This review paper will discuss the use of positron emission tomography/computed tomography (PET/CT) in paediatric oncology. Functional imaging with PET/CT has proven useful to guide treatment by accurately staging disease and limiting unnecessary treatments by determining the metabolic response to treatment. ¹⁸F-Fluorodeoxyglucose (2-[¹⁸F]FDG) PET/CT is routinely used in patients with lymphoma. We highlight specific considerations in the paediatric population with lymphoma. The strengths and weaknesses for PET/CT tracers that compliment Meta-[¹²³I]iodobenzylguanidine ([¹²³I]mIBG) for the imaging of neuroblastoma are summarized. 2-[¹⁸F]FDG PET/CT has increasingly been used in the staging and evaluation of disease response in sarcomas. The current recommendations for the use of PET/CT in sarcomas are given and potential future developments and highlighted. 2-[¹⁸F]FDG PET/CT in combination with conventional imaging is currently the standard for disease evaluation in children with Langerhans-cell Histiocytosis (LCH) and the non-LCH disease spectrum. The common pitfalls of 2-[¹⁸F]FDG PET/CT in this setting are discussed.

With Tuberculosis (TB) affecting millions of people worldwide, novel imaging modalities and tools, particularly nuclear medicine and molecular imaging, have grown with greater interest to assess the biology of the tuberculous granuloma and evolution thereof. Much early work has been performed at the pre-clinical level using gamma single photon emission computed tomography (SPECT) agents exploiting certain characteristics of Mycobacterium tuberculosis (MTb). Both antituberculous SPECT and positron emission tomography (PET) agents have been utilised to characterise MTb. Other PET tracers have been utilised to help to characterise the biology of MTb (including Gallium-68-labelled radiopharmaceuticals). Of all the tracers, 2-[¹⁸F]FDG has been studied extensively over the last two decades in many aspects of the treatment paradigm of TB: at diagnosis, staging, response assessment, restaging, and in potentially predicting the outcome of patients with latent TB infection. Its lower specificity in being able to distinguish different inflammatory cell types in the granuloma has garnered interest in reviewing more specific agents that can portend prognostic implications in the management of MTb. With the neutrophil being a cell type that portends this poorer prognosis, imaging this cell type may be able to answer more accurately questions relating to the tuberculous granuloma transmissivity and may help in characterising patients who may be at risk of developing active TB. The formyl peptide receptor 1(FPR1) expressed by neutrophils is a key marker in this process and is a potential target to characterise these areas. The pre-clinical work regarding the role of radiolabelled N-cinnamoyl –F-(D) L – F – (D) –L F (cFLFLF) (which is an antagonist for FPR1) using Technetium 99m-labelled conjugates and more recently radiolabelled with Gallium-68 and Copper 64 is discussed. It is the hope that further work with this tracer may accelerate its potential to be utilised in responding to many of the current diagnostic dilemmas and challenges in TB management, thereby making the tracer a translatable option in routine clinical care.

Background: PSMA PET/CT is the most sensitive molecular imaging modality for prostate cancer (PCa), yet much of the developing world has little or no access to PET/CT. [^99mTc]Tc-PSMA scintigraphy (PS) is a cheaper and more accessible gamma camera-based alternative. However, many resource-constrained departments have only a single camera without tomographic or hybrid imaging functionality, and camera time is frequently in high demand. Simplifying imaging protocols by limiting the field of view (FOV) and omitting SPECT/CT or even SPECT may provide a partial solution. The aim was thus to determine the adequacy of PS planar-only and/or SPECT-only imaging protocols with a limited FOV. Methods: The scans of 95 patients with histologically proven PCa who underwent PS with full-body planar and multi-FOV SPECT/CT were reviewed. The detection rates for uptake in the prostate gland/bed and in metastases were compared on planar, SPECT, and SPECT/CT. The agreement between modalities was calculated for the detection of metastases and for staging. The impact of imaging a limited FOV was determined. Results: Pathological prostatic uptake was seen in all cases on SPECT/CT (excluding two post-prostatectomy patients), 90.3% of cases on SPECT, and 15.1% on planar images (p < 0.001). Eleven (11.7%) patients had seminal vesicle involvement on SPECT/CT, which was undetectable/indistinguishable on planar images and SPECT. The agreement between modalities was moderate to good (κ = 0.41 to 0.61) for the detection of nodal metastases, with detection rates that did not differ significantly (SPECT/CT = 11.6%, SPECT = 8.4%, planar = 5.3%). Detection rates for bone metastases were 14.7% (SPECT/CT) and 11.6% (SPECT and planar). Agreement between modalities for the detection of bone metastases was good (κ = 0.73 to 0.77). Three (3.1%) patients had visceral metastases on SPECT/CT, two of which were detected on SPECT and planar. There was good agreement between modalities for the TNM staging of patients (κ = 0.70 to 0.88). No metastatic lesions were missed on the limited FOV images. Conclusion: When PS scintigraphy is performed, SPECT/CT is recommended. However, the lack of SPECT/CT capabilities should not preclude the use of PS in the presence of limited resources, as both planar and SPECT imaging are adequate and will correctly stage most PCa patients. Furthermore, time-based optimisations are achievable by limiting the FOV to exclude the distal lower limbs.

The SA Journal of Radiology is the official journal of the Radiological Society of South Africa and the Professional Association of Radiologists in South Africa and Namibia. The SA Journal of Radiology is a general diagnostic radiological journal which carries original research and review articles, pictorial essays, case reports, letters, editorials, radiological practice and other radiological articles.

Background: A wide range of nuclear imaging probes have been developed to address different metabolic processes and cell receptors in prostate cancer patients using positron emission techniques to aid diagnosis, staging, and monitoring for recurrence after treatment. While ⁶⁸Ga PSMA is a generator-derived PET radiopharmaceutical, SPECT/CT imaging using technetium-99m-labeled PSMA is now available as a suitable alternative. The aim of this study is to compare the pooled sensitivity, specificity, and accuracy of ^99mTc-PSMA SPECT/CT and ⁶⁸Ga-PSMA PET/CT in patients with prostate cancer. Main body of the A search strategy was developed using text words, MeSH, and entry terms. The following databases will be searched: PubMed, African Journals Online (AJOL), Embase, Google scholar, ResearchGate, Cochrane Library, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. Eligibility criteria include (a) all studies that are published or retrievable in English language, (b) observational studies, and (c) histopathology analysis or clinical and imaging follow-up or comparison with reference standards. Exclusion criteria will be interventional studies, editorials, reviews, and commentaries. Quality of the studies will be assessed using QUADAS2 Quality scores and risk of bias for individual studies will be reported. Full text of the studies will be reviewed and snowballed for any relevant literature. Assessment of methodological, clinical, and statistical heterogeneity for all the included studies will be made. Publication bias will be assessed using funnel plots. Statistical analysis and forest plots will be performed using the Open Meta-analyst software. The systematic review and meta-analysis will be reported according to PRISMA 2015 Statement. Short conclusion: This review will provide data on diagnostic accuracy of 99mTc-PSMA SPECT/CT and 68Ga-PSMA PET/CT in patients with prostate cancer. Results from this study will help nuclear medicine service providers to make better decisions on the appropriate use of 99mTc-PSMA SPECT/CT and 68Ga-PSMA PET/CT especially with regard to the use of 99mTc-PSMA SPECT/CT which is relatively affordable and more readily available in developing countries when compared to 68-Ga PSMA PECT/CT.