Benefits of basil tea for patients with differentiated thyroid cancer during radioiodine therapy: A randomized controlled trial.

Background: Acute sialadenitis is one of the major physical complications of radioactive iodine therapy (RAIT) for differentiated thyroid cancer (DTC). It is considered necessary to pay attention to the psychological impact on the patient as well as the physical influence during RAIT. Objective: To find evidence of the benefits of Basil tea on the psychological and physical side effects of RAIT. Methods: Forty-four DTC patients after total thyroidectomy were randomly divided into Group A (Basil tea group, n = 22) and Group B (Control group, n = 22). Subjects in Group A drank 180 mL of Basil tea prepared from 2.0 g of Holy basil (Ocimum tenuiflorum Linn.) leaves after each meal for four days, starting on the day RAIT was performed. Those in Group B drank the same amount of distilled water after each meal for the same period as those in Group A. The State-Trait Anxiety Inventory (STAI) was used to assess anxiety, while the saliva component test, and salivary gland scintigraphy were used to assess the oral cavity. Results: The rate of change of the STAI score (both State Anxiety and Trait Anxiety) was significantly lower in Group A than in Group B (P < 0.05). The rates of change of cariogenic bacteria, ammonia, protein, and occult blood were significantly lower in Group A than in Group B (P < 0.05). The rate of change of the washout ratio for salivary gland scintigraphy was significantly lower in Group B than in Group A (P < 0.05). Conclusions: Basil tea consumption not only protected against oral mucosal conditions and salivary gland disorders but also significantly relieved the patient's RAIT-related anxiety. Therefore, it was suggested that this tea could be useful for the maintenance of patients' QOL during RAIT.

Comparison of pain-relieving effects by number of irradiations, through propensity score matching and the international consensus endpoint.

Background: Palliative radiotherapy for bone metastases utilizes various dose fractionation schedules. The pain-relieving effects of a single fraction (SF) and multiple fractions (MF) are largely debated due to the difficulty in matching patients' backgrounds and in assessing the effectiveness of pain relief. This study aimed to compare the pain-relieving effects of SF and MF palliative radiotherapy for bone metastases using propensity score matching and the international consensus endpoint (ICE). Materials and methods: Our study included 195 patients irradiated for bone metastasis. The primary endpoint was the pain-relieving effects used by ICE. In addition, the evaluation was performed by using responder (complete response/partial response) and non-responder (pain progression/indeterminate response) categorization. The secondary endpoints were the discharge or transfer rate at one month after irradiation and postirradiation pathological fracture rate. Propensity score matching was used to adjust patient's characteristics and reduce selection bias. Results: After adapting propensity score matching, the total number of patients was 74. There was no significant difference in the pain-relieving effects between SF and MF (p = 0.184). There were no significant differences in them between SF and MF when using responder and non-responder categorization (p = 0.163). Furthermore, there were no differences in the discharge or transfer rates (p = 0.693) and pathological fracture rates (p = 1.00). Conclusions: The combination of propensity score matching and ICE revealed no significant difference in the pain-relieving effects between SF and MF for bone metastases, thus, SF has no significant disadvantage compared to MF in pain-relieving effects.

Effects of apitherapy against salivary gland disorder after radioactive iodine therapy for differentiated thyroid cancer.

OBJECTIVE: Sialadenitis and salivary gland disorders are complications of radioactive iodine therapy (RAIT) that affect the quality of life of patients with differentiated thyroid cancer (DTC). The current study aimed to provide evidence on the protective effect of apitherapy on salivary gland function during RAIT in patients with DTC. METHODS: In total, 120 patients with DTC who underwent total thyroidectomy were divided into the apitherapy group (group A, n = 60) and the control group (group B, n = 60). Group A received 2.5 g of acacia honey three times daily after each meal during admission for RAIT. Statistical analyses were performed using the Saxon test (which is used to evaluate saliva volume) and salivary gland scintigraphy (which is applied to assess maximum uptake ratio and washout ratio). RESULTS: Compared with group B, group A presented with a more significantly positive change in the rate of amount of saliva before and after treatment (P < 0.01). Group B presented a significant decrease in the maximum uptake ratio of the bilateral parotid and submandibular glands on salivary gland scintigraphy (P < 0.05) and washout ratio of all salivary glands (P < 0.05). Group A did not present significant differences in the maximum uptake ratio and washout ratio. CONCLUSIONS: Apitherapy can have protective effects against salivary gland disorder associated with RAIT in patients with DTC.

The utility of a deep learning-based algorithm for bone scintigraphy in patient with prostate cancer.

OBJECTIVE: Bone scintigraphy has often been used to evaluate bone metastases. Its functionality is evident in detecting bone metastasis in patients with malignant tumor including prostate cancer, as appropriate treatment and prognosis are dependent on the presence and degree of bone metastasis. The development of a deep learning-based algorithm in the field of information processing has been remarkable in recent years. We hypothesized that a deep learning-based algorithm is useful in diagnosing osseous metastases in patients with prostate cancer using bone scintigraphy. Thus, this study aims to examine the utility of deep learning-based algorithm in detecting bone metastases in patients with prostate cancer, as compared with nuclear medicine specialists. METHODS: In total, 139 serial patients with prostate cancer, who underwent whole-body bone scintigraphy, were enrolled in this study. Each scintigraphy examination was evaluated visually and independently by nuclear medicine specialists; this was also analyzed using a deep learning-based algorithm. The number of abnormal uptakes was assessed by the nuclear medicine specialists and with a software which used the deep learning-based algorithm, and the per-patient detection rate and the per-region detection rate were then calculated. The software automatically analyzed bone scintigraphy for the presence or absence of osseous metastasis in individual patients, for the 12 body regions. The detection rates analyzed separately by the nuclear medicine specialists and using the software were then compared. The sensitivity, specificity, and accuracy by the specialist and with the software were calculated. RESULTS: The sensitivity, specificity, and accuracy by the nuclear medicine specialists were 100%, 94.9% and 97.1%. On the other hand, they with the software were 91.7%, 87.3% and 89.2%. No statistically significant difference was determined between the per-patient detection rates assessed by the specialists versus the software. In regional assessment, there was also no statistically significant difference between most of the per-region detection rates (10 of 12 regions) by the specialists versus the results obtained by the software. CONCLUSIONS: The software with the deep learning-based algorithm might be used as diagnostic aid in the evaluation of bone metastases for prostate cancer patients.

Noninvasive estimation of quantitative myocardial blood flow with Tc-99m MIBI by a compartment model analysis in rat.

BACKGROUND: We aimed to investigate the use of dynamic cardiac planar images to estimate myocardial blood flow (MBF) by a compartment model analysis using time-to-peak (TP) map and compared it by the microsphere technique in rat. Positron emission tomography is considered the gold standard method, but is not available everywhere. By contrast, although myocardial perfusion imaging (MPI) with single-photon tracers is more widely available, it may be difficult to obtain adequate region of interest (ROI) settings. We proposed using the TP map to set the ROI, and hypothesized that this method could facilitate the measurement of absolute MBF by MPI in rat. METHODS: Twenty-one normal rats were studied. Dynamic planar images with Tc-99m MIBI were obtained, and input function and cardiac ROIs were set using the obtained TP map. MBF was estimated by a one-compartment model analysis with the Renkin-Crone model and by the microsphere technique. RESULTS: The MBFs from these two methods were significantly correlated. A negative proportional bias was observed, but no significant difference was observed between the mean MBFs calculated with each method. CONCLUSIONS: MBF estimation by a compartment model analysis using TP map could facilitate absolute MBF measurement in rats.

An investigation of asymmetric reduction in dopamine transporter density in patients with Parkinson's disease.

Asymmetric motor symptoms and the contralateral side of dopaminergic deficits are commonly observed in patients with Parkinson's disease. The laterality of the specific binding ratio (SBR) for dopamine transporter single-photon emission computed tomography may be useful for estimation of reduced dopamine transporter density in striatum of patients with Parkinson's disease. SBR with Southampton method (S-SBR) is widely used to evaluate in our country, but the results occasionally contradict with that of motor symptoms or visual evaluation in clinical practice, thus preventing a confident diagnosis. We reported dopamine transporter evaluation with distance-weighted histogram (DWH). We hypothesized that the SBR calculated using DWH (DWH-SBR) may also be useful to evaluate the laterality. The purpose of this study was to investigate the laterality of the SBR versus the asymmetry of motor symptoms, and versus visual evaluation. In total, 100 adult patients with Parkinson's disease were enrolled in our study. The symptom-affected side, the visual-affected side, and the lower SBR side were evaluated. The evaluation was performed in a blinded manner. Correlations between the Hoehn and Yahr scale (HY scale) and both the SBRs were also investigated. Concordance of lower DWH-SBR side for visual-affected side was significantly higher (99.0%) than it of lower S-SBR side (86.0%, P < 0.01). The HY scale was significantly related to both lower S-SBR and DWH-SBR (P < 0.01). The DWH method might minimize the disagreement of laterality between the SBR and visual evaluation, and be useful for making a confident diagnosis in patients with Parkinson's disease.

Inter- and intra-observer reproducibility of quantitative analysis for FP-CIT SPECT in patients with DLB.

BACKGROUND: Dopamine transporter single photon emission CT (DAT-SPECT) is useful in the evaluation of dementia with Lewy bodies (DLB). The specific binding ratio (SBR) is an index to measure DAT density. However, poorly reproducible cases are occasionally experienced in clinical practice. We hypothesized that distance-weighted histogram (DWH) may be useful to improve the reproducibility of SBR. The purpose of this study was to investigate inter- and intra-observer reproducibility of SBR with conventional and DWH methods, and to visually evaluate the precision in reference voxel of interest (VOI) definition using these methods. METHODS: This study included 50 adult patients with probable DLB. They underwent brain MRI, DAT-SPECT, and cerebral blood flow SPECT with N-isopropyl-p-[123I]iodoamphetamine (I-123 IMP). SBR of the striatum was calculated using conventional and DWH method. For inter-observer reproducibility validation, conventional and DWH SBR were independently evaluated by experienced nuclear medicine physicians; these measurements were repeated by the nuclear medicine physician to investigate intra-observer reproducibility. RESULTS: Proper reference VOI definition was achieved in 60.0% using conventional SBR and in 98.0% with DWH SBR. Both conventional and DWH SBR demonstrated good inter- and intra-observer reproducibility, however, there were statistically significant inter- and intra-observer variations with conventional SBR measurements. Average inter- and intra-observer errors of conventional SBR were 7.9 and 6.1%, respectively. Conversely, DWH SBR errors were not observed in all patients. Moreover, average inter- and intra-observer errors were significantly higher in conventional SBR with improper reference VOI definition than in that with proper reference VOI definition. CONCLUSIONS: Although the reproducibility of conventional and DWH SBR was good, inter- and intra-observer bias could not be ignored in conventional SBR, particularly with improper reference VOI definition. Thus, DWH may be useful to improve inter- and intra-observer reproducibility of SBR.

SUV navigator enables rapid [18F]-FDG PET/CT image interpretation compared with 2D ROI and 3D VOI evaluations.

PURPOSE: Positron emission tomography (PET) and the maximum standardized uptake value (SUVmax) is a useful technique for assessing malignant tumors. Measurements of SUVmax in multiple lesions per patient frequently require many time-consuming procedures. To address this issue, we designed a novel interface named SUV Navigator (SUVnavi), and the purpose of this study was to investigate its utility. MATERIALS AND METHODS: We measured SUVmax in 661 lesions from 100 patients with malignant tumors. Diagnoses and SUVmax measurements were made with SUVnavi, 2D, and 3D measurements. SUV measurement accuracy in each method were also evaluated. RESULTS: The average reduction in time with SUVnavi versus 2D was 53.8% and 3D was 37.5%; time required with SUVnavi was significantly shorter than with 2D and 3D (P < 0.001 and P < 0.001, respectively). The time reduction and lesion number had a positive correlation (P < 0.001 and P < 0.001, respectively). SUVmax agreed with precise SUVmax in all lesions measured with SUVnavi and 3D but in only 466 of 661 lesions (70.5%) measured with 2D. CONCLUSION: SUVnavi may be useful for rapid [18F]-fluorodeoxyglucose positron emission tomography/computed tomography ([18F]-FDG PET/CT) image interpretation without reducing the accuracy of SUVmax measurement.

A novel iterative modified bicubic interpolation method enables high-contrast and high-resolution image generation for F-18 FDG-PET.

Positron emission tomography (PET) has become a useful and important technique in oncology. However, spatial resolution of PET is not high; therefore, small abnormalities can sometimes be overlooked with PET. To address this problem, we devised a novel algorithm, iterative modified bicubic interpolation method (IMBIM). IMBIM generates high resolution and -contrast image. The purpose of this study was to investigate the utility of IMBIM for clinical FDG positron emission tomography/X-ray computed tomography (PET/CT) imaging.We evaluated PET images from 1435 patients with malignant tumor and compared the contrast (uptake ratio of abnormal lesions to background) in high resolution image with the standard bicubic interpolation method (SBIM) and IMBIM. In addition to the contrast analysis, 340 out of 1435 patients were selected for visual evaluation by nuclear medicine physicians to investigate lesion detectability. Abnormal uptakes on the images were categorized as either absolutely abnormal or equivocal finding.The average of contrast with IMBIM was significantly higher than that with SBIM (P < .001). The improvements were prominent with large matrix sizes and small lesions. SBIM images showed abnormalities in 198 of 340 lesions (58.2%), while IMBIM indicated abnormalities in 312 (91.8%). There was statistically significant improvement in lesion detectability with IMBIM (P < .001).In conclusion, IMBIM generates high-resolution images with improved contrast and, therefore, may facilitate more accurate diagnoses in clinical practice.

A Randomized Controlled Trial for the Effectiveness of Aromatherapy in Decreasing Salivary Gland Damage following Radioactive Iodine Therapy for Differentiated Thyroid Cancer.

Objective. The aim of this study was to investigate effects of aromatherapy in decreasing salivary gland damage for patients undergoing radioactive iodine (RAI) therapy with differentiated thyroid cancer (DTC). Materials and Methods. The subjects were 71 patients with DTC. They were divided into aromatherapy group (group A, n = 35) and a control group (group B, n = 36). We blended 1.0 mL of lemon and 0.5 mL of ginger essential oils. The patients in the inhalation aromatherapy group inhaled this blend oil and those in the control group inhaled distilled water as placebo for 10 min during admission. We statistically compared salivary gland function before and after treatment between groups A and B. Results. In comparison with group B, the rate of change of the accumulation rate was significantly higher in the parotid glands and submandibular glands of group A (P < 0.05). In comparison with group B, a significant increase in rate of secretion change before and after treatment was noted in the bilateral parotid glands in group A (P < 0.05). Conclusion. Because an amelioration of salivary gland function was observed in the present study, our results suggest the efficacy of aromatherapy in the prevention of treatment-related salivary gland disorder. This trial is registered with UMIN Clinical Trial Registry: UMIN000013968.

A Quantitative Evaluation of Hepatic Uptake on I-131 Whole-Body Scintigraphy for Postablative Therapy of Thyroid Carcinoma.

This study aimed to determine clinical association between quantitative hepatic uptake on postablative whole-body scan (WBS) with differentiated thyroid cancer (DTC) prognosis. We analyzed 541 scans of 216 DTC patients who were divided into 3 groups based on radioactive iodine (I-131) WBS uptake and clinical follow-up: group 1 (completion of ablation), group 2 (abnormal uptake in the cervical region), and group 3 (abnormal uptake with distant metastases). For each group, we calculated the ratio of I-131 WBS hepatic uptake (H) to cranial uptake as background (B); this ratio was defined as H/B. Furthermore, we made a distinction between group 1, as having completed radioactive iodine therapy (RIT) (CR), and group 2 and 3, as requiring subsequent RIT (RR). The average H/B scores were 1.34 (median, 1.36; range 1.00-2.1) for group 1; 1.89 (median, 1.75; range 1.41-4.20) for group 2; and 2.09 (median, 1.90; range 1.50-4.32) for group 3. Bonferroni multiple comparisons revealed significant differences in H/B among these groups. The H/B of group 1 was significantly smaller than that of other 2 groups (P < 0.0001). The precise cutoff value of H/B for therapeutic effect was ≤1.5. Moreover, 159 of 160 scans in the CR and 375 of 381 patients in the RR were correctly diagnosed using this cutoff value in the final outcome of RIT, yielding a sensitivity, specificity, positive predictive value, and negative predictive value of 99.4%, 98.4%, 99.7%, and 96.3%, respectively. Increased hepatic uptake of I-131 on WBS may predict disease-related progression.

Dual-time-point F-18 FDG PET/CT imaging for differentiating the lymph nodes between malignant lymphoma and benign lesions.

PURPOSE: The purpose of the present study is to evaluate the clinical value of dual-time-point F-18 FDG PET/CT imaging to differentiate malignant lymphoma (ML) from benign lymph node (BLN). MATERIALS AND METHODS: The subjects were 310 lymph nodes in 84 patients (195 ML lesions in 30 patients and 115 BLN in 54 patients associated with various etiologies.). F-18 FDG PET/CT scan was performed at 50 min (early scan) and at 100 min (delayed scan) after the injection. First, the maximum standardized uptake value (SUVmax) of each lesion at early and delayed scans was calculated. Second, we estimated the difference between early and delayed SUVmax (D-SUVmax) and the retention index (RI-SUVmax) to evaluate the change of tracers in the lesions. Furthermore, proper cut-off values of them were evaluated using receiver operating characteristic analysis. The efficacy of each parameter was analyzed with ANOVA. RESULTS: Delayed SUVmax and D-SUVmax in ML were significantly higher than those in BLN. Proper cut-off value in delayed SUVmax was 4.0 and in D-SUVmax was 1.0. When the proper cut-off value in D-SUVmax was applied, the D-SUVmax yielded the role of diagnosis with sensitivity of 82.6%, specificity of 65.2%, positive predictive value of 80.1% and negative predictive value of 68.8%, respectively. CONCLUSIONS: The delayed SUVmax and D-SUVmax were useful indices to differentiate ML from BLN, regardless of histologic subtype. Dual-time-point F-18 FDG PET/CT imaging may help to consider whether there is any need to proceed to more invasive tests, such as biopsy, in individual patients.

"Hot" vertebra on (18)F-FDG PET scan: a case of vertebral hemangioma.

An F-FDG-PET with CT scan was performed to stage a tongue cancer, revealing the hypermetabolic region in the thoracic vertebra. This corresponded to a benign lesion seen on MRIs and CT.Although these findings suggested a vertebral hemangioma, "hot" vertebra in FDG-PET was atypical. The final diagnosis was confirmed capillary hemangioma by the scopic biopsy and this lesion was no change at 1 year later.Careful interpretation of metabolic (FDG-PET) and anatomic (CT and MRI) images should be performed to accurately characterize the foci of increased FDG uptake.