Iranian Journal of Nuclear Medicine
Volume:30 Issue: 1, Winter-Spring 2022

Early recurrence of hepatocellular carcinoma (HCC) is a major risk factor affecting survival even after hepatectomy. Many clinical, biochemical parameters and pathological grading like fibrosis 1 index have been used for risk stratifying HCC. However not many studies have combined all of them. It is therefore important to risk stratify HCC especially with newer PET based metabolic parameters to see if they match with existing clinicopathological parameters to achieve better clinical outcome. The objectives of this study were twofold; firstly, to evaluate [18F]FDG PET as a prognostic biomarker to predict tumour recurrence. Secondly, if clinicopathological parameters combined with PET indices increase the risk correlate in predicting HCC disease recurrence. Records of 200 adult HCC patients were analysed, (6:1, Male: Female; mean age ± SD, 52 ± 2 year). All underwent [18F]FDG PET (PET MR: PET CT = 168:32) and subsequent therapy. Patients had a follow up for at least 15 months or onset of first recurrence, whichever was earlier. Clinicopathological data, alpha-fetoprotein (AFP) titres, SUVmax and few other PET indices were documented along with details of first recurrence. Statistical analysis was also performed. In a multivariate analysis of various prognostic factors including T (SUVmax)/ L (SUVmax), serum alpha-fetoprotein, T stage, size of tumour, and vascular invasion of tumour, T (SUVmax)/ L (SUVmax) was the most significant with a cut off value of 1.9. Only vascular invasion of tumour and AFP titres had additional significance. 16% ( 32/200 patients) developed recurrence (OR 1.673). Comparing the low and high AFP titres by Kaplan Meir curve, P was found to be 0.039 that predicted a worse prognosis in patients with higher AFP titres. Similarly patients with higher SUV T/L: ratio of tumour SUVmax to liver (> 1.9) also revealed higher recurrence rate. Cut-off SUVmax was 3.03 g/ml in our series (range 2.5 - 23.8 g/ml) and found to be strongly associated with AFP, tumour size, number, and histological grade of tumour. Our study shows that PET based metabolic indices are effective robust tools to predict tumour recurrence in aggressive HCC. Secondly, when clinicopathological parameters are combined with PET based indices there is better prediction of HCC recurrence and one can reclassify HCC patients into mild, moderate, and high-risk groups. We found it very useful in predicting poor clinical outcome especially in high-risk HCC patients; so that stricter surveillance measures can be recommended to identify early recurrence and offer appropriate therapy. The strength of this study lies in the fact that the observed associations between the combined parameters were found to be stronger than those reported in the past.

Describe the profile of patients referred for computed tomography (CT) likely to be scanned with scintigraphy imaging in Togo. Prospective study carried out from May 15 to August 15 2020 including patients referred for non-traumatic CT scans (excluding strokes) in all the radiology centres in Togo with operational CT scans. The good practice guide of the French Societies of Radiology (SFR) and Nuclear Medicine (SFMN) was used as a reference for case selection. A total of 328 patients, representing 14.6% of those referred for non-traumatic CT scans (excluding strokes) were concerned. The sex ratio was 0.74 and the average age 50.58 ± 19.02 years. The patients had a health insurance in 50% of cases and were civil servants in 62.5% of cases. They mainly came from the cardiology (6.7%) and oncology departments (6.1%). Most common explorations were chest-abdomen-pelvis CT scans (36.3%) and thorax angiography CT (22.9%). Pulmonary embolism (24.1%), breast and prostate cancer extension assessment (18.3%) were the most frequent indications. Scintigraphy was indicated mainly (85.37%) as a second line of exploration. The most concerned fields of nuclear medicine were nuclear oncology (26.2%), cardio-pneumology (25%) and nuclear neurology (20.1%). Scintigraphy imaging was of a better or the same grade of recommendation as CT scan in 53.7% of cases, and of a lower or the same dose class as CT scan in 90.2% of cases. A significant number of patients referred for CT scans in Togo were likely to be explored by scintigraphy imaging, hence the need to create a nuclear medicine department there.

Gated SPECT myocardial perfusion scanning has new capabilities in addition to its main applications such as left ventricular dyssynchrony using phase analysis. Phase analysis has been investigated through various software including Emory Cardiac Toolbox (ECTb) and Quantitative Gated SPECT (QGS). The aim of this study is to evaluate the effect of reconstruction parameters on dyssynchrony indices including phase histogram bandwidth (PHB) and phase standard deviation (PSD) derived from two different software packages. In this study three groups of patients including 47 patients with normal findings 53 patients with Left bundle branch block (LBBB) and 47 patients with heart failure (HF) (including gated studies with 8 or 16 frames). All studies were analyzed by both ECTb and QGS software and reconstructed by both FBP and OSEM reconstruction methods. Then, the PHB and PSD were compared between these methods in separate patient groups. Comparison of two reconstruction methods in ECTb and QGS software showed no statistical difference for mean PHB and PSD parameters except for PHB in HF patients that analyzed with ECTb and obtained by 8 frame. On the other hand, the comparison of two software (QGS and ECTb) showed significant difference for both PHB and PSD, although, the correlation of two software was acceptable and significant. The present study showed that the method of cardiac scan reconstruction had no significant effect on the ranges of dyssynchrony parameters obtained from phase analysis. However, the type of software used for phase analysis, significantly affect the PHB and PSD.

Endometriosis is a gynecological disease and disorder that occurs when endometrial cells are shed through the fallopian tubes and are implanted on the surfaces of pelvis and abdomen. They form lesions that respond to hormones of the menstural cycle and will stimulate inflammation. It is controversial whether [99mTc]Tc-RBC scan would be sufficient for localizing bleeding sites. This study evaluated the value of [99mTc]Tc-RBC in diagnosing endometriosis. Twenty patients were included in the study for endometriosis localization. Between the 2nd and the 5th days of menstruation, when the lesions were highly activated, [99mTc]Tc-RBC scan was performed and compared with TVUS, pelvic MRI and laparoscopic surgery findings. Scans of the patients were reported by two nuclear medicine specialists who were blind to patients’ history. The patients’ age range was 21-48 years (mean age: 35±8.79). The sensitivity, specificity, positive predictive value and negative predictive value for the right pelvic bleeding sites were 73.3%, 80.0%, 91.7% and 50%, respectively while the corresponding indices on the opposite pelvic site were find to be 87.5%, 75.0%, 93.0% and 60%, respectively. Radiolabeled red blood cell scintigraphy has the potential to be used as an alternative procedure for diagnosing endometriosis.

Accurate staging plays an important role in management of patients with prostate cancer especially in high-risk group. Today, [68Ga]Ga-PSMA-11 PET/CT should be considered as the preferred imaging tool for treatment planning and initial staging of the disease. A total number of 628 patients with prostate cancer referred to Razavi hospital nuclear medicine department between March 2016 and December 2019. Among 103 patients in initial staging category, 23 cases met our inclusion criteria and entered the study. All patients performed CT scan or MRI accompanied with bone scintigraphy before [68Ga]Ga-PSMA-11 PET/CT. The scan results were compared with conventional imaging and their treatment plan determined before and after performing[68Ga]Ga-PSMA-11 PET/CT. The detection rate of [68Ga]Ga-PSMA-11 PET/CT was superior to CT/MRI in local lymph node involvements (56.5% to 21.7%), as well as for distant metastases (47.83% to 13%). The scan findings lead to upstaging in 9 patients and down staging in 4 patients.[68Ga]Ga-PSMA-11 PET/CT results changes the therapeutic plan in 13 patients (56.5%). [68Ga]Ga-PSMA-11 PET/CTis a promising imaging tool for initial staging of high-risk prostate cancer patients with significant higher detection rate in comparison to the conventional imaging. The study showed 56.5% changes in treatment planning following [68Ga]Ga-PSMA-11 PET/CT study.

The aim of this study was to evaluate the human organ absorbed dose of [111In]In-DTPA-antiMUC1, as a newly developed radioimmunoconjugate. [111In]In-DTPA-antiMUC1 was prepared at optimized conditions while the radiochemical purity of the tracer was investigated using ITLC method. Biodistribution of the radiolabeled complex was assessed in tumor bearing BALB/c mice and the human absorbed dose of the radiotracer was estimated based on the gathered data in animals according to the standard methods. The highest absorbed dose is observed in the spleen and the liver with 0.112 and 0.087 mGy/MBq, respectively. In addition, the estimated human equivalent and effective absorbed dose were 0.008 mGy/MBq and 0.041 mSv/MBq, respectively. [111In]In-DTPA-antiMUC1 radioimmunoconjugate can be considered as an effective and safe radiolabeled compound for MUC1 positive breast cancer SPECT imaging.

One of the most important causes of death in patients with end-stage renal disease (ESRD) and even after kidney transplantation is cardiovascular diseases. Thus, cardiac evaluation is of utmost importance in the management of these patients especially during preoperative work up before renal transplantation. The aim of present study is to evaluate the role of myocardial perfusion imaging (MPI) in short-term prognosis of cardiac events in patients with ESRD. In this cohort study, patients with ESRD who were referred for MPI before kidney transplantation, during a two years’ time interval (December 2015- 2017) were evaluated. Those patients aged ≥30 years were included. Patients with a history of previous transplantation, congenital heart diseases, low MPI quality and incomplete /questionable history or follow-up data were excluded. The patients were subsequently followed by reviewing their hospital records, outpatient interviews and if required telephone contacts. The occurrence of cardiac related death, myocardial infarction and/or revascularization procedure was considered positive for short-term cardiac events. A total of 179 patients (67% males with mean age of 52 years) were included in this study. The mean follow-up duration was 15.3±6.6 months (2 to 32 months) during which, one hundred patients received kidney transplantation. The coronary artery disease (CAD), diabetes mellitus (DM), dyslipidemia and abnormal MPI findings were more prevalent in patients with cardiac events. Whereas those who had undergone kidney transplantation, developed fewer cardiac events during the follow up period. However, in multivariate Cox proportional hazard analysis only abnormal MPI findings and positive history of CAD were independent predictors of cardiac events. The kidney transplantation was a significantly protective marker. Other cardiac risk factors and none of quantitative perfusion parameters of MPI showed a significant association with cardiac events in multivariate Cox proportional hazard models. According to our study, abnormal MPI and previous CAD history were the best predictor of short-term cardiac events. The kidney transplantation can lead to a better short-term cardiovascular prognosis.

Production and applicationofradiopharmaceuticals is one of the priorities in the comprehensive health map of Iran. The present study examines the scientific documentation of the Iranian radiopharmaceutical development program in the horizon 2025 in comparison to other regional competitors. The present study is a descriptive review performed by the scientometric method. The sources of data collection are studies conducted in the Web of Science database (Clarivate Analytics) from 1992 to 2021. Excel software was used to collect data and data analysis. Among the countries in the horizon 2025, the highest rank of science production belongs to Iran and Turkey, each with 2.6%. The highest level of citation belongs to Turkey with 1.8% followed by Iran with 1.7%. Most of the radiopharmaceutical scientific productions and citations in Iran are recorded in 2020 (16.6% and 10.2%, respectively). The highest share of research area belongs to nuclear science technology with 37.1%. Iran has the most international cooperation with the United States (3.5%) and most citations from the scientific partnership with China (12.3%). Nuclear Science Research Center has the most share of science production and citations (22.1% and 7.1%, respectively). AR Jalilian is the top Iranian researcher with 11.5 percent of the total Iranian output in the radiopharmaceutical field. Although Iran ranks first in the production of science and second in citation recorded among competing countries, there is a need for continuous comprehensive nuclear science research and development plan for quantitative and qualitative advancement of this field. In addition, the Iranian researchers require having more interaction, scientific communication and cooperation with academic center in countries with advanced technology in nuclear and health sciences, especially East Asian countries.

Primary cardiac osteosarcoma is a very rare malignancy with a high incidence of local recurrence and systemic metastasis, contributing to the poor prognosis. Radiological modalities are commonly used for the evaluation of cardiac masses. 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) positron emission tomography/computed tomography is a valuable whole-body imaging modality in the evaluation of most subtypes of sarcomas. The value of [18F]FDG PET/CT is not well-established in primary cardiac osteosarcoma, and it has rarely been documented in the literature. Here, we report the findings of [18F]FDG PET/CT in a case of a 38-year-old man with primary cardiac osteosarcoma, which clearly demonstrates the recurrent lesions in the myocardium.

The diagnosis of prosthetic valve endocarditis continues to present a diagnostic challenge, due to the lower sensitivity of the modified Duke criteria and a higher percentage of negative or inconclusive echocardiography results. Diagnostic delay might result in significant morbidity/mortality. Imaging modalities like 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT), prove to be an added diagnostic modality in such cases, thus assisting the accuracy of diagnosis by the modified-Duke-criteria. [18F]FDG PET/CT can prove highly beneficial, provided proper preparation for adequate suppression of the physiological myocardial uptake is done prior to the scan, thus helping is semi-quantitative analysis of the infected focus. We herein, report a case of suspected infective endocarditis with known prior history of a prosthetic valve in situ where the diagnosis of infective endocarditis could not be established with conviction, despite the use of conventional modalities of imaging like 2D echocardiography. [18F]FDG PET/CT proved its mettle by determining the primary site of infection, as well as metastatic extra-cardiac infective foci, and thus avoiding morbidity arising out of delayed diagnosis.

Here, we describe a patient with a history of colorectal cancer in whom 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) was performed for the evaluation of response to therapy. [18F]FDG PET/CT showed a small residual disease in the rectum. In addition, multiple metabolically inactive soft tissue densities were demonstrated in the left hemithorax and the left upper abdominal region, previously interpreted as metastases on computed tomography. Furthermore, bizarre-shaped soft tissues were visualized in the anatomical location of the spleen. Hence, splenosis was suspected. Subsequently, the patient underwent [99mTc]Tc-denatured red blood cell ([99mTc]Tc-DRBC) scintigraphy, which confirmed the diagnosis of extensive thoracoabdominal splenosis.

Primary hyperparathyroidism (pHPT) is defined by the excess level of parathyroid hormone (PTH). Parathyroid adenoma is responsible for about 80% of all pHPT. Parathyroid adenoma with cystic feature and atypical pathology is recognized as a rare entity. Technetium-99m methoxy isobutyl isonitrile ([99mTc]Tc-MIBI) scintigraphy has favorable detection rate for ectopic gland as well as the brown tumors. SPECT/CT plays critical role in localizing abnormal tracer uptake. Herein, we report a severely hypercalcemic patient with cystic atypical parathyroid adenoma and mediastinal uptake, which was confined to a sternal lytic lesion (suggestive of brown tumor), which highlights the importance of SPECT/CT in [99mTc]Tc-MIBI imaging.