Pub Date : 2019-01-01DOI: 10.22038/AOJNMB.2019.13348
H. Komek, Tansel Ansal Balcı, C. Can
Objective(s): The aim of this study was to determine metastasis rate in patients with well-differentiated grade1 (G1) and grade 2 (G2) gastroenteropancreatic neuroendocrine tumors (GEP NETs) using the gallium-68 DOTATATE positron emission tomography/computed tomography (68Ga-DOTATATE PET/CT). This study was also targeted toward investigating the relationship of maximum standardized uptake value (SUVmax) with mitotic count, histological grade, and Ki-67 index. Methods: This retrospective study included 38 patients (i.e., 17 males and 21 females) with G1 or G2 GEP NETs who underwent 68Ga-DOTATATE PET/CT in Diyarbakir Gazi Yasargil training and research hospital between November 2014 and March 2018. The patients had at least one positive lesion that was approved by two nuclear medicine specialists with a minimum of 10 years of experience. Results: The median age of the patients was 50 years (age range: 27-80 years), and their mean age was 52±15 years. Out of 38 patients, 1 (2.6%), 2 (5.2%), 2 (5.2%), 3 (7.8%), 10 (28.5%), and 19 (50%) patients had primary hepatic, primary mesenteric, colon, duodenal, gastric, and pancreatic NETs, respectively. In addition, the liver metastasis, local lymph node invasions, distant lymph node metastasis, bone metastasis, peritoneal involvement, and lung metastasis were observed in 42%, 21%, 15.7%, 13%, 7.8%, and 5% of the cases, respectively. The SUVmax median values of G1 and G2 tumors were 9.45 (range: 4.2-43.6) and 34.9 (range: 4.1-103), respectively (P=0.003). The Ki-67 index showed a negative correlation with the SUVmax value of the liver metastases and the highest SUVmax value (P=0.001 and P=0.002, respectively). There was also a negative correlation between mitosis count and the highest SUVmax value (P=0.011). Conclusion: Based on the findings, although [68Ga]DOTATATE PET/CT is successfully used to diagnose primary GEP NETs and their metastases, the SUVmax value obtained from DOTATATE PET/CT showed a negative correlation with Ki-67 and mitotic count.
{"title":"Efficacy of Galium-68 DOTATATE PET/CT in the Detection of Metastasis Rate of Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors","authors":"H. Komek, Tansel Ansal Balcı, C. Can","doi":"10.22038/AOJNMB.2019.13348","DOIUrl":"https://doi.org/10.22038/AOJNMB.2019.13348","url":null,"abstract":"Objective(s): The aim of this study was to determine metastasis rate in patients with well-differentiated grade1 (G1) and grade 2 (G2) gastroenteropancreatic neuroendocrine tumors (GEP NETs) using the gallium-68 DOTATATE positron emission tomography/computed tomography (68Ga-DOTATATE PET/CT). This study was also targeted toward investigating the relationship of maximum standardized uptake value (SUVmax) with mitotic count, histological grade, and Ki-67 index. Methods: This retrospective study included 38 patients (i.e., 17 males and 21 females) with G1 or G2 GEP NETs who underwent 68Ga-DOTATATE PET/CT in Diyarbakir Gazi Yasargil training and research hospital between November 2014 and March 2018. The patients had at least one positive lesion that was approved by two nuclear medicine specialists with a minimum of 10 years of experience. Results: The median age of the patients was 50 years (age range: 27-80 years), and their mean age was 52±15 years. Out of 38 patients, 1 (2.6%), 2 (5.2%), 2 (5.2%), 3 (7.8%), 10 (28.5%), and 19 (50%) patients had primary hepatic, primary mesenteric, colon, duodenal, gastric, and pancreatic NETs, respectively. In addition, the liver metastasis, local lymph node invasions, distant lymph node metastasis, bone metastasis, peritoneal involvement, and lung metastasis were observed in 42%, 21%, 15.7%, 13%, 7.8%, and 5% of the cases, respectively. The SUVmax median values of G1 and G2 tumors were 9.45 (range: 4.2-43.6) and 34.9 (range: 4.1-103), respectively (P=0.003). The Ki-67 index showed a negative correlation with the SUVmax value of the liver metastases and the highest SUVmax value (P=0.001 and P=0.002, respectively). There was also a negative correlation between mitosis count and the highest SUVmax value (P=0.011). Conclusion: Based on the findings, although [68Ga]DOTATATE PET/CT is successfully used to diagnose primary GEP NETs and their metastases, the SUVmax value obtained from DOTATATE PET/CT showed a negative correlation with Ki-67 and mitotic count.","PeriodicalId":8503,"journal":{"name":"Asia Oceania Journal of Nuclear Medicine and Biology","volume":"22 1","pages":"141 - 148"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68222866","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}
Pub Date : 2019-01-01DOI: 10.22038/AOJNMB.2019.13360
Hamideh Abbasain, R. Sadeghi, F. Emami, V. D. Dabbagh Kakhki
Carcinosarcoma is a rare type of cancer that is composed of a mixture of sarcomatous and carcinomatous elements. Pulmonary carcinosarcoma has a 25% five-year survival rate with a prognosis poorer than other non-small cell lung carcinomas. Herein, we report a case of pulmonary carcinosarcoma and its 18F-FDG PET/CT findings. A 61-year-old male patient presented with brain symptoms, including headache, nausea, right hemiplegia, and few attacks of seizures. He underwent brain computed tomography (CT) scan showing a brain lesion in the left parietal lobe. The patient underwent excisional biopsy, and brain lesion was removed. The results of tissue sampling were indicative of carcinosarcoma. Based on anatomical imaging and evidence of pulmonary lesion, the patient underwent 18FDG PET/CT that revealed a heterogeneous mass on the upper lobe of the left lung. An intense FDG uptake was observed along the rim of the mass; however, no FDG uptake was observed in the center of the mass. There were multiple mediastinal lymph nodes with a high FDG uptake. Pulmonary carcinosarcoma was confirmed by tissue sampling.
{"title":"18FDG PET/CT in Pulmonary Carcinosarcoma and Brain Metastasis","authors":"Hamideh Abbasain, R. Sadeghi, F. Emami, V. D. Dabbagh Kakhki","doi":"10.22038/AOJNMB.2019.13360","DOIUrl":"https://doi.org/10.22038/AOJNMB.2019.13360","url":null,"abstract":"Carcinosarcoma is a rare type of cancer that is composed of a mixture of sarcomatous and carcinomatous elements. Pulmonary carcinosarcoma has a 25% five-year survival rate with a prognosis poorer than other non-small cell lung carcinomas. Herein, we report a case of pulmonary carcinosarcoma and its 18F-FDG PET/CT findings. A 61-year-old male patient presented with brain symptoms, including headache, nausea, right hemiplegia, and few attacks of seizures. He underwent brain computed tomography (CT) scan showing a brain lesion in the left parietal lobe. The patient underwent excisional biopsy, and brain lesion was removed. The results of tissue sampling were indicative of carcinosarcoma. Based on anatomical imaging and evidence of pulmonary lesion, the patient underwent 18FDG PET/CT that revealed a heterogeneous mass on the upper lobe of the left lung. An intense FDG uptake was observed along the rim of the mass; however, no FDG uptake was observed in the center of the mass. There were multiple mediastinal lymph nodes with a high FDG uptake. Pulmonary carcinosarcoma was confirmed by tissue sampling.","PeriodicalId":8503,"journal":{"name":"Asia Oceania Journal of Nuclear Medicine and Biology","volume":"7 1","pages":"181 - 184"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68222946","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}
Pub Date : 2019-01-01DOI: 10.22038/AOJNMB.2019.12734
Changyin Wang, Yanfen Zhao, Ying Shen
Objective(s): The aim of this study was to explore the accuracy of thyroid to background uptake ratio (UR) in the evaluation of 99mTc-pertechnetate thyroid uptake (TcTU) and establishment of an improved algorithm. Methods: This study was conducted on the thyroid images of 322 patients with thyroid diseases and 67 controls. For the purpose of the study, URs of the images were calculated, and then corrected by standardized thyroid area size to establish a corrected uptake ratio (CUR). Subsequently, the accuracy between UR and CUR was compared. Results: The results of linear regression using weighted least squares (using TcTU as a dependent variable and CUR, UR, or thyroid area size as independent variables) showed that CUR (t=105.5, P=0.000), UR (t=31.9, P=0.000), and thyroid area size (t=15.9, P=0.000) are influential factors of TcTU. Furthermore, the standardized coefficient of CUR (β=0.983) was obviously higher than those of UR (β=0.851) and thyroid area size (β=0.629). The linear goodness-of-fit between CUR and TcTU (R=0.983) was better than that between UR and TcTU (R=0.851). In addition, the total concordance rate between CUR and TcTU (96.7%) was significantly higher than that between UR and TcTU (83.0%; χ2=42.9, P=0.000). Discordance rates of CUR in large thyroid area (1.4% vs. 13.4%, χ2=17.0, P=0.000) and small thyroid area (3.3% vs. 42.2 %, χ2=44.3, P=0.000), were significantly lower than that of UR. In the abnormal thyroid areas, the discordance rates of UR obviously increased as compared to those of CUR. The UR overestimated the thyroid uptake in small thyroid areas and underestimated it in large thyroid areas. Conclusion: Based on the findings, CUR is more accurate than UR in measuring 99mTcO4ˉ thyroid uptake; accordingly, it is more significant in the diagnosis of thyroid disease.
{"title":"Inaccuracy of Thyroid to Background Uptake Ratio in Evaluating Technetium-99m-pertechnetate Thyroid Uptake and Establishing an Improved Algorithm","authors":"Changyin Wang, Yanfen Zhao, Ying Shen","doi":"10.22038/AOJNMB.2019.12734","DOIUrl":"https://doi.org/10.22038/AOJNMB.2019.12734","url":null,"abstract":"Objective(s): The aim of this study was to explore the accuracy of thyroid to background uptake ratio (UR) in the evaluation of 99mTc-pertechnetate thyroid uptake (TcTU) and establishment of an improved algorithm. Methods: This study was conducted on the thyroid images of 322 patients with thyroid diseases and 67 controls. For the purpose of the study, URs of the images were calculated, and then corrected by standardized thyroid area size to establish a corrected uptake ratio (CUR). Subsequently, the accuracy between UR and CUR was compared. Results: The results of linear regression using weighted least squares (using TcTU as a dependent variable and CUR, UR, or thyroid area size as independent variables) showed that CUR (t=105.5, P=0.000), UR (t=31.9, P=0.000), and thyroid area size (t=15.9, P=0.000) are influential factors of TcTU. Furthermore, the standardized coefficient of CUR (β=0.983) was obviously higher than those of UR (β=0.851) and thyroid area size (β=0.629). The linear goodness-of-fit between CUR and TcTU (R=0.983) was better than that between UR and TcTU (R=0.851). In addition, the total concordance rate between CUR and TcTU (96.7%) was significantly higher than that between UR and TcTU (83.0%; χ2=42.9, P=0.000). Discordance rates of CUR in large thyroid area (1.4% vs. 13.4%, χ2=17.0, P=0.000) and small thyroid area (3.3% vs. 42.2 %, χ2=44.3, P=0.000), were significantly lower than that of UR. In the abnormal thyroid areas, the discordance rates of UR obviously increased as compared to those of CUR. The UR overestimated the thyroid uptake in small thyroid areas and underestimated it in large thyroid areas. Conclusion: Based on the findings, CUR is more accurate than UR in measuring 99mTcO4ˉ thyroid uptake; accordingly, it is more significant in the diagnosis of thyroid disease.","PeriodicalId":8503,"journal":{"name":"Asia Oceania Journal of Nuclear Medicine and Biology","volume":"7 1","pages":"160 - 171"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68223168","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}
Pub Date : 2019-01-01DOI: 10.22038/AOJNMB.2019.33991.1236
Manabu Nakamura, M. Onoguchi, T. Shibutani
Objective(s): In heart failure, the heart-to-mediastinum (H/M) ratio of the delayed image and washout rate (WR) are well-known as a powerful cardiac event predictors. H/M ratio quantifies the accumulation rate of MIBG in the myocardium and WR quantifies reduction of meta-iodobenzylguanidine (MIBG) accumulation in the heart from the early planar image to the delayed planar images in the 123I-MIBG scintigraphy. The present study was conducted to estimate the role of the parameters of cardiac sympathetic imaging by 123I-MIBG myocardial scintigraphy in subacute phase of acute myocardial infarction (AMI) in the prediction of cardiac events, particularly in patients who are successfully responded to reperfusion therapy. Methods: This study was conducted on 145 patients with initial AMI who underwent 123I-MIBG myocardial scintigraphy and myocardial single-photon emission computed tomography (SPECT) after successful response to reperfusion therapy. The 123I-MIBG myocardial scintigraphy was averagely performed 16±5.8 days after the onset of AMI. The early image was taken 15 min after the intravenous administration of 123I-MIBG. Three hours after 123I-MIBG administration, an anterior planar delayed SPECT image was obtained. The H/M ratio and WR were calculated based on planar images. In addition, the average WR, defect volume, and extent were calculated from the SPECT image. The end points of the cardiac event was defined as hospitalization due to unstable angina, heart failure progression, myocardial infarction recurrence, malignant arrhythmia and cardiac death. Results: The follow-up period was 18.4±8.5 months on average, during which 38 (26.2%) cases experienced cardiac events. The results revealed a significant difference between the groups with and without cardiac events in terms of WR and WR (SPECT). Based on the multivariate analysis, WR was the only relevant factor predicting cardiac events. The cumulative event-free rate was significantly lower in the group with the delayed H/M ratio of < 1.74. The cumulative event-free rate were significantly lower in the groups with WR and WR (SPECT) more than 25% and 21.8%, respectively. There was no significant relationship between the cumulative event-free survival rate and the defect size. Conclusion: In the subacute phase of myocardial infarction, the increased WR of 123I-MIBG from the myocardium in planar scintigraphy and SPECT is the predictor of heart failure and cardiac events such as myocardial infarction and recurrence of unstable angina.
{"title":"Prediction of Long-term Cardiac Events by 123I-meta-Iodobenzylguanidine Imaging after acute Myocardial Infarction and Reperfusion Therapy","authors":"Manabu Nakamura, M. Onoguchi, T. Shibutani","doi":"10.22038/AOJNMB.2019.33991.1236","DOIUrl":"https://doi.org/10.22038/AOJNMB.2019.33991.1236","url":null,"abstract":"Objective(s): In heart failure, the heart-to-mediastinum (H/M) ratio of the delayed image and washout rate (WR) are well-known as a powerful cardiac event predictors. H/M ratio quantifies the accumulation rate of MIBG in the myocardium and WR quantifies reduction of meta-iodobenzylguanidine (MIBG) accumulation in the heart from the early planar image to the delayed planar images in the 123I-MIBG scintigraphy. The present study was conducted to estimate the role of the parameters of cardiac sympathetic imaging by 123I-MIBG myocardial scintigraphy in subacute phase of acute myocardial infarction (AMI) in the prediction of cardiac events, particularly in patients who are successfully responded to reperfusion therapy. Methods: This study was conducted on 145 patients with initial AMI who underwent 123I-MIBG myocardial scintigraphy and myocardial single-photon emission computed tomography (SPECT) after successful response to reperfusion therapy. The 123I-MIBG myocardial scintigraphy was averagely performed 16±5.8 days after the onset of AMI. The early image was taken 15 min after the intravenous administration of 123I-MIBG. Three hours after 123I-MIBG administration, an anterior planar delayed SPECT image was obtained. The H/M ratio and WR were calculated based on planar images. In addition, the average WR, defect volume, and extent were calculated from the SPECT image. The end points of the cardiac event was defined as hospitalization due to unstable angina, heart failure progression, myocardial infarction recurrence, malignant arrhythmia and cardiac death. Results: The follow-up period was 18.4±8.5 months on average, during which 38 (26.2%) cases experienced cardiac events. The results revealed a significant difference between the groups with and without cardiac events in terms of WR and WR (SPECT). Based on the multivariate analysis, WR was the only relevant factor predicting cardiac events. The cumulative event-free rate was significantly lower in the group with the delayed H/M ratio of < 1.74. The cumulative event-free rate were significantly lower in the groups with WR and WR (SPECT) more than 25% and 21.8%, respectively. There was no significant relationship between the cumulative event-free survival rate and the defect size. Conclusion: In the subacute phase of myocardial infarction, the increased WR of 123I-MIBG from the myocardium in planar scintigraphy and SPECT is the predictor of heart failure and cardiac events such as myocardial infarction and recurrence of unstable angina.","PeriodicalId":8503,"journal":{"name":"Asia Oceania Journal of Nuclear Medicine and Biology","volume":"26 1","pages":"121 - 128"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68223013","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}
Pub Date : 2019-01-01DOI: 10.22038/AOJNMB.2019.35953.1245
H. Wakabayashi, Tahahiro Konishi, H. Yoneyama, A. Inaki, T. Hiromasa, Takafumi Yamase, Norihito Akatani, Satoru Watanabe, H. Mori, Daiki Kayano, S. Kinuya
Objective(s): Single-photon emission computed tomography (SPECT) using metaiodobenzylguanidine (MIBG) is an important diagnostic tool for the treatment of refractory pheochromocytoma and paraganglioma (PPGL). Owing to the difficulty of SPECT quantification, the tumour-to-background ratio (TBR) is used to assess disease activity. However, the utility of TBR is limited owing to the background setting. A quantification technique of SPECT/computed tomography (CT) would facilitate image interpretation. This study aimed to assess the relationship between 123I-MIBG maximum standardized uptake value (SUVmax) and TBR and levels of urinary catecholamines and metabolites in patients with refractory PPGL. Methods: This study included 15 patients with refractory PPGL who underwent 131I-MIBG therapy. Overall, 27 123I-MIBG SPECT/CT images were acquired before and after the therapy. Lesions observed on whole-body images were analysed; the maximum number of lesions per scan was 10. 123I-MIBG SUVmax was semi-automatically calculated using Q. Metrix package (GE Healthcare). TBR was manually calculated according to the following formula: (max count in lesion − max count in background)/max count in background. Background was set in the contralateral area. When a background region of interest could not be set in the area, it was set in the thigh area. Urine was sampled for 24 h to measure catecholamine and metabolite levels. Increases of ≥3-fold were considered abnormal. TBR, 123I-MIBG SUVmax and urinary catecholamine and metabolite levels were compared using linear regression analysis. Results: All patients had MIBG-avid lesions, as seen on 123I-MIBG SPECT/CT. A significant relationship between 123I-MIBG SUVmax and TBR was observed (correlation coefficient [r] =0.84, P < 0.0001). In 27 SPECT/CT examinations, normetanephrine (NMN) level was abnormally increased in 51% (14/27), but other catecholamine and other metabolites were abnormally increased in < 26% (7/27). 123I-MIBG SUVmax strongly correlated with NMN (r=0.76, P < 0.01) and log NMN (r=0.74, P < 0.01). Conclusion: 123I-MIBG SUVmax demonstrated similar trends as TBR and reflected urinary NMN in patients with refractory PPGL. Semi-automatic quantification of SPECT/CT could be a useful tool for the evaluation of disease activity.
目的:利用metaiodobenzylguanidine (MIBG)进行单光子发射计算机断层扫描(SPECT)是治疗难治性嗜铬细胞瘤和副神经节瘤(PPGL)的重要诊断工具。由于SPECT量化的困难，肿瘤与背景比(TBR)被用来评估疾病的活动性。然而，由于背景设置的限制，TBR的实用性受到限制。SPECT/计算机断层扫描(CT)的量化技术将有助于图像解释。本研究旨在评估难治性PPGL患者123I-MIBG最大标准化摄取值(SUVmax)和TBR与尿儿茶酚胺和代谢物水平之间的关系。方法:本研究纳入15例难治性PPGL患者，采用131I-MIBG治疗。总的来说，治疗前后获得了27张123I-MIBG SPECT/CT图像。分析全身图像上观察到的病变;每次扫描最大病灶数为10个。使用Q. Metrix软件包(GE Healthcare)半自动计算123I-MIBG SUVmax。人工计算TBR，公式如下:(病变最大计数−背景最大计数)/背景最大计数。背景设置在对侧区域。当感兴趣的背景区域无法在该区域设置时，将其设置在大腿区域。尿液取样24小时，测量儿茶酚胺和代谢物水平。增加≥3倍被认为是异常。采用线性回归分析比较TBR、123I-MIBG、SUVmax和尿儿茶酚胺及代谢物水平。结果:所有患者在123I-MIBG SPECT/CT上均有MIBG-avid病变。123I-MIBG SUVmax与TBR呈显著相关(相关系数[r] =0.84, P < 0.0001)。27例SPECT/CT检查中，去甲肾上腺素(NMN)异常升高51%(14/27)，儿茶酚胺等代谢物异常升高< 26%(7/27)。123I-MIBG SUVmax与NMN (r=0.76, P < 0.01)和log NMN (r=0.74, P < 0.01)呈极显著正相关。结论:123I-MIBG SUVmax在难治性PPGL患者中表现出与TBR相似的趋势，反映了尿NMN。半自动定量SPECT/CT可能是评估疾病活动性的有用工具。
{"title":"Utility of 123I-MIBG Standardized Uptake Value in Patients with Refractory Pheochromocytoma and Paraganglioma","authors":"H. Wakabayashi, Tahahiro Konishi, H. Yoneyama, A. Inaki, T. Hiromasa, Takafumi Yamase, Norihito Akatani, Satoru Watanabe, H. Mori, Daiki Kayano, S. Kinuya","doi":"10.22038/AOJNMB.2019.35953.1245","DOIUrl":"https://doi.org/10.22038/AOJNMB.2019.35953.1245","url":null,"abstract":"Objective(s): Single-photon emission computed tomography (SPECT) using metaiodobenzylguanidine (MIBG) is an important diagnostic tool for the treatment of refractory pheochromocytoma and paraganglioma (PPGL). Owing to the difficulty of SPECT quantification, the tumour-to-background ratio (TBR) is used to assess disease activity. However, the utility of TBR is limited owing to the background setting. A quantification technique of SPECT/computed tomography (CT) would facilitate image interpretation. This study aimed to assess the relationship between 123I-MIBG maximum standardized uptake value (SUVmax) and TBR and levels of urinary catecholamines and metabolites in patients with refractory PPGL. Methods: This study included 15 patients with refractory PPGL who underwent 131I-MIBG therapy. Overall, 27 123I-MIBG SPECT/CT images were acquired before and after the therapy. Lesions observed on whole-body images were analysed; the maximum number of lesions per scan was 10. 123I-MIBG SUVmax was semi-automatically calculated using Q. Metrix package (GE Healthcare). TBR was manually calculated according to the following formula: (max count in lesion − max count in background)/max count in background. Background was set in the contralateral area. When a background region of interest could not be set in the area, it was set in the thigh area. Urine was sampled for 24 h to measure catecholamine and metabolite levels. Increases of ≥3-fold were considered abnormal. TBR, 123I-MIBG SUVmax and urinary catecholamine and metabolite levels were compared using linear regression analysis. Results: All patients had MIBG-avid lesions, as seen on 123I-MIBG SPECT/CT. A significant relationship between 123I-MIBG SUVmax and TBR was observed (correlation coefficient [r] =0.84, P < 0.0001). In 27 SPECT/CT examinations, normetanephrine (NMN) level was abnormally increased in 51% (14/27), but other catecholamine and other metabolites were abnormally increased in < 26% (7/27). 123I-MIBG SUVmax strongly correlated with NMN (r=0.76, P < 0.01) and log NMN (r=0.74, P < 0.01). Conclusion: 123I-MIBG SUVmax demonstrated similar trends as TBR and reflected urinary NMN in patients with refractory PPGL. Semi-automatic quantification of SPECT/CT could be a useful tool for the evaluation of disease activity.","PeriodicalId":8503,"journal":{"name":"Asia Oceania Journal of Nuclear Medicine and Biology","volume":"7 1","pages":"115 - 120"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68223198","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}
Pub Date : 2019-01-01DOI: 10.22038/AOJNMB.2019.40820.1275
A. Al-zaghal, Dani P. Yellanki, Esha Kothekar, T. Werner, P. Høilund-Carlsen, A. Alavi
Objective(s): This study was undertaken to determine the role of computed tomography (CT)-based methodology to segment the SI joint and quantify the metabolic activity using positron emission tomography (PET). We measured tracer uptake in the right and left SI joints independently to look for differences between the two sides. Further, we correlated tracer uptake with BMI and studied the inter-observer variation with regard to estimated tracer uptake in the SI joints. Methods: In this retrospective study, a total of 103 subjects (48 females, 55 males) from the CAMONA study database collected 2012-2016 at Odense University Hospital in Denmark were included. Mean age was 48±14.59 years, mean BMI was 26.68±4.31 kg/m2. The SI joints were segmented on fused PET/CT images using a 3D growing algorithm with adjustable upper and lower Hounsfield Units (HU) thresholds. The metabolic activities on the two sides were correlated with BMI. Results: For FDG, we found a higher average SUVmean on the right side (right: 1.3±0.33, left: 1.13±0.30; <0.0001). Similarly, for NaF, the uptake was higher on the right side (right: 5.9±1.29, left: 4.27±1.23; <0.0001). Positive correlations were present between BMI and FDG uptake (P<0.01) as well as NaF uptake (P<0.01). Conclusion: The PET-based molecular imaging probes along with the CT-based segmentation techniques revealed a significant difference in the metabolic activity between the two SI joints with higher inflammation and reactive bone formation on the right side. FDG and NaF uptakes correlated significantly and positively with BMI.
{"title":"Sacroiliac Joint Asymmetry Regarding Inflammation and Bone Turnover: Assessment by FDG and NaF PET/CT","authors":"A. Al-zaghal, Dani P. Yellanki, Esha Kothekar, T. Werner, P. Høilund-Carlsen, A. Alavi","doi":"10.22038/AOJNMB.2019.40820.1275","DOIUrl":"https://doi.org/10.22038/AOJNMB.2019.40820.1275","url":null,"abstract":"Objective(s): This study was undertaken to determine the role of computed tomography (CT)-based methodology to segment the SI joint and quantify the metabolic activity using positron emission tomography (PET). We measured tracer uptake in the right and left SI joints independently to look for differences between the two sides. Further, we correlated tracer uptake with BMI and studied the inter-observer variation with regard to estimated tracer uptake in the SI joints. Methods: In this retrospective study, a total of 103 subjects (48 females, 55 males) from the CAMONA study database collected 2012-2016 at Odense University Hospital in Denmark were included. Mean age was 48±14.59 years, mean BMI was 26.68±4.31 kg/m2. The SI joints were segmented on fused PET/CT images using a 3D growing algorithm with adjustable upper and lower Hounsfield Units (HU) thresholds. The metabolic activities on the two sides were correlated with BMI. Results: For FDG, we found a higher average SUVmean on the right side (right: 1.3±0.33, left: 1.13±0.30; <0.0001). Similarly, for NaF, the uptake was higher on the right side (right: 5.9±1.29, left: 4.27±1.23; <0.0001). Positive correlations were present between BMI and FDG uptake (P<0.01) as well as NaF uptake (P<0.01). Conclusion: The PET-based molecular imaging probes along with the CT-based segmentation techniques revealed a significant difference in the metabolic activity between the two SI joints with higher inflammation and reactive bone formation on the right side. FDG and NaF uptakes correlated significantly and positively with BMI.","PeriodicalId":8503,"journal":{"name":"Asia Oceania Journal of Nuclear Medicine and Biology","volume":"7 1","pages":"108 - 114"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68223350","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}
Pub Date : 2019-01-01DOI: 10.22038/AOJNMB.2019.38842.1260
Adil Lathif, R. Hashmi
In this series we present a quiz about identification of salient and important anatomical landmarks present at a given level on the computed tomography (CT) image. The representative image is followed by further images showing examples of various commonly encountered pathologies that can be seen at this level in clinical practice. Readers are expected to identify highlighted structures in all the images and appreciate how a given abnormality can alter the appearance of normal structures. The aim of this series is to foster understanding and interpretation of the CT component of the single photon emission computed tomography (SPECT) and positron emission tomography (PET) studies help nuclear physicians in interpretation by the nuclear medicine professionals.
{"title":"Sectional Anatomy Quiz - IV","authors":"Adil Lathif, R. Hashmi","doi":"10.22038/AOJNMB.2019.38842.1260","DOIUrl":"https://doi.org/10.22038/AOJNMB.2019.38842.1260","url":null,"abstract":"In this series we present a quiz about identification of salient and important anatomical landmarks present at a given level on the computed tomography (CT) image. The representative image is followed by further images showing examples of various commonly encountered pathologies that can be seen at this level in clinical practice. Readers are expected to identify highlighted structures in all the images and appreciate how a given abnormality can alter the appearance of normal structures. The aim of this series is to foster understanding and interpretation of the CT component of the single photon emission computed tomography (SPECT) and positron emission tomography (PET) studies help nuclear physicians in interpretation by the nuclear medicine professionals.","PeriodicalId":8503,"journal":{"name":"Asia Oceania Journal of Nuclear Medicine and Biology","volume":"7 1","pages":"188 - 193"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68222764","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}
Pub Date : 2013-10-01DOI: 10.7508/AOJNMB.2013.02.004
Mohammad Gharehdaghi, V. D. Dabbagh Kakhki, Alireza Khooei, Gholamhosein Novferesti, Alireza Hootkani, Mahdi Farzadnia, Ramin Sadeghi
Objectives: Multidrug resistance (MDR), which may be due to the over expression of P-glycoprotein (Pgp) and/or MRP, is a major problem in neoadjuvant chemotherapy of osteosarcoma. The aim of this study was to investigate the role of Tc-99m MIBI scan for predicting the response to pre-operative chemotherapy. Methods: Twenty-five patients (12 males and 13 females, aged between 8 and 52y) with osteosarcoma were studied. Before the chemotherapy, planar 99mTc-MIBI anterior and posterior images were obtained 10-min [tumor-to-background ratio: (T1/B1)10min] and 3-hr after tracer injection. After completion of chemotherapy, again 99mTc-MIBI scan was performed at 10-min after tracer injection. In addition to calculation of decay corrected tumor to background (T/B) ratios, using the 10-min and 3-hr images of the pre-chemotherapy scintigraphy, percent wash-out rate (WR%) of 99mTc-MIBI was calculated. Using the 10-min images of the pre- and post-chemotherapy scans, the percent reduction in uptake at the tumor site after treatment (Red%) was also calculated. Then after surgical resection, tumor response was assessed by percentage of necrosis. Results: All patients showed significant 99mTc-MIBI uptake in early images. Only 9 patients showed good response to chemotherapy (necrosis≥90%) while 16 patients were considered as non-responder (necrosis<90%). There was no statistical significant difference between non-responders and responders in (T1/B1)10min.There was a significant negative correlation between WR% and percentage of necrosis (P=0.001). On the other hand, there was a significant correlation between Red% and percentage of necrosis (P<0.001).There was also statistical significant difference in WR% and Red% between non-responders and responders (both P< 0.001). Conclusion: Washout rate of 99mTc-MIBI in pre-chemotherapy scintigraphy as well as Red% using pre- and post-chemotherapy MIBI scintigraphy are useful methods for predicting response to neoadjuvant chemotherapy.
{"title":"Is 99mTc-MIBI scintigraphy a predictor of response to pre-operative neoadjuvant chemotherapy in Osteosarcoma?","authors":"Mohammad Gharehdaghi, V. D. Dabbagh Kakhki, Alireza Khooei, Gholamhosein Novferesti, Alireza Hootkani, Mahdi Farzadnia, Ramin Sadeghi","doi":"10.7508/AOJNMB.2013.02.004","DOIUrl":"https://doi.org/10.7508/AOJNMB.2013.02.004","url":null,"abstract":"Objectives: Multidrug resistance (MDR), which may be due to the over expression of P-glycoprotein (Pgp) and/or MRP, is a major problem in neoadjuvant chemotherapy of osteosarcoma. The aim of this study was to investigate the role of Tc-99m MIBI scan for predicting the response to pre-operative chemotherapy. Methods: Twenty-five patients (12 males and 13 females, aged between 8 and 52y) with osteosarcoma were studied. Before the chemotherapy, planar 99mTc-MIBI anterior and posterior images were obtained 10-min [tumor-to-background ratio: (T1/B1)10min] and 3-hr after tracer injection. After completion of chemotherapy, again 99mTc-MIBI scan was performed at 10-min after tracer injection. In addition to calculation of decay corrected tumor to background (T/B) ratios, using the 10-min and 3-hr images of the pre-chemotherapy scintigraphy, percent wash-out rate (WR%) of 99mTc-MIBI was calculated. Using the 10-min images of the pre- and post-chemotherapy scans, the percent reduction in uptake at the tumor site after treatment (Red%) was also calculated. Then after surgical resection, tumor response was assessed by percentage of necrosis. Results: All patients showed significant 99mTc-MIBI uptake in early images. Only 9 patients showed good response to chemotherapy (necrosis≥90%) while 16 patients were considered as non-responder (necrosis<90%). There was no statistical significant difference between non-responders and responders in (T1/B1)10min.There was a significant negative correlation between WR% and percentage of necrosis (P=0.001). On the other hand, there was a significant correlation between Red% and percentage of necrosis (P<0.001).There was also statistical significant difference in WR% and Red% between non-responders and responders (both P< 0.001). Conclusion: Washout rate of 99mTc-MIBI in pre-chemotherapy scintigraphy as well as Red% using pre- and post-chemotherapy MIBI scintigraphy are useful methods for predicting response to neoadjuvant chemotherapy.","PeriodicalId":8503,"journal":{"name":"Asia Oceania Journal of Nuclear Medicine and Biology","volume":"26 1","pages":"22 - 27"},"PeriodicalIF":0.0,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89479619","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}
Pub Date : 2013-10-01DOI: 10.7508/AOJNMB.2013.02.001
Sabih Durre
Nuclear Medicine faces unique challenges in the 21st century as sophisticated equipment and radiotracers become available to define metabolic processes in ever more exquisite detail. These metabolic processes can be imaged and fused with conventional radiological techniques to provide a synthesis of anatomical and physiological information in the same image set. All of these exciting developments have led to the need of reorienting the very definition of nuclear medicine practice and the required knowledge of the nuclear medicine physician in this century. In Asia, while some countries are at the forefront of nuclear medicine development, unfortunately there are even more countries which have not kept up with the times nor committed resources to start nuclear medicine (Table 1). There are also questions of “ownership” of the science and art of nuclear medicine and battle lines are being drawn for a turf war in many places. The author has maintained, for over two decades, the urgent need for strengthening nuclear medicine training programs (1). This perception is now shared by many others who believe that the “market acceptance” of the current generation of nuclear medicine physicians depends on broadening the knowledge base by a greater emphasis on complimentary imaging (and therapy) in training programs. In fact, even dual certification is held desirable, if not needed (2). The UK has already started an ambitious program that ensures cross training in radiology and internal medicine for those who opt for the nuclear medicine specialization pathway (3). In addition to all of these, in Asia there are additional issues of standardization in nuclear medicine training, comparable competence and competency/deficiencies (4). Designing a national training program for any country in Asia has challenges that are compounded by varying organizational healthcare structures, needs, material resources and geopolitical stability. Governmental commitment to healthcare varies not only in terms of dollars per person, or percentage of GDP but also in priorities to the extent that in same places nuclear medicine and modern imaging have been relegated to the “nice-to-have” category of facilities rather than “must-have” services (5). Table 1 Nuclear Medicine Practice and Training in Selected ARCCNM* Member States The Asian Regional Cooperative Council for Nuclear Medicine (ARCCNM), as a body committed to promoting nuclear medicine knowledge in Asia, particularly in developing and less developed countries, has been cognizant of this heterogeneity in the practice and training of nuclear medicine in Asia. The organization has risen to the challenge by establishing an Asian Nuclear Medicine Board (ANMB) that seeks: To address growing concerns on the inhomogeneity of training & practice of Nuclear Medicine in Asia. To strengthen training programs by developing curriculum of appropriate content that integrates the radiological sciences in
{"title":"The Asian Nuclear Medicine Board (ANMB); Why Do We Need It?","authors":"Sabih Durre","doi":"10.7508/AOJNMB.2013.02.001","DOIUrl":"https://doi.org/10.7508/AOJNMB.2013.02.001","url":null,"abstract":"Nuclear Medicine faces unique challenges in the 21st century as sophisticated equipment and radiotracers become available to define metabolic processes in ever more exquisite detail. These metabolic processes can be imaged and fused with conventional radiological techniques to provide a synthesis of anatomical and physiological information in the same image set. All of these exciting developments have led to the need of reorienting the very definition of nuclear medicine practice and the required knowledge of the nuclear medicine physician in this century. \u0000 \u0000In Asia, while some countries are at the forefront of nuclear medicine development, unfortunately there are even more countries which have not kept up with the times nor committed resources to start nuclear medicine (Table 1). There are also questions of “ownership” of the science and art of nuclear medicine and battle lines are being drawn for a turf war in many places. The author has maintained, for over two decades, the urgent need for strengthening nuclear medicine training programs (1). This perception is now shared by many others who believe that the “market acceptance” of the current generation of nuclear medicine physicians depends on broadening the knowledge base by a greater emphasis on complimentary imaging (and therapy) in training programs. In fact, even dual certification is held desirable, if not needed (2). The UK has already started an ambitious program that ensures cross training in radiology and internal medicine for those who opt for the nuclear medicine specialization pathway (3). In addition to all of these, in Asia there are additional issues of standardization in nuclear medicine training, comparable competence and competency/deficiencies (4). Designing a national training program for any country in Asia has challenges that are compounded by varying organizational healthcare structures, needs, material resources and geopolitical stability. Governmental commitment to healthcare varies not only in terms of dollars per person, or percentage of GDP but also in priorities to the extent that in same places nuclear medicine and modern imaging have been relegated to the “nice-to-have” category of facilities rather than “must-have” services (5). \u0000 \u0000 \u0000 \u0000Table 1 \u0000 \u0000Nuclear Medicine Practice and Training in Selected ARCCNM* Member States \u0000 \u0000 \u0000 \u0000The Asian Regional Cooperative Council for Nuclear Medicine (ARCCNM), as a body committed to promoting nuclear medicine knowledge in Asia, particularly in developing and less developed countries, has been cognizant of this heterogeneity in the practice and training of nuclear medicine in Asia. The organization has risen to the challenge by establishing an Asian Nuclear Medicine Board (ANMB) that seeks: \u0000 \u0000 \u0000 \u0000 \u0000 \u0000To address growing concerns on the inhomogeneity of training & practice of Nuclear Medicine in Asia. \u0000 \u0000 \u0000To strengthen training programs by developing curriculum of appropriate content that integrates the radiological sciences in","PeriodicalId":8503,"journal":{"name":"Asia Oceania Journal of Nuclear Medicine and Biology","volume":"67 1","pages":"1 - 3"},"PeriodicalIF":0.0,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83292793","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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