The diagnostic value of dual-phase SPECT/CT scintigraphy based on transport kinetics of 99mTc-sestamibi confirmed with histopathological findings in patients with secondary hyperparathyroidism — practical consideration

BACKGROUND: Dual phase 99mTc-sestamibi SPECT/CT preoperative parathyroid scintigraphy (PPS) is seldom discussedin terms of the transport kinetics of the tracer.Objectives: To assess the relationship between the characteristic type of tracer transport in particular PPS and histopathologicalfindings in patients with secondary hyperparathyroidism (sHPT).MATERIAL AND METHODS: The study comprised 27 patients (13 females and 14 males) with sHPT. Based on tracer accumulationin early phase (EP) and delayed phase (DP), the following types of accumulation for PPS(+) lesions were identified: EP(–)/DP(+) (type I), EP(+)/DP(+) (type II), EP(+)/DP(–) (type III). EP(–)/DP(–) (type IV) lesions constituted PPS(–) group invisible inSPECT/CT. Overall, 69 lesions 59 PPS(+) and 10 PPS(–) were evaluated histopathologically.RESULTS: Among SPECT/CT PPS(+), types I, II and III occurred in 9 (15%), 49 (83%), and 1 (2%) lesions, respectively. Thefrequency of histopathological diagnosis of normal and abnormal (APG — adenoma or hyperplasia) parathyroid gland, as wellas non-parathyroid (thyroid, lymph nodes, or fat) lesions differed significantly between type I, II, and III lesions (p = 0.036).APG histopathological diagnosis was significantly more frequent in lesions with type II uptake than in lesions with type I uptake(76% vs. 33%, p = 0.0197). Type II lesions had significantly higher odds for histopathological diagnosis of APG or NPG thantype IV, PPS(–) lesions [odds ratio = 13.1 (95% CI: 2.75 to 63.27)].CONCLUSIONS: For SHP patients evaluated with SPECT/CT PPS accumulation type I is a weak premise for surgeon to findparathyroid pathology. Only persistent 99mTc-sestamibi accumulation in both phases - equivocal with accumulation type II— effectively differentiates parathyroid and non-parathyroid lesions as well as indicates with high probability the presence ofadenoma or hyperplasia. Type III consistent with washout pattern is rare in sHPT

The application of SPECT/CT scintigraphy with MIBI-Tc99m in the diagnosis of thyroid nodules - a preliminary report

Wstęp: Niediagnostyczne badania cytologiczne (FNAB, fine needle aspiration biopsy) guzków tarczycy lub inne przyczyny utrudniające podjęcie decyzji o leczeniu operacyjnym tarczycy, takie jak wiek pacjenta lub zawansowanie choroby towarzyszące, stanowią poważną przyczynę w ostatecznym wyborze posterowania, szczególnie jeżeli nie ma jednoznacznych danych wskazujących na obecność zmiany nowotworowej. Dodatkowym sposobem wyjaśnienia charakteru zmiany jest badanie radioizotopowe z MIBI-Tc99m. Gromadzenie MIBI jest interpretowane jako sygnał zwiększający ryzyko złośliwości, zwłaszcza gdy utrzymuje się przez dłuższy czas. W pracy postanowiono ocenić przydatność badania scyntygraficznego SPECT/CT z MIBI-Tc99m metodą wymywania w relacji do wyników badania histopatologicznego. Materiał i metody: W 2009 roku wykonano u 12 chorych w wieku 54-75 (śr. 63,5) lat badania scyntygraficzne tarczycy planarne oraz SPECT/CT z MIBI-Tc99m, poprzedzone o badanie wymywania. Wyliczono wskaźniki wymywania i wskaźniki guz/tło w obrazach wczesnych i późnych. Chorzy ze wzmożonym wychwytem znacznika byli operowani i badani histopatologicznie. Wyniki: Wzmożone gromadzenie MIBI-Tc99m obserwowano u 8 pacjentów (10 zmian), a brak gromadzenia (prawidłowy wynik) u 4 (5 zmian). Na 15 badań w 13 przypadkach zaobserwowano wymywanie się radiofarmaceutyku ze zmiany, które sugeruje łagodny charakter zmiany. Operowano trzech chorych ze zmianami gromadzącymi MIBI-Tc99m w badaniu scyntygraficznym, niemniej wynik badania histopatologicznego był we wszystkich przypadkach prawidłowy. Zaobserwowano, że interpretacja obrazów tarczycy SPECT/CT z MIBI-Tc99m uzyskiwanych metodą wymywania jest łatwiejsza i czytelniejsza niż w badaniu planarnym. U 3 z pozostałych 5 chorych dane kliniczne nie zwiększają obecnie podejrzenia raka, u 2 nie kontynuowano obserwacji. Wnioski: Ocena scyntygraficzna tarczycy wykonywana z zastosowaniem SPECT/CT z MIBI-Tc99m metodą wymywania może być pomocna w diagnostyce różnicowej guzków tarczycy. (Endokrynol Pol 2010; 61 (5): 422-426)Introduction: Thyroid cancer diagnosis is based mainly on fine needle aspiration biopsy (FNAB) performed under ultrasonography guidance. Questions arise in cases of an inconclusive FNAB result - when there is no clear evidential data to support the existence of a malignant lesion or when there are any other reasons which make the decision process difficult, such as the patient’s age or coexisting diseases. To clarify this issue the patient should be encouraged to undergo surgery treatment or to be followed up. Thyroid scintigraphy with an oncophilic tracer such as MIBI-Tc99m may be helpful. Material and methods: The study comprised a group of 12 patients, aged 54-75 (av. 63.5) years, who, in 2009, underwent planar and SPECT/CT thyroid scintigraphy with MIBI-Tc99m using washout method. The tumour/background ratio in early and delayed images was calculated and the wash-out ratio was estimated. Patients with increased focal lesion uptake were operated on and the lesions were histopathologically verified. Results: Abnormal scintigraphy results were obtained in 8 patients (10 lesions) and normal results in 4 patients (5 lesions). Out of 15 studies, in 13 cases the washout from the lesion was observed within 2 hours. It was noticed that the images obtained with SPECT/CT washout method were clearer and easier to read in comparison to planar studies. Three patients with an abnormal results underwent surgery and had benign histopathology results after the operation, in 3 patients the observation is being confirmed without any increase in malignancy suspicions, and 2 were lost for observation. Conclusions: Our preliminary results do support the use of MIBI-Tc99m in the evaluation of indeterminate thyroid nodules. To validate the hypothesis that MIBI-Tc99m may be used to exclude malignancy in lesions indeterminate by FNAB we propose to use SPECT-CT derived images and standardized evaluation criteria. (Pol J Endocrinol 2010; 61 (5): 422-426

The practical considerations of dose constraints in diagnostic medical departments using ionizing radiation

The term “dose constraint” has been used in radiological protection since 1990. Its practical application has varied from country to country to the present day. The authors of this paper believe that it is an underestimated tool for the purpose of radiological protection. This study aims to estimate local dose constraints for workers in conventional nuclear medicine and radiology departments, on the basis of doses received in the last 3 to 4 years by different groups of workers. The levels of exposure to employees of the nuclear medicine department correspond well to levels in other countries, but for employees belonging to the radiology department, the levels are significantly lower. Unification of the practical application of dose constraints and legislation concerning their specific values would increase the relevance and effectiveness of these operational units. This is a playing field for radiation safety officers for the determination and widespread publication of local dose constraints in their particular medical departments

Exposure of children with neuroblastoma to ionizing radiation during computed tomography and nuclear medicine imaging – a single centre experience

Purpose: To calculate cumulative doses of ionizing radiation absorbed by children with neuroblastoma during diagnostic CT and NM scans. Method: Retrospective analysis of 267 CT and NM scans performed in 21 children treated in 2009–2015. Results: The cumulative effective dose absorbed per child ranged from 58 to 536 mSv and was highest in infants under 3 years. Conclusion: Children with suspected neuroblastoma may be exposed to significant doses of radiation during the whole period of diagnosis and monitoring the progress of treatment

Occupational exposure at the Department of Nuclear Medicine as wa work environment : a 19-year follow-up

Background: This study assessed the radiation safety at Nuclear Medicine Department being a work environment. Ionizing radiation exposure of the employees in the last 19 years and the effects of legislative changes in radiological protection were analyzed. Material/Methods: All employees of the investigated department were regularly and individually monitored using chest badges equipped with Kodak film type 2. Overall, 629 annual doses of the employees of nuclear medicine department, registered in the period 1991-2009, were analyzed statistically. Results: Technicians were found to be the largest exposed professional group, whereas nurses received the highest annual doses. Physicians received an average annual dose at the border detection methods. Ancillary and administration staff occasionally received doses above the method detection limit (MDL). The average annual dose for all dosimetry records was 0.7 mSv, and that for dosimetry records equal and higher than MDL was 2.2 mSv. Conclusions: There was no case of an exceeded dose limit for a worker. Furthermore, improvement of radiological protection had a significant impact on the reduction of doses for the most exposed employees

The penetration of topically applied ointment containing hyaluronic acid in rabbit tissues

The properties of hyaluronic acid used for treatment of acute and chronic joint disease are known for many years and this compound is widely used both in humans and animals. To obtain a therapeutic effect of a certain drug, the appropriate concentration in the target organ or tissue is important. The application of labeled compounds is one of the frequently applied techniques to estimate drug penetration into the skin and other body tissues or organs. The aim of the study was to evaluate the penetration of hyaluronic acid labeled with I-131 through the skin and its distribution within the knee joint and other internal organs in rabbits after a topical application of an ointment containing hyaluronic acid.The experiment was performed on 22 albino rabbits divided into control and examined groups. Fifteen rabbits were exposed to the multicomponent ointment containing hyaluronic acid labeled with I-131. Time of exposure was 48 hours. Hyaluronate penetrated to a high degree into the examined tissues. No significant differences in terms of leg tissue activity were observed between a leg tissue exposed to labeled ointment and that unexposed, suggesting that after topical administration, the active component of the ointment is delivered to the joint via the blood stream. Hyaluronate applied topically penetrates through the skin into the rabbit tissues and organs and into the joint fluid of both legs (exposed and not exposed). This route of administration seems to be useful for this drug delivery and allows to avoid unnecessary side effects

Estimating the Reduction in the Radiation Burden From Nuclear Cardiology Through Use of Stress-Only Imaging in the United States and Worldwide

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Comparison of Radiation Doses and Best-Practice Use for Myocardial Perfusion Imaging in US and Non-US Laboratories: Findings From the IAEA (International Atomic Energy Agency) Nuclear Cardiology Protocols Study

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Nuclear cardiology practice and associated radiation doses in Europe: results of the IAEA Nuclear Cardiology Protocols Study (INCAPS) for the 27 European countries

Purpose: Nuclear cardiology is widely used to diagnose coronary artery disease and to guide patient management, but data on current practices, radiation dose-related best practices, and radiation doses are scarce. To address these issues, the IAEA conducted a worldwide study of nuclear cardiology practice. We present the European subanalysis. Methods: In March 2013, the IAEA invited laboratories across the world to document all SPECT and PET studies performed in one week. The data included age, gender, weight, radiopharmaceuticals, injected activities, camera type, positioning, hardware and software. Radiation effective dose was calculated for each patient. A quality score was defined for each laboratory as the number followed of eight predefined best practices with a bearing on radiation exposure (range of quality score 0 – 8). The participating European countries were assigned to regions (North, East, South, and West). Comparisons were performed between the four European regions and between Europe and the rest-of-the-world (RoW). Results: Data on 2,381 European patients undergoing nuclear cardiology procedures in 102 laboratories in 27 countries were collected. A cardiac SPECT study was performed in 97.9 % of the patients, and a PET study in 2.1 %. The average effective dose of SPECT was 8.0 ± 3.4 mSv (RoW 11.4 ± 4.3 mSv; P < 0.001) and of PET was 2.6 ± 1.5 mSv (RoW 3.8 ± 2.5 mSv; P < 0.001). The mean effective doses of SPECT and PET differed between European regions (P < 0.001 and P = 0.002, respectively). The mean quality score was 6.2 ± 1.2, which was higher than the RoW score (5.0 ± 1.1; P < 0.001). Adherence to best practices did not differ significantly among the European regions (range 6 to 6.4; P = 0.73). Of the best practices, stress-only imaging and weight-adjusted dosing were the least commonly used. Conclusion: In Europe, the mean effective dose from nuclear cardiology is lower and the average quality score is higher than in the RoW. There is regional variation in effective dose in relation to the best practice quality score. A possible reason for the differences between Europe and the RoW could be the safety culture fostered by actions under the Euratom directives and the implementation of diagnostic reference levels. Stress-only imaging and weight-adjusted activity might be targets for optimization of European nuclear cardiology practice