SPECT/CT con 99mTc-pirofosfato en la evaluación de la amiloidosis cardíaca: estudio preliminar / SPECT/CT with 99mTc-pyrophosphate in the evaluation of cardiac amyloidosis: a preliminary study / SPECT/CT com pirofosfato de 99mTc na avaliação de amiloidose cardíaca: estudo preliminar

Introducción: la amiloidosis cardíaca (AC) es una miocardiopatía infiltrativa producida por depósito miocárdico extracelular de amiloide. Las variantes más frecuentes son debidas a cadenas ligeras de inmunoglobulinas o transtiretina (ATTR). El centellograma con 99mTc-pirofosfato (99mTc-PYP) es una técnica de imagen molecular que permite diferenciar los subtipos más frecuentes de AC. El presente estudio analizó el rol del 99mTc-PYP y el SPECT-CT en la evaluación de pacientes con sospecha clínica de AC. Materiales y métodos: se realizó 99mTc-PYP y SPECT-CT en 16 pacientes con sospecha clínica de AC, con edad promedio de 63 años. Se realizó análisis cualitativo de las imágenes planares y del SPECT-CT (Mediso, AnyScan), adquiridas 1-3 horas tras la inyección del radiotrazador. Para el análisis cuantitativo de las imágenes planares se calculó la relación H/CL (cuentas promedio obtenidas sobre las regiones de interés del corazón y el hemitórax contralateral). El estudio se consideró positivo para ATTR cuando la relación H/CL fue ≥1.5. Las imágenes de SPECT-CT fueron interpretadas para observar la distribución del trazador a nivel cardíaco y extracardíaco. Resultados: se identificó captación miocárdica de 99mTc-PYP en el ventrículo izquierdo en 6 pacientes y en el ventrículo derecho en 3 pacientes. En estos casos, la relación H/CL fue >1.5. En el resto se descartó la captación miocárdica, con relación H/CL<1.5. Se detectó actividad de pool vascular en las imágenes tomográficas de 7 pacientes y captación extracardíaca ósea anormal de causas traumáticas/degenerativas en 9 pacientes. Cinco pacientes presentaron captación hepática difusa, sin alteración estructural en el TC. Conclusiones: el 99mTc-PYP es una técnica clínicamente relevante en pacientes con sospecha de AC. Constituye una herramienta mínimamente invasiva, ampliamente disponible, de bajo costo y útil en el diagnóstico, pudiendo orientar al subtipo de AC. La información que aporta permite además orientar las opciones terapéuticas y brindar información pronóstica adicional.

Introduction: Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy caused by extracellular myocardial amyloid deposition. The most frequent variants are due to immunoglobulin light chains or transthyretin (ATTR). 99mTc-pyrophosphate (99mTc-PYP) scintigraphy is a molecular imaging technique that allows differentiation of the most common subtypes of AC. The present study analyzed the role of 99mTc-PYP and SPECT-CT in the evaluation of patients with clinical suspicion of CA. Materials and methods: 99mTc-PYP and SPECT-CT were performed in 16 patients with clinical suspicion of AC, with an average age of 63 years. Qualitative analysis was performed on the planar and SPECT-CT images (Mediso, AnyScan), acquired 1-3 hours after the injection of the radiotracer. For the quantitative analysis of the planar images, the H/CL ratio (average counts obtained over the regions of interest of the heart and the contralateral hemithorax) was calculated. The study was considered positive for ATTR when the H/CL ratio was ≥1.5. The SPECT-CT images were interpreted to observe the distribution of the tracer at the cardiac and extracardiac level. Results: Myocardial uptake of 99mTc-PYP was identified in the left ventricle in 6 patients and in the right ventricle in 3 patients. In these cases, the H/CL ratio was >1.5. In the rest, myocardial uptake was ruled out, with a H/CL ratio of 1.5. Vascular pool activity was detected in the tomographic images of 7 patients and abnormal extracardiac bone uptake of traumatic/degenerative causes in 9 patients. Five patients presented diffuse hepatic uptake, without structural alteration on CT. Conclusions: 99mTc-PYP is a clinically relevant technique in patients with suspected CA. It constitutes a minimally invasive tool, widely available, low cost and useful in diagnosis, and can guide the AC subtype. The information it provides also makes it possible to guide therapeutic options and provide additional prognostic information.

Introdução: a amiloidose cardíaca (AC) é uma cardiomiopatia infiltrativa causada pela deposição extracelular de amiloide no miocárdio. As variantes mais frequentes são devidas a cadeias leves de imunoglobulina ou transtirretina (ATTR). A cintilografia com 99mTc-pirofosfato (99mTc-PYP) é uma técnica de imagem molecular que permite a diferenciação dos subtipos mais comuns de QA. O presente estudo analisou o papel do 99mTc-PYP e do SPECT-CT na avaliação de pacientes com suspeita clínica de AC. Materiais e métodos: foram realizados 99mTc-PYP e SPECT-CT em 16 pacientes com suspeita clínica de QA, com idade média de 63 anos. A análise qualitativa foi realizada nas imagens planas e SPECT-CT (Mediso, AnyScan), adquiridas 1-3 horas após a injeção do radiotraçador. Para a análise quantitativa das imagens planas, foi calculada a relação H/CL (contagens médias obtidas nas regiões de interesse do coração e do hemitórax contralateral). O estudo foi considerado positivo para ATTR quando a relação H/CL era ≥1,5. As imagens SPECT-CT foram interpretadas para observar a distribuição do traçador em nível cardíaco e extracardíaco. Resultados: a captação miocárdica de 99mTc-PYP foi identificada no ventrículo esquerdo em 6 pacientes e no ventrículo direito em 3 pacientes. Nestes casos, a relação H/CL foi >1,5. Nos demais, foi descartada captação miocárdica, com relação H/CL de 1,5. Atividade do pool vascular foi detectada nas imagens tomográficas de 7 pacientes e captação óssea extracardíaca anormal de causas traumáticas/degenerativas em 9 pacientes. Cinco pacientes apresentaram captação hepática difusa, sem alteração estrutural na TC. Conclusões: o 99mTc-PYP é uma técnica clinicamente relevante em pacientes com suspeita de AC. Constitui uma ferramenta minimamente invasiva, amplamente disponível, de baixo custo e útil no diagnóstico, podendo orientar o subtipo AC. A informação que disponibiliza permite também orientar opções terapêuticas e fornecer informação prognóstica adicional.

Dosis efectivas asociadas a estudios híbridos SPECT-CT en pacientes adultos / Effective dose associated to hybrid SPECT-CT imaging in adult patients / Doses eficazes associadas a estudos de SPECT-CT híbridos em pacientes adultos

Introducción: la técnica de imagen híbrida de SPECT-CT combina la imagen de la tomografía por emisión de fotón único (SPECT) con el estudio de tomografía computada (TC), obteniendo información funcional y anatómica en un mismo estudio. La dosis efectiva total de radiación ionizante recibida en los estudios SPECT-CT puede ser estimada a partir de la dosis efectiva atribuible a la actividad administrada del radiofármaco y la dosis efectiva del componente de tomografía computada (TC). Objetivos: estimar la dosis efectiva total en los protocolos SPECT-CT utilizados en población adulta y determinar el aporte adicional del estudio TC sobre la dosis efectiva total. Método: se evaluaron 258 estudios SPECT-CT para estimar la dosis efectiva total aportada por la administración de los radiofármacos y los estudios de TC de baja dosis. Para estimar el aporte de ambos componentes se utilizaron factores de conversión específicos de cada radiofármaco y región explorada mediante TC. Resultados: la dosis efectiva total (media ± DS) en los estudios SPECT-CT fueron: 12,4 ± 1,44 mSv en el estudio de perfusión miocárdica, 1,14 ± 0,25 mSv en ganglio centinela de mama, 8,6 ± 0,6 mSv paratiroides, 1,48 ± 1,02 mSv tiroides y los estudios óseos de las regiones de cuello 4,5 ± 0,3, tórax 6,07 ± 0,3 mSv, abdomen y pelvis 6,1 ± 0,3 mSv. La dosis de radiación aportada por el estudio TC se encuentra entre 0,46 mSv para la región del tórax en el estudio de ganglio centinela de mama y 2,3 mSv para el SPECT-CT óseo en la región de abdomen y pelvis. Conclusión: se logró estimar la dosis efectiva en los protocolos SPECT-CT de uso clínico más frecuente en población adulta y el aporte de los estudios TC a la dosis efectiva total siendo relativamente baja comparado con la dosis aportada por los radiofármacos administrados con la excepción del estudio de ganglio centinela donde la contribución del componente TC es aproximadamente la mitad de la dosis efectiva total.

Introduction: SPECT-CT Hybrid image technique combines the SPECT (single-photon emission computed tomography) image with the CT (computerized tomography) image to obtain both functional and anatomical images in the same study. The total effective ionizing radiation dose received in SPECT-CT studies may be estimated based on the effective dose from the radiopharmaceutical administered and the effective dose from the CT (computerized tomography) component. Objectives: the study aims to estimate the total effective dose in SPECT-CT protocols applied for the adult population, and to determine the additional contribution from the CT component to the total effective dose. Method: 258 SPECT-CT studies were evaluated to estimate the total effective dose from the administration of radiopharmaceuticals and low dose CT studies. Specific conversion factors for each radiopharmaceutical and area of the body explored with the CT were used to estimate radiation doses from both components. Results: total effective dose (average ± SD) in the SPECT-CT studies was: 12.4 ± 1.44 mSv in the myocardial perfusion study, 1.14 ± 0.25 mSv in the breast sentinel lymph node study, 8.6 ± 0.6 mSv in the parathyroid study, 1.48 ± 1.02 mSv in the thyroid study. As to bone studies, doses found were: 4.5 ± 0.3, in neck studies, 6.07 ± 0.3 mSv in thoracic studies and 6.1 ± 0.3 mSv in abdominal and pelvic studies. The radiation dose from the CT study ranges from 0.46 mSv for the thoracic region on the breast sentinel lymph node study to 2.3 mSv for the bone SPECT-CT study of the abdominal and pelvic region. Conclusions: we managed to estimate the effective dose in the the most frequently used SPECT-CT protocols for the adult population and the contribution of CT studies to the total effective dose. It was found to be relatively low when compared to the dose contributed by the radiopharmaceuticals administered, with the exception of the sentinel lymph node study for which the contribution from the CT study is approximately half the total effective dose.

Introdução: a técnica de imagem híbrida SPECT-CT combina a imagem de tomografia por emissão de fóton único (SPECT) com o estudo de tomografia computadorizada (TC), obtendo informações funcionais e anatômicas no mesmo estudo. A dose efetiva total de radiação ionizante recebida em estudos SPECT-CT pode ser estimada a partir da dose efetiva atribuível à atividade administrada do radiofármaco e da dose efetiva do componente de tomografia computadorizada (TC). Objetivos: estimar a dose efetiva total nos protocolos SPECT-CT utilizados na população adulta e determinar a contribuição adicional do estudo de TC na dose efetiva total. Método : 258 estudos SPECT-CT foram avaliados para estimar a dose efetiva total fornecida pela administração de radiofármacos e estudos de TC de baixa dose. Para estimar a contribuição de ambos os componentes, foram utilizados fatores de conversão específicos para cada radiofármaco e região explorada pela TC. ⁠ Resultados: a dose efetiva total (média ± DP) nos estudos SPECT-CT foi: 12,4 ± 1,44 mSv no estudo de perfusão miocárdica, 1,14 ± 0,25 mSv no linfonodo sentinela mamário, 8,6 ± 0,6 mSv paratireoide, 1,48 ± 1,02 mSv estudos de tireoide e ossos das regiões do pescoço 4,5 ± 0,3, tórax 6,07 ± 0,3 mSv, abdômen e pelve 6,1 ±0,3mSv. A dose de radiação fornecida pelo estudo de TC está entre 0,46 mSv para a região do tórax no estudo do linfonodo sentinela da mama e 2,3 mSv para o SPECT-CT ósseo na região do abdome e pelve. Conclusão: foi possível estimar a dose efetiva nos protocolos de SPECT-CT mais utilizados clinicamente na população adulta e a contribuição dos estudos de TC para a dose efetiva total, sendo relativamente baixa em relação à dose fornecida pelos radiofármacos administrados com a exceção do estudo do linfonodo sentinela onde a contribuição do componente TC é aproximadamente metade da dose efetiva total.

Application effect of MOOC+CBL teaching mode in practice teaching of nuclear medicine SPECT/CT / 中华医学教育探索杂志

Objective:To explore the application effect of massive online open course (MOOC) + case-based learning (CBL) in SPECT/CT practice teaching of nuclear medicine.Methods:Twenty-nine interns of nuclear medicine SPECT/CT in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2020 to October 2020 were selected as the research group and received MOOC + CBL teaching. Taking 31 interns from January 2019 to October 2019 as the control group, and the traditional teaching method was conducted. At the end of the internship, the students' theoretical and operational skills were assessed. Their learning motivation and thinking ability were evaluated by using the study process questionnaire (SPQ) and the Chinese version of California critical thinking disposition inventory (CTDI-CV), and the two groups' satisfaction with teaching was compared. SPSS 22.0 was used for Chi-square test and t-test. Results:The results of theoretical knowledge, PET/CT case analysis and image diagnosis in the study group were higher than those in the control group ( P<0.05). The total scores of surface motivation, deep motivation and SPQ in the study group were higher than those in the control group ( P<0.05). The self-confidence scores of open mind, analytical ability, systematization ability, and critical thinking and CTDI-CV total scores of the study group were higher than those of the control group ( P<0.05). The study group was more satisfied with the teaching and the enhancement of self-study ability than the control group ( P<0.05). Conclusion:MOOC + CBL teaching for nuclear medicine SPECT/CT interns can improve their examination results, learning motivation and thinking ability, and also enhance their self-study ability.

Accuracy of Choline PET/CT vs. Tc 99m Sestamibi SPECT/CT parathyroid imaging in comparison to histopathology in the diagnosis of parathyroid adenoma : A meta-analysis

Introduction@#In the advent of the recently accepted use of Choline in parathyroid PET/CT, we aimed to assess its accuracy in diagnosing parathyroid adenomas in comparison to the Tc 99m Sestamibi SPECT/CT parathyroid imaging, with histopathology as the reference standard.@*Objective@#To determine the diagnostic accuracy of Choline PET/CT in comparison to Tc 99m Sestamibi parathyroid imaging in detecting parathyroid adenomas, with histopathology as the reference standard. @*Methods@#Cross-sectional studies from 2014 to 2019 were identified through MEDLINE, Pubmed, clinicaltrials.gov, and Google scholar. Our literature search yielded 13 articles, of which only 3 met the set inclusion and exclusion criteria.@*Results@#Three published cross-sectional studies were included with a total of population of 157 patients. Choline PET/CT was found to have a pooled sensitivity of 0.99 (0.96 - 1.00), pooled specificity of 0.45 (0.17 - 0.77), positive likelihood ratio of 1.79 (1.1 – 2.9), negative likelihood ratio of 0.03 (0.0 – 0.1), positive predictive value of 96.0% (93.4 - 97.7%) and negative predictive value of 83.3% (39.0 - 97.6%), estimated with 95% CI. Tc 99m Sestamibi SPECT/CT parathyroid imaging had a pooled sensitivity of 0.77 (0.70-0.84), pooled specificity of 0.45 (0.17 - 0.77), positive likelihood ratio of 1.43 (0.8–2.4), negative likelihood ratio of 0.49 (0.2–1.4), positive predictive value of 96.0% (93.4-97.7%) and negative predictive value of 83.3% (39.0-97.6%), estimated with 95% CI@*Conclusion@#Choline PET/CT showed superior sensitivity, negative predictive value and negative likelihood ratio over Tc 99m Sestamibi SPECT/CT parathyroid imaging. The measured specificities, positive predictive values and positive likelihood ratios of both modalities were found to be similar.

Osteofibrous Dysplasia-like Adamantinoma Mimicking Bone Metastasis in a Patient With Rectosigmoid Cancer

@#A patient with underlying rectosigmoid cancer presented with solitary bone lesion at left tibia. Eventhough, solitary bone metastasis particularly in the appendicular skeleton is rare in rectosigmoid cancer, it remained as the most likely initial diagnosis. However, after further characterisation by various imaging modalities and subsequent biopsy, the lesion proved to be an osteofibrous dysplasia like-adamantinoma (OFD-like adamantinoma), which is a subtype of adamantinoma. Being a rare primary bone tumour, adamantinoma and its subtypes are infrequently thought of in the initial working diagnosis of a patient with known malignancy who presents with solitary bone lesion. We present here a case of OFD-like adamantinoma in a patient with underlying rectosigmoid cancer, which mimic a metastastic bone lesion.

Aporte de las imágenes híbridas spect/ct para el diagnóstico diferencial de lesiones óseas malignas y benignas en pacientes con cáncer de mama. Nuestra experiencia / Contribution of the spect/ct hybrid images for the differential diagnosis of malignant and benign bone lesions in patients with breast cancer. Our experience

Objetivo El objetivo del presente trabajo es evaluar el valor adicional del spect/ct sobre el Centellograma de Cuerpo Entero (cce) y la spect en pacientes con cáncer de mama con mínimo dos estudios: tiempo inicial (i) y evolución (e). Material y método Se evaluaron retrospectivamente 208 lesiones en 186 pacientes. Se realizaron imágenes: cce, spect y spect/ct del esqueleto axial con 99mTcmdp y equipo híbrido Infinia Hawkeye 4 GE. Las lesiones se caracterizaron del siguiente modo: benigna (b); maligna (m); y equívocas: probablemente benigna (pb) y probablemente maligna (pm). Resultados spect/cti clasificó 197/208 lesiones (94,7%), specti 155/208 (74,5%) y ccei 130/208 (51%). Los tres métodos coincidieron inicialmente en 138 lesiones: 106 b (77%), 23 m (17%) y 9 equívocas (6%), y en la evolución en 155: 110 b (71%), 44 m (28%), 1 equívoca (1%). La sensibilidad, especificidad y exactitud inicial para diagnóstico de metástasis (incluyendo como malignas las lesiones probablemente malignas) fueron 92/70/51% (ccei), 100/78/75% (specti) y 100/97/95% (spect/cti). Diferencias de a pares: ccei vs specti y spect/cti para sensibilidad (p<0,05) y specti y ccei vs spect/cti especificidad y exactitud (p<0,001). Conclusiones El aporte de spect/ct incrementó la precisión y certeza diagnóstica para diferenciar las lesiones benignas, malignas y equívocas. Su utilización debería ser rutinaria en la detección de metástasis óseas en pacientes con carcinoma de mama

Objective To assess the additional value of spect/ct on whole-body scintigraphy (wbs) and spect in patients with breast cancer, with a minimum of two tests: start time (i) and assessment (e). Materials and method Retrospective assessment of 208 lesions in 186 patients. Images were taken by wbs, spect and spect/ct of the axial skeleton with 99mTc- mdp and hybrid equipment Infinia Hawkeye 4 GE. Characterization of the lesions: benign (b), malignant (m) and equivocal: likely to be benign or malignant. Results By using spect/cti, 197/208 lesions (94.7%), specti 155/208 (74.5%) and wbsi 130/208 (51%) were classified. The three methods initially coincided on 138 lesions: 106 b (77%), 23 m (17%) and 9 equivocal (6%); and on assessment on 155: 110 b (71%), 44 m (28%), 1 equivocal (1%). The initial sensitivity, specificity and accuracy for the diagnosis of metastases (including as malignant those lesions which were likely to be so) were as follows: 92/70/51% (wbsi), 100/78/75% (specti) and 100/97/95% (spect/cti). Differences by pairs: wbsi vs specti and spect/cti for sensitivity (p<0,05) and specti and wbsi vs spect/cti for specificity and accuracy (p<0,001). On assessment 99%. Conclusions The contribution of spect/ct has increased diagnostic accuracy and certainty to differentiate benign, malignant and equivocal lesions. It should be used routinely for the detection of bone metastases in patients with breast cancer

Diagnosis of pulmonary embolism: A comparison between ventilation/perfusion SPECT/CT and perfusion-only SPECT/CT

@#Background: The role of nuclear medicine in diagnosing pulmonary embolism (PE) is continuously evolving owing to advancements in imaging methods. In recent years, ventilation/perfusion single photon emission computed tomography-computed tomography (V/Q SPECT/CT) has established a synergistic role over conventional V/Q planar scintigraphy and V/Q SPECT in diagnosing pulmonary embolism. Objectives: In this study, we aimed to assess the incremental value of V/Q SPECT/CT over conventional V/Q planar scintigraphy and V/Q SPECT, and to determine if Q only-SPECT/CT without the conventional ventilation component could replace the current imaging protocol in diagnosing pulmonary embolism. Methods: We retrospectively assessed 73 patients with suspicion of pulmonary embolism who had undergone/Q planar scintigraphy, V/Q SPECT and V/Q SPECT/CT consecutively. Combination of clinical follow-up, laboratory test results and correlative imaging were used as reference standard. Q-only SPECT/CT datasets were then analysed separately without the V-planar, V-SPECT and V-SPECT/CT datasets. Results: A total of 66 patients fulfilled our initial inclusion and exclusion criteria, with 23 patients as positive for PE and 43 patients ruled out of having PE based on the reference standard. Sensitivity and specificity for V/P planar scintigraphy, V/Q SPECT, and V/Q SPECT-CT were 86.9% and 39.5%, 91.3% and 55.8%, and 100% and 97.6% respectively. Overall, SPECT/CT resulted in significantly higher diagnostic accuracy than planar and SPECT imaging respectively (p<0.05). Q-only SPECT/CT significantly over diagnosed pulmonary embolism in 12 patients (p<0.05). Conclusion: Adding V/Q SPECT/CT to the algorithm of PE significantly improves the sensitivity and specificity. However, by eliminating the ventilation component, the diagnostic accuracy is significantly reduced.

SPECT-CT in Differentiating Metastatic and Degenerative Lesions of the Spine

@#Introduction: The purpose of this study was to determine the usefulness of SPECT-CT in differentiating metastatic and degenerative disease of the spine. Methods: Twenty-eight patients aged 50 years and above diagnosed with various cancers were referred for whole body (WB) planar bone scintigraphy. Those with a maximum three foci of tracer uptake in the spine were selected for the study. SPECT-CT of these areas of uptake was performed and the lesions were classified as degenerative, indeterminate or metastasis. A repeat study (WB planar bone scintigraphy and SPECT-CT) was performed between 3 to 12 months later. These areas of uptake were reassessed and compared with the first WB planar bone scintigraphy and SPECT-CT. The second SPECT-CT was used as the standard for the diagnosis. Results: Thirty-seven lesions in 28 patients were assessed. The sensitivity of the first WB planar bone scintigraphy, second WB planar bone scintigraphy and first SPECT-CT is 75%, 62.5% and 75% respectively. The specificity of the first WB planar bone scintigraphy, second WB planar bone scintigraphy and first SPECT-CT is 86%, 93%, 90% respectively. There was 2.7% of ‘indeterminate lesion’ in the first WB planar bone scintigraphy, 5.4% in the second WB planar bone scintigraphy, and 5.4% in the first SPECT-CT. The indeterminate lesions were resolved in the second SPECT-CT. Conclusion: SPECT- CT is useful in differentiating degenerative disease from metastatic lesions in the spine.

Model Validation of Breast Cancer Induced to Bone Using 99mTcMDP

@#Metastasis is a process of tumour cells escaping from the primary site and form a new lesion in other organs. It is a common phenomenon where bone is the frequent metastatic site. Bone scan using 99m-Techetium-Methylenediphosphate (99mTc-MDP) is used to diagnose bone pathologies such as bone metastases. 99mTc-MDP specifically binds to calcium which present in bone. This study aimed to validate 99mTc-MDP in breast cancer-induced to bone rat model and to determine calcium presence in the progression of metastasis. The rats were divided into two groups (normal and cancer-induced groups). For cancer-induced group, the left femur was induced with breast cancer cell line, MDA-MB-231. After 21 days, all rats were subjected to SPECT-CT scan. Our finding suggests that the kidney uptake of 99mTc-MDP is due to the calcium crystal presence caused by hypercalcemia. This is only a preliminary data, and further analysis will be conducted.

Dawn of Theranostics in Myanmar (Dream, Reality, and Constraint) / 대한핵의학회잡지

Prostate cancer is third common malignancy in men of old age (average 65 years) in Myanmar. Currently, serum PSA and bone scan are the markers of choice. Because of the evidence-based, promising success of ⁶⁸Ga-PSMA PET-CT and 177Lu-PSMA theranostics in prostate cancer worldwide, (99m)Tc-PSMA SPECT-CT imaging and ¹⁷⁷Lu-PSMA therapy has launched as a stepping-stone of theranostics in Myanmar with the available facilities. Twelve cases of prostate cancer patients were imaged with 600 MBq of (99m)Tc-PSMA I+S SPECT-CT. Four metastatic castration resistant prostate cancer (MCRPC) patients with abnormal result were treated with ¹⁷⁷Lu-PSMA. The protocol consists of 6–8 GBq of ¹⁷⁷Lu-PSMA, three successive doses at interval of 4–6 weeks. Post-therapy SPECT-CT imaging was done. All treated patients were improved by free of bone pain, and fall/rise in serum PSA level. Two patients with extensive skeletal metastases succumbed to complications. The results are well documented and present at the multidisciplinary conferences for clinical awareness. Theranostics in prostate cancer with available facilities is an additional boon to our health care professionals to upgrade cancer management in Myanmar. This paper provides the technology with cost effectiveness and benefit to prostate cancer patients of Myanmar.

Assessment of Left Ventricular Ejection Fraction by Thallium-201 Myocardial SPECT-CT in Patients with Angina Pectoris: Comparison with 2D Echocardiography / 대한핵의학회잡지

PURPOSE: Left ventricular (LV) ejection fraction (EF) is an important parameter for assessing cardiac systolic function and predicting prognosis in patients with cardiovascular disease. The aim of this study was to evaluate the feasibility of assessing LVEF by Tl-201 hybrid myocardial single-photon emission computed tomography (SPECT)/CT using two attenuation correction methods in patients with angina pectoris.METHODS: A total of 339 patients with angina pectoris (62.8 ± 12.9 years, male:female = 206:133) were analyzed. All patients underwent Tl-201 myocardial SPECT/CT and transthoracic two-dimensional (2D) echocardiograph. We compared LVEF assessed by SPECT/CT using two attenuation correction methods: CT-based attenuation correction (CTAC) and non-attenuation correction (non-AC) methods and 2D echocardiography.RESULTS: LVEF assessed by either of the two attenuation correction techniques and 2D echocardiography showed moderate correlation in all patients with angina pectoris (r = 0.487 for CTAC and r = 0.473 for non-AC, p < 0.001). Results were similar in the subgroup of patients with perfusion abnormalities on myocardial SPECT/CT images. Overall diagnostic performances were similar for the CTAC and non-AC methods for evaluating normal and decreased LVEF by myocardial SPECT/CT.CONCLUSION: LVEF measured by the CTAC method of Tl-201-gated myocardial SPECT/CT was comparable with the conventional non-AC method in patients with angina pectoris and in the subgroup of patients with perfusion abnormality. Tl-201-gated myocardial hybrid SPECT/CT can be a reliable tool in the assessment of LVEF in clinic.

Comparative Analysis of Lung Perfusion Scan and SPECT/CT for the Evaluation of Functional Lung Capacity / 대한핵의학회잡지

PURPOSE: This study aimed to compare lung perfusion scan with single photon emission computed tomography/computed tomography (SPECT/CT) for the evaluation of lung function and to elucidate the most appropriate modality for the prediction of postoperative lung function in patients with lung cancer.METHODS: A total of 181 patients underwent Tc-99m macroaggregated albumin lung perfusion scan and SPECT/CT to examine the ratio of diseased lung and diseased lobe. Forty-one patients with lung cancer underwent both preoperative and postoperative pulmonary function tests within 1 month to predict postoperative pulmonary function. Predicted postoperative forced expiratory volume in 1 s (ppoFEV₁) was calculated by the % radioactivity of lung perfusion scan and SPECT, and the % volume of the residual lung, assessed on CT.RESULTS: The ratios of diseased lung as seen on lung perfusion scan and SPECT showed significant correlation, but neither modality correlated with CT. The ratios of the diseased lung and diseased lobe based on CT were higher than the ratios based on either perfusion scan or SPECT, because CT overestimated the function of the diseased area. The lobar ratio of both upper lobes was lower based on the perfusion scan than on SPECT but was higher for both lower lobes. Actual postoperative FEV₁ showed significant correlation with ppoFEV₁ based on lung perfusion SPECT and perfusion scan.CONCLUSIONS: We suggest SPECT/CT as the primary modality of choice for the assessment of the ratio of diseased lung area. Both perfusion scan and SPECT/CT can be used for the prediction of postoperative lung function.

The Lymphatic Drainage Pattern of Internal Mammary Sentinel Lymph Node Identified by Small Particle Radiotracer ((99m)Tc-Dextran 40) in Breast / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to detect the lymphatic drainage pattern of internal mammary area and verify the concept of internal mammary sentinel lymph node (IM-SLN) in breast. MATERIALS AND METHODS: A small particle radiotracer ((99m)Tc-Dextran 40) was prepared and tested. (99m)Tc-Dextran 40 was injected into intraparenchyma at the sound breast by a modified radiotracer injection technique. Subsequently, dynamic single-photon emission computed tomography (SPECT), computed tomography (CT), and SPECT/CT combination images were performed to identify the radioactive lymph vessels and internal mammary lymph nodes (IMLNs). The direction of lymph drainage and the location of the IMLNs were identified in the SPECT/CT imaging. RESULTS: The radiochemical purity of (99m)Tc-Dextran 40 was > 95%. (99m)Tc-Dextran 40 could drainage into first, second, and third lymph node and the radioactive lymph node could be detected by the γ detector in the animal experiment. After (99m)Tc-Dextran 40 injecting into intraparenchyma, 50.0% cases (15/30) were identified the drainage lymphatic vessels and radioactive IMLNs by SPECT. The drainage lymphatic vessel was found from injection point to the first IMLN (IM-SLN) after 10.5±0.35 minutes radiotracer injection, and then (99m)Tc-Dextran 40 was accumulated into the IM-SLN. The combination imaging of SPECT/CT showed the second IMLN received the lymph drainage from the IM-SLN. The lymphatic drainage was step by step in the internal mammary area. CONCLUSION: The lymph was identified to drain from different regions of the breast to IM-SLN, and then outward from IM-SLN to other IMLN consecutively. It demonstrated the concept of the IM-SLN and provided more evidences for the application of internal mammary sentinel lymph node biopsy.

Target definition for internal mammary lymph node irradiation based on distribution of internal mammary sentinel lymph node developed on SPECT/CT fusion imaging / 中华放射医学与防护杂志

Objective To explore the target definition for internal mammary lymph nodes ( IMLNs) irradiation based on the distribution of internal mammary sentinel lymph nodes ( IM-SLNs ) developing on SPECT/CT fusion imaging. Methods A total of 709 breast cancer patients who underwent preoperative SPECT/CT fusion imaging examination in IM-SLN from 2014 to 2018 were selected. All of the selected patients were first diagnosed and did not receive neoadjuvant treatment before SPECT/CT examination. Finally, totally 97 patients with 136 positive imaging IM-SLNs were included in this study. The clinical target volumes ( CTVs) were delineated according to the consensus guidelines from RTOG and DBCG and defined as CTVRTOG and CTVDBCG , respectively. The positional relationship of CTVRTOG , CTVDBCG and IM-SLNs were determined. Results The number of IM-SLNs from the first to fifth intercostal spaces were 55, 40, 33, 6 and 1, respectively. And the number of IM-SLNs in the first three intercostal spaces accounted for 94. 85％ of the total. The average distance from the edge of CTVRTOG to the centre points and the edges of IM-SLNs were 4. 10 mm ( 95％CI 3. 54-4. 65 mm) and 6. 40 mm ( 95％CI 5. 81-6. 98 mm), respectively (t=-30. 486,P<0. 05). For the CTVDBCG, the average distance was 1. 60 mm ( 95％CI 1. 16-2. 05 mm) and 3. 34 mm ( 95％CI 2. 78-3. 89 mm) , respectively ( t=-16. 364,P<0. 05) . The average distances from the edge of CTV to the centre points and the edge of IM-SLNs for CTVRTOG were all significantly greater than those for CTVDBCG(t=16. 640, 19. 815, P<0. 05). The rate of covering IM-SLN center points for CTVRTOG and CTVDBCG were 18. 4％ and 60. 3％, respectively. In order to cover 90％or 100％ of the IM-SLN center points, the edge of CTVRTOG should be expanded by 8 or 15 mm, respectively, and the edge of CTVDBCG should be expanded by 5 or 13 mm, respectively. If the diameter of IM-SLN was assumed as 5 mm, the edge of CTVRTOG needed an expansion of 11 or 17 mm to contain 90％or 100％ of IM-SLNs, respectively, while the edge of CTVDBCG needed 7 or 16 mm to cover 90％ or 100％of IM-SLNs, respectively. Conclusions It is reasonable to include the first three intercostal spaces IMLNs for prophylactic irradiation based on the distribution of IM-SLNs. However, CTVs based on the two guidelines are both insufficient to cover 90％ of IM-SLNs.

Evaluación de la recurrencia de tumores musculoesqueléticos mediante gammagrafía complementada con SPECT/CT con talio-201 en población pediátrica / Evaluation of recurrence of musculoskeletal tumors with thallium-201 scintigraphy plus SPECT/CT in pediatric population

Resumen Introducción: Los estudios de imagen, como la tomografía simple y contrastada, son la primera aproximación diagnóstica para detectar la recurrencia de tumores musculoesqueléticos. El objetivo de este estudio retrospectivo fue demostrar la utilidad de la gammagrafía acoplada a tomografía computarizada por emisión de fotón único (SPECT/CT) con talio-201(201Tl) en la valoración de tumores musculoesqueléticos malignos con sospecha de recurrencia o enfermedad metastásica. Métodos: Se realizaron 72 estudios gammagráficos y de SPECT/CT para la valoración de la recurrencia locorregional y a distancia, al menos 8 semanas tras la última terapia, en 42 pacientes con diferentes tipos de tumores musculoesqueléticos malignos, como osteosarcoma, sarcoma de Ewing, rabdomiosarcoma, retinoblastoma, sarcoma sinovial y tumor de Wilms en el Hospital Infantil de México. Se calcularon el valor predictivo positivo (VPP) y el intervalo de confianza del gammagrama y de la SPECT/CT en comparación con el resultado del análisis histopatológico y el seguimiento clínico y radiológico para identificar la recurrencia. Resultados: La gammagrafía fue anormal en 30 (71.4%) de los 42 pacientes. Se detectaron 33 lesiones (30 pacientes) por gammagrafía y 25 (21 pacientes) por telerradiografía de tórax y tomografía de dos regiones. La SPECT/CT se realizó en 30 pacientes y se detectaron 12 lesiones adicionales al rastreo planar. El VPP con la gammagrafía fue del 82%, y con la SPECT/CT, del 100%. Conclusión: La gammagrafía con 201Tl puede considerarse un estudio adecuado para identificar los sitios de viabilidad tumoral, con alto grado de certeza diagnóstica al complementar con SPECT/CT.

Abstract Background: Imaging studies, particularly simple and contrast-enhanced tomography, constitute the first diagnostic approach to detect recurrence of musculoskeletal tumors. The aim of the present retrospective study was to demonstrate the usefulness of scintigraphy plus SPECT/CT (single photon emission computed tomography) with thallium-201 (201Tl) in the evaluation of malignant musculoskeletal tumors with suspicion of recurrence or metastatic disease. Methods: Eight weeks after the last therapy, 72 scintigraphy and SPECT/CT studies were performed to assess regional recurrence and metastatic disease in 42 patients with different types of malignant musculoskeletal tumors, such as osteosarcoma, Ewing's sarcoma, rhabdomyosarcoma, retinoblastoma, synovial sarcoma, and Wilms tumor at the Hospital Infantil de México Federico Gómez. The positive predictive value (PPV) and the confidence interval of the scintigraphy and SPECT/CT were calculated when compared with the results of the histopathological analysis and the clinical and radiological follow-up for the identification of recurrence. Results: Scintigraphy was abnormal in 30 (71.4%) of the 42 patients; 33 lesions (30 patients) were detected by scintigraphy and 25 lesions (21 patients) by chest X-ray and tomography of two regions. The SPECT/CT was performed on 30 patients, where 12 lesions were detected in addition to the planar scintigraphy. Scintigraphy showed a PPV of 82%; SPECT/CT, 100%. Conclusion: 201Tl-scintigraphy can be considered as an adequate study to identify the sites of tumor viability with a high degree of diagnostic certainty combined with the SPECT/CT technique.

Tc99m-Besilesomab With the Added Benefit of Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT): Current Role in Infection Detection and Localisation

@#Introduction: Imaging modality has become increasingly important in hospital setting especially in cases of unknown site of infection/pyrexia of unknown origin (PUO) and osteomyelitis (OM). In recent years, nuclear imaging has been used and is known to deliver prompt and precise diagnoses of numerous infectious diseases. The purpose of the study is to detect and localise the site of infection using Tc99m-besilesomab and to assess the added contributions of single photon emission computed tomography/computed tomography (SPECT/CT) over planar scan in patients with PUO and OM. Methods: Tc99m-besilesomab with SPECT/CT were prospectively performed in 23 patients (eight males, 15 females) with suspected infection. True findings were diagnosed by both cold and hot spot in the scan with reference to positive blood or tissue cultures, or other additional imaging. Results: Tc99m-besilesomab managed to detect presence of infection with high sensitivity of 87.5% and specificity of 71.4%. Interobserver variability agreement that was obtained between the presence of infection and the ability of Tc99m-besilesomab imaging to detect it was significant (p<0.05), Kappa=0.7. SPECT/CT has increased the detection sensitivity by 6.3% and specificity by 28.6%. Out of 23 patients, 15 had true positive, seven had true negative and only one patient had false negative study. SPECT/CT has changed the management in one patient which was missed by planar imaging. Conclusions: Indeed, SPECT/CT has further increased the detection sensitivity and specificity, provides extra information of the anatomical location and the extent of involvement of the disease as compared to planar imaging alone.

Focal Increased Tc-99m MDP Uptake in the Nutrient Foramen of the Femoral Diaphysis on Bone SPECT/CT / 대한핵의학회잡지

We present images of an 83-year-old female with a history of osteoporosis and bilateral total knee replacement arthroplasty, referred for bone scintigraphy and single-photon emission computed tomography (SPECT)/computed tomography (CT), owing to left knee pain. No trauma to, or intense exercise of, the kneewas reported. The bone scan and SPECT/CT revealed a focally increased Tc-99m methylene diphosphonate (MDP) uptake in the medial cortex of the left femoral diaphysis with matched linear radiolucency on CT images. This was misinterpreted as atypical femoral stress fracture; however, focal stress reaction injury to the nutrient foramen was confirmed on contrast-enhanced magnetic resonance imaging.

Value of SPECT/CT in Diagnostic I-131 MIBG Scintigraphy in Patients with Neuroblastoma / 대한핵의학회잡지

PURPOSE: Diagnostic I-131 MIBG scintigraphy is an important imaging modality for evaluation of patients with neuroblastoma (NB) especially in centers where I-123 MIBG is not available. Single photon emission computed tomography/computed tomography (SPECT/CT) could potentially improve lesion detection over planar scintigraphy, but studies regarding its usefulness as an add-on to diagnostic I-131 MIBG scintigraphy are limited. This study aimed to determine the usefulness and factors related to usefulness of SPECT/CT in diagnostic I-131 MIBG scintigraphy in NB patients.METHODS: Usefulness of SPECT/CT for lesion detection, lesion localization, resolving suspicious findings, and clarifying the nature of lesions on anatomical imaging were retrospectively reviewed in 86 diagnostic planar I-131 MIBG scintigrams with add-on SPECT/CT.RESULTS: SPECT/CT detected additional lesions in 23.2%(20/86), helped localize lesions in 21.1%(8/38), resolved suspicious findings in 85.7%(6/7), determined functional status of lesions on anatomical imaging in 94.4%(17/18), and changed diagnosis from a negative to a positive study in 19.5%(8/41). Independent predictors of SPECT/CT being useful included presence of suspicious findings on planar imaging (OR 99.08; 95% C.I. 6.99–1404.41; p = 0.001), positive findings on planar imaging (OR 4.61; 95% C.I. 1.05, 20.28; p < 0.001), and presence of structural lesions on anatomical imaging (OR 32.54; 95% C.I. 5.37–196.96; p < 0.001).CONCLUSION: SPECT/CT is a useful add-on to diagnostic planar I-131 MIBG scintigraphy. Predictors of usefulness of SPECT/CT include suspicious or positive findings on planar scintigraphy and the presence of structural lesions on anatomical imaging.

The combined therapeutic effects of iodine-labeled multifunctional copper sulfide-loaded microspheres in treating breast cancer

Compared to conventional cancer treatment, combination therapy based on well-designed nanoscale platforms may offer an opportunity to eliminate tumors and reduce recurrence and metastasis. In this study, we prepared multifunctional microspheres loading I-labeled hollow copper sulfide nanoparticles and paclitaxel (I-HCuSNPs-MS-PTX) for imaging and therapeutics of W256/B breast tumors in rats. F-fluordeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) imaging detected that the expansion of the tumor volume was delayed (<0.05) following intra-tumoral (i.t.) injection with I-HCuSNPs-MS-PTX plus near-infrared (NIR) irradiation. The immunohistochemical analysis further confirmed the anti-tumor effect. The single photon emission computed tomography (SPECT)/photoacoustic imaging mediated by I-HCuSNPs-MS-PTX demonstrated that microspheres were mainly distributed in the tumors with a relatively low distribution in other organs. Our results revealed that I-HCuSNPs-MS-PTX offered combined photothermal, chemo- and radio-therapies, eliminating tumors at a relatively low dose, as well as allowing SPECT/CT and photoacoustic imaging monitoring of distribution of the injected agents non-invasively. The copper sulfide-loaded microspheres, I-HCuSNPs-MS-PTX, can serve as a versatile theranostic agent in an orthotopic breast cancer model.

Fusion Imaging - The Broadened Horizon In Maxilloacial Imaginga Review

Fusion imaging is the amalgamation of various advanced imaging modalities used in oral and maxillofacial imaging today, which takes a lion share in improvising diagnostic and formulation of effective treatment outcomes. In today’s scenario, this has been widely accepted in various disciplines of dentistry in a broadened horizon for capturing the head and neck pathologies. This review paper therefore aims to highlight various aspects of fusion imaging with its bird’s view in various dental specialties