ABSTRACT
Purpose: Beaumont Hospital (Dublin) is a large academic teaching hospital and specialist centre for complex epilepsy and epilepsy surgery. Ictal SPECT is a unique Nuclear Medicine examination that can be used as a tool in pre-surgical localisation of an epileptic focus. During a seizure there is hyper perfusion in the epileptogenic focus. While the patient is being EEG monitored in the Epilepsy Monitoring Unit (EMU), rapid injection of a brain perfusion radiopharmaceutical at seizure onset followed by ictal SPECT imaging can provide the epilepsy surgical team with more specific localisation information to aid presurgical planning. In view of the potential benefits to epilepsy patients an Ictal SPECT service has been established in Beaumont Hospital. There are many challenges and complex issues to address when developing a routine Ictal SPECT service in order to provide a quality and safe service to patients and staff. A multi-disciplinary approach was taken when planning and developing this new service in Beaumont Hospital. Material(s) and Method(s): This procedure is carried out between the following departments: Nuclear Medicine Department, Neurology, the Epilepsy Monitoring Unit (EMU) and Neuro Physics. The following areas required careful development and planning for the project: (1) Patient Selection and Preparation: (2) Radiopharmaceutical Selection, Preparation and Dispensing: (3) Nuclear Medicine Radiation Protection Issues: (4) Patient monitoring and administration of Radiopharmaceutical on the EMU: (5) Nuclear Medicine Patient Scanning: (6) Data Post Processing (SISCOM): A site visit to UZ Leuven hospital Belgium occurred early in the project, this provided invaluable information and support from an experienced centre with a long established Ictal SPECT service. Result(s): There have been many unexpected challenges during the establishment of this service: - Supply issues of the Radiopharmaceutical tracer - The impact of Covid-19 - An issue with absorption of the radiopharmaceutical within the Delivery tubing system To date two patients have successfully undergone Ictal SPECT exams, both were administered the radiopharmaceutical within seconds of the onset of a seizure. The results of the Ictal SPECT exam were discussed at a multi-discipline meeting and were used in the patient pre-surgical planning. Conclusion(s): Ictal SPECT is an intricate procedure that requires extensive planning and co-operation between the multi-disciplinary team in order to provide a quality and safe service to the patient. Beaumont Hospital hopes to continue and expand this service.Copyright © 2023 Southern Society for Clinical Investigation.
ABSTRACT
Introduction: Extrapulmonary manifestations of COVID-19 must not be neglected during the pandemic. Subacute thyroiditis is one of the possible complications people encounter during post-COVID-19 days. Thyroid scintigraphy and radioiodine uptake test help discriminate hyperthyroidism from destructive thyrotoxicosis. Finding a more precise way to diagnose subacute thyroiditis can help in the early detection and treatment of thyroid-related disorders. Method(s): In this cross-sectional study, we evaluated 69 cases of COVID-19. Patients were divided into moderate and severe groups based on their clinical conditions. A thyroid scintigraphy scan was performed on the discharge day. Imaging was done 15-20 minutes after intravenous administration of 3-5 mCi of [99mTc]TcO4-. Scan findings were compared between moderate and severe groups and other participants' demographic and clinical features. Result(s): In 69 patients, according to thyroid scintigraphy, 25 (36%) cases were reported as thyroiditis, and the rest were normal. There was no significant difference between the normal and subacute thyroiditis groups based on age, gender, past medical history, the severity of COVID-19, laboratory values and clinical signs and symptoms. Patients with subacute thyroiditis experienced palpitation and sore throat significantly higher than the normal group (P=0.002 and P=0.009, respectively). Conclusion(s): We conclude that patients admitted due to acute COVID-19 infection experiencing palpitation and sore throat can develop subacute thyroiditis more than others. Whereas the severity of the disease and laboratory testing were not diagnostic in subacute thyroiditis, thyroid scintigraphy may help in early detection.Copyright © 2023 The Authors.
ABSTRACT
Aim/Introduction: 99mTc is used in about 80% of the convencional diagnostic nuclear imaging procedures and represent yearly approximately 30 million examinations/year worldwide a year in diagnostic tests in hospitals, among others by oncology, cardiology and neurology.The production of radiopharmaceuticals for use in Nuclear Medicine has a complex system. It involves carefully calculated production schedules that take into account supply, demand and many logistical operations.The aim of this study is to show how our nuclear medicine department manage the impact of the shortly 99Mo supply chain and consequently, in the 99mTc availability and other radiopharmaceuticals produced in nuclear reactora. Material(s) and Method(s): European nuclear medicine organizations had just pay attention to how the COVID-19 pandemic might affect different parts of the 99Mo supply chain when had to dealt again faced with a new problem;the shortness 99Mo production. There are only five nuclear reactors involved in the production of 99Mo on industrial scale. These aging reactors are subject to unscheduled shutdowns and longer maintenance periods making the 99Mo supply chain vulnerable. In the last few months at our nuclear medicine department we had to reinvent ourselves so as not to completely stop carrying out the previously scheduled exams and therapies. Result(s): The use of technetium generators in Europe represents about 17% - 25% of the worldwide consumption of 99Mo, representing 30,000 exams per day and about 1.1 million doses per month. The main consequences at the IPO-Porto was;Delays in diagnosis/staging, rescheduling exams, change of surgery dates (Sentinel Ganglion and Myocardial Perfusion Cardiacs), weeks of overbooking, delay in follow-up of Glomerular Filtration Rate in pre- or post-transplant patients, postponement of 131I Therapies, Scintigraphy and Whole Body Scintigraphy in patients who were already in hypothyroidism. we had to reinvent the use of 99mTc generators, change exams appointments times, reagroup exams types by defined days and other radiopharmaceutical management tools that were not commonly used. Conclusion(s): Approximately 2/3 of scheduled exams were postponed and we had to deal with weekly and daily stock updates. Our department suggest some measures and procedures that could help with future 99Mo shortages, in order to be ready in future situations and to avoid shortness of production: the creation of a centralized European radiopharmacy system, European policies to encourage long-term investment, homogenization of marketing specifications in the Member States, solid databases of radiopharmaceuticals used/ available in Europe and encouraging cooperation between other countries outside the European Union.
ABSTRACT
High redox potential reactive oxygen and nitrogen species (ROS/RNS), such as O2 free radicals, superoxide, and hypochlorous acid, generated by activities of the NADPH oxidase-2 (NOX2)/myeloperoxidase (MPO) axis and related enzymes, are key effector molecules of innate immunity in physiological and diseased inflammatory states. Other lower energy species (H2O2, NO) provide adjuvant signaling functions. NOX2- and MPO-derived high energy radicals are known to oxidize naphthol species, wherein the naphthol products bind to proximate proteins and activated myeloid cells. Herein, we present 4-[18F]fluoro-1-naphthol ([18F]4FN), a novel redox-tuned radiopharmaceutical that selectively detects by positron emission tomography (PET) high energy radicals produced by activated innate immunity. The products of human MPO plus H2O2 , but not H2O2 alone, rapidly and completely oxidized [18F]4FN. All-trans-retinoic acid-differentiated HL-60 'neutrophil-like' human cells activated with phorbol-12-myristate-13-acetate (PMA) retained [ 18F]4FN 5-fold over unstimulated cells. 4-ABAH, an MPO-specific inhibitor, or DPI, a broad oxidase inhibitor, blocked cellular retention by >95%. [18F]4FN PET/CT imaging readily discriminated foci of inflammation in vivo in three distinct murine models of acute inflammation: endotoxin-induced whole-body toxic shock, PMA-induced mild contact dermatitis of the ear, and lipopolysaccharide (LPS)-induced ankle arthritis. Mechanistically, in mice in vivo, 4-ABAH reduced inflammationinduced [18F]4FN retention, and Cybb-/- (Nox2-/-) gene-deletion strongly and significantly abrogated PMA-induced [18F]4FN retention. Thus, [18F]4FN shows promise as a robust redox-tuned reporter for imaging activation states of innate immunity by PET/CT, is ready for translation. [18F]4FN PET imaging may find application in a variety of inflammatory states associated with cancer therapy, immunotherapy-related adverse events, as well as other diseases, including arthritis, hepatitis, atherosclerosis, COVID-19, as well as up-staging and monitoring multi-organ inflammation.