Lucia Leccisotti

Fondazione Policlinico Universitario Agostino Gemelli IRCCS

Aims Recovery of cardiovascular diagnostic testing in Italy after the coronavirus disease-2019 (COVID-19) pandemic has not been quantified. The study aims to describe cardiac diagnostic procedure volumes, centres practice and protocols, and staff members’ well-being 1 year after COVID-19 outbreak in Italy. Methods and results A global survey was c...

A 61-year-old man underwent splenopancreasectomy for a 3-cm neuroendocrine tumor of the body of the pancreas (G2, pT1 pN0, Ki67 3%). Five months after surgery ⁶⁸ Ga-DOTATOC PET/CT showed increased radiotracer uptake in a solid tissue of the splenic fossa, possibly referring to a splenosis nodule. After 19 months, a further ⁶⁸ Ga-DOTATOC PET/CT show...

Introduction & Objective: Cardiovascular (CV) outcome trials have shown that in patients with type 2 diabetes (T2D), treatment with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) reduces CV mortality for heart failure. We demonstrated that 4-weeks-treatment with SGLT-2i leads to a 30% increase in coronary flow reserve (CFR) in T2D people with...

The role of fibroblast activation protein inhibitor (FAPI) positron emission tomography/computed tomography (PET/CT) is emerging for the assessment of non-oncological diseases, such as inflammatory and infectious diseases, even if the evidence in the literature is still in its initial phases. We conducted a systematic search of Scopus, PubMed/MEDLI...

Purpose Patients with fever and inflammation of unknown origin (FUO/IUO) are clinically challenging due to variable clinical presentations with nonspecific symptoms and many differential diagnoses. Positron emission tomography/computed tomography (PET/CT) with 2-deoxy-2-[¹⁸F]fluoro-D-glucose ([¹⁸F]FDG) is increasingly used in FUO and IUO, but the o...

(1) Background: In 90Y-TARE treatments, lung-absorbed doses should be calculated according to the manufacturer’s instructions, using the MIRD-scheme. This scheme is derived from the assumption that 90Y-microspheres deliver the dose in a water-equivalent medium. Since the density of the lungs is quite different from that of the liver, the absorbed d...

Objective We recently demonstrated that treatment with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) leads to an increase in myocardial flow reserve in patients with type 2 diabetes (T2D) with stable coronary artery disease (CAD). The mechanism by which this occurs is, however, unclear. One of the risk factors for cardiovascular disease is in...

To prospectively compare changes in myocardial blood flow (MBF) and myocardial flow reserve (MFR) in multivessel coronary artery disease (MVCAD) patients undergoing incomplete revascularization (IR) versus complete revascularization (CR) by coronary artery bypass grafting (CABG). Seven male patients (age 68 ± 9 years) with MVCAD underwent myocardia...

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have shown controversial results in modulating plasma lipids in clinical trials. Most studies found slight increases in high-density lipoprotein (HDL) cholesterol but few have provided evidence on HDL functionality with disappointing results. However, there is broad agreement that these drugs provid...

Objective: We recently demonstrated that treatment with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) leads to an increase in myocardial flow reserve in patients with type 2 diabetes (T2D) with stable coronary artery disease (CAD). The mechanism by which this occurs is, however, unclear. One of the risk factors for cardiovascular disease is i...

Cardiac sarcoidosis (CS), with either extracardiac involvement or in isolation, is increasingly recognized. Complications from cardiac involvement are the leading cause of death in patients with sarcoidosis, rendering early detection extremely important given the significant therapeutic and prognostic implications. However, the diagnosis of CS rema...

Purpose to prospectively compare changes in myocardial blood flow (MBF) and myocardial flow reserve (MFR) in multivessel coronary artery disease (MVCAD) patients undergoing incomplete revascularization (IR) versus complete revascularization (CR) by coronary artery bypass grafting (CABG). Methods Seven male patients (age 68 ± 9 years) with MVCAD, u...

A 71-year-old woman with multi-organ involvement due to Erdheim–Chester disease (ECD) was admitted to our ward for a diagnostic workup. On clinical examination, she reported dyspnoea on exertion, weakness, long bone pain, and exophthalmos. Magnetic resonance imaging (MRI) reported a right-side, retro-orbital mass (Panel A, black arrows), positive,...

Cardiac sarcoidosis (CS), with either extracardiac involvement or in isolation, is increasingly recognized. Complications from cardiac involvement are the leading cause of death in patients with sarcoidosis, rendering early detection extremely important given the significant therapeutic and prognostic implications. However, the diagnosis of CS rema...

Objective Cardiovascular (CV) outcome trials have shown that in patients with type 2 diabetes (T2D), treatment with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) reduces CV mortality and admission rates for heart failure (HF). However, the mechanisms behind these benefits are not fully understood. This study was performed to investigate the e...

Objective Cardiovascular (CV) outcome trials have shown that in patients with type 2 diabetes (T2D), treatment with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) reduces CV mortality and hospital admission rates for heart failure (HF). However, the mechanisms behind these benefits are not fully understood. This study was performed to investig...

Advanced imaging techniques are needed to help clinicians in the diagnosis, in the choice of the right time for therapeutic interventions or for modifications and monitoring of treatment response in patients with autoimmune connective tissue diseases. Nuclear medicine imaging, especially PET/CT and PET/MRI, may play an important role in detecting d...

Purpose Asymptomatic patients with follicular lymphoma (FL) and a low tumour burden can be followed without initial therapy, a strategy called watchful waiting (WW). Prediction of the time to treatment (TTT) is still a challenge. We investigated the prognostic value of baseline total metabolic tumour volume (TMTV) and whole-body total lesion glycol...

Background The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown. Objectives The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care...

Purpose To investigate whether the COVID-19 pandemic and national lockdown had an impact on the extent of cancer disease at FDG PET/CT staging as surrogate marker. Methods Retrospective observational study including cancer patients submitted to FDG PET/CT staging from June 1 to October 31, 2020, and June 1 to October 31, 2019, respectively. Data r...

Funding Acknowledgements Type of funding sources: None. Background Coronary microvascular dysfunction (CMD) occurs before left ventricular hypertrophy (LVH) in Anderson Fabry Disease (AFD). Few data exist about the role of CMD in Fabry cardiomyopathy, when overt LVH has already established. Purpose Aim of our study was to assess the relationship...

Background The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagn...

Purpose: To investigate whether the COVID-19 pandemic and national lockdown had an impact on the extent of cancer disease at staging using FDG PET/CT as surrogate marker. Methods: Retrospective observational study including cancer patients submitted to FDG PET/CT for staging purposes from June 1 to October 31, 2020, and June 1 to October 31, 2021,...

Diagnosis of infective endocarditis can be challenging for clinicians, especially when involving prosthetic valves. Recent data suggest that ¹⁸ F-fluorodeoxyglucose positron emission tomography/computed tomography ( ¹⁸ F-FDG PET/CT) could be a useful diagnostic tool in this setting. Here, we report a case of a patient with an aortic biological pros...

Background Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (UA) are caused often by destabilization of non-flow limiting inflamed coronary artery plaques. ¹⁸ F-fluorodeoxyglucose (FDG) uptake with positron emission tomography/computed tomography (PET/CT) reveals plaque inflammation, while intracoronary optical coherence tomograp...

We report the case of a 72-year-old woman who underwent neoadjuvant chemotherapy, right quadrantectomy (invasive ductal carcinoma, G3, pT2pN1pMx), and adjuvant radiotherapy. Two years later, a follow-up CT revealed a hepatic nodule of approximately 1 cm suspected for metastasis. 18F-FDG PET/CT was performed for restaging. Standard total-body 18F-FD...

Impact of COVID-19 on Cardiovascular Testing in the United States Versus the Rest of the World

Objectives This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardi...

Introduction: Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have been shown to have beneficial effects on various cardiovascular (CV) outcomes in patients with type 2 diabetes (T2D) in primary prevention and in those with a high CV risk profile. However, the mechanism(s) responsible for these CV benefits remain elusive and unexplained. The a...

Objectives This study sought to describe worldwide variations in the use of myocardial perfusion imaging hardware, software, and imaging protocols and their impact on radiation effective dose (ED). Background Concerns about long-term effects of ionizing radiation have prompted efforts to identify strategies for dose optimization in myocardial perf...

The clinical use of myocardial perfusion imaging (MPI) with positron emission tomography (PET) has grown significantly over the past decade with the increased availability of PET scanners and radiotracers. Compared to Rubidium-82 and Fluorine 18-labeled agents, the use of ¹³N-ammonia (ammonia) is limited to Centers with on-site cyclotron and radioc...

The modern personalized medicine approaches in oncology deal with a huge and barely manageable number of patient-specific variables, from genetic data to simple blood tests, trying to ensure a fully individualized and tailored therapy.

Objectives This study sought to establish worldwide and regional diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Background Reference levels serve as radiation dose benchmarks to compare individual laboratories against aggreg...

A 68-year-old woman with a history of multiple myeloma on regular hematological follow-up and with no previous relevant gynecological diseases was found to have an incidental focal uptake by the right ovary at C-methionine PET/CT (C-MET). Transvaginal ultrasound was then performed showing a 2-cm solid right ovarian mass with irregular borders and m...

Background 18-FDG PET/CT is a functional imaging method which allows to identify inflammation of vessel walls. The use of PET in large vessels vasculitis(LVV) at disease onset and during follow up is still debate either to confirm clinical remission either to drive the therapy choice. American Society of Nuclear Cardiology (ASNC) recently advanced...

AimThis mini-review aims to analyse the diagnostic performance and the prognostic role of FDG PET/CT performed at staging in anal cancer patients by the analysis of published literature.Materials and methodsA comprehensive computer literature search of studies published on PubMed/Medline database in the last 10 years was carried out. Sensitivity an...

Purpose This mini-review aims to qualitatively analyze the diagnostic performance of FDG PET in patients with diagnosis or suspected large vessel vasculitis (LVV). The future perspectives of PET in this field are also described. Methods A comprehensive computer literature search of case–control studies published in PubMed/MEDLINE database in the l...

Objective We assessed the prognostic value of several FDG PET/CT parameters, measured within the primary tumor and the involved lymph nodes, before definitive radio-chemotherapy (RCT) in anal cancer patients. Methods Anal cancer patients with positive baseline FDG PET/CT who underwent definitive RCT from May 2011 to February 2018 were retrospectiv...

Aims: FDG PET/CT could be useful in the prognostic stratification of anal cancer patients. Therefore, we retrospectively assessed the prognostic value of FDG PET/CT parameters, including MTV and TLG measured within the primary tumour and the involved lymph nodes, before definitive RCT in anal cancer patients. Methods: Anal cancer patients with posi...

This chapter is designed to clarify the role of Nuclear Medicine in the clinical decision-making process of non-oncological diseases. It presents a number of typical cases referring to one or a group of diseases. Being diverse in scope, the cases provide relevant information on the usefulness of nuclear medicine examinations in clinical practice. I...

Purpose In the last years, the identification of vulnerable atherosclerotic plaques to prevent acute coronary events has been one of the main objectives of the cardiovascular science community. In this review, we provide an overview of vulnerable coronary artery plaque imaging by positron emission tomography (PET). Methods and results Relevant met...

We report the case of a 43-year-old man with a history of lung carcinoid and a recent detection of thyroid nodules by ultrasound. The cytological analysis raised the suspicion of medullary thyroid carcinoma; however, calcitonin and carcinoembryonic antigen levels were in reference range. Considering the previous diagnosis of lung carcinoid, the pat...

We report the case of a 65-year-old man referred to our department because of a complex coronary aneurysmal disease presenting as subacute ST-segment elevation myocardial infarction due to intraluminal thromboembolism. The patient's past medical history (recurrent episodes of lymphadenopathies, parotid swelling, prostatitis, and dacryoadenitis) rai...

The diagnostic work-up of locally advanced rectal cancer (LARC) has also changed thanks to recent advances in positron emission tomography-computed tomography (PET-CT) and its increasing availability. Several studies showed that FDG PET-CT accurately changed the stage with a subsequent alteration in therapy in almost one-third of patients. Moreover...

Purpose: The aim of this study was to investigate the relationship between whole-tumor CT perfusion and FDG PET/CT parameters in non-small cell lung cancer (NSCLC). Methods: Twenty-five patients with NSCLC were prospectively included. CT perfusion parameters calculated were blood flow (BF), blood volume (BV), mean transit time, and peak enhancem...

A 73-year-old woman had a diagnosis of a plasmablastic lymphoma by the excision of the right parotid gland. Two years after the diagnosis, the patient underwent a whole-body C-methionine PET/CT in order to evaluate the amino acid avidity of a scalp metastasis and for plasmablastic lymphoma restaging. C-methionine uptake was detected in the scalp, i...

Objectives: To correlate imaging parameters from baseline magnetic resonance imaging (MRI)-diffusion-weighted imaging (DWI) and -2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography-computed tomography (PET-CT) with synchronous and metachronous metastases in mucinous (MC) and nonmucinous (NMC) rectal cancer. Methods: 111 patients with e...

Until a few years ago, myocardial perfusion imaging (MPI) the combined use of positron-emission tomography (PET) and absolute quantification of myocardial blood flow (MBF) was limited to research institutions. Following an increase in the number of PET scanner installations and in the availability of perfusion tracers that do not have to be produce...

Study Design. Retrospective study. To evaluate, in a pediatric population, F-FDG metabolic activity of normal spinal cord and to assess the correlation with demographic, clinical and environmental variables. F-FDG uptake of normal spinal cord is variable in children. The knowledge of physiological metabolism of spinal cord is essential to distingui...

To evaluate whether metabolic changes in the primary tumour during and after preoperative radiochemotherapy (RCT) can predict the histopathological response in patients with locally advanced rectal cancer as well as disease-free survival (DFS) and overall survival (OS). Consecutive patients with cT2-4 N0-2 rectal adenocarcinoma were included. (18)F...

To verify the feasibility, in clinical practice, of three simplified methods (Hunter, Sadato and another one proposed by our group) to calculate Ki and MRglu of 18F-FDG, comparing the results with those derived by the linear regression (LR) method (considered the golden standard), and also with SUV. Forty-five patients (32males, mean age 69±9years)...

To develop and externally validate a predictive model for pathologic complete response (pCR) for locally advanced rectal cancer (LARC) based on clinical features and early sequential (18)F-FDG PETCT imaging. Prospective data (i.a. THUNDER trial) were used to train (N=112, MAASTRO Clinic) and validate (N=78, Università Cattolica del S. Cuore) the mo...

Positron emission tomography-computed tomography (PET-CT) with (18)F-fluorodeoxyglucose (FDG) has emerged as a rapidly evolving diagnostic tool for infectious diseases. However, the optimal imaging time in this clinical setting is not clear yet. The aim of this study is to investigate whether delayed (3 hours) FDG PET-CT could increase the diagnost...

We report the case of a 20-year-old woman with surgically corrected transposition of the great arteries, pulmonary valve defects, and absence of left coronary ostium at a previous cardiac catheterization. Because of worsening dyspnea, she underwent myocardial perfusion PET/CT study with N-ammonia at rest and during pharmacological stress, which sho...

Introduction: 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) plays a key role in oncology, and it is now being used increasingly to diagnose, characterize, and monitor disease activity in inflammatory disorders, including vasculitis. Unfortunately, its role in the management of vasculitis is still not wel...

We report the case of a 53-year-old man with a chronic periaortitis (CP) in whom Fluorine-18-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has been useful in assessing the disease extent at diagnosis, in evaluating the treatment response, in diagnosing the relapse, and in monitoring the disease activity during f...

Background: In 2007, sorafenib was the first drug able to improve overall survival in patients with advanced hepatocellular carcinoma. Aim: In 2005 we designed a phase II study to assess safety and efficacy of sunitinib. Methods: This is a single arm, open-label, single-centre phase II trial. Eligibility criteria were advanced hepatocellular c...

A 31-year-old woman presenting with acute abdomen underwent an emergency Hartmann's procedure for fecal peritonitis due to perforated adenocarcinoma of the left colon. Shortly after a 7-month course of adjuvant chemotherapy, follow-up contrast-enhanced CT showed multiple peritoneal and hepatic nodules, showing focal intense and homogeneous FDG upta...

The role of PET-CT imaging in head and neck squamous cell carcinoma during pre-treatment staging, radiotherapy planning, treatment response assessment and post-therapy follow-up is reviewed with focus on current evidence, controversial issues and future clinical applications. In staging, the role of (18)F-FDG PET-CT is well recognized for detecting...

Fluorine-18-fluorodeoxyglucose positron emission tomography/ computed tomography (FDG-PET/CT) performed for restaging in a 70-year-old male patient with history of plasma cell leukemia (PCL) showed increased symmetrical and asymmetrical fluorine-18-fluorodeoxyglucose (FDG) uptake in some muscular groups. Magnetic resonance imaging showed structural...

Background 18F-fluoro-deoxy-glucose (18 F-FDG) positron emission tomography integrated/combined with computed tomography (PET-CT) provides the best diagnostic results in the metabolic characterization of undetermined solid pulmonary nodules. The diagnostic performance of 18 F-FDG is similar for nodules measuring at least 1 cm and for larger masses,...

The aim of our study was to assess the feasibility and usefulness of 2-[(18)F]-fluoro-2-deoxy-D: -glucose positron emission tomography computed tomography ([(18)F]FDG-PET/CT) in patients affected by retroperitoneal fibrosis. We retrospectively evaluated 25 patients studied in two centers: 18 underwent [(18)F]FDG-PET/CT as initial evaluation, three...

Congenitally corrected transposition of great arteries (ccTGA) consists of both atrioventricular and ventriculo-arterial discordance. In patients with ccTGA, the pulmonary artery arises from the left ventricle, whereas the aorta arises from the right ventricle. The burden of the systemic blood pressure on the right ventricle involves an increased r...

Positron emission tomography (PET) is widely used in the diagnostic evaluation and staging of different malignant tumors. The role of PET/computed tomographic scan in detecting distant metastases in the workup of Ewing sarcoma in children or young adults is less well defined. We report a case of a boy affected by a metastatic Ewing sarcoma with car...

To review the role of imaging in the diagnosis of recurrent disease in previously treated non-small cell lung cancer (NSCLC) and discuss the imaging pitfalls. A comprehensive review of published literature on CT and PET imaging of NSCLC recurrence was performed. Diagnostic and prognostic values are discussed. Representative imaging examples are ill...

We report a case of a patient with relapse of POEMS syndrome (peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasma proliferative disorder, skin changes) that occurred 6 years after an autologous peripheral blood stem cell transplantation. F-18 FDG PET/CT showed several hypermetabolic as well as nonhypermetabolic bone lesions. Base...

We evaluated the relationships between the cerebral metabolic rate of glucose (CMRglu) measured by dynamic (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and the clinical and neuropsychological assessment before and after the surgical procedure in idiopathic normal pressure hydrocephalus (INPH) patients. El...

Several imaging techniques have been used to assess cardiac structure and function, to understand pathophysiology, and to guide clinical decision making in the setting of acute coronary syndromes (ACS). Over the last years, cardiac positron emission tomography (PET) has affirmed its role in this setting. Indeed, the combined quantitative assessment...

Introduction: 18 F-fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomo-graphy (PET/CT) plays a key role in oncology, and it is now being used increasingly to diagnose, characterize, and monitor disease activity in inflammatory disorders, including vasculitis. Unfortunately, its role in the management of vasculitis is still not...

AB AIM: Pre-operative chemotherapy is applied to improve the prognosis of patients with locally advanced gastric cancer (LAGC). A correlation between changes in FDG uptake and tumor response has previously been reported in patients with gastrointestinal cancer. However, FDG PET-CT imaging was usually performed after pre-operative chemotherapy. The...

In this chapter, we describe the role of imaging in restaging rectal cancer after preoperative neoadjuvant chemoradiation therapy (CRT); especially we focused on its potential role in the prediction of complete tumor regression (pCR). On standard MRI, a normalized rectal wall without any detectable wall thickening is considered a definite criterion...

The objective of this study is to systematically review the role of positron emission tomography (PET) and PET/computed tomography (PET/CT) with fluorine-18-fluorodeoxyglucose (FDG) in patients with large-vessel vasculitis (LVV). A comprehensive literature search of published studies through April 2011 in PubMed/MEDLINE and Scopus databases regardi...

The aims of the present study were: (i) to evaluate the focal incidental colorectal uptake of (18)F-fluorodeoxyglucose ([(18)F]FDG) and to correlate it with colonoscopy and histological findings; (ii) to evaluate the relationship between the presence/absence of neoplastic disease and clinical data and the anatomical site of [(18)F]FDG uptake; and (...

La scintigrafia miocardica (SPET o PET) è una tecnica medico-nucleare non invasiva di imaging che, grazie all’impiego di opportuni radiofarmaci e alla sincronizzazione con l’elettrocardiogramma (ECG-gated), consente di valutare laperfusione miocardica in condizioni di riposo e dopo sforzo (fisico o farmacologico), la vitalità miocardica, la funzion...

PURPOSE/AIM 1) To describe CT and PET-CT imaging findings that could suggest recurrence of NSCLC after treatment; 2) To indicate false positive findings in patients treated with surgery, radiation therapy or radiofrequency ablation; 3) To identify risk of recurrence criteria that could guide integrated protocols of follow-up. CONTENT ORGANIZATION...

In recent years, preoperative therapy has become standard procedure for locally advanced rectal cancer. Tumor shrinkage due to preoperative chemotherapy-radiation therapy (CRT) is now a reality, and pathologically complete responses are not uncommon. Some researchers are now addressing organ preservation, thus increasing the demand for both functio...

It is recognized that the interplay between myocardial ischemia, perfusion, and oxygenation in the setting of coronary artery disease (CAD) is complex and that myocardial oxygenation and perfusion may become dissociated. Blood oxygen level-dependent (BOLD) cardiovascular magnetic resonance (CMR) has the potential to noninvasively measure myocardial...

Whole body and myocardial insulin resistance are features of non-insulin-dependent diabetes mellitus (NIDDM) and left-ventricular dysfunction (LVD). We determined whether abnormalities of insulin receptor substrate-1 (IRS1), IRS1-associated PI3K (IRS1-PI3K), and glucose transporter 4 (GLUT4) contribute to tissue-specific insulin resistance. We coll...

Blood oxygenation level-dependent (BOLD) MRI clinical studies at 1.5 Tesla (T) have been principally limited by low signal to noise. We sought to apply this method at 3T in patients with coronary artery disease (CAD) and normal volunteers, and validated it against perfusion measurements by PET. Twenty-two patients (age 62±8 yrs, 16 men) with CAD (a...

In the diagnostic assessment of medullary thyroid carcinoma (MTC), nuclear medicine imaging provides its contribution mainly in the postoperative work-up to detect residual or recurrent tumor. With respect to scintigraphy with gamma-emitter radiopharmaceuticals, positron emission tomography (PET) offers interesting perspectives owing to its higher...