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AACE Clinical Case Reports 2019The objective of this report is to present an unusual case of intramedullary spinal cord metastasis (ISCM) as the presenting feature of papillary thyroid carcinoma (PTC).
OBJECTIVE
The objective of this report is to present an unusual case of intramedullary spinal cord metastasis (ISCM) as the presenting feature of papillary thyroid carcinoma (PTC).
METHODS
The presented case includes clinical, biochemical, and imaging findings as well as surgical and pathology reports. Treatment with radioactive iodine (RAI) and the response to this treatment are presented.
RESULTS
A 71-year-old woman was evaluated for debilitating low back pain and walking disability. Magnetic resonance imaging demonstrated an oval, lumbar, intramedullary mass with benign features and surgery was scheduled. On preoperative evaluation for the lumbar mass, a multinodular thyroid goiter (unfortunately overlooked previously) was noticed, causing severe narrowing of the trachea. Total thyroidectomy was performed with a pathology diagnosis of PTC. In a second operation, the lumbar lesion was removed and proved to represent metastatic PTC. External beam radiation was subsequently administered to the thyroid bed, lumbar spine, and other skeletal metastases, followed by 150 milliCurie of RAI. A post-treatment scan showed high uptake over the lumbar spine, and skeletal and lung lesions. Clinically, the patient restored her walking ability and back pain improved.
CONCLUSION
ISCM rarely is the presenting feature of PTC. Our patient presented with back pain which is the typical, though non-specific symptom, of ISCM. She showed good clinical response to multimodal treatment which is in line with the few other differentiated thyroid cancer patients with ISCM reported in the literature. Prompt surgical resection, followed by external beam radiation and RAI, may improve neurological signs, alleviate pain, and improve quality of life.
PubMed: 31967051
DOI: 10.4158/ACCR-2019-0072 -
Cureus May 2022Background Radioactive iodine (RAI) is the treatment of choice for most patients with primary hyperthyroidism. The most common etiologies of hyperthyroidism are Graves'...
Background Radioactive iodine (RAI) is the treatment of choice for most patients with primary hyperthyroidism. The most common etiologies of hyperthyroidism are Graves' disease (GD), toxic adenoma (TA), and toxic multinodular goiter (TMNG). A single dose of RAI is usually sufficient to cure hyperthyroidism. The aim of this study was to assess the effectiveness of RAI therapy for patients diagnosed with primary hyperthyroidism. Methods and materials Patients diagnosed with hyperthyroidism who received RAI therapy between 2008 and 2018 were included in the study. The data was acquired from the hospital's electronic medical record system. Following the RAI treatment, a cure was defined as the development of euthyroidism or hypothyroidism after a single fixed-dose without antithyroid medication within one year of RAI therapy. In addition, a simple logistics regression model was used to identify the prognostic factors that may lead to better outcomes. Results A total of 112 patients diagnosed with hyperthyroidism with a mean age of 47 ± 14 were included in this study. The majority of the patients were female, 79 (70.5%). Within one year of RAI therapy, 84 (75%) patients achieved a cure that is either hypothyroid or euthyroid status. RAI dose was higher in responsive patients (18.50 ± 4.10 millicurie [mCi] versus 16.50 ± 4.10 mCi) than in non-responsive patients. The mean RAI doses were 16.05 ± 2.99 mCi in GD, 19.81 ± 4.40 mCi in TMNG, and 20.50 ± 3.30 mCi in TA, with a statistically significant p-value of 0.001. In the univariable logistic regression model, RAI dose was a significant prognostic factor of the responsive group (OR: 1.15, CI [1.01-1.31], p-value 0.03). Conclusion Our data presented that RAI therapy is effective for primary hyperthyroidism. We achieved remission with a single fixed-dose in the majority of patients. Most of our patients were cured within three months of RAI therapy. In addition, the RAI dose was higher in the responsive group as compared to the non-responsive group.
PubMed: 35719786
DOI: 10.7759/cureus.24992 -
Journal of Nuclear Medicine : Official... Aug 1997We have developed an image-based compartmental analysis for estimating effective renal plasma flow (ERPF in units of milliliters per minute) from the full time-activity...
UNLABELLED
We have developed an image-based compartmental analysis for estimating effective renal plasma flow (ERPF in units of milliliters per minute) from the full time-activity curves of regions of interest (ROI) placed over the heart, kidneys and bladder.
METHODS
Kidney or time-activity curves are corrected for physical attenuation using estimates of kidney depth derived from patient height and weight. Estimates of the calibration factors, Kp and Kb (mCl/counts/sec), for the plasma and bladder time-activity curves are determined by applying the following ROI analysis to each frame of the dynamic scan: (Kp)Pc(t) + (Kb)Bc(t) = Di - Rq(t), where P c(t) and Bc(t) represent the counting rates measured in ROI placed over the left ventricle blood pool and bladder at time t; Di is the known total injected dose, and Rq(t) represents the millicurie of tracer in the kidneys at time t. Once Kp and Kb have been determined by regression, the calibrated time activity curves are used to solve for the physiological parameter fERPF (min-1), which represents the fraction of the total body plasma cleared of mertiatide per min. The ERPF calculated by the product of fERPF and plasma volume, determined from patient weight, was compared to the ERPF as calculated by blood samples and the Schlegel and renal uptake plasma volume product scintigraphic techniques.
RESULTS
Twenty-five adult patients with a wide range of ages and renal function were studied. The results of this image-based method for calculating ERPF correlated well with the values obtained from blood samples (linear regression slope = 1.06; y-int = -34.68 ml/min, r = 0.905) and offered a significant improvement over both the Schlegel and renal uptake plasma volume product estimates (p < 0.05).
CONCLUSION
A scintigraphic estimation of ERPF without blood samples using time-activity data from the heart, kidneys and bladder acquired over the entire renogram is feasible and correlates well with more invasive techniques requiring blood samples.
Topics: Body Height; Body Weight; Feasibility Studies; Female; Humans; Male; Middle Aged; Models, Biological; Radioisotope Renography; Radiopharmaceuticals; Renal Plasma Flow, Effective; Technetium Tc 99m Mertiatide; Technetium Tc 99m Pentetate; Time Factors
PubMed: 9255169
DOI: No ID Found -
Journal of Nuclear Medicine : Official... Mar 1986The radiofluorination of L-dopa with [18F]F2 was investigated with the purpose of improving the yield of 6-[18F]fluoro-L-dopa. When boron trifluoride was added to the...
The radiofluorination of L-dopa with [18F]F2 was investigated with the purpose of improving the yield of 6-[18F]fluoro-L-dopa. When boron trifluoride was added to the reaction mixture in hydrogen fluoride (HF), the yield was increased threefold. Nine millicuries of 6-[18F]fluoro-L-dopa were produced from 100 mCi [18F]F2 routinely and reliably after 2 hr of preparation. If acetonitrile or water were substituted for HF, little or no 6-fluoro-L-dopa was made.
Topics: Arsenic; Arsenicals; Boranes; Chromatography, High Pressure Liquid; Dihydroxyphenylalanine; Fluorides; Fluorine; Isomerism; Isotope Labeling; Levodopa; Radioisotopes; Silanes; Silicon Compounds; Solvents
PubMed: 3086520
DOI: No ID Found -
Nuclear Medicine and Biology Jan 2006The goal of this study was to investigate the binding characteristics of [(11)C]KR31173 and its applicability for PET studies of the AT(1) receptor (AT(1)R). (Comparative Study)
Comparative Study
AIM
The goal of this study was to investigate the binding characteristics of [(11)C]KR31173 and its applicability for PET studies of the AT(1) receptor (AT(1)R).
METHODS
Ex vivo biodistribution and pharmacology were tested in mice. PET imaging was performed in mice, beagle dogs and a baboon. To assess nonspecific binding, PET imaging was performed both before and after pretreatment with a potent AT(1)R antagonist. In the baboon, PET imaging was also performed with the previously developed radioligand [(11)C]L-159,884 for comparison.
RESULTS
Ex vivo biodistribution studies in mice showed specific binding rates of 80-90% in the adrenals, kidneys, lungs and heart. Specific binding was confirmed in mice using small animal PET. In dogs, renal cortex tissue concentration at 75-95 min postinjection (pi) was 63 nCi/ml per millicurie at a specific binding rate of 95%. In the baboon renal cortex, tissue activity at 55-75 min pi was 345 nCi/ml per millicurie. In the baboon the specific binding of [(11)C]KR31173 was higher (81%) than the specific binding of [(11)C]L-159,884 (34%).
CONCLUSION
[(11)C]KR31173 shows accumulation and significant specific binding to the AT(1)R in the kidneys of mice, dogs and baboon. These findings suggest that this radioligand is suited for imaging the renal cortical AT(1)R in multiple species.
Topics: Animals; Carbon Radioisotopes; Dogs; Feasibility Studies; Imidazoles; Kidney; Male; Metabolic Clearance Rate; Mice; Organ Specificity; Papio; Positron-Emission Tomography; Radiopharmaceuticals; Receptor, Angiotensin, Type 1; Tetrazoles; Tissue Distribution
PubMed: 16459253
DOI: 10.1016/j.nucmedbio.2005.08.005 -
Journal of Nuclear Medicine : Official... Sep 1990Three children with Stage III neuroblastoma were treated with [125I]MIBG in a phase I toxicity study. Concepts of the treatment were: in small tumors, the absorbed dose...
Three children with Stage III neuroblastoma were treated with [125I]MIBG in a phase I toxicity study. Concepts of the treatment were: in small tumors, the absorbed dose of radiation from MIBG labeled with 131I is reduced but the absorbed dose from [125I]MIBG is less affected; and many recurrences of neuroblastoma arise from small tumors. Two patients exhibited only modest thrombocytopenia and leukopenia, the most sensitive indices of radiation toxicity, after receiving 261 and 407 mCi, and 83 and 104 rad of whole-body radiation. One patient died of progressive neuroblastoma; the other two patients have stable disease over 30 mo after treatment. Per millicurie given, [125I]MIBG imparts about one-fourth the radiation dose of [131I]MIBG to the whole body. Iodine-125-MIBG can be given in doses that impart over 100 rad of whole-body radiation and that exceed 400 mCi before toxicity becomes limiting, even in small children.
Topics: 3-Iodobenzylguanidine; Antineoplastic Agents; Child, Preschool; Drug Evaluation; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Neuroblastoma; Radionuclide Imaging; Radiotherapy Dosage
PubMed: 2395016
DOI: No ID Found -
Pharmaceutics Jul 2019Trans-nasal pulmonary aerosol delivery using high flow nasal cannula (HFNC) devices is described with the administration of high gas flows exceeding patient inspiratory...
BACKGROUND
Trans-nasal pulmonary aerosol delivery using high flow nasal cannula (HFNC) devices is described with the administration of high gas flows exceeding patient inspiratory flow (HF) and with lower flows (LF). The aim of this pilot clinical trial was to compare deposition and distribution of radiolabeled aerosol via nasal cannula in healthy adults across three rates of gas flow delivered with active heated humidification, and to further identify the impact of aerosol administration without heated humidity.
METHODS
Twenty-three (23) healthy adults (16F) were randomized to receive aerosol with active heated humidification or unheated oxygen at gas flows of 10 L/min ( = 8), 30 L/min ( = 7), or 50 L/min ( = 8). Diethylenetriaminepentaacetic acid labeled with 1 millicurie (37 MBq) of Technetium-99m (DTPA-Tc99m) was mixed with NaCl to a fill volume of 1 mL, and administered via mesh nebulizer placed at the inlet of the humidifier. Radioactivity counts were performed using a gamma camera and the regions of interest (ROIs) were delimited with counts from the lungs, upper airways, stomach, nebulizer, circuit, and expiratory filter. A mass balance was calculated and each compartment was expressed as a percentage of the total.
RESULTS
Lung deposition (mean ± SD) with heated humidified gas was greater at 10 L/min than 30 L/min or 50 L/min (17.2 ± 6.8%, 5.71 ± 2.04%, and 3.46 ± 1.24%, respectively; = 0.0001). Using unheated carrier gas, a lung dose of aerosol was similar to the active heated humidification condition at 10 L/min, but greater at 30 and 50 L/min ( = 0.011). Administered gas flow and lung deposition were negatively correlated ( = -0.880, < 0.001).
CONCLUSIONS
Both flow and active heated humidity inversely impact aerosol delivery through HFNC. Nevertheless, aerosol administration across the range of commonly used flows can provide measurable levels of lung deposition in healthy adult subjects (NCT02519465).
PubMed: 31284680
DOI: 10.3390/pharmaceutics11070320 -
Journal of Labelled Compounds &... Sep 2016The radiosynthesis of [(18) F]DCFPyL on 2 distinct automated platforms with full regulatory compliant quality control specifications is described. The radiotracer...
The radiosynthesis of [(18) F]DCFPyL on 2 distinct automated platforms with full regulatory compliant quality control specifications is described. The radiotracer synthesis was performed on a custom-made radiofluorination module and the Sofie Biosciences ELIXYS. The radiofluorination module synthesis was accomplished in an average of 66 minutes from end of bombardment with an average specific activity at end of synthesis (EOS) of 4.4 TBq/μmol (120 Ci/μmol) and an average radiochemical yield of 30.9% at EOS. The ELIXYS synthesis was completed in an average of 87 minutes with an average specific activity of 2.2 TBq/μmol (59.3 Ci/μmol) and an average radiochemical yield of 19% at EOS. Both synthesis modules produced large millicurie quantities of [(18) F]DCFPyL while conforming to all standard US Pharmacopeia Chapter <823> acceptance testing criteria.
Topics: Antigens, Surface; Chemistry Techniques, Synthetic; Enzyme Inhibitors; Glutamate Carboxypeptidase II; Humans; Isotope Labeling; Lysine; Radiochemistry; Urea
PubMed: 27470935
DOI: 10.1002/jlcr.3430 -
Radiology Case Reports 2008A 34-year-old man with hypercalcemia had a sestamibi scan that showed increased uptake that appeared to correspond with a 7 mm density in the mediastinum, adjacent to...
A 34-year-old man with hypercalcemia had a sestamibi scan that showed increased uptake that appeared to correspond with a 7 mm density in the mediastinum, adjacent to the aortic arch, on chest CT. This lesion was thought to be consistent with an ectopic parathyroid adenoma. Prior to surgical exploration, the patient was injected intravenously with 12.3 millicuries of Tc99m-sestamibi. The lesion identified preoperatively did not show abnormal radionuclide uptake using the intraoperative gamma probe, and was subsequently determined to be a hyperplastic lymph node. However, abnormal activity was localized to the thymus gland, from which an ectopic parathyroid adenoma was successfully excised. The patient recovered without incident. The use of the intraoperative gamma probe was critical in identifying and resecting the ectopic parathyroid adenoma in this patient, and in general, may reduce surgical time and reduce the morbidity and/or complications associated with surgical exploration.
PubMed: 27303512
DOI: 10.2484/rcr.v3i1.161 -
Fertility and Sterility May 1985The tubal capacity to transport radioactively labeled human albumin microspheres deposited in the vaginal fornix and cervical canal and to concentrate them on the...
The tubal capacity to transport radioactively labeled human albumin microspheres deposited in the vaginal fornix and cervical canal and to concentrate them on the ovarian surface was evaluated in a group of 34 patient-volunteers. One millicurie of technetium-99 was used to label human albumin microspheres of 20 mu in diameter, suspended in 1 ml of saline. The distribution of the radioactive material was imaged on a gamma camera at different intervals between 15 and 240 minutes. The radiation dose to the ovaries was estimated to be similar to that of a hysterosalpingogram. The results of the radionuclide evaluation were compared with the surgical findings at the time of laparoscopy or laparotomy performed for diagnostic or therapeutic reasons. The overall correlation was 87.1%. It would appear that as opposed to the traditional hysterosalpingogram, a radionuclide test may give a better understanding of the functional capacity of the tube and may also prove a useful method in the evaluation of the results of tubal microsurgical procedures.
Topics: Adult; Fallopian Tube Patency Tests; Fallopian Tubes; Female; Humans; Hysterosalpingography; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin
PubMed: 3996621
DOI: 10.1016/s0015-0282(16)48561-4