Update of the role of PET/CT and PET/MRI in the management of patients with cervical cancer.

In cervical cancer (CC), fluorine18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) has been proven to be beneficial for patient management. Positron emission tomography/CT is useful in pretreatment evaluation due to the ability to evaluate disease extent and to assess regional lymph nodes as well as distant sites for metastases. Positron emission tomography/CT has an impact on treatment planning as well as it is incorporated in radiation therapy planning, resulting in more appropriate and effective treatment with less cost and radiation dose to normal tissues. Positron emission tomography/CT is used to predict early treatment response and to assess treatment response after completion of concurrent chemoradiation therapy. Positron emission tomography/CT has been used for surveillance after treatment as well as for restaging in suspected recurrent or metastatic disease. Qualitative PET/CT imaging findings as well as quantitative parameters such as maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) are useful to predict prognosis and clinical outcome. Moreover, PET imaging using other radiotracers to detect and quantify hypoxia may help to identify aggressive tumors and predict treatment outcome even though it is not widely clinical used. Positron emission tomography/magnetic resonance imaging (PET/MRI) instruments are now available, which may potentially improve evaluation of primary tumors and metastatic sites given the improved soft tissue contrast resolution of MRI relative to CT. This article reviews the role of 18F-FDG PET/CT, hypoxia agent PET/CT, and 18F-FDG PET/MRI in the management of patients with CC.

Patterns of 18F-FDG PET images in patients with uncomplicated total hip arthroplasty.

OBJECTIVE: This retrospective study was carried out to determine the typical patterns of (18)F-FDG uptake in uncomplicated total hip arthroplasty (THA). SUBJECTS AND METHODS: (18)F-FDG-PET images of 62 asymptomatic THA patients who had undergone whole body scanning were evaluated for this retrospective study. The uptake was assessed qualitatively as positive or negative in the head/neck and the stem of the prosthesis. There were 76 hip prosthesis scans (34 left side and 42 right) and the average time following surgery was 75 months (range from 40 days to 372 months). Furthermore, the time course after surgery was subdivided into 3 time interval groups: Group I less than 2 years, Group II between 2 to 5 years, Group III more than 5 years. The regions of assessment were: head region including acetabulum and femoral head, femoral neck, trochanter, and femoral shaft. RESULTS: In patients who demonstrated increased peri-prosthetic (18)F-FDG uptake (59 of the 76 hip scans), the activity was confined to the femoral neck and proximal femoral shaft with the majority in the neck regions alone: 68% (40 of 59). Majority of the uptake was noted in the femoral neck, proximal shaft and trochanteric regions. CONCLUSION: Uptake of (18)F-FDG in the asymptomatic patients with THA is commonly visualized and appears to be confined to the proximal segment of the prosthesis with minimal or no activity in its femoral segment.

Syntheses and pH sensing applications of imine-coupled phenol and polyphenol species derived from 2-amino-4-nitrophenol.

Developing of new generation optical polymeric pH sensors has increasing importance due to their stable structures. Available polymeric sensors for different pH ranges are already needed. In the present study new kinds of monomeric and polymeric absorption pH sensors (HBANP and PHBANP) derived from 2-amino-4-nitrophenol were prepared. The novel sensors were investigated in various pH values using spectrophotometric, spectrofluorometric, and electrochemical techniques. The sensors showed sigmoidal correlations vs. pH range in optical measurements. These correlations were improved as mathematical formula to obtain the solution pH. HBANP and PHBANP differed from each other by response fields. HBANP had a sharp absorption increase between the pH of 6.5→7.5 while PHBANP spectrophotometrically responded at lower pHs. HBANP was colorless in acidic pHs, yellow-colored in neutral media and red-colored in alkaline pHs. With its colorimetric responses in various pHs HBANP can be used to develop color-tunable pH sensors. Electrochemical oxidation peak potentials and currents also particularly changed in various pHs.

Synthesis and spectrophotometric P(H) sensing applications of poly-2-[4-(diethylaminophenyl)imino]-5-nitro-phenol and its Schiff base monomer for two different P(H) ranges.

Poly-2-[4-(diethylaminophenyl)imino]-5-nitro-phenol (PEAPINP) and 2-[4-(diethylaminophenyl)imino]-5-nitro-phenol (EAPINP) were prepared as new pH sensors. Spectrophotometric and spectrofluorometric response of the novel sensors in various p(H) values were investigated. EAPINP has the ability to respond linearly at alkaline P(H) values, 8 to 9, and can be utilized in absorption and wavelength radiometric methods. PEAPINP has the ability to respond linearly at lower pH values, 6 to 7, and can be used as an alternative pH sensor in this range. The new sensors are yellow-colored in acidic and neutral media and red-colored in alkaline P(H)s. With their colorimetric responses at different pH ranges EAPINP and PEAPINP can be used to develop color-tunable P(H) sensors.

Fluorodeoxyglucose-positron-emission tomography findings in mantle cell lymphoma.

OBJECTIVE: Mantle cell lymphoma (MCL) is an aggressive type of non-Hodgkin lymphoma with a propensity for extranodal involvement. The role of fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging in common types of lymphoma has been well-established. However, there is limited information in the literature about the utility of FDG-PET imaging in patients who have MCL. The aim of this study was to determine the role of FDG-PET imaging in assessment of disease activity in MCL compared with conventional imaging techniques such as computerized tomography/magnetic resonance imaging (CT/MRI). METHODS: FDG-PET images of 20 patients with MCL who were referred to our center for assessment of extent of disease were reviewed retrospectively. The FDG-PET findings were compared with those of CT/MRI and were correlated with clinical information, histopathology, and outcome. RESULTS: The diagnostic sensitivity for PET was 90% (17/19), and specificity was 100% (1/1). For CT/MRI, the sensitivity was 87% (14/16) and specificity was 50% (2/4). PET was better than CT/MRI in detecting nodal involvement. With respect to extranodal involvement, PET detected more cases of spleen involvement than CT/MRI. PET was equivalent to conventional imaging in detecting bowel involvement. CONCLUSIONS: PET imaging has a high sensitivity in detecting both nodal and extranodal involvement in patients who have MCL. Based on the available data in patients who had other subtypes of non-Hodgkin lymphoma, the specificity of PET also appears to be superior to anatomic imaging techniques. FDG-PET imaging may prove to be the single most effective method for detection.

[The effects of water-pipe, cigarette and passive smoking on mucociliary clearance]. / Nargile, sigara ve pasif içiciligin mukosiliyer klerens üzerindeki etkileri.

We aimed to determine the effects of water-pipe smoking on lung mucociliary clearance system using radioaerosol ventilation scintigraphy and compare with cigarette and passive smoking and determine the level of exposure to tobacco smoke by measuring urinary cotinine in each group. Volunteer water-pipe only and cigarette only smokers from various cafés in Izmir city and passive smokers as control group were included in the study after exclusion and inclusion criteria. The ages, type of smoking, duration and daily amount of tobacco smoked and the medical histories of the volunteers were noted down. The pulmonary function tests (PFT), technetium-99m inhalation scintigraphy and urinary cotinine measurement with enzyme immunoassay (EIA) and were performed for each participant. Twenty water-pipe smokers, 23 cigarette smokers and 15 passive smokers were included into the study. There were no statistically significant differences among the mean ages, BMI and PFT parameters of all participants in study and control groups. Mucociliary clearance rates in terms of retention ratio after 1 hour and radioactivity half-life for each lung was lowest in the water-pipe smokers compared to others. Mucociliary clearance rate also decreased in the cigarette smokers compared to passive smokers. The differences in the mucociliary clearance rates among groups were statistically significant (p < 0.05). Urinary cotinine levels were highest in the cigarette smokers and higher in water-pipe smokers compared to passive smokers as statistically significant. As a conclusion mucociliary clearance rates decrease with tobacco smoking, being more prominent in water-pipe smokers in our study.

Effects of long-term methylphenidate treatment: a pilot follow-up clinical and SPECT study.

BACKGROUND: Although abnormalities in the regional cerebral blood flow (rCBF) responses to methylphenidate (MPH) treatment have been reported in children with attention deficit hyperactivity disorder (ADHD), there are few prospective longitudinal studies assessing the long-term effects of MPH and discontinuation effects after chronic treatment. METHODS: The authors studied ten drug-naive children (2 girls, 8 boys, mean age+/-S.D.=9.60+/-1.96) diagnosed with ADHD by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnostic criteria, using (99m)Tc-HMPAO-single photon emission computed tomography (SPECT). Patients were studied at baseline (visit 1), after 2 months of MPH treatment (visit 2) and after a drug-free period of 2 months following 12 months of MPH treatment (visit 3) at doses of 1 mg/kg/day. We evaluated SPECT data visually and semi-quantitatively. RESULTS: Two months of chronic MPH treatment resulted in visually detectable improvement in hypoperfusion in the right frontal cortex and all areas of temporal cortex with the exception of left lateral temporal cortex. This improvement was still detectable on visual evaluations of SPECT data after 2 months of treatment discontinuation. The treatment effects that were detected visually were not statistically significant in semi-quantitative analyses. CONCLUSIONS: Treatment effects of chronic MPH treatment may persist long after the discontinuation of the treatment.

Intense esophageal FDG activity caused by Candida infection obscured the concurrent primary esophageal cancer on PET imaging.

Esophageal cancer frequently causes a focal intense FDG uptake on positron emission tomography (PET) imaging while esophagitis often results in a mild to moderate degree of FDG activity in a diffuse pattern. However, detection of an esophageal cancer can become difficult in the presence of a diffuse esophageal activity because of esophagitis. We present such case in which esophageal cancer superimposed by Candidal esophagitis is difficult to recognize on FDG PET images.

Detection of bone marrow metastases by FDG-PET and missed by bone scintigraphy in widespread melanoma.

The optimal management of patients with melanoma requires accurate imaging techniques that can screen the entire body for metastases. One of the most used tests for this purpose is bone scintigraphy. PET has been reported to be more sensitive than bone scintigraphy in some malignancies. In our case, FDG-PET was also superior to bone scintigraphy in detecting the extent of skeletal disease in a patient with melanoma. This is likely the result of the fact that metastasis to bone marrow may not result in bone reaction in certain conditions and therefore bone scans may remain negative despite skeletal involvement.

Correlation between 99mTc-MIBI uptake and angiogenesis in MIBI-positive breast lesions.

This study was undertaken to assess the correlation between the degree of accumulation and the washout of 99m technetium methoxyisobutylisonitrile ((99m)Tc-MIBI) and angiogenesis in MIBI-positive breast lesions. Twenty-eight patients (mean age, 51+/-11 years) with 31 breast lesions who underwent scintimammography were studied. Anterior, left and right prone lateral images were obtained 20 min and 3 h after the injection of 740 MBq (99m)Tc-MIBI. All breast lesions showed increased (99m)Tc-MIBI uptake. Early and delayed tumor to background activity ratios (T/BG) and washout index (early tumor uptake-delayed tumor uptake divided by early tumor uptake) were calculated. Vascular endothelium was immunohistochemically labeled using a biotinylated monoclonal antibody directed against the factor-VIII-associated antigen using standard biotin-avidin technique. Angiogenesis was evaluated by assessing the vascular surface density (VSD) and the microvessel number (NVES) within 10 randomly chosen areas. All pathological data were compared with early and delayed T/BG activity ratios and washout index of (99m)Tc-MIBI. Statistical analysis was performed using Spearman correlation test. There was no statistically significant correlation between the degree of angiogenesis and early T/BG (r = .287, P > .05 with VSD, r = .351, P > .05 with NVES), delayed T/BG (r = .277, P > .05 with VSD, r = .315, P > .05 with NVES) and the washout index (r = .268, P > .05 with VSD, r = .285, P > .05 with NVES) of (99m)Tc-MIBI in all breast lesions. There was no statistically significant correlation between the degree of angiogenesis and early T/BG (r = .235, P > .05 with VSD, r = .356, P > .05 with NVES), delayed T/BG (r = .181, P > .05 with VSD, r = .285, P > .05 with NVES) and the washout index (r = .158, P > .05 with VSD, r = .187, P > .05 with NVES) of (99m)Tc-MIBI in 24 invasive breast lesions. No statistically significant correlation was found between the degree of angiogenesis and early T/BG (r = -.036, P > .05 with VSD, r = -.107, P > .05 with NVES), delayed T/BG (r = -.500, P > .05 with VSD, r = -.429, P > .05 with NVES), but there was a high correlation between angiogenesis and the washout index (r = .893, P < .05 with VSD, r = .964, P < .05 with NVES) of (99m)Tc-MIBI in seven noninvasive breast lesions. Amount of (99m)Tc-MIBI uptake in breast lesions is dependent on several factors. Our study indicates that early and delayed (99m)Tc-MIBI uptakes in MIBI-positive breast lesions are not related to angiogenesis in both invasive and noninvasive breast lesions. But washout index of (99m)Tc-MIBI in noninvasive breast lesions is highly correlated with angiogenesis. (99m)Tc-MIBI scintigraphy does not seem to be able to indicate angiogenic property of invasive breast lesions.

Demonstration of excessive metabolic activity of thoracic and abdominal muscles on FDG-PET in patients with chronic obstructive pulmonary disease.

PURPOSE: The purpose of this study was to determine if an FDG-PET study was able to visualize muscle uptake of the chest and abdomen in patients with chronic obstructive pulmonary disease (COPD). METHODS: This study included 25 patients with COPD and 25 patients without COPD who had undergone a FDG-PET study. The nonattenuation-corrected images were used to determine the degree of FDG uptake in the intercostals, subscapular, abdominal rectus, and abdominal oblique muscles. The intensity of uptake in the muscles was rated on a 4-point grading scale with 1 being less, 2 the same, 3 slightly more, and 4 markedly more intense than the sternum. RESULTS: Thirteen patients with COPD demonstrated FDG activity in the intercostal muscles that was equal to or greater than the sternum and the tracer was demonstrated predominantly in the inferolateral chest wall (n = 8), the entire lateral chest wall (n = 2), the posteroinferior chest wall (n = 2), and the entire chest wall (n = 1). In all 13 patients with COPD who demonstrated FDG activity in the abdominal oblique muscles, the site of muscle activity was predominantly in the anteroinferior abdominal wall (n = 8), the lateral wall (n = 4), and the anterior wall (n = 1). In patients without known COPD, the frequency and intensity of uptake in the muscles were less than those with the disease. CONCLUSION: This study demonstrates the ability of FDG-PET imaging to assess muscle function in respiratory disorders and may prove to be of some value in further characterizing this disorder.

Water-pipe smoking effects on pulmonary permeability using technetium-99m DTPA inhalation scintigraphy.

OBJECTIVE: Although extensive work has been done on cigarette smoking and its effects on pulmonary function, there are limited number of studies on water-pipe smoking. The effects of water-pipe smoking on health are not widely investigated. The aim of this study was to determine the effects of water-pipe smoking on pulmonary permeability. METHODS: Technetium-99m DTPA inhalation scintigraphy was performed on 14 water-pipe smoker volunteers (all men, mean age 53.7 +/- 9.8) and 11 passive smoker volunteers (1 woman, 10 men, mean age 43.8 +/- 12). Clearance half-time (T 1/2) was calculated by placing a monoexponential fit on the time activity curves. Penetration index (PI) of the radioaerosol was also calculated. RESULTS: PI was 0.58 +/- 0.14 and 0.50 +/- 0.12 for water-pipe smokers (WPS) and passive smokers (PS) respectively. T 1/2 of peripheral lung was 57.3 +/- 12.7 and 64.6 +/- 13.2 min, central airways was 55.8 +/- 23.5 and 80.1 +/- 35.2 min for WPS and PS, respectively (p < or = 0.05). FEV1/FVC% was 82.1 +/- 8.5 (%) and 87.7 +/- 6.5 (%) for WPS and PS, respectively (0.025 < p < or = 0.05). CONCLUSIONS: We suggest that water-pipe smoking effects pulmonary epithelial permeability more than passive smoking. Increased central mucociliary clearance in water-pipe smoking may be due to preserved humidity of the airway tracts.

Technetium-99m tetrofosmin uptake in insular thyroid carcinoma. A comparison with iodine-131.

The authors describe a 42-year-old man with insular thyroid carcinoma. In this patient, iodine-131 (I-131) and technetium-99m (Tc-99m) tetrofosmin imaging were performed to investigate residual thyroid tissue and metastatic foci of tumor. Both I-131 and Tc-99m tetrofosmin images showed metastatic foci, but Tc-99m tetrofosmin imaging revealed the lesions better than did the I-131 scan. Tc-99m tetrofosmin imaging does not require withholding of thyroid hormone suppression and can be used for follow-up evaluation of patients with insular thyroid carcinoma.