Clinical Nuclear Medicine最新文献

Abstract: Extraosseous MDP uptake was not uncommon on the bone scintigraphy. When the extraosseous activity is overlapping the bones, it might cause difficulty in interpreting the result when only static images were acquired. Here we report 2 cases that abnormal MDP activity overlapping the bones on planar images, which were confirmed as soft tissue lesions by SPECT/CT or CT imaging.

Purpose: Although rapid cognitive decline (RCD) is an important unfavorable prognostic factor, not much is known about it, especially in amyloid-negative individuals. The purpose of this study was to investigate risk factors for RCD in amyloid-negative individuals.

Patients and methods: We retrospectively enrolled 741 individuals who were either cognitively unimpaired or had early-stage cognitive ability loss and who underwent 18 F-florbetaben (FBB) (n = 402) or 18 F-flutemetamol (FMM) (n = 339) PET/CT. Based on visual and semiquantitative (SUV ratio [SUVR]-based) analysis, the following amyloid-negative groups were established: visual-negative FBB (n = 232), visual-negative FMM (n = 161), SUVR-negative FBB (n = 104), and SUVR-negative FMM (n = 101). Univariable and multivariable logistic regression analyses were performed for RCD using 5 SUVRs, 5 cortical thicknesses, and 5 neuropsychological domains and clinico-demographic factors.

Results: In the amyloid-negative groups, a decline in language function was commonly identified as a significant risk factor for RCD ( P = 0.0044 in the visual-negative FBB group, P = 0.0487 in the visual-negative FMM group, P = 0.0031 in the SUVR-negative FBB group, and P = 0.0030 in the SUVR-negative FMM group). In addition, declines in frontal/executive function, frontal SUVR, and parietal SUVR; a longer duration of education; and mild cognitive decline in the amyloid-negative groups were also significant risk factors for RCD.

Conclusions: Even in amyloid-negative individuals without cognitive impairment or with early-stage cognitive ability loss, those with decreased language and frontal/executive functions on neuropsychological testing are at risk of progression to RCD.

Abstract: Bilateral testicular involvement in prostate cancer is quite rare. It is often associated with widespread systemic disease and inadequate response to systemic therapy. We present a case of metastatic prostate cancer with bilateral testicular metastases and simultaneous involvement of the left spermatic cord detected on 68 Ga-PSMA-11 PET/CT and confirmed on the histopathology of bilateral orchiectomy done for achieving the androgen deprivation status. Early detection of such unusual sites of metastases has poorer prognostic outcome and management implications.

Abstract: Neuroblastoma presenting as obstructive jaundice due to compression of the extrahepatic bile duct is very rare. An 11-month-old girl had sudden onset of jaundice. Initial imaging suggested a dilated biliary system caused by hepatic hilum mass. 18 F-FDG PET/CT showed a lesion with increased 18 F-FDG accumulation associated with surrounding enlarged lymph nodes. Surgical pathology confirmed the diagnosis of a poorly differentiated neuroblastoma associated with multiple lymph node metastases.

Abstract: Extramedullary involvement is a rare presentation of multiple myeloma (MM), and testicular involvement is even rarer. Testicular involvement associated with poor prognosis and orchiectomy is necessary for definitive diagnosis. Although 18 F-FDG PET/CT is well-known for its ability to detect extramedullary involvement and assess treatment response in MM, testicular involvement of MM on 18 F-FDG PET/CT at initial diagnosis has not yet been reported. Herein, we present a rare case of MM with testicular involvement at initial diagnosis.

Abstract: Primary urethral urothelial carcinoma is a rare aggressive tumor with a high propensity for local invasion and regional and distal metastases. We describe the usefulness of FDG PET/CT in management of a patient with primary urethral urothelial carcinoma. FDG PET/CT at initial staging showed FDG-avid primary tumor and lymph node metastasis of the left groin, and mild or no activity of the lung metastases due to small size. FDG PET/CT after 4 cycles of chemotherapy showed progression of the primary tumor and lung metastases, partial response of the left inguinal lymphadenopathy, and multiple new sites of FDG-avid metastases.

Abstract: An 11-year-old boy with history of conventional high-grade osteosarcoma in the left distal femur was referred to our department for 99m Tc-MDP whole-body bone scan. In addition to multiple bone lesions and pleura, abnormal high radioactivity was found in the abdomen. SPECT/CT revealed diffuse peritoneal thickening with calcification and increased radioactive uptake, which suggest peritoneal metastases. The most common metastases of osteosarcoma can be found in bone and lungs, whereas peritoneal metastases are extremely rare.

Purpose: On the basis of the concept of sentinel lymph node biopsy (SLNB), SLNs should contain decisive information for clinical outcomes. In localized prostate cancer patients, this study assessed retrospectively clinical outcome after radical laparoscopic prostatectomy associated with SLNB and extensive pelvic lymph node dissection.

Methods: A total of 231 consecutive patients of intermediate to high risk were analyzed. Recurrence-free survival (RFS) was assessed with Kaplan-Meier curves. Various pathological parameters were analyzed using univariable and multivariable analyses through Cox regression analysis. The study was approved and registered under 2007-R41.

Results: The median follow-up was 7.1 years (95% confidence interval, 6.6-7.5). In total, 38/231 (16.5%) patients were pN1. Of these 38 patients, 27 had only SLN involvement (SLNI), 10 patients had both SLN and non-SLNI, and 1 patient had isolated non-SLNI, indicating a false-negative (FN). If the updated Briganti nomogram threshold set at >7% for recommending extensive pelvic lymph node dissection had been applied to these patients, we would have missed 44% (12/27) of patients with SLNI and 50% (5/10) of patients with SLNI and non-SLNI, as well as the FN patient. At the time of final follow-up, 84/231 (36.5%) patients had recurrence. In multivariable analysis, and regarding node status, the most significant prognostic factor was SLN with macrometastases and/or micrometastases, respectively, P = 10 -3 and P < 10 -3 . No more information was obtained with non-SLN status. Probabilities of RFS between negative and positive SLN patients presented a major significant difference ( P < 10 -15 ) with a risk of event 8.75 times more frequent if SLN was involved than if it was metastasis-free.

Conclusions: SLNB seems to contain decisive information for the clinical outcome of patients with localized intermediate- and high-risk prostate cancer patients. The question raised is thus whether immediate additional postoperative treatment should be offered to patients with metastatic SLN.

Purpose: Lung cancer surgery outcomes depend heavily on preoperative pulmonary reserve, with forced expiratory volume in 1 second (FEV1) being a critical preoperative evaluation factor. Our study investigates the discrepancies between predicted and long-term actual postoperative lung function, focusing on clinical factors affecting these outcomes.

Methods: This retrospective observational study encompassed lung cancer patients who underwent preoperative lung perfusion SPECT/CT between 2015 and 2021. We evaluated preoperative and postoperative pulmonary function tests, considering factors such as surgery type, resected volume, and patient history including tuberculosis. Predicted postoperative lung function was calculated using SPECT/CT imaging.

Results: From 216 patients (men:women, 150:66; age, 67.9 ± 8.7 years), predicted postoperative FEV1% (ppoFEV1%) showed significant correlation with actual postoperative FEV1% ( r = 0.667; P < 0.001). Paired t test revealed that ppoFEV1% was significantly lower compared with actual postoperative FEV1% ( P < 0.001). The study identified video-assisted thoracic surgery (VATS) (odds ratio [OR], 3.90; 95% confidence interval [CI], 1.98-7.69; P < 0.001) and higher percentage of resected volume (OR per 1% increase, 1.05; 95% CI, 1.01-1.09; P = 0.014) as significant predictors of postsurgical lung function improvement. Conversely, for the decline in lung function postsurgery, significant predictors included lower percentage of resected lung volume (OR per 1% increase, 0.92; 95% CI, 0.86-0.98; P = 0.011), higher preoperative FEV1% (OR, 1.03; 95% CI, 1.01-1.07; P = 0.009), and the presence of tuberculosis (OR, 5.19; 95% CI, 1.48-18.15; P = 0.010). Additionally, in a subgroup of patients with borderline lung function, VATS was related with improvement.

Conclusions: Our findings demonstrate that in more than half of the patients, actual postsurgical lung function exceeded predicted values, particularly following VATS and with higher volume of lung resection. It also identifies lower resected lung volume, higher preoperative FEV1%, and tuberculosis as factors associated with a postsurgical decline in lung function. The study underscores the need for precise preoperative lung function assessment and tailored postoperative management, with particular attention to patients with relevant clinical factors. Future research should focus on validation of clinical factors and exploring tailored approaches to lung cancer surgery and recovery.

Abstract: Although long COVID refers to numerous COVID-19-related symptoms after infection, including depression, fatigue, anosmia, sleep disturbances, and brain fog, the etiology of long COVID remains largely unknown. A 41-year-old woman presented with a 3-week history of complete insomnia without drowsiness throughout the day after contracting COVID-19. SPECT using N -isopropyl-p-[ 123 I] iodoamphetamine showed a significant regional cerebral blood flow reduction in the bilateral thalamus. We diagnosed her as having insomnia accompanied by thalamic hypoperfusion related to COVID-19 infection. To our knowledge, this is the first case of reduced regional cerebral blood flow specifically confined to the thalamus.