For patients with estrogen receptor (ER) positive breast cancer, endocrine therapy plays a major role in both the adjuvant and palliative setting. For adequate treatment decision-making it is crucial to obtain up-to-date information on the ER-status of the tumor(s), since ER-expression is the sole predictor for response to endocrine therapy. Moreover, ER-status can change during the course of disease in up to 30% of the patients, and therefore treatments based on the ER-status of the primary tumor may be inadequate. Positron emission tomography (PET) imaging of ER-expression by use of the tracer 16α-[18F]fluoro-17β-oestradiol (FES) can give functional information about the ER-status of all lesions within the body. The aim of this thesis is to address the clinical potential of the FES-PET technique in breast and ovarian cancer patients.

This thesis provides farsighted insights in the presence of cardiac sympathetic denervation in different patient groups, the outcome of patients with denervation and the value of SPECT and PET in predicting outcome.
Cardiac amyloidosis is associated with denervation and therefore belonging to one of these indications. Imaging of cardiac sympathetic innervation is of interest in these patients, since amyloid depositions can be present along the sympathetic nerves, and thus leading to electromechanical dissociation. Chapter 2 and 3 investigate the use of [123I]-MIBG for the visualization of denervation in patients with cardiac amyloidosis.
Chapter 4 focuses on the use of [123I]-MIBG for denervation imaging in patients with end-stage chronic kidney failure, who make the transition from the pre-dialysis phase to maintenance hemodialysis (HD). Cardiac sympathetic innervation appears to be already disrupted before the start of maintenance HD.
A third group of interest for cardiac sympathetic innervation imaging is patients with (non-) ischemic heart failure, especially regarding to risk on ventricular arrhythmia and response to resynchronization therapy (CRT). Chapter 5 describes the use of [11C]-mHED in patients with ischemic cardiomyopathy, treated with prophylactic implantable cardioverter defibrillator. Chapter 6 investigates the use of [11C]-mHED in patients with non-ischemic cardiomyopathy treated with CRT.
In Chapter 7 the value of [18F]-FDOPA is evaluated in detecting cardiac metastases and the relationship of these metastases to the presence of typical characteristics of carcinoid heart disease on echocardiography.
Chapter 8 focusses on future perspectives of imaging cardiac sympathetic innervation, with respect to better identification of patients at risk.