SPECT/CT fusion imaging in radionuclide cisternography for localization of liquor leakage sites.

OBJECTIVE: We report our experience with radionuclide cisternography (RC) with 111In-diethylenthriamine penta-acetic acid (DTPA) using a computed tomography (CT) mounted hybrid gamma camera in patients with cerebrospinal liquor leakage. METHODS: SPECT/CT fusion imaging was performed in case of suspected tracer egress on planar or SPECT images in order to obtain a detailed correlation of the leakage site. RESULTS: Leakage was detected in all 3 patients. Using SPECT/CT, the extradural tracer accumulation could be correlated to an anatomical structure, which had not been possible by evaluation of the scintigraphic studies alone. CONCLUSION: Introducing SPECT/CT for radionuclide cisternography seems to be a valuable tool to facilitate the diagnosis of cerebrospinal liquor leakage.

[11C] methionine and [18F] fluorodeoxyglucose PET in the follow-up of glioblastoma multiforme.

BACKGROUND: The aim of this study was to evaluate the value of [11C] methionine (MET) and [18F] fluorodeoxyglucose (FDG) PET in the follow-up of glioblastoma multiforme (GBM). PATIENTS AND METHODS: After surgical and/or conservative treatment, 28 patients (pts) with GBM underwent FDG and MET PET on average 12.7 months after the diagnosis had been established. Scans were evaluated visually and by calculating the maximal tumor SUV as well as the ratio of tumor vs. contralateral region (RTu). The degree of tracer uptake was compared with survival time, disease duration and MRI findings. RESULTS: The mean overall duration of survival was 12.7 months. The patients were divided into two groups: those that survived less than 12 months and those that survived longer than 12 months. Focally increased uptake was revealed by MET PET in 24 patients and by FDG PET in 2 patients. On MRI scans, viable tumor tissue was suspected in 18 patients. No correlations were registered between FDG/MET uptake and survival time or disease duration respectively; Kaplan-Meier calculations were negative in this regard. Similarly, negative results were obtained in subgroups of patients who had undergone microsurgical resection and whose disease was at least of 6 months' duration, and additionally in a subgroup who had undergone their last treatment longer than 6 months ago. With respect to survival groups, a positive MET PET was associated with a sensitivity of 86% and a specificity of 8%. SUV and RTu values did not differ between patients with positive or negative MRI results. CONCLUSIONS: In this study FDG PET seems to be of limited value in the work-up of recurrent GBM because of its lower sensitivity than MET PET and the fact that it allows no prediction of the outcome. MET PET visualizes viable tumor tissue without adding any prognostic information and appears to be in no way superior to conventional imaging.

Comparison of iodine uptake in tumour and nontumour tissue under thyroid hormone deprivation and with recombinant human thyrotropin in thyroid cancer patients.

AIM: Recombinant human thyrotropin (rhTSH) is a new option for diagnostic follow-up in patients with differentiated thyroid cancer (DTC). Iodine kinetics after administration of rhTSH is controversially discussed. The aim of our study was to compare the time course of radioiodine in tumour and normal tissue during periods of TSH elevation in patients in a hypothyroid state (HS) following hormone withdrawal, with those under euthyroidism (ES) after the administration of rhTSH. PATIENTS AND METHODS: We investigated four patients who had undergone near-total thyroidectomy and were suffering from metastatic disease. Dosimetric calculations were performed using tumour and whole-body uptake, and background measurements from 123-iodine scans performed 0, 4, 24 and 48 h after the application of (123)I. RESULTS: All patients had lesser uptake of (123)I under rhTSH stimulation than after hormone withdrawal. The median maximum TG (thyroglobulin) levels were 733.1 ng/ml with HS and 548.0 ng/ml with ES. The median half-life in tumour tissue was 39.8 h (mean 65.9, range 11.5-194.0) with HS and 21.9 h (mean 38.7, range. 8.7-113.9) with ES. The median uptake dose in per cent in tumour tissue was 0.08 (mean 0.15, range 0.04-0.6) with HS and 0.05 (mean 0.08, range 0.03-0.2) with ES. Furthermore, the cumulative activity in metastatic tissue was lower after rhTSH than during hypothyroidism, with considerable variations between individual lesions. CONCLUSION: In our small group of DTC patients with metastatic disease, the effectiveness of radioiodine therapy following rhTSH was anticipated to be less than that in individuals who were hypothyroid after levothyroxine (L-T(4)) withdrawal. Endogenous TSH stimulation of metastatic thyroid cancer with radioiodine should not be performed without prior target tumour lesion dosimetry with (123)I.

Clonal differences in expression of 25-hydroxyvitamin D(3)-1alpha-hydroxylase, of 25-hydroxyvitamin D(3)-24-hydroxylase, and of the vitamin D receptor in human colon carcinoma cells: effects of epidermal growth factor and 1alpha,25-dihydroxyvitamin D(3).

Human colon carcinoma cells express 25-hydroxyvitamin D(3)-1alpha-hydroxylase (CYP27B1) and thus produce the vitamin D receptor (VDR) ligand 1alpha,25-dihydroxyvitamin D(3) (1,25-D3), which can be metabolized by 25-hydroxyvitamin D(3)-24-hydroxylase (CYP24). Expression of VDR, CYP27B1, and CYP24 determines the efficacy of the antimitotic action of 1,25-D3 and is distinctly related to the degree of differentiation of cancerous lesions. In the present study we addressed the question of whether the effects of epidermal growth factor (EGF) and of 1,25-D3 on VDR, CYP27B1, and CYP24 gene expression in human colon carcinoma cell lines also depend on the degree of cellular differentiation. We were able to show that slowly dividing, highly differentiated Caco-2/15 cells responded in a dose-dependent manner to both EGF and 1,25-D3 by up-regulation of VDR and CYP27B1 expression, whereas in highly proliferative, less differentiated cell lines, such as Caco-2/AQ and COGA-1A and -1E, negative regulation was observed. CYP24 mRNA was inducible in all clones by 1,25-D3 but not by EGF. From the observed clonal differences in the regulatory effects of EGF and 1,25-D3 on VDR and CYP27B1 gene expression we suggest that VDR-mediated growth inhibition by 1,25-D3 would be efficient only in highly differentiated carcinomas even when under mitogenic stimulation by EGF.