Selective intraarterial radionuclide therapy with Yttrium-90 (Y-90) microspheres for unresectable primary and metastatic liver tumors

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to evaluate the success of selective intraarterial radionuclide therapy (SIRT) with Yttrium-90 (Y-90) microspheres in liver metastases of different tumors. We also interpreted the contribution of SIRT to survival times according to responder- non responder and hepatic- extra hepatic disease.</p> <p>Methods</p> <p>The clinical and follow-up data of 124 patients who were referred to our department for SIRT between June 2006 and October 2010 were evaluated retrospectively. SIRT has been applied to 78 patients who were suitable for treatment. All the patients had primary liver tumor or unresectable liver metastasis of different malignancies. The treatment was repeated at least one more time in 5 patients to the same or other lobes. Metabolic treatment response evaluated by fluorine-18 fluorodeoxyglucose (F18-FDG) positron emission tomography/computed tomography (PET/CT) in the 6^thweek after treatment. F18-FDG PET/CT was repeated in per six weeks periods. The response criterion had been described as at least 20% decrease of SUV value. Also in patients with neuroendocrine tumor serial Gallium-68 (Ga-68) PET/CT was used for evaluation of response. Patients were divided into 2 groups according to their treatment response.</p> <p>Results</p> <p>68 patients received treatment for the right lobe, seven patients received treatment for the left lobe and 3 patients for both lobes. The mean treatment dose was estimated at 1.62 GBq. In the evaluation of treatment response; 43(55%) patients were responder (R) and 35 (45%) patients were non-responder (NR) in the sixth week F18-FDG PET/CT. Mean pretreatment SUVmax value of R group was 11.6 and NR group was 10.7. While only 11 (31%) out of 35 NR patients had H disease, 30 (69%) out of 43 R patients had H disease (p < 0.05). The mean overall survival time of R group was calculated as 25.63 ± 1.52 months and NR group's 20.45 ± 2.11 (p = 0.04). The mean overall survival time of H group was computed as 25.66 ± 1.52 months and EH group's 20.76 ± 1.97 (p = 0.09).</p> <p>Conclusions</p> <p>SIRT is a useful treatment method which can contribute to the lengthening of survival times in patients with primary or metastatic unresectable liver malignancies. Also F18-FDG PET/CT is seen to be a successful imaging method in evaluating treatment response for predicting survival times in this patient group.</p

Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/ Computed Tomography in the Detection of Ovarian Cancer Recurrence in Patients with Elevated Serum Ca-125 Levels and Whether the Recurrence appears by Conventional Imaging

Introduction: We aimed in this study to evaluate the benefit of Fluorine-18 (18F) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the detection of ovarian cancer recurrence in a selected patient group who had elevated serum Ca-125 levels and whether the recurrence appears by conventional imaging.Material and Method: A total of 39 female patients (mean age: 59±12.3) who underwent 18F-FDG PET/CT for restaging of ovarian cancer due to of elevated serum Ca-125 levels were retrospectively included to this study. 18F-FDG PET/CT imaging have been performed for searching possible disease recurrence in 24 patients who had normal or undetermined abdominal CT or pelvic MRI (Group 1) and evaluating to extent of disease in 15 patients who had abnormal abdominal CT or pelvic MRI (Group 2). Disease recurrence was confirmed by histopathological examination of surgical procedures or clinical follow-up data for at least 6 months period.Results: The mean period between the completion of initial treatment and 18F-FDG PET/CT was 2.6±1.4 years. In 33 of the 39 patients (82%), recurrent disease was developed during the follow-up period. Of the 33 patients with recurrent disease, 6 (18%) were confirmed by histopathological examination, while in 27 (82%) were documented by clinical follow-up. The mean Ca-125 level and the SUVmax value of group 1 were 509 U/ml (range 50.3-6544 U/ml) and 12.26±4.9 (range 0-21.7), respectively. Overall sensitivity and specificity of 18F-FDG PET/CT in group 1 were quantified as 94% and 75%, respectively. The mean Ca-125 level and mean SUVmax value of group 2 at the time of 18F-FDG PET/CT scans were calculated as 358 U/ml (range 40.6-1233U/ml) and 11.4 ± 4.53 (range 4.5-20.1), respectively. Disease recurrence of 14 (93%) patients was correctly identified by 18F-FDG PET/CT. The sensitivity of 18F-FDG PET/CT in the detection of disease recurrence of group 2 was quantified as 100%. Specificity could not quantified due to absence of TN and FP results.Conclusions: 18F-FDG PET/CT has higher sensitivity and specificity in the detection recurrent ovarian cancer than serum Ca-125 levels and ceCT alone. The addition of 18F-FDG PET/CT to Ca-125 and ceCT improves the sensitivity of the evaluation of disease extension

Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/ Computed Tomography in the Detection of Ovarian Cancer Recurrence in Patients with Elevated Serum Ca-125 Levels and Whether the Recurrence appears by Conventional Imaging

Introduction: We aimed in this study to evaluate the benefit of Fluorine-18 (18F) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the detection of ovarian cancer recurrence in a selected patient group who had elevated serum Ca-125 levels and whether the recurrence appears by conventional imaging.Material and Method: A total of 39 female patients (mean age: 59±12.3) who underwent 18F-FDG PET/CT for restaging of ovarian cancer due to of elevated serum Ca-125 levels were retrospectively included to this study. 18F-FDG PET/CT imaging have been performed for searching possible disease recurrence in 24 patients who had normal or undetermined abdominal CT or pelvic MRI (Group 1) and evaluating to extent of disease in 15 patients who had abnormal abdominal CT or pelvic MRI (Group 2). Disease recurrence was confirmed by histopathological examination of surgical procedures or clinical follow-up data for at least 6 months period.Results: The mean period between the completion of initial treatment and 18F-FDG PET/CT was 2.6±1.4 years. In 33 of the 39 patients (82%), recurrent disease was developed during the follow-up period. Of the 33 patients with recurrent disease, 6 (18%) were confirmed by histopathological examination, while in 27 (82%) were documented by clinical follow-up. The mean Ca-125 level and the SUVmax value of group 1 were 509 U/ml (range 50.3-6544 U/ml) and 12.26±4.9 (range 0-21.7), respectively. Overall sensitivity and specificity of 18F-FDG PET/CT in group 1 were quantified as 94% and 75%, respectively. The mean Ca-125 level and mean SUVmax value of group 2 at the time of 18F-FDG PET/CT scans were calculated as 358 U/ml (range 40.6-1233U/ml) and 11.4 ± 4.53 (range 4.5-20.1), respectively. Disease recurrence of 14 (93%) patients was correctly identified by 18F-FDG PET/CT. The sensitivity of 18F-FDG PET/CT in the detection of disease recurrence of group 2 was quantified as 100%. Specificity could not quantified due to absence of TN and FP results.Conclusions: 18F-FDG PET/CT has higher sensitivity and specificity in the detection recurrent ovarian cancer than serum Ca-125 levels and ceCT alone. The addition of 18F-FDG PET/CT to Ca-125 and ceCT improves the sensitivity of the evaluation of disease extension

Impact of 18F-FDG PET/CT for Detecting Primary Tumor Focus in Patients with Histopathologically Proven Metastasis

Purpose: To describe the impact of fluorine (18F) - fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in detecting primary tumor focus in our patient population who had histopathologically proven metastasis.Methods: 37 patients who underwent 18F-FDG PET/CT to detect primary tumor focus in our department were included in the study. The results of PET/CT and clinical follow-up data were reviewed retrospectively. PET/CT results were compared with histological analysis and/or clinical follow-up data.Results: Primary site of malignancy was correctly identified by PET/CT in 16 patients (16/37, 43%). Lung was the most common detected site (7/16). The mean SUV of metastatic tumor was higher than that of primary tumor. False positive and false negative results were obtained in 2 patients, respectively. In the remaining patients (17/37; 46%) the primary tumor was not localized by PET/CT. According to these results, the sensitivity and specificity of PET/CT were calculated as 89% and 90%, respectively. However, PET/CT scan determined additional metastatic focus and therapy management was changed (9/37, 24%). The primary focus was established in 4 of 8 (50%) patients with metastatic cervical adenopathy and in 12 of 29 (41%) patients with extra cervical metastases.Conclusions: 18F-FDG PET/CT can detect the primary tumor focus in about half of all patients with histopathologically proven metastases. In the remaining patients, it may contribute to therapy management by identifying additional foci

Is Routine Diagnostic Radioiodine Whole-Body Scintigraphy Needed in Patients who Received Ablative doses of Radioiodine for Differentiated Thyroid Carcinoma?

Aim: The present large-series retrospective sought to assess DWBS findings 6‒12 weeks after RIAT in DTC patients in various risk groups. In addition, the study compared patients’ simultaneous sTg levels.Material and Methods: The follow-up data of 2879 patients who had received RIAT for DTC between 1998 and 2016 were evaluated for inclusion in the study. The study retrospectively evaluated the following: age at the time of diagnosis; gender; histopathological features of thyroidectomy materials (histological subtype, variant, dimension, multi-focality, thyroid capsule, and vascular invasion of tumors); TNM stage; ATA classification; sTg, suppressed-serum Tg, and antiTg antibody levels; and DWBS findings. Patients were categorized according to sTg level (undetectable, 1‒10 ng/ml, and &gt;10 ng/ml). Then, the DWBS findings were analyzed according to sTg level.Results: The study analyzed 2184 patients (1805 F, 379 M; mean age: 43.54±12.64). In 2077 (95%) patients, the DWBSs performed 6‒12 months after RIAT had shown no pathological uptake throughout the entire body. Pathological uptake had been detected in the neck and outside the neck in 88 (4%) and 19 (1%) patients, respectively. All patients who had had normal DWBSs also had had undetectable simultaneous sTg levels. In addition, the DWBSs had been normal in 187 (8%) patients who had had simultaneous sTg levels&gt; 1 ng/ml and in 286 (13%) patients who had had levels &gt; 10 ng/ml. In all patients who had pathological uptake in DWBSs, simultaneous sTg levels were &gt; 1ng/ml, and in 47, they were&gt; 10 ng/ml.Conclusion: Routine DWBS seems to be unnecessary, even in high-risk DTCs. However, in patients who have detectable levels of serum sTg, it could be performed to localize the disease and plan patient management

Ga-68 DOTATATE Accumulation in Sarcoidosis

We aimed in this case series to show Ga-68 DOTATATE uptake in relation with disease activity in sarcoidosis cases. 8 patients with previous diagnosis of sarcoidosis were included to the study. Ga-68 DOTATATE PET/CT was performed to evaluate of disease activity. Disease activity was described clinically by chest disease specialist by evaluation of lung function tests, serum ACE measurements and thorax CT. Correlation between Ga-68 DOTATATE uptake and disease activity was analyzed. Ga-68 DOTATATE PET/CT as a combination of SSR scintigraphy and anatomical imaging might be beneficial in the evaluation of active sarcoidosis

The Role of 18F-Flourodeoxyglucose (18F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) in Pelvic and Paraaortic Lymph Node Staging of Uterine Cervical Cancer

Aim: We aimed to evaluate the sensitivity of 18F-Flourodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the detection of pelvic and paraaortic lymph node metastases of uterine cervical cancer.  Material and Method: 32 female patients (mean age: 56.1±12.6) who underwent 18F-FDG PET/CT for preoperative staging of uterine cervical cancer between April 2009 and October 2013 were included to the study. Ethical committee approval was taken from Ankara University Medical Faculty Ethics Committee. All the patients had been performed trans-vaginal examination and diagnosed as uterine cervical cancer before 18F-FDG PET/CT. 18F-FDG PET/CT findings were compared with histopathological examination results. Sensitivity, specificity and accuracy of pelvic MRI and 18F-FDG PET/CT were calculated in the detection of pelvic and paraaortic lymph node metastases.  Results: 18F-FDG uptake was seen in primary cervical lesions of all the patients. Mean SUV max of primary cervical lesions was calculated as 13.6±6.6 (range: 6.7-25). In 16 (50%) patients, 18F-FDG uptake was not seen in pelvic and paraaortic lymph nodes. In the remaining patients, 18F-FDG uptake was detected in pelvic nodes in all the patients (50%) and in paraaortic nodes in 6 (18%) patients. Mean SUV max of pelvic lymph nodes were calculated as 8.4±5.2 and of paraaortic lymph nodes 12.45±6.41. 18F-FDG uptake was detected in a total of 47 lymph node stations in 16 patients. Mean SUVmax of all lymph nodes were calculated as 8.9±5.83 (range: 2.6-21.9). According to 18F-FDG PET/CT findings, disease was upstaged from I to IV in 1 (3%) patient, II to III in 2 (6%) patients, III to IV in 1 (3%) patients and I to III in 2 (6%) patients, and down staged from III to I in 1 (3%) patient, respectively. In the patient-based analysis, 18F-FDG PET/CT was TP, TN, FP and FN in 14 (%44), 14 (44%), 2 (6%) and 2 (6%) patients, respectively. Patients based sensitivity; specificity and accuracy of 18F-FDG PET/CT were calculated as 87%, 87% and 87%, respectively. In the lesion-based analysis, 18F-FDG PET/CT was TP, FP, TN and FN in 30, 7, 37 and 5 lymph node stations, respectively. Lesion based sensitivity; specificity and accuracy of 18F-FDG PET/CT were calculated as 85%, 84% and 84%, respectively.  Conclusion: 18F-FDG PET/CT is a reliable imaging tool with its high sensitivity and specificity in the pelvic and paraaortic lymph node staging of uterine cervical cancer. When performed in the preoperative staging it changes disease stage about in ¼ of patients. In combination of pelvic MRI, primary staging of primary cervical lesions and also pelvic/paraaortic lymph nodes can be done successfully

The Role of 18F-Flourodeoxyglucose (18F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) in Pelvic and Paraaortic Lymph Node Staging of Uterine Cervical Cancer

 Abstract: Aim: We aimed to evaluate the sensitivity of 18F-Flourodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the detection of pelvic and paraaortic lymph node metastases of uterine cervical cancer.Material and Method: 32 female patients (mean age: 56.1±12.6) who underwent 18F-FDG PET/CT for preoperative staging of uterine cervical cancer between April 2009 and October 2013 were included to the study. Ethical committee approval was taken from Ankara University Medical Faculty Ethics Committee. All the patients had been performed trans-vaginal examination and diagnosed as uterine cervical cancer before 18F-FDG PET/CT. 18F-FDG PET/CT findings were compared with histopathological examination results. Sensitivity, specificity and accuracy of pelvic MRI and 18F-FDG PET/CT were calculated in the detection of pelvic and paraaortic lymph node metastases.Results: 18F-FDG uptake was seen in primary cervical lesions of all the patients. Mean SUV max of primary cervical lesions was calculated as 13.6±6.6 (range: 6.7-25). In 16 (50%) patients, 18F-FDG uptake was not seen in pelvic and paraaortic lymph nodes. In the remaining patients, 18F-FDG uptake was detected in pelvic nodes in all the patients (50%) and in paraaortic nodes in 6 (18%) patients. Mean SUV max of pelvic lymph nodes were calculated as 8.4±5.2 and of paraaortic lymph nodes 12.45±6.41. 18F-FDG uptake was detected in a total of 47 lymph node stations in 16 patients. Mean SUVmax of all lymph nodes were calculated as 8.9±5.83 (range: 2.6-21.9). According to 18F-FDG PET/CT findings, disease was upstaged from I to IV in 1 (3%) patient, II to III in 2 (6%) patients, III to IV in 1 (3%) patients and I to III in 2 (6%) patients, and down staged from III to I in 1 (3%) patient, respectively. In the patient-based analysis, 18F-FDG PET/CT was TP, TN, FP and FN in 14 (%44), 14 (44%), 2 (6%) and 2 (6%) patients, respectively. Patients based sensitivity; specificity and accuracy of 18F-FDG PET/CT were calculated as 87%, 87% and 87%, respectively. In the lesion-based analysis, 18F-FDG PET/CT was TP, FP, TN and FN in 30, 7, 37 and 5 lymph node stations, respectively. Lesion based sensitivity; specificity and accuracy of 18F-FDG PET/CT were calculated as 85%, 84% and 84%, respectively.Conclusion: 18F-FDG PET/CT is a reliable imaging tool with its high sensitivity and specificity in the pelvic and paraaortic lymph node staging of uterine cervical cancer. When performed in the preoperative staging it changes disease stage about in ¼ of patients. In combination of pelvic MRI, primary staging of primary cervical lesions and also pelvic/paraaortic lymph nodes can be done successfully

Radionuclide Treatments

This book has been designed to give a brief information on the development and current status of radionuclide treatments. Today, despite most of them have been accepted experimentally in the clinical guidelines, the number of the radionuclide treatments has been increasing gradually. Theranostic concept is the leading cause for this increase. Behind the radioiodine treatment for benign and malignant thyroid diseases, other radionuclide treatments that consist of I-131 metaiodobenzylguanidine therapy for neuroectodermal tumors, radionuclide pain palliation for bone metastases, radiosynovectomy, and selective internal radiation therapy were included in the book. All the chapters have been written by experienced nuclear medicine physicians