Nuclear Medicine Communications最新文献

Purpose: Coronary artery disease (CAD) underestimation represents a major pitfall of single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI). Coronary artery calcium score (CACS) has emerged as a sensitive tool for the assessment of suspect CAD; however, the integration of SPECT-MPI with CACS has been seldom evaluated, so far, and was therefore the aim of the present study.

Methods: Patients undergoing SPECT-MPI with CACS and subsequent coronary angiography were included. ROC curves were used to identify the CACS values best predictive for CAD. In SPECT-MPI negative patients, the formula: defined the optimal CACS cut-points. The Systematic Coronary Risk Evaluation 2 was applied for 10-year cardiovascular risk estimation. Significant CAD was defined for an epicardial coronary stenosis >70 or 50% for the left main.

Results: Among 124 patients, 61 (49.19%) displayed positive SPECT-MPI, whereas 69 (56%) had significant CAD at angiography. Sensitivity, specificity, and positive predictive value (PPV) for SPECT-MPI were, respectively, 74, 82, and 84%. Considering 63 SPECT-MPI negative cases, the index values for CACS at the optimal cutoff value of 1949 were: sensitivity 28%, specificity 89%, and PPV 50%, allowing to further detect five (8%) of the patients with significant CAD. The increased discriminative power of the combined SPECT-MPI with CACS was not conditioned by the pretest cardiovascular risk.

Conclusion: Among patients with suspect CAD undergoing SPECT-MPI, the addition of CACS in negative cases allows to detect a consistent further 8% of patients with significant CAD, thus limiting the risk of disease underestimation and offering potential prognostic benefits.

Objectives: Brain imaging of regional metabolic changes in cancer patients can provide insights into cancer biology. We aimed to detect regional metabolic changes in the brains of untreated lung cancer patients without brain metastases using 2-deoxy-2-[18F]fluoroglucose PET/computed tomography.

Methods: The study included 44 lung cancer patients and 17 non-cancer patients as controls. Standardized uptake value (SUV) mean values of 68 different brain regions were recorded, and their ratios to whole brain and brainstem SUVmean were calculated.

Results: Comparisons between the groups showed significant reductions in the frontal lobe, inferior temporal gyrus, and right cingulate and paracingulate gyrus ratios in the patient group. Conversely, the right nucleus caudatus and right pallidum ratios were elevated. Correlation analysis with total lesion glycolysis (TLG) revealed positive correlations in the basal ganglia, right insula, amygdala, and right hippocampus ratios. Negative correlations were observed in the left frontal lobe and some temporal and parietal regions.

Conclusions: While most brain regions showed reduced metabolism, potentially due to tumor-brain glucose competition, others were preserved or positively correlated with TLG, suggesting a link to poor prognosis. The reduced metabolism in the frontal lobe might be associated with depression and cognitive decline in cancer patients.

Objective: Evaluating the predictive models (PM) for a major adverse cardiac event (MACE) only in women with abnormal summed difference score (SDS ≥ 1), borderline myocardial ischemia (borderline-MIsch: SDS = 1), MIsch (SDS ≥ 2), mild-MIsch (SDS = 2-4), and moderate-severe MIsch (ms-MIsch: SDS ≥ 5).

Methods: Between January 2000 and January 2018, of 25 943 consecutive patients who underwent gated single-photon emission computed tomography myocardial perfusion imaging (gSPECT-MPI) for coronary risk stratification; 717 women (age 68.37 ± 3.4 years) with an abnormal SDS ≥ 1 were included. During the follow-up (mean 4 ± 2.9 years) post-gSPECT-MPI, MACE (unstable angina, nonfatal myocardial infarction, coronary revascularization, cardiac death) was assessed.

Results: In the global women cohort with abnormal SDS ( n  = 717), the PM was angina [hazard ratio (HR): 1.65, P  = 0.016], diabetes (HR: 1.72, P  = 0.004), beta-blockers (HR: 1.61, P  = 0.009), pharmacological stress (HR: 1.74, P  = 0.007), ↓ segment (ST) mm ≥ 1 (HR: 1.54, P  = 0.039), and moderate-to-severe abnormal summed stress score (ms-SSS) (HR: 2.92, P  = 0.001). In borderline-MIsch group ( n  = 208), the PM was previous myocardial infarction (HR: 3.8, P  = 0.001), nitrates (HR: 2.13, P  = 0.047), pharmacological stress (HR: 4.81, P  < 0.001), and ↓ST mm ≥ 1 (HR: 3.07, P  = 0.014). In MIsch group ( n  = 509), the PM model was ms-SSS (HR: 2.25, P  = 0.001), diabetes (HR: 1.73, P  = 0.011), angina (HR: 1.68, P  = 0.029), beta-blockers (HR: 1.59, P  = 0.026), and ms-MIsch (HR: 1.62, P  = 0.044). In mild-MIsch group ( n  = 399), the PM was ms-SSS (HR: 2.55, P  = 0.003), diabetes (HR: 2.17, P  = 0.004), angina (HR: 1.89, P  = 0.037), and beta-blockers (HR: 2.01, P  = 0.011). In ms-MIsch group ( n  = 110), the predictive variable for MACE was ms-SSS (HR: 2.27, P  = 0.016). The ms-SSS significantly increases the prognostic value of the ms-MIsch ( P  = 0.001).

Conclusion: Women with different degrees of abnormal SDS have different PMs of MACE. The ms-SSS stands out as the most significant predictive variable.

Background: Differentiated thyroid carcinoma (DTC) is managed by surgery followed by radioiodine (RAI) therapy in most intermediate and high-risk patients. Most nonmetastatic patients have excellent treatment responses and have long-term disease-free status. A lack of comprehensive medical services in resource-limited nation leads to attrition of critical clinical prognostication information. This study aimed to identify readily available clinical, biochemical, and histopathological parameters to predict remnant ablation success and long-term outcomes.

Methods: The study included DTC patients who underwent RAI after surgery. Ablation success was determined by thyroglobulin (Tg) and whole-body radioiodine scan. Patients were followed for at least 5 years to assess biochemical incomplete response (BIR) and structural recurrence.

Results: The study included 383 patients (a mean age of 37.8 ± 12.9 years). Successful ablation was noted in 251 (65.5%). High preablative stimulated serum Tg (presTg), papillary variants, and central and lateral compartment lymph nodal metastases were associated with ablation failure. PresTg ( P  < 0.001) was the most significant predictor. After a 102.9 ± 34.5 months follow-up, 280 (73.1%) patients were disease-free. BIR and structural recurrence were noted in 103 and 32 patients. PresTg (8.1 ± 27.7 vs. 92.3 ± 99.9 ng/ml), ATg (112.9 ± 389.8 vs. 43.2 ± 89.8 IU/ml), papillary variant, central [109 (66.1%) vs. 56 (33.9%)], and lateral compartment [65 (63.7%) vs. 37 (36.3%) lymph nodal metastases were associated ( P  < 0.05) with BIR. PresTg >10.5 ng/ml has a sensitivity and specificity of 86.6 and 86.0% for predicting BIR. Patients with successful remnant ablation and a presTg level <10.5 ng/ml had a low risk of long-term disease recurrence (less than 5%).

Conclusion: This ambispective study found that successful ablation and long-term disease-free survival were achievable in a significant proportion of DTC patients. BIR (26.9%) and structural recurrence (8.4%) were not uncommon. PresTg levels emerged as a crucial predictor of ablation success and subsequent outcomes. In resource-limited regions, presTg levels and ablation failure can aid in optimizing treatment strategies and improving patient care.

Objectives: White blood cells, neutrophils, lymphocytes, and neutrophil-to-lymphocyte ratio (NLR) distribution patterns in patients with anatomic coronary disease have previously been associated with cardiac events such as myocardial infarct size, complications, and prognosis. However, it remains unknown whether myocardial perfusion mass defect percentage (MDP) obtained from gated myocardial perfusion imaging (G-MPI) correlates with these hematological parameters. Therefore, our research aimed to investigate the application of MDP in the evaluation of acute coronary syndrome (ACS).

Methods: Thirty-six patients with ACS underwent single-photon emission computed tomography/computed tomography using retrospective electrocardiography gating during the resting state. The primary outcome was the percentage of left ventricular mass with abnormal myocardial perfusion (i.e. MDP) in G-MPI. Furthermore, the correlation between myocardial perfusion MDP and lymphocyte count, neutrophil count, white blood cell count, and NLR was calculated. In addition, we explored the relationship of myocardial perfusion MDP with other cardiac function parameters obtained from G-MPI, such as summed rest score, left ventricular ejection fraction, end-systolic volume, and end-diastolic volume.

Results: Myocardial perfusion MDP significantly correlated with white blood cell count, neutrophil count, and NLR ( P  < 0.01). Furthermore, these hematological parameters were significantly different between low and high MDP groups. Additionally, myocardial perfusion MDP negatively correlated with end-systolic volume ( r  = -0.615) and left ventricular ejection fraction ( r  = -0.657).

Conclusion: Myocardial perfusion MDP has a high correlation with inflammatory cell counts and cardiac function parameters obtained from G-MPI in ACS; this may be of help in the evaluation and treatment of these patients.

Introduction: The use of in-house developed software as a medical device (IHD-SaMD) is core to many nuclear medicine (NM) services in the UK, including applications in nonimaging studies and image processing. Expected regulatory changes in 2025 could have significant implications due to a lack of resources and expertise in the implementation and maintenance of software Quality Management Systems (QMS) and associated standards. This survey investigated the national use of IHD-SaMD and the readiness of services to adapt to the upcoming regulatory changes.

Method: An online survey was used to investigate the current national usage of IHD-SaMD. Representatives of 64 UK NM physics services were invited to participate, with 43 responding.

Results: It was found that 98% of respondents use IHD-SaMD clinically. About 65% use IHD-SaMD that respondents felt was under-supported (e.g. legacy software). Approximately 60% of respondents use or support two or more pieces of IHD-SaMD. Around 66% of respondents use a QMS in their department, with about 48% using a software-specific QMS. Most respondents indicate understaffing, particularly with regard to IT/software skillsets. Almost all respondents indicate without an increase in the preparedness and understanding of the requirements, all dependent clinical services would be severely impacted or indeed stopped.

Conclusion: This national survey shows that pending regulatory changes could significantly impact NM services, up to and including stopping clinical services. Additional resources would be required to support in-house software management under an appropriate QMS or move to European conformity marking (CE)-marked software where available. This must be urgently considered and addressed by all NM stakeholders.

Objective: To evaluate the effect of prostate-specific membrane antigen (PSMA) PET/computed tomography (CT) on clinical decision-making of radical prostatectomy (RP) and pelvic lymph node dissection (PLND) after its utilization in daily clinical practice at an European high-volume cancer center.

Materials and methods: Patients who had unfavorable intermediate- and high-risk prostate cancer between 2017 and 2021 were included retrospectively and divided into two groups; those who staged using PSMA PET/CT (group 1) and those who staged using conventional modalities (group 2). Clinical decision-making of RP over nonsurgical treatments and f PLND were primary endpoints and evaluated using regression models.

Results: PSMA PET/CT claimed significantly more N1 (24.2% vs. 11.3%; P = 0.01; OR, 1.97; 95% CI, 1.18-3.28) but insignificantly more M1 disease (9.9% vs. 5.7%; P = 0.42; OR, 1.91; 95% CI, 0.39-9.23), compared with the conventional imaging modalities. miN0 stage was related to more RP decisions compared with cN0 stage ( P  < 0.001; OR, 1.91; 95% CI, 1.48-2.46). PLND decision-making was significantly driven by positive cmiN stage findings, which were more reliable when it was reported after a PSMA PET/CT examination ( P  < 0.001; OR, 35.55; 95% CI, 6.74-187.45 for conventional imaging modalities vs. P  < 0.001; OR, 91.72; 95% CI, 11.25-747.56 for PSMA PET/CT).

Conclusions: Patients with no suspicion of lymph node invasion on molecular imaging (PSMA PET/CT) tended to be referred to RP more compared to radiological imaging. Also, the PLND decision was strongly driven by staging findings. Compared with conventional imaging, PSMA PET/CT findings were more reliable during PLND decision-making.

Background: Pulmonary micro-aspiration (PMA) is a feared complication of gastroesophageal reflux disease (GORD). A novel scintigraphic test for GORD has been developed and validated. It can demonstrate contamination of the upper and lower airways by refluxate. Current observations have led to the hypothesis that prolongation in solid gastric emptying (SGE) is critical in pulmonary micro-aspiration.

Methods: Standard LGE and SGE studies and the novel reflux test were evaluated in paired studies in patients with severe GORD to measure rates of PMA after each meal. Either water labeled with 99m Technetium Phyton for the LGE or a labeled egg sandwich for the solid meal was utilized. Major symptoms were noted and the cough and reflux severity index (CSI & RSI) was obtained in all patients.

Results: A total of 131 patients were enrolled (59M/72F) with age range of 21-83 years (mean: 52 years). Patients were in the overweight range for BMI (mean: 26.8). Major symptoms were bloating, nausea, belching, and dyspepsia (< 20% had heartburn). SGE was abnormal in 92% (mean 766 min) and LGE abnormal in 53% (mean 82 min). PMA was shown in 35% after the SGE and in 71% after the LGE. PMA+ patients were older. A significant correlation was found between SGE and PMA ( P  < 0.00) but not LGE. The only significant symptom in the PMA group was bloating. RSI was abnormal in 64% and CSI in 46%.

Conclusion: The majority of patients with PMA do not complain of heartburn. Bloating in patients with severe GORD should raise the possibility of gastroparesis and PMA.

Purpose: Parathyroid imaging with dual-phase technetium-99m methoxyisobutrylizonitrile (Tc-99m MIBI) scintigraphy serves as an important prerequisite for the identification of hyperfunctioning parathyroid gland(s) in patients with primary hyperparathyroidism (PHPT) for a successful targeted parathyroidectomy. This study aimed to evaluate the clinical value of additional lateral imaging and single-photon emission computed tomography/computed tomography (SPECT/CT) versus conventional planar imaging for locating parathyroid pathologies in patients with PHPT.

Materials and methods: A retrospective review was performed on 105 patients who underwent dual-phase Tc-99m MIBI scintigraphy and were surgically treated by parathyroidectomy. Dual-phase Tc-99m-MIBI planar scintigraphy with additional lateral pinhole views and SPECT/CT imaging was performed on a routine basis, as per departmental protocol. Comparison study between imaging modalities was done by patient-based analysis and scintigraphy results were compared with the clinical findings, biochemical markers, and histopathological findings.

Results: Sensitivity and specificity for anterior planar dual-phase Tc-99m MIBI scintigraphy were 78.8 and 80%, respectively. In comparison, lateral pinhole scan and SPECT/CT alone were found to have sensitivities of 85.9 and 90.9%, respectively, with the same specificity. Sensitivity decreased in patients with normocalcaemia and multiglandular disease. The mean adenoma weight and size for true-positive studies were significantly higher than those for false-negative or false-positive studies.

Conclusion: SPECT/CT provided the highest diagnostic accuracy for preoperative identification of parathyroid lesions in PHPT patients. Lateral pinhole imaging offers comparable sensitivity and aids in adenoma localisation when SPECT/CT is unavailable.

Purpose: The present study aimed to predict the prognostic role of quantitative 18 F-fluorodeoxyglucose PET/computed tomography parameters such as maximum standardized uptake value (SUV max ), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) obtained from primary tumor, lymph node metastases, and liver metastasis (LM) in patients with colorectal LM (CLM).

Material and method: The research was designed as a retrospective study and 66 patients with CLM were enrolled between January 2017 and December 2018. Primary tumor SUV max (PSUV max ), liver SUV max (LSUV max ), and lymph node SUV max (LnSUV max ) values obtained from the primary tumor, liver, and lymph nodes were recorded. In addition, total MTV (TMTV) and total TLG (TTLG) values were obtained by summing the values obtained from the primary tumor (PMTV and PTLG), lymph nodes (LnMTV and LnTLG), and liver (LMTV and LTLG). Univariate and multivariate Cox regression analysis was used to measure the effects of prognostic variables on mortality and survival.

Result: In univariate Cox regression analysis, PMTV ( P  = 0.001), LnMTV ( P  = 0.008), LnTLG ( P  = 0.008), LnSUV max ( P  = 0.047), and TTLG ( P  = 0.038) were identified as prognostic factors for overall survival. No statistically significant relationship was found between MTV and TLG values of LM and overall survival. In multivariate analysis, PMTV ( P  = 0.022) was identified as an independent prognostic factor.

Conclusion: In conclusion, our study demonstrated that the PMTV value used in evaluating treatment-naive patients diagnosed with CLM is an independent prognostic factor for survival. Our results need to be confirmed with more studies involving more patients.