Three Cases of Primary Thyroid Lymphoma at a Single Institution / 영남의대학술지

Primary thyroid lymphoma is a relatively rare thyroid tumor and usually a non-Hodgkin type. Its most common histologic type is the diffuse large B cell lymphoma followed by mucosa-associated lymphoid tissue (MALT). It is known to be frequently associated with autoimmune thyroiditis such as Hashimoto's thyroiditis. We report three cases of thyroid lymphoma at a single institution with a review of the literature.

Evaluation of Hemodynamic Failure with Acetazolamide Challenged 123I-IMP Brain SEPCT and PET / 대한핵의학회잡지

PURPOSE: Cerebral blood flow (CBF) reactivity to acetazolamide (ACZ) is useful to select patients with hemodynamic failure. However, it is still a matter of speculation that varying degrees of regional CBF increases after ACZ administration represent the severity or stage of regional hemodynamic failure as assessed by positron emission tomography (PET). We studied to elucidate whether ACZ challenge (123) I-IMP brain single photon emission tomography (SPECT) can accurately grade the severity of regional hemodynamic failure. MATERIALS AND METHODS: Eighteen patients (M: 16, F: 2, average age: 61 years) with unilateral occlusive disease of the internal carotid artery or the trunk of the middle cerebral artery (MCA). Patients underwent (123) I-IMP brain SPECT study with acetazolamide challenge and PET study was carried out within 2 weeks before and after SPECT study. Five healthy volunteers with a mean age of 48 years (range: 28-73 yr, M: 3, F: 2) underwent PET studies to determine normal values. In SPECT study, an asymmetry index (AI) -the percentage of radioactivity of region of interest (ROI) in the occlusive cerebrovascular lesion to the contralateral homologous ROI-was used for numerical evaluation of relative (123) I- IMP distribution. In PET study, regional CBF, oxygen extraction fraction (OEF), cerebral metabolic rate of oxygen (CMRO2) and cerebral blood volume (CBV) values were measured with (15) O-labeled gas inhalation method and the values were used for comparison with AI (AI during acetazolamide challenge-AI of basal study) on the SPECT study. ROIs were classified by severity into three groups (normal, stage I and stage II). RESULTS: Mean values of AI in areas with normal, stage I and stage II hemodynamic failure were 6.25+/-7.77% (n=107), -10.38+/-10.41% (n=117) and 13.30+/-10.51% (n=140), respectively. AI significantly differed with each groups (p< 0.05). Correlation between AI and CBF, OEF and CBV/CBF in hemisphere with occlusive cerebrovascular lesion was 0.20 (p< 0.01), -0.28 (p< 0.01) and -0.28 (p< 0.01), respectively. CONCLUSION: We concluded that (123) I-IMP brain SPECT with acetazolamide challenge could determine the severity and stage of regional hemodynamic failure as assessed by PET.

Comparison of Thallium-201 Scan and Tc-99m Sestamibi Scan in the Differential Diagnosis of Breast Mass / 대한핵의학회잡지

PURPOSE: We performed this study to compare T1-201 and Tc-99m MIBI scans for the differentiation of malignant from benign breast mass. MATERIALS AND METHODS: Thirty-eight female patients underwent T1-201 breast scan and thirty-two of them also underwent Tc-99m MIBI scan of the breast. After intravenous injection of 74-111 MBq of T1-201, early (10 minutes) and delayed (3 hours) images were obtained. Then, 555-740 MBq of Tc-99m MIBI was injected and images after 30 minutes were obtained. We compared T1-201 and Tc-99m MIBI scans with pathologic RESULTS. RESULTS: Twenty-three patients were confirmed to have infiltrating duct carcinoma and fifteen patients to have benign breast mass by excisonal biopsy. The sensitivity of early and delayed T1-201 scan and Tc-99m MIBI scan in the detection of malignant breast lesion were 100% (23/23), 82% (18/22), and 90% (18/20), respectively. The specificity of early T1-201 scan was significantly higher than that of delayed T1-201 scan (p<0.05). The specificity of early and delayed T1-201 scan and Tc-99m MIBI scan were 73% (11/15), 73% (11/15) and 83% (10/12), respectively (p:not significant). Three patients out of nine with fibroadenoma and one patient with atypical duct hyperplasia were false positive in both early and delayed T1-201 scans. The size of fibroadenoma with false positvie in early and delayed T1-201 scan (4 cases) was larger than that of 11 fibradenoma with true negative scan (p<0.01). Metastatic axillary lymph node involvement was present in fifteen patients. The sensitive to detect metastatic nodes was 38% (5/13) for early T1-201 images, 15% (2/13) for delayed T1-201 images, 58% (7/12) for Tc-99m MIBI planar images and 67% (4/6) for Tc-99m MIBI SPECT. The sensitive of Tc-99m MIBI planar or SPECT was significantly higher than that of delayed T1-201 images (p<0.05). CONCLUSION: Early T1-201 and Tc-99m MIBI scan are useful noninvasive methods to differentiate malignant form benign mass of breast. Tc-99m MIBI scan was sensitive in detecting axillary lymph node metastasis in patients with brease cancer.

Clinical Features of Ectopic Thyroid Gland / 대한내분비학회지

BACKGROUND: Ectopic thyroid gland is relatively rare condition and a developmental anomaly characterized by an aggregated of thyroid tissue in the midline anywhere from the base of the tongue to the mediastinum. The role of ectopic thyroid in the pathogenesis of non-goitrous sporadic cretinism and primary hypothyroidism has been emphasized. 19 cases of ectopic thyroid for 12 years was presented with Tc-pertechnetate or radioactive iodine, which were diagnosed by scintigraphy. METHODS: We wish to report these 19 cases and 12 cases of brief review of literatures on the incidence, etiology and development, symptomatology, diagnosis and treatment of ectopic thyroid gland was done. RESULTS: The most frequent incidental age was between the age 1 year and 29 years. And the frequency of ectopic thyroid was about 7 times more common in female(27 cases) than in male(4 cases). The location of ectopic thyroid were found to be lingual in 18 cases, sublingual in 9 cases, prelaryngeal in 1 case, and combine with lingual and sublingual in 3 cases. In chief complaints, palpable mass was most common and there were foreign body sensation on throat, dysphagia, dysphonia, and hoarseness. In 15 cases of hypothyroidism, l2 cases were taken thyroid hormone replacement therapy, 1 case was removed ectopic thyroid gland. In 2 of 10 cases of euthyroidism, replacement of thyroid hormone were done and 2 cases were removed ectopic thyroid gland, in 6 cases of unknown thyroid function, 1 case was removed ectopic thyroid gland and 131I therapy was done in 1 case, and others were observed with following up thyroid function test. CONCLUSION: These results suggest that the long terms thyroid function test, thyroglossal duct eyst and malignant change in ectopic thyroid tissue when finding the ectopic thyroid in thyroid scintigraphy were recommended highly.

Comparison of Double Phase 99mTc-sestamibi Scintigraphy with Evaluation of Hyperparathyroidism / 대한내분비학회지

"BACKGROUND: Between 80 to 85% of patients with hyperparathyroidsm have a solitary adenoma of the parathyroid glands and another 15% have a parathyroid hyperplasia. Preoperative localization of the parathyoid glands is generally accepted as warranted in patients who have failed an initial attempt at parathyroidectomy, ectopic locations and inexperienced surgeons. Different imaging techniques have been used for detection of abnormal parathyroid glands such as high resolution ultrasonography, computerized tomography, arteriography, venous sampling or magnetic resonance imaging and 201Tl/99mTc subtraction scintigraphy. But these methods have had varying rates of success, with low specificity and low sensitivity. Among the several different techniques available for parathyroid radionuclide imaging, the most common is the use of a dualradioisotope procedure combining of Tl with Tc. However, there are some controversies regarding the optimal technical aspects of this procedure, including the relative amount of injected dose of radiotracers, failed detection for small sized and deeper cervical located parathyroids, and not easy procedures. Recently, double phase Tc-sestamibi scintigraphy would be useful to solve these technical limitations, more convenient and have higher sensitivities. The purpose of this study was to compare the diagnostic accuracy of 99mTc-sestamibi with 201Tl/ 99mTc subtraction scintigraphy in the localization of hyperparathyroidism. METHODS: 9 patients with hyperparathyroidism underwent preoperative evaluation with double phase 99mTc-sestamibi scintigraphy and 201Tl/99mTc subtraction scintigraphy for attempted localization of abnormal parathyroid glands and surgical explorations. Imaging results were compared to surgical findings. RESULTS: Of 9 patients, 7 had a solitary parathyroid adenoma, 1 had a carcinoma and 1 had parathyroid hyperplasia. The 201Tl/99mTc subtraction scintigraphy preoperatively localized 8 of 9 patients(sensitivity: S9%) and 99mTc-sestamibi scintigraphy correctly localized all lesions for a sensitivity of 100%. In one case, 201Tl/99mTc subtraction scan show only a hot uptake at left upper parathyroid area, but 99mTc-sestamibi scan was shown the three site of hot uptake at left upper, both inferior parathyroid area. CONCLUSION: In patients with hyperparathyoridism, 99mTc-sestamibi scintigraphy may be used as the single imaging technique as it show a very high sensitivity and specificity in the preoperative localization of pathological parathyroid glands.