Design and Harmonization Approach for the Multi-Institutional Neurocognitive Discovery Study (MINDS) of Adult Congenital Heart Disease (ACHD) Neuroimaging Ancillary Study: A Technical Note.

Dramatic advances in the management of congenital heart disease (CHD) have improved survival to adulthood from less than 10% in the 1960s to over 90% in the current era, such that adult CHD (ACHD) patients now outnumber their pediatric counterparts. ACHD patients demonstrate domain-specific neurocognitive deficits associated with reduced quality of life that include deficits in educational attainment and social interaction. Our hypothesis is that ACHD patients exhibit vascular brain injury and structural/physiological brain alterations that are predictive of specific neurocognitive deficits modified by behavioral and environmental enrichment proxies of cognitive reserve (e.g., level of education and lifestyle/social habits). This technical note describes an ancillary study to the National Heart, Lung, and Blood Institute (NHLBI)-funded Pediatric Heart Network (PHN) "Multi-Institutional Neurocognitive Discovery Study (MINDS) in Adult Congenital Heart Disease (ACHD)". Leveraging clinical, neuropsychological, and biospecimen data from the parent study, our study will provide structural-physiological correlates of neurocognitive outcomes, representing the first multi-center neuroimaging initiative to be performed in ACHD patients. Limitations of the study include recruitment challenges inherent to an ancillary study, implantable cardiac devices, and harmonization of neuroimaging biomarkers. Results from this research will help shape the care of ACHD patients and further our understanding of the interplay between brain injury and cognitive reserve.

Design of a multi-institutional neurocognitive discovery study in adult congenital heart disease (MINDS-ACHD).

BACKGROUND: Neurocognitive dysfunction (NCD) is a common comorbidity among children with congenital heart disease (CHD). However, it is unclear how underlying CHD and its sequelae combine with genetics and acquired cardiovascular and neurological disease to impact NCD and outcomes across the lifespan in adults with CHD. METHODS: The Multi-Institutional Neurocognitive Discovery Study in Adults with Congenital Heart Disease (MINDS-ACHD) is a partnership between the Pediatric Heart Network (PHN) and the Adult Alliance for Research in Congenital Cardiology (AARCC) that examines objective and subjective neurocognitive function and genetics in young ACHD. This multicenter cross-sectional pilot study is enrolling 500 young adults between 18 and 30 years with moderate or severe complexity CHD at 14 centers in North America. Enrollment includes 4 groups (125 participants each): (1) d-looped Transposition of the Great Arteries (d-TGA); (2) Tetralogy of Fallot (TOF); (3) single ventricle (SV) physiology; and (4) "other moderately or severely complex CHD." Participants complete the standardized tests from the NIH Toolbox Cognitive Battery, the NeuroQoL, the Hospital Anxiety and Depression Scale, and the PROMIS Global QoL measure. Clinical and demographic variables are collected by interview and medical record review, and an optional biospecimen is collected for genetic analysis. Due to the COVID-19 pandemic, participation may be done remotely. Tests are reviewed by a Neurocognitive Core Laboratory. CONCLUSIONS: MINDS-ACHD is the largest study to date characterizing NCD in young adults with moderate or severely complex CHD in North America. Its results will provide valuable data to inform screening and management strategies for NCD in ACHD and improve lifelong care.

An Analysis of Semicircular Channel Backscattering Interferometry through Ray Tracing Simulations.

Recent backscattering interferometry studies utilise a single channel microfluidic system, typically approximately semicircular in cross-section. Here, we present a complete ray tracing model for on-chip backscattering interferometry with a semicircular cross-section, including the dependence upon polarisation and angle of incidence. The full model is validated and utilised to calculate the expected fringe patterns and sensitivities observed under both normal and oblique angles of incidence. Comparison with experimental data from approximately semicircular channels using the parameters stated shows that they cannot be explained using a semicircular geometry. The disagreement does not impact on the validity of the experimental data, but highlights that the optical mechanisms behind the various modalities of backscattering interferometry would benefit from clarification. From the analysis presented here, we conclude that for reasons of ease of analysis, data quality, and sensitivity for a given radius, capillary-based backscattering interferometry affords numerous benefits over on-chip backscattering interferometry.

Measuring the refractive index and sub-nanometre surface functionalisation of nanoparticles in suspension.

Direct measurements to determine the degree of surface coverage of nanoparticles by functional moieties are rare, with current strategies requiring a high level of expertise and expensive equipment. Here, a practical method to determine the ratio of the volume of the functionalisation layer to the particle volume based on measuring the refractive index of nanoparticles in suspension is proposed. As a proof of concept, this technique is applied to poly(methyl methacrylate) (PMMA) nanoparticles and semicrystalline carbon dots functionalised with different surface moieties, yielding refractive indices that are commensurate to those from previous literature and Mie theory. In doing so, it is demonstrated that this technique is able to optically detect differences in surface functionalisation or composition of nanometre-sized particles. This non-destructive and rapid method is well-suited for in situ industrial particle characterisation and biological applications.

Shedding Light on Capillary-Based Backscattering Interferometry.

Capillary-based backscattering interferometry has been used extensively as a tool to measure molecular binding via interferometric refractive index sensing. Previous studies have analysed the fringe patterns created in the backscatter direction. However, polarisation effects, spatial chirps in the fringe pattern and the practical impact of various approximations, and assumptions in existing models are yet to be fully explored. Here, two independent ray tracing approaches are applied, analysed, contrasted, compared to experimental data, and improved upon by introducing explicit polarisation dependence. In doing so, the significance of the inner diameter, outer diameter, and material of the capillary to the resulting fringe pattern and subsequent analysis are elucidated for the first time. The inner diameter is shown to dictate the fringe pattern seen, and therefore, the effectiveness of any dechirping algorithm, demonstrating that current dechirping methods are only valid for a subset of capillary dimensions. Potential improvements are suggested in order to guide further research, increase sensitivity, and promote wider applicability.

Association between pregnancy and long-term cardiac outcomes in individuals with congenital heart disease.

BACKGROUND: As early life interventions for congenital heart disease improve, more patients are living to adulthood and are considering pregnancy. Scoring and classification systems predict the maternal cardiovascular risk of pregnancy in the context of congenital heart disease, but these scoring systems do not assess the potential subsequent risks following pregnancy. Data on the long-term cardiac outcomes after pregnancy are unknown for most lesion types. This limits the ability of healthcare practitioners to thoroughly counsel patients who are considering pregnancy in the setting of congenital heart disease. OBJECTIVE: We aimed to evaluate the association between pregnancy and the subsequent long-term cardiovascular health of individuals with congenital heart disease. STUDY DESIGN: This was a retrospective longitudinal cohort study of individuals identifying as female who were receiving care in two adult congenital heart disease centers from 2014 to 2019. Patient data were abstracted longitudinally from a patient age of 15 years (or from the time of entry into the healthcare system) to the conclusion of the study, death, or exit from the healthcare system. The primary endpoint, a composite adverse cardiac outcome (death, stroke, heart failure, unanticipated cardiac surgery, or a requirement for a catheterized procedure), was compared between parous (at least one pregnancy >20 weeks' gestation) and nulliparous individuals. By accounting for differences in the follow-up, the effect of pregnancy was estimated based on the time to the composite adverse outcome in a proportional hazards regression model adjusted for the World Health Organization class, baseline cardiac medications, and number of previous sternotomies. Participants were also categorized according to their lesion type, including septal defects (ventricular septal defects, atrial septal defects, atrioventricular septal defects, or atrioventricular canal defects), right-sided valvular lesions, left-sided valvular lesions, complex cardiac anomalies, and aortopathies, to evaluate if there is a differential effect of pregnancy on the primary outcome when adjusting for lesion type in a sensitivity analysis. RESULTS: Overall, 711 individuals were eligible for inclusion; 209 were parous and 502 nulliparous. People were classified according to the World Health Organization classification system with 86 (12.3%) being classified as class I, 76 (10.9%) being classified as class II, 272 (38.9%) being classified as class II to III, 155 (22.1%) being classified as class III, and 26 (3.7%) being classified as class IV. Aortic stenosis, bicuspid aortic valve, dilated ascending aorta or aortic root, aortic regurgitation, and pulmonary insufficiency were more common in parous individuals, whereas dextro-transposition of the great arteries, Turner syndrome, hypoplastic right heart, left superior vena cava, and other cardiac diagnoses were more common in nulliparous individuals. In multivariable modeling, pregnancy was associated with the composite adverse cardiac outcome (36.4%% vs 26.1%%; hazard ratio, 1.83; 95% confidence interval, 1.25-2.66). Parous individuals were more likely to have unanticipated cardiac surgery (28.2% vs 18.1%; P=.003). No other individual components of the primary outcome were statistically different between parous and nulliparous individuals in cross-sectional comparisons. The association between pregnancy and the primary outcome was similar in a sensitivity analysis that adjusted for cardiac lesion type (hazard ratio, 1.61; 95% confidence interval, 1.10-2.36). CONCLUSION: Among individuals with congenital heart disease, pregnancy was associated with an increase in subsequent long-term adverse cardiac outcomes. These data may inform counseling of individuals with congenital heart disease who are considering pregnancy.

COVID-19 in Adults With Congenital Heart Disease.

BACKGROUND: Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. OBJECTIVES: This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. METHODS: Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. RESULTS: From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not. CONCLUSIONS: COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.

Correction: Prospective on using fibre mid-infrared supercontinuum laser sources for in vivo spectral discrimination of disease.

Correction for 'Prospective on using fibre mid-infrared supercontinuum laser sources for in vivo spectral discrimination of disease' by Angela B. Seddon et al., Analyst, 2018, 143, 5874-5887.

Prospective on using fibre mid-infrared supercontinuum laser sources for in vivo spectral discrimination of disease.

Mid-infrared (MIR) fibre-optics may play a future role in in vivo diagnosis of disease, including cancer. Recently, we reported for the first time an optical fibre based broadband supercontinuum (SC) laser source spanning 1.3 to 13.4 µm wavelength to cover the spectral 'fingerprint region' of biological tissue. This work has catalysed the new field of fibre MIR-SC and now very bright sources equivalent to a 'few synchrotrons' have been demonstrated in fibre. In addition, we have made record transparency MIR fibre for routeing the MIR light and reported first-time MIR photoluminescence (with long lifetime) in small-core, rare earth ion doped, MIR fibre - an important step towards MIR fibre lasing at >4 µm wavelength for pumping fibre MIR-SC. First time fibre MIR-SC spectroscopic imaging of colon tissue is described at wavelengths in the 'fingerprint region'.

Electrophysiology and structural interventions in adults with congenital heart disease: Comparison of combined versus separate procedures.

BACKGROUND: Electrophysiologic (EP) and structural interventions in adult congenital heart disease (ACHD) are typically completed during separate hospital encounters. With planning/coordination, these cases can be combined. OBJECTIVES: We hypothesized that this integrated approach would yield patient and health system benefits. METHODS: Consecutive ACHD patients undergoing combined interventions were matched to controls with identical but separate procedures. Primary endpoints of total hospital length of stay and cost were compared. RESULTS: Sixty-six combined cases and 120 controls were identified (45% male, mean age 36.2 ± 14.2 years). The most common diagnoses were Fontan (27%), tetralogy of Fallot (23%), and transposition complexes (20%). The most common EP procedure was catheter ablation (n = 30) followed by electrophysiologic study (n = 13); the most common structural intervention was transcatheter valve replacement (n = 16) followed by angioplasty/stenting (n = 14). Compared to controls, cases showed shorter anesthesia duration (323 [IQR 238-405] vs. 355 minutes [270-498], P = 0.06), smaller contrast dose (130 [50-189] vs. 177 mL [94-228], P = 0.045), fewer venipunctures (4 [3-4] vs. 6 [5-7], P < 0.001), and fewer work days missed (2 [2-5] vs. 4 [4-6], P < 0.001). There was shorter hospital stay (30 [19-35] vs. 38 hours [26-50], P = 0.023) and a 37% reduction in hospital charges ($117,894 vs. $187,648; P = 0.039) and 27% reduction in payments ($65,757 vs. $88,859; P = 0.016), persisting after adjustment for group differences. There were no significant differences in number of complications or efficacy. CONCLUSIONS: There appear to be advantages to combining ACHD interventional procedures that include reductions in hospital length of stay and cost, without detectable difference in procedural outcome.

Aortic root compression during transcatheter pulmonary valve replacement.

OBJECTIVES: To describe the incidence of aortic root compression (ARC) during transcatheter pulmonary valve replacement (TPVR). BACKGROUND: ARC can occur during balloon sizing of the right ventricular outflow tract (RVOT) or during coronary compression testing (BS/CCT) prior to TPVR, causing aortic valve dysfunction and/or root distortion with or without coronary compression. This has limited the use of TPVR in patients with native RVOTs, including those with a transannular patch (TAP). The characteristics of this patient cohort have not previously been described. METHODS: A retrospective review was performed of all patients with congenital heart disease who presented for TPVR at UCLA from 2010 to 2015. ARC characteristics during BS/CCT were noted for all relevant cases. RESULTS: Inclusion criteria were met by 174 patients. ARC occurred in 16 patients (9%), of whom 14 had Tetralogy of Fallot with a native/TAP RVOT (14/42, 33%, of all native/TAP patients). Five ARC patients also had concomitant coronary artery compression. Isolated coronary compression occurred in six patients. Two patients underwent successful TPVR despite ARC by implanting the valves in the distal RVOT. One patient required surgical PVR and Sapien valve explantation after TPVR caused severe ARC. CONCLUSIONS: The majority of cases of ARC occur in patients with native/TAP RVOTs. ARC during BS/CCT may identify those at risk for ARC following TPVR. While ARC is a real phenomenon, it is unclear if it can be accurately predicted, what its clinical significance will be and how it is best avoided. Further studies are necessary to answer these questions. © 2016 Wiley Periodicals, Inc.

Cardiac Arrhythmias in Adults With Congenital Heart Disease: Scope, Specific Problems, and Management.

OPINION STATEMENT: Progressive advances in the field of congenital heart disease (CHD) have led to a dramatic rise in the number of affected patients surviving well into adulthood. Groundbreaking and innovative achievements in the medical, surgical, and interventional management of these patients have allowed them to lead full adult lives that have included raising families, completing degrees in higher education, and maintaining successful careers. As patients are living longer, arrhythmias have emerged as one of the most significant factors affecting their morbidity, mortality, and quality of life. This article aims to review the current understanding of arrhythmia within the adult congenital heart disease (ACHD) population, emphasizing recent advances and providing recommendations pertaining to the management of these patients.

Optical imaging beyond the diffraction limit by SNEM: effects of AFM tip modifications with thiol monolayers on imaging quality.

Tip-enhanced nanoscale optical imaging techniques such as apertureless scanning near-field optical microscopy (a-SNOM) and scanning near-field ellipsometric microscopy (SNEM) applications can suffer from a steady degradation in performance due to adhesion of atmospheric contaminants to the metal coated tip. Here, we demonstrate that a self-assembled monolayer (SAM) of ethanethiol (EtSH) is an effective means of protecting gold-coated atomic force microscopy (AFM) probe tips from accumulation of surface contaminants during prolonged exposure to ambient air. The period over which they yield consistent and reproducible results for scanning near-field ellipsometric microscopy (SNEM) imaging is thus extended. SNEM optical images of a microphase separated polystyrene-block-poly (methylmethacrylate) (PS-b-PMMA) diblock copolymer film, which were captured with bare and SAM-protected gold-coated AFM probes, both immediately after coating and following five days of storage in ambient air, were compared. During this period the intensity of the optical signals from the untreated gold tip fell by 66%, while those from the SAM protected tip fell by 14%. Additionally, gold coated AFM probe tips were modified with various lengths of alkanethiols to measure the change in intensity variation in the optical images with SAM layer thickness. The experimental results were compared to point dipole model calculations. While a SAM of 1-dodecanethiol (DoSH) was found to strongly suppress field enhancement we find that it can be locally removed from the tip apex by deforming the molecules under load, restoring SNEM image contrast.

Impact of liver disease after the fontan operation.

Liver disease is being reported with increased frequency in survivors of the Fontan operation. The clinical impact of structural hepatic abnormalities in these patients remains largely unknown. We sought to assess if, and how, cardiologists are screening for hepatic disease in these patients to evaluate for clinical or laboratory correlates of structural hepatic disease and determine the prevalence and clinical impact of such disease. Retrospective data analysis from tertiary institutions was performed. Hepatic imaging studies and serology performed over the last decade were reviewed and clinical and laboratory correlates of structural hepatic alterations on liver imaging or biopsy were sought. Outcomes were determined. In this cohort study, 53 of 60 adult survivors (88%) underwent hepatic imaging with computed tomography, magnetic resonance imaging, or ultrasound with a median number of 2 (0 to 10) studies over the past decade. The frequency of hepatic imaging varied widely with 70% of patients undergoing serial studies. Cirrhosis with or without abnormal hepatic nodules was seen in 29 of 53 patients (55%) at 18.4 ± 5.6 years after the Fontan procedure. Adverse hepatic-related outcome occurred in 22% of the entire patient cohort and was unrelated to time from Fontan operation. In conclusion, there exists significant variability in the type and timing of testing for hepatic complications after the Fontan procedure. Structural hepatic alterations are common and can be associated with significant morbidity and mortality. Routine imaging, and serologic evaluation, is recommended in all Fontan survivors.

Histopathological and immunohistochemical features of early hydatidiform mole in relation to subsequent development of persistent gestational trophoblastic disease.

OBJECTIVE: To examine histomorphological and immunohistochemical findings in hydatidiform moles to determine whether any features can reliably predict clinical behavior. STUDY DESIGN: Blinded semiquantitative review of histological and immunohistochemical findings in cases of partial hydatidiform mole (PHM) (N = 50) and complete hydatidiform mole (CHM) which either spontaneously resolved (N = 50) or required chemotherapy (N = 50). Immunostains assessed included MLH1, MSH2, nm23, TERT, p53, EGFR, and CerbB2 based on previous data. RESULTS: There were marked morphological differences in various criteria between CHMs and PHMs, including the proportion of villi with abnormal trophoblast hyperplasia (29% vs. 6%, respectively). However, there were no significant differences in any morphological parameters between CHMs that spontaneously resolved and those that subsequently required chemotherapy. Similarly, there were no clinically useful differences regarding any immunostaining scores between CHM groups. CONCLUSION: Neither morphological nor immunohistochemical features can reliably predict subsequent requirement of chemotherapy in CHMs.

Living at altitude adversely affects survival among patients with a Fontan procedure.

OBJECTIVES: This study sought to determine whether survival in this cohort of patients was adversely affected by increased residential altitude. BACKGROUND: The success of the Fontan procedure depends in large part on low pulmonary vascular resistance (PVR). Factors that increase PVR, including an increase in residential altitude, may adversely affect long-term outcome. Higher altitude has been shown to affect functional well-being in patients with a Fontan circulation. METHODS: Databases from a tertiary cardiac care center in the Intermountain West (elevation 5,000 feet) were analyzed for patients born with single-ventricle anatomy who would now be of adult age. Complete data were then collected on all identified patients who subsequently underwent the Fontan operation. Correlates of, and time to, adverse outcome, defined as death, cardiac transplantation, or clinical decompensation requiring a move to sea level, were determined. RESULTS: Of 149 patients with single-ventricle anatomy, 103 underwent the Fontan procedure, with 70 surviving to adulthood at moderate altitude. Adverse outcome occurred in 55, with death in 24 (23%), cardiac transplantation in 18 (17%), and clinical decompensation requiring move to sea level in 13 (13%). There was no relationship between type, age at, or era of Fontan procedure and long-term outcome. Correlates of long-term, transplant-free survival at moderate altitude included lower residential altitude (4,296 vs. 4,637 feet, p < 0.001), and lower pulmonary artery pressures before the Fontan procedure (13 vs. 15 mm Hg, p = 0.01), and after (14 vs. 18 mm Hg, p = 0.01). CONCLUSIONS: Long-term outcome after the Fontan procedure is adversely impacted by higher residential altitude.

Incoherently pumped continuous wave optical parametric oscillator broadened by non-collinear phasematching.

In this paper, we report on a singly resonant optical parametric oscillator (OPO) pumped by an amplified spontaneous emission (ASE) source. The pump focusing conditions allow non-collinear phasematching, which resulted in a 230 nm (190 cm(-1)) spectral bandwidth. Calculations indicate that such phasematching schemes may be used to further broaden OPO spectral bandwidths.

Broome virus, a new fusogenic Orthoreovirus species isolated from an Australian fruit bat.

This report describes the discovery and characterization of a new fusogenic orthoreovirus, Broome virus (BroV), isolated from a little red flying-fox (Pteropus scapulatus). The BroV genome consists of 10 dsRNA segments, each having a 3' terminal pentanucleotide sequence conserved amongst all members of the genus Orthoreovirus, and a unique 5' terminal pentanucleotide sequence. The smallest genome segment is bicistronic and encodes two small nonstructural proteins, one of which is a novel fusion associated small transmembrane (FAST) protein responsible for syncytium formation, but no cell attachment protein. The low amino acid sequence identity between BroV proteins and those of other orthoreoviruses (13-50%), combined with phylogenetic analyses of structural and nonstructural proteins provide evidence to support the classification of BroV in a new sixth species group within the genus Orthoreovirus.

Cold ischaemic preservation of human uterine tissue.

Uterine transplantation may be a possible treatment option in the future for absolute uterine infertility. The tolerance of human uterine tissue to cold ischemic preservation is one of the issues that need to be resolved. The objective of this study was to assess the morphological changes in human uterine tissue after cold ischemic preservation in a transplant solution. Small tissue samples of human uteri were subjected to cold ischemia (2-8 degrees C for up to 48 hours) in Celsior transplant solution. Histological analysis by light and electron microscopy was used to assess evidence of cold ischemic injury. Histological examination did not show any major changes of the uterine tissue after 48-hour cold preservation; whereas, electron microscopy after 24 hours confirmed unchanged structural integrity of the uterine myoendometrium. The human uterus is morphologically resistant toward cold ischemia in Celsior preservation solution for up to 24 hours and may be suitable for transplantation purposes.

Value of whole body 18FDG-PET to identify the active site of gestational trophoblastic neoplasia.

OBJECTIVE: To evaluate the usefulness of positron emission tomography with 18-fluorodeoxyglucose (18FDG-PET) in locating residual or relapsed gestational trophoblastic neoplasia (GTN). STUDY DESIGN: The Charing Cross GTN database was screened, and 11 patients who had undergone 18FDG-PET were identified. A retrospective analysis was conducted to determine the value of this investigation as compared with other imaging modalities in clinical care. RESULTS: All patients had elevated beta-human chorionic gonadotropin (beta-hCG) at the time of the investigation; none were false positive. In 7 patients the 18FDG-PET scans correctly confirmed the presence (4 of 7 cases) or absence (3 of 7 cases) of disease sites defined by other imaging investigations. In 2 patients positive PET-guided appropriate surgical resection of lung lesions that appeared of equivocal significance on computed tomography (CT) resulted in -hCG normalization. One patient had a pulmonary metastasis on CT not considered positive on 18FDG-PET (false negative). One patient with enlarged mediastinal lymph nodes on CT that were 18FDG-PET positive also had a vascular uterus on magnetic resonance imaging/Dopper ultrasound that was negative on PET (false negative). Hysterectomy led to hCG normalization and cure. The mediastinal lymph nodes were positive on CT and PET due to sarcoidosis (false positive). Patients with serum hCG levels <10 IU/L could have positive PET scans; that can contribute to patient care. CONCLUSION: 18FDG-PET can aid in identifying residual disease sites in women relapsing from previously treated GTN. However, careful evaluation in combination with other imaging modalities is required to reduce the risk of false positive and negative results.