I would like to thank organizers for inviting me to take part in this educational activity since it is very timely to make the community aware of the availability of FTG PET for assessing infection and inflammation. The CMS, our government agency that funds routine clinical studies, has approved payment for FTG PET assessment in infection and inflammation. So what I'm going to describe can be ordered on a routine basis for your patients. I have nothing to disclose. FTG was introduced by our team at Penn in 1976. Our initial intent was to use this agent to look at brain function and Alzheimer's, seizures, and many other brain disorders. But soon we realized that this is also a good agent for detecting, staging, assessing response of treatment in cancer, which has really dominated the applications of FTG PET in medicine for the past four decades. And as we started using FTG in cancer, we realized that types of infection and inflammation also pick up this agent. So this has been first used for research purposes in these domains upon the recent period when it was approved for clinical applications. You can also look at myocardial viability, atrial sclerosis, muscle dysfunction, and also clot detection. The reason that FTG is picked up at the sites of infection and inflammation is that white cells, when they're activated, have enormous glycolysis and therefore pick up this agent and allow us to visualize their presence and extent as we can quantify with this technology. That's really the beauty of PET is that it's not a yes or no answer. We can also determine the degree of uptake of any trace that we use with PET. This is an example of infected site. These are the dark areas that you see on the left part of the slide. And of course, it's very specific. It shows that it's a very active infection compared to MRI findings in this patient that could be due to some past abnormalities that have not completely disappeared. So when you see something on PET that is so vividly just active, that really means that there's an ongoing process. There are a lot of data in the literature that overall show that FTG PET is highly sensitive for detection of infection. In this case, looking at osteomyelitis, which shows that FTG is the study of choice because has 96% sensitivity compared to existing modalities that don't have that type of sensitivity and also has specificities as well. So this really makes FTG PET as an excellent test for assessing infection. Just some examples, a major domain for infection is presence of osteomyelitis and other infection in patients with diabetic foot, which is a very common problem dealing with in medicine. And this slide shows very clearly the sites of infection so vividly visualized on PET. This is also seen on MRI. And then we have to compose the PET images with MR to show how they relate to each other. Of course, these days we have PET-CT as well as PET-MRI that can provide this routinely in day-to-day practice of medicine. Another case of infection in the talus bone, that's the upper arrow, that really means there's osteomyelitis. And unfortunately, this means that this foot has to be amputated. But there's also inflammation in the arch of the foot that is also very inflamed. And this FTG PET scan visualizes the site as well. This is infection in this sas muscle that was not clearly defined by conventional techniques. And PET just clearly shows this linear uptake of FTG along with the sas muscle access and diagnosis presence of infection. A big area that was very important for approving FTG PET for routine clinical use in medicine was FUO, fever of unknown origin. As you all know, it's a very difficult clinical problem and has many causes. And it could occur anywhere in the body. And unfortunately, existing modalities, namely CT, MRI, fail to show the majority of these abnormalities and FTG PET being catch-all tracer allows to detect inflammation, infection, malignancy, whatever else, vasculitis as the cause of FUO. So this is it. It was a major factor in approving FTG PET for routine clinical use in medicine. This is a patient who came to the University of Pennsylvania Hospital several times with fever of unknown origin. Every time, the whole body imaging was done with CT, MRI, and nothing was found until we did this FTG PET scan showing that there's a site of infection in the middle of the medastinum that was just only drained semi-invasively by a needle and the fever went away and the patient never came back. These are the miracle aspects of FTG PET and FUO that you will notice on day-to-day practice of medicine. These are just shown, again, excellent sensitivity and specificity for FTG PET in this setting. Responsive treatment is a big thing. This is a patient with MIA infection. And again, within a week or two after treatment, you see significant update in entire lungs and both sides have decreased significantly and it's very comparable to the normal FTG PET scan in the right-hand side. So having so many antibiotic or other treatment resistance to infection makes FTG PET the ideal test to determine the efficacy of treatment. This is a big problem right now with drug resistance to bacteria and therefore, it should be used routinely for this purpose. Of course, I've talked about inflammation, but this is just—these are specific inflammations that we deal with, like patients with rheumatoid arthritis, regional itis, vasculitis, as I will show you. So these also disorders can be readily assessed by FTG PET and again, determine the efficacy of so many drugs that are now becoming available for inflammation. And then this test is either going to be a study of choice in these patients, especially we have developed some nice quantitative techniques that shows the course of the disease quantitatively in this population. This is facet joint arthritis in both sides of the sacroiliac joint. This is sarcoidosis, a relatively common disease. You see the extent of it in the lungs, in the lymph nodes, in the heart, and other parts of the body, spleen, as is the case in this patient. So a very good and important application of FTG in this disorder. Inflammatory bowel disease, again, very serious disease, and we can determine the effects of anti-inflammatory agents in this disorder. We also have become very interested in detection of clots in the venous system. This is especially going to be important for patients who have got cancer. So if we use FTG for cancer, we can also detect the clots since patients with cancer are prone to pulmonary embolism much higher, with much higher incidence than general population. And I'm actually hoping that this also will become a very important test in the future for patients who are suspected of having pulmonary embolism. Vasculitis, very clearly visualized. Here's a patient with aortic vasculitis, subclavian vasculitis, that we can detect. Again, this could be the cause of a febrile vernal origin, because these abnormalities cannot be seen on CT or MRI. So the conclusions are very clear. This is a new beginning for assessing patients with infection and inflammation, because of really what we have learned over the past four decades about the role of FTG-PET in this domain. It is very simple, accurate. It is quantitative, and it's superior to existing structural imaging techniques, such as CT and MRI, or even conventional medical medicine techniques. And the cost is substantially lower. You know, we charge $1,200 for the test, while white cell imaging, you know, costs about $5,000. So with all these assets, makes FTG-PET as the study of choice in assessing a variety of infectious and inflammatory disorders in the future. Thanks again for the invitation.

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