15 research outputs found
Comment on Kraft O. et al. Detection of sentinel lymph nodes in cervical cancer. Comparison of two protocols - a reply
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