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Annals of Nuclear Medicine (v.21, #6)

Assessment of cardiac function in patients with heart disease by quantitative gated myocardial perfusion SPECT by Ichiro Nakae; Shinro Matsuo; Takayoshi Tsutamoto; Tetsuya Matsumoto; Kenichi Mitsunami; Minoru Horie (pp. 315-323).

We examined the cardiac function of patients who underwent Tc-99m sestamibi quantitative gated myocardial single photon emission computed tomography with 16-framing data acquisition between January 1, 2004 and March 31, 2006 for an evaluation of suspected or known heart disease in our hospital.In 192 patients aged ≥40 years, the left ventricular (LV) systolic function [parameter: ejection fraction (EF)] and diastolic function [first third filling fraction (1/3FF), peak filling rate (PFR), and time-to-peak filling (TPF)] were estimated by volume curve analysis. In 51 (age ≥60 years) of 192 patients, brachial-ankle pulse wave velocity (baPWV) was also measured.The correlation between diastolic parameters PFR and 1/3FF was mild (r = 0.28, P < 0.001). On the basis of EF and PFR, 192 patients were divided into four groups: P (preserved LV function), Q (isolated systolic dysfunction, EF < 50%), R (isolated diastolic dysfunction, PFR < 1.8 EDV/s), and S (both dysfunctions). The numbers of patients in P, Q, R, and S groups were 94 (49.0%), 7 (3.6%), 31 (16.1%), and 60 (31.3%), respectively. The 1/3FF correlated weakly but significantly with age (r = −0.16, P < 0.05). The TPF also correlated weakly with age (r = 0.25, P < 0.01), but EF did not. The baPWV, an indicator of cardiovascular stiffness, correlated inversely with 1/3FF (r = −0.59, P < 0.001) or correlated positively with TPF (r = 0.45, P < 0.001), but not with EF.Our study suggests that cardiovascular stiffness associated with increased baPWV may contribute to the occurrence of diastolic dysfunction in elderly patients.

Keywords: Cardiac function; Gated myocardial perfusion SPECT; Pulse wave velocity

Diffuse and diffuse-plus-focal uptake in the thyroid gland identified by using FDG-PET: prevalence of thyroid cancer and Hashimoto's thyroiditis by Seiji Kurata; Masatoshi Ishibashi; Yuji Hiromatsu; Hayato Kaida; Ikuyo Miyake; Masafumi Uchida; Naofumi Hayabuchi (pp. 325-330).

To investigate and evaluate the prevalence of incidental thyroid diffuse and diffuse-plus-focal fluorine-18 fluorodeoxyglucose (FDG) uptake in healthy subjects who underwent cancer screening on positron emission tomography (PET) scan, and also to evaluate the prevalence of thyroid cancer and Hashimoto's thyroiditis.We carried out a retrospective review of 1626 subjects who underwent PET scanning at our institution. Diffuse uptake was defined as FDG uptake in the whole thyroid gland, whereas diffuse-plus-focal uptake was defined as a thyroid lesion with both diffuse uptake and focal FDG uptake. The maximum standardized uptake value of the thyroid lesions was recorded and reviewed. In each selected subject with positive thyroid FDG uptake, serum thyroid-stimulating hormone, thyroid hormone, and thyroid antibodies were measured. Fine needle aspiration cytology was performed on patients with a definite nodule using ultrasonography.Twenty-nine subjects (1.78%) were identified as having either diffuse FDG uptake (n = 25, 1.53%) or diffuse-plus-focal FDG uptake (n = 4, 0.24%). All subjects with diffuse FDG uptake were diagnosed as having Hashimoto's thyroiditis. In 1 of the 25 subjects with diffuse FDG uptake and two of the four with diffuse-plus-focal FDG uptake, histopathologic diagnosis showed papillary thyroid carcinoma associated with Hashimoto's thyroiditis. However, PET scan did not detect papillary carcinoma associated with Hashimoto's thyroiditis in one of the three subjects.Our results suggest that although diffuse FDG uptake usually indicates Hashimoto's thyroiditis, the risk of thyroid cancer must be recognized in both diffuse FDG uptake and diffuse-plus-focal FDG uptake on PET scan.

Keywords: FDG-PET; Diffuse FDG uptake; Cancer screening; Hashimoto's thyroiditis; Thyroid cancer

Comparison of MET-PET and FDG-PET for differentiation between benign lesions and lung cancer in pneumoconiosis by Kakuko Kanegae; Ikuo Nakano; Kiyonobu Kimura; Hiroshi Kaji; Yuji Kuge; Tohru Shiga; Songji Zhao; Shouzo Okamoto; Nagara Tamaki (pp. 331-337).

The aim of this study was to evaluate and compare the ability of C-11-methionine (MET) and F-18 fluoro-deoxy-d-glucose positron emission tomography (FDG-PET) to diagnose lung cancer in patients with pneumoconiosis.Twenty-six subjects underwent both whole-body MET-PET and FDG-PET on the same day. The first group was a lung cancer group, which consisted of 15 patients, and included those with pneumoconiosis with increased nodules (13 cases), hemoptysis (1 case), and positive sputum cytology (1 case). The second group was a no-malignancy control group, consisting of 11 patients with pneumoconiosis.Significant correlations between nodule size and the maximum standardized uptake value (SUV_max) of the two PET tracers were observed in the control group. The larger the nodule size, the greater were the amounts of these tracers accumulated (MET: r = 0.771, P < 0.0001; FDG: r = 0.903, P < 0.0001). The SUV_max of MET was significantly lower than that of FDG in the pneumoconiotic nodules (P < 0.0001). Lung cancer was found in 5 of 19 nodules (two with adenocarcinoma, one with squamous cell carcinoma, one with small cell carcinoma, and one with large cell carcinoma) in the first group. As for nodules equal to or less than 3 cm in diameter, the SUV_max of MET was significantly higher in the lung cancer than in the pneumoconiotic nodules, with 3.48 ± 1.18 (mean ± SE) for the lung cancer and 1.48 ± 0.08 for the pneumoconiotic nodules (P < 0.01), similar to the SUV_max of FDG, with 7.12 ± 2.36 and 2.85 ± 0.24 (P < 0.05), respectively. On the basis of the criteria for the control group, FDG and MET identified lung cancer with sensitivities of 60% and 80%, specificities of 100% and 93%, accuracies of 90% and 90%, positive predictive values of 100% and 80%, and negative predictive values of 88% and 93%, respectively.Our results indicate that nodules with an intense uptake of MET and FDG relative to their size should be carefully observed because of a high risk for lung cancer.

Keywords: FDG; PET; C-11-methionine; Pneumoconiosis; Lung cancer

Suppressing bladder artifacts in bone SPECT of the pelvis by Gilles Allenbach; John O. Prior; Nicolas Theumann; Nessria El-Hasnawy; Jerome Malterre; Angelika B. Delaloye; Ehab M. Kamel (pp. 339-344).

Bladder-filling reconstruction artifacts have a detrimental effect on the image quality of pelvic bone single photon emission computed tomography (SPECT). Using a simple protocol consisting of forced diuresis coupled with intravenous (IV) hydration, this study was undertaken to obtain an artifact-free pelvic SPECT after discarding the residual urinary activity.Thirty patients were enrolled. In group I, pelvic SPECT was performed directly after normal void, whereas in group II, SPECT was preceded by IV injection of 0.5 mg/kg furosemide (maximum 40 mg) coupled with IV infusion of 500 cc of physiologic saline. Bladder-filling reconstruction artifacts were analyzed in group I patients, who had their images reconstructed using both filtered backprojection and iterative algorithms, both qualitatively and quantitatively by means of regions of interest (ROIs) drawn around the artifact-bearing bone areas as well as the corresponding contralateral sites. For group II patients, besides visual analysis, ROIs were placed over the sites corresponding to those of the group I patients. In every patient, total counts of each ROI were normalized to a reference ROI placed over the sacrum, and a ratio was created.Using filtered backprojection, two forms of artifacts were identified in group I patients: first, a streak pattern that extended to the sacro-iliac joint in nine (60%) patients, the hip joint in five (33%), the superior pubic rami in four (27%), the sacrum in three (20%), and the ischium in one (6%); second, a count loss subtype which extended to the hip joints in nine (60%) patients. Corresponding values after iterative reconstruction were two (13%) for the sacro-iliac joint, three (20%) for the hip joint, one (6%) for the superior pubic ramus, and one (6%) for the sacrum. In five (33%) patients, residual count loss artifacts were still identifiable after iterative reconstruction. However in group II, no such effects were observed because the bladder activity reached near background level in 14 (93%) of 15 patients after three successive voids with a 3.5-fold decrease in the mean value of total bladder count in comparison with group I patients. A statistically significant difference was found between artifact- and non-artifact-harboring ROIs in group I whichever the method used for reconstruction, whereas the values of right and left hemi-pelvis ROIs/sacrum in group II were almost identical.Forced diuresis coupled with parenteral hydration facilitates the acquisition of an artifact-free pelvic SPECT. Especially for clinical questions that focus on femoral heads and pubic bones, applying the aforementioned protocol may improve the diagnostic accuracy of pelvic bone SPECT.

Keywords: Bladder artifacts; Forced diuresis; Pelvic bone SPECT

Physiological FDG uptake in the ovaries after hysterectomy by Sadahiko Nishizawa; Masayuki Inubushi; Fukujiro Ozawa; Aki Kido; Hiroyuki Okada (pp. 345-348).

It is known that focal ¹⁸F-fluorodeoxyglucose (FDG) uptake is physiologically seen in the ovaries and uterus of premenopausal women in correlation with the menstrual cycle, which may cause false-positive diagnoses on the images of FDG positron emission tomography (PET). The objective of this study was to clarify whether women of reproductive age after hysterectomy whose ovaries were preserved, also showed physiological ovarian FDG uptake.We reviewed 26 women after hysterectomy (age 51.1 ± 5.0 years), who underwent annual cancer screening, including FDG-PET and pelvic magnetic resonance (MR) imaging, three times.Seven women (age 45.9 ± 5.8 years, range 34–52 years) had at least one ovary, showing changes in its appearance including the size and number of follicles on MR images each year, which suggested that the ovary was functioning. Four of the seven women showed focal FDG uptake (standardized uptake value 4.2 ± 1.1) that corresponded to the normal ovaries on five PET examinations. Another group of 19 women (age 53.1 ± 3.1 years, range 47–59 years) who had small ovaries without changes on MR images each year did not show FDG uptake in the ovaries.Physiological FDG uptake observed in the ovaries of women of reproductive age even after hysterectomy is reasonably common. As it is not easy to determine the hormonal cycle in these women, it is essential to correlate focal FDG uptake in the pelvis with anatomical and morphological findings on MR images to avoid false-positive diagnoses.

Keywords: FDG; PET; Ovary; Physiological uptake; Hysterectomy

Effects of smoking on the lung accumulation of [¹¹C]McN5652 by Akihiro Takano; Hiroshi Ito; Yasuhiko Sudo; Makoto Inoue; Tetsuya Ichimiya; Fumihiko Yasuno; Kazutoshi Suzuki; Tetsuya Suhara (pp. 349-354).

The lung is one of the key organs for determining the distribution of drugs in the human body. Various factors influence the accumulation of drugs. In this study, we investigated the effects of smoking on drug distribution to the lung using radiolabeled drugs.We measured the lung uptake of [¹¹C](+)McN5652, a radioligand for serotonin transporter (5-HTT), and inactive enantiomer [¹¹C](−)McN5652 in 19 healthy men (12 nonsmokers and 7 smokers) using positron emission tomography. Pretreatment study was performed by the administration of clomipramine (50 mg), a potent 5-HTT inhibitor.The mean lung uptake of [¹¹C](+)McN5652 and [¹¹C](−)McN5652 was significantly higher in smokers than in nonsmokers. The lung uptake of [¹¹C](+)McN5652 decreased after pretreatment with clomipramine, whereas that of [¹¹C](−)McN5652 was not affected by clomipramine.Lung uptake of [¹¹C](−)McN5652 was influenced by smoking, possibly because the probable nonspecific binding accumulation was changed as [¹¹C](−)McN5652 was reported to have negligible affinity to 5-HTT. Smoking might be one of the important factors when distribution of radioligands is considered.

Keywords: Keywords Nonspecific binding; [¹¹C]McN5652; Smoking; Microdosing; Lung

Mapping of central dopamine synthesis in man, using positron emission tomography with l-[β-¹¹C]DOPA by Hiroshi Ito; Miho Shidahara; Harumasa Takano; Hidehiko Takahashi; Shoko Nozaki; Tetsuya Suhara (pp. 355-360).

To estimate the presynaptic function of the central dopaminergic system, positron emission tomography measurement of the endogenous dopamine synthesis rate was performed with l-[β-¹¹C]DOPA. In the present study, we developed a simple method for calculating an indicator of the dopamine synthesis rate with l-[β-¹¹C]DOPA on a voxel-by-voxel basis for parametric mapping.After intravenous injection of l-[β-¹¹C]DOPA, dynamic scanning was performed on ten healthy men for 89 min. The dopamine synthesis ratio was calculated on a voxel-by-voxel basis as the ratio of the area under the time-activity curves of brain regions to the reference brain region, that is, occipital cortex. The overall uptake rate constant as an indicator of dopamine synthesis was also calculated by kinetic and graphical analyses.The dopamine synthesis ratio calculated by the present method was in good agreement with the indicators of dopamine synthesis calculated by kinetic and graphical analyses, although a systemic underestimation was observed, especially when the integration interval was set in the early phase of the scan duration. In particular, underestimations were prominent in brain regions with relatively lower influx rate constant K ₁.By this method, regional dopamine synthesis could be estimated on a voxel-by-voxel basis. This method does not need an arterial input function and should prove to be useful for clinical research.

Keywords: Dopamine; DOPA; Brain; PET

Metastasis of the gastrointestinal tract: FDG-PET imaging by Kazumasa Hayasaka; Takashi Nihashi; Toshihiro Matsuura; Tetsuya Yagi; Kazumitsu Nakashima; Yasuji Kawabata; Kengo Ito; Takashi Katoh; Keita Sakata; Atsushi Harada (pp. 361-365).

We assess the usefulness of F-18-fluoro-deoxyglucose (FDG) positron emission tomography (PET) in the evaluation of gastrointestinal metastases. Four cases (five lesions) in which metastases from three lung cancers and one malignant fibrous histiocytoma (MFH) of the femur were found in the gastrointestinal tract were reviewed (men/women 3 : 1, age 63–78 years, mean 72 years). The five lesions were duodenal, jejunal metastasis, and two stomach metastases from lung carcinoma, and rectal metastasis from MFH of the femur. FDG-PET was unable to detect small masses, but it was able to detect unforeseen lesions such as gastrointestinal metastases because FDG-PET is a whole-body scan in a single-operation examination. FDG-PET imaging provided valuable information for the diagnosis of gastrointestinal metastasis.

Keywords: F18-FDG-PET; Gastrointestinal tract; Secondary neoplasms

Airway complication occurring during radioiodine treatment for Graves' disease by Seigo Kinuya; Tatsuya Yoneyama; Takatoshi Michigishi (pp. 367-369).

Airway complications rarely occur in ¹³¹I radioiodine therapy for Graves' disease. This study presents two cases in which ¹³¹I therapy caused this acute complication. The patients complained of the symptom 6 h and 33 h after administration of ¹³¹I. A histamine H1 receptor antagonist and hydrocortisone rapidly resolved symptoms in both cases. These two cases remind physicians that ¹³¹I therapy for Graves' disease may cause potentially life-threatening complications.

Keywords: ¹³¹I; Graves' disease; Airway complication

Massive inguinoscrotal herniation of the bladder with ureter: incidental demonstration on bone scan by Seyfettin Ilgan; Mehmet Ozguven; Mustafa O. Emer; Alper O. Karacalioglu (pp. 371-373).

Inguinoscrotal herniation of the bladder is a rare clinical entity. The condition is often diagnosed incidentally or during the course of surgical repair of inguinal hernias. In a smaller number of cases, bladder hernia can be seen during nuclear medicine studies. We report a rare case of massive inguinoscrotal bladder herniation with ureter, causing urinary stasis on bone scintigraphy.

Keywords: Inguinal hernia; Bladder; Bone scintigraphy

A ¹⁸F-FDG-positive, ⁶⁷Ga-negative, and transferrin receptor expression-negative patient with diffuse large B-cell lymphoma by Tetsuya Tsujikawa; Hidehiko Okazawa; Tatsuro Tsuchida; Yoshiki Demura; Yoshiaki Imamura; Yasuhisa Fujibayashi (pp. 375-378).

We recently experienced a case with uveitis suffering from fever of unknown origin suspected of being caused by sarcoidosis. Chest computed tomography showed right supraclavicular, bilateral mediastinal, and right hilar lymphadenopathy, and intensive abnormal uptake of 2-[¹⁸F]fluoro-2-deoxy-d-glucose (¹⁸F-FDG) was observed on positron emission tomography with ¹⁸F-FDG (FDG-PET). On the other hand, ⁶⁷Ga scintigraphy showed almost no abnormal findings. Histopathological examination revealed the lesion to be a diffuse large B-cell lymphoma (DLBCL), namely, an aggressive non-Hodgkin lymphoma from a right supraclavicular lymph node biopsy specimen. Additional immunohistochemical analysis showed the negative expression of transferrin receptor (TfR) on the formalin-fixed paraffin-embedded specimen. Although DLBCL is generally considered to be a ⁶⁷Ga-avid tumor, it does not always have a large number of TfRs and that leads to a discrepancy between the ⁶⁷Ga scintigraphy and FDG-PET findings. FDG-PET should be more appropriate for the initial staging of DLBCL than ⁶⁷Ga scintigraphy, whereas ⁶⁷Ga scintigraphy might be able to provide additional information including prognostic factors and to support strategies that target TfR for cancer therapy.

Keywords: Diffuse large B-cell lymphoma; ⁶⁷Ga scintigraphy; Transferrin receptor; FDG-PET

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Annals of Nuclear Medicine (v.21, #6)