fluorocholin, látky s důležitým uplatněním v onkologické diagnostice pomocí PET. [11C]methionin, značený izotopem uhlíku-11 s poločasem přeměny 20 min, je markerem proteosyntézy, sloužícím v drtivé většině k vizualizaci mozkových tumorů, zatímco [18F]fluorocholin, značený izotopem fluoru-18 s poločasem přeměny 109 min, je markerem syntézy buněčných membrán a proliferace, jehož největší využití spočívá v PET diagnostice karcinomu prostaty. Cíl: Pomocí výsledků získaných provedením klinických hodnocení PET radiofarmak ve spolupráci MOÚ a RECAMO s výrobcem radiofarmak na základě předem dohodnutých a schválených parametrů má být demonstrována účinnost a vhodnost těchto látek k onkologické PET diagnostice daných tumorů. V obou případech byla radiofarmaka hodnocena ve vztahu k jejich majoritnímu využití. Závěr: Výsledky získané v rámci těchto klinických hodnocení prokazují přínos a efektivitu obou látek v PET diagnostice příslušných nádorů. V podobě souhrnných zpráv z klinického hodnocení budou výsledky využity v aplikační sféře coby součást dokumentace potřebné k registraci daného radiofarmaka pro používání v České republice.

Background: In Masaryk Memorial Cancer Institute (MMCI), there is a long-running intensive joint effort of the RECAMO project and commercial entities, involving mainly clinical evaluations of state-of-the-art PET radiopharmaceuticals leading to their future availability for Czech physicians and their patients. Recently, the PET tracers [11C]methionine and [18F]fluorocholine, among others, were developed in this cooperation, both of them tracers with high importance for oncologic positron emission tomography diagnostics. [11C]methionine, labeled by carbon-11 with a half-life of 20 min, is a proteosynthesis marker used primarily for brain tumor visualization, whereas [18F]fluorocholine, labeled by fluorine-18 with a half-life of 109 min, is a marker of synthesis of cellular membranes and cell proliferation, its primary use being PET diagnostics of prostate carcinoma. Aim: The results of clinical evaluations of both PET radiopharmaceuticals, performed on the basis of parameters agreed and approved beforehand in cooperation of MMCI, RECAMO and the manufacturer of said radiopharmaceuticals, aimed to prove the efficiency and suitability of both compounds for oncologic PET diagnostics for said tumors. In both cases, the radiopharmaceuticals were evaluated in regard to their major use. Conclusion: The obtained results prove the benefits and efficiency of both compounds in PET diagnostics of respective tumors. The results, in the form of clinical evaluation reports, will be used as part of the documentation required for marketing authorization of these compounds for use in the Czech Republic.

• Keywords
• projekt RECAMO,
• MeSH
• Choline analogs & derivatives   chemical synthesis   therapeutic use   MeSH
• Clinical Trials as Topic methods   MeSH
• Humans MeSH
• Methionine analogs & derivatives   chemical synthesis   therapeutic use   MeSH
• Brain Neoplasms diagnosis   radiography   MeSH
• Prostatic Neoplasms diagnosis   MeSH
• Positron-Emission Tomography methods   utilization   MeSH
• Radiopharmaceuticals * classification   therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

PURPOSE OF REVIEW: The aim of this study was to summarize the available evidence on different PET imaging modalities for the staging of patients diagnosed with bladder cancer (BCa). We further discuss the use of PET/computed tomography (CT) and PET/MRI with different radiopharmaceuticals to characterize tumour biology for treatment guidance. RECENT FINDINGS: Available evidence supports the benefits of PET/CT in BCa staging due to its higher accuracy in the detection of nodal metastases compared with CT alone. The use of PET/MRI is of major future interest due to the higher soft tissue contrast of MRI, which might enable the early detection of the tumour in the bladder. For the time being, the sensitivity of PET/MRI is still too low, when it comes to the diagnosis of early-stage BCa. This is mainly due to the renal excretion of the commonly used [ 18 F]FDG PET tracer, wherefore small lesions in the wall of the bladder can be missed. Novel studies using PET radiopharmaceuticals to target immune checkpoints or other immune cell targets (immunoPET) demonstrated high uptake in tumour lesions with high PD-L1 expression. The use of immunoPET could therefore help identify BCa patients who exhibit PD-L1 positive tumours for systemic immune-therapy. SUMMARY: PET/CT and PET/MRI seem to be promising imaging tools in BCa staging, especially for the detection of lymph node and distant metastases, as they are more accurate than conventional CT. Future clinical trials with novel radiopharmaceuticals and machine-learning driven PET-technologies bear the potential to help in the early detection, staging, monitoring and precision-medicine approach. Specifically, immunoPET is of high future interest, as it could help develop the concept of precision-medicine in the age of immunotherapy.

• MeSH
• B7-H1 Antigen MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Urinary Bladder Neoplasms * diagnostic imaging   therapy   pathology   MeSH
• Positron Emission Tomography Computed Tomography MeSH
• Positron-Emission Tomography methods   MeSH
• Radiopharmaceuticals * MeSH
• Sensitivity and Specificity MeSH
• Neoplasm Staging MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

When a patient is examined by positron emission tomography (PET), radiotracer dose amount (activity) has to be determined. However, the rules for activity correction according to patients' weight used nowadays do not correspond with practical experience. Very high image quality is achieved for slim patients, whereas noisy images are produced for obese patients. There is opportunity to modify the correction rule with the aim to equalize image quality within the broad spectrum of patients and to diminish radiation risk to slim patients, with special importance for children. We have built a model of a particular PET scanner and approximated human trunk, which is our region of interest, by a cylindrical model with segments of liver, outer adipose tissue, and the rest. We have performed Monte Carlo simulations of PET imaging using the GATE simulation package. Under reasonably simplifying assumptions and for special parameters, we have developed curves that recommend amount of injected activity based on body parameters to give PET images of constant quality, the quality being expressed in terms of noise equivalent counts. The dependence qualitatively differs from the rules used in clinical practice nowadays, and the results indicate potential for improvement.

• MeSH
• Models, Biological MeSH
• Radiation Dosage * MeSH
• Phantoms, Imaging MeSH
• Body Mass Index MeSH
• Humans MeSH
• Monte Carlo Method * MeSH
• Tomography, X-Ray Computed MeSH
• Computer Simulation MeSH
• Image Processing, Computer-Assisted MeSH
• Positron-Emission Tomography methods   MeSH
• Radioactive Tracers MeSH
• Torso physiology   radiography   MeSH
• Body Size physiology   MeSH
• Drug Dosage Calculations * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

The σ-1 receptor is a non-opioid transmembrane protein involved in various human pathologies including neurodegenerative diseases, inflammation, and cancer. The previously published ligand [18 F]FTC-146 is among the most promising tools for σ-1 molecular imaging by positron emission tomography (PET), with a potential for application in clinical diagnostics and research. However, the published six- or four-step synthesis of the tosyl ester precursor for its radiosynthesis is complicated and time-consuming. Herein, we present a simple one-step precursor synthesis followed by a one-step fluorine-18 labeling procedure that streamlines the preparation of [18 F]FTC-146. Instead of a tosyl-based precursor, we developed a one-step synthesis of the precursor analog AM-16 containing a chloride leaving group for the SN 2 reaction with 18 F-fluoride. 18 F-fluorination of AM-16 led to a moderate decay-corrected radiochemical yield (RCY = 7.5%) with molar activity (Am ) of 45.9 GBq/μmol. Further optimization of this procedure should enable routine radiopharmaceutical production of this promising PET tracer.

• MeSH
• Azepines MeSH
• Benzothiazoles MeSH
• Humans MeSH
• Positron-Emission Tomography * methods   MeSH
• Radiopharmaceuticals MeSH
• Fluorine Radioisotopes chemistry   MeSH
• Sigma-1 Receptor * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

In recent years, several radioligands targeting prostate-specific membrane antigen (PSMA) have been clinically introduced as a new class of theranostic radiopharmaceuticals for the treatment of prostate cancer (PC). In the second decade of the 21(st) century, a new era in nuclear medicine was initiated by the clinical introduction of small-molecule PSMA inhibitor radioligands, 40 y after the clinical introduction of (18)F-FDG. Because of the high incidence and mortality of PC, the new PSMA radioligands have already had a remarkable impact on the clinical management of PC. For the continuing clinical development and long-term success of theranostic agents, designing modern prospective clinical trials in theranostic nuclear medicine is essential. First-in-human studies with PSMA radioligands derived from small-molecule PSMA inhibitors showed highly sensitive imaging of PSMA-positive PC by means of PET and SPECT as well as a dramatic response of metastatic castration-resistant PC after PSMA radioligand therapy. This tremendous success logically led to the initiation of prospective clinical trials with several PSMA radioligands. Meanwhile, MIP-1404, PSMA-11, 2-(3-{1-carboxy-5-[(6-fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (DCFPyL), PSMA-617, PSMA-1007, and others have entered or will enter prospective clinical trials soon in several countries. The significance becomes apparent by, for example, the considerable increase in the number of publications about PSMA-targeted PET imaging from 2013 to 2016 (e.g., a search of the Web of Science for "PSMA" AND "PET" found only 19 publications in 2013 but 218 in 2016). Closer examination of the initial success of PC treatment with PSMA inhibitor radiotracers leads to several questions from the basic research perspective as well as from the perspective of clinical demands: What lessons have been learned regarding the design of PSMA radioligands that have already been developed? Has an acceptable compromise between optimal PSMA radioligand design and a broad range of clinical demands been reached? Can the lessons learned from multiple successes within the PSMA experience be transferred to further theranostic approaches?

• MeSH
• Antigens, Surface MeSH
• Diagnosis * MeSH
• Glutamate Carboxypeptidase II antagonists & inhibitors   MeSH
• Humans MeSH
• Urea chemistry   pharmacology   therapeutic use   MeSH
• Molecular Weight MeSH
• Drug Discovery methods   MeSH
• Radioactive Tracers MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Syndrom Schnitzlerové je velmi vzácná autoinflamatorní choroba manifestující se v dospělosti. Hlavními znaky je chronická urtika a příznaky systémové zánětlivé reakce (horečka, artralgie, bolesti kostí) a monoklonální imunoglobulin typu IgM (M-IgM) vzácně IgG. Do analýzy jsme zařadili našich šest pacientů se syndromem Schnitzlerové, kteří splnili Štrasburská kritéria nemoci a jsou léčeni od roku 2007 do 2021. Medián věku pacientů (5 mužů 1 žena) v době stanovení diagnózy byl 54 (45–67) let. Medián sledování je 8 (3–14) roků. Všech šest pacientů mělo M-IgM, bolesti kloubů anebo bolesti kostí, zvýšenou hodnotu sedimentace erytrocytů a CRP, čtyři měli horečky, tři měli leukocytózu ≥ 10 × 109/l, lymfadenopatii měl jen jeden pacient. Pro detekci osteosklerotických změn, jednoho z kritérií této nemoci, jsme použili u 5 pacientů18FDG-PET/CT, u jednoho pacienta Na18F-PET/CT vždy s low-dose CT vyšetřením celého těla. Všichni pacienti měli při zobrazení metodou low-dose CT zřetelná osteosklerotická neboli hyperostotická kostní ložiska. Akumulace 18FDG byla mírně zvýšená v kostní dřeni pánve a femurů, zatímco akumulace Na18F byla výrazná právě v osteosklerotických ložiscích. Zobrazení pomocí Na18F-PET/CT je více senzitivní pro detekci osteosklerotických ložisek než 18FDG-PET/CT. Všichni pacienti byli a jsou léčeni anakinrou bez jakýchkoliv nežádoucích účinků, s excelentními výsledky – kompletním vymizením urtiky a dalších symptomů, aniž by se po letech léčby její účinek zmenšoval. IgM-MGUS se transformoval do Waldenströmovy makroglobulinemie (WM) u dvou pacientů, ale zatím pouze u jednoho se jednalo o symptomatickou WM, pro jejíž léčbu byla použita kombinace RBD (rituximab, bendamustin, dexametazon). Léčba docílila téměř úplné vymizení M-IgM a zároveň poklesla intenzita projevů syndromu Schnitzlerové, takže bylo možné protáhnout intervaly mezi aplikací anakinry z 24 na 48 hodin. U pacientů se syndromem Schnitzlerové je nutné sledovat vývoj M-IgM a v případě transformace do symptomatické WM včas podat účinnou léčbu, obvykle kombinaci rituximabu a chemoterapii s cílem dosáhnout kompletní hematologické odpovědi a snížení intenzity příznaků syndromu Schnitzlerov

Transformation of IgM-MGUS into Waldenström´s macroglobulinemia in two of six patients treated for Schnitzler´s syndrome Schnitzler´s syndrome is a very rare, adult-onset, apparently acquired autoinflammatory disease. Chronic urticarial rash and symptoms of systemic inflammation including fever, arthralgia and bone pain with the presence of monoclonal immunoglobulin M (IgM), rarely IgG, are among hallmarks of the disease. We performed a retrospective study of 6 patients (5 men, 1 woman) diagnosed with Schnitzler´s syndrome fulfilling the Strasbourg criteria who had been treated at our centre in the University Hospital Brno from 2007 to 2021. Median age at diagnosis was 54 (45–67) years, median follow up was 8 (3–14) years. All 6 patients had IgM κ monoclonal gammopathy, increased CRP and/or erythrocyte sedimentation rate and arthralgia or bone pain, 4 patients suffered from fever, three had leucocytosis ≥ 10 × 109/L and lymphadenopathy was found in one patient. 18FDG-PET/CT scan with low-dose total body CT became a part of the initial baseline assessment in 5 patients with suspected Schnitzler´s syndrome, while Na18F-PET/CT was used in one patient to confirm the presence of osteosclerotic leasions as a criterion of the disease. All patients had osteosclerotic or hyperostotic bone lesions detected by low-dose CT examination, with increased 18FDG uptake in illiac and femoral bone marrow. The patient with Na18F-PET/CT scan revealed intensive abnormal tracer uptake with Na18F-PET/CT being more sensitive for detection of osteosclerotic lesions in Schnitzler´s syndrome than 18FDG-PET/CT. All patients were treated with daily subcutaneous anakinra without any adverse events, with excellent clinical results. We observed complete disappearance of urticaria and other symptoms persisting during years of anakinra administration. IgM-MGUS transformed into Waldenström´s macroglobulinemia in two of six patients, but only one patient developed symptoms requiring RBD (Rituximab, Bendamustin, and Dexamethasone) treatment, which induced almost complete remission of the disease. Successful RBD therapy enabled to prolong intervals of maintenance anakinra from 24 to 48 hours with almost complete control of urticarial rash and other symptoms. We suggest close monitoring of patients with Schnitzler´s syndrome to early capture potential transformation into Waldenström´s macroglobulinemia with succesful treatment of both conditions.

• MeSH
• Interleukin 1 Receptor Antagonist Protein administration & dosage   therapeutic use   MeSH
• Immunoglobulin M analysis   adverse effects   MeSH
• Clinical Trials as Topic MeSH
• Middle Aged MeSH
• Humans MeSH
• Positron Emission Tomography Computed Tomography MeSH
• Aged MeSH
• Schnitzler Syndrome * diagnosis   drug therapy   pathology   MeSH
• Bone Marrow Examination MeSH
• Rare Diseases MeSH
• Waldenstrom Macroglobulinemia * diagnosis   drug therapy   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH

Invasive fungal infections have become a major challenge for public health, mainly due to the growing numbers of immunocompromised patients, with high morbidity and mortality. Currently, conventional imaging modalities such as computed tomography and magnetic resonance imaging contribute largely to the noninvasive diagnosis and treatment evaluation of those infections. These techniques, however, often fall short when a fast, noninvasive and specific diagnosis of fungal infection is necessary. Molecular imaging, especially using nuclear medicine-based techniques, aims to develop fungal-specific radiotracers that can be tested in preclinical models and eventually translated to human applications. In the last few decades, multiple radioligands have been developed and tested as potential fungal-specific tracers. These include radiolabeled peptides, antifungal drugs, siderophores, fungal-specific antibodies, and sugars. In this review, we provide an overview of the pros and cons of the available radiotracers. We also address the future prospects of fungal-specific imaging.

• MeSH
• Antifungal Agents therapeutic use   MeSH
• Invasive Fungal Infections * MeSH
• Humans MeSH
• Mycoses * diagnostic imaging   MeSH
• Tomography, X-Ray Computed MeSH
• Positron-Emission Tomography methods   MeSH
• Antibodies, Fungal MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH
• Research Support, N.I.H., Intramural MeSH

• MeSH
• Molecular Imaging MeSH
• Neurodegenerative Diseases MeSH
• Nuclear Medicine MeSH
• Publication type
• Collected Work MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• molekulární biologie, molekulární medicína
• radiologie, nukleární medicína a zobrazovací metody
• neurologie