Luisa Maria Knappe, Frederik Anton Verburg, Luca Giovanella, Markus Luster, Damiano Librizzi
Introduction The present study aims to evaluate the clinical diagnostic value of FDG-PET/CT in patients with inflammation of unknown origin. Material and methods We retrospectively analyzed data of 130 patients who presented general inflammatory symptoms and/or elevated level of CRP and underwent FDG-PET/CT for the purpose of identifying unknown foci of inflammation. The accuracy of PET/CT findings was assessed against the standard of eventual clinical diagnosis e.g. results of pathology, microbiology or other imaging methods. Results In 99/130 patients (76 %) a final diagnosis was established, FDG-PET/CT showed a sensitivity and specificity of each 93 %. A decreased pseudocholinesterase is associated with a higher SUVmax value and with a higher CRP value whereas no significant relationship was found between elevated CRP values and the SUVmax, although higher CRP values are associated significantly with a true positive PET/CT result. Conclusion FDG-PET/CT is a highly sensitive, specific and accurate method for the detection of foci of inflammation of unknown origin. The combination of decreased pseudocholinesterase and increased CRP levels may be a useful tool to select patients for FDG PET/CT.
{"title":"Diagnostic value of FDG-PET/CT in the diagnostic work-up of inflammation of unknown origin.","authors":"Luisa Maria Knappe, Frederik Anton Verburg, Luca Giovanella, Markus Luster, Damiano Librizzi","doi":"10.1055/a-1976-1765","DOIUrl":"https://doi.org/10.1055/a-1976-1765","url":null,"abstract":"<p><p>Introduction The present study aims to evaluate the clinical diagnostic value of FDG-PET/CT in patients with inflammation of unknown origin. Material and methods We retrospectively analyzed data of 130 patients who presented general inflammatory symptoms and/or elevated level of CRP and underwent FDG-PET/CT for the purpose of identifying unknown foci of inflammation. The accuracy of PET/CT findings was assessed against the standard of eventual clinical diagnosis e.g. results of pathology, microbiology or other imaging methods. Results In 99/130 patients (76 %) a final diagnosis was established, FDG-PET/CT showed a sensitivity and specificity of each 93 %. A decreased pseudocholinesterase is associated with a higher SUVmax value and with a higher CRP value whereas no significant relationship was found between elevated CRP values and the SUVmax, although higher CRP values are associated significantly with a true positive PET/CT result. Conclusion FDG-PET/CT is a highly sensitive, specific and accurate method for the detection of foci of inflammation of unknown origin. The combination of decreased pseudocholinesterase and increased CRP levels may be a useful tool to select patients for FDG PET/CT.</p>","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9220503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: To investigate the clinical value of 68Ga-FAPI-04 PET/CT for initial staging of esophageal cancer.
Methods: A total of 44 newly diagnosed patients with esophageal cancer were included in the analysis on the basis of postoperative pathology or clinical and radiologic follow-up.
Results: All primary lesions showed increased 68Ga-FAPI-04 uptake, with an SUVmax of 14.92 ± 6.91. A total of 561 lymph nodes were verified by surgery (507) or clinical and radiologic follow-up (54), of which 92 lymph nodes were diagnosed as showing metastases. Seventy-five lymph nodes with metastases showed positive findings on 68Ga-FAPI-04, with a diameter of about 1.06 ± 0.53 cm and SUVmax of 8.10±4.71. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for lymph node metastasis detection were 81.5%, 99.3%, 96.6%, 96.2%, and 96.5%, respectively.
Conclusion: 68Ga-FAPI-04 PET/CT showed good diagnostic performance in detecting lymph node metastases of esophageal cancer.
目的:探讨68Ga-FAPI-04型PET/CT对食管癌早期分期的临床价值。方法:对44例新诊断食管癌患者进行术后病理或临床及影像学随访分析。结果:所有原发病变68Ga-FAPI-04摄取增加,SUVmax为14.92±6.91。共561个淋巴结经手术(507个)或临床及影像学随访(54个)证实,其中92个淋巴结被诊断为转移。68Ga-FAPI-04阳性淋巴结75例,直径约1.06±0.53 cm, SUVmax为8.10±4.71。检测淋巴结转移的敏感性为81.5%,特异性为99.3%,准确性为96.6%,阳性预测值为96.2%,阴性预测值为96.5%。结论:68Ga-FAPI-04型PET/CT对食管癌淋巴结转移有较好的诊断价值。
{"title":"Role of 68Ga-FAPI-04 PET/CT in the Initial Staging of Esophageal Cancer.","authors":"Huipan Liu, Xiao Yang, Zhouxiang You, Zhi Hu, Yue Chen","doi":"10.1055/a-1984-8044","DOIUrl":"https://doi.org/10.1055/a-1984-8044","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the clinical value of 68Ga-FAPI-04 PET/CT for initial staging of esophageal cancer.</p><p><strong>Methods: </strong>A total of 44 newly diagnosed patients with esophageal cancer were included in the analysis on the basis of postoperative pathology or clinical and radiologic follow-up.</p><p><strong>Results: </strong>All primary lesions showed increased 68Ga-FAPI-04 uptake, with an SUVmax of 14.92 ± 6.91. A total of 561 lymph nodes were verified by surgery (507) or clinical and radiologic follow-up (54), of which 92 lymph nodes were diagnosed as showing metastases. Seventy-five lymph nodes with metastases showed positive findings on 68Ga-FAPI-04, with a diameter of about 1.06 ± 0.53 cm and SUVmax of 8.10±4.71. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for lymph node metastasis detection were 81.5%, 99.3%, 96.6%, 96.2%, and 96.5%, respectively.</p><p><strong>Conclusion: </strong>68Ga-FAPI-04 PET/CT showed good diagnostic performance in detecting lymph node metastases of esophageal cancer.</p>","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10667809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anne Katharina Krebold, Tina Schaller, Madeleine Appenzeller, Martin Schwaiblmair, Malte Kircher, Ralph Alexander Bundschuh, Constantin Lapa, Alexander Dierks
A 55-year-old man with a prior medical history of chronic sinusitis was referred due to progressive dyspnea and weight loss. Computed tomography (CT) of the chest revealed multiple consolidations in both lungs. For further work-up, positron remission tomography/CT (PET/CT) with [18F]fluoro-D-glucose ([18F]FDG) was subsequently performed demonstrating high [18F]FDG uptake in the nasal cavity (SUVmax: 16.9). In addition, intense tracer accumulation in the aforementioned lung lesions (SUVmax: 21.9) was observed (▶ Fig. 1). Biopsies of the nasal septum and the lungs were performed. Pathologic workup revealed acute and chronic inflammation with granulomatous features (▶ Fig. 2), confirmed by the presence of anti-neutrophil cytoplasmic antibodies in serum. A diagnosis of granulomatosis with polyangiitis (GPA) was established, and anti-inflammatory therapy consisting of high dose prednisolone and rituximab was initiated.
{"title":"[18F]FDG PET/CT guided biopsy confirms diagnosis of granulomatosis with polyangiitis.","authors":"Anne Katharina Krebold, Tina Schaller, Madeleine Appenzeller, Martin Schwaiblmair, Malte Kircher, Ralph Alexander Bundschuh, Constantin Lapa, Alexander Dierks","doi":"10.1055/a-1907-4248","DOIUrl":"https://doi.org/10.1055/a-1907-4248","url":null,"abstract":"A 55-year-old man with a prior medical history of chronic sinusitis was referred due to progressive dyspnea and weight loss. Computed tomography (CT) of the chest revealed multiple consolidations in both lungs. For further work-up, positron remission tomography/CT (PET/CT) with [18F]fluoro-D-glucose ([18F]FDG) was subsequently performed demonstrating high [18F]FDG uptake in the nasal cavity (SUVmax: 16.9). In addition, intense tracer accumulation in the aforementioned lung lesions (SUVmax: 21.9) was observed (▶ Fig. 1). Biopsies of the nasal septum and the lungs were performed. Pathologic workup revealed acute and chronic inflammation with granulomatous features (▶ Fig. 2), confirmed by the presence of anti-neutrophil cytoplasmic antibodies in serum. A diagnosis of granulomatosis with polyangiitis (GPA) was established, and anti-inflammatory therapy consisting of high dose prednisolone and rituximab was initiated.","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10686482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Friederike Eilsberger, Markus Luster, Damiano Librizzi, Fiona Rodepeter, Katharina Holzer, Andreas Pfestroff
The prostate-specific membrane antigen (PSMA) is established in imaging and treatment of prostate cancer, especially in recurrent disease. PSMA is a membranebound glycoprotein with the function of a glutamic acid releasing carboxypeptidase enzyme, which is biologically expressed by the prostate and among others, proximal renal tubule cells, small intestine, central and peripheral nervous system [1]. Positrone Emission Tomography (PET)/ Computed Tomography (CT) imaging with Gallium (Ga)-68 in prostate cancer has its benefits in demonstrating the extent of the current disease and in preceding possible therapy with radionuclides like Lutetium (Lu)-177 and also the feasibility of intraoperative probe-assisted detection and localization of respective lesions. Numerous immunohistochemical studies have shown that PSMA is also upregulated on the endothelial cells of the neovasculature of a diverse group of other solid tumors. PSMA appears to promote endothelial invasion cell proliferation through its regulation of lytic proteases that can cleave the extracellular matrix [2]. PSMA expression in the neovasculature of tumors was likewise shown for example in renal cell carcinoma, rectal carcinoma, lung cancer, hepatocellular carcinoma, lymphoma, urinary bladder, stomach, small intestine and differentiated thyroid cancer [3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14]. Heitkötter et al discussed that in thyroid carcinomas, PSMA expression was more common in poorly differentiated species [15]. Poorly differentiated tumors grow rapidly, resulting in intratumoral hypoxemia, in which PSMA supports neovascularization. It is therefore not surprising that several studies have demonstrated an association between high PSMA expression and poorer prognosis and outcome. Haffner et al. were able to demonstrate this association in squamous cell carcinoma of the oral cavity, Jiao et al. in hepatocellular carcinoma and Sollini et al. in differentiated thyroid cancer [16, 17, 18].
{"title":"Medullary Thyroid Carcinoma presenting as an Incidentaloma on Gallium-68-PSMA-PET/CT - Systematic Literature Review and Case Report.","authors":"Friederike Eilsberger, Markus Luster, Damiano Librizzi, Fiona Rodepeter, Katharina Holzer, Andreas Pfestroff","doi":"10.1055/a-1896-0106","DOIUrl":"https://doi.org/10.1055/a-1896-0106","url":null,"abstract":"The prostate-specific membrane antigen (PSMA) is established in imaging and treatment of prostate cancer, especially in recurrent disease. PSMA is a membranebound glycoprotein with the function of a glutamic acid releasing carboxypeptidase enzyme, which is biologically expressed by the prostate and among others, proximal renal tubule cells, small intestine, central and peripheral nervous system [1]. Positrone Emission Tomography (PET)/ Computed Tomography (CT) imaging with Gallium (Ga)-68 in prostate cancer has its benefits in demonstrating the extent of the current disease and in preceding possible therapy with radionuclides like Lutetium (Lu)-177 and also the feasibility of intraoperative probe-assisted detection and localization of respective lesions. Numerous immunohistochemical studies have shown that PSMA is also upregulated on the endothelial cells of the neovasculature of a diverse group of other solid tumors. PSMA appears to promote endothelial invasion cell proliferation through its regulation of lytic proteases that can cleave the extracellular matrix [2]. PSMA expression in the neovasculature of tumors was likewise shown for example in renal cell carcinoma, rectal carcinoma, lung cancer, hepatocellular carcinoma, lymphoma, urinary bladder, stomach, small intestine and differentiated thyroid cancer [3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14]. Heitkötter et al discussed that in thyroid carcinomas, PSMA expression was more common in poorly differentiated species [15]. Poorly differentiated tumors grow rapidly, resulting in intratumoral hypoxemia, in which PSMA supports neovascularization. It is therefore not surprising that several studies have demonstrated an association between high PSMA expression and poorer prognosis and outcome. Haffner et al. were able to demonstrate this association in squamous cell carcinoma of the oral cavity, Jiao et al. in hepatocellular carcinoma and Sollini et al. in differentiated thyroid cancer [16, 17, 18].","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10671602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01Epub Date: 2022-08-09DOI: 10.1055/a-1883-9281
Amelie Kugler, Torsten Kuwert, Philipp Ritt, Andreas Grings
Aim: Implanted metal prostheses can cause severe artifacts in reconstructed computed tomography (CT) images. To reduce the diagnostic impact of these artifacts and improve attenuation correction in single photon emission computed tomography (SPECT), an algorithm of iterative metal artifact reduction (iMAR) for SPECT/CT systems was developed. The aims of this study were (a) to assess the difference in visual image quality by comparing CT and SPECT images reconstructed with and without iMAR and (b) to determine the influence of iMAR on quantitative 99mTc-uptake in SPECT/CT.
Methods: This retrospective study includes 21 patients with implanted metal prostheses who underwent SPECT/CT bone scintigraphy. CT data were reconstructed with iMAR and without (noMAR) and were used for attenuation correction of SPECT data for xSPECT Quant and xSPECT Bone reconstruction. The effect of iMAR on image quality was evaluated by visual analysis and the effect on quantitative SPECT/CT was assessed by measuring HU values and absolute uptake values (kBq/mL) in volumes of interest (VOIs).
Results: There was a significant reduction of visible metal artifacts with iMAR (p<0.01) in the CT images, but visual differences in the SPECT images were minor. The values of quantitative tracer uptake in VOIs near metal implants were lower for iMAR vs. noMAR xSPECT Quant (p<0.01). Only VOIs near metal showed significant differences in HU values, which were 14.6% lower for iMAR CT (p<0.01).
Conclusion: The use of iMAR reduces metal artifacts in CT and improves the perceived image quality. Although in some cases a significant difference in the quantitative evaluation of SPECT/CT was observed, the influence of iMAR can be considered small in relation to other factors in the clinical setting.
{"title":"Influence of CT metal artifact reduction on SPECT/CT quantification of bone scintigraphy - Retrospective study for selected types of metal implants.","authors":"Amelie Kugler, Torsten Kuwert, Philipp Ritt, Andreas Grings","doi":"10.1055/a-1883-9281","DOIUrl":"https://doi.org/10.1055/a-1883-9281","url":null,"abstract":"<p><strong>Aim: </strong>Implanted metal prostheses can cause severe artifacts in reconstructed computed tomography (CT) images. To reduce the diagnostic impact of these artifacts and improve attenuation correction in single photon emission computed tomography (SPECT), an algorithm of iterative metal artifact reduction (iMAR) for SPECT/CT systems was developed. The aims of this study were (a) to assess the difference in visual image quality by comparing CT and SPECT images reconstructed with and without iMAR and (b) to determine the influence of iMAR on quantitative <sup>99m</sup>Tc-uptake in SPECT/CT.</p><p><strong>Methods: </strong>This retrospective study includes 21 patients with implanted metal prostheses who underwent SPECT/CT bone scintigraphy. CT data were reconstructed with iMAR and without (noMAR) and were used for attenuation correction of SPECT data for xSPECT Quant and xSPECT Bone reconstruction. The effect of iMAR on image quality was evaluated by visual analysis and the effect on quantitative SPECT/CT was assessed by measuring HU values and absolute uptake values (kBq/mL) in volumes of interest (VOIs).</p><p><strong>Results: </strong>There was a significant reduction of visible metal artifacts with iMAR (p<0.01) in the CT images, but visual differences in the SPECT images were minor. The values of quantitative tracer uptake in VOIs near metal implants were lower for iMAR vs. noMAR xSPECT Quant (p<0.01). Only VOIs near metal showed significant differences in HU values, which were 14.6% lower for iMAR CT (p<0.01).</p><p><strong>Conclusion: </strong>The use of iMAR reduces metal artifacts in CT and improves the perceived image quality. Although in some cases a significant difference in the quantitative evaluation of SPECT/CT was observed, the influence of iMAR can be considered small in relation to other factors in the clinical setting.</p>","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40694498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Identification of anaplastic lymphoma kinase (ALK) and epidermal growth factor receptor (EGFR) mutation types is of great importance before treatment with tyrosine kinase inhibitors (TKIs). Radiomics is a new strategy for noninvasively predicting the genetic status of cancer. We aimed to evaluate the predictive power of 18F-FDG PET/CT-based radiomic features for mutational status before treatment in non-small cell lung cancer (NSCLC) and to develop a predictive model based on radiomic features.
Methods: Images of patients who underwent 18F-FDG PET/CT for initial staging with the diagnosis of NSCLC between January 2015 and July 2020 were evaluated using LIFEx software. The region of interest (ROI) of the primary tumor was established and volumetric and textural features were obtained. Clinical data and radiomic data were evaluated with machine learning (ML) algorithms to create a model.
Results: For EGFR mutation prediction, the most successful machine learning algorithm obtained with GLZLM_GLNU and clinical data was Naive Bayes (AUC: 0.751, MCC: 0.347, acc: 71.4%). For ALK rearrangement prediction, the most successful machine learning algorithm obtained with GLCM_correlation, GLZLM_LZHGE and clinical data was evaluated as Naive Bayes (AUC: 0.682, MCC: 0.221, acc: 77.4%).
Conclusions: In our study, we created prediction models based on radiomic analysis of 18F-FDG PET/CT images. Tissue analysis with ML algorithms are non-invasive methods for predicting ALK rearrangement and EGFR mutation status in NSCLC, which may be useful for targeted therapy selection in a clinical setting.
{"title":"IMPORTANCE of PRETREATMENT 18F-FDG PET/CT TEXTURE ANALYSIS in PREDICTING EGFR and ALK MUTATION in PATIENTS with NON-SMALL CELL LUNG CANCER.","authors":"Nurşin Agüloğlu, Ayşegül Aksu, Murat Akyol, Nuran Katgı, Tuğçe Çiftçi Doksöz","doi":"10.1055/a-1868-4918","DOIUrl":"https://doi.org/10.1055/a-1868-4918","url":null,"abstract":"<p><strong>Objective: </strong>Identification of anaplastic lymphoma kinase (ALK) and epidermal growth factor receptor (EGFR) mutation types is of great importance before treatment with tyrosine kinase inhibitors (TKIs). Radiomics is a new strategy for noninvasively predicting the genetic status of cancer. We aimed to evaluate the predictive power of 18F-FDG PET/CT-based radiomic features for mutational status before treatment in non-small cell lung cancer (NSCLC) and to develop a predictive model based on radiomic features.</p><p><strong>Methods: </strong>Images of patients who underwent 18F-FDG PET/CT for initial staging with the diagnosis of NSCLC between January 2015 and July 2020 were evaluated using LIFEx software. The region of interest (ROI) of the primary tumor was established and volumetric and textural features were obtained. Clinical data and radiomic data were evaluated with machine learning (ML) algorithms to create a model.</p><p><strong>Results: </strong>For EGFR mutation prediction, the most successful machine learning algorithm obtained with GLZLM_GLNU and clinical data was Naive Bayes (AUC: 0.751, MCC: 0.347, acc: 71.4%). For ALK rearrangement prediction, the most successful machine learning algorithm obtained with GLCM_correlation, GLZLM_LZHGE and clinical data was evaluated as Naive Bayes (AUC: 0.682, MCC: 0.221, acc: 77.4%).</p><p><strong>Conclusions: </strong>In our study, we created prediction models based on radiomic analysis of 18F-FDG PET/CT images. Tissue analysis with ML algorithms are non-invasive methods for predicting ALK rearrangement and EGFR mutation status in NSCLC, which may be useful for targeted therapy selection in a clinical setting.</p>","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40634572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01Epub Date: 2022-07-29DOI: 10.1055/a-1868-5050
Michael Neuberger, Jan Axl Dropmann, Axel Kleespies, Heinrich Fuerst
Aim: In patients with recurrent primary hyperparathyroidism (pHPT) or preceding thyroid operation, scintigraphic localization of the pathological parathyroid gland is sometimes unsuccessful. Reason for diagnostic failure, and its clinical relevance is poorly understood.
Methods: This retrospective observational study in patients suffering from a pHPT evaluated independent predictors of a negative preoperative scintigraphy (SC) result, and its relevance for intraoperative outcome using logistic regression analysis.
Results: Among 86 pHPT patients scheduled for parathyroid operation, 63 (73%) had a history of a preceding thyroid or parathyroid operation. Preoperative SC could not identify an adenoma in 30 patients (34.9%), and in 12 patients (14.0%), the surgeon was subsequently unable to localize abnormal parathyroid tissue. Preoperative parathyroid hormone concentration was the only significant independent predictor of a negative SC finding (non-linear and indirect association). Independent from surgical history, an unsuccessful intraoperative focus localization was exclusively predicted by preoperative ultrasonographic (US) and SC findings (OR per diagnostic category 2.98; 95%-CI 1.03-8.58, p=0.043, and OR 2.26; 95%-CI: 1.10-4.63, p=0.027, respectively). Compared to exclusive US, however, the combination of SC and US significantly increased the sensitivity and predictive power to identify patients at a high risk for a complicated surgical procedure.
Conclusion: In patients before parathyroidectomy, a low preoperative parathyroid hormone concentration is significantly associated with a high likelihood for a negative SC finding. Combining US with SC before operation significantly increases the chance to identify patients prone to negative intraoperative findings.
目的:对于复发性原发性甲状旁腺功能亢进(pHPT)或既往甲状腺手术的患者,病理甲状旁腺的显像定位有时不成功。诊断失败的原因及其临床相关性尚不清楚。方法:对pHPT患者进行回顾性观察性研究,利用logistic回归分析评估术前显像阴性(SC)的独立预测因素及其与术中预后的相关性。结果:86例计划行甲状旁腺手术的pHPT患者中,63例(73%)既往有甲状腺或甲状旁腺手术史。30例(34.9%)患者术前SC不能识别腺瘤,12例(14.0%)患者术后无法定位异常甲状旁腺组织。术前甲状旁腺激素浓度是阴性SC发现的唯一显著独立预测因子(非线性和间接关联)。与手术史无关,术前超声检查(US)和SC检查结果完全可以预测术中病灶定位不成功(每个诊断类别的OR为2.98;95%-CI 1.03-8.58, p=0.043, OR 2.26;95% ci: 1.10-4.63, p=0.027)。然而,与单独的US相比,SC和US的结合显著提高了识别复杂外科手术高风险患者的敏感性和预测能力。结论:在甲状旁腺切除术前的患者中,术前甲状旁腺激素浓度低与SC阴性发现的高可能性显著相关。术前联合US和SC可显著增加识别术中阴性患者的机会。
{"title":"Determinants and clinical significance of negative scintigraphic findings in primary hyperparathyroidism: a retrospective observational study.","authors":"Michael Neuberger, Jan Axl Dropmann, Axel Kleespies, Heinrich Fuerst","doi":"10.1055/a-1868-5050","DOIUrl":"https://doi.org/10.1055/a-1868-5050","url":null,"abstract":"<p><strong>Aim: </strong>In patients with recurrent primary hyperparathyroidism (pHPT) or preceding thyroid operation, scintigraphic localization of the pathological parathyroid gland is sometimes unsuccessful. Reason for diagnostic failure, and its clinical relevance is poorly understood.</p><p><strong>Methods: </strong>This retrospective observational study in patients suffering from a pHPT evaluated independent predictors of a negative preoperative scintigraphy (SC) result, and its relevance for intraoperative outcome using logistic regression analysis.</p><p><strong>Results: </strong>Among 86 pHPT patients scheduled for parathyroid operation, 63 (73%) had a history of a preceding thyroid or parathyroid operation. Preoperative SC could not identify an adenoma in 30 patients (34.9%), and in 12 patients (14.0%), the surgeon was subsequently unable to localize abnormal parathyroid tissue. Preoperative parathyroid hormone concentration was the only significant independent predictor of a negative SC finding (non-linear and indirect association). Independent from surgical history, an unsuccessful intraoperative focus localization was exclusively predicted by preoperative ultrasonographic (US) and SC findings (OR per diagnostic category 2.98; 95%-CI 1.03-8.58, p=0.043, and OR 2.26; 95%-CI: 1.10-4.63, p=0.027, respectively). Compared to exclusive US, however, the combination of SC and US significantly increased the sensitivity and predictive power to identify patients at a high risk for a complicated surgical procedure.</p><p><strong>Conclusion: </strong>In patients before parathyroidectomy, a low preoperative parathyroid hormone concentration is significantly associated with a high likelihood for a negative SC finding. Combining US with SC before operation significantly increases the chance to identify patients prone to negative intraoperative findings.</p>","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40575473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01Epub Date: 2022-08-17DOI: 10.1055/a-1830-7767
Konstanze V Guggenberger, Marius L Vogt, Steven P Rowe, Takahiro Higuchi, Marc Schmalzing, Hans-Peter Tony, Andreas K Buck, Thorsten A Bley, Matthias Fröhlich, Rudolf A Werner
Objectives: 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) PET/CT can be utilized in patients with giant cell arteritis (GCA), but pretest probability of established laboratory marker such as C-reactive protein (CRP) and white blood cell count (WBC) has not been defined yet. We aimed to elucidate the clinical utility of CRP and WBC for scheduling an [18F]FDG scan.
Methods: 18 treatment-naïve GCA patients and 14 GCA subjects with anti-inflammatory treatment (glucocorticoids or comparable drugs), who underwent [18F]FDG PET/CT and who had no other inflammatory disease at time of scan, were identified. A semi-quantitative analysis in 11 vessel segments was conducted, with averaged jugular vein, healthy liver and lung tissue (Target-to-background ratio [TBR]VJ/liver/lung) serving as background. Derived TBR were then correlated with CRP and WBC at time of PET using Spearman's correlation.
Results: For all treatment-naïve patients, TBRVJ was 2.3±1.1 (95%CI, 2.2-2.5), TBRliver was 1.0±0.5 (95%CI, 0.9-1.0) and average TBRlung was 6.3±3.6 (95%CI, 5.8-6.8). No significant correlation was noted for either CRP (TBRVJ: R=-0.19; TBRliver: R=-0.03; TBRlung: R=-0.17; each P ≥ 0.44) or for WBC (TBRVJ: R=-0.40; TBRliver: R=-0.32; TBRlung: R=-0.37; each P ≥ 0.10). Similar results were recorded for patients under treatment at time of PET. Again, no significant correlation was reached for either CRP (TBRVJ: R=-0.17; TBRliver: R=-0.28; TBRlung: R=-0.09; each P ≥ 0.32) or WBC (TBRVJ: R=-0.06; TBRliver: R=-0.13; TBRlung: R=0.06; each P ≥ 0.65).
Conclusions: In GCA patients with and without anti-inflammatory treatment, CRP and WBC did not substantially correlate with TBR at time of scan. Given the rather limited pretest probability of those parameters, such laboratory values may have less diagnostic utility to order an [18F]FDG PET/CT.
目的:2-脱氧-2-[18F]氟-d -葡萄糖([18F]FDG) PET/CT可用于巨细胞动脉炎(GCA)患者,但尚未确定已建立的实验室标志物如c反应蛋白(CRP)和白细胞计数(WBC)的预测概率。我们的目的是阐明CRP和WBC在安排[18F]FDG扫描中的临床应用。方法:选取18例treatment-naïve GCA患者和14例接受抗炎治疗(糖皮质激素或类似药物)的GCA患者,均行[18F]FDG PET/CT扫描,扫描时无其他炎症性疾病。以平均颈静脉、健康肝脏和肺组织(目标与背景比[TBR]VJ/肝/肺)为背景,对11个血管段进行半定量分析。然后用Spearman相关法将所得TBR与PET时的CRP和WBC进行相关性分析。结果:在所有treatment-naïve患者中,TBRVJ为2.3±1.1 (95%CI, 2.2-2.5), TBRliver为1.0±0.5 (95%CI, 0.9-1.0), TBRlung平均为6.3±3.6 (95%CI, 5.8-6.8)。两组CRP均无显著相关性(TBRVJ: R=-0.19;TBRliver: R = -0.03;TBRlung: R = -0.17;每个P≥0.44)或WBC (TBRVJ: R=-0.40;TBRliver: R = -0.32;TBRlung: R = -0.37;P均≥0.10)。同样的结果也被记录在PET时接受治疗的患者身上。同样,CRP (TBRVJ: R=-0.17;TBRliver: R = -0.28;TBRlung: R = -0.09;P均≥0.32)或WBC (TBRVJ: R=-0.06;TBRliver: R = -0.13;TBRlung: R = 0.06;P均≥0.65)。结论:在接受和未接受抗炎治疗的GCA患者中,扫描时CRP和WBC与TBR无显著相关性。考虑到这些参数的预测概率相当有限,这些实验室值可能对订购FDG PET/CT的诊断效用较小[18F]。
{"title":"Clinical Utility of C-Reactive Protein and White Blood Cell Count for Scheduling an [18F]FDG PET/CT in Patients with Giant Cell Arteritis.","authors":"Konstanze V Guggenberger, Marius L Vogt, Steven P Rowe, Takahiro Higuchi, Marc Schmalzing, Hans-Peter Tony, Andreas K Buck, Thorsten A Bley, Matthias Fröhlich, Rudolf A Werner","doi":"10.1055/a-1830-7767","DOIUrl":"https://doi.org/10.1055/a-1830-7767","url":null,"abstract":"<p><strong>Objectives: </strong>2-deoxy-2-[<sup>18</sup>F]fluoro-D-glucose ([<sup>18</sup>F]FDG) PET/CT can be utilized in patients with giant cell arteritis (GCA), but pretest probability of established laboratory marker such as C-reactive protein (CRP) and white blood cell count (WBC) has not been defined yet. We aimed to elucidate the clinical utility of CRP and WBC for scheduling an [<sup>18</sup>F]FDG scan.</p><p><strong>Methods: </strong>18 treatment-naïve GCA patients and 14 GCA subjects with anti-inflammatory treatment (glucocorticoids or comparable drugs), who underwent [<sup>18</sup>F]FDG PET/CT and who had no other inflammatory disease at time of scan, were identified. A semi-quantitative analysis in 11 vessel segments was conducted, with averaged jugular vein, healthy liver and lung tissue (Target-to-background ratio [TBR]<sub>VJ/liver/lung</sub>) serving as background. Derived TBR were then correlated with CRP and WBC at time of PET using Spearman's correlation.</p><p><strong>Results: </strong>For all treatment-naïve patients, TBR<sub>VJ</sub> was 2.3±1.1 (95%CI, 2.2-2.5), TBR<sub>liver</sub> was 1.0±0.5 (95%CI, 0.9-1.0) and average TBR<sub>lung</sub> was 6.3±3.6 (95%CI, 5.8-6.8). No significant correlation was noted for either CRP (TBR<sub>VJ</sub>: R=-0.19; TBR<sub>liver</sub>: R=-0.03; TBR<sub>lung</sub>: R=-0.17; each P ≥ 0.44) or for WBC (TBR<sub>VJ</sub>: R=-0.40; TBR<sub>liver</sub>: R=-0.32; TBR<sub>lung</sub>: R=-0.37; each P ≥ 0.10). Similar results were recorded for patients under treatment at time of PET. Again, no significant correlation was reached for either CRP (TBR<sub>VJ</sub>: R=-0.17; TBR<sub>liver</sub>: R=-0.28; TBR<sub>lung</sub>: R=-0.09; each P ≥ 0.32) or WBC (TBR<sub>VJ</sub>: R=-0.06; TBR<sub>liver</sub>: R=-0.13; TBR<sub>lung</sub>: R=0.06; each P ≥ 0.65).</p><p><strong>Conclusions: </strong>In GCA patients with and without anti-inflammatory treatment, CRP and WBC did not substantially correlate with TBR at time of scan. Given the rather limited pretest probability of those parameters, such laboratory values may have less diagnostic utility to order an [<sup>18</sup>F]FDG PET/CT.</p>","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40634574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Simone Agnes Schenke, Michael C Kreissl, Michael Grunert, Anja Hach, Sarvar Haghghi, Tatjana Kandror, Eckhard Peppert, Sandra Rosenbaum-Krumme, Verena Ruhlmann, Alexander Stahl, Dieter Wanjura, Konstantin Zaplatnikov, Michael Zimny, Elena Gilman, Ken Herrmann, Rainer Görges
Aim: Thyroid scintigraphy enables the depiction of the functional status of thyroid nodules (TNs) with both, 99mTc-pertechnetate and 123Iodine. The functional status is relevant for diagnostic procedures for the differentiation of benign and malignant TNs. The aim of this study was to examine the current frequencies of hyper-, hypo- and isofunctioning TNs in Germany and to estimate the risk of malignancy with regard to functional status.
Methods: In 11 study centers, a minimum of 100 nodules per center were consecutively enrolled between July 2019 and April 2020. Inclusion criteria were: newly diagnosed nodule, nodule' size of 10 mm or more, thyroid scintigraphy. Exclusion criteria were: completely cystic TNs, patients with prior radioiodine therapy or thyroid surgery. The risk of malignancy was estimated for hyper- and hypofunctioning TNs.
Results: Overall, 849 patients (72 % women) with 1262 TNs were included. Patients' age ranged from 18 to 90 years. Most TNs were hypofunctioning (n=535, 42%) followed by isofunctioning TNs (n=488, 39%) and hyperfunctioning TNs (n=239, 19%). When only TNs with a maximum size of 2 cm or more were considered the rate of hyperfunctioning and hypofunctioning TNs increased (to 27% and 49%) while isofunctioning TNs decreased. Only one of all hyperfunctioning TNs was malignant. In hypofunctioning nodules, the malignancy rate was estimated at 10%.
Conclusion: In Germany, the proportion of hyperfunctioning TNs is approximately 20% and increases in larger TNs to up to 27%. Due to the low risk of malignancy in hyperfunctioning TNs, no further procedures to rule out malignancy are necessary. The risk of malignancy of hypofunctioning TNs is significantly higher. Thus, a thyroid scintigraphy is a useful diagnostic tool in Germany.
{"title":"Distribution of Functional Status of Thyroid Nodules and Malignancy Rates of Hyperfunctioning and Hypofunctioning Thyroid Nodules in Germany.","authors":"Simone Agnes Schenke, Michael C Kreissl, Michael Grunert, Anja Hach, Sarvar Haghghi, Tatjana Kandror, Eckhard Peppert, Sandra Rosenbaum-Krumme, Verena Ruhlmann, Alexander Stahl, Dieter Wanjura, Konstantin Zaplatnikov, Michael Zimny, Elena Gilman, Ken Herrmann, Rainer Görges","doi":"10.1055/a-1856-4052","DOIUrl":"https://doi.org/10.1055/a-1856-4052","url":null,"abstract":"<p><strong>Aim: </strong>Thyroid scintigraphy enables the depiction of the functional status of thyroid nodules (TNs) with both, <sup>99m</sup>Tc-pertechnetate and <sup>123</sup>Iodine. The functional status is relevant for diagnostic procedures for the differentiation of benign and malignant TNs. The aim of this study was to examine the current frequencies of hyper-, hypo- and isofunctioning TNs in Germany and to estimate the risk of malignancy with regard to functional status.</p><p><strong>Methods: </strong>In 11 study centers, a minimum of 100 nodules per center were consecutively enrolled between July 2019 and April 2020. Inclusion criteria were: newly diagnosed nodule, nodule' size of 10 mm or more, thyroid scintigraphy. Exclusion criteria were: completely cystic TNs, patients with prior radioiodine therapy or thyroid surgery. The risk of malignancy was estimated for hyper- and hypofunctioning TNs.</p><p><strong>Results: </strong>Overall, 849 patients (72 % women) with 1262 TNs were included. Patients' age ranged from 18 to 90 years. Most TNs were hypofunctioning (n=535, 42%) followed by isofunctioning TNs (n=488, 39%) and hyperfunctioning TNs (n=239, 19%). When only TNs with a maximum size of 2 cm or more were considered the rate of hyperfunctioning and hypofunctioning TNs increased (to 27% and 49%) while isofunctioning TNs decreased. Only one of all hyperfunctioning TNs was malignant. In hypofunctioning nodules, the malignancy rate was estimated at 10%.</p><p><strong>Conclusion: </strong>In Germany, the proportion of hyperfunctioning TNs is approximately 20% and increases in larger TNs to up to 27%. Due to the low risk of malignancy in hyperfunctioning TNs, no further procedures to rule out malignancy are necessary. The risk of malignancy of hypofunctioning TNs is significantly higher. Thus, a thyroid scintigraphy is a useful diagnostic tool in Germany.</p>","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9554216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}