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Annals of Nuclear Medicine (v.21, #9)
Performance profile of FDG-PET and PET/CT for cancer screening on the basis of a Japanese Nationwide Survey by Ryogo Minamimoto; Michio Senda; Kimiichi Uno; Seishi Jinnouchi; Takeshi Iinuma; Kengo Ito; Chio Okuyama; Kazuhiro Oguchi; Masami Kawamoto; Yutaka Suzuki; Eriko Tsukamoto; Takashi Terauchi; Rumi Nakashima; Masami Nishio; Sadahiko Nishizawa; Hiroshi Fukuda; Tsuyoshi Yoshida; Tomio Inoue (pp. 481-498).
The aim of this study is to survey the situation of 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) cancer screening in Japan and to describe its performance profile.“FDG-PET for cancer screening” was defined as FDG-PET or positron emission tomography and computed tomography (PET/CT) scan with or without other tests performed for cancer screening of healthy subjects. We sent questionnaires regarding FDG-PET cancer screening to 99 facilities in which FDG-PET tests were performed during the fiscal year 2005. Replies were obtained from 68 of the 99 facilities, of which 46 facilities performed FDG-PET cancer screening. The total number of subjects who underwent FDG-PET cancer screening was 50 558. From 38 of 46 facilities, reliable results of thorough examinations were obtained for the subjects who were positive by FDG-PET and/or one or more of the combined screening tests was performed and were referred for further evaluation. The total number of subjects in these 38 facilities amounted to 43 996.A total of 50 558 healthy subjects underwent FDG-PET (including PET/CT) scanning with or without other tests for cancer screening in 46 PET centers during the fiscal year of 2005 in Japan. Thorough examination was indicated for 9.8% of the cases as a result of positive findings suggesting possible cancer. On analyzing 43 996 cases from 38 PET centers from which detailed information was obtained, 500 cases of cancers (1.14%) were found, of which 0.90% were PET positive and 0.24% were PET negative, resulting in the relative sensitivity of PET being 79.0%. Cancers of the thyroid, colon/rectum, lung, and breast were most frequently found (107, 102, 79, and 35 cases, respectively) with high PET sensitivity (88%, 90%, 80%, and 92%). PET showed an overall positive predictive value of 29.0%. PET/CT had a better detection rate, sensitivity, and positive predictive value than dedicated PET (P < 0.01).We were able to clarify the performance profile of “FDG-PET for cancer screening” on the basis of a Japanese nationwide survey. The number of facilities possessing PET is increasing steadily, highlighting the necessity of evaluating the usefulness of “FDG-PET cancer screening” as soon as possible by undertaking long-term investigations of large series of subjects.
Keywords: FDG; PET; PET/CT; Cancer screening
Clinical significance of the serum IL-2R level and Ga-67 scan findings in making a differential diagnosis between sarcoidosis and non-Hodgkin's lymphoma by Tamotsu Kita; Sadahiro Watanabe; Fuzuki Yano; Katsumi Hayashi; Masayoshi Yamamoto; Yoshie Iwasaki; Shigeru Kosuda (pp. 499-503).
To compare the serum-soluble interleukin-2 receptor (sIL-2R) levels of non-Hodgkin's lymphoma patients and active sarcoidosis patients in relation to the 67Ga scan findings.A total of 29 adenopathy patients suspected of having non-Hodgkin's lymphoma or sarcoidosis were enrolled in the study. All patients underwent a whole-body 67Ga scan and single-photon emission computed tomography studies 48 h after intravenous injection of 67Ga citrate. The sIL-2R levels were compared between the sarcoidosis patients and non-Hodgkin's lymphoma patients, the patients with and without the panda and/or lambda sign, the lymphoma patients with stage I/II disease and with stage III/IV disease, and the sarcoidosis patients and non-Hodgkin's lymphoma patients with stage III/IV disease.The range of the sIL-2R levels was 195–3750 U/ml in sarcoidosis and 240–62 300 U/ml in non-Hodgkin's lymphoma. The sIL-2R levels of the six non-Hodgkin's lymphoma patients with stage III/IV disease were significantly higher than those of the 15 sarcoidosis patients (P < 0.001). The sIL-2R levels of the sarcoidosis patients with the panda and/or lambda sign were significantly higher than those with neither sign (P < 0.005). The sIL-2R levels of the non-Hodgkin's lymphoma patients with stage III/IV disease were significantly higher than those of the patients with stage I/II disease (P < 0.005).Measurement of sIL-2R levels was sometimes useful in differentiating between sarcoidosis and stage III/IV non-Hodgkin's lymphoma, staging non-Hodgkin's lymphoma, and predicting the presence of the panda and/or lambda sign in sarcoidosis patients.
Keywords: sIL-2R; Sarcoidosis; Malignant lymphoma
Creation and characterization of Japanese standards for myocardial perfusion SPECT: database from the Japanese Society of Nuclear Medicine Working Group by Kenichi Nakajima; Shinichiro Kumita; Yoshio Ishida; Mitsuru Momose; Jun Hashimoto; Koichi Morita; Junichi Taki; Shohei Yamashina; Hirotaka Maruno; Masami Ogawa; Masahiro Kubota; Munehiro Takahashi; Tetsuro Odagawa; Koichi Yokozuka (pp. 505-511).
Standards for myocardial single-photon emission computed tomography (SPECT) adapted for a Japanese population were not available. The purpose of this study was to create standard files approved by the Japanese Society of Nuclear Medicine and to make known the characteristics of the myocardial perfusion pattern of this population.With the collaboration of nine hospitals, a total of 326 sets of exercise–rest myocardial perfusion images were accumulated from subjects with a low likelihood of cardiac diseases. The normal database included a 99mTc-MIBI/tetrofosmin myocardial perfusion study with 360° (n = 80) and 180° (n = 56) rotations, 201Tl study with 360° (n = 115) and 180° rotations (n = 54) and a dual-isotope study with 360° rotation (n = 27). The projection images were transferred by digital imaging and communications in medicine (DICOM) format and reconstructed and analyzed with polar maps.The projection data from multiple centers were successfully transferred to a common format for SPECT reconstruction. When the average values were analyzed using a 17-segment model, myocardial counts in the septal segment differed significantly between 180° and 360° rotation acquisitions. Regional differences were observed between men and women in the inferior and anterior regions. A tracer difference between 99mTc and 201Tl was also observed in some segments. The attenuation patterns differed significantly between subjects from the United States and those from Japan.Myocardial perfusion data that were specific for the Japanese population were generated. The normal database can serve a standard for nuclear cardiology work conducted in Japan.
Keywords: Myocardial perfusion imaging; SPECT; Standard; Japanese population; Working Group of the Japanese Society of Nuclear Medicine
Prognostic value of 123I-metaiodobenzylguanidine in patients with various heart diseases by Hitoshi Nagamatsu; Mitsuru Momose; Hideki Kobayashi; Kiyoko Kusakabe; Hiroshi Kasanuki (pp. 513-520).
It has been reported that 123I-metaiodobenzylguanidine (MIBG) scintigraphy can predict the poor prognosis in patients with dilated cardiomyopathy (DCM). However, the prognostic significance of MIBG is still unknown in patients with other heart diseases. In this study, we compared the prognosis and MIBG findings in various heart diseases.Consecutive 565 patients undergoing MIBG scintigraphy were enrolled (392 men, 52 ± 16 years). Indications were that 127 had ischemic heart disease (IHD), 120 DCM, 101 hypertrophic cardiomyopathy (HCM), 21 hypertensive heart disease (HHD), 58 volume-load valvular disease (VVD), 38 pressure-load valvular disease (PVD), and 101 ventricular tachycardia or fibrillation (VTF). Heart-to-mediastinum ratio (H/M) and washout rate (WR) of MIBG were evaluated. Cardiac events were defined as sudden cardiac death, heart failure, and acute ischemic event (follow-up, 22.7 ± 17.0 months).A total of 106 cardiac events including 40 cardiac deaths occurred. Cox hazard model analysis showed that in the IHD, HCM, and DCM groups, H/M and WR were associated with cardiac death, but not in the HHD, PVD, VVD, or VTF groups. Only death and congestive heart failure (CHF) episodes were related to H/M and WR. On the other hand, fatal arrhythmia, myocardial infarction, or angina pectoris were not related to H/M and WR. The data indicated that WR or H/M may predict death and CHF but does not predict fatal arrhythmia or acute ischemic event.MIBG WR and H/M were associated with heart failure, sudden death, and cardiac death events, and were useful to predict the prognosis in DCM, HCM, and IHD. In contrast, fatal arrhythmia events were not associated with MIBG indices, and thus it does not appear to be useful in predicting cardiac events in patients with VTF.
Keywords: MIBG; Prognosis; Cardiac event
F-18 fluorodeoxyglucose accumulation in an inflammatory pseudotumor of the spleen by Motohiro Sato; Isao Takasaka; Toshiyuki Okumura; Yasukazu Shioyama; Yuji Asato; Fuyo Yoshimi; Jyouji Imura; Ryuta Amemiya (pp. 521-524).
We report on a case with an inflammatory pseudotumor of the spleen, which showed a moderate accumulation of F-18 fluorodeoxyglucose (FDG) in the tumor. F-18 FDG accumulated mainly in the peripheral portion of this tumor that showed abundant hypercellular inflammatory cells histopathologically. Splenic inflammatory pseudotumors should be recognized as F-18 FDG-avid benign tumors of the spleen.
Keywords: Inflammatory pseudotumor (IPT); Inflammatory myofibroblastic tumor (IMT); Spleen; F-18 fluorodeoxyglucose (F-18 FDG); Positron emission tomography (PET)
Visualization of nasolacrimal drainage system after radioiodine therapy in patients with thyroid cancer by Harumi Sakahara; Shuhei Yamashita; Kazunori Suzuki; Michiko Imai; Takashi Kosugi (pp. 525-527).
The objective of this study was to report three cases with an accumulation of 131I in the nasolacrimal duct after radioiodine therapy for papillary thyroid cancer. A whole-body scan was taken 3 days after the administration of 3.7 GBq of 131I. Single-photon emission computed tomography (SPECT)/CT images were added when the location of a focal tracer uptake was undetermined on whole-body scans. In case 1, a 62-year-old woman complained of epiphora of the left eye after nine radioiodine therapies with a cumulative dose of 31.08 GBq. The left nasolacrimal duct was visualized at her tenth treatment with 131I. In case 2, a series of three radioiodine therapies had been given to a 73-year-old woman with a cumulative dose of 11.1 GBq. The accumulation of 131I was noted in the left nasolacrimal duct at her fourth treatment. She complained of epiphora of the left eye. In case 3, bilateral nasolacrimal ducts were visualized at the second radioiodine therapy in a 75-year-old woman. The patient had received 3.7 GBq of 131I at the first therapy. She did not complain of epiphora. It is possible that radiation from 131I that is secreted in tears and/or actively accumulated in the nasolacrimal duct may induce nasolacrimal duct obstruction. 131I in tears would be responsible for the visualization of nasolacrimal duct in the first two cases. 131I actively accumulated in the nasolacrimal duct might have been visualized in the third case. In summary, 131I is excreted in tears and is actively accumulated in the nasolacrimal duct. Obstruction of the lacrimal drainage system could occur after high-dose radioiodine therapy.
Keywords: Radioiodine therapy; Nasolacrimal duct; Epiphora
Occult thyroid carcinoma detected by FDG-PET scan in elderly osteosarcoma patients: report of two cases by Min S. Kim; Youn S. Sim; Soo-Yong Lee; Dae-Geun Jeon (pp. 529-532).
Osteosarcoma is a rare tumor in elderly patients. Simultaneous osteosarcoma and thyroid papillary carcinoma are much rarer, especially in the absence of early radiation or cancer predisposition. We present two patients with concurrent osteosarcoma and thyroid cancer that were detected using positron-emission tomography.
Keywords: Osteosarcoma; Thyroid cancer; PET scan
Distribution volume as an alternative to the binding potential for sigma1 receptor imaging by Yuichi Kimura; Mika Naganawa; Muneyuki Sakata; Masatomo Ishikawa; Masahiro Mishina; Keiichi Oda; Kenji Ishii; Kiichi Ishiwata (pp. 533-535).
The applicability of total distribution volume (DVt) as an alternative to binding potential (BP) was investigated for neuroreceptor mapping by positron emission tomography (PET). BP is defined as a representative quantity of receptor density. However, for making parametric images of BP, a reference region where an aimed receptor has a very low density is assumed to exist in a target region such as the brain. Thus, if the kinetics of a radioligand for target receptors does not permit an appropriate reference region, BP imaging is unattainable. In this study, [11C]SA4503 PET is taken to be considered which has a high affinity to the sigma1 receptors. Through a clinical investigation using wide ranges of physiological situations, ages, sex, diseases, and selective drug-loading conditions, DVt has a good linear relationship with BP, and the images can be used as a spatial distribution of sigma1 density.
Keywords: Receptor imaging; Kinetic; PET; Sigma1 ; Logan plot
Accelerated 3D-OSEM image reconstruction using a Beowulf PC cluster for pinhole SPECT by Tsutomu Zeniya; Hiroshi Watabe; Antti Sohlberg; Hidehiro Iida (pp. 537-543).
A conventional pinhole single-photon emission computed tomography (SPECT) with a single circular orbit has limitations associated with non-uniform spatial resolution or axial blurring. Recently, we demonstrated that three-dimensional (3D) images with uniform spatial resolution and no blurring can be obtained by complete data acquired using two-circular orbit, combined with the 3D ordered subsets expectation maximization (OSEM) reconstruction method. However, a long computation time is required to obtain the reconstruction image, because of the fact that 3D-OSEM is an iterative method and two-orbit acquisition doubles the size of the projection data. To reduce the long reconstruction time, we parallelized the two-orbit pinhole 3D-OSEM reconstruction process by using a Beowulf personal computer (PC) cluster.The Beowulf PC cluster consists of seven PCs connected to Gbit Ethernet switches. Message passing interface protocol was utilized for parallelizing the reconstruction process. The projection data in a subset are distributed to each PC. The partial image forward- and back-projected in each PC is transferred to all PCs. The current image estimate on each PC is updated after summing the partial images. The performance of parallelization on the PC cluster was evaluated using two independent projection data sets acquired by a pinhole SPECT system with two different circular orbits.Parallelization using the PC cluster improved the reconstruction time with increasing number of PCs. The reconstruction time of 54 min by the single PC was decreased to 10 min when six or seven PCs were used. The speed-up factor was 5.4. The reconstruction image by the PC cluster was virtually identical with that by the single PC.Parallelization of 3D-OSEM reconstruction for pinhole SPECT using the PC cluster can significantly reduce the computation time, whereas its implementation is simple and inexpensive.
Keywords: Pinhole SPECT; Image reconstruction; 3D-OSEM; PC cluster; Parallel computing