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Martínez Bravo WR, García Vicente AM, Noriega Álvarez E, González García B, López-de la Manzanara C, Cordero García JM, Soriano Castrejón Á. Failure of scintigraphy lymphatic mapping in endometrial cancer. Causes and solutions. Rev Esp Med Nucl Imagen Mol 2022; 41:78-85. [DOI: 10.1016/j.remnie.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/20/2021] [Indexed: 10/21/2022]
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2
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Lymphoscintigraphy and lymphedema. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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3
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Martínez Bravo WR, García Vicente AM, Noriega Álvarez E, González García B, López-de la Manzanara C, Cordero García JM, Soriano Castrejón Á. Failure of scintigraphy lymphatic mapping in endometrial cancer. Causes and solutions. Rev Esp Med Nucl Imagen Mol 2021; 41:S2253-654X(21)00059-7. [PMID: 34420892 DOI: 10.1016/j.remn.2021.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the effect of technical problems and patient characteristics on sentinel lymph node (SLN) scintigraphic detection and mapping success in early stages of endometrial cancer (EC). METHODS Patients with clinical early stage EC (IA-IB) underwent SLN mapping using technetium-99m-nanocolloid,between September 2011 and February 2020. were included. There were excluded cases with technical problems, 92 patients were included for the analysis of the diagnostic performance and the relation of mapping failure (pelvic unilateral or not detected SLN) with patient (age, body mass index, previous pelvic disease or surgery) and disease characteristics (histology, grade, myometrial invasion, lymphovascular space infiltration, tumor size, and lymphatic infiltration risk). RESULTS The overall detection rate was 79%. Lymph node metastases were diagnosed in 7 patients. Age (p=0.01), depth of myometrial invasion ≥ 50% (p=0.04) and high risk of lymphatic infiltration (p=0.02) were positively associated with mapping failure. In multivariate analysis, age was significantly associated with mapping failure [odds ratio=1.63, 95%CI: 1.06-2.50; p=0.027]. CONCLUSIONS Age, depth of myometrial invasion and high risk of lymphatic infiltration were the factors associated with higher mapping failure. An individualized injection technique, optimizing the methodology, could minimize the detection failures.
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Affiliation(s)
| | - A M García Vicente
- Nuclear Medicine Department, University General Hospital, Ciudad Real, España.
| | - E Noriega Álvarez
- Nuclear Medicine Department, University General Hospital, Ciudad Real, España
| | - B González García
- Nuclear Medicine Department, University General Hospital, Ciudad Real, España
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Tucker AB, Krishnan P, Agarwal S. Lymphovenous shunts: from development to clinical applications. Microcirculation 2021; 28:e12682. [PMID: 33523573 DOI: 10.1111/micc.12682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/12/2021] [Indexed: 01/19/2023]
Abstract
The lymphatic system is a vast network of vessels that functions to return excess fluid from the interstitial space to the blood stream. Lymphovenous shunts are anastomoses, either natural or surgical, that connect the lymphatic and venous systems. Connections between the thoracic duct and venous system or between the right lymphatic duct and venous system are prime examples of anatomic lymphovenous shunts. Lymphovenous shunts are also present peripherally in tissues such as lymph nodes. Furthermore, pathologic lymphovenous shunts are observed in conditions such as lymphedema, malignancy, and lymphovenous malformations. Surgically, lymphovenous shunts may be constructed as an approach to treat lymphedema. Here, we discuss anatomic and surgical lymphovenous shunts in the context of normal development and disease. This perspective is intended to give an understanding of the role of lymphovenous shunts in health and disease and to show how they can be leveraged to treat disease surgically.
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Affiliation(s)
- A Blake Tucker
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Pranav Krishnan
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Shailesh Agarwal
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Fei X, Wang X, Lu Q, Lu C, Chen H, Li C. The influence of thoracic duct ligation on long-term survival of patients with esophageal cancer: a propensity score-matched analysis. J Thorac Dis 2020; 12:5532-5541. [PMID: 33209386 PMCID: PMC7656437 DOI: 10.21037/jtd-20-1341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Ligation of the thoracic duct (LTD) is known to be a useful way to prevent postoperative chylothorax, but its impact on long-term survival is rare to be assessed. Methods Data from 609 patients with esophageal cancer who underwent esophagectomy from September, 2012, to January, 2014, were retrospectively collected. The study cohort was classified into two groups: the thoracic duct ligation group (LG) and the non-ligation group (NLG). Propensity score matching (PSM) was performed to control confounding factors between the two groups. Postoperative complications and length of stay were compared between the two groups. Overall survival was estimated using the Kaplan-Meier method, and compared using the log-rank test. Independent prognostic factors were determined using Cox regression analysis. Results After PSM, there were 185 patients in each of the two groups. LTD had no significant impact on chylothorax, anastomotic leak, recurrent nerve palsy, pneumonia and length of stay (P>0.05). The 1-, 3- and 5-year survival rates were 87.0%, 64.1%, and 50.9% in the LG, respectively, compared to 85.4%, 59.9%, and 42.3%, respectively, in the NLG. The differences between the 2 groups were not statistically significant (P=0.156). In the multivariable analysis, LTD was not an independent prognostic factor, neither before nor after PSM. Conclusions Our study demonstrated that LTD had no significant impact on postoperative complications or long-term survival in patients with esophageal cancer.
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Affiliation(s)
- Xiang Fei
- Department of Thoracic Surgery, Changhai Hospital affiliated to Second Military Medical University, Shanghai, China
| | - Xinyu Wang
- Department of Thoracic Surgery, Changhai Hospital affiliated to Second Military Medical University, Shanghai, China
| | - Qijue Lu
- Department of Thoracic Surgery, Changhai Hospital affiliated to Second Military Medical University, Shanghai, China
| | - Chaojing Lu
- Department of Thoracic Surgery, Changhai Hospital affiliated to Second Military Medical University, Shanghai, China
| | - Hezhong Chen
- Department of Thoracic Surgery, Changhai Hospital affiliated to Second Military Medical University, Shanghai, China
| | - Chunguang Li
- Department of Thoracic Surgery, Changhai Hospital affiliated to Second Military Medical University, Shanghai, China
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6
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Absence of hepatic activity in lymphoscintigraphy performed with Tc-99m-Nanoscan. Nucl Med Commun 2020; 41:505-509. [DOI: 10.1097/mnm.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Vaz MMOLL, de Jesus Guirro RR, Carrara HHA, Montezuma T, Perez CS, de Oliveira Guirro EC. Alteration of Blood Circulation in the Upper Limb Before and After Surgery for Breast Cancer Associated with Axillary Lymph Node Dissection or Sentinel Lymph Node Biopsy. Lymphat Res Biol 2017; 15:343-348. [PMID: 28956696 DOI: 10.1089/lrb.2017.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This aim of this study was to assess and compare arterial and venous circulation in women with axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) before and after breast cancer surgery. METHODS AND RESULTS Fifty-two women took part in the study, divided into three groups: those undergoing ALND at levels I, II, and III (ALNDG), with mean age of 56.29 ± 10.85 years old; those undergoing sentinel lymph node biopsy (SLNBG), with mean age of 57.7 ± 7.07 years old; and controls without diagnosis of breast cancer (CG), with mean age of 53.92 ± 8.85 years old. Maximum venous and arterial flow velocities in upper limbs were assessed before and after surgical treatment for breast cancer by means of Doppler ultrasonography (Nicolet Vascular Versalab SE®). Data normality was assessed by using the Shapiro-Wilk's test, with normally distributed variables being analyzed with analysis of variance (ANOVA) and post hoc Tukey's test or t-test. For variables with non-normal distribution, Kruskal-Wallis' test and post hoc Dunn's test were used at p < 0.05. There was significant difference in the maximum blood flow velocities, both venous (ALNDG) and arterial (SLNBG). CONCLUSION The results suggest that ALND and SLNB can interfere with the upper limp blood circulation.
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Affiliation(s)
- Maíta M O L L Vaz
- 1 Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto, Brazil
| | - Rinaldo Roberto de Jesus Guirro
- 1 Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto, Brazil
| | - Hélio Humberto Angotti Carrara
- 2 Postgraduate Program in Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto, Brazil
| | - Thais Montezuma
- 1 Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto, Brazil
| | - Carla Silva Perez
- 1 Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto, Brazil
| | - Elaine Caldeira de Oliveira Guirro
- 1 Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto, Brazil
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Sahbai S, Taran FA, Staebler A, Wallwiener D, la Fougère C, Brucker S, Dittmann H. Sentinel lymph node mapping using SPECT/CT and gamma probe in endometrial cancer: an analysis of parameters affecting detection rate. Eur J Nucl Med Mol Imaging 2017; 44:1511-1519. [PMID: 28374119 DOI: 10.1007/s00259-017-3692-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 03/23/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE SPECT/CT after pericervical injection of technetium-99 m-nanocolloid was shown to be suitable for sentinel lymph node (SLN) mapping in endometrial cancer (EC). The aim of this study was to analyze factors affecting successful SLN detection by means of SPECT/CT such as imaging findings, patient characteristics and tumor biology in a large cohort of patients. METHODS One hundred and forty-five consecutive patients suffering from EC who received pre-surgical SLN mapping at our institution between 2011 and 2016 were included in this analysis. SPECT/CT data of abdomen and pelvis (mean 4:20 ± 1:20 h p.i.) were acquired after pericervical injection of technetium-99 m-nanocolloid (mean 230 ± 45 MBq) in all patients. Surgical staging was performed on the day after. Acquisition parameters, patient characteristics, SPECT/CT findings as well as histopathological results were collected. RESULTS A total of 282 SLNs were identified by means of SPECT/CT. Overall, preoperative and intraoperative SLN detection rates were 86%, 76% and 74% respectively. The most important factor associated with failure to detect SLNs was the presence of high bone marrow on SPECT/CT (p = 0.005). Peritoneal/abdominal radioactivity was also associated with missed SLN detection in SPECT/CT (p = 0.02). However, the presence of liver/spleen uptake on its own was not predictive for detection failure. Low numbers of detected SLNs in SPECT/CT were slightly related with older age and lower injected activity. No significant influence was found for the parameters of tumor histology and stage, lymph node involvement and the time gap between injection and imaging. CONCLUSIONS Venous drainage as indicated by bone marrow uptake is the most important factor associated with scintigraphic SLN detection failure. Moreover, high peritoneal and abdominal activity was also associated with detection failure. Thus, meticulous application of the radiotracer is crucial in EC.
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Affiliation(s)
- Samine Sahbai
- Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Otfried-Müller-Straße 14, 72076, Tübingen, Germany.
| | - Florin-Andrei Taran
- Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Diethelm Wallwiener
- Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Christian la Fougère
- Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Otfried-Müller-Straße 14, 72076, Tübingen, Germany
| | - Sara Brucker
- Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Helmut Dittmann
- Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Otfried-Müller-Straße 14, 72076, Tübingen, Germany
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Soares MM, Keramida G, Glass DM, Mortimer PS, Peters AM. Lymph proteins may access peripheral blood without entering thoracic duct in patients with lymphatic dysfunction. J Vasc Surg Venous Lymphat Disord 2016; 4:215-20. [DOI: 10.1016/j.jvsv.2015.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 10/11/2015] [Indexed: 10/22/2022]
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Miranda Garcés M, Mirapeix R, Pons G, Sadri A, Masià J. A comprehensive review of the natural lymphaticovenous communications and their role in lymphedema surgery. J Surg Oncol 2016; 113:374-80. [DOI: 10.1002/jso.24158] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/21/2015] [Indexed: 01/25/2023]
Affiliation(s)
- María Miranda Garcés
- Department of Plastic Surgery; Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona; Barcelona Spain
| | - Rosa Mirapeix
- Department of Anatomy and Embriology; Universitat Autonoma de Barcelona; Bellaterra Barcelona Spain
| | - Gemma Pons
- Department of Plastic Surgery; Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona; Barcelona Spain
| | - Amir Sadri
- Department of Plastic Surgery; Chelsea and Westminster Hospital; London United Kingdom
| | - Jaume Masià
- Department of Plastic Surgery; Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona; Barcelona Spain
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Proposed pathway and mechanism of vascularized lymph node flaps. Gynecol Oncol 2016; 141:182-8. [PMID: 26773469 DOI: 10.1016/j.ygyno.2016.01.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/29/2015] [Accepted: 01/06/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the pump mechanism and pathway of lymph transit in vascularized lymph node flaps. BACKGROUND Microsurgical treatment of lymphedema with vascularized lymph node transfer can improve signs and symptoms of disease, but the pathways and mechanisms of these flaps warrant further exploration. METHODS (Animal model) 72 flaps were raised in 18 rats: 36 groin flaps contained lymph nodes (LN), 36 deep inferior epigastric artery perforator flaps did not (non-LN). Indocyanine green (ICG) was added into normal saline (NS), 1%, 3%, 5%, 7% and 10% albumin. Three rats were assigned to each group. LN and non-LN flaps were submerged in solution and surveyed for venous fluorescence. In the 7% albumin and NS groups, volumetric change of solution was measured. (Human model) A similar experiment was performed in humans using five submental LN flaps. RESULTS (Animal model) Fluorescence was detected in the venous pedicle of LN flaps submerged in 5%, 7% and 10% albumin, and half of flaps submerged in 3% albumin. Fluorescence was not detected in LN node flaps submerged in ICG-containing NS or 1% albumin solution. Fluorescence was not detected in non-LN flaps. There was greater volume reduction with LN flaps than non-LN flaps (p<0.001). (Human model) Fluorescence was detected in the venous pedicle of all flaps immersed in lymph. CONCLUSIONS ICG fluorescence was detected in the venous pedicle of rat and human LN flaps submerged in lymph or albumin when the concentration was greater than 3%. Based on these results, a pathway for lymphatic uptake is presented.
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Keramida G, Lee M, Aplin M, Singh N, Peters AM. Reproducible lymph-to-blood transfer of Tc-99m-nanocolloid in a patient with abnormal lymphatic function. Vasc Med 2015; 20:569-70. [DOI: 10.1177/1358863x15582289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Georgia Keramida
- Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Matthew Lee
- Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Mark Aplin
- Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Nitasha Singh
- Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Michael Peters
- Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Estimating Lymphodynamic Conditions and Lymphovenous Anastomosis Efficacy Using (99m)Tc-phytate Lymphoscintigraphy with SPECT-CT in Patients with Lower-limb Lymphedema. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e404. [PMID: 26090294 PMCID: PMC4457267 DOI: 10.1097/gox.0000000000000375] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 04/01/2015] [Indexed: 11/27/2022]
Abstract
Background: Diagnostic and therapeutic strategies for lower-limb lymphedema have not yet been established. The purpose of this study was to estimate the lymphodynamic condition and therapeutic efficacy of lymphovenous anastomosis (LVA) in lower-limb lymphedema patients using 2-phase 99mTc-phytate lymphoscintigraphy with single-photon emission computed tomography-computed tomography (SPECT-CT). Methods: In this study, consecutive patients with lower-limb lymphedema who underwent 2-phase lymphoscintigraphy using 99mTc-phytate were enrolled between June 2013 and June 2014. SPECT-CT was also performed to clarify the relationships between functional and morphological information. In both the early and delayed images, inguinal lymph node accumulation, dermal backflow, and their sequential alternations were evaluated, and liver-to-blood ratio and inguinal lymph node-to-blood ratio were calculated. All participants were classified into 6 types of lymphodynamic conditions based on the image findings. Patients with both dermal backflow and associated normal lymphatic vessel accumulation proceeded to LVA and underwent a second lymphoscintigraphy after the operation. Results: Of all 30 participants, the largest population was categorized as type 4, which had consistent inguinal lymph node accumulation defect with dermal backflow. In 12 operated cases, dermal backflow was degraded in 10 cases by LVA. Liver-to-blood ratio in both early and delayed images and inguinal lymph node-to-blood ratio in delayed image significantly increased after LVA. Conclusions: Lymphoscintigraphy with SPECT-CT can provide both functional and morphological information simultaneously in patients with lower-limb lymphedema. Using these procedures, a type categorization for the patients was devised, which reflects their lymphodynamic conditions. The therapeutic efficacy of LVA could also be estimated quantitatively by the derived findings.
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Keramida G, Humphrys M, Ryan N, Peters AM. “Stocking Effect” in Lymphoscintigraphy. Lymphat Res Biol 2014; 12:194-6. [DOI: 10.1089/lrb.2014.0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Georgia Keramida
- Department of Nuclear Medicine, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Melissa Humphrys
- Department of Nuclear Medicine, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Nicola Ryan
- Department of Nuclear Medicine, Royal Sussex County Hospital, Brighton, United Kingdom
| | - A. Michael Peters
- Department of Nuclear Medicine, Royal Sussex County Hospital, Brighton, United Kingdom
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