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Fonda UDS, Leitão ALA, Paiva MMDP, Willegaignon J, Josefsson A, Buchpiguel CA, Sapienza MT. Influence on voxel-based dosimetry: noise effect on absorbed dose dosimetry at single time-point versus sequential single-photon emission computed tomography. Nucl Med Commun 2023; 44:596-603. [PMID: 37068008 DOI: 10.1097/mnm.0000000000001697] [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: 04/18/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate how statistical fluctuation in single-photon emission computed tomography (SPECT) images propagate to absorbed dose maps. METHODS SPECT/computed tomography (CT) images of iodine-131 filled phantoms, using different acquisition and processing protocols, were evaluated using STRATOS software to assess the absorbed dose distribution at the voxel level. Absorbed dose values and coefficient of variation (COV) were analyzed for dosimetry based on single time-point SPECT images and time-integrated activities of SPECT sequences with low and high counts. RESULTS Considering dosimetry based on a single time-point, the mean absorbed dose was not significantly affected by total counts or reconstruction parameters, but the uniformity of the absorbed dose maps had an almost linear correlation with SPECT noise. When high- and low-count SPECT sequences were used to generate an absorbed dose map, the absorbed dose COV for each of the temporal sequences was slightly lower than the absorbed dose COV based on the single SPECT image with the highest count included in the sequence. CONCLUSION The impact of changes in SPECT counts and reconstruction parameters is almost linear when dosimetry is based on isolated SPECT images, but less pronounced when dosimetry is based on sequential SPECTs.
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Affiliation(s)
- Uysha de S Fonda
- Departmento de Radiologia e Oncologia da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo
| | | | | | | | - Anders Josefsson
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carlos A Buchpiguel
- Departmento de Radiologia e Oncologia da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo
| | - Marcelo T Sapienza
- Departmento de Radiologia e Oncologia da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo
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2
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Costa E Silva VT, Gil LA, Inker LA, Caires RA, Costalonga E, Coura-Filho G, Sapienza MT, Castro G, Estevez-Diz MDP, Zanetta DMT, Antonângelo L, Marçal L, Tighiouart H, Miao S, Mathew P, Levey AS, Burdmann EA. A Prospective Cross-Sectional Study on the Performance of the 2021 CKD-EPI Equations Without Race in a Multiracial Population of Adults With Solid Tumors in Brazil. Am J Kidney Dis 2023:S0272-6386(23)00577-2. [PMID: 36965828 DOI: 10.1053/j.ajkd.2023.01.445] [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] [Received: 10/07/2022] [Accepted: 01/03/2023] [Indexed: 03/27/2023]
Affiliation(s)
- Verônica T Costa E Silva
- Serviço de Nefrologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR; LIM 12, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, BR.
| | - Luiz A Gil
- LIM 66, Serviço de Geriatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Renato A Caires
- Serviço de Nefrologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Elerson Costalonga
- Serviço de Nefrologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - George Coura-Filho
- Serviço de Medicina Nuclear, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Marcelo T Sapienza
- Radiology and Oncology Department, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, BR
| | - Gilberto Castro
- Serviço de Oncologia Clínica, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Maria D P Estevez-Diz
- Serviço de Oncologia Clínica, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Dirce Maria T Zanetta
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, SP, BR
| | - Leila Antonângelo
- LIM 03, Division of Clinical Pathology, University of São Paulo Medical School, São Paulo, SP, BR
| | - Lia Marçal
- LIM 03, Division of Clinical Pathology, University of São Paulo Medical School, São Paulo, SP, BR
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Biostatistics, Epidemiology, and Research Design (BERD) Center, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Shiyuan Miao
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Paul Mathew
- Division of Hematology-Oncology, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Emmanuel A Burdmann
- LIM 12, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, BR
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Ferraro DA, Hötker AM, Becker AS, Mebert I, Laudicella R, Baltensperger A, Rupp NJ, Rueschoff JH, Müller J, Mortezavi A, Sapienza MT, Eberli D, Donati OF, Burger IA. 68Ga-PSMA-11 PET/MRI versus multiparametric MRI in men referred for prostate biopsy: primary tumour localization and interreader agreement. Eur J Hybrid Imaging 2022; 6:14. [PMID: 35843966 PMCID: PMC9288941 DOI: 10.1186/s41824-022-00135-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/03/2022] [Indexed: 11/20/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is recommended by the European Urology Association guidelines as the standard modality for imaging-guided biopsy. Recently positron emission tomography with prostate-specific membrane antigen (PSMA PET) has shown promising results as a tool for this purpose. The aim of this study was to compare the accuracy of positron emission tomography with prostate-specific membrane antigen/magnetic resonance imaging (PET/MRI) using the gallium-labeled prostate-specific membrane antigen (68Ga-PSMA-11) and multiparametric MRI (mpMRI) for pre-biopsy tumour localization and interreader agreement for visual and semiquantitative analysis. Semiquantitative parameters included apparent diffusion coefficient (ADC) and maximum lesion diameter for mpMRI and standardized uptake value (SUVmax) and PSMA-positive volume (PSMAvol) for PSMA PET/MRI. Results Sensitivity and specificity were 61.4% and 92.9% for mpMRI and 66.7% and 92.9% for PSMA PET/MRI for reader one, respectively. RPE was available in 23 patients and 41 of 47 quadrants with discrepant findings. Based on RPE results, the specificity for both imaging modalities increased to 98% and 99%, and the sensitivity improved to 63.9% and 72.1% for mpMRI and PSMA PET/MRI, respectively. Both modalities yielded a substantial interreader agreement for primary tumour localization (mpMRI kappa = 0.65 (0.52–0.79), PSMA PET/MRI kappa = 0.73 (0.61–0.84)). ICC for SUVmax, PSMAvol and lesion diameter were almost perfect (≥ 0.90) while for ADC it was only moderate (ICC = 0.54 (0.04–0.78)). ADC and lesion diameter did not correlate significantly with Gleason score (ρ = 0.26 and ρ = 0.16) while SUVmax and PSMAvol did (ρ = − 0.474 and ρ = − 0.468). Conclusions PSMA PET/MRI has similar accuracy and reliability to mpMRI regarding primary prostate cancer (PCa) localization. In our cohort, semiquantitative parameters from PSMA PET/MRI correlated with tumour grade and were more reliable than the ones from mpMRI. Supplementary Information The online version contains supplementary material available at 10.1186/s41824-022-00135-4.
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Costa E Silva VT, Gil LA, Inker LA, Caires RA, Costalonga E, Coura-Filho G, Sapienza MT, Castro G, Estevez-Diz MD, Zanetta DMT, Antonângelo L, Marçal L, Tighiouart H, Miao S, Mathew P, Levey AS, Burdmann EA. A prospective cross-sectional study estimated glomerular filtration rate from creatinine and cystatin C in adults with solid tumors. Kidney Int 2022; 101:607-614. [PMID: 35032521 DOI: 10.1016/j.kint.2021.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 08/15/2021] [Revised: 11/18/2021] [Accepted: 12/09/2021] [Indexed: 01/06/2023]
Abstract
Current guidelines recommend estimating glomerular filtration rate (eGFR) using creatinine (eGFRcr) with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation as the first test for GFR evaluation, but the Cockcroft-Gault (CG) equation is still commonly used in oncology practice and clinical trials despite increasing evidence of its inaccuracy compared to measured GFR (mGFR). Guidelines recommend eGFR using cystatin C (eGFRcys) or both markers (eGFRcr-cys) as a confirmatory test, but neither was carefully evaluated in cancer patients. Therefore, we compared performance of the CKD-EPI equations and others to the CG equation in adults with a variety of solid tumors. The mGFR was determined by plasma clearance of 51Cr-EDTA. Bias was defined as the median of the differences between mGFR and eGFR while accuracy was defined as the percentage of estimates that differed by more than 30% from the measured GFR (1-P30). We prospectively recruited 1,200 patients between April 2015 and September 2017 with a mean age and mGFR of 58.8 years and 78.4 ml/min/1.73m2, respectively. Bias among eGFRcr equations varied from -8.1 to +6.1 ml/min/1.73 m2. CG was the least accurate, 1-P30 (95% confidence interval) was 24.9 (22.4- 27.3)%; CKD-EPI had 1-P30 of 19.1 (16.8-21.2)% while eGFRcr-cys had the best performance: bias -2.0 (-2.6 to -1.1) ml/min/1.73m2 and 1-P30 7.8 (6.3-9.4)%. Thus, the CG equation should not be preferred over CKD-EPI equation, and eGFRcr-cys can be used as a confirmatory test in adults with solid tumors. Hence, a major policy implication would be to adopt general practice guideline-recommended methods for GFR evaluation in oncology practice and clinical trials.
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Affiliation(s)
- Verônica T Costa E Silva
- Serviço de Nefrologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Luiz A Gil
- Laboratório de Investigação Médica (LIM) 66, Serviço de Geriatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Renato A Caires
- Serviço de Nefrologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Elerson Costalonga
- Serviço de Nefrologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - George Coura-Filho
- Serviço de Medicina Nuclear, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo T Sapienza
- Radiology and Oncology Department, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Gilberto Castro
- Serviço de Oncologia Clínica, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Dp Estevez-Diz
- Serviço de Oncologia Clínica, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Dirce Maria T Zanetta
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Leila Antonângelo
- Laboratório de Investigação Médica (LIM) 03, Division of Clinical Pathology, University of São Paulo Medical School, São Paulo, Brazil
| | - Lia Marçal
- Laboratório de Investigação Médica (LIM) 03, Division of Clinical Pathology, University of São Paulo Medical School, São Paulo, Brazil
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Biostatistics, Epidemiology, and Research Design Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Shiyuan Miao
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Paul Mathew
- Division of Hematology-Oncology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Emmanuel A Burdmann
- Laboratório de Investigação (LIM) 12, Serviço de Nefrologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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5
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Ferraro DA, Laudicella R, Zeimpekis K, Mebert I, Müller J, Maurer A, Grünig H, Donati O, Sapienza MT, Rueschoff JH, Rupp N, Eberli D, Burger IA. Hot needles can confirm accurate lesion sampling intraoperatively using [ 18F]PSMA-1007 PET/CT-guided biopsy in patients with suspected prostate cancer. Eur J Nucl Med Mol Imaging 2021; 49:1721-1730. [PMID: 34725726 PMCID: PMC8560591 DOI: 10.1007/s00259-021-05599-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/24/2021] [Accepted: 10/19/2021] [Indexed: 12/23/2022]
Abstract
Purpose Prostate-specific membrane antigen (PSMA)-targeted PET is increasingly used for staging prostate cancer (PCa) with high accuracy to detect significant PCa (sigPCa). [68 Ga]PSMA-11 PET/MRI-guided biopsy showed promising results but also persisting limitation of sampling error, due to impaired image fusion. We aimed to assess the possibility of intraoperative quantification of [18F]PSMA-1007 PET/CT uptake in core biopsies as an instant confirmation for accurate lesion sampling. Methods In this IRB-approved, prospective, proof-of-concept study, we included five consecutive patients with suspected PCa. All underwent [18F]PSMA-1007 PET/CT scans followed by immediate PET/CT-guided and saturation template biopsy (3.1 ± 0.3 h after PET). The activity in biopsy cores was measured as counts per minute (cpm) in a gamma spectrometer. Pearson’s test was used to correlate counts with histopathology (WHO/ISUP), tumor length, and membranous PSMA expression on immunohistochemistry (IHC). Results In 43 of 113 needles, PCa was present. The mean cpm was overall significantly higher in needles with PCa (263 ± 396 cpm) compared to needles without PCa (73 ± 44 cpm, p < 0.001). In one patient with moderate PSMA uptake (SUVmax 8.7), 13 out of 24 needles had increased counts (100–200 cpm) but only signs of inflammation and PSMA expression in benign glands on IHC. Excluding this case, ROC analysis resulted in an AUC of 0.81, with an optimal cut-off to confirm PCa at 75 cpm (sens/spec of 65.1%/87%). In all 4 patients with PCa, the first or second PSMA PET-guided needle was positive for sigPCa with high counts (156–2079 cpm). Conclusions [18F]PSMA-1007 uptake in PCa can be used to confirm accurate lesion sampling of the dominant tumor intraoperatively. This technique could improve confidence in imaging-based biopsy guidance and reduce the need for saturation biopsy. Trial registration number NCT03187990, 15/06/2017. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05599-3.
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Affiliation(s)
- Daniela A Ferraro
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Riccardo Laudicella
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Konstantinos Zeimpekis
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Iliana Mebert
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Julian Müller
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexander Maurer
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hannes Grünig
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Olivio Donati
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marcelo T Sapienza
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jan H Rueschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niels Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland.
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Roschel H, Hayashi AP, Fernandes AL, Jambassi-Filho JC, Hevia-Larraín V, de Capitani M, Santana DA, Gonçalves LS, de Sá-Pinto AL, Lima FR, Sapienza MT, Duarte AJS, Pereira RMR, Phillips SM, Gualano B. Supplement-based nutritional strategies to tackle frailty: A multifactorial, double-blind, randomized placebo-controlled trial. Clin Nutr 2021; 40:4849-4858. [PMID: 34358827 DOI: 10.1016/j.clnu.2021.06.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 01/12/2021] [Revised: 06/01/2021] [Accepted: 06/23/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Sarcopenia plays a central role in the development of frailty syndrome. Nutrition and exercise are cornerstone strategies to mitigate the transition to frailty; however, there is a paucity of evidence for which dietary and exercise strategies are effective. OBJECTIVE This large, multifactorial trial investigated the efficacy of different dietary strategies to enhance the adaptations to resistance training in pre-frail and frail elderly. METHODS This was a single-site 16-week, double-blind, randomized, placebo-controlled trial conducted at the Clinical Hospital, School of Medicine - University of São Paulo, Sao Paulo, Brazil. Four integrated, sub-investigations were conducted to compare: 1) leucine vs. placebo; 2) whey vs. soy vs. placebo; 3) creatine vs. whey vs. creatine plus whey vs. placebo; 4) women vs. men in response to whey. Sub-investigations 1 to 3 were conducted in women, only. Two-hundred participants (154 women/46 men, mean age 72 ± 6 years) underwent a twice-a-week, resistance training program. The main outcomes were muscle function (assessed by dynamic and isometric strength and functional tests) and lean mass (assessed by DXA). Muscle cross-sectional area, health-related quality of life, bone and fat mass, and biochemical markers were also assessed. RESULTS We observed that leucine supplementation was ineffective to improve muscle mass and function. Supplementation with whey and soy failed to enhance resistance-training effects. Similarly, supplementation with neither whey nor creatine potentiated the adaptations to resistance training. Finally, no sex-based differences were found in response to whey supplementation. Resistance exercise per se increased muscle mass and function in all sub-investigations. There were no adverse effects. CONCLUSION Neither protein (whey and soy), leucine, nor creatine supplementation enhanced resistance training-induced adaptations in pre-frail and frail elderly, regardless of sex. These findings do not support the notion that some widely used supplement-based interventions can add to the already potent effects of resistance exercise to counteract frailty-related muscle wasting and dynapenia. CLINICAL TRIAL REGISTRY NCT01890382; https://clinicaltrials.gov/ct2/show/NCT01890382. DATA SHARING Data described in the manuscript will be made available upon request pending application.
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Affiliation(s)
- Hamilton Roschel
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil; Laboratory of Assessment and Conditioning in Rhematology, Faculdade de Medicina FMUSP, Disciplina de Reumatologia, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Ana Paula Hayashi
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil; Laboratory of Assessment and Conditioning in Rhematology, Faculdade de Medicina FMUSP, Disciplina de Reumatologia, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alan L Fernandes
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil
| | - José Claudio Jambassi-Filho
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil
| | - Victoria Hevia-Larraín
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil
| | - Mariana de Capitani
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil
| | - Davi A Santana
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil
| | - Lívia S Gonçalves
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil
| | - Ana Lúcia de Sá-Pinto
- Laboratory of Assessment and Conditioning in Rhematology, Faculdade de Medicina FMUSP, Disciplina de Reumatologia, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Fernanda R Lima
- Laboratory of Assessment and Conditioning in Rhematology, Faculdade de Medicina FMUSP, Disciplina de Reumatologia, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marcelo T Sapienza
- Faculdade de Medicina FMUSP, Disciplina de Radiologia, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alberto J S Duarte
- Divisão de Laboratório Central do Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rosa M R Pereira
- Laboratory of Bone Metabolism, Faculdade de Medicina FMUSP, Disciplina de Reumatologia, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Stuart M Phillips
- McMaster University, Department of Kinesiology, Hamilton, Ontario, Canada
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil; Laboratory of Assessment and Conditioning in Rhematology, Faculdade de Medicina FMUSP, Disciplina de Reumatologia, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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7
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Abstract
Theranostics describes the pairing of diagnostic biomarkers and therapeutic agents with common specific targets. Nuclear medicine is the greatest theranostics protagonist, relying on radioactive tracers for imaging biologic phenomena and delivering ionizing radiation to the tissues that take up those tracers. The concept has gained importance with the growth of personalized medicine, allowing customized management for diseases, refining patient selection, better predicting responses, reducing toxicity, and estimating prognosis. This work provides an overview of the general concepts of the theranostics approach in nuclear medicine discussing its background, features, and future directions in imaging and therapy.
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Affiliation(s)
- Rafael F Nunes
- Department of Radiology, Hospital Sirio-Libanes, Sao Paulo, Brazil.
| | - Roberta M F Zuppani
- Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Artur M Coutinho
- Department of Radiology, Hospital Sirio-Libanes, Sao Paulo, Brazil; Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Felipe G Barbosa
- Department of Radiology, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Marcelo T Sapienza
- Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jose Flavio G Marin
- Department of Radiology, Hospital Sirio-Libanes, Sao Paulo, Brazil; Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos A Buchpiguel
- Department of Radiology, Hospital Sirio-Libanes, Sao Paulo, Brazil; Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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8
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Halpern B, Mancini MC, Bueno C, Barcelos IP, de Melo ME, Lima MS, Carneiro CG, Sapienza MT, Buchpiguel CA, do Amaral FG, Cipolla-Neto J. Melatonin Increases Brown Adipose Tissue Volume and Activity in Patients With Melatonin Deficiency: A Proof-of-Concept Study. Diabetes 2019; 68:947-952. [PMID: 30765337 DOI: 10.2337/db18-0956] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/04/2019] [Indexed: 11/13/2022]
Abstract
Melatonin, a pineal hormone synthesized at night, is critical for the synchronization of circadian and seasonal rhythms, being a key regulator of energy metabolism in many animal species. Although studies in humans are lacking, several reports, mainly on hibernating animals, demonstrated that melatonin supplementation and a short photoperiod increase brown adipose tissue (BAT) mass. The present proof-of-concept study is the first, to our knowledge, to evaluate BAT in patients with melatonin deficiency (radiotherapy or surgical removal of pineal gland) before and after daily melatonin (3 mg) replacement for 3 months. All four studied patients presented increased BAT volume and activity measured by positron emission tomography-MRI. We also found an improvement in total cholesterol and triglyceride blood levels without significant effects on body weight, liver fat, and HDL and LDL levels. Albeit not statistically significant, fasting insulin levels and HOMA of insulin resistance decreased in all four patients. The present results show that oral melatonin replacement increases BAT volume and activity and improves blood lipid levels in patients with melatonin deficiency, suggesting that melatonin is a possible BAT activator. Future studies are warranted because hypomelatoninemia is usually present in aging and appears as a result of light-at-night exposure and/or the use of β-blocker drugs.
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Affiliation(s)
- Bruno Halpern
- Department of Endocrinology and Metabolism, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcio C Mancini
- Department of Endocrinology and Metabolism, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Clarissa Bueno
- Department of Pediatric Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Isabella P Barcelos
- Department of Pediatric Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maria Edna de Melo
- Department of Endocrinology and Metabolism, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcos S Lima
- Nuclear Medicine Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Camila G Carneiro
- Nuclear Medicine Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo T Sapienza
- Nuclear Medicine Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Alberto Buchpiguel
- Nuclear Medicine Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - José Cipolla-Neto
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, Universidade de São Paulo, São Paulo, Brazil
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9
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Affiliation(s)
| | - Lázaro M Camargo
- Veterinary Medical School, University of Cuiabá, Cuiabá, Mato Grosso, Brazil
| | - Marcelo T Sapienza
- Institute of Radiology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos A Buchpiguel
- Institute of Radiology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Valdir S Amato
- Department of Infectious and Parasitic Diseases, University of São Paulo, Medical School, São Paulo, Brazil
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10
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Willegaignon J, Sapienza MT, Coura-Filho GB, Garcez AT, Alves CE, Cardona MR, Gutterres RF, Buchpiguel CA. Dose Calibrator Linearity Testing: Radioisotope (99m)Tc or (18)F? An Alternative for Reducing Costs in Nuclear Medicine Quality Control. World J Nucl Med 2015; 14:165-70. [PMID: 26420986 PMCID: PMC4564918 DOI: 10.4103/1450-1147.163245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 11/29/2022] Open
Abstract
Dose calibrator linearity testing is indispensable for evaluating the capacity of this equipment in measuring radioisotope activities at different magnitudes, a fundamental aspect of the daily routine of a nuclear medicine department, and with an impact on patient exposure. The main aims of this study were to evaluate the feasibility of substituting the radioisotope Fluorine-18 (18F) with Technetium-99m (99mTc) in this test, and to indicate it with the lowest operational cost. The test was applied with sources of 99mTc (62 GBq) and 18F (12 GBq), the activities of which were measured at different times, with the equipment preadjusted to measuring sources of 99mTc, 18F, Gallium-67 (67Ga), and Iodine-131 (131I). Over time, the average deviation between measured and expected activities from 99mTc and 18F were, respectively, 0.56 (±1.79)% and 0.92 (±1.19)%. The average ratios for 99mTc source experimental activity, when measured with the equipment adjusted for measuring 18F, 67Ga, and 131I sources, in real values, were, respectively, 3.42 (±0.06), 1.45 (±0.03), and 1.13 (±0.02), and those for the 18F source experimental activity, measured through adjustments of 99mTc, 67Ga, and 131I, were, respectively, 0.295 (±0.004), 0.335 (±0.007), and 0.426 (±0.006). The adjustment of a simple exponential function for describing 99mTc and 18F experimental activities facilitated the calculation of the physical half-lives of the radioisotopes, with a difference of about 1% in relation to the values described in the literature. Linearity test results, when using 99mTc, through being compatible with those acquired with 18F, imply the possibility of using both radioisotopes during linearity testing. Nevertheless, this information, along with the high potential of exposure and the high cost of 18F, implies that 99mTc should preferably be employed for linearity testing in clinics that normally use 18F, without the risk of prejudicing either the procedure itself or the guarantee of a high-quality nuclear medicine service.
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Affiliation(s)
- José Willegaignon
- Nuclear Medicine Service, Cancer Institute of São Paulo State, University of São Paulo, São Paulo, SP, Brazil ; Nuclear Medicine Service, Institute of Radiology, Clinical Hospital, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Marcelo T Sapienza
- Nuclear Medicine Service, Cancer Institute of São Paulo State, University of São Paulo, São Paulo, SP, Brazil ; Nuclear Medicine Service, Institute of Radiology, Clinical Hospital, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - George Barberio Coura-Filho
- Nuclear Medicine Service, Cancer Institute of São Paulo State, University of São Paulo, São Paulo, SP, Brazil ; Nuclear Medicine Service, Institute of Radiology, Clinical Hospital, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Alexandre T Garcez
- Nuclear Medicine Service, Cancer Institute of São Paulo State, University of São Paulo, São Paulo, SP, Brazil ; Nuclear Medicine Service, Institute of Radiology, Clinical Hospital, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Carlos E Alves
- National Commission on Nuclear Energy (CNEN), Rio de Janeiro, RJ, Brazil
| | - Marissa R Cardona
- National Commission on Nuclear Energy (CNEN), Rio de Janeiro, RJ, Brazil
| | | | - Carlos A Buchpiguel
- Nuclear Medicine Service, Cancer Institute of São Paulo State, University of São Paulo, São Paulo, SP, Brazil ; Nuclear Medicine Service, Institute of Radiology, Clinical Hospital, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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11
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Hayashi AP, Solis MY, Sapienza MT, Otaduy MCG, de Sá Pinto AL, Silva CA, Sallum AME, Pereira RMR, Gualano B. Efficacy and safety of creatine supplementation in childhood-onset systemic lupus erythematosus: a randomized, double-blind, placebo-controlled, crossover trial. Lupus 2014; 23:1500-1511. [DOI: 10.1177/0961203314546017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Introduction Creatine supplementation has emerged as a promising non-pharmacological therapeutic strategy to counteract muscle dysfunction and low lean mass in a variety of conditions, including in pediatric and rheumatic diseases. The objective of this study was to examine the efficacy and safety of creatine supplementation in childhood systemic lupus erythematosus (C-SLE). Methods C-SLE patients with mild disease activity ( n = 15) received placebo or creatine supplementation in a randomized fashion using a crossover, double-blind, repeated-measures design. The participants were assessed at baseline and after 12 weeks in each arm, interspersed by an eight-week washout period. The primary outcomes were muscle function, as assessed by a battery of tests including one-maximum repetition (1-RM) tests, the timed-up-and-go test, the timed-stands test, and the handgrip test. Secondary outcomes included body composition, biochemical markers of bone remodeling, aerobic conditioning, quality of life, and physical capacity. Possible differences in dietary intake were assessed by three 24-hour dietary recalls. Muscle phosphorylcreatine content was measured through phosphorus magnetic resonance spectroscopy (31 P-MRS). The safety of the intervention was assessed by laboratory parameters, and kidney function was measured by 51Cr-EDTA clearance. Additionally, self-reported adverse events were recorded throughout the trial. Results Intramuscular phosphorylcreatine content was not significantly different between creatine and placebo before or after the intervention (creatine-Pre: 20.5 ± 2.6, Post: 20.4 ± 4.1, placebo-Pre: 19.8 ± 2.0; Post: 20.2 ± 3.2 mmol/kg wet muscle; p = 0.70 for interaction between conditions). In addition, probably as a consequence of the lack of change in intramuscular phosphorylcreatine content, there were no significant changes between placebo and creatine for any muscle function and aerobic conditioning parameters, lean mass, fat mass, bone mass, and quality of life scores ( p > 0.05). The 51Cr-EDTA clearance was not altered by creatine supplementation and no side effects were noticed. Conclusion A 12-week creatine supplementation protocol at 0.1 g/kg/d is well tolerated and free of adverse effects but did not affect intramuscular phosphorylcreatine, muscle function, free-fat mass or quality of life in non-active C-SLE patients. Trial registration Clinicaltrials.gov number: NCT01217320.
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Affiliation(s)
| | | | | | | | | | | | | | | | - B Gualano
- School of Medicine
- School of Physical Education and Sport, University of São Paulo, Brazil
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12
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Balbo BEP, Sapienza MT, Ono CR, Jayanthi SK, Dettoni JB, Castro I, Onuchic LF. Cyst infection in hospital-admitted autosomal dominant polycystic kidney disease patients is predominantly multifocal and associated with kidney and liver volume. ACTA ACUST UNITED AC 2014; 47:584-93. [PMID: 24919173 PMCID: PMC4123838 DOI: 10.1590/1414-431x20143584] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 03/17/2014] [Indexed: 12/17/2022]
Abstract
Positron-emission tomography/computed tomography (PET/CT) has improved cyst infection
(CI) management in autosomal dominant polycystic kidney disease (ADPKD). The
determinants of kidney and/or liver involvement, however, remain uncertain. In this
study, we evaluated clinical and imaging factors associated with CI in kidney (KCI)
and liver (LCI) in ADPKD. A retrospective cohort study was performed in
hospital-admitted ADPKD patients with suspected CI. Clinical, imaging and surgical
data were analyzed. Features of infected cysts were evaluated by PET/CT. Total kidney
(TKV) and liver (TLV) volumes were measured by CT-derived multiplanar reconstruction.
CI was detected in 18 patients who experienced 24 episodes during an interval of 30
months (LCI in 12, KCI in 10 and concomitant infection in 2). Sensitivities of CT,
magnetic resonance imaging and PET/CT were 25.0, 71.4, and 95.0%. Dysuria
(P<0.05), positive urine culture (P<0.01), and previous hematuria (P<0.05)
were associated with KCI. Weight loss (P<0.01) and increased C-reactive protein
levels (P<0.05) were associated with LCI. PET/CT revealed that three or more
infected cysts were present in 70% of the episodes. TKV was higher in kidney-affected
than in LCI patients (AUC=0.91, P<0.05), with a cut-off of 2502 mL (72.7%
sensitivity, 100.0% specificity). TLV was higher in liver-affected than in KCI
patients (AUC=0.89, P<0.01) with a cut-off of 2815 mL (80.0% sensitivity, 87.5%
specificity). A greater need for invasive procedures was observed in LCI (P<0.01),
and the overall mortality was 20.8%. This study supports PET/CT as the most sensitive
imaging method for diagnosis of cyst infection, confirms the multifocal nature of
most hospital-admitted episodes, and reveals an association of kidney and liver
volumes with this complication.
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Affiliation(s)
- B E P Balbo
- Divisão de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M T Sapienza
- Divisão de Medicina Nuclear, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - C R Ono
- Divisão de Medicina Nuclear, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - S K Jayanthi
- Divisão de Radiologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J B Dettoni
- Divisão de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I Castro
- Divisão de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L F Onuchic
- Divisão de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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13
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Willegaignon J, Sapienza MT, Filho GBC, Traino AC, Buchpiguel CA. Determining thyroid 131
I effective half-life for the treatment planning of Graves’ disease. Med Phys 2013; 40:022502. [DOI: 10.1118/1.4788660] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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14
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Willegaignon J, Sapienza MT, Buchpiguel CA. Comparison of different dosimetric methods for red marrow absorbed dose calculation in thyroid cancer therapy. Radiat Prot Dosimetry 2012; 149:138-146. [PMID: 21586539 DOI: 10.1093/rpd/ncr214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Several dosimetric methods have been proposed for estimating red marrow absorbed dose (RMAD) when radionuclide therapy is planned for differentiated thyroid cancer, although to date, there is no consensus as to whether dose calculation should be based on blood-activity concentration or not. Our purpose was to compare RMADs derived from methods that require collecting patients' blood samples versus those involving OLINDA/EXM software, thereby precluding this invasive procedure. This is a retrospective study that included 34 patients under treatment for metastatic thyroid disease. A deviation of <10 % between RMADs was found, when comparing the doses from the most usual invasive dosimetric methods and those from OLINDA/EXM. No statistical difference between the methods was discovered, whereby the need for invasive procedures when calculating the dose is questioned. The use of OLINDA/EXM in clinical routine could possibly diminish data collection, thus giving rise to a simultaneous reduction in time and clinical costs, besides avoiding any kind of discomfort on the part of the patients involved.
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Affiliation(s)
- José Willegaignon
- Nuclear Medicine Center, Department of Radiology, School of Medicine, University of São Paulo, São Paulo, Brazil.
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15
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Brust ES, Beltrao CB, Chammas MC, Watanabe T, Sapienza MT, Marui S. Absence of mutations in PAX8, NKX2.5, and TSH receptor genes in patients with thyroid dysgenesis. ACTA ACUST UNITED AC 2012; 56:173-7. [DOI: 10.1590/s0004-27302012000300004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 03/13/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVES: To precisely classify the various forms of TD, and then to screen for mutations in transcription factor genes active in thyroid development. SUBJECTS AND METHODS: Patients underwent ultrasound, thyroid scan, and serum thyroglobulin measurement to accurately diagnose the form of TD. DNA was extracted from peripheral leukocytes. The PAX8, and NKX2.5 genes were evaluated in all patients, and TSH receptor (TSHR) gene in those with hypoplasia. RESULTS: In 27 nonconsanguineous patients with TD, 13 were diagnosed with ectopia, 11 with hypoplasia, and 3 with athyreosis. No mutations were detected in any of the genes studied. CONCLUSION: Sporadic cases of TD are likely to be caused by epigenetic factors, rather than mutations in thyroid transcription factors or genes involved in thyroid development.
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16
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Gualano B, Coelho DF, Sapienza MT, Seguro AC, Lancha AH. Effect Of Short-term, High-dose Creatine Supplementation On Kidney Function In A Young Man With A Single Kidney. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000385002.81932.0f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Methods currently employed to establish the etiology of congenital hypothyroidism include thyroid ultrasound and scintigraphic exams. Thyroglobulin is a protein almost exclusively secreted by thyroid tissue and indirectly reflects the amount of follicular cells. Even though thyroglobulin is easy to measure, it has been not frequently used because of discordant results to distinguish mainly athyreosis and ectopy (dysgenesis). Knowing the differences in inheritance and prognosis of thyroid dysgenesis and dyshormonogenesis, it is important to define the etiology of CH, combining tools that are easy, fast and available in most medical centers. Our objective was to evaluate and compare color Doppler ultrasound and serum thyroglobulin with radionuclide scan to define the etiology of congenital hypothyroidism. We evaluated 38 children above 3 years-old off-treatment that performed serum thyroglobulin by immunofluorometric assay, color Doppler ultrasound and radionuclide study. On color Doppler ultrasound, 11 patients had athyreosis, 5 ectopic glands, being 1 associated to hemiagenesis. Twenty one had topic thyroid (3 goiters, 10 normal, 8 hypoplastic). Hemiagenesis and cystic lesion were not revealed by radionuclide scan. We observed substantial agreement between color Doppler ultrasound and radionuclide scan (kappa=0.745, p<0.0001). Serum thyroglobulin in athyreosis ranged from <1.0 to 18.7 micro g/L. Patients with ectopic glands showed wider thyroglobulin range (4.5 to 123 micro g/L, median 28.4 micro g/L). Only one patient showed thyroglobulin deficiency. By using color Doppler ultrasound and serum thyroglobulin levels as valuable combined tools, we established the etiology of congenital hypothyroidism limiting excessive and harmful exams in children, like radionuclide scan.
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Affiliation(s)
- Cristine B Beltrão
- Laboratório de Endocrinologia Celular e Molecular, LIM 25, Unidade de Tireóide, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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18
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Medeiros FSR, Sapienza MT, Prado ES, Agena F, Shimizu MHM, Lemos FBC, Buchpiguel CA, Ianhez LE, David-Neto E. Validation of plasma clearance of 51Cr-EDTA in adult renal transplant recipients: comparison with inulin renal clearance. Transpl Int 2008; 22:323-31. [PMID: 19055616 DOI: 10.1111/j.1432-2277.2008.00799.x] [Citation(s) in RCA: 40] [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] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Plasma clearance of (51)Cr-EDTA ((51)Cr-EDTA-Cl) is an alternative method to evaluate glomerular filtration rate (GFR). This study aimed to investigate the concordance between (51)Cr-EDTA-Cl and renal inulin clearance (In-Cl) in renal transplant recipients as well to determine the repeatability of (51)Cr-EDTA-Cl in kidney donors. Forty four kidney recipients and 22 kidney donors were enrolled. Simultaneous measurements of (51)Cr-EDTA-Cl and In-Cl were performed. A single dose of 3.7MBq of (51)Cr-EDTA was injected and the plasma disappearance curve was created by taking blood samples at 2, 4, 6 and 8 h after injection. Bland and Altman statistical approach was used to quantify the agreement between In-Cl and (51)Cr-EDTA-Cl and to determine the better concordance between all possibilities of measure for the (51)Cr-EDTA-Cl. The mean of In-Cl was 44.5 +/- 17.9 ml/min/1.73 m(2). There was a positive correlation between In-Cl and all possible measurements of (51)Cr-EDTA-Cl. (51)Cr-EDTA-Cl with two samples taken at 4 and 8 h or at 4 and 6 h presenting the narrow limits of agreement and a difference (bias) of 2.8 and 2.7 ml/min, respectively. Two plasma sampling for (51)Cr-EDTA-Cl was a reliable method to measure GFR compared with In-Cl and comprises a suitable method to be used in kidney transplanted patients.
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19
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Buchpiguel CA, Smid J, Bottino CM, Duran FL, Ono CR, Leite CC, Sapienza MT, Watanabe T, Prando S, Busatto-Filho G, Nitrini R. IC‐P2‐081: Imaging substrates in early Alzheimer's disease: A spect, FDG‐PET and volumetric MRI correlation study. Alzheimers Dement 2008. [DOI: 10.1016/j.jalz.2008.05.074] [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: 10/21/2022]
Affiliation(s)
| | - Jerusa Smid
- School of Medicine - University of Sao PauloSao PauloBrazil
| | | | - Fabio L. Duran
- School of Medicine - University of Sao PauloSao PauloBrazil
| | - Carla R. Ono
- School of Medicine - University of Sao PauloSao PauloBrazil
| | | | | | | | - Silvana Prando
- School of Medicine - University of Sao PauloSao PauloBrazil
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Willegaignon J, Guimarães MIC, Stabin MG, Sapienza MT, Malvestiti LF, Marone MMS, Sordi GMAA. Correction factors for more accurate estimates of exposure rates near radioactive patients: experimental, point, and line source models. Health Phys 2007; 93:678-688. [PMID: 17993848 DOI: 10.1097/01.hp.0000275298.69543.5c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Radioactive patients may expose others after radiopharmaceutical administrations, and evaluation of the absorbed dose or exposure rates close to patients is important in keeping radiation doses as low as reasonably achievable. Two theoretical exposure models, point source and line source models, are frequently used to calculate exposure or dose rates without the support of actual measurements. If measurements of exposure rates were performed near patients, an experimental exposure model could be implemented. When measurements of exposure rates are performed, these measurements are made inside therapy rooms or other confined places, in which case scattered radiation may significantly influence the measurements. In this study we measured exposure rates from radioactive patients without the influence of scattered radiation and determined correction factors for the theoretical exposure models. The exposure rates from a total of 110 radioactive patients were measured at 1.0 h after oral administration of Na131I for thyroid therapy; the results +/-1 SD at distances of 0.5, 1.0, 1.5, 2.0, 3.0, and 4.0 m in front of the patients were (29 +/- 6), (9.9 +/- 1.7), (4.6 +/- 0.9), (2.7 +/- 0.5), (1.31 +/- 0.25) and (0.74 +/- 0.12) x 10(-10) C kg(-1) MBq(-1) h(-1) [1.0 x 10(-10) C kg(-1) MBq(-1) h(-1) = 14.34 x 10(-6) R mCi(-1) h(-1)], respectively. To obtain more accurate estimates of the actual exposure rates from patients using the theoretical exposure models, we found that correction factors should be applied; the functions CFEM = 1.19 + 32.80e(5.92D) and CFLS = 0.022LnD + 0.639 describe these correction factors for distances less than or equal to 1.0 m from the patients for experimental and line source exposure models, respectively. The function that describes the correction factors to the point source model is CFPS = 0.224LnD + 0.638 at the same distances; applying these correction factors leads to a reduction from 56% to 1% in the difference between measured exposure rates and theoretical exposure rates calculated by the point source exposure model at a distance of 1.0 m from patients. The results given here provide more accuracy in evaluation of exposure rates and consequently absorbed doses near radioactive patients and allow for more effective radiological protection procedures during patient management.
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Affiliation(s)
- J Willegaignon
- Nuclear Medicine Center, Instituto de Radiologia, Faculdade de Medicina, Universidade de São Paulo, Brazil.
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21
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Willegaignon J, Guimarães MIC, Sapienza MT, Stabin MG, Malvestiti LF, Marone M, Sordi GMAA. A new proposal for monitoring patients in nuclear medicine. Health Phys 2006; 91:624-9. [PMID: 17099406 DOI: 10.1097/01.hp.0000225467.10064.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The measurement of exposure rates is fundamentally important in the release of patients given radioactive materials and for keeping the exposures of others as low as reasonable achievable. Similar measurement methodologies have generally been used for point and extended sources, but this approach may lead to methodological errors in calculating radiation dose estimates. In this study, nuclear medicine patients who received high activities of Na131I for therapy were monitored using different measurement methodologies, and the results showed that the usual measurement performed at 1.0 m in front of the body resulted in a mean error of 40% between experimental and theoretical exposure rates. The best measurements were obtained when performed at 2.0 m in front of the patients. With this approach, the error was about 2% between experimental and theoretical values. These findings suggest a new methodology for patients' measurement in nuclear medicine and could be useful for personal monitoring in cases of radiological emergencies involving 131I ingestion.
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Affiliation(s)
- J Willegaignon
- Radiological Protection Service, Instituto de Pesquisas Energéticas e Nucleares, Av. Prof. Lineu Prestes, 2242, Cidade Universitaria, CEP 05508-000, São Paulo, Brazil.
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22
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Willegaignon J, Malvestiti LF, Guimarães MIC, Sapienza MT, Endo IS, Neto GC, Marone M, Sordi GMAA. 131I effective half-life (Teff) for patients with thyroid cancer. Health Phys 2006; 91:119-22. [PMID: 16832192 DOI: 10.1097/01.hp.0000202232.98823.87] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Nuclear medicine procedures that use I activity represent significant sources of potential absorbed dose to medical staff, volunteers, and the general public. The potential exposures are due principally from exposures to excreted and retained activities in the patients' bodies. In general, exposure rate decreases in a simple exponential manner. The average effective half-life found for all patients in the study reported here is 11.41 +/- 0.02 h; this information may be used in guidelines on the management of patients in thyroid cancer therapy and for general radioprotection practice.
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Affiliation(s)
- J Willegaignon
- Radiological Protection Service, Instituto de Pesquisas Energéticas e Nucleares, Cidade Universitária, São Paulo, Brazil.
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23
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Willegaignon J, Stabin MG, Guimarães MIC, Malvestiti LF, Sapienza MT, Maroni M, Sordi GMAA. Evaluation of the potential absorbed doses from patients based on whole-body 131I clearance in thyroid cancer therapy. Health Phys 2006; 91:123-7. [PMID: 16832193 DOI: 10.1097/01.hp.0000206041.25242.c0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The evaluation of the absorbed dose from radioactive patients during the treatment of thyroid disease is an important factor in establishing precautions in these procedures, and the I retention/excretion by patients' bodies provides additional information to medical and radioprotection service. In 94 patients, the measurement of exposure rates was performed over 7 d following NaI administration, and the rates permitted the study of the dynamics of excretion and the potential dose evaluation. The administered activities ranged from 3.7 GBq (100 mCi) to 16.65 GBq (450 mCi), and the results proved that the majority of the activity is excreted by patients in the first 3 d after NaI administration. The average (131)I activity excreted at 24, 48, 72, 96, and 120 h after oral administration was (72 +/- 10), (91 +/- 6), (97 +/- 3), (98.9 +/- 1.5), and (99.6 +/- 0.7)%, respectively. According to the administered activity, the evaluation of the accumulated absorbed dose from patients ranged from 3.0 +/- 0.7 to 8.4 +/- 1.1 mSv at 1 m and 1.2 +/- 0.4 to 3.2 +/- 0.4 mSv at 2 m. The data reported here are important to radioprotection policy and to add to and improve on the guidelines reported in U.S. NRC Regulatory Guide 8.39.
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Affiliation(s)
- J Willegaignon
- Radiological Protection Service, Instituto de Pesquisas Energéticas e Nucleares, Cidade Universitaria, São Paulo, Brazil.
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Sapienza MT, Ono CR, Watanabe T, Buchpiguel CA, Hironaka FH. First-pass scintigraphy with 99mTc macroaggregated albumin: a method for evaluating pulmonary arterial flow pulsatility. Nucl Med Commun 2004; 25:571-6. [PMID: 15167516 DOI: 10.1097/01.mnm.0000126509.73469.5c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/26/2022]
Abstract
OBJECTIVES The aim of this work was to develop and describe a non-invasive scintigraphic technique to detect flow pulsatility in peripheral pulmonary arteries. METHODS Ten normal volunteers were submitted to a first-pass scintigraphy using Tc macroaggregated albumin (Tc-MAA). A time-activity curve was generated for the right lung lateral third. Activity was shown to be restricted to the arterial compartment of the lungs, since there was no detectable progression of the radiopharmaceutical to the systemic circulation. Consequently, the rise in lung activity was attributed to the arterial inflow and the first derivative of the time-activity curve was assumed to represent pulmonary arterial flow. RESULTS Pulmonary flow curves showed two main positive peaks in six volunteers, followed by a third small peak in three others. Flow was predominant during systole, with an important reduction in magnitude before the diastolic peak, leading to a negative count variation in eight subjects. This pattern is comparable to that described in central pulmonary vessels by different methods. CONCLUSIONS First-pass scintigraphy with Tc-MAA was able to detect flow pulsatility in pulmonary arteries. These results need to be confirmed in a larger number of individuals, and, if shown to be reproducible, may increase our understanding of lung flow physiology, and of its modifications in the presence of cardiopulmonary diseases.
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Affiliation(s)
- Marcelo T Sapienza
- Department of Radiology, University of Sao Paulo Medical School, Brazil.
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Sapienza MT, Tavares MGM, Endo IS, Campos Neto GC, Lopes MMMF, Nakagawa S, Belfort FA, Soares Jr. J, Lewin S, Marone MMS. Pesquisa do linfonodo sentinela em pacientes com melanoma: experiência com fitato marcado com Tecnécio-99m e revisão da literatura. An Bras Dermatol 2004. [DOI: 10.1590/s0365-05962004000200006] [Citation(s) in RCA: 7] [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: 11/21/2022] Open
Abstract
FUNDAMENTOS: A progressão linfática do melanoma maligno habitualmente se inicia pelo linfonodo sentinela (LNS), cuja análise histopatológica permite predizer o acometimento de toda a cadeia. OBJETIVO: O trabalho tem por objetivo descrever a utilização do 99mTc-Fitato na detecção do LNS em pacientes com melanoma maligno, revisando as indicações e informações fornecidas por sua biópsia. MÉTODO: A pesquisa de LNS foi realizada por meio da linfocintilografia com 99mTc-Fitato em 92 pacientes com melanoma (54,0±14,3 anos). Após 18-24 horas, 88 pacientes foram submetidos à localização intra-operatória com detector portátil, seguida da ressecção e análise histopatológica do LNS. RESULTADOS: A linfocintilografia permitiu a identificação do LNS em todos os estudos, havendo detecção intra-operatória em 98,8% dos casos. O LNS estava acometido em 23 pacientes (26%). O valor preditivo negativo foi de 100% e não se observaram reações adversas pelo uso do 99mTc-Fitato. CONCLUSÃO: A detecção do LNS pode ser realizada com diferentes radiofármacos, incluindo o 99mTc-Fitato, que apresenta vantagens de custo e disponibilidade no Brasil. A pesquisa de LNS resulta em maior acurácia e menor morbidade no estadiamento de pacientes com melanoma maligno
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Affiliation(s)
| | | | - Irene S. Endo
- Unidade de Diagnóstico e Densitometria Óssea, Brasil
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- Unidade de Diagnóstico e Densitometria Óssea, Brasil
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Vigario A, Sapienza MT, Sampaio AP, Piato JR, Barros N, Barros A, Pinotti JA, Buchpiguel CA. Primary chemotherapy effect in sentinel node detection in breast cancer. Clin Nucl Med 2003; 28:553-7. [PMID: 12819407 DOI: 10.1097/00003072-200307000-00004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [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: 11/25/2022]
Abstract
PURPOSE Sentinel node (SN) biopsy is a reliable method for improved staging of breast cancer, offering an alternative to routine axillary dissection. Perhaps preoperative chemotherapy could increase the rate of false-negative SN because of induced lymphatic changes. The aim of the study was to evaluate the utility of lymphoscintigraphy and of hand-held probe detection in the SN approach after chemotherapy, correlating it with histologic analysis of the axilla. METHODS Eighty-three patients (mean age, 53 years; TNM stage I) were studied prospectively. They were separated into two groups: group 1 (G1), 37 patients with preoperative chemotherapy and group 2 (G2), 46 patients without chemotherapy. Mean tumor size was 2 cm in both groups. Lymphoscintigraphy was performed 3 to 4 hours after peritumoral injection of Tc-99m dextran-70 in a 0.2-ml volume and activity of 14.8 MBq (0.4 mCi), performed under ultrasound or mammographic control. On the following day, each patient underwent tumor resection with axillary dissection, included the SN. RESULTS The SN was detected by scintigraphy in 78 patients (94%). The failure of SN to predict the axillary histologic status was significantly higher (P = 0.01) in G1 than in G2 (7 and 1 false-negative result, respectively). CONCLUSION Preoperative chemotherapy seems to impair axillary evaluation by SN biopsy and should be used cautiously in this subset of patients.
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Affiliation(s)
- Adriano Vigario
- Department of Nuclear Medicine, Hospital Clinics of the Faculty of Medicine, University of São Paulo, Brazil.
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Doria AS, Guarniero R, De Godoy RM, Buchpiguel C, Modena M, Cunha FG, Luzo C, Molnar LJ, Sapienza MT, Cerri GG. Contrast-enhanced power Doppler imaging: comparison with scintigraphic phases of revascularization of the femoral head in Legg-Calvé-Perthes disease. J Pediatr Orthop 2002; 22:471-8. [PMID: 12131443] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The authors evaluated the usefulness of an ultrasound contrast agent (SHU 508A) to help identify different scintigraphic phases of revascularization of the femoral head in children with Legg-Calvé-Perthes (LCP) disease. Eighteen unenhanced and contrast-enhanced power Doppler images and scintigrams of the pathologic hip in 18 children with LCP disease were compared. The scintigraphic stages of Conway's classification for LCP disease (stage A, recanalization; stage B, neovascularization) were compared with the degree of vascularity and mean peak enhancement ratios obtained from analysis of Doppler sonograms. Qualitatively, the patient's age (< or = or >7 years old) at the time of examination had a significant effect on the degree of vascularity visualized on postcontrast ultrasound images according to the scintigraphic stages. Quantitatively, there were no differences for overall mean peak enhancement ratios between stages A and B. Power Doppler ultrasound increased visualization of Doppler signals significantly but did not help in differentiating scintigraphic phases.
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Tavares MG, Sapienza MT, Galeb NA, Belfort FA, Costa RR, Osório CA, Góes JC, Endo IS, Soares J, Lewin S, Marone MM. The use of 99mTc-phytate for sentinel node mapping in melanoma, breast cancer and vulvar cancer: a study of 100 cases. Eur J Nucl Med 2001; 28:1597-604. [PMID: 11702099 DOI: 10.1007/s002590100625] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sentinel node mapping reduces surgical morbidity and allows the use of more accurate tumour staging techniques. Radionuclide studies are preferentially performed using small colloids, which have limited availability in our country. The possibility of using phytate for sentinel node mapping was raised because of the similarity between its biodistribution and that of nanocolloids in the reticulo-endothelial system. In this paper we evaluated the use of 99mTc-phytate for sentinel node mapping, correlating the histopathological results with the status of the rest of the lymph node chain in different malignant tumours. A total of 100 patients were studied. group 1 consisted of 62 patients with breast cancer, group 2 of 20 patients with melanoma and group 3 of 18 patients with vulvar carcinoma. Lymph node scintigraphy was carried out after injecting 99mTc-phytate subdermally, and the sentinel node projection was marked on the skin. After 18-24 h, intraoperative sentinel node localisation was performed using a gamma probe (combined with visual localisation using patent blue dye) in 75 patients, and lymph node dissection was then carried out. Radionuclide scintigraphy identified the sentinel node in 98% of all studies. Intraoperative detection using the gamma probe was equally efficient: group 1=93% (38/41), group 2=95% (18/19) and group 3=100% (15/15). The sentinel node was involved in 41%, 31% and 20% of cases in groups 1, 2 and 3, respectively. Among the patients with positive nodes, the sentinel node was the only one affected in 53% of group 1, 50% of group 2 and 67% of group 3 cases. The method's negative predictive value was 91% in group 1 and 100% in the other groups. One false-negative study occurred in a patient who had a multifocal tumour and an intraparenchymatous lymph node; another occurred in a patient with a macroscopically affected node found during surgery. There were no side-effects related to the 99mTc-phytate. It is concluded that scintigraphic and intraoperative sentinel node identification was satisfactorily performed using 99mTc-phytate. The results were comparable to those previously described in the literature using other radiopharmaceuticals. Easy availability and low cost justify the use of phytate in our practice.
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Affiliation(s)
- M G Tavares
- UDDO - Nuclear Medicine Department, Avenida Alcantara Machado 2576, Mooca 03102-000, Sao Paulo, SP, Brazil.
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Sapienza MT, Hironaka F, Lima AL, Yamaga LY, Hamada E, Watanabe T, Costa PA, Buchpiguel CA. [Evaluation of inflammatory activity in chronic osteomyelitis. Contribution of scintigraphy with polyclonal antibodies]. Rev Assoc Med Bras (1992) 2000; 46:106-12. [PMID: 11022350 DOI: 10.1590/s0104-42302000000200004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 11/22/2022] Open
Abstract
BACKGROUND Active chronic osteomyelitis or complicating osteomyelitis are difficult to be diagnosed by radiological imaging modalities, such as plain radiograph and CT. They frequently cause increased bone remodeling, leading to nonspecific uptake of Tc-99m-bone scan agents and gallium-67. New radiopharmaceuticals with greater infection avidity are being developed, including the nonspecific polyclonal immunoglobulin (IgG) labeled with technetium-99m. Tc-99m-IgG may be available as a ready to use kit, with no reported side effects, low patient absorbed radiation dose and low cost. MATERIAL AND METHODS 23 bone segments with suspected active chronic osteomyelitis or violated bone osteomyelitis were studied by Tc-99m-IgG scintigraphy. All patients underwent standard three-phase bone scintigraphy using methylene diphosphonate (Tc-99m-MDP), gallium-67 scintigraphy and plain radiographs, compared with clinical evaluation and laboratory tests values. RESULTS Infection was found in 8 sites. Sensitivity and specificity for Tc-99m-MDP, gallium-67 and Tc-99m-IgG scintigraphy were, respectively, 88 and 36%, 75 and 73%, 88 and 82%. CONCLUSION Tc-99m-IgG may be usefull in the scintigraphic evaluation of osteomyelitis.
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Affiliation(s)
- M T Sapienza
- Departamento de Radiologia da Faculdade de Medicina, Universidade de São Paulo
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Buchpiguel CA, Sapienza MT, Vezzozzo DP, Rockman R, Cerri GG, Magalhães AE. Gallbladder emptying in normal volunteers. Comparative study between cholescintigraphy and ultrasonography. Clin Nucl Med 1996; 21:208-12. [PMID: 8846565 DOI: 10.1097/00003072-199603000-00005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [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: 02/02/2023]
Abstract
To assess the reproducibility of and compare the patterns of gallbladder emptying after a fatty meal stimulus, the authors analyzed 10 healthy fasting volunteers (8 men; mean age, 32 years). Cholescintigraphy was obtained after intravenous injection of 185 MBq of Tc-99m DISIDA. A standardized fatty meal was provided 70 minutes after injection. The ejection fraction was measured sequentially by ultrasound and cholescintigraphy 15, 30, 45, and 60 minutes after eating. All patients had repeat studies within 1-3 weeks. The two methods showed a distinct gallbladder time course of emptying after the fatty meal stimulus. Nuclear medicine showed higher values of gallbladder ejection fraction at 45 and 60 minutes after eating when compared to ultrasound (P < 0.01). The plotted curves, using the four different periods of time, also showed different behavior due mainly to distinct angular coefficients (nuclear medicine, 2.6; ultrasound, 0.9). Good reproducibility of fatty meal-induced gallbladder ejection fraction at 30, 45, and 60 minutes was also observed using both methods. Thus, ultrasound and nuclear medicine are reproducible methods of studying gallbladder dynamics. However, nuclear medicine demonstrated continued excretion of bile at 45 and 60 minutes, whereas ultrasound did not show significant volume variations in these time frames.
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Affiliation(s)
- C A Buchpiguel
- Department of Radiology, Sao Paulo University School of Medicine, Brazil
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