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.

Multiple Regression Analysis of Predictors of Bone Scintigraphy Positivity in Patients with Head and Neck Cancers / 대한핵의학회잡지

PURPOSE@#The value of bone scintigraphy (BS) in patients with head and neck cancers (HNCs) has been questioned, with conflicting findings regarding positivity yield with some reports recommending BS be omitted from work-up of HNC patients since it rarely yields positive results. This study aims to determine the positivity yield of BS in HNCs and to determine predictors for BS positivity to help tailor appropriate BS utilization.@*METHODS@#BS studies of HNC patients were reviewed, the positivity yield was determined. Clinical predictors for BS positivity including age, sex, site of cancer, staging, histological grading were analyzed using univariable and multivariable logistic regression.@*RESULTS@#Among the 259 BS studies included, 35 (13.5%), 194 (74.9%), and 30 (11.6%) were positive, negative, and equivocal for bone metastasis, respectively. After exclusion of equivocal cases, 229 were analyzed in the regression models. Independent predictors of BS positivity include site of tumor at the nasopharynx (OR 4.37, 95% C.I. 1.04–18.41, p = 0.044), age less than 45 years (OR 3.01, 95% C.I. 1.24–7.33, p = 0.015), and presence of distant metastasis to other organs (OR 3.84, 95% C.I. 1.19–12.43, p = 0.025).@*CONCLUSIONS@#In contrast to several studies, bone metastasis as detected by BS was found in a relatively high proportion of patients with HNCs. Independent predictors of BS positivity include the age of less than 45 years, tumor site at the nasopharynx, and the presence of extraskeletal distant metastasis. BS could be useful in patients with these characteristics which enhance the pretest probability of bone metastasis.

Multiple Regression Analysis of Predictors of Bone Scintigraphy Positivity in Patients with Head and Neck Cancers / 대한핵의학회잡지

PURPOSE: The value of bone scintigraphy (BS) in patients with head and neck cancers (HNCs) has been questioned, with conflicting findings regarding positivity yield with some reports recommending BS be omitted from work-up of HNC patients since it rarely yields positive results. This study aims to determine the positivity yield of BS in HNCs and to determine predictors for BS positivity to help tailor appropriate BS utilization.METHODS: BS studies of HNC patients were reviewed, the positivity yield was determined. Clinical predictors for BS positivity including age, sex, site of cancer, staging, histological grading were analyzed using univariable and multivariable logistic regression.RESULTS: Among the 259 BS studies included, 35 (13.5%), 194 (74.9%), and 30 (11.6%) were positive, negative, and equivocal for bone metastasis, respectively. After exclusion of equivocal cases, 229 were analyzed in the regression models. Independent predictors of BS positivity include site of tumor at the nasopharynx (OR 4.37, 95% C.I. 1.04–18.41, p = 0.044), age less than 45 years (OR 3.01, 95% C.I. 1.24–7.33, p = 0.015), and presence of distant metastasis to other organs (OR 3.84, 95% C.I. 1.19–12.43, p = 0.025).CONCLUSIONS: In contrast to several studies, bone metastasis as detected by BS was found in a relatively high proportion of patients with HNCs. Independent predictors of BS positivity include the age of less than 45 years, tumor site at the nasopharynx, and the presence of extraskeletal distant metastasis. BS could be useful in patients with these characteristics which enhance the pretest probability of bone metastasis.

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.

Recombinant Human TSH-Mediated Management of Differentiated Thyroid Cancer

Roles of recombinant human TSH (rhTSH) has been extensively studied during the past ten years in the management of patients with differentiated thyroid cancer.  Since it is convenient, safe and equally effective in the treatment with radioactive iodine and in the follow-up procedures after treatment, rhTSH has been used increasingly and is now considered a method to replace the conventional thyroid hormone withdrawal in the management of patients with differentiated thyroid cancer.  This review article aims to provide the evidence regarding the use of rhTSH in various aspects of taking care of this kind of patients, both in terms of treatment of the disease and follow-up of the disease. 

The Correlation of Bone Mineral Densities among the Lumbar Spines, Proximal Femur and Distal Forearm

Purpose:  To determine the correlation of bone mineral density (BMD) among the lumbar spines, proximal femur, and distal forearm in women.Design:  Retrospective, descriptive studyMaterials:  and Methods:  We reviewed the results of bone mineral density performed at Srinagarind Hospital from May 1997 to June 1999.  Dual energy X-ray absorptiometry (DEXA) technique was used to determine the bone mineral densities (BMDs) at the lumbar spines, proximal femur, and distal forearm in 230 women of age range from 31 to 87 years (mean age = 53.5 years).  Most cases were healthy, with only 10 cases being osteoporotic.Results:  A significant correlation (p

Vitamin D Deficiency and the Risk of Osteoporosis in Elderly Women

Backgroud : Vitamin D deficiency lead to elevations in parathyroid hormone levels, resulting in increased bone resorption and reduced  BMD, especially cortical bone, and caused skeletal osteoporosis.  Up  to now there are very few studies to show the effect of vitamin D deficiency on bone mineral density.  The level of vitamin D deficiency vary considerably with latitude, also the variability in the different vitamin D assays, that varies from 10 – 40 ng/ml. From our previous study about prevalence of vitamin D deficiency, it being found that the level of calcidiol \< 35 ng/ml was th level of vitamin D deficiency.Objective : To determine the risk of osteoporosis in lumbar spine, proximal femur and the distal radius, between the elderly women with and without vitamin D deficiency. Design : Cross – sectional descriptive study.Setting : Municipality  of Khon Kaen province, Thailand.Outcome Measurements : Serum calcidiol and PTH  levels and  bone mineral density of lumbar spine, proximal femur and distal forearm.Results : No any significant difference in age, weight, height, BMI  and  the  alkaline  phosphatase  level  between  both  groups.  There  was  only  PTH  level  that  showed  significant  difference  between  both  groups.  A  calcudiol  level  of