Check out our New Publishers' Select for Free Articles

Annals of Nuclear Medicine (v.25, #7)

Clinical implications of the body surface area method versus partition model dosimetry for yttrium-90 radioembolization using resin microspheres: a technical review by Yung Hsiang Kao; Eik Hock Tan; Chee Eng Ng; Soon Whatt Goh (pp. 455-461).

Yttrium-90 (Y-90) radioembolization is becoming established as an effective therapeutic modality for inoperable liver tumors. For resin microspheres, the ‘body surface area (BSA)’ method and the partition model can both be used for Y-90 activity calculation. The BSA method is semi-empirical, but more commonly used due its simplicity. The partition model is more accurate, scientifically sound and personalized, but less popular due to its complexity. This article provides a technical comparison of both methods with an emphasis on its clinical implications. Future dosimetric techniques for Y-90 radioembolization based on emerging technologies are also discussed.

Keywords: Yttrium-90 radioembolization; Yttrium-90 selective internal radiation therapy; Tumor-to-normal liver ratio; Body surface area method; Partition model dosimetry

Continuous intravenous infusion of prostaglandin E1 improves myocardial perfusion reserve in patients with ischemic heart disease assessed by positron emission tomography: a pilot study by Chi-Lun Huang; Yen-Wen Wu; Shoei-Shen Wang; Chuen-Den Tseng; Fu-Tien Chiang; Kwan-Lih Hsu; Chii-Ming Lee; Kai-Yuan Tzen (pp. 462-468).

Recent investigation has demonstrated that prostaglandin E₁ (PGE₁) therapy increased capillary density in explanted hearts. Dynamic ¹³N-ammonia positron emission tomography (PET) is reliable for non-invasive measurement of myocardial blood flow and myocardial perfusion reserve (MPR). The aim of this study was to investigate the effects of PGE₁ therapy during 4 weeks on reduction of myocardial perfusion abnormalities and increase of MPR in the patients with ischemic heart disease.In this double-blind, placebo-controlled trial, we randomly assigned 11 patients who had symptomatic heart failure and documented myocardial ischemia to 4 weeks intravenous infusion of PGE₁ (2.5 ng/kg/min; 8 patients, age 60 ± 13 years) or saline (3 patients, age 57 ± 13 years). Dynamic ¹³N-ammonia PET scans at rest and during adenosine stress were obtained at baseline and 12 weeks after treatment completion. Quantitative size/severity of perfusion defects and MPR change from baseline to follow-up PET were determined using a 17-segment model.Compared with the control group, baseline MPR in the PGE₁ group was significantly lower (1.96 ± 0.78 vs. 2.71 ± 0.73; P < 0.001). MPR significantly improved 12 weeks after completion of PGE₁ infusion (1.96 ± 0.78 to 2.16 ± 0.77; P < 0.001). In contrast, MPR declined significantly in the placebo group (2.71 ± 0.73 to 2.01 ± 0.58, P < 0.001).Four weeks of PGE₁ infusion sustained MPR improvement in patients with ischemic heart disease. This may be an attractive therapeutic approach for no-option patients with severe ischemic cardiomyopathy.

Keywords: Prostaglandin E₁ ; Ischemic heart disease; Myocardial perfusion reserve

Could the serial determination of Ca15.3 serum improve the diagnostic accuracy of PET/CT? Results from small population with previous breast cancer by Laura Evangelista; Zora Baretta; Lorenzo Vinante; Anna Rita Cervino; Michele Gregianin; Cristina Ghiotto; Fernando Bozza; Giorgio Saladini (pp. 469-477).

A single value of tumor marker elevation is not used for the diagnosis of breast cancer (BC) relapse, whereas the serial measurements which confirm a persistent Ca15.3 increase can represent an early signal of tumor relapse, even if described in asymptomatic patients without any other clinical or instrumental signs of cancer. The aim of this study was to assess the relationship between serial measures of Ca15.3 and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) findings in patients with already treated BC during follow-up.We retrospectively selected 60 patients (mean age 62 ± 11 years) with previous history of BC, already treated with surgery and other treatments. Three serial measures of Ca15.3 were collected within 1 year before PET/CT examination, respectively, at 12–9 months (297 ± 30 days), 9–3 months (154 ± 51 days) and 3–0 months (46 ± 28 days). Clinical outcome or imaging follow-up data were used to define disease relapse. The increase in tumor marker value was compared with PET/CT results and disease relapse. Coefficient of variation (CV) and ROC curves were used. Disease-free survival (DFS) curves were computed by Kaplan–Meier method.PET/CT was negative in 36 (60%) and positive in 24 (40%) patients. The median time between initial treatment and PET/CT was 3 years. CV of the Ca15.3 serial determinations was significantly higher in patients with positive than negative PET/CT (39 vs. 24%, p < 0.05). Disease relapse was found in 25 (42%) patients, of these 21 (88%) had positive PET/CT. ROC analyses showed that an increase of Ca15.3 between the 2nd and 3rd measures have better individuated positive PET/CT and disease relapse (AUC 0.65 and 0.64, respectively; p < 0.05). DFS was higher in patients with negative than positive PET/CT (65 vs. 15%, p < 0.05).Serial increase of Ca15.3 could be considered optimal to address FDG PET/CT examination during BC patients follow-up. PET/CT performed just on time might allow, earlier and with higher diagnostic accuracy, the detection of disease relapse in BC patients.

Keywords: Breast cancer; Ca15.3; PET/CT; Follow-up; Recurrence

Comparison of parameters of ¹²³I-metaiodobenzylguanidine scintigraphy for differential diagnosis in patients with parkinsonism: correlation with clinical features by Yumiko Uchiyama; Mitsuru Momose; Chisato Kondo; Kiyoko Kusakabe; Shinichiro Uchiyama (pp. 478-485).

The purpose of this study was to estimate the diagnostic accuracy of ¹²³I-metaiodobenzylguanidine (MIBG) scintigraphy to diagnose Lewy body disease (LBD), including Parkinson’s disease (PD) and dementia with Lewy bodies, and to clarify the relationship between MIBG parameters and the clinical findings.One hundred-and-forty-four patients with parkinsonism without diabetes mellitus or a history of cardiac disease were retrospectively selected in the study. Clinical diagnosis was confirmed by follow-up during more than 6 months by neurologists. All patients underwent MIBG imaging at 15 min (initial) and 4 h (delayed) after the tracer injection, and clinical features such as Hoehn and Yahr (H–Y) classification or symptoms specific to parkinsonism were also investigated. The heart to mediastinum ratio (H/M) and the washout ratio (WR) of MIBG were calculated, and correlation with the clinical features was analyzed.Ninety-seven and 47 patients were diagnosed as LBD and Parkinson’s syndrome (PS), respectively. Initial and delayed H/M were significantly lower and WR was significantly higher in LBD than in PS (p < 0.0001). The initial H/M was independently correlated with tremor (F value 10.45), hesitation (F = 4.49), and hallucinations (F = 5.09) (p < 0.0001). The sensitivity and specificity for the diagnosis of LBD were 64.9 and 87.2% with initial H/M, 78.4 and 68.1% with delayed H/M, and 80.4 and 61.7% with WR, respectively. Using multivariate analysis, initial H/M (F = 39.33) and tremor (F = 10.46) were independently correlated to the diagnosis of LBD (r = 0.562, p < 0.0001) among the MIBG and various clinical parameters.The initial H/M was the most useful of the 3 different parameters of MIBG for the diagnosis of LBD, but had low sensitivity. WR and delayed H/M had no incremental value to initial H/M for the diagnosis of PD. Careful long-term follow-up is needed for patients with parkinsonism who are clinically diagnosed as LBD with normal initial H/M, or diagnosed as no LBD with low initial H/M.

Keywords: Lewy body disease; ¹²³I-MIBG scintigraphy; Heart to mediastinum ratio; Autonomic nervous system; Parkinson’s syndrome

Performance of beta- and high-energy gamma probes for the detection of cancer tissue in experimental surgical resection beds by Rita Garcia-Parra; Neal Clinthorne; Li Wang; Maria Picchio; Morand Piert (pp. 486-493).

While high-energy gamma and beta probes have gained considerable attention due to their ability to detect cancerous lesions using ¹⁸F-FDG in humans intraoperatively, it is unknown whether the sensitivity of such probes would allow the detection of remaining tumor tissue in the resection bed after removal of macroscopically evident disease.9L tumors (13 primaries, 17 lymph node metastases) were generated at the upper thigh of Fisher 344 rats. After approximately 2 weeks, microPET was performed to verify increased ¹⁸F-FDG tumor uptake. Tumors were surgically exposed and probe readings of tumor and background tissues were performed in triplicate. To evaluate the ability to detect tiny tumor lesions, 12 tumor fragments (range 0.001–0.032 g) were placed into the resection bed and measured to obtain a tumor-to-muscle ratio (TMR). Lesions were classified as positive if count rates were above 2.5 SD of muscle background. All tumor and muscle tissues were weighed and counted to obtain the “true” tumor-to-muscle background ratio (TMR_counter) for reference. The presence or absence of tumor tissue was verified by histology.In the presence of background gamma radiation, the beta probe detected all tumor lesions with TMR greater than 2.5 SD of muscle background (TMR range 1.24–3.9 for all 41 lesions). Despite suitable shielding, lesion identification by the gamma probe was clearly limited by the presence of background radioactivity. As a result, only 11/13 primary tumors, 6/17 lymph nodes and 1/11 tumor fragments were identified above 2.5 SD of muscle background (TMR range 0.64–3.59 for all lesions).Under experimental conditions, the beta probe was capable to detect minute amounts of tumor tissue at the surface of resection beds. While clinical application of the current beta probe design may depend on the particular intraoperative circumstances including time requirements for surface scanning of resection beds, the data indicate clinical potential for novel designs of hand-held beta probes.

Keywords: Beta probe; Gamma probe; ¹⁸[F]2-fluoro-2-deoxy-d-glucose; Intraoperative tumor detection

Usefulness of gated SPECT myocardial imaging in evaluation of patients with inferior myocardial infarction by Isidora Grozdic; Dragana Sobic-Saranovic; Smiljana Pavlovic; Vera Artiko; Zorica Petrasinovic; Emilija Jaksic; Djordjije Saranovic; Vladimir Obradovic (pp. 494-500).

Gated single photon emission computed tomography (gated SPECT) myocardial imaging gives useful information about the extent and severity of perfusion abnormalities (PA) and global left ventricular (LV) function in patients with coronary artery disease. The aim of this study was to evaluate by gated SPECT myocardial imaging differences in perfusion scores and LV function between stress and rest in patients with mild left ventricular dysfunction and/or normal function and previous inferior myocardial infarction (IMI) and to detect myocardial stunning.The study included 77 patients (age 53 ± 8.21) with mild left ventricular dysfunction and previous IMI divided into two groups. Group 1 consisted of 34 patients with IMI and additional ischemia on perfusion scan and group 2 with 43 patients with previous IMI without ischemia on perfusion scan. All patients underwent a 2-day stress-rest gated SPECT myocardial imaging protocol with 99m technetium-methoxyisobutylisonitrile (^99mTc-MIBI).There was a more significant post-stress to rest decrease in ejection fraction (EFps) in patients with IMI and additional ischemia (group 1) than in patients with IMI (group 2) (−1.5 ± 2.5 vs. 1.5 ± 2.3, p < 0.001). In group 1, there was a significant increase in post-stress end-systolic volume (ESVps) in comparison to ESVr (70.4 ± 29.8 vs. 66.2 ± 26.2 ml, p = 0.044). However, the decrease in EF post-stress to rest did not reach the level of significance (51.7 ± 10.8 vs. 53.2 ± 10.2%, p = 0.147). The extent and severity of perfusion abnormalities were higher on stress (SSS) than on rest images (SRS) (13.9 ± 8.6 vs. 8.3 ± 7.8, p < 0.001). There was no difference in global LV parameters or perfusion abnormalities in patients in group 2 between stress and rest except for a significant increase in the post-stress EF to rest value (57.9 ± 11.9 vs. 56.2 ± 10.5%, p = 0.018). Severe decrease of post-stress EF to rest was found in 12 (16%) patients indicating stunning.In patients with mild left ventricular dysfunction and IMI with additional ischemia there is evidence of a decrease in the post-stress EF with an increase in the post-stress ESV. In addition, a significant association between the decrease of post-stress EF with the extent and severity of perfusion abnormalities was detected. Gated SPECT myocardial imaging has an important role in the evaluation of perfusion and LV function in patients with IMI especially in patients with additional ischemia.

Keywords: Gated SPECT 99mTc-sestamibi; Inferior myocardial infarction; Inferior myocardial infarction with ischemia; LV parameters

Additional value of FDG PET/CT to contrast-enhanced CT in the differentiation between benign and malignant intraductal papillary mucinous neoplasms of the pancreas with mural nodules by Kentaro Takanami; Tomomichi Hiraide; Masashi Tsuda; Yasuhiro Nakamura; Tomohiro Kaneta; Kei Takase; Hiroshi Fukuda; Shoki Takahashi (pp. 501-510).

This study aimed at determining the additional value of FDG PET/CT to contrast-enhanced CT in the differentiation between benign and malignant intraductal papillary mucinous neoplasms (IPMNs) of the pancreas with mural nodules.This retrospective review of medical records was approved by our institutional review board. The preoperative PET/CT images of 16 non-diabetic patients with surgically proven IPMN, where mural nodules of 3 mm or larger were shown by preoperative contrast-enhanced CT, were retrospectively evaluated. The 16 patients were divided into two groups: 7 patients with benign IPMN [adenoma (n = 1) and borderline tumor (n = 6)] and 9 patients with malignant IPMN [carcinoma in situ (CIS) (n = 8) and invasive carcinoma (n = 1)]. Nuclear medicine physician blinded to the pathologic assessment of malignancy of IPMN set a spherical volume of interest (VOI) over the mural nodules on PET/CT images and recorded the peak standardized uptake value (SUV_max) in the VOI, referring the contrast-enhanced CT images. Statistical differences in the size of mural nodule, the diameter of main pancreatic duct (MPD), and SUV_max of the tumors between benign IPMNs and malignant IPMNs were compared using the Mann–Whitney U test. Statistical significance was set at p < 0.05. Additionally, the diagnostic accuracy of FDG PET for the detection of malignancy was calculated.The SUV_max of the malignant IPMNs with mural nodules of 3 mm or larger was higher than that of benign IPMNs (2.7 ± 0.6 vs. 1.9 ± 0.3, p < 0.01). Meanwhile, there was no significant difference in mural nodule diameter and MPD diameter between the two groups. FDG PET/CT showed an excellent diagnostic accuracy for the differentiation between malignant and benign IPMNs with mural nodules: the sensitivity, specificity, PPV, NPV, and accuracy in malignant IPMN with mural nodule of FDG PET/CT were 77.8, 100, 100, 77.8, and 87.5 for the cutoff value of 2.3; and 100, 57.1, 75.0, 100, and 81.3 for the cutoff value of 2.0, respectively.The result of this study indicates that FDG PET/CT can provide additional information for the differentiation between benign and malignant IPMNs of the pancreas with mural nodules.

Keywords: FDG; PET; CT; Intraductal papillary mucinous neoplasm of the pancreas

Preoperative nodal staging of uterine cancer: is contrast-enhanced PET/CT more accurate than non-enhanced PET/CT or enhanced CT alone? by Kazuhiro Kitajima; Kayo Suzuki; Michio Senda; Masato Kita; Yuji Nakamoto; Setsu Sakamoto; Yumiko Onishi; Tetsuo Maeda; Takeshi Yoshikawa; Yoshiharu Ohno; Narufumi Suganuma; Kazuro Sugimura (pp. 511-519).

To determine whether contrast-enhanced PET/CT is more accurate than either non-enhanced PET/CT or enhanced CT alone for nodal staging of uterine cancer.Forty patients with endometrial cancer and cervical cancer underwent conventional PET/CT scan with low-dose CT (ldCT), followed by full-dose CT with IV contrast (ceCT) before radical hysterectomy with pelvic and, when applicable, para-aortic lymphadenectomy. Three data sets of PET/ldCT, PET/ceCT, and enhanced CT images were interpreted separately by two readers. For region-specific comparisons, para-aortic and pelvic lymph nodes were divided into the bilateral para-aortic, common iliac, external iliac, internal iliac, and obturator areas. Based on histopathological findings as the gold standard, we compared the diagnostic accuracy between the three methods using McNemar test with Bonferroni’s adjustment.Of the 40 patients, 21 underwent pelvic lymphadenectomy only. Region-based analysis showed that the sensitivity, specificity, and accuracy of PET/ceCT were 61.4% (27/44), 98.1% (308/314), and 93.6% (335/358), respectively, whereas those of PET/ldCT were 52.3% (23/44), 96.8% (304/314), and 91.3% (327/358), respectively, and those of enhanced CT were 40.9% (18/44), 97.8% (307/314), and 90.8% (325/358), respectively. Although PET/ceCT had the best sensitivity among the three imaging modalities, a significant difference was observed only between PET/ceCT and enhanced CT (p = 0.0027). Although PET/ceCT had better sensitivity and accuracy than PET/ldCT, the differences between the two imaging methods did not reach statistical significance (p = 0.046 and p = 0.047, respectively).PET/ceCT is slightly but not significantly superior to PET/ldCT for nodal staging of uterine cancer. Nodal metastasis cannot be excluded even if PET/ceCT gives negative findings.

Keywords: Uterine cancer; Lymph node metastasis; FDG; PET/CT; Enhanced CT

^99mTc-GSA SPECT analysis was clinically useful to evaluate the effect of interferon in a patient with interferon non-responsive chronic hepatitis C by Rika Ishii; Hitoshi Togashi; Akiko Iwaba; Chikako Sato; Hiroaki Haga; Mai Sanjo; Kazuo Okumoto; Yuko Nishise; Jun-itsu Ito; Hisayoshi Watanabe; Koji Saito; Akio Okada; Kazuei Takahashi; Takafumi Saito; Sumio Kawata (pp. 520-523).

We describe a 62-year-old woman with advanced chronic hepatitis C who showed no response to low-dose long-term interferon-beta monotherapy (3 MU, three times a week). The interferon monotherapy was continued for 2 years and 9 months. Despite this lack of response to interferon, the patient’s clinical course was good and liver function assessed by ^99mTc-galactosyl human serum albumin single photon emission computed tomography (^99mTc-GSA SPECT) analysis improved significantly. Improvement of the data obtained by ^99mTc-GSA SPECT analysis justified continuation of the treatment. ^99mTc-GSA SPECT analysis was clinically useful to evaluate the effect of interferon in a patient with interferon non-responsive chronic hepatitis C, despite a lack of reduction of the ALT level and HCV-RNA titer.

Keywords: Chronic hepatitis C; Interferon non-responder; ^99mTc-GSA SPECT

Prediction of lack of response to neoadjuvant chemotherapy in rare breast tumour histology with Tc-99m sestamibi scintimammography by Ashwani Sood; Rajeev K. Seam; Kavita Mardi; Manoj K. Gupta; Sandeep Sethi (pp. 524-527).

The authors report a case of a 47-year-old female with a malignant lump in the right breast and ipsilateral axillary nodal involvement. She was pathologically misinterpreted as a case of ductal cell carcinoma with papillary component on fine needle aspiration cytology (FNAC) pre-operatively. On lines of the FNAC report, the patient underwent scintimammography (SMM) for prediction of treatment response based on washout pattern. The SMM revealed rapid washout of radiotracer predictive of poor responder. Despite unfavourable result seen with SMM, the patient received 4 cycles of neo-adjuvant chemotherapy (NACT). However, there was no clinical response after chemotherapy. The post-surgical histopathology revealed the actual histology to be pleomorphic liposarcoma. This case highlights that SMM has the ability to predict non-responsiveness of unusual tumour histology to standard NACT.

Keywords: Pleomorphic liposarcoma; Locally advanced breast carcinoma; Neoadjuvant chemotherapy; Tc-99m sestamibi scintimammography

Sections

Personal tools

Annals of Nuclear Medicine (v.25, #7)

Sections

Personal tools

Local resources

Annals of Nuclear Medicine (v.25, #7)