Clinical Nuclear Medicine最新文献

Purpose: The aim of this study was to evaluate the role of quantitatively assessed bone SPECT/CT parameters for predicting the success of conservative treatment for symptomatic basal joint arthritis of the thumb.

Patients and methods: Seventy-eight patients (128 hands) with symptomatic basal joint arthritis of the thumb who underwent bone SPECT/CT scans within 4 weeks after their initial visit and completed conservative treatment for more than 6 months between April 2019 and April 2023 were retrospectively enrolled. PRWHE (patient-rated wrist/hand evaluation) was evaluated in all patients before and after the treatment. The SUV max from bone SPECT/CT was measured in the 4 peritrapezial joints, and the highest uptake was used for analysis.

Results: On the basis of the minimal clinically important difference in PRWHE scores, 64 hands (50.0% of 128 hands) were classified as the treatment success group and 64 hands (50.0% of 128 hands) were failure group. In multivariate logistic regression analysis, only high SUV max (odds ratio, 1.097; 95% confidence interval, 1.027-1.172; P = 0.006) was a factor significantly associated with the success of conservative treatment. In receiver operating characteristics curve analysis, the area under the curve of SUV max was 0.649 (95% confidence interval, 0.554-0.744; P = 0.002). As a prognostic parameter for the success of conservative treatment, SUV max showed a sensitivity of 56.3% and specificity of 70.3% with a cutoff of 9.52.

Conclusions: High initial SUV max on bone SPECT/CT was significantly associated with the success of conservative treatment for symptomatic basal joint arthritis of the thumb.

Abstracts: We report the clinical and multimodal PET/CT manifestations in a patient with behavioral variant frontotemporal dementia and parkinsonism. The 18 F-FDG PET scan revealed hypometabolism in the left supratentorial cortex. The 18 F-fluorodopa PET scan demonstrated decreased uptake in the bilateral striatum, most prominent in the head of caudate nucleus. The 18 F-florbetapir PET scan indicated an absence of β-amyloid deposition, whereas the 18 F-flortaucipir PET scan showed uptake in the left hemisphere neocortex. The clinical presentation and asymmetric neuroimaging features supported the underlying frontotemporal lobar degeneration-tau pathology.

Purpose: This study analyzed the association between anti-Ro/SSA and anti-La/SSB antibody levels with quantitative and visual sialoscintigraphy patterns in patients suspected of having Sjögren or sicca syndrome.

Patients and methods: Medical records of patients who underwent sialoscintigraphy between April 2020 and May 2022 were reviewed. Associations between antibody levels and sialoscintigraphy parameters were evaluated using linear regression. Receiver operating characteristic curve analysis was used to identify antibody cutoff values for predicting flat-type patterns and the risk of Sjögren or sicca syndrome.

Results: Of the 170 patients (mean age, 56.6 years; 78.8% female), 95.3% had dry mouth and eyes, 30% experienced polyarthralgia, and 66.5% were prescribed hydroxychloroquine. The most common sialoscintigraphy finding was the median-type time-activity curve (TAC) pattern. Anti-Ro/SSA and anti-La/SSB levels were significantly correlated with maximum accumulation or maximum secretion in the salivary glands. Receiver operating characteristic analysis for anti-Ro/SSA predicting a flat-type TAC pattern showed an area under the curve (AUC) of 0.659 to 0.780, with specificity between 82.1% and 86.3% for antibody levels greater than 85.2 units. Anti-Ro/SSA levels greater than 49.75 units predicted a higher risk of Sjögren or sicca syndrome, with an AUC of 0.622 and 83.9% specificity. Anti-La/SSB levels had no significant predictive value, with an AUC of 0.554.

Conclusions: Anti-Ro/SSA levels greater than 85.2 units were strong predictors of flat-type TAC patterns, indicating near-total salivary gland dysfunction and supporting their diagnostic utility in Sjögren or sicca syndrome.

Abstract: We report an interesting case of a 64-year-old man with a history of radical prostatectomy for prostate cancer. The patient presented with steady increasing prostate-specific antigen levels, but with negative findings on previous multiple conventional prostate-specific membrane antigen (PSMA) PET/CT (with [68Ga]Ga-PSMA-11) and [18F]FDG PET/CT. A recently introduced PSMA tracer using long-lived 89Zr (half-life 3.3 days), [89Zr]Zr-PSMA-617, was administered in attempt to localize potential local recurrence or metastasis. [89Zr]Zr-PSMA-617 PET/CT clearly revealed diffuse peritoneal carcinomatosis and local recurrence of the prostate cancer, which were unidentified on previous conventional PET/CT scans. This case highly demonstrates the potential of PET imaging with the novel PSMA tracer [89Zr]Zr-PSMA-617.

Abstract: High and frequent expression of somatostatin receptors in differentiated neuroendocrine neoplasms has paved the way for receptor-based, targeted peptide receptor radionuclide therapy especially for nonoperable or metastatic disease. Besides tumors, radiation, in one form or another, has been tested to treat inflammatory disease as well, and this goes back to the early 1990s when the first case of pneumonia treated with radiation showed complete resolution. Currently, radiotracers help in not only in vivo inflammation detection, characterization, and staging but also, and more importantly, for selection of treatment in individual patients. The same concept could be applied to treatment of infection, by coupling the radioisotopes to ligands that target sterile or nonsterile inflammation. In our case, targeted peptide receptor radionuclide therapy showed remarkable resolution of inflammatory joint disease.

Abstract: A 70-year-old man experienced an epileptic seizure. Subsequent MRI performed on close examination revealed high signal in the left occipital cortex on fluid-attenuated inversion recovery. Gadolinium contrast indicated enhancement along the cortex. 11C-Methionine PET/CT scan, performed to differentiate from a brain tumor, showed high uptake mainly along the left occipital lobe cortex. Spinal fluid examination revealed Cryptococcus neoformans, leading to a diagnosis of Cryptococcus meningoencephalitis.

Abstract: Hyperpolarized 1- 13 C-pyruvate magnetic resonance spectroscopy (MRS) and MRS imaging (MRSI) offer noninvasive and real-time direct assessment of the altered metabolism of cancer cells known as the Warburg effect-a key hallmark of cancer. When combined with simultaneously acquired 18 F-FDG PET in a PET/MR scanner, coined hyperPET by us, this dual-modality may unveil cancer-type specific glucose metabolic phenotypes with potential implications for patient prognostication, treatment-response assessment, and prediction. We here present the first human data of simultaneously acquired hyperpolarized MRS/MRSI and PET performed in a PET/MR scanner-and the first human hyperpolarized MRS/MRSI data from a patient with lymphoma.

Abstract: Choriocarcinoma is a rare and highly malignant trophoblastic tumor. We present a case involving a 30-year-old woman with abdominal pain, hemoptysis, and elevated serum amylase levels. Initial clinical suspicion included acute pancreatitis. Noncontrast and contrast-enhanced CT revealed hemorrhagic and hypervascular lesions in the lungs, pancreas, liver, and kidneys. 18 F-FDG PET/CT showed diffuse pancreatic enlargement with increased FDG uptake (SUV max , 5.3), consistent with malignancy. Histopathology confirmed choriocarcinoma with elevated HCG levels. Following chemotherapy, HCG levels declined, indicating a positive therapeutic response. 18 F-FDG PET/CT effectively detected choriocarcinoma and assessed its systemic involvement.

Abstract: A 47-year-old woman, recently diagnosed with breast cancer, underwent staging. A whole-body bone scan revealed an unexpected focal 99m Tc-MDP uptake in her right ovary. Extensive literature review suggested various malignant pathologies for this incidental ovarian uptake. Despite inconclusive results from other imaging modalities, the multidisciplinary tumor board recommended right ovarian resection due to a history of abnormal uterine bleeding. The final pathology confirmed an adult-type granulosa cell tumor. Interestingly, subsequent surgery performed for staging purposes found no additional tumor sources. This case highlights the enhanced diagnostic value of hybrid imaging in bone scintigraphy.

Purpose: The aim of this study was to compare the clinical application value of 68 Ga-DOTATATE and 18 F-FDG PET/CT in Epstein-Barr virus (EBV)-positive nonkeratinizing nasopharyngeal carcinoma.

Patients and methods: Patients underwent 18 F-FDG and 68 Ga-DOTATATE PET scans. The lesion numbers, tracer parameters, and primary tumor volume derived from contrast-enhanced MRI, 18 F-FDG, and 68 Ga-DOTATATE PET were compared. The correlation between clinical characteristics and PET parameters as well as the predictive value of PET parameters were analyzed.

Results: The median maximum standard uptake values (SUV max ) of 18 F-FDG and 68 Ga-DOTATATE in all 26 primary tumors was 15.00 and 9.73, respectively ( P = 0.001). 68 Ga-DOTATATE PET was superior to 18 F-FDG PET in detecting intracranial and skull base involvement. The primary tumor volume of 68 Ga-DOTATATE with 35% SUV max as the threshold had the highest consistency with that of contrast-enhanced MRI. 68 Ga-DOTATATE and 18 F-FDG PET/CT detected 103/108 (95.4%) and 101/108 (93.5%) regional lymph nodes metastases ( P = 0.552), and the median SUV max was 6.05 and 10.81, respectively ( P < 0.001). Furthermore, 68 Ga-DOTATATE PET/CT detected more distant metastases than 18 F-FDG (89/92 [96.7%] vs 54/92 [58.7%], respectively, P < 0.001). The plasma EBV DNA was positively correlated with the total metabolic tumor volume, lesion glycolysis, somatostatin receptor-expressing tumor volume, and lesion somatostatin receptor expression (all P values <0.05). The PET parameters in the non-objective response rate group were higher than those in the objective response rate group (all P values >0.05).

Conclusions: 68 Ga-DOTATATE PET/CT is a promising imaging modality for detecting primary and metastatic EBV-positive nonkeratinizing nasopharyngeal carcinoma and delineating primary tumor boundary.