the 27th annual congress of the european association of nuclear medicine ( eanm ) took place in gothenburg , sweden on 18    22 october 2014 under the chairmanship of prof . the meeting provided a forum for discussion for those working in the broad field of nuclear medicine in europe and the rest of the world . scientists coming from 82 countries shared their knowledge and presented and discussed new scientific results . the programme was of excellent quality and was based on the standardized eanm congress structure . the overall programme included plenary sessions , symposia , scientific sessions , featured sessions , poster walks and normal poster sessions , cme sessions and pre - symposia . two tracks were included in the main programme , clustering multi - committee involvement : the 5th international symposium on targeted radionuclide - therapy and dosimetry ( istard ) and the first molecules to man ( m2 m ) track , an initiative of the eanm committees for translational molecular imaging , radiopharmacy and drug development , the latter to promote high - quality research through interaction between basic and translational clinical scientists , stimulating interdisciplinary scientific discussion and educating the clinical scientists in future developments in the field . original scientific work submitted comprised 1,912 accepted abstracts , along with another 103 technologist abstracts . this was the second highest number of abstracts submitted to eanm congresses ( topped only by the milan 2012 congress with 2,079 accepted scientific abstracts ; fig .  1 ) . the majority of participants came from europe , while 15.4  % came from asia and 4.7  % from america.fig . 2014 dividing the abstracts by the country of origin of the first author , the major contributing country in absolute numbers was italy ( 221 ) , followed by spain ( 151 ) and turkey ( 137 ; fig .  2 ) . in relative terms per million inhabitants , however , the first place contributor was the host country sweden ( 8.2 ) , followed by denmark ( 5.5 ) and slovenia ( 4.8 ; fig .  3 ) . of interest , comparing the number of eanm congress scientific abstracts in 2014 with the number ten years earlier ( average of 2003 to 2005 ) , an increase was seen for sweden , denmark , france , uk and spain , while other countries ( especially belgium , finland and germany ) showed decrease in submission rates ( fig . whether this reflects less domain - specific activity or a dispersion phenomenon through participation in specific clinically oriented or other international specialized imaging congresses remains to be investigated by the national delegates . dividing the abstracts by category ( fig .  5 ) , the majority of were in the fields of oncology ( 542 , 28  % ) , radionuclide therapy ( 270 , 14  % ) , hybrid imaging ( 217 , 11  % ) and radiopharmaceuticals ( 214 , 11  % ) .fig 3numbers of scientific abstracts accepted by eanm 2014 per country in europe , normalized per 10 million inhabitantsfig . 4relative change ( % ) in number of scientific abstracts accepted by eanm for european countries over the past decadefig . 5evolution of abstracts accepted by eanm by category over the past 5  years numbers of scientific abstracts accepted by eanm 2014 per country in europe numbers of scientific abstracts accepted by eanm 2014 per country in europe , normalized per 10 million inhabitants relative change ( % ) in number of scientific abstracts accepted by eanm for european countries over the past decade evolution of abstracts accepted by eanm by category over the past 5  years all abstracts were graded by expert reviewers and , independent of the topic , the abstracts with the best individual scores were considered for the highlights lecture that focused on the following nuclear medicine areas : physics and instrumentation , radiopharmaceuticals , preclinical imaging , oncology and radionuclide therapy , cardiology and brain imaging . for each of these topics , we also invited six european experts ( fig . 6 ) , to share their opinion regarding challenges , novel developments and needs in these specific areas . 6the six nuclear domains depicted in the highlights lecture , with the respective experts who were consulted on trends , challenges and developments the six nuclear domains depicted in the highlights lecture , with the respective experts who were consulted on trends , challenges and developments because of time restrictions , only a selection of the excellent abstracts could be presented during the highlights lecture ( representing only 40  % of the total presentations submitted for the lecture ) . although strongly guided by reviewer scores , it should be noted that the final inclusion was also based on the personal decisions of the lecturers , seeking to stress important work and developments in the field . we congratulate all authors who were invited to provide slides of their excellent work for possible inclusion in the highlights lecture . one of the most exciting technological developments of the past years is the introduction of the hybrid pet / mri scanner that combines the high sensitivity molecular imaging with the high time and spatial resolution of mri . apart from its structurally superior tissue contrast and resolution , mri also allows complementary functional and molecular imaging . used simultaneous pet / mri withf - fdg and c - pyruvate in a liposarcoma model , using the dynamic nuclear polarization technique which enables imaging of pyruvate and its metabolites , such as lactate , thereby allowing simultaneous combined imaging of not only glycolysis ( fdg ) , but also increased lactate generation , the well - known warburg effect . it is expected that this combined technique will allow expanded noninvasive phenotyping of tumours with higher specificity ( fig . 7simultaneous f - fdg pet and c - pyruvate pet / mri imaging of liposarcoma in a dog   simultaneous f - fdg pet and c - pyruvate pet / mri imaging of liposarcoma in a dog   there are a number of important incompletely solved technical challenges with pet / mri , one of which is undoubtedly the correction for attenuation when using algorithms based on dedicated mr sequences using tissue classification . .   showed that for the different current pet / mri vendors these algorithms work reasonably well in patients although a quantification bias can exist . moreover , dedicated acquisition protocols are needed for quality control and multicentre instrumentation calibration , as severe quantitative artefacts and underestimation of suvs were seen when using clinical protocols for phantom studies . availability of time - of - flight ( tof ) within a simultaneous pet / mri system may provide an elegant way of estimating joint emission and transmission data . reported pilot results of a tof pet / mri system in oncology , showing excellent performance of the tof pet component and examples of improved signal - to - noise and disease detection when compared with a similar tof pet / ct system ( fig . as in most current comparative studies , pet / mr is performed after pet / ct as the current standard of care technique , which may give rise to some timing bias , so randomized timing studies are needed to further validate these comparisons . keller et al .   showed that sparsely sampled mr structural navigators inside a full mri multisequence protocol can be used , and results in improved image quality and decreased motion blur ( fig .  9).fig . 9use of sparsely sampled mr navigators as a tool for correction of head motion in simultaneous pet / mri   comparison of tof pet / ct and tof pet / mri for the detection of cervical lymph nodes   use of sparsely sampled mr navigators as a tool for correction of head motion in simultaneous pet / mri   another hardware development for spect is the availability of dedicated solid - state cameras for cardiac imaging . in order to realize the ultimate goal of quantitative cardiac spect , one important aspect is motion correction , for which solid - state czt ( cadmium zinc telluride ) cameras can be sensitive , due to simultaneous multiangle acquisition . kennedy and strauss   showed that total perfusion defects can be erroneously large with movements that surpass 10  mm . in such cases , selective rejection of projection data where greatest motion induced blur , results in better image contrast and improved perfusion defect quantification . the penalty from lower count rates in the clinical image was marginal because of the high sensitivity of the czt camera . several authors have addressed the important issue of validating simplified approaches compared to full kinetic modelling ( allowing better patient comfort or animal welfare in preclinical studies ) without introducing significant bias and loss in quantitative accuracy . .   showed that dual time - point quantification of among others the serotonin synthesis marker c-5ht - p allows quantitatively accurate measurements without invasive cannulization . .   showed that current gamma cameras are not optimal for this goal , as even with a high - energy global purpose collimator , typically only 15  % of detected events are originating from bremsstrahlung as scatter and septal penetration is extremely high . to optimize this , they used monte carlo simulations of a new detector with bgo ( better stopping power ) in combination with a pinhole collimator to ameliorate the signal - to - scatter ratio , resulting in a tenfold higher spectral signal of y in air across the whole energy spectrum . this allows fabrication of a portable system for 2-min continuous emission tomography in the catheter room during beta therapy administration ( fig . 10 ) . finally , as one of the highlighted technologist contributions , dore et al .   showed that conventional dose calibrators for novel radionuclide therapy applications such as ra also have the desired linearity and long - term accuracy characteristics for the more challenging physical characteristics of  emitters . they found that low background and absence of contamination traces are even more important in this setting.fig . 10improved signal - to - noise ratio of bgo detectors for measuring bremsstrahlung in y radionuclide therapy monitoring   improved signal - to - noise ratio of bgo detectors for measuring bremsstrahlung in y radionuclide therapy monitoring   we are moving towards quantitation and personalized nuclear medicine , with improvements in dosimetry , standardization and quantification . pet / mri and czt spect are here to stay , and show considerable promise for addressing true quantitative and multimodal structural plus functional evaluation . roland boellaard ( from the movie shown during the lecture ) :  the biggest challenge for medical imaging in general is to collect high quality , highly standardized image datasets in order to implement and develop , but also to validate , those new technologies and those advanced data analysis methods  . a strongly increasing interest in positron - emitting radiometals has been observed recently . in this context sc hernandez et al .   explored the advantageous radionuclide characteristics of sc for the development of a cyclic dimeric rgd peptide - based tracer for in vivo pet imaging of v3 integrin - associated angiogenesis processes , and using a well - established tumour angiogenesis model showed the feasibility of sc for the development of pet tracers . as for new targets , the glucose - dependent insulinotropic polypeptide receptor ( gipr ) , an interesting target for the imaging of neuroendocrine tumours ( net ) , was presented by gourni et al . . this new family of peptide receptors , the incretin receptor family , may be of great importance because it may enable in vivo peptide - based receptor targeting of nets which do not express somatostatin ( sst ) receptors , prompting the authors to evaluate newly developed radioligands for the in vivo targeting of gipr - positive tumours . the good characteristics of several of their newly developed radioligands , based on high receptor affinity , good internalization properties and specific targeting in vivo , support the potential of these radioligands as pet imaging probes for a broader spectrum of nets ( fig . 11evaluation of glucose - dependent insulinotropic polypeptide receptor ( gipr ) ligands for neuroendocrine tumours   evaluation of glucose - dependent insulinotropic polypeptide receptor ( gipr ) ligands for neuroendocrine tumours   garousi et al .   introduced a novel class of scaffold - based affinity proteins , adapt ( abd - based derived affinity protein ) , derived from an albumin - binding domain ( abd ) . this protein had promising characteristics in vitro and in vivo in a preclinical model and showed high - contrast in vivo imaging , making it promising for further evaluation , also with short - lived radionuclides . prostate - specific membrane antigen ( psma ) is definitely one of the most promising targets for prostate cancer imaging . in this area presented a single - chain variable fragment ( scfv ) of the monoclonal antibody ( mab ) j591 . a cys residue was introduced for conjugation with the bifunctional chelator ym103 and labelling with ga . the radiolabelled product was stable in serum and showed selective and favourable binding to psma - positive cells in vitro and in vivo in mice , warranting further evaluation as a clinical agent for imaging psma expression in prostate cancer . they developed a novel anti - psma nanobody ( jvz-007 ) , a small antibody fragment possessing excellent molecular imaging properties , high target specificity and rapid background clearance . replacement of the his - myc tag by the cys tag as well as coinjection with gelofusine significantly diminished kidney retention , resulting in excellent tumour - to - kidney ratios , bringing the theranostic potential of jvz-007 in psma - positive prostate cancer within reach . antagonists targeting gastrin - releasing peptide receptor ( grpr ) are also promising for prostate cancer imaging . they offer good tumour retention of radioactivity and fast washout from receptor - positive normal organs without inducing any side effects . such peptide analogues are however well - known substrates for the protease neutral endopeptidase ( nep ) that is abundantly expressed in mammalian tissues . lymperis et al .   introduced sb3 , a new dota - functionalized analogue of the potent and selective grpr antagonist [ dphe 6,leu - nhet 13]bbn(6 - 13 ) ] , suitable for labelling with the theranostic in / lu radionuclide pair . they evaluated the impact of transient in vivo nep inhibition using the potent , competitive and reversible nep inhibitor phosporamidon ( pa ) . it was found that pa treatment suppressed the degradation of the radioligands , inducing remarkable enhancement of tumour uptake in a prostate cancer mouse model ( fig . explored the impact of pa coinjection with the truncated gastrin analogue [ in]sg5 with very high specific activity of in ( by hplc purification unlabelled sg5 was removed ) . the combined approach impressively boosted tumour uptake and may allow clinical application of potent internalizing peptide receptor agonists without bioactivity concerns . in vivo nep inhibition appears to be a very powerful new tool strengthening the theranostic potential of peptide - based radioligands , and further investigation for translation into the clinic is warranted.fig . 12phosporamidon improves tumour uptake of sb3   phosporamidon improves tumour uptake of sb3   the large number of excellent abstracts during the eanm meeting concerning new radiopharmaceuticals , based on new vectors or novel radionuclides , is most promising . hopes for the future however depend on the successful introduction of such new drugs into clinical use . hans - jrgen wester ( from the movie shown during the lecture ) :  to improve our success rate we need goal - oriented alignment of academic research , including the selection of and subsequent focus on the really promising tracers for fast and efficient transfer and clinical assessment based on harmonized protocols  . preclinical evaluation and imaging studies of many different novel and promising tracers were also presented during the meeting . due to its association with tumour aggressiveness and metastasis , novel predictive biomarkers associated with epithelial - to - mesenchymal transition ( emt ) events in vivo would be very helpful . hernandez et al .   evaluated cd146 , an emt inducer , as a novel in vivo target for noninvasive imaging of emt in an orthotopic glioblastoma model . they developed a highly specific anti - cd146 mab ( yy146 ) and presented noninvasive pet imaging of cd146 expression in vivo in mice ( fig . 13 ) , envisaging the potential of this novel mab for targeted cancer diagnostics and/or therapy.fig . 13imaging of -conjugated and -conjugated folate acid derivatives   imaging of -conjugated and -conjugated folate acid derivatives   radiotracers targeting tumour - associated macrophages ( tams ) also deserve attention . they could be valuable for noninvasive , longitudinal visualization of macrophage infiltration to monitor response of drugs affecting tams . terry et al .   developed an imaging agent to monitor tams based on the f4/80 receptor , which encodes an adhesion g protein - coupled receptor expressed on the surface of murine macrophages . binding of in - anti - f4/80 was specific , but in vivo , in - f4/80 had a short circulation time as the spleen and liver acted as sink organs . increasing the antibody dose to 100  g in - f4/80 decreased spleen - to - blood and enhanced tumour - to - blood uptake ratios compared to 10  g in - f4/80 . tams could subsequently be successfully visualized by microspect , as were macrophages in the spleen and liver . applied targeting of the bradykinin b1 receptor ( b1r ) , a g protein - coupled receptor , which is overexpressed in a variety of cancers but not in normal tissues making it a promising imaging marker for cancer diagnosis . three ga - labelled b1r - targeting peptides generated specific and high - contrast images of hb1r - positive tumour xenografts in mice . p04158 and z02090 appeared to be the most promising analogues for imaging b1r expression with pet , as they showed significantly higher tumour uptake and target - to - nontarget ratios , probably due to their higher receptor affinity . the folate receptor is another very interesting target for both imaging and therapy due to its overexpression in a variety of tumour types of epithelial origin . presented the syntheses , biological evaluation and comparison of two pairs of folic acid conjugates labelled with f in both the  and  positions of the carboxylic functionalities . the authors demonstrated that -conjugated and -conjugated folate derivatives show different in vivo properties , while in vitro binding affinity to the folate receptor is almost identical . the site of conjugation on the glutamyl moiety in folic acid can therefore have dramatic effects on the in vivo behaviour of folic acid conjugates ( fig . 14preclinical studies with yy-146   preclinical studies with yy-146   very well - known tumour targets are sst receptors . receptor antagonists have recently been shown to have higher uptake in sst receptor - expressing tumours than sst agonists , possibly due to the higher number of available receptor binding sites . nicolas et al .   evaluated the tumour residence time and therapeutic index of the sst2 antagonist ops201 compared to the sst2 agonist dota - tate in a theranostic approach in mice . the increased tumour uptake and prolonged residence time of lu - ops201 as well as the favourable differential washout compared to lu - dota - tate improved the therapeutic index of the former . the mass - dependent study confirmed the higher number of binding sites for the antagonists in vivo compared to the agonist ( fig . 15improved therapeutic index of lu - labelled ops201 versus dota - tate   improved therapeutic index of lu - labelled ops201 versus dota - tate   in several papers the theranostic potential of novel compounds was underlined . a highly ranked paper on radionuclide therapy antitumour effects was presented by yook et al . , who aimed to improve localized brachytherapy radiation treatment of locally advanced breast cancer using locally administered egfr - targeted gold nanoparticles labelled with the -emitter lu ( lu - t - aunps ) . the authors found that the labelled particles were cytotoxic towards breast cancer cells in vitro and slowed tumour growth in vivo . egfr targeting increased cytotoxic potency in vitro , but appeared not to be required in vivo due to local tumour retention of both targeting and nontargeting particles following intratumoral injection . powerful  particle emitters are especially promising for radionuclide therapy , and several papers were presented on this topic . compared the anti - tumour efficacy and toxicity of non - internalizing ( anti - cea ) and internalizing ( anti - her2 ) pb - labelled mabs during -radioimmunotherapy ( -rit ) of small - volume peritoneal carcinomatosis . the authors found a strong therapeutic efficacy of pb - labelled mabs in intraperitoneal -rit of small - volume tumours . internalizing pb - labelled mabs were more efficient , although the tumour absorbed dose was lower than for non - internalizing pb - labelled mabs , which could be explained by the differential distribution : the distribution of the anti - cea radiolabelled mab was more heterogeneous at the tumour tissue level . we hope that the promising tracers and techniques presented here will find their way into the clinic , but several hurdles will have to be overcome . the new m2 m track during the meeting aims to bring together and train translational scientists to improve our successes in this respect . otto boerman ( from the movie shown during the lecture ) :  currently it takes too much time and money to determine the potential of useful tracers in the clinic . the micro - dosing guideline is a step in the right direction , but more adjustments are needed . the new m2 m track during the eanm meeting will improve the visibility of translational research in our field and stimulate discussions on how to proceed  . imaging of thromboembolic disease , such as myocardial infarction , stroke , tia and pulmonary embolism , is of high medical importance as these disorders are major causes of morbidity and mortality worldwide . currently no established whole - body imaging method is available to systematically search for the embolic source . the glycoprotein ( gp ) iib / iiia receptor is a key receptor required for platelet aggregation by primarily binding fibrinogen and is highly abundant in platelets . specific imaging of the gpiib / iiia was shown for the first time by stephens et al .   in preclinical studies in the monkey in arterial thrombi and on damaged endothelial surface ( fig . the f - gp1 tracer showed very good imaging characteristics including high affinity ( 18 nm ) , in vivo and ex vivo selectivity , stable binding , no influence by anticoagulation therapy and highly sensitive and specific in vivo detection of platelet depositions.fig . 16characterization and preclinical studies of f - gp1 , a new tracer for detection of thrombi   characterization and preclinical studies of f - gp1 , a new tracer for detection of thrombi   demeure et al .   reported on a novel f - labelled fatty acid analogue , fcpha , for imaging of myocardial ischaemia . they showed the results of the phase ii trial data assessing safety , kinetics , biodistribution and optimal timing . diagnostic images can be very rapidly acquired even from 5  min after injection , with no liver interference . also in the domain of cardiology , pet / mri has promising features and applications . nappi et al .   performed a feasibility study of simultaneous pet / mri in anderson - fabry disease . this x - linked lysosomal storage disorder is associated with severe multiorgan dysfunction and premature death caused by renal failure , cardiomyopathy or cerebrovascular disease . this group studied 13 patients with normal lv ef and no known cardiac disease , and found complementary information on early disease presence from a combination of late gadolinium enhancement as an expression of intermyocardial fibrosis , short inversion time inversion recovery indicative of oedema , and varying patterns of fdg uptake indicative of inflammation ( fig . lge late gadolinium enhancement , stir short inversion time inversion recovery pet / mri imaging in anderson - fabry disease . lge late gadolinium enhancement , stir short inversion time inversion recovery several novel studies on cardiac imaging systems and methodology were presented . used advanced pixel - wise mapping of ammonia pet in patients with hypertrophic cardiomyopathy , in which wall thickness may be large enough compared to the system resolution to study subendocardial ischaemia . after dipyridamole stress , the internal layer was decreased in patients with hypertrophic cardiomyopathy , and the difference after stress was highly significant compared to controls , with also a higher proportion of decreased segments compared to the external myocardial blood flow ( mbf ) . this indicates that pixel - wise parametric mapping could be useful for identifying intramyocardial differences in mbf that are not detectable by conventional segment schemes . developed an accurate semiautomatic analysis of cardiac c - pib retention to allow noninvasive diagnosis of different forms of amyloidosis in the heart . in ten patients with systemic amyloidosis , the cardiac amyloid load was assessed using the fractional uptake ratio as quantitative index . parametric polar maps and histogram analysis allowed fast , reproducible and straightforward interpretation ( fig . 18 ) , with differentiation of ttr ( transthyretin ) amyloidosis ( with low but increased uptake ) , light - chain precursor kappa amyloidosis ( with moderately elevated uptake ) and light - chain lambda fragment amyloidosis ( with very high global or regional uptake).fig . ttr transthyretin , fur fractional uptake ratio , al amyloid load fractional uptake determination in several forms of cardiac amyloidosis using carima software . .   investigated cardiac insulin resistance , which at the same time represents the cause and the consequence of heart failure and can affect prognosis . these authors investigated whether insulin resistance is associated with impaired cardiac sympathetic innervation in a study with 95 subjects . insulin - resistant subjects indeed showed impaired heart - to - mediastinum ratios in both the early and late phase , while the washout was not different . both early and late ratios were related to both fasting insulinaemia and to the homa - ir ( homeostasis model assessment insulin resistance ) index as calculated from fasting glucose and fasting insulin . this relationship gives mechanistic support for the theory that insulin resistance may have an independent adverse effect on prognosis in patients with heart failure through sympathetic nervous system overactivity . one advantage of recently marketed high - sensitivity dedicated cardiac instrumentation , such as semiconductor cameras , is the dramatic reduction in the combination of activity and acquisition time needed . perrin et al . , who advocate a stress - first examination and perform a rest study only if indicated , showed an average fourfold reduction in effective dose from 14 to 3.5  msv using czt spect . in a low - risk subgroup with normal stress without a rest study , this was reduced to as low as 2  msv on average . despite this dose reduction , they showed in a subgroup of 159 patients using coronarography as the gold standard that sensitivity was retained , implying no loss in diagnostic efficacy . this congress has shown that in cardiology , we may be able to provide faster and better answers with lower doses and improved technology and with tools to quantify coronary blood flow and reserve , or detect and assess prognosis in specific disorders such as amyloidosis , sarcoidosis , endocarditis and heart failure . ignasi carrio ( from the movie shown during the lecture ) :  other new important developments will be pet tracers for the atherosclerotic plaque and eventually also to image the vulnerable ones  . in neurodegeneration , enormous strides forward have been made over the past decade , with disease - specific biomarkers , such as amyloid , that have reached the clinic . in addition , several targets have been investigated that go beyond the classical neurotransmitter systems . parkinson s disease ( pd ) is not only a movement disorder , but is also characterized by extramotor cerebral abnormalities and extracranial symptoms caused by , for example , parasympathetic denervation inducing vagal nerve pathology . in this year .   from aarhus , denmark , showed that extracerebral parasympathetic pathology can be visualized using c - donepezil , which binds to acetylcholinesterase and can be seen as a marker of cholinergic innervation . a strong decrease in the small intestine and pancreas was found in 12 pd patients and with almost only half of the suv compared to 12 matched healthy controls ( fig . 19 
 c - donepezil acetylcholinesterase activity determination in the small intestine in parkinson s disease patients and controls  
 c - donepezil acetylcholinesterase activity determination in the small intestine in parkinson s disease patients and controls   fazio et al .   reported on a highly specific f - labelled dopamine transporter ( dat ) ligand , pe2i , that has favourable specificity over other transporters , as well as faster kinetics and modelling properties than existing dat ligands . while up to 70  % loss in patients with early pd occurs in the putamen , high - resolution pet showed that the dat signal in the substantia nigra ( sn ) can be quantified , but with much lower abnormality , indicating that the integrity of the sn cell bodies is relatively preserved and that in pd mainly the terminals are affected in the early disease course . several important modulatory or downstream targets that affect dopaminergic neurotransmission are now under study using molecular imaging . several tracers targeting phosphodiesterases ( pde ) , intracellular second messenger systems , were presented at this symposium , including pde2 , pde4 and pde10a subtypes which all have high cerebral expression . used f - mni-659 , a pde10a ligand , showing very large changes in patients with early huntington s disease ( hd ) even after partial volume correction . the effect was much larger compared with an only modest d2 receptor change which was previously known as the first abnormal imaging marker for hd ( fig . studies in presymptomatic hd are being conducted to investigate whether this biomarker may allow disease onset prediction or to provide mechanistic proof for a possible therapeutic target.fig . 20cerebral phosphodiesterase 10a pet ( partial volume - corrected ) versus dopamine d2/d3 receptor and volumetric imaging in carriers of huntington s disease gene expansion with early - stage disease   cerebral phosphodiesterase 10a pet ( partial volume - corrected ) versus dopamine d2/d3 receptor and volumetric imaging in carriers of huntington s disease gene expansion with early - stage disease   the glutamatergic system is another major neurotransmitter system that has not received attention due to lack of appropriate radioligands , but is crucial in many disorders with excitotoxicity ( including neurodegeneration , epilepsy , addiction , and schizophrenia ) . explored the preclinical validation of f - fnm , a novel pet tracer for the n - methyl - d - aspartate ( nmda ) receptor , which is abundantly expressed in cortical and subcortical grey matter . with good blood brain barrier crossing , fast pharmacokinetics and specific target validation shown by blocking studies , further in vivo human studies with this promising compound are awaited . used pet imaging in conscious rhesus monkeys in pharmacological experiments to elucidate a possible antidepressant mechanism of ketamine involving serotonin 1b receptors . ketamine upregulated the 5ht1b receptor as measured by the novel ligand c - az10419369 , only in areas central in the circuitry involved in mood regulation , the accumbens and ventral pallidum . investigated neuroinflammation in rats with highly localized unilateral labyrinthectomy using f - ge180 , a novel tspo ligand . the authors were able to follow the in vivo time course of the inflammation associated with the initial vestibular syndrome over 30  days that decreased with vestibular compensation . they showed a remarkably strong in vivo signal in the vestibular nuclei that was validated using autoradiography . simultaneous pet / mri sparks high hopes for new research applications in cns imaging , and this area may also contain the lowest - hanging fruit to allow implementation on a more clinical routine basis . shared their first experiences with combined amyloid pet / mri imaging in 100 patients with mild cognitive impairment ( mci ) or alzheimers ( ad ) , and showed that the combination of amyloid and structural imaging of the mesial temporal lobe ( as a marker of neuronal injury ) significantly improves differential diagnosis and clearly aids the early diagnosis of mci ( fig . 21simultaneous t1-weighted and f - florbetaben amyloid pet / mri in mci patients , allowing improved differential diagnosis and prognosis assessment in a one - stop - shop fashion   simultaneous t1-weighted and f - florbetaben amyloid pet / mri in mci patients , allowing improved differential diagnosis and prognosis assessment in a one - stop - shop fashion   pooled post - mortem validation of amyloid imaging shows high sensitivity and good specificity ( 98  % and 89  % , a negative predictive value of 96  % ) , confirming that amyloid imaging can reliably exclude amyloid pathology . .   investigated i - abc577 for measuring beta amyloid , and demonstrated good discrimination capacity between ad patients and healthy controls in a pilot study , with the advantage of low nonspecific white matter binding , thus potentially expanding the clinical utility of amyloid imaging using spect . however , the field is also moving  beyond amyloid. imaging trials have shown amyloid to be a very sensitive but very early marker in the disease course of ad , which hampers prediction of disease onset . as tau accumulation probably occurs later in the course of ad in most patients , tau imaging may provide a timelier marker of conversion to overt ad . moreover , it has potential to characterize the signature of other neurodegenerative disorders that are purely tau - based , such as frontal lobe dementia and progressive supranuclear palsy . retest data of f - av1451 ( formerly known as t807 ) that showed very good reproducibility of 4 5  % and high interreader consistency , both advantages necessary for picking up small changes in the early course of the disease and for accurate quantitative evaluation of disease - modifying therapies . shared the first results in humans from a second - generation tau ligand , f - thk5351 , which has a better signal - to - noise ratio and less white matter uptake than previous tohuku ligands ( fig . 22 
 f - thk-5351 , a novel radiotracer for pet tau imaging with improved signal - to - noise ratio and lower white matter uptake  
 f - thk-5351 , a novel radiotracer for pet tau imaging with improved signal - to - noise ratio and lower white matter uptake   in general , presentations at the congress on cns imaging were devoted to developments in tracers , methodology and disease applications . despite progress in the field of neurodegeneration , there seems to be a worrying decline in contributions in psychiatry . this may in part be reflected by less investment by the pharmaceutical industry in novel targets , since about two - thirds of new radioligands originate in or from collaboration with industry . as molecular imaging remains a unique bridge between genetics and human behaviour , new and collaborative efforts in this exciting area gitte moos - knudsen , whom we quote ( from the movie shown during the lecture ) :  the main challenges for cns imaging are the declining number of active programs in pharmaceutical companies resulting in fewer compounds and targets , the cost of pet imaging creating a tendency of underpowered studies , and the need for more and better collaborations not only between imaging centres , but also with basic scientists . many abstracts describing clinical studies on new radiopharmaceuticals were among the highest rated and were therefore selected for inclusion in the highlights lecture . earlier showed the feasibility of pretargeting using anti - cea bispecific mab and radiolabelled hapten peptides . they now compared the sensitivity of whole - body pretargeted immuno - pet / ct and f - dopa pet / ct in metastatic patients with medullary thyroid carcinoma ( mtc ) and demonstrated the potential of anti - cea pretargeted immuno - pet / ct for staging mtc patients , especially for nodes , liver , and bone evaluation . pretargeted immuno - pet showed a higher overall sensitivity than ct and f - dopa pet / ct , whereas ct seemed to be more effective than immuno - pet / ct for detecting lung metastases . mri showed better sensitivity than immuno - pet / ct for bone examination , but immuno - pet / ct allowed detection of bone lesions in areas not explored by mri ( fig .  23).fig . 23pretargeted immuno - pet versus ct , mri and f - dopa - pet   pretargeted immuno - pet versus ct , mri and f - dopa - pet   in the next study , the same group   aimed at optimizing molar doses and pretargeting intervals of bispecific mab and hapten peptide . high tumour uptake and tumour - to - mediastinum blood pool ratios were obtained with pretargeted anti - cea immuno - pet , especially when using optimized pretargeting parameters : bispecific mab / peptide molar ratio of 40 and a pretargeting delay of 30  h. another target of interest is her2 , a transmembrane tyrosine kinase receptor overexpressed in 12    25  % of breast cancers . imaging of her2 enables noninvasive repetitive determination of her2 status and stratification of patients for her2-targeted therapy . performed a phase i clinical trial of the her2-binding peptide molecule aby025 labelled with ga for pet to investigate the safety , biodistribution , pharmacokinetics , effect of two peptide masses , and correlation of uptake in tumours with immunohistochemistry . ga - aby025 pet / ct was performed without safety issues and appeared to be a most promising tool for assessing whole - body her2 receptor status in metastatic breast cancer and imaging with the higher peptide dose ( 500  g ) at 2  h after injection appeared the best combination for routine use ( fig . 24)fig . 24 
 ga - aby025 pet / ct imaging in metastatic breast cancer  
 ga - aby025 pet / ct imaging in metastatic breast cancer   glp-1-labelled analogues the authors concluded that tc - glp-1 receptor scintigraphy is a very useful diagnostic tool in patients with clinical symptoms of insulinoma . moreover , tc - glp-1 receptor imaging could also be useful in patients with mtc , phaeochromocytoma and gastrinoma , especially when other diagnostic methods are equivocal . currently there is huge interest ( and also during this meeting ) in prostate cancer imaging . presented a hybrid tracer , indocyanine green ( icg ) tc - nanocolloid , that was earlier found to successfully complement intraoperative radioguidance towards the sentinel node(s ) with optical fluorescence identification . for sophisticated procedures such as laparoscopic robot - assisted radical prostatectomy combined with sentinel node biopsy , fluorescence - based identification however required further optimization . they evaluated the effect of tracer preparation , injection technique , and the fluorescence imaging hardware on intraoperative sentinel node identification rate and found a significant improvement in intraoperative fluorescence - assisted sentinel node identification after stepwise optimization of tracer formulation and the fluorescence laparoscope , while preoperative spect / ct remained an essential tool for locating the sentinel nodes . prostate cancer cells express different interesting targets for imaging and therapy probes on their membranes . today 's clinical imaging modalities commonly applied to the evaluation of patients with prostate cancer include bone scan , ct and mri . however , due to the biochemical nature of the disease and its clinical and anatomical course , current imaging techniques have considerable limitations in accurately defining the presence and extent of disease . psma is a most promising target for imaging and therapy , and in this area several excellent papers were presented . performed a study using tc - mip-1404 , a small molecule showing specific binding to psma ( fig . compared to bone scan , mri and ct , psma imaging with tc - mip-1404 detected primary and metastatic prostate cancer in this study with higher specificity . uptake in the prostate gland lesions correlated well with both gleason score and psma expression . this pilot study clearly documented that psma scanning with tc - mip-1404 may be an appropriate imaging biomarker for early detection of prostate cancer and for selecting patients for therapy.fig . 25prostate cancer imaging using tc - mip-1404   prostate cancer imaging using tc - mip-1404    kulkarni et al . analysed a new pet tracer for psma imaging ( ga - psma - hbed - cc ) . the aim of their study was to investigate the role of ga - psma - hbed - cc pet / ct in patients presenting with rising psa levels . the high target - to - background ratio enabled accurate detection of very small lesions and of early bone marrow metastases . the authors concluded that ga - psma - hbed - cc is a very sensitive and specific pet tracer for the detection of prostate cancer with residual / recurrent disease and its metastases . ga - psma - hbed - cc pet / ct may also be useful for effective stratification of patients undergoing radioligand therapy with lu - labelled psma ligands . this theranostic approach was also studied by the same authors   using euk - sub - kff - dotaga ( psma - tum1 ) , a promising psma - targeting ligand exhibiting high and specific uptake in prostate cancer . the aim of the study was to determine the safety and efficacy of lu - psma - tum1 in an initial cohort of patients with castrate - resistant prostate cancer . the treatment was well tolerated by all patients without any significant adverse effects or alterations in any of the laboratory parameters or renal function . the initial results demonstrated that radionuclide therapy with lu - psma - tum1 is both safe and effective in castrate - resistant metastatic prostate cancer with appropriate selection and follow - up of patients by ga - psma - hbed - cc pet / ct ( fig . 26 ) , making psma an excellent target for both diagnostic imaging and radiotherapeutic approaches.fig . 26antitumour efficacy of lu - psma - tum1   antitumour efficacy of lu - psma - tum1   another radionuclide therapy study using a novel tracer was presented by krlicki et al . , who investigated a novel treatment strategy for glioblastoma multiforme that is characterized by a very bad prognosis with an overall survival of 9 substance p , a ligand for the nk-1 receptor system extensively expressed in glioma cells , was labelled with the  emitter bi , offering high potential for selective irradiation of tumours while minimizing damage to adjacent tissue . treatment of patients suffering from recurrent disease with bi - substance p appeared safe and was well tolerated . follow - up of therapeutic responses and toxicity was still on going at the time of the meeting ; the median survival of the patients with glioblastoma multiforme was > 30  months from initial diagnosis . the authors concluded that targeted  therapy with bi - substance p is a promising novel option for treatment of recurrent glioblastoma multiforme . at this meeting the most promising tracers currently being investigated for clinical imaging and therapeutic applications were discussed . to translate these successes into clinical reality , we now need to work on efficient and harmonized trial design for validation and dissemination of novel agents and get new radiopharmaceuticals fda / ema approved and reimbursed for clinical use  ( quote prof . nuclear medicine has benefited from rapid technological evolution that has yielded new imaging possibilities , new hardware and software developments and new radiopharmaceuticals which have gained widespread acceptance . the combination of diagnostic imaging , tissue characterization , function measurement and targeted therapy in nuclear medicine remains very powerful . the eanm 2014 congress provided a sample of such novel nuclear medicine contributions with excellent innovations in ( pre)clinical imaging methodology , physics , radiopharmaceuticals and radiochemistry . significant progress was demonstrated in the clinical applications of existing nuclear medicine procedures , whereas new applications are under development in preclinical and early clinical stages . we believe that the achievements of the gothenburg eanm congress are symbolized by the renowned international success of the group abba , who won the european song contest in 1974 , and who s member bjrn ( ulvaeus ) was born in gothenburg . nuclear medicine studies presented at the congress , spanning multiple application domains , demonstrated again the crucial role that nuclear medicine can play in contemporary medicine and biomedical science . novel radiopharmaceutical applications in both diagnosis and therapy were presented , the time to make the transition to a lasting clinical reality is now ! we should collaborate to pave the translational road , to bring promising novel tracers to ( multicentre ) clinical studies and reduce current hurdles , including legislation , high costs and reimbursement issues . i have a dream , a song to sing  : we call upon all collaborators in nuclear medicine to join forces , to reduce internal competition , and to work on harmonized protocols in order to make promising new developments a clinical success both in diagnostics and therapy .
the eanm congress 2014 took place in gothenburg , sweden , from 18 to 22 october under the presidency of prof . 
 wim oyen , chair of the eanm scientific committee . 
 prof . 
 peter gjertsson chaired the local organizing committee , according to the standardized eanm congress structure . 
 the meeting was a highlight for the multidisciplinary community that forms the heart and soul of nuclear medicine ; attendance was exceptionally high . 
 in total almost 5,300 participants came to gothenburg , and 1,397 colleagues participated via the eanm live sessions ( http://eanmlive.eanm.org/index.php ) . 
 participants from all continents were presented with an excellent programme consisting of symposia , scientific and featured sessions , cme sessions , and plenary lectures . 
 these lectures were devoted to nuclear medicine therapy , hybrid imaging and molecular life sciences . 
 two tracks were included in the main programme , clustering multi - committee involvement : the 5th international symposium on targeted radionuclide - therapy and dosimetry ( istard ) and the first molecules to man ( m2 m ) track , an initiative of the eanm committees for translational molecular imaging , radiopharmacy and drug development . 
 the industry made a substantial contribution to the success of the congress demonstrating the latest technology and innovations in the field . during the closing highlights 
 lecture , a selection of the best - rated abstracts was presented including diverse areas of nuclear medicine : physics and instrumentation , radiopharmacy , preclinical imaging , oncology ( with a focus on the clinical application of newly developed tracers ) and radionuclide therapy , cardiology and neurosciences . 
 this highlights lecture could only be a brief summary of the large amount of data presented and discussed during the meeting , which can be found in much greater detail in the congress proceedings book , published as volume 41 , supplement 2 of the european journal of nuclear medicine and molecular imaging in october 2014 .