99m Tc-Octreotide-Avid Brain Mass In A Patient With Poorly Differentiated Papillary Thyroid Carcinoma, Hope In Despair

Brain metastases of PTC are rare and occur in 0.1-5% of the patients, especially in the poorly differentiated types that usually fail to concentrate iodine. We present a rare case of PTC with probable brain metastasis in a 58-year-old woman with a history of poorly differentiated PTC that showed elevated Tg levels and no metastasis was detected in the whole-body iodine scan, despite the positive 99m Tc-octreotide scintigraphy. This imaging modality could be helpful as a diagnostic guide for radionuclide therapy with labeled somatostatin analogs in cases of thyroid carcinoma with elevated Tg levels and negative whole-body iodine scan

[68Ga] Ga-Pentixafor diffuse bilateral Adrenal & Breast uptake in a patient with High-grade Glioma: A note of caution on normal variants

[68Ga] Ga-labeled C-X-C motif receptor4 as a novel radio-ligand using PET/CT has been investigated for tracing various kinds of solid and hematopoietic malignancies in recent years. High-grade Glioma (WHO classification 2016 grade III and IV) shows elevated levels of CXCR4 ligand expression in the affected tumoral cells. Healthy and non-affected organ cells express low-level CXCR4 ligands density. We performed [68Ga] Ga-Pentixafor (Pars-Cixafor™) PET/CT in a patient with high-grade Glioma (anaplastic oligodendroglioma WHO grade III) with no other documented medical condition and history. In addition to the Pentixafor-avid tumor remnant in the PET/CT images, we observed mild symmetrical bilateral uptake in the fibro glandular tissue of the breasts and moderate CXCR4(Pentixafor) avidity in both adrenal glands without any discernable pathology and abnormal density changes in the CT component of the study. Attention should be paid to the interpreting [68Ga] Ga-Pentixafor PET/CT examination and its normal uptakes and variants

Incidental finding of a dermoid cyst in a whole-body iodine scan: importance of using [131I]SPECT/CT in the differentiated thyroid carcinoma

A 33-year-old female with a history of total thyroidectomy for papillary thyroid carcinoma was referred to the nuclear medicine department for ablative radioiodine therapy. Post ablation scan showed an area of intense iodine uptake on the left side of the pelvic region, corresponding to the large well-defined heterogeneous mass in the left ovary in the SPECT/CT images. The radiologic features of this lesion were compatible with a dermoid cyst, previously unrecognized. Eventually, the lesion was laparoscopically removed, and a typical dermoid cyst was confirmed through histopathologic assessment

Treatment efficacy of 153Sm-EDTMP for painful bone metastasis

Introduction: Involvement of the skeleton can cause an excruciating pain in two-thirds of terminal patients with a history of malignancy. Due to several limitations of other therapies, such as analgesics, bisphosphonates, chemotherapy, hormonal therapy and external beam radiotherapy; bone-seeking radiopharmaceuticals have an important role in palliation of pain from bone metastases. Although these kinds of therapies have many advantages including the ability to treat multiple sites of tumoral involvement simultaneously, no significant confliction with other treatments, ease of administration and the potential to be used repetitively; in Iran using of this modality is not widely practiced. In this study we evaluated the clinical usefulness of Sm-153 lexidronamfor pain management of bone metastases. Methods: 28 patients (14 males and 14 females) aged 38-77 years with a history of painful bone metastases caused by different cancers, not responding to conventional treatments were included in the study. All patients had a recent whole body bone scan indicating multiple bone metastases. 1 mCi/Kg Sm-153 lexidronam was injected intravenously to the patients. Whole body scintigraphy was done 3 or 18 hours post injection. Pain relief and quality of life have been evaluated by analog pain scale and Karnofsky index every week, respectively. Also, all patients were evaluated for hematological toxicity every two weeks. Active follow ups were performed. Results: 43% of patients showed the presence of the flare phenomenon during the first three days after Sm injection with a mean duration of 2.2 days. The pain relief began between 2 and 16 days post injection and the duration of pain palliation was in the range of 4 to 32 weeks (mean±SD=15.22±7.8). 64.3% of patients showed complete relief of pain and 21.4% achieved partial response to therapy. (Over all response to therapy was 85.7%). The lowest amount of peripheral blood cells was detected in the fourth week for RBCs and in the 6th week for WBCs and PLTs. No one experienced hematological toxicity induced problems. Conclusion: Sm-153 lexidronam is an effective treatment for painful bone metastases. The complication rate is low and the quality of life of the patients after treatment would be significantly improved

Association of Helicobacter pylori infection with the Lewis and ABO blood groups in dyspeptic patients

Background: Helicobacter pylori infection is a basic risk factor for chronic gastritis, and gastric carcinoma. Based on some studies, the reason is binding of H. pylori to H and Leb antigens in gastric mucosa. However, some other findings have not determined any association between the infection and these antigens. Because of this controversy and the fact that H. pylori infection and gastric adenocarcinoma are common diseases in Iran, the assessment of the association of H. pylori infection with these blood groups could be valuable. Materials and Methods: In a cross sectional study on 135 adult dyspeptic patients in Mashhad, Iran, from 2009 to 2010, H. pylori infection was evaluated by using the Heliprobe 14C‑urea breath test and the ABO and Lewis blood group antigens were determined by the tube method. Association between the Lewis and ABO phenotypes with H. pylori infection were analysed by Fisher’s exact test. A P ≤ 0.05 was considered to be significant. Results: 68 (50.4%) patients were positive for H. pylori infection. The frequencies of the ABO, Lewis and secretion phenotypes were not significant in the infected and non‑infected patients. We also did not find a significant association between Le<sup>a</sup> and Le<sup>b</sup> antigens and this infection. Conclusion: We could not establish a significant association between the Lewis, ABO and secretion phenotypes with H. pylori infection. Diversity of sequences of blood group antigen b‑binding adhesion (<i>bab</i>A gene) of H. pylori may be a reason why our findings are different from other studies in other geographic areas.Keywords: ABO blood groups, gastritis, Helicobacter pylori, Lewis blood group, secretor blood groupNigerian Medical Journal | Vol. 54 | Issue 3 | May-June | 201

A dataset of [68Ga]Ga-Pentixafor PET/CT images of patients with high-grade Glioma

This paper contains single-center prospective information showing illustrative examples of chemokine receptor-4 (CXCR4) targeting in high-grade glial brain tumors in treatment-naïve adult patients using a novel radiolabeled PET tracer: [68Ga]Ga-CXCR4 PET/CT.High-grade glioma is one of the most resistant malignancies to treatment. Despite major breakthroughs in diagnostic and therapeutic approaches, the overall 5-year survival rate remains in the 5–10% range. CXCR4 is a chemokine with the C-X-C motif that is overexpressed in high-grade gliomas.The 24 consecutive treatment- naïve enrolled patients underwent PET/CT images using the SIEMENS scanner (Biograph6 TrueV) and received the radiotracer intravenously. After approximately 60 min, the PET/CT acquisition was performed with a dedicated scanner and in 10 min time per bed position. The images were reconstructed and analyzed with the 3D-OSEM algorithm, applying point spread function (PSF) or resolution recovery algorithm (TrueX in Syngo ® software, Siemens Medical Solution), 3 iterations, and 21 subsets using a 3 mm Gaussian post-smoothing filter.These data would be potentially beneficial for automatic tumor delineation machine learning after augmented with other data retrieved from different papers as well as for differentiation between an active viable tumor vs. post-surgery/necrosis in indeterminate cases. The theranostics potential (CXCR4-tageted labeled beta emitters) is one of the most novel areas of interest for future studies

Tc-99m Labeled HMPAO white Blood Cell Scintigraphy in a patient with Hip Prosthesis

Background The ability to follow the distribution and migration of biologically active cells in human is essential for the development of cell-based therapies and diagnostics. Nuclear medicine imaging is widely applied in clinic as an attractive technique for in vivo WBC and stem cell tracking. The aim of this study was to evaluate prosthesis infection of a 51 years old man with previous history of hip prosthesis in the left side 17 years ago, and pain in the left femur since 7 months ago using 99mTc-HMPAO labeled WBC.   Methods: After sterile isolation of patient's WBCs from RBC and Platelet, they were incubated with 30 mCi of 99mTc-HMPAO for 20 minutes. The labeled WBCs were isolated from 99mTc-HMPAO by centrifuge (450 g, 5 min) in sterile condition and reinjected to the patient. Planar Imaging was acquired (256 × 256 matrix, 5 min) two & four hours post injection.   Results: Planar images showed no uptake on the left femur (suspicious to infection) which excludes the patient from surgery replacement of the prosthesis.    Conclusion: Leukocyte scintigraphy with 99mTc-HMPAO has been a useful diagnostic method for three decades in the detection of bone infection, fever of unknown origin and suspicion of acute appendicitis.   Key Words: Leukocyte labeling, Hip prosthesis, 99mTc-HMPAO, Scintigraphy