Hellenic journal of nuclear medicine最新文献

Objective: To analyze the diagnostic effect of fluorine-18-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) in patients with idiopathic inflammatory myopathies (IIM) and its relationship with disease severity.

Subjects and methods: A retrospective analysis was conducted on the clinical and imaging data of 31 IIM patients treated in our hospital from April 2020 to April 2024, who were included in the lesion group. Additionally, 30 patients without muscle disease during the same period were selected as the control group. The maximum standardized uptake value (SUVmax) of the proximal limb girdle muscles was measured in both groups and compared. A receiver operating characteristic (ROC) curve was plotted to analyze the diagnostic value of SUVmax for IIM using ¹⁸F-FDG PET/CT. Spearman rank correlation was used to analyze the relationship between muscle SUVmax in IIM patients and relevant laboratory indicators, including creatine kinase (CK), creatine kinase-MB (CK-MB), C-reactive protein (CRP), serum ferritin (SF), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and alanine aminotransferase (ALT).

Results: The SUVmax level of the lesion group (2.94±0.58) was significantly higher than that of the control group (1.17±0.23) (t=15.568, P<0.05). A receiver operating characteristic curve analysis indicated that the optimal cut-off value of SUVmax for distinguishing the lesion group from the control group was 2.16g/mL, with a diagnostic sensitivity of 100%, specificity of 91.8%, and an area under the curve (AUC) of 0.952. Correlation analysis showed a positive correlation between SUVmax and CK (r=0.659), CK-MB (r=0.523), AST (r=0.458), and LDH (r=0.437) (P<0.05), but no significant correlation with CRP (r=0.219), SF (r=0.348), or ALT (r=0.237).

Conclusion: Fluorine-18-FDG PET/CT demonstrates an ideal diagnostic effect for IIM patients, and its semi-quantitative parameter, SUVmax, holds good auxiliary diagnostic value for IIM. It can reflect the activity and severity of the disease to a certain extent.

The value of gallium-68 (⁶⁸Ga)-Pentixafor positron emission tomography/magnetic resonance (PET/MR) image in renal carcinoma is unknown. Herein, we reported ⁶⁸Ga-Pentixafor PET/MR findings in a 47-year-old man with accidental renal carcinoma. Gallium-68-Pentixafor PET/MR showed a small nodule in the left kidney with iso-signal on T1WI and low signal on T2WI. This lesion had intense ⁶⁸Ga-Pentixafor uptake with a maximum standardized uptake value (SUVmax) of 7.05. This case suggested the potential of ⁶⁸Ga-Pentixafor PET/MR in the image evaluation of renal carcinoma.

Objective: To analyze the relationship between fluorine-18-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) and ultrasound breast imaging reporting and data system (BI-RADS) classification, and to evaluate the diagnostic value of their combined application in breast diseases.

Subjects and methods: A retrospective analysis was conducted on the ¹⁸F-FDG PET/CT images and ultrasound BI-RADS classification data of 110 patients with suspected breast cancer treated at our hospital from July 2020 to May 2022. Pearson correlation analysis was used to assess the relationship between the maximum standardized uptake value (SUVmax) and BI-RADS classification. Using pathology or long-term follow-up results as the "gold standard," the diagnostic value of ¹⁸F-FDG PET/CT, ultrasound BI-RADS classification, and their combined application in breast diseases was analyzed.

Results: Based on the "gold standard" of pathology or long-term follow-up, of the 110 patients with suspected breast cancer, 49 were benign, and 61 were malignant. The SUVmax levels of malignant lesions were significantly higher than those of benign lesions (P<0.05). Pearson correlation analysis indicated a low correlation between SUVmax and ultrasound BI-RADS classification (r=0.458, P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of the combined application of SUVmax and ultrasound BI-RADS classification was higher than that of either method alone, both for breast tumors and for patients classified as BI-RADS category 3 to 4.

Conclusion: The correlation between SUVmax and ultrasound BI-RADS classification is low (r=0.458), indicating that these two methods assess different biological aspects of breast tumors. However, the combined use of SUVmax and BI-RADS classification significantly enhances diagnostic accuracy, particularly for patients with BI-RADS 3 to 4 lesions. Although this combination improves diagnostic efficacy, ¹⁸F-FDG PET/CT should not be used as a primary screening tool but rather as a complementary method in specific clinical scenarios where imaging findings are inconclusive or suspicion of malignancy is high.

Objective: Adult-onset Still's disease (AOSD) is an uncommon autoinflammatory syndrome characterized by quotidian fever, arthritis, evanescent exanthem and splenomegaly. Lymphadenopathy is present in about a half of patients; it is usually symmetrical with the cervical area being most commonly involved. When constitutional symptoms are present, an extensive work-up should be performed in order to exclude hematological malignancies, such as lymphoma.

Subjects and methods: A 38-year-old male is presented due to fatigue and high-grade fever that first appeared a month ago. He did also refer night sweats, arthralgias and an evanescent erythema on the trunk and anterior thigh area. Serology testing for bacteria and viruses as well as autoimmune rheumatic diseases was requested. Whole body computed tomography (CT) scan was ordered and displayed a marginal lymph node in the right hilum and smaller ones in the axillary region. Positron emission tomography/CT (PET/CT) with fluorine-18-fluoro-deoxy-glucose (¹⁸F-FDG) showed hypermetabolic lymph nodes, with the right upper internal jugular lymph node being the most dominant, as well as diffusely increased ¹⁸F-FDG uptake by bone marrow and spleen, posing in the differential diagnosis a neoplastic disease of the hematopoietic tissues.

Results: Further laboratory testing showed high ferritin levels. It was decided to procced with biopsy of the aforementioned hypermetabolic internal jugular lymph node and bone marrow. Histopathological examination did show hyperreactivity and no malignant cells neither in the lymph node nor in the bone marrow.

Conclusion: Adult-onset Still's disease is a rare disorder and it is a diagnosis of exclusion. High-grade fever along with arthralgias, splenomegaly, high serum ferritin levels and the presence of exanthem should pose high in the differential the AOSD. In this case, PET/CT guided the anatomical location for lymph node biopsy in order to differentiate AOSD from lymphoma. The dissociated increased ¹⁸F-FDG uptake from the cervical and axillary lymph nodes is characteristic of AOSD.

Many reputable medical journals, including The Lancet and the BMJ, have adopted the term "Theranostics". Under the alternative term "Theragnostics", PubMed currently registers 1207 articles. Both terms encountered by the reader for the first time are puzzling and largely meaningless, if not confusing. According to Idée et al. (2013), the concept of "Theranostics" was coined in 1998 in the USA by John Funkhouser, to describe a material that allows the combined diagnosis, treatment and follow up of a disease. Presumably the word was invented by truncating therapeutics to thera and diagnostics to nostics joining the two into Theranostics. But in Greek "thera" relates to hunting of wild beasts, the chase. Metaphorically, it may also mean "the eager pursuit of anything". Although chasing cancer by any means remains a justifiable and desirable pursuit, Theranostics does not exactly reflect the meaning intended by the originator. Iama (in Greek, ̓íαμα or ̓íημα) also refers to therapy but more importantly and specifically also, to means of therapy. May I, therefore, propose that a more meaningful term encompassing both therapy and diagnosis served by the same material, could be iama-gnostics? Considering the Anglo-Saxon compulsion for precise terminology and for laconic exactitude, could iama-gnostics find its place in the medical literature?

Objective: Ovarian goiter that meets the diagnostic criteria for malignant thyroid tumors or has invasive distant metastasis is called malignant struma ovarii (MSO). The incidence of MSO is very low. The level of serum thyroglobulin (Tg) is helpful to differentiate MSO with highly differentiated pathological type from other ovarian malignancies. But its therapeutic method is currently debated. Herein, we present a case of 54 years old woman, who was admitted to hospital due to frequent abdominal pain for 9 months and with normal serum Tg. Postoperative pathological examination revealed highly differentiated follicular thyroid carcinoma of bilateral ovarian origin, which penetrated bilateral ovarian cortex, involved the serosal surface of left fallopian tube and disseminated to sigmoid mesentery, small intestinal mesentery and pelvic cavity. The disseminated lesions were considered to originate from right ovary. After the total thyroidectomy, iodine-131(¹³¹I) treatment was performed with a dose of 150mCi. The ¹³¹I whole-body scintigraphy (WBS) 2 days after treatment showed residual thyroid tissue in the neck and implantation metastasis in mesentery. After 1-year regular follow-up, no significant abnormalities were found in tumor indicators, Tg, thyroid function, neck ultrasound and abdominopelvic enhanced computed tomography (CT). This MSO case with normal Tg and multiple implantation metastasis aimed to discuss its clinical management especially for Tg and ¹³¹I and to improve its prognosis.

Gallium-68-DOTA-D-phe1-try3-octreotide (⁶⁸Ga-DOTATOC) positron emission tomography/computed tomography (PET/CT) is a crucial diagnostic tool for neuroendocrine tumors (NET). Its accuracy is influenced by radiochemical purity and patient preparation. We present two cases where unexpected radiotracer uptake in ⁶⁸Ga-DOTATOC PET/CT imaging was observed. One case involved high vascular activity and reduced tumor-to-background contrast, attributed to radiochemical impurities. The other case demonstrated blocked somatostatin receptors due to inadequate patient preparation. Both cases highlight the importance of strict radiolabeling protocols and quality control measures, such as thin-layer chromatography (TLC), to ensure accurate ⁶⁸Ga-DOTATOC PET/CT results. Additionally, proper patient preparation, including discontinuing somatostatin analogues as recommended, is essential for optimizing diagnostic accuracy. By addressing these factors, healthcare providers can improve the effectiveness of ⁶⁸Ga-DOTATOC PET/CT in diagnosing and managing NET.

Objective: To investigate the diagnostic value of fluorine-18-9-fluoropropyl-(+)-dihydrotetrabenazine (¹⁸F-AV-133) positron emission tomography/computed tomography (PET/CT) for Parkinson's disease (PD) and the metabolic parameter changes in the PD macaque model.

Subjects and methods: Sixty three macaques were divided into an experimental group (n=55) and a normal group (n=8) for ¹⁸F-AV-133 PET/CT imaging. In the experimental group, the macaques were injected with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) solution into one side of the neck artery 2-3 months before imaging to induce unilateral striatal damage for self-control, while the normal group received no special treatment. After imaging, two nuclear medicine doctors conducted image analysis to determine the damaged side using visual inspection and compared the data with the actual damaged side to evaluate the model construction. The standardized uptake value (SUV) semi-quantitative analysis method was used to process the images, obtaining metabolic information of the damaged and preserved sides of the striatum, thalamus, occipital lobe, frontal lobe, parietal lobe, temporal lobe, and cerebellum in different sides of the normal group. Data analysis was performed using SPSS 25 to compare metabolic differences between different sides and evaluate the impact of modeling on the metabolism of other regions of the brain, with a significance level set at P<0.05.

Results: Fluorine-18-AV-133 PET/CT imaging showed that the normal group of macaques exhibited relatively symmetrical radiotracer uptake in the bilateral striatal regions; the experimental group of PD macaque models showed completely asymmetrical radiotracer uptake in the left and right striatal regions, with model construction success rate of 100%. Semi-quantitative analysis using SUV revealed that the metabolic parameters SUVmax, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) in the damaged striatal region of the experimental group of PD macaques were lower than those in the preserved side, with statistically significant differences (t/z=8.277, 12.032, 8.827, 8.744, P<0.001). The SUVmean in the damaged thalamus of the PD macaques was lower than in the preserved side (1.327±0.354 vs. 1.490±0.374), with a statistically significant difference (t=2.352, P=0.02).The metabolic parameters SUVmax, SUVmean, MTV, and TLG in the striatum of the normal group were higher than those in the preserved striatum of the experimental group, with P<0.05.

Conclusion: Fluorine-18-AV-133 PET/CT can accurately assess the construction of PD macaque models and visualize the differences in metabolic parameters between different sides, making it useful for detecting monoaminergic terminal reduction in PD patients and providing a theoretical basis for the diagnosis and follow-up treatment of PD.

Objective: Graves' disease represents 60%-90% of all causes of thyrotoxicosis in different regions of the world. Thyrotoxicosis contributes approximately 66% to thyroid disorders in South Africa and of those Graves' disease contributes about 34%. In most Sub-Saharan African countries, Graves' disease is managed mainly with medical treatment, due to a lack of or poor access to other means of treatment. Despite the primary use of anti-thyroid drugs (ATD) in the management of Graves' disease, the use of radioactive iodine (RAI) is required in many patients, especially in cases where ATD are contraindicated, or in patients who have failed ATD treatment and are poor surgical candidates. There is no consensus on the best method for deciding on how much activity of radioiodine to administer to patients with Graves' disease, that is, whether to use a calculated dose, or an empirical or fixed dose for RAI. The standardized fixed dose is particularly helpful in under-resourced areas or centres with few nuclear physicians and high patient loads. However, little is known about the efficacy of the fixed dose compared to the calculated or empirical dose methods. The purpose of this retrospective observational study was to assess the efficacy of a fixed low dose of radioiodine-131 (¹³¹I) in the treatment of Graves' disease.

Subjects and methods: Patients treated with a fixed dose of 10mCi between the periods of 2014 to 2017 were evaluated for treatment response after each dose of RAI. Outcome of therapy was evaluated at 3 monthly follow-up using biochemical markers: thyroid stimulating hormone (TSH), total free thyroxine (fT4), and or triiodothyronine (T3), and the presence or absence of clinical symptoms of thyrotoxicosis. According to their response to RAI therapy, patients were classified as responders (if they became euthyroid or hypothyroid), non-responders (if they failed to achieve euthyroidism or hypothyroidism at 6 months) and complete treatment failure (if no response was present within 18 months after two or three fixed low doses of RAI). Percentage uptake, baseline fT4 and patient age were compared according to treatment response.

Results: Our cohort included 111 patients, 95 (86%) females and 16 (14%) males, with a mean age of 41.9 years. Treatment was successful after the first dose in 89.2% of cases (27.0% euthyroid; 62.2% hypothyroid), with 10.8% requiring a second dose, and only a single patient who remained hyperthyroid after that second empiric dose. Statistical analysis demonstrated that a high percentage thyroid uptake was associated with treatment failure, whereas a low percent thyroid uptake was associated with a good treatment response (P=0.0048). We found no significant difference in FT4 levels or age, between hyperthyroid and non-hyperthyroid (euthyroid or hypothyroid) groups post initial RAI therapy (P=0.5 and P=0.96, respectively).

Conclusion: