prognostic value of conventional imaging tools to determine how patients with hodgkin lymphoma will respond to treatment

Introduction: This systematic review studies the prognostic value of two conventional imaging tools, sestamibi and gallium scans, for predicting how patients with Hodgkin lymphoma will respond to treatment

Methods: The PubMed database was searched for English-language articles that contained the following search terms: [Hodgkin AND [mibi OR sestamibi OR gallium OR spect] AND response]. All articles that were identified during this search were included in the study, regardless of date published. The inclusion criteria were as follows: articles that described studies that were limited to Hodgkin patients and that reported the predictive value of conventional imaging tools. Articles about other types of lymphoma and/or those that focused on the diagnostic and staging accuracy of mibi and gallium scans were excluded

Result: In total, 14 articles were retrieved. Of these, the majority met the inclusion criteria of the systematic review with the exception of two, which were limited to an examination of the reliability of performing sestamibi scans to predict the response to treatment. All remaining 12 articles considered both the sestamibi scans and the gallium scintigraphy. The results of the systematic review indicate that positive gallium scan results can be proposed as a poor prognostic factor that is associated with partial or full recurrence of Hodgkin disease, a reduction in overall survival rate, and progression-free survival compared with patients with a negative scan

Discussion: Both sestamibi and gallium scans revealed high sensitivity and specificity in predicting the response to treatment including complete remission, partial remission, and recurrence of the disease

Conclusion: These imaging tools can appropriately assess how Hodgkin patients will respond to chemotherapy. As such, clinicians can use these tools to devise appropriate treatment strategies

Treatment efficacy of 153Sm-EDTMP for painful bone metastasis

Involvement of the skeleton can cause an excruciating pain in two-thirds of terminal patients with a history of malignancy. Due to several limitations of other therapies, such as analgesics, bisphosphonates, chemotherapy, hormonal therapy and external beam radiotherapy; bone-seeking radiopharmaceuticals have an important role in palliation of pain from bone metastases. Although these kinds of therapies have many advantages including the ability to treat multiple sites of tumoral involvement simultaneously, no significant confliction with other treatments, ease of administration and the potential to be used repetitively; in Iran using of this modality is not widely practiced. In this study we evaluated the clinical usefulness of Sm-153 lexidronamfor pain management of bone metastases. 28 patients [14 males and 14 females] aged 38-77 years with a history of painful bone metastases caused by different cancers, not responding to conventional treatments were included in the study. All patients had a recent whole body bone scan indicating multiple bone metastases. 1 mCi/Kg Sm-153 lexidronam was injected intravenously to the patients. Whole body scintigraphy was done 3 or 18 hours post injection. Pain relief and quality of life have been evaluated by analog pain scale and Karnofsky index every week, respectively. Also, all patients were evaluated for hematological toxicity every two weeks. Active follow ups were performed. 43% of patients showed the presence of the flare phenomenon during the first three days after Sm injection with a mean duration of 2.2 days. The pain relief began between 2 and 16 days post injection and the duration of pain palliation was in the range of 4 to 32 weeks [mean +/- SD=15.22 +/- 7.8].64.3% of patients showed complete relief of pain and 21.4% achieved partial response to therapy. [Over all response to therapy was 85.7%]. The lowest amount of peripheral blood cells was detected in the fourth week for RBCs and in the 6th week for WBCs and PLTs. No one experienced hematological toxicity induced problems. Sm-153 lexidronam is an effective treatment for painful bone metastases. The complication rate is low and the quality of life of the patients after treatment would be significantly improved

role of nuclear medicine in the diagnosis and management of solitary pulmonary nodules

Solitary pulmonary nodule [SPN] is a frequent finding on the chest x-ray and computed tomography. Nuclear medicine techniques play an important role in the diagnosis and management of SPN. In the current review, we briefly will explain the different nuclear medicine modalities in this regard including positron emission tomography [PET] using 18-F-FDG, and 11-C-Methionine, and single photon emission computerized tomography [SPECT] using somatostatin receptor scintigraphy, 201-Thallium, and 99m-Tc-MIBI

Can gallbladder ejection fraction measured by fatty meal cholescitigraphy diagnose chronic cholecystitis?

Despite presence of a body of evidence in support of high accuracy of cholecystokinin cholescintigraphy [CCK-CS], for diagnosis of chronic cholecystitis[CC], some authors have claimed that gallbladder ejection fraction [GBEF] has poor predictive diagnostic values. The purpose of this study was to determine if there is any difference in GBEF between normal individuals and patients with CC. In a prospective case-control study, we studied 36 subjects as control group who did not have any abdominal symptoms, or history of abdominal disease or gallstone. Patients group were 42 with established choronic calcalous cholecystitis[CCC] who complaining of chronic biliary-like pain and had gallstone on ultrasonography. All subjects underwent gallbladder scintigraphy and GBEF was calculated at 30 and 60 minutes after fatty meal [FM] ingestion. In control group GBEF at 30-minute and at 60-minute after FM ingestion were 69.54% +/- 21.04% and 84.26% +/- 11.41% respectively while in patients group GBEF at 30-minute was 61.21% +/- 16.01% and at 60-minute was 80.22% +/- 12.57%. No significant difference was noticed between control and patient groups. GBEF didn't show significant difference between different groups based on the number of gallbladder stone, severity of chronic inflammatory [lymphoplasma] cell infiltration, wall thickness and evidence of fibrosis in the gallbladder wall. Our data are against the diagnostic value of the GBEF as measured by FM-CS in the workup of patients with CC. Thus, interpretation of GBEF should take the proper clinical context into consideration

Comparison between early and delayed images of [67]Ga scintigraphy for evaluation of recurrent lymphoma

Despite widespread use of [67]Gallium for lymphoma evaluation, timing of imaging after injection is a matter of controversy and to the extent of our knowledge no direct comparison has been made between early and delayed gallium images. We aimed to compare 24 and 48 hours post injection planar gallium imaging for evaluation of lymphoma recurrence. 255 patients suspicious of recurrent lymphoma were included in the study. Twenty four and 48 hours post injection [10 mCi] whole body Gallium imaging was performed. Semi-quantitative evaluation [background corrected] was carried out in positive whole body [67]Gallium scans. Diagnosis of recurrence was made by combination of clinical or pathologic examination if possible. In 59 patients the final diagnosis was made by tissue biopsy. In case of uncertain diagnosis, follow up of the patients [mean duration of 13 months] was used. The diagnosis was finally made by the referring hematologist. Whole body gallium scintigraphy was positive in 115 out of 150 patients with recurrence [sensitivity of 76%]. Comparison of the 24 and 48 hour images did not show any new lesion in the 48 hour images. However, delayed 48 hours images were required for definite detection of the gallium avid lesions in the abdominal and pelvic areas in 40 patients. Semi-quantitative evaluation of the lesion showed higher lesion to background ratio for 48 compared to the 24 hour images [p<0.001]. Considering higher lesion to background activity in the 48 hour images, delayed whole body [67]Gallium imaging may be more desirable for diagnosis of recurrent lymphoma, however 24 hour images may be sufficient. Delayed imaging can be reserved for suspicious activities [such as in abdominal images]. The strategy can save time and is more convenient for the imaging centers

Sentinel lymph node biopsy in melanoma patients: an experience with Tc-99m antimony sulfide colloid

Sentinel lymph node biopsy is the standard procedure for lymph node staging in intermediate thickness melanoma. In Iran, this procedure has not been addressed sufficiently. In this study, we report our experience in this area. Ten consecutive patients with intermediate thickness melanoma where included in our study. 1.5 mCi of Tc-99m antimony sulfide colloid in two divided dose was injected around the tumor. All patients underwent surgery 2-4 hours after injection of the tracer. Patent blue V dye was also used for 8 patients. Using a hand-held gamma probe, the sentinel nodes were harvested and sent to the pathologist for frozen section and H and E review. For patients with positive sentinel nodes, lymph node dissection was performed. At least one sentinel node could be harvested in all patients. The mean number of sentinel nodes was 1.66. Detection rate with radiotracer and blue dye was 100% and 75% respectively. 30% of the patients had positive sentinel nodes. One patient in the pediatric age range and one head and neck melanoma were included in our study with successful sentinel node mapping. Sentinel lymph node biopsy using Tc-99m antimony sulfide colloid is a reliable and safe method in melanoma patients which can help in treatment planning and patient's ultimate prognosis

Sensitivity of gallium scintigraphy for evaluation of recurrent lymphoma: comparison of planar and SPECT imaging

Although PET scanning using F-18[FDG] is considered the superior radiotracer for tumor imaging, Gallium-67 is still in use for some malignancies such as lymphoma and hepatoma. One of the strategies to improve the diagnostic accuracy of Gallium is to perform SPECT which is reported to be more sensitive compared to planar imaging. In this study we compared the sensitivity of SPECT and planar imaging in patients suspicious of thoracic recurrent lymphoma. 129 patients with suspicious recurrent lymphoma of the thorax were included into the study. All patients received 10mCi Gallium-67-citrate intravenously. Twenty four and 48 hours post injection whole body and thoracic SPECT imaging was performed. The final diagnosis of recurrence was achieved by combination of clinical and imaging findings or pathologic examination whenever possible. The final diagnosis of 83 [64.3%] patients was recurrence of lymphoma in the thoracic area and the remainder 46 [35.7%] were in remission. The sensitivity of planar and SPECT imaging for diagnosis of recurrent lymphoma was 63% [[52-73%] with 95% confidence intervals] and 87% [[79-94%] with 95% confidence intervals], respectively. In our study, 20 patients with the final diagnosis of lymphoma recurrence in the thoracic area had negative planar despite positive SPECT imaging. This showed an increase of 24% in sensitivity of the scan [from 63% to 87%] by adding SPECT imaging to the procedure. Our recommendation is integrating SPECT modality into all gallium scintigraphy for lymphoma recurrence

Minimally invasive radio-guided surgery for hyperparathyroidism: an experience with Tc-99m sestamibi

Radio-guided parathyroid surgery along with other minimally invasive surgeries constitutes the main surgical treatment procedures for different kinds of hyperparathyroidism. In this article we have reported our experience of radio-guided parathyroid surgery using Tc-99m sestamibi. Ten patients with hyperparathyroidism included in our study. Twenty mCi of Tc-99m sestamibi was injected intravenously to the patients in the day of surgery. All patients underwent surgery 4 hours after injection of the tracer. Abnormal parathyroid glands were localized by surgical gamma probe during surgery and were removed. Eight out of 10 patients had single adenoma. One patient had parathyroid hyperplasia secondary to chronic renal failure. The one remaining patient had persistent hyperparathyroidism with previous unsuccessful parathyroid surgeries. Except for the patient with parathyroid hyperplasia, parathyroid hormone [PTH] level of all other patients decreased after surgery including the patient with persistent hyperparathyroidism. Minimally invasive radio-guided parathyroid surgery is an easy and safe method for surgical treatment of hyperparathyroidism. With the increasing availability of surgical gamma probes and nuclear medicine facilities in Iran considering this kind of approach for surgical treatment of hyperparathyroidism seems rational