mohsen saghari

Differentiated thyroid carcinoma (DTC) is associated with excellent prognosis and high survival rates. This study was conducted to evaluate the influence of baseline and treatment-related factors on the health related quality of life (QoL) in cured DTC.
This study was an analytic cross-sectional study on radio-iodine (RAI) treated DTC patients during 2011-2012. The data on patients’ QoL were recorded using a validated EORTC QLQ-C30 version 3.0. Also a checklist was used to record demographic data as well as information about the educational, marital and economic status. Duration of follow up, frequency of RAI therapies and number of surgeries were also recorded. General linear model multivariate analysis of variances (GLM-MANOVA) was used to analyze the data.
Totally 435 DTC patients, 41.11±11.25 years, 77% female were assessed. Most of them were married (79%) and unemployed (57%). Global health and Qol as well as functional domains were better in women, single and higher educated patients. The QoL score in female cases was better in four functional subdomains, i.e physical, emotional, role and cognitive, but not for social functioning. QoL was adversely affected by increased number of radio-iodine therapies, radio-iodine cumulative doses and number of surgeries.
We found that quality-of-life scores are affected by the majority of socio-economic, treatment and follow-up variables. Attention to the quality of life and well-being of the patient as well as availability of professional support may be important aspects of the DTC patients’ treatment and follow-up.

The gastrin releasing peptide (GRP) receptor is over expressed in a variety of common human tumors. Radiolabeled bombesin analogues have exhibited high binding affinity for these receptors. The aim of this study was to assess the value of a new 99mTc-bombesin analog in the differentiation of malignant from benign breast tumors. 99mTc-bombesin scans were performed in 21 patients (45±21years) with breast tumor. Post-injection of 555-740 MBq 99mTc-bombesin, the dynamic imaging of the chest with 60 seconds for each frame up to 20 minutes was acquired. Subsequently, 360◦ image SPECTs of the chest was performed in 120 steps, 20 seconds per projection. In addition, whole-body anterior and posterior views were obtained 60 and 180 min after injection. Definite diagnosis was based on excisional biopsy and histopathological examination. Thirteen patients demonstrated breast carcinoma and 8 patients were diagnosed as benign lesions. 11 out of 13 patients with breast carcinoma showed radiotracer uptake in the breast lesion. Nine out of 13 patients with breast carcinoma showed axillary lymph node involvement from which only two revealed radiotracer accumulation in the axillary lesion. All patients with benign lesions revealed negative scan. Delayed planar whole body images showed no additional diagnostic information in comparison to one-hour images. The sensitivity, specificity, PPV and NPV of 99mTc-bombesin scan were 84.6%, 100%, 100% and 80%, respectively. Our data suggest that this new 99mTc-bombesin analog could be useful in SPECT imaging of primary breast cancer.

High-dose radioactive iodine therapy in differentiated thyroid cancer (DTC) may adversely affect the salivary gland function. This study is aimed to evaluate the effect of radioactive iodine (RAI) with dose of 100 mCi in DTC patients compared to lower doses of less than 30 mCi in hyperthyroid cases. Fifty four patients (13 men and 41 women) age: 42.3±14.3 (21-71) years were enrolled in the study. Twenty seven hyperthyroid cases received less than 30 mCi of I-131 for the treatment, and 27 DTC patients were treated with 100 mCi of I-131. All patients underwent Tc-99m pertechnetate scintigraphy before and three months after radioiodine therapy. Salivary gland excretion fractions (EF) were compared between groups. A decrease of more than 5% in EF was considered significant. The total frequency of salivary dysfunction was 41.7%. In patients received a dosage of 100 mCi of I-131, this frequency was 49.1%, while with less than 30 mCi, it was 34.3% (p<0.01). The right parotid gland was affected more than the left following 100 mCi treatment. Risk ratio of salivary gland involvement in high-dose versus low-dose group was significant (risk ratio=1.04-1.98, CI (95%); p=0.019). However, there was no significant difference in symptom presentation, i.e. xerostomia between two groups. RAI therapy may cause salivary gland dysfunction and this effect is more frequent in DTC patients with higher dose of 100 mCi compared to hyperthyroid cases with lower doses of less than 30 mCi.

We intended to assess the accuracy of re-expressed Modification of Diet for Renal Disease (MDRD) and Cockcroft-Gault (CG) equations to estimate glomerular filtration rate (GFR) in chronic kidney disease in two different etiologies of acute renal failure (ARF): acute tubular necrosis (ATN) and acute glomerulonephritis (AGN). Patients admitted for ARF or the patients complicated with ARF during the course of their hospitalization were enrolled to the study (n=21; 14 females and 7 males; 11 ATN and 12 AGN). When the plasma creatinine reached a steady state (DPSM) using 99mTc-DTPA. GFR was also estimated by MDRD (GFRMDRD) and CG (GFRCG) equations. The patients aged 44.8±19.5 years and weighted 67.8±10.7kg. GFRDPSM (32.9±14.7 ml/min) was statistically different from the GFRMDRD (11.6±8.2 ml/min; pCG was lower than GFRDPSM in patients with either ATN (16.5±12.5ml/min and pDPSM and GFRMDRD (r=0.34; p=0.13) but GFRDPSM and GFRCG values were correlated (r=0.48; p=0.03). Out of subjects with GFRDPSM >30, 92.3% had GFRMDRDCG Our results indicate that MDRD and CG equations were substantially inaccurate in patients with ARF. More precise methods of GFR evaluation is recommended in these patients.

The aim of the present study was to evaluate the efficacy and safety profile of bone palliative therapy following administration of 153Sm-EDTMP in patients with intractable metastatic bone pain. Sixteen patients (9 male, 7 female) aged 29-80 years (57.3±16.7 years) with severe metastasis-related bone pain resistant to analgesic medications were enrolled in the study. All patients having multiple bone metastases, positive bone scans, and estimated life expectancy of more than 2-3 months were entered the study. All patients received intravenous injection of 1.5 mCi (56 MBq)/kg of 153Sm-EDTMP. Four subscales for the intensity of pain were recorded: one as the present pain score (PPS) and the other three as maximum pain score (Max PS), minimum pain score (Min PS) and average pain score (APS) over the last 24 hours. Also the mean value of these 4 subscales was calculated as the mean total pain score (MTPS). The pain mental interference (PMI) was also assessed in 9 separate. Seven patients with breast cancer (43.75%), seven with prostate cancer (43.75%), one with papillary thyroid carcinoma (6.25%) and one with malignant paraganglioma (6.25%) were included in the study. A significant response to therapy, i.e. 2-point reduction in pain score and/or remarkable reduction (³25%) in the equivalent narcotic dose, was observed in 11 out of 16 patients (68.7%) by the 2nd week and in 12 patients (75%) by the 8th week. Regarding the palliative response to treatment and equivalent narcotic dose reduction, no significant difference between two major types of underlying malignancies (breast and prostate cancer) was found. There was no significant difference regarding response to therapy between two genders and among different age groups. The severity of bone marrow suppression was graded ≤2 in all patients. Response to palliative treatment with 153Sm-EDTMP in prostate and breast cancers is the same at the rate of 75% at the end of 8th week post-infusion. Hematologic toxicity is mild to moderate and no life-threatening side effect is observed.

Monte Carlo (MC) is the most common method for simulating virtual SPECT projections. It is useful for optimizing procedures, evaluating correction algorithms and more recently image reconstruction as a forward projector in iterative algorithms; however, the main drawback of MC is its long run time. We introduced a model based method considering the effect of body attenuation and imaging system response for fast creation of noise free SPECT projections. Collimator detector response (CDR) was modeled by layer by layer blurring of activity phantom using suitable Gaussian functions. Using the attenuation phantom, in each angle, attenuation factor (AF) was calculated for each voxel. This calculated AF is the weight for the emission voxel and states the detection probability of photons that are emitted from that voxel. Finally weighted ray sum of the blurred phantom was driven to create a projection. For the next projection, our phantom was rotated and the procedure was repeated until all projections were acquired. Root Mean Square error (RMS) between all 60 modelled projection and real MC simulated projections was decreased from 0.58 ± 0.15 using simple Radon to 0.19 ± 0.03 using our suggested model. This value was 0.56 ± 0.16 using blurred Radon without attenuation modelling, and 0.21 ± 0.03 using attenuated Radon without CDR modelling. Our suggested model that considers the effect of both attenuation and CDR simultaneously results in more accurate analytical projections compared with conventional Radon model. Creation of 60 primary SPECT projections in less than one minute may make this method as a proper alternative for MC simulation. This model can be used as a forward projector during iterative image reconstruction for correction of CDR and attenuation that is necessary for quantitative SPECT.

Ubiquicidin (UBI) 29-41 is a synthetic antimicrobial peptide that binds with the microbial cell membrane at the location of infection. This study was conducted to evaluate its probable efficacy as an infection-imaging agent with potential to differentiate bacterial infection from sterile inflammation in humans. Fifteen diabetic foot patients (10 males and 5 females) with suspected bacterial infection, prior to starting antibiotic treatment, were selected for this study. First a routine three phase bone scan and later a 99mTc-UBI scan was performed for all the patients. 555-740 MBq of 99mTc-UBI was injected intravenously. A 10 minute dynamic study was followed by spot views of the suspected region of infection and corresponding normal areas (liver and kidneys) at 60 and 120 min. Whole-body anterior and posterior images were also acquired. To interpret the studies as positive or negative, visual score (0 -3) was used, with scores of 0 (minimal or no uptake; equivalent to soft tissue) and 1 (mild; less uptake than in liver) being considered negative and scores of 2 (moderate; uptake equal to or greater than that in liver) and 3 (intense uptake equal to or greater than that in kidneys) being considered positive. Of 15 studies performed with 99mTc-UBI, all had positive bacterial cultures. The result of bone scan was positive for osteomyelitis in 12 patients (80%). 99mTc-UBI Scintigraphy was positive in 6 patients, but negative in nine. The sensitivity of 99mTc-UBI for detection of infection was therefore 40%. From 12 patients who had positive bone scans, only 6 had a positive 99mTc-UBI (50%) indicating the sensitivity of 50% for 99mTc-UBI in osteomyelitis cases. 99mTc-UBI was not positive in any patient who had evidence of soft tissue infection in the bone scan. Although 99mTc-UBI 29-41 was well tolerated by all the patients without any side effects, considering low sensitivity of this agent, this radiopharmaceutical is not of great value for diabetic foot infection diagnosis.

A 57-year-old male with history of prostatectomy, cyctectomy, cecal urinary diversion for invasive prostate cancer and with a recent rise in PSA level, was referred for bone scintigraphy to rule out osseous metastatic disease. An interesting finding was abnormal tracer accumulation throughout the large bowel, which was proved to be due to urinary diversion.

A 29- year old female with bone pain and history of precocious puberty was referred for bone scintigraphy. On physical examination café au lait macular spots were noted on her neck, buttocks and left leg. Bone scan showed multiple areas of intense increased activity which was in favour of polyostotic fibrous dysplasia. Considering the presence of polyostotic fibrous dysplasia, precocious puberty and café au lait macular spots, MacCune-Albright syndrome was confirmed in this patient.

Percutaneous transluminal coronary angioplasty (PTCA) is an effective method for revascularizing of stenotic coronary vessels. Lack of response to this treatment, either in symptomatic or asymptomatic patients, is usually due to incomplete revascularization, restenosis, and/or irreversibility of myocardial perfusion. Introduction of a noninvasive method with high predictive value for diagnosis of reversibility in ischemic myocardium is of high importance to determine the patients who will benefit from PTCA. Sixty patients with one or two vessel disease, who were candidates for PTCA and had a successful PTCA (proved by post- revascularization angiography), enrolled the study. For all patients myocardial perfusion imaging (MPI) was performed before PTCA in stress and rest phases. MPI was repeated in stress and rest phases within 6 months after PTCA. The predictive values of pre-PTCA scan for the diagnosis of reversibility and prediction of perfusion improvement after PTCA were evaluated. Perfusion improvement after PTCA was noted in 52 of 60 patients (86.7%). The positive predictive value of pre-intervention MPI for diagnosis of reversibility was 94.3% and the corresponding negative predictive value was 71.4%. Myocardial perfusion imaging may play an important role for accurate prediction of perfusion improvement after percutaneous transluminal coronary angioplasty.

A 36-year-old woman with right upper quadrant abdominal pain since three months previously and no other significant medical history was referred for evaluation of an abdominal mass. Upon clinical examination, a large palpable mass in the mid -upper abdominal area was noted. Abdominal ultrasound and spiral CT-scan showed a large hepatic mass in the left liver lobe. The patient was referred for Tc-99m labeled RBC scintigraphy to assess the possibility of presence of liver hemangioma. The radionuclide imaging confirmed the diagnosis of hemangioma which in this case, the huge size of the lesion was of interest.

The field of stem cell biology and regenerative medicine is rapidly moving toward translation to clinical practice. Stem cell therapy seems to be a new treatment option for some diseases. So, tracking the distribution of stem cells is crucial to their therapeutic use. Based on this fact we labeled human mesenchymal stem cells (MSCs) with 111In- oxine for the first time in our country. The aim of this study was to investigate the possibility of stem cell labeling in Iran. In addition the researchers assessed the cell viability, specific activity and labeling efficiency after labeling. After culturing mesenchymal stem cells (MSCs), for radio-labeling, the sample (which contained 1×106MSCs) were mixed, and suspended with 50 µCi 111In-oxine, and then incubated for 20 min at the room temperature. The cells were then washed with normal saline twice to remove the free 111In. The labeling efficiency, specific activity and cell viability was 70.6%, 31.70 µCi/106 and 100%, respectively. It seems that, this method is practical and easily applicable with acceptable efficiency and specific activity in our laboratory settings using pharmaceutical produced in Iran.

In patients with coronary artery disease (CAD) noninvasive evaluation for detection of ischemia is important to avoid invasive interventions like angiography. Exercise stress test is conventionally the first study used in evaluation of CAD. Considering the noninvasive nature of the myocardial perfusion scan, we decided to compare its accuracy with stress test. Patients with chest pain, and intermediate risk for CAD underwent stress test with Bruce standard method by treadmill, and myocardial perfusion SPECT scan with Tc-99m MIBI and the results were compared to the angiography as the gold standard. Analysis of the data was performed by SPSS11.5 soft ware. The study was performed on 89 patients (mean age: 55.5, min: 29 max: 80) including 53 man and 36 women. Exercise stress test had 54% sensitivity, 65% specificity, 68% PPV, 50% NPV, while for myocardial perfusion scan sensitivity was 94%, specificity 94%, PPV 96%, and NPV 92%. Correlation between involved walls in myocardial perfusion scan with stenotic artery in angiography was 77.6%, while this value was 32.7% for exercise stress test. There was also relationship between degree of stenosis determined by angiography and severity of ischemia detected by myocardial perfusion scan. Myocardial perfusion scan is of great value in detection of CAD with sensitivity and specificity far better than exercise stress test. It is suggested that this noninvasive study being considered the first diagnostic method for patient at risk for coronary artery disease.

Hemangiomas are the most frequent benign tumors of the liver and detecting them from metastasis or other malignant hepatic tumors is of outmost importance. 99mTc- RBC scan is highly specific and is the method of choice for this differentiation. This scintigraphy is performed in Planar and SPECT modes. These two procedures are in agreement most of the times, however since SPECT is more expensive and time consuming we planned a study to evaluate the agreement of these two methods. Sixty two patients (age range 20-80 yr, mean age 42 yr), 41 female (67%) and 20 male (33%), who were under evaluation for liver mass detected on abdominal ultrasound or CT scan, underwent 99mTc- RBC scan with both Planar and SPECT methods. The data was processed by computer and SPSS software (11.5). Planar scan was positive in 42% and negative in 59% of cases, while for SPECT study these values were 68.9% and 31.1%, respectively. The Kappa value for planar and SPECT scan results was 48%, and there were 17 lesions (27%) which were detected only by SPECT. SPECT scan defined 35% of the posteriorly located hemangiomas, and 58.3% of hemangiomas smaller than 3 cm, which were not detected by planar scans. Also 75% of patients with multiple hepatic lesions showed more lesions by SPECT as compared to planar scan. Since there is a weak agreement between SPECT and Planar scan, SPECT is considered the more reliable method in diagnosis of liver hemangioma and this is especially true when the hemangioma is of small size, has a posterior location or in cases of multiple lesions.