Revista Espanola De Medicina Nuclear E Imagen Molecular最新文献

Aim

Myocardial uptake on bone scintigraphy has become useful for the detection of transthyretin cardiac amyloidosis (ATTR-CA). This study aimed to assess the prevalence of myocardial uptake in patients over 18 years of age with no clinical suspicion of cardiac amyloidosis (CA) who had undergone bone scintigraphy.

Methods and results

This was an observational, retrospective, multicenter study across 21 Spanish hospitals (September–November 2019). Of the 9864 scans analyzed (locally and centrally), incidental cardiac uptake was observed in 71 patients (0.72%), a prevalence that increased with age. A previous diagnosis of heart failure was found in 16.9% of patients with positive uptake, with >50% in NYHA II. ATTR-CA was diagnosed in 10 patients, with a mean delay of 10.4 months (95% CI: 5.1-15.7). All were >70 years old, primarily male, and had greater left ventricular hypertrophy than patients without a confirmed diagnosis (p< 0.0001). ATTR-CA patients had higher rates of orthostatic hypotension (30.0% vs. 3.8% in non-ATTR-CA; p = 0.025).

Conclusions

This is the first retrospective, national, multicenter study evaluating the prevalence of incidental cardiac uptake in bone scintigraphy performed for non-cardiac reasons, showing a prevalence of 0.72% in this population. Referral of these patients may facilitate early diagnosis of CA with a resulting benefit for patients.

In recent years, concern about the effects of ionizing radiation on exposed individuals has led to the need to regulate and quantify the use of diagnostic and therapeutic techniques. Geopolitical events in recent times have also increased the population's perception of insecurity regarding ionizing radiation, and we increasingly face patients reluctant to undergo certain types of scans in our nuclear medicine services and, albeit less frequently, in radiology services. This article aims to summarise the extent to which ionizing radiation is present in our daily lives and how diagnostic and therapeutic procedures can affect our health, particularly from the perspective of their effects on the thyroid gland, one of the body's most radiation-sensitive organs.

Introduction

Patient safety is paramount in providing quality healthcare and constitutes a global concern for healthcare systems. Radioiodine treatment to patients with well-differentiated thyroid cancer is not without risks. The aim of this study is to identify, evaluate and mitigate the risks associated with this procedure.

Materials and methods

A single-centre descriptive study was conducted in which risk management was carried out by establishing a risk map using FMEA methodology.

Results

Based on the process map 6 sub-processes and 23 failure modes in the three phases of the treatment process were analysed. According to risk priority number (RPN), the sub-process with the highest risk was administrative management (RPN 82), followed by treatment per se and post-treatment imaging (both with RPN 70). An overall process RPN of 300 (156 pre-treatment, 74 treatment and 70 post-treatment) was obtained. Failures directly related to the patient pose a high risk. The implementation of verification systems, performing tasks earlier and providing quality medical information are the most relevant preventive measures to be implemented.

Conclusions

The application of the FMEA methodology in the risk management for radioiodine treatment is a valuable tool for improving the quality and safety of this process. The risk map has been able to identify failures at different stages, assess their causes and effects, prioritise the risks identified and implement preventive and corrective measures that can be monitored, ensuring the effectiveness of the actions taken.

Purpose

The main purpose is to evaluate the safety, and efficacy of ¹⁷⁷Lutetium labeled macroaggregated albumin (LUTMA) ablation of thyroid nodules.

Material and methods

Patients with confirmed benign nodules who were not candidate or did not accept surgery were enrolled. Under ultrasonography (USG) guidance, LUTMA which was produced in our department, was administered into the nodules. Nodule volumes were assessed via USG before the injection and at 1-week, 1-month, and 3-months post-treatment. We calculated the volume reduction rates (VRRs) for these intervals. To detect extranodular activity leakage, patients underwent SPECT/CT imaging at one hour, 24 hours, and one week post-injection.

Results

Fifteen patients (male: 12, female: 3) with benign thyroid nodules were eligible to join this study. These nodules were categorized as cystic (n = 9), solid (n = 3), or mixed (n = 3). Median nodules volume was 6.59 ml (range: 0.56-55 ml). Predicted absorbed dosee to the nodules varied between 10 to 1036 Gy. The VRRs at 3. months was 85% for all nodule types with gradual increases over time: 0-92%, 20-97%, and 28-98% at 1. week, 1. month, and 3-months, respectively. The median VRR of cystic nodules was 89% (range: 81%-98%) at 3-months. It is significantly higher than solid ones (p = 0.009). None of the patients experienced adverse reactions or discomfort during the injection or follow-up.

Conclusion

LUTMA treatment significantly reduces the volume of benign thyroid nodules, offering relief from disease-associated symptoms and cosmetic concerns. It emerges as a promising alternative to surgical and other local treatments for benign thyroid nodule ablation.

Clinical signification

LUTMA is a novel theranostic radiopharmaceutical which is promising in local ablative treatment of benign thyroid nodules.