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Dietlein M, Grünwald F, Schmidt M, Kreissl MC, Luster M. [Guideline for Radioiodine Therapy for Benign Thyroid Diseases (6/2022 - AWMF No. 031-003)]. Nuklearmedizin 2024; 63:8-20. [PMID: 37871629 DOI: 10.1055/a-2185-7885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
This version of the guideline for radioiodine therapy of benign thyroid disorders is an update of the version, which was published by the German Society of Nuclear Medicine (Deutsche Gesellschaft für Nuklearmedizin, DGN) in co-ordination with the German Society of Endocrinology (Deutsche Gesellschaft für Endokrinologie, DGE, Sektion Schilddrüse) and the German Society of General- and Visceral-Surgery (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, DGAV) in 2015. This guideline was harmonized with the recommendations of the European Association of Nuclear Medicine (EANM). According to the German "Directive on Radiation Protection in Medicine" the physician specialised in nuclear medicine ("Fachkunde in der Therapie mit offenen radioaktiven Stoffen") is responsible for the justification to treat with radioiodine. Therefore, relevant medical indications for radioiodine therapy and alternative therapeutic options are discussed within the guideline. This procedure guideline is developed in the consensus of an expert group. This fulfils the level S1 (first step) within the German classification of Clinical Practice Guidelines.
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Affiliation(s)
- M Dietlein
- Klinik und Poliklinik für Nuklearmedizin des Universitätsklinikums Köln
| | - F Grünwald
- Klinik für Nuklearmedizin des Universitätsklinikums Frankfurt
| | - M Schmidt
- Klinik und Poliklinik für Nuklearmedizin des Universitätsklinikums Köln
| | - M C Kreissl
- Bereich Nuklearmedizin, Klinik für Radiologie und Nuklearmedizin des Universitätsklinikums Magdeburg
| | - M Luster
- Klinik für Nuklearmedizin des Universitätsklinikums Marburg
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Happel C, Bockisch B, Leonhäuser B, Sabet A, Grünwald F, Groener D. The influence of thionamides on intra-thyroidal uptake of 131I during radioiodine-131 treatment of Graves' disease. Sci Rep 2023; 13:21190. [PMID: 38040820 PMCID: PMC10692093 DOI: 10.1038/s41598-023-47228-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/10/2023] [Indexed: 12/03/2023] Open
Abstract
Graves' disease is one of the most common causes of hyperthyroidism. Guideline recommendations advocate the intake of thionamides for at least 1 year. If hyperthyroidism persists, subsequent radioiodine-131 treatment (RIT) is a therapeutic option. Thionamides are known to influence intra-thyroidal bio-kinetics of iodine and should therefore be discontinued at least 3 days prior to RIT if possible. However, the required therapeutic activity has to be calculated individually by pre-therapeutic measurement of the uptake prior to RIT [radioiodine-131 uptake test (RIUT)] in Germany according to national guidelines. Therefore, the aim of this study was to quantify the influence of thionamides on intra-therapeutic uptake. A cohort of 829 patients with Graves' disease undergoing RIUT and RIT was analysed. Patients were subdivided into three groups. Group A: patients with carbimazole medication (n = 312), group B: patients with methimazole medication (n = 252) and group C: patients without thionamides (n = 265). Group A and B were further subdivided depending on the reduction of dosage of thionamides. In order to analyse the influence of thionamides, the variance of the determined individual extrapolated maximum intra-thyroidal uptake (EMU) between RIUT and RIT within the single groups and within the subgroups was statistically evaluated. When administering an equal dose of thionamides or no thionamides in RIUT and RIT (groups A1, B1 and C) no significant differences were detected when comparing EMU in RIT to EMU in RIUT (p > 0.05). In the subgroups A2-A4 (reduced dosage of carbimazole prior to RIT) EMU was significantly increased in RIT compared to RIUT [21% for a reduction of 0 to < 10 mg/d (A2), 39% for a reduction of 10-15 mg/d (A3) and 80% for a reduction of > 15 mg/d (A4)]. In the subgroups B2-B4 (reduced dosage of methimazole prior to RIT) EMU was as well significantly increased in RIT compared to RIUT [26% for a reduction of 0 to < 10 mg/d (B2), 36% for a reduction of 10-15 mg/d (B3) and 59% for a reduction of > 15 mg/d (B4)]. A significant dose-dependent increase of EMU in RIT compared to EMU in RIUT in patients discontinuing or reducing thionamides was detected. Therefore, thionamides should be discontinued at least 2 days prior to RIUT in order to achieve the designated target dose more precisely and to minimize radiation exposure of organs at risk.
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Affiliation(s)
- Christian Happel
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany.
| | - Benjamin Bockisch
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - Britta Leonhäuser
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - Amir Sabet
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - Daniel Groener
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
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Klimek K, Mader N, Happel C, Sabet A, Grünwald F, Groener D. Heat sink effects in thyroid bipolar radiofrequency ablation: an ex vivo study. Sci Rep 2023; 13:19288. [PMID: 37935715 PMCID: PMC10630443 DOI: 10.1038/s41598-023-45926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023] Open
Abstract
The study aimed to investigate heat sink effects in radiofrequency ablation (RFA) under thyroid-specific conditions. In an ex vivo model, bovine thyroid lobes were ablated using bipolar RFA with 2.0 kJ energy input at a power level set to 10 W (n = 35) and 25 W (n = 35). Glass vessels (3.0 mm outer diameter) placed within the ablation zone were used to deliver tissue perfusion at various flow rates (0, 0.25, 0.5, 1, 5, 10, 20 ml/min). Temperature was measured in the proximity of the vessel (Tv) and in the non-perfused contralateral region of the ablation zone (Tc), at equal distances to the ablation electrode (d = 8 mm). Maximum temperature within the perfused zone was significantly lowered with Tv ranging from 54.1 ± 1.5 °C (20 ml/min) to 56.9 ± 1.5 °C (0.25 ml/min), compared to Tc from 63.2 ± 3.5 °C (20 ml/min) to 63.2 ± 2.6 °C (0.25 ml/min) (10 W group). The cross-sectional ablation zone area decreased with increasing flow rates from 184 ± 12 mm2 (0 ml/min) to 141 ± 20 mm2 (20 ml/min) at 10 W, and from 207 ± 22 mm2 (0 ml/min) to 158 ± 31 mm2 (20 ml/min) in the 25 W group. Significant heat sink effects were observed under thyroid-specific conditions even at flow rates ≤ 1 ml/min. In thyroid nodules with prominent vasculature, heat dissipation through perfusion may therefore result in clinically relevant limitations to ablation efficacy.
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Affiliation(s)
- Konrad Klimek
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Nicolai Mader
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Amir Sabet
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Daniel Groener
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany.
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Mader N, Schoeler C, Pezeshkpour N, Klimek K, Groener D, Happel C, Tselis N, Mandel P, Grünwald F, Sabet A. Intermittent Radioligand Therapy with 177Lu-PSMA-617 for Oligometastatic Castration-Resistant Prostate Cancer. Cancers (Basel) 2023; 15:4605. [PMID: 37760574 PMCID: PMC10527374 DOI: 10.3390/cancers15184605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
177Lu-PSMA-617 radioligand therapy (177Lu-PSMA-RLT) in patients with metastatic castration-resistant prostate cancer (mCRPC) currently consists of 4-6 cycles of 6.0-7.4 GBq of 177Lu-PSMA-617 each every 6-8 weeks. While safety and efficacy could be demonstrated in larger prospective trials irrespective of the tumor burden at 177Lu-PSMA RLT initiation, increased renal absorbed doses due to a reduced tumor sink effect in early responding, oligometastatic mCRPC patients pose difficulties. Response-adapted, dose distributing, intermittent treatment with up to six cycles has not been routinely performed, due to concerns about the potential loss of disease control. Treatment was discontinued in 19 early-responding patients with oligometastatic tumor burden after two (IQR 2-3) cycles of 177Lu-PSMA-RLT and 6.5 ± 0.7 GBq per cycle and resumed upon 68Ga-PSMA-11-PET/CT-based progression (according to the PCWG3 criteria). Subsequent treatment breaks were imposed if a PSMA-based imaging response could be achieved. A total of five (IQR 3-6) cycles reaching a cumulative activity of 32 ± 11 GBq were applied. A routine blood work-up including blood counts and liver and renal function was measured throughout the 177Lu-PSMA-RLT and follow-up to grade toxicity according to CTCAE v5.0 criteria. Survival outcome was calculated based on the Kaplan-Meier method. In total, treatment-free periods of 9 (IQR 6-17) cumulative months and the application of 177Lu-PSMA-RLT cycles over 16 (IQR 9-22) months could be achieved. Fifteen (84%) patients responded to subsequent cycles after the first treatment break and in 7/19 (37%) patients, intermittent 177Lu-PSMA-RLT consisted of ≥2 treatment breaks. The median PFS was 27 months (95% CI: 23-31) and overall survival was 45 months (95% CI: 28-62). No grade ≥3 hematological or renal toxicities could be observed during the 45 ± 21 months of follow-up. The cumulative mean renal absorbed dose was 16.7 ± 8.3 Gy and 0.53 ± 0.21 Gy/GBq. Intermittent radioligand therapy with 177Lu-PSMA-617 is feasible in early-responding patients with oligometastatic disease. A late onset of progression after subsequent cycles and the absence of significant toxicity warrants further investigation of the concept of intermittent treatment in selected patients.
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Affiliation(s)
- Nicolai Mader
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (N.M.); (C.S.); (N.P.); (K.K.); (D.G.); (C.H.); (F.G.)
| | - Christina Schoeler
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (N.M.); (C.S.); (N.P.); (K.K.); (D.G.); (C.H.); (F.G.)
| | - Niloufar Pezeshkpour
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (N.M.); (C.S.); (N.P.); (K.K.); (D.G.); (C.H.); (F.G.)
| | - Konrad Klimek
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (N.M.); (C.S.); (N.P.); (K.K.); (D.G.); (C.H.); (F.G.)
| | - Daniel Groener
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (N.M.); (C.S.); (N.P.); (K.K.); (D.G.); (C.H.); (F.G.)
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (N.M.); (C.S.); (N.P.); (K.K.); (D.G.); (C.H.); (F.G.)
| | - Nikolaos Tselis
- Department of Radiation Oncology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany;
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany;
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (N.M.); (C.S.); (N.P.); (K.K.); (D.G.); (C.H.); (F.G.)
| | - Amir Sabet
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (N.M.); (C.S.); (N.P.); (K.K.); (D.G.); (C.H.); (F.G.)
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Groener D, Wichert J, Adams M, Mader N, Klimek K, Nguyen Ngoc C, Baumgarten J, Happel C, Mandel P, Chun FKH, Tselis N, Grünwald F, Sabet A. Impact of [ 177Lu]Lu-PSMA-617 Radioligand Therapy on Reference Organ Uptake Assessed by [ 68Ga]Ga-PSMA-11-PET/CT. Cancers (Basel) 2023; 15:3878. [PMID: 37568694 PMCID: PMC10417367 DOI: 10.3390/cancers15153878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
This study aims to assess the change in uptake to reference organs, including the liver, parotid and salivary glands after radioligand therapy (RLT) with [177Lu]Lu-PSMA-617 in relation to pretreatment imaging metrics. Eighty-five patients with mCRPC underwent [68Ga]Ga-PSMA-11 PET/CT imaging prior to (pre RLT PET) and after (post RLT PET) a median of 3 (IQR 2-6) RLT cycles with [177Lu]Lu-PSMA-617. PSMA-positive tumor burden was stratified into 4 groups based on modified PROMISE criteria (oligofocal, multifocal, disseminated, diffuse). Uptake (SUVmean, SUVmax) in liver tissue, parotid and submandibular glands was measured. A control group was established with 54 patients who had received two separate PET acquisitions following the same protocol (PET1, PET2) within 12 months for localized or oligofocal prostate cancer without RLT in the interim. Baseline uptake values (SUVmean, SUVmax) in parotid (10.8 ± 3.2, 16.8 ± 5.4) and submandibular glands (11.3 ± 2.8, 18.1 ± 4.7) are 2-fold compared to liver uptake (4.9 ± 1.4, 7.7 ± 2.0), with no significant change between PET 1 and PET 2 in the control group. In the RLT group, increasing tumor burden class is significantly associated with decreasing uptake in the liver (p = 0.013), parotid (p < 0.001) and submandibular glands (p < 0.001); this tumor sink effect by respective tumor burden is widely maintained after RLT (p = 0.011, p < 0.001, p < 0.001). RLT has a significant impact on salivary gland uptake with decreasing values per patient in all groups of disease burden change (up to -30.4% in submandibular glands, p < 0.001), while liver tissue shows rising values in patients with declining tumor burden throughout RLT (+18.6%, p = 0.020). Uptake in liver tissue and salivary glands on [68Ga]Ga-PSMA-11 PET/CT imaging is inversely related to tumor burden prior to and following RLT with [177Lu]Lu-PSMA-617. Per patient, salivary gland uptake is further reduced throughout RLT independently from tumor burden, while changes in liver uptake remain burden-dependent. Liver and salivary gland uptake-derived metrics and segmentation thresholds may thus be of limited value when used as reference for response assessment to RLT.
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Affiliation(s)
- Daniel Groener
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Jennifer Wichert
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Magdalena Adams
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Nicolai Mader
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Konrad Klimek
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Christina Nguyen Ngoc
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Justus Baumgarten
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (P.M.); (F.K.H.C.)
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (P.M.); (F.K.H.C.)
| | - Nikolaos Tselis
- Department of Radiation Oncology, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany;
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Amir Sabet
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
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Rosbach N, Fischer S, Koch V, Vogl TJ, Bochennek K, Lehrnbecher T, Mahmoudi S, Grünewald L, Grünwald F, Bernatz S. Correlation of mean apparent diffusion coefficient (ADC) and maximal standard uptake value (SUVmax) evaluated by diffusion-weighted MRI and 18F-FDG-PET/CT in children with Hodgkin lymphoma: a feasibility study. Radiol Oncol 2023; 57:150-157. [PMID: 37341195 DOI: 10.2478/raon-2023-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/27/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The objective was to analyse if magnetic resonance imaging (MRI) can act as a non-radiation exposure surrogate for (18)F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in children with histologically confirmed Hodgkin lymphoma (HL) before treatment. This was done by analysing a potential correlation between apparent diffusion coefficient (ADC) in MRI and the maximum standardized uptake value (SUVmax) in FDG-PET/CT. PATIENTS AND METHODS Seventeen patients (six female, eleven male, median age: 16 years, range: 12-20 years) with histologically confirmed HL were retrospectively analysed. The patients underwent both MRI and (18)F-FDG PET/CT before the start of treatment. (18)F-FDG PET/CT data and correlating ADC maps in MRI were collected. For each HL-lesion two readers independently evaluated the SUVmax and correlating meanADC. RESULTS The seventeen patients had a total of 72 evaluable lesions of HL and there was no significant difference in the number of lesions between male and female patients (median male: 15, range: 12-19 years, median female: 17 range: 12-18 years, p = 0.021). The mean duration between MRI and PET/CT was 5.9 ± 5.3 days. The inter-reader agreement as assessed by the intraclass correlation coefficient (ICC) was excellent (ICC = 0.98, 95% CI: 0.97-0.99). The correlated SUVmax and meanADC of all 17 patients (ROIs n = 72) showed a strong negative correlation of -0.75 (95% CI: -0.84, - -0.63, p = 0.001). Analysis revealed a difference in the correlations of the examination fields. The correlated SUVmax and meanADC showed a strong correlation at neck and thoracal examinations (neck: -0.83, 95% CI: -0.93, - -0.63, p < 0.0001, thoracal: -0.82, 95% CI: -0.91, - -0.64, p < 0.0001) and a fair correlation at abdominal examinations of -0.62 (95% CI: -0.83, - -0.28, p = 0.001). CONCLUSIONS SUVmax and meanADC showed a strong negative correlation in paediatric HL lesions. The assessment seemed robust according to inter-reader agreements. Our results suggest that ADC maps and meanADC have the potential to replace PET/CT in the analysis of disease activity in paediatric Hodgkin lymphoma patients. This may help reduce the number of PET/CT examinations and decrease radiation exposure to children.
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Affiliation(s)
- Nicolas Rosbach
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Sebastian Fischer
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Konrad Bochennek
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Thomas Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Leon Grünewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Simon Bernatz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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Groener D, Baumgarten J, Happel C, Mader N, Ngoc CN, Sabet A, Grünwald F. Thyroid papillary cancer elements arising from struma ovarii with benign peritoneal strumosis: Utility of iodine-123 imaging in diagnostics and treatment planning. Clin Case Rep 2023; 11:e7311. [PMID: 37151955 PMCID: PMC10160429 DOI: 10.1002/ccr3.7311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/03/2023] [Accepted: 04/19/2023] [Indexed: 05/09/2023] Open
Abstract
Key Clinical Message In this case of struma ovarii a right-sided ovarian mass contained features of papillary thyroid cancer. Diagnostic iodine-123 revealed multiple foci of extraovarian spread, likely as a manifestation of concomitant peritoneal strumosis. Unilateral oophorectomy, partial peritonectomy, and adjuvant iodine-131 treatment were performed for successful curative treatment. Abstract Struma ovarii is a rare form of mature teratoma defined by a predominance of thyroid tissue. Approximately 5% of all ovarian strumae exhibit malignant transformation. Due to their extreme rarity, there has been a lack of consensus concerning uniform diagnostic criteria. Appropriate, risk-stratified treatment strategies also remain widely unelaborated, based only on a small number of cases reported in the literature. We describe the case of a 35-year-old female, who presented after undergoing unilateral oophorectomy for a right-sided ovarian mass. Histological workup revealed a struma ovarii containing papillary thyroid cancer (PTC). Postoperative I-123 scintigraphy with single photon emission computed tomography (SPECT) detected multifocal extra-ovarian spread to the peritoneum, containing likely benign strumosis upon pathological examination. The subsequent treatment strategy involved an ablative concept including total thyroidectomy and subsequent I-131 radioiodine therapy. Throughout a 3-year follow-up, the patient has remained without recurrence with thyroglobulin levels ranging below detection limits. Surgical resection with adjuvant radioiodine therapy is a curative therapeutic strategy in cases of struma ovarii with thyroid-type carcinoma and peritoneal strumosis. Its benefits lay in avoiding more extensive surgery, potentially maintaining fertility, facilitating follow-up, and minimizing the risk of recurrence. Reliable criteria for risk stratification are needed to identify patients who are most likely to benefit from this treatment approach.
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Affiliation(s)
- Daniel Groener
- Department of Nuclear MedicineUniversity Hospital FrankfurtFrankfurtGermany
| | - Justus Baumgarten
- Department of Nuclear MedicineUniversity Hospital FrankfurtFrankfurtGermany
| | - Christian Happel
- Department of Nuclear MedicineUniversity Hospital FrankfurtFrankfurtGermany
| | - Nicolai Mader
- Department of Nuclear MedicineUniversity Hospital FrankfurtFrankfurtGermany
| | | | - Amir Sabet
- Department of Nuclear MedicineUniversity Hospital FrankfurtFrankfurtGermany
| | - Frank Grünwald
- Department of Nuclear MedicineUniversity Hospital FrankfurtFrankfurtGermany
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Happel C, Gröner D, Kranert WT, Grünwald F. Evaluation of activity kinetics in breast milk and calculation of the resulting effective radiation dose after 99mTc-MIBI scintigraphy of a breastfeeding women. Nuklearmedizin 2023; 62:45-46. [PMID: 36174645 DOI: 10.1055/a-1937-9466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION In breastfeeding women, the indication for scintigraphic imaging is strongly restricted due to potential transition of the radiopharmaceutical to the child via breast milk. The potential activity uptake of the breastfed child depends on the chemical compound of the radio pharmaceutical as well as biokinetics and metabolism in the maternal body. METHODS In the presented case 99mTc-MIBI scintigraphy was performed in a breastfeeding woman with sonographically suspicious thyroid nodules. Breastfeeding was interrupted for 30 hours and the breast milk during this period was collected and analysed to determine the excreted activity and the potentially resulting dose to the breastfed child. RESULTS Activity concentration in the first breast milk sample (1.83 hours after administration of 500 MBq 99mTc-MIBI) was 380 Bq/mL, resulting in an absolute activity of 50 kBq for a sample size of 132 mL. Subsequently activity concentration decreased to 6 Bq/mL (29.8 hours p.i.). The calculated effective half-life of the secretion of 99mTc-MIBI via breast milk was 4.7 hours. The potentially resulting effective dose for the breastfed child was 13.4 µSv (ICRP80: dose coefficient: 0.13 mSv/MBq for 99mTc). CONCLUSION Time activity curve showed a rapid decrease of the 99mTc-MIBI activity secreted to the breast milk. More than 90 % of the total secreted activity is attributable to the first 12 hours after administration. Therefore, an interruption of breastfeeding of 24 hours seems to be adequate.
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Affiliation(s)
- Christian Happel
- University Hospital; Department of Nuclear Medicine, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Germany
| | - Daniel Gröner
- University Hospital; Department of Nuclear Medicine, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Germany
| | - Wolfgang Tilman Kranert
- University Hospital; Department of Nuclear Medicine, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Germany
| | - Frank Grünwald
- University Hospital; Department of Nuclear Medicine, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Germany
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9
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Weber M, Kersting D, Riemann B, Brandenburg T, Führer-Sakel D, Grünwald F, Kreissl MC, Dralle H, Weber F, Schmid KW, Herrmann K, Jentzen W, Grafe H, Rischpler C, Theurer S, Bockisch A, Nagarajah J, Fendler WP. Enhancing Radioiodine Incorporation into Radioiodine-Refractory Thyroid Cancer with MAPK Inhibition (ERRITI): A Single-Center Prospective Two-Arm Study. Clin Cancer Res 2022; 28:4194-4202. [PMID: 35594174 PMCID: PMC9527501 DOI: 10.1158/1078-0432.ccr-22-0437] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/04/2022] [Accepted: 05/17/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Restoration of iodine incorporation (redifferentiation) by MAPK inhibition was achieved in previously radioiodine-refractory, unresectable thyroid carcinoma (RR-TC). However, results were unsatisfactory in BRAFV600E-mutant (BRAF-MUT) RR-TC. Here we assess safety and efficacy of redifferentiation therapy through genotype-guided MAPK-modulation in patients with BRAF-MUT or wildtype (BRAF-WT) RR-TC. PATIENTS AND METHODS In this prospective single-center, two-arm phase II study, patients received trametinib (BRAF-WT) or trametinib + dabrafenib (BRAF-MUT) for 21 ± 3 days. Redifferentiation was assessed by 123I-scintigraphy. In case of restored radioiodine uptake, 124I-guided 131I therapy was performed. Primary endpoint was the redifferentiation rate. Secondary endpoints were treatment response (thyroglobulin, RECIST 1.1) and safety. Parameters predicting successful redifferentiation were assessed using a receiver operating characteristic analysis and Youden J statistic. RESULTS Redifferentiation was achieved in 7 of 20 (35%) patients, 2 of 6 (33%) in the BRAF-MUT and 5 of 14 (36%) in the BRAF-WT arm. Patients received a mean (range) activity of 300.0 (273.0-421.6) mCi for 131I therapy. Any thyroglobulin decline was seen in 57% (4/7) of the patients, RECIST 1.1 stable/partial response/progressive disease in 71% (5/7)/14% (1/7)/14% (1/7). Peak standardized uptake value (SUVpeak) < 10 on 2[18F]fluoro-2-deoxy-D-glucose (FDG)-PET was associated with successful redifferentiation (P = 0.01). Transient pyrexia (grade 3) and rash (grade 4) were noted in one patient each. CONCLUSIONS Genotype-guided MAPK inhibition was safe and resulted in successful redifferentiation in about one third of patients in each arm. Subsequent 131I therapy led to a thyroglobulin (Tg) decline in more than half of the treated patients. Low tumor glycolytic rate as assessed by FDG-PET is predictive of redifferentiation success. See related commentary by Cabanillas et al., p. 4164.
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Affiliation(s)
- Manuel Weber
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany.,Corresponding Author: Manuel Weber, German Cancer Consortium (DKTK) partner site Essen, Hufelandstraße 55, 45147 Essen, Germany. Phone: 49-201-723-2032; Fax: 49-201-723-5658; E-mail:
| | - David Kersting
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany
| | - Burkhard Riemann
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Tim Brandenburg
- German Cancer Consortium (DKTK) partner site Essen, Essen, Germany.,Department of Endocrinology and Metabolism, Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dagmar Führer-Sakel
- German Cancer Consortium (DKTK) partner site Essen, Essen, Germany.,Department of Endocrinology and Metabolism, Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Michael C. Kreissl
- Clinic of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Frank Weber
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Kurt Werner Schmid
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ken Herrmann
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany
| | - Walter Jentzen
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany
| | - Hong Grafe
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany
| | - Christoph Rischpler
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany
| | - Sarah Theurer
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Bockisch
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany
| | - James Nagarajah
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wolfgang P. Fendler
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany
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10
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Happel C, Kranert WT, Bockisch B, Sabet A, Grünwald F, Groener D. The influence of thyroid hormone medication on intra-therapeutic half-life of 131I during radioiodine therapy of solitary toxic thyroid nodules. Sci Rep 2022; 12:13925. [PMID: 35978004 PMCID: PMC9385611 DOI: 10.1038/s41598-022-18170-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022] Open
Abstract
Despite a significantly improved dietary iodine supply, solitary toxic thyroid nodules (STN) are still a common clinical problem in former iodine deficient areas. Radioiodine treatment (RIT) is a well-established therapeutic option with few side effects and high success rates. As radioiodine biokinetics are individual for every patient, the necessary activity has to be calculated individually by a pre-therapeutic measurement of the intra-therapeutic effective half-life (EHL) in a radioiodine uptake test (RIUT). A suppressive medication with triiodothyronine (T3) or tetraiodothyronine (T4) is often needed to suppress uptake in normal thyroid tissue. Therefore, the aim of this study was to quantify the possible influence of this medication on intra-therapeutic radioiodine biokinetics. A cohort of 928 patients with STN undergoing RIUT and RIT was analysed. Patients were subdivided into 3 groups. Group T3: medication with T3 (n = 274), group T4: medication with T4 (n = 184) and group NM: no additional medication (n = 470). The T3 and T4 subgroups were further subdivided depending on the dose of thyroid hormone medication. In order to analyse the influence of thyroid hormone medication on individual intra-thyroidal biokinetics, the variance of the determined individual EHL between RIUT and RIT within the single groups and within the subgroups was investigated. EHL was significantly decreased between RIUT and RIT in the T3 and T4 subgroups (EHL: T3: 5.9 ± 1.1 d in RIUT and 3.3 ± 1.4 d in RIT (− 43%) (p < 0.05); T4: 5.9 ± 1.2 d in RIUT and 3.4 ± 1.5 d in RIT (− 42%) (p < 0.05). The decrease of EHL did not differ statistically between T3 or T4. However, both showed a highly significant difference compared to the NM group (p < < 0.05). A further subgroup analysis showed a significant dependence of the decrease in EHL related to the dose of thyroid hormone medication of 35–58% (T3) and 15–67% (T4) (p < 0.05). A significantly reduced EHL compared to RIUT in patients receiving thyroid hormone medication was detected. Moreover, a significant correlation between the dose of thyroid hormone medication (T3 or T4) and the decrease of EHL was found. Therefore, an adaption of the calculated activity should be considered in RIUT to obtain the required radiation dose in RIT of patients suffering from STN.
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Affiliation(s)
- Christian Happel
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany.
| | - Wolfgang Tilman Kranert
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Benjamin Bockisch
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Amir Sabet
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Daniel Groener
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
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11
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Grünwald F, Baumgarten J, Happel C, Sabet A, Gröner D. [Radiofrequency ablation of benign thyroid nodules]. Laryngorhinootologie 2022; 101:569-573. [PMID: 35738271 DOI: 10.1055/a-1057-3222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Radiofrequency ablation is an effective tool to treat benign thyroid nodules up to about 100 ml. It is well tolerated and is - together with echopulse therapy - currently the most frequently used technique in Germany for the local therapy of benign thyroid nodules. Overall, a volume reduction of about 50 % to 70 % can be expected. Cystic nodules and mixed-pattern lesions respond slightly better than solid nodules. Initial volume, structure and echogenicity are important parameters influencing the therapeutic efficacy. Bipolar as well as monopolar methods are used - the choice of the method depends mainly on the personal experience. For bigger nodules, the bipolar technique is preferred. Cooled systems should be favored, especially when using larger probes. Serious side effects are rare (< 1 %) and transient in most cases.
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Affiliation(s)
- Frank Grünwald
- Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Frankfurt am Main
| | - Justus Baumgarten
- Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Frankfurt am Main
| | - Christian Happel
- Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Frankfurt am Main
| | - Amir Sabet
- Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Frankfurt am Main
| | - Daniel Gröner
- Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Frankfurt am Main
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12
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Baumgarten J, Happel C, Groener D, Staudt J, Bockisch B, Sabet A, Grünwald F, Rink T. Retrospective Analysis of the Development of Human Thyroglobulin during Pregnancy in Patients with Treated Non-Recurrent Differentiated Thyroid Cancer. Curr Oncol 2022; 29:4012-4019. [PMID: 35735429 PMCID: PMC9221990 DOI: 10.3390/curroncol29060320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 12/04/2022] Open
Abstract
Aim: Therapy success in patients with differentiated thyroid cancer (DTC) after thyroidectomy and radioiodine therapy (RIT) is proven by permanent decrease in human thyroglobulin (hTg) to <1 ng/mL. In this retrospective analysis hTg development before, during and after pregnancy were analyzed. Material and methods: A descriptive analysis of hTg courses in 47 women with 57 pregnancies under levothyroxine substitution was performed after treatment of DTC without evidence of residual or recurrent disease. We compared hTg levels before, during and after pregnancies. A median of four measurements were performed during pregnancy. Results: In five out of the 47 patients at least one hTg increase to ≥1.0 ng/mL occurred during pregnancy (P1: 1.1; P2: 1.75; P3: 1.0; P4: 1.1; P5: 1.07 ng/mL). In another three cases an increase to ≥0.5 ng/mL occurred. After delivery, all patients returned to undetectable hTg levels. Human Tg maxima during pregnancy were significantly elevated according to Friedman´s Chi2 and p Holm−Bonferroni. Conclusion: In women with ablative thyroid therapy after DTC, a temporary elevation in hTg levels during pregnancy may occur. The reason therefore remains unclear and requires further investigation.
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Affiliation(s)
- Justus Baumgarten
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany; (J.B.); (D.G.); (B.B.); (A.S.); (F.G.); (T.R.)
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany; (J.B.); (D.G.); (B.B.); (A.S.); (F.G.); (T.R.)
- Correspondence:
| | - Daniel Groener
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany; (J.B.); (D.G.); (B.B.); (A.S.); (F.G.); (T.R.)
| | - Jennifer Staudt
- Department of Nuclear Medicine, Medizinisches Versorgungszentrum (MVZ), D-63739 Aschaffenburg, Germany;
| | - Benjamin Bockisch
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany; (J.B.); (D.G.); (B.B.); (A.S.); (F.G.); (T.R.)
| | - Amir Sabet
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany; (J.B.); (D.G.); (B.B.); (A.S.); (F.G.); (T.R.)
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany; (J.B.); (D.G.); (B.B.); (A.S.); (F.G.); (T.R.)
| | - Thomas Rink
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany; (J.B.); (D.G.); (B.B.); (A.S.); (F.G.); (T.R.)
- Institute for Nuclear Medicine, Nussallee 7, D-63450 Hanau, Germany
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13
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Sabet A, Mader N, Bittenbring JT, Khreish F, Grünwald F, Biersack HJ, Ezziddin S. Prophylactic Peripheral Blood Stem Cell Collection in Patients with Extensive Bone-Marrow Infiltration of Neuroendocrine Tumours Prior to Peptide Receptor Radionuclide Therapy with 177Lu-DOTATATE. Pharmaceuticals (Basel) 2021; 14:ph14101022. [PMID: 34681247 PMCID: PMC8539404 DOI: 10.3390/ph14101022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
Peptide receptor radionuclide therapy (PRRT) of metastatic neuroendocrine tumors (NET) can be successfully repeated but may eventually be dose-limited. Since 177Lu-DOTATATE dose limitation may come from hematological rather than renal function, hematological peripheral blood stem cell backup might be desirable. Here, we report our initial experience of peripheral blood stem-cell collection (PBSC) in patients with treatment-related cytopenia and therefore high risk of bone-marrow failure. Five patients with diffuse bone-marrow infiltration of NET and relevant myelosuppression (≥grade 2) received PBSC before one PRRT cycle with 177Lu-DOTATATE (7.6 ± 0.8 GBq/cycle). Standard stem-cell mobilization with Granulocyte-colony stimulating factor (G-CSF) was applied, and successful PBSC was defined as a collection of >2 × 106/kg CD34+ cells. In case of initial failure, Plerixafor was administered in addition to G-CSF prior to apheresis. PBSC was successfully performed in all patients with no adverse events. Median cumulative activity was 44.8 GBq (range, 21.3-62.4). Three patients had been previously treated with PRRT, two of which needed the addition of Plerixafor for stem-cell mobilization. Only one of five patients required autologous peripheral blood stem-cell transplantation during the median follow up time of 28 months. PBSC collection seems to be feasible in NET with bone-marrow involvement and might be worth considering as a backup strategy prior to PRRT, in order to overcome dose-limiting bone-marrow toxicity.
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Affiliation(s)
- Amir Sabet
- Department of Nuclear Medicine, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany; (N.M.); (F.G.)
- Correspondence:
| | - Nicolai Mader
- Department of Nuclear Medicine, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany; (N.M.); (F.G.)
| | - Jörg Thomas Bittenbring
- Department of Haematology and Oncology, Caritas Hospital Saarbrücken, 66123 Saarbrücken, Germany;
| | - Fadi Khreish
- Department of Nuclear Medicine, Saarland University Medical Center, 66421 Homburg, Germany; (F.K.); (S.E.)
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany; (N.M.); (F.G.)
| | | | - Samer Ezziddin
- Department of Nuclear Medicine, Saarland University Medical Center, 66421 Homburg, Germany; (F.K.); (S.E.)
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14
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Scherer J, Nolden M, Kleesiek J, Metzger J, Kades K, Schneider V, Bach M, Sedlaczek O, Bucher AM, Vogl TJ, Grünwald F, Kühn JP, Hoffmann RT, Kotzerke J, Bethge O, Schimmöller L, Antoch G, Müller HW, Daul A, Nikolaou K, la Fougère C, Kunz WG, Ingrisch M, Schachtner B, Ricke J, Bartenstein P, Nensa F, Radbruch A, Umutlu L, Forsting M, Seifert R, Herrmann K, Mayer P, Kauczor HU, Penzkofer T, Hamm B, Brenner W, Kloeckner R, Düber C, Schreckenberger M, Braren R, Kaissis G, Makowski M, Eiber M, Gafita A, Trager R, Weber WA, Neubauer J, Reisert M, Bock M, Bamberg F, Hennig J, Meyer PT, Ruf J, Haberkorn U, Schoenberg SO, Kuder T, Neher P, Floca R, Schlemmer HP, Maier-Hein K. Joint Imaging Platform for Federated Clinical Data Analytics. JCO Clin Cancer Inform 2021; 4:1027-1038. [PMID: 33166197 PMCID: PMC7713526 DOI: 10.1200/cci.20.00045] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Image analysis is one of the most promising applications of artificial intelligence (AI) in health care, potentially improving prediction, diagnosis, and treatment of diseases. Although scientific advances in this area critically depend on the accessibility of large-volume and high-quality data, sharing data between institutions faces various ethical and legal constraints as well as organizational and technical obstacles. METHODS The Joint Imaging Platform (JIP) of the German Cancer Consortium (DKTK) addresses these issues by providing federated data analysis technology in a secure and compliant way. Using the JIP, medical image data remain in the originator institutions, but analysis and AI algorithms are shared and jointly used. Common standards and interfaces to local systems ensure permanent data sovereignty of participating institutions. RESULTS The JIP is established in the radiology and nuclear medicine departments of 10 university hospitals in Germany (DKTK partner sites). In multiple complementary use cases, we show that the platform fulfills all relevant requirements to serve as a foundation for multicenter medical imaging trials and research on large cohorts, including the harmonization and integration of data, interactive analysis, automatic analysis, federated machine learning, and extensibility and maintenance processes, which are elementary for the sustainability of such a platform. CONCLUSION The results demonstrate the feasibility of using the JIP as a federated data analytics platform in heterogeneous clinical information technology and software landscapes, solving an important bottleneck for the application of AI to large-scale clinical imaging data.
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Affiliation(s)
- Jonas Scherer
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany
| | - Marco Nolden
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany.,Pattern Analysis and Learning Group, Radio-oncology and Clinical Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany
| | - Jens Kleesiek
- German Cancer Consortium, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Jasmin Metzger
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany
| | - Klaus Kades
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany
| | - Verena Schneider
- German Cancer Consortium, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Michael Bach
- German Cancer Consortium, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Oliver Sedlaczek
- German Cancer Consortium, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany.,Klinik Diagnostische und Interventionelle Radiologie der Universität Heidelberg, Heidelberg, Germany
| | - Andreas M Bucher
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Thomas J Vogl
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Frank Grünwald
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Jens-Peter Kühn
- German Cancer Consortium, Heidelberg, Germany.,Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Ralf-Thorsten Hoffmann
- German Cancer Consortium, Heidelberg, Germany.,Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Jörg Kotzerke
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Oliver Bethge
- German Cancer Consortium, Heidelberg, Germany.,Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Lars Schimmöller
- German Cancer Consortium, Heidelberg, Germany.,Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- German Cancer Consortium, Heidelberg, Germany.,Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Hans-Wilhelm Müller
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Andreas Daul
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Christian la Fougère
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin und Klinische Molekulare Bildgebung, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Wolfgang G Kunz
- German Cancer Consortium, Heidelberg, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Michael Ingrisch
- German Cancer Consortium, Heidelberg, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Balthasar Schachtner
- German Cancer Consortium, Heidelberg, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,German Center of Lung Research, Giessen, Germany
| | - Jens Ricke
- German Cancer Consortium, Heidelberg, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Peter Bartenstein
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Klinikum der Universität München, München, Germany
| | - Felix Nensa
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen AöR, Essen, Germany
| | - Alexander Radbruch
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen AöR, Essen, Germany
| | - Lale Umutlu
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen AöR, Essen, Germany
| | - Michael Forsting
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen AöR, Essen, Germany
| | - Robert Seifert
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Essen AöR, Essen, Germany
| | - Ken Herrmann
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Essen AöR, Essen, Germany
| | - Philipp Mayer
- German Cancer Consortium, Heidelberg, Germany.,Klinik Diagnostische und Interventionelle Radiologie der Universität Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- German Cancer Consortium, Heidelberg, Germany.,Klinik Diagnostische und Interventionelle Radiologie der Universität Heidelberg, Heidelberg, Germany.,German Center of Lung Research, Giessen, Germany
| | - Tobias Penzkofer
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Radiologie (mit dem Bereich Kinderradiologie), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Radiologie (mit dem Bereich Kinderradiologie), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Winfried Brenner
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Roman Kloeckner
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Mainz, Germany
| | - Christoph Düber
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Mainz, Germany
| | - Mathias Schreckenberger
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | - Rickmer Braren
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Georgios Kaissis
- German Cancer Consortium, Heidelberg, Germany.,Pattern Analysis and Learning Group, Radio-oncology and Clinical Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Computing, Imperial College London, London, United Kingdom
| | - Marcus Makowski
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andrei Gafita
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rupert Trager
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wolfgang A Weber
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jakob Neubauer
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Marco Reisert
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Michael Bock
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Jürgen Hennig
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Philipp Tobias Meyer
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Juri Ruf
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Uwe Haberkorn
- German Cancer Consortium, Heidelberg, Germany.,Klinische Kooperationseinheit Nuklearmedizin, Deutsches Krebsforschungszentrum Heidelberg, Heidelberg, Germany
| | - Stefan O Schoenberg
- German Cancer Consortium, Heidelberg, Germany.,Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Heidelberg, Germany
| | - Tristan Kuder
- German Cancer Consortium, Heidelberg, Germany.,Medizinische Physik in der Radiologie, Deutsches Krebsforschungszentrum Heidelberg, Heidelberg, Germany
| | - Peter Neher
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany
| | - Ralf Floca
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany.,Pattern Analysis and Learning Group, Radio-oncology and Clinical Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Klaus Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,Pattern Analysis and Learning Group, Radio-oncology and Clinical Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany
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15
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Staudt J, Happel C, Kranert WT, Bockisch B, Grünwald F. [Comparison of 186Re to 662 keV photon radiation concerning biological radiation effect on the human B-cell line BV-173]. Nuklearmedizin 2021; 60:438-444. [PMID: 34416784 DOI: 10.1055/a-1560-2079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZIEL: Ziel der Untersuchung ist es, die Strahlenwirkung des β--Emitters 186Re und von 662keV-Photonenstrahlung zu ermitteln, um die biologische Wirkung von Strahlung niedriger Dosisleistung (186Re) mit der hoher Dosisleistung zu vergleichen. MATERIAL UND METHODEN Zellen der humanen Leukämie-Zelllinie BV-173 wurden mit 662keV-Photonenstrahlung respektive 186Re bestrahlt. In einem Inkubationszeitraum von 7 Tagen wurden Zahl und Vitalität der Zellen täglich bestimmt und als Dosiseffektkurven basierend auf der Vitalität dargestellt. Hierfür wurde der Zeitpunkt mit minimalem Überleben verwendet (72h 186Re und 24h Photonenstrahlung). ERGEBNISSE Beide Strahlenarten zeigen am Auswertezeitpunkt (72h nach Versuchsbeginn für 186Re und 24h nach Versuchsbeginn für Photonenstrahlung) eine Überlebenskurve mit biexponentiellem Verlauf. Für Photonenstrahlung ist dies erklärbar durch eine Hypersensitivität im niedrigen Dosisbereich bis 1Gy, für die sich eine D0 von 3,3Gy ergibt, für Dosen über 1,0Gy liegt die D0 bei 10Gy. Für die 186Re-Inkubation ergibt sich eine D0 von 11,1Gy bei niedrigen Dosen verursacht durch die Reparatur subletaler Schäden, durch welche die biologische Wirkung abgeschwächt wird. Ab einer akkumulierten Dosis von etwa 1,6Gy zeichnet sich für 186Re ein wesentlich steilerer Kurvenverlauf mit einer D0 von 4,0Gy ab, der eine in diesem Bereich 2,5-fach stärkere biologische Wirkung als akute Photonenstrahlung wiedergibt (D0 4Gy für 186Re bzw. 10Gy für Photonen). SCHLUSSFOLGERUNG Strahlung niedriger Dosisleistung zeigt eine geringere biologische Wirkung als eine akute Bestrahlung. Es existiert aber ein Grenzwert der akkumulierten Dosis, ab dem die biologische Wirkung von β-Strahlung die der Photonenstrahlung sogar übertrifft.
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Affiliation(s)
- Jennifer Staudt
- Universitätsklinikum Frankfurt, Klinik für Nuklearmedizin, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Germany
| | - Christian Happel
- Universitätsklinikum Frankfurt, Klinik für Nuklearmedizin, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Germany
| | - Wolfgang Tilman Kranert
- Universitätsklinikum Frankfurt, Klinik für Nuklearmedizin, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Germany
| | - Benjamin Bockisch
- Universitätsklinikum Frankfurt, Klinik für Nuklearmedizin, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Germany
| | - Frank Grünwald
- Universitätsklinikum Frankfurt, Klinik für Nuklearmedizin, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Germany
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16
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Groener D, Baumgarten J, Haefele S, Happel C, Klimek K, Mader N, Nguyen Ngoc C, Tselis N, Chun FKH, Grünwald F, Sabet A. Salvage Radioligand Therapy with Repeated Cycles of 177Lu-PSMA-617 in Metastatic Castration-Resistant Prostate Cancer with Diffuse Bone Marrow Involvement. Cancers (Basel) 2021; 13:cancers13164017. [PMID: 34439172 PMCID: PMC8393804 DOI: 10.3390/cancers13164017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 01/09/2023] Open
Abstract
Simple Summary Metastatic castration-resistant prostate cancer (mCRPC) with extensive spread to the bone marrow is an incurable stage of disease associated with a poor prognosis and a high risk of impaired blood cell formation. Therapeutic options prolonging survival are limited and may result in significant bone marrow toxicity. The concept of radioligand therapy (RLT) in mCRPC is marked by the targeted delivery of radionuclides, such as beta particle emitting 177Lutetium (177Lu) to the prostate-specific membrane antigen (PSMA), a transmembrane protein frequently present on prostate cancer cells. RLT has yielded promising anti-tumoral activity and excellent tolerability in patients with mCRPC as shown by multiple retrospective series and a growing number of prospective trials. The presented study aims to investigate the role of RLT in mCRPC patients with metastases diffusely involving the bone marrow. Special emphasis is laid on identifying early indicators for a favorable treatment response and potential risk factors for adverse outcomes. The impact of RLT-specific variables, including administered treatment activity, cumulative activity and whole-body absorbed dose is assessed individually. Abstract Advanced stage metastatic prostate cancer with extensive bone marrow involvement is associated with a high risk of therapy-induced myelotoxicity and unfavorable outcomes. The role of salvage radioligand therapy (RLT) with 177Lu-PSMA-617 in this subset of patients remains to be further elucidated. Forty-five patients with progressive metastatic castration-resistant prostate cancer (mCRPC) and diffuse bone marrow involvement were treated with repeated cycles of RLT after having exhausted standard treatment options. A mean treatment activity of 7.4 ± 1.4 GBq 177Lu-PSMA-617 was administered in a median of four treatment cycles (IQR 2-6) and the mean cumulative activity was 32.6 ± 20.1 GBq. After two RLT cycles, ≥50% PSA decline was observed in 25/45 (56%) patients and imaging-based partial remission (PR) was observed in 18/45 (40%) patients. Median imaging-based progression-free survival (PFS) was 6.4 mo (95% CI, 3.0–9.8) and the median overall survival (OS) was 10.2 months (95% CI, 7.2–12.8). The biochemical response translated into a significantly prolonged PFS (12.9 vs. 2.8 mo, p < 0.001) and OS (13.5 vs. 6.7 mo, p < 0.001). Patients with PR on interim imaging after two cycles had a longer median OS compared to patients with stable or progressive disease (15.5 vs. 7.1 mo, p < 0.001). Previous taxane-based chemotherapy (HR 3.21, 95%CI 1.18–8.70, p = 0.02) and baseline LDH levels (HR 1.001, 95%CI 1.000–1.001, p = 0.04) were inversely associated with OS on a Cox-regression analysis. Grade ≥ 3 hematological decline was observed after 22/201 (11%) cycles with anemia, leukopenia and thrombocytopenia in 15/45 (33%), 6/45 (13%) and 8/45 (18%) patients, respectively. Cumulative treatment activity and absorbed whole-body dose were not correlated with new onset grade ≥ 3 hematotoxicity (p = 0.91, p = 0.69). No event of grade ≥ 3 chronic kidney disease was observed during RLT or the follow-up. Last line RLT with 177Lu-PSMA-617 in mCRPC patients with diffuse bone marrow involvement may thus contribute to prolonged disease control at an acceptable safety profile.
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Affiliation(s)
- Daniel Groener
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Justus Baumgarten
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Sebastian Haefele
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Konrad Klimek
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Nicolai Mader
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Christina Nguyen Ngoc
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Nikolaos Tselis
- Department of Radiation Oncology, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Amir Sabet
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
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17
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Groener D, Nguyen CT, Baumgarten J, Bockisch B, Davis K, Happel C, Mader N, Nguyen Ngoc C, Wichert J, Banek S, Mandel P, Chun FKH, Tselis N, Grünwald F, Sabet A. Hematologic safety of 177Lu-PSMA-617 radioligand therapy in patients with metastatic castration-resistant prostate cancer. EJNMMI Res 2021; 11:61. [PMID: 34216290 PMCID: PMC8254689 DOI: 10.1186/s13550-021-00805-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/20/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Myelosuppression is a potential dose-limiting factor in radioligand therapy (RLT). This study aims to investigate occurrence, severity and reversibility of hematotoxic adverse events in patients undergoing RLT with 177Lu-PSMA-617 for metastatic castration-resistant prostate cancer (mCRPC). The contribution of pretreatment risk factors and cumulative treatment activity is taken into account specifically. METHODS RLT was performed in 140 patients receiving a total of 497 cycles. A mean activity of 6.9 [Formula: see text] 1.3 GBq 177Lu-PSMA-617 per cycle was administered, and mean cumulative activity was 24.6 [Formula: see text] 15.9 GBq. Hematological parameters were measured at baseline, prior to each treatment course, 2 to 4 weeks thereafter and throughout follow-up. Toxicity was graded based on Common Terminology Criteria for Adverse Events v5.0. RESULTS Significant (grade ≥ 3) hematologic adverse events occurred in 13 (9.3%) patients, with anemia in 10 (7.1%), leukopenia in 5 (3.6%) and thrombocytopenia in 6 (4.3%). Hematotoxicity was reversible to grade ≤ 2 through a median follow-up of 8 (IQR 9) months in all but two patients who died from disease progression within less than 3 months after RLT. Myelosuppression was significantly more frequent in patients with pre-existing grade 2 cytopenia (OR: 3.50, 95%CI 1.08-11.32, p = 0.04) or high bone tumor burden (disseminated or diffuse based on PROMISE miTNM, OR: 5.08, 95%CI 1.08-23.86, p = 0.04). Previous taxane-based chemotherapy was associated with an increased incidence of significant hematotoxicity (OR: 4.62, 95%CI 1.23-17.28, p = 0.02), while treatment with 223Ra-dichloride, cumulative RLT treatment activity and activity per cycle were not significantly correlated (p = 0.93, 0.33, 0.29). CONCLUSION Hematologic adverse events after RLT have an acceptable overall incidence and are frequently reversible. High bone tumor burden, previous taxane-based chemotherapy and pretreatment grade 2 cytopenia may be considered as risk factors for developing clinically relevant myelosuppression, whereas cumulative RLT activity and previous 223Ra-dichloride treatment show no significant contribution to incidence rates.
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Affiliation(s)
- Daniel Groener
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Cam Tu Nguyen
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Justus Baumgarten
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Benjamin Bockisch
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Karen Davis
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Nicolai Mader
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Christina Nguyen Ngoc
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Jennifer Wichert
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Severine Banek
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Nikolaos Tselis
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Amir Sabet
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany.
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18
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Happel C, Kranert WT, Gröner D, Baumgarten J, Halstenberg J, Bockisch B, Sabet A, Grünwald F. Focus on radioiodine-131 biokinetics: the influence of methylprednisolone on intratherapeutic effective half-life of 131I during radioiodine therapy of Graves' disease. Endocrine 2021; 73:125-130. [PMID: 33439464 PMCID: PMC8211592 DOI: 10.1007/s12020-020-02593-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/15/2020] [Indexed: 12/13/2022]
Abstract
AIM Radioiodine therapy (RIT) may trigger the development of Graves' ophthalmopathy (GO) or exacerbate pre-existing subclinical GO. Therefore, glucocorticoid administration is recommended for patients with pre-existing GO. Aim of this study was to analyze the influence of glucocorticoid therapy with methylprednisolone on intratherapeutic effective half-life (EHL) of radioiodine-131 in patients with Graves' disease (GD) as recent studies showed an effect for prednisolone. METHODS In a retrospective study, 264 patients with GD who underwent RIT without any additional antithyroid medication were evaluated. Intrathyroidal EHL was determined pre- and intratherapeutically. Patients with co-existing GO (n = 43) received methylprednisolone according to a fixed scheme starting 1 day prior to RIT, patients without GO (n = 221) did not receive any protective glucocorticoid medication. The ratios of EHL during RIT and during radioiodine uptake test (RIUT) were compared. RESULTS Patients receiving methylprednisolone showed a slight decrease of the mean EHL from 5.63 d (RIUT) to 5.39 d (RIT) (p > 0.05). A comparable result was obtained in patients without glucocorticoids (5.71 d (RIUT) to 5.47 d (RIT); p > 0.05). The ratios of the EHL between RIT and RIUT failed to show a significant difference between the two groups. EHL is therefore not significantly influenced by an additional protective treatment with methylprednisolone. CONCLUSIONS In the present study a decreased intrathyroidal EHL under glucocorticoid medication with methylprednisolone could not be detected. Therefore, co-medication with methylprednisolone in patients with GO may be preferred to avoid an intratherapeutic decrease of EHL by accompanying protective glucocorticoides.
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Affiliation(s)
- C Happel
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany.
| | - W T Kranert
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - D Gröner
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - J Baumgarten
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - J Halstenberg
- Department of Anesthesiology, Alice-Hospital, Darmstadt, Germany
| | - B Bockisch
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - A Sabet
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - F Grünwald
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
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19
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Happel C, Borowski M, Kamp A, Rudolf F, Wicke JH, Gröner D, Grünwald F, Fiebich M. [Prenatal Radiation Exposure in Nuclear Medicine]. Nuklearmedizin 2021; 60:233-239. [PMID: 33572000 DOI: 10.1055/a-1365-7954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Radiation exposure from nuclear medicine procedures during pregnancy may cause uncertainty among patients and medical professionals. In 2019, the German Society of Medical Physics (DGMP) and the German Society of Radiology (DRG) published a fully revised version of the report "Prenatal Radiation Exposure Arising from Medical Indication, Dose Calculation, Conclusions for Physicians and Pregnant Women". This report offers a basis for dose calculation and determination of radiation exposure to the unborn. This review summarizes the most notable general adaptions made in the report's newest version and specifically points out the changes relevant to the field of nuclear medicine.The DGMP report provides physicians and medical physicists with means to estimate prenatal radiation exposure to the unborn conservatively, in a prompt and comprehensible approach. The rapidly evolving field of indications in nuclear medicine and radiology gave rise to the initiative of profoundly revising the previous version of the report from 2002. It now accounts for the extended range of devices, nuclear medicine hybrid imaging and radiotracers recently introduced. The most extensive change is a shift from the former 3-step-concept for the dose calculation to a 2-step-concept. In diagnostic nuclear medicine the first step comprises a conservative approximation of radiation exposure on the basis of current diagnostic reference levels (DRL). If exposure is assessed to be below 20 mSv, risk to the unborn child is sufficiently low, no further approaches are considered necessary. If calculated doses exceed 20 mSv, for diagnostic studies without existing DRL or in case of radionuclide therapies step 2 requires dose calculation based on administered activity and the stage of pregnancy.The DGMP report on prenatal radiation exposure offers valuable guidance for physicians and medical physicists in the field of nuclear medicine. The calculation concept provides an important basis to estimate radiation exposure to the unborn. Its extensive revision in 2019 accounts for recent scientific and technical developments and a reform of the stepwise approach to dose estimation.
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Affiliation(s)
- Christian Happel
- Universitätsklinikum Frankfurt am Main; Klinik für Nuklearmedizin
| | - Markus Borowski
- Städtisches Klinikum Braunschweig; Institut für Röntgendiagnostik und Nuklearmedizin
| | - Alexandra Kamp
- Bundesamt für Strahlenschutz, Abteilung medizinischer und beruflicher Strahlenschutz
| | - Frank Rudolf
- Medizinische Hochschule Hannover, Stabsstelle Strahlenschutz und Abteilung Medizinische Physik
| | - Jan Henryk Wicke
- Medizinische Hochschule Hannover, Stabsstelle Strahlenschutz und Abteilung Medizinische Physik
| | - Daniel Gröner
- Universitätsklinikum Frankfurt am Main; Klinik für Nuklearmedizin
| | - Frank Grünwald
- Universitätsklinikum Frankfurt am Main; Klinik für Nuklearmedizin
| | - Martin Fiebich
- Technische Hochschule Mittelhessen Gießen; Institut für Medizinische Physik und Strahlenschutz
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20
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Happel C, Gröner D, Borowski M, Schulze B, Fiebich M, Grünwald F. Radiojodtherapie bei unbekannter Frühschwangerschaft: Abschätzung der Dosis des Ungeborenen bei einer Patientin mit Schilddrüsenkarzinom. Nuklearmedizin 2021; 60:110-112. [PMID: 33440436 DOI: 10.1055/a-1338-1414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Christian Happel
- Universitätsklinikum Frankfurt am Main, Klinik für Nuklearmedizin
| | - Daniel Gröner
- Universitätsklinikum Frankfurt am Main, Klinik für Nuklearmedizin
| | - Markus Borowski
- Städtisches Klinikum Braunschweig, Institut für Röntgendiagnostik und Nuklearmedizin
| | | | - Martin Fiebich
- Technische Hochschule Mittelhessen Gießen, Institut für Medizinische Physik und Strahlenschutz
| | - Frank Grünwald
- Universitätsklinikum Frankfurt am Main, Klinik für Nuklearmedizin
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21
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Baumgarten J, Happel C, Sabet A, Grünwald F. MIBI Scintigraphy in a patient with hyalinizing trabecular tumor of the thyroid. Nuklearmedizin 2020; 59:438-439. [DOI: 10.1055/a-1200-0924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Justus Baumgarten
- Universitätsklinikum Frankfurt am Main; Klinik für Nuklearmedizin; Frankfurt/Germany
| | - Christian Happel
- Universitätsklinikum Frankfurt am Main; Klinik für Nuklearmedizin; Frankfurt/Germany
| | - Amir Sabet
- Universitätsklinikum Frankfurt am Main; Klinik für Nuklearmedizin; Frankfurt/Germany
| | - Frank Grünwald
- Universitätsklinikum Frankfurt am Main; Klinik für Nuklearmedizin; Frankfurt/Germany
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22
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Happel C, Kranert WT, Gröner D, Bockisch B, Sabet A, Vardarli I, Görges R, Herrmann K, Grünwald F. Correction for hyperfunctioning radiation-induced stunning (CHRIS) in benign thyroid diseases. Endocrine 2020; 69:466-473. [PMID: 32173798 DOI: 10.1007/s12020-020-02258-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Radioiodine-131 treatment has been a well-established therapy for benign thyroid diseases for more than 75 years. However, the physiological reasons of the so-called stunning phenomenon, defined as a reduced radioiodine uptake after previous diagnostic radioiodine administration, are still discussed controversially. In a recent study, a significant dependence of thyroid stunning on the pre-therapeutically administered radiation dose could be demonstrated in patients with goiter and multifocal autonomous nodules. A release of thyroid hormones to the blood due to radiation-induced destruction of thyroid follicles leading to a temporarily reduced cell metabolism was postulated as possible reason for this indication-specific stunning effect. Therefore, the aim of this study was to develop dose-dependent correction factors to account for stunning and thereby improve precision of radioiodine treatment in these indications. METHODS A retrospective analysis of 313 patients (135 with goiter and 178 with multifocal autonomous nodules), who underwent radioiodine uptake testing and radioiodine treatment, was performed. The previously determined indication-specific values for stunning of 8.2% per Gray in patients with multifocal autonomous nodules and 21% per Gray in patients with goiter were used to modify the Marinelli equation by the calculation of correction factors for hyperfunctioning radiation-induced stunning (CHRIS). Subsequently, the calculation of the required activity of radioiodine-131 to obtain an intra-therapeutic target dose of 150 Gy was re-evaluated in all patients. Furthermore, a calculation of the hypothetically received target dose by using the CHRIS-calculated values was performed and compared with the received target doses. RESULTS After integrating the previously obtained results for stunning, CHRIS-modified Marinelli equations could be developed for goiter and multifocal autonomous nodules. For patients with goiter, the mean value of administered doses calculated with CHRIS was 149 Gy and did not differ from the calculation with the conventional Marinelli equation of 152 Gy with statistical significance (p = 0.60). However, the statistical comparison revealed a highly significant improvement (p < 0.000001) of the fluctuation range of the results received with CHRIS. Similar results were obtained in the subgroup of patients with multifocal autonomous nodules. The mean value of the administered dose calculated with the conventional Marinelli equation was 131 Gy and therefore significantly below the CHRIS-calculated radiation dose of 150 Gy (p < 0.05). Again, the fluctuation range of the CHRIS-calculated radiation dose in the target volume was significantly improved compared with the conventional Marinelli equation (p < 0.000001). CONCLUSIONS With the presented CHRIS equation it is possible to calculate a required individual stunning-independent radioiodine activity for the first time by only using data from the radioiodine uptake testing. The results of this study deepen our understanding of thyroid stunning in benign thyroid diseases and improve precision of dosimetry in radioiodine-131 therapy of goiter and multifocal autonomous nodules.
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Affiliation(s)
- C Happel
- Department of Nuclear Medicine, University Hospital, Goethe University, Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany.
| | - W T Kranert
- Department of Nuclear Medicine, University Hospital, Goethe University, Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany
| | - D Gröner
- Department of Nuclear Medicine, University Hospital, Goethe University, Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany
| | - B Bockisch
- Department of Nuclear Medicine, University Hospital, Goethe University, Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany
| | - A Sabet
- Department of Nuclear Medicine, University Hospital, Goethe University, Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany
| | - I Vardarli
- Department of Medicine I, Klinikum Vest GmbH, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Recklinghausen, Dorstener Str. 151, D-45657, Recklinghausen, Germany
| | - R Görges
- Department of Nuclear Medicine, University Hospital, Essen, Hufelandstraße 55, D-45147, Essen, Germany
| | - K Herrmann
- Department of Nuclear Medicine, University Hospital, Essen, Hufelandstraße 55, D-45147, Essen, Germany
| | - F Grünwald
- Department of Nuclear Medicine, University Hospital, Goethe University, Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany
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23
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Feldkamp J, Grünwald F, Luster M, Lorenz K, Vorländer C, Führer D. Non-Surgical and Non-Radioiodine Techniques for Ablation of Benign Thyroid Nodules: Consensus Statement and Recommendation. Exp Clin Endocrinol Diabetes 2020; 128:687-692. [PMID: 31910466 DOI: 10.1055/a-1075-2025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Thyroid nodules and cysts are frequently diagnosed in Germany with a prevalence of about 20% in young adults reaching up to 70% in older adults. Surgery is the standard treatment of symptomatic nodules, nodules with suspicion of malignancy and thyroid cancer. Radioiodine treatment is applied for autonomously functioning nodules. During the last years new non-surgical and non-radioiodine techniques have been introduced to treat thyroid nodules. These techniques include ethanol/polidocanol treatment, radiofrequency, microwave, and laser ablation, and high frequency ultrasound ablation. A significant reduction in nodule size could be documented for these techniques in several studies, but long-term outcome data are missing. Until now, there is no general consensus regarding the appropriate indications for these methods. For this reason, the Thyroid Section (German Society for Endocrinology), the Thyroid Working Committee (German Society for Nuclear Medicine), and the German Association of Endocrine Surgeons (CAEK) for the German Society of General and Visceral Surgery (DGAV) reviewed the respective literature, discussed the pro and cons and developed a consensus statement and recommendation to help physicians and patients in their decision making.
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Affiliation(s)
- Joachim Feldkamp
- Department of General Internal Medicine, Endocrinology and Diabetes, Infectious Diseases, Klinikum Bielefeld, Bielefeld, Germany
| | - F Grünwald
- Department of Nuclear Medicine, Johann Wolfgang Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Kerstin Lorenz
- Departments of Visceral, Vascular and Endocrine Surgery, University Hospital Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christian Vorländer
- Department of Endocrine Surgery, Bürgerhospital Frankfurt, Frankfurt am Main, Germany
| | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, Essen, Germany
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24
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Leonhäuser B, Happel C, Gröner D, Bockisch B, Fiebich M, Hellwig D, Grünwald F, Kranert WT. [Evaluation of intratherapeutic 177Lu-HA-DOTATATE treatment in neuroendocrine tumors: dosimetry with SPECT, whole-body imaging and gamma probe]. Nuklearmedizin 2019; 58:379-386. [PMID: 31461752 DOI: 10.1055/a-0987-9689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM Peptide receptor radionuclide therapy (PRRT) with 177Lu-HA-DOTATATE has evolved as a new path in the treatment of somatostatin-receptor-expressing neuroendocrine tumors. The kidneys are proven as organs at risk and should be evaluated dosimetrically. Overlap with other organs will make dosimetry based on planar scintigraphy inaccurate. Aim of this study was to approximate the contribution of the kidneys to conjugated planar views without the use of a SPECT/CT. MATERIAL AND METHOD An algorithm was developed to determine the kidney dose using an EXCEL (Microsoft) based program. Dosimetric data were drawn and merged from three modalities: an individually calibrated gamma probe, a whole-body scintigraphy (WBS) and SPECT-acquisitions. The method was evaluated for 85 kidneys. Kidney masses were obtained via CT volumetry. RESULTS The developed algorithm combines data from the three modalities. The ratio of the events within a kidney-VOI and the events from the summed coronary SPECT views (kidney ROI) represents the contribution of the kidney to the whole-body kidney ROI. This fraction was calculated to 49 % (17 % - 78 %) and 45 % (18 % - 75 %) for the left and the right kidney, respectively. Quantification of activity was deduced from equalizing the WBS count with the concurrent gamma probe measurement. Monoexponential curves were fitted to the obtained kidney activities, with resulting doses of 0,13 to 0,77 Gy/GBq (average 0,36 and 0,39 Gy/GBq for the left and the right kidney). CONCLUSION The presented method is suitable to perform kidney dosimetry by using a gamma probe and a gamma camera, without using SPECT/CT.
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Affiliation(s)
- Britta Leonhäuser
- CHARITÉ - Universitätsmedizin Berlin, Abteilung Medizinphysik-Experten sonstige Einrichtungen, Berlin
| | - Christian Happel
- Universitätsklinikum Frankfurt am Main, Klinik für Nuklearmedizin, Frankfurt
| | - Daniel Gröner
- Universitätsklinikum Frankfurt am Main, Klinik für Nuklearmedizin, Frankfurt
| | - Benjamin Bockisch
- Universitätsklinikum Frankfurt am Main, Klinik für Nuklearmedizin, Frankfurt
| | - Martin Fiebich
- Technische Hochschule Mittelhessen, Fachbereich Life Science Engineering, Gießen
| | - Dirk Hellwig
- Universitätsklinikum Regensburg, Klinik für Nuklearmedizin, Regensburg
| | - Frank Grünwald
- Universitätsklinikum Frankfurt am Main, Klinik für Nuklearmedizin, Frankfurt
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25
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Davis KH, Happel C, du Mesnil de Rochemont R, Vogl TJ, Grünwald F. Konversion eines postoperativen Hypoparathyreoidismus in
einen Hyperparathyreoidismus bei ektopem Nebenschilddrüsenadenom. Nuklearmedizin 2019; 58:333-336. [PMID: 31140182 DOI: 10.1055/a-0914-2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We present a patient with a history of thyroid cancer, presumably following radiochemotherapy of a childhood medulloblastoma, who developed a primary hyperparathyroidism 10 years after long-term postsurgical hypoparathyroidism. All established imaging modalities failed to detect the origin and only selective neck sampling could identify the suspected parathyroid adenoma causing hyperparathyroidism. This encourages the use of selective neck vein catheterization, particularly in patients with only slightly elevated parathyroid hormone-levels or suspected small ectopic adenoma.
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Affiliation(s)
- K H Davis
- Universitätsklinikum Frankfurt; Klinik für Nuklearmedizin
| | - C Happel
- Universitätsklinikum Frankfurt; Klinik für Nuklearmedizin
| | | | - T J Vogl
- Universitätsklinikum Frankfurt; Institut für Diagnostische und Interventionelle Radiologie
| | - F Grünwald
- Universitätsklinikum Frankfurt; Klinik für Nuklearmedizin
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26
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Verburg FA, Schmidt M, Kreissl MC, Grünwald F, Lassmann M, Hänscheid H, Hohberg M, Luster M, Dietlein M. [Procedural guideline for Iodine-131 whole-body scintigraphy in differentiated thyroid carcinoma (version 5)]. Nuklearmedizin 2019; 58:228-241. [PMID: 31035298 DOI: 10.1055/a-0891-1839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Version 5 of the procedural guideline for Iodine-131 whole-body scintigraphy (WBS) in differentiated thyroid carcinoma is an update of the version 4, published by the "Deutsche Gesellschaft für Nuklearmedizin" (DGN). This procedural guideline advises on how to best perform I-131 whole body scintigraphy after I-131 therapy or after application of a diagnostic I-131 activity. A representative expert group has discussed and reached consensus on the procedural guideline; the development of this procedural guideline therefore fulfils the criteria for level S1 (first step) within the classification of the German Workgroup of Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften"; AWMF).
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Affiliation(s)
- Frederik A Verburg
- für die Deutsche Gesellschaft für Nuklearmedizin (DGN).,Klinik für Nuklearmedizin des Universitätsklinikums Marburg
| | - Matthias Schmidt
- für die Deutsche Gesellschaft für Nuklearmedizin (DGN).,Klinik und Poliklinik für Nuklearmedizin, Uniklinik Köln
| | - Michael C Kreissl
- für die Deutsche Gesellschaft für Nuklearmedizin (DGN).,Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg
| | - Frank Grünwald
- für die Deutsche Gesellschaft für Nuklearmedizin (DGN).,Klinik und Poliklinik für Nuklearmedizin der Universität Frankfurt
| | - Michael Lassmann
- für die Deutsche Gesellschaft für Nuklearmedizin (DGN).,Klinik und Poliklinik für Nuklearmedizin der Universität Würzburg
| | - Heribert Hänscheid
- für die Deutsche Gesellschaft für Nuklearmedizin (DGN).,Klinik und Poliklinik für Nuklearmedizin der Universität Würzburg
| | - Melanie Hohberg
- für die Deutsche Gesellschaft für Nuklearmedizin (DGN).,Klinik und Poliklinik für Nuklearmedizin, Uniklinik Köln
| | - Markus Luster
- für die Deutsche Gesellschaft für Nuklearmedizin (DGN).,Universitätsklinikum Gießen und Marburg, Standort Marburg, Klinik für Nuklearmedizin
| | - Markus Dietlein
- für die Deutsche Gesellschaft für Nuklearmedizin (DGN).,Klinik und Poliklinik für Nuklearmedizin, Uniklinik Köln
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27
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Happel C, Kranert WT, Ackermann H, Binse I, Bockisch B, Gröner D, Herrmann K, Grünwald F. Thyroid stunning in radioiodine-131 therapy of benign thyroid diseases. Endocrine 2019; 63:537-544. [PMID: 30599051 DOI: 10.1007/s12020-018-01833-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Existence and cause of thyroid stunning was controversially discussed for decades but the underlying mechanism remains unclear. Numerous studies describe thyroid stunning in radioiodine-131 therapy (RIT) of differentiated thyroid carcinoma. However, there are no studies evaluating thyroid stunning in benign thyroid diseases caused by the radioiodine uptake test (RIUT). Therefore, the influence of pre-therapeutic tracer radiation dose on therapeutic iodine-131 uptake was evaluated retrospectively. METHODS A total of 914 RIT patients were included. Exclusion criteria were anti-thyroid drugs, pre- and/or intra-therapeutic effective half-lives (EHL) beyond 8.04 days and externally performed RIUT or 24 h RIUT. All patients received RIUT 1 week before RIT. Thyroid volume was estimated via ultrasound. Tracer radiation dose to the thyroid was calculated retrospectively. The dependence of changes in the pre-therapeutic to the therapeutic extrapolated-maximum-131I-uptake (EMU) from the dose in RIUT was evaluated statistically. RESULTS EMU in RIUT ranged from 0.10 to 0.82 (median: 0.35) and EMU in RIT ranged from 0.10 to 0.74 (median: 0.33). Averaged over the whole cohort the therapeutic EMU decreased significantly (2.3% per Gray intra-thyroidal tracer radiation dose). A disease-specific evaluation showed dose-dependent thyroid stunning from 1.2% per Gray in solitary toxic nodules (n = 327) to 21% per Gray in goiters (n = 135) which was significant for the subgroups of disseminated autonomies (n = 114), multifocal autonomies (n = 178) and goiters (p < 0.05) but not for Graves' diseases (n = 160) and solitary toxic nodules (p > 0.05). CONCLUSIONS The presented data indicate for the first time a significant dependence of pre-therapeutic radiation dose on thyroid stunning in goiter and disseminated and multifocal autonomy. To achieve the desired intra-thyroidal radiation dose, RIT activity should be adapted depending on the dose in RIUT.
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Affiliation(s)
- Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany.
| | - Wolfgang Tilman Kranert
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany
| | - Hanns Ackermann
- Institute for Biostatistics, University Hospital Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany
| | - Ina Binse
- Department of Nuclear Medicine, University Hospital Essen, Hufelandstraße 55, D-45147, Essen, Germany
| | - Benjamin Bockisch
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany
| | - Daniel Gröner
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Hufelandstraße 55, D-45147, Essen, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany
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28
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Ngoc CN, Happel C, Sabet A, Bechstein WO, Grünwald F. Iodine Avid Papillary Thyroid Cancer Showing
PSMA-Expression in 68Ga-PSMA Ligand PET/CT. Nuklearmedizin 2019; 58:50-51. [PMID: 30769373 DOI: 10.1055/a-0808-0832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Christina Nguyen Ngoc
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Klinik für Nuklearmedizin
| | - Christian Happel
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Klinik für Nuklearmedizin
| | - Amir Sabet
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Klinik für Nuklearmedizin
| | - Wolf Otto Bechstein
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Zentrum der Chirurgie
| | - Frank Grünwald
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Klinik für Nuklearmedizin
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Tatsch K, Buchert R, Bartenstein P, Barthel H, Boecker H, Brust P, Drzezga A, la Fougère C, Gründer G, Grünwald F, Krause BJ, Kuwert T, Langen KJ, Rominger A, Sabri O, Schreckenberger M, Meyer PT. [Dopamine Transporter SPECT with I-123 labelled FP-CIT (DaTSCANTM)]. Nuklearmedizin 2019; 58:5-16. [PMID: 30769368 DOI: 10.1055/a-0807-8137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of the S1 guideline is to assist in establishing the indication and in performing, interpreting and reporting SPECT investigations of the dopamine transporter (DAT) with DaTSCANTM. Compared to the preceding version dated from 2007 the current update considers relevant new publications, the guidelines of the European (EANM) and Society of Nuclear Medicine (SNM), and the current version of the S3 guideline of the German Society of Neurology on "Idiopathic Parkinsonsian Syndrome". In addition new technical developments are incorporated.
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Affiliation(s)
- Klaus Tatsch
- Städtisches Klinikum Karlsruhe, Klinik für Nuklearmedizin
| | - Ralph Buchert
- Universitätsklinikum Hamburg-Eppendorf, Abteilung für Nuklearmedizin, Zentrum für Radiologie und Endoskopie
| | - Peter Bartenstein
- Klinikum der Ludwig-Maximilians Universität München, Klinik und Poliklinik für Nuklearmedizin
| | - Henryk Barthel
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Nuklearmedizin
| | - Henning Boecker
- Radiologische Universitätsklinik Bonn, FE Klinische Funktionelle Bildgebung
| | - Peter Brust
- Helmholtz-Zentrum Dresden-Rossendorf, Forschungsstelle Leipzig
| | | | - Christian la Fougère
- Universitätsklinikum Tübingen, Abteilung für Nuklearmedizin und klinische molekulare Bildgebung
| | - Gerhard Gründer
- Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Zentralinstitut für Seelische Gesundheit
| | - Frank Grünwald
- Universitätsklinikum Frankfurt, Klinik für Nuklearmedizin
| | - Bernd-J Krause
- Universitätsmedizin Rostock, Klinik und Poliklinik für Nuklearmedizin
| | - Torsten Kuwert
- Universitätsklinikum Erlangen, Nuklearmedizinische Klinik
| | - Karl-Josef Langen
- Forschungszentrum Jülich, Institut für Neurowissenschaften und Medizin
| | - Axel Rominger
- Universitätsklinik für Nuklearmedizin, Inselspital Bern
| | - Osama Sabri
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Nuklearmedizin
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Baumgarten J, Happel C, Becker S, El-Balat A, Grünwald F. HCG-induced hyperthyroidism in a 51-year-old patient with hydatidiform mole. Nuklearmedizin 2018; 57:N57. [PMID: 30562809 DOI: 10.3413/nukmed-0990-18-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Anwar H, Vogl TJ, Abougabal MA, Grünwald F, Kleine P, Elrefaie S, Nour-Eldin NEA. The value of different 18F-FDG PET/CT baseline parameters in risk stratification of stage I surgical NSCLC patients. Ann Nucl Med 2018; 32:687-694. [PMID: 30219989 DOI: 10.1007/s12149-018-1301-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 08/27/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Administration of postoperative chemotherapy to patients with completely resected stage I NSCLC is still a matter of debate. The aim of the present study was to evaluate the value of different baseline 18F-FDG PET parameters in identifying surgical stage I NSCLC patients who are at high risk of recurrence, and thus are indicated for further postoperative treatment. METHODS This is a retrospective study, which included 49 patients (28 males, 21 females) with the median age of 69 years (range 28-84), who had pathologically proven stage I NSCLC. All patients underwent 18F-FDG PET/CT at baseline followed by complete surgical resection of the tumor (R0). Baseline SUVmax, MTV and TLG were measured. Patients' follow-up records were retrospectively reviewed, and DFS (disease-free survival) was assessed. For each parameter, the most accurate cut-off value for the prediction of recurrence was calculated using the ROC curve analysis and the Youden index. DFS was evaluated for patients above and below the calculated cut-off value using the Kaplan-Meier method and the difference in survival between the two groups was estimated using the log-rank test. RESULTS Median observation time of the patients after surgery was 28.7 months (range 3.5-58.8 months). 9 patients developed recurrence. The calculated cut-off values for SUVmax, MTV and TLG were 6, 6.6 and 33.6, respectively. Using these cut-offs, the observed sensitivity for SUVmax, MTV and TLG for prediction of recurrence was 100%, 89% and 89%, respectively, while the observed specificity was 43%, 73% and 65%, respectively. The difference in survival between patients below and above the cut-off value was statistically significant in all three studied parameters. The highest AUC was observed for MTV (AUC = 0.825, p = 0.003), followed by TLG (AUC = 0.789, p = 0.007), and lastly SUVmax (AUC = 0.719, p = 0.041). ROC curve analysis showed that volumetric parameters had better predictive performance than SUVmax as regards recurrence. CONCLUSION PET-derived parameters at baseline were predictive of recurrence in stage I surgical NSCLC patients. Moreover, the metabolic volume of the tumor was the most significant parameter for this purpose among the studied indices.
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Affiliation(s)
- Hoda Anwar
- Nuclear Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Faculty of Medicine-Cairo University, Cairo, Egypt.
| | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang von Goethe University Hospital, Frankfurt am Main, Germany
| | - Mahasen A Abougabal
- Nuclear Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Faculty of Medicine-Cairo University, Cairo, Egypt
| | - Frank Grünwald
- Department of Nuclear Medicine, Johann Wolfgang von Goethe University Hospital, Frankfurt am Main, Germany
| | - Peter Kleine
- Department of Cardiothoracic Surgery, Johann Wolfgang von Goethe University Hospital, Frankfurt am Main, Germany
| | - Sherif Elrefaie
- Nuclear Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Faculty of Medicine-Cairo University, Cairo, Egypt
| | - Nour-Eldin A Nour-Eldin
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang von Goethe University Hospital, Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo, Egypt
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Verburg F, Grünwald F, Lassmann M, Hänscheid H, Luster M, Dietlein M. Iod-131-Ganzkörperszintigraphie beim differenzierten Schilddrüsenkarzinom. Nuklearmedizin 2018; 57:124-136. [DOI: 10.1055/s-0038-1649554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungDie Version 4 der Verfahrensanweisung für die Iod-131-Ganzkörperszintigraphie beim differenzierten Schilddrüsenkarzinom ist ein Update der Version 3, die im Jahr 2007
durch die Deutsche Gesellschaft für Nuklearmedizin (DGN) und die Deutsche Gesellschaft für Medizinische Physik (DGMP) publiziert wurde. Diese Verfahrensanweisung
beschreibt mit primärer Zielsetzung die fachgerechte Durchführung der Ganzkörperszintigraphie nach Applikation einer diagnostischen bzw. therapeutischen I-131-Aktivität.
Die aktualisierten Indikationen zur I-131-Ganzkörperszintigraphie werden in der Verfahrensanweisung aufgelistet. Neue Erkenntnisse bezüglich der Beziehung zwischen
verabreichter Aktivität und Bildqualität wurden in der aktualisierten Verfahrungsanweisung berücksichtigt. Die Verfahrensanweisung wurde von einer repräsentativen
Expertengruppe im Konsensverfahren verabschiedet. Sie entspricht damit einer Verfahrensanweisung der ersten Stufe (S1) nach den Kriterien der Arbeitsgemeinschaft der
Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Zusätzlich wurden Indikationsstellung, Zeitpunkt und Aktivitätswahl für die diagnostische
Ganzkörperszintigraphie im erweiterten Kollegenkreis am 30. November 2012, am 19. April 2013 und am 23. April 2015 bei Tagungen der Arbeitsgemeinschaft Schilddrüse der
Deutschen Gesellschaft für Nuklearmedizin ausführlich diskutiert.
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Korkusuz H, Wolf T, Grünwald F. Feasibility of bipolar radiofrequency ablation in patients with parathyroid adenoma: a first evaluation. Int J Hyperthermia 2018; 34:639-643. [DOI: 10.1080/02656736.2018.1453552] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- H. Korkusuz
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - T. Wolf
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - F. Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
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Korkusuz Y, Mader A, Gröner D, Ahmad S, Mader OM, Grünwald F, Happel C. Comparison of Mono- and Bipolar Radiofrequency Ablation in Benign Thyroid Disease. World J Surg 2018; 41:2530-2537. [PMID: 28474275 DOI: 10.1007/s00268-017-4039-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Radiofrequency ablation (RFA) is an approved minimal invasive method for the treatment of benign thyroid nodules. Several experimental, mainly ex vivo animal studies have compared the effectiveness of different RFA procedures in liver tissue. The aim of this retrospective clinical study was to evaluate the difference between monopolar and bipolar RFA in thyroid tissue considering thyroid volume reduction, patient discomfort and ultrasound evaluation. METHODS Eighteen patients with symptomatic complex benign thyroid nodules were treated in a single RFA session. Nine patients were treated with monopolar RFA, and nine other patients were treated with bipolar RFA. All patients underwent assessments before therapy and at 3-month follow-up (3MFU) including a complete hormone status (T3, T4, TSH, TG, TPOAb, TgAb, TRAb) and several ultrasound (US) evaluations using B-mode and color-coded Doppler imaging. The US evaluations contained measurement of volume, US Doppler, US echogenicity and US elastography. Additionally, applied energy (kJ), power output (W), number of shots (N) and total treatment time (s) were recorded in every case. RESULTS Monopolar RFA resulted in a significant (p < 0.05) average thyroid volume reduction of Ø 18 ± 77 ml (25.1 ± 103%) and a nodule volume reduction of Ø 10.6 ± 22 ml (60.3 ± 62%). Bipolar RFA resulted in a significant (p < 0.05) average thyroid volume reduction of Ø 21.2 ± 54 ml (43.2 ± 84%) and a nodule volume reduction of Ø 13.8 ± 33 ml (70.8 ± 46%). Both groups showed equal results concerning volume reduction (p > 0.05). Monopolar RFA did not lead to any significant changes concerning the US scores, whereas bipolar RFA led to a significant (p < 0.05) reduction in US Doppler and nodular blood flow. No significant difference between both groups could be found concerning applied energy, treatment time, power output and number of shots (p > 0.05). CONCLUSION Bipolar RFA did not show any disadvantages in comparison with monopolar RFA in the treatment of benign thyroid nodules. It shows better performance in terms of volume reduction and is superior when it comes to feasibility and patient discomfort. The recent study confirms the good ex vivo results for bipolar RFA.
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Affiliation(s)
- Yücel Korkusuz
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Alexander Mader
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany. .,Department of Nuclear Medicine, German Center for Thermoablation of Thyroid Nodules, University Medical Center Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Daniel Gröner
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Shadi Ahmad
- Department of General and Visceral Surgery, Agaplesion Elisabethenstift, Darmstadt, Germany
| | - Oscar Maximilian Mader
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
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Halstenberg J, Kranert WT, Korkusuz H, Mayer A, Ackermann H, Grünwald F, Happel C. [Influence of glucocorticoid therapy on intratherapeutic biodistribution of 131I radioiodine therapy in Graves' disease]. Nuklearmedizin 2018; 57:43-49. [PMID: 29590674 DOI: 10.3413/nukmed-0941-17-11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM Radioiodine therapy (RIT) is an important therapeutic method in the definitive treatment of Graves' disease (GD). However, RIT may trigger development of Graves' ophthalmopathy (GO) or exacerbate a pre-existing GO. Therefore, the procedure recommendation of the DGN (German Society of Nuclear Medicine) for RIT of benign thyroid diseases recommends an additional glucocorticoid therapy for patients with pre-existing GO. Aim of this study was to analyze the influence of a protective glucocorticoid therapy on 131I biokinetics during RIT of patients with GD. MATERIAL AND METHODS In this retrospective analysis 211 patients with GD who underwent RIT without additional thyreostatic medication were examined. To analyze 131I biokinetics the extrapolated maximum uptake (EMU) and the effective half-life of 131I in the thyroid were determined. Patients suffering from GO received glucocorticoids according to a fixed scheme starting one day prior to RIT, patients without GO did not receive glucocorticoids. Subsequently the ratios of values measured during RIT and those measured during radioactive iodine uptake test were compared among the groups. To take into account other factors, the groups were also compared regarding age, weight, TSH, TRAb, TgAb and TPOAb. RESULTS In patients with additional glucocorticoid therapy, a reduction of the median EMU from 44 % in radioiodine uptake test to 35 % during RIT was observed. The pretherapeutic (47 %) and intratherapeutic (46 %) EMU of the control group without glucocorticoids remained constant. Comparison of the change in the EMU showed a statistically significant difference between both groups (p < 0.001). Comparison of all other parameters including the effective half-life of 131I (p = 0.79) did not show any statistically significant difference. CONCLUSION The present study suggests that glucocorticoids affect the biokinetics of 131I by reducing its thyroidal uptake. As a result of this study, for patients without antithyroid medication undergoing glucocorticoid therapy, an adjustment of therapeutic 131I activity determined in radioiodine uptake test could be considered.
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Hotze A, Kropp J, Bockisch A, Overbeck B, Grünwald F, Kaiser W, Biersack HJ, Briele B. Vergleich von 201T1 und 99mTc-MIBI in der Nachsorge des differenzierten Schilddrüsenkarzinoms. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1629562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
12 patients with suspected recurrence of differentiated thyroid carcinoma following thyroidectomy, radioiodine therapy and, in some cases, external radiation therapy had 201T1 and 99mTc-MIBI scintigraphy. Except in one case, the findings concerning tumor localization and extension were identical. In all cases, locoregional lymph node metastases as well as osseous metastases were imaged by 201T1 and 99mTc-MIBI scintigraphy. MRI images obtained in all patients with suspected lymph node metastases revealed inoperable situations in 2 cases, whereas there was no correlation in patient with positive 201T1 and 99mTc-MIBI scintigraphy. In contrast, the sensitivity of the two methods was relatively low in the detection of pulmonary metastases which were imaged in 1 out of 3 patients only. Discrepancies between 201T1 and 99mTc-MIBI were observed in a case of axillary lymph node metastasis. Although tumor-/background ratios were slightly higher for 201T1, 99mTc-MIBI SPECT showed a higher imaging quality compared to 201T1 SPECT, especially in deeply situated tumor lesions. In conclusion, 99mTc-MIBI seems to be a promising alternative imaging agent in the follow-up of differentiated thyroid carcinomas.
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Grünwald F, Durwen H, Bülau P, Bockisch A, Elger CE, Rohde A, Reichmann K, Ammari B, Hotze A, Penin H, Biersack HJ. HMPAO-SPECT bei zerebralen Anfällen. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1629458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ln nine patients with suspected psychogenic seizures and in three patients with proven epileptic seizures HMPAO-SPECT was performed prior to and during seizure. In the patients with lateron-proven psychogenic seizures no, or only slight, changes of regional cerebral blood flow were found. Patients with proven epilepsy revealed partly normal findings interictally but during seizure a markedly increased circumscript blood flow was found in all patients. Even though PET is superior to SPECT with respect to spatial resolution, in the diagnosis of seizures HMPAO-SPECT has the advantage of enabling injection of the tracer during the seizure and the performance of the SPECT study subsequently.
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Abstract
ln 16 patients with reversible symptoms of cerebrovascular disease a HMPAO- and/or IMP-SPECT was performed. 12 of these patients were suffering from TIA, 4 from PRIND. Using HMPAO-SPECT in 8 out of 9 patients with TIA and in 1 of 2 with PRIND a hypoperfusion could be demonstrated; IMP-SPECT showed a pathological pattern in 3 of 5 patients with TIA and in none of 2 patients with PRIND. A semiquantitative evaluation showed a tracer accumulation reduced by 13 ± 12% (HMPAO) and 8 ± 7% (IMP), respectively, in the clinically involved hemisphere, compared to the contralateral side. In circumscript SPECT lesions a reduction by 21 ± 8% (HMPAO) or 17 ± 7% (IMP) was observed. The interhemispheric ratio from the HMPAO-SPECT showed a significant correlation to that of the 133Xe-rCBF measurement (r = 0.86; p <0.001). SPECT was positive in a higher percentage than TCT, Doppler sonography, radioangiography and 133Xe-rCBF measurement. This does not imply a higher specificity or sensitivity, because a slight inhomogenic SPECT pattern may occasionally be observed even in normal persons.
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Hotze A, Grünwald F, Overbeck B, Biersack HJ, Briele B. Erhöhte Sensitivität der Ganzkörperszintigraphie mit 131J für den Nachweis jodspeichernder Metastasen durch spätere Aufnahme-Zeitpunkte. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1629542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In the follow-up of thyroid cancer patients we sometimes observed discrepancies between elevated thyroglobulin levels and negative results of post- therapeutic or diagnostic scans 48 h and 72 h after oral application of131I routinely. Consequently, delayed 131I scans (96 h and later) were performed in addition. In all cases, delayed 131I scans either showed a higher imaging quality or additional metastatic lesions. Thus, posttherapeutic (and diagnostic) scans should include late images (4 d and later).
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Grünwald F, Barzó P, Ambrus E, Menzel C, Schomburg A, Borda L, Máté E, Bodosi L, Csernay L, Biersack HJ, Pàvics L. Evaluation of Cerebral Vasoreactivity by SPECT and Transcranial Doppler Sonography using the Acetazolamide Test. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1629709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungBei 29 Patienten (3 Kontrollpersonen, 26 Patienten mit zerebrovaskulärer Erkrankung) wurde prospektiv die Hirn-SPECT mit 99mTC-HMPAO und bei 20 Patienten (3 Kontrollpersonen, 17 Patienten mit ZVK) die transkranielle Dopplersonographie (TCD) vor und nach i. v. Gabe von Azetazolamid durchgeführt. Die Sensitivität der Hirn-SPECT erhöhte sich mit Azetazolamid von 62% auf 77%. Bei Patienten mit reversiblem neurologischem Defizit wurde eine Verbesserung von 50% auf 71 %, bei Patienten mit persistierendem Defizit von 75% auf 83% beobachtet. Die Ergebnisse der Hirn-SPECT und der TCD stimmten in der Beurteilung der zerebro-vaskulären Reservekapazität in 91% der Hemisphären überein. Die Korrelation zwischen den beiden Methoden war statistisch signifikant.
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Abstract
SummaryWe report a case of Hodgkin’s lymphoma (Stage I B) which was studied using Ga-67-scintigraphy as well as whole body FDG-PET. Ga-67-scintigraphy detected a slightly increased uptake in the paraaortic and pelvic lymph nodes. However, FDG-PET was able to localize a much larger number of affected foci with a high glucose utilization rate in the right and left paraaortal regions, in the middle of the epigastrium, in the right and left parailiacal regions and one focus in the left upper mediastinum. Our experiences give rise to the assumption that FDG-PET ist significantly superior to gallium scintigraphy in Hodgkin’s disease. Whole body FDG-PET can result in an upstaging of the patient and has therefore a major impact on the therapeutic management.
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Horn R, Rieker O, Klemm E, Menzel C, Möller HJ, Biersack HJ, Grünwald F. HMPAO-SPECT bei Demenz vom Alzheimer-Typ und Major Depression mit mnestischen Störungen. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1629660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungZiel der vorliegenden Untersuchung war es, zu prüfen, ob die HMPAO-SPECT zur Differenzierung zwischen der Demenz vom Alzheimer-Typ (DAT) und der Major Depression (MD) beitragen kann. Es wurden ECT-Befunde von 77 Patienten mit Gedächtnisstörungen beurteilt, davon hatten 48 eine DAT und 29 eine MD. Zunächst wurden die Defekte in der SPECT einer Hirn-Region zugeordnet und der Grad der Ausprägung (-1/-2/-3) bewertet. Anschließend wurden die einzelnen Befunde in eine von 7 Befundkategorien eingeordnet. In einigen dieser 7 Gruppen ergaben sich deutliche Häufungen der Fälle mit DAT bzw. MD. 35% aller DAT-Patienten wiesen bilaterale Defekte mit deutlicher (>-1) parietaler/parietotemporaler Minderperfusion auf, dagegen zeigte kein Patient mit MD dieses Muster. Unilaterale Defekte wiesen 62% der MD-, aber nur 31% der DAT-Patienten auf. Die Untersuchung zeigt, daß nur 35% der Patienten mit DAT das bislang als »pathognomonisch« bezeichnete Befundmuster aufwiesen. Dieses Perfusionsmuster kann aber - wenn es vorliegt - als sicheres Kriterium zur Abgrenzung gegen eine MD gewertet werden. Darüber hinaus lassen sich keine eindeutigen (»krankheitstypischen«) Perfusionsmuster erkennen, wenngleich unilaterale Defekte mehr auf eine MD hindeuten.
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Grünwald F, Layer G, Heidgen FJ, Menzel C, Biersack HJ, Rieker O. 99mTc-MAA-Anreicherung in der Leber bei cavo-portalem Shunt über eine rekanalisierte Vena umbilicalis. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1632299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungBei der Lungenperfusionsszintigraphie einer Patientin mit Vena-cava-superior-Verschluß fand sich eine deutliche MAA-Anreicherung in Teilen der Leber. Als Ursache konnte ein Kollateralkreislauf über Venen der Abdominalwand und eine rekanalisierte Vena umbilicalis ermittelt werden. Unter externer Bestrahlung von Lymphomen des oberen Mediastinums kam es zu einem raschen Rückgang des cavo-portalen Shunt-Volumens.
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Bender H, Grünwald F, Hümmelgen M, Willkomm P, Palmedo H, Lüderitz B, Biersack HJ, Bangard M. Myocardial Uptake of Technetium-99m-Furifosmin (Q12) Versus Technetiiim-99m-Sestamibi (MIBI). Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1632217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Aim: This study was performed to compare the myocardial uptake of Tc-99m-furifosmin (Q12) versus Tc-99m-sestamibi (MIBI) in correlation to the whole-body uptake under resting conditions. Methods: 21 patients
with coronary artery disease and no rest ischemia were examined. A whole-body scan was performed 60 min. p.i. under resting conditions. A quantification of the uptake (whole-body, heart and right lung) was done by ROI technique. Results: The heart-to-lung ratio of Q12 (1.56 ± 0.191) was significantly lower as compared to MIBI (1.94 ± 0.197; p <0.01). In contrast, the heart-to-whole-body ratios (Q12 versus MIBI: 0.027 ± 0.012 versus 0.026 ± 0.004; p <0.76) did not differ. The lung-to-whole-body ratio (Q12 versus MIBI: 0.018 ± 0.009 versus 0.013 ± 0.002; p <0.17) were different, but did not reach significance. Conclusion: These data show that under resting conditions the total myocardial uptake of Q12 does not differ significantly from that of MIBI. However, the pulmonary uptake of Q12 is slightly higher, resulting in a significant lower heart-to-lung ratio. These findings imply a lower image quality of Q12 compared to MIBI.
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Grünwald F, Herholz K, Kuwert T, Tatsch K, Sabri O, Weiller C, Bartenstein P. Rolle der Positronen-Emissions-Tomographie (PET) und Single-Photon-Emissions-Tomographie (SPECT) bei der sogenannten »Multiple Chemical Sensitivity« (MCS). Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1632224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungDie funktionell bildgebenden Verfahren SPECT und PET werden zunehmend genutzt, um die Existenz eines Syndroms der erworbenen Chemikalienüberempfindlichkeit »Multiple Chemical Sensitivity« (MCS) nachzuweisen. In der Folge spielen SPECT und PET-Befunde auch im Rahmen von Gutachten bei Berufskrankheiten-Anzeigen als Beweismittel eine große Rolle. In der vorliegenden Arbeit wird die zu diesem Thema existierende Literatur einer kritischen Betrachtung unterzogen. Die Autoren kommen zu dem Schluß, daß die gegenwärtig verfügbaren Daten nicht ausreichen, um die Existenz eines solchen Syndroms nachzuweisen. Die niedrige Spezifität der beschriebenen Veränderungen macht es sehr schwierig, einen kausalen Zusammenhang zu der toxischen Exposition herzustellen, und schränkt den Wert von PET und vor allem SPECT bei gutachterlichen Fragestellungen in diesem Zusammenhang ein.
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Grünwald F, Kuwert T, Tatsch K, Sabri O, Benkert O, Fahlbusch R, Gründer G, Herholz K, Weiller C, Bartenstein P. Clinical applications of single photon emission tomography in neuromedicine. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1632272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryThis article gives in his second part a critical review of the clinical applications of SPECT with perfusion markers and receptor ligands in dementing disorders and psychosis. In addition this review discusses clinical applications of SPECT investigations with perfusion markers in inflammatory diseases of the central nervous system and in brain trauma.
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Grünwald F, Kuwert T, Tatsch K, Sabri O, Benkert O, Fahlbusch R, Gründer G, Herzholz K, Weiller C, Bartenstein P. Clinical applications of single photon emission tomography in neuromedicine. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1632267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummarySingle photon emission tomography is, because of its availability and the relatively low costs, the functional imaging modality currently most widely used for clinical applications in the brain. Beside the application of radiopharmaceuticals for the assessment of regional cerebral blood flow there is an increasing clinical use of more selective SPECT-radiopharmaceuticals, like amino acid analogs or receptor ligands. This article gives in his first part a critical review of the clinical applications of SPECT in neuro-oncology, epilepsy, basal ganglia disorders and cerebrovascular disease.
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Vogt H, Bares R, Brenner W, Grünwald F, Kopp J, Reiners C, Schober O, Schümichen C, Schicha H, Sciuk J, Sudbrock F, Wengenmair H, Schmidt M. Verfahrensanweisung für die nuklear medizinische Wächter-Lymphknoten-Diagnostik. Nuklearmedizin 2018; 49:167-72; quiz N19. [DOI: 10.3413/nukmed-321] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Accepted: 05/07/2010] [Indexed: 11/20/2022]
Abstract
SummaryThe authors present a procedure guideline for scintigraphic detection of sentinel lymph nodes in malignant melanoma and other skin tumours, in breast cancer, in head and neck cancer, and in prostate and penile carcinoma. Important goals of sentinel lymph node scintigraphy comprise reduction of the extent of surgery, lower postoperative morbidity and optimization of histopathological examination focussing on relevant lymph nodes. Sentinel lymph node scintigraphy itself does not diagnose tumorous lymph node involvement and is not indicated when lymph node metastases have been definitely diagnosed before sentinel lymph node scintigraphy. Procedures are compiled with the aim to reliably localise sentinel lymph nodes with a high detection rate typically in early tumour stages. Radiation exposure is low so that pregnancy is not a contraindication for sentinel lymph node scintigraphy. Even with high volumes of scintigraphic sentinel lymph node procedures surgeons, theatre staff and pathologists receive a radiation exposure < 1 mSv/year so that they do not require occupational radiation surveillance.
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