Localisation of sentinel lymph nodes in patients with melanomas by planar lymphoscintigraphic and hybrid SPECT/CT imaging

BACKGROUND: The aim of the study was to assess the role ofplanar lymphoscintigraphy and fusion imaging of SPECT/CT in sentinellymph node (SLN) identification in patients with melanomas.MATERIAL AND METHODS: Planar and hybrid SPECT/low-doseCT lymphoscintigraphy were performed in 113 consecutive patientswith melanomas (59 men, 54 women, mean age 57.6 withrange 11–87 years, BMI 29.4 ± 12.5). The radiopharmaceuticalwas injected around the tumour (Group A, 59 patients), oraround the scar (Group B, 54 patients). Localisation of melanomas:head and neck 4, trunk 55, upper extremities 28, lowerextremities 26. Planar and SPECT/CT images were interpretedseparately by two nuclear medicine physicians. Abilities of thesetwo techniques to image SLN were compared.RESULTS: SLNs were detected on lymphoscintigraphy comprisingplanar and SPECT-CT images in 108 (95.6%) study patients;there was failure to detect SLNs in the remaining 5 (4.4%) patients. Planar images identified 253 SLNs in 100 (88.5%) pts,with a mean of 2.2 ± 1.7 (range 0–9 nodes) per patient. In theremaining 13 (11.5%) patients no SLNs were detected on planarimages. On SPECT-CT images, 334 hot nodes were detectedin 107 (94.7%) patients with a mean of 3.0 ± 2.1 (range 0–9)nodes per patient. In the remaining 6 (5.3%) patients, SPECT-CTwas negative.SPECT/CT visualised lymphatic drainage in 8 (7.1%) patientswith non-visualisation on planar imaging.CONCLUSIONS: In some patients with melanomas SPECT/CTimproves detection of sentinel lymph nodes. It can image nodesnot visible on planar scintigrams, exclude false positive uptakeand exactly localize SLNs.BACKGROUND: The aim of the study was to assess the role ofplanar lymphoscintigraphy and fusion imaging of SPECT/CT in sentinellymph node (SLN) identification in patients with melanomas.MATERIAL AND METHODS: Planar and hybrid SPECT/low-doseCT lymphoscintigraphy were performed in 113 consecutive patientswith melanomas (59 men, 54 women, mean age 57.6 withrange 11–87 years, BMI 29.4 ± 12.5). The radiopharmaceuticalwas injected around the tumour (Group A, 59 patients), oraround the scar (Group B, 54 patients). Localisation of melanomas:head and neck 4, trunk 55, upper extremities 28, lowerextremities 26. Planar and SPECT/CT images were interpretedseparately by two nuclear medicine physicians. Abilities of thesetwo techniques to image SLN were compared.RESULTS: SLNs were detected on lymphoscintigraphy comprisingplanar and SPECT-CT images in 108 (95.6%) study patients;there was failure to detect SLNs in the remaining 5 (4.4%) patients. Planar images identified 253 SLNs in 100 (88.5%) pts,with a mean of 2.2 ± 1.7 (range 0–9 nodes) per patient. In theremaining 13 (11.5%) patients no SLNs were detected on planarimages. On SPECT-CT images, 334 hot nodes were detectedin 107 (94.7%) patients with a mean of 3.0 ± 2.1 (range 0–9)nodes per patient. In the remaining 6 (5.3%) patients, SPECT-CTwas negative.SPECT/CT visualised lymphatic drainage in 8 (7.1%) patientswith non-visualisation on planar imaging.CONCLUSIONS: In some patients with melanomas SPECT/CTimproves detection of sentinel lymph nodes. It can image nodesnot visible on planar scintigrams, exclude false positive uptakeand exactly localize SLNs

International Czech and Slovak cooperation in the treatment of patients with differentiated thyroid cancer

BACKGROUND: The aim of this paper is to present our experience concerning cooperation in the treatment of Slovak patients with differentiated thyroid cancer in Slovak and Czech hospitals. The objectives of this study were to demonstrate the means of this cooperation and the results of therapy. MATERIAL AND METHODS: From September 1991 to October 2005 in the Department of Nuclear Medicine in Ostrava 357 patients from the Slovak Republic with differentiated thyroid cancers (follicular and papillary) underwent complex therapy. They were diagnosed and operated due to the cancer (near-total thyroidectomy and removal of lymph node metastases) in Slovak hospitals. Then they were sent to the Department of Nuclear Medicine in Ostrava in the Czech Republic. In this department a radioiodine ablation of thyroid remnants, by means of the treatment amount of radioiodine of a standard activity of 3.7 GBq, was performed, and then a suppression and substitution therapy of thyroid hormones was started. After 3-6 months some patients were examined by means of diagnostic whole body scintigraphy after application of 300 MBq 131I. Some patients were treated by means of a standard activity of 7.4 GBq 131I and after 5 days whole body scintigraphy (WBS) was performed. In both of these groups of patients the diagnostic or therapeutic radioiodine application was done after withdrawal of thyroid hormone treatment. If thyroglobulin levels were low and WBSs were negative, patients were followed up in the Department of Nuclear Medicine in Martin. Patients with radioiodine accumulated metastases were again treated with radioiodine in Ostrava. If indicated, external radiation therapy targeted on the neck and upper mediastinum was performed in the Slovak Republic, in the University Hospital in Martin. Newly formed lymph node metastases were surgically treated in Slovakia, too. Generally we have very good treatment results. Also, economically our partnership is cost effective. Our collaboration also successfully continues after entrance of the Slovak Republic and the Czech Republic to the European Union in 2004. CONCLUSIONS: The results of this multi-centre study show that international Czech and Slovak cooperation in the complex therapy of patients with differentiated thyroid cancers is successful, with high efficacy. The treatment results were very similar to therapeutic results in our patients from the Czech Republic

I-131 false positive uptake in a huge parapelvic renal cyst

A male patient had undergone total thyroidectomy for thyroid papillary carcinoma. He was administered thyroablation activity of radioiodine. Whole body imaging after diagnostic activity of 131-I demonstrated intense radioiodine uptake in the right side of the upper abdominal region. The serum thyroglobulin level was low. Ultrasonography demonstrated a large irregular anechoic structure in the centre of the right kidney — a cyst in the parapelvic region. Renal cysts can lead to erroneous interpretation of radioiodine scintigraphy. Nuclear Med Rev 2011; 14, 1: 36–3

Our first clinical experience with radiosynoviorthesis by means of 166Ho-holmium-boro-macroaggregates

BACKGROUND: In this paper, we evaluate the therapeutic and adverse effects of the application of 166-holmium-boro-macroaggregates (HMBA) in radiosynovectomy (RSO) of the knees. We assessed the efficacy and safety of 166Ho-HBMA in a prospective clinical trial in patients suffering from chronic synovitis. MATERIAL AND METHODS: An effective component of radiopharmaceutical 166Ho-boro-macroaggregates is radionuclide 166Ho which has both β-emission and γ-emission. The physical half-life time of 166Ho is 26.8 hours. After application of the radiopharmaceutical into a joint cavity, the effect of β-emission causes radiation necrosis of pathologically changed (inflamed) synovial membrane. From 15th April 2005, we have started RSO of knees by means of new radiopharmaceutical 166Ho-boro-macroaggregates in patients with gonarthrosis, rheumatoid arthritis, chronic synovitis, psoriatic arthritis, gout arthropathy. Seventeen intra-articular injections were performed in fifteen patients receiving a mean activity of 972 MBq (range: 904-1057 MBq) 166Ho-HMBA. The patients were hospitalized for three days. Side effects were evaluated during hospital stay and after 6-8 weeks. Static scintigraphy of knee joints and measurements of blood radioactivity were performed. Therapeutic effects were evaluated after 6-8 weeks. RESULTS: In 2 hours and 2 days after application, we proved, by means of knee and inguinal scintigraphy, only insignificant radiopharmaceutical leakage from the joint cavity to the inguinal lymph nodes in four patients. In treated patients, no serious adverse effects occurred. Nine patients were without complaints; 4 patients had slight knee exsudation and 2 patients had great exsudation. Therapeutic effects after 6-8 weeks were as follows: 2 patients were without pain, 9 with lower pain, 3 with the same pain and 1 patient with increased pain. Joint motion was improved in 7 patients, remained the same in 7 patients and was impaired in 1 patient. Analgesics consumption was lower in 5 patients, the same in 9 patients and greater in 1 patient. Knee exsudation was absent in 2 patients, lower in 4 patients, the same in 6 patients and greater in 3 patients. CONCLUSIONS: We proved only insignificant radiopharmaceutical leakage from the joint cavity to the inguinal lymph nodes. Six patients had early slight or great radiation synovitis. The possible cause could be rather high applicated activity. One can take into consideration its reduction. Therapeutic effects can be precisely evaluated after a longer time interval than was possible for us (6-8 weeks after RSO). 166Ho-boro-macroaggregates can extend the scale of clinically used radiopharmaceuticals for RSO. This paper is presented in the scope of the first stage of clinical evaluation of synovectomy application of holmium-boro-macroaggregates

Detection of sentinel lymph nodes in cervical cancer. A comparison of two protocols

BACKGROUND: The aim of this study was lymphatic mapping to identify SLN in cervical cancer (CaCerv) with radioactive colloids, intraoperative detection with patent blue dye (PBD) and gamma probe (GP) and biopsy and comparison of two protocols. MATERIAL AND METHODS: In 54 patients with CaCerv before hysterectomy and lymph nodes dissection (LND) we performed preoperative lymphoscintigraphy utilizing 99mTc-colloid (Nanocoll, SentiScint or Nanocis), activity 40 MBq, on the operation day (30 women) or the day before operation (24 women). Gynaecologists injected 4 peritumoural injections of colloid into the cervix around the tumour. Scintigraphy followed 25-50 minutes (one-day protocol) or 12-19 hours (two-day protocol) after injection. Gynaecologists also injected 4 peritumoural injections of PBD into the cervix around the tumour. All women underwent SLN biopsy and LND (in average 35 lymph nodes were taken) and hysterectomy. SLNs (active and/or blue lymph nodes) were examined by a pathologist [histopathology and immunohistochemistry (IH) with detection of cytokeratine]. No SLN was examined without IH. RESULTS: The gynaecologists withdrew 123 SLNs (on average 2.27/1 patient) and in total 1898 lymph nodes (on average 35/1 patient). In 1 woman the tumour was inoperable. Two-day protocol, which involved scintigraphy, PBD and GP detected SLNs on both sides (45 SLNs) in 17 women (70.8%), SLNs on the one side (6 SLNs) in 3 patients (12.5%) and no SLNs were found in 4 women (16.7%). One-day protocol detected SLNs on both sides in 23 patients (74.1%) - 63 SLNs, in 7 women on one side (25.9%) - 9 SLNs. Metastases in SLNs (with or without metastases in other LN) were found in 21 patients (38.9%) - in 1 woman of stage FIGO IB1, in 1 woman of stage FIGO IB2, in 1 patient of stage FIGO IIIA and in all 18 patients of stage FIGO IIIB. False negative SLN detection was 0%. CONCLUSIONS: In SLN detection in patients with CaCerv, all 3 methods - scintigraphy, PBD and GP - should be used, and the success rate of SLN detection increases, although scintigraphy has lower significance than in SLN detection in malignant melanoma and breast cancer. One-day protocol had a better detection rate of SLN than two-day protocol. The method is promising but its results are not as unequivocal and optimistic as in breast cancer and malignant melanoma, and it is still experimental. Additional experience is necessary

The diagnosis of brain death - own experience

BACKGROUND: The aim of this paper is a description of our experience with scintigraphic detection of brain death. MATERIAL AND METHODS: Thirty-four patients were studied from February 2003 to June 2006. We performed brain scintigraphic examination utilising 99mTc-HMPAO and a two-headed SPECT camera E.CAM. We used LEHR collimators. 15% energy window was centred around 140 keV. 650-750 MBq of radiopharmaceutical was injected as a bolus. Then dynamic scintigraphy of the head and neck was done in an anterior projection - 2 s per frame for 60 s. Then static scintigraphy of the head in four projections followed (anterior, both lateral and posterior views), for 4 minutes per view. RESULTS: A typical picture of brain death on planar dynamic and static scintigrams showed an absence of perfusion and radiopharmaceutical accumulation in both cereberal and cerebral hemispheres and brain stem. Radioactivity in the area of the scalp and face could be present. Borderline findings, which demanded careful interpretation, were the cases with preservation of minimal cerebral perfusion and simultaneous absence of radiopharmaceutical accumulation in its parenchyma and cutoff of tracer accumulation in cerebral parenchyma only supraor infratentorial. CONCLUSIONS: Cerebral perfusion scintigraphy is the most contributing factor for the diagnosis of brain death in patients after cranial trauma with subsequent neurosurgical operation, when angiography is often unsuitable. In these situations perfusion scintigraphy is able to show the absence of radiopharmaceutical accumulation in cerebral tissue. Scintigraphic detection of brain death gained an important role in new Czech legislation, and the demands of transplant centres for these examinations will certainly grow with the accrual of organ collections

Detekce a biopsie sentinelove uzliny u zhoubnych nadoru.

Detection of sentinel lymph node (SLN) in some types of malignant tumours is important in order to develop a therapeutic strategy, to determine staging and to predict prognosis. It is possible to avoid removal of whole groups of lymph nodes (dissection). In malignant melanoma the detection and biopsy of SLN is accepted as the standard technique, but in breast cancer it has not been yet. Great differencies prevail in almost all aspects of detection and biopsy of SLN. At least three techniques are now available for the detection of sentinel lymph nodes; lymphoscintigraphy, peroperative use of blue dye and surgical gamma probe. The aim of this study was to compare these methods of SLN detection in breast cancer and malignant melanoma patients, to compare three radiopharmaceuticals in lymphoscintigraphy and surgical probe procedure, to compare one-day and two-day protocols in SLN detection in breast cancer. The aim of the study also was to assess the false negative rate of SLN and to assess the detection of non-axillary SLNs and significance of biopsy of these SLNs in breast cancer, and to evaluate the necessity of axillary dissection in breast cancer of small size.Available from STL Prague, CZ / NTK - National Technical LibrarySIGLECZCzech Republi