Insulinoma is a relatively uncommon pancreatic neuroendocrine tumor, with approximately 10% of the cases being malignant. Diabetes mellitus (DM) with concurrent insulinoma is very rare and the diagnosis of such condition is easily missed as it can be misconstrued as improved glycemic control. Therefore, persistent hypoglycemic symptoms even after stopping antidiabetic medications may be considered for insulinoma. Herein, we present a patient with DM and pancreatic insulinoma with extensive hepatic and skeletal metastases on dual-tracer positron emission tomography/computed tomography (PET/CT) ([68Ga]Ga-DOTATATE and [18F]fluorodeoxyglucose). Given the extensive disease, the patient was treated with a combination of peptide receptor radionuclide therapy (PRRT) and chemotherapy (capecitabine and temozolomide). During therapy, patient showed early clinical and imaging response for insulinoma leading to unmasking of poor glycemic control necessitating requirement of insulin administration for DM. The patient did not experience any life-threatening hypoglycemia during the chemo-PRRT treatment and showed an improvement in quality of life. Unfortunately, the disease progressed at the 4th cycle, 10 months after the initiation of PRRT. We conclude that combined chemo-PRRT may be considered an effective treatment option for patients with metastatic insulinoma and DM owing to its favorable imaging response and effective symptom control.
{"title":"Aggressive Metastatic Insulinoma in a Patient of Diabetes Mellitus with Documentation on Dual-Tracer PET-CT ([68Ga]Ga-DOTATATE and [18F]FDG): Clinical Benefits with Combined Chemo-PRRT Approach","authors":"Yeshwanth Edamadaka, R. Parghane, Sandip Basu","doi":"10.1055/s-0044-1788735","DOIUrl":"https://doi.org/10.1055/s-0044-1788735","url":null,"abstract":"Insulinoma is a relatively uncommon pancreatic neuroendocrine tumor, with approximately 10% of the cases being malignant. Diabetes mellitus (DM) with concurrent insulinoma is very rare and the diagnosis of such condition is easily missed as it can be misconstrued as improved glycemic control. Therefore, persistent hypoglycemic symptoms even after stopping antidiabetic medications may be considered for insulinoma. Herein, we present a patient with DM and pancreatic insulinoma with extensive hepatic and skeletal metastases on dual-tracer positron emission tomography/computed tomography (PET/CT) ([68Ga]Ga-DOTATATE and [18F]fluorodeoxyglucose). Given the extensive disease, the patient was treated with a combination of peptide receptor radionuclide therapy (PRRT) and chemotherapy (capecitabine and temozolomide). During therapy, patient showed early clinical and imaging response for insulinoma leading to unmasking of poor glycemic control necessitating requirement of insulin administration for DM. The patient did not experience any life-threatening hypoglycemia during the chemo-PRRT treatment and showed an improvement in quality of life. Unfortunately, the disease progressed at the 4th cycle, 10 months after the initiation of PRRT. We conclude that combined chemo-PRRT may be considered an effective treatment option for patients with metastatic insulinoma and DM owing to its favorable imaging response and effective symptom control.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141808300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Malignancies are increasing worldwide with changing lifestyle, pollution, increasing life expectancy, and diagnostic advancements. However, multiple primary malignancies (MPMs) detected simultaneously are very rare. Here, we present a rare case of three primary malignancies (sigmoid colon, prostate, and thyroid) detected simultaneously in a 77-year-old male patient, who initially presented with bleeding per rectum and was then found to have a large pedunculated mass in the sigmoid colon on colonoscopy, which further turned out to be adenocarcinoma. On further imaging and investigations, two new separate malignancies (prostate and thyroid) were found by two different positron emission tomography radiotracers: prostate-specific membrane antigen (PSMA) and fluorodeoxyglucose (FDG). Hence, nuclear medicine modalities can play an important role in detecting MPMs using the vast array of radiotracers available now and perhaps reduce the need for multiple biopsies.
{"title":"Trifecta of Tumors: Simultaneous Detection of Three Primary Malignancies by Different Radiotracers of Nuclear Medicine","authors":"Siven Kar, Harshita Gupta, Nusrat Shaikh, V. Lele","doi":"10.1055/s-0044-1788738","DOIUrl":"https://doi.org/10.1055/s-0044-1788738","url":null,"abstract":"Malignancies are increasing worldwide with changing lifestyle, pollution, increasing life expectancy, and diagnostic advancements. However, multiple primary malignancies (MPMs) detected simultaneously are very rare. Here, we present a rare case of three primary malignancies (sigmoid colon, prostate, and thyroid) detected simultaneously in a 77-year-old male patient, who initially presented with bleeding per rectum and was then found to have a large pedunculated mass in the sigmoid colon on colonoscopy, which further turned out to be adenocarcinoma. On further imaging and investigations, two new separate malignancies (prostate and thyroid) were found by two different positron emission tomography radiotracers: prostate-specific membrane antigen (PSMA) and fluorodeoxyglucose (FDG). Hence, nuclear medicine modalities can play an important role in detecting MPMs using the vast array of radiotracers available now and perhaps reduce the need for multiple biopsies.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141809437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prostate cancer involving visceral organs are occurrences in the later disease course, usually following regional nodal and skeletal involvement, and are refractory to conventional treatment. A 61-year-old male patient presented with locally advanced disease at presentation, which progressed on androgen deprivation therapy and systemic therapy with involvement of the visceral organs (lungs and liver). Portal venous tumor thrombosis involving the right and main branch was also observed on contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI), which showed intense uptake on 68Ga-labeled prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA-11 PET/CT) and 18F-fluorodeoxyglucose PET/CT (18F-FDG-PET/CT). Post-177Lu-PSMA-617 radioligand therapy (PRLT) showed mixed response on tumor marker and imaging analysis with survival of 6 months after 177Lu-PSMA radioligand therapy. The high Gleason score, visceral organ metastasis, and increased metabolic activity on FDG were the adverse prognostic factors in the described patient.
{"title":"Portal Venous Tumor Thrombosis and Visceral Organ Metastasis without Skeletal Involvement in mCRPC: Adverse Prognostic Indicators on Dual Tracer PET/CT and Clinical Outcome after 177Lu-PSMA-617 PRLT and Cabazitaxel Therapy","authors":"Yeshwanth Edamadaka, R. Parghane, Sandip Basu","doi":"10.1055/s-0044-1788736","DOIUrl":"https://doi.org/10.1055/s-0044-1788736","url":null,"abstract":"Prostate cancer involving visceral organs are occurrences in the later disease course, usually following regional nodal and skeletal involvement, and are refractory to conventional treatment. A 61-year-old male patient presented with locally advanced disease at presentation, which progressed on androgen deprivation therapy and systemic therapy with involvement of the visceral organs (lungs and liver). Portal venous tumor thrombosis involving the right and main branch was also observed on contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI), which showed intense uptake on 68Ga-labeled prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA-11 PET/CT) and 18F-fluorodeoxyglucose PET/CT (18F-FDG-PET/CT). Post-177Lu-PSMA-617 radioligand therapy (PRLT) showed mixed response on tumor marker and imaging analysis with survival of 6 months after 177Lu-PSMA radioligand therapy. The high Gleason score, visceral organ metastasis, and increased metabolic activity on FDG were the adverse prognostic factors in the described patient.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141806584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sireesha Polisetty, Ramyapriya R., Hema latha D.S, T. Kalawat
Rosai-Dorfman disease (RDD) is a rare benign proliferative disorder. Lymph nodes are the usual and common sites of involvement. Involvement of the extranodal site is also documented in the literature. 18F-fluorodeoxyglucose positron emission tomography computed tomography (F18-FDG PET CT) is a valuable whole-body imaging modality in staging and treatment response of various lymphoproliferative and solid organ malignancy. Similarly, PET CT survey can detect the involved sites of various body systems, infective or inflammatory diseases, and provide guidance for biopsy and to reach to diagnosis. Here, we present a case of RDD, who presented with neurological manifestations and on F18-FDG PET CT, diagnosed with multiorgan involvement.
罗赛-多夫曼病（RDD）是一种罕见的良性增生性疾病。淋巴结是通常常见的受累部位。文献中也有结节外部位受累的记载。18F- 氟脱氧葡萄糖正电子发射计算机断层扫描（F18-FDG PET CT）是一种重要的全身成像模式，可用于各种淋巴增生性疾病和实体器官恶性肿瘤的分期和治疗反应。同样，正电子发射计算机断层扫描（PET CT）也能检测身体各系统受累部位、感染性或炎症性疾病，为活检和诊断提供指导。在此，我们介绍一例以神经系统表现为主的 RDD 患者，经 F18-FDG PET CT 诊断为多器官受累。
{"title":"Extensive Multiorgan and Neurological Involvement on F-18 FDG PET-CT in a Case of Rosai-Dorfman Disease","authors":"Sireesha Polisetty, Ramyapriya R., Hema latha D.S, T. Kalawat","doi":"10.1055/s-0044-1787962","DOIUrl":"https://doi.org/10.1055/s-0044-1787962","url":null,"abstract":"Rosai-Dorfman disease (RDD) is a rare benign proliferative disorder. Lymph nodes are the usual and common sites of involvement. Involvement of the extranodal site is also documented in the literature. 18F-fluorodeoxyglucose positron emission tomography computed tomography (F18-FDG PET CT) is a valuable whole-body imaging modality in staging and treatment response of various lymphoproliferative and solid organ malignancy. Similarly, PET CT survey can detect the involved sites of various body systems, infective or inflammatory diseases, and provide guidance for biopsy and to reach to diagnosis. Here, we present a case of RDD, who presented with neurological manifestations and on F18-FDG PET CT, diagnosed with multiorgan involvement.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141648022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Texture and radiomic analysis characterize the lesion's phenotype and evaluate its microenvironment in quantitative terms. The aim of this study was to investigate the role of textural features of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography–computed tomography (PET/CT) images in differentiating patients with cardiac sarcoidosis (CS) from patients with physiologic myocardial uptake. Methods This is a retrospective, single-center study of 67 patients, 17 diagnosed CS patients, and 50 non-CS patients. These patients underwent FDG PET/CT for the diagnosis of CS. The non-CS group underwent 18F-FDG PET/CT for other oncological indications. The PET/CT images were then processed in a commercially available textural analysis software. Region of interest was drawn over primary tumor with a 40% threshold and was processed further to derive 92 textural and radiomic parameters. These parameters were then compared between the CS group and the non-CS group. Receiver operating characteristics (ROC) curves were used to identify cutoff values for textural features with a p-value < 0.05 for statistical significance. These parameters were then passed through a principle component analysis algorithm. Five different machine learning classifiers were then tested on the derived parameters. Results A retrospective study of 67 patients, 17 diagnosed CS patients, and 50 non-CS patients, was done. Twelve textural analysis parameters were significant in differentiating between the CS group and the non-CS group. Cutoff values were calculated for these parameters according to the ROC curves. The parameters were Discretized_HISTO_Entropy, GLCM_Homogeneity, GLCM_Energy, GLRLM_LRE, GLRLM_LGRE, GLRLM_SRLGE, GLRLM_LRLGE, NGLDM_Coarseness, GLZLM_LZE, GLZLM_LGZE, GLZLM_SZLGE, and GLZLM_LZLGE. The gradient boosting classifier gave best results on these parameters with 85.71% accuracy and an F1 score of 0.86 (max 1.0) on both classes, indicating the classifier is performing well on both classes. Conclusion Textural analysis parameters could successfully differentiate between the CS and non-CS groups noninvasively. Larger multicenter studies are needed for better clinical prognostication of these parameters.
{"title":"Role of Textural Analysis Parameters Derived from FDG PET/CT in Diagnosing Cardiac Sarcoidosis","authors":"Rutuja Kote, M. Ravina, Rangnath Thippanahalli Ganga, Satyajt Singh, Moulish Reddy, Pratheek Prasanth, Rohit Kote","doi":"10.1055/s-0044-1788336","DOIUrl":"https://doi.org/10.1055/s-0044-1788336","url":null,"abstract":"\u0000 Introduction Texture and radiomic analysis characterize the lesion's phenotype and evaluate its microenvironment in quantitative terms. The aim of this study was to investigate the role of textural features of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography–computed tomography (PET/CT) images in differentiating patients with cardiac sarcoidosis (CS) from patients with physiologic myocardial uptake.\u0000 Methods This is a retrospective, single-center study of 67 patients, 17 diagnosed CS patients, and 50 non-CS patients. These patients underwent FDG PET/CT for the diagnosis of CS. The non-CS group underwent 18F-FDG PET/CT for other oncological indications. The PET/CT images were then processed in a commercially available textural analysis software. Region of interest was drawn over primary tumor with a 40% threshold and was processed further to derive 92 textural and radiomic parameters. These parameters were then compared between the CS group and the non-CS group. Receiver operating characteristics (ROC) curves were used to identify cutoff values for textural features with a p-value < 0.05 for statistical significance. These parameters were then passed through a principle component analysis algorithm. Five different machine learning classifiers were then tested on the derived parameters.\u0000 Results A retrospective study of 67 patients, 17 diagnosed CS patients, and 50 non-CS patients, was done. Twelve textural analysis parameters were significant in differentiating between the CS group and the non-CS group. Cutoff values were calculated for these parameters according to the ROC curves. The parameters were Discretized_HISTO_Entropy, GLCM_Homogeneity, GLCM_Energy, GLRLM_LRE, GLRLM_LGRE, GLRLM_SRLGE, GLRLM_LRLGE, NGLDM_Coarseness, GLZLM_LZE, GLZLM_LGZE, GLZLM_SZLGE, and GLZLM_LZLGE. The gradient boosting classifier gave best results on these parameters with 85.71% accuracy and an F1 score of 0.86 (max 1.0) on both classes, indicating the classifier is performing well on both classes.\u0000 Conclusion Textural analysis parameters could successfully differentiate between the CS and non-CS groups noninvasively. Larger multicenter studies are needed for better clinical prognostication of these parameters.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141653075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jordan Fenner, Israel Saramago, Jorge Oldan, M. Muhleman
Infant ectopic cervical thymus is a relatively uncommon diagnosis and, in many cases, subclinical. If not subclinical, it may present as a palpable swelling or with compressive symptoms (i.e., stridor or dysphagia). Standard radiologic workup includes an ultrasound followed by magnetic resonance imaging (MRI) with tissue sampling if the ultrasound is indeterminate. In this case, an incidental submandibular mass was noted on a noncontrast MRI for seizures in a 6-month-old male infant. A radiologic and pathologic workup was performed for evaluation. However, this case is unique as fluorodeoxyglucose positron emission tomography/computed tomography was also utilized to potentially aid in the establishment of a diagnosis.
{"title":"Submandibular Ectopic Thymic Mass in a 6-Month-Old Infant","authors":"Jordan Fenner, Israel Saramago, Jorge Oldan, M. Muhleman","doi":"10.1055/s-0042-1751055","DOIUrl":"https://doi.org/10.1055/s-0042-1751055","url":null,"abstract":"Infant ectopic cervical thymus is a relatively uncommon diagnosis and, in many cases, subclinical. If not subclinical, it may present as a palpable swelling or with compressive symptoms (i.e., stridor or dysphagia). Standard radiologic workup includes an ultrasound followed by magnetic resonance imaging (MRI) with tissue sampling if the ultrasound is indeterminate. In this case, an incidental submandibular mass was noted on a noncontrast MRI for seizures in a 6-month-old male infant. A radiologic and pathologic workup was performed for evaluation. However, this case is unique as fluorodeoxyglucose positron emission tomography/computed tomography was also utilized to potentially aid in the establishment of a diagnosis.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141658081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Toktam Hosseinnezhad Ariani, M. Ghodsirad, Faezeh Hosseinnejad Ariani, H. Poorzand, Ramin Sadeghi, V. D. Dabbagh Kakhki
Introduction Equilibrium radionuclide angiography (ERNA) has long been assumed as the preferred method to assess cardiac volumes as well as left ventricular systolic and diastolic indices. ERNA was used to diagnose subtle changes in cardiac function during chemotherapy or early stages of heart failure. Gated myocardial perfusion SPECT (GMPS) was introduced as a more feasible and versatile alternative to ERNA, but the precision of GMPS to assess systolic and diastolic indices has not yet been fully reviewed. Method We studied the left ventricular systolic and diastolic functional indices measured by a 16-frame GMPS and compared the results with those of ERNA in 25 patients. All the images were analyzed visually, semi-quantitatively, and quantitatively using quantitative gated SPECT (QGS), quantitative blood pool SPECT (QBS), and planar gated blood pool (PGBP) software. The left ventricular functional indices calculated using QGS compared with those obtained using QBS and PGBP Result Our study found a significant correlation between the left ventricular ejection fraction (LVEF) calculated using the PGBP, QGS, and QBS methods. There was a significant correlation between the LV peak ejection rate (LVPER) calculated by the PGBP and QGS analyses, and there was no significant difference in the LVPER calculated with the QGS and QBS methods. This study also revealed a significant correlation between the LV peak filling rate (LVPFR) calculated by QBS and QGS, with no significant difference between them. We also found a significant correlation between LV end systolic volume (LVESV) calculated using QGS and QBS and between LV end diastolic volume (LVEDV) calculated using QGS and QBS software. This study also revealed a significant correlation between the LV mean filling rate over the first third of diastole (LVMFR/3) calculated using the QGS and QBS software. Conclusion Considering the significant correlation between LVEF, LVPER, LVPFR, LVESV, LVMFR/3, and LVEDV calculated using the QGS and QBS methods in our study, the 16-frame GMPS could be regarded as an acceptable substitute for ERNA in the investigation of systolic and diastolic indices.
{"title":"Sixteen-Frame Gated Myocardial Perfusion SPECT as a Surrogate for Equilibrium Radionuclide Angiography in Measurement of Systolic and Diastolic Indices: A Cross-Sectional Study","authors":"Toktam Hosseinnezhad Ariani, M. Ghodsirad, Faezeh Hosseinnejad Ariani, H. Poorzand, Ramin Sadeghi, V. D. Dabbagh Kakhki","doi":"10.1055/s-0044-1788334","DOIUrl":"https://doi.org/10.1055/s-0044-1788334","url":null,"abstract":"\u0000 Introduction Equilibrium radionuclide angiography (ERNA) has long been assumed as the preferred method to assess cardiac volumes as well as left ventricular systolic and diastolic indices. ERNA was used to diagnose subtle changes in cardiac function during chemotherapy or early stages of heart failure. Gated myocardial perfusion SPECT (GMPS) was introduced as a more feasible and versatile alternative to ERNA, but the precision of GMPS to assess systolic and diastolic indices has not yet been fully reviewed.\u0000 Method We studied the left ventricular systolic and diastolic functional indices measured by a 16-frame GMPS and compared the results with those of ERNA in 25 patients. All the images were analyzed visually, semi-quantitatively, and quantitatively using quantitative gated SPECT (QGS), quantitative blood pool SPECT (QBS), and planar gated blood pool (PGBP) software. The left ventricular functional indices calculated using QGS compared with those obtained using QBS and PGBP\u0000 Result Our study found a significant correlation between the left ventricular ejection fraction (LVEF) calculated using the PGBP, QGS, and QBS methods. There was a significant correlation between the LV peak ejection rate (LVPER) calculated by the PGBP and QGS analyses, and there was no significant difference in the LVPER calculated with the QGS and QBS methods. This study also revealed a significant correlation between the LV peak filling rate (LVPFR) calculated by QBS and QGS, with no significant difference between them. We also found a significant correlation between LV end systolic volume (LVESV) calculated using QGS and QBS and between LV end diastolic volume (LVEDV) calculated using QGS and QBS software. This study also revealed a significant correlation between the LV mean filling rate over the first third of diastole (LVMFR/3) calculated using the QGS and QBS software.\u0000 Conclusion Considering the significant correlation between LVEF, LVPER, LVPFR, LVESV, LVMFR/3, and LVEDV calculated using the QGS and QBS methods in our study, the 16-frame GMPS could be regarded as an acceptable substitute for ERNA in the investigation of systolic and diastolic indices.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141658555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract We present a rare case of physiological uptake of [ 177 Lu]Lu-DOTATATE in the gallbladder, observed post-therapy, in a 47-year-old man with grade I duodenal neuroendocrine tumor (NET), despite no uptake being observed pre-therapy in the somatostatin receptor-positron emission tomography. On planar scintigraphy, the gallbladder uptake could have been misidentified as liver metastasis. By utilizing single photon emission computed tomography/computed tomography imaging, we were able to precisely localize the tracer and obtain anatomical morphological characteristics, thereby averting the potential for misinterpretation of liver metastasis resulting from the gallbladder's physiological uptake of [ 177 Lu]Lu-DOTATATE in NET patients.
摘要 我们报告了一例罕见的胆囊生理性摄取[177 Lu]Lu-DOTATATE 的病例，该患者 47 岁，患有 I 级十二指肠神经内分泌肿瘤（NET），尽管在治疗前的体生长抑素受体正电子发射断层扫描中未观察到摄取，但在治疗后观察到了胆囊摄取。在平面闪烁扫描中，胆囊摄取可能被误认为是肝转移。通过利用单光子发射计算机断层扫描/计算机断层扫描成像，我们能够精确定位示踪剂并获得解剖形态学特征，从而避免了因NET患者胆囊对[177 Lu]Lu-DOTATATE 的生理性摄取而误诊为肝转移的可能性。
{"title":"Incidental Visualization of Gallbladder on Post-therapy [ 177 Lu]Lu-DOTATATE Scintigraphy Mimicking a Liver Metastasis in a Duodenal Neuroendocrine Tumor","authors":"Parth Baberwal, R. Parghane, Sandip Basu","doi":"10.1055/s-0044-1788073","DOIUrl":"https://doi.org/10.1055/s-0044-1788073","url":null,"abstract":"Abstract We present a rare case of physiological uptake of [ 177 Lu]Lu-DOTATATE in the gallbladder, observed post-therapy, in a 47-year-old man with grade I duodenal neuroendocrine tumor (NET), despite no uptake being observed pre-therapy in the somatostatin receptor-positron emission tomography. On planar scintigraphy, the gallbladder uptake could have been misidentified as liver metastasis. By utilizing single photon emission computed tomography/computed tomography imaging, we were able to precisely localize the tracer and obtain anatomical morphological characteristics, thereby averting the potential for misinterpretation of liver metastasis resulting from the gallbladder's physiological uptake of [ 177 Lu]Lu-DOTATATE in NET patients.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141679699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Singhal, M. Narayan, R. Manchanda, Parneet Singh, Minakshi Dhar, Ashutosh Tiwari, Niraj Kumar
Abstract Aim Diagnosing movement disorders can be challenging owing to their similar clinical presentations with other neurodegenerative and basal ganglia disorders, like idiopathic Parkinson's disease (IPD), essential tremors (ET), vascular parkinsonism, multiple system atrophy (MSA), and progressive supranuclear palsy (PSP). Technetium-99m labeled tropane derivative (99mTc-TRODAT-1) imaging can help in diagnosing Parkinson's disease at an early stage to help early initiation of the treatment. The current study aimed to evaluate the role of 99mTc-TRODAT-1 imaging in differentiating IPD and Parkinson-plus syndromes (PPS). Material and Methods We have analyzed 38 patients, referred to our department for 99mTc-TRODAT imaging. These patients were thoroughly evaluated in the movement disorder clinic at our institute and had a possible/ probable diagnosis of IPD, Hoehn and Yahr (H&Y) stage I/II ( n = 28) or PPS (PSP [ n = 06] and MSA [ n = 04]). Striatal uptake ratio (SUR) was calculated in all the patients and data was statistically analyzed. Results The mean age of IPD, PSP, and MSA groups was 56.5 ± 12.15, 65.2 ± 11.1, and 51.2 ± 3.9 years, respectively. On qualitative evaluation, all patients had reduced striatal uptake on 99mTc-TRODAT imaging, with 31/38 patients showed a greater reduction in putaminal uptake compared with the caudate nucleus. On semiquantitative evaluation, mean total SUR was 0.58 ± 0.27, 0.53 ± 0.31, and 0.91 ± 0.20 in IPD, PSP, and MSA groups, respectively. The total SUR was lowest in the PSP group followed by IPD, but MSA had relatively higher SUR, although the difference was not statistically significant. Among the IPD patient group, 25/28 patients (89.3%) experienced a greater reduction in SUR values in the striatum contralateral to the side, where motor symptoms first manifested at disease onset. Conclusion 99mTc-TRODAT is a potential imaging biomarker for the evaluation of presynaptic dopaminergic dysfunction in patients with movement disorders. In our study cohort, mean SUR values were lowest for the PSP group followed by IPD and MSA group, which was in concordance with previous studies. However, the difference between SUR values in these two groups was not statistically significant. The present study emphasizes that the capacity of 99mTc-TRODAT-1 imaging alone for diagnosing IPD from PPS is constrained, although it offers a precise approach for distinguishing patients with IPD from those with essential tremors, drug-induced, or psychogenic parkinsonism. Consequently, more specific imaging biomarkers are needed to effectively differentiate between patients with IPD and those with PPS.
{"title":"Reviewing the Diagnostic Performance of 99mTc-TRODAT-1 Imaging in Distinguishing Idiopathic Parkinson's Disease from Parkinson-Plus Syndromes","authors":"T. Singhal, M. Narayan, R. Manchanda, Parneet Singh, Minakshi Dhar, Ashutosh Tiwari, Niraj Kumar","doi":"10.1055/s-0044-1787995","DOIUrl":"https://doi.org/10.1055/s-0044-1787995","url":null,"abstract":"Abstract Aim Diagnosing movement disorders can be challenging owing to their similar clinical presentations with other neurodegenerative and basal ganglia disorders, like idiopathic Parkinson's disease (IPD), essential tremors (ET), vascular parkinsonism, multiple system atrophy (MSA), and progressive supranuclear palsy (PSP). Technetium-99m labeled tropane derivative (99mTc-TRODAT-1) imaging can help in diagnosing Parkinson's disease at an early stage to help early initiation of the treatment. The current study aimed to evaluate the role of 99mTc-TRODAT-1 imaging in differentiating IPD and Parkinson-plus syndromes (PPS). Material and Methods We have analyzed 38 patients, referred to our department for 99mTc-TRODAT imaging. These patients were thoroughly evaluated in the movement disorder clinic at our institute and had a possible/ probable diagnosis of IPD, Hoehn and Yahr (H&Y) stage I/II ( n = 28) or PPS (PSP [ n = 06] and MSA [ n = 04]). Striatal uptake ratio (SUR) was calculated in all the patients and data was statistically analyzed. Results The mean age of IPD, PSP, and MSA groups was 56.5 ± 12.15, 65.2 ± 11.1, and 51.2 ± 3.9 years, respectively. On qualitative evaluation, all patients had reduced striatal uptake on 99mTc-TRODAT imaging, with 31/38 patients showed a greater reduction in putaminal uptake compared with the caudate nucleus. On semiquantitative evaluation, mean total SUR was 0.58 ± 0.27, 0.53 ± 0.31, and 0.91 ± 0.20 in IPD, PSP, and MSA groups, respectively. The total SUR was lowest in the PSP group followed by IPD, but MSA had relatively higher SUR, although the difference was not statistically significant. Among the IPD patient group, 25/28 patients (89.3%) experienced a greater reduction in SUR values in the striatum contralateral to the side, where motor symptoms first manifested at disease onset. Conclusion 99mTc-TRODAT is a potential imaging biomarker for the evaluation of presynaptic dopaminergic dysfunction in patients with movement disorders. In our study cohort, mean SUR values were lowest for the PSP group followed by IPD and MSA group, which was in concordance with previous studies. However, the difference between SUR values in these two groups was not statistically significant. The present study emphasizes that the capacity of 99mTc-TRODAT-1 imaging alone for diagnosing IPD from PPS is constrained, although it offers a precise approach for distinguishing patients with IPD from those with essential tremors, drug-induced, or psychogenic parkinsonism. Consequently, more specific imaging biomarkers are needed to effectively differentiate between patients with IPD and those with PPS.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141679839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jenipher None Zulu, Reuben None Katebe, Martalena None Ramli, Rita None Sakala, Elias None Mwape, Ernest None Chipasha, Bernard Mudenda Hang'ombe
Abstract Objectives The primary aim was to evaluate the prolonged quality characteristics of methyl diphosphonate (MDP) aliquots during ambient storage over a specified duration. This study further investigated potential additives that could enhance the stability of MDP aliquots stored under such conditions. Materials and Methods This was a laboratory-based experimental study conducted at the University Teaching Adult Hospital in Lusaka, Zambia. A total of 36 MDP aliquots stored at ambient conditions and 4 MDP aliquots stored at conventional refrigerated frozen conditions were labeled with technitium-99m ( 99m Tc) and tested for radiochemical purity (RCP) and other quality characteristics. A comparative analysis of the stability and quality of MDP aliquots from the two cohorts was then conducted. Statistical Analysis Stata 14 was used to analyze the data on the RCP of all MDP aliquots. Results The RCP of ambient stored MDP aliquots was found to be ranging from 98 to 99%, while that for frozen and refrigerated ones ranged from 99 to 100%. There was also a 1% increase in RCP for both cohorts with argon gas purging (98 and 99%, respectively). Conclusion The RCP of MDP aliquots from both cohorts was much higher than the required minimum of 90% implying that there was no significant association of their stability and quality with the mode of storage. However, purging with argon gas seemed to increase the stability further in both streams. The study findings show potential for application in resource-constrained environments and centers, especially in developing countries, where challenges to maintain the cold storage chain of these important radiopharmaceuticals are likely to be encountered due to power outages.
{"title":"Exploring the Use of Ambientally Stored Methylene Diphosphonate Radiopharmaceutical Aliquots in Solving Challenging Situations in Developing Countries","authors":"Jenipher None Zulu, Reuben None Katebe, Martalena None Ramli, Rita None Sakala, Elias None Mwape, Ernest None Chipasha, Bernard Mudenda Hang'ombe","doi":"10.1055/s-0044-1788278","DOIUrl":"https://doi.org/10.1055/s-0044-1788278","url":null,"abstract":"Abstract Objectives The primary aim was to evaluate the prolonged quality characteristics of methyl diphosphonate (MDP) aliquots during ambient storage over a specified duration. This study further investigated potential additives that could enhance the stability of MDP aliquots stored under such conditions. Materials and Methods This was a laboratory-based experimental study conducted at the University Teaching Adult Hospital in Lusaka, Zambia. A total of 36 MDP aliquots stored at ambient conditions and 4 MDP aliquots stored at conventional refrigerated frozen conditions were labeled with technitium-99m ( 99m Tc) and tested for radiochemical purity (RCP) and other quality characteristics. A comparative analysis of the stability and quality of MDP aliquots from the two cohorts was then conducted. Statistical Analysis Stata 14 was used to analyze the data on the RCP of all MDP aliquots. Results The RCP of ambient stored MDP aliquots was found to be ranging from 98 to 99%, while that for frozen and refrigerated ones ranged from 99 to 100%. There was also a 1% increase in RCP for both cohorts with argon gas purging (98 and 99%, respectively). Conclusion The RCP of MDP aliquots from both cohorts was much higher than the required minimum of 90% implying that there was no significant association of their stability and quality with the mode of storage. However, purging with argon gas seemed to increase the stability further in both streams. The study findings show potential for application in resource-constrained environments and centers, especially in developing countries, where challenges to maintain the cold storage chain of these important radiopharmaceuticals are likely to be encountered due to power outages.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141680136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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