Verification of Measurement Methods and Therapeutic Efficacy of Maximum Permissible Dose of I-131 in High Risk Patients with Differentiated Papillary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Radioiodine (I-131) therapy is an effective modality to reduce both recurrence and mortality rates in differentiated thyroid cancer. Whether higher doses shows higher therapeutic responses was still debatable. The purpose of this study was to validate curve-fitting (CF) method measuring maximum permissible dose (MPD) by a biological dosimetry using metaphase analysis of peripheral blood lymphocytes. METHODS: Therapeutic effects of MPD was also evaluated in 58 patients (49 females and 9 males, mean age 50±11 years) of papillary thyroid cancer. Among them 43 patients were treated with ≤7.4 GBq, while 15 patients with ≥9.25 GBq. The former was defined as low-dose group, and the latter high-dose group. Therapeutic response was defined as complete response when complete disappearance of lesions on follow-up I-131 scan and undetectable serum thyroglobulin levels were found. Statistical comparison between groups were done using chi-square test. P value less than 0.05 was regarded as statistically significant. RESULTS: MPD measured by CF method using tracer and therapeutic doses were 13.3±1.9 and 13.8±2.1 GBq, respectively (P=0.20). They showed a significant correlation (r=0.8, P<0.0001). Exposed doses to blood measured by CF and biological methods were 1.54±0.03 and 1.78±0.03 Gy (P=0.01). They also showed a significant correlation (r=0.86, P=0.01). High-dose group showed a significantly higher rate of complete response (12/15, 80%) as compared to the low-dose group (22/43, 51.2%) (P=0.05). While occurrence of side effects was not different between two groups (40% vs. 30.2%, P=0.46). CONCLUSIONS: measurement of MPD using CF method is reliable, and the high-dose I-131 therapy using MPD gains significantly higher therapeutic effects as compared with low-dose therapy.

Effect of Acupuncture on Regional Cerebral Blood Flow at Acupoints GV 20 , GV. 26 , LI. 4 , ST. 36 , SP. 6 Evaluated by Tc-99m ECD Brain SPECT / 대한핵의학회잡지

PURPOSE: To evaluate the effect of acupuncture on regional cerebral blood flow (rCBF) at acupoints suggested by oriental medicine to be related to the treatment of cerebrovascular diseases. MATERIALS AND METHODS: Rest/acupuncture-stimulation Tc-99m ECD brain SPECT using a same-dose subtraction method was performed on 54 normal volunteers (34 males, 20 females, age range from 18 to 62 years) using six paradigms: acupuncture at acupoints GV. 20, GV. 26, LI. 4, ST. 36 and SP. 6. In the control study, needle location was chosen on a non-meridian focus 1 cm posterior to the right fibular head. All images were spatially normalized, and the differences between rest and acupuncture stimulation were statistically analyzed using SPM for Windows . RESULTS: Acupuncture applied at acupoint GV. 20 increased rCBF in both the anterior frontal lobes, the right frontotemporal lobes, and the left anterior temporal lobe and the left cerebellar hemisphere. Acupuncture at GV. 26 increased rCBF in the left prefrontal cortex. Acupuncture at LI. 4 increased rCBF in the left prefrontal and both the inferior frontal lobes, and the left anterior temporal lobe and the left cerebellar hemisphere. Acupuncture at ST. 36 increased rCBF in the left anterior temporal lobe, the right inferior frontal lobes, and the left cerebellum. Acupuncture at SP. 6 increased rCBF in the left inferior frontal and anterior temporal lobes. In the control stimulation, no significant rCBF increase was observed. CONCLUSION: The results demonstrated a correlation between stimulation at each acupoint with increase in rCBF to the corresponding brain areas.

A Study of the Biological Characteristics of Breast Cancer by Using Tc-99m MIBI Scintigraphy

BACKGROUND: Some researchers have tried to use Tc-99m MIBI (2-methoxyisobutyl isonitril) scintigraphy to evaluate breast-cancer patients. Early reports revealed that Tc-99m MIBI breast scintigraphy was useful in distinguishing malignancies from benign masses in patients for whom mammographic evaluations were difficult. Further studies suggested that functional imaging with Tc-99m MIBI in breast cancer seemed to be correlated with the levels of P-glycoprotein (Pgp) expression and angiogenesis in cancer tissues. For that reason, we evaluated whether significant relationship actually existed between the pattern of Tc-99m MIBI uptake in tumor tissue and tumoric factors including Pgp expression and angiogenesis. METHODS: Thirty-one untreated breast-cancer patients (later pathologically proved to have had invasive ductal carcinomas) were prospectively studied by using both Tc-99m MIBI scintigraphy on and immunohistochemical analyses of angiogenesis and Pgp expression in sugically removed tumor tissues. Both lateral and anterior planar images were obtained at 10 minutes and 3 hours after intravenous injection of 740 MBq Tc-99m MIBI. The tumor-to-normal breast ratio (T/N) and the washout index (WI, early T/N minus late T/N divided by early T/N) were calculated. RESULTS: A significant correlation was found between the T/N's at early and late images (r=0.54, p=0.002 on early images; r=0.47, p=0.006 on late images). The T/N's of early images were not different among the different groups of Pgp expression (p=0.3696) while those of late images were significantly different among the groups (p=0.0276). An even more significant difference was noted in the WI's among the groups (p=0.0015). A significant negative correlation was noted between the T/N of late images and Pgp expression (p=0.0276). An even stronger correlation was found between WI and Pgp expression (r=0.668, p=0.001). CONCLUSIONS: The tumoral uptake and washout of Tc-99m MIBI can be used as a simple functional test for angiogenesis and P-glycoprotein expression in untreated breast cancer.

A Study for Biological Characteristics of Breast Cancer with Tc-99m MIBI Scintigraphy / 한국유방암학회지

Some researchers tried to use Tc-99m MIBI scintigraphy for evaluating breast cancer patients Early reports revealed that Tc-99m MIBI breast scintigraphy is useful in distinguishing malignancies from benign masses in patients who have difficulty in mammographic evaluation. Further studies suggested that the functional imaging with Tc-99m MIBI in breast cancer seems to be correlated with levels of P-glycoprotein (Pgp) expression and angiogenesis in cancer tissues. So we evaluated whether there is an actually significant relationship between the pattern of Tc-99m MIBI uptake in tumor tissue and tumoric factors including Pgp expression and angiogenesis. Thirty one untreated breast cancer patients (pathologically proved to invasive ductal carcinoma later) were prospectively studied by both Tc-99m MIBI scintigraphy and immunohistochemical analysis of angiogenesis and Pgp expression on sugically removed tumor tissues. Both lateral and anterior planar images were obtained at 10 minutes and 3 hours after intravenous injection of 740 MBq Tc-99m MIBI. Tumor-to-normal breast ratio(T/N) and washout index (WI, early T/N minus late T/N divided by early T/N) were calcuated. The results were follows; A significant correlation was found between T/N at early and late images(r=0.54, p=0.002 on early images, r=0.47, p=0.008 on late images). T/N of early images were not different among different groups of Pgp expression(p=0.3696), while those of late images were significantly different among groups(p=0.0276). Even more significant difference of WI among the groups were noted (p=0.0015). A significant negative correlation was noted between T/N of late images and Pgp expression (p=0.00276). A even stronger correlation was found between WI and Pgp expression (r=0.68, p=0.001). In conclusion, the tumoral uptake and washout of Tc-99m MIBI can be used as a simple functional test for angiogenesis and P-glycoprotein expression in untreated breast cancer.

Diagnostic Value of the Bone Mineral Densitometry in the Metastatic Prostatic Cancer / 대한비뇨기과학회지

The bone scan in patients with prostate cancer remains to be the most sensitive method to assess the bone metastasis. But it is nonspecific and shows similar finding in either benign or malignant disease. Bone mineral densitometry allows for the quantification of total body bone mass. So we evaluated the efficacy of the measurement of the bone mineral density with dual-energy X-ray absorptiometry in patients with prostate cancer who had showed hot spot on the bone scan. Of the 15 patients 7 cases( 47% ) showed increased bone mineral density. To evaluate the efficacy of bone mineral densitometry, we analyze the 11 patients whose bone scan show hot spot on lumbar spine. Among them 2 cases( 18%) show osteoblastic finding on the bone x-ray, but 5 cases(45%) show increased density and 2 cases show decreased density on the bone mineral densitometry. These results show that the bone mineral densitometry is more valuable than bone x-ray in the detection of abnormal bone density. Therefore we suggest that bone mineral densitometry can be used as a helpful method of bone scan to detect the metastatic bone lesion in the advanced prostatic cancer.

The effect of dismembered pyeloplasty on renal function in patients with ureteropelvic junction obstruction / 대한비뇨기과학회지

To elucidate whether dismembered pyeloplasty improves renal function, the authors studied 37 patients with ureteropelvic junction obstruction. Changes in various renal parameters pre-and postoperatively by 99mTc-DTPA diuretic renal scintigraphy(DTPA scan) and intravenous urography were evaluated. Subjects included 24 pediatric(mean age 9.7 years) and 13 adult(mean age 33 years) patients. Postoperative split renal function was improved in 79 % (l9/24) of pediatric patients and in 69%(9/13) of adult ones. While, the excretory slope was improved in 71%(17/24) of pediatric patients and in 77%( 10/13) of adult ones. Hydronephrosis on intravenous urogram was improved in 58% (14/24) and 54% (7/13), respectively between pediatric and adult patients. There was no statistically significant differences of improvement in split renal function and renographic washout curve between pediatric and adult patients. In summary, renal function was improved by dismembered pyeloplasty in both pediatric and adult patients.