The technical challenge of Functional 18F-FDG-PET Brain imaging in paediatric epilepsy

Epilepsy is a chronic brain disease, characterized by the appearance of crisis (whit or without convulsions), caused by abnormal electric activity on brain cells. Neuroimaging might be necessary in the work-up of epilepsy for localisation of the seizure focus for possible surgical cure. In our department, we started performing inter-ictal 18F-2-deoxyglucose (FDG)-PET/TC Brain imaging in 2009, in paediatric patients, following EANM procedure guidelines. Aim: the aim of the study was to retrospectively review all the performed inter-ictal 18F-FDG-PET/TC brain imaging, to assess the difficulties found during these procedures and the deviation according to guideline recommendations. We also intend to focus on the major importance of an optimal cooperation with other departments, such as anaesthesiology and neurophysiology. Material and Methods: between 2009 and 2012, eleven patients (pt) were referred for an 18F-FDG-PET-TC brain study, with ages between 10 months - 18 years old all with medically intractable epilepsy. The exams were performed with different conditions according to the needs of each patient, because we know that exceptional procedures call for special conditions. Results: All files were review for pt information pertinent to performance of the procedure, pt pre-arrival preparation, pt pre-injection preparation, pt monitoring for ictal crises before injection (EEG), pt sedation, variability of radiopharmaceutical administration and data acquisition parameters. 8 of the pt were performed with anaesthesia while 3 without since the pediatric patient were cooperative. All of the pt were monitored under parental surveillance, one with additional movie recording and other with EEG. Conclusion: We found that this process of retrospective review of this pool of paediatric patients with epilepsy enhanced the learning curve in this very specific procedure. We also found it critical to request the collaboration of the departments of anaesthesiology and neurophysiology

Primary Idiopathic Chylopericardium

O quilopericárdio é uma entidade rara, que é encontrada mais frequentemente associada a traumatismos (com lesão do canal torácico), neoplasias e infiltrações por filária. As formas primárias são mais raras e associam-se a malformações da circulação linfática. Apresenta-se o caso clínico de um doente de 52 anos, sexo masculino, com o diagnóstico de quilopericárdio primário, sendo discutida a abordagem diagnóstica, assim como a evolução clínica favorável com tratamento conservador

Comparação de dois tipos de colóides tecneciados na detecção de gânglio sentinela

Introdução: O gânglio sentinela define-se como o primeiro gânglio detectado numa via de drenagem linfática do tumor primário. O marcador ideal para pesquisa de gânglio sentinela deve apresentar: retenção persistente neste gânglio, reduzida acumulação de radiofármaco nos gânglios satélites e depuração rápida do local de injecção. Há dois tipos de colóides tecneciados que são frequentemente utilizados em linfocintigrafia – colóides de albumina humana e colóides de sulfureto de rénio. Objectivo: Comparar os dois radiofármacos tecneciados - colóides de albumina humana e colóides de sulfureto de rénio – quanto a: 1) tempo de migração e visualização do gânglio sentinela e 2) incidência de gânglios satélites, quando utilizados em linfocintigrafias para pesquisa de gânglio sentinela em doentes com carcinoma da mama. Material e Métodos: Analisaram-se os estudos de pesquisa de gânglio sentinela de 138 pacientes com carcinoma da mama. Em 63 doentes a linfocintigrafia foi realizada com colóides de albumina humana (Nanocoll®) e em 75 doentes o radiofármaco utilizado foi colóides de sulfureto de rénio (Nanocis®). Procedeu-se à aquisição de imagens iniciais após administração do radiofármaco e foram sendo adquiridas imagens seriadas aos 60min, 90min, 120min, 180min, 240min, 300min e 360min até aparecer o gânglio sentinela. Considerou-se como término do estudo o momento de visualização do gânglio sentinela. Em 5 pacientes não se visualizou gânglio sentinela; 3 correspondiam a colóides de albumina humana e 2 correspondiam a colóides de sulfureto de rénio. Estes 5 casos foram excluídos deste estudo. Resultados: Verificou-se que no grupo de doentes a quem foi administrado colóides de albumina humana, o intervalo de tempo para visualização do gânglio sentinela foi de; 130’ (média), 120’(mediana), com um tempo mínimo de 10’ e máximo de 330’. Neste grupo não foram visualizados gânglios satélites. No grupo de doentes a quem foi administrado colóides de sulfureto de rénio o intervalo de tempo para visualização do gânglio sentinela foi de; 145’(média) 150’(mediana), com 10’ de mínimo e 360’ de tempo máximo. Neste grupo de doentes foram observados gânglios satélites em 2 casos. Conclusão: Nesta amostra não foi observada diferença significativa entre os dois radiofármacos utilizados quanto a: taxa de detecção e tempo para visualização do gânglio sentinela, assim como quanto à incidência de visualização de gânglios satélite

Performance assessment and uncertainty evaluation of a portable NaI-based detection system used for thyroid monitoring.

This work aims at assessing the performance of a portable detection system, equipped with an NaI(Tl) scintillation detector for in vivo thyroid monitoring, which was properly calibrated using an anthropomorphic neck phantom. The anthropomorphic physical phantoms commonly used for the efficiency calibration of in vivo counters often present certain limitations regarding the geometry and the activity distribution. Therefore, the feasibility of these detection systems for in vivo monitoring should be assessed whenever possible. To accomplish this assessment, patients to whom (99m)Tc and (123)I marked radiopharmaceuticals have been administered in the framework of nuclear medicine diagnostic procedures were monitored. As the biokinetic models of the administered radiopharmaceuticals are known, the time-dependent activity functions in the critical organs after administration are easily quantified. The measured activities in the thyroid using the NaI(Tl) scintillation detector were compared with the estimated activities using the biokinetic models, in order to reach conclusion about the applicability of the portable scintillation counter for in vivo thyroid monitoring. The state-of-the-art Monte Carlo computer program PENELOPE and two voxel phantoms (male and female) were used to evaluate the overall uncertainties influencing the thyroid monitoring. A computational parametric study was performed to quantify the influence of several parameters in the activity quantification (neck-detector distance, thyroid shape, thyroid size and overlying tissue thickness), which allowed one to gain insight and to better understand the discrepancies between the calculated and measured activities

Guidelines for direct radionuclide cystography in children

These guidelines, which summarise the views of the Paediatric Committee of the European Association of Nuclear Medicine, provide a framework which may prove helpful to nuclear medicine teams in daily practice. They contain information on the indications, acquisition, processing and interpretation of direct radioisotope cystography in children. The guidelines should be taken in the context of ,,good practice" and any local/national rules which apply to nuclear medicine examinations

Guidelines for radioiodinated MIBG scintigraphy in children

These guidelines on the use of radioiodinated Tc-99m-MEBG scintigraphy in children, which summarise the views of the Paediatric Committee of the European Association of Nuclear Medicine, provide a framework which may prove helpful to nuclear medicine teams in daily practice. They have been influenced by the conclusions of the "Consensus Guidelines for MIBG Scintigraphy" (Paris, November 6, 1997) of the European Neuroblastoma Group and by those of the Oncological Committee of the French Society of Nuclear Medicine. The guidelines should be taken in the context of "good practice" and any local/national rules which apply to nuclear medicine examinations