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Kian Ara H, Alemohammad N, Paymani Z, Ebrahimi M. Machine learning diagnosis of active Juvenile Idiopathic Arthritis on blood pool [ 99M Tc] Tc-MDP scintigraphy images. Nucl Med Commun 2024; 45:355-361. [PMID: 38312058 DOI: 10.1097/mnm.0000000000001822] [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: 02/06/2024]
Abstract
PURPOSE Neural network has widely been applied for medical classifications and disease diagnosis. This study employs deep learning to best discriminate Juvenile Idiopathic Arthritis (JIA), a pediatric chronic joint inflammatory disease, from healthy joints by exploring blood pool images of 2phase [ 99m Tc] Tc-MDP bone scintigraphy. METHODS Self-deigned multi-input Convolutional Neural Network (CNN) in addition to three available pre-trained models including VGG16, ResNet50 and Xception are applied on 1304 blood pool images of 326 healthy and known JIA children and adolescents (aged 1-16). RESULTS The self-designed model ROC analysis shows diagnostic efficiency with Area Under the Curve (AUC) 0.82 and 0.86 for knee and ankle joints, respectively. Among the three pertained models, VGG16 ROC analysis reveals AUC 0.76 and 0.81 for knee and ankle images, respectively. CONCLUSION The self-designed model shows best performance on blood pool scintigraph diagnosis of patients with JIA. VGG16 was the most efficient model rather to other pre-trained networks. This study can pave the way of artificial intelligence (AI) application in nuclear medicine for the diagnosis of pediatric inflammatory disease.
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Gupta NK, Dhingra V, Hazari PP, Jha S, Ls S. TIP24-197: R Role of [99m Tc] DTPA-bis (Choline) in Evaluation of Breast Cancer: A Prospective Diagnostic Trial in Progress at AIIMS Rishikesh. J Natl Compr Canc Netw 2024; 22:TIP24-197. [PMID: 38580272 DOI: 10.6004/jnccn.2023.7224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
| | | | | | - Shranav Jha
- 1AIIMS Rishikesh, Rishikesh, Uttrakhand, India
| | - Sanjith Ls
- 1AIIMS Rishikesh, Rishikesh, Uttrakhand, India
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White KP, Sinagra D, Dip F, Rosenthal RJ, Mueller EA, Lo Menzo E, Rancati A. Indocyanine green fluorescence versus blue dye, technetium-99M, and the dual-marker combination of technetium-99M + blue dye for sentinel lymph node detection in early breast cancer-meta-analysis including consistency analysis. Surgery 2024; 175:963-973. [PMID: 38097484 DOI: 10.1016/j.surg.2023.10.021] [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] [Received: 07/18/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Axillary sentinel lymph node biopsies are standard of care in patients with breast cancer and no clinically apparent metastases. Traditionally, technetium-99m, blue dye, or both have been used to identify sentinel lymph nodes. However, blue dyes miss up to 40% of sentinel lymph nodes, while technetium-99m use is complex, costly, and exposes patients to radiation. Over the past decade, studies have consistently found the biologically inert fluorescent indocyanine green to be 95% to 100% sensitive in detecting breast cancer sentinel lymph nodes, yet indocyanine green remains infrequently used. METHODS We conducted an extensive meta-analysis comparing indocyanine green against blue dye, technetium-99m, and the dual-marker combination of technetium-99m + BD. Unlike prior meta-analyses that only assessed either per-case or per-node sentinel lymph node detection, we analyzed the following 5 metrics: per-case and per-node sentinel lymph node detection and metastasis-positive sentinel lymph node sensitivity, and mean number of sentinel lymph nodes/case. We further examined the consistency and magnitude of between-study superiority and statistically significant within-study superiority of each marker against others. RESULTS For every metric and analysis approach, indocyanine green was clearly superior to blue dye and at least non-inferior, if not superior, to technetium-99m and technetium-99m + blue dye. Assessing the consistency of superiority by at least 2.0%, indocyanine green was superior to blue dye 73 times versus 1, to technetium-99m 42 times versus 9, and to technetium-99m + blue dye 6 times versus 0. Within-study statistically significant differences favored indocyanine green over blue dye 29 times versus 0 and over technetium-99m 11 times versus 2. DISCUSSION For sentinel lymph node detection in patients with breast cancer with no clinically apparent metastases, indocyanine green is clearly and consistently superior to blue dye and either non-inferior or superior to technetium-99m and technetium-99m + blue dye.
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Affiliation(s)
- Kevin P White
- ScienceRight International Health Research, London, Canada
| | - Diego Sinagra
- Hospital de Clínicas Jose de San Martín, Buenos Aires, Argentina
| | - Fernando Dip
- Hospital de Clínicas Jose de San Martín, Buenos Aires, Argentina
| | | | - Edgar A Mueller
- Institute for Clinical Pharmacology, Medical Faculty, Technical University, Dresden, Germany
| | | | - Alberto Rancati
- Hospital de Clínicas Jose de San Martín, Buenos Aires, Argentina.
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Gibbons T, Perkins A, Barnett J. Safety, biodistribution and radiation dosimetry of the Arg-Gly-Asp peptide 99m Tc-maraciclatide in healthy volunteers. Nucl Med Commun 2024; 45:295-303. [PMID: 38312052 PMCID: PMC10916747 DOI: 10.1097/mnm.0000000000001814] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/19/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND 99m Tc-Maraciclatide is a radiolabelled RGD (Arg-Gly-Asp) peptide that binds with high affinity to α v β 3 and α v β 5 integrins, common receptors upregulated in disease states involving angiogenesis and inflammation. As such, it holds promise as a novel diagnostic imaging agent for a range of pathological conditions. The present study provides the safety, biodistribution and radiation dosimetry of 99m Tc-maraciclatide in healthy volunteers. METHODS A phase 1, randomised, placebo-controlled study assessed the safety, biodistribution and radiation dosimetry of 99m Tc-maraciclatide in healthy volunteers. Participants were randomised into three groups receiving 99m Tc-maraciclatide and three chemical amounts of maraciclatide in an escalating dose protocol. Eight participants in each group received the required amount of maraciclatide via intravenous injection, with the remaining two receiving a placebo. Biodistribution was assessed by acquiring scintigraphic images at time points up to 24 h after a bolus injection of 99m Tc-maraciclatide. 99m Tc-maraciclatide activity in plasma and urine was measured up to 7 days post-administration. RESULTS 99m Tc-maraciclatide was safe and well tolerated, with no serious adverse events reported. Initial uptakes of 99m Tc were highest in the gastrointestinal tract (20%), liver (15%), and lungs (9%). Similarly, the regions with the highest normalised cumulated activities were the contents of the urinary bladder and voided urine (3.4 ± 0.4 MBq*h/MBq), the combined walls of the small intestine and upper and lower large intestine (0.9 ± 0.2 MBq*h/MBq), liver (0.8 ± 0.2 MBq*h/MBq), lung (0.4 ± 0.1 MBq*h/MBq). The main route of 99m Tc excretion was renal (55%), with a systemic urinary clearance of approximately 6.7 ml/min/kg. The pharmacokinetic analysis gave a mean apparent terminal elimination half-life of the unlabelled molecular maraciclatide of approximately 1 h, independent of dose. The mean ED per unit injected activity was 7.8 ± 0.8 µSv/MBq. CONCLUSION 99m Tc-maraciclatide is a safe radiopharmaceutical formulation with a dosimetry profile similar to other 99m Tc-based imaging agents.
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Affiliation(s)
- Tatjana Gibbons
- Nuffield Department of Women's and Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford
| | - Alan Perkins
- Radiological Sciences, School of Medicine, University of Nottingham, Nottingham and
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Nakazawa Y, Okada M, Hyodo T, Tago K, Shibutani K, Mizuno M, Yoshikawa H, Abe H, Higaki T, Okamura Y, Takayama T. Comparison between CT volumetry, technetium99m galactosyl-serum-albumin scintigraphy, and gadoxetic-acid-enhanced MRI to estimate the liver fibrosis stage in preoperative patients. Eur Radiol 2024; 34:2212-2222. [PMID: 37673964 DOI: 10.1007/s00330-023-10219-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/24/2023] [Accepted: 07/16/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES To compare the efficacy of computed tomography volumetry (CTV), technetium99m galactosyl-serum-albumin (99mTc-GSA) scintigraphy, and gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic-acid-enhanced MRI (EOB-MRI) in estimating the liver fibrosis (LF) stage in patients undergoing liver resection. METHODS This retrospective study included 91 consecutive patients who had undergone preoperative dynamic CT and 99mTc-GSA scintigraphy. EOB-MRI was performed in 76 patients. CTV was used to measure the total liver volume (TLV), spleen volume (SV), normalised to the body surface area (BSA), and liver-to-spleen volume ratio (TLV/SV). 99mTc-GSA scintigraphy provided LHL15, HH15, and GSA indices. The liver-to-spleen ratio (LSR) was calculated in the hepatobiliary phase of EOB-MRI. Hyaluronic acid and type 4 collagen levels were measured in 65 patients. Logistic regression and receiver operating characteristic (ROC) analyses were performed to identify useful parameters for estimating the LF stage and laboratory data. RESULTS According to the multivariable logistic regression analysis, SV/BSA (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.003-1.02; p = 0.011), LSR (OR, 0.06; 95%CI, 0.004-0.70; p = 0.026), and hyaluronic acid (OR, 1.01; 95%CI, 1.001-1.02; p = 0.024) were independent variables for severe LF (F3-4). Combined SV/BSA, LSR, and hyaluronic acid correctly estimated severe LF, with an AUC of 0.91, which was significantly larger than the AUCs of the GSA index (AUC = 0.84), SV/BSA (AUC = 0.83), or LSR (AUC = 0.75) alone. CONCLUSIONS Combined CTV, EOB-MRI, and hyaluronic acid analyses improved the estimation accuracy of severe LF compared to CTV, EOB-MRI, or 99mTc-GSA scintigraphy individually. CLINICAL RELEVANCE STATEMENT The combined analysis of spleen volume on CT volumetry, liver-to-spleen ratio on gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic-acid-enhanced MRI, and hyaluronic acid can identify severe liver fibrosis associated with a high risk of liver failure after hepatectomy and recurrence in patients with hepatocellular carcinoma. KEY POINTS • Spleen volume of CT volumetry normalised to the body surface area, liver-to-spleen ratio of EOB-MRI, and hyaluronic acid were independent variables for liver fibrosis. • CT volumetry and EOB-MRI enable the detection of severe liver fibrosis, which may correlate with post-hepatectomy liver failure and complications. • Combined CT volumetry, gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic-acid-enhanced MRI (EOB-MRI), and hyaluronic acid analyses improved the estimation of severe liver fibrosis compared to technetium99m galactosyl-serum-albumin scintigraphy.
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Affiliation(s)
- Yujiro Nakazawa
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan.
| | - Tomoko Hyodo
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Kenichiro Tago
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Kazu Shibutani
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Mariko Mizuno
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroki Yoshikawa
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Hayato Abe
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tokio Higaki
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yukiyasu Okamura
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
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Bezverkhniaia E, Kanellopoulos P, Rosenström U, Tolmachev V, Orlova A. Influence of Molecular Design on the Tumor Targeting and Biodistribution of PSMA-Binding Tracers Labeled with Technetium-99m. Int J Mol Sci 2024; 25:3615. [PMID: 38612427 PMCID: PMC11011439 DOI: 10.3390/ijms25073615] [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: 02/29/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Previously, we designed the EuK-based PSMA ligand BQ0413 with an maE3 chelator for labeling with technetium-99m. It showed efficient tumor targeting, but our preclinical data and preliminary clinical results indicated that the renal excretion levels need to be decreased. We hypothesized that this could be achieved by a decrease in the ligand's total negative charge, achieved by substituting negatively charged glutamate residues in the chelator with glycine. The purpose of this study was to evaluate the tumor targeting and biodistribution of two new PSMA inhibitors, BQ0411 and BQ0412, compared to BQ0413. Conjugates were radiolabeled with Tc-99m and characterized in vitro, using PC3-pip cells, and in vivo, using NMRI and PC3-pip tumor-bearing mice. [99mTc]Tc-BQ0411 and [99mTc]Tc-BQ0412 demonstrated PSMA-specific binding to PC3-pip cells with picomolar affinity. The biodistribution pattern for the new conjugates was characterized by rapid excretion. The tumor uptake for [99mTc]Tc-BQ0411 was 1.6-fold higher compared to [99mTc]Tc-BQ0412 and [99mTc]Tc-BQ0413. [99mTc]Tc-BQ0413 has demonstrated predominantly renal excretion, while the new conjugates underwent both renal and hepatobiliary excretion. In this study, we have demonstrated that in such small targeting ligands as PSMA-binding EuK-based pseudopeptides, the structural blocks that do not participate in binding could have a crucial role in tumor targeting and biodistribution. The presence of a glycine-based coupling linker in BQ0411 and BQ0413 seems to optimize biodistribution. In conclusion, the substitution of amino acids in the chelating sequence is a promising method to alter the biodistribution of [99mTc]Tc-labeled small-molecule PSMA inhibitors. Further improvement of the biodistribution properties of BQ0413 is needed.
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Affiliation(s)
- Ekaterina Bezverkhniaia
- Department of Medicinal Chemistry, Uppsala University, 751 23 Uppsala, Sweden; (E.B.); (P.K.); (U.R.)
| | - Panagiotis Kanellopoulos
- Department of Medicinal Chemistry, Uppsala University, 751 23 Uppsala, Sweden; (E.B.); (P.K.); (U.R.)
| | - Ulrika Rosenström
- Department of Medicinal Chemistry, Uppsala University, 751 23 Uppsala, Sweden; (E.B.); (P.K.); (U.R.)
| | - Vladimir Tolmachev
- Department of Immunology, Genetics and Pathology, Uppsala University, 752 37 Uppsala, Sweden;
| | - Anna Orlova
- Department of Medicinal Chemistry, Uppsala University, 751 23 Uppsala, Sweden; (E.B.); (P.K.); (U.R.)
- Science for Life Laboratory, Uppsala University, 752 37 Uppsala, Sweden
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Takahashi K, Hiratsuka Y, Iwamura T, Sasaki D, Yamamura N, Kitazawa S, Ueda M, Morioka H, Okura T, Enomoto D, Uemura S, Kono T, Sakaue T, Ikeda S. Technetium-99m-pyrophosphate imaging-based computed tomography-guided core-needle biopsy of internal oblique muscle in wild-type transthyretin cardiac amyloidosis. Amyloid 2024; 31:12-21. [PMID: 37486102 DOI: 10.1080/13506129.2023.2235881] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/05/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Technetium-99m-pyrophosphate (99mTc-PYP) uptake in the internal oblique muscle (IOM), which is often observed in patients with wild-type transthyretin cardiac amyloidosis (ATTR-CA), indicates amyloid transthyretin (ATTR) deposition. OBJECTIVE This study aimed to assess the safety and efficacy of 99mTc-PYP imaging-based computed tomography (CT)-guided core-needle biopsy of the IOM as a new extracardiac screening biopsy for confirming the presence of ATTR deposits. METHODS Patients with suspected ATTR-CA in whom myocardial tracer uptake was detected on chest- and abdomen-centered images of 99mTc-PYP scintigraphy underwent CT-guided core-needle biopsy at the site with the highest tracer uptake in the IOM between September 2021 and November 2022. RESULTS All 18 consecutive patients (mean age, 86.3 years ± 6.5; 61.1% male) enrolled in the study showed 99mTc-PYP uptake into the IOM. Adequate tissue samples were obtained from all patients except one without serious complications. Immunohistochemical analysis confirmed ATTR deposits in 16/18 (88.9%) patients. In the remaining two patients, ATTR deposits were observed via endomyocardial biopsy. All patients were diagnosed with wild-type ATTR-CA based on transthyretin gene sequence testing results. CONCLUSION In wild-type ATTR-CA, 99mTc-PYP imaging-based CT-guided core-needle biopsy of the IOM could be used as an extracardiac screening biopsy to confirm the presence of ATTR deposits.
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Affiliation(s)
- Koji Takahashi
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | | | - Takaaki Iwamura
- Department of Radiology, Yawatahama City General Hospital, Ehime, Japan
| | - Daisuke Sasaki
- Department of Radiology, Yawatahama City General Hospital, Ehime, Japan
| | - Nobuhisa Yamamura
- Department of Clinical Pathology, Yawatahama City General Hospital, Ehime, Japan
| | - Sohei Kitazawa
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroe Morioka
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Takafumi Okura
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Daijiro Enomoto
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Shigeki Uemura
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Taizo Kono
- Department of Radiology, Yawatahama City General Hospital, Ehime, Japan
| | - Tomoki Sakaue
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Shuntaro Ikeda
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
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Guijarro-Campillo AR, Padilla-Iserte P, Couso B, Erasun D, Utrilla-Layna J, Arencibia O, Boldo-Roda A, Gilabert-Estellés J, Veiga N, Lago V, Cárdenas-Rebollo JM, Domingo S. Accuracy of ICG compared with technetium-99 m for sentinel lymph node biopsy in vulvar cancer. Eur J Obstet Gynecol Reprod Biol 2024; 294:11-19. [PMID: 38183845 DOI: 10.1016/j.ejogrb.2023.12.037] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/08/2023] [Accepted: 12/27/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE Sentinel lymph node biopsy with radioactive tracer is the standard-of-care in lymph node status assessment in vulvar cancer. Indocyanine green fluorescence-ICG is a promising detection method, due to its advantages over technetium-99 m. In vulvar cancer, the procedure is controversial due to study heterogeneity and the small sample size in previous studies. This study evaluates ICG sentinel lymph node detection compared with the criterion-standard with technetium (dual modality method). METHODS Preoperative technetium and intraoperative ICG for sentinel lymph node have been prospectively evaluated in early-stage vulvar cancer. The primary endpoint was to determine accuracy in the detection rate for ICG compared with technetium. Secondary objectives included tracer modality relationship with obesity, tumor size and location. RESULTS In total, 75 patients participated at 8 centers; 38 had lateral and 37 had midline vulvar tumors. The overall sentinel lymph node detection rate was 85.3 % for technetium and 82.7 % for ICG. For lateral tumors, the detection rate was 84.2 % vs. 89.5 %, while it was 86.5 % vs. 75.7 % for middle tumors, using technetium and ICG, respectively. The median sentinel node harvest was 1.7 (range 1-4), with 24 % metastatic involvement. The sensitivity and positive predictive value for ICG based on the standard technique with technetium was 91.08 % (95 % CI, 83.76-95.84) and 94.8 % (95 % CI, 84.84-96.48), respectively. No significant differences were found comparing the two tracers in patients with midline lesions, obesity (body mass index ≥ 30) and tumor size ≥ 2-4 cm. CONCLUSION(S) ICG shows comparable performance parameters to the gold-standard of radioisotope localization.
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Affiliation(s)
| | - Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Bárbara Couso
- Department of Obstetrics and Gynecology, University Hospital of Ourense, Spain
| | - Diego Erasun
- Department of Obstetrics and Gynecology, Hospital Marqués de Valdecilla, Santander, Spain
| | | | - Octavio Arencibia
- Department of Gynecologic Oncology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Ana Boldo-Roda
- Department of Obstetrics and Gynecology, University Hospital La Plana, Villareal, Spain
| | - Juan Gilabert-Estellés
- Department of Obstetrics and Gynecology, University General Hospital of Valencia, University of Valencia, Spain
| | - Nadia Veiga
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, Spain
| | - Víctor Lago
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Wu C, Menshikova E, Sethi I. Incidental Bleeding Gastrointestinal Stromal Tumor Identified on 99m Tc-RBC Scintigraphy. Clin Nucl Med 2024; 49:228-231. [PMID: 38170924 DOI: 10.1097/rlu.0000000000004943] [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: 01/05/2024]
Abstract
ABSTRACT Various pathologies could lead to occult gastrointestinal (GI) bleeding. Here we report the case of a 73-year-old woman who presented with hematochezia and syncope, and was found to have a large bleeding GI stromal tumor incidentally from 99m Tc-RBC scintigraphy. This study was done after negative workup with CT angiography, colonoscopy, and capsule endoscopy for the source of GI bleeding. Final pathology confirmed the mass being a low-grade GI stromal tumor after exploratory laparotomy.
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Affiliation(s)
- Chenxi Wu
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences
| | - Ekaterina Menshikova
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Ila Sethi
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences
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10
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Yan CL, Thakkar Rivera N, Hoffman J. Inappropriate use of technetium-99m pyrophosphate scanning for the evaluation of transthyretin amyloidosis. Amyloid 2024; 31:76-78. [PMID: 37800869 DOI: 10.1080/13506129.2023.2267162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Crystal Lihong Yan
- Division of Internal Medicine, University of Miami Health System, Miami, FL, USA
| | - Nina Thakkar Rivera
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, FL, USA
| | - James Hoffman
- Division of Hematology, Sylvester Comprehensive Cancer Center, Miami, FL, USA
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Leder T, Kühnel C, Gröber S, Drescher R, Freesmeyer M. 68 Ga-Oxine-Labeled Erythrocytes as a New PET Tracer for the Localization of Gastrointestinal Bleeding. Clin Nucl Med 2024; 49:280-282. [PMID: 38109049 DOI: 10.1097/rlu.0000000000005021] [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: 12/19/2023]
Abstract
ABSTRACT A 69-year-old man presented with recurring drops in hemoglobin levels and suspected gastrointestinal bleeding. Endoscopy did not show a site of bleeding so further examinations became necessary. Scintigraphy and SPECT/CT with 99m TcO 4- -labeled red blood cells were performed without evidence of a hemorrhage. Based on an established protocol for splenic PET/CT, autologous erythrocytes can be labeled with 68 Ga-oxine and used as a tracer for the localization of active bleeding sites. In the patient, PET/CT with 68 Ga-oxine-labeled undamaged erythrocytes was performed successfully and revealed a hemorrhage of the gastric corpus that was confirmed and treated by endoscopy.
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Affiliation(s)
- Theresa Leder
- From the Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
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Pujatti PB, Dos Santos JPG, Gomes ML, Cardoso MAS, Guimarães TT, Felix RCM. A comparative study on the quality of in vivo labeled red blood cell radionuclide ventriculography images employing different freeze-dried reagents. Nucl Med Commun 2024; 45:155-160. [PMID: 38010319 DOI: 10.1097/mnm.0000000000001794] [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: 11/29/2023]
Abstract
Radionuclide ventriculography or Multi Gated Acquisition (MUGA) employing [ 99m Tc]Technetium red blood cell (RBC) labeling is considered the gold standard for cardiotoxicity assessments in cancer patients undergoing chemotherapy. This in-vivo RBC labeling technique involves the reduction of [ 99m Tc]Technetium by the stannous chloride present in freeze-dried reagent kits, with the pyrophosphate kit (PYP) being the most employed for this purpose. The literature, however, describes diethylenetriaminepentaacetic acid (DTPA) as an alternative to PYP, although a lack of comparative data from MUGA images between both reagents is noted. A retrospective cross-sectional observational study was conducted at the Brazilian National Cancer Institute Nuclear Medicine Service concerning 80 randomized MUGA images, 20 obtained employing DTPA between 2020 and 2023 and 60 obtained employing PYP between 2017 and 2020, applying the mean count per pixel (ct/pixel) and heart background (C/F) ratios as quality image indicators. Although the heart ct/pixel ratio was statistically lower in the DTPA images compared with PYP ( P = 0.02), the C/F ratio was statistically similar when comparing both radiopharmaceuticals ( P = 0.697). A semi-quantitative analysis of MUGA images obtained with DTPA and PYP indicates similar image quality, supporting the use of DTPA as an alternative to PYP without compromising diagnostic interpretations.
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Affiliation(s)
- Priscilla B Pujatti
- Nuclear Medicine Service, Cancer Hospital I, National Cancer Institute (INCA),Health Ministry, Rio de Janeiro, Brazil
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Tanaka S, Abe M, Haga Y, Kaga Y. [Examination of Dosage Optimization Based on Body Weight Index in Resting Myocardial Blood Flow Scintigraphy Using 99mTc]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2024; 80:16-25. [PMID: 37940546 DOI: 10.6009/jjrt.2024-1374] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
PURPOSE The purpose of this study was to optimize radiopharmaceutical dosage in single-photon emission computed tomography (SPECT) nuclear medicine. Therefore, we examined a variable dose (VD) method using body weight as an index in resting myocardial scintigraphy using a 99mTechnetium (99mTc) preparation. METHODS In this study, we compared the VD method with the fixed dose (FD) method without a variable by body weight. There were 50 patients using the VD method and 50 patients using the FD method. For the VD method, we set the target average count (counts/pixel) per SPECT view. Using the myocardial average count of the FD method, and the estimated intracorporeal radioactivity at the start of the examination, the dose of the VD method, which varies appropriately depending on the body weight, was calculated. RESULTS The VD method had less variation in myocardial counting and was closer to the target count than the FD method, and the median dosage decreased. CONCLUSION The VD method suggested the possibility of obtaining a count independent of physique and stable image quality, reducing medical and occupational radiation exposure in resting myocardial blood flow scintigraphy.
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Affiliation(s)
- Shigehisa Tanaka
- Department of Radiology, General Incorporated Foundation Kouseikai Sendai Kousei Hospital
| | - Mitsuya Abe
- Department of Radiology, General Incorporated Foundation Kouseikai Sendai Kousei Hospital
| | - Yoshihiro Haga
- Department of Radiology, General Incorporated Foundation Kouseikai Sendai Kousei Hospital
| | - Yuuji Kaga
- Department of Radiology, General Incorporated Foundation Kouseikai Sendai Kousei Hospital
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Lee J, Park HL, Park SY, Lim CH, Kim MH, Lee JM, Chang SA, Oh JH. Gastroparesis might not be uncommon in patients with diabetes mellitus in a real-world clinical setting: a cohort study. BMC Gastroenterol 2024; 24:30. [PMID: 38212710 PMCID: PMC10782575 DOI: 10.1186/s12876-023-03106-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/25/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND This study investigated the frequency of diabetic gastroparesis and associated risk factors in a real-world clinical setting. METHODS This retrospective cross-sectional study included patients who underwent assessments of solid gastric emptying time (GET) by technetium-99 m scintigraphy between May 2019 and December 2020. We categorized patients into three groups according to gastric retention of technetium-99 m: rapid (< 65% at 1 h or < 20% at 2 h), normal (≤60% at 2 h and/or ≤ 10% at 4 h), and delayed (> 60% at 2 h and/or > 10% at 4 h). RESULTS Patients with diabetes mellitus (DM) were more likely to show abnormal GET than those without DM (119 [70.8%] vs. 16 [44.4%]). The mean glycated A1c was 10.3% in DM patients. DM patients with normal GET were significantly younger (57.2 years, P = 0.044) than those with delayed (65.0 years) or rapid GET (60.2 years). Fasting glucose levels were the lowest in the normal GET group and the highest in the rapid GET group (delayed: 176.3 mg/dL, normal: 151.2 mg/dL, rapid: 181.0 mg/dL, P = 0.030). However, glycated A1c was not significantly different among the delayed, normal, and rapid GET groups in patients with DM. Patients with delayed and rapid GET showed a higher frequency of retinopathy (6.0 vs. 15.5%, P = 0.001) and peripheral neuropathy (11.3 vs. 24.4%, P = 0.001) than those with normal GET. In the multinomial logistic regression analysis, retinopathy demonstrated a positive association with delayed GET, while nephropathy showed a significant negative correlation. CONCLUSION DM gastroparesis in the clinical setting was not uncommon. Abnormal GET, including delayed and rapid GET, was associated with DM retinopathy or peripheral neuropathy.
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Affiliation(s)
- Jeongmin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, South Korea
| | - Hye Lim Park
- Division of Nuclear medicine, Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, South Korea
| | - Su Young Park
- Division of Nuclear medicine, Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, South Korea
| | - Chul-Hyun Lim
- Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Seoul, 03312, Republic of Korea
| | - Min-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, South Korea
| | - Jung Min Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, South Korea
| | - Sang-Ah Chang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, South Korea
| | - Jung-Hwan Oh
- Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Seoul, 03312, Republic of Korea.
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Wang G, Lu X, Wang W, Yang J. Menstruation Confounding the Correct Interpretation of 99m Tc-RBC Bleeding Scan. Clin Nucl Med 2024; 49:93-95. [PMID: 37882082 DOI: 10.1097/rlu.0000000000004874] [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: 10/27/2023]
Abstract
ABSTRACT 99m Tc-RBC bleeding scan in a 17-year-old adolescent girl showed an increased focal activity in the pelvis. However, SPECT/CT showed that this activity was located in the uterus, which was considered a normal variant considering that the patient was in her fourth day of the menstrual period. Subsequent 99m TcO 4- Meckel scan showed the typical characteristic of ectopic gastric mucosa in the small bowel. Postsurgical pathology confirmed the diagnosis of ectopic gastric mucosa. This case suggested the menstrual period uterus should be included as differential diagnosis of 99m Tc-RBC scan.
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Affiliation(s)
- Guanyun Wang
- From the Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Manca G, Nonne G, Volterrani D. Intraoperative Radioguided Localization of an Occult Neuroendocrine Tumor of the Ileum. Clin Nucl Med 2024; 49:69-70. [PMID: 38048563 DOI: 10.1097/rlu.0000000000004971] [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: 12/06/2023]
Abstract
ABSTRACT We report the intraoperative radioguided localization of an occult well-differentiated neuroendocrine tumor of the ileum in a patient with a known neuroendocrine lymphonodal metastasis in the mesentery. Preoperative imaging included CT, PET/CT with 68 Ga-DOTATOC, and SPECT/CT with 99m Tc-HYNICTOC. These scans revealed morphological and functional properties of the primary tumor localized in the ileum. The day after IV 99m Tc-HYNICTOC injection, the patient underwent surgery, and the target lesion was intraoperatively detected by a collimated handheld γ-probe. Postoperative pathology examination confirmed the target lesion to be a neuroendocrine tumor of the ileum.
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Affiliation(s)
- Gianpiero Manca
- From the Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa
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17
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Brunson CP, McGregor HJ, Hennemeyer CT, Patel MV, Woodhead GJ, Young SJ. Measurement of the Tumor-to-Normal Ratio for Radioembolization of Hepatocellular Carcinoma: A Prospective Study Comparing 2-Dimensional Perfusion Angiography, Technetium-99m Macroaggregated Albumin, and Yttrium-90 SPECT/CT. J Vasc Interv Radiol 2024; 35:94-101. [PMID: 37783268 DOI: 10.1016/j.jvir.2023.09.023] [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] [Received: 03/28/2023] [Revised: 08/11/2023] [Accepted: 09/23/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE To calculate the preradioembolic tumor-to-normal (T:N) ratio in hepatocellular carcinoma (HCC) using 2-dimensional (2D) perfusion angiography and compare it with that calculated using technetium-99m macroaggregated albumin (99mTc MAA) single-photon emission computed tomography (SPECT)/computed tomography (CT). MATERIALS AND METHODS This prospective single-arm study enrolled 15 participants with HCC who underwent 2D perfusion angiography immediately before the enrollment and with the microcatheter located at the same location as 99mTc MAA injection, after which SPECT/CT was performed. Quantitative digital subtraction angiography was used to calculate the area under the curve for the tumor and normal hepatic parenchyma and subsequently calculate the T:N ratio. The T:N ratio was calculated from the 99mTc MAA SPECT/CT and post-yttrium-90 bremsstrahlung SPECT/CT using dosimetry software. RESULTS The mean participant age was 64.1 years ± 9.8, and the study included 14 (93%) men and 1 (7%) woman. The mean tumor size was 4.1 cm (SD ± 2.4), and all participants received segmental treatments with glass microspheres. The mean T:N ratio calculated by 99mTc MAA SPECT/CT was 2.28 (SD ± 0.89) vs 2.25 (SD ± 0.99) calculated by 2D perfusion angiography (P = .45). For the 13 participants who underwent selective internal radiation therapy (transarterial radioembolization), there was no significant difference between the T:N ratios calculated by 2D perfusion angiography and post-90Y SPECT/CT (2.25 [SD ± 1.05] vs 1.91 [SD ± 0.39]; P = .12). CONCLUSIONS The T:N ratio calculated by 2D perfusion angiography correlated well with that calculated by 99mTc MAA SPECT/CT.
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Affiliation(s)
- Christopher P Brunson
- Department of Radiology & Biomedical Imaging, University of California-San Francisco, San Francisco, California.
| | - Hugh J McGregor
- Department of Vascular and Interventional Radiology, University of Washington, Seattle, Washington
| | | | - Mikin V Patel
- Department of Vascular and Interventional Radiology, University of Chicago, Chicago, Illinois
| | | | - Shamar J Young
- Division of Interventional Radiology, University of Arizona, Tucson, Arizona
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Carsote M, Stanciu M, Popa FL, Sima OC, Petrova E, Cucu AP, Nistor C. Pitfalls of DualTracer 99m- Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue. Medicina (Kaunas) 2023; 60:15. [PMID: 38276049 PMCID: PMC10818294 DOI: 10.3390/medicina60010015] [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] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024]
Abstract
Diagnosis of primary hyperparathyroidism (PHP) is based on blood assessments in terms of synchronous high calcium and PTH (parathormone), but further management, particularly parathyroid surgery that provides the disease cure in 95-99% of cases, requires an adequate localisation of the parathyroid tumour/tumours as the originating source, with ultrasound and 99m-Technetium (99m-Tc) sestamibi scintigraphy being the most widely used. We aimed to introduce an adult female case diagnosed with PHP displaying unexpected intra-operatory findings (ectopic thyroid tissue) in relation to concordant pre-operatory imaging modalities (ultrasound + dual-phase 99m-Tc pertechnetate and sestamibi scintigraphy + computed tomography) that indicated bilateral inferior parathyroid tumours. A sudden drop in PTH following the removal of the first tumour was the clue for performing an extemporaneous exam for the second mass that turned out to be non-malignant ectopic thyroid tissue. We overviewed some major aspects starting from this case in point: the potential pitfalls of pre-operatory imaging in PHP; the concordance/discordance of pre-parathyroidectomy localisation modalities; the need of using an additional intra-operatory procedure; and the clues of providing a distinction between pathological parathyroids and thyroid tissue. This was a case of adult PHP, whereas triple localisation methods were used before parathyroidectomy, showing concordant results; however, the second parathyroid adenoma was a false positive image and an ectopic thyroid tissue was confirmed. The pre-operatory index of suspicion was non-existent in this patient. Hybrid imaging modalities are most probably required if both thyroid and parathyroid anomalies are suspected, but, essentially, awareness of the potential pitfalls is mandatory from the endocrine and surgical perspectives. Current gaps in imaging knowledge to guide us in this area are expected to be solved by the significant progress in functional imaging modalities. However, the act of surgery, including the decision of a PTH assay or extemporaneous exam (as seen in our case), represents the key to a successful removal procedure. Moreover, many parathyroid surgeons may currently perform 4-gland exploration routinely, precisely to avoid the shortcomings of preoperative localisation.
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Affiliation(s)
- Mara Carsote
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.C.); (E.P.)
- Department of Clinical Endocrinology V, C.I. Parhon National Institute of Endocrinology, 020021 Bucharest, Romania;
| | - Mihaela Stanciu
- Department of Endocrinology, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania
| | - Florina Ligia Popa
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania
| | - Oana-Claudia Sima
- Department of Clinical Endocrinology V, C.I. Parhon National Institute of Endocrinology, 020021 Bucharest, Romania;
- PhD Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Eugenia Petrova
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.C.); (E.P.)
- Department of Clinical Endocrinology V, C.I. Parhon National Institute of Endocrinology, 020021 Bucharest, Romania;
| | - Anca-Pati Cucu
- PhD Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Thoracic Surgery Department, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania;
| | - Claudiu Nistor
- Thoracic Surgery Department, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania;
- Department 4—Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Chan N, Einstein AJ, Griffin JM, Rosenblum H, Teruya S, Cuomo M, De Los Santos J, DeLuca A, Johnson LL, Kinkhabwala MP, Leb JS, Mintz A, Fine D, Helmke S, Muralidhar V, Pandey S, Sabogal N, Saith SE, Winburn M, Smiley D, Miller EJ, Ruberg FL, Maurer MS. Prevalence and significance of extracardiac uptake on pyrophosphate imaging in the SCAN-MP study: the first 379 cases. J Nucl Cardiol 2023; 30:2531-2539. [PMID: 37311914 DOI: 10.1007/s12350-023-03310-7] [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: 08/12/2022] [Accepted: 04/12/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Technetium-labeled bone-avid radiotracers can be used to diagnose transthyretin cardiac amyloidosis (ATTR-CA). Extracardiac uptake of technetium pyrophosphate (Tc-99m PYP) in this context has not been extensively explored and its significance is not well characterized. We assessed extracardiac Tc-99m PYP uptake in individuals undergoing nuclear scintigraphy and the extent of clinically actionable findings. METHODS The Screening for Cardiac Amyloidosis with Nuclear Imaging in Minority Populations (SCAN-MP) study utilizes Tc-99m PYP imaging to identify ATTR-CA in self-identified Black and Caribbean Hispanic participants ≥ 60 years old with heart failure. We characterized the distribution of extracardiac uptake, including stratification of findings by timing of scan (1 hour vs 3 hours after Tc-99m PYP administration) and noted any additional testing in these subjects. RESULTS Of 379 participants, 195 (51%) were male, 306 (81%) Black race, and 120 (32%) Hispanic ethnicity; mean age was 73 years. Extracardiac Tc-99m PYP uptake was found in 42 subjects (11.1%): 21 with renal uptake only, 14 with bone uptake only, 4 with both renal and bone uptake, 2 with breast uptake, and 1 with thyroid uptake. Extracardiac uptake was more common in subjects with Tc-99m PYP scans at 1 hour (23.8%) than at 3 hours (6.2%). Overall, four individuals (1.1%) had clinically actionable findings. CONCLUSION Extracardiac Tc-99m PYP uptake manifested in about 1 in 9 SCAN-MP subjects but was clinically actionable in only 1.1% of cases.
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Affiliation(s)
- Nicholas Chan
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
- Clinical Cardiovascular Research Laboratory for the Elderly, 21 Audubon Avenue, New York, NY, 10032, USA
| | - Andrew J Einstein
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
- Department of Radiology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, NY, USA
| | - Jan M Griffin
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Hannah Rosenblum
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
| | - Sergio Teruya
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
- Clinical Cardiovascular Research Laboratory for the Elderly, 21 Audubon Avenue, New York, NY, 10032, USA
| | - Margaret Cuomo
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
- Clinical Cardiovascular Research Laboratory for the Elderly, 21 Audubon Avenue, New York, NY, 10032, USA
| | - Jeffeny De Los Santos
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
- Clinical Cardiovascular Research Laboratory for the Elderly, 21 Audubon Avenue, New York, NY, 10032, USA
| | - Albert DeLuca
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
| | - Lynne L Johnson
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
| | - Mona P Kinkhabwala
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
| | - Jay S Leb
- Department of Radiology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, NY, USA
| | - Akiva Mintz
- Department of Radiology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, NY, USA
| | - Denise Fine
- Section of Cardiovascular Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Stephen Helmke
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
- Clinical Cardiovascular Research Laboratory for the Elderly, 21 Audubon Avenue, New York, NY, 10032, USA
| | - Varsha Muralidhar
- Section of Cardiovascular Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Shivda Pandey
- Section of Cardiovascular Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Natalia Sabogal
- Section of Cardiovascular Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Sunil E Saith
- Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - Morgan Winburn
- Section of Cardiovascular Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Dia Smiley
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Mathew S Maurer
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA.
- Clinical Cardiovascular Research Laboratory for the Elderly, 21 Audubon Avenue, New York, NY, 10032, USA.
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Norouzi G, Nikdel S, Pirayesh E, Salimi Y, Amoui M, Haghighatkhah H, Ghodsi Rad MA, Javanijouni E, Khoshbakht S. Utility of 99mTc-Sestamibi Heart/Liver Uptake Ratio in Screening Nonalcoholic Fatty Liver Disease During Myocardial Perfusion Imaging. Cancer Biother Radiopharm 2023; 38:663-669. [PMID: 36576502 DOI: 10.1089/cbr.2022.0062] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic hepatic disease worldwide, with functional impairment of the mitochondria occurring from early stages. Technetium-99m methoxy-isobutyl-isonitrile (99mTc-MIBI) is a lipophilic agent trapped in the mitochondria. This study aims to evaluate the utility of 99mTc-MIBI heart/liver uptake ratio in screening for NAFLD during myocardial perfusion imaging (MPI). Methods: Seventy eligible patients underwent a 2-d rest/stress 99mTc-MIBI scan with a 2-min planar image acquired in rest phase, at 30, 60, and 120 min postradiotracer administration. Heart/liver uptake ratio was calculated by placing identical regions of interest on the heart and liver dome. All patients underwent liver ultrasound and were allocated into groups A, having NAFLD; and B, healthy individuals without NAFLD. Results: Mean count per pixel heart/liver ratios gradually increased over time in either group; nonetheless the values were significantly higher in group A, regardless of acquisition timing; with the p-value equal to 0.007, 0.014, and 0.010 at 30, 60, and 120 min, respectively. Conclusion: Determining 99mTc-MIBI heart/liver uptake ratio during rest phase in patients undergoing MPI may be a useful, noninvasive screening method for NAFLD; with no additional cost, radiation burden, or adverse effects in these patients. Trial registration number: IR.SBMU.MSP.REC.1398.308.
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Affiliation(s)
- Ghazal Norouzi
- Department of Nuclear Medicine, Shohada-e Tajrish Medical Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Clinical Research Development Unit, Shohada-e Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Nikdel
- Department of Nuclear Medicine, Shohada-e Tajrish Medical Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elahe Pirayesh
- Department of Nuclear Medicine, Shohada-e Tajrish Medical Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Clinical Research Development Unit, Shohada-e Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yazdan Salimi
- Biomedical Engineering and Medical Physics Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahasti Amoui
- Department of Nuclear Medicine, Shohada-e Tajrish Medical Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Clinical Research Development Unit, Shohada-e Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Haghighatkhah
- Clinical Research Development Unit, Shohada-e Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Diagnostic Imaging, Shohada-e Tajrish Medical Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Ghodsi Rad
- Department of Nuclear Medicine, Shohada-e Tajrish Medical Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Clinical Research Development Unit, Shohada-e Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elmira Javanijouni
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Khoshbakht
- Department of Nuclear Medicine, Shohada-e Tajrish Medical Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Clinical Research Development Unit, Shohada-e Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Khor YM, Dorbala S. Extra-cardiac uptake on technetium-99m pyrophosphate (Tc-99m PYP) scan: not just a matter of the heart. J Nucl Cardiol 2023; 30:2540-2543. [PMID: 37468745 DOI: 10.1007/s12350-023-03341-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, 16 College Road, Block 2 Basement 1, Singapore, Singapore.
| | - Sharmila Dorbala
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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22
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Balouzet C, Michon-Colin A, Dupont L, Vidal-Petiot E, Prot-Bertoye C, Baron S, Ayari H, Cohen R, Houillier P, Smadja C, Flamant M, Courbebaisse M. Comparison of 99mTc-DTPA and 51Cr-EDTA for glomerular filtration rate measurement with the continuous infusion method. J Nephrol 2023; 36:2457-2465. [PMID: 37093492 DOI: 10.1007/s40620-023-01612-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/23/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND In late 2018, the production of 51Chromium-labelled ethylenediamine tetra-acetic acid (51Cr-EDTA), a validated and widely used radio-isotopic tracer for measuring glomerular filtration rate, was halted. Technetium-99m-diethylenetriaminepentaacetic acid (99mTc-DTPA) has been validated for GFR measurement with a single bolus injection, a procedure not suitable in patients with extracellular compartment hyperhydration. In such cases, a bolus followed by continuous infusion of the tracer is required. The aim of this study was to evaluate whether 99mTc-DTPA with the infusion protocol can replace 51Cr-EDTA for GFR measurement. METHODS We conducted a prospective single centre study during February and March 2019. All patients referred for GFR measurement received both radiotracers simultaneously: 51Cr-EDTA and 99mTc-DTPA bolus and continuous infusion were administered concomitantly through the same intravenous route. Over four and a half hours, plasma and urine samples were collected to calculate urinary and plasma clearance. RESULTS Twenty-two patients were included (mean age 63.4 ± 17.5 years; 68% men). Mean urinary clearance of 51Cr-EDTA and 99mTc-DTPA was 52.4 ± 22.5 mL/min and 52.8 ± 22.6 mL/min, respectively (p = 0.47), with a mean bias of 0.39 ± 2.50 mL/min, an accuracy within 10% of 100% (95% CI 100; 100) and a Pearson correlation coefficient of 0.994. Mean plasma clearance of 51Cr-EDTA and 99mTc-DTPA was 54.8 ± 20.9 mL/min and 54.4 ± 20.9 mL/min, respectively (p = 0.61), with a mean bias of - 0.43 ± 3.89 mL/min, an accuracy within 10% of 77% (95% CI 59; 91) and a Pearson correlation coefficient of 0.983. CONCLUSIONS Urinary and plasma clearance of 99mTc-DTPA can be used with the infusion protocol to measure GFR.
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Affiliation(s)
- Clara Balouzet
- Radiopharmacie, Pharmacie, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arthur Michon-Colin
- Faculté de Médecine, Université Paris Cité, Paris, France
- Explorations fonctionnelles rénales, Physiologie, Hôpital européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Léa Dupont
- Radiopharmacie, Pharmacie, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuelle Vidal-Petiot
- Faculté de Médecine, Université Paris Cité, Paris, France
- Explorations fonctionnelles multidisciplinaires, Physiologie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Recherche sur l'Inflammation, Inserm U1149, Université Paris Cité, Paris, France
| | - Caroline Prot-Bertoye
- Explorations fonctionnelles rénales, Physiologie, Hôpital européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Recherche des Cordeliers, INSERM U1138, Sorbonne Université, Université Paris Cité, Paris, France
| | - Stéphanie Baron
- Faculté de Médecine, Université Paris Cité, Paris, France
- Explorations fonctionnelles rénales, Physiologie, Hôpital européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Recherche des Cordeliers, INSERM U1138, Sorbonne Université, Université Paris Cité, Paris, France
| | - Hamza Ayari
- Faculté de Médecine, Université Paris Cité, Paris, France
- Explorations fonctionnelles rénales, Physiologie, Hôpital européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Néphrologie, AURA Paris Plaisance, Paris, France
| | - Raphaël Cohen
- Faculté de Médecine, Université Paris Cité, Paris, France
- Explorations fonctionnelles rénales, Physiologie, Hôpital européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pascal Houillier
- Faculté de Médecine, Université Paris Cité, Paris, France
- Explorations fonctionnelles rénales, Physiologie, Hôpital européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Recherche des Cordeliers, INSERM U1138, Sorbonne Université, Université Paris Cité, Paris, France
| | - Corinne Smadja
- Radiopharmacie, Pharmacie, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Martin Flamant
- Faculté de Médecine, Université Paris Cité, Paris, France
- Explorations fonctionnelles multidisciplinaires, Physiologie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Recherche sur l'Inflammation, Inserm U1149, Université Paris Cité, Paris, France
| | - Marie Courbebaisse
- Faculté de Médecine, Université Paris Cité, Paris, France.
- Explorations fonctionnelles rénales, Physiologie, Hôpital européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
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23
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Raval M, Siddiq S. Extra-cardiac uptake of 99mTc-pyrophosphate scan leading to the diagnosis of stage IV metastatic prostatic adenocarcinoma. J Nucl Cardiol 2023; 30:2807-2808. [PMID: 36823485 DOI: 10.1007/s12350-023-03208-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Maharshi Raval
- New York Medical College, Valhalla, NY, USA.
- Landmark Medical College, Woonsocket, RI, USA.
| | - Sajid Siddiq
- New York Medical College, Valhalla, NY, USA
- Landmark Medical College, Woonsocket, RI, USA
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24
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Perez-Ardavin J, Martinez-Sarmiento M, Monserrat-Monfort JJ, Vera-Pinto V, Sopena-Novales P, Bello-Arqués P, Boronat-Tormo F, Vera-Donoso CD. The sentinel node with technetium-99m for prostate cancer. A safe and mature new gold standard? Q J Nucl Med Mol Imaging 2023; 67:287-293. [PMID: 35762662 DOI: 10.23736/s1824-4785.22.03416-1] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The objective was to carry out a prospective study to compare the current extended pelvic lymph node dissection (ePLND) to the sentinel node (SN) technique with 99mTcnanocolloid. METHODS We conducted a prospective study between January 2013 and May 2020. In the first 74 patients, 99mTc-nanocolloid was used. Then from June 2017 onwards, in 38 patients we used a combined radiotracer prepared by adding indocyanine green (ICG). A preoperative SPECT/CT was also performed to check on the SNs. We extracted the SNs guided by a laparoscopic gamma-ray detection probe and/or a fluorescence camera. RESULTS We included 112 patients with a Briganti nomogram-assessed risk of 5% or more. In 4 out of the total, the radiotracer did not migrate. The mean number of extracted nodes was 21.56 (13.46-29.71) and the mean of extracted SNs was 5.17 (1.83-8.51) (P<0.001). The technique that registered the most nodes with high activity was SPECT/CT, with an average of 4.33 nodes (2.42-6.23) (P<0.001). We found SNs outside the template in 78% of the patients. A total of 46% of the complications were related to ePLND. The SN biopsy showed a sensitivity of 100%, specificity of 97.5%, PVV of 92.86%, and NPV of 100%. CONCLUSIONS Our results prove that ePLND is a technique with significant morbidity; up to 46% of the complications were related to the ePLND. The SN surgery showed great accuracy in detecting metastases due to the SPECT/CT and a lower rate of complications than ePLND.
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Affiliation(s)
- Javier Perez-Ardavin
- Doctoral School, Catholic University of Valencia San Vicente Mártir, Valencia, Spain -
| | | | | | - Victor Vera-Pinto
- Department of Nuclear Medicine, La Fe Universitary and Polytechnic Hospital, Valencia, Spain
| | - Pablo Sopena-Novales
- Department of Nuclear Medicine, La Fe Universitary and Polytechnic Hospital, Valencia, Spain
| | - Pilar Bello-Arqués
- Department of Nuclear Medicine, La Fe Universitary and Polytechnic Hospital, Valencia, Spain
| | | | - César D Vera-Donoso
- Doctoral School, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
- Department of Urology, La Fe Universitary and Polytechnic Hospital, Valencia, Spain
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25
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Pant AD, Ruhela R, Pilllai AS, Singh DK, Tomar BS. Rapid and reliable assaying of Tc-99 in sediment samples with novel MTPN polymeric resin. J Environ Radioact 2023; 270:107297. [PMID: 37738760 DOI: 10.1016/j.jenvrad.2023.107297] [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] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/04/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023]
Abstract
The paper describes a new method for the rapid determination of Technetium (Tc) in sediment samples using solid-phase extraction chromatography (SPEC) with a novel methyl triphenyl phosphoniumnitrate (MTPN) resin. The effectiveness of the resin in selectively recovering Tc was evaluated in both batch and column mode and exploited for rapid analysis of 'Tc'. The procedure involves the acid digestion of samples, pre-concentration of fission products in supernatant and co-precipitation of actinides with Fe(OH)3, followed by selective recovery of Tc by SPEC using a column filled with MTPN resin. The recovered Tc was then radiometrically assayed using beta counting. The method was validated using IAEA certified reference materials and was found to provide reliable and reproducible results for the activity concentration of Tc-99 in sediment samples within 24 h.
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Affiliation(s)
- Amar D Pant
- Environmental Monitoring and Assessment Division, India; Homi Bhabha National Institute, Bhabha Atomic Research Centre, Trombay, Mumbai, 400085, India.
| | - R Ruhela
- Material Processing and Corrosion Engineering Division, India; Homi Bhabha National Institute, Bhabha Atomic Research Centre, Trombay, Mumbai, 400085, India.
| | | | - D K Singh
- Material Processing and Corrosion Engineering Division, India
| | - B S Tomar
- Homi Bhabha National Institute, Bhabha Atomic Research Centre, Trombay, Mumbai, 400085, India
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26
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Akincioglu C, Murthi M, Romsa J, Warrington J, Malhotra S. Comparison of cardio-focal and chest reconstruction of technetium-99m pyrophosphate scintigraphy for diagnosis of transthyretin cardiac amyloidosis: a quality assurance study. J Nucl Cardiol 2023; 30:2607-2614. [PMID: 38245067 DOI: 10.1007/s12350-023-03256-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/08/2022] [Accepted: 03/08/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND SPECT improves diagnostic specificity of Technetium-99m pyrophosphate (PYP) scintigraphy. Diagnostic performance of PYP data, reconstructed as either chest or cardio-focal SPECT is not known. METHODS In this quality assurance study, blinded evaluation of PYP SPECT/CT data from 102 Caucasian patients (mean age 76 ± 11 years, 67% men) was performed by two readers. Reader 1 reviewed planar and PYP chest SPECT, while reader 2 reviewed planar and cardio-focal PYP SPECT. Demographic, clinical, and other testing data were obtained from the electronic medical records. RESULTS A total of 41 patients (40%) were considered positive based on myocardial uptake on chest PYP SPECT. Of these, 98% of the patients had a Perugini score ≥ 2 on planar imaging. There was good agreement between the two readers for visual score ≥ 2 (k = .88, P < .001) and excellent agreement for myocardial uptake on tomographic imaging (98%, P < .001). Only one study was categorized as false negative by cardio-focal SPECT reconstruction. Non-diffuse myocardial uptake was identified in 22% of those with a positive PYP SPECT. CONCLUSION When read by experienced readers, chest and cardio-focal reconstruction of PYP SPECT have comparable diagnostic performance. A substantial proportion of patients with a positive PYP SPECT have a non-diffuse distribution of PYP. Given the possibility of misclassification of non-diffuse myocardial uptake on cardio-focal reconstruction alone, chest reconstruction of PYP scintigraphy should be strongly considered.
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Affiliation(s)
- Cigdem Akincioglu
- Division of Nuclear Medicine, Medical Imaging, Western University, London, ON, Canada.
| | - Mukunthan Murthi
- Department of Internal Medicine, Cook County Health, Chicago, IL, USA
| | - Jonathan Romsa
- Division of Nuclear Medicine, Medical Imaging, Western University, London, ON, Canada
| | - James Warrington
- Division of Nuclear Medicine, Medical Imaging, Western University, London, ON, Canada
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health, Chicago, IL, USA; Division of Cardiology, Rush Medical College, Chicago, IL, USA
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27
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Liu X, Yan X, Yang X, Ning Y, Chen Y, Cai M, Li S. 99mTc-DTPA Renal Dynamic Imaging for Evaluating the Function of Duplex Kidneys in Adult Patients. ARCH ESP UROL 2023; 76:802-809. [PMID: 38186074 DOI: 10.56434/j.arch.esp.urol.20237610.97] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND This study aimed to explore technetium-99m-diethylenetriaminepentaacetic acid (99mTc-DTPA) renal dynamic imaging to evaluate duplex kidney function in adult patients. SUBJECTS AND METHODS We retrospectively analyzed the clinical data of 25 patients with duplex kidneys who underwent 99mTc-DTPA renal dynamic imaging between June 2011 and March 2023 at our hospital. Patients in the duplex kidney group (n = 25) were divided into renogram normal (n = 9) and abnormal (n = 16) groups according to the imaging data. Additionally, normal patients were selected as the control group (n = 25). After imaging, the region of interest of the kidneys was delineated, and renography was performed. Renography can provide renal function parameters, including glomerular filtration rate (GFR), Tmax, T1/2, renal clearance, and the GFR ratio of the duplex renal segment (upper renal moiety). RESULTS Compared with the control group, the serum creatinine level in the duplex kidney group was higher (p = 0.025), GFR was lower (p = 0.001), and patients with impaired renal function were mainly in the abnormal renography group (p = 0.001). In the duplex kidney group, the GFR (p = 0.026) and renal clearance (p = 0.006) of the affected kidneys were lower than those of the contralateral kidneys, and Tmax (p = 0.025) was higher than that of the contralateral kidneys. There were no differences in renal function indicators of duplex renal segments with different GFR ratios. However, when the GFR ratio exceeded 50%, the renal function tended to decline. CONCLUSIONS 99mTc-DTPA renal dynamic imaging was found useful to evaluate the total renal function, split renal function, and upper urinary tract patency in patients with duplex kidneys. Patients with abnormal renography results had worse renal function, and those with poor renal clearance in the affected renal moiety required surgical treatment.
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Affiliation(s)
- Xiaoji Liu
- School of Forensic Medicine, Shanxi Medical University, 030000 Taiyuan, Shanxi, China
| | - Xiaomin Yan
- Department of Medical Imaging, Shanxi Medical University, 030000 Taiyuan, Shanxi, China
| | - Xinrui Yang
- Department of Nuclear Medicine, Shanxi Provincial People's Hospital & Fifth Hospital of Shanxi Medical University, 030000 Taiyuan, Shanxi, China
| | - Yu Ning
- Department of Medical Imaging, Shanxi Medical University, 030000 Taiyuan, Shanxi, China
| | - Yao Chen
- Department of Medical Imaging, Shanxi Medical University, 030000 Taiyuan, Shanxi, China
| | - Min Cai
- Department of Nuclear Medicine, Shanxi Provincial People's Hospital & Fifth Hospital of Shanxi Medical University, 030000 Taiyuan, Shanxi, China
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, 030000 Taiyuan, Shanxi, China
| | - Sijin Li
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, 030000 Taiyuan, Shanxi, China
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28
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Yang X, Li G, Ruan C, Hu K, Tang G. Formulation and Preclinical Testing of Tc-99m-Labeled HYNIC-Glc-FAPT as a FAP-Targeting Tumor Radiotracer. Bioconjug Chem 2023; 34:2133-2143. [PMID: 37874952 DOI: 10.1021/acs.bioconjchem.3c00442] [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: 10/26/2023]
Abstract
Molecular imaging and targeted radiotherapy with radiolabeled fibroblast activation protein inhibitor (FAPI) targeting peptide probes hold great potential for enhancing the clinical management of patients with FAP-expressing cancers. However, the high cost of PET probes has prompted us to search for new FAP-targeting single-photon imaging agents. In this study, HYNIC-Glc-FAPT is synthesized and radiolabeled with technetium-99m using tricine/EDDA or dimer tricine as coligands to produce [99mTc]Tc-tricine/EDDA-HYNIC-Glc-FAPT and [99mTc]Tc-tricine(2)-HYNIC-Glc-FAPT. Both [99mTc]Tc-tricine/EDDA-HYNIC-Glc-FAPT and [99mTc]Tc-tricine(2)-HYNIC-Glc-FAPT were effectively synthesized with an excellent radiochemistry yield (both >97%, n = 6) in a single-step technique, and their stability in PBS and human serum was satisfactory. Compared to [99mTc]Tc-tricine(2)-HYNIC-Glc-FAPT, [99mTc]Tc-tricine/EDDA-HYNIC-Glc-FAPT exhibited a more hydrophilic nature with a log P of -3.53 ± 0.12. In vitro cellular uptake and blocking assays, internalization, efflux experiments, and affinity experiments all suggested a mechanism with high FAP-specificity and affinity. SPECT imaging and biodistribution of [99mTc]Tc-tricine/EDDA-HYNIC-Glc-FAPT demonstrated sustained high tumor uptake in BALB/c nude mice bearing U87MG tumors for 6 h. It demonstrated a long-range retention characteristic and more rapid clearance ability from nontarget organs. Collectively, we successfully synthesized [99mTc]Tc-tricine/EDDA-HYNIC-Glc-FAPT and [99mTc]Tc-tricine(2)-HYNIC-Glc-FAPT, and the excellent targeting properties of [99mTc]Tc-tricine/EDDA-HYNIC-Glc-FAPT suggest a potential diagnostic value in future clinical studies for advanced-stage FAP-expressing malignancies, especially in prognostic evaluation of tumors for it low price and convenient source.
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Affiliation(s)
- Xiaoqiang Yang
- GDMPA Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, PET Center and Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
- Department of Nuclear Medicine, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Guiping Li
- GDMPA Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, PET Center and Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Chuyin Ruan
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Kongzhen Hu
- GDMPA Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, PET Center and Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Ganghua Tang
- GDMPA Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, PET Center and Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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29
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Gemmell AJ, Brown CM, Ray S, Small A. Quantitative uptake in 99m Tc-EDDA/HYNIC-TOC somatostatin receptor imaging - the effect of long-acting release somatostatin analogue therapy. Nucl Med Commun 2023; 44:944-952. [PMID: 37578312 DOI: 10.1097/mnm.0000000000001746] [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: 08/15/2023]
Abstract
PURPOSE Withdrawal of long-acting release somatostatin analogue (LAR-SSA) treatment before somatostatin receptor imaging is based on empirical reasoning that it may block uptake at receptor sites. This study aims to quantify differences in uptake of 99m Tc-EDDA/HYNIC-TOC between patients receiving LAR-SSA and those who were not. METHODS Quantification of 177 patients (55 on LAR-SSA) imaged with 99m Tc-EDDA/HYNIC-TOC was performed, with analysis of pathological tissue and organs with physiological uptake using thresholded volumes of interest. Standardised uptake values (SUVs) and tumour/background (T/B) ratios were calculated and compared between the two patient groups. RESULTS SUVs were significantly lower for physiological organ uptake for patients on LAR-SSA (e.g. spleen: SUV max 13.3 ± 5.9 versus 33.9 ± 9.0, P < 0.001); there was no significant difference for sites of pathological uptake (e.g. nodal metastases: SUV max 19.2 ± 13.0 versus 17.4 ± 11.5, P = 0.552) apart from bone metastases (SUV max 14.1 ± 13.5 versus 7.7 ± 8.0, P = 0.017) where it was significantly higher. CONCLUSION LAR-SSA has an effect only on physiological organ uptake of 99m Tc-EDDA/HYNIC-TOC, reducing uptake. It has no significant effect on pathological uptake for most sites of primary and metastatic disease. This should be taken into account if making quantitative measurements, calculating T/B ratios or assigning Krenning Scores. There is the potential for improved dosimetric results in Peptide Receptor Radionuclide Therapy by maintaining patients on LAR-SSA.
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Affiliation(s)
- Alastair J Gemmell
- Department of Nuclear Medicine, Gartnavel General Hospital, NHS Greater Glasgow & Clyde
- Department of Clinical Physics & Bioengineering, NHS Greater Glasgow & Clyde
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
| | - Colin M Brown
- Department of Nuclear Medicine, Gartnavel General Hospital, NHS Greater Glasgow & Clyde
- Department of Clinical Physics & Bioengineering, NHS Greater Glasgow & Clyde
| | - Surajit Ray
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
| | - Alexander Small
- Department of Nuclear Medicine, Gartnavel General Hospital, NHS Greater Glasgow & Clyde
- Department of Clinical Physics & Bioengineering, NHS Greater Glasgow & Clyde
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30
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Hu LH, Kuo Y, Chang FP, Wang WT, Yang BH, Huang WS, Wang YF. Hyperphosphatemia-Related False-Positive 99m Tc-Pyrophosphate Myocardial Scan: A Case Report With Endomyocardial Biopsy Result. Clin Nucl Med 2023; 48:e544-e546. [PMID: 37801577 DOI: 10.1097/rlu.0000000000004869] [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: 10/08/2023]
Abstract
ABSTRACT With documented high specificity, 99m Tc-pyrophosphate (PYP) scan enables the diagnosis of transthyretin cardiomyopathy to be made reliably without endomyocardial biopsy in patients who do not have monoclonal gammopathy. We report a case with extensive myocardial uptake of Perugini 3 score in the 3-hour 99m Tc-PYP myocardial SPECT that suggested transthyretin cardiac amyloidosis. However, a followed endomyocardial biopsy revealed no amyloid deposition. In this case, hyperphosphatemia was the most likely and presumptive cause of the false-positive 99m Tc-PYP scan. With this case, our experiences of the potential causes of false-positive results of 99m Tc-PYP are further expanded.
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31
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Zhong P, Yang J, Wang Y, Wei L, Chen L. Thyroid Accumulation of 99m Tc-DTPA in Graves Disease. Clin Nucl Med 2023; 48:e552-e553. [PMID: 37703477 DOI: 10.1097/rlu.0000000000004858] [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: 09/15/2023]
Abstract
ABSTRACT 99m Tc-DTPA dynamic renal scintigraphy for evaluating glomerular filtration rate was performed in a 29-year-old woman with hyperuricemia and Graves disease. Subsequently, 99m Tc-DTPA orbital scintigraphy was conducted to determine the activity of Graves ophthalmopathy. Thyroid accumulation of 99m Tc-DTPA was incidentally identified. This should be cautiously distinguished from 99m Tc-pertechnetate uptake, considering that the salivary glands, oral cavity, and stomach were not visualized. Our case demonstrates that augmentation of blood supply, enhancement of capillary permeability, and accumulation of inflammatory exudate may be involved in the pathological process of Graves disease.
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Affiliation(s)
- Peng Zhong
- From the Departments of Nuclear Medicine
| | | | | | - Li Wei
- Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Libo Chen
- From the Departments of Nuclear Medicine
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32
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Araki Y, Misaki T, Ueda Y, Matsumoto N, Takaso Y. Diagnostic Utility of 99m Tc-MDP Bone Scintigraphy for Nivolumab-Induced Inflammatory Arthritis. Clin Nucl Med 2023; 48:971-973. [PMID: 37756256 DOI: 10.1097/rlu.0000000000004861] [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: 09/29/2023]
Abstract
ABSTRACT Immune checkpoint inhibitors can revive exhausted helper T-cells, and inflammatory cell reactivation may cause autoimmune disease-like conditions. Drug-induced arthritis is an immune-related adverse event, but the diagnostic approach is undefined. We present the diagnostic utility of 99m Tc-MDP bone scintigraphy for nivolumab-induced inflammatory arthritis. A 67-year-old man with hypopharyngeal carcinoma presented bilateral multiple metacarpophalangeal joint pain and swelling at each nivolumab administration. Regular imaging findings were atypical for inflammatory arthritis and did not fulfill the criteria for rheumatoid arthritis. We diagnosed nivolumab-induced inflammatory arthritis based on clinical symptoms and the symmetrical moderate uptake of the affected joints on 99m Tc-MDP bone scintigraphy.
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Affiliation(s)
| | - Tomonori Misaki
- From the Department of Orthopaedic Surgery, FukuiPrefectural Hospital, Fukui
| | - Yasuhiro Ueda
- From the Department of Orthopaedic Surgery, FukuiPrefectural Hospital, Fukui
| | - Naoyuki Matsumoto
- From the Department of Orthopaedic Surgery, FukuiPrefectural Hospital, Fukui
| | - Yuji Takaso
- Department of Otorhinolaryngology, Fukui Prefectural Hospital, Fukui, Japan
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Kim Y, Park JW, Cho HS, Jang WY, Han I, Kim HS. Does the Clinical Presentation of Secondary Osteosarcoma in Patients Who Survive Retinoblastoma Differ From That of Conventional Osteosarcoma and How Do We Detect Them? Clin Orthop Relat Res 2023; 481:2154-2163. [PMID: 37145140 PMCID: PMC10566973 DOI: 10.1097/corr.0000000000002667] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/07/2023] [Accepted: 03/28/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Osteosarcoma is the most common secondary malignancy among survivors of retinoblastoma. Most previous reports on secondary malignancy of retinoblastoma included all types of secondary malignancies without a focus on osteosarcoma, owing to its rarity. In addition, there are few studies suggesting tools for regular surveillance for early detection. QUESTIONS/PURPOSES (1) What are the radiologic and clinical characteristics of secondary osteosarcoma after retinoblastoma? (2) What is the clinical survivorship? (3) Is a radionuclide bone scan a reasonable imaging modality for early detection in patients with retinoblastoma? METHODS Between February 2000 and December 2019, we treated 540 patients for retinoblastoma. Twelve patients (six male, six female) subsequently developed an osteosarcoma in the extremities; two of these patients had two sites of osteosarcoma (10 femurs, four tibiae) . A Technetium-99m bone scan image was examined annually in all patients for regular surveillance after the treatment of retinoblastoma as per our hospital's policy. All patients were treated with the same strategy as that used for primary conventional osteosarcoma, namely neoadjuvant chemotherapy, wide excision, and adjuvant chemotherapy. The median follow-up period was 12 years (range 8 to 21 years). The median age at the time of diagnosis of osteosarcoma was 9 years (range 5 to 15 years), and the median interval from retinoblastoma diagnosis to osteosarcoma diagnosis was 8 years (range 5 to 15 years). Radiologic characteristics were assessed with plain radiographs and MRI, while clinical characteristics were assessed through a retrospective review of medical records. For clinical survivorship, we evaluated overall survival, local recurrence-free survival, and metastasis-free survival. We reviewed the results of bone scans and clinical symptoms at the time of diagnosis for osteosarcoma after retinoblastoma. RESULTS In nine of 14 patients, the tumor had a diaphyseal center, and five of the tumors were located at the metaphysis. The femur was the most common site (n = 10), followed by the tibia (n = 4). The median tumor size was 9 cm (range 5 to 13 cm). There was no local recurrence after surgical resection of the osteosarcoma, and the 5-year overall survival rate after the diagnosis of osteosarcoma was 86% (95% CI 68% to 100%). In all 14 tumors, the Technetium bone scan showed increased uptake in the lesions. Ten of 14 tumors were examined in clinic because of patient complaints of pain in the affected limb. Four patients showed no clinical symptoms detected by abnormal uptake on bone scan. CONCLUSION For unclear reasons, secondary osteosarcomas in patients who were alive after the treatment of retinoblastoma had a slight predilection for the diaphysis of the long bone compared with patients with spontaneous osteosarcoma in other reports. The clinical survivorship of osteosarcoma as a secondary malignancy after retinoblastoma may not be inferior to that of conventional osteosarcoma. Close follow-up with at least yearly clinical assessment and bone scans or other imaging modalities appears to be helpful in detecting secondary osteosarcoma after the treatment of patients with retinoblastoma. Larger multi-institutional studies will be needed to substantiate these observations.Level of Evidenc e Level IV, therapeutic study.
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Affiliation(s)
- Yongsung Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Woong Park
- Orthopaedic Oncology Clinic, National Cancer Center, Goyang-si, Korea
| | - Hwan Seong Cho
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo Young Jang
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Ilkyu Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Soo Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Wang A, Mahmood U, Tang X, Jain D, Pan S. A case of disappearing amyloid on technetium pyrophosphate scan. J Nucl Cardiol 2023; 30:1986-1991. [PMID: 37340232 DOI: 10.1007/s12350-023-03316-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 06/22/2023]
Abstract
Technetium-99mm pyrophosphate (Tc-PYP) scintigraphy is a highly accurate non-invasive method for the diagnosis of transthyretin (ATTR) cardiac amyloidosis. Prognosis for this disease is improved following treatment with the transthyretin (TTR) stabilizer tafamidis. Although tafamidis slows disease progression, its effects on myocardial amyloid and Tc-PYP uptake remain unclear. We present a patient with ATTR cardiac amyloidosis who had a strongly positive initial Tc-PYP scan, with a dramatic decrease in Tc-PYP uptake on repeat scan after 3 years of tafamidis treatment. However, myocardial biopsy showed persistent diffuse amyloid deposits. This case highlights the need for further studies regarding the utility of serial Tc-PYP scans in monitoring the progress of ATTR cardiomyopathy.
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Affiliation(s)
- Andy Wang
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Uzair Mahmood
- Department of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Rd, Macy Pavilion, Valhalla, NY, 10595, USA
| | - Xiaoyu Tang
- Department of Pathology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Diwakar Jain
- Department of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Rd, Macy Pavilion, Valhalla, NY, 10595, USA.
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Rd, Macy Pavilion, Valhalla, NY, 10595, USA
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Takahashi K, Morioka H, Sasaki D, Yamamura N, Kitazawa S, Ueda M, Sakaue T, Enomoto D, Uemura S, Okura T, Ikeda S. Two autopsy cases of wild-type transthyretin cardiac amyloidosis who died 10 days after technetium-99m-pyrophosphate scintigraphy. J Nucl Cardiol 2023; 30:2215-2221. [PMID: 36352088 DOI: 10.1007/s12350-022-03128-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/03/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Koji Takahashi
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime, 796-8502, Japan.
| | - Hiroe Morioka
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime, 796-8502, Japan
| | - Daisuke Sasaki
- Department of Radiology, Yawatahama City General Hospital, Yawatahama, Ehime, Japan
| | - Nobuhisa Yamamura
- Department of Clinical Pathology, Yawatahama City General Hospital, Yawatahama, Ehime, Japan
| | - Sohei Kitazawa
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomoki Sakaue
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime, 796-8502, Japan
| | - Daijiro Enomoto
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime, 796-8502, Japan
| | - Shigeki Uemura
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime, 796-8502, Japan
| | - Takafumi Okura
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime, 796-8502, Japan
| | - Shuntaro Ikeda
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime, 796-8502, Japan
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Zeven K, De Groof TW, Ceuppens H, Awad RM, Ertveldt T, de Mey W, Meeus F, Raes G, Breckpot K, Devoogdt N. Development and evaluation of nanobody tracers for noninvasive nuclear imaging of the immune-checkpoint TIGIT. Front Immunol 2023; 14:1268900. [PMID: 37799715 PMCID: PMC10548220 DOI: 10.3389/fimmu.2023.1268900] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction T cell Ig and ITIM domain receptor (TIGIT) is a next-generation immune checkpoint predominantly expressed on activated T cells and NK cells, exhibiting an unfavorable prognostic association with various malignancies. Despite the emergence of multiple TIGIT-blocking agents entering clinical trials, only a fraction of patients responded positively to anti-TIGIT therapy. Consequently, an urgent demand arises for noninvasive techniques to quantify and monitor TIGIT expression, facilitating patient stratification and enhancing therapeutic outcomes. Small antigen binding moieties such as nanobodies, are promising candidates for such tracer development. Methods We generated a panel of anti-human or anti-mouse TIGIT nanobodies from immunized llamas. In addition, we designed a single-chain variable fragment derived from the clinically tested monoclonal antibody Vibostolimab targeting TIGIT, and assessed its performance alongside the nanobodies. In vitro characterization studies were performed, including binding ability and affinity to cell expressed or recombinant TIGIT. After Technetium-99m labeling, the nanobodies and the single-chain variable fragment were evaluated in vivo for their ability to detect TIGIT expression using SPECT/CT imaging, followed by ex vivo biodistribution analysis. Results Nine nanobodies were selected for binding to recombinant and cell expressed TIGIT with low sub-nanomolar affinities and are thermostable. A six-fold higher uptake in TIGIT-overexpressing tumor was demonstrated one hour post- injection with Technetium-99m labeled nanobodies compared to an irrelevant control nanobody. Though the single-chain variable fragment exhibited superior binding to TIGIT-expressing peripheral blood mononuclear cells in vitro, its in vivo behavior yielded lower tumor-to-background ratios at one hour post- injection, indicating that nanobodies are better suited for in vivo imaging than the single-chain variable fragment. Despite the good affinity, high specificity and on-target uptake in mice in this setting, imaging of TIGIT expression on tumor- infiltrating lymphocytes within MC38 tumors remained elusive. This is likely due to the low expression levels of TIGIT in this model. Discussion The excellent affinity, high specificity and rapid on-target uptake in mice bearing TIGIT- overexpressing tumors showed the promising diagnostic potential of nanobodies to noninvasively image high TIGIT expression within the tumor. These findings hold promise for clinical translation to aid patient selection and improve therapy response.
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Affiliation(s)
- Katty Zeven
- Laboratory of Molecular Imaging and Therapy (MITH), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Timo W.M. De Groof
- Laboratory of Molecular Imaging and Therapy (MITH), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Hannelore Ceuppens
- Laboratory for Molecular and Cellular Therapy (LMCT), Department of Biomedical Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Robin Maximilian Awad
- Laboratory for Molecular and Cellular Therapy (LMCT), Department of Biomedical Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Thomas Ertveldt
- Laboratory for Molecular and Cellular Therapy (LMCT), Department of Biomedical Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Wout de Mey
- Laboratory for Molecular and Cellular Therapy (LMCT), Department of Biomedical Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Fien Meeus
- Laboratory for Molecular and Cellular Therapy (LMCT), Department of Biomedical Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Geert Raes
- Laboratory for Cellular and Molecular Immunology (CMIM), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Myeloid Cell Immunology Lab, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Brussels, Belgium
| | - Karine Breckpot
- Laboratory for Molecular and Cellular Therapy (LMCT), Department of Biomedical Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Nick Devoogdt
- Laboratory of Molecular Imaging and Therapy (MITH), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Staron A, Mendelson LM, Joshi T, Ruberg FL, Sanchorawala V. Factors affecting the accuracy of amyloidosis identification and referral to a specialty centre. Amyloid 2023; 30:297-302. [PMID: 36718932 DOI: 10.1080/13506129.2023.2171787] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/27/2022] [Accepted: 01/19/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Diagnostic algorithms for amyloidosis have evolved over the past decade, particularly with the incorporation of imaging-based techniques to detect amyloid cardiomyopathy. We sought to identify the key sources of amyloidosis misidentification in the community, which lead to false positive referrals to a tertiary centre. METHODS We conducted a retrospective review of all referrals to the Amyloidosis Centre from 2010 to 2021 and identified cases lacking amyloid pathology upon final adjudication after extensive assessment at the centre. Factors for false positive referrals were examined. RESULTS Among 2409 referrals of suspected amyloidosis, 147 (6%) demonstrated an absence of amyloid pathology. This percentage increased over time from 4% in 2010 to 13% in 2021. False positive referrals consisted of more people of colour. The most frequent source of inaccuracy was the erroneous staining of tissue specimens with Congo red, followed by suggestive findings on cardiac imaging. In recent years, misinterpretation of 99mtechnetium- pyrophosphate scintigraphy emerged as a major source of false positive referrals. CONCLUSION Recognising these potential sources of diagnostic error in the workup of amyloidosis can improve patient care. Referral to a centre of excellence for amyloidosis helps confirm an accurate diagnosis and avoid mistreatment.
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Affiliation(s)
- Andrew Staron
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Lisa M Mendelson
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Tracy Joshi
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Frederick L Ruberg
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Vaishali Sanchorawala
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
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Srwijitalai W, Wiwanitkit V. Re: Bilateral Axillary Nodal Uptake on 99m Tc-White Blood Cell Study Secondary to COVID-19 mRNA Vaccination. Clin Nucl Med 2023; 48:836. [PMID: 36730699 PMCID: PMC10417225 DOI: 10.1097/rlu.0000000000004485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Bondia Bescós S, Martin Marcuartu JJ, Bajén Lázaro MT, Mora Salvadó J, Benítez Segura A, Cortés Romera M. Intrahepatic splenosis visualized on a [ m99Tc]Tc-denatured erythrocyte scintigraphy. Rev Esp Med Nucl Imagen Mol 2023; 42:337-338. [PMID: 36746241 DOI: 10.1016/j.remnie.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 02/05/2023]
Affiliation(s)
- S Bondia Bescós
- Servicio de Medicina Nuclear - PET (ICS-IDI), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - J J Martin Marcuartu
- Servicio de Medicina Nuclear - PET (ICS-IDI), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M T Bajén Lázaro
- Servicio de Medicina Nuclear - PET (ICS-IDI), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J Mora Salvadó
- Servicio de Medicina Nuclear - PET (ICS-IDI), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Benítez Segura
- Servicio de Medicina Nuclear - PET (ICS-IDI), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Cortés Romera
- Servicio de Medicina Nuclear - PET (ICS-IDI), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Rezaeianpour M, Mazidi SM, Nami R, Geramifar P, Mosayebnia M. Vimentin-targeted radiopeptide 99m Tc-HYNIC-(tricine/EDDA)-VNTANST: a promising drug for pulmonary fibrosis imaging. Nucl Med Commun 2023; 44:777-787. [PMID: 37395537 DOI: 10.1097/mnm.0000000000001724] [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: 07/04/2023]
Abstract
OBJECTIVE Idiopathic pulmonary fibrosis (IPF) is a fatal disease characterized by the accumulation of extracellular matrix. Because there is no effective treatment for advanced IPF to date, its early diagnosis can be critical. Vimentin is a cytoplasmic intermediate filament that is significantly up-regulated at the surface of fibrotic foci with a crucial role in fibrotic morphological changes. METHODS In the present study, VNTANST sequence as a known vimentin-targeting peptide was conjugated to hydrazinonicotinic acid (HYNIC) and labeled with 99m Tc. The stability test in saline and human plasma and log P determination were performed. Next, the biodistribution study and single photon emission computed tomography (SPECT) integrated with computed tomography (CT) scanning were performed in healthy and bleomycin-induced fibrosis mice models. RESULTS The 99m Tc-HYNIC-(tricine/EDDA)-VNTANST showed a hydrophilic nature (log P = -2.20 ± 0.38) and high radiochemical purity > 97% and specific activity (336 Ci/mmol). The radiopeptide was approximately 93% and 86% intact in saline and human plasma within 6 h, respectively. The radiopeptide was substantially accumulated in the pulmonary fibrotic lesions (test vs. control = 4.08 ± 0.08% injected dose per gram (ID/g) vs. 0.36 ± 0.01% ID/g at 90 min postinjection). SPECT-CT images in fibrosis-bearing mice also indicated the fibrotic foci and kidneys. CONCLUSION Because there is no available drug for the treatment of advanced pulmonary fibrosis, early diagnosis is the only chance. The 99m Tc-HYNIC-(tricine/EDDA)-VNTANST could be a potential tracer for SPECT imaging of pulmonary fibrosis.
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Affiliation(s)
- Maliheh Rezaeianpour
- Department of Pharmaceutical Chemistry and Radiopharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences
| | | | - Reza Nami
- Department of Clinical Science, Faculty of Veterinary Medicine, University of Tabriz
| | - Parham Geramifar
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences
- Department of Nuclear Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Mosayebnia
- Department of Pharmaceutical Chemistry and Radiopharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences
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Naiki H, Yamaguchi A, Sekijima Y, Ueda M, Ohashi K, Hatakeyama K, Ikeda Y, Hoshii Y, Shintani-Domoto Y, Miyagawa-Hayashino A, Tsujikawa H, Endo J, Arai T, Ando Y. Steep increase in the number of transthyretin-positive cardiac biopsy cases in Japan: evidence obtained by the nation-wide pathology consultation for the typing diagnosis of amyloidosis. Amyloid 2023; 30:321-326. [PMID: 36795075 DOI: 10.1080/13506129.2023.2180334] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/29/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND In 2019, 2020 and 2022, the Japanese Government approved the use of tafamidis and two technetium-scintigraphies for transthyretin amyloid (ATTR) cardiomyopathy, and announced the patient criteria for tafamidis therapy. In 2018, we had started a nation-wide pathology consultation of amyloidosis. OBJECTIVE To reveal the impact of approval of tafamidis and technetium-scintigraphy on the diagnosis of ATTR cardiomyopathy. METHODS Ten institutes participated in this study on the pathology consultation of amyloidosis and shared rabbit polyclonal anti-κ116-133, anti-λ118-134, and anti-transthyretin115-124 antibodies. Proteomic analysis was performed when the typing diagnosis by immunohistochemistry was unavailable. RESULTS Out of 5400 consultation cases received from April 2018 to July 2022, the type of amyloidosis by immunohistochemistry was determined in 4119 of the 4420 Congo-red positive cases. The incidences of AA, ALκ, ALλ, ATTR, Aβ2M and others were 3.2, 11.3, 28.3, 54.9, 0.6 and 1.8%, respectively. Out of 2208 cardiac biopsy cases received, 1503 cases were ATTR positive. There were 4.0 and 4.9 times more total cases and ATTR-positive cases, respectively, in the last 12 months as compared to the first 12 months. CONCLUSIONS The approval of tafamidis and technetium-scintigraphy raised the awareness of ATTR cardiomyopathy, leading to an upsurge in ATTR-positive cardiac biopsy cases.
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Affiliation(s)
- Hironobu Naiki
- Department of Molecular Pathology, University of Fukui, Fukui, Japan
| | - Aina Yamaguchi
- Department of Molecular Pathology, University of Fukui, Fukui, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Ohashi
- Department of Human Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kinta Hatakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshinobu Hoshii
- Division of Diagnostic Pathology, Yamaguchi University Hospital, Yamaguchi, Japan
| | | | - Aya Miyagawa-Hayashino
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hanako Tsujikawa
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Jin Endo
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Tomio Arai
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Yukio Ando
- Department of Amyloidosis Research, Nagasaki International University, Sasebo, Japan
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Hou PN, Huang YE, Chan SH. Extrastriatal uptake related to dopaminergic dysfunction on 99mTc-TRODAT-1 brain SPECT in patient with atypical meningioma. Hell J Nucl Med 2023; 26:210-214. [PMID: 38085837 DOI: 10.1967/s002449912606] [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] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
Extrastriatal accumulation on technetium-99m-([2-[[2-[[[3-(4-chlorophenyl)-8-methyl-8-azabicyclo[3,2,1]oct-2-yl]methyl](2-mercaptoethyl)amino]ethyl]amino]- ethanethiolato(3-)-N2,N2',S2,S2']oxo-[1R-(exo-exo)])(99mTc)-TRODAT-1 is unexpected during nuclear medicine nigrostriatal pathway examinations on 99mTc-TRODAT-1 brain single photon emission computed tomography (SPECT). An 86-year-old female with a history of right hemiparesis, speech expressive difficulties, unstable gait, and bradykinesia on right side was reported. Technetium-99m -TRODAT-1 dopamine transporter SPECT revealed an incidental extrastriatal accumulation of radiotracer in the left anterior frontal region, accompanied by a photopenic area which resulted in the displacement of the left striatum with decreased dopaminergic neuronal function. The brain magnetic resonance imaging (MRI) revealed an invasive meningioma corresponding to the extrastriatal uptake on SPECT, accompanied by edema and mass effect. The patient received surgery and the histopathological results confirmed the diagnosis of atypical meningioma.This study emphasizes the importance of understanding the underlying causes of extrastriatal uptake from 99mTc-TRODAT-1 brain SPECT, which may indicate an invasive brain tumor.
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Affiliation(s)
- Po-Nien Hou
- Department of Nuclear Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan, Department of Nuclear Medicine, Chang-Bing Show Chwan Memorial Hospital, Changhua, Taiwan.
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Yan P, Jiang S. Tc-99m scan for pediatric bleeding Meckel diverticulum:a systematic review and meta-analysis. J Pediatr (Rio J) 2023; 99:425-431. [PMID: 37277097 PMCID: PMC10492155 DOI: 10.1016/j.jped.2023.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 01/10/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE Meckel diverticulum (MD) is a common malformation of the digestive tract, often accompanied by serious complications. It is important to find safe and effective diagnostic methods for screening MD. The aim of this study was to evaluate the effectiveness of a technetium-99m (Tc-99m) scan for pediatric bleeding MD. METHODS The authors conducted a systematic review of studies published in PubMed, Embase, and Web of Science before 1 January 2023. Studies based on PICOS were included in this systematic review. The flow chart was made by PRISMA software. The quality of included studies was assessed by RevMan5 software (QUADAS-2: Quality Assessment of Diagnostic Accuracy Studies-2). The sensitivity, specificity, and other measurements of accuracy were pooled using Stata/SE 12.0 software. RESULTS Sixteen studies with 1115 children were included in this systematic review. A randomized-effects model was used for the meta-analysis because of significant heterogeneity. The combined sensitivity and specificity were 0.80 [Confidence Interval (95% CI, 0.73-0.86) and 0.95 (95% CI, 0.86-0.98)], respectively. The area under the curve (AUC) was 0.88 (95% CI, 0.85-0.90). Publication bias (Begg's test p = 0.053) was observed. CONCLUSION Tc-99m scan has high specificity, but moderate sensitivity, which is always influenced by some factors. Hence, the Tc-99m scan has some limitations in the diagnosis of pediatric bleeding MD.
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Affiliation(s)
- Ping Yan
- Sichuan University, West China Hospital, Department of Gastroenterology, Sichuan, China
| | - Shouliang Jiang
- Sichuan University, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Department of Pediatrics, Chengdu, China.
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Ververs TF, Lobbezoo AFH, Hobbelink MG, Braat AJ. Patient Preparation with Esomeprazole Is Comparable to Ranitidine in Meckel Diverticulum Scintigraphy. J Nucl Med Technol 2023; 51:211-214. [PMID: 37316300 DOI: 10.2967/jnmt.123.265558] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/20/2023] [Indexed: 06/16/2023] Open
Abstract
To localize ectopic gastric mucosa in patients with unexplained gastrointestinal bleeding and diagnose a Meckel diverticulum, 99mTc-pertechnetate imaging is the standard procedure. H2 inhibitor pretreatment enhances the sensitivity of the scan by reducing washout of 99mTc activity from the intestinal lumen. We aim to provide evidence of the effectiveness of the proton pump inhibitor esomeprazole as an ideal substitute for ranitidine. Methods: The scan quality for 142 patients who underwent a Meckel scan during a period of 10 y was evaluated. The patients were pretreated with ranitidine orally or intravenously before a switch to a proton pump inhibitor after ranitidine was no longer available. Good scan quality was characterized by the absence of 99mTc-pertechnetate activity in the gastrointestinal lumen. The effectiveness of esomeprazole to diminish 99mTc-pertechnetate release was compared with the standard treatment using ranitidine. Results: Pretreatment with intravenous esomeprazole resulted in 48% of scans with no 99mTc-pertechnetate release, 17% with release either in the intestine or in the duodenum, and 35% with 99mTc-pertechnetate activity both in the intestine and in the duodenum. Evaluation of scans obtained after oral ranitidine and intravenous ranitidine showed absence of activity in both intestine and duodenum in 16% and 23% of the cases, respectively. The indicated time to administer esomeprazole before starting the scan procedure was 30 min, but a delay of 15 min did not negatively influence the scan quality. Conclusion: This study confirms that esomeprazole, 40 mg, when administered intravenously 30 min before a Meckel scan, enhances the scan quality comparably to ranitidine. This procedure can be incorporated into protocols.
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Affiliation(s)
- Tessa F Ververs
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands;
- Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands; and
| | | | - Monique G Hobbelink
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arthur J Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Dobner S, Pilgrim T, Hagemeyer D, Heg D, Lanz J, Reusser N, Gräni C, Afshar‐Oromieh A, Rominger A, Langhammer B, Reineke D, Windecker S, Stortecky S. Amyloid Transthyretin Cardiomyopathy in Elderly Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2023; 12:e030271. [PMID: 37581394 PMCID: PMC10492930 DOI: 10.1161/jaha.123.030271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/20/2023] [Accepted: 06/22/2023] [Indexed: 08/16/2023]
Abstract
Background The prevalence of calcific aortic stenosis and amyloid transthyretin cardiomyopathy (ATTR-CM) increase with age, and they often coexist. The objective was to determine the prevalence of ATTR-CM in patients with severe aortic stenosis and evaluate differences in presentations and outcomes of patients with concomitant ATTR-CM undergoing transcatheter aortic valve implantation. Methods and Results Prospective screening for ATTR-CM with Technetium99-3,3-diphosphono-1,2-propanodicarboxylic acid bone scintigraphy was performed in 315 patients referred with severe aortic stenosis between August 2019 and August 2021. Myocardial Technetium99-3,3-diphosphono-1,2-propanodicarboxylic acid tracer uptake was detected in 34 patients (10.8%), leading to a diagnosis of ATTR-CM in 30 patients (Perugini ≥2: 9.5%). Age (85.7±4.9 versus 82.8±4.5; P=0.001), male sex (82.4% versus 57.7%; P=0.005), and prior carpal tunnel surgery (17.6% versus 4.3%; P=0.007) were associated with coexisting ATTR-CM, as were ECG (discordant QRS voltage to left ventricular wall thickness [42% versus 12%; P<0.001]), echocardiographic (left ventricular ejection fraction 48.8±12.8 versus 58.4±10.8; P<0.001; left ventricular mass index, 144.4±45.8 versus 117.2±34.4g/m2; P<0.001), and hemodynamic parameters (mean aortic valve gradient, 23.4±12.6 versus 35.5±16.6; P<0.001; mean pulmonary artery pressure, 29.5±9.7 versus 25.8±9.5; P=0.037). Periprocedural (cardiovascular death: hazard ratio [HR], 0.71 [95% CI, 0.04-12.53]; stroke: HR, 0.46 [95% CI, 0.03-7.77]; pacemaker implantation: HR, 1.54 [95% CI, 0.69-3.43]) and 1-year clinical outcomes (cardiovascular death: HR, 1.04 [95% CI, 0.37-2.96]; stroke: HR, 0.34 [95% CI, 0.02-5.63]; pacemaker implantation: HR, 1.50 [95% CI, 0.67-3.34]) were similar between groups. Conclusions Coexisting ATTR-CM was observed in every 10th elderly patient with severe aortic stenosis referred for therapy. While patients with coexisting pathologies differ in clinical presentation and echocardiographic and hemodynamic parameters, peri-interventional risk and early clinical outcomes were comparable up to 1 year after transcatheter aortic valve implantation. REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT04061213.
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Affiliation(s)
- Stephan Dobner
- Department of Cardiology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Thomas Pilgrim
- Department of Cardiology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Daniel Hagemeyer
- Department of Cardiology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Dik Heg
- CTU BernUniversity of BernBernSwitzerland
| | - Jonas Lanz
- Department of Cardiology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Nicole Reusser
- Department of Cardiology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Christoph Gräni
- Department of Cardiology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Ali Afshar‐Oromieh
- Department of Nuclear Medicine, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Axel Rominger
- Department of Nuclear Medicine, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Bettina Langhammer
- Department of Cardiovascular Surgery, InselspitalUniversity of BernBernSwitzerland
| | - David Reineke
- Department of Cardiovascular Surgery, InselspitalUniversity of BernBernSwitzerland
| | - Stephan Windecker
- Department of Cardiology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Stefan Stortecky
- Department of Cardiology, InselspitalBern University Hospital, University of BernBernSwitzerland
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Affiliation(s)
- Jia Wen Chong
- Faculty of Medicine, University of Queensland, Herston, Australia
| | | | - Joseph C Lee
- Faculty of Medicine, University of Queensland, Herston, Australia.
- Department of Medical Imaging, The Prince Charles Hospital, Chermside, QLD, 4032, Australia.
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Pandey S, Teruya S, Rodriguez C, Deluca A, Kinkhabwala M, Johnson LL, Fine D, Sabogal N, Winburn M, Castillo M, Bhatia K, Malkovskaya R, Raiszadeh F, Kurian D, Miller EJ, Einstein AJ, Maurer MS, Ruberg FL. Diagnostic performance characteristics of planar quantitative and semi-quantitative parameters of Tc 99m pyrophosphate (PYP) imaging for diagnosis of transthyretin (ATTR) cardiac amyloidosis: the SCAN-MP study. J Nucl Cardiol 2023; 30:1414-1419. [PMID: 36823486 DOI: 10.1007/s12350-023-03203-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/21/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND The optimal heart-to-contralateral chest (H/CL) ratio threshold for non-invasive diagnosis of transthyretin cardiac amyloidosis (ATTR-CA) using Tc99m pyrophosphate (PYP) imaging in a population with low pretest probability is not known. METHODS Using myocardial PYP retention by SPECT as the reference standard, we evaluated the diagnostic performance of different semi-quantitative and quantitative (H/CL chest ratio) planar parameters obtained from 3-hour PYP imaging in a prospectively recruited cohort of minority older adults with heart failure and increased LV wall thickness. RESULTS Of 229 patients, 14 were found to have ATTR-CA (6.1%). No PYP uptake (grade 0) was observed in 77% of scans, all grade 3 scans were ATTR-CA, and only 4 of 11 (36%) grade 2 scans were ATTR-CA. An H/CL threshold of ≥ 1.4 maximized specificity (99%) and positive predictive value (93%) but resulted in decreased sensitivity (93%), compared to the ≥ 1.3 threshold which had 100% sensitivity. CONCLUSION Among patients with a low pretest likelihood of ATTR-CA, planar interpretation, while useful to exclude disease, must be interpreted with caution. H/CL ratio threshold of ≥ 1.3 resulted in clinically important misclassifications. These data suggest that quantitative planar imaging thresholds may not be appropriate to apply in low pretest likelihood populations being evaluated for ATTR-CA.
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Affiliation(s)
- Shivda Pandey
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.
- Section of Cardiology, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, C-8, Boston, MA, 02118, USA.
| | - Sergio Teruya
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Carlos Rodriguez
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Albert Deluca
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Mona Kinkhabwala
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Lynne L Johnson
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Denise Fine
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Natalia Sabogal
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Morgan Winburn
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Michelle Castillo
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Ketan Bhatia
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Rita Malkovskaya
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Farbod Raiszadeh
- Division of Cardiology, Harlem Hospital Center, New York City Health and Hospital Corporation, New York, NY, USA
| | - Damian Kurian
- Division of Cardiology, Harlem Hospital Center, New York City Health and Hospital Corporation, New York, NY, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Mathew S Maurer
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
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Durkan K, Ichedef C, Yurt Kilcar A, Koksal Karayildirim C. In vivo behavior of technetium-99m labeled ibuprofen in infection and inflamation animal models. Drug Dev Ind Pharm 2023; 49:479-484. [PMID: 37458266 DOI: 10.1080/03639045.2023.2235009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/22/2023] [Accepted: 07/05/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE The objective of this study was to develop radiolabeled ibuprofen (99mTc-ibu) for imaging and discrimination of inflammation and infection and compare its biodistribution in two different animal models. SIGNIFICANCE The development of radiolabeled ibuprofen as an imaging agent for inflammation and infection may have significant clinical implications for the diagnosis and management of various inflammatory and infectious diseases. This study provides a promising approach to the detection of sterile infections. METHODS Ibuprofen was radiolabeled with 99mTc using the stannous chloride method with a yield of 99.05 ± 0.83% (n = 5). The in vivo biological behavior of radiolabeled ibuprofen was determined in Wistar albino rat models of sterile inflammation and bacterial infection with Staphylococcus aureus gram-positive bacteria. Biodistribution studies were carried out at different time points, and the results were compared between the two animal models. RESULTS The uptake of 99mTc-ibu in sterile inflammation sites at all time points was higher than that in the infection sites. This suggests that 99mTc-ibu can be used to discriminate between sterile inflammation and bacterial infection. CONCLUSIONS The results of this study suggest that the detection of sterile infections with 99mTc-ibu is possible and highly encouraging.
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Affiliation(s)
- Kubra Durkan
- Department of Nuclear Applications, Institute of Nuclear Sciences, Ege University, Izmir, Bornova, Turkey
| | - Cigdem Ichedef
- Department of Biology, Faculty of Science, Ege University, Izmir, Bornova, Turkey
| | - Ayfer Yurt Kilcar
- Department of Nuclear Applications, Institute of Nuclear Sciences, Ege University, Izmir, Bornova, Turkey
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Park YJ, Lee J, Kim D, Choi JO, Kim SJ, Kim K, Choi JY. Direct comparison of diagnostic and clinical values between Tc-99 m DPD and Tc-99 m PYP scintigraphy in patients with cardiac amyloidosis. BMC Med Imaging 2023; 23:92. [PMID: 37460984 PMCID: PMC10353145 DOI: 10.1186/s12880-023-01054-x] [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: 02/07/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Technetium-99 m 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) and technetium-99 m sodium pyrophosphate (PYP) are the two most commonly used radiotracers for cardiac amyloidosis (CA), but no studies have directly compared them. Therefore, in this study, we directly compared the diagnostic and clinical utility of DPD and PYP scintigraphy in patients with CA. METHODS Ten patients with CA were enrolled. Eight clinical variables and 12 scintigraphic parameters were used. Clinical variables were age, sex, estimated glomerular filtration rate (eGFR), N-terminal pro brain natriuretic peptide (NT-proBNP), and the results of electromyography (EMG), a sensory test, electrocardiogram, and echocardiography (EchoCG). Four heart retention ratios (heart/whole-body profile, heart/pelvis, heart/skull, and heart/contralateral lung) were calculated from the DPD and PYP scans and two visual scoring systems (Perugini and Dorbala systems) were used. Comparative analyses were performed between radiotracers and between visual scoring systems using clinical variables and scintigraphic parameters. RESULTS Twenty DPD parameters and nine PYP parameters had significant associations with age, eGFR, NT-proBNP, EchoCG, and EMG. DPD parameters had more frequent significant associations with clinical variables than PYP parameters. Compared to visual scores in the DPD scan, the proportion of patients with higher visual scores in the PYP scan was relatively greater than those with lower visual scores, and there were more patients with a visual score of 2 or higher in PYP scans than DPD scans. CONCLUSIONS DPD scintigraphy may reflect the disease severity of CA better than PYP scintigraphy, whereas PYP scintigraphy may be a more sensitive imaging modality for identifying CA involvement.
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Affiliation(s)
- Yong-Jin Park
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Department of Nuclear Medicine, Ajou University Medical Center, Ajou University School of Medicine, Suwon, 16499, Republic of Korea
| | - Joohee Lee
- Department of Nuclear Medicine, CHA Ilsan Medical Center, CHA University, Goyang, 10414, Republic of Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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50
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Pérez-Velasco DL, Morales-Avila E, Ocampo-García B, Torres-García E, Izquierdo G, Jiménez-Mancilla N, Oros-Pantoja R, Díaz-Sánchez LE, Aranda-Lara L, Isaac-Olivé K. Biokinetics, radiopharmacokinetics and estimation of the absorbed dose in healthy organs due to Technetium-99m transported in the core and on the surface of reconstituted high-density lipoprotein nanoparticles. Nucl Med Biol 2023; 122-123:108363. [PMID: 37419070 DOI: 10.1016/j.nucmedbio.2023.108363] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/09/2023]
Abstract
The development of rHDL-radionuclide theragnostic systems requires evaluation of the absorbed doses that would be produced in healthy tissues and organs at risk. Technetium-99m is the most widely used radionuclide for diagnostic imaging, therefore, the design of theragnostic reconstituted high density-lipoprotein (rHDL) nanosystems labeled with Technetium-99m offers multiple possibilities. OBJECTIVE To determine the biokinetics, radiopharmacokinetics and estimate the absorbed doses induced in healthy organs by Technetium-99m transported in the core and on the surface of rHDL. METHODS Biokinetic and radiopharmacokinetic models of rHDL/[99mTc]Tc-HYNIC-DA (Technetium-99m in the core) and [99mTc]Tc-HYNIC-rHDL (Technetium-99m on the surface) were calculated from their ex vivo biodistribution in healthy mice. Absorbed doses were estimated by the MIRD formalism using OLINDA/EXM and LMFIT softwares. RESULTS rHDL/[99mTc]Tc-HYNIC-DA and [99mTc]Tc-HYNIC-rHDL show instantaneous absorption in kidney, lung, heart and pancreas, with slower absorption in spleen. rHDL/[99mTc]Tc-HYNIC-DA is absorbed more slowly in the intestine, while [99mTc]Tc-HYNIC-rHDL is absorbed more slowly in the liver. The main target organ for rHDL/[99mTc]Tc-HYNIC-DA, which is hydrophobic in nature, is the liver, whereas the kidney is for the more hydrophilic [99mTc]Tc-HYNIC-rHDL. Assuming that 925 MBq (25 mCi) of Technetium-99m, carried in the core or on the surface of rHDL, are administered, the maximum tolerated doses for the organs of greatest accumulation are not exceeded. CONCLUSION Theragnostic systems based on 99mTc-labeled rHDL are safe from the dosimetric point of view. The dose estimates obtained can be used to adjust the 99mTc-activity to be administered in future clinical trials.
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Affiliation(s)
- Diana L Pérez-Velasco
- Laboratorio de Investigación en Teranóstica, Facultad de Medicina, Universidad Autónoma del Estado de México, Toluca 50180, Estado de México, Mexico
| | - Enrique Morales-Avila
- Laboratorio de Toxicología y Farmacia, Facultad de Química, Universidad Autónoma del Estado de México, Toluca 50180, Estado de México, Mexico
| | - Blanca Ocampo-García
- Laboratorio Nacional de Investigación y Desarrollo de Radiofármacos-CONACyT, Instituto Nacional de Investigaciones Nucleares, Ocoyoacac 52750, Estado de México, Mexico
| | - Eugenio Torres-García
- Laboratorio de Dosimetría y Simulación Monte Carlo, Facultad de Medicina, Universidad Autónoma del Estado de México, Mexico
| | - Germán Izquierdo
- Facultad de Ciencias, Universidad Autónoma del Estado de México, Toluca 50200, Estado de México, Mexico
| | - Nallely Jiménez-Mancilla
- Laboratorio Nacional de Investigación y Desarrollo de Radiofármacos-CONACyT, Instituto Nacional de Investigaciones Nucleares, Ocoyoacac 52750, Estado de México, Mexico
| | - Rigoberto Oros-Pantoja
- Laboratorio de investigación en fisiología y endocrinología, Facultad de Medicina, Universidad Autónoma del Estado de México, Toluca 50180, Estado de México, Mexico
| | - Luis E Díaz-Sánchez
- Facultad de Ciencias, Universidad Autónoma del Estado de México, Toluca 50200, Estado de México, Mexico
| | - Liliana Aranda-Lara
- Laboratorio de Investigación en Teranóstica, Facultad de Medicina, Universidad Autónoma del Estado de México, Toluca 50180, Estado de México, Mexico.
| | - Keila Isaac-Olivé
- Laboratorio de Investigación en Teranóstica, Facultad de Medicina, Universidad Autónoma del Estado de México, Toluca 50180, Estado de México, Mexico.
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