Majdouline Bel Lakhdar, A. Mouaden, Mourad Zekri, Dounia Alami, Hamza Zarouf, I. Ghfir, Hasnae Guerrouj
Abstract Aim Differentiated thyroid carcinoma (DTC) is the most prevalent endocrine malignancy, with radioactive iodine (RAI) therapy being a standard of care. However, RAI refractoriness, occurring in a subset of patients, significantly impacts survival rates. Understanding predictive factors for RAI refractoriness is crucial for optimizing patient management. Methods This retrospective study analyzed data from 90 DTC patients at Ibn Sina University Hospital, Morocco. Patients were categorized into RAI-refractory (RAIR) and non-RAIR groups based on established criteria. Statistical analyses, including univariate and multivariate logistic regression, were performed to identify predictive factors of RAI refractoriness. Results Age at the time of diagnosis ≥ 54 years, primary tumor diameter ≥ 29 mm, and distal/nodal metastasis were independent predictors of RAIR-DTC. Additionally, the oncocytic carcinoma histological subtype significantly increased the risk of refractoriness. These findings were consistent with previous studies and underscored the importance of early detection and risk stratification. Conclusion Recognition of predictive factors for RAI refractoriness, including age, tumor size, distal/nodal metastasis, and histological subtype, facilitates early identification of high-risk patients. This enables timely intervention and personalized treatment strategies, particularly relevant in resource-limited settings. Further prospective studies are warranted to validate these findings and explore additional molecular markers for improved prediction of RAI refractoriness.
摘要 目的 分化型甲状腺癌（DTC）是最常见的内分泌恶性肿瘤，放射性碘（RAI）治疗是其标准治疗方法。然而，RAI难治性发生在一部分患者中，严重影响了患者的生存率。了解 RAI 难治性的预测因素对于优化患者管理至关重要。方法 这项回顾性研究分析了摩洛哥伊本-西纳大学医院 90 名 DTC 患者的数据。根据既定标准，患者被分为 RAI 难治组（RAIR）和非 RAIR 组。统计分析包括单变量和多变量逻辑回归，以确定 RAI 难治性的预测因素。结果 诊断时年龄≥ 54 岁、原发肿瘤直径≥ 29 毫米、远端/结节转移是 RAIR-DTC 的独立预测因素。此外，肿瘤细胞癌组织学亚型显著增加了难治性风险。这些发现与之前的研究一致，并强调了早期检测和风险分层的重要性。结论 识别 RAI 难治性的预测因素，包括年龄、肿瘤大小、远端/结节转移和组织学亚型，有助于早期识别高风险患者。这样就能及时采取干预措施和个性化治疗策略，尤其适用于资源有限的环境。有必要开展进一步的前瞻性研究来验证这些发现，并探索更多的分子标记物来改进 RAI 难治性的预测。
{"title":"Predictive Factors of Radioactive Iodine Therapy Refractoriness in Patients with Differentiated Thyroid Carcinoma","authors":"Majdouline Bel Lakhdar, A. Mouaden, Mourad Zekri, Dounia Alami, Hamza Zarouf, I. Ghfir, Hasnae Guerrouj","doi":"10.1055/s-0044-1787731","DOIUrl":"https://doi.org/10.1055/s-0044-1787731","url":null,"abstract":"Abstract Aim Differentiated thyroid carcinoma (DTC) is the most prevalent endocrine malignancy, with radioactive iodine (RAI) therapy being a standard of care. However, RAI refractoriness, occurring in a subset of patients, significantly impacts survival rates. Understanding predictive factors for RAI refractoriness is crucial for optimizing patient management. Methods This retrospective study analyzed data from 90 DTC patients at Ibn Sina University Hospital, Morocco. Patients were categorized into RAI-refractory (RAIR) and non-RAIR groups based on established criteria. Statistical analyses, including univariate and multivariate logistic regression, were performed to identify predictive factors of RAI refractoriness. Results Age at the time of diagnosis ≥ 54 years, primary tumor diameter ≥ 29 mm, and distal/nodal metastasis were independent predictors of RAIR-DTC. Additionally, the oncocytic carcinoma histological subtype significantly increased the risk of refractoriness. These findings were consistent with previous studies and underscored the importance of early detection and risk stratification. Conclusion Recognition of predictive factors for RAI refractoriness, including age, tumor size, distal/nodal metastasis, and histological subtype, facilitates early identification of high-risk patients. This enables timely intervention and personalized treatment strategies, particularly relevant in resource-limited settings. Further prospective studies are warranted to validate these findings and explore additional molecular markers for improved prediction of RAI refractoriness.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":"41 15","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141339917","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 Aim This article evaluates whether parameters derived from the gallium-68-labeled prostate-specific membrane antigen ( 68 Ga-PSMA) positron emission tomography/computed tomography (PET/CT) imaging studies of primary prostate cancer (PCa) lesions were associated with Gleason score (GS), D'Amico risk class, Candiolo nomograms, and the metastatic status of the disease. Methods We retrospectively evaluated newly diagnosed PCa patients who underwent 68 Ga-PSMA PET/CT before therapy. Age, baseline serum prostate-specific antigen (PSA), and metastatic status were recorded. Maximal standardized uptake value (SUVmax), mean SUV (SUVmean), total lesion PSMA (TL-PSMA), and PSMA-derived tumor volume (PSMA-TV) were analyzed. The patients were grouped according to GS (GS ≤ 7 and GS ≥ 8), D'Amico risk classes (low intermediate and high-risk), and also based on their results with the Candiolo nomogram which normally creates five risk classes. For Candiolo classes, very-low risk and low-risk patients were pooled into the low-risk Candiolo (LRC) group, high and very high-risk patients were pooled into the high-risk Candiolo (HRC) group. The intermediate-risk Candiolo group was utilized as-is (IRC). Results Mean age was 67 ± 8 years, median PSA value was 14.3 (3–211). There were 82 patients with GS ≤ 7 and 38 patients with GS ≥ 8; intermediate D'Amico class comprised 32 patients, while the high D'Amico class comprised 88 patients. For Candiolo, there were 23 LRC, 40 IRC, and 57 HRC patients. PSMA-positive metastases were detected in 44 (36.7%) patients. The SUVmean, SUVmax, PSMA-TV, and TL-PSMA values of the primary tumor demonstrated significant differences when compared according to classifications for GS, D'Amico, LRC versus HRC, and metastatic versus nonmetastatic patients. Of note, TL-PSMA was the only parameter that varied significantly among all risk groups. Conclusion Primary tumor parameters obtained from baseline 68 Ga-PSMA PET/CT are useful to distinguish PCa patients in terms of GS, D'Amico, Candiolo nomogram, and metastatic states. TL-PSMA appears to be the best parameter as it is the only parameter that can distinguish all risk groups from each other.
{"title":"Baseline Ga-68 PSMA PET-Derived Primary Tumor Parameters in Patients with Prostate Cancer and Their Association with Clinical Risk Stratification and Clinicopathologic Features","authors":"Özge Vural Topuz, A. Aksu","doi":"10.1055/s-0044-1787733","DOIUrl":"https://doi.org/10.1055/s-0044-1787733","url":null,"abstract":"Abstract Aim This article evaluates whether parameters derived from the gallium-68-labeled prostate-specific membrane antigen ( 68 Ga-PSMA) positron emission tomography/computed tomography (PET/CT) imaging studies of primary prostate cancer (PCa) lesions were associated with Gleason score (GS), D'Amico risk class, Candiolo nomograms, and the metastatic status of the disease. Methods We retrospectively evaluated newly diagnosed PCa patients who underwent 68 Ga-PSMA PET/CT before therapy. Age, baseline serum prostate-specific antigen (PSA), and metastatic status were recorded. Maximal standardized uptake value (SUVmax), mean SUV (SUVmean), total lesion PSMA (TL-PSMA), and PSMA-derived tumor volume (PSMA-TV) were analyzed. The patients were grouped according to GS (GS ≤ 7 and GS ≥ 8), D'Amico risk classes (low intermediate and high-risk), and also based on their results with the Candiolo nomogram which normally creates five risk classes. For Candiolo classes, very-low risk and low-risk patients were pooled into the low-risk Candiolo (LRC) group, high and very high-risk patients were pooled into the high-risk Candiolo (HRC) group. The intermediate-risk Candiolo group was utilized as-is (IRC). Results Mean age was 67 ± 8 years, median PSA value was 14.3 (3–211). There were 82 patients with GS ≤ 7 and 38 patients with GS ≥ 8; intermediate D'Amico class comprised 32 patients, while the high D'Amico class comprised 88 patients. For Candiolo, there were 23 LRC, 40 IRC, and 57 HRC patients. PSMA-positive metastases were detected in 44 (36.7%) patients. The SUVmean, SUVmax, PSMA-TV, and TL-PSMA values of the primary tumor demonstrated significant differences when compared according to classifications for GS, D'Amico, LRC versus HRC, and metastatic versus nonmetastatic patients. Of note, TL-PSMA was the only parameter that varied significantly among all risk groups. Conclusion Primary tumor parameters obtained from baseline 68 Ga-PSMA PET/CT are useful to distinguish PCa patients in terms of GS, D'Amico, Candiolo nomogram, and metastatic states. TL-PSMA appears to be the best parameter as it is the only parameter that can distinguish all risk groups from each other.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":"113 5","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141342126","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 herein present a patient initially suspected of multiple lytic skeletal metastasis of unknown primary on anatomical imaging. Metabolic imaging by [18F]-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) detected focal [18F]FDG uptake in the right thyroid nodule, mild [18F]FDG uptake in soft tissue lesion in the left inferior parathyroid region, and multiple nonavid osteolytic skeletal lesions. Fine-needle aspiration cytology of the right thyroid nodule showed papillary thyroid carcinoma (PTC). The patient had raised serum parathyroid hormone and serum calcium levels, suggesting parathyroid disease. [18F]-sodium fluoride (NaF)-PET/CT showed a metabolic superscan pattern of hyperparathyroidism with brown tumors rather than metastatic lytic skeletal lesions. Patient underwent total thyroidectomy and bilateral central compartment clearance, along with soft tissue lesion resection in the left inferior parathyroid region. Finally, histopathology confirmed PTC classical variant with no aggressive histology features (pT1N0) for thyroid nodule and parathyroid adenoma for soft tissue lesion in the left inferior parathyroid region. The findings of the [18F]FDG and [18F]NaF-PET/CT imaging were helpful for making a final diagnosis of synchronous thyroid cancer and parathyroid adenoma, which in turn guided the appropriate treatment strategy.
{"title":"Complimentary Role of [18F]FDG and [18F]NaF-PET/CT in Evaluating Synchronous Thyroid Carcinoma and Parathyroid Adenoma with Brown Tumors","authors":"Yeshwanth Edamadaka, R. Parghane, Sandip Basu","doi":"10.1055/s-0044-1787732","DOIUrl":"https://doi.org/10.1055/s-0044-1787732","url":null,"abstract":"Abstract We herein present a patient initially suspected of multiple lytic skeletal metastasis of unknown primary on anatomical imaging. Metabolic imaging by [18F]-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) detected focal [18F]FDG uptake in the right thyroid nodule, mild [18F]FDG uptake in soft tissue lesion in the left inferior parathyroid region, and multiple nonavid osteolytic skeletal lesions. Fine-needle aspiration cytology of the right thyroid nodule showed papillary thyroid carcinoma (PTC). The patient had raised serum parathyroid hormone and serum calcium levels, suggesting parathyroid disease. [18F]-sodium fluoride (NaF)-PET/CT showed a metabolic superscan pattern of hyperparathyroidism with brown tumors rather than metastatic lytic skeletal lesions. Patient underwent total thyroidectomy and bilateral central compartment clearance, along with soft tissue lesion resection in the left inferior parathyroid region. Finally, histopathology confirmed PTC classical variant with no aggressive histology features (pT1N0) for thyroid nodule and parathyroid adenoma for soft tissue lesion in the left inferior parathyroid region. The findings of the [18F]FDG and [18F]NaF-PET/CT imaging were helpful for making a final diagnosis of synchronous thyroid cancer and parathyroid adenoma, which in turn guided the appropriate treatment strategy.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":"53 49","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141345234","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 Gallium-68 ( 68 Ga)-fibroblast activation protein inhibitor (FAPI) positron emission tomography (PET) images the cancer-associated fibroblast that forms a vital component of the tumor microenvironment. It is known that 68 Ga-FAPI PET can aid in differentiating reactive lymph nodes from metastatic lymph nodes. 18 F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) is still the most commonly used PET radiopharmaceutical in the evaluation of a wide range of malignancies including breast carcinoma. Reactive lymph nodes may also show FDG uptake which can hinder optimal assessment for metastatic involvement. We report an interesting case of invasive ductal carcinoma of the right breast with associated World Health Organization clinical stage I acquired immunodeficiency syndrome for which 18 F-FDG PET/CT and 68 Ga-FAPI PET/CT were done.
摘要 镓-68（68 Ga）-成纤维细胞活化蛋白抑制剂（FAPI）正电子发射断层扫描（PET）可对构成肿瘤微环境重要组成部分的癌症相关成纤维细胞进行成像。众所周知，68 Ga-FAPI PET 可以帮助区分反应性淋巴结和转移性淋巴结。18 F-氟脱氧葡萄糖（FDG）PET/计算机断层扫描（CT）仍是评估包括乳腺癌在内的多种恶性肿瘤最常用的 PET 放射性药物。反应性淋巴结也可能显示 FDG 摄取，这可能会妨碍对转移受累的最佳评估。我们报告了一例有趣的右乳腺浸润性导管癌病例，该病例伴有世界卫生组织临床 I 期获得性免疫缺陷综合征，我们对其进行了 18 F-FDG PET/CT 和 68 Ga-FAPI PET/CT。
{"title":"68 Ga-FAPI PET/CT versus 18 F-FDG PET/CT: Differentiating Metastatic Disease and Reactive Lymph Nodes in a Case of Carcinoma of Breast/Acquired Immunodeficiency Syndrome","authors":"Gopinathraj Gunasekaran, Jaykanth Amalachandran","doi":"10.1055/s-0044-1787718","DOIUrl":"https://doi.org/10.1055/s-0044-1787718","url":null,"abstract":"Abstract Gallium-68 ( 68 Ga)-fibroblast activation protein inhibitor (FAPI) positron emission tomography (PET) images the cancer-associated fibroblast that forms a vital component of the tumor microenvironment. It is known that 68 Ga-FAPI PET can aid in differentiating reactive lymph nodes from metastatic lymph nodes. 18 F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) is still the most commonly used PET radiopharmaceutical in the evaluation of a wide range of malignancies including breast carcinoma. Reactive lymph nodes may also show FDG uptake which can hinder optimal assessment for metastatic involvement. We report an interesting case of invasive ductal carcinoma of the right breast with associated World Health Organization clinical stage I acquired immunodeficiency syndrome for which 18 F-FDG PET/CT and 68 Ga-FAPI PET/CT were done.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":"69 15","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141337811","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}
Z. Koç, Pınar Pelin Özcan, Ferah Tuncel, Caner İsbir, Yusuf Usta
Abstract Aim The imaging of Meckel's diverticulum (MD) is based of accumulation of Tc-99m pertechnetate in the ectopic gastric mucosa (EGM) content. Although the diagnostic accuracy of this imaging modality is high, there are some overlap patients with coexisting gastrointestinal bleeding and false positive causes hampering diagnostic power. The aim of this study was to evaluate the possible contribution of single-photon emission computed tomography/computed tomography (SPECT/CT) in EGM-MD diagnosis and to determine the indication of this additional imaging modality. Materials and Methods Fifty-two pediatric patients (24 girls, 28 boys; mean age: 8.06 ± 5.22 years old) who have suspicion of MD and referred for scintigraphy were evaluated retrospectively. Additional SPECT/CT were performed to selected five cases among the group. The results of the scintigraphy as well as SPECT/CT were compared with endoscopy, pathology, and/or follow-up results. Results There were 9 patients with equivocal study results, 12 positive results, and the others were considered negative MD scintigraphy. One patient was out of follow-up and 10 patients underwent surgery. Only one single patient was negative during surgery but scintigraphy was also negative. The diagnostic sensitivity, specificity, and accuracy were 100, 95, and 96%, respectively. Among five patients with SPECT/CT results one patient was diagnosed by only SPECT/CT who had EGM in duplication cyst, one equivocal patient was diagnosed as descending colon bleeding, and one patient's lesion was clearly delineated by SPECT/CT. Conclusion SPECT/CT has clear advantage over standard planar scintigraphy imaging in EGM-MD determination. This modality might decrease equivocal and false positive results but this issue has to be addressed with further studies.
{"title":"SPECT/CT in the Diagnosis of Ectopic Gastric Mucosa-Meckel's Diverticulum","authors":"Z. Koç, Pınar Pelin Özcan, Ferah Tuncel, Caner İsbir, Yusuf Usta","doi":"10.1055/s-0044-1787719","DOIUrl":"https://doi.org/10.1055/s-0044-1787719","url":null,"abstract":"Abstract Aim The imaging of Meckel's diverticulum (MD) is based of accumulation of Tc-99m pertechnetate in the ectopic gastric mucosa (EGM) content. Although the diagnostic accuracy of this imaging modality is high, there are some overlap patients with coexisting gastrointestinal bleeding and false positive causes hampering diagnostic power. The aim of this study was to evaluate the possible contribution of single-photon emission computed tomography/computed tomography (SPECT/CT) in EGM-MD diagnosis and to determine the indication of this additional imaging modality. Materials and Methods Fifty-two pediatric patients (24 girls, 28 boys; mean age: 8.06 ± 5.22 years old) who have suspicion of MD and referred for scintigraphy were evaluated retrospectively. Additional SPECT/CT were performed to selected five cases among the group. The results of the scintigraphy as well as SPECT/CT were compared with endoscopy, pathology, and/or follow-up results. Results There were 9 patients with equivocal study results, 12 positive results, and the others were considered negative MD scintigraphy. One patient was out of follow-up and 10 patients underwent surgery. Only one single patient was negative during surgery but scintigraphy was also negative. The diagnostic sensitivity, specificity, and accuracy were 100, 95, and 96%, respectively. Among five patients with SPECT/CT results one patient was diagnosed by only SPECT/CT who had EGM in duplication cyst, one equivocal patient was diagnosed as descending colon bleeding, and one patient's lesion was clearly delineated by SPECT/CT. Conclusion SPECT/CT has clear advantage over standard planar scintigraphy imaging in EGM-MD determination. This modality might decrease equivocal and false positive results but this issue has to be addressed with further studies.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":"19 9","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141359311","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}
Septi Hardina, T. Nugrahadi, H. Budiawan, A. Kartamihardja
Abstract Background Urinary tract infection (UTI) is one of the commonly encountered conditions in children. Dimercaptosuccinic acid (DMSA) scintigraphy is widely advocated for functional and morphological evaluation of the renal cortex including parenchymal defect. Moreover, only a small percentage of renal defects are detected by ultrasound. We aimed to examine DMSA scintigraphy of children and identify factors associated with cortical defect. Methods Patients aged ≤ 18 years old who underwent DMSA scintigraphy (November 18, 2019–February 2, 2023, 30 children) were included. All children received intravenous injections of 99m Tc-DMSA followed by static planar and single-photon-emission computed tomography imaging at 3 hours. Cortical findings and differential functions of the worst affected kidney were graded accordingly. Grade I has no more than two cortical defects, grade II has more than two cortical defects with normal parenchyma between the defects, while grade III is when generalized damage is noted, and grade IV is when a shrunken kidney is seen with no DMSA uptake. Normal functioning kidney is when the relative function at 45 to 55%, mildly reduced function at 40 to 44%, and substantially impaired function at 10 to 39%, while nonfunctioning is when the differential split renal function < 10%. All data were then statistically analyzed. Results Majority was female (53%). The mean age was 5.85 years. UTI episodes were 73%. Twenty-two children had congenital urinary tract anomalies. All patients with vesicoureteric refluxes (VURs) had positive defects. Scintigraphy showed abnormalities in 17 children affecting unilateral (64%) or both kidneys (36%). There were 17 children (57%) respectively in the abnormal DMSA scan findings category with normal until significant impairment of the functioning kidney category. VURs were significantly associated with abnormal scintigraphy ( p < 0.05). A significant association was found between abnormal DMSA scan findings and differential renal function ( p < 0.05). Conclusion Significant association was noted between VURs and abnormal DMSA scintigraphy, abnormal DMSA scan findings, and impaired differential renal function. Special consideration should be given to these cases.
{"title":"Renal Cortical Imaging with Tc-99m DMSA in Children: An Institutional Review","authors":"Septi Hardina, T. Nugrahadi, H. Budiawan, A. Kartamihardja","doi":"10.1055/s-0044-1787717","DOIUrl":"https://doi.org/10.1055/s-0044-1787717","url":null,"abstract":"Abstract Background Urinary tract infection (UTI) is one of the commonly encountered conditions in children. Dimercaptosuccinic acid (DMSA) scintigraphy is widely advocated for functional and morphological evaluation of the renal cortex including parenchymal defect. Moreover, only a small percentage of renal defects are detected by ultrasound. We aimed to examine DMSA scintigraphy of children and identify factors associated with cortical defect. Methods Patients aged ≤ 18 years old who underwent DMSA scintigraphy (November 18, 2019–February 2, 2023, 30 children) were included. All children received intravenous injections of 99m Tc-DMSA followed by static planar and single-photon-emission computed tomography imaging at 3 hours. Cortical findings and differential functions of the worst affected kidney were graded accordingly. Grade I has no more than two cortical defects, grade II has more than two cortical defects with normal parenchyma between the defects, while grade III is when generalized damage is noted, and grade IV is when a shrunken kidney is seen with no DMSA uptake. Normal functioning kidney is when the relative function at 45 to 55%, mildly reduced function at 40 to 44%, and substantially impaired function at 10 to 39%, while nonfunctioning is when the differential split renal function < 10%. All data were then statistically analyzed. Results Majority was female (53%). The mean age was 5.85 years. UTI episodes were 73%. Twenty-two children had congenital urinary tract anomalies. All patients with vesicoureteric refluxes (VURs) had positive defects. Scintigraphy showed abnormalities in 17 children affecting unilateral (64%) or both kidneys (36%). There were 17 children (57%) respectively in the abnormal DMSA scan findings category with normal until significant impairment of the functioning kidney category. VURs were significantly associated with abnormal scintigraphy ( p < 0.05). A significant association was found between abnormal DMSA scan findings and differential renal function ( p < 0.05). Conclusion Significant association was noted between VURs and abnormal DMSA scintigraphy, abnormal DMSA scan findings, and impaired differential renal function. Special consideration should be given to these cases.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":"173 ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141368789","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}
Background Glomerular filtration rate (GFR) estimation by Gates protocol using the gamma camera for diethylenetriaminepentaacetic acid (DTPA) dynamic renography has not compared well with the gold standard GFR by plasma sampling method. This is because depth of the kidneys is generally not considered. Our aim was to study whether manual depth correction using the skin to middle of kidney distance in lateral view and posterior aspect-lateral posterior method would reduce the bias in the Gates GFR as compared with the gold standard. Materials and Methods Retrospective study of 27 adult prospective renal donors who underwent GFR by plasma sampling and DTPA dynamic renography at Inlaks and Budhrani Hospital, Pune, Maharashtra, India between January 2022 and April 2023. The entire data was statistically analyzed using Statistical Package for Social Sciences (SPSS ver 21.0, IBM Corporation, United States) for MS Windows. Results There is no significant agreement between plasma sampling versus gamma camera method and plasma sampling versus lateral posterior method for depth correction for GFR measurements; however, the evidence of systemic bias is lower for the gamma camera method compared with the lateral posterior method for depth correction as against the plasma sampling method. Conclusion The lateral posterior method for depth correction while using the gamma camera-based Gates protocol is not a reliable method for depth correction in the western Indian adult population with preserved renal function.
背景盖茨方案使用伽马相机进行二乙烯三胺五乙酸（DTPA）动态肾脏造影术估算肾小球滤过率（GFR），但与金标准的血浆取样法相比效果并不理想。这是因为一般不考虑肾脏的深度。我们的目的是研究在侧视图中使用皮肤到肾中间的距离和后侧-侧后方法进行手动深度校正是否会减少盖茨 GFR 与金标准相比的偏差。材料和方法 对 2022 年 1 月至 2023 年 4 月期间在印度马哈拉施特拉邦普纳 Inlaks 和 Budhrani 医院通过血浆采样和 DTPA 动态肾图进行 GFR 检查的 27 名成年前瞻性肾脏捐献者进行回顾性研究。所有数据均使用 MS Windows 版社会科学统计软件包（SPSS 21.0 版，美国 IBM 公司）进行统计分析。结果 在 GFR 测量的深度校正方面，等离子体取样法与伽马相机法、等离子体取样法与侧后方法之间没有明显的一致性；但是，伽马相机法与侧后方法相比，在深度校正方面的系统偏差证据低于等离子体取样法。结论 在肾功能保存完好的印度西部成年人群中，使用基于伽马相机的盖茨方案进行深度校正的侧后方方法不是一种可靠的深度校正方法。
{"title":"Lateral Posterior Method for Depth Correction while Using the Gates Protocol for GFR Estimation: Is it Comparable to the Gold Standard GFR Estimation by Plasma Sampling?","authors":"Shefali Madhur Gokhale","doi":"10.1055/s-0044-1787100","DOIUrl":"https://doi.org/10.1055/s-0044-1787100","url":null,"abstract":"\u0000 Background Glomerular filtration rate (GFR) estimation by Gates protocol using the gamma camera for diethylenetriaminepentaacetic acid (DTPA) dynamic renography has not compared well with the gold standard GFR by plasma sampling method. This is because depth of the kidneys is generally not considered. Our aim was to study whether manual depth correction using the skin to middle of kidney distance in lateral view and posterior aspect-lateral posterior method would reduce the bias in the Gates GFR as compared with the gold standard.\u0000 Materials and Methods Retrospective study of 27 adult prospective renal donors who underwent GFR by plasma sampling and DTPA dynamic renography at Inlaks and Budhrani Hospital, Pune, Maharashtra, India between January 2022 and April 2023. The entire data was statistically analyzed using Statistical Package for Social Sciences (SPSS ver 21.0, IBM Corporation, United States) for MS Windows.\u0000 Results There is no significant agreement between plasma sampling versus gamma camera method and plasma sampling versus lateral posterior method for depth correction for GFR measurements; however, the evidence of systemic bias is lower for the gamma camera method compared with the lateral posterior method for depth correction as against the plasma sampling method.\u0000 Conclusion The lateral posterior method for depth correction while using the gamma camera-based Gates protocol is not a reliable method for depth correction in the western Indian adult population with preserved renal function.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":"41 21","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140965969","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}
The purpose of this report is to provide a comprehensive description of a post-transplant febrile patient's clinical course, complications, surgical procedure, and long-term management including evaluation by 18F-fluorodeoxyglucose [(18F)FDG] positron-emission tomography combined with computed tomography (PET/CT). A 35-year-old male, a postrenal transplant patient, developed chronic allograft dysfunction and presented with fever with chills, with suspicion of acute-on-chronic graft dysfunction, but no infective focus localization on chest X-ray, ultrasonography (USG) whole abdomen, or blood culture. Urine microscopy showed 8 to 10 pus cells/high-power field (hpf) and culture showed Klebsiella pneumoniae and Pseudomonas aeruginosa with low colony count. Culture-sensitive antibiotics were prescribed for 2 weeks, and after 3 weeks febrile episodes relapsed, symptoms progressed, and required emergency hospitalization due to acute painful urinary retention. Proteinuria and no growth were noted in urine analysis, serum creatinine was 5.36 mg/dL, and C-reactive protein was 15.7mg/dL, and remaining parameters were unremarkable. [18F]FDG-PET/CT was considered in order to resolve diagnosis, which revealed abnormal heterogeneous tracer uptake in the enlarged prostate with hypodense areas within, suggesting prostatitis with abscess formation and pyelonephritis in the upper pole of the transplant kidney. USG kidney urinary bladder (KUB) correlation confirmed prostatic abscess and transurethral drainage done, and pus culture revealed Burkholderia pseudomallei. Culture-sensitive intravenous meropenem treatment was given for 3 weeks. At 5 weeks, follow-up [18F]FDG-PET/CT showed low metabolic residual prostate uptake, suggesting a good response with residual infection. Thus, intravenous antibiotics was changed to oral antibiotics for another 6 weeks. His symptoms completely resolved at the end of treatment; however, his graft function worsened, with serum creatinine reaching 6 to 7 mg/dL, and eventually, after 8 months he became dialysis dependent.
{"title":"Febrile Immunocompromised Renal Transplant Recipient with Allograft Dysfunction: Detection of an Undiagnosed Prostate Abscess by [18F]FDG-PET/CT along with Treatment Response Monitoring","authors":"S. Sonavane, T. Jamale, Sreyasi Bose, Sandip Basu","doi":"10.1055/s-0044-1786705","DOIUrl":"https://doi.org/10.1055/s-0044-1786705","url":null,"abstract":"The purpose of this report is to provide a comprehensive description of a post-transplant febrile patient's clinical course, complications, surgical procedure, and long-term management including evaluation by 18F-fluorodeoxyglucose [(18F)FDG] positron-emission tomography combined with computed tomography (PET/CT). A 35-year-old male, a postrenal transplant patient, developed chronic allograft dysfunction and presented with fever with chills, with suspicion of acute-on-chronic graft dysfunction, but no infective focus localization on chest X-ray, ultrasonography (USG) whole abdomen, or blood culture. Urine microscopy showed 8 to 10 pus cells/high-power field (hpf) and culture showed Klebsiella pneumoniae and Pseudomonas aeruginosa with low colony count. Culture-sensitive antibiotics were prescribed for 2 weeks, and after 3 weeks febrile episodes relapsed, symptoms progressed, and required emergency hospitalization due to acute painful urinary retention. Proteinuria and no growth were noted in urine analysis, serum creatinine was 5.36 mg/dL, and C-reactive protein was 15.7mg/dL, and remaining parameters were unremarkable. [18F]FDG-PET/CT was considered in order to resolve diagnosis, which revealed abnormal heterogeneous tracer uptake in the enlarged prostate with hypodense areas within, suggesting prostatitis with abscess formation and pyelonephritis in the upper pole of the transplant kidney. USG kidney urinary bladder (KUB) correlation confirmed prostatic abscess and transurethral drainage done, and pus culture revealed Burkholderia pseudomallei. Culture-sensitive intravenous meropenem treatment was given for 3 weeks. At 5 weeks, follow-up [18F]FDG-PET/CT showed low metabolic residual prostate uptake, suggesting a good response with residual infection. Thus, intravenous antibiotics was changed to oral antibiotics for another 6 weeks. His symptoms completely resolved at the end of treatment; however, his graft function worsened, with serum creatinine reaching 6 to 7 mg/dL, and eventually, after 8 months he became dialysis dependent.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":"110 8","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141003706","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}
Matthew Clifton Miller, Avani T. Bansal, Daniel Wingard, M. Lindenberg, Derek J. Stocker, Stephen Adler, Kalpna Prasad
Purpose The biodistribution of gallium-68-dotatate (Ga-68-dotatate) and standardized uptake values (SUVs) using non-time-of-flight (TOF) positron emission tomography/computed tomography (PET/CT) cameras is well established. However, with the eventual retirement of older PET cameras and their replacement with newer, highly sensitive TOF PET/CT cameras, where SUVmax measurements are reportedly higher, updated knowledge of normal SUVmax range is needed and, to our knowledge, not previously reported. Our objectives are as follows: Methods Fifty consecutive patients referred routinely to our nuclear medicine service (20 men, 30 women; median age 55 years) with presumed neuroendocrine tumors underwent Ga-68-dotatate scans on a PET-CT camera having capability of reconstructing both TOF/non-TOF images. Region of interests (ROIs) were drawn around 24 normal structures as well as the primary lesion with abnormal radiotracer uptake and SUVmax was measured. The same ROI was analyzed using both algorithms simultaneously and both TOF and non-TOF SUVmax values were compared. Results Twelve hundred ROIs were evaluated. Non-TOF Ga-68-dotatate uptake in normal structures was in alignment with previously published studies. As compared to non-TOF, TOF images had better target to background ratios visually. TOF SUVmax was higher for all structures except for lung and brain. TOF SUVmax was more than double in adrenals/uncinate process of the pancreas; approximately 1.8 times in abnormal lesions, lymph nodes, pineal gland; and greater than 1.5 times in thyroid, breast, and pancreatic head. Conclusion Normal database of Ga-68-dotatate TOF SUVmax is provided for common structures to aid visual detection of abnormalities objectively. Overall, TOF SUVmax measures higher in identical ROIs, with abnormal lesions measuring approximately 1.8 times higher versus non-TOF technology. These findings need to be taken in consideration when comparing patient scans imaged on different PET/CT technologies.
{"title":"Time-of-Flight PET/CT Imaging of Ga-68-Dotatate: Normal Pattern, SUV Quantification, and Differences from Non-Time-of-Flight Imaging","authors":"Matthew Clifton Miller, Avani T. Bansal, Daniel Wingard, M. Lindenberg, Derek J. Stocker, Stephen Adler, Kalpna Prasad","doi":"10.1055/s-0044-1786529","DOIUrl":"https://doi.org/10.1055/s-0044-1786529","url":null,"abstract":"\u0000 Purpose The biodistribution of gallium-68-dotatate (Ga-68-dotatate) and standardized uptake values (SUVs) using non-time-of-flight (TOF) positron emission tomography/computed tomography (PET/CT) cameras is well established. However, with the eventual retirement of older PET cameras and their replacement with newer, highly sensitive TOF PET/CT cameras, where SUVmax measurements are reportedly higher, updated knowledge of normal SUVmax range is needed and, to our knowledge, not previously reported. Our objectives are as follows:\u0000 Methods Fifty consecutive patients referred routinely to our nuclear medicine service (20 men, 30 women; median age 55 years) with presumed neuroendocrine tumors underwent Ga-68-dotatate scans on a PET-CT camera having capability of reconstructing both TOF/non-TOF images. Region of interests (ROIs) were drawn around 24 normal structures as well as the primary lesion with abnormal radiotracer uptake and SUVmax was measured. The same ROI was analyzed using both algorithms simultaneously and both TOF and non-TOF SUVmax values were compared.\u0000 Results Twelve hundred ROIs were evaluated. Non-TOF Ga-68-dotatate uptake in normal structures was in alignment with previously published studies. As compared to non-TOF, TOF images had better target to background ratios visually. TOF SUVmax was higher for all structures except for lung and brain. TOF SUVmax was more than double in adrenals/uncinate process of the pancreas; approximately 1.8 times in abnormal lesions, lymph nodes, pineal gland; and greater than 1.5 times in thyroid, breast, and pancreatic head.\u0000 Conclusion Normal database of Ga-68-dotatate TOF SUVmax is provided for common structures to aid visual detection of abnormalities objectively. Overall, TOF SUVmax measures higher in identical ROIs, with abnormal lesions measuring approximately 1.8 times higher versus non-TOF technology. These findings need to be taken in consideration when comparing patient scans imaged on different PET/CT technologies.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":"156 4","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141001753","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}
Anjali Jain, Sharjeel Usmani, Khulood Al Riyami, Avni Mittal, Sofiullah Abubakar, Asiya Al Busaidi, S. Kheruka, Rashid Al Sukaiti
Purpose Recently developed digital positron emission tomography/computed tomography (PET/CT) scanners (digital PET [dPET]) have given new dimensions to molecular imaging. dPET scanner has very high sensitivity, spatial resolution, and image contrast that leads to increased uptake of signal in small-volume structures like pituitary gland (PG) making them visible on PET/CT scan even in absence of any pathology. Adequate knowledge of physiological fluoro-2 deoxy D glucose uptake in PG is required in interpretation of dPET for correct diagnosis and reducing unnecessary additional imaging. The aim of this study is to evaluate the frequency of physiological PG uptake on dPET. Material and Methods Eighty-eight subjects (mean age, 54.44 ± 14.18 years; range, 26–84 years; 63 females and 25 males) with normal PG on magnetic resonance imaging brain and imaged within 6 months on dPET were included in this research study. Out of 88 patients, 20 control subjects (mean age, 58.15 ± 11.08 years: 15 females and 5 males) underwent PET/CT on conventional PET. All images were acquired with similar and standard acquisition protocol and reconstruction done with Time of flight with Point spread function. PG uptake was compared visually and quantitatively. Results PG uptake was seen in 43 patients (48.8%). Out of 43 patients, 31 (72%) showed low uptake, 11 (26%) showed intermediate grade of uptake, and 1 patient (2%) showed intermediate-to-high uptake and was categorized as high-grade uptake. In the control group of 20 patients, 3 (15%) showed low uptake, while none of them showed intermediate or high uptake. Conclusions Physiological PG uptake is commonly seen on dPET. Low-to-intermediate grade of PG uptake on dPET in an asymptomatic patient is physiological and does not require further evaluation and should be reported with caution.
{"title":"High Physiological 18F-FDG Uptake in Normal Pituitary Gland on Digital PET Scanner","authors":"Anjali Jain, Sharjeel Usmani, Khulood Al Riyami, Avni Mittal, Sofiullah Abubakar, Asiya Al Busaidi, S. Kheruka, Rashid Al Sukaiti","doi":"10.1055/s-0044-1786733","DOIUrl":"https://doi.org/10.1055/s-0044-1786733","url":null,"abstract":"\u0000 Purpose Recently developed digital positron emission tomography/computed tomography (PET/CT) scanners (digital PET [dPET]) have given new dimensions to molecular imaging. dPET scanner has very high sensitivity, spatial resolution, and image contrast that leads to increased uptake of signal in small-volume structures like pituitary gland (PG) making them visible on PET/CT scan even in absence of any pathology. Adequate knowledge of physiological fluoro-2 deoxy D glucose uptake in PG is required in interpretation of dPET for correct diagnosis and reducing unnecessary additional imaging. The aim of this study is to evaluate the frequency of physiological PG uptake on dPET.\u0000 Material and Methods Eighty-eight subjects (mean age, 54.44 ± 14.18 years; range, 26–84 years; 63 females and 25 males) with normal PG on magnetic resonance imaging brain and imaged within 6 months on dPET were included in this research study. Out of 88 patients, 20 control subjects (mean age, 58.15 ± 11.08 years: 15 females and 5 males) underwent PET/CT on conventional PET. All images were acquired with similar and standard acquisition protocol and reconstruction done with Time of flight with Point spread function. PG uptake was compared visually and quantitatively.\u0000 Results PG uptake was seen in 43 patients (48.8%). Out of 43 patients, 31 (72%) showed low uptake, 11 (26%) showed intermediate grade of uptake, and 1 patient (2%) showed intermediate-to-high uptake and was categorized as high-grade uptake. In the control group of 20 patients, 3 (15%) showed low uptake, while none of them showed intermediate or high uptake.\u0000 Conclusions Physiological PG uptake is commonly seen on dPET. Low-to-intermediate grade of PG uptake on dPET in an asymptomatic patient is physiological and does not require further evaluation and should be reported with caution.","PeriodicalId":23742,"journal":{"name":"World Journal of Nuclear Medicine","volume":"63 6","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141052570","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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