Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 DOI 10.1007/s00259-011-1911-0
POSTER PRESENTATIONS
P02 — Sunday, October 16, 2011, 16:00 — 16:30, , NIA Exhibition Area
Physics & Instrumentation & Data Analysis: Image P01 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Physics
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Instrumentation
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Instrumentation
P001 Comparison of three techniques for calculating the 20% count rate loss in a gamma probe for sentinel node biopsy surgery K. L. Kirkbride, A. G. Irwin, T. Hague, A. J. Craig, A. Britten; St George's Hospital, London, UNITED KINGDOM. AimTo compare two standard methods (“decaying source” and “two-source” methods) for measuring count rate performance in gamma probes with a new method (“distance method”), and to evaluate the tests for their suitability as part of routine QA procedures.IntroductionCharacterisation of the count rate capability due to dead time is a component of gamma probe QA. Dead time reduces the recorded counts and QA measurements must be taken on the linear response range. NEMA recommends the decay method for gamma probes (1), whilst the two source method is a standard technique for nuclear instrumentation (2). No method is ideal. The decaying source method requires measurements over a long time interval, whilst the two-source method requires the count rate loss value to be roughly known, and it is an indirect measurement. The proposed distance method has the potential to be rapid and to be workable direct measurement with little a priori knowledge required.MethodThe 20% count rate loss count rate (R20) of a Europrobe gamma probe was estimated using the standard decaying source and two-source methods. The new distance method was applied using a “hot” source and a “cool” source and changing the count rate by varying the source-probe distance. The two responses were compared using the cold source count rate as a reference to obtain the R20 value.ResultsThe 20% count rate drop R20 was calculated to be at 3,937 cps (decay method), 3,500 cps (two-source method), 3,991 (distance method). The decay method duration was about 12 hours, whilst the two-source and distance methods took about an hour to prepare sources and record measurements, and both need a jig and/or water bath.ConclusionsGood agreement was observed between the decay method and the proposed distance method. This may be a practical, shorter-time alternative to the established decay method and further comparisons are being undertaken into reproducibility between probes and operator variability.References1. NEMA standards publication NU3-2004 “Performance measurements and quality control guidelines for nonimaging intraoperative gamma probes,” 20042. Adams et al., “Deadtime measurements in scintillation cameras under scatter conditions simulating quantitative nuclear cardiography,” J Nucl Med 19: 538-544, 1978
P002 Design and Construction of Shielding Sleeves to Test Radionuclide Calibrator Linearity for Clinical Use D. N. B. Yatigammana, J. L. Merrett, A. H. McLean, M. A. Masoomi; Queen Alexandra Hospital, Portsmouth, UNITED KINGDOM. AimTo investigate and design multi-element shielding sleeves to use as an alternative to the decaying source method of performing linearity measurements for radionuclide calibrators. This will allow linearity QC to be performed in a matter of minutes by replicating the natural decay of the source over a few days.Materials and MethodsA design was created by using a line source model to calculate the range of multi-element thicknesses needed to shield a Tc-99m source to produce a range of measurements across the entire range of clinically assayed activities. The sleeve design was chosen to ensure consistent geometry between measurements and various designs of sleeves were analysed to assess the range of measurements that could be performed and the practicality (weight, cost, etc) in performing the measurements. We investigated the attenuation properties of various materials when considering the final design.As part of the initial analysis, existing lead pots were used to determine the constancy in assays of a Tc-99m source through lead.ResultsThe range of Tc-99m activities used in the design of the sleeves was 10 - 6000 MBq to match the clinical range assayed. A sleeve set was designed such that combinations of sleeves could be placed within each other to produce 12 measurements with 4 sleeves, minimising the overall time of measurements and the manufacturing costs. The initial measurements through existing lead pots showed that there was consistency in the method of measurement with a standard deviation of 2.6% in the calculated equivalent decay time.ConclusionUsing the initial findings, a final design using alternative materials and manufacturing methods will be considered. A test design will be produced to measure the difference between expected and measured attenuation, considering scatter contribution, to produce a more accurate model with which to finalise the design of the sleeves.
Reconstruction
P003 Improvement of image quality using cross projection angle data in emission computed tomography K. Matsumoto1, K. Shimizu2, K. Murase3, Y. Wada4, Y. Watanabe4, M. Senda2, T. Mukai1; 1Kyoto College of Medical Science, Kyoto, JAPAN, 2 Institute of Biomedical Research and Innovation, Kobe, JAPAN, 3Graduate School of Medicine Osaka University, Osaka, JAPAN, 4RIKEN Center for Molecular Imaging Science, Kobe, JAPAN. Aim: General data acquisition for single photon emission computed tomography (SPECT) is performed in 90 or 60 direction using a gamma camera. On the other hand, positron emission tomography (PET) is measured from 128 to 256 directions, but cannot be changed as one chooses. The purpose of this study was to investigate a cross projection angle (CPA) method of emission computed tomography (ECT) by applying the cross plane in PET.Method: The CPA method was evaluated to a digital phantom (Shepp-Logan phantom) with attenuation and statistical noise and a Hoffman 3-D brain phantom. A PET scanner and a gamma camera, CTISiemens ECAT EXACT HR+ and GE Healthcare Millennium MG, were used to scan images of a Hoffman 3-D brain phantom. The projection data of CPA method was corrected for normalization. Attenuation and scatter corrections of SPECT image were performed using Chang's method and a modified triple energy window, respectively. Each correction (i.e. attenuation, scatter, deadtime, etc.) of PET image were used recommended for the scanner model. All ECT images were reconstructed by the filtered back-projection method with a ramp filter cut off at the Nyquist frequency. Quality of the reconstructed images was evaluated in terms of Normalized Mean Square Error (NMSE) values and a two dimensional power spectrum analysis.Results: NMSE values of PET and SPECT images using CPA method were very nearly zero. As for a two dimensional power spectrum analysis, PET and SPECT images quality using CPA method were approximately 1.8 times better than conventional method. Also, the spatial resolution of CPA method was not change compared with the conventional method.Conclusion: Our preliminary data suggest that effective improvement of image quality can be expected with cross projection angle. Also, the CPA method was considered clinical useful and a widely available simple method.
P004 The role of reconstruction algorithm and SPECT acquisition orbits in somatostatin receptors’ detectability F. Voltini, F. Zito, G. Marotta, R. Lambertini, C. Canzi, M. Migliavacca, P. Gerundini; Nuclear Medicine Department, IRCCS Fondazione Ca’ Granda Ospedale Maggiore, MILAN, ITALY. AimThe aim of this work was to evaluate the effects on the performance in somatostatin receptors’ detectability due to both reconstruction algorithms and different acquisition orbits.Material and MethodsThe study was performed by the γ-camera SYMBIA-S(Siemens), simulating SPECT patients examinations using an anthropomorphic Alderson phantom with seven inserts of different volumes(0.4÷4 ml), to reproduce tumoral foci in thorax, liver, abdomen. Mediastinum, liver, abdomen and lesions were filled with111In water solution with different concentrations to simulate lesion-to-background ratios found in clinical SPECT studies. Acquisitions were performed by body-contour(BC) and circular(CO) orbits. Data were reconstructed by FBP and iterative algorithms implemented on e.softworkstation:Osem-2D and Flash-3DTM. Flash-3DTM includes 3D-beam-collimation model. Iterative reconstructions were performed by 20 sub-sets and 5,10,15,20,30 iterations;the choice of sub-sets was previously optimized. Eleven sets of images were reconstructed for both OC and BC studies.Lesion detectability was assessed by contrast(C%) and signal-to-noise-ratio(SNR) therefore all the sets of images were analyzed: 1) to calculate C% and SNR for each lesion in the phantom acquired with circular orbit (C%LCO; SNR-LCO) and body-contour(C%LBC;SNR-LBC); 2) to evaluate the paired t-test between correspondent values of C%LCO,C%LBC and SNR-LBC , SNRLCO.ResultsC%LCO(C%LBC) evaluated on the images reconstructed with Flash-3DTM, were significantly higher (p<0.05) than correspondent values C%LCO(C%LBC) calculated with OSEM-2D and FBP, similarly for the C%LCO(C%LBC) of OSEM-2D compared to correspondent values of FBP. For each reconstruction algorithm differences between C%LCO and C%LBC were not significant.The mean values of C%LCO were for Flash-3DTM, OSEM-2D and FBP respectively: 76,72,57 while for C%LBC were respectively: 75,73,59.SNR-LBC(SNR-LCO) values for Flash-3DTMwere, both OC and BC, significantly lower (p<0.05) than correspondent values SNRLBC(SNR-LCO) for OSEM-2D and FBP. The differences between SNR-LBC and SNR-LCO values were significant only for OSEM-2D.ConclusionsPerformance in lesion detectability are influenced mainly by the choice of reconstruction algorithm rather than by the kind of orbits used for SPECT. When assessed for Flash-3DTM contrast was significantly higher, for both OC and BC, than OSEM-2D and FBP while the
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P005 Validation of advanced resolution recovery method on SPECT image using new digital phantom models H. Onishi1, N. Motomura2, K. Fujino3, T. Nastume4, Y. Haramoto5, H. Amijima6; 1Prefectual University of Hiroshima, Mihara Hiroshima, JAPAN, 2 Toshiba Medical Systems, Ohtawara Tochigi, JAPAN, 3Osaka University Hospital, Suita Osaka, JAPAN, 4Fujita Health University Graduate School of Health Science, Toyoake Aichi, JAPAN, 5Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima Hiroshima, JAPAN, 6Hyogo University of Health Sciences, Kobe Hyogo, JAPAN. Objectives: Currently, several resolution recovery (RR) methods have been developed. However, the lack of detailed information regarding these technological advancements and their operation creates a complex ‘black box’ environment for the user, who is ultimately forced to trust the results without being able to check their accuracy and precision. The aim of this study to validate advanced RR-method (four commercial reconstruction software packages): General Electric’s Evolution for cardiac (EVO), Philips Astonish (AST), Siemens Flash3D (FLA) and Toshiba 3DOSEM (3DOS). We verified using count profile, % coefficient of variation (%CV) and normalized mean square error (NMSE) by digital phantom (cylinder/sphere: CYS, myocardial: MYD).Method: In the CYS (32cm ø), sixteen spheres (Hot & Cold) were placed in concentric configuration, and each diameter was 9.6, 8.0, 6.4, 4.8, 3.2, 2.2, 1.6 and 0.96 cm, respectively. The MYD was created by computer simulation using EGS4, and included two defects in the left ventricle myocardium. The performance was evaluated in the collimator system (LEHR), source-to-detector distance (166 200, 250 mm) and reconstruction conditions (the product with subset and iterations: SI) using the NMSE and %CV. RR methods, conventional ordersubset expectation maximization (OS-EM) and filtered back projection (FBP) were inspected in evaluation criteria, respectively.Results: %CV in the RR methods significantly as compared with other methods (OSEM, FBP) showed a small value and could determine uniform improvement. As for NMSE in the hot and cold spheres, it was shown a minimum value that SI was high in all RR methods. In the RR methods, we analyzed count distribution of hot spheres from a profile curve. True count value was not indicated as the diameter of a sphere becomes small, and as for the count value was about 1.5 to 2.0 times. The overshoot of count was found in the marginal region for diameter of the small spheres using RR methods. Those diameters were less than 4.8 cm. The RR methods improved 20% contrast of the defect region as compared with FBP and OSEM in a MYD.Conclusions: The number of optimal SI depended on each RR method. If the number of SI increased, EVO, AST and FLA systems except 3DOS neared to a true image in the CYS. RR method caused to overshoot by Gibbs's phenomenon in the marginal region for diameter that was less than 4.8 cm. It is necessary to be careful enough in the hot region of clinical studies.
P006
greatest using a 64x64 matrix. These preliminary results showed no effect of number of projection angles on any quantifiable measures image quality. When analysing the short axis slices of the cardiac phantom, it was shown that reducing the scan time to 15 seconds per acquisition, half that currently used, had no significant effect on the contrast or on the measured width of the wall of the cardiac phantom. On comparison of the segmental polar maps of the cardiac phantom using different acquisition parameters there was no significant difference between original acquisition parameters and the half time scan using the same matrix and number of projections.ConclusionThe proposed reduction in the MPS scan time to half that currently used should not significantly affect image quality. This was tested clinically and upon initial inspection there seems to be little difference in the appearance of the results of the half time MPS scan when compared to the full time suggesting that the Astonish algorithm can reduce acquisition time of MPS scans, thorough clinical acceptance is currently underway.
P007 Optimization and validation of a technique for automatic tumor segmentation by adaptative thresholding on PET/CT images F. Giammarile1, M. Moussallem1, C. Houzard1, C. Jegou1, A. TraverseGlehen2, P. Valette3; 1Hospices Civils de Lyon, Service de Médecine Nucléaire, Centre Hospitalier Lyon-Sud and Université Claude Bernard Lyon1, EA 3738, Pierre-Benite, FRANCE, 2Hospices Civils de Lyon, Service d’anatomie pathologique, Centre Hospitalier Lyon-Sud, Pierre-Benite, FRANCE, 3Hospices Civils de Lyon, Service de Radiologie, Centre Hospitalier Lyon-Sud and Université Claude Bernard Lyon1, EA 3738, Pierre-Benite, FRANCE. Purpose. - The most critical element in planning dose of radiotherapy treatments is the delineation of the boundaries of the tumour. This delineation is usually done on the anatomical images of computed tomography (CT). Recently, for non-small cell lung cancer (NSCLC), it has been recommended to use functional Positon Emission Tomography (PET) images to take into account the biological characteristics of the target. However, until now, there is no satisfactory segmentation technique on the PET images for clinical applications. In the present study, we propose a solution of this problem.Materials and Methods - From the databases of the Nuclear Medicine Department, we included 65 lung lesions of 54 patients referred for FDG-PET/CT exams. Lesions were located in the upper part of lungs, had diameters smaller than 4.5 cm and presented abnormal FDG uptake.Our optimizations consist primarily on the adjustment of thresholds directly from patients, rather than from phantoms. We validated our technique by comparing our results with two different gold standards: measurements performed with CT images of the selected lesions and histological measurements of surgically removed nodules.Results - The percentage difference threshold between functions found using CT data and histological measures was smaller than 7.5%.For lesions bigger than 20 mm we found a very good conformation with the histological measurements (mean difference between measured and calculated data = +1.5 ± 8.4%) and an acceptable conformation with CT measurements. For lesions smaller or equal to 20 mm, we found a large gap between our segmentation technique and measures derived from histological or CT data.Conclusion. - Our segmentation technique seems currently the most accurate technique for NSCLC lesions of large axes between 2 and 4.5 cm. By cons, it does not correctly evaluate smaller lesions because of partial volume effect.
Optimisation of Myocardial Perfusion Scintigraphy using the Philips Brightview X-CT gamma camera and Astonish reconstruction software
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T. Watts, V. A. Smith, P. J. Turner, P. D. Strouhal; The Royal Wolverhampton NHS Hospitals Trust, Wolverhampton, UNITED KINGDOM.
J. Varga; University of Debrecen, Debrecen, HUNGARY.
IntroductionMyocardial perfusion scintigraphy (MPS) is used to determine whether patients deemed to have an intermediate risk of developing significant coronary arterial stenosis should have more invasive coronary angiography. An iterative reconstruction algorithm (Astonish) that includes depth dependent resolution recovery, may allow scan time to be reduced, resulting in decreased patient movement artefacts and increased patient comfort and machine throughput. The aim of this project was to reduce the imaging time of each scan to a minimum, whilst maintaining a clinically diagnostic image quality.MethodsThe currently used acquisition parameters are a 64x64 matrix, 64 projections and 30 seconds per projection and result in a 16 minute scan and it was hoped that this could be significantly reduced without impacting on image quality. The acquisition parameters tested were matrix sizes of 64x64, 128x128 and 256x256; 32, 64 and 128 projection angles using 10-30 seconds per acquisition. Initially, a Jaszczak phantom was used to assess the performance of the SPECT imaging system. This was followed by SPECT imaging of a cardiac phantom, filled with 99mTc with an activity of 13.5 ± 2.6 MBq, and inserted into the shell of a Jaszczak phantom, which contained water to provided reproducible attenuation.ResultsPreliminary measurements using transaxial slices of the reconstructed image of the Jaszczak phantom showed that the uniformity and signal to noise ratio within the image was
A Simplified Formula for the Position-Dependent Modulation Transfer Function of Gamma Cameras Aim: Resolution recovery reconstruction algorithms can effectively enhance the signal-to-noise ratio and improve the visibility of details in SPECT slices. Resolution depends both on the object-detector distance and the presence of scattering medium. We searched for a simple formula to describe the dependence of the modulation transfer function MTF(f) of a gamma camera on the source position and the thickness of body tissue, so that it can be included in iterative reconstruction algorithms and adaptive filters.Methods: We acquired images of line sources with two different gamma energies using a general purpose gamma camera (DHV, Mediso): Tc-99m with a low energy, high resolution collimator (used for the majority of patient studies), and I-131 with a high energy collimator. Targetdetector distance varied between 5 and 31 cm, with 0 to 26 cm layer of water as tissue equivalent scattering medium, giving 15 combinations altogether. First we fitted the MTF(f) measured in air by a function of the form exp(-f 2P/S), then included the effect of scattering in the model. The goodness of fit was characterized by the residual sum of squared differences.Results: We found a close correlation between the source-detector distance d and the parameters of the exponential function in air; e.g. for Tc-99m:P = 0.00898·d+ 0.81 , S = 1.173·exp(0.0865·d)In the presence of scatter we compared several functions, starting from a single exponential term as above, and testing various combinations (weighted sums and products) of such terms.When using a single exp term, we found that in a first
Poster Presentations
change of orbit from OC to BC did not introduce significant variation for all algorithms.The choice of 15-20 iterations seemed reasonable to guarantee a good trade-off between SNR and C% and then a better lesion detectability . To assess uptake of radiopharmaceutical labelled with 111In such as somatostatin receptors' the choice of reconstruction algorithm is more effective than the choice of acquisition orbit and iterative algorithms are suggested, however optimization of reconstruction parameter is mandatory.
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S262 approach parameter S depends on the distance only, while the scattering medium affects the value of P. 5 or 6 constants are sufficient to describe the MTF.Conclusion: The modulation transfer function characterizing the system resolution of gamma cameras can be well approximated by an analytical function with a few parameters. A separate set of constants applies for each cameracollimator-radionuclide combination.
P009 Image improvement in I123-MIBG adrenals scintigraphy by scattering corrections. N. P. Lagopati, M. A. Sotiropoulos, M. E. Lyra; Athens University, Radiology Department, Athens, GREECE. BackgroundMetaiodobenzylguanidine (MIBG) scintigraphy is used to image tumors of neuroendocrine origin and study disorders of sympathetic innervation of the myocardium. Scintigraphic imaging methods offer the possibility of qualitative and quantitative assessment of tracer concentration. Accurate correction for the physical degrading factors (attenuation, scatter, partial volume effects) is highly demanded. An analytical study of the I-123 energy spectrum, scattering and attenuation contribution to the resulting image of an I-123 MIBG scintigraphy, has been undergone, so as to improve the data that could be collected, without further increase of the absorbed dose in the patient.MethodsSeveral sources of inaccuracy and inconsistency as radionuclide purity have been shown to affect the quality of imaging, the estimation of uptake measurements and the absorbed dose of the patient. Depths, position, volume of the organ are other factors increasing the scattering effect. Corrections for scattering photons improve image quality and therefore are obligatory. In this work, quantitative data were gathered to determine the above factors effect on source activity data. I-123 MIBG images from 9 clinical studies of paediatric patients suffered by neuroblastoma were used to evaluate the scatter correction effect on them.The final image is being extracted by the Triple Energy Window (TEW) method as a combination of three images, all being acquired by a different energy window. The middle one has been obtained as a 20% window centered on the main I-123 photopeak (159 keV) and two 10keV sub-windows by the left and right side of the main window have been selected.The Compton scattering problem, as the dominant photon interaction phenomenon and its impact on both the quality of clinical images and accuracy of quantitative analysis is taken into consideration for a scatter modelling in non-uniform media.ResultsOur results show that the TEW method is a successful way to obtain qualitative and quantitative improvement of the I-123-MIBG image. Choosing regions of interest at x -ray, gamma-ray and coincidence peaks maximizes sensitivity for a given crystal geometry. By this technique, measurements of source activity were found to be independent of the source volume; coincidence counting of measuring I-123 is independent of the counting geometry, the volume and the depth of the source.ConclusionsBy choosing the specific energy windows, with the TEW method, described in this work, the image quality is improved. Relative ratios indicate that corrections for scattering photons increase also the data accuracy obtained through the images.
P010 Performance of 3D MAP in small animal PET: evaluation using the NEMA NU-4 standard phantom M. Khalil, W. Gsell; Biological Imaging Centre, MRC-CSC, Imperial College London, Hammersmith Campus, London, UNITED KINGDOM. Aim. Iterative reconstruction has gained a wide acceptance in clinical and research setting. The objective of this work was to optimize the iterative reconstruction maximum a posteriori (MAP) in small animal PET using the standard NEMA NU-4 image quality phantom in comparison to filtered backprojection (FBP). Methods. Four different activity distributions were used to examine the potential of MAP reconstruction in preclinical PET. We used a hom*ogenous water phantom and three different configurations of the NEMA NU-4 phantom: In air, inside the imaging bed and attached to 3 water cylinders as extreme condition of photon attenuation and scatter. The NEMA phantom was hom*ogenously filled with 5.5 MBq of F-18 then 20 min list mode acquisitions were performed using PET/CT workflows (Inveon, Siemens Medical Solutions). Raw data were sorted into 3D sinograms. After Fourier rebinning, images were reconstructed (128 x128 matrix) using 2D FBP (ramp filter at 0.5 Nyquist frequency) and OSEM3D/MAP (2 OSEM3D iterations and 18 MAP iterations) with different β values (0.01, 0.1, 0.5, and 1.5). Attenuation and scatter corrections were applied. The percentage standard deviation was used to assess image noise and spillover ratio to evaluate scatter correction. Percentage error of tracer concentration and recovery coefficient (RC) were also computed to evaluate resolution characteristics and partial volume effect. Results. In the hom*ogenous phantom, the activity concentration was estimated using the FBP and MAP reconstructions with an error of less than 1%. However, for the three NEMA phantoms the accuracy of tracer estimate was 5% and 3% using FBP and MAP at β=1.5 respectively. RCs were superior with iterative reconstruction especially at β=0.01 and 0.1 when compared to FBP. At rod size of 5 mm, a β value of 0.1 provided a high PET signal recovery (1.01±0.01 across the
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 three NEMA phantoms vs 0.90±0.02 with FBP). Spillover ratio indicated variations between FBP and MAP in air and water compartments. MAP reconstruction at high β values has significantly improved the noise properties of the images.Conclusion. Apart from its computational demands, MAP reconstruction showed improvement over FBP reconstruction in many aspects of image quality and quantitative accuracy. Image noise was improved with high β values but this occured with some loss in image resolution. However, RCs could significantly be improved with fine tuning of β especially at small values. Optimization of the algorithm is therefore application specific. Further investigations are warranted when MAP reconstruction is used with scatter correction.
P011 Effect of color scale used for display of images on diagnostic criterion for detection of ischemia in myocardial perfusion study J. Siennicki1, J. Kuśmierek2, K. Kovacevic-Kuśmierek1, M. Bieńkiewicz1, K. Chiżyński3, J. D. Kasprzak4, P. Lipiec4, A. Płachcińska1; 1Department of Quality Control and Radiological Protection, Medical University, Lodz, POLAND, 2Department of Nuclear Medicine, Medical University, Lodz, POLAND, 3Department of Invasive Cardiology, Medical University, Lodz, POLAND, 4II Chair of Cardiology, Medical University, Lodz, POLAND. Background: The aim of this study was to determine whether application of color scale used for display of reconstructed images affects semi-quantitative criterion for detection of ischemia in myocardial perfusion study (MPS).Material and methods: Study group consisted of 51 patients (19 females) selected retrospectively, at the age from 46 to 76 years, with neither prior history nor ECG signs of a myocardial infarction, who were referred for coronary angiography after MPS. All patients underwent a 2-day MPS using 99mTc-MIBI as a radiopharmaceutical.Myocardial slices reconstructed on Xeleris (GE) processing station were interpreted in 2 color scales: French and GEcolor, by consensus of 2 nuclear medicine experienced specialists. A semiquantitative method for evaluation of perfusion images was applied, based on segmentation of myocardium. Perfusion in each segment was scored using a five-point scale. Study interpretation (normal/abnormal perfusion) was based on summed stress scores (SSS), being equal/above or below a given threshold value. The choice of optimal SSS threshold value was based on sensitivity and specificity of the study in detection of perfusion defects resulting from critical stenoses of main coronary arteriesResults: Although mean SSS values did not differ significantly between color scales, p = 0,089 (SSS_FR = 4.7, SD= 7.6; SSS_GE 5.1, SD= 7.3), optimal threshold values were different. French scale provided high sensitivity (82%) as well as specificity (79%), but only when a low SSS threshold value of 2 was used (higher threshold values compromised study sensitivity). GEcolor provided similar indices of diagnostic efficacy (82% and 83%, resp.) with the SSS threshold value of 3.Conclusions: SSS threshold values accepted as a diagnostic criteria for detection of myocardial perfusion abnormalities should be suited separately for every color scale used for display of images. The choice of optimal value should be verified by results of coronary angiography.
P012 Comparison of CT-Based Nonuniform and Chang-Uniform Attenuation Correction Methods in Brain Perfusion SPECT K. Farid1, S. Petras2, X. Poullias1, N. Caillat Vigneron1; 1Hôtel dieu de Paris, APHP, Paris, Paris, FRANCE, 2Institut Curie, Paris, FRANCE. Introduction: Perfusion brain single photon emission computed tomography (SPECT) is used to evaluate patients with cognitive impairments presenting regional cerebral blood flow abnormalities. The brain counts distribution must be detected accurately, however physical limit such as attenuation could impair SPECT analysis and image assessment. The Chang uniform attenuation (UA) or nonuniform CTbased attenuation (NUA) correction methods have been recommended to be applied. The aim of the study was to analyse the differences between the 2 methods and to study theirs impact on visual interpretation.Patients and methods: Twelve consecutive patients (8F/4M), mean age 74±9 years presented with cognitive impairments and were included in this prospective study. After iv injection of 750 MBq of 99m-Tc-ECD, the SPECT acquisition on a Symbia T2 (Siemens) gamma-camera was performed. Images were reconstructed using the OSEM method and 2 consecutive corrections (UA and NUA) applied to generate axial slices for visual assessment. This was based on uptake visual analysis in 21 predefined cortical functional ROIs placed in the cingulate, frontal, temporal, parietal and the cerebellar regions. The image perfusion patterns, based on a 2score uptake scale (normal and reduced/pathologic) were used for interpretation. The differences between uptake scores obtained by UA and NUA methods and distribution of normal vs pathologic patterns in cortical areas were studied.Results: Normal perfusion patterns were detected in 226/252 (90%) and in 201/252 (80%) of analysed ROIs by UA and NUA methods, respectively. All patients presented with one or more abnormal brain perfusion ROI uptakes. In normal-scored ROIs, no difference between UA and NUA methods was found in the parietal, cerebellar,
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P013 3D SPECT Myocardium Volume differences at Stress/RestMatLab AlgoritmmM. A. Sotiropoulos, N. P. Lagopati, M. E. Lyra; University of Athens, Athens, GREECE. Aim: Stress/Rest SPECT imaging is one of the so-called “fist-step” non invasive cardiac stress testing procedures. It provides complementary perfusion information about the heart and it justifies the myocardial perfusion defects.Our aim is to model the heart left ventricle at stress and rest situation, using the myocardial scintigraphic data and focus on how to demonstrate differences in obtained 3D stress/rest images. We have developed and validated a novel algorithm for quantification of myocardium risk from myocardium perfusion imaging (MPI) volume data by MatLab.Method: 70 cardiac patients had completed myocardium tests by Tc-99m tetrofosmin and a GE-Starcam - 4000 SPECT gamma - camera. SPECT (Single Photon Emission Computed Tomography) slices were created and used. The myocardial perfusion was estimated by comparing those slices and the suspicion of an ischemia was indicated.3D myocardium images were reconstructed by GE Volumetrix software in the GE Xeleris processing system by FBP reconstruction method, Hanning frequency 0.8 cm-1 and a ramp filter and transferred in a Dicom format. The Dicom file, for each patient and each phase is imported to MATLAB R2010b. A series of isocontour surfaces were produced, in order to identify the appropriate threshold value, which isolates the myocardium surface from the residual area of the display. Based on the previously calculated threshold value, the myocardium volume was evaluated and be reconstructed in a 3D image. The possible difference relating to the rest and stress data of the 3D images was calculated, in voxels, using MatLab image processing analysis; the quantification and analysis of differences was followed.Results: We used the data of the 2 sets (stress-rest) of slices to calculate the myocardium Volume of Interest (VOI) at rest and at stress and measure the myocardium stress/rest volume ratio (VOI index) as an indicative diagnostic factor. The index is ranging from 1 (normal) to 2 (maximal severity). We determined also the global quantitative defect size (DF) as a fraction of the myocardial volume area in 3D images that will give confidence in cardiac perfusion efficiency recognition by SPECT. Our semi quantitative results overcome quantification difficulties as the index extracted is the ratio of similarly reconstructed volumes’ data.Conclusion: Our algorithm can be used to correctly assess myocardium risk by MPI. The 3D volume ratio, at rest and stress MPI, in relation to the myocardium defect position at stress, enables grade classification of myocardial functional state.
P014 The Impact of Reconstruction Algorithm and Variation of Projection Angles on the Image Contrast Between Vertebral Body and Intervertebral Area in Bone-SPECT Imaging K. Laatz, M. Nultsch, J. Ruf, A. Pethe, C. Loessel, G. Ulrich, H. Amthauer, O. S. Grosser; Universitätsklinikum Magdeburg A. ö. R., Magdeburg, GERMANY. Aim:Clinical imaging is characterized by an increasing demand for whole-body imaging (e.g. MRI, CT, PET). However, whole-body SPECT-imaging using conventional scanning protocols is usually limited due to the long examination time. The aim of this study is to investigate possible protocol optimizations to decrease scan time. Therefore we performed examinations of a phantom that simulated the activity pattern of the spine.Materials and Methods:A vertebral body phantom consisting of two cylinders (diameter d=34 mm, height h=50 mm) with an intervertebral distance of 15 mm was used for SPECT imaging. Both cylinders were filled with an activity concentration (AC) of 0.7 MBq/ccm Tc-99m. The intervertebral space was filled with silicone. This phantom was placed in a cylindrical phantom (d=21cm, h=19cm). This outer cylinder was filled with a reduced activity of Tc-99m to simulate the surrounding blood pool (ratio=1:8 regarding to cylinder AC). SPECT were performed with a dual-head gamma camera (e.cam 180, Siemens Medical) with a low energy high resolution (LEHR) collimator. Acquisitions were performed with 64 and 32 projections over 360° and a total acquisition time of t1=640s, t2=1280s and t3=1920s per study. Images were reconstructed with Filtered Backprojection (FBP), 2D-Ordered-Subset Expectation
Maximisation (2D-OSEM) and 3D-Ordered-Subset Expectation Maximization (3DOSEM) tacking into account the 3D-point spread function (3D-PSF) of the system. Attenuation correction was performed by Chang’s attenuation correction µ=0.14 1/cm. The contrast between vertebral body and intervertebral space (CVI) was estimated by using a CT-based ROI-template.Results:FBP provides the smallest CVI for all measurements (32 projections: CVI=1.46±0.29; 64 projections: CVI=1.70±0.10). For 2D-OSEM algorithm the reduction of the acquisition time has no impact to CVI for protocols with 64 projections (mean CVI=2.27±0.16). Meanwhile, for 32 projections the CVI for t1 (CV=1,56) and t2 (CVI=1,73) was reduced. For 32 projections and scanning time t3 an increased CVI (CVI=2.61) was observed. 3D-OSEM reconstructions provides for t2 and t3 an identical CVI for both scanning geometries (32 projections: mean CVI=3.21±0.21; 64 projections: mean CVI=3.43±0.03). By contrast acquisition time t1 results into a clearly reduced CVI (32 projections: CVI=2.33; 64 projections: CVI=1.74).Conclusions:Iterative 3Dreconstruction (3D-OSEM) provides the highest CVI and the possibility to decrease the number of projections as well as the total scanning time without decreasing the CVI. This algorithm is more robust regarding artificial reduced image information induced by the decrease of the number of projections as well as by decreased acquisition time.
P015 Impact of the new reconstruction algorithm trueX at Siemens PET/CT-scanners J. Neuwirth1, A. Stemberger2, T. Layer3, M. Blaickner3, A. Hefner1, E. Gerald1, A. Staudenherz4; 1Seibersdorf Labor GmbH, Seibersdorf, AUSTRIA, 2Hospital Rudolfstiftung, Vienna, AUSTRIA, 3AIT Austrian Institute of Technology GmbH, Vienna, AUSTRIA, 4General Hospital, Vienna, AUSTRIA. PURPOSE: The aim of this study was to compare the differences between the new reconstruction algorithm TrueX and conventional 2-dimensional (2D) and 3dimensional (3D) OSEM in a phantom study.METHODS: Measurements were carried out with a Siemens Biograph 64 TruePoint PET/CT Scanner and a self constructed phantom, which consists of eight joint cylinders (inner Phantom) with various diameters surrounded by a cylindrical outer body. The measurements were carried out with four different signal to background ratios with regard to inner and outer phantom (8:1, 6:1, 4:1 and 2:1) using F-18. For analyzing purposes a TrueX, a 2D OSEM and a 3D OSEM reconstruction algorithm with four iterations and eight subsets were used. Furthermore, each of them was reconstructed with a Gauss and an Allpass Convolution Kernel. For evaluation purposes IDL, a C++ based interpreter language for visualization and statistical evaluation, was used with a maximum line volume method.RESULTS: The results demonstrate that 2D OSEM and 3D OSEM display the true activity concentration within 10 %, whereas TrueX overestimates it up to 25 %. No significant difference could be identified between 2D and 3D OSEM.CONCLUSION: The advantage of TrueX in diagnostics can be seen for lesions of about 11 mm in diameter where 2D OSEM and 3D OSEM insufficiently display the activity concentration and consequently, the evaluated SUV. For scientific purposes 2D or 3D OSEM is the most useful reconstruction algorithms because of the minimal deviation from the real activity concentration for diameters bigger than 11 mm.
P016 Experimental evaluation of iterative reconstruction for wholebody F-18 PET in a 3- and 4-ring PET/CT system M. Ressner1, D. Gustafsson2, A. Gustafsson3, C. Jonsson4; 1Dept of Radiation Physics, University Hospital, Linköping, SWEDEN, 2Department of Medical Physics, Karolinska University Hospital, SWEDEN, 3Dept of Radiation Physics, University hospital, Linköping, SWEDEN, 4University Hospital/Karolinska institutet,, Stockholm, SWEDEN. Image quality and the diagnostic accuracy of clinical whole body PET images obtained are to a high degree dependent on the parameters in the reconstruction algorithm and the constraints imposed by the detector. The aim of this study was to evaluate the OSEM algorithm for whole body PET examinations with 18FDG in relation to detector sensitivity from model based measurements of a controlled phantom in both a 4- and 3-ring Siemens PET/CT system. Methods: The trade-off between contrast and noise was studied for an increasing number of iterations and subsets, as well as the effect of post-processing filters with varying kernel widths. Measurements were obtained with an IEC body phantom with the addition of PMMA-extensions to increase phantom dimensions to resemble different patient conditions. All measurements were performed for different activity concentration ratios, lesion sizes, bed position acquisition times and two different axial fields of view (FOV, 16.2 and 21.6 cm). Results: The results show that, an increased number of equivalent iterations followed by additional post-filtering improve the trade-off between contrast and noise compared to standard clinical settings currently used. Under less optimal conditions i.e. low contrast ratios, small lesion size, increased scatter and attenuation, or reduced bed position acquisition time, the improved sensitivity from the extended axial field of view of the 4-ring system resulted in a noticeable better contrast-to-noise relation and a difference in visual image quality
Poster Presentations
occipital regions bilaterally, and in the right temporal region. The uptake score differences between UA and NAU methods were recorded in 51/252 (20%) of ROIs and in 49% of them (25/51) perfusion evaluation changed from normal to pathologic patterns using the CT-based method. The score differences were found in bilateral frontal, hippocampus and left temporal cortex areas.Conclusion: Attenuation correction should be used systematically in all brain SPECT studies applying the Chang uniform or CT-based nonuniform methods. Visual assessment of normally perfused areas is identical for both methods in cerebellum and posterior regions. However, normal patterns are detected more frequently using the Chang method in bilateral frontal and hippocampus areas using the same visual criteria. These findings need to be considered when CT-based correction will be applied in further studies with clinical correlations.
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S264 was observed. Conclusions: Increasing the number of MLEM equivalent iterations, in clinical whole body FDG-PET with OSEM will improve the trade-off between contrast and noise, for both the 3- and 4-ring Siemens PET scanner. The benefit from post filtering is most prominent in situations with low count density images. Further, our preliminary results of the comparison between the 4- and 3-ring systems indicate that the increased sensitivity of the extended FOV could be used to reduce acquisition time while the sustained contrast level is preserved.
P017 Dual isotope cardiac imaging using Tl-Tc cross-contamination correction by subtraction method M. Kohanpour1, H. Rajabi2, M. Beheshti3, F. Kalantari2, M. Pouladian1; 1 Islamic Azad University, Science and Research Branch, tehran, IRAN, ISLAMIC REPUBLIC OF, 2Dept. of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, tehran, IRAN, ISLAMIC REPUBLIC OF, 3Paracelsus Medical University, salzburg, AUSTRIA. Introduction:Separate dual isotope, rest 201Tl-stress 99mTc, is a common protocol for heart imaging. Theoretically, this imaging protocol can perform simultaneously by defining different energy windows for each radionuclide. However, a potential limitation of simultaneous dual isotope SPECT imaging is contribution of scattered photons from technetium-99m and lead X-rays produced in the collimator into the thallium-201 energy window, referred to here as cross-contamination. The aim of this study is introducing a modified middle energy window method to compensate for this cross-contamination.Material and Methods:This investigation was performed in clinical study, that 30 men is gone for cardiac study. In simulation step, the most suitable functions by their ability to modeling cross-contamination were determined. To achieve this goal, Root Mean Square errors between our estimated and real cross-contamination for each view were used. SPECT images of patients who had angiographic data were acquired in different energy windows. In each step of this study, in addition to 201Tl and 99mTc windows centered at 77 keV and 140 keV respectively; a third window centered at 100 keV is established. at each projection angle, the contaminant image to be subtracted from the image in the 201Tl window was estimated as a linear combination of a scatter-window (90110 keV) image, convolved by a 2D modified exponential function, and the 99mTc photopeak image, convolved by a different Gaussian function.All of these images were compared by determining defect or left ventricle cavity to myocardium contrast.Results:Significant improvements in contrasts of simultaneous dual 201Tl images were found in each step . Better results in comparison with other similar methods also were acquired by our suggested functions.Discussion and Conclusion:Our results showed contrast improvement, however many other parameters should be evaluated for clinical approaches. Simultaneous dualisotope201Tl/99mTc myocardial imaging is seems feasible with 99mTc crosscontamination correction specific. There are many advantages by simultaneous dual isotope imaging. It halves imaging time and doubles patient throughput, improves scheduling flexibility, and reduces patient waiting time and discomfort. Identical rest/stress registration of images also makes motion or attenuation correction easy by physicist and image interpretation by physicians.Keywords: dualisotope, cardiac SPECT, cross-contamination, Thallium, Technetium
P018 Applying interpolated projections in cardiac SPECT and its effect on lesion detectability using Hotelling Trace M. A. Askari1, H. Rajabi1, A. Fard Esfahani2; 1Dept. of Medical Physics, Faculty of Medical Sciences, TarbiatModares University, tehran, IRAN, ISLAMIC REPUBLIC OF, 2Research Institute for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, tehran, IRAN, ISLAMIC REPUBLIC OF. Introduction:Myocardial SPECT imaging is usually performed acquiring 32 views in 180 degree with equal steps of 5.625 degrees. Mathematically, increasing the number of projections can increase the image quality and decrease reconstruction artifacts. But acquiring more projections requires spending more time or injection of more activity to the patients. An idea to improve the quality of the reconstructed images without acquiring extra projections is applying interpolated data between adjacent projections. The aim of present study was using Hotelling Trace method to investigate the lesion detectability in reconstructed images with interpolated projections.Methods:Such investigation cannot be performed on real patient's data. Therefore, data were simulated using NCAT digital phantom and SimSET Monte Carlo code. The imaging was performed as usual, acquiring 32 views from right anterior oblique to left posterior oblique. The data were interpolated to construct 5 images between adjacent projections convert it into 187 projections. The simulation was performed again acquiring 187 images as the reference. The conventional, interpolated and reference data set were reconstructed and compared for improvement and degradation in quality of final images. Four methods of interpolation used, linear, cosine, cubic and hermit. The above procedure was repeated for phantoms representing different types of heart disease, different cardiac size and different count densities. Then short-axis cuts were used for Hotelling Trace analysis. Comparing Hotelling J-number, would show
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 the best method for interpolation.Results:The results showed that linear interpolation technique produces better lesion detectability comparing to other interpolation methods tested. Results also confirmed that streak artifacts decreases, signal to noise ratio and contrast increased due to increasing the number of samples.Conclusion:These results indicate that lesion detectability and the physical properties of reconstructed images improve significantly using interpolation.Keywords:Myocardial SPECT, Projection data, Interpolation, Image quality, Hotelling trace
P019 Reducing Scan Time during Bone SPECT Imaging using Philips Astonish Resolution Recovery Software R. Cain, P. Turner; New Cross Hospital, Wolverhampton, UNITED KINGDOM. Aim: To compare the current Ordered Subset Expectation Maximisation (OSEM) reconstruction software to the Astonish resolution recovery software incorporated into the Philips product AutoSPECT 3.0 for JETStream Workspace for various times per frame for bone SPECT imaging. Reducing the scan time will be investigated, using the Astonish reconstruction algorithm, compared to the current 25 seconds per frame used for OSEM reconstruction.Methods:A patient bone SPECT protocol was carried out on a Jaszczak phantom filled with 99mTc with an activity of approximately 800MBq for 25 seconds per frame. This produced full time images, which can be separated into 10, 15, 20 and 25 seconds per frame for reconstruction. The images were then reconstructed using the OSEM and the Astonish processing software. Using the region of interest tools in ImageJ it was possible to compare the contrast for each lesion in the phantom and compare the uniformity of each reconstruction for each time per frame. A champagne glass phantom developed in the department to represent a bone was imaged to determine the diameter at which the Astonish software over compensates for the resolution recovery.Results and Conclusion:The relationship between contrast and lesion diameter showed a reduction in contrast as the diameter increased. A comparison of the full time OSEM reconstructions and the 10 seconds per frame Astonish reconstructions, showed the contrast for all Astonish images to be higher than the full time OSEM images. This suggests that a reduced scan time would be possible when using this software, reducing patient movement artefacts and increasing work flow. It was determined that imaging with 10 seconds per frame gave errors, making the optimum time per frame 15 seconds for more accurate for patient imaging. The uniformity was also improved using the Astonish software, with all the times per frame being an improvement on the full time OSEM reconstruction images.The investigation into the over compensation of resolution recovery showed that an artefact is present for larger diameter lesions of approximately 50mm, however this could be more extensively investigated. This investigation could be extended by applying the same principle to cardiac imaging within the department and also to using full time imaging with Astonish, but with a decreased patient dose.
P020 Effect of Resolution Recovery on Quantification and Clinical 123 Reporting of I FP-CIT Brain SPECT Images R. C. Fernandez, C. Sibley-Allen, L. Livieratos, G. Gnanasegaran, M. O'Doherty; Guy's & St Thomas' NHS Foundation Trust, London, UNITED KINGDOM. IntroductionApplications using iterative reconstruction together with distance dependant resolution modelling (DRM) have increasingly been explored in the literature. 123I FP-CIT brain SPECT imaging, with its relatively low count density, is a seemingly ideal application for DRM. However it is important that the various reconstruction parameters are optimised for the particular clinical application. This study demonstrates, using readily available phantoms and software, the effect of varying reconstruction parameters on both quantitative results as well as the clinical reporting of 123I FP-CIT images.MethodsA simple striatal phantom filled with clinically relevant striatal/background concentrations of 123I was imaged using a clinical acquisition protocol on a dual-headed gamma camera. OS-EM iterative reconstruction with DRM was performed using a Hermes (Nuclear Diagnostics) workstation. The effect of varying reconstruction parameters, such as number of iterations/subsets and post-reconstruction filter, on noise and recovered image contrast was investigated. Attenuation/scatter correction were not employed.An unselected, randomised cohort of clinical 123I FP-CIT studies (n=49) were retrospectively reconstructed using optimised DRM parameters as well using the standard reconstruction method of filtered back-projection with Butterworth prefiltering (FBP). Volume-of-interest analysis was used to calculate striatal uptake ratios (SUR) to assess the effect of reconstruction method on quantification for both normal/Parkinson groups (21/49 studies reported as normal in original clinical reporting).Using the same clinical data set, two experienced observers, blinded to both patient clinical details and reconstruction strategy (FBP/DRM), independently scored striatal uptake using a 5-point scale.ResultsPhantom data showed that 150 EM iterations (5 iterations/30 subsets) with Gaussian post-reconstruction filter
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P021 The robustness of TOF (PET) versus non-TOF (PET) in the presence of inconsistent attenuation correction data in patients with large body mass index S. T. Mahmood1, H. Megadmi1, A. Haroon2, V. Prakash3, M. Masoomi1; 1 Portsmouth Hospitals NHS Trust, Portsmouth, UNITED KINGDOM, 2 University College London Hospitals NHS Trust, London, UNITED KINGDOM, 3Kingston Hospital NHS trust, London, UNITED KINGDOM. Aim: To objectively evaluate the robustness of TOF reconstruction in the presence of inconsistent attenuation correction data as a result of truncated transmission data. Method: PET data is corrected for normalizations, coincidence due to scatter, random coincidence and attenuation correction. Amongst these corrections, the attenuation correction has the greatest impact on the PET image quality and quantification. The attenuation correction of PET data is performed using a CT attenuation map. The CT FOV of the PET/CT scanner is usually smaller than the PET FOV, for example 500 and 700mm, respectively for the Siemens mCT-Biograph. Truncation of the CT transmission data occurs when the patient’s body extends beyond the conventional CT FOV. This can happen for example when scanning obese patients with the arms down. This results in inconsistency between the transmission and the emission data. The use of a truncated CT attenuation map for attenuation correction of the PET data results in significant image loss of resolution and increased noise due to the inherent inconsistencies. TOF (PET) is said to be more robust to these inconsistency due to the improved localisation of an event along coincidence lines-of-response (LOR). In this work, the effect of inconsistencies between the attenuation map and the PET data is studied using clinical patient images as well as phantom experiments. A comparison of these images is made between the TOF and non-TOF reconstructions. Results: Qualitative and quantitative analysis of the resulting images proves that the TOF (PET) is more robust than non-TOF (PET) in the presence of attenuation correction inconsistencies between the emission and transmission data. The improvements were quantified as increased signal to noise ratio. This improves "subtle but significant" findings in obese patients, has implications in patient management and helps to better define the extent of disease which may be otherwise missed.
P03 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhitibion Hall
Physics & Instrumentation & Data Analysis: Data Analysis & Management
P022 A new method to accurately contour biological target volume (BTV) with FDG PET/CT for radiotherapy treatment planning E. Bellan1, C. Capirci2, G. Grassetto3, M. Gava1, G. Virdis2, M. C. Marzola3, S. Chondrogiannis3, A. Massaro3, O. Nibale1, D. Rubello3; 1Medical Physics; Santa Maria della Misericordia Hospital of Rovigo, Rovigo, ITALY, 2 Radiotherapy; Santa Maria della Misericordia Hospital of Rovigo, Rovigo, ITALY, 3Nuclear Medicine - PET/CT Centre; Santa Maria della Misericordia Hospital of Rovigo, Rovigo, ITALY. Aim:To describe a new method for an accurate contouring of PTV (planning target volume) for radiotherapy treatment planning (RTP), starting from biological target volume (BTV) obtained by FDG PET/CT.Materials and Methods:Although CT is the primary imaging modality for 3D planning in radiotherapy (RT), it may present some limitations for staging lesions which are better visualized by PET metabolic imaging.In a complete RT imaging system, the PET imaging series are imported from PET workstation and registered with a large-bore CT dedicated to RT treatment for associating functional & anatomical information. However, the result of imaging registration is often affected by saturation in the window/level visualization and the operator manipulates the pixel level of the PET images, providing metabolic volumes that therefore are not correlated to the level of
standardized uptake value (SUV). To overcome this problem, in our centre a new method was developed summarized in the following steps:1) The preliminary isocenter of anatomical area(s) to irradiate is individuated by temporary lead markers positioned on the patient;2) The patient is scanned both with FDG PET/CT and large-bore CT, by using a flat table, with the same anatomical orientation and immobilization devices used during the treatment;3) The PET/CT series are displayed on a dedicated workstation and a BTV is contoured by setting a 40% threshold for SUV;4) The BTV is exported as a DICOM RT structure to a dedicated RT workstation;5) An imaging registration is implemented between the large-bore CT (primary study) and the CT associated to the PET/CT (secondary study);6) The BTV is copied from the secondary CT study into the primary CT one;7) A virtual simulation is implemented on the primary CT study and definitive markers on the patient are signed.Results:The described method has been validated in 10 patients with a good relationship between SUV information and PTV contouring.Conclusion:The preliminary data of our study demonstrate the possibility of contouring a BTV on a dedicated PET/CT workstation and to perform the image registration between two series of the same imaging modality (i.e. primary and secondary CT), thus providing accurate results and avoiding the window/level limitations of RT dedicated systems. In this way, the delineated BTV directly corresponds to a particular level of SUV and, moreover, it represents the starting point to program a personalized dose distribution in the radiation treatment plan.
P023 Fuzzy-clustering segmentation in oncological SPECT/CT D. O. Hall1, T. Lambrou2, B. F. Hutton2; 1University Hospitals Bristol NHS FT, Bristol, UNITED KINGDOM, 2Institute of Nuclear Medicine, University College London, London, UNITED KINGDOM. AimTo develop and validate a method for image segmentation in oncology SPECT/CT, taking account of information from both SPECT and CT.Materials and MethodsSoftware was developed in IDL (www.ittvis.com) to segment SPECT/CT oncology studies using a semi-automatic unsupervised classification process [1], Fuzzy Maximum Likelihood Estimation [2]. A fuzzy clustering process is carried out, taking account of information from co-acquired SPECT and CT data, with a number of classes which can be chosen to correspond to the complexity of the clinical data. The operator defines a bounding region around the target lesion, and selects one or more classes. Grey-scale erosion and dilation operators are applied [3], and voxels above a minimum level of class membership within the bounding region are selected for the segmentation.Validation of the segmentation was carried out using 4 separate lesions from an In-111 Octreoscan SPECT/CT study. The axial slices were classified with 10 classes using the method described above. One to three classes were chosen by the operator; these were acted upon by an erosion operator once and by a dilation operator twice, and segmented at a class membership of 90%. The results were compared with manual segmentation. The Dice coefficient and Jaccard index [4] were calculated, and compared with those from grey-scale thresholding at 40-60% of maximum. Classification was repeated, and different bounding regions were chosen.Results The Dice coefficient was 83-87% for the fuzzy clustering method, compared with 51-96%, 60-90%, and 46-88% for 40%, 50% and 60% thresholds.The Jaccard index was 71-77% for the fuzzy clustering method, compared with 34-93%, 43-81%, and 30-80% for 40%, 50% and 60% thresholds.The results were identical for repeated clustering or for different bounding boxes.ConclusionA segmentation method for SPECT/CT using a fuzzy clustering method has been developed, and compared with thresholding. Segmentation from fuzzy clustering was repeatable, and produced reasonable segmentation in all cases. In contrast, the results for any particular threshold were sometimes good, but often unacceptable.References1.Canty MJ. Image analysis, classification, and change detection in remote sensing. 2nd edition. CRC Press 2010.2.Gath I and Geva AB. Unsupervised optimal fuzzy clustering. IEEE Trans Pattern Analysis and Machine Intelligence. 1989; ii(7): 773-781.3.Sonka M, et al. Image processing, analysis, and machine vision. 2nd edition. PWS Publishing 1999.4.Crum WR, et al. IEEE Trans Medical Imaging, 2006; 25:1451-1461.
P024 The Impact of Small Dental Implants on the PET/CT Derived SUVs of Localised Lesions K. J. Saint, O. Adesanya, N. R. Williams; University Hospitals Coventry and Warwickshire, Coventry, UNITED KINGDOM. Positron emission tomography (PET) with computed tomography (CT) has in recent years become the technique of choice for evaluating malignancy, including lesions in the head and neck region. The purpose of the structural CT images being two fold, to act as an attenuation correction map for the functional PET images and to assist with the localisation and interpretation of functionally abnormal regions.A difficulty that can arise with PET/CT imaging of the head and neck is associated with non removable dental implants and the artefacts they produce on the CT images. Such artefacts have the potential to influence the evaluation of attenuation corrected radiopharmaceutical uptake and diminish the localisation capability.The
Poster Presentations
(FWHM 1.0cm) gave optimal contrast/noise characteristics. Importantly, these parameters when applied to patient data also gave clinically acceptable image quality.Two-way ANOVA showed that mean SURs (for both caudate and putamen) differed significantly between reconstruction method (putamen: FBP/DRM: F[1,96]=223.03, p<0.0005, ηP2=0.70) and patient group (putamen: normal/Parkinson: F[1,96]=60.50 p<0.0005, ηP2=0.39). For the putamen, both mean and standard deviation of SURs were lower for DRM compared with FBP (mean[SD] DRM=1.67[0.41] c.f. FBP=2.08[0.52] for normal patients; DRM=0.69[0.37] c.f. FBP=0.82[0.42] for Parkinson patients).A Wilcoxon signed-rank test showed a statistically significant difference in overall clinician scores (p=0.02) depending on reconstruction method (DRM
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S266 aim of this project was to investigate the effect metallic dental implants have on standardised uptake values (SUVs) of lesions in the head and neck region. A phantom was constructed to simulate a jaw bone, teeth, dental fillings and surrounding soft tissue. Bone equivalent epoxy resin was used to produce a model of a jaw and repositionable teeth, each of 1cm3 volume. Silver cylinders of length and diameter 0.5cm were used to represent dental fillings and, in combination, bridgework. A 0.2ml cylindrical volume of F18-fluorodeoxyglucose represented a lesion and was positioned at various locations around the jaw phantom. The SUV of the lesion was calculated at each of these positions, with and without the dental implants in place.With a single dental implant in place and the tumour in various positions within the plane of the jaw, the average percentage difference in the SUV, compared to that with no implant present, was 10.3% (± 20.2 SD), varying from -29.4% to 63.4%. No correlation was found between implant position and lesion location (r=0.58).When the lesion was located out of the jaw plane, up to a distance of 2.5cm, with the equivalent of a dental bridge in place, the overall impact was to overestimate the SUV by an average of 6.9% (± 2.4 SD).A lesion lying in the same plane of the mouth as a single dental implant results in a SUV that cannot reliably be assessed. The influence of dental implants on lesions located less than 2.5cm from their transaxial plane is minimal. It is important that Radiologists reporting PET/CT images consider the effect of dental implants on the attenuation correction of the images, reviewing any CT artefacts to assess the potential impact on SUV calculations.
P025 Real Time Muga Acquistition for Patients with Complex Cardiac Rhythm V. Fidler1, S. Skalič2, K. Skalič2, M. Vuk3, U. Platiše4, E. Kolar2, M. Medved1, S. Fidler5, B. Vidergar-Kralj2; 1Xlab Medical Imaging Dept, University Technology Park, Ljubljana, SLOVENIA, 2Institute of Oncology, Dept of Nuclear Medicine, Ljubljana, SLOVENIA, 3Xlab Research, University Technology Park, Ljubljana, SLOVENIA, 4Institute of Jozef Stefan, University of Ljubljana, Ljubljana, SLOVENIA, 5Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, SLOVENIA. IntroductionMUGA studies for follow-up of cardiac left ventricle ejection fraction provide high quality diagnostic value for oncology patients. Extension of real time method from normal regular (standard MUGA) to complex irregular rhythm is highly desirable.AimDevelopment of reliable real time acquisition and processing method for patients with irregular cardiac rhythm.MethodsReal time complex MUGA demands the digitized ECG amplitude values synchronized with the sequence of gamma camera positional and time mark signals, ECG pattern analysis and sorting of positional data in the corresponding functional image sequences. We have built multi parametric selection tools for differentiating the normal and extrasystolic cycles in ECG signal: derivative diagram and histogram of cycle time durations in initial pre-recording phase. Applying these discriminating values for normal and extrasystolic R waves to current ECG the normal, extrasystolic and normal post-extrasystolic image sequences can be formed. In the recording phase the discriminating values can be currently adjusted according to the variations of patient cardiac rhythm. Final selection of image sequences is made on the basis of their frequencies: if the number of extrasystolic beats is less than 5% of all cycles, only normal sequence is considered for the final processing. When extrasystolic beats are more frequent, the effective ejection fraction is computed from the geometrical average of separate Efs and their frequencies.Results The presented real time acquisition, ECG pattern analysis and sorting the image data into different functional image sequences is applicable to wide range of different cardiac rhythm. All necessary acquisition functions and ECG pattern recognition diagrams, parameters and different functional image sequences are currently displayed and manually controlled. Acquisition and processing time per study is much shorter comparing to the separate sequential procedure and provides solution in many cases, where the standard MUGA fails.ConclusionsThe developed MUGA method provides several advanced features and data in the estimation of cardiac function in patients with variable and complex rhythm, and speeds up the study.
P026 Skin Labelling in Sentinel Node Imaging Using Simultaneous Multi-Window Energy Acquisition V. Fidler1, S. Skalič2, K. Skalič2, S. Fidler3, M. Medved1, B. Vidergar-Kralj4; 1 Xlab Medical Imaging Dept, University Technology Park, Ljubljana, SLOVENIA, 2Institute of Oncology, Dept for Nuclear Medicine, Ljubljana, SLOVENIA, 3Faculty of Computer and Information Science, University of Ljubljana, Slovenia, Ljubljana, SLOVENIA, 4Oncology Institute, Dept of Nuclear Medicine, Ljubljana, SLOVENIA. IntroductionMulti energy window acquisition can be used for exact differentiating the SLNs (Tc-99m) and the point source (Co-57) images in the fused mode.AimDevelopment of reliable acquisition and computing method using different radioisotopes for labelling the SLNs in daily nuclear medicine routine work.MethodsIn principle the proper gamma camera energy resolving power in the scanning of SLN and labelling point source should be enough to clearly distinguish
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 between the patient SLNs and the point source even in the region of overlapping the high injected activity in the tumour (cca 1-2 mCi of Tc-99m colloid) and the low activity of point source (up to 250 microCi of Co-57). Our method consists from: a) simultaneous acquisition of Tc-99m coloid body distribution in Tc-99m (image W1) and in Co-57 energy window (image W2) up to 5 minutes; b) after finishing these 2 images the image W1 is transformed in algorithmic density image, SLNs are visually determined and labelled by cross signs; c) image W2 is smoothed and normalized to 1 second interval (image W2N); d) Co-57 point source is manually moved to each of the cross signs in the magnified W1 image after subtracting the image W2N from the current one second point source image and after computing the position of regional maximum activity (corresponds to the position of Co point source) in the subtracted image. The current position of the point source in W1 image is presented only by one of the predefined selected signs (tiny ring, arrow, star). All labelled SLNs are stored and for the report added to the patient scan.Results The described method provides a general labelling technique for all kind of oncology (SLN, ROLL, melanomas, etc) and some functional nuclear medicine studies (thyroid scanning). Takes up to 7 minutes per projection and the positional error of labels was estimated to 2 mm. All acquisition steps and computing phases are presented on the computer display throughout the study.ConclusionsThe developed exact labelling technique is a unique one and presents a considerable improvement for the daily routine work in oncology nuclear medicine.
P027 Extraction of input function from H215O PET imaging of rat heart N. Kudomi1, H. Sipilä2, A. Autio2, V. Oikonen2, H. Liljenbäck2, M. Tarkia2, J. Laivola2, J. Johansson2, M. Teräs2, A. Roivainen2; 1Kagawa University, Kagawa, JAPAN, 2Turku PET Centre, Turku, FINLAND. Purpose:PET with H215O facilitates the visualization and quantification of blood flow also in small animals. The quantification of blood flow requires an input function, which is generally obtained by measuring radioactivity in arterial blood withdrawn during PET scanning. However, this approach is not always feasible, because abundant blood sampling may affect the physiological process being measured. The purpose of the present study was to develop and test the feasibility of an image-based method for obtaining the input function for rat H215O PET. Methods:The study material consisted of two separate groups of rats. Group 1 rats were imaged twice by an HRRT PET camera at resting condition for a test-retest study (n=4), and Group 2 rats were imaged with and without adenosine infusion for a rest-stress study (n=4). In Group 1, radioactivity concentration in arterial blood was measured with a new flow-through detector during imaging, and a bloodbased input function was obtained. The image-based input function was estimated using time-activity curves from the left ventricle and myocardial regions. To validate the image-based method, myocardial blood flow (MBF) and cerebral blood flow (CBF) were computed, and the methods were tested for reproducibility (testretest study) and changes (rest-stress study). Results:The blood-based and imagebased input functions were similar and the corresponding CBF values differed only by -6.9 ± 8.1%. In the test-retest study, both MBF and CBF showed good reproducibility, and in the rest-stress study, adenosine significantly increased both MBF (P = 0.035) and CBF (P = 0.029), compared with the resting condition. Conclusion:It is possible to estimate the input function from rat H215O PET images, thereby facilitating the assessment of blood flow in organs visible in PET images.
P028 Simultaneous estimation of blood flow and oxygen consumption in human myocardium by 1-tissue compartment model for [11-C]Acetate study C. Han, S. Nesterov, H. Tuunanen, J. C. Hannukainen, J. Knuuti; The Turku PET Centre, Turku, FINLAND. Purpose: [11-C] labeled acetate is an established tracer for the noninvasive evaluation of myocardial oxygen consumption in PET, additionally, this tracer has been shown to measure the myocardial blood flow(MBF). In this study, we implemented 1-tissue compartment model into Carimas 2 heart plugin software (http://www.turkupetcentre.fi/carimas) to investigate the simultaneous measurement of myocardial blood flow and oxygen consumption using one single tracer of acetate.Methods: 1-tissue compartment model is set up for describing the acetate kinetic process in blood and myocardium. This model is expressed mathematically: Ca<-(k1)(k2)->C1, where Ca is arterial acetate concentration (taken from left ventricular cavity and corrected by metabolism). C1 represents the tracer concentration in myocardium, k1 and k2 are rate constants. The correction of spill over and partial volume effect is considered as Cpet=(1-VlvVrv)*C1+Vlv*Ca_lv+Vrv*Ca_rv, where Cpet is the measured activity in myodial ROI, Ca_lv and Ca_rv are activity in left and right ventricular cavities correspondingly. MBF is calculated from extraction function of k1=1-0.64*exp(-1.2/MBF). The k2 is used directly as oxygen consumption index. The MBF from acetate were compared against water data. The results of k2 were compared against the standard kmono(monoexponental fitting) method from acetate.Results: We analyzed
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P029 Reporting PET Treatment Responses as Ratios or Differences - Robustness Against Confounding Factors F. O. Kaster, T. Kadir; Mirada Medical Ltd., Oxford, UNITED KINGDOM. AimsSemi-quantitative PET measures such as Standardized Uptake Values (SUVs) are widely reported for oncologic treatment response assessment in clinical studies. Experimental measures of the SUV depend on the true tumour uptake as well as confounding factors such as tumour size and PET reconstruction parameters. Both SUV difference and relative change are routinely used for pre/post-treatment comparison although there is no consensus as to which is more appropriate. From a statistical viewpoint, a good measure should depend mostly on the true response and be robust against noise and confounding factors. We performed a simulation study to examine the effect sizes of the different influence factors on both SUV differences and ratios.Materials & MethodsUsing the STIR library, we simulated PET image acquisition on a Philips Allegro scanner and both FBP and OSEM reconstruction with different reconstruction parameters for NEMAlike phantoms containing spherical tumours. We varied tumour-to-background ratio (TBR; 2, 3, ..., 9), tumour size (1.0 cm, 1.3 cm, 1.7 cm, 2.2 cm, 2.8 cm, 3.7 cm), FBP ramp filter α (0.3, 0.6, 0.9) and cut-off (0.3 cycles, 0.4 cycles, 0.5 cycles), number of OSEM iterations (2, 4, ..., 12) and post-reconstruction Gaussian filter width (2 mm, 4 mm, ..., 12 mm). 15 noise realisations were created for each combination. The maximum value inside a predefined region of interest was used to measure the uptake value. TBRs of 3, ..., 9 were interpreted as pre-treatment conditions, and both ratios and differences were formed between the values extracted for these TBRs and the post-treatment TBR of 2. The effect sizes of pretreatment TBR, tumour size, reconstruction parameters (ramp filter α and cut-off, number of OSEM iterations) and post-filter width on these experimental ratios and differences were estimated by multi-factor ANOVA.ResultsSUV ratios are almost twice as dependent on pre-treatment TBR (partial eta²=0.192 [FBP]/0.198 [OSEM]) compared to SUV differences (0.0980 [FBP]/0.103 [OSEM]). Taking ratios also increased the effect size of tumour size (0.163 [FBP]/0.148 [OSEM] versus 0.136 [FBP]/0.123 [OSEM]), while decreasing the influence of post-filter scanner width (0.198 [FBP]/0.187 [OSEM] versus 0.249 [FBP] / 0.240 [OSEM]). The effects of the other reconstruction parameters were negligible.ConclusionsSUV ratios are more sensitive to TBR and hence PET response, yet more robust against noise and reconstruction parameters than differences, though differences should still be reported for completeness. Tumour size must still be accounted for.
P030
differences between the aligned stress and rest patient heart images. The regions of abnormal perfusion identified by the nuclear medicine expert are in most cases correctly identified by the developed tool. In many cases the tool identifies additional differences, which are not of diagnostic interest, but are present between the images. The tool has a potential for quantification of stress induced abnormalities in SPECT heart studies. Examples of the application of the developed tool to patient scans will be presented and discussed.CONCLUSIONS: A new tool for computer-aided diagnosis in myocardial perfusion SPECT imaging is developed and presented. The tool is intended to assist the diagnostic process by highlighting the regions of statistically significant differences to the physicians.
P031 Solid Radioactive Waste Management: Bar-coding Saves Time and Money R. Penny, J. Cullis, N. R. Williams; University Hospitals Coventry & Warwickshire, Coventry, UNITED KINGDOM. Accurate records of solid radioactive waste accumulation and disposal are a requirement of all EU countries’ legislation. Data relating to the quantity, type and location of an organisation’s radioactive waste needs to be accurate and immediately available. The recording of solid radioactive waste at UHCW involved paper records being subsequently entered onto a computer database. The time taken to enter the data, transcription errors and the occasional incomplete record reduced the effectiveness of the system and led to an inefficient use of resources. To overcome this problem a bar coding system utilizing hand held data logging devices has been developed.The system involves assigning a unique bar code label to individual items containing radioactive waste. Storage and disposal areas consist of shielded cupboards, large volume hoppers in the main waste store and disposal skips for non active or active waste; each of which are assigned a location barcode. The data loggers have been programmed to read the item and its location barcodes and, using in most cases drop down menus, records the operator, radionuclides and activities. Placing the logger in a docking stations connected to a PC allows the data to be automatically transferred to a database. An immediate record of the quantity, type and location of waste is therefore continually available.Short lived waste items (T½ ≤ 6 hours) are stored until activities are below statutory limits and are then disposed of via the hospital clinical waste system. All long lived waste items (T½ > 6 hours) are removed from the hospital in skips provided by a specialist company. Information concerning the appropriate disposal time for short and long lived radioactive waste is available. Information relating to the quantity and type of long lived radionuclides within the waste store and disposal skips ensures maximum decay time within our licensing requirements; thus minimising disposal cost. Implementation of this system has reduced the time needed to deal with solid radioactive waste and improved the accuracy of the records. It was estimated that approximately 10 working hours per month were given up to inputting data and investigating errors associated with these waste records, this has currently reduced to less than 4 hours.The presentation will demonstrate the practical application of the radioactive waste system. Examples of data entry and database records and reports will be shown.
P032
A New Tool for Computer-aided Diagnosis in Myocardial Perfusion SPECT Imaging
Tissue equivalent heart defects for quantification of perfusion in nuclear cardiology
K. K. Mitev1, G. V. Gerganov1, I. S. Dimitrova1, I. Kawrakow2, E. N. Piperkova3; 1Sofia University, Sofia, BULGARIA, 2Siemens AG, Heidelberg, GERMANY, 3National Oncology Center - SHATO, Sofia, BULGARIA.
I. Chrysanthou-Baustert1, Y. Parpottas2, O. Demetriadou3, S. Christofides4, D. Kaolis4, A. Lontos2, C. Yiannakkaras5, M. Wasilewska-Radwanska6; 1 Frederick Research Centre, Nicosia, CYPRUS, 2Frederick University, Nicosia, CYPRUS, 3Limassol General Hospital, Limassol, CYPRUS, 4 Biomedical Research Foundation, Nicosia, CYPRUS, 5Nicosia General Hospital, Nicosia, CYPRUS, 6AGH University of Science and Technology, Krakow, POLAND.
AIM: The comparison between stress and rest SPECT heart images is widely used by physicians to detect abnormalities in myocardial perfusion. These comparisons play a key role in the diagnostic process and are typically performed by experienced physicians. The objective of this work is to present a new numerical tool intended to aid the diagnostic process by automatic detection of regions of statistically significant differences between stress and rest SPECT heart images.METHODS AND MATERIALS: The rest heart image is first registered (aligned) to the stress heart image using a dedicated non-rigid image registration algorithm. The algorithm iteratively applies Miobius transformations and a non-linear optimization technique (simulated annealing). The goal of the optimization technique is to minimize the sum of squared differences between the pixel intensities in the two images. The registered (aligned) stress and rest images are then compared by means of a dedicated algorithm for automatic detection of statistically significant differences between the images. The algorithm employs statistical test for outliers (Grubbs’ test) to identify the statistically significant differences. The identified differences are shown in a separate image. According to the nature of the stress/rest study this image is supposed to carry essential diagnostic information.RESULTS: The developed tool is applied to patient SPECT stress/rest scans and its performance is evaluated by a clinical nuclear medicine expert. The experience with patient data demonstrates that iterative Miobius transforms are adequate for non-rigid image registration of stress/rest heart images. The statistical test for outliers manages to identify the regions of statistically significant
AimCardiac phantoms are designed to assess image processing. The only way to produce areas of abnormal perfusion, i.e. heart defects, is to use small containers of diverse sizes filled with various tracer concentrations. These are than inserted into a larger hotter phantom. The aim of this work is to test a novel design of heart defects which can be easily and reproducibly utilized for the assessment of image processing. The new design is verified by Monte Carlo simulations and phantom measurements. Further, the resolution in perfusion of various image processing techniques has been compared with this novel phantom.Materials and MethodsThe new defect is a tissue equivalent (solid water) cube from which a certain volume has been removed in an isotropically way, by drilling small cylindrical holes through the cube. The cubes are placed in a larger hotter phantom. The tracer can penetrate the perforated structure and the finite structure of the cube cannot be resolved by the gamma-camera. The water equivalence of the cubes ensures hom*ogeneous scatter and absorption throughout the phantom.First, Monte Carlo Simulations with the code SIMIND were performed. Simulations of the new defect were compared to simulations with plain containers of equivalent tracer concentrations.Second, 3 different cubes (0%, 34% and 50% of material removed) were produced and mounted into a Perspex
Poster Presentations
myocardial PET studies in healthy and heart failure subjects (n=30). Each subject underwent PET scanning with [O-15] water and [C-11] acetate at rest status.The linear regression (water - x; acetate - y) for global MBF was y=1.0599x+0.0176 with R2 = 0.9483. The linear regression (kmono - x; k2 - y) for global oxygen consumption was y=1.3404x+0.003 with R2 = 0.7572.Conclusions: The results of this study suggest that a single-tissue compartment model can yield myocardial blood flow and oxygen consumption simultaneously for [11-C] acetate PET study for both healthy subjects and heart failure patients. Further studies are needed to compare the results during stress conditions.
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phantom. This new phantom (Aphrodite Petite) was filled with water and 99mTc and was imaged on a GE and a Philips gamma-camera.ResultsThe results of the Monte Carlo simulations showed good agreement (within 3%) between the new defect design and the reference. The phantom experiments showed a visible reduction in counts at the location of the three cubes. The internal structure of the cubes could not be resolved by the gamma-camera and the cubes were not seen on attenuation maps. The percent reduction in counts imaged on 0° projections were similar (within 5%) to the percent reduction simulated with SIMIND. On the reconstructed SPECT images differences in reconstruction algorithms (FBP, MLEM and OSEM) were apparent. OSEM gave best perfusion discrimination between the cubes for high count rates.ConclusionsThe results show that different tracer concentrations can be produced in one single container in an easy and reproducible manner. Such phantoms with defects of various sizes, concentrations and thicknesses represent a helpful tool for the assessment of imaging and reconstructions techniques in quantitative molecular imaging.
P033 The role of attenuation correction in the quantitative evaluation of dopamine transporter SEPCT imaging 1
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Z. Besenyi , N. Orosi , T. Séra , L. Pávics ; Euromedic Hungary Ltd., Szeged, HUNGARY, 2Department of Nuclear Medicine, University of Szeged, Szeged, HUNGARY. Aim: The aim of this study is to evaluate the effect of attenuation correction on the quantitative assessment of dopamin transporter brain SPECT.Method: The results of 24 123-FP-beta-CIT SPECT studies were analysed. DAT SPECT-s of 12 healthy volunteers (4 males, 8 females, aged 25-51 years) and 12 depressed patients (1 male, 11 females, aged 20-56 years) were involved in the study. The injected doses were 185 MBq. The acquisition parameters included the step-and-shoot mode over 50 min, with 120 projection angles over 360° in a 128x128 matrix. 3D reconstruction was performed using a filtered backprojection (by means of the manufacturer’s software), with a Butterworth filter (order 10, cut-off 0.61 cm-1). The SPECT images were reoriented in 3D and were further analysed with and without an automatic uniform Chang attenuation correction (cut-off 0.12 cm-1). On the transversal, reconstructed SPECT slices at the level of the basal ganglia, regions of interest were fixed (larger than 2x FWHM of the SPECT resolution) manually in the striatum bilaterally, and the occipital cortex was used as a reference for the non-specific binding site. The binding potential was estimated by the specific to non-specific activity ratio (S/NS, striatum/ occipital region). Each elliptical ROI was visually optimised to that of the actual structure in order to decrease partial volume effects. In the second group we repeated our ROI analysis for each subject without attenuation correction.In the next phase of our study on the reconstructed images, 3D VOI were fixed semi-automatically as well. The quantitative evaluation (S/NS determination) was performed on the corrected and uncorrected images in the same way. First, the images were spatially normalised in the Talariach space with SPM using a template. Then 3D masks were generated by WFU Pickatlas, and were used as a VOI, and Mathlab script calculated the average photon impact.Results: From our ROI analysis in the first group (with correction), the S/NS ratio was 2.78 (1.63-4.26). In the second group (without correction), the S/NS ratio was 2.05 (1.46-3.2). Overall, the correlation between the two groups was significant, but the values displayed an individually large variation of p=0.02. However, after the 3D VOI analysis, these differences seemed less marked.Conclusion: According to our data, the attenuation correction does indeed have an influence on the quantitative SPECT results of DAT scans. Hence it should be taken into account during the interpretation of DAT SPECT investigations.
P034 Optimal Framing in Dynamic FDG-PET J. A. Disselhorst, D. Vriens, L. de Geus-Oei, W. J. G. Oyen, C. H. Slump, E. P. Visser; Radboud University Nijmegen Medical Centre, Nijmegen, NETHERLANDS. ObjectivesThe microparameters of glucose metabolism in tumors can be determined with dynamic FDG-PET. The estimated values of these parameters, however, are greatly affected by the choice of framing of the dynamic acquisition. The purpose of this study was to determine the influence of framing on the microparameters and to find an optimal framing protocol that produces the most accurate parameter values. Because there are no means to find the true values for these parameters in vivo, optimization was performed using simulations in silico.MethodsNoiseless arterial plasma time activity curves (APTACs) and tissue time activity curves (TTACs) were generated according to an irreversible two-tissue compartment model, using microparameters within a plausible biological range. Framing schedules were developed based on a generalized APTAC and TTAC. Also framing schedules used in literature were evaluated. Ten thousand simulations were performed for each framing schedule with randomly generated curves. The noise of the Siemens Biograph was modeled in order to simulate realistic measured signals. All simulated signals were processed with a pharmaco*kinetic modeling toolbox and the resulting parameter values were compared to the input
parameters.ResultsFor most framing schedules, an increase in number of frames improved the accuracy of the results, with a lower bias and variance. The high noise level in very short timeframes did not lead to inaccuracy of estimated parameter values. The optimal frame duration during the first minute of the scan was found to be 4 to 5 seconds.Clinical dynamic FDG-PET data reconstructed with different framing schedules showed a large difference in estimated microparameters. The parameter unaffected by the choice of framing schedule was the FDG influx constant (Ki).ConclusionThere are large differences between different framing schedules. An optimal framing schedule can be obtained from a population based APTAC leading to more accurate kinetic analyses.
P035 A method for model-free recovery correction in PET F. Hofheinz1, J. Langner1, E. Will1, L. Oehme2, B. Beuthien-Baumann2, J. van den Hoff1; 1Helmholtz-Zentrum Dresden-Rossendorf, Dresden, GERMANY, 2Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Carl Gustav Carus, Dresden, GERMANY. Objectives : As is well known, limited spatial resolution leads topartial volume effects and consequently to limited signalrecovery. Determination of the true activity concentration of a targetstructure is thus compromised even at target sizes much larger thanthe reconstructed spatial resolution. This leads to serioussizedependent underestimates of true signal intensity in hot spotimaging. For quantitative PET in general and in the context of therapyassessment in particular it is therefore mandatory to perform anadequate recovery correction (RC). The goal of our work was to developand to validate a model-free RC for hot spot imaging.Methods : The algorithm proceeds in two steps. Step 1: automaticestimation of the true object volume V with an automatic thresholdbased method and the corresponding total activity A within V. Step 2:automatic determination of the background corrected activity fractionB, which is measured outside the object due to the partial volumeeffect. The recovery coefficient is then given by R = A/(A+B). Forvalidation, we used a cylindrical phantom with six sphere inserts(volume: 2.5 - 27 ml) and performed measurements at three differenttarget/background levels. RC was computed using the analyticalconvolution of the object function with the best fitting Gaussianpoint spread function and then compared to the results of themodel-free approach.Results : For the investigated target/background contrasts themodel-free approach yields RC values which agree very well with theknown (computable) RC values for the spheres (mean deviation +/-5%). The model-free nature of the approach allows, however, directapplication to real patient data where the exact target shape is notknown and model-based RC would fail.Conclusions : The described method provides an easy and essentiallyautomated way of doing quantitative RC in oncological hot spotimaging. It works well for sufficiently high contrast (>5) and ahom*ogeneous background. The limits of the method have to beinvestigated further.
P036 Non-invasive quantification of blood flow in the brain using 15O-labelled water in the HRRT scanner. M. L. Lassen, F. Andersen, J. M. Grüner, I. Law, S. Keller; PET Center, Copenhagen University Hospital, Copenhagen, DENMARK. Aim.Quantification of blood flow in the brain using an Image Derived Input Function (IDIF) derived directly from the image data of the brain arteries seems promising due to the high resolution of the HRRT scanner (1.4mm). We aim to replace the invasive methods of arterial blood sampling (manual or using an automatic sampler) or estimate blood flow where arterial blood sampling is not possible.Methods.Six patients with brain tumors and five healthy subjects were included. They all underwent dynamic H215O (800MBq) PET scans of 330s (18x5s, 9x10s, 10x15s) in the HRRT scanner, Siemens Healthcare, Knoxville. Arterial blood was sampled continuously from the radial artery using the ALLOGG blood sampler. The IDIF was derived from image data of the internal carotid arteries using custom developed software. Comparing the arterial input functions (AIF) to the IDIF we found, as expected, that the IDIF underestimated the activity compared to the arterial measurements. This is due to the partial volume effect (PVE) and thus a correction is needed. A linear model based on variables in the individual scan was derived from the 11 subjects. From this model a correction factor (cf) for the individual subject can then be calculated: cf = 16.88-1.60·10-5*a-7.41·10-4*i3.98*s+9.10·10-10*(a*i)+2.56·10-4*(i*s), where a is the maximal activity in the peak, i is IDIF activity at 180s, and s is the status (healthy=1, tumor=0) of the subject. This replaces the common approach of correcting the IDIF using a venous sampling. Global blood flow was then calculated using PXMOD by PMOD technologies.Results.Comparing the calculated global blood flow using AIF and IDIF a linear relationship was found (R^2 =0.77, 0.62*fIDIF+12.83ml/min/100ml) where fIDIF is the IDIF blood flow. By correction the blood flow using this relationship and comparing the IDIF-method to the AIF-method we found an average deviation in flow of 1.2%, σ=11.3% in the 11 subjects (mean global IDIF blood flow=31.48ml/min/100ml).Conclusion.We suggest that this method can be used to
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P037 The effect of gamma ray attenuation correction on the regional cerebral blood flow in normal volunteers: A Statistical Parametric Mapping (SPM) Study. S. S. Shakushiya1, E. N. Itikawa1, H. T. A. Silva1, R. F. Amaral1, P. M. Azevedo-Marques2, L. Wichert-Ana1; 1University of São Paulo, Ribeirão Preto 3900, BRAZIL, 2Ribeirão Preto School of Medicine - University of São Paulo, Ribeirão Preto 3900, BRAZIL. AIM: To determine the effects of the gamma ray attenuation correction (AC) on regional cerebral blood flow (rCBF), evaluated by Statistical Parametric Mapping (SPM). These effects may alter the way the nuclear medicine physicians report their brain SPECT scans. MATERIAL AND METHODS: We applied the Statistical Parametric Mapping software to determine the effects, ordered by significance, of uniform AC in increase and decrease of rCBF in brain SPECT images using the Talairach Atlas. We performed a SPM group analysis of 10 brain SPECT’s of 10 healthy male volunteers, divided in two groups: the first processed without the AC and the second applying 1st order Chang AC (µ=0.12cm-1). The more significant clusters areas, with p<0.00000001 uncorrected , were ordered by Z-scores and sorted by grey matter structures in Talairach atlas. RESULTS: The SPM analysis revealed regions of increased rCBF after applying the AC in Paracentral Lobule, in Medial Frontal Gyrus, in Thalamus, in Culmen, in Inferior Semi-Lunar Lobule, in Caudate Body and in Substania Nigra. We also found areas of decreased rCBF in Middle and Superior Temporal Gyrus, in Inferior, Medial, Middle and Superior Frontal Gyrus, in Precuneus, in Angular Gyrus and in Postcentral Gyrus. In addition, some fractions of Pulvinar, 6 and 31 Broodmann areas showed increased rCBF with the AC and 2, 7, 9, 10, 19, 21, 22, 37, 39, 40 and 46 Brodmann areas showed decreased rCBF with the AC. CONCLUSIONS: Nuclear medicine physicians should take care about the decision to use brain SPECT images, either with or without AC. Once the application of the AC may increase the perfusion maps in the inner brain structures, it also may decrease the perfusion in the dorso lateral regions of the brain. Under clinical conditions, images without AC should probably be better to evaluate perfusion changes in the lateral regions of the brain, while images with the AC would be better to evidence perfusion changes in the inner structures of the brain. In first analysis, our results suggest that brain SPECT images should routinely be evaluated with and without the application of AC. Further clinical studies should be performed using pathological brain SPECT scans like in Epilepsy and Dementia.
P038 Change of SUV and metabolic volume products after use of rigid coregistration algorithms in F18-FDG-PET I. G. Steffen1, F. Hofheinz2, O. S. Großer3, C. Furth3, T. Denecke4, M. Plotkin1, H. Amthauer3, J. Ruf3; 1Charité Universitätsmedizin Berlin, Klinik für Nuklearmedizin, Berlin, GERMANY, 2PET Zentrum, Forschungszentrum Dresden Rossendorf, Dresden, GERMANY, 3Otto-von-Guericke Universität, Universitätsklinikum Magdeburg A.ö.R., Klinik für Radiologie und Nuklearmedizin, Magdeburg, GERMANY, 4Charité Universitätsmedizin Berlin, Klinik für Strahlenheilkunde, Berlin, GERMANY. Aim:Image fusion of anatomical and functional data is an established procedure in nuclear medicine. Whereas elastic image fusion is expected to alter the information of the transformed data, we assessed whether rigid transformations also change the information contained in the PET-data.Methods:F-18-FDG-PET/CT (Biograph 16, Siemens Medical, Erlangen, Germany) data of 14 tumor patients with a total of 18 solid pulmonary lesions were included in this retrospective analysis. For coregistration, rigid fast (RF) and rigid slow (RS) transformation algorithms of the Fusion7d-software were employed (Fusion7d, Mirada Solutions Ltd./Siemens Medical, Erlangen, Germany). Original PET-images (voxel size: 0.417cm x 0.417cm x 0.5cm) were fused with the attenuation-corrected CT (LR, voxel size: 0.417cm x 0.417cm x 0.5cm) and diagnostic CT (HR, voxel size: 0.098cm x 0.098cm x 0.1cm).PET data were saved in the respective CT-geometry and CT-resolution. Segmentation of lesions was performed using a 3D ROI volume determination software with automatic background detection (Rover, ABX GmbH, Radeberg, Germany). SUVmax, SUVmean, volume and metabolic volumes (volume*SUVmax and volume*SUVmean) of the lesions were determined in the original and in the coregistered PET data and compared. SUVmax in original PET ranged from to 1.630.9 (mean±SD, 8.8±7.0). CT-segmented volumes ranged from 1-58 ml (mean±SD, 9.9±15 ml).Results:The relative differences of volume between original data and rigid fast fused-data ranged from 2-45% (mean±SD, 19%±13%) for LR-coregistration and from 0-12% (mean±SD, 3%±3%) for HR-coregistration. Fusing data with the
rigid slow algorithm resulted in relative volume differences ranging from 1-48% (mean±SD, 20%±18%) for LR-coregistration and from 0-14% (mean±SD, 4%±4%) for HR-coregistration. Analyzing relative differences of metabolic volume products (volume*SUVmax) between original data and rigid fast fused-data ranged from 033% (mean±SD, 12%±9%) for LR-coregistration and from 0-11% (mean±SD, 3%±3%) for HR-coregistration. After fusion with the rigid slow method differences of volume*SUVmax ranged from 0-41% (mean±SD, 13%±13%) for LR-coregistration and from 0-16% (mean±SD, 4%±5%).Conclusions:Transformation of PET data by rigid coregistration algorithms results in a redistribution of the respective voxel information in the new coordinate system. Volumetric analysis based on a sourceto-background algorithm showed substantial differences between original and coregistered data, which may have a potential impact on e.g. PET-based planning of radiotherapy or the assessment of treatment response by measurement of metabolic burden in follow-up studies. This effect is dependent on the source data (CT) resolution. The extent of the observed effect on the data of modern high resolution PET-systems remains to be evaluated.
P039 The Better Alignment Performance of Tsallis Entropy Over Classic Cost Functions in the Intra-modality SPECT and MRI Co-registration Using Statistical Parametric Mapping (SPM) H. T. Amaral-Silva1, L. O. Murta-Jr.2, P. M. Azevedo-Marques1, A. C. Sakamoto1, L. Wichert-Ana1; 1Ribeirão Preto School of Medicine University of Sao Paulo, Ribeirão Preto, BRAZIL, 2Ribeirão Preto Faculty of Philosophy Sciences and Letters - University of Sao Paulo, Ribeirão Preto, BRAZIL. Purpose: The overlapping of medical images, technically known as co-registration, plays an important role in determining topographical variations in morphological and/or functional observations to achieve diagnosis, as well as for therapeutic proposals. This paper purpose the study of the Tsallis Entropy as a alternative cost function for medical imaging co-registration though of the quantitative analysis of the error and robustness and posterior comparative analysis with the traditional cost functions using the Statistical Parametric Mapping (SPM).Methods: Magnetic Resonance Imaging (MRI) and Single Photon Emission Computed Tomography (SPECT) images of 3 morphologically normal patients were performed by an experienced neurologist. The selected images were pre-processed in SPM for the construction of anatomical phantoms containing predetermined geometric variations. For each image modality was created 8 simulators incorporating the fallowing transformations in its three axis (x, y and z): rotations of 5º, 10º and 15º; and translations of 1mm, 3mm, 6mm, 9mm and 12mm. Initially, the simulated images were co-registered with the original images using the proposed technique with the non-extensive parameter of the Tsallis Entropy, q in the interval from [0.1 to 3.0] which was found in previous pilot study. The values that presented the best co-registrations based on qualitative and quantitative analysis were selected for the comparative analysis against the traditional methods. For each patient and for each possible pair of images (MRI vs. MRI, SPECT vs. SPECT and MRI vs. SPECT); 8 co-registrations were accomplished; 3 corresponding to rotation phantoms and 5 to translation ones.Results and Discussion: The best non-extensive Tsallis parameters were the following values: 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9 and 0.999; this behavior was observed for all modalities. The comparative analysis between the co-registration techniques showed that the Tsallis Entropy was superior in intra-modalities co-registrations, with an optimized adjustment for coefficient values of 0.5 for MRI vs. MRI and 0.999 for SPECT vs. SPECT. However, the Shannon Entropy provided the best performance for inter-modality coregistration (MRI vs. SPECT), followed by the Tsallis Entropy with 0.1. Regarding the processing time, the co-registrations lasted from 100 to 250 milliseconds however there weren´t strong correlation between error and processing time.Conclusion: The Tsallis Entropy was more efficient for intra-modality alignment, while Shannon Entropy for inter-modality alignment. It is possible to conclude that is quite importance the implementation of the Tsallis Entropy in SPM for neurology and neuropsychiatric research applications.
P040 The Superiority of Tsallis Entropy as Cost Function in Clinical Simulations of SPECT and MRI Co-registration Using Statistical Parametric Mapping (SPM) H. T. Amaral-Silva1, L. O. Murta-Jr.2, P. M. Azevedo-Marques1, A. C. Sakamoto1, L. Wichert-Ana1; 1Ribeirão Preto School of Medicine University of Sao Paulo, Ribeirão Preto, BRAZIL, 2Ribeirão Preto Faculty of Philosophy Sciences and Letters - University of Sao Paulo, Ribeirão Preto, BRAZIL. Purpose: The medical imaging co-registration is an important technique for surgical planning applications. In neurosurgery it is useful to identify tumors, functional and morphological changes and for Epilepsy treatment, the co-registration of images can improve the localization of the epileptogenic zone. Motivated by the results of a previous study on the use of Tsallis Entropy in co-registration of simulated
Poster Presentations
estimate blood flows in patients using 15O-water where blood sampling fails or where arterial blood sampling is not possible. We still see overestimation of the peak of the corrected IDIF and thus further work is needed.References.Imagederived input function in dynamic human PET/CT: methodology and validation with 11C-acetate and 18F-fluorothioheptadecanoic acid in muscle and 18Fflurodeoxyglucose in brain by Croteau et al.Image derived input functions for dynamic High Resolution Research Tomograph PET brain studies by Mourik JE et al.
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S270 medical images containing known transformations of rotation or translation; this article proposes the study of Tsallis Entropy in simulations with merged transformation of rotations and translation as a way to approach the clinical reality.Methods: Magnetic Resonance Imaging (MRI) and Single Photon Emission Computed Tomography (SPECT) images of 2 morphologically normal patients were used for the construction of 5 simulators (called S1, S2, S3, S4 and S5) with varied geometric transformations of translation and rotation predetermined. Each simulator was then co-registered with the original images using the traditional and the proposed cost function (Tsallis). Whereas the transformations applied were already known, was possible predict what transformation parameters were expected, hence, the transformation parameters were recovered to determine the error of the translation and rotation transformations for the quantitative analysis. These data were then used for the comparative analysis between the traditional and proposed cost functions for all possible combinations (MRI vs. MRI, SPECT vs. MRI and SPECT vs. SPECT).Results and Discussion: Through analysis of the best performances based on minor error was possible identify some patterns; in the intra-modality co-registration of MRI, the Tsallis entropy (0.4, 0.5 and 0.7) was more effective in 83.33% of the cases studied, surpassed only by the NCC in the translation error in the co-register of S2. In the intra-modality co-registration of SPECT, the Tsallis (0.5, 0.6, 0.7 and 0.8) figured as the cost function more reliably in all simulators analyzed. In the inter-modality co-registration, Tsallis was also more effective in 83.33% of all cases, overcome again by the NCC in the rotation error in the co-register of S1. The S4 and S5 didn´t present satisfactory results and weren´t evaluated in the comparative analysis.Conclusion: The use of the Tsallis entropy as a cost function for the medical image co-registration showed superiority in 88.88% of all cases analyzed and therefore it has relevant indicatives of its application in clinical routine. Given these results, a new study aiming to analyze the performance of the Tsallis entropy in the clinical routine is already in development.
P041 Anatomical Measurements to Estimate Height in NonAmbulatory Patients L. Sanders, L. Holmes; Portsmouth Hospitals NHS Trust, PORTSMOUTH, UNITED KINGDOM. AimHeight measurements are used in many clinical application, in Nuclear Medicine it is necessary for the calculation of glomerular filtration rate (GFR). Accurate height measurements can be difficult to obtain from the immobile or frail, and it may be necessary to rely on estimates, either patient’s or using formulae not devised for clinical uses.Personal estimates may be skewed; for example, tall people underestimate, shorter overestimate and older people believe they are as tall as they always were.This study aims to investigate if formulae developed in forensic science (Trotter and Gleser) to estimate statures are sufficiently accurate and precise for clinical use, specifically GFR tests.Measurements of supine bone lengths from routine clinically required radionuclide bone scans may be used to establish long bone to height ratios and supine to erect changes in height. Thus more accurate height estimates may be made of wheelchair bound patients, especially frail elderly with age related height loss.Method and materialsPreviously calculated GFRs were re-analysed altering height by 10% and 5 cm and the altered GFR result recorded.Anatomical measurements were taken of volunteers; age, gender, height, sitting height, ulna length, demi-span and knee to floor height.Estimated height was calculated using formula used in forensic science and tables included in the British Association for Parenteral & Enteral Nutrition malnutrition universal screening tool (MUST). Sitting height to standing height ratios were calculated. Ulna, demi-span and knee to floor heights were used to calculate estimated height using the forensic formulae and MUST tables.ResultsA 10% change in height, equivalent to 18 cm and 16 cm in an average British male and female respectively, resulted in a GFR change of less than 6.5 and 6.8 ml/min, with a maximum change of 7.7 ml/min in any of the patients selected. A 5 cm change resulted in a maximum 2.0 and 2.4 ml/min change in male and female respectively.Heights obtained using the MUST tables had a maximum error from the measured height of 15 cm, compared to the Trotter formula with a maximum error of 13 cmConclusionThe Trotter formula performed slightly better than the MUST tables in estimating height, both with an error less than 10%, resulting in less than 7ml/min error in GFR results. Bone scans can provide a database of long bone and torso lengths to produce a formula which could aid both wheelchair bound patients and forensic applications.
P042 A novel iterative thresholding algorithm for segmentation on PET images: preliminary results on volumetric accuracy and criticalness of the calibration specific for the PET system C. Basile1, M. Pacilio1, F. Botta2, A. Di Dia2, M. Cremonesi2, M. Ferrari2, D. Aragno1, E. Santini1; 1san camillo-forlanini hospital, rome, ITALY, 2Istituto Europeo Oncologia, milan, ITALY. AIM. PET imaging plays an important role in the segmentation of functioning parts of organs or tumours, but an accurate and reproducible delineation is still a
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 challenging task. In this work, an innovative iterative thresholding method for tumour segmentation has been proposed and implemented for two PET systems taking also into account the partial volume effects to improve the quantitative accuracy of the imaging technique.MATERIALS AND METHODS. The RIThM is an iterative thresholding-based method, implemented using threshold-volume calibration at different source-to-background ratio (SBR), as well as the Recovery Coefficients (RC) to improve the quantitative accuracy of the imaging technique. The algorithm has been coded using MATLAB. The RIThM was implemented for two different PET/CT systems, a Discovery ST and a Discovery D600 (GE Healthcare), using a Jaszczak phantom and several test objects. Different test objects (flasks and vials) were imaged experimentally for validation purposes. The impact of the RC implementation on the volumetric accuracy has been studied. Moreover a balanced two-way ANOVA statistical test was used to analyze the experimental observations: i) the correlation of thresholds or RC (the dependent variables) on volume and SBR (the independent variables); ii) the likeness of the calibration results between the two PET systems. The statistical tests were performed using MATLAB. Finally, it was investigated whether the calibration procedure, specific for the imaging system, is a critical point for the volumetric accuracy.RESULTSExperimental threshold-volume and (RC) curves were obtained for several SBR ratios. Preliminary results showed that volume percent differences for the test objects without the RC implementation were within ±20% for volumes down to about 4 mL, reaching about -90% for 1 mL. The RC implementation slightly improved the volumetric accuracy, yielding percent differences within ±16% in the entire volume range (1-150 mL). Preliminary statistical results showed that calibration data obtained with different imaging systems significantly differed, nevertheless the impact of these differences on the volumetric accuracy appeared of low relevance.CONCLUSIONThe RIThM method appeared robust and stable and yielded reliable volume and SBR estimations for volumes down to 1 mL. The calibration procedure, specific for the imaging system, did not appear to be a critical point for the PET systems used. Further studies are worthwhile comparing more equipments, possibly including equipments from other companies.
P043 Dosimetric evaluation of static renal scintigraphy for children -Determining total activity within kidneys’ volume by SPECT imagingM. Andreou, P. Charalabatou, I. Vamvakas, M. E. Lyra; University of Athens, Athens, GREECE. Paediatric patients, whose tissues and organs are still developing, are significantly more sensitive to radiation than adults. On radiation safety in paediatric patients the view that the benefits of imaging studies in children almost certainly outweigh the risks of exposure to ionizing radiation is supported. However, the consistency of the ALARA concept in children highlights the importance of minimizing radiation exposure.Our aim is to identify specific concerns relating to absorbed dose in paediatric patients renal nuclear medicine imaging.Method: For the accurate determination of activity within a volume of interest (kidney) that is necessary to be known, for absorbed dose calculations, single-photon emission computed tomography (SPECT) is employed. A method to convert counts to activity is required. We use a phantom-based conversion; that is, we image an elliptical outer cylinder containing a smaller cylinder of known volume with a known amount of Tc99m activity inside. The medical image analysis software Segment algorithm (Einar Heiberg, Lund University, Sweden) and a low energy high resolution collimator were used. The estimates for small cylinder activity varied with changes in 1) the level of uniform background activity in the outer cylinder, 2) the image resolution due to different values of the radius of rotation, R, 3) the volume of the small cylinder.For conversion of reconstructed counts into an activity estimate within a patient’s kidneys, the resultant value may have been in error because of patient-phantom mismatch. We have used an Ordered Subsets Expectation Maximization (OSEM) algorithm, with a 3D depth-dependent detector-response model and a low-energy collimator. Results after 10 iterations 12 subsets in OSEM and using a maximum counts registration show the estimates for the small cylinder activity:1) To have a dependence on the level of background activity 2) are independent of R, and 3) are independent of volume smaller than 20 cm3. Conclusion: We conclude that using a conversion factor to relate counts to activity and no volume-based correction, with OSEM-based quantification, using 1) a global-average conversion factor and 2) no volume-based correction, mean bias in the simulated-kidney activity estimate over 20 realizations is 11%.With Segment-based quantification, using 1) the conversion factor corresponding to the experimental estimate of background and 2) volumebased correction, the mean bias is 8%. The mean bias is smaller in a statisticallysignificant way and relative standard deviation (SD) is not more than a factor of 2.5 greater with OSEM compared to Segment.
P044 Bayesian and Artificial Neural Networks Algorithms at Myocardial Perfusion Imaging D. Vieira, F. Nogueira, L. F. Metello; Nuclear Medicine Dept, ESTSP.IPP, Vila Nova de Gaia, PORTUGAL.
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P045 Three Dimensional Image Registration In Nuclear Medicine Using Dual-Tree Complex Wavelet Transform(DT-CWT) Features M. Carroll; Royal Liverpool University Hospital, Liverpool, UNITED KINGDOM. Objectives: Accurate robust image registration is an important precursor to many image processing tasks in nuclear medicine. These include fusion of external imaging modalities e.g. MRI and high quality CT to SPECT-CT data and change detection in monitoring therapy efficacy across sequential imaging series. In this work we apply wavelet derived features to accomplish automatic matching and registration.Methods: In this work we apply a newly developed wavelet transform , the DT-CWT, which is nearly invariant to translation and much less sensitive to rotation than the traditional wavelet transform. We employ the DT-CWT to accomplish global, rigid, shape based registration of 3D tomographic data sets by extracting features in a multi-resolutional format hence rapidly detecting and matching feature points. Given two 3D data sets we determine the rotation and translation such that : A = RB +T where R is the orthogonal rotation matrix and T is the translation vector. The matching algorithm is:1) Apply DT-CWT to both data sets2) Select large magnitude wavelet coefficients in A and B as feature points3) Search within the lists of feature points for matching point triplets4) For each matching set of triplets , determine the rotation5) Use a voting scheme to select the best rotation6) Using the selected rotation , determine the translationResults: This technique has been applied to the registration of multi-temporal SPECT-CT data post targeted radionuclide radiotherapy and to fuse external high resolution CT to SPECT-CT.Conclusions: Global registration is successfully achieved and allows for further fine registration to be conducted using elastic registration methods.
P04 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Physics & Instrumentation & Data Analysis: Radiation Exposure & Protection
P046 Evaluation of patient doses relating to nuclear medicine investigations in the past 20 years in Hungary T. Sera1, M. Papos1, S. Pellet2, L. Pavics1; 1University of Szeged, Szeged, HUNGARY, 2Office of the Chief Medical Officer, Budapest, HUNGARY.
International reports dealing with the exposure of the population to radiation from medical sources describe a continuous increase during recent years due to the increase in the number of medical investigations (CT scans, interventional radiological examinations, unnecessarily repeated investigations, etc.). The radiation protection scientific committees are making great efforts to assess the patient doses, to follow up the cases, and, if possible, to decrease these doses.The aim of our study was to evaluate the patient doses in nuclear medicine in Hungary in representative years during the past two decades.Material and Methods: For the calculation of the effective doses, we used the mSv/MBq values from the ICRP 53. Publication; the data relating to the different types of nuclear medicine examinations were provided by the Hungarian College of Nuclear Medicine and the National Registry. Results: During the analysed years 1991, 1997, 2004, 2005, 2007 and 2009; the total number of investigations was 155682, 177208, 173385, 187184, 156534, and 171846, respectively, while the collective effective doses (man Sv) were 471, 1025, 1010, 1016, 812 and 835, respectively. The total numbers of bone, lung, brain, kidney, thyroid (between 2004 and 2009), inflammation and tumour investigations exhibited good correlations (R2= 0.9) with the corresponding effective doses; for cardiology and gastroenterology, R2 was 0.6; and for all different types of examinations combined, R2 was 0.8.Conclusions: during the past 20 years, the patient doses in nuclear medicine in Hungary have varied in proportion to the total number of investigations and did not display a continuous increase, whereas the average effective dose per procedure increased from 3.03 to 4.86 mSv.
P047 Evaluation of radiopharmacists’ radiation exposure at the hot 18 11 13 lab -Clinical practice with F-FDG, C-MET and N-NH3T. Uchida, T. Henmi, S. Onotera, T. Yoshino, H. Endou, Y. Uchino; Chiba Nyogo Center, Mihama-Ku Chiba City, JAPAN. [Objective] PET/CT has played an important role in cancer diagnosis and treatment. But there were few reports on the exposure of hot lab workers. We conducted a prospective study of the occupational radiation exposure of radiopharmacist working at the hot lab, and evaluated the exposure doses of radiopharmaceuticals.[Materials and Method] Radiation doses were measured by pocket radiation dosimeter (ALOKA, Co. Ltd. Japan, MYDOSE mini PDM-112). We checked the daily radiation exposure dose after each completion of radiopharmaceutical synthesis; 18F-FDG, n=87; 11C-MET, n=51; and 13N-NH3, n=14.[Results] The exposure doses were suppressed by using fully automated 18FFDG synthesis system (average dose 2.1 μSv/synthesis). However, another radiopharmaceuticals (11C-MET and 13N-NH3) indicated higher the exposure dose (8.3 μSv, 15.3 μSv, respectively) than 18F-FDG. The synthesis systems for 11C and 13N are not popularized at the cyclotron facilities for clinical use in Japan. Since 11C-MET and 13N-NH3 have short half-life, quality control should be done in short time by some manual procedures.[Conclusion] Exposure doses tended to increase as the shorter half-time radiopharmaceuticals. To achieve further reduction of occupational radiation exposure, improvement of the radiopharmaceutical devices for 11C and 13N are desired. Minimum exposure doses can be achieved by solid multidisciplinary collaborative team.
P048 Assessment of radiation doses in different diagnostic imaging and radiation therapy occupational groups Y. Bouchareb, M. Tarabieh, A. Al-Attar, S. M. Al Manea, H. M. Al Naemi; Hamad Medical Corporation, Doha, QATAR. Purpose There has always been an increasing interest in monitoring levels of exposure to ionising radiation in different diagnostic and therapeutic occupational groups. The purpose of this study was to assess occupational radiation doses in Radiology, Nuclear Medicine and Radiation Oncology over the last three years, aiming to reduce personnel radiation doses further. Methods & Materials Personnel radiation doses resulted form the use of ionising radiation sources including x-ray machines, sealed and unsealed radioactive substances for the last three years, were collected. For the sake of an objective assessment, we considered only effective whole body doses measured using TLDs during the full 36 months in each speciality. Due to differences in level of radiation exposure, three specialities forming the Radiology group: Interventional Radiology, Cath Lab and CT were studies. Total mean doses, maximum and cumulative doses per year in each occupational group were estimated and compared against maximum permissible doses (MPD) and the local dose investigation levels (DIL), which consist of 12 mSv for Nuclear Medicine, 9 mSv for Radiology and 2.4 mSv for Radiation Oncology workers. Results Personnel radiation doses analysis performed for the three occupational groups over three years resulted in an average personnel dose of 0.81 mSv for Radiology, 2.14 mSv for Nuclear Medicine and 0.51 mSv for Radiation Oncology workers. Over the three years, maximum whole body doses received by the Radiology, Nuclear Medicine and Radiation Oncology personnel were 4.52 mSv, 5.03 mSv and 0.64 mSv, respectively. Similar figures of average and maximum whole body doses were observed on a year-to-year basis. In the Radiology group,
Poster Presentations
Introduction:One major focus of data mining process - especially Machine Learning researches - relates to automatically learn to recognize complex patterns and help to take the adequate decisions strictly based on the acquired data. In a preliminary study, advantages on Computerized Analysis of data over Human Analysis in MPI Myocardial Perfusion Imaging context were identified (shorter time, hom*ogeneity and consistency, automatic recording of analysis results, relatively inexpensive, etc), especially when considering the use of Naïve Bayes algorithm.Objectives: This study pretended to compare and evaluate the efficacy of BN - Bayesian Networks and ANN - Artificial Neural Networks when applied to MPI Stress studies and the process of decision taking about the continuation - or not - of the assessment of each patient. According with the first part of the study, it has been pursued has an objective to automatically classify each of the patients MPI in one of three groups: “Positive” (directly concluding with the study continuation, to the Rest part of the test) “Negative” (directly exempting the patient from continuation) and “Indeterminate” (requiring the clinician analysis and final decision). Methods:WEKA v3.6.4 open source software was used to produce a comparative analysis of four WEKA algorithms (“Naïve Bayes”, “BayesNet-K2”, “BayesNet-TAN” and “ANN Multilayer Perceptron”) - on a retrospective study using the comparison with correspondent clinical results as reference, signed by nuclear cardiologist experts on “SPECT Heart Dataset”, available on University of California - Irvine, at the Machine Learning Repository. For evaluation purposes, criteria as “Precision”, “Incorrectly Classified Instances” and “Receiver Operating Characteristics (ROC) Areas” were once again considered.Results:The interpretation of the data suggests that the ANN - Multilayer Perceptron algorithm possess the best performance among the four selected algorithms.Conclusions:The findings seems to support that BN and especially ANN machine learning algorithms could significantly assist, at least in an intermediary level, on the analysis of the scintigraphic data obtained on MPI, in terms of economy of Nuclear Cardiologists’ time and effort, as well as increasing workflow fluidity at Technologist’s level, due to reducing time, while also increasing comfort to the patients directly involved.In the expected continuation of this study, it is planned to analyze the chosen ANN algorithm in more detailed parameters (pretending to obtain improvements on system accuracy) and also implement this methodology in medical imaging software in order to test it in real medical practice.
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estimated average whole body doses were 1 mSv, 0.81 mSv and 0.61 mSv for Interventional Radiology,Cath Lab and CT radiation workers, respectively. Conclusions Based on the current findings, cumulative personnel radiation doses for all occupational groups are well below maximum permissible doses setup in the ICRP and IAEA safety standards and the DIL currently applicable for radiation workers at our institution. This study suggests lower DIL for the three studied specialities without compromising the quality of service offered to patients. The use of radiation area monitors in offices adjacent to rooms, where radiation sources exist is not necessary except in case of newly installed ionising radiationbased machines or major changes in clinical practice.
laboratory. A single PET patient walking past the laboratory had a negligible effect on an open counting window.ConclusionsDoses to staff, patients and visitors caused by PET patients to the Nuclear Medicine department have been controlled using of time, distance and shielding.The potential effects of PET patients on the WIZARD2 can be limited by ensuring these patients are encouraged to exit the department after their scan without lingering outside the shielded laboratory in the Nuclear Medicine department.
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B. Serrano, C. Hoog, M. Bondouy, B. Paulmier, M. Vergé, P. Rigo; Nuclear Medicine Department, Princess Grace Hospital Center, MONACO, MONACO.
Design and evaluation of a new innovant radioprotected device for internal targeted radiotherapy. S. Brillouet1, P. Sauvageot2, O. Caselles1, D. Brescon2, J. Cazalet2, S. Zerdoud1, L. Dierickx1, F. Courbon1; 1CLAUDIUS REGAUD, Toulouse, FRANCE, 2ISP SYSTEM, Vic en bigorre, FRANCE. Aim: The development of internal targeted radiotherapy treatments, particularly in nuclear oncology, led us to develop and test an innovative radioprotective equipment for preparation and administration of high activity of radiopharmaceuticals. Indded, in France, we don’t have at our disposal suitable equipment for high activity internal targeted radiotherapy treatments. The purpose of this study is firstly to present our new equipement and secondly to compare the irradiation of the staff without and with our innovative radioprotective equipment.Materials and Methods: Our project developed with an industrial company ISP System’s collaboration, specialized in design and manufacture of precision engineering, mechatronics and robotics, has enabled the design and manufacture of a radioprotected device suitable for all internal radiation therapy, fully automated and controlled distance. Firstly, during 111Indium-pentetreotide high activity (6660 MBq) therapy without using our new radioprotective equipment, we measured with rings the values of fingers exposure of the radiopharmacist during the steps of preparation and the values of finger exposure of the personal during administration to the patient. In parallel, we noted the whole body exposure with a dosimeter.Results: The values of exposure are: 1° for the preparation: 333 ± 32 μSv for the right hand. The most radiant step is the preparation of the syringe. 2° for the administration of internal targeted radiotherapy treatment: 1498 ± 102 μSv for the right hand. The most radiant step is the positioning of the syringe into the syringe pump. Total finger dose is 1831 μSv and whole body dose is 46 μSv. Currently, this values require us to space out the treatments. Our innovative device, developped for internal targeted radiotherapy treatment, include an automatized system for the preparation of radiopharmaceuticals (we don’t have to use the hands) and a new transport system with an innovative injection device keeping the lead radioprotected syringe in the syringe pump (which doesn’t exist in France actually). Currently, a comparative dosimetric study of our current operating mode and the use of this device is underway to prove the lower irradiation thanks to the use of our innovant radioprotected equipment.Conclusion: Presentation of the system and results of the dosimetric study will be presented at the conference.
P050 Effect Of PET Patients On Radiation Doses And Gamma Counting Equipment A. Stapleton, N. Pratt-Boyden, L. Sanders, M. A. Masoomi; Queen Alexandra Hospital, Cosham, Portsmouth, UNITED KINGDOM. AimThis work is intended to establish the effect of positron emission tomography (PET) patients attending the new PET/CT scanner at the Nuclear Medicine department on radiation doses of staff, patients and visitors. It also considers the impact of the PET patients on sensitive clinical equipment, specifically a Perkin Elmer WIZARD2 2470 gamma counter located adjacent to the PET patients’ route out of the department, used for Tc-99m glomerular filtration rate (GFR) tests and wipe tests.Materials and methodsRadiation doses due to the PET patients were calculated using the methodology identified in the AAPM guidelines.The effect of a PET patient (~100 minutes post injection of 550 MBq F-18 FDG) walking past the WIZARD2's shielded laboratory was measured using an open energy window counting protocol. Additionally, a GFR counting protocol, acquired using a Tc-99m window, was performed whilst a uniform cylindrical Ge-68 source (activity = 22.3 MBq) was left just outside the WIZARD2's shielded laboratory. The effect with distance from the WIZARD2 (between 0.1 m and 4 m) of 2 identical Ge-68 PET line sources (total activity = 21.0 MBq) on the WIZARD2 inside the shielded laboratory was measured during a GFR counting protocol and the open energy window counting protocol.ResultsDose calculations suggest that the PET suite has been sufficiently well shielded throughout to maintain staff, patient and visitor doses within acceptable levels at all times under current radiation legislation.In terms of effects on clinical measurements, the stationary Ge-68 sources could be detected by the gamma counter during both a GFR counting protocol and an open energy window protocol at all distances tested both inside and outside of the shielded
P051 Investigation of dose decrease on a high sensitivity PET
An investigation of the potential dose decrease was performed with a high sensitive PET/CT. To reach the optimal patient dose injected we search for the compromise between the TRUES detected, the injected dose and the acquisition duration.We worked on a Siemens mCT with an extended field of view; four rings of detector and time of flight. Experiments were first performed using the IEC body phantom at target-to-background of 4:1. Emission data was acquired for 300s and for injected doses of 4.7 down to 1.5 MBq/kg in List Mode data. We reconstructed acquisitions with durations from 300 to 3s. To control image quality we quantified the number of TRUES detected and the Standardized Uptake Value (SUVmaximum and SUVaverage). We also use the List Mode data on 11 patient acquisitions in clinical conditions: 5MBq/kg for injection and 150s per bed position acquisition. The TRUES, SUV and the uptake uniformity (ratio between the standard deviation of the SUV and the SUVaverage in a liver centered sphere) in the liver were studied. We correlated the SUV of a pathological fixation and the liver uniformity with the time acquisition. The threshold for determination of the volume of interest used to measure the SUVaverage was 4 g/ml. Finally we compared the PET scans of 7 patients (79+/-23kg) acquired with 5.37+/-1.1MBq/kg and 3+/-0.2MBq/kg.The relation TRUES=Cte*AD*ID (1) between the injected dose (ID), the acquisition duration (AD) and the number of TRUES detected for each acquisition was validated on phantom and applied on clinical acquisition. Values of SUVmax and SUVaverage of pathological uptakes in 11 patients differed less than 10% between AD=150s and 20s (with step of 10s). The uniformity of the SUVaverage in the liver between AD=150 to 90s differed less than 2.8%. Those results conduced using relation (1) that we could decrease the FDG-F18 injected activity from 5 to 3MBq/kg (same ratio of 150 to 90s). Finally on 7 patients who had at first an injection around 5MBq/kg then more than six month after a new injection around 3MBq/kg, we showed a diminution of the uniformity on the liver less than 4.4% average of 2.5%.This study shows the possibility to decrease the injection dose (from 5 to 3MBq/kg) for a FDG-F18 examination on a high sensitive PET/CT without reducing the quality of the images. In addition it resulted on a reduction of the effective dose received by the patients from 7.2 to 4.4 mSv.
P05 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Physics & Instrumentation & Data Analysis: Quality Control & Performance Measurements
P052 Standardization of threshold intensity value from 18F-FluoroDeoxy-glucose-positron emission tomography (18F-FDG PET) images for tumor volume calculation - a phantom study. A. Gupta1, R. Kumar2, C. D. Patel2, A. K. Pandey2, P. Sharma2, A. Malhotra2; 1B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, NEPAL, 2All India Institute of Medical Sciences, New Delhi, INDIA. Objectives: Estimation of metabolic tumor volume (MTV) from 18 F-FDG PET image is a challenging task. We have standardized the method to determine threshold intensity value using locally fabricated phantom.Method and materials: We filled the phantom (cylindrical phantom having six spherical spheres of diameters ranging from 1.10 cm to 1.93 cm) on different occasions to have 6:1, 7:1, 8:1 and 10:1 sphere to background (S/B) activity concentration ratio using 18F-FDG. These ratios were from 154 lesion sites (42 lymphoma patients). 18F-FDG PET/CT image data were acquired and volume of spheres was calculated by the help of RT_Image software. It was done by drawing region of interests (ROIs) on every slice at different threshold values ranging from 40% to 75% to the maximum standardized uptake value (SUVmax) of the spheres and then compared with known volume.Results: Threshold intensity value of 40% to SUVmax was suitable for spheres of diameter greater than 1.83 cm, 60% for diameter less than 1.83 cm & greater than 1.35 cm and 75% for diameter less than 1.35 cm. We found almost similar results at four different S/B ratios.Conclusions: The standardized threshold intensity values determined from 18F-FDG PET images of our phantom study is dependent on the diameter (size) of the spheres but is independent of S/B ratios.
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The Effect of Head Sensitivity Mismatch on Dual-Headed Nuclear Cardiology
National Software Audits - The UK Experience
AimTo investigate the effect of a range of detector sensitivity mismatches for a dual-headed gamma camera. The nationally recommended limit is a 10% difference in sensitivity between heads and it is desirable to know the clinical effect of exceeding this limit.MethodA Siemens Signature ECAM dual-headed gamma camera was used to investigate the sensitivity mismatch. This was carried out with our clinical cardiac protocol: LEAP collimators, heads at 76º to each other and 37 projections per head for 30 seconds each projection. A Jaszczak phantom containing 600MBq was imaged. A “Torso Phantom” (Data Spectrum) was also imaged. All compartments were filled with non-radioactive water except the myocardial region which had 25MBq of Tc-99m added. No lesions were included in the myocardial region.A Siemens ESOFT workstation was used for analysis. The projections of one head had arithmetic functions applied to reduce counts over a range whilst the other was not adjusted. Reconstructions were then performed using Filtered Back Projection with Butterworth filters. For the Torso Phantom, images were adjusted to obtain “short”, “horizontal long” and “vertical long” orientations. A limited number of patient images were also analysed. Thus, a set of reconstructed data was obtained with increasing head sensitivity mismatch up to 50% for the Torso Phantom and 30% for the patients and Jaszczak Phantom.ResultsThere were no obvious artefacts introduced to any of the images inspected. Visual examination and contrast analysis of the reconstructions from the Jaszczak phantom did not reveal any obvious differences in either visualisation of cold spheres, rods or differences in cold sphere contrast. For the Torso Phantom subtle changes in the short axis hom*ogeneity appeared by 30% mismatch which became clear by 50%. Patient images did not show any clear changes.DiscussionThe lack of any artefacts or other obvious effects at less than 30% mismatch is surprising considering the existing limit. Further work will be presented that will examine the mismatch in more detail, including quantitational data. We will attempt to establish the level of mismatch that has discernable clinical effects.ConclusionMismatches in head sensitivity below 30% did not generate obvious artefacts or other clear defects in myocardial perfusion imaging.
P054 Partial Volume Correction in Small Animal PET imaging: performance evaluation of a reconstruction based algorithm using the NEMA NU4 2008 image quality phantom. D. D'Ambrosio, F. Zagni, G. Cicoria, S. Boschi, S. Fanti, M. Marengo; S.Orsola-Malpighi Hospital, Bologna, ITALY. Aim:This work is focused on Partial Volume Correction (PVC) in small animal PET imaging. The main goals are the implementation of an iterative reconstruction algorithm including spatial resolution information for 18F,11C,68Ga,64Cu and 89Zr and performance evaluation using the NEMA NU4-2008 image quality (NU4IQ) phantom.Materials and methods:In order to get an accurate model of PSF of eXplore Vista Small Animal PET system, Monte Carlo simulations of radioactive point sources were performed. A gaussian fit was performed on sinogram to create a spatial resolution map.NU4IQ was modeled using GATE. PET data for the cited radionuclides were simulated. Rods and uniform region were filled with the same activity concentration, one cylinder was filled with activity (cylinder/background equal to 4) while the other cylinder was left cold. For each study 2*10^8 counts were collected using 100-700keV energy window.PET images were acquired in the same condition. The overall activity in the phantom was about 25MBq.Simulated images were reconstructed using EM algorithm with and without PSF model varying the number of iteration from 1 to 96. The optimal value of iteration number was used to reconstruct acquired images. All the routines were developed using IDL8.0.Original and PVC images were compared drawing line profiles across rods and cylinders. The noise level in reconstructed images was estimated as coefficient of variation in a uniform volume of interest (VOI). Cylindrical VOI were drawn in hot and cold cylinders in order to calculate contrast with respect to the background region. Recovery coefficients (RC) were estimated using the maximum value measured inside ROIs with diameters twice the physical diameter of the rods.Results:The analysis of simulated and acquired images with and without PVC provided similar results. The improvement of spatial resolution is clear from the RC curves. RC for 3mm rod of uncorrected image were equal to 0.8, 0.6, 0.4, 0.8 and 0.6 respectively for 18F,11C,68Ga,64Cu,89Zr. Analogously for PVC images RC for 3mm were equal to 0.9, 0.7, 0.5, 0.9 and 0.7. The noise level of simulated (acquired) images was equal to 6% (7%) and 7% (8%), respectively before and after PVC for all the used radionuclides. The effect of PVC algorithm on hot and cold region contrast is a variation of few percentage points with respect to the uncorrected images.Conclusion:Results suggest that the iterative reconstruction algorithm including an accurate spatially variant model of PSF for 18F,11C,68Ga,64Cu and 89Zr provides images of better quality.
S. Cade1, D. Hall2, B. Kenny3, A. Knight4, R. Lawson5, L. Livieratos6, K. Nijran7, D. White8, Institute of Physics and Engineering in Medicine,Nuclear Medicine Software Quality Group; 1Royal United Hospital Bath, Bath, UNITED KINGDOM, 2University Hospitals Bristol NHSFT, Bristol, UNITED KINGDOM, 3Link Medical, Bramshill, UNITED KINGDOM, 4City Hospitals Sunderland NHSFT, Sunderland, UNITED KINGDOM, 5Central Manchester University Hospitals NHSFT, Manchester, UNITED KINGDOM, 6Guy's & St Thomas' NHSFT, London, UNITED KINGDOM, 7Hammersmith Hospital, London, UNITED KINGDOM, 8Barnsley Hospital NHSFT, Barnsley, UNITED KINGDOM. Background. The results of the first UK nationwide audit of nuclear medicine software quantitative analysis, which dealt with calculation of relative renal function in DMSA scans, were published in October 1998. This audit was carried out by the Nuclear Medicine Software Working Party, established by the Radionuclide Special Interest Group (RSIG) of the Institute of Physics and Engineering in Medicine (IPEM), to investigate the problem of variation in quantitative results between centres and between techniques. Although this audit showed 98% of results within 5% of the study median, it also identified statistically significant differences in techniques and some excessive outliers, hence establishing the need to continue the audit process; a further 7 audits covering a range of imaging and non-imaging studies have been completed. The Working Party has become a permanent subset of the RSIG and has changed its name to the Nuclear Medicine Software Quality Group (NMSQG).Aim. To share the UK model for the audit process and the benefits realised over 10 years of auditing. To encourage Nuclear Medicine Departments to use the freely available data sets from past audits to evaluate their operator training and commission new software by making their own comparisons to the published results.Method. Either anonymous patient data or phantom studies are selected by the Group. Manufacturers are sent the data sets and asked to convert these to their proprietary formats and then provide the data sets in an electronic and physical format that their customers can transfer to their processing systems. Regional Area Coordinators (RACs) covering the whole of the UK are delegated the tasks of informing Nuclear Medicine Departments in their locality of the audit, providing proformas and collating results. Members of the NMSQG analyse the results and then publish the findings. As published results do not identify centres, individual results are returned through the RACs allowing centres to compare their own results with the published data.Results. Even a straightforward process for quantitative image analysis, such as calculating relative renal function in DMSA scans, has shown significant differences between centres. UK practice has been influenced by the audits and guidelines have been issued to encourage standardisation where significant variation in technique has been uncovered.Conclusion. Software audit is a necessary process to encourage reproducibility across platforms, and between operators and departments. The data from the NMSQG web site (http://nmsqg.org/) can be used by all Nuclear Medicine Departments for internal audit.
P056 Improvement in clinical evaluation of PET/CT images with high resolution algorithms L. Orlandini1, M. Betti1, M. Dona2, D. Fisicaro2, A. Castagnoli2; 1Centro Oncologico Fiorentino, Medical Physics Department, Firenze, ITALY, 2Prato General Hospital, Nuclear Medecine Unit, Prato, ITALY. AimThe positron emission tomography/computed tomography (PET/CT) plays an important role in staging and evaluating therapy response of various cancer types. The quality of reconstructed images strongly depends on the algorithms used because of the relationship between images and projection space. The aim of this work is to quantify how the introduction of high resolution algorithms allows to increase the diagnostic ability and allows an accurate identification of reduced dimensions lesions, anticipating and improving diagnosis.Materials & methodsThe diagnostic performances of the PET/CT used for this work have been checked with NEMA NU 2-2007 standards in terms of spatial resolution and image quality. The results were derived processing the data measured for a point source at different positions and the NEMA quality image phantom. Once tested the PET/CT performances, we compare results from clinical studies; twenty lesions upcoming from ten patients referred for PET/CT evaluation of lung cancer, head and neck, pelvis, lymphonodal deseases, were selected at this purpose. Studies have been reconstructed with two different algorithms: iterative one (fore plus osem 2-D) and high resolution (full 3D trueX); the clinical images have been estimated in terms of geometric characteristics and values of SUVmax, SUVmin, SUVmean.ResultsThe results of average transverse and axial spatial resolutions of FWHM obtained with NEMA standard measurements, and the results of image quality elaborated with the different algorithms confirms the values declared and the correct performance of Siemens PET/CT used. For the clinical studies, the results obtained show an increase in SUV max using TrueX algorithm of 8% for lesions with Vol > 3 cm3 ; this value rises up to 11% for Vol < 3cm3 ;the enhancement of SUVmean for in axis
Poster Presentations
A. G. Irwin, A. J. Craig, A. J. Britten; St. George's Hospital, London, UNITED KINGDOM.
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lesions is around 9% while for off axis the value reaches 15%. For SUVmax the increase is 20% for both the position. The difference obtained in the volume evaluation lead to higher values of volume estimation for small lesion (17%) while no significative changes are found for bigger lesions. The same analysis carried out for lesion with low uptake (SUV<5) indicate an improvement in volume estimation of about 10%.ConclusionsThe high resolution algorithms have the effect of reducing the high frequency noise, simultaneously improving the spatial resolution of the image; the partial volume effect is strongly reduced making the tracer uptake and contrast higher especially for small lesions. These properties provide an improvement on the evaluation of clinical images.
P057 Evaluation Study of a new gamma probe prototype 1
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A. Vicedo , M. Seimetz , L. Brualla , R. Angullo , R. Sanchez , J. Ferrer , R. Polo2, D. Abellán2, D. Granero1, C. Molinos2, L. Vidal2, T. Garcia1, J. Rosello4; 1ERESA - Medical Physics Department - HGUV, Valencia, SPAIN, 2 I3M -Molecular Image Research Institution, Valencia, SPAIN, 3ERESA Nuclear Medicine Department - HGUV, Valencia, SPAIN, 4ERESA - Medical Physics Department -UV-Department of Fisiology, Valencia, SPAIN. Introduction: Success in the detection of a sentinel lymph node depends on the user experience but also on the quality of the gamma probe used. Quality criteria to assure a good probe performance have been suggested in previous publications. The aim of this study is to evaluate a gamma probe prototype and to compare the new probe performance to other commercially available systems.Material and Methods: A W-Probe wireless gamma probe prototype from Oncovision was evaluated. The parameters measured to test the quality of the probe were the spatial resolution, the maximum activity, the aperture angle, the shielding, and the correlation between signal and display. The Navigator GPS 14mm and Neoprobe 2000 14mm were also evaluated and the results were compared to those published in previous studies to verify the methodology of work and to compare these probes to the prototype tested.Results: The new prototype showed good performance and fulfilled beyond the minimal requirements. The values obtained were: spatial selectivity 33º ( 5cps/kcps), spatial resolution 8.6 ± 1.0 mm ( < 15 mm) , 10 mm diameter and 0.5 % shielding, the acoustic signal shows good correlation between signal and tone. The values obtained for the Navigator GPS and Neoprobe 2000 were: maximum system sensitivity measured 5.7 ± 0.1 cps/kBs and 10.4 ± 0.4 cps/kps respectively (published data 5 cps/kBq and 9.8 cps/kBq), spatial resolution 15.9 ± 1.0 mm and 11.7 ± 1.0 mm respectively (published data 20 mm and 15 mm), shielding 0.9 % and 0.4% respectively ( published data 0.9% and 0.14% ).Conclusions: Most of the values measured for the Navigator GPS and Neoprobe 2000 agree with those published in other studies, which validates the methodology of work. The new probe prototype not only fulfils beyond the minimal established requirements but also improves the sensitivity, spatial resolution and spatial selectivity values of most of the commercially available systems. A wide range of gamma probes are commercially available with a wide range of system characteristics which makes necessary to evaluate the probe prior to purchase.
P06 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Molecular & Multimodality Imaging: PET/CT
P058 Diagnosis Of Recurrences And Metastases Of Colorectal Carcinomas Using 18FDG PET/CT V. B. Obradovic, V. Artiko, D. Sobic, N. Petrovic, M. Todorovic-Tirnanic, L. Brajkovic, E. Jaksic, S. Pavlovic; Center for Nuclear Medicine Clinical Center, Beograd, SERBIA. Aim: The aim of the study was assessment of recurrences and metastases of colorectal carcinomas using 18FDG PET/CT.Patients and methods: The total of 76 patients was investigated, 40 males and 36 females, mean age 55.2±6.7 years. Investigation was performed with PET/CT, 64 slice, Siemens, Biograph, during 25 min, started 45 min after i.v. application of 10 mCi 18FDG.All the patients were suspected of having recurrent or metastatic lesions, according to tumor marker (CEA and Ca 19-9) levels, physical examination, a clinical imaging work-up and endoscopy.Results: In 48/76 patients with recurrences, findings were true positive (TP), in 22/76 findings were true negative (TN), in 3/76 findings were false positive (FP) while in 3/76 findings were false negative (FN). In 2/3 FP finding was due to local inflammation on the region of anastomosis (both patients were investigated < 8 months after surgery), while in 2/3 FN findings, radiopharmaceutical was not taken by the tumor tissue (mixed tumors with the high mucin level). Sensitivity was 94% specificity was 88%, positive predictive value was 94%, negative predictive value was 88%, and accuracy 92%. PET/CT finding contributed to the patient management in 52 patients.Conclusion: FDG PET/CT is a valuable tool for diagnosis, staging and follow-up of metastases and recurrences of colorectal carcinoma, especially to distinguish recurrence or metastases from postoperative changes or
other benign lesions in postoperative colorectal cancer and radiologically or clinically suspicious lesions.
P059 FDG PET/CT in cutaneous lymphoma T. A. Szyszko1, S. Bouyoucef2, E. Wedgeworth3, M. O'Doherty1, Z. Viney3, B. Wilkins3, S. Morris3, M. Wain4, F. Child4, S. Whittaker4, S. F. Barrington1; 1 PET Imaging Centre, Kings College, London, UNITED KINGDOM, 2CHU Bab El Qued, Algiers, ALGERIA, 3Guys and St Thomas' NHS Trust, London, UNITED KINGDOM, 4St John's Institute of Dermatology, London, UNITED KINGDOM. AimTo establish the role of FDG PET/CT in imaging cutaneous lymphoma - if whole body imaging offers improved staging versus half body imaging; if the nodal biopsy site is appropriate and if metabolic activity correlates with histologyMaterials/MethodsThis was a retrospective audit of 87 patients with cutaneous lymphoma, who were underwent PET/CT imaging from October 2008 to August 2009. The mean age was 60 (28-87) and 23 patients were female. Selection was on the basis of discussion at a multidisciplinary meeting. Indications for imaging included disease staging, treatment response and assessment of biopsy site. Whole body imaging was done if the clinical history mentioned lower limb disease. Maximum SUV measurements of cutaneous and nodal uptake were recorded and divided into 4 categories: 6. Lymph node biopsy samples were all reviewed by a skin lymphoma histopathologist and classified as LN1-4 according to the National Cancer Institute criteriaResults21/34 patients who had whole body scans showed skin lesions in both the half body and legs; 4/34 showed skin lesions in the legs only; 5/34 showed skin lesions in the half body only and in 4/34 no skin lesions were identified. Popliteal nodal uptake was present in 4 patients. This did not alter patient management. Central nodes were present in 19 patients. Visceral involvement was seen in 7 patients with 5/7 having incidental lung pathology. 25 patients had nodal biopsies. 14 were malignant; maximum SUV was > 4 in 11 cases and 3.5 - 4 in 2 cases (one case was excluded). 11 biopsies were benign and nodal uptake was variable: 5 cases had a max SUV 6. The node with greatest short axis diameter was not in the same region as the most metabolically active node in 26% cases.ConclusionWhole body imaging with PET/CT should be limited to patients with lower limb only cutaneous lymphoma and those with leg tumours/masses. There is no advantage to scanning below the knees. PET/CT may have a role in distinguishing reactive from malignant lymphadenopathy and biopsy of peripheral nodes with maximum SUV >3.5 is recommended, although cases should be considered on an individual basis. PET/CT also offers great potential for improving the staging and monitoring of response to therapy. Clinical examination is required for the assessment of thin skin patches and plaques
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Utility of additional dedicated neck [ F]FDG-PET/CT imaging in patients with known or suspected neck malignancy E. Skoura, M. Skilakaki, E. Panagiotidis, A. Bournazos, C. Giannopoulou, E. Vlontzou, I. E. Datseris; EVANGELISMOS HOSPITAL, ATHENS, GREECE. Aim: The head and neck area is difficult to evaluate using traditional anatomical imaging or [18F]FDG-PET alone, due to the complex anatomy and multiple normal structures with variable physiologic [18F]FDG uptake. The aim of our study is to evaluate the utility of additional dedicated neck [18F]FDG-PET/CT images in the work out of patients with known or suspected neck malignancy.Materials and Methods: From January 2008 until January 2011, 6186 patients were examined with [18F]FDG-PET/CT in our department. 2743 of them had known or suspected disease at the head and neck area or equivocal findings on conventional imaging. A standard whole-body protocol was used in all these patients and the PET/CT images were reviewed by a nuclear medicine physician and a radiologist and agreement was reached by consensus. Studies were visually scored as positive, negative and equivocal.Among them, 97 patients, 56 men and 41 women, with mean age 64 years old (range 14-80), were included in our study using as inclusion criteria either the existence of a misalignment between PET and CT images or inconclusive results in whole-body [18F]FDG-PET/CT. In these patients, an additional dedicated neck [18F]FDG-PET/CT was performed. 48 of them had lymphoma-30 with Hodgkin disease and 18 with non-Hodgkin lymphoma-with neck involvement, 11 thyroid cancer, 7 laryngeal cancer, 8 nasopharyngeal cancer, 3 tongue cancer, 2 salivary gland cancer, one parathyroid cancer and one had mandibular cancer. Of the rest 16 patients 6 were examined for cancer of unkown primary, 1 for breast cancer, 1 for rectal cancer, 2 for non-small cell lung cancer, 2 for melanoma restaging and 4 had cervical lymph node metastasis of a known primary cancer outside the neck.Results: In 77 (of 97) cases there was misalignment between PET and CT images in whole-body [18F]FDG-PET/CT.After the additional dedicated neck [18F]FDG-PET/CT protocol was performed, 44 out of 97 patients (45.4%) had positive [18F]FDG uptake in lesions of the neck in the standard whole-body PET as well as in the additional dedicated neck [18F]FDG-PET/CT and 33 patients (34%) had both scans negative. Of the rest 20 patients (20.6%) with inconclusive whole-body [18F]FDG-PET/CT the additional dedicated neck images revealed lesions with
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P061 Diagnostic accuracy of FDG-PET/CT and ultrasound for the detection of lymph node metastases in breast cancer patients T. A. Heusner1, A. Koeninger2, S. Kuemmel2, A. Bockisch3, M. Forsting4, G. Antoch1; 1Dept. of Diagnostic and Interventional Radiology, Düsseldorf, GERMANY, 2Dept. of Gynecology and Obstetrics, University Hospital Essen, Essen, GERMANY, 3Dept. of Nuclear Medicine, University Hospital Essen, Essen, GERMANY, 4Dept. of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, GERMANY. PurposeTo retrospectively compare the diagnostic accuracy of FDG-PET/CT and ultrasound for the detection of lymph node metastases in breast cancer patients.Materials and Methods90 patients (89 female, one male, mean age, 55.5 +/- 16.6 y) suffering from primary breast cancer underwent whole-body FDGPET/CT and axillary ultrasound. The ipsilateral axillary fossa was evaluated for metastatic spread. The sensitivity, specificity, the PPV, NPV, and accuracy of both methods was calculated and statistically compared using the McNemar Test (p<.05). Analyses were made on a patient-basis. The number of patients with extraaxillary locoregional lymph node metastases only detected by FDG-PET/CT was evaluated. For axillary lymph node metastases histopathology served as the reference standard.ResultsThe sensitivity, specificity, PPV, NPV, and accuracy of FDG-PET/CT for the detection of axillary lymph node metastases was 54%, 89%, 77%, 74% and 75%, respectively. For ultrasound it was 38%, 78%, 54%, 65%, and 62%, respectively. FDG-PET/CT was significantly more accurate than ultrasound for the detection of axillary lymph node metastases (p=0.0003) (figure 1). In addition, FDG-PET/CT detected extra-axillary locoregional lymph node metastases in 7 patients (8%) that had not been detected by ultrasound.ConclusionDue to the higher diagnostic accuracy of FDG-PET/CT for the detection of axillary lymph node metastases in breast cancer patients axillary ultrasound may be dispensable in patients undergoing FDG-PET/CT. By detecting locoregional extra-axillary lymph node metastases FDG-PET/CT contributes to a correct locoregional staging in a relevant number of patients. However, based on its overall moderate sensitivity and accuracy it cannot replace invasive axillary staging approaches.
P062 Comparative analysis of image processing algorithms on quadratic and hexagonal grids S. A. Kis, G. Opposits, I. Lajtos, T. Spisak, L. Balkay, G. Kovacs, L. Tron, M. Emri; University of Debrecen, Debrecen, HUNGARY. AIM: The goal of the study was to examine how hexagonal sampling affects filtering, region analysis and image reconstruction. Comparing to the ordinary quadratic grid, the hexagonal grid structure gives smoother and denser sampling rate even with the same pixel size. The expectation is that the studied image processing and image reconstruction methods give better results on hexagonal grid .MATERIAL AND METHODS: The algorithms working on hexagonal grids have been implemented and tested in the Multimodal Medical Imaging (M3I) software development environment. The volumetric data representation in M3I libraries was extended to model hexagonal sampling besides the commonly used quadratic sampling approach. Furthermore, algorithms have been developed and implemented to calculate the area of intersecting polygons and hexagonal pixels and to evaluate the path of lines in hexagonal grids using a fast ray tracing technique. These algorithms enable us to develop test programs applying quadratic and hexagonal sampling models on the same input data. The test programs were applied to Monte-Carlo simulated data and images acquired by the MiniPET-II and human PET cameras, as well.RESULTS: According to our expectations, tests have shown that the 2D iterative image processing and filtering algorithms, give better results on hexagonal grid than on quadratic grid. In region analysis the hexagonal and quadratic sampling methods lead to similar results, no significant differences were experienced.CONCLUSION: It is definitely useful to fit the hexagonal sampling method in the process of image reconstruction. However, the efficient use of hexagonal grids in visualization and complex data processing procedures requires thoughtful and thorough design.
P063 Comparison of findings of 18FDG PET/CT and conventional imaging in recurrence of intrabdominal cancer in patients with rising tumour markers E. Panagiotidis, D. Exarhos, C. Giannopoulou, M. Skylakaki, D. Drougas, E. Vlontzou, I. Datseris; Evaggelismos Hospital, Athens, GREECE.
Objective: The aim of this retroprospective study was to evaluate the diagnostic performance of 18FDG PET/CT and conventional imaging (CI) to assess the extent of recurrence of intrabdominal cancer in patients with increasing levels of tumor markers.Methods- Materials: 128 cancer patients (48 male; 80 female; age 61,1 ± 11,5SD) with rising tumour markers underwent 146 FDG PET/CT examinations between March 2009 and November 2010 in our department in search of occult recurrent cancer. Conventional images negative for recurrence were excluded from the study. The median interval time between the last treatment (surgery and chemotherapy and/or radiotherapy) and imaging exams was 65±6 weeks. All patients underwent both CI (CT, MRI) and subsequently PET/CT within 2±1 months. The respective malignancies in decreasing order of frequency were 65 cases (50.8%) with colon cancer, 23 (18%) with ovarian cancer, 10 (7%) with pancreatic cancer, 8 (6,3%) with hepatic cancer, 7 (5.5%) with endometrial cancer, 6 (4.7%) with gastric, 5 (4%) rectal cancer, 2 (1,5%) with esophageal cancer and 2 (1.5%) with cervical cancer. 46 (36%) patients presented with elevated carcinoembryonic antigen (CEA), 33 (26%) patients with elevated cancer antigen 199 (CA199), 28 (22%) patients with elevated cancer antigen 125 and 21 (16%) patients with elevated both CEA and CA199. Conventional images negative for recurrence were excluded from the study. 97 (75%) patients underwent CT, 25 (20%) patients underwent MRI and 6 (5%) underwent both imaging modalities. Follow-up data were obtained with clinical evaluation and/or radiological findings.RESULTS: PET/CT lesions were in concordance with CI studies in 74 (58%) patients: 57 CT, 15 MRI and 2 both imaging modalities. In 48 (37%) examinations PET/CT revealed more lesions than CI: 37 CT, 7 MRI and 4 both scans, concerning lymph node invasion, peritoneal dissemination, bone and hepatic metastasis. Clinical management was changed in 28 (22%) of these patients, by upgrading the clinical stage. Of the remaining 6 (5%) patients with relapse from conventional imaging, 3 PET/CT exams revealed fewer liver lesions than MRI without altering either the clinical stage or the management decision, 1 PET/CT exams were true negative for liver lesion compare to CT and 2 PET/CT exams were false negative for pulmonary nodules (measuring<5mm) compare to CT.CONCLUSION: 18FDG PET/CT can be useful in the detection of tumor relapse, as well as in performing accurate restaging in patients with known malignancy and raised tumor marker level.
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Use of benzodiazepines before F-FDG-PET/CT dual-phase imaging does not decrease the efficacy of the study. T. Özülker, F. Özülker, Ö. Eker, T. Tatoğlu, T. Özpaçacı; Okmeydanı Training and Research Hospital, İstanbul, TURKEY. It has been well known that delayed imaging (2-3 h post injection) in 18F-FDGPET/CT studies might help in differentiating malignant lesions from benign ones. It has also been postulated that the routine use of benzodiazepines before intravenous administration of 18F-FDG might decrease the hexokinase/glucose-6phosphatase ratio and render dual-phase study ineffective since the efficacy of dual-phase or delayed imaging is thought to be related to the elevated ratio of hexokinase to glucose-6-phosphatase in tumor cells. We aimed to investigate whether administration of benzodiazepines decreases the efficacy of 18F-FDGPET/CT dual-phase imaging.Eighteen patients with malignant tumours (14 male and 4 female; mean age 49.6± 12.3 years; age range 28-71 years) who were administered 0.5 mg alprazolam before undergoing 18F-FDG-PET/CT scan (Group A) and 21 patients with malignant tumors (12 male and 9 female; mean age 52±11.8 years; age range 31-71 years) who were not administered alprazolam before 18FFDG-PET/CT scan (Group B) were included in this study. Initial "early" whole body imaging commenced 60±5 minutes after injection of 18F-FDG and "delayed" scan was obtained 120±10 minutes after the injection. The retention index (RI) of the lesions were obtained by calculating the percent change in SUVmax between SUVmaxE and SUVmaxD using the formula: (SUVmaxD−SUVmaxE) × 100/SUVmaxE.The average SUVmax in lesions in Group A (mean ± S.D.) was 10.2±6.4 on early examination (SUVmaxE) and 12.6±7.6 on delayed examination (SUVmax D). There was a significant difference between these two time points (p < 0.05). In 36 of 40 lesions (90%) an increase in uptake values were detected. Similarly, for the lesions in Group B, the average uptake values were 9.3±5.2 (SUVmaxE) and 11.2±6.5 (SUVmaxD). The increase in these values was significant as it was in the Group A (p < 0.05). In 60 of 66 lesions in this group (90.9%) an increase in uptake values were detected. Differences between Group A and B for the variables SUVmaxE , SUVmaxD and RI were not significant statistically (p>0.05).There was not any significant difference between patients who were given alprazolam before FDG-PET study and who were not administered any benzodiazepines, concerning the ratio of increase of SUVmax between early and delayed imaging studies. We concluded that benzodiazepines do not adversely affect the efficacy of the dual-phase FDG-PET imaging technique.
Poster Presentations
positive [18F]FDG uptake in 11 patients and negative in 9 patients.[18F]FDG-PET/CT findings were confirmed by biopsy or follow-up.Conclusion: Additional dedicated neck [18F]FDG-PET/CT imaging seems to be useful in patients with known or suspected neck malignancies and inconclusive standard whole-body [18F]FDGPET/CT scan.
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P065 Incremental value of 18F FDG PET-CT over CECT in the surveillance of large bowel malignancies. S. Dash, P. Thakral; Sir Ganga Ram Hospital, NEW DELHI, INDIA. Aim: To determine the impact of whole body 18F FDG PET-CT in decision making in the management of large bowel malignancy patients.Material and Methods: A prospective study of 110 patients of suspected or biopsy proven large bowel malignancy with normal or raised serum CEA level was carried out using whole body 18F-FDG PET-CT scan along with CECT. Oral contrast was used in all the patients to better delineate the abdominal tumors. Intravenous and rectal contrast were also used in selected cases. Both the scans were interpreted by two independent observers.Result: All 110 patients were grouped in two categories, one with normal CEA level and the other with elevated CEA level. Out of these 110 patients, 6 patients had CEA level within normal range and 104 patients had raised CEA level. In both patients with normal CEA level, PET CT was able to detect local disease and the results were discordant with CECT abdomen.In the other group of 104 patients with unexplained rise in serum CEA levels, in 59 patients PET CT and CECT results were concurrent in detecting locoregional and distant metastatic disease. In 16 patients PET CT and CECT results were discordant. In these patients CECT findings suggestive of post radiation fibrosis were detected to have recurrence on the PET CT scan, which were later proven histopathologically as well.PET CT demonstrated an absence of any abnormal FDG avid focus in the whole body survey in 29 patients. Out of these 29 patients, the PET CT results were concordant with CECT scan in 15 patients and there was no evidence of active disease on the CECT scan as well. However PET CT results were discordant with CECT in 4 patients. In these 4 patients, CECT suggested lesions suspicious of local recurrence or metastases. Of these 4 CECT positive patients, 3 were negative histopathologically whereas 1 had a positive biopsy for mucinous adenocarcinoma of rectum which could be the possible explanation for non FDG avid lesions on PET CT.Conclusion: 18F FDG PET CT as an isotropic metabolic imaging modality has an incremental role over CECT in the work up of colorectal and other large bowel malignancies. The ability to detect metabolic activity helps in detecting occult malignancies and in lesion characterization when used in surveillance for local residual / recurrent disease or in unsuspected distant metastasis.Key Words: 18F FDG PET CT, CEA
P066 Potential Application of 18F-FDG-PET/CT for Nuclear Power Plant’s Workers in South Korea M. Chae1, S. CHOI1, B. KIM2; 1Radiation Health Research Institiute, Seoul, KOREA, REPUBLIC OF, 2Korea Institute of Radiation and Medical Science, Seoul, KOREA, REPUBLIC OF. PURPOSE: 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET /CT) have the potential to detect a wide variety of cancers at early stages in asymptomatic subjects. This study was to evaluate the potential advantage of FDG-PET/CT for cancer screening and other clinical value of workers in nuclear power plants.METHODS: Between March 2003 and March 2011, 1629 of asymptomatic workers at nuclear power plants (1,592 men and 37 women, mean age +/- SD, 46.0+/-7.6 years) were examined using FDG-PET/CT for medical checking-up. In subjects showing positive findings for PET/CT (hypermetabolic lesion in PET or abnormal findings in CT), further diagnostic tests and pathological confirmation were performed.RESULTS: Malignant tumors were detected only in 3 of the 1,629 workers (0.18%). There were one of sigmoid colon caner, one of rectal cancer, and one of nasal cavity cancer, respectively. We detected a lot of controversial lesions. Those were 16 of colonic polyp, 52 of thyroid lesions (thyroiditis, and benign nodule), 20 of pulmonary lesions (focal pneumonia and old tuberculosis), 15 of gastric lesions, and 8 of uterine lesion. Those lesions were revealed benign lesions after follow-up. There were obvious benign lesions, which were 55 of renal cyst, 42 of hepatic cyst, 36 of renal stone, 21 of gall stone, and 8 of prostate hyperplasia.CONCLUSIONS: FDG-PET/CT provides functional and anatomical state of subjects of their whole body image. We could detect malignant tumors and differentiate the benign disease from malignancy using this PET combined CT modality. Therefore, FDG PET/CT can be a useful cancer screening tool in high-risk group and appropriate combination with other screening modalities.
weighted image (DWI) by MRI can be useful in detecting malignancies similar to FDG-PET imaging. We studied the potential prognostic significance of pre-surgery FDG-PET and MRI in pancreatic cancer.Materials and MethodsPre-surgery patients with either proven or suspected primary pancreatic cancer underwent a FDGPET/CT and DWI by MRI. The malignancy or benignancy of excised specimens was pathologically confirmed in all cases.The apparent diffusion coefficient (ADC) was measured with DWI. We obtained standardized uptake value (SUV) in PET image. We can slightly improve SUV by using blood glucose corrected SUV (SUV*g: SUV × blood glucose level).The value of each factor for differential diagnosis of tumor malignancy was determined by receiver operating characteristic (ROC) analysis with suspected pancreatic cancer. Similarly, the predictive value of each factor for 1-year disease-free survival (DFS) and overall survival (OS) were determined by ROC analysis with proven pancreatic cancer.ResultsOn ROC analysis for differential diagnosis of tumor malignancy, the areas under the curve (AUC) of ADC, SUV and SUV*g were 0.830, 0.855 and 0.892, respectively. We considered that these three factors were good indexes for the diagnosis of tumor malignancy.For DFS, the AUC of ADC, SUV and SUV*g were 0.600, 0.843 and 0.811, respectively. The AUC of SUV and SUV*g were larger than the AUC of ADC. For OS, the AUC of ADC, SUV and SUV*g were 0.573, 0.648 and 0.867, respectively. The AUC of SUV*g was larger than the AUC of ADC and SUV. The SUV and SUV*g of FDG-PET/CT might be better indexes for estimation of prognosis.The 1-year DFS rate above the cutoff (SUV>4.3, SUV*g>400) were markedly lower than the rate below the cutoff (SUV≤4.3, SUV*g≤400) (0% vs. 67% p<0.002, 11% vs. 75% p<0.02). There is no statistically significant difference in the OS, but the OS rate above the cutoff (SUV*g>400) tended to be lower than the rate below the cutoff (SUV*g≤400) (0% vs. 57%, p=0.06).ConclusionsThe results of FDG-PET/CT were significantly associated with outcome after definitive therapy of pancreatic cancer. FDG-PET/CT in preoperative evaluation of pancreatic tumor might be useful not only for differential diagnosis of tumor malignancy but also for estimation of prognosis.
P068 Clinical role of C-11-methionine-PET/CT in detection of adrenal metastasis from lung cancer. S. Ohashi, K. Yoshikawa, T. Sachiko, M. Hasebe, H. Ishikawa, K. Tamura, K. Tanimoto, S. Kandatsu, N. Yamamoto, M. Baba, T. f*ckumura, T. Saga, T. Kamada; National Institute of Radiological Sciences., Chiba, JAPAN. Purpose:Phase I/II clinical trial on carbon ion radiotherapy (CIRT) has been conducted in patients with non-small cell lung cancer (NSCLC) in our institute, and we use C-11-methionine (MET) PET/CT for staging and monitoring treatment of NSCLC. Adrenal gland is one of common sites of metastasis from NSCLC. The objective of this study was to determine if MET-PET/CT could distinguish adrenal metastasis from benign gland.Materials and Methods:We performed a retrospective review of patients with NSCLC and found 125 cases evaluated with MET-PET/CT, Toshiba Aquiduo, who treated by CIRT and followed more than 2 years from 2006 to 2009. There were 71 adenocarcinoma, 48 squamous cell carcinoma and 6 other carcinoma. Five patients in these 125 patients proved developing adrenal metastasis, three in left adrenal gland and 2 in right adrenal gland. All these 5 adrenal lesions were histologically proved. We use TNR, tumor to normal tissue ratio, to estimate MET accumulation. We evaluated statistically, nonpared t-test, the difference between normal left and right adrenal gland MET uptake, and then we compared MET uptake in adrenal metastasis with normal adrenal gland. We analyzed the ability of MET-PET/CT for differential diagnosis by receiver operating characteristic (ROC) analysis.Results:Mean MET uptake of left and right normal adrenal gland was 3.9±2.0 and 2.8±1.0, respectively. There was significant difference in MET uptake of normal adrenal gland between left and right (p<0.01). Right adrenal gland showed higher MET uptake than left adrenal gland. It seemed because of spilling over into the right adrenal gland from adjacent liver with high accumulation of MET. Mean MET uptakes of left adrenal metastasis (3 tumors) and right (2 tumors) were 9.3 and 2.8, respectively. The ROC analysis of MET uptake of left adrenal metastasis and left normal adrenal gland resulted 0.77 area under the curve (AUC), that expressed as moderate accuracy. For right adrenal metastasis, AUC was 0.68 that was low accuracy.Conclusions:Normal adrenal gland showed significantly higher MET uptake in right than left adrenal gland. The diagnostic accuracy of MET-PET/CT for detecting adrenal metastasis from NSCLC was moderately accurate in left adrenal gland, but was low accurate in right adrenal gland.
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P067 Pre-surgery SUV and ADC as prognostic factor for outcome in pancreatic cancer 1
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K. Tanimoto , K. Yoshikawa , T. Shiraishi , E. Inagaki , S. Toubaru , S. Ohashi1, T. Obata1, T. Saga1, K. Watanabe1, H. Tsuji1, Y. Ando1, T. Kamada1, A. Kato2, M. Miyazaki2; 1National Institute of Radiological Sciences, Chiba, JAPAN, 2Chiba University, Chiba, JAPAN. ObjectivesFDG-PET provides quantitative information regarding the tumor glucose metabolism which is useful for the clinical diagnosis of tumor diseases. A diffusion
18F-FDG-PET/CT in Prostate Cancer: is there any role? L. Gogou, D. Kehagias, A. Nikaki, V. Filippi, F. Vlachou, R. Efthimiadou, K. Gogos, V. Papoutsis, I. Andreou, V. Prassopoulos; HYGEIA HOSPITAL, ATHENS, GREECE. AIM: the role of PET/CT in prostate cancer regardless of the radioisotope used is to show local recurrence, to exclude distant disease whenever local salvage therapy is planned and to determine the extent of disease. About 86% of the patients with biochemical relapse have negative anatomic imaging. In this retrospective study,
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P070 A correlative study with age and sex associated changes of cerebral glucose metabolism in healthy subjects using 18FDG PET. A. Anjum, P. Payoux, P. Celsis, K. Boulanouar, Alzheimer's Disease Neuroimaging Initiative.; INSERM; Imagerie Cerebrale et Handicaps Neurologiques UMR 825; université de Toulouse, TOULOUSE, FRANCE. Objectives:-As we know, the cerebral glucose metabolism depends upon age and sex. The regions where the changes occurred are different and controversial in different previous studies. For more reliable assessment, we investigated the cerebral metabolic changes considering age in continuous manner in healthy subjects using Positron emission tomography (PET) with 18-fluoro-2-deoxyglucose.Materials and methods:-156 healthy subjects (86 males, 70 females), age between (59-81) years were included in the present study. Cerebral metabolic images were obtained from site of ADNI (http://adni.loni.ucla.edu/). Age related and sex related changes and their interaction was assessed through group analysis using statistical parametric mapping (SPM8).The cerebral metabolic changes associated with age and sex declared significative at p<0.01; corrected for multiple comparisons (False discovery rate) and an extent threshold k=40 voxels.Results:-In females, a negative correlation with age was observed mostly in frontal gyrus (BA 8, 9, 47) and insula (BA 13) whereas positive correlation was observed in temporal gyrus. In males, a negative correlation was observed in right parietal (BA 40) and left superior frontal (BA 6) whereas a positive correlation was found in posterior cingulate (BA 29).When comparing males to females, we found more age-related changes in females than males in right precentral gyrus (BA 6), right insula (BA 13), right inferior frontal gyrus (BA 45) and right inferior parietal lobe (BA 40) whereas changes in males greater than females are in left posterior cingulate (BA 29), bilateral parietal gyrus (BA 7) and frontal gyrus (BA 6).Without taking into account age, the regions which show more metabolic changes in males are posterior cingulate (BA 30), left cerebellum and medial frontal gyrus (BA 10) whereas in females these effects are in right precentral gyrus (BA 6) and left parietal gyrus (BA 3).Conclusion:-We conclude the negative effect of aging in females occurs mainly in frontal lobe and insula whereas in males this effect occurs in parietal and posterior cingulate. For some regions our results are consistent with the previous studies. The effect of age and sex should be taken into account when 18-FDG PET images are used for clinical purposes concerning cerebral pathology.Bibliography:-1. Kim IJ et al, Acta Radiol : 50 (2009)1169-11742. Fujimoto T et al, Psychiatry Research: Neuroimaging 164 (2008) 58- 723. Kawachi T et al, Journal of the Neurological sciences: 199 (2002) 79-83
P071 18
F-FDG relationship with histopathological and immunohistochemical data in breast cancer using SUV with or without Partial Volume Correction
F. Gallivanone1, A. Stefano2, C. Canevari3, S. Isabella3, E. Grosso2, S. Pulizzi4, L. Gianolli3, C. Messa5, M. Gilardi6, I. Castiglioni1; 1IBFM - CNR, Segrate (MI), ITALY, 2LATO srl, Cefalù (PA), ITALY, 3Scientific Institute H. San Raffaele, Milan, ITALY, 4Nuclear Medicine Department, HSR-Giglio,
Cefalù (PA), ITALY, 5Tecnomed Foundation, Milan, ITALY, 6IBFM - CNR and Tecnomed Fundation, Segrate (MI) / Milan, ITALY. The assessment of the prognostic value of in vivo molecular imaging by 18F-FDG PET-CT is crucial to address oncological patient to optimal therapy (including surgical resection), allowing tumour malignancy to be characterized non invasively. Quantification errors on the measurement of in vivo quantitative PET parameters can affect their prognostic value.AIM: to assess the value of 18F-FDG quantification with Partial Volume Correction (PVC) in breast cancer in comparison with histopathological and immuno-histochemical data.MATERIALS & METHODS 30 oncological patients with biopsy-proven breast cancer (size ranging from 1 cm to.5 cm) were enrolled. Patients underwent a 18F-FDG PET-CT study before surgery on a PET-CT scanner (1mCi/10kg injected, exam started after 45min from injection). Patient weight, injected dose, and residual were measured. Averaged Body-Weight Standardized Uptake Value (SUVBW) was calculated and PVC was applied using a Recovery Coefficient-based method [1]. After surgery, excised tissues were sectioned. Tumors were classified according to the WHO guidelines [2]. Standard pathological data (histological type, grade) and baseline immunohistological characterization were obtained. Mann-Whitney and Kruskal-Wallis tests were used to evaluate one-to-one correlation of SUV with histopathological and immunohistochemical findings.RESULTS SUV strongly correlated with histological type (Invasive Ductal Carcinoma, IDC or Lobular Carcinoma, ILC) both with and without PVC (p<0.019, p<0.023). In particular, IDC was found correlated to a broad distribution of SUV values (e.g. PVC-SUV: 3.1÷28.2 g/cc) , ILC to a narrow distribution of SUV (e.g. PVC-SUV: 1.7÷3.5 g/cc ). SUV correlated strongly also with histological grade, and a better statistical significance level was found when PVC was applied (p<0.034 vs p< 0.011, before and after PVC, respectively). Poor correlation was found between SUV and MiB-1 (proliferation index), only when PVC was applied (p<0.10 vs p>0.10 without PVC).CONCLUSIONSA strong correlation between SUV - histological type and SUV - grade, indicative of malignancy and outcome, was found, thus suggesting a SUV prognostic value in breast cancer, independently from PVC. However, PVC increases the statistical significance of statistical tests between SUV and histo-pathological and immuno-histochemical factors.[1] Gallivanone F. et al., (2011) “PVE Correction in PET-CT Whole-Body Oncological Studies From PVE-Affected Images” , IEEE Transactions on nuclear Science[2] Tavassoli FA, Devilee P, eds. (2003) “World Health Organization Classification of Tumours: Pathology and Genetics of tumours of the Breast and Female Genital Organs” IARC Press.
P072 Accuracy, reproducibility, feasibility and clinical impact of a PVC on 18F-FDG quantification in bone metastases by PET/CT follow-up studies A. Stefano1, F. Gallivanone2, E. Grosso1, G. Russo2, C. Messa3, V. Tripoli1, M. C. Gilardi2, I. Castiglioni2; 1LATO HSR Giglio S.c.a.r.l., Cefalù (PA), ITALY, 2IBFM-CNR, Milan, ITALY, 3University of Milan-Bicocca, Milan; LATO HSR Giglio S.c.a.r.l., Cefalù (PA), ITALY. AIM The aim of this work was to evaluate the accuracy, reproducibility, feasibility and clinical impact of a Partial Volume Correction (PVC) method on 18F-FDG quantification in bone metastases by PET/CT follow-up studies.MATERIALS & METHODS PVC method was based on Recovery Coefficients obtained for different PET measured sphere-to-background ratios and sphere volumes (NEMA phantom) by operator-independent standardized regions of interest on lesion and background [1]. PVC accuracy and reproducibility were evaluated on thoraxoncological phantom simulating three bone metastases (spheres with diameter=9.8,12.3,15.6mm) within a thorax region in terms of Residual error and Coefficient of Variation (CV), averaged over different operators. The clinical feasibility of the PVC method was assessed. The clinical impact of PVC was evaluated in a follow-up study of oncological patients, by assessing the changes, as effect of PVC, on Standardized Uptake Value (δSUV) and on tumour response classification (EORTC 1999). 30 patients with bone metastases were 18F-FDG PET/CT studied before and after chemotherapy treatment. SUV was calculated with and without PVC, for both studies (49 lesions in total).RESULTS Accuracy: PVC recovered 92% and 76% of radioactivity concentration for lesions with diameter >1cm and <1cm, respectively. Reproducibility: CV was found 5.7% (averaged over 2 operators). Feasibility: bone metastases had a round shape (93%) and uniform tracer distribution (90%), with sphere-equivalent diameter from 0.6 to 3.4cm (1.47±0.55cm) and measured Lesion-to-Background from 2 to 26 (6.46±4.5). All parameters were found compliant with the proposed PVC approach and the PVC was found feasible. Clinical impact: In 16% of cases, PVC changed the tumor response classification: in 4 cases from stable response to progression, in 3 from stable to partial response and in 1 from partial to stable response. In the remaining 84% of cases, PVC did not change the tumor response classification, but greatly changed the SUV variation during follow up (δSUV), as follows. Lesions in partial response (14): δSUV increased by 16% (<δSUV>=-54,5%±13,9% VS <δSUVPVC>=46,7%±11,3%); lesions in stable response (19): δSUV decreased by 40% (<δSUV>=5,2%±14,3% VS <δSUVPVC>=-8,8%±11,7%); lesions in disease-progression (8): δSUV decreased by 50% (<δSUV>=93,3%±59.5% VS <δSUVPVC>=62%±39,7%).
Poster Presentations
the value of 18F-FDG-PET/CT in prostate cancer patients with biochemical relapse was attempted to be determined.METHOD-MATERIAL: In this retrospective study, we searched the files of 35 patients who underwent 37 18F-FDG-PET/CT examinations, from 2004 until 2010, for evaluation of recurrent/ residual clinical disease, after biochemical relapse (PSA >0.4ng/ml). For 28 patients the exact values of the measured PSA were available. These patients were separated into 3 groups according to PSA levels: GROUP A: PSA<4ng/ml (number of patients: 8), GROUP B: PSA=4-10ng/ml (number of patients: 11), GROUP C: PSA>10ng/ml (number of patients: 9).RESULTS: 18F-FDG-PET/CT was positive in 14 cases (lung metastatic disease in one case, osseous metastasis in 7 cases, lymph node invasion in 8 cases, invasion of iliac-psoas in one case and local recurrence in 2 patients) and negative in 23 cases, while anatomic imaging (CT) was negative in 17 cases, positive in 15 and equivocal in 5. Of the patients, whose structural imaging was negative, PET was positive in 2 (bone, local recurrence) and of those with equivocal (CT), PET was negative in 3 and positive in 2 (bone, lymph node). In 4 cases PET revealed more metastatic lesions (2 local recurrence, 1 osseous, 1 iliac-psoas invasion). In one case PET/CT revealed secondary primary (pancreatic) tumor. In detail, GROUP A: 18FFDG-PET/CT was positive in one case (12.5%), revealing local recurrence (SUV=5.7) and one bone hypermetabolic foci (SUV=7.24). GROUP B: 18F-FDG-PET/CT was positive in three (30.7%) cases revealing pulmonary (SUV=6.4), osseous (SUV=5.7), lymph node invasion (SUV=13-21.6) for the first patient, local recurrence for the second and second primary (pancreatic) cancer for the third. GROUP C: 18F-FDGPET/CT was positive in eight cases (88.8%). The patient, whose PET was negative had a negative anatomic imaging assessment.CONCLUSION: According to our findings, the value of 18F-FDG-PET is limited when PSA values are under 4ng/ml (PET positive in 12.5%), but, for PSA values over 10ng/ml, PET was positive in 88.8% of the cases. PET can be useful when the rest imaging assessment is negative or equivocal.
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S278 CONCLUSION The proposed PVC approach was found accurate, reproducible and feasible in follow-up quantitative studies on bone metastases. Moreover, PVC can increase the diagnostic confidence on monitoring treatment response by PET/CT studies.[1] F. Gallivanone et al., PVE correction in PET from PVE affected images. 2009 IEEE Nuclear Science Symposium Conference Record (NSS/MIC), pp. 31463150.
P073 Dual-phase, 18FDG-PET/CT imaging in patients with various cancer types. D. Drougas, C. Giannopoulou, E. Panagiotidis, M. Skilakaki, P. Rondogianni, E. Vlontzou, E. Chousianakou, I. Datseris; Evaggelismos Hospital, Athens, GREECE. AIM: The purpose of this study was to evaluate whether dual-phase (DP) fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) imaging, has the potential to improve detection ability of FDG avid, hypermetabolic abdominal foci, such as peritoneal implants or small lymph nodes, in patients with various cancer types.PATIENTS-METHODS: 5100 patients with histologically proven various types of cancer, referred to our nuclear medicine department for initial staging, restaging and recurrence evaluation in the time period of May 2009 to March 2011, were included in this retrospective analysis.140 patients underwent dual-phase 18F-FDG PET/CT studies, at an early (60 min), as well as delayed (90-120 min) time, after the intravenous administration of 370MBq 18F-FDG. The decision about performing a DP study (additional acquisition) and the final evaluation (qualitative and semi-quantitative) were performed by two experienced physicians, one nuclear medicine specialist and one radiologist.Lesion final status was determined by pathologic findings or by clinical follow-up.RESULTS: In 140 of 5100 patients (2,7%) with inconclusive initial site detection due to either low FDG uptake, or precise localization difficulty , an additional delayed study (DP) was performed.DP was performed in decreasing order of frequency in patients with: pancreatic cancer (14.29%), urinary bladder cancer (14.29%), ovarian cancer (10.91%), colorectal cancer (5.49%), CUP (3.5%), NHL (2.91%) and HL (1.01%). In the rest cancer types DP was performed in less than 1% of patients.In 79 patients (56.4 %) the delayed image confirmed the initial positive impression; in 44 (31.4%) it leaded to site exclusion and in 17(12.1%) the site impression remained inconclusive.CONCLUSIONS: Dual-phase fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) imaging, has the potential to improve the detection ability of hypermetabolic abdominal foci, in a cohort of patients with various malignancies examined in a large tertiary hospital
P074 Correlation of Pre- and Post- Transplantation 18F-FDG-PET/CT IN HODGKIN DISEASE (HD) Using Different Cutoff Of STANDARDISED UPTAKE VALUES (SUV) A. Nikaki, D. Savvidou, F. Vlachou, D. Kehagias, L. Gogou, R. Efthymiadou, K. Dalianis, K. Gogos, I. Andreou, V. Prassopoulos; HYGEIA HOSPITAL, ATHENS, GREECE. AIM: To evaluate the correlation of pre-transplantation PET/CT with posttransplantation PET/CT in patients with HD, who underwent autologous transplantation, using different cutoffs of SUV to discriminate positive from negative PET.METHOD- MATERIAL: 37 patients with HD, underwent 18F-FDGPET/CT 1 week- 3 months before (1st PET) and 1- 3 months after (2nd PET) autologous transplantation. Additional therapeutic intervention between the two examinations was co-evaluated. Different cutoff values of mean SUVmax were used to discriminate positive from negative PET: A) cutoff=2.5 was applied, B) cutoff=4. Correlation between the 1st and 2nd PET was searched for both cutoff values separately. Comparison of the results gained from the two different cutoff values was also assessed.RESULTS: A)Using cutoff=2.5, concordance between 1st and 2nd PET was found in 21/37 patients, 14 pairs of PET examinations being positive (11 patients received extra therapy) and 7 being negative (none received extra treatment). Disagreement between the two PET examinations was found in 16/37 cases. In 15 cases 1st PET was positive and 2nd PET was negative (11/15 patients received additional treatment). In one case 1st PET was negative and 2nd PET was equivocal. B)Using cutoff= 4, concordance between 1st and 2nd PET was found in 19/37 patients, 10 pairs positive (9 patients received additional therapy) and 9 negative (without extra treatment). Disagreement between the two PET examinations was found in 18/37 cases. In 16 cases 1st PET was positive and 2nd negative (12 with extra therapy). In one case, 1st PET showed 2 active lesions (meanSUVmax=2.8, 3.2), while the 2nd was positive pointing the above lesions with mean SUVmax= 11. Finally in one case (as described above) 1st PET was negative and the 2nd equivocal. Differences between the two ways of discriminating positive from negative PET were found in 5 patients: for 3 patients, agreement (positive PET) was described when a 2.5 cutoff was used and disagreement when 4 was used. For 1 patient, correlation occurred with cutoff=4 and disagreement with cutoff=2.5. Interestingly, both pairs of PET examinations of a patient showed agreement, one pair being positive and the other one negative.CONCLUSION:
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 Patients with negative 1st PET tend to have negative 2nd regardless of the cutoff value used (2.5 or 4) and do not receive additional treatment. Concordance was better when cutoff= 2.5 was used for positive examinations and 4 for negative examinations, however it is equivocal if that difference is important in a small sample.
P075 Development of PET in Western Europe A. N. Stevens; Medical Options, London, UNITED KINGDOM. AIMS To track the development of PET in Europe.MATERIALS AND METHODS Facilities with PET, PET/CT and or cyclotron(s) were identified from a number of sources and were invited to provide details of their equipment profile, workload and the source(s) of radiopharmaceuticals. We were able to identify over 95% of sites operating in Western Europe. 66.8% of these sites provided workload numbers. To estimate throughput of sites who hadn’t taken part in the study we took two approaches. For routine FDG studies we developed a segmentation scheme which identified ten types of facility and applied an average to these sites. For compounds other than 18FDG country workload was calculated based on the segmentation scheme and whether a site had access to an on-site cyclotron.RESULTS In 2010 there were 506 providers of PET and/or PET/CT in Western Europe of which 22 were mobile. PET/CT accounted for 87% of the installed scanners up from 72% in 2008. 96% of studies used 18FDG. Of the remainder the majority of scans used longer life isotopes. 55% were 18F of which 18F-choline comprised 32%, 16% were 68Ga. There has been little change in the overall use of short lived isotopes although the mix has shifted away from 18O and 13N towards 11C.Levels of investigation in Northern Europe (1,387/million) and Southern Europe (3,283/million) are consistent with activity seen with other modalities. West Europe (NL,B,D,CH,A) (1,840/million) continues to be held back by low activity in Germany. Current throughput accounts for 52% of the potential maximum throughput per scanner. The main reasons are limitations in the number of patients primarily due to funding and FDG supply. There is wide variation in what is seen as the maximum throughput the median is 12 patients per day with 10 the lower and 15 the upper quartiles (n=207). Current throughput, age of equipment and typical working practices all play a part in the differences.CONCLUSIONS We can estimate the potential number of cancer patients who will benefit from an examination using 18FDG as somewhere over one million while in 2010 the European study number exceeded 900,000. This points to saturation but with the need for repeat examinations and therapy planning there is still considerable opportunity for growth. The tailing off in oncology applications opens the door to other applications using FDG but also and expansion in the use of other compounds particularly 18F tracers.
P076 The usefulness of PET/CT scan and metabolic tumour volume measurement in staging and evaluate the response for chemoradiotherapy in the patients with squamous cell head and neck cancer O. Ekmekcioglu1, E. Kocak2, E. Ozer2, S. Sager1, M. Halac1, K. Sonmezoglu1, O. Uzel2, I. Uslu1; 1Istanbul University,Cerrahpasa Medical Faculty Nuclear Medicine Dept., Istanbul, TURKEY, 2Istanbul University,Cerrahpasa Medical Faculty Radiation Oncology Dept., Istanbul, TURKEY. Purpose: 18F-Fluorodeoxyglucose (FDG) PET/CT is widely used for staging and planning radiotherapy in patients with head and neck cancer. It has also can be used for detecting answer after radiotherapy and makes advantage for detecting residuel metabolic activity which cannot be detected by only CT scan. Therefore in this study we try to evaluate the response for radiochemotheraphy with measuring metabolic tumour volume with PET-CT scan in the follow up patients which diagnosed squamous cell head and neck cancer.Material and Methods: We analyzed 18 patients, median age 54± 16, with squamous cell type head and neck cancer who underwent PET-CT scan for staging and after treatment between January 2009 and May 2010 in our Nuclear Medicine department. 15 patients were male and 3 patients were female. FDG PET/CT images were obtained 75 minutes after intravenous administration of approximately 580 MBq of 18F-FDG using a Siemens Biograph 6 scanner. All patients fasted at least 6 hours before injection and their glucose level were under control. Lesions with SUVmax>3 accepted as positive . Threshold is calculated as %40 ( MTV%40 ) and %50 (MTV%50) of the SUV max values with “cm3” unit.Results: The PET-CT scan did not show any abnormal FDG uptake (SUVmax<3, metabolic complete response) in 14 patients. In this group 2 patients with complete response, distant meastasis has been detected. 1 patient showed complete metabolic response in tumor but partial metabolic response in lymph node. Lymph node dissection showed meastasis for this patient. The total median of tumour pretreatment SUVmax was 16.2 and the median lymph nodes SUVmax was 9,7. Persistent abnormal FDG uptake was found in 3 patients. These patients tumour pretreatment median SUVmax was 22.3 and the median posttreatment SUVmax was 10.1. The median threshold %50 was calculated 0.51
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P077 Cu-62-ATSM hypoxic imaging of uterine cervical cancer and outcome of carbon ion radiotherapy K. Yoshikawa, M. Hasebe, S. Ohashi, S. Toubaru, H. Ishikawa, K. Tamura, K. Tanimoto, H. Kiyohara, S. Kato, S. Kandatsu, T. f*ckumura, T. Saga, T. Kamada; National Institute of Radiological Sciences, Chiba-shi, JAPAN. Purpose: Tumor hypoxia is well recognized as one of the major factors affecting resistance against radiation therapy and local failure. However, carbon ion radiotherapy (CIRT) is believed to decrease tumor radiation resistance originating from hypoxia. Cu-62 labeled diacetyl-bis (N (4)-methylthiosemicarbazone); (Cu-62ATSM) radiopharmaceutical has shown promise for use in PET imaging to assess tissue hypoxia. We investigated the tumor hypoxia by PET/CT using Cu-62-ATSM and made a comparison of tissue hypoxia and clinical outcome of carbon ion beam therapy on cervical cancer.Materials and Methods: Eighteen patients with cervical cancer underwent both Cu-62-ATSM and C-11-methionine (MET) PET/CT before the initiation of radiotherapy, and the set of PET/CT studies was done one month after termination of radiotherapy. There were histologically confirmed 11 squamous cell carcinoma, 2 adenosquamous carcinoma, 2 endometrioid carcinoma, 1 adenocarcima, 1 clear cell adenocarcinoma and 1 mucinous adenocarcinoma in this study. Fifteen patients treated by CIRT and 3 patients treated by RALS and LINAC. Two whole-body PET/CT scanners, Biograph-16 (Siemens) and Aquiduo (Toshiba) were used for data acquisition. Both Cu-62-ATSM and MET were administrated approximately 740 MBq. Tumor uptake of each tracer was analyzed semiquantitatively by tumor to normal tissue ratio (TNR).Results: Pre-therapeutic Cu62-ATSM uptake of squamous cell carcinoma was significantly higher than other tumor group with clear cell adenocarcinoma removed (Mann-Whitney U test, p=0.035). Squamous cell carcinoma seemed to tend to be hypoxic. Clear cell adenocarcinoma showed high Cu-62-ATSM uptake, it seemed due to high expression of Hypoxia-Inducible Factor-1α(HIF-1α). There was no significant relationship between Cu-62-ATSM uptake and local recurrence. Patients with higher Cu-62-ATSM uptake at post-CIRT showed significantly higher probability to develop distant metastasis (TNR>2.39, p=0.037). Three patients prognosis were poor in 15 patients received CIRT, but there were no significant relationships between Cu-62-ATSM uptake at both pre- and post-CIRT and patients prognosis (p=0.24, p=0.40). This might mean that tumor hypoxia did not affect the outcome of CIRT. There was significant relationship between MET uptake at post-CIRT and prognosis (Cut off TNR =11.5, p=0.0056).Conclusions: Squamous cell carcinoma of uterine cervical cancer showed tendency to be hypoxic. There was no statistically significant relationship between Cu-62-ATSM uptake and patients prognosis after CIRT, that is, tumor hypoxia did not affect the outcome of CIRT.
P078 18FDG Muscular Uptake versus 99mTc-MIBI Perfusion in Patients with Emery-Dreifuss Muscular Dystrophy (EDMD)Preliminary Report. M. M. Kobylecka1, M. Marchel2, J. Maczewska1, K. FronczewskaWieniawska1, M. T. Plazinska1, J. Kunikowska1, L. Krolicki1; 1Nuclear Mecicine Dep, Warsaw Medical University, Warsaw, POLAND, 2Chair and Dep. of Cardiology , Warsaw Medical University, Warsaw, POLAND. Background: Emery-Dreifuss muscular dystrophy (EDMD) is characterized by musculoskeletal abnormalities, quite frequently accompanied by cardiac defects (conduction disturbances and dilated cardiomyopathy). It has been shown, that maximal standardized uptake value (SUV) of fluorodeoxyglucose (FDG) detected by positron emission tomography is proportional to regional metabolic disturbances in muscle tissue, 99mTc-MIBI is widely used for muscle perfusion estimation. The aim of the study was an analysis of skeletal and heart muscle perfusion and metabolism in EDMD patients (pts) with the use of FDG-PET and conventional 99mTc-MIBI scintigraphy.Methods: 3 non-diabetic pts with genetically confirmed EDMD (autosomal dominant form, defect in LMNA gene, 1 man and 2 women) with different stage of cardiomyopathy (EF in the range of 38 to 57%) reported to FDG_PET for oncological reasons were included in this study. Whole body FDGPET/CT scanning followed by 99mTc-MIBI cardiac SPECT with additional scan of the upper and lower limb muscles was performed. SUVmax of FDG was measured in thigh (TM), arm (AM) and heart muscles (HM) in EDMD pts and in a group of healthy volunteers matched for age, sex and BMI. Similar measurements were taken from 99mTc-MIBI perfusion studies.Results: The SUVmax of heart muscle and in the surrounding tissue were similar in two cardiomyopathic EDMD pts and in
controls. In 1 EDMD with preserved left ventricular function SUV was greater in comparison with surrounding tissue and controls [4,68 vs 2,37]. The maximal SUV of the TM were lower in EDMD that in controls [0,79 vs. 1,01] and AM SUV were similar in both groups. There were no cardiac perfusion abnormalities seen in SPECT study. The 99mTc-MIBI perfusion of TM was decreased in comparison to the controls.Conclusions: Metabolic activity of heart muscle reflected by SUVmax differs between patients with different stages of dilated cardiomyopathy in the course of EDMD. There are differences between different muscle groups in FDG uptake detected by PET in this group.
P079 The value of Ga-68 DOTATATE PET/CT in pre-operative localisation of insulinoma compared to CT, MRI, EUS and Angiography I. Zerizer, R. Carroll, J. Todd, A. Al-Nahhas, A. Al-Nahhas; Imperial College NHS trust, London, UNITED KINGDOM. Introduction:Insulinomas are rare neuroendocrine tumours that are usually resected since the majority are solitary, necessitating accurate pre-surgical localisation. Traditional localisation studies include CT/MRI and Octreoscan. Angiography with venous sampling is considered the gold standard method of localisation. We aimed to investigate whether Ga-68 DOTATATE PET/CT could replace multimodality imaging in localizing insulinoma.Materials and methods:We performed Ga-68 DOTATATE PET/CT studies in 7 patients (3 females, 4 males; age range 31 - 80) referred with clinical and biochemical evidence of insulinoma. All patients also underwent CT, 4 had MRI (pancreatic protocol), 4 endoscopic ultrasound (EUS) and 1 Octreoscan. Angiography was performed in 3 patients. We correlated Ga-68 DOTATATE PET/CT findings with CT, MRI, EUS, Octreoscan and angiographyResults:Ga-68 DOTATATE PET/CT studies localised the insulinoma accurately in all patients (100%). Combined CT/MRI and EUS studies were also positive (100%) while Octreoscan was negative. Angiography with arterial stimulation and venous sampling also confirmed the presence of insulinoma in the 3 patients who had this procedure. All patients underwent subsequent tumour enucleation and histopathological examination. In 4 cases, surgical resection was performed based on CT/MRI and Ga-68 DOTATATE PET/CT findings alone without the need for EUS or angiography.Conclusion:Our study has demonstrated that Ga68 DOTATATE PET/CT is a highly sensitive imaging modality in the detection of insulinoma which could replace the need for multiple imaging procedures including angiography with venous sampling.
P080 18F-fluorodihydroxyphenylalanine positron emission tomography/contrast-enhanced CT (18F-DOPA PET/CT) in paraganglioma: comparison with PET and enhanced CT S. Kommata, S. Magnaldi, A. Khameneh, M. Schuetz, M. Weber, K. Kletter, R. Dudczak, G. Karanikas; Centre of Diagnostic Imaging, Departments of Nuclear Medicine and Radiology, Medical University of Vienna, Vienna, AUSTRIA. 18 F-fluorodihydroxyphenylalanine positron emission tomography/contrastenhanced CT (18F-DOPA PET/CT) in paraganglioma: comparison with PET and enhanced CTAim: 18F-fluorodihydroxyphenylalanine (18F-DOPA) PET shows a high specificity and CT has the ability to localize paragangliomas. The aim of this study was to investigate whether combined 18F-DOPA PET/CT more accurately detects and localizes paragangliomas than does each modality alone.Material and Methods All 9 patients [2 men, 7 women, age: 45±12 years, range: 30-65 years] with histologically verified paragangliomas (3 staging, 6 follow-up) underwent a whole body 18F-DOPA-PET/CT (270-370 MBq). The 18F-DOPA PET, CT and 18F-DOPA PET/CT images were analyzed and compared to each other.Results: The main lesion diameter ranged from 0.9 cm to 5 cm (mean value: 2.9 cm). In 18F-DOPA PET scans 25 lesions showed an increased tracer uptake, while in CT scans only 10 lesions could be detected. These 10 lesions were 18F-DOPA positive (40%). PET/CT revealed consecutively the 25 PET-positive lesions and those could be anatomically correlated with CT.Conclusion: 18F-DOPA PET/CT is an excellent diagnostic tool for detection of paraganglioma. 18F-DOPA PET alone has the same sensitivity as 18FDOPA PET/CT, though CT is necessary for the anatomical localisation.
P081 Role of 18F-DOPA PET/CT in the evaluation of medullary thyroid carcinoma. A. Kumar, C. Bal, J. Shukla, R. Kumar, A. Malhotra, G. Bandopadhyaya; All India Institute Of Medical Sciences, New Delhi, INDIA. Objectives : The aim of this study was to establish the role of 18F-DOPA PET/CT in the evaluation of medullary thyroid carcinoma (MTC).Methods : Nineteen patients with MTC were prospectively enrolled and scheduled for 18F-DOPA PET/CT. Fifteen of these patients were post operative and were being evaluated for restaging/recurrence or response evaluation. Rest of the four patients were being
Poster Presentations
before treatment and 0.28 after treatment and the median threshold %40 was 0.60 before and 0.38 after.Conclusion: In this study we found that 18FFluorodeoxyglucose (FDG) PET/CT scan is a valuable way to understand the response for treatment in the follow up the patients with squamous cell head and neck cancer. Especially detecting unexpected distant metastases is an advantage which can entirely change treatment modality. Also measuring and confront metabolic tumor volume before and after chemoradiotherapy can be a benefit to confirm residue tumour which cannot be just detected with CT scan.
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evaluated as inoperable neck mass (n=3) and retrosternal mass (n=1). Histopathological diagnosis was available for all the patients except in patient with inoperable retrosternal mass. Serum calcitonin levels were obtained for each patient. The scans were reported independently by two nuclear medicine physicians who were aware of patients clinical and biochemical status. These findings were compared with routine neck ultrasound, CECT and 68Ga - DOTANOC PET/CT for establishing the gold standard.Results : 18F-DOPA was positive in 14 of total 16 positive patients with a sensitivity of 87%. On a lesion basis 18F - DOPA identified total 20 metastatic lymph nodes out of 28 positive nodes. In evaluation of bone metastasis 18F - DOPA was positive in 2 out of 6 positive sites.Conclusions : 18F-DOPA is a promising modality in the evaluation of medullary thyroid carcinoma. However scan findings should be critically correlated with calcitonin levels, CECT and 68Ga - DOTANOC PET/CT whenever available to establish the actual burden of disease.
P082 Development of a multiparametric surface interventions supported by virtual bronchoscopy
model
for
M. Koselák1, T. Spisák1, S. A. Kis1, I. Lajtos1, G. Opposits1, L. Galuska1, Z. Hascsi2, P. Szabó3, M. Emri1; 1Medical and Health Science Center, University of Debrecen, Debrecen, HUNGARY, 2ScanoMed Medical, Diagnostic, Research and Teaching Ltd., Debrecen, HUNGARY, 3 Pulmonology, Jozsa Andras Teaching Hospital, Nyíregyháza, HUNGARY. Aims The virtual bronchoscopy has been proved to be an efficient tool for planning the bronchoscopic procedures since it is able to simulate the inner surface of the trachea and the bronchi segmented from CT images and allows to navigate in the airways virtually. However, the performance of the transbronchial needle aspiration biopsy is still detained because there is not adequate information to localize the tumor exactly and it is needed special equipment to estimate the risk of lesions of the vascular system in the lung. We have aimed the development of a multi parametric surface model and a method to visualize the vascular density information of diagnostic CT and the metabolic information of PET scans in the same time by a a single color code to support the choice of the optimal point of the biopsy.Materials and Methods The MultiModal Medical Imaging software system developed in-house was used for processing diagnostic CT and PET/CT data. The bronchi were segmented from both the diagnostic CT and the low-dose CT images and surfaces were created. The PET metabolic information was sampled and projected to the surface derived from the low-dose CT image. The vascular density information was evaluated using the diagnostic CT image and the bronchial surface belonging to it was also parametrized. After registration, multi-parametric polyhedron surface was generated using different range of colors belonging to each parameters. A multi-parametric surface visualization software was developed for the virtual navigation.Results A method to increase the accuracy of transbronchial needle aspiration biopsy has been developed and during the planning information about the vulnerability of the vascular system and the metabolism are available. Studies of five patients were processed. Besides, an easy-to-use virtual bronchoscopy software was developed.Conclusion Clinical projects should be launched to examine how our method increases the efficiency and safety of the bronchoscopic interventions.
P083 Comparison of Receptor Expression in Normal Spleen and Splenosis by Somatostatin Receptor PET/CT and Correlation with Immunohistochemistry H. R. Kulkarni1, V. Prasad1, D. Kaemmerer2, J. Sänger3, R. P. Baum1; 1Dept. of Nuclear Medicine and Centre for PET/CT, Zentralklinik Bad Berka, Bad Berka, GERMANY, 2Department of General and Visceral Surgery, Zentralklinik Bad Berka, Bad Berka, GERMANY, 3Institute of Pathology, Bad Berka, GERMANY. Aim: Splenosis is a rare condition involving autotransplantation of normal splenic tissue in the peritoneal cavity after trauma to the spleen (splenectomy or abdominal injury). It has histological features different from that of normal spleen. It is well known that the spleen exhibits a very high uptake of somatostatin receptor (SSTR) analogues; however, the mechanism of this phenomenon has not been clearly elucidated. The aim of our study was to compare the expression of somatostatin receptors in splenosis and normal spleen by somatostatin receptor PET/CT (SMS-R PET/CT) using 68Ga-DOTATOC, and to correlate and ascertain the histological basis of the SSTR expression by immunohistochemical analysis of the spleen cells.Materials and Methods: 10 patients with known neuroendocrine neoplasm involving the tail of the pancreas first underwent SMS-R PET/CT for staging. SUVmax of the spleen was documented. Accessory spleens were ruled out on pre-therapy CT/MRI. Then, left pancreatectomy and splenectomy was performed. 10 paraffin blocs from 3 of the spleen specimens were analysed by histology and immunohistochemistry using monoclonal antibodies to SSTR 2A, CD20 and CD3. Post splenectomy CT and MRI performed for follow up after 3 - 6 months, showed evidence of splenosis in the left hypochondrium in all of these
patients. SUVmax of splenosis in each patient was noted on follow up SMS-R PET/CT using 68Ga-DOTATOC.Results: The SUVmax (mean ± SD) of the splenosis was 10.5±4.3 and that of normal spleen was 28.8 ±12.5 (around 3 times that of splenosis). T-lymphocytes (expressing CD3) and B-lymphocytes (expressing CD20) were found scattered in the red pulp of the spleen, but more clustered in the white pulp (Malpighian corpuscles) with B-lymphocytes at the centre and T-lymphocytes at the periphery. The staining for SSTR 2A was highly concentrated in the B- and Tlymphocytes in the white pulp.Conclusion: In this study, splenosis was found to have extremely low somatostatin receptor expression on SMS-R PET/CT as compared to the normal spleen. SSTR 2A is strongly expressed by T- and Blymphocytes in the white pulp of the spleen resulting in a high splenic uptake on somatostatin receptor PET/CT using 68Ga-DOTATOC (which also has a high affinity to SSTR 2A). The findings in our study are concordant with the fact that splenosis has poorly formed or deficient white pulp with normal-appearing red pulp, as described in previous histological studies.
P084 Imaging Mesenchymal Stem Cells Delivered for the Treatment of Symptomatic Degenerated Intervertebral Discs Z. Lee1, L. Yuan1, D. Corn1, N. Tenley1, J. Molter1, D. Lennon2, A. Caplan2, J. D. Prologo1; 1University Hospitals Case Medical Center, Cleveland, OH, UNITED STATES, 2Case Western Reserve University, Cleveland, OH, UNITED STATES. Degenerated intervertebral discs (IVDs) are a significant contributor to low back pain, and effective therapies for this entity are lacking. Stem cell-based therapy has shown great promise for tissue regeneration and repair. The purpose of this study is to image percutaneously injecting mesenchymal stem cells (MSCs) under image guidance into a porcine model of degenerated IVDs for repair.Human MSCs were isolated from bone marrow obtained as scoops from patients undergoing hip or knee arthroplasty following IRB approved informed consent. These cells were expanded and transduced, by way of lenti-vrial vector, with HSV1-tk containing reporter gene driven by a constitutively active promoter. Three 28-35 kg pigs were obtained and intervertebral disc degeneration induced as per established methods at L1/L2 and L2/L3. 1-2 weeks following injury, a 22 gauge coaxial needle was advanced to the edge of the annulus under fluoroscopic guidance. Through the anchor, a 25 gauge needle was advanced and middle one-third location of the needle confirmed in two planes. Approximately 100,000 reporter tk-labeled MSCs were incubated with [I-124]-FIAU, a substarte for tk, following a similar protocol that was used to label MSCs with [F-18]-FDG. The radiolabled ([I-124]-FIAU) MSCs measured 1.5-3.4 μCi in a volume of about 0.7 ml were then delivered. The animals were imaged by PET for 10 minutes immediately following delivery and 3 days postprocedure both with CT co-localization. Four weeks after cell delivery, the animals were sacrificed, and tissue samples between the discs were harvested for histology evaluation with staining for collagen type I, collagen type II and collagen type X. In addition, a human marker was also stained to track human MSCs.The PET images showed the initial deposition of the delivered cells, and the retion of the these cells in the annulus/nucleus space between the discs 3 days after the delivery. The histology examinations showed the collagen markers. It is feasibly to deliver stem/progenitor cells under imaging guidance for the treatment of degenerated IVDs.
P085 [18F]choline PET in patients with biochemical recurrence of prostate cancer after radical prostatectomy: influence of antiandrogen therapy B. Henninger, P. Vesco, D. Putzer, D. Kendler, A. Loizides, R. Bale, I. Virgolini; Medical University Innsbruck, Innsbruck, AUSTRIA. Purpose: [18F]choline PET is a very useful tool in restaging prostate cancer (PC) patients with biochemical failure. Our purpose was to evaluate the influence of anti-androgen therapy (AAT) on [18F]choline in patients with biochemical recurrence after radical prostatectomy (RPE).Subjects & methods : In a retrospective study we evaluated 2 groups of patients, all with histologically proven carcinoma of the prostate, RPE and a subsequent [18F]choline PET because of biochemical failure. (A PSA-level under 4ng/ml was mandatory). One group consisted of 9 patients (age range, 57-79; median 68) with a total of 13 PETexaminations. All patients were under AAT at the time of the PET examination. The other group without any AAT consisted of 22 patients (age range, 48-72; median 67) with 22 PET-examinations.Our results were correlated with follow-up information referring to histopathology, PSA-levels and -changes, other imaging modalities and clinical examination. Mean follow-up were 20 months.Results: In patients treated with AAT [18F]choline PET was true positive (TP) in 8/10 examinations. The overall sensitivity was 80%. In 3 PET-examinations no cause for biochemical recurrence could be found with all available modalities. In two cases [18F]choline PET turned out to be false negative (FN): one patient had a local relapse and in the other one no site of recurrence could be found.In patients only treated with RPE 10/20 turned out to be TP, inducing a sensitivity of 50%. In one
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P086 Comparison of 68Ga-DOTA-TATE PET/CT imaging in the same Neuroendocrine Tumors
and 68Ga-DOTA-NOC patient group with
E. Demirci1, M. Ocak2, L. Kabasakal1, C. Decristoforo3, B. Gunes1, E. Arslan1, A. Araman2, I. Uslu1; 1Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, TURKEY, 2Department of Pharmaceutical Technology, Pharmacy Faculty,Istanbul University, Istanbul, TURKEY, 3Clinical Department of Nuclear Medicine, Medical University,, Innsbruck, AUSTRIA. Aim: The application of 68Ga-labelled somatostatin (sst) derivatives is becoming of increasing interest for cancer imaging and can be used for positron emission tomography (PET) imaging of tumors expressing sst receptors. Among the all available 68Ga-labelled sst derivatives, DOTANOC has shown high affinity to sstr-2 and sstr-5, DOTATATE has shown high affinity to sstr-2 in sstr-positive tumors imaging. The aim of our study was to compare the diagnostic value of 68Ga-DOTANOC and 68Ga-DOTA-TATE in the same patientgroup with neuroendocrine tumors.Materials and Methods: All patients had given written informed consent to participation in the study, which had been approved by the local ethics committee. Twenty patients (F/M: 13/7, mean age 55.33±12.65) with a diagnosis of primary or recurrent NET (8 unknown primary metastatic NET, 5 pancreas NET,1 Merkel cell carcinoma, 2 lung carcinoid tumor, 2 gastrinoma, 2 paraganglioma) were prospectively examined. Patients were intravenously injected 148±42 MBq 68GaDOTA-NOC and 68Ga-DOTA-TATE (which was synthesized by using Fractionated Moduler System with 30 mCi 68Ga/68Ge Generator, Eckert& Ziegler Eurotope, Berlin, Germany) at least in 8 hours intervals. 30-60 minutes after the injection of radiolabelled peptides, PET/CT images were obtained. PET imagings were obtained with both tracers and compared with each other.Results: The image quality of 68Ga-DOTA-NOC was not different than that of 68Ga-DOTA-TATE PET/CT. With 68Ga-DOTA-TATE physiological SUVmax value of pituitary gland, parotid gland was found significantly higher (p <0.05). In 6 patients (30%) no pathologic uptake was seen with both tracers. The number of lesions detected by PET images with both tracers were not significiantly different (p> 0.05). In 2 patients number of detected liver lesions were found higher with 68Ga-DOTA-TATE. And also in 1 patient with pancreas NET, number of detected lenf node metastases was higher with 68GaDOTA-TATE.Conclusion: The results of the present study have suggested that 68GaDOTA-NOC and 68Ga-DOTA-TATE PET imaging is same in diagnosis sst expressing tumors. However in some tumors which have different subtype of sstr behavior of both 68Ga-labelled peptides can be different.Acknowledgement: This work was supported by Scientific Research Projects Coordination Unit of Istanbul University. Project number 3264
P087 Early and Late 68Ga-DOTA-NOC PET/CT in somatostatin receptor (sstr) expressing organ and tumour E. Demirci1, M. Ocak2, L. Kabasakal1, C. Decristoforo3, Y. Ozsoy2, A. Araman2, I. Uslu1; 1Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, TURKEY, 2Department of Pharmaceutical Technology, Pharmacy Faculty,Istanbul University, Istanbul, TURKEY, 3Clinical Department of Nuclear Medicine, Medical University,, Innsbruck, AUSTRIA. Aim: 68Ga-DOTA-sst peptides are group of PET tracers that specifically bind to sstr that over-expressed on Neuroendocrine (NET) cells. Among them 68Ga-DOTA-NOC is a first compound for PET imaging with high affinity for sst2 and sst5. The aim of this study was to compare early and late image quality of 68Ga-DOTA-NOC in sstr positive organ and tumor by using SUV max.Materials and Methods: Eleven patients (F/M: 5/6, mean age 54.72±15.33) with suspicious of NET were injected with 148±45 MBq 68Ga-DOTA-NOC. 30-60-90 minutes after injection of radiopeptides whole body PET/CT images were obtained. Images were evaluated visually and SUVmax values obtained in different time points from the pituitary, salivary gland,liver, spleen, adrenal glands, lesions were compared.Results: The late image quality of 68Ga-DOTA-NOC was not different than that of early 68Ga-DOTANOC and it did not provide additional informations according to lesion numbers and localisation. There was not significiant differences (p>0.05) in the SUVmax values of pituitary, salivary gland,liver, spleen, adrenal glands, lesions in between time period.Conclusion: 68Ga-DOTA-NOC PET/CT can be used in the diagnosis and follow-up of NET patients after 30-90 min injection of radiopeptides.
Acknowledgement: This work was supported by Scientific Research Projects Coordination Unit of Istanbul University. Project number 3264
P088 68Ga-DOTA-TATE and 68Ga-DOTA-NOC PET neuroendocrine tumors: First year experience in Turkey
in
E. Demirci1, M. Ocak2, L. Kabasakal1, B. Gunes1, C. Decristoforo3, I. Uslu1; 1 Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, TURKEY, 2Department of Pharmaceutical Technology, Pharmacy Faculty,Istanbul University, Istanbul, TURKEY, 3Clinical Department of Nuclear Medicine, Medical University, Innsbruck, AUSTRIA. Aim: In January 2010, we set up fully automated 68Ga-DOTA-peptides Moduler Synthesis device with the 68Ge/68Ga generator to diagnose patients suspected from neuroendocrine tumors (NETs) in Cerrahpasa Medical Faculty, Nuclear Medicine Department in Istanbul. Therefore in this study we aimed to report diagnostic value of 68Ga-DOTA-TATE and 68Ga-DOTA-NOC in patients who applied in our department for PET scintigrapy in last one year. Materials and Methods: 137 patients with NETs (38 unknown primary, 24 pancreatic, 12 lung, 12 gastric, 7 small bowel, 7 colon, 6 gastrinoma, 5 insulinoma, 5 Mercel, 4 MEN, 4 paraganglioma, 13 others), 9 search for the primary site (high chromogranin ), 1 prostate, 2 acromegaly, 4 thyroid carcinoma (papillary and follicular), 2 germ cell carcinoma, 1 ectopic cushing, 1 hepatocellulary carcinoma, 1 glial tumor, totally 158 patients (mean age 51.77±14.22, F/M: 91/67) were injected with 161.3± 43.42MBq 68GaDOTA-TATE (n=131) or Ga-68-DOTA-NOC (n=27) (which was synthesized by using Fractionated Moduler System with 30 mCi 68Ga/68Ge Generator, Eckert& Ziegler Eurotope, Berlin, Germany). 30-60 min. after injection PET/CT images were obtained and evaluated.Results: 91 patients had positive 68Ga-DOTA-peptides and 67 patients had negative 68Ga-DOTA-peptides scan. In 46 patients lesions were located in liver, in 41 patients in area of abdomen and pelvis, in 24 patients in lymph lenf node stations, in 20 patients in bone system, in 8 patients in lung and in 16 patients in other parts of the body. There were no significant differences (p>0.05) between Ki67 proliferation indexes in 68Ga-DOTA-TATE/DOTA-NOC positive (32) and negative (17) patients.Conclusion: In all our cases the image quality was excellent and most of them provided clinically useful information. The fully automated synthesis module with cyclotrone independent Ga-68 allowed us successfully, reliably and reproducibly preparation of 68Ga-DOTA-sst analogues for routine preparations in clinical applications.Acknowledgement: This work was supported by Scientific Research Projects Coordination Unit of Istanbul University. Project number 3264
P089 Factors affecting SUV measurement in PET/CT studies in neuroendocrine tumors
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Ga-DOTANOC
C. Chotipanich1, K. Przewloka2, O. Israel2, A. Frencel2, J. Kennedy2; 1 National Cyclotron and PET Centre, Chulabhorn Hospital, Bangkok, THAILAND, 2Rambam Health Care Campus, Haifa, ISRAEL. Objective: This study aims to define the range of standardized uptake values (SUV) and factors affecting measurement of 68Ga- DOTANOC uptake in normal organs and neuroendocrine tumor sites.Materials and Methods: A retrospective study was conducted in 65 patients (pts), 25 men, 40 women, aged 25-86 years who underwent 68Ga-DOTANOC studies November 2009 - March 2011 using a time-offlight PET/CT (Discovery 690, GE Healthcare). Of the 65 pts 28 pts (43%) had carcinoid , 25 neuroendocrine tumors (NET, 39%), 6 medullary thyroid cancers (MTC, 9%) and 6 had other malignancies (9%).SUVmax was measured in normal organs (pituitary, thyroid, liver, spleen, pancreas, adrenal, and kidney) and in 139 tumor sites. The intensity of uptake in different histologic tumors and lesion locations was statistically compared using the Mann-Whitney test and the relationship between measured SUVmax and patient age (61.57±12.27 ), body mass index (BMI 25.87±4.82 kg/m2) and uptake time (65.09±11.19 min) was evaluated using linear regression analysis.Results:, Overall, 13 pts (19%) had 68Ga-DOTANOC negative studies and in 55 pts (81%) the studies were positive. The mean±SD of SUVmax (g/mL) physiologic 68Ga-DOTANOC uptake was: in the kidney 17.20±5.01, spleen 15.96±4.96, adrenal gland 10.82±3.40, pituitary 5.36±1.97, pancreas 4.27±2.49, liver 4.15±1.26 and thyroid 2.29±1.16. In tumor sites, the mean±SD of SUVmax of 68Ga-DOTANOC uptake was 26.15±24 in pancreatic lesions (n=12), 18.26±9.39 in bowel lesions (n=7), 12.17±7.54 in liver metastases (n=32), 7.74±3.71 in peritoneal metastases (n=11), 6.01±2.03 in pleural nodules (n=2), 4.74±3.37 in lymph node metastases (n=63), 3.61±1.63 in bone lesions (n=3), 3.30±0.82 in pulmonary nodules (n=8) and 19.97 in a single splenic lesion. On a histology subtype-based analysis carcinoid showed the highest uptake (15.00±9.51, p<0.001) compared to NET (9.93±12.34) and MTC (2.78±0.86). For a lesion location-based analysis the highest uptake was found in tumors in the pancreas ( p<0.001) as compared to all other anatomic locations except for lesions in the bowel. There was no correlation between SUVmax measured in any organ or tumor lesions and patient age, BMI, or uptake time (p>0.05).Conclusion: 68Ga-DOTANOC is excellent tracer for imaging of neuroendocrine tumors. Present results demonstrate a large
Poster Presentations
patient a [18F]choline positive lymph node in pelvic region was unremarkable in histopathology, this was assessed as false positive (FP). In 1 patient the cause for biochemical recurrence could not be found, neither with [18F]choline PET nor with any other modality.Taken together, the difference between sensitivity in patients with or without AAT was statistically not significant (p=0,235).Conclusion: In patients after RPE with biochemical recurrence during AAT [18F]choline PET is able to yield true positive findings and seems to be an accurate method for the detection of recurrence. Therefore [18F]choline PET should not be restricted to patients under AAT.
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S282 range of 68Ga-DOTANOC SUVmax in normal organs, highest in the kidney, and in neuroendocrine tumor sites, highest in carcinoid and lesions in the pancreas. There was no correlation between 68Ga-DOTANOC SUVmax and patient age, BMI, or uptake time.Key Words: 68Ga-DOTANOC, positron emission tomography (PET), neuroendocrine, standardized uptake value (SUV)
P090 Novel PET/CT Imaging of Diffuse Parenchymal Lung Disease Combining a Labeled Somatostatin Receptor Analogue and 18 F-FDG T. Win1, N. SCreaton2, J. Porter3, R. Endozo3, R. Shortman3, D. Wild4, J. Reubi5, P. Ell3, A. M. Groves3; 1Lister Hospital, Stevenage, UNITED KINGDOM, 2Papworth Hospital, Cambridge, UNITED KINGDOM, 3UCL, London, UNITED KINGDOM, 4University Hospital Freiburg, Freiburg, GERMANY, 5University of Bern, Bern, SWITZERLAND. AIMWe prospectively investigate the potential of positron emission tomography (PET) imaging using the somatostatin receptor (SSTR) analogue 68Ga-DOTATATE and 2-deoxy-2[18F]fluoro-D-glucose (18F-FDG) in diffuse parenchymal lung disease (DPLD).MATERIAL AND METHODSTwenty-six patients (mean-age 68.9±11.0y) with DPLD were recruited for 68Ga-DOTATATE and 18F-FDG combined PET/ highresolution computed tomography (HRCT) studies. Ten-patients had idiopathic pulmonary fibrosis (IPF), 12-patients non-specific interstitial pneumonia (NSIP) and 4-patients other forms of DPLD. Using PET, the pulmonary tracer uptake (SUVmax) was calculated. Distribution of PET tracer was compared to the distribution of lung parenchymal changes on HRCT. All patients demonstrated increased pulmonary PET signal with 68Ga-DOTATATE and 18F-FDG. The distribution of parenchymal uptake was similar with both tracers corresponding to the distribution of HRCT changes.RESULTSThe mean 68Ga-DOTATATE maximum standardised uptake value (SUVmax) was 2.2±0.7 and 2.8±1.0 (t-test, p=0.018) for 18F-FDG. The mean 68GaDOTATATE SUVmax in IPF patients was 2.5±0.9 whilst 2.0±0.7 (p=0.235) in NSIP. Correlation between 68Ga-DOTATATE SUVmax and gas transfer (TLCO) was r = -0.34 (p=0.127) and r = -0.49 (p=0.028) between 18F-FDG SUVmax and TLCO.CONCLUSIONWe provide non-invasive in vivo evidence in man, showing that SSTRs may be detected in the lungs of patients with DPLD in a similar distribution to sites of increased uptake of 18F-FDG on PET.
P091 Detection Of Second Primary Tumours In 18F-FDG-PET-CT Studies Performed In Oncological Patients: Preliminary Results A. Gomez-Grande, I. Rodriguez-Lizarbe, B. Rodriguez-Alfonso, J. Mucientes-Rasilla, R. Suarez-Orozco, A. Gonzalez-Ramirez, T. MoralesAvellaneda, J. Chamorro-Romero; Hospital Universitario Puerta de Hierro de Majadahonda, Majadahonda, SPAIN. AIM: It is deemed that the risk of suffering from a second primary tumour is fifty percent higher in oncological patients when compared to healthy population. Our purpose was to determine the impact of the detection of these second tumours during a 18F-FDG-PET-CT study and to analyze their characteristics as well as to assess the strategies selected by petitioner physicians to correlate these findings.MATERIALS AND METHOD: 18F-FDG-PET-CT studies performed at the Nuclear Medicine Department since the beginning of its activity in June 2009 have been retrospectively reviewed. The inclusion criteria were: findings in PET-CT which, because of their location and metabolic behaviour, did not accomplished for metastasis, and in which the nuclear physician explicitly applied for confirmation through complementary test. Percentage of verification of these findings by the petitioner physicians was assessed and, when possible, PET-CT findings were correlated with hystopathological confirmation.RESULTS: A total of eight hundred studies were reviewed. The possibility of a second tumour was suggested in 57 patients (7.1%). Eight patients were missed during the follow-up period. Forty-nine (85.9%) could be followed by our department and the existence of a pathological process was confirmed in all cases in which complementary tests were performed (29 (59.2%)). Fourteen were diagnosed for a malignant tumor, 3 for premalignant disease, 7 for a benign disease and 5 for an inflammatory process. In 20 cases PETCT findings were not further investigated by the petitioner physician. The most common location for the second primary tumour was lung followed by colorectal carcinoma, prostate, breast and thyroid.CONCLUSION: The use of the PET-CT in oncological patients allows the preclinical detection of second tumours in a significant amount of cases. More than a half of the second primary tumours suspected by PET-CT that are further investigated are finally confirmed as a malignant or premalignant lessions. Nevertheless it is worth stressing the importance of the findings due to the fact that in a high number of cases complementary explorations are not performed.
P092 Standardization of 18F-FDG-PET/CT prior to introducing response evaluation of lung cancer patients Evaluation of
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 standardization parameters J. Fledelius, K. Hjorthaug, A. A. Khalil, J. Frokiaer; Aarhus university hospital, Aarhus C, DENMARK. Aim:To evaluate the impact of variations in 18F-FDG dose, uptake time and plasma glucose level, prior to introducing response evaluation in non small cell lung cancer (NSCLS) patients. Furthermore examining the effect of the changes introduced when implementing the EANM 2009 guidelines for 18F-FDG-PET/CT, including the influence of a staff-educational program.Materials and methods:From March 2010 until February 2011 a total of 782 patients had an 18F-FDG-PET/CT scan as part of an accelerated diagnostic and pre-therapeutic staging program. Information on 18FFDG dose and uptake time was available in all patients while information on plasma glucose levels was available in 651 patients (83%). Data were retrospectively analysed. As part of the implementation of the 2009 guidelines, we introduced some changes in the scanning procedures during this period, including: 1) September 2010: In the regular education program of technicians, focus was on the importance of uptake time. 2) December 2010: The protocol for 18F-FDG dose was changed to 5 MBq/kg +/- 10% (formerly 400 MBq +/- 10 %). The effect of these interventions was tested using unpaired T-test.Results:Prior to implementation of EANM 2009 guidelines in December 2010, 578 patients received 200-440MBq mean (389 MBq (SD34)), 7,8% received a dose < 360MBq (< 400 MBq - 10%) and after implementation 203 patients received 190-592 MBq, (mean 336 MBq (SD 80)). The mean dose was significantly lower (p<0,00001) using 5 MBq/kg. In 413 scans performed prior to September 15th 2010 the uptake time ranged from 54 to 143, with an average of 70 minutes (SD 14), range (54 - 143) with 48% > 70 minutes. After September 15th 2010 the uptake time decreased significantly with an average of 67 minutes (SD 9), range (53 - 115), with 27% > 70 minutes. The difference was highly significant with p < 0,00001.The plasma glucose level was < 7 mM in 87%, from 7 to 11 mM in 16 % and > 11 mM in 1 %Conclusions:Raising the awareness of standardization had a profound impact on the variation in uptake time. The variation should still become lower, in order to avoid a large differences between pre- and post- treatment scans. The implementation of guidelines for FDG dosing lowered the mean dose in the population. The plasma glucose level should be lower, but guidelines and recommendations for diabetics were implemented from January 2011 and still need to be evaluated.
P093 The value of 18F-FDG PET/CT scan in the evaluation lymph node status in patients with non-small cell lung carcinoma R. Czepczyński1, P. Zieliński1, A. Stangierski1, P. Gabryel2, M. Kasprzak2, W. Dyszkiewicz1, J. Sowiński1; 1Poznan University of Medical Sciences, Poznań, POLAND, 2Greater Poland Centre of Pulmonology and Thoracosurgery, Poznań, POLAND. Introduction: Therapy planning in patients with NSCLC requires an adequate TNM staging. PET imaging has become a frequently used tool in the evaluation of lung cancer patients. The aim of the study was to estimate the accuracy of PET/CT in the evaluation of lymph node status in the TNM staging in patients with NSCLC, treated with surgery at our institution.Study group and methods: Patients with newly diagnosed NSCLC in stages I-IIIA were enclosed in the study. Before the surgery was chosen as the most adequate treatment, PET/CT scan had been performed to obtain the metabolic TNM staging. PET/CT scans were performed 60 ± 10 min after administration of 18F-FDG (activity: 5 MBq/kg) using the Discovery ST (GE) scanner. After surgery, histopathological findings were compared to PET/CT scan results.Results: 51 of 440 patients with NSCLC (aged 39-73) who had PET/CT scans in 2008-09 were qualified to the study. The patients underwent anatomical resection of the lung tumour, as well as the mediastinal lymph nodes, max. 6 weeks after PET/CT. According to the clinical condition of the patients, staging had been estimated as: IA - 9 patients; IB - 18; IIA - 2; IIB - 11; IIIA - 11. TNM 2006 classification was used. The N stage obtained with the use of PET/CT was concordant with N stage according to histopathological evaluation in 50 cases (98%). Only in one patient, the PET/CT overestimated the N stage (N1 instead of N0). Conclusion: Results of the study confirm high diagnostic value of 18F-FDG PET/CT in the evaluation of lymph nodes in patients with NSCLC qualified to surgery.
P094 Correlation Between the Intensity of 18-fluoride Uptake in PET/CT and the Presence of Foot Pain A. Samarin1, D. R. Fischer1, M. Betz2, N. Espinosa2, K. D. M. Stumpe1; 1 University Hospital Zurich, Zurich, SWITZERLAND, 2Orthopedic University Hospital Balgrist, Zurich, SWITZERLAND. Purpose: Evaluation of unclear ankle and foot pain is a promising indication of 18Ffluoride PET/CT imaging. Being a very sensitive technique for the detection of bone alterations and new bone formation, 18F-fluoride PET/CT often shows multiple sites of focally increased 18F-fluorid uptake with different intensity in the symptomatic and asymptomatic ankle and foot. The aim of this study was to
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P095 Efficacy of 18F-FDG PET-CT in Patients with Suspicion of Testicular Germ-Cell Cancer Recurrence. J. Sanchez Catalicio, F. Perez Angel, A. Montellano Fenoy, C. Villena Garcia, M. Murcia, L. Frutos Esteban, M. Gallego Peinado, J. Navarro Fernadez, M. Castellon Sanchez, L. Mohamed Salem, F. Nicolas Ruiz, D. Sanz, M. Claver Valderas; HOSPITAL UNIVERSITARIO VIRGEN DE LA ARRIXACA, EL PALMAR (MURCIA), SPAIN. Introduction:There is a controversy about the role that PET-CT can play to identify Testicular Germ-Cell Cancer Recurrence, when morphological and biochemical tests are abnormal.Aim:To evaluate the diagnostic efficacy of 18F-FDG PET-CT in patients with suspicionof Testicular Germ-Cell Cancer recurrence.Material and methods:We revise retrospectively 27 patient males (mean age of 33 years and antecedents of Germ-Cell Cancer (11 seminomas and 16 no seminomas) with a suspicion of recurrence according morphological tests and elevation of tumour markers who underwent a 18F-FDG PET-CT study between the year 2007 and 2010.The images were analyzed qualitatively and semiquantitatively by two nuclear expert physicians. The results of the PET-CT were confirmed by histology (5 patients) or by clinical - radiological follow-up within an average period of 17 months (range 3-36 months).Results:The following results were obtained:The prevalence of recurrence of the disease in the studied population was 55.5 % with a Sensitivity of 93.3 % and Specificity of 100 %. The PET-TAC detected disease in 14/27 patients (PPV: 100 %) and VPN rejected it in 12/27 (NPV: 92.3 %), with only 1 False Negative.Conclusion: The PET-TAC with 18F-FDG is effective since it allows ruling out the existence of disease in these patients with high accuracy, therefore it must be included routine imaging test in the follow-up of patients with suspicion of recurrence.
P096 Implementation of PET/CT dual respiratory gating : evaluation in lung and abdominal lesions. J. Badel, J. Ceccone, S. Cimarelli, V. Isnardi, M. Balanche, T. Mognetti; Centre Léon Bérard, LYON, FRANCE. Aim :Respiratory motion causes large artefacts in PET/CT image. We propose to evaluate the gain made by respiratory gating for characterization of lung and abdominal tumours.Materials and Methods:Clinical study was performed on Gemini TF (Philips) PET/CT. Seven patients (2 female and 5 male patients, mean age 65 years) with lung lesions and 4 patients (1 female and 4 male patients, mean age 56 years) with abdominal tumours were scanned since December 2010. Each patient underwent a standard whole-body acquisition (3D) followed by a 4D PET and 4D CT acquisitions centred on interest region (thorax or abdomen) synchronized with the respiratory cycle from a pressure sensor placed in a belt around the patient’s abdomen. The acquisition time for 4D emission PET scan was 6 minutes. The data were stored in a list-mode file. The gating is created by dividing the list-mode data in bins according to the position of each annihilation event in the breathing cycle. The 4D images were obtained by a retrospective reconstruction method into 4 phases.To evaluate the motion compensation by dual 4D PET/CT, the SUVmax values have been calculated for each lesion then compared with and without respiratory gating.ResultsThe SUVmax values for the all 7 patients with lung lesions varied from 2.6 to 18 for standard 3D and from 2.8 to 19.7 for gating 4D. In 4 abdominal lesions cases, the SUVmax values varied from 16.5 to
20.5 for 3D acquisition and from 19.7 to 27 for gated images. There was an increase in SUVmax values for all gated tumours compared with standard acquisition. Mean SUVmax percentage variation between 3D and 4D values [(SUVmax 4D - SUVmax 3D)/SUVmax 3D] were 21% and 23% for lung and abdominal tumours respectively.ConclusionThe dual 4D PET/CT appears to be a major tool to improve evaluation of lung and abdominal lesions. We expect to include more patients to confirm our first results.
P097 PETCT in the detection of unknown primary in head and neck cancer A. Nasoodi, C. Fahy, D. McCaul, W. Primrose, R. Ullah, S. Hughes; RVH, Belfast, UNITED KINGDOM. Purpose:To assess PETCT in management of patients with head and neck cancer of unknown source.Materials and methods:24 subsequent patients were included in the study in a period of 2 years. These were all patients with biopsy/FNA proven disease in the neck region referred to Royal Victoria hospital as a tertiary centre. All patients underwent routine work up for an unknown primary in the head and neck region followed by PETCT. The cases were discussed subsequently at the local multidisciplinary team (MDT) meetings and a management plan was agreed and documented. Then the PETCT findings were presented and after further discussion any change of management plan was recorded.Results:Twenty four patients were included. Fourteen patients underwent surgical neck dissection or excision for the nodal and primary disease identified on panendoscopy, routine imaging and PETCT. Fourteen patients proceeded to adjuvant chemoradiotherapy (6) or radiotherapy (8). Three patients had chemoradiotherapy only as they were too frail or suffering from other premorbid conditions which precluded them from surgery. One patient received only palliative radiotherapy due to severe other co-morbidities.PETCT correctly identified the primary in 9 patients and missed a subsequently proven primary in 2 cases (both tonsils). Three patients were found to have benign pathologies (branchial cyst) and no primary was found in 8 patients during followup. PETCT was wrong in 2 patients in detecting the primary.The sensitivity, specificity and accuracy of PETCT in detecting the primary source in this group of patients were 80%, 79% and 79% respectively.PETCT findings were influential in change of the managment in 37% of the cases.Conclusion:PETCT is a valuable diagnostic modality in the management of patients with head and neck cancer in detecting the primary disease and influential in changing the management of the patients in more than third of the cases.
P098 Can 18F-FDG Uptake in the Spinal Cord be a New Pitfall in HD*PET? A. Amin1, A. Bockisch2, S. J. Rosenbaum2; 1Cairo University, Cairo, EGYPT, 2 Essen-Dusiburg University, Essen, GERMANY. Purpose:It is essential to be familiar with normal patterns of 18F FDG distribution in the whole body for accurate PET interpretation. Introduction of new PET reconstruction modes is potentially expected to be accompanied with new pitfalls. Our aim was retrospective evaluation of FDG focal uptake in the spinal cord as a possible new pitfall encountered in HD*PET reconstruction mode of modern PETCT scanners.MethodsThe spinal cords of 101 consecutive patients, who underwent 18F FDG PET/CT for different clinical indications, were assessed for focal FDG uptake along its segments. PET reconstruction was done by using fully- 3D attenuation-weighted (AW-OSEM3D) and HD*PET. The spinal cord pitfall (SCP) was defined as a focal increased uptake seen on visual basis in the spinal cord without CT morphological correlate. This assessment was correlated with the patient’s database variables.Results49/101(48.5%) were positive for SCP. 49/49(100%) of SCP were detected with HD*PET and only 6/49(5.9%) in AW-OSEM3D mode (P 0.001). The most encountered sites were lower dorsal [36/49(73.5%)] and cervical [24/49(49%)] segments (P 0.001). 38/49(77.6%) & 11/49(22.4%) were detected in winter and summer respectively (P 0.005). The SCP positive subjects were reevaluated in follow-up studies; 41/49(83.7%) faded completely while the remainders [8/49(16.3%)] showed stationary or reduced uptake.ConclusionWith HD*PET reconstruction, focal increased FDG uptake in several levels of the spinal cord is commonly detected and must be recognized as a possible pitfall to avoid being mistaken with malignant involvement, mostly encountered in cervical, lower dorsal and first lumbar levels quite frequently in winter.
Poster Presentations
evaluate the correlation between the intensity of 18-fluoride uptake in PET/CT and the presence of foot pain.Materials and methods: 20 consecutive patients who underwent clinical 18F-fluoride PET/CT for the evaluation of unclear foot pain were included in the study and their imaging data was retrospectively analyzed. Scanning started 30-45 min after the i.v. injection of a 94-135 MBq of 18F-fluoride.The maximal standard uptake values (SUVmax) of focally increased fluoride uptake were measured in feet. Additionally, to account for factors that may influence the intensity of tracer uptake, SUVmax values of fluoride uptake in distal diaphysis of the ipsilateral tibia were measured. Consecutively, the ratio of the tracer uptake in the foot and in the distal tibia (foot/tibia ratio) was calculated for every foot. Patients were questioned about pain in both feet at the time of PET/CT examination and clinical follow-up (range 2-8 months).Results: 13 of 20 patients showed low grade focally increased 18F-fluoride uptake in the asymptomatic foot at the time of examination, two of them developed pain during clinical follow-up examination. The mean foot/tibia ratio of tracer uptake was significantly higher in the symptomatic foot than the asymptomatic foot with corresponding values of 6.7 ± 5.2 and 2.3 ± 0.9 (p<0.05), respectively. On the basis of ROC analysis on the values obtained by the latter calculation, it was concluded that a foot/tibia uptake ratio threshold of 3.4 was considered as positive for clinical foot symptoms resulting in a sensitivity and specificity of 79% and 91%, respectively.Conclusion: Focally increased low grade 18F-fluoride uptake is common in painless foot. Assessment of intensity of 18F-fluoride uptake by using foot/tibia ratio shows good prediction of clinical symptoms. The information provided by 18F-fluorid PET/CT might contribute to early detection of osteoarthritis and other bone disorders preceding morphological alterations.
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Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441
P07 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Molecular
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Imaging:
SPECT
&
SPECT/CT
P099 Evaluation of diagnostic accuracy of hybrid cardiac SPECT/CT on for attenuation correction of stress myocardial perfusion imaging in patients according to Body Mass Index M. Mulazimoglu, M. O. Tamam, T. Ozpacaci, K. Yildiz, S. Koca, N. Edis; Okmeydani Training and Research Hospital, Istanbul, TURKEY. Aim: The purpose of this study was to evaluate the diagnostic accuracy of attenuation corrected (AC) single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) on inferior wall compared to uncorrected SPECT (NC) in consecutive obese (body mass index [BMI] > 30) compared to normal weight patients. These images were compared to prone ones.Methods: Consecutive 157 patients (122 M:35 F) (mean age 57,4±11 years) who underwent AC sestamibi SPECT MPI at Okmeydani Training and Research Hospital was included to the study. The inclusion criterion was patients with normal perfusion and left ventricular function, and no known CAD. A hybrid single-photon emission computed tomography and transmission computed tomography (SPECT/CT) system was used for the diagnosis. One day Sestamibi protocol was used, and stress imaging was performed first. SPECT imaging was done with 60 stops over 180 degrees. Attenuation correction during stress myocardial perfusion imaging was routinely acquired on all patients. In addition, CT images were acquired. Rest imaging was not applied to patients with normal stress images.During Attenuation correction processing on a Xeleris workstation using Myovation cardiac software ordered subset expectation maximization (OSEM) iterative reconstruction (IRAC) is used and in uncorrected images filtered back projection (FBP) is used. SPECT studies were evaluated visually and semiquantitatively.Results: This study included 73 patients with BMI < 30 (normal group) and 84 patients with BMI > 30 (obese group). The mean weight of patients were 84±15 (range 53-15 kg); BMI averaged 30,2±4,7 (range 18.9-51.9) in the all group.In patients with higher BMI, increased amount of both visual and quantitative attenuation of inferior wall were detected. IRAC reconstruction corrects the diaphragm attenuation of the inferior wall better then FBP. These images are confirmed with prone imaging.Conclusion: In patients with higher BMI, increased attenuation of inferior wall were detected. Attenuation correction with ordered subset expectation maximization (OSEM) iterative reconstruction significantly improves the diagnostic accuracy of stress-only MPI SPECT in normal weight and obese patients, but the improvements are significantly greater in obese patients. Prone imaging was also helpful to resolve inferior wall defects. Stress-only SPECT imaging with attenuation correction provides shorter and lower radiation exposure.
P100 Detecting parathyroid pathologies in patients with primary hyperparathyroidism: 99mTc MIBI Parathyroid scintigraphy, SPECT and SPECT/CT. M. Mulazimoglu, M. O. Tamam, T. Ozpacaci, S. Koca, E. Uyanik, K. Yildiz, H. Ozcevik; Okmeydani Training and Research Hospital, Istanbul, TURKEY. Aim: Primary hyperparathyroidism is the most frequent pathology of the parathyroid glands and one of the most frequent endocrine disorders overall, generally caused by a solitary parathyroid adenoma, less frequently by multiple parathyroid gland disease and rarely by parathyroid carcinoma.Single photonemission computed tomography/computed tomography (SPECT/CT) is particularly helpful for preoperative localization due to its efficiency in localization of the adenoma in relation to adjacent anatomic structures, and its depth in the neck or mediastinumWe aimed at our study to determine that SPECT/CT may be superior to SPECT and dual-phase 99mTc methoxy-isobutyl-isonitrile scintigraphy (99mTc MIBI) parathyroid planar scintigraphy in patients with primary hyperparathyroidism.Material-methods: Between March 2010 and January 2011, a total of 53 patients (46 females, 7 males) with a mean age of 57±16 years (range, 17-81 years) with biochemical evidence of hyperparathyroidism, increased serum calcium and parathyroid hormone concentrations. All patients underwent ultrasound and 99mTc MIBI scintigraphy with planar and SPECT or hybrid SPECT/CT imaging.All patients underwent early and delayed planar and SPECT imaging at 20 and 120 minutes postinjection of 20 mCi of 99mTc MIBI, by planar parathyroid scintigraphy, SPECT and/or SPECT/CT using a dual-head gamma camera and a lowpower X-ray CT transmission system mounted on the same gantry (GE Infinia Hawkeye GE Medical Systems). SPECT/CT images were acquired 100 minutes after injection. Retention of MIBI in parathyroid tissue in delayed images of 99mTc MIBI is interpreted as hyperfunction .Results: 99mTc MIBI scintigraphy identified a parathyroid pathology in 30 patients and was negative in 23 patients. Based on scintigraphy, the parathyroid pathology were localized as follows; in one patients bilateral lobe, one retrosternal, eight left inferior lobe, eighteen right inferior lobe,
two right superior lobe.Planar imaging in 11 patients considered to be suspicious pathology of parathyroid SPECT and/or SPECT/CT was considered positive confirmation. Total 16 cases were confirmed histopathologically.Conclusion:SPECT/CT is superior to SPECT and planar imaging in providing anatomic detail and clear identification of the lesion,especially if deep in the neck or ectopic and should, therefore, be routinely used to detect parathyroid pathologies in patients with hyperparathyroidism
P101 Our impressions from the application of SPECT-CT in patients with a suspicion of infection of joint prosthesis in comparison with those with combined method for leukocyte’s and bone marrow scintigraphy I. Kostadinova, V. Hadjiiska, T. Petrov, V. Stoinova; Medical University, Sofia, BULGARIA. The disadvantage of leukocyte’ scintigraphy /LS/, when applied in patients /Pts/ with a suspicion of infection of joint prosthesis, is the difficulties in localizing and differentiation of bone from soft tissue infection. Additionally false positive results could be obtained in some cases if bone marrow scintigraphy is not performed. Between 2007 and 2010, we have investigated 31 patients with hip or knee prosthesis, in whom an infection was suspected. Final diagnosis was proved with surgery or microbiological aspiration. The patients were divided in 2 groups. In the first group - 15 of them were included / 11 with hip and 4 with knee joint replacement / and LS was performed 2h p.i./ with in vitro labelled leukocytes with 370MBq 99mTc-HMPAO /. In the following days- bone marrow scintigraphy / with 370MBq 99mTc-nanocolloid / was also applied. In 8 of the patients a right positive result was received / 2 of them had additional soft tissue infection with fistulas /, in 5-right negative result, in 1-false negative, without false positive result with a sensitivity of 89%, specificity-100% and accuracy-93%. In a second group of 16 Pts / 12-with hip and 4-with knee replacement /, we have applied SPECT-CT technique / low dose CT / after injection of in vitro labelled leukocytes with 370MBq 99mTcHMPAO / without bone marrow scintigraphy /. In 7 of the patients a right positive result was received / in 2 of them also fistulas were visualized /, in 8-right negative result, in 1-false positive, with a sensitivity of 100%, specificity- 89% and accuracy94%. When difficulties in interpreting of the result were encountered, because of the metal prosthesis artefact, non-attenuated corrected images were also considered. Having CT as a method for anatomical reference, it was also easy to localize and differentiate a bone from soft tissue infection and to determine its extend. As a conclusion, after applying both techniques for a visualization of infection in Pts with joint prosthesis, we suggest that they have comparable accuracy. The hybrid SPECT-CT technique is easier and quicker to perform and the patient has the possibility to achieve the result on the same day and respectively, to follow the therapeutic plan.
P102 Application of SPECT/CT for a testicular scintigraphy in a patient with Morris syndrome I. Kostadinova, M. Siriakov, V. Stoinova; Medical University, Sofia, BULGARIA. Morris syndrome is a name, given to a syndrome, found in individuals with cariotype of 46 XY but possessing normal female external genitalia, normal developed breasts, due to mutations in the androgen receptor gene, leading to organ insensitivity to androgens. Having in mind that sometimes gynecologists might have difficulties in localizing testicl*s, subject to gonadectomy due to their propensity to malignant degeneration, we have decided to apply the hybrid technique SPECT/CT for testicular scintigraphy in an individual, who has experienced laparoscopy without any result for visualization and localization of testes. The person was 16 years old girl without menstruation, with normal breast development, absent pubic and axillary hair, absent uterus and 46 XY cariotype.The following protocol for visualization and localization of the testicular tissue was applied using SPECT-CT camera: 370 MBq 99mTc-pertechnetate is injected i.v. as a bolus; dynamic acquisition is started immediately /2sec. frames, 30-frames, matrix size 128/128/; static acquisition is performed 5 min.p.i.for 600sec., matrix size 256/256; SPECT acquisition is performed with 32 frames, 20s/frames, 3600 Low dose CT is performed on Symbia T2 / 130kV, 17 mAs /.From the planar and tomographic scintigraphy, we have depicted vascularized oval structure in the left inguinal region and another one, less vascularized in the right inguinal canal, localized more down, compared to the left one. From the low dose CT- in the distal part of the left inguinal canal - an oval structure is visualized with size 27/18mm at the level of the common femoral vessels and depth 12 mm. In the right inguinal canal - also ellipsoid structure was visualized, with unclear borders, size 20/13mm and depth 18 mm.Usually, testicular scintigraphy is a highly accurate technique for evaluation of acute scrotal pain for a prompt diagnosis of testicular torsion, acute epididymitis or after trauma. There are scarce publication for its usage in patients with cryptorchism or Morris syndrome. We have no found any published experience with the hybrid technique SPECT-CT in the literature.CONCLUSSION:
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P103 Characterisation of the IQSPECT™ cardiac SPECT system A. Paramithas, A. G. Irwin; St. George's Hospital, London, UNITED KINGDOM. AimTo characterise the physical imaging performance of the IQSPECT (Siemens, USA) cone beam myocardial SPECT systemMethodIn order to measure reconstructed resolution within and around the area defined by the focal plane of the cone beam collimators, a phantom was designed that may support up to 10 point sources held in a line 30 mm apart, thus allowing up to 270 mm coverage for measurements. High specific activity Tc-99m point sources were prepared in glass capillary tubes. Measurements may be made over a 3D volume simply by making consecutive acquisitions after moving the phantom, without the need to refill point sources. The volume investigated is that which the heart would occupy in clinical imaging. Both spatial resolution and relative sensitivity are measured from line profiles of the points seen in the reconstructed images.The acquisition and reconstruction follows the protocol used for myocardial perfusion imaging, with 34 images of 18s duration of 128 by 128 pixels with dual heads at 76 degrees and a 104 degree rotation per head. Reconstruction is by propriety iterative OSEM 3D algorithm employed with 30 iterations and 1 subset.ResultsPreliminary resolution results made within the manufacturer’s defined 3D region demonstrate that the Full Width Half Maximum (FWHM) is between 14mm to 18mm and improves a little towards the collimator face. Relative sensitivity was observed to vary by 22%, with the trend tending to improve with distance from the camera face.DiscussionThe IQSPECT system claims to optimise imaging performance within a volume corresponding to the anatomical location of the heart. This study is designed to investigate the uniformity of performance over this volume. Further work will be presented that defines the whole of this central field of view, in terms of resolution and relative sensitivity. Furthermore, the importance of positioning of the heart in the central region will be established.ConclusionThe method enables the practical evaluation of the physical imaging performance of a novel cone beam cardiac SPECT system. Preliminary results have revealed performance trends associated with resolution and relative sensitivity in the characterisation of a novel cone beam myocardial perfusion collimation system.
P104 Early identification of Alzheimer’s disease - Is there a role for precuneal hypoperfusion on HMPAO SPECT? S. V. Faulkes, P. M. Kemp; Southampton General Hospital, Southampton, UNITED KINGDOM. AimTo assess the predictive value of the solitary abnormality of precuneal hypoperfusion on HMPAO SPECT to determine the risk of the subsequent development of Alzheimer’s disease (AD).BackgroundAlthough late onset Alzheimer’s disease is typically associated with medial temporal pathology in the early stages, HMPAO SPECT and FDG PET have identified that the remote effects of disconnection to the precuneus and posterior cingulate gyrus can also be identified in early AD. Although these regions are difficult to assess by simple visual interpretation, significant regional hypoperfusion/hypometabolism can be detected using software programmes incorporating normal databases. To our knowledge, however, there is no information in the literature as to the predictive value of this solitary abnormality on HMPAO SPECT imaging in determining the likelihood of subsequent development of AD in patients referred with mild cognitive impairment (MCI).MethodsThis study consisted of 47 consecutive clinical patients referred in 2008/9 with MCI in which the HMPAO SPECT report noted the solitary abnormality of precuneal hypoperfusion (using SPM 99 containing a normal database of 32 local healthy individuals aged 40 -90 years). Clinical follow up has been obtained at 8-25 months post imaging. Patients were divided into those who had progressed to fulfil criteria for a diagnosis of AD, those who are currently cognitively stable, and those patients who had subsequently been diagnosed with a different type of dementia, predominantly vascular dementia (VaD) or dementia of the Lewy body type (DLB).ResultsOf the 47 patients identified, follow up was successfully obtained in 35 cases. Of these, 46% had deteriorated into AD, 40 % were still regarded as currently stable with their cognitive impairment and 14 % had been given a different dementia diagnosis, predominantly VaD or DLB.ConclusionObviously longer clinical follow-up is required in those who remain cognitively stable to determine their clinical outcome. We would recommend that MCI patients who have not deteriorated clinically should be re-imaged at 1-2 years after their first scan to assess for disease progression. However, it does appear that precuneal hypoperfusion is a marker for a dementia process in many cases, the majority of which go on to fulfil AD criteria.
P105 Impact of 131I SPECT-CT on Nodal Staging of Differentiated
Thyroid Carcinoma A. Mhiri, I. Meddeb, I. Slim, I. Elbez, W. El Ajmi, D. Ben Sellem, I. Yeddes, B. Letaief, M. Ghezaiel, F. ben Slimene; Nuclear Medicine Department. Salah AZAIEZ Institute. University El Manar II, TUNIS, TUNISIA. Introduction: Lymph node metastases (LNM) can be detected by elective neck dissection. However, elective neck dissection is not performed in a significant number of patients with differentiated thyroid carcinoma (DTC). Furthermore, in a few cases, LNM may elude surgical removal. 131I-imaging performed after radioiodine ablation also offers the possibility of nodal staging. However, 131ISPECT-CT more accurately detects regional lymph node metastases (LNM) than does planar imaging which is poor on sensitivity and anatomic landmarks. Objective: The aim of our study was to assess the diagnostic value of 131I SPECT-CT on nodal staging of patients with thyroid carcinoma. Methods: We studied 35 consecutive thyroidectomized DTC patients underwent post therapeutic131I-planer imaging and SPECT-CT of the neck. The planar scans and the SPECT-CT images were evaluated for cervical tracer uptake independently of each other and of the clinical findings. Results: Planar imaging and SPECT-CT showed respectively 43 and 55 foci of uptake in 30 of 35 patients (86%). SPECT-CT confirmed all foci seen on planar imaging and identified 12 occult additional foci in 9 of patients (26%). SPECT-CT allowed the identification of 10 lymph node metastases classified as thyroid remnant or as indeterminate on planar imaging. Based on this revision, SPECT-CT yielded a gain in information on nodal stage in 7 of the 35 patients studied (20%). SPECT-CT altered nodal stage from N0 to N1 in 2 of 7 patients and from indeterminate (Nx) to N1 in 2 of 7 patients. Conclusion: According to our results, 131I-hybride imaging completes the postsurgical staging of DTC. SPECT-CT reduces the number of equivocal diagnoses on planar imaging and improves the interpretation of 131-Iscintigraphy. The consequent changes in TNM scores and staging should influence the 131-I dose prescribed at initial therapy.
P106
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The usefulness of therapeutic I SPECT-CT in Differentiated Thyroid Carcinoma. A preliminary study A. Mhiri, I. Slim, I. Meddeb, W. El Ajmi, I. Elbez, F. Ben Slimene; Nuclear Medicine Department. Salah AZAIEZ Institute. University El Manar II, TUNIS, TUNISIA. Introduction: Planar 131I-scintigraphy is routinely used to detect radioiodine-avid metastases of differentiated thyroid carcinoma (DTC). However, the modality has limitations, such as low sensitivity and lack of anatomic landmarks. Hybrid SPECTCT has added clinical value over SPECT imaging alone primarily due to more precise anatomical lesion localization. Objective: The purpose of our study is to evaluate the contribution of the single photon emission computed tomography with integrated low-dose CT (SPECT-CT) over traditional planar imaging in patients with DTC. Material and methods: We evaluate 60 thyroidectomized patients (9 men and 51 women; mean age: 42.7 years) with DTC (48 papillary, 9 follicular, 3Hürthle cell). Planar imaging and SPECT-CT were performed after 3 weeks of L-thyroxine withdrawal and 4 days after oral administration of 1,1 - 5,55 GBq (30-150mCi) of I131. The indication for treatment was remnant ablation or additional radioiodine therapy (in cases of metastatic disease) with rising thyroglobulin levels. We assigned contribution to SPECT-CT when it provided better identification and interpretation of the foci of radioiodine uptake, more correct anatomic localization and characterization, and precise differentiation between tumor lesions and physiologic uptake. Results: Planar imaging showed 97 foci of uptake in 55 of 60 patients (91%), and SPECT-CT showed 119 foci in 57 of 60 patients (95%), confirming all foci seen on planar imaging but identifying an additional 22 occult foci in 18 of patients (30%). SPECT-CT was determinant in classifying as neoplasic 40 foci for which planar imaging seemed to exclude malignancy, discriminating in 44 cases between residue and lymph node metastases in the neck, or showing thoracic lesions in 13 cases. SPECT-CT information changed the proposed therapeutic indication in 35 cases (58 %) of patients, on the basis of our department protocol. Conclusion: According to our results, SPECT-CT enhances sensitivity for DTC lesions detection over planar scintigraphy. In addition to improve anatomic localization of scintigraphic findings, this equipment offers the opportunity to add true diagnostic information derived from CT imaging with impact on therapeutic management. A wider use of this method is suggested complementary to planar imaging in selected DTC patients.
P107
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Evaluation of the impact of I-SPECT and integrated lowdose CT in the neck area on the management of patients with thyroid carcinoma. I. Meddeb, A. Mhiri, I. Slim, I. Elbez, W. El Ajmi, D. Ben Sellem, L. Zaabar, B. Letaief, M. Ghezaiel, F. Ben Slimene; Nuclear Medicine Department. Salah AZAIEZ Institute. University El Manar II, TUNIS, TUNISIA. Introduction: In patients with differentiated thyroid carcinoma (DTC); 131Iscintigraphy aims to detect residual neck disease and distant metastases. New
Poster Presentations
Testicular scintigraphy with application of SPECT-CT technique is a rapid, accurate, noninvasive method in cases with Morris syndrome, for visualization, localization and determining vitality of the testicular tissue, useful for a subsequent surgery.
S285
S286 hybrid single photon emission computed tomography with integrated low-dose CT (SPECT-CT) cameras that permit functional and anatomical image fusion may improve its clinical relevance, over traditional planer imaging particularly in neck area due to physiologic accumulation of the tracer complicating interpretation of the images. Objective: Our objective was to test the added value of SPECT-low dose CT to 131I-planer scintigraphy in the clarification of equivocal focal uptake at the neck area. Materials and methods: 70 patients; 11 men and 59 women aged between 16 - 78 years, previously underwent total thyroidectomy for DTC (55 papillary, 10 follicular, 5 Hürthle cell) were studied. These patients underwent planar imaging and SPECT-CT after 3 weeks of L-thyroxine withdrawal and 4 days after oral administration of 3,7-5,55 GBq (100-150mCi) of I-131. The indication for treatment was remnant ablation or additional radioiodine therapy (in cases of metastatic disease) with rising thyroglobulin levels. SPECT -low dose CT of the neck was acquired with a Symbia T camera with high energy collimators. Results: In 21 % of cases approximately, SPECT-CT showed a higher number of DTC lesions in the neck, more precisely localizing and characterizing DTC foci, and more correctly differentiating between physiologic uptake and metastases. Hybrid imaging changed the planar scan interpretation for 23 (38 %) of 60 patients, discriminating between residue and lymph node metastases in the neck in 11 patients. Conclusion: Our results show the complementary role of neck SPECT-CT to 131Iplaner scintigraphy by confirming or ruling out residual disease in most of our patients where 131Iplaner imaging remains unclear.
P108 Impact of SPET/CT with 99mTc-Labeled Anti-Granulocyte Antibodies in the Management of Patients with Suspected Low-Grade Infection of Endoprothesis C. Neumann1, A. H. Hering1, A. Zeh2, B. Meller1, K. Delank2, M. Baehre1; 1 University Hospital of Halle, Dept. of Nuclear Medicine, Halle/Saale, GERMANY, 2University Hospital of Halle, Dept. of Orthopedics, Halle/Saale, GERMANY. AimThe goal of this prospective study was to determine the benefit of scintigraphy with 99mTc-labeled anti-granulocyte monoclonal antibodies (ag-MAb) using SPET/CT hybrid imaging to detect septic loosening of endoprothesis. As scintigraphy with 99mTc-labeled ag-MAb is known to be highly sensitive, this study is focussed at the increase in information using SPET/CT.Patients and methodsSince July 2010, up to now 19 consecutive patients with clinically suspected septic loosening of hip or knee endoprothesis were included. After determination of HAMA (human anti-mouse antibodies) titre, all patients underwent whole body scintigraphy with 800 MBq 99mTc-BW250/183 antibody (IBA) after 4 and 24 h p. i. Furthermore, SPET/CT (Brightview XCT, Philips) investigations of interesting regions were performed 5 and 25 h p. i.The results of planar scintigraphy, SPET and SPET/CT, investigated by two experienced investigators, were related to a clinical score as substitute for a gold standard. This score comprised several indicators like elevated CRP and/or leucocytes, positive microbiology, suspicious X-ray, pathological findings in surgical preparations, and clinical follow-up.ResultsIn 8/19 patients low-grade infection was probable due to the clinical score. Among the 8, planar scintigraphy was positive in 3 cases and equivocally positive in 2. SPET resulted positive in 4, equivocally positive in 3 cases. SPET/CT was clearly positive in 7 cases of this group.In the remaining 11/19 patients no infection was suspected due to the clinical score. Among the 11, planar scintigraphy was negative in 7 cases, SPET in 7 and equivocally negative in 1 case. SPET/CT turned out negative in 7 cases of this group, too.In 2/8 patients who underwent surgery SPET/CT changed surgical strategy (septic vs. aseptic).ConclusionsThe known impact of scintigraphy with 99mTc-labeled ag-MAb was confirmed. However, the use of hybrid imaging technique (SPET/CT) lead to a significant increase in information when compared to planar imaging. Especially, the number of equivocal findings in SPET imaging was considerably decreased with SPET/CT investigation. Since scintigraphic results are one of the most important criteria for further treatment of patients with suspected low-grade septic loosening of endoprothesis in our University Hospital, SPET/CT seems to have the potential to become the state-of-art imaging tool for this indication.
P109 Preoperative Localization of Secondary Hyperparathyroid Adenomas with Early and Delayed MIBI-Tc99m SPECT/CT M. H. Listewnik1, B. Birkenfeld1, M. Ostrowski1, T. Sulikowski1, A. Borowiecki2, H. Piwowarska-Bilska1, P. Zorga2, T. Jurczyk3; 1Pomeranian Medical University, Szczecin, POLAND, 2Autonomous Public Clinical Hospital No.1 of PMU, Szczecin, POLAND, 3Non-Public Health Care Institution-"MEDIS" Laboratory, Szczecin, POLAND. Aim: Secondary hyperparathyroidism is an increasing problem, especially because rising number of dialyzed patients. Ultrasonography examination is usually not effective. Parathyroid scintigraphy is well-established method in primary hyperparathyroidism. Localization of parathyroid adenomas in secondary hyperthyroidism is much more difficult due to their usually smaller volume and
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 multiplicity. The aim of the study was to localize secondary adenomas before surgery.Materials & methods: Dialyzed 40 patients (21F and 19M, aged 23-81 years, av. 58) with laboratory features of hyperparathyroidism were studied. All early and delayed SPECT/ CT examinations were performed after an injection of 800 MBq of MIBI-Tc99m. Detailed localization of lesions was presented to the surgeons on fusion transverse, sagittal and coronal slices. All patients were operated on and histopathology examinations were performed.Results: In all patients suspected for parathyroid adenomas, lesions were removed. In 36 (90%) of patients success was achieved. There were no laboratory signs of hyperthyroidism after surgery. In 4 of the patients there were still elevated levels of parathyroid hormone and elevated serum calcium after surgery.Conclusions:1. Early and delayed SPECT/CT successfully localized secondary parathyroid adenomas in 90% of cases.2. Hybrid slices presented to the surgeons were very helpful.
P110 Added values of SPECT- CT in assessing indeterminate bone scan foci in cancer patients
solitary
D. Ben Sellem, L. Zaabar, I. El Bez, I. Slim, I. Meddeb, A. Mhiri, B. Letaief, M. Ben Slimene; Department of Nuclear Medicine Salah Azaiez Institute, TUNIS, TUNISIA. Aim:Planar bone scintigraphy lacks specificity. But single photon emission computed tomography/computed tomography (SPECT/CT), by clarifying anatomic localization of lesions in 3D and correlating to CT aspects, allows accurate diagnosis.The purpose of our study was to investigate the value of SPECT- CT in the assessment of solitary foci of increased bone metabolism classified as indeterminate on whole-body planar scintigraphy in oncologic patients.Materials and Methods:Our prospective study included 42 patients (5 men, 37 women) aged 41 to 75 years (mean ± SD = 55.8 ± 10.5) with known carcinoma breast cancer, prostate cancer and others respectively 78.6 %, 4.8 % and 16.6 %.All these patients underwent planar whole-body scintigraphy 2-3 h after intravenous injection of a mean activity of 740 MBq (20 mCi) 99m technetium- methylene diphosphonate (99mTc-MDP). Immediately after acquisition, these images were analyzed by a board-certified nuclear medicine physician. All of them had at most two indeterminate increased uptake on planar scintigraphy and therefore they underwent SPECT/CT scan and among them 37 (88%) had solitary focus.We performed our studies on the same hybrid camera combining a dual-head γ-camera with a dual-slice spiral CT scanner installed within the same gantry (Symbia T2; Siemens Medical Solutions).Afterwards, the corresponding SPECT/CT images were analyzed and the findings previously considered as indeterminate were classified either as definitely benign, indeterminate, or definitely malignant.Results:SPECT-CT allowed us to classify these indeterminate lesions as malignant in 40.4 % of cases (19 foci) and benign in 49 % of cases (23 foci). However, 5 (10.6 %) remained indeterminate.This technique detected over them, 6 additional metastatic bone foci included in the field of SPECT exploration that were invisible on planar scan. In 2 patients, spine lytic metastases were multiple.SPECT-CT was able so to clarify 89.4 % of planar findings classified as indeterminate, modifying the final report in 88 % of our patients.Conclusion:Our preliminary study highlighted the higher diagnostic value of SPECT-CT over planar skeletal scintigraphy in clarifying more than 89 % of solitary indeterminate lesions in oncologic patients.Thus, this technique modified the final report for 88 % of our patients, allowing early adequate therapeutic management.
P111 SPECT-CT versus SPECT in the management of progressive necrotizing external otitis D. Ben Sellem, L. Zaabar, I. Slim, I. El Bez, I. Meddeb, A. Mhiri, B. Letaief, M. Ben Slimene; Department of Nuclear Medicine Salah Azaiez Institute, TUNIS, TUNISIA. Aim:Progressive necrotizing (malignant) external otitis (PNEO) is an uncommon but severe and evolutive infection caused by resistant pathogens occurring mainly on old diabetic. This osteitis spreads to the skull base at the temporal bone. An energetic, rapid and well adapted treatment must be instituted to preserve vital prognostic.99m technetium- methylene diphosphonate (99mTc-MDP) is an early valuable tool to confirm diagnosis and assess extension. SPECT showed its superiority over planar images. The aim of this study is to evaluate if there is additional diagnostic value of fused single photon emission computed tomographic (SPECT) and computed tomographic (CT) images (SPECT-CT).Materials and Methods:Over one year, we explored 12 diabetics with a trailing otitis resistant to different treatments. Only five of them benefitted of SPECT-CT. These patients (3 men, 2 women) aged 52 to 75 years (median 71 years) underwent, 2-3 h after intravenous injection of a mean activity of 740 MBq (20 mCi) 99mTc-MDP, static planar scintigraphy views in the anterior, posterior and lateral positions and SPECT/CT scan focused on skull. Images of SPECT and SPECT-CT were retrospectively and separately interpreted. First, the nuclear medicine physician read bone scintigraphic images, including planar and SPECT images. Secondary, few days later, the reviewer interpreted scintigraphic images and fused SPECT/CT
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P112 Additional Diagnostic Value Of SPECT-CT Fusion Imaging In Suspected Cerebrospinal Fluid Leakage S. Ucak Semirgin, T. Basoglu, C. co*kluk, O. Yapici, Z. Sahin; Ondokuz Mayıs University, Samsun, TURKEY. Aim:Currently used imaging methods in determining the localization of cerebrospinal fluid (CSF) leaks remain frequently incapable to detect this compartmental pathology, that can be, not rarely, quite subtle. Although planar radionuclide cisternography (PRC), a high-contrast compartmental CSF visualization method, proved to be useful in patients with CSF leaks, accurate anatomic localization of the leakage site can often be troublesome. The findings of a pilot study demonstrating the usefulness of SPECT-CT fusion imaging in suspected CSF leakage are presented in this report.Materials and Methods:Seven patients with rhinorrhea and 1 patient with postural headache were imaged with SPECT-CT following conventional planar imaging. Radiological imaging procedures (CT and/or MRI) were performed in all but one of the patients before or immediately after radionuclide procedure. Radionuclide studies (both planar and SPECT-CT) were performed using a Siemens Symbia TruePoint SPECT-CT.Two and 6 hours after the intrathecal administration of 74 MBq 99mTc-DTPA, initial static images were obtained for each patient. Immediately after planar imaging, SPECT images were acquired in 3° angle steps and 25-s per frame. CT scans were performed with low dose (40-60 mAs), 130 KeV and in 5 mm slice thickness. Scintigraphic findings were evaluated on both planar and SPECT-CT fusion images.Results:One patient with no pathological scintigraphic findings refused further radiological imaging. In 5 patients, planar radionuclide cisternography alone revealed minimal or suspicious focal tracer accumulation, which was difficult to interpret in favor of a CSF leak. SPECT-CT fusion imaging was capable to strengthen the diagnosis by assigning these foci to meaningful anatomical leakage areas. In one patient, SPECT-CT was able to detect a CSF leak that was not detected at all with planar imaging. Among all six patients in whom the leakage site could be localized with SPECT-CT, CSF leak was detected only in one patient with CT and in another patient with both CT and MRI. In 3 patients, CT scans detected soft tissue densities suspicious of CSF, but no leakage could be demonstrated.Three patients undergone surgical operation and the demonstrated defective areas were treated. Blood patching was performed in the patient with intracranial hypotension. Remaining four patients were followed up by symptoms.Conclusion:This relatively new method that combines anatomical and functional data provides useful information in patients with suspected CSF leakage. We concluded that SPECT-CT could take place among the first choices in the detection of anatomical localization of CSF leakage.
P113 99mTc-EDDA/HYNIC-TATE scintigraphy: Results of 1 year experience in Turkey S. Asa1, Ö. Ekmekçioğlu1, M. Ocak2, C. Decristoforo3, L. Kabasakal1, S. Sağer1, Ç. Önsel1, A. Araman2, &. Uslu1; 1Department of Nuclear Medicine, Cerrahpaşa Medical Faculty, Istanbul, TURKEY, 2Department of Pharmaceutical Technology, Pharmacy Faculty, Istanbul University, Istanbul, TURKEY, 3Clinical Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, AUSTRIA. Introduction: 99mTc-EDDA/HYNIC-TATE is an excellent alternative to 111-In Octreoscan for staging of carcinoids and it has been shown to be the cost effective of choice for detection of the primary focus in patients with metastases from an unknown primary tumour with high imaging quality. The aim of this study was to assess the diagnostic efficiency of 99mTc-EDDA/HYNIC-octreotate scintigraphy in the detection and staging of NET.Materials and Methods: The study population composed of 88 patients (F/M: 54/34, age 52.3 ±13.2 y). Seventy three of them had histological confirmation and 15 of them had suspected NET. SPECT and CT images were performed after 4 hour injection of inhouse produced 99mTc-EDDA/HYNICTATE (290-740MBq, mean 536.8±125.1). Then SPECT/CT fusion images were interpreted.Results: High-quality 99mTc-EDDA/HYNIC-TATE images were obtained
in all cases. 54 patients (61%) had positive 99mTc-EDDA/HYNIC-TATE scan. Lesions localization were in liver (33 patients), in mediastinum(15 patients), in lung (10 patients), abdomen and pelvis (40 patients), in skeletal system (10 patients), in other parts of the body (4 patients). There was significant difference (p<0.05) between the Ki67 proliferation index in 99mTc-EDDA/HYNIC-TATE positive and negative patients.Conclusion: 99mTc-HYNIC-TATE scintigraphy is easy, cheap and efficient method for detecting NETs lesion localisation.Acknowledgement: This study was supported by Turkish Scientific and Research Council (TUBITAK) with project no: 109S101
P114 Hybrid SPECT and CT coronary angiography is more reliable than stand alone SPECT or CT to exclude significant coronary artery disease in high risk patients. J. Schaap1, R. M. Kauling1, S. M. Boekholdt2, M. C. Post1, J. A. S. Van der Heyden1, T. L. de Kroon1, H. W. van Es1, B. J. W. M. Rensing1, J. F. Verzijlbergen1; 1St. Antonius Hospital, Nieuwegein, NETHERLANDS, 2 Academic Medical Center, Amsterdam, NETHERLANDS. Purpose: Prevalence of significant coronary artery disease (CAD) in patients with high pre test likelihood of disease may be as low as 50%. CT coronary angiography (CTA) has limited value in this subset of patients due to un-evaluable segments. Myocardial perfusion SPECT (SPECT) is known for its performance in diagnosis, risk stratification and choice of therapy. But this might be hampered by the prevalence of disease in a subset of patients with high risk. We evaluate the efficacy of hybrid SPECT and CT coronary angiography in excluding significant CAD in high risk patients.Methods: In total, 97 patients (mean age 62.8±10.1 years, 67% male) with stable anginal complaints and high risk of coronary artery disease, mean pre-test probability 84%, were prospectively included in this study. Hybrid SPECT and CTA was performed prior to CAG. By non-invasive assessment, significant CAD was defined as a Summed Stress Score (SSS) of >3 on SPECT or the presence of >70% stenosis on CTA. Un-evaluable segments on CTA were not assessed. The specificity, positive (PPV) and negative (NPV) predictive value and 95% confidence intervals (CI) were calculated, using a luminal loss of >70% on CAG as gold standard.Results: The CAG showed significant CAD in 43 patients (44%). Mean CCS was 552±769, range 0-3719. The specificity of SPECT was 83% (95%CI 71-91), PPV 80% (95%CI 6688), NPV 85% (95%CI 73-92). By CTA 341 (26%) segments were un-evaluable. The specificity of CTA was 47% (95%CI 35-60), PPV was 55% (95%CI 43-67), NPV 87% (95%CI 70-95). The combination of the presence of >70% luminal narrowing on CTA or an abnormal SPECT increased the specificity, PPV and NPV for the presence of significant CAD to 57% (95%CI 44-70), 65% (95%CI 52-75) and 97% (95%CI 84-99), respectively.Conclusions: In patients with a high risk of CAD, pre-test probability of 84% and high average CCS of 552, hybrid SPECT and CTA was able to safely exclude significant disease. In these patients invasive coronary angiography can be safely avoided.
P115 Detection of pulmonary embolism with perfusion SPECT/CT A. Radácsi, Z. Olbrich, K. Gyimesi, K. Bor; Euromedic Diagnostics Hungary, Budapest, HUNGARY. The aim of our study was to present our experience of the detection of pulmonary embolism with perfusion SPECT/CT.Patients and methods: Consecutive patients (N=81) suspected of pulmonary embolism from July 2010 to March 2011 were send to perfusion pulmonary scintigraphy in our hospital. PIOPED criterions were taken into account at the evaluation.Results: In 58/81 cases, it was clearly low or high probability of pulmonary embolism, so low-dose native CT was not necessary. Based on SPECT/CT, in 6/23 cases it was a high probability -, and in 13/23 cases it was a low probability of pulmonary embolism. Only in 4/23 cases we found as medium probability of pulmonary embolism we suggested Dual-Energy CT.Conclusions: Perfusion SPECT/CT was not sufficient to detect pulmonary embolism only in 4/81 cases. Taking into account the lower radiation exposure, whether perfusion SPECT/CT should be the first choice in the suspicion of the pulmonary embolism is considered.
P116 Two Years Initial Experience of the First SPECT/CT Scanning System in Kuwait M. U. Khan1, Z. S. Abdullah2, S. K. Kodali2, M. Naeem2, A. Dafalla2, E. Habib2; 1Department of Nuclear Medicine, Al-Jahra Hospital/PET Unit, KCCC, Kuwait, KUWAIT, 2Department of Nuclear Medicine, Al-Jahra Hospital, Kuwait, KUWAIT. Introduction: The era of SPECT/CT systems have contributed to provision of hybrid imaging, resulting in improved patient management. We aim to present our preliminary two-year experience of the first SPECT/CT scanning system in Kuwait, evaluating how its introduction made a difference to the services and patient management.Materials & Methods: From April 2009 to March 2011, 190 SPECT/CT
Poster Presentations
images focusing on the additional value of fused images.Results:The qualitative analysis of the planar acquisition showed an increased temporal uptake in 4 patients. Among them, one patient had an extension of the uptake towards the midline suspecting an invasion of the skull base. In the fifth patient, normal and symmetric temporal bones uptake was objectified.SPECT has objectified a radiotracer uptake of the mastoid in 4 cases with a limited extension to the petrous bone in one case and more extend to the petrous apex in 2 cases.Sphenoid extension was noted in one patient and involvement of the temporomandibular joint was visualized in two patients. In the fifth patient, no abnormalities were objectified.After analyzing the fused images, no changes in the final report were noted.Conclusion:The value of bone scintigraphy notably tomographic acquisitions in early diagnosis of PNEO and in estimation of its extension to the base of skull is well proven. Despite the higher diagnostic value of SPECT-CT in assessing suspected bone metastasis, our preliminary study does’nt objectified an additional diagnostic value of fused SPECT-CT images in the assessment of this infectious disease.
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S288 procedures were performed on 189 patients (Mean age 43.34y). 117 females: 72 males. SPECT/CT was performed for 98-bone (69 Three-phase; 29 Delayed), 80Parathyroid, 5-Cardiac, 4-Gallium, 1-each MIBG, labelled RBC, and sentinel lymph node scintigraphy procedures. Activity of Tc-99m radiopharmaceutical used ranged from 33.3 MBq (0.9mCi) to 1036 MBq (28mCi) depending upon the procedure. Acquisition parameters SPECT/CT (matrix size:128 x 128, zoom-1.00, Rotation clockwise, Degree of rotation 180-degree x 2 detectors, Orbit: non-circular, Time 20sec/view, Number of views: 64, Mode: Step-and-Shoot; Low-dose CT acquired at variable mA depending upon the site and 130KVp post SPECT images). Five different categories were devised to evaluate information gathered after SPECT/CT (I: Better anatomical localization; II: Additional information-relevant to query/incidental; III: Ruled out a possibility; IV: Alteration in patient’s management; V: No significant contribution). Summed set analysis into the preceding categories was also done.Results: In 28(14.7%) procedures SPECT/CT provided solely better anatomical localization. Further summed (Group I+II) information was provided in 69(36.3%) and (Group I+III) information in 5(2.6%) procedures. In 1(0.5%) it helped solely by providing additional information either relevant to clinical query or an incidental finding. Further summed (Group II+III) information was provided in 7(3.7%). There were 52(27.4%) procedures in which it helped rule out a possibility. Further summed (Group III+IV) information was provided in 1(0.5%). Results of summed (Group I+II+III) and (Group I+II+IV) information was provided by 6(3.2%) and 9(4.7%) procedures respectively. In 12(6.3%) procedures SPECT/CT information did not contribute significantly.Conclusion: In our initial experience the addition of SPECT/CT has assisted in making a major difference to Nuclear Medicine service resulting in improvement of diagnostic services.
P117 The value of Tc-99m HYNIC-TATE SPECT/CT in patients with recurrent or metastatic Medullary Thyroid Carcinoma S. Asa1, Ö. Ekmekçioğlu1, M. Ocak2, C. Decristoforo3, E. Arslan1, L. Kabasakal1, S. Sağer1, Ç. Önsel1, A. Araman2, &. Uslu1; 1Departments of Nuclear Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TURKEY, 2Department of Pharmaceutical Technology, Pharmacy Faculty, Istanbul University, Istanbul, TURKEY, 3Clinical Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, AUSTRIA. Introduction: Medullary thyroid carcinoma (MTC) originates from the calcitoninsecreting parafollicular C-cells of the thyroid. Total thyroidectomy with central neck lymph node dissection is only early curative approach. Recurrent MTC can be detected with high calcitonin and carcino-emriogenic antigen (CEA). Morphological imaging modalities such as ultrasonography, computered tomography and magnetic resonance imaging are limited in detecting many metastases. In our study, we aimed to investigate 99mTc-HYNIC-TATE scintigraphy in the detection of recurrent or metastatic MTC.Material and methods: 17 patients (F/M: 9/8 male; mean age 46.8±13.47 y) which have operated and proven as MTC and have elevated calcitonin or CEA levels were prospectively examined. SPECT and CT images were taken after 4 h injection of 99mTc-HYNIC-TATE (mean 482,85±93,85MBq) then SPECT/CT fusion images were interpreted.Results: In 16 patients higher level of total calcitonin and in 1 patient higher level of CEA was observed. Pathologic uptake was seen in 11 patients . Eight lesions were localised in the neck, 8 in the mediastinum, 2 in the supraclavicular region. SPECT / CT fusion images assisted reader confidence in more precise localisation. In 99mTc-HYNICTATE positive patients calcitonin levels were found significiantly higher than 99mTc-HYNIC-TATE negative patients (1341.98±686.54 and 135.96±85 respectively, p<0.01).Conclusion: Our study suggested that 99mTc-HYNIC-TATE scintigraphy is cost-effectiveness method and can be an advantage for detection and localisation of lesions with high calcitonin and CEA levels patients.Acknowledgement: This study was supported by Turkish Scientific and Research Council (TUBITAK) with project no: 109S101
P118 99m Tc-HYNIC-TATE in detection of well differantiated thyroid cancer with negative radioiodine uptake S. Asa1, Ö. Ekmekçioğlu1, M. Ocak2, C. Decristoforo3, E. Arslan1, L. Kabasakal1, S. Sağer1, A. Araman2, &. Uslu1; 1Departments of Nuclear Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TURKEY, 2Department of Pharmaceutical Technology, Pharmacy Faculty, Istanbul University, Istanbul, TURKEY, 3Clinical Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, AUSTRIA. Introduction: The lesions can lose the capability of iodine uptake by passage of time, in patients with well differantiated type of thyroid cancer. Detecting the tumor or the residue tissue is very important and surgery can be the last chance of treatment option for these patients. USG, [18F] FDG PET/CT scan and MRI can be alternative approach for localising tumour focus. In our study, we investigate the value of 99mTc-HYNIC-TATE scintigraphy for the patients with well differantiated thyroid cancer which have elevated thyroglobulin or anti-thyroglobulin levels and negative radioiodine uptake.Material and Methods: We analyzed 27 patients (F/M: 17/10; median age 55,85±15,35 y) which have operated and proven as well
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 differantiated thyroid cancer and have elevated thyroglobulin or anti-thyroglobulin levels. The I-131 whole body scan was negative in all patients. All patients were injected 444-777 MBq 99mTc-HYNIC-TATE (mean 593.11±95.9 MBq) which was prepared in our department. The whole body planar images, SPECT and CT images were performed after 4 hour of injection. SPECT-CT fusion images were composed with a PMOD fusion software programme.Results: 22 patients have elevated Tg levels (284.2±405.41) and 5 patients have elevated anti-Tg levels (670.96±341.91). The uptake of 99mTc-HYNIC-TATE was seen in 17 patients. The lesions were counted and localised as 7 in the neck, 7 in mediastinum, 4 in lung, 1 supraclavicular region, 1 in bone and 1 retrofarengeal area. The SPECT-CT fusion images of the same sections of the body can provide complementary anatomical and physiological information that is of great importance to diagnosis. Tg levels were significantly higher with 99mTc-HYNIC-TATE positive scan than 99mTc-HYNICTATE negative scan (p<0.05).Conclusion: Our study suggested that 99mTc-HYNICTATE scintigraphy can be an advantage for localising tumours of the patients which has elevated tyroglobulin or anti-tyroglobulin levels. 99mTc-HYNIC-TATE scintigraphy is cost-effective, safe and simple to use.Acknowledgement: This study was supported by Turkish Scientific and Research Council (TUBITAK) with project no: 109S101
P119 The added value of SPECT-CT and SPECT with side-by -side spiral CT in the evaluation of neuroendocrine tumours of the abdomen and pelvis. Is it still beneficial in the era of PET-CT? R. K. Kulshrestha, S. Wadhwani, Y. Jain; North Manchester General Hospital, Manchester, UNITED KINGDOM. PurposeTo assess the usefulness of SPECT-CT and SPECT with side-by-side CT correlation in the evaluation of neuroendocrine tumours (NETs), with attention to the impact upon clinical management.To assess the improvement in anatomical localisation using side-by-side CT correlation in the diagnosis of NETs.Materials and MethodsA Retrospective analysis of 79 Indium 111-Octreotide scans (70 SPECT, 9 SPECT-CT) performed at a tertiary referral centre over a 3 year period was undertaken. Independent review by a Consultant Radiologist assessed the added benefit of anatomical cross sectional correlation with CT in anatomical terms. This was either in the form of the low dose CT of the SPECT-CT VG Millenium Hawkeye, (GE) or the separate multislice spiral CT scanner (Toshiba Aquilion).The clinical impact was assessed with respect to subsequent management and followup.Results79 examinations were performed on 73 patients (mean age 53.3yrs +/6.8yrs), with histology obtained from 31 patients. A specificity of 85.7% and sensitivity of 70.6% was obtained, with an overall accuracy of 77.4%. Anatomical localisation was 100%. Based on combined imaging findings, 43% of patients required no further management, 25% were followed-up with interval imaging, and 32% received surgery. In two cases, NET metastases not apparent on cross sectional imaging were diagnosed which precluded surgery and thereby altered management significantly.ConclusionAlthough 68Ga-DOTA-Tyr3-Octreotide (DOTATOC) PET-CT and 18F-DOPA PET-CT (more for carcinoid tumours) are recognised as definitive investigations from recent clinical trials, their availability remains very limited in the UK (with only 26 PET-CT fixed site scanners currently in the UK). The use of SPECT with low-dose fused CT and side-by-side CT correlation remains useful, providing both a high specificity and accuracy, with reasonable sensitivity in the detection of neuroendocrine tumours of the abdomen and pelvis. Patient management is thereby improved. It is hoped that the newer generation SPECT-CT scanners with high-end CT scanners would lead to further improvements in sensitivity, specificity and accuracy.References1. Pfannenberg AC et al. Benefit of anatomical-functional image fusion in the diagnostic work-up of neuroendocrine neoplasms. EuJNM&Mol I. 2003, Vol 30, No6, P835-843.2. Prasad V, Ambrosini V, Fanti S et al. Detection of unknown primary neuroendocrine tumours using 68Gallium-DOTA-NOC receptor PET_CT. EuJNM&Mol I. 2010, Vol 37, No 1, p 67-77.3. Haug A et al. Intraindividual comparison of 68Gallium-DOTA-TATE and 18F-DOPA PET-CT in patients with well differentiated neuroendocrine tumours. EuJNM&Mol I. 2009, Vol 36, No5, p765-770.
P120 Diagnostic Value Of Early SPECT-CT Imaging In Diagnosis Of Parathyroid Pathologies
The
S. Ucak Semirgin, M. Şahin, B. Atmaca, O. Yapici, T. Basoglu; Ondokuz Mayıs University, Samsun, TURKEY. Aim:Although conventional radionuclide imaging is used for a long time in parathyroid pathologies; method may be insufficient in the detection and localization of lesions. In our study, SPECT-CT fusion imaging method that allows the evaluation of both anatomical and functional images, compared with conventional techniques.Materials and Methods:Nineteen patients (10 F, 9 M) who had undergone radionuclide imaging and had been operated for parathyroid pathologies were included the study. Preoperative serum calcium (Ca) and parathormone (PTH) levels, ultrasonographic (US) and scintigraphic findings were evaluated. After 30 minutes of the intravenous injection of 740 MBq Tc-99m MIBI,
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P121 A simple way to quantify bone tracer uptake in mice. P. Choquet, F. Hubele, C. Goetz, A. Constantinesco; Universitaires de Strasbourg, STRASBOURG, FRANCE.
Hopitaux
AIM: Quantification in bone planar scintigraphy is not a simple task. Achieving a calculation to obtain a concentration of tracers requires blood sampling and renal function quantification. These conditions are more difficult to setup in small animals. Given some assumptions and taking care of measurement of activity administered, radioactive decay and positionning of animals, we want to extract a value which is correlated to the fixation of HDP to bone, allowing for longitudinal follow-up or exploration of systemic bone diseases in mice.MATERIAL AND METHODS:A dedicated Anger type gamma camera (field of view 170mm x 170mm, 25 photomultiplicators) was used with 2mm hole diameter’s pinhole collimator (Gaede Medizinsysteme Gmbh, Freiburg, Germany). 5 to 10mCi of [99mTc]oxidronate (CIS bio international, Gif-sur-Yvette, France), was administered to Swiss adult mice (12, about 1 year old) under general gaseous anesthesia (isoflurane 3%), through a tail vein. After tracer administration, animals were allowed to wake up and went back to their cage (with food and water ad libitum). Activities in the syringe before and after administration were measured and time of measurement recorded. Between 1 and 1.5 hours after, they are put in a large warmed (38°C) bed under general gaseous anesthesia (isoflurane 2%), in a position with their limbs spreaded as much as possible and secure to the bed. Pinhole whole-body acquisitions were performed (peak at 140keV±10%). Rectangular ROIs were drawn on each knee and elbow. Counts (expressed by pixels and seconds) were corrected for activity administered, decay between administration and imaging and individual weight.RESULTS:We found for the elbows a mean of 1.43.10-6 counts.s-1.pixel 1 .MBq -1.g -1 and a standard deviation of 0.23.10-6 counts.s-1.pixel -1.MBq -1.g -1, for the knees respectively 4.08.10-6 counts.s-1.pixel -1.MBq -1.g -1 and a standard deviation of 0.66.10-6 counts.s-1.pixel -1.MBq -1.g -1.CONCLUSION:We have calculated an index related to bone uptake which is independant of the activity administered, the animal weight and the delay between administration and acquisition, with a small standard deviation in a group of mice of same strain and age. Careful experimental conditions are however required to obtain a reliable result.
P122 The Effect of Attenuation Correction to Determine Reversible Defects in Myocardial Perfusion Scintigraphy: Comparison With Coronary Artery Based Angiographic Findings.
images. Reversible defect (RD), fixed defect (FD), reverse redistribution pattern (RRP) and normal (N) areas were determined for every CAR in each patient.Findings: A strong correlation was found between both stress NAC / AC and rest NAC/AC GPS (r=0,77 and 0,79; p70% (two were N and three were FD in AC), one was < 70% (N in AC) and one was normal (FD in AC). It was remarkable that, in two CAR with severe stenosis (NAC study revealed with RD), AC study showed normal perfusion pattern. In 21 regions that AC study identified RD, 13 were RD in NAC study, four were FD (two had 70% stenosis), one was RRP ( 70%, one had <70% and one N). There was not certain coronary artery dominance in the areas that observed differences.Conclusion:There was a strong correlation between scores of NAC and AC images. The reason for low sensitivity and specificity values may be due to balanced ischemia of three vessel disease in 19 of 33 patients or relatively normal assessment of some coronary artery areas. While 65% concordance was observed in RD regions for NAC and AC images, other areas were in different patterns.
P08 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Molecular & Multimodality Imaging: PET - MR
P123 Diffusion-weighted MRI and (68)Ga-DOTATOC PET for early monitoring of response to intraarterial(90)Y-/(177)LuDOTATOC therapy in patients with neuroendocrine liver metastases F. Giesel1, S. Wulfert1, T. Kuder2, H. Kauczor1, L. Schwartz3, U. Haberkorn1, C. Kratochwil1; 1University of Heidelberg, Heidelberg, GERMANY, 2German Cancer Research Center, Heidelberg, GERMANY, 3University of Columbia, New York, NY, UNITED STATES. Purpose: Monitoring response to therapy is predominantly based upon evaluating tumor size before and after treatment, for example, in the Response Evaluation Criteria in Solid Tumors (RECIST). However, alterations on a molecular basis may occur earlier than structural changes seen at imaging. Therefore we evaluated if diffusion-weighted MR imaging (DW-MRI) and (68)Ga-DOTATOC PET are potential surrogate biomarkers for providing earlier information about a possible treatment response to intraarterial DOTATOC therapy.Methods: In 12 consecutive patients (5 male, 7 female; age 55.7) with 29 liver metastases of gastroenteropancreatic neuroendocrine cancer (GEP-NET) were evaluated. All patients underwent both diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging (DWI-/DCE-MRI) including breath-hold echoplanar DWI sequences (b-values 50, 300, 600s/mm2) as well as (68)Ga-DOTATOC PET before therapy (baseline) and after last intervention (follow-up). Largest diameter (LD), intratumoral apparent diffusion coefficient (ADC) and maximal standardized uptake value (SUVmax) were measured in all target lesions as well as in normal liver parenchyma and spleen.Results: Tumor metastases were subclassified, based upon change in tumor size in responding lesions (RL, n=7) and non-responding lesions (NRL, n=22). In NRLs, baseline median tumor ADC increased from 1,21x10-3mm2/sec to 1,47x103 mm2/sec while the responding lesion increased from 1,06x10-3 mm2/sec to 1,32x10-3 mm2/sec after last loco-regional intervention (p<0,001) whereas the change in SUVmax of (68)Ga-DOTATOC was not significantly different (Figure 1).Conclusion: After intraarterial DOTATOC therapy non-responder and responder subgroups both presented a change in ADC, prior to SSR2-receptor expression changes and although morphological response according to RECIST criteria was only measurable in few lesions. Therefore, this work suggests that diffusionweighted imaging may be an earlier tumor integrity surrogate for therapeutic intervention and possible early indicator for treatment response.
P124 Presentation of Test Results of an Integrated Small Animal Sequential PET/MRI System
S. Ucak Semirgin, M. Sahin, S. Demircan, O. Yapici, M. A. Sahin; Ondokuz Mayıs University, Samsun, TURKEY.
K. Nagy1, D. Máthé2, P. Major3, G. Németh3, G. Patay3, D. Völgyes3, J. Lantos3, Z. Nyitrai3, B. Gulyás1, B. Bulyás1, C. Halldin1, I. Bagaméry3; 1 Karolinska Institute, Stockholm, SWEDEN, 2CROmed Translational Imaging Centres, Budapest, HUNGARY, 3Mediso Medical Imaging Systems Ltd., Budapest, HUNGARY.
Aim:Artifacts due to tissue attenuation affect the diagnostic accuracy of myocardial perfusion scintigraphy (MPS). In this study, attenuation corrected (AC) and non attenuation corrected (NAC) images were evaluated. Coronary artery regions (CAR) as LAD, RCA and Cx based findings were compared with coronary angiography (CA) results.Materials and methods:Thirty-three cases that undergone MPS and CA were retrospectively reviewed. Tl-201 viability protocol was performed in four patients, Tl-201 stress-rest protocol in 14 patients and single day rest-stress Tc-99m MIBI protocol in 15 patients. Images were obtained by a SPECT/CT device. NAC and AC images scored over 17 segments and global perfusion scores (GPS) were obtained. Spearman correlation was used to research the relationship between NAC and AC
Objectives: Our aim was to sequentially integrate a magnetic resonance and a positron emission tomography imaging system. The effects of integration are considered in this presentation. We present some first, test measurements of the system integration where PET and MR are working in a distance less than 10 cm sequentially.Methods: We are presenting some preliminary specification measurement results for a new, compact, sequential PET/MR system for rodents. The PET/MR system was constructed on the basis of existing Mediso crystal-based PET detector technology and a special, permanent magnet 1 T MR subsystem minimizing external magnetic field. The Mediso nanoScan® PET/MR imaging system has 12 PET detector modules of 81x39 LYSO crystals (1.12x1.12x13mm), tightly
Poster Presentations
early pinhole (with GE Starcam 4000i gamma camera), early planar and SPECT-CT (with Siemens Symbia True Point SPECT/CT) imaging were performed. Late planar and pinhole imaging were performed after 2 hours of radionuclide injection.Results:Parathyroid adenoma was detected in 13 patients histopathologically, (median Ca: 11,5 mg/dl; median PTH: 1433,6 pg/ml). Single or multiple hyperplasia was defined in 6 patients (median Ca: 9,7 mg/dl; median PTH: 838,7 pg/ml). In early and late pinhole imaging, 8/13 and 10/13 adenoma; 3/6 and 4/6 hyperplasia were detected respectively. Pinhole imaging showed 77% of adenoma and 67% of hyperplasia. Number of adenoma and hyperplasia detected with early planar imaging was 6/13 and 1/6 respectively; whereas late planar imaging was detected 8/13 adenoma and 3/6 hyperplasia. Planar imaging showed 61% of adenoma and 50% of hyperplasia. Early SPECT-CT imaging showed adenoma in 11/13 and hyperplasia in 4/6 patients. Pathology was detected in 85% of adenoma and 67% of hyperplasia with early SPECT-CT imaging. There as no case of mediastinal parathyroid adenoma. SPECT findings were found to be adequate to assess lesion detection and localization, CT component was not providing an additional contribution to the localization of the lesion. US detected adenoma in 4/13 and hyperplasia in 3/6 cases.Conclusion:Late imaging technique should be preferred if pinhole or planar imaging is to be used to evaluate parathyroid pathologies. SPECT imaging demonstrated a greater number of parathyroid pathologies than conventional nuclear medicine techniques in this study. CT component of SPECT / CT has not additional contribution in detecting or localizing parathyroid pathology in the cervical region. A small number of parathyroid hyperplasia could be shown with all imaging methods. These findings are required to support with large number of patients.
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S290 packed (pitch 1.17mm, PF 92%) coupled to two 256-channel PS-PMT’s. To avoid inhom*ogeneities in the centre of the FOV, modular PET detector ring design was favored. PET is aligned axially in front of the MR component that has 1 Tesla field strength with 90 mm diameter and 60 mm high barrel FOV, specified with 100 micron areal pixel resolution. Animal is moved from the PET ring bore to the MR subsystem bore with a common animal bed (as in PET/CT devices). The center of the PET FOV is close to the MR magnet bore opening (distance: 6.425 cm). We have measured the PET ring performance with the working MR system using a 22Na point source and a 0.8-1.5 mm rods Micro-Derenzo phantom filled with 18F-FDG. We also present signal/noise ratio (S/N) of the MR subsystem before and after integration using a 35 mm diameter mouse coil.Results: PET resolution in center FOV (2DOSEM reconstruction) ranged from 0.97 to 1.34mm, sensitivity in the center was 7.40%. The MR subsystem S/N ratio was 714/mm3 before the integration. With working PET electronics and PET detector within the combined system MR S/N ratio was 664/mm3. Original MR subsystem specification is >500/mm3.Conclusions: The nanoScan® imaging system fulfils the original PET and MR specifications. Cross-talk effects are not affecting imaging efficiency. The sequential Mediso PET/MR system presented here is a prompt, viable stand-alone solution providing high PET resolution and effective, flexible MR imaging in the same animal and imaging session with affordable throughput.Research support: Mediso Ltd.
P09 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Molecular & Multimodality Imaging: Biology
P125 Gene Expression Profiling of the T-cell Receptor Signalosome Reveals Novel Immune-Endocrine Interactions in Hashimoto's Thyroiditis M. Stefanic, S. Tokic, L. Glavas-Obrovac, I. Mihaljevic; Clinical Institute of Nuclear Medicine and Radiation Protection, Osijek University Hospital, Osijek, CROATIA. CD28/TCR/CTLA-4 complex controls T-cell homeostasis, tolerance and autoimmunity in Hashimoto’s thyroiditis (HT). Many other receptors, CD45 protein tyrosine phosphatase and vitamin D receptor (VDR) in particular, are indispensable for CD28/TCR signaling efficiency and affect Th1/Th17/Treg processes central to the pathogenesis of HT. However, their role has been less well established. Aim: To explore disease-modifying effects of the expression levels of selected mRNAs, centered around T-cell pathways involving CTLA-4, in patients with HT. Methods: 44 HT patients and 46 euthyroid, thyroid peroxidase autoantibodies (TPOAb)negative controls without a personal or family history of autoimmune disorders were recruited. HT was diagnosed by positive TPOAb-IgG, characteristic ultrasonographic and cytopathologic findings on fine needle aspiration biopsy and/or biochemical hypothyroidism. Untouched T-lymphocytes were negatively isolated from peripheral blood mononuclear cells by use of magnetic beads. Total mRNA was extracted and gene expression studied by RT-PCR and ImageQuant method relative to GAPDH products (%). Biochemical data were compared to gene expression levels by robust regression procedures. Results: Total VDR, CTLA-4, CD28, CD45RABC and CD45R0 mRNA expression did not differ by case-control status, gender and need for hormone replacement therapy. CTLA-4 mRNA expression was related to both CD28 (β=0.758±0.283, P=0.011, R2a~13%) and VDR mRNA expression (β=0.311±0.148, P=0.042, R2a~7%), irrespective of the thyroid function level (unsorted T-cells, HT patients). Log-transformed TSH values at diagnosis were inversely correlated with T-cell CTLA-4 mRNA levels in untreated patients (β=-0.0047±0.002, P=0.026, R2a~5%), independent of the serum free thyroxine and age. Increased CD45RABC expression, a characteristic of naïve Tcells, was associated with younger age and higher VDR mRNA (β=0.093±0.045, P=0.04, R2a~5%), independent of the case-control status. At the same time, ageing (β=0.54±0.151, P<0.001, R2a~11%) and decreased VDR mRNA expression (β=0.212±0.07, P=0.003, R2a~8%) were associated with accumulation of CD45R0 transcripts characteristic of activated and memory T-cells.Conclusion: Thyroid dysfunction is associated with down-regulation of CTLA-4 mRNA in peripheral blood T-cells of untreated HT patients. T-cell VDR mRNA abundance is linked to CTLA-4 mRNA expression and involved in attenuation of an age-related shift from naïve to memory T-cell mRNA signature in HT patients. A cross talk between endocrine and immune functions apparently exists in chronic thyroiditis: thyroid function, ageing and VDR mRNA expression seem to play a role in the maintenance of peripheral T-cell subpopulations in affected individuals. Thus, transcriptome profiling of the TCR signalosome in selected T-cell populations holds promise to unravel novel, therapeutically amenable disease-modifying networks in autoimmune thyroid disorders.
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441
P126 Preclinical and Early Clinical Research of an Asialoglycoprotein Receptor Imaging Marker for Residual Liver Function Measurement M. H. Wang1, C. Y. Chien1, H. M. Yu1, M. C. Weng1, P. Y. Wang1, W. T. Kuo1, J. W. Kuo1, J. T. Wang1, Y. X. Chang1, H. S. Lee2, W. J. Lin1; 1Institute of Nuclear Energy Research, Taoyuan, TAIWAN, 2National Taiwan University, Taipei, TAIWAN. Aim: Drug induced hepatitis and hepatoma model were systematically studied for their ASGPR molecular imaging to validate the feasibility of ASGPR imaging marker for residual liver function measurement. Method: The drug induced mice were established by 500mg/kg acetaminophen induction for acute hepatitis, and 0.001%/gm thioacetamide ip induction every two days for fibrosis production until 4 months. Hepatoma mice were established by N1S1 hepatoma seeded surrounding in the liver of SD rat, BNL hepatoma seeded in the leg of Balb/c, and HepG2 seeded in the leg of nude mice. The 111In-Hexa Lactoside previously reported was used as the asialoglycoprotein receptor imaging marker in our studies. The linearity and precision of the nanoSPECT scanner with parallel hole collimater was previously validated, and the nanoSPECT imaging data was acquired. Time-activity curves were derived from image region of interest (ROI) analysis. Three human hepatoma were done immunocytochemical stain with anti-ASGPR to see ASGPR distribution in normal, hepatitis, hepatoma and the surrounding tissue qualitatively and the tissue protein was extracted to run western blot with antiASGPR to see ASGPR quantity difference individually. Results and Discussion: The fibrosis mice have diseased symptom such as icterus, alopecia, cataract, loss weight and anorexia. The liver appears multiple nodules and many fibrosis by collagen stain. GOT and GPT data did not show the difference of normal group from fibrosis group. By molecular image, thioacetamide induced fibrosis has much lower liver uptake than normal group. Hepatitis caused by high dose acetaminophen ip injection happened after 4h, which appears clinical symptom such as diarrhea, lethargy and low activity. GOT and GPT have significant increase but the residual liver uptake is much lower, and even die within 1wk if lower than 25% residual liver uptake. The radioactivity image was only in normal liver, but nearly none in hepatoma. For early clinical research, only one patient did not have different ASGPR distribution between tumor and its surrounding site. The other two showed their 43kD ASGPR in non-tumor part were expressed significantly more than tumor part, and there is no anti-ASGPR stain appeared in situ on the tumor site. Our preclinical and preliminary clinical data indicated that 111In-Hexa Lactoside is a good imaging tool for measurement of residual liver function, but more human hepatoma samples should be validated further in the future.
P127 Asialoglycoprotein Receptor Expression for Liver Fibrosis Models by in vivo and in vitro Study M. H. Wang, C. Y. Chien, J. T. Wang, W. T. Kuo, J. W. Kuo, P. Y. Wang, H. M. Yu, M. C. Weng, Y. X. Chang, S. P. Lin, W. J. Lin; Institute of Nuclear Energy Research, Taoyuan, TAIWAN. Aim: By paper review, asialoglycoprotein receptor(ASGPR) resides specifically in hepatic membrane and soluble asialoglycoprotein receptor(Asgr) could be found in serum. The sequence of Asgr was previously reported to have EGHRG insertion in its 34-88 peptide region for liver fibrosis individual. In this study, ASGPR expression in fibrosis patients was investigated in vivo and in vitro individually to see its quantitative and qualitative change in liver disease model. Method: Serum protein was digested with trypsin to acquire glycopeptides and the total N-glycopeptide was captured by hydrazide. After digestion with peptide:N-glycanase (PNGase), differential liver proteome was analyzed with LC/MS/MS and statistically established by Discovery, Mascot and SWISS-Prot protein identification software. ASGPR sequence expressed was investigated in serum of twelve fibrosis or cirrhosis patents for Asgr2 (IPI00011155) to check its 34-88 peptide sequence. At the same time, ASGPR expression in liver was investigated and quantified by molecular ASGPR imaging. Results and Discussion: For Metavir classified F1, F2 fibrotic serum, we found the Asgr sequence has EGHRG characteristic insertion, but for F4 fibrotic serum, we could not find Asgr sequence anymore. This in vitro study indicates the Asgr expression was negatively correlated with fibrosis progression and contains the qualitatively continuous change along with the progression from normal to cihhrosis. For in vivo ASGPR image, the uptake in fibrotic model was 50% lower than normal case. Basically, the in vivo and in vitro ASGPR study for ASGPR expression has the coincident results. Our preliminary data indicates that the ASGPR imaging marker was suitable for measurement of residual liver function, and the soluble Asgr sequence was a valuable indicator to evaluate the progression of liver disease. Furthermore, the EGHRG insertion in 34-88 peptide sequence might be a good biomarker for early fibrosis detection.
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
Molecular & Multimodality Imaging: New & Innovative
P128 Influence of Tc-99m-besilesomab antigranulocyte scintigraphy on treatment in patients with suspected infection of the musculoskeletal system - results of a blinded read study C. Öser1, J. Ruf1, I. G. Steffen1, A. Zarva1, G. Ulrich1, W. S. Richter1, W. Neumann2, C. H. Lohmann2, H. Amthauer1; 1Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A-ö-R., Magdeburg, 2 GERMANY, Orthopädische Universitätsklinik, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, GERMANY. Aim: Evaluation of Tc-99m-besilesomab antigranulocytescintigraphy for the diagnosis and treatment in patients with suspected infection of the musculoskeletal system.Methods: In this retrospective study the data of 40 consecutive patients with a total of 51 suspicious localizations were evaluated. After intravenous injection of on average 615 MBq besilesomab (Scintimun®) planar whole body scans after 4 and 24 hours as well as Single Photon Emission Tomography (SPECT) of the affected region were performed. Image data were evaluated for the presence of infection in a blinded read by 3 independent investigators, assessing reader confidence and image quality with a 5-point score. moreover the intensity of pathological tracer uptake over time was determined. The correctness of the final diagnosis was compared to the actual clinical course, using the decision of an interdisciplinary truth-panel, that had all clinical, surgical and imaging data with a follow-up >12 months at their disposal, as a standard of reference.Apart from sensitivity, specificity, PPV, NPV and accuracy the interobserver-agreement (Fleiss' Κ) was determined. All tests were two sided and P values of less than 0.05 were considered statistically significant.Results: In 14/40 (35%) of patients an infection of the musculoskeletal system was confirmed by the truth-panel. The analysis shows for all readers on average a sensitivity of 88%, a specificity of 65% and an accuracy of 73%. Positive (PPV) and negative predictive value (NPV) were 62% and 90%. The overall interobserver-agreement rate was 70% (Κ=0.5). 68% of the findings were classified by the readers as absolutely or relatively sure (i.e. score 4 or 5). When compared to actual clinical setting, scintigraphy had had an influence on the therapeutic approach in 27/40 (67.5%) patients examined.Conclusions: Tc-99m-besilesomab antigranulocytescintigraphy shows a high accuracy for the detection of musculoskeletal infections under blinded read conditions. Moreover the high NPV and sensitivity allow a reliable exclusion of infection. Clinical decision making was influenced in more than two thirds of the examined patients.
final concentration of these agents was lowered quickly by dilution in the total blood volume and excretion resulting in less influence of osmolarity. A decreased glomerular filtration rate by co-injection of contrast agents may have resulted in the increased uptake in kidneys and somatostatin receptor-expressing normal organs.Therefore, when SPECT is acquired after MRI, possible effects of MRI contrast agents on the pharmaco*kinetic profile of radiopeptides should be taken into account.
P130 Evaluation of functional magnetic resonance urography in obstructive uropathy of childhood in comparison to the present diagnostic algorithm - a pilot study. P. Genseke1, C. Furth1, G. Neumann1, H. Krause2, F. Fischbach1, A. Rißmann3, U. Liehr4, H. Amthauer1, J. Ruf1; 1Universitätsklinikum Magdeburg A.ö.R., Klinik für Radiologie und Nuklearmedizin, Magdeburg, GERMANY, 2 Universitätsklinikum Magdeburg A.ö.R., Universitätskinderklinik m.S. Kinderchirurgie, Magdeburg, GERMANY, 3Universitätsklinikum Magdeburg A.ö.R., Universitätskinderklinik m.S. Nephrologie, Magdeburg, GERMANY, 4 Universitätsklinikum Magdeburg A.ö.R., Urologische Universitätsklinik, Magdeburg, GERMANY.
Magnetic Resonance Imaging (MRI) Contrast Agents Negatively Influences Binding and Internalization of 111InDTPA-octreotide into tumour cells in vitro and in vivo in rats
Aim: Functional magnetic resonance urography (fMRU) is of increasing interest in the diagnosis of obstructive uropathy (OU). Aim of the study is to analyze the impact of fMRU on the therapeutical management in pediatric patients with OU compared to the present diagnostic algorithm consisting of ultrasound (US) and radioisotope nephrography (RN).Patients, material, methods: In this retrospective analysis 10 consecutive patients [female, n=4; male, n=6; average age, 18.8 (2-121) months] with suspicion of OU were included. Initially patients were examined with US and RN for clinical routine. In addition, contrast enhanced fMRU was performed. Images were evaluated by experienced physicians in pediatric radiology and nuclear medicine in a blinded read setting.Findings of US, RN and fMRU were presented to an interdisciplinary truth-panel and the impact of fMRU on the therapeutically management was recorded. In addition, quantitative estimation of kidney function (KF) was assessed by both, RN and fMRU.Results: According to the conventional diagnostic algorithm (US+RN) surgical intervention was indicated in 8 patients and conservative treatment in two. Additional use of fMRU changed treatment approaches in two patients (conservative to surgery, n=1; surgery to conservative, n=1). Moreover, fMRU depicted additional morphological information in 7 of 8 patients that led to the modification of the initially chosen surgical approach in 6 of those 7 patients (surgical access path, n=1; modification ureter-neoimplantation, n=2; modification pyeloplasty, n=3).The measurement of KF by RN and fMRU showed concordant results in 14/19 kidneys. In two patients measurement of KF by fMRU differed more than 5% when compared to KF measured by RN and was not possible in one patient.Conclusion: fMRU indicates potential to improve therapeutical management of OU in children. Especially, if surgical treatment is advised, the value of additional morphological information by fMRU is to consider. Concerning the measurement of SKF the preliminary results are encouraging, but need a further investigation in larger cohorts.
T. Brabander, J. Haeck, H. Groen, M. Melis, S. van Tiel, M. Bernsen, M. de Jong; Erasmus Medical Centre, Rotterdam, NETHERLANDS.
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Aim: For diagnostic imaging of somatostatin receptor-expressing gastroenteropancreatic neuroendocrine tumours (GEP-NETs) the combination of functional and anatomical imaging is warranted. Combination of SPECT with CT or MRI can be used. MRI shows the highest resolution for anatomical information. The aim of the current study was to determine possible influence of MRI contrast agents on the binding and internalization of Octreoscan (111In-DTPA-octreotide), a radiolabelled somatostatin analogue being used in SPECT of GEP-NETs.Materials & methods: In vitro binding and internalization studies using Octreoscan were performed with the somatostatin receptor-expressing rat pancreatic CA20948 tumour cell line. To determine possible influence of MRI contrast agents, increasing concentrations of Gadovist or Magnevist (70 μM to 70 mM) were added to the incubation medium, before or during the incubation with Octreoscan. Biodistribution studies were performed in Lewis rats bearing subcutaneous CA20948 tumours. 70 μL Gadovist (0.2 mmol/kg) was administered intravenously five minutes before injection of Octreoscan. After one hour blood, organs and tumours were collected and counted for radioactivity. Uptake was expressed as percentage of injected dose per gram of tissue (%ID/g).Results: In vitro results showed a 60% (p<0.01) lower uptake of Octreoscan in the presence of 70 mM Gadovist added before or at the start of the incubation, whereas 70 mM Magnevist resulted in 83% (p<0.01) reduction of uptake. The reduction of uptake was time and concentration dependent. A sham incubation with NaCl solutions of similar osmolarities as that of the contrast agents induced the same effects on Octreoscan uptake. In vivo, no significant effect of Gadovist on tumour uptake was found compared to that in the control group. A significantly higher uptake of radioactivity in somatostatin receptor-expressing normal organs and kidneys was found though. Kidney uptake was approximately 25% (p<0.01) higher than that in the control group.Conclusion: The reduced uptake of Octreoscan in tumour cells in vitro might be effected by the high osmolarity of the MRI contrast agent solutions. In vivo, the
The Implementation of Tracer Uptake Adjustment Atlases for Correction of Bone Attenuation in PET A. Samarin, C. Burger, F. P. Kuhn, G. K. von Schulthess; University Hospital Zurich, Zurich, SWITZERLAND. Purpose: Attenuation correction for PET/MR is technically challenging as MR signal does not directly reflect the radiodensity of tissues. Accurate attenuation correction (AC) in PET/MR systems is essential when one wishes to have a quantitative measure such as SUV to compare PET/CT and PET/MR data sets for treatment response assessment. AC in MR is commonly done by “replacing” bone with soft tissues in the AC map. We have investigated, whether information derived from CT data can be used to improve accuracy of SUV values stemming “boneless” MR AC derived SUV data.Materials and Methods: In 12 patients who underwent FDG-PET/CT imaging, MR like CT attenuation correction maps were produced by replacing pixels > 100 HU corresponding to bone tissue with pixel values of 36 HU representing soft tissue. PET images were reconstructed using the standard and the modified attenuation correction maps. A whole body atlas showing the difference in SUV between standard and modified PET images was created using the data of a patient without pathological FDG uptake. Subsequently, a total of 30 FDG positive soft tissue lesions in thoracic, abdominal and pelvic regions of different patients were identified and analyzed. The SUV error in each lesion obtained by using the soft tissue only AC correction, was compared with the expected error in the atlas. This was done by placing a volume of interest on a lesion and the same anatomical location in the atlas.Results: Substitution of bones by soft tissue values in AC maps resulted in average underestimation of SUV of 2 ± 1.2% in soft tissue lesions. The largest SUV errors in soft tissue were in lesions adjacent to bone (4.5% in a lesion adjacent to pelvic bone). The average underestimation of SUV in soft tissue in the same anatomical locations using atlas
Poster Presentations
P10 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
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was 2.5 ± 1.8%. The application of coefficients derived from the atlas resulted in average decrease of underestimation of SUV of lesions to 1 ± 0.7%.Conclusion: The application of coefficients derived from a previously generated whole body atlas allows to substantially reduce the underestimation of tracer uptake in case of erroneous bone attenuation in PET images.
P132 First intraoperative demonstration of sentinel node biopsy using 3D lymphatic mapping by freehand SPECT in an head and neck melanoma patient M. C. Kreissl1, M. Scheich2, A. K. Buck1; 1Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, GERMANY, 2Dept. of Otorhinolaryngology, University Hospital Wuerzburg, Wuerzburg, GERMANY. Background: Sentinel lymph node biopsy (SLNB) is successful applied in head and neck cancer/melanoma. However routine techniques of SLNB lack intraoperative image guidance for a safe and complete removal of the SLNs. In order to perform intraoperative 3D visualization and guidance, a SLN freehand SPECT was developed and applied (1).Methods A 77-year old woman presented with a melanoma on the right cheek. The sentinel node procedure was performed according the guidelines of the EANM In the 24-hr period prior to surgery 100 MBq of 99mTc-labelled nanocolloid was injected peritumorally. Following injection, dynamic lymphoscintigraphic images were obtained. Further planar and SPECT/CT imaging was performed 2 hours p.i.. Two adjacent SLNs next to the parotid gland were identified and marked (altogether) by one cross on the skin. The next day, SLNB was performed using the freehand SPECT system. This system (declipseSPECT, SurgicEye, Germany) combines a gamma probe system with an infrared optical spatial localization system using infrared referencing markers attached to the probe and the patient. A data processing unit analyses the data and generates 3D image realtime in the operating room.The region of interest (area of the expected SLNs) was scanned by moving the gamma probe in different angels and directions. Both, freehand SPECT and conventional gamma probe visualized one tracer accumulation close to the parotid gland at first. This accumulation was resected by guidance of freehand SPECT using an overlay of 3D image date on live video of the patient and a 3D viewing mode. The direction and the distance of the SLN in relation to the tip of the gamma probe was displayed in realtime. After excision, the same area was scanned and compared on-screen to the previous scan before. A second SLN, with about the same intensity as the first, was visualized and removed. After surgery the patient recovered without complications.Results Freehand SPECT was able to identify intraoperatively the SLNs, which were found on preoperative SPECT/CT and lymphoscintigraphy. The freehand SPECT system was of additional value in determining the depth of the SLN for precise and fast extraction especially in such a sensitive area like the parotid gland.Conclusions: Use of the freehand SPECT system may add additional value to the routine SLNB procedure in early stage oral carcinoma by 3D visualization of the radioactive distribution and image guided resection.References:1. Wendler et al. EJNMMI 2010;37:1452-1461.
P11 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Radiopharmaceuticals & Radiochemistry & Dosimetry: Radiopharmaceuticals - PET
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Validation of the Synthesis of F-FNa M. De Arcocha Torres, F. Ortega-Nava, H. Portilla-Quattrociocchi, I. Martinez-Rodriguez, R. Quirce, P. Medina-Quiroz, L. Del Carpio-Bellido, J. Carril; Servicio Medicina Nuclear. Hospital Universitario Marques de Valdecilla. Universidad De Cantabria, SANTANDER, SPAIN. AIM18F-sodium fluoride has shown great utility in the diagnosis of bone disease and have been proposed for use in clinical practice in certain situations. In our service, our unit has developed the synthesis and quality control of this radiopharmaceutical.MATERIAL AND METHODSIn the first step the qualifications of the installation (IQ) and the operation (OQ) of production equipment and quality control as well as analytical methods were made. The following equipment were validated; Tracerlab methylation module (General Electric), HPLC (KANUER), gas chromatograph (GC Varian 3900), gamma spectrometer (Canberra) and pH meter (Mettler-Toledo)Afterwards, the validation of the radiopharmaceutical manufacturing process (PQ) started following Even-Sapir method1.The 18 F is produced on a Cyclotron (16,5 MeV), by the 18O(p,n) 18F nuclear reaction in 1.5 ml of enriched 18 O-water. Once produced, the 18F is transferred to a commercial module using teflon conduits. After trapping, it is loaded on an anion exchange column (Chromafix, Macherey-Nagel) that is subsequently eluted with 0.5 mL of potassium carbonate (K2CO3) 6 mg/ml solution and transferred to the reactor. After the addition of 1mL of sterile water, the solution is heated to 110ºC for 3 minutes to evaporate the present solvents, followed by the lowering of
temperature to 30ºC, addition of 5mL of 0.9% saline and 2mL of phosphate buffer, and the transferred into a product vial through a 0.22 µm filter for sterilization and subsequent dose dispensing.The last step was a quality control procedure (pharmacophea, monograph ). The following tests were performed; visual inspection, pH determination, chemical and radiochemical purity by liquid chromatography, residual solvents concentration, bacterial endotoxins and sterility. CONCLUSIÓN: The results confirm that the manufacturing process of the 18 F-FNa is consistent and repetitive and meets the quality requirements required by the pharmacophea.
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Synthesis and biological studies of Cu-6-(4-aminobenzyl)5,7-dioxo-1,11-(carboxymethyl)-1,4,8,11tetraazacyclotridecane-Ser-BBn-NH2 in mice bearing prostate tumor A. K. Mishra1, R. Varshney1, P. P. Hazari1, P. Fernandez2, M. Allard3; 1 Institute of Nuclear Medicine and Allied Sciences, Delhi, INDIA, 2UMRCNRS-5287, University of Bordeaux-2,France, France, FRANCE, 3UMRCNRS-5231, University of Bordeaux-2, France, FRANCE. Aim: The purpose of this study was to obtain the convenient, synthetically useful bifunctionalchelating agent, 6-(4-aminobenzyl)-5,7-dioxo-1,11-(carboxymethyl)1,4,8,11 tetraazacyclotridecane (DODAT), and to apply it to stable 64Cu-labelling of Ranatensins peptide Ser-Gln-Trp-Ala-Val-Gly-His-Phe-Met-CONH2. Ranatensin peptide binds to G-protein coupled receptors (BN receptor) present on the cell surface; their internalization and phosphorylation give rise to a complex cascade of kinase activation. It is worthwhile to synthesize ranatensin derivatives for GastrinReleasing Peptide (GRP) Analogues for Cancer Imaging.Methods: The chelate was synthesised by reaction of nitrobenzyl malonate and triethylenetetraminefollowed by alkylation by reacting with bromoacetic acid at pH 10. The-COOH group was used to couple with peptide on solid phase using Fmoc strategy and subjected to purification on C-18 RP- HPLC.Results: When peptide conjugate was labeled with Cu-64 the specific activity of conjugates was 20-30 mCi/mg of protein and receptor binding against PC3 cell line demonstrated saturable binding at 64pM. The stability in serum indicated that the metal remained bound to peptide conjugate. Biodistribution studies in athymic micegrafted with PC3 human prostrate carcinoma revealed significant localization of Cu-64 labeled peptide in tumors and reduced accumulation in normal organs.Conclusion: This bifunctional chelating agent is promising for targeting GRPS receptor using (peptide) because of good tumour-to-normal organ contrast.
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A “Click” chemistry approach to develop [N-methyl- C]bis Triazole-MPP with enhanced affinity for PET imaging of serotonin-1A (5-HT1A) receptors P. P. Hazari1, N. Singh1, R. Varshney1, J. Schulz2, M. Allard3, H. chandra4, A. K. Mishra*1; 1Institute of Nuclear Medicine and Allied Sciences, Delhi, INDIA, 2UMR-CNRS 5231, Université de Bordeaux2, France, FRANCE, 3 EPHE, France, France, FRANCE, 4Delhi University, Delhi, INDIA. 5-HT1A receptor function as the somatodendretic autoreceptor (presynaptic) in the dorsal raphe nucleus and as a postsynaptic receptor for 5-HT in terminal field areas which is related to the variety of neurological disorders. Serotonin manipulations produce transient changes in the brain morphology and results in neurological disorders in humans. Based on the role of 5-HT1A receptors in the regulation of neuroendocrine functions it is enticing to synthesize terminal alkynyl functionalised 2-methoxyphenyl piperazine for Cu (I ) catalysed formation of 1,2,3-triazole using Huisgen 1,3-dipolar cyloaddition of terminal alkynes with azides. Bis(chloroethyl)amine was subjected to azidation using sodium azide in presence of sodium hydroxide base. Terminal alkynyl functionalization of 2methoxyphenylpiperazine(MPP) was achieved by reacting MPP with propargyl bromide. Copper catalyzed cycloaddition of alkyne and azide derivative produce bis-Triazole-MPP as precursor for 11C-radiosynthesis in 78 % yield. N-alkylation of secondary amine was done using methyl iodide, DIAD and TPP which was readily converted to the corresponding tertiary amine in good yield (87%). The radiosynthesis method involved alkylation of the precursor with [11C]CH3I.Cytotoxity assay were determined by MTT and clonogenic assay. Radioligand binding studies were performed by incubating rat hippocampal primary cultures with the increasing concentration of ([N-methyl-11C]bis-Tz-MPP) for 2 h at 37oC, [3H] 8-OH-DPAT was used to define non-specific binding.Under the optimal reaction conditions, A potent and selective 5-HT1A ligand [N-methyl-11C]bisTz-MPP was synthesized in a decay-corrected radiochemical yield of 44%. The overall synthesis time, from EOB to HPLC analysis of [N-methyl-11C]bis-MPP was 40 min. The retention time was found to be 4.7 min for [N-methyl-11C]bis-Tz-MPP. Specific activity was 120-176 GBq/mmol. Radiochemical purity determined by analytical Radio-HPLC was higher than 99%. In vitro binding of ([N-methyl-11C]bisMPP in the hippocampal cells was 9.1 nM. N-Methylation of bis triazole product Bis-Tz-MPP displayed high 5-HT 1A affinity (Kd=24 pM) on transfected Neuro 2A cells
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441 expressing 5HT1A receptors. In vitro studies with primary cultures of rat hippocampal cell lines and 5HT1A transfected neuro 2A cells indicated that the novel compound [N-methyl-11C]bis-MPP is highly selective for the serotonin (5-HT 1A) receptor.
P139 Capability improvement: O-18 enriched water validation for cyclotron produced F-18 radionuclide in Taiwan M. Li; institute of nuclear energy research, Taoyuan, TAIWAN.
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Quality Control of [ F]FDG Amperometric Detector (PAD)
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M. Kropacek, J. Zimova, M. Tomes, J. Ventruba, F. Melichar; Nuclear Physics Institute of the ASCR, Rez near Prague, CZECH REPUBLIC. The Aim:The quality control of [18F]FDG, the most commonly used radiopharmaceutical, has received attention due to its widespread use in clinical practice. The aim of work was to verify suitability of Pulsed Amperometric Detector (PAD) electrochemical detector as an analytical tool for routine quality control of [18F]FDG and to compare its performance with commonly used detectors such as refractive index detector (RI) or UV/VIS detector.Material & methods:The PAD Antec Decade II detector was used with the HPLC system consisted of following components. Isocratic HPLC pump DIONEX P680, the Rheodine valve for manual sample injection, the Dionex PA-1 anion exchange column, the Raytest Gabi NaI(Tl) radiodetector, the Dionex Ultimate 3000 UV/VIS detector and the Shodex RI-100 refractive index detector. Mobile phase 0.1M NaOH was prepared by dilution of concentrated NaOH solution in the water for injection previously degassed by Helium. The flow rate was 1 ml/min. Analytical standards were purchased from Sigma Aldrich and from ABX (Radeberg, Germany).Results:First experiments suggested that compared to both RI and UV/VIS detectors, PAD detector provided approximately 100 times higher response for FDG compound of concentration of 50 mg/l that is limit concentration according to the European Pharmacopeia monograph. HPLC analysis of the standard solution of 1 mg/l FDG was found to be below the detection limit of RI and UV/VIS detectors. However, sensitivity of the PAD detector allowed analysis of standard solution < 0.1 mg/l FDG.Conclusion:The HPLC/PAD appears to be the efficient analytical tool allowing detection of certain compounds with essentially higher sensitivity in comparison to common detectors such as UV/VIS or refractive index detectors, while the daily duty and maintenance requirements are not time consuming. Experience also indicated that the PAD detector could be used without necessity to change significantly condition of widely used analytical method for routine quality control of [18F]FDG.
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Synthesis of Ga labeled NOTA-conjugated composite for PET imaging agent
PAMAM
E. Lee1, I. Kim1, Y. Park1, J. Park1, S. Kim2, M. Hur1, S. Yang1, K. Yu3; 1 Korea Atomic Energy Research Institute, jeoungup-si, KOREA, REPUBLIC OF, 2Dongguk University, Gyeongju, KOREA, REPUBLIC OF, 3Dongguk University, Seoul, KOREA, REPUBLIC OF. Aim: 68Ga (t1/2 =68 min) is an attractive radionuclide for positron emission tomography (PET), which can be easily obtained from a 68Ge/68Ga generator without an on-site cyclotron. 1,4,7-triazacyclononane-1,4,7-triaceticacid (NOTA) which forms complexes with 68Ga is one of the most important chelators in radiochemistry. Polyamidoamine (PAMAM) dendrimers as a new class of macromolecule are known for their three-dimensional, monodispersed, and high branching with amine groups. Recently, PAMAM dendrimers have been used successfully in the field of biomedicine, such as drug and gene delivery, cancer diagnosis, and sensors. Hence 68Ga labeled NOTA-PAMAM dendrimer composite may be promising as a potent PET radiotracer for tumor imaging.Materials and Methods: A mixture of 2-(pisothiocyanatobenzyl)-1,4,7-triazacyclononane-1,4,7triaceticacid (SCN-Bz-NOTA) and PAMAM dendrimer in a 0.1 M sodium carbonate buffer (pH 9.5) was stirred for 20 h at room temperature in the dark. A NOTAPAMAM dendrimer composite was labeled with [68Ga]GaCl3, which was obtained from a 68Ge/68Ga generator eluted with 0.1 N hydrochloric acid.Results: We conjugated a PAMAM dendrimer with SCN-Bz-NOTA to produce a NOTA-PAMAM dendrimer composite using a thiourea bond formation. PAMAM dendrimer has an N-terminal group with potential reactivity which easily couple with the isothionate group in a NOTA derivative. The conjugated product of the NOTA-PAMAM dendrimer composite was confirmed through mass and NMR spectroscopy. A [68Ga]Ga-NOTA-PAMAM dendrimer composite was rapidly labeled with a 68Ga in 23% yield. The reaction mixture was purified by HPLC (XTerra preparative column RP18; 7.8Χ300 mm; 0%-100% acetonitrile gradient in 0.1% trifluoroacetic acid from 0 to 30 min; flow rate, 3 mL/min), and a [68Ga]Ga-NOTA-PAMAM dendrimer composite peak sample was collected at a retention time of 16.4 min.Conclusions: A [68Ga]Ga-NOTA-PAMAM dendrimer composite can be quickly and easily prepared. Based on these results, we are currently developing nano-dendrimer composites using Fe3O4 nano particles and a 68Ga radioisotope that can be used for therapy in hyperthermia cases and for diagnoses in the fields of PET and MRI applications.
ObjectivesCyclotrons are currently used for the preparation of a wide variety of radionuclides that find application in positron emission tomography (PET) as well as in single photon emission computed tomography (SPECT). For F-18 radiopharmaceuticals, limits of impurities of unwanted radioisotopes are welldefined for labeling. Written procedures to document the operation of the cyclotron should ensure that all intended operating parameters will be followed. Most PET target materials, like O-18 enriched water, are not manufactured in PET centers. Therefore, it is essential that the PET center validate the quality of the target materials. Consequently, the O-18 enriched water quality specification should be adequately specified and appropriately validated.MethodsO-18 enriched water should be controlled in order to produce the radioisotope of required radionuclidic specifications. The raw materials (enriched water) used in F-18 production would be required to be of certain specifications with an acceptable range of enrichment, and the cyclotron beam energy clearly defined.We graph the curves for O-18(P,N)F-18, O-16(P,A)N-13, O-17(P,N)F-17 incident energy and reaction cross-section with different F-18, N-13, F-17 irradiation doses. The actual enrichment of O-18 enriched water can be calculated.ResultsThe irradiation energy parameters derived from the above assessment are used in cyclotron irradiation to generate the best yield and the minimal other nuclides. The experimental irradiation parameters are as follows:1. Irradiation energy: 2.5~29.5 MeV2. Accelerated particle: proton3. Beam current: 17~18 micro-A4. Irradiation time: 1 hrsConclusionsIt can be known the aforementioned curves for the O-18 enriched water proves to be predictive and controllable. Moreover, the irradiation products have consistent quality. Therefore, the present results have proved to possess industrial usefulness, novelty and progressiveness.
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Sterility testing of Ga-DOTA-NOC solution produced by a semi-automated system C. Capelo1, B. Ferreira1, M. A. Guimarães2, A. Lima Bastos1; 1Oncology Institute, Nuclear Medicine Department, Oporto, PORTUGAL, 2Oncology Institute, Microbiology Department, Oporto, PORTUGAL. Aim: to evaluate the assepsy of the 68Ga-DOTA-NOC solution produced by a semiautomated system.Material and Methods: We inoculated aseptically into an aerobic media (0,3-0,5ml) of [68Ga-DOTA,1-Nal3]octreotide-DOTA-NOC after the synthesis in a Modular Lab PharmTracer from Eckert & Ziegler, using IGG100 68Ge68 Ga generator and ITG 68Ge-68Ga generator . We used swabs (“DELTALAB“) for microbiological sample collection in open wounds. The transport media used to transport samples which are supposed to contain microorganisms, have an appropriate chemical composition in order to maintain the bioburden levels with the minimum physiological activity to assure the smallest variation of the sample from the collection to the laboratory arrival where is going to be processed. These swabs with our media were kept in the Nuclear Medicine Department, in Radiopharmacy lab, 24h at room temperature before going to our hospital’s microbiology department where they were analysed.Results: Between January and March of 2011, we tested 14 samples of [68Ga-DOTA,1-Nal3]octreotide-DOTA-NOC: 10 samples from the synthesis using IGG100 68Ge-68Ga generator which corresponding at the end life of this generator; and 4 samples using the ITG 68Ge68 Ga generator. The results for all the samples were negative, all of them were sterile.Conclusions: All of this negative sterility tests have shown that the procedures we have for the synthesis of 68Ga-DOTA-NOC are correct in microbiological field’s concern. These sterility tests should continue to be made, because they prove to us the reliability for routine preparations (SOPs) in clinical studies.
P141 Paediatric power of [124I] mIBG: Synthesis, Biological Evaluation and PET imaging in Neuroblastoma C. Villano1, C. Pennacchioni1, D. Martini1, G. Valentini1, P. Panichelli1, C. Vesprini1, L. Castignani1, M. Paparelli1, M. Venanzi1, U. Ficola2, A. Sperandeo2, T. Calabria2; 1A.C.O.M. S.p.A., località Cavallino, 62010 Montecosaro (MC), ITALY, 2La Maddalena S.p.A., Via San Lorenzo, 312, 90146 Palermo, ITALY. Aim: Children affected by stage IV neuroblastoma have poor survival. It is crucial to have a reliable method for evaluating functional response to new therapies. Metaiodobenzylguanidine (mIBG), a functional analog of norepinephrine, labeled with radioiodine, was helpful to detect adrenals diseases. Neuroendocrine tumors such as neuroblastoma and pheochromocytoma of all types, including sporadic and extra-adrenal lesions, metastatic deposits and medullary hyperplasia, have been diagnosed successfully with this agent. The purpose of this study is to investigate the labelled mIBG value as PET diagnostic agent in paediatric population affected
Poster Presentations
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S294 by neuroblastoma.Materials & Methods: The production of mIBG labeled with [124I] involves solid-state exchange reaction on “cold” mIBG facilitated by ammonium sulfate.In fact ammonium sulfate was added to the solution containing mIBG mixed with [124I].The reactant solution was completely dried within 15 minutes of heating and the solid residue, cooled for 2 minutes, was dissolved within saline for injection.Following the chromatographic purification, using a mini column of Dowex AG1-X8 resin, the labeled product was diluted as required and was sterilized by 0.22 µm membrane filtration.The product specifications are in compliance with the radiopharmaceuticals acceptance criteria and, particularly, the radiochemical yield and purity of radioiodinated mIBG generally exceeded 80 and 98%, respectively.Results: This analysis investigated the role of [124I]mIBG imaging in staging and response assessment in neuroblastoma. The study involved a paediatric population , affected by stage IV neuroblastoma, already undergone surgery and chemotherapy. In order to evaluate the power of [124I] mIBG as a PET diagnostic agent, the radiopharmaceutical was administered to patient, already studied with scintigraphy.Particularly, in a patient with a late relapsed neuroblastoma on L2 vertebra, already treated with a cycle of [131I]mIBG radio metabolic therapy, PET images reveal, as depict by [123I] mIBG, the satisfactory results of therapy. A child, with two lung lesions, was treated with the diagnostic agent. Data confirm the previous diagnosis with [123I]mIBG.Moreover the radiopharmaceutical showed an higher accuracy in compare with the scintigraphy as demonstrated by the scan results on patient of 4 years, affected by multiple bone lesions.Conclusion: Results reveal the sensitivity, specificity and diagnostic accuracy of [124I]mIBG. The higher sensitivity of mIBG imaging supports continued preferential use of mIBG scans as surveillance imaging for patients not receiving therapy as well as for response evaluation during therapy for relapse.
P142 Synthesis, radiolabeling and biological evaluation of cross bridged macrobicyclic chelating agent with 5HT as potential 64 PET imaging agent: Cu- PABHD-5HT
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 the tracers and cellular uptake of radioactivity was determined at 1, 15, 30, 45 and 60 min. The wash out rate was evaluated similarly over 20 hr after replacement with fresh medium following the initial 30 min incubation.Results: The radiochromatograms showed 100% labelling efficiency for all Cu-64 complexes. Cellular uptake of Cu-64 with GTS, GTSM, PTS and PTSM plateaued at 49% - 54% by 30 min, 56% - 59% by 15 min, 53% - 60% by 30 min and 51% - 57% by 45 min, respectively. 64Cu (DEDTC)2, 64Cu (DMDTC)2, and 64Cu (DPDTC)2 were rapidly taken up in cells and reached plateau at 61% - 73% by 1 min, 34% - 35% by 30 min and 54% - 55% by 30 min, respectively. In contrast to the differing uptake kinetics, efflux kinetics of all complexes were strikingly similar. The retention of 64Cu GTS, 64Cu GTSM, 64Cu PTS and 64Cu PTSM decreased from 85.52+0.36% to 13.90+1.77%, 76.03+2.08% to 20.61+2.31%, 86.69+4.07% to 15.73+1.66% and 74.72+2.13% to 28.16+0.83%, respectively, over 20 h. Similar to the retention of Cu-64 complexes with DEDTC, DMDTC and DPDTC decreased from 84.26+0.57% to 19.8+1.48%, 84.3+0.37% to 20.54+0.13% and 85.68+2.49% to 15.41+1.49%, respectively.Conclusion: Although lipophilic copper-64 complexes were easy to prepare, high labelling efficiently, high reproducibility and rapid association with cells, the rate of wash out of all complexes from the cells was too rapid for most uses. The similarity of the efflux profiles suggests that there may be a common copper efflux mechanism that follows intracellular dissociation of the complexes.
P12 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Radiopharmaceuticals & Radiochemistry & Dosimetry: Radiopharmaceuticals - SPECT
P144 Development of the Tc-99m Glutathione-DTPA: Novel Imaging Agent for Tumor
S. Chaturvedi1, B. Singh2, A. K. Mishra1; 1Institute of Nuclear Medicine and Allied Sciences, Delhi, INDIA, 2Banaras Hindu University, Varanasi, INDIA.
D. Kim1, C. Kim1, J. Min2; 1Wonkwang University School of Medicine, Iksan, Jeollabuk-do, KOREA, REPUBLIC OF, 2Chonnam National University Medical School, Gwangju, Korea, KOREA, REPUBLIC OF.
The targeting of 5HT1A receptors for mapping neurological disorders has increased in the recent past due to their widespread prevalence in various neurological conditions. The attractive physicochemical features and high specific activity of 64 Cu prompted us to label serotogenic receptor ligands to be used for diagnostic application. The pathophysiology of 5HT1A receptors can be imaged using 64Cu labeled specific ligands conjugated with 5-hydroxytryptophan. Further, the chelation of 64Cu can be achieved using novel cross bridged macrobicyclic chelators that offer high in vivo stability due to increased kinetic inertness and thermodynamic stability.Here, we present the results from the synthesis of a cross bridged macrobicyclic chelator PABHD (pentaazabicycloheptadecanethanamine) conjugated to 5-hydroxytryptophan for the imaging of 5HT1A receptors. The synthesis scheme involves cross bridging of cyclen with N,N’- bis(2-chloroethyl)-N” (2-aminoethyl) amine with an approximate yield of 70% and further conjugation with 5-hydroxytryptophan. All the resulting compounds - final as well as intermediate - were characterized by 1H, 13C and mass spectrometry. Radiolabeling carried out with 64Cu showed high reproducible labeling efficiency under physiological conditions. The MTT assay was performed to assess the cellular toxicity on HEK cell line. No significant toxicity was observed at low concentrations. The cell uptake assay reflected high affinity in nanomolar range for the radioconjugate on Neuro 2A cells transfected with 5HT1A receptors. The initial results of in vivo biodistribution indicate renal and hepatobiliary routes of excretion.The results indicate that the 5HT1A specific cross bridged macrobicyclic chelators based ligand conjugated to 5-hydroxytryptophan has strong potential application as copper radiopharmaceutical for neuronal imaging using positron emission tomography.
PURPOSE: There were several evidences of increased reactive oxidative stress (ROS) in cancer cells. Glutathione (GSH) is a multifunctional intracellular nonenzymatic antioxidant and the major thiol-disulphide redox buffer of the cell. The authors have developed Tc-99m GSH- diethylenetriaminepentaaceticacid (DTPA) as a tumor imaging agent and evaluated the diagnostic performance of Tc-99m GSHDTPA in tumor bearing mouse model. The authors also have evaluated the ability of Tc-99m GSH-DTPA to differentiate the tumor and inflammation in inflammation mouse model. METHODS: Successful synthesis of GSH-DTPA was done and confirmed using NMR spectra. In CT-26 adenocarinoma bearing mice model, in vivo imaging and biodistribution study were performed. In inflammatory mice model, in vivo imaging was performed. RESULTS: Tc-99m GSH-DTPA showed high labeling efficiency up to 90-95% in vivo and vitro condition. On in vivo imaging, tumor to non-tumor ratio was 2.6, 3.0, 3.3, 4.0, 4.1 and 4.5 at 15 min, 30 min, 1 hour, 2 hours, 4 hours and 6hours after injection, respectively. Otherwise, liver, kidney and bladder were the most radioactive organs. In biodistribution study, uptake of Tc99m GSH-DTPA in tumor was also evident. Tumor to non-tumor ratio was 1.5, 1.8, 4.9 and 4.3 at 30 min, 1 hour, 3 hours, and 6hours after injection, respectively. High uptake of kidney represented the excretion of GSH-DTPA via urinary system. Moderate uptake of liver and large bowel might be caused the clearance of GSHDTPA through hepatobiliary system. Other organs, such as lung, spleen, stomach and heart showed minimal uptake. In vivo imaging of inflammation model showed mild uptake of GSH-DTPA in inflamed site. CONCLUSION: Tc-99m GSH-DTPA might be a novel imaging agent for tumor. It could differentiate tumor from inflammation.
P143 PET tracers for cell labelling with the complexes of copper 64 with lipophilic ligands P. Charoenphun, R. Paul, A. Weeks, D. Berry, K. Shaw, G. Mullen, J. Ballinger, P. J. Blower; King's College London, London, UNITED KINGDOM. Aim: Cell labelling with SPECT radionuclides have been approved for clinical practice and widely used in a range of researches. However, the study of cell trafficking by PET tracers may provide better resolution and detectability than SPECT. Long half life PET radionuclides are therefore required for labelling cells. Apart from that, lipophilic ligands play important role to administration PET tracers to targeted cells. In this study we synthesized and evaluated new lipophilic Cu-64 complexes for this propose.Method: Cu-64 complexes with bis (thiosemicarbazones), GTS (64Cu GTS), GTSM (64Cu GTSM), PTS (64Cu PTS) and PTSM 64Cu PTSM), and dithiocarbamate analogues, DEDTC (64Cu (DEDTC)2), DMDTC (64Cu (DMDTC)2), and DPDTC (64Cu (DPDTC)2) were synthesized and purified. Their purity was determined by thin layer chromatography compared with their non-radioactive samples. J774 mouse macrophages cells were incubated with
P145 New radiopharmaceuticals of technetium-99m and rhenium188 with zoledronic acid A. O. Malysheva, G.E. Kodina, O.E.Klementyeva; Burnasian Federal Medical Biophysical Center FMBA Russia, Moscow, RUSSIAN FEDERATION. 99m
Tc and 188Re represent an attractive pair of radionuclides for biomedical use. These elements reveal similar chemical properties. This circ*mstance offers the possibility to simultaneously develop diagnostic and therapeutic tracers with almost identical chemical and pharmaco*kinetic characteristics. Diphosphonic acid derivatives have been widely used as imaging agents for bone diseases (with 99mTc) and for treatment of bone metastases (with 188Re). Zolidronic acid (ZA) was chosen as the object for investigation due to it therapeutic effect and accumulation in the bone metastases.Aim: Preparation of lyophilized forms of 99mTc-ZA and 188Re-ZA complexes and investigation of biodistribution in experimental animals.Materials and methods: Na99mTcO4 and Na188ReO4 were obtained from the domestic generators (Institute of Physics and Power Ingineering, Obninsk). Zoledronic acid was synthesized in Farm-Syntez Ltd. Radiochemical yields of 99mTc-ZA, 188Re-ZA, free
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P146 “Clicked” estradiol based derivatives: Their preclinical evaluation as SPECT/PET radiopharmaceuticals for tumor imaging A. Datta, J. Tanwar, K. Chauhan, S. Pal, A. K. Mishra; Institute of Nuclear Medicine and Allied Sciences, Delhi, INDIA. Aim:Estrogen receptor (ER) is an attractive target for molecular imaging and therapy due to its upregulation in osteoporosis, ovarian cancer, and breast cancer. Ability to use molecular imaging in-vivo for monitoring expression of ER offers a mean for differentiating primary tumors, detecting metastases, guiding optimal choice of therapy, and following the impact of novel interventions based on targeting ER. Some of the known compounds having potential as PET and SPECT agent for detemining the status of estrogen receptor are 16α-[18F]-fluoro-17βestradiol and cis-methoxy-[123I]-iodovinylestradiol, respectively. Towards the same direction, we have designed target specific estradiol derivatives, DTPA-bis-Est4 and EDA-Est2, for SPECT and PET applications, respectively. These derivatives contain tetrameric and dimeric estradiol, thus are capable of binding to ER with high affinity. Widely used concept of click chemistry was applied during synthesis.Method:Synthesis was performed using estrogen derivative, 17αethynylestradiol as precursor. The 17α-ethynyl-estradiol was reacted with diethylenetriamine using click chemistry with proper stoichiometry to give tetravalent, 17,17'-(1,1'-(2,2'-azanediylbis(ethane-2,1-diyl))bis(1H-1,2,3-triazole4,1-diyl))bis(13-methyl-7,8,9,11,12,13,14,15,16,17-decahydro-6Hcyclopenta[a]phenanthrene-3,17-diol. Its conjugation with chelate, diethylenetriaminepentaacetic acid gave DTPA-bis-Est4 for radiolabeling with 99mTc. Synthesis was confirmed by 1H NMR, 13C NMR and ESI-MS spectroscopy. The ER binding affinity was checked by 99mTc radiolabeled DTPA-bis-Est4. Estrogen receptor ability was evaluated in human MCF7 cells. Scintigraphic and biodistribution studies were carried out on estrogen receptor-positive MCF7 tumor bearing athymic mice. The methylation of bivalent, EDA-Est2 was optimized with CH3I in acetonitrile.Results:Synthesized compounds were characterized by NMR and Mass spectroscopy. Radiolabeling efficiency with 99mTc was found to be > 97%, serum stability indicated that 99mTc remained bound to DTPA-bis-Est4 upto 24h. High invitro uptake on on MCF-7 cells shows significant uptake of 99mTc-DTPA-bis-Est4 Blood clearance showed quick washout from the circulation via renal route. 99mTcDTPA-bis-Est4 accumulation in tumor was determined at various time intervals. Biodistribution studies showed prominent tumor (ER+) localization with high target to non target ratio. Labeling of EDA-Est2 with 11CH3 increases its application as PET agent. Methylation of EDA-Est2 with cold CH3I has been successfully optimized in acetonitrile using 2M NaOH in 75% yield.Conclusion:99mTc-DTPA-bis-Est4 can be prepared in high radiochemical yield. High target specificity towards ER+ tumor was observed. Synthesis of [11C]EDA-Est2 according to the optimized procedure using an automated synthesis system is in progress and their binding ability towards estrogen receptor cell lines will be evaluated simultaneously. Preliminary in-vivo binding affinity suggests that derivatives have the potential as receptor based agents for imaging ER+ tumors using SPECT and PET.
P147 Facile synthesis of methionine conjugated picolinic acid based bifunctional chelating agent as target specific SPECT imaging agent K. Chauhan, A. Datta, J. Tanwar, D. Kakkar, A. Tiwari, A. K. Mishra; Institute of Nuclear Medicine and Allied Sciences, Delhi, INDIA. Aim:In SPECT imaging, technetium-99m is a radionuclide of choice for diagnostic imaging due to its favourable decay properties, 6 h half life, low cost and easy
availability. Current interest is focused on developing new generation of highly selective, target specific radiopharmaceuticals consisting of a metal complex conjugated to an organic molecule with high binding for a receptor. So far many radiolabeled amino acids have been exploited for understanding protein synthesis pathways and believed to reflect the malignant nature and increased proliferation of cancer cells in better way, methionine based are one of them. Methionine is known for its active participation in protein synthesis, it acts as methyl group donor in the biosynthetic pathways. The metabolic rate at cancerous tissues is more and so is the uptake of methionine. Currently, many methionine based compounds have found applications in SPECT and PET. The objective is to develop a new bifunctional chelating agent based on picolinic acid for 99mTc labeling and conjugate it with amino acid, methionine to synthesize a methionine based picolinic acid derivative for tumor imaging having application in SPECT and PET.Methods:This work describes the potential of 99mTc-Pic2-N-MET (diethyl-6-(2-((6(ethoxycarbonly)pyridine-2-yl)methyl)-9-(methoxycarbonyl)-7-oxo-12-thia-2,5,8triazatridecyl)picolinate) as diagnostic pharmaceutical by evaluating its deposition in cancerous tissues after the synthesis and radiolabeling with 99mTc. Pyridine-2,6dicarbonyl dichloride was used as the precursor for the synthesis of the chelating agent diethyl-6,6'-(2-aminoethylazanediyl)bis(methylene)dipicolinate (Pic2-N). Finally, Pic2-N was conjugated to L-methionine to give Pic2-N-Met. The compound is radiolabeled with 99mTc for scintigraphic studies.Results:Pic2-N-Met was synthesized and characterized by NMR and mass spectroscopy. Radiolabeling efficiency with 99mTc was found to be > 97% and the stability in serum indicated that 99mTc remained bound to Pic2-N-Met up to 24h. Initial investigation of blood clearance showed a quick wash out from the circulation and biological half life were determined. Biodistribution characteristics of 99mTc-Pic2-N-Met were examined in BALB/c mice and it shows prominent tumor (EAT) localization. The uptake in the non target organs was minimal and exhibited quick washout. The drug was excreted mainly through renal routes and accumulation of 99mTc-Pic2-NMet in tumor was determined at various time intervals.Conclusion: The chelating agent, Pic2-N shows strong binding with 99mTc, even after 24h the binding was > 90%. 99mTc-Pic2-N-Met has high tumor (EAT) accumulation property. Further investigation on the BMG glioblastoma is being carried out. Toxicity studies and trans-stimulation studies are in progress to further check the potential of the compound in tumor uptake.
P148 A versatile synthetic approach to develop dithiocarbamate functionalised 2-MPP for imaging distribution of 5HT1A receptors using SPECT S. Chaturvedi1, P. P. Hazari1, B. Singh2, A. K. Mishra1; 1Institute of Nuclear Medicine and Allied Sciences, Delhi, INDIA, 2Department of Chemistry, Faculty of Science, Banaras Hindu University, Varanasi., Varanasi, INDIA. The 5 HT 1A receptor, a sub-class of the serotonin receptor, has been implicated in a number of physiological processes and psychiatric disorders. 2methoxyphenylpiperazine known as 2-MPP, an antagonist for 5 hydroxytryptamine1A (5-HT1A), is being extensively exploited for the receptor mapping via imaging. We report here the synthesis and bioevaluation of a novel dithiocarbamate based imaging agent derived from 2-MPP . Dithiocarbamate is a versatile group which binds to nearly all the transition elements, stabilising a wide spectrum of oxidation states and can be used for subsequent functionalization. It is an excellent group for technetium binding particularly using [99mTcN]2+ core. The notable feature is that the technetium in nitride complex is highly stable towards reoxidation and reduction and pH variations. The presence of the [99mTcN]2+ core in the radiopharmaceutical molecular structure may dramatically alter its biological behaviour in comparison to the corresponding oxo complex. The 99mTcNdithiocarbamate complexes formed are neutral and lipophilic, which is a necessary criteria for potential brain imaging agents in facilitating crossing of the blood-brain barrier.The dithiocarbamate derivative was easily synthesised by reacting equimolar carbon disulphide with alkylated product of 2-MPP with bromoethylamine and was characterised with 1H, 13C and DEPT NMR. The C-13 NMR indicated C=S and C-S peaks indicating the formation of dithiocarbamate. Further, the validation was done by the two-dimensional correlation spectroscopy. The expected molecular ion peak of 310.2 was obtained using soft electrospray ionisation in mass spectrometry. Technetium labeling was carried out with over 97% radiolabeling efficiency. Cellular toxicity and cellular binding was evaluated with primary hippocampal cultures with saturable binding in nanomolar range. Excellent images showing uptake of the imaging agent in neuroblastoma (IMR 32) tumor grafted in athymic mice and the biodistribution pattern indicated hepatobilliary and renal route of excretion.
Poster Presentations
pertechnetate or perrhenate and reduced hydrolyzed technetium or rhenium were determined by TLC in aceton and paper chromatography in 0.9 % saline. 200 g female white rats with and without bone pathology were used. The bone pathology was simulated by the closed femur fracture.Results: The radiopharmaceutical composition of 99mTc-ZA with radiochemical purity > 95 % can be prepared using ligand:SnCl2 molar ration from 2.5 to 3.5 at pH 5.0 - 6.5. 188Re-ZA can be prepared with radiochemical yield > 90 %.The skeletal uptake of 99mTc-ZA was about 50 %, the uptake ratios of bone-to-blood were more than 20 at 1 h and up to 100 at 5 h after injection. Differential coefficient of uptake (CDU) femur-to-femur with pathology was between 1.7 to 2.1. 188Re-ZA rapidly accumulates and securely fixed in both normal femur bone and in bone pathology.Since the use of 99mTc-ZA expected in patients receiving therapeutic dose of zoledronic acid, we studied the effect of this therapy on the quality of SPECT imaging of bone pathology. Seven days after fracture the animals were intravenously injected a solution of zoledronic acid in 0.9% saline at the dose of 0.04 mg per rat. The obtained data suggest that the use of therapeutic drugs based on zoledronic acid does not cause an overflow of the exchange of bone pool and therefore will not have a significant impact on the quality of the SPECT imaging of the skeleton lesions with 99mTc.Conclusion: Nowadays all clinical trials were carried out with 99mTc-ZA and it is recommended for clinical usage, the preclinical trials with 188Re-ZA are in progress.
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P149 Synthesis and biological evaluation of triazaspiro[4,5]decan-4-one)ethylamine radiopharmaceuticals for neuroendocrine tumor
Bis-2-(1,3,8based
S. K. Sethi1, R. Varshney1, P. P. Hazari1, M. D. Milton2, A. K. Mishra*1; 1 Institute of Nuclear Medicine and Allied Sciences, Delhi, INDIA, 2Delhi University, Delhi, INDIA. Dopamine neurotransmitter and its receptors play a critical role in the cell signaling process responsible for information transfer in neurons functioning in the nervous system. Dopamine acts on target cells through two classes of G-protein coupled receptors, D1 and D2. Spiperone is a psychoactive drug and a well known D2 receptor antagonist. The triazaspirodecanone moeity of spiperone is a major determinant of its D2 receptor binding affinity and selectivity. The preservation of specific binding towards dopamine D2 receptor even after large chemical modification performed to make the molecule chosen to be the SPECT active agent.DOTA-bis-2-(1,3,8-triazaspiro[4,5]decan-4-one)ethylamine was obtained by covalently linking two molecules of 1,3,8-triazaspiro[4,5]decan-4-one to bischloroethylamine and was labeled with 99mTc in high radiochemical purity and specific activity. The radiolabeling efficiency was found to be > 97% and the stability in serum indicated that 99mTc remained bound to the drug upto 24h. The tumor (IMR-32) grafted in athymic mice were readily identifiable in the gamma images. Biodistribution revealed significant tumor uptake and in the IMR-32 tumor bearing mice.99mTc- DOTA-Bis chloroethyl-Spiperone showed excellent tumor targeting and has promising utility as SPECT-radiopharmaceutical for imaging.
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Synthesis of [ I]-Iodide Labeled Benzopyran Derivative for a Potential Neurodegeneration Imaging Agent S. Jung1, I. Kim1, J. Park1, Y. Park1, S. Kim2, M. Hur1, S. Yang1, K. Yu3; 1 Korea Atomic Energy Research Institute, Jeongeup, KOREA, REPUBLIC OF, 2Department of Nano Material Chemistry, Dongguk University, Gyeongju, KOREA, REPUBLIC OF, 3Department of Chemistry, Dongguk University, Seoul, KOREA, REPUBLIC OF. Purpose: The overstimulation of glutamate receptors causes neurodegeneration and neural damage such as that found in Alzheimer’s disease due to a process called excitotoxicity. It has been reported that a benzopyran derivative (glutamate receptor antagonist) has a therapeutic effect in neurodegenerative diseases. Therefore, the radioisotope labeled benzopyran derivative can be used in the diagnosis of brain diseases. In this study, the [123I]-Iodide labeled benzopyran derivative was synthesized for investigation as a potent imaging agent for neurodegeneration disorders.Subjects & Methods: 2-hydroxy-5nitroacetophenone was treated with benzylacetone in toluene to give 2-methyl-6nitro-2-phenethyl-4-benzopyranone (1). 1 was converted into 2-methyl-6-nitro-2phenethyl-4-benzopyranol (2) when reacted with NaBH4 in THF and methanol. 2 on reaction with mesyl chloride and 1,8-diazabicyclo[5.4.0]undec-7-ene gave 2methyl-6-nitro-2-phenethyl-2H-benzopyran (3). The reduction of 3 by hydrogen gas afforded 6-amino-2-methyl-2-phenethyl-2H-benzopyran (4), catalyzed by Pd/C. 2Fluorobenzylamino-2-methyl-2-phenethyl-2H-benzopyran (5) was prepared using 4 and 2-fluorobenaldehyde in THF and methanol. The reference compound was prepared through the reaction of 5 and sodium iodide in the presence of peracetic acid, and the direct labeling of 5 with [123I]-Iodide to give the target compound.Results: Both the reference and target compound were prepared through the reaction of 2-fluorobenzylamino-2-methyl-2-phenethyl-2H-benzopyran with sodium iodide and sodium [123I]-Iodide in the presence of peracetic acid. The structure of the reference compound was confirmed through 1H NMR spectroscopy and mass spectrometry. The radiolabeling reaction was monitored using a radioTLC, and the radiochemical purity was over 90% after HPLC purification.Conclusion: The [123I]-Iodide labeled benzopyran derivative was synthesized as a novel potential SPECT radiotracer. These results provide the foundation for further evaluation as a potential imaging for SPECT.
P151
111
Development and Preclinical evaluation of In(III) based PET radiotracer DO3A-butyl-MPP selective for Serotonin 5HT1A for neuroreceptor Imaging N. Singh1, H. Khurana1, S. Prakash1, H. Chandra2, P. P. Hazari1, A. K. Mishra*1; 1Institute of Nuclear Medicine and Allied Sciences, Delhi, INDIA, 2 Delhi University, Delhi, INDIA. Objective: Potent and selective ligands for 5-HT 1A receptors labeled with 111In with high specific activity aids the progress of understanding the neurological disorders at early stage. The goal of the present study was to develop a high binding specific radiotracer based on 2-methoxyphenylpiperazine (MPP) with the spacer possessing four carbon atoms as the best choice for imparting high binding towards 5HT1A for neuroreceptor Imaging.Methods: Alkylation of methoxyphenylpiperazine with Nbromobutylpthalimide was done followed by hydrazinolysis to get NH2-butyl-
MPP.Chloroacetylated product of NH2-butyl-MPP was then reacted with DO3-tert butyl ester to yield DO3A-butyl-MPP after TFA cleavage of t-butyl ester groups in 72% yield. Radiolabeling of the chelate was carried out in double distilled water under nitrogen atmosphere. 111InCl3 (74 MBq) was added to solution of DO3Abutyl-MPP in 0.4 M ammonium acetate. The pH of the reaction mixture was adjusted to 6.0. The reaction mixture was incubated for 1 h at 80°C. Then, an aliquot of 2mM EDTA (50 uL) was added to the reaction mixture to complex unreacted 111In+3. The resulting conjugates were purified to by RP-HPLC. The 111Incomplex eluted between at 3.6 min before the associated unlabeled species, enabling collection of high-specific activity complex.Results: Spectroscopic characterization of all intermediates and final chelate was done using 1H-NMR, 13CNMR and mass spectroscopy. The 111In(III) complex was readily formed with a radiochemical purity of >99%. In vitro stability of the complex, determined in human serum incubated at 37°C, was greater than 95% intact at 2 h by silica gel and reversed-phase radio-thin layer chromatography. Addition of long chain (n=4) on 2-MPP and further elongation through alkylation demonstrated enhanced binding and high selectivity towards 5-HT1A present in hippocampal cultures with Kd=28 pM. .Biodistribution studies conducted in BALB/c mice showed the complex cleared rapidly from the blood with initial high kidney uptake followed by liver. Significant uptake was observed in the brain, with brain:blood ratios increasing from 2.51 ± 0.9 %ID/g at 5 min postinjection to 18 ± 2.2 %ID/g at 60 min postinjection.Conclusion: The above studies suggest that the compound has promising potential as brain imaging agent using SPECT.
P152 Evaluation of radioiodinated ICdR as a proliferation imaging probe in a mouse lung tumor model H. M. Yu1, C. Y. Lin1, W. T. Kuo1, M. C. Weng1, J. W. Kuo1, Y. X. Chang1, M. H. Wang1, C. L. Chen2, H. E. Wang2, W. J. Lin1; 1Institute of Nuclear Energy Research, Longtan Township,Taoyuan County, TAIWAN, 2Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, TAIWAN. Objective: This study aims to evaluate radioiodinated 5-iodo-2'-deoxycytidine (*IICdR) as a probe for imaging tumor in a LL/2 lung carcinoma-bearing mouse model. Methods: Starting from 5-tributylstannyl-2'-deoxycytidine and 5-tributylstannyl-2'deoxyuridine, 131I-ICdR and 131I-IUdR were prepared in high radiochemical yield (both ≥85%, decay corrected) and radiochemical purity (both ≥95%), respectively. Biological characterization studies of *I-ICdR and *I-IUdR including serum stabiliy, cellular uptake and scintigraphic planar imaging were performed. Results: The percentage of intact 131I-ICdR in mouse serum after 24 h incubation was greater than 90%. In a parallel study, about 30% of 131I-IUdR was decomposed. The result demonstrated good in vitro stability of 131I-ICdR. The accumulations of 131I-ICdR and 131I-IUdR in LL/2 cells increased with time. The cell-to-medium ratio (C/M) of 131I-ICdR and 131I-IUdR reached 97.24 ± 5.34 and 277.49 ± 33.42 after 8 h incubation, respectively. Gamma planar imaging of 131I-ICdR and 131I-IUdR in LL/2 lung carcinoma-bearing mouse clearly delineated the tumor lesion with increasing tumor-to-muscle ratio from 6.98 ± 1.02 at 4 h p.i. to 14.49 ± 1.89 at 24 h p.i. and from 4.07 ± 0.42 at 2 h p.i. to 7.04 ± 0.97 at 24 h p.i.. Conclusion: In this study, the radioiodinated ICdR was successfully prepared with high yield and radiochemical purity. *I-ICdR is metabolically stable in vivo and is demonstrated a promising radio-probe for tumor imaging in a LL/2 lung carcinoma-bearing mouse model.
P13 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Radiopharmaceuticals & Radiochemistry & Dosimetry: Radiopharmacy
P153 The development of method for preparation of human serum albumin microspheres as potential radionuclide carriers for diagnostic and therapeutic use J. Pijarowska, A. Jaron, R. Mikolajczak; Institute of Atomic Energy Polatom, Otwock, POLAND. Aims: Human serum albumin microspheres (HSAM) of various size have been widely used for clinical nuclear medicine as carriers for radioactive diagnostic and therapeutic molecules.Non-toxic, non-antigenic and biodegradable HSAM labelled with 99mTc and 68Ga have been used for clinical nuclear medicine, particularly for lung perfusion studies. Particles radiolabelled with beta-emitters (90Y and 188Re) have found application in therapy of hepatocellular cancer and liver metastases. The purpose of this study was to develop a method of HSAM preparation with reproducible physical and biological properties suitable for labeling with a variety of radionuclides.Methods: In the present study HSAM were prepared by dispersion of human serum albumin (HSA) solution in liquid paraffin, the emulsification and stabilization of spherical particles by heat. Preliminary HSAM labelling with 99mTc was performed to confirm the utility of obtained particles as radionuclide carriers.
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P154 Radiochemical Purity and Particle Size of 99mTC-Nanocolloid Obtained from Aliquots of Nanocoll® S. Maymo1, L. Camacho1, M. Garcia2, M. Roca1, J. Mora3, J. Martin-Comin3; 1 Unitat de Radiofarmacia, Servei Medicina Nuclear. Hospital Universitari de Bellvitge-Idibell, BARCELONA, SPAIN, 2Department Fisico-Quimica, Facultat de Farmacia, BARCELONA, SPAIN, 3Servei Medicina Nuclear. Hospital Universitari de Bellvitge-Idibell, BARCELONA, SPAIN. Aim:Evaluate the radiochemical purity (RCP) and the size of the colloidal particle of 99mTc-Nanocolloid obtained from saline aliquots of Nanocoll® stored at -20ºC and at -44ºC for 8 weeks.Materials and methods:The content of 8 vials of Nanocoll® of the same batch was hom*ogenously suspended in 1.5 ml of 0.9 % NaCl each and 24 aliquots of 0.5 ml were obtained from them. 12 aliquots were kept at -20ºC and the rest at -44ºC. An aliquot from each temperature was labelled with 20 mCi of 99mTc-pertechnetate in 0.5 ml. The RCP was determined at 40 min and 6 h after labelling using ITLC-SG / saline chromatography. The analysis of the radioactivity was done with a radiochromatograph. Another aliquot from each temperature was labelled by the same procedure but using 99Tc (decayed 99mTc) and the size of the coloidal particle analyzed by photon correlation spectroscopy.The same methodology was carried out at 1,2,4,6 and 8 weeks. The content of each of 3 vials of Nanocoll® was suspended in 3 ml of saline and it was used as reference for particle size control.Results:All the samples had a satisfactory (>95%) RCP. More of the 95% of the coloidal particle of all the samples had a mean diameter minor than 80 nm, as the technique file states.The mean diameter of the coloidal particle of the samples stored at -20ºC was slightly but significantly greater (about 4 nm) than the control samples (p< 0.05, n=9). The diameter of the samples stored at -44ºC was not significantly different than the control samples.Conclusions:The 99mTcnanocolloid obtained from saline aliquots of Nanocoll® stored at -20ºC or at -44ºC maintains the requirements stated by the manufacturer both the RCP and the particle size, during a minimum period of 8 weeks.
P155 Improved Sulphide
Method
to
Obtain
99mTc-Colloidal
Rhenium
L. Camacho1, M. Roca1, S. Maymo1, E. Carmona2, E. Calvo2, A. Benitez2; 1 Unitat de Radiofarmacia, Servei de Medicina Nuclear. Hospital Universitari de Bellvitge-Idibell, BARCELONA, SPAIN, 2Servei de Medicina Nuclear. Hospital Universitari de Bellvitge-Idibell, BARCELONA, SPAIN. Introduction:The radiochemical purity (RCP) of 99mTc-Colloidal rhenium sulfide not always meets with the requirements of the European Pharmacopoeia (EP). A recent study demonstrated a significant increase of the RCP by incubating at 130ºC instead of at 100ºC, as the manufacturer states, without modifying the particle size.Aim:To obtain 99mTc-rhenium sulfide nanocolloid that fulfills with the indications of the manufacturer and those of the EP by modifying the 99mTcpertechnetate volume, the temperature and the incubation time. To check the stability of the radiopharmaceutical obtained with the new conditions.Material and methods:99mTc-rhenium sulfide nanocolloid was prepared according to the indications of the manufacturer by using different 99mTc-pertechnetate volumes (1.0 ml, 1.5 ml and 2.0 ml) but by modifying the incubation temperature (100ºC and 130ºC). All of the comparative studies were performed using the same batch and activity.The RCP was analyzed by means thin-layer chromatography ITLC-SG / MEK and ITLC-SG / 0.9% NaCl. This method is based on the European Pharmacopoeia and detects 99mTc-pertechnetate and other 99mTc-impurities, like
99mTc-pyrophosphateResults:Using 1.0 ml of 99mTc-pertechnetate , the RCP was significantly higher by incubating at 130ºC (96.6±1.3) than that ones obtained at 100ºC (89.8±2.4) (n=5, p=0.008).After 10 min of incubation at 130ºC the RCP obtained fulfills the one required for the EP (93.4±1.0). The RCP was higher after 30 min of incubation (97.6±0.9) (n=3).By incubating at 130ºC, the RCP obtained using 1.0 ml of 99mTc-pertechnetate was higher (97.0±1.4) than the obtained with 1.5 ml (95.5±1.2) and with 2.0 ml (94.3±0.7) (n=3).The RCP of 99mTc-rhenium sulfide nanocolloid remained practically constant, at least 4h after labeling, using 1.0 ml of 99mTc-pertechnetate and incubating at 130ºC.Conclusions:The 99mTc-colloidal rhenium sulphide (nanocolloid) obtained by using 1.0 ml of 99mTc-pertechnetate and by incubating at 130º C during 30 min, fulfills with the EP’s quality criteria and is stable for at least 4 hours.
P156 Radiochemical Purity of 99mTc-Colloidal Rhenium Sulphide by a Method Based on the European Pharmacopoeia M. Roca1, S. Maymo1, L. Camacho1, Y. Ricart2, R Puchal2, J. Martin-Comin2; 1 Unitat de Radiofarmacia, Servei de Medicina Nuclear. Hospital Universitari de Bellvitge-Idibell, BARCELONA, SPAIN, 2Servei de Medicina Nuclear. Hospital Universitari de Bellvitge-Idibell, BARCELONA, SPAIN. Introduction:According to the Summary of Product Characteristics of Nanocis®, the radiochemical purity (RCP) of 99mTc-rhenium sulfide nanocolloid should be performed by ascending paper chromatography using Whatman 1 and methylethylketone (MEK). With this method 99mTc-perthecnetate is detected at Rf 1. The kit uses pyrophosphate as intermediate chelating of the species of reduced 99mTc, before the formation of 99mTc-rhenium sulfide nanocolloid by the warming step. The monograph “99mTc colloidal rhenium sulphide injection” of the European Pharmacopoeia (EP) describes 0.9%NaCl instead of MEK to identify 99mTc-perthecnetate at Rf 0.6 and other impurities at Rf 0.8-0.9.Aim:Analyzing the RCP of 99mTc-colloidal rhenium sulfide by the method described by the manufacturer and another one based on the described in the EP.Material and methods:12 samples of 99mTc-rhenium sulfide nanocolloid were analysed. These samples were prepared according to the manufacturer instructions by using 1.0 ml of 99mTc-perthecnetate and warming for 30 min at 100ºC.The RCP was analyzed according to the manufacturer (Whatman 1 / MEK) and the described by the EP (ITLC SG / 0.9%NaCl)Results:The average percentage of 99mTc-perthecnetate was 0.1 ± 0.2.The average percentage of 99mTc-other impurities was 8.5 ± 5.2.Acording to the method established by the manufacturer, all the samples had a successful RCP (>95%). Acording to the method based on the EP monography, only 5 of the 12 samples had a successful RP (>92%).Conclusions:The SPC of Nanocis don’t take into account all the radiochemical impurities that could be present in the final radiopharmaceutical. The likely presence of 99mTc-pyrophosphate makes it advisable an additional analysis to identify this impurity, and so, to improve the labelling procedure.
P157 Production of Generators Technetium-99M on the Basis of Enriched Molybdenum-98 in Tomsk S. Elena, V. Skuridin, Professor, E. Nesterov; Tomsk polytechnic university, Tomsk, RUSSIAN FEDERATION. Stasyuk E., Skuridin V., Nesterov E., Larionova L.E-mail:[emailprotected] radionuclide Technetium -99m and radiopharmaceutical preparations produced on its basis are widely used for the diagnostic research in cardiology, oncology and other fields of medicine. More than 80% of diagnostic tests of all the number of radio diagnostic procedures use preparations of 99mTc.World and also Russian production of chromatographic (sorption) generators of technetium-99m is based on the use of radio nuclide Molybdenum -99, emitted from the fission product of Uranium-235. 99Mo obtained by such a technology has a specific activity of more than 200 Ci/g at practically full absence of the carrier in the form of stable atoms of Molybdenum, the combined (total) output of which (95Mo, 97Mo, 100Mo) doesn’t exceed 18,1 %. Besides 99Mo during the split of Uranium there appear more than 20 long life split radio nuclides from which the further purification is conducted. Their integral activity exceeds the activity of the targeted product by hundreds of times which creates great ecological problems while reprocessing and utilizing. Partially split radionuclide impurity 131I, 103Ru, 89Sr, 90Sr can exist in the eluate of Technetium -99m, used for intravenous introduction.The work offers alternative opportunities of the production of generators using the waste free technology on the basis of 99Mo, obtained by the reaction of radiological capture (n,γ) from highly enriched Molybdenum - 98 irradiated by the neutrons of reactor. General quantity of radioactive waste doesn’t exceed 10-4 % from the activity of 99 Mo, because Molybdenum-98 can be regenerated from the worked out generators after their return from the consumer and can be used again in technological cycle. Long life impurity are also absent in the obtained preparation of Technetium -99m.Thanks to the realization of the proposed waste free technology of the production of highly active generators of Technetium self cost of the product in comparison with other technologies of its production lowed by more
Poster Presentations
The labelling with 99mTc was carried out using the direct method by reduction with SnCl2x2H2O. For that, the HSAM were coated with tin chloride. Radioactive particles labelled with 188Re were prepared in the presence of tin chloride and gentistic acid. For HSAM labelling with 90Y, 177Lu and 68Ga the particles were modified by covalent attachment of suitable chelators onto the surface of the spheres. Modified microspheres (X-HSAM) were labelled with 90Y and 177Lu in ascorbic buffer (pH 4.5) and with 68Ga in sodium acetate buffer (pH 3.75). For assessment of labelling yields in each case radioactive products were separated from non-bound radionuclides by filtration. In vitro stability of the radiolabelled complexes was determined for 90Y-XHSAM and 177Lu-X-HSAM after incubation in human serum for 48 h at 37°C. The biodistribution of 99mTc-HSAM and 177Lu-X-HSAM was studied after intravenous administration in rats, lungs were considered as target organ.Results: The average production yield of HSAM for receiving the desired size range between 10-32 μm amounted to 84%. The labelling yields determined as relation of measured radioactivity remaining after filtration on the membrane filter to the total radioactivity were >99% for 99mTc-HSAM, 188Re-HSAM, 90Y-X-HSAM, 177Lu-X-HSAM and >75% for 68Ga-X-HSAM complexes. Labelled modified microspheres showed high in vitro stability in human plasma with only 4-5% loss of radioactivity at 48 h. The biodistribution performed at 15 minutes after administration showed >87% activity in lungs for 99mTc-HSAM and >92% for 177Lu-X-HSAM.Conclusions: The microspheres prepared from human serum albumin are useful carriers for variety of radionuclides.
S297
S298
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441
than 40%.Created as the result technology won’t have world analogies in the sphere of producing of highly active generators from low active 99Mo, obtained by the reaction of radiological capture.
P158 Evaluation of the Radiochemical Purity of 99mTc-oxidronate (99mTc-HMDP) with ITLC-SG, WHATMAN-17 and WHATMAN31Et L. Sanz-Ceballos, J. M. Calero, E. Teijeiro, A. Ramirez, J. M. Llamas-Elvira; Hospital Universitario Virgen de las Nieves, Granada, SPAIN. AIM: To analyze the cutoff of radiochemical purity (RCP) of 99mTc-OXIDRONATE (99mTc-HMDP) as alternative methods using stationary phases: Whatman-17 and Whatman-31Et and distilled H2O as mobile phase.MATERIAL AND METHODS: We made 63 RCP controls to 15 vials of 99mTc-HMDP marked according to the manufacturer's specifications (OSTEOCIS ® CIS bio international). In each preparation we made the control contains in the data sheet (strip ITLC-SG/NaCl 0.9%) against two alternative methods (Whatman-31Et and Whatman-17 / distilled H2O). Tin chloride (II) was added for a low RCP in 6 of these vials. These strips were counted employing the Chromatography Analyzer Raytest Mini-Gita®. We calculated the average (x), standard deviation (SD), the range of values [[Unsupported Character - ]][[Unsupported Character - ]]for each of the methods and Kappa index of the new compared methods against that proposed by the manufacturer, for a cutoff of 95% RCP.RESULTS: For a cutoff of 95% RCP, the agreement obtained through the Kappa index was high (0.61 to 0.80) when comparing the two new methods proposed against the control contained in the manufacturer´s data sheet. By lowering the cutoff point of the RCP to 93% in the studied methods we would get a very good agreement (k = 1).CONCLUSIONS: New methods tested are suitable for determining the RCP of 99mTc-OXIDRONATE if you decrease the cutoff point where the preparation is considered suitable for use from 95% to 93%.
P159 Observed interference effects of reagent water in critical HPLC analysis J. G. CHAN, K. Young, A. M. Scott; Austin Health, Heidelberg VIC, AUSTRALIA. BACKGROUND: Interfering UV impurity peaks were observed in a gradient HPLC analysis and the quality of reagent water used was suspected to be the cause. Reagent water is used in all aspects of HPLC from preparation of mobile phase to standards and over 70% of HPLC performance problems are attributable to the quality of water used (1).AIM: To investigate the effects of different reagent water grades in HPLC mobile phase formulations and the effects of mobile phase degradation with time. Different sources of water for injection (WFI) were also investigated for interference as WFI is commonly used in final product formulation.METHOD: Two sources of reagent water, Baxter WFI and Milli-Q Plus 185 System, were used to make up the mobile phases for the gradient HPLC. Multiple samples of different sources of WFI were also analyzed. The experiment was repeated at 24 hours and 5 days. Different batches of reagent water and WFI were also used to eliminate batch variation. All analysis was performed with UV/Vis wavelength at 300nm as this is our HPLC method under investigation.Experiment conditions: Column XBridge C18 2.5µm, 3.0 x 50mm, flow at 0.85 mL/min, mobile phase A: acetonitrile/water (5:95), mobile phase B: acetonitrile/water (90:10). Gradient 100% A to 100% B in 8.6 minutes hold at 100% B for 3 minutes 100% A for 3.3 minutes. All analysis was performed with LC solution software.RESULTS: Impurity peaks were observed in mobile phase formulations using Baxter WFI which interfered with chemical purity determinations. The same impurity peaks were not observed in experiments utilizing ultrapure water from the Milli-Q Plus system. In addition investigation of different brands of WFI resulted in different UV impurity peaks being observed. Impurities were observed to increase in the mobile phase with time.DISCUSSION: Our observations show the use of Type I ultrapure reagent water produced by the Milli-Q Plus 185 System in the HPLC mobile phase has eliminated the impurity peaks observed with WFI (Baxter). Different sources of WFI show different UV impurity peaks. For critical HPLC methods it is preferable to avoid using high-purity water with a high total organic carbon (TOC) level (1).CONCLUSION: Our recommendation is that fresh mobile phase (<24 hours) with Type I ultrapure reagent water should be considered if interfering UV peaks is an issue for quantitative analysis.1. S. Mabic, C. Regnault and J. Krol, LC GC North America, 23 (1), 74-82 (2005)
P160 Validation of new Rediopharmacy Unit
99m
Tc-Sestamibi
Generics
in
our
R. Pérez Pascual, E. Martínez Montalban, C. de Gracia González, B. Santos Montero, L. Martin Curto, B. Martínez de Miguel; HOSPITAL UNIVERSITARIO LA PAZ, Madrid, SPAIN.
INTRODUCTION:The use of generics has been settled in Spain for years due to its effectiveness and lower cost. However, they have not been introduced on Radiopharmacy until 2010 with the marketing of generics for 99mTcSestamibi.AIM:To compare and evaluate the efficiency, stability and labeling conditions of generics with regard to Cardiolite® (IBA); and the quality of the in vivo parathyroid scintigraphy.MATERIALS AND METHODS:10 units of STAMICIS® (IBA) and 10 units of MIBI-Technescan® (COVIDIEN) were labeled as generics, and 1 vial of Cardiolite® was taken as reference by each one of them. In all cases, the preparation was done in accordance with the manufacturer's instructions. Controls for radiochemical purity (RQP) were performed during its validity period (V.P.) (10h) by two different methods: 1) as proposed by the manufacturer (chromatography on aluminum oxide Baker-Flex and ethanol as solvent) and 2) a validated method in our Radiopharmacy Unit (alumina N Sep-pak column (Waters) and ethanol as mobile phase). The RPQ must be over 94%. The dose given to patients was 740 MBq. The scintigraphies were evaluated by two nuclear medicine physicians by following a double blind protocol.RESULTS:The radiolabeling method described by the manufacturers was the same for the 3 radiopharmaceuticals.The mean results in RPQ (%) ± SD obtained from 0h to the end of the V.P are: method1: Cardiolite® 97.762 ± 0.649, STAMICIS® 97.512 ± 0.610, MIBI-Technescan® 98.614 ± 0.483; method-2: Cardiolite® 96.612 ± 1.469, STAMICIS® 96.072 ± 1.372, MIBITechnescan® 97.185 ± 0.959.There were no significant differences (calculated by Wilconxon test) in RPQ variation in the generics with respect to Cardiolite® to show different stability; STAMICIS® method-1: p=0.3173, method-2: p=0.8248; MIBITechnescan® method-1: p=0.2752, method-2: p=0.6579. Observers did not notice any change in the quality of the images.CONCLUSION:Since the obtained results are equivalent to the radiopharmaceutical used as reference and the cost of the generics is considerably lower, these ones become a good alternative for daily use.
P161 Study of the Influence of Chemotherapy with Anthracyclines on the Binding Efficiencies after Preparation of in VIVO/IN 99m TcO4 Red Blodd Cells VITRO E. Martinez Montalban, R. Perez Pascual, B. Santos Montero, C. De Gracia Gonzalez, B. Martinez de Miguel, L. Martin Curto; HOSPITAL UNIVERSITARIO LA PAZ, MADRID, SPAIN. INTRODUCTIONRadiolabeling red blood cells (RBC) with 99mTcO4- is a widely used test to determine heart function by the ventricular ejection fractionIt is known that different factors such as certain drugs (as metildopa and digoxine) could affect the binding efficiencies (BE)AIMTo study the anthracyclines (AC) influence on the BE after radiolabeling RBC with 99mTcO4- using the in vivo/in vitro method. Reference yield value 90%PATIENTS AND METHODS69 patients, female mean age 58.5 years diagnosed of breast cancer, were studied. All off them, except 5, were treated or had been treated with a chemotherapy (ChT) regimen where one of the drugs in all cases was an AC.Several variables were studied: number of ChT cycles, RBC values, haemoglobin and hematocrit.Patients were divided into 4 groups based on the number of ChT cycles received: 1. 0 cycles (5 patients); 2. Between 1 and 5 cycles (15); 3. 6 cycles (24); 4. >6 cycles (25). The in vivo /in vitro method was used to radiolabel the RBC. This formula was used to calculate the BE: BE= (final activity / initial activity) x 100RESULTSStatistical analysis shows that when the 4 groups of patients are compared with each variable they are all hom*ogeneus between groups, so they do not influence on BEThe relationship between groups shows that statistically significant differences exist between group 2 and 3 (p=0.010) and between 2 and 4 (p=0.001). BE mean values (%) and its standard deviations, are, for each group: 1. 91.00% ± 0.05; 2. 92.05% ± 3.43, 3. 86.62% ± 7.21; 4. 85.88% ± 8.11CONCLUSIONStatistically significant differences exist in BE depending on the number of cycles of ChT with AC received: the more cycles received the lower BE obtained. However we can not state that a direct cause-effect relationship exists; that means that AC and/or it’s metabolites are the cause of this decrease
P162 Formulation of alginate Neuroendocrine tumor
nanoparticles
for
targeting
G. Bandopadhyaya, J. Shukla, G. Arora; All India Institute of Medical Sciences, Delhi, INDIA. AimRadiolabeled peptides (Lu-177 DOTATATE), used for therapy of Neuroendocrine tumors, are excreted mainly via kidneys and are partly reabsorbed in proximal tubular cells. Their renal retention causes a relatively high radiation dose to kidneys, leading to kidney failure, thus limiting the efficacy of therapy. Coinfusion of basic amino acids for renal protection is not much effective. The ectopic expression of β-HCG had been reported by advance staged metastasized cancers of different origins. The objective of the work is to develop methods for targeted delivery of radiation selectively to cancer expressing β-HCG. We encapsulated the peptide inside nano-assemblies to restrict its release.Material and MethodsA highly specific monoclonal antibody fragment, F(ab’)2, was labeled with I-131 by Iodogen method. Its ability to bind with JEG3 choriocarcinoma cells and lack of binding to a non-HCG secreting tumor SP2O was evaluated. Radiolabeled anti-HCG
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441 F(ab’)2 fragment was injected in tumor induced athymus mice and scanned by Philips double headed scanner. DOTATATE was labeled with Lu-177 and labeling efficiency was determined by ITLC using 50% Acetonitrile as a mobile phase. Lu-177 DOTATATE-Alginate nanoparticles (2, 5 & 10%) were formulated by inducing gelification with Calcium chloride (30, 50, 100, 150 & 200 mM). 2% Alginate and 30mM CaCl2 were found to be most suitable concentration with respect to both size distribution and ease of recovery. After optimization, particles were coated with 10% polyethylene glycol to prevent opsonization. The size and shape of formulated nanoparticles were evaluated with electron microscopy and Particle Size Analyzer. In-vitro release kinetics of Lu-177 DOTATATE encapsulated nanoparticles was studied. Nanoparticles were incubated with anti-HCG F(ab’)2 fragment at 4°C overnight to coat the nanoparticles with antibody fragment.ResultsThe scan revealed localization of radioactivity in the JEG3 tumor predominantly. On the other hand, mice developing SP2O tumor had no localized radioactivity. Results indicated the expression of β-HCG in JEG3 tumors. Labeling efficiency of DOTATATE was 98% (Rf value ~ 0.8). The stability of the labeled compound was checked by repeating chromatography till 6 days after labeling and was found to be stable with a labeling efficiency of 95.4% on 6th day. The mean particle size of all formulated nanoparticles of alginate ranged between 110.45 296.52 nm. Lu-177-DOTATATE encapsulation was 95-99%. All Nanoparticles showed an initial burst release, with around 52-62% release upto 4 h.CONCLUSIONThe radiolabeled alginate nanoparticles are suitable for selective delivery of radiation to β-HCG expressing Neuroendocrine tumors.
well counter for 1 minute. All the measurements were expressed in count-perminute and using the Formula: %99mTc-Complex= [(99mTc-Complex)/(Total amount of 99mTc-labeled species)] x 100. Coefficients of variation were calculated to compare the RCP and the stability results of each group stored at vials and syringes at 0, 2 and 4 h after labeling. At all time points, three radiopharmacists repeated all the procedure twice for each TLC paper types to analyze intra-operator reliability.RESULTS:Highest % binding efficiency results were obtained with ITLC-SA for MAG3; Whatman No:3 for DMSA and MIBI, Whatman No:1 for HDP and DTPA, ITLC-SG for MAA and NC. Inter-operator and intra-operator results were in good agreement with the results of those chromatography strips. According to the stability test results of 99mTc-MAA, the %RCP decreased from 98.15 % to 92.10% at 2h, at storage in a syringe. Also %RCP result of 99mTc-MAA stored in a vial is higher than stored in a syringe (%99.37 and %92.10 at 2 h) for MAA. The product is less stable when stored in a syringe than a vial. In addition, %RCP result of 99mTcHDP decreased in a syringe at 4h, from %95.2 to %84.2. The other Tc-99m radiopharmaceuticals were stable in both vial and syringe for all chromatographic papers for 4 h.CONCLUSIONS:When all kinds of ITLC/TLC strips were assessed for the Tc-99m radiopharmaceuticals, %RCP, stability, inter-operator and intraoperator results indicated that ITLC-SA, Whatman No:3, Whatman No:1, ITLC-SG have the highest %RCP results for MAG3, DMSA, MIBI, HDP, DTPA, MAA and NC respectively.
P14 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area Medicine
Workers
During
J. Olszewski1, M. Wrzesien2; 1The Nofer Institute of Occupational Medicine, Łódź, POLAND, 2University of Lodz, Łódź, POLAND. 131
I belongs to radioisotopes which have been used in medicine for longest time; due to its valuable physical characteristics, it constitutes a basis for thyroid diagnostic and treatment procedures. Radioiodine-containing preparations are dispensed by workers of nuclear medicine departments. As the radioiodinedispensing operations are performed manually, the hands of the involved medical personnel may be exposed to high doses of the ionising radiation. High-sensitivity thermoluminescence detectors were used to determine the doses. The detectors can be used to measure the doses ranging from 2 μSv to 10 Sv. The detectors were placed at 19 points on workers’ left and right hands, including fingertips, middle phalanges, fingernails, palmar and dorsal metacarpus and wrists, and in a standard ring dosemeter location.Over half of dose values for the right hand did not exceed 0.27 mSv. Eighty three percent of the values were within 0 ÷ 1.62 mSv range. There was, however, a group of workers for whom the values of the doses measured during one work day were as high as several hundred mSv. By way of example, the dose recorded for a worker during one day for the thumb tip was almost 194 mSv. For the left hand, the measured values of the doses did not exceed 5.8 mSv. Nearly seventy two per cent of the recorded doses ranged from 0 to 0.27 mSv. All participants of the study were right-handed. Depending on the recorded doses, the study workers may be classified into two groups. Worker's manual dexterity may significantly affect the level of the recorded dose, while similar working conditions do not ensure that the radiopharmacists operate in the same manner. Standard dosemeter ring used in nuclear medicine units by workers whose level of hand exposure was classified as high tended to underestimate the exposure. The group of workers characterised by high level of hand exposure to the ionising radiation was shown to be at a high risk of exceeding the annual equivalent dose limit of 500 mSv, particularly to the right hand fingertip. The doses received during one year may be as high as multiples of the limit doses specified by relevant regulations.
P164 Radiochemical Purity and Stability Testing of Radiopharmaceuticals Stored in Vials and Syringes
Tc-99m
S. Türker, K. Cinkilli, E. Ozcan, M. Caglar; Hacettepe University, Ankara, TURKEY. AIM:Paper and thin layer chromatography (TLC) methods are frequently used for determination of radiochemical purity (RCP) on radiopharmaceutical preparation. The purpose of the study was to compare different chromatography strips, to evaluate the stability of Tc-99m radiopharmaceuticals (99mTc-MAG3, 99mTcDMSA, 99mTc-MIBI, 99mTc-HDP, 99mTc-DTPA, 99mTc-MAA and 99mTc-NC) dispensed by vial and syringe with storage time (0h, 2h, 4h) and to assess inter- and intra-operator variability. TLC was used to determine optimal, limiting radiochemical purity values for separate reconstitutions.MATERIALS and METHODS:Lyophilized radiopharmaceuticals were reconstituted as suggested by manufacturers. For the determination of RCP of Tc-99m radiopharmaceuticals, Whatman No:1, Whatman No:3, Gelman instant thin-layer chromatography silica gel (ITLC-SG) and Gelman instant thin-layer chromatography silica acrylic (ITLC-SA) were used as stationary phase. After the development of solvent front, strips were cut in Rf and resultant pieces were smashed in an assay tube and counted in the
Radiopharmaceuticals & Radiochemistry & Dosimetry: Radiometals
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Development of [ Lu]-Tetra phenyl porphyrin complexes as possible imaging agents H. Yousefnia, A. R. Jalilian, Y. Fazaeli, A. Bahrami Samani, M. GhannadiMaragheh; Radiopharmaceutical Research and Development Lab, Nuclear Science and Technology Research Institute, Tehran, IRAN, ISLAMIC REPUBLIC OF. Aims: Due to interesting therapeutic properties of 177Lu and tumor avidity of tetraphenyl porphyrins (TPPs), 177Lu-tetraphenyl porphyrin (177Lu-TPP) was developed as a possible therapeutic compound.Materials and Methods: Lu-177 of 2.6-3 GBq/mg specific activity was obtained by irradiation of natural Lu2O3 sample with thermal neutron flux of 4 × 1013 n.cm-2.s-1. [17Lu]labeled tetraphenyl porphyrin ([177Lu]-TPP) was prepared using freshly prepared [177Lu]-LuCl3 and tetraphenyl porphyrin (TPPH2) for 30-60 min at 25°C (radiochemical purity: >97±1% ITLC, >98±0.5 % HPLC, specific activity: 13-14 GBq/mmol). Stability of the complex was checked in final formulation and human serum for 24 h. The partition coefficient was calculated for the compound (log P. 1.89).Results and discussion: The biodistribution of the labeled compound in vital organs of wild-type rats was studied using scarification studies and SPECT imaging up to 24 h. A detailed comparative pharmaco*kinetic study performed for 177Lu cation and [177Lu]TPP.Conclusion: The complex is mostly washed out from the circulation through kidneys and can be an interesting tumor imaging/targeting agent due to low liver uptake and rapid excretion through the urinary tract.
P166 Preparation and quality control of radiosynovectomy
166
Ho-chitosan complex for
S. Zolghadri, A. R. Jalilian, A. Bahrami Samani, S. Shirvani-Arani, M. Mazidi, M. Akhlaghi, M. Ghannadi-Maragheh; Radiopharmaceutical Research and Development Lab (RRDL), Nuclear Science and Technology Research Institute, Tehran, IRAN, ISLAMIC REPUBLIC OF. Ho-166 chloride was obtained by thermal neutron flux (4-5 × 1013 n.cm-2.s-1) of natural Ho2(NO3)3 sample, dissolved in acidic media. 166Ho-holmium chloride (185 MBq) was used in preparation of 166Ho-chitosan complex successfully with high radiochemical purity (>99%, ITLC) using MeOH: H2O: acetic acid (4: 4: 2) as mobile phase. The complex stability and viscosity were checked in the final solution up to 2 days. The prepared complex solution (60 µCi/100 µl) was injected intra-articularly to male rat knee joint. Leakage of dose from injection site and its distribution in organs were investigated up to 6 days for 166Ho-chitosan and free 166Ho cation. Approximately, all injected dose has remained in injection site 6d after injection. The complex is a dedicated agent for cavital radiotherapy in oncology and rheumatology.
Poster Presentations
P163 Hand Exposure of Nuclear Administration of Radioiodine
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P167 Production, Quality Control and Biological Evaluation of 153 153 Sm-TTHMP and Sm-PDTMP as a Possible Bone Palliation Agent Z. Naseri1, A. R. Jalilian2, A. Nemati Kharat1, A. Bahrami Samani2, M. Ghannadi-Maragheh2; 1School of chemistry, University college of science, University of Tehran,, Tehran, IRAN, ISLAMIC REPUBLIC OF, 2 Radiopharmaceutical Research and Development Lab (RRDL), Nuclear Science and Technology Research Institute, Tehran, IRAN, ISLAMIC REPUBLIC OF. Radionuclides have been used to treat skeletal diseases for decades. At present an array of radionuclides have been proposed for treating bone pain due to cancer. The most promising among these radionuclides is 153Sm. This radionuclide has favourable radition characteristics t1/2= 1.93d, βmax= 0.81 Mev(20%), 0.71 Mev (49%), 0.64 Mev (30%) and γ= 103 Kev (30%) emission which is suitable for imaging purposes during therapy.Various bone palliative therapeutic agents have been developed for bone metastasis such as 153Sm-EDTMP, widely used in the world. (EDTMP) has been proved to be a good therapeutic agent for the treatment of pain due to skeletal metastases and is now commercialized.In this study, production, quality control and biodistribution studies of a newly developed therapeutic compound have been presented followed by imaging studies in wild-type rodents. 153Sm-PDTMP and 153Sm-PDTMP was prepared starting 153Sm-SmCl3, prepared by neutron activation of an enriched 152Sm sample (purity >98%), and in-house synthesized TTHMP and PDTMP(amine: 1,2-diaminopropane) in 1h at 25ºC followed by stability tests, partition coefficient determination and biodistribution studies of in wild-type rodents using scarification. The radiolabeled Sm complex was prepared in high radiochemical purity (>99%, ITLC) and specific activity of 278 GBq/mmol and demonstrated significant stability at 4, 25 and 37ºC (in presence of human serum). Initial biodistribution data showed significant bone accumulation of the tracer in 48h. The produced 153Sm-PDTMP and 153Sm-PDTMP properties suggest an efficiently new bone palliative therapeutic agent in the country in order to overcome the metastatic bone pains.
P168 Production and Biological evaluation of new Samarium 153 Sm-[Tris (1,10 Phenanthroline) Samarium complex (III)]trithiocyanate for targeted tumor radiotherapy A. R. Jalilian1, A. Hakimi2, Z. Naseri3, S. Shirvani Arani1, A. Arbabi4, A. Bahrami Samani1, M. Ghannadi-Maragheh1; 1Radiopharmaceutical Research and Development Lab (RRDL), Nuclear Science and Technology Research Institute, Tehran, IRAN, ISLAMIC REPUBLIC OF, 2Department of Nuclear Engineering, Science and research branch, Islamic Azad University,, Tehran, IRAN, ISLAMIC REPUBLIC OF, 3School of chemistry, University college of science, University of Tehran,, Tehran, IRAN, ISLAMIC REPUBLIC OF, 4Department of Medical Physics, Imam Hossein Hospital, Shahid Beheshti Medical Sciences University, Tehran, Iran, Tehran, IRAN, ISLAMIC REPUBLIC OF. Radiotherapy using open radioactive sources has become an important and promisingmode of treatment of cancer patients, particularly in conjunction with other modalities like surgery and chemotherapy. For this purpose therapeutic radiopharmaceuticals are designed to deliver high doses of radiation to selected target organs or tissues with an aim of minimizing unwanted radiation to surrounding healthy tissue.In spite of the potential of targeted radiotherapy to treat a wide range of malignant conditions, new Samarium complex 153Sm-[Tris (1,10 Phenanthroline) Samarium (III)]trithiocyanate ( 153Sm-TPTTC )was prepared using Sm-153 chloride (radiochemical purity >99.9%; ITLC and specific activity). The radiolabeled complex was prepared in high radiochemical purity (>99% precipitation method) and specific activity of 278 GBq/mmol and demonstrated significant stability at 4, 25 and 37°C (in presence of human serum). The stability of the labeled compound was determined in the final solution up to 72h as well as the partition coefficient. Biodistribution studies of Sm-153 chloride, 153Sm-[Tris (1,10 Phenanthroline) Samarium (III)]trithiocyanate were carried out in normal and tumoral mice comparing the critical organ uptakes.The produced 153Sm- TPTTC properties suggest an efficiently new liver accumulating therapeutic agent in order to overcome possible liver malignancies with the lowest toxicity.
P169 Production of Holmium-166 DOTMP: A Promising Agent for Bone Marrow Ablation in Multiple Myeloma R. Bagheri, A. Bahrami Samani, A. R. Jalilian, M. Mazidi, S. Moradkhani, M. Ghannadi-Maragheh; Radiopharmaceutical Research and Development Lab (RRDL), Nuclear Science and Technology Research Institute (NSTRI),, Tehran, IRAN, ISLAMIC REPUBLIC OF. Therapeutic radiopharmaceuticals are radiolabeled molecules to deliver sufficient doses of ionizing radiation to specific disease sites such as bone metastases, brain
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 and liver tumors and bone marrows in multiple myeloma. Among some therapeutic 166 radiopharmaceuticals, Ho-1,4,7,10 -tetraazacyclo dodecane-1,4,7,10 tetraethylene phosphonic acid (166Ho-DOTMP) is used for delivering high doses to bone marrow. In this research production, quality control, pharmaco*kinetics and biodistribution studies of 166Ho-DOTMP with respect to its radiochemical and in vivo biological characteristics have been presented. Holmium-166 was produced by irradiation of holmium oxide (Ho2O3, purity > 99.8%) at a thermal neutron flux. This radionuclide was labeled at room temperature and radiochemical purity of 166HoDOTMP was checked by ITLC. 166Ho produced by irradiation of holmium-165 oxide demonstrated high radionuclide purity. 166Ho-DOTMP complex was obtained in very high yields (radiochemical purity > 99%) under the reaction conditions employed. This complex exhibited excellent in vitro stability at pH~7 when stored at room temperature and human serum. Wild type rats were used for biodistribution and imaging studies of this agent. Biodistribution studies in rats showed favorable selective skeletal uptake with rapid clearance from blood along with insignificant accumulation of activity in other non-target organs. This warrants the detailed evaluation of the agent for bone marrow ablation in multiple myeloma by injection of high activity of radiopharmaceutical in patients.
P15 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Radiopharmaceuticals & Radiochemistry & Dosimetry: Radiopharmakinetics & Drug Development
P170 Evaluation of an analysis method of radiochemical purity and fluoride content in [18F]NaF using anion-HPLC with radioactive and suppressed conductivity detectors C. Li, S. Farn (FAN), Y. Yeh, Y. Tu, L. Huang, J. Chen, W. Lin, L. Shen; Institute of Nuclear Energy Research, Jiaan Village, Longtan Township, TAIWAN. Aim: 18F-labeled sodium fluoride ([18F]NaF) is better than 99mTc-labeled polyphosphonates for bone metastases imaging due to higher uptake of bone, faster blood clearance and better signal-to-noise ratio. Several chromatographic methods for analysis of [18F]NaF were reported, however, the published chromatographic methods investigated were found to be unacceptable for routine analysis of [18F]NaF radiopharmaceuticals. It is essential to develop a sensitive and accurate method for analysis of [18F]NaF.Materials and Methods: The method developed for radiochemical purity and fluoride content by [18F]NaF and NaF reference standard uses an isocratic elution in a Hamilton anion-exchange column using a mobile phase which consists of 7.5 mM sodium carbonate and 0.018 mM potassium thiocyanate. The flow rate and temperature were 1.0 ml/min and 30°C, respectively.Results: The analysis results are described as follows: (1) Because the radioactive detector was coupled in series with the conductivity detector, the difference of retention time between [18F]NaF and NaF reference standard is about 0.5 min. (2) The chromatographic result of [18F]NaF by conductivity detector with retention times of 16 min for chloride peak shows over scale which arises from Normal saline (Sterile Sodium Chloride 0.9% ) present in [18F]NaF. (3) The linear regression of measured values (y-axis) against 5 known concentration (x-axis) from 10 to 400 μg/mL NaF reference standard was y=22804x -14693, R2=0.9992. (4) The LOD and LOQ of fluoride are 0.0678 and 0.20μg/mL, respectively. Furthermore, the stability of three batches of [18F]NaF radiopharmaceuticals were analyzed in 0, 2, 4, 6, and 8 hours using the analysis method. The radiochemical purity and fluoride content of [18F]NaF are above 98.5% and less than 0.2 ppm, respectively. The CV (%) of retention time for analysis of [18F]NaF is less than 2.0% for all batches.Conclusion: All of the analysis results demonstrate this method is sensitive, specific and suitable for routine analysis of [18F]NaF radiopharmaceuticals.
P171 Production, quality control and biodistribution studies of labeled (ethylenediamine tetra (methylene phosphonic acid) with thulium-170 S. Shirvani Arani, A. Bahrami Samani, A. R. Jalilian, M. Mazidi, M. Ghannadi-Maragheh; Radiopharmaceutical Research and Development Lab (RRDL), Nuclear Science and Technology Research Institute (NSTRI),, Tehran, IRAN, ISLAMIC REPUBLIC OF. Thulium-170 [T1/2=128.4 days, Eβ(max)=968 keV, Eγ=84 keV (3.26%)] has radionuclidic properties suitable to be used in palliative therapy of bone metastases as an alternative to 89SrCl2.170Tm can be produced by a relatively easy route involving thermal neutron bombardment on natural Tm2O3 (100% 169Tm) in medium flux research reactors. The requirement for an enriched target does not arise and radionuclidic impurities are not formed by radiative capture during neutron activation. In this study 170Tm was produced using Tm (NO3)3, prepared by neutron activation (3-4 × 1013) of a natural sample. ethylenediamine tetra
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P172 Development of a reversed-phase HPLC method for analysis 123 of radiochemical purity in [ I] IBZM C. Li, S. Farn, Y. Yeh, W. Lin, L. Shen; Institute of Nuclear Energy Research, Jiaan Village, Longtan Township, TAIWAN. Aim: [123I] IBZM (l23I-S-(-)-N-[(l-ethyl-2-pyirolidinyl) methyl]-2-hydroxy-3-iodo- 6rnethoxybenzarnide) is a SPECT radio-seeking agent which was used widely for dopamine D2 receptor image. In addition, [123I] IBZM shows relatively fast kinetics and a greater susceptibility to synaptic dopamine released than other SPECT radioligands.Although several chromatographic methods for analysis of [123I] IBZM were reported, the unacceptable chromatographic data made the procedures inappropriate for analysis of [123I] IBZM while using the published methods. The goal of this study is to develop a rapid and accurate HPLC method for analysis of [123I] IBZM by using UV/VIS and radioactive detectors.Materials and Methods: To identify the BZM from [123I] IBZM during chromatographic process, we used cold IBZM as reference standard and investigated several chromatographic conditions including the type of mobile phase (DMGA, Tris and MOPS buffer), the type of elution and different stationary phase of column. In preliminary experiments, subsequent assays were performed by isocratic elution and C-8 column using the mobile phase consisted of water (with 10 mM of MOPS, Tris and DMGA, respectively, pH 7.0) and acetonitrile (30:70, v/v) that was set at a flow rate of 1.0 ml/min. Finally, the method uses a stepwise elution in a Zorbax XDB C-18 column using a mobile phase that consists of 10 mM 3,3-dimethylglutaric acid (DMGA), pH 7.0 and acetonitrile (AcCN). The flow rate and elution time were 1.0 ml/min and 20 min with detection at λ = 254 nm.Results: The analysis results are described as followed: By using DMGA as the mobile phase, the better resolution between BZM and IBZM was achieved than other buffers. Additionally, we observed that there is significant tailing peak using isocratic and gradient elution and tried to minimize this peak tailing effect by stepwise elution. Good peak symmetry, resolution and the tailing factor (0.8-1.2) were obtained from the chromatographic condition. Moreover, changing the column from C-8 bonded phase to C-18 resulted in better resolution between BZM and IBZM and the higher theoretical plates. Using the method, the retention times of [123I] NH4I, [123I] IBZM, cold IBZM and BZM are 1.621, 9.556, 8.921 and 5.398 min, respectively. The resolution between IBZM and BZM is 9.945 that is considered acceptable (Rs>1.5).Conclusion: All of chromatographic data including resolution, peak tailing factor and elution time are within acceptable range that demonstrates this method can be performed in a timely manner for analysis of [123I] IBZM.
P16 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Radiopharmaceuticals & Radiochemistry & Dosimetry: Antibodies & Peptides
P173 Radiolabelling and quality control of anti-CD20 antibodyrituximab with 90Yttrium for the treatment of relapsed and refractory large B-cell NHL P. Thakral, A. Malhotra; Ali India Institute of Medical Sciences, NEW DELHI, INDIA. Introduction: Radioimmunotherapy (RIT) using 131 Iodine or 90 Yttrium labeled anti CD 20 mouse antibodies has been in use for past few years for the treatment modality for B-cell NHL patients who have been refractory to conventional chemotherapy or radiotherapy or relapsed following an initial favorable response. Most B-cell lymphomas express CD20antigen on the surface of the tumor cells, making it a suitable target for therapeutic radioactive monoclonal antibodies. Owing to its suitable physical properties and decay characteristics β- emitting radioisotope 90Yttrium is a promising radionuclide for therapeutic use. In present study, we have prepared the immunoconjugate with monoclonal antibody (MoAb)Rituximab and the macrocyclic chelator DOTA and then labeled it with 90Yttrium whose safety and efficacy for the therapeutic purpose was further evaluated.Materials and Methods: Anti CD20 antibody Rituximab was incubated with a chelate p-SCN-Bz-DOTA in different molar ratios (1:30, 1:50).The conjugate
was then radiolabelled with 90Y. Purification of the conjugate and radiolabelled 90Y-DOTA-Rituximab was carried out using Sephadex G-50 size exclusion column. The 90Y-DOTA-anti CD20 conjugate was characterized by radioactive thin layer chromatography. Numbers of chelators per antibody molecule were estimated by cobalt binding assay using spectrophotometer. In-vitro stability studies of the radiolabelled conjugate were checked in human serum,by periodic sampling and DTPA challenge. Radionuclide purity was assessed using TLC & HPLCResults: The radiochemical purity of the labeled antibody was > 95 %. TLC patterns showed that the radiolabelled antibody and non-chelate Yttrium stayed at the origin whereas free migrate to Rf 0.4-0.6. An average of 4.02 ± 1.04 p-SCN-Bz-DOTA molecules could be randomly conjugated to Rituximab molecule as estimated by cobalt binding assay. The radiolabelled antibody conjugate when monitored by TLC was stable up to ~170 h at 370C. Stability in serum indicated that 90Y was bound to the antibody upto 80 hrs and 96-98% labelling was found. No evidence of degradation in percentage of intact chelate was found in different concentrations of DTPA. Radionuclide purity was assessed using TLC & HPLC, sterility was acquired by passing through millipore filerConclusion: A favorable radiochemical purity and stability of the radiolabelled immunoconjugate indicates that 90Y-DOTA- anti CD20 antibody Rituximab could be a promising molecule in the treatment of relapsed and refractory Non Hodgkin's Lymphoma.Keywords: Radioimmunotherapy, MoAb, rituximab, Non Hodgkin's lymphoma
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Comparison of Sm-labeled Cetuximab-chelate conjugates using five different bifunctional chelating agents O. Awh1, D. Kim1, T. Lee2, K. Kim2, J. Kang2, W. Park3; 1Yonsei University, Wonju, KOREA, REPUBLIC OF, 2KIRAMS, Seoul, KOREA, REPUBLIC OF, 3 KAERI, Daejeon, KOREA, REPUBLIC OF. Aim: 153Sm (T1/2 = 46.3 hr) is a medium energy β- emitter (0.808 MeV, 17.5%; 0.705 MeV, 49.6%; 0.635 MeV, 32.2%) with 30% abundance of γ emission (103 KeV) that is suitable for the radioimmunoscintigraphy and radioimmunotherapy. In addition to the desirable emission properties of 153Sm, this lantanide also readily forms compexes with various bifunctional chelating agents that can be conjugated to antibodies. Cetuximab, a chimeric monoclonal antibody against epidermal growth factor receptor (EGFR), is currently used to treat several solid tumors. In this study, varied types of 153Sm-labelled Cetuximab were prepared with five different bifunctional chelates (DTPA anhydride, p-SCN-Bn-DOTA, p-SCN-Bn-NOTA, p-SCNBn-Oxo-DO3A, and p-SCN-Bn-PCTA) for radioimmunotherapy and their biodistributions were then examined.Methods: FIve different chelates (DTPA anhydride, p-SCN-Bn-DOTA, p-SCN-Bn-NOTA, p-SCN-Bn-Oxo-DO3A, and p-SCN-BnPCTA) were conjugated to Cetuximab at 100:1 molar ratio of chelate to Cetuximab. The Cetuximab-chelate conjugates were labeled with 153Sm at room temperature. Immunoreactivities of the 153Sm-labeled Cetuximab immunoconjugates were analyzed by in vitro cellular binding assay. The biodistribution of 153Sm-labelled Cetuximab conjugates was evaluated in nude mice bearing A431 tumor.Results: Numbers of bound DTPA anhydride, p-SCN-Bn-DOTA, p-SCN-Bn-NOTA, p-SCN-BnOxo-DO3A, and p-SCN-Bn-PCTA per Cetuximab was 39.2, 32.6, 28.3, 33.2, and 41.5, respectively. All of the Cetuximab-chelates were effectively labeled with 153Sm as above 98% labeling yield. Immunoreactivities of the radiolabeled Cetuximab were maintained by 65.5%. Intratumoral uptakes of 153Sm-DTPA-Cetuximab, 153Sm-DOTACetuximab, 153Sm-NOTA-Cetuximab, 153Sm-DO3A-Cetuximab, and 153Sm-PCTACetuximab were 5.10±0.21, 5.69±0.43, 1.10±0.37, 2.04±1.08, 11.89±3.77 %ID/g, respectively.Conclusion: These results suggest that the five different types of 153Smlabeled Cetuximab would be clinically useful as a radioimmunotherapeutic agent against EGFR-expressing tumors as further optimized.
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Preparation of [ Cu]-DOTA-trastuzumab radioimmunoscintigraphy
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B. Alirezapour1, A. R. Jalilian1, M. Rasaee2, S. Rajabifar1, K. Yavari1, M. Kamalidehghan1, F. Bolourinovin1, A. Majdabadi1; 1Radiopharmaceutical Research and Development Lab, Nuclear Science and Technology Research Institute, Tehran, IRAN, ISLAMIC REPUBLIC OF, 2Tarbiat Modares University (TMU), Tehran, IRAN, ISLAMIC REPUBLIC OF. Aims: In this study, trastuzumab was successively labeled with [64Cu]CuCl2 after conjugation with DOTA-NHS-ester. The conjugates were purified by molecular filtration, the average number of DOTA conjugated per mAb was calculated and total concentration was determined by spectrophotometrically.Materials and methods: DOTA-Trastuzumab was labeled with 64Cu produced by 68Zn(p,αn)64Cu nuclear reaction (30 MeV protons at 180 µA). Radiochemical purity, integrity of protein after radiolabeling and stability of 64Cu-DOTA-Trastuzumab were determined followed by biodistribution studies in wild-type mice (30 ± 5.5 µCi, 2h, 6h, 12h,18h p.i.).Results and Discussion: The radioimmunoconjugate was prepared with a radiochemical purity of higher than 95% (RTLC). The average chelate to antibody ratio (c/a) for the conjugate used in this study was 5.8:1. The final compound was stable in presence of PBS at 37ºC and room temperature. The
Poster Presentations
(methylene phosphonic acid) (EDTMP) was synthesized and radiolabeled with 170 Tm. Complexation parameters were optimized to achieve maximum yields (>99%). The Radiochemical purity of 170Tm-EDTMP was checked by RTLC and ITLC. It was found to retain its stability at room temperature even after 2 months of preparation (> 95%). Biodistribution studies of the complexes carried out in wildtype rats showed significant bone uptake with rapid clearance from blood.the produced 170Tm-EDTMP properties suggest applying a new efficient bone pain palliative therapeutic agent in the country instead of some other in use radiopharmaceuticals, such as 89SrCl2 and 32P, in order to overcome the metastatic bone pains.
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sample was showed to have similar patterns of migration in the gel electrophoresis. The accumulation of the radiolabeled antibody in lungs, liver, spleen and other tissues demonstrates a similar pattern to the other radiolabeled anti-HER2 immunoconjugates.Conclusion: 64Cu-DOTA-Trastuzumab is a potential compound for molecular imaging of PET for diagnosis and treatment studies and follow up of HER2 expression in oncology.
P176
cell surface membrane while using suitable ligand. This automatic method can be new useful tool, which can offer valuable data in shorter time and with less needed manual work then the established classical method. Unfortunately the experiments showed that nimotuzumab is not a proper ligand for determining the number of EGFR. We presume that it is due to high unspecific ligand binding to the wall of incubation vessels.The work was supported by grant No.124409/FaF/C-LEK of the Grant Agency of Charles University and SVV-2011-263-003.
Synthesis and biodistribution studies of Ga-DOTAtrastuzumab as a diagnostic radioimmunoconjugate for oncology imaging by SPECT
P178
B. Alirezapour1, A. R. Jalilian2, M. Rasaee1, S. Rajabifar2, K. Yavari2, M. Kamali-dehghan2, F. Bolourinovin2, S. Moradkhani2, H. Zolata2; 1Tarbiat Modares University (TMU),, Tehran, IRAN, ISLAMIC REPUBLIC OF, 2 Radiopharmaceutical Research and Development Lab, Nuclear Science and Technology Research Institute, Tehran, IRAN, ISLAMIC REPUBLIC OF.
S. Shirvani Arani, A. R. Jalilian, A. Bahrami Samani, M. Mazidi, M. Ghannadi-Maragheh; Radiopharmaceutical Research and Development Lab (RRDL), Nuclear Science and Technology Research Institute (NSTRI),, Tehran, IRAN, ISLAMIC REPUBLIC OF.
67
Introduction: Radiolabeled monoclonal antibodies have shown great promise for cancer diagnosis and therapy. Trastuzumab (trade name; Herceptin) is a humanized IgG1 monoclonal antibody directed against the extracellular domain of the Human Epidermal Growth Factor Receptor 2(HER2). HER 2 receptor is over expressed in 2030% of the early-stage breast cancers and these patients may be candidates for Herceptin treatment. we attempted to label trastuzumab with radioactive gallium(67Ga) 67Ga is cyclotron produced, decays by electron capture (EC) with t1/2 = 77.9h accompanied with γ-rays, mainly 93, 184 and 296 keV, and is suitable for SPECT imaging. In the present study, 67Ga labeled trastuzumab was prepared followed by the biodistribution studies in normal mice.Methods: Herceptin was conjugated with DOTA-NHS-ester (Macrocyclics), purified by molecular filtration, the average number of DOTA conjugated per mAb was calculated and total concentration was determined by spectrophotometrically. DOTA-Trastuzumab was labeled with 67Ga then Radiochemical purity, integrity of protein after radiolabeling and stability of 67Ga -DOTA-Trastuzumab were determined. The biodistribution studies was performed in normal rats (67Ga -DOTA-Trastuzumab i.v., 75 ± 5.5 µCi, 30min, 2h, 4h, 24h, 48h, 72h).Result: The radioimmunoconjugate was prepared with a radiochemical purity of 88% (RTLC). The average chelate to antibody ratio(c/a) for the conjugate used in this study was 5.8:1. The final compound was stable in presence of PBS at 37ºC and room temperature.The sample were showed to have similar patterns of migration in the gel electrophoresis.The accumulation of the radiolabeled antibody in lungs, liver, spleen and other tissues demonstrates a similar pattern to the other radiolabeled anti-HER2 immunoconjugates.Conclusion: 67 Ga-DOTA-Trastuzumab is potentially good probe for diagnosis and treatment studies of HER2 expression in oncology by SPECT.
P177 Determination of epidermal growth factor receptor (EFGR) number: comparison of two in vitro methods Z. Novy, P. Barta, J. Mandikova, F. Trejtnar, M. Laznicek; Faculty of Pharmacy, Charles University, HRADEC KRALOVE, CZECH REPUBLIC. Aim:The experiment compared two methods with use of two radiolabeled ligands in several cell lines expressing various number of EGFR(subtype1). The study was focused on a comparison of classical manual method and the automatic radioimmunoassay. The experiment is about to show whether the automatic method is comparable with the classical one.Materials and methods:Two monoclonal antibodies cetuximab and nimotuzumab labeled with iodine-131 were used as EGFR ligands.Cell lines: Three cell lines expressing EGFR, A431, HaCaT and HCT116 were employed. Hep-G2 cell line was used as a negative control. Presence of EGFR was confirmed by Western blot analysis.Classical manual method: The cells were seeded in triplicates in 24-well plates. 131I-cetuximab/nimotuzumab in complete medium was added to cells in six different concentrations. After four hours incubation (~4°C), cells were washed with serum free medium and trypsinated. Resuspended cells were then counted and radioactivity was measured 131 Ito evaluate EGFR levels.Automatic radioimmunoassay: The cetuximab/nimotuzumab binding was measured in real-time at laboratory temperature using special gamma counter (LigandTracer Yellow,Ridgeview Instruments AB,Uppsala,Sweden). Three-step addition of radiolabeled ligand in full culture medium was performed. The incubation times were chosen adequately to reach the equilibrium of the labeled ligand - receptor saturation. The bivalent kinetic model was used to evaluate measured data in TraceDrawer 1.2 (Ridgeview Instruments AB,Uppsala,Sweden).Results:Cetuximab: the highest number of EGFR was detected in A431 (about 2*106/cell), in case of HaCaT it was about 900*103/cell. The HCT116 showed the lowest number of EGFR (about 200*103/cell). Hep-G2 cells presented about 75*103 EFGR/cell. The results of the both methods were quite corresponing to each other.Nimotuzumab: the results in the both methods were highly incoherent for all cell models in comparison to each other and to cetuximab too.Conclusion:The study showed that the both methods are comparable. The results for cetuximab are nearly identical. We conclude that the automatic method is suitable for determining of the receptors number on the
Development applications
of
170
Tm-DOTA-cetuximab
for
therapeutic
Combining beta-particle emission of Tm-170 with therapeutic properties of C225 monoclonal antibody (cetuximab) was targeted in this study. 170Tm-Thulium chloride was obtained by a thermal neutron flux (3-4 × 1013 n·cm-2·s-1) of a natural thulium nitrate sample. Conjugated-cetuximab was obtained by the addition of 0.5 ml of a cetuximab pharmaceutical solution (1 mg, in phosphate buffer, pH = 7.8) to a glass tube precoated with in situ prepared, 1,4,7,10-tetraazacyclododecaneN,N,N,N-tetraacetic acid mono-(N-hydroxysuccinimidyl) ester (DOTA-NHS) (~5 mg) at 25°C. The C225 antibody was labeled with 170Tm-Thulium chloride (100 MBq) after conjugation with DOTA-NHS in 2-3 hours (Radiochemical purity> 9?%, ITLC, specific activity = 72 TBq/mmol). The final isotonic 170Tm-cetuximab complex was checked by gel electrophoresis for protein integrity retention. Biodistribution studies in wild-type rats for free Tm-170 and the radioimmunoconjugate were performed to determine the distribution up to ? h followed by SPECT imaging. A comparative time-frame study performed for critical organs for both radiochemical species. The major accumulated organs were shown to be liver, lung and spleen.
P179 Evaluation of the potential of 111In-Hexa lactoside for hepatic functional reserves P. Wang, C. Chien, H. Yu, M. Weng, W. Kuo, J. Kuo, J. Wang, Y. Chang, M. Wang, W. Lin; Institute of Nuclear Energy Research, Taoyuan County, TAIWAN. Evaluation of the potential of 111In-Hexa lactoside for hepatic functional reserves AbstractObjective: It is important to estimate accurately the remnant liver function for patient underwent hepatic surgery, such as liver resection and transplantation. In the previous study, it had been demonstrated that In-111 hexa-lactoside could target hepatocyte specifically through ASGP receptor mediated endocytosis and the expression of asialoglycoprotein receptors (ASGPR) was associated with hepatic function. The potential of In-111 hexa-lactoside as a tool for remnant liver function estimation was evaluated in this study.Method: By consecutive liver lobe dissection (left lateral lobe, median lobe, and lower right lobe)on male BALB/c mice, three groups of hepatic resection (n=4) with about 67.6%, 46.6%, and 33.5% remnant liver mass %(remnant liver weight/ total liver weight) respectively were performed iv injection of 5μCi In-111 hexa-lactoside and distributed for 15 minutes prior to sacrifice at the 0, 1st, 3rd, and 7th day after operation. The percentage (%ID/organ) of liver uptake of In-111 hexa-lactoside was evaluated by measuring hepatic radioactivity uptake divided by the iv injection dose.Result: At the 0 day after operation, the In-111 hexa-lactoside liver uptake (%ID/organ) of each group which underwent liver dissection with different percentage is related closely to its remnant liver mass% (R2=0.855). The In-111 hexa-lactoside liver uptake increases along with the time increases in all these three groups . For both 32.4% and 53.4% liver excision group, the In-111 hexa-lactoside liver uptake has recovered to the level of normal mice at the 7th day post liver resection.Conclusion: Our preliminary data indicate that it has very high correlation between the In-111 hexa-lactoside liver uptake and the remnant liver mass%. The results demonstrated that In-111 hexa-lactoside was a promising imaging agent to evaluate the remnant liver function of patient underwent liver resection and follow-up. Correlation studies for the remnant liver mass% and liver μSPECT imaging are in progress.Key words : ASGPR, remnant liver function, hepatectomy
P180 The development of VP1 radio-probes to pre-clinical research in human ovarian tumor bearing mice M. Weng1, M. Wang1, H. Yu1, J. Kuo1, W. Kuo1, C. Chien1, P. Wang1, J. Wang1, Y. Chang1, J. Peng2, C. Liang2, S. Liang3, W. Lin1; 1Institute of Nuclear Energy Research, Longtan Township,Taoyuan County, TAIWAN, 2 Institute of Biological Chemistry, Academia Sinica, Taipei, TAIWAN, 3 Institute of Bioagricultural Sciences, Academia Sinica, Taipei, TAIWAN. Background: As previous studies, the capsid protein VP1 of foot-and-mouth disease virus (FMDV) can bind to cellular integrins through an RGD motif and performed a
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P17 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Radiopharmaceuticals & Radiochemistry & Dosimetry: New Targets
P181 Preparation and Stability Evaluation of Small Interference RNA Radiolabeled with Technetium-99m R. Wang, L. Kang, P. Yan, M. Liu, C. Zhang, M. Yu, Y. Cui; Peking University First Hospital, beijing, CHINA. Objective:This study was to develop an available method of radiolabeling siRNA via conjugation with chelator of S-acetyl NHS-MAG3, and to evaluate its radiolabeled efficiency and stability in vitro. Methods: The 21 mer sense and antisense strands of siRNA were synthesized with 2`-OMethyl sugar modification. The bifunctional chelator S-Acetyl-NHS-MAG3 was conjugated via a six-carbon alkyl linker on the 5’terminal of antisense strand. The conjugated antisense strand was annealed with sense strand to form duplex. The MAG3-siRNA was radiolabeled with 99mTc with different reacting time and quantity of SnCl2·2H2O. The stability in vitro of 99mTcsiRNA probe was evaluated in saline and fresh human serum at room temperature and 37°C. The molecular mass of MAG3 was 245.7 based on the MALDITOF-MS analysis, as the same as the molecular mass of MAG3 group. Results: The labeling efficiency reached 73.4%±3 % (n=5) at room temperature, and the RNA recovery rate was always higher than 98%. The specific activities were up to 25.9 GBq/μmol. Longer reaction time than 1 h seemed not improving the efficiency significantly, and much dose of SnCl2·2H2O could produce too much technetium collide to lead to decrease of labeling efficiency. After Sephadex G25 purification, the radiochemical purity was no less than 92 % and kept high stability in saline and fresh human serum in room temperature and 37 °C. Conclusion: There was no significant difference of RNA stability between the two media of saline and serum. The methodology of radiolabeling RNA with 99mTc via chelator NHS-MAG3 provides the basis for construction of antisense imaging probe from siRNA probe in molecular imaging.Key words: Small interference RNA; Technetium-99m; Radiolabel; Stability
P182 Study on the biodistribution and imaging of model of AA-amyloidosis
value. Method Standard sample SAP was radiolabeled with 131I by Iodogen method. The labeling efficiency and radiochemical purity of 131I -SAP were calculated, and its stability were determined. Amyloidotic KM mice model was produced by daily subcutaneous injection of 0.5ml 10% casein for 21 days. The control group was injected with Normal Saline. Both groups were injected with 200µl 131ISAP(7.4MBq)via tail vein and subjected to radiographic imaging at 1h,3h,6h,24h,48h,72h respectively. 50 amyloidotic KM mice were divided into 5 groups and dissected at 1h,3h,6h,24h,48h respectively after intravenous injected with 131I-SAP. The tissues of interest(the heart, lung, liver, spleen, renal, stomach, intestine, bladder, bone, muscle, vascular, brain and blood) were weighed, and their radioactivity was measured using a γwell counter. Radioactivity results were recorded as percentage injected activity per gram(%ID/g). Results The labeling efficiencies of 131I-SAP reached 60% ~ 70%, and the radiochemical purity was above 90% even after 48 hours. There were marked radioactivity uptakes in the specific regions of liver, spleen and kidneys after 24h in the test group while there were mild uptakes in the control group. The results of biodistribution were consistent with the imagings. Conclusion 131I -SAP is easy to be radiolabeled and stable in vivo and in vitro. It may be a novel tracer in the diagnosis of amyloidosis.[Key words] Amyloidosis; Serum amyloidosis P-component(SAP); Biodistribution; SPECT scintigraphy
P183
131/125
Synthesis of I Labelled Diethylstilbestrol (DES) Glucuronide Conjugated Magnetic Nanoparticles and Investigation of Biological Affinities P. Unak, T. Yilmaz, F. Z. Biber Müftüler, E. &. Medine, Ç. Ichedef, A. Yurt Kilcar, T. Ünak; Ege University, Izmir, TURKEY. Introduction: Magnetic radioactive nanoparticles have the advantage of being able to deliver high concentrations of radioactivity to the target area, without damaging normal surrounding tissue. It’s thought that these new complexes will find a wide spread field in creation of materials besides medicine.Diethylstilbestrol (DES), a synthetic nonsteroidal estrogen, exhibits high estrogenic activity by binding to ERs; therefore, it is used to evaluate the potential toxicity of various chemicals that affect or mimic estrogen activity. Also diethylstilbestrol continues to be used in clinical trials for treatment of prostate and breast cancer. It is known that these types of cancer cells have high β-glucuronidase enzyme. This is why the synthesis compounds which undergo glucuronidation come into question in the imaging and therapy of these cancer cells.The aim of this study is to synthesize diethylstilbestrol glucuronide (DESG) conjugated magnetic nanoparticles radiolabeled with I-131/125 and to evaluate its biological behavior in vitro and in vivo. Experimental: DESG was synthesized enzymatically by the conjugation of the glucuronic acid. Magnetic nanoparticles, Fe3O4, were prepared by the co-precipitation method from ferrous and ferric ion solutions with a molecular ratio of 1:2 and they coated with TEOS. The obtained silica-coated magnetic particles coated with aminosilane. Finally DESG, was conjugated to the NPs by the cross-linker of glutaraldehyde. Magnetic nanoparticles were characterized with Zeta potential, AFM, SEM methods. Finally, DESG conjugated magnetic nanoparticles (NP-DESG) were radiolabeled with 131I by iodogen method. Results: Radiolabeling yield of 131I-NP-DESG were found to be 97.3 ± 0.07% respectively according to TLRC method (n=6). In vitro cell culture studies of 125I-NP-DESG were performed on MCF-7, A-549, Caco-2 cells. Cell uptake studies show that glucuronidation reaction was increased the uptake of radiolabeled compound by the cells for all three cell lines. While the conjugation of magnetic nanoparticles to the DESG increased the cell uptake on MCF-7 cells, it was decreased on A-549 and Caco-2 cell lines. Also applying external magnetic field increase the cell uptake of radiolabeled NP-DESG at all cell lines. Besides in vivo biological affinities of 131I-NP-DESG was examined on female Wistar Albino rats. The biodistribution results showed that NP-DESG have receptor affinity on uterus, ovarian and breast.Conclusion: In conclusion, 131I-NP-DESG shows a potential for imaging of estrogen positive tumor imaging. Also using this molecule under external magnetic field can increase its affinity for therapeutic purposes.Keywords: Diethylstilbestrol (DES); DES glucuronide; magnetic nanoparticles, 131/125I radiolabeling, cancer imaging and therapy.
P184 131
I-SAP in a mice
Development of Sm-153 Chitosan for Radiosynovectomy
R. Wang, H. Wei, C. Zhang, J. Zhang, P. Yan, L. Kang, M. Liu, F. Guo; Peking University First Hospital, beijing, CHINA.
A. Bahrami Samani, A. R. Jalilian, H. Yousefnia, M. Akhlaghi, M. Mazidi, M. Ghannadi-Maragheh; 1Radiopharmaceutical Research and Development Laboratory, Nuclear Science and Technology Research Institute, Tehran, IRAN, ISLAMIC REPUBLIC OF.
Objective Serum amyloid P component(SAP)is a normal plasma protein and a universal non-fibrillar constituent of amyloid deposits. Radiolabelled serum amyloid P component scintigraphy is a non-invasive and quantitative method for imaging amyloid deposits in vivo, which produces diagnostic images in most patients with systemic amyloidosis, and can be used repeatedly to monitor the course of the disease. The purpose of this paper was to validate 131I -SAP as a novel tracer in mice bearing amyloidosis and to evaluate its potential diagnostic
Introduction: Developing new radiosynovectomy agents is of great importance due to the aging of human populations around the world and increasing the incidence of inflammatory diseases. In this work, Sm-153 chitosan agent was developed for the first time in our country and preparation and quality control of the compound is described.Methods: Sm-153 chloride was obtained by thermal neutron flux (4-5 × 1013 n.cm-2.s-1) of natural Sm2O3 sample, dissolved in acidic media. 153Smsamarium chloride (370 MBq) was used in preparation of 153Sm-chitosan complex
Poster Presentations
potent apoptotic agent for human cancer cells such as human breast carcinoma and prostate cancer cell lines. However, the in vivo kinetics and primary collection of VP1 proteins was not well defined in animal models. In our research we have developed a radio-labeling system combining the VP1 proteins with iodine-123 that can easily assess pharmaco*kinetics, biodistribution and metabolic performance in human ovarian tumor bearing mice.Methods: The radiochemical purities of 123IVP1 was found >95% after purification. Tracers were evaluated the in vitro stability by putting them in PBS and serum for 48 h at 37°C and also i.v. injected to normal mice to define the in vivo radiochemical stability and pharmaco*kinetics. The biodistribution was evaluated at 4 and 24 h and SPECT/CT imaging was examined at 1 and 4 h after i.v. injection of 123I-VP1 to human ovarian tumor-bearing mice assessing the collection of probes in tumors.Results: The stability results showed that the radiochemical purity of 123I-VP1 was found >90% at 6 h on ITLC. The pharmaco*kinetics performed quick clearance within 48 h (T1/2α=0.05 h, T1/2β=9.18 h) and was in common with the in vivo stability data (T1/2α=0.10 h, T1/2β=10.04 h); we also found free iodine (>95%) but few 123I-VP1 in urine. In biodistribution the accumulation in small intestine, spleen, pancreas, lung, kidney, stomach and urine at 4 and 24 h; however, low collection in tumors and other organs was shown (tumor to muscle ratio was 2.47 ± 0.05 at 24 h), which is similar to the results on micro SPECT/CT at 1 and 4 h.Conclusion: A novel probe 123I-VP1 has been well established for molecular imaging studies. The i.v. pharmaco*kinetics of VP1 proteins was revealed and furthermore the intramuscular injected one is also in progress. Although papers indicated it could be used as an apoptotic agent for breast and prostate cancer, our data showed no significant increase uptake in ovarian tumors. More specificity study between ovarian and breast tumors for this image marker is under investigation.Key words: VP1, foot-and-mouse disease, pharmaco*kinetics
S303
S304 followed by quality control using MeOH: H2O: acetic acid (4: 4: 2) as mobile phase. The complex stability and viscosity were checked in the final solution up to 2 days. The complex solution and 153Sm3+ (80 µCi/100 µl) were injected intra-articularly into male rat knee joint followed by scarification studies 6 d post injection.Results: Sm153 chitosan was prepared successfully with high radiochemical purity (>99%, ITLC) at room temperature after 10-30 min followed by autoclave sterilization. The complex was stable at room temperature and 37ºC up to 2 days. No significant leakage of dose from injection site and its distribution in organs were observed up to 6 days for 153Sm-chitosan.Conclusion: Approximately, more than 90% of injected dose remained in injection site after 6d. The complex is a dedicated agent for radiosynovectomy. The experience from this study would lead to the development of more sophisticated radiosynovectomy radiopharmaceutcals for human use in the country.
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441
P185
1015/2009 and RD 223/2004, the Spanish Society of Nuclear Medicine and Molecular Imaging’s proposal for approval of PET radiopharmaceutical indications by way of compassionate use and the guide for the off-label drug use of the SEFH (Spanish Society of Hospital Pharmacy). We compared the differences between the current Spanish legislation and previous legislation.RESULTS: The compassionate use of drugs outside a clinical trial in patients without adequate treatment are regulated by RD 223/2004 and RD 1015/2009. Both provide for individual access to this application. The RD 1015/2009 includes also access to compassionate use of drugs to a group of patients in the same clinical situation, with the figure of the temporary authorization of use by the AEMPS (Spanish Medicines Agency) approved under a protocol. This figure allows the creation of protocoled uses of drugs in clinical trials or unresolved approval applications without requiring an application for compassionate individualized use to each patient. Thus, the temporary authorization of use includes requirements and conditions under which the drug is used outside a clinical trial, where the hospital is responsible for the inclusion or exclusion of patients for the purposes authorized.CONCLUSION: RD 1015/2009 allows a more agile and transparent proceedings for the authorization process for off-label use of drugs for compassionate use, giving more participation to health centers where these drugs are used. RD 1015/2009 solve more effectively the use of radiopharmaceuticals in unapproved indications in the data sheet, but it gives no answer to the problem of the use of PET radiopharmaceuticals lack of prior authorization.
Media Fill Test for Validation of Autologous Leukocyctes 99m Tc-HmPAO. Separation and Labelling by
P187
N. Urbano, S. Modoni; Nuclear Medicine, University Hospital "Ospedali Riuniti", Foggia, ITALY.
99mTc-HMDP to assess the effect of zoledronate therapy on bone loss in experimental periapical lesions in rats
Aim. Manufacturing of sterile products must be carried out in order to minimize risks of microbiological contamination. White blood cells (WBC) labelled with 99mTcesametazime (99mTc-hesamethylpropyleneamineoxime, 99mTc-HmPAO) have been successfully applied in the field of infection/inflammation scintigraphy since many years. In our radiopharmacy lab, separation and labelling of autologous leukocyctes with 99mTc-HmPAO were performed, according to Peters’ protocol, in a laminar flow class A cabinet, placed in a non-controlled area. 99mTc-HmPAO radiolabelling procedure, according to the manufacturer’s instructions, was performed in a leadshielded hot manipulation cell. Current study was undertaken to assay the overall sterility of the aseptic labelled leukocyte production line in order to satisfy one critical requirement for sterility assurance.For this purpose we used, according to Italian Pharmacopoeia, a process simulation test (media fill test) reproducing as closely as possible the routine aseptic production process with all the critical steps (including worst-case situations), which are described in internal Standard Operative Procedure.Methods. Simulation test was carried out using, in place of actual product, the Tryptic Soy Broth (TSB), a sterile microbiological growth media for wide variety of aerobic, facultative and anaerobic bacteria and fungi. The medium was exactly subjected to the same conditions as the product and with the same personnel. As positive control, an aliquot of TSB medium was added with a sample of 105 CFU Geobacillus stearothermophilus spores.All manipulations were conducted inside the laminar air flow (WBC separation and radiolabelling) and the hot cell (99mTc-HMPAO radiolabelling) carefully cleaned using strict aseptic technique adhering to our sanitizing procedures.The sterility of production line was checked (negative control) at every step in the process and for three times.The final vials containing the media of each processed step were incubated for 14 days at different temperature (7 days at 32.5°C and 7 days at 22.5°C) and examined for the evidence of microbial growth.Results. No evidence of turbidity was observed in all the steps assayed with the media fill, ensuring that the process used together with the ability of operators, were able to obtain a final product without microbiological contamination.Conclusions. In the separation and labelling of autologous leukocyctes with 99mTc-HmPAO, media-fill test represents a reliable tool to validate the asepsis of the whole production line (processes and compounding personnel) satisfying the critical requirement for sterility assurance of this radiopharmaceutical product.
M. M. Ferreira1, A. M. Abrantes2, S. Paulo1, E. V. Carrilho1, M. F. Botelho3; 1 Department of Dentistry, Faculty of Medicine, University of Coimbra, Coimbra, PORTUGAL, 2Biophysics, IBILI, CIMAGO, Faculty of Medicine, University of Coimbra, Coimbra, PORTUGAL, 3Biophysics, IBILI, CIMAGO, Faculty of Medicine, ICNAS, University of Coimbra, Coimbra, PORTUGAL.
P18 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Radiopharmaceuticals & Radiochemistry & Dosimetry: Miscellaneous
P186 Use of Radiopharmaceuticals on the Compassionate Use Situations in Spain J. M. Calero, L. Sanz-Ceballos, E. Teijeiro, A. Ramirez, J. M. Llamas-Elvira; Hospital Universitario Virgen de las Nieves, Granada, SPAIN. INTRODUCTION: Compassionate use in Spain is called to the use of a drug in other conditions than those approved by the Health Administration (indications, doses or routes of administration) or it is a drug that is still under clinical investigation and it is used in a particular patient outside a clinical trial. This use of medicines in general and radiopharmaceuticals in particular was regulated by the Royal Decree (RD) 223/2004 and now by the RD 1015/2009.A particular case is constituted by PET radiopharmaceuticals. Only the 18F-FDG is registered in Spain from all those with clinical utility.AIM: To analyze the application procedure of radiopharmaceuticals on the compassionate use basis to Spanish RD 1015/2009 and to compare it with the previous legislation.MATERIAL AND METHODS: We analyzed the Spanish RD
Aim - The aim of the research was to evaluate the impact of zoledronate (ZOL) therapy on bone loss resulting from experimental periapical lesions in rats, using Tc-HMDP to quantify bone remodelation.Methodology - After 3 weekly subcutaneous administrations of 0.06 mg/kg of ZOL in Wistar rats, periapical lesions were induced in first lower left molar. The animals were divided in two groups. The animals of the Group I were euthanized 2 weeks after the last injection and the animals of the Group II 4 weeks after the last injection. Before euthanized the animals were injected with 555-740 MBq of 99mTc-hydroxylmethylene diphosphonate (99mTc-HMDP) and performed a scintigraphic acquisition 3 hours later. After euthanized, the mandibles were removed and radiopharmaceutical uptake was calculated using a gamma camera. The uptake of the radiopharmaceutical in the two groups was evaluated and analyzed using the Mann-Whitney test (p=0.05).Results: This study documented a favorable outcome of analyzing of apical periodontitis, using the 99mTc-HMDP. The results showed no statistically significant difference found in the absorption of the 99mTc-HMDP, between the groups. Conclusions: This study demonstrated that there was no difference between the two groups in terms of the bone periapical destruction in rats taking ZOL. Besides that it is possible to conclude that 99mTc-HMDP is a reliable method to assess the apical periodontitis. 99m
P188 Biological studies of samarium-153 bleomycin complex in human breast cancer murine xenografts for therapeutic applications A. Bahrami Samani, A. R. Jalilian, M. Mazidi, M. Ghannadi-Maragheh; Radiopharmaceutical Research & Development Laboratory (RRDL), Nuclear Science and Technology Research Institute (NSTRI),, Tehran, IRAN, ISLAMIC REPUBLIC OF. In this work, a potential therapeutic DNA targeting agent, 153Sm-bleomycin complex (153Sm-BLM), was developed and the tumor accumulation studies were performed using single photon emission computed tomography (SPECT) and scarification studies. 153Sm-BLM was prepared at optimized conditions (room temperature, 4-8 h, 0.1 mg bleomycin for 740-3700 MBq 153SmCl3, radiochemical purity over 98%, HPLC, specific activity = 55 TBq/mmol). 153Sm-BLM was administered into human breast cancer murine xenografts and the biodistribution and imaging studies were performed up to 48h. 153Sm-BLM demonstrated superior tumor accumulation properties in contrast with the other radiolabeled bleomycins with tumor:blood ratios of 41, 72 and 182 at 4, 24 and 48 h respectively and tumor:muscle ratios of 23, 33 and >1490 at 4, 24 and 48 h respectively while administered intravenously. The SPECT images also demonstrated the obvious tumor uptake at the chest region of the breast-tumor bearing mice. These initial experiments demonstrate significant accumulation of 153Sm-BLM in tumor tissues.
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
Isolation of Autologue Granulocytes for 99mTc-Exametazime Labelling: Initial Results B. Lopez Lorenzo, M. Quera Turu, G. Plà González, C. Palacio Garcia, M. Martínez Gallo, J. Castell Conesa; Vall d´Hebron Hospital, Barcelona, SPAIN. AIM:Labelling mixed leukocytes with 99mTc-Exametazime leads to innecessary irradiation of lymphocytes increasing the possibility of causing chromosome abnormalities. Our aim was to establish a method for the separation of autologue granulocytes from peripherical blood using gradient density media with no affected viability.MATERIALS & METHODSTwelve pacients (average age 58.6±20, three women) that came to our hospital service to undergo a 99mTc-Exametazime (Ceretec®) leukocyte scintigraphy were studied, after informed consent given. They all needed septic or inflammatory process assessment.Approval from the hospital's Research Ethics Committee was achieved.Peripherical blood (10ml) was collected from each patient. In order to provide reference values, 5ml were used for hemogram determination. The other 5ml were added hidroxietilstarch 6% (HES) and sedimented for 30minutes in order to obtain leukocyte rich plasma. Then platelets were eliminated by centrifugation. Finally, a density gradient media (Ficoll-Paque 1.077g/ml) allowed isolating the polymorphonuclear cells population.Samples were analysed by Multiparametric Flow Cytometry (MFC) and measurements of the blood count report (leukocytes, erythrocytes and platelets) and leukocyte subpopulations (lymphocytes, monocytes and neutrophils) were obtained.Viability of the neutrophils was assessed by the same procedure with 7Amino-Actinomicin-D (7-AAD).Same parameters were analysed for samples of mixed leukocytes isolated following the method described in Spanish Pharmacopoeia guides to obtain reference data.RESULTS:Samples obtained after granulocyte isolation contained 93.52±2.39% of granulocytes (versus 70.7±6.3 in the control) and 4.16±1.77% of lymphocytes (versus 18.4±7.1% in the control).Neutrophil viability was higher than 95% in all cases (96.75%±1.63).Erythrocyte percentage (31±17.8%) or platelet percentage (56.6±21.1%) were not reduced in comparison with the habitual method (24±7.4% and 56.3±12.6, respectively).CONCLUSION:The percentage of granulocytes isolated by this method is a 23% higher than with the habitual method and the presence of lymphocytes is lower, although “contaminant” cells such as platelets or erythrocyte are not totally removed.
P19 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
SPECT. This low figure may be a result of the improved resolution and sensitivity of the solid state detectors or the camera design as scans are performed with breast tissue touching the camera face and should increase both specificity and confidence in reporting of female patients using the Discovery 530C.
P192 One-year prognosis of patients with normal myocardial perfusion imaging using technetium-99m sestamibi in suspected coronary artery disease: A single- center experience of 1,047 patients G. Raziei1, A. Tavakoli1, S. Seifollahi asl1, M. Amoiei2, H. Javadi3, M. Assadi4; 1Departemet of Nuclear Medicine, Milad Hospital, Tehran, IRAN, ISLAMIC REPUBLIC OF, 2Departemet of Nuclear Medicine, Shohada-e Tajrish Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, IRAN, ISLAMIC REPUBLIC OF, 3Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, IRAN, ISLAMIC REPUBLIC OF, 4The Persian Gulf Nuclear Medicine Research Center , Bushehr University of Medical Sciences, Bushehr, IRAN, ISLAMIC REPUBLIC OF. Aim: The aim of the present study was to evaluate the clinical outcome of a normal stress technetium-99m (99mTc)-sestamibi single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) with different probabilities of coronary artery disease (CAD).Material and methods: A total of 1,047 subjects with a normal 99mTc-MIBI SPECT were followed up for one year and hard and soft cardiac events were assessed. Hard cardiac events were defined as cardiac death or nonfatal myocardial infarction (MI). Soft cardiac events included patients’ development of recurrent chest pain requiring coronary revascularization or significant stenosis in coronary arteries on angiography.Results: Overall, 1,047 patients (248 men and 799 women; mean age: 60.07 ± 12.31, range 29-92) were enrolled. Three hard cardiac events occurred in the groups; two had cardiac arrest and one nonfatal MI. As a result, the annualized hard cardiac event rate was 0.28%, the annualized cardiac mortality rate was 0.19%, and the rate of overall annualized cardiac events was 1.25%. Furthermore, there was a significant difference in cardiac events among patients with various pretest likelihoods of CAD (p value=0.04).Conclusion: Our data confirmed that patients with a normal 99mTcsestamibi myocardial SPECT are associated with a very low incidence of cardiovascular events.
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Assessment of left ventricular dissynchrony change in patients with coronary artery disease during adenosine stress 201 and rest using Tl GMPS : a comparison with using RT3DE during adenosine stress and rest
Low incidence of attenuation artefacts in women on myocardial perfusion imaging using a Discovery 530C solid state cardiac gamma camera
M. Ota1, M. Nagaya1, T. Kato1, R. Tanaka1, T. Noda1, S. Watanabe1, M. Tsuzaka2; 1Gifu Prefectural General Medical Center, GIFU, JAPAN, 2Nagoya University school of Health Sciences, Nagoya, JAPAN.
P. J. Thorley, F. U. Chowdhury; Leeds General Infirmary, LEEDS, UNITED KINGDOM.
Purpose; Different imaging modalities have been explored for assessment of LV dyssynchrony. 201Tl gated myocardial perfusion single photon emission computed tomography (GMPS) with phase analysis is a reliable technique to quantify. Real time three-dimensional echocardiography (RT3DE) with contraction front mapping (CFM) analysis is a novel imaging technique.The purpose of this study was to compare LV dyssynchrony between rest and adenosine stress in CAD patients using201Tl GMPS and RT3DE.Methods; Eighteen patients undertaken cardiac angiography were studied at rest and during stress with adenosine (120mcg/kg/min. IV) with 201Tl GMPS and RT3DE. Stress images using RT3DE were acquired during adenosine, and stress images using 201Tl GMPS were soon acquired to finished adenosine stress. Rest images using RT3DE were acquired before stress, and rest images using 201Tl GMPS were acquired at three hours later stress. Result of 201Tl GMPS was analyzed that fourier analysis converts regional myocardial counts into a continuous thickening function, allowing resolution of phase of onset of myocardial thickening, the SD of LV phase distribution (phase SD) and histogram bandwidth describe LV phase dispersion as a measure of dyssynchrony. And result of RT3DE with CFM that provides a LV systolic dyssynchrony index, based on regional volumetric changes as a function of time and calculated as the SD of time to minimum systolic volume of 16 standard myocardial segments expressed in percentage of cardiac cycle and Dispersion End-Systole, Latest-Earliest, 16Segment Model (DISPES16).Changes from stress to rest was compared with phase SD, bandwidth and DISPES16.Results; We compared 201Tl GMPS with RT3DE, a significant same change (increase or decrease from stress to rest) in six patients was observed in phase SD, bandwidth and DISPES16 in seven nonischemic patients (SDS=0).But different changes in three patients were shown in four ischemic patients (SDS>3).Conclusion; The variable change LV dyssynchrony between rest with adenosine stress with201Tl GMPS and RT3DE was shown in ischemic patients. Because of different acquired timing at rest imaging 201Tl GMPS from RT3DE, these findings suggest that post-stress regional LV stunning may cause LV systolic and
Cardiovascular: Perfusion
Attenuation artefacts in SPECT myocardial perfusion imaging (MPI) are a major cause of reduced specificity. In women breast tissue causes anterior/lateral defects which are usually fixed but can be reversible if breast position varies between stress and rest. Attenuation correction or assuming that fixed defects are due to attenuation artefacts if wall motion is normal can increase specificity but attenuation remains a major problem with conventional SPECT. Initial experience with a Discovery 530C solid state cardiac gamma camera indicated much reduced levels of anterior/lateral attenuation artefacts in women, prompting this study to investigate the incidence of attenuation artefacts in women using a new solid state cardiac camera.Method227 consecutive female patients from our routine referrals who underwent stress/rest MPI using the Discovery 503C were included in this study. Patients were scanned with either 99mTc MIBI or tetrofosmin using a 2 day protocol, standard dose of 450MBq for a patient of less than 80Kg up to 600MBq for patients over 100Kg and scan time of 300sec. Scans were reported by a consensus of both authors who are experienced in reporting conventional SPECT and data from the solid state camera. Scans which were reported as ‘no prognostically significant disease’ and with normal gated data were then divided into two categories: either definitely normal perfusion or having a small, mild fixed or reversible anterior or lateral defect which could be attributed to attenuation artefact,.Results110 patients (48.5%) had definitely normal scans and only 4 patients (1.8%) were classed as having possible attenuation artefacts. These patients had BMI of 27.7, 34.2, 41.3 and 43.8 Kg/m2. The number of patients with possible attenuation artefacts is very low for BMI<40 at 1%, but increases to 12% in the very obese group. Analysing data from our institution in the same way for 200 female patients with perfusion imaging on a conventional SPECT gamma camera gives much higher values for possible attenuation artefacts (20%).Conclusion Possible attenuation artefacts in women were seen on only 2% of scans on the Discovery 530C, (1% in patients with BMI < 40 ) compared to 20% on conventional
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S306 diastolic dyssynchrony after adenosine stress.(SDS: the sum of the difference between each of the 17 segments from stress to rest images with 201Tl GMPS)
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P196 Does the receiver of a myocardial perfusion report precisely understand the message? A pilot study
The extent of infarct size and proportion of hypoperfused viable tissue assessed by rest sestamibi SPECT determines left ventricular reverse remodeling after surgical revascularization
E. Trägårdh-Johansson1, M. Wieloch2, D. Nilsson1, L. Edenbrandt1; 1 Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Malmö, SWEDEN, 2Department of Cardiology, Skåne University Hospital, Lund University, Malmö, SWEDEN.
M. Kaminek1, M. Hutyra2, T. Skala2, I. Metelkova1, M. Budikova1, P. Koranda1, M. Myslivecek1; 1Department of Nuclear Medicine, University Hospital, Olomouc, CZECH REPUBLIC, 2Department of Internal Medicine I, University Hospital, Olomouc, CZECH REPUBLIC.
Aim: It is of great importance that the treating clinician understands the report written by the physician at the department of nuclear medicine (NM). The aim of the study was to investigate whether a referring physician interprets the final report of a myocardial perfusion scintigram (MPS) the same way as the physician responsible for the interpretation of the examination does.Methods: Twenty-five MPS were selected of which only five were completely normal examinations. The physician at the department of NM who interpreted the examinations and wrote the reports participated in the study, as well as a cardiologist. The two physicians independently classified the examinations on the presence/absence of ischemia/infarction, based on the final report, in grades of 1-5 (1 = No ischemia/infarction, 2 = Probably no ischemia/infarction 3 = Equivocal, 4 = Probable ischemia/infarction, and 5 = Certain ischemia/infarction). When ischemia and/or infarction were thought to be present in the left ventricle, the physicians were asked to mark the involved segments. Kappa statistics were used to measure agreement between the physicians.Results: The agreement of classifications between the two physicians was better for ischemia (kappa statistics 0.69) than for infarction (kappa statistics 0.35). For ischemia, the physicians agreed on the classification in 20 patients. In the remaining five, the classifications differed from 1 to 2 or from 4 to 5. In all patients, the suggested area of ischemia was very similar, except in one case. As for infarction the results were more disparate. In 16 of the cases the two physicians agreed completely or from 1 to 2 or from 4 to 5. In one patient the cardiologist classified a 4 and the physician in NM a 2. In three patients, the cardiologist classified a 4 and the physician in NM a 3. In all these cases, the final report did not state infarction/no infarction in the “conclusion section”. In the “finding section” words such as “mild reduction in myocardial perfusion” or “uneven distribution” were used.Conclusion: For ischemia, the two physicians agreed well on the interpretation. For infarction, the cardiologist often interpreted the report in favour of infarction where the physician in NM was less certain. The disparate classifications were most obvious when the “conclusion section” of the report did not state either “infarction” or “no infarction” due to equivocal examinations. These results demonstrate the need for structured reporting in order to avoid misunderstandings in interpretations of MPS.
Aim: Currently, there are available a number of radionuclide methods with different diagnostic accuracy for revealing the presence of viable or nonviable myocardium. However, the amount of viable myocardium needed for left ventricle (LV) function improvement is not definitely known. To find preoperative predictors of revascularization effect in patients indicated for coronary artery bypass grafting (CABG), we analyzed rest perfusion SPECT imaging (as the most simple viability method).Methods: 37 patients (66±11 years) underwent rest sestamibi gated SPECT imaging at baseline and 10.7±1.2 months after CABG. The size of perfusion defect (PD = deterioration > 2.5 SD compared to normal database, expressed as % ot total LV), nonviable myocardium (PD with sestamibi uptake <50 % of maximum), left-ventricular ejection fraction (LVEF), and end-diastolic/end-systolic volumes (EDV/ESV) were automatically calculated using 4D-MSPECT. Patients were divided according to revascularization effect (improvement of the LVEF by > 5 % with no enlargement of the EDV) into responders (R, n = 20) and nonresponders (NR, n = 17).Results: At baseline, there were not significant differences between R and NR subgroups in the LVEF (34±10 % vs. 33±8 %), EDV (212±87 vs. 222±65 ml), ESV (147±81 vs. 151±55 ml), and PD size (35±15 vs. 42±16 % of total LV, P = NS). The only preoperative parameters predicting LV reverse remodeling were the size of nonviable myocardium (R = 11±13.5 vs. NR = 22±15 % of total LV, p <0.05), and lower ratio between nonviable myocardium and PD size (R = 0,31 vs. NR = 0,52, p <0.05).Conclusions: The extent of rest perfusion abnormality and nonviable myocardium assessed by rest sestamibi SPECT determines left ventricular reverse remodeling after CABG. In patients with substantial LV function improvement, we observed significantly smaller extent of nonviable myocardium and larger proportion of hypoperfused, but still viable tissue.
P195 Prone Versus Supine Myocardial Gated Spect (GSPECT) In The Evaluation of Ventricular Volumes, Ejection Fraction And Myocardial Perfusion H. A. A. Amer; King Abdulaziz Hospital for National Guards, KINGDOM OF SAUDI ARABIA, AL-AHSA, SAUDI ARABIA. Attenuation of cardiac activity by soft tissue during acquisition by the gamma camera is one source of difficulty with interpretation of Myocardial Perfusion Imaging (MPI). Many centers have used prone imaging for several years as a method to eliminate attenuation artifacts and consequently improving the diagnostic accuracy.The aim of this study is to observe the effects of prone position during Gated SPECT cardiac acquisition in improving the accuracy of the diagnosis through elimination of inferior wall attenuation artifacts and the impact on various cardiac parameters particularly ventricular volumes and ejection fraction. Methods: 32 patients selected randomly underwent two-day protocol for stress and rest MPI in supine and prone positions after administration of 650±100 MBq 99m Tc-Sestamibi. Acquisition was done in a 180° elliptical orbit, starting at 45° (RAO) for supine and prone positions, in 64 steps, 15 sec each, and 8 frame gating per step. Percentage uptake of the tracer was calculated using 17-segment model and level of agreement were calculated to assess MPI. Other parameters for both acquisitions were calculated using QGS. Results: Higher inferior wall activity was observed in prone position compared to supine position in stress and rest MPI (63%±15.13% vs. 55.6%±12.7%) and (62%±11.7% vs. 56.6±10.71), respectively. Level of agreement between both positions in stress and rest MPI was moderate ([[Unsupported Character - К]]=0.56 and [[Unsupported Character К]]=0.60, respectively). EDV, ESV, SV and HR for prone acquisitions were significantly lower than supine acquisitions in the stress and rest MPI (P < 0.024 and P < 0.002 respectively). The LVEF did not differ significantly in stress and rest studies (p=0.06 and p = 0.32 respectively). Level of agreement for myocardial wall motion was [[Unsupported Character - К]]=0.92 and [[Unsupported Character - К]]= 0.93 in stress and rest MPI respectively. A very good level of agreement for myocardial wall thickening was observed ([[Unsupported Character К]]= 0.90) during both studies. Conclusion: Prone Gated SPECT MPI can be utilized as an effective way for attenuation correction along with supine MPI if required. The differences in quantitative cardiac parameters in both positions were attributable to physiological alterations.
P197 Evaluation of the time-course of changes in the myocardial perfusion images in patients with acute myocardial infarction R. Tanaka1, Y. Okada1, T. Kasai2, T. Nakamura1; 1Kushiro Sanjikai Hospital, Kushiro, JAPAN, 2Jikei University School of Hospital, Tokyo, JAPAN. Objective : MIBI SPECT study was performed over time after revascularization therapy in acute myocardial infarction (AMI) patients, and the relationship between the time-course of changes in the myocardial washout and cardiac function was evaluated based on the myocardial perfusion images.Method : The study subjects were 65 patients who underwent emergency hospitalization within 24 hours after the onset of AMI. After the infarct-related artery was identified by CAG, direct PTCA was performed and a stent was deployed. After the PTCA, MIBI SPECT study was performed. SPECT images were obtained 5 minutes (0h), 1 hour (1h), and 6 hours (6h) after tracer infusion. In addition, ECG-gated SPECT images were obtained at 0h and at 1h. Each of the SPECT images was divided into 17 segments, and the percent uptake was calculated for each segment. Myocardial washout index (WO INDx) was evaluated based on the percent uptake, with WO INDx values of 10 or more being considered as abnormal. Also, assuming that less than 60% uptake was abnormal, the number of abnormal areas (NAA) was calculated.Results : The WO INDx of 0h to 1h did not show abnormal values in 33 patients (group A), whereas abnormal values were observed in 32 patients (group B). The mean NAA was 1.90 at 0h, 2.6 at 1h, and 4.53 at 6h, showing significant differences among the different time-points (p<0.001). WO INDx value of 1h to 6h between the group A and group B was 13.38 and 18.33, respectively, showing a significant difference (p<0.001). In addition, the EF was 58.6% and 48% in the two groups, respectively, being higher in the group A (p<0.001). Furthermore, CPK values were 1382 IU/l and 3610 IU/l, respectively, being higher in the group B (p<0.001).The NAA in the group A was 0.39 at 0h, 0.54 at 1hr, and 2.64 at 6h, with no significant difference between 0h and 1h. In contrast, the NAA in the group B was 3.44 at 0h, 4.71 at 1h, and 6.54 at 6h, showing significant differences among the time-points of 0h, 1h and 6h (p<0.001).Conclusion : SPECT images obtained immediately after tracer infusion allow accurate evaluation of the myocardial perfusion following reperfusion in patients with AMI. Our results suggest that myocardial perfusion and cardiac function are severely impaired in patients with myocardial washout observed in the early-phase images.
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ECG-gated SPECT in the selection transmyocardial laser revascularization
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M. Vakhromeeva, A. Vakhrameeva; Pirogov National Medical Surgical Center, Moscow, RUSSIAN FEDERATION. OBJECTIVE: ECG-gated myocardial perfusion single photon emission computed tomography (GSPECT) gives simultaneous information on both myocardial perfusion and global/regional left ventricular (LV) function in ischemic heart disease (IHD). We studied diagnostic usefulness of the GSPECT in the selection of patients with end stage of coronary arteries lesion for isolated transmyocardial laser revascularization (TMR).METHODS: 82 patients with end stage of coronary artery disease refractory to conventional modes of therapy were performed stress/rest GSPECT with 99mTc-Technetrill using two-detector rotating gammacamera (“Forte”, Philips) before and in different periods (3, 6 and 12 months) after TMR.RESULTS: Of the 82 patients, 24 (29% - group 1) had reversible perfusion defects (PD), 41 (50%) - party reversible PD (group 2) and 17 (21%) were interpreted as irreversible PD (group 3). 12 months after operation myocardial perfusion improved in 54 (66%) patients: 19 (79%) in group 1, 31 (76%) in group 2 and only 4 (23%) in group 3. There were no significant differences between preoperative (56% ± 8,6) and post-operative (58% ± 8,1) global left ventricular function. But the systolic wall-thickening improved in the regions of laser treatment, and the number of normokinetic segments had significantly increased (more than 20%) in these regions. In all patients myocardial perfusion and contractility improved in the regions of laser treatment with viable/hibernating myocardium.CONCLUSIONS: Identification of viable myocardium plays a key role in the selection of patients for transmyocardial laser revascularization. TMR is safe and effective procedure. Post-operative improvement in myocardial perfusion and contractility in the regions of laser treatment is related to the preoperative identification of viable myocardium.
P199 Computer Aided Diagnosis systems for the Interpretation of Myocardial Perfusion Scintigrams L. Johansson1, M. Lomsky1, J. Marving2, S. Svensson2, L. Edenbrandt1; 1 Department of Molecular and Clinical Medicine, Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, SWEDEN, 2Department of Clinical Sciences, Lund University, Malmö, SWEDEN. Purpose: To compare the diagnostic performance in the detection of ischemia of the two computer aided diagnosis software packages EXINI heart (EXI) and PERFEXtm (PER) for interpretation of myocardial perfusion scintigram (MPS).Methods: We studied 470 consecutive patients, 225 men and 245 women, who underwent 2-day stress/rest 99mTc-sestamibi MPS studies. Patients were stressed using either maximal exercise or pharmacological test with adenosine. The reference/gold standard classifications for the MPS studies regarding presence or absence of ischemia were obtained from three physicians, with more than 25 years each of experience in nuclear cardiology, who re-evaluated all MPS images. The majority rule was applied in cases of disagreement. No quantitative results from software packages were available during the re-evaluation. Automatic processing was done using EXI (artificial neural networks based) and PER (rule based expert system) software packages.Results: Ischemia was found in 127 patients by the three experts and the sensitivity for ischemia was 66.9% for EXI and 65.4% for PER. This difference was not statistically significant. In the remaining 343 patients without ischemia the specificity was found to be significantly higher for EXI compared to PER (89.2% vs. 81.6%; p=0.0028).Conclusion: EXI shows a significantly higher specificity for ischemia than PER. This difference in performance should be taken in consideration when software packages are used in the clinical routine. These results show the high potential for neural networks as computer aided diagnosis system.
P200 Correlation of nuclear cardiac function and perfusion imaging in patients with chronic kidney disease A. O. Al-Mardoof1, I. Loutfi2; 1Department of Nuclear Medicine, Mubarak Hospital, Kuwait, KUWAIT, 2Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait, KUWAIT. Gated SPECT myocardial perfusion imaging (G-MPI) is a non-invasive tool for evaluation of cardiac function and perfusion in patients with chronic kidney disease (CKD), in whom cardiac abnormalities are major causes of morbidity and mortality.The objective of this study is to correlate impaired cardiac function (abnormalities of wall motion, ejection fraction and left ventricular volumes), to perfusion findings in CKD patients, to identify whether the observed dysfunction is related to coronary artery disease (CAD). Also, quantitation by G-MPI software (QGS), was evaluated.Fifty G-MPI studies with reported cardiac dysfunction were selected. Visual assessment as well as quantitative polar-plot analysis were applied to define and correlate abnormalities of function and perfusion.Forty-five patients
(90%) showed marked myocardial perfusion defects denoting underlying CAD. In only 5 patients (10%), abnormal function could be assumed to be related to uremic cardiomyopathy. Quantitative QGS data showed correlation between certain aspects of the functional and perfusion findings e.g. severity of abnormalities.In conclusion, using G-MPI, the majority of CKD patients with cardiac pump dysfunction have underlying CAD. The supplementation of visual interpretation, by quantitative polar plot analysis, can help in confirmation of the abnormalities present.
P201 Geted-SPECT for Assessment of Perfusion and Functional Abnormalities in Hypertensive LBBB Patients with LV Hypertrophy K. Nikoletic1, S. Lucic1, A. Peter1, S. Stojsic2, M. Stefanovic2, S. Tadic2; 1 Institute of Oncology of Vojvodina, Sremska Kamenica, SERBIA, 2Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, SERBIA. Aim of the study: In patients with left bundle branch block (LBBB) often occur certain functional and perfusion abnormalities on myocardial perfusion scintigraphy (MPS). Aim of this study was to assess and compare functional and perfusion abnormalities in hypertensive LBBB patients with left ventricular hypertrophy (LVH) and hypertensive patients with normal ECG and LVH.Materials and methods: Since August 2007 until January 2011 eighty hypertensive patients with LVH on echocardiography and no previously reported coronary artery disease (CAD) were divided in two groups: group 1) 62 patients with electrocardiographic LBBB (26 man, 36 women; aged 49-71; mean 59,2 ± 4); and group 2) 18 patients with normal ECG (10 man, 18 women aged 38-69; mean 51 ± 6). Two-day stress/rest protocol ECG-gated MPS with 99mTc-MIBI was performed starting with stress dipyridamole study followed by rest study the next day. ECG-gated MPS images were evaluated for perfusion, ejection fraction (EF), left ventricular (LV) volume on end-diastolic and end-systolic images, LV mass, wall motion and wall thickening. The LV was divided into 19 segments, which were scored for perfusion and function (wall motion and wall thickening) on a 4-point scale.Results: Global parameters that differed between group 1 versus group 2 included EF, LV enddiastolic volume, LV end-systolic volume and LV mass. The average EF was lower and average LV end-diastolic and end-systolic volume were higher in group 1 compared to patients in group 2 (34,3±11 vs. 54,5±8ml; 224,2±63 vs. 81,5±22ml and 140±35 vs. 50±12ml respectively). Mean LV mass was elevated in both groups but markedly higher in LBBB group 1 compared to group 2 (207,1±23 vs. 126±9g respectively). Myocardial perfusion, wall thickening and wall motion abnormalities were seriously more reduced not only in the septal area but in other segments as well(predominantly apex and inferior wall) in group 1 compared to group 2 (p less than 0,0001 vs. group 2).Conclusion: This study shows that the presence of hypertension and LVH among LBBB patients identifies patients at risk of having worse global and regional LV perfusion and functional abnormalities not only in septal but also in remote segments which are not due to coronary stenosis but induced by LBBB.
P202 Relationship Between Myocardial Perfusion and Oxidative Stress in Asymptomatic Patient with Psoriasis E. Kaya1, H. Saglam2, S. Karaca3, M. Cemek4, M. Kulaç5; 1Department of Nuclear Medicine, Acıbadem Hospital, Kayseri, TURKEY, 2Department of Cardiology, Erciyes Hospital, Kayseri, TURKEY, 3Department of Dermatology, Faculty of Medicine, Kocatepe University, Afyonkarahisar, TURKEY, 4Department of Bioengineering, Faculty of Chemical-Metallurgical Engineering, Yıldız Tecnical University, Istanbul, TURKEY, 5Department of Dermatology, Training and Research Hospital, Namık Kemal University, Tekirdag, TURKEY. Psoriasis is a chronic and recurrent inflammatory skin disease characterized by an aberration of lipid metabolism, and has been associated with an increased risk for atherosclerosis and occlusive vascular disease (thrombophlebitis, myocardial infarction, pulmonary embolization, and stroke). Oxidative Stress (OS) is a disturbance in oxidant/antioxidant balance in favour of oxidants. Oxidative modification of lipoproteins may play a crucial role in the pathogenesis of atherosclerosis. The OS which increases acutely and chronicaly due to the inflammatory process plays an important role in the pathogenesis of the cardiovascular system of the disease by causing endothelial dysfunction in vascular structures. The aim of our study was to evaluate the relationship between myocardial perfusion and oxidant/antioxidant status in asymptomatic patients with psoriasis.Material and method:Twenty-nine patients with psoriasis (16 M, 13 F, mean age: 40.2 ± 7.3 years) and 23 healthy volunteers (13 M, 10 F, mean age: 38.8 ± 7.1 years) participated in our study. Technetium-99m methoxyisobutylisonitrile single photon emission computed tomography (Tc-99m MIBI SPECT) stress-rest test was performed with two-day protocol. Myocardial perfusion scores (summed stress score, summed rest score, summed difference score, fix defect score) and perfusion defect prevalence (stress, rest, ischemic and fixed) were determined as
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the percentage of left ventricle. Coronary angiography was performed in patients with abnormal myocardial perfusion scintigraphy. For oxidant-antioxidant status, the blood samples were taken immediately before the first imaging procedure and were studied for very low density lipoproteins (VLDL), low density lipoproteins (LDL), malondialdehyde, glutathione, nitrite, nitrate, vitamin C, retinol, and carotene.Results: In the psoriasis group, a total of 12 patients had abnormal findings in their stress electrocardiography. Perfusion defect in myocardial perfusion scintigraphy was observed in 11 patients (37.9%). Nine patients accepted coronary angiography, and eihgt patients results were normal. In the comparison of myocardial perfusion scores and OS parameters, there was a significant difference between the psoriasis and control groups. In the psoriais group, there was a correlation between myocardial perfusion scores, perfusion defect prevalence and OS parameters.Conclusion: Defects in myocardial perfusion and increase in OS were observed, and there was also a correlation between oxidant/antioxidant status and myocardial perfusion scores in asymptomatic patients with psoriasis.
stunned group showed a significant higher SDS (9.5±4.7) than the non-stunned group (5.2 ± 3.5) (p<0.001). Stunning was significantly more frequent in patients who underwent physical stress 17/31(55%) than in the pharmacological stress group 7/31 (23%) (p=0.009). SDS was significantly higher in multivessel disease at CAG (6.5±3.6) compared to one vessel disease (4±5.7) p < 0.05.Conclusions: Poststress stunned coronary artery disease patients were found to have a significant higher SDS than the non-stunned group. These findings were found to be more frequent after physical stress than pharmacological stress.
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Target Coronary angiography is considered as the gold standard method for detection of coronary artery disease. On the other hand, the pathophysiologic impact of coronary microangiopathy, frequent in diabetics, is best detected by myocardial perfusion scintigraphic study which estimates the effect of coronary flow at stress.Materials - Methods We retrospectively examined the stress-rest Myocardial Perfusion SPECT studies of 117 diabetics (men:92, women:25), mean age 62 years, 1-35years duration of DM, following the appropriate therapy, from whom 78 (66,6%) had no previous history of CAD and were referred to us for scintigraphic imaging either for claiming typical or atypical angina symptoms, either for screening for possible target-organ damage.Results SPECT scans revealed 77% (n:90) coronary disease of diverse degree (45% reversible ischemia, 15%scar, 17% mixed filling defect). All patients with positive SPECT studies underwent coronary angiography and subsequent stenting. Statistical analysis of angiographic and scintigraphic lessions, showed matched findings of coronary artery disease between the 2 methods in 68% of the cases, and mismatching in 32% (+ Spect vs cor. angiog.). This discordance was attributed to coronary microangiopathy, misdiagnosed by angiography.Conclusions Myocardial perfusion scintigram is a reliable, sensitive, non invasive method of screening silent coronary artery disease in diabetics, as it also diagnoses early the diabetic microangiopathy in adverse to the coronary angiography. Careful scintigraphic screening of asymptomatic diabetics might prevent few acute fatal events in this specific population.
Comparison of Tc99m-Sestamibi SPECT/F-18 FDG PET and N13 NH3 PET/F-18 FDG PET in assessment of myocardial viability. A. Nazar, S. Singla, P. Kundu, S. Jeph, M. Patnecha, A. Malhotra, C. Patel; All India Institute of Medical Sciences, New Delhi, INDIA. Aim: The use of N-13 NH3 as PET perfusion agent requires dedicated on-site cyclotron facility which may not be available in every medical center. This study was aimed to evaluate the role of Tc99m-Sestamibi in comparison to N-13 NH3 PET perfusion agent in assessment of myocardial viability.Materials and methods- we retrospectively analyzed sixty nine patients with angiographically proven multivessel coronary artery disease. All the patients were referred for assessment of myocardial viability. Thirty five patients (age 40-67yrs; mean 53.4±8.4) had undergone resting Nitrogen-13 Ammonia (N-13 NH3) perfusion & F-18 FDG glucose metabolic study (Group-1) and 34 patients(age 40-74; mean 54.6±8.6) had undergone resting Tc99m-sestamibi & F-18 FDG study (Group- 2) . The subjects in both the groups were matched for confounding variables-age, sex, smoking, diabetes, and angiographic findings. All the studies were processed on dedicated cardiac quantitative software using 20 segments model. The results of the perfusion & metabolic studies were categorized as hibernating, scarred, and mixed in each patient. The findings were further assigned to the coronary territory in correlation with angiography.Results- In Group-1, 90 segments showed hibernating myocardium compared to 64 segments in Group-2, which was statistically insignificant (P=0.286). The hibernating segments for left anterior descending artery (LAD), right coronary artery (RCA) and left circumference artery (LCx) territory were 60, 12, 18 in group-1 and 32, 14, 18 in group 2 (p=0.161; p=0.906; p=0.638 respectively). There were 16 and 26 segments with mixed lesion in Group1 and Group-2 respectively (p=0.456). Mixed lesion were noted in 13, 3, 0 segments in Group-1 and 19, 4, 3 segments in Group-2 for LAD, RCA, LCx vascular territories respectively (p=0.667; p=0.552; p=0.310). There was no statistically significant difference in Group-1 and Group-2 for scarred myocardium having 89 and 118 segments respectively (p=0.144). For LAD, RCA and LCx the number of scarred myocardial segments were 54, 17, 18 in Group-1 and 81, 31, 6 in Group-2 which was not significant (p=0.099; p=0.073; p=0.157).Conclusion- Assessment of myocardial viability using Tc99m sestamibi SPECT perfusion agent gives comparable results with N-13 Ammonia PET tracer. The results are comparable for the detection of hibernating, mixed and scarred myocardium for multi-vessel and individual coronary vascular territory.
P204 Gated SPECT Evaluation of Post-Ischemic Stunning in Patients who underwent Coronary Angiography. M. Gorenberg1, L. Radan2, N. Mahul1, U. Rosenschein1; 1Bnai Zion Medical Center, Haifa, ISRAEL, 2Department of Nuclear Medicine, Haifa, ISRAEL. Background:Postischemic left ventricular (LV) dysfunction on stress-gated Tc99m Sestamibi single photon emission computed tomography (GSPECT) imaging is attributed widely to myocardial stunning (MS).Methods:We studied 62 consecutive patients (36 were men, mean age 58.6±11.4 (31-78 years) who underwent same day stress/rest GSPECT and CAG performed within 6 month(2.1 ± 1 months) with no intervening coronary event or revascularization procedure.Perfusion was analyzed using 20 segments scored on a 5-point scale (0 = normal, 4 = no uptake. Summed difference scores (SDS), ejection fraction (EF) were determined by Cedars Sinai Quantitative Gated SPECT (QGS) software.Results:GSPECT studies showed that myocardial perfusion was normal in 4 patients (6%) and abnormal in 58 (94%). Mild induced ischemia (SDS >3) was present in 10 patients (16%). Twenty-Four (39%) had moderate stress induced ischemia and 24 patients (39%) had severe stress induced ischemia. The mean SDS was 6.9 ± 4, (range 0-19).In 24/58(41%) patients with reversible perfusion defects, post-stress LVEF was > 5% lower than that rest (Group A: stunned), whereas in the remaining 34 (59%) patients, poststress LVEF was either< 5% or greater than that at rest (Group B: non-stunned). The
P205 Comparison of Scintigraphic and Angiographic findings in Diabetes type 2 I. Kotsalou1, A. Kotsalos1, C. Kotsalos1, N. Zakopoulos2; 1NIMTS Hospital, Cardiothoracic Surgery Dept., Athens, GREECE, 2University of Athens, Internal Therapy Dept., Alexandra Hospital, Athens, GREECE.
P206 Influence of Sex on the Outcome of Myocardial Perfusion SPECT with Diagnosis Purposes in Diabetic Patients A. M. Alvarez1, V. Pubul2, M. Garrido2, C. Pena1, M. Pombo2, S. Argibay2, S. Raposeiras2, J. Cortes2, L. Campos1, A. Ruibal2; 1Vigo University Hospital Complex, Vigo, SPAIN, 2Santiago de Compostela University Hospital Complex, Santiago de Compostela, SPAIN. AIM:To assess the impact of sex on the outcome of myocardial perfusion SPECT in diabetic patients and to analyze if gender could be a determinant prognostic factor for future major adverse cardiac events at the follow-up on this cases.MATERIALS & METHODS:Retrospective observational study. A consecutive series of 1126 diabetic patients without known coronary artery disease underwent dual-isotope myocardial perfusion SPECT (MPS). A total of 373 cases were followed- up for a median of 2.05±1.8 (range 1-7) years. We divided this population in two groups: Group A (total population) and Group B (only with the cases over 65-year.old). Age, type of DM, smoking, hypertension, dyslipidemia, body mass index, renal insufficiency, menopausal status, myocardiopathy and peripheral arterial disease were variables to study. The symptoms and clinical reason for requesting the test were also included. The major adverse cardiac events (MACE) were Coronary Revascularization, Acute Myocardial Infarction, Hospitalization for Cardiac Causes and Heart-Related Deaths. Two days dual-isotope SPECT protocol, with either exercise or pharmacological stress and Gated rest acquisition was performed. The statistical analysis was performed using SPSS v.17.RESULTS:GROUP A: Total of 373 patients (100%), 176 women vs. 197 men (Mean age: 66,7± 9 vs. 63,9±11,4). The MPS was positive in 32 women and 93 men (p0.05).GROUP B: Total of 211 patients (57%), 108 women vs. 103 men (Mean age: 72,5 ± 4,4 vs. 72,8 ± 4,5). The MPS was positive in 19 women and 55 men (p0.05).No significance difference between Group A and B was found. Smoking and peripheral arterial disease were cardiovascular risk factors affecting for MPS results. During follow-up, a total of 59 (15.8%) patients presented MACE (half of cases within 12 month period after SPECT). A common variable predictor of MACE was MPS findings. Multivariate Cox analysis showed that Gated Rest results (X2 7.4; P<0.006) and reversible defects (X2 10.7; P<0.001) were independent predictors of total cardiac events.CONCLUSION:Gender influence on the outcome of Gated SPECTmyocardial perfusion in diabetic patients. The SPECT results, and special the Gated rest acquisition, had an important prognostic value on the presence of major cardiac events on the follow up. Sex on diabetic patients is not a determinant prognostic factor for future major cardiac events on the follow up.
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Evaluation of Left Ventricular Injection Fraction (LVEF) values immediately after and six months post primary Percutaneous Transluminal Coronary Angioplasty (PTCA), using a Gated SPECT method. A. Doumas, T. Christoforidis, I. I. Iakovou, D. Boundas, D. Lo Presti, S. Georga, V. Nikos, G. Arsos, N. Karatzas; 3d Nuclear Medicine Dept. of the Aristotle University, General Hospital “ Papageorgiou”, thessaloniki, GREECE. AIM : To assess any change in LVEF values, in patients who undergo primary PTCA, immediately after and six months post intervention.METHODS: Twenty two male patients mean age 64 (43-74 years), who admitted the coronary unit due to acute myocardial infraction and underwent successful PTCA were investigated. The day before their discharge, dipyridamol Sestamibi myocardial imaging was performed, using Gated SPECT technique, evaluating both the area of infarction, the existence of ischemia and the global LVEF. Scintigraphy, using the same parameters, was repeated six months later.RESULTS: The mean LVEF immediately post primary PTCA was estimated 46+/-12 percent and increased up to 54+/-8 percent at the follow up study six months later. The difference was statistically significant and was not associated to the existence of ischemia. The infracted area was also smaller at the six month images (from 34+/-9 to 26+/-8 percent of the total left ventricular myocardial mass).CONCLUSION: Statistically significant increase in LVEF was recorded six months after successful primary PTCA, compared to the immediate post the intervention values. This was not associated to the existence of ischemia at both the exams (immediate post and six months later). This is attributed most probably to the recovery of the stunned myocardium, the improvement of left ventricular performance and the shrinkage of the infracted area, due to the revascularization procedure.
P208 Aerobic exercise training reduces the perfusion defects and angina in patients with coronary microvascular ischemia. E. E. V. Carvalho, L. F. L. Oliveira, L. Wichert-Ana, D. C. Costa, P. V. Schwartzmann, G. L. De Santi, J. C. Crescêncio, J. A. Marin-Neto, L. GalloJunior, M. V. Simões; Ribeirão Preto School of Medicine, Ribeirão Preto SP, BRAZIL. Aerobic exercise training reduces the perfusion defects and angina in patients with coronary microvascular ischemia.Eduardo Elias Vieira de Carvalho, Luciano Fonseca Lemos de Oliveira, Lauro Wichert-Ana, Daniela Caetano Costa, Pedro Vellosa Schwartzmann, Giovani Luiz De Santi, Júlio César Crescêncio, José Antonio MarinNeto, Lourenço Gallo-Junior, Marcus Vinícius Simões.Coronary microvascular ischemia (CMI) can be characterized by the association of angina pectoris with reversible defects in myocardial perfusion scintigraphy (MPS) and normal coronary angiography. Even though this frequent condition is associated to relevant morbidity and quality of life reduction, effective therapeutic is still missing. We aimed at testing the therapeutic effect of aerobic exercise training (AET) in patients with CMI. Methods: We prospectively investigated 10 patients with CMI (5 men, age = 55 10 years) who underwent at baseline and after 4 months of the AET: stress-rest MPS with 99mTc-Sestamibi, cardiopulmonary exercise testing to evaluate the functional capacity (peak ) and a quality of life questionnaire (QoL). The perfusion defects on rest and stress images were semi-quantified by 2 experimented observers by attributing visual scores (0 = normal, 4 = absent) using a 17-segment model of left ventricular walls. Summed stress and rest scores were calculated for each patient. The summed stress-rest difference score (SRD) was used to evaluate the global extent of defects reversibility. The AET was carried out on a treadmill, three times per week, one hour per day. Results: At baseline all patients had at least 2 segments with reversible perfusion defects (ranging from 2 to 16 segments). We observed an increase in the peak VO2 after AET (22.6±6.6ml/Kg/min) when compared to the baseline (20.3±4.9 ml/Kg/min), p=0,03. Global extent of reversibility (SRS) at MPS has significantly decreased after AET (3.4 ± 5.2) as compared to the baseline (9.4 ± 7.9), p = 0.01. After AET, 8 patients (80%) showed any degree of SRS reduction, and 6 patients (60%) presented complete reversion of reversible defects (SRD = 0). Moreover, there was a significant improvement in the QoL, including functional capacity and angina domains, p<0,05. Conclusion: The AET produced significant improvement in myocardial perfusion and significant control of angina symptoms in patients with coronary microvascular ischemia. These results suggest that the AET may be a valid therapeutic option to treat patients with this common clinical condition.
P209 Effects of Enhanced External Counterpulsation on Myocardial Perfusion in Patients, Unsuitable for Invasive Interventions B. Mahmoudian1, F. Eslamian2; 1Tabriz Gamma Scan Nuclear Medicine Center, Tabriz, IRAN, ISLAMIC REPUBLIC OF, 2Tabriz University of Medical
Sciences, Department of Physical Medicine and Rehabilitation, Tabriz, IRAN, ISLAMIC REPUBLIC OF. Background: Enhanced external counter-pulsation (EECP) is a non-invasive outpatient treatment used for angina pectoris. In patients with intractable angina who were symptomatic after medical and invasive strategies, several novel techniques are considered including EECP. EECP produces an acute hemodynamic effect that is presumed to be similar to that produced by the invasive intra-aortic balloon pump. By applying a series of compressive cuffs sequentially from the calves to the thigh muscles upon diastole and rapidly deflating the cuffs in early systole, an increase in diastolic and decrease in systolic pressure is created.Objectives: The purpose of this study was finding effects of EECP on status of myocardial perfusion in patients, unsuitable for invasive interventions.Method and materials: In an intermediary study, 50 consecutive patients (34 male, 16 female) with known coronary artery disease, which was found on coronary angiography, were treated with EECP and followed for one month post treatment. For all patients ECG Gated Myocardial Perfusion Single Photon Emission Computerized Tomography (SPECT) with 99mTc - MIBI in rest and stress was carried out before and one month after completion of treatment with 30 session EECP. Any differences in myocardial perfusion before and after EECP were compared qualitatively and semi-quantitatively and analyzed statistically.Results: The mean age was 62.18±8.67 years. A significant difference was found in Summed Rest Score (SRS) before and after EECP treatment (p=0.010). Differences between pre and post treatment Summed Stress Score were not significant (p=0.058). Before and after EECP treatment Summed Difference Score (SDS) were significant (p<0.001). End Diastolic Volume Index (EDVI), End Systolic Volume Index (ESVI) and Left Ventricle Ejection Fraction (LVEF) were not changed after treatment (p=0.67). Severity of ischemia is diminished significantly after EECP compared to before that (p=0.044), however, extent of ischemia showed no significant changes (p=0.105). Difference of fixed defects extension was also not significant before and after treatment (p=0.051).Conclusion: This study demonstrated that EECP is a useful method in improvement of myocardial perfusion in patients who are not suitable for intervention such as PCI and CABG, which is more prominent at rest status. So could be assumed that EECP augments angiogenesis in diseased myocardium after cardiovascular accident.Key words: Enhanced external counter-pulsation, Gated SPECT, Coronary artery disease, Myocardial perfusion
P210 The washout rate of adenosine triphosphate stress 201 Thallium scintigraphy in patients with myocardial vasospastic angina reflect the activity of vasospasm. H. Kohno, S. Sueda, T. Sakaue, H. Habara; Ehime Prefectural Niihama Hospital, NIihama, JAPAN. [Purpose] To verify the effectiveness of adenosine triphosphate stress myocardial 201 Thallium washout rate in patients with vasospastic angina(VSA).[Methods] From May 2008 to Jan 2011, we have diagnosed 79 VSA patients by spasm provocation tests: intracoronary injection of acetylcholine or ergonovine. The adenosine triphosphate stress myocardial 201Thallium scintigraphy was performed with 66 out of 79 patients. Non-VSA group was 11 patients with negative spasm provocation test.[Results]The washout rate of 201Thallium was significantly decreased in patients with VSA compared to non-VSA groups (34.8% vs. 45.1%, p<0.05). The 10 VSA patients was performed second 201Thallium scintigraphy and seven patients washout rate were significantly improved after medication (24.5% vs. 38.5%, p<0.01).[Conclusions]In VSA patients, the washout rate of adenosine triphosphate stress myocardial 201Thallium scintigraphy reflect activity of vasospasm and is useful to assess the effectiveness of treatment.
P211 Coronary microvascular ischemia is associated to stressinduced left ventricular systolic dysfunction. E. E. V. Carvalho, C. Crescêncio, L. Wichert-Ana, P. V. Schwartzmann, A. B. Figueiredo, G. L. De Santi, J. A. Marin-Neto, L. Gallo-Junior, M. V. Simões; Ribeirão Preto School of Medicine - University of São Paulo, Ribeirão Preto - SP, BRAZIL. Coronary microvascular ischemia (CMI) is a very common clinical condition whose clinical relevance and pathophysiological significance is controversial. We aimed at investigating the functional repercussion of CMI on left ventricular systolic function during stress. Methods: We prospectively investigated 10 patients (54±9 years, 5 male) exhibiting anginal chest pain with reversible perfusion defects in the myocardial perfusion scintigraphy (MPS) and normal coronary arteries, constituting the CMI group; and a control (CO) group (n=15, 51±9 years, 9 male) of healthy subjects without risk factors for coronary artery disease. All patients underwent assessment of left ventricular ejection fraction (LVEF) with radionuclide ventriculography at rest and during exercise. A normal response of the LVEF during exercise was considered a progressive increase of [[Unsupported Character ]]5 ejection units. Results: LVEF at rest was comparable in CO (66.4 ± 5.4%) and CMI (68.8 ± 10.1%) groups, p = 0.74. The exercise peak workload was
Poster Presentations
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S310 significantly lower in the CMI group (77.5 ± 34.3 W) when compared to the CO (133.3 ± 52.3 W), p = 0.01. In controls only 2 subjects (13%) had abnormal LVEF during exercise, with biphasic behavior (initial increase followed by a significant drop at peak exercise). In the MI group all patients (100%) had abnormal LVEF during stress: 5 patients (50%) with plateau behavior (no increase in LVEF during exercise), 3 patients (30%) with biphasic behavior and two patients (20%) exhibited a progressive decrease in LVEF during exercise). The increase in LVEF during exercise was higher in the CO group (8.8 ± 5.1%) than in the MI group (2.9 ± 10.1%), p = 0.02. Conclusions: The presence of coronary microvascular ischemia is associated with reduced inotropic reserve or latent systolic dysfunction unmasked during exertion in most of these patients. These results suggest that CMI may contribute to the development of left ventricular dysfunction and reduced functional capacity in these patients.
P212 Computed Tomograpy Based Attenuation Corrction in Myocardial Perfusion SPECT Using a Hybrit SPECT/CT System; Preliminary Results Compared with Coronary Angiography F. Canbaz1, S. Akpinar1, D. Ersoy1, M. Meric2; 1Ondokuz Mayis University Nuclea Medicina Dept., SAMSUN, TURKEY, 2Ondokuz Mayis University Cardiology Dept., SAMSUN, TURKEY. Aim:Attenuation artefacts resulted from heterogenity of thoracal structures diminish the specificity of myocardial perfusion SPECT(MPS). The aim of the study was to investigate the diagnostic yield of computed tomography(CT) based attenuated corrected(AC)MPS findings by comparing the results of coronary angiography(CAG)Method:We retrospectively reviewed MPS images of 22 patients referred for diagnosis of coronary artery disease (12 men,10 women;mean age:61± 11years) who underwent CAG within one month.Thallium -201 stressreinjection(n: 14) or one day rest -stress Tc-99m sestamibi scans were performed.NAC and AC perfusion images were semiquantitatively interpreted using the 5 scoring system in 17 segment model.Summed difference score(SDS) was calculated for both of AC and NAC images in each patient. In CAG,> 70% stenosis was considered as significant.The sensitivity, specificity and accuracy of the NAC, AC and combined interpretation of NAC/AC perfusion images based upon the standard coronary artery territories(LAD,RCA and CX;3 districts) were obtained regarding CAG as gold standart.The mean SDS values obtained from NAC and AC perfusion images were compared with Wilcoxon test.Results:After AC, apical thinning was present in 11(50%) and decreased anterior wall activity due to subdiafragmatic activity exacerbation was detected in 4(18%) patients.SDS scores were calculated higher for five patients in NAC and for 10 patients in AC perfusion images, respectively.Identic SDS scores were obtained for 7 patients both in NAC and AC images.Mean± SD of SDS values of NAC and AC perfusion were calculated as 8.90 ± 6.5 ve 8.86 ± 5. 8, respectively(p >0.05).In CAG, in a total of 22 patients , 6 patients had 3 , 7 patients had 2 and 3 patients had single-vessel disease.CAG findings were normal in 6 patients.Based upon the coronary artery territories,the sensitivity, specificity and accuracy of NAC, AC and combined interpretation of NAC/AC perfusion images were: for LAD, NAC: 79%, 38%, 78% ; AC: 86%, 60%, 68% ; NAC/AC: 86%, 67%, 80 ; % for RCA, NAC: 90%, 75%, 82% ; AC: 90%, 75%, 82% ; NAC/AC: 90%, 91%, 86% ; for CX : NAC: 55%, 55%, 55% ; AC: 82%, 82%, 82%; NAC/AC: 88%, 88%, respectively.Conclusion: Perfusion images obtained after CT attenuation correction provides overall increased sensitivity, specificity, and accuracy in the diagnosis of coronary artery stenosis.The most reliable and accurate results in CTAC studies can be reached by being aware of the artefactual perfusion defects that may occur after CTAC and interpretating of both NAC and AC images together.
P213 Evaluation of the relation between transient ischeamic dilatation, lung/heart ratio and stress induced left ventricular dysfunction in gated perfusion SPECT D. Ersoy1, F. Canbaz1, M. Meric2, D. Cocabicak1, T. Basoglu1; 1Ondokuz Mayis University Nuclear Medicine Dept., SAMSUN, TURKEY, 2Ondokuz Mayis University Cardiology Dept., SAMSUN, TURKEY. Aim:Our aim was to investigate the relationship between elevated lung/heart ratio(LHR),transient ischemic dilatation(TID) and stress induced left ventricular dysfunction (SLVD) in gated myocardial perfusion SPECT(g-MPS) by comparing the results with coronary angiography(CAG) Methods:Forty-four patients(30 M and 14 FM;59±11.6) with clinical suspicion of coronary artery disease(CAD) who underwent treadmill exercise g-MPS(23Tl-201;21 Tc-99m sestamibi protocols) and CAG within 3 months were included.LHR was visually scored referring to heart(0:normal to 2:severe increased) in post stress raw data.TID scores were visually(v) and quantitatively(q) obtained.Using 17-segment model, perfusion was semi-quantitatively assessed in 5 scoring system(0:normal to 4:defect).Summed difference scores(SDS) were calculated for each patient.≥5% decrease in ejection fraction(EF) after stress(ΔEF%=Rest EF-Stress EF) was considered as significant for
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 SLVD.The patients were classified into 4 groups:G1:normal,mild ischemia;SDS%≤5%;G2:moderate-severe ischemia, SDS>5%; G3:≥ patients with 70% artery stenosis and G4:<70% artery stenosis in CAG.Results:Positive qTID and vTID rates were found in 20% and 43% of patients, respectively. Elevated LHR was detected in 27%,while SLVD was determined in 25% of patients.Only ΔEF values were significantly different between G1 and G2(P<0,05).In G1,only TID and ΔEF was significantly correlated. In G2, all perfusion and non-perfusion parameters other than SSS-LHR and TID-LHR were demonstrated significant correlation(p<0.05).In G3-G4 comparison, only mean SSS and SDS values showed significant difference(p<0,05).Except TID-LHR and LHR-ΔEF,all parameters in G3 showed significant correlation (p< 0,05).The highest correlation value was determined between SDS and ΔEF (R=0,81, p<0,05) in patients with 3 vessel disease belonging G3. A significant agreement was determined in G2 between TID and ΔEF(kappa= 0,41,p <0,05).However, regarding CAG findings, the highest agreement was found in G3 between TID and ΔEF(kappa=0,47;p<0,05).No significant cut-off levels could be determined for TID and SDS(p> 0,05) both in differentiation between G3-G4 and between single vessel and multivessel disease in ROC analysis. In the differentiation of G3 and G4,the SDS cut-off values were significant(SDS1=3,5;Sensitivity=77%; Specificity=61%; SDS=4,5; Sensitivity=73%; Specificity= 72%; p=<0,005)Conclusion:Increased correlation and agreement values between TID and ΔEF seen in moderately-severe(G2) and significantly stenotic groups(G3) supports them be severe ischemia markers. Significant correlation between SLVD and LHR in G2 refer their co-existence in moderetely-severe ischemia. No significant correlation found between TID and elevated LHR in all of the patient groups, supports their different physiopathological basis. Non-perfusion parameters in gMPS such as LHR, TID and SLVD may appear individually or in various combinations in severe CAD and their assessment in addition to standard perfusion interpretation may provide additional diagnostic and prognostic values.
P214 Reduced Heart Rate Response to Dipyridamole in Patients Undergoing Myocardial Perfusion SPECT G. Daglioz Gorur, E. Alkan Ciftci, S. Isgoren, M. A. Oc, C. Haksal, M. Gur, H. Demir; Kocaeli University, Kocaeli, TURKEY. Aim: A mild decrease in blood pressure and increase in heart rate is considered normal hemodynamic response to Dipyridamole (DIP). Reduced heart rate (HR) response to DIP is an important prognostic marker for cardiac death but, the mechanism of this phenomenon is not fully understood. In this study, we tried to investigate HR response to DIP and its predictors in patients undergoing gated myocardial perfusion SPECT (MPS).Materials and Methods: 201 consecutive patients undergoing DIP stress Tc99m-MIBI two day protocol or Tl-201 MPS were prospectively enrolled. DIP (0.56 mg/kg) was in infused over 4 minutes and radiopharmaceutical was injected 3 minutes after the end of infusion. A reduced heart rate response to DIP considered if the HR ratio (maximal HR/rest HR) was 1.20 or less. MPS images were evaluated semiquantitatively. Stress (SLVEF), rest (RLVEF) left ventricular ejection fractions, stress and rest motion (SMS, STS) and thickening scores (STS, RTS) were derived automatically by QGS. Summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) for myocardial perfusion were calculated using a 20-segment model and a five-point scoring system. Patients were grouped according to HR response and groups were compared. A logistic regression analysis was used to determine independent predictors of reduced HR response.Results: Reduced HR was found in 78 % of patients. Patients with abnormal HR response were more frequently with a history of diabetes mellitus, chronic renal failure and taking calcium channel blocker. Maximal HR, SSS, SRS, SLVEF and RLVEF were lower; Rest HR and RTS was higher in reduced HR group (all p<0.05). There was no difference between groups by means of gender, rest and maximal systolic or diastolic tension, SDS, SMS, STS, RMS, history of hypertension, peripheral arterial disease, metabolic syndrome, coronary interventions, digoxin or beta blocker usage. Multivariable logistic regression analysis demonstrated that the independent predictors of reduced HR were chronic renal failure (p=0.042, 95% CI 1,06-11,9), diabetes mellitus (p=0.046, 95% CI 0,89-4,03), rest HR (p=0,004, 95% CI 1,01-1,08) and SSS (p=0,031, 95% CI 1,011,14).Conclusion: Our results showed that reduced HR response to DIP is associated with diabetes mellitus, chronic renal failure, left ventricular dysfunction and high basal HR which are compatible with previous reports. More studies are needed to evaluate the mechanism and clinical importance of reduced HR response to DIP.
P215 Post-stress and resting perfusion myocardial GATED-SPECT: role of hypertension on post-stress left ventricular dysfunction R. Barone, F. M. Pau, M. L. Menghini, M. Perino, P. Ghilardi, B. Schiavo; UO Studio del Flusso Coronarico, Az. Ospedaliera S. Camillo Forlanini, Roma, ITALY.
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P216 Gender differences and prognostic value in the exercise capacity and gated SPECT in patients with suspected coronary artery disease (CAD) V. Pubul1, M. Garrido1, S. Argibay1, C. Peña2, A. B. Ciobotaru1, S. N. Nieves1, A. Sánchez-Salmón1, R. Agra1, P. Arce1, A. Ruibal1; 1Hospital clínico Universitario de Santiago de Compostela, Santiago de Compostela, SPAIN, 2Complejo Hospitalario de Vigo, Vigo, SPAIN. BACKGROUNDThe exercise ECG has a lower sensitivity and specificity for detection of obstructive CAD in women compared with men. The clinical limitations of the exercise-electrocardiography test included a lower percentage of women reaching target heart rate than men and higher false positive rate in women. Our objective was to examine gender differences in the exercise capacity and prognostic value of gated SPECT in patients with suspected CAD.METHODSWe selected consecutive 1576 patients, 738 men and 838 women with suspicion of CAD were submitted to the realization of a myocardial perfusion SPECT for diagnostic purpose. We consider a positive result in the stress test by obtaining a clinical response or/and a significant alteration of the EKG. Positive SPECT criteria included the visualization of both reversible and non-reversible significant perfusion defects. In the posterior follow-up, we considered as events the presence of acute coronary syndrome, revascularization surgery, development of cardiac insufficiency or death from heart failure in the twelve months after the SPECT.RESULTSPatients obtained a high proportion of test that surpassed the 80% of the target heart rate, and there were no differences between sexes (70.8% vs 72.8%; p 0.40). The stress test results showed no differences between men and women (72.7% vs 75,8%; p 0.161). The SPECT, however, showed a higher percentage of positive results in men than women (37.38% vs 14.45%; p<0.001). Positive/negative results in the stress test were related to the number of events in the follow-up (Registered events in 17.4% of patients with positive stress test vs events in 10.30% patients with negative stress test; p<0,001) , but when we analyzed men and women separately, this relation only persisted in men (Registered events in 23.5% men with positive stress test vs events in 13.4% men with negative stress test; p<0,001), but not in women (Registered events in 11,2% women with positive stress test vs events in 7,6% men with negative stress test; p<0,107). The SPECT showed significant relation with the outcome in both sexes.CONCLUSIONS-In our experience, women showed no differences with men in the target objectives in the stress test.-There were gender differences for the stress test in the prediction of future events. The result of the stress test was related with events in men, but not in women.-The SPECT was more positive in men, and a positive result was associated with more number of events in men and women.
P217 Tomographic modalities in myocardial structure and perfusion assessment in ischemic heart disease patients A. Ansheles, V. Sergienko; Russian Cardiology Research Center, Moscow, RUSSIAN FEDERATION. Purpose: retrospectively compare contrast-enhanced magnetic-resonance (MRI), multi-detector computed-tomography (MDCT), 99mTc-MIBI single-photon emissiontomography (SPECT) in myocardial structural/functional status detection in patients (pts) with proven ischemic heart disease (IHD), using routine, everyday imaging protocols.Methods: 162pts with proven IHD underwent SPECT&MRI (30pts), SPECT&MDCT (36pts), SPECT alone (96pts). Gated-SPECT included two-day rest&stress study: bicycle-stress used in 144pts (89%), nitroglycerine in unable pts. 1.5T-MRI included rest study with Gd-based contrast administration, using improved IR-sequences. 64-MDCT included rest study with high-concentrated nonionic iodine contrast. All pts underwent echocardiography (US). All modalities performed within 5-7 workdays, before coronarography (CAG).Results: Rest accumulation defects comparison performed using 17-segment (sgm) model, with 75.0% sgm agreement in SPECT-MRI, 68.1% in SPECT-MDCT group. Better subendocardial IM detection with MRI (60sgm vs 56 with SPECT), impaired contractility in 2. Overall Summed Rest Score (SRS) nearly equal in MRI and SPECT (4.8±0.6 vs 4.6±0.6, p>0.5). In 79.0% of 162pts transient ischemia (TI) detected with stress-SPECT, revealed no reliable rest-MDCT/MRI TI-patterns. In 57 ischemic pts TI-severity determinated CAG performing, in 55 (including 12pts with 3-vessel CAD) CAG findings were consistent with stress-SPECT stenoses estimation. MDCT’s calcium burden, stenosis severity, weren’t predictive for TI in SPECT-MDCT group. Only 13 of 24pts with >50%-stenoses resulted LV-area TI>10%, 10 of them had subtotal stenoses. 2 women had moderate TI with CCS=0. LV ejection fraction (EF) correlated well within the modalities, SPECT seems to understate EF in pts with EF<35% by US (mean SPECT values 21±3.6 vs 26±4.6 in US, p<0.05).Discussion: TI is major coronary reserve indicator and IHD course predictor, assessed only during stress-studies. Well-reputated MRI/MDCT stress-protocols aren’t quite suitable for routine work for their technical, performing complicacy, especially with physical stress-test. SPECT has convenient ventricular perfusion/contractility quantative assessment tools, making easy follow-up comparisons, most effective routine selecting all-risk IHD-pts for medicamentous/operative treatment, monitoring. Rest-MRI subendocardial scar detection is superior, SPECT and MRI have similar overall irreversible area calculating capability. Segment delineation errors explain moderate defects localization agreements. MDCT proved NPV in suspected CAD (not obligatory IHD) pts, having indications for CAG passing SPECT only with occlusive stenosis found, otherwise MDCT is poor myocardial perfusion status predictor. In general, term “perfusion”, initially used for cardiomyocyte status assessment, is acceptable only for SPECT/PET, because of their intracellular agents distribution.Conclusion: Anatomical/functional (MDCT/MRI) and perfusion/cellular (SPECT/PET) methods aren’t competitive but complementary. Knowing exact study purpose, each method’s advantages profound understanding, enables every IHD case optimal diagnostic algorithm.
P218 Early Gated Myocardial Perfusion SPECT in Detecting Myocardial Stunning in Patients with and without fixed Perfusion Defect M. Tóth, K. Buga, M. Moravszki, I. Szilvási; Military Hospital - State Health Centre, Budapest, HUNGARY. AIM:Early gated myocardial perfusion SPECT (early-GSPECT) is useful in detecting ergometric stress-induced left-ventricular (LV) dysfunction (myocardial stunning: MS) in patients with ischemic heart disesae (IHD). Transient decrease of global/regional LV systolic function is of prognostic value. However many patients with IHD have fixed perfusion defect as well. We studied relationship between severity of stress-induced ischaemia and MS detected by early-GSPECT and effect of fixed perfusion defect on detecting MS.PATIENTS AND METHODS:37 (36 male) patients with angiographic evidence of coronary artery disease were enrolled in the study (age 36 - 75 years). 20 patients had previous myocardial infarction and/or PCI. Patients underwent ergometric (treadmill) stress. 15 minutes after injection of Tc-99m-tetrofosmin early-GSPECT (8 frame/cycle) was performed using GE Infinia GP3 gamma camera. Resting GSPECT was also performed on next day. Semiquantitative evaluation of perfusion and LV-ejection fraction was determined by Emory CTB. SSS, SRS and SDS were calculated, and LV EF values with earlyGSPECT and resting GSPECT were compared.MS was defined as at least 5.0 % decrease of LV EF on early-GSPECT compared to EF by resting GSPECT.RESULTS:23 patients had reversible perfusion defect(s): 12 mild-moderate, 11 severe defects (using SDS criteria). 18 out of these patients had MS. Half of the patients with mild, 3/4 of patients with moderate, and all with severe reversible perfusion defect had MS. No MS was detected in patients without reversible defect (n=14) and in 5 patients with mild-moderate ischaemia. Correlation (r=0.76) was found between SDS and severity of MS (decrease of LV EF in percent on early-GSPECT).16 patients had fixed perfusion defect. 12 of them had MS, but 10 out of these 12 patients had
Poster Presentations
Introduction. We previously described an early increase of ejection fraction (EF) in negative patients, according to the physiologic response to the adrenergic stimulation during stress and a drop in post exercise left ventricular function in patients with moderate/severe reversible scintigraphic defect.Aim. The aim of this analysis was to investigate the role of hypertension on post exercise left ventricular function variation in negative and in ischemic patients. The influence of antihypertensive therapy on ventricular function was also investigated.Methods. We analysed results obtained in 325 patients with negative myocardial perfusion scintigraphy and 78 patients with scintigraphic findings of moderate/severe ischemia who underwent study for diagnostic purpose. 190 out of 325 negative patients and 54 out of 78 ischemic patients were hypertensive. Among 78 ischemic patients, 15 performed study under anti-hypertensive therapy according to clinician’s request. Two G-SPECT were acquired 6 min and 12 min after the injection of 99mTc myoview respectively to obtain early (E-EF) and delayed (D-EF) post-stress EF. 30 frame G-SPECT acquisition (10sec/frame) on a 180 degree orbit, using Ventri GE camera was done for the early post stress study; 40sec/frame acquisition for the delayed images. The study was repeated 20-30 min p.i. at rest according to the two-day protocol. Mean E-EF, D-EF and rest-EF were calculated and compared by Student t-test.Results. Negative patients showed an increase of E-EF compared to R-EF (66.27±11.64 vs 62.01±11.46 p<0.0001). The EF values rapidly decrease with a mean D-EF of 62.20±11.64. The same behaviour of E-EF vs R-EF was observed in both hypertensive and not hypertensive patients (67.50±11.29 vs 63.70±11.25 p<0.0001 and 64.55±11.94 vs 59.64±11.36 p<0.0001 respectively). Opposite trend was observed in total ischemic patients with significant D-EF reduction compared to R-EF (53.30±12.68 vs 56.84±12.64, p<0.0001). This reduction was still registered in the subgroup of ischemic patients with hypertension (52.31 ±12.08 vs 56.23±12.32, p<0.0001) but not without hypertension (55.54±14.05 vs 58.21±13.49 p=ns). In 15 hypertensive patients with ischemia, therapy caused a global decrease of EF, without a significant differences between D-EF and R-EF (45.72±14.93 vs 47.45±13.16; p=ns). Conversely, in 39 hypertensive patients with ischemia who underwent scan in therapy washout, a significant drop in D-EF was registered (54.84±9.78 vs 59.61±10.28; p<0.0001)Conclusions. These preliminary results suggest that hypertension do not significantly impair ventricular function in patients with normal myocardial perfusion. Conversely it contributes to deteriorate ventricular function in patients with perfusion defects. Hypertension treatment seems to protect against postexercise function drop.
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S312 reversible perfusion defect(s) as well. Only two patients without ischaemia had MS, but both had extensive fixed defect. 8 out of 21 patients without fixed defect had MS, all of them had reversible perfusion defect. No correlation was found between SRS and severity of MS.CONCLUSIONS:Severity of exercise-induced myocardial ischaemia correlates with severity of MS on early-GSPECT. This technique is sensitive in detecting MS in patients with IHD even in patients with mild-moderate ischaemia. Patients without ischaemia do not show MS with exception of cases with extensive fixed defects. Severity of fixed defects does not correlate with severity of MS.With aknowledgement of the IAEA (RP:14676).
P20 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Cardiovascular: New & Innovative
P219 The association of Rate-Pressure Product (RPP) and myocardial perfusion imaging (MPI) findings; a preliminary study M. Assadi1, H. Javadi2, M. Pourbehi1, M. Rayzan1, M. Mogharrabi3, A. Amini1, M. Barekat1, S. Jalallat4, M. Abbaszadeh1; 1The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, IRAN, ISLAMIC REPUBLIC OF, 2Golestan Research Center of Gastroenterology and Hepatology (GRCGH),Golestan University of Medical Science, Gogan, IRAN, ISLAMIC REPUBLIC OF, 3Department of Nuclear Medicine,5th Azar Hospital, Golestan University of Medical Science, Gogan, IRAN, ISLAMIC REPUBLIC OF, 4Golestan Research Center of Gastroenterology and Hepatology (GRCGH),Golestan University of Medical Science, Bushehr, IRAN, ISLAMIC REPUBLIC OF. Aim. The product of heart rate and systolic blood pressure, termed as RatePressure Product (RPP), is a very reliable indicator of myocardial oxygen demand and is widely used clinically .The study was aimed to evaluate the association of RPP results with scan findings which is scare in the literature.Materials and methods: In total from 1250 patients who suspected to coronary artery disease (CAD) underwent gated SPECT imaging with dipyridamole , exercise and dobutamine stress, 497 cases with satisfied inclusion and exclusion criteria were included in this study. The difference between the RPP max and the basal RPP is known as the RPP reserve. The semi-quantitave analysis of MPI using gated software, as well as the demographic, risk factors of CAD and pretest likelihood of CAD using nomogram were also obtained.Results. In total, 497 cases including 426 patients with dipyridamole stress , 59 with exercise stress and 12 with dobutamine stress underwent myocardial perfusion imaging. In patients undertaking dipyridamole , there was a significant difference between HR at rest and at maximum ; between systolic BP in rest and maximum ; between diastolic BP and between EF at rest and maximum. There was a significant correlation between sum stress score(SSS) and reserved RPP (r= -0.12, p value =0.00) which in dipyridamole patients was r=-0.18, p value=0.00). In addition, there was a significant association between reserved RPP and risk of CAD ( p value=0.00). In the patients with dipyridamole stress , the EF change (odds ratio =0.92; 95% CI: 0.86-0.98; p = 0.01), reserve RPP (odds ratio =1.00; 95% CI: 1.00-1.00; p = 0.04), risk of CAD (odds ratio =5.80; 95% CI: 3.21-10.50; p = 0.00) and age (odds ratio =0.94; 95% CI: 0.89-0.98; p = 0.01) were associated significantly with MPI results by using multiple logistic regressions. Multivariate linear analyses adjusting for main clinical risk factors revealed that age, SSS, risk of CAD, and sex were the independent determinants for prediction of reserve RPP across different models in the patients.Conclusion. The study demonstrated that RPP might become an appropriate indicator for optimal analysis of the dipyridamole stress MPI and it can help to nuclear medicine physicians for a favorable interpretation .
P220 Renal Uptake Index during Myocardial Perfusion Imaging with 99mTc-labeled Tracers A. Jimenez-Heffernan, C. Ramos, J. Lopez-Martin, E. Sanchez de Mora, C. Salgado; Hospital Juan Ramón Jiménez, Huelva, SPAIN. AimDiabetes mellitus (DM), hypertension (HTN), atherosclerosis and renal vascular disease are significant precursors of both heart failure and renal failure. Initial nephropathy is not easy to detect as techniques commonly used to estimate renal function often fail to detect patients with mild to moderate reduction in glomerular filtration rate (GFR) and screening for albuminuria is not consistently performed.We aim to assess the role of the renal uptake index (RUI) of 99mTclabeled myocardial perfusion agents.Materials & MethodsWe studied 79 patients from a population presenting for SPECT myocardial perfusion imaging (MPI) for suspicion of coronary artery disease. Patients were 45 men and 34 women, mean age 61 ±10.2 years. DM and HTN were present in 42 and 45 patients respectively, 32 of whom had both risk factors. 24 patients had neither factor.A 20 minute renogram was acquired on the day of the rest study of a 2-day stress/rest protocol
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 following the iv bolus injection of 740 MBq of either 99mTc-tetrofosmin (52) or Tc-sestamibi(27). The renogram comprised 60 one-second, 25 5-second and 34 30-second frames respectively on a 64x64 matrix. The study was approved by the Hospital´s Ethical Committee and the patients gave informed written consent. RUI was obtained from background-corrected kidney counts over the second minute after injection divided by injected dose counts. Correlations, linear regression and t test were performed.ResultsBoth 99mTc-tetrofosmin and 99mTc-sestamibi renograms provided high quality images of the kidneys. RUI values ranged from 2.7 to 22.63%, mean: 11.46 ±3.9% with no differences observed regarding the tracer (mean 11.48 ± 4% for tetrofosmin and 11.44 ±3.8% for sestamibi). RUI showed significant correlation with GFR estimated by MDRD-4 equation (r=0.6, p<0.001) and serum creatinine (r= -0.4, p<0.001). Each unit of the percentage RUI accounted for 2.67 mL/min/1.73m2 of GFR and for -0.035 mg/dL of serum creatinine, both p<0.001. RUI was significantly lower in DM versus ND patients (10.7 vs 12.3, p<0.05) and in hypertensive vs non-hypertensive patients (10.65 vs 12.54 p<0.05) No differences were observed in RUI between patients with and without ischemia on MPI.ConclusionRenogram acquisition on the day of rest MPI with 99mTc-labeled tracers is feasible providing high quality anatomic and functional information of the kidneys with no extra radiation. While follow-up of patients is needed, RUI appears to have a potential role in the diagnosis of nephropathy in patients undergoing MPI. 99m
P221 Quantification of myocardial contraction parallel to the cardiac walls by gated myocardial perfusion SPECT: changes in the amplitude and synchronization in patients with coronary artery disease T. Niimi1, H. Maeda2, M. Nanasato1, S. Morita1, M. Sugimoto1, A. Mano1; 1 Nagoya Daini Red Cross Hospital, Nagoya, JAPAN, 2Nagoya University School of Health Sciences, Nagoya, JAPAN. Purpose: Ischemic injury of the myocardium was thought to first manifest as an abnormal contraction of the left ventricle rather than as changes in the overall amplitude of wall motion, which is calculated from the centripetal motion of the inner surface of the cardiac walls. Therefore, quantitative measurement of myocardial contraction parallel to the cardiac wall was considered important for the diagnosis of coronary artery disease (CAD). In this study, the amplitude and synchronization of the myocardial contraction of patients with known CAD were evaluated using QSFP (quantification of segmental function by solving the Poisson equation) to calculate the reduction in the distances between 2 points parallel to the cardiac walls.Methods and Materials: We assessed 20 patients with old myocardial infarction (10 patients) and normal control (10 patients) by using electrocardiographically (ECG)-gated 99mTc-methoxyisobutylisonitrile in the resting state and 99mTc-tetrofosmin single photon emission computed tomography (SPECT) for QSFP, which was performed for all the patients with myocardial infarction before and after revascularization. To identify abnormal regional contractions parallel to the cardiac walls, the amplitude and synchronous contraction index (SCI) of the wall motions were analyzed. The amplitudes of left ventricular (LV) segment length-shortening were calculated as the difference between the maximum and the minimum values of percentile length-shortenings. SCI was defined as the temporal correlation coefficients between LV volume and myocardial contraction. The cardiac wall was divided into 17 segments on a polar map, and the accumulation of perfusion agents, amplitudes of contraction, and SCIs for each segment were calculated.Results: In the normal cases, the global amplitude and SCI (average of 17 segments) were 35.4% ± 3.8% and 94.9% ± 3.0%, respectively, whereas in cases of old myocardial infarction before revascularization, the corresponding values were 24.1% ± 6.6% and 61.2% ± 27.4%, respectively. The regional amplitudes in all the patients before and after revascularization were improved from 0% to a maximum of 10.2% (mean, 4.7%), likewise, SCI were improved from 0% to a maximum of 60% (mean, 15.3%). LV dysfunction owing to CAD could be quantitatively detected using regional amplitudes and SCIs, and the areas of improved LV function could be clearly delineated.Conclusion: The amplitude of contraction and SCI calculated parallel to the cardiac walls were found to be novel indices of cardiac function and, with LV ejection fraction, were thought to be useful in the diagnosis of regional wall motion abnormality of the myocardium of CAD patients.
P222 Reduced Isotope Dose with Rapid SPECT MPI Imaging Y. Narin, U. Elboga, M. Urhan, E. Sahin, Ö. Yiginer; Gülhane Military Medical Academy Haydarpaşa Training Hospital, Istanbul, TURKEY. PURPOSE: Cardiac SPECT imaging needs to become shorter and use lower radiation doses to compete with other available noninvasive imaging modalities. Recently introduced cadmium zinc telluride (CZT) SPECT cameras have the potential to achieve both goals, but clinical experience is limited. We aimed to assess the diagnostic performance of a novel ultrafast cardiac gamma camera with cadmiumzinc-telluride (CZT) solid-state semiconductor detectors for nuclear myocardial
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P224 Shorter SPECT Acquisition Time with Ordered Subset Expectation Maximum and Resolution Recovery Software with Attenuation Correction A. Jimenez-Heffernan1, J. Lopez-Martin1, E. Sanchez de Mora1, C. Ramos1, A. Ortega2, C. Salgado1; 1Hospital Juan Ramón Jiménez, Huelva, SPAIN, 2 Centro de Salud El Torrejon, Huelva, SPAIN. AimLong acquisition times in full-time SPECT compromise patient comfort and image quality due to frequent motion artifacts. High patient throughput in a nuclear medicine facility calls for shorter SPECT imaging times. We aim to assess the benefit of a reduced-time (12 minutes versus 18 minutes) gated SPECT acquisition reconstructed with ordered subset expectation maximum and resolution recovery (OSEM-RR)(GE Evolution for Cardiac®) with attenuation correction using a standard SPECT/CT hybrid gamma camera (GE Infinia Hawkeye®).Materials & Methods572 consecutive patients (57% male, age 65.1 ±10.6 years, weight 78.6 ± 14.4 Kg) presenting for SPECT myocardial perfusion imaging (MPI) for suspicion of coronary disease were imaged using a shorter time acqusition and AC. 60 frames of 12 second duration (in lieu of the standard 18 second) were acquired over 90º in a 64x64 matrix. OSEM-RR reconstruction includes modeling of the integrated collimator and detector response function. Collimator hole and septa dimensions, intrinsic detector resolution, crystal thickness, collimator to detector gap and projection-angle specific center-ofrotation to collimator face distances are accounted for and compensated. In addition, OSEM-RR incorporates noise suppression. Our protocol performs 12 iterations with a maximum number of 10 subsets. A 2-day stress/rest protocol with 740 MBq of 99mTc-tetrofosmin (51.3%) or 99mTc-sestamibi (48.7%) was used. Stress was exercise alone or combined with adenosine (92.8%). In patients with COPD or asthma the stress was performed with dobutamine (5.2%) or exercise combined with regadenoson (2%). Normalcy rate using very low pretest likelihood of disease was obtained and compared to that of 147 patients undergoing full-time SPECT without AC using the same gamma camera and general conditions. One-year cardiac event rate was obtained from the 260 patients with at least one year of follow-up.ResultsImages were considered of very good quality in all patients. MPI was reported as normal in 55%, abnormal in 43.6% and equivocal in 1.4% of patients. In the full-time SPECT group reports were normal in 43.4%, abnormal in 51.7% and equivocal in 4,9% of patients respectively. Normalcy rate was 80% versus 68.6% in the full-time SPECT patients. At one year there was no death or cardiac event in the normal perfusion group and there was one death and 16 revascularizations in patients with abnormal perfusion.ConclusionShorter- time SPECT with OSEM-RR and AC provides good quality images with better diagnostic performance than full-time SPECT without AC, greatly improving patient comfort and patient throughput in busy units.
P225 Myocardial Quantitative Gated SPECT Help in Better Patient Selection for ICD and CRT Implantation and Device Optimization A. N. Hovhannesyan, I. Hapetyan; Yerevan Cardiology Institute, Yerevan, ARMENIA. The aim of this study was to assess incremental prognostic value of non-invasive myocardial quantitative gated SPECT in better patient selection for ICD implantation, cardiac resynchronization therapy (CRT) and CRT optimization
procedure. At least 30% of patients selected for CRT by use of traditional criteria do not respond to CRT.The objective of the study was to evaluate mechanical dyssynchrony in patients selected for CRT therapy and to find a group of not responders for ICD implantation, and to perform CRT optimization after implantation.Material and Methods: 28 patients (18 men) , mean age 71±12. Mean EF - 24±4,2%, QRS- 136±9mm. By phase analysis we are assessing left ventricular dyssynchrony and dyssynchrony between left and right ventricles.Results: Prior to CRT implantation 10 patients had no dyssynchrony while 14 patients had both intra- and inter- ventricular dyssynchrony, 4 patients had only intra - ventricular dyssynchrony. After the myocardial quantitative gated SPECT we exclude this 10 patients and implant them dual chamber ICD’s. In 14 patients CRTd device was implanted and in 4 CRT. A significant improvement in LVEF was observed in this group 133,33% (mean EF 32±3,9%). In those 10 patients with ICD improvement in LVEF was 122,5% (mean EF±29,4%).Conclusion: Our results suggests that prognostic value of non-invasive myocardial quantitative gated SPECT for patient selection for ICD or CRT implantation is very high and helps to find the group who will be real responders. The improvement in LVEF in ICD group could be explained by optimizing AV timing and rhythm stabilization.
P226 Effect of diabetes mellitus on quantitative data of stress myocardial perfusion scintigraphy - a retrospective analysis O. Lang1, M. Penicka2, F. Malek3, R. Pichova2, V. Knotkova4, I. Kunikova2, H. Syslova2, L. Treslova2, M. Andel2, P. Jebavy5, M. Kaminek6, M. Myslivecek6; 1Charles Univ, 3rd Medical Faculty and Center for Nuclear Medicine, Prague 10, CZECH REPUBLIC, 2Charles Univ, 3rd Medical Faculty, Prague 10, CZECH REPUBLIC, 3Charles Univ, 3rd Medical Faculty and hom*olka Hospital, Prague 10, CZECH REPUBLIC, 4Charles Univ, 1st Medical Faculty, Prague 10, CZECH REPUBLIC, 5Kardiologie Ltd., Prague, CZECH REPUBLIC, 6Palacky Univ, Medical Faculty, Olomouc, CZECH REPUBLIC. Objectives: Diabetes mellitus (DM) is one of the serious risk factors for myocardial ischemia. Diabetics usually have more serious coronary aterosclerosis including microcirculation. The aim of our study was to conduct a restrospective analysis of selected quantitative parameters of stress myocardial perfusion scintigraphy in diabetics and nondiabetics referred to our department.Methods: Records of all patients with stress myocardial perfusion study performed between 2005 and 2009 were analysed for parameters of myocardial perfusion (extent, severity and reversibility of perfusion defects) and function (left ventricular ejection fraction (EF), end-systolic (ESV) and end-diastolic (EDV) volumes). We compared diabetics to non-diabetics and also performed an analysis of diabetics divided into several groups according to the duration and the type of therapy of DM. The results were compared using cross-tabulation and ANOVA, p value < 0.05 was considered significant.Results: A total of 2385 patients were analysed, 533 (22%) of those had some form of diabetes. The percentage of diabetics in our study population was significantly higher than in the country´s general population (22% vs 6%, p<0.0001). Stress perfusion defects were larger (10.6% vs 8.5% of the left ventricle, p<0.0001), more severe (1.8 vs 1.6, p=0.040) and with a larger reversibility (2.2% vs 1.5%, p=0.011) in diabetics than in nondiabetics. Corroborating these findings, diabetics showed lower resting (55.8% vs 57.9%, p=0.004) as well as post-stress (57.5% vs 59.1 %, p=0.027) EF, as compared with nondiabetics. Analysis of diabetics did not reveal any differences between groups of different duration of DM and only differences of functional parameters between groups of different type of therapy were detected.Conclusions: Diabetics had significantly worse parameters of myocardial perfusion and function compared to non-diabetics. However, the duration of diabetes had no effect on these parameters and the type of therapy influenced only the functional parameters.
P227 Low dose thallium-201 protocol with a Cadmium-ZincTelluride (CZT) cardiac camera B. Songy, D. Lussato, M. Guernou, M. Queneau; Centre Cardiologique du Nord (CCN), Paris, FRANCE. Background: Thallium-201 is an efficient radiotracer for myocardial perfusion imaging but leads to relative high radiation exposure for patients.Objectives: We used a new cardiac CZT camera to decrease the effective dose with thallium-201 in myocardial perfusion imaging.Methods: We prospectively studied 137 consecutive patients referred for stress myocardial perfusion imaging and who previously had in the last 5 years a myocardial SPECT with thallium-201. We injected at stress a low activity of thallium-201 (1 to 1.2 MBq/kg, i.e. 74 MBq for 70kgs), performed stress myocardial imaging in 5 to 7 mn with a CZT camera GE Discovery NM 530c and redistribution imaging when initial images were abnormal, with reinjection (37MBq) when previous myocardial infarction or severe defect or without reinjection in other cases. We compared the CZT scan with the scan previously performed in the last 5 years with conventional dual head tomographic Anger camera (CC) with a regular dose of thallium-201.Results: Patients had known coronary artery diseases in 85% of cases, myocardial scar in 38% and ischemia in
Poster Presentations
perfusion imaging (MPI).METHODS:The study group comprised 84 consecutive patients who underwent 259 mBq Tc99m-MIBI dose of a two-day stress/rest imaging protocol. Scanning was performed first on a conventional dual-detector SPECT gamma camera with a 15-min acquisition time each for stress and rest. All scans were immediately repeated on an ultrafast CZT camera (Discovery 530 NMc, GE Healthcare) with a 4-min and 6-min scan time for stres, a 4-min and 6-min scan time for rest. Clinical agreement (normal, ischaemia, scar) between CZT and SPECT was assessed for each patient and for each coronary territory using SPECT MPI as the reference standard. Left ventricular ejection fraction (EF) values obtained using CZT were compared with those obtained using conventional SPECT by intraclass correlation.RESULTS: Of 84 patients imaged, the mean age was 62.8 years, 51.1% were male, 48.9% were female. There was excellent clinical agreement between CZT and conventional SPECT on a per-patient basis (93.6%) and on a per-vessel territory basis (95.4%) as shown by a highly significant correlation between EF values for both scanners (r=0.98, p<0.001) .Imaging repeated on an ultrafast CZT camera for 4 minutes scan time and for 6 minutes resulted in a similar number of total counts. This produced similar image quality in the three groups with a 65% isotope dose reduction compared to routinely a conventional dual-detector SPECT gamma camera who underwent 740 mBq Tc99m-MIBI dose of a two-day stress/rest imaging protocol.CONCLUSION: New SPECT CZT camera technology allows significantly reduced radiation exposure and acquisition time resulting in excellent agreement with provides clinical information equivalent to conventional standard SPECT MPI.
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S314 20%. The average stress activity was 88 MBq versus 125 MBq previously (- 30%) The average time for camera acquisition was 6 mn versus 13 mn (-54%) Myocardial counts were 2 to 3 times higher with CZT(400-600 Kcts vs 150-200) By comparison with CC, the quality of CZT images was better ( better delineation of left ventricular cavity, visualization of papillary muscles, easier thickening analysis ) in 69% of cases, equal in 25% and worse in 6%. Comparison of artifacts showed 59 artifacts with CC and 29 artifacts with CZT (p<0.01). The inferior artifacts are 4 times less and the anterior artifacts twice less frequent. Diagnosis agreement is good in 97%. In the 3 cases of disagreement, additional clinical and angiographic data showed that the CZT diagnosis was more accurate. Calculated effective dose was less than 12 mSv when no reinjection (additional dose of 4 mSv when reinjection). High myocardium counts rate allowed us to decrease more injected activity, down to 0.7 MBq/kg, leading to an effective dose of 8 mSv.Conclusions: With reduced activities of thallium-201 and effective doses lower than 10 mSv, CZT camera gives reliable high quality imaging.
P228 Very low dose myocardial perfusion imaging with 1 mSv using Cadmium-Zinc-Telluride (CZT) cameras and Tc99m-sestaMIBI. B. Songy, D. Lussato, M. Guernou, M. Queneau; Centre Cardiologique du Nord (CCN), Paris, FRANCE. Background: Myocardial perfusion imaging leads to relative high radiation exposure for patients and contributes up to 20% of the estimated annual collective radiation dose in the developed countries. It could result in additional future cancers. So the American guidelines recommend to reduce exposure lower than 9 mSv.Objectives: We used new cardiac CZT cameras to decrease the effective dose with technetium agents in myocardial perfusion imaging.Methods: We prospectively studied 100 consecutive patients without previously known coronary artery disease referred for diagnosis with stress myocardial perfusion imaging . We injected at stress a low dose of Tc99m-sestaMIBI (less than 2 MBq/kg, i.e.120 MBq for 70kgs), performed stress myocardial imaging in 10 mn with a CZT camera GE Discovery NM 530c immediately after stress. We practiced rest myocardial imaging 4 hours later only when stress images were abnormal, with injection of a treble activity.Results: Patients were 59 males and 41 females. They were 61±11 years old. There weight was 78±15 kgs. They received at stress 135±30 MBq of Tc99m-sestaMIBI. Total acquired counts were 1092±308 kcts and myocardial acquired counts were 317±91 kcts. Quality of scan was excellent in 82 cases, acceptable in 10 cases and poor in 8 cases, leading to an additional scan half an hour later after a fat meal. The result were normal in 90 cases and abnormal in 10 cases (3 artifacts,4 stress ischemia and 3 previously unknown myocardial infarction scar). Normal stress ejection fraction was 68± 7%, end-diastolic and end-systolic volumes were 72±27 and 23±11 ml. The effective dose at stress was 0.79±0.08 mSv for men and 1.02±0.07 mSv for women (7.4µSv/MBq for men and 9.9 µSv/MBq for women). The additional rest activity (average 430 MBq) leads to an additional dose of 3.02 mSv for men and 3.89 mSv for women (8.5µSv/MBq for men and 11 µSv/MBq for women).Conclusions: With reduced activities of Tc99m-sestaMIBI, CZT cameras give high quality imaging. It leads to an important decrease of equivocal results and a low ratio of patients needing an additional rest scan. The effective dose is thus very low, less or equal to 1 mSv in most cases.
P229 Adenosine Stress with Light Ergometer Exercise Better than Only Adenosine Stress in Japanese
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 other hand, when comparing with presence of the adverse events, there are no significant differences sex, age, height, based disease, however significant difference has 60kg over weight (P<0.05).Conclusion: Adenosine stress with light ergometer exercise is useful for decreasing adverse effect. Though the Japanese physique is small, and quantity consumed of adenosine is a little, we believe that more than 60kg patients can undergo adenosine stress more safely with light ergometer exercise in Japanese.
P230 Comparison of gated myocardial perfusion scintigraphy (GMPS) with strain echocardiography for evaluating left ventricular functions in patients with myocardial infarction S. Karacavus1, A. Celik2, M. Kula3, I. Özdogru4, A. Tutus3, A. Oguzhan4; 1 Bozok University, School of Medicine, Department of Nuclear Medicine, YOZGAT, TURKEY, 2Elazıg Education and Research Hospital, Department of Cardiology, ELAZIG, TURKEY, 3Erciyes University, School of Medicine, Department of Nuclear Medicine, KAYSERI, TURKEY, 4Erciyes University, School of Medicine, Department of Cardiology, KAYSERI, TURKEY. Background: Assesment of left ventricular (LV) function, infarct size and myocardial viability provides useful diagnostic and prognostic information for major cardiac events after acute myocardial infarction (AMI). GMPS or strain (S) and strain rate (SR) echocardiography analyses are sensitive and quantifiable methods for the evaluation of regional and global LV functions.Objective: The purpose of the study is to compare the strain echocardiography and GMPS for determining the LV’s functions after myocardial infarction. Material and Methods: Fifty four patients (M/F: 36/18; mean age 62±13 years) with myocardial infarction were prospectively enrolled in the study. All the patients underwent a rest protocol using gated SPECT myocardial perfusion imaging with technetium-99m methoxyisobutylisonitrile (Tc99m MIBI) and echocardiographic examination. GMPS datas were processed and analyzed using 4D-MSPECT software. The myocardium was divided into 17 segments and was used a scale of 0-4 for grading wall motion (0=normal, 1= mildly hypokinetic, 2= hypokinetic, 3= akinetic, 4= dyskinetic), and a scale of 0-3 for grading thickening (0= normal, 1= mildly reduced, 2= moderately to severely reduced, 3= no thickening) by automatic scores for each of the segments. Furthermore, the echocardiographic strain and strain rate values were calculated. Left ventricular ejection fraction (LVEF) was measured by both echocardiography and GMPS. Results: A total of 918 segments of LV wall were evaluated. In all patients, 385 segments were automatically scored as normokinetic, 206 as hypokinetic, 122 as akinetic, 205 as dyskinetic and 300 as normal thickening, 348 as decrease thickening and 270 as no thickening. Acording to the motion scores of left ventricular wall segments, S and SR values were significantly different from each other, but no difference between akinetic and dyskinetic (p<0.01) and acording to the thickening scores S and SR values were significantly different from each other (p<0.001). There was a negative significant correlation between LV wall thickening sum score and S and SR and between LV wall motion sum score and S and SR (p<0.001). There was a good corelation GMPS and echocardiographic LV-EF (r2=0.68, p<0.001). Conclusion: These imaging modalities showed good agreement with each other for determining the LV’s functions. The use of electrocardiographic gating during the acquisition of myocardial perfusion scintigraphy, it has become possible to simultaneously assess LV perfusion, function and volumes.
P231 Asymptomatic diabetics type 2, candidates for myocardial perfusion SPECT screening
T. Morishima1, M. Aiga1, K. Takeishi1, A. Yamazaki1, T. Hatano1, H. Kobayashi1, K. Takazawa1, A. Yamashina2; 1Tokyo Medical University Hachioji Medical Center, Tokyo, JAPAN, 2Tokyo Medical University, Tokyo, JAPAN.
I. Kotsalou1, C. Kotsalos1, A. Kotsalos1, N. Zakopoulos2; 1NIMTS Hospital, Cardiothoracic Surgery Dept., Athens, GREECE, 2University of Athens, Internal Therapy Dept., Alexandra Hospital, Athens, GREECE.
Background: In the recent report, adenosine stress with light exercise is useful for the decrease in the side effect. But it is not clear cut off level and comparison of many patients is still obscure in Japan.Objective: To evaluate adverse events in patients who underwent adenosine stress with light ergometer exercise and to compare only adenosine stress. To determine cut off level with light ergometer exercise.Methods: We studied 667 consecutive patients who underwent adenosine stress myocardial perfusion imaging (MPI). All patients were injected adenosine into forearm with one-route to use Japanese standard protocol, 0.12mg/min/kg less than America and Europe. The light ergometer group is while sitting on a chair, and pedaled ergometer with light exercise for 25W during infusion adenosine. We investigate adverse events based on opinion, symptoms by the questionnaire and electrocardiogram, blood pressure. Afterwards, compare between only adenosine stress and plus ergometer.Results: All patients complete underwent drug stress before imaging. Four hundred twenty one men and 246 women with an age range 68.7 ± 10.3 years and the 329 patients is only adenosine infusion(age, 69.9 ± 10.3 years), 338 patients has adenosine infusion plus light ergometer exercise(age, 68.7 ± 10.4 years). No significant difference is admitted in the age and sex ratio (p=n.s). As for the appearance of the adverse events include hypotension and AV block, only adenosine infusion group (n=85) was strong significantly high (p<0.05). On the
Aim It is known that Autonomic Dysfunction is common in patients with Diabetes Mellitus type 2 (DB) causing Silent Coronary Disease and reviewing the literature it is proven that almost 22-39% of diabetics with not known or suspected CAD have silent myocardial ischaemia. Therefore we aimed to resume which asymptomatic diabetics should preventively undergo Myocardial Perfusion Studies.Materials Methods In this study we included 96 diabetics type 2 (mean age 62 years, 78,6% male and 21,4% female) and DM duration 1-35 years, which were asymptomatic or had atypical or nonspecific anginal symptoms. Inclusion criteria were: HbA1C ≤ 7,0% and LDL < 206 mmol/L. 50 (52%) and Blood Pressure controlled (≤ 140/90 mmHg) using appropriate medication or not. 37 out of 96 diabetics had also history of Hypertension (38,5%- Group A), 20 were smokers (20,8% Group B), 26 (27% Group C) had hyperlipidemia, 32 (33,3% Group D) were overweight, whereas 46 (48%Group E) had no additional risk factors, but Diabetes. All patients were subjected to a rest and stress Technetium-99m tetrofosmin myocardial perfusion SPECT study. The images were interpreted as fixed perfusion defects, reversible ischemia findings and normal perfusion studies. The correlation of MPS with the coronary angiogram which followed, showed similar incidence of CAD in both groups.Results Significant perfusion abnormalities were found in 37 (74%) out of the 50 diabetics with more than two cardiovascular risk factors, and in 33 (71%) out of 46 diabetics
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P232 Patient experience questionnaire of a brand new UK regional nuclear cardiology service - how can we improve? R. K. Kulshrestha, S. Wadhwani, D. Rosof-Williams; North Manchester General Hospital, Manchester, UNITED KINGDOM. PurposeTo assess the patient anxiety levels before nuclear cardiology stress scans, to see whether further explanation helps, the patient’s perspective of the stressing and post stress scanning, and to look for ways to improve overall patient experience.Materials and MethodsA questionnaire was devised for the patient to fill-in in two parts, firstly whilst waiting for the scan and then post scanning. 151 questionnaires were included but not all parts were completed by the patient in several cases.Results59% of patients were anxious beforehand, with 77% of patients feeling relieved with a further explanation by the Doctor in the stress room. During the scan, 82% were comfortable, 23% were claustrophobic, with 58% of claustrophobics stating they would benefit from a video of the procedure beforehand to reduce anxiety on the day of the scan. The patient’s experience of the stress scan was satisfactory or more in 88% of cases and overall patient experience was more than good in 87% of patients.ConclusionsA clear explanation to the patient is foremost in reducing patient anxiety, and a video of the procedure beforehand would be clearly beneficial to a good proportion of claustrophobics. Although the patient’s experience of the stress procedure and overall patient experience was good, there is still room for improvement in terms of stressing and scanning. It is hoped that the newer stressing agents (e.g. regadenoson) which produce fewer side effects would benefit the patient experience as would newer, faster, claustrophobic-free dedicated cardiac scanners.
P233 Left and Right Ventricular Performance and Exercise Capacity in Chronic Hemodialysis Patients before and after Long-Term Correction of Anemia with Recombinant Human Erithropoietin (EPO) - an Assessment with Radionuclide Ventriculography N. Topuzović1, I. Mihaljević1, V. Rupčić2, A. Rusić2; 1University Hospital Centre Osijek and School of Medicine J. J. Strossmayer University of Osijek, Osijek, CROATIA, 2University Hospital Centre Osijek, Osijek, CROATIA. Aim: To investigate left ventricular (LV) and right ventricular (RV) function at rest and during exercise in chronic hemodialysis patients after correction of their anemia with EPO.Patients and Methods: This study included forty patients having regular hemodialysis (mean age 38 ± 11 years, mean duration of dialysis 5.3 ± 3 years) and with severe renal anemia (hematocrit < 0.25). Radionuclide equilibrium ventriculography were performed at rest and exercise testing after in vivo Tc-99m labeling of red blood cells on three occasion: 1) before EPO therapy, 2) intermediate - at the time when target hemoglobin (Hb) reached 100 g/l, and 3) late - after 12 months of maintained EPO therapy.Results: Mean Hb at initiation was 72 ± 6 g/l, increased to 111 ± 11 during 3.5 ± 1.5 months and was maintained thereafter. After correction of anemia, at peak stress patients showed significant rise in maximal work load (72.5 ± 18.1 vs. 90.4 ± 14.3 W, p<0.05) and exercise duration (8.4 ± 2.2 vs. 11.3 ± 1.4 min, p<0.05), and in maximal heart rate achieved (74 ± 11 to 104 ± 16 vs. 73 ± 11 to 125 ± 15 beats/min, p<0.05). There were no significant changes between intermediate and late studies. No significant difference was observed in LV and RV ejection fraction, peak ejection rate (PER) and time to PER before and after treatment with EPO. At rest, LV peak filling rate (PFR) was significantly reduced from 2.94 ± 1.3 to 2.33 ± 1.0 end-diastolic volume/second, p<0.05, and was maintained by late studies; during exercise no significant difference was observed. LV time to PFR was prolonged significantly during EPO treatment from 158 ± 34 to 183 ± 29 msec at rest, p<0.05, and from 102 ± 22 to 130 ± 29 msec during exercise, p<0.05, but without significant difference by late studies. While RV PFR remained unchanged at rest during therapy, RV time to PFR was significantly prolonged at intermediate studies and maintained late, but no difference was obtained during exercise.Conclusion: LV and RV systolic function at rest and exercise was unchanged during correction of anemia with EPO in chronic hemodialysis patients, but LV and RV diastolic filling dynamics are altered with EPO.
P234 Could be predicted and determined the effectiveness of cardiac resynchronization therapy with nuclear imaging? I. Balogh1, N. Nyolczas2, M. Dékány2, Z. Galler1; 1Uzsoki Street Hospital, Department of Nuclear Medicine, Budapest, HUNGARY, 2Military Hospital, Budapest, HUNGARY. Objectives: The growing number of heart failure (HF) treated with cardiac resynchronization therapy (CRT) creates the need to predict and measure the effectiveness of the therapy. We investigated the usefulness of different nuclear cardiology methods from this point of view.Methods: We examined 14 drugrefractor patients with HF (QRS > 120 ms), in NYHA III-IV clinical stage. The cause of HF was ischemic heart disease (IHD) only in 3/14 cases, in any other cases we could not find IHD. Planar and SPECT MUGA (multiple gated acquisitions) was performed to analyze the left (LV) and right ventricular (RV) function (EF, volume of LV, RV), phase angle in all cases. We evaluated the phase-dyssynchrony of LV with Interview XP-Synchrony software (S - normal value 1) on the planar “best oblique position” image. All of these examinations were performed before and 5-7 months after the CRT. Before CRT gated myocardial perfusion scintigraphy(GMPS) was performed in every case to distinguish the viable and necrotic myocardium and to measure functional parameters as well.Results: Before CRT planar and SPECT - MUGA showed low LVEF (8-28%) in 14/14 cases and in 3/14 cases RVEF was damaged as well (20-38%). On MUGA-SPECT we could detect inter- and/or intraventricular dyssynchrony characterized by standard deviation (SD) of PA (in degree), both ventricles and also before and after the CRT. The difference (the improvement of SD) was 13 +/- 7 degree for LV and 4,8 +/- 3,5 degree for RV. GMPS showed necrosis in 3 cases in which intraventricular dyssynchrony was seen at the localization of necrosis. The clinical stage improved significantly (NYHA III-IV to I-II) after CRT therapy in every case. We could detect increasing RVEF in 2 cases and the RVEF decreased in 1 case. The S value improved significantly in most of the cases (12/14). The ventricular volumes in every clinically improved cases increased as well - the mean value in LV was 73 +/- 53 ml, in RV 63,7 +/- 33 ml . The S value change was 0,3 +/- 0,2 .Conclusions: Planar and SPECT-MUGA seems to be useful method for measuring the response to CRT. GMPS can diagnose the necrotic (nonresponder) myocardium, beyond that can evaluate the LV function and the dyssynchrony before the therapy - as a predictor of success rate of CRT. The most reliable method seems to be the evaluation of S value with planar-MUGA, and the change of ventricular volumes.
P235 Role of Coronary Calcium Score in assessment of patients with suspected cardiac chest pain M. Shawgi, S. Muthu, R. Khattar, P. Arumugam; Central Manchester Hospitals Foundation Trust, MANCHESTER, UNITED KINGDOM. BACKGROUND: Calcification of coronary arteries is a sign of atherosclerotic disease and has been shown to have prognostic value. In the UK, National Institute of Clinical Excellence (NICE) guidelines for stable angina now recommends the use of coronary artery calcium score (CACS) as a first line diagnostic investigation in patients with a low pre-test likelihood of coronary artery disease (CAD). NICE recommends that further testing is not necessary if the score is 0 and that invasive coronary angiography should be considered in those with a score more than 400. The aim of the study is to assess the relationship between coronary calcium score and the presence or absence of ischaemia on myocardial perfusion imaging (MPI).METHODS:To date we have identified 123 patients (mean age 61, M: F ratio nearly 1:1) who underwent 82-Rubidium PET/CT MPI and CACS as part of the investigative pathway for suspected CAD. All patients underwent Adenosine stress and images were acquired using Siemens Biograph mCT PET -CT scanner. CACS was obtained in the same setting, prior to the perfusion study. All studies were read by an experienced Nuclear Medicine physician.RESULTS:49 patients had a CACS of 0 of whom 42 patients had normal perfusion and 7 were abnormal. In the group where CACS was between 1 and 400 (n = 49), 10 had abnormal scans and 39 normal perfusion. 25 patients had a score of more than 400; 15 had an abnormal scan and 10 normal studies.CONCLUSIONS: Despite the small sample size, the results show that negative CACS rules out ischaemia in the vast majority of patients (86%). However, in patients with positive CACS, the coronary calcium burden does not appear to have a consistent relationship with ischaemia. Therefore, when applying NICE guidelines in clinical practice, in patients with high CACS, clinicians should not rely exclusively on the absolute calcium score and should use their clinical judgement prior to proceeding to invasive coronary angiogram. We plan to continue collating data for this patient group with the view to achieving a larger sample size and combining the results with clinical follow up information.
Poster Presentations
(Group E). On the other hand, there were totally 26 (27%) normal myocardial perfusion SPECT studies.Conclusions Coronary Artery Disease (CAD) is common complication of Diabetes Mellitus type 2 which often lacks diagnosis, due to silent ischemia. Diabetics with more than 2 risk factors even asymptomatic, should preventively undergo Myocardial perfusion SPECT studies to estimate their specific cardiovascular risk profile, which is proved to be heavy. Research data suggest that 41% of abnormal MPS results come from asymptomatic diabetics with ≥ 2 risk factors. The high incidence of ischemia findings in our study, may be explained by the long diabetic history and the heavy cardiovascular profile of our patients and further research is requested.
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P236 Flow mediated hyperemic reactivity: A multivariate kinetic biomarker of coronary artery disease correlated with major cardiovascular risk factors A. Arsenault1, X. Zhao1, J. Dupuis1, B. Meloche1, K. Lavoie2, S. Bacon3; 1 Montreal Heart Institute, Montréal, QC, CANADA, 2Department of Psychology, UQAM, Montréal, QC, CANADA, 3Department of Exercise Science,, Concordia University, Montreal, QC, CANADA. Background: An improved biomarker of CAD from flow mediated hyperemic reactivity (FMHR) of the forearms is proposed. We used a two compartment kinetic model to discriminate CAD patients from low-risk individuals. The biomarker was correlated with major cardiovascular risk factors.Methods and results: 46 confirmed CAD and 47 low risk participants were reanalyzed. A two-compartment model of blood and muscle kinetics was fitted to both forearms time activity curves during reactive hyperemia. Six predictors were identified by discriminant analysis and the canonical score was saved for ROC curve analysis. Each predictor was tested by GLM taking all others as covariates including major risk factors. The correlation between risk factors, the six parameters and the canonical score was assessed. The score predicted groups with a sensitivity of 0.91(0.87), a specificity of 0.83, and an area under the ROC curve of 0.90(0.87). Five of the parameters showed significant differences between groups after covariate adjustment. The score showed a significant link with age, BMI, HDL, triglycerides and glucose levels. Conclusions: Tetrofosmin forearm kinetic analysis of FMHR is a powerful biomarker of the presence of CAD. The six parameters differentially relate to major cardiovascular risk factors. It is an improvement from the previous method.
P237 The Effect of Anciety Disorders and Insuline Resistance on Muscular Hyperemic Uptake B. Meloche1, A. Arsenault1, S. L. Bacon2, L. Jolicoeur1, K. L. Lavoie3; 1 Montreal Heart Institute, Montréal, QC, CANADA, 2Concordia University, Montréal, QC, CANADA, 3Université du Québec à Montréal, Montréal, QC, CANADA. Background: We developed a two-component kinetic model of tetrafosmin to evaluate muscle forearm hyperemic reactivity uptake (MFHRU). Anxiety disorders (AD) and insulin resistance (IR) have been linked to cardiovascular disease (CVD) development. In this study, we compared the muscle kinetic parameters of MFHU in association with AD and IR.Methods: A total of 281 subjects underwent a five minute supra-systolic ischemic provocation of the right arm as part of the rest study of a standard SPECT myocardial perfusion imaging study, with the left arm being used as a control. The MFHRU time activity curves were used to derive a tetrafosmin blood to muscle uptake rate ( Kbm ).A general linear model was used to estimate the main and interaction effects of AD and IR on Kbm adjusting for sex, age, and beta blocker medication use.Results: MFHRU was 30% lower in the presence of IR (F=6.1, p<0.01) and 30% higher in the presence of AD (F=4.4, p<0.04). There was a significant interaction between AD and IR (F=4.3, p=0,04) such that AD in the absence of IR multiplied Kbm by a factor of two.Conclusion: These results suggest that AD and IR have direct effects on peripheral muscle hyperemic uptake but also interact so that the presence of AD without IR multiply muscle uptake. Future research is needed to replicate these findings and elucidate the mechanisms of these interactions between metabolic, psychological, and physiological parameters.
P238 Anxiety disorders and triglyceride/HDL ratio: an interactive effect on muscular hyperemic flow response A. Arsenault1, L. Jolicoeur1, B. Meloche1, K. L. Lavoie2, S. L. Bacon3; 1 Montreal Heart Institute, Montréal, QC, CANADA, 2Université du Québec à Montréal, Montréal, QC, CANADA, 3Concordia University, Montréal, QC, CANADA. Background: Anxiety disorders (AD) have been linked to cardiovascular disease (CVD) while triglyceride/HDL ratio (TG/HDL) has been recently associated with CVD development and progression. We developed a two-component kinetic model of tetrafosmin, a molecule with specific muscle affinity, to evaluate the muscular component of the forearm hyperemic reactivity (FHR). In this study, we investigated the link between AD, TG/HDL ratio and the muscle uptake of tetrafosmin.Methods: A total of 150 patients (mean age 58.2 ± 9.6 years) were recruited among patients undergoing exercise stress testing at Montreal Heart Institute (MHI). A psychiatric interview (PRIME-MD) was used to assess AD while TG/HDL was calculated from standard blood work results. A two-component kinetic model was used to evaluate tetrafosmin muscle uptake from a five minutes time activity curve (TAC) obtained using a large field-of-view gamma camera. The rate of uptake from blood to muscle (kbm) was the dependent variable and tested by general linear modeling using the TG/HDL ratio and AD as the independent variables, sex and age as covariates.Results: In patients with abnormally high TG/HDL ratio, kbm was significantly higher (F= 9.0, p<0.003). AD was also associated
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 with an increased kbm (F = 5.0, p<0.03). The interaction between TG/HDL ratio and AD was significant (F =8.65, p<0.004) where people with normal TG/HDL and AD had much higher rates of uptake. Future research is needed to replicate these findings and elucidate the mechanisms of this interaction in larger samples.
P21 — Sunday, October 16, 2011, 16:00 — 16:30, NIA Exhibition Area
Cardiovascular: Miscellaneous
P239 Influnence of overt and subclinical hypothyroidism on cardiovascular risk factors C. Schneider1, F. Baer2, J. Hahn3, H. Schicha1, D. Moka1; 1Departement of Nuclear Medicine, Cologne, GERMANY, 2Departement of Cardiology, Cologne, GERMANY, 3Institute of Inorganic Chemistry, Cologne, GERMANY. Introduction: Subclinical and overt hypothyroidism is associated with significant cardiovascular abnormalities.1 Although TSH-receptors have been found in tissue outside of the thyroid2, it is still uncertain whether cardiovascular abnormalities are caused by a T3-decrease or by TSH-elevation.Methods: We evaluated different atherogenic factors in 30 patients with subclinical or overt hypothyroidism. All patients had a curatively treated, differentiated thyroid carcinoma prior to final I131 whole body scanning. Group A was examined in overt hypothyroidism after withdrawal of thyroid hormone substitution, Group B was examined in the formal subclinical hypothyroid state (single TSH-elevation after rhTSH-administration) in preparation for whole body scanning. To exclude the influence of intra-individual variables on the atherogenic factors measured, all patients were studied again after 6-12 weeks following radioiodine treatment in euthyroidism. Peripheral endothelial function was assessed by plethysmography, atherogenic lipid profiles were assessed biochemically and using in-vitro phosphorus-31 high resolution NMR spectroscopy.Results:Statistically significant alterations were found in peripheral endothelial function and all atherogenic factors assessed in patients with decreased levels of T3, whereas the condition of the Group B patients, with only a single elevated TSH-level, did not differ in any way from stable euthyroidism.Discussion:Our results suggest that these cardiovascular risk factors depend only on decreased serum fT3 concentrations, while a single serum TSH elevation has no effect. Our results accord to the findings of Biondi and Pingitore. Biondi reported that thyroid hormone deficiency impairs vascular function by damaging endothelial function at the level of the peripheral vasculature.3 Pingitore reported that in heart failure the main alteration of the thyroid function is related to a low-T3 syndrome characterized by a reduction in serum total T3 and free T3 with normal levels of thyrotropin.4The definition “subclinical” hypothyroidism should therefore be reconsidered, at least regarding cardiovascular effect.References1. Biondi B, Klein I. Hypothyroidism as a risk factor for cardiovascular disease. Endocrine. 2004;24:1-132. Drvota V, Janson A, Norman C, et al. Evidence for the presence of functional thyrotropin receptor in cardiac muscle. Biochem Biophys Res Commun. 1995;211:426-431.3. Biondi B, Galderisi M, Pagano L, et al. Endothelial-mediated coronary flow reserve in patients with mild thyroid hormone deficiency. Eur J Endocrinol. 2009;161:323-329.4. Pingitore A, Iervasi G. Thyroid function and heart failure: from the new clinical evidences to the potential therapeutic implications. Recenti Prog Med. 2005;96:535-541.
P240 Septal flattening detected by rest Tc-99m tetrofosmin gated SPECT in right ventricular overload secondary to pulmonary hypertension S. S. Salem, M. El-Shafie; Cairo University, Cairo, EGYPT. Introduction: : There are published data about nonspecific perfusion abnormalities in the RV seen on gated SPECT studies in patients with arrhythmogenic RV dysplasia without RV overload. Paradoxical septal motion is commonly described in patients with pulmonary hypertension and RV pressure overload during echocardiographic examinations, but rarely reported during myocardial perfusion studies. Interventricular septal flattening [D-shape left ventricle] is described and reported commonly during echocardiagraphic examinations of patients with significant RV overload. Aim of study: Our study aimed at documentation of septal flattening during rest gated SPECT imaging of patients with echocardiographic confirmation of pulmonary hypertension or right ventricular overload. Material & methods: The study included 68 patients [35 males, 33 females, mean age 49+11 years] with echocardiographic proven pulmonary hypertension. All patients were subjected to echocardiography and rest gated SPECT perfusion scanning following injection of 555 MBq Tc-99m tetrofosmin using triple head general purpose large field scintillation gamma camera.Results: The study population divided into 2 groups; group A: patients showed septal flattening in gated SPECT [56 patients; 82%] and group B: patients did not show septal flattening [12 patients; 18%]. Septal flattening in gated SPECT significantly correlated with pulmonary artery pressure
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P241 An investigation of the relationship between sequential change in heart to mesiastimun ratio and washout of Tc-99m MIBI and pharmaco*kinetic parameters through a mathematical compartment model analysis. A. Okizaki1, M. Nakayama1, S. Ish*toya1, Y. Urano2, J. Sato1, M. Sakaguchi1, Y. Sasagawa2, T. Aburano1; 1Asahikawa Medical University, Asahikawa, JAPAN, 2Rumoi City Hospital, Rumoi, JAPAN. Objectives:The heart to mediastinum ratio (H/M) and washout (WO) of Tc-99m sestamibi (MIBI) has been reported to be useful for evaluation of myocardial damage in various heart diseases. The uptake of Tc-99m MIBI is relatively unstable immediately after the injection. We hypothesized that it may take some time for stabilization of H/M and WO. The purpose of this study was to investigate the sequential change of H/M in several variations of time interval between the radiotracer injection and scanning (TI). Moreover, the relationships between the H/M, WO and pharmaco*kinetic parameters through a mathematical compartment model analysis were examined.Methods:Fifty-four patients with various heart diseases were studied. After an injection of Tc-99m MIBI (720MBq), the dynamic planar imaging was performed on a gamma camera system for 24 minutes. ROIs were drawn over the whole heart and mediastinum to obtain the H/M. Ten of 3minute TI data (from 3-6 to 21-24) were extracted from the continuously collected data. Furthermore, influx (k1), outflux (k2) and specific uptake (k3) rate constants for the myocardium were obtained through a mathematical compartment model analysis. Three and half hours after the injection, second scan was performed to calculate WO. Finally, 540 of H/M, WO and time-activity curves were analyzed. Tukey's multiple comparison test was performed to estimate whether there was a significant difference of H/M in each TI or not, and Pearson’s correlation coefficients were calculated to evaluate the relationships between H/M, WO and each rate constant.Results:The H/M and WO gradually increased with TI. The H/M in small TI (3-6) was significantly smaller than it in the others (p < 0.05). There were significant correlations between H/M and k2 in 5 minutes or more after the injection (p < 0.05), WO and k2 in all TI (p < 0.01). There was no significant correlation between H/M, WO and k1, k3.Conclusions:According to the H/M itself and the relationship between H/M, WO and k2, scanning time might have to be 5 minutes or more after the radiotracer injection to estimate H/M. Moreover, there were significant correlations between H/M, WO and k2, no significant correlations between H/M, WO and k1, k3.
P242 Radionuclide assessment of diastolic parameters after acute myocardial infarction B. R. Mittal, R. Kashyap, R. Senthil, K. Manohar, A. Bhattacharya, B. Singh; PGIMER, Chandigarh, INDIA. Background: Ventricular remodelling plays an important role in pathogenesis of heart failure following acute myocardial infarction (AMI). Diastolic dysfunction possibly has a significant role in the process, though this has not been elucidated. We tried to evaluate the changes in diastolic parameters using radionuclide ventriculography in patients post AMI.Methods: Eighteen patients (16 male, 2 female) with a recent AMI were prospectively included in the study. Patients were referred for myocardial perfusion imaging with Tc-99m Tetrofosmin and assessment of viable myocardium with Thallium-201 imaging or F-18 FDG PET. Radionuclide ventriculography was also performed to assess the ventricular function in all the patients. The ejection fraction and the peak filling rate (PFR) were derived from the data of radionuclide ventriculography. The imaging was done after a mean duration of 28.16 days.Results: Based on myocardial perfusion imaging results, the patients were grouped into those with perfusion abnormality (scar or hibernating myocardium) less than 3 segments of LV myocardium (n=7) and those with equal to or more than 3 segment involvement (n=11). The mean age (49.7 and 57.4 respectively) of patients of both groups was not significantly different. The resting heart rate of the patients in both the groups was also not significantly different. The mean PFR of patients in group with defect size less than 3 segments was 2.40 end diastolic volumes/second. The PFR for the group with equal to or more than 3 segment perfusion defect was 1.72 end diastolic volumes/second which was significantly different (p<0.05) from the previous
group.Conclusion: Our data suggests that the myocardial diastolic function is related to the extent of the perfusion abnormality in a patient with AMI. Diastolic dysfunction could possibly be the initial parameter predicting the development of heart failure subsequently.
P243 Impact of CT Attenuation Correction in SPECT Myocardial Perfusion Imaging F. Vlachou, A. Nikaki, K. Gogos, E. Tsiakas, D. Papoutsani, D. Giannis, L. Gogou, V. Prassopoulos; HYGEIA HOSPITAL, ATHENS, GREECE. AIM: To compare the scintigraphic myocardial images obtained from stress/ rest SPECT myocardial perfusion scintigraphy, with and without attenuation correction.METHOD- MATERIAL: 70 consecutive patients underwent Tc-99mtetrofosmin-stress/rest SPECT myocardial perfusion scintigraphy, for evaluation of coronary artery disease. The examination was performed in PHILIPS XCT, using low dose x- ray flat panel tomography for attenuation correction. SPECT acquisition parameters were: 64 frames, 30 sec each for stress and 64 frames, 25 sec each for rest., 180deg. Images were reconstructed using PHILIPS ASTONISH®, 4 iterations, 8 subsets, Hanning filter with cutoff set at 0.95 for stress and 1 for rest images. All data obtained were reconstructed with and without attenuation correction, and therefore two sets of stress/ rest images were obtained, one set with attenuation correction (ACI) and one without (NACI). Results were assessed qualitatively and quantitatively. For quantification analysis a 20 segment score was used: 2 segments for apex, and 3 segments (corresponding to apical, middle and basal sectors) for each of the following walls: anterolateral, anterior wall, anteroseptal, inferoseptal, inferior, inferolateral. Images were read by two nuclear medicine physicians. In cases of disagreement, consensus was reached.RESULTS: Differences in per segment uptake of the radiopharmaceutical between ACI and NACI: for stress examinations: apical segment 17/70, anterior-apical 19/70, anterior (middle and basal sectors) 7/70, lateral 4/70, inferior-apical 15/70, inferior (middle sectors) 45/70, inferior basal 48/70, inferoseptal 12/70, inferolateral 38/70; for rest examinations respectively: 23, 16, 3, 1, 18, 38, 46, 12, 31.ACI showed decreased uptake of the radiopharmaceutical at 26/104 apical segments, 10/1260 anterior - 9 of which at the apical sector of the anterior wall- and 9/1260 at the inferior walls. NACI showed decreased uptake at 308/1260 inferior segments, at 36/ 1260 anterior segments and 14/104 apical.In a per patient basis, ACI concluded in reversible defects for 13 patients, and irreversible defects for 16 patients, while findings for NACI were29 reversible- only 7 concerned other than inferior wallsand 34 irreversible defects- only 4 concerned other than inferior walls. ACI and NACI agreed in findings in 30 cases, 9 reversible, 11 irreversible defects and 10 without findings.CONCLUSION: CT corrected the attenuation and improved the images in ~24% of the inferior walls and in ~29% of the patients. CT attenuation correction solves in a major degree the problem of inferior wall interpretation and saves the patient from unnecessary further examinations.
P244 Seasonal variability in physiological myocardial FDG-uptake? J. Schildt, A. Ahonen, E. Hippeläinen; HUCH, Division of Nuclear Medicine, Helsinki, FINLAND. Aim There can be high variability intraindividually in the physiological myocardial FDG-uptake. This constitutes a problem when analyzing diseases of the heart with FDG-PET. The reliable detection of for example vulnerable plaques or cardiac inflammation such as cardiac sarcoidosis requires that the physiological myocardial FDG-uptake is as low as possible. Brown fat is known to become active in the winter months and due to it’s hypermetabolic state may become a problem when interpreting FDG-PET scans. To our knowledge, there are no studies assessing the effect of open air temperature changes on myocardial FDG-uptake. In the nordic countries the temperature changes between seasons can be remarkable. The aim of this study was to assess the seasonal variability of myocardial FDGuptake.Materials and methods 29 cancer patients (aged 10-72, mean 47,9) who had PET-CT study in the summer and again in the winter. The patients fasted 6 hours before the study. The PET-CT images were visually analyzed and the patients divided into five different categories depending on the intensity and distribution of the myocardial FDG-uptake. Quantitative analysis was made after ROIs were drawn over the myocardium, liver and mediastinum and the SUVmax-values calculated. We compared the results from the studies performed in the summertime to those made in the wintertime (mean temperature change 24 degrees Celcius ( SD 7.09). An independent samples T-test was used to compare means between studies.Results We found no significant difference in the myocardial FDG-uptake of the patients in the summer versus in the winter. The difference between the two studies in SUVmax of the myocardium (p= 0.59), the myocardium/mediastinal SUVmax ratio (p= 0.48) or the myocardium/liver SUVmax ratio (p= 0.8) was not significant. Further, the number of patients in the visually analyzed categories did not differ significantly between studies.Conclusions There seems to be no significant effect of outside temperature change on myocardial FDG-uptake. Therefore warming of the patients preceding cardiac FDG-PET studies is not obligatory.
Poster Presentations
(85.7+16.4 mmHg for group A compared to 50+12.5 mmHg for group B, P<0.001), pulmonary artery diameter (3.7+ 0.6 mm for group A compared to 2.1+0.4 mm for group B, P<0.02), LV diastolic volume (156.4 + 24 ml for group A compared to 111+ 12.5 ml for group B, P<0.004) and RV tracer uptake. There was no significant correlation between septal flattening and septal thickness (0.92+0.16 mm for group A compared to 0.81+0.17 mm for group B, P<0.3) or LV ejection fraction (60+6 % for group A compared to 58+9 % for group B, P<0.2).Conclusion: Flattening of the interventricular septum on gated SPECT imaging was correlated with echocardiographic finding of septal flattening and was associated with RV overload. The shape of the interventricular septum and the term of septal flattening, if present, should be routinely reported during interpretation of gated SPECT studies similar to echocardiographic descriptions in patients with suspected RV overload.
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P245 Coronary Artery Calcium Score - A Prognostic Tool in CAD? C. Sonneck-Koenne1, L. Leherbauer2, R. Zakavi3, D. Haoula2, B. Heyadri2, G. Agu2, P. Knoll2, S. Gueltekin2, K. Huber2, S. Mirzaei2; 1Nuclear Medicine, Vienna, AUSTRIA, 2Wilhelminenspital, Vienna, AUSTRIA, 3Mashhad University of Medical Sciences, Mashhad-Iran, IRAN, ISLAMIC REPUBLIC OF. Abstract:Aim: The aim of this study was to evaluate the impact of measurement of coronary artery calcification score (CAC) in patients with suspected coronary artery disease (CAD) and a normal myocardial perfusion scan.Methods: In a prospective study we measured the calcium score of 74 patients (29 m, 45 f, mean age 58.7 (m) and 64.4 (f)) with suspicion of CAD and a normal perfusion scan. In all patients a pharmacological stress myocardial perfusion imaging (MPI) with dipyridamole was performed. Both the myocardial perfusion scintigraphy and calcium scoring were performed on a T6 Symbia gamma camera (Siemens, Knoxville, USA). Attenuation correction was performed using a low dose CT.Results: The mean total CAC score was 182.6±435.7 and ranged from 0 -2309. 21/29 of the male patients (72%) and 17/45 of the female patients (38%) had an Agatston score of > 10. There were 9 cases (5m, 4f) with a calcium score of > 400 and 3 cases (2m, 1f) with a calcium score > 1000. No cardiac event was noted in these patients during a mean follow up time of 10.3 months (range 7-13 months, median 11 months) except one cardiac death of a patient with total Agatston score of 278.7 patients also underwent angiography because of their clinical symptoms, 4 of which (57%) had an elevated Agatston score.Conclusion: Increased CAC is a known predictor of future cardiac risk. Calcium scoring in addition to a normal stress perfusion scintigraphy on a SPECT-CT device might improve risk stratification of the patients on the same day and depict those in need of more aggressive treatment.In the presented study the angiographic results showed coronary artery disease in 3 cases despite a negative MPI and Agatston score of 0.Further prospective studies with larger patient numbers and longer follow-up time are needed to find out the impact of this advantage by hybrid imaging.Key words: coronary artery disease, myocardial perfusion imaging, coronary artery calcification score
P246 Comparison of adrenergic cardiac innervation in diabetic and normal patients using 123-I MIBG :planar and SPECT study J. Bakala1, A. Adamikova2, J. Bernatek1, P. Minar1; 1Department of Nuclear Medicine, Bata´s Regional Hospital, Zlin, CZECH REPUBLIC, 2Department of Internal Medicine, Bata´s Regional Hospital, Zlin, CZECH REPUBLIC. Abstract:Goal: Detect the impairment of the adrenergic innervation in diabetic patientsMaterials and Methods: Tests carried out after iv 185 MBq of 123 I-MIBG. Planar aquisition 30 min and 4 hours post injection, SPECT performed for 40 minutes and 4.5 hours after aplication. H/M, heart and mediastinum ratio and wash out was calculated.We examined 28 diabetic patients without CHD, 12 men and 16 women (Avg.age 46.3 age ± 6.8, BMI 27.7±5.2)123I MIBG and a control group of 20 non-diabetic patients without CHD, 10 men and 10 women ( Avg. age 44.2 ± 6.6, BMI 25.7 ± 5.1).Patients with diabetes were divided according to therapy :insulin-12, oral antidiabetics 11, 3 of both above and 2 with special dietetic programme. Diabetic patients were further divided according to neuropathic/10pts/- or non neuropatic/18pts/ complications.Results: normal patients, the H / M 3.88, patients with diabetes without neuropathy- H/M 2.1, with neuropathy H/M1.5.Wash-out for patients with diabetes was faster - 44% ± 6.6 compared with normal patients - 20% ± 2.6.Conclusion: Scintigraphy with 123-I MIBG to view the adrenergic innervation plays a crucial role in prognosis and further therapy of diabetic patients with cardiac neuropathy.
P247 Evaluation of the relationship between coronary artery disease and carotid intima-media complex thickness by gated myocardial perfusion imaging S. Ince, A. O. Karacalioglu, O. Emer, E. Alagoz, A. Ayan, B. Gunalp, N. Arslan, M. A. Ozguven; Gülhane military medical academy and school of medicine, department of nuclear medicine, Ankara, TURKEY. Introduction:Atherosclerotic changes as thickened intima-media complex (cIMT),presence of plaques,rough arterial wall and calcifications detected by ultrasonography have been shown to be strongly associated with a number of classic cardiovascular risk factors.cIMT is also known as an indicator for atherosclerosis in both pediatric and adult patients.Aim of this study was to evaluate the relationship between ultrasonographically detected cIMT and coronary artery disease evaluated by gated myocard perfusion imaging (gMPI).Materials and Methods:199 patients (80 women, 119 men; 65±9 years) were included in the study. GMPI was performed with Tl-201 in 52 patients and with Tc-99m MIBI in 147 patients and exercise test was performed with pharmacologic stress agent of adenosine in 14 patients and with treadmill exercise stress test according to Bruce protocol in 185 patients in a gamma camera (Optima,
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 GE, USA) equipped with low energy high resolution collimator.According to summed stres score (SSS), patients were categorized as normal (SSS≤4) and having coronary artery disease (CAD group: SSS>5).Study population were also divided into four subgroups according to time intervals of age (Group 1:<50, group 2:51-60, group 3:61-70 and group 4:> 71 years).cIMT was measured from both common carotid arteries by high resolution ultrasound scanner (Hologic 9,GE,USA) equipped with high frequency (14 MHz) linear array transducer in all patients.Five measurements were performed in a segment of 1 cm length approximately 1 cm proximal to bifurcation of carotid artery. The relationship between measurements was evaluated by using paired-t test.Results:Summed stress scores of the 74 patients were >5 and the others were 4 or less.The results of cIMT measurements of the right and left common carotid arteries in normal group were 0.645±0.136 mm,0.676±0.170 mm,respectively and in the other group were 0.684±0.188 mm,0.715±0.163 mm,respectively. Although the results of the left cIMT measurements were slightly higher than the values of the right, this difference was not statistically significant. Similarly, there was no significant difference between cIMT values of normal and CAD groups of age subgroups .According to our results, the age was the dominant factor affecting an increase in cIMT values in both common carotid arteries and this effect was more prominent in men.Conclusion:Absence of the difference between the cIMT values of normal and patients with CAD can be interpreted like that atherosclerosis is a lifetime progressive chronic process in humans beginning from birth, and the presence of coronary artery disease was just a timeless complication of this process.
P248 Is there an effective role for intramyocardial stem cells implantation for refractory angina? P. Mapelli1, E. Busnardo2, E. Spinapolice1, M. Picchio2, C. Godino3, L. Gianolli2, C. Messa4; 1Molecular Bioimaging Center, University of MilanoBicocca, Milan, ITALY, 2Nuclear Medicine Unit, Scientific Institute San Raffaele, Milan, ITALY, 3Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, ITALY, 4IBFM, National Research Council, Milan, ITALY. Aim Implantation of bone-marrow stem cells in the heart might be a new method to restore tissue viability after myocardial infarction. In the present study the effect of stem cells transplantation on cardiac ventricular function has been investigated.MethodsThis study includes 8 patients (7 males and 1 female) treated with intramyocardial stem cells implantation for refractory angina, previously treated with ineffective conventional revascularization procedures. Each patient underwent perfusion single photon emission computed tomography (SPECT) before, 1 and 6 months after the implantation. A dual days protocol, with injection of 20mCi of 99Tc-Tetrophosmine for each study and dypiridamole as a stress stimulus, was performed. Images were reconstructed with iterative algorithm filter back projection and corrected for attenuation. Perfusion and ventricular function semi-quantitative indexes were calculated obtaining respectively ejection fraction (EF) and end diastolic volume (EDV) from the QGS software, and summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS) from QPS software.Two-tailed t-test analysis was performed to evaluate the differences in cardiac function parameters in pre, 1 and 6 months after treatment.ResultsMean EF in pre-treatment, 1 and 6 months after the transplant were respectively 51%, 50% and 49% for rest studies and 45,%, 47% and 47% for stress studies and mean EDV were respectively 129mL, 128mL and 133mL for rest studies and 146mL, 136mL and 139mL for stress studies. Rest and stress EF didn’t show significant variations between pre and 1 month (p=0.52, p=0.8), between pre and 6 months (p=0.3; p=0.8), between 1 and 6 months (p=0.7; p=0.8). There were also no significant changes in rest and stress EDV between all times measured. No significant variations were observed in SSS (p=0.4 between pre-1 month, p=0.6 pre6 months, p=0.1 between 1 and 6 months), SRS (p=0.08 between pre-1 month, p=0.2 pre-6 months, p=0.08 between 1 and 6 months) and SDS (p=0.7 between pre-1 month, p=0.8 pre-6 months, p=0.9 between 1 and 6 months). Also transitory ischemic dilatation (TID) didn’t show significant variation (p=0.3 between pre-1 month, p= 0.9 pre-6 months, p=0.08 between 1 and 6 months).ConclusionThese preliminary data do not show an improvement in cardiac function as measured by perfusion SPECT after intramyocardial stem cells implantation. A larger cohort of patients would be required for further studies.
P249 Serial alterations of myocardial fatty acid metabolism in patients with acute myocardial infarction K. Koyama1, N. Oriuchi2, T. Higuchi2, Y. Arisaka2, T. Toyama1, H. Hoshizaki1, S. Ooshima1, K. Endo2; 1Gunma Prefectural Cardiovascular center, Maebashi, JAPAN, 2Gunma University Faculity of Medicine, Maebashi, JAPAN. Aim: In Patients with acute myocardial infarction (AMI), damaged myocardium undergone revascularization in acute phase, shows discrepancy of myocardial perfusion and fatty acid metabolism. And this myocardium is expected to improve its function. Single-photon emission computed tomography (SPECT) using
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P250
revascularization procedure, in period of time from 6 months up to 6 years. All of pts had previous exercise stress testing with indeterminate findings in 56%, positive finding in 21.3% and negative in 22.7%, and were selected as pts with intermediate to high risk of coronary artery or graft restenosis. SPECT MPS and CA findings were compared in general and regionally, by the affected coronary arteries and their irrigational territories.Results: SPECT MPS demonstrated myocardial ischemia in 42(56%) pts, while in 33(44%) pts no myocardial ischemia has been found. CA showed the presence of significant coronary arteries stenosis or restenosis in 49(65.3%) pts, and the absence of the significant stenosis in 26(34.7%) pts. Regarding the coronary artery territories CA and SPECT MPS we found no stenosis in 26(34.7%) and 33(44%) pts, significant stenosis of LAD in 12(16%) and 15(12%), Cx in 6(8%) and 6(8%), RCA in 11(14.7%) and 9(12%) and multi-vessel changes in 20(26.7%) and 12(16%), respectively. Complete match of the positive SPECT MPS findings on myocardial ischemia and CA findings on coronary arteries stenosis has been presented in 38(50.7%) pts, complete match of negative SPECT MPS and CA findings was noted in 22(29.3%) pts, and in 15(20%) pts SPECT MPS findings were not in the correlation with the CA findings, demonstrating the overall high correlation between two methods with the sensitivity of 77.5%, specificity of 84.6%, accuracy of 80%, positive predictive value of 90.5% and negative predictive value of 66.6%.Conclusion: Though the results were correlated regardless of CA findings such as existence of collaterals or SPECT MPS with mixed reversible/irreversible perfusion defects, SPECT MPS represents a useful noninvasive diagnostic method with high diagnostic value in evaluation and followup of patients with revascularization procedures and can be used as a decisive selection tool for further invasive diagnostic procedure (CA).
Are diastolic function and mechanical synchrony affected in patients with perfusion abnormalities but normal left ventricle ejection fraction on gated myocardial perfusion study?
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C. Low, A. Notghi, M. Pandit, J. O'Brien; City Hospital (Sandwell and West Birmingham NHS Trust), Birmingham, UNITED KINGDOM.
I. Kotsalou1, P. Xaplanteris2, I. Karfis1, M. Vogiatzis1, I. Karydas2, A. Zoumboulidis1, K. Lazaridis2, N. Dimakopoulos1; 1NIMTS Hospital Nuclear Medicine Dept., Athens, GREECE, 2NIMTS Hospital, Cardiology Department, Athens, GREECE.
Aim:To investigate the correlation of diastolic function and mechanical synchrony with perfusion defects in patients with a normal left ventricle ejection fraction (LVEF) on gated myocardial perfusion study.Methods:We retrospectively reviewed 83 patients who underwent a 2-day MPS study with gating performed either at rest or post-stress with LVEF ≥50% within a 2-month period. All patients had adenosine for coronary vasodilatation and 99mTc-tetrofosmin was used for imaging. An automatic quantitative program for gated MPS (QGS/QPS, Autoquant v.7, Cedar Sinai/Philips) was used to obtain the functional parameters and phase analysis.LV diastolic function was determined by the peak filling rate (PFR), mean filling rate over first third of diastole (MFR/3) and time to peak filling from end systole (TTPF). The phase analysis was performed by measuring the LV entropy and phase bandwidth standard deviation (PSD).Perfusion defect patients were grouped into those with total LV perfusion defect ≤3% (Group TD1) or >3% (Group TD2) and reversibility ≤3% (Group R1) or >3% (Group R2). A 2-sample t-test was performed between group TD1 and TD2 and group R1 and R2 to investigate the significance of any difference. P-value of <0.05 was taken to be significant.Results:Comparison between group TD1 and TD2 showed significant difference for PFR (2.73±0.87 vs. 2.29±0.83), MFR/3 (1.46±0.32 vs. 1.16±0.06) and TTPF (159.4±24.8 vs. 177.5±33.0) with p-value <0.05.Comparison between group R1 and R2 also showed significant mean difference for PFR (2.71±0.87 vs. 2.29±0.83), MFR/3 (1.46±0.33 vs. 1.15±0.29) and TTPF (159.4±24.6 vs. 178.8±33.7) with p-value <0.05.There is however no significant difference in mechanical synchrony as measured by LV entropy and PSD in both total perfusion defect and reversibility groups.Conclusion:Both LV total perfusion defects and reversibility extent affects the diastolic function even in patients with normal LVEF. Diastolic functional parameters may provide further information for risk stratification. LV mechanical synchrony however does not occur when the LV systolic function is normal even in the presence of ischaemia.
P251 SPECT myocardial perfusion scintigraphy and coronary angiography in patients after coronary arteries revascularization procedure - what and when? S. Lucic1, A. Peter1, K. Nikoletic1, S. Tadic2, R. Jung2, M. A. Lucic3; 1Institute of Oncology of Vojvodina, Sremska Kamenica, SERBIA, 2Institute of Cardiovascular diseases of Vojvodina, Sremska Kamenica, SERBIA, 3 Institute of Oncology of Vojvodina, Diagnostic Imaging Center, Sremska Kamenica, SERBIA. The aim of the study was to confirm the validity of SPECT myocardial perfusion scintigraphy (SPECT MPS) in the diagnostic evaluation and follow-up of patients (pts) who underwent revascularization procedures (Percutaneous Transluminal Coronary Angioplasty - PTCA or Coronary Artery Bypass Graft Surgery - CABG) and were classified as pts with intermediate to high risk of coronary artery restenosis.Material & Methods: 75 pts (27 males, 48 females, mean age 57.99 ± 8.42) subsequently underwent SPECT MPS and invasive coronary angiography (CA) in a time frame up to 3 months. All pts underwent previous PTCA or CABG
Prognostic value of scintigraphic SSS and comparison with SYNTAX and GENSINI score: Preliminary study
AIM: Gensini and Syntax score are angiographic scores grading the complexity of coronary artery disease (CAD), which have been proposed as accurate methods for assessing CAD severity, patient risk and further therapeutic options. We investigated their correlation with Summed Stress Score (SSS), a well-established SPECT myocardial perfusion imaging (MPI) score, in a cohort of patients with positive SPECT MPI tests.MATERIALS: We retrospectively reviewed MPI studies and subsequent angiographies of 41 patients with no known prior history of CAD. All patients underwent stress [treadmill (n:35), adenosine (n:6)] 99mTc- tetrofosmin MPI and were later subjected to coronary angiography, on the basis of a positive MPI test. Semi quantitative visual interpretation was performed using the 20segment model and SSS was obtained by adding the scores of 20 segments of the stress tetrofosmin images. SYNTAX score was calculated from angiographies using version 2.02 of the SYNTAX score calculator; patients were divided in a high (SYNTAX score ≥ 33) and low risk (SYNTAX score: 0-32) group candidates for bypass according to guidelines, whereas Gensini score was respectively determined. Spearman’s ρ correlation coefficient was calculated for the Syntax, Gensini score and SSS.RESULTS: Median (25th-75th percentiles) for SSS, SYNTAX, GENSINI score were 6 (4-9.5), 21 (1-37.5) and 33 respectively. Using SYNTAX score, 71% (n=29) and 29% (n=12) of patients were classified to low and high-risk group respectively. The correlation of two scores did not reach statistical significance in the entire cohort (ρ=0.062, P=0.699). In subgroup analysis, both scores did not significantly correlate either (low-risk group:ρ=0, P=0.998; high-risk group:ρ=-0.313, P=0.322).CONCLUSIONS: SSS and SYNTAX or Gensini score are not interchangeable, thus providing complementary information regarding the management of CAD patients. The lack of association may be attributed to the fact that Syntax and Gensini score both take into account a panel of parameters regarding vessel anatomy (tortuosity, angulation of side branches, thrombus and calcification) that are relevant to the feasibility of revascularisation, but not to the myocardial territories adequately perfused, as does the SSS. SYNTAX score is used to determine best optional therapeutic procedure (PTCA of Bypass), whereas SSS reflects the severity and presence of viable myocardium related to specific relative risk for acute cardiac events.
P253 Polyunsaturated Fatty Acids Effects Assessment in Patients with CAD by Means of Nuclear Medicine V. Y. Sukhov, A. A. Ismailov, S. L. Grishaev; Military Medical Academy, St.Petersburg, RUSSIAN FEDERATION. Objective. This study examined the effects of polyunsaturated fatty acids (PUFAs) on myocardial perfusion and metabolism in patients with CAD using widely used in clinical practice SPECT with 99mTc-tetrofosmine and 123I-BMIPP as in vivo methods for diagnostics of different heart diseases.Material and Methods. 37 male patients 63.4±9,0 y.o. with CAD I-II FC NYHA treated with standard anti-ischemic
Poster Presentations
technetium-99m sestamibi (MIBI) expresses damaged area and its washout image demonstrates mitochondrial function. 123I-BMIPP(BMIPP) expresses fatty acid metabolism in myocardium. Cardiac magnetic resonance imaging (CMR) is useful method for identification of myocardial damage and evaluates myocardial viability. The purpose of this study was to investigate serial alterations of myocardial fatty acid metabolism in patients with AMI with SPECT and evaluate the relationships between SPECT and CMR. Materials and Methods: Fourteen patients with AMI were examined. In acute phase and follow up phase (6 months interval), both SPECT and CMR were examined. Defect score in MIBI and BMIPP, segmental washout rate in MIBI and delayed enhancement image, T2 weighted image in CMR were assessed. The relationships between SPECT and CMR were also evaluated. The images were measured and localized according to the 17-segment model. Results: In 238 left ventricular segments were examined. The average of LVEF, defect scores of BMIPP and defect scores of MIBI in acute phase (in follow up phase) were 48.8% (53.2%), 16.3(13.3), 12.5 (11.5), respectively. Average washout rate was 3.1. In 21% cases were improved their defect scores (improved more than 5 scores). In the segments improved defect scores, CMR showed relatively high T2 weighted intensity and revealed not transmural but faint delayed enhancement. The myocardium that had less damage and larger discrepancy of perfusion and fatty acid metabolism and remained their function tended to improve their fatty acid metabolism.Conclusions: Many factors, such as myocardial damage, mitochondrial function, and myocardial viability contribute to BMIPP SPECT images. BMIPP SPECT may be valuable method for comprehensive treatment of patients with acute myocardial infarction.
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agents (control group) were compared with 32 male patients 63.7±8,0 y.o. with CAD I-II FC NYHA treated with standard anti-ischemic agents + PUFAs. All of them underwent standard clinical investigation, Bruce protocol ETT, EchoCG and rest/stress gated SPECT with 99mTc-tetrofosmine and 123I-BMIPP. Both tracers SPECT data were analyzed with 17-segment model.Results. There were definite regional perfusion of tracer uptake at rest/stress concordant with metabolic defects at the same site. While comparing regions of repolarization disturbancies, shifted metabolism and decreased perfusion tracer uptake in 32 patients, 92% of them were considered match (di=0,615-0,998), 8% - mismatch (di=0,002-0,385). Though sensitivity in detecting of impaired repolarization by ECG and decreased 99mTc-tetrofosmine/123I-BMIPP uptake regions by SPECT were 17.6% vs 83.0%./87.7%.Moreover, number of sectors with low 99mTc-tetrofosmine and/or 123I-BMIPP uptake (<70%) and with EchoCG signs of cardiac insufficiency, ECG abnormalities and decrease of tracers uptake were equal.Repeated gated SPECT studies after treatment with PUFAs showed increase of perfusion tracer uptake in previously altered sectors compared to patients treated with only standard therapeutic schemeConclusion. 123I-BMIPP and 99mTc-tetrofosmine SPECT can characterize cardiomyocyte metabolic activity and myocardial perfusion. These techniques allow to perform adequate assessment of changing (decreasing) of myocardial metabolic activity (i.e. levels of beta-oxydation in cardiomyocytes) that together with perfusion data can fully represent the state of heart tissue impairments in CAD patients. Therefore, this method is feasible and highly informative for assessment of effects metabolic polyunsaturated fatty acids treatment and during follow-up.
P254 Heart Rate Response During Dipyridamole Stress in a Gated Myocardial Perfusion SPECT: Predictor of Global Death in Men with Known Cardiovascular Disease R. Ruano Perez1, A. Rosero Enriquez1, M. Diego Dominguez2, F. GomezCaminero1, A. Martin de Arriba1, C. Albarran2, J. Garcia-Talavera1; 1Nuclear Medicina. University Hospital of Salamanca, SPAIN, 2Cardiology Department. University Hospital of Salmanca, SALAMANCA, SPAIN. Aim: to evaluate the prognostic value of heart rate (HR) response during dipyridamole stress in patients submitted for a gated myocardial perfusion spect. Hypothesis: an achieved HR ratio >1.20 basal HR induced by dipyridamole implies a better prognosis and lower death event rate.Methods: we analyzed 649 consecutive dipyridamole gated-spect (dose 0.84mg/kg) during the period 20062007 (372 male, 277 female). End follow-up was September 2010, mortality was the event recorded. For statistical analysis we considered 3 HR groups for male and female: A- HR>1.20 after dipyridamole injection, B- HR>1.20 only after handgrip, CHR not >1.20 nor injection or handgrip. Variables considered were: test indication (diagnosis or ischemic severity in known cardiovascular disease), age (<70y, >70y), risk factors (HT, DM, obesity, alcohol, smoking, cholesterolemia), coronary bypass, infarction, chronic illnesses (excluded renal insuffiency and peripherical artheriopathy), use of betablockers, perfusion results (SSS>13,SDS>8, SRS>4), and function gated variables (EFstress<40%, EFrest<35%, ESVolume>70ml). SPPS 15.0 was the statistical program used.Results: Global mortality was 11.86%. In men, we found statistical relation (X2, p<0.05) between mortality and the variables age and HR groups. When correcting by age and compared with HRgroup A, we found statistical relation (X2) between mortality and men >70years and HR groups B (p=0.028) and C (p=0.025). Analysing test indication, this situation appears only in patients with known cardiovascular disease. There was not statistical relation when compared B and C groups. HRresponse did not show statistical relation to any variable. In women, we found statistical relation (X2, p<0.05) only between mortality and EFstress<40%, HR response was not related to mortality. Compared with men, women dipyridamole indication was statistically related with diagnosis. Also the incidence of risk factors and high risk perfusion or functional gated variables was statistically lower in women.Conclusion: In men over 70 years with known cardiovascular disease to achieve a good heart rate response after dipyridamole stress implies a better prognosis that not responders or only handgrip heart rate responders.
obtained automatically with autoquant®. Variables considered were: test indication (diagnosis or ischemic severity in known cardiovascular disease), type of test (treadmill, dipyridamole), age (<50, 51-70, >71y), risk factors (HT, DM, obesity, alcohol, smoking, cholesterolemia), stress test result (clinical+/-, electrical+/-), coronary bypass, infarction, chronic illnesses, perfusion results (SSS>13,SDS>8, SRS>4), and function gated variables (gEFstress<40%, gEFrest<35%, [gEFsgEFr]>5points, gESVolume>70ml). SPPS 15.0 was the statistical program used.Results: LHR>0.55 appeared in 56 patients (6.72%), and TID>1.22 in 41 (4.9%). LHR was not statistical related to TID (X2, p>0.05). LHR>0.55 was statistical related to sex (p=0.006, men>women), TID>1.22 was not related to sex.After correcting by sex, in men LHR>0.55 was significantly related with gEFs<40% (p=0.004), gEFr<35% (p=0.011), SSS>13 (p=0.000), VTS>70 (p=0.003), SRS>4 (p=0.000), and the variable >3risk factors (p=0.007). In women LHR>0.55 was significantly related to gEFs<40% (p=0.032), SSS>13 (p=0.000), and SRS>4 (p=0.014).TID>1.22 was statistical related to stress positive ECG result (p=0.007), gEFs<40% (p=0.010), SDS>8 (p=0.000), [gEFs-gEFr]>5points (p=0.002), SSS>13 (p=0.001), previous coronary graft (p=0.004).The rest of variables analyzed showed no significant relation nor with LHR nor TID.Conclusion: Lung heart rate and transient ischemic dilatation are not related but complementary variables. LHR correlates with non-ischemic systolic charge, while TID correlates with other positive ischemic variables.
P256 From Regional to Global Heart Function M. Žigman, M. Punda, D. Planing, Z. Kusic; UHC "Sestre milosrdnice", Zagreb, CROATIA. The aim of the study was to evaluate the clinical significance of measuring regional Fourier amplitude values in estimation of left and right ventricular regional and global myocardial function.Patients: Study included a total of 450 patients (pts): 411 pts with verified cardiomyopathy (286 of ischemic and 125 of no ischemic origin), the rest of 39 pts were used to determine reference regional Fourier amplitude values (21 pts after heart transplantation and 18 pts before the treatment with cardiotoxic chemotherapeutics).Methods: All patients previously underwent complete cardiologic examination. Radionuclide ventriculography (RNV) was performed in 3 projections. Regional values of Fourier amplitude (a total of 15 regions in LV and 9 regions in RV) were performed in order to determine regional quantification of myocardial contractility.Results: In group of patients with preserved regional contractility registered amplitude values were above 50%, while basal septal region showed the lowest and the most variable values. In group of patients with cardiomyopathy significant decrease of regional amplitude values, especially in single regions, suggested stenosis of coronary arteries in their supply area. Values of 20-40% corresponded to viable ischemic myocardium while infarcted myocardium had values below 20%. In patients with no ischemic cardiomyopathy, contractility of medial and apical ventricular regions was better preserved compared to ischemic cardiomyopathy. In those patients regions of hypertrophic myocardium with amplitude values above 65% were often determined. In patients with significantly impaired global EF (below 20%) the best preserved were basal region of RV and anterobasal region of LV. Significant decrease of amplitude values in apicoinferior region of RV often represented pulmonary hypertension, while multiregional apical deterioration of contractility was a sign of significant reduction of global LVEF. Well preserved contractility in inferoapical region of RV among pts with severely decreased global EFLV is a good prognostic sign for patient survival.Conclusion: Evaluation of regional amplitude values using Fourier analysis with gated RNV is a simple, reproducible procedure independent of edge-detection, threshold and background. Analysis of regional values enables insight into global RV and LV ejection fraction. The method enables recognition of intensity and character of heart disease (ischemic, non ischemic, systolic or diastolic myocardial dysfunction) and also follow-up of pulmonary hypertension and a grade of mitral insufficiency. Interpretation of the results discriminates patients who require invasive treatment from those in whom conservative therapy is sufficient. Quantification of regional myocardial contractility enables precise follow-up of the disease and of therapeutic efficiency.
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P255 Lung Heart Rate and Transient Ischemic Dilation: complementary and useful variables automatically obtained in a gated myocardial perfusion spect 1
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R. Ruano Perez , A. Rosero Enriquez , M. Diego Dominguez , F. GomezCaminero1, A. Martin de Arriba1, C. Albarran2, J. Garcia-Talavera1; 1Nuclear Medicina. University Hospital of Salamanca, SPAIN, 2Cardiology Department. University Hospital of Salmanca, SALAMANCA, SPAIN. Aim: to evaluate the relevance and correlation of automated lung-heart rate (LHR) and transient ischemic dilation (TID) with perfusion results and functional variables in patients submitted for a gated myocardial perfusion spect.Methods: we analyzed 833 consecutive gated-spect where LHR and TID was recorded (544 male, 289 female). For statistical analysis we considered LHR>0.55 and TID >1.22
Maximum Intensity Projection images review - Is there a role in Cardiac PET/CT? S. Muthu, M. Shawgi, A. Goldstone, J. James, P. Arumugam; Department of Nuclear Medicine, Central Manchester Foundation Trust, Manchester, UNITED KINGDOM. Introduction: Rubidium 82 cardiac PET /CT (Rb PET) is used to assess myocardial perfusion in patients with suspected or known coronary artery disease. Its mechanism of cellular uptake is thought to be similar to thallium. Unlike cardiac SPECT where the raw data is used not only to assess quality of the study including patient motion, bowel/liver scatter and extra cardiac uptake, the utility of maximum intensity projection (MIP) images in Rb PET is unclear. MIP images are however routinely reviewed when reporting oncology PET studies as it provides an overview of overall tracer distribution.Aim: To assess incidence of extra cardiac
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P22 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Neurosciences: Basic Science
P258 Study on the neuroprotective effect of hyperbaric oxygen therapy in the ischemic stroke rats using micro-PET W. Huang1, K. Ma2, B. Huang3, T. Tsai4, K. Huang3, R. Liu5, C. Shiue6; 1TriService General Hospital and Taipei Veterans General Hospital, Taipei, TAIWAN, 2National Defense Medical center, Taipei, TAIWAN, 3National Defense Medical Center, Taipei, TAIWAN, 4Tri-Service General Hospital, Taipei, TAIWAN, 5National Yang-Ming University, Taipei, TAIWAN, 6TrService General Hospital, Taipei, TAIWAN.
cells recruitment in CNS structures might be of high relevance for developing cell therapy approach in this setting. In the present study, we aim to show that stem cells can reach brain in animals with a BBB damage induced by total body irradiation (TBI).Materials and methods. Nine Lewis rats, underwent intravenous administration of two millions of stem cells harvested from syngeneic animals, purified according to CD90 expression and labeled with 37 MBq of 99mTcexametazime. Animals were randomly divided into two groups: five naïve rats served as control group while four were exposed to TBI the day before the experiment. Cell injection was performed during a planar dynamic acquisition (360x5 seconds frames and 2x300 seconds frames). Regions of interest were positioned to plot time activity curves on heart and head. Injected dose was measured by a counting rate of the whole body. Patlak graphical approach was used to estimate tissue recruitment of stem cells. To this purpose, time activity curves in the heart and head regions were considered as representative of plasma and tissue curve, respectively.Results. At the end of the experiment, the fraction of the dose in the head region did not differ in TBI and control rats (5.1±1.4% vs 3.9±1.2%, respectively, p=ns). Patlak graphical approach provided a recognizable regression line in all animals, whose slope was significantly higher in irradiated than in naïve rats (0.0086±0.005 vs 0.00004±0.00002 1/minute, respectively p<0.01).Conclusion. The present data indicate that targeted CNS cell therapy requires BBB disruption. Compartmental analysis of stem cell kinetics permits to document CNS recruitment of these cells. Exploiting this method might help in developing cellular therapy approaches for nervous diseases.
P260 Investigating the effects of noise on serotonin transporters in rat brain using micro-PET K. Ma1, H. Kang1, H. Chen2, C. Wang2, W. Huang3, R. Liu4, C. Shiue2; 1 National Defense Medical Center, Taipei, TAIWAN, 2Tri-Service General Hospital, Taipei, TAIWAN, 3Tri-Service General Hospital and Taipei Veterans General Hospital, Taipei, TAIWAN, 4National Yang-Ming University, Taipei, TAIWAN.
Aims: Stroke is the leading cause of long-term disability and death in Taiwan. There are two kinds of stroke, ischemic stroke and hemorrhagic stroke. The population that suffer ischemic stroke is more than that of hemorrhagic stroke. Recent studies have demonstrated that hyperbaric oxygen (HBO) therapy has neuroprotective effect in ischemic stroke. However, little is known the effect of HBO therapy on stroke-induced serotonergic damage. In this study, we used the 4-[18F]-ADAM (a serotonin transporter imaging agent) coupled with micropositron emission tomography (micro-PET) and immunohistochemistry to examine the effect of HBO on the brain serotonin transporters (SERT) of ischemic stroke rats.Methods:The ischemic stroke rats were created by permanently ligating the right middle cerebral artery and transiently ligating the both side common carotid artery for 90 minutes. After ligated the arteries, the ischemic stroke rats were treated with HBO therapy under 2.5 atmospheres for 1 hour. Micro-positron emission tomography (microPET) coupled with 4-[18F]-ADAM was performed 3 days after the HBO treatment. The specific uptake ratios (SURs) of 4-[18F]-ADAM were calculated by drawing the regions of interest (ROI) in various areas of rat’s brains relative to the cerebellum (i.e., [ROI-cerebellum]/cerebellum). Immunohistochemistry was performed 1 day after the micro-PET scan.Results: The uptakes of 4-[18F]-ADAM were significantly decreased in various regions of rat’s brain on 3th day after ischemic stroke. In the HBO-treated group, the SURs of 4-[18F]-ADAM were significantly higher than those of ischemic stroke rats in the midbrain (3.31±0.25 vs 2.35±0.34, P<0.01), thalamus (2.13±0.09 vs 1.38±0.26, P<0.01), hypothalamus (2.94±0.15 vs 2.14±0.42, P<0.01), caudate putamen (1.88±0.14 vs 1.22±0.40, P<0.01), and frontal cortex (2.07±0.37 vs 1.40±0.25, P<0.01) The results of immunohistochemistry were comparable to the micro-PET imaging data.Conclusions: HBO may prevent ischemic strokeinduced loss of SERT in rat’s brain, and the 4-[18F]-ADAM/micro-PET may be a feasible method for monitoring the protective effects of HBO on ischemic stroke induced serotonergic damage.
Aims: Serotonin transporter (SERT) is an integral membrane protein which located on pre-synaptic serotonergic neurons. The main function of SERT is to regulate the serotonin concentration in the synapse. The SERT is also an important indicator to evaluate the status of serotonergic neurons. The SERT has been found existed in the cochlear nucleus and auditory cortex of the central auditory pathway. In addition, the selective serotonin reuptake inhibitors may have a beneficial effect in auditory processes for elderly patients. These observations show that the SERT may play a role in auditory process. However, little is known on the effect of noise on brain serotonin system. In this study, we aimed to explore the status of brain SERT in hearing loss rat model using 4-[18F]-ADAM (a serotonin transporter imaging agent) coupled with micro-PET imaging.Methods: Hearing loss rat model was created by exposing the rats to an 8 kHz noise at 115 dB SPL for 3hours. 4-[18F]ADAM / micro-PET and auditory brainstem response (ABR) test were performed on 4th, 11th , 18th, and 32th day after the noise exposure. Specific uptake ratios (SURs) of 4-[18F]-ADAM were calculated from the micro-PET imaging data in various brain regions. Immunohistochemistry (IHC) was performed 1 day after the final microPET scan.Results: The data of ABR test showed that hearing loss was induced on 4th day and was persisted to 32th day after the noise exposure. The SURs of 4-[18F]ADAM of the hearing loss rats were significantly lower than those of control rats in the midbrain (3.98±0.34 vs 2.94±0.16, p<0.01 ), thalamus (3.54±0.33 vs 2.33±0.18, p<0.01), hypothalamus (3.92±0.24 vs 2.87±0.19, p<0.01), hippocampus (2.25±0.17 vs 1.35±0.11, p<0.01), caudate putamen (3.20±0.31 vs 1.95±0.20, p<0.01) and frontal cortex (2.37±0.16 vs 1.24±0.07, p<0.01) on 32th day after noise exposure. The results of IHC studies paralleled those of 4-[18F]-ADAM / PET studies.Conclusions: The results suggest that the noise may induce SERT loss in almost all regions of rat brain and the loss of SERT is detectable by 4-[18F]-ADAM / micro-PET in vivo.
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P23 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Blood-brain barrier damage permits the recruitment of stem cell in central nervous system. A study by compartmental analysis of labeled cell kinetics.
Neurosciences: Clinical Science Neurology
A. Buschiazzo1, M. Massollo1, C. Marini2, S. Morando3, C. Cassanelli4, S. Morbelli1, M. Verardi1, I. Bossert1, M. Piana5, F. Frassoni4, A. Uccelli3, G. Sambuceti1; 1Dept. Internal Medicine, University of Genoa, Genova, ITALY, 2 CNR Institute of Bioimaging and Molecular Physiology, Milan, Genoa Section, Genova, ITALY, 3Department of Neuroscience Ophthalmology and Genetic, San Martino Hospital, University of Genoa, Genova, ITALY, 4Stem Cell center Hospital San Martino, Genova, ITALY, 5Dept of Mathematics, University of Genoa, Genova, ITALY. Background. Stem cells or immune cells targeting the central nervous system (CNS) bear significant promises. However, brain or spinal cord delivery of therapeutic cells to the CNS structures is limited by the blood-brain barrier (BBB) that remains one of the recognized rate-limiting steps. Accordingly, methods to estimate stem
P261 Body Composition in Ambulatory Patients with Multiple Sclerosis C. Sioka, A. Georgiou, S. Markoula, S. Papakonstantinou, S. Pelidou, V. Ragos, A. Kyritsis, A. Fotopoulos, J. Kalef-Ezra; University hospital of Ioannina, Ioannina, GREECE. Aim: The aim of this study was to compare between ambulatory patients with multiple sclerosis (MS) and control subjects, bone mineral density (BMD) and body composition, i.e. percent of bone minerals (M%), fat (F%) and remaining substances (L%).Materials and Methods: Total body composition and BMD were assessed by dual X-ray absorptiometry (DXA) in 68 patients with definite MS and expanded
Poster Presentations
rubidium uptake by reviewing the MIP images on cardiac PET.Method: Patients referred for rubidium cardiac PET/CT as part of their routine clinical management were included. The scans were acquired using Siemens Biograph PET/CT scanner. 40 mCi of Rb was administered for each of the studies. The MIP images were routinely reviewed for extra cardiac uptake.Results: Of the 600 patients, who underwent Rb PET, 14 patients ( 2.3%) had abnormal extra cardiac uptake of rubidium - 2 in the lung parenchyma, 1 in pleura, 3 in pleural effusions, 2 had unilateral breast uptake, 1 had rib uptake, 1 in a liver lesion, 2 in lymph nodes and 2 in oesophagus. Of these 2 were known pathology (oesophageal malignancy and pleural plaques) and 12 were unknown. Of the 12, based on CT features 8 were considered benign and in 4 further imaging/investigations was advised. Two of them had features suggesting malignancy on a diagnostic contrast CT.Conclusion: In this small group of patients, uptake was noted in both benign and malignant pathologies. Correlation of this uptake with the low dose CT may be helpful in further characterisation of these findings and alerting the referring clinician to arrange further investigations. This study emphasises the importance of systematic review of both the PET and CT data for extra-cardiac abnormalities.
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S322 disability scale score (EDSS) less than 6.5 (41 females and 27 males) and 114 control individuals (72 females and 42 males).Results: The amount of F%, L%, M% and BMD in the whole body, arms and trunk was not statistically different between MS patients (males and females) and controls, except in the lower extremities of female patients where there was increased F% and reduced L% compared to controls. There were no correlations between F%, L%, M%, or BMD at any anatomic region with EDSS or the cumulative corticosteroid dose.Conclusions: The reduced L% in the lower extremities of female patients may represent a risk for local osteoporosis and suggests that regular physical therapy may prevent this complication. In addition, brief steroid courses in ambulatory MS patients can be safely given during disease exacerbations.
P262 Regional brain metabolic glucose changes to diazepam and Progressive muscle relaxation according to Jacobson: a FDGPET study P. Pifarré1, M. Simó1, J. Gispert2, P. Plaza1, E. Martinez-Miralles3; 1Nuclear Medicine Department CRC-Hospital Quiron Barcelona, Barcelona, SPAIN, 2 Centre imatge molecular CIM-CRC, Barcelona, SPAIN, 3CRC Corporación Sanitaria, Barcelona, SPAIN. Introduction:Orally administered Diazepam is commonly prescribed in standard PET-CT oncological studies to control patient anxiety. However, its usefulness and discretionary prescription is controversial. At present and according to Jacobson, drug-free methods have shown efficacy to induce relaxation and reduce anxiety in these patients, like progressive muscle relaxation (PR).The aim of our study was to evaluate the changes in cerebral metabolic glucose rate induced after the administration of an anxiolytic medication and after PR as compared to a control group.Material and methods: Seventy-seven oncological patients without neurodegenerative clinical disorders or metastatic brain lesions were included in this study; 30 patients were studied after sedative medication (Diazepam); 17 subjects were studied after PR. Another 30 patients scanned in resting conditions were also included as control group. All groups were age and gender matched.Brain PET scans were acquired in a Siemens tomograph (Biograph) in 3D mode, 30 minutes after 18F-FDG administration. Regional cerebral glucose metabolism was compared among groups with SPM8, after intensity normalizing the global 18F-FDG PET uptake to that of white matter (WM). A WM mask was created by thresholding the a-priori WM image provided with SPM8. Voxels having a WM probability over 95% were selected and images were multiplicatively scaled to render identical WM uptake values. Two Student's two-sample t-tests were conducted comparing the Diazepam and PR groups with respect the Control group. Statistical significance threshold was set to p < 0.001 uncorrected for multiple comparisons and no extent threshold was applied.Results:Compared to the control group, both Diazepam and PR induced similar, although not identical, significant decreases in cortical metabolic activity. Statistical significance of these hypometabolisms is shown in tables (1, 2). No statistically significant increases in 18F-FDG uptake were observed in either of the two groups.Conclusion:The pattern of changes in cerebral glucose metabolic rate induced after diazepam administration was very similar than that observed after PR. In conclusion, the relaxation states achieved after PR and the pharmacological intervention were very similar, thus pointing at PR as an effective, drug-free and non-invasive alternative for the control of anxiety in patients undergoing oncological PET-CT scanning.
P263 Interobserver Variability of FDG Brain PET in Clinical Routine: More Than You Think T. L. J. Wagner1, N. Brucher2, A. Hitzel1, A. Julian1, T. Filleron3, P. Payoux1; 1 Nuclear Medicine Department Toulouse University Hospital, Toulouse Cedex, FRANCE, 2Radiology Department Toulouse University Hospital, Toulouse Cedex, FRANCE, 3Medical Oncology Department Claudis Regaud Institute, Toulouse Cedex, FRANCE. Introduction:More than 26 million people worldwide suffer from dementia. Early diagnosis is essential for adequate management, remains difficult and is based on a combination of clinical, biological and imaging tests. FDG PET has shown to improve diagnostic accuracy, in particular for the differential diagnosis between Alzheimer’s disease (AD) and frontotemporal dementia (FTD), and is increasingly used for diagnosis and follow-up. Reproducibility when interpreting brain scans is very important. This study aims to evaluate the interobserver variability in clinical routine.Patients and Methods:We conducted a prospective monocentric study in 30 consecutive patients undergoing FDG brain PET. Patient files were reconstructed in a standardised manner: re-sliced along the bicommissural axis; the color scale was normalised with a maximum on the thalami and striata. Three independent observers interpreted the scans, first by looking at the same 24 slices (standardised technique), then by reconstructing the scan themselves with no constraint on reslicing and color scale normalisation (individualised technique). Eleven cerebral areas were rated from 4 to 0 (4 normal FDG uptake, 0 no uptake). The observers also rated the scans normal or pathological. Kappa statistics were used to
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 determine the degree of intra- and interobserver agreement. Weighted kappa is an index of agreement over and above that expected by chance. All statistical analysis was performed using Stata 11.0 software.Results:For the rating of cerebral areas there was fair agreement between observers with the individualised technique (Kappa=0.308) and moderate agreement with the standardised technique (Kappa=0.346). The areas with the least concordance were mesial frontal, anterior temporal and mesial temporal (Kappa=0.266, 0.280 and -0.163 respectively) with the individualised technique. For the classification in normal and pathological there was fair interobserver agreement with the standardised technique (Kappa=0.289) and moderate agreement with the individualised technique (0.550).Discussion:This study shows significant interobserver variability when reporting on FDG brain PET in a routine clinical setting. The least reproducible areas: mesial frontal, anterior temporal and mesial temporal are involved in neurodegenerative disorders such as AD and FTD. This finding is of critical importance and raises issues regarding the ability of FDG brain PET to be used as a diagnostic and follow-up tool, in particular in multicenter clinical trials. Centers performing FDG brain PET should be aware of this finding and pay particular attention to its consequences in patient management. Prospective trials should investigate whether diagnostic accuracy and interobserver concordance are improved with software-assisted interpretation.
P264 Voxel-Based Brain SPECT Control Data Base from Clinical Patient Data using Generalized Extreme Studentized Deviate Many-Outlier Procedure: Comparison with Subject-Based Normal Data Base from Normal Volunteers N. Shuke1, A. Ando1, T. Ohnishi1, J. Sato2, T. Aburano2, S. Irie1, T. Inagaki1, K. Saito1, K. Nishikawa3, M. Kato-Azuma3; 1Kushiro Kojinkai Memorial Hospital, Kushiro, JAPAN, 2Asahikawa Medical College, Asahikawa, JAPAN, 3 Imaging Information Technology Center, Nihon Medi-Physics Co., Ltd., Tokyo, JAPAN. Objective: Generalized extreme studentized deviate many-outlier (ESD) procedure (Rosner B, Technometrics 25, 165, 1983), which is a noble method to detect potential outliers, could be used to generate voxel-based control database from clinical patient data for statistical brain SPECT analysis. The objective of this study was to demonstrate its validity in comparison with the multicenter normal database generated from normal volunteers. Method: The multicenter subjectbased normal database (NDB) for I-123 IMP brain perfusion SPECT, which was generated from normal healthy volunteers (n=34, 61±8 y old , M/F=17/17) using the same gamma camera system and 3D-SSP co-registration software, was used for comparison. A voxel-based control data base (CDB) was generated from randomly selected age-matched patients (n=47, 63±7 y old, M/F=20/27) from one institution using the same data acquisition method as used for NDB and ESD procedure to eliminate outliers on a voxel-by-voxel basis. Between NDB and CBD, voxel mean and SD were compared, and number of voxels that had statistically different voxel mean and SD was counted and expressed as fraction (%) of the total voxel numbers (n=15964) in the standardized brain surface image. Results: Voxel mean and SD were close to each other between NDB (1.00±0.11 and 0.06±0.001) and CDB (1.00±0.12 and 0.08 ±0.021) . The fractions of the voxels that had statistically different (P<0.05 with BonFerroni multiple comparison correction) voxel mean and SD between NDB and CDB were3.1% and 1.2%. Mean differences between NDB and CDB were small enough in both voxel mean (0.026 ±0.024) and SD ( 0.022 ±0.013). There were significant correlations in voxel mean (R=0.959, P<0.00001) and SD (R=0.248, P<0.0001) between NDB and CDB, indicating similar spatial distributions of these values. Conclusion: Although voxel-based CDB was not completely the same as subject-based NDB, the difference between them was small enough. Generation of voxel-based control database with ESD procedure could be clinically feasible as a practical approach in statistical brain SPECT analysis.
P265 Comparison of FDG-PET, MRI and EEG findings and surgical outcome in operated lesional and non-lesional temporal lobe epilepsy T. Sucak, L. O. Kapucu, I. Capraz, U. O. Akdemir, G. Kurt, T. Hirfanoglu, N. Cıtak Kurt, M. Karacan Golen, M. Mercan, A. Y. Oner, A. Serdaroglu, E. Bilir; Gazi University School of Medicine, Ankara, TURKEY. Aim:To evaluate the diagnostic value of PET, EEG and MRI in patients with lesional and non lesional temporal lobe epilepsy(TLE) by comparing the findings with the operated side and surgical otcome.Materials&Methods:494 patients with intractable epilepsy were studied with PET between 2004-2010. Patients were evaluated retrospectively. 114 of these patients diagnosed with TLE underwent surgery. Sixteen of these had normal findings on MRI(non-lesional) and the rest had lesional TLE. All patients had video-EEG monitoring(ictal-interictal), MRI, PET and some of the patients had invasive EEG monitoring as part of a presurgical evaluation. The dominant hypometabolic area on PET and the side with the dominant discharges on EEG’s were considered as the epileptogenic lobe. The
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P266 Superiority of Tc-99m ECD brain SPECT to Tc-99m HMPAO brain SPECT in localizing the infarction zone in the same brains with subacute stroke
(Milon and Wechsler) for the assessment of imbalance, personality changes and memory deficits. Results: Twenty five patients showed abnormal and 20 revealed normal brain perfusion on early SPECT images. In 19 cases of total 20 normal SPECTs, we didn’t see any sign of delayed or sustained memory deficit and imbalance (negative predictive value=95%). However, the predictive value of positive initial SPECT for the detection of delayed memory deficit and imbalance were 40% and 20%, respectively. An early abnormality on SPECT, but not on CT, was the significant predictor of long-standing memory deficits (odds ratio=13.49, p=0.020). Conclusion: Negative SPECT study is a more reliable predictor of good outcome than CT in terms of absent memory deficit and imbalance beyond a 6month follow-up period in patients with MTBI. In addition, SPECT abnormality was confirmed to reliably predict more chance of persistent memory deficit. However, abnormal SPECT does not necessarily predict unfavorable outcome.
P268 Evaluation of perfusion differences in Semantic Dementia and 99m Tc-HMPAO SPECT with Alzheimer’s disease using automated Brodmann areas mapping V. Valotassiou1, J. Papatriantafyllou2, N. Sifakis3, C. Tzavara1, J. Tsougos1, D. Psimadas1, E. Kapsalaki4, G. Chadjigeorgiou5, P. Georgoulias1; 1 Department of Nuclear Medicine, University Hospital of Larissa, Larissa, GREECE, 2Memory & Cognitive Disorders Clinic, Department of Neurology, “G.Gennimatas” Hospital,, Athens, GREECE, 3Department of Nuclear Medicine, “Alexandra” University Hospital, Athens, GREECE, 4Department of Radiology, University Hospital of Larissa, Larissa, GREECE, 5Department of Neurology, University Hospital of Larissa, Larissa, GREECE.
Background: We investigated diagnostic performance of Tc-99m ECD brain singlephoton emission computed tomography (SPECT) and Tc-99m HMPAO brain SPECT to localizing the infarction zones in the same brains with subacute strokes.Methods: We examined 49 patients using brain SPECT with Tc-99m ECD and with Tc-99m HMPAO, and magnetic resonance imaging (MRI) of the brain less than 7 days of their stroke onset. MRI showed cortical infarction in 29 patients. Split dose and sequential SPECT techniques were used for Tc-99m ECD SPECT and Tc99m HMPAO SPECT, without repositioning of patients. Asymmetric index (AI) of infarction zones was calculated. The subtraction images of Tc-99m ECD SPECT and Tc-99m HMPAO SPECT were coregistered to MRI template.Results: Among 29 patients with cortical infarction on MRI, visual side-by-side interpretation of Tc99m HMPAO SPECT showed hypoperfusion in infarct zones in 27 patients except two patients with infarction in occipital lobes. In these two patients, Tc-99m ECD SPECT showed hypoperfusion in the same site with cortical infarctions in one patient. In the other patient, there was no hypoperfusion on both of Tc-99m ECD SPECT, and Tc-99m HMPAO SPECT. The asymmetric index (AI; 35.0 ± 30.0) of Tc99m ECD SPECT was larger (p = 0.002) than the AI (17.4 ± 20.2) of Tc-99m HMPAO SPECT. Visual side-by-side interpretation showed larger extent of hypoperfusion in infarct zones on Tc-99m ECD SPECT than Tc-99m HMPAO SPECT in 10 (34%) of 29 patients. Among these 10 patients, the subtraction images of Tc-99m ECD and Tc99m HMPAO SPECT coregistered to MRI sowed significant lower Tc-99m ECD uptake than Tc-99m HMPAO uptake in 4 (40%) patients. Conclusions: Compared with Tc-99m HMPAO SPECT, the degrees of hypoperfusion in infarct zones was significantly larger with Tc-99m ECD SPECT in a head-to-head comparison of the same patient during subacute stroke. The subtraction images coregistered to MRI supported the visual assessment. Therefore, we suggest that Tc-99m ECD SPECT was superior to Tc-99m HMPAO SPECT for enabling the mapping of full extent of the infarct and also the degree of tissue destruction
AIM: Semantic dementia (SD) and Alzheimer’s disease (AD) are both associated with neurodegenerative changes in temporal lobes which lead to impairment of semantic and episodic memory, respectively. Clinical assessment may not easily detect the differing cognitive profiles, resulting in under-diagnosis of SD, presumably mislabelled as AD.The aim of our study was the evaluation of perfusion in specific Brodmann areas (BA) in AD and SD patients, using an automated 3Dvoxel-based processing software, in order to reveal more localised perfusion differences between these disorders and improve the differential diagnosis of SD from AD patients.MATERIALS-METHODS: Sixty consecutive patients from an outpatient Memory Clinic were participated in the study. We used the established DSM-IV criteria for the diagnosis of dementia and the specific established criteria for the diagnosis of AD and SD. All the patients had a neuropsychological evaluation with a battery of tests including the mini-mental state examination (MMSE). We studied 39 patients with AD (10 men and 29 women, age±SD 71±8 years, MMSE±SD 19±5, education±SD 9.3±4.7 years, duration of disease±SD 4±2 years) and 21 patients with SD (5 men, 16 women, age±SD 69±8 years, MMSE±SD 13±8, education±SD 9.5±5 years, duration of disease±SD 4.1±3.2 years). All patients were right-handed, except 2 patients who were left-handed. All the patients underwent a brain SPECT scan 20 min after the intravenous administration of 740MBq of 99mTcHMPAO. We applied the NeuroGamTM software on the reconstructed data, for the semi-quantitative evaluation of brain perfusion in BA in the right (R) and left (L) hemispheres. Perfusion values in BA were expressed as mean±SD percentage of mean perfusion of the cerebellum.RESULTS: SD patients had lower perfusion values in BA 20L and 21L (inferior and middle left temporal lobe) compared to AD patients. Multiple logistic regression analysis showed that 21L could independently differentiate SD from AD (p=0.046). The AUCs for 21L was 0.68. The optimal cut-off of 21L for the discrimination of SD from AD was 61.2 with sensitivity 82.1, specificity 52.4, positive predictive value 76.2 and negative predictive value 61.1.CONCLUSION: Hypoperfusion in inferior and middle temporal lobe of the left (dominant) hemisphere in SD patients is associated with the different cognitive profile to that seen in AD patients. Brain perfusion SPECT imaging with automated BA mapping could improve the definition of brain areas that are specifically implicated in these disorders resulting in a more accurate differential diagnosis.
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I. Hyun , J. Lee , D. Lee , J. Rha , C. Ha ; Inha University Hospital, Incheon, KOREA, REPUBLIC OF, 2Seoul National University Hospital, Seoul, KOREA, REPUBLIC OF.
The role of tecnetium-99m ECD SPECT in the evaluation of long-term outcome after mild traumatic brain injury
Scintigraphic Methods in the Evaluation of Brain Death and Their Correlation with Clinical Examination and Apnea Test
B. Fallahi1, S. Nezameddini-Kachooei2, D. Beiki1, M. Mehrazin2, A. FardEsfahani1, M. Saghari1, A. Emami Ardekani1, M. Eftekhari1; 1Research Institute for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, IRAN, ISLAMIC REPUBLIC OF, 2Department of Neurosurgery, Dr. Shariati Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, IRAN, ISLAMIC REPUBLIC OF.
U. Yararbas1, M. Argon1, I. Çankayalı2, M. Uyar2, A. R. Moral2; 1Ege University Hospital, Department of Nuclear Medicine, Izmir, TURKEY, 2Ege University Hospital, Department of Anesthesiology, Izmir, TURKEY.
Introduction: We prospectively evaluated the role of 99m Tc-ECD SPECT in acute phase of mild traumatic brain injury (MTBI) for predicting the delayed and sustained neuropsychological complications after a typical recovery period. Methods: Forty five cases with MTBI were participated in this study. They underwent computed tomography (CT) and 99m Tc-ECD SPECT imaging within a week of their closed head trauma. After mean interval of 9 months from the time of accident, all patients were re-evaluated by clinical and neuropsychological tests
Aim: Although brain death is a clinical diagnosis, confirmation of the diagnosis with a diagnostic test is mandatory in several countries including ours. Since patients with brain death diagnosis are potentially organ donors, test selection is important in terms of sensitivity, timing and also organ preservation. Scintigraphic methods are known to be sensitive, non-invasive and safer than contrast angiography which is accepted as gold standard. In this retrospective study we evaluated the concordance of scintigraphic methods including radionuclide angiography and brain perfusion SPECT with clinical diagnosis and apnea test.Material and Method: Between July 2008 and September 2009, 24 patients including 2 pediatric and 22 adult cases (age range: 7-57) were referred to nuclear medicine department for the
Poster Presentations
findings of PET and other modalities were compared to the operated temporal lobe for lobar concordance. Operated temporal lobe side was excepted as the gold standard for epileptogenic zone(EZ). Operated 82 patients out of 114 were followed up for 25.8±10.2months(5-47months) after surgery according to seizure outcome.Results:In the non-lesional TLE group, PET was able to correctly lateralize the EZ in all of 16 patients showing %100 concordance with the resection side. At follow-up after surgery (22.9±12.1months), seizure control was achieved in 13 patients (%81)(Engel I) and 3 patients has rare seizures(almost seizure free)(Engel II). There were no patients without improvement in seizure control (Engel III and IV). Ictal EEG also showed a %100 concordance, while interictal EEG was concordant with the EZ in %75 of the patients. In the lesional TLE group of 98 patients, PET showed %100 concordance with the operation side, while ictal EEG, interictal EEG and MRI showed %98, %89 and %97 concordance, respectively. Ictal EEG had bilateral temporal discharges on 2 patients, whose EEG findings could correctly lateralize the EZ only after invasive EEG monitoring. At follow-up(26.5±9.6 months), %89(59/66) of the patients were classified as Engel I. There were no patients in Engel III and IV class. Between two groups (lesional and nonlesional) there were no significant difference in the follow-up duration after surgery and the surgical outcome.Conclusion:It was found that lobar concordance of PET for both lesional and non-lesional TLE was %100. In the non-lesional TLE group %81 and in the lesional TLE group %89 of the patients were seizure free after surgery. There were no patients in both groups with poor outcome, which may show that PET may be a predictor of good surgical outcome.
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S324 confirmation of brain death diagnosis. According to clinical examination and apnea test, all patients had brain death. Patients were injected with 20 mCi of Tc99mHMPAO. Dynamic images during the first 120 second and 500.000 counts static images in anterior, posterior and lateral projecitons in following minutes were recorded. SPECT imaging was started at 20th minute using high resolution collimator, 128*128 matrix and 360 degree SPECT options. Images were interpreted visually for the presence or absence of perfusion in anterior and medial cerebral arteries, sinus activity in sagital and transvers sinuses and Tc99m-HMPAO uptake in cerebral and cerebellar cortexes.Results: In dynamic perfusion and postinjection static views, none of the 24 patients had perfusion in anterior or medial cerebral arteries or sinus activity in sagital and transvers sinuses. In 2 patients scalp hyperemia due to craniotomy was observed. Tomographic images showed bilateral and complete perfusion loss in all cases.Conclusion: In our study group, in the diagnosis of brain death, clinical examination and apnea test results were found to be in concordance with radionuclide angiography and Tc99m-HMPAO SPECT. When compared with conventional radionuclide angiography, SPECT has the advantage of evaluating both infra and supratentorial structures.
P270 Brain perfusion SPECT with Brodmann areas mapping in the differential diagnosis of Alzheimer’s disease from behavioural variant of Frontotemporal lobar degeneration
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 available, is unreliable to determine the ictal onset zone and is usually only used for comparison with ictal SPECT images. On the other hand, “hyperfixation phenomenon” identified as the increased Tc-99m HMPAO accumulation in the relatively low flow regions is known in patients with subacute stroke. So we expected that Tc-99m HMPAO brain perfusion SPECT would detect the seizure onset zone even if not ictal period. The aim of the present study was to assess whether Tc-99m HMPAO brain perfusion SPECT could detect the seizure onset zone in patients with symptomatic epilepsy in the postictal period.Tc-99m HMPAO brain perfusion SPECT studies were performed on 14 patients with symptomatic epilepsy within 72 hours after the seizure onset. To perform an ROI analysis of the brain with improved objectivity and excellent reproducibility, we used automated ROIbased analysis software for the brain, the so-called 3DSRT and calculated asymmetric index, cerebellar ratio. We considered as positive when each of these values was over 1.1.In eight patients who were performed Tc-99m HMPAO brain perfusion SPECT within 24 hours after the seizure, 5 patients were considered as positive. Surprisingly, all of 6 patients who were performed it within 24-72 hours after the seizure were considered as positive. These results suggested that Tc-99m HMPAO brain perfusion SPECT which was performed within 72 hours after the seizure could detect the seizure onset zone in patients with symptomatic epilepsy.We concluded that Tc-99m HMPAO brain perfusion SPECT in the postictal period was useful to detect the seizure onset zone in patients with symptomatic epilepsy.
V. Valotassiou1, J. Papatriantafyllou2, N. Sifakis3, C. Tzavara1, J. Tsougos1, E. Kapsalaki4, G. Chadjigeorgiou5, P. Georgoulias1; 1Department of Nuclear Medicine, University Hospital of Larissa, Larissa, GREECE, 2Memory & Cognitive Disorders Clinic, Department of Neurology, “G.Gennimatas” Hospital, Athens, GREECE, 3Department of Nuclear Medicine, “Alexandra” University Hospital, Athens, GREECE, 4Department of Radiology, University Hospital of Larissa, Larissa, GREECE, 5Department of Neurology, University Hospital of Larissa, Larissa, GREECE.
C. A. Sánchez Catasús1, J. Cabrera Gómez1, J. Bosh Bayard2, R. Díaz1, A. Aguila1, K. Romero1, R. Rodríguez1, L. Galán2, P. Valdés Sosa2; 1CIREN, Havana, CUBA, 2Cuban Neuroscience Center, Havana, CUBA.
AIM: The accurate distinction between behavioural variant of frontotemporal lobar degeneration (bvFTLD) and Alzheimer’s disease (AD) based on clinical diagnostic criteria alone, may be difficult since many AD patients present impaired executive tests, while bvFTLD patients may present episodic memory disorders. The aim of our study was the evaluation of perfusion in specific Brodmann areas (BA) in AD and bvFTLD patients, using an automated 3D-voxel-based processing software, in order to reveal more localised perfusion differences between these disorders and improve the differential diagnosis of AD from bvFTLD patients.MATERIALSMETHODS: We studied 59 consecutive patients from an outpatient Memory Clinic. We used the established criteria for the diagnosis of dementia and the specific established criteria for the diagnosis of AD and bvFTLD. All the patients underwent a neuropsychological evaluation with a battery of tests including the mini-mental state examination (MMSE). Thirty nine patients received the clinical diagnosis of AD (age±SD 71±8 years, MMSE±SD 19±5, education±SD 9.3±4.7 years, duration of disease±SD 4±2 years), and 20 patients received the clinical diagnosis of bvFTLD (age±SD 63±10.5, MMSE±SD 18.6±7.6, education±SD 10.4±4.4, duration of disease±SD 2.65±1.6). All the patients had a CT and/or MRI of the brain in order to exclude the presence of anatomical brain lesions. All the patients underwent a brain SPECT scan 20 min after the intravenous administration of 740MBq of 99mTcHMPAO. We applied the NeuroGamTM software on the reconstructed data, for the semiquantitative evaluation of brain perfusion in BA in the right (R) and left (L) hemispheres. Perfusion values in BA were expressed as mean±SD percentage of mean perfusion of the cerebellum.RESULTS: Compared to AD patients, bvFTLD patients had significantly lower mean percentage perfusion values in dorsolateral prefrontal (BA 9L-9R-46L-46R), anterior prefrontal (BA 10L-10R), orbitofrontal (BA 11L-11R) and inferior prefrontal (BA 47L-47R) cortex, anterior and posterior cingulated gyrus (BA 23L-23R-24L-24R-32L-32R), Broca’s area (BA 44L-45L) and BA 8R. BA 46R was found in multiple logistic regression analyses that could discriminate AD from bvFTLD patients (p=0.002), the optimal cut-off value being 63, with sensitivity 74.4%, specificity 80.0%, positive predictive value 87.9 and negative predictive value 61.5.CONCLUSION: Hypoperfusion in specific BA of bvFTLD patients is consistent with the prominent behavioural changes which characterize these patients. Brain perfusion SPECT imaging with automated BA mapping could improve the differential diagnosis between bvFTLD and AD patients.
Aim: due to the incremental disability in patients with Neuromyelitis optica (NMO) is attack related we were interested whether the patients with more optic neuritis (ON) attacks during the clinical course show different patterns of brain perfusion and structure as compare with less ON-attacks patients. Material and Methods: two NMO-patient groups were studied during non-acute phase. Group A (ON attacks ≤ 2) was composed by 8 patients (7 females; attacks range = 1-2); and group B (ON attacks > 2) was composed by 7 patients (6 females; attacks range= 3-4). The control group comprised 8 subjects (7 females). All subjects underwent high resolution brain MRI study (T1 MPRAGE) and 99mTc-ECD SPECT using a double-head system. The voxel-based morphometry (VBM) preprocessing step was performed by DARTEL protocol on SPM8 software. Modulated images were obtained for grey (GM) and white matter (WM) segments. The SPECT images were corrected for partial volume effect and then coregistered onto their respective MRI image and normalized to MNI space by reapplying the same DARTEL parameters obtained from the VBM protocol. For the 3 data set, ANOVA and group comparisons analyses were carried out using Statistical Non-Parametric Mapping (SnPM8) software. The SnPM tests were performed based upon 10,000 random permutations. Correction for multiple comparisons was applied using FWE approach at cluster level (p<0.01). Results: different patterns were identified for each NMO-patient group. GM and WM volumes were extensively increased in the group A as compared with group B in the bilateral frontal and temporal lobe (GM) and in the bilateral peri-aqueductal areas (WM), corresponding to the sites where aquaporin 4 antibody (AQP4) is mostly expressed. Controls were in an intermediate level. Inhibition of AQP4 during the early course of the disease could explain these findings, producing abnormal water movement to the extracellular space (ECS) and consequently producing edema, in agreement with previous immunopathology findings. With more ON attacks AQP4 is lost and then the same regions become atrophied. On the contrary, perfusion was extensively reduced in the group A as compared with controls in the similar WM regions described above (less extensive as compared with group B), which could be interpreted as a compensatory mechanism to reduce water movement (and edema) to the ECS. Conclusions: our findings Improve our understanding about pathogenetic mechanisms involved in the development of MNO and could be useful to differentiate multiple sclerosis patients with an initial event of ON.
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Postictal brain perfusion SPECT with Tc-99m HMPAO is useful to detect the seizure onset zone in patients with symptomatic epilepsy K. f*ckushima, N. Morita, H. Naito; National Cerebral and Cardiovascular Center, Suita, JAPAN. MRI demonstrate morphologic changes in approximately 80% of patients with epilepsy. However, structural lesions may not always correlate with clinical, EEG and pathologic localization of epileptogenic foci. Seizures are associated with pronounced changes in regional cerebral blood flow. Interictal SPECT imaging with Tc-99m hexamethylpropyleneamine oxime (HMPAO), which is more widely
P272 Patients with neuromyelitis optica show different patterns of brain perfusion and structure as the optic neuritis attacks increase during the clinical course
Are Brain Perfusion SPECT Data and Neuropsychological Disturbances correlated in Patients with Alzheimer Disease and Vascular Demantia? E. Ceylan Gunay1, O. Yalin2, A. Ozge2, A. Erdogan1, K. Kiral3, M. Sungur4, B. Tellioglu2, A. Kanik4; 1Mersin University, Faculty of Medicine, Department of Nuclear Medicine, Mersin, TURKEY, 2Mersin University, Faculty of Medicine, Department of Neurology, Mersin, TURKEY, 3Mersin University, Faculty of Science and Literature, Division of Psychology, Mersin, TURKEY, 4 Mersin University, Faculty of Medicine, Department of Biostatistics, Mersin, TURKEY.
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Purpose: The clinical identification and the role of imaging studies for differential diagnosis of dementias is challenging. The aim of this study is to define the correlation of quantitative brain SPECT characteristics and neurophsychological test battary in Alzheimer Dementia (AD), and Vascular Dementia (VaD) patients and evaluate their contribution to diagnosis.Subjects and Methods: A total of 56 AD and 16 VaD patients, and 16 patients in the control group were evaluated by neurophsychological test battary and Tc-99m HMPAO brain SPECT study. All of the patients underwent detailed neurological examination, cerebral magnetic resonance imaging, and labaratory evaluation. Quantitative evaluation of SPECT imaging has been performed and statistically analyzed with comparison to neurophsychological tests.Results: When comparison was done on the basis of neuropsychological screen results; clinical dementia rating scale (CDR),global deterioration scale daily living activity and habituations scale, clock drawing, forward and bacward digit span, abstraction, praxis, understanding, Boston naming and construction test, NPI-total were not statistically different from each other in AD and VaD patients. Mini Mental State Examination was identical in AD and VaD patients, but there was statistically significant difference between study groups when compared with control subjects (p=0,001). When semiquantitative evaluation of SPECT studies were taken into account, the difference between control and AD groups were statistically significant on the basis of the scores of posterior syngulate (p=0,030).In AD group CDR and duration of the disease were statistically correlated to perfusion defects in anterior cingulate gyrus, right frontal and limbic lobes. There was relationship between Global deterioration scale and CDR, and perfusion defects in bilateral limbic region, posterior cingulate gyrus and right parietal lobe in VaD patients. Backward counting in AD patients and daily living activities and habituations in VaD patients were correlated to right parietal perfusion defect.Conclusion: We concluded that brain SPECT imaging with quantitative analysis accompanied by detailed neurophsychological battary provides evaluation of cerebral metabolism more accurately. There are some strictly suggestive clues about usefullness of this method for identification and differential diagnosis of dementia.
P24 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Neurosciences: Clinical Science Psychiatry
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F. Le Jeune1, T. Dondaine2, A. Bourguignon2, M. VERIN3, B. MILLET2; 1 Centre Eugene Marquis, RENNES, FRANCE, 2University Department of Adult Psychiatry, RENNES, FRANCE, 3Neurology Department, RENNES, FRANCE. Aim: From the last ten years, several data have suggested that obsessive compulsive disorder (OCD) could be due to a dysfunction of the orbitofrontostriatal circuits.Deep brain stimulation had recently brought important data within the field of OCD. Due to the strong impact of the PET imaging which shown metabolic modifications consequently to implantation, we decided to reconsider resting glucose metabolism in patients suffering from pure OCD. This study could lead us to reconsider the pathophysiology of OCD and show the evidence for involvement of brain regions outside the prefrontal cortex.Material and Method: We used the data of resting 18FDG-PET data of 15 pure OCD patients with those of 15 ages, sex matched healthy controls. The data were analyzed by SPM2, which allows a statistical voxel by voxel analysis of functional brain images. All subjects were assessed with a neuropsychological battery including executives’ functions. We first analyzed the changes of resting cerebral glucose metabolism between OCD patients and healthy controls and second correlated metabolism modifications and neuropsychological data witch were impaired in OCD patients.Results: Modifications of glucose metabolism were found in frontal regions (orbitofrontal cortex and dorsolatéral cortex), anterior cingulate gyrus, insula and parietal gyrus (figure1). Executive functions impairments are correlated with prefrontal cortex metabolism (Stroop inhibition and London tower), with parietal cortex (London tower and verbal fluencies), and with temporal cortex (Stroop inhibition).Conclusion: As expected, the prefrontal cortex is involved with executive function and procedural memory. These findings are consistent with the literature showing a dysfunction of frontal network in cognitive deficit of OCD. But we here demonstrated that regions outside the orbitofrontal cortex are also concerned with the pathophysiology of OCD. We are in line with a revised model for OCD, proposed by Menzies et al, in which the pathology of OCD associated dorsoparietal cortex, insula, parietal cortex.
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S. Sestini , R. Perone , S. Domenichetti , C. Mazzeo , M. Dona , L. Mansi , A. Castagnoli1; 1Ospedale Misericordia e Dolce, Prato, ITALY, 2Functional Unit for Mental Health A.S.L. 10, Florence, ITALY, 3University Federico II, Neaples, ITALY. Aim: Functional neuro-imaging has been extensively used to detect brain areas underlying the observed improvement in cerebral functions after treatment. The aim of this follow-up study was to assess cognitive and regional cerebral blood flow (rCBF) changes in a group of schizophrenic patients with Psychotic Syndrome treated with a Psychosocial Rehabilitation namely Social Skill Training (SST).Methods: 17 patients underwent two rCBF SPECT studies at rest and in offdrug condition before and after SST at 1 year respectively. Patients were assessed using a careful psychodiagnostic and neuropsychological evaluation (W.A.I.S., T.M.T, Verbal Fluency, Story Recall Test, Wisconsin). SPM was used to investigate baseline rCBF changes from the pre- to the post-SST condition and the relationship between rCBF and clinical scores used as covariate of interest.Results: psychotic patients showed significant improvements in several cognitive functions, particularly in problem solving (W.A.I.S.: comprehension sub-test) and reality examination (W.A.I.S.: picture completion sub-test) which are known to be strictly related to adaptive social performance. The main effect of SST was to produce baseline rCBF increases in the pre-supplementary motor cortex (medial BA6), lateral premotor cortex (BA6), dorsolateral pre-frontal cortex (BA8, 9, 46), orbitofrontal region (BA47), superior parietal cortex (BA5, 7), and posterior cingulated cortex (BA31) (p<0.0001). A significant correlation was detected between increases in rCBF and improvements in cognitive functions. Particularly, a positive correlation was found between the improvement in comprehension sub-test scores and rCBF increases in the premotor (BA6), pre-frontal (BA8, 46), and orbito-frontal cortex (BA 47) (p<0.0001) and between the improvement in picture completion sub-test scores and rCBF increases in the lateral premotor (BA6) and pre-frontal cortex (BA8) (p<0.0001).Conclusion: our study suggests that psychosocial rehabilitation with SST in schizophrenic patients with psychotic syndrome may induce rCBF increases in cortical areas of the so-called default brain network, which are known to be implicated in disease. Particularly, improvement of cognitive functions related to adaptive social performance seems to be mainly related to rCBF increases in frontal cortical regions.
Differences in brain glucose metabolism in bipolar II disorder and borderline personality disorder A. Babovic, E. Bøen, J. Holtedahl, K. Forså, B. Hummelen, S. Karterud, U. Malt, K. Rootwelt; Oslo University Hospital, Oslo, NORWAY. Aim: In psychiatry, the relationship between bipolar II disorder (BIP-II) and borderline personality disorder(BPD) has been debated. Some researchers believe they both represent variations of bipolar disorder, others believe them to represent distinct diagnostic categories. No study has compared the disorders on a neurobiological level. Several studies of resting brain glucose metabolism have been conducted on the disorders separately. Most studies of bipolar disorder have showed a decrease in glucose metabolism in the dorsolateral prefrontal cortex and an increase in the anterior part of gyrus cinguli, while studies of BPD have shown decreased metabolism in medial prefrontal regions. The aim of our study was to compare BIP-II and BPD patients using 18FDG-PET/CT. We hypothesized that the BIP-II group would have a significant higher glucose metabolism in medial prefrontal cortex including the gyrus cinguli compared to the BPD group.Materials and methods: 21 patients (mean age 32.0 years, 71.4% females) with BIP-II and 21 patients (mean age 26.5 years, 85.7% females) with BPD were included. All patients were euthymic to moderately depressed. The two diagnoses in question were mutual exclusion criteria. Clinical psychiatric assessment included diagnostic evaluation using the MINI neuropsychiatric interview and the SCID-II interview and was carried out within 2 days of the PET scan. 18FDG-PET/CT was performed according to standard procedure for PET - brain study during rest. After a short resting period in a dim and quiet room, a dose of 250 MBq 18F-FDG was injected and the image acquisition performed about 1 hour later using a Siemens 64 Biograph PET/CT. The standard MI Siemens Application Softwere was used for the reconstruction. The data was analyzed using the BRASS ™ software (Hermes Medical Solutions), and SPSS (Statistical Package for the Social Sciences).Results: Preliminary results show significantly increased glucose metabolism in gyrus cinguli bilaterally (left: p = 0.001; right: p= 0.012) in BIP-II compared to BPD patients. Results from other brain regions as well as correlations with clinical parameters will be presented at the conference.Conclusion: Preliminary results indicate that BIP-II and BPD patients have differences in resting state glucose metabolism in frontal medial brain regions. The finding supports the notion that the disorders have different biological underpinnings and represent separate diagnostic categories.
Poster Presentations
“Cortical Network Underlying the Improvement of Cognitive Functions in Schizophrenic Patients with Psychotic Syndrome treated with a Psychosocial Rehabilitation: a 1-year follow-up study with regional cerebral blood flow SPECT” 2
OCD networks revisited: PET imaging provides new insights
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Value of combined brain blood flow and Dopamine transporter imaging in patients with dementia
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Tc-HMPAO cerebral blood flow SPECT and scan in mild cognitive impairment.
A. Sreedasyam, S. Muthu, N. Seshadri, S. Vinjamuri; ROYAL LIVERPOOL UNIVERSITY HOSPITAL, LIVERPOOL, UNITED KINGDOM.
F. Ortega-Nava, I. Banzo, I. Martínez-Rodríguez, R. Quirce, J. JiménezBonilla, M. de Arcocha Torres, R. Del Castillo Matos, H. Portilla Quatrociocchi, J. Carril; Hospital Universitario Marqués de ValdecillaUniversidad de Cantabria, Santander, SPAIN.
Purpose:To assess the utility of combined brain blood flow and Dopamine transporter imaging in patients with dementia.Introduction:Diagnosing the cause of dementia has proven to be extremely difficult using clinical assessment and standard cross-sectional imaging studies of the brain alone. Meta-analysis of the literature regarding functional brain imaging in the dementias concluded that functional brain imaging provided critical information in the initial diagnosis of dementia. Despite this, on occasions it is difficult to provide the clinicians a conclusive diagnosis of specific dementia with greater confidence using either Tc99m HMPAO or I123 Ioflupane alone, due to inherent drawback of lower specificity of functional imaging. We tried to assess whether ‘Sequential Brain imaging’ would improve our diagnostic accuracy of various dementia disorders.Materials and Methods:We reviewed 7 Patients with suspected clinical diagnosis of dementia in whom LBD was suspected based on either clinical or scan features. All of these underwent concurrent functional imaging using Tc99m HMPAO and I123 Ioflupane in 2010 (either test first based on clinical symptoms and clinical question). The subsequent functional imaging was justified when the scan diagnosis was inconsistent with clinically suspected diagnosis.Patients undergoing Tc99m HMPAO SPECT imaging were given 500 MBq Tc99m HMPAO injection iv.Patients undergoing I123 Ioflupane study had Thyroid blockade prior to 185 MBq I123 Ioflupane injection. SPECT Brain images were acquired using dual-headed Gamma camera 10 min post injection for Tc99m HMPAO and 3 hour post injection for I123 Ioflupane.The acquired data of projection views were reconstructed with ‘Filtered Back Projection’ using Metz filter. Reconstructed slices were displayed in trans-axial, Coronal and Sagittal planesResults:In 6 of 7 patients with complex clinical symptoms, Tc99m HMPAO was performed first. 4 of these 6 patients had indeterminate diagnosis of dementia for which they underwent I123 Ioflupane study, which conclusively diagnosed Lewy body dementia (LBD). In 2 of 6 patients, the subsequent I123 Ioflupane study ruled out LBD.In 1 of 7 patients with suspected dementia and symptoms consistent with Parkinson’s disease, I123 Ioflupane study was performed first. The study did not show scan features of LBD. A subsequent Tc99m HMPAO study confirmed vascular dementia in this patient.Conclusion:In patients with complex clinical symptoms and signs of dementia, our study clearly showed the usefulness of Sequential functional brain imaging in improving diagnostic confidence of our Nuclear medicine physicians.
P25 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Neurosciences: Neurodegeneration
P278 FDG-PET in Dementia - Correlation Between Different Clinical Tests and Glucose Hypometabolism : Preliminary Report A. Macioszek1, A. Kolodziejczyk1, P. Piwkowski1, J. Zebrowski1, E. Trypka2, R. Wojtynska2; 14th Military Clinical Hospital, Wroclaw, POLAND, 2 Department of Psychiatry, Wroclaw Medical University, Wroclaw, POLAND. Aim:FDG-PET is a well-known examination in dementia diseases. The purpose of this study is to evaluate the relationship between glucose hypometabolism in variety of brain regions and psychiatric tests describing patient clinical condition.Materials and methods:Study includes forty-five patients (28 women; mean age 67,2) with clinical symptoms of dementia and various diagnoses Alzheimer disease (AD), mild cognitive impairment (MCI), vascular dementia (VaD). Patients were examined with neuropsychological tests - CDR (Clinical Dementia Rating), MMSE (Mini-Mental State Examination), GSD (Geriatric Depression Scale) and DemTec (Toolkit for Effective Communication with People with Dementia); then FDG-PET was performed. Hypometabolism in 14 regions on both sides of brain was calculated as z-score, using 3D-SSP (stereotactic surface projection) algorithm implemented in CORTEX ID GE Healthcare program.Statistics was made using Spearman correlation index.Results and conclusions:Highest values of Spearman index with p-level <0,05 were noted between results of MMSE test and glucose metabolism (CMRglc) in anterior and posterior cingulate gyrus (ACG and PCG), parietal and temporal lobes - results above 0,4 (in absolute values). Comparison Dem-Tec test and CDR to CMRglc shows similar results, although Spearman index values were significantly lower.Glucose metabolism in vermis reveal inverse correlation witch dementia severity in all three test; this unexpected result need to be confirmed in further study.As expected, there was no significant correlation with GSD; it proves no dependence between depression and CMRglc.These results indirectly indicate a higher accuracy of MMSE in describing clinical state of patient, as it better reflects pathophysiological processes in brain, proved by PET examination.
18
F-FDG PET/CT
AimMild cognitive impairment (MCI) is considered an intermediate stage between dementia and normal ageing. Our purpose was to perform a comparative analysis of cerebral blood flow (CBF) SPECT and 18F-FDG PET/CT (FDG) scan in patients with different levels of cognitive impairment.Materials and MethodsFrom February to November 2010, a prospective study was carried out in 24 patients (11 men, 13 women, age mean 71.18 years, range 48-83 years). Informed consent was obtained for every patient. Four groups of patients were studied: 1) Subjective memory complaints (SMC) (4 patients) 2) Amnestic MCI (9 patients) 3) Prodromal Alzheimer´s disease (AD) (5 patients) 4) Mild AD (6 patients). Drugs affecting nervous central system were withdrawn whenever possible. CBF SPECT was performed after 740 MBq intravenous injection of 99mTc-HMPAO. 128 projections in a 128x128 matrix were acquired. In an interval shorter than 7 days, an FDG scan was completed. Serum glucose levels were lower than 180 mg/dl. FDG scan was performed in a single bed for 15 minutes after 3 MBq/Kg intravenous injection and 60 minutes incorporation period. Images were analyzed by two experienced observers in neuroimaging studies. Both explorations were examined anonymously, without awareness of either any other exploration or patient history. Discordances between readers were resolved by consensus. Two patients were excluded from the analysis due to technical difficulties.ResultsOverall results: CBF SPECT was normal in 7 patients and showed hypoperfusion areas in 15 of 22 patients. FDG scan was normal in 3 patients and revealed hypometabolism in 19 patients.Results by clinical group: SMC: A positive CBF SPECT was reported in 2 patients; FDG scan demonstrated alterations in 3 of 4 patients. Amnestic MCI: CBF SPECT showed hypoperfusion areas in 3 patients. FDG scan showed hypometabolic areas in 6 of 8 patients. Prodomal AD: Both explorations achieved positive results. Mild AD: All patients showed both hypoperfusion and hypometabolic areas.Extent comparison: Of the 15 patients with a positive CBF SPECT and FDG scan, 6 of them showed larger hypometabolic areas than hypoperfusion findings. These patients were allocated in Amnestic MCI (1 patient), Prodomal AD (2 patients) and Mild AD (3 patients).ConclusionsCBF SPECT and FDG scans showed cerebral hypoperfusion and hypometabolism in patients with cognitive impairment, even in patients with clinical diagnosis of SMC. Hypometabolism is detected in patients with normal perfusion. Some of the patients revealed a more pronounced extent of hypometabolism than hypoperfusion.
P280 Visual Neglect in Posterior Cortical Atrophy: Lesional and Functional Correlates A. Kas1, K. Andrade2, R. Valabrègue3, D. Samri4, M. Sarazin2, B. Dubois2, M. Habert1, P. Bartolomeo5; 1Médecine Nucléaire, Hôpital Pitié-Salpêtrière & UMR_S 678, UPMC, Paris, FRANCE, 2CRICM, INSERM U975 & IMMA, hôpital Pitié-Salpêtrière, Paris, FRANCE, 3CENIR, Hôpital Pitié-Salpêtrière, Paris, FRANCE, 4IMMA, Hôpital Pitié-Salpêtrière, Paris, FRANCE, 5CRICM, INSERM U975 & Department of Psychology, Catholic University, Milan, Paris, FRANCE. Aims. Dysfunction of fronto-parietal networks often causes impaired attention and awareness for contralateral events, called visual neglect (VN). The precise lesional bases of VN remain controversial, and have been poorly explored in neurodegenerative disorders. Our objectives were (i) to characterize VN and its neural correlates in the Posterior Cortical Atrophy (PCA), a focal variant of Alzheimer’s disease characterized by early, higher order visual deficits and a severe parietal atrophy; (ii) to determine whether VN reflects local or network-based cortical deficits using brain perfusion scintigraphy. Materials and Methods. Two VN tasks were performed in 27 PCA patients (62 ± 6.9 year-old): (i) for line bisection (LB), patients were required to mark the center of five 20-cm long lines, each centered on an A4 horizontal sheet; (ii) for the Bell’s test, they were asked to surround 35 bells equally distributed among 280 distracters, in 7 columns on an A4 sheet. A brain perfusion scintigraphy (99mTc-ECD) was obtained in all patients, and in 24 healthy subjects (69 ± 6.9 year-old). Voxel-based correlations were explored between VN scores and perfusion in all patients, and also with gray matter atrophy in a subgroup of 15 patients. Results. Behavioral data: nineteen patients (70%) had signs of VN with LB being more sensitive (59%) than target cancellation (26%). Ten patients presented left neglect (LN), 9 others showed right neglect (RN). Scintigraphy data. PCA group showed severe hypoperfusion in the posterior cortex mainly affecting the right parietal lobe (P<0.05 corrected). The maximal parietal hypoperfusion was found on the right and left hemispheres in LN and RN, respectively. LN revealed more severe hypoperfusion than RN in the right parietal, temporal and prefrontal cortices (P <0.001). The correlation analyses revealed that LN was associated with right parietal atrophy, and with large hypoperfused areas
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P281 Glucose brain metabolism alterations in chronic smokers S. Cauda1, G. Castellano1, B. Baudino1, A. Skanjeti1, A. Parente1, M. Zotta1, F. Giunta1, M. Manfredi1, F. D’Agata2, P. Caroppo2, G. Bisi1; 1Nuclear Medicine Unit , University of Turin, Turin, ITALY, 2AOU San Giovanni Battista, Department of Neuroscience, Turin, ITALY. Background: Chronic smoking is associated with multiorgan damage, typically pulmonary and cardiovascular diseases. A growing number of studies on MRI in smokers have demonstrated morphological and functional alterations in cerebral structures, in particular the prefrontal lobes, and there also appears to be evidence on cerebral modifications induced by treatment for tobacco dependence.Aim of this study was to explore possible alterations of brain glucose metabolism in chronic smokers.Materials and Methods: we studied the brain [18]FDG-PET images at resting state of 31 adult patients: 20 non smokers (14M and 6F: mean age: 56.9 ± 11.1yrs) and 11 chronic smokers (6M and 5F; mean age: 54.8 ± 16.6yrs) referred to our institution for oncological work-up without evidence of central nervous system involvement, no known neuro-psychyatric pathologies, and no treatment. Mood and neurobehavioral performances were assessed by the administration of standardized neuropsychological tests (Mini Mental State Examination, Verbal Fluency, Short Story, Trail Making Test B, Montgomery-Asberg Depression Rating Scale, Hospital Anxiety and Depression Scale, State Trait Anxiety Inventory) to exclude neurocognitive deficits.Voxel-based statistical analyses were performed by Statistic Parametric Mapping (SPM2). Spatially normalized and proportional scaled images were analyzed by using a General Linear Model. In this analysis age and sex were used as nuisance factors. Statistical thresholds of p<0.05 for each analysis were applied. Clusters with p ≤0.05 corrected for multiple comparisons were considered as significant.Results: smokers, compared to no-smokers, presented a significant deficit of regional cerebral metabolic rate of glucose metabolism (rCMRglc) in the left frontal lobe (p=0.008) in particular in the prefrontal cortex, (Broadmann area 9). The extension of this cluster was more than 5000 voxels. Further analysis showed in this group of patients a trend toward significance of increased rCMRglc in the right cerebellar hemisphere in particular in the culmen (p=0.062) with an extension of more than 2000 voxels.Conclusions: in this study, deficits in glucose metabolism evidenced in the left prefrontal lobe, confirm the detrimental role of tobacco in the nervous system. Given that metabolic changes precede structural ones, cerebral FDG-PET could be used to evaluate the effects of treatment in smokers. Moreover, it appears that some possible compensatory dynamics could partecipate in this setting, in particular we observed a greater glucose metabolism in cerebellar structures. Finally, a clear evidence of cerebral damage could be a greater incentive to stop smoking.
P282 The SPM and Neurogam analysis of perfusion SPECT data in the differential diagnosis of dementia disorders C. Tranfa*glia1, L. Parnetti2, D. Siepi1, L. Bellesi3, I. Sabalich1, L. Fedeli1, H. Sinzinger4, B. Palumbo1; 1Section of Nuclear Medicine, Department of Surgical Radiological and Odontostomatological sciences, University of Perugia, Perugia, ITALY, 2Neurological Sciences Department, University of Perugia, Perugia, ITALY, 3Laboratory of Medical Physics and Expert Systems, Regina Elena Institute –IFO, Rome, ITALY, 4Department of Nuclear Medicine, University of Vienna, Vienna, AUSTRIA. AimThe aim of our study was to compare two software for semiquantitative analysis of perfusion SPECT data (Neurogam and Statistical Parametric MappingSPM) in detecting specific hypoperfusion patterns in different dementia categories.Materials and methodsBrain SPECT with 99mTc-HMPAO was performed in 43 patients, 17 with Alzheimer’s disease (AD), 17 with Fronto-Temporal Dementia (FTD) and 19 with Mild Cognitive Impairment (EADC criteria). SPECT data were analysed by SPM2 comparing groups using t-student test (p<0.05) and by the software NeuroGam (Segami Corp.), that compares single patients with a database of healthy subjects expressing results as SD. Mean values obtained within ROIs of Brodmann areas (BA) in different groups were evaluated by one-way ANOVA with Tukey’s correction (p< 0.05).ResultsIn AD patients both Neurogam and SPM analysis showed significant hypoperfusion in cyngulate gyrus, temporal association cortex, left parietal association cortex in comparison with MCI subjects. Neurogam identified as significantly hypoperfused also the superior temporal gyrus, while SPM also the left insula and the right middle and inferior frontal gyrus. Comparing AD with FTD Neurogam showed significantly hypoperfused left parietal association
cortex while analysing data with SPM also right parietal association cortex and superior and left middle temporal gyrus raised a significant level of hypoperfusion.In FTD patients when compared with MCI both methods showed a significant hypoperfusion in the cyngulate gyrus, frontal operculum and frontal association cortex; furthermore SPM analysis demonstrated significant differences also in the right medial frontal gyrus and the right parietal association cortex. When comparing the same subjects with AD patients only SPM detected significant hypoperfusion in the pre- and postcentral gyrus and superior-inferior and medial frontal gyrus.Conclusion: Neurogam and SPM semiquantitative analysis of perfusion SPECT were similarly useful to differentiate dementia categories identifying specific hypoperfusion pattern.In both cases the limbic cortex hypoperfusion distinguished dementia and MCI.Moreover both software identified the alteration of strategical parietal and temporal areas characteristic of our AD patients and the frontal area hypoperfusion, more typical of the FTD group.SPM detected a significant impairment always in more areas than Neurogam. This tool, suitable for clinical daily practice, provides a comparison of perfusion difference with respect to normal subjects among groups, while SPM simply identifies significant differences between groups showing a high sensitivity with a specificity strictly depending on the number of subject per group
P283 Brain SPECT perfusion patterns of verbal fluency tests in the normal elderly R. Pichova1, H. Trojanova1, A. Bartos1, O. Lang1, D. Ripova2; 1University Hospital, Prague 10, CZECH REPUBLIC, 2Psychiatric Center, Prague 8, CZECH REPUBLIC. Introduction: Verbal fluency tests (VFT) are simple neuropsychological tests, which can hint cognitive impairment. Two different tasks are used: the phonemic one (PVF) (to name as many words beginning with the letters N, K, P as possible) and categorical - semantic one (SVF) (to name as many fruits, animals and shopping items as possible), both within one minute limit.Aim: The aim of this study was to identify perfusion SPECT brain correlates with PVF and SVF performances in seniors without cognitive impairment.Subjects and Methods: We evaluated a group of 49 healthy volunteers (f/m 37/12, mean age 67 + -6 years, age range 56-83). We assessed the relationships between the number of words summarized in each VFT and brain perfusion values using SPM.Results: The PVF performance is reflected by the cerebral perfusion in multiple areas: occipital cortex, cerebellum, gyrus cinguli anterior, posterior and the thalamus, the highest correlation being in the frontoparietal area.The word number of SVF is related to brain perfusion mainly in the temporal cortex. Other areas (thalamus, radiatio optica, gyrus cinguli posterior and Brocca´s center) correlated less.Conclusion: Each VFTs requires different strategy which is supported by distinct brain foci observed on SPECT examination. Temporal localization of SVF is in a good agreement with initial impairments of SVF in Alzheimer disease (AD). Multifocal nature of PVF explains relative resistance to decline in early phases of AD.This study was supported by research projects MSMT CR 1M0517 and MH CR MZ0PCP2005.
P284 The contribution of brain perfusion SPECT with Brodmann areas mapping in the differential diagnosis of Alzheimer’s disease from Frontotemporal lobar degeneration V. Valotassiou1, J. Papatriantafyllou2, N. Sifakis3, C. Tzavara1, J. Tsougos1, D. Psimadas1, E. Kapsalaki4, G. Chadjigeorgiou5, P. Georgoulias1; 1 Department of Nuclear Medicine, University Hospital of Larissa, Larissa, GREECE, 2Memory & Cognitive Disorders Clinic, Department of Neurology, “G.Gennimatas” Hospital, Athens, GREECE, 3Department of Nuclear Medicine, “Alexandra” University Hospital, Athens, GREECE, 4Department of Radiology, University Hospital of Larissa, Larissa, GREECE, 5Department of Neurology, University Hospital of Larissa, Larissa, GREECE. AIM: Frontotempolar lobar degeneration (FTLD) and Alzheimer’s disease (AD) patients may be similarly impaired in several cognitive tasks, increasing the difficulty of the differential diagnosis. The aim of our study was the evaluation of perfusion in specific Brodmann areas (BA) in AD and FTLD patients, using an automated 3D-voxel-based processing software, in order to reveal more localised perfusion differences between these disorders and improve the differential diagnosis of AD from FTLD patients.MATERIALS-METHODS: We studied 112 consecutive patients from an outpatient Memory Clinic. We used the established criteria for the diagnosis of dementia and the specific established criteria for the diagnosis of AD and FTLD. All the patients underwent a neuropsychological evaluation with a battery of tests including the mini-mental state examination (MMSE). Thirty nine patients received the clinical diagnosis of AD (age±SD 71±8 years, MMSE±SD 19±5, education±SD 9.3±4.7 years, duration of disease±SD 4±2 years), and 73 patients received the clinical diagnosis of FTLD (age±SD 65±9 years, MMSE±SD 16±9, education±SD 10.7±4.7 years, duration of disease±SD 3±2 years). All the patients had a CT and/or MRI of the brain in order to exclude the presence of anatomical brain lesions. All the patients underwent a brain SPECT scan 20 min
Poster Presentations
including the right parietal and superior frontal cortices whereas LN was associated with right frontal and insula hypoperfusion on target cancellation (P <0.005). On this task, RN correlated with left temporal and temporo-occipital hypoperfusions. Conclusions. Our findings suggest that neglect tasks partially dissociated in terms of behavior and brain perfusion, consistent with the hypothesis that they tap distinct components of the neglect syndrome each based on specific neural substrates. These results also complement data from patients with focal brain lesions, showing that VN in PCA depends on dysfunction of large-scale fronto-parietal networks, including regions not directly affected by cortical atrophy.
S327
S328 after the intravenous administration of 740MBq of 99mTc-HMPAO. We applied the NeuroGamTM software on the reconstructed data, for the semiquantitative evaluation of brain perfusion in BA in the right (R) and left (L) hemispheres. Perfusion values in BA were expressed as mean±SD percentage of mean perfusion of the cerebellum.RESULTS: The BA 9L-9R-46L-46R (dorsolateral prefrontal cortex), 10L-10R (anterior prefrontal cortex), 11L (orbitofrontal cortex), 23L-23R-24L-32L32R (posterior and anterior cingulated cortex), 25L-25R (subgenual cortex), 44L-44R (pars opercularis), 47L-47R (inferior prefrontal cortex), 17L (primary visual cortex) and 8L had significantly lower mean percentage perfusion values in FTLD compared to AD patients. Multiple logistic regression analyses showed that 46R could differentiate between AD and FTLD patients (p=0.017). Roc analysis demonstrated that the optimal cut-off of 46R for the discrimination of AD from FTLD patients was 62 with sensitivity 76.9%, specificity 50.7%, positive predictive value 45.5 and negative predictive value 80.4.CONCLUSION: Hypoperfusion in BA mainly of the frontal lobes in FTLD patients compared to AD patients, is consistent with the neuropsychological features associated with FTLD. Brain perfusion SPECT imaging with automated BA mapping could improve the definition of brain areas that are specifically implicated in these disorders resulting in a more accurate differential diagnosis.
P26 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Neurosciences: Dopamin Imaging
P285 Inter-limb transfer of implicit motor learning is related to dopamine innervation of the striatum G. Marotta1, I. U. Isaias2, C. Moisello3, P. Cavallari2, F. Voltini1, G. Pezzoli4, M. F. Ghilardi3, P. Gerundini1; 1Nuclear Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, ITALY, 2Human Physiology Department, Universita' di Milano, Milano, ITALY, 3Department of Physiology and Pharmacology, CUNY Medical School, New York, NY, UNITED STATES, 4Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, ITALY. AIM: Inter-limb transfer of a motor skill implies the formation with a limb of an internal model that can be applied to the other limb with different dynamic characteristics. The adaptation to a visuomotor rotation is a learning process that occurs mostly implicitly and that has been shown to transfer to some extent to the opposite effector. In this work, we investigated whether striatal dopamine is involved in implicit visuomotor adaptation and inter-limb transfer using Parkinson’s disease (PD) as a model.METHODS: We thus studied the time course of motor adaptation to 30° visual rotation of the cursor in 11 drug-naïve patients with PD versus a control group of age-matched neurologically intact right-handed adults. All subjects performed ten blocks of movements with the right hand in which they adapted to a 30° visual rotation of the cursor, and then performed one block of rotation adaptation with the left hand.The 11 PD subjects and 15 age-matched healthy subjects underwent I123-FP-CIT SPECT. The voxel-wise analysis was applied to SPECT images by means of “single-subject: conditions and covariates” design: the PD patients and healthy controls were modeled as ‘conditions’, and the ‘covariates’ were the score of adaption transfer and the score of curvature transfer. For each individual SPECT acquisition, a parametric binding image was calculated using ImCalc and WFU-PickAtlas toolboxs.RESULTS: Transfer of adaptation derived from the directional error was lower in patients compared to controls (Controls: 84.12±2.33 %; PD: 71.35±4.57 %, p<0.05). On the contrary, transfer of curvature resulted similar in the two cohorts.The voxel-wise analysis revealed the dopamine transporter (DAT) density significantly differed in caudate and putamen bilaterally in PD subjects versus healthy control (p<0.001), consistent with the typical presynaptic pattern described in PD patients. In PD subjects the covariate analysis identified that DAT density of right caudate and putamen was associated with the adaption transfer score (p<0.01).A selective correlation between right-to-left transfer of directional error, but not of curvature, positively correlated with DAT binding values of the right striatum (opposite to the transfer direction) (caudate: p<0.01, ρ=0.74 and putamen: p=0.01, ρ=0.71).CONCLUSION: Despite normal adaptation rates, patients with PD showed a reduced transfer compared to agematched normal controls. The magnitude of the transfer, but not the adaptation rate, was predicted by dopamine-transporter binding values of the right caudate and putamen. We conclude that striatal dopaminergic activity is crucial to retain and transfer visuomotor skills.
P286 Evaluation and comparison of quantification tools for early diagnosis of Parkinson's disease with DaTSCAN SPECT. A. Davidsson1, C. Georgiopoulos1, A. Gustafsson2, H. Zachrisson1; 1 Division of Cardiovascular Medicine, Department of Medical and Health Sciences, University Hospital, Linköping, SWEDEN, 2Dept of Radiation Physics, University Hospital, Linköping, SWEDEN.
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 Background: In Parkinson’s Disease (PD) the degeneration in the basal ganglia starts long before the onset of clinical symptoms. DaTSCAN SPECT (isotope 123I) is a useful tool in order to identify early degeneration. Both the visualisation and the quantification of the uptake of striatum are used in order to set a diagnosis.EXINI DAT (EXINI diagnosed AB, Lund, Sweden) is a newly developed software for quantification of uptake of striatum using 3D calculations. Comparison is needed with 2D calculations for quantification (Xeleris (GE medical) using (Crescent ROI analysis, written in Alladin).Aim: To estimate if Putamen/Caudatus and (StriatumOccipital)/Occipital ratios differ between EXINI and Xeleris software. A second goal was to examine if it is possible to distinguish between patients in an early phase of Parkinson’s Disease (Group A) from healthy individuals (Group B) and patients with Parkinson’s Disease (Group C).Materials and Methods: Thirteen healthy individuals (Group A), (8 males/ 5 females), aged 68 (49-78). Twenty-one patients in an early stage of PD, before the onset of L-dopa medication (Group B), (13males/ 8 females), aged 65 (50-77). Twenty patients with PD (Group C), (12 males/ 8 females), aged 62 (43-79). For all calculations, the lowest striatal uptake ratio was used. In EXINI software a correction factor can be used for partial volume’s effect in 3D (2.5). DaTSCAN SPECT: Patients were examined with a gamma camera (Millennium VG with LEHR collimator, General Electric). Statistical analysis: All data are presented with mean (SD) and for calculations unpaired t-test were used.Results: We found a significant difference in the ratio (StriatumOccipital)/Occipital between Xeleris and EXINI (p<0.001), but not concerning the ratio Putamen/Caudatus, (p>0.05). There was a significant difference for both ratios (p<0.001), between control participants and patients in an early phase of PD, independent of the used software. The ratio (Striatum-Occipital)/Occipital showed a significant difference between patients in an early phase of PD and PD patients (p<0.05) compared to the ratio Putamen/Caudatus (p>0.05) (no significant difference).Conclusions: This study shows that the ratio Putamen/Caudatus seems to be fairly robust when comparing Xeleris and EXINI softwares. The results also show that calculation of specific uptake ratios for DATSCAN can be used as a complement to visual assessment of striatal uptake in Parkinssons disease.
P287 Critical DaTSCAN differences between Dementia with Lewy bodies and Parkinson’s disease B. Shepherd, P. M. Kemp; Southampton Universities Hospitals NHS Trust, Southampton, UNITED KINGDOM. BackgroundThe DaTSCAN has proved to be a highly accurate marker in patients with suspected Parkinson’s disease and the abnormal scan is easily identified by the loss of the uptake in the putamen. This is consistent with histological data demonstrating the loss of the dopaminergic terminals in this part of the striatum with preservation of the caudate nuclei. However in patients presenting with DLB it has been shown histologically that there is a more balanced loss of presynaptic dopaminergic terminals affecting both the caudate as well as the putamen. Theoretically this should give rise to a slightly different scan appearance on in vivo imaging.MethodsA consecutive series of 37 patients with PD and 37 patients with DLB were selected who were imaged in their diagnostic phase and their disease state was subsequently confirmed on clinical follow up. All scans were anonymised and assessed separately for the pattern of uptake to the striata and background. Striatal appearances were classified as either caudate only (full stops), asymmetrical scan of caudate only on one side and caudate + putamen on the other (full stop and comma), or caudate and putamen seen bilaterally (commas). The background was classified as either normal, moderate or markedly raised.Results92% of PD patients had the classical appearance of either uni or bilateral caudate nuclei only, compared to 62% of DLB patients (p<0.01). 54% of PD patients had raised background levels compared to 81% of DLB patients (p<0.05).In total, 38% of DLB patients and 8% of PD patients had images demonstrating uptake in both putamen and caudate nuclei with significantly raised background activity (p<0.01) i.e. representing a balanced reduction of tracer uptake throughout the striata.ConclusionThis study clearly shows that approximately 1/3 of patients with DLB will have striatal appearances showing both the caudate and putamen on a DaTSCAN however the significantly raised background (i.e. weak commas) indicates dopaminergic terminal loss throughout the whole striatum. This pattern of image findings is consistent with histopathological findings and is critically important that this pattern is identified when interpreting these images.
P288 DAT-SPECT in patients with parkinsonism and SAE E. Funke1, A. Kupsch2, F. Klostermann3, R. Buchert1, I. G. Steffen4, W. Brenner1, M. Plotkin1; 1Charité Berlin, Department of Nuclear Medicine, Berlin, GERMANY, 2Charité Berlin, Department of Neurology Campus Virchow Klinikum, Berlin, GERMANY, 3Charité Berlin, Department of Neurology Campus Benjamin Franklin, Berlin, GERMANY, 4Charité Berlin, Department of General, Visceral, and Thoracic Surgery, Berlin, GERMANY. Aim:Subcortical arteriosclerotic encephalopathy (SAE) can impair the nigrostriatal system and cause a vascular pseudoparkinsonism (VP) (1). The differentiation of VP
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P289 FP-CIT SPECT reported with BasGan (V2) and with our selfmade software: correlation with final diagnosis at late follow up M. Margheron1, A. Skanjeti2, T. Angusti1, M. Giors1, M. Di Franco3, E. Trevisiol1, V. Podio1; 1Nuclear Medicine Unit, University of Turin, Orbassano, ITALY, 2Nuclear Medicine Unit, University of Turin, Turin, ITALY, 3Hospital Pharmacy, Ospedale San Luigi Gonzaga, Orbassano, ITALY. Introduction: FP-CIT SPECT is widely used in the assessment of extra-pyramidal diseases. Report of FP-CIT SPECT is usually both qualitative and semi-quantitative. BasGan (V2) has been proposed as a tool to uniform images evaluation by the use of automated VOIs; furthermore, it has been used to analyze SPECT from normal subjects according to age: data are included in the package and it is possible to compare patients results with normal values.Aim of our study was to evaluate BasGan results and to compare them with those from our self-made software, when final diagnosis has been achieved.Materials and methods: SPECTs from 59 patients (age 68+/-8 years, 32 M and 27 F) were obtained on 2006 and 2007. Final diagnosis was established by the neurologists in light of all relevant data; diagnosis were dicotomized (true Parkinson disease and parkinsonisms vs. essential tremor and non-extrapyramidal disease). Images were obtained with dual-head camera with LEHR parallel hole collimators, 120 images/360°, 40 sec/image, pixel size 2.92 mm. Filtered backprojection was used for BasGan as requested, while iterative reconstruction was used for analysis of our self-made semi-quantitative evaluation software. BasGan (V2) builds full-3D volumes of interest (VOIs) of both caudates and putamina; our software analyzes a single 2 cm thick slice with ROIs of caudates and putamina. In all occurrences, we considered the worst result of the two caudates as “caudate” result and the worst value of the two putamina as “putamen”. When analyzing results with BasGan (V2), we evaluated patients’ data also with age-related normal values (we tested both differences from and ratio to “normal” values). Statistical analysis was performed by logistic regression; finally ROC curves were obtained.Results: all results showed a good correlation with final diagnosis. With BasGan (V2) results, logistic regression demonstrated a significant correlation between final diagnosis and caudate values (p<0.001) as well as putamen values (p=0.0001); our self-made software gave similar results.The obtained eight ROC curves showed high AUC values (range 0.82-0.89, p≤0.0001 for all occurrences).Conclusion: BasGan(V2) and our self-made software showed similar accuracies in reporting FP-CIT SPECT images. However, BasGan working with automated VOIs is more operator independent than the in-house software, in particular from operator’s experience. On the other hand, BasGan has been proposed to be used in order to compare exams from different centers: this is our next goal.
P290 What can be learned about 123-I ioflupane brain SPECT as a diagnostic tool in patients with movement disorders - three years of experience
R. Petrovic1, T. Samardzic1, M. Relja2, S. Telarovic2, L. Unusic2, D. Dodig1; 1 University Hospital Zagreb, Clinical Department of Nuclear Medicine and Radiation Protection, Zagreb, CROATIA, 2University Hospital Zagreb, Clinic of Neurology, Zagreb, CROATIA. Aim: to evaluate the effectiveness of brain SPECT with 123I-ioflupane (DaTSCAN) in detection of nigrostriatal neuronal integrity in patients with clinically diagnosed movement disorder.Materials and methods: In group of 159 patients with clinical diagnosis of: Parkinson disease (PD) (62; 39%), essential tremor (ET) (63; 39.6%), hepatolenticular degeneration (15; 9.4%), Parkinson plus syndromes (MSA, PPS) (8; 5%) and other (dementia, dystonia, extrapyramid symptoms) (11; 7%) a dose of 185 MBq of 123I-ioflupane was administered and SPECT imaging conducted after 4 hours. Images were analyzed visually, classifying SPECT images as normal or pathologic (in 5 stages of striatal uptake reduction), and semiquantitatively using ROI based method.Results: In a group of 63 patients clinically diagnosed as ET the 123I-ioflupane brain SPECT was normal in 21 patients (33 %) while 42 patients (67 %) showed different stages of pathologic reduction in striatal uptake. In 51 of 62 patients (82 %) clinically suspected as Parkinson's disease pathologic nigrostriatal reductions of 123I-ioflupane were found, while 11 patients (18%) had normal scans.Striatum, caudate and putamen uptake ratios were significantly reduced, even in early stage of disease and S/NS ratios were highly correlated with the disease stages and severity assessed by Hoehn and Yahr rating scale. Looking at group of 125 patients with PD and ET there was confirmation of clinical PD diagnosis in 51 (40%) patients (thus increasing clinical confidence), non-PD confirmation in 21 (17%) patients, diagnose is changed to PD in 42 (34%) patients and changed to non-PD in 11 (9 %) patients. All patients benefited from 123Iioflupane SPECT, mostly the group of 42 (35%) patients whose diagnosis switched from suspected ET to PD and new therapy was initiated. Therapy was withdrawn in 9% of patients while 40% patients confirmed as PD gained mostly from avoidance of unnecessary hospitalizations and other preplanned tests.In group of 15 patients with hepatolenticular degeneration apparent loss of the 123I-ioflupane uptake in the striatum was found in 9 patients (64 %), suggesting significant damage in presynaptic nigrostriatal dopaminergic nerve terminals.Conclusion: 123I-ioflupane brain SPECT has an important role in detecting and monitoring nigrostriatal dopaminergic degeneration and should be routinely used in clinical practice to support the diagnosis of PD and differentiate between other conditions. Moreover, 123I-ioflupane brain SPECT can be used as important contribution to the early diagnosis of PD. Also, it could be significant diagnostic aid in detection and followup of patients with Wilson's disease.
P291 Interobserver agreement in the visual and semi-quantitative analysis of the 123IFP-CIT SPECT images in the diagnosis of Parkinsonian syndrome. M. Suárez-Piñera1, L. Prat2, J. Fuertes1, S. Mojal3, E. Balaguer4; 1Nuclear Medicine Department. Hospital del Mar- CRC Mar, Barcelona, SPAIN, 2 Nuclear Medicine Department. Hospital General de Catalunya- CRC Mar, Barcelona, SPAIN, 3Statistics Department AMIB-IMIM, Parc de Reserca Biomédica de Barcelona (PRBB), Barcelona, SPAIN, 4Neurology Department. Hospital General de Catalunya. Sant Cugat del Valles., Barcelona, SPAIN. Aims: Presynaptic degeneration of the dopaminergic pathway is possible to evaluate using 123I-FP-CIT SPECT by studying the dopamine transporter (DAT). A correct analysis and interpretation of the SPECT images contributes to study and to diagnose parkinsonian syndrome in patients with movement disorders. Aims:1. To compare visual and semiquantitative analysis of 123I-FP-CIT SPECT images in patients with movement disorders. 2. To evaluate interobserver agreement in visual and semiquantitative analysis. 3. To obtain a cut-off in the semiquantitative analysis to discriminate primary Parkinsonism Syndrome (PS) from non-primary PS.Methods: A 123I-FP-CIT SPECT was performed in 32 patients (12 F, 51-88 yrs)with movement disorders suggestive of primary PS. Visual and semiquantitative images analyses were performed independently by two nuclear medicine physicians. Visual analysis was based on the visual interpretation. Semiquantitative analysis was calculated as specific uptake (caudate, putamen and striatum) versus non-specific uptake (occipital). Sensitivity, specificity, PPV, and NPV were calculated. Data were compared using ANOVA test followed by Bonferroni post-hoc test. Interobserver agreement of the visual and semiquantitative analysis was assessed by intraclass correlation coefficient and Kappa statistics, respectively. ROC curve was generated with semiquantitative data.Results: Visual analysis showed 86% sensitivity and 100-88% specificity for the differential diagnosis of primary PS from non-primary PS. Semiquantitative analysis showed a gradual hypouptake proportional to the disease severity obtained in the visual analysis. Semiquantitative analysis did not provide any additional information to the visual analysis. Intraclass correlation coeffcient and Kappa statistics showed 0.92 and 0.80 values, respectively. The Cut-off value to differentiate primary PS from non-primary PS was1.9 on the putamen index.Conclusions:Qualitative and semiquantitative analysis of 123I-FP-CIT SPECT images are able to demostrate presynaptic dopamine hypoactivity indicative of PS, however semiquantitative data does not provide any
Poster Presentations
from idiopathic Parkinson’s syndrome (IPS) in pat. with SAE is often difficult. The aim of the present study was to examine the presynaptic part of nigrostriatal system in pat. with SAE and parkinsonism.Methods:15 consecutive pat. with parkinsonism and SAE (as detected by MRI) were retrospectively selected from a database of pat., studied in our clinic with 123I-FP-CIT SPECT in the last 5 years. Out of these 15 pat., 9 had akinetic-rigid symptoms and 5 had an equivalent type of parkinsonism. As a reference group served 15 retrospectively chosen age- and gender-matched pat. with clinical diagnosis of IPS (12 with akinetic-rigid symptoms; 2 with equivalent type of parkinsonism an 1 pat. with tremor-dominant parkinsonism) without any abnormalities in MRI. 123I-FP-CIT SPECT data were acquired on a triple-head system (Multispect 3, Siemens) and quantified using an investigator-independent BRASSTM software (HERMES). Specific binding ratios (BRs) for striata, caudate nuclei and putamina were calculated with occipital lobe as a reference region. After testing the BR values for normality, the differences were analysed using the t-test for independent samples.Results:We found a DAT deficit in 9/15 pat. from the SAE-group and in 15/15 pat. from the reference group (p=0.008; Fisher's exact Test). The BRs for putamen contralateral to the more affected limb were significantly higher in pat. with SAE as compared to the IPSgroup (mean values±SD: 1.20±0,74 vs. 0.77±0.33, p=0.05). The BR values for ipsilateral putamen, both caudate nuclei and both striata were higher in the SAEgroup (the difference was not significant).Conclusion:In our study, DAT deficit was observed in patients with parkinsonism and SAE less frequently than in age- and gender-matched IPS patients without any abnormalities on MR scans. Patients with SAE who present parkinsonian symptoms, but show no DAT-deficit possibly suffer on VPS. Pseudoparkinsonism caused by SAE may contribute to the group of socalled ,,subjects without evidence of dopaminergic deficit“ (SWEDD). A potential role of DAT SPECT in the differential diagnosis of VPS and IPS requires further assessment within prospective studies.Literature:1. Winikates J, Jankovic J (1999) Clinical Correlates of Vascular Parkinsonism. Arch Neurol 56: 98-102.
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additional information to the visual analysis in our sample of patients. There is high interobserver agreement in the visual and semiquantitative analysis of the 123I-FPCIT SPECT images encouraging the strength of this test.
P292 Evaluation of Parkinson´s Disease Progression with Statistical Parametric Analysis of 123I-FP-CIT SPECT: Preliminary Results P. Tamayo, C. Montes, F. Gomez-Caminero, D. Sevillano, P. Cacabelos, E. Martin, R. Ruano, A. Rosero, J. R. Garcia-Talavera; UNIVERSITY HOSPITAL OF SALAMANCA, SALAMANCA, SPAIN. INTRODUCTION. It is known that Parkinson´s disease is a progressive neurodegenerative movement disorder accompanied by a progressive loss of dopamine transporters (DAT) localized in the presynaptic nigrostriatal nerve terminals. The aim of this study was to delineate the loss of DAT during disease progression in patients with parkinsonism using statistical parametric analysis of 123I-FPCIT SPECT data.MATERIAL AND METHODS. We studied 14 patients with Parkinson´s disease (9 women, mean age 65 years) who had been referred from neurology service to diagnosis and follow-up. All patients were scanned on two separate occasions with 123I-FP-CIT SPECT as part of a longitudinal study of parkinsonism, i.e. baseline and repeat, with a mean scan interval of 33 months. SPECT studies were analysed with the SPM8 software package. Images were normalized to a specific FP-CIT template and smoothed. Striatal binding-ratio (SBR) values were obtained for each voxel using mean counts in the occipital region. The second study were substracted from the first one for each patient, and this new study were correlated with the number of months between both studies, using a multiple regression model with significance threshold at p<0,001 uncorrected for multiple comparisons and k > 50 voxels for cluster extent.RESULTS. The SPM analysis revealed the presence of a significant reduction in dopamine transporter binding between the two scans. This reduction was located in the left caudate and directly correlated with the number of months between the two studies.CONCLUSION. Our results confirm that statistical parametric analysis of serial 123I-FP-CIT SPECT data demostrates progressive DAT loss in patients with parkinsonism, showing that serial FP-CIT studies may be useful in monitoring disease progression and effects of neuroprotective treatments.
P293 Small animal SPECT/CT brain imaging: Reverse translation using validated tracers M. Raki1, E. Hippeläinen2, M. Pitkonen3, S. Savolainen3, K. Bergström1; 1 Centre for Drug Research, Faculty of Pharmacy, University of Helsinki, Helsinki, FINLAND, 2HUSLAB, Helsinki, FINLAND, 3Department of Physics, University of Helsinki, Helsinki, FINLAND. Molecular imaging such as SPECT is valuable tool in drug development. Besides clinical imaging trials, preclinical imaging is, especially, an opportunity to decrease the drug development costs. Small animal SPECT/CT imaging is a recently established methodology to study rodent brain, and SPECT has been shown to be capable of accurate, repeatable, and quantitative measurement of the receptor occupancy in the mouse brain. In this study, a clinically validated tracer, I-123 betaCIT, was evaluated in rodent brain imaging to show its applicability in preclinical drug development.Methods: Four-headed multipinhole nanoSPECT/CT (Bioscan Inc.) gamma camera featuring 1.0 mm pinhole apertures was used for imaging. The image quality and system resolution was evaluated using a resolution phantom. Three healthy mice received 40 MBq of I-123 beta-CIT intravenously and SPECT acquisition was started 4 h post-injection. Image analysis was performed using region of interests (ROIs) drawn over striatum (str) and cerebellum (cbl). The parameter V’’3 was calculated as a ratio of specific binding to non-specific binding: [ (ROI_str - ROI_cbl) / ROI_cbl ].Results: Phantom image showed that image quality was excellent and rods were resolved in the images. Traditional ROI analysis showed comparable results by two independent researchers, V’’3 = 10.5 +- 1.0 and V’’3 = 9.6 +- 1.7, respectively (mean+-SD). A template based analysis with healthy mice will be evaluated: Comparison with traditional vs. template ROI analysis and longitudinal test-retest results.Discussion: I-123 beta-CIT is used extensively in clinical trials. Based on imaging, clinical drug developers may provide feedback on early discovery regarding clinical needs. Image quality of small objects is better than that available from current small animal PET devices. Reverse translation of SPECT imaging using validated tracers may help to overcome potential limitations regarding tracer development.Conclusion: Preclinical SPECT/CT brain imaging using I-123 beta-CIT appears to be a feasible methodology to study rodent dopamine transporter density in healthy and diseased states. It may be possible to utilize other clinically validated SPECT tracers in preclinical drug development in a same manner.
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Correlation between I-IBZM SPECT and clinical diagnosis in parkinsonian syndrome
A. Sainz-Esteban1, P. García-Talavera1, J. Marco2, M. Tola-Arribas3, M. Ruiz1, M. Gonzalez-Selma1, R. Olmos1, C. Gamazo1, M. Muñoz-Moreno4, A. Gómez-López1; 1Department of Nuclear Medicine. Hospital Clínico Universitario, Valladolid, SPAIN, 2Department of Neurology. Hospital Clínico Universitario, Valladolid, SPAIN, 3Department of Neurology. Hospital Universitario Río Hortega, Valladolid, SPAIN, 4Research Department. Hospital Clínico Universitario, Valladolid, SPAIN. Aim: To determine the concordance between 123I-IBZM SPECT (123I-IBZM) and clinical diagnosis in patients with parkinsonian syndrome with atypical symptoms and/or no response to standard therapy.Material and methods: The study included 21 patients (10 males; mean age: 68.3±13.0 years old) with parkinsonian syndrome. All of them were examined with 123I-IBZM during the years 2010-2011. Fifteen patients were referred for parkinsonian syndrome with atypical symptoms, one for no response to standard therapy and 5 for both reasons. The images were performed 2-3 hours after the i.v. injection of 185 MBq of 123I-IBZM (matrix 128x128, fam beam, 128 images, 35 s/image) in a Symbia T2 (Siemmens) gammacamera. The images were interpreted visually by two nuclear medicine physicians with experience in reporting this kind of studies. 123I-IBZM results were correlated with the clinical diagnosis obtained by a neurologist. In 15 patients of our sample a 123I-FP-CIT SPECT was also performed and all of them were pathological except one. The mean disease duration by the time of the 123I-IBZM was 3.9±3.4 years.Results: In 13 patients (61.9%) the 123I-IBZM was normal and in 8 abnormal. Among the 8 patients with pathological 123I-IBZM in 7 patients the result of 123I-IBZM was concordant with the neurologist’s clinical diagnosis. These patients were diagnosed as multiple system atrophy (3 patients), progressive supranuclear palsy (1 patient), Hallervorden-Spatz syndrome (1 patient) and unclassifiable Parkinson’s “plus” syndrome (2 patients). The discordant patient was diagnosed as a Parkinson’s disease. Among the patients showing normal uptake in 123I-IBZM, in 10 (76.9%) these results were concordant with the neurologist’s clinical diagnosis. These patients were diagnosed as Parkinson’s disease (4 patients), pharmacological parkinsonian syndrome (1 patient), and others (5 patients). The 3 discordant patients were diagnosed as progressive supranuclear palsy (1 patient) and unclassifiable Parkinson’s “plus” syndrome (2 patients). Our study showed a good correlation between the 123I-IBZM interpretation and the neurologist’s clinical diagnosis (Kappa index=0.62; p-value=0.004). The sensitivity, the specificity, the negative and positive predictive values were 70%, 91%, 88% and 77% respectively.Conclusions: Our study showed a good correlation between the 123IIBZM interpretation and the neurologist’s clinical diagnosis in patients with parkinsonian syndrome with atypical symptoms and/or no response to standard therapy as well as high specificity and negative predictive value.
P295 Diagnostic accuracy of 123I-FP-CIT (DaTSCAN) in dementia with Lewy bodies: a meta-analysis of published studies N. D. Papathanasiou1, A. Boutsiadis2, J. Dickson1, J. B. Bomanji1; 1 University College London Hospital, London, UNITED KINGDOM, 2Athens Medical School, Athens, GREECE. Objective: A systematic meta-analysis of published studies on the diagnostic accuracy of presynaptic dopaminergic imaging with 123I-FP-CIT (DaTSCAN) in dementia with Lewy bodies (DLB).Materials-Methods: We included a) studies with DaTSCAN performed in cases of diagnostic uncertainty to differentiate between DLB and non-DLB dementia and b) studies of patients with already established diagnoses of DLB, non-DLB dementia or normalcy, against which the diagnostic accuracy of DaTSCAN was tested. We applied fixed-effects Mantel-Haenszel and hierarchical logistic regression models for meta-analysis of diagnostic test’s accuracy. Heterogeneity among studies was estimated by calculating the corresponding I2 statistic. We tested for publication or other bias by creating the respective Funnel plot. The pooled sensitivity, specificity and diagnostic odds ratio (DOR) were estimated.Sensitivity and specificity measures of the fitted hierarchical model were plotted on the corresponding summary receiver operating characteristic (SROC) curve, along with their 95% confidence and prediction regions.Results: Of the initially retrieved 21 studies, 5 were judged to be suitable for meta-analysis, with a total number of 513 subjects . According to hierarchical models, the estimated pooled sensitivity of DaTSCAN to differentiate DLB vs. noDLB was 83.8% (95% CIs: 72.6 - 91.0%), the specificity 92.8% (95% CIs: 88.6 - 95.6%) and the DOR 67.3 (95% CIs: 25.3 - 178.9). Mantel-Haenszel estimate of overall DOR was 46.28 (95% CIs: 26.50 - 80.83). Heterogeneity among studies was moderate with I2=28.8% and non-significant (chi2 p-value= 0.229). Funnel plot and associated Begg's test (p-value=0.221) showed no significant asymmetry, in keeping with nonsignificant bias.Conclusion: Allowing for the small number of meta-analysed studies, our results showed increased diagnostic accuracy of DaTSCAN in DLB diagnosis, especially in terms of specificity.
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Neurosciences: Miscellaneous
PET-MRI hybrid brain imaging: preliminary experiences
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V. Garibotto, S. Heinzer, S. Vulliemoz, F. Grouiller, J. Perez, R. Guignard, M. Wissmeyer, M. Seeck, K. O. Lovblad, H. Zaidi, M. I. Vargas, O. Ratib; Geneva University Hospital (HUG), Geneva, SWITZERLAND.
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G. Gerasimou , S. Tsounis , E. Papanastasiou , P. Bousbouras , E. Moralidis1, N. Taskos2, A. Gotzamani-Psarrakou1; 1Ahepa HospitalLaboratory of Nuclear Medicine, THESSALONIKI, GREECE, 2Ahepa Hospital-2nd Neurologic Clinic, THESSALONIKI, GREECE. Epilepsy is a brain disorder that causes people to have recurring seizures. Temporal lobe epilepsies (TLE) are a group of medical disorders in which humans experience recurrent epileptic seizures arising from one or both temporal lobes of the brain. Because of strong interconnections, seizures beginning in either the medial or lateral temporal areas often spread to involve both areas and also to neighboring areas on the same side of the brain as well as the temporal lobe on the opposite side of the brain. In many cases, other symptoms, except seizures are present in those patients. The aim of this study is to elucidate coexisting findings in brain SPET cerebral blood flow (SCBF) in cases of TLE and connect SPET findings with possible clinical manifestations.A total of 21 patients (10 males plus 11 females), aged 18-64 years, with an initial diagnosis of TLE are enrolled in the study. All patients underwent clinical examination, EEG, video-EEG, brain CT and MRI and interictal brain SPET with the lipophilic compound Tc-99m-HMPAO (Ceretec). Brain SPECT study was performed 5 to 7 days after the last epileptic seizure.Abnormal routine EEG findings were found in 19 of the patients (spikes, sharp waves and/ or δ abnormalities). CT findings were abnormal in 10/21, whilst MRI revealed temporal atrophy in 14/16 patients. SCBF findings were consistent with low temporal blood flow in 18/21 patients (10 on the right, 6 on the left and 2 bilateral). In addition, reduced blood flow to the parietal areas was found in 10/18 and to the frontal cortex in 8/18 of patients presenting an abnormal SCBF. Perception disturbance correlated to reduced parietal blood flow was present in 2 of the patients whilst mood disorder correlated to reduced blood flow to the frontal areas was present in only one of the them. Patients with bilateral temporal abnormality and those with a normal SCBF study did not reveal any symptoms.In this series of patients with TLE we can assume that expansion of cerebral blood flow abnormalities is present in patients with TLE. The lack of additional symptoms in a vast majority of them can be attributed to expansion of neuronic circuits in a period of vigorous growth of neurons exhaustion, which is present for a long time post epileptic seizure.
P298 The Role of Nuclear Medicine in Childresn's Epilepsy F. X. Setoain1, A. Perissinotti1, S. Rubí1, J. Aparicio2, F. X. Sanmartí2, A. Donaire1, B. Martí3, J. Rumià1, N. Bargalló1, M. Carreño1, F. Pons1; 1Hospital Clinic, Barcelona, SPAIN, 2Sant Joan de Deu, Barcelona, SPAIN, 3 Universitat de Barcelona, Barcelona, SPAIN. Aim: To evaluate the clinical usefulness of SISCOM analysis (subtraction ictal SPECT corregistered to MRI), to localize seizure focus (SF) in pediatric patients with intractable complex partial seizures and to compare the sensitivity of SISCOM image with interictal and periictal SPECT, MRI and PET.Methods: 30 patients (14 male and 16 female, from 1 to 22 years - mean age: 10 years) with intractable complex partial seizures were studied using video-EEG monitoring (V-EEG) and imaging techniques. MRI, interictal and periictal SPECT were performed in all cases while 18FDG PET/CT was performed on 27 patients. Both SPECTs were performed after the intravenous injection of 99mTc-ECD. SISCOM was obtained using Focusdet software. Results of PET, MRI, interictal SPECT, periictal SPECT and SISCOM were compared with V-EEG and clinical data.Results: V-EEG localized SF in 26/30(87%) patients and in two other cases indicated the hemisphere of the SF. MRI localized SF in 11/30(37%) patients but failed to localize SF in 19 cases. In 5 of these, MRI determined anatomical lesions that did not localize SF, was normal in 13/30(43%) patients and in one case MRI localized a lesion that did not match ictal scalp video EEG monitoring. Interictal SPECT localized SF in 8/30(27%) patients. In 4 cases, it identified anatomical lesions that did not localize SF and was normal in the remaining 16/30(53%) patients. Visual ictal SPECT localized SF in 13/30(43%) patients. SISCOM analysis localized SF in 17/30 (57%) patients, successfully identifying SF in 8 out of the 19 cases where MRI had failed. PET localized SF in 15/27(56%) patients and identified SF in 5 out of the19 patients (26%) where MRI had failed. SISCOM + PET localized SF in 20/30 (67%) patients, successfully identifying SF in 10 of the 19 patients (53%) whose SF was not localized by MRI.Conclusions: Nuclear medicine image techniques (SISCOM + PET) can improve the sensitivity of SF localization and thus change the management of pediatric patients in one half of the cases where MRI could not localize the SF. The information provided by SISCOM analysis was determining in cases where MRI and PET could not localize SF because of anatomical brain lesions.
Aim. We tested a new whole-body integrated PET/MR scanner to evaluate the performance and clinical applicability of combined imaging protocols for brain studies. PET and MRI are two modalities of choice for neuroimaging, they provide complementary information and it is not uncommon to have the two studies performed separately in routine patient workup. One of the major challenges in this new technology is optimization of acquisition protocols in order to obtain diagnostic quality images in clinically acceptable time frame for both modalities, including specific MR sequences, such as spectroscopy, diffusion tensor imaging, perfusion imaging and functional MRI (fMRI).Methods. 9 patients (4 males; 5 females, mean age and range: 45±22, 6-78) were scanned on a Philips Ingenuity TF PET/MR. This device consist of the two separate scanners linked through a single patient table allowing sequential imaging. Standard imaging protocols of both modalities were combined. We also tested a specific MR-compatible EEG recording system in order to obtain simultaneous EEG monitoring of epileptic patients during fMRI and PET acquisition. Images were interpreted by a multidisciplinary team of nuclear physicians, radiologists and neurologists.Results. The clinical indications currently under evaluation (from routine patient referral) for the PET/MR hybrid modality are the following: a. FDG imaging for functional assessment after stroke (1 patient), b. FDG imaging for epileptic focus localization (3 patients), c. FDG imaging for the investigation of cognitive disturbances (1 patient) and d. tumour brain imaging with specific aminoacidic tracer (fluoro-ethyl-tyrosine) (4 patients). In all cases, we obtained full diagnostic quality of both modalities. Simplification of imaging protocols allowed reducing the total duration of the exam, which has an important impact on MRI quality A quantitative validation of specific methods for attenuation correction and correction for inhom*ogeneities and metal artefacts (deriving from the EEG recording system) is ongoing.Conclusion. This paper reports preliminary clinical results of a whole-body hybrid PET-MR imaging device in brain imaging. Acquiring both modalities in a single session on a hybrid tomograph minimized patient discomfort while maximizing clinical information and optimizing coregistration. In addition, it allowed a decrease of effective dose (removing the CT related component which is associated to the existing PET-CT technique) which is particularly beneficial in children.
P300 Usefulness of 123I-MetaIodoBenzylGuanidine (123I-MIBG) cardiac scintigraphy in doubtful Parkinsonian Syndromes S. Nuvoli1, M. R. Piras2, C. Bagella2, A. Nieddu3, M. D. Azzena1, A. Spanu1, G. Madeddu1; 1Nuc.Med.; Univ.of Sassari, Sassari, ITALY, 2Neurology; Univ.of Sassari, Sassari, ITALY, 3Geriatrics; Univ.of Sassari, Sassari, ITALY. Aim: To evaluate the cardiac sympathetic nervous system assessment by 123IMIBG in Parkinsonian Syndromes (PS).Material and Methods: We evaluated 46 consecutive pts initially classified as PS at clinical examination (25 M and 21 F; mean age 68.1±8.3 yrs) with vascular signs in basal ganglia at MR but with pathological inconclusive 123I-Ioflupane SPECT. All pts underwent cardiac planar imaging (anterior and left anterior oblique views) after 111MBq of 123I-MIBG i.v. injection at 15 min (early) and 240 min (delayed) by a dual head gamma camera with a 128 × 128 matrix. Images were evaluated both qualitatively and quantitatively, the latter calculating the early (e) and delayed (d) heart/mediastinum ratios (H/M) by regions of interest (ROIs) manually drawn in anterior view.Results: 123I-MIBG cardiac uptake was normal/hom*ogeneous in 13/46 (28.2%) cases (Group A) while slight to severe reduced uptake was observed in 33/46 (71.8%) cases (Group B); in Group A early and delayed H/M mean values were 1.69±0.12 (range: 1.62-1.92) and 1.73±0.16 (range: 1.56-2.01), respectively. In Group B early and delayed H/M mean values were 1.33±0.14 (range:1.10-1.48) and 1.26±0.19 (range:1.0-1.45), respectively. During follow up, according to specific international clinical criteria, 5/13 Group A pts were classified finally as affected by Progressive Supranuclear Pulsy (PSP), 5/13 as cerebellar Multiple System Atrophy (MSA-c) and 3/13 as Vascular Tremor (VT). Among Group B cases 19/33 were considered as Parkinson’s Disease (PD), 10/33 as Lewy bodies Dementia (LBD) and 4/33 as parkinsonian MSA (MSA-p). One of these four latter cases was considered an overlap between MSA-p/LBD, while in the remaining 3 sympathetic postganglionic damage related to a systemic “synucleinophaties” was supposed. Mean early and delayed H/M values were significantly (p<0.00007 and p<0.00002, respectively) higher in Group A than in Group B.Conclusions: These data suggest that 123I-MIBG scintigraphy may be useful in differentiating Parkinsonian Syndromes since cardiac sympathetic post ganglionic assessment supported an appropriate diagnosis in 43/46 (91.3%) of our cases better clarifying also inconclusive 123I Ioflupane SPECT and MR. Moreover, the reduced 123I-MIBG uptake observed in 3 MSA-p pts might be considered an extensive neuronal damage closely related to “Lewy bodies pathology”, but these data require further confirmation.
Poster Presentations
Expansion of blood flow abnormalities in the cerebral cortex in patients with temporal lobe epilepsy.
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P301 The Neural Correlates of Kleine Levin Syndrome: a Brain Perfusion SPECT Study A. Kas1, S. Lavault2, E. Bonnet2, M. Habert1, I. Arnulf2; 1Médecine Nucléaire, Hôpital Pitié-Salpêtrière & UMR_S 678, UPMC, Paris, FRANCE, 2Unité des pathologies du sommeil, Pitié-Salpêtrière & CRICM, Inserm U975, UPMC, Paris 6, Paris, FRANCE. Aims. Kleine-Levin Syndrome (KLS) is a rare neurological disorder of unknown origin, primarily affecting young subjects. KLS is characterized by relapsingremitting episodes of hypersomnia in association with cognitive and behavioral disturbances (apathy, confusion, slowness, amnesia, hypersexuality and megaphagia) and a specific feeling of derealization (dreamy state, altered perception). Structural brain imaging is normal. Because of the rarity of the disease (1 case/million) little is known about the neural correlates of KLS. Abnormalities have been reported with functional imaging, however, to date, only few cases have been described in the literature. Our objectives were to explore the changes in cerebral perfusion during symptomatic vs. asymptomatic KLS periods, and to correlate them with neurological symptoms. Materials & Methods. 7 patients (20.9 ± 5.1 years old; disease duration 5.9 ± 4.4 years) had neuropsychological examinations and brain perfusion scintigraphy (99mTc-ECD) during both symptomatic and asymptomatic periods. Perfusion changes between both conditions were studied on the voxel basis with a paired t-test using the Statistical Parametric Mapping (SPM). Results. During episodes of hypersomnia, all patients presented with apathy, major asthenia and a feeling of derealization. Others symptoms were bradyphrenia (57%), anxiety (43%), disorientation and agitation (29%). Changes in eating or sexual behavior were less frequent (14%). SPM analysis revealed that the right inferior parietal and the medial prefrontal cortices were significantly hypoperfused during KLS attack (P< 0.001 uncorrected), whereas the left striatum (especially the caudate nucleus) and the right thalamus were hyperperfused (P< 0.002 uncorrected). Conclusions. Cerebral blood flow is clearly changed during KLS episodes. These functional (rather than morphological) changes may explain several striking symptoms of the disease. The hypoperfusion in the medial prefrontal could underly the apathy while the hypoperfusion in right inferior parietal cortices may cause the feeling of derealization during KLS attack. In contrast, the hyperperfusion in the striatum and thalamus suggest compensatory mechanisms, involving automated behavioral motor programs.
P302 99mTcHM-PAO and 123I-Ioflupane brain SPECT usefulness in cognitive and movement associated disorders S. Nuvoli1, A. Nieddu2, K. S. Paulus3, E. Rubattu1, F. Chessa1, A. Spanu1, G. Madeddu1; 1Nuclear Medicine DPT, University of Sassari, Sassari, ITALY, 2 Geriatrics DPT, Policlinico Sassarese, Sassari, ITALY, 3Neurology DPT, University of Sassari, Sassari, ITALY. Aim: To study the clinical usefulness of 99mTcHM-PAO and 123I-Ioflupane brain SPECT in pts with combined cognitive and movement symptoms.Material and Methods: We enrolled 76 consecutive patients ( 42M; 34F), affected by both movement and cognitive abnormalities: 18 had advanced Parkinson’s disease (PD) (H-Y scale: 2-3), 8 parkinsonism (P), 20 Alzheimer Dementia (AD), 19 Lewy Body Dementia (LBD), 6 psychiatric catatonia (PC) and 5 Vascular Tremor (VT); CT/MR were normal or aspecific. In all patients both 99mTc HM-PAO and 123I-Ioflupane SPECT were performed by dual head gamma camera with fan beam collimators according to standard protocols. SPECT images were evaluated both by qualitative and quantitative analysis, the latter by specific software quantifying 99mTcHM-PAO brain perfusion as Standard Deviation in respect of different groups of agematched normal controls; 123I-Ioflupane striatal uptake was calculated as Bindings Potential (BP) in comparison to 20 age matched normal controls (C).Results: At 99mTc HM-PAO SPECT, bilateral cortical perfusion defects were present in all AD (12 temporo-parietal, 8 fronto-temporal), in 10/18 PD (7 temporo-parietal, 11 fronto-parietal) and in all 19 LBD (10 temporo-occipital and 9 parieto-occipital); diffuse hypoperfusion cortical areas were ascertained in all P patients and in one PC case who previously was intravenous drug user, while multifocal hypoperfusion areas were present in the 5 VT patients. However, the perfusion was normal in 8/18 PD and in 5/6 PC cases. 123I-Ioflupane SPECT was pathological in 42/76 cases (all 18 PD, 5/8 P, 18/19 LBD, 1/5 VT) and normal in the remaining 34. In all PD patients both putamen were involved (in 7 cases also one caudate) with BP values (1.01±0.93 and 1.99±1.23, respectively) significantly (p<0.001) lower than C (4.67±0.24 and 4.53±0.61, respectively). The two SPECT procedures combined use confirmed correct diagnosis in 88.1% of cases (all AD, P, PC and VT cases, 10/18 PD and 18/19 LBD), while changed the diagnosis in the remaining 11.9% (8 PD cases with associated dementia and 1 LBD finally considered AD).Conclusions: Our results seem to demonstrate 99mTc HM-PAO and 123I-Ioflupane Brain SPECT combined use usefulness in correctly classifying patients affected by both movement and cognitive disorders. In particular, the two procedures permitted to identify PD cases with an associated dementia in whom MMSE was inconclusive and to detect
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 AD in a case wrongly considered as LBD at the first clinical diagnosis, thus permitting better therapeutic strategies of both disorders.
P303 Pharmacologically provoked ictal SPECT in drug-resistant temporal and extratemporal epilepsies: diagnostic efficacy and predictive value on surgical outcome D. Di Giuda1, C. Barba2, I. Bruno1, C. Caldarella1, F. Fuggetta3, D. Fortini1, F. Papacci3, M. Meglio3, G. Colicchio3, A. Giordano1; 1Nuclear Medicine Institute, Catholic University of the Sacred Heart, Rome, ITALY, 2Pediatric Neurology Unit, Children's Hospital A. Meyer, Florence, ITALY, 3 Neurosurgery Institute, Catholic University of the Sacred Heart, Rome, ITALY. Aim: Ictal SPECT (ISPECT) plays an important role in the presurgical assessment of drug-resistant epileptic pts. Limitations associated with ISPECT mainly concern the logistics of successfully injecting the radiotracer as early as possible after the seizure onset. We assessed the localising ability of pharmacologically provoked ISPECT and its predictive value on surgical outcome in temporal (TLE) and extratemporal lobe epilepsies (ETLE).Materials & methods: 56 drug-resistant epileptic pts (34 m, 22 f, mean age: 29.7 ± 8.4 yrs) were submitted to resective surgery: 35 TLE and 21 ETLE. Presurgical work-up included neurological examination, MRI, neuropsychological assessment, scalp-video-EEG monitoring, interictal and ISPECT with 99mTc-ECD and invasive EEG recordings (if necessary). ISPECT was performed during seizures provoked with pentylenetetrazol injection and recorded by scalp-video-EEG and/or invasive EEG monitoring. Side-by-side visual analysis of ictal and interictal images was performed blind to clinical data. Seizure onset time, radiotracer injection delay and seizure duration were assessed by reviewing video-EEG. SPM analysis of individual ISPECT was available in 24 cases.Results: MRI was normal in 14 cases. Radiotracer injections were performed during provoked seizures similar to spontaneous ones in all pts. Mean delay from clinical and EEG seizure onset to radiotracer injection was 11 ± 7 sec and 9 ± 6 sec, respectively. Visual interpretation of provoked ISPET was concordant with the epileptogenic zone (EZ) in 50 (89%) pts: 18 ETLE (3 cryptogenic, 15 symptomatic) and 32 TLE (10 cryptogenic, 22 symptomatic). Postoperative outcome according to Engel’s classification (follow-up ≥ 2 yrs) was class I (free of disabling seizures) in 43 (86%), class II in 2 (4%), class III in 3 cases (6%). In the remaining 2 pts follow-up was too short to be considered. Of the 43 pts in class I, 38 were completely seizure free since surgery (class IA). Discordant results between ISPECT and EZ were obtained in 6 cases (3 TLE, 3 ETLE): postoperative outcome was class III in 4 and class I in 2 pts. Long-term surgical follow-up (≥ 5 yrs) was also available in 27/50 pts with ISPECT-EZ concordance: no changes in Engel’s class were observed in 26 cases.Conclusion: We demonstrated the localising ability of provoked ISPECT in both surgical TLE and ETLE. Predictive value was supported by the high rate of excellent outcome, also in patients with normal MRI or unclear EEG. The main advantage was the optimisation of 99mTc-ECD injection timing, indispensable for unambiguous localisation of the EZ.
P304 Cortical metabolic changes in vestibular neuritis detected by 18F-FDG PET/CT. A. Chiaravalloti1, M. Pagani2, M. Alessandrini1, B. Napolitano1, B. Di Pietro1, A. Micarelli1, R. Danieli1, E. Bruno1, O. Schillaci1; 1University Hospital Tor Vergata, Rome, ITALY, 2Institute of Cognitive Sciences and Technologies, CNR, Rome, ITALY. Aim:Vestibular neuritis (VN) is a sudden unilateral partial labyrinthine failure due to infectious, vascular or autoimmune diseases of inner ear. This study evaluated the regional cerebral metabolic changes during and after the acute phase in VN. Materials and Methods: Brain 18F-FDG PET/CT of six patients (2 males, 4 females; mean age 48±7 yrs) were performed during the acute phase of VN (mean, 48 hours after symptoms onset) (PET0; n=6) and after 1 month (PET1; n=5). Differences between PET0 and PET1 and a control group of 30 subjects (CS) were analyzed by statistical parametric mapping (SPM2) introducing age and sex as nuisance variables. A further within-subject analysis was performed between PET0 (n=5) and PET2 (n=5). SPM t-maps were corrected either for multiple comparison with False Discovery Rate (p<0.05) or thresholded at p<0.001, uncorrected, at voxel level and corrected for multiple comparison at cluster level (p<0.001). Results: As compared to CS, patients at PET0 showed a significant lower FDG uptake in bilateral visual (Brodmann Areas, BAs, 17, 18, 19) and posterior cingulate cortex, and a significantly higher FDG uptake in right orbitofrontal cortex (BAs 11, 47) and temporal pole (BA 38). No differences were found between CS and PET1. As compared to PET1, patients at PET0 showed a significant hypometabolism in left sensorimotor (BAs 2, 4, 6), posterior cingulated (BA 31) and parietal (7, 40) cortex and a significant hypermetabolism in right temporal lobe (BAs 20, 38) and thalamus.Conclusion: 18F-FDG PET/CT is able to image the transient metabolic changes induced by VN in the brain: patients during the acute phase showed a significant hypometabolism in large portions of visual cortex and a
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P305 PET Evaluation of Norepinephrine Transporter in the Stomach Using Fluorinated Reboxetine Analog R. S. Liu1, C. W. Chang2, C. L. Chen1, K. H. Lin1, J. W. Kuo1; 1National Yang-Ming University, Taipei, TAIWAN, 2Taipei Veterans General Hospital, Taipei, TAIWAN. Objectives: The norepinephrine transporters (NET) regulate adrenergic neurotransmission in the brain as well as in the peripheral organs. Alterations of NET may affect the motility, contractility tone and secretion of gastrointestinal tract. This study aimed to evaluate the fluorinated reboxetine analog, (S,S)[18F]FMeNER-D2 (FMeNER) as a probe for assessment of adrenergic neuronal function of the stomach.Methods: FMeNER was prepared using the method as described in the literature (Synapse 2004;53:57-67). The radiochemical purity is > 99%. MicroPET imaging was performed in 8-week-old SD rats. 18.5 MBq of FMeNER was i.v. injected into the rat anesthesized with isoflurane and dynamic imaging was done for 180 min. Data obtained from 120-180 min were summed and reconstructed. ROI was selected on the stomach for calculation of standard uptake value (SUV) of radiotracer uptake. The animals received baseline PET scan and repeated scan in the alternative day at 6 hr after oral administration of norepinephrine reuptake (NER) inhibitor, Duloxetine (30 mg/kg). The changes of FMeNER uptake in stomach were analyzed qualitatively and semiquantitatively.Results: There is remarkable uptake of FMeNER in the stomach on the baseline PET images. Being challenged by Duloxetine, the stomach uptake was dramatically reduced. The SUV (mean) was decreased from 20.7 of baseline FMeNER uptake to 4.3 after the use of NER inhibitor. Accumulation of radiotracer was also noted in bone due to defluorination of FMeNER.Conclusion: FMeNER is a potential NET imaging probe for assessment of adrenergic neuronal function in the stomach. It may be useful in evaluation of motility dysfunction of stomach and of the effect of NER inhibitors.
P306 Relations between autonomic cardiovascular stress responses and brain 5-HTT binding may depend on serotonin genotype
HTT binding (r = 0.8, p= 0.005, n = 10) and SBP(IV)max/min indirectly related to thalamus and midfrontal 5-HTT binding (r = -0.8, p = 0.008; r = -0.9, p =0.003; n=9).Conclusion: Stress responses in VAL were not affected by serotonin genotype. Metrics of VAL, reflecting sympathetic and mixed sympathetic/parasympathetic activation were to some extent related to brain serotonin function in l/l genotype group, but not in s carriers.
P28 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Neurosciences: Data Analysis & Quantification
P307 Automated region analysis of brain PET examinations G. Opposits1, T. Spisak1, I. Lajtos1, L. Pohubi1, L. Galuska1, A. Jakab2, E. Berenyi2, M. Emri1; 1University of Debrecen, Medical and Health Science Center, Institute of Nuclear Medicine, Debrecen, HUNGARY, 2University of Debrecen, Medical and Health Science Center, Department of Biomedical Laboratory and Imaging Science, Debrecen, HUNGARY. Aim: The Institute of Nuclear Medicine offers automated image registration services for partners via a DICOM server using an in-house developed image processing pipeline. During the development of BrainLOC software several utilities have been worked out to evaluate the automated regional analysis of spatial standardized MRI and PET data by using predefined region systems of more than 20 digitalized brain atlases. Our goal was to introduce a new service to support the automated region analysis of brain PET examinations for academic purposes.Materials and Methods: We have used the MultiModal Medical Imaging software system to develop the main software components required by the automated regional analysis service: pre-defined functional and anatomical brain structures as part of the VOI database of the BrainLOC application; 3rd party (MNI, FSL) and in-house developed multimodal registration and standardization software; utilities for ROI analysis. We have also developed the DicomBBox software to receive and convert images, which is built on the basis of the DICOM server in our institute. Processing and monitoring services are available through the interfaces developed for the R+D web site of our institute.Results: In contrast with our initial goals, a completely automated software system was developed to evaluate regional analysis of brain PET data using customized regional definitions of various brain atlases. The user requesting this service could select regions from more than 20 brain atlases and for spatial standardization T1-weighted MRI or PET templates. The results of the analysis of the images received by our DICOM server can be accessed by email or through the web site of the institute. For validation 10 methionine-PET examinations were used. The standardization was carried out by the automated system and the fitted brain regions have been verified by two independent professionals. A nuclear medicine expert supervised the PET-MRI and a radiologist checked the CT-MRI fitting using the BrainLOC software.Conclusion: By means of institutional infrastructure we have introduced a new service for clinical projects, which facilitates individual and population-based region analysis for institutes lacking the specific software and infrastructure. The service is available through our R+D web page and DICOM server.
E. Kauppila1, E. Vanninen2, T. Kuusela3, S. Kaurijoki4, L. Karhunen4, K. H. Pietiläinen5, A. Rissanen6, J. Kaprio7, J. Tiihonen8, U. Pesonen9, J. Kuikka2; 1 North Karelia Central Hospital; Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Joensuu, FINLAND, 2Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, FINLAND, 3Department of Physics, University of Turku, Turku, FINLAND, 4Food and Health Research Centre, Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, FINLAND, 5Obesity Research Unit, Department of Psychiatry, Helsinki University Hospital; Department of Public Health, Hjelt Institute, University of Helsinki,, Helsinki, FINLAND, 6Obesity Research Unit, Department of Psychiatry, Helsinki University Hospital, Helsinki, FINLAND, 7 Department of Public Health, Hjelt Institute, University of Helsinki; Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare; Institute of Molecular Medicine (FIMM), University of Helsinki, Helsinki, FINLAND, 8Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi hospital; Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Kuopio, Helsinki, FINLAND, 9Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, FINLAND.
C. Tranfa*glia1, L. Pagan2, S. Galli1, G. Lucchi1, S. Zoboli1, G. Guidarelli2, G. fa*gioli1; 1Nuclear Medicine Unit, Department of Services, Major Hospital, Bologna, ITALY, 2Health and Medical Physics Department, Major Hospital, Bologna, ITALY.
Objective: Even carrying one short allele form of promoter region of serotonin transporter gene may inflict a risk for spectrum anxious depression disorders. Amygdala stress response is affected by this genotype polymorphism (5-HTTLPR). We studied, whether cardiovascular autonomic stress responses are similarly dependent on serotonin genotype.Material and methods: Using standardized Valsalva test (VAL) we examined twenty-two young healthy monozygotic twins (26 ± 2 yr, 11 female), who were genotyped by 5-HTTLPR (thirteen l/l genotype, ten s carriers). For brain 5-HTT binding imaging subjects were studied with (iodine-123 labelled 2-beta-carbomethoxy-3-beta-(4-iodophenyl) nortropane) single-emission computed tomography (SPECT). Continuous ECG and BP recordings were obtained from each subject.Results: In repeated tests intraclass-correlations for Valsalva and tachycardia ratio (VR, TR), and for maximum-minimum systolic BP ratio at IV phase of VAL [SBP(IV)max/min] were 0.56 (p =0.003), 0.62 (p = 0.002) and 0.96 (p < 0.001), respectively. VAL metrics, means of two tests, were not significantly different by 5HTTLPR. Brain 5-HTT binding availability values were not different by genotype in any regions of interest (midbrain, thalamus, right and left temporal, midfrontal). Statistically significant relations between brain 5-HTT binding and autonomic metrics were observed in l/l group, in whom TR was directly related to midbrain 5-
AimWe performed simulations on the anthropomorphic Alderson RSD phantom to study the influence of the reconstruction algorithm on semiquantitative evaluation results, comparing simultaneously the performance of a recently developed, fully automatic software (Basal Ganglia Version 2-BasGanV2) and a conventional manual ROI method of analysis.Materials and methodsWe performed nine SPECT acquisitions of the Alderson phantom (designed ad hoc to reproduce the striatal morphology) after filling striatum and background chambers with solutions at different concentration of 123I-FP-CIT (GE-Healthcare, Amersham, UK). Experimental specific caudate-to-background (C/B) and putamen-to-background (P/B) ratios obtained ranged from 1 to 8.7, while specific caudate-to-putamen (C/P) ratios ranged from 1 to 2.Data acquisition was performed by a Philips-Irix three head camera with LEHR collimators. Images were firstly reconstructed by a filtered backprojection (FBP) algorithm with a Butterworth filter (order=5; cut-off=0.26) using Chang’s method (µ=0.11/cm) for the attenuation correction. Then OSEM reconstruction algorithm was applied to built the second set of data.For the semiquantitative analysis were used the “BasGanV2” software, an algorithm for automatic segmentation of striatal SPECT studies, that provides normalized striatal uptake values, and then a conventional method based on manual ROI
P308 Semiquantitative analysis of striatal SPECT studies with BasGanV2 and manual ROI method: the FBP and the OSEM reconstruction algorithm
Poster Presentations
hypermetabolism in right orbitofrontal and temporal limbic structures; this cortical pattern disappeared after 1 month.
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S334 plotting.Correlation was calculated between true and measured ratios for each method in the two datasets.ResultsFBP and OSEM reconstruction algorithm lead to similar semiquantitative analysis results.Both the BasGanV2 and the manual ROI method showed a good correlation, in both cases, with true experimental values, but a better linear trend was evidenced with the first one.“R” values obtained with BasGanV2 for left C/B and P/B, right C/B and P/B, right C/P and left C/P were respectively 0.93, 0.97, 0.78 0.93, 0.95 and 0.95 in FBP SPECT data, and 0.93, 0.95, 0.73, 0.92, 0.98 and 0.93 in OSEM SPECT data. With the manual ROI method “R” values obtained were respectively 0.87, 0.96, 0.72, 0.89, 0.95 and 0.93 in the FBP dataset and 0.84, 0.94, 0,78,0.93, 0.96 and 0.91 in the OSEM one.Conclusions Our results suggest that the choice between the FBP and the OSEM reconstruction does not affect semiquantitative analysis results. In each case a similar good correlation with true experimental binding values was achieved with both methods of analysis. The automatic algorithm BasGanV2, however, performs better with respect to manual ROI method confirming to be an accurate tool for 123I-FP-CIT SPECT studies measurements.
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441
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relative perfusion in PD1 vs. NC and PD1 vs. PD2 for each normalization method.Results: Based on whole-brain intensity normalization, in PD1 vs. NC hypoperfusion of PD1 was found predominantly in parietal lobes and hyperperfusion in brain stem, cerebellum and in the right medial temporal cortex spreading towards basal ganglia, whereas PD1 vs. PD2 comparison showed increase in parietal perfusion after treatment.Based on cerebellar intensity normalization, PD1 vs. NC showed hypoperfusion of PD1 in more regions of both parietal lobes and in frontal lobes as well as hyperperfusion in less clusters in medial brain structures (medial temporal lobe and cerebellar vermis), whereas in PD1 vs. PD2 perfusion was increased after treatment in slightly-below-threshold size cluster in parietal region (p<0.01 uncorrected, cluster<100 voxels)Conclusion: Cerebellar intensity normalization in comparison to whole-brain one, results in revealing more hypoperfusion regions in brain cortex and less hyperperfusion regions in PD1 patients vs. NC. Similar was observed in studying the treatment effect (PD1 vs. PD2) with one exception in cerebellar hyperactivity which was found in PD1 at cerebellar normalization but not at whole-brain normalization. In general, perfusion changes between studied groups were less pronounced in the case of cerebellar normalization compared to whole-brain one.
Evaluation of relationship between lung uptake and clinical 123 I-IMP in patients with cerebrovascular factors by using disease
P29 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
N. Morita, K. f*ckushima, M. Higashi, N. Yamada, H. Naito; National Cerebral and Cardiovascular Center, Osaka, JAPAN.
Neurosciences: Movement Disorders
(Purpose)In evaluating cerebral blood flow (CBF) by using N-isopropyl-p-(123I) iodoamphetamine (123I -IMP), tracer retention in the lung is one of the most important factors, which is affected CBF value. Smoking has reported to have an influence on tracer retention in the lung and respiratory condition is also supposed to affect the tracer accumulation. The purpose of our study was to evaluate the relationship between the degree of tracer retention in the lung and clinical factor including history of smoking, blood test and respiratory condition by using 123I-IMP in patients with cerebrovascular disease.(Materials and methods)Thirty seven patients, 40 examinations (26 male, 11 female, mean age 63.7 y.o.) with suspected cerebrovascular disease were collected. Seven of 37 patients were taken under sedation and 2 of 7 were repeated the same examination under different respiratory condition. All patients were taken brain 123I-IMP SPECT and obtained pulmonary time activity curve at the same time by using mobile detector generated by semiconductor (THE DIGIRAD, 2020tc IMAGER SYSTEM, DIGIRAD CORPORATION, Sandiego, CA.). Three ROIs were set in the rt. lower lobe and measured total counts per minute (cpm). The average counts were applied and calculated the time from peak count to a half count (T1/2). We evaluated the correlation between T1/2 and demographic feature (age, gender, past history, blood test (pO2, pCO2, Hct) and patient condition) (spearman’s rank test). We also divided into 2 groups by smoking history (smoking and non-smoking), compared T1/2 in each groups (unpaired ttest).(Result)T1/2 showed statistically correlated to smoking history and pO2, respectively. Smoking group showed longer T1/2 (32.2±7.1, 26.3±5.6) and lower pO2 (75.8±8.2, 89.0±9.1) compared to non-smoking group (p<0.03). In patients with under sedation, T1/2 of them were extended compared to normal condition.(Conclusion)Smoking and respiratory condition would be affected tracer retention in the lung. We should pay attention to the influence of these factors in evaluating CBF by 123I-IMP SPECT. We will also evaluate the correlation between tracer retention in the lung and CBF.
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P310 Effect of Whole-Brain and Cerebellar Intensity Normalization of SPECT Images on Identification of Perfusion Changes in Parkinson's Disease P. Tomše, B. Starovasnik Žagavec, J. Fettich, M. Grmek, I. Slodnjak, Z. Pirtošek, M. Trošt; University Medical Centre, Ljubljana, SLOVENIA. Aim: Single Photon Emission Tomography (SPECT) brain image intensity values vary due to many parameters. Image intensity normalization needs to be applied in order to avoid misinterpretation of different intensity values with changes in brain perfusion and to obtain meaningful statistical comparisons during image analysis. The aim of our study was to compare results of brain perfusion analysis in Parkinson's disease (PD) patients derived by two different types of image intensity normalization: cerebellum and whole-brain.Materials and Methods: 99mTc-ECD SPECT brain perfusion images of 12 patients with early PD (age: 55±8 yrs, disease duration 21.8±8.2 months) prior to treatment (PD1) were compared with 16 images of PD patients following the 3-months treatment with dopamine agonist pramipexole (age: 57±7 yrs, pramipexole dose: 3.7±0.125 mg) (PD2) and with 16 normal controls (NC) (age: 55±7 yrs). Images were acquired with Siemens Multispect II, 20 minutes after injection of 600 MBq activity of 99mTc-ECD and were reconstructed using filtered back-projection with Chang attenuation correction. In the preprocessing images were spatially normalized using SPM8 template and smoothed by 12mm FWHM Gaussian. Whole-brain and cerebellum regions were separately used for intensity normalization. Voxel by voxel image analysis with statistical parametric mapping (SPM8) was applied to compare
Diagnostic Performance of Myocardial Innervation Imaging 123 I-metaiodobenzylguanidine Scintigraphy in Using Differential Diagnosis between Parkinson’s Disease and Other Parkinsonism: a Meta-analysis G. Treglia1, E. Cason2, A. Stefanelli1, D. Di Giuda1, F. Cocciolillo1, G. fa*gioli2, A. Giordano1; 1Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, ITALY, 2Unit of Nuclear Medicine, Maggiore Hospital, Bologna, ITALY. Aim: Differential diagnosis between Parkinson’s disease (PD) and other parkinsonism using clinical criteria or imaging methods is often difficult. Myocardial innervation imaging using 123I-metaiodobenzylguanidine (MIBG) has emerged as a useful method to confirm or exclude the presence of PD. The purpose of this study is to systematically review and meta-analyze published data about the diagnostic performance of myocardial innervation imaging using MIBG scintigraphy in differential diagnosis between PD and other parkinsonism.Methods: A comprehensive computer literature search of studies published through March 2011 regarding MIBG scintigraphy in patients with PD and other parkinsonism was performed in PubMed/MEDLINE and Embase databases. Only studies in which MIBG scintigraphy was performed for differential diagnosis between PD and other parkinsonism were selected. Patients without parkinsonism and patients with other LBD were excluded from the analysis. Pooled sensitivity and specificity of MIBG scintigraphy were presented with a 95% confidence interval (CI). The area under the ROC curve was calculated to measure the accuracy of MIBG scintigraphy in differential diagnosis between PD and other parkinsonism.Results: Twenty studies comprising a total of 1999 patients (1096 patients with PD, 117 patients with other Lewy body diseases [LBD] and 786 patients with other diseases) were included. The pooled sensitivity of MIBG scintigraphy in detecting PD was 88% (95% CI, 85-89%); the pooled specificity of MIBG scintigraphy in discriminating between PD and other parkinsonism was 85% (95% CI, 81-88%). The area under the ROC curve was 0.94.Conclusions: In patients with clinically suspected PD innervation imaging with MIBG scintigraphy demonstrated high sensitivity and specificity. MIBG scintigraphy is an accurate test in this setting, and this method may support or exclude a diagnosis of PD. Nevertheless, possible causes of false negative and false positive results should be kept in mind when interpreting the scintigraphic results. Furthermore, studies with pathological confirmation and large multicenter studies will be necessary to substantiate the high diagnostic accuracy of MIBG scintigraphy in this setting.
P312 Discordances between clinical diagnosis and 123I-FP-CIT SPECT in 23 patients with movement disorders. D. Flores Couce1, F. Romero de Avila1, M. Martinez Lozano2, M. Tajahuerce Romera1, M. Latorre Ibanez1, A. Lara Pomares1; 1Consorcio Hospitalario Provincial, CASTELLON, SPAIN, 2Hospital La Magdalena, CASTELLON, SPAIN. Background and aim: Many medical studies show safety and effectiveness of I 123FP-CIT SPECT (DaTSCAN®) in the diagnosis of patients with movement disorders. Some of them describe discordances between clinical diagnosis and dopamine transporters SPECT´s findings. Our aim is to assess the diagnostic accuracy of DaTSCAN® in patients of our environment with movement disorders by analyzing these discordances.Materials and Methods: We performed routine I123-FP-CIT
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P313 Can various quantification methods’ indexes successfully reproduce a broad range of radionuclide concentration ratios in an Alderson striatal head phantom imaged in a gammacamera as to mimic a 123I-FP-CIT SPECT study? K. Badiavas1, I. Iakovou2, E. Molyvda3, M. Tsolaki4, A. Psarrakou3, N. Karatzas2; 1Medical Physics Dept, General Hospital "Papageorgiou", Thessaloniki, GREECE, 23rd Nuclear Medicine Dept, Aristotle University, Thessaloniki, GREECE, 3Medical Physics Dept, Aristotle University, Thessaloniki, GREECE, 4Neurology Dept, Aristotle University, Thessaloniki, GREECE. Aim. We explored whether various quantification methods used in our department successfully reproduce a broad range of radionuclide concentration ratios in an Alderson striatal head phantom, imaged in a gamma-camera as to mimic a 123I-FPCIT SPECT study.Materials and methods. The Alderson striatal head phantom was filled with various radionuclide concentration ratios and imaged in a gammacamera with the standard protocol for 123I-FP-CIT SPECT studies (HR collimators, 128x128 matrix, 120x40sec steps, 2.3mm pixel size). The striatal-to-background concentration ratios ranged from approximately 2:1 to 10:1, as was verified by well-counter measurements, covering very pathologic to normal ratios as seen in human pathology. Imaging was performed in a dual-headed ADAC Vertex-plus gamma-camera, connected to a PEGASYS UNIX-based workstation and also to a windows-based PHILIPS JETStream workstation for exporting DICOM data. Quantification was done by individualized “manual” ROIs creation and by the application of three - the “two box”, “three box” and “crescent” - semi-automated methods, available in the QuantiSPECTTM software package. For all methods, the mean L-R indexes were used and the reconstruction was done with the combination of FBP and Butterworth filtering. No attenuation correction was applied. Each method was evaluated by the R2 value of the fitted line on a plot between the filling ratios and each method’s representative index. Bland-Altman analysis was performed in order to evaluate methods’ agreement.Results. The results of the linear fitting between the filling ratios and each method’s quantitative index are the following: R2=0.981 for the specific activity of the “manual” method, R2=0.932 for the specific activity binding index of the “two box” method, R2=0.780 for the total striatal binding potential index of the “three box” method and, R2=0.812 for the striatum to visual cortex ratio of the “crescent” method.Conclusion. The “manual” method’s results produced by an experienced medical doctor and the “two box” method results showed very good linear relationship with the radioactivity concentration ratios. The other two methods were not so successful, the “three box” method suffering from a serious dependence on the background ROI's size and position and the “crescent” method’s striatal templates not fitting well on the phantom’s imaged striata, which only approximately mimic the human ones. Our future plans involve the exploration of the attenuation correction effect in quantification, the application of more advanced, maybe of the pixel-based statistical analysis type, quantification methods and the attempt to extrapolate our results to patients’ studies.
P314 A Descriptive Study about Patients with Plus-Parkinson 123 Disease Using DaTscan and MIBG Cardiac Scintigraphy. J. Herrera-Henriquez, A. Santana-Borbones, F. Armas-Serrano, M. A. Ochoa-Figueroa, J. Miranda-Ramos, M. Canelas-Subieta, R. Malo de Molina-Zamora, C. Isla-Gallego, M. J. Hernández-Briz; Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, SPAIN. AIM:To analyze visually and semiquantitatively the striatal dopamine transporters binding 123Ioflupane (DaTSCAN) and 123MIBG cardiac scintigraphy in patients with
parkinsonism syndrome who also had atypical clinical signs, being the main suspected diagnosis Parkinson-Plus disease.MATERIAL AND METHOD:We studied 15 consecutive patients (average age=67.9years; 9 men) from 2009 to 2010. All patients underwent a neurological examination. Every subject was classified according to Hoehn-Yahr Clinical Scale and a minimental test was performed for those patients with cognitive impairment.DaTSCAN was performed and visually analyzed. 123I-Ioflupane-Uptake-Binding-Ratio (123IUBR), Right/Left-AsymmetryRatio (Asym), and Putamen/Caudate-Ratio (PC) were calculated. Futhermore, chest planar images were acquired at 15 minutes (early phase) and 4 hours (late phase) of intravenous administration of 123MIBG and using ROIs, Heart/Mediastinum Index in both phases and the rate of washing were calculated.RESULTS:We found a normal uptake in DaTSCAN in 3 subjects, and clinical follow-up determined 3 neurodegenerative disorders different from extrapiramidal syndrome (Alzheimer’s disease, pharmacological parkinsonism and frontotemporal dementia).In 12 of 15 patients brain-SPECT showed decreased uptake of Ioflupane in striatum, confirming a parkinsonism syndrome. Lately, we performed 123MIBG-cardiac-scintigraphy. We obtained two different groups, in one of them there were 6 patients whose common clinical characteristics were: Hoehn-Yahr-Scale II-III, half of patients had cognitive impairment and/or atypical signs. DaTSCAN data showed especially putaminal impairment which followed a posterior-anterior gradient and left predominance, similar to idiopathic Parkinson’s Disease (PD). 123MIBG data showed severe cardiac hipoactivity and the average value of Heart/Mediastinum(late) was 1.32 and washout was 54.86% in all of them, except one case. The final diagnosis was Parkinson’s disease in 4 subjects, Lewy Bodies Disease (LBD) in one case and the PD vs LBD in the remaining case.The second group of 6 members with normal 123 MIBG (average Heart/Mediastinum(late)=1.9; washout=25.6%), presented the following common characteristics: Hoehn-Yahr-Scale III, 60% with cognitive impairment and/or atypical signs. DaTSCAN showed in 4 subjects the same scintigraphic pattern as the first group, although without predominance. The final diagnosis was multiple system atrophy (MSA) in 3 patients, normotensive hydrocephalus in one subject and PD in another one. A patient was lost in the follow-up.CONCLUSION:123MIBG may be a useful tool to differentiate between PD and MSA in those patients who required this differential diagnosis.
P30 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Basic Science: Preclinical Imaging
P315 Comparison of fasting with low carbohydrate high-fat diet on 18 the standardized uptake values of F-FDG in human tissues N. Peng, C. Hu; Kaohsiung Veterans General Hospital, Kaohsiung, TAIWAN. Low-carbohydrate high-fat diet (LCHFD) has been reported to suppress myocardial 18 F-FDG uptake and to decrease uptake of 18F-FDG in hypermetabolic brown adipose tissue, and might decrease false-positive findings on oncologic 18F-FDG PET scans. This study is proposed in order to compare fasting with LCHFD for the distribution of 18F-FDG in human body of same individuals, and evaluate the availability of LCHFD instead of fasting for the routine 18F-FDG PET study.Methods: We recruited asymptomatic volunteers to perform fasting and LCHFD 18F-FDG-PETs. Both 18F-FDG-PETs were performed 24 hours apart within 30 days. The LCHFD and fasting protocols were standardized. Blood tests before 18F-FDG injection were recorded. The maximal standardized uptake value (SUVmax) and mean standardized uptake value (SUVmean) of organs on 18F-FDG-PET were measured including brain, heart, liver, mediastinum, lung, muscle, and tumor for patients with cancer. Means and standard deviation (SD)s were determined, and a site-tosite comparison using the paired Student's t test wa performed to assess P values.Results: Fifteen asymptomatic volunteers were recruited in this study. All of the blood tests including blood glucose, HbA1c, C-peptide and insulin on fasting protocol showed no significantly different from those on LCHFD protocol. No significant difference of SUVmax and SUVmean on organs between 18F-FDG-PETs of fasting and LCHFD protocols, except for SUVmean of brain (P< 0.05). Eleven subjects showed decrease of SUVmax and SUVmean in myocardium on LCHFD protocol, 9 did decrease of SUVmax and SUVmean in brain, and 9 decrease of SUVmax in lung.Conclusions: LCHFD can suppress myocardial 18F-FDG uptake in most subjects, and provide better image quality than fasting on 18F-FDG-PET. However, it didn’t reach the statistical significance.
Poster Presentations
SPECT and clinical follow-up during 12 months in 23 patients with movement disorders.For SPECT acquisitions we used a Starcam 4000i (General-Electric®) and a Symbia S (Siemens®) gamma cameras with 1 and 2 detectors respectively.SPECT studies were reviewed by at least 2 specialists, by visual interpretation of tomography study and compressed images and also semi-quantitative analysis of caudate, putamen and occipital lobe ROIs.For clinical diagnosis, considered as the standard of reference, we reviewed clinical history findings, imaging techniques (CT, MR and SPECT) and therapy response.Results: 23 p (15w y 8m; mean age: 74 yr).We undertook 16 SPECT with single-head gamma camera and 7 SPECT with double-head one.We observed discordances between SPECT and clinical diagnosis in 7 patients (30%), out of them 3 had pathological SPECT with vascular dementia (2) and atypical Alzheimer disease (1) diagnosis, and the rest had normal SPECT with DLB (3) y PSP (1) diagnosis.5 discordances were noticed with single-head camera, and 2 with the double-head one.Conclusions: I123-FP-CIT SPECT was useful, safe and precise in the diagnosis of patients with movement disorders, although the number of discordances observed were higher than those published in Scientific Literature, being necessary to extend the follow-up period and the number of patients included in the study in order to get more reliable results.
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P316 In Vivo Detection of Apoptosis Using 18F-labeled Bis(Cyclen)Zinc Complexes A. Mueller1, D. Oltmanns2, P. Dewi-Wuelfing1, N. Boehnke1, S. ZitzmannKolbe1, L. M. Dinkelborg1, V. Gekeler1, M. Eisenhut2; 1Bayer Healthcare Pharmaceuticals, Berlin, GERMANY, 2DKFZ, Heidelberg, GERMANY. Aim: Apoptosis suppression is one of the hallmarks of cancer. To overcome this blockade is a major goal of anticancer treatment regimens, including cytotoxics, external beam radiation and new targeted therapies. Visualization of apoptosis induction by PET imaging could be highly valuable for early assessment of treatment response or to confirm the mode-of-action of new drugs in clinical development. Phosphatidylserine exposure on the outer cell membrane is one of the characteristics of apoptotic cells. Radiolabeled Annexin V, binding to phosphatidylserine, was used extensively for detection of apoptosis. Due to its molecular size and pharmaco*kinetic profile it is not suitable for 18F-labeling. Therefore, we aimed to discover new 18F-labeled tracers for the detection of apoptosis in vivo mimicking the annexin V binding motif.Materials & Methods: 2x106 HeLa-MaTu (human cervix carcinoma) cells were inoculated into NMRI nude mice. 11 days after inoculation the animals were treated once with 18 mg/kg taxol (dissolved in 5 % EtOH, 5 % Cremophore EL). 2 days later PET imaging was performed using BAY 1106817, a 18F-labeled bis-cyclen derivative complexed with Zn(II). 18F-fluoroethylbromid was used for an indirect labeling approach. Immediately after imaging the tumors were removed and radioactivity was determined. In addition, tumor slices were examined by autoradiography and stained for cleaved Caspase 3.Results: Cyclens were chosen as a lead motif for the detection of apoptosis. Bis-cyclens were attached to carboxyfluorescein and were tested in FACS experiments for their binding to Jurkat cells treated with staurosporine, as previously reported. A simplified derivative without fluorescein moiety was 18F-labeled with 23% d.c yield. This 18F-labeled tracer was examined in HeLa-MaTu tumor bearing nude mice after taxol-treatment. Significantly increased uptake in the taxol-treated tumors was observed compared to the untreated controls, although the 18F-labeled derivative BAY1106817 showed partial defluorination in mice. Cleaved Caspase 3 staining confirmed induction of apoptosis in the tumors of the taxol treated animals.Conclusion: Bis-cyclen zinc complexes are promising new derivatives for the imaging of apoptosis in tumors which can be applied for the visualization of anti-tumor therapy response. Further metabolically stable derivatives are under investigation.
P317 Differences of in vivo uptake in mice and rats of the sodium/iodide symporter PET imaging agent 18FTetrafluoroborate. M. Collantes1, M. Jauregui-Osoro2, G. Quincoces3, M. Ecay1, I. Bilbao1, P. J. Blower2, I. Peñuelas3; 1Small Animal Imaging Research Unit, CIMA-CUN, University of Navarra, Pamplona, SPAIN, 2Division of Imaging Sciences, King's College, London, UNITED KINGDOM, 3Radiopharmacy Unit, Department of Nuclear Medicine, University Clinic of Navarra, Pamplona, SPAIN. AIM:18F-Tetrafluoroborate ([18F]TFB) is a recently described PET agent that is actively taken up by the sodium/iodide symporter (NIS) that could provide a new and promising tool in the field of the thyroid imaging. The aim of this work was to describe the biodistribution of this compound in rodents (mice and rats), in order to assess its ability to discriminate the thyroid and other organs expressing NIS, and to compare results from different species.MATERIALS AND METHODS:Wistar rats and C57 mice were used. PET images were performed in a microPET with animals placed prone under inhalational anaesthesia (isoflurane 2%). [18F]TFB (rats: 38,8±0,1; mice: 20,3±0,3 MBq) was injected intravenously at the beginning of a 110 minutes list mode acquisition. Dynamic sinograms (10x90´´, 9x300´´; 5x600´´) were created and images were reconstructed using 3D Ramla algorithm applying conventional corrections. Regions of interest were drawn in principal organs (thyroid, stomach, glands…) to obtain time-activity curves (TACs). Additionally, whole-body static images were performed in rats (40min uptake) and also inhibition studies (treatment with 220mg/kg potassium perchlorate).RESULTS:All studies, both in rats and mice, gave clear images of thyroid. However, mice showed about 5-fold higher uptake (9,7 vs 2,1 SUV, 40min uptake) in this organ and an increasing uptake during time that was not observed in rats. The organ with the highest uptake was stomach, which showed a different uptake pattern between glandular and aglandular regions in the rat. Also in rats, an important uptake in olfactory mucosa, higher than in thyroid, was observed. Other organs with minor uptake were skin (hair follicles) and salivary glands, with a slight uptake in mice testes. In delayed images, an increasing uptake in esophagus was clearly distinguished in rats, probably caused by saliva. The study of TACs pointed out that a static protocol with 10min of uptake is suitable to study the thyroid in rats, whereas in mice a more extended protocol (30-40min uptake) is recommended. All the inhibition studies with perchlorate avoid [18F]TFB uptake in thyroid and the rest of mentioned organs.CONCLUSIONS:[18F]TFB is a new and appropriate PET
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 tracer for the visualization of thyroid and the inhibition with perchlorate demonstrates the specificity of binding to NIS. However, there are clear differences in the dynamic and uptake pattern of the radiotracer between rats and mice, so studies in primates would be necessary to evaluate its usefulness in the clinical arena.
P318 Studying Phenotypic Divergences in HNSCC Cell Lines In 18 Vitro Using [ F]FDG and Digital Autoradiography J. Sinkkonen1, P. Jaakkola2, T. Grönroos1; 1Turku PET Centre, University of Turku, Turku, FINLAND, 2Turku Centre of Biotechnology, University of Turku, Turku, FINLAND. Aim: Investigating the metabolic differences in head and neck squamous cell carcinoma (HNSCC) cell lines (UT-SCC) after different hypoxia treatment by using [18F]FDG and digital autoradiography.Material and Methods: Four cell lines, UTSSC-8 (larynx), -25 (tongue), -34 (larynx) and -74A (tongue), were used. To achieve proliferatively active cells for the study, the proliferation curve was determined for each cell line (n=3). According to these curves, the right amount of cells were plated to 8-well chamber slides (Nunc). After three day culturing (+37 ºC, 5% CO2), the slides were moved to hypoxia workstation (Invivo2) and incubated in 1% O2. Five different time points were used (1, 3, 6, 12 and 24h) and the time was taken 30 min after adding [18F]FDG (50kBq/ml in NaCl). After tracer incubation, the cells were washed with PBS, fixed with 4% PFA and permeabilized in 100% acetone. The slides were placed to imaging plate (IP) and after 4h IP was scanned with phosphoimage scanner (FLA-5100) with the resolution of 10µm (n=2). Slides were then stained with hematoxylin and eosine and filmed for a reference picture for the autoradiography analysis (Aida Image Analyzer v.4.22). Cells grown in normoxia (21% O2) were used as a control group. [18F]FDG activity was measured in PSL/mm2-Bkg and values were compared to normoxia (H/N). For Western blot studies, cells were cultured in hypoxia workstation at the same conditions as in the [18F]FDG study (n=3). Cellular protein extract was collected and proteins were separated with 10% SDS-Page. Immunoblots against Hif-1α were detected with monoclonal mouse anti-human Hif-1α antibody and ECL.Results: In each cell line, the [18F]FDG accumulation followed the Hif-1α expression, which represents the survival and adaptation of the cells to the stressful hypoxic conditions. In UT-SCC34 and -74A cells, there was a growing [18F]FDG uptake between 1h and 24h in hypoxia. The highest [18F]FDG uptake (PSL/mm2-Bkg) was in -74A cells after 24h in hypoxia, but the uptake in normoxic cells was the highest of all controls, which is why it decreased the H/N values of -74A cells. The overall [18F]FDG uptake (H/N) in cell lines and in increasing order was UT-SCC-25, -8, -74A and -34, respectively. The difference between -8 and -34 H/N values was double (~5H/N ~10H/N).Conclusion: We have proven that this method is a valuable tool when studying differences in HNSCC cell lines and comparing the effect of short term hypoxia in radiotracer accumulation in vitro.
P319 Nanotamoxifen as a Therapeutic Option: Assessment by Labeling With 99mTc J. Shukla, G. Arora, G. P. Bandopadhyaya; All India Institute of Medical Sciences,, New Delhi, INDIA. AimTamoxifen is beneficial in the breast cancer patient with an increase in overall survival, decrease recurrence and the risk of contralateral disease. However, tamoxifen treatment elicits a higher incidence of endometrial and liver tumors. Tumors possess unique patho-physiological characteristics of enhanced permeability and retention (EPR) effect. We had formulated and characterized nanotamoxifen for particulate drug delivery system.Materials & methodsNanotamoxifen was formulated and characterized by electron microscopy and 1HNMR. Nanotamoxifen was radiolabelled with 99mTcO4- by stannous chloride reduction method. Labeling efficiency was assessed by ITLC using MEK. Biodistribution studies of nanotamoxifen 99mTc-nanotamoxifen was injected in wistar albino rats and the images were acquired under gamma camera after 15 min, 1h and 3h of intravenous injection(n=5). The animals were sacrificed after acquiring 3h images. The organs were removed and counted by gamma well counter. The percentage injected dose per gram of the tissues (%ID/g) was calculated.Labeling efficiency of nanotamoxifen was >98%. 99mTc-nanotamoxifen image after 15 min demonstrated the heart, kidney and bladder activity. The 3h image showed high concentration of 99mTc-nanotamoxifen in urinary bladder and kidneys. Approximately 14% ID/g in blood, ~ 31% ID/g in kidney, ~ 1.3 % ID/g in heart, ~ 2.2% ID/g spleen, ~ 3% ID/g in lung ~ 7% ID/g in liver, ~2% ID/g in bone was observed. Ovary, uterus and breast showed 1.66%, 1.54%, 1.45%, ID/g activity, respectively.Nanotamoxifen showed excellent in vivo stability as negligible uptake was visualised in thyroid and intestine and also demonstrated predominately renal excretion. 99mTc-nanotamoxifen remained in the circulation at high levels after intravenous injection (14% after 3h). The Kupffer cells of the liver are extremely efficient in removing particles recognized as foreign. Normally, a foreign particle upon injection will be coated by blood components (opsonisation) and takenup by
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P31 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Basic Science: Tumor Biology
P320 18F-FLT as a PET biomarker of cell cycle arrest J. Tsakok; Imperial College, London, UNITED KINGDOM. FLT (fluorothymidine) is a thymidine analogue that is selectively taken up in the S phase of cell division. Time dependence of FLT response following selective G1/S blockade (using MEK inhibitor GSK1120212B) in colon cancer cells HT29 may be used to inform translation of image-guided drug development to xenograft models and ultimately clinical trials in humans, in particular to optimise the timing of FLT scans following drug exposure. Experiments in monolayer culture suggest that the S phase in HT29 monolayers is 15 hours (FLT uptake reaches a nadir after 15 hours of MEK inhibition at IC50). with gradual recovery from G1/S block (normalisation of FLT uptake) over 30 hours after removal of MEK inhibition. Also, translational differences exist in between monolayer culture and three-dimensional multicellular tumour aggregates in a) thymidine kinase subtype 1 and 2 expression, demonstrated by differential FLT and FMAU uptake respectively b) IC50 c) amounts of radiotracer needed for uptake experiments. In summary, drug specific and tracer specific experiments in a translational environment may provide necessary biological understanding in planning trials correctly.
P321 Evaluation early response of thermotherapy, chemotherapy, and thermo-chemotherapy on colon cancer cell HCT-116 18 using F-FDG uptake inhibition rate B. Zhang, Z. Wang, S. Chen, Y. Wu; The First Affiliated Hospital of Soochow University, Suzhou, CHINA. Objective To establish a stable method to detect the 18F-FDG uptake in HCT-116 cell, and using 18F-FDG uptake inhibition rate to evaluation early response of heat therapy, chemotherapy, and thermo-chemotherapy on colon cancer cell HCT-116. Methods Uptake rate of 18F-FDG in HCT116 were determined when the experimental conditions were changed in turn, including cell concentration, reaction time, 18F-FDG radioactive activity, and glucose concentrations. Before and after giving different concentrations 5-FU, the MTT method was adopted to measure cell proliferation inhibition rate and 18F-FDG uptake rates were also measured. 24h after chemotherapy (100 μg/ml 5-FU, 10μl), thermotherapy (43°C, 40min) and thermo-chemotherapy (combining two conditions, first thermotherapy, then 5-FU), cell proliferation inhibition rate and 18F-FDG uptake inhibition rates were measured. The degree of cellular apoptosis was determined by flow cytometry, and the cell ultra structure was observed by transmission electron microscope. The glucose concentration and lactate dehydrogenase concentration in cell culture of supernatant fluid before and after treatment were measured. Results Uptake rate of 18F-FDG was (44.25± 2.19)% at the condition of 1×106 cells, 18 F-FDG radioactive activity of 3.7 KBq, glucose concentration of 5.5mmol/L and 100min incubation at 37°C. 24h after administration of 5-FU, the Uptake rates of 18 F-FDG were negatively correlated with the dose of 5-FU (r=-0.879,P<0.01), and the 18F-FDG uptake inhibition rates were positively correlated with the cell proliferation inhibition rates (r = 0.831, P < 0.01). 24h after treated with thermotherapy, chemotherapy, and thermo-chemotherapy, cell proliferation inhibition rates were (10.24±8.00)%, (25.68±6.10)%, (20.67±7.24)%,respectively, and the 18F-FDG uptake inhibition rates were (12.94±2.80)%, (28.25±4.59)%, (21.60±3.68)%. After treatment early apoptosis showed, and glucose concentration and lactate dehydrogenase concentration in the cell culture medium were higher than before treatment. Conclusions 18F-FDG uptake inhibition rate can evaluated early effect of thermotherapy and chemotherapy,and there was no synergistic effect by combining 43°C heat treatment 40min to low concentration 5-FU on human colon cancer cell HCT - 116.
P322 The experimental studies of evaluating the early effect of 18 F-FLT in human pancreatic radiotherapy by uptake of carcinoma cell Patu 8988
B. Zhang, Y. He, S. Deng, Y. Wu; The First Affiliated Hospital of Soochow University, Suzhou, CHINA. Objective To evaluate the early effect of radiotherapy by uptake of 18F-FLT in human pancreatic carcinoma cell Patu 8988. Methods The human pancreatic carcinoma cell Patu 8988 were exposed to a single fraction of γ-ray radiation of 0Gy, 2Gy, 4Gy or 8Gy,respectively. The OD values were detected by MTT method at 24 hours and 48 hours after irradiation and the cell inhibition rate were calculated. The uptakes of 18F-FLT were measured at 24 hours and 48 hours after irradiation, and the 18F-FLT uptake inhibition rate were calculated. Results At 24 hours after irradiation, the differences of OD values between groups of various dose were no significant (P>0.05). At 48 hours after irradiation, the cell inhibition rate were (9.28±11.92)%, (21.03±3.37)%, (32.96±3.77)%, respectively. At 24 hours and 48 hours after irradiation, the differences of 18F-FLT uptakes between groups of various dose were significant (P<0.05). At 24 hours after irradiation, the 18F-FLT uptake inhibition rate were (6.99±11.93)%, (11.77±7.35)%, (25.57±7.61)%, respectively. At 48 hours after irradiation, the 18F-FLT uptake inhibition rate were (14.69±4.43)%, (17.71±6.08)%, (40.81±7.61)%, respectively. The 18F-FLT uptakes decreased with the increasing dose of γ-ray. At 48 hours after irradiation, the cell inhibition rate measured by MTT was positively correlated with the 18F-FLT uptake inhibition rate (r=0.782,P<0.01). Conclusions The uptakes of 18F-FLT with human pancreatic carcinoma cell Patu 8988 decreased at 24h after irradiation. Response to radiotherapy could be early predicted by 18F-FLT PET scans.
P323 Influence of oxygen, glucose and GLUT-1 and -3 expressions on 18F-FDG uptake in a colorectal adenocarcinoma cell line. A. M. Abrantes1, C. C. Matos2, A. C. Mamede3, A. F. Brito1, M. C. Rodrigues4, A. Rodrigues4, M. F. Botelho5; 1Biophysics, IBILI, CIMAGO, Faculty of Medicine, University of Coimbra, Coimbra, PORTUGAL, 2 Biophysics, IBILI, Faculty of Medicine, Faculty of Sciences and Technology, University of Coimbra, Coimbra, PORTUGAL, 3Biophysics, IBILI, CIMAGO, Faculty of Medicine, University of Coimbra; CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Coimbra, PORTUGAL, 4 ICNAS, University of Coimbra, Coimbra, PORTUGAL, 5Biophysics, IBILI, CIMAGO, Faculty of Medicine, ICNAS, University of Coimbra, Coimbra, PORTUGAL. Introduction: Recent clinical data indicate that tumor hypoxia negatively affects the outcome of radiotherapy and chemotherapy in various cancers, emphasizing the need for noninvasive detection of tumor hypoxia. The application of 18F-FDG PET imaging in oncology is based on the upregulation of glucose transporters and glycolytic enzymes, associated with tumor hyperglycolysis. This means that the degree of FDG uptake by tumors may indirectly reflect the hypoxia level. The decrease of oxygen concentration constitutes a characteristic of solid tumors such as colorectal adenocarcinoma. In this context, the main objective of this study is to determine the pattern of uptake of 18F-FDG in a colorectal adenocarcinoma cell line in normoxia/hypoxia conditions and low/high glucose environment and correlate the results with GLUT1 and GLUT3 expression.Methods: The studies were performed in a colorectal adenocarcinoma cell line (WiDr, ATCC). A cell suspension of 2×106 cells/ml was incubated with 18F-FDG (25µCi/ml). Samples of 200μl were collected to eppendorf tubes for uptake determination. Eppendorfs were then centrifuged and radioactivity of cell pellets and supernatants was measured with a well-type gamma counter. These studies were conducted under conditions of normoxia and hypoxia (2% of oxygen), as well as high (4.5 g / L) and low (1 g / L) glucose content. GLUT1 and GLUT3 protein expression was assessed by flow cytometry.Results: The WiDr cell line uptake of 18F-FDG in hypoxia is about twice higher than in normoxia. Moreover, when the results of radiopharmaceutical uptake in a normoxic environment and in a low and high level of glucose were compared, it appears that the uptake of 18F-FDG is several times higher when cells are grown in a medium with low glucose content. The expression of GLUT1 and GLUT3 in the cell line under study is low.Conclusions: The 18F-FDG seems to be a good tracer for the detection of hypoxia in solid tumors, particularly in colorectal cancers. Our results seem to strongly reinforce the importance of low glycemia when PET image is obtained with this radiopharmaceutical. Finally, our data indicate that the low expression of GLUT1 and GLUT3 in colorectal cancer is not decisive in the uptake of 18F-FDG, being this probably explained by the expression of other GLUT isoforms.
P324 Effects of Chemotherapy on F-18-FDG Uptake in Tumour Cells X. Gao, F. Hajos, U. Olszewski-Hamilton, F. Girschele, P. Ubl, M. Schuetz, R. Dudczak, G. Hamilton, S. R. Li; Medical University of Vienna, Vienna, AUSTRIA. Aim: The purpose of this study was to determine changes in F-18-FDG incorporation at the different tumour cell level in response to conventional and novel chemotherapy agents and examine how these changes relate to factors involved in F-18-FDG incorporation.Materials and Methods: Cells derived from
Poster Presentations
the reticulo-endothelial system. Nanotamoxifen were prepared with hydroxypropyl-beta-cyclodextrin, rich in -OH moiety (Hydrophilic) and help to escape liver (RES). The liver uptake was only ~7% ID/g after 3h. The circulating nanoparticles are concentrated in the tumour due to enhanced permeability and retention (EPR) property of tumou.ConclusionThe nonspecific endocytic process, followed by a gradual release of the drug and binding of tamoxifen to the estrogen receptor around the nucleus may produce the desired antitumor effect. Nanotamoxifen may provide better therapeutic benefit by delivering the drug locally, for a longer period of time and reduce the systemic side effects.
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S338 human small-cell lung cancer (SCLC) (NCl-H417 and DMS153) and human colon cancer cell line (COLO 320DM) were incubated with cisplatin, carboplatin, pemetrexed or etoposide for 72 hrs. Cultures were incubated with drug doses (cisplatin 6.5 and 16.2 µM; carboplatin: 26.2 µM; pemetrexed: 34.6 µM; etoposide: 6.8 and 17 µM) corresponding to approximately 40%-95% proliferation inhibition and > 95% survival. Treatment was stopped and cells washed with phosphate buffered saline (PBS) before F-18-FDG was added for 30 min in PBS. Control cultures were incubated without chemotherapy agents. Cell counts, viability and cell cycle distribution estimated by flow cytometry and incorporation assay were used to evaluate the effects of chemotherapy.Results: F-18-FDG uptake in NCIH417 cells was increased significantly (p<0.05) after treatment with etoposide at the concentration of 6.8 µM and decreased significantly (p <0.05) at the concentration of 17 µM. In contrast, significantly decrease of F-18-FDG incorporation was found in NCI-H417 tumour cells after treatment with carboplatin, cisplatin and pemetrexed at the different concentrations. Whereas, F18-FDG accumulation was significantly reduced at cytostatic concentrations of cisplatin, carboplatin, pemetrexed and etoposide in DMS 153 and COLO 320DM cells and was decreasing in a dose-related manner.Moreover, F-18-FDG uptake significantly decreased in all tumour cell lines with increasing glucose concentration in the mediumConclusion: These findings demonstrate that tumour cell uptake of F-18-FDG reveals specific changes depending on the concentration of drugs used and the type of tumour cells This drug- and cell-specific modulation of FDG uptake has to be taken into account in positron emission tomography studies using F-18FDG for treatment monitoring.
P325 18F-FDG uptake in hepatocellular carcinoma: correlation with GLUT1 and p53 expression A. F. Brito1, A. M. Abrantes1, C. P. Costa2, C. C. Matos3, A. C. Mamede4, A. C. Gonçalves5, M. C. Rodrigues6, A. Rodrigues6, A. B. Sarmento-Ribeiro5, J. G. Tralhão7, M. F. Botelho8; 1Biophysics, IBILI, CIMAGO, Faculty of Medicine, University of Coimbra, Coimbra, PORTUGAL, 2Biophysics, IBILI, Faculty of Medicine, University of Coimbra, Coimbra, PORTUGAL, 3 Biophysics, IBILI, Faculty of Medicine, Faculty of Sciences and Technology, University of Coimbra, Coimbra, PORTUGAL, 4Biophysics, IBILI, CIMAGO, Faculty of Medicine, University of Coimbra; CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Coimbra, PORTUGAL, 5 Biochemistry, CIMAGO, Faculty of Medicine, University of Coimbra, Coimbra, PORTUGAL, 6ICNAS, University of Coimbra, Coimbra, PORTUGAL, 7Biophysics, IBILI, CIMAGO, Faculty of Medicine, University of Coimbra; Surgical Department, Surgery III, HUC, Coimbra, PORTUGAL, 8 Biophysics, IBILI, CIMAGO, Faculty of Medicine, ICNAS, University of Coimbra, Coimbra, PORTUGAL. Background and aims: Malignant cells require high energy via glycolytic generation of ATP for cell proliferation and survival, a process that is thought to be mediated by glucose transporters (GLUTs). Notably, GLUT1 is overexpressed and confers poor prognosis in a wide range of solid tumors, including liver tumors. A recent study has shown that expression of GLUT1 is increased in Hepatocellular Carcinoma(HCC) and promotes tumorigenesis. Conversely, suppression of GLUT1 expression by small interfering RNA significantly impaired tumorigenicity of HCC cells in in vitro models, suggesting that GLUT1 as an innovative therapeutic target for this highly aggressive tumor. Positron Emission Tomography (PET) using the radiolabeled glucose analogue 18F-FDG (2-[18F]fluorodeoxyglucose) enables the detection of increased glycolysis events in cancer cells and reveals high value in diagnosis, staging, relapse and therapeutic response evaluation. There are three phenomena responsible for increased glycolysis in tumor cells documented: over-expression of GLUTs (GLUT’s 1 and 3), increased activity of hexokinase and reduced levels of glucose-6phosphatase. This study aims to evaluate18F-FDG uptake in three different human HCC cell lines with different expression levels of p53, and to correlates with the expression of GLUT1.Methods: The cell lines used are HepG2, HuH7 and Hep3b2.17. 18F-FDG was incubated in a cell suspension with 2×106 cells/ml (25µCi/ml). Samples of 200μl were collected to eppendorf tubes for tracer uptake determination. Eppendorfs were then centrifuged and radioactivity of cell pellets and supernatants was measured with a well-type gamma counter. GLUT1 protein expression was assessed by flow cytometry. The expression of p53 was confirmed by flow cytometry.Results: We observed a higher 18F-FDG uptake in Hep3b2.1-7 (does not express p53). HepG2 cells (express normal p53) showed the lowest 18FFDG uptake comparing with Hep3b2.1-7 and HuH7 (express a mutated form of p53) cell lines. The expression of GLUT1 differs in the three cell lines studied, since each genetic profile have different expression levels of GLUT1.Conclusions: In the three cell lines studied, each genetic profile have different expression levels of GLUT’s 1 and 3. These results suggest that the uptake profile of 18F-FDG is related with expression of p53 and GLUT’s 1 and 3, which can be useful to help in the interpretation of PET images. This data can be very useful in clinical practice to evaluate therapeutic effectiveness of neoadjuvant treatment (chemo and radiotherapy) in HCC with increased expression of membrane Gluts.
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441
P326 99mTc-Tk uptake in MIA PaCa-2 pancreas cancer cell line. Preliminary results. R. Gradiz1, A. M. Abrantes2, A. C. Mamede3, A. M. Pinto1, M. F. Botelho4; 1 General Pathology Laboratory, CIMAGO, Faculty of Medicine, University of Coimbra, Coimbra, PORTUGAL, 2Biophysics, IBILI, CIMAGO, Faculty of Medicine, University of Coimbra, Coimbra, PORTUGAL, 3Biophysics, IBILI, CIMAGO, Faculty of Medicine, University of Coimbra; CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Coimbra, PORTUGAL, 4Biophysics, IBILI, CIMAGO, Faculty of Medicine, ICNAS, University of Coimbra, Coimbra, PORTUGAL. Pancreas cancer is the fourth leading cause of cancer worldwide. This is a tumor resistant to surgery, chemo and radiotherapy, and in which the five years survival rate is less than 5%. 99mTc-TOC(HYNIC-(D-Phe1,Tyr3-Octreotide) is a radiopharmaceutical used for diagnostics of pathological lesions in which somatostatin receptors is overexpressed (especially subtype 2 and to a lesser extent, subtypes 3 and 5) Therefore its use may be applied especially in gastroentero-pancreatic-neuroendocrine tumors. MIA PaCa-2 cell line is a human pancreatic duct adenocarcinoma, a cancer that represents about 90% of all pancreatic tumors and loses their somatostatin receptors during carcinogenesis, so it cannot be treated like neuroendocrine tumors.Aims: we want to characterize MIA PaCa-2 cells not only histologicaly but also about somatostatin 2 receptors expression. We also evaluate its 99mTc-TOC uptake.Materials and methods: MIA PaCA-2 cells (ATCC) were cultured with DMEM supplemented with horse and bovine fetal serum (ATCC) at 37% C and in a 5% CO2 atmosphere. For immunostaining, antibiodies against MNF-116, CK-19, vimentin, chromogranin-A, synaptophysin and CD-56 were used. Immunohistochemical staining was carried out by the streptoavidin-biotin method. For identification of somatostatin 2 receptors we used Western Blot technique and ABCam antibody (EPR3340) (ab81320), with a 1:200 dilution. 99mTc-TOC(99mTc-Tektrotyde®) was used for the uptake curves in which we incubated 2x106 cells with 99mTc (control) and with growing activities of 99mTc-TOC: 25, 50, 75 and 100 µCi. Duplicated samples of pellet and supernatant were taken and the uptake was measured with a well counter at 5, 10, 15, 30, 45, 60, 90 and 120 minutes. The percentage of uptake was calculated by the ratio between the pellet and the supernatant.Results: MNF-116, CK-16, vimentin and chromogranin-A were positive. Synaptophysin and CD-56 were negative. 99mTc-TOC uptake increased with time and reached 1.23% with 75μCi of the radiopharmaceutical at 120 minutes. Using 100μCi of the radiopharmaceutical it was observed a decrease in uptake (0.84% at 120 minutes) comparing with 75μCi incubation. 99m-Tc showed the lowest uptake (0.27% at 120 minutes).Conclusions: MIA PaCa-2 cells are EMT (epithelial-mesenchimal transition) cells of pancreas adenocarcinoma with neuroendocrine-like differentiation, capable of uptake 99mTc-TOC depending on receptor presence.
P327 99mTc-Hynic-Annexin-V: cellular uptake of apoptotic cells induced by TRAIL and in vivo imaging of apoptosis in colon tumour S. Valente1, A. M. Abrantes1, A. C. Gonçalves2, A. C. Mamede3, A. B. Sarmento-Ribeiro2, M. F. Botelho4; 1Biophysics, IBILI, CIMAGO, Faculty of Medicine, University of Coimbra, Coimbra, PORTUGAL, 2Biochemistry, CIMAGO, Faculty of Medicine, University of Coimbra, Coimbra, PORTUGAL, 3 Biophysics, IBILI, CIMAGO, Faculty of Medicine, University of Coimbra; CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Coimbra, PORTUGAL, 4Biophysics, IBILI, CIMAGO, Faculty of Medicine, ICNAS, University of Coimbra, Coimbra, PORTUGAL. Aim: Colorectal cancer is the third most common type of cancer and the second leading of mortality. One of the therapeutic objectives in cancer is to induce cell death by apoptosis. The externalization of the phosphatidylserine is one of the earliest events of the apoptosis. TNF-related apoptosis-inducing ligand (TRAIL), is a protein functioning as a ligand that induces cell death by apoptosis. Once, the use of Annexin-V, which has a high affinity to the phosphatidylserine, when radiolabelled with 99mTc becomes useful for in vivo detection and monitorization of cancer. 99mTc-HYNIC-Annexin-V was used to detect apoptosis in colorectal cells (WiDr) in vitro and in vivo.Material&Methods: Annexin-V was labeled with 99mTc using HYNIC as bifunctional agent, and the radiolabeling yield were evaluated with microchromatography. WiDr cells were cultured in vitro and studied without and with different concentrations of TRAIL (20, 100, 200 ng/ml) incubated 2, 12 and 24h. 99mTc-HYNIC-Annexin-V (0.925MBq/mL of culture medium) was dissolved in the culture medium, in both condition, and cellular uptake was studied between 5 min and 120min after the addition of 99mTc-HYNIC-Annexin-V. Flow cytometry with FITC-Annexin-V were used to evaluate apoptosis cells after the same periods of time incubated with TRAIL. In vivo studies were performed in nude mice (Balb-c nu/nu) injected with eight million cells. So, after 3 weeks the animals were injected with approximately 6MBq of 99mTc-HYNIC-Annexin-V and were performed dynamic and static images. Next, the animals were sacrificed, in periods of time between
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441 30min and 360min after injection, and several organs were excised and counted in a gamma counter for biodistribution.Results: The radiochemical purity of 99mTcHYNIC-Annexin-V was superior to 90%. Through in vitro studies were observed an increase cellular uptake of the 99mTc-HYNIC-Annexin-V over time in WiDr cells, and higher than 99mTc uptake. There were statistical differences in the cellular uptake with 99mTc-HYNIC-Annexin-V over the time (p<0.05), and between cellular uptake of 99m Tc. Cells incubated with TRAIL also showed an increased uptake over the time for all concentrations. Accordingly to the biodistribution studies the tumour uptake (%ID/g), excluding the organs involved in the radiophamaceutical excretion, like kidneys and liver, was a little higher than the remaining structures. It was also possible to verify that the uptake in tumour maintains over time. Comparing tumour with muscle there were statistical differences among them (p<0.05).Conclusion: These data demonstrate the detection of apoptosis in colorectal tumour using 99mTc-HYNIC-Annexin-V as a noninvasive technique.
P32 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Basic Science: Animal Models
S339 humidified air and 5% CO2. Mesenchymal stem cells may also be represented in cell mixture. To evaluate this hypothesis the cells were successfully differentiated towards adipogenic, osteogenic and chondrogenic lineages. Moreover, FACS measurements are carried out to identify the expression of the appropriate cell surface markers. Radiolabelling (99mTc-HMPAO, Leuco-Scint® kit) method was performed following the producer’s (Medi-Radiopharma Ltd) instructions.The adipose derived MSC cells - similarly to the human adipose derived cells - showed fibroblast-like morphology in light microscope. The phenotype of the isolated cADMSC was identified by detecting cell surface markers with flow cytometry (FACS); that is we successfully isolated canine adipose derived stem cells. The induced differentiation, further FACS measurements are in progress. Non-specific radiolabelling with 99mTc-HMPAO (Leuco-Scint®, Medi-Radiopharma Ltd) resulted high labelling efficiency with retained functional abilities so that labelled MSCs are available for reinjecting and further SPECT/CT imaging.Our preliminary results suggest that isolation-, identification-, differentiation- and radiolabelling of cADMSC are feasible. Canine adipose tissue represents an easily available source for veterinary stem cell therapies. Beside dog proved to be a promising biomedical model in the field of stem cell therapy too.Scientific work was supported by several national (OTKA-68376, JEDIONKO, KMOP-1.1.1-08/1-2008-0017, GOP-1.1.1.-09/12010-0107) and international (IAEA-CRP, EMIL NoE) projects.
P328 P. Yan, R. Wang, C. Zhang, F. Guo, L. Kang, M. Yu, Y. Cui; Peking University First Hospital, beijing, CHINA. Objective: Human tumors from epithelial origin produce IgG. IgG contributes to cancer initiation in the precancerous stage when epithelial cells are actively proliferating. Tumor-derived IgG light chain genes have the identical sequence and high expression in many tumor cells. The study is to develop a radioiodinated antihuman tumor-derived IgG light chain monoclonal antibody (named 4E9) and evaluate its cellular binding in vitro, biodistribution and imaging in nude mice bearing tumor for researching the potentiality in radioimmunoimaging and targeted therapy of human cancers.Methods: 4E9 was labeled with 131I through Chloramine-T method and purified with Sephadex G-25 column. Cellular binding in vitro was analyzed the binding ratio, Kd and Bmax. BALB/c nude mice were inoculated with HeLa MR cells in the right hind limb. 131I-4E9 was injected intravenously via tail vein for biodistribution study and SPECT imaging postinjection at 5h, 24h, 48h and 72h respectively. mIgG was used as a control. All data were analyzed by the statistic software of SPSS13.0.Results: The labeling efficiency of 131I-4E9 reached 89.9%±4.7% (n=4), the specific activity was up to 1.3MBq/μg, and the radiochemical purity was 98.1%±1.2% (n=4). The radiochemical purities of 131 I-4E9 kept highly stable (>90%) at 4 oC and 37 oC in human serum within 72h. In cellular binding test of saturation, Kd=8.20×108L/mol, and Bmax=9.36fmol/106cell. 131 I-4E9 combined to HeLa MR cells more in supernatant portion than cellular portion, and had higher binding ratio than 131I-mIgG respectively (P<0.001). 131I-4E9 removed from blood more fast than 131I-mIgG (P<0.001). In comparison with the T/NT ratio of 131I-4E9 and 131I-mIgG, there was significant difference besides liver, bladder and bone (P<0.05). The ratio of T/M and T/B reached 6.67±1.91(n=5)and 1.51±0.577(n=5)in 72h. As for imaging in vivo, 131I-4E9 was more clearly focused on tumor lesion after 24h.Conclusion: 131I-4E9 maintained good cellular binding characteristics and was successful used in tumor imaging. This method provides a prospective approach for radioimmunoimaging and targeted therapy of tumor in vivo.Key Works: antihuman tumor-derived IgG light chain monoclonal antibody; radioiodinate; tumor; radionuclide imaging
P329 Isolation, Identification, Differentiation and Radiolabelling of Canine Adipose Tissue Derived Mesenchymal Stem cells (cAD-MSC) - Preliminary Studies L. Balogh1, Z. Postenyi1, V. Haasz1, A. Polyak1, P. Tatrai2, K. Nemet2, F. Uher2, J. Thuroczy3, G. Andocs3, R. Torok4, G. Janoki4, G. A. Janoki5; 1 NRIRR, Budapest, HUNGARY, 2National Blood Transfusion Service, Budapest, HUNGARY, 3SzIE Vet Fac, Budapest, HUNGARY, 4 Radiopharmacy Laboratory Ltd, Budaors, HUNGARY, 5Medi-Radiopharma Ltd, Erd, HUNGARY. The autologous adipose-derived stem cell therapy (cAD-MSC) is a promising novel treatment choice in the field of regenerative medicine and tissue engineering for both human and veterinary medicine. Our aim was to establish isolation-, differentiation- and radiolabelling method of canine adipose tissue derived mesenchymal stem cells (cAD-MSC) and parallelly to prove the usefulness of the canine model for human biomedical sciences.The adipose tissue samples were collected from visceral and different subcutaneous fat depots from Beagle dogs using standard sterile surgical procedures. The SVF (Stromal Vascular Fraction) was obtained by digestion with collagenase. Following centrifugation and washing of the pellet, cells were incubated in Dulbecco modified Eagle’s medium (DMEM) supplemented with 10% Fetal Bovine Serum (FBS), in incubator supplied with
P33 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Basic Science: New & Innovative
P330 A new method for estimating extension and distribution of red bone marrow in living humans. A computational approach to PET/CT images. F. Fiz1, M. Brignone1, C. Marini2, A. Buschiazzo1, M. Massollo1, S. Capitanio1, S. Morbelli1, M. Podesta'3, C. Campi4, M. Piana5, F. Frassoni3, G. Sambuceti1; 1Nuclear Medicine, Dept of Internal Medicine, University of Genoa, Genova, ITALY, 2CNR Institute of Bioimages and Molecular Physiology, Genova, ITALY, 3Stem Cell center Hospital San Martino, Genova, Genova, ITALY, 4Department of computer science, University of Helsinki, Helsinki, FINLAND, 5Dept of Mathematics, University of Genoa, Italy, Genova, ITALY. Aim. We aim at developing and validating a method to estimate extension and distribution of active bone marrow (BM) in living humans based on an innovative computational integration of CT maps and PET data of FDG uptake.Materials and Methods. Based on the assumption that BM is surrounded by compact bone, the developed software asks for a loose region including the head vertex and then automatically recognizes external bone boundaries, based their high attenuation coefficient. The procedure is repeated throughout all CT slices allowing a 3D reconstruction of the whole skeleton. Then the algorithm extracts all voxels included in this volume according to a simple thresholding procedure and recognizes them as space potentially available for BM. A binary mask is thus generated and applied to the co-registered PET images to extract the metabolic activity of intraosseous tissue. Results concerning the skull are finally rejected because of contamination by brain radioactivity.Results. This algorithm was applied in 102 patients submitted to PET/CT because of a non-metastatic melanoma with negative two-year follow up. To define red BM metabolic pattern, we analysed the soma of all dorsal and lumbar vertebrae documenting an average standard uptake value (SUV) of 2.01±0.36. Accordingly, intrabone voxels with SUV≥1.1 (mean spine SUV - 2.5 SDs) were considered red BM while those with SUV <1.1 were considered as yellow (inactive) BM. The mean BM volume throughout the skeleton was 1631±592ml. This variable was higher in males than in females, it was loosely correlated with measured body weight (r=0.43, p<0.01) and strictly predicted by ideal body weight (r=0.81, p<0.001) in both groups. Overall, red BM volume had an extension of 541±195 ml accounting for 34±9% of the total available intrabone space. Red BM was more frequently found in axial than in appendicular skeleton (87±8% vs 10±8%, respectively, p<0.001) where it was confined to the heads of long bones. Age only modestly predicted SUV values in the red BM, while it robustly and inversely correlated with red BM volume expressed as % occupancy of intrabone space.Conclusion. Applying our software to a population of “normal subjects” provides a normalcy picture of BM that adequately fits with previous pathological evidence both in terms of absolute measurements and effects of age and gender. The possibility to estimate BM extension and metabolism in patients has the potential to improve our comprehension of the pathophysiology of this tissue in several clinical conditions and treatments.
Poster Presentations
Evaluation of 131-I Radiolabeled Anti-Human Tumor-Derived IgG Light Chain Monoclonal Antibody for Tumor Imaging
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P331
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 Types of Benign Meningiomas
Potential Use of Radioiodinated Arg-Arg-Leu peptide as an Molecular Tumor Imaging Agent in Tumor Xenografts
G. A. Alexiou, S. Tsiouris, A. Goussia, A. P. Kyritsis, S. Voulgaris, A. D. Fotopoulos; University Hospital of Ioannina Greece, IOANNINA, GREECE.
R. Wang, X. Lu, P. Yan, M. Liu, M. Yu, C. Zhang, F. Guo; Peking University First Hospital, beijing, CHINA.
Purpose: Meningiomas account for about 30% of all intracranial tumors and are classified into 3 grades. Benign meningiomas recur in nearly 7-15%. Several subgroups of benign meningiomas have been proposed to harbor different molecular characteristics. Abnormalities of chromosome 22q are more frequent in transitional and fibrous meningiomas than in the meningothelial variants and are associated with more aggressive behavior. Single-photon emission computed tomography (SPECT) by various radiotracers can metabolically characterize intracranial tumors. In the present study we prospectively evaluated whether 99mTc-Tetrofosmin (99mTc-TF) brain SPECT could discriminate different subtypes of benign meningiomas.Methods: Seventeen consecutive cases of benign meningiomas (3 males, 14 females; mean age 60.5 years, range 48 to 75 years) diagnosed over a 24-month period were enrolled in the study. They all had been preoperatively evaluated by anatomic brain imaging (CT and MRI) and within a week were submitted to functional imaging by 99mTc-TF SPECT. Surgical excision was performed within a week after scintigraphy. Surgical specimens were graded following the WHO criteria.Results: Histology of the surgically resected tumors provided the diagnosis of meningothelial meningiomas in 9 cases. Five meningiomas were transitional, one angiomatous and two psammomatous. Meningothelial meningiomas tended to exhibit a higher tracer uptake as compared to other meningiomas (5.39 ±1.73 vs 3.18 ± 1.7, p=0.032). ROC analysis provided 4.5 as the optimal cutoff value thresholding the discrimination between these two groups, with 75% sensitivity and 85.7% specificity.Conclusion: This pilot study implies that 99mTc-TF brain SPECT could prove useful in differentiating different subtypes of benign meningiomas.
Objective to develop a novel iodine-131 labeled tumor peptide imaging agent Arginine-Arginine-Leucine (Tyr-Cys-Gly-Gly-Arg-Arg-Leu-Gly-Gly-Cys, tripeptide RRL) targeted to tumor cells and tumor-derived endothelial cells to perform molicular tumor imaging in varied tumor xenografts.Methods The RRL sequence motif was identified as a tumor molecular marker specifically binding to tumor angiogenic endothelium. Tyrosine was conjugated to the amino terminal of RRL (Cys-Gly-Gly-Arg-Arg-Leu-Gly-Gly-Cys) for labeling with radionuclide iodine-131 (131I-RRL). One part of RRL was conjugated to fluorescein isothiocyanate(FITC-RRL) and prepared for cell binding experiments. We cultured four colon cancer cell lines with different invasive activity, angiosarcoma cells, glioma cell line, renal carcinoma cell line and smart muscle cell line in medium containing 2 μg/ml FITC-RRL for 12hr and then observed under confocal microscope. State molecular tumor imaging using 131I-tRRL were performed in B16, EOMA, OS732 and HepG2 tumor-bearing mice in vivo.Results In vitro cellular binding experiments revealed a new discover that RRL could adhere largely to various malignant tumor cells from different origins besides to tumor angiogenic endothelium. The uptake ability of FITC-RRL in different cells was distinguishing and glioma cell showed the high bright fluorescence intensity. 131I-RRL accumulated in tumors, not other organs at 24 hr after injection. SPECT imaging with 131I-RRL clearly showed tumors, especially at 24 hr in melanoma-bearing mice. Furthermore, 131I-RRL can visualize liver cancer, angiosarcoma and osteosarcoma in vivo at 24 hr after injection.Conclusion Radioiodinated RRL offers a noninvasive nuclear imaging method for functional molecular imaging of tumors targeted to neovascularization and also tumor cells, and could be a carrier for tumor radioimmunotherapy.Key words: iodine-131, peptide Arg-Arg-Leu (RRL), uptake ability, molecular tumor imaging, tumor bearing mice
P332 Measurement the expression of microRNA let-7 in lung adenocarcinoma A549 cell with radioiodide uptake mediated by human sodium iodide symporter W. Yang, J. Wang; Xijing hospital, Xi'an, CHINA. Objective:microRNAs are a family of 21- 25 nucleotides, function as on-cogene or tumor suppressor gene, always aberranting expressed in the tumor, could be served as a new marker for tumor detection and therapy. The aim of this study is trying to establish a new technique to measure the expression of the miRNA in tumor cell with radioisotope.Method:We cloned the human sodium iodine transporter gene(hNIS)as report gene, 3’-UTR of ras gene (RU) which complementary bind with let-7, pri-let-7 and pri-mir143 which will be processed to mature let-7 and pri-mir143 were also cloned. The fusion gene of hNIS-RU was constructed by binding hNIS with RU together, expressing of reporter gene hNIS will then be regulated by the let-7. Transfected hNIS and hNIS-RU to A549 cell separately, 24 hours later 37kBq of 125I was supplied to A549 cell, the radioactivity of 125I was counted and the expression of hNIS was detected by Western blot an hour later. Cotransfected hNIS-RU with a different amount of pri-let-7 to A549, as a control, hNIS-RU with different amount of pri-mir143 will also be cotransfected to A549 cell, the uptake of 125I will be counted separately after cotransfection.Results:The uptake of the 125I is 12 times higher in the hNIS transfected A549 than A549 only. When transfected hNIS-RU, its uptake decreased to 70 percent compared to hNIS transfected A549, but still 8 times higher than nontransfected. The expression of hNIS was significantly decreased when transfected hNIS-RU compare to hNIS transfected only. The uptake of the 125I decreased further more when cotransfected hNIS-RU and pri-let-7, the more pri-let-7 cotransfected, the less uptake of the 125I was counted, consistently the expression of hNIS was also decreased when pri-let-7 increased. However pri-mir143 transfection could not affect neither the uptake of 125I nor the expression of hNIS when cotransfected with hNIS-RU to A549 cell.Conclusion:We successfully constructed the hNIS-RU fusion gene, in which the expression of the reporter gene (hNIS) was regulated by miRNA let-7. To do so, we first reported the method to measure the expression of miRNA in tumor cells with sensitive radioisotope. It will not only lay a foundation for the further study of miRNA, but also provide a new idea for tumor diagnosis and therapy.
P34 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Brain
P333 99mTc-Tetrofosmin Brain SPECT for Predicting Histological
P334 Usefulness of C-11-Methionine PET in diagnosis Symptomatic Epilepsy: a comparison with F-18-FDG PET
of
S. Fujita1, T. Ootsubo1, S. Nagamachi2, Y. Umemura1, S. Ueno1, R. Nishii2, S. Tamura2, T. Fujimoto1; 1Fujimoto Hayasuzu Hospital, Miyazaki, JAPAN, 2 MIyazaki Medical College, Miyazaki, JAPAN. Objectives: As Epilepsy patients often have several intracranial lesions, the presurgical differential diagnosis using MRI, SPECT and PET is difficult in some cases. In this study, we assessed the C-11-Methionine uptake in pre-surgical symptomatic epilepsy patients by PET, and then compared the results with that of F-18-FDG PET; no previous study assessed the evaluation of diagnostic value using C-11Methionine PET in diagnosis of pre-surgical symptomatic epilepsy compared with F18-FDG PET.Methods: Ten patients were underwent C-11-Methionine PET, F-18FDG PET and MRI within pre-surgical 1 week. After resection along with focus excision, all patients were divided into three groups: Brain tumor (BT), cortical dysplasia (CD) and encephalomalacia (EM). The uptake tracers were evaluated by the lesion to contra-lateral ratio (L/C ratio) and maximum standardized uptake value (SUV) with MRI fusion image.Results: Although there was no significant difference among BT, CD and EM using both SUV of C-11-Methionine and SUV, L/C ratio of F-18-FDG, there was a significant difference among BT, CD and EM using L/C ratio using C-11-Methionine (average L/C ratio: BT 1.14, CD 1.10, EM 0.86).Conclusions: As F-18-FDG widely used to diagnose malignancy and to detect focus of epilepsy, it appeared from this study that F-18-FDG was not contribute to difference diagnosis and that another tracer such as C-11-Methionine was required. C-11-Methionine PET results correlated well with the pathological diagnoses in symptomatic epilepsy.
P335 Dose escalation study on FET-PET delineated glioblastoma based on a signal-to-background ratio adaptive thresholding V. Garibotto, F. Buchegger, F. Caparrotti, M. Wissmeyer, H. Zaidi, R. Miralbell, O. Ratib, D. C. Weber; Geneva University Hospital (HUG), Geneva, SWITZERLAND. Aim. Dose escalation studies for glioblastoma (GBM), previously performed using MRI for delineation, have given inconsistent results. The purpose of this prospective pilot study is to evaluate 18F-fluoro-ethyl-tyrosine (18F-FET) PET for GBM delineation using an automatic signal-to-background ratio (SBR)-based adaptive thresholding method, in order to identify the most metabolically active component of the lesion. We tested this approach in a population of patients with biopsy-proven primary GBM addressed for a radio-chemotherapy: 66-72 Gy were administered to the metabolically active tumor using a simultaneous integrated boost (SIB) technique.Materials and methods. The SBR-based adaptive thresholding we tested takes into account the mean background SUV and the maximal SUV value of the lesion (over 9 voxels) using the following formula: SUVthreshold= SUVBkgr + (0.45 + 0.4/rTB) x (SUVtumoral-SUVBkgr) (rTB = tumor-to-background ratio). We compared the GTV obtained with this approach (GTVSBR1) with a previously proposed SBR-based adaptive thresholding allowing the segmentation of
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P336 Additional value of SPECT/CT in non invasive grading of gliomas using Tc99m-sestamibi B. R. Mittal, C. Harisankar, S. Sura, A. Bhattacharya, S. Mathuriya; PGIMER, Chandigarh, INDIA. Non invasive grading of brain tumors is of immense clinical value. Tc99m-sestamibi has been tried in differentiating tumor recurrence from radiation necrosis. Degree of sestamibi uptake correlates with the histological grade of tumor. This study was performed in patients with glioma using Tc99m-sestamibi to non-invasively predict the histologic grade and to determine the additional value of SPECT/CTThirty consecutive patients with MRI evidence of gliomas were included. All the patients were subjected to SPECT/CT of the brain 30 minutes after intravenous injection of 20 mCi of Tc99m-sestamibi. Tumor to contralateral normal brain tissue ratio (T/N), tumor to scalp (T/S) and tumor to choroid plexus (T/P) ratios were calculated. All patients were subjected to surgery and histopathological examination for grading of the tumor. Tumors were divided into low grade (WHO grade I/II) and high grade (WHO grade III/IV). ROC analysis was performed to determine the best T/N and T/S ratio. Additional findings on CT such as tumor volume, mass effect, midline shift, calcification and hydrocephalus were also noted.Of the 30 patients, 11 patients had WHO grade II, 4 had grade III and 15 had grade IV gliomas. Mean T/N ratio in patients with low grade tumors was 1.9 and 7.6 in high grade tumors. T/N ratio and T/S ratio between low grade and high grade tumors, WHO grade II and Grade IV tumors were statistically significant (p<0.05). There was no statistically significant difference in T/N and T/S ratio between WHO grade II and III or WHO grade III and IV tumors. There was no correlation between T/P ratio with the WHO histologic grade. T/N ratio of >3 had 100% specificity and T/S ratio of >0.8 had 90% sensitivity.In 21 patients, the size of the tumor was significantly larger in CT than in SPECT. CT helped in localizing the site of abnormality in all the patients. Additionally, CT identified edema in 26, calcifications in 6, mass effect in 25, midline shift in 12 and hydrocephalus in 5 patients. In fifteen patients with either hydrocephalus or midline shift, CT helped in differentiate physiological uptake in choroid plexus from tumor.Our data suggests that T/N ratio of >3.0 is indicative of high grade glioma. T/N ration is a more robust parameter than T/S ratio. CT from SPECT/CT provides additional information in almost all the patients. CT is invaluable in interpretation of SPECT images in up to 50% of the patients.
P337 Integration of 11C-methionine (MET) PET and Magnetic Resonance (MR) for radiotherapy target definition of highgrade gliomas M. Rodari, G. Pepe, F. Alongi, L. Antunovic, P. Navarria, P. Rossi, M. Scorsetti, A. Chiti; IRCCS Humanitas, Rozzano, ITALY. Purpose: Differentiation between radiation necrosis and non specific postoperative changes in high-grade gliomas follow-up is a diagnostic dilemma. MR is flawed by low accuracy in this setting, while MET-PET is considered a valuable tool to detect hyper metabolic tissue.The aim of this study was to evaluate the ability of MET-PET to delineate target volume of high-grade gliomas recurrence. We also investigated the differences between tumour burden as measured with MR and METPET.Methods: between October 2009 and January 2011 we studied 5 patients with previous surgery for high-grade gliomas and 2 patients with biopsy proven highgrade gliomas (mean age 53±13 years). Each patients underwent CT-simulation, MR and MET-PET scan. 11C-methionie was synthesized on a General Electric TracerLab FxC module, according to the method described by Langstrom B. Radiochemical purity was always above 95%. Images were acquired 10 minutes after the injection of 250-350 MBq on a Siemens Biograph 6 LSO scanner. A 10 minutes acquisition of the whole brain was performed, using low-dose CT (80 mAs, 130 Kv, thickness 3mm, collimation 6x3 mm, pitch 1.0) for attenuation correction and lesion localisation.The procedures were performed with patients in the treatment
position, with a commercially available stereo-tactic mask which incorporated fiducial markers for images co-registration. Gross tumour volume (GTV) was outlined on CT scans fused to contrast-enhanced MR (GTV-MRI/CT). GTV-MRI/CT encompassed pathological gadolinium enhancements areas and post surgical cavity.A second GTV, encompassing the MET-PET positive region only on basis of visual analysis (GTV-PET), was generated. This additional information was evaluated using PET/CT/MRI co-registered images.Results: The average GTV MRI/CT was 497 cc (range 18-110 cc). The average GTV MET-PET was 227 cc (range 7.8-71cc). The average of composite GTV for PET and MRI (composite GTV MRIMET) was 593 cc (range 23-133cc).Percentage differences of reduction between composite GTV MRI-MET with GTV MRI/CT and GTV MET-PET were respectively 17% and 62%.Conclusion: our data demonstrated that the integration of GTV METPET with GTV MRI/CT in radiotherapy planning of high-grade gliomas influence the Planning Target Volume (PTV), resulting in an increase of the treated volume. Composite CTV MRI-MET might have an impact in tailoring patient treatment.
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Diagnostic Accuracy of PET with [ C]Methionine in Differential Diagnosis of Primary Brain Tumor Recurrence from Radiation-Induced Brain Injury T. Skvortsova, Z. Brodskaya, Z. Savintseva; Bechtereva Institute of the Human Brain of Russian Academy of Sciences, Saint-Petersburg, RUSSIAN FEDERATION. The purpose of the study was to assess the diagnostic accuracy of positron emission tomography with [11C]methionine (PET-Met) in distinguishing brain tumor recurrence from posttreatment radiation effect (PRTE) .Material and method. PET with [11C]methionine were performed in 156 patients (median age 35 years, range 3-71) with glioma (n=148, 50-low-grade, 98-high-grade) or other type of primary cerebral tumors (n=8) previously treated with multimodal therapy. Entry criteria included new or progressive MR imaging enhancing lesions after brain irradiation and definite final diagnosis on the basis of the pathological examination (n=35) or clinical course with MRI and PET follow-up. PET examinations were assessed by visual inspection and calculating [11C]methionine uptake index (UI) as the ratio of the highest lesion uptake to normal cortex.Results. Patients exhibited the three different types of PET-detected abnormalities of the brain: pure PTRE in 68 patients (74 lesions), recurrent tumors in 62 patients and mixture of radionecrosis with recurrent/residual tumor in 26 patients. Pattern of increased [11C]methionine accumulation and UI were compared between three groups. In PTRE group PET scans were either negative (n=51) or slightly increased tracer uptake (range 1,2 1,95) was seen in the site of contrast enhancement on MR imaging (n=23). The UI was 1,18±0,28 (mean±SD). In 7 patients diagnosis was verified after resection or biopsy. Other cases were considered to have PRTE on the basis of regressing or stable neuroimaging findings during follow-up period on average 14 months after first PET. In recurrence group PET-Met showed abnormal high focal [11C]methionine uptake close to margins of postoperative cavity or at distance. The UI was 2,42±0,77 (range 1,3-5,4). In third group the part of the lesion represented an active tumor mass had high MET uptake whereas the other part with radionecrosis showed low MET uptake. The UI was 1,74±0,38 (range 1,4-2,8). The uptake index was significantly different between three groups (p<0,001). After excluding 26 patients showed combination of the active tumor tissue with postradiation effects an UI threshold value of greater than 1,45 optimized differentiation between recurrent tumor and PTRE with a highest sensitivity of 93,5% and specificity of 89,3%.Conclusion. PET with [11C]methionine is a valuable additional tool for followup of brain tumors allowing early noninvasive differentiation of the lesion with ambiquous morphology after irradiation.
P339 11C-methionine positron emission tomography in diagnosis cerebral low-grade astrocytomas E. S. Malakhova, T. Y. Skvortsova, Z. L. Brodskaya; IHB RAS, SaintPetersburg, RUSSIAN FEDERATION. The purpose of this study was to assess the diagnostic and prognostic value of positron emission tomography with 11C-methionine (11C-MET-PET) in diagnosis of cerebral low-grade astrocytomas.MATERIAL AND METHODS:Data of 11Cmethionine PET obtained for 187 patients with brain gliomas with different types of grade were included in retrospective analysis. Results showed 107 low-grade gliomas, 80 high-grade.PET-images were analyzed by visual interpretation and semiquantitative uptake values.11C-MET uptake index (ratio of tracer uptake levels ROI/referent area) was calculated for dividing tumor to reference activity. A lowgrade astrocytomas were suspected for lesions showing increased 11C-MET uptake on PET images with a mean lesion-to-cortex ratio of less 2,0. A high-grade gliomas were suspected in cases with a mean lesion-to-brain ratio equal or more than 2,0.Accuracy of PET results was evaluated by comparison of PET findings with subsequent histological analysis in 187 patients.RESULTS:In 95 gliomas 11C-MET uptake index exceeded the threshold value of 1,31 and was less 2,0.11C-MET uptake index in 23 gliomas were less of tumor threshold (1,31±0,19) that caused to
Poster Presentations
the whole lesion (GTVSBR2) (Vees et al., 2009). The study population consisted of 5 patients with newly diagnosed GBM (mean age 59.6 ± 10.7). All patients were investigated with standard MRI and 18F-FET PET. Static 10 min PET images were acquired 40 min after intravenous administration of 200 MBq 18F-FET. So far, 3 patients were treated, with a follow-up of 3, 9 and 16 months respectively. The two remaining patients are currently under treatment.Results. SUVtumoral, SUVBkgr and SUVthreshold were on average 3.6±1.8, 0.9±0.1 and 2.4±0.9, respectively. The resulting GTVSBR1 for the SIB was on average 7.5 ± 9.5 mL, smaller as compared with the results of the GTVSBR2 (32.6 ± 35.5 mL). The GTV based on the MRI data was 43 ± 59.8 mL. No patient showed grade CTCAE > 2 acute toxicity following treatment. Clinical follow-up is ongoing.Conclusion. The selection of the most appropriate 18F-FET PET-based segmentation algorithm is crucial, especially for a SIB approach, as it impacts both the volume and shape of the resulting GTV. This proposed SBR-based thresholding for 18F-FET PET, adapted in order to define the most active component also for lesions with a low rTB, seems a promising strategy for automated SIB volume delineation.Reference:Vees H, Senthamizhchelvan S, Miralbell R, Weber DC, Ratib O, Zaidi H. EJNMMI, 2009, 36:182-193.
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trouble of clear visualization of gliomas.In 24 low-grade astrocytomas a mean lesion-to-brain ratio was equal or more than 2,0.Sensitivity and specificity of 11CMET PET in differentiation of low- and high grade gliomas were 72% and 76% respectively (threshold value of 11C-MET uptake equal 2,1). Such characteristics may attribute to divergence of PET and histological results, not false PET results in some cases.An assessment of 11C-MET PET prognostic value was performed using Kaplan-Meier method and log-rank test. The 11C-MET gliomas PET-syndrome prognostic value (p=0,000001) was found higher than histological prognostic value (p=0,00001).CONCLUSION:PET-syndrome of low-grade gliomas shows high diagnostic significance in typical cases.Cystic component, small sizes of tumor, low metabolic activity, probable histological anaplasia overvalue may lead to falsenegative results, high 11C-MET uptake index overvalue lead to falsepositive. Results showed that PET seems to be a more reliable prognostic factor in case of conflict between 11C-MET PET findings and glioma histopathology.
P340 Contribution of differentiation of necrosis
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C-methionine PET to MRI in the recurrent brain tumor from radiation
R. Pavlicek, J. R. Garcia, M. Baquero, M. Soler, Y. Fernandez, S. Fuertes, I. Carrio, F. Lomeña; CETIR - ERESA, Esplugues Llobregat, SPAIN. Contribution of 11C-methionine PET to MRI in the differentiation of recurrent brain tumor from radiation necrosisAIMIn patients with gliomas, the distinction of recurrent tumor from radiation necrosis is often difficult after radiotherapy. MRI is limited when patterns of gadolinium uptake are inconclusive. We evaluated the possible contribution of PET with 11C-methionine PET to MRI in the evaluation of glioma patients after radiotherapy.METHODS14 patients who had been previously treated with radiotherapy after primary treatment for glioma underwent MRI examinations and 11C-methionine PET( in less than 15 days) when the differential diagnosis between recurrent tumor and radiation necrosis was needed (9,4+/- 2,3 months).MRI exams were performed first and consisted of gadolinium enhanced images. Eventual 11C-methionine uptake in the lesions was assessed visually and expressed as the ratio of the lesion to contralateral normal lobe gray matter uptake (L/B). 11C-methionine images were coregistered to T1-weighted 3D MR images using SPM8 software.Imaging results were confirmed by clinical course and followup diagnostic images (7,5+/- 4,8 months).RESULTS17 lesions were evaluated in 14 consecutive patients. MRI images were reported as indeterminate (non-typical gadolinium uptake pattern) in 8 (47,1%). Adding the 11C-methionine results converted 6 indeterminate studies to determinate (4 recurrent tumor and 2 radiation necrosis). The others 2 (11,8%) remained indeterminate after 11Cmethionine PET.SUV ratio L/B of positive 11C-methionine PET was 1,60+/-0,49 while ratio L/B of negative studies was 0,77+/-0,46.CONCLUSIONSThe combination of semi-quantitative 11C-methionine PET and appropriate coregistration techniques PET/MRI provides more accurate differentiation of recurrent tumor from radiation necrosis than MRI alone.
P341 Cost-effectiveness analysis of FET selection for the diagnosis of gliomas
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A. Heinzel1, S. Stock2, K. Langen3, D. Müller2; 1University of Düsseldorf, Jülich, GERMANY, 2University of Cologne, Cologne, GERMANY, 3Research Centre Jülich, Jülich, GERMANY. AimStudies have indicated that the combined use of amino acid PET and MRI is superior to MRI alone in order to select the biopsy site for the diagnosis of gliomas. In this paper we aim to analyse the cost-effectiveness of the use of amino acid PET for this indication from the perspective of the national health insurance in Germany.Material and MethodsThe costs for amino acid PET are not covered by the German national health insurance. Therefore, the costs were obtained using the “Gebührenordnung für Ärzte (GOÄ)”. The GOÄ is a cost scale for medical procedures that represents the basis of calculation for medical procedure outside of the system of German national health insurance.The effectiveness is calculated based on the best available evidence from the literature by using a decision tree model comparing two strategies: the use of MRI alone and the combined use of MRI and PET. The probability of a correct diagnosis is defined as outcome. In order to test the robustness of the results of the model we calculated deterministic oneway sensitivity analyses as well as probabilistic sensitivity analyses using Monte Carlo Simulation.ResultsThe combined use of PET and MRI resulted in an increased likelihood of a correct diagnosis with an incremental effectiveness of 18.5% avoiding ineffective treatment and corresponding costs as well as harm to the patient. The probabilistic sensitivity analysis showed that, within the interval of 95% of the samples, the probability of a correct diagnosis using amino acid PET is increased between 8% and 27%.DiscussionThe model indicates that the use of amino acid PET may be cost-effective for this indication. However, the model is based on weak empirical evidences. Therefore, further studies are needed to confirm the results.
P342 The impact of 11C-Methionine PET/CT in comparison with Conventional Imaging (CI) in patients (pts) with glioblastoma: preliminary results. I. Grassi1, C. Nanni1, S. Matteo2, S. Nicolini1, A. Paccapelo2, V. Ambrosini1, S. Fanti1; 1Ospedal S.Orsola-Malpighi, BOLOGNA, ITALY, 2Dipartimento di Onco-Ematologia, ANCONA, ITALY. The aim of this study was to compare 11C-Methionine PET/CT with Conventional Imaging (CI) results for the evaluation of glioblastoma pts and to investigate how 11C-Methionine PET/CT could affect pts clinical management.39 pts (21M and 18F, age 44,3± 13,99 ) with glioblastoma were enrolled; they underwent both 11CMethionine PET/CT and CI (brain CT and MR) in a short time lapse (on average 1 month); 51,4% had a suspect of disease relapse, 25,6% came to evaluate chemotherapy response and 23% came both to detect relapse and to evaluate chemotherapy response.11C-Methionine PET/CT and CI results were compared in terms of presence/absence of active disease (in particular after RT). In positive pts SUV max trend was analyzed. Finally the impact of 11C-Methionine PET/CT on pts management was evaluated.RESULTS: in 87,1% cases 11C-Methionine PET/CT and CI results were in agreement while in 12,9% patients were discordant. In particular, 5,1% of patients had negative 11C-Methionine PET/CT scans but MRI was positive; in 7,7% of cases abnormal findings were found at 11C-Methionine PET/CT but CT (2,6%), MRI (2,6%) or both (2,6%) did not detect active disease. When 11CMethionine PET/CT and CI were discordant, there was not a statistically significant difference (t-Test, p=0.55) between pts who had received RT before PET or not. SUVmax was higher in pts with a positive 11C-Methionine PET/CT and negative CI ( 5.5 ± 1.6 ) compared with pts with positive PET and CI (3.7 ± 1.9), but the difference was not statistically significant (p= 0,15).Among 29 pts who were not under chemo at the moment of PET scan, 55,2% had a positive PET and underwent a subsequent therapy; 10% had a positive scan but did not undergo any therapy; 17,6% had a negative scan and did not undergo any therapy and 17,2% had a negative scan but underwent therapy. We noticed a significative association between 11CMethionine PET/CT positive scans and the beginning of a new therapy (p=0,05).In our pt population there was a high agreement between 11C-Methionine PET/CT and CI. When discordant results were found, this was not related to a previous RT. There was not a significant difference between SUVmax in pts with positivity at PET and CI compared to PET positive/CI negative pts. Finally 11C-Methionine PET/CT results affected clinical decision in a high number of pts (73%).
P343 Diagnostic efficacy of neuroimaging methods in brain tumors with special regard to the clinical impact of 11C-methionine PET/CT E. Nagy1, L. Novák2, J. Varga1, B. Szűcs3, G. Fekete2, L. Galuska1; 1Institute of Nuclear Medicine, University of Debrecen, Debrecen, HUNGARY, 2 Department of Neurosurgery, University of Debrecen, Debrecen, HUNGARY, 3ScanoMed Ltd., Debrecen, HUNGARY. Aim: The purpose of our retrospective study was to compare the diagnostic value of methionine, FDG PET/CT (MET, FDG) and MRI in the detection of intracranial tumors. In addition, we evaluated the clinical impact of MET PET/CT on patient management.Materials and methods: MET, FDG and MRI findings were collected from PET/CT and Medsol data bases between February 2007 and January 2011. The diagnosis was confirmed either by histology or clinically applying additional followup imaging examinations (average follow-up time, 322 days).ROC analyses were performed to assess the diagnostic efficacy of MET PET/CT and MRI.Neurosurgeons estimated the clinical impact of MET PET/CT.Results: Altogether we analyzed 99 MET, 50 FDG PET/CT and 91 MRI findings of 95 patients. 78 MET PET/CT studies of 74 patients with brain neoplasms were performed comprising 32 primary and 32 recurrent/rezidual neuroglial lesions as well as 14 non neuroglial tumors. Sensitivity, specificity, positive and negative predictive values as well as accuracy of MET were 94%, 91%, 97%, 80% and 93%, whereas these values of MRI were 93%, 86%, 95%, 79% and 91% and that of FDG were 88%, 83%, 97%, 50% and 88%, respectively. The areas under the curves of MET and MRI were 0,916 and 0,922, respectively.Histological subgroup analyses revealed that the sensitivity of MET and MRI in gliomas including oligodendroglial component (oligodendrogliomas, oligoastrocytomas) was 95% and 86%, respectively, whereas in astrocytomas MET and MRI had 94% vs. 75% sensitivity. In grade II gliomas, the sensitivity of MET and MRI was 94% vs. 75%, respectively.Retrospectively, the clinical impact of MET PET/CT was estimated in 82 cases. Altogether the therapeutic management was changed after 62 examinations (76%), which implied the following options: treatment to watching, watching to treatment or change in treatment methods.Conclusion: We can state that the diagnostic performance of both MET PET/CT and MRI are high in the detection of intracranial tumors. The diagnostic efficacy of MET is superior to MRI in cases of recurrent/residual and low grade tumors. Our study indicate that MET PET/CT might have major impact on patient management.
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Assessment of system A amino acid transport of glioblastoma multiforme using C-11-MeAIB PET
Assessment of response to proton therapy by PET/CT and MRI in head and neck tumors
R. Nishii1, T. Higashi2, S. Kagawa2, M. Saiki2, K. Kawai3, Y. Kishibe2, M. Takahashi2, S. Nagamachi1, H. Yamauchi2, S. Tamura1; 1Faculty of Medicine, Miyazaki University, Miyazaki, JAPAN, 2Shiga Medical Center Research Institute, Shiga, JAPAN, 3Kanazawa University, Ishikawa, JAPAN.
H. Munechika, T. Saginoya, Y. Miura, N. Fuwa, K. Watanabe; SOUTHERN TOHOKU GENERAL HOSPITAL, KORIYAMA, f*ckUSHIMA, JAPAN.
P35 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Head & Neck
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Serial F-FDG-PET/CT During Radiotherapy Nasopharyngeal Carcinoma: A Prospective Clinical Study
in
H. Wu1, Q. LIN2; 1Department of Nuclear Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, CHINA, 2Department of Radiation Oncology , The First Affiliated Hospital & School of Life Sciences of Xiamen University, Xiamen, CHINA. We used serial 18F-fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/ CT) to evaluate tumors’ maximum standardized uptake value (SUVmax) during and after radiotherapy and explore the utility of 18F-FDG PET/ CT in early monitoring of radiotherapy efficacy in patients with nasopharyngeal carcinoma (NPC).Method: Thirty-nine patients with primary biopsy-proven NPC were prospectively enrolled into the study. All patients underwent four 18F-FDG PET/CT scans: before radiotherapy, during radiotherapy at the cumulative dose of 50Gy, at the end of radiotherapy, and one month after completion of radiotherapy. Tumor 18F-FDG uptake was analyzed against disease characteristics. Results: There were significant differences (P <0.001) between mean SUVmax of primary sites before treatment (11.3±5.9) and at all three subsequent measurements: at the dose of 50Gy (3.6±1.7), at the end of radiotherapy (2.9±1.4), and one month after radiotherapy (2.5±1.1). The rate of decline was greatest at the 50Gy cumulative dose (61%). There were also significant differences (P <0.001) between neck node SUVmax before treatment (9.1±6.7), and at all three subsequent measurements: 3.4±2.4, 3.3±1.8, and 2.2±0.7, respectively. The difference in SUVmax between World Health Organization (WHO) pathologic type IIB and type IIA tumors (68% reduction at dose 50Gy for type IIB vs. 51% for type IIA) was significant (P =0.045) in the primary sites but not in the lymph nodes (P =0.54).Conclusion: Significant decreases in tumor SUVmax were demonstrated during and after radiotherapy in NPC. The most significant reduction was at the 50Gy dose both in primary sites and lymph nodes. WHO type IIB disease had a more dramatic response than type IIA disease at the primary site. Therefore, early PET scan during radiotherapy at 50Gy is indicated instead of the conventional 3 month after radiotherapy to evaluate tumor response and develop individualized adaptive radiotherapy in NPC
P347 Additional value of 18F-FAMT PET/CT in the assessment of preoperative oral tumor patient with suspected cervical lymph node metastasis;Comparative study with 18F-FDG PET/CT. G. Miyash*ta1, T. Higuchi2, N. Oriuchi2, Y. Arisaka2, H. Tominaga3, T. Ishikita2, A. Negishi1, S. Yokoo1; 1Department of Stomatology and Oral Surgery, Gunma University Graduate school of Medicine, Showamachi Maebashi, Gunma, JAPAN, 2Department of Diagnostic Radiology and Nuclear Medicine,Gunma University Graduate school of Medicine, Showamachi Maebashi, Gunma, JAPAN, 3Departmenet of Molecular Imaging, Gunma University Graduate school of Medicine, Showamachi Maebashi, Gunma, JAPAN. Aim: To evaluate the presence and extent of neck lymph node metastases (pN1) which significantly affect outcomes and potential treatment strategies for oral tumor, FDG-PET is routinely performed before surgery. However, its usefulness is sill controvertible and it is also reported that it may not affect patient management and the policy of neck dissection (ND). FAMT, which is an amino-acid tracer for PET and is transported into cancer cell by L-type amino acid transporter 1 (LAT1) and showed higher specificity for malignant tumors. Its usefulness in the primary lesion of head and neck cancer was already reported in our institute. In this current study, the utility of FAMT PET for the identification of cervical lymph node metastases was evaluated comparing with FDG-PET and pathological diagnosis after surgery and its impact in patient management and the policy of neck dissection (ND) were discussed.Materials & Methods: This study includes 90 patients with untreated malignant tumors (62 SCC, 4 adenoid cystic carcinoma, 1 adenocarcinoma, 3 malignant lymphoma, 1 malignant melanoma ) and 19 patients with benign lesion. Both FAMT-PET and FDG-PET were performed within 4 weeks before surgery in all cases. The uptake of FAMT and FDG was compared by the semiquantitative analysis with maximal standardized uptake values (SUVmax) of the primary tumors and cervical lymph nodes. To define cut off value for each study, SUV data were analyzed using receiver operating characteristic (ROC) analysis.Results: Average SUVmax of FDG-PET and FAMT-PET of all patients were 9.56±5.28 vs 3.33±1.75, respectively, and FDG showed significantly higher SUV (p<0.01).Optimal cut-off value for FAMT and FDG using ROC analysis for the differential diagnosis of malignancy were 2.1 and 5.2 for primary and were 2.3 and 1.0 for metastasis.FAMT and FDG showed similar results (73.2% and 80.3%, respectively). For the diagnosis of lymph node metastasis, sensitivity of FAMT and FDG showed similar result (79.2% and 83.3%, respectively), however, FAMT showed significantly higher specificity (81.3% vs 77.1%, p<0.01).Conclusions: Our current study suggests that pre-surgical diagnosis of lymph node metastasis could be performed with higher accuracy using FAMT-PET followed by FDG-PET and it may contribute to less invasive surgery with restricted resection of cervical lymph node of oral tumor patient.
Poster Presentations
Purpose: Amino acid PET imaging using [S-methyl-11C]-L-methionine ([11C]-MET) have been reported as a useful for the diagnosis of brain tumors better than [18F]FDG PET. We recently have started novel amino acid PET imaging with [N-methyl11C]α-methylaminoisobutyric acid ([11C]-MeAIB) as a biomarker of the system A amino acid transport in tumor. In this study, to assess the efficacy of [11C]-MeAIB PET for tumor imaging, we investigated PET images of the patients with glioblastoma mutiforme (GBM).Methods: Twelve GBM lesions (9 patients, primary: n=4, recurrence: n=5) were included for [11C]-MeAIB PET and/or [18F]-FDG PET and/or [11C]-MET in this study. In the amino acid PET imaging, patients receive 540+/-35 MBq of [11C]-MeAIB and 469+/-129 MBq of [11C]-MET intravenously, and brain PET image was obtained from the dynamic scanning at 30min after injection of the radiotracer. In [18F]-FDG PET, a static image at 60 min after injection of [18F]-FDG (280+/-30 MBq, i.v.) was obtained. Drawing the region of interest in the tumor lesion and normal brain area, the SUVmax in tumor and T/N ratio (SUVmax in tumor / SUVmean in the normal brain tissue) were calculated to compare these PET images.Results: [18F]-FDG uptake in GBM tumor was high (SUVmax=8.30+/-2.59). In [11C]-MeAIB, the uptake was moderate (SUVmax=2.95+/-1.33) as compared to high [11C]-MET uptake (4.37+/-1.56), which was considered the difference of expression levels of system A and L amino acid transports in tumor. But in one case, the uptake of [11C]-MeAIB (SUVmax=5.85) was higher than that of [11C]-MET (SUVmax=4.57). On the other hand, in the analysis by T/N ratio, the ratio of MeAIB was highest among them ([11C]-MeAIB: 13.46+/-5.69, [11C]-MET: 2.79+/-1.41, [18F]-FDG: 1.15+/-0.39), because the uptake of [11C]-MeAIB in the normal brain tissue was very low depends on the less expression of system A amino acid transport on the BBB in the brain.Conclusions: Although the uptake of [11C]-MeAIB in GBM lesion was moderate, higher T/N ratio of [11C]-MeAIB PET image would lead to precise detection of the tumor. [11C]MeAIB PET imaging based on the expression and activity of system A amino acid transport has an advantage in detection of GBM tumor compared with [11C]-MET PET and [18F]-FDG PET.
Aim: Response to radiation treatment was assessed easily by PET/CT in head and neck tumors although inflammatory or physiological uptake of FDG could be coexisted. The purpose of this study was to see assessment of response to proton therapy by PET/CT and MRI in head and neck tumors. Material and Methods: Response to proton therapy was assessed by PET/CT in comparison with MRI in 62 patients (M/F=38/24). PET/CT or MRI was obtained within 2 weeks intervals. PET/CT after proton therapy was obtained at intervals of various times. Results: No difference was seen in assessment of response to proton therapy between PET/CT and MRI in 30 patients (48%). PET/CT was more suitable for the assessment than MRI in 27 patients (44%). On the contrary, MRI was more suitable for the assessment than PET/CT in 5 patients (8%). The profitable aspect of MRI was not correlated with the time of PET/CT obtained after proton therapy. A small residual tumor was depicted easily by PET/CT. Pre-treatment PET/CT was helpful for assessment of post-treatment PET/CT. MRI was suited for assessment in a tumor adjacent to the brain when compared with PET/CT. MRI was useful when physiological FDG uptake coexisted in PET/CT. Conclusion: PET/CT was generally more suitable than MRI for assessment of response to proton therapy in head and neck tumors. However, MRI was complementary to PET/CT if physiological uptake of FDG coexisted with a residual tumor. Therefore, combined use of MRI and PET/CT was more accurate for assessment of response to proton therapy in head and neck tumors.
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P348 FDG-PET/CT and Diffusion-Weighted Imaging of Head and Neck Squamous Cell Carcinoma: Comparison of Prognostic Significance between Primary Tumor Standardized Uptake Value and Apparent Diffusion Coefficient 1
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M. Nakajo , M. Nakajo , Y. Kajiya , A. Tani , T. Kamiyama , R. Yonekura , T. Mastuzaki4, K. Nishimoto4, M. Nomoto5; 1Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, JAPAN, 2Department of Radiology, Nanpuh Hospital, Kagoshima, JAPAN, 3Department of Radiology, National Hospital Organization Kagoshima Medical Center, Kagoshima, JAPAN, 4Department of Otolaryngology, National Hospital Organization Kagoshima Medical Center, Kagoshima, JAPAN, 5Department of Pathology, National Hospital Organization Kagoshima Medical Center, Kagoshima, JAPAN. AbstractTo compare the prognostic significance for head and neck squamous cell carcinoma (HNSCC) between primary tumor 18F-fluorodeoxyglucose (FDG) maximum standardized uptake value (SUVmax) and diffusion-weighted imaging (DWI) apparent diffusion coefficient (ADC).Materials and Methods: The study population consisted of 26 patients with HNSCC visible on both pre-treatment FDG PET/CT and DWI. Both SUVmax and ADC (b values; 0 and 800 seconds/mm2) associations with clinicopathological factors were examined by the MannWhitney U test and their correlation was analyzed by the Spearman’s rank test. The disease free survival (DFS) was calculated by the Kaplan-Meier method. The prognostic significance was assessed by the long rank test and Cox proportional hazards analysis.Results: SUVmax was significantly associated with T stage (P=0.002), but not associated with N stage and histological grade. ADC was not associated with these clinicopathological factors. SUVmax and ADC were negatively correlated (ρ=-0.566, P= 0.005). The log-rank test revealed that high (>12.1) SUVmax (P<0.001), low (≤0.88) ADC (P=0.009), high (T3-4) T stage (P=0.030) and high (N2-3) N stage (P=0.007) were significant in predicting poor DFS at 2 years. On proportional hazards analysis, disease event hazards ratios for significant unadjusted SUVmax (P=0.015) and ADC (P=0.039) remained significant or at marginally significant when SUVmax was adjusted for other dichotomized clinical covariates (P=0.009-0.094) and when ADC was adjusted for other dichotomized clinical covariates (P=0.017-0.089) except for SUVmax (P=0.438) respectively. N stage also remained significant, but other factors were not significant predictors of disease events.Conclusion: These results suggest that although both of primary tumor SUVmax and ADC can be predictive of prognosis, SUVmax may be more significant than ADC for predicting DFS.
P349 Predictive value of tracer accumulation to evaluate effects of cancer therapy studied using Cu-62 ATSM and F-18 FDG PET in head-and-neck cancers. H. Okazawa, A. Kositwatanarerk, Y. Kimura, Y. Kiyono, T. Mori, S. Fujieda; University of f*ckui, Eiheiji-cho, JAPAN. Aim: [62Cu]-diacetyl-bis(N4-methlythiosemicarbazone) (62Cu-ATSM) was reported to show the resistant hypoxic tissue in malignant tumors, and its distribution was different from that of 18F-FDG, especially in the lung squamous cell carcinoma. In the present study, the tracer distributions were compared between the two tracers and evaluated the predictive ability of effectiveness of tumor treatment after radiation and/or chemotherapy. Materials and Methods: Thirty-three patients with head-and-neck cancer (mean age = 68 ± 13 y.o.) underwent 62Cu-ATSM and 18F-FDG PET within a week interval. For 62Cu-ATSM PET scans, 600-800 MBq of the tracer was injected and 20-min dynamic PET data were acquired. 18F-FDG PET was performed with whole body acquisition about one hour after the tracer injection. Accumulation of tracer for each PET image was converted to standardized uptake values (SUV). After co-registeration of 62Cu-ATSM and 18F-FDG images with anatomical information of individual CT or MR image, multiple small ROIs were drawn on tumor mass and applied to both PET images. SUV values were obtained for all ROIs (SUVroi) and the slopes of regression line between SUVroi for 62CuATSM and 18F-FDG of each tumor were determined. In cases of residual tumors after treatment, location of residual tumor and tracer accumulation before the treatment was compared to evaluate relationship between tracer accumulation and the effect of treatment. Results: In most of squamous cell carcinomas, 62CuATSM tended to accumulate higher in the peripheral region than in the center of the tumor mass, and 18F-FDG uptake showed the other tendency (spatial mismatching). Thus, the relationship of the SUVroi for 62Cu-ATSM and 18F-FDG showed negative correlation in squamous cell carcinomas. However, a few cases of adenocarcinoma showed similar and spatially hom*ogenous accumulation in the tumor mass, which showed positively correlated SUVroi values for the two tracers (matched distribution). The mean of regression slopes for all tumor lesions was 0.10 ± 0.08 (p < 0.001) for SUV and -0.30 ± 0.25 (p < 0.001) for %SUV. In cases of advanced head-and-neck cancer, tumors were treated by chemoradiation, and peripheral regions of high 62Cu-ATSM accumulation showed residual tissue after the treatment. Conclusion: In patients with head-and-neck cancer, intratumoral
distribution of 62Cu-ATSM and 18F-FDG showed negative correlation in squamous cell carcinomas as seen in lung cancers. The regions of high 62Cu-ATSM accumulation tended to predict resistant tissue after the cancer therapy.
P350 Multivariate analyses for prognostic evaluation with C-11 methionine PET for head and neck adenoid cystic carcinoma treated by carbon ion radiotherapy S. Toubaru1, K. Yoshikawa1, S. Ohashi1, M. Hasebe1, H. Ishikawa1, K. Tamura1, K. Tanimoto1, S. Kandatsu1, J. Mizoe2, A. Hasegawa1, T. f*ckumura1, T. Saga1, K. Kawaguchi3, Y. Hamada3, T. Kamada1; 1National Institute of Radiological Sciences, Chiba, JAPAN, 2Fondazione Centro Nazionale Adroterapia Oncologica, Milano, ITALY, 3First Dept. of Oral & Maxillofacial Surgery, Tsurumi University, Yokohama, JAPAN. [Purpose]Carbon ion radiotherapy (CIRT) has been developed, and a phase I/II clinical trial has been conducted in patients with adenoid cystic carcinoma in head and neck region. We use C-11-methionine (MET) PET for staging and monitoring treatment of head and neck carcinoma. We evaluated whether C-11-mthionine (MET) uptake could be an early predictor for local recurrence, metastasis and the prognosis in patients with adenoid cystic carcinoma. Multivariate analyses were carried out based on univariate analyses.[Materials and Methods]Forty-eight patients were entered into this study. They were examined by MET-PET, Siemens ECAT EXACT 47 and HR+, before and about 1 month after CIRT from 1995 to 2007, who followed up to about 5 years. All patients had primary adenoid cystic carcinoma in head and neck and were histological proved. There were 20 males and 28 females (15-84y, mean age 53y). The tumor MET uptake was measured with the semiquantitative tumor to normal tissue ratio (TNR). At first, TNRs of tumor at pre- and post-CIRT, age, gender and tumor size were evaluated by univariate analyses. And then, multivariate analyses were carried out using significant parameters from univariate results.[Results]TNRs before and after CIRT were 5.1±1.5 and 3.1±1.5, respectively. MET uptake after CIRT was significantly decreased from the uptake before CIRT (p<0.0001). In univariate analyses, local recurrence was observed more frequently in the group with larger tumor size (diameter>40mm). Metastasis was observed more frequently in male. And also metastasis and poor prognosis were observed more frequently in the group with larger tumor size and higher TNR before CIRT (TNR>5.5). It was summarized as follows, TNR before CIRT, gender and tumor size were significantly related to some of outcomes of CIRT. Based on these results, TNR before CIRT, gender and tumor size were entered into multivariate analyses. In multivariate analyses, significant differences were observed for the relationship between TNR before CIRT and metastasis (Cut off value=5.5, p<0.042). Significant differences were observed for tumor size and both local recurrence and metastasis. No significant relation was observed for prognosis.[Conclusions]MET uptake before CIRT for head and neck adenoid cystic carcinoma is an independent factor for predicting metastasis and the prognosis by univariate analysis. According to multivariate analysis, MET uptake was significantly related to the incidence of metastasis but was not significant factor for the prognosis.
P351 Sentinel Lymph Node Preliminary Results
in
Pharyngolaryngeal
Tumours:
N. Kisiel, I. Roca, M. González Doñate, M. Sabaté, J. Lorente, J. Castell; Hospital Universitario Vall d´Hebron, Barcelona, SPAIN. OBJECTIVE: Validation of the lymphoscintigraphy with sentinel lymph node biopsy (SLNB) for the initial surgical treatment of hypopharyngeal and laryngeal tumors T1-T2N0.Until now, these patients are submitted to: Clinical and CT staging, Biopsy and Surgical treatment (tumour resection and uni/bilateral lymphadenectomy depending on tumour location).SLNB is a less aggressive technique than systematic lymphadenectomy, and it allows a more accurate nodal staging and detection of micrometastases.MATERIAL / METHODS: First patients of this prospective study: 10 men with pharyngolaryngeal tumours N0 (7 supraglotic and 3 glotic).First day: Lymphoscintigraphy with intratumoral injection of 99mTc-nanocolloid (surgical theatre, laryngoscopy), obtaining planar and SPECT- CT images 2-4 hours after injection.Second day: lumpectomy, SLNB (SPECT-CT and gamma probe) and uni/ bilateral lymphadenectomy (according to committee decision).RESULTS: Drainage was detected in 8/10 patients and 22 SLN have been identified on images and removed during surgery. 2/10 cases had no drainage due to technical injection problems.Location of the SLN: Level II (11), III (5) and IV (6).Positivity of the SLN: 3/22 +SLN were found in 2 patients, with other positive nodes in lymphadenectomy:Patient 1: 1 SLN+ for squamous cell carcinoma and 1 SLN+ for papillary thyroid carcinoma.Patient 2: 1 SLN+ micrometastases. N=199 lymph nodes have been removed by lymphadenectomy (10.5/lymphatic area). 11/199 have been positive for metastasis: 3 SLN and 8 non-sentinel lymph nodes, all in the two patients with SLN+ (0%FN). Surgical removal: In 8/10 patients, 22 SLN were correctly identified on planar and SPECT-CT images (average 2.2, range 2-5). All lymph nodes identified by imaging were removed.Technical problems:
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P352 Correlation of Apparent Diffusion Coefficients Measured by Diffusion-Weighted MRI and SUVmax from FDG PET/CT in Head and Neck Cancer 1
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E. Sürer Budak , A. Yıldız , F. Aydın , &. Ertem , K. Karaali , M. Özdoğan , A. Boz1, F. Güngör1; 1Akdeniz University Nucleer Medicine Department, Antalya, TURKEY, 2Akdeniz University Department of Radiology, Antalya, TURKEY, 3Akdeniz University Department of Medical Oncology, Antalya, TURKEY. Aim: Diffusion-weighted magnetic resonance imaging (DWI) and fluordeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) are recently used imaging techniques in cancer patients. Combining images obtained with different amounts of diffusion weighting provides an apparent diffusion coefficient (ADC) map. It is increasingly used to differentiate benign and malignant lesions where increased cellularity of malignant lesions restricts water motion in a reduced extracellular space. ADC measured in DWI might be lower in tumors because of supposed restriction of water diffusion in cancer tissues. Negative correlations between glucose metabolism in FDG PET and ADC values were reported in some studies. The aim of this study was to evaluate the correlation between ADCSUVmax and ADC-relative SUVmax in head and neck cancer.Materials and Methods: 17 patients (13 man and 4 woman; between ages 40-77 years old) with documented head and neck cancer were recruited (6 with nasopharyngeal carcinoma, 4 with larynx carcinoma, 1 with tongue carcinoma, 1 with submandibular mass, 2 with thyroid carcinoma, 1 with tonsillar carcinoma, 1 with hypopharynx carcinoma and 1 with lip carcinoma). All patients underwent DWI and FDG PET/CT. Size (in transvers CT section), minimum ADC (mADC) and maximum SUVmax values were measured for primary tumor and for any other metastatic lesions around the tumor. In 17 patients; 26 lesions including primary tumor and metastases were evaluated. Relative SUVmax value was also defined as SUVmax/tumor size. Pearson correlation coefficients were calculated to assess the relationship between mADC-SUVmax and mADC-relative SUVmax .Results: 17 patients including 26 lesions were evaluated in this study. Lesion size ranged 1.1 cm to 8.1 cm. mADC and SUVmax values varied between 0.493-3.4 x 10-3 and 1,9-34,7 in the lesions, respectively. Statistically significant correlation between ADC and relative SUVmax was detected (r:0,045). There was no significant correlation between ADC and SUVmax (r:0,179).Conclusion: In this study no statistically significant correlation between mADC-SUVmax and mADC-relative SUVmax was detected. Different molecular mechanism of these parameters might be a reason. Further studies with larger patient sample mandatory to clarify whether DWI and FDG PET/CT might play a complementary role in cancer imaging.
P353 Combined PET/MRI system in Head and Neck Cancer: Initial Experience B. Beuthien-Baumann1, I. Platzek1, M. Schneider1, V. Gudziol1, J. Langner2, E. M. Brüning2, M. Laniado1, J. Kotzerke1, J. van den Hoff2; 1University Hospital Dresden, Dresden, GERMANY, 2Helmholtz-Zentrum DresdenRossendorf, Dresden, GERMANY. The recently introduced whole-body PET/MRI systems combine the unique metabolic imaging capabilities of positron emission tomography (PET) and the excellent soft tissue contrast of magnetic resonance imaging (MRI). The aim of this pilot study was to evaluate the feasibility of PET/MRI for initial staging of head and neck cancer.Materials and Methods:Ten male patients aged (age 52 to 78 years, median age 62.8 y) with histologically proven squamous cell carcinoma of the head and neck region were examined using both a stand-alone PET scanner and a wholebody PET/MRI scanner. Scanning started 60 minutes after intravenous administration of 350 MBq [18-F]-2-fluoro-2-deoxy-D-glucose (FDG) for the body trunk to exclude distant metastases. PET/MRI of the head and neck region followed immediately the first scan. The study was approved by the local ethics committee.A four-point-scale was used for qualitative evaluation of PET image quality. Furthermore, the signal-to-noise ratio (SNR) of the tumor and of both cerebellar hemispheres were determined for both PET data sets and used for semiquantitative comparison of image quality. Results were compared using the Wilcoxon matched-pair test.Results:The primary tumor was detected by PET/MRI in all 10 patients, by PET in 9 out of 10 cases, and by MRI in 9 out of 10 cases. Seven patients had lymph nodes suspect for metastatic disease. In two patients, lymph nodes considered suspect using MRI showed no pathological FDG uptake. In
contrast, a single patient had lymph nodes considered suspect by PET but not by MRI.Visual evaluation of PET images showed consistent results (including regional contrast) for both scanners. There were no statistically significant differences regarding SNR between conventional PET and PET/MRI for the tumor and for both cerebellar hemispheres (p > 0.05).Conclusion:PET/MRI of head and neck cancer is feasible with a whole-body PET/MRI scanner with excellent image quality and fusion. While previously available PET/MRI systems were largely restricted to brain examinations, whole-body PET/MRI scanners allow comprehensive tumor staging. Further patients will be examined to evaluate the clinical role of PET/MRI in head and neck cancer.
P36 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Thyroid
P354 Relations between pathological markers and radioiodine scan 18 and F-FDG PET/CT findings in thyroid cancer patients with recurrent cervical nodal metastases S. Lee1, J. Lee2, J. Chung3, H. Min4, H. Kwon3, M. Lee3; 1Department of Nuclear Medicine, Soonchunhyang University Hospital, Cheonan, KOREA, REPUBLIC OF, 2Department of Nuclear Medicine, Jeju University Hospital, Jeju-si, KOREA, REPUBLIC OF, 3Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, KOREA, REPUBLIC OF, 4 Department of Pathology, Seoul National University Hospital, Seoul, KOREA, REPUBLIC OF. Aim: The aim of this study was to investigate relationships between immunohistochemical results and radioiodine scan and 18F-fluorodeoxyglucose (18FFDG) positron emission tomography (PET) findings in well-differentiated thyroid cancer patients with recurrent cervical nodal metastases. Methods: A total of 47 papillary thyroid cancer patients (male:female = 10:37, mean age: 49 ± 12 years) that underwent a preoperative radioiodine scan and/or 18F-FDG PET/CT and subsequent surgical resection of recurrent cervical lymph nodes were enrolled. Of these 47 patients, 26 patients underwent 18F-FDG PET/CT, 9 patients underwent a radioiodine scan, and 12 patients underwent both scans. Radioiodine scan and 18FFDG PET/CT results were visually assessed and categorized with respect to the positivities or negativities of uptakes. In all surgical specimens, the immunoexpressions of thyroglobulin (Tg), sodium-iodide symporter (NIS), glucose transporter 1 (Glut-1), and somatostatin receptor 1 and 2A (SSTR1 and SSTR2A) were assessed, and associations between these expressions and radioiodine scan and 18F-FDG PET findings were evaluated. Results: Of the 38 patients that underwent 18F-FDG PET/CT, all patients (7/7) with weak Tg expression had positive 18 F-FDG uptake, while only 45% of the patients (14/31) with moderate or strong Tg expression showed positive uptake (p = 0.01). Furthermore, the proportion of patients with positive 18F-FDG uptake increased as the degree of Glut-1 expression with luminal accentuation increased. Of the 21 patients that underwent a radioiodine scan, the proportion with positive radioiodine uptake was greater among patients with strong NIS and SSTR2A expression than among patients expressing these markers at weak levels (p = 0.001 and p = 0.045, respectively). Moreover, all 3 patients with weak Tg expression were negative for radioiodine uptake. Conclusion: The 18F-FDG uptakes of recurrent cervical nodes are related to strong Glut-1 expression with luminal accentuation and weak Tg expression, whereas radioiodine uptake was related to the strong expressions of NIS and SSTR2A.
P355
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The clinical usefulness of I scans on tenth day after I therapy in patients with well-differentiated thyroid cancer: 131 comparison with third day I scans J. Lee1, S. Lee2, G. Koh3, D. Lee3; 1Department of Nuclear Medicine, Jeju University Hospital, Jeju-si, KOREA, REPUBLIC OF, 2Department of Nuclear Medicine, Soonchunhyang University Hospital, Cheonan, KOREA, REPUBLIC OF, 3Department of Internal Medicine, Jeju University Hospital, Jeju-si, KOREA, REPUBLIC OF. Aim: The purpose of the present study was to evaluate the clinical usefulness of the delayed post-therapeutic 131I scan in patients with well-differentiated thyroid cancer by comparing the early scanned images with the delayed images. Methods: A total of 107 patients (female : male = 88 : 19; age: 53 ± 14 years) with welldifferentiated thyroid cancer who underwent scans the third and tenth day after 131 I treatment were included in this study. The therapeutic dose ranged from 3.7 GBq (100 mCi) to 7.4 GBq (200 mCi). The early and delayed scan images were visually analyzed and the thyroid remnant-to-background uptake ratio (RBR) and the lesion-to-background uptake ratio (LBR) of metastatic lesions were calculated. Results: Of the 107 patients, 6 lesions (2 lung lesions, 3 cervical lymph node lesions, and one thyroid remnant) in 5 patients (5%) were additionally found on the
Poster Presentations
Gastroesophageal contamination was severe in 3/10 (2/3 no drainage) and mild in 5/10 patients, without interference with images and surgery.DISCUSSION:This initial assessment of SLN technique in pharyngolaryngeal cancer has positive results. The intratumoural injection is probably the most difficult part of the technique, and the learning curve is essential.As SLNB is less aggressive than lymphadenectomy and more accurate for nodal staging, the clinical use of this technique will be an improvement in the initial clinical and surgical management of patients with hypopharyngeal and laryngeal tumors T1-T2N0.
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delayed scans, which were not identified on the early scans. Of 9 patients with high serum thyroglobulin (Tg) and negative finding on the early scan, the delayed scan identified additional lesions in 4 patients (44%). Visual analysis scores significantly decreased for both thyroid remnants and metastatic lesions on the delayed scan (p < 0.001 for all). Diffuse hepatic uptake was visualized in 90% of all patients on the delayed scan, while only 5% of the patients on the early scan (p < 0.001). The RBRs of both scans were compared in 78 patients, and the LBRs were compared in 11 patients with 31 lesions. The mean RBR and LBR on the delayed scan (7.4 ± 6.7 and 5.7 ± 5.2, respectively) were significantly lower than those on the early scan (11.9 ± 9.6 and 7.1 ± 7.3, respectively; p = 0.005 and p = 0.03, respectively). Conclusions: The 131I-avid lesions on the early scan were more easily detected by visual analysis and had higher uptake ratios than those on the delayed scan. However, for patients with high serum Tg and negative finding on the early scan, the delayed scan was helpful in identifying additional 131I-avid lesions.
P356 Monitoring of medullary thyroid cancer 131 estimation of treatment efficacy with I-MBG
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O. Solodyannikova, N. Voit, G. Sukach; National Institute of Cnacer, Kyiv, UKRAINE. Purpose: to estimate the diagnostic value of planar and SPECT studies using 131IMIBG in MTC patients after the 1st cycle of radionuclide therapy.Materials and methods: 40 patients (22 females and 18 males) with MTC and verified metastasis desease, aged 23 - 64 years, underwent scintigraphy with 131I-MIBG. Planar scintigraphy, followed by SPECT was performed 1 month after surgery treatment (total thyroidectomy) and after the 1st cycle of radionuclide therapy of MTC. Investigations were performed using dual-head gamma-camera "E - CAM - 180" (Siemens). The obtained results were compared to the clinical data and other employed imaging methods.Results: Metastatic lymph nodes involvement had been detected in 19 patients (5 of them had metastases in the mediastinal lymph nodes, and 14 - in the neck lymph nodes), 12 patients had distant metastases in lung, and 9 had multiply metastases in lung and liver. Metastases in lymph nodes were detected by both methods - planar scan and SPECT in all 14 patients. At the same time mediastinal lymph nodes were revealed only by SPECT. In 4 of 12 patients distant lung metastases visualised by both planar scintigraphy and SPECT study, and at 8 patients - only by SPECT. In multiple lung and liver metastases diagnostic value of planar and SPECT studies were equal and were definitely positive in all 9 patients. The diagnostic value of both - planar and SPECT studies were assessed. The sensitivity of neck lymph nodes planar scintigryphy and distant multiply metastases in lung and liver was 100%, SPECT-100%. Planar scans were uninformative in patients with metastatic involvement of mediastinum lymph nodes, while the sensitivity of SPECT was 100%. Sensitivity of planar scintigraphy in lung metastases patients were 34%, versus SPECT-66%.Conclusion: Thus, follow-up in patients with MTC after the treatment can be carried out using both planar and SPECT scintigraphy with 131I-MIBG. In spite SPECT is a more sensitive functional imaging modality for detecting regional and distant metatstatic disease in MTC patinets.
P357 Nasolacrimal Duct Obstruction as a Complication of Iodine131 Therapy in Patients with Thyroid Cancer A. Fard-Esfahani, S. Farzanefar, B. Fallahi, D. Beiki, M. Eftekhari, M. Saghari, A. Emamiardekani, M. Majdi; Research Institute for Nuclear Medicine, Tehran, IRAN, ISLAMIC REPUBLIC OF. Introduction: 131I has been widely used in treatment of differentiated thyroid carcinoma for almost 70 years. During this period many complications such as sialadenitis and lacrimal gland dysfunction have been established. This study argues a new complication “symptomatic or asymptomatic nasolacrimal duct obstruction”.Materials and Methods: 81 patients (162 eyes) treated with more than 100 mCi 131I were categorized in 4 groups based on received cumulative dose and were evaluated in a historical cohort study. In addition 17 (34 eyes) age and sex matched persons were selected as control group. Using dacroscintigraphy, patients and control group were evaluated for partial or complete nasolacrimal duct obstruction. The data on different groups of patients were compared with the data of control group. Fisher’s exact and Mann-Whitney U tests were applied for analyses of categorical and numeric variables, respectively. The analyses were considered significant with p<0.05.Results: 18% of exposed eyes (29 out of 162) and 9% of control eyes (3 out of 34) had evidences of nasolacrimal duct obstruction on the scan images. Among the patients treated with less than 300 mCi of 131 I,12.8% (5 out of 39) had asymptomatic nasolacrimal duct obstruction and 2.6% (1 out of 39) had symptomatic obstruction. These values for patients treated with more than 300 mCi were 19% (8 out of 42) and 35.7% (15 out of 42), respectively. Mean cumulative 131I dose that lead to nasolacrimal duct obstruction was 429±264 mCi. This value was 273±173 mCi for the patients without obstruction (p<0.05).Conclusion: This study confirms nasolacrimal duct obstruction as a
complication of 131I therapy. The symptomatic form of this complication occurs mainly in cumulative dose more than 300 mCi.
P358 Treatment and Long Term Follow-up Results of 247 Thyroid Papillary Microcarcinoma Patients G. U. Vural, G. Tan, B. E. Akkas, B. B. Demirel; Ankara Oncology Research and Training Hospital, Ankara, TURKEY. Patient management and treatment strategies in thyroid papillary microcarcinoma (PMC) is still a subject of debate. The aim of this study is to discuss the treatment and long term follow up results of our clinic in patients with PMC.Method: 247 patients with PMC (mean age 46.8, 227 females, 20 males) were treated and followed up for 12-408 months (mean: 66.6) in our clinic. Tumor size was > 5 mm in 116, ≤ 5 mm in 89 and was unreported in 43 patients. At the time of diagnosis, 40 patients had multifocal tumor (16 %), 13 patients had lymphatic metastases (5%), 20 patients had capsular invasion (8%), 4 patients had extrathyroidal spread (2%) and1 patients had lung metastases. All patients underwent total thyroidectomy. Patients with distant metastases and patients who have two or more of the following criteria had I131 ablation therapy (n:181); elevated Tg or Tg unrelated to residual tissue, tumor size > 5mm, lymphatic metastases, multifocal tumor, capsular or vascular invasion, exthyroidal spread. Others didn’t have I131 therapy (n:73). Patients who had I131 treatment were grouped as; group1:ablated/cured, group2:stable disease, group3:progressive disease according to clinical, imaging and laboratory findings.Results:167 of 181 patients were cured, 11 had stable and 3 had progressive disease. Post-operative Tg with TSH stimulation were 14.3 ng/ml in cured patients, 42.5 ng/ml in patients with stable disease and 258.3 ng/ml in patients with progressive disease (p<0.05). Tg levels were significantly elevated in patients with stable and progressive disease. Age, sex, tumor size did not effect the treatment results in our patients.Conclusion: Post-operative high Tg unrelated to residual tissue is an independent prognostic factor and predicts the presence of recurrent and/or progressive disease on follow-up. Our results indicate that after total thyroidectomy, PMC patients who have high Tg levels and poor prognostic histopathological factors must be treated just like classical differentiated thyroid carcinoma.
P359 Evaluation of I-131 radioiodine therapy for bone metastases of differentiated thyroid carcinoma by F-18 FDG-PET/CT S. Ito1, S. Iwano1, K. Kato2, S. Naganawa1; 1Nagoya University Graduate School of Medicine, Nagoya, JAPAN, 2Nagoya University School of HealthSciece, Nagoya, JAPAN. Purpose: The purpose of this study was to evaluate I-131 therapy for bone metastases of differentiated thyroid carcinoma by F-18 FDG-PET/CT.Methods: We evaluated 29 bone metastases of 8 patients (1 male, 7 females; age 33 to 68y: mean age 57±12y) with differentiated thyroid carcinoma. F-18 FDG-PET/CT scan was performed before and 6 months after the I-131 therapy. We measured the size and the maximum standardized uptake value (SUVmax) of the bone metastases before and after the therapy, and compared these values before and after the therapy.Result: After the therapy, the size of metastases was decreased in 10 lesions, increased in 11 lesions, and did not change in 8 lesions, and SUVmax was decreased in 27 lesions and increased in 2 lesions. The median size of lesions before and after the therapy was 16mm and 15mm, respectively; the difference between these values was statistically not significant (p = 0.42). The mean ratio of size of lesions before and after the therapy was 1.03. However, the median SUVmax of lesions significantly decreased from 4.1 to 2.8 (p < 0.001), and the mean ratio of SUVmax before and after the therapy was 0.79. Serum thyrogloblin was also checked before and after the therapy and was found to decline in 7 patients and elevate in 1 patient. In the latter case, there was a lesion having an increased SUVmax from 6.3 to 13.8.Conclusion: This study suggested that F-18 FDG-PET/CT is a promising tool to evaluate I-131 therapy for bone metastases of differentiated thyroid carcinoma.
P360 Treatment and Long Term Follow up Results of Differentiated Thyroid carcinoma Patients with Lung Metastasis G. U. Vural, Z. Tazeler, B. B. Demirel, B. E. Akkas; Ankara Oncology Research and Training Hospital Department of Nuclear Medicine, Ankara, TURKEY. The aim of this study is to discuss the treatment results and to define the clinical factors that affect the treatment results in differentiated thyroid carcinoma (DTC) patients with lung metastasis.Method: 80 DTC patients with lung metastasis [histopathology: papillary (n:54), follicular (n:18), Hurthle (n:3), poorly differentiated (n:2), mixed type(n:3)] were treated and followed up for 24- 216 (mean 84.7) months in our clinic. All patients had total thyroidectomy and I131 therapy (total dose: 200-1850 mCi, for 1-6 times). In order to prevent pulmonary
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fibrosis and for anti-inflammatory effect, corticosteroid medication were administered to all patients with I131 therapy. All patients were grouped according to clinical follow up results. Patients with suppressed Tg< 1 ng/ml and not having pathological I131 uptake were defined as cured. Patients with suppressed Tg>1 ng/ml despite marked reduction after I131 treatment were defined as responders. Patients with suppressed Tg>1 ng/ml and without any reduction in Tg after I131 treatment were defined as non-responders. Patients with progressive elevation in Tg and/or with clinical progression were defined as having progressive disease. Clinical and histopathological factors were evaluated for the effects on treatment results and clinical outcome.Results: 15 patients were cured (19%), 24 patients were responders (30 %), 22 patients were non-responders (27 %), 19 patients had progressive disease (24 %). Significant difference was observed in post operative stimulated Tg levels between patients (p<0.01). Tg levels were 110.2±137 ng/ml in cured ones, 1004±2754 ng/ml in responders, 914.7±1449 ng/ml in non-responders, 2751±7735 ng/ml in patients with progressive disease. Statistical analysis results demonstrated that >45 years of age, initial Tg > 100 ng/ml, non-papillary histology and the presence of other distant metastases were the poor prognostic factors to effect the clinical outcome. Sex, lymphatic metastasis and capsular invasion did not found to be statistically significant to effect treatment results.Conclusion: Early diagnosis and I131 treatment is crucial for long term disease free survive in DTC patients with lung metastasis. Higher cure rates in DTC patients with lung metastasis can be achieved after adequate surgery and I131 treatment for patients younger than 45 years of age, having papillary tumor, without other distant metastasis and having post-operative initial Tg<100 ng/ml.
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Impact of F-FDG PET/CT for detecting recurrence of medullary thyroid carcinoma
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E. Ozkan, C. Soydal, O. N. Kucuk, E. Ibis, G. Erbay; Ankara University, Medicine Faculty, Ankara, TURKEY.
Aim: We introduced and evaluated a portable gamma camera for radioguided intra-operative visualization of radioiodine-negative cervical recurrences from differentiated thyroid cancer (DTC).Materials & Methods: The procedure was carried out in 4 consecutive patients [already submitted to several neck surgeries ("hostile" anatomy)] scheduled for surgery because of loco-regional recurrences of DTC with poor/absent radioiodine-trapping ability. Planar scintigraphy and SPECT/CT were performed after intra-lesional injection of 99mTc-albumin macroaggregates (99mTc-MAA) under ultrasound guidance; 2 to 18 hours later, radiolabeled lesions were localized intra-operatively with a portable gamma camera (IP Guardian 2 Li-tech, Roma, Italy), and with hand-held gamma-probe. The portable gamma camera was used to visualize the distribution of the remaining radioactivity after excision of the radiolabelled lesion.Results: Radioguidance allowed to identify/remove 5/5 lesions in four patients, one of whom presented with two lesions (100% overall localization). In particular, at the very moment of injection of the tracer the leakage of some 99mTc-MAA in the surrounding tissues of one patient hampered the detection of a lesion, correctly located by the portable gamma camera and successfully removed. Histopathology confirmed metastatic involvement of all radiolabeled lesions. Neither nerve injury nor hypoparathyroidism occurred.Conclusion: In our initial experience, the use of a portable gamma camera (providing intraoperative real time imaging) in combination with a traditional hand-held gamma-probe improves the accuracy of this procedure in selected patients with loco-regional recurrence from DTC, showing to be particularly useful especially in patients already submitted to cervical dissections and/or with small lesions located in surgically difficult sites.
Objective: The aim of this study is to evaluate the value of Fluorine-18 Fluorodeoxglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting recurrence of medullary thyroid carcinoma (MTC) in patients with elevated calcitonin levels.Method: 33 patients (9 Male, 24 Female; mean age: 50.3+12 years old) who were referred to perform 18F-FDG PET/CT for restaging of MTC in patients with calcitonin levels were included in this study. Five patients had also suspected lymph nodes detected by neck ultrasonography (US). The results of 18F-FDG PET/CT and clinical follow-up data were reviewed retrospectively. Histological analysis was accepted gold standard in the confirmation of 18F-FDG PET/CT results. Patients have been followed-up 45.6+4.2 months.Results: There were 14 negative and 19 positive PET/CT results for detection of MTC recurrence. In the positive scans, possible recurrence was detected in the neck lymph nodes in 14 patients, in the thyroid bed in 2 patients, in mediastinal lymph nodes in 2 patients and in lung in 1 patient. Recurrence was confirmed with histologically by surgical excision or fine needle aspiration biopsy (FNAB) in 13 patients (TP). In the rest 6 patients, recurrence was excluded as it was reactive as a result of pathological examination (FP). However, one patient with negative scan underwent neck lymph node excision after 18F-FDG PET/CT examination and lymph node recurrence was detected histologically (FN). According to these results sensitivity and specificity of PET/CT was calculated as 50%, 14%. According to recommended calcitonin level by ATA (calcitonin levels higher than 150 pg/ml), the sensitivity was calculated as 57%. The mean SUVmax value of TP group was computed as 4.72+2.17 while FP group as 4.22+1.02. The difference between two groups was not statistically significant (p>0.05).Conclusion: PET/CT is a sensitive imaging tool in detecting MTC recurrence especially in patients with high calcitonin levels and it gives additional information in average one thirds of all patients detecting an occult disease or confirming findings of other imaging tools.
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uPA and PAI-1 Can Be Novel Predictive Parameter for the Prognosis of Differentiated Thyroid Carcinoma Patients
Would the Thyroglobulin threshold levels specific for every center lead to a significant change in the management of DTC patients?
G. Manca, G. Boni, M. Puccini, V. Duce, M. Tredici, E. Biggi, S. Chiacchio, M. Grosso, B. Dell’Anno, D. Volterrani, G. Mariani; Regional Center of Nuclear Medicine, University Hospital of Pisa, PISA, ITALY.
G. Horvatic Herceg, D. Herceg, Z. Bence-Zigman, H. Tomic-Brzac, S. Kusacic-Kuna, M. Kralik, A. Kulic, D. Dodig; University Hospital Zagreb, Zagreb, CROATIA. Higher levels of urokinase-type plasminogen activator (uPA) and its inhibitor (PAI-1) are linked to the poor prognosis in a variety of malignances. Aim of the present study was to investigate the expression and clinical relevance of uPA and PAI-1 in differentiated thyroid cancer.Patients and methods: Analysis prospectively included 128 patients with thyroid tumors, among them 105 patients with differentiated thyroid carcinoma, 2 patients with anaplastic carcinoma and 21 patient with thyroid adenoma, who underwent surgery between 2002. and 2008. uPA and PAI-1 in paired cytosol samples of thyroid tumor and normal tissue were determined using enzyme-linked immunosorbent assay and correlated to the known prognostic features.Results: Both uPA and PAI-1 concentrations were significantly higher in differentiated thyroid tumors (uPA = 0.509±0.767 and PAI-1 = 6.337±6.415 ng/mg protein) than in normal tissue (uPA = 0.237±0.051, P<0.001 and PAI-1 =2.368 ±0.418 ng/mg protein, P<0,001) with positive correlation of the two proteins in the
O. N. Kucuk, C. Soydal, M. Filik, M. Araz, G. Aras; Ankara University, Medicine Faculty, Ankara, TURKEY. Introduction: After radioiodine ablation treatment, serum thyroglobulin (Tg) measurement is generally the accepted method for conforming ablation and prediction of disease progression in DTC patients. At the sixth month, the threshold value of thyroglobulin to predict disease progression has been subject of discussion. In this study, we aimed to describe the success of this threshold value in the prediction of disease progression in our patient group with longer follow-up periods.Materials and methods: 142 patients who had differentiated thyroid carcinoma and referred to our centre for their first, ablative dose of I-131 between January 1993 and January 2000 were evaluated. The thyroglobulin levels during T4 off state sixth month scintigraphy(Tg2) were noted for analyze. Patients were divided into two groups according to thyroglobulin levels on the sixth month. Disease progression rates were calculated in each group. For 10 ng/ml threshold Tg level, sensitivity, specificity, positive predictive value (PPV) and negative predictive
Poster Presentations
A portable gamma camera for intra-operative radioguided localization of cervical recurrences from differentiated thyroid cancer
tumors (Pearson r=0.817, Spearman ρ=0.475, P<0.001). Both proteins’ concentrations were significantly different among various histological grades, showing higher values in higher tumor grades. uPA and PAI-1 were significantly higher if extrathyroidal invasion (uPA P=0.015, PAI-1 P <0.001) or distant metastases (PAI-1 P<0.001) had been present, and in tumors whose size exceeded 1 cm in diameter (uPA P=0.002 and PAI-1 P=0.001). Only uPA, but not PAI-1 was significantly higher in multicentric vs. solitary tumors. The differences of uPA and PAI-1 did not reach the significant level when patients with differentiated tumors below and above 40 years of age had been compared and in lymph node positive tumors compared to lymph node negative tumors. Survival analysis revealed the significant impact of both uPA and PAI-1 on the Progression-Free Survival (PFS) (82.22 vs. 49.478 months for patients with low and high uPA, respectively, P < 0.001; 8.068 vs. 44.964 months for patients with low and high PAI-1, respectively, P<0.001). Univariate analysis showed that sex, tumor size, gradus, extrathyroid invasion, local lymph nodes involvement, distant metastases, uPA and PAI-1 were significant predictors of PFS. Multivariate analysis confirmed that only distant metastases (P = 0.037), tumor tissue uPA (P= 0.009), and PAI-1 (P= 0,06) were strong independent predictors of PFS in patients with differentiated thyroid carcinoma.Conclusion: The correlation of high uPA and PAI-1 with the known prognostic factors of poorer outcome and with lower PFS rate in patients with differentiated thyroid cancers proved that these proteins could be an additional prognostic parameter.
S348 value(NPV) were calculated.Results: During the follow-up period, disease progression was seen in 2 patients in group 1. In group 2, disease progression developed in 8 patients. Sensitivity and specificity of 10ng/ml threshold thyoglobulin level was computed as 80% and 81%, respectively. In order of positive predictive value (PPV), negative predictive value and accuracy were found 0,40, 0,96 and 0,81.Conclusion: With results of this analysis it seem to be useful to determine own threshold value for each clinic and to follow-up their DTC patients who had low risk factors and early stage of disease for this threshold value at least in early postablative period.
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I-SPECT/CT in the follow up of patients with Differentiated Thyroid Carcinomas (DTC). A. Spanu, F. Chessa, D. Sanna, A. Falchi, P. Marongiu, B. Piras, S. Nuvoli, G. Madeddu; Unit of Nuclear Medicine. University of Sassari, Sassari, ITALY. Aim: SPECT/CT images have proved to improve 131I-WBS planar scintigraphy performance in detecting radioiodine fixing metastases from DTC. We evaluated whether SPECT/CT may have an incremental diagnostic value than planar in DTC patients follow up.Methods: We enrolled 437 DTC thyroidectomized patients, 120 at high risk (H), 317 at low risk (L), 168 of whom at very low risk (VL), 14 preablation and 423 during chronic follow up; 399 had 131I diagnostic and 38 posttherapeutic WBS planar scanning and SPECT/CT by hybrid dual head gamma camera integrated with a low-dose X-ray tube. SPECT images were reconstructed with iterative method (OSEM) and fused with CT.Results: SPECT/CT evidenced 321 iodine fixing foci in 145/437 patients (224 in the neck and 97 outside the neck), while planar identified 244 foci (181 in the neck and 63 outside the neck), all positive at SPECT/CT. Thus, SPECT/CT ascertained 77 further occult foci in 41 patients than planar which was completely negative in 22/41 cases. Of occult foci, 67/77 were malignant in 32 patients, 48 of these foci in 18 H patients and 19 in 14 L, including 2 VL: 37/67 foci were lymph node metastases, 28 of which in the neck (11/28 in 8 patients, 5 H and 3 L, completely negative at planar, with undetermined TG in 6 cases, 3 H and 3 L, with single lesions), 5 in mediastinum and 4 in abdomen/pelvis; 15/67 were pulmonary and 15/67 small size bone metastases. Moreover, SPECT/CT correctly classified as neck lymph node metastases 7 single foci considered as thyroid remnants by planar, while it confirmed 143 foci that planar classified as benign. SPECT/CT properly classified as malignant 25 of 72 foci unclear at planar and benign the remaining 47, 31 of which were physiologic iodine accumulations (22 representing single foci). Globally, SPECT/CT obtained an incremental value than planar in 74/145 (51.03%) positive patients and changed planar classification and therapeutic management in 52/145 (35.9%) cases; moreover, SPECT/CT also avoided unnecessary treatments correctly characterizing benign lesions or foci of physiologic iodine accumulations thus reducing false positive results at planar in 35/145 (24.13%) patients.Conclusions: SPECT/CT, in our series, improved planar 131I WBS image interpretation, precisely localizing and characterizing thyroid remnants and metastases, differentiating the latter from benign lesions and areas of physiologic uptake, thus reducing planar false positive results. SPECT/CT was also able to establish more correct patient classification for guiding therapeutic management.
P366 Comparison of FLT-PET/CT and FDG-PET/CT in detection of metastases of differentiated thyroid cancer K. Tsuchiya1, K. Kato2, S. Iwano1, N. Ota1, S. Ito1, S. Naganawa1; 1 Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, JAPAN, 2Department of Radiological Technology, Nagoya University School of Health Sciences, Nagoya, JAPAN. Purpose: 3′-deoxy-3′-18F-fluorothymidine (FLT) has been recently developed as a PET/CT proliferation tracer. At present, there are no studies investigating its role in differentiated thyroid carcinoma (DTC). The aim of this study was to assess the efficacy of FLT-PET/CT for the detection of metastases in DTC in comparison with 2deoxy-2-18F-fluoro-D-glucose (FDG)-PET/CT.Methods: We examined 6 patients (3 women, 3 men; mean age, 56.8±14.5 years) with DTC who had undergone total thyroidectomy and were hospitalized to be given I-131 therapy. All patients were examined by FLT-PET/CT and FDG-PET/CT before the therapy, and they were examined by I-131 scintigraphy after the therapy. All scans were evaluated by 2 experienced nuclear medicine physicians who were unaware of the clinical data and the results of other imaging studies. The sites of metastases were identified as areas of focally increased uptake, exceeding that of surrounding normal tissue. When the results between the 2 readers differed, they reached a consensus. For semi-quantitative analysis, the maximal standardized uptake value (SUV) was calculated in FLT-PET and FDG-PET. Radioiodine scintigraphy after the therapy was used to confirm the sites of metastases.Results: Twenty-two metastases were detected by FLT PET/CT and 26 metastases were detected by FDG PET/CT. The mean SUV for FLT-PET and FDG-PET was 2.22 and 9.44, respectively. The mean SUV for FLT was lower than that for FDG. Conclusion: These results may suggest that
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 the proliferative potential of DTC is not so active as compared with its glucose metabolism. The sensitivity of FDG PET/CT for the diagnosis of bone metastases in patients with DTC is higher than that of FLT PET/CT.
P367 Prognostic Value of the First Serum Thyroglobulin Levels in Patients with Differentiated Thyroid Carcinoma D. Ben Sellem, B. Letaief, T. Kraiem, M. Ben Slimene; Department of Nuclear Medicine Salah Azaiez Institute, TUNIS, TUNISIA. Aim: Thyroglobulin (Tg) is a serum tumor marker of differentiated thyroid carcinoma (DTC). Its diagnostic value in monitoring these cancers is well established. Tg also has prognostic value.The objective of our study was to investigate the prognostic value of stimulated serum Tg (measured at 2.5 months after total thyroidectomy prior to 131I therapy) for disease-free remission and persistent disease at the first year after surgery.Materials and methods: Forty five patients (9 men, 36 women) aged 15 to 62 years (mean ± SD = 36.7 ± 10.8), with well DTC benefited of stimulated thyroglobulin serum measurement 2.5 months after total thyroidectomy prior to 131I therapy. The Tg was measured by radioimmunoassay technique (IRMA).Tg cut-off values with the highest accuracy were calculated using receiver operator characteristic (ROC) curve analyses.Results:One year later, patients were divided into two groups: 31 patients with complete remission, 14 patients with persistent disease (6 in partial remission and 8 in metastatic progression).Pre-ablative stimulated Tg levels in the first group were significantly lower than in the second one (3.5 ± 3.6 ng/ml vs 149.8 ± 269.8 ng/ml) (p = 0.04).We determined a Tg cut-off value of 6 ng /ml for discrimination between the two groups. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were respectively 85.7%, 74.2%, 60%, 92% and 77.8%.Conclusion: In addition to its diagnostic value for recurrences and metastases, the first stimulated Tg level measured at 2.5 months after total thyroidectomy prior to 131I therapy predicts the progression at one year. Patients with a Tg level greater than 6 ng/ml are at increased risk of progress to incomplete remission or to metastases and may be candidates for more intensive follow-up or additional treatment.
P368 Diagnostic accuracy of 18-F-FDG PET/CT and its relationship with thyroglobulin levels in Differentiated Thyroid Carcinoma (DTC) with Evidence of Disease and Negative Radioiodine Whole-Body Scan A. García-Burillo, E. Mariscal, N. Kisiel, M. Barios, G. Obiols, J. Castell; Hospital General Universitari Vall d'Hebron, Barcelona, SPAIN. Aim: To assess the diagnostic accuracy of 18-F-FDG PET/CT and to analyse their relationship with thyroglobulin (Tg) serum levels in patients with DTC in whom recurrence is suspected and radioiodine whole-body scan (WBS) is negative.Population and Methods: Thirty seven 18-F-FDG PET/CT studies from 27 patients (18 women, age 48.6 ± 15.2 y) were retrospectively analysed. Whole-body images were acquired 50 minutes after intravenous injection of 370 MBq FDG using a PET/CT scanner (Biograph 6, Siemens). Focal uptakes with higher intensity than the surrounding normal tissue or with SUV max above 2,5 were interpreted as pathological. Results were classified as true of false after histopahological study when needed, or with clinical, biochemical or imaging data during monitoring. Two 18-F-FDG PET/CT were excluded because their clinical status were not definitively established. Later on, results of 18-F-FDG PET/CT were correlated to Tg serum levels.Results: Of the 35 18-F-FDG PET/CT finally included in the study, 27 showed pathological uptake, of which 26 proved to be true-positive, while 1 case was a false-positive finding. On the other hand, 8 cases were negative. Three of them were true-negative, whereas the remaining 5 cases were false-negative. Sensitivity was 84%, specificity was 75%, positive predictive value was 96%, and negative predictive value was 37%.We defined three intervals to categorize Tg serum levels (less than or equal 2 ng/mL, between 2 and 10 ng/mL, and greater than 10 ng/mL) and correlated them to 18-F-FDG PET/CT results. True-positive 18-F-FDG PET/CT findings were correlated positively to increasing Tg levels (true-positive in 37.5 %, 83%, and 100% of patients with Tg levels of <2, 2-10, and >10 ng/mL, respectively). Treatment was changed in all 26 cases with true-positive PET findings (17 patients, 63 % of total): 16 cases (11 patients) underwent further surgery, and 10 cases (6 patients) were referred to palliative treatmentConclusion: 18-F-FDG PET/CT is a valuable diagnostic tool that shows high accuracy in patients with DTC who present negative radioiodine scansIn this selected population, the high rate of lesion localization implies an significant impact in patient management, changing the therapeutic decision and guiding surgical treatment. 18-F-FDG PET/CT diagnostic accuracy shows high correlation with Tg serum levels, being most useful at Tg levels of >10 ng/mL.
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
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Pediatric Thyroid Cancer in "Prof. Ion Chiricuta" Institute of Oncology Cluj-Napoca, Romania
Diagnostic impact of 68Ga-DOTA-TATE PET/CT imaging in the detection of recurrent or metastatic medullary thyroid carcinoma and elevated calcitonin levels
Background: Thyroid carcinoma (TC) has an increasing incidence in the last decades and continues to represent the most frequent endocrine tumor. The aim of the study was to analyze the pediatric files of TC from the registry of “Ion Chiricuta" Institute of Oncology Cluj-Napoca, Romania (IOCN) and to provide the data needed to optimize the treatment of TC in children.Patients and methods: We studied 72 children with TC treated in 1991-2010. The mean age was 15, 3 years; the ratio female/male was 6, 2:1. We analyzed these patients according to distribution by sex, histology, stage, type of treatment, remission and recurrence. The group of study was divided into 4 different periods of time: 1991-1995 - 4 children; 19962000 - 17 children; 2001-2005 - 25 cases; 2006-2010 - 29 cases.Results: All patients were under 18 years old at the moment of diagnostic. A number of 29 children (40, 2%) revealed metastasis in regional lymph nodes or lungs at the initial diagnostic. There were 65 differentiated thyroid carcinoma (DTC), 6 medullary cancer (MC) and 1 anaplazic carcinoma (AC). A number of 63 cases were in stage I and 6 cases in stage II, 2 children in stage III and 1 patient was in stage IVA. The surgery consisted in total thyroidectomy in 71 cases and diagnostic biopsy in the case of AC; selective lymphadenectomy was performed in 27 cases. Radioiodine was administered in 64 cases, with a range of activity 1,1-28,1 GBq I-131; there were 169 doses of I-131 with a mean of 2,62 doses/ patient and a mean activity/ patient of 5,99 GBq I-131. A number of 17 children (26, 6%) received 1 single dose of I-131 with a mean activity of 2,375 GBq I-131; all are free of disease with undetectable thyroglobuline. The other 47 patients needed more doses (2-10 doses). All patients with DTC and MC are alive at minimum 6 months of follow-up; a number of 52 children (80.5%) are free of disease, 8 children are in partial remission and 4 children are in evolution of the disease. There were no lung fibrosis and no hematological side effects.Conclusion: Pediatric TC is more aggressive and less sensitive to specific treatment. The diagnostic is made frequent in metastatic disease and the therapies must be conducted for many years till complete remission. A more clear strategy adapted to children is needed in the future.
P370 Salivary gland-related pathology within a year after 131-Iodine administration for thyroid remnant ablation. Is there any relationship with the method of patient’s preparation (rhTSH / LT4 withdrawal) or the administered iodine activity?
A. Aliyev1, M. Ocak2, L. Kabasakal1, C. Decristoforo3, E. Demirci1, S. Yılmaz1, I. Uslu1; 1Departments of Nuclear Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TURKEY, 2Department of Pharmaceutical Technology, Pharmacy Faculty, Istanbul University, Istanbul, TURKEY, 3Clinical Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, AUSTRIA. Aim: Medullary thyroid cancer (MTC) is a neuroendocrine tumour of the parafollicular or C cells of the thyroid gland. MTC is a rare thyroid tumour that accounts for 5- 10% of thyroid malignancies. MTC is more difficult to treat and has higher rates of recurrence and mortality. Total thyroidectomy is the preferred initial treatment for patients with MTC. In one large series who were biochemically cured, the five-year recurrence rate was 5 percent. The diagnosis and treatment of recurrent tumour show specific features. Nuclear medicine imaging is particularly useful in the postoperative follow-up to detect recurrent tumour. A great number of radiopharmaceutical have been used with advantage of specific expression of receptors or molecular targets by MTC lesions. In patients with MTC, rising level of the calcitonin after primary surgery relate with tumour recurrence or metastases incidence. The only chance of cure is the resection of localised tumour tissue. For conventional scintigraphic procedures (i.e. somatostatin receptor scintigraphy, DMSA-V, MIBI), varying but low sensitivities between 25% and 50% are reported. 68 Ga-DOTA-TATE is a new PET tracer and it has already shown satisfactory sensitivity in neuroendocrine tumour imaging. We tried to investigate 68Ga-DOTATATE PET/CT imaging’s diagnostic performance in the detection of recurrent or metastatic MTC.Methods: This evaluation contains data from 15 patients (nine female, six male, mean age 45.2 years, range 23-64 years) with previously surgically treated MTC (all the patients with sporadic MTC). All patients had elevated calcitonin levels. Whole body 68Ga-DOTA-TATE PET/CT was performed in 15 patients with MTC to detect recurrences or metastases.Results: With 68Ga-DOTATATE PET/CT, eight of 15 patients showed small foci suspicious for MTC in the neck, mediastinum or bone. Postoperative calcitonin concentrations ≤500 pg/ml, generally indicate a small residual disease in the neck or mediastinal lymph nodes, not easily detectable by conventional imaging. In our study, 68Ga-DOTA-TATE PET/CT has 100% sensitivity associated with calcitonin serum concentrations higher than 316.5 pg/ml (specificity 72%, p<0.05).Conclusion: 68Ga-DOTA-TATE PET/CT can be useful imaging’s detection at postoperative recurrent or metastatic MTC.Acknowledgement: This work is supporting by; Scientific Research Projects Coordination Unit (BAP) of Istanbul University with Project number 3264.
I. Iakovou, A. Doumas, T. Christoforidis, K. Badiavas, V. Nikos, V. Balaris, D. Lo Presti, S. Georga, G. Arsos, N. Karatzas; 3d Nuclear Medicine Dept. of the Aristotle University, General Hospital “ Papageorgiou”, thessaloniki, GREECE.
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Aim: The aim of this study was to determine the incidence of salivary gland-related pathology (SGP) one year post successful thyroid ablation (RAI) and to investigate any relationship of this phenomenon with the method of patient’s preparation for remnant ablation (recombinant human thyroid-stimulating hormone (rhTSH) vs. traditional thyroid hormone withdrawal (OFF-LT4), as well as with the administered iodine activity.Method: A total of 124 patients were divided in four groups, depending of the ablation method: 31 in group A (rhTSH and 3700 MBq), 31 in group B ( rhTSH / 2590 MBq), 31 in group C (OFF-LT4 and 3700 MBq) and 31 in group D (OFF-LT4 and 2590 MBq). In groups A and B one injection of 0,9 mg rh TSH was administered for 2 consecutive days and 131I was given orally 24 h after the last injection. In groups C and D 131I was administered after a sufficient elevation of serum TSH level (> 50mU/ml). All clinical records of patients were retrospectively reviewed, in order to determine the incidence of SGP within a year after RAI.Results: Successful ablation rate (86% in total) was the same, with no statistical difference between all groups. In groups A, B and D, 87% of patients had no uptake in the follow up I-131 whole-body scan and 83% of patients in group C. Stimulated serum thyroglobulin was nearly undetectable (<1 ng/ml) in all successfully ablated patients.SGP was reported in 31% of all patients within the first month after RAI, which declined to 12% at the end of the first year. SGP incidence was significantly higher in unsuccessfully ablated patients (11/17: 64% vs 4/107: 4%) at the end of the follow up year. This difference was not significant during the first month. SGP had a lower incidence in groups A,B strongly associated to the use of rhTSH (p <0.05). There was no relationship between dose administered and SGP appearance.Conclusion: Using 2590 MBq of I-131 has a similar ablation effect as 3700 MBq in patients with differentiated thyroid cancer and no distal metastases, no matter if rhTSH or LT4 withdrawal is used for patient’s preparation. The incidence of SGP after RAI is seldom seen, if rhTSH is used, with no significant dose dependence. Despite the small incidence of this side effect, physicians must consider it during treatment planning, in order to not influence the patient’s quality of life.
M. Moreno Caballero1, M. Muros de Fuentes1, M. Carrero Lérida2, J. Villar del Moral1, H. Palacios Gerona1, M. Navarro-Pelayo Laínez1, J. López Ruiz1, J. Llamas Elvira1; 1Hospital Universitario Virgen de las Nieves, Granada, SPAIN, 2Hospital Universitario San Cecilio, Granada, SPAIN.
Cervical lymph node dissection after 18F-FDG-PET/CT: Follow-up of patients with differentiated thyroid cancer (DTC) for suspected recurrence
AIM:To evaluate the utility of 18F-fluordeoxiglucose Positron Emission Tomography/CT (18-FDG-PET/ct) in diagnosing recurrence of DTC in patients who have undergone cervical lymph node dissection.MATERIALS AND METHODS:17 patients with previously diagnosed DTC (12 papillary and 5 follicular) with suspected recurrence of differentiated thyroid cancer (increased thyroglobulin or positive US) were referred to our department for 18-FDG-PET/CT studies. The 18FDG-PET/CT studies were done on a Siemens Biograph 16 tomograph and iterative OSEM reconstruction (2 iterations, 8 subset) was used for processing. In the followup analysis, other imaging techniques, previous analysis and treatments were taken into consideration.RESULTS:16 patients had positive 18F-FDG-PET/CT studies and were referred for cervical surgery, which confirmed positive pathology in 14 of the 16 patients. Pathology reports were negative for malignancy in 2 patients (reactive lymphadenopathy).During the follow-up, 10 of the 14 patients had decreased thyroglobulin levels ranging from 1,3 to 372 (average Tg: 111,2) and 4 patients had increased thyroglobulin levels. Among these 4 patients, 2 had disseminated lesions toseveral lymph node chains ,1 metastatic lesion to the lungs and 1 patient had metastatic lesions in lymph nodes of the central-compartment (level VI).CONCLUSIONS:18-FDG-PET/CT is a useful tool in diagnosing patients with suspected recurrence of differentiated thyroid cancer (DTC). In our series, 18-FDGPET/CT positive results accurately predicted the diagnosis of 14/16 (87,5%) patients who underwent cervical lymph node dissection for suspected recurrence of differentiated thyroid cancer.
Poster Presentations
D. Piciu1, A. Irimie2, A. Bara1, S. Neamtu1, A. Piciu2, C. Pestean1; 1Institute of Oncology "Prof.Ion Chiricuta", CLUJ-NAPOCA, ROMANIA, 2University of Medicine and Pharmacy "Iuliu Hatieganu", CLUJ-NAPOCA, ROMANIA.
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P373 Heterogenous Radioactive Iodine Response in patient with metastatic thyroid carcinoma : lesion-based analysis H. Kwon1, J. Chung1, K. Kang1, D. Park2, B. Cho2, Y. Youn3, M. Lee1, D. Lee1; 1Departments of Nuclear Medicine, Seoul National University College of Medicine, Seoul, KOREA, REPUBLIC OF, 2Department of Internal Medicine , Seoul National University College of Medicine, Seoul, KOREA, REPUBLIC OF, 3Departments of Surgery, Seoul National University College of Medicine, Seoul, KOREA, REPUBLIC OF. In the present study, we investigate the proportion of patients with heterogenous response to RAI and metabolic change per lesion on serial post-therapy I-131 whole body scan (WBS) and FDG PET scans. Methods: There were 22 patients with metastatic thyroid carcinoma who underwent total thyroidectomy and repeated RAI in our hospital from October 2004 to October 2010 (age = 57±12y, M:F = 7:15, papillary 15, follicular 5, others 2). All patients underwent two FDG PET scans at near time of RAI (time interval between therapy and FDG PET 148±149d). Response of RAI per patient was evaluated by change of serum thyroglobulin (Tg). Response of RAI per lesion was evaluated by I-131 and FDG uptake. FDG uptake of lesion was represented by maximal standardized uptake value (maxSUV). Results: Of the 22 patients, 7 patients show RAI response (decreased Tg 64.5±22.1%) and 15 patients shows no RAI response (increased Tg 280.3±269.3%). Of the 7 responders, 4 (57.1%) have heterogenous response (having both I-131 positive and negative lesions, n=3; showing discrepant change of maxSUV between lesions, n=1). Of the 15 non-responders, 5 (33.3%) have heterogenous response (having both I-131 positive and negative lesions, n=3; showing discrepant change of iodine uptake, n=2). MaxSUV of metastatic lesions increased but not statistically significant in responder group (115.6±55.5%, p=0.64) and significantly increased in nonresponder group (180.8±98.9%, p=0.001). Conclusions: Heterogenous response of high dose RAI is frequently shown in both of responder and non-responder group. These findings suggested combined therapeutic approaches should be considered in addition to radioiodine treatment.
P374 What Does incidentally Detected Increased FDG Accumulation in Thyroid Gland Represent in F-18 FDG PET/CT Examiantion? E. Sürer Budak, F. Aydın, A. Boz, A. Yıldız, F. Güngör; Akdeniz University Nucleer Medicine Department, Antalya, TURKEY. OBJECT:In this study we investigated the meaning of incidentally detected increased F-18 FDG uptake in thyroid gland. METHODS:Medical records of 1960 patients (except tyroid cancer) performed F-18 FDG PET/CT between march 2010 march 2011 were reviewed retrospectively. Patients detected increased F-18 FDG uptake in thyroid gland were selected among 1960 patients. RESULTS:In 82 patients (4.1%), increased F-18 FDG uptake in thyroid gland were detected. In 61 of 82 patients (74.4%), no further examination was performed in the follow-up by clinicians. In 21 of 82 patients (25.6%, 9 men and 12 women with median age of 63 years ), FNAB (18 patients) or total thyroidectomy (3 patients) was performed after F-18 FDG PET/CT examination in order to evaluate the thyroid pathology. In the histopathological examination of 21 patients, 3 patients were reported as malignant (14.2%), 2 were reported as suspicious for malignancy (9.5%), 1 was reported as follicular neoplasm or suspicious for a folliculer neoplasm (4.8%) and the other 15 patients were reported as benign (71.5%) according to the Bethesda System for Reporting Thyroid Cytopathology. SUVmax values were between 2.432.5, 3.0-46.0, 5.2-6.1 and 9.4 in benign, malignant, suspicious for malignancy and follicular neoplasm or suspicious for a folliculer neoplasm groups, respectively.CONCLUSION:The results showed that F-18 FDG PET/CT examination could incidentally detect thyroid gland pathology. However, SUVmax value was not able to differentiate between benign and malignant lesions in thyroid gland.
P375 The Importance of Radionuclide Thyroid Angiography in the Differential Diagnosis of Benign and Malign Thyroid Nodules F. Aras, P. Demireli, Z. Hekimsoy, I. Basara, G. Gumuser, E. Sayit; CELAL BAYAR UNIVERSITY, MANISA, TURKEY. Aim: In this study, we purposed to decide activity of thyroid nodule that supplement of radionuclide thyroid angiography (RTA) in the differentiation of benign and malign thyroid nodules.Material and Method: Twenty-nine patients (20 female,9 male; mean age: 53.7±15.2 years) were included to study with solid cold thyroid nodules greater than 1 cm in diameter. Radionuclide thyroid angiography was performed with a gamma camera (GE,Infinia,Tirat,Hacermel) equipped with a low energy all purpose parallel hole collimator. Patients were imaged in the supine position with neck extended. 185 MBq 99m Tc-pertechnetate was administered into on antecubital vein and data acquisition started simultaneously. Sixty sequential images at 5 s per frame were recorded during the 5 min acquisition period. The dynamic perfusion images were acquired in 64x64 matrices. Routine pinhole thyroid static scan was acquired at 20 min after injection. Time-activity curves were
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 obtained from dynamic RTA images and retention ratios were calculated by this curves. Power Doppler ultrasonography (PDUS) patterns were classified as nodule vascularisation patterns and central-peripheral resistive indexes were measured. The malignancy criteria were set as follows; hypervascular nodule with rapid washout in RTA; complex ring sign with anarchic structure or delta sign in PDUS. These data were compared with the cytopathological (fine needle aspiration biopsy) results.Results: Cytology revealed malign cytology in three patients and benign results in seventeen patients. There wasn’t fine needle aspiration biopsy of nine patients. There was a statistical significance between retention ratios of malign cytological nodules with peripheral resistive indexes of malign cytological nodules at the 0.000 level. The correlation was determined between retention ratios of benign cytological nodules with central resistive indexes of benign cytological nodules (p= 0.02).Conclusion: Radionuclide thyroid angiography with 99m Tc-pertechnetate scintigraphy and PDUS along with resistive indexes could be helpful in the preoperative assessment ofmalignancy. In this study, we conclude that RTA was the really accurate, specific and easy method for differentiation of malignant from benign thyroid nodules.
P376 Comparison of the aggressiveness of papillary thyroid microcarcinomas (≤10 mm) with papillary thyroid carcinomas larger than 11 mm and less than 20 mm in diameter F. A. Caliskan, R. L. Uslu, S. Sager, C. Onsel, H. B. Sayman, L. Kabasakal, B. Kanmaz, K. Sonmezoglu, M. Halaç, I. Uslu; Istanbul University, Cerrahpasa Medical Faculty, Department of Nuclear Medicine, Istanbul, TURKEY. Aim: To compare the characteristics of papillary thyroid microcarcinomas (≤10 mm in diameter) with papillary thyroid carcinomas measuring 11-20 mm in diameter.Materials and methods: Among 1120 patients with thyroid carcinoma treated in our department from 1992 to 2005, 319 cases (28,48%) with tumors measuring 20 mm and less in diameter who were diagnosed as papillary thyroid cancer were included in the study. The first group consisted of 184 patients (57,69%) with microcarcinomas (≤10 mm in diameter) and the second group consisted of 135 patients (42,31%) with tumors measuring 11-20 mm in diameter. The median follow up was 100,26 ± 34,6 months. The frequency of capsular, peripheral tissue and lymph node invasion, multicentricity, distant metastases and the frequency of relapse were analysed in comparison within both groups. X2 test or Student-t test was used to find the significance of the differences between groups in the study. The statistical analysis of the risk factors was made with the use of multiple regression analysis (age, type, diameter, multicentricity, capsular and lymph node invasion, relapse). The results are presented by average ± SD and in range.P≤0,05 value was considered as statistically significant.Results: Eighty (43,47%) of the patients in the first group and 53 (39,25%) in the second group were older than 45 years old. The average diameters of tumors measured were 0,62 ± 0,59 mm and 1.64 ± 0.59 mm in the first and second group respectively. The frequencies of capsular, peripheral tissue, lymph node and vascular invasion were higher in the second group (p<0,05). There were capsular invasion in 15 (8,15%) and 24 (17,77%) patients (p<0,05) in the first and second group respectively; peripheral tissue invasion in 8 and 20 patients (p<0,05); lymph node invasion in 26 and 33 (p<0,05); vascular invasion in 2 and 8 patients (p0,05)between two groups. Four patients in the first group (2,17%) and 9 in the second group (6,66%) experienced relapse.Conclusion: Based on the evaluation of capsular, peripheral, lymph node invasions and relapses among papillary thyroid carcinomas, the cases with tumors measuring 11-20 mm in diameter experienced a more aggressive course in comparison to cases with microcarcinomas.
P377 Frequency of multifocality and contralateral lobe involvement in papillary carcinoma of thyroid, SKMH experience H. Ahmed, H. Bashir, M. K. Nawaz, I. Munir, S. Mufti, S. Riaz, A. Qureshi, A. Muhammad, A. I. Khan; Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, PAKISTAN. Objective: The optimal extent of thyroidectomy in papillary carcinoma of thyroid PTC has always been a focus of discussion. Our purpose is to determine frequency of unifocal, multifocal and contralateral lobe involvement in PTC at our hospital.Material and methods: We reviewed histopathological features, laboratory workup and relevant clinical history of 320 diagnosed cases of thyroid carcinoma, which were treated and followed up at our hospital from August 2006 to December 2010. Out of total reviewed cases, 100 cases of PTC who underwent total/completion thyroidectomy and had their histopathology reports reviewed by our pathology department were included in the study.Results: The 100 patients consisted of 69 females and 31 males with a mean age of 33 years (range 5-66 years). The mean size of primary thyroid cancer was 2.8 cm (SD +/- 1.86 cm). The mean tumor size in females and males is 2.6 cm and 3.1 cm respectively. Out of all selected cases, 60% were found to be unifocal and 40% multifocal. In female population, 57% cases were unifocal and 43% multifocal. In male population, 68%
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P378 Diagnostic value of pre-ablative and post-ablative serum thyroglobulin to predict ablation success in differentiated thyroid cancer K. Kim1, S. Kim2, Y. Seo2; 1Daejeon Regional Cancer Center, Daejeon, KOREA, REPUBLIC OF, 2Chungnam National University Hospital, Daejeon, KOREA, REPUBLIC OF. Aim : Successful I-131 ablation after total thyroidectomy can reduce recurrence rate and survival rate in different thyroid cancer (DTC). So, it is important to predict ablation success, clinically. We investigated whether pre-ablative and post-ablative thyroglobulin (Tg) can predict ablation success in DTC.Methods : Patients with DTC who underwent total thyroidectomy and high dose remnant ablation (3700-5550 MBq) between Aug 2008 to Jun 2010 were included. All 83 patients were testing serum Tg at the time of ablation therapy, 24 hours, and 48 hours later. Patients were followed serum Tg level and whole body scan after minimum 6 months, with thyroid hormone withdrawal. Each of ablative Tg level is compared to follow-up serum Tg level. Patients who elevated serum antiTg-antibodies and didn’t arrive sufficient TSH (sTSH <30 ng/mL) were excluded.Result : Serum Tg level of ablation time (TgA) shows 5.4±8.4 ng/mL. In a group of TgA < 2ng/mL, follow-up Tg showed more than 2 ng/mL in 8% (3 of 37). In a group of TgA ≥ 2 ng/mL or TgA < 5ng/mL, follow-up Tg showed more than 2 ng/mL in 0% (0 of 21). In a group of TgA ≥ 5ng/mL, follow-up Tg showed more than 2 ng/mL in 60% (15 of 25).Serum Tg level after 24 hour of ablation time (TgB) shows 8.2±11.8 ng/mL. In a group of TgB < 2ng/mL, follow-up Tg showed more than 2 ng/mL in 4% (1 of 24). In a group of TgB ≥ 2 ng/mL or TgB < 5ng/mL, follow-up Tg showed more than 2 ng/mL in 9% (2 of 23). In a group of TgB ≥ 5ng/mL, follow-up Tg showed more than 2 ng/mL in 41% (15 of 37).Serum Tg level after 48 hour of ablation time (TgC) shows 110.4±285.2 ng/mL. In a group of TgC < 2ng/mL, follow-up Tg showed more than 2 ng/mL in 9% (1 of 11). In a group of TgC ≥ 2 ng/mL or TgC < 5ng/mL, follow-up Tg showed more than 2 ng/mL in 0% (0 of 8). In a group of TgC ≥ 5ng/mL, follow-up Tg showed more than 2 ng/mL in 27% (17 of 64).Conclusion : We found no correlation of testing Tg between ablation time, 24 hour, and 48 hour later. But Low Tg level (Tg < 5ng/mL) at pre-ablation and post-ablation predict lower follow-up Tg levels. Pre-ablative and post-ablative Tg helps to predict ablation success.
P379 Value of Thyroglobuline (Tg) measurements and Iodine-131 whole body scintigraphy (I131-WB) after rhTSH stimulation in patients with Differentiated Thyroid Carcinoma (DTC) - 10 years of follow-up H. Carvalho, T. Ferreira, E. Limbert, L. Salgado; Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, PORTUGAL. Aim: to evaluate the value of Tg values under rhTSH stimulation and I131-WB findings in predicting disease recurrence in the follow-up of patients (pts) with DTC.Materials and Methods: retrospective analyses of the medical files of consecutive DTC pts who had undetectable Tg values; these pts underwent I131WB after rhTSH stimulation.54 pts were included in our study (8 males and 46 females); all the pts had been submitted to surgery (total thyroidectomy) and had a histopatologic diagnosis of DTC (48 pts with papillary cancer and 6 pts with folicular cancer).All the pts were taking T4 in supressive doses and had undetectable Tg values.Results: After rhTSH stimulation the values of Tg remained undetectable in 32 pts (Group A) and become detectable in 22 pts (Group B). Only one pt had a Tg>10ng/mL. Group A - 5 males and 27 females, mean age 52 y; 26 pts with papillary and 6 pts with folicular cancer.Group B - 3 males and 19 females, mean age 46 y; all the pts had papillary cancer.The I131-WB performed 72 hours after oral administration of 148 MBq of Iodine-131 showed cervical uptake in 7 pts (22%) of Group A and in 12 pts (55%) of Group B.After 10 years of follow-up six pts were lost to follow-up, three in each group.In Group A only one pt (3%) had a detectable Tg value but very low (0,2ng/mL) and no evidence of disease.In Group B seven pts (32%) had evidence of disease. Two of them had both local (cervical) and metastatic lung involvement and were submitted to Iodine.131 therapy.Conclusions: Group B pts had a poorer outcome compared with pts in Group A.No patient of the Group A needed additional therapy with Iodine-131 even when cervical uptake was present in the I131-WB.Our findings are in complete agreement with data published proving that stimulated Tg has a very high sensitivity to detect disease and that those values are a very good indicator of prognosis.
P380 The Correlation of Radioiodine Whole Body Scan and Stimulated Thyroglobulin in Patients with Differentiated Thyroid Carcinoma M. Vlajkovic1, M. Matovic2, M. Rajic1, S. Ilic1, M. Stevic1, A. Karanikolic1; 1 Clinical Center Nis, Nis, SERBIA, 2Clinical Center Kragujevac, Kragujevac, SERBIA. The aim of this study was to evaluate the correlation between the 131J-diagnostic whole body scan (DxWBS) results and the value of stimulated thyroglobulin (sTg) in patients with differentiated thyroid carcinoma (DTC) after the surgery and during the follow up period.Retrospective review comprises 164 DxWBS of 93 patiens. Postsurgical scan alone was performed in 40 of them, whereas the rest went through the additional control DxWBS as well. Scan results were considered positive if any focal uptake in the neck or elsewhere was visible, and negative if the physiological radioiodine accumulation persisted. Stimulated Tg was considered positive if higher than 2ng/ml.Negative value of sTg was detected in 56 cases with negative DxWBS scan results, and positive sTg was concordant with higher values of sTg in 78 cases. Overall concordant findings were detected in 82% of cases. Discordant findings were detected in 30 cases (18%), out of which 20 (12%) were scan positive and sTg negative, and 10 (6%) scan negative and sTg positive. All thirty patients with discordant results of DxWBS and sTg received radioidine ablation/therapy.Post-therapy whole body scan (TxWBS) showed iodine uptake in all 20 patients with positive DxWBS and negative sTG and in 3 patients with negative DxWBS and positive sTG. However, negative TxWBS scan results were found in 7 out of 10 patients with negative DxWBS and positive sTg.The results presented demonstrated high correlation of diagnostic radioiodine scan results and values of sTg in the majority of patients with DTC. However, some of the patients presented with detectable iodine avid lesions on DxWBS and low level sTg suggest that sTg alone can be an unreliable prognostic factor when it comes to estimating the risk of persistent disease. Therefore, the use of both DxWBS and sTg should be included in diagnostic work up during the different phases of managing patients with DTC.
P381 Co-relation of Positive Radiologic Studies to the Outcome of Patients with Radioiodine Avid Lung Metastases R. Silva, T. Saraiva, A. Albuquerque, G. Costa, J. Pedroso de Lima; Serviço de Medicina Nuclear dos Hospitais da Universidade de Coimbra, Coimbra, PORTUGAL. AimLungs are one of the most common sites of distant spread of differentiated thyroid cancer (DTC). Radioiodine avidity and radiological invisibility appear to be among the factors most closely associated with a better prognosis in patients with lung metastases (LM). The aim of this study was to compare the outcome of iodine avid LM according to radiological features.Material & MethodsWe reviewed the charts of 808 patients with DTC submitted to thyroidectomy and radioiodine therapy at our institution from 1984-2009. From those, 51 patients with radioiodine avid LM were identified. Of these, 22 were excluded due to insufficient follow-up data. Our sample included 29 patients (mean age 53±15.4 years; 16-78), 13 males and 16 females. Twenty two had papillary and 7 had follicular carcinoma (papillary/follicular=3.14). Lungs alone were involved in 23 patients (79.3%) while 6 patients also had bone metastases (20.7%). TSH, Tiroglobulin (Tg) and Tgantibodies values were obtained at treatment and during follow-up. According to the positivity of LM in radiologic studies (chest X-ray, chest CT), two groups were created: Group1 (G1) included 12 patients with negative radiologic studies; Group2 (G2) included 17 patients with positive radiologic studies. Response to treatment in each group was evaluated by comparison of 131I-post-treatment whole-body-scans (txWBS) between therapies and/or by Tg evolution.ResultsThe number of radioiodine therapies per patient ranged from 1-10. Analysis of the txWBS showed scintigraphic improvement in 11/27 patients, 10 didn’t register a significant scintigraphic change and in 6 patients new/increased thoracic activity was observed. Two patients were not included because only one txWBS was performed. A good association between G1 and a favorable txWBS evolution was found using a crosstabulation and a Pearson Chi-Square analysis (<0.05). The same statistical method applied to correlate radiological findings and Tg showed no relation between them; however, the sample size was further reduced due to the presence of other known metastatic sites that could influence Tg.ConclusionA strong association was found between the absence of LM in radiological studies and scintigraphic improvement in txWBS. However, to obtain a more robust statistical analysis, a larger sample is needed. A correlation between the presence of positive radiological findings and Tg was not found probably because the existence of other variables that could influence Tg but were not taken into account. Nonetheless, not one patient in G1 presented climbing Tg values, contrary to G2, where 5 patients had rapidly rising Tg levels.
Poster Presentations
cases were unifocal and 32% multifocal. Out of total 40 multifocal cases, 53% were found to have foci of tumor in contralateral lobe and/or isthmus on total / completion thyroidectomy.Conclusion: In our population, multifocality and contralateral lobe involvement is very common in PTC hence warranting total thyroidectomy. Our results are consistent with the previous studies and show similar trends.
S351
S352 P37 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Breast
P382 Functional imaging of breast cancer with 99mTc-MIBI: high accuracy in routine practice. S. N. Novikov, S. V. Kanaev, P. V. Krivorotko, V. F. Semiglazov, L. A. Jukova; N.N. Petrov Inst. Oncol., St. Petersburg, RUSSIAN FEDERATION. Functional imaging becomes an important tool in diagnosis and staging of patients with breast cancer (BC). Scintimamography (SMG) can be used as functional method of choice for routine BC visualization but its diagnostic accuracy is still a matter of debates.Material and methods: We studied 132 patients with clinical and/or radiological suspicion for BC. Planar imaging of both breasts in laterals and anterior projections started 15 min after i/v injection of 740-860 MBq 99mTcsestamibi and was followed by single photon emission tomography (SPECT). Images with focal and scattered patchy uptake were scored as abnormal. Uptake rate (UR) was scored by dividing counts in lesion by background counts. All lesions had histological verification: 98 - by operation, 35 - by core biopsy. Lymph node status was determined in 98 operated patients.Results: In 132 patients we visualized 262 breasts. Sensitivity (Sen), specificity (Sp) and accuracy (Ac) of planar SMG of all breasts were 94% (105/112), 96% (143/150), 95%. For 132 breasts suspicious for BC diagnostic results were as follows: Sen - 94% (105/112), Sp 68% (7/21), Ac - 90%. Surprisingly, SPECT in this group was less accurate: Sen - 89% (100/112), Sp - 77% (5/21), Ac - 89%. Combined interpretation of planar and SPECT data characterized by high Sen (97%), low Sp (68%) and acceptable Ac (92%). We tried to improve Sp of planar images with the help of UR. Best discrimination of BC from benign lesions was obtained with UR-1,3 with following diagnostic values: Sen - 86% (92/107), Sp 75% (15/20) and Ac - 83%. Multicentric/multifocal disease was diagnosed by SMG in 11 patients with only 6 cases detected by conventional methods - US and mammography.Planar SMG showed moderate Sen, Sp and Ac in diagnosis of axillary metastases: 60% (23/37), 86% (52/60), 76%. SPECT had the same diagnostic value with Sen - 51% (25/43), Sp - 90% (53/58), Ac -75%. Efficacy of combination “planar and SPECT” was nearly the same: Sen - 70%, Sp - 81%, Ac - 77%.Conclusion: 1. SMG has excellent Sen (94%) and Ac (90%) when used for visualization of primary tumors in patients with suspicious BC. 2. SMG is more sensitive than conventional methods in diagnosis of multicentric/ multifocal BC. 3. Taking into account equal diagnostic accuracy of planar and SPECT images we recommend planar SMG for routine use as the most efficacious in terms of “costs-benefits”.
P383 Staging and Prognosis in Patients With Breast Cancer by Means of MR-Mammography, Mammoscintigraphy and WholeBody PET V. Y. Sukhov1, T. E. Demshina1, K. L. Zaplatnikov2; 1Military Medical Academy, St.Petersburg, RUSSIAN FEDERATION, 2Clinic of Nuclear Medicine, Nurnberg, GERMANY. PURPOSE: To compare diagnostical and prognostical value of positron emission tomography with 18-F-fluorodeoxyglucose (FDG-PET), magnetic resonance mammography (MRM) and mammoscintigraphy (MSG) in breast cancer (BC) patients.Materials: MRM, MSG and FDG-PET studies were performed in 79 BC patients. Whole-body PET-scanning started 1 hr after i.v. injection of 370 MBq, SUV. Planar scintigraphy was performed 10 min p.i. of 500 MBq of 99mTc-MIBI in 3 (anterior and both lateral) projections. The count density, measured within a region of interest, was divided by the one, measured in ipsilateral and/or contralateral area. This value represents coefficient of T/NT tracer uptake. MRM included assessment of T1 and T2 weighted images with the use of FLASH-mode and Gdenhancement.Results: Statistically significant correlation coefficients (tumor/background) were observed for evaluated regions of increased uptake of radiopharmaceuticals in primary lesions: MIBI - T/NT > 1.61+/-0.27, FDG - SUV > 1.72+/-0.21. These data were concordant with MR findings of primary breast tumor lesions. In all cases p<0.001. Regional lymph nodes involvement was assumed in cases of axillary region uptake with SUV > 1.50+/-0.22 for PET and T/NT > 1.57+/0.22. In all cases of parasternal lymph nodes and distant metastases detection it was the responsibility of FDG-PET only.Conclusion: Significant and strong correlation exists between results of MRM, MSG and FDG-PET in assessment of BC. While MSG and FDG-PET are considered as the best tools for evaluating of regional lymph nodes (FDG-PET - also for distant metastases) that enable the staging and adequate planning of radiation and chemotherapy.
P384 Myocardial Perfusion Imaging with 99mTc - Tetrofosmin SPECT in Breast Cancer Patients that Received Postoperative Radiotherapy
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 C. Sioka, T. Exarhopoulos, A. Georgiou, I. Tasiou, E. Tzima, N. Fotou, A. Capizzello, P. Tsekeris, A. Fotopoulos; University hospital of Ioannina, Ioannina, GREECE. Aim: To evaluate the cardiac toxicity of radiotherapy (RT) in breast cancer (BC) patients employing myocardial perfusion imaging (MPI) with Tc-99m Tetrofosmin.Materials and Methods: We studied 46 BC female patients (28 patients with left and 18 patients with right BC) treated with postoperative RT compared to a control group of 85 age-matched females. The median time of RT to SPECT was 40 months (6-263).Results: Abnormalities in the summed stress score (SSS) were found in 54% of left BC patients, 44.4% of right BC patients, and 32.9% of controls. In left BC patients there were significantly more SSS abnormalities compared to controls (4.0 ± 3.5 vs 2.6 ± 2.0, p=0.05) and possible trend of increased abnormalities of right BC patients (3.7 ± 3.0 vs 2.6 ± 2.0, p=0.14). Multiple regression analysis showed more abnormalities in the MPI of left BC patients compared to controls (SSS, p=0.0001); Marginal toxicity was also noted in right BC patients (SSS, p=0.045). No additional toxicity was found in patients that received adjuvant cardiotoxic chemotherapy. All T-SPECT abnormalities were clinically silent.Conclusion: The study suggests that radiation therapy to BC patients result in MPI abnormalities but without apparent clinical consequences.
P385 The impact of radionuclide guided sentinel lymph node biopsy in high risk ductal carcinoma in situ of breast S. Usmani, F. abu Huda, N. Al Saleh, F. Marafi, N. al Nafisi, F. al Kandari; Hussain Makki Al jumma Centre for Specialized Surgery, kuwait, KUWAIT. PURPOSE: The role Sentinel Lymph Node (SLN) biopsy in DCIS is still unclear. Although inherently a non-invasive disease, occult invasive disease could be found at definitive histology. The aim of the present study is to evaluate the clinical usefulness of sentinel lymph node biopsy in a selected high-risk ductal carcinoma in situ who are at highest risk for being upstaged to invasive carcinoma. MATERIALS AND METHODS: Thirty three high risk patients with DCIS proven on core biopsy (mean age, 50.4±11yrs, age range, 37-78 yrs) were prospectively included in the study. High-risk DCIS patients are defined as who had one or more of the following: a palpable or mammographic mass, suspicion of microinvasion, high-grade histology, extensive or multicentric disease requiring mastectomy. SLN scintigraphy was performed 2-4 hour before surgery by injecting Tc-99m labeled nanocolloid intra-dermally in the periareolar region. LN was explored in the axilla using a gamma probe. RESULTS: The SLN was identified in all patients (100% success rate). One out of 33 cases, SLN was positive for metastasis. Ten patients (30%) were came out to be ductal carcinoma on final histological specimen despite of DCIS on core biopsy. Among these ten patient, four has only minimal invasive carcinoma (<1cm). CONCLUSIONS: Our study suggests that high risk DCIS patients and have an increased risk of invasive disease and approximately one-third of patients with DCIS population has invasive disease at the time of definitive operative procedure. SLNB is a reliable and minimally invasive procedure providing axillary information and avoiding a second operation in this particular group of patients.
P386 Breast specific gamma imaging (BSGI) and magnetic resonance imaging for the detection of biopsy proven breast masses. S. Yoon1, M. Pai2; 1Cheil General Hospital & Women's Cancer Center, Seoul, KOREA, REPUBLIC OF, 2Myongji Hospital,Kwandong University, Seoul, KOREA, REPUBLIC OF. Breast specific gamma imaging (BSGI) and magnetic resonance imaging for the detection of biopsy proven breast masses.SN Yoon1, MS Pai2: 1Department of Nuclear Medicine, Cheil General Hospital,Women Cancer Center, Kwandong University, Seoul, REPUBLIC OF KOREA, 2Myong Hospital, Kwandong Univeristy, Seoul, REPUBLIC OF KOREAWe evaluated the sensitivity of high resolution breast specific gamma imaging(BSGI) for the detection of malignant breast nodules based on histopathology and compared the sensitivity of BSGI with MRI.Forty four women (mean 48y, range 31-75y) had BSGI imaging with Tc-99m MIBI in craniocaudal and mediolateral oblique projections and MRI, which were retrospectively reviewed after surgery. 74 lesions (56 IDC, 1 ILC, 3 mucinous carcinoma, 8 DCIS, 4 ADH, 1 praffinoma, 1 fibsoris, size : 0.7-6.0 cm, Ave 2.4cm) were included.Focal findings on BSGI were all malignancy which showed strong contrast enhancement on MRI. Multifocal small daughter lesions showed mild patchy uptake. Mild heterogeneous uptake on BSGI revealed the presence of DCIS or ADH, while MRI has no differences in enhancement pattern or intensity.BSGI has high sensitivity for the detection of malignant breast mass and demonstrated excellent correlation with MRI. Breast mass with non-focal and heterogeneous uptake on BGSI should also be considered for further evaluation.
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Utility of FDG-PET in the Follow-Up of Breast Cancer. A Comparison with CT Imaging. A. Benitez Velazco, M. D. Albala Gonzalez, F. J. Hidalgo Ramos, P. I. Contreras Puerta, C. Pacheco Capote, J. M. Latre Romero; UNIVERSITARY HOSPITAL REINA SOFIA, CORDOBA, SPAIN. AIM: The purpose of this job is to determinate the utility of 18F-FDG-PET in the follow-up of patients with breast cancer and in the early diagnosis of recurrence. Also to compare with CT findings.MATERIAL & METHODS: We performed a retrospectively analysis of 62 FDG-PET scan in 48 patients (age 35-81years) referred for: 1) detection of recurrence in patients with progressive elevation of serum tumour markers or 2) re-staging in recurrent breast cancer. A CT exploration was performed in all the patients.We compared FDG-PET and CT findings in each patient and at the different anatomical regions.Results were confirmed by pathology when histological sampling was possible, by another conventional imaging modalities (bone scintigraphy, ultrasound and MR) and/or by clinical follow-up to 12 months at least.RESULTS: Among the 62 studies performed, 21/62 FDG-PET and 25/62 CT resulted negative. We had 7/21 false negatives in FDG-PET, in 4 patients the recurrence was limited to the liver, and in the other 3 cases there were metastasis in lung and pleura. Otherwise, 12/25 CT studies were false negatives in patients with local recurrence and lesions localized in pleura, lung, liver, lymphatic nodes and skeleton. There were 16 patients referred to FDG-PET for progressive elevation of tumour markers and in 8 of them, FDG-PET findings were the unique evidence of recurrence. The percentage of false negatives (PFN) was 33% for FDG-PET and 58% for CT.For anatomical regions, the Sensitivity (Sn) in lymphatic node and bone metastasis was 100% and 85% for FDG-PET and 52% and 36% for CT. Otherwise, the Sn in liver lesions was 50% and 75% and in lung lesions was 61% and 84% for FDG-PET and CT, respectivelyThe anatomical distribution of the lesions is resumed in the table.CONCLUSIONS: 1. FDG-PET has been shown to be helpful: a) in the early detection of recurrence in patients with progressive elevation of serum tumour markers. b) in staging recurrent breast cancer2. FDGPET is the most useful technique in the evaluation of lymph node involvement, skeletal lesions and local recurrence.3. FDG-PET alone can’t replace CT evaluation of liver and lung lesions.
P388 Importance of FDG PET-CT in diagnosis and follow-up of patients with breast cancer in the basis of Hungarian experiences H. Galgóczy1, A. Németh2, Z. Varga1, P. Szabó1, I. Garai3; 1Scanomed Kft., 2 Budapest, HUNGARY, Semmelweis University, Department of Transplantation and Surgery, Budapest, HUNGARY, 3Scanomed Kft., Debrecen, HUNGARY. Objective: Our aim was to define extra information of FDG PET-CT examination comparing to the previous diagnostic images; to evaluate the percentage of confirmation of clinically supposed status and to define it’s influence on oncologic treatment of patients.Material and methods: The medical records of 143 consecutive patients with breast cancer referred from three oncologic centers from October 2008 to September 2009 were retrospectively reviewed. PET-CT imaging was performed with GE Discovery ST scanner according to the usual protocol. 143 patients (142 women, 1 man, mean age 56,9 years) have 155 breast tumors. The hystologic subtypes of the primary tumors were infiltrating ductal carcinoma in 102, infiltrating lobular carcinoma in 18, DCIS alone in 9, other/unknown in 26 cases. Hystologically Grade 2 carcinoma occured in largest proportion. 70 conservative operations and 74 mastectomies were performed. In remainder cases the operation was not performed or type of surgical procedure was not known.Results: Definite diagnosis was established in 129 cases (84.3%), the extent of disease was increased in 40 (31%), diagnosis was unchanged in 24 cases (18.6%), it was negative in 65 cases (50%).The PET-CT result was equivocal in 24 cases (15.6%) having caused partly inadequate referral. PET-CT examination gave excess information for physicians in 31%. The therapy was altered in 40 cases (26%) based on PET-CT result.Conclusion: FDG PET-CT examination is useful in management of patients with breast cancer (especially advanced or metastatic disease) in case of adequate indication.
P389 Morpho-Metabolic Changes at the Operation Site in Recently Mastectomized Patients: Impact of Staging FDG PET/CT S. Ozguven1, F. Dede1, T. Ones1, B. Gulluoglu2, S. Inanır1, T. Y. Erdil1, H. T. Turoglu1; 1Marmara University School of Medicine Nuclear Medicine Department, İstanbul, TURKEY, 2Marmara University School of Medicine General Surgery Department, İstanbul, TURKEY. Purpose:Because FDG is not a tumor specific agent, several situations include postoperative inflammation may decrease the diagnostic performance of oncological PET studies. The aim of this study was to define postoperative morpho-
metabolic changes according to initial staging PET/CT.Methods:A total of 61 female breast cancer patients who recently underwent modified radical mastectomy (MRM) and initial staging PET/CT were retrospectively investigated . After medical record and PET/CT image analysis, morpho-metabolic changes at operation site were described and its relationship with postoperative period was evaluated.Results:61 female patients [mean age of 56.11± 14 years (range 25-88)] underwent MRM with axillary sampling (SLN biopsy and/or curettage) were included. CT images showed thickening of skin in anterior chest wall and increased density at subcutaneous fat tissue without a mass formation at operation site (anterior chest wall and axilla) in all cases. In 34 cases (55.6%) CT images showed fluid collection (hematoma or seroma) in operation site. For our group PET showed mild to moderate increased asymmetrical FDG uptake [average SUVmaximum: 2.67±0.77 (1.3 - 4.8)] at the operation site (except in fluid collection area) with no distinct focus. Mean postoperative time was 25.52±14.3(6-90) days .Statistically significant inverse relationship between postoperative period and FDG uptake levels (r: -0.33, p:0.01) was shown by linear regression analysis . Average SUV maximum values were over critical threshold value (SUVmax> 2.5) in the first 30 days after surgery [first 15 days (n:19) mean SUVmax.: 3.1±0.9, 15-30 days(n:30) mean SUVmax.: 2.6±0.7] and it decreased to 2.2±0.5 (n:12) after 30 days (nonparametric ANOVA, p:0.0132).Conclusion:Diffuse mild to moderate asymmetric increased metabolism with thickening of skin and increased density in subcutaneous fat tissue at operation site was observed in all recently operated breast cancer patients. Approximately in half of the cases hypometabolic fluid collections were detected. During the first month of surgery, asymmetric hypermetabolism over the critical threshold was observed at operation site and it declined over the time.
P390 Synchorunous Metastases in Recently Diagnosed Breast Cancer: Role of Staging FDG PET/CT S. Ozguven1, F. Dede1, T. Ones1, B. Gulluoglu2, S. Inanır1, T. Y. Erdil1, H. T. Turoglu1; 1Marmara University School of Medicine Nuclear Medicine Department, İstanbul, TURKEY, 2Marmara University School of Medicine General Surgery Department, İstanbul, TURKEY. Purpose:Breast cancer is the most common cancer in women and demonstration of distant metastasis at time of diagnosis is important in determining management to patient and prognosis. In this study we aimed to investigate the role of staging FDG PET/CT in newly diagnosed breast cancer patients and to analyse relationship between stage of the disease and synchronous metastasis patterns.Methods:In this study, a total of 103 recently diagnosed (biopsy or surgery) female breast cancer patients who underwent initial staging PET/CT were retrospectively analysed. All medical and PET/CT reports of patients were examined and distant organ metastasis patterns were determined.Results:103 patients with a mean age of 56.2 ± 13.6 years (25-88 years) included in this study. Distant organ metastasis was detected in 35 cases (34%). Of these cases, in 51% (18/35) has multiple and 49% has single organ metastasis pattern (solitary or multiple) . In our group, metastasis most commonly seen in skeleton (69%). Following organs were non-locoregional lymph nodes (40%), liver (26%), lung (20%), adrenal glands (11%), pleura (11%), soft tissue (muscle and subcutaneous fat tissue) (9%) and thyroid gland (9%). In patients with single organ involvement, metastasis were mostly to skeleton (59%). Others were to mediastinal lymph nodes (18%), liver (12%), adrenal glands (6%) and thyroid gland (6%). Non loco-regional distant lymph node metastasis was observed in 14 (14%) patients. Of these cases, involved lymphatic stations were mediastinal (79%), cervical (29%), anterior diaphragmatic (7%) and abdominal lymphatics (7%). In mastectomised group (n:63) distant metastases were observed in 27% of cases. Rate of distant metastasis in these cases with according to histopathological stage I, II and III were 0%, 16% and 34% respectively. (p:0.258). The frequency of detecting distant organ metastases were 45% in non-operated patients (n:40) diagnosed by biopsy. In these cases, rate of distance metastases for clinical T1, T2, T3 and T4 tumour were 44%, 42%, 50% and 0% respectively (p:0.517). Interestingly in biopsy group, 4 cases (%10) had distant metastasis without any hot spot in the axillary region.Conclusion:In one third of initial staging FDG PET/CT scans, single or multiple synchronous distant organ metastasis with similar frequencies were observed in patients with recently diagnosed breast cancer. Most commonly involved organs were skeleton and non-locoregional lymph nodes. Although it is not statistically significant, rate of synchronous metastasis was tent to increase with histopathological stage.
P391 Bone scintigraphy or PET/CT; which modality shows better bone metastasis of breast cancer? T. A. Balci1, Z. P. Koc1, H. Komek2; 1Firat University, Faculty of Medicine, Department of Nuclear Medicine, Elazig, TURKEY, 2Training Hospital, Nuclear Medicine Division, Diyarbakir, TURKEY. Aim: Although PET/CT can successfully show metastasis of various cancers its superiority over bone scintigraphy especially for breast cancer metastasis is not
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S354 definite. In many departments these two modalities usually are used together. We aimed to compare the concurrent PET/CT and bone scintigraphy results of breast cancer patient in this multicenter study.Materials and Methods: One hundred sixty two breast cancer patients (158 F, 4 M; mean age: 50.6 years) were included into the study. PET/CT examination was performed to all patients and concurrent bone scintigraphy to 68 patients. The results of PET/CT and bone scintigraphy were compared.Results: One hundred thirty two of 162 breast cancer patients were operated because of breast cancer. Eighty nine patients had metastasis and 4 had recurrent disease according to PET/CT results. Metastatic sites were: lymph node, bone, lung, liver, adrenal gland, local skin or muscle, brain, peritonitis carcinomatosa, respectively according to frequency.Among the 68 patients who were applied two modalities, 24 had metastatic bone scintigraphy and 5 of these metastatic patients had no bone metastasis on PET/CT. Although 24 of these 68 patients had bone metastasis on PET/CT examination; 23 of 24 patients had also metastasis on bone scintigraphy.Conclusion: Although two modality were in concordance with each other, PET/CT couldn’t show bone metastasis in 5 (%21) and bone scintigraphy in 1 (%4) patients. Bone scintigraphy found superior to PET/CT for showing bone metastasis of breast cancer and preserve importance in this issue. However PET/CT should be remembered when evaluating soft tissue.
P392 The usefulness of 18F-FDG uptake to histopathological and immunohistochemial analysis in primary breast cancer B. Kim; Nuclear medicine, school of medicine, Ewha Womans University, Seoul, KOREA, REPUBLIC OF. IntroductionThe aim of this study was to analyze the clinical significance of maxSUV in patients with primary breast cancer.MethodsNinety-one women (48.5±11.5 years old) with breast cancer underwent FDG PET before surgery were enrolled, retrospectively. All of breast cancers were no less than 10 mm of invasive ductal carcinoma to exclude partial volume effect.MaxSUVs of primary breast cancer were compared to histopathological and immunohistochemial finding after surgery.ResultsHigh maxSUV of primary breast cancer was significantly correlation with several poor prognosis factors: more than 2 cm of tumor invasive size (p<0.001), high score of nuclear or histologic grade (p<0.008 and p<0.001), no less than 10 % of Ki 67 (p<0.002), ER negativity (p<0.019), and triple negative tumors (negative of ER and PR, no overexpression of c-erbB-2, p<0.029).MaxSUV was not affected by the menstruation status, axillary lymph node metastases, lymphovascular invasion, PR status, C-erbB-2 status, and P53.From multivariate analyses, tumor invasiveness, histologic grade were significantly correlation with maxSUV (p<0.001, and 0.001).The sensitivity and specificity of FDG PET for discriminating axillary lymph nodes were 51.1 % (23/45) and 97.8 % (45/46), respectively.ConclusionsHigh maxSUV was correlation with several poor prognosis factors (tumor invasive size, high grade, Ki 67 status, ER negativity, triple negativity) of invasive ductal carcinoma. Preoperative FDG PET could be a useful modality to predict the clinopathological or immunohistochemial status and to help therapeutic plan of primary breast cancer.
P393 Simultaneous Radionuclide Occult Lesion Localization and Sentinel Lymph Node Biopsy in Patients with Non-palpable Breast Lesions B. Zengel1, U. Yararbas2, O. Bingolballi1, Z. Adibelli3, A. G. Denecli1; 1Izmir Bozyaka Research and Training Hospital, Department of General Surgery, Izmir, TURKEY, 2Ege University Hospital, Department of Nuclear Medicine, Izmir, TURKEY, 3Izmir Bozyaka Research and Training Hospital, Department of Radiology, Izmir, TURKEY. Aim: Radionuclide occult lesion localization (ROLL) has been an alternative to classical wire localization since early 2000s. It can be performed by ultrasonographic or mammographic guidance. Sentinel lymph node biopsy (SLNB) is the preferred method in the evaluation of axillary status in T1-2N0M0 breast cancers. Both techniques use Tc99m labelled agents and therefore their simultaneous performance may be questionable. The aim of our study is to test the feasibility of simultaneous ROLL and SLNB.Material and Method: Sixty-one nonpalpable breast lesions in 54 female patients (mean age: 53.8) were included in the study. All patients underwent lymphatic mapping using radiocolloid or combined method (radiocolloid+blue dye) to make SLNB available in case of malignant frozen section result of the breast lesion. A total of 1 mCi activity was injected at 4 quadrants of periareolar region intradermally the day before surgery and isosulphan blue was injected at subareolar space after the induction of general anesthesia. The day of the surgery in 37 lesions using ultrasound and in 24 using mammography guidance, 0.5 mCi of Tc-99m MAA in 0.2 ml volume was injected into the lesion. MAA injection was followed by 0.2 ml saline. During operation, injection sites in periareolar region, SLNs in axilla and occult breast lesion area are counted with gamma probe. Breast lesion was excised with the guidance of gamma probe and excision material was evaluated radiologically to verify the removal of the lesion and then evaluated by frozen section analysis. In case of malignant
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 histology, appropriate breast surgery and SLNB were perfomed.Results: In all patients, ROLL technique could successfully localize the lesion. Mean count rate obtained on skin before the incision was 328 counts/second on periareolar injections, 27 counts/second on SLNs and 4300 counts/seconds on the breast lesions. No interference between occult lesions, periareolar injection sites and SLNs were observed. In all patients, removal of the lesion with safe margins was confirmed with radiological evaluation. According to intra-operative frozen section analysis of the breast lesions, 27 had benign and 34 had malignant histology. Successful SLN detection was reached in all patients.Conclusion: Due to significant count rate differences between periareolar injection sites, ROLL injection sites and SLNs, simultaneous performance of ROLL and SLNB techniques is found to be feasible. Simultaneous ROLL+SLNB (SNOLL) avoids a second operation in patients with malignant tumor histology detected during per-operative frozen section analysis.
P394 Prognostic value of staging FDG PET/CT in breast cancer E. Han1, J. Oh1, J. O2, Y. Park2, S. Kang3, S. Chung1; 1The Catholic University of Korea, Seoul, KOREA, REPUBLIC OF, 2The Catholic University of Korea, Suwon, KOREA, REPUBLIC OF, 3The Catholic University of Korea, Daejeon, KOREA, REPUBLIC OF. Objective: To examine if quantitative FDG uptake variables measured in staging FDG PET/CT images of operable primary breast cancer patients have prognostic value for recurrence within 2 years from diagnosis.Materials and methods: The FDG PET/CT studies performed between November 2003 and March 2010 for initial staging of breast cancer patients with complete surgical resection planned were reviewed. The maximum standard uptake value (SUVmax) and metabolic tumor volume (MTV) were computed by drawing region of interest manually around the primary tumor. Different SUV (1.5, 2.0 and 2.5) and percent (25%, 50% and 75%) thresholds were used to compute the MTV. The SUVmax and 6 different MTVs for detecting each patient’s future disease status (disease free for 2 years versus tumor recurrence within 2 years) were evaluated by receiver operating characteristic (ROC) analysis.Results: Of the 224 eligible cases, 31 were excluded due to image data or clinical follow-up loss, and 193 patients were available for assessment. There were 9 cases with visually imperceptible or indistinguishable FDG uptake in the primary breast tumor, and recurrence was observed within 2 years of diagnosis in 1 out of the 9 cases. The SUVm and MTV’s were computed for the remaining 184 tumors with perceptible FDG uptake. Recurrence was detected in 22 out of 184 patients (12%). The area under the curve (AUC) for the ROC curves was greater for SUVmax (AUC 0.625, 95% CI, 0.509 to 0.741) than the 6 MTVs. Among the MTVs, AUC was greatest when fixed threshold of SUV 2.5 was used (AUC 0.620, 95% CI, 0.496 to 0.745).Conclusion: Primary tumor SUVmax from staging FDG PET/CT may be able to detect breast cancer patients who will have recurrent disease within 2 years. The value of MTV computed using various fixed SUV or percent threshold appears to be relatively limited.
P395 Sentinel Lymph Node Mapping in Breast Cancer Patients: Comparison of Planar and SPECT/CT Images D. Kocabıçak, M. Sahin, S. Akpınar, O. Yapici, S. U. Semirgin, D. Ersoy, T. Basoglu; 19 Mayıs University, Faculty of Medicine, Department of Nuclear Medicine, Samsun, TURKEY. Aim: The purpose of our study is to map the localizations of the sentinel lymph nodes (SLN) in breast cancer (BC) patients preoperatively by planar and single photon emission computed tomography (SPECT) which provides 3D images and to compare these two techniques.Patients and Methods: Forty-one early stage female patients with BC had undergone SLN and lymphatic mapping imaging. Periareolar intradermal administration of 500 µCi 99mTechnetium -rhenium colloid were performed at the quadrant with the tumour. Kinetic, static and SPECT/CT images were obtained by a SPECT/CT system. Planar, SPECT and SPECT/CT fusion images were evaluated visually. The first lymph node (LN) detected in axilla in kinetic images and the other LNs detected by planar and SPECT/CT images were recorded. Lymph nodes were classified as axillary and extraaxillary in dynamic, static and SPECT/CT studies. Lymph nodes detected in anterior, lateral and SPECT/CT images were compared with Mann-Whitney U test and the values were shown in medians (minimum-maximum value). P<0.05 was regarded as significant. Age group value was shown as mean±standart deviation.Results: The study group consisted of 41 female patients aged between 27 and 81 who were diagnosed as BC. The tumour was localized to the right breast in 18 patients and left breast in 23 patients. Lymph nodes were detected in 40/41 of the patients by lymphoscintigraphy (%97.5). Planar images showed LNs in 39/41 of the patients.. On kinetic anterior images, 38 LNs were detected in 30/41 of the patients as the first LN draining the breast region. On anterior, lateral and SPECT/CT images 678 (median:2, minimum 0-maximum 5),71(median:2, minimum 0-maximum 5) and 113 (median:3, minimum 0-maximum 6) LNs were detected consecutively. A total of 113 LNs were visualized on SPECT/CT studies in 40/41 patients (%97, 5). No LN
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P396 Quality standards evaluation in the clinical application phase of the sentinel node biopsy (SNB) in breast cancer: a 1425 patient’s review P. Serra, E. Goñi, C. Estébanez, A. Camarero, F. Domínguez, F. Vicente, M. Martínez-Lozano; Hospital Complex of Navarra, Pamplona, SPAIN. The criteria to validate the SNB procedure are mandatory for the implementation of the technique in a hospital. After this phase, to evaluate the quality standards of the clinical application phase are not established as well as could be expected, but is highly recommendable. The Spanish Society of Senology and Breast Pathology published in 2007 a self-evaluation guidelines with some objective and measurable evaluation criteria related to the main aspects of the procedure: care experience (6 criteria), operative aspects (18 criteria) and scientific and formative activity (8 criteria).Aim: To evaluate the quality of the SNB in a tertiary public hospital in Spain during the clinical application phase, between 2004 and 2010. To assess the possible influence of the recent incorporated technologies in the procedure such as the one-step nucleic acid amplification -OSNA- and the intraoperative mobile gamma camera.Materials and Methods: The validation phase started in 2001 including 89 patients. In the clinical application phase 1425 patients were studied. The different aspects of the procedure were evaluated according to four quality standards.Results: After the application of the self-evaluation guideline, the global score is 55 out of 71 points. The quality level more prevalent is II, which implies an adequately fulfilling of the minimum requisites. However, level III (excellence level) is the most prevalent in the criteria related to care experience and scientific and formative activity. The results are influenced by two criteria related to the intraoperative analysis of the SN due to the recent incorporation of OSNA technique. Otherwise, it could be incorporated another criterion to assess the utility of the intraoperative mobile gamma camera in the operation theatre.Conclusions: The evaluation of the quality in the clinical application phase of the SNB measures and analyses the multidisciplinary team. It makes possible to identify the areas of improvement and to guarantee the best recommendations. It would be necessary to add and modify some criteria influenced by the incorporation of new technologies.
P397 No visualization axillary sentinel node after intratumoral administration in breast cancer: Tumor and other factors J. Freire, M. Pajares, A. Utor, P. Moreno, R. Rodríguez, C. Téllez, D. Martinez-Parra; University Hospital Puerta del Mar, Cadiz, SPAIN. AimTo investigate the relationship between non axillary sentinel node (SN) after intratumoral administration (IT) of the radiotracer with characteristics of the tumor and breast and the effect of other variables.Materials & methodsWe retrospectively studied 364 patients (27-86 y) with breast cancer ≤ 3 cm and negative axillary or validation by size or multiplicity, with sentinel node biopsy (SNB) after administration of 99mTc-nanocolloid IT and subaerolar if axillary SN was not found.We analyzed variables of the patients, tumor and surrounding breast by univariate test and multiple logistic regression.ResultsAxillary drainage was observed in 322 patients after IT administration (Group A); not observed in 43 patients (group B), and was found in 41 patients after subaerolar axillary drainage.It was more common in Group B: patients> 70 years (27% vs. 10%), SN masive metastases (57% vs. 12%, p = 0.056) and metastatic involvement in axillary lymphadenectomy (67% vs. 19%). Tumor size, histologic type and metastasis in SN were not statistically significant. The only significant variable on multiple logistic regression was age (p <0.05).Variables related to the tumor and breast:MacroscopicTumor: without peri or intratumoral vs inyury (p=0.001)Tumor necrosis microscopy: No, Necrosis<10% and necrosis >10% (p= 0.023)Breast characterístics: Proliferative mastopathy; No proliferative mastopathy, Atrophy, Normal (p=0.060)ConclusionsDespite the limitation of the study sample, besides confirming the determination of age as a factor, the presence of peri-or intratumoral macroscopic lesions and microscopic tumor necrosis were found to be significant variables in no axillary drainage after intratumoral tracer administration. The characteristics of the breast in which the tumor is located, particularly atrophy, could also be a variable to consider.
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Utility of F-FDG PET CT in the evaluation of breast carcinoma with bone metastasis. L. Geraldo, J. Duch, J. Deportós, A. Domènech, C. Gaeta, A. Fernández, M. Estorch, C. Artigas, A. Flotats, V. Camacho, I. Carrió; Hospital de la Santa Creu i Sant Pau. Nuclear Medicine department, Barcelona, SPAIN. IntroductionBone metastasis are the most frequent ones in patients with disseminated breast carcinoma (DBC). DBC prognosis not only is defined by tumor biological characteristics but also by kind of metastasis (visceral vs bone metastasis).DBC systemic treatment is based on hormone therapy, chemotherapy and monoclonal antibodies. Additionally, biphosphonates can reduce pain, pathologic fractures, spinal cord compressions and hypercalcemia in those patients with bone metastasis. Hormone therapy (in patients expressing positive hormone receptors) and Trastuzumab (in those with expression or amplification of her2/neu) provide favourable response. However, overexpression of cellular proliferation factor Ki67 is usually associated with unfavorable prognosis.AimTo evaluate the utility of 18F-FDG PET CT in restaging patients with breast carcinoma and known bone metastasis.Methods25 patients with breast carcinoma and bone dissemination were included (mean age: 64 +/- 15 years old; mean time from initial diagnosis: 14+/-6 years). All patients underwent a FDG PET CT study and restaging was established by local relapse, locoregional relapse (axillary, supraclavicular, infraclavicular and internal mammary lymph nodes), distant lymph node relapse and non-bone metastasis. Hormone receptors, her2/neu and Ki67 were also assessed.ResultsNone of 25 patients had local relapse. 7 of them (28%) showed locoregional relapse and 10 (40%) distant lymph node relapse. 15 patients (60%) had also non bone metastasis.20/25 patients had positive hormone receptors and 9 of them (2/9 also with positive her2/neu) showed new disseminated disease. All patients with negative hormone receptors were diagnosed with new pathologic findings (the only triple negative case had locoregional, distant lymph node, lung and liver relapse; this patient was the only one with overexpression of Ki67 (>20%)).ConclusionFDG PET CT study was able to demonstrate new metastatic lesions in 14 out of 25 patients, changing treatment management in 56% of patients.
P399 Sentinel lymph node biopsy with intratumoral injection in palpable and non palpable breast cancer R. Diaz Exposito1, A. Orozco Molano1, I. Casans Tormo1, M. Esteban Poveda1, J. Roberto Baez1, C. Rocafuerte Avila1, A. Caballero Garate2, A. Julve Parreno3; 1Nuclear Medicine. Hospital Clinico Universitario, VALENCIA, SPAIN, 2General Surgery. Hospital Clinico Universitario, VALENCIA, SPAIN, 3Radiology. Hospital Clinico Universitario, VALENCIA, SPAIN. AimDiagnosis of breast cancer is every time earlier, so that the frequency of patients with non palpable (nP) breast cancer referred for sentinel lymph node biopsy (SLNB) has increased. We have assessed the results obtained in a group of nP compared with another group of palpable tumor (P) patients.Materials and methodsWe analyzed 103 consecutive patients, 49 P and 54 nP, after intratumoral injection of 99mTc-albumin nanocolloid administered by palpation and ultrasound or stereotaxy guide respectively. We obtained lymphoscintigraphy in different projections, with external mark of sentinel node (SN) in surgical position, intraoperative detection with hand-held gammaprobe, removal and pathologic analysis. We used portable gammacamera (PG) in 28P and in all nP (SNOLL) for tumor and SN removal.ResultsMean age 32-73 years (56.3±10) in P and 38-73 (59.9±7.9) nP. We found infiltrative ductal cancer (IDC) in 79.5% P and 87% nP, estrogenic receptors in 75.5%P and 81.4%nP, progesterone receptors in 48.9%P and 37.0%nP. We detected SN in 48/49(97.7%)P and 49/54(90.7%)nP (NS). We found 1 SN in 38/48(79.1%) P and 35/49(71.4%) nP, 2 SN in 7P and 13nP and more than 2 SN in 3P and 1nP (NS). The location was only axillary in 41/45(85.4%) P and 38/49(77.5%) nP, only internal mamary in 2P (4.1%) and 4nP(8.1%), both locations in 2P(4.1%) and 3nP (6.1%) and other locations in 3P(6.2%) and 4nP (8.1%). There was SN involvement in 19/48(39.5%)P and 11/49(22.2%)nP (NS), founding after lymphadenectomy more nodes involved in 8P and 9nP. Considering both groups, negative SN was more frequent in patients older than 57 years (46/58(79.3%) than in lower than 57y (22/39 (56.4%) (p: 0.01). The differences were not significant between SN involvement and estrogenic receptors or tumor histology. The PG was useful in both groups for the SN and tumor detection and the evaluation of surgical bed. After a follow-up of 3-36 months, one patient died with liver metastases of a concurrent melanoma diagnosed a year later of SLNB. All the other patients were free of disease.ConclusionsThe SLNB results in nP are similar to P. Although the SN detection and involvement percentage tended to be higher in P than nP, the difference was not significant. The main location of SN was axillary in both groups. The negative SN was more frequent in patients older than 57 y in both groups of patients, without differences in relation to estrogenic receptors or tumor histology.
Poster Presentations
were visualized in one patient (%2,4) on both planar and SPECT/CT images. Extraaxillary drainage was seen in only 2 patients (%4, 8). One of these was parasternal which had already been visualized on anterior planar images and the other was an intramammarian LN detected on lateral image.Conclusion: SPECT/CT seems to be a useful method in SLN and lymphatic mapping by differentiating artifacts and lymphatic channels from LNs with the proper anatomic localization in addition to the improved LN detection.
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P400 99mTc-MIBI SPECT/CT in the follow-up of neoadjuvant chemotherapy of breast cancer E. Schmidt1, Y. Al-Farhat2, K. Derczy1, C. Weninger1, Z. Nemerey2, J. Czifra2, Z. Szabo1, S. Szekeres1, K. Zambo1; 1University of Pecs, Pecs, HUNGARY, 2Tolna County Hospital, Szekszard, HUNGARY. The intensity of 99mTc- MIBI accumulation in breast cancer depends on tumor size, on vascularisation and on several important prognostic factors. The aim of our study was to determine the role of 99mTc-MIBI SPECT/CT in the follow-up of neoadjuvant chemotherapy of breast cancer. Patients and methodes: 8 breast cancer patients were observed, with the indication of neoadjuvant chemotherapy. Before the beginning of therapy, and after the III. and VI. cycle 99mTc-MIBI scintigraphy were performed. 10 and 60 minutes after the injection of 370 MBq 99mTc-MIBI, planar scans of the chest and axilla, whole body scan and SPECT/CT of the chest were completed. We observed the change of intensity of 99mTc- MIBI accumulation in the breast tumors and axillary lymph nodes, with the quantitative analyses on SPECT/CT slices (VOI, maximum pixel value), compared to the change of tumor and lymph node size and histological finding. Results: In 7 cases histological findings showed ductal carcinoma. In 5 patients pathological axillary lymph nodes were detected by mammography and US, which were proved by 99mTc-MIBI planar and whole body scans, but chest SPECT/CT showed in all 7 patients pathological lymph node accumulation, in two cases with normal lymph node size. In 1 case the SPECT/CT scan found a pathological mediastinal lymph node and lung metastases, which was an indication for changing the therapy. In 6 cases, the intensity of 99mTc-MIBI accumulation shows a significant reduction already after the III. cycle of therapy. In 1 patient, with mastitis the histology proved an undifferentiated tumor with high malignity. There was no reduction in tumor size and intensity of 99mTc-MIBI accumulation and after mastectomy the histology proved extraosseal osteosarcom. Conclusions: 99mTc-MIBI SPECT/CT, combining function and morphology, in addition to quantitative analyses is a useful and sensitive method in the follow-up of neoadjuvant chemotherapy of breast cancer. The first examination, before the beginning of therapy can detect unknown metastases, which modifies the therapy.
P401 PET/CT and breast cancer E. E. Urbanova, J. Vizda, E. Malirova; Dept. of Nucl. Med. University Hospital, Hradec Kralove, CZECH REPUBLIC. Aim of this study was to determine retrospectively the correlation of increased value of tumour markers (TM) with FDG-PET/CT. 18F-FDG PET is a sensitive method for detecting malignancy. Hybrid devices provide both, the metabolic information from PET and anatomic information from CT in a single examination. The recent development of hybrid systems PET/CT has increased the accuracy of diagnostic imaging.Method: During the year 2008 till 2010 we examined 21 female (range from 28-to 73years), after surgery for breast carcinoma. In all patients were increasing level some of following tumour markers (CA15-3, CA19-9, CA72-4, CEA) but without other signs of malignancy. All patients underwent PET/CT images evaluation. The patients fasted for at least six hours before the study in order to minimize glucose utilization in normal tissues. Acquisition started 60 min after intravenous administration of 18F-FDG. Whole body image from the mid femur to the base of the brain was obtained. All examinations were performed with complex PET/CT protocol combined PET and whole diagnostic contrast enhanced CT.Results: In five patients second tumour was revealed (twice pancreatic cancer, twice colorectal cancer and once oesophageal carcinoma). Recurrence was present in nine patients with metastases in lymph nodes, liver or bone. The results from PET/CT were confirmed by biopsy, surgery or MRI. In seven patients the PET/CT findings were negative, but they are still in follow up examinations.Conclusion: PET/CT is by no means a perfect imaging modality for patients after surgery for breast cancer with increased level of tumour markers and without clinical signs of the disease.FDG-PET/CT and tumour marker tests can describe cancer activities in different ways, so their diagnostic added value takes advantage of this combination. Here is still the problem of the limited sensitivity of PET in early stages, which is not able to rule out the microscopic metastases. False-negative results of tumour markers are rare in patients with advanced disease and metastases but they are most frequent in the first stages. False-positive results can be due to different non malignant conditions.
P402 Overexpression of serum calctitonin gene-related neuropeptide (CGRP) in patients with mixed in situ and invasive ductal breast carcinoma (DCIS+IDC). Correlation with mammographic breast density V. Papantoniou, P. Valsamaki, A. Fothiadaki, E. Arhontaki, V. Skalistis, S. Marinopoulos, T. Karianos, T. Liotsou, A. Tsaroucha, A. Tsakmakli, E. Stypsanelli, A. Antsaklis; University Hospital "Alexandra", Athens, GREECE.
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 Aim: To investigate the fluctuation of the serum neo-angiogenic neuropeptide CGRP in patients with benign and malignant breast diseases and to assess its possible correlation with mammographic breast density (BD%).Material and Methods: Forty eight women with histologically confirmed breast diseases were studied: mild epithelial hyperplasia (MEH): n=12, florid epithelial hyperplasia (FEH): n=5, atypical hyperplasia (AH): n=4, DCIS: n=5, DCIS+IDC: n=9 and pure IDC: n=13. Serum CGRP levels were measured by RIA methods and compared (Mann-Whitney test) between the various groups. Mammographic BD% was calculated based on computer-assisted methods and was correlated (linear regression analysis) with serum CGRP concentration.Results: Serum CGRP concentration (mean±SD: pg/mL) in the various groups, was: MEH: 96.8±22.5, FEH: 135.5±33.5, AH: 139±44.4, DCIS: 131.4±37.5, DCIS+IDC: 1167.5±927.5, pure IDC: 198±82. DCIS+IDC lesions presented statistically significantly higher serum CGRP levels (versus: MEH p<0.001, FEH p<0.001, AH p<0.001, DCIS p<0.001 and IDC p<0.001). Serum CGRP concentration presented statistically significant correlation with BD% (r=0.947, p<0.0001).Conclusion: Women with DCIS+IDC lesions presented significantly increased serum CGRP concentration. The significant correlation between serum CGRP levels and BD, enhances the suggestion that DCIS+IDC represents a distinct pathological entity, associated with an interactive mechanism between BD and serum CGRP expression. Thus, serum CGRP levels could constitute a future useful preoperative index of the nature or type of suspicious mammographic lesions, in order to schedule the appropriate therapeutic treatment, and potentially propounds the perspective of adjunctive therapeutic administration of anti-CGRP peptides.
P403 Multiple sentinel lymph nodes in preoperative lymphoscintigraphy. Is it necessary to remove all of the radioactive nodes? D. Papadouli, D. Antoniou, I. Sevaslidou, k. Diamantakis, L. Iordanidou; “Metaxa” Cancer Hospital, Piraeus, GREECE. Aim:Multiple sentinel lymph nodes (SLNs) are found quite often during lymphoscintigraphic techniques and it is usual to find that not necessarily the most radioactive SLN is the node that is histological positive. We sought to determine both the number of ‘’hot’’ SLNs per patient and if there is an appropriate number of nodes that should be removed without increasing the FNR of the study.Materials and methods:Seventy-three patients with T1-T2N0M0 breast cancer were included in our study. 99mTc-nanocolloid was injected the day before surgery with periareolar intradermal injections.Dynamic gamma-camera images were acquired on oblique projection in distinguishing SLNs along the lymphatic basin and static images were followed on anterior oblique and lateral projections. All SLNs that were detected by lymphoscintigraphy and intraoperatively using a handheld gamma probe (with radioactive counts of 10% or greater of the most radioactive node) were recorded per patient base and underwent subsequently for SLNB.Results: The sentinel lymph node was successfully identified by preoperative lymphoscintigraphy(PLS) in 71 of 73 patients with a detection rate of 97.2 % and a false negative rate of 2.7%. There was at least one radioactive SLN identified intraoperatively in all of 71 patients with visualised SLNs on PLS, but the correct number of removed SLNs was underestimated in 20.5% of patients mainly because in PLS hot spots correspond to groups or clusters of lymph nodes rather than by a single node. The number of SLNs that have been removed intraoperatively ranged from 1-4(mean 2.0).Twenty three out of 71(32.3%) patients had histologically positive pN1+ SLNs, 7(9.8%) had pN1mi/pN0i+SLNs and 41 (57.7%) were pN0 negative. Of the positive pN1+ SLNs patients 11/23(47.8%) had only one SLN involved in the axilla and 12/23 (52.2%) had multiple SLNs. Among the 12 node positive patients with multiple SLNs 58.3% were identified within the first two SLN sites examined, while 33.4 % and 8.3% by third and fourth sites, respectively. The recovery of 93.1% of SLN metastases was carried out with the removal of 3 SLNs and 100% with 4 SLNs.Conclusions: According to our results, in patients with multiple SLNs removal of four nodes is a reasonable number to limit the surgical procedure yielding an optimal false negative rate near zero..
P404 Metabolic tumor volume by F-18 FDG PET/CT correlates with occult lymph node metastatis in invasive ductal breast cancer B. Song, S. Lee, B. Ahn, J. Lee; Department of Nuclear Medicine, Kyungpook National University School of Medicine, Daegu, KOREA, REPUBLIC OF. Objectives: Breast cancer is the most common invasive cancer in women and status of lymph node (LN) metastasis is one of the most important prognostic indicator in breast cancer. We have analyzed the relationship between pretreatment metabolic tumor volume (MTV) as determined by F-18 FDG PET/CT and occult LN metastasis (OLM) in invasive ductal breast cancer (IDC). Methods: Forty-one clinically node-negative (cN0) IDC female patients (mean age, 50.6±9.5), diagnosed by preoperative workups (biopsy, USG, MRI and PET/CT) were enrolled. All patients had undergone surgical resection of primary tumor with sentinel LN
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P405 Detection of small primary invasive ductal carcinoma lesions 18 of the breast using F-FDG PET /CT S. Kim, Y. Seo, K. Kim, E. Chang, J. Lee; Chungnam National University, Daejeon, KOREA, REPUBLIC OF. PurposeThe aim of the study is to assess the sensitivity of 18F-FDG PET/CT with sequential prone position scan in detecting small primary breast invasive ductal carcinoma lesions.MethodFrom November 2008 to April 2010, 92 patients (all female, 51 ± 11 years old) with 99 lesions of newly diagnosed as small (≤ 30 mm in greatest dimension) invasive ductal carcinoma of the breast were enrolled in this study. After 18F-FDG PET/CT scan with supine position, second regional PET/CT scan with prone position was done immediately (mean interval 29 ± 6 minutes). The maximum standardized uptake value (maxSUV) of 18F-FDG for lesion was measured at each scans (maxSUV1 and maxSUV2). All lesions were confirmed by histopathologic results after surgery.ResultOf the 99 small primary breast lesions, 24 lesions were T1a or T1b (≤ 10 mm, group 1), 53 lesions were T1c (> 10 mm but ≤ 20 mm, group 2), and 22 lesions were T2 (over 20 mm and 30 mm or under in greatest dimension, group 3). In group 1, the sensitivities of only supine positioned PET/CT and supine positioned PET/CT with prone positioned PET/CT were 45.8% (11/24) and 58.3% (14/24) (cut-off = 2.5). There was no significant difference between the maxSUV1 (2.3 ± 1.0) and the maxSUV2 (2.4 ± 1.1) (p=0.297). The sensitivities of each methods were 84.9% (45/53) and 90.6% (48/53) in group 2 and 100% (22/22) and 100% (22/22) in group 3. There were significant difference between the maxSUVs of each scans (group 2, 6.1 ± 4.4 vs. 6.6 ± 4.4, p=0.006; group 3, 9.9 ± 4.5 vs. 10.6 ± 4.9, p=0.018).Conclusion18F-FDG PET/CT with sequential prone position scan improves the sensitivity in assessing small primary invasive ductal carcinoma lesions of the breast. The sensitivity of over 10 mm sized lesions was high, but that of T1a or T1b lesions was still low.
P406 Contribution of Lymphoscintigraphy in the intraoperative localization of sentinel lymph node in patients with breast cancer in Brazil. F. C. Bernardes, T. M. Granzotto, E. N. Itikawa, S. S. Shakushiya, M. Kato, W. M. Araújo, P. M. P. Philbert, J. M. Andrade, D. G. Tiezzi, H. H. A. Carrara, L. Wichert-Ana; Ribeirão Preto School of Medicine, Ribeirão Preto - SP, BRAZIL. Breast cancer is the most common tumor in women. In Brazil, the highest incidences are found in South and Southeast regions of the country. This tumor spreads via the lymphatic system affecting regional lymph nodes, and primarily to the sentinel lymph node (SLN), that is commonly the first to be affected. The technique of preoperative lymphoscintigraphy is essential because it allows to evaluate the lymphatic chain involved and allows the localization of the SLN during surgery. The aim is to describe the lymphatic drainage patterns and evaluate the contribution of lymphoscintigraphy in the localization of SLN in patients with breast CA. We studied 60 patients undergoing surgical treatment of CA breast with SLN study by lymphoscintigraphy and gamma probe. Lymphoscintigraphy were applied in four intradermal injections of 1.0 mCi of 99mTechnetium-Phytate, around the areola. Skin markings were done in the dermal projections of SLN, in lateral, oblique and anterior or posterior views. This marks will assist the surgeon in the surgical approach further, along with intraoperative gamma probe. The average
age of patients was 54 years (29-77), comprising only females (100%). On Lymphoscintigraphy, it was visualized 89 SLN in the axillary region and 2 SLN in the chest, an average of 1.5 lymph nodes in each patient. The SLN localized in the thoracic region were not addressed surgically, since it would imply high surgical risk. From 89 SLN found, all o them were located and removed with the help of the Probe Gama. The examination of the SLN biopsy showed tumor infiltration in 12 SLN (13%). The sensitivity and false-negative rates for lymphoscintigraphy in the localization of SLN were 84% and 1.95%, respectively. The analysis of the primary breast tumor revealed that the mean tumor size was about 1.9 cm and that invasive ductal carcinoma (58% of patients) and in situ ductal carcinoma (17.5%) were the most common histological types, followed by the other types (20%). We conclude that the lymphoscintigraphy has high sensitivity for visualization of lymphatic drainage channels and location of SLN in the evaluation of breast cancer. Additionally, we found tumor infiltration in 13% of the SLN resected, in 8 (13%) patients, warning up for the importance of the SLN biopsy.
P407 Is there a relationship between FDG uptake and hormone receptors and expression of c-erbB-2 in patients with breast cancer? Y. Sanli, H. Karanlık, G. Isik, C. Turkmen, S. Kuyumcu, B. Ozturk, E. Yavuz, A. Mudun; Istanbul University, Istanbul Faculty of Medicine, Istanbul, TURKEY. Purpose: Lymph node involvement, tumor size and tumor grade are the most important prognostic factors in breast cancer. Meanwhile, hormone receptors, oncogenes (c-erbB-2), tumor suppressor genes (p53), and Ki-67 proliferation index are the other prognostic factors. In the present study, we aimed to evaluate the relationship between FDG uptake and above-mentioned prognostic factors such as; hormone receptors (estrogen and progesterone), expression of c-erbB-2, tumor grade, tumor size.Material-Methods: Between May 2009 and February 2011; 72 patients (mean age±SD: 53.9±14.4 years) with biopsy proven breast cancer underwent F-18 FDG PET/CT scanning for staging. Patients who had excisional biopsy or neoadjuvant chemotherapy were excluded from the study. Histological types included were invasive ductal carcinoma (n= 61), invasive lobular carcinoma (n= 3), invasive ductal and lobular mikst carcinoma (n= 7) and inflammatory breast cancer (n= 1). Maximum standard uptake values (SUVmax) were compared with estrogen and progesterone receptors, expression of c-erbB-2, as well as tumor grade and tumor size. For the evaluation of relationship between tumor SUVmax values and prognosticators such as hormone receptors, tumor histologic grade, tumor size, statistical analyses were performed using Mann-Whitney U and KruskalWallis tests and p values of less than 0.05 were considered to indicate statistically significant differences.Results: All primary breast neoplasms were detected by PET/CT scanner. The mean SUVmax values and breast cancer tumor size were ranged from 2.09 to 39.3 and 0.7 to 9.0 cm, respectively. Negativity for estrogen [(n= 19); SUVmax mean±SD (min-max): 18±11,3 (2-39.3)] and progesterone [(n= 28); SUVmax mean±SD (min-max): 16.5±10.3 (2-39.3)] receptors was associated with higher SUVmax (p= 0.03 and 0.02, respectively). C-erbB-2 positivity [11.8±8 (239.3)] and increased tumor size were associated with higher maximum standard uptake values.Conclusions: A strong relationship was detected between the negativity of hormone receptors, expression of c-ERB2, tumors grade and SUVmax values. Thus, we believe that; SUVmax values obtained with F-18 FDG PET/CT may provide some information about tumor biology of breast cancer.
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Accurancy of F-FDG PET/CT for Restaging after Postoperative Regional Nodal Irradiation in Sentinel NodePositive Early Breast Cancer Á. Sávolt1, G. Péley2, C. Polgár1, Z. Mátrai1, É. Szabó1, Z. Horváth1, K. Borbély1; 1Hungarian National Institue of Oncology, Budapest, HUNGARY, 2 Norfolk and Norwich University Hospital, Norwich, UNITED KINGDOM. PurposePerforming a restaging work-up with 18F-fluorodeoxyglucose-positron emissiontomography/computed tomography (18F-FDG PET/CT) after postoperative regional nodal irradiation (RNI) in Sentinel Node-Positive Early Breast Cancer. The Hungarian National Institute of Oncology has just closed a randomized clinical phase III study. The trial compared the results of completion axillary lymph node dissection (ALND) and RNI without ALND in patients with early-stage breast cancer after positive sentinel lymph node biopsy (SLNB). In the investigational arm of the trial patients received 50 Gy RNI postoperatively without ALND. The aims of this study included the evaluation of the therapeutic effect of RNI and the detection of early axillary failures.Patients and MethodsForty-five SLNB positive patients were retrospectively selected from the investigational arm of the trial. All patients underwent surgery (breast-conserving or mastectomy) and SLNB. The patients received 50Gy RNI instead of completion ALND. Part of the restaging all patients underwent 18F-FDG PET/CT and mammography combined with breast and axillary ultrasound or breast MRI simultaneously.ResultsOnly 5 out of 45 patients (11.1%) had suspicious findings in the axillary tail on mammography combined with breast
Poster Presentations
biopsy and/or axillary LN dissection without any neoadjuvant treatment. Metabolically active tumor regions were delineated on pretreatment PET scans semi-automatically using custom software. To obtain the MTV, we used a threshold of SUV 2.0, 25%, 50% and 75% for the SUVmax. Total lesion glycolysis (TLG) was calculated as multiplication of MTV and its SUV mean. Pretreatment variables [age, clinical T stage, MRI-tumor volume (MRI-TV), maximum standardized uptake value (SUVmax), MTVs and TLGs] and posttreatment variables (pathologic T stage, tumor grade and lymphovascular invasion) were analyzed to identify their correlation with OLM. Results: Fourteen (34.1%) of 41 patients were found to have OLM in pathologic specimen. Among the volume-based parameters, MTV-75%, MTV-50%, and TLG-75% were significantly higher in patient with OLM (P=0.013, 0.019, 0.037, respectively). A cut-off of 1.09 ml for the MTV-75% was determined to be the most discriminative value for predicting OLM. By univariate analysis, the patients with an MTV-75% of > 1.09 ml had significantly higher number of OLM than those with an MTV-75% of ≤ 1.09 ml (P=0.004). Also, MTV-50%, TLG-75%, lymphovascular invasion and pathologic T stage showed a statistically significant correlation with OLM by univariate analysis (P=0.008, 0.011, 0.039, 0.049, respectively). MRI-TV showed only trends toward significance (P=0.068). Among these five parameters (MTV-75%, MTV-50%, TLG-75%, lymphovascular invasion and pathologic T stage), MTV-75% had one of the highest hazard ratios associated with the OLM (72.7% vs. 20%, hazard ratio 10.667, 95% confidence interval, 2.153-52.848). Conclusions: MTV-75% as determined by F-18 PET/CT demonstrated a statistically significant correlation with OLM in patients with cN0 IDC. Therefore patients with high MTV75% should be cautiously evaluated for LN metastasis.
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S358 and axillary ultrasound. In those five patients PET/CT suggested locoregional residual disease in only one patient (2.2%) confirmed by core biopsy. In the remaining four cases both PET/CT and biopsy showed no evidence of recurrent/residual disease in the axilla.Conclusions The results of our study demonstrate the benefit of 18F-FDG PET/CT in the follow-up of breast cancer patients with positive SLN without ALND.
P409 Prediction of non-sentinel lymph node metastases in breast cancer patients with metastatic sentinel nodes D. Antoniou, K. Diamantakis, D. Papadouli, I. Sevaslidou, L. Iordanidou; “Metaxa” Cancer Hospital, Piraeus, GREECE. Aim:. The purpose of this study was to evaluate the expression patterns of particular markers of the primary tumor MiB1 (Ki67) and Her-2/neu (c-erbB2) and to determine whether the above factors might help predict the involvement of metastasis in the SLN and non sentinel axillary lymph nodes.Materias and Methods: A retrospective analysis was performed for 63 early breast cancer patients who have undergone an excisional or core needle biopsy with full pathology report prior to lymphoscintigraphy and sentinel lymph node biopsy. For each patient included in the study, HER2/neu status (scored from 0 to 3+) and the Ki67 index (percentage of Ki67-positive cancer nuclei) were determined immunohistochemically. All patients with metastatic SLN had axillary dissection and selected for analysis. The above biological parameters were analyzed for their influence on the result of the positive SLN / non SLN positive axillary lymph nodes.Results: Sentinel lymph node was successfully located on the pre-operative lymphoscintigraphy images in 60 patients (95.2%).Twenty four out of 63(38.1%) patients had positive pN1+ SLNs , 6/63(9.5%) had pN1mi/pN0i +SLNs and 33/63 (52.3%) were PN0.Within the pN1+ SLNs group, we identified non SLN-positive axillary lymph nodes in 14 patients (58.3%).When the Her-2/neu status and Ki67 index were used to subtype the patients under study we found a statistical significant difference among pN1+ SLN /non SLN-positive and pN0 patients. Using a ki67 cut off of 15% positive nuclei we found an average positive tumor nuclei of 33% in patients of pN1+ SLN /non SLNpositive and 9% in patients of pN0 respectively. There was not a significant difference among pN1mi/pN0i+SLN and pN0 patients. Only 6.3% of primary tumors were Her-2/neu +3 positive in pN1+SLN / non SLN-positive patients indicating that this clinical marker alone is not sensitive enough to predict metastasis in axillary nodes.Conclusion:. According to our results there is a strong indication of the ability of Ki-67 to identify high-risk women with pN1+ SLN /non SLN-positive axillary lymph nodes. This clinical marker may prove to be valuable in near future determining which patients with metastatic SLN will require further axillary treatment.
P410 Usefulness of Sentinal Lymph Node Biopsy in Multicentric Breast Cancer. Our Experience. S. I. Vasquez Tineo, A. Mariana Monguia, A. Mendoza Paulini, M. A. Balsa Breton, M. P. Garcia Alonso, A. M. Ortega Valle, L. Castillejos Rodriguez; HOSPITAL UNIVERSITARIO DE GETAFE, MADRID, SPAIN. Introduction: We report our experience with sentinel lymph node biopsy (SLNB) multicentric breast cancers. Although it is not an absolute contraindication to perform it, there is controversy in the literature.Objective: To retrospectively evaluate axillary lymphadenectomy (AL) in multicentric breast cancer, only if the SLNB is positive.Material and Methods: Between January 2006 and January 2011, SNL biopsy was performed in 338 patients with breast cancer, 14 of them multicentric, with clinical and echographyc negative axilla. In 11/14 periareolar injection was performed and in 3/14 peritumoral way was used, the evening before surgery. SNLB was done and axillary dissection was performed, only positive SLNB.Results: Mean age was 55 years ± 11. The most common tumor type was invasive ductal cancer (57.1%) and average size was 2.15 cm ± 1.26 cm. The number of sentinel nodes identified was 1.64 ± 0.63, without significant differences regarding the type of administration and with an identification rate of 100%.• In 4 of 14 patients (28.5%) the SLNB was positive and in axillary lymph node dissection more lymph nodes affected were found in 3 patients (75%).• In 10/14 patients with negative SLNB was performed a mean follow up of 19.9 months, was performed. No relapse were found along that time withough AL.Conclusion: In our experience negative SLNB was associated to a rate of 0% axillary recurrence, supporting the indication of this therapeutic approach in multicentric tumors, avoiding unnecessary axillary dissections.
P411 Micrometastasis in Sentinel Node Breas. Assessment on the Involgement in Axillary Lymphadenectomy. S. I. Vasquez Tineo, A. Mendoza Paulini, A. Mariana Monguia, M. A. Balsa Breton, M. P. Garcia Alonso, A. M. Ortega Valle, L. Castillejos Rodriguez, F.
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 J. Penin Gonzalez, C. Pey Illera; HOSPITAL UNIVERSITARIO DE GETAFE, MADRID, SPAIN. Introduction: Nowadays axillary lymphadenectomy (AL) remains the standard option when micrometastasis are found in the sentinel node (SN), although at present there is controversy about it.Objective: Retrospectively to evaluate the metastatic spread on lymph nodes in the AL of patients with micrometastasis in the SN.Material and Methods: Between January 2006 and January 2011 sentinel lymph node biopsy (SLNB) was performed in 338 patients with breast cancer. The mean age was 55 years ± 11. The most common tumor was invasive ductal cancer (87.5%) with mean size of 1.68 cm ± 0.72 cm. AL was performed in all found cases.Results: The mean number of SN identified and removed was 1.5 ± 0.63, with an identification rate of 100%.• 4 patients (25%) micrometastasis were intraoperatyvely identified and underwent immediate axillary lymphadenectomy.• In 12 patients (75%) intraoperative SN study was negative, but positive in the differed,study performing the AL in a second operation.• In 13/16 patients (81.25%), the AL was negative.• In 3 /16 patients found it more involved nodes were found (18.75%), of which 2/3 were macrometastasis and 1/3 was micrometastasis.Conclusion: The small number of patients in this study the high rate of metastasic involvement in AL (18.75%) does not allow to advise the nonrealization of AL in patients with micrometastasis in the SN.
P412 The Impact of Pet/Ct Imaging Performed in the Early Postoperative Period on Management of Breast Cancer Patients A. T. Akpinar, F. Sen, U. Ogur, G. Duman, D. Kumtepe, S. Gonul; Uludag University, Department of Nuclear Medicine, Bursa, TURKEY. Aim:In this retrospective study, we aimed to investigate the impact of PET/CT imaging performed in the early post-operative period on management of breast cancer patients.Materials and Methods:Between January 2009 and December 2010, the PET/CT images of the patients with histopathologically proven breast cancer who underwent surgery following preoperative evaluation with conventional methods and received no chemotherapy and radiotherapy were retrospectively reviewed. 18F-FDG PET/CT images were performed in the early postoperative period ranging between 8 to 55 days, (mean: 25 days) for restaging purpose. A total of 66 women ( age:29-87; mean:52) were included in this study. Among these, 16 were classified as stage 1, 44 as stage 2, 14 as stage 3, and the remaining two as stage 4. In 24 of 66 (group A: 36,4%) patients there were no thorough conventional imaging for distant metastases, whilst in 42 patients (group B: 63,6%) conventional methods were used.Results:Five patients of group A (21%) and 6 patients of group B (14%) were found to have metastases, unknown before, on PET/CT. Furthermore in 2 patients, PET/CT found out metastatic lymph nodes which could not be identified by post-operative pathologic staging previously and led to a change in TNM staging. In two patients there were lung lesions diagnosed as metastases by conventional imaging methods and PET/CT revealed in one that the lesions had low probability for malignity, which was confirmed as benign by follow-up CT. Thus, an alteration of stage was occurred in 14 out of 66 patients (21%) by PET/CT. The disease was upstaged in 13 patients (19,7%) and downstaged (1,5%) in only one patient.Conclusion:The findings of our study have made us consider that PET/CT imaging that is performed in the early post-operative period has a major impact on patient management and may alter staging to such an extent that affect the choice of post-treatment methods and monitoring.
P413 Introducing hybrid SPECT/CT imaging in breast cancer-related arm lymphoedema S. Vöö1, M. Heitink2, D. Janssen1, M. van Kroonenburgh1; 1Maastricht University Medical Center, Maastricht, NETHERLANDS, 2VieCurie Medical Center, Venlo, NETHERLANDS. Aim. Arm lymphoedema is a common complication in women after axillary surgery and radiotherapy for breast cancer-related lymphoedema (BCRL). Despite intensive decongestive therapy, a significant number of women with BCRL develop complicated forms of lymphoedema. Our study investigated the ability of nuclear lymphoscintigraphic and hybrid SPECT/CT imaging in characterizing the lymph flow disturbance in women with therapy refractory BCRL, in order to be referred for further therapeutic interventions.Material and methods. The study included 26 women with BCRL, persistent 5±3 years after breast cancer therapy and refractory to conventional decongestive therapy. Women were subjected to Tc-99m-labelled nanocolloid arm lymphoscintigraphy, followed by SPECT/CT imaging of the affected arm. Besides the visual evaluation, lymph flow was quantified as percentage of tracer uptake in the axillary regions at 6h after injection.Results. Women with therapy refractory BCRL showed absent (5/26 cases) or a severely disturbed lymph flow in the affected arm (21/26 cases), with different localisations of dermal backflow in the forearm, elbow, or upper arm. Quantitatively, the axillary uptake in the affected arm reached only levels of 3.8±1.3%, significantly lower compared to the uptake levels in the non-affected arm (12.9±4.3%, P=0.0001).For a more detailed characterization of the lymph system disturbances, additional SPECT/CT
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P414 Molecular Breast Imaging (MBI) Preparation for High-Risk Screening J. W. Hugg1, D. J. Wagenaar1, R. A. Moats2, A. Weinmann3, M. K. O'Connor3, C. B. Hruska3, S. Chowdhury1, B. E. Patt1; 1Gamma Medica, Northridge, CA, UNITED STATES, 2LA Children's Hospital / USC, Los Angeles, CA, UNITED STATES, 3Mayo Clinic, Rochester, MN, UNITED STATES. Aim: Molecular Breast Imaging (MBI) has proven its value in over 4000 clinical secondary diagnostic studies, matching MRI in sensitivity and outperforming MRI in specificity. The aim of this work was to decrease the whole-body dose to levels equivalent to mammography to enable application of MBI to high-risk screening, especially in radiographically dense breasts.Materials & Methods: The LumaGEMTM MBI system uses light compression of the breast between two camera heads composed of solid-state, digital CZT detectors. We designed a high-sensitivity tungsten collimator with square holes registered to the 1.6 mm CZT pixels, which are optimally sized for efficient molecular breast imaging. We further developed algorithms for optimally combining the two opposing view images with modeling of the collimator-detector response and a denoising filter.Results: Theoretical studies demonstrate that the optimal pixel size for MBI is in the range 1.2 to 1.6 mm. A pixel size of 2.5 mm, as used in cardiac optimized CZT systems, results in only 65% of the optimal efficiency and, thus, requires a 50% higher dose. Small lesion detectability is greatly improved with 1.6 mm pixels. The use of dual camera heads is much more efficient and provides better resolution than single-head systems. We have begun testing doses as low as 2 mCi (0.6 mSv) and will present clinical study results.Conclusions: MBI has been proven as a secondary diagnostic tool and is poised for use as a high-risk screening tool.
P38 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Lung
P415 Usability of the Heparin appositional whole body FDG PET New methods to reduce cardiac physiological accumulationS. Fujita1, S. Nagamachi2, Y. Umemura1, S. Ueno1, R. Nishii2, S. Tamura2, T. Fujimoto1; 1Fujimoto Hayasuzu Hospital, Miyazaki, JAPAN, 2MIyazaki Medical College, Miyazaki, JAPAN. Objectives: FDG-PET is useful examination for cancer diagnosis, but, it is difficult in mediastinal lesions for cardiac physiological accumulation. As intravenous injection of Heparin before FDG injection, blood lipoprotein lipase activity develops, and cardiac physiological accumulation reduces because cardiac glycometabolism changes in fatty acid metabolism. We present the early experience of new methods to reduce cardiac physiological accumulation in whole body FDG-PET; no previous study assessed the Heparin appositional FDG-PET for cancer diagnosis.Methods: Twenty patients (11 pericardiac lung cancer, 4 mediastinal tumor, 3 cardiac tumor, 2 sarcoidosis) were underwent the Heparin appositional FDG-PET. All patients were intravenous injected heparin (50 unit/kg) just before 15 minutes of FDG injection, and PET images were obtained 1hour and 2hours after injection of 185 MBq of FDG.Results: 35 images of 20 patients were no cardiac physiological accumulation in FDG-PET image after injection of Heparin, so it was useful for diagnosis of cardiac and pericardiac lesions (88%, 35/40). But 2 patients of both images and another only delayed image were visualized cardiac accumulation, so it was difficult for diagnosis of pericardiac lung tumor and cardiac tumor. All patients were not side effect of heparin-induced thrombocytopenia.Conclusions: This is the first report; the clinical Heparin appositional FDG-PET has the potential to detect cardiac or pericardiac tumor clearly because of reduction of cardiac physiological accumulation. With care of side effect included heparin-induced thrombocytopenia, it is useful method of the heparin appositional whole body FDG-PET for diagnosing lung and mediastinal cancer.
P416 Essential thrombocythemia in primary lung cancer and 18FFDG PET/CT: Case Report B. Chaushev, G. Nikolova, A. Klisarova, P. Bochev, I. Krasnaliev, Z. Dancheva, K. Iordanov; MBAL''ST.MARINA'', Varna, BULGARIA. Essential thrombocythemia is a chronic blood disorder characterized by increased number of platelets in the blood. Reactive trombocytosis is commonly observed in neoplastic diseases. The frequency of elevated platelet counts in patients with primary lung cancer was higher. High circulating levels of platelets are found in patients with metastatic disease and have been related to extensive disease in patients with lung cancer and other malignancy.Aim: The aim of our study was to analyze 18F-FDG PET/CT scan unexpected findings in bone marrow at the whole skeleton in patient who underwent operation for primary lung cancer.Material: We examined a sixty-five year old male who underwent upper lobectomy of the right lung in concerning of primary lung cancer before year and a half with high platelets levels at the time of operation and at the present moment.Methods: The patient underwent a PET/CT scan of the whole body with 18F-FDG for re-staging of primary disease, blood count, aspiration biopsy, histological and immunohistochemical examination of bone marrow, cytogenetic analyze, immunophenotyping and JAK2 (V618F) mutation analysis.Results: The PET/CT scan of the whole body revealed diffuse uptake of 18F-FDG in bone marrow through all skeleton. Manifested increased numbers of platelets in the blood. Bone marrow biopsy and histological examination showed hypercellularity with increase in megakaryocytes. Immunohistochemical examination excluded bone marrow metastasis. Is not activity of CDA1/AE3, epithelial marker. Diagnosis of essential thrombocythemia was established with positive heterozygotic mutation of JAK2 (V618F) gene.Conclusion: Unexpected increased 18F-FDG metabolism in PET/CT in bone marrow at the whole skeleton prove another hematological myeloproliferative disease essential thrombocythemia.
P417 Diagnostic value of PET/CT in preoperative staging in patients with non-small cell lung cancer G. E. Łapińska1, A. Fijołek-Warszewska1, M. Bryszewska1, I. KozłowiczGudzińska1, M. Głogowski2, M. Żmijewski2, K. Piech2, J. Wudarska3, A. Sontowska3, K. Rupińska3; 1Cancer Center and Institute of Oncology, Department of Nuclear Medicine and Oncological Endocrinology, Warsaw, POLAND, 2Cancer Center and Institute of Oncology, Lung and Thoracic Tumors Department, Warsaw, POLAND, 3Cancer Center and Institute of Oncology,Department of Radiology, Warsaw, POLAND. In patients with non-small cell lung cancer (NSCLC) proper stage evaluation determines the choice of medical treatment strategy. In early stages (I and II) patients undergo surgical resection and in more advanced stages the treatment of choice is chemo- and/or radiotherapy.AimThe aim of this study was to assess PET/CT usefulness in pre-treatment staging of NSCLC patients qualified for surgery.Materials and methodsThe study included 63 patients (26 female, 37 male) aged 41-79 (median - 60 years) with histologically verified NSCLC. Basing on computer tomography and other staging procedures carried out before the treatment patients were diagnosed with clinical stages I or II and therefore scheduled for surgery. Previous to the procedure all patients underwent PET/CT scan 60 minutes after intravenous injection of 250-370 MBq of 18F - FDG (Gemini 16TF, Philips).ResultsIn all patients metabolically active tumour presence was detected. Additionally, in 14 patients (22%) other lesions were visualized (satelit nodules(2); contralateral lung metastases(3); distant metastases:bones(4), liver(1), brain(1); ipsilateral nodes(2) and supraclavicular nodes(1) involved). Basing on those finding, 11 patients (17,5%) were disqualified from surgical intervention and 3 patients underwent surgery after previous neoadjuvant chemotherapy. In all 78 operated patients histopathological verification confirmed the presence of malignancy (27 adenocarcinomas; 24 scuamos cell carcinoma; 6 large cell carcinoma; 6 other). In two patients operation was incomplete due to mediastinal and superior vena cava infiltration which was discovered during operation.ConclusionsOur finding indicate that PET/CT is a useful method in preoperative staging of patients with non-small cell lung cancer. Information provided by PET/CT has changed therapeutic strategy in 22% of all the patients leading to more appropriate therapy application.
P418 The prognostic relevance of response evaluation to chemotherapy by FDG-PET/CT in patients with metastatic non-small-cell lung cancer N. A. Selcuk1, B. O. Uluc2, C. Ordu2, C. Akosman2; 1Yeditepe Üniversity Hospital, Department of Nuclear Medicine, Istanbul, TURKEY, 2Yeditepe Üniversity Hospital, Department of Medical Oncology, Istanbul, TURKEY. Background: The aim of this retrospective study was to explore the prognostic role of metabolic response to chemotherapy, determined by 18-fluorodeoxyglucose
Poster Presentations
imaging was performed. SPECT/CT demonstrated that, irrespective to the site of dermal backflow, the majority of cases were associated with lymph flow stagnation along fibrotic changes: i) in the upper arm (para-axillary) or ii) in the pectoral area, mostly at the level of pectoralis minor muscle. Besides a diffuse tracer accumulation in the subcutaneous (epifascial) compartment, an additional tracer accumulation in the muscular (subfascial) compartment can be observed in BCRL women, indicating a severe decompensation of the lymph system in the affected arm.Conclusion. Nuclear lymphoscintigraphic (SPECT/CT) imaging is able to characterize the lymph flow disturbance -localization, interdependence with fibrosis, extent to the epifascial and subfascial compartments, grade of lymph system failure- in patients with BCRL refractory to conventional decongestive therapy. This may have an important clinical value for understanding the mechanisms of lymphoedema and for planning of further (localized) therapeutic intervention.
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S360 positron emission tomography (FDG-PET), in pts with metastatic non-small-cell lung cancer (NSCLC). Methods: In this study, 30 pts with metastatic NSCLC were retrospectively analyzed for the prognostic factors of survival. Disease evaluation was done with FDG-PET/CT before, 2-3 cycles after and at the end of the chemotherapy. Anatomical response was evaluated according to ‘Response Evaluation Criteria In Solid Tumors (RECIST 1.1)’ and metabolic response was evaluated according to ‘PET Response Criteria in Solid Tumors (PERCIST 1.0)’. Results: During the mean follow-up of 12.2 months, 23 (77%) pts died and 7 (23%) pts are still alive. The median overall survival (OS) and progression free survival were 10.2 months (3.5-51.3) and 6 months (2.1-18), respectively. At the end of first-line chemotherapy, 10 pts (33%) achieved metabolic and anatomic response (complete or partial response). Of the 19 pts who had an interim response analysis after 2-3 cycles of chemotherapy, 3 (16%) achieved an anatomic response, while 9 (47%) achieved a metabolic response. In univariate analyses, favorable prognostic factors for OS were number of cycles of first-line chemotherapy (>4 vs. ≤4 cycles), achieving a response to chemotherapy at completion of therapy according to the PERCIST 1.0 and RECIST 1.1. Median OS was longer in pts achieving an anatomical response (11.5 mo vs. 9.6 mo, p=0.038) and metabolic response (16.6 mo vs. 7.3 mo, p=0.009) at the completion of first line therapy when compared to nonresponding pts. The OS of pts with metabolic response after 2-3 cycles of chemotherapy also extended (17.2 mo vs. 6.1 mo, p=0.047). Anatomic response at interim analysis did not predict OS, probably due to few pts with anatomic response. In multivariate analyses, metabolic response after completion of therapy was the independent factor for OS. Conclusions: Metabolic response to first line chemotherapy is at least as effective as anatomic response in predicting survival. It may be an earlier prognostic factor for survival in pts with metastatic NSCLC.
P419 The prognostic value of SUVmax and MTV on FDG PET/CT images of SCLC patients E. Han1, I. Yoo1, W. Choi1, J. Oh1, Y. Park2, S. Kang3, Y. Kim1, J. Kang1, Y. Kim1; 1The Catholic University of Korea, Seoul, KOREA, REPUBLIC OF, 2 The Catholic University of Korea, Suwon, KOREA, REPUBLIC OF, 3The Catholic University of Korea, Daejeon, KOREA, REPUBLIC OF. Purpose: The aim of this study was to evaluate the prognostic value of metabolic parameters in small cell lung cancer (SCLC) patients.Patients and methods: We retrospectively reviewed medical records and image findings of SCLC patients, who had been evaluated with FDG PET/CT for staging between December 2003 and July 2010. The maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV) of the tumors were measured. Traditional prognostic factors for SCLC - age, sex, serum LDH level, and performance status - were also recorded.Results: A total of 82 patients were enrolled (66 male, 16 female, mean age 64.3±9.1 years). Overall survival of cases with high MTV (≥160 cm3) was worse than those with low MTV (p=0.030). LDH level (≥460 vs. <460 U/L) and performance status (ECOG score 0, 1 vs. 2, 3) were significantly associated with overall survival. SUVmax of the tumor, age, and sex were not related to overall survival. Performance status and serum LDH level were identified as independent prognostic factors on multivariate analysis.Conclusion: Although the MTV correlated with survival, it could not be an independent prognostic factor.
P420 The role of FDG-PET/CT in detecting unsuspected distant metastasis in the staging of non-small cell lung cancer M. Ozhan, M. Halac, A. Aliyev, S. Yılmaz, S. Sager, N. Ergul, K. Sonmezoglu, I. Uslu; Departments of Nuclear Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TURKEY. Aim: Being a whole body imaging modality, FDG-PET or FDG PET/CT is an effective imaging modality which evaluates thoracic and extrathoracic metastasis in only one session in patient with non-small cell lung cancer (NSCLC). The high sensitivity of PET/CT in detection of unsuspected distant metastasis decrease the non-curative surgery incidence in patient with unresectable tumor.Our objective in this retrospective study is assessment of FDG-PET/CT to determine unsuspected (inside the region of thorax CT) and unknown (outside the region of thorax CT) metastasis ratio in patient with diagnosis of solitary pulmonary lesion (solitary pulmonary nodule or solitary mass) on thorax CT who underwent FDG-PET/CT to evaluate metabolic characterization of lesion and in patient with NSCLC who underwent FDG-PET/CT for staging. Consequently, we aimed to investigate the contribution of FDG-PET/CT to describing M stagingMethods: Of all 567 patients (489 male, 78 female, mean age 60.9±10.7), 156 patients (group 1) with solitary pulmonary lesion on thorax CT and 411 patients (group 2) with NSCLC underwent FDG-PET/CT to evaluate metabolic characterization of solitary pulmonary nodule or solitary mass and for staging NSCLC respectively between December 2004 and January 2007 were enrolled in this study.Results: In the metabolic characterization group, of the 39 patients with increased FDG uptake at the solitary pulmonary nodule, 5 patients (12.8%) had distant metastasis (true positive increased FDG uptake focus) in which one of them is inside the area, two of them are outside of the area, two of them
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 are inside + outside of the area. Of the 117 patients with increased FDG accumulation at the solitary pulmonary lesion, 29 patients (24.8%) had distant metastasis (true positive increased FDG uptake) of which 8 inside the area, 5 outside area and 16 inside + outside the area. In the staging group, 129 patients of total 411 patients (31.4%) had distant metastasis (true positive increased FDG uptake) of which 42 inside the area, 29 outside the area and 58 inside + outside the area.Conclusion: Although FDG-PET/CT is a useful method for discrimination between benign/malign solitary pulmonary lesion and in regional lymph node staging of NSCLC, it also has some limitations. As it’s seen in our study, FDG-PET/CT is proven to be an effective method either in detection of surprise metastatic lesion in patient with solitary pulmonary lesion or determination of unsuspectedunknown metastasis for the initial staging of patients with NSCLC.
P421 Somatostatin Receptor Scintigraphy and FDG PET/CT in Pulmonary Carcinoid Tumours Correlated with Pathological Findings S. Kuyumcu1, Y. Sanli1, E. Yilmaz1, I. Adalet1, D. YILMAZBAYHAN2; 1 Istanbul University Faculty of Medicine Department of Nuclear Medicine, Istanbul, TURKEY, 2Istanbul University Faculty of Medicine Department of Pathology, Istanbul, TURKEY. Purpose: Although there are studies evaluating the usefulness of various imaging modalities in pulmonary carcinoid tumours, there is no pathognomonic radiological finding that helps to clearly differentiate pulmonary carcinoid and the number of studies that evaluate more than one modality is limited. The aim of this study is to evaluate somatostatin receptor scintigraphy (SRS) and FDG PET/CT in patients with pulmonary carcinoid tumours.Methods: We retrospectively studied 14 patients who were suspected to have neuroendocrine tumours in the lung and underwent FDG PET/CT and/or SRS with In111-Octreotide. Seven patients were performed one modality (6 SRS, 1 FDG PET/CT). Seven patients underwent both SRS and FDG PET/CT. SRS and FDG PET/CT findings were evaluated with correlation of pathologic findingsResults: We retrospectively studied 14 patients (5male, 9 female, mean age 48 ± 16 years) with pulmonary carcinoid. Nine patients were proven pathologically to be typical carcinoid (mean Ki67 index %1,66±%1,63), 5 patients atypical carcinoid (mean Ki67 index %40±%10). Eight patients were indicated for formerly diagnosis or initial stating and 1 patient for treatment monitoring. Five patients with suspected ectopic Cushing Syndrome were indicated for SRS only and were diagnosed pulmonary carcinoid after SRS showed uptake in lung. PET/CT findings showed FDG uptake in the primary lesion with mean SUV max value of 14,5 ±11,5 in atypical carcinoid group and 3,9±0,7 in the typical carcinoid group. SRS revealed low uptake in the primary lesions in atypical carcinoid group and mild to high uptake in the typical carcinoid group. One patient indicated for treatment monitoring had low uptake in primary lesion site which was decided to be due to post-operative inflammation since PET/CT showed no evidence of pathologic uptake. Both SRS and PET/CT demonstrated distant metastasis in the lung, bone, cervical and mediastinal lymph nodes in this patient. One patient showed no significant uptake in the primary lesion with SRS but distant metastasis was detected with both SRS and FDG PET/CT. FDG PET/CT also showed distant metastasis in 6 patients. Five of 6 patients who were found to have distant metastasis in PET/CT also had pathologic uptake in SRS.Conclusion: Conventional imaging does not provide findings that are specific for pulmonary carcinoid. The use of FDG PET/CT scan combined with SRS proves to be useful not only in the detection and distant metastasis of pulmonary carcinoid tumours but also in treatment planning since SRS determines receptor density thus predicts treatment benefit.
P422 Role of FDG PET-CT in detection of skeletal muscle metastases in lung cancer M. Yilmaz1, E. Kalender1, U. Elboga1, Z. Celen1, S. Zincirkeser1, F. Isik2, E. Tutar3; 1Dept. of Nuclear Medicine, Gaziantep University Hospital, Gaziantep, TURKEY, 2Dept. of Thoracic Surgery, Gaziantep University Hospital, Gaziantep, TURKEY, 3Dept. of Pathology, Gaziantep University Hospital, Gaziantep, TURKEY. Aim: Lung cancers most commonly metastasize to the adrenal glands, liver, bone and brain. Skeletal muscle metastases from lung cancer are rare. The purpose of this retrospective study is to determine frequency of skeletal muscle metastases in patients with lung cancer detected by FDG PET-CT scans and examine the diagnostic value of FDG PET-CT. Materials and Methods: We reviewed 1583 FDG PET-CT studies of 1410 patients with lung cancer performed at our nuclear medicine department between 2006 and 2011. The PET-CT scans were performed for benign/malignant characterization of pulmonary lesions, inital staging, restaging or evaluating treatment response. Patients with solitary or multiple markedly increased FDG uptakes in muscle localizations and considered to be skeletal muscle metastases were selected. Patients who had history of intramuscular injections, recent trauma or soft tissue infection were excluded. Results: After reviewing the
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P423 The fibrotic changes in lung tissue increased the SUVmax values on F-18 FDG PET/CT N. Torun, B. Dirlik, G. Durmus-Altun; Trakya University, Edirne, TURKEY. OBJECTIVE: Lung cancer is the most common cancer in the world. Fibrotic areas in the lung have a higher risk of growing cancer. The development risk of cancer is three times more in sarcoidosis and 8 times more in scar tissue due to tuberculosis. PET/CT is one of the most important non-invaziv methods in diagnosis of lung cancer. In this study we aimed to find whether SUV values and the diagnostic accuracy of F-18 FDG PET/CT evaluation are affected by the fibrotic change which was a diagnostic problem in lung.METHODS: Two hundred four consecutive patients (31 female and 173 male; mean age 63; range, 18-88 years; SD±11 years) who underwent F-18 FDG PET/CT examination, enrolled in this study. One hundred one patients were with an initial diagnosis of lung cancer and 103 patients were with non-lung cancer prediagnosis. Non-contrast CT images of PET/CT scan were visually evaluated and scored with VAS (visual analistic scale). The fibrosis degree of apical lung area was scored with VAS (0=Normal, 1=mild, 2=moderate, 3=severe). In the visual evaluation of apical area with CT; normal lung, normal lung with small bulla and pleural thickening was defined as grade 0, lung with subpleural bulla and thin fibrotic withdrawal was defined as grade 1, lung with bulla and fibrotic band was defined as grade 2 and lung with a large bulla and with a normal tissue under 25% was defined as grade 3.RESULTS: VAS values were different in groups as expected. SUV max values of right and left apical areas were statistically differ in groups (Table 1) ( p =0.001 for SUV max R and p =0.003 for SUV max L). Cut off value of SUV max for fibrotic and non-fibrotic areas were evaluated. Cut off value of SUV max for non-malign fibrotic lung areas was defined as 0.86. In non-fibrotic normal lung tissue apical SUV max value was defined as 0.68.CONCLUSIONS: In summary the mean of SUV max value was higher in fibrotic areas however those were not over the critical value that assumed to be pathological level.
P424 Comparative value of SUVmax, dual time point imaging and non-attenuation corrected images in PET/CT in the evaluation of solitary pulmonary nodule G. H. Kaplan1, A. Yıldız1, Ö. Özbudak2, B. Karaboğa2, S. Demirelli1, F. Aydın1, F. Güngör1, A. Boz1; 1Akdeniz University Faculty of Medicine, Department of Nuclear Medicine, Antalya, TURKEY, 2Akdeniz University Faculty of Medicine, Chest Diseases, Antalya, TURKEY. Aim: To evaluate the accuracy of dual time point imaging and non-attenuation corrected FDG PET/CT (fluorine18-fluorodeoxyglucose positron-emission tomography/computed tomography) in the evaluation of the solitary pulmonary nodule (SPN) and to determine the optimal parameter for differentiation.Materials and methods: A retrospective study was performed involving 31 patients (8 female, 23 male, mean age: 65±14) referred for SPN characterization with PET/CT between March 2009 - December 2010. Whole-body FDG PET images were acquired at 60. min (early), followed by second imaging for chest 120. min (delayed). Early and delayed maximum standardized uptake value (SUVmax) for calculation of retention index (RI) and non-attenuation corrected (NAC) images were evaluated. Three methods were used for the determination of malignancy: 1. Nodules with SUVmax higher than 2.5; 2. Increasing 10% of RI; 3. Visually increased activity compare to mediastinal blood pool in NAC images.Results: There were 15 malignant and 16 benign lesions. Diagnosis of the lesions was established using biopsy in 4, surgery in 19 and radiological follow-up data in 8 nodules. Early phase SUV max values were calculated as 1.8 ± 1.1 (mean±SD), 7.1 ± 5.5 in benign and malignant lesions, respectively (p=0,001). The sensitivity, and specificity of using an early SUVmax threshold of 2.5 or more; RI, and; NAC criteria as an indication of malignancy was 100%, and 87.5%; 100%, and 81.2%, and; 100%, and 75%, respectively.Conclusion: In this small series of patients, all criteria showed 100% sensitivity, whereas the criteria of early SUVmax < 2.5 values showed the highest
specificity and accuracy. Dual-time-point or NAC imaging has not potential impact on improving the diagnostic accuracy for solitary pulmonary nodules.
P39 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Esophageal
P425 Methods for predicting prognosis in oesophageal carcinoma with FDG PETCT D. O. Hall1, J. Searle2, M. Shaw2, C. Candish2, I. D. Lyburn1; 1Cheltenham Imaging Centre, Cobalt Health, Cheltenham, UNITED KINGDOM, 2 Cheltenham General Hospital, Cheltenham, UNITED KINGDOM. Title: Methods for staging oesophageal carcinoma with FDG PETCTAimTo compare methods for predicting prognosis from baseline FDG PETCT in oesophageal carcinoma, for patients who received neoadjuvant chemotherapy followed by surgery. SUVmax is the main measure used clinically, but tumour metabolic volume, total glycolytic volume, and metabolic tumour width [1] may give additional prognostic information. Materials and Methods: Retrospective review of data of 20 patients receiving neoadjuvant chemotherapy after full staging, who were deemed suitable for oesophagectomy. Half body PET/CT scans acquired 60minutes post-injection of FDG were analysed using the following methods:I.SUVmax;II.Metabolic volume measured with a lower threshold of SUV=2.5;III.Total Glycolytic Volume (TGV) (mean SUV X volume) with a lower threshold value of SUV = 2.5;IV.diameter-SUV index, calculated from mean SUV X diameter of tumour measured on PETCT [1].These were evaluated and correlated with overall survival. The follow up period was 14 to 46 months. Results: 10/20 patients had follow-up beyond 36 months after diagnosis, 5/10 of these survived beyond 36 months.SUVmax>median (=9.6) had a sensitivity of 100% and specificity of 100%, to predict survival at 36 months. 5/5 patients with SUVmax > median survived beyond 36 months, 0/5 with SUVmax < median survived to 36 months.TGV>median (=130) had a sensitivity of 60% and specificity of 60% (29-100) to predict survival at 36 months. 3/5 patients with high TGV survived to beyond 36 months, 2/5 with low TGV survived to 36 months.PETvolume>median (=32ml) had a sensitivity of 60% and specificity of 60% to predict survival at 36 months. 3/5 patients with high volume survived to beyond 36 months, 2/5 with low volume survived to 36 months.Diameter-SUV index >median (=15 SUV.cm) had a sensitivity of 80% and specificity of 80% to predict survival at 36 months. 4/5 patients with high diameter-SUV index survived to beyond 36 months, 1/5 with low diameterSUV index survived to 36 months. Conclusion: TGV, tumour volume and tumour metabolic width may offer additional prognostic information to SUVmax in using FDG PET/CT in patients receiving neoadjuvant chemotherapy and radical treatment for oesophageal malignancy. References: 1.Roedl JB et al. Metabolic tumour width parameters as determined on PETCT predict disease-freee survival and treatment response in squamous cell carcinoma of the esophagus. Molecular Imaging and Biology 2009; 11:54-60.
P426 The relationship between 18F-FDG uptake and GLUT-1, GLUT3, CD34, CD68 expressions in esophageal squamous cell carcinoma patients. Y. Hirose, H. Kaida, S. Kurata, M. Kobayashi, A. Kawahara, S. Hattori, M. Hayakawa, M. Kage, H. Fujita, N. Hayabuchi, M. Ishibashi; kurume univercity school of medicine, kurume city, JAPAN. Purpose: Glucose transporter (GLUT)-1 and 3 have played a crucial role in 18F-FDG (fluorine-18-fluorodeoxyglucose) in cancer cells and inflammatory cells such as macrophage.Recently, angiogenesis has been considered to be related with 18F-FDG uptake in malignant cells.The aim of this study is to investigate the relationship between 18F-FDG uptake and GLUT expression and CD34, CD68 expression.Material and Methods:Forty-two patients were included in this study. 18F-FDG-PET /CT (positron emission tomography/ computed tomography) was performed before surgery. Histopathological findings were confirmed by postoperative specimens. The patients who underwent neoadjuvant chemotherapy and radiation therapy before surgery were excluded in this study. We investigated the relationship between maximum standardized uptake value (SUV max) and clnicopathological biological parameters (GLUT-1, 3 CD34, 68, pathological T (p-T stage) and lymph node metastasis, tumour differentiation).Results:On immnohistochemical findings, strong GLUT-1 expression was appeared on membrane of cancer cells, and strong GLUT-3 expression was observed on macrophage in non-neoplastic tissue . SUV max of primary tumor was correlated with GLUT-1, GLUT-3, CD34 and CD68 (GLUT1; r = 0.612, P < 0.001, GLUT-3; r = 0.476, P = 0.001, CD34; r = 0.329, P = 0.033, and CD 68; r = 0.368, P = 0.016). GLUT-3 was correlated with CD 68 expression, but not with CD 34 (CD 68; r = 0.322; P = 0.037, CD 34; r = 0.289, P = 0.064). GLUT-1 was not correlated with CD 34 and CD 68 (CD 34; r = 0.202; P = 0.199, CD68; r = 0.131, P = 0.408). High SUV max tended to be higher p-T stage significantly, however did not
Poster Presentations
PET-CT images, other imaging results and medical records, 17 patients (15 males, 2 females; age range, 34-71 years) demonstrating a focus or foci of markedly increased FDG uptakes in muscle localizations were found to have skeletal muscle metastases (17/1410, 1.2%). Of these 17 patients, 4 had hypermetabolic muscle involvements without any other distant organ metastases (2 cases with solitary, 2 cases with multiple muscle metastases only), and 13 had hypermetabolic muscle involvements along with other hypermetabolic distant metastases such as bone, adrenal gland and liver metastases. Muscle metastases from lung cancer were histopathologically confirmed in 4 patients who had hypermetabolic muscle lesions only. Histopatological results of the primary lung tumors were non-small cell lung cancer in 16 patients (10 adenocarcinomas, 5 squamous cell carcinomas, 1 nonsmall cell lung cancer showing neuroendocrine differentiation), and small cell lung cancer in 1 patient. Detection of muscle metastases affected patient’s management in 4 cases. Conclusions: FDG PET-CT is a useful imaging method for detecting skeletal muscle metastases from lung cancer and contributes to a more accurate staging of lung cancer patients.
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to be positive on lymph node metastasis significantly. There was no statistically significant difference between SUV max and tumour differentiation, between CD 34 and p-T stage, lymph node metastasis and tumour differentiation and between CD 68 and p-T stage, lymph node metastasis or tumour differentiation.Conclusion:On ESCC, 18F-FDG uptake maybe determined GLUT-1, 3, 18 CD 34, CD 68. F-FDG uptake of ESCC may reflect the cancer cell activity, macrophage in non-neoplastic tissue and angiogenesis.
P427 Reproducibility of semi-quantitative analysis of FDG PET/CT in esophageal cancer O. Palie1, F. Mechken1, S. Becker1, A. Edet-Sanson1, A. Benyoucef2, C. Rousseau3, B. Bridji3, C. Houzard4, F. Giammarile4, E. Itti5, P. Michel6, P. Vera1; 1Henri Becquerel Center - QuantIF-LITIS (EA4108), Rouen, FRANCE, 2 Henri Becquerel Center, Rouen, FRANCE, 3Renée Gauduch*eau Center, Nantes, FRANCE, 4Hospices civils Center, Lyon, FRANCE, 5Henri Mondor Hospital, Creteil, FRANCE, 6Charles Nicolle Hospital, Rouen, FRANCE. Objective. FDG-PET/CT is frequently analyzed with a semi-quantitative 5-scores scale. Very few studies have tested the reproducibility of results, particularly for esophageal cancer. Reproducibility was tested in a prospective study on the value of PET/CT performed at day 21 (d21) of radio-chemotherapy.Methods. 23 patients with stage IIB, III or IV esophageal squamous cell carcinoma underwent a FDGPET/CT (Biograph S16, Siemens) before and during concomitant radiochemotherapy (at d21). The 46 FDG-PET/CT were blindly analyzed by four physicians: 2 experienced (senior) and 2 residents (junior). Esophageal and extraesophageal uptakes (nodes and metastasis) were firstly classified into 5-rank score: 0=no uptake, 1=minimal or physiological, 2=moderate or doubtful, 3=intense, 4=very intense. Secondly, uptakes were classified into 2-rank score (0=normal, 1=pathologic), successively with a threshold for a pathological uptake ≥ 2 (S1 cutoff) and a threshold for a pathological uptake ≥ 3 (S2 cut-off). Weighted kappa tests (K) were performed between physicians, on the 5-rank scores and 2-rank scores.Results. The S2 cut-off (threshold ≥ 3 for pathological uptake) was rejected (insufficient number of lesions with no-uptake - K not calculable). Only the S1 cutoff (threshold ≥ 2 for pathological uptake) was used. For esophageal uptake, reproducibility between the 2 senior physicians was good for the 5-rank score (K=0.64) and the 2-rank score (K=0.64). Reproducibilities were low or intermediate between junior and senior physicians, and between junior physicians (K=0.19 and 0.44). For esophageal uptake, reproducibility between senior and junior physicians, and between junior physicians was improved by using 2-rank score (from 0.33 to 0.78). For extra-esophageal uptake, reproducibility was intermediate between senior physicians (K=0.52) with the 5-rank score, and improved by using the 2-rank score (K=0.60). The reproducibilities between senior and junior physicians were low to intermediate (K=0.28 to 0.63) and improved with the 2-rank score (K=0.39 to 0.82).Conclusion. Reproducibility of uptake analysis with FDG-PET/CT in esophageal cancer is good between senior physicians but requires learning for young physicians (less reproducibility for junior physicians). Reproducibility is better for esophageal lesions than for extra-esophageal lesions. A 2-rank score (with a cut-off ≥ 2) improves the reproducibility of the semi-quantitative analysis, particularly for junior physicians.
P40 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Urological Cancer
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The diagnostic usefulness of F-Fluorocholine Positron Emission Tomography in Recurrent/Metastatic Prostate cancer R. Yen, H. Yu, Y. Pu, C. Cheng, P. Liang; National Taiwan University Hospital, Taipei, TAIWAN. Background and objectives: Prostate cancer is the 7th leading cause of cancer death for male in Taiwan. Conventional imaging techniques, including MRI and 18FFDG PET are not sensitive or specific enough to detect metastatic or recurrent disease. Choline is one of the components of phosphatidylcholine, an essential element of phospholipids in the cell membrane. Some malignant cells (especially prostate cancer cells) show their ability to actively incorporate choline to produce phosphocholine and phosphatidylcholine to facilitate tumor cell duplication. 18Ffluorocholine has been shown to have the ability to localize primary or metastatic prostate cancer. This study was prospectively conducted to delineate the diagnostic effectiveness of 18F-fluorocholine (FCH) in detecting recurrence in prostate cancer patients with biochemical failure but negative conventional work-up after initial curative therapy.Methods:From August 2008 to February 2011, 33 patients with biochemical recurrence (PSA range: 0.03 - 33.0 ng/ml, median: 4.3 ng/ml) and negative or indeterminate conventional workup (including pelvic MRI, abdominal CT and bone scan) were included in this study. Each patient received 18F-FCH PET
whole-body imaging 15 minutes after injection of 18F-FCH (3-5 MBq/kg body weight). Delay imaging of pelvis was performed 60 minutes after tracer injection. PET imaging was interpreted both qualitatively (visual interpretation) and quantitatively (SUV, retention index). The accuracy of the 18F-FCH for detecting recurrent/metastatic prostate cancer lesions for each patient will be evaluated according to the patient’s final histopathology, further imaging and clinical followup results.ResultsAmong these 33 patients, 18F-FCH PET showed negative for 8 patients (PSA range: 0.03-22.1ng/ml, medium: 0.44 ng/ml) and positive for 25 patients (PSA range: 0.22-33 ng/ml, medium: 8.20 ng/ml). For the 25 PET positive patients, 21 patients had been confirmed of recurrence, and 4 patients had negative pathology at the areas with abnormal PET uptake up to the date of data analysis (2011/3/6). For the 8 PET negative patients, they had been follow-up for 831 months (medium: 21.5 m) after their PET scan without detecting focus of recurrence. At present, the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy were 100%, 67%, 84%, 100%, 88% respectively.Conclusion18F-FCH PET is an effective diagnostic tool for patients with biochemical recurrence but negative in conventional workup. The PET results provide valuable information for subsequent treatment planning for these patients.
P429 To evaluate response to conventional chemotherapy in patients with recurrent non-seminomatous germ cell tumours using 18F-FDG PET/CT S. Jeph, R. Kumar, P. Sharma, C. Bal, A. Malhotra, R. Reddy, H. Singh, P. Kundu, A. Singhal, V. Dhull, M. K. Sahoo, A. Kumar; ALL INDIA INSITUTE OF MEDICAL SCIENCES, NEW DELHI, INDIA. Objectives : This study was aimed at evaluating the role of 18F-FDG PET/CT scanning in assessing the response to the conventional chemotherapy in patients with non-seminomatous germ cell tumours (NSGCT).Methods: A total of 27 patients of recurrent non-seminomatous germ cell tumours, who had recurrent/residual disease on 18F-FDG PET-CT and had follow-up 18F-PET-CT scan after chemotherapy were analyzed retrospectively. The age range was 18 to 71 years with mean age of 30.7 years. Follow-up 18F-FDG PET-CT (post treatment) was done 4-6 weeks after last cycle of chemotherapy. PET/CT scan was acquired 60 minutes after the intravenous injection of 333-707 MBq of 18F-FDG.. Visual and semiquantitative (standardized uptake value [SUV]) analysis was performed for all the studies. Response to therapy was assessed according to EORTC recommendations for PET. A decrease in SUV of more than 50% was graded as significant response, decrease in SUV of more than 25% but less than 50 % was graded as partial response. Decrease in SUV of less than 25 % or increase in SUV of less than 25 % was graded as stable disease. Increase in SUV of more than 25% or appearance of new lesion (s) was graded as progression. Results were confirmed by histological analysis (when available) or clinical follow-up with tumour markers and CECT findings.Results: Of the 27 patients who received chemotherapy, 16 patients showed significant response, 3 had partial response, 5 showed stable disease (4 out of these 5 had lymphnodes metastasis). Three patients had progression of disease, all three also had lymph nodes disease, two of them had lung lesions and one of them had metastasis to bone. One patient had partial response with active disease involving para-aortic and mediastinal group of lymph nodes and lung.Conclusions: 18F-FDG PET-CT appears to be a very useful promising modality in assessing the response to chemotherapy in patients with recurrent non-seminomatous germ cell tumours.
P430 Prediction of nuclear grade of clear-cell-type renal cell carcinoma 4cm or larger using F-18 FDG PET/CT: A preliminary study K. Takanami1, Y. Nakamura2, T. Kaneta1, H. f*ckuda3, S. Takahashi1; 1 Department of Radiology, Tohoku University Graduate School of Medicine, Sendai, JAPAN, 2Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, JAPAN, 3Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, JAPAN. Purpose: To evaluate the usefulness of F-18 fluorodeoxyglucose (FDG) PET/CT in the prediction of high Fuhrman nuclear grade (FG) of clear-cell-type renal cell carcinoma (c-RCC) 4cm or larger by FDG PET/CT.Subjects & Methods: Eleven patients (2 females and 9 males; mean age, 57.5 years; range, 34 -76 years), who underwent PET/CT and were subsequently shown to have c-RCC 4cm or larger by pathologic examination, were included in this study. The patients were divided into two groups based on FG: 5 cases with low FG tumor (grades 1 and 2) and 6 cases with high FG tumor (grades 3 and 4). The SUVmax of the lesions on PET/CT images and the tumor diameter were compared between the two groups using the MannWhitney U test. Significance was assumed as p < 0.05.Results: The SUVmax of high FG tumors (9.4 ± 3.4) was significantly higher than that of low FG tumors (3.6 ± 2.6) (p <0.05). Meanwhile, there was no significant difference in tumor diameter between high FG c-RCCs (65.2 ± 16.9 mm) and low FG c-RCCs (60.4 ± 23.8 mm). The
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
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Detection of urinary tract cancer by C-choline PET/CT 1
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K. Kato , S. Abe , N. Ota , K. Tsuchiya , S. Suezawa1, N. Sassa2, M. Ikeda1, K. Shimamoto1, S. Naganawa2; 1Nagoya University School of Health Siences, Nagoya, JAPAN, 2Nagoya University Graduate School of Medicine, Nagoya, JAPAN. Purpose: The aim of this study is to investigate the detectability of urinary tract cancer by 11C-choline PET/CT.Methods: Sixteen patients (10 men, 6 women) with suspected urinary tract cancer were examined by 11C-choline PET/CT (Siemens Biograph 16). 11C-choline PET/CT was performed 10-20 min after intravenous injection of 3.7MBq/kg of 11C-choline. All the patients received surgical operation or biopsy and the tumor was diagnosed histopathologically.Results: In 16 study patients, 12 were confirmed histopathologically to be urothelial cancer, 1 malignant lymphoma, 1 IgG4-related disease, and 2 other benign diseases. The 11Ccholine uptake in the tumor site expressed as SUVmax in 11C-choline PET was 1.978.08 (mean±S.D. 4.24±0.52) in urothelial cancer, 2.94 in malignant lymphoma, 3.25 in IgG4-related disease, and 1.85-2.21 (2.03±0.25) in other benign diseases. The difference in SUVmax between urothelial cancer and benign diseases including IgG4-related disease was statistically not significant.Conclusion: 11C-choline uptake in tumor site seemed to be higher in urothelial cancer than in benign diseases, but the difference between them was statistically not significant. Further studies with increased numbers of patients will be needed to determine the diagnostic value of 11 C-choline uptake in urothelial cancer.
P432 SPECT / MDCT fused images and radioguided sentinel node lymphadenectomy in prostate cancer patients. K. Bolcak, M. Stanik, J. Vasina, J. Bartl; Masaryk Memorial Cancer Institute, Brno, CZECH REPUBLIC. Aim: The objective of the study was to assess usefulness of fused SPECT / MDCT images for pelvic lymphonode mapping in prostate cancer patients and establish senzitivity and negative predictive value of the procedure for metastatic lymphonode involvement.Method: The sentinel node mapping was performed in 15 prostate cancer patiens with medium (cT2b/c and/or GS 7 and/or PSA 10-20 ng/ml) or high (cT3a and/or GS 8-10 and/or PSA > 20 ng/ml) risk in 1 day protocol after transrectal administration of radiotracer (99mTc-Nanocoll 100MBq 2x0,4ml) into prostate. SPECT and MDCT of pelvic region were performed with 4 markers ( 99mTc-pertechnetat + lead grein) attached to the skin over the pelvis. A standart pelvic radioguided lymphadenectomy with gamma probe approximately 5 hours after injection of radiotracer was performed.Results: Preoperative lymfoscintigraphy allowed detection of sentinel nodes in 93,3% 14 from 15 patients), there were 53 lymphonodes detected ( on average 3,5 / 1 patient ), 255 lymphonodes were surgicaly removed ( on average 17 / 1 patient) and examined, negative predictive value was 91,7%.Conclusion: Detection of pelvic lymfonodes in prostate cancer patiens using fused SPECT / MD CT images combined with radioguided lymfadenectomy has high importance for detection of metastatic lymphonode involvement in prostate cancer pacients.
P433 18F-FDG PET/CT delayed images retrograde filling with sterile saline for staging bladder cancer O. Eker1, M. O. Tamam1, M. Mulazimoglu1, T. Alışkan2, T. Ozulker1, F. Ozulker1, T. Tatoglu1, T. Ozpacaci1; 1Okmeydani Training and Research Hospital,Department of Nuclear Medicine, Istanbul, TURKEY, 2Okmeydani Training and Research Hospital,Department of Urology, Istanbul, TURKEY. BACKGROUND: 18F-fluorodeoxyglucose (FDG) is the most frequently used PET tracer in oncologic imaging but has been considered to be of limited value for the detection of urinary tract cancers due to interference by the FDG excreted in urine. Several techniques have been used to overcome this limitation, especially for evaluation of bladder cancer. Retrograde filling technique has been used to reduce urinary FDG activity for better image interpretation in patients with bladder cancer. We investigated the efficacy of delayed 18F-fluorodeoxyglucose positron emission tomography /computed tomography (FDG-PET/CT) with retrograde filling of urinary bladder in the assessment of urinary bladder cancer.METHODS: Eleven patients (1 female and 10 male) with a mean age of 64,5±5,5 years (range, 56-73 years) with invasive cancer of the urinary bladder were included in this study. In all the patients the types of the cancer were either low or high grade papillary urethral tumor histopatologically. FDG-PET/CT was applied for staging. All patients underwent FDG-PET/CT scan from the skull base to the mid-thighs 60 min after IV injection of 370 mega-Becquerel (MBq) of FDG. After an hour Additional delayed images were
acquired 60 minute after retrograde filling with sterile saline. Early and delayed maximum standardized uptake values (SUVmax) were calculated. The correlation between histopathologic diagnosis and SUV max was assessed.RESULTS: In all patients included to the study (n:11), the lesions were seen clearly in delayed pelvic FDG-PET/CT images. There was a significant increase in SUVmax values, however no correlation between SUVmax and histopathologic diagnosis.The retrograde filling reduced the interference with physiologic urinary accumulation of FDG in patients with possible pelvic lesions; no false-negative results were documented.CONCLUSION: In FDG-PET/CT studies, delayed pelvic PET/CT imaging with retrograde filled-bladder technique is recommended to assess bladder wall lesions.
P434 Imaging biochemical relapse of prostate cancer with 11 and C-Choline PET/CT scan
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P. Medina-Quiroz, I. Martinez-Rodriguez, I. Banzo, R. Quirce, J. JimenezBonilla, M. de Arcocha, H. Portilla-Quattrociocchi, R. del Castillo-Matos, A. Rubio-Vassallo, J. M. Carril; Servicio de Medicina Nuclear. HU Marques Valdecilla. Universidad de Cantabria, Santander, SPAIN. Aim: The increase in serum PSA levels in prostate cancer (PC) recurrence is observed before clinical and radiological manifestations. The possibility of discriminating between local/regional relapse and distant metastasis spread assumes a crucial relevance in order to choose the appropriate treatment. 11CCholine PET/CT (CHO) scan has shown promising results for restaging after biochemical relapse of PC. Our aim was to compare the findings of the 18F-FDG PET/CT (FDG) scan and CHO scan in PC recurrence.Materials and methods: We prospectively evaluated 25 patients (mean age: 71 y, Gleason index: 4 - 7, serum PSA range: 0.44-6.5 ng/mL) with biochemical suspicion of recurrent PC. Nine patients had prostatectomy; 4, prostatectomy plus hormone therapy; 3, radiotherapy; 8, radiotherapy plus hormone therapy and 1, radiotherapy plus prostatectomy. All patients underwent two PET/CT scans. An FDG scan after intravenous injection of 8 MBq/Kg of 18F-FDG and a CHO scan after intravenous injection of 740 MBq of 11C-Choline. Maximum interval between studies was 2 months. Results were confirmed by histological analysis in 5 patients and biochemical monitoring in 20.Results: In 10/25 patients FDG and CHO scans were positive, showing the same findings in 9 (5 local involvement, 3 lymph node and 1 both); in the other patient, CHO scan detected more lymph node involved. In 10/25 patients, CHO scan was positive and FDG scan was negative (8 local involvement and 2 regional lymph node). In 5/25 patients, CHO and FDG scans were negative. There was no patient with negative CHO scan and positive FDG scan.Serum PSA levels were available in 23 patients. Nineteen had a serum PSA > 1 ng/mL and the other 4, a serum PSA < 1 ng/mL. In the 19 patients with PSA > 1 ng/mL, 6 had positive CHO and FDG scans, 10 had positive CHO scan and negative FDG scan, and the other 3 patients had negative scans. In the 4 patients with serum PSA < 1 ng/mL, 3 showed positive CHO and FDG scans and 1, negative scans.Conclusion: CHO scan was better than FDG scan for the evaluation of biochemical PC recurrence, specially in loco-regional involvement. Therefore, CHO scan should be the technique of choice in these patients for planning the appropriate therapy.
P435 The influence of hormone therapy in 18F-fluorocholine PET in prostate cancer C. Lu; National Taiwan University Hospital, Taipei, TAIWAN. Purpose: Radiolabelled choline is superior in diagnosing prostate cancer than 18FFDG-PET due to the nature of slow glycolysis and enhanced β-oxidation pathway in prostate cancer cells. Dual phase SUV value is also considered helpful in differentiating benign and malignant prostate lesion. Hormone therapy plays an important role in managing prostate cancer. This study is aimed at evaluating the influence of hormone therapy on dual phase SUV value of 18F-choline PET.Methods: From June 2009 to October 2010, 19 prostate cancer patients were included (age range, 54-81 years; mean age, 68.8 ± 7.5 years). The pathology results were either by prostatectomy (7 patients) or by prostate biopsy (12 patients). The interval between 18F-fluorocholine PET and pathological results is 56 ± 36 days. Eight patients were without hormone therapy between the time interval of 18Ffluorocholine PET and pathological results, and 11patients were with hormone therapy. Early SUV and delayed SUV were obtained at 15 minutes and 60 minutes after 18F-fluorocholine injection by its maximal value at prostate area.Results: The mean early SUV in 8 patients without hormone therapy was 6.5 ± 2.1, and in 11 patients with hormone therapy was 4.6 ± 1.3 (p=0.0019). The mean delayed SUV in hormone-free group was 5.8 ± 2.0, and in hormone therapy group was 4.7 ± 1.5 (p=0.0659). The retention index was -0.11 ± 0.15 for hormone free group and 0.04 ± 0.25 for hormone therapy group (p=0.0431).Conclusion: Our study suggests that hormone therapy do influence the early SUV value and retention index of 18Ffluorocholine PET in prostate cancer patients.
Poster Presentations
sensitivity, specificity, PPV, NPV, and accuracy for predicting high FG were 83.3%, 80%, 83.3%, 80%, and 81.8% with a cut-off SUVmax of 6, respectively.Conclusions: The results indicate that FDG PET/CT may be a useful tool for the preoperative prediction of nuclear grade of c-RCC 4cm or larger.
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Indium Capromab Pendetide (CP) Imaging (PROSTASCINT®) in the management of recurrent Prostate Carcinoma (CaP): One Centers Experience. D. Lamonica1, V. Rivero-Martino2, W. Tan1, Z. Grossman1, R. Pili1; 1Roswell Park Cancer Institute, Buffalo, NY, NY, UNITED STATES, 2University at Buffalo, State Unversity of New York, Buffalo, NY, NY, UNITED STATES. Background: Mid abdominal uptake with CP is associated with worse prognosis in CaP although its precise role as a predictor of clinical outcome is understudied. We evaluated outcome and scan results in 95 RPCI pts from Jan. 2003 - Dec. 2008.Methods: Pts were imaged prior to salvage radiation- alone (37) or with hormone (8) or chemotherapy (1); cryotherapy- alone (1) or with hormone (1) or chemotherapy (4); hormone therapy- alone (21) or with chemotherapy (2); chemotherapy- (6) or active surveillance- (14). 5 pts were lost to followup. Median age was 64 (range, 43 - 86). Median PSA at diagnosis was 6.8 (range: 1.0 - 131); at recurrence was 0.4 (range: 0.05 - 125). Scan results were categorized as positive or negative with relation to the pelvis. Clinical data were judged as indicative of stable or progressive disease. Fisher’s exact test was used to explore the association between scan result and disease status.Results: CP imaging was positive in 43%. In 15% lesions were limited to the pelvis, in 72% they were only seen beyond, and in 13% they were seen in both areas. Overall test results were significant (P=0.0086), with pts with detectable tumor more likely to show progression. Lesions beyond pelvis were not necessarily more indicative of treatment-refractory tumor.Conclusions: CP predicts a more aggressive tumor phenotype and higher likelihood of progression and adverse outcome in recurrent CaP. Scan pattern does not predict response to systemic therapy. Given the natural history of CaP, more experience and longer follow-up is needed to determine its role in guiding salvage regimens.
P437 The importance of SPECT and/or SPECT-CT fusion in sentinel lymph node detection with prostate cancer patients Z. Galler1, I. Balogh1, A. Páczelt2, J. Varga2, F. Salamon3, Z. Tóth4; 1Uzsoki Street Hospital, Department of Nuclear Medicine, Budapest, HUNGARY, 2 Uzsoki Street Hospital, Department of Urology, Budapest, HUNGARY, 3 Uzsoki Street Hospital, Department of Pathology, Budapest, HUNGARY, 4 ScanoMed Ltd., Budapest, HUNGARY. Objectives: Our aim was studying the usefulness of sentinel lymph node detection with SPECT and/or SPECT-CT fused images in early stage (T1-2, N0, M0) of prostate cancer.Methods: In 85 patients both planar and SPECT images were taken 3 and 21 hours after the transperineal-intraprosttatic administration of 100-150 MBq Tc99m-SentiScint. In 20 cases low dose CT has been made as well for better localization of sentinel lymph node (SLN). For SPECT-CT image fusion MedisoInterview Fusion software was used. During operation Navigator gamma probe was utilized localizing the SLN found by SPECT and/or SPECT-CT examinations. The SLN(s) were examined separately for detailed pathological processing.Results: Except of the 5 lymph nodes in presacral localization detected by SPECT-CT fused images all other SLN were excised. Only in 27 cases were found the SLN in the usual place, obtural triangle (OT), other 32 cases the SLN were excided outside the OT (along with the iliacal arteries, iliacal bifucation - localized by SPECT-CT). In 10 cases SLN-s were detected both inside and outside the OT. In 9/85 cases micrometastasis could be found in SLN by pathological processing.Conclusions: On the bases of our results (1) micrometastasis could be found in very early stage of prostate cancer (9/85) what emphasizes the importance of SLN detection. (2) The localization of SLN outside the OT is a common finding (32/85). In these cases (3) the importance of SPECT-CT fused images is essential for accurate localization of SLN, leading the hand of the surgeon (i.e. tailored surgery).
P438 Expression of matrix metalloproteinases -2 and -9 (MMP) in serum of prostate cancer patients and their role as prognostic factors to 153Sm-Lexidronate treatment efficacy. I. Iakovou1, M. Siabanopoulou2, A. Doumas1, K. Badiavas1, G. Galaktidou3, V. Nikos1, T. Christoforidis1, S. Georga1, D. Lo Presti1, G. Arsos1, A. Gotzamani-Psarakou2, N. Karatzas1; 13d Nuclear Medicine Dept. of the Aristotle University, General Hospital “Papageorgiou”, thessaloniki, GREECE, 22d Nuclear Medicine Dept. of the Aristotle University, AHEPA General Hospital, thessaloniki, GREECE, 3Research Dpt. of THEAGENIO Anticancer hsp, thessaloniki, GREECE. Introduction: MMPs have been involved not only in tumor invasion and metastasis but also in tumor growth and angiogenesis. Studies on MMPs expression in prostate cancer (PCa) revealed a correlation between molecular overexpression, enhanced crossing and destruction of the basal membrane and stromal invasion. The study assesses the efficacy of palliative treatment using 153-Samarium Lexidronam (153Sm) regarding pain symptoms, quality of life and bone marrow
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 function in men with painful bone metastases due to PCa and investigates the role of MMPs as prognostic factors.Methods: We examined whether serum matrix metalloproteinases MMP-2 and MMP-9 could serve as predictors for appearance and expansion of prostate cancer. Therefore, we recruited 42 patients with PCa (20 patients with localized PCa -M0- and 22 with bone metastatic cancer -M1). Control sera were obtained from 30 healthy and 33 men with benign prostate hyperplasia (BPH). All metastatic patients had pain palliative therapy using 153Sm-Lexodronate. Serum levels of MMP-2 and MMP-9 were assessed, before and post treatment, by an ELISA sandwich technique. Pain palliation was evaluated on the basis of the Wisconsin pain test improvement and response was graded as complete, partial, minimal or absent. All patients were interviewed using standardized sets of questions before and after therapy on a weekly basis for 3 months. Haematological toxic side effects were reported according to WHO guidelines.Results: The mean serum levels of MMP-2 and MMP-9 in PCa patients were significantly higher compared to the control and BPH groups (p<0,014 and p<0,038 respectively). Furthermore, serum levels of MMP-2 and MMP-9 in metastatic PCa patients were highly elevated compared with those without metastases. Pain palliative treatment efficacy was complete in 10 (46%), partial in 8 (36%) and none in 4 (18%) men. Two patients with athrombocytopenia grade I and only one with grade III were noticed. A month after radiopharmaceutical therapy a statistically significant difference in MMP’s serum levels was found between responders and no- responders (MMP-2: p=0,003 and MMP-9: p=0,021), while this difference was not evident before therapy.Conclusion: The type IV collagenases/gelatinases matrix metalloproteinase-2 and -9 are probable significant for cancer invasion and metastasis. Our results suggest that serum concentration of MMPs could play a role in monitoring therapy and evaluating malignant progression in PCa. Their role as a prognostic tool in predicting pain palliative treatment response remains to be established.
P439 Role of 18F-FDG PET/CT in predicting ureteral stent placement success in hydronephrosis patients with malignant obstruction A. Cho, Y. Choi, H. Suh, H. Kim, J. Lee, W. Kang; Yonsei University Health System, Seoul, KOREA, REPUBLIC OF. Hydronephrosis caused by external compression by retroperitoneal tumors or periurethral metastasis is often encountered in 18F-FDG PET/CT scans. As hydronephrosis caused by malignant obstruction often warrants stent placement, prediction of hydronephrosis improvement is clinically needed. The purpose of this study is to compare 18F-FDG excretion patterns with hydronephrosis grade and evaluate whether these patterns can predict hydronephrosis improvement after stent insertion.Methods: A retrospective review of 69 patients (mean age 53.6 years old, 21 male) who underwent 18F-FDG PET/CT for abdominal tumors and showing hydronephrosis on CT was performed. Hydronephrosis was graded by initial CT and correlated with 18F-FDG renal parenchymal uptake and 18F-FDG excretion patterns. Maximum SUV of renal parenchyma was obtained on coronal renal cortex images. 18F-FDG excretion was determined to be present or absent by visual analysis of the hydronephrotic renal pelvis. Stent insertion was performed for 49 ureters (22 bilateral) on average 10 days after PET scan. Follow up CT or PET/CT was re-evaluated for hydronephrosis improvement (average follow up 13.3months, range 3-14months).Results: Hydronephrotic kidney showed significant 18 F-FDG uptake compared to contralateral normal kidney (3.09 vs 2.41, p<0.001). 18 F -FDG excretion was either present or absent in the hydronephrotic kidney. There was a significant correlation between hydronephrosis severity with 18F -FDG excretion patterns. Hydronephrotic kidneys showing renal excretion of 18F -FDG tended to show no improvement after stent insertion (3 improvement, 12 no improvement), and hydronephrotic kidneys showing 18F -FDG excretion either improved showed no improvement (19 improvement, 15 no improvement). Initial CT hydronephrosis grade did not predict hydronephrosis improvement after stent insertion, whereas 18F-FDG excretion presence significantly predicted hydronephrosis improvement.Conclusion: Increased parenchymal 18F-FDG uptake is seen in hydronephrotic kidneys compared to non-obstructive kidneys. Minimal 18 F-FDG excretion in the renal pelvis suggests minimal improvement after stent insertion, whereas presence of 18F-FDG excretion suggests improvement after stent insertion.
P440 Dual phase 18F-Flouro-Ethyl-Choline (FECH) PET/CT imaging in evaluation of "radio-recurrent" Prostate Cancer. A. Haroon1, A. Almuhaideb1, J. Dickson1, M. Emberton1, N. Soomro2, A. Kirkham1, A. Freeman1, I. Kayani1, J. Bomanji1; 1University College Hospitals London, London, UNITED KINGDOM, 2The Newcastle upon Tyne Hospitals NHS Foundation Trust, London, UNITED KINGDOM. Objectives:In this study, we prospectively evaluated the role of dual phase 18F PET/CT for the assessment of disease recurrence in patients with biopsy proven prostate cancer who had received different treatments for prostate
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P441 Serum parameters ICTP and PICP are promising bone turnover markers in prostate cancer patients 1
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M. T. Siabanopoulou , I. Iakovou , T. Vasileiadis , S. El Mantani Ordoulidis1, G. Moustakas3, A. Sioundas4, A. Gotzamani-Psarrakou5; 1 Biomed Diagnostics, Thessaloniki, GREECE, 23rd Nuclear Medicine Dept Aristotle University, General Hospital “G. Papageorgiou”, Thessaloniki, GREECE, 3Theagenion Cancer Institute, Thessaloniki, GREECE, 4Med Physics Lab, Aristotle University, AHEPA University Hospital, Thessaloniki, GREECE, 52nd Nuclear Medicine Dept Aristotle University, AHEPA University Hospital, Thessaloniki, GREECE. Introduction: Prostate cancer has a high frequency of bone metastases. Skeletal metastases in prostate cancer (PCa) patients are detectable with bone scintigraphy, before clinical evaluation and bone radiographs. Since conventional imaging is not highly specific, serum bone turnover markers are eligible for both pre-treatment staging and monitoring of therapeutic response to skeletal metastases.Aim: The aim of this study was to evaluate the collagen turnover markers carboxyterminal cross-linked telopeptide of type I collagen (ICTP) and type I procollagen propeptide (PICP) in PCa patients with or without bone metastases compared with benign prostatic hyperplasia (BPH).Materials and Methods: 40 patients with histologically proven PCa (21 with -M1 and19 without- M0 bone metastases) and 32 controls with BPH were included in the study. Serum concentrations of ICTP and PINP were analyzed using specific radioimmunoassays. All patients received endocrine therapy as initial treatment and 10 patients received combined hormonal and radionuclide therapy.Results: The mean values of the parameters measured for the BPH-, CaPM0-, and CaPM1-cohort were as follows: PSA:2,71(±0,33), 12,82(±19,17), 106,52(±10,16) ng/ml, ICTP:3,74(±0,41), 5,61(±1,49), 7,18(±2,48) ng/ml and PICP 109,50(±35,20), 138,70(±40,90) and 226,50(±52,30) ng/ml, respectively. Both collagen metabolism markers were significantly elevated in the CaPM1-patients compared to the CaPM0-patients (p<0, 01). In the patients who responded to therapy the pre-treatment and the follow-up mean values (±SD) detected were for PSA 119,16(±13,18) and 37,62(±23,42) ng/ml, for PICP 222,0(±30,30) and 104,80(±19,60) ng/ml and for ICTP 7,21(±2,33) and 5,56(±1,42) ng/ml respectively. Increases in PICP and ICTP levels paralleling those in PSA were observed in all cases when bone metastases progressed.Conclusion: ICTP and PICP levels reveal metastatic bone turnover in PCa-patients with skeletal metastases and thus may be useful not only for early detection of metastatic disease progression but for monitoring therapeutic response as well.
P442 Bone metabolism markers PINP, ICTP and CTx for detection of bone metastases in patients with prostate cancer M. T. Siabanopoulou1, T. Vasileiadis2, S. El-Mantani Ordoulidis1, G. Galaktidou2, E. Zaromitidou3, M. Dikeakou2, G. Moustakas2, A. Sioundas4, A. Gotzamani-Psarrakou5; 1Biomed Diagnostics, Thessaloniki, GREECE, 2 Theagenion Cancer Institute, Thessaloniki, GREECE, 3Kavala General Hospital, Thessaloniki, GREECE, 4Med Physics Lab, Aristotle University, AHEPA University Hospital, Thessaloniki, GREECE, 52nd Nuclear Medicine Dept Aristotle University, AHEPA University Hospital, Thessaloniki, GREECE. Introduction: Prostate cancer is the most frequent malignancy in men and bone metastases are an important cause of morbidity and disability. Serial bone turnover markers have been recommended to predict and patients at risk for progression of bone lesions and subsequent skeletal complications.Aim: The aim of this study was to evaluate the usefulness of bone metabolism markers: PINP, ICTP and CTx in
prostate cancer patients. To assess the diagnostic efficacy of detection of skeletal metastases we performed serial measurements of the above markers in serum of patients with prostate cancer.Materials and Methods: 52 patients with histologically proven PCa (31 with -M1 and 21 without evidence of bone metastases -M0) were included in the study. Control sera were obtained from 30 men with benign prostate hyperplasia (BPH). Serum levels of PINP, ICTP and CTx were analyzed before endocrine treatment and 3 months after, using specific radioimmunoassay. Serum PINP, ICTP was assayed by quantitative radioimmunoassay RIA (Orion Diagnostica UniQ, Finland). Serum PSA was determined by a “sandwich” type assay IRMA and CTx (β-crossLaps) was measured on Elecsys analyzer (Roche).Results: Higher baseline concentrations of all markers were observed in M1 group compared with BPH (p<0, 05). In M1 clinical responders group, PSA and the bone markers PINP and CTx, except for ICTP, decreased compared to baseline, after administration of androgen deprivation treatment combined with biphosphonates. CTx showed the greatest decrease. In patients with metastatic bone progression PINP and ICTP were significantly higher compared with patients without progression (p<0,003 and p<0,028). In addition to the information of PSA as a monitoring parameter, the bone formation marker showed the better distinction between patients with and without disease progression.Conclusion: Follow up measurement of PINP and ICTP is useful in the assessment of skeletal metastases and provide valuable information regarding progression of bone metastases in patients with prostate cancer.
P443 Physiological F18-FDG Uptake in Testicular Tissue: The correlation with Age and Testicular Volume S. Aksoy, N. Torun, T. Aktoz, G. Durmus-Altun; Trakya University, Edirne, TURKEY. Objective: Previous study reported that FDG is observed in the normal testis and declines slightly with age. The purpose of this study was to determine the normal testicular tissue uptake values with F-18 florodeosiglukoz (FDG) positron emission tomography uptake, and whether to determine correlation with age and testicular volume.Method: In this retrospective study, 210 consecutive patients with known or suspicious lung cancer were included between 1 January 2010- 31 January 2011. All of patients had supradiaphragmatic primary disease and the pathologic FDG uptake was not observed in infradiaphragmatic area. The patients were scanned in an integrated PET/CT scanner (GE STE8). The testicular uptake of 18F-FDG, expressed as the standardized uptake value (SUVmax and SUVmean). Patients were divided according to age groups and groups created for every 10-year intervals. In group A (30-39years), Group B (40-49 years), Group C (50-59 years), Group D (60-69 years), Group E (70 to 79 years) and Group F (80-89 years).In the patients, SUVmax, SUVmean values and ml volumes in CT images (Volume = WxLxHx0.6) were measured. Between-group differences were calculated by ANOVA. FDG uptake of testicular tissue was classified as visually hom*ogeneous and heterogeneous.Results: The mean age was 62 ± 10 (30-87) years. We calculated SUVmax and SUVmean values and volumes bilateral testis tissues with PET/CT (Table). There were no significant differences between groups. In visual assessment, there were significant statistical differences between the age groups and heterogeneity. The value of heterogeneity of Group B was detected %38 (X2: 18, df (10), p = 0.04). There was no correlation between the testicular SUVmax and SUVmean values and testicular volumes. The group name, the value of N, the age range (years), SUVmax, SUVmean, Volume (ml), and heterogeneity imaging (%), are given for groups, respectively. Conclusion: Testicular tissue FDG uptake values were not different between age groups in our study. There was no corelation between the testicular SUVmax and SUVmean values and tissue volume.
P444 Initial results with 18F-Fluorcholine PET/CT in patients with elevation of PSA. R. Jover-Diaz1, A. Vicente-Bartulos1, C. Nunez-Mora2, J. Viera-Jorge2, P. Lopez-Criado2, N. Carballo Gonzalez2, L. Gorospe-Sarasua1, M. Pozo Garcia3, J. Alfonso-Alfonso3; 1Instituto Tecnologico Servicios SanitariosCentre Oncologico MD Anderson, MADRID, SPAIN, 2Centre Oncologico MD Anderson, MADRID, SPAIN, 3Instituto Tecnologico PET, MADRID, SPAIN. Objective: To evaluate the clinical usefulness of 18Fluorocholine PET/CT in patients with elevation of PSA.Material and methods:We evaluated retrospectively the results of the first 28 patients (mean age of 69 years) with elevation of PSA. All patients, except one of them, had biopsy-proven prostate adenocarcinoma. Treatments received were: 53% surgery, 25% pelvic Radiotherapy, 14% Brachytherapy, 14% Hormone therapy. Most of the patients (89%) were referred for re-staging purposes because of biochemical recurrence of disease (with negative or equivocal conventional imaging). The serum PSA at the time of the study ranged between 0.3 and 115 ng/ml (mean value of 14.0). PSA values were higher in patients who underwent PET/CT scanning for initial staging (mean value of 93.5) than for those being studied for restaging purposes (mean value of 6.6).A 18Fluorocholine PET/CT performed between July-2009 and January-2011 in all
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cancer.Methods:A total of 56 patients with radio-recurrent prostate cancer and biochemical and clinical suspicion of radio-recurrent disease underwent dual phase 18F- FECH PET/CT. 370MBq 18F- FECH was injected IV and whole body images were acquired at 60 minutes and limited (1 bed position) pelvic view at 90 min postinjection. Tracer uptake in the prostate was measured and expressed as maximum standardized uptake value (SUV max) on initial and delayed image data sets. The pattern of uptake on 18F- FECH PET/CT study was further classified as focal or diffuse in both lobes of the prostateResults:The age range was 52-88 years. The prostate specific antigen (PSA) range was 0.12-45 (Unit: ug/L; normal range 0.004.00; Roche Modular method).Out of 56 patients, the pattern of uptake in the right lobe on 60 minutes scan was diffuse in 17, focal in 21 and normal background uptake in 18 patients. On the left side, diffuse uptake was seen in 24, focal in 14 and normal background uptake in 18 patients.On 90 minutes images, the pattern of uptake in the right lobe was diffuse in 18, focal in 24 and 14 showed normal background uptake. On the left side diffuse uptake was seen in 25, focal in 15 and normal background uptake in 16 patients.The results of the 18F-FECH PET CT data were correlated with ultrasound guided core biopsies and state of the art MRI template guided biopsies.Conclusions:Both 60 and 90 min imaging with 18F-Flouroethyl-choline PET/CT scan facilitates lesion localisation in radio-recurrent prostate cancer and improves the diagnostic confidence of physicians for further therapeutic interventions.
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S366 patients in a hybrid camera (GE ST 4) with acquiring pelvic and whole-body images, until 60 minutes post-injection. All studies were reviewed by experienced nuclear medicine physicians and radiologists at 15, 30 and 60 min.Results:- Pathologic PET/CT in 20 patients, with accumulation of 18F-Fluorocholine in the prostate bed (70%), regional lymph nodes (50%), or in distant locations (30%). Mean PSA value in this patient group was 15.6 (0.3-115), although 75% had a PSA < 10 ng/ml. PET/CT answered most of the oncologist’s concerns and provided useful additional information in 100% of the cases. Also it modified patient treatment in 90% of the cases.- Negative PET/CT in 7 patients. Mean PSA value in this patient group was 2.4 (0.3-7.0). PET/CT answered most of the oncologist’s concerns, provided useful additional information in 71% of cases, and modified patient treatment in 57% of cases.- Inconclusive PET/CT in 1 patient. PSA value in this patient was 3.3 ng/mlConclusion:18Fluorocholine PET/CT in prostate cancer has a high percentage of positive cases, many of them being true positive. It is very useful for the detection of disease in patients with biochemical recurrence, for whom conventional imaging has been negative or inconclusive. Also PET/CT provide useful additional information and help -in some cases considerably- with disease management (> 50%).
P445 Clinical Usefulness of 18Fluorocholine PET/CT in Prostate Cancer R. Núñez1, R. Jover1, M. Pozo2, C. Núñez3, J. Viera3, D. Lasa1, L. Gorospe1, D. Lourido1, A. Vicente1, J. García1, P. Lopez-Criado3, N. Carballo3, J. Alfonso2; 1Instituto Tecnologico de Servicios Sanitarios, Madrid, SPAIN, 2 Instituto Tecnologico PET, Madrid, SPAIN, 3Centro Oncológico MD Anderson International España, Madrid, SPAIN. Objective: To evaluate the clinical usefulness of 18Fluorocholine PET/CT in prostate cancer patients.Material and Methods: We present the results of the first 75 patients (pts), ages 49 to 83 (mean of 67 years) with proven prostate cancer, who had a 18Fluorocholine PET/CT done between July 2009 and February 2011. 48 pts were referred due to biochemical recurrence of disease, 10 for initial staging, 7 to confirm and characterize suspicious findings in other imaging modalities, 1 for assessment of response to therapy and 9 pts for re-staging. The serum PSA at the time of the study ranged between 0.01 ng/ml and 115 ng/ml (average of 14.4 ng/ml), and the Gleason score from 5 to 9. The PET/CT scan was carried out after the intravenous injection of 8 mCi (296MBq) of 18Fluorocholine, starting with in an initial dynamic scan of the pelvis at one minute post-injection, and lasting for 8 minutes, followed by additional imaging of the pelvis at 15 and 60 minutes postinjection. At 30 minutes, a whole body scan (from the vertex of the skull to the upper thighs) was also acquired. The CT scan was done without intravenous or oral contrast. Validation of imaging results was obtained from biopsy (directed by PET/CT findings) and/or surgical pathology in 11 cases, conclusive and unequivocal radiological and clinical follow up findings of at least 9 months in other 12 cases, and in 7 cases from the highly characteristic and clear cut findings seen mainly in the CT component of the 18Fluorocholine PET/CT scan. In total, for 30 pts clear cut validation of imaging results could be obtained, 12 of which have had negative conventional imaging results.Results: Of the 30 pts, Fluorocholine PET/CT was positive in 25 and negative in the other 5 pts. All the positive scans, were true positive. In addition, there were 3 true negatives and 2 false negatives. Therefore, Fluorocholine PET/CT had a 92% sensitivity, 100% specificity and an accuracy of 93%.Conclusion: 18Fluorocholine PET/CT in prostate cancer has a high percentage of positive cases, many of them being true positive. It is very useful for the detection of disease in patients with biochemical recurrence, for whom conventional imaging has been negative. In these cases, the PET/CT findings facilitate and guide biopsy sampling to confirm and pinpoint the recurrence of disease, helping -in some cases considerably- with disease management.
P41 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Gynecological
P446 The role of MRI and FDG-PET/CT in detecting recurrence of cervix cancer M. O. Tamam, M. Mulazimoglu, S. Koca, H. S. Yavuz, O. Eker, T. Ozpacaci; Okmeydani Training and Research Hospital, Istanbul, TURKEY. AIM:In gynecological malignancies, conventional morphological imaging modalities, including radiography, ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) are widely used to diagnose recurrent lesions. However, when used alone, these conventional imaging modalities are poor at visualizing small disseminated lesions, small lymph node metastases.The aim of this study is to compare diagnostic accuracy of MRI and 18F-fluoro-2-deoxyglucose positron emission tomography /computed tomography (FDG-PET/CT) for recurrence and assess diagnostic discrepancy between the two modalities in detection of local
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 recurrence and local/ distant lymph node or organ metastasis in patients with cervix cancer.MATERIAL-METHODS:The retrospective study has been conducted on 63 patients (mean age:53,5±11,3) (range 31-78 years) who referred to our department in May 2009 to December 2010 to evaluate cervix cancer recurrence. FDG-PET/CT application was done twice, first for restaging/ recurrence detection and second was for response to treatment.The cervix cancer diagnosis of the patients was obtained from the results of histopathological examination after surgery or biopsy. Treatment of radiotherapy and/or chemotherapy was applied to histopathologically positive patients. FDG-PET/CT was applied to patients with recurrence suspicion due to clinical findings, elevated tumor markers and/or MRI and/or CT modalities in follow up period. Application of FDG- PET/CT and pelvic MRI was within 4 weeks with each other. The patients with abnormal uptake of FDG retreated with radiotherapy and/or chemotherapy. To evaluate the results of the therapy FDG-PET/CT was applied to assess the response to the treatment.RESULTS:Out of 63, 55 patients finally diagnosed as recurrent cervix tumors and /or metastases due to FDG-PET/CT results. The results of the treatment were checked with the control FDG-PET/CT and clinical follow-up. Discordant results between the first FDG-PET/CT and MRI occurred in 8 patients. FDG-PET/CT findings were all negative in these patients whereas 5 of these patients had cervical cancer recurrence findings in MRI, 2 sacroiliac metastasis, and 1 suspicious liver metastase. After the first FDG-PET/CT, no treatment was applied to eight patients. Control PET findings were negative in seven of these patients, while one patient had cervical recurrence, which also showed the false negativity of the first PETCT.The posttreatment FDG-PET/CT results revealed 15 regression, 13 progression, 6 stabile and 28 complete metabolic responseCONCLUSIONS: MRI can play a role in detecting the extent of disease and helps in local staging of cervical tumors. FDGPET/ CT is a more accurate modality for assessing recurrence of cervix cancer and in detecting distant metastatic disease.
P447 The accuracy of 18F-FDG-PET/CT in re-staging endometrial carcinoma M. O. Tamam1, M. Mulazimoglu1, O. Eker1, A. Salman2, T. Ozpacaci1; 1 Okmeydani Training and Research Hospital, Department of Nuclear Medicine, Istanbul, TURKEY, 2Okmeydani Training and Research Hospital,Department of Radiation Oncology, Istanbul, TURKEY. Endometrial carcinoma is the most common gynecologic malignancy in the developed countries. Early and accurate detection of recurrence in patients with endometrial carcinoma has an important influence on therapy, and selection of appropriate treatment strategies can be expected to have a significant impaction overall survival. 18F-fluoro-2-deoxyglucose positron emission tomography /computed tomography (18F-FDG-PET/CT) imaging has proven to be of value for staging, re-staging, planning and monitoring therapy in different cancer patients. The purpose of this preliminary study is to evaluate the value of 18F-FDG-PET/CT in re-staging endometrial carcinoma and to assess the impact of 18F-FDG-PET/CT findings on clinical management.METHODS: 67 consecutive patients (age range 3276 years, mean age 57±10years) who had undergone surgery for histopathologically proven endometrial carcinoma with suspected recurrence underwent 18F-FDG-PET/CT examinations at our institution between January 2010 and March 2011. Out of histopathologically proven 67 patients, 53 endometrioid adenocarcinoma, 9 endometrial sarcoma, 2 serous papillary carcinoma, 1 adenosquamous cell carcinoma, 1 mixed epithelioid carcinoma and 1 case trophoblastic neoplasia.RESULTS: In 30 of the 67 patients, 18F-FDG-PET/CT results were negative whereas in 37 patients had positive signs for recurrence and distant metastasis. The sites of lesion recurrence were: 15 abdominopelvic lymph nodes, 8 local recurrence, 8 peritoneal or omental implants, 8 lungs, 7 supradiaphragmatic lymph nodes, 9 livers, 1 gallbladder, 3 bones, 2 adrenal glands, 1 spleen, 1 rectum, 1 muscle.In well-differantiated and early stage tumors 18F-FDG-PET/CT was negative. In sarcomas and indifferentiated tumors the incidence of recurrance and /or distant metastasis.CONCLUSION: This preliminary study shows that 18F-FDGPET/CT may be an accurate method for the evaluation of recurrence in patients who have been treated for endometrial sarcoma and indifferentiated endometrial carcinoma.
P448 Impact of F-18 FDG PET/CT in pretreatment evaluation of patients with cervical carcinoma B. E. Akkas, B. B. Demirel, G. U. Vural; Ankara Oncology Research and Training Hospital, Department of Nuclear Medicine, Ankara, TURKEY. The aim of this study is to evaluate the impact of F18-FDG PET/CT in pretreatment evaluation of patients with cervical carcinoma.Method: 49 patients with cervical carcinoma underwent FDG PET/CT imaging for pretreatment evaluation and staging. Pelvic and abdominal MRI imaging was performed to 31 patients 2-7 days before PET/CT imaging. The contribution of PET/CT to treatment planning was evaluated and the role of PET/CT in staging was compared to MRI in patients having synchronized pelvic- abdominal MRI.Results: In 15 of 31 patients, PET/CT
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was superior to MRI in the detection of disease extent in terms of metastatic foci. In 16 patients PET/CT did not define more lesions compared to MRI. Other 18 patients did not have synchronized pelvic- abdominal MRI. In 3 of 15 patients, pelvic lymph node metastasis, in 6 patients paraaortic lymph node metastasis and in 1 patient peritonitis carcinomatosa that did not defined by MRI was detected by PET/CT. In patients with paraaortic lymph nodes, radiotherapy planning has changed by PET/CT and included paraaortic boost. In 49 patients, PET/CT found distant metastasis in 9 patients, secondary primer malignancy (thyroid carcinoma) in 1 patient and milimetric lung nodules which are suspected for metastasis in 6 patients. Patients with distant metastasis and peritonitis carcinomatosa received chemotherapy. In overall, PET/CT contributed and changed the treatment plan in 20 of 49 patients (41 %).Conclusion: In cervical carcinoma whilst MRI remains the most common imaging technique for initial primary tumor staging, we consider that PET/CT is highly sensitive to determine the extent of disease. PET/CT has the potential to show lymph node metastasis both in and outside the pelvis, more particularly in the paraaortic region that result in a change of radiotherapy area. PET/CT not only helps to determine the radiotherapy area, but also can successfully detect distant metastasis in patients with cervical carcinoma.
positive, 22/88 negative at PET/CT.- Endometrioid Carcinoma : 29/156 (19%); (A: 38%, B: 44%, C: 13%, D: 5% ); 20/29 positive, 9/29 negative at PET/CT- Mucinous cystadenocarcinoma : 12/156 (7%); (all group A); 8/12 positive, 4/12 negative at PET/CT- Clear cell carcinoma : 14/156 (9%); (all group A); 10/14 positive, 4/14 negative at PET/CT- Sarcoma : 6/156 (4%); (all group A); 4/6 positive, 2/6 negative at PET/CT- Cystoadenocarcinoma : 7/156 (5%); (A: 66.6 %, C: 33.3%); 7/7 negative at PET/CTAll positive scans (110/159 ) were correlated to the different Ca 125 levels:26/108 ( 24%): group A (10 clear cell, 8 mucinous, 3 Endometrioid, 4 sarcomas, 1 Serous papillary)23/108 (21%): group B (6 Serous papillary, 17 Endometrioid)9/108 (8%): group C (4 serous papillary e 5 Endometrioid)50/108 (47%): group D (43 Serous Papillary, 7 Endometrioid)Conclusions : Our study suggests that higher the level of Ca125 the greater the probability to detect metastatic lesions at 18F-FDG PET/CT. However clear cell and mucinous histotypes, can present metastatic disease also in presence of low Ca 125 levels, therefore we propose 18-F FDG PET/CT during follow-up of ovarian cancer in patients with high Ca 125 levels but also in cases with low/undetectable Ca125 levels but clear cell or mucinous histotype, in order to early detect recurrence of the disease.
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The standardized uptake value for F-18 FDG is a sensitive biomarker for the presence of pelvic / paraaortic lymph node metastasis in patients with cervical carcinoma G. U. Vural, B. E. Akkas, B. B. Demirel, Z. Tazeler, N. Ercakmak; Ankara Oncology Research and Trainig Hospital, Department of Nuclear Medicine, Ankara, TURKEY. The objective of this study was to evaluate cervical tumor uptake of F-18 fluorodeoxyglucose (FDG) measured as the maximal standardized uptake value (SUV(max)) by positron emission tomography/ computed tomography (PET/CT) and its association with pelvic and /or paraaortic lymph node metastasis.Method: 62 patients with stage IB through IVB cervical cancer underwent pretreatment FDGPET studies for staging and treatment planning. SUVmax, sites of lymph node metastasis and distant metastasis were recorded.Results: 59 patients had squamous and 3 had nonsquamous carcinoma. According to International Federation of Gynecology and Obstetrics [FIGO] staging criteria, the patients were grouped as stage 1(n:5), stage 2(n:19), stage 3(n:14) and stage 4(n:24). Mean value of SUVmax of the primary tumor was 8.7 in stage 1 patients, 17.1 in stage 2 patients, 18.1 in stage 3 patients and 17.1 in stage 4 patients. No significant difference was observed in tumor FDG uptake expressed as SUVmax according to FIGO stage, p:0.2. 42 of 62 patients (68%) had hypermetabolic pelvic and /or paraaortic lymph nodes suggestive of metastasis in PET/CT studies. Mean value of SUVmax of the primary tumor was 17.9 in patients with lymph node metastasis and 14.01 in patients without lymph node metastasis. Tumoral FDG uptake was significantly higher in patients with lymph node metastasis (p:0.03).Conclusion: Tumoral FDG uptake associates with lymph node metastasis in cervical carcinoma. SUVmax of primary tumor is known as a prognostic biomarker in some tumor types. PET/CT is a sensitive imaging method to successfully detect the metabolic activity of the tumor and lymph node metastasis in cervical carcinoma. FIGO staging is clinical, does not rely on surgico-pathological findings and lymph node metastasis. The lack of association between SUVmax of the tumor and FIGO staging and the association of SUVmax with the presence of lymph node metastasis suggest the need to use PET/CT in treatment planning and primary staging and in cervical carcinoma beyond FIGO staging.
P450 Predictive value of 18F-FDG PET/CT in patients with ovarian cancer; correlation with CA125 values and tumor histotype. Our experience on 156 patients 1
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L. Rampin , S. Chondrogiannis , C. Barile , M. C. Marzola , S. Cittadin , G. Grassetto1, A. Massaro1, F. Pasini2, V. Ambrosini3, S. Fanti3, D. Rubello1; 1 Nuclear Medicine - PET/CT Centre; Santa Maria della Misericordia Hospital of Rovigo, Rovigo, ITALY, 2Oncology; Santa Maria della Misericordia Hospital of Rovigo, Rovigo, ITALY, 3Nuclear Medicine - PET/CT Centre; Policlinico S.Orsola-Malpighi, Bologna, ITALY. Aim : To evaluate the diagnostic value of 18FFDG PET-CT in detecting recurrent disease in ovarian cancer patients, correlated to the serum levels of Ca 125 and the tumor histotype.Materials and methods : In this prospective study (01/200801/2011) 156 ovarian cancer patients (previously treated by surgery and chemotherapy) were evaluated with a WB 18F-FDGPET/CT scan (60 minutes after injection of 2.2 MBq/Kg/b.w.). Patients were subdivided in 4 groups based on the Ca125 values: group A) < a 35 mU/ml, B) 35 - 70 mU/ml, C) 70 - 100 mU/ml, D) > 100 mU/ml. All scans were evaluated by two skillful nuclear medicine physicians and correlated to the Ca 125 values and the tumor histotype.Results : 108/156 (69%) of the scans were positive and 46/156 (30 %) negative. Histotypes and Ca125 levels were correlated to the PET/CT as follows:- Papillary serous cystadenocarcinoma 88/156 ( 56 %); (A: 33% , B: 17 %, C: 8 %, D: 42 % ); 66/88
Value of 18F-FDG FDG-CT in the characterization of ovarian lesions B. Gonzalez, M. E. Bellon Guardia, A. Palomar Munoz, P. Pilkington Woll, M. Talavera Rubio, R. Garrido Esteban, V. Poblete Garcia, J. Cordero Garcia, A. Garcia Vicente, V. Peiro Valganon, J. Mendoza Narvaez, E. Becerra Nakayo, A. Soriano Castrejon; HGUCR, CIUDAD REAL, SPAIN. OBJECTIVE:Study the value of 18F-FDG PET-CT in assessing ovarian lesions and their correct classification as benign or malignant.MATERIAL AND METHODS:We performed a prospective study (PI-2009/39) that included patients who had an ovarian lesion suspicious for malignancy by laboratory (elevated CA125) and / or conventional imaging criteria.All patients underwent a PET-CT study with 18F-FDG following a standard protocol. A lesion was considered as highly suspicious of malignancy when the SUVmáx was ≥ 2.5.The final diagnosis was established by histopathological examination in all cases because all patients underwent surgery (excisional biopsy with or without formal intervention based on intraoperative biopsy results).Finally, we compared the PET-CT results with those obtained with conventional methods.RESULTS:We included 18 lesions belonging to 17 patients. The mean age of those patients was 58 years. Regarding the histology, 10 lesions were benign and 8 malignant.10/18 lesions had a PET-CT study compatible with malignancy. Eight of them were true positive results and no false negative was found.The sensibility, specificity, positive predictive value and negative predictive value of PET-CT were 100%, 80%, 80% and 100% respectively, and in conventional imaging techniques were 84.6%, 45%, 50% and 82%. Finally, the increase of CA125 showed a sensitivity of 85.7% and a specificity of 37.5%.The average SUVmáx in malignant lesions was 9.6 (range: 3.5-27) and in benign 1.7 (range: 0.663.9).CONCLUSION:In our experience, PET-CT with 18F-FDG is the imaging test that shows the best statistical parameters for the assessment of ovarian lesions.Its systematic use may avoid unnecessary interventions if the result is negative, due to its high VPN.
P452 Pelvic lymph node recurrence or lymphocele following surgery of gynecologic cancer: can FDG PET/CT make the difference ? D. Grahek1, J. M. Broglia1, G. De Rauglaudre2; 1Hôpital Henri Duffaut, service de médecine nucléaire, Avignon, FRANCE, 2Institut Sainte Catherine, service de radiothérapie, Avignon, FRANCE. Aim:Lymphocele is a well-known complication following lymphadenectomy, especially after surgery of gynecologic cancers. Sometimes, the radiological images can be inconclusive and cannot differentiate a recurrence of cancer from a lymphocele. Consequently, we have evaluated the ability of FDG PET/CT examination to differentiate these two diagnoses in this clinical setting. Materials & methods:FDG PET/CT was performed in 3 patients suspected of early recurrence of a cervical uterine cancer after a radical hysterectomy and lymphadenectomy. In the first patient, a right leg oedema appeared five months, after surgery. In the second patient, a right pelvic mass was present at the physical examination, three months after surgery. In the two cases, CT or MRI images had shown an uncharacteristic pelvic fluid collection, which could correspond to a necrotic lymph node or a lymphocele. In a third patient, a typical radiological image of lymphocele was visualized, 4 months after surgery, but the CA125 was increased. FDG-PET/CT included a whole body acquisition 1h after FDG injection and a delayed acquisition 2h30 later, centered on abdomen and pelvis. SUVmax was obtained at the active lesion site. Results:In the first and second cases, a high FDG uptake focus, with respectively an early SUVmax of 7 and 8, was visualized in the pelvis. The retention index of the lesion ([delayed SUVmax - early SUVmax] .100 /early SUVmax) was more or equal to 20%. During follow-up, the diagnosis of lymphocele was confirmed in the 2 patients. In the first case, 6 weeks after PET, a CT-guided biopsy was scheduled, but
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the pelvic mass had disappeared on CT images. In the second case, 3 months after PET, a new CT scan was performed. The size of the fluid collection had greatly decreased. In the third patient, no abnormal uptake was visualized. Conclusion:These case reports have shown that FDG uptakes could be observed in lymphoceles with uncharacteristic radiological images. In these cases, FDG PET/CT was not able to differentiate a lymphocele from a necrotic lymph node recurrence of gynecologic cancer. Furthermore, the increasing FDG uptake at delayed time falsely indicated malignant lesions.
P453 Contribution of 18F/FDG-PET/CT in the staging and restaging of ovarian carcinoma. B. Intriago1, M. Danús1, N. Calvo1, C. Trampal1, D. Martin de Barberá2; 1 DIMATGE-CRC Hospital Sant Joan Reus, Tarragona, SPAIN, 2Hospital Sant Joan Reus, Tarragona, SPAIN. INTRODUCTION :The standard treatment of advanced Ovarian Carcinoma (OC) consists of debulking surgery followed by chemotherapy. To ensure the most appropriate pre-operative or salvage management, a correct staging is strongly required.The aim of this study is to assess the roll of FDG-PET/CT in staging and restaging advanced OC.METHODS: We retrospectivly reviewed all patients with OC ( Stage >II) , who were referred to our hospital in the last 2 years to perform a PET/CT-scan for staging or re-staging purposes.We compared the staging accuracy between CT and PET/CT, as well as the influence of PET/CT findings on the further treatment approach.RESULTS: 19 patients underwent an FDG-PET/CT-scan: 8 for staging purposes and 11 for restaging. All patients performed also an abdominal/pelvic-CT.The patients from the staging-group showed more number of lesions on PET/CT compared to CT-scan. PET/CT contributed to a more accurate debulking surgery in patients presenting in particular small paracolic ( n=5/8) and perihepatic implants (n=2/8), but also lymph nodes ( 3/8)A PET/CT scan after debulking surgery showed absence of disease in 3 of the patients, being still free of disease at least 1 year after surgery.The group of patients performing re-staging PET/CT showed in 4/11 patients positive findings despite previous negative CTscan.CONCLUSIONPET/CT was able to detect more lesions than CT in the staging of ovarian carcinoma, rendering a more complete debulking surgery.PET/CT detects earlier than CT-scan sites of recurrence, allowing an earlier salvage therapy.
P454 Reproducibility assessment of a novel image analysis approach for quantification of ovarian cancer on FDG-PET/CT S. Alehashemi1, B. Saboury1, S. Alapati1, F. Hofheinz2, A. Alavi1, D. A. Torigian1; 1University of Pennsylvania School of Medicine, Philadelphia, PA, UNITED STATES, 2ABX, Radeberg, GERMANY. Aim:To assess the reproducibility of a novel image analysis approach for quantification of ovarian cancer on FDG-PET/CT.Materials & Methods:35 women (mean age 64.2±11.9) with ovarian cancer who underwent FDG-PET/CT imaging were retrospectively studied. Tumor metabolically active volume (MAV), SUVmean, partial volume corrected (PVC) SUVmean (cSUVmean), and metabolic volumetric product mean (MVPmean=MAVxSUVmean), and PVC MVPmean (cMVPmean= MAVxcSUVmean) for 400 lesions were quantified by two independent readers using ROVER software (ABX GmbH, Germany). Comparisons of repeated PET measures were then performed using Bland-Altman analysis.Results:Mean differences ± standard deviation (SD) and 95% limits of agreement (LOA) of repeated PET measures of tumor MAV, SUVmean, cSUVmean, MVPmean, and cMVPmean were -0.06±0.7cc (-1.5,1.3),0.001±0.01 (-0.2,0.2), 0.6±3.6 (-6.5,7.6), 0.1±2.3cc (-4.8,4.4), 0.8±10.8cc (-20.5,22.1cc), respectively. The effect of PVC on SUVmean was an average increase of 108%.Conclusions:It is feasible tool to quantify MAV, SUVmean, cSUVmean, MVPmean, and cMVPmean of FDG-avid ovarian cancer lesions on FDG-PET/CT using novel image analysis software. PET measures of tumor MAV, SUVmean, and MVPmean are highly reproducible, whereas PET measures of cSUVmean and cMVPmean are somewhat less reproducible. PVC has a significant effect upon SUVmean quantification.
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clinicopathologic variables, and the relationship between TLG and recurrence was also analyzed. Results: Mean preoperative TLG in the primary tumors were significantly higher in patients with large (>2.0 cm) tumor (p<0.001), invasion of more than half of the myometrium (p=0.020) and presence of lymphovascular space involvement (LVSI) (p=0.009). TLG was significantly different according to FIGO stage (p<0.001) and histologic grade (p<0.001). The median duration of follow-up was 22 months (range 1 to 54 mo) after treatment. TLG was inversely associated with disease-free survival (DFS). Patients were divided into two groups according to TLG (<85.1 vs. ≥85.1). The Kaplan-Meier survival analysis revealed a significant difference in DFS between the two groups (p<0.001). In univariate analysis, TLG (uncategorized value; p=0.004, HR 1.002, 95% CI 1.001-1.003), histologic grade (p=0.015, HR 19.844, 95% CI 1.795-219.328), tumor size (uncategorized value; p=0.009, HR 2.111, 95% CI 1.210-3.685), myometrial invasion (p=0.048, HR 11.241, 95% CI 1.019-124.048) and LVSI (p=0.044, HR 11.845, 95% CI 1.073-130.737) were significantly associated with recurrence. In multivariate analysis, only TLG was significantly associated with recurrence (p=0.015). Conclusions: TLG on a preoperative 18F-FDG was an excellent predictor for recurrence and might be used as a new useful prognostic marker in patients with endometrial cancer.
P456 FDG PET/CT compared with MRI for differentiation between ovarian cancer, low potential malignancy, and benign ovarian tumors T. Okamura1, H. Seura1, Y. Hamazawa1, M. Yamazaki1, T. Murata1, A. Moriyama1, K. Koyama2, Y. Masuoka2; 1Saiseikai Nakatsu Hospital Osaka, Osaka, JAPAN, 2Osaka City University Graduate School of Medicine, Osaka, JAPAN. [Aim] It is important to differentiate between low potential malignancy (LPM), benign tumors, and ovarian cancer in order to plan the resection procedure before surgery. Adnexectomy and/or simple total hysterectomy are adequate for LPMs, with pelvic lymph node resection and omentectomy not being required, unlike cancer surgery. We evaluated the usefulness of FDG PET/CT for differentiation between ovarian tumors in comparison with MRI.[Patients & Methods] Eighteen women (aged 24-84 years, mean: 59.3 years) who had ovarian tumors histologically diagnosed at operation were studied. There were six ovarian cancers (2 clear cell adenocarcinomas, 2 papillary serous adenocarcinomas, 1 mucinous adenocarcinomas, and 1 endometriod adenocarcinoma), six LPMs (3 serous cystic tumors, 2 mucinous cystic tumors, and 1 granulosa cell tumors), and six benign tumors (1 fibroma, 1 fibrothecoma, 1 dermoid cyst, 1 mature teratoma, 2 mucinous cystadenomas, and 1 serous cystadenoma). Tumor markers were measured in all patients. For FDG PET/CT was also performed in all patients, with the early scan (E) at 1 hour and the delayed scan (D) at 2 hours after administration of FDG. Quantitative evaluation was done using SUVmax. MRI was performed within 24 days prior to PET/CT. [Results] CA125 was elevated in all patients with cancer, 3 of 6 with LPMs, and 3 of 5 with benign tumors. FDG uptake was seen in the solid areas of tumors on MRI. SUVmax (E) and (D) of ovarian cancers was 7.10 ±2.07 (mean±SD) and 9.44±2.05, respectively, while the values for LPMs were 2.15±0.36 and 2.15±0.49, respectively. Two of 5 benign tumors had solid areas and the mean SUVmax was 2.90(E) and 3.17(D). Three benign tumors were only cystic without FDG uptake. The SUVmax (D) of cancers was significantly higher than SUVmax (E), while there was no significant difference between SUVmax (E) and (D) for LPMs. SUVmax (E) and (D) values of LPMs were significantly lower than those of cancers and were also lower than those of benign tumors with solid areas. [Conclusion] It is often difficult to differentiate between ovarian cancer, LPM and benign tumors with solid areas on MRI. Tumor markers can be elevated in patients with LPMs and benign tumors as well as those with cancer. FDG PET/CT was useful for differentiating LPM from cancer in this study, because the SUVmax of LPMs was lower than that of cancers and did not increase in delayed scans. However, further investigation is needed to confirm these findings.
P457 Sentinel lymph node biopsy in vulvar cancer: our experience
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Preoperative F-FDG volume-based metabolic parameter as a prognostic marker of recurrence in endometrial cancer H. Lee, B. Ahn, S. Lee, J. Lee; Kyungpook National University School of Medicine and Hospital, Daegu, KOREA, REPUBLIC OF. Purpose: The aim of this study was to evaluate the prognostic significance of preoperative tumor metabolic activity measured as total lesion glycolysis (TLG) by integrated 18F-FDG PET/CT imaging in patients with endometrial cancer. Methods: Between Jul 2006 and May 2010, 52 women (mean age, 53.4±9.9 y) with endometrial cancer, who underwent 18F-FDG PET/CT for preoperative staging workup and followed by primary cytoreductive surgery, were enrolled in this study. TLG is calculated by multiplying the metabolic tumor volume (MTV) by the SUVmean using a 50% isocontour region of interest (ROI). TLG was compared with the various
E. Goñi, C. Estébanez, J. Muruzábal, P. Serra, R. Guarch, A. Camarero, M. Martínez-Lozano; Complejo Hospitalario de Navarra, Pamplona, SPAIN. Objective: The aim of this study is to assess the diagnostic accuracy of the sentinel lymph node biopsy (SLNB) procedure in vulvar cancer.Patients and methods: Between 2001 and 2011, 24 women with vulvar cancer, clinical stages I and II, were included in the study and treated with sentinel lymph node (SLN) removal after injection of 99mTc-labeled rhenium colloid. The day before the surgery a lymphoscintigraphy was performed, with dynamic and static images. For the last 2 years we have been including a tomographic scan (SPECT-CT). A hand-held gamma probe was used to find the SLN in the surgery theatre. Subsequently, in all women a complete inguinofemoral lymphadenectomy and the adequate vulvar surgery were performed. SLN were examined by routine pathologic examination (H&E), followed by immunhistochemistry if negative.Results: The mean age of the patients
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was 70.75 years (range 43-85). Histologically, 22 were squamous carcinoma and 2 verrucouse, 6 of them at the mid-line, size range from 0.90 to 6.50 cm (mean 2.7±1.3). The SLNB was successful in 21 out of 24 cases, in 3 cases no sentinel nodes were detected, therefore the overall detection rate was 87.5%. In one of them, the lymphadenectomy showed metastasized nodes in both inguinal areas. In 15 patients we found migration to a single inguinal area and in 6 to both of them. 38 sentinel lymph nodes were excised, median 2 (range 1-4), 6 of them were positive corresponding to 5 patients (23.8%) because in one case both inguinal areas were affected. There was one false negative case (4.7%) in a patient with mid-line tumour who presented a SLN in one groin and whose bilateral lymphadenectomy was positive in both. Infiltrated nodes were not found in the rest of the performed lymphadenectomies. Conclusions: Lymphoscintigraphy is a relatively simple and useful technique to identify the SLN in this kind of tumours. The results presented, corresponding to the learning curve of our team, emphasize the importance of each methodological aspects of this procedure in order to obtain the best results.
organ metastases were infrequent. However FDG PET did not identify a reason for tumor marker elevation in ~20% of the patientsOrgan metastases are relatively easy to identify on conventional imaging. Conversely, lymph node involvement on CT is size dependent and more difficult to assess even with contrast enhancement, but is easily delineated by FDG PET/CT and appear to be the primary source of elevated SCC levels where other imaging techniques fail to localize disease. In case FDG PET do not localize malignant foci other non-malignant causes of SCC elevation should be considered, with non-recognized malignancy being always the primary concern.
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AimTo evaluate the role of the sentinel node biopsy in endometrial cancer at initial stages.Material and methodsProspective study (PI-2009/31) that includes 19 patients with clinical stage I-IIIa endometrial cancer. An injection of 2 mCi of 99mTc-nanocoll, in two opposite sites of the uterine cervix, was carried out in order to identify the sentinel node. Planar and SPECT-CT images of the pelvis were obtained 30 min later, completed with delayed images 16h after when the identification of the sentinel node was no possible.A surgical gamma-probe was used intraoperatively in order to identify the sentinel node.Immediately before the surgery, blue dye was injected also in the cervix, as an aid in the identification of the sentinel node.In all patients was performed histerectomy, plus double anexectomy and pelvic lymphadenectomy, being both the sentinel nodes and the lymphadenectomy histologically studied with conventional staining, using haematoxiline and eosine.ResultsIn 17/19 patients at least 1 sentinel node was found intraoperatively (detection rate 89,5%). Only in two patients was not possible to find a sentinel node, whilst 1 node was identified in nine patients, two in six patients and 3 or more in the rest.The histological examination revealed no metastatic involvement in any sentinel node (28 out of 28), being also negative the lymph nodes included in the lymphadenectomy specimen (negative predictive value of sentinel node=100%)ConclusionsThe sentinel lymph node biopsy technique seems to be a feasible tool in the staging of endometrial cancer at initial stages, with reasonably good detection rate and histological correlation.The low prevalence of lymphatic spread in this group of patients and the encouraging results obtained could make the sentinel lymph node in the nearer future an alternative to systematic complete lymphadenectomy.
J. Pilkington Woll1, C. López de la Manzanara2, J. Cordero García2, A. García Vicente2, A. Palomar Muñoz2, V. Poblete García2, B. González García2, M. Bellón Guardia2, E. Becerra Nakayo2, Á. Soriano Castrejón2; 1 Hospital General de Ciudad Real, Ciudad Real, SPAIN, 2Hospital General de Ciudad Real, Madrid, SPAIN. AimTo evaluate the potential utility of 18FDG-PET-CT in the presurgical evaluation of early stage endometrial cancer.Material and methodsProspective study (PI2009/31) that includes 16 patients with endometrial cancer histologically proven, at clinical stage I-IIIa. All of them were clinically and radiologically evaluated before surgery, and underwent a conventional PET-CT study. Delayed 3 h images of the pelvic area were obtained when necessary. The images were visually and semiquantitatively (SUVmax) evaluated, being defined as positive uterine study when any area of increased glucose consume was detected. Node were defined as positive when SUVmax>2.5, or when SUVmax was <2.5 but diameter was <10 mm and increased its SUVmax in the delayed study.In all patients was performed histerectomy, double anexectomy and pelvic lymphadenectomy, with histological study of the surgical specimens.ResultsIn 5 out of 16 patients (31%), the initial stage was modified after the PET-CT study. Two of them were downstaged, whilst the initial stage rose in other two and the remaining one showed an unexpected recurrence of a previous cancer, considered in complete remission.Only one of these five patients was finally considered as a false positive result. No false negative results were found.ConclusionsThe 18FDG-PET-CT seems to show a good correlation with the final histological staging in early stage endometrial cancer. Thus, the presurgical implementation of this technique could improve the presurgical knowledge of lymphatic and locoregional extension, and it allows the detection of unexpected synchronic tumours.
P459 FDG-PET/CT findings in patients with cervical cancer and elevated serum SCC levels P. H. Bochev1, B. Chaushev1, J. Dancheva1, Y. Bocheva1, A. Klisarova2; 1St. Marina hospital, Varna, BULGARIA, 2Medical University, Varna, BULGARIA. Elevated levels of a tumor marker with lack of localized disease on imaging is a typical clinical situation, indicated for FDG-PET/CT in case of FDG avid tumors. SCC ( squamous cell carcinoma antigen) is the preferred tumor marker in the surveillance of uterine cervix carcinomas. Although not specific for cervical cancer , high levels of the marker are at a high degree indicative of recurrence or progressive disease. However the source of marker elevation is not always identified by conventional imaging proceduresAim of our study was to evaluate the role of FDG PET/CT in patients, treated for cervical cancer, who present with elevated SCC levels and no imaging evidence of disease.Materials and methods: Files of all cervical cancer patients, referred for FDG PET/CT in our center were retrospectively reviewed. In 16 patients (49,8+/-9,9 years old) the primary indication for referral was elevated SCC levels at surveillance (SCC-4,6+/-2,8μg/L). All patients were treated with surgery and radiotherapy, two patients had received chemotherapy. All patients had undergone at least CT of pelvis and abdomen and chest x-ray which were read as negative. All patients underwent a whole body FDG PET/CT (Phillips GeminiTF).Results: In 9 patients FDG PET identified only hypermetabolic lymph nodes suggestive of malignancy. One of the patients presented with a single iliac lymph node and another with supraclavicular lymph nodes (both findings are biopsy proven to be metastatic). One patient had a single lung metastasis (missed on x-ray). Two patients had liver metastases, two had peritoneal metastases and one had pelvic recurrence. Three patients with high SCC did not show any focal FDG uptake, suggestive or suspicious for malignancy, including the patient with the highest SCC level (13.3)Conclusion. The most common finding on FDG PET of patients with elevated SCC levels were hypermetabolic lymph nodes. Localized
Sentinel node in endometrial cancer at initial stages. P. Pilkington Woll, C. López de la Manzanara, J. Cordero García, M. Talavera Rubio, M. Bellón Guardia, A. Palomar Muñoz, V. Peiró Valgañón, J. Mendoza Narváez, A. García Vicente, Á. Soriano Castrejón; Hospital General de Ciudad Real, Madrid, SPAIN.
P461 Reliability of sentinel node biopsy in early stage vulvar carcinoma O. Puig Calvo, M. Bajén, A. Rodriguez-Gasén, P. Notta, Y. Ricart, A. Sabaté-Llobera, J. Ponce, J. Martín-Comín; Hospital de Bellvitge, L'Hospitalet de Llobregat, SPAIN. Aim:To analyze nodal recurrence in early stage vulvar cancer operated patients and selective sentinel node biopsy.Materials and methods:30 patients (aged 62-93 years, mean 76) affected of vulvar carcinoma (clinical stage T1 and T2 N0) were studied retrospectively between 2006 and 2011. Lymphoscintigraphy was performed with 111MBq 99mTc-nanocolloid. The sentinel node (SN) was involved in 11 (37%) patients and 4 of them underwent regional lymphadenectomy; in the other 7 patients it was not performed due to comorbidity. pN0 patients did not received any additional treatment on regional lymph nodes region.Factors analysed: scintigraphic and surgical detection of the SN, metastatic involvement of de SN and regional limphadenectomy (when performed), and lymph node recurrence in pN0 patients.Follow-up: clinical, radiological and histopathological regular exams. Mean follow-up 23 months (4 59 months).Results:Lymphoscintigraphy showed regional lymphatic drainage in all patients and modified the surgery on 9 out of 30 patients (30%): 8/26p (30%) having unilateral lesions showed bilateral drainage and 1/4 (25%) having bilateral lesions showed unilateral drainage.Surgical detection was 100%. All patients with bilateral drainage on lymphoscintigraphy had also bilateral surgical detection.The SN was negative in 19p (63%), none of which had nodal recurrence during the follow-up. The SN was positive in 11p (37%), regional lymphadenectomy was performed in 4 of them, being positive in 1 patient.Conclusion:Lymphoscintigraphy is a useful technique in the surgical planning in patients with early stage vulvar cancerSN analysis is a reliable technique to study regional nodal involvement in early stage vulvar cancer patients.
Poster Presentations
Clinical impact of PET-CT in staging of endometrial cancer at initial stages.
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P462 18F-FDG PET/CT in Institution experience.
P464 gynecologic
malignancies:
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Role of FDG PET-CT in post therapy patients with uterine sarcomas
M. Dalla Palma1, M. Gregianin2, L. Evangelista2, A. R. Cervino2, G. Saladini2, L. Borgato1, M. O. Nicoletto1, V. Zagonel1; 1Medical Oncology Unit 1 - Oncologic Institute of Veneto IOV-IRCCS, Padova, ITALY, 2Radiotherapy and Nuclear Medicine Unit - Oncologic Institute of Veneto IOV-IRCCS, Padova, ITALY.
P. Sharma, H. Singh, S. Jeph, C. Bal, A. Malhotra, R. Kumar; All India Institute of Medical Sciences, New Delhi, INDIA.
Aim of the study: in the last years a growing consensus has consolidated PET/CT with 18F-fluorodeoxyglucose (FDG) as one of the most important diagnostic tools in numerous malignant tumors for staging, assessing prognosis, therapy monitoring, detection of recurrence and follow-up. Our aim was to report our Institute experience in the use of 18F-FDG PET/CT in the management of gynecologic cancer.Patients & Methods: We evaluated retrospectively 116 patients (pts) affected by cervical, uterine corpus and ovarian cancer who underwent FDGPET/CT imaging at IOV-IRCCS between 2005 and 2010. The indications were: a) suspicion of recurrence based on clinical symptoms, raise of CA-125 serum level above 35 U/ml and/or uncertain conventional imaging (CI), b) assessment of therapy response, c) follow-up. The results from PET/CT were correlated with findings from biopsy, surgery, CI (CT, MRI, US) and/or with patient clinical follow-up for at least 6 months. We used a dedicate PET/CT scanner (Biograph 16 by Siemens Medical Solutions, Illinois, USA); the patients fasted at least 6 hours before i.v. injection of tracer (3 MBq of 18F-FDG/kg/bw) and the scans were performed 60-75 minutes after. The sensitivity (Sen), Specificity (Spe), Positive and Negative Predictive Values (PPV, NPV) were calculated on patient-based analysis.Results: The primary tumor was ovarian cancer in 88 patients (76%), uterine cancer in 19 (16%) and cervical cancer in 9 (8%); the median age was 56 years (range 20-82). All patients had been treated with curative intent according to FIGO stage. In patients evaluated for assessment of relapse (67) we obtained: Sen of 98.3%, Spe of 83.3%, PPV of 98.3% and a NPV of 83.3%. In pts evaluated for assessment of treatment response (30 pts): Sen of 75%, Spe of 88.8%, PPV of 81.8% and NPV of 84.2%. In 19 pts evaluated during follow-up there were not true positive results and so we obtained a Spe of 89.4% with a NPV of 100%.Conclusions: In this retrospective study the greatest utility of 18F-FDG PET/CT was seen in the clinical scenario of suspected cancer recurrence. PET/CT was helpful in defining the extent of metastatic disease, including normal-sized pelvic and/or retroperitoneal lymph nodes, and in unsuspected distant sites. As a result, PET/CT allows a better disease restaging and optimization of treatment, especially in case of single metastatic lesion that could be surgically treated. On the other hand PET/CT does not seem useful in routine follow-up for the relatively high number of false positive.
P463 Renoscintigraphy as a useful method in monitoring renal function in the patients with FIGO II-III stage cervical cancer. M. Benke, J. Niewiadomska, A. Garszel, I. Kozlowicz-Gudzinska; Maria Sklodowska-Curie Memorial Cancer Center, Warszawa, POLAND. Cervical cancer (CC) is one of the most common neoplastic diseases affecting women. Renal dysfunction in patients with cervical cancer may be associated with paraneoplastic syndrome and treatment nephrotoxicity (radiotherapy or radiochemotherapy).Objective:The aim of this study was to assess the value of renoscintigraphy for monitoring kidney function in patients with CC, and to determine the correlation between the results of radioisotope studies and selected clinical and biochemical parameters.Materials and methods:The study enrolled 148 patients with cervical cancer in FIGO stage II and III. Dynamic renal scintigraphy with 99Tc-DTPA was used for the evaluation of glomerular filtration rate (GFR). All patients were tested twice: before treatment and immediately after radiochemotherapy. We adopt the filtration rate of 60 ml/min/1, 73m 2 , recommended by the Kidney Disease Outcome Quality Initiative, as the lower limit of normal GFR. On this basis patients were divided in two groups: I - with reduced GFR (N = 39), representing 26.4% of respondents and II - with normal renal function (N = 109). Factors that may affect the GFR values were analyzed: levels of serum tumor markers (SCC and CEA) , types of external beam radiotherapy, brachytherapy, and total dose of cisplatin.Results:We observed increased GFR values after treatment (more strongly expressed in Group II, p<0.02) probably due to radiation induced active hyperemia in retroperitoneal organs. We found statistically significant correlation between EBRT with 15 MeV and reduction in GFR (p<0,005). Greater impairment of GFR was observed in the right kidney. It was also found that higher serum level of CEA correlates with impaired renal function (p<0,05). We didn’t observe correlation between GFR values and the total dose of cisplatin.Conclusions:In 26,4% of patients in the study GFR values before treatment were below the normal range.Lower GFR values are correlated with high serum levels of CEA and 15MeV external beam radiotherapy.Renoscintigraphy allows simple, safe, accurate and reproducible assessment of renal function in patients with cervical cancer. Early kidney failure detection in this group is an important information that may affect the therapy.
Aim: Uterine sarcomas are rare tumors with poor prognosis. Even with early and appropriate primary therapy most of the patients have recurrence. The aim of the present study was to evaluate the efficacy of 18F-flurodeoxyglucose (18-FDG) positron emission tomography computed tomography (PET-CT) for detecting recurrence in post therapy patients with uterine sarcoma.Methods: Total 13 FDG PET-CT studies were done in 11 post therapy patients with histopathologically proven uterine sarcomas. PET-CT studies were acquired 45-60 minutes after intravenous injection of 370MBq of FDG. PET-CT studies were evaluated by 2 experienced nuclear medicine physicians in consensus. All the patients also had underwent conventional imaging (contrast enhanced CT/MRI of chest, abdomen and pelvis). Result of FDG PET-CT was compared to conventional imaging. Clinical/imaging follow up (minimum 4 months) and/or histopathology were taken as reference standard.Results: The median age of patients was 54 years (Interquartile range: 50-53.5). The primary tumor was leiomyosarcoma in 5 patients, carcinosarcoma (malignant mixed mullerian tumor) in 5 and endometrial stromal sarcoma in 1 patient. Five PET-CT studies were done for suspected recurrence on conventional imaging, while remaining 8 were done for routine surveillance. On reference standard local recurrence was seen for 3 studies, nodal disease for 2 studies and lung metastasis for 1 study. The sensitivity, specificity and accuracy of FDG PET-CT were 100%, 100% and 100% respectively on per study basis and, 85.7%, 100% and 90% on per lesion basis. The sensitivity, specificity and accuracy of conventional imaging were 100%, 85.7% and 90% respectively on per study basis and, 100%, 85.7% and 92% on per lesion basis. No significant difference was found between FDG PET-CT and conventional imaging either on per study or per lesion basis. However, FDG PET-CT missed the pulmonary metastasis because of the low uptake and small size on lesions.Conclusion: FDG PET-CT has high sensitivity and specificity for detecting recurrent disease in post therapy patients with uterine sarcoma. However, it provides no significant benefit over conventional imaging alone.
P42 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Colon Cancer & Liver
P465 Comparison of Serum CEA and FDG-PET/CT on Detection of Recurrent Colorectal Cancer N. Peng, C. Hu, T. King; Kaohsiung Veterans General Hospital, Kaohsiung, TAIWAN. Elevation of the serum CEA has been shown to be a tumor marker of recurrent colorectal cancer (CRC). This study is proposed in order to evaluate the ability of FDG-PET/CT for early detection of recurrent CRC in patients with elevation of serum CEA or clinical or radiologic suspicion of recurrence.Materials & methods: We retrospectively collect patients with prior CRC. FDG-PET/CT was performed due to serum CEA >5 ng/ml and low-level increase of serum CEA (Group 1), or various reasons without rise of serum CEA (Group 2). The sensitivity, specificity and accuracy of the serum CEA and FDG-PET/CT were calculated based on the results of pathology, other modalities, disease progression and/or clinical follow-up.Results: Eighteen of the 48 consecutive patients were proven recurrent, 2 tubular adenomas and a second primary cancer with no evidence of recurrent CRC. In Group 1 (n=23), FDG-PET/CT detected 13 recurrent cancers but a false positive lesion of a tubular adenoma. In Group 2 (n=25), FDG-PET/CT detected 5 recurrent cancer but a false positive lesion of a second primary cancer. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 72.22%, 50%, 56.52%, 80% and 68.75% for serum CEA, and 100%, 93.33%, 90%, 100% and 95.83% for FDG-PET/CT, respectively. The intended management was changed in 21 patients (43.75%).Conclusions: Serum CEA is a tumor marker of recurrent CRC with limited sensitivity and specificity. FDG-PET/CT has the ability to localize the recurrent lesions and other malignant tumors. We concluded that FDGPET/CT should be used to detect recurrent CRC in combination with serum CEA and/or other modalities.
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Clinical Impact of FDG PET-CT on Management Decisions in Patients with Primary Hepatobiliary Tumours R. Albazaz, C. Patel, F. Chowdhury, A. Scarsbrook; St James University Hospital, Leeds, UNITED KINGDOM. AimTo review the impact of FDG PET-CT in the management pathway of patients with primary hepatobiliary malignancy.Materials and MethodsConsecutive patients with primary hepatobiliary tumours undergoing FDG PET-CT at a single large tertiary referral centre between November 2007 and September 2010 were retrospectively analysed. Scan indication, findings on PET-CT compared to conventional imaging and impact on subsequent patient management were evaluated. Clinical impact was divided into: Major: Detection of occult disease or characterisation of indeterminate lesion(s) on conventional imaging; Minor: Confirmation of suspected metastases seen on conventional imaging; No impact.Results130 patients underwent 137 PET-CT scans during the study period (mean age 66 years, range 24-87) including 81 patients with cholangiocarcinoma (49 intrahepatic, 32 extrahepatic), 32 with gallbladder carcinoma and 17 with hepatocellular carcinoma.99 scans were performed for initial staging, 5 scans for restaging following chemotherapy prior to consideration of radical surgery and 33 scans for assessment of suspected disease recurrence. Comparison was made with contemporary cross-sectional imaging.In 37 cases (27%) PET-CT had a major impact on subsequent patient management (26% of intrahepatic cholangiocarcinomas, 18% of extrahepatic cholangiocarcinomas, 29% of hepatocellular carcinomas, and 36% of gallbladder carcinomas). 12 patients had occult metastatic disease, 7 had unsuspected lymph node involvement and 8 had both. In a further 8 patients, PETCT clarified indeterminate lesions seen on cross-sectional imaging as either malignant (1 patient) or benign (7 patients). 2 patients were found to have incidental synchronous primary cancers (rectal and gastric). PET-CT had a minor impact in 17 cases (12%) and no impact in 83 cases (61%).Conclusion FDG PET-CT has a valuable role in the management pathway of primary hepatobiliary tumours and helps triage patients to the most appropriate treatment. By improving staging accuracy and characterising indeterminate lesions, FDG PET-CT can have a major influence on clinical decision making in patients with primary hepatobiliary malignancy.
P467 PET-CT in metastatic liver tumor of unknown origin verification of primary diagnosis, influence on final diagnosis and place in diagnostics algorithm P. Piwkowski, A. Kołodziejczyk, J. Żebrowski, A. Macioszek; Lower Silesian Center of Nuclear Medicine, Wroclaw, POLAND. Aim: the aim of the study is to report the influence of PET-CT on final diagnosis in patients withmetastatic liver tumors examined to locate the primary tumor.Method: between June 2007 and April 2010 28 patients with metastatic lesions in liver or liver andbones were examined in Lower Silesian Center of Nuclear Medicine. All patients hadcytologically or histopathologically confirmed metastases of adenocarcinoma (21 patients)or undifferentiated carcinoma (2 patients). One patient had histopathological suspicionof hepatic cellular cancer and the other one of cholangiocarcinoma. All of them werereferred to the Center to locate the primary tumor. The patients were examined on hybridPET-CT GE Discovery 60minutes after intravenous administration of 5MBq/kgb.m. 2-[F-18]fluoro-2deoxy-D-glucose.Results: In 23 patients PET-CT images suggested liver or bile tract as a primary location of a tumor.Five of these patients undergone second biopsy which confirmed hepatic cellular carcinomain one case and cholangiocarcinoma in 4 cases. Five patients were referred to palliativetreatment without further examinations. In two patients primarily suspected of hepaticcellular carcinoma and cholangiocarcinoma PET-CT scans were consistent with pathologicaldiagnosis. No further data was available in eleven cases because of death of thepatients.PET-CT changed the initial diagnosis in at least 22% of examined individuals. PETCTconfirmed diagnosis in two patients with hepatic cellular carcinoma andcholangiocarcinoma.Conclusions:1. PET-CT is a potentially reliable tool of verification primary diagnosis in patients withmetastatic liver tumors and unidentified primary tumor in other examinations.2. Normal fluorodeoxyglucose distribution apart from lesions in liver or liver and bones with subsequent confirmation of hepatic or bile tract origin of tumor in all patients with available follow up confirms high negative predictive value of this method for adenocarcinomas which are a potential source of hepatic metastases.3. PET-CT should be considered in all patients with hepatic lesions suggestive of metastases and lack of primary tumor in other imaging or endoscopic procedures. The authors suggest that the examination should be carried out before referral to biopsy.
P468 Utility of 18 F FDG PET-CT in detecting recurrence after interventional therapy of unresectable hepatocellular carcinoma
P. Sharma, R. Kumar, H. Singh, M. Patnecha, S. Jeph, C. Bal, A. Malhotra; All India Institute of Medical Sciences, New Delhi, INDIA. Introduction: Interventional therapy forms an important component of management of unresectable hepatocellular carcinoma. However, majority of these patients develop recurrent disease. The aim of present study was to evaluate the role of FDG positron emission tomography computed tomography (PET-CT) for the detection of local and extrahepatic recurrence in patients with HCC previously treated with interventional therapy.Material and methods: Twelve previously treated patients with suspected recurrence of HCC (clinical suspicion and/or elevated alpha fetoprotein [AFP]) underwent FDG PET-CT. All were unresectable histopathologically proven HCC treated with interventional therapy (transarterial chemoembolisation [TACE]-9 and radiofrequency ablation [RFA]-3). They also underwent conventional imaging [CI] (contrast enhanced computed tomography [CECT]/ magnetic resonance imaging [MRI] and ultrasonography [USG]). FDG PETCT was evaluated by two nuclear medicine physicians and looked for local recurrence and distant metastasis.Results: The median age was 52 years; range-3064. AFP levels were elevated in 11 patients (mean-546.5±881.5 ng/ml) and normal in 1 patient. CI was positive for recurrence in 10/12 patients. CI showed local recurrence in 8/12, bone metastasis 1/12, pleural metastasis 1/12 and peritoneal metastasis 1/12. FDG PET-CT was positive for recurrence in 7/12 patients. FDG PETCT showed local recurrence in 6/12, lymph nodal metastasis in 3/12 and peritoneal metastasis in 1/12 patients. The sensitivity and specificity of CI for detecting local/distant recurrence was 85.7% and 20% respectively, while that of FDG PET-CT for detecting local/distant recurrence was 100% and 100%. FDG PET-CT was specifically better in detecting lymphnodal metastasis.Conclusion: These preliminary results show that FDG PET-CT can be used with high sensitivity and specificity for detecting recurrence in patients with HCC previously treated with interventional therapy.
P469 Interim report of a Phase I study on pretargeted radioimmunotherapy (PT-RIT) in patients with colorectal cancer (CRC) R. Schoffelen1, O. C. Boerman1, W. T. A. van der Graaf1, C. van Herpen1, R. Sharkey2, W. J. McBride3, C. H. Chang3, C. H. Chang3, E. Rossi4, D. M. Goldenberg2, W. J. G. Oyen1; 1Radboud University Nijmegen Medical Centre, Nijmegen, NETHERLANDS, 2Center for Molecular Medicine and Immunology, Belleville, NJ, UNITED STATES, 3Immunomedics, Morris Plains, NJ, UNITED STATES, 4IBC Pharmaceuticals, Morris Plains, NJ, UNITED STATES. Objectives: PT-RIT is investigated in this phase I clinical trial to determine the optimal dose schedule using a humanized recombinant bispecific monoclonal antibody, TF2, directed against CEACAM5 and the hapten, histamine-succinylglycine (HSG) in combination with the 177Lu-labelled di-HSG-DOTA peptide IMP288 (DOTA-Gly-Lys(HSG)-Tyr-Lys(HSG)-NH2) in advanced CRC patients.Methods: The intervals between the infusion of 75 mg TF2 and the i.v. injection of 100 µg 177LuIMP288 were 5 days (n=5) in the first cohort and 1 day (n=5) in the second cohort. Patients in the third cohort (n=5) received 150 mg TF2 and 1 day later 100 µg 177Lu-IMP288. A pre-therapy cycle with 111In-labelled IMP288 was used to predict the radiation dose of 177Lu and assure safety of high 177Lu doses (1st and 2nd cohorts of 3.7 and 7.4 GBq, respectively). Toxicity was determined by NCI-CTC v3.0. Whole-body planar scintigraphy and SPECT were acquired up to 3 days post injection (p.i.).Results: In all cohorts TF2 administration was safe, with only mild grade-2 infusion reactions in 5 patients, that were controlled with antihistamines and corticosteroids. TF2 cleared rapidly from the blood, with <1% ID in the blood 1 day p.i., as did 111In/177Lu-IMP288 (1st, 2nd and 3rd cohorts of 0.014, 0.25 and 0.12 % ID/L in the blood 1 day p.i.). Known tumour masses was visualized, with some kidney retention and no evidence of targeting of any other normal tissue. Absorbed kidney doses for the 3 cohorts were 0.21, 0.42 and 0.28 mGy/MBq and red marrow doses were 0.011, 0.032 and 0.044 mGy/MBq, respectively. Bone marrow toxicity was very mild, apart from one grade 4 thrombocytopenia in the 2nd cohort, with fast and complete recovery.Conclusion: These first results confirm that CEACAM5-expressing CRC can be targeted with TF2 and 177Lu-IMP288 with minimal radiation exposure to normal organs, which allows for a multiple-dosing strategy.
P470 Intra-arterial radioembolization with Y-90 for unresectable primary and metastatic liver tumors and evaluation of treatment response by FDG PET/CT. O. N. Kucuk, C. Soydal, S. Lacin, E. Ozkan, M. Araz, E. Ibis; Ankara University, Medicine Faculty, Ankara, TURKEY. Aim: The aim of this study was to evaluate the success of SIRT treatment in liver metastases of different tumors. Also we interpreted the contribution of SIRT treatment to survival times according to responder- nonresponder and hepaticextrahepatic disease.Method: The clinical and follow-up data of 124 patients who
Poster Presentations
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S372 were referred to our department for SIRT treatment between June 2006 and October 2010 were evaluated retrospectively. SIRT treatment has been applied in 78 patients who were suitable for treatment. All patients had unresectable liver metastasis of different malignancies (35/78 colorectal, 25/78 hepatocellular, 7/78 gastric, 4/78 breast, 1/78 malign melanoma, 1/78 pancreas, 1/78 renal cell, 1/78 esophagus and 3/78 neuroendocrine tumor patients). Treatment was repeated at least one more time in 5 patients to same or other lobe. Treatment response evaluated by PET/CT as metabolically 6 months after treatment. FDG-PET/CT was repeated in per six weeks periods. The response criterion which had been described recently was accepted as at least 20% decrease of SUV value. Also in patients with neuroendocrine tumor serial Ga-68 PET/CT was used for evaluating response. Patients were divided into 2 groups according to treatment response (R=responder, NR=non-responder) and also into two groups according to disease stage; patients have only liver metastases (H) and have metastases in other organs (EH).Results: 68 patients received treatment for right lobe, seven patients received treatment for eft lobe and 3 patients for both lobes. The mean treatment dose was estimated as 1.62 GBq. In the evaluation of treatment response; 43(55%) patients were responder (R) and 35 (45%) patients were non-responder (NR). Mean pretreatment SUVmax value of R group was 11.6 and NR group was 10.7. While only 11 (31%) out of 35 NR patients had H disease, 30 (69%) out of 43 R patients had H disease (p<0.05). Mean overall survival time of R group was calculated as 25.63+1.52 months and NR group’s 20.45+2.11 (p=0.04). Mean overall survival time of H group was computed as 25.66+1.52 months and EH group’s 20.76+1.97 (p=0.09).Conclusion: SIRT is a useful treatment method which can contribute to lengthening of survival times in patients with primary or metastatic unresectable liver malignancies. Also 18F-FDG PET/CT is seem to be a successful imaging method in evaluating treatment response for predicting survival times in this patient group.
P471 Frequency and pattern of obstructive colitis proximal to colorectal cancer on FDG PET/CT J. Oh1, Y. Park2, H. Park1, I. Yoo1, S. Kim1; 1Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, KOREA, REPUBLIC OF, 2St Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, KOREA, REPUBLIC OF. AimThis study was performed to determine the frequency and patterns of obstructive colitis (OC) seen on PET/CT of patients with adenocarcinoma of the colon.Materials and methodsPreoperative PET/CT and enhanced abdominal CT scans of 308 patients with surgically proven adenocarcinoma of the colon were retrospectively reviewed for the presence of colon obstruction and OC proximal to the colon adenocarcinoma. The frequency, distributions, patterns and SUVmax of OC were evaluated on PET/CT. Colonoscopic findings were also reviewed for possible synchronous lesion proximal to the colon cancer.ResultsOf 308 patients, PET/CT of 29 (9.4%) showed OC. Mean SUVmax of OC was 3.6±2.2. OC was contiguous to the tumor in 23 patients (79.3%) and noncontiguous in six (20.7%). OC was segmental in 16 (55%) patients and pancolonic in 13 (45%). Abdominal CT showed bowel obstruction with or without colon wall thickening in all cases. On colonoscopy, nine proximal polyps were detected in seven out of 29 (24.1%) patients. Of these, seven proximal polyps were removed before PET/CT scan while remaining two were masked by OC on PET/CT scan.ConclusionOC is always associated with colon obstruction, and is predominantly contiguous with the obstructing adenocarcinoma. OC may mask synchronous proximal colonic lesions on PET/CT scan.
P472 Do Age, Gender and Hounsfield Unit Affect The SUVmax of The Liver and Spleen ? M. Aras, F. Dede, T. Öneş, S. Inanır, T. Y. Erdil, H. T. Turoglu; Marmara University School of Medicine Nuclear Medicine Department, İstanbul, TURKEY. Aim: The aim of the current study was to investigate whether the SUVmax of the liver and spleen changed with the age, gender and Hounsfield Unit (HU).Methods:A total of 107 cancer patients (58 female, 49 male) referred for initial staging with FDG PET/CT were included in this retrospective study. None of the patients received prior chemo-radiation therapy. The patients with focal or diffuse liver and/or spleen involvement were excludued from the study. The SUVmax and HU of the liver and spleen and liver/spleen SUVmax ratios were obtained. The effect of age, gender and HU on the the SUVmax of the liver and spleen were analysed.Results:The mean age (female:57.8±14.5, male:56.6±14) were similar in both gender (p>0.05). The mean SUVmax of the liver and spleen and the liver/spleen SUVmax ratio in women (3.6±0.7, 3.0±0.5, 1.3±0.2 respectively) were significantly higher than in men (3.2±0.6, 2.7±0.4, 1.2±0.1 respectively) (p<0.05). There is no statistical difference in terms of the mean HU of the liver (female:56.6±10.2, male:58.2±9.7) and spleen (female:53.8±5.3, male:54.3±5.8) between 2 gender (p>0.05). Although there is no correlation between the age and the mean SUVmax of the liver, the mean SUVmax of the spleen increased with the
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 age in females (r:0.4, p<0.05). There was a negative correlation between the age and the liver/spleen SUVmax ratio in women (r:-0.3, p<0.05). There is no correlation between the age and the mean SUVmax of the liver and spleen and liver/spleen SUVmax ratio in males. In both gender, although the mean HU of the spleen decreased with the age (r:-0.3, p<0.05), age didn’t affect the mean HU of the liver. Additionally no significant relationship was observed between the SUVmax and HU of the liver and spleen in both gender.Conclusion:The liver is still used as a gold standard reference point in available guidelines like PERCIST. On the other hand measurements belong to liver and spleen are used in differentiating spleen pathologies. In our study, the glycolytic activity of the liver and spleen in females were significantly higher than males. In females, while the mean SUVmax of the spleen increased with the age, the liver/spleen SUVmax ratio decreased. The age had a negative effect on the mean HU of the spleen in both gender. These patient based variabilities must be considered in both clinical studies and research trials.
P473 18FDG PET/CT evaluation in diagnosis and follow up of patients with hepato-cellular carcinoma A. Notaristefano, F. Iuele, A. Niccoli Asabella, D. Rubini, G. Rubini; Nuclear Medicine Unit-Di.M.I.M.P. - University of Bari, Bari, ITALY. AIM: the aim is to evaluate the role of 18FDG PET/CT in the management of patient with primitive hepato-cellular carcinoma (HCC), recurrent HCC and extrahepatic metastases before and after any treatment.MATERIALS AND METHODS: We performed 18 FDG PET/CT in 43 patients (pts) (32 male, 11 female, mean age 71 years). We evaluated in 13 pts primitive lesions of HCC and in 30 pts recurrence. HCC was assessed by histology in all patients. 6 pts underwent hepatic lobectomy, 3 pts transarterial chemoembolization (TACE) treatment; 3 pts percutaneus ethanol injection (PEI); 3 pts lobectomy + TACE; 2 pts to TACE + radio frequences ablation (RFA); 3 pts PEI + RFA; 1 pts radiotherapy (RT) + RFA; 1 pts RFA + chemiotherapy (CHT); 1 pts RFA+PEI+TACE; 1 pts was treated with Sorafenib.RESULTS: In pts with primitive HCC, 18FDG PET/CT was positive in 8/13 (61,5%) pts: hepatic lesions of HCC in 2 pts, hepatic and extrahepatic (lymph nodes) lesions of HCC in 4 pts and extrahepatic metastases in the last 2 pts were observed. The number of lesions observed by PET/CT was 27 (9 hepatic and 18 extra-hepatic lesions).In the pts with recurrence, we evaluated the therapy efficacy, looking for residual tumours, local recurrence or extra-hepatic metastases. 18FDG PET/CT was positive in 19/30 (63,3%) pts. Extrahepatic metastases were observed in 14/30 pts (46,6%). The site was in lymphnodes (ln) in 9/14 (64,2%) pts (hepatic hilus ln, pulmonary hilus ln, supraclavicular ln, abdomen ln near small gastric curve, lumbo-aortic and celiac ln). In 6/14 pts (42%) bone metastasis were found in sternum, ribs, sacrococcygeous and ischiopubic bone. In 9/14 (64,2%) pts parenchimal metastases were found (lung, abdominal wall and brain)The 18FDG PET/CT was useful to early valuation of recurrence of HCC, when CT imaging didn’t discern the anatomic change of liver after the treatment, because of the fibrosis.CONCLUSIONS: 18FDG PET/CT is not suited to the evaluation of pts with unclear solid livers tumours. Only in selected cases with known HCC that is moderately to poorly differentiated, the 18FDG PET/CT is useful for pre-therapy detection of intra- or extrahepatic lesions and for post-therapy evaluation of recurrent disease. The 18FDG PET/CT can be used in the diagnostis of hepatic and extrahepatic lesions only in the above mentioned histological groups and correlated with the contrast-enhanced ultrasound, dynamic contrast-enhanced CT and MRI.
P474 Radioembolization Using YTTRIUM-90 Microspheres Advanced Primary and Metastatic Liver Malignancies
for
L. Uslu, E. Arslan, M. Ozhan, S. Nisli, S. Sager, L. Kabasakal, F. Gulsen, M. Cantasdemir, F. Numan, I. Uslu; Istanbul University Cerrahpasa Medical Faculty, Istanbul, TURKEY. AimAlthough surgery remains the treatment of choice for most liver tumors, there are several alternative treatment modalities for inoperable liver tumors, such as systemic chemotherapy and locoregional therapies. Radioembolization with Yttrium-90 (90Y) microspheres is another advancing locoregional treatment modality for both primary and metastatic liver tumors.Here we present our patients with inoperable liver tumors, who failed to respond alternative systemic or locoregional treatment modalities and treated with 90Y resin microspheres between March 2009 and March 2011.Material and MethodsA total of 49 patients, aged between 32-85 (mean:63.75±12,1), with female to male ratio 1/ 2,06 were selected for therapy. 21 of them were diagnosed for primary liver tumor, including hepatocellular carcinoma (n=19) and cholangiocarcinoma (n=2), remaining other metastatic tumors (n=28). 37 patients had multifocal liver masses. All patients were accepted to be inoperable and not suitable for other treatment modalities, with medium-good performance status and Child Pugh classification A or B.Blood examination, MRI or CT scan and PET-CT scan were completed as initial examination, followed by 5 mCi (0,18 GBq) 99mTc macroaggregated albumin (MAA) injection via hepatic artery resulting in hepatopulmonary shunt ratio less than 20% and without sign of extrahepatic shunting. Administered 90Y activity was calculated
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P475 Diagnosis in hepatocellular carcinoma using 18 PET/CT by comparison with F-FDG: Pilot study
11
C-Choline
U. Vutrapongwatana, W. Juiklom, N. Wilaipraphakorn, S. Suratako, J. Sarasamkan, P. Wongsa, N. Boonkawin, S. Keeratipiriyakul, P. Kongsakorn, R. Chanachai, C. Chotipanich; Chulabhorn Hospital, Bangkok, THAILAND.
16 patients (66.6%). Two patients had a complete response (8.3%), 11 patients had partial response (45.9%) and 3 patients had stable disease (12.5%). Eigth patients had findings consistent with progression (33.3%).Conclusion: This study showed that radioembolization produced meaningfully effective response and disease stabilization with minor complication rates in patients with advanced, unresectable and chemorefractory liver tumors.
P43 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Gastrointestine & Pancreas
P477 Evaluation of PET/CT
18
F-FDG uptake in gastric cancers using FDG
K. Koyama1, T. Okamura2, H. Seura2, Y. Hamazawa3, Y. Miki1; 1Department of Radiology, Osaka City University Graduate School of Medicine, Osaka, JAPAN, 2Department of PET center, Saiseikai Nakatsu Hospital Osaka, Osaka, JAPAN, 3Department of Radiology, Saiseikai Nakatsu Hospital Osaka, Osaka, JAPAN.
Diagnosis in hepatocellular carcinoma using 11C-Choline PET/CT by comparison with 18 F-FDG: Pilot studyAbstractPurpose: We conducted a pilot trial to evaluate the value of 11C-Choline positron emission tomography (PET)/computerized tomography (CT) by comparison with 18F-Fluorodeoxyglucose (FDG) PET/CT.Materials and Methods: A prospective study of 7 hepatis B carrier patients (4 males, 3 females) of ages 43 to 62 years who suspected hepatocellular carcinoma (HCC) by abdominal ultrasonography (U/S) underwent Gadoxetic acid enhanced 3-Tesla magnetic resonance imaging (MRI) and 11C-choline and 18F-FDG PET/CT studies within 1-week period was analysed. The 18F-FDG and 11C-Choline PET/CT were analyzed visually and quantitatively (tumor:background ratio (T/B)). Histological confirmation of the diagnosis was used as the reference standard.Results: Seven patients with hepatitis B carrier with suspected HCC by abdominal U/S underwent MRI, which were positive findings. Almost patients were moderately differentiated HCC (6/7) and the others was well differentiation. Three patients demonstrated increased choline uptake in hepatic nodules/mass with no increased FDG uptake (well differentiated 1; mixed between well and moderately differentiation 1; rupture hepatoma 1). One patient shows no abnormal choline uptake despite of intensely FDG avidity. One patient shows negative in both PET tracers. Mean of T/B of choline and FDG were 1.17±0.44 (mean±SD) and 2.21 ± 3.22, respectively. Median of T/B ratio of choline and FDG were 1.55 (min-max; 1.06-2.3) and 1.48 (1.14-9.42), orderly. However, there is no statit*tical significant in T/B ratio of choline and FDG in all HCC (p=0.373) and moderately differentiatied HCC (p=0.364). However, overall sensitivity of T/B ratio in choline and FDG were 71% and 42%, respectively.Conclusion: Our preliminary results suggested that T/B ratio of 11C-Choline may be a potential ratio and superior to 18F-FDG for demonstrated well and moderately differentiated HCC. However, a larger study is necessary to further define the role of 11C-Choline PET/CT.
Objectives: The purpose of this study was to retrospectively evaluate the degree of 18 F-FDG (FDG) uptake in gastric cancers using FDG PET/CT.Methods: Among patients who underwent dual-time-point FDG PET/CT in the PET center at Saiseikai Nakatsu Hospital between August 2006 and March 2011, 64 patients with 68 lesions who were diagnosed histopathologically to have gastric cancer were investigated (41 men, 23 women; mean age, 69 years; range, 35-89 years). For dual-time-point FDG PET/CT, early and delayed images were acquired at 1 and 2 h after intravenous FDG injection, respectively. FDG PET/CT images were examined visually and statistically.Results: Visual analysis of PET images showed abnormal FDG uptake in 50 of 68 lesions on early images and 52 of 68 lesions on delayed images. All 52 lesions detected in delayed images showed increasing FDG uptake compared to lesions in early images. Excluding 5 lesions in which status as early or advanced cancer was not confirmed, 8 of 13 early cancers and 5 of 50 advanced cancers showed no FDG uptake in either early or delayed images. According to quantitative analysis of images from PET, mean (± standard deviation) standardized uptake values (SUVs) of advanced cancers were 6.9 ± 4.2 in early images and 8.7 ± 5.7 in delayed images, showing a significant difference (p<0.0001). SUVs of early cancers were 3.0 ± 2.5 in early images and 3.4 ± 3.2 in delayed images, showing no significant difference (p=0.0908). In terms of advanced cancers, SUVs of 20 tubular adenocarcinomas (TUBs), 17 poorly differentiated adenocarcinomas (PORs), 4 papillary adenocarcinomas and 3 signet-ring cell carcinomas were 6.4 ± 3.4, 7.7 ± 4.9, 10.4 ± 2.3 and 2.9 ± 1.2 in early images and 8.2 ± 4.4, 9.9 ± 6.9, 13.4 ± 4.0 and 3.3 ± 1.4 in delayed images, respectively. Significant differences were seen between SUVs of TUBs and PORs in advanced cancers at both early and delayed images. SUVs of 11 TUBs in early cancers were 3.1 ± 2.8 in early images and 3.7 ± 3.4 in delayed images. Significant differences in SUVs of TUBs at both early and delayed images were seen between early and advanced cancers.Conclusions: Most advanced gastric cancers can be detected using FDG PET/CT, whereas more than half of early cancers cannot. The degree of FDG uptake in advanced cancers differs according to histopathological type.
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The Role Radioembolization Malignancies
for
Treatment
of
Liver
G. H. Kaplan1, A. Yıldız1, S. Yılmaz2, M. Özdoğan3, F. Aydın1, H. Bozcuk3, H. Coşkun3, M. Çevener2, A. Boz1, F. Güngör1, T. Sindel2; 1Akdeniz University Faculty of Medicine, Department of Nuclear Medicine, Antalya, TURKEY, 2Akdeniz University Faculty of Medicine, Radiology, Antalya, TURKEY, 3Akdeniz University Faculty of Medicine, Medical Oncology, Antalya, TURKEY. Aim: The aim of this study is the evaluation of effectiveness of yttrium-90 microspheres treatment in malignant liver lesions.Materials and Methods: Twentyfive patients (11 female, 14 male) with nonresectable hepatic metastases or hepatocellular carcinoma nonresponding to chemotherapy or interventional local treatment were treated and retrospectively evaluated. Three patients had hepatocellular carcinoma the others had metastatic cancer with liver dominant disease. All patients had advanced disease and multiple prior courses of chemotherapy. Eligible patients had adequate hepatic, haemopoietic and renal function, and an absence of major hepatic vascular anomalies and pulmonary shunting. Diagnostic and therapeutic angiograms, computed tomography (CT) or positron-emission tomography/computed tomography (PET/CT), and MAA scintigraphy were done for evaluation procedures. Two patients received two treatments. The mean follow-up period was 5.5±2.3 months. The response to radioembolization was analyzed using imaging according to size and metabolic activity and laboratory data.Results: No major complication was observed except three patients had gastroduodenal ulcer. Overall response to therapy was seen in
Additional value of FDG PET/CT to contrast-enhanced CT in the detection of malignant intraductal papillary mucinous neoplasms of the pancreas with mural nodules K. Takanami1, T. Kaneta1, H. f*ckuda2, S. Takahashi1; 1Department of Radiology, Tohoku University Graduate School of Medicine, Sendai, JAPAN, 2 Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, JAPAN. Purpose: To determine the additional value of FDG PET/CT to contrast-enhanced CT in the differentiation between benign and malignant intraductal papillary mucinous neoplasms (IPMNs) of the pancreas with mural nodules.Subjects & Methods: This retrospective review of medical records was approved by our institutional review board. The preoperative PET/CT images of sixteen non-diabetic patients with surgically-proven IPMN, where mural nodules of 3 mm or larger was shown by preoperative contrast-enhanced CT, were retrospectively evaluated. The 16 patients were divided into two groups: 7 patients with benign IPMN (adenoma (n = 1) and borderline tumor (n = 6)) and 9 patients with malignant IPMN (carcinoma in situ (CIS) (n = 8) and invasive carcinoma (n = 1)). Nuclear medicine physician blinded to the pathologic assessment of malignancy of IPMN set a spherical volume of interest (VOI) over the mural nodules on PET/CT images and recorded the peak standardized uptake value (SUVmax) in the VOI, referring the contrast-enhanced CT images. Statistical differences in the size of mural nodule, the diameter of main pancreatic duct (MPD), and SUVmax of the tumors between benign IPMNs and malignant IPMNs were compared by the Mann-Whitney U-test. Statistical significance was set at p < 0.05.Results: The SUVmax of the malignant
Poster Presentations
using body surface area method and calculated activity was reduced for patients with lung shunting 10-20%.90Y resin microspheres (SIR-Spheres, Sirtex, Australia) was applied via hepatic artery during angiography. The mean administered acitivity was 1,66±0,28 GBq. Mean activity for patients receiving second 90Y therapy was 1,6±0,28 GBq. Bremsstrahlung image was taken 1 day posttreatment for each patient.ResultsThe most common side effect related to 90Y microsphere therapy was mild abdominal pain due to gastric irritation , seen in 14 patients, resolved after non-narcotic analgesics. Other complaints were nausea and vomiting (n=8), fatigue (n=7), increased abdominal distention (n=1), edema (n=1) and imbalance (n=1). Patients with prolonged abdominal pain were referred to gastroscopy, revealing ulcer in 4 patients.Blood examination and PET-CT scan was done during follow up of patients, which revealed regression in tumor size or activity in 15 patients. 4 patients had progressive liver tumor despite therapy.ConclusionRadioembolization with 90Y microspheres is an effective regional therapy for both primary and metastatic liver tumors and a good alternative in patients whom other treatment modalities can not be performed.
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IPMNs with mural nodules of 3 mm or larger was higher than that of benign IPMNs (2.7 ± 0.6 vs. 1.9 ± 0.3, p < 0.01). Meanwhile, there was no significant difference in mural nodule diameter and MPD diameter between the two groups.Conclusions: The results of this study indicate that FDG PET/CT can provide additional information for the differentiation between benign and malignant IPMNs of the pancreas with mural nodules.
improved with SPECT-CT image fusion in the detection of primary and metastatic lesions as well.
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T. Sugaya, S. Sakamoto, R. Yoshida, K. Kaneko, S. Hiki, E. Yamazaki, H. Arakawa, Y. Kaji; Dokkyo University School of Medicine, Mibu, Tochigi, JAPAN.
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Prognostic Value of Postoperative F-FDG PET/CT During the Re-staging of Gastrointestinal Stromal Tumors J. Correia, P. Lapa, G. Costa, J. Pedroso de Lima; Serviço de Medicina Nuclear - Hospitais da Universidade de Coimbra, Coimbra, PORTUGAL. Aim: 18F-FDG PET/CT may provide very useful information in Gastrointestinal Stromal Tumors (GIST) for the evaluation of tumor activity, staging and early response to therapy. The purpose of this study was to evaluate the usefulness of postoperative PET/CT in the re-staging and prognosis of GIST patients following surgery. Materials and Methods: We reviewed 136 18F-FDG PET/CT studies performed in our department, from April 2005 to February 2011, in 41 patients (24 female, 17 male, mean age 60.8 years, range 15-85 years) with the diagnosis of GIST proven by histopathology. PET/CT was performed after surgery in 36 patients (mean time between surgery and PET/CT of 5.0 months) and for evaluation of imatinib mesylate therapy in 5 patients. Histopathology data (tumor size and mitotic index) were used to establish a risk category. Postoperative PET/CT results were compared to imaging studies and clinical follow up (mean follow up period 33.7 months). Residual disease and tumor recurrence after surgery were assessed. Results: The primary lesion was located in the stomach (21 patients), small intestine (14 patients), esophagus (2 patients), rectum (2 patients), colon (1 patient) and in the peritoneum (1 patient). Mean size of the tumors was 6.75 cm (1.2-27 cm). Eighteen patients were categorized as high risk, 10 as intermediate, 9 as low and 4 as very low risk. No abnormal FDG uptake was observed in 28 (77.8%) of the 36 patients in whom PET/CT was carried out for re-staging purpose after the primary tumor resection. In these patients, a residual/recurrent disease rate of 14.3% (4/28) has been found during the follow up. All those residual/recurrent tumors were categorized as high-risk at initial diagnosis and persistently showed intense FDG uptake in the follow up PET/CT studies. Postoperative PET/CT showed abnormal uptake of FDG in the remaining 8 (22.2%) re-staged patients (5 classified as high, 2 as intermediate and 1 as low risk), 6 of them (75%) with residual/recurrent disease confirmed during the follow up and the other 2 considered as false positive studies. Conclusion: In this retrospective study, a negative postoperative PET/CT was associated with a GIST residual/recurrent disease rate of 14.8% compared to a residual/recurrent rate of 75% for a positive postoperative PET/CT.
Feasibility of detecting small intestinal diseases by FDGPET/CT
Aim: It might be difficult to interpret the accumulation in the small intestines by FDG-PET/CT whether abnormal condition or not. The aim of this study is to delineate the features of the uptake in the small intestines and to investigate the impact of whole-body FDG-PET/CT, which will detect small bowel diseases need to be treated.Materials & methods: We retrospectively inspected all the cases in the Dokkyo Medical University Hospital PET Center’s database, referred from all the departments, from April 2005 to December 2010. We used only the database which indicated the uptake in the small intestines except the duodenum. There were 147 cases matched up to the above criteria. In the preliminary study, patients were examined either by CT, endoscopy, or follow-up FDG-PET/CT. Out of 147 cased, the subjects of our research were 81 patients who could be followed up (42 men and 39 women, mean age: 61.3 yr.) We visually classified FDG uptake into two groups: Group A; accumulation along the small intestines and Group B; uptake not along them. They were also measured the maximum standardized uptake values (SUVmax) in the corresponding region. As for the evaluation of clinical criteria for diagnosis, we focused on three factors. One was the pathological examination, another was diminished uptake on the next PET/CT, and the other was CT following up more than 6 months without any medical interventions. Every case was classified into pathological or non-pathological state (physiological or minor nonspecific inflammatory disorders need no treatment).Results: Of all 81 cases, 19 cases were confirmed to be pathological (9 lymphoma, 5 GISTs, 1 primary and 1 metastatic small intestinal cancer, and 3 others), and 62 were identified to be nonpathological state. Regarding the types of uptake, 59 cases categorized into Group A, 22 to Group B. SUVmax in the small intestines ranged from 2.8 to 32.3 (mean: 7.0) in the all cases, (group A: 3.0 - 20.3, mean: 5.4/ group B: 2.8 - 32.3, mean: 11.4). If we defined all group B cases as pathological, the sensitivity, specificity, PPV, NPV, accuracy were 84.2%, 90.3%, 72.7%, 94.9%, 88.0%, respectively. And if we supposed group B cases with SUVmax ≥ 4.0 as pathological, those were 78.0%, 73.5%, 78.9%, 93.5%, 90.1%, respectively.Conclusion: FDG-PET/CT is useful to diagnose the small intestinal disorders that need treatment.
P44 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Lymphoma
P480 How can SPECT-CT fusion neuroendocrine tumors?
P481
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F. Halasi1, Z. Galler1, I. Balogh1, V. Tóth2, Z. Varga1; 1Uzsoki Street Hospital, Department of Nuclear Medicine, Budapest, HUNGARY, 2 ScanoMed Ltd., Budapest, HUNGARY. Objectives: Neuroendocrine tumors (NET) are an uncommon type of neoplasm frequently with late symptoms. The somatostatin receptor scintigraphy (In111OctreoScan) is a very sensitive but lower specific method for detecting both the primary and the metastatic lesions. Some aspecific accumulation (acute and chronic inflammations, etc.) causes diagnostic problems. The aim of our study was to analyze the importance of the SPECT-CT fused imaging at the diagnosis of NETs in the daily routine. Is it possible to distinguish the specific and aspecific accumulation with the fusion of SPECT and CT images? Is it able to increase the sensitivity and the specificity (the diagnostic accuracy) of the scintigraphy?Methods: 12 patients with known NET underwent (1) diagnostic CT or MR examination (2) serum Chromogranin-A investigation and (3) In111-OctreoScan examination - whole body and the necessary additional images, SPECT examinations - after 24, 48, 72 hours of the intravenous injection of radiopharmaceutical. All of the patients low dose CT examination was performed as well. The SPECT-CT fused images were reconstructed with MEDISO Interview XP Fusion- software.Results: In every (12/12) case accumulation sites of In111OctreoScan were detected. Most (10/12) of the patients had unusual localization and/or uncommon extension of tracer uptake as well. In these cases localizing and identifying the accumulation was difficult by only-SPECT. With the help of the SPECT-CT fused images we were able to identify more preciously the extension, localization of OctreoSan accumulation and the previously described lesions by CT or MR than SPECT alone. We also compared the sensitivity of the serum Chromogranin-A levels with the OctreoScan examinations resulting a lower sensitivity for the Chromogranin-A.Conclusions: The In111-OctreoScan examination completed with SPECT images plays an important role in the diagnosis of NETs. The sensitivity and the specificity, ie. the diagnostic accuracy of the examination can be
P482 Combined Use of 99mTc-Tetrofosmin Scintigraphy and Serum Beta-2-Microdlobulin in the Diagnosis and Folow Up of Patients with Lymphomas D. Vassileva1, A. Tsonevska2, E. Piperkova2; 1National Hospital of Haematology, Sofia, BULGARIA, 2National Hospital of Oncology, Sofia, BULGARIA. In patients with lymphoma exact diagnosis and staging is important for the treatment and the relapse identification of the disease. 99mTc- Tetrofosmin is currently used to study myocardial perfusion, but also has been reported to be localized in various types of malignant tumours, including lymphomas. With previously used visualized techniques it has been extremely difficult to differentiate active tumour tissue from posttherapy fibrosis. Serum beta-2-microglobulin levels have recently been used to detect tumour regression and progression in malignant lymphomas.Aim: The aim of the study was to assess the clinical value of 99mTcTetrofosmin scintigraphy, serum beta-2-microglobulin and the correlation between them for diagnosis, staging and therapy control of patients with Hodgkin’s disease and non- Hodgkin’s lymphoma.Material and methods: 130 patients with biopsy proven Hodgkin’s and non-Hodgkin’s lymphoma (63 men and 67 women), aged between 19 and 75 years, in clinical stage IA to IVB were investigated. Scintigraphy was performed 30 minutes after intravenous injection of 740 MBq 99mTcTetrofosmin (Myowiev, Amersham). Planar and SPECT images were obtained on gamma camera Diacam (Siemens) and analysed qualitatively and quantitatively. Serum beta-2-microglobulin levels were measured by radioimmunoassay using the Immunotech international microtest.Results: 99mTc-Tetrofosmin scintigraphy was positive in 95 patients. From 128 detected lesions, 96 were with lymph node involvement and 32 were with extranodal localization. Lymph node lesions were detected in mediastinal, neck, supraclavicular, axillar and inguinal area. Lesions, identified in the lung as a primary tumour were 16. 99mTc- Tetrofosmin scinthigraphy showed also primary thyroid lymphoma in 2 patients. In 4 patients in whom a medullary biopsy showed lymphamatous infiltration, 99mTc-Tetrofosmin
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P483 Evaluation of dual-time-point 18F-FDG PET/CT for the differentiation between malignant lymphoma and benign lymph nodes. M. Nakayama, A. Okizaki, M. Sakaguchi, S. Ish*toya, J. Sato, M. Odashima, T. Aburano; Asahikawa medical university, Asahikawa, Hokkaido, JAPAN. PURPOSE: Some authors reported that delayed FDG-PET/CT scan is useful for the differentiation between malignant lesion and benign one. When we perform examination of patient with lymphoma, we must identify malignant lymphoma (ML) from benign lymph node (BLN). We hypothesized that the differences of both SUVmax (DeltaSUVmax) and change rate of them (%DeltaSUVmax) might be better predictors to make diagnosis of ML. The purpose of the present study was to evaluate the clinical value of dual-time-point FDG-PET/CT imaging to distinguish ML from BLN.MATERIALS AND METHODS: The subjects were 143 lymph nodes in 33 patients (82 ML lesions in 15 patients and 61 BLN in 18 patients with neck or chest disorder). All patients were diagnosed according to histopathological results or clinical follow-up for at least 6 months.18F FDG-PET/CT scan was performed at 50 minutes (early phase) and at 100 minutes after the injection (delayed phase). First, the maximum standardized uptake value (SUVmax) of each lesion at early and delayed phase was calculated. Second, we estimated DeltaSUVmax and %DeltaSUVmax to clarify the pharmaco*kinetics of the lesions. Furthermore, proper cut-off values of them were evaluated using by a mathematical method, which was cumulative distribution curve.RESULTS: The results were summarized in the table. Delayed SUVmax was increased compared with early SUVmax in 80 /82 (97.6%) MLN and 55/61 (90.2%) BLN. DeltaSUVmax and %DeltaSUVmax in MLN were significantly higher than those in BLN. Proper cut-off value in DeltaSUVmax was 1.5 and in %DeltaSUVmax was 0.26. When the proper cut-off values were applied, the sensitivity and specificity derived from DeltaSUVmax were 75.6 and 73.8, on the other hand, from %DeltaSUVmax were 36.6 and 44.3.CONCLUSIONS: Dual-timepoint 18F FDG-PET/CT may provide more help in the differentiation of ML from BLN. DeltaSUVmax may be good predictor to make diagnosis of ML compared with %DeltaSUVmax.
P484 Pre-treatment FDG PET bone marrow (BM) uptake and disease involvement. Can semiquantitative measures discriminate between a normal, hypercellular or infiltrated bone marrow? M. Djekidel, Y. Fourzali, R. Ahmed; Yale New Haven Hospital, New Haven, CT, UNITED STATES. PET studies are used on a regular basis to stage lymphoma patients pretreatment. BM uptake can be associated with disease involvement, however occasionally uptake is related to benign etiologies (anemia, stimulation, a hypercellular marrow…etc). Uncovering quantitative and qualitative parameters to elucidate the etiology of bone marrow uptake may help the radiologist and oncologist.We looked retrospectively at a group of consecutive lymphoma patients who had an initial staging PET scan performed at our institution in the past year. Out of 121 patients , 36 had a (BM) biopsy report available for review. We attempted to evaluate whether semi quantitative parameters -SUVm (maximum standardized uptake value); Average SUV; SUVm/Mediastinal blood pool (MBP) ratio - could discriminate between different bone marrow patterns (normal, hypercellular, positive). SUV’s were measured by drawing an ROI on a sagital view including the midthoracic to midlumbar spine and MBP with an ROI at the Aortic arch level. We also looked at the type of BM uptake (none; mild; prominent) and pattern (patchy; diffuse; focal)The average age of our patient population was 52.19. 66.66% were males (24/36). Most of our patient’s had a normal BM biopsy. 58.33% (21/36) had a normal BM. 25 % (9/36) had a positive BM. No correlation was found between BM findings, quantitative parameters, pattern or type of uptake. In the BM positive group, no pts had patchy uptake. 2 pts were found to have no appreciable uptake. 66.66% had diffuse uptake and 33.33% had focal uptake. 55.5% had an Av SUV<1.5.71.5 % (15/21) had either mild or prominent uptake in the BM normal group and only 28.5% had no uptake. None had focal uptake and 90% pts had diffuse uptake.The majority of pts had an SUVm> 2.5: 90 % of BM normal; 100% of
hypercelluar BM and 88.88% of the BM positive group and an ROI/MBP>2.5: 52.4%; 66.66% and 55.5% respectively.In Summary, qualitative and quantitative parameters of BM uptake on an initial staging PET in lymphoma pts cannot discriminate between BM histology. No statistical significance was reached in our study and further exploration with a larger cohort is necessary.
P485 Does Three Cycle Chemotherapy Affect Liver, Spleen and Bone Marrow Glycolytic Activity in Non-Hodgkin Lymphoma Patients? M. Aras, F. Dede, T. Öneş, S. Candemir, S. Inanır, T. Y. Erdil, H. T. Turoglu; Marmara University School of Medicine Nuclear Medicine Department, İstanbul, TURKEY. Aim: Due to the fact that the liver, spleen and bone marrow (BM) are commonly involved extranodal sites in the course of the Non-Hodgkin lymphoma, an increase in the FDG uptake of these sites during follow-up may be significant in terms of involvement. On the other hand chemotherapy is known to affect FDG biodistribution through bone marrow hyperplasia and/or expansion. The aim of the current study was to investigate whether chemotherapy contributed to the metabolic activities of these sites.Methods:A total of 22 patients (14 female, 8 male; mean age: 59±14.5) with diffuse large B cell lymphoma referred for initial staging with FDG PET/CT were included in this retrospective study. Patients with liver, spleen and/or BM involvement were excluded from the study. All patients received 3 cycle of rituximab, cyclophosphomide, doxorubicin, vincristine, prednisolone (R-CHOP) chemotherapy and then referred to PET/CT for evaluating response to treatment approximately 3 months after the initial scan (3.8±1 months). Complete remission was achieved in all patients at the end of the treatment The SUVmax and Hounsfield unit (H.U.) of the liver and spleen and liver/spleen SUVmax ratios in both scans were acquired and all the values were compared in each other. Additionally the glycolytic activity of the L1-L5 vertebra in 2 scans were also compared.Results:There was no significant difference between basal and follow-up PET/CT in terms of injected dose and interval between FDG administration and the start of acquisition (p>0.05). When pre- and post-treatment SUVmax and H.U. of the liver and spleen were compared, no statistical difference were found (p>0.05). The liver/spleen SUVmax ratios in 2 scans were also similar (p>0.05). The chemotherapy didn’t cause a significant change in the metabolic activity of the L1-L5 vertebra too (p>0.05).Conclusion:With limited number of patients we showed that chemotherapy didn’t affect the metabolic and the morphologic status of the liver, spleen and BM. When our results are validated in larger lymphoma patient series an increase in the FDG uptake of these sites during early follow-up will accurately suggest disease involvement rather than false (+) interpretations.
P486 Can A Pre Transplantation 18F-FDG-PET/CT Predict The Outcome Of A Post Transplantation PET And The Course Of The Disease In Patients With Hodgkin Disease (HD) Undergoing Autologous Transplantation? F. Vlachou, V. Filippi, A. Nikaki, R. Efthymiadou, L. Gogou, D. Kehagias, K. Gogos, K. Dalianis, I. Andreou, V. Prassopoulos; HYGEIA HOSPITAL, ATHENS, GREECE. AIM: To evaluate the correlation of pre transplantation PET/CT with post transplantation PET/CT and follow up in patients with HD, who underwent autologous transplantation.METHOD- MATERIAL: In this retrospective study 21 patients, suffering from HD, who underwent autologous transplantation were included. All patients underwent PET/CT examination 1week- 3months before (pre transplantation, 1st PET) and 1-3 months after (post transplantation, 2nd PET) autologous transplantation. Additional therapy between the two PET examinations disease were co- evaluated. Patients were followed with additional PET/CT examinations for 9- 36 months after transplantation. The correlation between the 1st , the 2nd PET and the later outcome of the disease during follow up was examined. A cutoff of mean SUVmax =2.5 was used to discriminate positive from negative PET.RESULTS: 4/21 patients achieved negative 1st PET. All of them had negative 2nd PET and remained in complete response, without receiving extra therapy. 17 patients had a positive 1st PET. 10/17 received additional therapy and 5/10 achieved a negative 2nd PET; PET remained negative for 4/5, while one patient was diagnosed with secondary primary tumor. 5/10 patients did not achieve a negative PET. Of them, only one patient managed to reach complete response. 7/17 patients did not have additional treatment between the 1st and the 2nd PET, 4 out of whom had a positive 2nd PET and remained in disease during follow up, 2 achieved a negative 2nd PET and complete response during follow up and one, although had a negative 2nd PET, showed recurrence of the disease at 6 months, received additional treatment and achieved complete response.CONCLUSION: A negative pre transplantation PET can predict a negative post transplantation PET as well as a favorable outcome of the disease. Patients with a positive 1st PET are more likely to further obtain additional therapy. A
Poster Presentations
scintigraphy showed abnormally increased uptake in bone marrow. Bone lesions were identified on 99mTc-Tetrofosmin scintigraphy in 10 patients. The tumour-tobackground ratio ranged from 1,5 to 2,1. In patients with advanced disease, the serum levels of beta-2-microglobulin were with mean value 4,3 mg/L (normal value 1,2-2,4 mg/L). Significant correlation was found in true positive 99m TcTetrofosmin scintigraphy and higher serum beta-2-microglobulin levels in patients with advanced disease. 35 patients had negative 99mTc- Tetrofosmin scan after chemotherapy. In these patients, the levels of the serum beta-2-microglobulin were near to the normal levels.Conclusion: 99m- Tetrofosmin is a promising tracer in determining disease activity, site of active lesions and the fellow up of the patients with lymphomas. The uptake score correlates significantly with clinical status and stage of the disease and with disease activity as determined by beta-2microglobulin.
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negative 2nd PET is correlated with a favorable outcome, while a positive with a prolonged course of residual disease even in cases of multiple chemo/ radio therapies.
P487 Pulmonary Langerhans cell histiocytosis - evaluation of the 18 disease activity using F-FDG PET/CT (SUVmax Pulmo/SUVmax Hepar index). Z. Rehak1, R. Koukalova1, Z. Adam2, P. Szturz2, K. Bolcak1; 1Masaryk Memorial Cancer Institute, Brno, CZECH REPUBLIC, 2University hospital, Brno, CZECH REPUBLIC. Introduction: Pulmonary Langerhans cell histiocytosis (LCH) is caused by multiple granulomas in terminal bronchioles, these nodules progress through cavitating nodules into thick-walled and, subsequently, thin-walled cysts.Treatment is indicated in patiens in whom pulmonary involvement is associated with multisystem involvement or when a progression has been confirmed. To document disease progression examination of the lungs using HRCT is routinely applied. Measuring 18F-FDG uptake of the individual small nodules is not possible due to the high number and small size of the nodules.Material and methodes: A total of 32 18 F-FDG PET/CT examinations were performed in 7 of patients with pulmonary LCH. The maximum 18F-FDG uptake in a defined volume of the right lung (SUVmax Pulmo) to maximum 18F-FDG uptake in a defined volume of the liver tissue (SUVmax Hepar) ratio (index) was used.Results: The index value was compared to other parameters characterising the disease activity such as: HRCT of the lungs, functional examinations, bronchoalveolar lavage CD1a positivity and clinical picture. The SUVmax Pulmo/SUVmax Hepar index correlated closely with other disease activity. parameters. The index higher than 0,4 was found in disease progression, while index lower than 0,3 was observed in patient with inactive pulmonary LCH.Conclusion: The traditional 18F-FDG PET/CT examination is useful in detecting the LCH loci in the bone, lymphatic nodes and other tissue but not in the presence of diffuse involvement of pulmonary parenchyma. The SUVmax Pulmo/SUVmax Hepar index correlated closely with other disease activity parameters. This index appears to be a promising approach. However, this is a pilot study and further verification is required.
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Value of F-FDG PET/CT for the Detection of Bone Marrow Infiltration in Hodgkin´s Lymphoma Staging J. Correia, P. Lapa, G. Costa, J. Pedroso de Lima; Serviço de Medicina Nuclear - Hospitais da Universidade de Coimbra, Coimbra, PORTUGAL. Aim: Detection of bone marrow disease is an important step during the diagnostic work-up of Hodgkin´s lymphoma (HL) patients and is usually assessed by bone marrow biopsy (BMB) despite its known technical limitations. 18F-FDG PET/CT is accepted as a valuable tool in the management of HL and is now an established modality for staging and for the assessment of therapy response. This study aims to evaluate the value of 18F-FDG PET/CT for the detection of bone marrow involvement when compared to BMB. Materials and Methods: Between February 2004 and January 2011, fifty patients (29 male and 21 female, age range 14-57 years, mean age of 31.42 years) with newly diagnosed HL performed a 18F-FDG PET/CT scan for staging and were submitted to unilateral BMB from the iliac crest. Biopsy results were not known at the time of the 18F-FDG PET/CT scan. To evaluate bone marrow involvement, the 18F-FDG PET/CT results were retrospectively reviewed and compared with the BMB results. Results: In 34 patients (68%), both 18 F-FDG PET/CT and BMB were negative (concordant cases). In the remaining 16 patients (32%), 18F-FDG PET/CT was reported as positive for bone marrow infiltration; 9 of these patients had multiple focal bone marrow uptake and the other 7 had diffuse bone marrow disease. Of the 16 18F-FDG PET/CT positive patients, 4 (8%) had positive BMB and multiple focal bone marrow uptake of FDG (concordant cases). Twelve patients of the 18F-FDG PET/CT positive group showed a negative BMB (discordant cases). Of these discordant cases, 4 patients had multifocal FDG bone marrow uptake but excluding the iliac crest biopsy site, 2 patients showed persistent bone marrow FDG uptake in follow-up studies and 6 had a diffuse FDG bone marrow uptake consistent with the presence of anemia. Conclusion: 18F-FDG PET/CT and BMB results were concordant in 38/50 (76%) of the patients studied. In our experience, all the discordant results could be explained by the methodological particularities of BMB or by clinical reasons (anemia). In our opinion, 18F-FDG PET/CT is an adequate complement of BMB for bone marrow staging.
P489 Prognostic Value of SUV in Interim Hodgkin’s Lymphoma Patients
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F-FDG PET in Non-
M. Cozar Santiago1, J. Ferrer Rebolleda1, A. Vicedo Gonzalez2, R. Sanz Llorens1, J. Aguilar Barrios1, M. Devis Saiz1, R. Sanchez Jurado1; 1Servicio de Medicina Nuclear-Eresa Hospital General de Valencia, VALENCIA,
SPAIN, 2Servicio de Radioterapia-Eresa Hospital General de Valencia, VALENCIA, SPAIN. Aim: to evaluate the value of the SUV (Standardized Uptake Value) in interim 18FFDG PET-CT in non-Hodgkin’s lymphoma (LNH) patients in order to predict complete remission after treatment.Material and methods: 111 whole PET-CT body studies have been retrospectively analyzed of a total of 37 non-Hodgkin’s lymphoma patients (male, n=22; female, n= 15). All patients had PET-CT scans performed at diagnosis, during treatment (after two-three cycles), and at the end of therapy. SUV's values have been calculated for every study and there has been established the relation of the SUV difference between the first and second study with regard to the one obtained between the first and third study. We noted only the highest SUVmax value in patients with more than one abnormal FDG uptake lesions. We calculate the average of the SUV of the interim study and the average of the percentage of decrease of the same one between the first and the second examination. The patients were followed up with a median of 6-12 months after end treatment.Results: All patients were evaluable for response. At the end of therapy 27 patients achieved a complete response. We obtain SUV's average of 1.6±2.3 in interim PET-CT (after 2 º-3 º cycle) in patients who will present complete remission after treatment, and SUV's average of 3.5±3.8 in those who will not present it. ROC curves demonstrated high especificity (81.4%) with a cutoff of 73 in percentage of SUV decrease with a confidence level of 95% in patients who will present complete remission.Conclusion: SUV (Standardized Uptake Value) in interim 18F-FDG PET-CT can be predictor of the outcome in non-Hodgkin’s lymphoma patients.
P490 FDG PET/CT in Diagnosing Bone Marrow Involvement in Lymphoma C. S. Wu1, C. H. Lee2, J. F. Hsieh2, W. J. Yao3; 1Chi Mei Medical Center, Liouying, Tainan, TAIWAN, 2Chi Mei Medical Center, Yungkung, Tainan, TAIWAN, 3National Cheng Kung University Hospital, Tainan, TAIWAN. Objectives: Bone marrow involvement in Hodgkin’s Disease (HD) and nonHodgkin’s lymphoma (NHL) represents extensive stage of the disease. At present, bone marrow biopsy (BMB) is the method of choice for the detection of bone marrow infiltration. However, BMB may associate with a high false negative rate. FDG PET/CT has been widely used in staging of lymphoma. We aim to investigate the ability of FDG PET/CT in detecting bone marrow infiltration in lymphoma.Methods: 380 patients of histologically proved lymphoma with 493 FDG PET/CT scans and 233 BMB were retrospectively reviewed from Mar., 2005 to Feb., 2011. One hundred and sixty-five scans (HD: 20, NHL: 145) with BMB performed within 2 weeks were enrolled in this study. The results were confirmed by BMB and clinical follow up.Result: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of FDG PET/CT were 62%, 89%, 58%, 90% and 83% respectively in detection of bone marrow involvement in lymphoma. There were 15 patients of FDG+ /BMB- and 13 patients of FDG-/BMB+. In 15 FDG+ /BMB-patients, 12 were focal bone marrow involvement, either solitary or multiple foci, and 3 were diffuse. The 12 focal involvements resolved or exacerbated after treatment. If the focal intense FDG uptake in the bone marrow is interpreted as positive bone marrow involvement, the sensitivity, specificity, PPV, NPV, and accuracy of FDGPET/CT increased to 72%, 98%, 92%, 90%, and 90% respectively. In 13 patients of FDG-/BMB +, 9 were indolent NHL.Conclusion: Our study demonstrates that FDG PET/CT has a complementary role with BMB in the evaluation of bone marrow involvement in lymphoma, especially in the presence of focal bone marrow involvement. False negative FDG PET findings are often associated with the indolent NHL.
P491 Agreement between contrast-enhanced and noncontrastenhanced PET/CT in initial staging of lymphoma patients. I. Navales Mateu, X. Setoain, S. Rodríguez, S. Rubí, O. Solà, A. Perissinotti, D. Fuster, C. Ayuso, F. Pons; Hospital Clinic i Provincial de Barcelona, Barcelona, SPAIN. AIM:The aim of this study was to evaluate the agreement between contrastenhanced full-dose PET/CT (PET/CECT) and unenhanced low-dose PET/CT (PET/NCECT) in initial staging of lymphoma patients.MATERIAL AN D METHODS:One hundred and three biopsy-proven lymphoma patients were prospectively evaluated. Thirty one were Hodgkin lymphoma, 34 follicular nonHodgkin lymphoma and 38 diffuse large B-Cell non Hodgkin lymphoma. All patients underwent a 18D-FDG PET/CT for initial staging that included unenhanced lowdose CT and enhanced full-dose CT. PET/NCECT was evaluated by a pair of nuclear physicians and PET/CECT was evaluated by a pair of readers, 1 radiologist and 1 nuclear physician, both unaware of the results of the other modality.PET/CT lesions were assessed in cervical, thoracic, abdominal and extra nodal regions. Disease stage was assessed according the Ann Arbor staging.Agreement between techniques was determined by kappa-statistic for all grouped lymphoma patients and for each histological subgroup.RESULTS:PET/NCECT detected lesions in the
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P492 Interim 18F-FDG PET/CT in Lymphomas: How to Predict a Complete Metabolic Response at the End of Treatment P. Pilkington Woll, A. García Vicente, A. Palomar Moñoz, J. Cordero García, M. P. Talavera Rubio, V. M. Poblete García, B. González García, M. Bellón Guardia, V. Peiró Valgañon, J. A. Mendoza Narváez, E. M. Becerra Nakayo, A. M. Soriano Castrejón; Hospital General Universitario de Ciudad Real, Ciudad Real, SPAIN. AIM: To analyze and compare the likelihood of predicting a complete metabolic response (CMR) at the end of treatment (EOT) when using a qualitative or a semi quantitative method while interpreting the interim PET/CT. MATERIALS & METHODS: We retrospectively analyzed the PET/CT studies performed for staging, middle of treatment and end of treatment in 66 patients (36 male, 30 female) with Hodgkin's Lymphoma (37) and non-Hodgkin's Lymphoma (29).The interim PET/CT was performed between the 2nd and the 4th chemotherapy cycle and was classified according to the criteria proposed by the “International Workshop on Interim PET in Lymphoma” (IWIPL). Also, the SUVmax of the lesion with the highest metabolic activity in the staging and interim PET/CT were registered and the percentage difference (%Δ) between both values was calculated.The PET/CT at the end of treatment was classified according to the criteria of the “International Harmonization Project in Lymphoma” (IHPL).We calculated the probability of obtaining a CMR at the end of treatment according to the classification obtained on the interim PET/CT (negative / positive).Using ROC curves we also determined the %Δ SUVmax between the staging and interim PET/CT that better predicted a CMR at the end of treatment.Finally we compared both methods (qualitative and semi quantitative) to establish which of them predicted with a higher reliability a CMR at the end of treatment. RESULTS: When using the IWIPL classification, we observed that a negative interim PET/CT predicted a CMR at the end of treatment in 88.9% (PPV) of patients, with a sensitivity and specificity of 90.9% and 76.2% respectively, and with a likelihood ratio of 32.Attending to the semi quantitative method, the best cutting value of the %Δ SUVmax to predict a CMR at the end of treatment was of 83%, with a sensitivity and specificity of 79.5% and 66.7% respectively. Obtaining a %Δ of 83 or higher predicted a CMR at the end of treatment in 83.3% (PPV) of patients, with a likelihood ratio of 7.8.Globally, there was no statistically significant differences between both techniques (p=0.1942). CONCLUSION: Even though there was no statistically significant difference between both methods used to evaluate an interim PET/CT, in our experience, the qualitative method has a higher likelihood ratio to predict a CMR at the end of treatment.
P493 Prognostic Value of Interim 18FDG-PET/CT in Patients with Hodgkin’s Lymphoma Using Different 5-point Visual Scales for Interpretation S. Barna1, N. Fedinecz1, F. Magyari2, J. Varga3, Á. Illés2, I. Garai1; 1 ScanoMed Nuclear Medicine Centres, Debrecen, HUNGARY, 23rd Department of Internal Medicine, University of Debrecen, Debrecen, HUNGARY, 3Department of Nuclear Medicine, Debrecen, HUNGARY. Aim: Interim 18FDG-PET/CT examination is of great importance predicting prognosis of HL patients. Currently there is no standard definition of minimal residual uptake (MRU) using 5-point visual scales.The aim of our study was to compare the effect on prognosis of the currently applied MRU definitions.Methods: Interim 18FDG-PET/CT examinations of 82 newly-diagnosed HL patients (male, 40; female, 42; average age, 36 years) were evaluated by London, Hutchings, Gallamini and Barrington criteria. The 18FDG-PET/CT studies were performed on the same camera according to the standard protocol. The studies were analysed by two experienced specialists.All patients had six courses of ABVB/EBVD and received radiotherapy according to the protocol if it was necessary. The result of interim 18FDG-PET/CT did not affect the later used therapy. The median follow-up period
was 24 months (range, 9-47 months).Kaplan-Meier analysis was performed to determine the overall survival (OS) and progression free survival (PFS) and MantelCox probe was calculated to compare the outcome of the different groups.Results: During the observation period 78% (64/82pts) of patients showed no progression.Comparing the PET negative group to the PET positive group poor prognosis was measured on the basis of all four criteria. The Barrington and Gallamini methods were more robust in estimating prognosis. Using forward stepwise Cox regression analysis of 4 criteria, the Barrington method was proved to be the most effective. However, when comparing PET negative groups there were not significant differences in OS or PFS in either defined MRU groups.Conclusion: Our results suggest that interim 18FDG-PET/CT studies allow to identify patients with poor prognosis applying Barrington and Gallamini criteria. Although any MRU definitions might not have prognostic value in the clinical outcome of HL patients.
P494 Analysis of the usefulness of PET / CT in the follow up of patients with lymphoma and clinical diagnosis of complete remission. A. Mariana Monguia, A. Mendoza Paulini, S. I. Vasquez Tineo, M. P. Garcia Alonso, M. A. Balsa Breton, L. Castillejos Rodriguez, A. M. Ortega Valle, F. J. Penin Gonzalez, C. Pey Illera; HOSPITAL UNIVERSITARIO DE GETAFE, MADRID, SPAIN. Introduction: Follow up in patients with lymphoma is usually done by clinical and analytical assessem*nt and imaging tests (torax abdomen and pelvis CT and 67Ga whole body scan) depending on the clinical suspicion of relapse. Objective: To evaluate the advantages of PET/CT in the detection of early relapse in patients with clinical diagnosis of complete remission. Material and method: 79 patients with clinical and anaytical diagnosis of complete remission were included, 51 non Hodgkin lymphoma (NHL) and 28 Hodgkin lymphomas (HL).They underwent at least 2 PET/CT studies and clinical-analytical follow up by hemathology department during the last two years.We also compare total costs of previous tests (CT scan and 67Ga whole body scan) with that assigned to PET/CT in our hospital. Results: PET/CT detected relapse on: 12 NHL patients, 8 not clinically suspected. Those who had clinical suspicion 1 was by lymphadenopathy, analytical findings and bone marrow abnormalities and other 3 by bone marrow abnormalities. 4 HL patients, 3 not clinically suspected. The one suspicion was by lymphadenopathy, analytical findings and bone marrow abnormalities. Cost assigned to PET/CT is 666€, less than for the combination of a TC scan and 67Ga whole body scan (766.31€).Total effective dose equivalent for PET/CT is 18mSv (8mSv assigned to a low dose CT and 7mSv to 10 mCi dose of 18F-FDG) and for convencional techniques 72mSv (35 mSv to a CT scan and 37mSv to 10 mCi dose of 67Ga). Conclusion: In our experience PET/CT is an appropriate approach in follow up of patients with lymphoma, because it is able to detect early relapse, subjecting patient to a lower radiation dose and with lower cost than conventional techniques.
P45 — Monday, October 17, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Leukemia & Myeloma
P495 The Value of FDG PET/CT after Autologous Stem Cell Transplantation (ASCT) in Patients Affected by Multiple Myeloma (MM) C. Nanni, M. Celli, E. Zamagni, V. Ambrosini, P. Caroli, A. Brioli, B. Zannetti, P. Tacchetti, M. Cavo, S. Fanti; Azienda Ospedaliero Universitaria di Bologna Policlinico S.Orsola-Malpighi, BOLOGNA, ITALY. to analyze the prognostic value of FDG PET/CT carried out at the completion of first line therapy (induction chemo+single or double ASCT) in an hom*ogeneous population of patients (pts) affected by MM.a total of 107MM pts (31F;76M;mean age 57yo) were enrolled in the study. All the pts were referred for an FDG PET/CT at staging, 3months after the completion of therapy and every 6to12 months during the follow up (mean 41 months). All the patients underwent standard controls during the FU to assess disease relapse.Pts were divided into gr1:clinically relapsed and gr2:clinically non relapsed.In gr1 the result of PET in terms of positivity-negativity and in terms of SUV max were compared to the time to relapse. In gr2 the possible presence of positive finding changes at PET scans during the follow up was analyzed to identify typical patterns of disease behaviour.Pts with a negative PET at staging scan were excluded to avoid possible false negative results after therapy.47/107 (44%) pts relapsed during FU. 10 had a negative PET scan at staging. In the end, Gr1 consisted of 37pts. Among them, 22 had a negative post therapy PET scan (59%, mean time to relapse 27,6 months) and 15 had a positive post therapy PET scan (41%, mean time to relapse 18 months). There was a statistically significant difference between the two times to relapse (t Test p=0,05).In pts with a positive PET post therapy scan, the SUV max was inversely correlated to the time to relapse (Correlation Coefficient =-0,7; p<0.003).59/107
Poster Presentations
following regions: cervical in 68 patients, thoracic in 62 patients and abdominal in 53. PET/CECT detected cervical lesions in 68 patients, thoracic in 62 and abdominal in 55. PET/NCECT detected 36 cases of extra nodal disease and PET/CECT detected 35 cases. The total number of indeterminate findings for region-based analysis was 5 for PET/NCECT and 13 for PET/CECT.Agreement between the 2 types of PET/CT taking into account all the regions was good for all grouped lymphoma patients (kappa=0,92, CI 95%: 0,88-0,95), and for each histologic subtype (with kappa values of at least 0,89). Analyzing each region considered, the agreement between the two techniques was also good with kappa values of at least 0,88. The agreement in disease stage was absolute in Hodgkin lymphoma, showed 2 discordant findings in follicular non-Hodgkin lymphoma (one upstaged and one understaged by PET/CECT), and 1 in diffuse large B-Cell non Hodgkin lymphoma (upstaged by PET/CECT).CONCLUSION:Our study showed a good correlation between unenhanced low-dose PET/CT and contrast-enhanced full dose PET/CT for the initial staging of Hodgkin lymphoma, follicular non-Hodgkin lymphoma and in diffuse large B-Cell non Hodgkin lymphoma patients, suggesting that low-dose PET/CT should be enough in most lymphoma patients.
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(56%) pts did not relapse during FU. 19 of them had a negative PET scan at staging. In the end, Gr2 consisted of 40pts. Among them, 27 had a negative post therapy PET (68%) scan and 13 had a positive post therapy PET scan (32%). Two non relapsed patients showed a progressive mild decrease in SUV max during the FU.There was not a statistically significant difference between relapsed and non relapsed pts in terms of SUV max post therapy (t Test p=0,7).in this study a negative post therapy PET in patients treated for MM was predictive for a longer disease free survival. However, half of the patients with a positive post therapy PET did not relapse during the follow up. The meaning of positive PET findings in patients who did not relapse is yet to be clarified.
P496 Value of Tc-99m (V) DMSA compared to Tc-99m MIBI in evaluation of bone and bone marrow lesions in patients with multiple myeloma S. S. Salem1, M. I. Ismaeil2; 1Cairo University, Cairo, EGYPT, 2Mansoura University, Mansoura, EGYPT. Introduction: Multiple myeloma (MM) is a primarily bone marrow neoplasm that is characterized by proliferation of monoclonal myeloma cells with possible bone and soft tissue extension. Tc-99m sestamibi (MIBI) has been proposed as a potential imaging tracer in patients with multiple myeloma. Tc-99m Pentavalent dimercaptosuccinic acid (V-DMSA) has been shown to have an implications in imaging medullary carcinoma, head and neck tumors as well as soft tissue and bone tumors. Few reports evaluated imaging of multiple myeloma by Tc-99m (V) DMSA and none of them compared Tc-99m (V) DMSA with Tc-99m MIBI. Aim of the study: Is to compare the value of Tc-99m (V) DMSA and Tc-99m MIBI in the detection of bone and bone marrow lesions in patients with multiple myeloma. Materials & Methods: Thirty two consecutive patients with MM (18 males and 14 females, mean age 55±9 years) were enrolled in this study. Diagnosis and staging were made according to standard criteria. Tc-99m MIBI scan was done first in all patients followed 48 hours later by Tc-99m (V) DMSA scan to avoid carryover of image data. Whole body Tc-99m MIBI scans were obtained 10 minutes after IV injection of 555 MBq of the tracer. Whole body Tc-99m (V) DMSA scans were acquired 2 hours following IV injection of 740 MBq of the tracer. Both sets of images were obtained using dual-head gamma camera (Vertex, ADAC), equipped with a low energy, high-resolution collimator. Results: the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Tc-99m (V) DMSA was 93%, 100%, 100%, 67% & 94 % Versus 71%, %100, 100%, 33% and 75% for Tc-99m MIBI, respectively. Comparing the pattern of bone & bone marrow involvement in both scans, it was focal in 18 (56%) patients, diffuse in 6 (19%) patients, diffuse and focal in 3 (9%) patients and normal in 5 (16%) patients in Tc99m (V) DMSA scans, while, it was focal in 6 (19%) patients, diffuse in 11 (34%) patients, focal and diffuse in 3 (9%) patients and normal in 12 (38%) patients in Tc99m MIBI scans.Conclusion: Tc-99m (V) DMSA is better than Tc-99m MIBI in evaluation of bone and bone marrow lesions in patients with multiple myeloma. Tc-99m (V) DMSA performed better than Tc-99m MIBI in the detection of focal lesions, whereas Tc-99m MIBI was superior in the visualization of diffuse disease.
P497 Additional value of FAMT PET/CT for the assessment of multiple myeloma; Comparative study with FDG PET/CT 1
1
2
1
1
1
S. Nakano , Y. Arisaka , A. Isoda , T. Higuchi , M. Anamuma , N. Oriuchi ; 1 Gunma University Graduate School of Medicine, Maebashi, JAPAN, 2 Nishigunma Hospital, Shibukawa, JAPAN. PurposeUtility of [F-18]2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography/computedtomography (PET/CT) in the evaluation of multiple myeloma is already establishedin the definition of active lesions and it is also reported that patients withmore than 3 FDG avid lesion shows poorer survival rate. FDG-PET/CT intherapeutic evaluation is still challenging and it is suggested that decreasedFDG uptake is related with successful treatment. [F-18] alpha-methyl tyrosine(FAMT), which was established in our institute, is an amino acid PET tracer andis transported into tumor cells via L-type amino-acid transporters and is reportedto be more specific to malignancy. In our study, we evaluated the additionalvalue of FAMT PET/CT in the evaluation of multiplemyeloma’s bone marrow lesion and compared with FDG PET/CT.Materialsand Methods Eight patients with multiple myeloma areincluded and FAMT and FDG PET/CT were performed in all cases within 1 weekinterval. The uptakes of tracers were semi-quantitatively evaluated using max standardizeduptake value (SUVmax). Lesions with positive FDG uptake were picked up andsemiquantitative analysis was performed. In detail, average SUV are set on aorticarch as mediastinal background SUV and on normal bone marrow to calculate the lesionto mediastinum ratio (L/M ratio) and lesion to bone marrow ratio (L/B ratio) inboth FDG and FAMT-PET and those values were statistically compared usingstudent t- test.ResultTotally 34 FDG avid bone lesions weredefined and all of these lesions had an increase uptake of FAMT. Average SUVmaxand L/B ratio of FDG (3.1+/- 1.2 and 3.3+/- 1.9, respectively) were significantly(p<0.05 for each) higher than that of FAMT (2.0+/- 1.0 and 2.6 +/- 1.1,
respectively).In contrast, L/M ratio of FDG showed no significant difference with that ofFAMT (2.2 +/- 1.0 and 2.4 +/- 1.2, respectively, p=0.3).ConclusionAlthough the absolute uptake level is lower thanFDG-PET, FAMT-PET showed definite FAMT uptake in most FDG avid myeloma lesionin bone marrow. Furthermore, equivalent semi-quantitative value was obtainedusing L/M ration and its application as independent monitoring tool of multiplemyeloma lesions is expected in future study.
P498 Comparison between whole-body diffusion MRI and PET-CT in the diagnosis of symptomatic Myeloma.
18
FDG
E. Brillet1, O. Decaux1, A.-M. Bernard2, A.-M. Devillers2, T. Lamy de la Chapelle1, R. Guillin1, E. Garin2, R. Duvauferrier1; 1University Hospital of Rennes, Rennes, FRANCE, 2Centre Eugène Marquis, Rennes, FRANCE. Introduction:Our work aims to compare whole-body diffusion MRI and 18 FDG PETCT in the diagnosis of symptomatic Myeloma.Both techniques use the fusion of a morphological imaging and a functional imaging, using two different properties from myelomatous infiltration: tissular modifications inferred by plasmocytory infiltration (hypercellularity, néoangiogenesis and architectural distortion) for diffusion MRI , and cellular hypermetabolism for PET-CT.Material and method:From November, 2008 till May, 2010, 19 patients one investigated by whole-body diffusion MRI and 18 FDG PET-CT. The patients were classified according to the criteria of the International Myeloma Working Group in 8 non-symptomatic myélomas and 11 symptomatic myelomas.The sensibility and the specificity of 2 methods of imaging were studied by retaining the presence or the absence of a diffuse infiltration (ID), focal lesions (FL), or 2 parameters ( FL+ID), in both modalities of imaging. We compared the concordance between 2 techniques for every patient by using these signs using a weighted kappa test.The examinations were read by a radiologist, for MRI, and a nuclear physician for PET-CT.Results:The performances of both modalities seem comparable, with superior diagnostic performances for the FL (Se= 84 % and Sp = 100 % in diffusion MRI and Se=83 % and Sp=85 % for PET-CT) that for ID only (Se= 56 % and Sp = 41 %).By combining both parameters, the PET-CT seems more sensitive, but the specificity is comparable in both modalities. (Se=68 % in MRI and Se=78 % in PET-CT and Sp=100 % in both techniques).The concordance between both techniques is better by taking into account the focal lesions that the other parameters (Weighted kappa=0.61 for FL (good concordance), Weighted kappa =0.5 for the FL+ID (moderate concordance) and 0.16 for ID alone (low concordance)).Conclusion:Diagnostic performances of whole-body diffusion MRI 18 and FDG PET-CT seem equivalent, but concordance between both techniques is unperfect. Both techniques exploit two different properties of myelomatous tissue, and are probably complementary.
P499 The usefulness of dual-time multiple myeloma
18
F-FDG PET/CT in patients with
H. Seura1, T. Okamura1, K. Koyama2, Y. Hamazawa1, K. Ota1; 1Saiseikai Nakatsu Hospital Osaka, Osaka, JAPAN, 2Osaka City University Graduate School of Medicine, Osaka, JAPAN. Aims: To our knowledge, there are few reports discussing about the usefulness of 18 F-fluorodeoxyglucose positron emission tomography / computed tomography (FDG PET/CT) imaging on multiple myeloma (MM). In this study, we examined the usefulness of dual-time FDG-PET/CT in patients with MM.Methods: Sixteen patients (8 male, 8 female; average age 69 years) with MM seen between October 2006 and September 2011 were investigated in this study. MM lesions were diagnosed pathologically or clinically with at least 6 months follow-up. For dualtime FDG PET/CT, the initial and the delayed PET image were acquired at 1 and 2 h after intravenous FDG injection, respectively. PET/CT images were assessed visually and quantitatively.Results: PET and/or CT imaging had identified 181 bony and bone-marrow lesions. In visual analysis of the 181 previously identified lesions, 135 could be identified using CT (75%), 152 using PET (84%), and 106 (59%) using both modalities. Of the 135 lesions identified using CT, 79% were also identified using PET. Of the 152 lesions identified using PET, 70% were identified using CT. Dividing lesions into spinal, rib, pelvic and long bones, detection rates for PET and CT were 86% and 73%, respectively, for the 59 spinal lesions; 86% and 58% for the 36 rib lesions; 90% and 79% for the 42 pelvic lesions; and 80% and 92% for the 25 long bone lesions. In quantitative analysis of the 152 lesions in which abnormal accumulation was detected, the mean (± standard deviation) standard uptake values (SUVs) were 4.12±3.01 in the initial images and 5.33±4.05 in the delayed images, with a significant difference (p<0.0001). SUV was increased in the delayed image compared to the initial image in 135 lesions (89%).Conclusions: Our results revealed that PET imaging had a higher detection rate than CT imaging in MM lesions. For evaluating CT negative and PET negative MM lesions, further investigations are needed including magnetic resonance imaging (MRI).
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18F-FDG-PET/CT in the evaluation of response to treatment in patients with active multiple myeloma.
Oncology Clinical Science: Neuroendocrine Tumours
Introduction: Multiple Myeloma (MM) is a malignant hematologic disorder that is characterized by monoclonal proliferation of malignant plasma cells. Conventional imaging procedures have not shown reliable results in MM treatment assessment.Aim: To evaluate the usefulness of PET/CT in routine clinical monitoring of patients with MM.Material and Methods: We retrospectively studied 20 patients diagnosed of active MM (13 male; 7 female) with a mean age of 58±14 ys. All patients underwent 18F-FDG PET/CT at baseline and post-treatment. PET findings were analyzed based on EORTC criteria. The mean ΔSUVmax was defined as the change of SUVmax in percentage between baseline and posttreatment. The final diagnosis was established into two categories as responders (complete or partial) and non-responders (stable or progression), following the International Myeloma Working Group response criteria.Results: Ninety five percent (95%) of the patients showed pathological uptake in baseline PET (19/20). The patient with negative baseline PET (1/20) was excluded from the analysis. Six out of nineteen (6/19) patients were classified as responders and 13/19 as nonresponders. The baseline SUVmax in the responder (SUVmax= 3.4) and in the nonresponder group (SUVmax= 3.3) was similar. Following EORTC criteria, the metabolic response by PET in the responder group was complete (n=3) or partial (n=3). In the non-responder group, the metabolic response by PET was partial (n=2), stable (n=7) or progressive (n=4). The responder group showed a decrease of the SUVmax (ΔSUVmax= 1.67) between baseline and post-treatment PET and the non-responder group showed an increase of (ΔSUVmax= 1.76). The mean ΔSUVmax differences between the two categories were statistically significant (P< 0.01).Conclusions: PET/CT can be a useful non-invasive imaging technique to monitor the response in patients with active MM. SUVmax changes (ΔSUVmax) were able to identify all the responder patients in this series.
P501 FDG PET-CT in Myeloma - is there a role for a half body versus a whole body protocol?
(NET)
P502 I-123 MIBG SPECT/CT Hybrid Imaging in Evaluation of Neuroectodermal Tumors B. Vatankulu, M. F. Bozkurt, O. Ugur; Hacettepe Universty, Ankara, TURKEY. Aim : I-123 MIBG scintigraphy has an important role in the management of neuroectodermal tumors. In this study, we evaluated additional diagnostic contribution of SPECT/CT hybrid imaging compared to the planar and SPECT imaging..Method: I-123-MIBG scintigraphy was performed in 27 patients with diagnosis of neuroectodermal tumor (16 male, mean age:19) Planar, SPECT and SPECT/CT hybrid imaging were performed 24 hours after injection of 3-10 mCi MIBG. The difference and coherence between efficiency of planar, SPECT and SPECT/CT methods were determined by Friedman and Wilcoxon tests, respectively.Results: Lesions were detected by at least one of planar, SPECT or SPECT/CT methods in total of 15/27 (55%) patients whereas all three methods were found negative in 12/27 (45%) patients. In six of these twelve patients, disease could not be detected with conventional methods and histopathological evaluation. In three patients whom planar and SPECT analysis did not show pathologic I-123 MIBG involvement, CT component of SPECT/CT hybrid imaging showed anatomic lesions suggestive of metastasis (lymphadenopathy and sclerotic lesions in bone). In three patients, uptake showed by planar and SPECT imaging was found to be physiological involvement after SPECT/CT evaluation. Total number of lesions detected by planar, SPECT and SPECT/CT methods were 22,23 and 25 respectively. There was no significant difference between each three methods with respect to the number of lesions ( p=0.076)Conclusion: SPECT/CT hybrid imaging may have an important role to reduce false negative and false positive results compared to planar and SPECT imaging in I-123 MIBG scintigraphy for neuroectodermal tumors.
P503
M. Morgan, J. Davidson, I. Mitra, M. W. Jenner, F. X. Sundram; Southampton General Hospital, Southampton, UNITED KINGDOM.
Sensitivity of Octreoscan in neuroendocrine tumours and its association with primary site and histological tumour grade
Background: Conventional imaging techniques including plain radiographs, CT and MRI are well-established and have an important role in myeloma management. PET-CT is increasingly used and the experience is in evolution. This technique provides distinct advantages, evaluating the entire body in one examination and identifies medullary and also extra-medullary lesions. It evaluates the extent of active disease, assists in treatment response assessment, is useful in non-secretory myeloma and may detect other bony abnormalities in apparently solitary plasmacytomas.Aim: The vast majority of FDG PET-CT oncology studies utilize a half-body protocol (skull base to upper thighs). However, as myeloma can involve any part of the skeleton, whole body acquisitions (skull vertex to feet) are usually employed. Osteolytic lesions commonly involve the vertebrae, ribs and skull; lesions distal to elbows and knees being rare. Therefore, it may be possible to perform a half body, instead of a whole body acquisition, without reducing diagnostic accuracy. We reviewed our data to determine if a half-body protocol could be used.Materials and methods: A retrospective review of PET-CT studies for multiple myeloma/plasmacytoma performed at our institution over a 2 year period (2009-2010). The indication for the study, sites of lesions (including the limbs) and associated FDG activity were collated.Results:49 patients underwent whole body FDG PET-CT scans: 37 for multiple myeloma, 12 for axial skeleton plasmacytomas. The indications included staging (11), disease recurrence (28) and treatment response (10).In the myeloma group, 4/37 (11%) had lower limb lesions - 1 femoral neck, 1 proximal femur, 1 mid femoral shaft, 1 distal femur. Only 1/12 (8%) in the plasmacytoma group had a lower limb lesion, at the proximal femur. 3/5 lesions (2 proximal and 1 neck of femur) in the total patient group would have been identified if a half body only protocol was used. All lesions were metabolically active and morphologically either had lytic foci or focal textural change, one lesion demonstrating cortical disruption. No lesions were noted below the knees or elbows.Conclusion: Whole body PET-CT acquisition in myeloma patients identifies mid/distal femoral lesions that could be missed on half body acquisition. However, in this series no lesions below the knees or elbows were identified. Although a halfbody protocol may suffice, it seems more appropriate to consider a modified protocol (skull base to distal thighs). This appears to have several advantages including reducing radiation dose, saving time and likely increasing patient throughput.
E. J. A. Nowosinska, S. Navalkissoor, M. Caplin, A. Quigley; Royal Free Hospital, London, UNITED KINGDOM. Objectives: To evaluate the overall sensitivity of 111In-pentetreotide (OctreoScan) in NETs and correlate intensity of tracer uptake with primary tumour site and histological grade.Methods: All patients with NETs who underwentan OctreoScan within a 75 months period (January 2004- March 2011) and had available histology were included. The degree of tracer uptake seenon Octreoscan (Krenning grade=KG) was evaluated and correlated with primary tumour site and histological grade of NET. Histological grading was in accordance with ENETS guidelines.Results: Of the 119 patients with NETs identified, 104/119 (87%) were gastroenteropancreatic neuroendocrine tumours (GEP-NETS): foregut 41/104(39%), midgut 57/104 (55%), hindgut 6/104(6%) with bronchial NETs making up 6/119(5%) and other NETs 9/119 (7%). The overall sensitivity for detection of NETs was 88/119 (74%), with 69/119(58%) having intense, positive tracer uptake (KG ≥3). The sensitivity for the detection of primary site in GEP-NETS was as follows: foregut 28/41 (68%), midgut 44/57 (77% ) and hindgut 5/6 (83%). The sensitivity for detection of primary site in bronchial NETs was 4/6 (67%) and other 7/9 (78%). Intense, increased tracer uptake on Octreoscan (KG ≥3) in GEP-NETs were seen in 25/41 (61%) of foregut, 35/57 (61%) of midgut and 3/6(50%) of hindgut NETs.1/6 (17%) of bronchial NETs and 5/9( 56%) of other NETs demonstrated KG ≥ 3.Overall, 62/119 (52%) of patients had histologically low grade tumours and 49/119 (41%) had intermediate grade. A positive scan was seen in 42/62 (68%) of histologically low grade tumoursof which 32/62 (52%) were KG≥ 3. Of thosewith intermediate histological grade 38/49 (78%) had positive scan with 33/49 (67%) showing KG ≥3.Conclusion:Octreoscan demonstrated higher sensitivity inGEP-NETs than non-GEPNETS, but had lower sensitivity in foregut GEPNETS than midgut and hindgut tumours.More intense uptake was predominantly seen in patients (GEP-NET and non-GEPNET) with histologically intermediate grade tumours
Poster Presentations
N. S. Eftychiou, D. Fuster, X. Setoain, L. Rosiñol, A. Perissinotti, M. Depetris, J. Bladé, F. Pons; Hospital Clinic, Barcelona, SPAIN.
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P504 111In-pentetreotide SPECT and SPECT/CT vs conventional imaging procedures (CIP) in non-functioning gastroenteropancreatic neuroendocrine tumor (GEP) patient management A. Spanu1, O. Schillaci2, A. Falchi1, R. Danieli2, G. B. Di Santo3, P. Marongiu1, F. Chessa1, S. Nuvoli1, F. Dore3, G. Madeddu1; 1University of Sassari, Sassari, ITALY, 2University of Rome Tor Vergata, Rome, ITALY, 3 Hospital of Trieste, Trieste, ITALY. Aim. Controversial results have been reported on the better performance between 111In-pentetreotide receptor scintigraphy (SRS) and conventional imaging procedures (CIP), such as TC, MRI and US, in comparative studies of nonfunctioning GEP tumor patients. We further investigated whether SPECT and SPECT/CT SRS may have an incremental diagnostic value than CIP in affected non functioning GEP tumor patients.Methods. We enrolled 101 non functioning GEP tumor patients, 64 in follow up after primary tumor treatment and 37 at initial diagnosis and staging, all asymptomatic for neuroendocrine hormone overexpression. Definitive diagnosis was obtained by surgery, percutaneous biopsy and laparatomy. All patients underwent at least 2 CIP procedures before scintigraphy. 111In-pentetreotide whole body scan and SPECT over abdomen and other suspect regions in all patients, and also SPECT/CT in 27/101 cases, were performed using a dual head gamma camera including a low-dose CT.Results. Neoplastic lesions were ascertained in 75/101 patients. SPECT was positive in 68/75 cases and CIP in 58/75 cases, both procedures being true negative in the remaining 26/101 patients. Both CIP and SPECT were concordantly true positive in 51/75 patients, only CIP in 7 and only SPECT in 17. Per-patient sensitivity, specificity and accuracy were 90.7%, 100% and 93.1%, respectively for SPECT and 77.3%, 100% and 83.2%, respectively for CIP; the difference was not significant. Globally, 269 neoplastic lesions (144 hepatic, 83 abdominal extra-hepatic and 42 extra-abdominal) were identified and SPECT was positive in 256/269, while CIP in 182/269 (per-lesion sensitivity: 95.% vs 67.6%; P<0.001). SPECT detected 95.1% hepatic, 95.2% abdominal extraepatic and 95.2% extra-abdominal lesions, while CIP identified 79.9%, 48.2% and 64.2%, respectively. SPECT correctly modified CIP patient classification and management in 30 pts (29.7%), while it gave an uncorrect classification downstaging the disease in 12 (11.9%). In the 27 patients submitted to SPECT/CT, 10 were confirmed true negative, one false negative and the remaining 16 true positive; SPECT/CT had an incremental value in respect of SPECT in 10/16 (62.5%) of the latter patients, since it detected additional lesions, correctly identified the anatomic site, in particular of small size bone, pulmonary and abdominal lymph node metastases and duodenal neoplastic lesions not easy to be characterized.Conclusion. 111In-pentetreotide SPECT and SPECT/CT proved to be a more sensitive diagnostic tool than CIP in our series of non functioning GEP tumor patients, giving additional information for patient management. Moreover, SPECT/CT improved SPECT imaging correctly characterizing the lesions and identifying their anatomic site.
P505 Ga-68-DOTATATE-PET in multiple endocrine neoplasia 1 (MEN1) M. Marx1, H. Mönig2, M. Lürken1, M. Zuhayra1, Y. Zhao1, B. Egeler1, E. Henze1, U. Lützen1; 1Klinik für Nuklearmedizin, UK S-H, Kiel, GERMANY, 2 Klinik für Innere Medizin I, UK S-H, Kiel, GERMANY. Aim: Multiple endocrine neoplasia 1 (MEN1) is a rare genetic disorder covering combinations of more than 20 different endocrine tumours (among them foregut carcinoids) and nonendocrine tumours. The diagnosis is possible if 2 of 3 main MEN1-related endocrine tumours (parathyroid adenoma, entero-pancreatic endocrine tumours, pituitary tumour) are present. Decisive diagnostic tools are biochemical and hormonal studies, endoscopy, ultrasound, CT, MRI, and somatostatin receptor scintigraphy (SRS). An improvement in the diagnosis of neuroendocrine tumours is obtained by Ga-68-DOTATATE-PET - We investigated the diagnostic benefit of Ga-68-DOTATE-PET in patients with MEN1.Materials and methods: In 8 patients with MEN1 (7 women and 1 man; aged 23 - 58 years, mean 35 years) a Ga-68-DOTATATE-PET was performed. Twenty minutes after intravenous injection of 97 - 162 MBq Ga-68-DOTATATE PET was carried out using an ACCEL PET scanner (Siemens, Erlangen, Germany). Standardized uptake values (SUV max) were determined in foci and organs suspicious to be affected by MEN1 (pituitary gland, thyroid gland, stomach, liver, spleen, pancreas, intestine, adrenal glands). In 6 of 8 patients fusions of PET with CT or MRI were made.Results: The pancreas of 5 patients presented one or more lesions with an increased Ga-68DOTATATE uptake. Twelve suspicious foci were observed in these 5 patients; the organ/number of lesions/ SUVmax were: pancreas/9/62,3; lung/1/2,8 ; stomach/1/26,9; lymph node/1/1,4. One patient showed an increased uptake in the adrenal glands (SUVmax 18,2) without pathological findings in CT. Three patients presented a normal distribution of Ga-68-DOTATATE. The highest physiological activity was observed in the spleen (SUVmax 28,7 + 7,9), the lowest in the lungs (SUVmax 1,5 + 0,4). The SUVs in the examined organs partially showed a widespread range: SUV max of the liver 9,3 + 2,8, adrenal glands 9,2 + 3,2, stomach
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 8,6 + 3,1, intestine 7,4 + 2,2, pancreas 6,0 + 0,5, pituitary gland 5,4 + 2,4, thyroid gland 5,2 + 1,6.Conclusion: Ga-68-DOTATATE-PET appears to be a diagnostic improvement in patients with MEN1, especially in those with small pancreatic tumours. The determination of cut-off values of normal uptake, especially as to pituitary gland or other organs affected by MEN1, necessitates to increase the number of patients studied. The early detection of MEN1 manifestations should be achieved before clinical symptoms arise.
P506 Contribuction of SPECT-CT Hybrid Imaging to Conventional 111 In-Pentetreotide in Patients with Imaging with Neuroendocrine Tumours P. García-Talavera, A. Sainz-Esteban, M. L. González-Selma, R. Olmos, M. Á. Ruiz, C. Gamazo, A. Gómez; Nuclear Medicine Department. Hospital Clinico Universitario de Valladolid, Valladolid, SPAIN. Aim:To evaluate the contribution of SPECT-CT imaging to conventional imaging (whole body scintigraphy -WBS- and tomography) with 111In-pentetreotide in neuroendocrine tumours.Material and Methods:Forty eight studies performed to 43 patients between 2010 and 2011 were included (24 males; mean age: 59 ± 17 years). All patients were diagnosed with neuroendocrine tumours (6 bronchopulmonary tumours, 15 gastrointestinal tumours, 11 pancreatic tumours, three metastatic NET of unknown primary, two medullary thyroid carcinomas and 6 paragangliomas). A WBS was performed to all of them 4 and 24 hours after the injection of 148-222 MBq of 111In-pentetreotide. Besides, a cervical, thoracic or abdominal SPECT-CT was acquired at either 4 or 24 h, depending on the pathology. The number of pathological foci was evaluated (up to a maximum of three foci). The conventional imaging and the SPECT-CT were evaluated independently. The findings were confirmed with the clinical follow-up, other imaging tests and/or pathological studies.Results:In total, 68 foci were detected. The SPECT-CT showed two new foci and confirmed two doubtful foci with respected to conventional imaging. Besides, it improved the localization of 40 foci (30 tumours and 10 false positives of the conventional study). The tumour foci were localized at pancreas (12), liver (7), skeleton (6), carotid bifurcation (2), pulmonary hilum (2) and abdominal adenopathy (1). The false positive cases corresponded to a rib fracture (1), a pneumonia (1) and to physiological activity in the gallbladder (2), breast (1), ovary (1), and gastrointestinal tract (4). All foci, except three, were confirmed by means of follow-up, other imaging tests, and pathological studies.Assessing the results by study, 23 did not show any pathological uptake. In 25 studies (52%) the SPECT-CT was more helpful than conventional imaging. Out of these 25, the localization of tumor foci was improved in 17 studies (35%), false positives of the conventional imaging were detected in 8 studies, new foci were showed in the pancreas (2) and one doubtful foci of the conventional study, in the pancreas as well, was confirmed.Conclusions:The SPECT-CT detected two new foci and confirmed 2 doubtful foci compared to the conventional imaging and improved the localization of 40 foci helping to discriminate between tumour lesions and physiological uptake. In global, making an SPECT-CT in addition to the conventional imaging proved useful in half of the studies assessed.
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The Diagnostic Efficiency of Tc-HYNIC-octreotate SPECT111 In-pentetrotide in the Detection of CT in Comparison with Neuroendocrine Tumours. E. Koçyiğit Deveci1, M. Ocak2, S. Türker1, L. Kabasakal2, Ö. Uğur1; 1 Hacettepe University, Ankara, TURKEY, 2İstanbul University, İstanbul, TURKEY. Introduction: The aim of this study was to assess the diagnostic efficiency of 99mTcEDDA/HYNIC-octreotate in comparison with 111In-pentetrotide scintigraphy in the detection of neuroendocrine tumours. This study also evaluates the impact of SPECT-CT hybrid imaging on somatostatin receptor scintigraphy (SRS) interpretation and clinical management of these tumors.Material and methods: 14 patients were included in the study. All patients underwent a whole body and SPECT-CT imaging at 4 hours post injection of 370-400 Mbq of 99mTc-EDDA/HYNICoctreotate and In-111 DTPA-D-Phe-octreotide imaging at 24-48 hours after injection. Images were evaluated both visually and semiquantitatively.Results: On patient basis, the diagnostic results of both studies were similar. The number of lesions detected by 99mTc-EDDA/HYNIC-TATE were found higher than the number of lesions detected by 111In-DTPA-D-Phe-octreotide however it is not significant statistically (40/45 (%88), 36/45 (%80) p=0.109). Semiquantitative analysis showed higher tumour/organ count ratios for both whole-body and SPECT 99mTcEDDA/HYNIC-TATE scans.Conclusion: The results of this study suggested that, 99m Tc-EDDA/HYNIC-TATE may be a better alternative to 111In-DTPA-D-Pheoctreotide due to high image quality and lower radiation dose. SPECT/CT is a valuable tool for the assessment of neuroendocrine tumours by providing the precise anatomic localization of scintigraphic findings thus improving lesion detectability and characterization. This study was supported inpart by Turkish Scientific and Research Council (TUBITAK) project no: 109S498 and 109S101
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
Performance of DOTATOC PET/CT for the detection of insulinomas in adults F. Montravers1, V. Nataf1, A. Prignon1, J. Rose1, S. Balogova1, M. Calzada2, G. Maurel2, K. Kerrou1, O. Pascal1, V. Huchet1, L. Michaud1, J. Devaux2, J. Talbot1; 1Hopital Tenon, Paris, FRANCE, 2Hopital Saint-Antoine, Paris, FRANCE. The purpose of this study was to evaluate the performance of DOTATOC-(68Ga) PET/CT in comparison with Somatostatin Receptor Scintigraphy (SRS) and in 2 cases with FDOPA PET/CT for the detection of insulinomas in adults.Patients:Between February 2008 and February 2011, 10 adult patients were referred for localisation of a suspected sporadic insulinoma (6 patients), for localisation of insulinoma in one patient with Multiple Endocrine Neoplasia type 1 (MEN-1), for staging of a proven insulinoma in one patient and for re-staging of metastatic insulinoma in 2 patients. DOTATOC PET/CT and SRS were performed in all patients and FDOPA PET/CT was also performed in 2 patients.Results:- Localisation of a suspected sporadic insulinoma: The diagnosis of insulinoma was finally excluded in 3 patients and confirmed in 3 patients. DOTATOC PET/CT and SRS were true negative (TN) for the 3 patients without insulinoma. In the 3 patients with confirmed insulinoma, DOTATOC PET/CT was true positive (TP) in the 3 patients, SRS was TP in 1 patient and false negative (FN) in 2 patients and the FDOPA PET/CT performed in 1 patient was FN.- In the patient with MEN-1, DOTATOC PET/CT was superior to SRS and FDOPA PET/CT, showing clearly the insulinoma and leading to the detection of an unexpected second functioning tumour in the pancreas (glucagonoma), while SRS was positive only for the insulinoma and FDOPA PET/CT was positive only for the glucagonoma.- In the patient referred for staging of a proven insulinoma, DOTATOC PET/CT was TP for the insulinoma and TN for the distant extension and SRS was FN for the insulinoma.- In the 2 patients referred for re-staging, DOTATOC PET/CT and SRS were both TP on a per-patient basis but DOTATOC PET/CT showed more lesions than SRS.Conclusion:In this prelimary series of insulinomas in adults, DOTATOC PET/CT appeared to be superior to SRS to detect the primary tumours with a sensitivity (Se) of 5/5 vs 3/5 for SRS. The specificity of DOTATOC PET/CT and SRS was 3/3. DOTATOC PET/CT and SRS were TP on a per patient basis in the 2 patients with a metastatic insulinoma but DOTATOC PET/CT was clearly superior to SRS on a per-site basis. FDOPA PET/CT was FN for the localisation of the primary insulinoma in 2 patients.
P509 Comparative diagnostic value of Tc-99m and In-111 labelled somatostatin analogues for somatostatin receptor scintigraphy. Preliminary results. I. Szilvási1, Z. Varga2, K. Buga1, E. Takács2, V. Valent1, G. Dabasi2; 1Military Hospital-State Health Centre, Dept. of Nuclear Medicine, Budapest, HUNGARY, 2Semmelweis University, Dept. of Nuclear Medicine, Budapest, HUNGARY. Aim.Somatostatin receptor scintigraphy (SRS) is a well-established method in evaluating patients with neuroendodine tumours (NET). In-111-pentetreotide (Octreoscan: O) has remained the ,,gold standard”, but some new, Tc-99m-labelled somatostatin analogues are also used. Only few data are available on direct comparison of different radiopharmaceuticals. In our study we compared diagnostic value of O and Tc-99m-EDDA-HYNIC-octreotide (Tektrotyde: T).Methods.We performed T scintigraphy in 63 patients in the last two years. 18 of them had O scintigraphy as well. Both methods were performed according to prodedure guidelines. The first radiopharmaceutical was randomly choosen. The second scintigraphy was performed, if results of the first scintigraphy were equivocal or contradicting to clinical data. SRS was indicated for staging of histologically proven NETs (n=5), or for postoperative restaging (n=13). Nine males and nine females were studied, with mean age 57 (41-80) years.Results.Abnormal SRS was found in 12 patients. In 6 postoperative cases no recidive/metastasis were detected. Findings of O and T scintigraphies were concordant in 13 patients. In 5 cases we had discordant results. In 1 patient O was false-negative (in the thorax), and in 1 case T was false negative (in the abdomen). In one patient O found less number of lesions, in another patient T. In one case T was positive in the thoracic and abdominal regions as well, but O was positive in the abdomen only.Conclusion.Based on our study, O and T have similar diagnostic value in evaluating patients with NETs by a patient-by-patient analysis. In our small patient material and various type of NETs T seems to be more sensitive in the thorax, O seems to be better in the abdomen. Further studies are needed to define possible differences of diagnostic value of both radiopharmaceuticals in SRS of tumours with various histological types.
P510
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Comparison of Ga-DOTA-Tyr -Octreotide to Lanreotide PET in NET patients
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Ga-DOTA-
D. Putzer, D. Waitz, A. Kroiss, B. Nilica, D. Kendler, B. Warwitz, J. Gradl, I. J. Virgolini; Innsbruck Medical University, Innsbruck, AUSTRIA. Department of Nuclear Medicine, Innsbruck Medical University²Department of Diagnostic Radiology, Innsbruck Medical University PurposeEvaluation of somatostatin receptor (SSTR) expression in patients with Neuroendocrine Tumors (NET) is a prerequisite for considering peptide receptor radionuclide therapy (PRRT) as treatment option. 68Ga-DOTA-Tyr3-octreotide (DOTA-TOC) and 68Ga-DOTA-lanreotide (DOTA-LAN) as tracers for positronemission-tomography (PET), which address different subtypes of SSTR, have been adapted to the diagnostic assessment of these patients.Patients and MethodsWe evaluated the diagnostic importance of somatostatin analogs, 68Ga-DOTA-TOC and 68 Ga-DOTA-LAN, for PET in a total of 54 consecutive patients with NET (mean age 65 ± 14 years). Our study included patients with inoperable, metastasized NET, who were referred for initial staging, further treatment planning including PRRT or posttherapeutic restaging. Patients underwent PET imaging with both somatostatin analogs to individually select the most promising treatment approach.ResultsSix patients showed intense uptake within the tumor lesions in 68Ga-DOTA-TOC and 68 Ga-DOTA-LAN PET, while 10 patients had no uptake in both scans. Six patients with intense tracer accumulation in the octreotide PET had only faint or no uptake in the lanreotide PET. Furthermore, out of all patients lacking tracer uptake in the ocreotide scan, 9 had intense tracer accumulation, and 12 faint uptake in 68GaDOTA-LAN PET. Regarding patients with only faint uptake in the octreotide scan, 2 had intense tracer uptake and 5 faint tracer accumulations in 68Ga-DOTA-LAN PET.ConclusionSSTR-PET is of high diagnostic value concerning extension and localisation of disease in NET patients, allowing assessment of feasibility of PRRT. In patients lacking tracer uptake in 68Ga-DOTA-TOC PET, 68Ga-DOTA-LAN PET seems a promising alternative as diagnostic modality, indicating whether the patient is a candidate for PRRT using Lanreotide.
P511 Performance of DOTATOC PET/CT for the detection of gastrinomas F. Montravers, V. Nataf, A. Prignon, J. Rose, S. Balogova, K. Kerrou, V. Huchet, O. Pascal, L. Michaud, J. Grellier, J. Talbot; Hopital Tenon, Paris, FRANCE. The purpose of this study was to evaluate the performance of DOTATOC(68Ga)PET/CT in comparison with Somatostatin Receptor Scintigraphy (SRS) for the detection of gastrinomas.Patients:Between February 2008 and February 2011, 15 adult patients were referred for localisation of a suspected sporadic gastrinoma (5 patients), to search for the primary after diagnosis of a lymph node metastasis (1 patient), for localisation of gastrinoma(s) in one patient with Multiple Endocrine Neoplasia type 1 (MEN-1), for suspicion of recurrence (6 patients) or for re-staging of metastatic gastrinoma in 2 patients. DOTATOC PET/CT and SRS were both performed in all patients.Results:- Of the 5 patients suspected of sporadic gastrinoma, the diagnosis was finally excluded in 1 (DOTATOC PET/CT and SRS both true negative). One case is still under investigation. Of the 3 patients with confirmed sporadic gastrinoma, DOTATOC PET/CT was true positive (TP) in 2 patients and false negative (FN) in one patient. SRS was TP in one patient and FN in 2 patients.- In the patient referred to search for the primary, DOTATOC PET/CT and SRS were both TP for the detection of the lymph node metastasis but both failed to detect the primary which remained unknown after surgery.- In the patient with MEN-1, DOTATOC PET/CT and SRS were both TP on a per patient basis but DOTATOC PET/CT was superior to SRS, showing multiple gastrinomas in the duodenum and in the pancreas, and several regional tumour lymph nodes, while SRS was positive only for the largest lesions.- In patients suspected of recurrence, DOTATOC PET/CT and SRS were FN in 2 patients. Two patients negative with morphological imaging, DOTATOC PET/CT and SRS are still under investigation. In two patients, DOTATOC PET/CT and SRS were both TP on a per-patient basis but DOTATOC PET/CT was superior to SRS on a per site basis.- In the 2 patients referred for re-staging, DOTATOC PET/CT and SRS were both TP on a per-patient basis but DOTATOC PET/CT showed more lesions than SRS.Conclusion:In this prelimary series of gastrinomas, the sensitivity of detection of sporadic gastrinomas was 1/3 for SRS and 2/3 for DOTATOC PET/CT. In case of MEN-1 and for detection of recurrences, the sensitivities of SRS and DOTATOC PET/CT were identical (3/5) on a per-patient basis but DOTATOC PET/CT was clearly superior to SRS on a per-site basis.
P512 The Impact of SPECT/BT Method to Planar Imaging in Somatostatin Receptor Scintigraphy for the Evaluation of Neuroendocrine Tumours D. Has, S. Kuyumcu, Y. Sanli, E. Yilmaz, C. Turkmen, I. Adalet; Istanbul University Faculty of Medicine Department of Nuclear Medicine, Istanbul, TURKEY. Object: Somatostatin receptor scintigraphy (SRS) is used for the imaging of somatostatin receptors in the diagnosis and follow-up of neuroendocrine tumours (NET). In this study, we aimed to determine the impact of SPECT/CT in planar
Poster Presentations
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S382 imaging for the correct detectin and localization of lesions in SRS.Materials and Method:Eighty-two patients with suspected neuroendocrine tumours were performed SRS with In111-octreotide between June 2009 and January 2011. Thirtynine patients with normal SRS findings were excluded. Twenty-three patients were female and 20 were male with mean age of 52±16,8. Planar imaging was performed after 4 and 24 hours and SPECT/CT was performed after 24 hours following administration of 0.1mCi/kg In111-octreotide. Planar andSPECT/CT images were compared.Findings: Results of 47 SRS studies of 43 patients were evaluated. Patients were indicated for restaging (17), primary tumour detection (7), response to treatment (7) and metabolic characterization (3). Patients were classified according to site of lesions which were pancreas (9), lung (7), gastrointestinal tract (7),thyroid (2), thymus (2), mediastinum (2), other localizations than indicated above (9) and metastatic liver lesions(4). Fifty-five lesions were defined in 47 SRS studies with planar imaging whereas 87 lesions were defined with SPECT/CT. In our study 36, 8% of the lesions defined with SPECT/CT were not detected with planar imaging. In 27 studies number of lesions detected by planar imaging and SPECT/CT were equal. In 20 studies SPECT/CT detected pathologic uptake in abdominal (7), mediastinal (7), iliac (2) and supraclavicular (1) lymph nodes, liver (5), lung (2), pancreas (4), adrenal gland (2) and caecum(2) which were not detected with planar imaging. Planar imaging detected focal uptake in the lower right abdominal region in 4 patients and upper right abdominal region in 3 patients which were decided to be physiological intestinal and gallbladder uptake respectively with SPECT/CT. Overall, SPECT/CT detected 32 lesions which were not detectedwith planar imaging and changed managementof 15 patients. Six were found to benormal with planar imaging and reported positive with SPECT/CT and in 9 patients who were reported to be positive with planar imaging, number of detected lesions increased.Conclusion: SPECT/CT in conjunction with planar imaging increases the sensitivity of SRS. It is a reliable and useful technique in the correct anatomic localization of the lesions and in the differentiation of physiological uptake from pathologic uptake in NET.
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In-Pentetreotide in Neuroendocrine Tumours: Comparison Between Diagnostic Scintigraphy and “Post-Therapy” WholeBody Scan F. Minutoli, A. Herberg, D. Cardile, A. Sindoni, V. Militano, G. Murè, F. Catania, M. Raniolo, E. Amato, S. Baldari; Nuclear Medicine Unit, Messina, ITALY. Aim-111In-Pentetreotide scintigraphy plays a crucial role in the management of neuroendocrine tumors (NETs). This simple diagnostic imaging method allows the visualization of somatostatin receptors (sstr), which are expressed by the majority of differentiated NETs, providing an approximation of tumoral receptor density and a prediction of the efficacy of somatostatin analogs treatment. 111In-Pentetreotide scan accuracy is limited by low sensitivity in revealing small lesions because of the physical properties of the radionuclide (emission of γ medium energy photons not ideal for gamma camera imaging) and the low activity administered for diagnostic purpose.We suppose that, as it happens for radioiodine imaging in thyroid differentiated tumours, post-therapy whole body scan could detect more lesions than standard diagnostic scintigraphy, due to higher activity administered and more available radio-labelled peptide.The aim of this retrospective study is to investigate differences between the diagnostic imaging and the post-therapy scan obtained after administration of high activity of 111In-Pentetreotide.Materials and Methods- We evaluated 48 patients affected by metastatic NET (17 GEP, 11 lung NET, 1 gall-bladder NET, 8 liver metastases from unknown primitive, 1 intracranial metastases from unknown primitive, 5 medullary thyroid cancer, 1 chemodectoma, 1 bladder paraganglioma) or other sstr+ tumors (papillary thyroid cancer, NSCLC, breast cancer: 1 each) who underwent standard diagnostic 111In-Pentetreotide scintigraphy (150-220MBq) and then were treated with high activity of the same radiopharmaceutical (5.5-7.4GBq) in our Unit. Two days after therapeutic administration, all patients underwent whole-body scan with the same equipment. We compared the location of the detected lesions and their number.Results- In 10/48 patients (19%) discrepancies between diagnostic and post-therapy scans arose. In 9/48 patients (19%) post-therapy scan revealed more lesions. Namely, unsuspected skeletal, nodal, peritoneal and breast metastases were found in 7 patients,; moreover, more liver and skeletal lesions than expected were found in 2 patients. Finally in 1/48 patients (2%) post-therapy scan did not show abnormal multiple lung focal uptake areas which had been previously detected by the diagnostic scintigraphy. In such case CT scan and follow-up demonstrated the absence of any focal lung lesion.Conclusion- Post-therapy scan shows more lesions than diagnostic imaging with a significant discrepancy in about 20% of our cases leading to obvious prognostic issues and modification of patients management. It seems particularly relevant the detection of bone involvement for its importance, besides the clinical issues, also for the dosimetric consequences.
P514 Comparison of positron emission tomography with 68Ga DOTA-TATE and 18F FDG in neuroendocrine tumours
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 S. Yılmaz1, E. Demirci1, M. Ocak2, B. Günes1, L. Kabasakal1, M. Halaç1, A. Araman2, C. Decristoforo3, I. Uslu1; 1Departments of Nuclear Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TURKEY, 2 Department of Pharmaceutical Technology, Pharmacy Faculty, Istanbul, TURKEY, 3Clinical Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, AUSTRIA. AIM: Neuroendocrine tumours (NETs) are rare tumours originating from the neural crest and typically characterized by peptide receptors and neuroamine uptake mechanism on their cell membrane. Most frequently, NET arise in the gastrointestinal tract, the pancreas, the lung and rarely in other organs. NET are generally asymptomatic and slow-growing tumours. The diagnosis of NET relies on radiological-scintigraphic imaging methods and tumour marker levels. Is’s difficult to detect NET by positron emission tomography (PET) with 18F FDG because of low metabolic activity. However, PET using 68Ga DOTA peptides is a promising imaging method in diagnosis and follow-up of NET because NET typically express somatostatin receptor. The aim of this study is to compare the diagnostic efficacy of 68Ga-DOTA-TATE and 18F-FDG PET scintigraphyMETHOD: 29 patients (14 men, 15 women, range:11-64 mean age:46 y) with diagnosis of NET who underwent 68Ga-DOTA-TATE and 18F-FDG PET /CT at our institution were enrolled in this study. Maximum interval between the two study was 2 months (median interval: 16,7 d). The imaging findings were recorded per region in 7 regions (thyroid bed, lymphatic stations, lungs, liver, bones, pancreas and other) for every patient. PET images were evaluated visually.RESULT: Of 29 patients with NET (1 urinary-bladder NET, 3 gastric carcinoid, 3 pheochromacytoma, 4 lung carcinoid tm, 9 metastasis of unknown primary, 5 pancreatic NET, 2 medullary thyroid tm, 1 paraganglioma, 1 MEN-1 disease). 9 patients had no uptake; 14 patients had uptake by either modality. On a lesion basis, 68Ga-DOTA-TATE PET detected more lesion than 18FFDG PET. In 4 patients (14,3%), 68Ga-DOTA-TATE PET was positive but 18F-FDG PET was negative. On the other hand, 2 patients (7%) had 18F-FDG positive but 68GaDOTA-TATE negative lesions. 68Ga-DOTA-TATE PET is found to be superior to 18FFDG PET for detection of NET (P=0,002). There was significant correlation with FDG SUV and Ki-67 index (r=0,810; p=0,008) The correlation with 68Ga SUV and Ki-67 index was nas statisticaly significant (r=0,287; p=0,453).CONCLUSION: 68Ga-DOTATATE PET/CT is a valuable imaging modality for diagnosis and follow-up of NETs and is superior to 18F-FDG PET /CT.Acknowledgement: This work is supporting by; Scientific Research Projects Coordination Unit (BAP) of Istanbul University with Project number 3264.
P47 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Bone
P515 Usability of a co*cktail 18F-Fluoride and 18F-FDG PET scan for new methods to evaluate of Malignancy S. Fujita1, S. Nagamachi2, Y. Umemura1, S. Ueno1, R. Nishii2, S. Tamura2, T. Fujimoto1; 1Fujimoto Hayasuzu Hospital, Miyazaki, JAPAN, 2MIyazaki Medical College, Miyazaki, JAPAN. Objectives : 18F-FDG PET is used for detecting cancer and monitoring cancer response to therapy. However, because of the variable rates of glucose metabolism, not all cancers so as bone metastases are identified reliably. Sodium 18F was previously used for bone imaging and can be used as a PET skeletal tracer. The combined administration of 18F and 18F-FDG in a single PET study for cancer detection has not been reported to date.Methods : Sixteen patients (8 lung cancer, 4 prostate cance, 3 breast cancer, 1 liposarcoma) and three volunteers were underwent a 18F-FDG PET, 18F-Fluoride PET and a the co*cktail 18F-Fluoride and 18F-FDG PET scan (a total of 3 scans each). PET images were obtained 1hour after injection of 185 MBq of 18F-FDG or/and 74 MBq of 18F-Fluoride. There were 13 men and 6 women (age range, 23-73 y;average, 49.5 y).Results : Interpretation of the combined 18F/18F-FDG PET scans compared favorably with that of the 18FFDG PET (no lesions missed) and the 18F PET scans (only 1 skull lesion and 2 rib lesions seen on an 18F PET scan was missed on the corresponding combined scan). Through image processing, the combined 18F/18F-FDG scan yielded results for bone radiotracer uptake comparable to those of the 18F PET scan performed separately.Conclusions : This is the first report; the co*cktail 18F-Fluoride and 18FFDG PET scan has the potential to detect variable cancers or metastases so as bone metastases, and this new scan administration followed by a single PET scan is feasible for cancer detection. With care of false negative included high 18F-FDG accumulation of brain and liver, it is useful method of the co*cktail 18F-Fluoride and 18F-FDG PET scan for evaluation of Malignancy and reduction in health care costs.
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
Is FDG Uniformly Distributed Throughout The Skeleton? M. Aras, F. Dede, T. Öneş, S. Inanır, T. Y. Erdil, H. T. Turoglu; Marmara University School of Medicine Nuclear Medicine Department, İstanbul, TURKEY. Aim:The differential physiologic biodistribution of FDG throughout the skeleton was not analysed before. The aim of this study was to investigate whether FDG was uniformly distributed throughout the skeleton and whether age and gender affected this biodistribution.Methods:A total of 158 cancer patients (100 female, 58 male) referred for initial staging with FDG PET/CT were included in this retrospective study. None of the patients received prior treatment that directly affected bone marrow (chemo/radiotherapy or colony stimulating factors) and the patients had no history of anaemia. The patients with bone metastases were excluded from the study. SUVmax of the 24 different locations in the skeleton [the heads and proximal diaphysises of the bilateral upper and lower extremities, 10th rib, sternum (manibrium and corpus), vertebral column (C3, C5, T3, T7, L1, L3) and bilateral pelvic bones (sacrum and bilateral anterior and posterior parts of the iliac bones and acetabulum)] were obtained and all the values were compared in each other.Results:The mean age (male:59.3±14.4, female:57.6±13.8) and the mean SUVmax of 24 different locations in the skeleton (male:2.0±0.3, female:2.1±0.4) were similar in both gender (p>0.05). When taken together for both sexes FDG uptake in the skeleton was not uniform (p<0.05). While the highest FDG uptake was seen in L3 vertebra (meanSUVmax:2.9±0.7), the least glucose metabolism was observed in the heads of the lower extremities (meanSUVmax:1.4±0.3). The SUVmax of the bilateral diaphysises of the upper and lower extremities were significantly higher than the neighbouring heads (p<0.05). The SUVmax of the manibrium of the sternum was significantly higher than the corpus (p<0.05). For pelvic bones, while the highest FDG uptakes were detected in sacrum (meanSUVmax:2.6±0.7), the least FDG uptakes were seen in anterior iliac bones (SUVmax:1.8±0.4), (p<0.05). For vertebral column FDG uptakes were also nonuniform and the SUVmax gradually increases from cervical to lumber part (C3meanSUVmax:2.2±0.4, L3-meanSUVmax:2.9±0.7), (p<0.05). Although mean skeletal SUVmax was decreased by the age in females (r:-0.20, p<0.05), similar relationship was not observed in males.Conclusion: The FDG was not uniformly distributed throughout the skeleton in both gender. It had a tendency to increase from apendicular to axial skeleton and from servikal to lomber regions in vertebral column which may be related with the normal distribution of the red marrow. Additionally, the glycolytic metabolism of whole skeleton was gradually decreased by the age in females but not in males.
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Comparison of F-fluoride PET/CT, F-FDG PET/CT, and bone scintigraphy in detection of bone metastases of differentiated thyroid cancer N. Ota1, K. Kato2, S. Iwano1, S. Ito1, K. Tsuchiya1, Y. Okochi1, Y. Okada1, S. Naganawa1; 1Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, JAPAN, 2Department of Radiological Technology, Nagoya University School of Health Sciences, Nagoya, JAPAN. Purpose: The aim of this study is to evaluate efficacies of 18F-fluoride PET/CT, 18FFDG PET/CT, and bone scintigraphy for the detection of bone metastases in patients with differentiated thyroid carcinoma(DTC).Methods: We examined 7 patients (4 women, 3 men; mean age,59.6±9.8y) with DTC who had undergone total thyroidectomy and were hospitalized to be given 131I therapy. All patients underwent whole-body 18F-fluoride PET/CT, 18F-FDG PET/CT, and bone scintigraphy before 131I therapy, and underwent 131I scintigraphy after 131I therapy. 18F-fluoride PET/CT, 18F-FDG PET/CT, and bone scintigraphy were performed within 5 weeks. The skeletal system was classified into 16 anatomic segments and assessed for the presence of bone metastases by 2 radiologists with consensus. Bone metastases were verified when 131I scintigraphy and another imaging modality were positive.Results: Bone metastases were confirmed in 17 of 112 (15.2%) bone segments in 5 of 7 (71.4%) study patients. 18F-fluoride PET/CT, 18F-FDG PET/CT, and bone scintigraphy could detect 5, 4, 3 patients with bone metastases, respectively. The sensitivities for bone metastases on a segment basis using 18F-fluoride PET/CT, 18 F-FDG PET/CT, and bone scintigraphy were 16 of 17 (94.1%), 11 of 17 (64.7%), and 10 of 17 (58.8%), respectively. The difference between the value for 18F-fluoride PET/CT and the values for 18F-FDG PET/CT and bone scintigraphy was statistically not significant. The specificities of those studies were 95 of 95 (100%), 95 of 95 (100%), 94 of 95 (98.9%), respectively. Conclusion: The sensitivity of 18F-fluoride PET/CT in detecting bone metastases of DTC seemed to be higher than that of 18FFDG PET/CT and bone scintigraphy, but the difference between these was statistically not significant. The specificities for all these three modalities were 100% or near 100%.
P518 Clinical usefulness of FDG PET/CT in the patients with low back pain
I. Cho, E. Kong, K. Chun; Yeungnam universtiy medical center, Daegu, KOREA, REPUBLIC OF. AimsRecently developed FDG PET/CT is an imaging modality that can detect both metabolism rate of glucose, which is especially high in tumor and in inflammatory cells and anatomic information. Low back pain is a common musculoskeletal problem and has diversities of causes; from degenerative disease to malignancy. We analyzed the clinical usefulness of FDG PET/CT to figure out the cause of low back painMaterials and MethodsThis retrospective study was performed on 81 patients(male 43; mean age: 60.6 ± 15.3 y-o) who underwent FDG PET/CT examination to find out the cause of low back pain. We excluded the patient with existing malignancy. All the patients had non-conclusive abnormalities of other imaging study (including MRI).ResultsOn the FDG PET/CT examination, 75 patients showed abnormal bone lesion, and 6 patients showed abnormal soft tissue lesion. They were diagnosed with tumorous bone lesion(metastatic bone lesion[n=34], primary bone tumor[n=4], multiple myeloma[n=8] and benign bone tumor[n=1]) in 47 patients, 28 patients were diagnosed with non-tumorous bone lesion(osteomyelitis[n=3], fracture[n=9], others[n=6], 2 patients had metastatic soft tissue lesion and 4 patients had soft tissue tumor. The primary sites of metastatic bone lesions were lung(n=13), prostate(n=5), unknown origin(n=5), stomach(n=3), breast(n=2), thyroid(n=2), pancreas(n=2) and others(n=2).ConclusionFDG PET/CT is an effective imaging modality to assess the cause of low back pain. Forty-four percent of patients came out metastasis, therefore, FDG PET/CT is needed expecially in the patients with non-diagnostic results on other imaging study.
P48 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology
Clinical
Science:
Cancer
of
Unknown
Primary (CUP)
P519 The value of F-18 FDG PET-CT for detecting primary foci in the metastatic cancer of unknown primary origin. E. Sürücü, M. Şentay, T. Şengöz, Y. Demir, H. Durak; Dokuz Eylül University, School of Medicine, Department of Nuclear Medicine, izmir, TURKEY. Metastatic cancers of unknown primary origin (CUP) have poor prognosis and the median survival for patients with CUP is approximately 1 year. This survival can be extended by the identification of the primary origin and treating with specific therapy.F-18 FDG PET-CT scans of 75 patients (36 M 39 W, mean age 60 ±12) with metastatic cancers of unknown primary origin referred to our clinic between January 2009 and January 2011 were evaluated retrospectively. Whole body images were obtained using PET/CT (Gemini-TOF-Philips) 60 minutes after the injection of approximately 370 MBq (10 mCi) F-18 FDG. Emission scans were obtained for 1.5 min per bed position and transmission scans were obtained with low dose CT using 50 mA and 120 kvp.In 58 patients, the tumor was identified histopathologically as shown in the table. 4 of 58 patients were treated as CUP. 17 patients could not be followed so final diagnosis could not be made. In 54 patients, the primary was identified as 17 lung, 8 colorectal, 7 breast, 3 stomach, 3 pancreas, 2 endometrial, 2 nasopharynx, 2 gallbladder cancers, 2 lymphoma, 2 peritoneum, 1 maxillary sinus, 1 salivary gland carcinoma, 1 brain tumor, 1 leiomyosarcoma, 1 ovary cancer and 1 multiple myeloma. If reports are considered, F-18 FDG PET-CT helped to detect primary origin in %65 of these 58 patients, 38 of 54 primary sites were true positive (%70). There were 6 false positive sites (%10.3), 14 false negative (%24) results in F-18 FDG PET-CT. After the retrospective evaluation of the false negative patients, we have seen that primary sites were ignored in 5 of 14 patients, so actually F-18 FDG PET-CT helped in %74 of the patients showing 43 of 54 primary sites (%80). F-18 FDG PET-CT could not detect 2 breast cancers, 1 lymphoma, 1 colon cancer and 1 intra maxillary sinus cancer.F-18 FDG PET-CT is an important imaging tool for detecting primary origin in the patients with CUP. Besides, F-18 FDG PET-CT can help to determine the extent of the disease and help to evaluate the therapy response. In the patients with CUP, lung, breast, colon and the physiologic uptake areas should be scrutinized carefully for any tumor location.
P520 Role of 18F- FDG PET/CT in carcinoma of unknown primary (CUP) syndrome. I. Munir, H. Ahmed, M. K. Nawaz, S. Muzhair, M. Mian, H. Bashir, Z. S. Faruqui, S. Sajid, T. A. Shahbaz; Shaukat Khanum Memorial Cancer Hospital and Research center, Lahore, PAKISTAN. Background: Detection of unknown primary tumor site has always been a diagnostic dilemma, necessitating extensive workup. Early detection of primary tumor site coupled with specific therapy significantly improves the prognosis. The low detection rate of primary tumor site can be attributed to very small tumor size to be picked up by the conventional imaging alone and biological behavior of the
Poster Presentations
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S384 primary tumor.Aim: The aim of the study was to evaluate the role of 18F-FDG PET/CT in detection of the primary tumor site in patients with metastatic cancer from unknown primary origin (CUP syndrome).Material & Methods: Thirty two consecutive biopsy proven and negative conventional imaging patients from September 2009 to March 2011 were included in the study. Out of 32 patients 16 were male and 16 female with mean age of 58.6years and age ranges from 20-85 years. PET/CT images from vertex to mid-thigh were acquired after injecting 300+30 MBq of 18F-FDG on dedicated Philips Gemini TF PET/CT scanner. Images were interpreted by a team of nuclear physicians and radiologist to localize the site of primary tumor.Results: Primary tumor site was correctly identified by the FDG PET/CT in 24/32 (75%): GI 12/24 (50%), lungs 6/24(25%), ovary 3/24(12.5%), head and neck 2/24(8.33%) and others 1/24(4.16%). In 8/32(25%) primary tumor site was not localized. However, in 5/32, PET/CT identified unexpected metastases which lead to the upstaging of the disease. Conclusion: Our data strongly supports the diagnostic contribution of 18F-FDG PET/CT in the evaluation of patients with CUP syndrome and suggests its use in an early phase of the diagnostic workup to optimize patient management.
P521 The role of PET\CT in cancer patients with unknown primary and brain metastasis. T. A. Balci1, Z. P. Koc1, H. Komek2, H. Kaya3, Y. Guzel1; 1Firat University Medical Faculty, Department of Nuclear Medicine, Elazig, TURKEY, 2 Training Hospital, Nuclear Medicine Division, Diyarbakir, TURKEY, 3Dicle University Medical Faculty, Department of Nuclear Medicine, Diyarbakir, TURKEY. Aim: The importance of PET/CT in tumors of unknown primary is a known subject. We more specifically investigated the role of PET/CT in patients with unknown primary and brain metastasis in this study.Materials and Methods: 15 patients (4 F, 11 M; mean: 54.7 years old) with single or multiple brain lesion who were referred to PET/CT for investigation of primary were included to the study.Results: 5 patients had primary tumor in lung, 1 had disseminated hypermetabolic lymph nodes in the body (lymphoma); PET/CT couldn’t find primary site for the other patients. On the follow up 1 patient had the diagnosis of brain lymphoma, one menengioma. PET/CT revealed hypermetabolic mass in uterus and hypermetabolic obturatuar lymph node (endometrium carcinoma) on the 1 patients’ follow up. PET/CT with addition of follow up results, diagnosed totally 7 patients’ primary (46.6%).Conclusion: PET/CT can identify 50% of unknown primary cancer patients’ primary site according to literature. Generally most common site is lung. Others are breast, melanoma, pancreas, gastrointestinal tumors, respectively in terms of frequency. In our study 5 patients’ primary pathology was lung cancer, concordant with the literature. We had two lymphoma patients in different. PET/CT can replace many other diagnostic tests and identifies primary tumor in a single test.
P522 The role of 18F-FDG positron emission tomography/computed tomography in detecting carcinoma of unknown primary E. Ozkan, C. Soydal, M. Araz, O. N. Kucuk, G. Aras; Ankara University, Medicine Faculty, Ankara, TURKEY. Objective: The aim of this analysis to describe the value of PET/CT in detecting primary site of malignancy in our patient population with histologically proven metastasis or with a high clinical suspicion of malignancy.Method: A total of 52 patients (24 male, 28 female; mean age: 55.1±14.3; age range: 21-82 years) who had PET/CT in our department due to histologically proven metastasis or had a high clinical suspicion for malignancy were included in the study. The results of 18F-FDG PET/CT and clinical follow-up data were reviewed retrospectively. Histologically analysis and/or clinical follow-up data were accepted gold standard in the confirmation 18F-FDG PET/CT results. Patients were evaluated in two groups as 29 patients with histologically proven metastasis (group 1) and 23 patients with clinical suspicion of malignancy (group 2).Results: Primary site of malignancy was discovered in 16 of 52 patients (30.7%) histologically. Twelve of 16 patients (75%) was in group 1 and 4 patients was in group 2. In the remaining patients (36/52; 69.3%) primary tumor sites were not found by PET/CT. The findings for group 1 and 2 were TN in 15 and 18 patients, respectively. In 3 patients, 18F-FDG PET/CT findings were discordant with gold standard and all of them had FP findings. Primary tumor site could not be determined in none of patients with negative PET/CT. Regarding the whole patient population, a sensitivity and specificity of 18FFDG PET/CT for detecting primary site were calculated 100% and 91% respectively. Regarding the patients groups, the sensitivity and specificity of 18F-FDG PET/CT for group 1 and group 2 were calculated 100% and 88%; 100% and 94% respectively.Conclusion: In this retrospective analysis we concluded that PET/CT is a useful imaging method in detecting primary site of tumor in patients with histopathologically proven metastasis. Also it can be used in exclusion of malignancy in patients have strong clinical suspicion of malignancy.
P523
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 Identification of the primary tumor using 18F-FDG PET-CT in carcinoma of unknown origin M. P. Talvera Rubio, A. Garcia Vicente, V. M. Poblete Garcia, A. Palomar Munoz, P. Pilkington Woll, M. Bellon Guardia, B. Gonzalez Garcia, J. M. Cordero Garcia, V. Peiro Valganon, A. Soriano Castrejon; HGUCR, CIUDAD REAL, SPAIN. AIM:To value the impact of the 18F-FDG PET/CT in the localization of the primary tumor in patiens with carcinoma of unknown origin (CUO).MATERIAL AND METHODS:We retrospectively included in this study the PET-CT performed between november 2006 to October 2010 in search for the primary tumor. All patients had metastasis confirmed by histopathology and the primary sites could not be located by conventional diagnostic workup.All the patients underwent a standard PET-CT, 50-60 minutes after intravenous injection of 370 MBq 18F-FDG. Delayed images were acquired in doubtful lesion.Final diagnosis was established by histology or follow up range of 6-52 months.RESULTS:We studied 74 patiens (59 males, 15 females), range of age 41-89 year.Primary tumor sites were detected by PET-CT in 41 of 74 patients (55%): 16 lung carcinomas, 6 head and neck tumors, 5 gastrointestinal carcinomas, 3 pancreatic cancers, 3 prostate cancers, 2 lymphomas, 2 gynaecologic cancers, 1 brain tumor, 1 liver carcinoma,1 breast cancer and 1 muscle sarcoma.No primary tumor was discovered in the remaining 33 patients (45%). During the follow-up the primary tumor was detected in seven of them (7/33): 3 lung carcinomas, 2 gynaecologic cancers, 1 neuroendocrine tumor and 1 hepatocarcinoma.CONCLUSION:PET scanning has a great impact in detecting primary cancer in CUO patients. In our sample we identified more than half of the primary sites, improving their management and therapy.
P524 A case of F-18 FDG PET/CT imaging in multifocal Castleman's disease Z. Dancheva, A. Klisarova, P. Bochev, B. Chaushev; University Hospital St. Marina, Varna, BULGARIA. AbstractIntroduction. Multicentric Castleman's disease (MCD) is an uncommon lymphoproliferative disorder that presents with fevers, anaemia and multifocal lymphadenopathy, and nowadays it is most commonly diagnosed in individuals infected with human immunodeficiency virus type-1 (HIV. It is commonly associated with POEMS syndrome (polyneuropathy, organomegally, endocrinopathy, monoclonal gammopathy, and skin changes), paraneoplastic pemphigus, Hodgkin’s disease, and follicular dendritic cell sarcoma, but very rarely with myasthenia gravis. Sometimes that lymphoproliferative disease progresses to lymphoma.Case and discussion. We present a 35 years old woman, diagnosed with a multifocal Castleman’s disease. The diagnosis has been established 8 years ago. Two years ago she was diagnosed for myasthenia gravis and Hashimoto disease. The patient recently presented for treatment because of new exacerbation of symptoms including lymph node swelling, fatigue, weakness, double vision, dispnea, ptosis and disphagia. There were three differential diagnoses discussed myasthenia gravis syndrome, paraneoplastic syndrome and tumor of unknown origin or progression to lymphoma . Dysmetabolic disturbance in Hashimoto disease was excluded, because the patient was euthyroid. The PET/CT performed excluded a solid tumor growth but could not rule out a progression to lymphoma. The subsequently performed lymph node biopsy proved Castleman’s disease (plasma cell variant).Conclusion. In complicated cases of Castleman’s disease with a variety of associated syndromes and diseases, PET/CT might be helpful not only for treatment monitoring but also for ruling out a solid tumor growth. Its role in excluding progression to lymphoma, particularly in multifocal Castleman’s disease is not reliable.
P525 F-18-FDG PET/CT for Detection of Unkown Primary Tumor. Our Experience. D. R. Mendez, D. Marin, I. Hernandez, M. Coronado, I. Santos, S. Rodado, L. M. Martin-Curto; Nuclear Medicine Division University Hospital "La Paz", Madrid, SPAIN. The aim of this study was to evaluate the role of 18 FDG-PET-CT for detection of the primary tumor in patients with biopsy proven metastasis.Material and Methods: 43 consecutive patients (26 male y 17 female) age range 39-92 years (mean 64 years) with cancer of unknown primary (CUP) underwent PET/CT study from October 2003 to June 2010. Location of metastases was: 21 lymph node (19 cervical, 1 retroperitoneal and 1 mediastinum) 2 lung , 7 liver , 4 skeletal, 1 brain metastasis and 8 other sites.Histology of proven metastases was:15 (34 %) adenocarcinoma, 13 (30%) squamous cell carcinoma , 8 (18% ) undifferentiated, 6 ( 14%) giant cell tumor and 1 ( 4.3%) papilar carcinoma.Whole body PET-CT was performed 60 minutes after iv inyection of 340 MBq 18 FDG using a Discovery LS. GE Tomograph.Final diagnosis was based on histopathological data and follow up between 13 days - 51 months ( mean 16,5 months).RESULTS:Primary tumor site was indentified in 23 patients out of 43 ( 53%).PET/CT correctly detected primary
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
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tumor in 13 patients (13/43, 30%): 2 lung adenocarcinoma , 2 colon adenocarcinoma, 1 ovary adenocarcinoma , 4 naso/oro-pharinx tumor ( 2 tongue, 2 lingual amygdale),1 larynx, 1 mesothelioma, 1 peritoneal adenocarcinoma and 1 pancreas giant cell adenocarcinoma. Patient´s survival in this group was 61% .PET/CT did not identify primary tumor in 10 patients (10/43, 23%) which was detected by other diagnostic techniques performed after PET-CT: 3 ovary adenocarcinoma, 2 naso/oro-pharinx (1 amygdala squamous cell carcinoma, 1 submandibular gland mucoepidermoid carcinoma),1 pyriform sinus squamous cell carcinoma , 2 cholangiocarcinoma 1 stomach adenocarcinoma and 1 mediastinum neuroendocrine tumor. Patient´s survival in this group was 50% .Primary tumor was not detected in 20 patients (20/43 46%) at the end of the study .In this group patient´s survival was 25%.CONCLUSIONIn our study PET/CT identified primary tumor in 30% of patients with CUP.Our results suggest that PET/CT could affect survival of patients with CUP.18F-FDG PET/CT scan can be considered a useful tool in the clinical management of patients with CUP.
P526 1
Oncology Clinical Science: Melanoma
3
A. Bournazos, P. Rondogianni , D. Exarhos , E. Vlontzou , M. Skilakaki , E. Panagiotidis1, C. Giannopoulou1, I. Housianakou1, I. Datseris1; Nuclear Medicine1, Computerized Tomography2 and Radiology3 Departments “Evangelismos” General Hospital, Athens, GREECE. AIM: To assess the diagnostic accuracy of 18F-FDG in the detection of primary tumors of unknown origin.METHODS : A total of 161 patients ( 95 male -66 female) aged 16 - 85 (mean age 59,19years) underwent PET/CT and were studied retrospectively. Clinical examination, conventional imaging (CT, MRI, U/S, and bone scan et.c) and biopsy in some cases revealed metastatic lesions in these patients but the primary carcinoma remained undetected. PET/CT images from the skull base to the mid thighs were taken 60min after I.V. administration of 370 MBq 18FFDG. CT scanner at 140kV and 80mAs was used for anatomic localization and attenuation correction of PET .PET/CT images (including additional images of brain, head, neck and lower extremities when needed) were evaluated by an expert nuclear physician and a radiologist in consensus and compared to the findings of conventional modalities. PET/CT results were confirmed finally by follow up and biopsy .RESULTS: Normal 18F-FDG uptake was observed in 22/161 (13, 65%). Fewer findings than conventional methods were detected in 20/161 (12,4%) patients while similar results were found in 37 /161(23%) of them. PET/CT revealed more lesions than all other imaging modalities in 82/161(51%) patients. In 20 out of them (12,4% of the whole population) PET/CT did not contribute at all in the detection of CUP but in 18 patients (11,2% of the whole population) it played an important role in guiding the final diagnosis. Findings in 44 patients (27,4%) revealed the primary tumor:20 cases of lung cancer, 11 cases of head and neck cancer, 3 of adrenal gland cancer, 3 of thyroid cancer, 2 of colorectal, 1 of breast,1 of kidney, 1 of pancreas, 1 of prostate gland, 1 of testicular cancer.CONCLUSION: The metabolic information provided by PET combined with the specific localization of a lesion through CT scan can give high diagnostic precision in patients with CUP. Even in the absence of precise localization of the primary malignant focus PET/CT offers precious diagnostic information by guiding biopsy and facilitating the final diagnosis. However it seems that in an important number of patients the primary lesion continues to be unknown even after PET/CT.
P527 68Ga-DOTANOC PET/CT Imaging in the Detection of Unknown Primary Neuroendocrine Tumors: Preliminary Experience on a Single Site I. M. S. L. Sampaio, H. Duarte, L. Costa, J. Teixeira, R. Martins, J. Couto, F. Lopes, O. Soares, L. Bastos; IPOFG-E.P.E., Oporto, PORTUGAL. Aim: Detection of the primary neuroendocrine tumor site may impact clinical management and improve patient prognosis. PET/CT imaging scans with PET tracers specifically binding to somatostatin receptors (e.g. 68Ga-DOTANOC) are being increasingly used as the primary tool in the assessment of neuroendocrine tumors. The purpose of this study was to evaluate the clinical value of 68GaDOTANOC PET/CT for detection and localization of unknown primary neuroendocrine tumors.Materials & methods: Nine patients (5 women, 4 men, mean age 49,9 years) with histologically proven neuroendocrine tumor metastasis (6 patients with liver metastasis, 1 patient with a lymph node mesenteric metastasis, 1 patient with bilateral ovarian metastasis, 1 patient with cervical lymph node metastasis) and unidentified primary tumor underwent a 68-GaDOTANOC PET/CT investigation searching for the “primary location”. PET/CT images were acquired 60 minutes after intravenous injection of approximately 100 MBq of 68Ga-DOTANOC. PET/CT positive findings, considered as any area with nonphysiological 68-Ga-DOTANOC uptake greater than the liver and anatomically located in a potential primary tumor site, were then submitted to confirmation by histological tissue biopsy.Results: Six of the 9 patients studied had positive 68-GaDOTANOC PET/CT findings (66,7%; - 4 lesions located in the ileum and two in the pancreas). In the other 3 (33,3%) the primary tumor site remained occult.Five
Posttreatment assessment of response using FDG-PET/CT for patients treated with proton therapy for head and neck melanoma Y. Nakagami, H. Kuno, T. Kobayashi, R. Iwata, T. Hayashi, M. Satake; National Cancer Center Hospital East, Chiba, JAPAN. Aim: Proton therapy for head and neck melanoma provides high-conformal dose application to the target volume and, thus, an optimal saving of the organs at risk nearby. The goal of this study was to evaluate coregistered [18F] fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) for the detection of persistent disease after proton therapy in head and neck melanoma.Materials and Methods: Posttreatment FDG-PET/CT was performed in 16 patients on several weeks after proton therapy. FDG-PET/CT was visually analyzed for the entire patient group. The contrast-enhanced CT and contrast-enhanced MRI were separately analyzed blinded to the results of coregistered FDG-PET/CT and classified as negative or positive for residual locoregional disease. Pathologic findings and clinical follow-up served as the reference standard.Results: Follow-up data were available for all 16 patients. Regarding the detection of residual disease, the overall sensitivity of FDG-PET/CT was lower than contrast-enhanced CT and contrast-enhanced MRI. The overall specificity of FDG-PET/CT was higher than contrast-enhanced CT. The accuracy of FDG-PET/CT was higher than contrast-enhanced CT. FDG-PET/CT could equal contrast-enhanced MRI in the specificity and the accuracy.Conclusions: The metabolic-anatomic information from coregistered FDG-PET/CT provided the most accurate assessment for treatment response after the conclusion of proton therapy. FDG-PET/CT excelled by a higher specificity and overall diagnostic performance than CT imaging alone. These results support a potential clinical role of FDG-PET/CT in the early assessment of therapy response after proton therapy in head and neck melanoma.
P529 Prognostic value of staging 18FDG PET/CT in patients with malignant melanoma in correlation with Clarke level O. Sántha1, J. Varga2, J. Olajos3, I. Garai1; 1ScanoMed Ltd, Debrecen, HUNGARY, 2Institute of Nuclear Medicine University of Debrecen, Debrecen, HUNGARY, 3Jósa András Training Hospital, Nyíregyháza, HUNGARY. The aim of this study was to find correlation between early staging 18FDG PET/CT results, Clark level and progression-free survival (PFS) of patients with primary cutaneous malignant melanoma (CMM) lesions.Patients, methods: 99 CMM patients (57 women and 42 men, mean age: 40,73; 18-61 years) who underwent 18FDG PET/CT within 6 months from diagnosis were enrolled in this retrospective study. Diagnosis was determined by surgical removal and histological confirmation. PET/CT evaluation was concluded positive or negative depending on the presence of lesions related to CMM. Last clinical appearance was considered as positive or negative depending on the findings related to CMM. The median follow-up period was 19 months (8-45 mo).Results: Positive PET/CT was found 39pts/99pts (37,3%) to be definitely more frequent in patients with higher Clark level lesion (khi-square test: p=0.0066). Unexpectedly, Kaplan-Meier analysis and Mantel-Cox log rank test found no relations between Clark level and progression-free survival (p>0.1). Our data showed a remarkable difference of the progression-free survival curves of patients with positive and negative PET/CT findings on Kaplan-Meier analysis, and Mantel-Cox log rank test(p<0.005). 46% of the patients with initial positive PET/CT result showed progression during the follow-up. The period of progression-free survival was not significantly different between the PET/CT-positive and negative groups which can be the result of relatively short follow-up.Conclusion: PET positivity shows significant correlation with Clark level rising. Positive 18FDG PET/CT result within 6 months after surgery indicates significantly higher risk of progression.
Poster Presentations
2
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P528
Carcinoma of unknown primary (CUP) . Is PET/CT helpful? 1
patients with positive 68-Ga-DOTANOC PET/CT findings subsequently underwent surgical resection and histological confirmation of neuroendocrine tumour was obtained. In one patient the positive PET/CT finding (located in the pancreas) has not yet been confirmed by histology.Additionally, 68-Ga-DOTANOC PET/CT also detected previously unknown metastasis in 5 patients (55,6%): lymph node metastasis (3 patients), bone metastasis (one patient) and a thyroid metastasis (one patient).Conclusion: Our preliminary data reveals that 68Ga-DOTANOC PET/CT is helpful for the management of patients with neuroendocrine tumors by detecting the primary site and defining the extension of disease. Further experience is warranted to define the 68Ga-DOTANOC PET/CT role in the management of these patients.
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P530 Malignant Melanoma: role of PET/CT imaging and correlation with protein S-100B D. Grigolato1, M. Zuffante1, E. Fiorio2, B. Caruso3, L. E. Etta4, F. Bosco5, M. Governa5, M. Ferdeghini1; 1O.U. of Nuclear Medicine, Az Ospedaliera Universitaria Integrata Verona, ITALY, 2O.U. of Oncology, Az Ospedaliera Universitaria Integrata Verona, ITALY, 3O.U. of Clinical Immunology, Az Ospedaliera Universitaria Integrata Verona, ITALY, 4O.U. of Radiotherapy, Az Ospedaliera Universitaria Integrata Verona, ITALY, 5O.U. of Plastic Surgery, Az Ospedaliera Universitaria Integrata Verona, ITALY. Molecular imaging using 18F-fluoro-deoxyglucose positron emission tomography/computed tomography(PET/CT) has been successfully used in the diagnosis, initial staging, response assessment and follow-up of various malignant tumours. The serum level of the S-100B protein is used as a tumour marker during follow-up of high risk melanoma patients (pts). AIM: to assess the main clinical requests for PET/CT examination in melanoma pts at our institution and to evaluate the values of the serum protein S-100 in relation to the results of functional imaging. METHODS: a review analysis of prospectively collected melanoma pts presented at our Unit of Nuclear Medicine between May 2010 and March 2011 identified a total of 31 consecutive PET/CT in 23 patients (10 women, 13 men). All pts were imaged from the head to the feet after 60 minutes from the injection of 3 MBq/kg of 18-FDG. Images were taken with PET/CT scanner: Philips Gemini Big Bore. We collected for each patient clinical data, hystopathological melanoma characteristics at presentation, results of sentinel lymph node and protein S-100 values. The positive FDG pattern of uptake was divided in two groups - focal (local recurrence) and diffuse (locoregional and distant recurrence) - and each group was correlate to the serum level of protein S-100. RESULTS: clinical requests for PET/CT imaging were: restaging (30%), therapy control (29%), staging (16%), doubtful reports at conventional imaging (19%) and radiotherapy planning (6%).PET/CT was negative in 8 pts (35%) and protein S-100 was below 134 ng/L in all of them. Positive results were obtained in 15 pts (65%) with different levels of increased S100. Five pts (5/15) had focal uptake and the maximum serum level of protein S100 was 665 ng/L. In the group with diffuse FDG uptake (10/15) there were high values of protein S-100 in relation to the extension of the disease (above 665 ng/L). Seven pts (7/15) repeated PET imaging to asses chemiotherapy respone: functional imaging showed progression disease in 3 pts, partial response in 2 pts, one patient was stable and the last one was completely negative.CONCLUSION: PET/CT imaging has clinical relevance in the correct assessment of pts with MM, recognizing the effective presence and extension of the disease with the exception of the brain. Also serum level of protein S-100 can be hepful indicating the aggressiveness of the disease but the real cut-off value must be analyzed in studies with bigger number of pts
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Metastatic spread of uveal melanoma. Our experience with FFDG PET/CT. M. Moreno Caballero, J. López Ruíz, L. Sanz-Ceballos, E. Teijeiro Vázquez, G. Guzmán Caro, M. Muros de Fuentes, J. Llamas Elvira; Hospital Universitario Virgen de las Nieves, Granada, SPAIN. INTRODUCTION:Uveal melanoma is the most common malignant intraocular neoplasia in adults although it´s an unusual disease. Approximately 50% of uveal melanomas develop metastases from 10 to 15 years post-enucleation, suggesting the possible existence of subclinical metastases at diagnosis.The PET/CT with 18Ffluorodeoxyglucose (FDG) is a technique widely used in staging patients with cutaneous melanoma diagnosis. However there is still little experience in cases of uveal melanoma.AIMS:To describe the distribution of metastases found by extension study with 18F-FDG PET/CT in our group of patients and to compare it with the findings reported in the literature.To assess the correlation between Standardized Uptake Value (SUV) of primary tumor against the presence of metastatic spread at the time of the study.MATERIAL AND METHODS:We retrospectively evaluated 19 patients (11 men and 8 women) diagnosed with uveal melanoma and average age 58,3 years (32 - 77) during the period 2007-2011. We analyzed the lesions visually and semiquantitatively (SUV), making a whole body study using 18F-FDG PET/CT. Diagnostic confirmation was obtained by follow-up and /or other diagnostic imaging techniques.We compare our results with similar work by specialized search engines. Furthermore, we use non-parametric statistical hypothesis test to estimate the measures of central tendency and dispersion.RESULTS:At the time of the study 9 patients had enucleation and 1 tumor surgery. Primary tumor SUV ranged from 1.41 to 6.07 in the remaining patients. From these patients only 4 had metastatic involvement (median SUV 2,90; p=0.905).The literature reflects different conclusions as to the degree of metastatic spreading of uveal melanoma, although it agrees about that the liver is the first organ affected (83-100% of cases). Other described locations are: bone (42-50%), lymphatic system (25-50%) and lung (17-25%).In our series 10 patients had metastatic lesions (52.6% of total), 3 of them in various locations. The organic and systemic distribution of these metastases were: 7 liver, 3 lymph node, 2 lung and 2
bone.CONCLUSION:PET/CT using 18F-FDG is shown as an effective exploration in detecting distant metastases in patients with uveal melanoma. The most common location was the liver, coinciding with high percentages of similar affectation as those reflected in the literature.The relationship between the value of SUV in the primary tumor and metastatic spread were not statistically significant, although the scarcity of the sample cannot allow us to state this with certainty.
P532 Detection Rate of Sentinel Node Mapping Using Combined Labeling Technique in Patients with Cutaneous Melanoma L. Jaukovic1, M. Rajovic2, L. Kandolf-Sekulovic3, M. Novakovic2, B. Ajdinovic1; 1Institute of Nuclear Mediicine, Military Medical Academy, Belgrade, SERBIA, 2Clinic for Plastic and Reconstructive Surgery,MMA, Belgrade, SERBIA, 3Clinic for Dermatology,MMA, Belgrade, SERBIA. Objective: Status of regional lymph nodes is the most important prognostic factor to determine the survival for melanoma patients. Sentinel lymph node (SLN) biopsy technique can be used to identify patients, who would not benefit from a complete lymphadenectomy,Aim: To evaluate the detection rate of SNL using blue dye/ Technetium colloidal rhenium sulphide injection (Nanocolloid) combined method of labeling, and to asses the contribution of SLN biopsy in staging of patients with melanoma.Method: During the first trimester after establishing SLN biopsy in our Institution, 16 patients (4 males, 12 females, median age 48 years) with cutaneous malignant melanoma underwent SLN biopsy. Preoperative lymphoscintigraphy was performed using dual head Gamma camera Adac Vertex, after 3-4 intradermal injection of 99m Technetium Nanocolloid dose activity 15MBq around the scar. Dynamic study was obtained acquiring ten 60seconds/ frame over the site of injection; the early and delayed static studies (300seconds/ frame) over the regional basins of drainage. Once the SLN was visualized the mark was set on the skin in the “surgical “position of patient. Blue dye (1%, 3 ml) was injected around the scar 15 minutes before the surgery. During the surgery gamma probe was used to localize SLN.Results: primary melanoma sites were the extremities in 7 patients, the trunk in 8 patients and head and neck in one patient. The median Breslow thickness was 3.0 mm.Blue dye failed to mark SLNs (groin basin) in 3 patiens. Using combined technique, 22 SLNs were successfully identified in all the patients (16/16); All SLNs were examined by frozen section, hematoxylin eosin staining and immunohistochemically. SLN metastases were detected in two patients (12.5 %), and they both underwent complete lymphadenectomy. Lymph nodes other than SLNs were found to contain metastases only in one patient (5 out of 9 lymph nodes evacuated).Conclusion: The success rate of SLN detection was 100%. SLN biopsy is currently available and effective diagnostic procedure for the precise staging of patients with cutaneous melanoma.
P533 Characterization of lymphatic drainage in the intraoperative localization of sentinel lymph node in patients with Cutaneous Malignant Melanoma in Brazil. T. M. Granzotto, F. C. Bernardes, E. N. Itikawa, S. S. Shakushiya, M. Kato, W. M. Araújo, M. E. P. M. Barros, C. C. Hetem, J. A. Farina Jr., C. S. Souza, L. Wichert-Ana; Ribeirão Preto School of Medicine - University of São Paulo, Ribeirão Preto - SP, BRAZIL. The cutaneous malignant melanoma (MM) is the less common skin cancer, but with high mortality and increased incidence in recent decades. The main treatment is surgery, but as any solid tumor, its spread can occur via the lymphatic system, affecting regional lymph nodes, or hematogenous, affecting remote organs. The sentinel lymph node biopsy (SLN), which is the first lymph node to drain directly into a tumor-specific, is highly sensitive in identifying metastases. Our objectives were to evaluate the clinical, demographic and surgical data, as well as the lymphatic drainage patterns in patients that underwent lymphoscintigraphy and were operated for MM. We evaluated 29 patients operated with MM, who underwent preoperative lymphoscintigraphy (LFSc) for SLN detection. The LFSc was performed using four injections, containing between 0.5 and 1.0 mCi of the radiopharmaceutical 99mTechnetium-Phytate in four cardinal points, 1.0 cm around the edge of the excision of the lesion and images were acquired 60 minutes after dosing. In this study, we found greater involvement by MM in the elderly female population and, most located in the posterior trunk region. The majority (37.04%) drained to 2 LNS / LNSS, 88.89% of the patients drained only to the ipsilateral region, and also 88.89% had lymphatic drainage to only a single drainage area. We found unexpected lymphatic drainage patterns in MM localized in head and neck, trunk, anterior and posterior trunk. The technique of lymphoscintigraphy was effective to show SNL / LNNS in 93.10% of patients and 23 pathological examinations performed, 6 (26.09%) had metastatic involvement in the SLN. This study confirmed the high sensitivity of Lymphoscintigraphy in to localize the SNL in patients with malignant melanoma.
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Sentinell Lymph Node Mapping in Cutaneous Melanoma E. Sürer Budak1, F. Aydın1, Ö. Özkan2, A. Boz1, A. Yıldız1, Ö. Özkan2, F. Güngör1; 1Akdeniz University Nucleer Medicine Department, Antalya, TURKEY, 2Akdeniz University Department Of Plastic And Reconstructive Surgery, Antalya, TURKEY. OBJECT:In this study, it was aimed to evaluate the efficiency of pre-op sentinel lymph node mapping in melanoma patients.METHODS:Medical records of 56 melanoma patients performed pre-op sentinel lymph node mapping in the Nuclear Medicine Department between December 2007 - January 2011 were reviewed retrospectively. Patients were consisted of 34 men and 22 women with median age of 50 years (range 14-77 years). (99m) Tc sulfur colloid and (99m) Tc sulfur nanocolloid was used in sentinel lymph node mapping. All patients were operated concomitantly with sentinel lymph node mapping. Lymph node resection from the lymphoscintigraphy positive area was performed without using gamma probe intraoperatively. Specimens were examined histopathologically.RESULTS:In the 14 of 56 melanoma patients performed sentinel lymph node mapping, melanoma metastasis was detected in histopathological examination and these patients underwent lymph nose dissection. In 39 patients, reactive lymph node hyperplasia was detected histopathologically and no more lymph node dissection was performed. In 3 patients, in histopathological examination no evidence of lymph node was detected while 2 of them were reported as salivary gland and the other as fatty tissue.CONCLUSION:Recently, while the incidence of melanoma increases, accurate staging becomes very important for surgery and treatment options. Also, extensive lymph node resection without pre-op sentinel lymph node mapping causes decreased life quality after surgery in nonmetastatic patients. As a result, sentinel lymph node mapping which is an easy and non-invasive method should be performed all melanoma patients before surgery.
P535 Value of 18F-FDG PET/CT for staging and restaging patients with malignant melanoma. I. Santos, C. Escabias, D. Marin, D. Mendez, A. C. Hernandez, J. Coya, L. M. Martin-Curto; LA PAZ HOSPITAL, MADRID, SPAIN. Malignant melanoma (MM) prognosis is strongly related to stage, therefore accurate staging/restaging is imperative to determine appropriate clinical management and best treatment protocol.AIM:To review our experience using 18F-FDG PET-CT to staging/restaging patients with MM and to evaluate clinical and treatment the management implications.MATERIALS AND METHODS:This retrospective study, from January 2008 to June 2010, includes 107 patients with MM (52 female, 55 male; mean age 58, range 25-84 years) who underwent 18FFDG PET-CT for staging or restaging. Breslow index mean was 3.57mm (range 0.512).Whole body PET-CT was performed after 60 minutes of 370MBq 18F-FDG injection in normoglucemia conditions on a dual modality PET/CT system (GE Discovery). Twenty patients were studied for initial staging purpose and 87 for restaging. Staging included sentinel lymph node biopsy (when indicated), physical examination, images studies (CT, MRI) and/or pathology when necessary. PET-CT images were visual interpreted for “N and M“ staging as positive, negative or inconclusive. Findings were correlated with biopsy, other imaging studies and follow up (at least 9 months).RESULTS:18F-FDG PECT-CT was positive in 39 patients, negative in 66 cases and inconclusive in 2. False negative images occurred in 3 patients (lymph node and small size lesions) and there were found 2 false positive (second tumours).Clinical stage (as AJCC staging system) before PET-CT was: IV (with surgical option of treatment) in 15 patients, III (locoregional) in 54 and stage I-II in the other 38 cases. After PET-CT staging of patients was as follows: 12 patients IV (with surgical option distant metastases), 22 patients IV (disseminated), 38 III (locoregional disease) and 28 I-II. 18F-FDG PET-CT findings changed in 30% (30 out of 100 patients evaluated) treatment planning. Seventeen patients stage I-III were upstaged as IV. Management changes in locorregional group occur in 25% (13 out of 52 evaluated) and 42.8% (6 out of 14) of distant disease group with surgical option treatment.CONCLUTIONS:Staging/restaging MM patients with 18F-FDG PETCT seems to be a useful to improve clinical management of these patients. The coordination of a rational protocol (with 18F-FDG PET-CT) to staging/restaging MM patients in essential for early detection of locorregional and distant disease resecable.
P50 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Soft Tissues & Sarcoma
P536 Correlation between CT and 18FDG-PET/CT in follow up of retroperitoneal sarcoma patients: preliminary results
C. Altini, F. Iuele, A. Niccoli Asabella, A. Nicoletti, A. Notaristefano, G. Rubini; Nuclear Medicine Unit -Di.M.I.M.P -University of Bari-Italy, Bari, ITALY. AIM: the aim is to evaluate the accuracy of 18FDG-PET/CT for depiction of recurrence, lymph node and hepatic and pulmonary metastases, in early follow-up of retroperitoneal sarcoma (RS) patients (pts), using morphological findings of CT as the reference standard.MATERIALS AND METHODS: This is a retrospective study of 17 RS pts, which have been undergone to 18FDG-PET/CT and CT. The average time interval was 21 days.The histotypes were: 7/17 liposarcomas, 5/17 leiomyosarcomas, 5/17 unspecified sarcomas.These pts were treated with: surgical excision of the lesion (24%) and surgical resection + adjuvant chemotherapy (76%).For statistical analysis, PPA (positive percent agreement) and NPA (negative percent agreement) were calculated.RESULTS: In 30% of pts, both methods were positive for recurrence, in 24% of pts both negative (PPA= 41.6% ; 95% CI: 18.3%, 64.9% - NPA=80%; 95%CI: 61%, 99%).The PET/CT and CT were positive for recurrence in 20% of pts with leiomyosarcomas (PPA=33%; 95%CI: 7%, 73.7% NPA=100%; 95%CI: 100%, 100%), in 43% of pts with liposarcomas (PPA=16%; 95%CI: 10.8%, 42.8% - NPA=100%; 95%CI: 100%, 100%), in 20% of pts with unspecified sarcomas (PPA=33%; 95%CI: 7%, 73.7% - NPA=100%; 95%CI: 100%, 100%).In the assessment of locoregional lymph node metastases, no patients were positive in 18FDG-PET/CT and CT (PPA=0%; 95%CI: 0%, 0% - NPA=86.6%; 95%CI: 70%, 100%).For the evaluation of hepatic metastases, CT scans found lesions in only 6% of pts that are not evidenced in 18FDG-PET/CT, in 94% of pts both techniques were negative (PPA=0%; 95%CI: 0%, 0% - NPA=100%; 95%CI: 100%, 100%).For lung metastases in 31% of the pts 18FDG-PET/TC was negative and CT scans positive, in 69% of pts both techniques were negative (PPA=0%; 95%CI: 0%, 0% - NPA=100%; 95%CI: 100%, 100%).CONCLUSIONS: Histotype, grade and surgical resection usually dictate CT imaging follow-up interval.18FDG-PET/CT is a useful tool in association with CT, in following sarcoma treatment, helping identify possibly more effective therapy strategies, grading sarcoma, separating benign from malignant masses, selecting biopsy sites, assessing the extent of sarcomas.We can conclude that an overall agreement was found acceptable in negative pts of our study. The changes in tumour FDG uptake are often seen in the absence of change in tumour dimensions. Decreases in FDG uptake can be correlated with better survival, validating its use as a tumour response biomarker. Our data are numerically limited and we are working on better analysis, including new pts.
P537 Value of PET-CT in the evaluation of sarcomas in children A. Mazurek; Military Institute of Medicine, Warsaw, POLAND. Aim: PET-CT is used for staging sarcomas, while the value of PET-CT in children has not been determined. The aim of this study was to evaluate the usefulness of PETCT in the diagnosis of various types of sarcomas in children.Methods: 22 children aged 2-18 years, mean age 13 years, diagnosed with: Ewing sarcoma-12, rhabdomyosarcoma ( RMS)-5, embrional rhabdomyosarcoma ( RME)-1, osteosarcoma ( OS)-1, synovial sarcoma ( SS)-3.PET-CT was performed after intravenous administration of 18FDG ( 0,21 mCi/kg). In two cases, general anesthesia was used.Acquisition was performed using 16-row PET-CT scanner 60 minutes after injection.PET-CT findings were compared with other imaging studies of and with histopathology if available.Results: The mean SUVmax for primary foci = 5,6±4,3, for lymph nodes 4,7±3,5, for bones 5,1±2,1. Taking into account the type of sarcoma was found that Ewing sarcoma, RMS and OS are characterized by the average uptake for metastasis SUVmax = 5, RME and SS- SUVmax = 2,4. In addition, in one child with SS PET-CT do not showed metastatic lesions in the lungs- that was qualified as false negative result.Conclusion: PET-CT can be a valuable tool in staging of sarcomas in children. In the interpretation of results histological type of sarcoma and the possible low SUVmax for metastatic lesions in the case of RME and SS especially in the lungs should be considered.
P538 A Single Institutional Retrospective Experience with Fdg Pet/Ct on Treatment Response and Follow-up of Gastrointestinal Stromal Tumors (Gist) F. Sen, A. T. Akpinar, D. Kumtepe, U. Ogur; Uludag University, Bursa, TURKEY. Aim:We aimed to review our experience with FDG PET/CT imaging of GISTs based on treatment response and follow-up evaluation and to compare the PET/CT findings with the previous and/or subsequent CT images.Materials and methods:Between 2006-2010, a total of 58 PET/CT images of 25 patients (15 M, 10 F; aged: 24-75, mean: 55.8) with histopathologically proven GIST were evaluated in comparison with the previous and/or subsequent CT images. Primary tumor was localized in small intestine (52%), stomach (44%) and retroperitoneum (4%). All patients but two had undergone primary tumoral resection. 10 out of 25 patients had liver metastases only, one had both liver and omentum metastases and one had metastatic lymph nodes, whilst the remaining had none at diagnosis by conventional methods. Sixteen of them had more than one PET/CT study. Twenty-
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one patients received imatinib mesylate (IM) therapy due to recurrence after surgery or inoperability. Among them, one being intolerant and six with progression on IM on follow-up were switched to sunitinibe, instead.Results:The lack of concordance between PET/CT and CT findings were associated with lesion size, the whole-body (WB) imaging advantage of combined PET/CT and metabolic vs. anatomic response criteria for both PET and CT. In one patient, PET/CT missed a millimeter-sized lesion in spleen which was proved to be a metastasis thereafter. One more bone lesion was found by WB PET/CT, in a patient with known solitary bone metastases detected by CT. No pathologic FDG uptake was seen on a lesion that was highly susceptible for recurrence on CT in another patient. On follow-up it was considered as benign. In a patient with previous liver metastasectomy, a lesion interpreted previously as a post-operative change on CT showed highly increased FDG uptake suggesting malignancy on PET/CT and led to imatinib dose escalation. On follow-up CT, recurrence was verified. In patients that respond to treatment, it was seen that small-sized lesions were underdiagnosed by PET/CT in comparison to CT.Conclusion:For an accurate evaluation of tumor response, anatomic imaging alone was insufficient because tumor shrinkage may move on slowly. We may consider that combined PET/CT makes one step forward as a more practical method rather than CT-only in monitoring especially early treatment response of GIST. On follow-up evaluation of patients with GIST, PET/CT may provide more reliable results in terms of tumor recurrence and make significant contribution on patient management.
P51 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Miscellaneous
P539 Accuracy of sentinel lymph node biopsy for inguinal lymph nodes staging of penile squamous cell carcinoma: systematic review and meta-analysis of the literature R. Sadeghi1, H. Gholami2, S. Zakavi2, V. Dabbagh Kakhki2, K. Tavakkoli Tabasi2, S. Horenblas2; 1Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, IRAN, ISLAMIC REPUBLIC OF, 2 Mashhad University of Medical Sciences, Mashhad, IRAN, ISLAMIC REPUBLIC OF. Background: Sentinel lymph node (SLN) biopsy is emerging as a promising method for inguinal lymph node staging of penile squamous cell carcinoma (SCC).Objective: The aim of the current systematic review was to meta-analyse the accuracy of SLN biopsy for inguinal lymph node staging in penile SCC and possible influential factors.Evidence Acquisition: Medline, SCOPUS, ISI, OVID SP, Springer, Science direct, and Google scholar were searched by the following key word: “(penile OR penis) AND sentinel”. No date or language limitation was imposed on the search. The meeting abstracts were not excluded either. Last search was done on December 2010.Evidence Synthesis: Random effects model was used for statistical pooling. 17 studies were detected suitable for meta-analysis. Three articles had two different sub-groups of patients and each sub-group was considered as a separate study. Overall, 18 studies (including the sub-groups) were used for detection rate meta-analysis and 19 studies for sensitivity meta-analysis. Pooled detection rate was 88.3% [95% CI: 81.9-92.6%]. Pooled detection rate of 90.1% [95% CI: 83.694.1%] was calculated for the studies used both blue dye and radiotracer. Pooled sensitivity was 88% [95% CI: 83-92%]. The highest pooled sensitivity (92% [95% CI: 86-96%]) was in the studies used both radiotracer and blue dye and recruiting only cN0 patients.Conclusions: SLN mapping in penile SCC is a method with high detection rate and sensitivity. Using both radiotracer and blue dye for SLN mapping and including only cN0 patients ensures the highest detection rate and sensitivity.
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Myocardial Washout of TC-Tetrofosmin in Breast Cancer and Lymphoma Patients, Treated with Anthracyclines. A. Tzonevska, K. Tzvetkov, D. Vasileva, M. Atanasova, E. Piperkova; National Oncology Hospital, Sofia, BULGARIA. Aim: The aim of the study was to assess 99mTc-Tetrofosmin washout from the myocardium and to evaluate the usefulness of myocardial scintigraphy as a monitoring tool for early sign of anthracycline cardiotoxicity in anthracycline treated patients. The current study defines the relationship between tracer washout and pathological myocardial changes after anthracycline treatment.Material and method: We studied 64 patients, 6 months to 1 year after anthracycline therapy: 32 with breast cancer and 32 with Hodgkin’s Lymphoma, mean age 47,3. Each patient passed myocardial scintigraphy (GSPECT and planar AP) 30 min. and 3 hours after 99mTc-Tetrofosmin (740 MBq) application. During GSPECT, myocardial perfusion and kinetic were assessed. The tracer washout in the late scan was calculated in % using ROI regions including LV myocardium in early and late AP scans and equilibrium::E-L x 100.EResults: All patients were divided into 3 groups: I group (control)- 13 patients without anthracycline therapy and normal
early myocardial scintigraphy; II group- 28 patients after anthracycline therapy with cumulative dose 550 mg/m2 and normal early myocardial scintigraphy and III group- 23 patients after anthracycline therapy with cumulative dose 550 mg/m2 and visualized hypoperfused defects during myocardial scintigraphy. All patients (n64) had normal LV kinetic.The mean tracer washout rates in group I (control) were 13,9%± 9; in II group- 21,01%±12; in III group-60,87%±13. The statistical analysis indicated significant difference in the tracer washout in group I and III, P<0,001 and nonsignificant difference in group I and II. The most probable reason for the result is the mechanism of myocardial deterioration after anthracycline treatment in group III.Conclusion: 99mTc-Tetrofosmin myocardial washout up to 50%, 3 hours after application, can be used as an indicator for early detection of anthracycline cardiotoxicity and therapy adoption in patients after anthracycline treatment. Relationship was found between tracer washout and myocardial perfusion.
P541 Is fasting for at least 4-5 hours adequate in FDG-PET/CT protocol? : An age-stratified case-control study. K. Nakatani, Y. Nakamoto, K. Togashi; Kyoto University Graduate School of Medicine, Kyoto, JAPAN. AIM: Insulin secretion after meal intake causes extensive skeletal muscle accumulation (ESMA) of FDG that is problematic in interpreting PET images. Currently accepted preparation protocols require fasting for at least 4 hours, but 4hour fast may be insufficient to avoid this problematic condition. We investigated those who had ESMA despite at least 4-hour fast to find specific features which the occurrence of such condition depended on.PATIENTS & METHODS: From Jul 2009 to Feb 2011, 3603 patients underwent oncologic FDG-PET/CT in our institute. There were 44 case subjects (mean age 66.6, range 28-90) that showed ESMA, likely to be affected by insulin, together with decreased accumulation in brain and/or intense uptake in myocardium. 100 controls with 4- to 5-hour fasting (mean age 65.5, range 28-88) were selected by age-matched random sampling. Patients with systemic muscle diseases, e.g. polymyositis, those who had had strenuous exercise, and those who failed to keep fasting for 4 hours were excluded. Body mass index (BMI), plasma glucose level (PG), whether to satisfy diabetes criteria or to be suspicious for diabetes, whether to be treated with exogenous insulin, and the approximate volume of food residue in stomach estimated by CT, were compared between the case subjects and the controls.RESULTS: 29 of 44 case subjects (66%) fasted for 4-5 hours. (The remaining patients fasted for more than 5 hours.) There was no significant difference of BMI between in case subjects (22.0±3.0) vs. in controls (21.4±2.9) (P=0.31). PG was significantly higher in case subjects (134.9±44.0) than in controls (114.1±32.9) (P=0.0065). Patients with satisfying diabetes criteria or suspected diabetes was significantly more frequently existed in case subjects than in controls with odds ratio of 4.73 (95%CI, 2.22 to 10.1: P<0.0001). In case subjects, those treated with exogenous insulin significantly more frequently existed with odds ratio of 5.59 (95%CI, 1.78 to 17.5: P=0.0026), and a conspicuous amount of food residue in stomach was also significantly more often observed with odds ratio of 4.62 (95%CI, 1.92 to 11.1: P=0.0008).CONCLUSIONS: Unfavorable extensive accumulation in skeletal muscles tended to be observed in known or suspected diabetic patients, and those who still kept a considerable amount of undigested food in stomach at acquisition, probably due to the residual endogenous insulin activity. For patients with known or suspected diabetes, longer fasting time would be preferable in FDG-PET/CT. And it seems that too many meals should be avoided before fasting.
P542 Does high serum glucose really predict poor image quality in FDG PET/CT? H. Khirwadkar, J. Rees, S. Jayaprakasam, P. Fielding; PETIC, University Hospital of Wales, Cardiff, UNITED KINGDOM. Aim : To investigate the effect of serum glucose on the reporting quality of PET/CT imaging with 18F-FDG.Methods : We retrospectively reviewed the PET/CT reports performed in a PET referral centre during a 3 month period (October to December 2010). Serum glucose levels prior to 18F-FDG injection were documented within the report. All patients with a serum glucose of above 7mmol/L, as well as randomly selected patients with a serum glucose of less than 7mmol/L had a blinded re-review of their images by a consultant experienced in PET/CT reporting.The level of skeletal muscle and brown fat uptake as well as overall image quality were assessed qualitatively and assigned a value between 1-5. A value of 1 was assigned to scans of poor quality, up to 5 in those of excellent quality. The SUVmax of background liver and gluteal muscle were also recorded. Patient data was then grouped into those with a serum glucose of < 7, those with a serum glucose between 7 - < 11 and those with a serum glucose of 11 or more.Results : 307 patients were imaged in a 3 month period, 289 of which had documented serum glucose levels contained in the report. 28 patients were found to have a serum glucose of greater than 7mmol/L (23 found to be between 7 and 11mmol/L and 5 greater than 11mmol/L). A further 15 randomly selected patients with a
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441 serum glucose of less 7mmol/L were also selected for review. (total 43 patients) We found similar average scores across the 3 groups; skeletal muscle scores were 2.9 (< 7mmol/L), 3.1 (7-11mmol/L) and 3.0 (> 11 mmol/L). Average values for overall image quality were 3.6(< 7mmol/L), 3.2 (7-11mmol/L) and 3.0 (> 11mmol/L).SUV values for gluteal muscle across the groups were 1.4 (< 7mmol/L), 1.3 (7-11mmol/L) and 1.4 (> 11 mmol/L).Conclusion : We found no evidence to suggest that elevated serum glucose predicts poor scan quality on FDG PET studies. None of the 28 patients with elevated serum glucose had unacceptably poor scan quality. We suggest that serum insulin levels are of more importance than measured glucose levels. Whilst we continue to measure serum glucose prior to imaging, we will not defer the scan on the basis of the glucose level alone.
S389 cancer; P < 0.001, PTC; P = 0.312). On lymph node metastasis, increased SUV max was apt to be lymph node metastasis positive on lung cancer and breast cancer, which were statistically significant (lung cancer; P = 0.036, breast cancer; P = 0.026). There was tendency to be lymph node metastasis positive on ESCC and PTC, which did not show statically significant (ESCC; P = 0.073, PTC; P = 0.164). Conclusion: The relationship between SUV max of primary tumor and GLUT -1, p T staging and lymph node metastasis may be different in various cancers. We consider that SUV max do not always show a connection with GLUT-1 expression in all malignant tumors.
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Quantitative PET/CT-PET/MRI comparison of lesions and normal tissues SUV values M. Lord, V. Garibotto, A. Figueiral, S. Heinzer, H. Zaidi, O. Ratib; University Hospitals of Geneva, Geneva, SWITZERLAND. ABSTRACTPositron emission tomography (PET)-magnetic resonance imaging (MRI) is an hybrid imaging modality with new indications in oncology. Standardized uptake value (SUV) measurement is the classical measurement method used to assess the metabolic activity of a lesion on PET/CT. This study compares the reproducibility of SUV values for lesions and normal tissues obtained on both PET/CT and PET/MRI.Methods:62 patients (27 women, 35 men; mean age 59 y.o.; range 6-80 y.o) with 30 known or suspected malignant lesions were compared on both PET/CT and PET/MRI. Whole-body PET-CT was done at 60 min after injection of 300 MBq of 18F-fluorocholine and then whole-body PET/MRI 92±24 minutes (range 46-161) later. Regions of interest for normal tissues were traced over brain, cerebellum, right lung, heart, liver, colon, right psoas muscle, right gluteus muscle and 4th lumbar vertebra and in the areas of suspect hypermetabolic lesions. The mean and maximum standardized uptake values (SUVs) were then calculated and compared (paired t-test).Results:SUVmax and SUVmean values of the lesions did not significantly differ between the two acquisitions (paired t-test) but showed a trend for an increase over time (+33.1% (p=0.05) for SUVmax on PET/IRM vs on PET/CT and + 24.8% (p=0.08) for SUVmean), as expected with tumor continuing tracer accumulation. The correlation between the PET/CT and PET/MRI measurements was excellent, both for mean and maximal SUV values, with an R2 of 0.89 and 0.91, respectively. The analysis of body regional SUV values showed some variability across subjects, with no significant difference between the two acquisitions for the lung, heart, bone (lumbar vertebra L4) and gluteus muscle, while there was a significant decrease between PET/CT and PET/MRI in brain (p<0.001) and liver (p=0.001) and a significant increase in the psoas muscle (p = 0.005), consistently with previous observations (Kubota, Itoh et al. 2001; Basu, Kung et al. 2009; Chin, Green et al. 2009). We also measured a ratio between lesion SUVmax and SUVmean measured for the psoas muscle, resulting in a significant, but less strong correlation between PET/CT and PET/MRI values (R2 : 0.77).ConclusionMean and maximum SUVs on PET/CT and PET/MRI are highly correlated, and thus SUV measurements on attenuation corrected PET/MRI are considered reliable, with no need to correct them for normal tissue activity, which would introduce only greater variability.
P544
18
The relationship between F-FDG uptake expression on various cancers.
and GLUT-1
K. Hayato, M. Ishibashi, A. Kawahara, S. Hattori, M. Hayakawa, S. Kurata, M. Kobayashi, Y. Hirose, U. Toh, M. Kage, Y. Hiromatsu, H. Fujita, S. Takamori, T. Nakashima, N. Hayabuchi; Kurume University School of Medicine, Kurume City, f*ckuoka, JAPAN. Purpose: Recently, 18F-FDG (fluorine-18-fluorodeoxyglucose) uptake has been reported to be associated with other glucose transporters (GLUT) except for GLUT1. The aim of this study is to investigate the relationship between 18F-FDG uptake and GLUT -1 expression on various cancers. Material and Methods: One hundred fifty-two patients were included in the present study. The type and number of each cancer were as follows; breast cancer (n = 37), esophageal squamous cell carcinoma (ESCC) (n = 39), papillary thyroid cancer (PTC) (n = 39), lung cancer (n = 37).18F-FDG-PET (positron emission tomography) was performed before surgery. Histopathogical findings were confirmed by postoperative specimens. The patients who underwent neoadjuvant chotherapy and radiation therapy before surgery were excluded in this study. We investigated the relationship between maximum standardized uptake value (SUV max) and GLUT-1, and pathological T stage (pT stage) and lymph node metases . Results: Significant difference was observed in GLUT-1 expression on immunohistochemistry and SUV max among four cancers (P < 0.0001). Regarding lung cancer and ESCC, SUV max was correlated with GLUT-1 expression significantly, however, was not on breast cancer and PTC (lung cancer; r = 0.543, P = 0.008, ESCC; r = 0.529, P = 0.002, breast cancer; r = 0.205, P = 0.386, PTC; r = 0.272, P = 0.099). On lung cancer, ESCC and breast cancer, high SUV max tended to be higher pT stage, however, did not on PTC (ESCC, lung and breast
FDG PET/CT Imaging in Oncological Animal Patients Feasibility and Radiotoxicological Aspects, Clinical Experiences.
L. Balogh1, Z. Postenyi1, V. Haasz1, A. Polyak1, T. Marian2, I. Garai2, L. Galuska2, L. Galuska2, L. Balkay2, G. Trencsenyi2, J. Szabo2, J. Thuroczy3, R. Torok4, G. Janoki4, G. A. Janoki5; 1NRIRR, Budapest, HUNGARY, 2 Medical University, Debrecen, HUNGARY, 3SzIE Vet Fac, Budapest, HUNGARY, 4Radiopharmacy Laboratory Ltd, Budaors, HUNGARY, 5MediRadiopharma Ltd, Erd, HUNGARY. Despite that the clinical usefulness of 18FDG PET/CT in human oncology is well understood much less data are available from the veterinary side.Client owned dogs and cats altogether over 70 suspected or known oncological cases were referred for 18FDG PET/CT whole body examinations Phillips Brillance). The goal was to detect primary tumour localizations, extensions and to visualize regional and far metastases (WHO staged diagnosis). Pets were sedated and injected iv. with 18Ffluoro-deoxy-glucose (FDG) 15 MBq/bwkg and one hour later after the injection whole body fusion images were taken. We also collected blood samples from patients to check the haematological and biochemical parameters.18FDG PET/CT revealed very sensitive in case of a wide variety soft tissue and bone tumours eg.: osteosarcomas, mast cell tumours, lymphomas, soft tissue sarcomas, melanomas and different epithelial tumours. Some benign, low metabolic rate tumours (adenomas, lipomas, fibromas, intracranial) showed much lower 18FDG-uptake where the method seems to be questionable. Few degenerative-, inflamed- and hypertrophic tissues (arthrosis, lymph adenitis, muscle hypertrophy) revealed intense focal uptake that could be confusing in differential diagnoses.PET/CT imaging is well-tolerated even in late stage animal patients and provides important information to veterinary clinicians in disease staging, monitoring response to treatment, planning and choosing appropriate therapies, detecting recurrence and predicting prognosis. The relatively high incidence rate of some cancers, similar biological behaviour, larger body size, comparable response to radio-, and chemotherapeutic agents, shorter overall lifespan and shorter latency period are the factors that contribute to the advantages of the companion animals as a model for human neoplastic diseases.Scientific work was supported by several national (OTKA-68376, JEDIONKO, KMOP-1.1.1-08/1-2008-0017, GOP-1.1.1.-09/1-20100107) and international (IAEA-CRPs, EMIL NoE) projects.
P547 Translating evidence to clinical practice: the case of PET-TC prescription and coverage in MUFACE C. Asensio1, H. Castaño2, B. Caballero3, E. Llorente3, C. Vera2; 1Instituto de Salud Carlos III, Madrid, SPAIN, 2MUFACE, Madrid, SPAIN, 3Hospital de Fuenlabrada, Madrid, SPAIN. Background: MUFACE is the spanish public organisation in charge of the health assistance of some civil servants (1,557,840 in 2010) through public or private insurance entities. Positron Emission Tomography (PET)-Computed Tomography (CT) was legally introduced in the Common Health Service in 2006 as a diagnostic test for only some specific oncological situations. Since that date, prescriptions of PET-CT in non-authorised indications increased considerably making necessary to consider the precise scope and coverage criteria of this technology.Aim: To elaborate a clinical PET-CT Guide based in the scientific evidence in order to facilitate not only the medical prescription of PET-CT but also all health policy decisions of MUFACE and its associated entities related to PET examinations.Methodology: A multidisciplinary work-team hold some meetings to decide, by consensus, the methodology and type of tumours and clinical situations to study, solve difficulties and disagreements, and achieve final recommendations for the prescription and coverage of PET-CT based on the scientific evidence. A comprehensive literature review including health technology assessment reports, systematic reviews, meta-analysis, clinical practice guidelines, consensus conferences, and guidelines supported by Scientific Societies, published from January 2000 to October 2010 was performed.Results: Nine persons in the workteam attended six meetings. Eight indications of PET-CT (primary diagnosis, initial staging, re-staging, recurrence detection, follow-up, therapy monitoring, radiotherapy planning with PET, and prognostic information from PET) for 23 different tumours were analysed. Two different glosaries, one for those 8 clinical indications and the second one for 8 possible final recommendations (authorised,
Poster Presentations
P543
S390 recommended, proposed, indeterminant results, still in investigation, not recommended, and not studied) were developed by the group. Results from scientific evidence were extracted and tabulated for each tumour and indication, and for every one of them the work-team made, by consensus, a final decision of PET-CT coverage. Besides the 23 authorised oncological situations, 26 indications (16,1% of all the evaluated situations) were classified as recommended and 38 (23,6%) as proposed. A clinical Guide of PET-CT was elaborated, including a decision management algorithm for PET prescription, according to the level of recommendation, and a PET examination request form.Conclusions: PET-CT is an effective diagnostic test for a great number of tumours and clinical situations, considerably higher than those legally authorised in Spain. This PET-CT Guide is a representative example of how scientific evidence can influence policymakers to improve the quality and efficiency of health services translating, directly, the best knowlegde to the clinical practice.
P548 Three cases of Castleman’s disease studied by FDG-PET/CT M. Jinguji1, Y. Kajiya1, I. Ueno1, S. Tanohata1, M. Ueno1, H. Tanabe2, M. Nakajo2, Y. f*ckukura2, Y. Nakabeppu2, M. Nakajo2, S. Jinnouchi3, M. Higashi4; 1Nanpuh hospital, Kagoshima city, JAPAN, 2Kagoshima University Graduate School of Medical and Dental sciences, Kagoshima city, JAPAN, 3 Atsuchi PET Memorial Clinic Center, Kagoshima city, JAPAN, 4Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima city, JAPAN. Aim:Castleman's disease is a very rare disorder characterized by non-cancerous growths (tumours) that may develop in the lymph node tissue at a single site or throughout the body. The aim of this study was to report findings of FDG-PET/CT and glucose transporter 1(GLUT 1) expression in 3 cases of unicentric Castleman’s disease.Materials and methods: We retrospectively reviewed 3 cases of abdominal Castleman’s disease studied by FDG-PET/CT before surgery. FDG-PET/CT was performed 1 hour after intravenous injection of FDG (3.7MBq/kg). The maximum standardized uptake value (SUVmax) was calculated for each tumour. Paraffin embedded sections obtained from each resected tumour were stained with haematoxylin and eosin and immunostained for GLUT 1. Pathological type of Castleman’s disease and the expression of GLUT 1 were evaluated by a pathologist.Results: A 74 year-old woman had a retroperitoneal mass which showed slight FDG uptake (SUVmax: 2.4). This case was mixed type of Castleman’s disease without Glut 1 expression. A 69 year-old woman had a retroperitoneal mass which showed moderate FDG uptake (SUVmax: 3.5). This case was hyaline vascular type of Castleman’s disease without Glut 1 expression. A 21 year-old woman had a mass in the porta hepatis which showed intense FDG uptake (SUVmax: 8.9). This case was plasma cell type of Castleman’s disease with Glut 1 expression.Conclusion: Our 3 cases of Castleman’s disease showed variable degree of FDG uptake and varied in pathological type and GLUT 1 expression. Although it appears to be difficult to make the diagnosis of Castleman’s disease by the FDGPET/CT findings alone, the potentiality exists to differentiate among 3 pathological types of Castleman’s disease based on the degree of FDG uptake. It is necessary to accumulate more cases of Castleman’s disease to verify this hypothesis.
P549 Evaluation of Treatment Response in Solid Tumors: Comparison of Conventional and Functional Criteria B. Gunalp1, S. Ince1, C. Liman2, B. Tasdemir1, T. Haciosmanoglu1, S. Donmez1, E. Alagoz1, O. Karacalioglu1, M. Ozguven1; 1Gulhane Medical Faculty, ANKARA, TURKEY, 2Pozitron Nuclear Imaging Center, ANKARA, TURKEY. Aim: We retrospectively investigated conventional anatomic and functional PET/CT parameters for the evaluation of treatment response.Material and Methods: Nineteen patients (11 men, 8 women; age 55±12 SD) with solid tumors (lung, breast, nasopharynx, liver) who referred for F-18 FDG PET/CT imaging before and after chemotherapy were included in this study. Studies were done with GE Discovery PET/CT 600 scanner. PET VCAR interactive data analysis program was used for functional volume determination and monitoring response to treatment. Changes in sum of longest diameters according to Response Evaluation Criteria in Solid Tumors (RECIST 1.1), maximum standard uptake values (SUV Max) calculated both using body weight (bw) and lean body weight (lbw), functional lesion volume (FLV) and total lesion glycolysis (TLG) which is product of the volume and the SUV mean were determined in the 55 tumor foci and evaluated according to PERCIST 1.0 criteria.Results: Ten (52%) patients partially responded (PR), three (15%) patients completely responded (CR), one (5%) patient was stable (SD) and 5 patients (26%) disease progressed (PD). RECIST 1.1 criteria has been found the less valuable for determining tumor response. Maximum 60% change at the sum of diameters has been observed when tumor completely responded to the therapy according to both F-18 FDG PET/CT and clinical results. Changes in SUV Max (bw) and SUV Max (lbw) showed quite good correlation (95%) with therapy response. Functional volume determination failed in 2 patients due to very low lesion to background ratio. When edge detection threshold was increased, functional
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 volume was determined more correctly and functional volume change also has been found very valuable parameter for determining therapy response. The best clinical correlation was observed in percent changes of TGV which is a combination of both metabolic activity and active tumor volume. Percentage declines in TGV were greater than declines in SUV Max and found to be superior to both SUV Max and functional volume changes alone.Conclusion: Our preliminary results showed that the conventional criteria for therapy response (RECIST 1.1.) have to be refined using PET/CT functional parameters for the more accurate determination of therapy response.
P550 Determine the Best Threshold of SUVmax of Cervical Cancer With 18F-FDG for Biological Target Volume W. Yang, S. Wang, X. Ma, B. Jia, J. Wang; Xijing hospital, Xi'an, CHINA. Objective: Accurately delineate the biological target volume in cervical cancer is critical for its radiotherapy, but it is still remain unclear. This study explored the best threshold of SUVmax for determining the biological target volume of the cervical cancer with 18F-FDG PET/CT.Methods: 12 patients(50.2±6.6year) with biopsy-proven cervical cancer were underwent 18F-FDG PET/CT(Siemens Biograph 40) before surgery. Two nuclear medicine physicians delineate the boundary of tumor in the TrueD station (Siemens) by 18F-FDG PET imaging and enhancement CT imaging respectively. For PET imaging, the tumor boundary slightly larger than visualization when delineate the boundary by manual,when set threshold of SUVmax as 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45% and 50%, the boundary of tumor were delineated and the volume of tumor were calculated accordingly. According to the enhance boundary of tumor to acquire CT GTV. After surgery, the whole tissue was cut into 5mm thickness sections. Define the boundary of tumor in each slice and calculated the area of tumor by Photoshop, add up areas in all sections and multiply slice thickness to acquire the pathological volume as golden standard. The best threshold of SUVmax which PET GTV is similarly to the pathological volume can be determined. It defined as a coincidence if the difference of CT GTV, PET GTV and the pathological volume is less than 10%. Otherwise, it is an inconsistent.Results: The threshold of SUVmax is between 35% to 50%( 43.33%±3.61%). It will be well correlated with the pathological volume when define the threshold of SUVmax of tumor as 45%. CT GTV is significant difference with PET GTV or the pathological volume. 4 CT GTV is larger than pathological volume, 3 is smaller than pathological volume, all other 5 is similar with pathological volume. The radiotherapy target area for 7 patients were changed when set the threshold of SUVmax of tumor as 45%.Conclusion: PET GTV is more accurate than CT GTV comparing with pathological volume for cervical cancer if defined the threshold of SUVmax as 45%, it should be play more important role in directing radiotherapy for cervical cancer.
P551 Early detection of Virchow’s node infiltration with 18FFDG/PET-CT compared with ce-CT. B. Intriago1, N. Calvo1, M. Danús1, C. Trampal2, J. Escobar1; 1DIMATGECRC. Hospital St. Joan Reus, Tarragona, SPAIN, 2CRC. Hospital del Mar, Barcelona, SPAIN. The left supraclavicular node is called Virchow's node, and takes its supply from lymph vessels in the abdominal cavity. If it is enlarged it is referred to as the Troisier's sign and usually strongly associated of the presence of malignancy in the abdomen.We report about patients showing unexpected 18F/FDG uptake in the left supraclavicular fossa, with previous negative CT.MatherialWe studied in the last year all patients with pathological 18F/FDG nodal uptake in the left supraclavicular fossa, with no sign of pathological enlargement on ce-CT ( contrast enhanced CT). All had further histological confirmation of metastatic infiltration.Results.We recruited 11 patients: 3 patients were studied for staging gastric cancer, 2 for esophageal cancer, 1 cervix uteri and 5 for lung cancer.All nodes were unspecific on ce-CT, no bigger than 11 mm and all presented a SUVmaximun > 2.. There were no other involved nodes in the same area ( no nodes in the axilar, mediastinal or laterocervical areas).There were 3 patients showing a single node and the rest 2 or more.In all cases the histological confirmation of the Virchow´node changed the stage and the intention to treat.Conclusion18FFDG/PET-CT was able to detect earlier than ce-CT the metastatic infiltration of the Virchow’s node, representing in the cases of this report ( gastric, esophageal , cervix uteri and lung cancer) an expected finding and representing a major change in the staging and treatment.
P552 Impact of FDG PET/CT on management of patients’ candidate to radiotherapy (RT) M. Rodari, G. Pepe, K. Marzo, F. Alongi, P. Navarria, M. Scorsetti, A. Chiti; IRCCS Humanitas, Rozzano, ITALY.
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P553 18F-FDG PET/CT in patients with fever of unknown origin P. Caroli1, V. Ambrosini1, L. Fantini1, S. Nicolini1, M. Celli1, S. de Vivo1, L. Zannoni1, M. Zompatori1, C. Nanni1, V. Allegri1, G. Montini1, S. Fanti1, D. Rubello2; 1Azienda Ospedaliero-Universitaria di Bologna, S.Orsola-Malpighi University Hospital, Bologna, ITALY, 2Azienda Ospedaliera di Rovigo, S.Maria della Misericordia Hospital, Rovigo, ITALY. AIM: to assess the value of 18F-FDG PET/CT in the investigation of patients with fever of unknown origin (FUO).MATERIALS AND MHETODS: We retrospectively evaluated the patients with persistent fever (122 cases) that underwent 18F- FDG PET/CT and included only those who met the diagnostic criteria for FUO (1. a temperature greater than 38.3°C on several occasions, 2. more than 3 weeks' duration of illness, and 3. failure to reach a diagnosis despite one week of inpatient investigation).18F-FDG PET/CT was performed following standard procedure and clinical follow-up and pathologic confirmation were used as standard of reference to finally evaluate PET results.RESULTS: Overall 22 patients with FUO were included in the study (7 male, 15 female; mean age 62 years-old [31-85]).A final diagnosis was reached in 15/22 patients (vasculitis=6; autoimmune disorder=1; neoplasm=2; infectious disease=2; inflammatory disorder=4). In the remaining 7/22 cases, no cause of FUO was established.PET resulted positive in 13/22 cases with a mean SUVmax of 4,3 [2,8-7,7]. SUVmax standard deviation was 1.7.PET/CT allowed the identification of aetiology in 12 patients with FUO, showing a diagnostic yield of 46% (12/22). In particular PET/CT showed unsuspected vasculitis in 6 patients, inflammatory disorder in 4 patients and malignancy in 2 patients.In one case, PET was false positive showing FDG gastric uptake that was not confirmed at followup.Among the 9/22 cases with a negative PET, 2/9 cases were false negatives (final diagnosis: spondilodiskitis and colangitis).CONCLUSIONS: Since FUO represents a diagnostic challenge for the clinicians, 18F-FDG PET/CT may provide valuable information for the identification of etiology. In our series, PET resulted helpful in about half the studied cases.
P554 Frequency and Type of Central Venous Catheter (Port-A) Complications in FDG PET/CT Imaging for Cancer Patients P. Kao1, C. Huang2, J. Weng3, J. Lee3, T. Tsao1; 1Institue of Medicine, Chung Shan Medical University and Department of Nuclear Medicine, Chung Shan Medical University Hospital, Taichung, TAIWAN, 2School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, TAIWAN, 3Department of Nuclear Medicine, Chung Shan Medical University Hospital, Taichung, TAIWAN. AimCentral venous catheter (Port-A) implantation is commonly use for chemotherapy administration for cancer treatment. Complications of Port-A had been reported on diagnosed radiology imaging. FDG PET/CT was widely used for cancer treatment monitoring and recurrent restaging. The frequency and pattern of incidental Port-A complication findings in FDGPET/CT was retrospectively
studied.Materials and MethodsCancer patients referred for FDG PET/CT during Aug 2007 to Jan 2011 were retrospectively reviewed. The frequency of Port-A implantation in cancer patients for FDG PET/CT scan, and frequency and types of Port-A complications were recorded.ResultsThere were 2443 FDG PET/CT scans for cancer study during the abovementioned period. Among these scans, 894 (894/2443, 36.59%) demonstrated Port-A implantation in the PET/CT images. Complications including Port-A fracture (25/894, 2.80%) with/without dislodgment, infection (1/894, 0.11%), and mal-positioning (13/894, 1.45%) were found by either attenuation CT alone and/or PET/CT fusion imaging. Among 25 Port-A fracture cases, 8 fracture ends dislodged in inferior vena cava (2/25, 8%), right ventricle (4/25, 16%), pulmonary artery (1/25, 4%), right lung (1/25, 4%). Mal-position of Port-A were all to the ipsilateral jugular veins. Infection at the tip of Port-A demonstrated FDG uptake in mediastinal region, mimic lymphadenopathy. For all of the Port-A complications, only 15.38% (6/39) were accurately diagnosis on the FDG PET/CT report, including the 1 infection and 5 fracture cases.ConclusionMore than 1/3 of cancer patients for FDG PET/CT had Port-A implantation. Port-A complications could be found in 4.36% (39/894) of FDGPET/CT scan for cancer patients. When interpreting oncologic FDG PET/CT imaging, we often overlooked CT imaging. Careful inspection on PET/CT fusion images could help in early diagnosis of Port-A complications which can prevent subsequent lethal events.
P555 Effect of Patients Sex and Seasonal Outdoor temperatures on Incidence of Metabolically Active Brown Adipose Tissue (BAT) in Adults Underwent 18F FDG- PET/CT A. Bournazos, M. Skilakaki, I. Housianakou, E. Panagiotidis, J. Exarhos, P. Rondogianni, E. Vlontzou, C. Giannopoulou, I. Datseris; Nuclear Medicine1, Computerized Tomography2 and Radiology3 Departments “Evangelismos” General Hospital, Athens, GREECE. PURPOSE: It has been shown that increased ambient temperature and anxiolytic medication or sympathetic blockade may decrease uptake by BAT.The aim of this study is to evaluate if this effect is subject to seasonal variation in relation to patients sex.PATIENTS AND METHODS: 5408 consecutive patients, 2569 men (47.5%) and 2839 women (52.5%) referred to our Hospital for whole-body 18F FDGPET/CT, from 01/11/08 to 31/10/10, were included in this retrospective study. In 2442 patients (1172 men -48%- and 1270 women -52%- ) PET/CT was performed from November 2008 to April 2009 and from November 2009 to April 2010, when the median seasonal temperature was 12.6oC (cold period of the year in Athens). The rest 2966 patients (1397 men - 47.1%- and 1569 women -52.9%- ) underwent PET/CT between May and October 2009 and from May to October 2010, when the median outside temperature was 24.2oC (warm period of the year in Athens). All patients were given pre-medication known to reduce FDG uptake by BAT - oral diazepam or oral propranolol- and were kept in the PET injection room at a constant 25oC for 30min before and until 60min following 18F FDG administration.RESULTS: 18F FDG uptake by BAT occurred in 51 of 2442 patients (2.088%) underwent PET/CT from November to April (8 of 1172 men- 0.68%- and 43 of 1270 women -3.39% -) compared to 18 of 2996 patients (0.61%) underwent PET/CT from May to October (3 of 1397 men -0.21%- and 15 of 1569 women 0.96% -). The effect of difference in seasonal outdoor temperatures between the cold and warm period of the year on increasing 18F FDG uptake by BAT was statistically significant in the female population of our study (p<0.001). However, in men although the effect of lower temperatures on increasing FDG accumulation in BAT was evident, it was not statistically significant (p>0.10).CONCLUSION: Low outdoor temperatures is a factor to consider especially in female patients undergoing 18F FDG PET/CT studies, even after a warming preparation and anxiolytic premedication protocol.
P52 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Oncology Clinical Science: Pediatric
P556 Does 18F-FDG-PET/CT provide further information than conventional imaging in pediatric bone sarcoma ? N. Quartuccio1, P. Fania2, M. Pagano3, A. M. Postini3, S. Asaftei3, A. Linari4, G. Gino5, F. fa*gioli3, A. Cistaro2; 1Department of Radiological Sciences, Unit of Nuclear Medicine, University of Messina, Messina, ITALY, 2Positron Emission Tomography Centre I.R.M.E.T., Turin, ITALY, 3Dept. of Pediatric Oncohematology, Regina Margherita Children’s Hospital, Turin, ITALY, 4 Dept. of Anatomy-Pathology, Regina Margherita Children’s Hospital, Turin, Italy, Turin, ITALY, 5Oncological Orthopedic and Reconstructive Surgery Unite, C.T.O. Hospital, Turin, ITALY. Aim: PET/CT has been recognized as an important modality, providing complementary metabolic information in many oncological applications and successfully used in adult patients. Few studies have been performed in pediatric
Poster Presentations
Aim: PET/CT is increasingly used in RT planning for a better evaluation of target volume in malignant tumours, defining the metabolically active volumes. We are using PET/CT in radiotherapy planning for lung cancer, colon-rectal cancer, digestive tract cancer, head and neck cancers, and other malignancies. Aim of this study was to evaluate the impact on patient’s management of FDG PET/CT acquired for RT planning.Material and methods: We studied 156 patients (mean age 65±13 years). The distribution of the patients was as follows: 87 lung cancer, colon-rectal 22, gastro-enteric but colon-rectal 15, head and neck 18, other 14. PET/CT scans were performed as a diagnostic whole-body with an additional subset of dedicated images for the radiotherapy planning. It has been a specific choice to acquire whole body images with a diagnostic intent to re-stage diseases prior to RTplanning.All PET/CT scans were performed on a Siemens Biograph 6 LSO scanner. The patients fasted (8 hours) prior to the imaging and had blood glucose level below 200 mg/dl. An average of 370 MBq of FDG was administered 60 minutes before acquiring images. All patients underwent CT-simulation and FDG-PET/CT scan on the same day. Both procedures were performed with patients in the treatment position, with thermoplastic immobilization devices, which incorporated fiducial markers for image co-registration. Both exams were co-registered in order to compare the target volume obtained with each modality. PET scans were interpreted on the basis of visual analysis.All scans were interpreted by an experienced nuclear medicine physician who also delineate PET positive Gross Tumour Volume (GTV-PET) using a semi-automatic threshold system on a Siemens workstation. Data were transferred to the Varian dose planning system, where the final treatment plans were designed.Results and Conclusion: In 93 of 156 patients PET/CT and CT results were concordant. In 54 patients (34%), PET/CT upstaged the disease revealing unknown sites of malignancy that caused a change in treatment procedure: 41 patients were still eligible for RT (27 with curative aim and 14 with palliative intent); conversely, 13 patients underwent a different combined treatment, which included chemotherapy. In 9 patients PET/CT was negative and therefore it was not used for RT-planning. We conclude PET/CT played a main role toward a personalized treatment of patients, which goes beyond volume definition.
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S392 patients affected by osteosarcoma (OS) and Ewing’s sarcoma (ES). The purpose of this study is to evaluate benefit of PET/CT results in management of pediatric bone sarcoma patients.Materials and Methods: PET/CT results have been compared to histology, when available, conventional imaging (CI) and clinical follow-up. We performed a retrospective analysis, evaluating when PET/TC results modified clinical tools or supported medical decision suggested by CI.Results: Since March 2004 to September 2010, 57 patients affected by OS (31) and ES (26) underwent PET/CT. Median age at diagnosis was 12 years (range 6-18), median age at first PET/CT exam was 14 years (range 7-22). We performed 125 PET/CT exams (68 in OS, 57 in SE patients), as part of the imaging evaluation: 17/125 (13%) at the beginning of disease, 67/125 (54%) to evaluate the response to treatment or during follow-up, 41/125 (33%) in patients with suspect of relapse or progression. In 69/125 (55%) cases we found complete concordance between PET/CT and CI results; correct understaging in 26/125 (21%), wrong understaging in 11/125 (9%) and wrong overstaging in 19/125 (15%). In 18/125 (14%) cases, decision about therapy and/or follow-up were strongly conditioned from PET/CT results, in 60/125 (48%) PET/CT supplied a better metabolic characterization of disease or doubtful lesion, supporting clinical decision suggested by CI, in 47/125 (38%) therapeutic procedures were unmodified. Altogether we obtained: sensitivity 94%, specificity 100%, accuracy 96%, positive predictive value 100%; negative predictive value 90%. PET/CT appeared useful in evaluation of doubtful pulmonary nodules and to detect skeletal and lymph nodal metastatic lesions.Conclusion: Protocols of diagnosis and follow-up disease in pediatric oncology do not include traditionally PET/CT. In our experience PET/CT may be helpful in bone sarcoma in detection of metastatic lesions at the diagnosis and at time of relapse, overcoming some typical restrictions of CI. Besides, therapy monitoring and metabolic characterization of doubtful lesions are potentially clinical indications for PET/CT. The main things are integration with CI and work in a multidisciplinary team.Considerable aspects to evaluate are the interpretation of pulmonary lesions with diameter < 5 mm, correct time of carrying out, cost of PET/CT and patient’s irradiation. Therefore, prospective studies will clarify the role of PET/CT scan in this context.
P557 Correlation between functional, cognitive impairment and and buccality in patients affected by Traumatic Brain Injury: preliminary results of a single center prospective cohort 18FFDG-PET/CT study P. Fania1, N. Quartuccio2, S. Vesco3, A. L. Fogliato4, M. Alloero4, M. Cancelli4, C. Macchetta4, M. C. Valentini5, M. Beatrici4, A. Cistaro1; 1Positron Emission Tomography Centre I.R.M.E.T., Turin, ITALY, 2Department of Radiological Sciences, Unit of Nuclear Medicine, University of Messina, Messina, ITALY, 3Unit of Rehabilitation Salvatore Maugeri Foundation, Work and Rehabilitation Clinic IRCCS, Veruno, Novara, ITALY, 4Rehabilitation Unit, Department of rehabilitation CTO-Maria Adelaide Hospital of Turin, Turin, ITALY, 5Department of Neuroradiology, CTO Hospital, Turin, ITALY. Aim: Buccality is a new concept in logaoedics defined by Prof. Shindler. It indicates all that occurs in oral cavity and oro-pharynx. Impairment in some aspect of buccality is a common sequaele of Traumatic Brain Injury (TBI) and other brain injuries and can hardly affects recovery. In sub-acute state after brain injury, evaluation of ability in swallowing provides many information about level of consciousness and clinical evolution and outcome (Schindler A. et al. 2001).We performed a single center prospective cohort study, in order to analyze if there is a correlation between functional, cognitive impairment and disorders in some aspect of buccality and if that is supported by instrumental analysis ((18F) fluorodeoxyglucose positron emission tomography - FDG PET -).Materials and Methods: Twenty-three consecutive patients (16 with traumatic and 7 with not traumatic brain injury) recovered in the Unit of Neurorehabilitation from 1/03/2008 to 31/12/09 underwent clinical evaluation in which the commonly used predictors of functional outcome were examinated: age, presedation Glasgow Coma Scale (GCS), time to follow commands, length of Post-Traumatic Amnesia (PTA), Glasgow Outcome Scale (GOS), presence of major extracranial injury, instrumental index of severity, cognitive impairment (Levels of Cognitive Functioning Scale - LCF -), qualitative analysis of memory, qualitative analysis of attention , awareness, impairment in some aspect of buccality (oral sensibility, oral motility, presence of primitive oral reflexes, orofacial praxis, swallowing disorder classified by Dysphagia Outcome and Severity Scale - DOSS -, speech disorder.Patients were studied with 18F-FDG-PET/CT at 6 month from injury to qualitatively measure cerebral glucose metabolism in cerebral areas implicated in cognitive functioning and/or in buccality.Results: Our findings suggest that could exist a correlation between buccal disorders, commonly used predictors of functional outcome and cognitive impairment (LCF score, attention, vigilance, memory), and that seems to be supported by 18F-FDG-PET analysis. Particularly, anatomical or metabolical alteration in left cerebellum seem to be correlated to presence of primitive oral reflexes, LCF score at 6 months, DOSS score at 6 months, time to regression of primitive oral reflexes. Instead hypometabolism or anatomical alteration in lateral part of right somatosensory area seem to be correlated to LCF score at 6 months; DOSS score at 6 months; time to regression of primitive oral reflexes.Conclusion: Such findings may help to explain the variable nature of
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 buccality disorders after brain injury and to understand correlation between buccality disorders, functional and cognitive impairment in patient with brain injury.
P558 18F-FDG-PET/CT and Metabolic characterisation Of Lesions Suspected For Malignant disease In Paediatric Patients P. Fania1, N. Quartuccio2, E. Basso3, R. Laudati3, M. Bianchi3, M. Piglione3, S. Lijoi3, A. Linari4, F. fa*gioli3, A. Cistaro1; 1Positron Emission Tomography Centre I.R.M.E.T., Turin, ITALY, 2Department of Radiological Sciences, Unit of Nuclear Medicine, University of Messina, Messina, ITALY, 3OncoHematology Department, Regina Margherita Infant Hospital, Turin, ITALY, 4 Histopathology Departement, Infant Hospital Regina Margherita, Turin, ITALY. Aim: The value of PET/CT in paediatric patients has not yet been completely established. The most noticeable clinical benefit of combined PET/CT is the improvement of lesion localisation and the ability to apply the fused data set for planning of biopsy and/or local therapy such as surgery or radiotherapy. The purpose of this work is to asses the role of PET/CT in the metabolic characterisation of lesions of unknown origin, suspected for malignant disease, in paediatric patients.Materials and Methods: twelve patients (6 M, 6 F; median age: 12 years) with suspected diagnosis of malignant disease, underwent FDG-PET/CT at our institution. FDG-PET imaging was performed 60 min after i.v. injection of 18FDG using an hybrid FDG-PET/CT. FDG-PET were interpreted visually and semiquantitatively with maximal standardized uptake value (SUVmax) normalized for body mass. Guided-biopsy was performed, within 2 weeks of FDG-PET, in the pathological focus showing the higher SUVmax when a malignant disease was suspected on the basis of PET/CT exam. On the contrary, patients with negative PET/CT underwent only a clinical-radiological follow-up.Results: PET/CT was positive in 7/12 patients. The histological analysis on guided-biopsy performed on the site with higher metabolic activity has shown: 2 NHL following autoimmune lymphoproliferative syndrome caused by FAS mutation, 3 primitive NHL and 2 primitive HL. PET/CT was negative (low metabolically active lesions) in 5/12 patients: 1 eosinophilic granuloma, 2 lung aspergillosis, 1 spondilodiscitis, 1 lymphadenitis. In all “negative” patients clinical-radiological follow-up (at least 6 months after PET/CT) confirmed the absence of malignant disease.Conclusions: PET/CT is a useful tool in the metabolic characterisation of lesions of unknown origin, suspected for malignant disease in paediatric patients. It improves lesion localisation and it allows a guided-biopsy, identifying the more accessible and active sites, thus increasing diagnostic rate. It also allows to avoid biopsy in patients with a PET-CT negative for disease, with a high metabolical activity. The combination of structural and metabolic information improves the accuracy of diagnosis and has the potential to change management in a significant number of paediatric patients. It remains to be seen whether PET/CT can reduce the number of other studies that are requested for confirmation or exclusion of malignancy in the presence of equivocal findings.
P559 I-123 meta-iodo-benzyl-guanidine (MIBG) whole body scan in children with probable neuroblastoma. Our experience in subtraction technique and SPECT imaging V. G. Moschogiannis, M.Gavrilleli, M.Lyra; ‘Iatriki Apeikonisi’, Nuclear Medicine Laboratory, Athens, GREECE. The radioisotope I-123 conjugated with the meta-iodo-benzyl-guanidine (MIBG) carrier is a radiopharmaceutical for the detection, staging and follow-up on therapy of neuroblastomas.Aim: The aim of this study was to investigate the scintigraphy results of I-123 MIBG scan in young patients with probable neuroblastoma in our department and to evaluate subtraction technique and SPECT imaging as additional useful tools.Methods and materials: Last two years (2009-2010), 99 patients (52 male, 47 female, aged 1month to 8 years old underwent I-123-MIBG whole body scan in our department for neuroblastoma.I-123-MIBG is normally taken up by liver, spleen, myocardium and salivary glands. Thyroid uptake of liberated radioiodine may also occur and our procedure starts with the thyroid gland’s blockage by stable iodide.In 32 cases that underwent the examination first time in a pre-operable condition, a subtraction technique was applied. In this technique, a kidneys’ image using Tc-99m-DMSA is obtained and subsequently subtracted from the I-123-MIBG scintigram, achieving a better localization of the adrenal medulla as well as a more exact determination of adrenal uptake.In thirteen cases, SPECT scan was completed to distinguish the anatomical limits of the primary lesion, 24h after the tracer injection. In three cases, SPECT I-123-MIBG imaging revealed the location of the primary tumor under bladder’s activity that they were not visualized with I123-MIBG planar imaging. The feasibility of SPECT depends on the child and on the equipment available, but lesions in or close to the liver, as well as close to the bladder or any other area of intense physiological uptake, gives a particularly good indication to complete SPECT images.Results: 48 patients had positive scan with at least one focus of pathological uptake of the radiotracer. 6 of them (12,5%)
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P560 18
F-FDG PET-CT features of the spinal cord in children
S. Taralli, P. Castaldi, L. Leccisotti, M. V. Mattoli, V. Rufini, A. Giordano; Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, ITALY. 18
Aim: F-FDG uptake of the normal spinal cord is widely variable in children. The knowledge of the normal metabolic changes that occur in the spinal cord during development is essential to distinguish normal from pathological findings on PETCT in children. For this reason the aim of this study was to evaluate the metabolic activity of the normal spinal cord in children and to assess a correlation with age.Materials and methods: We retrospectively evaluated 134 patients (76 male and 58 female, mean age 14,2 ± 4 years; range 3,9-18,9 years) submitted to 18F-FDG PET-CT for staging (n=38), restaging (n=87), or follow-up (n=9) of neoplastic disease (Hodgkin lymphoma in 55 cases, non-Hodgkin lymphoma in 32 cases, sarcoma in 15 cases, neuroblastoma in 4 cases, head and neck carcinoma in 4 cases, germ cell tumors in 4 cases, melanoma in 4 cases, hepatocellular carcinoma in 3 cases, and other neoplastic diseases in 13 cases). Patients recently submitted to diagnostic or therapeutic procedures on the spinal cord and with tumors involving the spinal cord were excluded. 134 patients were classified into four groups according to age: 0-4 yrs (n=4), 5-9 yrs(n=18), 10-14 yrs (n=36) and 15-18 yrs (n=76). The spinal cord was divided into three levels (C1-C7; D1-D6; D7-L1) and evaluated using maximum standardized uptake value (SUVmax).Results: The median SUVmax values were 1.8, 1.4, and 1.8 in cervical, high thoracic and low thoracic levels, respectively. These differences were significant in the cervical and low thoracic tracts respect to the high thoracic level (p<0.001). When patients were classified into four groups according to age, the median SUVmax values resulted 1.1, 1.4, 1.6 and 2 in the cervical tract, 0.9, 1, 1.3 and 1.6 in the high thoracic tract and 1.1, 1.5, 1.5 and 2 in the low thoracic level, respectively. SUVmax significantly increased with age in all spine cord levels (p<0.005) except for the first group of age (0-4yrs), probably due to the small number of cases, and in the low thoracic tract between patients ranging 5-9 and 10-14 yrs.Conclusions: Our preliminary results showed that in children FDG uptake was highest in cervical and in low-thoracic tracts, where the brachial and lumbar nerve plexi originate. Moreover metabolic activity increased with age, probably due to the spinal cord plasticity and growth that occur during childhood development.
P53 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Conventional & Specialised NM: Endocrinology
P561 Changes of Tc-99m MIBI uptake in salivary glands of patients with Graves’ and Hashimato’s Diseases D. Söylemez, G. Gumuser, Y. Parlak, E. Sayit Bilgin; Celal Bayar University, Manisa, TURKEY. The changes of thyroidal Tc-99m MIBI uptake and wash out rate in patients with Graves’ disease has already been investigated. In this study, we aimed to investigate the changes in the uptake of Tc-99m MIBI in salivary glands of patients with Graves’ and Hashimato Diseases.Materials and methods: Nineteen patients with Graves’ disease (6 males, 13 females; mean age=34.47 ± 11.76 years) and 28 Hashimato’s disease patients ( 5 males, 23 females; mean age: 44.5 ± 10.94 years) and 11 euthyroid controls ( 4 males, 26 females; mean age: 49.6± 14.5 years) were investigated. None of the patients had complaint such as pain, xerostomia and lack of taste. Static images were obtained at 20, 60, 120 min after the injection of Tc99m MIBI. Images were acquired by using a dual headed gamma camera ( Infinia, GE, Tirat, Hacermel, Israel) with LEHR collimators on a 128x128 matrix. Uptake values of parotid and submandibular glands were calculated by drawing elliptical ROIs and using the formula for uptake calculationResults: No statistically significant difference was detected between the uptake values of parotid glands of three different groups (p >0.5).In Hashimato’s disease the uptake values of Tc-99m MIBI in submandibular glands were significantly higher than the normal control group at all three different times (p<0.5).In Graves’ disease the uptake values of Tc-99m MIBI in submandibular glands were statistically significantly higher than the normal control group at 20 min (p<0.5). Although no statistically significant difference was
detected at 60 min and 120 min , the uptake values of Tc-99m MIBI were higher than the normal control group.The uptake of Tc-99m MIBI in Graves’ and Hashimato diseases was not effected from TSH levels.Conclusion: We suggest that increased Tc-99m MIBI uptake in salivary glands is due to the histopathological findings of autoimmune diseases such as increased number of mitochondria and the inflammatory infiltrate. Our findings suggest that Tc-99m MIBI could be used in the early detection of autoimmune diseases that affect salivary glands.
P562 Tc-99m-MIBI parathyroid scintigraphy in hyperparathyroidism :Usefulness of SPECT/CT
secondary
I. Slim, A. MhiriI, I. Meddeb, D. Ben Sellem L. Zaabar, I. Yeddes, B. Letaief, M. F. Ben Slimene; Nuclear Medicine Department, Salah Azaiez Institute ; University El Manar II, Tunis, TUNISIA. Secondary hyperparathyroidism is a common problem in patients on hemodialysis for end-stage renal disease. Despite progress in parathyroid imaging, detection and correct localization of hyperfunctioning parathyroid glands remains a problem. Aim: The purpose of the present study was to evaluate the incrimental dignostic value of early single photon emission computed tomography with low dose CT study (SPECT-CT) in detection and localisation of abnormal parathyroid glands as compared with planar imaging alone. Patients and Methods: We evaluate 14 patients (7 M, 7 F, age 43,9±18 years) with biochemical diagnosis of secondary hyperparathyroidism. An optimized parathyroid scintigraphic protocol based on planar imaging with dual-phase, dual-tracer scintigraphy and an early SPECT-CT study was was performed on all patients (pre-operative localization in 6 cases and persistent or recurrent hyperparathyroidism in 8 cases). Scintigraphic imaging protocol included: thyroid exam with 50 MBq of pertechnetate and dual-phase parathyroid planar study (at 10 min and 150 min) post 99mTc-Sestamibi (740 MBq) injection. SPECT /low dose CT of the neck and chest was acquired with a Symbia T camera at early phase (30-40 min after Sestamibi injection). Results: Planar imaging identified hyperfunctioning parathyroid glands in 8 patients (57%), while SPECT/CT detected hyperfunctioning parathyroid glands in 10 patients (71%) with an evident improvement in diagnostic accuracy. In 2 cases ectopic glands was detected by planar imaging and SPECT/CT study provided more precise localisation (lateraljugular and low-lying inferior glands). In 2 more patients, SPECT/CT localised ectopic glands in the tracheoesophageal groove, while in planar imaging this parathyroid lesions seems to be in eutopic position. Discordant planar - SPECT/CT information was obtained in 4 patients (29%). Conlusion: According to our results, preoperative SPECT/CT enhances sensitivity for parathyroid detection over planar scintigraphy and also provides incremental anatomic information wich is useful in the preoperative assessment of patients with secondary hyperparathyroidism.
P563 Methods of Nuclear Medicine for Diagnostics and Prognosis of Mixed forms of Immunthyroiditis K. L. Zaplatnikov1, V. Y. Sukhov2, W. Wiedemann1; 1Clinic of Nuclear Medicine, Nurnberg, GERMANY, 2Military Medical Academy, St.Petersburg, RUSSIAN FEDERATION. Background: Among definite signs of Graves’ Thyroiditis (GT) there are goiter and increased thyroglobulin antibodies (TGAb) and thyroid peroxidase antibodies (TPOAb) levels. But not only positive TGAb and/or TPOAb have indicated GT. Recently method of human RIA for TSH-Receptor-Ab (TRAb) assessment was introduced in clinical practice.Purpose of this study was to investigate the relationship between thyroid Abs, especially TRAb, and Technetium-99m pertechnetat (Tc) accumulation for diagnostics, therapy planning and prognosis in patients with GT.Methods and Results: After introduction of second generation of human RIA for TSH-Receptor-Ab (TRAb) (Fa. Brahms) in routine assessment of HT in Group of patients (n=114) it was shown that 10% of them have a positive TRAb too (Range 1.5- 22.2 UI/l), with 8/11 pts. having typical hypothyroidism, 3/11 pts euthyroidism. All these pts. have goiter from 20-42 ml. with moderatly increased Tc-uptake: above 4,1%. During follow-up (6 to 12 mos) stabilization of function without TRAb increase was noted in 4 pts under LT4-substitute. All patients with this pathology were informed about danger of Iodine consumption and smoking. 4 pts under thyroxin therapy that initially had positive TRAb (50%) showed spontaneous shift of function towards Graves' hyperthyroidism and significant increase of Abs within 14-28 mos later. One patient developed endocrine ophtalmopathy. So, in patients with mixed immune thyroiditis positive TRAb is highly prognostic for possible recovery of the disease. With RIA control of TRAb we have sensitivity of 92% and specificity of 85% comparing to group of pts with similar symptoms that were assessed by immunfluorescent methods before introducing of RIA.Resume: We recommend to perform initial and control evaluation of all thyroid Abs, and especially TRAb, in patients with lymphocytic Goiter that have increased volume of the gland and high Tc99m uptake for prognosis of the development of Graves disease and choose adequate diagnostic algorithm and therapeutic strategy for these patients.
Poster Presentations
presented one focus in the thoracic area and 42 (87,5%) in the abdominal area. In 18 patients (37,5%) skeletal metastases had been detected, too. In 7 patients (14,6%) only skeletal metastases had been delineated, without any evident site of the primary tumour.Conclusion: Our technique in I-123-MIBG scans is a sensitive method of detecting, staging and response evaluation in neuroblastoma and is essential for evaluation of the efficacy of new therapy. It is a sensitive method of diagnosis, not only for the primary site of the neuroblastoma, but also for its skeletal metastases. In cases where uncertainty exists as to the exact location of lesion, subtraction technique and I-123-MIBG SPECT imaging offer further assistance
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P564 Efficiency of Echography and Scintigraphy 99mTc-MIBI for the Diagnosis of Parathyroid Adenoma in the Nuclear Medicine Department I. Rodriguez-Lizarbe, A. Gomez-Grande, J. Mucientes-Rasilla, B. Rodriguez-Alfonso, R. Suarez- Orozco, J. Chamorro-Romero; Hospital Universitario Puerta de Hierro de Majadahonda, Majadahonda, Madrid, SPAIN. AIMCervical echography is a non invasive and easy work technique that in association with 99mTc-MIBI Scintigraphy could contribute to improve the diagnostic performance of parathyroid pathology.The aim of this study is to analyze and compare the effectiveness of ecography and 99mTc-MIBI scintigraphy in the diagnostic of parathyroid pathology, versus the use of both techniques performed separately.MATERIAL AND METHODSWe retrospectively analyzed patients with high suspicious of primary hyperparathyroidism that have undergone parathyroid surgery between 2009 and 2010. All patients included were first submitted for an echography and scintigraphy study in our department. The results were analyzed for both techniques used together or separately, and they were compared to the histopathological and PTH Pre-surgery and post-surgery levels. A positive scintigraphy was considered when focal uptake was noted in the parathyroid glands area suggesting adenoma or hyperplasia and positive echography was that in which an hypoechogenic lesion was noted corresponding to an parathyroid gland.RESULTS53 patients who underwent parathyroid’s surgery were enrolled. 48 met the inclusion criteria. The number of positive findings were 89.6% in echography and 70.8% in scintigraphy. The parathyroid pathology was confirmed in all cases by hystopathology and by a decrease greater than 50% of PTH postsurgery levels. 27.9% of positives echography had a negative scintigraphy result, 50% of them showed unclear results for the early scintigraphy. 60% of the negative echography studies had a positive scintigraphy. Using both studies in combination, the diagnosis was positive for adenoma/hyperplasia in 95,8. Histological confirmation with total agreement was obtained in all of these cases. Only in one the imaging modality based diagnosis was negative, which was finally confirmed as adenoma after surgery.CONCLUSIONSThe use of echography and 99mTc-MIBI scintigraphy for the diagnosis of parathyroid adenoma/hyperplasia in the Nuclear Medicine department increase performance yield of both test, when compared with both separately.A positive scintigraphy finding in early phase study could help to confirm parathyroid pathology in association with echography, particularly in those cases with doubtful scintigraphy findings in late phase imaging.
P565 The Role of Serum Free Thyroxine to Free Triiodothyronine Ratio in the Diagnostics of Thyroid Dysfunction S. Gaberscek, J. Grmek, K. Zaletel, E. Pirnat, S. Hojker; University Medical Centre, Ljubljana, SLOVENIA. Aim. Only a few reports have demonstrated the role of either total or free triiodothyronine to thyroxine ratio in the diagnostics of thyroid disorders. The usefulness of the distinction between Graves' disease and painless thyroiditis has been postulated. Our aim was to evaluate the role of the serum free thyroxine to free triiodothyronine ratio (fT4/fT3) in the diagnostics of thyroid dysfunction.Methods. We included 878 consecutive subjects, examined under the suspicion of thyroid dysfunction, 723 females and 155 males aged between 15 and 97 years (mean 49.6±18.6 years), 52 with Graves' disease (GD), 33 with toxic adenomas (TA), 12 with disseminated autonomy (DA), 7 with iodine-induced hyperthyroidism (IIH), 11 with subacute thyroiditis (ST), 323 with euthyroid Hashimoto's thyroiditis (EuHT), 250 with hypothyroid Hashimoto's thyroiditis (HypoHT), 45 with hyperthyroid Hashimoto's thyroiditis (HyperHT) and 145 healthy subjects (HS). In all subjects, thyrotropin (TSH), free thyroxine (fT4), free triiodothyronine (fT3), thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and in hyperthyroid patients also TSH receptor antibodies (humanTRAK) were measured. We also calculated the fT4/fT3 ratio.Results. HS were significantly (p<0.05) younger (44.1±20 years) than patients with HypoHT (51.7±17.8 years), TA (67.4±13.4 years), DA (77.8±5.7 years) and HyperHT (53.6±21.3 years). TSH levels were lower in HS than in EuHT (P<0.001) and different in various types of hyperthyroidism (P<0.001). Levels of fT4 were higher in HS than in EuHT (P<0.001) and the highest in GD when compared with other types of hyperthyroidism such as TA, DA, ST, HyperHT (P<0.001, P=0.003, P=0.012, P<0.001, respectively), but not when compared with IIH (P=0.176). Similarly, levels of fT3 were higher in HS than in EuHT (P<0.001) and the highest in GD when compared with other types of hyperthyroidism such as TA, ST, HyperHT (P<0.001, P=0.003, P<0.001, respectively), but not when compared with IIH (P=0.062) or DA (P=0.814). fT4/fT3 ratio did not differ between HS and EuH (2.9±0.5 and 2.8±0.5, respectively, P=0.578). fT4/fT3 ratio was lower in HypoHT (2.5±0.7) than in EH (P<0.001). Even more, patients with TSH values above 20 mU/L had a lower fT4/fT3 ratio than patients with TSH values below 20 mU/L (2.1±1 and 2.6±0.5, respectively, P<0.001). In hyperthyroidism, fT4/fT3 ratio was significantly lower in GD (2.6±0.5) than in other types of hyperthyroidism such as TA, DA, IIH, ST and HyperHT (P=0.046,
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 P=0.012, P=0.028, P=0.009, P<0.001, respectively).Conclusions. Our results confirm the useful role of fT4/fT3 ratio in the diagnostics of thyroid dysfunction.
P566 Comparison of Planar Scintigraphy, SPECT/CT, US and MR Imaging Modalities for Preoperative Detection of the Patients with Hyperparathyroidism. I. Peksoy, A. E. Aslan, P. Arican, S. Guler, D. Berker; Ankara Numune Training and Research Hospital, Ankara, TURKEY. The aim: Hyperparathyroidism is a common endocrine disorder and the priority curative treatment is surgical removal of the pathological parathyroid gland(s). In recent years especially in primary hyperparathyroidism bilateral neck exploration , the approach of treatment, has been replaced by minimally invasive procedures, so the accurate localization of parathyroid pathology has become more important. The purpose of our study is compare the sensitivity, spesifity and diagnostic accuracy values of Planar, SPECT/CT imaging with Tc 99m MIBI, US and MRI.Materials and Methods: Between May 2010 and December 2010, 107 patient with the diagnosis of hyperparathyroidism who have taken parathyroid scintigraphy in our clinic are examined and thirty two patient who have been operated enrolled in the study. Ultrasound was done in 28 patient, MRI was done in 17 patient. After 20 minute injection of 20 mCi Tc 99m MIBI early planar imaging, after 180 minute planar and SPECT/CT imaging were obtained.Results: A total of 42 lesion was detected from 32 patient. Parathyroid pathology were found in 28 of 32 patients. Two patient have two lesion, another two patient have three lesion and one patient has four lesion. Pathology results: 22 parathyroid adenoma, 4 parathyroid hyperplasia, 1 parathyroid tissue, 2 nodular hyperplasia, 1 parathyroid neoplasm, 1 atypical parathyroid adenoma, 1 chronic thyroiditis. Parathyroid pathology could be localized in 25/32 (%75) patient with planar imaging, 29/32 (%91) patient with SPECT/CT, 20/28 (% 71.4) patient with US and 11/17 (% 64.7) patient with MRI. Sensitivity and spesifity were %82.1, % 50; %96.4, % 50;%79, %75; % 78.6, % 100; Planar imaging, SPECT/CT, US and MRI respectively. One patient couldn’t be localized with MRI and US who has parathyroid adenoma in the mediastinum.Conclusion: SPECT/CT imaging is adequate imaging modality for the preoperative detection of parathyroid pathologies by itself and guide to surgeon by anatomic localisation.
P567 Evidence of increased bone loss in males with Major Depression I. Kotsalou, P. Valsamaki, A. Chatzipetrou, G. Fountos, S. Gerali; Pammakaristos General Hospital, Nuclear Medicine Dept., Athens, GREECE. AIM:Hormonal changes, including declining sex steroid levels, probably contribute to age-related bone loss, as do impairments in osteoblast number and/or activity. Recently unipolar depression, which is 2 times more frequent in women than in men, has been linked to osteoporosis. Proposed triggering mechanisms of bone loss in depression involve concurrent activation of the hypothalamo-pituitaryadrenal and sympatho-adrenal axes, suppression of the gonadal and somatotrophic axes, as well as high inteleukin-6 and low leptin levels. This study investigated the incidence of bone mineral density (ΒΜD) loss in men with major depression.MATERIALS - METHODS:We retrospectively reviewed the bone mineral densitometry studies (ΒΜD, DEXA method) of 124 white men, performed in lumbar spine and femoral neck. Our male population had mean age ±SD 66±9years and mean body mass index (BMI)±SD: 30.2 ± 5.3 and was divided into two groups: Group A (n=56) including men with major depression and Group B (n= 68) consisting of healthy controls.RESULTS:The incidence of osteoporosis and osteopenia in depressive men (Group A) was 35% and 39.5% respectively, while corresponding percentages for Group B were 9.3% και 48%. Mean BMD was statistically significantly different (p=0.02) between the two groups (Group A: m1 = -1.72 and Group B: m2 = -1.06) with regression coefficient b: 0.665.CONCLUSIONS:In our study, depressive men exhibited statistically significantly lower BMD and higher incidence of osteoporosis compared to agecompatible healthy individuals. These findings support that underlying neurohormonal changes in major depression are associated with accelerated bone loss in this population, thus preventive BMD screening is suggested.
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Muscle uptake on I-Metaiodobenzylguanidine imaging for phaeochromocytoma. E. Shin, S. Lawes, V. Vinayakamoorthy; Nottingham University Hospitals NHS Trust, Nottingham, UNITED KINGDOM. Purpose: We noticed extensive muscle uptake on an I-123 metaiodobenzylguanidine (MIBG) study performed for the investigation of suspected phaeochromocytoma. There is a single case report in the literature describing muscle uptake following mirtazapine administration, a tetracyclic
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P569 Value of Thyroid Scintigraphy in Evaluation of Dual Phase Tc99m MIBI Parathyroid Scintigraphy K. Demirel1, G. Koca1, &. Yıldırım1, M. Korkmaz1, A. Baskın1, S. Kuru2; 1 Department of Nuclear Medicine, Ankara Research and Training Hospital, Ankara, TURKEY, 2Department of Surgery, Ankara Research and Training Hospital, Ankara, TURKEY. AIM: The aim of this study was to define the value of dual phase Tc-99m MIBI scintigraphy and the benefit of thyroid scintigraphy for the definition of the parathyroid lesions of patients with primary hyperparathyroidism in surgically proven cases.MATERIAL-METHODS: 46 patients (36 female, 10 male; mean age: 41.75±15,39 years, age range:11-83 years) with primary hyperparathyroidism were enrolled the study. Parathyroid scintigraphy and thyroid scintigraphy were performed in all patients. Parathyroid scintigraphy early phase images were acquired at 10-20 minutes, late phase images were acquired at 2-4 hours after i.v. injection of 370-740 MBq Tc-99m MIBI. SPECT images were added in 26 patients. Thyroid scintigraphy was performed 2-4 days later (at 15-20 minutes after injection of 185 MBq Tc-99m pertechnetate). Assessment was made only with parathyroid scintigraphy and later with addition of thyroid scintigraphy whether the parathyroid lesion was positive or negative. All the patients’ neck USG, parathormone levels and thyroid function tests were recorded. Parathyroid lesion assessment was made with histopathological results after surgery in all 46 patients.RESULTS: 29 of 46 patients had parathyroid adenoma, 2 had parathyroid hyperplasia. 3 patients had Hashimoto thyroiditis, 2 had papillary thyroid cancer, 1 had follicular adenoma. 24 patients had thyroid nodules. 14 of the parathyroid lesions were in the right-inferior, 10 were left-inferior, 3 were left middle-posterior, 2 were right middle-posterior, 1 was left-superior and 1 was ectopic thyroid near the cervical vertebral. For the assessment of the parathyroid lesions, parathyroid scintigraphy’s sensitivity was 80.6%, specificity was 60%, accuracy was 73.9%. When parathyroid scintigraphy is evaluated with thyroid scintigraphy sensitivity increased to 90.3%, specificity 86.7% and accuracy 89.1%. 4 of 6 false positive results that is determined by parathyroid scintigraphy, were true negative when evaluated with thyroid scintigraphy. 2 of these 4 patients were colloidal nodular thyroid, 1 was thyroiditis and 1 was thyroid follicular adenoma. Only one case was false negative evaluated with thyroid scintigraphy in case parathyroid scintigraphy was true positive. That case had coincidentally nodular goitre with parathyroid adenoma. 1 of the 2 parathyroid hyperplasia was detected by parathyroid scintigraphy. Glandular weight means of parathyroid lesions with histopathological reports was obtained 1636mg (minimum 109mg to maximum 11700mg). There was a statistically significant difference between the averages of the weight of adenomas (1753mg) and hyperplasias (645mg).CONCLUSION: In patients with primary hyperparathyroidism, dual phase Tc-99m MIBI parathyroid scintigraphy with thyroid scintigraphy is useful in case of detecting parathyroid lesions.
P570 Accidental discovery of lung metastases from Differentiated Thyroid Cancer by Tc-99m pertechnetate scan in a patient with secondary hyperparathyroidism. A. Campenni', R. M. Ruggeri, D. Santoro, G. Bellinghieri, C. Vigneri, M. Cucinotta, A. Sindoni, S. Baldari; Università di Messina, Messina, ITALY. Aim. We report on a 75-year-old man with a 4-years history of renal insufficiency treated by dialysis.Patient. Ten years before, patient underwent near-total thyroidectomy because of a large multinodular goiter causing compression and dislocation of the neck structures. Pathological examination was negative for Differentiated Thyroid Cancer (DTC) or un-Differentiated Thyroid Cancer (uDTC). In the last year serum levels of intact parathyroid hormone (iPTH) and phosphorus constantly increased while calcium was under normal range [533 pg/ml (normal value for the patients under dyalitic protocol 150-300); 6 mg/dl (4-5.5 mg/dl); 8 mg/dL (8.2-10.4 mg/dL), respectively]. No bone pain, abdominal symptoms or neurological abnormalities were noted.Results. Ultrasonography of neck region did not demonstrate parathyroid disease. Patient underwent 99mTc-pertechnetate scan of the neck/upper thorax regions obtained 20 minutes after administration of the tracer (magnification 1, matrix 256x256). Few days later, dual phase parathyroid scintigraphy with 99mTc-MethoxyIsobutylIsonitrile (MIBI) was performed by planar images of the neck/upper thorax regions obtained 10 and 120 minutes after tracer administration (magnification 1 and 2; matrix: 256x256 and 128x128 respectively; frame time: 10 minutes). 99mTc-pertechnetate and MIBI images were acquired by dual-headed gamma camera equipped with low-energy high-resolution parallelhole collimator (LEHRPAR).Abnormal uptake of both tracer were demonstrated in the lungs suspicious for metastatic lesions from DTC. Both tracers still showed unspecified uptake in the left jugular region. Computed Tomography (CT) confirmed the presence of multiple and bilateral lung lesions with variable sizes (up to 2 cm). The hTg level was consistent with metastatic disease (350 ng/ml, normal value <50) in absence of Ab Tg and with dosable level of TSH (3.5 mcUI/ml).Patient underwent radioiodine treatment (RIT) with therapeutic activity (3700 MBq) after rhTSH stimulation (by standard protocol: 0.9 mg/die for two consecutive days). Post-dose Whole Body scan (pWBS) showed multiple areas of abnormal radioiodine uptake in the lungs, consistent with metastases from DTC (already demonstrated by 99mTc-pert. and MIBI scans). Intense uptake of radioiodine still showed in the left jugular region. At the time of RIT peak leves of TSH and hTg were 170 mcUI/ml and 2000 ng/ml, respectively.Anti-thyroglobuline antibodies (Tg-Ab) were negative.Conclusion. In conclusion we report a rare case of lung metastasis from DTC detected in first time by 99mTc-pert. abnormal uptake. According to literature data, we suppose that 99mTc-pert. uptake in the metastasis from DTC depend to hyperexpression of sodium iodide symporter (NIS) in the surface of functioning metastatic cells.
P571 Atypical presentation of parathyroid carcinoma (PC): report of two cases. A. Sindoni, R. M. Ruggeri, S. Castorina, G. Tuccari, E. Calbo, L. Calbo, S. Benvenga, A. Campennì, S. Baldari; University of Messina, Messina, ITALY. Aim- PC is a rare endocrine malignancy accounting for about 1% of patients with primary hyperparathyroidism (PHP). In the cases reported in literature, the tumor size ranges from 1 to 12 cm, with a mean of 3.1 cm; associated kidney, bone, gastrointestinal and psychiatrics symptoms are much more frequent than in parathyroid adenomas, due to the markedly increased calcemia (up to 24 mg/dL).We report two cases observed in our Hospital.Material and Methods - The first patient was a 62-year-old woman with a two-year history of asthenia, hypertension and mental disorders. Serum levels of intact parathyroid hormone (iPTH) and calcium were 104.7 pg/mL (normal range: 12.0-72.0 pg/mL) and 10.21 mg/dL (8.2-10.4 mg/dL), respectively. No bone pain, abdominal symptoms or renal abnormalities were noted. Dual phase parathyroid scintigraphy with 99mTcMethoxyIsobutylIsonitrile (MIBI) was performed. Planar images of the neck and thoracic regions (magnification 1 and 2; matrix 256x256 and 128x128, respectively) were acquired 10 and 120 minutes after tracer administration (370 MBq) using a dual-headed gamma-camera equipped with low-energy high-resolution parallelhole collimator (LEHRPAR). A focal area of abnormal tracer uptake was appreciated next to the lower pole of the right thyroid lobe. Thyroid scintigraphy (99mTcpertechnetate) performed few days later did not show areas of increased uptake of the tracer in the gland. Minimally invasive radio-surgery was performed; the resected node measured 35 mm. Histopathological examination permitted a diagnosis of PC. Serum iPTH and calcium decreased postoperatively (28.4 pg/mL and 8.6 mg/dL).The second patient was a 54-year-old woman who underwent total thyroidectomy two years earlier. Biochemical follow-up disclosed hypercalcemia and hypercalciuria (10.7 mg/dL and 540 mg/24 h), which prompted iPTH assay (320 pg/mL). No bone pain, abdominal symptoms or renal lithiasis were noted. A 21-mm hypoechoic nodule with indistinct margins was detected by echography in a position equivalent to the lower right thyroid lobe. Dual-phase 99mTc-MIBI parathyroid scintigraphy demonstrated an abnormal tracer uptake in the same
Poster Presentations
antidepressant, in a patient being investigated for phaeochromocytoma1. Following further cases at our Institute, which also demonstrated this unusual appearance, we attempted to establish a causal relationship.Methods: We reviewed all I-123 MIBG studies performed at our Institute over a 6 month period from 9th September 2010 to 5th April 2011. The indication for the study, age and gender of the patient, renal function, catecholamine and chromgranin A levels and patient medication were recorded. Body mass index data was not available for correlation. Each study was evaluated by 3 reviewers to determine if there was significant muscle uptake.Results: 23 I-123 MIBG studies were performed during the study period. 15 were men, 8 were women. Of the 23 patients, 16 were adults. Ages ranged from 1 to 74 years.3 cases demonstrated muscle uptake and were in adult patients being investigated for suspected phaeochromocytoma. Pictorial examples of the muscle uptake are included.The cases of suspected phaeochromocytoma were further evaluated to try and identify a causal relationship. Of these 10 cases, 8 were men and 2 were women, ages ranging from 25 to 70 years. 7 had elevated urinary noradrenaline levels ranging from 475 to 827nmol/24hours (normal range 0430nmol/24hours). One patient was anuric and therefore had plasma sampling which demonstrated an elevated normetadrenaline. One patient had an elevated urinary dopamine level. In the cases with muscle uptake urinary noradrenaline varied from 497 to 776 nmol/24hours whilst in the negative cases it ranged from 475-827 nmol/24hours. Chromagranin A was elevated in patients with muscle uptake but was also seen in a patient with no significant muscle uptake. Estimated glomerular filtration rate ranged from 5 to >90 ml/min/1.73m2 (normal >90 ml/min/1.73m2). There were no common medications.Conclusions: I-123 MIBG uptake in muscle was demonstrated in 3 male patients being investigated for suspected phaeochromocytomas. However muscle uptake did not significantly correlate with age, renal function, catecholamine or chromagranin A levels or medication. Of note, none of the patients with muscular uptake were taking mirtazapine.Reference:1. Goel SR, Ponzo F, and Friedman KP. Tetracyclic antidepressant causing altered biodistribution of MIBG. Radiology case reports. 2009; 4(3):1-3. DOI: 10.2484/rcr.2009.v4i3.306
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S396 position. After minimally invasive surgery and histopathological examination, a diagnosis of PC was made. Serum iPTH and calcium dropped postoperatively (<5 pg/mL and 8.4 mg/dL). No recurrent disease was observed 24 months after surgery in both patients.Conclusion- Diagnosis of PC is difficult pre-operatively, particularly in asymptomatic patients (as in our cases). 99mTc-MIBI scintigraphy is a fast, effective and non invasive technique for preoperative localizing hyper-functioning parathyroid tissue accurately. Minimally invasive parathyroidectomy ensures a good outlook at least in the short term.
P572 Normal and Ectopic Lacalized Parathyroid Adenomas: Is There No Difference in Scintigraphic Parameters? U. Korkmaz, A. Sarıkaya; trakya university medical faculty department of nuclear medicine, edirne, TURKEY. Hyperparathyroidism is a common endocrine disorder of general population and characterized by excessive secretion of parathyroid hormone by parathyroid glands. Treatment of asymptomatic patients is medical but symptomatic patients needs early surgical treatment. Unilateral neck exploration is becoming most popular surgical method. Radionuclide scintigraphy has proved to be a reasonably accurate method for locating parathyroid adenoma or hyperplasia. Dual phase Tc99m sestamibi imaging is main nuclear medicine method at present day. Normal localization of parathyroid glands is the side posterior of thyroid gland. However, sometimes placed different localization. Different factors such as gland weight, oxyphil cell content and P-glycoprotein expression effect sestamibi uptake of parathyroid adenomas. The aim of this study was to evaluate the difference of scintigraphic and biochemical parameters between ectopic and normal localized adenomas and to evaluate correlation of these parameters (early parathyroid/thyroid ratio, late parathyroid/thyroid ratio, early/late ratio, retention index, serum intact parthormone, calcium and phosphorus values ).The patients were divided into two groups according to adenoma location (14 Male, 45 Female; mean age 53 yr). Group 1 consisted of 28 patients with ectopic location, and group 2 consisted of 37 patients with normal location.Statistically significant differences were not seen between retention index, early parathyroid/thyroid ratio, late parathyroid/thyroid ratio and early/late ratio for both groups (17.88±17.51, 1.10±0.45±0.4, 0.86±0.12 for ectopic group; 20.29±24.94, 1.16±0.22, 1.33±0.35, 0.85±0.11 for normal location group). Otherwise, for both ectopic and normal location groups, there was significant difference between the early parathyroid/thyroid ratio and late parathyroid/thyroid ratio. Scintigraphic parameteres of normal location group did not correlate with serum calcium, phosphorus and parathyroid hormone values. However, in the ectopic locatin group, there was significant positive correlation between retention index and serum calcium and phosphorus values. Besides, there was a significant adverse correlation between early parathyroid/thyroid ratio and calcium values, as well as between early/late ratio and serum calcium and phosphorus values.The results of our study show that the optimal imaging times after intravenous injection of sestamibi are 15 min and 2 hour for both groups. The fact of a relation between calcium, phosphorus and sestamibi retention in ectopic location group suggests that calcium and phosphorus levels should be considered prior to sestamibi imaging.Key words: Ectopic parathyroid adenoma, scintigraphy, Tc99m sestamibi
P54 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Conventional & Specialised NM: Thyroid
P573 Diagnostic value of 99mTc-MIBI scintigraphy in combination with ultrasound guided aspiration biopsy (USGAB) for diagnosis of thyroid cancer in patients with hypofunctioning solitary thyroid nodules (HSTN). S. V. Kanaev1, S. N. Novikov1, D. N. Djalilov2, E. V. Kostromina1, L. A. Jukova1, V. M. Moiseenko2; 1N.N. Petrov Inst. Oncol., St. Petersburg, RUSSIAN FEDERATION, 2Postgraduated Medical Academy, St. Petersburg, RUSSIAN FEDERATION. The purpose: to evaluate diagnostic accuracy of 99mTc-MIBI scintigraphy alone and in combination with USGAP in patients with HSTN.Materials & Methods: study group consisted of 136 patients with HSTN diagnosed on the 99mTc-pertechnetate scans. In 73 cases final diagnosis was verified by operation, in 63 - by follow up.Planar thyroid imaging in anterior, semi-lateral and lateral projections was performed 15-30 and 120 min after intravenous injection of 370-540 MBq 99mTcsestaMIBI. All acquisitions were done with low-energy, high-resolution, parallelhole collimators and zoom-2. Images with focal and scattered patchy uptake of 99mTc-MIBI were scored as abnormal and suspicious for thyroid malignancy. All patients underwent USGAB directly from HSTN.Results: On the first stage we evaluate diagnostic results in the group of 73 operated patients who had histological verification of thyroid disease. Scintigraphy with 99mTc-MIBI
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 demonstrated abnormal accumulation of tracer in HSTN in 61 cases: 55 true positive, 6 - false positive. In 12 patients 99mTc-MIBI uptake was normal: 8-true negative, 4- false negative Sensitivity (Sen), Specificity (Sp) and Accuracy (Ac) of scintigraphy with 99mTc-MIBI were as follows 93%, 57% and 80%.USGAB was false negative in 5 cases: 3 of these 5 patients had abnormality on 99mTc-MIBI scintigraphy and all 5 had malignant tumor on histology. USGAB was false positive in another 2 cases. Finally, Sen, Sp and Ac of USGAB were 91%, 85% and 90%. The most interesting results were obtained by combination of 99mTc-MIBI scintigraphy and USGAB with excellent Sen-97%, low Sp- 50% and moderate Ac-88%.Taking into account significant prevalence of cases with malignant tumors in the group of operated patients we recalculate Sp of all methods for the whole group of 136 patients with HSTN: 63 of them were not operated but had normal results of 99mTc-MIBI scintigraphy and USGAB on diagnosis and during at least 12 months follow-up. For scintigraphy, USGAB and their combination Sp values were as follows: 92%, 97% and 92%Conclusion: 1. Scintigraphy with 99mTc-MIBI has high Sen (93%) for malignancy with low Sp (57%) in operated patients and high Sp (92%) in the whole group. 2. Combination of 99mTc-MIBI scintigraphy and USGAB offered highest Sen (97%) in diagnosis of thyroid cancer in patients with HSTN.
P574 Impact of untreated hyperthyroidism on bone mineral density T. A. Balci, Z. P. Koc; Firat University Medical Faculty, Department of Nuclear Medicine, Elazig, TURKEY. Aim: Hyperthyroidism is one of the common reasons of osteoporosis. We classified hyperthyroidism patients according to their etiology and compared these groups in terms of bone mineral density (BMD) loss.Materials and Methods: Thirthy patients with hyperthyroidism (5 M, 25 F; 19-72, mean age: 44,43 ±16,68 years) were included into the study. Antithyroid medications were stopped 3-5 days before the thyroid scintigraphy. Dual X-ray absorbtiometry examinations were performed to all patients at the same day with thyroid scintigraphy. Patients were grouped as Graves patients and toxic multinoduler guatr (TMNG) patients according to their laboratory and ultrasonography results. Bone densitometry results of these 2 groups were compared. Among Graves and TMNG patients both 6 patients had osteopenia and 3 had osteoporosis. Totally 12 hyperthyroidism patients (66.6%) had osteopenia and 6 patients (33.3%) had osteoporosis.Conclusion: In this study we demonstrated that 60% of hyperthyroid patients had osteoporosis or osteopenia. The risk of both Graves and TMNG patients were same. Since hyperthyroidism patients are usually in young and middle age groups it is important to perform BMD measurement at the time of diagnosis.
P575 Concurrent Thyroid Scintigraphy and I-131 Whole Body Scintigraphy Findings in Differantiated Thyroid Carcinoma T. A. Balci, Z. P. Koc; Firat University Medical Faculty, Department of Nuclear Medicine, Elazig, TURKEY. Aim: The most important follow-up method for differentiated thyroid carcinoma patients is I-131 whole body scintigraphy (WBS). We retrospectively compared WBS with concurrent Tc-99m pertechnetate thyroid scintigraphy (TS) findings of these patients.Materials and Methods: Thirty six patients (26 F, 10 M; 19-67, mean age: 45±10.81 years) with diagnosis of differentiated thyroid carcinoma were included into the study. Their thyroid hormone replacement medications were stopped and iodine free diet was applied 3 weeks prior to the WBS. Iodine-131 WBS of 36 patients and concurrent TS of 12 patients were evaluated.Results: Pathological diagnoses of patients were: papillary (n=29), follicular (n=3), medullar (n=3) and follicular variant of papillary carcinoma (n=1). The thyrotropin stimulating hormone (TSH) levels prior to the WBS were 31-143mlU/L and thyroglobulin (TG) levels were 0.2-102 ng/mL. Results of 9 out of 12 patients that were evaluated both with WBS and TS were in agreement. One patient had one more focus of residue tissue at WBS which was not seen on TS and 2 patients had residue tissue on WBS but there was no activity on their TS. Additionally 6 patients out of 36 patients had extrathyroidal involvement on WBS.Conclusion: WBS is found to be superior to TS in showing residue tissue which is in agreement with prior studies. Additionally in terms of opportunity to scan whole body; WBS is the most sensitive and accurate method in follow-up of differentiated thyroid cancer patients.
P576 Follicular Thyroid Carcinoma in a Patient with Graves’ disease. I. Meddeb, A. Mhiri, I. Slim, I. Elbez, W. El Ajmi, I. Yeddes, L. Zaabar, M. Ghezaiel, F. Ben Slimene; Nuclear Medicine Department. Salah AZAIEZ Institute. University El Manar II, TUNIS, TUNISIA. Introduction: Thyroid carcinoma incidentally found in patient subjected to surgery for hyperthyroidism is not uncommon and it is almost always papillary cancer when it occurs. Follicular cancer has a very low incidence in Graves’ disease when compared to papillary thyroid cancer. Some studies have not reported any follicular
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P577 What can cause Reduced 99Tc(m)sestamibi uptake on thyroid? M. Ben Fredj, A. Bernard, H. Bahri, E. Garin; department of nuclear medicine, CRLCC EUGENE MARQUIS, FRANCE. Introduction: Diffusely reduced 99Tc(m)-pertechnetate uptake is a relatively infrequent but annoying finding that impairs evaluation of the thyroid gland. This finding is more annoying if associated with reduced 99Tc(m)sestamibi uptake. The aim of this poster is to discuss the causes of this findings.Patient and method: A 66year-old woman was referred to the nuclear medicine unit because of suspicion of Hyperparathyroidism. Her medical history was made essentially by chronic thyroiditis and suppression therapy with T4.Result:Thyroid scintigraphy with 99mTcO4 was performed by means of a computerized camera equipped with a pinhole collimator 10 min after i.v. injection of 110 MBq 99mTcO4 with anterior projection. The scintigraphic aspect was completely absent uptake of the radiopharmaceutical in thyroid and parathyroid parenchyma.Thyroid 99m Tc-MIBI scintigraphy was performed by means of the same camera used for 99mTcO4 scintigraphy after i.v. injection of 185 MBq of MIBI. Images were acquired on early and delayed times. The scintigraphic aspect was identical to Thyroid scintigraphy with 99mTcO4.conclusion: Even reduced 99Tc(m)-pertechnetate uptake is a relatively infrequent , this aspect can easily associated in this case to suppression therapy with T4. What is it of the reduced uptake of 99m Tc-sestaMIBI?99mTcsestaMIBI is a well-known lipophilic monovalent cation that shows an increased uptake in epithelial cells containing high numbers of mitochondria. For this reason, increased retention of MIBI is currently employed to detect hyperfunctioning parathyroid tissue and may be observed in benign or malignant thyroid tumours, and this phenomenon is believed to be the consequence of increased mitochondria number in hypermetabolic cells. On the other hand, MIBI accumulation is reduced or absent in apoptotic or necrotic processes involving mitochondrial membrane potential collapseas observed in thyroiditis.
P578 Is there an advantage of SPECT/CT over planar subtraction parathyroid imaging? Z. Jurasinovic, H. Tomic-Brzac, R. Petrovic, I. Bracic, G. Horvatic-Herceg, S. Tezak; Clinical Hospital Zagreb, Zagreb, CROATIA. In order to compare SPECT/CT with planar subtraction parathyroid scintigraphy, we analyzed data from 78 patients with either primary or secondary hyperparathyroidism in whom parathyroid adenomas were proven with ultrasound examination (US) and fine needle aspiration biopsy (FNAB). They were all sent to parathyroid scintigraphy prior to surgical parathyroidectomy in order to exclude possible ectopic glands.SPECT/CT imaging with Tc-99m MIBI of head, neck and thoracic region was performed in 39 patients (group 1, 29 female, 10 male, age span 27-89, median age 60). In the rest of 39 patients (group 2, 32 female, 7 male, age span 24-81, median age 59) planar imaging of head, neck and thorax using the same Tc-99m MIBI and Tc-99m pertechnetate was done. Neck images were acquired using pinhole collimator, while head, neck and thoracic regions were scanned using large field of view gamma-camera mounted with all-purpose lowenergy parallel hole collimator.In 39 patients from group one 52 enlarged parathyroid glands were detected with US and FNAB while SPECT/CT with Tc-99m
MIBI detected 35 of them (sensitivity 67,3%). In group two out of 53 enlarged parathyroid glands that were visible on ultrasound examination and proven with FNAB, 41 were visualized with planar subtraction scintigraphy (sensitivity 77,3%). Using χ2 test we found no statistically significant difference between SPECT/CT and planar subtraction imaging modalities (p=0,30601) regarding their sensitivities.We concluded that the advantage of the SPECT/CT lies only in the ease of use, since it is much less time-consuming and it requires only one administration of the radiopharmaceutical. Furthermore, the use of CT enables more precise localization of the lesions detected.
P579 Value of Tc-99m-MIBI scintigraphy for choosing between waitand-see and surgical strategies in hypofunctioning thyroid nodules when FNAB is unfeasible or not representative G. Linzberger1, E. Dworak-Gammauf1, S. Potolzky1, M. Hold2, A. Nader3, M. Rodrigues1; 1Institute of Nuclear Medicine, Hanusch-Hospital, Vienna, AUSTRIA, 2Department of Surgery, Hanusch-Hospital, Vienna, AUSTRIA, 3 Institute of Pathology and Microbiology, Hanusch-Hospital, Vienna, AUSTRIA. Tc-99m-methoxyisobutylisonitrile (MIBI) was primarily introduced for perfusion myocardial imaging but was also found to accumulate in the thyroid cells depending on the number of mitochondria and the potential of plasma and mitochondria membranes.Aim:To evaluate prospectively the value of Tc-99m-MIBI scintigraphy for the clinical decision between conservative and surgical strategies in patients with hypofunctioning, cold thyroid nodules when fine-needle aspiration biopsy (FNAB) is unfeasible or not representative.Material and Methods:Eighteen patients (12f, 6m; 43-74 a) with a solitary hypofunctional thyroid nodule on Tc-99m pertechnetate scintigraphy and unfeasible FNAB (13 patients) or inconclusive cytologic results (5 patients) were prospectively investigated.Thyroid scintigraphy was performed at 30 min after 185 MBq Tc-99m-MIBI i.v. injection. Planar images were done, imaging time was 7-10 min. Tc-99m-MIBI scintigraphy was considered positive if there was a clear tracer retention in the area of the cold nodule found on the Tc-99m pertechnetate scintigraphy which was performed at least 3 days before. The scintigraphic images were rated visually by two experienced observers. Thyroid nodules were evaluated sonographically and histologically on each patient.Results:Histopathological diagnoses revealed degenerative changes in the goiter in 8 patients, thyroid adenomas in 7 patients, and papillary thyroid carcinoma, subacute thyroiditis de Quervain and nodular hyperplasia in 1 patient each.Tc-99m-MIBI scintigraphy was positive in 9 patients and negative in the other 9 patients. Positive Tc-99m-MIBI scintigraphy was found in all the 7 patients with thyroid adenomas, in the patient with thyroid carcinoma and in the patient with subacute thyroiditis de Quervain. Negative Tc-99m-MIBI scintigraphy was seen in all the patients with degenerative goiter changes and in the patient with nodular hyperplasia.Conclusions:These results confirm that Tc-99m-MIBI scintigraphy performed at 30 minutes p.i. is useful for choosing between wait-and-see and surgical strategies in patients with hypofunctioning thyroid nodules when FNAB is unfeasible or not representative. However, Tc-99m-MIBI scintigraphy cannot differentiate between benign and malignant hypofunctional thyroid nodules.
P580 Lacrimal DUCT Obstruction after High Dose Radioiodine Treatment Ö. Ömür, A. Akgün, Z. Özcan; Ege University Medical Faculty, Department of Nuclear Medicine, İzmir, TURKEY. AIM: Although the long-term side effects of high-dose radioiodine (RAI) therapy are well known on salivary glands, side effects concerning lacrimal glands are less documented. In this report, two cases of papillary thyroid carcinoma presented with ocular symptoms following RAI treatment were presented.CASES:Case 1: 33year-old female patient with a story of thyroidectomy due to tall cell variant of papillary carcinoma was treated with 100 mCi RAI for remnant ablation. In the second year of treatment, the patient defined redness and tearing in both eyes. The routine follow-up I-131 scan at that time showed bilateral focal radioiodine accumulation in medial aspects of the orbital rims especially on the left. The patient was evaluated by an ophthalmologist and bilateral nasolacrimal duct obstruction was detected. She underwent bilateral dacryocystorinostomy with placement of a silicone tube. Ocular complaints of the patient were completely resolved after the operation.Case 2: 55-year-old female patient with papillary carcinoma classic type and lymph node metastasis received 200 mCi RAI therapy three times with an interval of 1.5 years. After the last treatment burning, stinging and tearing symptoms appeared in both eyes. The post-therapeutic I-131 scan showed increased I-131 accumulation in both ocular regions. The ophthalmologic investigation revealed bilateral stenosis of the lacrimal ducts and surgery was recommended.CONCLUSION: The long-term effects of radioiodine therapy on lacrimal glands are presumed to be very rare. However, there are reports documenting up to 4-5% incidence of ocular side effects. While little experience has been reported, this lacrimal dysfunction might be related to RAI accumulation
Poster Presentations
cancer in patients with Graves’ disease. We describe a rare occurrence of follicular cancer in a patient with Graves’ disease. Case report: A 37 year-old female patient presented to our institute with symptoms of thyrotoxicosis. She had no family history of thyroid cancer or of radiation exposure in the neck area. She presented with typical clinical and biochemical features of Graves’ disease. Tc-99m scintigraphy of the thyroid showed diffusely increased uptake with hypofunctioning (cold) nodule. She underwent uneventful surgery after achieving a euthyroid state with carbimazole. Intraoperative findings were enlarged thyroid lobes, a solid nodule measuring 1.2 x 1.0 cm in the lower pole of the right lobe and an enlarged right lymph node. A total thyroidectomy was performed. The enlarged lymph node was resected. A follicular thyroid carcinoma was diagnosed on the cold nodule and the lymph node showed metastatic deposits of follicular carcinoma. Six weeks after surgery, the patient was given an ablative dose of I131. Planar 131I scintigraphy followed by SPECT -low dose CT of the neck and chest were performed to correlate functional and anatomical images, with a Symbia T camera with high energy collimators revealing a significant residual thyroid remnant in the neck. The TSHstimulated serum Tg level measured by radioimmunoassay was 13ng/ml. Being sensitive to iodine, patient will continue to receive I-131cures to complete remission. Conclusion: Thyroid cancer has been reported to be found in 2% - 7% of surgically treated hyperthyroid patients. Follicular cancer is much less common than papillary cancer in Graves’ disease patients. Our case emphasizes the importance of careful search for malignancy in nodules associated to Graves' disease. Follicular thyroid cancer as well as papillary cancer should be kept in mind and total thyroidectomy after achieving an euthyroid state, should be the treatment of choice for Graves' disease with nodules.
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in choroids plexus. It seems to develop on the late term rather than early after RAI treatment and may be identified as increased RAI accumulation on orbital regions. Prospective studies are hopefully will investigate the prevalence of lacrimal gland dysfunction and define possible protective measures that can be taken to reduce these adverse effects.
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P581 Normal Thyrotropin Pregnant Women
and the course of dysthyroid orbitopathy. Controversial questions arise such as why euthyroid patients at times develop orbitopathy and patients with Graves’s disease sometimes do not. Answers to this question should be given in further investigations.
adn
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T. Bogovic Crncic1, D. Kustic1, T. Stimac1, I. Kristofic2, K. Cosic2, O. Kmet Planinac3, I. Mrakovcic Sutic4, A. Smokvina1, S. Grbac Ivankovic1; 1Clinical Hospital Centre Rijeka, RIJEKA, CROATIA, 2Community Health Centre of Rijeka, RIJEKA, CROATIA, 3General Hospital Pula, PULA, CROATIA, 4 Medical Faculty University of Rijeka, RIJEKA, CROATIA. The aim of our study was to investigate serum thyrotropin (TSH) and free thyroid hormone levels in healthy pregnant women and to compare the results with hormones' concentrations in non pregnant controls. The thyroid auto-antibody titres in both groups were also determined.Materials and methods: The study included 66 women in the first half of pregnancy and 44 in the second half. The TSH, free thyroxine (FT4) and free triiodothyronine (FT3) levels in serum were measured, as well as auto-antibody titres against thyroid peroxidase (TPOAb) and thyroglobulin (TgAb). The control group consisted of 43 healthy, non pregnant women in reproductive age. The laboratory methods used were radioimmunoassay (RIA) and chemiluminescent method (ILMA).Results: The TSH values of healthy pregnant women were within normal reference range and the mean TSH level for the whole pregnancy was 2,24 mIU/L, in comparison to 1,95 mIU/L in non pregnant contols. The difference was statistically significant (p<0,05). However, the mean TSH level in the first half of pregnancy was 2,09 mIU/L, while in the second half it was significantly higher, 2,45 mIU/L (p<0,05). The FT4 and FT3 levels in pregnancy were within normal range. However, the mean FT4 value was significantly lower in both halves of pregnancy compared to controls (p<0.05, p<0.05). Twelve out of 66 (18%), and 8 out of 44 (16 %) pregnant women had positive thyroid auto-antibodies in the first and in the second half of pregnancy, respectively. The mean TSH level in these women was 2,4 mIU/L, which was significantly higher compared to the mean TSH level of non pregnant controls. Approximately 9 % of non pregnant women had positive antibody titresConclusion: Our preliminary results showed that the TSH values in normal pregnancy, although within the normal reference range, were higher while FT4 levels were lower in comparison to non pregnant women. The obtained results should be considered when thyroid function tests are evaluated in pregnancy.
P582 Hyperthyreosis and Eye Disease - Dysthyroid Orbitopathy A. Valković Mika, A. Valković, I. Valković Antić, S. Grbac Ivanković; Clinical Hospital Center Rijeka, Rijeka, CROATIA. Introduction: Dysthyroid orbitopathy is an autoimmune disorder usually associated with Graves' disease involving the thyroid gland and the orbit. Even though it is a common disease involving almost 85% of hyperthyroid patients, dysthyroid orbitopathy is still of great ophthalmological concern. Ophtalmopathy can be clinically diagnosed by the clinical picture, however, timely detection and therapy introduction is invaluable. The commencement of therapy is the basic precondition of socioeconomic rehabilitation and a long-term content and “healthy” patient.The main goal of this study was to establish whether determining the Thyroid Stimulating Hormone (TSH) receptor antibodies could help monitor dysthyroid orbitopathy.Materials and Methods: Forty patients with diffuse goiter, autoimmune hyperthyreosis and eye disease symptoms were investigated, 32 (80%) women and 8 (20%) men. Their age was between 35 and 65 years, and their mean age was 52.56±1.28 years. After clinical examination in all patients we determined the hormonal status, the microsomal antibody (TPO-Ab) concentration, TSH receptor antibodies (TRAb), performed a 99mTc- pertechnetate scintigraphy, an ultrasound and ophthalmology assessment.Results: In all patients the concentration of serum thyroid hormones was above normal and thyroid scintigraphy presented a hom*ogenous concentration of radiopharmaceuticals. Echographically the parenchyma presented as an inconsistently distributed echo, of lower amplitudes than the normal thyroid tissue in 35 (87%) of patients. In 5 (12%) the results were normal. In all patients the TPO-Ab levels were above normal. After effective thyreostatic therapy in patients with autoimmune hyperthyreosis the TPO-Ab levels were still above normal levels, while TRAb levels were within normal levels as an indicator of achieved remission. Symptoms of dysthyroid orbitopathy were not in regression in 6 (15%) patients (4 men and 2 women) in whom remission was not attained, and TRAb levels continued to be elevated with a developing ophthalmopathy. In these patients appropriate ophthalmological treatment was applied. Pulse therapy was applied in 4 patients, radiotherapy in one, and one patient underwent surgery.Conclusion: The obtained results indicate the value of TRAb assay in autoimmune hyperthyreosis with orbitopathy because of its simplicity and reliability in the evaluation of the achieved disease remission
Value of Oblique views in nodular thyroid disease M. A. Ghanem1, A. H. Elgazzar2; 1Department of Nuclear Medicine, Mubarak Al Kabeer Hospital, Jabriya, KUWAIT, 2Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Jabriya, KUWAIT. Introduction and background: thyroid gland scintigraphy through its functional images is considered an important diagnostic tool in the evaluation of the thyroid gland. Thyroid imaging can help in the assessment of neck masses and thyroid malignancy. This scan can be performed with several types of radiopharmaceuticals, depending on which can be taken orally or intravenously. The images of the thyroid gland are conventionally acquired by a gamma camera equipped with a pinhole collimator and 5 mm in diameter aperture. The routine image views of the thyroid gland are anterior and oblique. However, it has been noted that there has been a trend in many Nuclear Medicine departments to acquire anterior views only.Aim: the purpose of this retrospective study is to assess the importance of oblique views and their impact on the diagnosis of thyroid nodular disease. Materials and Methods: we reviewed 100 consecutive cases with the diagnosis of nodular disease using our data base. Two physicians read the scans based only on anterior projection and another time after adding oblique views.Result: there were a total of 144 nodules found. Thirty nodules (21%) were not seen on the anterior view alone. Among 8 nodules seen within the isthmus, 6 were totally unrecognized in the anterior view.Conclusion: oblique views are a must in the interpretation of thyroid scintigraphy. Acquiring only anterior view can lead to missing 21% of nodules. Following proper techniques with oblique views will reduce the chance of missing nodules that may contain cancer.
P584 Follicular variant of papillary thyroid carcinoma presenting as a toxic nodule in an adolescent girl. A. Campenni', R. M. Ruggeri, G. Saraceno, D. Carlotta, S. Giovinazzo, R. Nania, V. Gangemi, M. Cucinotta, S. Baldari; Università di Messina, Messina, ITALY. AIM. Discovery of a “hot” nodule is usually comforting due to the presumption that the nodule represents a benign toxic adenoma. Here, we present an adolescent with a hot nodule turned out to be a papillary cancer.PATIENT. A 15-year-old girl was referred to our Endocrine Unit, complaining of a painless mass in the right side of the neck that had appeared a few months earlier. Her family history was significant for benign nodular goiter (mother). RESULTS. Thyroid US showed a 25mm hypoechoic, non-hom*ogenous nodule in the right lobe. Serum TSH was 0.26 mU/L (n.v. 0.27-4.2), with normal values of FT3 and FT4.131I thyroid scintigraphy was consistent with an autonomous thyroid nodule. Six months later, the girl returned complaining of fatigue, weight loss and palpitations of 1-month duration. Physical examination revealed warm, moist skin; tremors of the extremities; hyperreflexia. The patient’s weight was 42.5 kg. Her pulse rate was 94 /min. At endocrine evaluation, TSH was 0.001 mU/L, and FT3 (7.68 pml/L; n.v. 3.0-6.7) and FT4 (26 pml/L; n.v. 12.0-22.0) were elevated. Thyroid US revealed an increase in the size of the nodule, that measured 35x30x21mm and displayed an abnormal intranodular blood flow. Treatment with MMI (20mg/day) was started, with normalization of FT3 and FT4 values. Subsequently, the patient underwent near-total thyroidectomy. Pathological examination revealed a papillary carcinoma, follicular variant. The excised nodule was examined for activating mutations of TSH receptor and Gαs genes by direct sequencing. No mutations were detected. Nevertheless, two combined non-functioning mutations were detected. The first mutation is a known single nucleotide polymorphism (SNP), in the transmembrane region of the TSHR gene, at codon 187 (AAC→AAT, both encoding asparagines). The second mutation is within exon 8 of Gsα gene, at codon 185, (ATC→ATT, both encoding isoleucine). Search for mutations in BRAF gene was negative.Few months later, patient underwent: Radioiodine thyroid uptake measurement (RTU=3%) after oral administration of 131I (1.85 MBq) and 131I ablation therapy (1850 MBq) (at this time: TSH: 45 mIU/L and Tg <1.6 ng/ml). 131I post-dose WBS did not reveal areas of radioiodine uptake outside the thyroid bed. At one year-follow-up, the patient is on levo-thyroxine therapy, with TSH values <0.2 mIU/ml and both basal and rhTSHstimulated serum Tg <1.6 ng/mL, and neck US is negative.CONCLUSION. This case demonstrated that the presence of hyperfunctioning thyroid nodule(s) does not preclude malignancy and warrants careful evaluation, especially in children and adolescents.
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Diffuse hyperactive thyroid gland with hypoactive nodules: Marine-Lenhart syndrome E. Ceylan Gunay, A. Erdogan; Mersin University, Faculty of Medicine, Department of Nuclear Medicine, Mersin, TURKEY. Aim: Autonomously functioning nodules in Graves’ disease is known as MarineLenhart syndrome. We report 7 cases of Marine-Lenhart syndrome to take attention to the malignancy potential of this rare entity.Subjects and Methods: Seven patients with Graves’ disease with autonomic nodules detected by Tc-99m pertechnetate thyroid scintigraphy have been evaluated. Corresponding nodules were also confirmed by thyroid ultrasonography. Patients' cytological and histopathological findings were analyzed for clarifying the malignancy potential of these nodules. Median age of the patients was 42 ranged between 29 and 59.Results: Cytological evaluations in 3 of the 7 patients were benign, and nondiagnostic in one. Three of the patients underwent surgery regarding to the suspicious fine needle aspiration biopsy findings. Histopathological diagnosis was papillary carcinoma in two cases, where as follicular adenoma was reported in one patient.Conclusion: Nuclear medicine physicians should be vigilant in cases presenting with autonomous nodules in Graves’ disease for possible malignancy risk.
P55 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Conventional & Specialised NM: Pulmonology
P586 The Introduction of SPECT VQ - Our Experience in the First Year J. Speakman, J. Birchall, I. Jones; Royal Derby Hospital, Derby, UNITED KINGDOM. The combined use of ventilation and perfusion scintigraphy (VQ) is well established in the diagnosis of pulmonary embolism (PE). Traditionally, planar imaging has been employed; however, recent EANM guidelines (Bajc, et al., 2009) advocate the use of SPECT. An audit was conducted to assess the introduction of SPECT VQ into routine clinical practice in our department, both in terms of its effect on departmental throughput and the compliance with our clinical protocol; whilst also identifying opportunities for improvement.A prospective study of sixty six consecutive patients was performed using a data collection form. Firstly, the proportion of patients able to complete a SPECT VQ study was assessed against an audit standard of 95%. The second part of the audit assessed the proportion of patients for which a satisfactory study was completed on a single visit to the department against a standard of 80%.86% of patients were able to complete a SPECT VQ study whilst 94% of patients completed a “satisfactory” study in a single visit, compared to an estimated figure of 64% prior to the change in practice. Problems with the ventilation procedure and the infirmity of the patients were the main contributory factors in failing to meet the first standard.The results confirm SPECT VQ has already proven to be a useful adjunct to our service, facilitating a significant increase in departmental throughput. Despite not achieving the audit standard in terms of the proportion of patients able to complete a SPECT VQ study, this is an encouraging result after only twelve months of the new protocol. Further analysis of the results and plans to improve departmental practice will be presented.Bajc, M., Neilly, J.B., Miniati, M., Schuemichen, C., Meignan, M., Jonson, B., 2009. EANM guidelines for ventilation/perfusion scintigraphy. European Journal of Nuclear Medicine and Molecular Imaging, 36, p.1356-1370.
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perfusion scintigraphy (planar AP,PA and SPECT/CT) after administration of 185 MBq 99mTc-microalbumin and postoperative spirometry (FEV1post). Prediction of postoperative FEV1 values was based on calculation of percentage of remaining lung tissue after surgery. Values of FEV1 predicted with three methods (FEV1APPA, FEV1SPECT/CT and FEV1seg) were compared with actual values obtained after surgery (FEV1post).Results: Mean values of FEV1pre and FEV1post were 2,28 l (sd 0.71 ) and 1.74 l (sd 0.51 ), respectively. Mean FEV1 values predicted with 3 methods were: 1.73 (sd 0.64) for FEV1APPA, 1.68 (sd 0.59 ) for FEV1SPECT/CT and 1.55 (sd 0.59) for FEV1seg.Both radionuclide methods accurately predicted FEV1post values (r appa = 0.932 ; r SPECT/CT = 0.933, no systematic differences between predicted and actual values), whereas results of non-imaging method, although very highly correlated with post-operative values (rseg = 0.911), were systematically lower (mean difference 0.27 l, p = 0.00035).Conclusion: Both radionuclide methods, planar and SPECT/CT, accurately predict postoperative FEV1 values, better than non-imaging method. No advantage of SPECT/CT over planar method could be revealed at this stage of the study.
P588 18F-FDG PET/CT clinical impact in patients with diagnostic challenging tuberculosis in a non-endemic country V. Ambrosini1, G. Rorato2, M. Zompatori3, C. Nanni1, P. Caroli1, V. Allegri1, D. Rubello4, S. Nicolini1, L. Zanoni1, P. Viale2, S. Fanti1; 1Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, S.Orsola-Malpighi University Hospital, Bologna, ITALY, 2Infectious Diseases, Azienda OspedalieroUniversitaria di Bologna, S.Orsola-Malpighi University Hospital, Bologna, ITALY, 3Radiology, Azienda Ospedaliero-Universitaria di Bologna, S.OrsolaMalpighi University Hospital, Bologna, ITALY, 4Nuclear Medicine,S. Maria della Misericordia Hospital, Rovigo, ITALY. Aim: to evaluate the clinical impact of 18F-FDG in patients with diagnostic challenging tuberculosis (TB) in a non-endemic country.Materials and methods: Inclusion criteria were: 1) aspecific symptoms for TB without microbiological/pathological confirmation (not performed/negative/equivocal at the time of PET scanning) with epidemiological, blood tests criteria for TB suspicion, 2) symptoms suggestive for TB, with negative microbiology and pathology at the time of PET), 3) Follow-up evaluation of known TB.An extensive clinical evaluation, PET/CT imaging and clinical follow-up were performed in all cases, while conventional imaging (CI: CT/MRI) was available in 9 cases. Referring clinicians were contacted after PET/CT imaging to assess weather PET findings altered the patients clinical management.Results: Overall, 7 patients were included and 13 PET/CT scans were evaluated. On a scan basis, indications to perform PET/CT included the assessment of disease activity (5/13), response to the on-going treatment (6/13) and pre-therapy imaging (2/13). TB diagnosis was confirmed by culture in 4pts (8/13 scans), while in 1pt (2 scans) was excluded (arthrosis) and 2 pt (3 scans) are still under evaluation.PET showed an increased glucose uptake in 13/13 scans (mean SUVmax was 8.67, range 1.4-18). The clinical management was changed after 10/13 PET/CT scans: initiation of TB empiric therapy in the absence of positive cultural examination at the time of PET scanning (3), variation of treatment regimen (1), confirmation of initial response to treatment (3), suspicion of concomitant benign disorder (arthrosis, 2) or malignancy (lymphoma, 1). The clinical management was unchanged after 3 PET/CT scans: baseline evaluation before starting therapy in pts with active disease documented by culture at the time of PET scanning (2) and equivocal pattern of tracer uptake suggestive for lymphoma in accordance with CI findings (1).Conclusions: PET/CT was useful for the assessment of patients with diagnostic challenging TB, resulting in a change in clinical management after 10/13 scans; in particular PET resulted helpful to assess disease activity and to early evaluate the efficacy of on-going treatment.
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Accuracy of radionuclide methods predicting postoperative residual lung function
Differential Regional Lung (DRL) Perfusion Analysis of the Lung Scan as an Adjunct Interpretation Parameter for Pulmonary Embolism
K. Kovačević-Kuśmierek1, J. Kozak2, M. Bieńkiewicz1, A. Płachcińska1, J. Kuśmierek3; 1Department of Quality Control and Radiological Protection , Medical University, Łódź, POLAND, 2Ward of Thoracic surgery and Respiratory Rehabilitation, Medical University, Łódź, POLAND, 3Department of Nuclear Medicine , Medical University, Łódź, POLAND.
L. Ali1, I. Loutfi2, Y. Al-Sayed3, S. Burezq4; 1Faculty of Allied Health Sciences, Kuwait University, KUWAIT, 2Faculty of medicine, Kuwait University, KUWAIT, 3Department of Nuclear Medicine, Chest hospital, Ministry of Health, KUWAIT, 4Hammed Al-Issa Transplant Center, Ministry of Health, KUWAIT.
Background: In patients prepared for lung resection postoperative forced expiratory volume in 1s (FEV1) should be estimated in order to minimize postoperative morbidity and mortality. This value defines functional operability in patients undergoing lung resection. Postoperative FEV1 can be estimated with quantitative lung perfusion scintigraphy set together with spirometry.The aim of the study was to assess accuracy of radionuclide methods (planar and SPECT/CT) predicting postoperative functional lung capacity in comparison with non-imaging method based on percentage of residual lung segments after surgery.Material and methods: Thirty five patients (24 males and 11 females) prepared for lung surgery (lobectomy or pneumonectomy) because of diagnosed non small cell lung cancer were studied. All patients underwent: preoperative spirometry (FEV1pre),
Pulmonary embolism (PE) causes blockage of branches of the pulmonary artery by clots, manifested as defects on the standard lung perfusion scan. Another effect on the pulmonary circulation, which has not been well studied, is the diversion of blood and the blood-borne radiolabeled particles injected for the lung scan, from the blocked areas to the adjacent territories, supplied by patent branches of the pulmonary artery. Hence, a pattern of increased uptake would be seen in those areas on the lung perfusion scan that would show normal uptake if no such diversion exists. The aim of this study is to evaluate a semiquantitative analysis method, namely, differential regional lung uptake (DRLU) of Tc-99m MAA lung perfusion scan to check for areas of increased uptake as a parameter that shows this phenomenon, and that could help as an adjunct in the diagnosis of PE.
Poster Presentations
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S400 Material & methods: The posterior view of the standard lung perfusion scan was divided into 6 segmental regions of interest (ROI) for each lung. The differential regional lung uptake was calculated as the ratio of the deviation from the average count in a selected segmental ROI to the average count in two adjacent segmental ROIs and was calculated for 30 of each category of V/Q scans reported: normal, low, intermediate and high probability for PE, using the PIOPED criteria. The DRLU of 10 intermediate scans were compared with spiral CT findings. Results: Significantly higher DRLU with an average involvement of 8.3 ± 2.1 lung segments per study were found in high probability scans compared to normal (p<0.001). An average involvement of 2.8 ± 0.9 and 5.4 ± 1.2 lung segments per study was found in low and intermediate probability categories respectively. In intermediate scans, higher number of segments with an increase of DRL similar to high probability was found to have positive spiral lung CT, whereas lower values similar to low probability had negative CT. Conclusion: Cutoff values for the ratio in each region were defined using the data from normal and high probability scans. These values could be used as basis for comparison in cases with intermediate or low probability scans for PE to provide a more objective confirmation of the pathophysiological phenomenon of regional blood flow diversion and its potential usefulness as adjunct in the diagnosis of PE.
P590 Tracheal Bronchus Diagnosed by Tc-99m DTPA Ventilation Scintigraphy T. A. Balci1, A. E. Balci2, Z. P. Koc1; 1Firat University Medical Faculty, Department of Nuclear Medicine, Elazig, TURKEY, 2Firat University Medical Faculty, Department of Thoracic Surgery, Elazig, TURKEY. INTRODUCTION: Pulmonary ventilation and perfusion scintigraphy is usually an important part of diagnosis of pulmonary embolism. In addition, there are some other indications of these techniques. We wanted to present a patient who have suspicion of bronchial stump leakage at postoperative period and diagnosed with ventilation scintigraphy.CASE: A hilar mass lesion of right lung was shown on thoracic CT of 65 years old male patient who had shortness of breath and weight loss history. His bronchoscopic biopsy was concordant with pulmonary epidermoid carcinoma. He underwent a right lobectomy. After one week of operation his status became worse. Tc-99m DTPA ventilation scintigraphy was performed with suspicion of bronchial stump leakage. Radioactivity accumulation in right hemithorax was visualized on scintigraphy. Air leak was verified on reoperation but surprisingly because of a small tracheal bronchus not from bronchial stump.CONCLUSION: Lung scintigraphy can be used for some reasons beyond pulmonary embolism and it gives specific information about the feature of lung pathology. Ventilation scintigraphy have to be remembered and used for those situations such as pneumothorax due to air leak or bronchopleural fistula. It is an easy, simple, repeatable, convenient and also confident technique.
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Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 showed perfusion defects. In the PISAPED evaluation, three of these patients were accepted as “PE compatible abnormal scintigraphy” while eight “PE incompatible abnormal scintigraphy” and six were accepted as normal. Sensitivity, specificity and accuracy were respectively found as 91%, 76% and 86% in the PPS, while 100%, 82%, and 94% in the SPECT study, respectively. High compatibility was determined between MDCTA and SPECT perfusion.Conclusions: In patients with PE suspicion, SPECT study compared to the PPS was founded as more successful to reveal lesion numbers and defect size. SPECT and CT images instead of planar scintigraphy and lung graphy increased the diagnostic accuracy of the test in the PISAPED classification.
P592 Usefulness of 3D lung scintigraphy for embolism A. M. Maffione, G. P. Di Santo, L. Scarpa, T. Spitale, F. Dore; Nuclear Medicine Unit, Trieste, ITALY. AIM: planar images are currently the standard technique of acquisition for the diagnosis of pulmonary embolism (PE) in most nuclear medicine centres even if recent studies have shown a greater sensitivity and specificity of single photon emission computed tomography (SPECT). The aim of this study was the diagnostic comparison between planar and SPECT lung scintigraphy. Concordance with multislice CT pulmonary angiography (CTPA) reports was also evaluated.MATERIALS & METHODS: in this retrospective study, 150 patients suspected for pulmonary embolism, underwent planar and SPECT lung scintigraphy. Eighty-two patients underwent diagnostic CTPA within 7 days before scintigraphy. PISAPED criteria were applied by two expert nuclear physicians to review all cases. The reference diagnosis made by respiratory physicians was considered as gold standard. All reports were divided into five groups: massive (ME), sub-massive (SME), sub segmental (SSE), micro embolism (MiE) and negative for embolism (NegE).RESULTS: discordance between planar and SPECT scintigraphy was observed in 28 patients (4 of ME, 3 of SME, 9 of SSE, 10 of MiE and 2 of NegE cases). Additionally segment defects were observed by SPECT that provided better definition of shape, dimension, localization and better evaluation of paramediastinal defects rather than with planar images. The observed percentage of agreement between SPECT and CTPA for the diagnosis of PE was 68/82 (83%), in good agreement with the literature data. Anatomical versus functional discordance was observed in 14 patients: 3 cases of ME, 1 of SME, 7 of SSE, 2 of MiE and 1 of NegE (most of them were patients affected by other pulmonary or systemic concomitant disease).CONCLUSIONS: the higher accuracy of SPECT compared with planar images is evident both for initial diagnosis and for the therapeutic follow-up management, having superior diagnostic performance. Furthermore, in our study, SPECT demonstrated to have greater sensitivity than CTPA without any contrastrelated limitation and involving significantly less radiation dose to breast tissue, particularly significant in women. In our opinion, there is no reason to persevere in the acquisition of planar images in the lung scintigraphy for PE.
Evaluation of Planar and Tomographic Lung Perfusion Images According to PISAPED Criteria in Suspected Pulmonary Embolism Patients
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K. K. Terkuran, M. Sahin, S. U. Semirgin, Z. Şahin, O. Yapici, T. Basoglu; 19 Mayıs University, Faculty of Medicine, Department of Nuclear Medicine, Samsun, TURKEY.
V. Vinayakamoorthy, E. Shin, C. Jacobs, K. Blackband, S. Lawes, M. Blaze, C. Kalirai; Nottingham University Hospitals NHS Trust, Nottingham, UNITED KINGDOM.
Aim: The objective of this study is to compare the images of planar perfusion scintigraphy (PPS) with the images of single photon emission computed tomography (SPECT) perfusion and, to research its importance on PE diagnosis when assessed according to the prospective investigative study of acute PE diagnosis (PISAPED) criteria.Patients and Methods: Study group included 53 patients (18 males, 35 females; mean age±sd: 58,6±16) prediagnosed with median and high probability. “PE positive” was accepted in the patients with positive multidetector CT angiography (MDCTA). The patients without PE compatible filling defect and those suspected/nondiagnostic results without any supporting laboratory and clinical findings were accepted as “PE negative”. Perfusion studies were performed with Tc-99m MAA. Planar and SPECT/CT images were taken with a SPECT/CT system. Perfusion images were classified according to PISAPED. The compability between imaging methods was determined with the calculation of k value.Results: In the PPS, 140 subsegmental and 67 segmental defects were determined. In the SPECT study, 158 subsegmental and 146 segmental defects were determined. In “PE positive” group, 36 patients presented perfusion defects in the PPS. Thirty-three of these patients were accepted as “PE compatible abnormal scintigraphy” according to PISAPED evaluation, while three were accepted as “PE incompatible abnormal scintigraphy”. SPECT images also showed perfusion defects in all patients of this group. All patients were accepted as “PE compatible abnormal scintigraphy” according to PISAPED. In “PE negative” group (n=17), 13 patients presented perfusion defects in planar images. Four of these patients were accepted as “PE compatible abnormal scintigraphy” according to PISAPED evaluation, while nine were accepted as “PE incompatible abnormal scintigraphy” and four were accepted as normal. In SPECT study, 11 patients
Purpose: We have seen an increasing move from planar ventilation/perfusion scintigraphy (V/Q) to computed tomography pulmonary angiography (CTPA) at our Institute, for the investigation of suspected pulmonary emboli (PE). The greater availability of CTPA and the apparently more definitive report has provided greater clinician confidence in its utility. However the European Association of Nuclear Medicine (EANM) guidelines for ventilation/perfusion scintigraphy1,2 published in 2009 advocates a greater role for V/Q SPECT imaging and a more holistic approach to reporting. We are therefore expanding our service to include V/Q SPECT imaging using Krypton-81m as a ventilation agent. In addition, we hope that by adopting the more holistic EANM reporting criteria for V/Q SPECT imaging, that we will provide a greater number of diagnostic and clinically useful results thus increasing clinician confidence and referral numbers.Methods: We discuss the issues that occurred during the development of the service including areas that required further training; the impact on imaging times; problems that arose and the ways that they were overcome. We plan to audit our practice both before and after the service is established, to compare the diagnostic rates of V/Q SPECT with planar V/Q imaging at our Institute and, to evaluate the impact on our referral numbers.Discussion: V/Q SPECT has a greater diagnostic accuracy than V/Q planar imaging for the evaluation of suspected PE3. In combination with the EANM reporting guidelines for ventilation/perfusion scintigraphy we hope to demonstrate an increase in diagnostic utility, clinician confidence and referrals for V/Q SPECT imaging.References:1. Bajc M, Neilly JB, Miniati M, Schuemichen C, Meignan M, Jonson B. EANM guidelines for ventilation/perfusion scintigraphy : Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. Eur J Nucl Med Mol Imaging. Aug 2009;36(8):1356-1370.2. Bajc M, Neilly JB, Miniati
Developing a Nottingham.
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Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P594 Relationship Between Helicobacter Pylori Infection and Pulmonary Obstruction Severty in Obstructive Pulmonary Disease G. Koca1, S. Gultekin2, G. Bilgin3, K. Demirel1, A. Baskin1, M. Korkmaz1; 1 Department of Nuclear Medicine, Ankara Training and Research Hospital, Ankara, TURKEY, 2Department of Nuclear Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, TURKEY, 3Department of Thorasic Disease, Ankara Training and Research Hospital, Ankara, TURKEY. Aim: The purpose of this study was to evaluate the relationship between the presence of helicobacter pylori (Hp) infection and obstruction severity in patients with chronic obstructive pulmonary disease.Material and Methods: A C14-urea breath test and pulmonary function test was performed in 117 consecutive patients (87 female, 30 male; mean age; 46,5±15,2 yrs). The patients were configured into four stages by GOLD spirometric criteria, according to the degree of obstruction in forced vital capacity (FVC) and forced expiratory volume in one second (FEV1).Results: The C14-urea breath test was positive (>50 dpm, mean±SD;199,6±87,1) in 76/117 (65%) patients and negative (<50 dpm; mean±SD;7,8±6,1) in 41/117 (35%) patients. Distribution according to the stages of these patients as follows: there were 24/76 positive and 11/41 negative in stage 1, 23/76 positive and 8/41 negative in stage 2, 10/76 positive and 5/41 negative in stage 3, 19/76 positive and 17/ 41 negative in stage 4. There was no statistically significant difference (p>0,05) between stages for distribution of Hp positive patient. There was no statistically significant difference (p>0,05) among Hp negative and positive group of the patients for FEV1/FVC median values (80,5 (min.-max.; 55,0-98,2) in the positive group and 81,3 (min.-max.; 54,0-98,4) in the negative group).Conclusion: In patients with chronic obstructive pulmonary disease, severity of the pulmonary obstruction did not found associated with presence of concomitant Hp infection in our series.
P595 The value of SPECT-CT in the calculation of post-operative FEV1 value: Preliminary results M. Tuncel1, P. O. Kıratlı2; 1Hacettepe University, ankara, TURKEY, 2 Hacettepe University, Ankara, TURKEY. Aim: Planar lung perfusion scintigraphy is the most commonly used method for calculation of forced expiratory volume in one second (FEV1) after lung surgery.In this study we aimed to investigate the contribution of SPECT-CT to planar imaging in a group of patients who were schedulded for lobectomy or pneumonectomy due to malign or benign diseases.Materials and Methods: Twelve patients who were schedulded for lung surgery due to primary/metastatic lung cancer and benign reasons (8/3 and 1 patient respectively) (F/M: 8 /4, average age: 58 ± 21 years) underwent planar lung perfusion scintigraphy and SPECT-CT to estimate FEV1 after lung surgery. Five minutes after injection of 2 mCi (200.00 particles) Tc-99m MAA, planar anterior and posterior images were obtained in a 256x256 matrix, with a dual-headed, gamma camera equipped with parallel-hole, high-resolution collimator (GE INFINIA USA) . SPECT-CT images were obtained from both lungs with a dual-head gamma camera equipped with a low-power X-ray system (Millenium, VG&Hawkeye™; GE Medical Systems, Milwaukee, WI). SPECT acquisition was performed with high-resolution low-energy collimators, with matrix size of 128x 128, 3° angle steps and 15 seconds per frame. Transmission CT data were acquired over 360° during 14 seconds for each transaxial slice with a thickness of 5 mm. The percentage of the lung that will remain after surgery was calculated by zone method, which used anterior and posterior images divided into 6 parts, lob mapping method, according to anatomical lobar shape using planar images and SPECT-CT method by using 3D perfusion and anatomical data .Results: The average contribution of right lung and left lung perfusion to total lung perfusion according to planar methods vs. SPECT-CT were 54.5 ± 19% vs. 55.5 ± 21% and: 45.5 ± 19% vs. 43.5 ± 21% respectively (p> 0.05). The FEV1 after planned surgery (pneumonectomy: 4, lobectomy: 7 and bilobectomy: 1) calculated with zone, lobe mapping and SPECT-CT methods were 1.52 ± 0.32, 1.51± 0.3 and 1.53 ± 0.3 liters respectively (p> 0.05). In two patients SPECT-CT showed completely collapsed aperfused lobe after surgery which estimated no change in the FEV1 after surgery.Conclusion: SPECT-CT did not provide significant advantage over planar perfusion lung scintigraphy in the calculation of FEV1 after lung surgery. Our findings should be verifed in more patients with different surgery types.
P596 Pulmonary Embolism Imaging in Pregnancy - A 3year retrospective Review N. Butt, J. Coffey, J. C. Hill; Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, UNITED KINGDOM. OBJECTIVE: To evaluate imaging for suspected Pulmonary Embolism (PE) in pregnancy. MATERIALS AND METHODS: A retrospective review of imaging performed in pregnancy for suspected PE. RESULTS: Over 3-years, 105 pregnant patients with suspected PE were imaged according to BTS guidelines (Thorax 2003; 58: 470-484). 106 CXR and low dose radionuclide lung perfusion scans were undertaken.12(11.3%) perfusion scans demonstrated significant perfusion defects. 1 perfusion scan (0.94%) demonstrated high probability perfusion defects due to pulmonary embolic disease..The remaining scans with significant perfusion defects, representing 11(10.3%) of the 106 perfusion imaging scans underwent subsequent CT Pulmonary Angiography (CTPA). These were scans with perfusion defects of intermediate probability for PE.CTPA diagnosed PE in 5(45.5%) of the 11 CTPA’s undertaken. The remainder confirmed atelectasis, infection and a raised hemidiaphragm not shown on CXR..Of those with PE, none had lower limb deep vein thrombosis (DVT) on Doppler and only four underwent anticoagulation with treatment dose Low Molecular Weight Heparin until delivery. A medical history of previous PE and DVT were predictors of PE.. CONCLUSION:Low dose radionuclide perfusion scintigraphy with normal radiographic findings and CTPA for abnormal CXR and equivocal perfusion defects, in the investigation of pregnant patients with suspected PE is effective.Use of anticoagulation was only utilized in less than 4% of patients.Our presentation will highlight medical history predictors along with gestation and outcome data.
P56 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Aea
Conventional & Specialised NM: Gastroenterology
P597 Functional changes of the kidneys in patients with liver cirrhosis assessed with renal dynamic scintigraphy with 99mTc - DTPA M. P. Yaneva, A. Botushanova, M. Marovska; Medical University, Plovdiv, BULGARIA. The aim of the present study was to determine the role of the dynamic renal scintigraphy with 99mTc - DTPA in patients with liver cirrhosis. In these patients the presence of renal dysfunction is often missed because creatinine in the blood may stay in the reference ranges even with very low glomerular filtration rate due to reduced liver synthesis of creatin, increased tubular secretion of creatinin and reduced muscle weight. Morphologic abnormalities of kidneys are frequently absent and tubular function is preserved. One of the most difficult tasks in clinical evaluation of patients with cirrhosis is to diagnose renal functions, because the standard methods used in evaluation of glomerular filtration are not reliableMaterials and methodsDynamic renal scintigraphy with 99mTc DTPA was done in 29 patients- 6 women and 23 men between 37-75 years of age. All the patients were with diagnosis liver cirrhosis - 27 with stage Child B and 2 with stage Child C without history and physical signs of concomitant renal diseases. The creatinine in the blood was above the reference ranges in 2 patients and in all the rest it was normal.The scintigraphy was done on a gamma -camera ‘SYMBIA E Dual’ Siemens according to a predefined protocol with quantitative measurements in two phases: perfusion and secretion-excretion. 222 MBq/70kg /99mTc - DTPA was injected as bolus at the very beginning and a quality assessment and quantitative determinations of T max, T ½, relative function of each kidney and GFR were done.ResultsNormal renal function with normal GFR and normal values of blood creatinine were found in 9 /31.03 %/ patients.Normal GFR and mild changes in the excretion of the kidneys were found in 9 /31.03%/ patients with normal blood creatinine values.In two /6.8%/ patients with high creatinine values we found low GFR and changes in the excretion.Low GFR , preserved secretion and slowed at various degree excretion of the kidneys we found in 9 /31.03%/ patients with normal blood creatinine.ConclusionThe results of the present study showed that dynamic renal scintigraphy with 99mTc - DTPA can be used to establish early and different changes of the renal function in patients with liver cirrhosis and normal serum creatinine and without concomitant renal diseases. Further investigations are needed to elucidate its exact role in this clinical condition.
Poster Presentations
M, Schuemichen C, Meignan M, Jonson B. EANM guidelines for ventilation/perfusion scintigraphy : Part 2. Algorithms and clinical considerations for diagnosis of pulmonary emboli with V/P(SPECT) and MDCT. Eur J Nucl Med Mol Imaging. Sep 2009;36(9):1528-1538.3. Bajc M, Olsson B, Palmer J, Jonson B. Ventilation/Perfusion SPECT for diagnostics of pulmonary embolism in clinical practice. J Intern Med. Oct 2008;264(4):379-387.
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P598 Comparison Of The Gallbladder Motility Parameters Obtained By Bolus And Infusion Cholescintigraphy M. Petrovic, V. Artiko, N. Petrovic, V. Obradovic; Clinical Center of Serbia, Belgrade University School of Medicine, Belgrade, SERBIA. Aim: The aim is the estimation of GB motility parameters by bolus (BC) and infusion (IC) cholescintigraphy.Patients and Methods: The study was perfomed with ROTA scintillation camera and MicroDelta computer. BC lasted 90 min, with test meal stimulation in 60th min, while IC lasted 180 min (10ml/h) with test meal in 120th min.Results: In the controls with stimulation (BC/IC;n=20/19) appearance time was registered earlier with BC (9.55±4.9 min) than with IC (23.38±16.3 min) (p<0.05). Also, in comparison to BC (29.90±11.87 min), filling time was prolonged with IC (74.5±18.4 min) (p0.05). Emptying time (ET) was shorter (18.00±5.99) and ejection rate (ER) faster (5.11±1.85%/min) with BC comparing to IC (37.8±11.4 min; 2.32±0.8%/min).In the 15 patients with chronic cholecystitis/calculosis, with BC EF and ER were lower (21.65±18.85% X=2.24±1.88%/min) than in the controls after stimulation (p<0.01). EF and ER obtained by IC in 6 patients were also decreased (p<0.01) (48.4±7.1% and 1.05±0.41%/min).Conclusion: EF did not depend upon the method performed. Among the parameters studied, EF and ER were significantly decreased in patients with altered GB contractile function comparing to the controls. BC is a feasible and reliable method, but IC is carried out in more physiological conditions, when the steady state of the 99mTc-EHIDA in hepatocytes and GB is achieved.
P599 Comparison of three with six regions of interest analyses in patients with idiopathic constipated subjects undertaking 67 colon transit scintigraphy using Ga-citrate: sub-analysis of our previous report I. Neshandar Asli1, M. Ehsani2, H. Javadi3, M. Assadi4; 1Department of Nuclear Medicine, Taleghani Hospital, Shaheed Beheshti University of Medical Science, Tehran, IRAN, ISLAMIC REPUBLIC OF, 2Department of Gastroenterology, Taleghani Hospital, Shaheed Beheshti University of Medical Science, Tehran, IRAN, ISLAMIC REPUBLIC OF, 3Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, IRAN, ISLAMIC REPUBLIC OF, 4 The Persian Gulf Nuclear Medicine Research Center , Bushehr University of Medical Sciences, Bushehr, IRAN, ISLAMIC REPUBLIC OF. Aim: Preparation of data from 6 geometric regions of interest of colon is time consuming, particularly in the busy nuclear medicine departments, and therefore we decided to investigate an alternative method. Materials and methods: In this study, we report our results of reanalysis of the data according to the 3 ROIs including right colon, left colon and also rectosigmoid, comparing our original work. In addition, the proximal colonic emptying (PCE) was determined at 24 hr post ingestion among 3 patient groups. Results: In quantitative assessment, time which half of activity was eliminated from colon (mean half clearance time (MCT)) was not affected by reanalysis. There is no significant difference in GMC24h, GMC48h and GMC72h between two groups using Man Whitney u test (p value >0.05) in the current study while in the previous work there was statistically significant two later GMC (GMC48h and GMC72h) (p=0.016 and p=0.027 respectively) .The PCE in the group 1 was= 2.50 (0.37); group2, 1.57 (0.47) and group3, 2.97. The PCE was not different in two groups (p value=0.21). Conclusion: This study demonstrated that radionuclide colon transit study is a safe, physiologic, and quantitative method for evaluating the transit of fecal material from cecum to rectum. Although, the visual assessment of diagnosis of subjects of two analyses is the same, it was not supported by quantitative measurements completely and needs further studies.
P600 The ability of milk-augmented hepatobiliary scintigraphy (HBS) to predict outcome in patients with right upper quadrant pain with use of ejection fractions N. Shay1, D. Nandurkar1, W. McKay1, G. Soo1, R. Shakher1, M. SchneiderKolsky2, I. Jong1; 1Monash Medical Centre, Clayton, AUSTRALIA, 2Monash University, Clayton, AUSTRALIA. Aim:To determine if 600mls of full cream milk is an adequate fat challenge in hepatobiliary scintigraphic for the assessment of chronic cholecystitis using gall bladder ejection fractions (GBEF) of 35% and 50%.Materials and methods: After institutional ethics approval, we retrospectively reviewed 113 consecutive adult patients (31 males and 82 females) aged between 20 and 82 that presented to our institutions between 1/1/2008 to 31/12/2010 with upper abdominal pain. These patients were all investigated with a milk (600 mls of full cream milk, containing 21.6 g of fat) augmented - HBS study. Images were obtained at least 30 minutes after milk ingestion on a wide field of view gamma camera with an all-purpose parallel-hole collimator. All studies were reviewed by two nuclear medicine physicians blinded to outcome; any discrepancies were addressed by consensus.
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 This was correlated with the patient outcome (obtained through histology, patient medical records and/or follow-up phone call directly to patients). Positive histology with symptom resolution post cholecystectomy was considered as a true positive and symptom resolution without cholecystectomy with alternate diagnosis of gastritis (biopsy proven) was considered as a true negative.Results:113 patients were reviewed, of which 52 had a histologically confirmed diagnosis of either chronic cholecystitis or gastritis, the remaining 61 were excluded.31/52 patients had cholecystectomy, all with confirmed histology of chronic cholecystitis, of which 6 (6/6 - GBEF>35%) had persistent symptoms and 25 (23/26 - GBEF<35% and 2/26 GBEF>50%) had symptom resolution.21/52 had gastritis, of these, 21/21 (3/21GBEF<35% and 18/21- GBEF>35%) had resolution of symptoms with medical management, and 0/21 patients had persistence of symptoms.Specificity and sensitivity for outcome following therapy using different GBEF’s was as follows:23%: 53% and 100%- 35%: 67% and 91%- 50%: 65% and 79%Using GBEF of 35% the NPV was 90% and the PPV was 70%, with an accuracy of 78%Conclusion:Hepatobiliary scintigraphy using 600 mls of full cream milk is an adequate fat challenge, and is an easily reproducible test for diagnosis of chronic cholecystitis. Using this fat challenge, a GBEF of < 35% was considered the most useful EF for prediction of chronic cholecystitis and overall outcome prediction post-intervention with the best combination of sensitivity, specificity and overall accuracy.
P601 Superior Clinical Impact of FDG-PET/CT Dual Time Point Compared to MRI and CT for the Follow Up of Patient with Presacral Mass J. Pou Ucha, J. M. Nogueiras, A. Iglesias, B. Suarez, A. M. Alvarez, F. Loira, A. Serena, L. Campos, M. Arias, R. Guitian; UNIVERSITY HOSPITAL COMPLEX OF VIGO, VIGO, SPAIN. INTRODUCTION: The assessment of residual presacral mass after treatment of Colorrectal Carcinoma (CRC) is often difficult. Although Magnetic Resonance (MR) is a standard imaging tool for the assessment of presacral space involvement, there have been few reports documenting the results of comparative studies on the usefulness of F18-FDG-PET/CT is superior to MR not only in the evaluation of a residual mass but in the judgment of recurrence after treatment of such patients.MATERIALS: 14 Patients (8 men) from Jan-09 to Jan-11 with presacral mass diagnosed by MR or CT were included in our study. They have undergone F18-FDGPET/CT (14/14), MR (5/14) and CT (13/14). Similar dates between imaging studies were selected and their results correlated with imaging studies and clinical follow up. No oncologic treatments were given until presacral tumor viability was confirmed.RESULTS: Mean month interval (MMI) between imaging studies: 1,9. MMI between studies and presacral tumor viability/necrosis confirmation: 5 (8 for necrosis diagnosis / 3 for viability diagnosis). Kappa index: PET 0,78 ; NMR 0,8 ; CT 0,46. Sensibility/Specificity/PPV/NPV: PET (75% / 83% / 85% / 71%); NMR (75% / 100% / 100% / 50%) ; CT (60% / 75% / 75% / 60%). The CT was inconclusive in 4 cases. Decision Impact: PET 57%, NMR 20%, CT 15%.CONCLUSION: PET/CT was useful in those cases where MR and CT were confused or inconclusive..
P602 Dynamic radionuclide scintigraphy in the diagnosis of Rotor syndrome P. Sirucek1, M. Jirsa2, A. Sulakova1, L. Mrhac1, O. Kraft1; 1Faculty Hospital, Ostrava, CZECH REPUBLIC, 2Institute for Clinical and Experimental Medicine, Prague, CZECH REPUBLIC. Abstract:Inherited disorders of bilirubin metabolism in the liver include predominantly unconjugated (Gilbert and Crigler-Najjar) and predominantly conjugated (Dubin-Johnson and Rotor syndrome) forms. Whereas the diagnosis of Dubin-Johnson syndrome can be confirmed by histological, immunohistochemical and molecular genetic examination, no such examinations are available for Rotor syndrome molecular basis of which is unknown.A seven-year-old girl has been followed up for persistent conjugated hyperbilirubinemia since her birth.. The child's parents are distant relatives. The girl had no clinical problems. The only objective finding was subicterus of sclerae, liver and spleen were never enlarged. Serum levels of total bilirubin ranged from 45-74 umol/l, direct bilirubin was 49 68% of the total bilirubin level. Liver enzyme activity of ALT, AST, GGT and LD was within the normal range and proteosynthetic function of the liver has never been altered. Infectious etiology of jaundice, autoaggressive disease, drug-induced liver injury, hemolytic anemia, deficiency of alpha-1 antitrypsin, Wilson disease and Gilbert syndrome have been ruled out. Inflammatory markers and porphyrinuria were normal. The gallbladder and extrahepatic bile ducts were sonographically normal and without gallstones. Mutational analysis of ABCC2 did not support the diagnosis of Dubin-Johnson syndrome.At the age of 6 years the patient was indicated for radionuclide dynamic cholescintigraphy by the comprehensive examination. Scintigraphy showed poor accumulation of the administered radiopharmaceutical in the liver. As radiopharmaceutical was used 99mTc-N-(3bromo-2,4,6-trimethylphenylcarbamoylmethyl) of iminodioacetic acid, also known
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as HIBIDA, Mebrofeninum, Bromtrimetyl-HIDA. During the examination, radiopharmaceutical remained predominantly in the blood pool i.e. in the heart was seen in the 90th minute of the study. Gallbladder was visualized during the examination and responded to the nonspecific stimulus (chocolate) by satisfactory evacuation. Alternative renal excretion of radiopharmaceuticals with urinary bladder imaging was seen.The decreased plasma clearance of anionic dyes such as BSP and indocyanine green and the lack of, or greatly delayed, visualization of the liver by anionic radiotracers used for cholescintigraphy such as 99mTc-HIDA and related compounds, and to a lesser extent, 99mTc-Mebrofenin, have been reported in the literature (Bar-Meir et al., 1982; LeBouthillier et al., 1992). In the absence of molecular testing dynamic radionuclide scintigraphy represents the only way how to confirm the diagnosis of Rotor syndrome.
transit time and weighloss t after bariatric surgery was calculated.Results:Solid gastric emptying seems to be faster post-SG surgery than post-RYGB. After SG surgery T ½ gastric emptying was 33± 19 min and weigh loss t was 18% (11-24%). After RYGB T ½ was 115± 35 min and weight loss was 32%(32-33%). Small bowel transit time showed a wide range of values patients probably related to techniques problems to draw the cecum ROIs after surgery. A significant correlation between surgical procedure and weight loss has not been found in this sample.Conclusions: TC 99m-DTPA scintigraphy can be used as a safe and non invasive method for the study of GE and small transit in obese patients after bariatric surgery. This technique allows to study a possible correlation between gastrointestinal transit time, weight loss and hormonal secretion changes after bariatric surgery.
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V. Marković1, M. Lalovac2, V. Čapkun1, D. Eterović1, A. Punda1, D. Martinović1; 1University Hospital Split, Split, CROATIA, 2General Hospital Dubrovnik, Dubrovnik, CROATIA.
C - Urea Breath Test in the diagnosis of Helicobacter Pylori infection in Pakistani population. S. Riaz, I. Munir, M. K. Nawaz, H. Bashir, S. Muzahir, M. Saadullah, S. Mufti, H. Ahmad, Z. E. Huma, Y. I. Khan; Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, PAKISTAN.
Aim: The purpose of this study was to investigate can esophageal scintigraphy (ES) discriminate patients with scleroderma from patients with suspected but not established diagnosis of scleroderma.Patients and methods: ES was performed in 21 patients with scleroderma (18 women and 3 men; mean age 53 years), 15 patients with suspected but not established diagnosis of scleroderma (13 women and 2 men; mean age 60 years) and 14 volunteers (13 women and 1 man; mean age 60 years).The patients were positioned supine beneath a gamma-camera after a 5-hour fast and instructed to swallow 11 MBq of Tc-99m-DTPA in 2 ml of water in a single gulp on command. After 30 seconds patients were instructed to do dry swallow and every 15 seconds until the end of two minutes study. A region of interest was drawn over the entire esophagus and a time activity curve was generated. Frame with maximum counts was defined and retention ratio (RR), defined as a percentage of maximum activity retained after 30, 60 and 90 seconds, was calculated.Results: Patients with scleroderma had higher RR at 30, 60 i 90 seconds than healthy volunteers (82% vs. 25%; p<0,05 at 30 seconds; 83% vs. 24% p<0,05 at 60 seconds; and 75% vs. 19%; p<0,05 at 90 seconds), as well as patients with suspected but not established diagnosis of scleroderma (70% vs. 25%; p<0,05 at 30 seconds; 66% vs. 24%; p<0,05 at 60 seconds and 60% vs.19%; p<0,05 at 90 seconds). Although patients with scleroderma had higher RR at 30, 60 i 90 seconds than patients with suspected but not established diagnosis of scleroderma, the difference didn’t reach statistical significance (82% vs. 70%; p>0,05 at 30 seconds; 83% vs. 66% p>0,05 at 60 seconds and 75% vs. 60%; p>0,05 at 90 seconds).Conclusion: RR discriminate patients with scleroderma and patients with suspected but not established diagnosis of scleroderma from healthy subjects, but can not discriminate patients with scleroderma from patients with suspected but not established diagnosis of scleroderma.
Background: Helicobacter pylori prevalence varies widely in different geographical locations and is especially high in our part of South Asia. The diagnosis of H. pylori infection has traditionally involved endoscopy with biopsies of the gastric mucosa for histology and culture. In search for less intrusive, the urea breath test developed which is a non-invasive, simple and safe test. It provides excellent accuracy both for the initial diagnosis of Helicobacter pylori infection and for the confirmation of its eradication after treatment.Objective: Retrospective review of C14 Urea Breath Test done at our centre.Material and Methods: 114 patients were referred to our department for C14 Urea Breath test during 2006 to 2010 from gastrointestinal clinic. 32 out of these 114 patients had undergone endoscopic biopsy for the assessment of H.Pylori infection. The protocol followed was, no antibiotics and proton pump inhibitors 4 weeks and 2 weeks prior to the test respectively and NPO for at least 6 hours. Patients were given a capsule containing 1 mg urea labeled with 37 kBq (1 micro Ci) C-14 with 50 ml of lukewarm water. Patient’s breath was collected at 15 min post capsule ingestion using Breath cardTM and readings were determined by using Heliprobe. Values of 0, 1 and 2 taken as negative, borderline and positive for active H.Pylori infection respectively.Results: Endoscopic biopsies of abnormal gastric mucosa was taken in all 32 patients. 25 (68%) biopsies were positive while 7 (21%) biopsies were negative. In 23 (92%) out of 25 positive patients, C14 UBT was positive for active H.Pylori infection with value of 2 (Positive) and 2 (8%) showed borderline result with value 1 (Borderline) on Heliprobe. In 6 (86%) out of 7 negative patients, C14 UBT was negative for active H.Pylori infection with value of 0 (Negative) and 1 (14%) showed borderline result with the value of 1(Borderline). Above results validated the sensitivity and specificity of C14 UBT about 92% and 85% respectively with accuracy value of 93%. All 23 true positive patients were given H.Pylori eradication therapy and follow-up C14 UBT was negative.Conclusion: C14 UBT is a non-invasive, simple, safe and cost effective procedure for H.Pylori detection and treatment response evaluation.
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Gastric Emptying and Small Boweltransit Assessed by Scintigraphy in Obese Patients after Bariatric Surgery: Sleeve Gastrectomy and Gastric Bypass. (preliminary results) 1
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M. Suárez-Piñera , L. Prat , J. Fuertes , B. Gras , S. Delgado-Aros ; 1 Nuclear Medicine. Hospital del Mar- CRC Mar, Barcelona, SPAIN, 2Nuclear Medicine. Hospital General de Catalunya- CRC Mar, Barcelona, SPAIN, 3 Neuro-Enteric Translational Science (NETS) IMIM-Parc de Salut Mar. PRBB, Barcelona, SPAIN. Background. Morbid obesity is a disease with high prevalence in the developed world. Bariatric surgery (Sleeve gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB)) is currently the only treatment that achieves long-term effective weight loss. One of the mechanisms of weight loss after bariatric surgery seems to be related with acceleration of gastro-intestinal transit.Aims: To evaluate gastric emptying (GE) and small bowel transit post-bariatric surgery in morbidly obese patients . To compare GE and small bowel transit in Sleeve gastrectomy and RYGB. To correlate GE and small bowel transit time after these two surgical procedures with weight loss.Methods: GE and small bowel transit scintigraphy was perfomed in 6 morbidly obese subjects ( 6F, 32-58) 3-4 months after RYGB (n=3) and Sleeve (n=3). After an overnight fast, patients consumed a standard solid meal marked with 1 mCi TC 99m-DTPA. A dinamic scintigraphic study was performed immediately after eating the food and static images were acquire at 30, 60, 120,150,180,210,240, and 270 min Quantitative analysis was performed drawing a manual ROI on the stomach and on the cecum images. Time 0 was considered the time of meal completion and was defined as the 100% retention in stomach. Gastric emptying curves were constructed. T ½ was the time at which the activity in the gastric area was half (50%) from the activity at time 0. Time of meal arrival to the cecum was defined as the time required for the first 10% of total activity to reach the cecum (Small bowel transit time) . A correlation between gastrointestinal
Assessment of colonic transit times M. D. Rutland, L. Que, I. Hassan; Auckland Hospital, Auckland, NEW ZEALAND. Purpose: Records of previous Colonic Transit Studies were reviewed with the intention of establishing a normal range for the New Zealand population. Method: Colonic Transit Studies were performed by collecting anterior and posterior abdominal images at 6 hours and then every subsequent morning after the oral ingestion of approximately 15 MBq of 67Ga-Gallium Citrate. Each image was analysed to obtain the geometric mean background corrected count rates from the following regions:- Caecum, Ascending Colon, Transverse Colon, Descending Colon and Recto-sigmoid. The data were analysed to display a “Retention Function” of gallium in the colon and calculate a Colonic Transit Time (CTT). By assigning weighting factors to each colonic region it was possible to determine the weighted mean position of the tracer along the colon, and hence the rate of tracer movement along the colon.A review of old cases, going back to 1993, was undertaken. The following exclusions were made:- Paediatric studies (3) ; Laxative use during the study (4) ; Transit normal but with regional delays (10) ; Equivocal results (29). The remaining studies were assigned to one of the following groups on the basis of the original interpretation and a subsequent review being in agreement:- Normal (60) ; Rapid Transit (20) ; Slow overall Transit (63). Results: Setting the “Normal Range” for CTT at 25-80 hours produced accuracies of 95% and 99% respectively in separating the normal group from abnormally fast or abnormally slow colonic transit. Setting the Normal rate of progress at 42% to 20% per day produced accuracies of 86% and 92% in separating normal from fast and slow transit respectively. Conclusion: The most useful feature of colonic transit quantification was found to be the Colonic Transit Time, with a normal range of 25 - 80 hours.
Poster Presentations
Esophageal scintigraphy in evaluation of impaired esophageal motility in patients with scleroderma and patients with suspected but not established diagnosis of scleroderma
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P607 Scintigraphic estimation of salivary glands function in secondary Sjögren’s syndrome in systemic sclerosis in comparison with primary. M. N. Mojsak1, E. Gindzienska-Sieskiewicz2, S. Sierakowski2, F. Rogowski1, P. M. Szumowski1; 1Department of Nuclear Medicine, Medical University, Bialystok, POLAND, 2Department of Rheumatology and Internal Diseases, Medical University, Bialystok, POLAND. Sjögren’s syndrome (SS) is a chronic autoimmune inflammatory disease, that involves the exocrine glands. The main symptoms of SS are dry eyes and dry mouth (xserostomia). This process can manifest either as the independent primary SS (pSS) or as secondary SS (sSS), when the patient is suffering from the other autoimmune disease as a rheumatoid arthritis or systemic lupus erythematosus, but also systemic sclerosis.The aim of the study was to compare the severity of salivary gland involvement and function alteration in patients with pSS and sSS in systemic sclerosis. Estimation of salivary glands scinthygraphy (SGS) as quantitative method presenting functional impairment of salivary glands and comparison SGS changes to clinical symptoms in both groups of patients.Materials and methods: In 10 patients with pSS and 10 patients with sSS in systemic sclerosis (the patients were hospitalized in Department of Rheumatology and Internal Diseases) salivary glands function was quantitative measured by using of SGS. After intravenous injection of 99mTc-pertechnetate images were acquired up to 40 minutes. About 15 minutes postinjection 3 mL of lemon juice were administered intraorally as sialogogue. To quantify salivary glands function we calculated uptake (U) of 99mTcpertechnetate and excretion function (EF). The results were compared with norms used in our Department. In all the patients was measured also: the level of antibodies specific for SS - anti-Ro and anti-La antibodies. All the patients and healthy persons had answered questionnaires including questions about complaints and subjective symptoms of main disorder.Results: In patients with pSS the progession of parenchymal impairment and exocrine function disorders was more advanced and more common then in patients with sSS. In patients with pSS the mean U in parotids glands (Up) was 0,15±0,05%, in submandibular glands (Usub) 0,09±0,03%, EF in parotids glands (EFp) 2,25±10,6%, in submandibular glands (EFsub) 2,93±8,7%. In patients with sSS In systemie sclerosis the values of U and EF were lower then In our Depatment’s norms.The clinical symptoms in pSS usually correspond with changes of SGS but in sSS in systemic sclerosis there were poorly demonstrated signs of xerostomia, also in patients with important changes in SGS.Conclusion: SGS is a suitable imaging method for diagnosis of SS and distinguish between pSS and sSS. SGS evaluate the severity of salivary glands functions impairments that not always corresponds with clinical symptoms.
P57 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Conventional & Specialised NM: Pediatrics
P608 Acute renal cortical scintigraphy in children with first episode of febrile UTI E. Jaksic1, R. Bogdanovic2, A. Paripovic2, S. Beatovic1, M. Blagic1, V. Artiko1, V. Obradovic1; 1Center of Nuclear Medicine Clinical Center of Serbia, Belgrade, SERBIA, 2Institute of Mother and Child Health Care of Serbia, Belgrade, SERBIA. Aim: Non-specific symptomatology in infants and young children makes the clinical differentiation of lower urinary tract infection (UTI) and acute pyelonephritis (APN) difficult. The level of infection is of a great importance for the choice of treatment and prognosis. The purpose of this study was to assess the role of systematically performed initial cortical scintigraphy in young children with the first symptomatic UTI and to compare scintigraphic findings with commonly required diagnostic tests. Material and Methods: A prospective study was conducted in 34 infants and young children (18 boys, 16 girls), aged 1.5-36 months (mean 9.8 ± 8.7 months), hospitalized with a first episode of clinically suspected APN. Within the first 5 days after admission, Tc-99m DMSA renal scintigraphy, ultrasonography (US), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC) and urine analyses were performed. The criteria indicative of early parenchymal damage on the acute renal cortical scan were divided into three types of abnormalities of increasing severity. Results: DMSA scintigraphy showed changes consistent with APN in 27/34 (79%) patients, mean age of 10.9 months, 44% males and 56% females. Out of 9 febrile children with negative urine culture and supportive evidence of UTI, scintigraphy showed parenchymal involvement in 8 children (24% in the whole group, 30% in scintigraphically documented APN). There were no statistically significant correlations between the frequency or size of the initial scintigraphic abnormalities and age, sex, body temperature, CRP levels or ESR. A CRP level of >54mg/L and a WBC of > 13,300/mm3 had sensitivities of 56 and 59% and specificities of 86 and 71%, respectively. US showed changes consistent with APN in 7/34 (21%) in the whole group and in 7/27 (26%) patients
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 with positive cortical scan (p<0.05). Conclusion: In the absence of specific symptomatology in infants and young children, initial DMSA renal scintigraphy is a sensitive method for the early diagnosis of APN, particularly useful in the assessment of the severity of kidney injury even in patients with negative urine culture. Clinical, biological and ultrasound parameters do not identify children with renal damage. Normal DMSA study, excluding parenchymal involvement and late sequelae, could minimize the use of scintigraphy in the follow up.
P609 The relationship between age and bone densitometry findings of the children with celiac disease T. A. Balci, Z. P. Koc; Firat University Medical Faculty, Department of Nuclear Medicine, Elazig, TURKEY. Objective: The effect of Celiac Disease (CD) on children’s bone is decrease in bone mineral density (BMD). Osteoporosis is a consequence of this decrease and usually manifests in adult ages. The studies about CD patients generally show that bone density of these patients can be different at the same ages for the same duration of disease. The aim of this study is to investigate the relationship between age and bone mineral density of CD patients.Methods: Ninety one patients (36 M, 55 F; mean: 9.6 years old) with diagnosis of CD were included into the study. BMD survey from L1-L4 lumbar spine and hip of the patients was evaluated at presentation.Results: The disease duration of patients was 17.15±16.45 months in mean. There were 13 patients with osteoporosis (z score<-2.5) (5 M, 8 F; mean age: 10.27±4.25 years old), 37 patients with osteopenia (-1>z score>-2.5) (16 M, 21 F; mean: 11.11±2.88 years old) and 41 patients with normal (z score>-1) bone density results (15 M, 26 F; mean: 7.95±3.31 years old). The BMD values of both lumbar spine and femur and z scores of lumbar region were in mild correlation with age. There was significant difference between mean ages of patients with osteoporosis and normal bone densitometry values (p<0.05). We evaluated the patients in 3 groups according to their ages; group 1 (3-7 years), group 2 (8-11 years) and group 3 (12-18 years). The difference between mean BMD results of these groups were statistically significant (p<0.05). The mean values of lumbar z scores of patients were -1.08±1.27, -1.42±1, -1.86±1.14 respectively for these three groups.Conclusion: The decrease in BMD of the patients with CD begins in the beginning of childhood. Although BMD slightly increase with age in children with CD as duly because of the growth, the z score decrease with increasing age as a result of the disease, trending osteoporosis. Hence the defining the BMD on the early stage of the disease and following up with z score is important for the evaluation of osteoporosis progress and the management of those patients.
P610 Scintigraphical characteristics of pediatric patients with horseshoe kidney T. A. Balci1, Z. P. Koc1, H. A. Mitil1, B. B. Demirel2; 1Firat University Medical Faculty, Department of Nuclear Medicine, Elazig, TURKEY, 2Oncology Hospital, Ankara, TURKEY. Aim: Horseshoe kidney is one of the most common congenital kidney anomaly. This group of patients is prone to some complications. We investigated scintigraphical results of patients with horseshoe kidney sent for kidney scintigraphy.Materials and Methods: Thirty seven patients (17 M, 20 F, mean age: 8.8 years) who were sent to our clinic for dynamic or static renal scintigraphy for various reasons were included into this retrospective study.Results: Fifteen patients had urinary tract infection, 2 had hydronephrosis and 4 neurogenic bladder and 16 patients were asymptomatic in terms of urinary system. Eighteen patients weren’t recognized as horseshoe kidney despite ultrasonography or voiding tests prior to scintigraphy. Six patients had grade 1-4 vezicoureteral reflux by the time of diagnosis.Twenteen patients had normal scintigraphic result except horseshoe kidney. Eight patients had associated fusion, 2 cross renal ectopia, 1 rotation anomaly. Three patients’ left component weren’t present (one due to multicystic displasia). One patient had atrophy of left and 4 right component and 1 of them had also multiple defects of left component. All the three patients who were evaluated with dynamic scintigraphy had bilateral pelvic stasis. One had bilateral and one unilateral functional impairment and volume loss.Conclusion: Static renal scintigraphy is one of the best methods to decide congenital anomalies and also gold standard method to evaluate renal cortex after urinary tract infection. It was also method of choice for our patient group and accurately identified horseshoe kidney deformity and associated complications and anomalies. Furthermore it defined horseshoe kidney deformity in 18 patients that weren’t identified by the other modalities.
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
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Aim: Thyroid scintigraphy is the gold standard method to decide whether the hypothyroidism is permanent or not. We evaluated the scintigraphical results of patients with congenital hypothyroidism send to our clinic for thyroid scintigraphy (TS).Materials and Methods: Thirty four patients with congenital hypothyroidism (18 male, 16 female; 1day-12 years old) were included to the study. The hormon replacement was stopped for 3-4 weeks prior to the scintigraphy.Results: TS of 24 patients were normal. There were 2 partial and 3 total suppressive and 2 heterogen uptake in thyroid which were attributed to immediate thyrotropin releasing hormone (TRH) test. One patient had hemi-agenesis, one with ectopic thyroid gland. One patient had indentation of left lobe but ultrasonographically normal. Patients were divided into 2 groups according to thyroid stimulating hormone (TSH) level at diagnosis: group 1 (17 patients, 11 M, 6 F; 1day-12 years old) consists of patients with TSH level below 30 mIU/L (mild hypothyroidism), group 2 (17 patients, 7 M, 10 F; 1day-11 years old) patients with TSH level above 30 mIU/L (severe hypothyroidism). There were 9 patients who had normal thyroid scintigraphy in group 1 and 13 patients in group 2. Patients with hemiagenesis and ectopic gland were in group 2.Conclusion: Most of the patients (71%) who were sent for thyroid scintigraphy with congenital hypothyroidism had normal thyroid scintigraphy. Even most of the patients with severe hypothyroidism had normal scintigraphy; we have to perform thyroid scintigraphy in congenital hypothyroidism to decide permanency of the disease especially for iodine deficient areas.
underlying disease (organic or functional obstruction) and it is associated to other urinary tract pathologies (pelvi-ureteric and vesico-ureteric junction, mega-ureter, complicated duplex kidney, valves of the posterior urethra). The VUR is found most often by a urinary tract infection but sometimes may remain asymptomatic; its discovery is so coincidental.We report cases of reflux discovered incidentally during a renal scintigraphy with 99mTc-DTPA (diethylene triamine penta acetic acid) or 99m Tc-Mercaptoacetyltriglycine (99mTc-MAG3).MATERIALS AND METHODS: Medical records of 37 children referred for renal scintigraphy based on excretion mechanisms performed with 99mTc-DTPA or 99mTc- MAG3 were reviewed. Of these children 18 (49%) were boys and 19 (51%) were girls. Renogram curves obtained from bilateral regions of interest (ROI) over each kidney and renal backgrounds and bladder were completed.All these patients had secondary peaks on renogram curves concomitant to bladder curve depletion. After eliminating any movement of the patient using the cine mode, vesicorenal reflux was then suspected. Over these 37 patients, only 23 patients underwent other investigations (radiological cystography, isotopic cystography and 99mTc-DMSA scintigraphy) and were retained, the other 14 patients were excluded.RESULTS:Vesicoureteral reflux was confirmed in 17 patients. It was bilateral in 3 of them. In 6 other children, other investigations have not revealed reflux. The positive predictive value was 77 %.In 8 cases the reflux was known. But in the remaining 12 cases, the appearance of secondary peaks on renogram curves indicating a massive retrograde ascent of activity from the bladder to the kidney was indicative of reflux. This indirect evidence has also assessed the severity of reflux which is classified at least grade 2.CONCLUSION:The appearance of secondary peaks on renogram curves, in the absence of any patient motion, during 99mTc-DTPA or 99mTc-MAG3 renal scintigraphy should alarm the physician about the possibility of vesicorenal reflux and should push him to ask for further investigations, especially as asymptomatic complications can be severe and irreversible.
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Scintigraphical patients.
evaluation
of
congenital
hypothyroidism
T. A. Balci, Z. P. Koc; Firat University Medical Faculty, Department of Nuclear Medicine, Elazig, TURKEY.
The incremental value of pertechnetate imaging in the diagnosis of Meckel’s diverticulum I. Meddeb1, A. Mhiri1, I. Slim1, W. El Ajmi1, I. Elbez1, H. Hammami2, F. Ben Slimene1; 1Nuclear Medicine Department. Salah AZAIEZ Institute. University El Manar II, TUNIS, TUNISIA, 2Military Hopital, TUNIS, TUNISIA. Introduction: Meckel's diverticulum (MD) is the most prevalent congenital abnormality of the gastrointestinal tract. Clinical symptoms can result in pain, bleeding and perforation caused by peptic ulceration. In all imaging modalities for findings of MD, Tc-99m scintigraphy is the most sensitive, revealing an accumulation of radiotracer by mucous cells in ectopic gastric mucosa, which will allow a simple and quick detection of MD. The aim of our study is to assess the utility of 99mTc imaging when MD is suspected in pediatric patients with gastrointestinal (GI) bleeding. Methods: We have conducted a retrospective study of 140 pediatric cases for a query diagnosis of MD. They were 58 females and 89 males, their age ranged from 24 days to 15 years with a mean age of 4,4years. Scintigraphy was performed after intravenous injection of an activity of 37-148MBq of TcO4-, depending upon the body weight of the patient. Sequential images of the anterior abdomen were acquired with the child in the supine position, using a large field of view gamma camera coupled with a low energy high resolution collimator. Images were acquired in 128 x 128 matrix, with a frame rate of 60 sec per frame for 20 min. Additional static images were acquired at the end of the dynamic acquisition in a 256 x 256 matrix, at 15 minutes intervals for 3 hours. We had considered as positive for MD, activity appearing at the same time as normal gastric mucosa, persisting throughout the study in same position, despite peristaltis and increasing in intensity parallel to the intensity of the stomach. Results: Our results have shown that the most frequent presenting symptom was bleeding per rectum. 14 cases of the 140 were positive for functioning gastric tissue indicating MD. More than half of the positive cases (57%) were at the age group of 3-4 years. The site of the ectopic activity was at the right iliac fossa in 9 cases (64%), right hypochondrium in 3 cases and right lumbar region in 2 cases. Endoscopic and others morphological explorations were inconclusive in the 5/14 positive cases and negative for the others. Conclusion: Scintigraphic research of a MD is simple, minimally invasive, effective and very well accepted by the patient. This is the technique of choice for the detection of MD with ectopic gastric mucosa. According to the literature, its specificity, sensitivity and negative predictive value were respectively 95%, 85% and 90%.
P613 Incidental vesicourethral reflux diagnosis on excretory renal nuclear medicine investigations D. Ben Sellem, L. Zaabar, I. El Bez, I. Slim, I. Meddeb, A. Mhiri, B. Letaief, M. Ben Slimene; Department of Nuclear Medicine Salah Azaiez Institute, TUNIS, TUNISIA. Vesicourethral reflux (VUR) is the most common uropathy in children, often reaching the girl. It is classified as primary and secondary reflux. The first one is the result of a congenital intrinsic abnormality of the physiological anti-reflux system and often disappears spontaneously with age. While the second is the result of
Agreement of Radionuclide salivagram, Videofluoroscopic swallow study and Barium esophagography in children with suspected chronic aspiration D. Y. Lee, H. O. Kim, S. H. Park, J. S. Ryu, D. H. Moon, K. H. Choi, K. M. Kim, J. S. Kim; Asan medical center, Seoul, KOREA, REPUBLIC OF. Purpose: Recurrent aspiration fo food, saliva, or gastric contents is an important cause of pneumonia in children. It is not easy to establish making diagnosis & treatment plan due to lack of specific symptoms and best diagnostic tools predicting aspiration pneumonia. We compared the frequency of positive aspiration in radionucide salivagram, videofluoroscopic swallow study(VFSS) and barium esophagography in children with suspected chronic aspiration and the agreement between these tests. Methods: Thirty-six children (16.3mo, range:296mo, M:F=17:19) with suspected chronic aspiration underwent radionuclide salivagram. Of these, 27 children also underwent VFSS and/or barium esophagography. For salivagram, 15 min dynamic images and 2hr delay images were obtained after dropping 0.2cc saline with Tc-99m phytate (3.7MBq) sublingually. Radioactivity on tracheobronchial tree or lung field was as positive finding. We evaluated the frequency of aspiration and the agreement among 3 tests for the diagnosis of aspiration. The clinical factors (age, feeding type, developmental delay, history of preterm delivery and congenital anomaly) associated with 3 tests results were also evaluated. Results: Frequency of positive aspiration was not significantly different amon 3 tests (p>0.05): 16 of 36 salivagram (44.4%, 95% Confidence Interval 27 to 62%); 16 of 27 VFSS (59.3%, 95% CI 39 to 79%); 10 of 27 esophagography (37.0%, 95% CI 18 to 57%), Agreement between test was poor to moderate: between salivagram & VFSS (kappa=0.02);between salivagram & esophagography (kappa=0.54); between VFSS & esophagraphy (kappa=0.48). Positive salivagram for aspiration was only significantly associated with developmental delay (p=0.04, OR 7.0). Conclusion: Frequency of positive aspiration was not significantly different among salivagrams, VFSS and esophagraphies, but the agreement between tests was not good. This result is of importance in assessing the significance of test results and suggest that 3 tests could be complementarily used according to the risk factors in children.
P615 99m
Tc-DTPA scintigraphy for glomerular determination in single kidney children
filtration
rate
P. Caroli, E. Lopci, C. Pettinato, S. Civollani, V. Ambrosini, C. La Scola, M. Lega, G. Cicoria, G. Montini, S. Fanti; Azienda Ospedaliero-Universitaria di Bologna, S.Orsola-Malpighi University Hospital, Bologna, ITALY. AIM: to assess the correlation between the value of glomerular filtration rate (GFR) based on the plasma disappearance curve after single bolus injection of technetium-99m diethylenetriamine penta-acetate (Tc-99m DTPA) in single kidney pediatric patients.MATERIALS AND MHETODS: The study was performed on 22 patients (15 male, 7 female; mean age 7 years-old [2-14]) with single kidney. Tc99m-DTPA (5 MBq/kg) was injected intravenously. At a distance of 120 minutes and 240 minutes after injection were carried out blood samples. Radioactivity in the
Poster Presentations
P611
S406 injection syringe and plasma was measured by means of a double-well singleplastic scintillation counter and analyzed with two methods: “slope-intercept method” (the determination of only late exponential by means of at least two blood samples around 2 and 4 hours after intravenous injection) and “distribution volume” (based on a single blood sample taken at 2 hours) for the determinaiton of GFR (GFRTc-99m DTPA).RESULTS: We compared the values [[Unsupported Character - ]][[Unsupported Character - ]]of GFRTc-99m DTPA obtained by “slope-intercept method” and “distribution volume”. By the first we obtained a mean GFRTc-99m DTPA of 109 ml/min/1.73 m2 [47-281.7], while by the seconds the mean GFRTc-99m DTPA was 101.1 ml/min/1.73 m2 [46.7-262.1]. In particular, we found to be not statistically significant with t test analysis (P=0.28). These two methods were in fact comparable.CONCLUSIONS: In our study for the assessment of GFRTc-99m DTPA in paediatrics single kidney patients the “slopeintercept method” and “distribution volume” were equivalent. From the practical point of view this scientific results shows that we can only use the “distribution volume” method to assess the GFRTc-99m DTPA in this pediatric patients.
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 in function was shown in three and non functioning kidney in two infants. DTPA diuretic renography was useful in estimation of drainage and evaluation of function in postnatal management of infants with ANH.
P618 Characteristics of isotope cystography performed in children at a university hospital and a regional hospital in Denmark M. H. Christensen1, J. A. Ejlersen2, J. Frøkiær1; 1Nuclear medicin, Aarhus, DENMARK, 2Nuclear medicin, Herning, DENMARK.
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Isotope cystography is an important low-radiation examination both at the university hospital (UH) and the county hospitals (CH) for diagnosis and follow-up studies in children with vesico uretral reflux (VUR).Aim: To describe the pattern of children referred for isotope cystography at UH and CH during a 10 year period with focus on the diagnostic performance of indirect versus direct isotope cystography. Further we examined the clinical consequences when isotope cystography identified VUR.Materials and method: Children aged 0-15 years undergoing one or more isotope cystographies between 2000-2010 at a UH and CH were retrospectively included. Patient characteristics were registered from hospital records. Statistics were performed using un-paired t-test (continuous data) and Chi2 test (categorical data).Results: Two hundred cystographies (78% indirect) performed in 165 children were included. Mean age at the first performed cystography was 8 years (SD 3) at both institutions (p=0.85). More girls (127) than boys (38) were examined (p<0.0001). There were no difference in the gender distribution between institutions (p=0.45). One hundred fifty nine cystographies were performed at the UH versus 41 at the CH. Of the 159 UH cystographies, 88% were performed as indirect cystographies versus 39% at the CH (p<0.0001). Of the 200 performed examinations 47 (24%) showed VUR. Overall 22 (47%) of the examinations identifying VUR were performed by the indirect and 25 (53%) by the direct method (p<0.0001). Thirty one (20%) of the cystographies at the UH revealed VUR versus 16 (39%) at the CH (p= 0.009). Neither the fraction of direct cystographies identifying VUR (44% versus 42 % (p=0.90)) nor the fraction of indirect cystographies identifying VUR (13% versus 14% (p=0.85)) differed between the CH and the UH. Twenty four (51%) of the positive cystographies had an immediate clinical consequence: 21 underwent a deflux-operation (13 from the UH / 8 from the CH (p=0.03)), 2 started prophylactic antibiotics and one were referred to contrast MCU. An almost identical fraction of direct cystographies gave rise to clinical intervention at the CH and the UH both for the direct (56% versus 47% (p=0.49)) and for the indirect cystography (0.06% versus 0.04 (p=0.60)).Conclusion: The diagnostic performance of direct cystography was better than for indirect cystography with no difference between hospital types. Half of the positive examinations had an immediate clinical consequence, indicating that isotope cystography is highly justified as a routine examination both at a university hospital and county hospital nuclear medicine department.
Postnatal Evaluation of Infants with Antenataly Detected Hydronephrosis
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P616 Importance of DMSA Renal Scan in Children with the First Urinary Infection Z. Petrovski; Clinical Hospital-Bitola, Bitola, MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF. Purpose: The aim of the study was to evaluate the role of Tc-99m DMSA scintigraphy in children with onset of symptoms of urinary tract infection (UTI).Material and Methods:We investigated 107 children (92 female and 15 male) without previous UTI, aged between 1 - 8 years with average 3,5 yrs.Diagnosis of UTI was confirmed with clinical and biological date and urine culture. DMSA images were obtained withing 10 days of diagnosis.Changes of DMSA scan were classified in three groups (group A and B - with focal changes of different intensity and group C - global contraction of kidney).Results:Focal cortical defects suggestive of renal scarring with reduction of DMSA uptake were found in 32 (30,9%) pts, unilateral in 25 pts and bilateral in 7 pts.Among the 37 pts with clinical symptoms for acute pyelonephritis, 21 (57%) pts showed abnormal DMSA scintigraphy findings, while 8 (14,5%) of the 52 children considered as UTI also revealed pathology in DMSA scan.After treatment, 6 months later, 29 abnormal scintigrams were repeated, from wich 45,2% (13/29) did completety normalized, 31,3% (9/29) showed partial recovery and 23,5% (7/29) revealed constant renal lesions in DMSA scan.Conclusion: The first UTI in childhood is a well recognized cause of chronic renal scarring and renal failure and therefore Tc-99m DMSA scan should be a routine examination in children with first urinary infection without and with clinical findings of acute pyelonephritis.
B. Ajdinovic1, L. Jaukovic1, Z. Krstic2, M. Dopudja1; 1Insitute of nuclear medicine MMA, Belgrade, SERBIA, 2University Pediatric Clinic, Belgrade, SERBIA. Purpose: Antenatal hydronephrosis (ANH) is the most commonly detected fetal abnormality. The goal of postnatal management of ANH is to detect the causative factors categorized into those leading to obstruction, those leading to reflux and the group comprising of “idiopathic” hydronephrosis. The aim of our study was to evaluate the relationship between diuretic renography findings, the severity of ANH and the reported postnatal underlying diagnosis.Patients and methods: DTPA diuretic renography was performed in thirty six infants (34 boys and 2 girls, 2-24 months old, median 6.5 months) with 72 renal units to assess for changes in kidney function and drainage. After adequate hydration a standard renal scan was performed for 30 minutes using 99m Tc -DTPA a dose of 1.85 MBq/ kg. The acquisition was performed using the scheme: basic renogram followed by F+15 diuretic test..Results: Perinatal US revealed unilateral hydronephrosis in all the patients. Antero posterior pelvic diameter (APD) range 7 - 30mm was categorized as APD<=9mm, 10 mm<=APD <=14mm and APD>= 15mm. Left sided hydronephrosis was shown in 19 of 36 patients. Micturating cystoureterography such as further diagnostic study was performed in 23/ 36 patients. No signs of VUR were detected in 21 patients, low grade VUR in two patients. DTPA diuretic renography was used to evaluate the renal drainage and split renal function. Upon the diuretic half-times of less than 10 min as the criteria of good drainage, obstruction was excluded in 40/72 renal units (RU). There were 21 RU with halftimes falling between 10 and 20 min, the slowing drainage zone. Percent differential function of the left/ right kidney in the range 45-55% was found in 21 patients; in range 25-45% in 10 patients. Relative kidney function was significantly affected (< 25%) in three patients. Two patients with nonfunctioning kidney (<10%) were withdrawn from calculation. The reported postnatal underlying diagnosis was unilateral hydronephrosis in 10, pelviureteric junction obstruction in 7, megaureter in 14, multicystic kidney and duplex system in 4 and posterior urethral valves in one case.Conclusion: Obstruction was excluded in 61 renal units. Significant reduction
Normal Sacroiliac Joint Index Values and Ephyphysis Visibility with Bone Scintigraphy in 4-19 Years Age Group K. Demirel, G. Koca, H. I. Atılgan, M. Korkmaz, A. Baskın, S. Özyurt; Department of Nuclear Medicine, Ankara Research and Training Hospital, Ankara, TURKEY. AIM: The aim of this study was to determine the normal sacroiliac joint index values and the visibility of the epiphysis with bone scintigraphy in childhood and young age group.MATERIAL-METHOD: 96 patients (50 female, 46 male; mean age: 11.7±4.5 years, age range: 4-19 years) with normal bone scintigraphy were included in the study. None of the patients had localized or systemic disease that could affect sacroiliac joint or epiphyseal plate. The patients were divided in four groups according to age with 4 years interval. Bone scintigraphy was obtained at 23 hours after i.v injection of Tc-99m-HDP. Sacroiliac joint index values were calculated as the mean count of the circular region of interest (ROI) in the sacroiliac joint / the mean count of the circular ROI in the sacrum. Also L4 vertebrae is used for the sacroiliac joint index instead of sacrum. Ephyphis lines were evaluated visually and semi-quantitative. Semi-quantitative evaluation was calculated as the mean count of the ROI in the epiphysis/the mean count of the ROI in middiaphyseal portion of the same bone.RESULTS: Sacroiliac joint index values were (sacrum and L4 vertebrae as background respectively) 1.19±0.20 (0.82-1.64) and 1.31 ± 0.19 (1.04-1.78) in 4-7 years, 1.23 ± 0.16 (0.92-1.58) and 1.35 ± 0.17 (1.071.82) in 8-11 years, 1.27 ± 0.19 (0.95-1.64) and 1.46 ± 0.18 (1.10-1.81) in 12-15 years, 1.34 ± 0.15 (0.94-1.58) and 1.48 ± 0.19 (1.16-2.13) in 16-19 years. There were not statistically significant differences between right and left sacroiliac joint index values. Epiphysis visibility was at most intense in proximal tibia and distal femur epiphysis. The scintigraphic visibilities of the epiphysis were documented according to the age groups. The latest visible epiphysis was proximal humerus epiphysis. In semi-quantitative evaluation, the most intense epiphysis was proximal tibia and distal femur epiphysis. The most visible epiphysis was proximal humerus epiphysis in 16-19 years age group. Distal humerus and proximal ulna epiphysis visibility decreased significantly after 8-11 years age group.CONCLUSION: When age
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P620 Pinhole SPECT and parallel hole SPECT comparison in 99m Tc-DMSA children kidneys studied with 1
1
2 1
G. Demonceau , M. Hesse , S. Walrand ; St Elisabeth Hospital, Zottegem, BELGIUM, 2UC Louvain, Brussels, BELGIUM. We evaluated the quality of the reconstructed images obtained with pinhole- and parallel hole SPECT in children, assessing the qualitative as well as quantitative differences between them and comparing with planar views.Eight children (mean age: 24+14 months) suspected of pyelonephritis were studied. Four planar views of 6 min were first acquired, 6 hours after a weight-dependant injection of 99mTcDMSA. A 180° pinhole (1 head) SPECT and a parallel hole SPECT (1 or 2 heads, 180° posterior or 360°), both of 25 minutes, immediately followed. Pinhole SPECT reconstruction was performed with the PHS software, using OSEM algorithm and adaptable intra- and post-reconstruction filters. Automatic motion correction was based on the path of the centre of mass of both kidneys on the acquired projections. The cortex-cavity ratio was calculated with manually drawn ROI’s in both SPECT techniques, with and without motion correction. Also, the general quality of the SPECT images was visually compared with the planar imaging.A significant motion was observed during the acquisition in 6 of the 8 patients. With or without motion correction, the cortex-cavity ratio measured in pinhole SPECT was significantly higher to that measured in parallel hole SPECT (2.34 vs 1.82; paired t-test). In all patients, the Bertin columns were better visualised with pinhole SPECT while the border of the kidneys appeared sharper, especially with motion correction. Regarding the visualization of the defects, a complete agreement with planar imaging was noticed in both SPECT techniques, but the defects were better visualised in pinhole SPECT. No additional defect was seen with both SPECT techniques compared to planar images, but an equivocal defect on planar view was only seen with parallel hole SPECT. This case will be discussed.This comparison based on a limited amount of patients supports the use of pinhole instead of parallel hole collimator for the kidney SPECT imaging with 99mTc-DMSA.
P621 Is there a relation between Helicobacter pylori infection and gastroesophageal reflux in childhood? E. Ceylan Gunay1, H. Yalcin2; 1Mersin University, Faculty of Medicine, Department of Nuclear Medicine, Mersin, TURKEY, 2Mustafa Kemal University, Faculty of Medicine, Department of Nuclear Medicine, Hatay, TURKEY. Purpose: The relation between Helicobacter pylori (Hp) infection and gastroesophageal reflux (GER) disease has been controversial particularly in children. The aim of this study was to investigate the possible relation between Hp infection and GER in pediatric patients on the basis of a retrospective examination of gastroesophageal reflux scintigraphy and C14- urea breath test(UBT) results.Subjects and Methods: The data of 130 patients (54 male, 76 female) aged between 5 and 16 ( mean age:11) has been retrospectively evaluated. The clinical indications were recurrent abdominal pain,cough or vomitting.Four hours of hunger was provided before UBT and GER scintigraphy. Medications of patients such as antiacids, H2 receptor blockers, proton pump inhibitors and antibiotics were stopped for a proper time before C-14 UBT. Breath test results were taken right after the test by using Heliprobe. GER scintigraphy was performed after oral administration of 200uCi Tc-99m DTPA in 100-200 ml orange juice. The time interval between UBT and GER scintigraphy was between 7 to 30 days.Histopathological evaluation was available in 40 of the patients besides C-14 UBT in Hp positive group.Results: Among the 130 patients, 39 (30%) were positive for GER, and 64 (49%) of 130 patients were found to have Hp infection. The ratio of GER in the Hp positive population was 32.8% compared with 27.7% in the Hp negative population (p >0.05). C14-UBT was negative in 48 of the 91 patients with negative GER scintigraphy.There was no statistically significant relation between GER scintigraphy and C14-UBT results (p >0.05).Conclusion: No correlation between GER and C-14 UBT results were detected according to our retrospective evaluation. A relation between Hp infection and GER could not be demonstrated.
P58 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Conventional & Specialised NM: Uronephrology
P622 Should the MDRD, CKD-EPI and co*ckcroft-Gault equations be used for a Nuclear Medicine population? A. J. Craig, A. Britten, S. D. Heenan, A. G. Irwin; St George's Hospital, London, UNITED KINGDOM. AimTo evaluate Estimated Glomerular Filtration Rate (eGFR) calculated from three recommended equations and compare with clinical radionuclide GFR (rGFR) measurements.IntroductioneGFR is being used increasingly in clinical practise worldwide in a variety of indications. The National Kidney Foundation K/DOQI guidelines recommend the eGFR for staging Chronic Kidney Disease (CKD). eGFR is also used in various clinical situations including assessing patients prior to contrast studies within Radiology and Cardiology. Two of the estimating equations recommended by K/DOQI are the Modification of Diet in Renal Disease (MDRD) equation and the co*ckgroft-Gault (CG) equation. A third equation the Chronic Kidney Disease Epidemiology collaboration (CKD-EPI) equation was developed after the K/DOQI guidelines were published and is said to be more accurate than the MDRD equation and is recommended to replace it in clinical use.MethodsFive hundred and sixteen retrospective rGFR (51Cr-EDTA) studies (male 279, female 237) from a mixed referral population (mainly Oncology, 74% outpatients) and mixed ethnicity were selected and the eGFR using the three equations were calculated. Regression and Bland-Altman analysis was performed. The bias was calculated as the mean difference and the precision as the standard deviation of the bias. These were calculated over four rGFR ranges: below 30 ml/min/1.73m2; 30-60 ml/min/1.73m2; 60-90 ml/min/1.73m2; and over 90 ml/min/1.73m2. These are important categories for classifying renal insufficiency.ResultsSignificant correlations were found between the rGFR and the three estimating equations (MDRD: R2=0.62, p<0.0001; CKD-EPI: R2=0.67, p<0.0001; CG: R2=0.61, p<0.0001. Significant differences (p<0.0001) in the medians between the rGFR and the eGFR estimates were found.The eGFR was found to overestimate the rGFR over the whole range of rGFR with the smallest bias (mean difference) from the CG eGFR (bias 9.8 ml/min/1.73m2, difference range -88.0 to 86.0 ml/min/1.73m2, precision 17.2 ml/min/1.73m2) and the largest from the CKD-EPI eGFR (bias 13.2 ml/min/1.73m2, difference range -62.6 to 87.1 ml/min/1.73m2, precision 14.3 ml/min/1.73m2).For those studies with an rGFR of less than 30 ml/min/1.73m2, 3060 ml/min/1.73m2 and 60-90 ml/min/1.73m2 bias was found to be lowest for the CG eGFR (2.8, 10.4 and 10.6 ml/min/1.73m2 respectively). 40.5% of rGFR studies were less than 60 ml/min/1.73m2 compared to 25.4, 24.0 and 32.0% for the MDRD, CKD-EPI and CG equations respectively.ConclusionsAlthough the estimation equations show a significant correlation with the rGFR, a positive bias was noted and the ability of eGFR to distinguish those patients with CKD stages 3, 4 and 5 was poor.
P623 Comparison of glomerular filtration rate measurements with the two plasma sample using Tc-99m DTPA, gamma camera, MDRD methods and other renal function tests in donor candidates for renal transplantation A. K. Ayan1, E. Varoglu2, M. Keles3, B. Seven1, A. Uyanık3; 1Department of Nuclear Medicine, Ataturk University, Medical School, Erzurum, TURKEY, 2 Department of Nuclear Medicine, Selcuk University, Meram Medical School, Konya, TURKEY, 3Division of Nephrology, Department of Internal Medicine, Ataturk University, Medical School, Erzurum, TURKEY. Introduction: Glomerular filtration rate has a big importance for the evaluation of renal functions in potential kidney donors. Materials and methods: Thirty potential kidney donors (19 female, 11 male; mean age 50.8 years) were included in this study. The present study has been designed to define the reliability of the gamma camera, MDRD and co*ckcroft Gault prediction equations in the determination of GFR measurements in potential kidney donors considering TPSM as a reference method. Results: The mean ± SD GFR value was 76.91 ± 12.46 ml/min/1.73 m2 in the two plasma sample method. GFR values calculated using gamma camera, MDRD 1, MDRD 2, Re-exp MDRD and co*ckcroft Gault prediction equations were 102.95 ± 16.36 ml/min/1.73 m2, 112.45 ± 34.71 ml/min/1.73 m2, 111.3 ± 35.16 ml/min/1.73 m2, 102.67 ± 23.08 ml/min/1.73 m2 respectively.Serum creatinine values were 0.70 ± 0.18 mg/dl in thirty donors.There is a good correlation among the methods of TPSM and gamma camera, MDRD 1, MDRD 2, Re-exp MDRD prediction equations. The correlation coefficiants were r=0.78, p=0.0001; r=0.46, p=0.009; r=0.39, p=0.03; r=0.56, p=0.001 respectively.There was no statistically significant correlation between TPSM and co*ckcroft Gault prediction equation. The correlation coefficient was r=0.25, p=0.17.Conclusion: There has been found a good correlation among the methods of TPSM, gamma camera method and MDRD prediction equations. As these procedures are easy to perform they can be used for the determination of GFR values in the potential transplant donors.
Poster Presentations
increases, normal sacroiliac joint index values increased relatively in childhood and young age group. In young age group sacroiliac joint index values need to be reevaluated according to age group normals that documented in the results when epiphysis lines are still visible. Patterns of epiphysis lines according to age should be studied in larger groups for more reliable data.
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P624 A new imaging method of multimodal diagnostic in patients with urolithiasis. V. H. Hadzhiyska1, T. Petrov1, I. Kostadinova1, V. Mladenov2, V. Marianovski3, V. Stoinova4; 1Clinic of nuclear medicine, Alexandrovska Hospital, Sofia, BULGARIA, 2Clinic of urology, Alexandrovska Hospital, Sofia, BULGARIA, 3Clinic of urology, Pirogov Hospital, Sofia, BULGARIA, 4 Department of computed tomography, St. Ekaterina Hospital, Sofia, BULGARIA. The aim of the study was to apply a new multimodal diagnostic method in patients with urolithiasis. We had to estimate its significance for the diagnosis of calculosis and the degree of persistent complications.Thirty patients (15 male, 15 female) aged between 13 and 85 years, with 60 kidneys, and suspected lithiasis were studied. All of them were examined with a new hybrid technology , including dynamic renal scintigraphy (DRS) with 99mTc-MAG 3 (74 MBq)., single photon emission computed tomography (SPECT) of the kidneys, ureters and the bladder and low dose computed tomography (CT, 51 mAs, 110 kV) of the same region. A diuretic test with furosemide, administrated 15 min. after the radiopharmaceutical injection was performed in 16 patients (53%) with an accumulation renographic curve (in 32 kidneys). The final diagnosis was proved with surgery or with a clinical follow up of the patients.By using the combined method (DRS - SPECT/CT), urolithiasis and its complications was found in 24 (80%) patients and in 36 (60%) kidneys. With the low dose CT were detected 42 stones, 30 of them in the kidney and 13 in the ureter. Secondary signs of obstruction on CT (dilatation of the collecting system and perinephric stranding) were found in 15 (25%) of the investigated kidneys. Among the 36 (60%) kidneys with positive helical CT findings, 25 (42%) were found to have obstruction by scintigraphy (25% completely, 11% partially). A DRS showed decreased split function in 20 (33%) of the investigated kidneys, while CT detected parenchymal reduction in 11 (18 %) of them. The SPECT procedure had additional role in determing the level of tracer retention in the cases with complete obstruction.Our experience show that this new hybrid imaging technique could be used for initial diagnosis of uroithiasis, localization and size of the urinary stones, providing complex information about the kidneys function, drainage and parenchymal changes. It could be also performed for fast differential diagnosis of obstructive and non-obstructive uropathy and for distinguishing dialatated renal collecting system from other conditions with similar image, for example parapelvic cysts. As a final result, the type of the further treatment could be determined - conservative, endoscopic, surgical, extra corporal shock wave and other.
P625 Improved Accuracy of Renal Clearance Measured by Gamma Camera M. Samal, V. Ptacnik, H. Jiskrova, D. Kotalova, J. Kubinyi, R. Rysava, V. Tesar; Charles University Prague & General University Hospital in Prague, Prague, CZECH REPUBLIC. Despite significant improvement in detection techniques and data processing methods, principal parameter derived from dynamic renal scintigraphy (DRS) remains split renal function while measurement of total renal function is considered inaccurate. The aim of the study was to compare 3 methods for attenuation correction (AC) and to assess their effect on accuracy of measurement of total renal function. The 2 methods chosen to measure total renal function were (1) clinically validated regression-based method by A.Taylor (AT), and (2) modelbased method by M.Rutland (MR). In posterior projection, AC was applied using kidney depth (KD) estimated by original regression formula. In geometric mean, AC was applied using body thickness (BT) estimated by regression and also using transmission measurement (TM) with 57Co flood source. Total renal function estimated in DRS has been compared with plasma clearance (PC) derived from a single plasma sample (C.Russell et al 1989). Comparisons have been performed in 107 patients with a wide range of 99mTc-MAG3 plasma clearance from 38 to 375 ml/min. The results were evaluated using correlation (R) and the mean absolute error (MAE) of prediction obtained by cross-validation. In posterior projection, the results have confirmed poor accuracy reported before. In our data, MR-KD predicted PC with R = 0.89 and MAE = 31 ml/min, AT-KD predicted PC with R = 0.77 and MAE = 45 ml/min. The accuracy was improved using geometric mean with estimated body thickness (MR-BT - R = 0.93, MAE = 26 ml/min, AT-KD - R = 0.94, MAE = 23 ml/min) and especially using simple transmission measurement (MR-TM R = 0.95, MAE = 16 ml/min, AT-TM - R = 0.96, MAE = 15 ml/min). In geometric mean, agreement between AT and MR was perfect (R = 0.99, MAE = 5 ml/min). In conclusion, acquisition of DRS in 2 opposite views (except in small children where close proximity of anterior detector may be scaring) and transmission measurement using 57Co flood source represent a procedure that is simple and fast enough to be easily introduced into clinical practice. The method substantially improves accuracy of measurement of total renal function with the error of prediction reduced by the factor of 2 - 3. Agreement between regression-based method derived from a group of patients and model-based method using individual
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 patient data documents quality of A.Taylor's method and M.Rutland's model. The study was supported by the Czech Science Foundation grant no. 303/07/0950.
P626 Evaluation of GFR by renal dynamic imaging in potient kidney donors X. Zhang, R. Wang, C. Zhang, L. Zuo; Peking University First Hospital, beijing, CHINA. Objective To evaluate GFR by renal dynamic imaging in potient kidney donors. Methods 45 potient kidney transplantation donors were selected. GFR were estimated using two methods: radionuclide renal dynamic imaging(gGFR); dual plasma sampling method(rGFR). GFR with radionuclide renal dynamic imaging was compared with rGFR. The spearman correlation and linear regression were used to describe the relationship between gGFR and rGFR. The difference and absolute difference between gGFR and rGFR were calculated. Accuracy was measured as the percentage of estimated GFR not deviating more than 15%, 30% and 50% from rGFR, respectively. All statistics were performed using SPSS 10.0. P<0.05 indicates statistical significance. Quantitative variables were described as mean±SD or median. Result gGFR was correlated well with rGFR(r=0.88,P<0.001. The linear regression equation was gGFR=0.66tGFR+21.78. The 15%, 30% and 50% accuracy of rGFR was 60.78%,89.56% and 100%. The median of difference and absolute difference between rGFR and gGFR were -1.23ml/(1.73m2.min) and 10.78 ml/(1.73m2.min), respectively. Conclusion Radionuclide renal dynamic imaging is a accuracy method to obtain the GFR of potient kidney donors.[Key words] Glomercular filtration rate; Kidney transplant; Radionuclide; Renal dynamic imaging; Dual plasma sampling method
P627 Precision of estimates of renal function by Modification of Diet for Renal Disease equation in Iranian patients with acute renal failure A. Emami-Ardekani, B. Fallahi, A. Fard-Esfahani, S. Farzanefar, D. Beiki, L. Sadeghian, M. Abbasi, M. Eftekhari, M. Saghari; Research Institute for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of, Tehran, IRAN, ISLAMIC REPUBLIC OF. Introduction:There are several validated equations to estimate glomerular filtration rate (GFR) in chronic kidney disease (CKD); re-expressed Modification of Diet for Renal Disease (MDRD) is recently the most confident method. These formula are not validated but are clinically imitated for patients with acute renal failure (ARF). The ARF is a diagnosis with diverse prognoses and corresponding treatments including acute tubular necrosis (ATN) and acute glomerulonephritis (AGN). We intended to study the accuracy of re-expressed MDRD and the practically more interested co*ckcroft-Gault equations in patients with ARF.Methods:The participants were patients admitted for ARF into or those complicated with ARF on the course of their hospitalization in the nephrology department of a university hospital, Tehran, Iran (n=21; 14 females (67%); age=44.8 ±19.5 years). After stabilization of the plasma creatinine level (<15% change in two consecutive days), GFR was measured with double plasma sample method (DPSM-GFR) using (99m)TcDTPA; also GFR was estimated by re-expressed MDRD (MDRD-GFR) and co*ckcroftGault (GFR-CG) equations. Because the MDRD-GFR and CG-GFR values were skewed the logarithmic transformations were employed for analyses.Results:The patients aged 44.8±19.5 years and weighted 67.8±10.7kg. DPSM-GFR (32.9±14.7 ml/min) was statistically different from the values of MDRD-GFR (11.6±8.2 ml/min; p<0.001) and CG-GFR (16.5±10ml/min; p<0.001). The difference between DPSMGFR and MDRD-GFR was significant in patients with either ATN (n=11; 31.9±15.0 vs. 11.7±10.3ml/min and p=0.001) or AGN (n=10; 34.1±15.1 vs. 11.4±5.6 ml/min and p=0.001) ; similarly the CG-GFR was lower than DPSM-GFR in patients with either ATN( 16.5±12.5ml/min and p<0.01) or AGN( 16.3±7.1ml/min and p30 (stage 2 renal failure) to have GFR <30ml/min (false positively as stage 3 renal failure). The false positive rate for the CG-GFR method was 84.6%.Conclusion:The results reveal that in Iranian patients with ARF, MDRD equation is substantially imprecise and co*ckcroft-Gault equation underestimates the GFR; clinicians should refer to more precise methods.
P628 Quantative assessment of renal function with 99mTc-MDP in comparison with 99mTc -DTPA H. M. Yassin; Cairo Univeristy Hospital, CAIRO, EGYPT. ABSTRACTRenal scintigraphy can provide the valuable split renal function which is not obtainable by other non invasive measurements. This study was designed to evaluate the usefulness of the bone tracer 99mTc-MDP for quantitative assessment of relative renal function as compared with renal imaging radiotracers used for that purpose. Differential renal function, i.e., the percent contribution each kidney makes to global renal function, was determined prospectively in 33 patients (22 males ,11 female, age 41±14 y) using 99mTc-MDP and a renal radionuclide tracer
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P629 Renal Clearance, Differenial Renal Function and Uptake Using 99mTc-MAG3 & 99m Tc-DMSA: What Are Optimal Time Interval and Background Region? H. Gad; Urology and Nephrology center, Mansoura, EGYPT. Purpose:The aim of this study was to evaluate the effects of various time intervals (1-2, 1.5-2.5,2-3min) post injection and different background regions (lateral, subrenal, between the kidneys) on MG3 clearance & differential renal function in 99mTc-MAG3 dynamic imaging together with differential renal uptake at 99mTcDMSA study.Methods:One hundred volunteers (donors) underwent both MAG3 and DMSA scintigrapic studies.Chemical creatinine clearance was calculated for all, differential renal function was estimated for each time interval (1-2, 1.5-2.5, 23min) and various background regions (lateral, subrenal ,between kidneys) after MAG3 administration and correlated with differential renal uptake of DMSA scans. MAG3 clearance was calculated at different positioned background ROIs and correlated with chemical creatinine clearance.Results:Right kidneys at DMSA scans with different time intervals revealed mean relative uptake 50%, standard deviation 4.5% and correlation coefficient 0.97%. However, they were 50.04, 4.3 & 1.00 respectively for left kidneys. At MAG3 studies; mean relative function, standard deviation & correlation Co-efficient for right kidneys were 49.99%, 4.5% & 0.96% and for left kidneys 49.98% 4.1% & 0.98 respectively for different time intervals. MAG3 clearance was calculated with different back-ground ROIs are correlated to chemical clearance.Conclusion:We concluded that no statistical significant difference between the mean DRF values obtained for MAG3 at each time interval and DMSA relative uptake.The highest correlation was obtained between the MAG3 clearance and creatinine chemical clearance with subrenal background ROI.
P631 Comparison of the Hayco*ck and DuBois and DuBois body surface area (BSA) calculation formulas in glomerular filtration rate (GFR) indexation in relation to age in children 1
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I. Tsechelidis , C. Sachpekidis , A. Svoukas , G. Sakagiannis , A. Iakovidoy1, A. Sioundas2, A. Papagianni3, G. Arsos1; 11st Dept of Nuclear Medicine, Aristotle University Medical School, Hippokration Hospital, Thessaloniki, GREECE, 2Dept of Medical Physics, Aristotle University Medical School, Hippokration Hospital, Thessaloniki, GREECE, 3Dept of Nephrology, Aristotle University Medical School, Hippokration Hospital, Thessaloniki, GREECE. Introduction : From birth to adulthood, GFR considerably increases with age due to both kidney maturation and body growth, thus necessitating indexation for body size. GFR is traditionally indexed by BSA which can be estimated as a function of height (H) and weight (W) by a number of formulas. Although the Hayco*ck (HA, 1978) formula is currently recommended (BSNM, 2005) for use in children, the DuBois and DuBois (DB, 1916) one is still widely applied. Both HA and DB formulas are of the form : BSA = a x Hb x Wc (a, b, c, constants) and differences between them are considered negligible. The present study is aiming to compare GFR-BSA indexation according to HA and DB formulas in relation to age in children.Subjects and methods : Eight hundred nineteen children and adolescents (37.1 % females), aged 8.2±4.9 years (range 3 months - 18 years) were enrolled in the study. BSA was calculated according to HA (BSA/HA) and DB (BSA/DB) formulas. GFR was measured with the slope-intercept, two-sample (2 and 4 hours p.i) technique after i.v. administration of Cr-51-EDTA, indexed by BSA/HA and BSA/DB (GFR/HA and GFR/DB respectively) and expressed as ml/min/1.73 m2. Patients were allocated in five (A-E) age groups (A, 81 patients, <2 years; B, 239 patients, 2-5 years; C, 194 patients, 5-10 years; D, 244 patients, 0-15 years and E, 61 patients, 15-18 years). For all age groups, the BSA/HA-BSA/DB and GFR/HA-GFR/DB differences were calculated. Statistical significance was accepted at p<0.05 level.Results : Values represent mean±SD (mean % difference in parentheses). The BSA/HA and BSA/HABSA/DB (m2) for age groups A-E were 0.43±0.08, -0.036± 0.016 (-8.12); 0.64±0.10, 0.074± 0.019 (-11.70); 0.92±0.16, -0.128± 0.028 (-14.00); 1.32±0.23, -0.201± 0.042 (-15.41) and 1.47±0.24, -0.220± 0.036 (-15.01) respectively. The GFR/HA and
GFR/HA-GFR/DB (ml/min/1.73 m2) for BMI groups A-E were 104.2±40.5, 8.73± 9.80 (7.74); 118.6±34.4, 12.39± 4.45 (10.42); 100.6±43.2 13.46± 5.87 (12.23); 105.0±41.4, 14.11± 6.17 (13.31) and 76.8±39.6, 9.93±5.35 (13.07) respectively. BSA/HA and GFR/HA were significantly different from BSA/DB and GFR/DB respectively in all age groups (paired t-test, P<0.001).Conclusion : In comparison to Hayco*ck’s formula, the DuBois and DuBois formula overestimates BSA in all age groups in children and adolescents leading to a comparable GFR underestimation. These changes are more prominent in children older than 2 years (>10%). Data from DuBois and DuBois formula GFR indexation are not directly comparable to those from Hayco*ck BSA indexation.
P632 The Evaluation of Lithium Influence on the Glomerular Filitration Rate by Using Double Blood Sampling Method A. A. İlhan1, D. Doguc2, M. Ylıdız1, S. S. Cerci1; 1Suleyman Demirel University Faculty of Medicine Department of Nuclear Medicine, Isparta, TURKEY, 2Suleyman Demirel University Faculty of Medicine Department of Biochemistry, Isparta, TURKEY. Aim: Although the number of alternative treatment methods introduced for bipolar disorder has increased recently, the Lithium treatment remains as one of the mostly used methods. It has been noted that Li may damage to kidney in several ways from mild damages to established kidney failure. For this reason, it has been recommended that patients who are treated with Li must be observed regularly and it is crucial to detect and prevent any major damage to the patient. In this study it has been aimed to measure the Li influence on glomerular functions of kidneys depending on the time when the subjects are treated.Methods: There are 49 patients consisting of 19 (38.7%) male and 30 (61.3%) female with the mean age 41.16 ±13.6 and they are chosen from patients who are diagnosed to have bipolar disorder and who have been treated with Li in Suleyman Demirel University Faculty of Medicine Department of Psychatry. In addition to them, 5 (31.5%) male and 11 (68.5%) female subjects have been incorporated as the control group who are healthy and not treated with Li. The Li treated patients are divided into 3 groups [grup I: 1 to 12 months, grup II: 1 to 5 years and grup III: more than 5 years of Li treatment] depending on the time of Li treatment and in order to measure the GFR of subjects, Tc-99m DTPA and double blood sampling methods have been applied. The Kruskal-Wallis test has been used to compare the data of the treatment groups to the control group. Results: The GFR means have been calculated for each group. Although it has been observed that the GRF means of experimental groups are lower than GRF means of control group especially group III; a significant correlation among groups could not found out statistically. (X²K-W: 2.181 SD: 3 p: 0.536). Conclusions: It has been concluded that Li does not create a significant effect on glomerular kidney functions clinically; therefore, double blood sampling method can be safely used on patients who are treated with Lithium.
P633 Comparison of Aspirin Renography and Captopril Renogram in the Diagnosis of Renovascular Hypertension S. Dabiri1, H. Argani2, B. Mahmoudian3; 1Tabriz University of Medical Sciences, Department of Nuclear Medicine, Tabriz, IRAN, ISLAMIC REPUBLIC OF, 2Shahid Beheshti University of Medical Siences, Department of Internal Medicine, Division of Nephrology, Tehran, IRAN, ISLAMIC REPUBLIC OF, 3Tabriz Gamma Scan Nuclear Medicine Center, Tabriz, IRAN, ISLAMIC REPUBLIC OF. Objectives: Renal artery stenosis (RAS) is the most common cause of secondary hypertension. Preliminary data suggest the aspirin renography is more sensitive than captopril renogram for indicating RAS. Aspirin reduces both renal blood flow and glomerular filtration. This study aimed to test whether filtration agents have the same accuracy as tubular agents or not.Methods: We prospectively compared aspirin renogram (20 mg/kg orally 1 hour before injection of radiotracer) and captopril renogram (50 mg orally 1 hour before injection of radiotracer) with 99mTcDTPA in 20 consecutive patients (pts) suspected of having RAS. Tracer uptake, timeactivity curves and glomerular filtration rate (GFR) were evaluated separately for each kidney. All pts underwent renal angiography.Results: Of the 20 pts enrolled, 11 had unilateral RAS on angiography. Decreased parenchymal uptake and GFR (9 ± 3 ml/min) with delayed secretion were observed in 11 pts after captopril test. The same findings were observed after aspirin test in one kidney of 9 pts. Aspirin renography could not show two cases with RAS (81.8% sensitivity). Captopril test showed 10 pts with unilateral RAS correctly and one patient was captopril positive without RAS on angiography (91% sensitivity and 90% specificity).Conclusion: Our data suggest that aspirin renography with 99mTc-DTPA has comparable sensitivity with captopril renogram in detection of unilateral RAS.
Poster Presentations
99mTc-DTPA. Differential function was computed in all cases from the early (1-3 minutes) renal uptake of the tracers by region-of-interest analysis of the computeracquired data. There was a high correlation between values of differential function obtained with 99mTc-MDP and those obtained with 99mTc-DTPA (r = 0.98, P less than 0.0001). Total GFR, differential GFR and renograms time to peak activity derived from both tracers were also highly correlated [r=0.96 (p<0.0001), r=0.98 (p<0.0001) and r=0.973(p<0.0001) respectively]. Qualitative assessment of the images revealed equivalent scintigraphic patterns in all patients. It is concluded that the early characteristics of renal handling of 99mTc-MDP are sufficiently similar to those of 99mTc-DTPA so that accurate estimates of differential renal function are possible with this agent, and that 99mTc-MDP determined renal differential most likely reflects differential glomerular filtration rate.Keywords: TC 99m-MDP, TC99m-DTPA, GFR, Scintigraphy
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P634 Comparative analysis of evolution in kidney transplant depending on the donor renal graft type: living, cadaveric heart-beating or asystolic. M. Suarez-Piñera1, L. Prat2, A. Mestre-Fusco1, J. Fuertes1, E. Tellez3, C. Barrios3; 1Nuclear Medicine. Hospital del Mar-CRC Mar, Barcelona, SPAIN, 2 Nuclear Medicine. CRC Hospital General de Catalunya, Sant Cugat, SPAIN, 3Nephrology. Hospital del Mar., Barcelona, SPAIN. Background:Kidney trasplant (KT) is the best therapeutic option for endstage renal failure. Characteristics of the donor is one of the most important predictive factor in kidney transplant outcome.Aim:1. To analyze the immediate evolution after KT based on the donor type. 2. To assess frequency, total number and data obtained from mercapto-acetyl-triglycine (99mTc-MAG3) renogram in the follow-up of KT. 3. To compare MAG3 results between different donor renal graft type.Material and methods:A retrospective analysis of 51 KT was performed in our center during 2010. Successive renograms were carried out in KT patients attending a follow-up defined by recovery of graft function. Patients were classified into three groups depending on donor type: Living donor (type I), cadaveric heart-beating donor (type II) and asystolic kidney donor (type III).Analyzed parameters were: type of donor (I, II or III), donor age, cold ischemia time of renal graft, resolution of tubular injury (days with tubular injury) and renogram parameters (perfusion, function, time/activity curves and renal maximum counts). Acute tubular necrosis period was defined as period of days between KT and last dialysis session.Results:Eight out of 51 KT were type I, 39 type II and 4 type III. Donor mean age was 52.9±12.3. Acute tubular necrosis time was: Type I 0±0, type II 5.4±9.1 and type III 5.2±6.0. Cold ischemia time was: Type I 1.7±0.8, type II 16.4±5.5 and type III 17±8.9. One to 3 renograms (mean 1.5) were performed in type I, which 78 % of patients showed a normal function in the first renogram. One to 5 renograms (mean 1.83) were performed in type II, which 5 % of patients showed a normal function in the first control. Finally, one to 5 renograms (mean 3.5) were carried out in type III which non-normal function in all of them in the first control.Conclusion:The most frequent renal graft is cadaveric donor type. It seems that graft recovery is similar in asystolic kidney donor group and cadaveric heart-beating donor group. Nevertheless time/activity curve has a slow normalization on serial studies in asystole group. Living donor group showed faster graft functional recovery and shorter follow-up by renogram.
P59 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Conventional
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NM:
Infection
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Inflammation
P635 The diagnostic value of 99m Tc-ubiquicidin (UBI) scintigraphy for osteomyelitis and comparisons with 99m Tc-MDP scintigraphy and magnetic resonance imaging M. Assadi1, K. Vahdat2, I. Nabipour3, M. Sehhat1, F. Hadavand2, H. Javadi4, A. Tavakoli5, J. Saberifard1, M. Kalantarhormozi3, M. Abbaszadeh1; 1The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, IRAN, ISLAMIC REPUBLIC OF, 2Department of Infectious Diseases, The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, IRAN, ISLAMIC REPUBLIC OF, 3Department of Endocrine and Metabolic Diseases, The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, IRAN, ISLAMIC REPUBLIC OF, 4Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences (GUOMS), Gorgan, IRAN, ISLAMIC REPUBLIC OF, 5Dept. of Orthopedic Surgery, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, IRAN, ISLAMIC REPUBLIC OF. Aim: The discrimination of bacterial infections from sterile inflammatory processes is of great importance in the management of inflammation. Currently available techniques cannot decisively address this issue. In this respect, antimicrobial peptide 99m Tc-ubiquicidin (UBI) 29-41 scans have been showing interesting results. The aim of this study was to determine 99m Tc-UBI scan accuracy in the detection of osteomyelitis and to compare it with 99m Tc-MDP scan and magnetic resonance imaging (MRI).Matherials and methods: Twenty patients (mean age=48.90 years) with suspected osteomyelitis were included in this study. After evaluation of each patient through history taking, physical examination, appropriate laboratory tests, and other processes including bone probing, wound culture, and plain film radiography (PFR), MRIs, 99m Tc-UBI scans, and 99m Tc-MDP scans were performed. For quantitative analysis, the mean count of abnormal to normal region (A/N) was calculated for images acquired at 15, 30, 45, 60, 120, and 240 min to obtain the most favorable time for imaging. The final diagnosis of osteomyelitis was made clinically, laboratorically, and radiographically.Results: In total, osteomyelitis was detected in the 99m Tc-UBI scans of 17 patients_indicating
100% accuracy, compared with an accuracy of 90% for osteomyelitis detected in 3phase bone scans. The maximum mean A/N was observed at 15 min after intravenous injection [median 1.91, interquartile range (1.54-2.94)]. MRI was performed in 12 cases only, with 75% accuracy. In addition, the A/N ratios for the 99m Tc-UBI scans were not significantly different between patients with or without Staphylococcus aureus growth on wound cultures.Conclusion: For fast imaging with high accuracy, 99mTc-UBI 29-41 is a suitable choice for the detection of osteomyelitis.
P636 99mTc HMPAO labeled leukocytes, photopenic defects; our experience S. Rodríguez Martínez de Llano1, I. Candal Casado1, R. Babarro Fernández2, P. Pais Silva1; 1Centro Oncológico de Galicia, La Coruña, SPAIN, 2Arquitecto Marcide Hospital Ferrol, La Coruña, SPAIN. IntroductionThe appearance of photopenic defects in labeled leukocyte scintigraphy with 99mTc HMPAO is a fact that, although rare, difficults our clinical practice, concluding scintigraphic studies as suggestive of infection.ObjectiveEstimate its frequency, search for a characteristic pattern to identify an underlying entity and its significance.Material and methodsWe performed a retrospective study from January 2009 to December 2010, selecting patients referred to our department to perform a scan with 99mTc HMPAO labeled leukocytes (dose injected mean 740MBq), selecting those that showed a photopenic (“cold”) defect. Results were assessed qualitatively by three experienced nuclear physicians. In addition, we contacted the referring physicians for confirmation of clinical diagnosis with other imaging thecniques or histology.Results4 patients (2.07%) of 193 reviewed, presented photopenic lesions, two of them with increased tracer uptake in the bone scan. All males (mean age 51.5 years), with a history of splenectomy, rheumatoid arthritis and spinal cord injury. Two cases located in column (lumbar) and two in the pelvis (hip and ischium). All were on antibiotics, with confirmation of infection process on MRI and germ isolated except in one case, all different (Streptococo pneumonie, Candida Albicans and Pseudomona Aeruginosa & Proteus Mirabilis). A follow-up study after 4 months without antibiotic showed no change in a patient.ConclusionsA photopenic defect though rare, is associated with active infectious process in specific locations such as spine and hip in patients with increased risk of infection, with no apparent relation to antibiotic treatment. Studies with more patients are needed to draw final conclusions.
P637 A novel scintigraphic agent, 99m Tc -UBI 29-41, to monitor antibiotic therapy in patients with orthopedic infection B. Nazari1, Z. Azizmohammadi1, M. Rajaei2, M. Karami2, H. Javadi3, M. Assadi4, I. Neshandar Asli1; 1Department of Nuclear Medicine, Taleghani Hospital, Shaheed Beheshti University of Medical Science, Tehran, IRAN, ISLAMIC REPUBLIC OF, 2Department of Orthopedic Surgery, Taleghani Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, IRAN, ISLAMIC REPUBLIC OF, 3Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences (GUOMS),, Gorgan, IRAN, ISLAMIC REPUBLIC OF, 4The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, IRAN, ISLAMIC REPUBLIC OF. Aim: Ubiquicidin (UBI) 29-41 is a cationic synthetic antimicrobial peptide fragment that binds preferentially with anionic microbial cell membranes at the site of infection. The current study evaluated the potential ability of 99m Tc-UBI 29-41 to assess response to antibiotic therapy in orthopedic infection.Matherials and methods: A total of 12 patients, 10 male and 2 female (mean age 41.6y; range 2375y), with suspected orthopedic infection (bone, soft tissue, or prosthesis) and positive UBI scan for infection were included in the study. One day after the 99m Tc-UBI scan, a bone scan was performed as well. After the first scan series, 9 of the 12 patients underwent appropriate treatment including empirical antibiotics; 3 patients refused treatment. After a 10-14 day interval all patients were divided into two groups: a) responder to therapy and 2) non-responder/non-treated. In all 12 patients, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured; and in most of them, wound cultures were carried out before and after the 10-14 day interval. Then, 3 of the 4 patients in the non-responder/non-treated group underwent antibiotic therapy and were evaluated again after 10-14 days. One of these patients responded to recent therapy and 2 patients did not. Thus, 15 cases were analyzed in this study and divided in two groups: a) 9 responder and b) 6 non-responder/non-treated. Results: Quantitative analysis of ESR, CRP, and bone scan before and after the 10-14 day interval showed no significant change in either group, but a quantitative 99m Tc-UBI scan 30, 60, and 120 minutes after tracer injection indicated significant reduction in radiotracer uptake after the 10-14 day interval compared to the 99m Tc-UBI scan before this interval in the responder group, and no significant change in the non-responder/ non -treated group. Conclusion: The 99m Tc-UBI scan can determine response to antibiotic therapy in orthopedic infection in humans.
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The role of Tc-99m MIBI scintigraphy in the management of patients with pulmonary tuberculosis
Fever of uknown origin and PET/CT E. Urbanova, J. Vizda; Dep. of Nucl. Med. University Hospital, Hradec Kralove, CZECH REPUBLIC.
Aim: This study aimed to determine whether 99mTc-methoxyisobutylisonitrile (MIBI) scanning could improve diagnostic accuracy of pulmonary tuberculosis (PTB) and help clinical decision making for accurate management.Material and methods: 99mTc-MIBI scintigraphy was performed in 62 cases of pulmonary which 34 cases had active pulmonary tuberculosis (APTB) and were at the beginning of antituberculosis medication ( group 1) as well as 28 cases had inactive pulmonary tuberculosis (IPTB) and were post antituberculosis medication ( group 2) . The qualitative and semiquantitative findings of both scanning methods were assessed. For semiquantitative evaluation, regions of interest (ROIs) were drawn over the lesion (L), non-lesion (NL) and neck soft tissue (NST).The mean count values of ROIs were obtained and L/NL and L/NST were calculated.Results: Thirty-four patients with APTB (15 males and 19 females; mean age of 47.85 ± 1.91 yrs) and 28 cases with IPTB (9 male and 19 females; mean age of 53.96 ± 2.33 yrs) were included in this study. The sensitivity, specificity, accuracy, positive and negative predictive (PPV and NPV) values of 99mTc-MIBI were 88.2%, 75 %, 82.2%, 81.1% and 84 % respectively. The mean value of L/NL in the APTB for 99mTc-MIBI was 1.45 ± 0.18 and L/NST was 1.57 ± 0.26 which was significant statistically ( p value< 0.00).Conclusion: The study demonstrated that 99mTc-MIBI scanning can be complementary to other diagnostic techniques especially in patients with indeterminate APTB and those in whom recurrent disease is suspected. In addition, ,because of its availability, rather low costs, easy performance, and objective semiquantitative information supplied, 99mTc-MIBI scanning might be establish in routine imaging center to assess the pulmonary tuberculosis ;however, further exploration is needed to validate its clinical role .
The aim of this study was to determine retrospectively the clinical value of PET/CT in patients with fever of unknown origin (FUO). Due to wide aetiology of FUO clinicians still have difficulties in identifying the causal disease. The three major categories that account for most FUO are: infection, malignancies and non infectious inflammatory diseases. 18F-FDG accumulates at the sites of infection and inflammation and granulomatous diseases, but also in malignant tissues. FDG-PET is known as a metabolic imaging modality and CT for morphology, so hybrid system has increased accuracy of diagnostic imaging.Method: In our study were 59 pts (21 men and 38 women with range 29-69years) with fever and clinical or laboratory signs of inflammation of unknown origin. The patient was asked to fast for six hours before the study in order to minimize glucose utilization in normal tissues. Acquisition started 60 min after intravenous administration of 18F-FDG. Whole body image from the mid femur to the base of the brain was obtained. All examinations were performed with complex PET/CT protocol combined PET and whole diagnostic contrast enhanced CT (except patients with renal impairment). PET/CT findings were compared with results of biopsy, immunology, other imaging methods and follow up of the patients.Results: The cause of FUO was explained correctly according to the PET/CT findings and followed investigations in 44 cases. In eight cases Hodgkin and non-Hodgkin lymphoma was proofed. In ten patients microbial infection was present (focal infection in thorax or abdomen), in six patients non infectious granulomatous disease (sarcoidosis) and nine patients with autoimmune inflammations (large vessel vasculitis). In three patients join prosthetic infection was revealed. Negative PET/CT findings essentially rules out orthopaedic prosthetic infections. Vascular graft infection was discovered in two patients, bowel inflammation in two patients and amoebic brain abscess in one patient. In 15 patients PET/CT not revealed the cause of FUO. False negative results were in two patients with temporal arteritis due to lower spatial resolution of PET and high physiological uptake of 18F-FDG in the brain.Conclusion: Our experience demonstrates PET/CT as useful method for discovery cause of FUO. PET/CT should be a part of the work up for detection of main disease underlying FUO aetiology.It can eliminate application unnecessary invasive and non-invasive diagnostic technique.
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Relationship between the alveolar-capillary membrane clerance of aerolized Tc-99m DTPA and Ga-67 uptake in the patients with sarcoidosis E. Sürücü1, R. Bekiş1, O. Kılınç2, H. Bozkurt1, S. Özkal3, E. S. Uçan2, H. Durak1; 1Dokuz Eylül University, School of Medicine, Department of Nuclear Medicine, izmir, TURKEY, 2Dokuz Eylül University, School of Medicine, Department of Pulmoner Medicine, izmir, TURKEY, 3Dokuz Eylül University, School of Medicine, Department of Pathology, izmir, TURKEY. Sarcoidosis is characterized with abnormal accumulation of chronic inflammatory cells in the differnet areas of the body. Inflammatory cells may damage the lung tissue, especially alveolar-capillary membrane. In this study, we aimed to evaluate the relation between alveolar-capillary membrane clearance and Galyum-67 (Ga67) uptake.26 patients with sarcoidosis were examined for this study. (average age 43±12; 9 men 17 women). Aerolize Tc-99m Diethylenetriamine pentaacetate (DTPA) was performed in order to find alveolar-capillary membrane clerance and Ga-67 scintigraphy was performed in order to evaluate the state of the sarcoidosis. Ga-67 uptake for Lung/ liver ratio in 48 and 72 hours was calculated. The correlation between Ga-67 uptake for Lung/ liver ratio, the alveolar-capillary membrane clerance and the result of BAL (Bronchoalveolar Lavage), furthermore, the correlation between alveolar-capillary membrane clerance and the result of BAL were analysed with spearman correlation test separately.Active sarcoidosis was detected in 23 patients with Ga-67 scintigraphy. The average alveolar-capillary membrane clerance was found 1,01 ±0.3 %/dk. The average Ga-67 uptake for Lung/ liver ratio in 48 and 72 hours was 1.18±0.45 and 1,15±0.51 respectively. We could not found a correlation between Ga-67 uptake for Lung/ liver ratio and alveolarcapillary membrane clerance (p=0,71;0,49). In addition, there was no correlation between Ga-67 uptake for Lung/ liver ratio and the percent of macrophage in BAL (p=0,84; 0,77), the percent of the lymphocytes (p=0,85; 0,88), the ratio of CD4/CD8 (p=0,098; 0,17). Moreover, there was no correlation between alveolar-capillary membrane clerance and the percent of macrophage in BAL (p=0,69), the percent of the lymphocytes (p=0,58), the ratio of CD4/CD8 (p=0,60).According to our results, The amount of Ga-67 uptake did not predict the disorder of the alveolar-capillary membrane clerance. Previous studies demonstrated alveolar-capillary membrane clerance was accelerated in the patients with sarcoidosis. However, the average alveolar-capillary membrane clerance in our study was lower than the value in the literature. The reason of the lower value can be due to th stage of the patients. Since there are different results about the alveolar-capillary membrane clerance in the literature, the studies with more patients are still necessary.
Body fat loss and fat distribution changes in HIV patients treated with highly active antiretroviral therapy (HAART) G. Madeddu1, A. Spanu2, F. Chessa2, G. M. Calia1, C. Lovigu2, A. Falchi2, M. Mannazzu1, P. Solinas2, M. S. Mura1, G. Madeddu2; 1Unit of Infectious Diseases. University of Sassari, Sassari, ITALY, 2Unit of Nuclear Medicine. University of Sassari, Sassari, ITALY. Aim: Body fat changes (BFC) are common in HIV infected patients on HAART, particularly in cases receiving protease inhibitors (PI); however, the pathogenic mechanism underlying BFC is still unclear. We further investigated whether both fat loss and fat distribution exist in HAART patients and which risk factors may be identified.Methods: We studied 165 patients (104 M, 61 F); 67 patients were CD4 Stage A, 55 Stage B and 43 Stage C. Fat changes were clinically present in 87/165 patients (FC) while these were absent in the remaining 78/165 cases (NFC). In each patient fat mass (FM; g) by dual energy X-ray adsorbiometry was measured in: whole body (W), trunk (T), peripheral regions (P), arms (A) and legs (L), also calculating trunk/peripheral (T/P) ratio and total weight (TW). We also determined BMI, CD4 count, CD4 cell nadir and rise from nadir, HIV RNA, HAART duration, including PI, NRTI and NNRTI.Results: W (p<0.01), P (p<0.0001) and L (p<0.0001) values were significantly lower in FC than in NFC while A was lower in FC, but the difference was not significant. Moreover, FC patients showed higher T and T/P ratio in respect of NFC patients; however, the difference was significant (p<0.0001) only when T/P was compared. There was no significant difference in TW and BMI between the FC and NFC groups. HAART duration was globally significantly (p<0.0001) higher in FC patients than NFC as well as was PI (p<0.02) and NRTI (p<0.002) therapy duration. Current CD4 count and CD4 rise from nadir were significantly (p<0.02 and 0.006, respectively) higher in FC than in NFC, while nadir, NNRTI duration and CDC stage showed no difference. W, P and L negatively correlated, but T/P positively, with PI and NRTI therapy duration, while no correlation was found with NNRTI therapy duration.Conclusions: In HIV patients on HAART fat distribution changes can occur, with higher fat loss in FC patients in respect of NFC in our cases. Fat loss seems to involve mainly peripheral regions, while fat accumulation is maintained in the trunk. The significantly higher rise in CD4 cells count from nadir in FC than in NFC could suggest a proinflammatory cytokine mediated role of immune recovery and dysfunction in peripheral fat loss. The longer exposure to PI and NRTI therapy as well as the better immune recovery in FC could represent risk factors for fat loss, both conditions affecting adipocyte metabolism.
Poster Presentations
G. Raziei1, R. Taghizadeh2, H. Javadi3, M. Assadi4; 1Departemet of Nuclear Medicine, Milad Hospital, Tehran, IRAN, ISLAMIC REPUBLIC OF, 2 Department of Nuclear Medicine, Taleghani Hospital, Shaheed Beheshti University of Medical Science, Tehran, IRAN, ISLAMIC REPUBLIC OF, 3 Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, IRAN, ISLAMIC REPUBLIC OF, 4The Persian Gulf Nuclear Medicine Research Center , Bushehr University of Medical Sciences, Bushehr, IRAN, ISLAMIC REPUBLIC OF.
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Evaluation of Tc-Ubiquicidin scintigrapghy in differentiation of bacterial infection from sterile inflammation in suspected orthopedic implants D. Beiki1, B. Fallahi1, G. Yoosefi1, M. Tahmasebi2, M. Eftekhari1, A. FardEsfahani1, A. Emami Ardekani1, M. Saghari1; 1Research Institute for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, IRAN, ISLAMIC REPUBLIC OF, 2Shariati Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, IRAN, ISLAMIC REPUBLIC OF. Introduction: Ubiquicidin (UBI) 29-41 is a synthetic antimicrobial peptide fragment that binds preferentially to the microbial cell membrane at the site of infection . The present study was conducted to assess potentiality of UBI (29-41) for the differentiation between bacterial infection and sterile inflammation or loosening of bone prosthetic device in humans. Methods: Nine male patients (mean age, 41.56 yrs; range: 24-82 yrs) with suspected implant infection or loosening due to positive three-phase bone scans were included in the study. 99mTc-UBI in a dose of 555740 MBq was injected intravenously. A dynamic study, comprised 10 frames of 60 s each, was followed by spot views of the suspected region (target), a corresponding normal area (nontarget), liver and kidneys at 60 and 120 min. The target-tonontarget ratios were used to find the optimum time for imaging. Whole-body anterior and posterior images were also acquired at 60 and 120 min. Visual score (0-3) was used to categorize studies as positive or negative, with scores of 0 (minimal or no uptake; equivalent to soft tissue) and 1 (mild; less uptake than in liver) being considered negative while scores of 2 (moderate; uptake greater than or equal to that in liver) and 3 (intense; uptake greater than or equal to that in kidneys) being considered positive. The scan findings were interpreted as true- or false-positive and true- or false-negative on the basis of bacterial culture as the gold standard. Results: Visual and quantitative analyses revealed no significant difference of target-to-nontarget ratio between 60 and 120 min images. Of 9 studied patients, 6 showed positive and 3 showed negative findings. Statistical analysis revealed a sensitivity of 100% (5/5) and specificity of 75% (3/4) for the detection of bacterial infection. Only one false-positive case was identified. Positive and negative predictive values were 83.3% and 100%, respectively. Conclusion: 99mTc-UBI 29-41 showed high potentiality in localizing foci of implant infection with high sensitivity and specificity.
P643 Possibilities of a quantitative scintigraphy method of joints in early diagnostics of arthritises. D. N. Shulgin, D. R. Olisaeva, O. A. Fomicheva, V. B. Sergienko; Russian Cardiology Research Centr, Moscow, RUSSIAN FEDERATION. The rheumatoid arthritis (RA) is surveyed now as a chronic autoimmune system inflammatory disease with a primary lesion of peripheric joints. At present about 1% of the population of the Earth suffers from RA. Disease debuts with the articulate syndrome which is most expressed in first 4-5 years. There is a tendency to disease development at young age, to fast advance of RA and to an early exit of patients on physical inability (from 40% to 46.6 % in the first year of disease). Radiological changes in joints are often minimal or are not visualized at all. It is caused by insufficient resolving power of roentgenography.The purpose is:to analyse possibilities of a quantitative scintigraphy method of joints in early diagnostics of arthritises, in revealing of subclinical phases of joints’ lesions, in differential diagnostics of inflammatory and dystrophic lesions of joints.Research methods:Standard osteoscintigraphy with 99mTc-pyrophosphate with the subsequent quantitative estimation of condition of metacarpophalangeal, knee and metatarsophalangeal joints (as the most often affected by RA joints) was carried out on 60 patients at the age from 18 to 65 years. Also the joint pain was estimated by means of a questionnaire, and morbidity in joints was estimated by a palpation. As a measure of joints’ lesion the accumulation factor was used (it is measured at a relation of a count over the joint area to a count over the adjacent bone).The results:The lesion of metatarsophalangeal joints is visualized in 47 persons (78 %), the lesion of knee joints is visualized in 37 persons (62 %), the lesion of metacarpophalangeal joints is visualized in 23 persons (38 %). At the same time 34 persons (57 %) had lesions of both knee and metatarsophalangeal joints, and 12 persons (20 %) had lesions of all three groups of joints.The conclusion:The quantitative scintigraphy of joints is an exact and sensitive method which can appear to be useful for screening of arthropathies, for examination and differential diagnostics of joints’ diseases.
P644 Scintigraphic Evaluation of Stump Region and Effect to the Therapy Modalities after Amputation G. Koca, K. Demirel, A. Comak, A. Baskin, S. Yildirim, M. Korkmaz; Department of Nuclear Medicine, Ankara Training and Research Hospital, Ankara, TURKEY.
AIM: We purpose to evaluate stump region with scintigraphy and compare the correlation of treatment modalities and scintigraphic resuts.MATERIAL-METHODS: Mean age 51.39±2.70 years (min: 2, max: 82) of 44 cases (11 female, 33 male) with extremity amputation were included in the study. Amputation applied cases because of trauma or peripheric vessel disease underwent 4 phases Tc-99m HDP scintigraphy. According to the scanning time after amputation, 4 groups (0-3 months, 3 months-1 year, 1-3 years, more than 3 years) were formed. According to the amputation regions 5 groups ( toes, ankle, under knee, femur, arm) were evaluated. After scintigraphic evaluation, results were recorded into 5 groups as osteomyelitis, soft tissue infection, reactive changes secondary to surgery, chronic osteomyelitis and normal). Postsurgical treatment modalities of the patients were determined and results were evaluated.RESULTS: In the scintigraphic evaluation of stump regions of the 44 amputated cases, 19 acute osteomyelitis, 1 chronic osteomyelitis, 7 soft tissue infection, 8 changes secondary to the surgery were observed. 9 of 44 cases had normal scintigraphis features. In the scintigraphic evaluation,15/20 of the cases reported as osteomyelitis took antibiotic treatment and 5/20 had surgery. All the cases that are reported as soft tissue infection took antibiotic treatment (7/7). For the cases that are reported changes secondary to the surgery, 1/8 had surgery, 2/8 took antibiotic treatment and 5/8 had no additional treatment. There was strong correlation between scintigraphic result and treatment approach (p<0.0001, r=0,803) by means of preffered therapy and effectiveness of the therapy. Scintigraphic need increases with age after amputation and negative correlation between patient age and scintigraphic need was found (p<0.02, r= -0.339). There was no pathology in the cases that are scintigraphically normal.CONCLUSION: Bone scintigraphy is a cost effective, noninvasive and efficient method that directs treatment in the evaluation of the stump region after amputation.
P645 Tc99m-HMPAO-labeled leucocyte scan in the diagnosis of infected hip prostheses:early imaging and combination with bone marrow scan but not semiquantitative analysis are useful adjuncts to the diagnosis S. Georga1, T. Christoforidis1, D. Lo-Presti1, S. Fares2, V. Nikos1, I. Iakovou1, A. Dumas1, G. Kapetanos2, N. Karatzas1; 1Dept of Nuclear Medicine, Aristotle University Medical School,Papageorgiou Hospital, Thessaloniki, GREECE, 23rd Clinic of Orthopaedic Surgery, Aristotle University Medical School,Papageorgiou Hospital, Thessaloniki, GREECE. Aim: To evaluate the efficacy of Tc99m-HMPAO-labeled-leucocyte scan (LS), alone, in combination with Tc99m-colloid bone marrow scan (BMS), and with the addition of semiquantitative analysis, for diagnosing infected hip prostheses.Methods: 48 patients with painful total hip prostheses underwent LS followed by BMS after two days. LS images were acquired 1 and 4 hours post injection and were interpreted alone and in conjunction with separately obtained BMS images as follows: a) increased periprosthetic uptake on late LS images or b) leucocyte uptake raising over time or c) incongruent late LS/BMS images all indicated infection. In addition, mean counts/pixel in the suspected infection area (SA) and in the contralateral area (CA) were recorded and SA-to-CA ratios for early and late LS and for BMS were calculated (early LSR, late LSR and BMSR respectively). Furthermore, late LSR to BMSR ratios were calculated. Diagnosis was confirmed by surgical, histological and bacteriological findings or clinical follow-up.Results: Among the 48 hip prostheses investigated, 16 infected and 32 uninfected prostheses were diagnosed. Sensitivity, specificity and accuracy of late LS alone for diagnosing periprosthetic hip infection were 80.0%, 81.8 % and 81.2% respectively. The same parameters were 66.7%, 88.2% and 80.8% respectively for combined early and late LS and 72.7%, 96% and 88.9% respectively for combined late LS/BMS. Semiquantitative analysis wasn’t helpful in the diagnosis as both early and late LSR ratios as well as late LSR/BMSR were not significantly different between infected and uninfected prostheses (1.49 ± 0.74 vs 1.13 ± 0.55, 1.56 ± 0.98 vs 1.41 ± 0.91 and 1.28 ± 0.47 vs 1.15 ± 0.47 respectively). These low values, even in infected prostheses, may reflect the presence of functioning marrow in the contralateral area used as control. A different control with potentially lower marrow activity might be more helpful in discrimination of aseptic loosening from infection. Moreover, it seems that the pattern of leucocyte periprosthetic uptake, as visually assessed, rather than the uptake intensity, is more important for infection diagnosis. Conclusions: According to our results, late (4hour) Tc99m-HMPAO-labeled-leucocyte imaging is an effective method for diagnosing infected hip prostheses. The addition of early imaging may improve the specificity of LS. The additional performance of BMS further improves specificity and accuracy of LS. Consequently, combined LS/BMS is the most optimal procedure to diagnose infected hip prostheses. Finally, in our study, semiquantitative analysis wasn’t proved helpful in discrimination of aseptic loosening from infection of hip prostheses.
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The Efficiacy of F-18 FDG PET Scan in Differential Diagnosis of Orthopedic Prostheses Infection A. O. Öner1, A. Gülten2, F. Aydın1, M. Ürgüden2, F. Güngör1; 1Akdeniz University Nucleer Medicine Department, Antalya, TURKEY, 2Akdeniz University Faculty of Medicine Department of Orthopedics and Traumatology, Antalya, TURKEY. Aim: The aim of this study was to evaluate the value of F-18 Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) imaging in suspicious orthopedic prosthesis infection.Method: Eighteen patients with the diagnosis of prosthetic infection applied to Department of Nuclear Medicine and were evaluated between December 2009-February 2011. Seven of these patients were not included in the study due to no clinical follow up and final diagnosis, 11 of the patients (8 women, 3 men; 40-81 years old, mean 64.3 ± 15.4), (5 knees prosthesis and 6 hip prostheses) were evaluated retrospectively. All patients had suspicion of prostheses infection as clinical and laboratory. Cases were evaluated with three phase bone scintigraphy and F-18 FDG PET imaging. Infection diagnosis was done according to operation and culture results, or clinical follow-up.Results: F-18 FDG PET imaging were evaluated as positive in 8 cases (all true positive) and as negative in 3 cases (2 true negative, one false negative) in terms of prosthesis infection.Conclusion: FDG PET might be an alternative imaging modality in the differantial diagnosis of infection of orthopedic prosthesis.
P647 The added value of hybrid SPECT/CT in patients undergoing labelled leukocyte scintigraphy for suspected abdominal aortic graft sepsis M. Shawgi, S. Muthu, J. James; Central Manchester Hospitals Foundation Trust, MANCHESTER, UNITED KINGDOM. BACKGROUND and OBJECTIVES: Abdominal aortic graft infection is one of the most severe complications of vascular surgery, with high mortality and morbidity, and can be difficult to diagnose clinically and radiologically. Indium-111 (In-111) labelled leukocyte scintigraphy is a well established technique for imaging infection and is perceived to be superior to Tc-99m and Ga-67 in localising abdominal and pelvic infections due to the absence of bowel and renal excretion. However, computed tomography (CT) and magnetic resonance imaging (MRI) are often preferred as the first line investigations in patients with suspected aortic graft infections due to the limitations of traditional In-111 imaging, i.e. prolonged imaging time, lack of specific anatomical localisation and the less favourable imaging qualities of In-111. Introduction of SPECT/CT as a clinical dual-modality has allowed integration of molecular imaging to detect infection and anatomical imaging to localise it. We report on the value of SPECT/CT in evaluation of patients with suspected abdominal aortic graft infection undergoing Indium-111 labelled imaging.METHODS and RESULTS: We retrospectively evaluated a series of patients with (1) history of abdominal aortic aneurysm repair, (2) pyrexia of unknown origin, and (3) no demonstrable focus of infection on other diagnostic imaging modalities. All the patients underwent planar Indium-111 labelled leukocyte scintigraphy over 48 hours, in addition to SPECT/CT imaging using Siemens Symbia T TruePoint or GE Millennium VG/Hawkeye. Positive findings included aortic grafts infections and infected pelvic collections. Compared with planar imaging, SPECT/CT images yielded added value for clinical interpretation, anatomical localisation and diagnostic confidence in all the cases.CONCLUSION: SPECT/CT is a valuable tool that provides enhanced anatomical localisation and improves diagnostic confidence in patients with suspected abdominal aortic graft sepsis.
P648 A large population of patients affected by Alveolar Echinococcosis followed by standard and delayed PET scan. C. Caoduro1, C. Porot1, G. Barrali-Quemard1, O. Laurent1, O. Angoué2, C. Ungureanu2, E. Zunon-Kipre1, H. Boulahdour2, O. Blagosklonov2; 1Jean Minjoz university hospital, Besançon, FRANCE, 2University of FrancheComté and Jean Minjoz university hospital, Besançon, FRANCE. Aim : Alveolar echinococcosis (AE) is a rare and chronic parasitic disease caused by the intra-hepatic development of the larval form of Echinococcus multilocularis, a small taeniid cestode. AE behaves like a slow-growing liver cancer and the lesions can cause severe complications such as cholangitis, biliary cirrhosis, liver abscesses, bleeding from esophageal or duodenal varices due to portal hypertension, BuddChiari disease, and complications of heart, lung or brain metastases. Complete surgical removal of the lesion which remains the gold standard treatment can only be performed in 30-40% of patients because of long clinical latency. The cases of late diagnosis require life-long treatment with benzimidazole (BZM), able to slow down parasite growth and to improve survival. The main endemic regions are Central Europe but also Turkey, Iraq, Japan, northern India, central China and North America. In this context, our study deals with the management of a large population of AE followed between 2004 and 2010 in our WHO-Collaborating
Centre of Besançon, Franche-Comté. FDG-PET scan has proved his usefulness for the following of AE patients. Thus, EA lesions show the halo FDG uptake and lesionto-background contrast may be decreased in patients under long-life parasitostatic BZM treatment.Materials and methods : From march 2004 to september 2010, 74 AE patients treated by BZM underwent a whole-body imaging on a PET/CT device, 1h after the IV injection of FDG (4Mbq/kg), followed by a delayed PET/CT scan performed 3h after injection, and focused on the hepatic region.Results : 121 exams have been interpreted. Among them, 13 presented negativ lesions on the standard PET scan and became positiv on the delayed exam. Furthermore 20 exams considered as suspect on the first acquisition, presented clear perilesional enhancement on the delayed PET scan. Finally, 6 negativ exams on standard PETscan became suspect on the second acquisition. In this way, delayed PET scan has changed results for 32,23% of the exams.Conclusions : Our study illustrates the usefulness of FDG-PET in the management of AE patients. The results also demonstrate that delayed acquistion of PET-CT images is actually the most sensitive tool to assess metabolic activity in AE lesions and to confirm the lack of FDG uptake on a standard PET-scan. Moreover, such delayed PET scan helps to decide the discontinuation of BZM, which may be parasitocidal in selected cases.
P60 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Conventional
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NM:
Bone
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P649 Correlation of circulating omentin-1 with bone mineral density in multiple sclerosis: the crosstalk between bone and adipose tissue M. Assadi1, H. Salimipour2, S. Akbarzadeh3, Z. Samani1, R. Nemati2, S. Jafari4, M. Seyedabadi1, M. Abbaszadeh1, I. Nabipour5; 1The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, IRAN, ISLAMIC REPUBLIC OF, 2Department of Neurology, School of Medicine, Bushehr University of Medical Sciences,, Bushehr, IRAN, ISLAMIC REPUBLIC OF, 3Department of Biochemistry, School of Medicine, Bushehr University of Medical Sciences,, Bushehr, IRAN, ISLAMIC REPUBLIC OF, 4Department of Endocrine and Metabolic Diseases, The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, IRAN, ISLAMIC REPUBLIC OF, 5Department of Endocrine and Metabolic Diseases, The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, IRAN, ISLAMIC REPUBLIC OF. Aim: Adipose tissue-derived adipokines play important roles in inflammatory and autoimmune diseases. Although the relationship of adipokines with chondrocyte function and the skeleton have been investigated, the role of novel adipokines (e.g., omentin-1 and vaspin) in osteoimmunology remains to be elucidated. Patients with multiple sclerosis (MS) are at increased risk of osteoporosis and fractures.Matherials and methods: In order to investigate circulating levels of these novel adipokines in relation to bone health in MS, 35 ambulatory MS patients with relapsingremitting courses were compared with 38 healthy age- and sex-matched healthy controls.Bone mineral density (BMD) was determined for the lumbar spine (L2-L4) and the proximal femur using dual-energy x-ray absorptiometry. Circulating omentin-1, vaspin, osteocalcin, osteopontin, osteoprotegerin, the receptor activator of nuclear factor-κB ligand, matrix metalloproteinase 9, and C-reactive protein were evaluated by highly specific enzyme-linked immunosorbent assay methods. Results: There was no significant difference between the two groups regarding bone-related cytokines, adipocytokines, and the BMD measurements of patients with MS and the healthy controls. However, age- and body mass indexadjusted circulating omentin-1 levels were positively correlated with BMD at the femoral neck (r= 0.44,p=0.017), total hip (r=0.41, p=0.027), osteopontin (r=0.44, p=0.031) and osteocalcin (r=0.47,p=0.012) in MS patients. No correlations were found between vaspin, biochemical, and BMD measures in both groups. Conclusion:Elevated omentin-1 serum levels are correlated with BMD at the femoral neck and the serum levels of osteocalcin and osteopontin in MS patients.Therefore, there is crosstalk between adipose tissue and bone in MS as an autoimmune disorder.
P650 Bone mineral density and body composition in ankylosing spondylitis C. Sioka, I. Saougou, A. Papadopoulos, E. Gkika, V. Botzoris, N. Tsifetaki, J. Kalef-Ezra, A. Fotopoulos, A. Drosos; University hospital of Ioannina, Ioannina, GREECE. Aim: To compare bone mineral density (BMD) and body composition in male patients with ankylosing spondylitis (AS) and healthy individual (defined as control group (C)), and to determine their relationships with disease activity
Poster Presentations
P646
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S414 parameters.Materials and Methods: Thirty-seven male patients were compared with thirty-seven age-matched controls. All of them were subjected to total hip, lumbar spine and total body dual energy X-ray absorptiometry (DXA). BMD in all studied areas were evaluated, as well as total body bone mineral content (BMC) and fat (F) and remaining substances (L). Radiological grading was determined by New York criteria for sacroilitis and modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and disease activity by using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Bath Ankylosing Spondylitis Functional Index (BASFI), as well as C-reactive protein (CRP) levels and the erythrocyte sedimentation rate (ESR).Results: BMD in male AS patients were significantly lower compared with controls (p<0.05) in femoral neck but not in lumbar spine. Total body DXA reveal a lower mean BMD and BMC values in patients compared with the C males, but not in fat and remaining substances. Finally, when studying for possible relationships between BMD with radiological scores and disease activity parameters (BASDAI, BASFI, CRP and ESR), no correlations was found, except femoral neck BMD that was correlated with ESR (p=0.041).Conclusion: This study demonstrated that there is a generalized reduction in BMD and BMC in male AS patients without alterations in soft tissue composition. No correlation was found with disease activity. Patients with AS should be routinely screened with DXA for evaluation of BMD.
P651 Follow-Up Quantitative Bone SPECT-CT in the Diagnosis of Active Condylar Hyperplasia L. Mohamed Salem, J. Sanchez Catalicio, F. Perez Angel, C. Villena Garcia, A. Montellano Fenoy, J. Navarro Fernandez, L. Frutos Esteban, M. Castellon Sanchez, D. Segarra Fenoll, M. CLAVER VALDERAS; Hospital Universitario Virgen de la Arrixaca, El Palmar (Murcia), SPAIN. IntroductionCondylar Hyperplasia (CH) has an important aesthetic and psychological impact on young patients. In the absence of a criterion or a gold standard for the diagnosis of active CH, Quantitative Condylar Bone SPECT-CT (QCB SPECT-CT) seems to be promising improving significantly sensitivity and specificity compared to Planar Bone Scintigraphy.There are few published data on the normal values of QCB SPECT and its clinical efficacy to differentiate active from non-active CH to establish optimal surgical approach to correct the facial asymmetry. According to some published data, there is some evidence that a Differential Condylar Quantification (DCQ) >= 55% in the hyperactive condyle is suggestive of active CH, however further investigation is required to determine the reference values and clarify its real clinical usefulness.AimTo assess the value of follow-up QCB SPECT-CT in the diagnosis of active CH.Materials and methodsTogether with the Oral and Maxillofacial Surgery Department, we study prospectively 31 patients who underwent a cranial QCB SPECT-CT study during the period between 2009 and 2011.We randomly repeated the QCB SPECT-CT in 10 patients who had not received any treatment (9 females and 1 male aged between 21 and 36 years) with at least a 6 month-interval; 5 patients females with a DCQ >= 55%, and 5 patients with a DCQ < 55%, including one patient with a three-time study.Results -5 patients with a DCQ < 55% (mean 53.33 ± 0.80): DCQ decreased in the second study in 4 patients (mean 51.71 ± 1.08), in the patient with three-time study, DCQ decreased in every successive study, DCQ increased slightly in one patient from 51.12% to 52.74%.-5 patients with DCQ >= 55% (58.78 ± 2.22): DCQ decreased in the second study (53.73±3.28), becoming less than 55% in 3 patients-Osteogenic activity showed a decreasing tendency in 9 patients-Clinical follow-up, diagnostic imaging and other methods were not impressive of active CH.ConclusionsThe follow-up QCB SPECT-CT performed twice within at least 6 months interval is useful and necessary to confirm the presence of active CHDCQ <55% was related with inactive HC, while DCQ >= 55% was not indicative of active HC in 3 of 5 patientsClinical watchful waiting and follow-up with QCB SPECT-CT may be the best method to avoid partial condylectomy in most patients with facial asymmetry supposed to have active CH
P653 Prediction of survival in prostate cancer patients by bone scan index using computer-assisted diagnosis system M. Yoshimura, Y. Takahashi, K. Uchida, K. Suzuki, T. Hashimoto, T. Funatsu, N. Yoshimura, J. Park, T. Saguchi, K. Saito, K. Tokuuye; Tokyo Medical University, Shiujuku-ku, Tokyo, JAPAN. the aim:The extent of disease (EOD) score has previously been proven to correlate with survival of prostate cancer. However, the current manual method is heavily time consuming and sometimes causes interobserver variation. This time we obtained bone scan index (BSI) by CAD system developed by EXINI diagnostics AB automatically, and assessed the possibility of replacement of EOD score to this automated BSI.materials & methods:(EOD score)On the basis of the number or extent of metastases, the bone scintigraphy was divided into five EOD grades as follows: 0. normal; 1. number of bony metastases less than six, each of which is less than 50% the size of a vertebral body; 2. number of bone metastases between six and 20; 3. number or metastases more than 20 but less than a “superscan”; 4.
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 “superscan” or its equivalent.(BSI)One hundred fifty-eight individual bones in the body were listed by name.The fractional involvement of each bone by tumor was estimated visually from the bone scan. The BSI was then calculated by summing the product of the weight and the fractional involvement of each bone expressed as percentages of the entire skeleton. In this study, the automated quantification method of BSI developed by EXINI diagnostics AB was employed. The training and validation of the artificial neural networks were performed using customized software including 907 Japanese patients with bone scintigraphy.(Patients)A total of 135 patients with a diagnosis of prostate cancer were involved. Ninety-nine patients were classified as EOD 0, 26 as EOD I, 10 as EODII-IV. In all patients, BSI was obtained automatically.results:BSI varied from 0 to 26.4. BSI of each category were 0.2998±0.282, 2.4031±1.2367, 16.6842±6.9045, for EOD 0, EOD I, EODIIIV.EOD 0, I and II-IV are significantly different from the other categories (Tukey Kramer test : EOD 0 versus EOD 1, P<0.001; EOD 0 versus EODII-IV, P<0.001; EOD I versus EODII-IV, P<0.001) .conclusion:EOD score and BSI correlated significantly. So this quantification method of BSI will be able to predict the survival of prostate cancer automatically instead of EOD score.
P654 Utility of whole body blood pool imaging in three phase bone scintigraphy. J. Koutsikos1, T. Pipikos2, I. Xirafi1, H. Tourkohoriti1, F. Chroni1, A. Velidaki3; 1Central Clinic of Athens, Nuclear Medicine dept., Athens, GREECE, 2401 General Army Hospital, Nuclear Medicine dept., Athens, GREECE, 3Laiko General Hospital of Athens, Nuclear Medicine dept., Athens, GREECE. IntroductionThree-phase bone scintigraphy (3phBS) is widely used for the diagnosis and localization of inflammation and infection and other clinical circ*mstances, such as complex regional pain syndrome and sports-related injuries. 3phBS involves targeted imaging of the area of interest in the first phase (flow, immediately after injection), second (soft tissue blood pool, 2-10 minutes after injection), and delayed bone uptake (3-4 hours after injection). The entire skeleton in addition to the area of interest is routinely imaged during the delayed phase (WBS). The purpose of this study was to determine the diagnostic utility and clinical importance of a wholebody blood pool scintigraphy (WBBPS) in directed 3phBS.Materials & Methods50 pts (14 males, 36 females, mean age 73.6 years), were referred for a 3phBS with main indications prosthesis evaluation, occult fracture or stress reaction and pain. 20 mCi Tc-99m MDP were injected and WBBPS and WBS were obtained. The findings from WBBPS were compared to WBS findings and if recommended additional evaluation were characterized as additive. Clinical indications, findings, recommendations, and outcome were assessed.ResultsAdditive findings were evaluated in 14/50 pts. The most common finding (11/14 pts) was lower extremity vessel disease. In an 84-year-old female was detected dextrocardia and in an 88year-old female, WBBPS differentiated the tracer distribution in an abdominal kidney. Finally in a 26-year-old female, in WBBPS increased uptake was observed in both lungs (left greater than right), with no evidence of pulmonary uptake in WBS. A rare idiopathic disorder, pulmonary alveolar microlithiasis, was confirmed by transbronchial lung biopsy. The early stage of the disease explained the discordance between WBBPS and WBS.ConclusionsThe WBBPS provided useful informations in 28% of our patients. Even if WBBPS improved diagnosis in only 3 pts, we suggest that, without increasing either the radiation dose to the patient or the study duration, WBBPS could be performed additional to 3phBS.
P655 Clinical Experience of Fusing Nuclear Medicine Bone Scans and CT Images Obtained from Separate Scanners A. L. Brason, J. Green; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UNITED KINGDOM. AimWith the development of SPECT/CT cameras it has been possible to utilize and combine the different information acquired from both modalities on one image. These cameras are not universally available and for this reason we decided to make use of the current separate CT in our department. This project was designed to assess whether it is possible to achieve the fused images using existing equipment in the department.We began our study investigating feet. Patients present with painful feet and sometimes long term problems can be hard to diagnosis properly due to the number of bones and joints the foot encompasses. Subtle changes can be difficult to diagnosis on CT alone and a nuclear medicine bone scan is often required. Using a nuclear medicine bone scan alone the inflammation can be imaged however is difficult to localise due to the lack of anatomical detail.Materials and MethodsThe department has a Siemens e-cam, Toshiba Aquilon 32 Slice scanner and a Hermes Workstation. The study involved patients undergoing a NM Bone Scan (SPECT and Static Images) and a CT scan on the same day. The foot is immobilised using a Vac-Fix bay and markers are drawn on the bag and patient to facilitate a reproducible set up. The images are fused using the Hermes Multimodality program.Results and ConclusionThe results from 15 patients have been excellent and fusion has been possible on all patients. The images produced
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P656 FDG-PET/CT in Cancer Patients with Fibrous Dysplasia: Case Report and Review of The Literature T. Ones1, M. Aras1, F. Dane2, F. Dede1, T. Erdil1, S. Inanir1, H. Turoglu1; 1 Marmara University School of Medicine, Department of Nuclear Medicine, Istanbul, TURKEY, 2Marmara University School of Medicine, Department of Internal Medicine, Oncology Division, Istanbul, TURKEY.
of the muscles, which has a globular appearance especially on CT images. Lesions with signal intensity similar to skeletal muscle such as extraabdominal desmoid, neurofibroma, cicatricial fibroma and malignant fibrous histiocytoma should be considered in the differential diagnosis. Another helpful feature for differential diagnosis is bilaterality of the lesion. Presence of a similar periscapular lesion on the contralateral side strongly eliminates malignancy from differential diagnosis.Thoracic mass presented as an elastofibroma dorsi is very well-known, however multi-regional bilateral elastofibromas are rare even for the radiologist. Although there are few FDG avid elastofibroma dorsi cases reported in the literature, to the best of our knowledge, PET/CT appearance of multi-regional involvement especially including bilateral greater trochanteric regions has not been reported yet. Unnecessary radiological or surgical interventions and anxiety in oncology patients will be avoided by recognition of the PET/CT pattern of elastofibroma.
P658 Lymphoscintigraphic staging in the evaluation of lymphedema M. Kula1, Y. Akcali2, S. Karacavus3, E. Mavili4, U. Abdulrezzak1, A. Tutus1; 1 Erciyes University, School of Medicine, Department of Nuclear Medicine, Kayseri, TURKEY, 2Erciyes University, School of Medicine, department of Cardiovascular Surgery, Kayseri, TURKEY, 3Bozok University, School of Medicine, Department of Nuclear Medicine, Yozgat, TURKEY, 4Erciyes University, School of Medicine, Department of Radiology, Kayseri, TURKEY.
Fibrous Dysplasia (FD) is a slowly progressive bone disorder in which normal bone is replaced by abnormal fibroosseus tissue. Several FDG-PET/CT reports suggest that the appearance of FD could mimick a malignant process. Therefore, this case is presented with the aim of guiding physicians in evaluating bone lesions in cancer patients with FD.A 48-year-old male patient presented with an abdominopelvic USG which showed a tumoral mass lesion in the urinary bladder. Transurethral resection of the mass was performed and revealed transitional cell carcinoma. FDG-PET/CT was requested and it showed multiple lytic, expansile bone lesions. The lesions showed heterogeneous hypermetabolic activity and a clear distinction can not be made for the probability of metastasis. When the past medical history of the patient was reviewed in detail, it revealed polyostotic FD diagnosed 10 years ago. We reached the patient’s previous bone scintigraphy which was obtained 10 years ago. It showed increased osteoblastic activity in the polyostotic FD lesions. Later a new bone scan was requested for reevaluate the polyostotic FD lesions. When these three imaging studies were reviewed together, the PET/CT scan appearances of the lesions have similarities to those on the scintigraphic ones. These overlapping findings were evaluated in favour of FD. Additionally the costal lesion in the left hemithorax was biopsied and reported as FD rather than metastasis.Several case reports have been described that FD can have either intense FDG activity or can be metabolically normal without any increased FDG activity. These significantly increased FDG activities may mimick bone metastases or skeletal involvement of the primary malignancy in cancer patients with FD. These findings may change the stage of the cancer. On the other hand, few studies showed that FDG-PET/CT is useful for detecting and differentiating bone metastasis from FD in patients with a malignancy. Malignant transformation may also be seen in some FD patients. In the light of the literature findings it might be concluded that FDG-PET/CT scans need to be interpreted in the overall clinical context, on a patient-per-patient basis. In conclusion; if the FDG positive bone lesions is the only positive finding on PET/CT scan except for the primary tumour in cancer patients with a past medical history of FD; they should not be misinterpreted as bone metastases. To improve the diagnostic accuracy, such lesions need to be correlated with the previous imaging studies and biopsied if they are equivocal.
Background: Lymphedema is the excess accumulation of protein rich fluid in the interstitial space. Lymphoscintigraphic scan findings in patients with lymphedema will depend on the cause of swelling, the length of time that the process has been present, and compensatory mechanisms that developed to circumvent the flow disturbance.Objective: The aim of this study was to propose an applicable method for classifying lymphedema according to lymphoscintigraphic scan findings.Material and Methods: In this study radionuclide lymphoscintigraphy was performed in 230 patients (156 females and 44 males) with clinically suspected lymphedema. A retrospective study method was used to analyze the imaging results and the typical patterns of lymphedema on radionuclide lymphoscintigraphy were summarized. We staged (I to IV) lymphedema based on lymphoscintigraphic finding; main lymphatics, collaterals, dermal backflow and lymph node uptake, etc.Results: The majority of the patients had primary lymphedema (55%), and lower limb involvement was dominant (94%). The most common scintiigraphic patterns were decreased flow, dermal backflow and decreased lymph node uptake. Among the 258 extremity of proved lymphedema, lymphoscintigraphic stages were as follows: stage I 73(28,29%), IIa 81 (31,39%), IIb 25 (9,69%), III 52 (20,15%) and IV 27 (10,47%). Conclusion: Lymphoscintigraphy of suspected extremity lymphedema is a simple and accurate technique. It can help distinguish between swelling of venous and lymphatic origin, may demonstrate the underlying cause and help guide therapy.
P657
T. A. Balci, Z. P. Koc; Firat University Medical Faculty, Department of Nuclear Medicine, Elazig, TURKEY.
FDG-PET/CT Appearance of Multi-regional Elastofibroma S. Gungor, T. Ones, M. Aras, F. Dede, S. Inanir, T. Erdil, H. Turoglu; Marmara University School of Medicine, Department of Nuclear Medicine, Istanbul, TURKEY. A 70-year-old woman with biopsy proven intracranial large B cell lymphoma was sent to FDG-PET/CT imaging for initial staging. Mild to moderate hypermetabolic multiple soft tissue masses were observed between the inferior tips of the scapulae and chest wall and between the gluteal muscles and greater trochanters of femur bilaterally in FDG-PET/CT. For the differential diagnosis of these findings, CT images were consulted to a radiologist and elastofibroma was considered according to characteristic appearance of multiple soft tissue masses. Because of its diagnostic CT pattern, neither invasive procedures nor further imaging was planned for this asymptomatic patient.Elastofibroma was first described by Järvi and Saxén in 1959. It is not a true neoplasm, and is generally considered to be a slowly growing, fibroblastic pseudotumor. It probably arises from periosteal fibroblasts with deranged elastic fibrillogenesis. It is not uncommon and was predominantly found in elderly patients. The pathogenesis is thought to be related to repeated mechanical friction. Although in the majority of the cases, elastofibroma is located in the subscapular region as a mass, rarely it can be presented as multiple foci in the various parts of the body as in our case.Plain radiography, CT and MRI have been used to diagnose elastofibroma. Plain chest radiographs may show a soft tissue density mass in the subscapular region. Thoracic CT has a main role in the diagnosis and the classical pattern is poorly defined inhom*ogeneous soft-tissue density with attenuation approximately the same as that of skeletal muscle in subscapular region. Normal structure can also mimic elastofibroma, like the fibers
P659 Peripheral Bone Densitometry Measurement with Radiographic Absorbtiometry (RA) versus Spine and Femur Dual X-Ray Absorbtiometry (DXA) Measurements
Aim: Bone mineral densitometry with dual X-ray absorptiometry (DXA) is the most important modality to decide bone mass of a patient. There are several factors which influence spine and femur DXA measurements like osteodegenerative changes for spine and implants for femur. Aim of this study is to compare RA measurement of hand with spine and femur densitometry measurements by DXA and decide if they can be used in stead of or in conjunction with each other.Materials and Methods: One hundred seventy seven (mean age: 56.7 years) postmenopausal women were included to our study. They were referred for routine bone densitometry measurements with suspicion of osteoporosis. Both axial (i.e. spine and femur) bone mineral densitometry and peripheral (left hand second, third and fourth finger middle phalanx) RA measurements were measured at the same session. T and z scores of patients’ peripheral and axial measurements were compared.Results: All the parameters of axial and peripheral measurements were correlated with each other. The bone mineral density of spine, femur and phalanx RA measurements were in good agreement. The difference between mean t scores and z scores of phalanx and spine weren’t statistically significant (p>0.05) but there was a significant difference between phalanx and femur scores (p<0.05).Conclusion: Although DXA is the most important modality to decide bone mineral density, RA can be used when DXA is not present. It can also be used as an additive tool when the DXA measurements are not reliable because of osteodegenerative changes of spine or implants of femur.
Poster Presentations
are of high quality and has aid the diagnosis made by the Clinicians. A variety of different abnormalities involving joints and metal screws and plates from previous surgery have been imaged. Several patients have had their treatment changed due to the results of the fused imaging. Initially there were problems with patient set up with errors accruing between scanners and these were solved using the Vac-fix bag. There was also a problem of the software cropping the NM images during fusion due to the foot not being positioned in the centre of the SPECT acquisition.We hope to progress this project by implementing this technique on parathyroids and maybe eventually MIBG patients.
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Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441
P660 A Pictorial Review of the SPECT-CT Findings Complications Following Total Hip Replacement
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B. Bhaludin1, F. Rahman1, A. Weller1, V. Ejindu2, A. Parthipun1; 1St Helier Hospital, Carshalton, UNITED KINGDOM, 2St George's Hospital, London, UNITED KINGDOM. PURPOSE/AIMThe purposes of this exhibit are:1. To be aware of the novel technique of hybrid imaging using 99mTc-HDP SPECT-CT.2. To understand the value of hybrid imaging for painful hip replacements.3. To understand how CT can be optimised to overcome metallic artefact from total hip replacements.4. To review the normal SPECT-CT appearances and composition of the most widely used hip prostheses.5. To understand how SPECT-CT can be used to evaluate the geometry of the hip prostheses and how poor positioning can result in complications, including a systematic reporting structure.6. To review the common pathological complications of hip replacement.7. To review the appearances of the complications of hip replacements on SPECT-CT.CONTENT ORGANIZATIONSections will be divided into:1. A review of the most commonly used hip prostheses and their normal appearances on SPECT-CT.2. A technical description of performing 99mTc-HDP SPECT-CT bone scintigraphy; including CT parameters used to reduce metal artefact and volume rendered image reconstruction.3. Complications of hip replacements illustrated using fused hybrid SPECT-CT images. The imaging has been collected from our case load and will demonstrate the salient features in:a. Looseningb. Peri-prosthetic Infectionc. Periprosthetic fracturesd. Component fracturee. Histiocytic reactionsf. Stress shieldingg. Acetabular cup wearSUMMARYThe major teaching points are:The combination of anatomical information and function information from hybrid studies allows us to understand the mechanisms for failure of hip replacement.The CT aquisition can be optimised to reduce metal artefact in order to provide the most detailed image reconstructions.
P661 The role of the SPECT/CT in gall[[Unable to Display Character: ı]]um-67 and three phase bone imaging for osteomyelitis and prosthetic infections P. Arıcan, I. Peksoy, S. Naldöken, R. Şefizade; Ankara Numune Hospital, Ankara, TURKEY. Aim: The aim of this study was evaluated the role of SPECT/CT in Ga-67 imaging and 3-phase bone scintigraphy for diagnosis and localization of osteomyelitis and prostetic bone infections.Material and methods: Twenty-seven patients ( 14 women-13 men; age range 25-73 years) with suspected bone infections (n=11) and suspected prostetic bone infections (n=16) were included in the study. Dynamic perfusion images were started immediately after bolus injection of the 740 MBq Tc 99m MDP. Blood pool images were acguired after perfusion images. Whole body and static images were performed at 3 hours postinjection. The next day Ga-67 static and SPECT/CT images were taken at 24 hours after 175 MBq Ga-67 injection. Three phase bone, Ga-67 static and SPECT/CT images were seperately assessed by two nuclear medicine physicians. Ga-67SPECT/CT findings were compared with the findings of bone , Ga-67 planar images and SPECT. Findings were categorized as infection ( the uptake of Ga-67 more than uptake of Tc99m MDP), no infection (the uptake of Ga-67 less than the uptake of Tc99m MDP) and equivocal (the the uptake of Ga-67 similar the uptake of Tc99m MDP). The final diagnosis was verified by tissue culture, surgery and clinical -laboratory follow up. All patients were gave information about this study.Results:Three phase bone scintigraphy was true positive for osteomyelitis in 12 patients and true negative in 2patients. It was found the 3 false positive and 10 equivocal findings ( sensitivity 100%, specificity 40%). Ga-67 static images classified 12 patients as true positive and 14 patients as true negative. One patient was interpreted as equivocal (sensitivity 100%, specificity 100%). SPECT/CT was true positive in 13 patients and true negative in 14 patients. There was not false positive and negative results both static and SPECT/CT images ( sensitivity 100 %, specificity 100%). One equivocal result in static images was confirmed as soft tissue infection. SPECT/CT provided on accurate anatomic localization of all uptake sites and differentiated soft tissue from bone involvement in patient with suspected osteomyelitis.Conclusion:In this series, Ga-67 images increased the specificity of bone scan. Althought the sensitivity and specificity of planar Ga-67 scan were same with SPECT/CT, the use of SPECT/CT in Ga-67 scans have proven to be helpful for the diagnosis and accurate anatomic localization of osteomyelitis and prosthetic infection.
P662 Role of three phase bone scintigraphy in patients with suspicion of CRPS in various stages S. Arun, S. Santhosh, A. Bhattacharya, B. Singh, B. R. Mittal; PGIMER, Chandigarh, INDIA. Introduction: Chronic regional pain syndrome (CRPS) is an exaggerated response to injury of an extremity, manifested by four constant characteristics: intense
prolonged pain, vasomotor disturbances, delayed functional recovery, & associated trophic changes. Three phase bone scintigraphy (TPBS) is a routinely used investigation in patients with suspected CRPS.Aim: To assess the usefulness of TPBS in establishing a diagnosis in patients with suspicion of CRPS in various stages.Material and Methods: Retrospective analysis of patients referred for TPBS with clinical suspicion of CRPS based on MacKinnon and Holder’s criteria, was done. They were divided into three stages based on the duration of symptoms: stage I: 020 weeks, stage II: 20-60 weeks, and stage III: > 60 weeks. Perfusion, blood pool and delayed images were analysed and diffusely increased activity with periarticular accentuation was taken as positive for CRPS.Results: Study included 53 patients (19 males) with average age of 45 yrs. Of the 53 patients, 24 (45%) were found to be positive for CRPS by TPBS. Among them, 7 had history of trauma, 5 had neurological cause, & 12 with no identifiable cause. Eleven patients were referred for CRPS in foot of which 5 (45%) were positive & 42 patients for CRPS in wrist of which 19 (45%) were positive. Among the 23 patients in stage I, 11(48%) were positive for CRPS. In those negative for CRPS six had focal increased tracer uptake while the other six had no increased tracer uptake. Among the 15 patients in stage II, nine (60%) were positive for CRPS. In those negative for CRPS one had focal increased tracer uptake while five had no increased tracer uptake. Among the 15 patients in stage III, only four (27%) were positive for CRPS. In those negative for CRPS four had focal increased tracer uptake while seven had no increased tracer uptake. CRPS was diagnosed in 53% patients (20/38) in combined stage I and II by TPBS.Conclusion: TBPS is useful in diagnosing CRPS irrespective of site involved (foot/wrist) especially in stages I and II (<60 weeks). Patients with features suspicious of CRPS for >60 weeks are less likely to be picked up by TPBS.
P663 Solitary Bone Lesions in Patients with Known Neoplastic Disease. Value of SPECT-CT in Their Characterisation C. González Roiz1, G. Salazar Andía1, M. P. Fierro Alanis1, M. Fernández Sáez1, J. R. Chicharo de Freitas1, M. N. Cabrera Martín1, A. Ortega Candil1, C. Rodríguez Rey1, M. García García-Esquinas1, R. C. Delgado Bolton1, L. Lapeña Gutiérrez2, J. L. Carreras Delgado2; 1Hospital Clínico San Carlos, Madrid, SPAIN, 2Universidad Complutense de Madrid. Hospital Clínico San Carlos, Madrid, SPAIN. Objectives: Solitary bone lesions (SBL) are a frequent and non specific scintigraphic finding in patients with known neoplastic disease. In about 50% of cases they correspond to bone metastases and in the other 50% they are benign lesions. In order to clarify their benign or malignant origin, they require a clinical correlation with other imaging studies. The objective of our study is to evaluate the usefulness of SPECT-CT in this setting.Material and methods: We retrospectively analysed 76 patients (24 men; mean age 67 years), 33 of them (60%) with breast cancer, 13 (17%) with prostate cancer and the remaining 30 patients with other tumours, in whom a total-body bone scan was performed to study the extent of disease or as follow-up and an SBL was found. A localised SPECT-CT (a hybrid technique, with low-dose CT) was then performed in the patients and the results were correlated with the findings of a later high-dose CT and/or MRI which were considered the “gold standard”.Results: SPECT-CT was conclusive in 59/76 (78%) of the patients in our series to characterise a lesion as benign or malignant. In 17/76 (22%) of them SPECT-CT was indeterminate and other imaging methods were needed to define the lesion. Of all 35 lesions characterised as benign with SPECT-CT, 94% (33/35) were also benign with the later method performed. Of the 24 characterised as malignant, 18 (75%) were malignant. Of the 17 cases in which SPECT-CT was inconclusive, 79% (13/17) were finally benign. In the group in which the result of SPECT-CT was conclusive, the sensitivity (SE) and specificity (SP) to detect malignancy were, respectively, 84% and 90%. In addition, the accuracy of the method was better when analysing spinal lesions than when analysing lesions in other sites.Conclusions: Our results indicate that, although the diagnostic value of SPECT-CT to characterise an SBL is limited when its results are inconclusive, in the cases in which it is conclusive it can significantly reduce the number of other imaging studies with their corresponding appointments and diagnostic delays.
P664 Bone scan findings in a vaso-occlusive crisis of the femur in childhood T. Kamoun, M. Dhifallah, M. Guezguez, M. Ben Fredj, R. Sfar, M. Nouira, N. Ayachi, N. Zouari, K. Chatti, A. Harbi, H. Essabbah; University Hospital of Sahloul, Sousse, TUNISIA. PURPOSE: We present the bone scan findings in a vaso-occlusive crisis of the femur in an 8- year-old girl who suffers from sickle cell-thalassemia. Patient and methods: An 8-year-old girl who suffers from sickle cell-thallassemia admitted for right lower limb pain with limping. The girl was afebrile and had pain on palpation of upper third of right femur without local inflammatory signs. Laboratory tests, ultrasonography and bone scan imaging were done. Results: Laboratory tests demonstrated inflammatory syndrome without hyperleucocytosis. Ultrasonography was normal. 99mTc-HMDP bone scan imaging was indicated. The
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P665 Dietary calcium intake and bone density in middle-aged white men I. Kotsalou, P. Valsamaki, A. Chatzipetrou, S. Gerali; Pammakaristos General Hospital, Nuclear Medicine Dept., Athens, GREECE. AIM - Background :Osteoporosis in men is a heterogeneous clinical entity. The prevalence of osteoporosis is estimated to be 7% in white men, 5% in black men, and 3% in Hispanic men. Hormonal changes, including declining sex steroid levels, probably contribute to age-related bone loss, as do impairments in osteoblast number and/or activity. Adequate calcium daily intake during childhood and adolescence has been associated with preventive influence on age-related bone loss.MATERIALS - METHODS:We reviewed the bone mineral densitometry studies (Bone Mineral Density, ΒΜD, DEXA method) of 126 white men, performed in lumbar spine and femoral neck. Our male population of mean age±SD 66±9years and body mass index (BMI)±SD: 30.2 ± 5.3 and was divided according to compliance with WHO guidelines for calcium daily intake for middle-aged men (normal ≥ 800 mg/ day, 2-3 portions). Men of Group A (n = 52, 41%) had followed the instructions, whereas Group B patients (n = 74, 59%) were completely undisciplined.RESULTS:In this retrospective study mean BMD differed statistically significantly (p<0.001) between Group A men (mean T-value: -0.43) and Group B men (mean T-value: 1.99). The incidence of osteoporosis and osteopenia in Group A was 9.5% and 23.8% and in Group B were 23.6% and 50%, respectively. Relative risk for osteoporosis in men excluding calcium intake from their daily dietary was RR=2.5.CONCLUSIONS:Bone loss for middle aged men disobedient to dietary WHO Guidelines regarding daily calcium intake is two-fold higher, increasing the risk of fractures, subsequent hospitalisation and mortality.
P666 The role of P1NP and BGP levels as an early indicator of the skeletal involvement in malignant and endocrine disorders 1
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P. Valsamaki , I. Kotsalou , A. Zanglis , D. Papamichail , A. Chatzipetrou , G. Fountos2, S. Gerali1; 1"Pammakaristos" General Hospital, Athens, GREECE, 2Technological Educational Institute, Athens, GREECE. Aim: Increased bone turnover rate may be detected by serum bone biomarker levels. This study was designed to investigate the variation and possible correlation of total Procollagen type 1 Amino-terminal Propeptide (total P1NP) and osteocalcin (bone Gla protein, BGP) levels in the serum of patients bearing malignant and endocrine diseases with skeletal involvement.Materials and Methods: Forty-eight patients (39 females/9 males, groups A and B) and 10 healthy, age-compatible controls (8 females/2 males, mean age±SD=66.9±12.5 years, group C) comprised the study population. Based on complete clinical, laboratory and imaging evaluation, group A (mean age±SD= 65.6±9.3years) consisted of 12 lung and 14 breast cancer patients, among which 58.3% and 64.3% had metastatic bone spread, respectively. Twenty-two patients had bone scan lesions or abnormal bone mineral densitometry studies due to underlying hyperparathyroidism or hyperthyroidism (group B, mean age±SD= 67±8.8 years). Potential correlations were investigated between serum tumor markers (CEA, CA 15-3, CA 19-9, CA 125, CA 50 and AFP), P1NP and BGP levels, which were measured using electrochemiluminescence immunoassay methods (Elecsys, Roche Diagnostics, Basel, Switzerland) or immunoradiometric assays. Data statistical analysis was performed by the MedCalc™ software package.Results: Patients with bone metastases exhibited significantly higher P1NP levels as compared to group A patients without bone metastases (p<0.0001), group B (p<0.0001) and group C (p<0.0001). On the contrary, non-statistically significant BGP values were measured in patients with bone metastases, as compared to group A without metastases: p=0.82, group B: p=0.84 and group C: p=0.44. Breast cancer patients with bone metastases displayed significantly higher CA 15-3 levels in comparison to patients without osseous metastatic spread (p<0.0001). Patients with endocrine-related bone lesions showed statistically significantly higher P1NP levels as compared to group A patients without bone metastases (p=0.013) and group C (p=0.0121), whereas nonsignificant BGP findings were observed (p=0.93 and p=0.36, respectively).Conclusion: Significantly raised P1NP concentrations differentiated patients with and without bone lesions in malignant and endocrine diseases. BGP did not present similar behaviour, possibly due to different hormonal regulation compared to P1NP. Therefore, measurement of serum P1NP levels may be clinically useful for the early detection of increased bone turnover rate in patients with lung
cancer, hyperparathyroidism and hyperthyroidism. For breast cancer patients, our data suggest that P1NP and CA 15-3 represent reliable markers for prompt diagnosis of bone metastases.
P667 SPECT-CT - Potential impact in sports medicine? W. P. Murphy, T. Lynch, O. McNally; Belfast Health and Social Care Trust, Belfast, UNITED KINGDOM. Aim: Ultrasound, Computed Tomography and Magnetic Resonance Imaging (MRI) are established methods for investigating athletes complaining of bone and joint pain. Single-photon emission computed tomography/ computed tomography (SPECT-CT) is a relatively new modality for investigating athletes with these symptoms. In this poster we aim to demonstrate its potential with three cases.Methods: Three athletes were identified from our institution that had a SPECT-CT with positive findings.Results: Three elite athletes (one professional rugby player, one international triathlete and one intercounty gaelic footballer) were referred for SPECT-CT.Two of the three athletes complained of knee pain. Both had had an ultrasound and an MRI which had not demonstrated any abnormality.In one case, SPECT-CT demonstrated increased uptake in the superior lateral aspect of the patella at the insertion of the vastus lateralis muscle. In the other case, SPECT-CT demonstrated uptake in the tibial tubercle at the insertion of the patellar tendon.In the final case a patient was referred with hip pain, the clinical suspicion was of osteitis pubis but MRI had not demonstrated any abnormality. SPECT-CT demonstrated uptake in the left pubic bone consistent with osteitis pubis.In all three patients the SPECT-CT findings directed management. In the patients with knee pain, their training programmes were adjusted on the basis of the SPECT-CT findings. In the patient with hip pain, as well as the training programme being changed, the patient received bisphosphonate therapy.Conclusion: SPECT-CT has a potential role in sports medicine when morphological imaging has failed to identify a cause for symptoms. This requires further investigation into its value and where it fits into the imaging algorithm for these patients.
P668 Imprtance of Tc99m Sestamibi Scintigraphy in Determining the Level of Amputation Before Surgery I. Alic Özaslan, Ö. Pilancı, A. Özel, A. C. Aygıt; Bagcilar Training and Research Hospital, İstanbul, TURKEY. Purpose: Even though various noninvasive procedures have been proposed to determine the optimal level of amputation of limbs in patients who have injured and suffered from necrosis in extremities, Tc99m sestamibi scintigraphy is rather useful method. The aim of this study is to determine whether 99mTc sestamibi scintigraphy is correlated with clinical signs and literature.Method: 3 patients (3 men, age range 23, 25, 61) presenting with gangrene of the foot and hand were included in this retrospective study. The indications for amputation were gangrene, frostbite (1 patient), electrical injury (1 patient) and trauma (1 patient) of extremities. The amputation levels were chosen according to clinical criteria; however scintigraphic results were evaluated before surgery. In total of three cases, amputations of necrotic areas in 2 upper and 5 lower distal extremities were performed. Scan results were compared with operation findings to access demarcation line of necrosis.Results: All patients were evaluated with 999mTc sestamibi scintigraphy before amputation in surgery. No perfusion was observed to the nonviable areas. Scintigraphy suggested nonviable tissue in the extremities with clear-cut edges of perfused muscle tissue.Conclusion:The findings are correlated with the literature. The results of this study indicate that 99mTc sestamibi scan is a valuable imaging method in the assessment of demarcation line between viable and necrosis tissue.
P669 [18 F]FDG PET/CT in a patient with extranodal Rosai-Dorfman disease: case report. F. Guidoccio, D. Volterrani, M. Perri, F. Orsini, G. Mariani; Regional Center of Nuclear Medicine, University of Pisa Medical School., PISA, ITALY. Background: Rosai-Dorfman disease (RRD) is a rare histiocytic proliferative disorder of unknown etiology originally identified by Rosai and Dorfman in 1969. Although it mainly involves lymph nodes, extranodal involvement is observed in 33%-43% of the cases, and the most common locations include the paranasal sinuses, skin, orbits, bone, soft tissues, and salivary glands. Bone involvement occurs in less than 5%-10% of the cases, and skeletal lesions are usually multifocal. RDD is usually selflimitings, although steroid therapy and surgical treatment are employed to alleviate symptoms.Case Report: We describe the case of a 47-year-old man who had been diagnosed 2 years previously with RDD of the right orbit. The patient presented with backache and numbness in legs and arms, without any accompanying lymphadenopathy, fever or weight loss. Routine blood chemistry revealed only increased erythrocyte sedimentation rate (33 mm/h), increased
Poster Presentations
blood pool phase and the delayed images showed a photopenic area in the upper right femoral diaphysis and a heterogeneous hyperfixation in the rest of the diaphysis. The rest of the skeleton was normal. The diagnosis of vaso-occlusive crisis was more probable than osteomyelitis. The patient was treated by hyperhydration and oxygen therapy. The evolution was marked by the disappearance in a week of the pain and limping. Conclusion: Bone scan findings: the photopenic area and the absence of metaphysis abnormalities; correlated to the laboratory and ultrasonography data can reliably help to the diagnosis of bone vaso-occlusive crisis.
S418 relative neutrophil count (78%) and decreased relative lymphocyte (15%). X-ray of the left shoulder revealed an osteolytic intramedullary lesion involving the proximal omeral metafisis, while the 99mTc-HDP bone scan showed multiple areas of increased uptake in pelvis, sternum, femora and humeri. In order to exclude nodal and lung involvement and to complete disease staging, the patient underwent whole-body [18F]FDG PET/CT. Images were acquired from the meatus of the ear to the midthigh during shallow breathing; furthermore, images of the legs were also acquired. [18 F]FDG PET/CT showed abnormal focally increased [18F]FDG uptake in the right orbit, as well as multiple hypermetabolic skeletal lesions in pelvis, sternum, femora and humeri (SUV max = 6.6); the low-dose CT images showed an osteolytic intramedullary pattern . No significant tracer uptake was observed in lymphonodes.Our case highlights the impact of [18F]FDG PET/CT for characterizing patients with Rosai-Dorfman disease, as it detects both soft-tissue and bone lesions, thus allowing a complete staging of the disease. To date, although approximately 500 cases of extranodal RRD have been described; in only 2 cases, the patients have undergone [18F]FDG PET/CT imaging. Although the role of [18F]FDG PET/CT imaging has so far not been well established, this imaging procedure can be employed for accurate assessment of the extent of the disease and possibly of response to therapy as well.
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left knee served as a control. Dissected limbs were imaged using the µCT gantry of a PET/SPECT/CT Inveon™, (Siemens Medical Solution, USA, Inc) with the following settings: 35kVp and 500uA, isotropic voxel size of 35µm. Regions of interest were identified in the lateral and medial tibial plateaus by defining consistent areas (n=4) within the depth of the epiphysis, omitting any bone areas associated to osteophytes. Average bone density was measured from the micro-CT image normalised to Hounsfield Unit and processed with ImageJ (NIH, USA). The DMM limb was compared to the contralateral limb (non-operated) using paired t-test (P<0.05).Results:Significantly higher bone density was measured in the medial tibial plateaus of the DMM knee compared to their counterpart control knees (0.77 ±0.05 vs. 0.66 ±0.05 g/cc respectively). There were no differences in subchondral bone density in the lateral tibial plateaus between the injured knee and the nonoperated knee. 3D surface rendering of the µCT images also demonstrate other OA-related bone remodelling lesions (e.g. hypertrophic calcifications). Histology analysis is ongoing for further validation of the µCT findings.Discussion:This study supports the use of the µCT as an effective tool for investigating the changes in subchondral bone structures in a murine model of OA. This technology will be very useful for longitudinal assessment of the development of OA and by implementing other nuclear imaging modalities such as PET and SPECT will allow integration of the structural changes with metabolic/inflammatory process that develop in the knee during OA.
Bone Scan Role in SAPHO Syndrome Differential Diagnosis: a Case Report
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T. S. Vieira, P. Oliveira, A. Oliveira, T. Faria, R. Castro, M. B. Pérez, I. Ramos, J. G. Pereira; Hospital de São João, Porto, PORTUGAL. Introduction: SAPHO is an acronym for a rare syndrome characterized by synovitis, acne, pustulosis, hyperostosis, and osteitis. SAPHO syndrome (SS) usually follows a prolonged relapsing and remitting course. Patients most frequently complain of bone pain and dermatologic manifestations. We report a case of SS in which bone scan (BSc) revealed the typical skeletal findings of this difficult to diagnose clinical entity.Case Description: A 41-year-old woman presented with a six year history of bone pain in multiple sites, more pronounced in the upper right chest and in the right pelvis, which relieved with non-steroidal anti-inflammatory drugs. She also had a three year history of skin lesions that first manifested as widespread pustules on the trunk and limbs. These lesions relapsed several times but were limited to the limbs. Histologically, they revealed a neutrophilic infiltrate. Thorough revision of the medical records brought to knowledge previous left suprarenalectomy, six years before, due to the clinical suspicion of pheochromocytoma, not confirmed histologically. Previous BSc, motivated by osteoarticular pain, revealed increased multifocal uptake of 99mTc-HDP in the axial skeleton, especially intense at the sternoclavicular region (SCR), and the right femur. These findings, in the setting of persistently mildly elevated urinary normetanephrine levels, prompted a 123I-MIBG scintigraphy (MIBG-S), for evaluation of possible pheochromocytoma bone metastases. MIBG-S showed only discrete multifocal uptake in dorsal vertebrae and sacrum, but not at the SCR. Subsequent computed tomography showed lytic and blastic manubrium abnormalities, and irregularity of the sternoclavicular joints, that was reported as eventually related to sequelae from infection.The patient was followed clinically, and worsening bone pain associated with the dermatologic lesions raised the suspicion of SS. Reevaluation with BSc revealed persistence of intense uptake in the SCR and uptake in new bone sites.Discussion and Conclusions: Bone scan revealed the characteristic “bull´s head” sign - intense uptake at the SCR consistent with hyperostosis -, highly specific of the SS. Moreover, there was increased multifocal 99mTc-HDP uptake in the axial and appendicular skeleton, with frank cortical thickening of the right femur diaphysis, related to osteitis and osteosclerosis. In this sense, bone scan turned out to be decisive in the final diagnosis.This case also seems to add a new cause for MIBG bone uptake.
P671 The use of micro-computed tomography to study bone changes in a preclinical model of Osteoarthritis J. L. Tremoleda1, M. Khalil1, W. Gsell1, T. Vincent2; 1Clinical Sciences Centre, Imperial College London, London, UNITED KINGDOM, 2Kennedy Institute of Rheumatology, Imperial College London, London, UNITED KINGDOM. Background:Osteoarthritis (OA) is a degenerative condition affecting the cartilage and the underlying subchondral bone within joints. There is a driving demand for implementing imaging technologies to elucidate the pathogenesis of the disease and its progression, to enable the development of novel therapies. We investigated the use of micro-computed tomography (µCT) for assessing changes in the subchondral bone architecture in a murine model of OA, that causes destabilization of the medial meniscus (DMM) inducing robust cartilage damage patterns and bone changes within 8-12 weeks of surgery.Methods:CT acquisitions were performed in ex vivo samples collected from 20 weeks old male C57Bl6 mice that had undergone DMM surgery at 12 weeks of age (n=6). After 8 weeks post-surgery, OA degenerative changes can be clearly identified by histology. The non-operated
Hybrid Dual-isotope Arthroscintigraphy in Loosening of Total Hip Prosthesis-components M. J. J. Lakeman; Westfries Gasthuis, Hoorn, NETHERLANDS. Purpose: Aseptic loosening of the Total Hip Prosthesis, which consists of an acetabular component (AC) and a femoral component (FC), is a common complication after Total Hip Artrhoplasty. Loosening of prosthesis-components is hard to asses in conventional medical imaging. This study examines a protocol that consists of a dual-isotope planar scintigraphy, combined with a SPECT/low-dose computer tomography sequence of the neo-hip joint, preceded by a digital subtracted arthrography. The aim is to assess the added value of this protocol compared to plain arthroscintigraphy.Methods: From April 2008 until October 2010, eighteen patients (mean age: 68.3 year) underwent an arthrography of the neo-hip joint. All of them were suspected for having aseptic loosening of one or both components of their Total Hip Prosthesis. Using a hollow needle, an iodinated contrast agent was injected intra-articular in the neo-hip joint. Using the same needle, a standardized quantity of [111]Indium-colloid ([111]In) was injected. Right before, or after this procedure [99m]Technetium Oxidronate ([99m]Tc-HDP) was administered intravenously. After two hours the dual-isotope scintigraphy was started. The acquisition consisted of two static views and a SPECT/low dose CT sequence.Results: In two cases the procedure failed, meaning that the contrast agent and [111]In were administrated extra-articular. In another case, the patient was considered lost to follow up. Nine patients underwent surgery after the exam, four because of alleged acetabular component-loosening, five because of alleged femoral component-loosening. These results were used to validate the diagnosis of the SPECT/low dose CT combined with plain dual-isotope views and the blind assessment (from an objective observer) of the plain [99m]Tc-views and [111]Inviews in the same patients.Sensitivity and specificity were obtained for validated results of the acetabular component assessment. This resulted in: Static planar [99m]Tc-views (sensitivity, 100%; specificity, 29%), static planar [111]In-views (sensitivity, 100%; specificity, 43%) and our protocol (sensitivity, 100%; specificity, 71%).The same calculations were done for femoral component assessment: Static planar [99m]Tc-views (sensitivity, 86%; specificity, 100%), static planar [111]Inviews (sensitivity, 43%; specificity, 100%) and our protocol (sensitivity, 71%; specificity, 100%).Conclusions: An additional low-dose computer tomography sequence with SPECT is not required for good assessment of loosening of the femoral component. The assessment of the planar [99m]Tc-views was even more sensitive than the dual-isotope SPECT/low dose CT.However, the method can rule out far more false positive findings then planar dual-isotope imaging in acetabular component loosening because of its greater specificity.
P673 Quantifying the improvement in image quality when using an asymmetric energy window in planar bone imaging R. A. Ruddlesden, K. A. McKay, S. C. Cade, M. J. Evans; Royal United Hospital, Bath, UNITED KINGDOM. Aim: An audit of planar bone scans at the Royal United Hospital, Bath demonstrated that diagnostic image quality in planar bone imaging decreases with increasing patient body mass index (BMI) [1]. Monte Carlo simulations have shown that use of an asymmetric energy window can reduce the proportion of scatter in an acquired image and hence has the potential to improve image quality [2].This work quantifies the improvement in image quality and presents the potential clinical benefit to patients’ with high BMI undergoing planar bone imaging. Methods and Materials: A standard window of 140keV ± 10% was compared to an
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P61 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Conventional & Specialised NM: Sentinel Lymph Node (SLN)
P674 Efficacy of Radioguided Sentinel Lymph Node Biopsy in Breast Cancer Patients after Neoadjuvant Therapy M. Lazar1, J. Pieler2, Z. Simonka2, A. Paszt2, K. Ormandi1, G. Kelemen3, A. Voros4, T. Sera1, G. Lazar, Jr.2, Z. Kahan3, A. Palko5, B. Ivanyi3, L. Pavics6; 1 Euromedic Diagnostics Hungary Ltd., Szeged, HUNGARY, 2Department of Surgery, University of Szeged, Szeged, HUNGARY, 3Department of Oncology, University of Szeged, Szeged, HUNGARY, 4Department of Pathology, University of Szeged, Szeged, HUNGARY, 5Department of Radiology, University of Szeged, Szeged, HUNGARY, 6Department of Nuclear Medicine, University of Szeged, Szeged, HUNGARY. Aim: The role of sentinel lymph node biopsy after neoadjuvant therapy is not fully justified, but according to some authors, it can be used in this patient group almost as efficiently as in patients with no such treatment. Our workgroup applied radiogiuded method for the localization of the former or residual tumour and/or for sentinel lymph node biopsy, but it did not show the usual effectiveness in terms of sentinel node detection. Therefore we aimed to compare the efficacy of our method in this two (neoadjuvant treated and non-treated) patient groups.Patients and methods: We enrolled 23 patients treated with neoadjuvant therapy (20 chemotherapy, 3 hormone therapy) and 1114 patients without such treatment in the study. The radiopharmaceutical (99mTc-Senti-Scint, 150 MBq, 0,4 ml) was administered by ultrasound or by X-ray guidance or by palpation intra- or peritumourally, or (in 9 cases) to the ring marker placed into the tumour before the initialization of neoadjuvant therapy. We performed gamma camera acquisition and sentinel node mapping (including skin marking) at least 3 hours after administration. The next day, during the operation sentinel lymph nodes were detected by intraoperative gamma probe and by blue staining.Results: In the neoadjuvant treated group sentinel node had been detected by gamma camera in 26% (6/23) of patients, during the operation we could remove sentinel lymph node in 30% (7/23) by gamma probe detection and in further 9% (2/23) of patients by blue staining. In the non-treated group these ratios were 82% (912/1114), 87% (965/1114) and further 7% (76/1114) consequently. We could remove sentinel lymph node by gamma probe detection in all 3 patients treated with only neoadjuvant hormone therapy, and in 2 of them gamma camera acquisition was successful as well.Conclusions: According to our results, radioguided sentinel lymph node biopsy after neoadjuvant chemotherapy is much less effective compared to the non-treated group, but in patients undergoing only neoadjuvant hormone treatment the efficacy of the technique seems to be not affected.
P675 Internal mammary chain sentinel nodes: our experience M. E. Garcia, R. Menéndez, A. Alvarez, N. Zeidan, F. González; Nuclear Medicine Department, Hospital Central de Asturias, Oviedo, SPAIN. Objective: To evaluate lymphoscintigraphy and surgical sentinel node detection in internal mammary chain (IMC) in non-palpable breast cancer (NPBC) and palpable
breast cancer patients (PBC). Material and Methods: A retrospective study was conducted on 77 patients (from our centre and other peripheral local centres) with drainage to internal mammary chain in palpable and non-palpable breast cancer lesions from January 2009 to January 2011.Lymphoscintigraphy was performed 90 to 120 minutes after intratumoral, peritumoral and subareolar injection of 74-148 MBq 99 mTc-nanocolloid in 0,4 ml in PBC (under US guidance in NPBC). Surgery was performed 4-24 hs after lymphoscintigraphy using a gammaprobe to localise the sentinel node. In our centre, where the Breast Pathology Unit is part of the Gynaecology Department, removal of the sentinel from the IMC requires a thoracic surgeon. In peripheral centres for which we perform lymphoscintigraphies, a general surgeon dissects the IMC. Hystopathological sentinel node analysis was performed by delayed study.The following parameters were analyzed: scintigraphic and surgical detection rates and correlation with tumour localization in NPBC and PBC. Results: Lymphoscintigraphy visualized sentinel nodes in IMC in 77 of the 437 patients (18%). Of these patients, 33 underwent breast cancer operations in our centre (43%), IMC sentinel nodes were removed from 31, 2 had positive IMC (6%) and 29 had negative IMC (94%). 44 patients underwent breast cancer operations in peripheral centres (57%), 21 IMC sentinel nodes were removed (48%), 2 were positive (9.5%) and 19 were negative (90.5%). 23 did not undergo IMC removal (52%).The 4 positive IMC also underwent adjuvant local or systemic therapy. Of these, 2 had positive axillary sentinel nodes (ASN), 1 did not have drainage to ASN and the last one had negative ASN.The primary tumour was palpable in 49 (63%) and non palpable in 28 (37%).The tumour localizations were in the inner quadrants in 45 (58%) and in the outer quadrants in 32 (42%).Conclusions: Drainage to internal mammary chain was more frequently seen in medial tumours and in PBC.Evaluation of the nodes in the IMC may provide more accurate staging in breast cancer patients and a better selection of the patients who will be submitted to adjuvant locoregional radiotherapy or systemic therapy.A trained team, suitable organizational level and multidisciplinary collaboration are needed for the correct detection and extirpation of sentinel nodes in IMC.
P676 Does the Probability of Lymph Node Metastases Depend on Tumour Size and Number of Tumour Foci in Early Stage Breast Cancer? R. Begum, S. Navalkissoor, F. Wickham, M. Burniston, M. Hall; Royal Free Hospital, London, UNITED KINGDOM. Aims: Sentinel lymph node (SLN) studies in unifocal breast cancer are well established and validated. However, there is less data for SLN studies in multifocal breast cancers. Current literature suggests that patients with large and/or multifocal breast cancers may have a greater incidence of axillary metastases. As a result, the use of SLN biopsies in these patients remains controversial.Our aim was to determine whether there was a significant difference in the incidence of SLN metastases in unifocal vs. multifocal early stage breast cancer disease. In addition, we aimed to assess the outcome of SLN biopsy in breast cancer patients with large tumours, >5cm and compare it to tumours <5cm.Methods: A retrospective clinical review was carried out for 100 patients with early breast cancer who underwent mammography or ultrasonography between 2009-2010. Tumour size, location and its unifocal or multifocal status were determined by reviewing images and correlating them with SLN histology. Unifocal vs. multifocal breast cancer positivity was analysed to see if there was a significant difference in the incidence of SLN metastases between them, using Fisher’s exact test. In addition, large primary tumours (>5cm, T3) were compared with smaller tumours (<5cm, T1 or T2) to evaluate whether there was a greater risk of SLN metastases in the former group.Results: A total of 75 patients were found to have unifocal tumours and the remaining 25 were multifocal. For patients with unifocal disease, 18 of 75 (24%) were SLN positive compared to 11 of 25 (44%) for patients with multifocal tumours (p value = 0.051). Overall, 89 patients had tumours <5cm whereas the remaining 11 had large tumours >5cm, of those 23 (26%) and 6 (55%) were SLN positive respectively (p value = 0.056).Conclusion: Incidence of SLN metastases was found to be higher in patients with larger or multifocal tumours. However, in both cases, the observed incidence was not statistically significant. This may be a consequence of a small sample size used here and an adequately powered study may help to resolve this issue.
P677 Sentinel Lymph NOde Biopsy Chemotherapy in Breast Cancer.
after
Neoadjuvant
I. Cepedello Boiso1, M. Urena Lara1, B. Duenas Rodriguez2, C. Ramirez Tortosa3, J. Martinez Ferrol4; 1Complejo Hospitalario De Jaen. Servicio De Medicina Nuclear, JAEN, SPAIN, 2Complejo Hospitalario De Jaen. Servicio De Cirugia, JAEN, SPAIN, 3Complejo Hospitalario De Jaen. Servicio De Anatomia Patologica, JAEN, SPAIN, 4Complejo Hospitalario De Jaen. Servicio De Radiodiagnostico, JAEN, SPAIN. AIM: Neoadjuvant chemotherapy in breast cancer patients could be a valuable method to determine the chemotherapy’s efficacy and potentially downsize the
Poster Presentations
asymmetric window of 140keV +10%, -7.5% on an Infinia Hawkeye gamma camera [GE Healthcare Ltd.]. A uniformity map was created with the asymmetric energy window and applied to all image acquisitions made with the asymmetric window.Images of several phantoms including: a line source, a point source and the Williams Liver Phantom [Bright Technologies Ltd] were acquired with both the standard and asymmetric windows. A range of patient BMIs were simulated by surrounding the phantoms with different thicknesses of scattering material. Quantitative image analysis allowed the comparison of resolution and signal to noise ratios between images acquired with the two window settings. The reduction in sensitivity when using the narrower asymmetric energy window was also measured.ResultsPreliminary results indicate an improvement in signal to noise ratio of at least 15% when using the asymmetric energy window and a simulated patient thickness of 30cm. On average the sensitivity was found to be 14% lower when using the asymmetric window compared to the standard window. Further results in image quality improvement and sensitivity reduction will be presented. Conclusions: Monte Carlo simulations and phantom studies indicate that there is a significant improvement in image quality when an asymmetric energy window is used. The decreased sensitivity means that increased scan time or administered activity would be required to obtain an equivalent number of counts in the image.[1] Narang, G. et al. Preliminary study of image quality of bone scans with respect to Body Mass Index (BMI)-. Nucl Med Commun. 2010 May:31(5)[2] Ruddlesden R, Cade S, Narang G, Evans M. Improvement of planar bone imaging by means of an asymmetric energy window- Medical Physics and Engineering Conference 2010 Abstract Book, IPEM, September 2010.
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S420 primary tumor, which facilitates breast-conserving therapy. But, the feasibility, accuracy and clinical significance of sentinel lymph node biopsy has not yet been determined. The aim of this study was to investigate these questions.MATERIALS & METHODS: This is a prospective study performed from January 2009 to December 2010. Sentinel node biopsy was performed after neoadjuvant chemotherapy in patients with breast cancer (stage IIIB, tumor size > 3 cm or tumor size < 3cm not suitable for breast-conserving surgery). Lymphatic mapping and SLN biopsy were carried out using standard technique technetium 99m (99mTc) sulfur colloid (activity of 3 mCi and 0,2-0,5 ml volume). The SLN were analyzed by One-Step Nucleic Acid Amplification (OSNA). The OSNA results were classified as negative (<250 copies/lL), micrometastases (from _250 to <5000 copies/lL), or macrometastases (_5000 copies/lL). Sentinel Lymph Node was considered to be positive if macrometastases or micrometastases were found, and in such cases axillary dissection was consequently implemented.RESULTS: A total number of 15 patients was recorded (all woman, 36-62 years old, average age 45,5) from which 19 NSL samples were analyzed. Lymphoscintigraphy showed axillary drainage in every patient. Axillary lymph nodes were histologically positive in 3 patients (20%) and negative in 12 patients (80%).CONCLUSION: Performing sentinel lymph node biopsy after chemotherapy seems to be a successful and reliable technique in patients with breast cancer. However, further research taking account of larger samples and longer post-surgery monitoring time are needed to firmly settle its reliability.
P678 Sentinel Lymph Node Biopsy in Breast Cancer; Review of our Experience on Various Methodological Approaches B. Zengel1, U. Yararbas2, A. Sirinocak3, A. G. Denecli1; 1Izmir Bozyaka Research and Training Hospital, Department of General Surgery, Izmir, TURKEY, 2Ege University Hospital, Department of Nuclear Medicine, Izmir, TURKEY, 3Susehri State Hospital, Department of Genaral Surgery, Sivas, TURKEY. Aim: Sentinel lymph node biopsy is currently accepted as a standard method in the determination of axillary status in early breast cancer. In this retrospective analysis, methodological approaches using radiocolloid with/without blue dye are studied.Method: A total of 112 sentinel lymph node biopsies (SLNB) were performed in 108 breast cancer patients with T1-2N0M0 disease. Group A (73 patients) underwent lymphatic mapping using combined method (subareolar blue dye and periareolar intradermal (ID) radiocolloid injections) and group B (39 patients); using only periareolar ID radiocolloid. As blue dye; isosulphan blue and as radiocolloid; a large sized (tin colloid -TC-), and two different small sized radiocolloids (nanocolloid of serum albumin -NL- and colloidal rhenium sulphide NC-) were used.Results: Successful lymphatic mapping was reached in 111 of 112 procedures (99.1%). Radiocolloids could localize SLN in 99.1% and blue dye in 78% of the cases. SLNs removed were higher in NL and NC groups (p≤0.05). Thirty-nine sentinel and 1 parasentinel lymph nodes were found to be metastatic. Frozen section analysis of 31/39 cases could detect metastatic deposits (2 micro and 29 macrometastatis). Seven of 8 metastatic deposits that frozen section analysis failed to demonstrate were micrometasis and 1 macrometastasis. Radiocolloid uptake was higher in SLNs accumulating blue dye (137.6 counts/10 sec versus 90.0 counts/10 sec, p=0.000).Conclusion: Radiocolloids are more successful than blue dye in SLN detection. Large and small sized radiocolloids are equally successful and with small sized colloids higher numbers of SLNs were harvested. SLNs having higher radiocolloid uptake tended to accumulate blue dye more frequently. Frozen section analysis using H&E staining was very successful in detecting macrometastatic disease in SLNs, however the technique failed in most of the micrometastates.
P679 Utility of SPECT-CT in sentinel lymph node detection. K. Y. Gupta, B. Krishna, N. Singh, J. Antony; P.D. HINDUJA HOSPITAL AND MRC, MAHIM (W), MUMBAI, INDIA. AIM:In the era of minimal invasive surgery, sentinel lymph node (SLN) identification plays an important role for the decision making in surgical extent. The method for SLN detection (like Methylene Blue (MB) dye method and Sentinel Node Lymphoscintigraphy), should enable identification and precise anatomical localization of sentinel node. The fusion imaging of SPECT-CT has a potential advantage of dual nature of structural and functional imaging. We summarize our institutional experience with this modality.MATERIAL AND METHOD:15 patients with biopsy proven primary breast cancer (11 patients) and head and neck cancer (4 patients - 3 Squamous Cell Carcinoma of tongue and 1 buccal mucosa) underwent SLN 12 to 24 hours before surgery. Intra-dermal Injection of 5 to 20 MBq was given in peritumoral region and sequential images were acquired till sentinel node was visualised. SPECT-CT imaging was performed in all of these patients at 45 to 60 minutes of injection. Pre-operatively MB dye was used in 14/15 patients. The results were validated comparing the intra-operative gamma probeguided SLN biopsy and histological examination.RESULT:Multiple nodes were
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 identified in most of the patients (9/15). The total number of nodes biopsied by gamma probe identification method and MB dye method were 28 in number. The total number of nodes visualized on MB dye were 18/27 (MB was not used in 1 patient), on Planar images 19/28 and on SPECT-CT 27/28. The node not identified on SPECT-CT was identified by MB dye, however, in the same patient, 2 nodes were detected by SPECT-CT and by gamma-probe intra-operatively. Hiostologically 6 patients (3 breast carcinoma and 3 head and neck carcinoma) had metastases in SLN. Out of the above, 2 patients had axillary node metastases and 2 patients had neck node metastases respectively.SLN in all 6 patients were identified on SPECTCT, hence demonstrating good sensitivity, whereas Planar images could identify sentinel node in 4/6 (66.6%)patients and MB dye method could identify sentinel node in 3/6 patients (50%)patients.CONCLUSION:SPECT-CT readily identifies the nodes not visualized on planar images and hence reduces the false-negative rate. It also has an additional value in enhancing topographic orientation and detecting more number of sentinel nodes. Hence SPECT-CT has a valuable contribution in SLN detection technique and therefore in patient management.
P680 Comparison of Two Scintillation and Solid-State Gamma Probe Systems for the Localisation of Sentinel Lymph Nodes in Breast Cancer J. L. Merrett, N. P. L. Pratt-Boyden, A. H. McLean, M. A. Masoomi; Queen Alexandra Hospital, Portsmouth, UNITED KINGDOM. AimTo perform the NEMA recommended performance measurements (NEMA Standards Publication NU 3-2004) for a Europrobe 3® intra-operative gamma probe system to enable comparison with the Europrobe 2® currently used by the surgical team for localising sentinel lymph nodes.Materials and MethodsBreast cancer patients often have associated metastases, caused by cancerous cells spreading through the lymphatic system to other areas of the body. As a result, it is common to remove and assess the sentinel lymph node (SLN) during the surgical removal of the tumour. To localise the SLN, an injection of Tc99m nanocoll is administered interstitially and a nuclear medicine scan is acquired. A gamma probe is used to locate the SLN during surgery using the image for guidance.A water tank we had previously designed and manufactured was used for the performance measurements in a scatter medium. For the measurements in air clamp-stands were used to suspend the probe away from all nearby surfaces. Initially sensitivity, spatial resolution and count rate capability were investigated. The set-ups used to obtain the measurements were identical for each probe, allowing accurate comparison of the probes’ performance.ResultsInitial solid-state detector results indicate that Europrobe 3® has both improved spatial resolution and sensitivity in a scatter medium compared to the Europrobe 2®. For spatial resolution, the newer system has a full width half maximum of 33mm compared to 39mm for the currently used system. At a distance of 10mm from the face of the probe, the Europrobe 3® is ~25% more sensitive than the Europrobe 2®.ConclusionThe detection efficiency of SLNs is important in the localisation of the node and therefore the patient management in the clinical setting. The remaining NEMA tests will be performed shortly, and a full performance comparison of the probes will be produced to analyse and assess whether utilising the Europrobe 3® would be beneficial to the surgical team.
P681 Long-term clinical follow-up of sentinel node negative patient in malignant melanoma M. Papós1, J. Oláh2, M. Lázár3, J. Varga2, E. Varga2, G. Mohos2, E. Kis2, I. Korom2, T. Séra1, L. Kemény2, L. Pávics1; 1Department of Nuclear Medicien, University of Szeged, Szeged, HUNGARY, 2Department of Dermatology and Allergology, University of Szeged, Szeged, HUNGARY, 3Euromedic Diagnostics Ltd., Szeged, HUNGARY. The validation of the radioguided sentinel lymph node (SN) biopsy in patients with malignant melanoma (MM) needs a long-term clinical follow-up.Aim: The aim of this study was to analyse the follow-up data of SN negative patients concerning the later lymph node involvement. The MM-free survival and the survival with an active MM was also investigated.Patients and methods: SN biopsy was performed preoperatively by gamma-camera technique using 99mTc-nanocolloid (Senti-Scint), and intraoperatively with gamma-probe in 337 MM patients. In all cases the Breslow thickness of MM was more than 1 mm, or less than 1 mm, but grade Clark IV, or ulcerated or regressed, and clinically the lymph node stage was N0. The validity of the sentinel node biopsy was analyzed on the basis of the clinical follow up of the lymph node status of the SN negative patients. The follow-up period was longer than 5 years (61-127 months).Results: In 202 patients (60% of all patients) the SN was MM free. We enrolled 152 SN negative patients into this study, in whom more than 5-yers clinical follow up was performed. In this group the MM associated mortality was 10% (15/152). The survival rate with an active MM in SN negative cases was 5% (8/152) and the other patients were clinically tumour free (85%, 129/152). During the clinical follow-up lymph node metastasis was detected only in 5% (8/151, lymphatic status of one patient who died in MM is actually
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P682 A False Negative Sentinel Lymph Node Biopsy Due to Obstruction of Lymphatics U. Yararbas1, B. Zengel2, M. Argon1; 1Ege University Hospital, Department of Nuclear Medicine, Izmir, TURKEY, 2Izmir Bozyaka Research and Training Hospital, Department of General Surgery, Izmir, TURKEY. Injection modality is one of the variables that may affect the success of sentinel lymph node (SLN) visualization. Injection of the tracer to the periareolar region intra or subdermally is becoming more and more preferred since it has higher SLN detection rates and it is easy to perform. One disadvantage of the superficial injections is the fact that extra-axillary SLNs are rarely visualized.We present a 47 years old female patient with T2N0M0 breast cancer. Lymphatic mapping was performed the day before surgery using Tc99m-nanocolloid. Radicolloid was injected to the periareolar region intradermally at 4 quadrants. At 45th minute, static views at anterior and lateral projections were recorded. While there was no activity accumulation at axillary fossa, a prominent lymphatic drainage to the midline and activity accumulation at internal mammary chain consistent with SLN were imaged. Repeat images at 2rd hour did not show any further axillary drainage. During operation, gamma probe could not identify any axillary drainage either. Following incision, several enlarged lymph nodes in the axilla were observed and axillary dissection was performed. Histopathological evaluation showed that axillary lymphatic flow was obstructed with extensive nodal involvement.This case is an example of false negativity in sentinel lymph node detection due to obstruction of the lymphatic drainage by tumor cells. As observed in the current case, presence of unusual lymphatic drainage on lymphoscintigraphy should be interpreted with caution since it may be relevant with extensive axillary lymph node involvement.
P62 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Conventional & Specialised NM: Miscellaneous
P683 A software for automatic calculation of platelet survival J. L. Gomez-Perales1, A. Garcia-Mendoza2; 1Hospital Universitario Puerta del Mar. Servicio Andaluz de Salud, Cádiz, SPAIN, 2Hospital Torrecárdenas. Servicio Andaluz de Salud, Almería, SPAIN. Introduction: Platelet survival studies are performed in large number in hospitals throughout the world. The object of platelet survival studies is to obtain estimates of the rates of platelet production and destruction. The calculation of the time taken for half the label to leave the circulation (T1/2 ), the percentage of platelet destroyed a day and the mean platelet life span (SP), are not very complex, but tedious and time-consuming. Objective: The goal of this work is to develop a computing facility to automatically calculate the parameters of platelet survival studies. Materials and methods: For developing a software incorporating these calculations we have used Visual Basic 6.0 and Visual Studio Installer. Results: We have developed a form for automatic calculation of platelet survival studies. This form relies on a database to store, manage and retrieve the data of platelet survival studies. Moreover the form offers the possibility of printing a detailed report of each study.This form is included in a software called Nucleolab, which is freely available at http://www.radiofarmacia.org/nucleolab-englishConclusion: The software we have developed has an easy-to-use interface, that makes the calculation complexity of platelet survival studies completely hidden for the user, saving you the time that you previously spent on these laborious calculations and reducing the risk of error.
P684 Whole body soft tissue blood pool imaging in bone scintigraphy. Is there any additive value? J. Koutsikos1, I. Xirafi1, T. Pipikos2, F. Chroni1, H. Tourkohoriti1, A. Velidaki3; 1Central Clinic of Athens, Nuclear Medicine dept., Athens, GREECE, 2401 General Army Hospital, Nuclear Medicine dept., Athens, GREECE, 3Laiko General Hospital of Athens, Nuclear Medicine dept., Athens, GREECE. IntroductionBone scintigraphy is well known to be a sensitive but nonspecific examination. In cancer patients with a suspected bone abnormality, scintigraphy is considered as a first-line imaging test. A delayed whole body imaging (WBS) and targeted spot images are routinely performed. At our institution, a whole body soft tissue blood pool imaging (WBBPS) in addition to the delayed imaging is performed 2-10 minutes post injection. The literature contains little evidence supporting this
practice. We suggest that a WBBPS provide additional information without increasing the radiation dose to the patient. The aim of our study was to evaluate the additive value of WBBPS in bone scintigraphy.Materials & Methods38 pts (22 males, 16 females, mean age 68.6 years), suffering from various types of cancer were included in the study. 20 mCi Tc-99m MDP were injected and WBBPS and WBS were obtained. Each study was interpreted separately. The findings from WBBPS were categorized as similar to WBS findings (if in concordance) and as additive (if recommended additional evaluation).Clinical indications, findings, recommendations, and outcome were assessed.ResultsBone metastases were detected in 9/38 pts in WBS. Other findings indicating benign lesions, such as arthritis, were detected in 17/38 pts. 12 pts had no findings in WBS. WBBPS had similar findings to WBS in 6/9 pts with metastatic foci and in 5/17 pts with benign findings. Additive findings were evaluated in 13/38 pts. In 11 pts lower extremity vessel disease was detected (7/11 pts were asymptomatic). In one patient with prostate cancer, photopenic foci that was not observed in WBS detected at the left kidney, proved to be a metastatic mass, and in a female patient with breast cancer and cecum cancer under chemotherapy, tracer distribution in the transverse colon proved to be inflammatory secondary to chemo and radiotherapy.ConclusionsThe WBBPS provided useful informations in 34% of our patients. Even if the findings altered the diagnosis or diagnostic certainty in only 2 pts, we suggest that any additional information from WBBPS, without increasing the radiation dose and without direct financial cost to the patient, could be valuable.
P685 99m
TcDPD scintigraphy detects transthyretin amyloidosis across a wide spectrum of involvement
cardiac
L. Fantini1, L. C. Quarta2, P. Guidalotti1, S. Longhi2, P. Ciliberti2, O. Leone3, G. Galati2, A. Ferlini4, E. Biagini2, C. Villani2, C. Gagliardi2, C. Pettinato1, S. Fanti1, C. Rapezzi2; 1Nuclear Medicine Unit, University of Bologna, Sant’Orsola-Malpighi Hospital, Bologna, ITALY, 2Institute of Cardiology, University of Bologna, Sant’Orsola-Malpighi Hospital, Bologna, ITALY, 3 Department of Pathology, University of Bologna, Sant’Orsola-Malpighi Hospital, Bologna, ITALY, 4Section of Medical Genetics, University of Ferrara, Italy, Ferrara, ITALY. Purpose. We previously reported, in a small series of patients, that Usefulness of 99m Tc-3,3-Diphosphono-1,2-Propanodicarboxylic Acid Scintigraphy (99mTc-DPD) tests positive in transthyretin-related (TTR) (both mutant and wild-type) but not in primary (AL) echocardiographically diagnosed cardiac amyloidosis (CA). In this study we extended the study population and assessed the usefulness of 99mTc-DPD scintigraphy for detecting TTR-related cardiac involvement within a wide spectrum of myocardial amyloid infiltration. Methods. We evaluated three groups of subjects: 1) 40 patients with AL-related CA; 2) 56 patients with TTR-related CA (37 mutant; 19 wild-type); 3) 21 patients carrying TTR mutations (6 with Val30Met, 15 with non-Val30Met mutations) without any echocardiographic sign of CA. Myocardial uptake of 99mTc-DPD (740 MBq iv) was semiquantitatively/visually assessed by experts at 3 h (and also 5 min). Results. Semiquantitative measures of late (3 h) 99mTc-DPD uptake were ~2-3 fold higher in TTR-related CA (table). Among the TTR mutation carriers without any echocardiographic sign of CA, 99mTc-DPD myocardial scintigraphy tested positive in 4 cases, all with non-Val30Met TTR mutations (Ala36Pro, Gly47Ala, Thr49Ala and Glu89Gln mutations, respectively). All these cases showed ECG abnormalities, and endomyocardial biopsies documented the presence of mild to moderate amyloidotic infiltration in the heart. Conclusions. In a large cohort of patients with CA, 99mTc-DPD scintigraphy was confirmed to be accurate for differentiating TTR-related from AL-related etiology. 99mTc-DPD scintigraphy was able to detect cardiac amyloidosis across a wide spectrum of myocardial involvement, ranging from mild myocardial infiltration with (still) normal echocardiogram to overt symptomatic diseases.
P686 Diaphragmatic Schwannoma Mimicking Hydatid Cyst Depicted by FDG-PET/CT S. Gungor, T. Ones, F. Dede, T. Erdil, S. Inanir, H. Turoglu; Marmara University School of Medicine, Department of Nuclear Medicine, Istanbul, TURKEY. A 39-year-old man who presented with cough and sputum was referred to the outpatient clinic of chest medicine. CT was performed. It showed encapsulated, well-defined, round, heteregenous cystic soft tissue mass that arised from the right diaphragm. The lesion was measured approximately 10 cm in diameter and extended from right dome of the diaphragm to superior pole of the right kidney. It was initially misdiagnosed as a hydatid cyst according to its CT pattern. FDG-PET/CT was requested to exclude possible malignancy. FDG-PET/CT demonstrated mild to moderate FDG uptake (SUVmax: 4,1) at the solid components which were located in the peripheral and central zones of this cystic lesion. The total resection was perfomed and histological examination revealed a benign schwannoma.Schwannoma is a benign tumor that originates from Schwann cells surrounding peripheral and cranial nerves. It has a predilection for the head and neck and flexor surfaces of the upper and lower extremities. They comprise 5% of
Poster Presentations
unknown), therefore these cases were classified as false-negative concerning the SN biopsy.Conclusion: The low false negative rate confirms the validity of SN biopsy technique.
S421
S422 all benign soft tissue tumours. Schwannoma of the chest wall and diaphragm are rare. Schwannoma is often found incidentally or present with vague, non-specific symptoms. Schwannoma is almost invariably slow growing, non-aggressive neoplasm and it is solitary in the vast majority of cases. Malignant transformation is very rare. It is important for the radiologist to consider the diagnosis of benign schwannoma when presented with a retroperitoneal or pelvic mass, to avoid unnecessary surgery, because these lesions can be managed conservatively. On CT schwannoma typically reveals encapsulated, well-defined round, solid or cystic soft tissue mass. On T1-weighted MR the lesion showes a round mass of hom*ogeneous low signal intensity. The tumor has a characteristic target appearance on unenhanced T2-weighted image, with non-hom*ogeneous decreased signal intensity in the central zone of the tumor and with markedly increased signal intensity in the peripheral zone.In FDG-PET/CT, a few reports have indicated that schwannoma has a diffuse and wide range of SUV uptake on FDG-PET imaging depending on the degree of its cellularity. Schwannoma can rarely be almost entirely cystic, in which case they may resemble benign entities such as retroperitoneal pseudocyst, abscess or lymphocele. In case of the similarity of their clinical and radiological findings, schwannoma should be included in the differential diagnosis of hydatid cysts especially in endemic countries as in our case. In conclusion, this is the first report of a primary diaphragmatic schwannoma which was evaluated with FDGPET/CT.
P687
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 epiphora through a study of 15 patients. Materiel and methods: Dacryoscintigraphy was performed in patients aged from 3 years to 43 years, using a gamma camera with a high-resolution collimator centered on the nose. An activity of 1,85 MBq of pertechnetate (TcO4-) was instilled in both eyes simultaneously at the inner angle. Sequential images were performed for 20 minutes at one frame per minute, supplemented by static delayed images in case of stasis in order to distinguish between delayed emptying and nasolacrimal duct obstruction. Results: Of the 15 patients who were tested, abnormalities were detected in 10 lacrimal drainage systems. Furthermore, patients were classified according to the results of dacryoscintigraphy; those with delayed secretion in the distal nasolacrimal duct, those with delays in the proximal nasolacrimal duct; and those with delayed secretion from the pre-lacrimal sac to the lacrimal sac. Conclusion: Our results show the incremental value of dacryoscintigraphy in epiphora. Although this functional imaging did not delineate the anatomical features quite as well as contrast dacryocystography, it is considered as a useful tool, not only in diagnosing nasolacrimal duct obstruction but also in making a decision for therapeutic procedures with a little stress to the patient and much lower radiation dose received at the lens( 0,02- 0,04mGy) over anatomical imaging.
P689 Novel Ideas to Reduce Radioiodine Contamination Ablation rooms
131
I
Value of Radionuclide Cisternography in the Diagnosis of a Cerebrospinal Fluid Leak, a Case Report
W. A. Sanders, R. Cain, M. Foley, V. Smith; Wolverhampton Hospitals NHS Trust, Wolverhampton, UNITED KINGDOM.
E. Levigoureux1, C. Bolot1, S. Lancelot2, G. Aulagner1, G. Pina-Jomir3; 1 Radiopharmacy, Pharmacy Department, Groupement Hospitalier Est, Hospices Civils de Lyon, University-Hospital of Lyon, Lyon, FRANCE, 2 Radiopharmacy, Pharmacy Department, Groupement Hospitalier Edouard Herriot, Hôpitaux de Lyon, University-Hospital of Lyon;CNRS, Lyon Neuroscience Research Center, Radiopharmaceutical and Neurochemical Biomarkers Team, Lyon, FRANCE, 3Nuclear Medicine Center, Groupement Hospitalier Est, Hôpitaux de Lyon, University-Hospital of Lyon;CNRS, Lyon Neuroscience Research Center, Radiopharmaceutical and Neurochemical Biomarkers Team, Lyon, FRANCE.
Purpose: This investigation was performed to determine the suitability of new products for the decontamination of 131I ablation treatment rooms. Expected benefits: reduced levels of contamination during the patients stay, reduced the time the room is unavailable for patient use and the lessened dose rates to staff. The two new products being introduced are Packexe disposable plastic flooring and Bind it a new decontamination product. Bind it is available as a concentrated decontamination solution specifically designed for Iodine based products, and as hand soap for patient use during their stay and for staff if required.Method: The permeability of the Packexe was tested by comparing dose measurements of the flooring before removal of Packexe and after on a linoleum tile. Materials mimicking those found in the patient’s room were contaminated with 131I and decontaminated with Bind it (10:1 concentration) and the product currently used in the department. Surface dose rates were compared before and after decontamination.Initial Results: The Packexe covered tile measured 70 counts per second (cps) above background; after Packexe was removed 30cps were detected, reducing contamination by approximately 60%.Ceramic tiles which were presprayed with bind-it before contaminating with I131 showed a reduction in counts per second (cps) of 70% when using bind-it and 68% when using our current product. Without pre-spraying with the decontaminant, bind-it reduced cps by 73% and our current product reduced counts by 56%. Decontaminating a linoleum tile with bind it gave a 66% difference in cps and 22% with our current product.Initial results for decontamination products indicate that pre-spraying the sink and toilet during room preparation with bind-it would increase the efficiency of the decontamination process.Discussion: Initial results show a vast improvement in the level, ease and speed of decontamination.
IntroductionRadionuclide cisternography (RC) is an examination based on intrathecal injection of [111In]diethylenetriaminepentaacetic acid ([111In]DTPA). Intrathecal radioactivity leakage can then be detected via planar imaging or SPECT (Single Photon Emission Computed Tomography) or in swabs from the nasal cavities and throat. We report the case of a 53-year-old woman presenting with rhinorrhea three months after transnasal neurosurgery for tuberculum sellae meningioma. Neither MRI nor CT scans showed signs of cerebrospinal fluid (CSF) leakage. MRI showed filling inflammatory in the sphenoid sinus, CT showed undisplaced repair material covering the bone defect consecutive to the transnasal transsphenoidal neurosurgery and the absence of pneumocephalus. RC was prescribed to confirm or exclude CSF leakage.Material & methodsRC was performed by injection of 67 MBq of [111In]DTPA into the lumbar subarachnoid space. Cranial and abdominal planar images and cranial SPECT/CT scans were acquired six hours and 24 hours after injection. Plasma samples and swabs from both nasal cavities and throat were taken six and 24 hours after injection. Radioactivity in the plasma samples and swabs was measured with a gamma Wizard 1470 counter. The ratio of swab and volume plasmatic activity was calculated.ResultsPlanar images showed radioactivity in the colon after six and 24h indirectly indicating CSF leakage followed by swallowing. SPECT-CT didn’t show extra-cranial leakage path. There was radioactivity accumulation at the site of the operation. Nasal swabs were distinctly radioactive. Both imaging and swab counting provided strong evidence for CSF leakage, most likely originating from the surgical site.Discussion and conclusionThe case highlights the complementarity of RC imaging and swab counting for the diagnosis of CSF leakage. Imaging studies can confirm the diagnosis of a CSF leak and show the leakage site. In this case with intermittent rhinorrhea, CT and MRI showed no signs of a CSF leak and RC together with swab counting was a key element for the positive diagnosis of CSF leakage. The sensibility of nasal swabs could be increased by placing one cotton pledget into each nasal cavity during several hours, particularly if the CSF leak is intermittent. Extended RC helps to detect and localize intermittent cerebrospinal fluid rhinorrhea so that therapeutic decisions are facilitated.The patient was re-operated to establish a lumbar peritoneal shunt. Six months after lumbar peritoneal shunting, there has been no recurrence of rhinorrhea and no episode of meningitis.
P688 Clinical Value of Dacryoscintigraphy in Epiphora A. Mhiri, I. Meddeb, I. Slim, F. Ben Slimene; Nuclear Medicine Department. Salah AZAIEZ Institute. University El Manar II, TUNIS, TUNISIA. Dacryoscintigraphy, introduced in 1972 by Rossomondo, is a simple and non invasive method frequently used for assessment of the lacrimal drainage system that causes pathological overflow of tear known to epiphora. Our aim was to evaluate the value of dacryoscintigraphy in the assessment of patients followed for
P690 Salivary gland scintigraphy in Sjögren's syndrome I. Meddeb1, A. Mhiri1, I. El Bez1, I. Slim1, I. Yeddes1, D. Ben Sellem1, A. Sellem2, H. Hammami2, F. Ben Slimene1; 1Nuclear Medicine Department. Salah AZAIEZ Institute. University El Manar II, TUNIS, TUNISIA, 2Military Hopital, TUNIS, TUNISIA. Introduction: Sjögren’s syndrome is an autoimmune disease characterized by a chronic inflammatory process involving salivary glands. Salivary gland scintigraphy can evaluate the severity of salivary gland involvement, which may not be accurately reflected by xerostomia, one of required diagnostic criteria for Sjögren's syndrome. The aim of our study was to assess the value of salivary scintigraphy in the detection of xerostomia for Sjögren’s syndrome through a study of 208 patients. Materials and methods: 208 patients referred over a 5 years period for 99m Tc-pertechnetate salivary scanning were included in this study (181 females and 27 males), aged between 8 - 85 years (mean age: 52,5 years). 44 patients had rheumatoid arthritis, 58 patients had systemic lupus erythematosus, 5 patients had scleroderma and 101 patients were not labeled. The diagnosis of Sjögren’s syndrome was made on clinical, immunological and histological features in 62 patients. The most common clinical sign was sicca syndrome. Immunological laboratory tests were performed in 20% of patients. Dynamic Salivary scintigraphy was performed after intravenous injection of 185 MBq 99mTc-pertechnetate, with a 128 × 128 matrix. Anterior sequential salivary gland images were obtained at 30 s per frame for 30 min. Twenty minutes after, vitamin C was administered orally as a stimulus (500 mg). After completion of the examination, regions of interest (ROI) were drawn manually around each of the parotid and submandibular glands. Timeactivity curves over the salivary glands were generated. A distribution of the
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P691 The Role of 18F-FDG PET/CT in Ovarian Cancer: Case Study Review M. Nathan1, P. Jackson1, E. Barden1, N. Gauthaman2, G. Gnanasegaran1; 1 Guy's and St. Thomas' NHS Foundation Trust, London, UNITED KINGDOM, 2South London Healthcare Group, London, UNITED KINGDOM. Ovarian carcinomas are the second commonest gynaecological malignancy after cervical cancer but are the commonest cause of death in young women with gynaecological malignancy. Primary tumour growth and metastatic spread are often insidious in ovarian carcinomas, frequently resulting in clinical presentation at an advanced stage. The main treatment for ovarian carcinomas is debulking surgery followed by chemotherapy or chemotherapy in isolation for non-operable tumours.Imaging plays a central role in the management of ovarian carcinomas. Structural imaging techniques such as US and MRI are used to evaluate adnexal masses with greater specificity provided by MRI due to its ability to characterise equivocal masses on US. Though surgical staging is the gold standard, crosssectional imaging with CT or MRI aids pre-operative staging and subsequent surgical planning through evaluation of disease extent, spread into adjacent organs and the identification of peritoneal metastases. CT and MRI are also used for the assessment of treatment response and detection of recurrent disease.Extensive literature over the last decade has demonstrated the integral role of 18F-FDG PET/CT in pre-operative staging, re-staging, assessment of disease recurrence and response to therapy in a number of different oncological conditions. Consequently, its utility in ovarian carcinoma management has been the subject of evolving interest in recent years.Through a series of case studies, we describe the role of 18FFDG PET/CT in the diagnosis of primary ovarian carcinoma, pre-operative staging and post-operative assessment of residual disease or recurrence. The limitations of 18 F-FDG PET/CT imaging in this group of patients are also highlighted.
P692 Radiation Hazards and Legal Medicine (Forensic Pathology) J. Elísio de Campos e Sousa; UIC - Hospital Privado do Algarve, Alvor Algarve, PORTUGAL. Aim:Seldom thought of as such, Forensic Pathologists are a risk group for the exposure to radiation whenever they perform autopsies or handle with products of irradiated corpses.Materials & methods:The author, Nuclear Medicine Specialist and Legal Medicine Expert (Forensic Pathologist), describe some procedures to follow in order to prevent contamination of the forensic team and the victim’s relatives and the community.Results and conclusion:Forensic pathologists may eventually be involved with bodies radiologically contaminated, either by way of medical radiation for diagnosis purposes, therapeutic purposes, accidental circ*mstances or terrorist attack.The handling of victims, whether at the scene or at the autopsy room, must be based on the fundamental pillars of radiation protection (distance, time and physical barriers) and forensic staff should carry dosimeters which allow, in real time, to check the absorbed dose; they should also carry proper equipment and establish right procedures to allow general care of personal protection.The delivery of bodies to relatives should only be through if and when radiation is diminished; if not, must be stored or buried, assuring correct identification for eventual later delivery, in special places especially adapted for the effect.
P63 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
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Epiretinal Sr brachytherapy: radioprotection procedures G. Tosi, F. Provenzano, L. Antunovic, A. Chiti; Humanitas Clinical Institute, Rozzano, ITALY. Aim: Age-related macular degeneration (AMD) is one of the leading causes of adult visual loss in the developed world; the current standard of care for neovascular AMD is antiangiogenic therapy. A new progress in the treatment of subfoveal AMD uses a localized radiation treatment to prevent proliferation of vascular tissue by inhibiting neovascularisation.We analysed the different steps to be done in order
to have an effective procedure, from source receipt to patient treatment, from a radiation protection point of view. This work was done with an intraocular device loaded with a 90Sr source (Neovista VIDION). Material and Method: The 90Sr sealed source has an activity of about 430 MBq; different steps have to be done before patient’s treatment: first of all, a smear test at source receipt must be done to exclude surface contamination. Then, a source acceptance test is needed, to assure that predicted and measured outputs overlap.After these preliminary steps, the source is ready to be used on patient; the team involved in the procedure is composed by an eye surgeon, a nuclear medicine physician, a medical physicist and a nurse. Source is transferred in the operating theater by a medical physicist, who is also in charge of calculating the irradiation time, in order to give a dose of 24 Gy to the target. The nuclear medicine physician is responsible for source assembling and release, while the eye surgeon performs the therapy. The sealed source is contained in the Reusable Delivery Module (RDM - Neovista VIDION) and is shielded until operator transfer it into the patient’s eye, through the Disposable Delivery Module. Result: Table below shows data of smear test and dose rate measurements made at source receipt. In the second table data of measurements carried out in the operating theatre during treatment are shown. At the moment we performed three procedures. Data confirm low environmental and workers exposure. Conclusion: Epiretinal 90Sr brachytherapy seems to be a safe treatment if all radioprotection procedures and rules are observed. Effective and equivalent doses per procedure stay on low values.
P694 Perspective: optimization of liver-SIRT by dosimetry assessment using pinhole bremsstrahlung SPECT during the catheterization procedure. S. Walrand, R. Lhommel, H. Van Loo, S. Pauwels, F. Jamar; Université Catholique de Louvain, Brussels, BELGIUM. Purpose: to evaluate on a conceptual basis whether fast dosimetry based on pinhole bremsstrahlung SPECT is achievable in liver-SIRT. Materials and methods: Bremsstrahlung SPECT of an abdominal shaped phantom including 1 cold and 5 hot spheres was performed using a medium energy pinhole (MEPH) 6mm-aperture collimator. The product of the acquisition duration by the phantom activity corresponded to a 6 min acquisition using a single head camera in a typical liverSIRT (1.2GBq). An analytical model of the scattering inside the phantom was included in the iterative reconstruction. A TOF-PET acquisition was also performed for comparison. Results: MEPH SPECT provided similar contrast recovery coefficient (the optimal result being as close as possible to 1) than PET for the 36, 30, 28 and 24mm-diameter spheres whilst MEPH SPECT gave the best visualization of the 19mm-diameter sphere.Conclusion: Bremsstrahlung pinhole SPECT provided similar results than PET, and is usable for the dosimetry assessment of the liver and of the tumors with diameter higher than 2.8 cm. The price of a single head gamma camera is only about tenfold that of a liver-SIRT procedure and it could be advisable to install one in the catheterization room. This would allow implementing a dosimetry assessment during the liver-SIRT procedure with the major advantage of not moving the catheter, and at the end, injecting the optimal activity that provides the highest absorbed dose to the tumors while remaining safe for the surrounding liver. This may definitely improve the patient outcome. Multi-pinhole helical SPECT is under development to image patients.
P695 The importance of renography in following of renal toxicity caused by radiotherapy in gastric cancer patients Z. Fejes1, A. Maráz2, M. Lázár1, Z. Kahán2, L. Pávics3; 1Euromedic Diagnostics Hungary Ltd., Szeged, HUNGARY, 2University of Szeged, Faculty of Medicine, Department of Oncotherapy, Szeged, HUNGARY, 3 University of Szeged, Faculty of Medicine, Department of Nuclear Medicine, Szeged, HUNGARY. Objectives: postoperative chemoradiotherapy improves locoregional control and survival in gastric cancer patients. Renal toxicity is one of the most serious complications in upper abdominal radiotherapy.The first aim of this study was analyzed the role of pre-treatment renography in the planning of radiotherapy. The second one, we prospectively analyzed the changes of separate kidney function of patients undergoing postoperative chemoradiotherapy for gastric cancer.Methods: between 2006 and 2009 renography (99mTc-ethylene-dicysteine) was performed in 25 patients (age 39-81 years, average age: 61.4 years) after the surgery, but before the postoperative chemotherapy and conformal radiotherapy. The in-damage kidney to in-safe kidney (D/S) ratio was used as an index of relative kidney function. The in-damage kidney received average 26.5Gy (maximum: 46.2Gy; minimum: 8.8Gy). Control renography was performed within 6-24 months in 20 patients after postoperative radiotherapy, in-damage kidney of 7 patients received less than 20Gy (I. group), 13 patients more than 20Gy (II. group). Control renography was performed within 24-60 months in 10 patients after postoperative radiotherapy, the absorbed dose was less than 20Gy in 4 patients (III. group), more than 20Gy in 6 patient (IV. group). In 5 patients it was performed during both time
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excretion rate in the bilateral parotids and submandibular glands in each patient were estimated. Results: Salivary scintigraphy showed a hypofunction of two on the four salivary glands, at least; compatible with sicca syndrome in 158 patients (76%). The 59 cases with histological confirmed diagnosis had a positive salivary scintigraphy. Conclusion: Despite the lack of specificity of the salivary scintigraphy, it’s the most sensitive functional imaging to detect xerostomia and have subsequently an additional value for diagnosis of Sjögren disease.
S424 intervals.Results: the left-to-right ratio according to pre-treatment renography was more than 1.5 in four patients, which influenced the planning of radiotherapy. After the radiotherapy in the I. group was no significant correlation between functional renal impairment and absorbed dose. In the II. group the average D/S ratio decreased from 0.99 to 0.76 (p<0.05). In the III. group the average D/S ratio decreased from 1.07 to 0.68 (p<0.01). In the IV. group the decline of D/S ratio was 0.57 (from 1.03 to 0.45, p<0.001)Conclusion: in four patients the side difference of renal function observed by pre-treatment renography influenced the planning of radiotherapy. The relative function impairment of the damaged kidney in patients following postoperative radiotherapy for gastric cancer is demonstrated. After postoperative radiotherapy renography is useful to monitor the condition of the damaged kidney in case of long survival or when the absorbed dose is more than 20Gy for years.
P696 Initial Report on [18F]FAZA-PET Clinical Study in Lung Cancer M. Inubushi1, M. Koizumi1, K. Kudo2, N. Yanagitani2, A. Horiike2, F. Ohyanagi2, M. Nishio2, T. Saga1; 1National Institute of Radiological Sciences, Chiba, JAPAN, 2Cancer Institute Hospital, Tokyo, JAPAN. Aim: The aim of the clinical study is to investigate whether PET imaging with a hypoxia tracer [18F]fluoroazomycin arabinoside (FAZA) can discriminate between radioresistant and radiosensitive cancers in histologically-proven primary lung cancer patients planned for radiotherapy. Here shown are the initial results on the [18F]FAZA uptake to the primary lesions.Materials & Methods: Eighteen primary lung cancer patients were enrolled (63 ± 9 y/o, male: female = 11: 7, adenocarcinomas: squamous cell carcinomas: large cell carcinomas = 9: 5: 4, clinical stage IIIA: IIIB: IV = 7: 7: 4). [18F]FAZA-PET images were obtained 2 hours after the tracer injection (370 MBq). The standardized uptake values (SUV), the tumor-tocontralateral normal lung (T/N) ratio, the tumor-to-blood measured in the left ventricle (T/Bl) ratio, and the tumor-to-buck muscles (T/M) ratio were calculated as the semiquantitative parameters for [18F]FAZA uptakes to the primary lesions under the guidance of concomitant CT images. The SUV of [18F]Fluorodeoxylucose (FDG) was also compared with these parameters.Results: There was no statistical difference in the maximum tumor diameter or in the SUV of [18F]FDG between genders, among histological types, or among clinical stages. The T/N ratio of [18F]FAZA was significantly higher in patients with large cell carcinomas than those with adenocarcinomas (5.0 ± 1.9 vs 2.5 ± 0.9, p < 0.0001). The T/Bl ratio of [18F]FAZA was significantly correlated with the maximum tumor diameter (R2 = 0.670, p < 0.0001) and with the SUV of [18F]FDG (R2 = 0.507, p < 0.0001), as well as with the SUV of [18F]FAZA (R2 = 0.748, p < 0.0001). The T/M ratio, however, seemed inappropriate as the parameter in lung cancer, since there was a gender difference in the SUV of [18F]FAZA to the buck muscles themselves (male 1.45 ± 0.12 vs female 1.26 ± 0.19, p = 0.02).Conclusion: Histological difference was found in a parameter of [18F]FAZA uptake to the primary lesions in the lung cancer patients. In addition, reasonable relationships with the tumor size and with the tumor [18F]FDG uptake was found in another parameter of the [18F]FAZA uptake. The best parameter of the [18F]FAZA uptake for predicting the resistance to radiotherapy will be determined through following up the therapeutic outcome of these patients.
P697 Hypertiroidism Treatment with Calculated Activity of 131Radioiodine: Our Experience A. Campenni', R. M. Ruggeri, E. Amato, S. Giovinazzo, N. Quartuccio, A. Murabito, M. Cucinotta, S. Castorina, A. Sindoni, S. Baldari; Università di Messina, Messina, ITALY. Aim: Radio-iodine treatment (RIT) is a well-established method for treatment of hyperthyroidism due to Graves' disease (GD), toxic adenoma (TA), toxic multinodular goiter (TMG). The optimal 131I activity to be administered is still matter of debate. We report our experience with calculated activity of radioiodine.Material and Methods: 34 patients with GD (n=6), TMG (n=5) and TA (n=23) [24 female and 10 men; mean age 65 years, range 41-83] were enrolled. All but seven patients (79%) were overtly hyperthyroid and 19/34 (56%) had received anti-thyroid drugs, withdrawn 5-10 days before RIT. Eight patients were antithyroid antibody positive (6 with GD). All patients underwent: a) Thyroid Scintigraphy (TS) and Radioiodine Thyroid Uptake (RTU) measurements from 3 to 168 hours after 131I administration (1.8 MBq); b) thyroid ultrasonography, to calculate the volume of the “hot” thyroid nodule(s) or of the whole gland. In TMG and TA patients, the “effective” volume of the hot nodule(s) was calculated taking into account the presence of involving area(s) [(whole nodule(s)’ volume - involving area(s)’ volume)].Mean RTU was 51% (range 26-73%). Therapeutic activity was calculated by Snyder formula modified according to the “effective” volume. In three patients with TMG the activity was calculated for both “hot” nodules. Mean administrated activity was 330 MBq (range 109-600) and mean adsorbed dose was 222 Gy (range 93.5-320). Mean follow-up was 19 months (range 3-31).Results: Twenty-eight patients became euthyroid and six developed hypothyroidism within
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 a mean of 3.5 months after RIT (range 2-11 months). TS was performed 3 months after RIT, in 19 TMG or TA patients, demonstrating partial (13 patients) or total (6 patients) ablation of the “hot” area. Neither recurrence of hyperthyroidism nor side effects were observed during the follow-up.Conclusions: The calculated activity of 131-iodine permitted to obtain euthyroidism in 28/34 (82%) patients. The cure-rate was higher (100%) if we consider hypothyroidism as a successful outcome. In our previous experience with standard activity of 131-iodine the cure-rate was lower (63% and 85 %, respectively).Our data confirmed RIT as effective and safe treatment of hyperthyroidism. The calculated activity allows a higher rate of cure compared with standard activity, even though the administrated activity was significantly lower (mean 330 MBq, range 109-600, vs 548 MBq, range 185-1110; p<0,05). Thus, the dose absorbed by “critical organs” (stomach, bladder) will also be correspondingly lower.Finally, the lower administrated activity will result in decreased radiation exposure to family and population.
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Radiometabolic Therapy with I for the Ablation of the Thyroid Remnant in Patients Affected by Differentiated Thyroid Cancer: Comparison Between Four Different Activities. A. Campenni', R. M. Ruggeri, S. Castorina, D. Cardile, C. Vigneri, M. Cucinotta, E. Amato, A. Sindoni, S. Baldari; Università di Messina, Messina, ITALY. Aim: To evaluate the efficacy of four different activities of Na-131I in the thyroid remnant ablation (TRA) in patients affected by Differentiated Thyroid Cancer (DTC): 555, 1110, 2220 and 3700 MBq.Material and Methods: We have enrolled 84 patients (63 Females and 21 Males) with DTC (79/84 or 94% were papillary histotype (PTC), 5/84 or 6% were follicular histotype (FTC). All patients except one (treated after rhTSH administration) underwent radioiodine thyroid uptake (RTU) obtained 24 hours after administration of Na-131I (1.8 MBq) and radioiodine therapy after conventional L-T4 withdrawal (TSH ≥ 30 μUI/ml). The patients, everyone without loco-regional and/or distant metastases at the time of recruitment, were subdivided into four groups based on histotype and pT-staging (pTNM sixth edition).RTU ranged from 1 to 27% of the administered tracer activity. Hospitalization was not necessary only for the Group A patients.Group A: 19 PTC patients (12 F, 7 M) treated with 555 MBq; hTg ranged from 1.6 to 33.9 ng/ml.Group B: 25 patients (23 F, 2 M; 22/25 PTC, 3/25 FTC) treated with 1110 MBq; hTg ranged from 1.6 to 58 ng/ml.Group C: 17 patients (12 F, 5 M; 16/17 PTC, 1/17 FTC) treated with 2220 MBq; hTg ranged from 2.7 to 46.4 ng/ml.Group D: 23 patients (16 F, 7 M; 22/23 PTC, 1/23 FTC) treated with 3700 MBq; hTg ranged from 1.6 to 75.8 ng/ml.In all patients Anti-thyroglobuline antibodies (Tg-Ab) were negative.TRA was examined six/twelve months later. The treatment was considered successful when RTU was <1% (Groups A, B) and/or Tg was undetectable (<1.6 ng/ml) in hypothyroidism (Groups A, B) or after rhTSH administration (Groups C, D).Results: TRA was obtained in: 11/19 (58%), 21/25 (80%), 17/17 (100%) and 22/23 (96%) patients, respectively. In the group D, TRA did not obtain only in the patient treated after rhTSH administration.Conclusion: Our data demonstrate that 2220 and 3700 MBq of radioiodine are significantly more effective than 555 or 1110 MBq in the TRA (100 and 96% of the patients versus 58 and 80%, respectively), without relevant differences between 2220 and 3700 MBq. Hence, 2220 MBq of radioiodine are like better respect to 3700 MBq because the whole body radiation exposure (in particular stomach and bladder) is lower and the duration of the hospitalization is shorter (mean 2 and 3 days, respectively), with consequent lower public health fee.
P699 Assessment of treatment response with molecular imaging using 18F-FLT, 18F-FDG and 18F-FMISO in advanced head and neck cancers W. Cholewinski1, J. Kazmierska1, T. Piotrowski1, A. Ryczkowski2, P. Pienkowski2; 1Electroradiology Department, Medical University, Poznan, POLAND, 2Greatpoland Cancer Center, Poznan, POLAND. Introduction: Despite the ongoing progress in the treatment of advanced head and neck cancers the outcomes remain unsatisfactory. Molecular imaging before and during treatment using tracers assessing glucose metabolism, cell proliferation and tumor hypoxia may help to optimize treatment.Aim: To assess proliferation, hypoxia and glucose metabolism in advanced head and neck cancer before and during treatment with radio- and radiochemotherapy.Material and Methods: Fourteen patients with unresectable head and neck cancer scheduled for radical radiotherapy or radiochemotherapy were enrolled in the study. During the week preceding treatment three PET/CT examinations were performed in each patient including 18F-FDG, 18F-FMISO and 18F-FLT. In addition the CT scans (CT) with contrast were performed for treatment planning. Patients were treated with standard radiotherapy, 35fr/2Gy with simultaneous administration of cisplatin 100 mg/m2 on days 1, 22, 43 of treatment. The PET-CT scan with FLT was repeated during treatment at dose of 14Gy (FLT1) and 28Gy (FLT2) and a survey of FMISO -
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S425 PurposeThe purpose of this study was to correlate F-18-FDG PET (FDG-PET) with change in the parameters of rheumatoid arthritis (RA) after the treatment with anti TNFα antibody.Material and methodsSixteen patients were enrolled in the study. FDG PET and clinical assessment before and 6 months after the treatment with anti TNFα antibody were performed. FDG uptake was evaluated by the maximum standardized uptake value (SUVmax).All patients underwent clinical assessment such as number of tender joints and swollen joints, CRP and disease activity score (DAS28) before and 6 month after the initiation of anti TNFα antibody therapy.ResultsTotally 128 joints are evaluated. Pre and post treatment changes in the ratio of DAS28 score (rDAS28) was correlated with that of CRP (rCRP), average SUV of large joints (rJASUV) and total involved joints (rTIJ) using multi-regression analysis in all patients. No significant correlations were noted with rCRP (r=0.401, p=0.124) and rTIJ (r=0.474, p=0.0636). On the other hand, significant correlation was noted only with rJASUV (r=0.6269, p<0.01)ConclusionChange of the FDG uptake in the large joints correlated with DAS28 at 6 months. The present study indicated that FDG-PET was a significant marker of disease activity of RA undergoing anti TNFα antibody therapy.
after 36Gy. In every scan, the tumour volume and value of SUVmax and SUVmean were assessed. For automatic tumour contouring on the PET images the gradient base method was used.Results: In every patient, the contour of the FLT and FMISO was contained within the outline of FDG. The values of SUVmax and SUVmean were higher for FDG than FLT: mean 11.75 vs 6.68 and 7.9 vs 4.17 and for the FMISO study 1.8 and 1.49, respectively. Significant differences in the volume of the primary lesion was observed before treatment between the CT and FLT (p=0.002) and between FLT and FDG (p=0.036). In the course of treatment there were significant differences between the volumes of FLT and FLT1 (p=0.02) and between SUVmean FLT vs FLT1 (p=0.017) and SUVmax FLT vs FLT1 (p=0.017). There were no significant differences between SUVmean and SUVmax values for FLT and FLT2 (p=0.1 and p=0.17 respectively). In FMISO scans there was significantly reduced volume (p=0.04) and a significant reduction in SUVmax (p=0.04) but not SUVmean (p=0.06). Until now, PET-CT examination was performed in 4 patients after treatment. In 3pts no signs of recurrence in physical and imaging examination was found. In 1pt the recurrence of the disease was found in the area of initially high FLT uptake.Conclusions: The assessment of tumor biology including morphological and metabolic response to treatment may optimize the treatment by identifying areas of high risk of recurrence.
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Is PET/CT with 18FDG necessary for qualification patients to Peptide Receptor Radionuclide Therapy (PRRT) -preliminary report ?
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P700 Objective and automatic evaluation of the response to therapies using absolute quantification of oncology SPECT/CT studies S. Shcherbinin1, S. Chamoiseau2, A. Celler1; 1The University of British Columbia, Vancouver, BC, CANADA, 2Centre Hospitalier de Bigorre, Tarbes, FRANCE. Aim. To improve quality of diagnosis/monitoring of oncology patients and enable treatment modifications, an objective measurement of tumor aggressiveness is required. The goal of this study is to develop an accurate and clinically viable method for evaluation of the response to therapies based on the absolute activity bio-distributions reconstructed from a series of oncology SPECT/CT studies. Materials & Methods. We quantitatively examined the regression of an abdominal neuroendocrine tumor for a patient who underwent 13 chemotherapy sessions (LV5FU2 and dacarbazine) and 2 metabolic radiotherapies (Y-90-DOTATOC) over two years. Five SPECT/CT scans with In-111-Octreoscan were performed (i) before treatments (one study), (ii) in the middle of the chemotherapy sessions (one study), (iii) after the chemotherapy sessions (one study), and (iv) after radiotherapies (two studies). The ability of our reconstruction algorithm to recover the bio-distribution of absolute activity in the patient’s body from routine SPECT/CT scans constitutes the key element of the proposed technique. Specifically, we reconstructed images with patient-specific corrections for attenuation, scatter, and resolution loss and then multiplied them by the camera sensitivity factor which results in absolute activity bio-distributions. Each of reconstructed images was rescaled to take into account (i) the injected In-111 dose and (ii) the time of injection. The obtained images of bio-distribution were fused with the corresponding low-dose CT images. Then, these five CT images were co-registered to each other. Finally, the total absolute activities inside the same 3D region of interest (ROI) encompassing the tumor were determined for each SPECT/CT study and compared with each other. To assess the accuracy of our method, phantom experiments with four active In111 sources were performed. Results. The calculated indexes reflected tumor cell somatostatin receptor density and closely correlated with clinical outcome and the chromogramin A levels. After the chemotherapy sessions, the concentration of chromogramin A was decreased by 60% and the SPECT-measured activity had decreased by 49%. After radiotherapy, these relative differences were equal to 85% and 89%, respectively. From phantom experiments, the absolute activities of four active sources were recovered with errors of 2%. Conclusion. The absolute activities inside a ROI encompassing the tumor(s) obtained from our quantitative analysis of a series of SPECT/CT scans adequately correlate with the therapies’ efficiencies. The proposed method is independent of the imaging protocol, camera type, and injected dose. Each step of the technique can be done automatically or semi-automatically depending on the availability of co-registration software.
P701 Assessment of disease activity with F-18-FDG-PET for evaluating response to anti TNFα antibody in rheumatoid arthritis Y. Arisaka, T. Higuchi, A. Nakazawa, S. Nakano, S. Kodaira, N. Oriuchi; Gunma Uiversity Graduate School of Medicine, Maebashi, JAPAN.
J. Kunikowska1, L. Królicki1, D. Pawlak2; 1Medical University of Warsaw, Warsaw, POLAND, 2IEA POLATOM, Świerk, POLAND. Peptide Receptor Radionuclide Therapy (PRRT) using radiolabelled somatostatin analogues is a treatment option for patients with disseminated neuroendocrine tumours (NET) with Ki-67 below 30 %. Grading is based on primary tumors, but metastatic lesions could have higher Ki-67. In disseminated NET is not possible perform biopsy of all metastases. On the based on the literature typically high grade tumors overexpress somatostatin analogues and don’t characterize increase uptake of 18FDG.The aim of the study was to observed response to the tandem 90Y/177Lu-DOTATATE therapy in patients with overexpresion somatostatin analogues with and without increasing 18FDG uptake.Materials and methods: 18 patients with disseminated NET were included in the study prospectively. Before treatment PET-CT on scanner Biograph 64 TruePoint (Siemens Medical Solutions) was performed 60 minutes after 300-370 MBq 18FDG injection and 60-80 minutes post injection of 120-185 MBq 68Ga - DOTATATE. The period between both study was no longer than 4 weeks. Treatment was based on tandem therapy 1:1 90Y/177Lu DOTATATE with activity 3.7 GBq/m2 body surface area in 3-5 cycles, with amino-acids infusion for nephroprotection.Results: Ki-67 of primary tumours in examined group was bellow 20%. All patients had positive 68Ga - DOTATATE study in all defined lesions.18FDG was positive in 7/18 patients: 3 patients presented 18FDG uptake in all metastases, 2 in part and 2 only in one focus. 11 patients had negative 18FDG study.Time to progression (TTP) was 11.7 months in patients 18FDG positive and it was not reached in patients with 18FDG negative study. The median overall survival (OS) time in both groups was not reach.In group with 18FDG positive 57 % showed progression after PRRT. All patients with 18FDG positive uptake in all metastases showed progression - 6, 12 and 18 months after completed therapy. 1 patient with uptake of 18FDG only in one focus progressed 13 months after therapy.In group with 18FDG negative study 18 % showed progression after PRRT- 7 and 19 months after therapy.Conclusions: 18FDG PET/CT seems to be additional useful tool for prognosis of PRRT response, but it needs longer time of observation. Patients with 18FDG positive uptake in all metastasis need very careful follow-up.
P703 Effect of Peptide Receptor Radionuclide Therapy (PRRT) with tandem isotopes- 90Y/ 177Lu-DOTATATE in patients with disseminated neuroendocrine tumors. J. Kunikowska1, L. Królicki1, D. Pawlak2, R. Mikołajaczak2; 1Medical University of Warsaw, Warsaw, POLAND, 2IEA POLATOM, Świerk, POLAND. Peptide Receptor Radionuclide Therapy (PRRT) is a new treatment modality for inoperable or disseminated neuroendocrine tumours (NET). De Jong was the first one to have described the use of combination treatment consisting of 50% 177LuDOTATATE and 50% 90Y-DOTATOC in rats; which demonstrated that survival rates were 3 times longer.The aim of the study was to evaluate the tandem 90Y/177LuDOTATATE therapy.Materials and methods: 34 patients with disseminated NET were included in the study prospectively. The administered activity was based on 1:1 90Y/177Lu DOTATATE 3.7 GBq/m2 body surface area in 3-5 cycles, with aminoacids infusion for nephroprotection. Blood tests for hematology, kidney and liver function, and CgA were evaluated before therapy. All patients underwent CT scans and somatostatin receptor imaging with 99mTc-HYNIC-TATE or 68Ga DOTATATE. Treatments were repeated, up to a total calculated dose-200 mCi/m2; 100 mCi was usually used per one course. Median period between the treatment was 49 days. Mixed amino-acids infusion over 8 hours was used for kidney protection.Results: At
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the time of treatment all patients showed progressive disease confirmed by CT examination, somatostatin receptor imaging and/or increasing blood concentration of chromogranin A (CgA). The median overall survival (OS) time was 49.8 months, and time to progression (TTP) was 24.2 months. 23 patients before PRRT received chemotherapy, 11 not. In group with chemotherapy before PRRT TTP was 18.7 months and OS 29.8 months, while in group without chemotherapy before PRRT TTP was 24.3 months and OS was not calculated due to insufficient statistical levels. Nevertheless, analysis of Kaplan-Meyer curves showed significantly longer median OS in group without chemotherapy before PRRT (p= 0.028) The differences between both groups in TTP was not statistically significant.On the 12 months follow-up was observed: stable disease(SD) in 21 patients, disease regression(RD) in 5 patients, disease progression(PD) in 4 patients and 3 patients died.The 24 months follow-up resulted as below: SD 11 patients; RD 1 patients and PD 6 patients and 4 patients died. On 36 months follow up: SD 4 patients; PD 5 patients and 3 patients died. Side-effects were rare and mild.Conclusions: The results indicate that tandem radioisotopes ( 90Y/177Lu DOTATATE) therapy is safety treatment option for patients with disseminated or inoperable neuroendocrine tumors. It seems that previous chemotherapy is negative prognostic factor for response of PRRT. The further observation is needed.
P704 Recurrences and survival of differentiated thyroid carcinoma patients initially treated by surgery and radioiodine L. J. Stefanovic1, E. G. Matovina1, R. M. Stankovic2, J. M. Mihailovic1; 1 Oncology Institute of Vojvodina, Sremska Kamenica, SERBIA, 2University of Belgrade, Belgrade, SERBIA. All differentiated thyroid carcinoma (DTC) patients (pts) according to the European consensus are grouped into three risk categories at the time of initial treatment: high risk (HR), low risk (LR) and very low risk (VLR). Aim of the study was to investigate influence of initial therapy on the appearance of recurrences and disease-related survival of DTC pts. Patients: 259 DTC pts were treated by radioiodine and followed-up in our institution. The median of follow-up was 10.4 years (range 2 months to 26.6 years). The outcome of disease is known in all of them at the end of follow-up. 213 pts were in HR, 46 pts in LR (3 of them in VLR) category. Methods: Initial treatment of all pts was surgery, and after that radioiodine (131-I) therapy (ablative radioactivity 3.7 GBq, tumor activity from 3.7 7.4 GBq - in most of pts 5.55 GBq), once or a few times. All pts were treated by lifelong hormonal therapy. The SPSS 11.0 package was used for statistical analyses. Results: Median of follow-up in HR category was10.4 years (2 months - 26.6 years), in LR category 10.3 years (2.3 - 26.2 years), the ratio between females and males in HR was 2:1 and in LR 6.7:1, the ratio between <45 years old pts against >45 years old in HR was 0.8:1 and in LR 1.7:1, the ratio between papillary and follicular DTC in HR was 5.3:1 and in LR 4.8:1. The probabilities of recurrences in HR were 10% after 5 years, 21% after 10 and 15 years, and in LR 2% after 5 years, 12% after 10 years, 17% after 15 years; the differences are not significant (p = 0.0865); hazard ratio is 2.274 (CI95%: 0.899 - 5.749).The probabilities of disease-related survival in HR were 92% after 5 years, 89% after 10 years, 80% after 15 years and in LR after 5, 10 and 15 years were 98%; the differences are significant (p = 0.0252); hazard ratio is 5.166 (CI95%: 0.681 -39.182). Conclusion: After adequate surgery and radioiodine treatment as initial therapy disease-related survival is significantly shorter in HR than i LR category. Differences in frequency and dynamics of recurrences are not statistically significant, although hazard is two times higher in HR category.
P705 Methodology for Identifying Response to Therapy in pre- and post- therapy PET/CT studies using Registered Images 1
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M. Phillips , D. M. Cash , D. L. G. Hill , P. K. Marsden ; King's College London, London, UNITED KINGDOM, 2IXICO, London, UNITED KINGDOM. Aim: The aim of this study was to develop an interactive software [>] package in MATLAB to aid identifying response to therapy in whole body oncological PET/CT studies. The infrastructure was designed to allow the user to register pre- and posttherapy PET/CT scans and extract quantitative information such as SUVmax, SUVmean, the intensity volume histogram (IVH) and gray-level co-occurrence matrix (GLCM) statistics of a segmented 3-D region from the images for analysis. Materials & Methods: Firstly, a subvolume selection tool was designed allowing the user to select a cubic 3-D subvolume of the PET images using two points designating the top left and bottom right hand corners. The corresponding subvolume is identified on the CT images and all are saved. Secondly, a script then registers the two CT images using a customised non-rigid image registration toolkit (IRTK) algorithm. These registered images can be saved for analysis. Finally, analysis is performed using a therapy response analyser tool which allows the user to pick a seed point or choose a value for the image background and a seed point for an area of abnormal uptake. A number of different threshold-based segmentation algorithms can then be used to get a volume of interest (VOI). This can be achieved for more than one area on both the PET images. Common response parameters such as SUVmax, SUVmean, standard deviation, tumour volume, and volumetric
measures such as metabolic burden and total lesion glycolysis can be obtained from the segmented region. The IVH of the area can be constructed and shown visually or as a number of single values. A 3-D version of the GLCM can be calculated which returns measures such as correlation, contrast, energy and hom*ogeneity. All of these can be compared between the two images on a voxel-byvoxel basis. Results: The tools developed in MATLAB allow the user to select subvolumes of pre- and post -therapy PET/CT images, register them using IRTK and analyse them in order to produce a range of statistics from SUVmax to textural features from the GLCM. Conclusion: The tools developed successfully allow the user to register, segment and analyse pre- and post- therapy PET/CT scans. The software is currently being used to evaluate novel indices for the assessment of response to therapy.
P706 Indium-111-Zevalin-SPECT/CT and FDG-PET/CT as quantitative evaluation in radioimmunotherapy for B-cell nonHodgkin's lymphoma K. Hanaoka, M. Hosono, Y. Yamazoe, Y. Tatsumi, Y. Komeya, N. Tsuchiya, K. Ishii, K. Usami, T. Murakami, T. Uto; Kinki University School of Medicine, Osaka-sayama, JAPAN. ObjectivesThe purpose of this study was to evaluate quantitative tumor accumulations of 111In-Zevalin (In-Zevalin) and 18F-FDG (FDG) on SPECT/CT and PET/CT, respectively, as compared to tumor response in B-cell non-Hodgkin’s lymphoma patients receiving Zevalin therapy.MethodsSixteen consecutive patients (8 females and 8 males, mean age: 65.2 ± 8.7 years, range: 49-79 years) confirmed non-Hodgkin B-cell lymphoma who underwent Zevalin therapy along with InZevalin SPECT/CT and FDG PET/CT between January 2009 and December 2010 were enrolled in this retrospective study.The numbers of patients with Ann Arbor stages 1, 2, 3, and 4 were 5, 4, 3, and 4, respectively. Cross calibration of 111In scan was performed with SPECT/CT scanner to measure tumor accumulations as percent of injected doze per gram(%ID/g). All SPECT/CT data were reconstructed using OSEM with depth-dependent 3D resolution recovery with CT-based attenuation correction and energy window?based scatter correction to precisely quantify tumor accumulation. To obtain count recovery coefficients, a NEMA image phantom containing 111In solution was imaged with the SPECT/CT scanner. %ID/g was corrected for size on CT images with relevant recovery coefficients (c%ID/g). Volumetric regions of interest (VOI) were placed over lymphoma lesions on PET and SPECT images by referring to CT images. On PET/CT images, maximum standardized uptake value (SUVmax) of FDG was measured. On SPECT/CT images, tumor accumulations expressed as %ID/g of In-Zevalin were measured at 48 h after injection. All lesions (n=40) were classified into responders and non-responders according to International Workshop Criteria on pre- and post-therapeutic CT images.ResultsPretherapeutic lesion long diameter was 17.1±7.2 mm and 17.7±6.0 mm (not significant), for responders (n=24) and non-responders (n=16). Pretherapeutic SUVmax was 6.5±3.3 and 8.2±4.7 (p<0.05), respectively, for responders and non-responders. Tumor accumulation of In-Zevalin was 0.0019±0.0007 and 0.0025±0.0008%ID/g (p<0.05), and 0.0055±0.0034 and 0.0077±0.0032 c%ID/g (not significant), respectively, for responders and nonresponders. All 4 lesions with the lowest accumulation (<0.001%ID/g) showed high reduction rates in size of more than 90%.ConclusionsThree-dimensional quantitative evaluation of Indium-111-Zevalin was feasible by using SPECT/CT. Tumor response was independent of In-Zevalin accumulation. Low In-Zevalin accumulation does not preclude 90Y Zevalin therapy.
P707 18
F-FDG PET for assessment of therapy response after neoadjuvant chemotherapy in stage IIIA non-small cell lung cancer.
R. Fernández López, I. Borrego Dorado, J. Corral Jaime, R. Vázquez Albertino, L. Paz-Ares Rodríguez; H.U. Virgen del Rocío, Seville, SPAIN. PurposeThe aim of this study was to evaluate 18FDG-PET for assessment of therapy response and prediction of patient outcome after neo-adjuvant chemotherapy (NACT) of IIIA non-small cell lung cancer (NSCLC).MethodsTwelve patients (11 men and 1 women, mean age: 64.33 years old (range:19-81) with newly diagnosed and histologically proven IIIA NSCLC (5 adenocarcinoma and 7 squamous cell carcinoma) were included in a prospective study between September 2008 and January 2010. All patients underwent CT and 18F-FDG-PET-CT (Siemens Biograph. 16 ®) before and after NACT (cisplatin-based chemotherapy). The images data were collected, analyzed and correlated with outcome data. Maximum SUV (SUVmax) value and the NACT response (EORTC criteria) were correlated with clinical outcome. We also compared the assessment of treatment response between CT scan (RECIST criteria) and PET-CT scan (EORTC criteria).ResultsThe mean average 18 FDG uptake of the primary tumours was 13.26 compared with 7.72 after NACT. According to RECIST criteria, one patient developed a complete response (CR), 7 had partial response (PR), 3 stable disease (SD) and one had progressive disease (PD). On PET-CT scan images, according to EORCT criteria, 7 patients had PR, 1 SD
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and 4 had PD. NACT understaged 4 patients because PET-CT scan found new lesions in 2/4, PD for metabolic progression (>25% increase of SUVmax) in lymph node disease in another one and PR instead of CR in the last one. In 2 cases in which CT scan showed SD, PET-CT scan showed PR. 33.3% of patients underwent surgical intervention after NACT.Progressive disease or stable disease according to PET-CT (new tumour manifestations or increasing SUV) was well correlated with an unfavourable outcome.Conclusion18FDG-PET is suitable to assess response to NACT in patients with stage IIIA NSCLC accurately. 18FDG-PET-CT may be helpful in improving restaging after NACT since it allows a reliable assessment of residual tumour viability and it can find new lesions.
lowest.Conclusions: The study showed that the intra-observer agreement between clinicians comparing standard scans with either Pixon or unenhanced scans was excellent.The inter-observer agreement with the Pixon scan was not as good as with either the standard scan or the unenhanced scan (although this was not statistically significant).The inter-observer agreement was equally good with the standard scans and the unenhanced half-count scans. This provides evidence for using half-count scanning with its potential for either lower radiation exposure for patients or quicker scan times.However, these outcomes need to be set in the context of reduced confidence in reporting and further work is required to investigate the implications of this as well as the reproducibility with other reports.
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P710
Assessment of tumour response to therapy
Metabolic effects of chemotherapy on the brain in NonHodgkin Lymphoma (NHL) patients as measured on FDGPET/CT
E. Mehrara, E. Forssell-Aronsson, P. Bernhardt; Göteborg University, Gothenburg, SWEDEN. Purpose: Current criteria that use change in tumour size for assessment of tumour response to therapy (a) categorize therapeutic efficacy values, inappropriate for patient-specific and deterministic studies, (b) neglect the natural growth characteristics of tumours, (c) are based on post-treatment tumor shrinkage (cytotoxic effect), inappropriate for new generation of cytostatic therapies, and (d) do not accommodate integration of functional/biological means of therapeutic efficacy assessed with, e.g. PET or MRI, into data from anatomical changes in tumor. The aim of this study was to develop a general tumour response model based on the effect of therapy on kinetics of tumor growth.Materials and methods: The specific growth rate of tumour, SGR=(1/V) dV/dt (V=tumour volume at time t), is a result of the challenge between cell proliferation rate, CPR, and cell loss rate, CLR, within tumour. Assuming that an effective treatment may decrease the CPR (cytostatic effect) and/or increase the CLR (cytotoxic effect), which consecutively decreases the SGR of tumour; a quantity for tumour response was formulated in relation to pre- and post-treatment volumes of tumour. Tumour response values were analyzed for a group of 11 Non-Hodgkin’s lymphoma patients treated with 131I-labelled anti-B1 antibody.Results: Tumour response was found to be equal to the logarithm of the ratio of post-treatment tumour volume to the volume of corresponding untreated tumour. Results from the new tumour response model indicated that neglecting the natural growth characteristics of tumours, results in underestimation of treatment effectiveness calculated based on currently used criteria. The presented model may also facilitate integration of data from tumour size changes into data from functional imaging for therapeutic efficacy assessment, e.g. PET or MRI.Conclusions: Tumour response to therapy can be assessed with a general continuous dimensionless quantity for both cytotoxic, e.g. radiation therapy, and cytostatic treatments.
B. Saboury1, A. A. JinHyung1, F. Hofheinz2, A. Alavi1, D. A. Torigian1; 1 University of Pennsylvania School of Medicine, Philadelphia, PA, UNITED STATES, 2ABX, Radeberg, GERMANY. Aim:The goal of this study was to determine the metabolic effects of chemotherapy on global brain glucose metabolism in patients with NHL as measured by FDGPET/CT.Materials & Methods:This retrospective study included 20 subjects with NHL (without malignant involvement of the central nervous system) who underwent whole-body FDG-PET/CT before and after standard chemotherapy (CRx). Mean subject age was 63+21 (range 47-82).A 3D ROI was placed around the whole brain on pre- and post-CRx scans in all subjects. An adaptive thresholding method was used to segment the cerebral cortex, and to measure its SUVmean, partial volume corrected SUVmean (cSUVmean), metabolically active volume (MAV), and to calculate global cortical glycolysis (GCG=MAVxcSUVmean) (ROVER software, ABX GmbH, Germany). The effect of CRx in each subject was determined by calculating the cortical metabolic reduction index (CMRi = [Post-CRx GCG - PreCRx GCG]/Pre-CRx GCG x 100%). Paired t-testing was used to assess for significant decreases in GCG due to CRx. Linear regression modeling was used to adjust for effects of age, gender, and time interval between CRx and PET/CT imaging.Results:An average decrease in cerebral cortical metabolism (Mean CMRi = -21.2+5.1%) was observed following CRx. The mean decrease in GCG following CRx was 334.12+114.64cc (P =0.008). After adjusting for possible confounders, there was still a statistically significant decrease in GCG following CRx (adjusted P=0.03).Conclusions:These data suggest that a decline in the cerebral cortical metabolism occurs after chemotherapy, and that global quantitative FDG-PET/CT methods can successfully detect such unanticipated effects.
P711 Therapy & Clinical Trials: Miscellaneous
P709 Evaluation of image enhancement software as a method for performing half-count bone scans A. J. Krom, F. Wickham, M. L. Hall, S. Navalkissoor, D. McCool, M. Burniston; Royal Free Hospital, London, UNITED KINGDOM. Aim: The worldwide molybdenum crisis and a wish to reduce radiation exposure to patients has made imaging with fewer counts more desirable. We studied standard scans, half-count scans and a new technology called Pixon which aims to deliver quality planar scans with half the counts.Methods: Images of 150 patients referred for suspected metastatic bone disease (April - August 2010) were produced in three formats: original (standard images acquired over 20 minutes), unenhanced halfcount (generated from original images using Poisson preserving binomial resampling) and Pixon-enhanced half-count (processing of the latter using Pixon planar image enhancement software). All three scan types were presented in a blinded, random order to two experienced clinicians, who reported whether or not the scan suggested metastatic bone disease (primary outcome), and their confidence of diagnosis using a four-point scale (secondary outcome).The original images were used as a reference standard, and both sets of half-count images were assessed against this, using intra-observer agreement as the measure of quality. This was compared with the inter-observer agreement for standard scans, as this level of agreement is considered acceptable in current clinical practice.Results: The Inter-observer agreement values for the primary outcome were 92% (CI ±4%, Kappa 0.80) for standard scans; 92% (CI ±4%, Kappa 0.79) for unenhanced halfcount scans and 87% (CI ±5%, Kappa 0.70) for Pixon-enhanced scans.The Intraobserver agreements comparing diagnoses made on standard scans vs. unenhanced half-count scans, and between standard scans and Pixon enhanced scans, were both 95% (CI ±2%, Kappa 0.88).There was a significant difference in the clinicians’ confidence in diagnosis (p=0.003), with standard scans scoring highest, followed by half-count scans, and Pixon-enhanced half-count scans scoring
Age-related inflammatory changes in the spine as demonstrated by FDG-PET: observation and insight into degenerative spinal changes A. Aliyev1, B. Saboury1, T. C. Kwee2, D. A. Torigian1, A. Alavi1; 1University of Pennsylvania School of Medicine, Philadelphia, PA, UNITED STATES, 2 University Medical Center Utrecht, Utrecht, NETHERLANDS. Aim:To determine whether the inflammatory component associated with agerelated degenerative changes in the spine can be assessed by in vivo quantitative FDG-PET/CT imaging.Materials & Methods:This retrospective study included 45 subjects (23 men, 22 women; mean age 56 years, age range 28-81) who had undergone FDG-PET for any clinical indication and did not have any report of clinical events (e.g., history of malignancy, spinal surgery, recent osteomyelitis) that would influence FDG-PET quantification. For each subject, the SUVmean and SUVmax of all lumbar intervertebral discs were calculated and averaged. Also, average SUVmean and SUVmax of all cervical, thoracic, and lumbar spinous processes were calculated. Correlation between age and intervertebral disc or spinous process average SUVmean and average SUVmax were calculated using Pearson’s correlation coefficient analysis.Results:Pearson’s correlation coefficients of intervertebral disc SUVmean, intervertebral disc SUVmax, and spinous process SUVmean with age were 0.48, 0.39, and 0.50 (p<0.05), respectively, indicating moderate positive correlations between these parameters. However, Pearson’s correlation coefficient of spinous process SUVmax with age was 0.04 (p>0.05), indicating the absence of a correlation between these two parameters.Conclusion:FDG uptake in intervertebral discs and spinous processes generally increases with age, likely reflecting increasing inflammatory change in these locations. Future prospective studies are required to confirm these initial observations and to increase our understanding of the role of inflammation in spinal degenerative disease, which might have important implications for FDG-PETbased preventive therapeutic strategies in the future.
Poster Presentations
P65 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
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P712 177Lu-DOTA-TATE in Peptide Receptor Radionuclide Therapy: first year experience in Turkey L. Kabasakal1, E. Demirci1, M. Ocak2, C. Decristoforo3, C. Papilla4, A. Araman2, I. Uslu1; 1Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, TURKEY, 2Department of Pharmaceutical Technology, Pharmacy Faculty,Istanbul University, Istanbul, TURKEY, 3Clinical Department of Nuclear Medicine, Medical University,, Innsbruck, AUSTRIA, 4Department of Internal Medicine, Division of Medical Oncology, Cerrahpaşa Medical Faculty,Istanbul University, Istanbul, TURKEY. Aim: Initial treatment for patients with inoperable metastatic neuroendocrine tumors (NET) has been started with high doses of 111In-DTPA-octreotide (Octreoscan). 111In-coupled peptides were found not ideal for peptide receptor radionuclide radiotherapy (PRRT) because of the small particle range and short tissue penetration. Therefore 90Y-DOTATOC was developed. After this achievment 177Lu-DOTATATE was also shown to be very successful in tumour regression. Therefore we have started to treat inoperable NET patients with 177Lu-DOTATATE and in this study we aimed to present the first datas on side-effects of the treatment.Materials and Methods: From May 2010 to February 2011, 26 patients (mean age 50.88±13.87, F/M: 14/12, 186±36mCi) have received 36 therapy doses. As a renal protection i.v. infusion of amino acid solution were used during the treatment sessions. Initial side effects, haematological and renal parameters were monitored before and after therapy.Results: After therapy 27% of patients had nausea/vomiting, 17% patients had hair loss. No significant difference was observed with levels of urea, creatinin and white blood, platelet, hematocrit counts after therapy (p>0.05). But a significant decrease in lymphocyte count was observed (p<0.05). Three patient died during follow up before having second therapy.Conclusion: 177Lu-DOTATATE therapy has been started safely and efectively in our department for the patients who have no therapeutic options.Acknowledgement: This work was part of COST Action BM0607 “Targeted Radionuclide Therapy”.
P713 Successful Treatment of Diffuse Pigmented Villonodular Synovitis with Radiosynovectomy G. Koca1, H. Ozsoy2, S. Ozyurt1, H. Atilgan1, A. Sakaogullari2, H. Yigit3, K. Demirel1, A. Baskin1, M. Korkmaz1, M. Ozdemir2; 1Department of Nuclear Medicine, Ankara Training and Research Hospital, Ankara, TURKEY, 21st Orthopedics Clinic , Ankara Training and Research Hospital, Ankara, TURKEY, 3Department of Radiology, Ankara Training and Research Hospital, Ankara, TURKEY. Aim: Diffuse pigmented villonodular synovitis (DPVNS) is the neoplasia originating from synovial membrane of the joints, tendon sheaths or bursae. Although surgery is the choice of the treatment, recurrence may be seen up to 50% of the cases. We studied the efficiency of radiosynovectomy (RSV) after surgery.Materials-Methods: Cases were retrieved from the period September 2006-July 2010. RSV was applied at least 6 weeks after arthroscopic surgery. 18 knees and 1 elbow of 17 patients (12 Female, 5 Male) that has histopathological DPVNS diagnosis with mean age 30.5±13.1 were included. Average 5.1 weeks following surgery, RSV was applied. 3 mCi Rhenium-186 and 5 mCi Yttrium-90 were injected in elbow and knee joints, respectively. Three phase bone scintigraphy and MR were used evaluate remnant residual and recurrence in 12 patients. Five patients of total six joint sites were excluded because their follow up studies were carried in other hospitals.Results: Three phase bone scintigraphy (blood flow, blood pool and statics images) was evaluated for the degree of radionuclide uptake (none, mild, moderate and marked). Mean follow-up period was 27.5±15.5 months. Blood flow and blood pool images showed that 1/13 patient had marked, 4/13 had moderate, 5/13 had mild and 3/13 had no uptake. Late static images showed 4/13 had marked, 9/13 had moderate Tc-99m HDP uptake in the related joint. With MRI images, lesions were evaluated as progression, stable, regression or cure. MRI revealed no progression, 1/13 stable, 9/13 regression, 3 cure of disease. After RSV we didn’t observe any complications regarding to Y-90 treatment.Conclusion: RSV is an efficient and costeffective method beside surgical synovectomy. We consider that RSV treatment should be applied in cases with DPVNS.
P714 Global quantitative assessment of G-CSF related changes in red marrow on FDG-PET/CT A. B. Esfahane, B. Saboury, M. S. Sanj, A. Alavi, D. A. Torigian; University of Pennsylvania School of Medicine, Philadelphia, PA, UNITED STATES. Aim:To quantify global granulocyte colony-stimulating factor (G-CSF) related changes in red marrow on FDG-PET/CT.MATERIALS AND METHODS:7 subjects (4 men, 3 women) with lymphoma but without known bone marrow disease were retrospectively studied. The subjects were selected by searching the radiology
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 database at the University of Pennsylvania who underwent FDG-PET/CT before and 2-4 months after administration of granulocyte colony-stimulating factor (G-CSF). 2D ROI were placed centrally within medullary cavities of the vertebrae, sternum, manubrium, sacrum,coccyx, pubic rami, iliac bones, ischial bones, proximal femora, and proximal humeri. SUVmean and SUVmax were recorded from these selected locations. Paired t-testing was then used to compare SUVmean and SUVmax of before and after G-CSF administration.RESULTS:Average bone marrow SUVmax and SUVmean over all locations before G-CSF were 2.01 + 0.13 (men 2.32 + 0.19, women 1.59 + 0.16) and 0.93 + 0.04 (men 1.02+ 0.06, women 0.82 + 0.05), respectively. Average bone marrow SUVmax and SUVmean over all locations after G-CSF were 2.59 + 0.15 (men 3.21 + 0.18, women 1.76 + 0.15) and 1.20 + 0.05 (men 1.44+ 0.07, women 0.89 + 0.05), respectively. Increases in average SUVmean and SUVmax due to G-CSF were statistically significant (P< 0.001).CONCLUSIONS:Global functional measurement of red marrow metabolism significantly increased after administration of G-CSF. This quantitative approach on FDG-PET/CT may be useful to evaluate changes in red marrow activity due to therapy by granulocyte colonystimulating factor (G-CSF), disease conditions, or therapeutic intervention.
P715 Global quantitative assessment of age-related changes in the lumbar spinal medullary cavity on FDG-PET/CT A. B. Esfahane, B. Saboury, M. S. Sanj, D. A. Torigian, A. Alavi; University of Pennsylvania School of Medicine, Philadelphia, PA, UNITED STATES. Aim:To quantify global age-related changes in lumbar spinal medullary cavity on FDG-PET/CT.MATERIALS AND METHODS:54 subjects (36 men,18 women) without known bone marrow disease were retrospectively studied. The patients were selected by searching the radiology database at the University of Pennsylvania. Subjects were classified into 7 groups of 5-10 subjects each based on age-decade from 20-89 years old (mean age 57±18). Volume (V) of each lumbar vertebral medullary cavity was approximated from CT as medullary height × mid-vertebral medullary area, and SUVmean and SUVmax of each lumbar vertebral medullary cavity were measured from FDG-PET using a 2D ROI centrally in each lumbar vertebral medullary cavity. Lumbar vertebral medullary cavity mean and max metabolic volumetric product (MVPmean=SUVmean×V and MVPmax=SUVmax×V) were also calculated. Average mean and max total lumbar vertebral medullary MVP (LMVP) in each subject was calculated as the average of MVPmean and MVPmax, respectively, over all lumbar vertebrae. Regression modeling with LMVP as the dependent variable and subject age, height, and gender as independent variables was performed.RESULTS:Average lumbar vertebral medullary SUVmean, SUVmax, and V for all subjects were 1.35±0.34, 1.96±0.53, and 25.82±7.18cc, respectively. SUVmean and SUVmax had decreasing trends with age [Beta = -0.94±0.34 (P=0.34) and -1.41±0.001 (P=0.15), respectively]. Average lumbar vertebral medullary MVPmean and MVPmax for all subjects were 194.97±65.10cc and 282.10±97.73cc, respectively. There were significant decreases in LMVPmean and LMVPmax with age [Beta= -1.01±0.45cc (P=0.031) and -1.58± 0.70cc (P=0.029), respectively]. After adjustment for gender and subject height, the average decreases in LMVPmean and LMVPmax for each decade of age were 10.10 cc and 15.81 cc, respectively.CONCLUSIONS:Global functional measurement of lumbar spinal medullary cavity significantly declined with normal aging. This quantitative approach on FDG-PET/CT may be useful to evaluate changes in marrow activity due to aging, disease conditions, or therapeutic intervention.
P66 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Radionuclide Therapy & Dosimetry: MIBG & Peptides
P716 Targeted Radionuclide Therapy for Neuroendocrine Tumours: Challenges and Pitfalls identified on retrospective review of 3 years experience. S. Vinjamuri1, J. Vora1, A. Sreedasyam1, P. Maltby1, D. Cuthbertson2, M. Pritchard3, G. Poston2; 1Royal Liverpool University Hospital, Liverpool, UNITED KINGDOM, 2University Hospital Aintree, Liverpool, UNITED KINGDOM, 3University of Liverpool, Liverpool, UNITED KINGDOM. Introduction: Targeted radionuclide therapy represents a key area for growth in nuclear medicine. However, the lack of structured protocols for assessment of patients, treatment regimens, availability of local expertise and funding disparities has resulted in a disproportionate distribution of centres performing these procedures.Aims/ Objectives: To review our clinical experience over the past 3 years and identify the barriers preventing the proper evaluation of patients. We would anticipate that more structured, internationally acceptable and translatable data can be acquired, thereby enhancing the evidence base in this complex area of medicine.Methods: A retrospective database review was conducted of Y90 and Lu177 dotatate (55 patients over 3 years). Side effect profile was catalogued for 10 weeks post administration and delayed side-effects were reviewed in the clinical
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P717 Morphological changes in neuroendocrine metastases after radiopeptide therapy.
cancers
D. Handkiewicz-Junak, J. Szczasny, M. Kaszuba, T. Olczyk, J. Roskosz, J. Krajewska, B. Jarzab; Maria Sklodowska Curie Memorial Cancer Center and Institute of Oncology, Gliwice, POLAND. Background. Although neuroendocrine cancers (NECs) constitute a very heterogeneous group, they express somatostatin receptors in more than 80% of cases that allows for their treatment with somatostatin radiolabelled analogues. Disease remission or stabilization is observed in majority of patients, yet little is known about evolution of NETs metastases after radiopeptide treatment. The aim of this retrospective study was to evaluate morphological changes of liver NECs metastases as assessed in radiological examinations. Next, time and site of disease progression was evaluated in the whole group of patients.Material. 35 (14 female/21 male) patients, who were treated with radiolabelled DOTATATE and had their last treatment before 01/01/2009, were included into the study. 30 (86%) patients were treated with four 90Y-DOTATATE treatments (median activity 80 mCi) repeated every 12 weeks, 5 patients were treated with four 90Y-DOTATATE and one cycle of 177LU-DOTATATE at 6 week intervals. After the treatment radiological examinations (CT or MRI) were repeated at 4-6 month intervals. Following radiological features of liver metastases were assessed: contrast enhancement, outline and diameter of the metastatic tumor. Disease progression was measured from the start of 90Y-DOTATATE treatment.Results. 32 (91%) patients suffered from liver metastases, in 20 (54%) they were synchronous/metachronous with extrahepatic ones. There was a direct correlation between number of liver metastases and the diameter of the largest one. After the radiopeptide treatment there was a significant decreases in: (1) tumour contrast enhancement (89 Hounsfield unit before and 76 Hounsfield unit after the radiopeptide therapy), (2) purely solid metastases (43% and 7% respectively) and (3) the sharp outline of metastases (76% and 59% respectively). During the followup 15 (43%) of patients suffered from disease progression. The median time to progression was 50 months. 6/15 (40%) of the patients progressed both in liver and extrahepatic sites, 5/15 (33%) progressed in liver only and 4/15 (27%) patients suffered from extrahepatic progression only. 8/11 (73%) of liver progressions was due to diagnosis of new metastases, 2/11 (18%) was mixed (new foci and progression of the diameter of the metastases diagnosed before treatment). 1 patient with liver metastases progressed outside the liver only.Conclusions. After the radiopeptide treatment of NECs there is a significant change in metastatic tumor morphology as assessed in radiological examinations. Most of the disease progression after the treatment is due to the growth of new liver metastases.
P67 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Radionuclide
Therapy
&
Dosimetry:
Radioimmunotherapy (RIT)
P718 90
Y-ibritumomab tiuxetan therapy of follicular non-Hodgkin’s lymphoma: the experience in our hospital
D. Ramal Leiva1, A. Sabaté-Llobera1, S. Mercadal Vilchez2, N. García Muñoz2, M. Roca Engronyat1, J. Mora Salvadó1, J. Martín-Comín1, E. González-Barca2, Y. Ricart Brulles1; 1Servei de Medicina Nuclear, Hospital
Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, SPAIN, 2Servei d'Hematologia, Institut Català d'Oncologia - Hospital Duran i Reynals, L'Hospitalet de Llobregat, SPAIN. AIMTo retrospectively analyze the evolution of patients with CD20+ follicular B-cell non-Hodgkin’s lymphoma (FBCNHL) treated with 90Y-Ibritumomab tiuxetan (90Y-IT) in our hospital between February 2005 and February 2010.MATERIAL AND METHODSDuring a five years period, 18 patients diagnosed of FBCNHL (average age 54.3 years, Ann-Arbor stage at diagnose: IV in 12 patients (66.7%), III in 3 (16.7%), II in 2 (11.1%) and I in 1 patient (5.6%)) underwent a therapy with 90Y-IT (average dose 1155 mBq (31.2 mCi)). These patients had received a median of 2.2 (1-6) previous treatments, which resulted in complete response (CR) in 1 patient (5.6%), partial response (PR) in 9 (50%) and disease progression (DP) in 8 (44.4%). Clinical and hemathological parameters were used to evaluate toxicity, response and survival after 90Y-IT therapy.RESULTSAfter the 90Y-IT therapy, the overall response was 83% (11 patients (61%) CR and 4 patients (22%) PR, while 3 patients (17%) kept with DP. The whole group average free of disease period was of 15.4 months (m), being 18.2 m for patients in CR and 7.8 m for those with PR. Of the 3 patients that kept in DP, 2 were exitus (3 and 7 m after the treatment) and the other one was lost to further follow-up after 21 months.Analyzing those 10 patients that had already responded to previous treatments, 8 of them reached CR keeping it during a median of 19.6 m (6-59), 5 of them still currently, and the other 3 having had a recurrence in an average of 14 m after 90Y-IT; 2 patients reached PR and kept it during an average of 9.5 m. The median response duration of this group was of 17.6 m.The toxicity after the treatment was basically hematological: thrombocytopenia and neutropenia, generally moderated, with nadir values between weeks 4-6 and 6-8 respectively. 7 patients (38.9%) suffered thrombocytopenia and 9 (50%) had neutropenia of grades 3-4. Mild anemia showed between weeks 8-10, and in only one patient reached grade 3. All the hematological series recovered progressivelly until reaching values close to the initial ones, between weeks 12-14.CONCLUSIONThis study confirms the feasibility of the treatment with 90Y-Ibritumomab tiuxetan in patients with FBCNHL. The therapy shows a high overall and complete response, with a long time duration of the complete response, overpassing 4 years in some patients, and with secondary haematological effects that are usually mild.
P719 177
Lu labeling of monoclonal antibody PR81 for therapy of breast cancer M. Salouti; Department of Biology, Faculty of Sciences, Zanjan Branch, Islamic Azad University, Zanjan, IRAN, ISLAMIC REPUBLIC OF. Aim PR81, a new murineanti-MUC1 monoclonal antibody, was labeled with 177Lu via DOTA. The quality control tests were performed for production of an agent for radioimmunotherapy of breast cancer. Material and methods The immunorectivity and cell toxicity of 177Lu labeled PR81 were tested on MCF7 cell line. The biodistribution and scintigraphy studies were performed in BALB/c mice bearing breast tumor. Results The immunoreactivity of the complex was 83.4±2.4%. The cell toxicity study showed that the complex inhibited 85.2±3.4% growth of MCF7 cells at a concentration of 2500 ng/ml after 96 h. The biodistribution and scintigraphy studies showed the accumulation of the complex at the site of tumors with high sensitivity. Conclusion 177Lu-DOTA-PR81 showed potential for therapy of breast cancer which needs further investigations.
P720 Absorbed dose to the kidneys after treatment with octreotate
177
Lu-
M. Larsson, P. Bernhardt, E. Forssell-Aronsson; Dept of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, SWEDEN. 177
Lu-DOTA-octreotate (177Lu-octreotate) is used for therapy of patients with somatostatin-receptor- (sstr) expressing tumours. After administration, 177Luoctreotate is mainly secreted via the kidneys, with reabsorption and accumulation of 177Lu in the kidney cortex. One of the limiting factors in this treatment is kidney toxicity.The aim of this study was to estimate the absorbed dose to the kidneys after fractionated therapy, and examine which time-points are necessary for accurate determination of the biokinetics and cumulated activity of 177 Lu.Methods:Totally, 33 patients with sstr-expressing tumours received 3.5-8 GBq 177 Lu-octreotate, up to five times, combined with amino acid infusion to block the kidney uptake. Whole body planar gamma camera images were collected at day 0, 1, 2 and 7. The conjugate-view method was used to determine the 177Lu activity in the kidneys. Then, activity data from one time-point at a time was excluded, and the resulting absorbed dose was compared with that based on all timepoints.Results:Large variations were found in the time-activity curve forms of the kidneys between patients. There was also large variation between patients regarding the absorbed dose to the kidneys per administered activity (0.34-2.4 Gy/GBq), and between fractions for an individual patient. Excluding data for day 7 resulted in a deviation in the absorbed dose to the kidneys up to a factor of
Poster Presentations
context by the treating team. As part of a shared care programme, the referring hospital retained key responsibility for the patient while the treating team retained responsibility for the treatment related issues. Post-treatment letters identifying treatment response and maintenance of remission are logged when available. Survival data were checked on Hospital Information Systems just prior to data analysis.Results: While the shared care system provides good continuity of care to patients, the lack of direct and continuing responsibility of the treating team has resulted in huge gaps in follow-up data. The incidence of serious side effects is relatively low with only 2 patients developing delayed myelotoxicity and 1 patient developing chronic renal dysfunction in our series. More than half of patients developed reversible minor side effects. Where radiological response is well demonstrated (such as progression or partial response on CT), this is well documented and communicated to the treatment team. However, the lack of recording of improvement in symptoms of carcinoid syndrome by some teams means that vital subjective patient data cannot be captured and logged. In the absence of automatic updates of clinical databases, Survival data currently can only be performed by spot-checking on hospital information systems, and this again can lead to some inconsistencies of data collection and analysis.Conclusion: From our experience the area of targeted radionuclide therapy can be improved by the following : 1) A standardised approach to selection of patients; 2) Wider availability of skills and expertise; 3) Good pre and post-treatment assessment of patients; 4) Use of “live” patient registries to improve accuracy of data.
S429
S430 2.3.Conclusion:A large variation in the absorbed dose to the kidneys per administered activity was found after therapy with 177Lu-octreotate. The results clearly show that treatment planning and treatment follow-up is necessary for each patient for individual optimisation of the treatment.
P721 Radiolabeled somatostatin analogues in nuclear medicine therapy: first one hundred patients in a single center experience. M. Roncali, A. Froio, M. Casali, A. Versari, A. Fraternali, A. Filice, M. L. Di Paolo, C. Guidotti, E. Grassi, D. Salvo; Santa Maria Nuova Hospital, Reggio Emilia, ITALY.
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 moreover the domain of functional health that evaluate the overall health of cancer patients.Conclusion: The study has demonstrated that in spite of the therapy be very effective and safe, the damage arising from the treatment leads to a poorer quality of life. Nevertheless, other studies in this direction and with a larger number of patients are welcome.
P723 Lingual thyroid Radioactive ablation Treatment M. Mulazimoglu1, M. Kuzdere2, M. O. Tamam1, G. Yildirim2, E. Uyanik1, M. Bel2, N. Edis1, T. Ozpacaci1; 1Okmeydani Training and Research Hospital, Dept. of Nuclear Medicine, Istanbul, TURKEY, 2Okmeydani Training and Research Hospital, Department of Otorhinolaryngology, Istanbul, TURKEY.
Aim: Somatostatin receptors are over-expressed in most neuroendocrine tumors and other neoplasms (thyroid, breast, lung, etc): radiolabeled somatostatin analogues can be used for imaging and therapy of these neoplasms. In this study, we evaluated our first 100 patients (pts) treated with radiolabeled somatostatin analogues (RSA).Methods: One hundred pts, male/female 66/44, age 32-83 yrs, mean age 63 yrs, with metastatic somatostatin-receptor-positive tumors not responding to conventional therapy, were treated with RSA. The primary tumor was NET in 64 pts (23 gastrointestinal, 16 pancreas, 15 lung, 10 unknown origin), thyroid cancer in 19 pts (13 differentiated, 4 medullary, 2 anaplastic), small cell lung cancer in 7 pts, and 10 pts affected by other neoplasm (thymoma, pheochromocytoma and meningioma).60 pts were treated with 90Y-DOTATOC (average dose of 2804 MBq/cycle; total range 2479-16798 MBq). Total dose was calculated according to clinical status and dosimetry evaluation performed by 111InDOTATOC scintigraphy.16 pts were treated with 177Lu-DOTATOC (average dose of 5912 MBq/cycle; total range 3848-24642 MBq) and dosimetry evaluation was performed during the 1st cycle.24 pts underwent both 90Y and 177Lu-DOTATOC.All pts underwent 68Ga-DOTATOC PET/CT before therapy to evaluate the suitability for treatment and 2 months after each cycles step to monitor the response, associated to clinical and biochemical findings.Results: The global results are : 1% had complete response (CR), 34% experienced a partial response (PR), 29% were in stable disease (SD) and 30% had progression disease (PD). 6% of the pts were not evaluable. In the PD cases are included the 7 pts with SCLC and 2 pts with anaplastic thyroid cancer that underwent incomplete treatment (1-3 cycles) because of the progression.The clinical response resulted higher than biochemical and PET/CT findings. The PET/CT improvement was superior in liver metastases than in other tissues. The visual analysis is good in case of progression disease or complete response. In partial response evaluation, PET semiquantitative analysis is superior to the visual one and SUV tumor/non-tumor ratio performed better than SUV alone; the site for the reference ROI was the muscle tissue of the supracetabular region. The side effects were absent or minimal in 97% of the pts.Conclusions: RSA therapy is very promising. 68Ga-DOTATOC PET/CT is useful in pts choice and treatment monitoring. Further investigation is necessary to evaluate the appropriate timing of PET during therapy.
Objectives: Lingual thyroid is a rare anomaly which is due to failure of the descent of thyroid gland from foramen caecum of tongue to lower neck and remaining of residual thyroid tissue along the thyroglossal duct. Tongue is the most common location. Our aim is to evaluate diagnosis producers and treatment of rare development anomaly lingual thyroid tissue. Materials and Methods: A retrospective review of our 6 patients with the complaint of progressive disphagia who are examined by Otorhinolaryngology and Nuclear Medicine Clinic.The patients were evaluated retrospectively by multiple parameters ie, age, sex, location of the mass, biopsy results, follow-up period, magnetic resonans imaging, thyroid scintigraphy and neck ultrasound results. Were performed in all patients, radioactive iodine status and thyroid function tests and symptoms were evaluated. Patients were controlled. Results: All our 6 patients were female. The age at presentation ranged from 19 to 35 years (average age 24.5 years). The most common complaint was progressive dysphagia. Radiologic images and thyroid scans shows no thyroid tissue on usual location of thyroid in all patients. For treatment radioactive ablation is used to all patients according to size of lingual thyroid tissue and serious of symptoms. During 4-8 years of follow-up, regression of symptoms were seen. Endoscopic examination of oropharyngeal passage revealed complete opening. Sublingual thyroid tissue was shrinked and no recurrence was seen. Conclusion: Although uncommon, lingual thyroid is an entity that should be considered especially a mass is encountered at the root of the tongue. Scintigraphy should be performed to demonstrate functional thyroid and for planning treatment. In selected cases suppression therapy, and depending on the size and mass surgical treatment or radioiodine therapy. All the patients will be at need of lifetime thyroid hormone replacement. Follow-up should be performed for the recurrence and the complications. We have to know that in most cases, an ectopic lingual thyroid is unique functioning thyroid tissue, and so treatment should be carefully done by talking to patients.
P68 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Introduction:Standard fixed 131I activities between 1.1 GBq and 3.7 GBq are usually administered for thyroid remnant ablation during hospitalization. Many postoperative patients are not ablated because there are currently very few institutions that can provide the specialist facilities necessary for postablation hospitalization in Japan. This time we ablated with administering 1.1 GBq of 131I to outpatients and assessed the success rate.Subjects & Methods: (Patients) High risk patients, defined as T3/T4a cases of macroscopically complete resection or bulky N1 lymph node metastases, of well-differentiated thyroid cancer who underwent total thyroidectomy with no signs of metastases to other organs were ablated. A total of 39 patients with differentiated papillary carcinoma were evaluated. (131I therapy) All patients were prepared for 131I treatment by the withdrawal of levothyroxine for 4 weeks, which was replaced with triiodothyronine for the first 2 weeks of this withdrawal interval. Patients were instructed to follow a low-iodine diet for 2 weeks prior to treatment until day 5 after therapy, and were prepared according to conventional methods with serum thyrotropin (TSH) greater than 30 μIU/ml. (Ablation assessment) Post-therapy whole body scan (WBS) was performed 6-12 months after ablation, with 1.1GBq of 131I by thyroid hormone withdrawal (THW) or with 185-481 MBq of 131I by recombinant human thyroid-stimulating hormone (rhTSH) administration. At the same time, serum thyrogloblin (TG) concentration was measured.Results: Successful ablation was assessed by WBS and TG level measurement. Fulfillment of the two criteria, that is, negative WBS and TG less than or equal to 10 ng/ml was required to declare successful ablation with no latent metastases. TG increased in 4 patients, which were supposed to have latent progressive metastases. TG decreased insufficiently with negative WBS in 10 patients, which were supposed to have latent metastases or remnant thyroid tissue. TG decreased sufficiently with negative WBS in 20 patients, which were supposed to have neither remnant tissue thyroid nor latent metastases. And WBS proved the remnant thyroid tissue in 5 patients. The 4 of these 5 WBSs were obtained with THW and one was with rhTSH method. The method of the postablative WBS might have improved the results.Conclusion:Success rate of
Radionuclide Therapy & Dosimetry: Thyroid
P722 "Evaluation of quality of life related to the impact of I131 therapy in patients with well-differentiated thyroid cancer in infancy" E. T. Rocha1, L. G. Correa1, S. M. Moriguchi1, A. L. Carvalho1, E. Boldrini1, E. T. Silva2; 1Cancer Hospital - Pio XII Foundation, Barretos, BRAZIL, 2 University of Campinas, Campinas, BRAZIL. Introduction: Thyroid cancer accounts for about 1% of all cancers in adults, being the most common malignant disease of the endocrine system. However, in infancy and adolescent population thyroid carcinoma is a less common condition, ranging from 0.5 to 3% of the malignancies. Treatment option is surgery, and usually followed by ablation with iodine-131. Aim: To evaluate the impact of therapy with Iodine-131 and correlate with the quality of life. Material and Methods: We studied 19 patients with mean age 20 years, who had well-differentiated thyroid cancer in infancy and adolescence, and who underwent thyroidectomy supplemented with iodine-131 therapy. We also recruited a control group of healthy subjects with the same demographics. All patients underwent salivary gland scintigraphy as well as they were requested to answer a questionnaire in order to evaluate the overall quality of life - QLQ - C30; and, a specific questionnaire for head and neck cancer patients - H & N35 EORTC. Results: Qualitative and quantitative analysis of the salivary glands revealed functional deficits with greatar involvement of the parotids on the volume, concentration and excretion; right submandibular gland had significance for volume. Through the questionnaires it was possible to observe significant differences between the two groups related to the domains thick saliva, dry mouth and problems with speech,
P724 Thyroid remnant ablation with 1.1 GBq of
131
I for outpatients
K. Suzuki, H. Tsutsui, A. Suzuki, M. Yoshimura, T. Hashimoto, K. Uchida, K. Koizumi, K. Tokuuye; Tokyo Medical University Hospital, Shinjuku-ku, Tokyo, JAPAN.
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
P725 Radioiodine treatment of hyperthyroidism - a joint approach D. J. Pears1, M. Malik2; 1Diana, Princess of Wales Hospital, Grimsby, UNITED KINGDOM, 2Sc*nthorpe General Hospital, Sc*nthorpe, UNITED KINGDOM. BackgroundRadioiodine has been used to treat hyperthyroidism for over 60 years. Its role in treatment varies internationally, but also nationally within the UK. Historically many centres, including our own, relied on Oncologists to facilitate treatment. Local regulatory requirements dictated that a practitioner must hold a Certificate granted by the Medicines (Administration of Radioactive Substances) Advisory Committee (ARSAC). To obtain a Certificate requires training, experience and competence in the use of radioactive substances, which could be demonstrated by an Oncologist. ARSAC now recognise a national training scheme from the Royal College of Physicians and Royal College of Radiologists to assist Consultant Endocrinologists to obtain certification. Locally, our Consultant Endocrinologist obtained an ARSAC Certificate in 2007 which allowed a change in approach to the provision of radioiodine treatment.The Joint ClinicHistorically, an Endocrinologist referred a patient to an Oncologist, who then referred to a Clinical Scientist for treatment. Advice regarding radiation protection following treatment was provided at 3 stages by 3 different clinicians from 3 different specialties. Although advice may have been consistent, patient perception and understanding varied.We have operated a joint clinic dedicated to radioiodine treatment since 2007. Patients are seen by an Endocrinologist and a Clinical Scientist together. Full clinical assessment is undertaken and radiation protection issues are discussed and clarified to the satisfaction of the patient. An appointment for the treatment itself and a date for withdrawal of antithyroid medication and date for subsequent follow up are agreed.MethodWe wanted to assess patient satisfaction with the joint clinic and include an assessment of issues relevant to radiation protection. A questionnaire was devised and sent to patients who had received treatment between 2007 and 2009. This focussed on information given prior to the appointment, discussed at the joint clinic, discussed at the time of treatment and the overall satisfaction of the treatment process.Results150 questionnaires were sent with a response received from 100 patients. Responses confirmed that patients understood the treatment and appreciated the radiation protection implications and how they must adhere to these post treatment.ConclusionWe recommend a joint approach to radioiodine treatment. We have demonstrated that this has meant patients are well informed and satisfied with the overall service. A second Endocrinologist has obtained an ARSAC Certificate and has just commenced joint clinics at the second major hospital in our Trust.
P726 Scintigraphic Criteria for Radioablation of Small Thyroid Residua in Patients with Differentiated Thyroid Cancer D. A. Dzhuzha; National Institute of Cancer, Kyiv, UKRAINE. Aim: The aim of this study was to determine the quantitative scintigraphic criteria for the radioiodine ablation of the small thyroid residua (TR) in the patients with differentiated thyroid cancer (DTC) after thyroidectomy.Materials & Methods: The results of postoperative monitoring of 62 patients without the radioablation of TR during 24 months were analyzed. All patients had stage pT1-2N0M0 and only the small TR with the low accumulation of a radioiodine at postoperative scintigraphy. Suppressive hormone therapy was carried out under the TSH control. The control scintigraphy with 70-80 MBq of iodine-131 and determination of thyroglobulin were made every 6 months.Results: In 30 patients 37 parts of TR were not determined at the scintigraphy after 6-24 months of monitoring (after 6 months - in 10 pts, after 12 - in 8, after 18 - in 6, after 24 - in 6). Significant correlations between the time interval of the TR visualization and the absolute accumulation of radioiodine in TR (p < 0.05), the percent of accumulation of radioiodine (p < 0.05), the TR volumes (p < 0.05) were found. In 20 patients with the TR volumes more than 1 cm3 significant correlation between the specific volume relative accumulation of radioiodine in TR and the time of TR visualization was estimated (p< 0.05). Taking into account the median values, the percent of accumulation of radioiodine (0.24 %) and the TR volumes (1.4 cm3) were selected as threshold values for the radioablation of TR using the single diagnostic scintigraphy. In patients with TR more than 1 cm3 the specific volume relative accumulation of radioiodine in TR (0.16 %/cm3) may be used as quantitative criterion. If these criteria are lower the indicated values only the suppressive hormone therapy and monitoring are recommended.Conclusions: In patients with DTC who had the small TR and had not the histopathologic and scintigraphic evidences of metastases it is expedient to use certain scintigraphic criteria for the TR radioablation. In case of visualization of TR during 18-24 months the decision about the radioablation must be made individually.
P727 Does Radioiodine I-131 Effect on the Intima-Media THickness of the Common Carotid Artery in the Treatment of Hyperthyroidism? E. Sürücü1, R. Bekiş1, T. Şengöz1, A. O. Çelik2, Y. Demir1, Ö. Orbay2, B. Birlik2, Ö. Özdoğan1, E. İğci2, H. Durak1; 1Dokuz Eylül University School Of Medicine, Department Of Nuclear Medicine, izmir, TURKEY, 2Dokuz Eylül University School Of Medicine, Department Of Radiology, izmir, TURKEY. AIM: The radiation can induce vessel injury. The result of this injury can be severe and life-threatening. There are few studies demonstrating an increase in intimamedia thickness (IMT) of the common carotid artery (CCA) after radiotherapy, especially in head and neck cancers. We evaluated the effect of I-131 to the IMT of the CCA in the patients who were treated for hyperthyroidism.MATERIALS and METHODS: 38 patients (25M, 13W) referred to our department for radioiodine treatment with the diagnosis of nodular guatr (NG) (25patients) and diffuse hyperplasia (DH) (13patients). USG was performed in all patients before, 3 and 6 months after radioiodine therapy in order to measure IMT of CCA and the femoral artery (FA). The IMT was measured at the level of proximal part of bulbus anteriorly on the left and right site. The IMT of FA was measured just before the bifurcation.RESULTS: There was an increase in IMT of both CCA and FA bilaterally in both DH and NG patients. The increase as percentages in IMT of CCA and FA were given in the tables. There was statistically significant increase in the IMT in all arteries for the patients with NG. However, in the patients with DH, there was only statistically significant increase in the left IMT of CCA between 0. and 6. months. Furthermore, there was also significant increase in the IMT of FA.Table : % increase for nodular guatr and diffuse hyperplasia CONCLUSIONS: Though the limitation of the study is the interobserver and intraobserver variability, the first results of the study was seen that I-131 therapy might effect the IMT of CCA in the patients with NG. The I-131 effect to the IMT of CCA in the patients with NG was higher than the IMT of CCA in the patients. The reason of this might be secondary to the administered dose of I-131. The interesting point of our study was the increased thickness of IMT in FA. We think that the increase in IMT may be due to the systemic effect of radioactivity circulating in the blood vessel. The I-131 effect to the IMT of FA in the patients with NG was also higher than the IMT of FA in the patients. The reason of this may be due to I-131 uptake of thyroid gland. The I-131 uptake may be lower in patients with NG, thus the I-131 in systemic circulation may be higher.
P728 Outcome of Radioiodine Therapy in Patients Hyperthyroidism: Calculated Doses vs. Fixed Doses
with
K. Demirel1, G. Koca1, A. Çomak1, M. Korkmaz1, A. Baskın1, C. Çulha2; 1 Department of Nuclear Medicine, Ankara Research and Training Hospital, Ankara, TURKEY, 2Department of Endocrinology and Metabolism, Ankara Research and Training Hospital, Ankara, TURKEY. Aim: We purpose to compare the factors that affect the results and the therapy success of I-131 therapy according to the calculated dose or fixed dose for in the patients with Graves’ disease, toxic nodular goitre and multinodular toxic goitre.Materials-Methods: 128 patients (104 female, 24 male; mean age:55.62±13.18 years, age range:25-85 years) that admitted to our Nuclear Medicine Clinic for the hyperthyroidism therapy with I-131 were included in the study. Of these 128 patients, 59 (46.09%) had multinodular toxic goiter, 37 (28.91%) had Graves’ disease, and 32 (25%) had toxic nodular goiter. Baseline thyroid function tests, thyroid USG, thyroid scintigraphy, radioactive iodine uptake tests, history of antithyroid drug usage and thyroid function tests in 12 months after therapy were recorded. Radioactive iodine therapy doses were calculated dose in 48 patients and fixed dose in 80 patients. Calculated dose formula was thyroid gland weight(g) x 120-200 µCi/ 24. hour thyroid uptake value. 10-15 mCi I131 for Graves’ disease, 15-20-25-30 mCi I-131 for toxic nodular/multinodular goitre as fixed doses was used.Results: After mean one year follow up, in calculated dose group 29/48 (60.42%) were euthyroid, 10/48 (20.83%) were hypothyroid, and 9/48 were (18.75%) were hyperthyroid. In fixed dose group, 35/80 (43.75%) were euthyroid, 35/80 (43.75%) were hypothyroid, and 10/80 (12.5%) were hyperthyroid. Outcome of calculated doses of radioiodine for 7 patients with Graves’ disease, 3 were hypothyroid, 3 were hyperthyroid and 1 was euthyroid; outcome of fixes doses, 18/30 were hypothyroid, 9/30 were euthyroid, 3/30 were hyperthyroid. Outcome of calculated doses of radioiodine for 17 patients with toxic nodular goitre, 13 were euthyroid, 2 was hypothyroid, 2 was hyperthyroid; outcome of fixed dose, 9/15 were hypothyroid, 5/15 were euthyroid, and 1/15 were hyperthyroid. Outcome of calculated doses of radioiodine for 24 patients with multinodular toxic goitre, 15 were euthyroid, 5 was hypothyroid, 4 was hyperthyroid; outcome of fixed doses, 21/35 were euthyroid, 8/35 were hypothyroid, and 6/35 were hyperthyroid. If euthyroid and hypothyroid were evaluated as treatment success after mean 1 year follow up, treatment success had 81.25% for calculated dose group and 87.5% for fixed dose group.Conclusion: Radioiodine theraphy for hyperthyroidism is an effective treatment method for
Poster Presentations
thyroid remnant ablation with 1.1 GBq of 131I was supposed to be from 51.3 to 87.2 %. Further investigations are needed.
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Graves' disease, toxic nodular goitre and multinodular toxic goitre. There was not significant statistical differences between calculated and fixed doses for the treatment success.The rates of hypothyroidism were low in the patients applied radioiodine theraphy with calculated doses than fixed doses.
P731
P729
I image quantification for thyroid ablation therapy: four pediatric patients case study
were due to accurate measurement of administered activity, relatively high effective half-life, and well-organised follow up.
131
Average length of hospitalization of patients with differentiated thyroid cancer treated with radioiodine: preparation with thyroid hormone withdrawal versus recombinant thyrotropin. A. J. Montellano Fenoy, J. Sánchez Catalicio, A. C. Villena Garcia, F. Pérez Ángel, M. J. Murcia Duréndez, M. I. Castellón Sánchez, M. Gallego Peinado, L. M. Salem, L. Frutos Esteban, J. L. Navarro Fernández, F. Nicolás Ruiz, D. Sanz García, M. A. Claver Valderas; Hospital Universitario Virgen de la Arrixaca, El Palmar (Murcia), SPAIN. Introduction: The differentiated thyroid carcinoma (DTC) is treated with surgery followed by radioiodine applications in order to ablate normal residual thyroid tissue. Owing to this process, the sensitivity of thyroglobulin determination increases; the risk of relapse diminishes and any other tumoral focus is extinguished. The radioiodine treatment needs TSH prior stimulation by means of either thyroid hormone withdrawal (THW) during 4 weeks or the use of rhTSH. The application of rhTSH makes it possible to keep the patient euthyroid throughout the whole process. It also helps to maintain the renal clearance and the intestinal function. Previous researches have proved the decrease in radioiodine body retention after rhTSH compared to THW.Aim: To evaluate the radioiodine retention impact on length of hospitalization (LOH) in patients with DTC treated with rhTSH.Materials and methods: We retrospectively checked the average hospital stay of 238 patients with DTC treated with radioiodine in our hospital centre (53 men and 185 women), aged 13-86 (197 papillary and 41 follicular) in the period between May 2009 and January 2011. The first measurement was taken 30 minutes after the administration of the dose. The patients were discharged from the radiation protection ward when the value of radioiodine retention was below 30mSv/h from 1 meter away. All patients have been treated with raioiodine, 158 for postsurgical thyroid ablation (68 with thyroid hormone withdrawal and 90 with rhTSH), 66 with therapeutic doses (38 with thyroid hormone withdrawal and 28 with rhTSH) and 14 empirical doses (5 with thyroid hormone withdrawal and 9 with rhTSH).Results: The mean effective half-life of radioiodine in the whole body was frequently shorter in the rhTSH group than in patients submitted to THW. Therefore, patients who received rhTSH were associated with a low mean LOH (38,95h) compared to those submitted to THW (42,77h) as a preparation for TSH stimulation for treatment with radioiodine.Conclusion: According to the results, the use of rhTSH for the radioiodine treatment makes the average length of hospital stay shorter, allowing a preservation of quality of life (avoiding hypothyroidism during 4 weeks) and reducing the side effects and potential hazards linked to radiation.
P730 The effect of radioiodine therapy in patients with non-toxic goiter with hot nodules on thyroid scan S. S. Abdelrazek, F. Rogowski, P. Szumowski, M. Mojsak, M. Daniluk, M. Winska; Department of Nuclear Medicine Medical University of Bialystok, Bialystok, POLAND. Radioiodine therapy is non-invasive, safe and cost effective method of therapy for reduction of goitre. We aimed to determine whether radioiodine therapy has benefit effect on the symptoms mimicking hyperthyroidism in nontoxic goitre patients. Material and Methods: We studied 20 patients with non toxic nodular goitre, aged 42-79 years, 12 female and 8 male. All the patients complained of some symptoms of hyperthyroidism (palpitation, hot intolerance, sweating, tiredness and tachycardia). In all the patients serum TSH was in the lower normal range, serum levels of fT3, and fT4 were in the normal range, initial RAIU after 24h was ranged between 23-47%, and thyroid volume ranged between 40-80 ml. The serum fT4, fT3, and TSH were evaluated before and monthly up to 12 months after RIT. Thyroid ultrasound, and thyroid scan with thyroid RAIU were done before and after12 months of radioiodine therapy. The activity dose was calculated by Marinelli’s formula and was ranged between 280 and 800 MBq. The absorbed dose ranged between 180-260 Gy and was proportional to thyroid volume. Follow up control was done every 4 weeks. Results: After 12 months of radioiodine therapy a mean thyroid volume reduction of 48% was achieved in all the patients, euthyroidism persist in 96% of patients, and hypothyroidism develop in one patient (4%). All patients were highly satisfied; all the symptoms relieved and exercise tolerance improved. Conclusions: The hot nodules may contribute to the symptoms complained by the patient, and this was confirmed when all the symptoms relieved after radioiodine therapy. Radioiodine is non-invasive, safe and cost effective method of therapy for reduction of goitre and should be used as first choice in every patient with non-toxic nodular goitre (>40 ml) with and without symptoms. The reduction of thyroid volume with low percent of hypothyroidism,
S. M. V. D. Oliveira1, R. Biancardi1, R. Corbo2, M. Mamede2; 1Institute of Radiation Protection and Dosimetry, Rio de Janeiro, BRAZIL, 2National Cancer Institute, Rio de Janeiro, BRAZIL. Aiming to establish individual treatment planning for thyroid ablation therapy of pediatric patients, it has been developed a phase II non-randomized prospective trial in the National Cancer Institute (INCA), in Rio de Janeiro, Brazil. A pilot-study was concluded with four 13.3±1.5 years-old female patients, who received 131I-NaI both whole-body screening (107.0±15.0 MBq) and thyroid ablation (5.5±0.3 GBq), within 15±13 days between diagnostic and therapeutic doses. Dosimetric parameters as effective half-lives, residence times and cumulated activities were estimated in remanescent thyroid tissue, stomach, intestine, submandibular glands, lungs (one patient) and salivary and parotid glands (one patient) through planar images quantification with GE Millenium MG gamma camera dual head by conjugate-view method, single source model and considering organs hom*ogenious uptake. One patient lateral projection was performed for determining organ thickness. Quality control routine tests were performed, as well as attenuation correction by using a flood phantom filled with 131I. Sensitivity test determined the conversion factor of counts to activity (Bq) for a specific scan velocity. Three wholebody scans per phase (tracer and ablative) were performed per patient. Organ activities were determined by drawing regions of interest and counts were converted to activity using a standard source supplied by the Brazilian Secondary Standard Laboratory (LNMRI/IRD). Images acquisition time were 9.6±1.6 h, 33.3±1.6 h and 56.6±1.4 h for tracer phase and 31.0±1.1 h, 63.7±14.9 and 105.5±25.6 h for ablative phase. Ablative residence times were: 64.9±25.6 h (thyroid tissue), 35.9±7.4 h (submandibular glands), 32.9±17.3 h (intestine), 24.3±5.7 h (stomach), 32.2 h (salivary glands), 24.9 h (parotid glands) and 49.1 h (lungs). The data-collecting period shall be extended to 7 days after therapy, in order to achieve best estimation in the 131I long-term decay. This study will be continued with 26 patients: 16 patients belonging to the control group (standardized activities) and 20 randomized patients to the internal dosimetry group (individualized activities).
P732 Urine and blood bioanalysis for four pediatric patients case study
131
I thyroid ablation therapy:
S. M. V. D. Oliveira1, R. Biancardi1, R. Corbo2, M. Mamede2; 1Institute of Radiation Protection and Dosimetry, Rio de Janeiro, BRAZIL, 2National Cancer Institute, Rio de Janeiro, BRAZIL. A pilot study was developed to adequate urine and blood bioanalysis methodologies during radioiodine thyroid ablation therapy. 131I was administered to four 13.3±1.5-year-old and 50±11 kg female patients for whole-body screening (107.0±15.0 MBq) and for thyroid ablation (5.5±0.3 GBq). All urine was separately collected and 2 mL were measured from each sample. Blood samples from periphery vein were collected from 2 h to 76 h after 131I administration. It was used a sodium iodine Genesys well counter. Body residual activities were estimated excluding the excreted activity in urine from the corrected initial activity administered. Blood activities were estimated multiplying the 131I activities concentration in the blood volumes normalized per the patient corporal weight. Urine volume collected varied between 7.0±4.8 L in 95±46 h (tracer phase) and 7.8±5.1 L in 108±50 h (ablative phase). According urine bioassay, 131I whole-body effective half-lives were 31.3±12.7 h (tracer phase) and 34.7±26.5 (ablative phase) and whole-body residence times were 45.0±18.3 h (tracer phase) and 50.0±38.2 h (ablative phase). 131I effective half-lives in the blood were 9.6± 0.7 h (tracer phase) and 13.2±3.1 h (ablative phase). 131I residence times in the blood were 13.7±1.0 h (tracer phase) and 19.0±4.4 h (ablative phase). Due to the pilot study, blood collecting-time will be expanded to the next 36 patients enrolled in the trial. Considering that urine bioassay is extremely patient-dependent and operationally difficult, this method will be discontinued in the study.
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P69 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Therapy
&
Dosimetry:
Bone
Pain
P735
Palliation
P733 Strontium-89 imaging with bremsstrahlung in patients with metastatic breast cancer M. Yoshimura, N. Kohno, K. Yamada, H. Kaise, J. 0kamoto, K. Suzuki, T. Hashimoto, K. Koizumi, N. Kanesaka, H. Nakayama, K. Tokuuye; Tokyo Medical University, Shiujuku-ku, Tokyo, JAPAN.
Radionuclide treatment in prostate cancer: is there any correlation of favorable outcome with PSA levels and spread of bone disease? G. Gerasimou1, E. Papanastasiou1, C. Karanikiotis2, E. Moralidis1, A. Sofos3, C. Pliakos3, G. Liaros1, E. Hilidis1, N. Papadimitriou1, E. Dedousi1, A. Gotzamani-Psarrakou1; 1Ahepa Hospital-Institute of Nuclear Medicine, THESSALONIKI, GREECE, 2424 Military Hospital, THESSALONIKI, GREECE, 3Ahepa Hospital-1st Pathologic Clinic, THESSALONIKI, GREECE.
the aim: Tumoricidal effect of strontium-89 (89Sr) is sometimes assumed by magnetic resonance imaging, 99mTc-MIBI, FDG-PET, or some tumor markers such as PSA. It is thought to become more effective, when the accumulation of 89Sr is more obvious. We retrospectively compared 89Sr imaging with bremsstrahlung (89Sr imaging) in 16 patients of metastatic breast cancer with the markers of bone metabolism or some other factors at the time of administration.materials & methods: Sixteen patients with multiple bone metastases from breast cancer were treated with intravenous 89Sr of 2.0MBq/kg. 89Sr imaging was obtained 2-6weeks after the administration, using a gamma camera fitted with a multi-purpose collimator with 71-KeV photopeak with a window width of 100%. Sr-index was calculated by subtracting the counts/pixel of the non-affected femur from the counts/pixel of the affected site on 89Sr imaging. Sr-index of each patient was compared with type I collagen cross-linked N-telopeptide (NTX), bone-alkaline phosphatase (BAP), serum carboxyterminal telopeptide of type I collagen (ICTP), Creactive protein (CRP), alkaline phosphatase (ALP), calcium (Ca), hemoglobin (Hb) at the time of administration and history of treatment with bisphosphonate (BP).results:Sr-index showed significant correlations with NTX and CRP, moderate correlations with BAP and ALP, and negatively correlated with Hb. As for the relevant to BP, BP treatment duration for 1.5 or more years might have decreased NTX and Sr-index even when the treatment intermitted for several weeks previously just before administration of 89Sr.conclusion:89Sr accumulation was thought to be relevant to turnover of bone, especially bone resorption, and vascularization due to inflammation. Long-term treatment by BP might make them less. On the other hand, to start the combined therapy of 89Sr and BP nearly at the same time might increase the accumulation and prolong the biological half life of 89Sr. And anemia was another unfavorable factor for the accumulation. Transfusion in advance will be an option for anemic patients. To enhance the tumoricidal effect of 89Sr, appropriate combined therapy must be established.
Aim: Prostate cancer is an osteophilic neoplasm spreading to the bones, producing thus pain, discomfort and poor quality of life of patients. Treatment with radiopharmaceuticals emitting β radiation is an effective alternative treatment reducing pain scale and improving quality of life. The aim of this study is to clarify if pain relief is correlated with reduction of prostatic specific antigen (PSA) levels plus reduction of bone involvement evaluated by bone scan index (BSI).Patients and Methods: Twenty-one patients aged 59-81 years (73.7+6.4) with proven by biopsy prostate cancer and secondary bony involvement evaluated by bone scan with 99m Tc-HDP, are enrolled in the study. All patients underwent radionuclide treatment with Rhenium-186 (186Re-16 patients) or strontium-89 (89Sr-5 patients). Repetition of treatment was performed with a 3-4 months interval to all of them. Acceptable levels of erythrocytes, leukocytes and platelets and a good level of renal function were conditions for the application of treatment. PSA levels were measured pre- and post radionuclide treatment and a second bone scan was performed after the third application of treatment.Results: All patients had median or major recession of pain evaluated by daily diary of activities and drug intake. The non-parametric Wilcoxon Signed Ranks test was used for statistical analysis of the data. Baseline mean PSA levels (PSA1) were as high as 231.36ng/ml (minimum 9.00-maximum 1899.40), whilst mean post treatment levels (PSA2) were 212.78ng/ml (minimum 9.50-maximum 2149.50)-p=0.18, non significant. Negative ranks (PSA2
P734
Therapeutic effect of 153Sm-EDTMP on bone metastases from prostate cancer : A case report
Evaluation of treatment efficacy of metastatic bone pain with 153 Sm-EDTMP 1
1
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1
D. Beiki , B. Fallahi , A. Keyvan , P. Haddad , A. Fard-Esfahani , F. Ammozegar Hashemi2, A. Emami Ardekani1, M. Saghari1, M. Eftekhari1; 1 Research Institute for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, IRAN, ISLAMIC REPUBLIC OF, 2Department of Radiation Oncology, Faculty of Medicine,Tehran University of Medical Sciences, Tehran, IRAN, ISLAMIC REPUBLIC OF. Introduction: Samarium-153 ethylene diamine tetramethylene phosphonate (153Sm-EDTMP) is an available and approved radiopharmaceutical for palliative therapy of patients with painful multiple bone metastases. The aim of this study was to evaluate the palliative effect and myelotoxicity of 153Sm-EDTMP treatment in patients with painful bone metastases.Methods: Sixteen cases (9 male, 7 female, mean age: 57.25±16.74 yrs) with severe refractory painful bone metastases from the malignancies of prostate (n=7), breast (n=7) and endocrine glands (n=2) were entered in a before-after study. A standard questionnaire for numeric rating of pain severity, quality of life (QL) and the dose of analgesic drugs was applied for all patients and the scores (ranged between 0 and 10) before treatment as well as the scores at the end of the 2nd, 4th and 8th weeks after treatment were recorded. Cell blood count was measured at the baseline and weekly up to 4 weeks after treatment. A standard common toxicity criteria (CTC) was defined for scoring the degree of myelotoxicity. Repeated measures analysis of variances was applied to analyze within subject effects of treatment on the scores over different time points of the study.Results: A significant pain relief was found in 68.7% of patients by the 2nd week after treatment. The rate of significant pain relief at the end of the 8th week was 75%. Average total pain scores in repeated measures were significantly reduced from 5.68±1.97 to 4.42±2.44 (p=0.048) and 4.12±1.61 (p=0.032) by the 2nd and 4th weeks after treatment, respectively. The QL scores was also improved over three time points of the study (p=0.002). Although average cell blood counts in every four weeks after treatment were diminished as compared to the baseline counts, all patients were in grade 1 or 2 of myelotoxicity based on CTC scores.Conclusion: The present study reveals a significant analgesic effect for 153 Sm-EDTMP in patients suffering from metastasis-related bone pain refractory to the other analgesic drugs or narcotics. This treatment may also improve the quality
P736 I. Slim, A. Mhiri, I. Meddeb, L. Zaabar, I. El Bez, D. Ben Sellem, B. Letaief, M. F. Ben Slimene; Nuclear Medicine Department, Salah Azaiez Institute, Tunis, TUNISIA. Bone metastases are responsible for most of the morbidity associated with hormone-refractory prostate cancer. 153Sm-ethylenediaminetetramethylene phosphonate (153Sm-EDTMP) has been approved for palliation of painful skeletal metastases. Occasionally objective evidence of tumor regression occurs. We report the case of a complete disappearance of multiple painful metastasis on bone scintigraphy, after 6 infusions of 153Sm-EDTMP in a 73 year old man with hormone refractory prostate adenocarcinoma. The Prostate-specific antigen (PSA) decrease to normal level. These findings may be consistent with a possible weak tumoricidal effect of bone seeking radiopharmaceuticals. Indeed, combined treatment (153SmEDTMP with chemotherapy) have been reported to produce a significant improvement in pain palliation and a therapeutic effect on bone disease.
P70 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Radionuclide Therapy & Dosimetry: Preclinical Studies (Animal & in Vitro)
P737
188
In Vitro and Ex Vivo Examinations of Re-E[c(RGDyK)]2-PEGliposome as Antitumor Agent in C26 Tumor-bearing Mouse Model W. Y. Chen1, F. Y. J. Huang1, T. W. Lee2, J. M. Lo1; 1Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, TAIWAN, 2Institute of Nuclear Energy Research, Longtan, TAIWAN. Aim: A proposed dimeric RGD-conjugated liposome, 188Re-E[c(RGDyK)]2-PEGliposome was investigated for its potent as a targeting radio-therapeutic agent for αvβ3 expressive tumors.Materials and Methods: The agent was constructed with
Poster Presentations
Radionuclide
of life and reduce the dose of analgesic and narcotic drugs during the period of 8 weeks after treatment while resulting in only mild and trivial adverse effects.
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E[c(RGDyK)]2 conjugated on the PEG-liposome surface and 188Re-BMEDA (abbreviated from N,N-bis(2-mercaptoethyl)-N’,N’-diethylethylenediamine) complex encapsulated in the liposome core. The in vitro cellular binding was studied using human umbilical vein endothelial cells (HUVECs) with overexpression of αvβ3 integrin. The targeting radiolabeled liposome and the non-targeting radiolabeled liposome (i.e., without RGD conjugation ) were incubated respectively with 5×103 HUVECs at 37°C for 12 h. The cell uptake was estimated from the fraction of the radioactivity measured in the cells. Biodistribution was studied by administering the targeting and non-targeting liposomes in subcutaneous C26 colon tumor-bearing mice with the tumor size ranged 50-100 mm3, respectively. The mice were sacrificed at 24 h and 48 h and the organs or tissues of interest were dissected, weighed and counted for radioactivities. The result was expressed as percentage of injected dose per gram of organ or tissue (%ID/g).Results: The in vitro cell binding study demonstrated that 188Re-E[c(RGDyK)]2-PEG-liposome surpassed 188Re-PEG-liposome about four-fold of cell uptake. The ex vivo study indicated that the tumor uptake by the proposed RGD-targeting liposome was apparently lower than the non-targeting liposome (e.g.,0.43±0.13 and 3.52±0.68 %ID/g of 50-100 mm3 tumor, n=3, respectively at 24 h p.i.). It was also noticed that the proposed targeting radiolabeled liposome showed a much more rapid clearance from the blood followed by a prominent uptake in the liver and the spleen compared to the non-targeting radiolabeled liposome.Conclusion: In the ex vivo study, the proposed targeting188Re-labeded liposome showed lower tumor uptake than the non-targeting 188Re-labeded liposome; this was apparently not consistent with the in vitro cell binding result. It was speculated that E[c(RGDyK)]2 conjugated on the liposome surface might have shielded PEG (estimated ~2500 RGD to ~5000 PEG per liposome) and thus reduced its protection function against the uptake of liposome by the recticuloendothelial system (RES). Modification on the dimeric RGD/PEG ratio of 188Re-E[c(RGDyK)]2-PEG-liposome to minimize RES uptake and improve tumor uptake would be furthermore undertaken.
P738 Study of Non-Targeted Effects Induced on Cell Lines Using Low Doses of Ionizing Radiation 1
1
1
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H. Caires , P. Costa , J. Lemos , R. A. Silva , I. Bravo , L. Cunha , L. F. Metello1; 1Nuclear Medicine Dept., ESTSP.IPP, Vila Nova Gaia, PORTUGAL, 2Anatomic Pathology Dept., ESTSP.IPP, Vila Nova Gaia, PORTUGAL, 3Radiobiology Dept, IPOFG, Porto, PORTUGAL. The LNT - Linear-no-Threshold model, used to analyze dose-effect ratios after biological irradiation exposures, theorizes that effects produced are directly proportional to the irradiating doses, with a linear without threshold pattern.Nevertheless, there is a relevant number of evidence, accumulated essentially over the last decade, suggesting that risks inherent to low doses of irradiation cannot be strictly predicted by the LNT model. Among those, there is a significant number of experimental evidence for a variety of low dose induced biological phenomena, which seems to have an impact on modulating the shape of dose-effect curves, namely for expositions below 0.2 Sv, causing the deviation of LNT model. Accumulated evidence demonstrate that cell irradiation induces biological effects, both to directly irradiated cells as well as to cells not exposed to any kind of ionizing radiation, present in a mixed population. This assumption is breaking the classical idea, based on the belief that damage to cellular DNA is only induced by purely ionizing events in cells directly irradiated. This phenomenon, based on cell communication pathways, is termed “Bystander Effect” - clearly highlighted between the “non-targeted effects” of irradiation not considered by the LNT model - being considered one of the biggest paradigm shifts of modern radiobiology.Aim: Knowing that not all types of cells will produce or respond similarly to bystander soluble factors generated by the irradiated cells, this paper pretends to disseminate the preliminary results obtained after the analysis of bystander phenomena triggered by low doses of irradiation - starting in the medical imaging, diagnostic region - in three distinct cell lines.Material and Methods:Three human cell lines (fibroblasts, pheochromocytoma and follicular thyroid carcinoma) were cultured in 2D (monolayer) were subjected to various protocols of irradiation, with essentially two kind of approaches (exposition to identical doses, but with distinct exposition times, and exposition to distinct doses, during an identical exposition time), both using sources of X and Gamma Rays, with, in all the cases but after distinct periods of time - the resulting conditioned media was collected and transferred to the correspondents non-irradiated cell cultures, where the occurrence of bystander effect was studied by examining the apoptosis / necrosis ratio and the clonogenic survival.Results and Conclusion:Tables including the preliminary results already obtained will be presented and discussed, allowing comparison with published available data.
P71 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Radionuclide Therapy & Dosimetry: Dosimetry Models & Treatment Planning
P739 Comparison of three method of calculation, experimental and Monte Carlo simulation to determine absorbed organs dose in thyroid cancer patients following radioiodine therapy D. Shahbazi-Gahrouei1, S. Ayat2; 1Isfahan Uni. of Medical Sciences, Isfahan, IRAN, ISLAMIC REPUBLIC OF, 2Azad Uni. Unit of research, Tehran, IRAN, ISLAMIC REPUBLIC OF. Introduction: In radioiodine therapy, it is important to determine the amount of radiation absorbed doses in the thyroid and surrounding tissues to evaluate risk and benefit. This work describes comparison of three methods of direct dosimetry using TLDs, calculations using MIRD method and simulation by MCNP4C. The aim of the dissymmetric studies is to help relating the therapy technique to the outcome.Materials and Methods: The study was performed on 27 patients using TLD for thyroid, sternum and cervical vertebra. There were 5 TLDs for each organ which they were taken after 24 hr. To calculate the amount of activity in the thyroid a head and neck phantom was used. Based on the administered doses, the patients were divided into three groups of 100, 150 and 175 mCi. Several TLDs were placed on the surface of thyroid on phantom for 24 hr and then compared with the dose of phantom and patients followed by calculation of the activity in patient's thyroid. Then, MIRD formula was used to calculate absorbed dose in cervical vertebra and sternum. Finally, MCNP4C simulation method also was used and results of all three methods were compared.Results and Discussion: Cumulated radiation absorbed dose (cGy) showed in table.Table. Cumulated absorbed dose of organs by three methods (cGy). The results showed that absorbed dose obtained from three mentioned methods are in a good compromise with each other and each of them may be used to measure the absorbed dose of vital organs of thyroid cancer patients undergoing radioiodine therapy.Keywords: Radioiodine therapy, Thyroid cancer, TLD, MIRD, MCNP4C.
P740 A software for automatic calculation of radiation dose to patients from radiopharmaceuticals J. L. Gomez-Perales1, A. Garcia-Mendoza2; 1Servicio Andaluz de Salud, Cádiz, SPAIN, 2Hospital Torrecárdenas. Servicio Andaluz de Salud, Almería, SPAIN. Objective: The aim of this project is to develop a software application to determine and report the radiation dosimetry of radiopharmaceuticals administered to patients.Method: The application was developed in Visual Basic programming language, and dosimetric calculations are made based on the values given by the International Commission on Radiological Protection (ICRP).Result: We have developed a computer program easy to use, it will automatically calculate the radiation dosimetry of radiopharmaceuticals administered to patients, according to the patient's age, the type of radiopharmaceutical and the administered activity (in mCi or MBq). The resulting dosimetry is shown in a report that specifies the absorbed doses for each organ (in mGy) sorted from highest to lowest and the effective dose (in mSv).Conclusion: The software DosisRad allows the automatic calculation of the radiation dosimetry of a radiopharmaceutical administered to a patient, and the issue of a dosimetric report that can be attached to the patient's history.
P741 Analytical solution of absorbed dose for spherical sourcetarget geometries using Monte Carlo derived point-kernels: An 131 application to I thyroid microdosimetry D. Eterovic1, V. Markovic1, P. Stipanovic2, A. Punda1; 1Department of Nuclear Medicine, University Hospital Split, Split, CROATIA, 2Department of Physics, University of Split Faculty of Science, Split, CROATIA. In microdosimetry one has to model the specific geometry and calculate the dose distribution. The dose distribution may be precisely assessed by Monte Carlo radiation transport simulation, which, however, requires expertise and is numerically demanding.Methods: When both the source and the target are uniformly distributed in the spheres in a hom*ogenous medium we derive an analytical expression for the mean absorbed dose, which requires knowing the dose point-source kernel. For the case of 131I we used the EGSncr Monte Carlo code to obtain the discrete estimates of the point-source kernel. Using the function fitted to these data the mean absorbed dose in a sphere from a spherical source is given as a sum of elementary functions. The new method is compared against the direct Monte Carlo simulation and the approximate method that neglects electron straggling. Results: The new method and the Monte Carlo method produce identical results. These two methods differ from the approximate method for 5% in case of relatively large spheres 200 μm in radius that touch each other, which increases to about 17% in case of spheres 50 μm in radius separated by 500 μm. In case of thyroid follicular cells 10 μm tall that encompass spherically the source of 131 I uniformly distributed in the follicular colloidal lumen of 150, the error in the absorbed dose of the approximate method is 11%.Conclusion: A simple tool is
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P742 Patient Specific Dosimetry Analysis and Optimisation using Polymer Gel Dosimetry J. I. Gear1, M. Partridge2, G. Flux1; 1Royal Marsden NHS Foundation Trust, Sutton, UNITED KINGDOM, 2Institute of Cancer Research, Sutton, UNITED KINGDOM. Aim: To determine the accuracy of dosimetry performed on a patient undergoing I 131 mIBG therapy for stage IV neuroblastoma, using a patient-specific phantom incorporating polymer gels. Method: A tumour phantom was created based on a patient’s CT scan. This was filled with a polymer gel dosimeter mixed with I-131. The resultant absorbed dose distribution was determined by measuring the magnetic resonance relaxation coefficient T2. This was compared with SPECT-based dosimetry performed using a standard protocol described by Buckley et al, (Cancer Biother Radio vol. 22(1): p105-12). Sequential SPECT scans were acquired 1, 3, 6, 9 and 12 days post preparation. Filtered back projection reconstruction was performed and phantom activity determined using pre-acquired calibration data and a volume thresholding technique. Mean absorbed dose was determined using sphere S-factors. Dose was also calculated using a voxel-based method, exploring different reconstruction and correction methodologies. Parameters investigated included; reconstruction, scatter correction, attenuation, and detector resolution modelling. Results: Comparisons of CT images showed that the phantom was a good representation of the patient with a close anatomical resemblance. Mean absorbed dose values calculated with the standard methodology agreed to within 36% of that measured by gel dosimetry. The optimal reconstruction and correction methodologies were found to be: OSEM reconstruction with linear attenuation correction based on the body contour and a single attenuation coefficient and triple-energy window scatter correction adding the scatter estimates into a Poisson statistical model during reconstruction. Depth-dependent detector modelling was explored but found to have no significant improvement on image quality or dose quantification. The mean tumour dose calculated using the optimised voxelmethod of dosimetry agreed to within 3% that measured with gel dosimetry. Having optimised the dosimetry protocol, dosimetry was performed using the data obtained for the patient from whom the phantom was designed using both the optimised voxel-method and the standard protocol. Differences in the calculated doses between the two techniques were evident which could have lead to different courses of action being taken with regard to subsequent therapies. Conclusion: To our knowledge this is the first time patient-specific polymer gel dosimeters have been used for targeted radionuclide therapy. Dosimetry using a patient-specific polymer gel phantom enabled the dosimetry protocol for that patient to be optimised, allowing for a more informed decision regarding future treatment regimes.
P743 Does the Intratumoral Uptake pattern of Tc-99m-MAA allow a Prediction of Response to Yttrium-90-Radioembolization in Patients with Colorectal Liver Metastases? G. Ulrich, M. Zeile, O. S. Großer, J. Ruf, R. Seidensticker, A. Zarva, M. Pech, J. Ricke, O. Dudeck, H. Amthauer; University of Magdeburg, Magdeburg, GERMANY. Aim:The aim of the present study was to evaluate the predictive value of the intratumoral uptake pattern of Technetium-99m labeled macro-aggregated albumin (Tc-99m-MAA) with regard to the prediction of therapeutic response after Yttrium-90-Radioembolization (Y-90-RE) in patients with colorectal liver metastases.Methods:Inclusion of 50 patients (m:f=34:16, mean age 62y±9.4y) with overall 185 liver lesions and a successful Y-90-RE of one liver lobe in a sequential therapeutic procedure. Pre-therapeutically the patients must have received Tc99m-MAA perfusion scintigraphy (planar whole body scan and abdominal SPECT), baseline magnetic resonance imaging (MRI) and a follow-up MRI (41.8±9.6 days after Y-90-RE). Lesions affected by Y-90-RE were identified by image fusion of posttherapeutic Bremsstrahlung-imaging and the initial MRI. Intratumoral Tc-99mMAA nuclide accumulation on fused images was rated into four groups. In Group 1 the metastases had non and in Group 2 a low intratumoral Tc-99m-MAA accumulation. Group 3 showed a good and Group 4 had an obvious intratumoral Tc-99m-MAA accumulation. A potential bias due to central necroses was taken into account. For analysis Groups 1 and 2 were pooled into “low MAA” and Groups 3 and 4 into “high MAA” categories. Treatment response was evaluated by means of follow-up MRI after Y-90-RE with help of RECIST-Criteria. Furthermore, all hepatic metastases were grouped according to individual increase/decrease in size which was estimated by changes of the lesion diameter. Statistical analysis was performed using Fisher’s exact test and a generalized linear mixed model. A p-value of 0.05 was set to be the level of statistical significance.Results:From the 50 patients one patient showed a partial response, 41 patients presented with stable
disease and the remaining 8 patients had a disease progression according to RECIST. There was no association of tumor response with the overall intratumoral Tc-99m-MAA distribution in the treated liver lobe (p=0.247).126/185 lesions showed a decrease in size after Y-90-RE. From these 126 lesions 52 were rated as low MAA and the remaining 74 as high MAA. The residual 59/185 lesions showed an increase in size, with 28 showing low MAA and 31 high MAA uptake. There was no relationship of response to Y-90-RE and intratumoral Tc-99m-MAA distribution in the lesion based analysis (p=0.741).Conclusion:Our results indicate that in patients with hepatic metastases of colorectal carcinoma the pattern of intratumoral Tc-99m-MAA distribution is not useful for the prediction of response to Y-90-RE.
P744 Combining 99mTc-MAA SPECT/CT and 18-FDG PET/CT for planning liver 90Y radioembolization (SIRT) J. Chalaye1, M. Bernardini2, C. Smadja2, O. Pellerin3, O. Dubreuil4, J. Pelage5, M. Sapoval3, P. Rougier4, J. Taïeb4, J. Darcourt6, M. Faraggi2; 1 Hôpital Henri Mondor, Service de Médecine Nucléaire, Créteil, FRANCE, 2 Hôpital Européen Georges Pompidou, Service de Médecine Nucléaire, Paris, FRANCE, 3Hôpital Européen Georges Pompidou, Service de Radiologie Interventionnelle et Cardiovasculaire, Paris, FRANCE, 4Hôpital Européen Georges Pompidou, Service d'Oncologie Digestive, Paris, FRANCE, 5Hôpital Ambroise Paré, Service de Radiologie, Paris, FRANCE, 6 Centre Antoine Lacassagne, Nice, FRANCE. Aim: SIRT is now a treatment of unresectable primary or metastatic cancer in the liver. Prior to the therapy, the Y90 administered activity must be determined using, most commonly, 99mTc-macroaggregated albumin (MAA) liver scintigraphy and the tumor volume calculated on CT images. The purpose of our study was to provide an objective comparison of 99mTc-MAA and 90Y SPECT/CT images and to evaluate 18-FDG PET/CT in the tumor volume definition and the treatment planning.Methods and materials: Nine patients (8 men and 1 woman; mean age: 56 years) with primary (n=1) and secondary ( n=8) liver cancer, having 12 SIRT (3 whole liver and 9 selective), were enrolled in the study. We retrospectively analyse the 99mTc-MAA SPECT/CT, 90Y SPECT/CT, CT and 18-FDG PET/CT registered images. We compared the distribution of 99mTc-MAA and 90Y, visually on each liver segment, and semiquantitatively by the mean of their distribution volume and their tumor/normal liver (T/N) ratio. We also compared the 99mTc-MAA and 90Y T/N ratio whether the tumor volume was defined on the CT or on the 18-FDG PET/CT. Finally, we analysed the correlation of volume and maximum standardized uptake value (SUVmax) with the 99mTc-MAA and 90Y uptake of 37 18-FDG avid lesions.Results: A good visual correlation was found between 99mTc-MAA and 90Y SPECT/CT images, except for whole liver treatments. The T/N ratio (p=0.009) and the uptake of 99mTc-MAA and 90Y (p=0.002) in 18-FDG avid lesions was also good. The T/N ratio of 99mTc-MAA and 90Y was higher and more similar to what found in ex-vivo studies, with the functional tumor volume defined on 18-FDG PET/CT than with the anatomical tumor volume defined on CT ( p<0.005). Interestingly, a positive correlation was seen between colorectal cancer liver metastases (CRCLM) SUVmax and their 99mTc-MAA and 90Y uptake (p=0.006).Conclusion: The concordance of 99mTc-MAA and 90Y distribution on SPECT/CT images is good except for whole liver treatment. The functional tumor volume defined on 18-FDG PET/CT could be a relevant way to determine the T/N ratio, and the SUVmax a prognostic tool for patients with CCRLM undergoing SIRT.
P745 Biodistribution and dosimetry of free 211At, 125I- and 131I- in rats J. Spetz, N. Rudqvist, E. Forssell-Aronsson; Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg, SWEDEN. 131I is widely used in clinical applications and 125I, 131I and 211At are often used in in vitro studies and research. When treating patients with radiopharmaceuticals containing these radionuclides it is important to know the dosimetry in normal tissue in order to determine potential risk organs. To determine the dosimetry requires a known biodistribution of accumulated activities for these radionuclides and tissues. This has been well established in mice, however the difference in size between rats and mice makes organ sampling easier in rats, particularly for the smaller organs which can be difficult to entirely excise alone in mice. This may result in a more extensive future use of rat animal models. The purpose of this project was to study and compare the biodistribution of 125I, 131I and free 211At in rats and to determine absorbed doses from all three radionuclides to various organs and tissues. Methods: Male Sprague Dawley rats were injected simultaneously with 0.1-0.3 MBq 125I- and 0.1-0.3 MBq 131I-, or 0.05-0.2 MBq 211At. The rats were sacrificed and dissected 1 hour to 7 days after injection. Radioactive measurements were performed on the organs and tissues collected and the activities and activity concentrations were determined and mean absorbed doses were calculated. Results: The biodistribution of 125I- was similar to that of 131I-. All three radionuclides were accumulated selectively in the thyroid gland; however the activity concentration of radioiodine was about five times higher than
Poster Presentations
derived that produces results identical to direct Monte Carlo method in solving the dose distribution for any spherical source-target geometry in a hom*ogenous medium.
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that of 211At. The activity concentration of 211At was higher than that of radioiodine in all extrathyroidal tissues. The mean absorbed dose was highest to the thyroid. 131I gave the highest dose to the thyroid at t=∞, and 211At gave the highest dose to all other tissues studied. Conclusions: The biodistribution of free 211At was different compared to 125I- and 131I-. 211At gave the highest mean absorbed dose per unit injected activity to all extrathyroidal tissues.
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Data from patients that participated in a Phase-II clinical trial for prostate cancer metastatic to bone were analysed. All 27 patients were treated with 5000MBq (4974±78) 186Re-HEDP. During a four-day period of hospitalisation a number of blood samples were taken and the activity clearance in the plasma was calculated. Up to five sequential pelvic and chest SPECT scans were acquired for tumour and normal organ dosimetry and Whole Body counts with a 2m arc NaI detector were obtained for Whole Body absorbed dose (WBD) calculations.Dosimetric calculations were performed based on MIRDmethodology. The WBDs were estimated using two different methods to determine the Cumulated Activity: a semi-empirical phase fitting method on a semi-log plot and Spectral Analysis (SA). The mean and standard deviations of the WBDs as calculated with the semi-empirical method and with the SA were 0.32±0.11 Gy and 0.48±0.22 Gy respectively. SA showed predominantly 3 phases for the Time Activity Curves (TACs); 3 patients with 2 phases, 14 patients with 3 phases and 9 with 4 phases. (WB data was not available for one patient).The blood clearance curves of 10 patients were analysed using SA and all show 3 phases with a rapid clearance of ~80% in the first hour.Tumour dosimetry was performed using a dual energy window scatter correction and FBP with Chang attenuation correction using an effective attenuation factor of 0.142/cm. Spinal lesions were analysed which showed two distinct phases with the first being an uptake phase followed by a decay phase with the effective half life of the latter close to the physical half life. Calibration data based on a cylindrical phantom 20 cm in diameter and 11 cm in height with a range of cylindrical insert sizes to represent different tumour volumes were used to obtain the tumour dose. Initial results show mean doses to range between 8 Gy and 32 Gy showing large intra patient variability.Ongoing work focuses on tumour dosimetry using in addition to FBP the OSEM and attenuation correction based on anatomical images. A three compartmental model seems to predominantly describe this therapy as indicated with the SA analysis.
Mutual Information Based Statistical Change Detection Applied to Sequential Post Radionuclide Therapy Imaging M. Carroll; Royal Liverpool University Hospital, Liverpool, UNITED KINGDOM. Objectives : The detection of significant changes between 3D nuclear medicine data sets is crucial in therapy monitoring . But these significant changes have to be distinguished from pervasive differences from image misregistration. In this work we compensate for registration noise by constructing an image change map.Methods : Significant changes are detected based on level curves of the ratio P(x,y)/P(x)P(y) where P(x) and P(y) = distribution if x and y were independent where x,y are the respective SPECT voxel values . We do not know the underlying distribution for P(x,y) only samples {(x1,y1),(x2,y2),…}.We can produce samples from Q(x,y)=P(x)P(y) by resampling the original data by randomly sampling from both image sets coordinates to give {(xi,yj),..}.We identify significant changes with high values of mutual information :S(x,y) = logeP(x) + logeP(y) - logeP(x,y), where after removing the data mean from both images the probability densities are described in terms of data covariances X= [xxT] , Y=[yyT], and cross-covariance C = [yxT].Robustness to misregistration is achieved by taking voxel x in the reference image and a small window containing yn values centred on the corresponding voxel in the second data set. If x represents a true change then all [xyTn] are likely to have significant change values but if the change is due to misregistration then some of [xTyTn] will not be significant if the local window is large enough to include the registration error.Results : This technique has been applied in determining the efficacy of targeted radionuclide radiotherapy using Leutitium-177 and Ytterium-90 in fused multiple image time series by detecting size change in pre-existing lesions and by confirming the absence or presence of new lesions , a key indicator of disease progression.Conclusions : Mutual information based change detection is effective at detecting significant changes and is robust when coupled with local coregistration optimisation.
P72 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Radionuclide Therapy & Dosimetry: Clinical Dosimetry
P747 Bone Marrow Radiation Dose in Thyroid Carcinoma Patients Treated with Iodine-131 Y. Parlak1, M. Demir2, S. Erees1, G. Gumuser1, B. Uysal3, G. Capa Kaya3, M. Koc3, U. Ergene1, E. Sayit1; 1Celal Bayar University, Manisa, TURKEY, 2 Istanbul University, Istanbul, TURKEY, 3Dokuz Eylul University, Izmir, TURKEY. Aim: Internal dosimetry is a controversial issue in the therapy of thyroid carcinoma with I-131 (radioiodine). Radiation absorbed dose to the red bone marrow, a critical organ in the therapy of thyroid carcinoma, has to be less than < 2 Gy. The aim of this study was to calculate bone marrow radiation dose, as it is highly radiosensitive, by using a modified approach based on the formalism of the Medical International Radiation Dose Committee (MIRD).Method: Thirty-one thyroid cancer patients (8 male, 23 female; mean age: 49.87 ± 12.12 years), treated with I-131 were included in the study. Radioiodine was administered as 3700, 5550, and 7400 MBq to patients via oral route. Blood samples were taken in 2, 19, 24, 48, 72, 96, 120 and 144. hours after the treatment, and were counted well-type gamma detector and time-activity curves have been generated. Data on blood clearance rate of radioiodine, absorbed radiation dose to bone marrow of patients calculated by using MIRD method. The amount of activity relationship with radiation dose and radioiodine effective half-life was determined by ANOVA test.Results: Effective half-life of radioactive iodine in patients receiving 3700MBq, 5550MBq, 7400MBq were calculated as 20.57±5.4, 17.8±5.8 and 18.7±3.9 hours, respectively. Bone marrow doses for patients receiving 3700MBq, 5550MBq, 7400MBq were found as 0.32 ± 0.08 Gy, 0.42 ± 0.14 Gy and 0.60 ± 0.24 Gy, respectively.The average of the effective half-life for all the given doses was calculated as 19.42 ± 5.42 hours. No statistically significant difference was detected between the effective half-life and the dose of administered radioactivity.Conclusion: Blood biokinetics of the given radioactive iodine is not associated with the amount of activity. The amount of activity was correlated with bone marrow doses and our findings can be used as an extrapolation coefficient to determine the total bone marrow dose.
Retrospective analysis of data from a phase-II trial on HEDP for prostate cancer metastatic to bone.
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A. Divoli, D. Morgan, S. Chittenden, G. D. Flux; Royal Marsden Hospital, SUTTON, UNITED KINGDOM.
P749 Hybrid SPECT-CT dosimetry for some standard nuclear medicine exams A. Mhiri, I. Slim, I. Meddeb, M. GhezaielL, F. Ben Slimene; Nuclear Medicine Department. Salah AZAIEZ Institute. University El Manar II, TUNIS, TUNISIA. Single photon emission computed tomography associated to X ray computed tomography (SPECT-CT) is a nuclear medicine tomographic imaging technique which improves diagnostic accuracy for some clinical indications due to the possible attenuation and/or scatter correction of the SPECT functional images and the availability of helpful anatomic information. Our purpose is to evaluate effective doses received during some standard nuclear medicine exams in patients undergoing SPECT-CT and to precise parameters involved in variation of these doses. In fact, combined imaging results in a significant increase of the patient dose. The effective dose is dependent on administered activity and the patient’s age for SPECT; whereas for CT scan, it depends on tube current, tube potential, rotation speed, pitch, slice thickness, patient mass, and the exact volume of the patient that is being imaged. A sensible choice of these parameters used can significantly reduce radiation dose, without any compromise in the quality of the diagnostic information. The dose in the patient must be as low as compatible with the medical purpose. Practice leading to a medical exposure must be clearly justified and protection against radiation must be optimized, particularly for children. Also, quality control procedures have to be defined because of the coupling between the two devices.
P750 Biokinetics and Radiation Dosimetry of Datscan™ Ioflupane (123I) in Patients with Suspected Alzheimer’s Disease or Parkinsonism M. Sydoff, H. Uusijärvi, S. Mattsson, S. Leide Svegborn; Medical Radiation Physics, Department of clinical sciences, Malmö, Lund University, Skane University Hospital, Malmö, SWEDEN. Aim: 123I ioflupane is used for the investigation of Alzheimer´s disease, Parkinsonism or Lewy body dementia. The aim of this study was to determine the biokinetics of ioflupane in routine patients up to 48 h post injection (p.i.) as a base for improved organ absorbed dose and effective dose estimates.Materials and methods: The biokinetics of DaTSCAN™ ioflupane (123I) were investigated in eight male adults with suspected Alzheimer’s disease or Parkinsonism. Wholebody, conjugate view scans were performed on the subjects at approximately 10 min, 1 h, 4 h, 24 h and 48 h p.i.. SPECT/CT thoracic images were acquired 0.5-2 h p.i. and SPECT/CT brain images 3 h p.i.. Blood samples were collected prior to each
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P751 Preliminary results of pretherapeutic blood and bone marrow dosimetry of patients with differentiated thyroid cancer T. Kalathas, P. Mitsakis, M. Kotzassarlidou, V. Hatzipavlidou, E. Raptou, N. Salem, A. Makridou; Theagenio Cancer Hospital, Thessaloniki, GREECE. Radioiodine is used for treatment of differentiated thyroid cancer (DTC). Bone marrow is actually the organ at risk, therefore it is essential to tailor the therapeutic activity such as blood dose doesn’t exceed 2Gy. Aim: This study aimed to perform and present the preliminary results of pretherapeutic blood and bone marrow dosimetry performed to patients with DTC, scheduled to be treated for ablation of remnant thyroid tissue after surgery, according to EANM Dosimetry Committee guidelines. Materials & Methods: For 10 DTC patients a tracer dose of 15MBq I-131 was administered orally and an I-131 standard source was prepared simultaneously. Measurements of whole-body activity and blood sampling (2ml) were performed at 2,6,24,96,144h post administration. A dual-headed gammacamera (SOPHA-Xli) with high-energy collimators was used for whole-body activity measurements. Transmission scan of each patient was acquired before administration. Attenuation corrected anterior (IA) and posterior (IP) images of whole body scan were manipulated and their geometric mean (GM) was calculated. ROIs around each patient’s whole body and standard source were drawn and their activity was measured. Aliquots of 1ml were prepared from each blood sample and counted in a Captus 3000 well-type counter. Blood activities were normalised to the administered activity and retention per millilitre of blood was calculated. Timeactivity curves describing the activity in blood and total body were assessed and residence times for whole body and activity concentration in blood, Ttotalbody [h] and Tmlofblood [h] were calculated. Mean absorbed dose to blood per unit administered activity is determined by the sum of contributions of blood selfirradiation and penetrating radiation from the whole body. Mean blood absorbed dose per unit administered tracer activity and red marrow absorbed dose per unit activity were calculated by adding the 2 components and assessed for the activity to be administered for a blood absorbed dose of 2Gy. Results: Mean blood absorbed dose per unit administered tracer activity was 0.039Gy/GBq0.157Gy/GBq. Activity to be administered for a blood absorbed dose of 2Gy was 22GBq-12.7GBq. Red marrow absorbed dose per unit activity was 0.06Gy/GBq0.1Gy/GBq. Conclusions: The calculated activities are well beyond the 3.7GBq that are routinely used for ablation. This allows for better therapeutic results, without the risk of increased blood toxicity. Although the results are preliminary, patient specific dosimetry helped in our department to increase the administered dose (up to 7.4GBq) in multifocal and/or aggressive DTC cases. Dosimetry is time-consuming and automating the steps is really needed.
P752 The Application Of An Augmented NEMA IEC Body Phantom For Acquiring Recovery Coefficients For Y90 And Lu-177 SPECT-CT Data. M. Carroll, G. Jones, I. Hufton; Royal Liverpool University Hospital, Liverpool, UNITED KINGDOM. Objectives : The aim of this work was to derive recovery coefficients for Lu-177 and Y90 SPECT data for use in dosimetry by developing a camera specific look up table to compensate for the loss of counts in small tumours due to the limits in spatial resolution of imaging systems.Methods: In this work the NEMA IEC Body Phantom and its associated hollow spheres of diameters 10mm,13mm,17mm,22mm,28mm and 37 mm were augmented by the incorporation of up to 6 additional hollow spheres from the Data Spectrum SPECT phantom covering a range of diameters
from 33mm to 5.94 mm. The additional spheres were incorporated within the NEMA phantom by means of a sliding disc attached to the NEMA cylindrical lung insert distal from the standard NEMA spheres. The potential to translate and rotate the second set of spheres relative to the fixed NEMA sphere set allows the acquisition of nonstandard data sets where spheres are in close contact modelling the clinical situation where tumours are in close proximity .For Y90 the spheres were filled with the same concentration of activity , approximately 11 MBq per ml and placed within the empty body of the NEMA phantom. SPECT-CT data was acquired using a Siemens Symbia T SPECT-CT camera using a medium energy collimator . The acquisitions were repeated after filling the phantom body with water.For Lu177 the spheres were filled with the same concentration of activity , approximately 2.58 MBq /ml and acquisitions repeated with the phantom body empty and filled with water for acquisition times from 5 to 20 seconds per projection. Finally the phantom body was filled at a concentration of 0.21MBq/ml to give a sphere to background contrast of 12.3 :1 and SPECT-CT acquisitions repeated for 5 to 20 seconds per projection.Results : After reconstruction, ROIs were contoured using a threshold value that resulted in a volume closest to the known volume. The volume, total counts in each sphere, total pixels in each sphere and count per pixel were recorded for all spheres. A circular ROI was drawn within the uniform centre of the phantom to record the background count statistics. These data were tabulated and the recovery coefficients calculated .The recovery coefficient curve can be used to correct counts per pixel values for measured patient tumours.
P73 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Radionuclide Therapy & Dosimetry: Radiobiology & Absorbed Dose-Effect Relationship
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Effects of Low Dose Normal Mouse Tissues
I Irradiation on Gene Expression in
E. Schüler, T. Parris, N. Rudqvist, K. Helou, E. Forssell-Aronsson; Institute of Clinical Sciences, Göteborg, SWEDEN. Purpose: To investigate the response of normal tissues following internal low absorbed dose irradiation of 131I, using whole genome gene expression microarray technique.Methods and Materials: Balb/c mice were injected i.v. with 131I and euthanized 24 hours after injection. The injected activity ranged from 13 to 260 kBq. Kidneys, liver, lungs, and spleen were surgically removed and the absorbed dose to the tissues ranged between 0.1 - 9.7 mGy. Total RNA was extracted and Illumina MouseRef-8 Whole-Genome Expression Beadchips used to compare the expression of the irradiated tissues to that of non-irradiated controls. To determine differentially expressed transcripts and control for false discovery rate, the Benjamini-Hochberg method was used. Only transcripts with modulation of 1.5fold or higher, either positive or negative regulation, was included in the analysis.Results: The number of transcripts affected ranged from 260 in kidney cortex to 857 in the lungs. The majority of the affected transcripts were specific for the different absorbed doses delivered and few transcripts were shared between the different tissues investigated. The response of the transcripts affected at all dose levels was generally found to be independent of dose, and only a few transcripts showed increasing or decreasing regulation with increasing absorbed dose. Few biological processes were commonly affected at all absorbed dose levels studied as well as in all tissues studied. There was a clear tissue dependence on type of biological process affected. Immune response was the only biological process commonly affected in all tissues, and processes affected in more than three tissues were primarily associated with response to stimuli and metabolism.Conclusions: Despite the low absorbed doses delivered to the investigated tissues, a surprisingly strong response was observed. Affected biological processes were primarily found to be associated with the normal function of the tissues and it can be stipulated that only small deviations from the normal tissue specific activity was induced.
Poster Presentations
wholebody scan and all voided urine was collected from the time of injection until 48 h p.i.Percent of injected activity (% IA) for liver, lungs, brain, spleen and heart was determined from regions of interest (ROI:s) drawn in the wholebody scans and in the SPECT/CT images. The activity in blood and urine samples was measured using a NaI(Tl) gamma counter. All results were related to standards with thoroughly determined activity and corrected for physical decay. The mean absorbed doses to organs and tissues and the effective dose per unit activity administered were calculated using OLINDA/EXM1.1.Results and conclusion: The results showed that 26% of the injected activity was in the blood 10 min p.i. with a rapid decrease to 3% 1 h p.i. and a slow washout until 48 h p.i.. The highest activity content were seen in the liver, which was on average 17% IA 10 min p.i., increased to 23% IA 1 h p.i. and decreased slowly until 48 h p.i.. High activity content was also seen in the lungs, which showed an uptake of on average 20% IA with a virtually linear decrease for the subsequent time points. As a mean, 20% IA was excreted in urine during 24 hours after injection and 25% IA was excreted during 48 h.Preliminary results also show that the mean absorbed dose per unit administered activity (mGy/MBq) was estimated to 0.035 for liver and lungs, 0.011 for brain, 0.039 for spleen, 0.028 for heart and the effective dose was 0.025 mSv/MBq. All values were based on the biological half time of the nuclide.The work was carried out within the Collaborative Project "MADEIRA", cofunded by the European Commission through EURATOM Seventh Framework Programme.
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P754 3D vs 2D Cell Cultures in the Evaluation of Radiobiological Effects of Exposition to Low Doses - Medical Imaging Levels of Ionizing Radiation P. Costa1, H. R. Caires1, J. Lemos1, L. Cunha1, J. Bravo2, I. Bravo3, R. A. Silva4, T. Summavielle5, L. F. Metello1; 1Nuclear Medicine Dept, ESTSP.IPP, Vila Nova de Gaia, PORTUGAL, 2Neuroprotection Lab, Mollecular Neurobiology, IBMC, Univ. of Porto, Porto, PORTUGAL, 3Radiobiology Dept, IPOFG - Porto, Porto, PORTUGAL, 4Anatomic Pathology Dept, ESTSP.IPP, Vila Nova de Gaia, PORTUGAL, 5Functional Sciences Dept, ESTSP.IPP, Vila Nova de Gaia + Neuroprotection Lab, Mollecular Neurobiology, IBMC, Univ. of Porto, Vila Nova de Gaia + Porto, PORTUGAL. Introduction:Pretending to develop advanced biological models to study biological effects of low doses of ionizing radiation and following the actual policies on Animal Sciences, based on 3 R’s Rule (to Reduce, Refine and Replace) - that limits as much as possible the application of animal models - scientific research using cellular models is constantly increasing. Nevertheless, the intrinsic limitations of actual cellular models quite often had been recognized on a significant number of papers pointing a significant number of non-concordances between results obtained using in vitro and in vivo studies. Actually, an increasing number of authors admit that three-dimensional cell culture (and spheroid cell culture in particular) could represent an interesting solution and a step further on use of cellular models. The work here to be presented reflects the first phase on the use of this methodology on the study, evaluation and quantification of cellular effects of low doses - starting on medical imaging level - of exposition to ionizing radiation.Aim:This paper demonstrate and pretend to collaborate on dissemination of the preliminary results obtained on the comparison between several techniques to perform spheroid cell culture, helping to create evidence to support and sustain the choice of an advanced cellular model to study radiobiological effects.Materials and Methods: Different cell lines (healthy fibroblasts, pheochromocytoma, follicular thyroid carcinoma, medullar thyroid carcinoma, hepatocellular carcinoma, transient cells bladder carcinoma,…) were cultured on two-dimensional cell culture (monolayer) with the appropriate recommended medium and stored in cell incubators at 5% CO2 atmosphere, but also had been cultured as spheroid, using three different techniques: Agar Coating, Shaker and Matrigel®. The comparison had been performed and the selection of “the best methodology” has been done regarding criteria as technical easiness, practicability and reproducibility, namely regarding the amount of specialization and inherent complexity needed in terms of human resources, materials and equipment being used, but also reproducibility when performing the biological and functional characterization using Cellular and Molecular Biology techniques.Results and Conclusion: The results obtained will be presented and discussed, demonstrating our findings and opinions about methods and techniques to produce spheroid human tumor cell cultures to be used in radiobiology studies to evaluate Low Dose radiation Effects.
P74 — Tuesday, October 18, 2011, 16:00 — 16:30, NIA Exhibition Area
Radionuclide Therapy & Dosimetry: Miscellaneous
P755 PEDDOSE.NET: Dosimetry and Health Effects of Diagnostic Applications of Radiopharmaceuticals with Particular Emphasis on the Use in Children and Adolescents U. Eberlein1, J. H. Bröer2, C. Vandevoorde3, P. Santos4, A. Lisbona5, M. Bardiès4, D. Nosske2, K. Bacher3, M. Lassmann1; 1Universitaet Wuerzburg, Klinik und Poliklinik für Nuklearmedizin, Wuerzburg, GERMANY, 2German Federal Office for Radiation Protection, Department of Radiation Protection and Health, Oberschleißheim, GERMANY, 3Ghent University, Department of Medical Physics, Ghent, BELGIUM, 4INSERM, UMR892, Nantes, FRANCE, 5 Centre René Gauduch*eau, Saint-Herblain, FRANCE. Aim:The aim of the EU-funded Project PEDDOSE.NET (www.peddose.net) is to provide data on dosimetry and corresponding dose related risks when administering radiopharmaceuticals for diagnostic purposes in children and adults. Furthermore information on potential reduction scenarios of the absorbed doses in paediatric nuclear medicine procedures and for computed tomography used in hybrid scanners should be collected.Methods:The work plan of the project has been divided into several work packages addressing various aspects of the project. The project partners are from five different institutions from Germany, Belgium, France, and Austria. Most of the work in the work packages is based on retrospective literature reviews.Results:The first work package (WP1) is the essential part of the project as it deals with a retrospective analysis of currently available data in the literature on dosimetry and epidemiology in nuclear medicine diagnostics and is used as input for the other work packages.WP2 provides an overview of national and international bodies and their recommendations concerning age dependent absorbed doses for radiopharmaceuticals and their
Eur J Nucl Med Mol Imaging (2011) 38 (Suppl 2):S260–S441 underlying data and used biokinetic and dosimetric models.WP 3 concentrates on a detailed analysis of the properties of the imaging system (detector sensitivity, acquisition parameters, and new technologies) including hybrid systems with the aim of reduction of patient radiation dose.In WP 4 the existing and used phantoms/models and the pharmaco*kinetic modelling for the dose delivery of the identified radiopharmaceuticals in WP1 are reviewed.WP5 deals with the identification of future clinical trials needed for providing missing data on biokinetics or dosimetry in diagnostic nuclear medicine.WP6 compiles conclusions and summaries for a derivation of recommendations and criteria with regard to the questions how much activity should be administered in a given diagnostic procedure and which CT protocols would be the best for hybrid imaging.Conclusions:The unique data set of publicly available data on biokinetics, dosimetry, phantoms and protocols for diagnostic nuclear medicine as compiled by the PEDDOSE.NET consortium will give a comprehensive overview in this field for the benefit of the global nuclear medicine community and the patients.Acknowledgement:PEDDOSE.NET is financially supported by the European Commission under the 7th Framework Programme.
P756 Biokinetics and Dosimetry of Frequently used Diagnostic Radiopharmaceuticals U. Eberlein1, J. H. Bröer2, C. Vandevoorde3, P. Santos4, M. Bardiès4, D. Nosske2, K. Bacher3, M. Lassmann1; 1Universitaet Wuerzburg, Klinik und Poliklinik für Nuklearmedizin, Wuerzburg, GERMANY, 2Federal Office for Radiation Protection, Department of Radiation Protection and Health, Oberschleißheim, GERMANY, 3Ghent University, Department of Medical Physics, Ghent, BELGIUM, 4INSERM, UMR892, Nantes, FRANCE. Aim: The evaluation of the impact on patients’ health of radiopharmaceuticals, in Nuclear Medicine diagnostics, has, up to now, not been addressed systematically in a European context. The aim of the present study is to summarize the current knowledge on biokinetics and dosimetry of frequently used diagnostic radiopharmaceuticals.Methods: A systematic literature review on available biokinetics and dosimetry data was performed. The search was mostly conducted through PubMed and secondary literature contained in the PubMed references. The inclusion criteria were: publications of official bodies such as the ICRP and peer-reviewed journals. The search was restricted to the publication date of ICRP 53 (1987) unless there were no other data available.Results: Up to now more than 700 references relevant to our project PEDDOSE.NET (www.peddose.net) were selected and stored in a database. In general, the quality of the underlying experimental data is highly variable. In many studies the number of subjects included for obtaining biokinetic and dosimetry data is less than 10. Some of the biokinetic data were acquired more than 25 years ago. Especially the dosimetry data calculated from actual measurements for paediatric nuclear medicine applications of radiopharmaceuticals are sparse. In the case of missing paediatric data, the ICRP reports use the biokinetics obtained for adults and paediatric agedependent mathematical phantoms.For Tl-201-chloride ICRP 106 (2009) shows a substantial decrease of the effective dose as compared to ICRP 80 (0.14mSv/MBq vs. 0.22mSv/MBq) due to a re-evaluation of the testes dose. For some radiopharmaceuticals no absorbed dose estimates have been published in a peerreviewed journal.For comparing diagnostic procedures, the effective dose can be very useful. The 2007 ICRP recommendations (ICRP 103) now clearly define male and female reference voxel phantoms which have to be used for the calculation of equivalent doses for organs and tissues. Presently, the modified tissue weighting factors and the subsequent calculation of the effective dose according to ICRP 103 cannot be applied to nuclear medicine as the absorbed fractions based on the new voxel models are not yet available.Conclusions: As there is a lack of data particularly for paediatric nuclear medicine new data on biokinetics and dosimetry in diagnostic nuclear medicine need to be generated using state-of-the art equipment. In addition, for easier access to dosimetry data, we suggest creating a public database.Acknowledgement: PEDDOSE.NET is financially supported by the European Commission under the 7th Framework Programme.
P757 Investigation of intraarticular radionuclide distribution with SPECT-CT in the patients treated with yttrium-90 and rhenium186 for haemophilic arthropathy T. Özülker, F. Özülker, T. Tatoğlu, M. Altun, T. Özpaçacı; Okmeydanı Training and Research Hospital, İstanbul, TURKEY. Monitorisation for leakage from the joint after radiosynovectomy (RS) is being done by obtaining planar images with gamma camera. In this study we aimed to understand whether the use of SPECT-CT might give additional information. We have been performing RS to patients who fulfills the following prerequisites; (1) more than four haemorrhagic episodes in six months (2) at least a Stage II haemophilic arthropathy according to the classification of Arnold and Hilgartner (3) persistent synovitis. Between December 2010 and April 2011 we performed Yttrium-90 RS on 6 knee joints of 5 patients and Rhenium-186 on 1 elbow joint of 1
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P758 Diagnostic Reference Levels for Radiopharmaceuticals for Children and Adults - a Status Report J. H. Bröer1, U. Eberlein2, C. Vandevoorde3, P. Santos4, M. Bardiès4, K. Bacher3, M. Lassmann2, D. Nosske1; 1Federal Office for Radiation Protection, Oberschleißheim, GERMANY, 2University Wuerzburg, Würzburg, GERMANY, 3Universiteit Gent, Gent, BELGIUM, 4INSERM, Nantes, FRANCE. Aim:The aim of the present study is to identify national and international bodies involved in assessing radiopharmaceutical dosimetry and to create a compilation of recommendations of these bodies concerning age-dependant administered activities for radiopharmaceuticals (diagnostic reference levels (DRL)). Also the underlying data, biokinetic models and computational methods for dosimetry were asked.Methods: Several national and international bodies involved in assessing radiopharmaceutical dosimetry were identified by personal knowledge and the appendix of UNSCEAR 2008. A questionnaire was compiled concerning information on DRL, used dose coefficients, recommendations/regulations for the operation of hybrid systems like PET/CT, pretherapeutic dosimetry and expectations of future developments. About 30 bodies were contacted and about 20 identified themselves as responsible and received the questionnaire.Results:The national DRL for adults vary concerning the mentioned imaging methods/radiopharmaceuticals as well as concerning the recommended activities, which differ for some examinations by more than a factor of two (e.g. renal scan with 99mTc-DTPA). The DRL for children are mainly based either on the recommendations by Piepsz et al. from 1990 or on the new EANM 2008 paediatric dosage card. But as Piepsz et al. have only published coefficients that are multiplied with the national DRL for adults, the resulting administered activities also vary. For biokinetic models and dose coefficients most national bodies rely on international expert groups like ICRP. Besides EANM most other contacted international bodies do not recommend administered activities but publish data on biokinetic models, dose coefficients and computational methods. The answers concerning the necessity for pretherapeutic dosimetry vary among the contacted bodies.Conclusion:While for dosimetry the ICRP recommendations are a well accepted standard in most countries the gathered data show a large variation in the recommendations of DRL.Acknowledgement:This study is part of the PEDDOSE.NET project .The Support Action PEDDOSE.NET is financially supported by the European Commission under the 7th Framework Programme.
P759 Radiosynoviorthesis improves arthroscopic synovectomy
functional
outcome
after
M. Grmek, B. Pompe, L. Suhodolcan; University Medical Centre, Ljubljana, SLOVENIA. Aim: The report evaluated effects of radiosynoviorthesis (RS) subsequent to arthroscopic synovectomy and to disclose indications for its use.Material and methods: Single joint in 10 patients was treated with combination of arthroscopic synovectomy followed by RS, between January 2007 and June 2010. Four patients had rheumatoid arthritis, four patients had psoriatic arthritis and two had nonspecific chronic synovitis. RS, following EANM procedure guidelines for radiosynovectomy, were performed 2 to 6 months after arthroscopic resection of actively inflamed synovium, using shaver. For RS of knee joint (9 patients) 185 MBq of 90Y colloid was used. In one patient with elbow involvement, 186Re colloid activity 74 MBq was used for RS. An experienced orthopaedic surgeon performed intraarticular application of the radiopharmaceutical. After application of the radiopharmaceutical, the joint was immobilized in a plaster splint for four days. The
effectiveness of treatment was evaluated at regular follow-up visits (up to 12 months after RS) and special attention was paid to range of motion, presence of joint effusion and patient satisfaction.Results:Patient’s satisfaction and the functional outcome following RS improved in 8 patients (80% of treatments), which consisted of improved range of motion in 2, no recurrence of joint effusion in 2, or both in 4 patients.RS was not effective in 2 cases (20% of treatments), in one case, joint effusion persisted, where the other suffered from septic arthritis 5 weeks after RS.Our recommendations for use of RS after arthroscopic synovectomy include:- Insufficient removal of the inflamed synovial membrane.- Persistent joint effusions.- Limited range of motion.Conclusion:This report demonstrated that the chronic inflamed synovitis can been successfully treated by combination of arthroscopic synovectomy and RS, where residua of hypertrophic synovial membrane can only be effectively eliminated with radiosynoviorthesis.For favourable results close collaboration between orthopaedic surgeon and nuclear medicine physician is essential.
P760 Literature review on existing phantoms for absorbed dose estimation and the impact of their characteristics on dosimetric results P. A. Santos1, U. Eberlein2, J. Bröer3, C. Vandevoorde4, A. Lisbona1, D. Nosske3, K. Bacher4, M. Lassmann2, M. Bardies1; 1INSERM, Nantes, FRANCE, 2University Würzburg, Würzburg, GERMANY, 3Bundesamt für Strahlenschutz, Salzgitter, GERMANY, 4UGENT, GENT, BELGIUM. AimThe PEDDOSE.NET project, through Work-Package 4 aims at providing information regarding the phantoms that exist and have been used for estimation of standard absorbed dose values from radiopharmaceuticals and the impact of their characteristics on dosimetric results.MethodsThe information for this work was obtained by analysis of the currently available peer reviewed literature on dosimetry in nuclear medicine diagnostics.ResultsAn analysis and compilation of peer reviewed articles on radiopharmaceutical dosimetry is presented.The standard absorbed dose coefficients currently available for radiopharmaceutical dosimetry have been published in MIRD Pamphlet-11(1975) for the reference person as defined in ICRP23(1975), calculated for the mathematical phantom published in MIRD Pamphlet-5(1969). ICRP has also published such values in ICRP Publications 53(1988), 80(1998) and 106(2008), calculated for the ORNL mathematical phantoms (Cristy-Eckerman adult-male and pediatric series (1987), and Stabin’s series on non-pregnant and pregnant adult-female (1995).While mathematical phantoms represent the anatomy through simple surface equations, the recent enhancement in computer capabilities and the emergence of highresolution structural imaging modalities (CT and MRI) has allowed the development of voxel-based phantoms with a more realistic anatomical representation regarding organ shape and position. The ICRP/ICRU have also recently developed gender specific voxelized phantoms (ICRP110, 2009) representing the reference male and female as defined in ICRP89(2002). However, age-dependent phantoms have not yet been released by the ICRP, nor have the dose coefficients corresponding to the adult phantoms.Several authors have reported discrepancies between the dosimetric quantities calculated for the voxelized phantoms and for the ORNL phantoms. These discrepancies are mainly due to the different shapes and distances between the organs in the two types of phantoms.ConclusionsIn the context of diagnostic nuclear medicine radiation safety the definition of a “reference-patient” is required in order to allow the comparison of results obtained from various modalities, and different radiopharmaceuticals. This model-based dosimetry approach will profit from the use of voxelized phantoms, since these constitute a significant improvement in more accurately representing human anatomy. However, additional progress towards greater accuracy on the estimation of absorbed doses could arise from the use of the recently developed hybrid phantoms that can be conformed to represent specific sizes and shapes. The use of such hybrid phantoms could even allow a patient-specific dosimetric approach in which patient biodiversity or pathology related anatomical differences could be taken into account.Acknowledgement:PEDDOSE.NET is financially supported by the European Commission under the 7th Framework Programme.
P761 166Holmium-Phytate-Radiosynoviorthesis in Rheumatoid Arthritis. Seven Years Clinical Results. Phase III Prospectiv Study M. Szentesi, P. Géher; Semmelweis Univ., Chair of Rheumatology and Physiotherapy, Budapest, HUNGARY. Study objectives: Examination of anti-inflammatory effect of 166-Holmium-phytate injection.Methods: Phases III, prospectiv study. 30 patients suffering from chronic synovitis, rheumatoid arthritis were examined. The protocol commenced with screening. The patients were selected according to inclusion and exclusion criteria.Holmium phytate injectable suspension marked by 600 MBq 166Holmium phytate injectable suspension, and 40 mg of 1 ml triamcinolone acetonide and 1 ml of lidocaine 1 %. There were 84 month follow-up period after the administration of
Poster Presentations
patient. with haemophilic arthropathy. All of the patients were male, with a mean age of 8±1.72 (range 6-11). Our goal was to prevent joint destruction by eliminating frequent joint bleeding before the onset of arthropathy. All patients were admitted to the hospital and treated with factor replacement so as to raise the factor level of the patient to 80% the following morning and 50% for three days thereafter. The effusion in the joint was evacuated before the injection of the radiocolloid. An empirically estimated dose of 5 mCi of Y-90 and 2-3 mCi of Re-186 was injected to the joint. After the injection, the needle was flushed with a small volume of saline and the needle was withdrawn. The joint was moved rapidly a few times to distribute the radiocolloid, after which a plaster of paris cast was applied for 72 hours. One hour after the radionuclide injection images of the joints were obtained with SPECT-CT (Millenium VG and Hawkeye, GE Healthcare) by using brehmstrahlung rays of Y-90 and gamma rays of Re-186. The distribution of radionuclide was normal and no extraarticular leakage was detected in 4 knee joints and 1 elbow joint of 4 patients. In 2 knee joints of 2 patients the radionuclide was confined to suprapatellar recess and not distributed in joint space. SPECT-CT correctly detected the localisation of the radionuclide in these patients while on planar images the distribution was not clear.We concluded that SPECT-CT might show any possible extraarticular leakage or local accumulation of radionuclide better than planar imaging alone.
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the isotope.Inflammatory activity of the affected knee-joint was tested prior to treatment, and the 3th and 3, 6, 9, 12, 24, 36, 48, 60,72 and 84 months after the treatment. Evaulation was based on the criteria as described by Müller, Rau and Scütte the score system was developed by the authors.Results: During the study period, inflammation decreased. In the first seven years excellent and good results were recorded in 93.3%. Seven years after radiosynoviorthesis 93.3% of patients did not need another punction. Administration of Holmium-166 phytate is a safe procedure. We did not detect any symptoms of radiation sickness. We found no deviations in either haematological or chemical parameters during the study period.Conclusion: Holmium-166 phytate isotope is an effective radiopharmacy treating synovitis. Due to its physical parameters it is optimal to treat large joints (knee) and medium size joints (hips, shoulder, elbow, wrist, ankle). Effective dosage is 555-925 MBq.References:Margit Szentesi:Radiosynoviorthesis with Ho-166 phytate. First clinical resultsEANM Post-Congress Scintific Meeting.Radionuclide therapy in theory and practice.Gyor, Hungary. 5. szeptember. 2002.Szentesi M.,1 Környei J.,2 Antalffy M.,2 Törko J.2 Tóth Gy.,2 Jánoki Gy.,3 Balogh L.,3:Study of intraarticular application of 166-Holmium IHPP in rabbits.World Journal of Nucl. Med. 1. Suppl. 2. S243. September, 2002.Szentesi M.,Takács S., Farbaky Zs., Nagy E., Környei J., Antalffy M., Törko J., Géher P.:Ultrasound monitoring of the synovial thickness after 166-holmium-phytate radiosynoviorthesis Four years results. Phase III prospectiv studyEur.J.Nucl.Med.Mol.I. 2008. 35. Suppl. 2. S346-347 Szentesi M., Z. Nagy, P. Géher;Biological hasards of radiation synovectomy I.Chromosomal analysis of periferial lymphocytes of patients before and after radiation synovectomy with 166-Holmium-PhytateEur.J.Nucl.Med.Mol.I. 2010. 37. Suppl. 2. S478. Szentesi M., Z. Nagy, P. Géher;Biological hasards of radiation synovectomy II. Leakage.Holmium-Phytate-Radiosynoviorthesis in Rheumatoid arthritis. Five years clinical results. Phase III. Prospektive study.Eur.J.Nucl.Med.Mol.I. 2010. 37. Suppl. 2. S478
the eighties. Today it is not widely used although it still may represent the best tool for the treatment of polycythaemia vera (PV) and essential thrombocythaemia (ET) in elderly.AIM: to review the radionuclide therapy using 32P orthophosphorus in the treatment of the patients with PV and essential thrombocythaemia (ET).MATERIAL AND METHODS: Twenty patients with polycythaemia vera and essential thrombocythaemia have been treated with P32 over last 12 years. Patients were considered for 32 P administrations after they have failed treatment by phlebotomy and cytoreductive drugs. Under the standard criteria, PV was diagnosed in 14 and 6 patients had ET. Patients ages ranged from 43 to 81 years. The number of 32P administration per patient ranged from 1-3. Patients were injected intravenously via canula to avoid extravasation. Fixed dose activity of 3 mCi per m2 was increased up to 5 mCi for the additional administration. Full blood count was used for monitoring the patients and asses the response to therapy.RESULTS: The average duration of disease between the time of establishing the diagnosis and 32P administration was 22 months. Among 20 patients injected by 32P orthophosphorus, in seven of them two doses of 32P were administered in the median interval of 28.5 months. The outcome showed a normalization of a full blood count in 71 % of the patients at end of the first year after therapy. There was no report of the development of acute myelogenous leukaemia in treated patients.Thrombotic events were registered in 2 patients.CONCLUSION: 32P therapy was proved to be effective and simple modality of disease control in elderly patients with polycythaemia vera and essential thrombocythaemia . Compared with the alternative of chemotherapy, 32P therapy is cost effective and requires less frequent hospital visits.
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H. Gabriele; University of Mainz, Mainz, GERMANY.
Ultrasound Monitoring of the Synovial Thickness after 166Holmium-Phytate Radiosynoviorthesis -Eight-Years Results. (Phase I-IIA, Comparative, Randomized, Singel-Blind, PlaceboControlled Study with Increasing Dosage)
AimThe thermal column of the TRIGA reactor of the University of Mainz is being used very effectively for research in boron neutron capture therapy (BNCT). The project is focused on the treatment of liver tumours. Before BNCT can be applied efficiently, many questions concerning boron uptake, radiobiology, and dosimetry have to be resolved.Materials and MethodsA preclinical trial has been started on patients suffering from liver metastases of colorectal carcinoma. Prior to normal liver resection, patients are infused with a p-borono-phenylalanine-fructose (BPAF) complex. During infusion, blood samples are taken to provide pharmaco*kinetic data. Biopsies from tumour and tumour-free tissue are taken, removed liver specimen is then irradiated in the TRIGA for dosimetric investigations.For the analysis of the tissue, Quantitative Neutron Capture Radiography (QNCR) is used. Analysis are performed afterwards in cooperation with pathologists. Prompt Gamma Activation Analysis (PGAA) is performed at the HFR in Petten, The Netherlands, and at the FRM II in Garching, Germany, to determine the boron content in blood and the tumour-free tissue samples.In vitro experiments with HuH7 cells are carried out to investigate the relative biological effectiveness (RBE) using neutron irradiation at the thermal column and photon irradiation with a 60Co γ-ray emitter.For the described experiments, as well as for the later treatment, a reliable dosimetry system is developed. Therefore alanine detectors in combination with Monte Carlo (MC) simulations have been tested in various experiments.ResultsThe results obtained with the different methods for boron analysis show a good agreement. Furthermore, the determined bloodconcentration curves reflect very well the course of surgery. The boron concentration in the tissue has been found to depend on the cell type.First results of the in vitro experiments deliver RBE values in the expected range for the used cell line.The measurements with alanine pellets and the simulations with MC Codes are in good agreement. From the simulations, it was also possible to calculate the different dose components associated with BNCT irradiations.ConclusionThe TRIGA reactor in Mainz is well suited for various applications concerning the BNCT project. A preliminary clinical study has explored BPA pharmaco*kinetics and concentrations in blood and tissue. The used boron analysis techniques are established. RBE values can be determined and Alanine pellets are suitable for dose measurements in a mixed neutron - gamma field. All these works contribute to the creation of a treatment planning protocol in BNCT.
M. Szentesi1, P. Géher1, Z. Farbaky2; 1Semmelweis Univ., Chair of Rheumatology and Physiotherapy, Budapest, HUNGARY, 2Polyclinic of the Hospitaller Brothers of St. John of God., Budapest, HUNGARY. 166-Holmium-phytate has a: radiation type beta energy maximum: 1.84 MeV; and radiation type gamma, energy maximum: 0.66 MeV; soft tissue penetration: maximum 8.4 mm; /average: 3.3 mm /; half-life: 26.9 hours; particle size: 0.62mikrom./>Study objectives: measur the synovial thickness after 166-Holmium radiosynoviorthesis by sonography.Methods: Phase I-IIA, randomized, simple-blind, placebo-controlled comparative study using increasing dosage. 31 patients suffering from chronic synovitis, rheumatoid arthritis, or seronegative spondylarthritis were examined.Patients: Gender (male/female): 12-19; Diagnosis (RA / SNSA): 21 / 10; Stage of knee joint x-ray (I / II): 7/24; Duration of synovitis (years): 7.9; Duration of disease (years): 5.72; Number of punctures before the Ho166 treatment: 18.76; Number of steroid injections before the treatment: 18.85. The protocol commenced with screening. The patients were selected according to inclusion and exclusion criteria. Patients were randomly distributed into four treatment arms: Group I. 185 MBq 166Holmium phytate /166-Ho/ injectable suspension and 40 mg of 1 ml triamcinolone acetonide /TA/, and 1 ml of lidocaine injection 1 % Group II. 555 MBq 166Ho injectable suspension, and 40 mg of 1 ml TA and 1 ml of lidocaine 1 % Group III. 925 MBq 166Ho injectable suspension and 40 mg of 1 ml TA and 1 ml of lidocaine 1 %. Group IV. Solely 40 mg of 1 ml TA and 1 ml of lidocaine injection 1 %. There were 96 month follow-up period after the administration of the isotope. We measured the quantity of the synovial fluid and the thickness of the synovia before the treatment, and the 14th, 28th days and 3, 6, 9, 12, 24, 36, 48, 60 and 96 months after the treatment. We measured the synovial thickness the following locations: In the midline, lateral and medial, by the condylus of femur medial and lateral.Results: The thickness of the synovia decreased significantly in the Group II. (555 MBq) and III. (925 MBq). After a transient improve (the steroid effect) the thickness of the synovia began to rise in the Group I. (185 MBq) and in the control group. We find a significant correlation between the synovial thickness and the clinical improvenes.Conclusions: The 166Holmium-phytate is an effective new radiopharmacon in the treatment of synovitis. We detect the clinical improvement by sonography. The effective dose is 555-925 MBq.
P763 Treatment of Myeloproliferative Diseases using Phosphorus 32 L. Jaukovic, B. Ajdinovic, S. Dugonjic, Z. Jankovic; Insitute of Nuclear Medicine, Military Medical Academy, Belgrade, SERBIA. Phosphorus 32 was introduced in our Department to treat the patients with myeloproliferative disorders in 1956 and it was used extensively since the middle of
P764 The Boron Neutron Capture Therapy (BNCT) Project of the University of Mainz, Germany
P765 Initial experience of establishing radiation protection
177
Lu DOTATATE therapy and
R. T. Meades, D. J. Towey, L. Perry, M. Naji, I. Zerizer, A. Al-Nahhas, K. S. Nijran; Imperial College Healthcare NHS Trust, London, UNITED KINGDOM. BACKGROUND: Tumor-targeted peptide radionuclide radiation therapy (PRRT) is a well established treatment modality for advanced neuroendocrine tumours, in particular, 177Lu Dotatate has proven to be clinically successful. Starting at our centre in September 2008, this therapy has seen a steady increase in demand and this work provides details of aspects such as administered doses, patient doserates, retained/excreted activities and staff radiation exposures.METHOD: Records of administered activities, administration and discharge times, dose rate and count
Eur J Nucl Med Mol Imaging ( 2011 ) 38 (Suppl 2):S260–S441
S441
Poster Presentations
rate measurements from the patient at administration and discharge and percentage retention/excretion of dose at discharge were analysed. Real-time dose-rate monitoring of the staff administering the dose was also performed using RadEye G-10 personal radiation monitors (Thermo Scientific).RESULTS: A total of 28 patients were treated in the period between September 2008 and April 2011. A maximum of 3 out-patients were treated per month. Mean administered activity was 7.18GBq (±0.43GBq). Mean activity at discharge was 2.96GBq (±1GBq) giving a mean activity to the site drainage system per patient of 4.22GBq (59% of administered activity). Mean dose-rates at 1m from the patient at administration and discharge were 43µSv hr-1 and 21µSv hr-1 respectively. The main member of staff involved in the administration procedure received an average of 5.91 µSv (±2 µSv) whole body effective dose per patient. Contributions to this mean dose were from initial administration (36%), subsequent patient contact (19%), second flush of dose (14%), second subsequent patient contact (2%) and dismantling delivery set and disconnecting from patient (29%).CONCLUSIONS: Our initial results show that administered activities are within the desired ±10% of the standard 7.4GBq recommended activity. However, the mean and distribution show that they are predominantly less than 7.4GBq. This is due to logistical problems encountered with dose supply and delivery times in conjunction with restrictions around patient admission. Activities to the site drainage system are significant and require due consideration to be given to legislative radioactive waste limits for the site. Doserates from the patient allow for the therapy to be performed on an out-patient basis using a suitably shielded/located side room and require behavioral restriction advice to be given at the time of discharge to minimise doses to comforters/carers/family/friends. Staff doses are significant and require consideration to be given to shielding of the administration set and observation of good working practices concerning radiation protection.
