SPECT and PET Imaging of Meningiomas

Meningiomas arise from the meningothelial cells of the arachnoid membranes. They are the most common primary intracranial neoplasms and represent about 20% of all intracranial tumors. They are usually diagnosed after the third decade of life and they are more frequent in women than in men. According to the World Health Organization (WHO) criteria, meningiomas can be classified into grade I meningiomas, which are benign, grade II (atypical) and grade III (anaplastic) meningiomas, which have a much more aggressive clinical behaviour. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are routinely used in the diagnostic workup of patients with meningiomas. Molecular Nuclear Medicine Imaging with Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET) could provide complementary information to CT and MRI. Various SPECT and PET tracers may provide information about cellular processes and biological characteristics of meningiomas. Therefore, SPECT and PET imaging could be used for the preoperative noninvasive diagnosis and differential diagnosis of meningiomas, prediction of tumor grade and tumor recurrence, response to treatment, target volume delineation for radiation therapy planning, and distinction between residual or recurrent tumour from scar tissue

Myocardial Perfusion SPECT Imaging in Patients after Percutaneous Coronary Intervention

Coronary artery disease (CAD) is the most prevalent form of cardiovascular disease affecting about 13 million Americans, while more than one million percutaneous transluminal intervention (PCI) procedures are performed annually in the USA. The relative high occurrence of restenosis, despite stent implementation, seems to be the primary limitation of PCI. Over the last decades, single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), has proven an invaluable tool for the diagnosis of CAD and patients’ risk stratification, providing useful information regarding the decision about revascularization and is well suited to assess patients after intervention. Information gained from post-intervention MPI is crucial to differentiate patients with angina from those with exo-cardiac chest pain syndromes, to assess peri-intervention myocardial damage, to predict-detect restenosis after PCI, to detect CAD progression in non-revascularized vessels, to evaluate the effects of intervention if required for occupational reasons and to evaluate patients’ long-term prognosis. On the other hand, chest pain and exercise electrocardiography are largely unhelpful in identifying patients at risk after PCI

The cientificWorldJOURNAL Review Article SPECT and PET Imaging of Meningiomas

Meningiomas arise from the meningothelial cells of the arachnoid membranes. They are the most common primary intracranial neoplasms and represent about 20% of all intracranial tumors. They are usually diagnosed after the third decade of life and they are more frequent in women than in men. According to the World Health Organization (WHO) criteria, meningiomas can be classified into grade I meningiomas, which are benign, grade II (atypical) and grade III (anaplastic) meningiomas, which have a much more aggressive clinical behaviour. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are routinely used in the diagnostic workup of patients with meningiomas. Molecular Nuclear Medicine Imaging with Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET) could provide complementary information to CT and MRI. Various SPECT and PET tracers may provide information about cellular processes and biological characteristics of meningiomas. Therefore, SPECT and PET imaging could be used for the preoperative noninvasive diagnosis and differential diagnosis of meningiomas, prediction of tumor grade and tumor recurrence, response to treatment, target volume delineation for radiation therapy planning, and distinction between residual or recurrent tumour from scar tissue

Relationship of cell proliferation (Ki-67) to (99m)Tc-(V)DMSA uptake in breast cancer

INTRODUCTION: The aim of the present study was to identify the relationships between the uptake of radiotracers – namely pentavalent dimercaptosuccinic acid [(V)DMSA] and sestamibi (MIBI) – and the following parameters in primary breast cancer: steroid receptor concentrations (i.e. estrogen receptor [ER] and progesterone receptor [PR]), Ki-67 expression, tumor size, tumor grade, age, and levels of expression of p53 and c-erbB-2. In addition, by multivariate regression analysis, we further isolated those factors with independent associations with (V)DMSA and/or MIBI uptake in primary breast cancer. METHODS: Thirty-four patients with histologically confirmed breast carcinoma underwent preoperative scintimammography with technetium-99m ((99m)Tc)-(V)DMSA and/or (99m)Tc-MIBI in consecutive sessions 10 and 60 min after administration of 925–1110 MBq of each radiotracer. The tumor-to-background ratio was calculated and correlated with the presence of ER, PR, Ki-67, tumor size, tumor grade, p53, and c-erbB-2. ER, PR, p53, and c-erbB-2 were determined immunohistochemically. The analysis included tumor-to-background ratio of (V)DMSA and MIBI uptake as dependent and all of the other parameters as independent variables. RESULTS: Correlation was positive between Ki-67 and (V)DMSA (r = 0.37 at 10 min, P = 0.038; r = 0.42 at 60 min, P = 0.018) and inverse between PR and (V)DMSA uptake (r = -0.46 at 10 min, P = 0.010; r = -0.51 at 60 min, P = 0.003). Multivariate regression analysis demonstrated a positive correlation between Ki-67 and (V)DMSA at 60 min (P = 0.045). Ki-67 was not significantly correlated with MIBI uptake, whereas tumor size was positively correlated with MIBI uptake at 60 min both in univariate (r = 0.45, P = 0.027) and multivariate analysis (P = 0.024). Negative correlations were observed between (V)DMSA uptake and ER, as well as between ER/PR and MIBI uptake, but these were not significant. CONCLUSION: Ki-67 appears to represent the major independent factor affecting (V)DMSA uptake in breast cancer. Tumor size was the only independent parameter influencing MIBI uptake in breast cancer. (V)DMSA appears to have an advantage over MIBI in that it can be used to visualize tumors with intense proliferative activity, and thus it can identify those tumors that are more aggressive

Moderate performance of serum S100A12, in distinguishing inflammatory bowel disease from irritable bowel syndrome

<p>Abstract</p> <p>Background</p> <p>S100A12, a calcium-binding proinflammatory protein secreted by granulocytes, has been associated with different diseases of inflammatory origin, including inflammatory bowel disease (IBD). In this study, the utility of serum S100A12, in discriminating IBD from irritable bowel syndrome (IBS), was tested.</p> <p>Methods</p> <p>S100A12 serum levels were determined in 64 patients with ulcerative colitis (UC), 64 with Crohn's disease (CD) and 73 with IBS, by means of an enzyme-linked immunosorbent assay. S100A12 serum levels were evaluated with respect to the levels of known inflammatory markers and patients' characteristics.</p> <p>Results</p> <p>The median values of serum S100A12 levels were 68.2 ng/mL (range: 43.4-147.4) in UC, 70 ng/mL (41.4-169.8) in CD and 43.4 ng/mL (34.4-74.4) in IBS patients. UC and CD patients had significantly higher serum S100A12 levels compared to IBS patients (<it>P </it>= 0.001 for both comparisons). Moreover, a cut-off for serum S100A12 levels of 54.4 ng/mL could predict both UC and CD with a 66.7% sensitivity and a 64.4% specificity. The area under curve was estimated at 0.67 with a 95% confidence interval of 0.60-0.75 (<it>P </it>< 0.001). Considering standard activity indices, higher serum S100A12 levels in active compared to inactive IBD were observed, although the recorded difference did not reach statistical significance. C-reactive protein (CRP) and serum amyloid A (SAA) levels, showed a statistically significant positive correlation with S100A12 (r = 0.39, <it>P </it>= 0.001 and r = 0.23, <it>P </it>= 0.02 respectively).</p> <p>Conclusions</p> <p>Increased levels of circulating S100A12 are found in IBD, compared to IBS. When used to distinguish IBD from IBS adult patients, serum S100A12 levels exhibit moderate performance. On the other hand, serum S100A12 may serve as an inflammatory marker in IBD, since it is well correlated with CRP and SAA.</p

Imaging in situ breast carcinoma (with or without an invasive component) with technetium-99m pentavalent dimercaptosuccinic acid and technetium-99m 2-methoxy isobutyl isonitrile scintimammography

INTRODUCTION: The aim of the study was to retrospectively define specific features of the technetium-99m pentavalent dimercaptosuccinic acid ((99m)Tc-(V)DMSA) and technetium-99m 2-methoxy isobutyl isonitrile ((99m)Tc-Sestamibi [(99m)Tc-MIBI]) distribution in ductal breast carcinoma in situ and lobular breast carcinoma in situ (DCIS/LCIS), in relation to mammographic, histological and immunohistochemical parameters. MATERIALS AND METHODS: One hundred and two patients with suspicious palpation or mammographic findings were submitted preoperatively to scintimammography (a total of 72 patients with (99m)Tc-(V)DMSA and a total of 75 patients with (99m)Tc-Sestamibi, 45 patients receiving both radiotracers). Images were acquired at 10 min and 60 min, and were evaluated for a pattern of diffuse radiotracer accumulation. The tumor-to-background ratios were correlated (T-pair test) with mammographic, histological and immunohistochemical characteristics. RESULTS: Histology confirmed malignancy in 46/102 patients: 20/46 patients had DCIS/LCIS, with or without coexistent invasive lesions, and 26/46 patients had isolated invasive carcinomas. Diffuse (99m)Tc-(V)DMSA accumulation was noticed in 18/19 cases and (99m)Tc-Sestamibi in 6/13 DCIS/LCIS cases. Epithelial hyperplasia demonstrated a similar accumulation pattern. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for each tracer were calculated. Solely for (99m)Tc-(V)DMSA, the tumor-to-background ratio was significantly higher at 60 min than at 10 min and the diffuse uptake was significantly associated with suspicious microcalcifications, with the cell proliferation index ≥ 40% and with c-erbB-2 ≥ 10%. CONCLUSION: (99m)Tc-(V)DMSA showed high sensitivity and (99m)Tc-Sestamibi showed high specificity in detecting in situ breast carcinoma ((99m)Tc-(V)DMSA especially in cases with increased cell proliferation), and these radiotracers could provide clinicians with preoperative information not always obtainable by mammography

Application of brain perfusion SPECT in demented patients: evaluation of Brodmann areas perfusion using an automated software

In this study, we evaluated brain perfusion in Brodmann areas (BAs) in mild AD, as well as between AD and FTD subtypes (behavioural variant – bvFTD, progressive non-fluent aphasia - PNFA, semantic dementia – SD and progressive supranuclear palsy - PSP/corticobasal degeneration – CBD) and between FTD subtypes themselves, with single photon emission computed tomography (SPECT) and an automated software (NeuroGamTM).We used the DSM-IV criteria for the diagnosis of dementia and the specific established NINCDS-ADRDA and Neary criteria for the diagnosis of AD and FTD, respectively.For the comparison between AD and FTD subtypes, we studied 144 patients, 53 (36.8%) with AD and 91 (63.2%) with FTD, mean age(SD) 70.3(8) years and 65.1(9) years, respectively. The duration of disease in AD and FTD was 3.6(2.5) years and 3.0(2.1) years, respectively, while the Mini Mental State Examination (MMSE) score was 18.9(5.9) and 16.8(8.1), respectively. Statistical analysis showed that ΒΑs 17LR and 23R had lower mean perfusion values in FTD compared with AD. In SD patients, perfusion was higher in BA 6R compared with AD, while PNFA patients had lower perfusion values in ΒΑs 11LR, 20L, 22L, 25LR and 44L, compared with AD patients. Furthermore, in CBD/PSP perfusion was lower in ΒΑs 5R, 6R, 17LR, 18R, 22R and 23R, compared with AD and finally ΒΑs 8R, 9R, 10LR, 11LR, 23LR, 24LR, 32LR, 44L, 46LR, 47LR had lower values in bvFTD compared with AD. Stepwise logistic regression analysis showed that ΒΑ 17R could differentiate FTD from AD, while BAs 6R, 23R, 25R and 47L could discriminate AD from SD, CBD/PSP, PNFA and bvFTD, respectively.From the comparison between FTD subtypes, it was found that BAs 8R and 25R could differentiate bvFTD from SD and PNFA, respectively, and BAs 7R and 32R could discriminate bvFTD from CBD/PSP. BA 6L could differentiate SD from PNFA, while BAs 20L and 22R could discriminate CBD/PSP from PNFA. Additionally, BAs 6R, 20L and 45R were found to independently discriminate CBD/PSP from SD.For the evaluation of brain perfusion SPECT in early diagnosis of AD, we studied 34 patients with mild AD, mean age 70.9(8.1) years, mean MMSE score 22.6(2.5). The lower mean perfusion values were found in BAs 25LR, 38LR, 28LR, 36LR, while the higher mean values were found in BAs 31LR, 19R, 18LR, 17LR. The greatest deviations from the healthy sample were found in BAs 25LR, 28RL, 36LR, while the lowest deviations were found in BAs 32LR, 19R, 24L, 17LR, 18LR. In conclusion, brain perfusion SPECT with automated analysis could be useful ancillary tool in daily practice, for early diagnosis and differential diagnosis of dementia.Σκοπός της παρούσας διατριβής ήταν η εκτίμηση της αιμάτωσης των περιοχών Brodmann (ΒΑs) στην πρώιμη νόσο Alzheimer (AD) και στη διαφορική διάγνωση της AD από την Μετωποκροταφική άνοια (FTD) και τους υπότυπους αυτής (συμπεριφορική μορφή-bvFTD, σημασιολογική άνοια-SD, προϊούσα μη ρέουσα αφασία-PNFA, φλοιοβασική εκφύλιση/προϊούσα υπερπυρηνική παράλυση-CBD/PSP) και μεταξύ των υποτύπων της FTD, με SPECT και αυτοματοποιημένο πρόγραμμα ανάλυσης των σπινθηρογραφικών δεδομένων. Από τη σύγκριση της AD με την FTD και τους υποτύπους αυτής, βρέθηκε ότι οι ΒΑs 17LR, 23R είχαν χαμηλότερη αιμάτωση στην FTD συγκριτικά με την AD. Στην SD η αιμάτωση ήταν υψηλότερη στην ΒΑ6R συγκριτικά με την AD, ενώ στην PNFA ήταν χαμηλότερη στις ΒΑs 11LR, 20L, 22L, 25LR, 44L συγκριτικά με την AD. Στις CBD/PSP η αιμάτωση ήταν χαμηλότερη στις ΒΑs 5R, 6R, 17LR, 18R, 22R, 23R συγκριτικά με την AD και στην bvFTD ήταν χαμηλότερη στις ΒΑs 8R, 9R, 10LR, 11LR, 23LR, 24LR, 32LR, 44L, 46LR, 47LR συγκριτικά με την AD. Η ΒΑ17R μπορούσε να διακρίνει την FTD από την AD, η ΒΑ6R την SD από την AD, οι ΒΑs 23R, 25R, 47L την AD από τις CBD/PSP, PNFA και bvFTD, αντιστοίχως.Από τη σύγκριση μεταξύ των υποτύπων της FTD, βρέθηκε ότι συγκριτικά με την SD, η bvFTD είχε χαμηλότερη αιμάτωση στις ΒΑs 8LR, 9LR, 10LR, 11R, 23R, 32LR, 44R, 45LR, 46LR, 47LR. Στην PNFA, οι ΒΑs 25LR, 28L είχαν χαμηλότερη αιμάτωση συγκριτικά με την bvFTD. Οι CBD/PSP είχαν χαμηλότερες τιμές στις ΒΑs 5R, 7R και υψηλότερες τιμές στις ΒΑs 10L, 24LR, 32LR συγκριτικά με την bvFTD. Χαμηλότερες τιμές στις ΒΑs 6L, 8L, 11R, 25R και 44R βρέθηκαν στην PNFA συγκριτικά με την SD. Οι CBD/PSP είχαν χαμηλότερες τιμές στις ΒΑs 7R, 19R, 22R, 40R και υψηλότερες στις ΒΑs 20L, 21L, 25LR, 28L, 36L, 38L συγκριτικά με την PNFA. Συγκριτικά με την SD, οι CBD/PSP είχαν χαμηλότερες τιμές στις ΒΑs 4R, 5R, 6LR, 7R, 8LR, 9R, 10R, 18 R, 19R, 23R, 31R, 40R, 44R, 45R, 46R, 47R και υψηλότερες στις ΒΑs 20L, 21L, 28L, 36L, 38L. Οι ΒΑs 8R, 25R μπορούσαν να διακρίνουν την bvFTD από την SD και PNFA, αντίστοιχα, οι ΒΑs 7R, 32R την bvFTD από τις CBD/PSP, η ΒΑ6L την SD από την PNFA, οι ΒΑs 20L, 22R τις CBD/PSP από την PNFA, οι ΒΑs 6R, 20L, 45R τις CBD/PSP από την SD.Στην πρώιμη AD, χαμηλότερη αιμάτωση βρέθηκε στις ΒΑs 25LR, 38LR, 28LR, 36LR, και υψηλότερη αιμάτωση στις ΒΑs 31LR, 19R, 18LR, 17LR. Οι μεγαλύτερες αποκλίσεις από τους υγιείς βρέθηκαν στις ΒΑs 25LR, 28RL, 36LR και οι μικρότερες στις ΒΑs 32LR, 19R, 24L, 17LR, 18LR.Η SPECT σε συνδυασμό με αυτοματοποιημένα προγράμματα ανάλυσης, αποτελεί χρήσιμο επικουρικό εργαλείο στην καθημερινή κλινική πράξη για τη διάγνωση, διαφορική διάγνωση και πρώιμη διάγνωση της άνοιας