101 research outputs found
Abnormal Tc99m sulesomab in Klippel-Trenaunay syndrome
Tc-99m sulesomab is indicated in bone and joint infection, but
reading of scans can be affected by pre-existing conditions. This
case report describes a case of Klippel-Trenaunay syndrome
(KTS) which results in vascular malformations of one or more
limbs. Tc-99m sulesomab imaging demonstrated persistent
blood pool activity up to 20 hours post injection. However,
despite this, septic arthritis could be identified with confidence
in the same limb.
Nuclear Med Rev 2010; 13, 2: 84–8
Exploring the nature of atheroma and cardiovascular inflammation in vivo using positron emission tomography (PET)
Positron emission tomography (PET) has become widely established in oncology. Subsequently, a whole new “toolbox” of
tracers have become available to look at different aspects of cancer cell function and dysfunction, including cell protein
production, DNA synthesis, hypoxia and angiogenesis. In the past 5 years, these tools have been used increasingly to look
at the other great killer of the developed world: cardiovascular disease. For example, inflammation of the unstable plaque
can be imaged with 18-fludeoxyglucose (18F-FDG), and this uptake can be quantified to show the effect that statins have
in reducing inflammation and explains how these drugs can reduce the risk of stroke. 18F-FDG has also become
established in diagnosing and monitoring large-vessel vasculitis and has now entered routine practice. Other agents such
as gallium-68 (68Ga) octreotide have been shown to identify vascular inflammation possibly more specifically than 18FFDG.
Hypoxia within the plaque can be imaged with 18F-fluoromisonidazole and resulting angiogenesis with 18F-RGD
peptides. Active calcification such as that found in unstable atheromatous plaques can be imaged with 18F-NaF. PET
imaging enables us to understand the mechanisms by which cardiovascular disease, including atheroma, leads to
morbidity and death and thus increases the chance of finding new and effective treatments.2016-05-30am2015Nuclear Medicin
Use of lung and brain perfusion imaging in the HELLP syndrome
Patients with multi-organ disorders may present with a plethora of confusing symptoms and signs. Often early diagnosis of significant disease is essential and can be difficult with standard radiological techniques. This case report presents the use of two radioisotopic techniques to assess brain and lung perfusion in a patient with such an acute-multi-organ disorder-the HELLP syndrome
Evaluation of radiological and clinical efficacy of ^{90}Y-DOTATATE} therapy in patients with progressive metastatic midgut neuroendocrine carcinomas
Background: To evaluate the radiological and clinical therapeutic effectiveness of ^{90}Y-octreotate [DOTATATE] inpatients with progressive somatostatin receptor-positive midgut neuroendocrine carcinomas (GEPNETs). Material/Methods: The study group: 34 patients, with histological proven extensive non-resectable and progressive midgut GEP-NETs. Radionuclide therapy (^{90}Y-DOTATATE) was given i.v. with a mean activity per administration 3,82 GBq. Initial clinical tumor responses were assessed 6-7 weeks after therapy completion and then once 3-monthly. The objective tumor response was classified according to the RECIST, initially between 4-6 months and then after each of the 6 months interval. Results: At 6 months after treatment completion, radiological tumor response was observed in 6 subjects with PR (19%), 25 presented SD (78%) and single had PD (3%). Overall clinical response to therapy at 6 months follow-up was observed in 23 patients (68%), SD in 5 patients (15%) and PD in 6 (18%). A year after therapy radiological tumour response was seen in 11 patients (44%), SD had 12 subjects (44%) and DP was noted in 2 patients. Two years after completed therapy PR was seen in 6 patients (33%), SD in additional 11 subjects (61%), single patient had PD. Clinical response to treatment in terms of PR and SD were noted in 22 patients (88%) after 1 year and in 14 patients (87%) after 2 years. Median PFS was 20 months, while the median OS was 23 months. In the 6 patients with clinical PD within initial 6 months the median PFS was 6 months and OS 11 months, while in those with SD or PR PFS was 22 months and OS 26 months (P<0.05). Conclusions: Therapy with ^{90}Y-DOTATATE} is effective in terms of clinical response, however the radiological response measured by the RECIST criteria underestimates benefits of this type of therapy in patients with progressive somatostatin receptor-positive midgut neuroendocrine carcinomas
Myocardial uptake of Tc-99m HDP in a patient with prostate carcinoma
In this case report we present an unusual appearance of myocardial
uptake of Tc-99m HDP in a 59-year-old renal transplant
patient who was imaged while looking for metastases from adenocarcinoma
of the prostate. Subsequent investigation demonstrated
no obvious cause for this appearance, such as myocardial
disease or metastatic cancer. The case report, therefore,
discusses the possible causes of such an appearance and reviews
the literature concerning this phenomenon
The value of the Duke Activity Status Index (DASI) in predicting ischaemia in myocardial perfusion scintigraphy — a prospective study
BACKGROUND: Functional capacity assessment may be
a useful tool to stratify patients according to risk of coronary
artery disease (CAD). The Duke Activity Status Index (DASI)
is a functional assessment based on activities of daily living
and cardiovascular fitness, assessed using a self-administered
questionnaire.
MATERIAL AND METHODS: We assessed the relationship
between established clinical risk factors for CAD and the DASI
with results of myocardial perfusion scintigraphy (MPS). The
MPS results used in the analysis were the presence of reversible
ischaemia and the resting left ventricular ejection fraction (LVEF).
A DASI self-administered questionnaire was completed by 117
consecutive participants, and a patient history was taken to
ascertain established risk factors. All participants underwent
a stress test, and myocardial perfusion scintigraphy was performed. Statistical analysis consisted of logistic and linear
regression using a statistical software package.
RESULTS: The DASI was the only factor that correlated significantly
with reversible ischaemia on MPS. None of the previously
established risk factors had a significant association with reversible
ischaemia within the model. Our study found a potential
relationship between the DASI score and the left ventricular ejection
fraction (LVEF) although this was not statistically significant.
CONCLUSIONS: Our study findings suggest that the DASI may
represent a powerful tool for risk stratification prior to investigation
of CAD. A further study with a larger sample size will be
required to investigate the predictive value of the DASI and the
association with LVEF.
Nuclear Med Rev 2010; 13, 2: 59–6
Association between plasma homocysteine and myocardial SPECT abnormalities in patients referred for suspected myocardial ischaemia
BACKGROUND: Elevated plasma homocysteine level has emerged as a relatively newly recognised risk factor for coronary artery disease (CAD). However, reduction of plasma homocysteine levels in large prospective studies did not appear to reduce the risk for subsequent cardiac events. In this study, we investigated the association between plasma homocysteine levels and quantitative indices of myocardial perfusion SPECT imaging in patients referred for myocardial ischaemia.
METHODS: Quantitative myocardial perfusion SPECT indices were obtained for 120 patients who were recruited for the study. All patients underwent a two-day rest-stress myocardial perfusion imaging. Plasma venous sampling was done on all patients after an overnight fast. Of the 120 participants (mean age 56 years, 53% males), 33% had elevated plasma homocysteine levels. The plasma homocysteine level was then compared to the results of imaging and other known risk factors.
RESULTS: After adjustment for traditional risk factors of coronary artery disease, patients with elevated homocysteine levels had a significantly higher mean summed stress score (SSS) (11.3 vs 6.9, p = 0.02) than patients with a normal homocysteine level. This was true for both single- and multi-vessel disease. Also, patients with elevated homocysteine levels had a higher stress end-systolic volume (SESV) (137 vs 105 ml, p = 0.03) and lower post-stress left ventricular ejection fraction (SEF) (54 vs 64%, p = 0.02). The patients with elevated plasma homocysteine levels also had a significantly lower mean body mass index (BMI) (26.6 vs 30.6 kg/m2, p = 0.002). There was a significant relationship between the total number of known risk factors in a patient with CAD and the proportion of patients presenting with elevated plasma homocysteine levels (p = 0.03). Also, the extent of infarct, as measured by the summed rest score (SRS), was more closely correlated with an elevated homocysteine level than with the degree of ischaemia.
CONCLUSION: There was a correlation between plasma homocysteine level and the presence and extent of myocardial perfusion abnormalities in patients with established coronary artery disease, in particular those with multiple risk factors and multi-vessel infarction.http://www.cvjsa.co.z
Diagnostic imaging of neuroendocrine tumours
Guzy neuroendokrynne (NET) stanowią heterogenną grupę nowotworów posiadających mechanizmy
gromadzenia prekursorów amin biogennych oraz ekspresję specyficznych białek receptorowych na swojej
błonie komórkowej, które pomagają w lokalizacji oraz w leczeniu. Guzy typu NET różnią się między
sobą substancjami wydzielanymi przez komórki, obecnością czynności hormonalnej lub jej brakiem,
objawami klinicznymi, cechami histopatologicznymi oraz rokowaniem.
Pochodzą one z gruczołów wydzielania wewnętrznego (przysadka, przytarczyce, rdzeń nadnercza) oraz
dodatkowo z komórek rozlanego systemu endokrynnego o lokalizacji w ścianie przewodu pokarmowego,
trzustce, tarczycy, grasicy czy w oskrzelach. Guzy NET o pochodzeniu GEP-NET stanowią większość
tego typu guzów (> 70% wszystkich NET).
Badania obrazowe i ocena swoistych markerów guzów NET umożliwiają identyfikację i ocenę stadium
zaawansowania tych rzadkich nowotworów, a ponadto mają wartość prognostyczną. Najbardziej uniwersalną
techniką obrazową wykorzystywaną w badaniu NET jest SRS. Innych badań obrazowych, takich jak
spiralna wielorzędowa CT, MRI, endoskopowe oraz śródoperacyjne badanie USG, używa się do precyzyjnej
anatomicznej lokalizacji zmian patologicznych. Kolejnym badaniem czynnościowym wykorzystywanym
w diagnostyce NET jest scyntygrafia MIBG (metajodobenzyloguanidyna). Badanie to pozwala
identyfikować przede wszystkim guz chromochłonny oraz MTC. W postaciach złośliwych guza chromochłonnego
oraz raka rdzeniastego tarczycy znaczenie ma również badanie SRS. Bardzo ważnym aspektem
wykorzystania technik obrazowych (zwłaszcza CT, SRS i MRI) jest ocena odpowiedzi na leczenie.
Coraz większe znaczenie kliniczne w lokalizacji guzów NET ma badanie PET z użyciem nowych ligandów
receptorowych wyznakowanych 68Ga. Wykorzystanie standardowego FDG PET stosuje się w guzach
NET o wysokiej złośliwości.Neuroendocrine tumours (NET) consists of a heterogeneous group of neoplasms, that are able to express
cell membrane neuroamine uptake mechanisms and/or specific receptors, such as somatostatin
receptors, which can be used in the localization and treatment of these tumours. Conventionally NETs
may present with a wide variety of functional or nonfunctional endocrine syndromes and may be familial
and have other associated tumors, also they have different histology pattern and prognosis. They originate
from endocrine glands such as the pituitary, the parathyroids, and the (neuroendocrine) adrenal, as
well as endocrine islets within glandular tissue (thyroid or pancreatic) and cells dispersed between exocrine
cells, such as endocrine cells of the digestive system (gastroenteropancreatic GEP-NET) and respiratory
tracts. GEP-NET are the most common including more then 70% of all NETs.Imaging modalities and assessment of specific tumor markers offers high sensitivity in establishing the
diagnosis and can also have prognostic significance. Most important single imaging technique in terms
of initial identification and staging of GEP-NET seems to be somatostatin receptor scintigraphy (SRS).
Other investigations like helical computed tomography (CT), magnetic resonance imaging (MRI), endoscopic
and/or peri-operative ultrasonography are used for the precise localization of NET.
Another one functional approach include MIBG (meta-iodobenzylguanidine scintigraphy). This technique
is sensitive in the identification of chromaffin cell tumours pheochromocytoma, and also medullary thyroid
carcinoma (MTC), although SRS seems to be very useful in the localization of malignant chromaffin
cell tumours and MTC as well. The further localization and monitoring of the response to treatment CT,
SRS and MRI are used with high diagnostic accuracy.
More recently, positron emission tomography (PET) scanning is being increasingly used for the localization
of NETs, due to develop new PET tracers (68Ga), the standard one FDG PET is currently used in
groups of high malignant NET
EANM/SNMMI Guideline for 18F-FDG Use in Inflammation and Infection
The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote the science, technology and practical application of nuclear medicine. Its 16,000 members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine. In addition to publishing journals, newsletters, and books, the SNMMI also sponsors international meetings and workshops designed to increase the competencies of nuclear medicine practitioners and to promote new advances in the science of nuclear medicine. The European Association of Nuclear Medicine (EANM) is a professional nonprofit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985
Clinical application of autologous technetium-99m-labelled eosinophils to detect focal eosinophilic inflammation in the lung.
This is the final version of the article. It first appeared from the BMJ Group via http://dx.doi.org/10.1136/thoraxjnl-2015-207156The detection of focal eosinophilic inflammation by non-invasive means may aid the diagnosis and follow-up of a variety of pulmonary pathologies. All current methods of detection involve invasive sampling, which may be contraindicated or too high-risk to be performed safely. The use of injected autologous technetium-99m (Tc-99m)-labelled eosinophils coupled to single-photon emission computed tomography (SPECT) has been demonstrated to localise eosinophilic inflammation in the lungs of a patient with antineutrophil cytoplasmic antibody-positive vasculitis. Here, we report on the utility of this technique to detect active eosinophilic inflammation in a patient with focal lung inflammation where a biopsy was contraindicated.The authors thank all the staff at the Department of Nuclear Medicine at Addenbrooke’s Hospital and the Wellcome Trust Clinical Research Facility, Cambridge; Cambridge Biomedical Research Centre Core Biochemistry Assay Laboratory; and the National Institute for Health Research, through the Comprehensive Clinical Research Network. This work was supported by Asthma-UK [08/11], the Medical Research Council [grant number MR/J00345X/1], the Wellcome Trust [grant number 098351/Z/12/Z], and Cambridge NIHR Biomedical Research Centre. Written informed consent was obtained in accordance with the Declaration of Helsinki. The study was approved by Cambridgeshire Research Ethics Committee (09/H0308/119) and the Administration of Radioactive Substances Advisory Committee of the United Kingdom (83/3130/25000)
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