فهرست مطالب

Iranian Journal of Nuclear Medicine
Volume:25 Issue: 1, Winter-Spring 2017

  • تاریخ انتشار: 1395/11/03
  • تعداد عناوین: 12
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  • Amir Reza Jalilian*, Joao Osso Jr Pages 1-10
    Copper-64 was produced in large scales and high specific activities in late 1990s’ using compact cyclotrons based by 64Ni(p,n)64Cu reaction and many radiopharmaceuticals developed since then by various groups based on interesting physicochemical and nuclear properties of the radionuclide. The unique emission of beta particles as well as positron particles offers a spectacular real therapeutic/diagnostic (“Theranostic”) radionuclide in nuclear medicine. Although the development of copper-64 radiopharmaceuticals continued with a slower rate in 2010s’ due to availability of 68Ga-tracers, however recent advances in application of therapeutic doses of 64Cu has emerged a new trend in the radiopharmaceutical development based on coppe-64. In this review, recent advances in the copper-64 theranostic radiopharmaceuticals including introduction of new chelating groups with enhanced stability as well as radiolabelling conditions as well as application of simple 64CuCl2 radiopharmaceutical as areal theranostic agent in human subjects are summarized. A proposed strategy for development of peptide based copper-64 radiopharmaceuticals with high and low dose therapeutic applications has been suggested.
    Keywords: Copper, 64, Theranostic, Radiopharmaceutical, Chelates, PET, Therapy
  • Hassan Ranjbar *, Ali Bahrami, Samani, Davood Beiki, Mohammad Ghannadi, Maragheh Pages 11-16
    Introduction
    Targeted radionuclide therapy (TRT) has been demonstrated to be an effective therapeutic tool in patients with disseminated bone metastasis. TRT is generally performed with a single radionuclide. In this study we investigated the feasibility of combined TRT with a high-energy beta emitter (153Sm) and a low energy beta emitter (177Lu) in wistar rats.
    Methods
    The cocktail complex of 153Sm/177Lu-EDTMP was prepared. To determine the effect of metal-to-ligand (Me:EDTMP) molar ratio on labeling yield, several complex were analyzed after changing Me:EDTMP molar ratio from 1:1 to 1:50. 153Sm/177Lu-EDTMP was administered intravenously through the tail vein of wistar rats. Biodistribution data were collected at 2 hours to 7 day post injection and scintigraphic images were taken at 24 hours and 1, 2 week after administration of radiopharmaceutical.
    Results
    The results revealed high skeletal uptake (3.5% and 3.4% ID/g at 24 hours post injection for 153Sm and 177Lu, respectively) with rapid blood clearance and minimal uptake in any of the major organs. Scintigraphic images verified high skeletal uptake.
    Conclusion
    Our results indicate that the combination of 153Sm and 177Lu is feasible and safe. This study suggests that the combination of different radionuclides with different radiation energies and half-life, such as 153Sm and 177Lu, could be advantageous in patients with tumoral lesions of different sizes.
    Keywords: 153Sm, 177Lu, EDTMP, Radiopharmaceutical cocktail, Biodistribution, Radiolabeling, Bone pain palliation
  • Maged Abdel Galil Hamed, Ahmed Fathy Abdel Ghany Pages 17-22
    Introduction
    Brain imaging with F-18 fluorodeoxyglucose (18F-FDG) positron ýemission tomography or Tc-99m hexamethylpropyleneamine oxime (ý99mTc-HMPAO) SPECT is widely used for the evaluation of Alzheimer's ýdementia (AD); we aim to assess superiority of one method over the ýother.
    Methods
    Twenty four patients with clinical diagnosis of Alzheimer disease ýunderwent 18F-FDG PET and ý99mTc-HMPAO SPECT in order to ýassess the zones of hypo metabolism & hypoperfusion specific for ýAlzheimer's disease.
    Results
    18F-FDG PET showed specific zones of ýhypometabolism in 19 patients (79.1%) while SPECT was positive in 15 ýcases (62.5%) with statistically significant difference (P= 0.027).
    Conclusion
    18F-FDG PET was significantly superior to HMPAO ýSPECT and 18F-FDG PET could replace the classic role of perfusion ýSPECT in diagnosis of Alzheimer's disease.
    Keywords: PET, SPECT, HMPAO, Alzheimer's disease
  • Nafise Salek, Mojtaba Shamsaei *, Mohammad Ghannadi Maragheh, Simindokht Shirvani Arani, Ali Bahrami Samani Pages 23-33
    Introduction
    Owing to its favorable radionuclidic characteristics, such as tl/2 = 6.73 day and Eβ (max) = 497 keV and ease of its large-scale production using medium flux research reactors, lutetium-177 (177Lu) is an attractive radionuclide for various therapeutic applications. No carrier added (NCA) 177Lu was obtained by thermal neutron bombardment (4×1013n/cm2.s) of 176Yb target through 176Yb(n, γ)177Yb 177Lu process have the advantage of preparing radiopharmaceuticals with high specific activity. So the existence of an effective Lu/Yb separation method is critical.
    Methods
    Many researchers illustrated no-carrier added 177Lu production. However, the present study is based on comparison between two potential separation methods, namely extraction chromatography and electro-amalgamation separation with respect to separation yield and radiochemical characteristics.
    Results
    The no carrier added 177Lu separated from 176Yb target by two extraction chromatography and electro-amalgamation separation methods. The effective parameters on separation Lu/Yb were investigated in two procedures. The 177Lu production yield by extraction chromatography and electro-amalgamation procedures were 82% and 88.83% respectively. The no carrier added 177Lu was obtained with radionuclidic purity of 99.99% in two separation methods.
    Conclusion
    Although both separation methods have exhibited promising feature, the study reveals that electro-amalgamation separation offers the advantages of higher yield of 177Lu, simplicity and easier to operate for large amount of target and less overall processing time.
    Keywords: 177Lu, No carrier added, Extraction chromatography separation, Electro, amalgamation separation
  • Afshin Akbarzadeh, Valiallah Saba *, Mohammad Reza Ay Pages 34-42
    Introduction
    SURGEOSIGHT is a dedicated intra-operative hand-held gamma camera designed and manufactured by our team to be used for lymphoscintigraphy. Although conventional gamma cameras are widely used, they lack the capability of the sentinel lymph node (SLN) imaging in the operation room. Like conventional gamma cameras it is necessary to calibrate SURGEOSIGHT for linearity distortion, energy and flood correction. Our main objective in this study is to develop and implement three techniques for linearity, energy and uniformity corrections.
    Methods
    The camera is made up of a pixelated cesium iodide (sodium-activated) (CsI(Na)) scintillation crystal with 1 × 1 mm2 element size along with a Hamamatsu H8500 flat-panel multi-anode (64 channels) photomultiplier tube. All triple corrections required lookup tables (LUTs). To generate all three LUTs, one uncalibrated acquisition is necessary. Linearity distortion correction was based on localization of physical pixels of crystal and thin plate spline interpolation to estimate the amount of distortion. Energy correction LUT was simply a photo-peak map of incoming events which was estimated using self-organizing map technique.
    Results
    The results showed improvements qualitatively and quantitatively. The extrinsic energy resolution was enhanced from 50% to about 20.6%. Integral uniformity and the differential uniformity, after uniformity correction, in useful field-of-view (UFOV) was measured 9.5% and 4.5%, respectively.
    Conclusion
    Results substantiated that the correction techniques guarantee uniform and accurate output of the SURGEOSIGHT which is desirable for intra-operative localization of the sentinel lymph nodes in breast cancer and also for imaging of other superficial tumors.
    Keywords: Uniformity correction, Energy correction, Linearity distortion correction, Self, organizing map, Intra, operative gamma camera
  • Siamak Derakhshan *, Mozaffar Mahmoudi, Sirous Shahsawari Pages 43-50
    Introduction
    There is considerable amount of controversy about the long term effects of multiparity and duration of breast-feeding on maternal bone mineral density after menopause. This study was conducted to determine whether multiple pregnancy and prolonged duration of breast-feeding are independent predictors of low bone mass in post-menopausal Kurdish women.
    Methods
    In a retrospective study, we evaluated 991 post-menopausal women with mean age of 58.9 years screened for osteoporosis by dual energy X-ray absorptiometry (DXA). According to the parity (1-2, 3-4, 5-7, >7 children) and total duration of breast-feeding (1-24, 25-60, 61-96, >96 months) they were classified. Bone mineral density (BMD) results for femoral neck and lumbar spine were classified into three groups (normal, osteopenia, and osteoporosis) according to the WHO criteria. Binary logistic regression was used to assess the independent associations of low femur or spine BMD with parity and total duration of breast-feeding.
    Results
    We found that women with 5 or more children and having more than 60 months history of total breast-feeding, were older (p
    Conclusion
    Multiparity has a detrimental effect on maternal BMD. History of multiple pregnancy is a risk factor for low bone mass in post-menopausal women. However, prolonged duration of breast-feeding has no long-term adverse effect on maternal BMD in post-menopausal age.
    Keywords: Multiparity, Breast, feeding, Bone density, Menopause, Osteoporosis
  • Babak Fallahi, Armaghan Fard, Esfahani *, Alireza Emami, Ardekani, Somayeh Sahari, Davood Beiki, Arman Hassanzadeh, Rad, Seyed Mohammad Abedi, Parham Geramifar, Mohammad Eftekhari Pages 51-59
    Introduction
    Differentiated thyroid carcinoma (DTC) follow-up after thyroidectomy and radioiodine-ablation is performed mainly by thyroglobulin (Tg), diagnostic iodine-131 whole body scan (DxWBS) and sonography. Some patients with undetectable Tg have thyroid-bed uptake after ablation in whom decision making regarding the need for retreatment is still controversial.
    Methods
    In this study, we enrolled DTC patients with undetectable Tg but small thyroid residue in six-month-DxWBS following first radioiodine-ablation. Patients with detectable Tg, high TgAb, suspicious neck lymphadenopathy in sonography and metastasis were excluded. Ninety four patients were placed in two groups of cohort, i.e., radioiodine-retreatment group (n=36) versus observation (untreated) group (n=58). After six months, the clinical outcome was compared by evaluating DxWBS, Tg, TgAb and sonography.
    Results
    DxWBS showed sustained thyroid remnant in 47.2% of retreated patients while 34.5% of untreated group revealed negative DxWBS over the next period of follow-up. Also, only 6 cases (16.7%) in retreatment group and 12 cases (20.7%) in observation group revealed an additional finding other than local faint RAI uptake, including detectable serum Tg, rising TgAb or suspicious ultrasound finding, favoring no significant difference of the outcome as well as relative risk of new finding incidence between treated and untreated patients (CI 95% for relative risk: 0.58-2.41; p=0.630).
    Conclusion
    Regarding sonologic and laboratory follow-up evidences, RAI-retreatment shows no significant advantage over observation in DTC patients with Tg negative, remnant positive DxWBS. In addition, residual thyroid tissue was completely disappeared in about one third of patients without retreatment.
    Keywords: Undetectable thyroglobulin, Differentiated thyroid carcinoma, Retreatment, Thyroid remnant, Radioiodine, Follow, up without treatment
  • Vahid Reza Dabbagh Kakhki, Ali Eshraghi, Narjes Ayati, Mohammad Vojdanparast, Ramin Sadeghi, Azadeh Rezvani Khorashad* Pages 60-65
    Introduction
    Patients with the coronary slow flow phenomenon (SCF) frequently experience angina episodes. The purpose of this study was to determine efficacy of nicorandil in myocardial perfusion in patients with SCF.
    Methods
    Twenty patients (50.85 ± 12.96 y) with SCF were studied. We evaluate coronary slow flow according to protracted thrombolysis in myocardial infarction (TIMI) frame count. After diagnosis of SCF, all patients underwent dipyridamole stress/rest gated 99mTc-sestamibi SPECT. Subsequently, the patients received 10 mg nicorandil BD (20 mg per day). After starting nicorandil for one month, patients underwent dipyridamole stress/rest gated 99mTc-sestamibi SPECT again. Gated SPECT images were analyzed based on 17-segment scoring system, and QPS (quantitative perfusion SPECT) and QGS (quantitative gated SPECT) softwares were used.
    Results
    In patients with SCF subtle perfusion abnormality was noticed. With nicorandil consumption, EDV and ESV were decreased and LVEF was increased in both stress and rest gated SPECT phases (P>0.05). After nicorandil consumption, decreased in most semi-quantitative perfusion indices (Severity score; P=0.03, Extension score; P=0.06, RAW reversibility; P=0.002, severity reversibility; P=0.03 and Extension reversibility; P=0.001) except for RAW score were observed demonstrating significant difference with pre-nicorandil consumption quantities. In multi-vessels involvement with SCF, there was a trend to see more abnormality with more remarkable post-nicorandil change as compared to the patients with one vessel involvement.
    Conclusion
    The main finding of this study was better myocardial coronary flow after nicorandil consumption in patients with SCF specially those with multi-vessel involvement.
    Keywords: Angina, Nicorandil, Gated SPECT, Myocardial perfusion
  • Subramanyam Padma*, Palaniswamy Shanmuga Sundaram Pages 66-69
    Although aplastic anemia (AA) and myelodysplastic syndrome (MDS) are separate entities with different management, distinction between the two can be difficult on morphological basis due to hypocellularity of bone marrow. MDS is one of the serious complications of AA. Karyotyping is definitive in the diagnosis of MDS. Better and robust investigations like 18F-Fluoro-deoxy-Glucose Positron Emission Tomography/Computed Tomography (18F-FDG PET-CT) are essential in high risk patients with haematological malignancies and in those relapsing within a short period of time after initiation of therapy or having refractory disease. It might be helpful in the development of individual treatment algorithms for these high-risk patients. There may be unique problems in hematological malignancies where the transformation of one pathology into another may be silent with no biomarkers that can predict this transformation e.g. transformation of MDS from AA. Studies have shown that immune suppression can lead to a variety of haematological and lymphoproliferative disorders which may co-exist. 18F-FDG PET-CT may be useful in identifying the primary or occult sites of malignancy and also can direct the site from which biopsy can be attempted. We present a patient with Carcinoma right breast who developed hematological and lymphoproliferative disorders during the course of her treatment. In this case, AA transformed to MDS with abnormal karyotype (chromosome 9 mutation) and then progressed further to manifest cutaneous T cell lymphoma before patient succumbed to her illness. Immune mediated suppression of haemopoiesis has been considered the most important mechanism in this case.
    Keywords: Aplastic anemia_Myelodysplastic syndrome_Cyclosporine_Carcinoma breast_Methotrexate_Cutaneous T cell lymphoma
  • Leili Zarifmahmoudi, Ramin Sadeghi * Pages 70-72
    We reported a 35 year old breast cancer patient who was referred to our nuclear medicine department for sentinel node mapping. She was planned to undergo mastectomy and lymphatic mapping. A dose of Tc-99m Phytate was injection in the peri-areolar region in an intra-dermal fashion. Two hours post-injection no sentinel node was visible in the axilla. Due to a high liver uptake, inadvertent intra-vascular injection was suspected and another dose of the radiotracer was injected in the breast. Lymphoscintigraphy two minutes post-injection showed an axillary sentinel node. Our case underscores the importance of second radiotracer injection in case of sentinel node non-visualization.
    Keywords: Re, injection, Sentinel, Lymphoscintigraphy, Non, visualization, Breast
  • Avs Anil Kumar *, Pg Kumar, Karunesh Chand Pages 73-76
    Gastrointestinal duplications are rare congenital malformations and they may vary greatly in presentation, size, location and symptoms. The presence of ectopic gastric mucosa (EGM) in them is not common and they are difficult to diagnose prior to surgery. We present the case of a child with long intestinal duplication with ectopic gastric mucosa who presented with just severe anaemia and delayed milestones without any history of evident bleeding or abdominal symptoms and was accurately diagnosed prior to surgery with Meckel’s scan. The case highlights the importance of the simple pertechnetate Meckel’s scan in the imaging armamentarium involved in the evaluation of such cases.
    Keywords: Meckel's scan, Pertechnetate, Intestinal duplication
  • Saeed Farzanefar *, Mehrshad Abbasi, Davood Beiki Pages 77-80
    We report a young male with an initial excisional biopsy report of melanoma of the lower back, referred to our hospital for complete excision and sentinel lymph node (SLN) biopsy. Four peritumoral intradermal Tc-99m phytate injection was performed and SLNs were detected in both axillary and right inguinal regions. On the biopsy only the right axillary SLN was metastatic leading to right axillary lymph nodes dissection 6 days later. No other surgical intervention was done for two other lymphatic drainage basins. On follow up the patient noted a right axillary mass with highly suspicious ultrasound findings. Metastatic work up was negative. Second axillary lymph node dissection confirmed conglomerated lymph nodes metastases in this area. Multiple drainage basins in the trunk melanoma are common and many authors have concern about changing in lymphatic drainage pattern after SLN biopsy and surgical manipulation. This case showed correct initial diagnosis of involved lymph nodes in one out of three lymphatic drainage basins, and also correctly predicts regional recurrence in the same location.
    Keywords: Sentinel lymph node, Melanoma, Multiple drainage basin, Recurrence