فهرست مطالب

Nuclear Medicine - Volume:28 Issue:1, 2020
  • Volume:28 Issue:1, 2020
  • تاریخ انتشار: 1398/10/19
  • تعداد عناوین: 11
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  • Getu Ferenji Tadesse, Parham Geramifar, Pardis Ghafarian, Eshetu Ejeta Cheka, Eyachew Misgana Tegaw, Seifu Gizaw Feyisa, Ramin Sadeghi, Mohammad Reza Ay * Pages 1-13
    Introduction

    The accuracy of positron emission tomography with computed tomography (PET/CT), positron emission mammography (PEM), and breast specific-gamma imaging (BSGI) in diagnosing breast cancer has never been systematically assessed, the present systematic review was aimed to address this issue. 

    Methods

    PubMed, Scopus and EMBASE were searched for studies dealt with the detection of breast cancer by PET/CT, PEM or BSGI. Histopathologic examination and/or at least six months imaging follow-up were used as a golden reference. To calculate diagnostic test parameters: sensitivity, specificity, summary receiver operating characteristic curves (SROC) and to test for heterogeneity, true positive (TP), true negative (TN), false positive (FP) and false negative (FN) were extracted.

    Results

    Thirty one studies were included in the analysis. On per-patient basis, the pooled sensitivities after corrected for threshold effect for 18F-FDG PET/CT, PEM, and 99mTc-MIBI BSGI were 0.89 (95% CI: 0.78- 0.95), 0.73 (95% CI: 0.41 - 0.92), and 0.80 (95% CI: 0.72 - 0.86) respectively. The pooled specificities for detection of breast cancer using FDG PET/CT, PEM, and 99mTc-MIBI BSGI were 0.93 (95 % CI, 0.86 - 0.96), 0.91 (95 % CI, 0.77- 96), and 0.78 (95 % CI, 0.64 - 0.88), respectively. AUC of FDG PET/CT, PEM, and BSGI were 0.9549, 0.8852 and 0.8573, respectively.

    Conclusion

    This meta-analysis indicated that PET/CT showed better diagnostic accuracy than PEM, and BSGI on per-patient basis. On per-lesion analysis, PEM with the highest AUC, DOR and Q* was better than PET/CT, and BSGI for detecting breast cancer.

    Keywords: Breast cancer, PET, CT, Positron emission mammography, Breast specific-gamma imaging, meta-analysis
  • Armaghan Fard Esfahani, Mohammad Reza Valipouri, Sara Harsini *, Davood Beiki, Alireza Emami Ardekani, Babak Fallahi, Mohammad Eftekhari Pages 14-20
    Introduction

    Differentiatedthyroid carcinoma (DTC) constitute approximately 90% of all thyroid tumors with an overall excellent prognosis. However, there is a small group of patients with a more aggressive form of disease, usually associated with certain poor prognostic factors. Using our large database of patients with DTC, the current study aims at identifying some of these factors. 

    Methods

    This retrospective study was based on the registry of patients with non-medullary thyroid carcinoma. Data were collected on the clinical, laboratory, and outcome characteristics of 501 patients followed at our department.

    Results

    On multivariate analysis, the following variables were predictive of persistent disease: less than total thyroidectomy, residual disease on the post treatment whole body radioiodine scan (WBIS), higher received radioiodine activities, and higher levels of baseline stimulated thyroglobulin (Tg) and thyroid stimulating hormone (TSH). The greatest predictive value for the persistent/recurrent disease was attributed to the presence of residual disease on the post-treatment WBIS (odds ratio (OR): 33.72, 95% confidence interval (95% CI): 18.17-62.57), followed by type of surgical procedure (OR: 8.92, 95% CI: 2.90-27.39), radioiodine ablation dose (OR: 4.03, 95% CI: 1.56-10.39), stimulated baseline Tg level (OR: 2.79, 95% CI: 1.53-5.08) and finally, the stimulated baseline TSH level (OR: 2.21, 95% CI: 1.08-4.519).

    Conclusion

    In patients with DTCs, surgical procedures other than total thyroidectomy, presence of residual disease on the post-treatment WBIS, higher received radioiodine activities, higher baseline stimulated Tg and TSH levels are associated with a higher probability of having persistent disease and can be used in conjunction with other disease characteristics to reach proper decisions with regard to treatment and follow-up.

    Keywords: Differentiated thyroid cancer, Prognostic markers, Stratification, Thyroglobulin
  • Subramanyam Padma *, Palaniswamy Shanmuga Sundaram Pages 21-27
    Introduction
    Detecting renal allograft dysfunction early will allow timely diagnosis and treatment. There is no objective recommendation by national kidney societies for glomerular filtration rate (eGFR) estimation in post-transplant setting. 99mTc-DTPA Technetium-99m Diethylene triamine penta acetic acid) renogram can identify early renal dysfunction much before serum creatinine levels get deranged. Our objectives are: 1) We hypothesised that if Gates formula is depth corrected for anteriorly placed renal allograft, can it serve as a reliable, accurate investigation 2) To compare how DTPA renogram with depth correction (CT based) and without depth correction (fixed distance) fares with creatinine based MDRD (Modification of Diet in Renal Disease), and CKD-EPI Chronic Kidney Disease Epidemiology Collaboration) equations in transplant recipients in our population. GFR values were compared with gold standard venous blood GFR single sampling method in a few patients. 
    Methods
    Forty adults live related adult renal allograft recipients with serum creatinine values of less than 2.0 mg/dl at 6 months follow-up were enrolled.
    Results
    Mean measured GFR was calculated for 4 different methods along with single plasma sampling method. MDRD and CKD-EPI equations showed higher values in our study but correlated well with each other in GFR estimation. Accuracy was highest with GFR derived from depth corrected DTPA renogram (69.2%) than for fixed depth method (60 %, p ¼ 0.0012). GFR obtained by DTPA depth correction method also showed good correlation to SPSM.
    Conclusion
    99mTc-DTPA based GFR estimation with depth correction is not affected by serum creatinine level and showed highest accuracy.
    Keywords: 99mTc-DTPA renogram, Transplant renogram, Glomerular filtration rate, Creatinine, Single plasma sample method
  • Hameed Ullah *, Aakif Ullah Khan, Iftikhar Ahmad, Shakil Ahmad Pages 28-32
    Introduction
    The post-surgical management of patients with differentiated thyroid cancer include ablation of remnant local and distant metastatic tissues with 131I therapy, which accentuates isolation of the patient in order to avoid unnecessary radiation exposure to the care givers, general public and the environment. The duration of isolation is subject to the reduction of exposure to the safe limit as defined by the regulatory bodies. 
    Methods
    This study presents the correlation of isolation period of the radioiodine treated patients with administered activity, surgical endeavors and the disease extent. The study was conducted on 222 patients at the Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan from 2008-2012.
    Results
    The number of patients in the four groups on the basis of 131I administered activity were, 131I administration while 27.03%, 24.32%, 10.81%, 6.31%, and 0.90% patients were kept in isolation for 72, 96, 120, 144 and 168 hours, respectively.
    Conclusion
    The isolation period of radioactive 131I treated patients is directly related to the 131I activity administered, size of the remnant, and extent of the disease.
    Keywords: Metastatic disease, Papillary carcinoma, Radioactive iodine, Release criteria, Thyroidectomy
  • Azadeh Emami, Pardis Ghafarian, Hossien Ghadiri, Parham Geramifar, Mohammad Reza Ay * Pages 33-38
    Introduction
    MAMMI is a dedicated PET based on high resolution detectors placed close to the breast. In this study, we presented a GATE model for the simulation of MAMMI scanner and model its performance of the MAMMI based on an adaptation of the NU 4-2008 NEMA standard. 
    Methods
    A detailed of geometry MAMMI system that uses scintillation crystals coupled to position sensitive photomultipliers. The detector ring consists of 12 LYSO detector modules with a scanner aperture of 186 mm. We validated the model against experimental measurement, including spatial resolution, sensitivity, counting rates, noise equivalent count rate (NECR) and scattering pattern.
    Results
    Overall results showed reasonable agreement between simulation and experimental data. For a breast phantom with a capillary source, the SF reaches 50.9 and NECR is 45 kcps with an activity of 11 MBq, 18F in quad rings. The spatial resolution at the axial FOV of quad rings (2.1 mm axial, 1.8 mm radial, and 1.7 tangential) is slightly better than that measured at the axial center of dual rings (2.1 mm axial, 1.8 mm tangential and radial).
    Conclusion
    The MAMMI-PET has excellent spatial resolution and high sensitivity for primary breast cancer lesions. The results show performance improvement, especially in the absolute sensitivity, because of the more rings introduced in the MAMMI PET. The performance of the scanner and the validation results are considered to be reasonable enough to support its use in breast cancer imaging.
    Keywords: Positron emission tomography, Breast, Simulation
  • Hamideh Abbasian, Farshad Emami, Farnaz Banezhad, Ramin Sadeghi * Pages 39-42

    After thyroidectomy in papillary thyroid carcinoma (PTC) patients, whole body radioiodine scan (WBIS) is necessary for localization of any abnormal radioiodine avid lesions. However false-positive radioiodine uptake in WBIS can be problematic. We report a 32 years old female patient with PTC. After thyroidectomy and radioiodine therapy WBIS was performed. In her post therapy WBIS, there were zones of radioiodine uptake in the chest, mediastinum, and pelvic regions.  In SPECT/CT, we encountered simultaneous uptake of radioiodine in breast, thymus, adnexa and intrauterine device (IUD) site. SPECT/CT images could identify these potential false positive uptakes as benign accumulations of the tracer.

    Keywords: Papillary Thyroid Carcinoma, Whole body radioiodine scan, False-positive, SPECT, CT
  • Alireza Emami Ardekani, Sara Harsini *, Armaghan Fard Esfahani, Mohammad Eftekhari Pages 43-47

    Multiple myeloma (MM) is a clonal B-lymphocyte neoplasm of terminally differentiated plasma cells. Imaging modalities which allow the recognition of the effects of myeloma cells on the skeletal system have been utilized for a long time. Herein, we represent a patient with generalized osteoporosis and hypercalcemia, who was referred for parathyroid scan, in whom the widespread bone marrow technetium-99m-methoxy-2-isobutylisonitrile (99mTc-MIBI) uptake suggested the presence of a bone marrow involving pathology, which turned out to be multiple myeloma on bone marrow biopsy. The current case report highlights the importance of 99mTc-MIBI scintigraphy, with a relatively low cost and better accessibility compared with other high sensitivity modalities such as PET-CT, to be used to demonstrate multiple myeloma bone marrow involvement, which could incline physicians to consider 99mTc-MIBI scintigraphy as a complementary diagnostic tool for multiple myeloma.

    Keywords: Multiple Myeloma, Hypercalcemia, Tc-99m-Methoxy-2-isobutylisonitrile
  • Parinaz Jahanpanah, Sara Shakeri, Zahra Kiamanesh, Zakie Nasiri, Kamran Aryana * Pages 48-50

    A 75-year-old male patient with non-avid radioiodine Hurthle cell carcinoma was evaluated by 99m Tc- octreotide scintigraphy, in order to find possible metastatic lesions. A bony metastatic lesion was detected by this procedure which was confirmed by histopathology.99mTc-octreotide scintigraphy is a precise and cost-effective imaging modality for detection of non-iodine avid lesions in metastatic differentiated thyroid carcinomas.

    Keywords: Hurthle cell carcinoma, 99mTc-octreotide scintigraphy, Negative whole body iodine scan, Thyroid cancer, Elevated Tg level
  • Farnaz Banezhad, Zakieh Nasiri, Zahra Kiamanesh, Ramin Sadeghi * Pages 51-53

    An enostosis or bone island is a benign bony lesion that is almost diagnosed based on clinical and radiologic defining characteristics. One of the known diagnostic procedures in the evaluation of enostosis is bone scintigraphy. Generally, we don’t expect to see increased uptake by enostosis in the bone scan. Herein we present a 52-year-old lady who was suffering from chronic low back pain that was referred for 99mTc-MDP bone scanning. A bony lesion in a thoracic vertebral body had been discovered on CT and MRI and conventional imaging characteristics were compatible with enostosis, but skeletal scintigraphy showed increased uptake both on planar and SPECT images.

    Keywords: Enostosis, Skeletal scintigraphy, SPECT
  • Rashid Rasheed *, Fareeda Al Kandari, Syed Faheem Askari Rizvi, Sharjeel Usmani Pages 54-56

    Neurolymphomatosis (NLY) is a type of rare disease with poor prognosis, characterized by infiltration of nerves, nerve roots and plexus. We report a case of 54-years old female patient non-diabetic and normotensive diagnosed with chronic lymphocytic leukemia presented with pain in the neck and arm and numbness in the ipsilateral hand. The patient underwent 18F fluorodeoxyglucose PET/CT scan, which showed increased tracer accumulation in the right neck and supraclavicular region in the brachial plexus. 18F-FDG PETCT is highly sensitive technique for early localization of NLY than MRI or CT alone.

    Keywords: Neurolymphomatosis, Brachial plexus, Rare clinical presentation, 18F-fluorodeoxyglucose PET, CT
  • Zahra Kiamanesh, Farnaz Banezhad, Zakie Nasiri, Farshad Emami, Ramin Sadeghi * Pages 57-59

    A 47 year old female with papillary thyroid carcinoma was referred to our department for post-treatment whole body iodine scanning. The acquired images revealed a focal zone of intense radiotracer uptake in the right lower quadrant of the abdomen. SPECT/CT fused slices showed a focal zone of the radioiodine (131I) uptake in the right colon wall. Colonoscopy revealed a pedunculated polyp in the right colon. Eventually, a benign adenomatous polyp was confirmed by histopathologic assessment. To the extent of our knowledge, this is the first case of large bowel polyp demonstrating radioiodine uptake, reported in the literature.

    Keywords: Benign colon polyp, 131I uptake, Whole body radioiodine scan