Clinical utility of strontium-89 chloride for the palliation of bone pain in metastatic prostate carcinoma

Metastatic bone disease is a major sequela of several malignancies, such as the prostate, breast, lung, kidney and thyroid. Bone pain is a common symptom in advancing malignancy and often determines the quality of life in the later stages of disease. Management of bone pain from metastasis remains palliative at present. With the improved cancer survival resulting from advances in cancer management, the population of patients seeking relief of bone pain has increased. Radiopharmaceutical therapy offers potential pain relief with minimal adverse effects. This is a case report on the clinical utility of strontium-89 chloride for the palliation of bone pain in metastatic prostate cancer. A 67-year-old male presented with bone pain due to disseminated bone metastases form prostate cancer, most intense in the lower back (Visual Analogue Scale pain score of 8). Strontium-89 chloride was administered intravenously at a dose of 148 MBq (4mCi). There was a transient, moderate, tolerable pain flare (Visual Analogue Scale pain score of 4) within the first week of treatment, which was relieved by oral opioid analgesics. He was pain-free thereafter (Visual Analogue Scale pain score of 0). Reversible bone marrow suppression was also observed a few weeks after the treatment.

Hemodynamic Significance of Internal Carotid or Middle Cerebral Artery Stenosis Detected on Magnetic Resonance Angiography.

PURPOSE: We evaluated hemodynamic significance of stenosis on magnetic resonance angiography (MRA) using acetazolamide perfusion single photon emission computed tomography (SPECT). MATERIALS AND METHODS: Of 171 patients, stenosis in internal carotid artery (ICA) and middle cerebral artery (MCA) (ICA-MCA) on MRA and cerebrovascular reserve (CVR) of MCA territory on SPECT was measured using quantification and a 3-grade system. Stenosis and CVR grades were compared with each other, and their prognostic value for subsequent stroke was evaluated. RESULTS: Of 342 ICA-MCA, 151 (44%) presented stenosis on MRA; grade 1 in 69 (20%) and grade 2 in 82 (24%) cases. Decreased CVR was observed in 9% of grade 0 stenosis, 25% of grade 1, and 35% of grade 2. The average CVR of grade 0 was significantly different from grade 1 (p<0.001) and grade 2 stenosis (p=0.007). In quantitative analysis, average CVR index was -0.56±7.91 in grade 0, -1.81±6.66 in grade 1 and -1.18±5.88 in grade 2 stenosis. Agreement between stenosis and CVR grades was fair in patients with lateralizing and non-lateralizing symptoms (κ=0.230 and 0.346). Of the factors tested, both MRA and CVR were not significant prognostic factors (p=0.104 and 0.988, respectively), whereas hypertension and renal disease were significant factors (p<0.05, respectively). CONCLUSION: A considerable proportion of ICA-MCA stenosis detected on MRA does not cause CVR impairment despite a fair correlation between them. Thus, hemodynamic state needs to be assessed for evaluating significance of stenosis, particularly in asymptomatic patients.

Correlation of 18F-FDG uptake with apparent diffusion coefficient ratio measured on standard and high b value diffusion MRI in head and neck cancer.

UNLABELLED: Although the clinical applications of (18)F-FDG PET/CT and diffusion-weighted MRI (DWI) are similar to each other in head and neck cancer, the image acquisition methods in the 2 modalities are significantly different. (18)F-FDG PET/CT traces glucose metabolism, a nonspecific process essential for tumor growth. On the other hand, DWI provides information on Brownian motion of water molecules in tissues, which represents cellularity. The aim of our study was to investigate whether apparent diffusion coefficient (ADC) values at b = 1,000 (ADC(1,000)) and 2,000 (ADC(2,000)) s/mm(2) or whether the change (ADC(ratio)) of ADC values from b = 1,000 to 2,000 s/mm(2) has any significant correlation with the standardized uptake value (SUV) in patients with head and neck squamous cell carcinoma (HNSCC). METHODS: Our hospital's institutional review board approved this retrospective study. We included 47 patients (32 men and 15 women) with histopathologically proven HNSCC, who underwent both DWI (at both b = 1,000 s/mm(2) and b = 2,000 s/mm(2)) and (18)F-FDG PET/CT in the 2 wk before treatment. ADC(ratio) maps were generated using a pixel-by-pixel computation for which ADC(ratio) is (ADC(2,000)/ADC(1,000)) × 100. The mean ADC(1,000), ADC(2,000), and ADC(ratio) values were evaluated within a manually placed polygonal region of interest within the main tumor on every slice of the ADC(1,000), ADC(2,000), and ADC(ratio) maps, respectively. In addition, the maximal SUV (SUV(max)) and mean SUV (SUV(mean)) were measured for the entire tumor region of interest. Comparisons were made using Pearson correlation analysis, and partial correlation coefficients were derived. RESULTS: No significant correlation was found between the mean ADC(1,000) and SUV(mean) (r = -0.222, P = 0.1325) or the mean ADC(2,000) and SUV(mean) (r = -0.1214, P = 0.4163). However, the ADC(ratio) was significantly and positively correlated to both the SUV(mean) (r = 0.667, P < 0.001) and SUV(max) (r = 0.5855, P < 0.001). CONCLUSION: The ADC(ratio) and SUV were significantly correlated with each other in primary HNSCC patients, possibly because of a higher-cellularity region as a result of relatively increased tumor proliferation. Further studies are warranted to investigate the possible complementary role of DWI and PET/CT in various clinical settings, including staging and treatment response.

Prognostic value of myocardial perfusion scintigraphy in patients with diabetes mellitus

Diabetes mellitus is a major risk factor for cardiovascular disease. Diabetics often have asymptomatic coronary artery disease that is less amenable to favorable interventional treatment compared with the non-diabetic population. Myocardial perfusion scintigraphy [MPS] is used widely to evaluate patients with suspected or known coronary artery disease. Prognosis and management can be assessed after the evaluation of coronary arteries and overall left ventricular systolic function. This study aimed to evaluate the role of MPS in the prediction of cardiac events in patients with diabetes mellitus. A prospective study was done on diabetic patients who underwent MPS in 2007. Patients were followed for at least 18 months after MPS. The occurrence of major and minor cardiac events was determined. A total of 149 patients were included in the study. Of the 114 patients with normal MPS findings only one patient had a minor cardiac event while the rest [99.1 %] had no events. On the other hand, of the 35 patients with abnormal findings, two [5.7%] patients had major cardiac events while 25 [71.4%] had minor cardiac events. The risk of developing a major cardiac event in patients with abnormal MPS is 4.4 times higher compared to those with normal MPS. The risk of developing a minor cardiac event in patients with abnormal MPS is 9.3 times higher compared to those with normal MPS. Myocardial perfusion imaging has a very high negative predictive value for any cardiac [99.1 %], minor cardiac [99.1 %], and major cardiac events [100%]. Diabetics with normal MPS findings have a very good prognosis.